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OBJECTIVE: In postpartum healthy women, inflammatory lesions of the sacroiliac joint (SIJ) can appear and mimic sacroiliitis. However, the impact of delivery on imaging abnormalities in women with axial spondyloarthritis (axSpA) is unknown. Thus, this study aimed to evaluate the impact of delivery on SIJ imaging in early axSpA. METHOD: Women with axSpA from the French prospective cohort DESIR were included, with a follow-up of 5 years. Demographic and disease characteristics, and SIJ imaging abnormalities at baseline, were described in all women and then according to nulliparous status. Changes on imaging over time were analysed in the 38 women who were nulliparous at baseline and had their first pregnancy with delivery during follow-up. RESULTS: At baseline, nulliparous women were younger and had a higher educational level than other women with axSpA. The presence of sacroiliitis on magnetic resonance imaging (MRI) and X-ray was more frequent in nulliparous women (16.9% vs 9.9% and 33.8% vs 19.4%, respectively). When focusing on first incident deliveries, these patients had more sacroiliitis on X-ray and MRI at baseline than nulliparous patients at the end of follow-up, but lower Ankylosing Spondylitis Disease Activity Score-C-reactive protein (ASDAS-CRP). Only the modified New York score on the left SIJ was statistically different after delivery. CONCLUSION: Pregnancy with delivery does not seem to aggravate imaging in women with. Following axSpA patients who had their first delivery showed a mild increase in left sacroiliitis on X-ray after delivery, but without other signs of structural or inflammatory aggravation on imaging.
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INTRODUCTION: Biologics (bDMARDs) have revolutionized the prognosis of patients with inflammatory arthritis, but are not without serious side effects. The patient must be able to identify them, acquire self-care abilities or skills and adhere to their treatment. Multidisciplinary consultations, including a pharmaceutical consultation could improve the care of these patients. The pharmaceutical presence make it easier to switch to a biosimilar with etended patient support thanks to the community-hospital network. The return on investment is possible thanks to the more frequent use of biosimilars and the pricing of this type of consultation by the "Forfait de Prestation Intermédiaire". METHODOLOGY: Eligible patients are patients with rheumatoid arthritis or spondyloarthritis, treated with subcutaneous bDMARDs. The criteria assessed were patient's knowledge of their biotherapy using the Biosecure score, their medication adherence using the CQR-5, the total of switch to biosimilars perform and the financial statement of the consultations. An assessment of the actions deployed for the community-hospital network. RESULTS: Two hundred and ninety-five patients (47.4%) benefited multidisciplinary consultation. The mean score of the Biosecure score was 69.6/100 (moderate knowledge) and 261 patients (88.5%) were highly adherent. 57 patients (73%) accepted the switch to biosimilar. 197 pharmacy were contacted, all of witch for patients who receive the switch. Overall patient's satisfaction was 26.9/28. CONCLUSION: Multidisciplinary consultations with involvement of the pharmacist should optimized patient care and the management of outpatients treated with bDMARDs. Patients have already expressed their satisfaction with this course of care and the return on investment is positive.
