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1.
Medicine (Baltimore) ; 98(48): e18114, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770236

RESUMO

There is a paucity of succinct measures of physician satisfaction. As part of a Performance Improvement Project, we developed and piloted a simple questionnaire to determine rheumatologists satisfaction.Thirty 5 rheumatologists in the academic or private setting were sent opened-ended questions to determine the factors that made them satisfied or dissatisfied with respect to their rheumatology practice. From the responses we formed 14 questions 1 to 10 scale centering on satisfaction and dissatisfaction that was piloted in 30 rheumatologists and subsequently validated in 173 rheumatologists within the US and Latin America.Our combined sample included 173 rheumatologists (55 English and 118 Spanish-speaking respondents). The mean satisfaction for the combined sample was 6.92 (standard deviation=1.1, range 4.08-9.62). The strongest contributors to physician satisfaction were "Seeing interesting and challenging cases" (8.6 ±â€Š1.5) and "The ability to make a difference in patient's life" as well as "Establishing long term relationship with patients" (8.39 ±â€Š1.5). The strongest contributors to physician dissatisfaction were "Getting inappropriate referrals not in the scope of practice" (4.3 ±â€Š2.13) and "Time spent on documentation" (4.5 ±â€Š2.59). The scale had good reliability, relatively normal distribution, and little or no redundancy among items.A simple and practical questionnaire to measure physician satisfaction, in particular rheumatologists satisfaction, was developed, piloted and successfully validated on a predominately academic sample of rheumatologists within the US and Latin America. This scale will serve as a means to identifying potential barriers to the implementation of performance improvement projects in the practice of Rheumatology.


Assuntos
Satisfação no Emprego , Prática Profissional , Reumatologistas/psicologia , Reumatologia/normas , Inquéritos e Questionários/normas , Adulto , Feminino , Humanos , América Latina , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estados Unidos
3.
Arthritis Rheumatol ; 71(9): 1400-1412, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31385462

RESUMO

OBJECTIVE: To develop new classification criteria for systemic lupus erythematosus (SLE) jointly supported by the European League Against Rheumatism (EULAR) and the American College of Rheumatology (ACR). METHODS: This international initiative had four phases. 1) Evaluation of antinuclear antibody (ANA) as an entry criterion through systematic review and meta-regression of the literature and criteria generation through an international Delphi exercise, an early patient cohort, and a patient survey. 2) Criteria reduction by Delphi and nominal group technique exercises. 3) Criteria definition and weighting based on criterion performance and on results of a multi-criteria decision analysis. 4) Refinement of weights and threshold scores in a new derivation cohort of 1,001 subjects and validation compared with previous criteria in a new validation cohort of 1,270 subjects. RESULTS: The 2019 EULAR/ACR classification criteria for SLE include positive ANA at least once as obligatory entry criterion; followed by additive weighted criteria grouped in 7 clinical (constitutional, hematologic, neuropsychiatric, mucocutaneous, serosal, musculoskeletal, renal) and 3 immunologic (antiphospholipid antibodies, complement proteins, SLE-specific antibodies) domains, and weighted from 2 to 10. Patients accumulating ≥10 points are classified. In the validation cohort, the new criteria had a sensitivity of 96.1% and specificity of 93.4%, compared with 82.8% sensitivity and 93.4% specificity of the ACR 1997 and 96.7% sensitivity and 83.7% specificity of the Systemic Lupus International Collaborating Clinics 2012 criteria. CONCLUSION: These new classification criteria were developed using rigorous methodology with multidisciplinary and international input, and have excellent sensitivity and specificity. Use of ANA entry criterion, hierarchically clustered, and weighted criteria reflects current thinking about SLE and provides an improved foundation for SLE research.


Assuntos
Lúpus Eritematoso Sistêmico/classificação , Reumatologia/normas , Adulto , Anticorpos Antinucleares/sangue , Anticorpos Antinucleares/imunologia , Anticorpos Antifosfolipídeos/sangue , Anticorpos Antifosfolipídeos/imunologia , Autoanticorpos/sangue , Autoanticorpos/imunologia , Estudos de Coortes , Proteínas do Sistema Complemento/análise , Técnicas de Apoio para a Decisão , Técnica Delfos , Europa (Continente) , Feminino , Humanos , Cooperação Internacional , Lúpus Eritematoso Sistêmico/diagnóstico , Masculino , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Sociedades Médicas , Estados Unidos
4.
Z Rheumatol ; 78(8): 765-773, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31456005

