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Journal Cover Reumatología Clínica
  [SJR: 0.451]   [H-I: 14]   [1 followers]  Follow
    
   Full-text available via subscription Subscription journal
   ISSN (Print) 1699-258X
   Published by Elsevier Homepage  [3043 journals]
  • Evaluación de la implementación de un programa integrado de atención a
           las enfermedades del aparato locomotor
    • Authors: Igor Larrañaga; Myriam Soto-Gordoa; Arantzazu Arrospide; María Luz Jauregi; Jesús Millas; Ricardo San Vicente; Jabier Aguirrebeña; Javier Mar
      Pages: 189 - 196
      Abstract: Publication date: July–August 2017
      Source:Reumatología Clínica, Volume 13, Issue 4
      Author(s): Igor Larrañaga, Myriam Soto-Gordoa, Arantzazu Arrospide, María Luz Jauregi, Jesús Millas, Ricardo San Vicente, Jabier Aguirrebeña, Javier Mar
      Introducción El carácter crónico de las enfermedades del aparato locomotor requieren una atención integrada de atención primaria y las especialidades de reumatología, traumatología y rehabilitación. El objetivo del trabajo fue evaluar la implementación de un modelo organizativo integrado de gestión de la osteoporosis, lumbalgia, enfermedades del hombro y enfermedades de la rodilla mediante el proceso de mejora continua de Deming, teniendo en cuenta las derivaciones y el consumo de recursos. Material y métodos En la fase de planificación se utilizó un modelo de simulación para predecir la evolución del consumo de recursos en cada enfermedad del aparato locomotor y realizar un análisis del impacto presupuestario desde 2012 hasta 2020 en la comarca Goierri-Alto Urola. En la etapa de revisión se evaluó el estado del proceso en 2014 utilizando el análisis estadístico para comprobar el grado de consecución de los objetivos para cada enfermedad. Resultados Según el modelo de simulación la población de pacientes con enfermedad osteomuscular aumentará en un 4,4% en 2020, con un incremento en costes para un sistema convencional de un 5,9%. Si la intervención integrada alcanzase sus objetivos este presupuesto se reduciría en un 8,5%. El análisis estadístico evidenció un descenso de derivaciones a traumatología y una reducción de consultas sucesivas en todas las especialidades. Discusión La implementación del modelo integrado en las enfermedades de osteoporosis, lumbalgia, hombro y rodilla está todavía en un estadio inicial. Sin embargo, el empoderamiento de la atención primaria mejoró la derivación de pacientes y redujo ligeramente los costes. Introduction The chronic nature of musculoskeletal diseases requires an integrated care which involves the Primary Care and the specialities of Rheumatology, Traumatology and Rehabilitation. The aim of this study was to assess the implementation of an integrated organizational model in osteoporosis, low back pain, shoulder disease and knee disease using Deming's continuous improvement process and considering referrals and resource consumption. Material and methods A simulation model was used in the planning to predict the evolution of musculoskeletal diseases resource consumption and to carry out a Budget Impact Analysis from 2012 to 2020 in the Goierri-Alto Urola region. In the checking stage the status of the process in 2014 was evaluated using statistical analysis to check the degree of achievement of the objectives for each speciality. Results Simulation models showed that population with musculoskeletal disease in Goierri-Alto Urola will increase a 4.4% by 2020. Because of that, the expenses for a conventional healthcare system will have increased a 5.9%. However, if the intervention reaches its objectives the budget would decrease an 8.5%. The statistical analysis evidenced a decline in referrals to Traumatology service and a reduction of successive consultations in all specialities. Discussion The implementation of the integrated organizational model in osteoporosis, low back pain, shoulder disease and knee disease is still at an early stage. However...
      PubDate: 2017-07-02T10:31:11Z
      DOI: 10.1016/j.reuma.2016.04.014
       
  • Association between serum dickkopf-1 levels and disease duration in axial
           spondyloarthritis
    • Authors: Roxana Rubio Vargas; Enrique Melguizo Madrid; Concepción González Rodríguez; Federico Navarro Sarabia; Carmen Dominguez Quesada; Rafael Ariza Ariza; Victoria Navarro Compán
      Pages: 197 - 200
      Abstract: Publication date: July–August 2017
      Source:Reumatología Clínica, Volume 13, Issue 4
      Author(s): Roxana Rubio Vargas, Enrique Melguizo Madrid, Concepción González Rodríguez, Federico Navarro Sarabia, Carmen Dominguez Quesada, Rafael Ariza Ariza, Victoria Navarro Compán
      Background Axial spondyloarthritis (axSpA) is characterized by new bone formation. The complex systems underlying this process involve Wnt-signaling pathway. It has been observed that serum levels of dickkopf-1 (DKK-1), an important inhibitor of Wnt-signaling, are decreased in patients with axSpA. However, these data are from studies including only patients with long-standing disease. The aim of this study is to investigate if symptom duration influences on serum DKK-1 levels in patients with axSpA. Material and methods A cross-sectional study including consecutive patients with axSpA (ASAS criteria) naïve for anti-TNF therapy. Collected data included demographic and disease characteristics, time since first symptom onset, assessment of disease activity and function, and determination of DKK-1 serum levels. Patients were classified as early axSpA (symptom duration ≤5 years) and established axSpA (>5 years). Linear regression models were employed to investigate the variables related to DKK-1 serum levels. Results In total, 90 patients were included. Sixty-eight patients had early axSpA and 22 had established disease. Serum levels of DKK-1 were significantly higher in patients with early axSpA compared with established axSpA (22.1±12.6 vs 16.4±10.7pM; p =0.04). Among all tested variables, only symptom duration was significantly and inversely correlated with DKK-1 serum levels (beta: −0.041; p =0.01). Conclusion Serum DKK-1 levels in axSpA depend on disease duration. As disease duration increases, DKK-1 serum levels decrease. Based on this, an intensive treatment at early stages of the disease could have a better outcome on inhibiting/slowing radiographic progression in patients with axSpA.

      PubDate: 2017-07-02T10:31:11Z
      DOI: 10.1016/j.reuma.2016.04.013
       
  • Tofacitinib, an oral Janus kinase inhibitor, for the treatment of Latin
           American patients with rheumatoid arthritis: Pooled efficacy and safety
           analyses of Phase 3 and long-term extension studies
    • Authors: Sebastião Cezar Radominski; Mario Humberto Cardiel; Gustavo Citera; Annelise Goecke; Juan Jose Jaller; Andrea Barranjard Vannucci Lomonte; Pedro Miranda; Patricia Velez; Daniel Xibillé; Kenneth Kwok; Ricardo Rojo; Erika Gabriela García
      Pages: 201 - 209
      Abstract: Publication date: July–August 2017
      Source:Reumatología Clínica, Volume 13, Issue 4
      Author(s): Sebastião Cezar Radominski, Mario Humberto Cardiel, Gustavo Citera, Annelise Goecke, Juan Jose Jaller, Andrea Barranjard Vannucci Lomonte, Pedro Miranda, Patricia Velez, Daniel Xibillé, Kenneth Kwok, Ricardo Rojo, Erika Gabriela García
      Objective Tofacitinib is an oral Janus kinase inhibitor for the treatment of rheumatoid arthritis (RA). We assessed tofacitinib efficacy and safety in the Latin American (LA) subpopulation of global Phase 3 and long-term extension (LTE) studies. Materials and methods Data from LA patients with RA and inadequate response to disease-modifying antirheumatic drugs (DMARDs) were pooled across five Phase 3 studies. Phase 3 patients received tofacitinib 5 or 10mg twice daily (BID), adalimumab or placebo; patients in the single LTE study received tofacitinib 5 or 10mg BID; treatments were administered alone or with conventional synthetic DMARDs. Efficacy was reported up to 12 months (Phase 3) and 36 months (LTE) by American College of Rheumatology (ACR) 20/50/70 response rates, Disease Activity Score (DAS)28-4(erythrocyte sedimentation rate [ESR]) and Health Assessment Questionnaire-Disability Index (HAQ-DI). Incidence rates (IRs; patients with event/100 patient-years) of adverse events (AEs) of special interest were reported. Results The Phase 3 studies randomized 496 LA patients; the LTE study enrolled 756 LA patients from Phase 2 and Phase 3. In the Phase 3 studies, patients who received tofacitinib 5 and 10mg BID showed improvements vs placebo at Month 3 in ACR20 (68.9% and 75.7% vs 35.6%), ACR50 (45.8% and 49.7% vs 20.7%) and ACR70 (17.5% and 23.1% vs 6.9%) responses, mean change from baseline in HAQ-DI (−0.6 and −0.8 vs −0.3) and DAS28-4(ESR) score (−2.3 and −2.4 vs −1.4). The improvements were sustained up to Month 36 in the LTE study. In the Phase 3 studies, IRs with tofacitinib 5 and 10mg BID and placebo were 7.99, 6.57 and 9.84, respectively, for SAEs, and 3.87, 5.28 and 3.26 for discontinuation due to AEs. IRs of AEs of special interest in tofacitinib-treated LA patients were similar to the global population. Conclusion In Phase 3 and LTE studies in LA patients with RA, tofacitinib demonstrated efficacy up to 36 months with a manageable safety profile up to 60 months, consistent with the overall tofacitinib study population.