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Antirreumáticos , Artrite Reumatoide , Medicamentos Biossimilares , Humanos , Antirreumáticos/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Encaminhamento e Consulta , Preparações FarmacêuticasRESUMO
UNLABELLED: Patients with axial spondyloarthritis (axSpA) have an increased risk of osteoporosis related to inflammation. We evaluate the performance of low bone mineral density (BMD) in diagnosis of axSpA for patients with symptoms suggestive of the disease. A low BMD (T ≤ -2) could be an additional tool for the diagnosis of axSpA. INTRODUCTION: Diagnosis of axial spondyloarthritis (axSpA) can be challenging, especially in the absence of radiographic abnormalities. Patients with axSpA have an increased risk of osteoporosis related to inflammation. This study evaluated the performance of low bone mineral density (BMD) in diagnosis of axSpA for patients with symptoms suggestive of the disease. METHODS: Medical files of patients that visited a tertiary centre for symptoms suggestive of axSpA were reviewed. Two hundred and sixty-seven patients were classified in confirmed axSpA or unconfirmed axSpA according to the diagnosis of a senior rheumatologist. BMD measurements results and percentage of patients with a low BMD (T ≤ -2) at either spine or hip were compared between the two groups. Diagnostic performances of low BMD (specificity, sensitivity, positive, negative predictive values and positive likelihood ratio (LR+)) were assessed. RESULTS: Compared to patients with unconfirmed axSpA (n = 74), patients with confirmed axSpA (n = 193) had similar age, were more frequently male, with positive HLA B27, higher disease duration and higher C-reactive protein (CRP). Low BMD was more frequent at spine and hip, in patients with confirmed (40.3%) than unconfirmed axSpA (24.6%, p = 0.021). The LR+ of low BMD for an axSpA diagnosis was 2.60 and 3.12 at the spine and hip. In the subgroup of patients without any radiographic abnormalities (n = 128), the LR+ of low BMD for an axSpA diagnosis was 2.90 and 2.54 at the spine and hip. CONCLUSION: In patients with symptoms suggestive of axSpA, a low BMD (T ≤ -2) could be an additional tool for the diagnosis of axSpA.
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Densidade Óssea/fisiologia , Osteoporose/etiologia , Espondilartrite/complicações , Espondilartrite/diagnóstico , Absorciometria de Fóton/métodos , Adulto , Feminino , Colo do Fêmur/fisiopatologia , Articulação do Quadril/fisiopatologia , Humanos , Vértebras Lombares/fisiopatologia , Masculino , Pessoa de Meia-Idade , Osteoporose/diagnóstico , Osteoporose/fisiopatologia , Estudos Retrospectivos , Índice de Gravidade de Doença , Espondilartrite/fisiopatologiaRESUMO
OBJECTIVES: Nowadays, the recommended measures for optimal monitoring of axial Spondyloarthritis (ax-SpA) disease activity are either BASDAI and CRP, or ASDAS-CRP. However, there could be a gap between recommendations and daily practice. We aimed to determine the measures collected by rheumatologists in an ax-SpA follow-up visit, and to determine the impact of a meeting (where rheumatologists reached a consensus on the measures to be collected) on the collection of such measures. METHODS: A consensual meeting of a local network of 32 rheumatologists proposed, four months later, to report at least the BASDAI score in the medical file of every ax-SpA patient at every follow-up visit. An independent investigator reviewed the medical files of 10 consecutive patients per rheumatologist, seen twice during the year (e.g. before and after the meeting). The most frequently collected measures were assessed, and then, the frequency of collection before and after the meeting was compared. RESULTS: A total of 456 medical files from 228 patients were reviewed. Treatment (>60%), CRP (51.3%) and total BASDAI (28.5%) were the most reported measures in medical files. Before/After the meeting, the frequencies of collected measures in medical files were 28.5%/51.7%, 51.3%/52.2%, 16.7%/31.6% and 0.9%/6.1% for BASDAI, CRP, BASDAI + CRP and ASDAS, respectively reaching a statistically significance for BASDAI, ASDAS and BASDAI+CRP (p<0.05). CONCLUSIONS: This study revealed a low rate of systematic report of the recommended outcome measures in ax-SpA. However, it suggests that a consensual meeting involving practicing rheumatologists might be relevant to improve the implementation of such recommendations.
