RESUMO
BACKGROUND: The aims of this study were to establish robust reference intervals and to investigate the factors influencing bone turnover markers (BTMs) in healthy premenopausal Spanish women. METHODS: A total of 184 women (35-45 years) from 13 centers in Catalonia were analyzed. Blood and second void urine samples were collected between 8 a.m. and 10 a.m. after an overnight fast. Serum procollagen type I amino-terminal propeptide (PINP) and serum cross-linked C-terminal telopeptide of type I collagen (CTX-I) were measured by two automated assays (Roche and IDS), bone alkaline phosphatase (bone ALP) by ELISA, osteocalcin (OC) by IRMA and urinary NTX-I by ELISA. PTH and 25-hydroxyvitamin D (25OHD) levels were measured. All participants completed a questionnaire on lifestyle factors. RESULTS: Reference intervals were: PINP: 22.7-63.1 and 21.8-65.5 µg/L, bone ALP: 6.0-13.6 µg/L, OC: 8.0-23.0 µg/L, CTX-I: 137-484 and 109-544 ng/L and NTX-I: 19.6-68.9 nM/mM. Oral contraceptive pills (OCPs) influenced PINP (p=0.007), and low body mass index (BMI) was associated with higher BTMs except for bone ALP. Women under 40 had higher median values of most BTMs. CTX-I was influenced by calcium intake (p=0.010) and PTH (p=0.007). 25OHD levels did not influence BTMs. Concordance between the two automated assays for PINP and particularly CTX-I was poor. CONCLUSIONS: Robust reference intervals for BTMs in a Southern European country are provided. The effects of OCPs and BMI on their levels are significant, whilst serum 25OHD levels did not influence BTMs. Age, calcium intake, BMI and PTH influenced CTX-I. The two automated assays for measuring PINP and CTX-I are not interchangeable.
Assuntos
Biomarcadores/sangue , Remodelação Óssea , Ensaio de Imunoadsorção Enzimática , Adulto , Fosfatase Alcalina/análise , Fosfatase Alcalina/normas , Biomarcadores/urina , Índice de Massa Corporal , Colágeno Tipo I/sangue , Colágeno Tipo I/normas , Ensaio de Imunoadsorção Enzimática/normas , Feminino , Humanos , Pessoa de Meia-Idade , Osteocalcina/análise , Osteocalcina/normas , Hormônio Paratireóideo/análise , Hormônio Paratireóideo/normas , Fragmentos de Peptídeos/sangue , Fragmentos de Peptídeos/normas , Fragmentos de Peptídeos/urina , Peptídeos/sangue , Peptídeos/normas , Pré-Menopausa , Pró-Colágeno/sangue , Pró-Colágeno/normas , Pró-Colágeno/urina , Valores de Referência , Vitamina D/análogos & derivados , Vitamina D/análise , Vitamina D/normasRESUMO
UNLABELLED: Osteoporosis resulting in bone fractures is a complication in patients with primary biliary cirrhosis (PBC). Once-weekly alendronate improves bone mass and is well tolerated in these patients, but there is a concern because of poor compliance. Therefore, the efficacy, adherence, and safety of monthly ibandronate (150 mg) with weekly alendronate (70 mg) were compared in a randomized, 2-year study in 42 postmenopausal women with PBC and osteoporosis. Bone mineral density (BMD) of the lumbar spine and proximal femur (by DXA), liver function, and bone markers were measured at entry and every 6 months over 2 years. Adherence to therapy was assessed by the Morisky-Green score. At enrollment, the two groups were similar with respect to age, BMD, severity of cholestasis, previous fractures, and bone markers. Thirty-three patients, 14 in the ibandronate group and 19 in the alendronate group, completed the trial. At 2 years both treatments resulted in a significant increase in BMD at the lumbar spine (from 0.875 ± 0.025 to 0.913 ± 0.026 g/cm(2), P < 0.001 with alendronate, and from 0.898 ± 0.024 to 0.949 ± 0.027 g/cm(2), P < 0.001 with ibandronate). The mean percentage change was 4.5% and 5.7%, respectively (P = not significant). BMD increased at the total hip by 2.0% and 1.2%, respectively. Changes in bone markers were similar in both groups and one patient with alendronate developed a new vertebral fracture. Adherence to therapy was higher with ibandronate (P = 0.009). Neither treatment impaired liver function or cholestasis. CONCLUSION: Both regimens, weekly alendronate and monthly ibandronate, improve bone mass and are comparable in safety for osteoporosis therapy in patients with PBC, although adherence is higher with the monthly regimen. Further larger studies are needed to assess fracture prevention.
