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1.
J Clin Rheumatol ; 2020 Feb 20.
Artigo em Inglês | MEDLINE | ID: mdl-32084069

RESUMO

BACKGROUND: Dermatomyositis (DM) and polymyositis (PM) are forms of idiopathic inflammatory myopathies (IIMs), which are associated with the production of autoantibodies that are useful in the diagnosis and prognosis of the disease. OBJECTIVE: The aim of this study was to determine the frequency of antinuclear autoantibodies (ANAs), myositis-specific autoantibodies (MSAs), and myositis-associated autoantibodies (MAAs) in 6 Latin American countries. METHODS: Two hundred ten patients with IIM were included in this cross-sectional study from 2014 to 2017: 112 from Mexico, 46 from Colombia, 20 from Peru, 16 from the Dominican Republic, 10 from Argentina, and 6 from Guatemala. Antinuclear autoantibodies were detected by indirect immunofluorescence on HEp-2 cells. MSAs and MAAs were tested by a line immunoassay method. Mann-Whitney U and χ tests were used for statistical analysis. RESULTS: Of the 210 IIM patients, 139 (66.2%) had DM, 59 (28%) PM, and 12 (5.7%) juvenile DM. The mean age was 43.5 (6-79 years); 158 (75.2%) were female, and 52 (24.8%) were male. The overall frequency of ANA was 60%. The most frequent patterns were fine speckled (AC-4) (78.3%) and cytoplasmic (AC-19) (6.45%). The most frequent MSA were anti-Mi-2 (38.5%) and anti-Jo-1 (11.9%). Anti-Mi-2 was more frequent in patients from Colombia (40.1%). The MAA more frequent were anti-Ro-52/TRIM21 (17.6%) and anti-PM-Scl75 (7.5%). CONCLUSIONS: This is the first study of ANA, MSA, and MAA in patients from 6 countries from the Panamerican League against Rheumatism myositis study group. We observed a general prevalence of 60% of ANA. In relation to MSA and MAA, anti-Mi-2 was the more frequent (38.5%).

2.
Clin Rheumatol ; 37(7): 2017-2018, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29752584

RESUMO

The original publication contains two areas which require correcting. None of these errors change the results or conclusions of the article, but the authors wish to highlight the areas of change to the reader.

3.
Clin Rheumatol ; 37(5): 1417-1420, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29611083

RESUMO

GO-MORE (NCT00975130) was a large open-label, multinational, multicenter, prospective phase 3 trial evaluating add-on therapy with golimumab in biologic-naïve patients with active rheumatoid arthritis (RA). The objective of this post hoc analysis was to examine regional differences in baseline disease activity and remission rates following golimumab treatment for RA. This was a planned, descriptive post hoc analysis of data from the GO-MORE trial. Baseline disease activity and remission were defined as moderate or severe based on EULAR criteria. This analysis included 3280 participants from the GO-MORE trial. All participants included in this analysis had high or moderate disease activity at baseline. At baseline, high disease activity was least common in Europe (71.0%), Canada (77.0%), and the Middle East (78.2%) and most common in Latin America (90.7%), South Africa (91.5%), and Asia (92.5%). Month 6 remission rates were highest in South Africa (29.1%), Europe (27.9%), and the Middle East (27.3%) and lowest in Canada (19.7%), Latin America (17.2%), and Asia (15.0%). Higher rates of remission in each geographical region generally corresponded with lower baseline disease activity. We suspect that access to care and implementation of the treat-to-target strategy were the most important determinants, but this apparent relationship needs to be confirmed in further studies that include a statistical analysis of prognostic indicators.


Assuntos
Anticorpos Monoclonais/uso terapêutico , Antirreumáticos/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Quimioterapia Combinada , Feminino , Humanos , Masculino , Metotrexato/uso terapêutico , Pessoa de Meia-Idade , Estudos Prospectivos , Indução de Remissão , Índice de Gravidade de Doença , Resultado do Tratamento , Adulto Jovem
4.
Clin Rheumatol ; 37(4): 869-874, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29455267

RESUMO

At this time, reactive arthritis (ReA) is considered to be part of the spectrum of the spondyloarthritis, previously known as Reiter's syndrome, and refers to an infection induced systemic illness, characterized by a sterile synovitis occurring in a genetically predisposed individual, secondary to an infection localized in a distant organ/system, but also accompanied with multiple extra articular manifestations.


