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1.
Artigo em Inglês | MEDLINE | ID: mdl-29693320

RESUMO

Systemic Lupus Erythematosus (SLE) predominantly affects women. Clinical phenotype and outcomes in SLE may vary by sex; complicated further by unique concerns depending on gender defined roles. Herein, we describe gender differences in disease specific quality of life (QOL) assessment scores using LupusPRO in a large International study. METHODS: Cross-sectional data from 1,803 SLE patients on demographics, self-identified gender status, LupusPRO and disease activity were analyzed. LupusPRO has two constructs: health-related QOL (HRQOL) and non-HRQOL. Disease activity and damage were evaluated using SELENA-SLEDAI and the SLICC/ACR-Damage Index (SDI), respectively. Non-parametric tests were used to compare QOL and disease activity by gender. RESULTS: 122 men and 1681 women with SLE participated. Mean age was similar by gender. Damage score was greater among men. Men fared worse on the non-HRQOL social support domain than women (p=0.02). When comparing disease and QOL among men and women aged ≤45 years, men were found to have greater damage and worse social support than women. However, women fared significantly worse on lupus symptoms, cognition and procreation domains with trends for worse functioning on physical health and pain-vitality domains. CONCLUSIONS: In the largest study of diverse SLE patients with a disease specific QOL tool, gender differences in QOL were observed on both HRQOL and non-HRQOL constructs. While men performed worse in the social support domain, women, especially those in the reproductive age group, fared worse on other domains. These observations may assist physicians in appropriately addressing QOL issues in a gender focused manner. This article is protected by copyright. All rights reserved.

2.
Int J Rheum Dis ; 2018 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-29611343

RESUMO

OBJECTIVE: To study the prevalence and the associated factors of work disability (WD) in systemic lupus erythematosus (SLE) patients. METHODS: A sample of 419 SLE patients from an observational cross-sectional multicenter study was included. Sociodemographic features, disease characteristics, comorbidities, quality of life, unhealthy behaviors, and work-related factors were measured in a standardized interview. Work disability was defined by patient self-report of not being able to work because of SLE. To identify variables associated with work disability, two different multivariate regression models using a stepwise backward method were performed. RESULTS: Prevalence of WD due to SLE was 24.3%. Eighty-nine percent were female and 51% were Caucasians. Mean disease duration was 8.9 ± 7.2 years, and median System Lupus International Collaborating Clinics/American College of Rheumatology damage index SLICC-SDI was 1.5 (range 0-17). In stepwise multivariate logistic regression, living below the poverty line (odds ratio [OR] = 4.65), less than 12 years of education (OR = 2.84), Mestizo ethnicity (OR = 1.94) and SLICC-SDI (OR = 1.25) were predictors of WD. A second model was performed including patient-derived measures; in this model sedentary lifestyle (OR = 2.69) and lower emotional health domain score of the Lupus Quality of Life (LupusQoL) questionnaire (OR = 1.03) were found to be associated to WD and a higher score in LupusQoL physical health domain (OR = 0.93) was protective. CONCLUSION: The prevalence of WD in Argentinian SLE patients was 24.3%. WD was associated with ethnic (Mestizo), socioeconomic (poverty) and disease-related factors. Patient-related outcomes such us sedentary lifestyle and poor emotional quality of life were also associated with WD.

3.
J Rheumatol ; 44(12): 1804-1812, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29093158

RESUMO

OBJECTIVE: To define whether Amerindian genetic ancestry correlates with clinical and therapeutic variables in admixed individuals with rheumatoid arthritis (RA) from Latin America. METHODS: Patients with RA (n = 1347) and healthy controls (n = 1012) from Argentina, Mexico, Chile, and Peru were included. Samples were genotyped for the Immunochip v1 using the Illumina platform. Clinical data were obtained through interviews or the clinical history. RESULTS: Percentage of Amerindian ancestry was comparable between cases and controls. Morning stiffness (p < 0.0001, OR 0.05), rheumatoid factor (RF; p < 0.0001, OR 0.22), radiographic changes (p < 0.0001, OR 0.05), and higher number of criteria were associated with lower Amerindian ancestry after Bonferroni correction. Higher Amerindian ancestry correlated only with weight loss (pBonferroni < 0.0001, OR 2.85). Increased Amerindian ancestry correlated with higher doses of azathioprine (p < 0.0001, OR 163.6) and sulfasalazine (p < 0.0001, OR 48.6), and inversely with methotrexate (p = 0.001, OR 0.35), leflunomide (p = 0.001, OR 0.16), and nonsteroidal antiinflammatory drugs (pBonferroni = 0.001, OR 0.37). Only the presence of RF and weight loss were modified after confounders adjustment. CONCLUSION: Amerindian ancestry protects against most major clinical criteria of RA, but regarding the association of RF with increased European ancestry, age, sex, and smoking are modifiers. Ancestry also correlates with the therapeutic profiles.


