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2.
Reumatol. clín. (Barc.) ; 19(3): 123-129, Mar. 2023. tab
Artigo em Inglês | IBECS | ID: ibc-217286

RESUMO

Background and objective: Periodontitis and rheumatoid arthritis (RA) have been associated in a bidirectional way. The objective of this study was to determine the association between clinical parameters of periodontitis and RA. Materials and methods: Seventy-five (75) participants distributed in 3 groups (21 patients with periodontitis without RA, 33 patients with periodontitis with RA and 21 patients with reduced periodontium with RA) were included in this cross-sectional study. A full periodontal and medical examination was performed in each patient. Additionally, subgingival plaque samples for the detection of Porphyromonas gingivalis (P. gingivalis) and blood samples for biochemical markers of RA were also taken. Logistic regression analysis adjusted for confounding variables, Spearman's rank correlation coefficient and a linear multivariate regression were used to analyze the data. Results: Patients with RA presented less severity of periodontal parameters. The highest levels of anti-citrullinated protein antibodies were detected in non-periodontitis patients with RA. Covariates such as age, P. gingivalis, diabetes, smoking, osteoporosis and use of medication were not associated with RA. All periodontal variables and P. gingivalis expressed a negative correlation with biochemical markers of RA (P<0.05). Conclusions: Periodontitis was not associated with RA. Furthermore, there was no correlation between periodontal clinical parameters and biochemical markers of RA.(AU)


Fundamento y objetivo: La periodontitis y la artritis reumatoide (AR) se han asociado de forma bidireccional. El objetivo de este estudio fue determinar la asociación entre parámetros clínicos de periodontitis y AR. Materiales y métodos: Setenta y cinco (75) participantes distribuidos en 3 grupos (21 pacientes con periodontitis sin AR, 33 pacientes con periodontitis con AR y 21 pacientes con periodonto reducido con AR) fueron incluidos en este estudio transversal. En cada paciente se realizó un examen médico y periodontal completo. Además, también se tomaron muestras de placa subgingival para la detección de Porphyromonas gingivalis(P. gingivalis) y muestras de sangre para marcadores bioquímicos de AR. Para analizar los datos se utilizó el análisis de regresión logística ajustado por variables de confusión, el coeficiente de correlación de rangos de Spearman y una regresión lineal multivariada. Resultados: Los pacientes con AR presentaron menor severidad de los parámetros periodontales. Los niveles más altos de anticuerpos antiproteína citrulinada se detectaron en pacientes con AR sin periodontitis. Las covariables como la edad, P. gingivalis, diabetes, tabaquismo, osteoporosis y uso de medicamentos no se asociaron con la AR. Todas las variables periodontales y P. gingivalis expresaron una correlación negativa con los marcadores bioquímicos de AR (p<0,05). Conclusiones: La periodontitis no se asoció con la AR. Además, no hubo correlación entre los parámetros clínicos periodontales y los marcadores bioquímicos de la AR.(AU)


Assuntos
Humanos , Periodontite , Artrite Reumatoide , Proteína C-Reativa , Porphyromonas gingivalis , Coleta de Amostras Sanguíneas , Reumatologia , Estudos Transversais
3.
Reumatol. clín. (Barc.) ; 19(3): 130-135, Mar. 2023. ilus, tab, graf
Artigo em Inglês | IBECS | ID: ibc-217287

RESUMO

Background and objective: Familial Mediterranean fever (FMF) and systemic lupus erythematosus (SLE) are autosomal recessive auto-inflammatory diseases, triggered by FMF-associated gene mutations and auto-antigens. The literature on the co-occurrence of these two disorders is limited to case reports and their correlation is considered rare. We investigated the proportion of FMF among SLE patients when compared with a healthy adult cohort in South Asia. Methods: For this observational study, data from our institutional database were collected for the patients diagnosed with SLE. The control group was randomly selected from the database and were age- matched for SLE. The overall proportion of FMF among patients with and without SLE was considered. Student's t-test, Chi-square, and ANOVA were used for univariate analysis. Results: The study population included 3623 SLE patients and 14,492 controls. In the SLE group, there was a significantly higher proportion of FMF patients compared with the non-SLE group (1.29% vs. 0.79% respectively; p=0.015). SLE was prevalent in Pashtun's (50%) in the middle socioeconomic group while FMF was dominant in Punjabi's and Sindhi's (53%) in the low socioeconomic class. Conclusion: This investigation demonstrates that FMF is more prevalent in a South-Asian population cohort of SLE patients.(AU)


Antecedentes y objetivo: La fiebre mediterránea familiar (FMF) y el lupus eritematoso sistémico (LES) son enfermedades autoinflamatorias autosómicas recesivas, desencadenadas por mutaciones genéticas asociadas a la FMF y autoantígenos. La literatura sobre la coexistencia de estos dos trastornos se limita a informes de casos y su correlación se considera rara. Investigamos la proporción de FMF entre pacientes con LES en comparación con una cohorte de adultos sanos en el sudeste asiático. Métodos: Para este estudio observacional se recolectaron datos de nuestra base de datos institucional para los pacientes diagnosticados con LES. El grupo control se seleccionó al azar de la base de datos y se emparejaron por edad y sexo para LES. Se consideró la proporción global de FMF entre pacientes con y sin LES. Se utilizaron la prueba t de Student, χ2 y ANOVA para el análisis univariado. Resultados: La población de estudio incluyó a 3.623 pacientes con LES y 14.492 controles. En el grupo de LES, hubo una proporción significativamente mayor de pacientes con FMF en comparación con el grupo sin LES (1,29 vs. 0,79%, respectivamente; p=0,015). LES prevaleció en la región pastún (50%) en el grupo socioeconómico medio, mientras que FMF fue dominante en Punyab y Sind (53%) en la clase socioeconómica baja. Conclusión: Esta investigación demuestra que la FMF es más frecuente en una cohorte de pacientes con LES del sudeste asiático.(AU)