Assuntos
Fraturas Ósseas/prevenção & controle , Cirrose Hepática Biliar/tratamento farmacológico , Osteoporose Pós-Menopausa/tratamento farmacológico , Administração Oral , Idoso , Alendronato/administração & dosagem , Densidade Óssea , Difosfonatos , Esquema de Medicação , Feminino , Humanos , Ácido Ibandrônico , Cirrose Hepática Biliar/complicações , Pessoa de Meia-Idade , Osteoporose Pós-Menopausa/complicações , Cooperação do Paciente , Resultado do TratamentoRESUMO
INTRODUCTION: To reach the diagnosis of giant cell arteritis (GCA), signs, symptoms, laboratory tests, imaging findings, and occasionally anatomopathological results from temporal artery biopsy are evaluated. This study describes the results of an algorithm analysis based on clinical and ultrasound evaluation of patients with suspected GCA, highlighting its diagnostic utility by contrasting its use in different clinical suspicion scenarios. METHOD: Prospective multicenter study evaluating patients referred with suspected GCA through a preferential circuit (fast track), grouping them according to low or high clinical suspicion of GCA. Each of these scenarios is evaluated by biopsy and ultrasound for all patients, resulting in positive, indeterminate, or negative outcomes, yielding six possible groups. Potential areas of improvement are explored, emphasizing that, following a negative or indeterminate ultrasound, 18-FDG-PET-CT could be recommended. We analyze the results and application of a diagnostic algorithm, confirming its efficiency and applicability based on whether there is high or low clinical suspicion. RESULTS: Sixty-nine patients (41 in the high suspicion group and 28 in the low suspicion group). There were 41 new diagnoses of GCA: 35 in the high suspicion group and 6 in the low suspicion group. Using ultrasound alone, the initial algorithm has an overall diagnostic efficiency of 72.5%, which improves to 80.5% when including 18F-FDG-PET/CT. The negative predictive value of ultrasound in patients with low clinical suspicion is 84.6%, and the positive predictive value of ultrasound in patients with high suspicion is 100%, improving sensitivity from 57.1% to 80.8% with 18F-FDG-PET/CT in this scenario. Temporal artery biopsy was performed on all patients, with no differences in sensitivity or specificity compared to ultrasound. In cases where all three tests - ultrasound, biopsy, and 18F-FDG-PET/CT - are performed, sensitivity increases to 92.3% in patients with high clinical suspicion. CONCLUSION: In situations of high clinical suspicion, the algorithm provides sufficient information for the diagnosis of GCA if ultrasound is positive. A negative ultrasound is sufficient to rule out the diagnosis in the context of low clinical suspicion. 18-FDG-PET-CT may be useful in patients with high suspicion and negative or indeterminate ultrasound results.
Assuntos
Algoritmos , Arterite de Células Gigantes , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Ultrassonografia , Arterite de Células Gigantes/diagnóstico , Arterite de Células Gigantes/diagnóstico por imagem , Humanos , Estudos Prospectivos , Idoso , Feminino , Masculino , Idoso de 80 Anos ou mais , Biópsia , Pessoa de Meia-Idade , Fluordesoxiglucose F18 , Artérias Temporais/patologia , Artérias Temporais/diagnóstico por imagem , Sensibilidade e Especificidade , Compostos RadiofarmacêuticosRESUMO
OBJECTIVES: To estimate the incidence of clinical fragility fractures in postmenopausal women with rheumatoid arthritis (RA) and analyze risk factors for fracture. METHODS: Incidence of clinical fragility fractures in 330 postmenopausal women with RA was compared to that of a control population of 660 age-matched postmenopausal Spanish women. Clinical fractures during the previous five years were recorded. We analyzed associations with risk factors for fracture in both populations and with disease-related variables in RA patients. RESULTS: Median age of RA patients was 64 years; median RA duration was eight years. Sixty-nine percent were in remission or on low activity. Eighty-five percent had received glucocorticoids (GCs); 85 %, methotrexate; and 40 %, ≥1 biologic DMARD. Fifty-four patients and 47 controls had ≥1 major osteoporotic fracture (MOF). Incidence of MOFs was 3.55 per 100 patient-year in patients and 0.72 in controls (HR: 2.6). Risk factors for MOFs in RA patients were age, previous fracture, parental hip fracture, years since menopause, BMD, erosions, disease activity and disability, and cumulative dose of GCs. Previous fracture in RA patients was a strong risk for MOFs (HR: 10.37). CONCLUSION: Of every 100 postmenopausal Spanish women with RA, 3-4 have a MOF per year. This is more than double that of the general population. A previous fracture poses a high risk for a new fracture. Other classic risk factors for fracture, RA disease activity and disability, and the cumulative dose of GCs are associated with fracture development.