Assuntos
Anti-Inflamatórios não Esteroides/uso terapêutico , Antirreumáticos/uso terapêutico , Artrite Reumatoide/genética , Genótipo , Fator Reumatoide/genética , Adulto , Fatores Etários , Idoso , Alelos , Argentina , Artrite Reumatoide/diagnóstico por imagem , Artrite Reumatoide/tratamento farmacológico , Chile , Feminino , Humanos , Índios Norte-Americanos , Índios Sul-Americanos , Isoxazóis/uso terapêutico , Leflunomida , Masculino , Metotrexato/uso terapêutico , México , Pessoa de Meia-Idade , Peru , Radiografia , Fatores Sexuais , Sulfassalazina/uso terapêutico
4.
Arthritis Rheumatol ; 68(5): 1060-71, 2016 05.
Artigo em Inglês | MEDLINE | ID: mdl-26749174

RESUMO

OBJECTIVE: To update the 2009 Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) treatment recommendations for the spectrum of manifestations affecting patients with psoriatic arthritis (PsA). METHODS: GRAPPA rheumatologists, dermatologists, and PsA patients drafted overarching principles for the management of PsA, based on consensus achieved at face-to-face meetings and via online surveys. We conducted literature reviews regarding treatment for the key domains of PsA (arthritis, spondylitis, enthesitis, dactylitis, skin disease, and nail disease) and convened a new group to identify pertinent comorbidities and their effect on treatment. Finally, we drafted treatment recommendations for each of the clinical manifestations and assessed the level of agreement for the overarching principles and treatment recommendations among GRAPPA members, using an online questionnaire. RESULTS: Six overarching principles had ≥80% agreement among both health care professionals (n = 135) and patient research partners (n = 10). We developed treatment recommendations and a schema incorporating these principles for arthritis, spondylitis, enthesitis, dactylitis, skin disease, nail disease, and comorbidities in the setting of PsA, using the Grading of Recommendations, Assessment, Development and Evaluation process. Agreement of >80% was reached for approval of the individual recommendations and the overall schema. CONCLUSION: We present overarching principles and updated treatment recommendations for the key manifestations of PsA, including related comorbidities, based on a literature review and consensus of GRAPPA members (rheumatologists, dermatologists, other health care providers, and patient research partners). Further updates are anticipated as the therapeutic landscape in PsA evolves.


Assuntos
Corticosteroides/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Antirreumáticos/uso terapêutico , Artrite Psoriásica/terapia , Modalidades de Fisioterapia , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Administração Oral , Anticorpos Monoclonais/uso terapêutico , Humanos , Injeções Intra-Articulares , Ustekinumab/uso terapêutico
5.
Arthritis Rheumatol ; 68(4): 932-43, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26606652

RESUMO

OBJECTIVE: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with a strong genetic component. We undertook the present work to perform the first genome-wide association study on individuals from the Americas who are enriched for Native American heritage. METHODS: We analyzed 3,710 individuals from the US and 4 countries of Latin America who were diagnosed as having SLE, and healthy controls. Samples were genotyped with HumanOmni1 BeadChip. Data on out-of-study controls genotyped with HumanOmni2.5 were also included. Statistical analyses were performed using SNPtest and SNPGWA. Data were adjusted for genomic control and false discovery rate. Imputation was performed using Impute2 and, for classic HLA alleles, HiBag. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated. RESULTS: The IRF5-TNPO3 region showed the strongest association and largest OR for SLE (rs10488631: genomic control-adjusted P [Pgcadj ] = 2.61 × 10(-29), OR 2.12 [95% CI 1.88-2.39]), followed by HLA class II on the DQA2-DQB1 loci (rs9275572: Pgcadj = 1.11 × 10(-16), OR 1.62 [95% CI 1.46-1.80] and rs9271366: Pgcadj = 6.46 × 10(-12), OR 2.06 [95% CI 1.71-2.50]). Other known SLE loci found to be associated in this population were ITGAM, STAT4, TNIP1, NCF2, and IRAK1. We identified a novel locus on 10q24.33 (rs4917385: Pgcadj = 1.39 × 10(-8)) with an expression quantitative trait locus (eQTL) effect (Peqtl = 8.0 × 10(-37) at USMG5/miR1307), and several new suggestive loci. SLE risk loci previously identified in Europeans and Asians were corroborated. Local ancestry estimation showed that the HLA allele risk contribution is of European ancestral origin. Imputation of HLA alleles suggested that autochthonous Native American haplotypes provide protection against development of SLE. CONCLUSION: Our results demonstrate that studying admixed populations provides new insights in the delineation of the genetic architecture that underlies autoimmune and complex diseases.