RESUMO

Since April 2018, the new third level care model of outpatient specialist care (ASV) according to §116b of the Social Code Book V (SGBV) has been available for patients with chronic inflammatory rheumatic diseases in Germany. Not only is a multiprofessional cooperation between the disciplines involved in treating rheumatic diseases promoted but also the cooperation between specialized rheumatologists and other specialists in private practice and in hospitals is encouraged. As budget capping limiting services and number of cases do not apply in ASV, a significant improvement of patient care in rheumatology is expected due to an increase in provider capacity. At the end of May 2019, 72 rheumatologists in the first 9 newly approved ASV teams had qualified for this new care concept. Bureaucratic obstacles have so far delayed the implementation of ASV. Difficulties arose in building a team with different specialties, in the process of registration of the teams and the assessment of the registration by certain regional boards responsible for access control. The national associations of rheumatologists, the Professional Association of German Rheumatologists (BDRh), the VRA (Verband der Rheumatologischen Akutkliniken e. V.) and the German Society of Rheumatology (DGRh) campaign for an easier admission of providers to the ASV and for adequate financing of all specialties involved in the ASV. The aim is to realize the chance of the ASV for better rheumatological care nationwide with shorter waiting times for a medical appointment and a better cooperation between specialists.


Assuntos
Assistência Ambulatorial/normas , Reumatologia , Especialização , Assistência Ambulatorial/organização & administração , Alemanha , Humanos , Pacientes Ambulatoriais , Reumatologia/organização & administração , Reumatologia/normas , Resultado do Tratamento
6.
Acta Reumatol Port ; 44(1): 7-28, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31249273

RESUMO

INTRODUCTION: Ultrasound (US) is a relatively cheap, easily available and reliable method to improve the care of rheumatic patients. However, its use in rheumatology practice is very heterogeneous and needs to be standardized. OBJECTIVES: To develop recommendations for the use of US in rheumatic diseases endorsed by the Portuguese Society of Rheumatology. METHODS: A systematic literature review of the available recommendations on the use of ultrasound in rheumatic diseases was performed and presented in a Portuguese Society of Rheumatology meeting to a subgroup of rheumatologists and rheumatology trainees with special interest in the subject. The most important topics to be addressed were selected and assigned to subgroups for literature review and draft recommendations. Following an iterative process of consensus, the final recommendations were developed, and their level of agreement voted anonymously online. A recommendation was approved when the average level of agreement was ≥ 7.5 in a 10-point Likert scale. RESULTS: Fourteen recommendations were produced regarding nine rheumatology topics: rheumatoid arthritis, spondyloarthritis, connective tissue diseases, polymyalgia rheumatica, vasculitis, crystal-deposition diseases, soft tissue rheumatism, osteoarthritis and ultrasound-guided procedures. CONCLUSION: We developed an up-to-date guidance in the form of recommendations for the use of US in nine different areas of rheumatology. As ultrasound is an important imaging modality with increasing use in the rheumatology setting, and there are frequent technological advances in the ultrasound machines and probes, in parallel with continuous associated research, these recommendations should be regularly updated.


Assuntos
Doenças Reumáticas/diagnóstico por imagem , Reumatologia/normas , Ultrassonografia/normas , Artrite Reumatoide/diagnóstico por imagem , Humanos , Artropatias/diagnóstico por imagem , Portugal
7.
Z Rheumatol ; 78(9): 865-874, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31172266

RESUMO

BACKGROUND: Only very few data are available on the comprehensive care in patients with axial spondylarthritis (axSpA), one of the most frequent inflammatory rheumatic disease. OBJECTIVE: Description of the comprehensive care and common prescription patterns of medications and other therapies in patients with axSpA depending on the type of medical care by rheumatologists or nonrheumatologists. METHODS: A cross-sectional analysis was performed based on claims data of the BARMER health insurance company (in 2015) and a questionnaire, which was sent to a representative sample of patients with axSpA (International Classification of Diseases, 10th revision, German modification, ICD-10-GM, code M45) aged 18-79 years. A stratified sample of 5000 patients was used. The patients received a postal questionnaire including questions regarding the disease, health-related and psychological parameters and socioeconomic factors. Claims data consisted of demographic factors, medicinal and nonmedicinal treatment and the extra-articular manifestations inflammatory bowel disease, psoriasis and uveitis. RESULTS: A total of 1741 patients (mean age 55.9 years, female 46.4%, 86.2% Human Leucocyte Antigen[HLA]-B27 positive) confirmed the diagnosis and answered the questionnaire. The mean Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) was 4.5 and the mean Bath Ankylosing Spondylitis Functional Index (BASFI) 4.1. Of the patients 46% were treated by rheumatologists. There was a substantial difference between patients in rheumatological care and those who were not in rheumatological care regarding prescriptions for drug treatment of axSpA (91.8% versus 66.4%). This difference was especially prominent for prescriptions of biologic disease-modifying antirheumatic drugs: 34.1% of patients in rheumatological care versus 3.1% of patients treated by nonrheumatologists (p < 0.0001), despite similar disease activity in both groups. CONCLUSION: The data show that the majority of patients diagnosed with axSpA did not receive regular care from rheumatologists. This seemed to be associated with insufficient medicinal care at least in some of these patients.