Assuntos
Artrite Reativa/diagnóstico , Artrite Reativa/patologia , Antígeno HLA-B27 , Humanos
5.
Arthritis Rheumatol ; 70(2): 242-254, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29073348

RESUMO

OBJECTIVE: Reactive arthritis (ReA) is an inflammatory disorder occurring several weeks after gastrointestinal or genitourinary tract infections. HLA-B27 positivity is considered a risk factor, although it is not necessarily predictive of disease incidence. Among nongenetic factors, the intestinal microbiome may play a role in disease susceptibility. The objective of this study was to characterize the gut microbiota and host gene interactions in ReA and postinfectious spondyloarthritis. METHODS: Adult subjects with peripheral spondyloarthritis and control subjects with preceding infections who did not develop arthritis were prospectively recruited from a geographic region with a high prevalence of ReA. Clinical variables, HLA status, and 16S ribosomal RNA gene sequencing of intestinal microbiota were analyzed. RESULTS: Subjects with ReA showed no significant differences from controls in gut bacterial richness or diversity. However, there was a significantly higher abundance of Erwinia and Pseudomonas and an increased prevalence of typical enteropathogens associated with ReA. Subjects with ultrasound evidence of enthesitis were enriched in Campylobacter, while subjects with uveitis and radiographic sacroiliitis were enriched in Erwinia and unclassified Ruminococcaceae, respectively; both were enriched in Dialister. Host genetics, particularly HLA-A24, were associated with differences in gut microbiota diversity irrespective of disease status. We identified several co-occurring taxa that were also predictive of HLA-A24 status. CONCLUSION: This is the first culture-independent study characterizing the gut microbial community in postinfectious arthritis. Although bacterial factors correlated with disease presence and clinical features of ReA, host genetics also appeared to be a major independent driver of intestinal community composition. Understanding of these gut microbiota-host genetic relationships may further clarify the pathogenesis of postinfectious spondyloarthritides.


Assuntos
Artrite Reativa/microbiologia , Microbioma Gastrointestinal/genética , Espondilartrite/microbiologia , Adolescente , Adulto , Artrite Reativa/genética , Estudos de Casos e Controles , Fezes/microbiologia , Feminino , Antígenos HLA-A/genética , Humanos , Masculino , Pessoa de Meia-Idade , RNA Ribossômico 16S/genética , Espondilartrite/genética , Adulto Jovem
6.
Clin Rheumatol ; 37(2): 415-422, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29139030

RESUMO

The objective of the study is to determine the risk factors for the development of reactive arthritis (ReA) and examine the factors associated with the persistence of symptoms. Patients with a new diagnosis of ReA and controls with a gastrointestinal (GI), urogenital, or sexually transmitted infection in the 3-6 months prior to study entry were prospectively enrolled in Guatemala City. ReA patients fulfilled the Assessment in Spondyloarthritis International Society criteria for peripheral spondyloarthropathy (SpA). Patients underwent history, examination, Achilles tendon ultrasound, and blood draw. Human leukocyte antigen (HLA) type and serum biomarkers were measured. t tests and nonparametric equivalents were used to examine the association of clinical, laboratory, and imaging factors with ReA. Patients were contacted 2 years later to assess for persistence of symptoms. Study subjects included patients with ReA (N = 32) and controls (N = 32). ReA patients were most frequently infected in April whereas controls were most frequently infected in August. Two ReA patients and two controls were HLA-B27-positive. Serum cathepsin K and C-reactive protein were higher in ReA patients compared to controls (p = 0.03 for both), while total cholesterol and low-density lipoprotein were lower (p = 0.008 and 0.045, respectively). Among those with ReA, 15 (47%) patients had continued symptoms at 2 years. These patients had a lower matrix metalloproteinase-3 level at diagnosis than patients for whom ReA resolved (p = 0.004). HLA-B27 was not associated with development of ReA in Guatemala; however, the month of infection was associated with ReA. The most striking finding was the persistence of arthritis at 2 years in nearly half of the patients.