Assuntos
Grupo com Ancestrais Nativos do Continente Americano/genética , Lúpus Eritematoso Sistêmico/genética , Argentina , Antígeno CD11b/genética , Estudos de Casos e Controles , Chile , Cromossomos Humanos Par 10/genética , Proteínas de Ligação a DNA/genética , Grupo com Ancestrais do Continente Europeu/genética , Feminino , Predisposição Genética para Doença , Estudo de Associação Genômica Ampla , Antígenos HLA-DQ/genética , Cadeias beta de HLA-DQ/genética , Haplótipos , Humanos , Fatores Reguladores de Interferon , Quinases Associadas a Receptores de Interleucina-1/genética , Masculino , México , ATPases Mitocondriais Próton-Translocadoras/genética , NADPH Oxidases/genética , Razão de Chances , Peru , Análise de Componente Principal , Fator de Transcrição STAT4/genética , Estados Unidos , beta Carioferinas
6.
Rheumatol Int ; 35(1): 107-14, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-24948375

RESUMO

To determine the prevalence of and associated factors to work instability (WI) in rheumatoid arthritis (RA) Argentinean patients. Observational cross-sectional study that assessing employment status in currently working RA patients. They answered the validated version of RA work instability scale (RA-WIS). High-risk WI was considered when RA-WIS was ≥17. Factors associated with high-risk WI were examined by univariable and multivariable analysis. Four-hundred and fifty RA patients were enrolled; of these, 205 patients were currently employed, but only 172 have completed questionnaires required [RA-WIS and health assessment questionnaire (HAQ-A)]. Their mean age was 49.3 ± 10.8 years; 81.3 % were female; and their mean disease duration was 8.1 ± 7.2 years. Fifty-two percent of patients were doing manual work. The mean RA-WIS score was 11.4 ± 6.8, and 41 % of patients had a high-risk WI. High-risk WI was associated with radiographic erosions (p < 0.001) and HAQ-A >0.87 (p < 0.001) in the univariable analysis, whereas in the multivariable logistic regression analysis the variables associated with a high-risk WI were as follows: HAQ-A >0.87 [odds ratio (OR) 12.31; 95 % CI 5.38-28.18] and the presence of radiographic erosions (OR 4.848; 95 % CI 2.22-10.5). In this model, having a higher monthly income (OR 0.301; 95 % CI 0.096-0.943) and a better functional class (OR 0.151; 95 % CI 0.036-0.632) were protective. Forty-one percent of RA working patients had high-risk WI. The predictors of high RA-WIS were HAQ-A ≥0.87 and radiographic erosions, whereas having a better functional class and have higher incomes were protective.


Assuntos
Artrite Reumatoide , Avaliação da Deficiência , Emprego , Adulto , Argentina , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Inquéritos e Questionários
7.
J Rheumatol ; 41(11): 2295-300, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25362714

RESUMO

Dactylitis, a hallmark clinical feature of psoriatic arthritis (PsA) and other spondyloarthropathies, may also be a severity marker for PsA and psoriasis. Traditionally, clinicians have used nonsteroidal antiinflammatory drugs and local corticosteroid injections to treat dactylitis, although conventional disease-modifying antirheumatic drugs are also used. We performed a systematic literature review to determine the most efficacious current treatment options for dactylitis in PsA. Effect sizes were greatest for the biologic agents ustekinumab, certolizumab, and infliximab, suggesting that therapy with one of these agents should be initiated in patients with dactylitis. However, the limited data highlight the need for randomized, placebo-controlled trials, with dactylitis as a primary outcome, to determine a valid, reliable, and responsive clinical outcome measure for PsA patients with dactylitis.