      PubDate: 2017-07-02T10:31:11Z
      DOI: 10.1016/j.reuma.2016.04.010
       
  • Sustained remission after long-term biological therapy in patients with
           large vessel vasculitis: an analysis of ten cases
    • Authors: Juan P. Vinicki; Rosario García-Vicuña; Miguel Arredondo; Juan P. López-Bote; Jesús A. García-Vadillo; Santos Castañeda; José M. Álvaro-Gracia
      Pages: 210 - 213
      Abstract: Publication date: July–August 2017
      Source:Reumatología Clínica, Volume 13, Issue 4
      Author(s): Juan P. Vinicki, Rosario García-Vicuña, Miguel Arredondo, Juan P. López-Bote, Jesús A. García-Vadillo, Santos Castañeda, José M. Álvaro-Gracia
      Objectives To describe the results obtained in clinical practice with the use of biological therapy (BT) in patients diagnosed with Takayasu arteritis (TA) and giant cell arteritis (GCA). Methods Retrospective single center study of TA/GCA patients who received BT (infliximab [IFX], etanercept [ETN] and tocilizumab [TCZ]). In TA, active disease was defined according to a previous National Institutes of Health study. In GCA, active disease was defined with a modified criteria and clinical manifestations secondary to temporal artery involvement or polymyalgia rheumatica symptoms. Clinical data and outcomes are reported using descriptive statistics. Results Five patients with TA and 5 with GCA were included. The main reason for starting BT was lack of response to prior therapy and/or ≥2 relapses during GC tapering. Five patients started IFX, four TCZ and 1 ETN. Remission was observed before 6 months in all cases. Only one patient had a relapse during long-term follow-up and the overall GC daily dose was reduced by 70%. Two AEs were considered attributable to IFX and one to TCZ. Conclusion A favorable and sustained response to BT was observed in our patients with TA and GCA. Thus, BT might be considered as an alternative in patients with large vessel arteritis refractory to conventional treatment or with GC related comorbidities.

      PubDate: 2017-07-02T10:31:11Z
      DOI: 10.1016/j.reuma.2016.06.003
       
  • Role of physical activity in the management and assessment of rheumatoid
           arthritis patients
    • Authors: María Vanesa Hernández-Hernández; Federico Díaz-González
      Pages: 214 - 220
      Abstract: Publication date: July–August 2017
      Source:Reumatología Clínica, Volume 13, Issue 4
      Author(s): María Vanesa Hernández-Hernández, Federico Díaz-González
      Objectives Rheumatoid arthritis (RA) is a chronic inflammatory disease affecting diarthrodial joints, in which patients tend to perform less physical activity (PA) than recommended. This review focuses on the existing evidence about the relationship of PA and RA, specifically how the former influences joint inflammation, disability, quality of life and pain in RA patients, and also how disease activity potentially impacts PA in these patients. Methods A literature search of EMBASE and MEDLINE databases from January 2000 to January 2015. Results The evidence indicating that PA in RA patients is safe and the benefits from regularly performing, both aerobic and resistance exercises, in these patients include improvement in: quality of life, functionality, pain and number of swollen joints. Interestingly, recent studies suggest that changes in disease activity in RA patients inversely correlate with variations in PA, as assessed by accelerometry. Conclusions The regular monitoring of PA in RA patients might facilitate a more objective evaluation of variations in disease activity, helping physicians to make general and therapeutic recommendations that will improve both the health status and the joint functionality of these patients.

      PubDate: 2017-07-02T10:31:11Z
      DOI: 10.1016/j.reuma.2016.04.003
       
  • Coexistence of sarcoidosis and Familial Mediterranean Fever
    • Authors: Hüseyin Semiz; Senol Kobak
      Pages: 221 - 223
      Abstract: Publication date: July–August 2017
      Source:Reumatología Clínica, Volume 13, Issue 4
      Author(s): Hüseyin Semiz, Senol Kobak
      Sarcoidosis is a chronic inflammatory disease with unknown cause characterized by non-caseating granuloma formations. It may present with bilateral hilar lymphadenopathy, skin lesions, the involvement of eye and symptoms on the locomotor system. FMF (Familial Mediterranean Fever) is an autosomal recessive autoinflammatory disease, characterized by recurrent episodes of fever and polyserositis. Simultaneous occurrence of these diseases is rare. In this paper, we reported the coexistence of sarcoidosis with FMF.

      PubDate: 2017-07-02T10:31:11Z
      DOI: 10.1016/j.reuma.2016.05.001
       
  • Catatonia – An unusual presenting clinical manifestation of systemic
           lupus erythematosus
    • Authors: Debasish Chaudhury; Arshna Qureshi; Shiv Prasad; Ravi Kumar Meena; Simran Sharma
      Pages: 224 - 226
      Abstract: Publication date: July–August 2017
      Source:Reumatología Clínica, Volume 13, Issue 4
      Author(s): Debasish Chaudhury, Arshna Qureshi, Shiv Prasad, Ravi Kumar Meena, Simran Sharma
      A 24-year-old female presented with catatonia and symptoms suggestive of Depressive Disorder. She also gave history of undocumented low grade irregular fever. The patient was worked up to rule out any organic cause or psychiatric illness. However, further investigations revealed immunological profile diagnostic of Systemic Lupus Erythematosus (SLE) with CNS involvement (CNS lupus). The diagnosis of SLE in this patient presenting with catatonia was of practical importance because catatonia as one of the manifestations of SLE or as a standalone presenting symptom is extremely rare. Hence, clinicians should be aware of this rarity so that diagnosis of Neuropsychiatric SLE (NPSLE) or catatonia as a presenting feature of SLE is never missed.

      PubDate: 2017-07-02T10:31:11Z
      DOI: 10.1016/j.reuma.2016.03.013
       
  • Sarcoidosis: An unusual presentation
    • Authors: Pedro Madureira; Sofia Pimenta; Hélder Cardoso; Rui Guimarães Cunha; Lúcia Costa
      Pages: 227 - 229
      Abstract: Publication date: July–August 2017
      Source:Reumatología Clínica, Volume 13, Issue 4
      Author(s): Pedro Madureira, Sofia Pimenta, Hélder Cardoso, Rui Guimarães Cunha, Lúcia Costa
      A 35-year-old man presented with a 3-year history of arthralgia and purple coloration of the skin of his fingers and feet. Hand and foot radiography showed cystic bone lesions on phalanges suggestive of sarcoidosis. Lab tests revealed increased liver enzymes. Liver MRI evidenced an enlarged liver and retroperitoneal lymphadenopathy. Histological analysis of the finger skin, lymph nodes and liver demonstrated the presence of granulomas, confirming the diagnosis of sarcoidosis. The patient started prednisolone with rapid improvement of the symptoms. Skin lesions are divided into two groups: specific for sarcoidosis (with granulomas, lupus pernio-like) and nonspecific (without granulomas, erythema nodosum-like). Specific cutaneous lesions usually cause no other symptoms beyond cosmetic changes. Lupus pernio stands out for having distinctive features but, to the best of our knowledge, the simultaneous involvement of both hands and feet has never been reported.

      PubDate: 2017-07-02T10:31:11Z
      DOI: 10.1016/j.reuma.2016.03.008
       
  • Aortitis por arteritis de células gigantes y artritis psoriásica: una
           asociación infrecuente
    • Authors: M. del Pilar García-Cezón de la Cruz; Raquel Almodóvar; Javier García Pérez; Patricia Fanny Dhimes; Pedro Zarco
      Pages: 230 - 232
      Abstract: Publication date: July–August 2017
      Source:Reumatología Clínica, Volume 13, Issue 4
      Author(s): M. del Pilar García-Cezón de la Cruz, Raquel Almodóvar, Javier García Pérez, Patricia Fanny Dhimes, Pedro Zarco
      Presentamos el caso de una mujer de 65 años seguida por artritis psoriásica, que desarrolló una aortitis por arteritis de células gigantes, con un comienzo de tos seca, fiebre y astenia de 2 meses de evolución. Se realizó estudio descartando procesos tumorales e infecciosos y evidenciándose en la TAC abdominal y la angio-TAC datos indicativos de aortitis. Se realizó biopsia de arteria temporal con confirmación histológica de arteritis de células gigantes. Realizamos una revisión de la información disponible sobre esta infrecuente asociación. We report the case of a 65-year-old woman with psoriatic arthritis who developed aortitis secondary to giant cell arteritis. She presented with a 2-mounth history of dry cough, fever and fatigue. There was no evidence of tumor or infectious processes. Abdominal computed tomographic and computed tomography coronary angiographic findings were suggestive of aortitis. Histological study of a temporal artery biopsy confirmed temporal arteritis. We also review the available literature on this uncommon condition.

      PubDate: 2017-07-02T10:31:11Z
      DOI: 10.1016/j.reuma.2016.03.016
       
  • Manifestaciones cutáneas del síndrome antifosfolípido
    • Authors: Lucía Campos-Muñoz; Alejandro Fueyo-Casado; Jose Antonio Cortés-Toro; Eduardo López-Bran
      Pages: 233 - 234
      Abstract: Publication date: July–August 2017
      Source:Reumatología Clínica, Volume 13, Issue 4
      Author(s): Lucía Campos-Muñoz, Alejandro Fueyo-Casado, Jose Antonio Cortés-Toro, Eduardo López-Bran


      PubDate: 2017-07-02T10:31:11Z
      DOI: 10.1016/j.reuma.2016.03.018
       
  • Cristales de hidroxiapatita y pirofosfato de calcio imitando gota en una
           paciente con esclerosis sistémica
    • Authors: Lucio Ventura-Ríos; Diana Ferrusquia-Toriz
      Pages: 235 - 236
      Abstract: Publication date: July–August 2017
      Source:Reumatología Clínica, Volume 13, Issue 4
      Author(s): Lucio Ventura-Ríos, Diana Ferrusquia-Toriz


      PubDate: 2017-07-02T10:31:11Z
      DOI: 10.1016/j.reuma.2016.04.001
       
  • Presentación simultánea de espondilitis anquilosante e hiperostosis
           esquelética idiopática difusa (enfermedad de Forestier-Rotès-Quérol)
    • Authors: Cristina Clara Macía-Villa; Walter Alberto Sifuentes-Giraldo; Julio Medina-Luezas
      Pages: 237 - 238
      Abstract: Publication date: July–August 2017
      Source:Reumatología Clínica, Volume 13, Issue 4
      Author(s): Cristina Clara Macía-Villa, Walter Alberto Sifuentes-Giraldo, Julio Medina-Luezas