Assuntos
Produtos Biológicos/uso terapêutico , Qualidade da Assistência à Saúde , Reumatologia/normas , Espondilartrite , Espondilite Anquilosante , Adolescente , Adulto , Idoso , Estudos Transversais , Feminino , Alemanha , Antígeno HLA-B27/sangue , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Espondilartrite/terapia , Inquéritos e Questionários , Adulto Jovem
8.
J Rheumatol Suppl ; 95: 38-45, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31154403

RESUMO

OBJECTIVE: In 2016, members of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA), in collaboration with KPMG LLP (UK), conducted a study to measure care in psoriatic arthritis (PsA). A key finding was that centers do not usually have processes in place to measure the effect of improved quality of care. Our objectives were to identify and select best-practice indicators to enable PsA caregivers to assess and monitor the outcomes of specific initiatives aimed at improving care in 4 focus areas: (1) shortening time to diagnosis; (2) improving multidisciplinary collaboration; (3) optimizing disease management; and (4) improving disease monitoring. METHODS: (1) Structured review of scientific and grey literature to obtain evidence for a long list of 100 potential indicators across the 4 focus areas; (2) survey expert rheumatologists and dermatologists to review the long list and identify the most meaningful and feasible indicators for use in day-to-day practice; (3) consensus discussion to identify a shortlist of indicators based on predefined selection criteria; (4) electronic group discussion to refine definitions of shortlisted indicators and targets; and (5) review of the shortlisted indicators at the annual GRAPPA meeting in July 2018 to ensure the indicators meet the preliminary criteria. RESULTS: The expert group arrived at a consensus with a shortlist of 8 best-practice indicators across 4 key focus areas aligned with the patient pathway. CONCLUSION: There were 8 evidence-based best-practice indicators and respective targets that were identified to enable the monitoring of quality of care and target improvements.


Assuntos
Artrite Psoriásica/terapia , Psoríase/terapia , Indicadores de Qualidade em Assistência à Saúde , Qualidade da Assistência à Saúde , Artrite Psoriásica/diagnóstico , Dermatologia/normas , Humanos , Psoríase/diagnóstico , Reumatologia/normas
9.
Clin Rheumatol ; 38(8): 2029-2038, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31102085

RESUMO

Given the plethora of studies today on the same topic, clinicians in rheumatology as well as others increasingly rely on systematic reviews, with or without meta-analysis, to aid in their evidence-based decision-making. However, given time constraints, staying up-to-date on current methods for conducting systematic reviews and meta-analyses as well as interpreting the results of these reviews for application in clinical practice can be challenging. The purpose of this paper is to try and address this gap. In this paper, a description of the different types of systematic reviews and meta-analyses is provided as well as a description of the major elements, including methodology and interpretation of systematic reviews with meta-analyses. Included is a broad, five-question checklist to aid clinicians in rheumatology for making decisions about the utility of a systematic review. It is the hopes that this paper will aid clinicians in rheumatology as well as other consumers of systematic reviews and meta-analyses with the information necessary for judging the utility of systematic reviews and meta-analyses in their own work.


Assuntos
Metanálise como Assunto , Reumatologia/normas , Revisão Sistemática como Assunto , Tomada de Decisões , Medicina Baseada em Evidências , Humanos , Publicações , Reumatologia/métodos
10.
Clinics (Sao Paulo) ; 74: e722, 2019 05 13.
Artigo em Inglês | MEDLINE | ID: mdl-31090795