Assuntos
Artrite Reumatoide , Fraturas por Osteoporose , Humanos , Feminino , Pessoa de Meia-Idade , Estudos de Casos e Controles , Pós-Menopausa , Incidência , Artrite Reumatoide/complicações , Artrite Reumatoide/epidemiologia , Fraturas por Osteoporose/etiologia , Fatores de Risco , Densidade ÓsseaRESUMO
BACKGROUND & AIMS: The influence of osteoporosis and liver disease on fracture risk is not well characterized in patients with primary biliary cirrhosis (PBC). We studied a large series of women with PBC to assess the prevalence and risk factors for fractures and the fracture threshold. METHODS: In female patients with PBC (n = 185; age, 55.7 +/- 0.7 years; range 28-79 years), age, duration of PBC, menopausal status, and histologic stage and severity of liver disease were assessed. Vertebral and non-vertebral fractures were recorded in 170 and 172 patients, respectively. Osteoporosis and osteopenia were diagnosed based on densitometry analysis. RESULTS: The prevalences of vertebral, non-vertebral, and overall fractures were 11.2%, 12.2%, 20.8%, respectively. Osteoporosis was significantly more frequent in patients with PBC than in normal women. Osteoporosis was associated with age, weight, height, histologic stage, severity, and duration of liver damage; fractures were associated with osteoporosis, menopause, age, and height but not with severity of PBC. Osteoporosis was a risk factor for vertebral fracture (odds ratio [OR], 8.48; 95% confidence interval [CI]: 2.67-26.95). Lumbar T score <-1.5 (OR, 8.27; 95% CI: 1.84-37.08) and femoral neck T score <-1.5 (OR, 6.83; 95% CI: 1.48-31.63) were significant risk factors for vertebral fractures. CONCLUSIONS: Fractures, particularly vertebral fractures, are associated with osteoporosis, osteopenia, and T scores less than -1.5, whereas osteoporosis and osteopenia are associated with the severity of liver damage. Patients with T scores less than -1.5 might require additional monitoring and be considered for therapy to prevent fractures.
Assuntos
Densidade Óssea , Colestase/complicações , Fraturas Ósseas/etiologia , Cirrose Hepática Biliar/complicações , Adulto , Idoso , Feminino , Fraturas Ósseas/epidemiologia , Humanos , Pessoa de Meia-Idade , Osteoporose/epidemiologia , Prevalência , Fatores de RiscoRESUMO
BACKGROUND AND OBJECTIVE: Giant cell arteritis (GCA) is the most frequent systemic vasculitis in adults. In recent years, the usefulness of temporal artery ultrasound (TAUS) as a diagnostic tool to assess the underlying inflammation of the vascular wall during the inflammatory process has been under clinical investigation. MATERIAL AND METHODS: Observational and descriptive cohort study of 120 TAUS in 60 patients with clinical suspicions of GCA, according to the ACR (American College of Rheumatology) classification criteria. RESULTS: Among all patients who underwent ultrasound, 42.3% met clinical criteria for GCA according to ACR. Sensitivity and specificity of TAUS in our cohort with clinical suspicion was 81.8% and 93.3%, respectively. A PPV of 90.1% and a VPN of 87.5% were observed. CONCLUSION: Our results showed that TAUS as a useful, indolent, fast, and accessible tool with high diagnostic specificity and diagnostic value.
Assuntos
Arterite de Células Gigantes/diagnóstico por imagem , Artérias Temporais/diagnóstico por imagem , Ultrassonografia Doppler , Feminino , Arterite de Células Gigantes/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Sensibilidade e EspecificidadeRESUMO
Patients with rheumatoid arthritis (RA) treated with disease-modifying antirheumatic drugs are susceptible to severe infections such as leishmaniasis. As L. infantum is endemic in the Mediterranean region, it is necessary to rule this infectious process out in any RA patient presenting with fever and pancytopenia. An early diagnosis based on a high suspicion can prevent a fatal outcome.