      PubDate: 2017-07-02T10:31:11Z
      DOI: 10.1016/j.reuma.2016.03.017
       
  • Síndrome de activación macrofágica: experiencia sobre el cuestionado
           papel del etopósido
    • Authors: Leslye F. Conde; Karla P. Aedo; Tatiana Miraval-Niño de Guzmán
      Pages: 239 - 240
      Abstract: Publication date: July–August 2017
      Source:Reumatología Clínica, Volume 13, Issue 4
      Author(s): Leslye F. Conde, Karla P. Aedo, Tatiana Miraval-Niño de Guzmán


      PubDate: 2017-07-02T10:31:11Z
      DOI: 10.1016/j.reuma.2016.10.004
       
  • Osteoma osteoide de rodilla simulando artritis psoriásica juvenil
    • Authors: Alina Lucica Boteanu; Walter Alberto Sifuentes-Giraldo; Fred Antón-Pagés; María Luz Gámir-Gámir
      Pages: 240 - 242
      Abstract: Publication date: July–August 2017
      Source:Reumatología Clínica, Volume 13, Issue 4
      Author(s): Alina Lucica Boteanu, Walter Alberto Sifuentes-Giraldo, Fred Antón-Pagés, María Luz Gámir-Gámir


      PubDate: 2017-07-02T10:31:11Z
      DOI: 10.1016/j.reuma.2016.09.004
       
  • Enfermedad de Gaucher: a propósito de un caso
    • Authors: María Mar Herráez-Albendea; Eva Gloria Fernández-Cofrades; María Castillo Jarilla-Fernández; Francisco Jiménez-Burgos
      Pages: 242 - 243
      Abstract: Publication date: July–August 2017
      Source:Reumatología Clínica, Volume 13, Issue 4
      Author(s): María Mar Herráez-Albendea, Eva Gloria Fernández-Cofrades, María Castillo Jarilla-Fernández, Francisco Jiménez-Burgos


      PubDate: 2017-07-02T10:31:11Z
      DOI: 10.1016/j.reuma.2016.09.001
       
  • Enfermedad de Whipple, la gran desconocida
    • Authors: Marina Soledad Moreno García; Marta Casorrán Berges; Pilar S. del Río-Martínez; María Teresa Bosque Peralta
      Pages: 243 - 244
      Abstract: Publication date: July–August 2017
      Source:Reumatología Clínica, Volume 13, Issue 4
      Author(s): Marina Soledad Moreno García, Marta Casorrán Berges, Pilar S. del Río-Martínez, María Teresa Bosque Peralta


      PubDate: 2017-07-02T10:31:11Z
      DOI: 10.1016/j.reuma.2016.08.002
       
  • Artritis séptica sin foco por Eikenella corrodens
    • Authors: María Guerrero Vadillo; María Isabel Sánchez Romero; María Espinosa Malpartida; María Francisca Portero Azorín
      First page: 245
      Abstract: Publication date: July–August 2017
      Source:Reumatología Clínica, Volume 13, Issue 4
      Author(s): María Guerrero Vadillo, María Isabel Sánchez Romero, María Espinosa Malpartida, María Francisca Portero Azorín


      PubDate: 2017-07-02T10:31:11Z
      DOI: 10.1016/j.reuma.2016.07.012
       
  • Hiperparatiroidismo primario: una forma infrecuente de presentación
    • Authors: María Riestra Fernández; Lorena Suárez Gutiérrez; Mar Martínez; Marta Diéguez Felechosa
      Pages: 246 - 247
      Abstract: Publication date: July–August 2017
      Source:Reumatología Clínica, Volume 13, Issue 4
      Author(s): María Riestra Fernández, Lorena Suárez Gutiérrez, Mar Martínez, Marta Diéguez Felechosa


      PubDate: 2017-07-02T10:31:11Z
      DOI: 10.1016/j.reuma.2016.07.004
       
  • Fe de errores de «La actividad de una unidad de densitometría ósea
           española desde el punto de vista de FRAX» <[Reumatol Clin 8 (2012)
           179-183]>
    • Authors: Carmen Gómez-Vaquero; María Bianchi; Pilar Santo; Daniel Roig-Vilaseca; Javier Narváez; Joan M. Nolla
      First page: 248
      Abstract: Publication date: July–August 2017
      Source:Reumatología Clínica, Volume 13, Issue 4
      Author(s): Carmen Gómez-Vaquero, María Bianchi, Pilar Santo, Daniel Roig-Vilaseca, Javier Narváez, Joan M. Nolla


      PubDate: 2017-07-02T10:31:11Z
      DOI: 10.1016/j.reuma.2017.06.001
       
  • Indicador compuesto para evaluar la calidad asistencial en el manejo de
           los pacientes con artritis reumatoide en las consultas externas de
           Reumatología
    • Authors: María Auxiliadora Martín-Martínez; Jose Luis Andreu-Sanchez; Fernando Sanchez-Alonso; Hector Corominas; Jose Javier Perez-Venegas; Jose Andres Roman-Ivorra; Mercedes Alperi; Ricardo Blanco-Alonso; Rafael Caliz; Eugenio Chamizo-Carmona; Jenaro Graña-Gil; Blanca Hernández; Carlos Marras; Ramon Mazzucchelli; Julio Antonio Medina Luezas; Antonio Naranjo-Hernández; Ana Ortiz; Rosa Roselló; Ginés Sanchez-Nievas; Raimon Sanmartí; Paloma Vela-Casasempere
      Abstract: Publication date: Available online 6 August 2017
      Source:Reumatología Clínica
      Author(s): María Auxiliadora Martín-Martínez, Jose Luis Andreu-Sanchez, Fernando Sanchez-Alonso, Hector Corominas, Jose Javier Perez-Venegas, Jose Andres Roman-Ivorra, Mercedes Alperi, Ricardo Blanco-Alonso, Rafael Caliz, Eugenio Chamizo-Carmona, Jenaro Graña-Gil, Blanca Hernández, Carlos Marras, Ramon Mazzucchelli, Julio Antonio Medina Luezas, Antonio Naranjo-Hernández, Ana Ortiz, Rosa Roselló, Ginés Sanchez-Nievas, Raimon Sanmartí, Paloma Vela-Casasempere
      Objetivo El paradigma actual en el tratamiento de la artritis reumatoide (AR) contempla el diagnóstico temprano y el uso precoz de fármacos modificadores de enfermedad (FAME) para alcanzar la remisión o baja actividad inflamatoria, lo cual, se conoce como «treat to target» (T2T). El objetivo del trabajo es desarrollar un indicador compuesto (IC) para evaluar la calidad asistencial en el manejo de los pacientes con AR atendiendo a la estrategia T2T y a otras recomendaciones generales para la atención de estos pacientes. Material y método La construcción del IC siguió las fases: 1) selección de los criterios de calidad mediante un juicio de expertos; 2) priorización de los criterios, a partir de un Delphi con 20 expertos; 3) diseño de los indicadores de calidad, y 4) cálculo del IC ponderado. La fuente de información para el cálculo del IC son las historias clínicas de los pacientes con AR. Resultados De los 37 criterios seleccionados, 12 necesitaron una segunda ronda Delphi. Se priorizaron 31 criterios, los cuales presentaron una mediana en relevancia y factibilidad, en las rondas Delphi, mayor o igual a 7,5, con un rango intercuartílico inferior a 3,5, y un grado de acuerdo (puntuación mayor o igual a 8) igual o superior al 80%. Conclusiones El IC construido, consensuado y ponderado, permite evaluar la calidad asistencial de los pacientes con AR, en las Unidades de Reumatología de hospitales españoles, ofreciendo una medida resumen válida y fácilmente interpretable. Objective The current guidelines in the treatment of rheumatoid arthritis (RA) include the early diagnosis and early use of disease modifying drugs to achieve remission or low disease activity level, known as “Treat to Target” (T2T). The objective of this study is to develop a composite indicator (CI) to evaluate the quality of care in the management of patients with RA, according to the T2T strategy and other general recommendations concerning the management of these patients. Material and method The phases of the construction of the CI were: 1) selection of quality criteria through expert judgment; 2) prioritization of the criteria, according to relevance and feasibility, applying the Delphi methodology (two rounds) involving 20 experts; 3) design of quality indicators; and 4) calculation of the weighted CI, using the mean value in relevance and feasibility granted by the experts. The source of information for the calculation of the CI are the medical records of patients with RA. Results Twelve criteria out of 37 required a second Delphi round. Thirty-one criteria were prioritized. These criteria presented a median in relevance and feasibility greater than or equal to 7.5, with an interquartile range of less than 3.5, and a level of agreement (score greater than or equal to 8) greater than or equal to 80%. Conclusio...
      PubDate: 2017-08-16T06:50:15Z
      DOI: 10.1016/j.reuma.2017.06.017
       