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Lúpus Eritematoso Sistêmico , Febre Familiar do Mediterrâneo , Doenças Hereditárias Autoinflamatórias , Doenças Reumáticas , Ásia Oriental , Reumatologia , Estudos de Casos e Controles
4.
Reumatol. clín. (Barc.) ; 19(3): 136-142, Mar. 2023. ilus, tab, graf
Artigo em Inglês | IBECS | ID: ibc-217288

RESUMO

Background: Ankylosing spondylitis is a chronic inflammatory disease that is associated with adverse cardiovascular events. This study aimed to determine the relationship between ankylosing spondylitis and the risk of stroke. Methods: A systematic literature search in PubMed/MEDLINE, Scopus, and Web of Science were conducted from inception to December 2021 to identify relevant articles investigating the risk of stroke in patients with ankylosing spondylitis. A random-effects model (DerSimonian and Laird) was used to estimate a pooled hazard ratio (HR) and 95% confidence intervals (CI). Meta-regression based on the length of follow-up and subgroup analysis based on the type of stroke, study location, and year of publication to investigate the source of heterogeneity. Results: A total of eleven studies comprising 1.7 million participants were included in this study. Pooled analysis showed a significantly increased stroke risk (56%) among patients with ankylosing spondylitis (HR: 1.56, 95% CI 1.33–1.79). Subgroup analysis revealed a higher risk of ischemic stroke among patients with ankylosing spondylitis (HR: 1.46, 95% CI: 1.23–1.68). However, meta-regression analysis showed no association between the duration of ankylosing spondylitis and stroke incidence (Coef=−0.0010, P=0.951). Conclusion: This study reveals that ankylosing spondylitis was associated with an increased risk of suffering a stroke. Management of cerebrovascular risk factors and the control of systemic inflammation should be considered in patients with ankylosing spondylitis.(AU)


Antecedentes: La espondilitis anquilosante es una enfermedad inflamatoria crónica que se asocia con eventos cardiovasculares adversos. Este estudio tuvo como objetivo determinar la relación entre la espondilitis anquilosante y el riesgo de accidente cerebrovascular. Métodos: Se realizó una búsqueda sistemática de la literatura en PubMed/Medline, Scopus y Web of Science a partir de diciembre de 2021 para identificar los artículos relevantes que investigan el riesgo de accidente cerebrovascular en pacientes con espondilitis anquilosante. Se usó un modelo de efectos aleatorios (Dersimonian y Laird) para estimar una relación de peligro agrupada (HR) e intervalos de confianza (IC) del 95%. Meta-regresión basada en la duración del seguimiento y análisis de subgrupos basados en el tipo de accidente cerebrovascular, la ubicación de estudio y año de publicación para investigar la fuente de heterogeneidad. Resultados: Un total de 11 estudios que comprenden 1,7 millones de participantes, se incluyeron en este estudio. El análisis agrupado mostró un riesgo de accidente cerebrovascular significativamente aumentado (56%) entre los pacientes con espondilitis anquilosante (HR: 1,56; IC 95%: 1,33-1,79). El análisis de los subgrupos reveló un mayor riesgo de accidente cerebrovascular isquémico entre los pacientes con espondilitis anquilosante (HR: 1,46; IC 95%: 1,23-1,68). Sin embargo, el análisis de meta-regresión no mostró ninguna asociación entre la duración de la espondilitis anquilosante y la incidencia de accidentes cerebrovasculares (coef=−0,0010; P=0,951). Conclusiones: Este estudio revela que la espondilitis anquilosante se asocia a un mayor riesgo de sufrir un accidente cerebrovascular. La gestión de los factores de riesgo cerebrovasculares y el control de la inflamación sistémica deben considerarse en pacientes con espondilitis anquilosante.(AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Acidente Vascular Cerebral , Fatores de Risco , Espondilite Anquilosante , Reumatologia
5.
Reumatol. clín. (Barc.) ; 19(3): 168-170, Mar. 2023. ilus
Artigo em Inglês | IBECS | ID: ibc-217291

RESUMO

The chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS) and autoimmune/inflammatory syndrome induced by adjuvants (ASIA) were described a decade ago. There are a limited number of reports and these diseases are still underdiagnosed.We presented a 35 years-old patient with clinical manifestations of cerebellum affection and enhancement in the MRI, with the influenza vaccine as the only triggering factor.Infectious diseases, malignancy, and additional systemic involvement were ruled out; therefore, on suspicion of CLIPPERS syndrome, the patient received corticosteroid therapy with an adequate response.The knowledge of CLIPPERS syndrome as an unusual ASIA presentation and high response to the corticosteroids may lead to a timely diagnosis, appropriate treatment, and follow up with better outcomes for patients.(AU)