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Avaliação de Processos e Resultados em Cuidados de Saúde , Reumatologia , Espondilite Anquilosante , Adulto , Feminino , França , Pesquisas sobre Atenção à Saúde , Necessidades e Demandas de Serviços de Saúde , Indicadores Básicos de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde/métodos , Avaliação de Processos e Resultados em Cuidados de Saúde/organização & administração , Melhoria de Qualidade , Reumatologia/métodos , Reumatologia/normas , Espondilite Anquilosante/diagnóstico , Espondilite Anquilosante/terapiaRESUMO
Comorbidities are conditions that coexist with a disease of interest, and may lead to a delayed diagnosis, be confounders in analysis of clinical status and course, and increase morbidity and mortality. Therefore, it appears desirable to summarise efficiently one or multiple comorbidities into a single score in an efficient manner, using comorbidity indices and self-administered comorbidity questionnaires. The two most commonly used comorbidity indices are the Charlson Comorbidity Index (CCI) and the Elixhauser et al. comorbidity measure (ECM). The CCI was constructed based on the mortality rates of 607 patients admitted to the general internal medicine service over 1 month; sixteen diseases were included in this index, with different weights, and were selected and weighted based on the strength of their association with mortality. Elixhauser et al. used administrative data to identify the 30 comorbidities that had a major impact on short-term outcomes in acutely hospitalised patients. Although ECM appeared to have better performance in all aspects of validity, difficulty in terms of feasibility in collecting 30 comorbidities may encourage investigators to use the CCI. Self-administered questionnaires could be a valid and reliable alternative approach to assess comorbidities, and a tool to be included in prospective studies.
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Comorbidade , Inquéritos e Questionários , Fatores de Confusão Epidemiológicos , Humanos , Valor Preditivo dos Testes , Prognóstico , Reprodutibilidade dos Testes , Medição de Risco , Fatores de Risco , Fatores de TempoRESUMO
BACKGROUND: Stunting is a major health problem in low-income countries. We aimed to describe the implementation of a lipid-based nutrient supplement (LNS) program in a rural neighborhood in Cambodia and to assess its impact on statural growth. METHOD: This was a before-after comparative study. The program was promoted by the Pédiatres du Monde (PDM) organization between 2011 and 2019 in six villages in a rural area in Cambodia. The supplementation program consisted of daily administration of LNS during the third semester of pregnancy for the mothers and then between 6 and 24 months of age for the toddlers. Anthropometric data of the children were recorded during PDM visits before and after the program implementation, which allowed us to compare child growth in the two groups: control and intervention groups. Primary outcome was height-for-age between 24 and 35 months of age. RESULTS: Overall, 198 data were collected for children between 24 and 35 months of age in the control group. A total of 347 pregnant women were enrolled in the intervention phase. A total of 188 data were collected for children between 24 and 35 months of age in the intervention group. The mean height-for-age z-score in the population receiving LNS was higher than in the control group (-1.14 vs. -1.60, p < 0.001). There was no significant difference between the two groups regarding the weight-for-height z-score (WHZ; -1.11 vs. -1.26, p = 0.18) and children in the intervention group had a higher middle upper-arm circumference z-score (MUACZ; -0.75 vs.. -1.1, p < 0.001). CONCLUSION: LNS supplementation significantly and increased the HAZ between 24 and 35 months of age. However, the fight against malnutrition is complex and needs intervention on multiple levels.
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Suplementos Nutricionais , Desnutrição , Povo Asiático , Estatura , Pré-Escolar , Feminino , Transtornos do Crescimento/epidemiologia , Transtornos do Crescimento/prevenção & controle , Humanos , Lactente , GravidezRESUMO
CLINICAL CASE: A 46-year-old woman with no relevant medical history, native of Honduras and resident in Spain for one and a half months. The patient went to the Emergency Department due to inflammation of the upper eyelid of the right eye, with an area that simulated an abscess. This was drained (obtaining hardly any purulent content). Treatment was prescribed with oral and topical antibiotics, as well as an anti-inflammatory drug. One week later the patient returned, with improvement of the inflammatory signs, but with discomfort and corneal erosions. After eversion of the upper eyelid, a «worm¼ type parasite emerged from the tarsus. The extraction was completed with a clamp, and was later identified as Dermatobia hominis (Dh) by examination of a fresh specimen. The subsequent outcome of the patient was favourable. DISCUSSION: Preseptal cellulitis in patients from tropical and sub-tropical areas can be caused by Dh.