Assuntos
Artrite Psoriásica/diagnóstico , Artrite Psoriásica/tratamento farmacológico , Articulações dos Dedos/fisiopatologia , Guias de Prática Clínica como Assunto , Anti-Inflamatórios não Esteroides/uso terapêutico , Antirreumáticos/uso terapêutico , Artrite Psoriásica/complicações , Fatores Biológicos/uso terapêutico , Quimioterapia Combinada , Medicina Baseada em Evidências , Feminino , Articulações dos Dedos/efeitos dos fármacos , Humanos , Masculino , Prognóstico , Medição de Risco , Índice de Gravidade de Doença , Resultado do Tratamento
8.
Rheum Dis Clin North Am ; 40(3): 433-54, vii-viii, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25034155

RESUMO

Genetic factors seem to play a more important role early in the course of systemic lupus erythematosus (SLE), whereas nongenetic factors seem to play a more important role over the course of the disease. SLE is more frequent with less favorable outcomes in nonwhite populations. To overcome these differences and reduce the immediate-term, mediate-term, and long-term impact of SLE among disadvantaged populations, it is essential to increase disease awareness, to improve access to health care and to provide care to these patients in a consistent manner regardless of the severity of their disease.


Assuntos
Predisposição Genética para Doença , Lúpus Eritematoso Sistêmico , Farmacogenética , Grupos Étnicos , Disparidades nos Níveis de Saúde , Humanos , Rim/fisiopatologia , Lúpus Eritematoso Sistêmico/diagnóstico , Lúpus Eritematoso Sistêmico/epidemiologia , Lúpus Eritematoso Sistêmico/genética , Lúpus Eritematoso Sistêmico/fisiopatologia , Lúpus Eritematoso Sistêmico/terapia , Gravidade do Paciente , Prognóstico , Terapia de Substituição Renal/métodos
9.
Curr Rheumatol Rep ; 15(12): 380, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24178589

RESUMO

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that has major implications for health-related quality of life (HRQoL). Improvements in the monitoring and management of SLE improves survival; however, improvement of HRQoL remains of paramount importance among these patients. Measurement of HRQoL has been recommended in clinical practice and research including drug development and testing in clinical trials. Both generic and disease specific instruments have been developed to ascertain HRQoL. In an increasingly global collaborative environment, the importance of assessing HRQoL across nations, acknowledgment of their confounders, and limitations of used instruments are critical. Here, we review selected major developments in the past 5 years highlighting: the importance of measuring HRQoL in SLE patients, the benefits and limitations of instruments that exist, and their application in research settings.


Assuntos
Lúpus Eritematoso Sistêmico/reabilitação , Qualidade de Vida , Fatores de Confusão (Epidemiologia) , Comparação Transcultural , Indicadores Básicos de Saúde , Humanos , Lúpus Eritematoso Sistêmico/terapia , Psicometria , Melhoria de Qualidade , Ensaios Clínicos Controlados Aleatórios como Assunto
10.
J Clin Rheumatol ; 19(6): 329-31, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-23965483

RESUMO

The first annual meeting of the Latin American Spondyloarthritis Society for Education and Research in Immunology and Medicine (LASSERIM) was held in Bogotá, Colombia, in September 2012 and was attended by key opinion leaders, researchers, and rheumatologists. The meeting included presentations and discussions from renowned speakers during 2 days and a coaching leadership exercise led by an expert in the field followed by an open forum. Two groups defined a priori discussed the establishment of a professional network and organization to be involved in the identification, assessment, and effective resolution of health care issues in Latin America.A broad spectrum of topics were discussed but focused on the following: pharmacoeconomics in general rheumatology, spondyloarthritis and chronic back pain, therapeutic interventions in rheumatoid arthritis, ultrasonography in spondyloarthritis, impact of social media in medicine and global trends in leadership, quality of life, and innovation. A special workshop on coaching in health care and coaching as a tool to implement LASSERIM goals was part of the 2-day conference.LASSERIM will be working in the future on education, research, and innovation in the field of rheumatology and immunology. A special focus will be on spondyloarthritis, by promoting research, open discussions, and by conducting carefully planned research studies to impact on the quality of life of patients and doctors from Latin American countries.


