Limited Joint Mobility Progression in Type 1 Diabetes: A 15-Year Follow-Up Study.

OBJECTIVE: To assess the evolution of joint mobility over a period of 15 years in type 1 diabetic patients and healthy controls and to determine whether microalbuminuria is associated with a different evolution of joint mobility. METHODS: Joint mobility of hand and wrist was determined in 63 patients with type 1 diabetes and 63 healthy subjects. Fifteen years later, 37 (58.7%) diabetic patients and 16 (25.4%) healthy subjects were studied again. Joint mobility was assessed with the Prayer sign and by measuring the angle of maximal flexion of the fifth and third metacarpophalangeal (MCP) joints and wrist. Patients with diabetes were visited 2-4 times every year with regular assessment of glycated hemoglobin (HbA1c), urinary albumin excretion (UAE), and ophthalmoscopy. RESULTS: Fifteen years after the initial exam, diabetic patients showed reduced flexion of the fifth MCP joint (82.6 ± 5.8 versus 76.0 ± 6.4 degrees, p < 0.001) and wrist (75.9 ± 8.1 versus 73.2 ± 7.4 degrees, p = 0.015) compared to baseline examination. Joint mobility did not change significantly in healthy subjects. Patients with microalbuminuria showed greater reduction in hand joint mobility than diabetic patients with normal UAE or than healthy subjects (p < 0.001). CONCLUSIONS: In type 1 diabetic patients, the severity of LJM progresses with time, and the progression is enhanced in patients with microalbuminuria.

Improved prediction of knee osteoarthritis progression by genetic polymorphisms: the Arthrotest Study.

OBJECTIVE: The aim of this study was to develop a genetic prognostic tool to predict radiographic progression towards severe disease in primary knee OA (KOA) patients. METHODS: This investigation was a cross-sectional, retrospective, multicentric association study in 595 Spanish KOA patients. Caucasian patients aged ≥40 years at the time of diagnosis of primary KOA of Kellgren-Lawrence grade 2 or 3 were included. Patients who progressed to Kellgren-Lawrence score 4 or who were referred for total knee replacement within 8 years after diagnosis were classified as progressors to severe disease. Clinical variables of the initial stages of the disease (gender, BMI, age at diagnosis, OA in the contralateral knee, and OA in other joints) were registered as potential predictors. Single nucleotide polymorphisms and clinical variables with an association of P < 0.05 were included in the multivariate analysis using forward logistic regression. RESULTS: A total of 23 single nucleotide polymorphisms and the time of primary KOA diagnosis were significantly associated with KOA severe progression in the exploratory cohort (n = 220; P < 0.05). The predictive accuracy of the clinical variables was limited: area under the curve (AUC) = 0.66. When genetic variables were added to the clinical model (full model), the prediction of KOA progression was significantly improved (AUC = 0.82). Combining only genetic variables (rs2073508, rs10845493, rs2206593, rs10519263, rs874692, rs7342880, rs780094 and rs12009), a predictive model with good accuracy was also obtained (AUC = 0.78). The predictive ability for KOA progression of the full model was confirmed on the replication cohort (two-sample Z-test; n = 62; P = 0.190). CONCLUSION: An accurate prognostic tool to predict primary KOA progression has been developed based on genetic and clinical information from OA patients.

Diferencias en la frecuencia de osteoporosis según la región esquelética evaluada. Análisis de 987 mujeres posmenopáusicas remitidas a una unidad de densitometría / Differences in the frequency of osteoporosis according to the skeletal site evaluated. Analysis in 987 Spanish postmenopausal women referred to a bone densitometry unit

Objetivo: Analizar, en un grupo de mujeres posmenopáusicas, las diferencias en la frecuencia de osteoporosis según la localización anatómica utilizada para realizar el diagnóstico. Métodos: Se recopilaron las características demográficas y los valores de la densidad mineral ósea (DMO) de 987 mujeres posmenopáusicas (media de edad, 53,8±5,5 años). La DMO se evaluó mediante absorciometría fotónica dual de fuente de rayos X (DXA). Se utilizaron las categorías de la OMS para clasificar a las pacientes. Se calcularon los T-score de cada vértebra lumbar de forma individualizada (L2, L3 y L4), del valor medio del análisis de la columna lumbar (L2-L4), del cuello femoral y de la cadera total. Resultados: En 144 (14,7%) mujeres, se observaron discrepancias entre el análisis individualizado de cada vértebra lumbar y el análisis de L2-L4; 62 (6%) mujeres que presentaban osteoporosis en al menos una vértebra se adscribían a la categoría osteopenia al considerar el valor medio del análisis de L2-L4. En 271 (27,8%) mujeres, se observaron discrepancias entre el análisis de la cadera total y el cuello femoral. La frecuencia de osteoporosis osciló entre el 3% cuándo se consideró sólo los resultados de la cadera total y el 16% cuando se tuvo en cuenta los valores del análisis de L2-L4 y del tercio proximal del fémur (cadera total o cuello femoral) . Conclusiones: La frecuencia de osteoporosis varía notablemente según la región esquelética considerada (AU)