La inflamación linfocítica crónica con realce perivascular pontino que responde a los esteroides (CLIPPERS) y el síndrome autoinmune/inflamatorio inducido por adyuvantes (ASIA) se describieron hace una década. Hay un número limitado de reportes y estas enfermedades aún están infra diagnosticadas.Presentamos un paciente de 35 años con cuadro clínico de afectación del cerebelo y realce en la RM, con la vacuna anti-influenza como único factor desencadenante.Se descartaron enfermedades infecciosas, malignidad y afectación sistémica, por lo tanto, ante sospecha de síndrome de CLIPPERS, recibió tratamiento con corticoesteroides con una respuesta adecuada.El conocimiento del síndrome de CLIPPERS como una presentación inusual de ASIA y su alta respuesta a los corticosteroides puede conducir a un diagnóstico oportuno, un tratamiento adecuado y un seguimiento con mejores resultados para los pacientes.(AU)


Assuntos
Humanos , Masculino , Adulto , Doenças do Sistema Nervoso , Vacinação/efeitos adversos , Vacinas contra Influenza/efeitos adversos , Corticosteroides , Cerebelo/lesões , Reumatologia , Doenças Reumáticas
6.
Reumatol. clín. (Barc.) ; 19(3): 159-167, Mar. 2023. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-217292

RESUMO

Antecedentes y objetivo: La artritis psoriásica (APs) es una enfermedad inflamatoria crónica mediada por el sistema inmune que afecta al sistema musculoesquelético y la piel, y se manifiesta de forma heterogénea y con un curso variable. En la práctica clínica habitual se ha observado variabilidad y limitaciones en su seguimiento. El objetivo del proyecto CREA fue consensuar estrategias de mejora para la valoración inicial y el seguimiento de los pacientes con APs en España. Materiales y métodos: Se realizó una encuesta a una muestra representativa de reumatólogos expertos del territorio español, que contenía 33 preguntas sobre la práctica clínica habitual, los recursos disponibles y las limitaciones actuales en el seguimiento de los pacientes con APs. Se discutieron los resultados en reuniones regionales y se propusieron 105 estrategias que, finalmente, fueron valoradas por 85 expertos en un consenso Delphi. Resultados: Las limitaciones destacadas en el seguimiento de la APs fueron la falta de tiempo en consulta, de personal de enfermería, y el retraso en la realización de pruebas de imagen. Se propusieron 108 estrategias relacionadas con la evaluación de los índices de calidad de vida e impacto de la enfermedad; las comorbilidades y las manifestaciones extraarticulares; las pruebas de laboratorio; las pruebas de imagen; la exploración física y metrología y los índices de actividad y función. Entre todas, 53 se consideraron altamente aconsejables, sin diferencias regionales en los valores de consenso. Discusión y conclusiones: Las propuestas ofrecidas en el estudio actual son aplicables a todo el territorio nacional, responden a las necesidades no cubiertas detectadas en la encuesta inicial, conforman un cuadro de actuación mínimo y aseguran un seguimiento óptimo de los pacientes con APs.(AU)


Background and aim: Psoriatic arthritis (PsA) is a chronic immune-mediated inflammatory disease that affects the musculoskeletal system and skin, and manifests heterogeneously, with a variable course. In current clinical practice, variability and limitations in its follow-up have been observed. The aim of the CREA project was to agree on strategies to improve the initial assessment and follow-up of patients with PsA in Spain. Materials and methods: A survey was conducted among a representative sample of expert rheumatologists in Spain, containing 33 questions on current clinical practice, available resources, and current limitations in the follow-up of patients with PsA. The results were discussed in regional meetings and 105 strategies were proposed and finally evaluated by 85 experts in a Delphi consensus. Results: The most important limitations in the follow-up of PsA were lack of consultation time, lack of nursing staff, and delays in performing imaging tests. A total of 108 strategies were proposed related to the assessment of quality of life and disease-impact indices; comorbidities and extra-articular manifestations; laboratory tests; imaging tests; physical examination and metrology; and activity and function indices. Of the total, 53 were considered highly advisable, with no regional differences in consensus values. Discussion and conclusions: The proposals offered in the current study are applicable to the entire country, respond to the unmet needs detected in the initial survey, form a minimum action framework, and ensure optimal follow-up of patients with PsA.(AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Gerenciamento Clínico , Artrite Psoriásica , Sistema Musculoesquelético , Reumatologistas , Espondilartrite , Recursos em Saúde , Espanha , Inquéritos e Questionários , Reumatologia
10.
Pediatr Rheumatol Online J ; 21(1): 24, 2023 Mar 14.
Artigo em Inglês | MEDLINE | ID: mdl-36918902

RESUMO

BACKGROUND: Despite guidelines, poor access to appropriate care for juvenile idiopathic arthritis (JIA) patients remains a global issue. Prompt referral to a pediatric rheumatology (PR) center and effective care is known to be critical for changing the natural history of the disease and improving long-term prognosis. This project assesses socio-economic factors of delayed referral to a pediatric rheumatologist (PRst) for JIA patients in France and Switzerland within the Juvenile Inflammatory Rheumatism (JIR) Cohort. METHODS: All patients diagnosed with JIA, presenting at one center of the JIRcohort in France or Switzerland with additional data on referral pathway were included. Patient characteristics at first visit to the PR center, dates of visits to healthcare providers during referral, and parent characteristics were extracted from the JIRcohort database. RESULTS: Two hundred fifty children were included. The overall median time to first PR assessment was 2.4 months [1.3; 6.9] and ranged widely across the JIA subtypes, from 1.4 months [0.6; 3.8] for children with systemic juvenile idiopathic arthritis (sJIA) to 5.3 months [2.0; 19.1] for children with enthesitis-related arthritis (ERA). A diagnosis of ERA and an appointment with an orthopedist during the referral pathway were significantly associated with a longer time before the first PR visit (hazard ratio HR 0.50 [95% CI: 0.29; 0.84]) and HR 0.68 [95% CI: 0.49; 0.93], respectively) in multivariable analysis. Having a mother with a post-graduate educational attainment level was tendentially associated with a shorter time before the first PR visit, (HR 1.32 [95% CI: 0.99; 1.78]). CONCLUSIONS: Time to first PRst visit was most often short compared to other studies and close to the British recommendations. However, this time remained too long for many patients. We observed no social inequities in access to a PRst, but we show the need to improve effective pathway and access to a PR center for JIA patients.