RESUMO

OBJECTIVES: This study aimed to provide evidence for understanding how to treat osteoarthritis (OA) in our country. Therefore, it was necessary to match information and investigations related to the treatment of the disease from the three main types of specialists involved: physiatrists, orthopedists and rheumatologists. METHODS: The authors acted as a scientific advisory committee. From the initial discussions, a structured questionnaire was developed for use with a group of specialists on OA using the Delphi technique. The questionnaire was sent to 21 experts appointed by the authors, and the results obtained were critically analyzed and validated. RESULTS: The prevalence of OA was 33% in Brazil, corresponding to one-third of the individuals in the reference population, which included individuals over 25 years of age. Another significant finding was that most patients did not receive any form of treatment in the early stages of OA. CONCLUSION: The committee pointed to the need for early intervention and that the available medicinal resources can fulfil this important role, as is the case with SYSADOA treatments. Glucosamine-based medicinal products with or without chondroitin could also fulfill this need for early treatment. The other generated evidence and included investigations were then grouped together and are the subject of this publication.


Assuntos
Competência Clínica/normas , Técnica Delfos , Medicina Baseada em Evidências/normas , Osteoartrite/terapia , Adulto , Anti-Inflamatórios não Esteroides/administração & dosagem , Brasil , Sulfatos de Condroitina/uso terapêutico , Consenso , Quimioterapia Combinada , Feminino , Glucosamina/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Ortopedia/normas , Osteoartrite/tratamento farmacológico , Osteoartrite do Joelho/terapia , Medicina Física e Reabilitação/normas , Guias de Prática Clínica como Assunto , Reumatologia/normas , Índice de Gravidade de Doença , Resultado do Tratamento
11.
Lupus ; 28(6): 778-782, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31046572

RESUMO

In a joint effort, the European League Against Rheumatism (EULAR) and the American College of Rheumatology (ACR) recently proposed new criteria for the classification of systemic lupus erythematosus (SLE) with the overarching goal to identify potential participants for clinical studies. Herein, we present the first independent evaluation of these criteria in comparison with older classification grounds using an adult Scandinavian study population of confirmed SLE cases and individuals with SLE-mimicking conditions. We included 56 confirmed SLE cases meeting the 1982 ACR criteria (ACR-82) and/or the Fries "diagnostic principle" (antinuclear antibodies on at least one occasion plus involvement of at least two defined organ systems) and 55 controls with possible systemic autoimmune disease, including the presence of any SLE-related autoantibody. The proposed EULAR/ACR criteria showed a diagnostic sensitivity of 93% (95% confidence interval (CI), 0.83-0.98) compared with 83% (95% CI, 0.72-0.91) for the updated ACR criteria from 1997. The diagnostic accuracy of all tested classification grounds was fairly similar, achieving approximately 85%. However, the disease specificity of the EULAR/ACR criteria reached only 73% (95% CI, 0.59-0.83), which was comparable with the 2012 Systemic Lupus International Collaborating Clinics (SLICC) criteria, 75% (95% CI, 0.61-0.85), but clearly lower than for ACR-82, 94% (95% CI, 0.83-0.99). In this first independent evaluation of a limited number of cases, we found comparable results with respect to diagnostic sensitivity, specificity and accuracy regarding the SLICC-12 and the proposed EULAR/ACR classification criteria. However, their specificity for SLE appeared to be lower compared with ACR-82.


Assuntos
Lúpus Eritematoso Sistêmico/classificação , Lúpus Eritematoso Sistêmico/diagnóstico , Reumatologia/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Suécia , Adulto Jovem
12.
Arthritis Care Res (Hoboken) ; 71(6): 717-734, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31021516

RESUMO

OBJECTIVE: To develop treatment recommendations for children with juvenile idiopathic arthritis manifesting as non-systemic polyarthritis, sacroiliitis, or enthesitis. METHODS: The Patient/Population, Intervention, Comparison, and Outcomes (PICO) questions were developed and refined by members of the guideline development teams. A systematic review was conducted to compile evidence for the benefits and harms associated with treatments for these conditions. GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology was used to rate the quality of evidence. A group consensus process was conducted among the Voting Panel to generate the final recommendations and grade their strength. A Parent and Patient Panel used a similar consensus approach to provide patient/caregiver preferences for key questions. RESULTS: Thirty-nine recommendations were developed (8 strong and 31 conditional). The quality of supporting evidence was very low or low for 90% of the recommendations. Recommendations are provided for the use of nonsteroidal antiinflammatory drugs, disease-modifying antirheumatic drugs, biologics, and intraarticular and oral glucocorticoids. Recommendations for the use of physical and occupational therapy are also provided. Specific recommendations for polyarthritis address general medication use, initial and subsequent treatment, and adjunctive therapies. Good disease control, with therapeutic escalation to achieve low disease activity, was recommended. The sacroiliitis and enthesitis recommendations primarily address initial therapy and adjunctive therapies. CONCLUSION: This guideline provides direction for clinicians, caregivers, and patients making treatment decisions. Clinicians, caregivers, and patients should use a shared decision-making process that accounts for patients' values, preferences, and comorbidities. These recommendations should not be used to limit or deny access to therapies.