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Dípteros , Infecções Oculares Parasitárias/diagnóstico , Doenças Palpebrais/parasitologia , Miíase/diagnóstico , Animais , Antibacterianos/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Celulite (Flegmão)/tratamento farmacológico , Celulite (Flegmão)/etiologia , Celulite (Flegmão)/parasitologia , Úlcera da Córnea/etiologia , Dexametasona/uso terapêutico , Dípteros/crescimento & desenvolvimento , Drenagem , Quimioterapia Combinada , Doenças Palpebrais/cirurgia , Feminino , Honduras/etnologia , Humanos , Larva , Pessoa de Meia-Idade , Miíase/parasitologia , Tobramicina/uso terapêuticoRESUMO
OBJECTIVE: Comorbidities add to the burden of disease and its complexity, and may prevent the achievement of treat-to-target goals. The objective of this study was to study the relationship between comorbidities and key disease outcomes in spondyloarthritis (SpA), namely function, work ability, and quality of life. METHODS: Patients from the multinational (22 countries), cross-sectional Assessment in SpondyloArthritis international Society (ASAS) Comorbidities in Spondyloarthritis study were included in the analysis, provided they fulfilled the ASAS criteria. Data on comorbidities based on both self- and physician-report were collected through questionnaires and were subsequently used to compute the Rheumatic Disease Comorbidity Index (RDCI). Univariable and multivariable (adjusted for relevant confounders) multilevel (with country as a random effect) linear or logistic (as appropriate) regression analyses were conducted to investigate the relationship between the RDCI and functional ability, work ability, and quality of life. RESULTS: In total, 3,370 of 3,984 recruited patients (85%) fulfilled the ASAS criteria: 66% were male, mean ± SD age was 43 ± 14 years, mean ± SD disease duration was 8.4 ± 9.5 years, and mean ± SD RDCI was 0.7 ± 1.1. At least 1 comorbidity was reported in 51% of patients; 9% had ≥3 comorbidities. RDCI was independently associated with a higher Bath Ankylosing Spondylitis Functional Index score (ß = 0.37, 95% confidence interval [95% CI] 0.30, 0.43), lower EuroQol 5-domain questionnaire (ß = -0.03, 95% CI -0.04, -0.02), less work employment (odds ratio [OR] 0.83, 95% CI 0.76, 0.91), higher absenteeism (OR 1.18, 95% CI 1.04, 1.34), and higher presenteeism (OR 1.42, 95% CI 1.26, 1.61). CONCLUSION: Comorbidities in SpA adversely influence physical function, work ability, and quality of life and are important to take into account in daily clinical practice.
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Comorbidade , Avaliação da Deficiência , Qualidade de Vida , Espondilartrite/fisiopatologia , Espondilite Anquilosante/fisiopatologia , Absenteísmo , Atividades Cotidianas , Adulto , Estudos Transversais , Feminino , Humanos , Incidência , Internacionalidade , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Medição de Risco , Índice de Gravidade de Doença , Sociedades Médicas , Espondilartrite/epidemiologia , Espondilartrite/psicologia , Espondilite Anquilosante/epidemiologia , Espondilite Anquilosante/psicologiaRESUMO
OBJECTIVE: To evaluate the performances (sensitivity, specificity, and positive and negative predictive values) at diagnosis and study visit of the Assessment of SpondyloArthritis international Society (ASAS) criteria in axial spondyloarthritis in patients with chronic back pain (CBP). A secondary objective was to identify the most contributory item to diagnosis/classify spondyloarthritis. METHODS: We conducted a multicenter, cross-sectional study. Patients were ages <45 years with a history of CBP and seeing a rheumatologist in France. Data included items from the different sets of criteria, checking if present at diagnosis ("diagnosis")/after diagnosis, but at study visit ("classification"), and the rheumatologist's diagnosis at study visit. Statistical analysis included descriptive characteristics and performances for diagnosis and classification. The diagnosis of the rheumatologist was considered the "gold standard." RESULTS: A total of 1,210 patients were eligible for our analysis. Sensitivity and specificity for ASAS axial criteria were 0.76 and 0.94, respectively, and 0.87 and 0.92 for diagnostic and classification purposes, respectively. The positive likelihood ratio of the ASAS axial criteria was 13.6 and 10.30 for diagnostic and classification purposes, respectively. The most contributory items to diagnosis and classification were radiographic sacroiliitis, followed by magnetic resonance imaging sacroiliitis for diagnosis and history of uveitis for classification. CONCLUSION: We confirm the validity of the ASAS criteria for both diagnostic and classification purposes in a clinical setting of patients with CBP.