Assuntos
Artrite Juvenil , Febre Reumática , Tempo para o Tratamento , Criança , Humanos , Artrite Juvenil/terapia , Artrite Juvenil/diagnóstico , Estudos de Coortes , Prognóstico , Reumatologia , Acesso aos Serviços de Saúde , Fatores Socioeconômicos , França , Suíça , Masculino , Feminino , Pré-Escolar , Características de Residência
11.
Turk J Med Sci ; 53(1): 193-198, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36945955

RESUMO

BACKGROUND: Antinuclear antibody (ANA) is among the most frequently ordered tests in paediatric rheumatology setting. Diseases like systemic lupus erythematosus and Sjögren syndrome is closely related with a positive ANA and classified as ANA associated diseases. Besides, ANA test is ordered in patients with juvenile idiopathic arthritis (JIA) to assess the risk for uveitis and a positive ANA could be detected in children with nonrheumaticrheumatic conditions. In this study, we aimed to investigate frequency of positive ANA in paediatric rheumatology setting and the association of immunofluorescence staining patterns and titres of ANA with rheumatic diseases. METHODS: : Immunofluorescence staining patterns, and titres of the ANA and diagnoses of children who tested for ANA between January 2016 and December 2021 were retrospectively analysed. RESULTS: Among 2477 patients with ANA tested, 28.1% had a positive ANA result. Among them, 39.2% had a diagnosis of a rheumatic disease. Most common rheumatic diagnosis was JIA (43.8%) and ANA associated diseases were observed in 24.5% of the patients with a rheumatic diagnosis. While ANA associated diseases had significantly more frequent homogenous staining, dense fine speckled pattern was significantly more common in children with nonrheumatic diagnoses. Despite ANA associated diseases was found to be significantly associated with higher titres, no difference was observed between patients with JIA and nonrheumatic conditions. DISCUSSION: Our study showed that the majority of children with a positive ANA test were not diagnosed with a rheumatic disease. While titres and patterns of ANA were found to be important in diagnosis of rheumatic diseases, ordering ANA test with solid indications might give improved probability of rheumatic diagnoses in children with a positive test.


Assuntos
Artrite Juvenil , Doenças Reumáticas , Reumatologia , Criança , Humanos , Anticorpos Antinucleares , Estudos Retrospectivos , Artrite Juvenil/diagnóstico , Doenças Reumáticas/diagnóstico , Imunofluorescência
12.
Adv Rheumatol ; 63(1): 12, 2023 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-36922853

RESUMO

Clinical practice guidelines (CPG) are developed to align standards of health care around the world, aiming to reduce the incidence of misconducts and enabling more effective use of health resources. Considering the complexity, cost, and time involved in formulating CPG, strategies should be used to facilitate and guide authors through each step of this process. The main objective of this document is to present a methodological guide prepared by the Epidemiology Committee of the Brazilian Society of Rheumatology for the elaboration of CPG in rheumatology. Through an extensive review of the literature, this study compiles the main practical recommendations regarding the following steps of CPG drafting: distribution of working groups, development of the research question, search, identification and selection of relevant studies, evidence synthesis and quality assessment of the body of evidence, the Delphi methodology for consensus achievement, presentation and dissemination of the recommendations, CPG quality assessment and updating. This methodological guide serves as an important tool for rheumatologists to develop reliable and high-quality CPG, standardizing clinical practices worldwide.


Assuntos
Reumatologia , Humanos , Brasil , Consenso
13.
RMD Open ; 9(1)2023 03.
Artigo em Inglês | MEDLINE | ID: mdl-36868782

RESUMO

OBJECTIVE: To describe demographic, clinical and laboratory features of systemic sclerosis sine scleroderma (ssSSc) in a large multicentre systemic sclerosis (SSc) cohort. METHODS: Data involving 1808 SSc patients from Italian Systemic sclerosis PRogression INvestiGation registry were collected. The ssSSc was defined by the absence of any cutaneous sclerosis and/or puffy fingers. Clinical and serological features of ssSSc were compared with limited cutaneous (lcSSc) and diffuse cutaneous (dcSSc) subsets. RESULTS: Among patients with SSc, only 61 (3.4%) were classified as having ssSSc (F/M=19/1). Time from Raynaud's phenomenon (RP) onset to diagnosis was longer in ssSSc (3 years, IQR 1-16.5) than lcSSc (2 years, IQR 0-7), and dcSSc (1 year, IQR 0-3) (p<0.001). Clinical ssSSc phenotype was comparable to lcSSc, except for digital pitting scars (DPS) (19.7% vs 42%, p=0.01), but significantly milder than dcSSc, particularly for digital ulcers (DU) (6.6% vs 35.7%, p<0.001), oesophagus (46.2% vs 63.5%, p=0.009), lung (mean diffusion capacity for carbon monoxide 72.2±19.6 vs 62.4±22.8, p=0.009; mean forced vital capacity 105.6±21.7 vs 89.2±20.9, p<0.001) and major videocapillaroscopic alterations (late pattern 8.6% vs 47.6%, p<0.001). Moreover, in ssSSc the percentages of anticentromere and antitopoisomerase were comparable to lcSSc (40% and 18.3% vs 36.7% and 26.6%), but divergent respect to dcSSc (8.6% and 67.4%, p<0.001). CONCLUSION: The ssSSc is a quite rare disease variant characterised by clinico-serological features comparable to lcSSc, but significantly different from dcSSc. Overall, longer RP duration, low percentages of DPS and peripheral microvascular abnormalities, and increased anti-centromere seropositivity distinguish ssSSc. Further investigations based on national registries might provide useful insights on the actual relevance of the ssSSc within the scleroderma spectrum.