Assuntos
Antirreumáticos/uso terapêutico , Artrite Juvenil/terapia , Entesopatia/terapia , Terapia Ocupacional , Modalidades de Fisioterapia , Reumatologia/normas , Sacroileíte/terapia , Anti-Inflamatórios não Esteroides/uso terapêutico , Antirreumáticos/efeitos adversos , Artrite Juvenil/diagnóstico , Artrite Juvenil/epidemiologia , Produtos Biológicos/uso terapêutico , Consenso , Entesopatia/diagnóstico , Entesopatia/epidemiologia , Glucocorticoides/uso terapêutico , Humanos , Fatores de Risco , Sacroileíte/diagnóstico , Sacroileíte/epidemiologia , Resultado do Tratamento
13.
Arthritis Care Res (Hoboken) ; 71(6): 703-716, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31021540

RESUMO

OBJECTIVE: To develop recommendations for the screening, monitoring, and treatment of uveitis in children with juvenile idiopathic arthritis (JIA). METHODS: Pediatric rheumatologists, ophthalmologists with expertise in uveitis, patient representatives, and methodologists generated key clinical questions to be addressed by this guideline. This was followed by a systematic literature review and rating of the available evidence according to the GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology. A group consensus process was used to compose the final recommendations and grade their strength as conditional or strong. RESULTS: Due to a lack of literature with good quality of evidence, recommendations were formulated on the basis of available evidence and a consensus expert opinion. Regular ophthalmic screening of children with JIA is recommended because of the risk of uveitis, and the frequency of screening should be based on individual risk factors. Regular ophthalmic monitoring of children with uveitis is recommended, and intervals should be based on ocular examination findings and treatment regimen. Ophthalmic monitoring recommendations were strong primarily because of concerns of vision-threatening complications of uveitis with infrequent monitoring. Topical glucocorticoids should be used as initial treatment to achieve control of inflammation. Methotrexate and the monoclonal antibody tumor necrosis factor inhibitors adalimumab and infliximab are recommended when systemic treatment is needed for the management of uveitis. The timely addition of nonbiologic and biologic drugs is recommended to maintain uveitis control in children who are at continued risk of vision loss. CONCLUSION: This guideline provides direction for clinicians and patients/parents making decisions on the screening, monitoring, and management of children with JIA and uveitis, using GRADE methodology and informed by a consensus process with input from rheumatology and ophthalmology experts, current literature, and patient/parent preferences and values.


Assuntos
Artrite Juvenil/diagnóstico , Artrite Juvenil/tratamento farmacológico , Produtos Biológicos/uso terapêutico , Glucocorticoides/uso terapêutico , Imunossupressores/uso terapêutico , Oftalmologia/normas , Reumatologia/normas , Uveíte/diagnóstico , Uveíte/tratamento farmacológico , Artrite Juvenil/epidemiologia , Produtos Biológicos/efeitos adversos , Consenso , Glucocorticoides/efeitos adversos , Humanos , Imunossupressores/efeitos adversos , Valor Preditivo dos Testes , Fatores de Risco , Resultado do Tratamento , Uveíte/epidemiologia
14.
Int J Rheum Dis ; 22(7): 1233-1238, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30993889

RESUMO

AIM: The aims of this study were to: (a) measure the proportion of CARTaGENE rheumatoid arthritis (RA) patients fulfilling pre-specified quality indicators (ie disease-modifying antirheumatic drug [DMARD] use, regular follow up, use of folate supplementation, use of vitamin D and calcium, exercise and smoking status); and (b) examine variation in DMARD use with respect to patient age, sex, education and income. METHODS: A cohort of RA patients was constructed based on the CARTaGENE survey and health administrative database. CARTaGENE is a large, established, population-based study which recruited 19 995 participants from four metropolitan regions in Quebec. Six quality indicators (QI) were assessed; four pertained to RA management and treatment received (use of DMARD therapy, annual medical visits, use of folate supplementation with methotrexate therapy, and use of calcium and vitamin D in steroid-exposed patients) and two pertained to lifestyle factors (physical activity and smoking cessation). QI were reported in terms of proportion of patients fulfilling them. Bayesian logistic regression analyses were preformed to investigate potential variation with DMARD use. RESULTS: Our cohort included 142 RA patients. The QI that pertain to RA pharmacotherapy and medical management ranged 60-80%. Regarding the QI focusing on lifestyle factors, 55% of patients reported performing moderate physical activity and only 16.6% reported current smoking. Results from the Bayesian logistic regression showed no definite associations between DMARD use and patient characteristics (age, education, income and sex). CONCLUSION: Our findings suggest a seemingly modest performance of Quebec's health-care system for RA patients, with respect to these QI.