Assuntos
Pesquisa Biomédica/tendências , Reumatologia/educação , Espondilartrite/epidemiologia , Espondilartrite/terapia , Colômbia , Assistência à Saúde , Farmacoeconomia , Humanos , América Latina/epidemiologia , Qualidade de Vida , Espondilartrite/diagnóstico por imagem , Ultrassonografia
11.
J Rheumatol ; 40(8): 1367-73, 2013 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-23772085

RESUMO

OBJECTIVE: To determine the prevalence of diffuse idiopathic skeletal hyperostosis (DISH) in patients with psoriatic arthritis (PsA) and to identify the features associated with its occurrence. METHODS: Patients were recruited from the University of Toronto PsA observational cohort initiated in 1978. All patients fulfilled the CASPAR criteria. Radiographs of peripheral joints and spine were obtained every 2 years. DISH was defined as flowing bony bridges in at least 4 contiguous thoracic vertebrae. Each PsA patient with DISH was matched by sex to 3 PsA patients without DISH. Demographics, disease characteristics, and radiographic features were compared using McNemar test, Fisher's exact test, chi-square test, and paired t test as appropriate. Logistic regression analyses models with stepwise regression were conducted. RESULTS: DISH was observed in 78 (8.3%) of 938 patients with PsA. Patients with DISH were older and had longer disease duration, higher body mass index (BMI), and higher uric acid levels. Diabetes and hypertension were more prevalent in patients with DISH than in those without. The severity of radiographic damage to peripheral joints was also greater in patients with DISH. The presence of inflammatory back pain, HLA-B*27 allele, and sacroiliitis was similar in both groups. Patients with DISH had more syndesmophytes and calcaneal spurs. Older age, higher BMI, and the presence of radiographic damage to peripheral joints were associated with DISH in multivariate analysis. CONCLUSION: The diagnosis of DISH is possible in the presence of axial PsA. DISH was associated with known DISH-related factors including older age and high BMI, as well as the presence of radiographic damage to peripheral joints.


Assuntos
Artrite Psoriásica/epidemiologia , Hiperostose Esquelética Difusa Idiopática/diagnóstico por imagem , Hiperostose Esquelética Difusa Idiopática/epidemiologia , Adulto , Fatores Etários , Idoso , Artrografia , Índice de Massa Corporal , Estudos de Casos e Controles , Estudos de Coortes , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Análise de Regressão , Coluna Vertebral/diagnóstico por imagem
12.
Arthritis Rheum ; 65(6): 1457-67, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23460240

RESUMO

OBJECTIVE: To identify susceptibility loci for rheumatoid arthritis (RA) in Latin American individuals with admixed European and Amerindian genetic ancestry. METHODS: Genotyping was performed in 1,475 patients with RA and 1,213 control subjects, using a customized BeadArray containing 196,524 markers covering loci previously associated with various autoimmune diseases. Principal components analysis (EigenSoft package) and Structure software were used to identify outliers and define the population substructure. REAP software was used to define cryptic relatedness and duplicates, and genetic association analyses were conducted using Plink statistical software. RESULTS: A strong genetic association between RA and the major histocompatibility complex region was observed, localized within BTNL2/DRA-DQB1- DQA2 (P = 7.6 × 10(-10) ), with 3 independent effects. We identified an association in the PLCH2-HES5-TNFRSF14-MMEL1 region of chromosome 1 (P = 9.77 × 10(-6) ), which was previously reported in Europeans, Asians, and Native Canadians. We identified one novel putative association in ENOX1 on chromosome 13 (P = 3.24 × 10(-7) ). Previously reported associations were observed in the current study, including PTPN22, SPRED2, STAT4, IRF5, CCL21, and IL2RA, although the significance was relatively moderate. Adjustment for Amerindian ancestry improved the association of a novel locus in chromosome 12 at C12orf30 (NAA25) (P = 3.9 × 10(-6) ). Associations with the HLA region, SPRED2, and PTPN22 improved in individuals positive for anti-cyclic citrullinated peptide antibodies. CONCLUSION: Our data define, for the first time, the contribution of Amerindian ancestry to the genetic architecture of RA in an admixed Latin American population by confirming the role of the HLA region and supporting the association with a locus in chromosome 1. In addition, we provide data for novel putative loci in chromosomes 12 and 13.