Assuntos
Artrite Reumatoide/complicações , Imunossupressores/efeitos adversos , Leishmaniose Visceral/etiologia , Metotrexato/efeitos adversos , Anfotericina B/uso terapêutico , Antiprotozoários/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Suscetibilidade a Doenças , Diagnóstico Precoce , Feminino , Humanos , Hospedeiro Imunocomprometido , Imunossupressores/uso terapêutico , Indometacina/uso terapêutico , Leishmaniose Visceral/diagnóstico , Leishmaniose Visceral/tratamento farmacológico , Metotrexato/uso terapêutico , Pessoa de Meia-Idade , Pancitopenia/induzido quimicamente , Prednisona/efeitos adversos , Prednisona/uso terapêuticoRESUMO
At present, data comparing the quantification methods for measurement of free vitamin D (direct assay [direct 25-OHDF] and estimated by calculation [calculated 25-OHDF]), are scarce. The aim of this study was to analyse the concordance between these two methods of 25-OHDF analysis (direct vs. calculated). METHODS: Serum values of total 25-OHD (25-OHDT), vitamin D binding protein (DBP) (by R&D Systems ELISA), calculated 25-OHDF (by DBP, albumin and 25-OHDT) and direct 25-OHDF (by DIAsource ELISA) were analysed in 173 healthy women (aged 35-45years). Assessment of concordance was evaluated by the Bland-Altman plot and the total deviation index (TDI). RESULTS: The mean values of calculated and direct 25-OHDF in these subjects were 5.27±2.5 and 3.83±1.01pg/mL, respectively. We found significantly lower values of 25-OHDF on comparing subjects with and without vitamin D deficiency, independently of the method used. The total deviation index evaluated by the Bland-Altman plot showed low concordance for both measurements. Only low 25-OHDF levels were concordant. CONCLUSIONS: This study shows that the concordance between these two methods of 25-OHDF analysis is low and has a concentration dependent bias. Further studies are necessary to clarify the reference values and the indications for 25-OHDF measurement.
Assuntos
Calcifediol/sangue , Ensaio de Imunoadsorção Enzimática/normas , Deficiência de Vitamina D/sangue , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Análise de Regressão , Reprodutibilidade dos Testes , Deficiência de Vitamina D/diagnóstico , Proteína de Ligação a Vitamina D/sangueRESUMO
The aim of this study was to assess the diagnostic value of the Psoriatic Arthritis Screening Evaluation (PASE) and Early Psoriatic Arthritis Screening Questionnaire (EARP) questionnaires in the ultrasonographic detection of enthesitis, synovitis, and tenosynovitis. A cross-sectional study was done in a total of 96 consecutive patients. Double blind clinical examination and echographic assessment were performed. A receiver-operating characteristic (ROC) model analysis for the questionnaires was established using echographic findings as reference variable. The optimal diagnostic point was determined following a Youden analysis model from the obtained data, calculating sensitivity and specificity along with predictive values, likelihood ratio, and diagnostic odds ratio. A logistic regression analysis was used to determine possible predictor variables of enthesitis, synovitis, and tenosynovitis. When enthesitis, synovitis, and tenosynovitis were considered as one outcome for the diagnostic study of the PASE or EARP questionnaire, there were no statistically significant differences among the score of the study groups and the rest of patients. The PASE and EARP tests had a diagnostic performance for enthesitis, synovitis, and tenosynovitis that followed the expected pattern when the prevalence of findings is low. In these cases, the tests increase their negative predictive value, being particularly interesting in ruling out the disease.
Assuntos
Artrite Psoriásica/diagnóstico , Psoríase/complicações , Inquéritos e Questionários , Sinovite/diagnóstico , Tenossinovite/diagnóstico , Adulto , Idoso , Artrite Psoriásica/complicações , Artrite Psoriásica/diagnóstico por imagem , Estudos Transversais , Feminino , Humanos , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Psoríase/diagnóstico por imagem , Sensibilidade e Especificidade , Sinovite/complicações , Sinovite/diagnóstico por imagem , Tenossinovite/complicações , Tenossinovite/diagnóstico por imagem , UltrassonografiaRESUMO
UNLABELLED: Primary Sjögren syndrome (PSS) is a chronic inflammatory autoimmune disease. Interstitial lung disease (ILD) can be an extraglandular complication. OBJECTIVE: To evaluate the clinical characteristics of patients diagnosed with PSS with ILD. METHODS: Multicentre cohort study with 25 patients diagnosed with PSS and ILD. Data of PSS, prognostic factors, pulmonary involvement variables, complementary tests that suggest a worse diagnosis and treatment given were collected. EULAR index was measured for Sjögren's syndrome. RESULTS: We identified 25 patients. In 15/25 the diagnosis of ILD was done before the diagnosis of PSS. The histopathological patterns found were: 12 NSIP, 5 UIP, 4 OP, 2 LIP. PFRs showed restrictive pattern. The majority of the patients received glucocorticoid therapy, antimalarial or immunosuppressive treatment. CONCLUSIONS: Patients affected with PSS must be screened to catch a precocious diagnosis of ILD. The majority of the patients were diagnosed of ILD before being diagnosed of PSS. Multicenter cohorts are increasingly demanded and a multidisciplinary management is needed.