  • Criterios de cribado de enfermedad inflamatoria intestinal y
           espondiloartritis para derivación de pacientes entre Reumatología y
           Gastroenterología
    • Authors: Jesús Sanz Sanz; Xavier Juanola Roura; Daniel Seoane-Mato; Miguel Montoro; Fernando Gomollón
      Abstract: Publication date: Available online 4 August 2017
      Source:Reumatología Clínica
      Author(s): Jesús Sanz Sanz, Xavier Juanola Roura, Daniel Seoane-Mato, Miguel Montoro, Fernando Gomollón
      Objetivo Definir criterios clínicos de cribado de espondiloartritis (SpA) en pacientes con enfermedad inflamatoria intestinal (EII) y viceversa, que sirvan de referencia en la derivación entre Reumatología y Aparato Digestivo. Material y métodos Revisión sistemática de la literatura y Delphi a dos rondas. Formaron parte del comité científico 2 reumatólogos y 2 digestólogos; del panel de expertos, 7 reumatólogos y 7 digestólogos. El comité científico definió los componentes potenciales de los criterios, teniendo en cuenta aspectos de sensibilidad, especificidad, facilidad de uso y estandarización. A continuación, se realizó el Delphi. Aquellos ítems para los que hubo acuerdo en primera o segunda ronda formaron parte de la versión final de los criterios. Resultados Cribado positivo de SpA si se cumple al menos uno de los siguientes: dolor lumbar crónico con inicio antes de los 45 años; dolor lumbar inflamatorio o dolor alternante en nalgas; HLA-B27 positivo; sacroilitis en pruebas de imagen; artritis; entesitis del talón; dactilitis. Cribado positivo de EII si uno de los criterios mayores o al menos dos de los menores. Mayores: rectorragia; diarrea crónica de características orgánicas; enfermedad perianal. Menores: dolor abdominal crónico; anemia ferropénica o ferropenia; manifestaciones extraintestinales; fiebre o febrícula, sin focalidad aparente y de más de una semana de duración; pérdida de peso no explicable; antecedentes familiares de EII. Conclusiones Se han definido criterios de cribado de EII en pacientes con SpA y viceversa. Estos han de ser de utilidad en la detección precoz de dichas patologías. Objective To define clinical screening criteria for spondyloarthritis (SpA) in patients with inflammatory bowel disease (IBD) and vice versa, which can be used as a reference for referring them to the rheumatology or gastroenterology service. Method Systematic literature review and a two-round Delphi method. The scientific committee and the expert panel were comprised of 2 rheumatologists and 2 gastroenterologists, and 7 rheumatologists and 7 gastroenterologists, respectively. The scientific committee defined the initial version of the criteria, taking into account sensitivity, specificity, standardization and ease of application. Afterwards, members of the expert panel assessed each item in a two-round Delphi survey. Items that met agreement in the first or second round were included in the final version of the criteria. Results Positive screening for SpA if at least one of the following is present: onset of chronic low back pain before 45 years of age; inflammatory low back pain or alternating buttock pain; HLA-B27 positivity; sacroiliitis on imaging; arthritis; heel enthesitis; dactylitis. Positive screening for IBD in the presence of one of the major criteria or at least two minor criteria. Major: rectal bleeding; chronic diarrhea with organic characteristics; perianal disease. Minor: chronic abdominal pain; iron deficiency anemia or iron deficiency; extraintestinal manifestations; fever or low grade fever, of unknown origin and duration >1week; unexplained weight loss; family history of IBD. Conclusion Screening criteria for IBD in patients with SpA, and vice versa, have been developed. These criteria will be u...
      PubDate: 2017-08-05T22:45:57Z
      DOI: 10.1016/j.reuma.2017.07.001
       
  • High Prevalence of Gallstone Disease in Rheumatoid Arthritis: A New
           Comorbidity Related to Dyslipidemia'
    • Authors: María Carmen García-Gómez; Eugenia de Lama; Sergi Ordoñez-Palau; Joan Miquel Nolla; Emili Corbella; Xavier Pintó
      Abstract: Publication date: Available online 2 August 2017
      Source:Reumatología Clínica
      Author(s): María Carmen García-Gómez, Eugenia de Lama, Sergi Ordoñez-Palau, Joan Miquel Nolla, Emili Corbella, Xavier Pintó
      Objective To assess the prevalence of gallstone disease and identify associated risk factors in rheumatoid arthritis (RA) patients compared to the general population. Methods Eighty-four women with rheumatoid arthritis were included in the study. Each patient was assessed via a structured interview, physical examination, abdominal ultrasound and blood test including lipid profile. The prevalence of gallstone disease in rheumatoid arthritis was compared with data from a study of the Spanish population matched by age groups. Results Twenty-eight of the 84 women had gallstone disease (33.3%). RA women with and without gallstone disease were similar in most of the variables assessed, except for older age and menopausal status in the former. A greater prevalence of gallstone disease was seen in rheumatoid arthritis patients compared to the general population of the same age; however, the differences were significant only in women aged 60 or older (45.5% versus 23.1% respectively, P-value .008). The age-adjusted OR of developing gallstone disease in RA women compared with general population women was 2,3 (95% CI: 1.3–4.1). A significantly higher HDL3-c subfraction and higher apoA-I/HDL and HDL3-c/TC ratios were observed in patients with gallstone disease. Conclusion Women with rheumatoid arthritis may have a predisposition to gallstones that can manifest in middle or older age compared with women in the general population. This situation could be related to chronic inflammation and HDL metabolism.

      PubDate: 2017-08-05T22:45:57Z
      DOI: 10.1016/j.reuma.2017.06.013
       
  • Prevalencia de enfermedades reumáticas en población adulta en España
           (estudio EPISER 2016). Objetivos y metodología
    • Authors: Daniel Seoane-Mato; Carlos Sánchez-Piedra; Lucía Silva-Fernández; Francisca Sivera; Francisco J. Blanco; Fernando Pérez Ruiz; Antonio Juan-Mas; José M. Pego-Reigosa; Javier Narváez; Neus Quilis Martí; Raúl Cortés Verdú; Fred Antón-Pagés; Víctor Quevedo Vila; Gustavo Añez Sturchio; Fermín Medina Varo; María del Mar Ruiz Tudela; Antonio Romero Pérez; Javier Ballina; Anahy Brandy García; Dolores Fábregas Canales; Teresa Font Gayá; Carolina Bordoy Ferrer; Beatriz González Álvarez; Laura Casas Hernández; Fátima Álvarez Reyes; Mónica Delgado Sánchez; Cristina Martínez Dubois; Simón Ángel Sánchez-Fernández; Luisa Marena Rojas Vargas; Paula Virginia García Morales; Alejandro Olivé; Paula Rubio Muñoz; Marta Larrosa; Noemí Navarro Ricos; Eduard Graell Martín; Eugenio Chamizo; Lara Chaves Chaparro; Sara Rojas Herrera; Jordi Pons Dolset; Miguel Ángel Polo Ostariz; Susana Ruiz-Alejos Garrido; Cristina Macía Villa; Ana Cruz Valenciano; María Luisa González Gómez; Mercedes Morcillo Valle; Deseada Palma Sánchez; María José Moreno Martínez; Marta Mayor González; Joana Atxotegi Sáenz de Buruaga; Irati Urionagüena Onaindia; Boris Anthony Blanco Cáceres; Federico Díaz-González; Sagrario Bustabad
      Abstract: Publication date: Available online 31 July 2017
      Source:Reumatología Clínica
      Author(s): Daniel Seoane-Mato, Carlos Sánchez-Piedra, Lucía Silva-Fernández, Francisca Sivera, Francisco J. Blanco, Fernando Pérez Ruiz, Antonio Juan-Mas, José M. Pego-Reigosa, Javier Narváez, Neus Quilis Martí, Raúl Cortés Verdú, Fred Antón-Pagés, Víctor Quevedo Vila, Gustavo Añez Sturchio, Fermín Medina Varo, María del Mar Ruiz Tudela, Antonio Romero Pérez, Javier Ballina, Anahy Brandy García, Dolores Fábregas Canales, Teresa Font Gayá, Carolina Bordoy Ferrer, Beatriz González Álvarez, Laura Casas Hernández, Fátima Álvarez Reyes, Mónica Delgado Sánchez, Cristina Martínez Dubois, Simón Ángel Sánchez-Fernández, Luisa Marena Rojas Vargas, Paula Virginia García Morales, Alejandro Olivé, Paula Rubio Muñoz, Marta Larrosa, Noemí Navarro Ricos, Eduard Graell Martín, Eugenio Chamizo, Lara Chaves Chaparro, Sara Rojas Herrera, Jordi Pons Dolset, Miguel Ángel Polo Ostariz, Susana Ruiz-Alejos Garrido, Cristina Macía Villa, Ana Cruz Valenciano, María Luisa González Gómez, Mercedes Morcillo Valle, Deseada Palma Sánchez, María José Moreno Martínez, Marta Mayor González, Joana Atxotegi Sáenz de Buruaga, Irati Urionagüena Onaindia, Boris Anthony Blanco Cáceres, Federico Díaz-González, Sagrario Bustabad
      Objetivos Describir la metodología del estudio de prevalencia de las enfermedades reumáticas en la población adulta en España, EPISER 2016, así como sus fortalezas y limitaciones. El objetivo del proyecto es estimar la prevalencia de artritis reumatoide (AR), artropatía psoriásica (APs), espondilitis anquilosante (EA), lupus eritematoso sistémico (LES), síndrome de Sjögren (SS), artrosis (de rodilla, cadera, manos, columna cervical y lumbar), fibromialgia, gota y fractura osteoporótica clínica. Material y método Estudio transversal multicéntrico de base poblacional en el que participan 45 municipios de las 17 comunidades autónomas. La población de referencia está compuesta por adultos de 20 o más años residentes en España. La recogida de información se llevará a cabo mediante encuesta telefónica empleando el sistema Computer Assisted Telephone Interview (CATI). Las sospechas diagnósticas y los diagnósticos autorreferidos serán estudiadas por reumatólogos del hospital de referencia de los municipios seleccionados. Análisis estadístico: se calcularán las prevalencias de enfermedades reumáticas mediante estimadores y sus IC del 95%. Se calcularán factores de ponderación en función de la probabilidad de selección en cada una de las etapas del muestreo. Se tendrá en cuenta la distribución de la población en España según datos del Instituto Nacional de Estadística. Conclusiones Los cambios sociodemográficos y en hábitos de vida durante los últimos 16 años justifican la realización de EPISER 2016. El estudio ofrecerá datos actualizados de prevalencia en AR, EA, APs, LES, SS, artrosis, fibromialgia, gota y fractura osteoporótica clínica. Los resultados permitirán comparar los datos con estudios de otros países y con el EPISER 2000. Aims To describe the methodology of the EPISER 2016 (study of the prevalence of rheumatic diseases in adult population in Spain), as well its strengths and limitations. The aim of this study is to estimate the prevalence of rheumatoid arthritis (RA), psoriatic arthritis (PsA), ankylosing spondylitis (AS), systemic lupus erythematosus (SLE), Sjögren's syndrome (SS), osteoarthritis (knee, hip, hands, and cervical and lumbar spine), fibromyalgia, gout and clinical osteoporotic fracture. Material and method Population-based, multicenter, cross-sectional study, with the participation of 45 municipalities in the 17 Spanish autonomous communities. The reference population will consist of adults aged 20 years and over residing in Spain. A computer-assisted telephone interview (CATI) system will be used for data collection. Diagnostic suspicions and diagnoses received by the part...
      PubDate: 2017-08-05T22:45:57Z
      DOI: 10.1016/j.reuma.2017.06.009
       