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Dor nas Costas/diagnóstico , Dor Crônica/diagnóstico , Médicos , Sociedades Médicas/normas , Espondilartrite/classificação , Espondilartrite/diagnóstico , Inquéritos e Questionários/normas , Adulto , Dor nas Costas/terapia , Dor Crônica/terapia , Estudos Transversais , Feminino , Humanos , Internacionalidade , Masculino , Reprodutibilidade dos Testes , Reumatologia/métodos , Reumatologia/normas , Adulto JovemRESUMO
Mujer de 46 años, sin antecedentes de interés, natural de Honduras y residente en España desde hace un mes y medio. Acude a urgencias por inflamación del párpado superior del ojo derecho, con zona que simula absceso. Se procede a drenado del mismo (sin obtener apenas contenido purulento), se prescribe tratamiento con antibióticos y antiinflamatorios tópicos y orales. A la semana siguiente acude con mejoría del cuadro inflamatorio, pero con molestias y erosiones corneales. Tras eversión del párpado superior se observa parásito tipo «gusano» emergiendo del tarso. Se completa extracción del mismo con pinza, identificándose como Dermatobia hominis (Dh) mediante examen en fresco. La evolución posterior de la paciente resultó favorable. DISCUSIÓN: La celulitis preseptal en pacientes procedentes de zonas tropicales y subtropicales puede ser causada por Dh
A 46-year-old woman with no relevant medical history, native of Honduras and resident in Spain for one and a half months. The patient went to the Emergency Department due to inflammation of the upper eyelid of the right eye, with an area that simulated an abscess. This was drained (obtaining hardly any purulent content). Treatment was prescribed with oral and topical antibiotics, as well as an anti-inflammatory drug. One week later the patient returned, with improvement of the inflammatory signs, but with discomfort and corneal erosions. After eversion of the upper eyelid, a «worm» type parasite emerged from the tarsus. The extraction was completed with a clamp, and was later identified as Dermatobia hominis (Dh) by examination of a fresh specimen. The subsequent outcome of the patient was favourable. DISCUSSION: Preseptal cellulitis in patients from tropical and sub-tropical areas can be caused by DH
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Humanos , Feminino , Pessoa de Meia-Idade , Doenças Palpebrais/microbiologia , Pálpebras/parasitologia , Miíase/diagnóstico , Miíase/cirurgia , Córnea/parasitologia , Córnea/cirurgia , Antibacterianos/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Fluoresceína/administração & dosagemRESUMO
We present this case that we consider of particular interest in palliative care because of the difficulty we encountered in palliating the patient's symptoms. The difficulties derived, at least in part, from particular personality traits and complex social circumstances. We think this case is an excellent example to demonstrate the complexity of the process of pain and the different resources and techniques that can be used to manage it. We also wish to underline the importance of clinical signs in diagnosis. In fact, this patient showed signs compatible with Pierre-Marie disease (or pulmonary hypertrophic osteoarthropathy, HOA). Finally, we would like to restate a possible link between neoplastic syndromes and the Chernobyl radiation disaster.