Assuntos
Doenças Pulmonares Intersticiais/etiologia , Síndrome de Sjogren/complicações , Adulto , Idoso , Feminino , Seguimentos , Humanos , Doenças Pulmonares Intersticiais/diagnóstico , Doenças Pulmonares Intersticiais/patologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Síndrome de Sjogren/diagnóstico , Síndrome de Sjogren/patologiaRESUMO
OBJECTIVES: To analyze the clinical characteristics and the principal causes of osteoporosis in premenopausal women. METHODS: This study included 52 osteoporotic premenopausal women ages 20-51 years (mean 36.2 +/- 7) who were referred to an outpatient rheumatology department for osteoporosis evaluation. Bone mass assessment, automated biochemical profile, urinary calcium excretion, and bone marker assays were performed on all patients. Hormonal measurements were made when a specific etiology was not readily apparent. The diagnosis of osteoporosis was defined by the presence of atraumatic vertebral fractures and/or by densitometric criteria. Previous skeletal fractures, weight, height, body mass index (BMI), age at menarche, and family history of osteoporosis also were recorded. RESULTS: Twenty-nine patients (56%) had idiopathic osteoporosis and 23 (44%) had secondary osteoporosis. Fifteen patients (29%) had vertebral fractures and 12 had previous peripheral fractures. Patients with secondary osteoporosis showed higher BMI (23.2 +/- 3 v 21.2 +/- 2, P =.02) and lower femoral Z-scores of bone mineral density (BMD) (-2.1 +/- 0.6 v -1.5 +/- 0.9, P =.02) than those with idiopathic disease. The most frequent causes of secondary osteoporosis included Cushing syndrome, pregnancy osteoporosis, and osteogenesis imperfecta. Nearly half of the patients (48%) with idiopathic osteoporosis had a family history of osteoporosis. In addition, 11 patients (38%) with idiopathic osteoporosis had associated hypercalciuria. Except for an increase in urinary calcium excretion (248 +/- 53 v 143 +/- 47 mg/24 h, P <.0001), no other significant differences in the remaining variables analyzed were found between hypercalciuric and normocalciuric patients with idiopathic osteoporosis. CONCLUSIONS: Idiopathic osteoporosis was the most frequent diagnosis of pre-menopausal osteoporosis in our unit. These patients showed lower BMI and higher femoral neck Z-scores than patients with secondary causes. A family history of osteoporosis and hypercalciuria were factors frequently associated with this disorder.
Assuntos
Osteoporose/etiologia , Pré-Menopausa , Adulto , Densidade Óssea , Feminino , Colo do Fêmur/diagnóstico por imagem , Colo do Fêmur/metabolismo , Fraturas de Estresse/epidemiologia , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/metabolismo , Pessoa de Meia-Idade , Osteoporose/epidemiologia , Osteoporose/metabolismo , Pacientes Ambulatoriais , Radiografia , Espanha/epidemiologia , Fraturas da Coluna Vertebral/epidemiologiaRESUMO
Sweet's syndrome or acute neutrophilic febrile dermatosis is a systemic disease of unknown etiology characterized by the appearance of skin lesions produced by a neutrophilic dermal infiltrate, fever and peripheral leukocytosis. It may be associated with hematologic diseases, including leukemia, with immune diseases as rheumatoid arthritis, or can occur in isolation. The myelodysplasias are hematological disorders characterized by one or more cytopenias secondary to bone marrow dysfunction. We present the case of a patient with Sweet's syndrome associated with myelodysplastic syndrome and treated with glucocorticoids who did not present a good clinical outcome. We discuss the different treatment of these diseases because in most cases glucocorticoids, which are the treatment of choice in Sweet's syndrome, may be insufficient.
Assuntos
Síndromes Mielodisplásicas/complicações , Síndrome de Sweet/complicações , Idoso , Humanos , MasculinoRESUMO
OBJECTIVES: The aims of this study are to evaluate the level of fear of post-injection pain prior to the administration, the difficulty in handling the device, and the level of satisfaction of patients using a pre-filled syringe versus an etanercept pen, as well as to evaluate the usefulness of the training given by nursing staff prior to starting with the pen, and the preferences of patients after using both devices. METHOD: A prospective study was designed to follow-up a cohort of patients during a 6 months period. The data was collected using questionnaires and analyzed with SPSS 18.00. Rank and McNemar tests were performed. Statistical significance was pre-set at an α level of 0.05. RESULTS: A total of 29 patients were included, of whom 69% female, and with a mean age 52.5±10.9 years. Of these, 48% had rheumatoid arthritis, 28% psoriatic arthritis, 21% ankylosing spondylitis, and 3% undifferentiated spondyloarthropathy. There were no statistically significant differences either with the fear or pain or handling of the device between the syringe and the pen (P=.469; P=.812; P=.169 respectively). At 6 months, 59% of patients referred to being satisfied or very satisfied with the pen. Almost all (93%) found useful or very useful the training given by nursing staff prior to using the pen, and 55% preferred the pen over the pre-filled syringe. CONCLUSIONS: The etanercept pen is another subcutaneous device option for patients with chronic arthritis. According to the present study, nursing educational workshops before starting this therapy are recommended.