Assuntos
Doenças Autoimunes , Reumatologia , Escleroderma Sistêmico , Humanos , Estações do Ano
14.
J Clin Rheumatol ; 29(3): 165-169, 2023 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-36959199

RESUMO

ABSTRACT: Telemedicine is the delivery of health care services by health care professionals using information and communication technologies to exchange valid information for the diagnosis, treatment, and prevention of diseases. Telemedicine was further developed in Latin America during the COVID-19 (coronavirus disease 2019) pandemic, becoming the first line of defense for health professionals to stop the spread of infections and allow them to continue the care of their patients. During the pandemic, 79% of rheumatologists in Latin America reported the use of remote communication, the most frequent being the use of phone calls and WhatsApp voice messages. In contrast, 84% of the patients reported that telemedicine was appropriate for them during the pandemic, but only 54% considered telemedicine to be a valid option for rheumatic health care after the pandemic. Telemedicine and telehealth have advantages such as lower costs, improved access in rural areas, shortage of care providers, and reduction in waiting time for appointments. However, it also has some challenges, such as legal, technological, and organizational barriers. In this review, we explore the current state of telemedicine in Latin America and discuss its future.


Assuntos
COVID-19 , Reumatologia , Telemedicina , Humanos , América Latina/epidemiologia , SARS-CoV-2
15.
Reumatol. clín. (Barc.) ; 19(2): 63-66, Feb. 2023. tab
Artigo em Inglês | IBECS | ID: ibc-215746

RESUMO

Objective: To identify differential features between patients with seropositive and seronegative rheumatoid arthritis (RA). Method: Prospective cohort study, including patients who were admitted for polyarthralgia. At baseline was performed: laboratory studies, X-rays of hands and feet, ultrasound of both hands with power Doppler technique, clinical data and clinimetry. In subsequent visits the definitive diagnosis of RA was established or not. It was considered as seronegative RA when patients were negative for both RF and ACPAs. Results: 746 patients were included, of which 128 (17.1%) ended with a final diagnosis of RA. Of these 128 patients, 87 (67.9%) were seropositive RA, while 41 (32%) were seronegative RA. The only feature that showed significant differences was the presence of tenosynovitis detected by ultrasound with a positive power Doppler signal, 13.7% of the patients with seropositive RA vs 41.6% of the patients with seronegative RA (p=0.0028). Conclusion: The only differential feature of patients with seronegative RA was the higher proportion of tenosynovitis detected by ultrasound.(AU)


Objetivo: Identificar características diferenciales entre pacientes con artritis reumatoide (AR) seropositivos y seronegativos. Método: Estudio de cohorte prospectivo, incluyendo pacientes con poliartralgias. Al inicio se realizó: estudios de laboratorio, radiografías de manos y pies, ecografía de ambas manos con técnica power doppler, datos clínicos y clinimetría. En visitas posteriores se estableció o no el diagnóstico definitivo de AR. Se consideró AR seronegativa cuando los pacientes eran negativos tanto para factor reumatoide como para anticuerpos antipéptido cíclico citrulinado. Resultados: Se incluyeron 746 pacientes, de los cuales 128 (17,1%) terminaron con diagnóstico final de AR. De estos 128 pacientes, 87 (67,9%) eran AR seropositivos, mientras que 41 (32%) eran AR seronegativos.La única característica que mostró diferencias significativas fue la presencia de tenosinovitis detectada por ecografía con señal power doppler positiva, el 13,7% de los pacientes con AR seropositiva frente al 41,6% de los pacientes con AR seronegativa (p=0,0028). Conclusión: El único rasgo diferencial de los pacientes con AR seronegativa fue la mayor proporción de tenosinovitis detectadas por ecografía.(AU)


Assuntos
Humanos , Masculino , Feminino , Tenossinovite , Artrite Reumatoide , Fator Reumatoide , Anticorpos Antiproteína Citrulinada , Ultrassonografia , Radiografia , Reumatologia , Estudos de Coortes , Estudos Prospectivos
16.
Reumatol. clín. (Barc.) ; 19(2): 67-73, Feb. 2023. tab, ilus
Artigo em Inglês | IBECS | ID: ibc-215747

