Effectiveness of a decision aid for patients with knee osteoarthritis: a randomized controlled trial.

OBJECTIVE: To assess the effectiveness of a Patient Decision Aid (PtDA) for knee osteoarthritis. METHOD: Randomized controlled trial, in which 193 patients were allocated to the PtDA or usual care. Outcome measures were the Decisional Conflict Scale (DCS), knowledge of osteoarthritis and arthroplasty, satisfaction with the decision-making process (SDMP) and treatment preference, assessed immediately after the intervention. At 6 months, the same measures were applied in non-operated patients, whereas those who underwent arthroplasty completed the SDMP and the Decisional Regret Scale (DRS). RESULTS: The PtDA produced a significant immediate improvement of decisional conflict (MD = -11.65, 95%CI: -14.93, -8.37), objective knowledge (MD = 10.37, 99%IC: 3.15, 17.70) and satisfaction (MD = 6.77, 99%CI: 1.19, 12.34), and a different distribution of preferences (χ2 = 8.74, p = 0.033). Patients with less than secondary education obtained a stronger effect on decisional conflict (p = 0.015 for the interaction) but weaker for knowledge (p = 0.051). At 6 months, there were no significant differences in any variable, including the rate of total knee replacement. Operated patients showed a low level of regret, which was not affected by the intervention. CONCLUSION: The PtDA is effective immediately after its application, but it shows no effects in the medium-term. Future research should investigate which subgroups of patients could benefit more from this intervention, as well as the longitudinal evolution of decision-related psychological variables.

Relación entre enfermedad periodontal y artritis Reumatoide / Relationship between periodontal disease and rheumatoid arthritis

INTRODUCCIÓN: La periodontitis crónica y la artritis reumatoide (AR) son desórdenes inflamatorios crónicos caracterizados por la destrucción de tejidos, la reabsorción ósea y la producción de citoquinas proinflamatorias. OBJETIVOS: Analizar la relación entre ambas enfermedades y la posible influencia del tratamiento de una sobre la otra. MATERIAL Y MÉTODOS: Se realiza una revisión bibliográfica acerca de la patogénesis de la AR y la EP y los aspectos relacionados. RESULTADOS: La patogénesis de ambas enfermedades muestra semejanzas notables. Bacterias periodontopatógenas, como Porphyromonas gingivalis, y mediadores inflamatorios, como el factor de necrosis tumoral y la proteína C reactiva, juegan un papel importante en la AR. La EP es un factor importante en la respuesta a la terapia en pacientes con AR. CONCLUSIONES: Ambas enfermedades tienen una patogenia común. La prevalencia de enfermedad periodontal (EP) es mayor en pacientes con AR y viceversa. Aunque el control de la EP mediante tratamiento periodontal no quirúrgico parece mejorar los signos y síntomas en ambas enfermedades, hacen falta estudios más rigurosos con mayor número de casos y de mayor tiempo de evolución

INTRODUCTION: Chronic periodontitis and rheumatoid arthritis (RA) are chronic inflammatory disorders characterized by tissue destruction, bone resorption and the production of pro-inflammatory cytokines. OBJECTIVES: Analysed the relationship between both diseases and the possible influence of treating one disease on the evolution of the other. MATERIAL AND METHODS: Bibliographical revision of the pathogenesis of RA and periodontal disease(PD) and their related aspects. RESULTS: The pathogenesis of both diseases shows remarkable similarities. Periodontal pathogenic bacteria such as Porphyromonas gingivalis and inflammatory mediators such as tumor necrosis factor and C-reactive protein, play an important role in RA. PD is an important factor in the therapeutic response of patients with RA factor. CONCLUSIONS: Both diseases have a common pathogenesis. The prevalence of periodontal disease(PD) is higher in patients with RA and vice versa. Although PD control through non-surgical periodontal treatment improves the signs and symptoms of both diseases, more rigorous studies are need