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Reumatol Clin ; 2018 Jul 24.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30054254


OBJECTIVE: To generate a quality standard for the management of patients with psoriatic arthritis (PsA). METHODS: We employed qualitative methodology that included: 1) Two focus groups (one with patients with PsA and another with non-rheumatologist specialists involved in the care of PsA patients); 2) A narrative literature review of published documents related to the quality of care in PsA; 3) A nominal group meeting in which 15 expert rheumatologists generated and reached a consensus on a series of quality criteria, as well as formulas or quantifiable objective measures to evaluate them; 4) The Delphi method to establish the feasibility, priority and agreement with the quality criteria; 5) A final generation of standards of care and their attributes. A descriptive analysis of the results was carried out. RESULTS: A total of 59 standards of care was generated, 18 of mandatory compliance, grouped into 4 blocks according to specific objectives: 1) early diagnosis (n=6); 2) optimizing the management of the disease (n=26); 3) multidisciplinary collaboration (n=9); 4) monitoring improvement (n=18). To assess compliance with these standards of care, in many cases, the medical records will be reviewed. Other sources will be the records of the service and hospital and bibliographic databases. Regarding the level of compliance, for some of the standards of care this is yes/no; for others, compliance ranges from 50% to 100% and, in this range, in many cases, compliance was 80%. CONCLUSIONS: This set of standards of care should help improve quality of care in PsA patients.

Semin Arthritis Rheum ; 46(1): 95-101, 2016 08.
Artigo em Inglês | MEDLINE | ID: mdl-27060872


OBJECTIVE: To assess the efficacy of golimumab (GLM) in refractory uveitis associated to spondyloarthritis (SpA). METHODS: Multicenter study of SpA-related uveitis refractory to at least 1 immunosuppressive drug. The main outcome variables were degree of anterior and posterior chamber inflammation, visual acuity, and macular thickness. RESULTS: A total of 15 patients (13 men/2 women; 18 affected eyes; mean age 39 ± 6 years) were evaluated. The underlying SpA subtypes were ankylosing spondylitis (n = 8), psoriatic arthritis (n = 6) and non-radiographic axial SpA (n = 1). The ocular involvement patterns were recurrent anterior uveitis in 8 patients and chronic anterior uveitis in 7. Before GLM they have received methotrexate (n = 13), sulfasalazine (n = 6), pulses of methylprednisolone (n = 4), azathioprine (n = 3), leflunomide (n = 2), and cyclosporine (n = 1). Overall, 10 of them had also been treated with TNF-α blockers; etanercept (n = 7), adalimumab (n = 7), infliximab (n = 6), and certolizumab (n = 1). GLM was given at the standard dose (50mg/sc/monthly) as monotherapy (n = 7) or in combination with conventional immunosuppressive drugs (n = 8), mainly methotrexate. Most patients had rapid and progressive improvement of intraocular inflammation parameters. The median number of cells in the anterior chamber at 2 years [0 (0-0)] was significantly reduced compared to baseline findings [1 (0-3); p = 0.04]. The mean best corrected visual acuity value also improved (0.84 ± 0.3 at 2 years versus 0.62 ± 0.3 at baseline; p = 0.03). Only minor side effects were observed after a mean follow-up of 23 ± 7 months. CONCLUSIONS: Our results indicate that GLM may be a useful therapeutic option in refractory SpA-related uveitis.

Anticorpos Monoclonais/uso terapêutico , Imunossupressores/uso terapêutico , Espondilartrite/complicações , Uveíte/tratamento farmacológico , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Uveíte/etiologia
Rev. esp. reumatol. (Ed. impr.) ; 28(5): 255-259, mayo 2001. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-2028


Objetivo: Investigar mediante radiología convencional la frecuencia de aparición de calcificaciones en los tendones de los músculos gastrocnemio y cuádriceps en la enfermedad por depósito de cristales de pirofosfato cálcico (EDCPC).Pacientes, material y método: Se estudiaron retrospectivamente los historiales clínicos de 100 pacientes diagnosticados de EDCPC (objetivación de cristales de pirofosfato en el líquido sinovial, junto con la presencia de condrocalcinosis radiológica). Se analizaron 6 áreas radiológicas: ligamento triangular del carpo, meniscos de la rodilla, cartílago hialino de los cóndilos femorales, sínfisis del pubis, tendones cuadricipitales y del gastrocnemio. La significación estadística de las asociaciones entre las distintas localizaciones de las calcificaciones se estableció mediante la prueba de 2 y la prueba exacta de Fisher. Se consideró significativa una p < 0,05.Resultados: Se evidenciaron calcificaciones en los tendones gastrocnemios en el 32 por ciento de pacientes y en los tendones cuadricipitales en el 15,6 por ciento de casos. Las calcificaciones en el tendón del gastrocnemio solamente se asociaban significativamente a la presencia de calcificaciones meniscales (p = 0,04). Únicamente tres pacientes presentaban calcificaciones en el tendón del gastrocnemio en ausencia de calcificaciones meniscales. Las calcificaciones en el tendón del cuádriceps no se asociaban significativamente con la presencia de calcificaciones en otras localizaciones. Solamente tres pacientes presentaban calcificaciones en el tendón del cuádriceps en ausencia de calcificaciones meniscalesConclusiones: Las calcificaciones en los tendones del gastrocnemio y del cuádriceps son frecuentes en la EDCPC. Ya que es excepcional que dichas calcificaciones aparezcan en ausencia de calcificaciones meniscales, su utilidad en el diagnóstico es limitada (AU)

Adulto , Idoso , Feminino , Masculino , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Humanos , Pirofosfato de Cálcio/efeitos adversos , Calcinose/induzido quimicamente , Músculo Esquelético , Tendões , Estudos Retrospectivos , Distribuição de Qui-Quadrado