Objective: To analyze the differences in the frequency of osteoporosis according to the skeletal site evaluated in a group of Spanish postmenopausal women. Methods: We reviewed the data of 987 postmenopausal women (mean age, 53.8±5.5 years). BMD status was evaluated by DXA. We used the WHO thresholds to classify the patients. T-score was obtained from the single evaluation of each lumbar vertebra (L2, L3 and L4), the mean value of lumbar spine (L2-L4), femoral neck and total hip. Results:In 144 (14.7%) women, discrepancies were observed when we considered the single vertebral analysis versus the L2-L4 analysis; 62 (6%) women who presented osteoporosis in at least one vertebra would have been due to the osteopenia category when L2-L4 value was selected. In 271 (27.8%) women, discrepancies were observed when we considered the total hip analysis versus the femoral neck analysis. The frequency of osteoporosis ranged from 3% when only the analysis of the total hip was considered to 16% when the results of L2-L4 and proximal femur (total hip or femoral neck) measurements were selected. Conclusions: Frequency of osteoporosis varies notably according to the skeletal zone considered (AU)

[Differences in the frequency of osteoporosis according to the skeletal site evaluated. Analysis in 987 Spanish postmenopausal women referred to a bone densitometry unit]. / Diferencias en la frecuencia de osteoporosis según la región esquelética evaluada. Análisis de 987 mujeres posmenopáusicas remitidas a una unidad de densitometría.

OBJECTIVE: To analyze the differences in the frequency of osteoporosis according to the skeletal site evaluated in a group of Spanish postmenopausal women. METHODS: We reviewed the data of 987 postmenopausal women (mean age, 53.8±5.5 years). BMD status was evaluated by DXA. We used the WHO thresholds to classify the patients. T-score was obtained from the single evaluation of each lumbar vertebra (L2, L3 and L4), the mean value of lumbar spine (L2-L4), femoral neck and total hip. RESULTS: In 144 (14.7%) women, discrepancies were observed when we considered the single vertebral analysis versus the L2-L4 analysis; 62 (6%) women who presented osteoporosis in at least one vertebra would have been due to the osteopenia category when L2-L4 value was selected. In 271 (27.8%) women, discrepancies were observed when we considered the total hip analysis versus the femoral neck analysis. The frequency of osteoporosis ranged from 3% when only the analysis of the total hip was considered to 16% when the results of L2-L4 and proximal femur (total hip or femoral neck) measurements were selected. CONCLUSIONS: Frequency of osteoporosis varies notably according to the skeletal zone considered.

Decision rules for selecting women for bone mineral density testing: application in postmenopausal women referred to a bone densitometry unit.

OBJECTIVE: Although several decision rules have been developed to identify postmenopausal women who may be selected for dual-energy x-ray absorptiometry measurements, information on their utility in a clinical setting is scarce. We evaluated the utility of 4 previously validated decision rules in a large group of Spanish postmenopausal women referred to a bone densitometry unit. METHODS: We reviewed the data on 665 postmenopausal women (mean age 54.2 +/- 5.4 yrs). We selected the 4 decision rules that could be applied with the information that was available: the Osteoporosis Risk Assessment Instrument (ORAI), Osteoporosis Self-Assessment Tool (OST), Osteoporosis Index of Risk (OSIRIS), and Body Weight Criterion (BWC). The sensitivity, specificity, and predictive values of each decision rule were determined. RESULTS: The ORAI would recommend 45% of women for bone mineral density (BMD) testing, OST 46%, OSIRIS 37%, and BWC 70%. Sensitivity values obtained in the overall series were 64.1% for the ORAI, 69.2% for OST, 58.1% for OSIRIS, and 83.8% for BWC. The sensitivity increased progressively with age. The negative predictive value in the overall series was 88.5% for ORAI, 89.9% for OST, 88.4% for OSIRIS, and 90.6% for BWC. CONCLUSION: In a complementary way with previous studies in older women, where decision rules were valuable to identify the majority of women likely to have osteoporosis, our data indicate that in younger postmenopausal women, decision rules are useful as a screening method to rule out the presence of osteoporosis and the need for BMD scanning.