  • Doble costilla cervical: a propósito de un caso
    • Authors: Nahia Plaza Aulestia; Sergio Rodríguez Montero; María Luisa Velloso Feijoo
      Abstract: Publication date: Available online 31 July 2017
      Source:Reumatología Clínica
      Author(s): Nahia Plaza Aulestia, Sergio Rodríguez Montero, María Luisa Velloso Feijoo


      PubDate: 2017-08-05T22:45:57Z
      DOI: 10.1016/j.reuma.2017.06.015
       
  • Las habilidades de comunicación de los aspirantes a la certificación en
           Reumatología se asocian con su desempeño en el examen clínico objetivo
           estructurado
    • Authors: Virginia Pascual-Ramos; Diana Elsa Flores-Alvarado; Margarita Portela-Hernández; María del Rocío Maldonado-Velázquez; Luis Manuel Amezcua-Guerra; Judith López-Zepeda; Everardo Álvarez; Nadina Rubio; Olga Vera Lastra; Miguel Ángel Saavedra; César Alejandro Arce-Salinas
      Abstract: Publication date: Available online 26 July 2017
      Source:Reumatología Clínica
      Author(s): Virginia Pascual-Ramos, Diana Elsa Flores-Alvarado, Margarita Portela-Hernández, María del Rocío Maldonado-Velázquez, Luis Manuel Amezcua-Guerra, Judith López-Zepeda, Everardo Álvarez, Nadina Rubio, Olga Vera Lastra, Miguel Ángel Saavedra, César Alejandro Arce-Salinas
      Introducción El Consejo Mexicano de Reumatología certifica anualmente reumatólogos mediante una prueba teórica y un examen clínico objetivo estructurado (ECOE). Desde el año 2015, se evalúan las habilidades de comunicación (HC) de los candidatos. Los objetivos fueron comparar las HC evaluadas por el paciente (HCP) y por el médico (HCM) y correlacionarlas con el desempeño de los candidatos en el ECOE. Material y métodos Durante los años 2015, 2016 y 2017, se evaluaron las HC en las estaciones dinámicas, mediante una escala de Likert aplicada a 8 áreas. Pacientes y evaluadores fueron entrenados cada año para calificar a los aspirantes, lo cual se realizó el día del ECOE, de manera ciega, por ambos. Se calcularon coeficientes de correlación de Pearson. Resultados En general, a lo largo de los 3años, los candidatos obtuvieron puntajes altos en las HC. Los pacientes puntuaron mejor a los candidatos que los evaluadores médicos. Las HCP y las HCM correlacionaron entre sí (de leve a moderado) en la mayoría de las estaciones. El puntaje de las HC de cada candidato correlacionó con su desempeño en la estación correspondiente; se encontraron mejores correlaciones con las HCP. El promedio de las HC de cada candidato correlacionó con el desempeño global en el ECOE, pero no así con la prueba teórica (salvo en el año 2017, cuando hubo una correlación baja). Conclusiones Las HC evaluadas durante un examen de certificación en Reumatología correlacionan con el desempeño de cada candidato en cada estación y en el ECOE global. Background The Mexican Accreditation Council for Rheumatology annually certifies trainees in Rheumatology using a multiple-choice test and an objective structured clinical examination (OSCE). Since 2015, candidate's communication skills (CS) have been rated by both patients and by physician examiners and correlated with results on the OSCE. This study compared the CS from candidates to annual accreditation in Rheumatology as rated by patients and by physician examiners, and assessed whether these correlated with candidate's performance in the OSCE. Material and methods From 2015 to 2017, 8areas of CS were evaluated using a Likert scale, in each OSCE station that involved a patient. Both patient and physician evaluators were trained annually and their evaluations were performed blindly. The associations were calculated using the Pearson correlation coefficient. Results In general, candidates were given high CS scores; the scores from patients of the candidate's CS were better than those of physician examiners; within the majority of the stations, both scores were found to correlate moderately. In addition, the scoring of CS correlated with trainee performance at the corresponding OSCE station. Interestingly, better correlations were found when the skills were rated by the patients compared to physician scores. The average CS score was correlated with the overall OSCE performance for each trainee, but not with the multiple-choice test, except in the 2017 accreditation process, when a weak correlation was found.
      PubDate: 2017-07-28T20:34:25Z
      DOI: 10.1016/j.reuma.2017.06.007
       
  • Miositis como forma de presentación de panarteritis nodosa
    • Authors: Romina Calvo; Melina Negri; Alberto Ortiz; Susana Roverano; Sergio Paira
      Abstract: Publication date: Available online 26 July 2017
      Source:Reumatología Clínica
      Author(s): Romina Calvo, Melina Negri, Alberto Ortiz, Susana Roverano, Sergio Paira
      Varón de 47 años que consulta por pérdida de peso, dolor con tumefacción en pantorrillas, fiebre, hipertensión arterial, orquitis y oligoartritis. Laboratorio: anemia y aumento de enzimas musculares. Resonancia magnética: hiperintensidad en gemelos (miositis). Histología de músculo: infiltrado inflamatorio con atrofia y regeneración perifascicular. Tratamiento: pulsos de metilprednisolona y ciclofosfamida. Mialgias, tumefacción muscular y deambulación dificultosa son hallazgos comunes en poliarteritis nodosa (PAN), no así la miositis demostrada histológicamente y más infrecuente aún como forma de inicio de esta vasculitis. A 47-year-old man presented with weight loss, bilateral calf pain, fever, hypertension, orchitis and oligoarthritis. Lab tests: anemia and elevated muscle enzymes. Resonance magnetic imaging: hyperintensity in gastrocnemius muscles (myositis). Histologic exam of the muscles: inflammatory infiltrate with atrophy and perifascicular regeneration. Treatment: methylprednisone (bolus) and cyclophosphamide. Muscle pain and swelling and difficulty in walking are common in panarteritis nodosa (PAN), whereas histologically demonstrated myositis is not. Even more rare is myositis as the initial presentation of this vasculitis.

      PubDate: 2017-07-28T20:34:25Z
      DOI: 10.1016/j.reuma.2017.06.010
       
  • Sarcoma miofibroblástico de trapecio
    • Authors: Carlos Antonio Guillen Astete; Carmen Larena Grijalva
      Abstract: Publication date: Available online 25 July 2017
      Source:Reumatología Clínica
      Author(s): Carlos Antonio Guillen Astete, Carmen Larena Grijalva


      PubDate: 2017-07-28T20:34:25Z
      DOI: 10.1016/j.reuma.2017.06.011
       
  • Artritis crónica en la infección por virus de Chikunguña
    • Authors: Lourdes Mateo; Silvia Roure
      Abstract: Publication date: Available online 24 July 2017
      Source:Reumatología Clínica
      Author(s): Lourdes Mateo, Silvia Roure
      Introducción La infección por virus de Chikunguña ocasiona artralgias y artritis en la fase aguda de la enfermedad, pero en más de la mitad de los casos las manifestaciones musculoesqueléticas pueden prolongarse en el tiempo y en algunos casos se hacen crónicas. Aunque la poliartralgia es la manifestación crónica más frecuente, también son comunes las formas con poliartritis, tenosinovitis y entesopatía. Objetivo Analizar las características clínicas de los pacientes con manifestaciones articulares persistentes tras la infección por virus de Chikunguña. Pacientes Presentamos 3 casos de artritis crónica tras infección por virus de Chikunguña diagnosticados en las consultas de reumatología de un hospital universitario de Catalunya, todos ellos casos importados tras exposición en zonas de infección epidémica entre 2013-2015. Resultados Los 3 pacientes presentaron clínica articular inflamatoria durante más de un año tras la viriasis (3,2 y un año, respectivamente). En todos los casos en forma de poliartritis con predominio de afectación de pequeñas articulaciones de manos y pies (patrón seudoartritis reumatoide). En las pruebas de laboratorio se observó leve elevación de los reactantes de fase aguda, con negatividad de los marcadores inmunitarios. Dos de las pacientes precisaron tratamiento con glucocorticoides e hidroxicloroquina. La evolución fue hacia una lenta mejoría clínica, pero tan solo una de ellas quedó totalmente asintomática. Conclusiones En el diagnóstico diferencial de la poliartritis crónica se debe considerar la enfermedad por virus de Chikunguña, no solo en las zonas endémicas. Introduction Chikungunya virus infection causes arthralgia and arthritis in the acute phase of the disease but, in more than half of the cases, musculoskeletal manifestations can be prolonged over time and, in some cases, become chronic. Although polyarthralgia is the most frequent chronic manifestation, forms with polyarthritis, tenosynovitis and enthesopathy are also common. Objective To analyze the clinical characteristics of patients with persistent articular manifestations after infection with the Chikungunya virus. Patients Report of 3 cases of chronic arthritis after infection with chikungunya virus diagnosed at outpatient care in a university hospital of Catalonia, all of them imported after exposure in areas of epidemic infection between 2013-2015. Results All three patients had inflammatory joint pain for more than one year after acute disease (3, 2 and 1 years, respectively). In all cases, it appeared as polyarthritis with involvement of small joints of hands and feet (pseudorheumatoid arthritis-like). Laboratory tests showed a slight elevation of acute phase reactants, and analyses for immune markers were negative. Two of the patients required treatment with glucocorticoids and hydroxychloroquine. The course led to slow clinical improvement, but only one of them came to be completely asymptomatic.
      PubDate: 2017-07-28T20:34:25Z
      DOI: 10.1016/j.reuma.2017.06.012
       