RESUMO

Background: Rheumatological manifestations following COVID-19 are various, including Reactive Arthritis (ReA), which is a form of asymmetric oligoarthritis mainly involving the lower limbs, with or without extra-articular features. The current case series describes the clinical profile and treatment outcome of 23 patients with post-COVID-19 ReA. Methods: A retrospective, observational study of patients with post-COVID-19 arthritis over one year was conducted at a tertiary care centre in India. Patients (n=23) with either a positive polymerase chain reaction test for SARS-CoV2 or an anti-COVID-19 antibody test were included. Available demographic details, musculoskeletal symptoms, inflammatory markers, and treatment given were documented. Results: Sixteen out of 23 patients were female. The mean age of the patients was 42.8 years. Nineteen patients had had symptomatic COVID-19 infection in the past. The duration between onset of COVID-19 symptoms and arthritis ranged from 5 to 52 days with a mean of 25.9 days. The knee was the most involved joint (16 out of 23 cases). Seven patients had inflammatory lower back pain and nine had enthesitis. Most patients were treated with non-steroidal anti-inflammatory drugs (NSAIDs) and steroids – either depot injection or a short oral course. Three patients required treatment with hydroxychloroquine and methotrexate which were eventually stopped. No relapse was reported in any of the patients. Conclusion: On combining our data with 21 other case reports of ReA, a lower limb predominant, oligoarticular, asymmetric pattern of arthritis was seen with a female preponderance. The mean number of joints involved was 2.8. Axial symptoms and enthesitis were often coexistent. Treatment with NSAIDs and intra-articular steroids was effective. However, whether COVID-19 was the definitive aetiology of the arthritis is yet to be proven.(AU)


Antecedentes: Las manifestaciones reumatológicas posteriores al COVID-19 son diversas, entre ellas, la artritis reactiva, que es una forma de oligoartritis asimétrica que afecta principalmente a los miembros inferiores, con o sin características extraarticulares. La serie de casos actual describe el perfil clínico y el resultado del tratamiento de 23 pacientes con artritis reactiva posterior a COVID-19. Métodos: Se realizó un estudio observacional retrospectivo de pacientes con artritis post-COVID-19 durante un año en un centro de atención terciaria en India. Se incluyeron pacientes (n=23) con una prueba de reacción en cadena de la polimerasa positiva para SARS-CoV-2 o una prueba de anticuerpos anti-COVID-19. Se documentaron los detalles demográficos disponibles, los síntomas musculoesqueléticos, los marcadores inflamatorios y el tratamiento administrado. Resultados: Dieciséis de los 23 pacientes eran mujeres. La edad media de los pacientes fue de 42,8 años. Diecinueve pacientes habían tenido infección sintomática por COVID-19 en el pasado. La duración entre el inicio de los síntomas de COVID-19 y la artritis osciló entre 5 y 52 días, con una media de 25,9 días. La rodilla fue la articulación más comúnmente involucrada (16 de 23 casos). Siete pacientes tenían dolor lumbar inflamatorio y 9 tenían entesitis. La mayoría de los pacientes fueron tratados con medicamentos antiinflamatorios no esteroideos y esteroides, ya fuera una inyección de depósito o un ciclo oral corto. Tres pacientes requirieron tratamiento con hidroxicloroquina y metotrexato, que finalmente se suspendieron. No se reportaron recaídas en ninguno de los pacientes. Conclusión: Al combinar nuestros datos con otros 21 informes de casos de artritis reactiva, se observó un patrón de artritis oligoarticular asimétrico predominante en las extremidades inferiores con predominio femenino.(AU)


Assuntos
Humanos , Masculino , Feminino , Infecções por Coronavirus , Coronavírus Relacionado à Síndrome Respiratória Aguda Grave , Artrite , Artrite Reativa , Atenção Terciária à Saúde , Reumatologia , Estudos Retrospectivos , Índia , 29161
17.
Reumatol. clín. (Barc.) ; 19(2): 74-81, Feb. 2023. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-215748

RESUMO

Objetivo: Elaborar una propuesta multidisciplinar de criterios de cribado de enfermedad pulmonar intersticial difusa (EPID) en pacientes con artritis reumatoide (AR) y, a la inversa, que sirvan de referencia en la derivación entre los servicios de Reumatología y Neumología para la detección precoz de estos pacientes. Métodos: Se revisó de forma sistemática la literatura sobre factores de riesgo para el desarrollo de EPID en la AR, la utilidad de los distintos métodos diagnósticos para su identificación en pacientes con AR y las diferentes propuestas de criterios de derivación a Reumatología por sospecha de AR precoz. Basándose en la evidencia disponible y en su experiencia clínica, un comité científico formado por dos reumatólogos y dos neumólogos propuso unos criterios de cribado que fueron evaluados mediante el método Delphi por un panel de siete neumólogos y siete reumatólogos. Todos los participantes eran expertos en esta patología. Resultados: Se han elaborado unos criterios para el cribado de EPID en pacientes diagnosticados de AR, y unos criterios para la detección precoz de AR en casos de EPID de causa no filiada. Se incluyen también propuestas sobre las pruebas complementarias a realizar en los diferentes escenarios clínicos considerados y sobre la periodicidad con la que debe repetirse el cribado. Conclusiones: Se propone por primera vez una estrategia de cribado selectivo para el diagnóstico precoz de los pacientes con EPID-AR. Esta propuesta pretende resolver algunos interrogantes clínicos habituales y facilitar la toma de decisiones. Los criterios propuestos deben ser evaluados en futuros estudios de validación.(AU)


Objective: To develop a joint proposal for screening criteria of interstitial lung disease (ILD) in patients with rheumatoid arthritis (RA) and vice versa, which serves as a guidelines in patient referral between the Rheumatology and Pneumology departments to early detection of these patients. Methods: A systematic literature review was carried out on the risk factors for the development of ILD in RA patients, and for the referral criteria to Rheumatology for suspected early RA. Based on the available evidence, screening criteria were agreed using the Delphi method by a panel of pneumologists and rheumatologists with expertise in these pathologies. Results: Screening criteria for ILD in patients with RA and for the early detection of RA in cases with ILD of unknown etiology have been developed. In both cases, a detection strategy was based on clinical risk factors. Recommendations also included the complementary tests to be carried out in the different clinical scenarios and on the periodicity that screening should be repeated. Conclusion: A selective screening strategy is recommended for the first time in the early diagnosis of patients with ILD-RA. This multidisciplinary proposal aims to solve some common clinical questions and help decision-making, although its usefulness to identify these patients with good sensitivity must be confirmed in a validation study.(AU)