Assuntos
Artrite Reumatoide/genética , Cromossomos Humanos Par 12/genética , Cromossomos Humanos Par 13/genética , Cromossomos Humanos Par 1/genética , Antígenos HLA/genética , Feminino , Genótipo , Humanos , Índios Sul-Americanos , América Latina , Masculino , Análise de Sequência com Séries de Oligonucleotídeos
13.
J Rheumatol ; 40(1): 34-9, 2013 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23118108

RESUMO

OBJECTIVE: To describe the development of the Systemic Lupus Erythematosus Disease Activity Index 2000 Responder Index-50 (S2K RI-50) Website (www.s2k-ri-50.com) and to assess satisfaction with its training and examination modules among rheumatologists and rheumatology fellows. METHODS: The development of the Website occurred in 3 phases. The first was a deployment phase that consisted of preparing the site map along with its content. The content included the S2K RI-50 training manual, the tests and corresponding question bank, and the online adaptive training module, along with the extensive site testing. The second phase included the participation of rheumatologists and trainees who completed the Website modules. The third was a quality assurance phase in which an online survey was developed to determine the satisfaction level of its users. Further modifications were implemented per participants' recommendations. RESULTS: The site has been online since it was registered in September 2010. Fourteen rheumatologists and rheumatology trainees from different centers reviewed and completed the material contained in the Website. The survey revealed acceptance among rheumatologists for the Website's content, design, and presentation. The Website was rated as user-friendly and useful in familiarizing investigators with the S2K RI-50. After completion of the training and examination modules, participants reported a suitable level of preparation to implement the S2K RI-50 in clinical trials and research settings in a timely manner. CONCLUSION: The Website includes training and examination modules that familiarize rheumatologists with the S2K RI-50 and assesses their competence to use the index. This prepares them for the use of the S2K RI-50 in clinical trials and research settings.


Assuntos
Atitude do Pessoal de Saúde , Pesquisas sobre Serviços de Saúde , Lúpus Eritematoso Sistêmico/diagnóstico , Reumatologia , Feminino , Humanos , Internet , Masculino , Índice de Gravidade de Doença
14.
J Rheumatol ; 39(11): 2216-9, 2012 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-23118292

RESUMO

OBJECTIVE: To determine the presence of psoriasis and psoriatic arthritis (PsA) in aboriginal people living in the Andean Mountains of Peru. METHODS: Consecutive patients with psoriasis and PsA attending an arthritis clinic in Juliaca, Puno, Peru, located 3824 m above sea level were examined. The CASPAR (ClASsification of Psoriatic ARthritis) criteria were used for classification of PsA. Diagnosis of psoriasis was confirmed by a dermatologist. RESULTS: Seventeen patients [11 (65%) men and 6 (35%) women] fulfilled classification criteria for PsA; one patient was of European ancestry and is not included in this report. Of the 16 aboriginal patients in this report, 5 were natives of Quechua ancestry and one was native Aymara. At the time of their first clinic visit, no native patient with PsA had a family history of psoriasis or PsA, and all patients exhibited an established disease of long duration and severity. Methotrexate was the drug of choice for all patients; 2 patients are currently receiving biological therapy. CONCLUSION: Contrary to what has been reported in the literature, both psoriasis and PsA are present in aboriginal people from the Andean Mountains of Peru. More studies are needed to further define the phenotype of these disorders, as well as the pathogenetic role of genetic and environmental factors.


Assuntos
Artrite Psoriásica/etnologia , Artrite Psoriásica/epidemiologia , Grupos Populacionais/etnologia , Psoríase/etnologia , Psoríase/epidemiologia , Adulto , Idoso , Antirreumáticos/uso terapêutico , Artrite Psoriásica/tratamento farmacológico , Feminino , Humanos , Masculino , Metotrexato/uso terapêutico , Pessoa de Meia-Idade , Peru/epidemiologia , Prevalência , Psoríase/tratamento farmacológico , Estudos Retrospectivos , Índice de Gravidade de Doença
15.
J Rheumatol ; 39(2): 445-7, 2012 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-22298278

RESUMO

Documenting the disease burden of psoriasis and psoriatic arthritis (PsA) in Central and South America is difficult. The most conclusive data have come from the Iberoamerican Registry of Spondyloarthritis (RESPONDIA), which registered patients with a diagnosis of spondyloarthritis in a multinational, multicenter (Argentina, Brazil, Costa Rica, Chile, Mexico, Peru, Uruguay, Venezuela, Spain, and Portugal) cross-sectional study conducted between 2006 and 2007. Compared with elsewhere in the Western world, patients with PsA from RESPONDIA were older at study visit, at onset of symptoms, and at diagnosis of spondyloarthritis (SpA); had longer mean disease duration from onset of symptoms to diagnosis; and were more likely to have dactylitis, nail involvement, enthesitis, and peripheral arthritis in lower and upper extremities. It is critical to understand the biologic basis, estimate the disease burden, and determine the clinical treatment of PsA in Latin America. The Group for Research and Assessment of Psoriasis and PsA (GRAPPA) has an increasing number of members from this region. In a coordinated effort, GRAPPA, the Latin American Psoriasis and PsA Society (LAPPAS), and the Pan American League of Associations for Rheumatology (PANLAR) are supporting clinician researchers with educational initiatives in Latin America to understand these conditions.