Assuntos
Artrite Reativa/diagnóstico , Adolescente , Adulto , Artrite Reativa/etiologia , Artrite Reativa/imunologia , Biomarcadores/sangue , Estudos de Casos e Controles , Feminino , Seguimentos , Antígeno HLA-B27/imunologia , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Avaliação de Sintomas , Adulto Jovem
7.
Rev. med. interna Guatem ; 19(3): [7], sept.-dic. 2015. tablas
Artigo em Espanhol | LILACS | ID: biblio-996569

RESUMO

Gota proviene del latin Gutta es un término acuñado en el siglo V que significa exceso o derrame de flema por exceso de vino, comida y sexo. Llamada "Rey de las enfermedades yenfermedad de reyes" fue uno de los primeros desordenes reumáticos en ser reconocidos como entidad clínic a. Es la artritis por deposito de microcri s tales más común debida a desequilibrio en el metabolismo de las purinas que conlleva a hiperuricemia y el depósito de cristales de urato monosódico, caracterizada por ser de inicio monoarticular, que a fecta con mayor frecuencia la primera articulación metatarso de pie y que progresa en su forma crónica a poliarticular, asociada a destrucción progresiva y a la formación de tofos, falla renal y enfermedad cardiovascular. Predomina sexo masculino, su pr evalencia se calcula de 0.08% a nivel mundial, aumentando la frecuencia de sus ataques con el alto contenido de carnes, mariscos, cervezas y bebidas espirituosas. El objetivo de la presente revisión bibliográfica es proporcionar una guía dietética para lo s médicos enfatizando y destacando su contenido de purinas en alimentos de uso cotidiano en la población guatemalteca, para obtener un mejor control de la artritis gotosa y disminuir la frecuencia de sus ataques ...(AU)


Gota comes from Latin Gutta is a term coined in the fifth century that means excess or spill of phlegm for excess wine, food and sex. Called "King of diseases and disease of kings" was one of the first rheumatic disorders to be recognized as a clinical entity. Arthritis is the most common microcritical deposit due to imbalance in the metabolism of purines that leads to hyperuricemia and the deposition of monosodium urate crystals, characterized by monoarticular initiation, which most often occurs with the first metatarsal joint. standing up and progressing in its form chronic to polyarticular, associated with progressive destruction and the formation of tophi, renal failure and cardiovascular disease. Male sex predominates, its pr evance is estimated at 0.08% worldwide, increasing the frequency of its attacks with the high content of meats, seafood, beers and spirits. The aim of this bibliographical review is to provide a dietary guide for physicians emphasizing and highlighting their content of purines in foods of daily use in the Guatemalan population, to obtain a better control of gouty arthritis and to reduce the frequency of their attacks. .. (AU)


Assuntos
Humanos , Masculino , Feminino , Purinas/efeitos adversos , Artrite Gotosa/diagnóstico , Hiperuricemia/diagnóstico , Hiperuricemia/prevenção & controle , /educação , Gota/prevenção & controle , Ácido Úrico , Guatemala , Articulações/patologia
8.
J Clin Rheumatol ; 18(4): 170-4, 2012 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-22647863

RESUMO

BACKGROUND: Guatemala is a multiethnic, multilingual, and multicultural country. We have evaluated 2 different ethnic groups from (1) San Juan Sacatepéquez County (SJSC), a rural population (30% illiterate), with 65% from Kaqchiquel ethnic group; and (2) Zone 5 of Guatemala City (Z5GC), an urban population (6.6% illiterate), with 95.5% mestizos. OBJECTIVE: This study aimed to measure simultaneously the prevalence of rheumatic diseases in these 2 Guatemalan populations, both located in the State of Guatemala. METHODS: A convenience sample of 4000 inhabitants 15 years and older was selected in each group. The Core Community Oriented Program for Control of Rheumatic Diseases Questionnaire was used in this survey. Phase 1 was for screening (identification of study subjects), phase 2 was for obtaining information from subjects with musculoskeletal complaints, and phase 3 was for rheumatologic diagnostic purposes. Phases 1 and 2 were performed by 6 interviewers. Phase 3 was completed by 4 rheumatologists. RESULTS: In phase I, 8000 subjects were identified in both groups. In phase II, 949 subjects reported musculoskeletal complaints: 371 (39%) in Z5GC and 578 (61%) in SJSC. In phase III, 419 patients were clinically evaluated: 141 (34%) in Z5GC and 278 (66%) in SJSC. The most prevalent musculoskeletal diseases were (1) osteoarthritis, (2) soft tissue rheumatism, (3) rheumatoid arthritis, (4) low back pain, and (5) arthralgias of unknown etiology. Osteoarthritis and soft tissue rheumatism were significantly more common in the rural population. CONCLUSIONS: The most prevalent musculoskeletal diseases in Guatemala seem to be similar to those in most previous Community Oriented Program for Control of Rheumatic Diseases studies. Most subjects were still working. Further studies examining medical care received and impact on function can now be of interest.