Assuntos
Humanos , Masculino , Feminino , Pneumopatias , Prova Pericial , Programas de Rastreamento , Pesquisa Interdisciplinar , Artrite Reumatoide , Pneumologia , Diagnóstico Precoce , Estratégias de eSaúde , Reumatologia , Doenças Reumáticas
18.
Reumatol. clín. (Barc.) ; 19(2): 82-89, Feb. 2023. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-215749

RESUMO

Antecedentes y objetivo: La espondiloartritis axial (EspAax) es una enfermedad musculoesquelética con manifestaciones diversas. En la práctica clínica se ha observado variabilidad y limitaciones en la recogida de las variables necesarias para su seguimiento. El objetivo del proyecto CREA fue consensuar estrategias de mejora para la valoración inicial y el seguimiento de los pacientes con EspAax en España. Materiales y métodos: Se realizó una encuesta con 33 preguntas a una muestra representativa de reumatólogos expertos del territorio español sobre la práctica clínica, los recursos y las limitaciones actuales en el seguimiento de los pacientes con EspAax. En 10 reuniones regionales se discutieron los resultados de la encuesta y se propusieron 107 estrategias que fueron valoradas mediante un consenso Delphi en el que participaron 85 expertos. Resultados: La falta de tiempo en consulta, de personal de enfermería y/o de apoyo, y el retraso en la realización de pruebas de imagen fueron las limitaciones más destacadas en el seguimiento de los pacientes con EspAax. Se propusieron 202 estrategias relacionadas con la evaluación de los índices de calidad de vida e impacto de la enfermedad; las comorbilidades y manifestaciones extraarticulares; las pruebas de laboratorio; las pruebas de imagen; la exploración física y metrología; y los índices de actividad y función. De todas, 54 se consideraron altamente aconsejables. No se encontraron diferencias regionales en los valores de consenso. Conclusiones: Las propuestas consensuadas como altamente aconsejables en el estudio actual son aplicables a todo el territorio nacional, permiten realizar un seguimiento y control más estrecho y homogéneo de los pacientes con EspAax, facilitar un manejo integral y responden a las necesidades no cubiertas detectadas en la encuesta inicial.(AU)


Background and objective: Axial spondyloarthritis (axSpA) are musculoskeletal diseases with different manifestations. In clinical practice, variability, and limitations in the collection of the outcomes required for follow-up have been observed. The objective of the CREA project was to agree on improvement strategies for the initial assessment and follow-up of patients with axSpA in Spain. Materials and methods: A survey with 33 questions was conducted by a representative sample of rheumatologists on clinical practice, resources, and present limitations in the follow-up of patients with axSpA. The results of the survey were discussed in 10 regional meetings, and 105 strategies were proposed and evaluated through a Delphi consensus in which 85 experts participated. Results: The lack of time for clinical visits, the lack of nurses and/or support staff and the delay in performing the imaging tests were the most prominent limitations in the follow-up of patients with axSpA. One hundred and five strategies were proposed related to the evaluation of disease activity, physical function, quality of life and disease impact, to the evaluation of comorbidities and extra-articular manifestations, laboratory tests; imaging tests, physical examination and metrology. Of the total, 85 were considered highly advisable. No regional differences were found. Conclusions: The proposals agreed upon as highly advisable in the present study are applicable to the entire national territory, allow tighter and more homogeneous monitoring of the patients with axSpA, facilitate more comprehensive management of the disease, and respond to the unmet needs detected in the initial survey.(AU)


Assuntos
Humanos , Masculino , Feminino , Estratégias de eSaúde , Espondilartrite/diagnóstico , Espondilartrite/prevenção & controle , Espondilartrite/terapia , Doenças Musculoesqueléticas , Prova Pericial , Reumatologia , Doenças Reumáticas , Inquéritos e Questionários , Espanha
19.
Reumatol. clín. (Barc.) ; 19(2): 90-98, Feb. 2023. tab, ilus
Artigo em Inglês | IBECS | ID: ibc-215750

RESUMO

Introduction and objectives: To determine the disease burden and costs in patients with hip or knee OA and chronic moderate-to-severe refractory pain, receiving strong opioids in Spain. Materials and methods: This was a 36-month longitudinal secondary analysis of the real-word OPIOIDS study. Patients aged ≥18 years with hip or knee OA and chronic moderate-to-severe refractory pain receiving strong opioids were considered. The disease burden included analgesia assessments (NRS scale), cognitive functioning (MMSE scale), basic activities of daily living (Barthel index), and comorbidities (severity and frequency). Costs due to the use of healthcare resources and productivity loss were estimated. Results: 2832 patients were analyzed; age was 72.0 years (SD=14.3), 76.8% were women. Patients had mainly been treated with fentanyl (n=979; 37.6%), tapentadol (n=625; 24.0%), oxycodone (n=572; 22.0%), and buprenorphine (n=425; 16.3%). Pain intensity decreased by 1 point (13.7%), with a 2.6-point decline in the cognitive scale (14.3%, with a 5.3%-increase in patients with cognitive deficit) over a mean treatment period of 384.6 days (SD: 378.8). Barthel scores decreased significantly yielding to a slightly increase in proportion of patients with severe-to-total dependency; 1.2%–2.9%. In the first year of treatment, average healthcare costs were €2013/patient, whereas the average productivity loss cost was €12,227/working-active patient. Discussion and conclusions: Strong opioids resulted in high healthcare costs with a limited reduction in pain, an increase in cognitive deficit, and a slight increase of patients with severe to total dependency over 36 months of treatment.(AU)