  • Fibrosis retroperitoneal nodular asociada a IgG4 como diagnóstico
           diferencial en tumores retroperitoneales. Reporte de un caso
    • Authors: Gabriela Ruiz Mar; Óscar E. Cárdenas Serrano; Jorge Roldan García; A. Cañavera-Constantino; Víctor M. Menéndez Trejo; Óscar Chapa Azuela
      Abstract: Publication date: Available online 19 July 2017
      Source:Reumatología Clínica
      Author(s): Gabriela Ruiz Mar, Óscar E. Cárdenas Serrano, Jorge Roldan García, A. Cañavera-Constantino, Víctor M. Menéndez Trejo, Óscar Chapa Azuela
      Paciente de 55 años de edad con cuadro de dolor en flanco izquierdo irradiado a región lumbar de 4 meses de evolución, con tomografía axial computarizada que reporta tumoración quística en región retroperitoneal que comprime uréter y sistema pielocaliceal izquierdo en contacto con cuerpo y cola de páncreas. Es intervenida quirúrgicamente y se encuentra en reporte patológico definitivo fibrosis retroperitoneal nodular asociada a IgG4; con Ki67 positivo en centros germinales (5%) e IgG4 positivo (40 células plasmáticas en 3 campos de 40x) por inmunohistoquímica. La fibrosis retroperitoneal nodular es una enfermedad poco frecuente, de evolución paulatina con excelente respuesta al manejo con esteroides. El tratamiento quirúrgico se reserva para casos que comprometen estructuras adyacentes, por lo que el identificarlo al estudiar una tumoración retroperitoneal conlleva un mejor pronóstico y sobrevida. The patient was a 55-year-old woman with a 4-month history of pain in left flank that irradiated to the lumbar region. Computed tomography revealed a cystic tumor in the retroperitoneal region that compresses the ureter and left renal pelvis in contact with pancreatic body and tail. Surgery was performed and the definitive pathological report diagnosed nodular retroperitoneal fibrosis associated with IgG4; Ki67-positive in germinal centers (5%) and IgG4-positive (40 plasma cells in 3 fields of 40x) by immunohistochemistry. Retroperitoneal fibrosis is a rare disease, that develops gradually and has an excellent response to steroid management. Surgical treatment is reserved for cases that compromise adjacent structures. Thus, identifying it when studying a retroperitoneal tumor leads to better prognosis and survival.

      PubDate: 2017-07-21T19:34:07Z
      DOI: 10.1016/j.reuma.2017.06.008
       
  • Development and Internal Validation of a Prediction Model to Estimate the
           Probability of Needing Aggressive Immunosuppressive Therapy With
           Cytostatics in de Novo Lupus Nephritis Patients
    • Authors: Mauricio Restrepo-Escobar; Paula Andrea Granda-Carvajal; Fabián Jaimes
      Abstract: Publication date: Available online 18 July 2017
      Source:Reumatología Clínica
      Author(s): Mauricio Restrepo-Escobar, Paula Andrea Granda-Carvajal, Fabián Jaimes
      Objective To develop a multivariable clinical prediction model for the requirement of aggressive immunosuppression with cytostatics, based on simple clinical record data and lab tests. The model is defined in accordance with the result of the kidney biopsies. Methods Retrospective study conducted with data from patients 16 years and older, with SLE and nephritis with less than 6 months of evolution. An initial bivariate analysis was conducted to select the variables to be included in a multiple logistic regression model. Goodness of fit was evaluated using a Hosmer–Lemeshow test (H–L) and the discrimination capacity of the model by means of the area under the ROC (AUC) curve. Results Data from 242 patients was gathered; of these, 18.2% (n=44) did not need an addition of cytostatics according to the findings of their kidney biopsies. The variables included in the final model were 24-h proteinuria, diastolic blood pressure, creatinine, C3 complement and the interaction of hematuria with leukocyturia in urinary sediment. The model showed excellent discrimination (AUC=0.929; 95% CI=0.894–0.963) and adequate calibration (H–L, P =.959). Conclusion In recent-onset LN patients, the decision to use or not to use intensive immunosuppressive therapy could be performed based on our prediction model as an alternative to kidney biopsies.

      PubDate: 2017-07-21T19:34:07Z
      DOI: 10.1016/j.reuma.2017.05.010
       
  • Fibromialgia y Facebook®: más allá del «me gusta»
    • Authors: Paul Jesús Tejada-Llacsa; Judith Cahuana-Aparco; Carlos A. Cordova Cassia
      Abstract: Publication date: Available online 16 July 2017
      Source:Reumatología Clínica
      Author(s): Paul Jesús Tejada-Llacsa, Judith Cahuana-Aparco, Carlos A. Cordova Cassia


      PubDate: 2017-07-21T19:34:07Z
      DOI: 10.1016/j.reuma.2017.05.008
       
  • Diagnóstico de policondritis recidivante en una paciente con tos crónica
           y sin condritis nasal ni auricular
    • Authors: Luis Gorospe Sarasúa; Deisy Barrios-Barreto; Ismael Said-Criado; Carlos de la Puente-Bujidos
      Abstract: Publication date: Available online 16 July 2017
      Source:Reumatología Clínica
      Author(s): Luis Gorospe Sarasúa, Deisy Barrios-Barreto, Ismael Said-Criado, Carlos de la Puente-Bujidos


      PubDate: 2017-07-21T19:34:07Z
      DOI: 10.1016/j.reuma.2017.06.005
       
  • Hiperpigmentación de la mucosa oral y discromía ungueal inducida
           por cloroquina
    • Authors: Gabriel Horta-Baas
      Abstract: Publication date: Available online 16 July 2017
      Source:Reumatología Clínica
      Author(s): Gabriel Horta-Baas


      PubDate: 2017-07-21T19:34:07Z
      DOI: 10.1016/j.reuma.2017.06.003
       
  • Prevalence of Comorbidities in Rheumatoid Arthritis and Evaluation of
           Their Monitoring in Clinical Practice: The Spanish Cohort of the COMORA
           Study
    • Authors: Alejandro Balsa; Leticia Lojo-Oliveira; Mercedes Alperi-López; María García-Manrique; Carmen Ordóñez-Cañizares; Lorena Pérez; Virginia Ruiz-Esquide; Alfonso Corrales; Javier Narváez; José Rey-Rey; Carlos Rodríguez-Lozano; Soledad Ojeda; Santiago Muñoz-Fernández; Joan M. Nolla; José García-Torrón; Fernando Gamero; Rosario García-Vicuña; Blanca Hernández-Cruz; José Campos; José Rosas; José Francisco García-Llorente; Antonio Gómez-Centeno; Rafael Cáliz; Raimon Sanmartí; Alberto Bermúdez; Lydia Abasolo-Alcázar; Antonio Fernández-Nebro; Luis Rodríguez-Rodríguez; Carlos Marras; Miguel Ángel González-Gay; Ihsane Hmamouchi; Emilio Martín-Mola
      Abstract: Publication date: Available online 12 July 2017
      Source:Reumatología Clínica
      Author(s): Alejandro Balsa, Leticia Lojo-Oliveira, Mercedes Alperi-López, María García-Manrique, Carmen Ordóñez-Cañizares, Lorena Pérez, Virginia Ruiz-Esquide, Alfonso Corrales, Javier Narváez, José Rey-Rey, Carlos Rodríguez-Lozano, Soledad Ojeda, Santiago Muñoz-Fernández, Joan M. Nolla, José García-Torrón, Fernando Gamero, Rosario García-Vicuña, Blanca Hernández-Cruz, José Campos, José Rosas, José Francisco García-Llorente, Antonio Gómez-Centeno, Rafael Cáliz, Raimon Sanmartí, Alberto Bermúdez, Lydia Abasolo-Alcázar, Antonio Fernández-Nebro, Luis Rodríguez-Rodríguez, Carlos Marras, Miguel Ángel González-Gay, Ihsane Hmamouchi, Emilio Martín-Mola
      Objectives To describe the prevalence of comorbidities in patients with RA in Spain and discuss their management and implications using data from the Spanish cohort of the multinational study on COMOrbidities in Rheumatoid Arthritis (COMORA). Methods This is a national sub-analysis of the COMORA study. We studied the demographics and disease characteristics of 200 adults patients diagnosed with RA (1987 ACR), and routine practices for screening and preventing the following selected comorbidities: cardiovascular, infections, cancer, gastrointestinal, pulmonary, osteoporosis and depression. Results Patients had a mean age of 58 years and a mean RA duration of 10 years. Mean DAS28 score was 3.3 and approximately 25% of patients were in remission (DAS28 <2.6). Forty-four (22%) patients had ≥1 comorbidity, the most frequent being depression (27%) and obesity (26%). A history of myocardial infarction or stroke was observed in 5% and 1% of patients, respectively, and any solid tumor in 6%. Having a Framingham Risk Score >20% (51%), hypercholesterolemia (46%) or hypertension (41%) and smoking (25%) were the most common CV risk factors. For prostate, colon and skin cancers, only 9%, 10% and 18% of patients, respectively, were optimally monitored. Infections were also inadequately managed, with 7% and 17% of patients vaccinated against influenza and pneumococcal, respectively, as was osteoporosis, with 47% of patients supplemented with vitamin D and 56% with a bone densitometry performed. Conclusions In Spain, the prevalence of comorbidities and CV risk factors in RA patients with established and advanced disease is relatively high, and their management in clinical daily practice remains suboptimal.