Assuntos
Anti-Inflamatórios não Esteroides/administração & dosagem , Artrite/tratamento farmacológico , Imunoglobulina G/administração & dosagem , Preferência do Paciente , Receptores do Fator de Necrose Tumoral/administração & dosagem , Doença Crônica , Educação em Enfermagem , Desenho de Equipamento , Etanercepte , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , SeringasRESUMO
BACKGROUND AND OBJECTIVE: Vertebral fractures (VF) are a major risk factor for the development of further fractures. Therefore, it is important to identify clinical risk factors and laboratory abnormalities related to VF. We aimed to analyse clinical and biochemical alterations related to the presence of radiological VF in postmenopausal women with osteoporosis. PATIENTS AND METHODS: Two-hundred and four postmenopausal women with osteoporosis (aged 64,9 [10] years) who were referred to an outpatient Rheumatology Unit were prospectively included. Bone mineral density (BMD), spine X-ray, and laboratory tests were performed in all participants before treatment. RESULTS: Twenty-eight per cent of patients had VF. Comparing women with and without VF, those with fractures were older (71.9 [10] vs 61.8 [8,6], P<.001), had lower stature (152 [7.2] vs 155 [6.2], P=.01), lower total hip T-score values (-2.2 [0,9] vs -1.9 [0.8], P=.041), higher prevalence of non-VF (38 vs 30%, P=.04) and a higher prevalence of low serum 25(OH)D levels (69 vs 53%, P<.05). In logistic regression analysis, age and BMD at the total hip were independent predictors of VF. Patients over 65 presented a higher frequency of VF (47 vs 12%, P<.0001). In addition, a T-score lower than -2,5 at the total hip was associated with an increased risk of VF (OR 2.5; 95% CI 1.2-4.9). CONCLUSIONS: Over the age of 65 nearly half of the postmenopausal women with osteoporosis have VF and a higher prevalence of low 25(OH)D serum measurements. Spinal X-ray and 25(OH)D serum measurements are especially indicated in this group of women since it influences the therapeutic approach.
Assuntos
Osteoporose Pós-Menopausa/complicações , Fraturas por Osteoporose/etiologia , Fraturas da Coluna Vertebral/etiologia , Idoso , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de RiscoRESUMO
Los pacientes con artritis reumatoide (AR) tratados con fármacos modificadores del curso de la enfermedad están expuestos a desarrollar infecciones potencialmente graves como la leishmaniasis. L. infantum es endémica en el Mediterráneo, hecho que obliga ante un paciente con AR que presenta fiebre y pancitopenia, a descartar este proceso. Un diagnóstico de sospecha precoz, puede evitar un curso y pronóstico fatal (AU)
Patients with rheumatoid arthritis (RA) treated with disease-modifying antirheumatic drugs are susceptible to severe infections such as leishmaniasis. As L. infantum is endemic in the Mediterranean region, it is necessary to rule this infectious process out in any RA patient presenting with fever and pancytopenia. An early diagnosis based on a high suspicion can prevent a fatal outcome (AU)
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Leishmaniose Visceral/complicações , Artrite Reumatoide/tratamento farmacológico , Metotrexato/uso terapêutico , Hidroxicloroquina/administração & dosagem , Glucocorticoides/administração & dosagem , Anfotericina B/administração & dosagem , Prognóstico , Comorbidade , Diagnóstico Diferencial , Diagnóstico PrecoceRESUMO
Primary Sjögren syndrome (PSS) is a chronic inflammatory autoimmune disease. Interstitial lung disease (ILD) can be an extraglandular complication. Objective. To evaluate the clinical characteristics of patients diagnosed with PSS with ILD. Methods. Multicentre cohort study with 25 patients diagnosed with PSS and ILD. Data of PSS, prognostic factors, pulmonary involvement variables, complementary tests that suggest a worse diagnosis and treatment given were collected. EULAR index was measured for Sjögren's syndrome. Results. We identified 25 patients. In 15/25 the diagnosis of ILD was done before the diagnosis of PSS. The histopathological patterns found were: 12 NSIP, 5 UIP, 4 OP, 2 LIP. PFRs showed restrictive pattern. The majority of the patients received glucocorticoid therapy, antimalarial or immunosuppressive treatment. Conclusions. Patients affected with PSS must be screened to catch a precocious diagnosis of ILD. The majority of the patients were diagnosed of ILD before being diagnosed of PSS. Multicenter cohorts are increasingly demanded and a multidisciplinary management is needed (AU)