Introducción y objetivos: Determinar la carga de la enfermedad y los costes en pacientes con osteoartritis de cadera y rodilla y dolor crónico refractario moderado-severo, en tratamiento con opioides mayores en España. Materiales y métodos: Se trata de un subanálisis de 36 meses de duración, procedente del estudio observacional OPIOIDS. Participaron pacientes con una edad ≥18 años, diagnosticados con osteoartritis de cadera y rodilla y dolor crónico refractario moderado-severo, en tratamiento con opioides mayores. La carga de la enfermedad incluyó la evaluación de la analgesia (escala NRS), del funcionamiento cognitivo (escala MMSE), de la capacidad para realizar las actividades de la vida diaria (índice de Barthel) y de las comorbilidades (gravedad y frecuencia). También se estimaron los costes asociados al uso de recursos sanitarios y a la productividad laboral. Resultados: Se analizaron 2.832 pacientes (edad: 72,0 años [DE: 14,3]; mujeres: 76,8%), que habían sido principalmente tratados con fentanilo (n=979; 37,6%), tapentadol (n=625; 24,0%), oxicodona (n=572; 22,0%) y buprenorfina (n=425; 16,3%). La intensidad del dolor disminuyó una unidad (13,7%), con una reducción de 2,6 unidades en la escala cognitiva (14,3% y aumento del 5,3% en los pacientes con déficit cognitivo) durante una media de 384,6 días (DE: 378,8). Las puntuaciones en la escala de Barthel disminuyeron significativamente, con un ligero aumento en la proporción de pacientes con dependencia grave/total, entre 1,2% y 2,9%. En el primer año, los costes sanitarios medios fueron 2.013€/paciente, mientras que los costes medios de pérdida de productividad fueron 12.227€/trabajador. Discusión y conclusiones: El tratamiento con opioides mayores durante 36 meses implicó elevados costes sanitarios, con una eficacia analgésica limitada, un aumento del déficit cognitivo y un ligero aumento de los pacientes con dependencia grave/total.(AU)


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Dor Crônica , Osteoartrite do Quadril , Osteoartrite do Joelho , Analgésicos Opioides , Custos de Cuidados de Saúde , Efeitos Psicossociais da Doença , Espanha , Reumatologia , Doenças Reumáticas
20.
Reumatol. clín. (Barc.) ; 19(2): 114-116, Feb. 2023. ilus
Artigo em Inglês | IBECS | ID: ibc-215752

RESUMO

Introduction: Cases of acute myocarditis have been after administration of the BNT162b2 and Ad26.COV2.S vaccine. Objective: Describe another possible mechanism of myocarditis after COVID-19 vaccination. Case presentation: We describe the clinical case of a 72-year-old female with pleuritic chest pain one week after the third of the BNT162b2 mRNA vaccine. Serological tests for cardiotropic pathogens were negative, and autoimmunity screening was positive with anti-nuclear antibody (ANA) in 1:160 dilution, Anti-double-stranded DNA (anti-dsDNA), and anti-histone antibodies. 18F-fluoro-deoxy-glucose (FDG) positron emission tomography/computed tomography (PET/CT) showed a focal myocardial and pericardial inflammatory process in the cardiac apex. Results and discussion: Systemic lupus erythematosus (SLE) diagnosis was made with myocardial affection. As far as we know, this is the first report of a case of lupus myocarditis after the COVID-19 vaccine. Conclusion: Given the pathogenic rationales, the association between SLE and myocarditis should be considered.(AU)


Introducción: Se han presentado casos de miocarditis aguda tras la administración de las vacunas BNT162b2 y Ad26.COV2.S. Objetivo: Describir otro posible mecanismo de miocarditis posterior a la vacunación contra el COVID-19. Presentación del caso: Describimos el caso clínico de una mujer de 72 años con dolor torácico pleurítico una semana después de la tercera vacuna de ARNm BNT162b2. Las pruebas serológicas para patógenos cardiotrópos fueron negativas y el cribado de autoinmunidad fue positivo con anticuerpos antinucleares (ANA) en dilución 1:160, anticuerpos anti-ADN de doble cadena (anti-dsADN) y antihistonas. La tomografía por emisión de positrones/tomografía computarizada (PET/TC) con 18F-fluorodesoxiglucosa (FDG) mostró un proceso inflamatorio miocárdico y pericárdico focal en el ápex cardíaco. Resultados y discusión: Se realizó el diagnóstico de lupus eritematoso sistémico (LES) con afectación miocárdica. Hasta donde sabemos, este es el primer reporte de un caso de miocarditis lúpica después de la vacuna contra el COVID-19. Conclusión: Dadas las justificaciones patogénicas, se debe considerar la asociación entre lupus eritematoso sistémico (LES) y miocarditis.(AU)


Assuntos
Humanos , Feminino , Idoso , Vacinação , Pandemias , Infecções por Coronavirus/epidemiologia , Miocardite , Lúpus Eritematoso Sistêmico , Reumatologia , Doenças Reumáticas
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