      PubDate: 2017-07-21T19:34:07Z
      DOI: 10.1016/j.reuma.2017.06.002
       
  • Embolismo pulmonar central bilateral asintomático por cemento tras
           vertebroplastia múltiple
    • Authors: Luis Gorospe Sarasúa; Paola Arrieta; Deisy Barrios-Barreto; Carlos de la Puente-Bujido
      Abstract: Publication date: Available online 11 July 2017
      Source:Reumatología Clínica
      Author(s): Luis Gorospe Sarasúa, Paola Arrieta, Deisy Barrios-Barreto, Carlos de la Puente-Bujido


      PubDate: 2017-07-21T19:34:07Z
      DOI: 10.1016/j.reuma.2017.06.004
       
  • Edema subcutáneo en dermatomiositis juvenil
    • Authors: Alfonso Ragnar Torres Jiménez; Eunice Solís-Vallejo; Adriana Ivonne Céspedes-Cruz; Magdalena Sánchez-Uribe
      Abstract: Publication date: Available online 11 July 2017
      Source:Reumatología Clínica
      Author(s): Alfonso Ragnar Torres Jiménez, Eunice Solís-Vallejo, Adriana Ivonne Céspedes-Cruz, Magdalena Sánchez-Uribe


      PubDate: 2017-07-21T19:34:07Z
      DOI: 10.1016/j.reuma.2017.06.006
       
  • Afectación del hombro en la gota tofácea
    • Authors: Ana María Tierra Rodriguez; Lucía Pantoja Zarza; Pelayo Brañanova López; Carolina Diez Morrondo
      Abstract: Publication date: Available online 2 July 2017
      Source:Reumatología Clínica
      Author(s): Ana María Tierra Rodriguez, Lucía Pantoja Zarza, Pelayo Brañanova López, Carolina Diez Morrondo


      PubDate: 2017-07-02T10:31:11Z
      DOI: 10.1016/j.reuma.2017.05.011
       
  • Análisis de la efectividad, seguridad y optimización de tocilizumab en
           una cohorte de pacientes con artritis reumatoide en práctica clínica
    • Authors: Natalia Mena-Vázquez; Sara Manrique-Arija; Marta Rojas-Giménez; Inmaculada Ureña-Garnica; Francisco G. Jiménez-Núñez; Antonio Fernández-Nebro
      Abstract: Publication date: Available online 1 July 2017
      Source:Reumatología Clínica
      Author(s): Natalia Mena-Vázquez, Sara Manrique-Arija, Marta Rojas-Giménez, Inmaculada Ureña-Garnica, Francisco G. Jiménez-Núñez, Antonio Fernández-Nebro
      Objetivo Evaluar la efectividad y la seguridad de tocilizumab (TCZ) en pacientes con artritis reumatoide (AR) en práctica clínica; la optimización de dosis y el cambio de formulación intravenosa (iv) a subcutánea (sc). Material y métodos Estudio observacional retrospectivo. Se incluyó a 53 pacientes con AR tratados con TCZ. El desenlace principal fue efectividad de TCZ en la semana 24. Variables de desenlace secundarias incluyeron: efectividad en la semana 52, tiempo de retención del tratamiento, función física y seguridad. También se midió efectividad de la optimización de dosis y del cambio de formulación iv a sc a los 3 y 6 meses. La efectividad se midió con el índice de actividad según el Disease activity score-28. Se usó la prueba T pareada o prueba de rangos con signos de Wilcoxon para evaluar efectividad y el tiempo de supervivencia mediante curvas de Kaplan-Meier. Resultados La proporción de pacientes que alcanzaron la remisión o baja actividad de la enfermedad en las semanas 24 y 52 fue del 75,5 y el 87,3%, respectivamente. La media de tiempo de retención (intervalo de confianza del 95% [IC del 95%]) fue de 81,7 meses (76,6-86,7). Veintiuno de 53 pacientes (39,6%) optimizaron la dosis de TCZ y 35 pacientes cambiaron a TCZ sc desde iv, sin cambios en resultados de efectividad. La tasa de efectos adversos fue 13,6 eventos/100 pacientes-año. Conclusiones Tocilizumab parece efectivo y seguro en AR en práctica clínica. La reducción de dosis parece efectiva en la mayoría de los pacientes en remisión, incluso cuando cambian de iv a sc. Objective To evaluate the effectiveness and safety of tocilizumab (TCZ) in patients with rheumatoid arthritis (RA) in clinical practice, establishing the optimized regimen and switching from intravenous (IV) to subcutaneous (SC) therapy. Material and methods Retrospective observational study. We included 53 RA patients treated with TCZ. The main outcome was TCZ effectiveness at week 24. Secondary outcome variables included effectiveness at week 52, therapeutic maintenance, physical function and safety. The effectiveness of optimization and the switch from IV to SC was evaluated at 3 and 6 months. The efficacy was measured with the Disease Activity Score. Paired t-tests or Wilcoxon were used to evaluate effectiveness and survival time using Kaplan-Meier. Results The proportion of patients who achieved remission or low disease activity at weeks 24 and 52 was 75.5% and 87.3%, respectively. The mean retention time (95% confidence interval [95% CI] was 81.7 months [76.6-86.7]). Twenty-one of 53 patients (39.6%) optimized the TCZ dose and 35 patients switched from IV TCZ to SC, with no changes in effectiveness. The adverse event rate was 13.6 events/100 patient-years. Conclusions Tocilizumab appears to be effective and safe in RA in clinical practice. The optimized regimen appears to be effective in most patients in remission, even when they change from IV to SC.

      PubDate: 2017-07-02T10:31:11Z
      DOI: 10.1016/j.reuma.2017.05.012
       
  • Miositis osificante circunscrita en codo simulando un sarcoma de partes
           blandas: hallazgos clínico-radiológicos similares
    • Authors: Elena Espinosa Muñoz; Diego Ramírez Ocaña; Ana María Martín García; Carmen Puentes Zarzuela
      Abstract: Publication date: Available online 19 June 2017
      Source:Reumatología Clínica
      Author(s): Elena Espinosa Muñoz, Diego Ramírez Ocaña, Ana María Martín García, Carmen Puentes Zarzuela


      PubDate: 2017-06-22T02:09:42Z
      DOI: 10.1016/j.reuma.2017.05.007
       
  • Reumatología intervencionista, una asignatura pendiente
    • Authors: Marco Aurelio Ramírez Huaranga; Ángel Estuardo Plasencia Ezaine
      Abstract: Publication date: Available online 17 June 2017
      Source:Reumatología Clínica
      Author(s): Marco Aurelio Ramírez Huaranga, Ángel Estuardo Plasencia Ezaine


      PubDate: 2017-06-22T02:09:42Z
      DOI: 10.1016/j.reuma.2017.05.009
       
  • Artritis reumatoide y miastenia gravis ocular: efectividad del rituximab
           en el manejo de ambas enfermedades
    • Authors: Marta Novella-Navarro; Juan Salvatierra-Ossorio; María del Mar Muñoz-Gómez; María Pavo-Blanco
      Abstract: Publication date: Available online 16 June 2017
      Source:Reumatología Clínica
      Author(s): Marta Novella-Navarro, Juan Salvatierra-Ossorio, María del Mar Muñoz-Gómez, María Pavo-Blanco


      PubDate: 2017-06-17T00:14:42Z
      DOI: 10.1016/j.reuma.2017.05.006
       
  • Linfoma no Hodgkin y cervicalgia atípica. A propósito de un caso
    • Authors: Natividad Rojas; Carlos Fernandes; Montse Conde; Nuria Montala; Xavier Fornos; Lluís Rosselló; Francésc Pallisó
      Abstract: Publication date: Available online 16 June 2017
      Source:Reumatología Clínica
      Author(s): Natividad Rojas, Carlos Fernandes, Montse Conde, Nuria Montala, Xavier Fornos, Lluís Rosselló, Francésc Pallisó
      La cervicalgia es un motivo de consulta muy frecuente en la consulta médica. Se sabe que al menos un 15% de la población activa y hasta el 40% de los profesionales de riesgo la presentan. Por otro lado, el linfoma óseo primario es una patología muy poco frecuente (menos del 1% de todos los tumores óseos malignos) y la asociación entre ambos ha sido pocas veces descrita. Presentamos el caso clínico de un paciente con clínica compatible con cervicalgia de un mes de evolución, que al examen físico destacaba dolor a la palpación de apófisis espinosas C2-C6 y contractura trapezoidal que no cedía con tratamiento habitual. Posterior a estudios de imagen patológicos, se interviene quirúrgicamente realizando exéresis de cuerpo vertebral C4 y masa tumoral epidural anterior más biopsia compatible con linfoma difuso de células grandes B. Buena evolución al tratamiento quirúrgico y radioterapia. Neck pain is a common reason for seeking medical attention. It affects at least 15% of the labor force and up to 40% of individuals whose occupation is hazardous. On the other hand, primary bone lymphoma is a very rare disease (less than 1% of all malignant bone tumors), and the relationship between the 2 has rarely been mentioned. We report the case of a patient who had a 1-month history of neck pain. The main symptom was pain on palpation of C2-C6 cervical spinous processes and contracture of the trapezius muscle that did not cease with conventional treatment. Imaging studies indicated an abnormality. He underwent surgery and the results of vertebral biopsy were compatible with diffuse large B-cell lymphoma. He was treated with radiotherapy with a good outcome.