Assuntos
Antirreumáticos/uso terapêutico , Artrite Reumatoide/terapia , Suplementos Nutricionais , Padrões de Prática Médica/normas , Indicadores de Qualidade em Assistência à Saúde/normas , Reumatologia/normas , Comportamento de Redução do Risco , Adulto , Fatores Etários , Idoso , Artrite Reumatoide/diagnóstico , Bases de Dados Factuais , Escolaridade , Exercício , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Renda , Masculino , Pessoa de Meia-Idade , Quebeque , Fatores Sexuais , Abandono do Hábito de Fumar , Resultado do Tratamento
15.
Clin Rheumatol ; 38(8): 2265-2273, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30989408

RESUMO

INTRODUCTION/OBJECTIVES: Septic arthritis is a diagnostic and therapeutic emergency because of a high morbidity and mortality. Nevertheless, the etiologic diagnosis is often difficult. The aim of our study was to determine if serum procalcitonin was a discriminatory biomarker in case of arthritis of undetermined etiology. METHOD: Patients were separated in five groups: gouty arthritis, calcium pyrophosphate deposition arthritis, osteoarthritis or post-traumatic arthritis ("mechanical" arthritis), chronic inflammatory rheumatic arthritis, and septic arthritis. Levels of serum white blood cells, C-reactive protein and procalcitonin were measured. RESULTS: Ninety-eight patients were included: 18 in the "gout" group, 26 in the "calcium pyrophosphate deposition arthritis" group, 16 in the mechanical group, 18 in the "chronic inflammatory rheumatic" group, and 20 in the "sepsis" group. The area under the receiver operating characteristic curve of white blood cells, C-reactive protein, and procalcitonin levels to diagnose a septic arthritis were 0.69 (IC95% 0.55-0.83), 0.82 (IC95% 0.73-0.91), and 0.87 (IC95% 0.76-0.98) respectively. For a cutoff of 0.5 ng/ml, procalcitonin sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio were 65%, 91%, 65%, 91%, 7.2, and 0.4, respectively. Serum C-reactive protein and procalcitonin levels were correlated, were not different in sepsis or gout groups, and were higher in non-septic arthritis with poly-arthritis than with mono-arthritis (p < 0.05). CONCLUSIONS: Serum procalcitonin is a useful biomarker in arthritis management with diagnosis performances higher than those of other biomarkers (white blood cells, C-reactive protein).Key Points• Diagnostic performances of serum procalcitonin level in septic arthritis are higher than those of serum C-reactive protein or white blood cells levels.• Serum procalcitonin levels are not different in septic arthritis or gouty arthritis.• Serum procalcitonin levels are higher in non-septic arthritis with poly-arthritis than with mono-arthritis.


Assuntos
Artrite Infecciosa/sangue , Artrite Infecciosa/microbiologia , Pró-Calcitonina/sangue , Reumatologia/normas , Idoso , Idoso de 80 Anos ou mais , Artrite Gotosa/sangue , Biomarcadores/sangue , Proteína C-Reativa/análise , Pirofosfato de Cálcio/metabolismo , Feminino , Humanos , Inflamação , Leucócitos/citologia , Masculino , Pessoa de Meia-Idade , Osteoartrite/sangue , Valor Preditivo dos Testes , Estudos Prospectivos , Precursores de Proteínas/sangue , Curva ROC , Febre Reumática/sangue , Sensibilidade e Especificidade
16.
Int J Rheum Dis ; 22(3): 340-356, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30816645