Evaluación de dos propuestas basadas en factores clínicos para seleccionar a qué varones con artritis reumatoide debe realizarse una densitometría ósea / Evaluation of two proposals based on clinical factors for selecting what male patients with rheumatoid arthritis should undergo a bone densitometry

En 1998, se propusieron unos criterios basados en la edad, la actividad de la enfermedad y el grado de inmovilidad para seleccionar a pacientes con artritis reumatoide (AR) tributarios de la realización de una densitometría. Con posterioridad, se ha postulado una versión modificada en la que se incluye, además, el peso y la toma de glucocorticoides. Hasta la actualidad no se ha comprobado su valor en pacientes varones en un contexto asistencial. Objetivo: Analizar la utilidad de ambas propuestas en un grupo de varones con AR controlados de forma habitual en un hospital universitario. Pacientes y método: Se incluyó a 65 varones con AR remitidos a la unidad de densitometría durante un período de 4 años. Mediante la revisión de las historias clínicas, se obtuvieron los datos clínicos y demográficos necesarios para llevar a cabo el estudio. La densidad mineral ósea en columna lumbar y en cuello femoral se evaluaron por absorciometría fotónica dual de fuente radiológica. Se calcularon la sensibilidad, la especificidad, el valor predictivo positivo (VPP) y el valor predictivo negativo (VPN) de la propuesta de 3 ítems (edad, inflamación e inmovilidad) y de la propuesta de 5 ítems (edad, inflamación, inmovilidad, peso y tratamiento con glucocorticoides). Resultados: Del total, 32 (54%) pacientes cumplían los requisitos de la propuesta de 3 ítems y 38 (59%), los de la propuesta de 5 ítems. Para el diagnóstico de osteoporosis, con la propuesta de 3 ítems la sensibilidad fue del 62%; la especificidad, del 48%; el VPP, del 23%, y el VPN, del 83%, mientras que con la propuesta de 5 ítems fueron del 90, el 47, el 23 y el 96%, respectivamente. Conclusiones: La propuesta de 5 ítems resulta más útil en la práctica asistencial que la propuesta de 3 ítems para decidir a qué varones con AR se practica una densitometría. La propuesta de 5 ítems puede ser un buen método de cribado, ya que los valores obtenidos en cuanto a sensibilidad y VPN parecen aceptables (AU)

Criteria based on age, inflammation, and immobility have been proposed to identify which patients with rheumatoid arthritis (RA) should be examined by dual energy X-ray absorptiometry (DXA) to diagnose osteoporosis. Recently, a modified version of the criteria by including weight and the use of corticosteroids has been proposed. These two set of criteria have not been tested in male patients in a clinical setting. Objective: To analyse, in a group of patients followed in a teaching hospital, the value of two proposals to select men with RA for bone densitometry. Patients and method: Clinical and demographic data were collected from the charts of a total of 65 men with RA, submitted to the bone densitometry unit during a fouryear period. Bone mineral density (BMD) was measured in spine and femoral neck by DXA. Two set of criteria were tested: a) three item criteria (age, inflammation and immobility), and b) five item criteria (age, inflammation, immobility, weight, and ever use of corticosteroids). Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated Results: Thirty five (54%) patients fulfilled the three item criteria and 38 (59%) the five item criteria. For the diagnosis of osteoporosis using the three item criteria, the sensitivity was 62%, specificity 48%, PPV 23% and NPV 83%; using the 5 item criteria the sensitivity was 90%, specificity 47%, PPV 23%, and NPV 96%. Conclusions: The five item criteria are a more accurate tool to identify, in clinical practice, male patients with RA and osteoporosis than the three item criteria. It seems a good screening method for the selection of those patients with RA whose BMD should be assessed, as the sensitivity and NPV seem acceptable (AU)

[Evaluation of two proposals based on clinical factors for selecting what male patients with rheumatoid arthritis should undergo a bone densitometry]. / Evaluación de dos propuestas basadas en factores clínicos para seleccionar a qué varones con artritis reumatoide debe realizarse una densitometría ósea.

UNLABELLED: Criteria based on age, inflammation, and immobility have been proposed to identify which patients with rheumatoid arthritis (RA) should be examined by dual energy X-ray absorptiometry (DXA) to diagnose osteoporosis. Recently, a modified version of the criteria by including weight and the use of corticosteroids has been proposed. These two set of criteria have not been tested in male patients in a clinical setting. OBJECTIVE: To analyse, in a group of patients followed in a teaching hospital, the value of two proposals to select men with RA for bone densitometry. PATIENTS AND METHOD: Clinical and demographic data were collected from the charts of a total of 65 men with RA, submitted to the bone densitometry unit during a fouryear period. Bone mineral density (BMD) was measured in spine and femoral neck by DXA. Two set of criteria were tested: a) three item criteria (age, inflammation and immobility), and b) five item criteria (age, inflammation, immobility, weight, and ever use of corticosteroids). Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated. RESULTS: Thirty five (54%) patients fulfilled the three item criteria and 38 (59%) the five item criteria. For the diagnosis of osteoporosis using the three item criteria, the sensitivity was 62%, specificity 48%, PPV 23% and NPV 83%; using the 5 item criteria the sensitivity was 90%, specificity 47%, PPV 23%, and NPV 96%. CONCLUSIONS: The five item criteria are a more accurate tool to identify, in clinical practice, male patients with RA and osteoporosis than the three item criteria. It seems a good screening method for the selection of those patients with RA whose BMD should be assessed, as the sensitivity and NPV seem acceptable.

Síndrome RS- PE asociado a tumor renal / RS-PE syndrome and renal cancer

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