      PubDate: 2017-06-17T00:14:42Z
      DOI: 10.1016/j.reuma.2017.03.018
       
  • Nefritis túbulo-intersticial aguda en paciente con espondiloartritis
           axial HLA-B27 en tratamiento con adalimumab
    • Authors: David Castro Corredor; María Dolores Sánchez de la Nieta; Isabel María de Lara Simón
      Abstract: Publication date: Available online 16 June 2017
      Source:Reumatología Clínica
      Author(s): David Castro Corredor, María Dolores Sánchez de la Nieta, Isabel María de Lara Simón
      Los antagonistas del factor de necrosis tumoral-alfa (ATNF) se utilizan en el tratamiento de múltiples enfermedades, como artritis psoriásica, enfermedad de Crohn, espondilitis anquilosante, artritis idiopática juvenil, generalmente, cuando son refractarias al tratamiento de primera línea 1 . La utilización de los ATNF se ha asociado con la inducción de enfermedades autoinmunes, como lupus eritematoso sistémico-like, vasculitis, sarcoidosis-like y, recientemente, nefritis túbulo-intersticial aguda granulomatosa. Describimos un caso de nefritis túbulo-intersticial aguda no granulomatosa en un paciente con espondiloartritis axial HLA-B27 positiva y enfermedad de Crohn en tratamiento con adalimumab. Antagonists of tumor necrosis factor-alpha (ATNF) are used for the treatment of multiple diseases such as psoriatic arthritis, Crohn's disease, ankylosing spondylitis and juvenile idiopathic arthritis, usually, when they are refractory to first-line treatment 1 . The use of ATNF has been associated with the induction of autoimmune diseases such as systemic lupus erythematosus-like disease, vasculitis, sarcoidosis-like diseases and, recently, acute granulomatous tubulointerstitial nephritis. We report a case of acute nongranulomatous tubulointerstitial nephritis in an HLA-B27-positive patient with axial spondyloarthritis and Crohn's disease being treated with adalimumab.

      PubDate: 2017-06-17T00:14:42Z
      DOI: 10.1016/j.reuma.2017.03.012
       
  • Estenosis bronquiales web-like secundarias a granulomatosis con
           poliangeitis
    • Authors: Catalina Ulloa-Clavijo; Miguel Ariza-Prota; Manuel Vaquero-Cacho; Luis Caminal-Montero
      Abstract: Publication date: Available online 11 June 2017
      Source:Reumatología Clínica
      Author(s): Catalina Ulloa-Clavijo, Miguel Ariza-Prota, Manuel Vaquero-Cacho, Luis Caminal-Montero


      PubDate: 2017-06-11T22:36:55Z
      DOI: 10.1016/j.reuma.2017.05.005
       
  • Afectación osteoarticular por Streptococcus pneumoniae tras la
           autorización de las vacunas conjugadas
    • Authors: María Arrizabalaga; Yolanda Borjas; María Peñaranda; Margarita Garau; Enrique Ruíz de Gopegui; Antoni Payeras
      Abstract: Publication date: Available online 7 June 2017
      Source:Reumatología Clínica
      Author(s): María Arrizabalaga, Yolanda Borjas, María Peñaranda, Margarita Garau, Enrique Ruíz de Gopegui, Antoni Payeras


      PubDate: 2017-06-11T22:36:55Z
      DOI: 10.1016/j.reuma.2017.05.003
       
  • Una reflexión sobre el anticoagulante lúpico: cómo lo definimos,
           determinamos e interpretamos
    • Authors: Lara Valor; Diana Hernández-Flórez; Julia Martínez-Barrio; Francisco Javier López Longo
      Abstract: Publication date: Available online 7 June 2017
      Source:Reumatología Clínica
      Author(s): Lara Valor, Diana Hernández-Flórez, Julia Martínez-Barrio, Francisco Javier López Longo


      PubDate: 2017-06-11T22:36:55Z
      DOI: 10.1016/j.reuma.2017.04.013
       
  • Comunicación de un caso de granulomatosis con poliangeítis con
           detección de granulomas en médula ósea
    • Authors: Isabel de la Cámara Fernández; Fernando Lozano Morillo; Luis Morillas López; Mario Martínez López
      Abstract: Publication date: Available online 7 June 2017
      Source:Reumatología Clínica
      Author(s): Isabel de la Cámara Fernández, Fernando Lozano Morillo, Luis Morillas López, Mario Martínez López


      PubDate: 2017-06-11T22:36:55Z
      DOI: 10.1016/j.reuma.2017.05.004
       
  • Unusual presentations and pitfalls of secondary syphilis: Periosteitis,
           tenosynovitis and hepatic abnormalities
    • Authors: Diana Rosa-Gonçalves; Miguel Bernardes; Lúcia Costa
      Abstract: Publication date: Available online 3 June 2017
      Source:Reumatología Clínica
      Author(s): Diana Rosa-Gonçalves, Miguel Bernardes, Lúcia Costa
      We herein describe two cases of secondary syphilis in patients with human immunodeficiency virus (HIV) infection with an unusual presentation, a diffuse polyostotic periosteitis. Patients referred mainly intense bone pain. Other relevant aspects of the clinical pictures were flexor tenosynovitis and hepatic abnormalities. Given the persistence of symptoms, the treatment duration performed was different from most described in literature. However, although more slowly than expected, both obtained a favorable clinical response after treatment with benzathine penicillin G. Presentamos 2 casos de la sífilis secundaria en pacientes con infección por el virus de la inmunodeficiencia humana (VIH) con una presentación inusual, una periosteitis difusa poliostótica. Los pacientes han reportado principalmente al dolor óseo intenso. Otros aspectos relevantes de los cuadros clínicos fueron tenosinovitis y anomalías hepáticas. Dada la persistencia de los síntomas, la duración del tratamiento realizado ha sido diferente de la mayoría de los descritos en la literatura. Sin embargo, aunque más lentamente de lo esperado, ambos han obtenido una respuesta clínica favorable después del tratamiento con benzatina penicilina G.

      PubDate: 2017-06-06T22:07:22Z
      DOI: 10.1016/j.reuma.2017.03.009
       
  • Necesidades informativas de los pacientes con espondiloartritis sobre su
           enfermedad
    • Authors: Raquel Almodóvar; Jordi Gratacós; Pedro Zarco
      Abstract: Publication date: Available online 2 June 2017
      Source:Reumatología Clínica
      Author(s): Raquel Almodóvar, Jordi Gratacós, Pedro Zarco
      Objetivo 1. Describir la información que reciben o buscan los pacientes con espondiloartritis axial y artritis psoriásica. 2. Analizar fórmulas para mejorar la misma. Métodos Análisis cualitativo del discurso en grupos focales (con pacientes asociados y no asociados y reumatólogos) para identificar los elementos que configuran la realidad estudiada, describir las relaciones entre ellos y sintetizar el resultado mediante: 1)segmentación según criterios temáticos; 2)categorización en función de situaciones, relaciones, opiniones, sentimientos u otras; 3)codificación de las diversas categorías, y 4)interpretación de los resultados. Se diseñaron casilleros tipológicos para asegurar la máxima representatividad de la muestra. Resultados El reumatólogo es la principal fuente de información. Las asociaciones de pacientes juegan un papel fundamental y son muy bien valoradas. Internet se consulta con mucha cautela por falta de filtro. Son temas de interés las características de la enfermedad y sus tratamientos, pero también la evolución, el pronóstico y las ayudas sociales, administrativas y de otra índole. Se necesita más información (objetiva y constructiva, no catastrofista), que debe darse de forma progresiva y adaptada a las características y necesidades del paciente. Existen áreas de mejora y de oportunidad que incluyen: la estandarización y actualización de contenidos (basados en la evidencia) y la optimización de materiales (escritos, electrónicos) y de otros recursos, como enfermería o atención primaria. Conclusiones El reumatólogo es la fuente de referencia y de veracidad en relación con la información proporcionada a pacientes con espondiloartritis axial y artritis psoriásica. Se precisan cambios en cuanto al contenido, el formato y las fuentes de información. Objective 1. To describe the information provided to, or inquired about, by patients with axial spondyloarthritis and psoriatic arthritis. 2. To analyze improvements. Methods Analysis of the discourse of focus groups (with patients, some of them from patient associations, and rheumatologists). The discussion included the identification of elements that shape the reality being studied, describing the relationship among them and summarizing the results by: 1)thematic segmentation; 2)categorization according to situations, relationships, opinions, feelings or others; 3)coding of the various categories, and 4)interpretation of results. Representativeness was ensured by using a typological framework. Results Rheumatologists are the main source of information. Patient associations have a fundamental role and are well-regarded. Internet is used with caution due to its limited reliability. Patients are interested in: disease characteristics and treatments, the course and prognosis, and social, administrative and other kinds of support. More information is needed (objective and constructive, avoiding a catastrophic tone); it should be provided progressively, adjusted to patients features and needs. There are areas for improvement including: the standardization and updating of contents (based on scientific evidence), the optimization of informative materials (written, electronic), and other resources such as nursing and primary care.
      PubDate: 2017-06-06T22:07:22Z
      DOI: 10.1016/j.reuma.2017.02.004
       
  • Impactos probables de la reforma migratoria estadounidense: algunos
           escenarios para la reumatología mexicana
    • Authors: Carlos Pineda; Hugo Sandoval
      Abstract: Publication date: Available online 16 May 2017
      Source:Reumatología Clínica
      Author(s): Carlos Pineda, Hugo Sandoval


      PubDate: 2017-05-18T11:02:38Z
      DOI: 10.1016/j.reuma.2017.04.012
       
 
 
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