El síndrome de Sjögren primario (SSP) es una enfermedad inflamatoria autoinmune. La enfermedad pulmonar intersticial (EPI) puede ser una complicación extraglandular. Objetivo. Evaluar las características clínicas de los pacientes diagnosticados de SSP con EPI. Métodos. Estudio de cohortes multicéntrico con 25 pacientes diagnosticados de SSP y EPI. Se recopilaron datos propios del SSP, factores pronóstico, variables de medida de la afectación pulmonar, pruebas complementarias que sugieren un peor pronóstico, así como el tratamiento recibido. Se calculó el índice EULAR para el síndrome de Sjögren. Resultados. Se identificaron 25 pacientes. Quince de ellos fueron diagnosticados de EPI antes que de SSP. Los patrones histopatológicos encontrados fueron 12 con neumonía intersticial inespecífica, 5 con neumonía intersticial común, 4 con neumonía organizada, 2 con neumonía intersticial linfocítica. Las pruebas de función respiratoria mostraron un patrón restrictivo. La mayoría de los pacientes recibió un tratamiento con glucocorticoides, antipalúdicos o inmunodepresores. Conclusiones. Los pacientes afectados por SSP deben ser sometidos a pruebas para detectar un diagnóstico precoz de EPI. La mayoría de los pacientes fueron diagnosticados de EPI antes que de SSP. Los estudios de cohortes multicéntricos son cada vez más demandados y se precisa una gestión multidisciplinar (AU)
Assuntos
Humanos , Masculino , Feminino , Doenças Pulmonares Intersticiais/complicações , Doenças Pulmonares Intersticiais/epidemiologia , Doenças Pulmonares Intersticiais , Síndrome de Sjogren/complicações , Síndrome de Sjogren/epidemiologia , Diagnóstico Precoce , Síndrome de Sjogren/imunologia , Síndrome de Sjogren/fisiopatologia , Síndrome de Sjogren , Prognóstico , Bronquiolite/complicações , Bronquiectasia/complicações , Bronquiectasia , Estudos de CoortesRESUMO
OBJECTIVE: Due to increasing improvement in the diagnosis, evaluation and management of osteoporosis and the development of new tools and drugs, the Spanish Society of Rheumatology (SER) has promoted the development of recommendations based on the best evidence available. These recommendations should be a reference to rheumatologists and other health professionals involved in the treatment of patients with osteoporosis. METHODS: Recommendations were developed following a nominal group methodology and based on a systematic review. The level of evidence and degree of recommendation were classified according to the model proposed by the Center for Evidence Based Medicine at Oxford. The level of agreement was established through Delphi technique. Evidence from previous consensus and available clinical guidelines was used. RESULTS: We have produced recommendations on diagnosis, evaluation and management of osteoporosis. These recommendations include the glucocorticoid-induced osteoporosis, premenopausal and male osteoporosis. CONCLUSIONS: We present the SER recommendations related to the biologic therapy risk management.
Assuntos
Osteoporose , Absorciometria de Fóton , Densidade Óssea , Conservadores da Densidade Óssea/uso terapêutico , Feminino , Humanos , Masculino , Osteoporose/complicações , Osteoporose/diagnóstico , Osteoporose/tratamento farmacológico , Fraturas por Osteoporose/diagnóstico , Fraturas por Osteoporose/etiologia , Fraturas por Osteoporose/terapia , Fatores de Risco , EspanhaRESUMO
Fundamento y objetivo: La arteritis de células gigantes (ACG) es la vasculitis sistémica más frecuente en adultos. En los últimos años, existe un interés creciente en evaluar la utilidad de la ecografía de arterias temporales superficiales (EATS), que permite valorar la inflamación de la pared vascular. Material y métodos: Estudio de cohorte observacional y descriptivo de 120 EATS a 60 pacientes con sospecha clínica de ACG según criterios clásicos de ACR (American College of Rheumatology). Resultados: De todos los pacientes a quienes se les realizó la EATS, el 42,3% presentó diagnóstico de ACG según los criterios de clasificación ACR. La sensibilidad y la especificidad de la ecografía en nuestra cohorte de pacientes con alta sospecha clínica fueron de 81,8 y 93,3%, respectivamente, con un VPP de 90,1% y un VPN de 87,5%. Conclusión: Los resultados avalan la ecografía de arteria temporal bilateral como una técnica útil, indolora, rápida, accesible, de alta especificidad y amplia validez diagnóstica