Assuntos
Grupos Étnicos/estatística & dados numéricos , Doenças Reumáticas/etnologia , População Rural/estatística & dados numéricos , População Urbana/estatística & dados numéricos , Adolescente , Adulto , Estudos de Coortes , Estudos Transversais , Feminino , Guatemala/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Inquéritos e Questionários , Adulto Jovem
9.
Am J Med Sci ; 343(5): 350-2, 2012 May.
Artigo em Inglês | MEDLINE | ID: mdl-22543535

RESUMO

Treatment of ankylosing spondylitis and related disorders has been revolutionized by the advent of biological therapy, especially tumor necrosis factor-α inhibitors. Nonsteroidal anti-inflammatory drugs, however, remain the first line of treatment. Evidence has accumulated that nonsteroidal anti-inflammatory drug therapy of ankylosing spondylitis and related disorders is effective in controlling several of the clinical manifestations seen in these disorders, particularly pain, physical function and perhaps progressive spinal fusion. What needs to be proven, however, is the long-term safety profile of these drugs.


Assuntos
Corticosteroides/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Espondilite Anquilosante/tratamento farmacológico , Humanos
10.
Am J Med Sci ; 341(4): 295-7, 2011 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-21372662

RESUMO

The authors reviewed retrospectively a cohort of 233 spondyloarthropathy patients observed in 2 centers in Guatemala City, Guatemala, and in hospitals in San Salvador, El Salvador, and San José, Costa Rica. Guatemalan patients were either from the clinic of Guatemalan Association against Rheumatic Diseases (n = 105) or from the private clinic of AGK (n = 78). El Salvador patients (n = 17) were from Hospital Instituto Salvadoreño del Seguro Social, and Costa Rican patients (n = 33) were from Hospital Calderón Guardia, San José, Costa Rica. Except for the Costa Rican data, which were published in 2007, the patients' medical records were analyzed using standardized questionnaires. Prevalence of spondyloarthropathy was slightly higher in females than males (57% versus 43%, respectively). The median age was 47.5 years. Most of our patients were diagnosed with reactive arthritis or undifferentiated arthritis (47% and 33%, respectively); 10% of patients had ankylosing spondylitis and 9% psoriatic arthritis.


Assuntos
Espondiloartropatias/epidemiologia , Artrite Psoriásica/epidemiologia , Artrite Reativa/epidemiologia , América Central/epidemiologia , Estudos de Coortes , Costa Rica/epidemiologia , El Salvador/epidemiologia , Feminino , Guatemala/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Espondilite Anquilosante/epidemiologia
11.
J Clin Rheumatol ; 16(3): 113-8, 2010 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-20375820

RESUMO

OBJECTIVE: To develop guidelines for Musculoskeletal Ultrasound (MSKUS) training for rheumatologists in the Americas. METHODS: A total of 25 Rheumatologists from 19 countries of the American Continent participated in a consensus-based interactive process (Delphi method) using 2 consecutive electronic questionnaires. The first questionnaire included the following: the relevance of organizing courses to teach MSKUS to Rheumatologists, the determination of the most effective educational course models, the trainee levels, the educational objectives, the requirements for passing the course(s), the course venues, the number of course participants per instructor, and the percentage of time spent in hands-on sessions. The second questionnaire consisted of questions that did not achieve consensus (>65%) in the first questionnaire, topics, and pathologies to be covered at each course MSKUS level. RESULTS: General consensus was obtained for MSKUS courses to be divided into 3 educational levels: basic, intermediate, and advanced. These courses should be taught using a theoretical-didactic and hands-on model. In addition, the group established the minimum requirements for attending and passing each MSKUS course level, the ideal number of course participants per instructor (4 participants/instructor), and the specific topics and musculoskeletal pathologies to be covered. In the same manner, the group concluded that 60% to 70% of course time should be focused on hands-on sessions. CONCLUSION: A multinational group of MSKUS sonographers using a consensus-based questionnaire (Delphi method) established the first recommendations and guidelines for MSKUS course training in the Americas. Pan-American League of Associations for Rheumatology urges that these guidelines and recommendations be adopted in the future by both national and regional institutions in the American continent involved in the training of Rheumatologists for the performance of MSKUS.