Assuntos
Artrite Psoriásica/epidemiologia , Psoríase/epidemiologia , Idade de Início , Artrite Psoriásica/diagnóstico , Artrite Psoriásica/genética , Estudos Transversais , Humanos , América Latina/epidemiologia , Psoríase/diagnóstico , Psoríase/genética
16.
Arthritis Care Res (Hoboken) ; 64(2): 206-14, 2012 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-22052672

RESUMO

OBJECTIVE: To assess the determinants of patients' (PTGL) and physicians' (MDGL) global assessment of rheumatoid arthritis (RA) activity and factors associated with discordance among them. METHODS: A total of 7,028 patients in the Quantitative Standard Monitoring of Patients with RA study had PTGL and MDGL assessed at the same clinic visit on a 0-10-cm visual analog scale (VAS). Three patient groups were defined: concordant rating group (PTGL and MDGL within ±2 cm), higher patient rating group (PTGL exceeding MDGL by >2 cm), and lower patient rating group (PTGL less than MDGL by >2 cm). Multivariable regression analysis was used to identify determinants of PTGL and MDGL and their discordance. RESULTS: The mean ± SD VAS scores for PTGL and MDGL were 4.01 ± 2.70 and 2.91 ± 2.37, respectively. Pain was overwhelmingly the single most important determinant of PTGL, followed by fatigue. In contrast, MDGL was most influenced by swollen joint count (SJC), followed by erythrocyte sedimentation rate (ESR) and tender joint count (TJC). A total of 4,454 (63.4%), 2,106 (30%), and 468 (6.6%) patients were in the concordant, higher, and lower patient rating groups, respectively. Odds of higher patient rating increased with higher pain, fatigue, psychological distress, age, and morning stiffness, and decreased with higher SJC, TJC, and ESR. Lower patient rating odds increased with higher SJC, TJC, and ESR, and decreased with lower fatigue levels. CONCLUSION: Nearly 36% of patients had discordance in RA activity assessment from their physicians. Sensitivity to the "disease experience" of patients, particularly pain and fatigue, is warranted for effective care of RA.


Assuntos
Artrite Reumatoide , Atitude do Pessoal de Saúde , Atitude Frente a Saúde , Relações Médico-Paciente , Autoavaliação , Artralgia/diagnóstico , Artralgia/fisiopatologia , Artralgia/psicologia , Artrite Reumatoide/diagnóstico , Artrite Reumatoide/fisiopatologia , Artrite Reumatoide/psicologia , Fadiga/diagnóstico , Fadiga/etiologia , Fadiga/fisiopatologia , Feminino , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Reprodutibilidade dos Testes , Índice de Gravidade de Doença
17.
Curr Rheumatol Rep ; 13(4): 324-37, 2011 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-21633837

RESUMO

Systemic lupus erythematosus (SLE) is an autoimmune disease that disproportionately affects women of childbearing age during their most productive years. Current therapeutic measures have improved patient survival; however, the impact of interventions on general and specific domains of health-related quality of life requires further study. Medical Outcomes Survey Short Form 36 (SF-36), the most commonly used measure, has been included in some SLE randomized controlled trials, but the observed effect sizes were generally small and in some cases negligible. An SLE patient's quality of life is known to be significantly worse than that of someone in the general population and perhaps worse than those with most other common chronic diseases. SF-36, although useful as a general measure, may not be the most sensitive way to gauge changes perceived by patients with SLE. Ongoing trials and observational longitudinal studies using lupus-specific health-related quality-of-life measures may help better determine health-related quality-of-life responses and determine the domains most amenable to interventions.