Background and objective: Giant cell arteritis (GCA) is the most frequent systemic vasculitis in adults. In recent years, the usefulness of temporal artery ultrasound (TAUS) as a diagnostic tool to assess the underlying inflammation of the vascular wall during the inflammatory process has been under clinical investigation. Material and methods: Observational and descriptive cohort study of 120 TAUS in 60 patients with clinical suspicions of GCA, according to the ACR (American College of Rheumatology) classification criteria. Results: Among all patients who underwent ultrasound, 42.3% met clinical criteria for GCA according to ACR. Sensitivity and specificity of TAUS in our cohort with clinical suspicion was 81.8% and 93.3%, respectively. A PPV of 90.1% and a VPN of 87.5% were observed. Conclusion: Our results showed that TAUS as a useful, indolent, fast, and accessible tool with high diagnostic specificity and diagnostic value
Assuntos
Humanos , Masculino , Feminino , Arterite de Células Gigantes/diagnóstico por imagem , Ultrassonografia Doppler/métodos , Artérias Temporais/diagnóstico por imagem , Programas de Rastreamento/métodos , Fatores de Risco , Arterite de Células Gigantes/classificação , Glucocorticoides/uso terapêuticoRESUMO
The influence of osteoprotegerin and RANKL as regulators of osteoclastogenesis and bone remodeling in liver disease and in the development of osteoporosis in primary biliary cirrhosis (PBC) is uncertain. Therefore, 68 women with PBC and 20 healthy females were studied by assessing circulating osteoprotegerin and RANKL. Bone mineral density and markers of bone turnover were measured as well. Osteoprotegerin-mRNA expression was also assessed in liver tissue from 16 patients and 5 controls. Osteoprotegerin was higher in PBC than in controls (5.4 +/- 0.2 vs. 2.9 +/- 0.2 pM/l, P < 0.0001), whilst RANKL was lower in patients than in controls (0.39 +/- 0.06 vs. 1.40 +/- 0.16 pM/l, P < 0.0001). Osteoprotegerin was more elevated in patients with more advanced disease, as defined by bilirubin above 1.2 mg/dl (6.6 +/- 0.6 vs. 5.2 +/- 0.2 pM/l, P = 0.02) or by Mayo over 4 (5.9 +/- 0.3 vs. 4.8 +/- 0.2 pM/l, P = 0.02). Osteoprotegerin and RANKL were unrelated with osteoporosis, and no associations were found with markers of bone remodeling, except for RANKL, which was particularly decreased in patients with low osteocalcin. This marker of bone formation was also higher in patients with elevated circulating osteoprotegerin. Liver osteoprotegerin gene expression was similar in patients and controls, and no correlation was found between liver osteoprotegerin-mRNA and patients' respective circulating levels. In conclusion, osteoprotegerin and RANKL are abnormal in patients with PBC, regardless of osteoporosis. The elevated circulating osteoprotegerin is associated with the severity of disease, but not with gene expression in the liver.
Assuntos
Regulação da Expressão Gênica , Cirrose Hepática Biliar/sangue , Cirrose Hepática Biliar/patologia , Fígado/metabolismo , Fígado/patologia , Osteoprotegerina/sangue , Biomarcadores/metabolismo , Remodelação Óssea , Estudos de Casos e Controles , Feminino , Humanos , Pessoa de Meia-Idade , Osteoprotegerina/genética , Ligante RANK/sangue , RNA Mensageiro/genética , RNA Mensageiro/metabolismoRESUMO
OBJECTIVE: To analyze the influence of a primary care rheumatology consultancy program on the number of referrals to the rheumatology unit (RU), the waiting times for new visits at the RU, and the satisfaction of the general practitioners (GPs) with respect to the RU. METHODS: From September 2003 to August 2004 a consultancy program was carried out by 4 consultant rheumatologists of the RU and 117 GPs, consisting of biweekly clinical sessions in which cases were commented upon prior to referral and local clinical guidelines on 10 musculoskeletal disorders were discussed. Referral rates to the RU, 5-item GP satisfaction questionnaires (patient accessibility to the RU, information obtained after the visit, GP accessibility to the RU, communication between levels, and resolution capacity of the RU), waiting times, and number of patients waiting for a visit were analyzed. These variables were compared before and after the intervention. RESULTS: New referrals to the RU significantly diminished during the intervention year (1141 vs 1652 in the previous year, 5.5% patients referred vs 8.1% previous year; p < 0.0001). GP satisfaction improved significantly for all items (p < 0.0001). The waiting time for first non-urgent visit diminished from 7 months to 1 month (p < 0.01) during the intervention year, and the number of patients on the waiting list was reduced from 790 to 51 (p < 0.05). CONCLUSION: A consultancy program between rheumatologists of a RU and GPs of the same area showed improvement in GP satisfaction and reduced the number of referrals to the RU and the waiting times for new non-urgent visits.