Assuntos
Educação Médica Continuada/normas , Reumatologia/educação , Ultrassonografia/normas , América , Técnica Delfos , Humanos , Doenças Musculoesqueléticas/diagnóstico por imagem
12.
J Clin Rheumatol ; 11(3): 140-5, 2005 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-16357732

RESUMO

BACKGROUND: The importance of past adverse experiences is increasingly recognized in patients with rheumatic disease. OBJECTIVE: The objective of this study was to study the association of physical, verbal, and sexual abuse in patients with rheumatic disorders as compared with healthy volunteers. METHODS: In this case-control study, 500 new patients attending an outpatient rheumatic clinic were interviewed from September 1, 1999, to August 31, 2001. A total of 187 patients with 3 diagnoses were selected: 58 had fibromyalgia (FM), 74 rheumatoid arthritis (RA), and 55 patients with soft tissue rheumatic disease (STRD). All selected patients were asked to complete a questionnaire designed to obtain information regarding demographics and history of verbal, physical, and sexual abuse. A group of 187 healthy control subjects were also included, matched for sex and age. RESULTS: The prevalence of abuse was significantly more common in the rheumatic disease group than in the control group (48.1% versus 15%, P < 0.001). The prevalence of abuse among the groups was as follows: 70.7% of patients with FM reported abuse (24.3% verbal, 60.9% physical, and 14.8% sexual), 35.1% of patients with RA had a history of abuse (42.3% verbal, 30.7% physical, and 0% sexual), whereas 41.8% of patients with STRD reported abuse (43.4% verbal, 43.4% physical, and 0% sexual). When comparing the 3 groups, patients with FM showed a higher prevalence of abuse (P < 0.05). The abuse was usually longstanding (range, 1-10 years), and most abusers were close family members. CONCLUSION: Abuse, both physical and psychologic, was significantly increased in our rheumatic disease population, especially in patients with FM. Further studies are needed to fully establish its role. Questions about abuse may provide important information relative to care of our patients.


Assuntos
Violência Doméstica/estatística & dados numéricos , Fibromialgia/psicologia , Doenças Reumáticas/psicologia , Adulto , Fatores Etários , Instituições de Assistência Ambulatorial , Estudos de Casos e Controles , Consanguinidade , Feminino , Guatemala , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Fatores de Tempo
13.
Rev. med. interna ; 15(1): 7-16, jun. 2004. tab, graf
Artigo em Espanhol | LILACS | ID: lil-412040

RESUMO

El LES (Lupus Eritematoso Sistémico) representa un síndrome clínico, más que una entidad patológica única con diversidad de presentaciones clìnicas que varían en las diferentes poblaciones del mundo. En Guatemala actualmente existen pocos estudios publicados. Nuestro objetivo: evaluar aspectos socioeconómicos, demográficos, raciales, evolución clínica y comportamiento de la enfermedad, en grupo de pacientes con LES, entre julio 1997 y diciembre 2003. En base a estudio descriptivo de 47 pacientes que consultaron en clínicas AGAR y una clínica privada AGK. Resultados: Mayor incidencia en cuarta década; 100/100 sexo femenino; la deserción es alta 21 (44.6/100) en ambos centros, mayor en clínica privada, creemos que es por factores económicos


Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Anticorpos Antinucleares , Lúpus Eritematoso Sistêmico/economia , Lúpus Eritematoso Sistêmico/patologia , Pacientes Desistentes do Tratamento
14.
Rev. med. interna ; 14(1): 43-45, jun. 2003. graf
Artigo em Espanhol | LILACS | ID: lil-412026

RESUMO

La sinovitis villonodular pigmentada es una enfermedad poco común pero no rara, usualmente de presentación monoarticular, es la causa más frecuente de hemartrosis no traumática. Se presenta el caso de paciente femenina de 17 años, con diagnóstico de sinovitis villonodular pigmentada confirmado por biopsia.


Assuntos
Humanos , Feminino , Adolescente , Sinovite , Sinovite Pigmentada Vilonodular
15.
J Clin Rheumatol ; 7(1): 1-2, 2001 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-19078499
16.
Rev. med. interna ; 8(2): 64-6, dic. 1997. tab
Artigo em Espanhol | LILACS | ID: lil-262783

RESUMO

Este es un estudio retrospectivo descriptivo y transversal que se realizó con el objetivo de evaluar los aspectos demográficos y clínicos de los pacientes con artritis reumatoidea de la Clínica de la Asociación Guatemalteca Anti-Enfermedades Reumáticas (AGAR) y establecer una relación con lo reportado por la literatura


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Artrite Reumatoide/epidemiologia , Depressão
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