Assuntos
Nível de Saúde , Lúpus Eritematoso Sistêmico/psicologia , Lúpus Eritematoso Sistêmico/terapia , Qualidade de Vida , Adaptação Psicológica , Terapias Complementares , Feminino , Humanos , Lúpus Eritematoso Sistêmico/fisiopatologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Perfil de Impacto da Doença , Resultado do Tratamento
18.
Curr Rheumatol Rep ; 13(4): 360-8, 2011 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-21552999

RESUMO

Psoriasis and its related manifestations, including psoriatic arthritis, are prevalent disorders in the Western world, particularly among Caucasians. The study of these disorders in Latin America lags way behind the study of other more common rheumatic disorders, such as rheumatoid arthritis and systemic lupus erythematosus. From the scarce evidence available, however, it appears that the prevalence and incidence of psoriasis and psoriatic arthritis are lower than in other parts of the Western world and almost negligible among natives from the Andean region, although confirmatory epidemiologic studies are lacking.


Assuntos
Artrite Psoriásica/epidemiologia , Artrite Psoriásica/etiologia , Artrite Psoriásica/fisiopatologia , América Central/epidemiologia , Predisposição Genética para Doença , Humanos , Incidência , Prevalência , Psoríase/epidemiologia , Psoríase/etiologia , Psoríase/fisiopatologia , Índice de Gravidade de Doença , América do Sul/epidemiologia
19.
J Rheumatol ; 38(5): 868-73, 2011 May.
Artigo em Inglês | MEDLINE | ID: mdl-21324961

RESUMO

OBJECTIVE: To test the interrater and intrarater reliability of the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) Responder Index (SRI-50), an index designed to measure ≥ 50% improvement in disease activity between visits in patients with systemic lupus erythematosus. METHODS: This was a multicenter, cross-sectional study with raters from Canada, the United Kingdom, and Argentina. Patient profile scenarios were derived from real adult patients. Ten rheumatologists from university and community hospitals and postdoctoral rheumatology fellows participated. An SRI-50 data retrieval form was used. Each rheumatologist scored SLEDAI-2K at the baseline visit and SRI-50 on followup visit, for the same patients, on 2 occasions 2 weeks apart. Physician global assessment (PGA) was determined on a numerical scale at baseline visit and a Likert scale on followup visit. Interrater and intrarater reliability was assessed using intraclass correlation coefficient (ICC) and kappa statistics whenever applicable. RESULTS: Forty patient profiles were created. The ICC performed on 80 patient profiles for interrater ranged from 1.00 for SLEDAI-2K and SRI-50 to 0.96 for PGA. The intrarater ICC for SLEDAI-2K, SRI-50, and PGA scores ranged from 1.00 to 0.86. Substantial agreement was determined for the interrater Likert scale, with a kappa statistic of 0.57. CONCLUSION: The SRI-50 is reliable to assess ≥ 50% improvement in lupus disease activity. Use of the SRI-50 data retrieval form is essential to ensure optimal performance of the SRI-50. SRI-50 can be used by both rheumatologists and trainees and performs equally well in trained as well as untrained rheumatologists.


Assuntos
Lúpus Eritematoso Sistêmico/diagnóstico , Adulto , Argentina , Canadá , Estudos Transversais , Feminino , Humanos , Lúpus Eritematoso Sistêmico/fisiopatologia , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Medição da Dor , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Reino Unido
20.
Curr Rheumatol Rep ; 12(4): 237-49, 2010 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-20461481

RESUMO

Although the survival rate for systemic lupus erythematosus (SLE) has improved dramatically during the past 50 years, the quality of life of patients afflicted with this disease remains poor. Currently existent measures of disease activity and damage in SLE do not capture the patient's perspective and health-related quality of life (HRQoL). Most studies in SLE pertaining to HRQoL are from developed Western societies, with only a few from others. These studies have been conducted predominantly in women and using the Medical Outcomes Survey Short Form 36, a generic HRQoL instrument that has been shown not to be sensitive to change in lupus. Existent lupus-specific HRQoL measures have not yet been used in SLE clinical trials. New HRQoL research tools are currently undergoing validation in different countries, languages, and cultural settings, which may help dissect the underlying role of socioeconomic status and specific disease-related features that impact SLE-related quality of life.


Assuntos
Comparação Transcultural , Nível de Saúde , Lúpus Eritematoso Sistêmico/etnologia , Lúpus Eritematoso Sistêmico/psicologia , Qualidade de Vida , Ensaios Clínicos como Assunto , Feminino , Humanos , Masculino , Índice de Gravidade de Doença , Resultado do Tratamento
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