RESUMO

INTRODUCTION: Despite the availability of axial spondyloarthritis (SpA) recommendations proposed by various rheumatology societies, we considered that a region-specific guideline was of substantial added value to clinicians of the Asia-Pacific region, given the wide variations in predisposition to infections and other patient factors, local practice patterns, and access to treatment across countries. MATERIALS AND METHODS: Systematic reviews were undertaken of English-language articles published between 2000 and 2016, identified from MEDLINE using PubMed, EMBASE and Cochrane databases. The strength of available evidence was graded using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Recommendations were developed through consensus using the Delphi technique. RESULTS: Fourteen axial SpA treatment recommendations were developed based on evidence summaries and consensus. The first 2 recommendations cover non-pharmacological approaches to management. Recommendations 3 to 5 describe the following: the use of non-steroidal anti-inflammatory drugs as first-line symptomatic treatment; the avoidance of long-term corticosteroid use; and the utility of conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) for peripheral or extra-articular manifestations. Recommendation 6 refers to the indications for biological DMARDs (bDMARDs). Recommendation 7 deals specifically with screening for infections endemic to Asia, prior to use of bDMARDs. Recommendations 7 to 13 cover the role of bDMARDs in the treatment of active axial SpA and include related issues such as continuing therapy and use in special populations. Recommendation 14 deals with the utility of surgical intervention in axial SpA. CONCLUSION: These recommendations provide up-to-date guidance for treatment of axial SpA to help meet the needs of patients and clinicians in the Asia-Pacific region.


Assuntos
Corticosteroides/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Antirreumáticos/uso terapêutico , Produtos Biológicos/uso terapêutico , Reumatologia/normas , Espondilartrite/tratamento farmacológico , Corticosteroides/efeitos adversos , Anti-Inflamatórios não Esteroides/efeitos adversos , Antirreumáticos/efeitos adversos , Ásia/epidemiologia , Produtos Biológicos/efeitos adversos , Consenso , Técnica Delfos , Medicina Baseada em Evidências/normas , Humanos , Segurança do Paciente , Medição de Risco , Fatores de Risco , Espondilartrite/diagnóstico , Espondilartrite/epidemiologia , Espondilartrite/imunologia , Resultado do Tratamento
17.
Clin Rheumatol ; 38(8): 2219-2226, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30834997

RESUMO

OBJECTIVES: To assess the validity, reliability, comprehensibility, and responsiveness to change of an illustrated child/parent multidimensional patient-reported outcome measures (PROMs) questionnaire which can assess construct outcome measures of children with juvenile inflammatory arthritis. METHODS: A total of 122 children with juvenile idiopathic arthritis were included in this work in a multicenter study. The questionnaire included seven categories: (1) functional ability; (2) health-related quality of life; (3) disease activity measures: pain, global assessment, fatigue, and morning stiffness; (4) self-reported joint tenderness; (5) current medication, side effects, and adherence to therapy; (6) comorbidities; and (7) patient motivation. All the items were supported by illustrations to provide children with a visual impression of what was meant by the questions. The questionnaire has parent and patient versions. The disease activity status was assessed using JADAS-27. RESULTS: The questionnaire was reliable as demonstrated by a high-standardized alpha (0.890-0.978). The questionnaire items correlated significantly (p < 0.01) with clinical parameters of disease activity. The patient-reported tender joints correlated significantly with the physician's scores (0.842). Changes in functional disability, quality of life, and the motivation score showed significant variation (p < 0.01) with disease activity status in response to therapy. The illustrated PROMs questionnaire showed also a high degree of comprehensibility (9.6). CONCLUSIONS: Integrating PROMs into standard clinical practice is feasible and applicable. The illustrated questionnaire was valid and reliable. It provides an informative, quantitative measure for the disease activity score set data, and in the meantime, facilitates the assessment of the children's adherence to therapy, comorbidities, and motivation on an individual basis.


Assuntos
Artrite Juvenil/terapia , Medidas de Resultados Relatados pelo Paciente , Reumatologia/normas , Adolescente , Artrite Juvenil/psicologia , Criança , Pré-Escolar , Avaliação da Deficiência , Feminino , Humanos , Articulações/fisiopatologia , Masculino , Medição da Dor , Pais , Assistência Centrada no Paciente , Estudos Prospectivos , Psicometria , Qualidade de Vida , Reprodutibilidade dos Testes , Autorrelato , Índice de Gravidade de Doença , Inquéritos e Questionários , Resultado do Tratamento
18.
Medicine (Baltimore) ; 98(9): e14641, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30817584

RESUMO

To compare the characteristics of dry eye (DE) patients who did and did not satisfy the 2016 American College of Rheumatology (ACR)-European League Against Rheumatism (EULAR) classification criteria for primary Sjögren's syndrome (SS) among patients with pre-existing SS diagnosed according to the 2012 ACR criteriaThis cross-sectional study evaluated 91 patients with pre-existing SS and 55 with non-SS DE. Patients with SS were divided into 2 groups according to whether they met the revised 2016 ACR-EULAR classification criteria for primary SS. Group 1 (n = 71) was comprised of patients who satisfied the revised 2016 criteria and group 2 (n = 20) was comprised of patients who did not satisfy the newly revised criteria. Group 3 consisted of 55 patients with non-SS DE. The ocular surface disease index (OSDI) score, tear break-up time (TBUT), Schirmer score, tear clearance rate (TCR), and corneal and conjunctival staining scores were evaluated and compared between the groups. Laboratory profiles, including antinuclear antibodies, rheumatoid factor levels, erythrocyte sedimentation rate, and C-reactive protein levels, and focus scores were analyzed.TBUT, Schirmer, and corneal/conjunctival staining scores were significantly worse in both groups of patients with SS (groups 1 and 2) than in those with non-SS DE (group 3). However, there were no significant differences between groups 1 and 2 in laboratory findings as well as in ocular surface findings, including OSDI, TBUT, Schirmer score, TCR, and corneal/conjunctival staining scores. The focus score, which shows the level of lymphocytic infiltration in the salivary glands, was higher in group 1 than in group.Of the patients with pre-existing SS who were diagnosed according to the 2012 ACR classification, patients who did not satisfy the 2016 ACR-EULAR classification criteria for primary SS showed similar ocular surface parameters and laboratory findings to patients who did meet the revised classification, except for focus score. There is no need to change the direction of treatment of DE in patients with pre-existing SS who did not meet the revised 2016 ACR-EULAR criteria.


Assuntos
Síndromes do Olho Seco/classificação , Reumatologia/normas , Índice de Gravidade de Doença , Síndrome de Sjogren/complicações , Adulto , Idoso , Estudos de Casos e Controles , Túnica Conjuntiva/patologia , Córnea/patologia , Estudos Transversais , Síndromes do Olho Seco/etiologia , Síndromes do Olho Seco/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Glândulas Salivares/patologia
19.
Med Hypotheses ; 125: 89, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30902159

RESUMO

Remission is the goal of therapy in patients with rheumatoid arthritis (RA). However, drug free remission has not been investigated adequately. Early and intensive treatment may increase the chances of successful drug free remission. Effect of long term remission while on medical therapy on the success of drug withdrawal has not been previously evaluated in RA. Long term immune suppression has been shown to have beneficial effects on relapse rates in other diseases with dysregulated immune tolerance. Therefore, drug withdrawal could be an acceptable option in RA patients in long term remission.


Assuntos
Antirreumáticos/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Indução de Remissão , Humanos , Sistema Imunitário , Imunossupressores/uso terapêutico , Modelos Teóricos , Recidiva , Projetos de Pesquisa , Reumatologia/métodos , Reumatologia/normas , Resultado do Tratamento
20.
Int J Rheum Dis ; 22(3): 357-375, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30809944

RESUMO

AIM: To update recommendations based on current best evidence concerning the treatment of rheumatoid arthritis (RA), focusing particularly on the role of targeted therapies, to inform clinicians on new developments that will impact their current practice. MATERIALS AND METHODS: A search of relevant literature from 2014 to 2016 concerning targeted therapies in RA was conducted. The RA Update Working Group evaluated the evidence and proposed updated recommendations using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach, to describe the quality of evidence and strength of recommendations. Recommendations were finalized through consensus using the Delphi technique. RESULTS: This update provides 16 RA treatment recommendations based on current best evidence and expert clinical opinion. Recommendations 1-3 deal with the use of conventional synthetic disease-modifying antirheumatic drugs. The next three recommendations (4-6) cover the need for screening and management of infections and comorbid conditions prior to starting targeted therapy, while the following seven recommendations focus on use of these agents. We address choice of targeted therapy, switch, tapering and discontinuation. The last three recommendations elaborate on targeted therapy for RA in special situations such as pregnancy, cancer, and major surgery. CONCLUSION: Rheumatoid arthritis remains a significant health problem in the Asia-Pacific region. Patients with RA can benefit from the availability of effective targeted therapies, and these updated recommendations provide clinicians with guidance on their use.


Assuntos
Antirreumáticos/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Reumatologia/normas , Antirreumáticos/efeitos adversos , Artrite Reumatoide/diagnóstico , Artrite Reumatoide/epidemiologia , Artrite Reumatoide/imunologia , Ásia/epidemiologia , Consenso , Técnica Delfos , Medicina Baseada em Evidências/normas , Humanos , Segurança do Paciente , Medição de Risco , Fatores de Risco , Resultado do Tratamento
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