Reumatologia Clinica最新文献

{"title":"Performance of adenosine deaminase in synovial fluid for the diagnosis of tuberculous arthritis: A systematic review and meta-analysis","authors":"Juan Carlos Cortes-Quiroz,&nbsp;Jose Bernal,&nbsp;Jose Rosas,&nbsp;Javier Ena","doi":"10.1016/j.reuma.2023.11.003","DOIUrl":"10.1016/j.reuma.2023.11.003","url":null,"abstract":"<div><h3>Objectives</h3><p>Adenosine deaminase (ADA) activity has shown good performance in diagnosing pleural, peritoneal, and meningeal tuberculosis. This meta-analysis aimed to evaluate the performance of measuring ADA activity in synovial fluid for the early diagnosis of joint tuberculosis.</p></div><div><h3>Methods</h3><p><span>We searched published information in MEDLINE, Embase, Cochrane Library, Web of Science, and MedRxiv databases, as well as unpublished information in the American College of Rheumatology and European League Against </span>Rheumatism for conference abstracts (2012–2021). We also scanned the reference lists of articles. Two reviewers independently applied the criteria for selection, assessed quality, and extracted data (PROSPERO number CRD42021284472).</p></div><div><h3>Results</h3><p>Seven independent studies (<em>N</em> <!-->=<!--> <!-->305 subjects) that compared ADA activity in synovial fluid with a composite reference diagnostic method for tuberculosis were included. Overall, the risk of bias was judged low. Studies were classified as high quality (<em>n</em> <!-->=<!--> <!-->3; 148 subjects) and low quality (<em>n</em> <!-->=<!--> <!-->4; 157 subjects). Pooled sensitivity and specificity of ADA activity was 94% (95% confidence interval [CI], 0.89–98; <em>I</em>² <!-->=<!--> <!-->23%) and 88% (95% CI, 83–92; <em>I</em>² <!-->=<!--> <!-->83%), respectively. The random-effects model for pooled diagnostic Odds ratio was 67.1 (95%CI, 20.3–222.2; <em>I</em>² <!-->=<!--> <!-->30%). The receiver operating characteristic curve area was 0.96 (95% CI, 0.92–0.99). Meta-regression did not identify the quality of the study, country of publication, or the type of assay as a source of heterogeneity.</p></div><div><h3>Conclusions</h3><p>Measuring ADA activity in synovial fluid demonstrates good performance for the early diagnosis of joint tuberculosis.</p></div>","PeriodicalId":47115,"journal":{"name":"Reumatologia Clinica","volume":"20 3","pages":"Pages 117-122"},"PeriodicalIF":1.5,"publicationDate":"2024-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139633072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utilidad de la ecografía reumatológica en la toma de decisiones en la práctica clínica: Estudio unicéntrico longitudinal","authors":"Marta Serrano-Warleta ,&nbsp;Aliuska Palomeque-Vargas ,&nbsp;Rosa Manzo ,&nbsp;Boris Blanco-Cáceres ,&nbsp;Mónica Vazquez-Díaz ,&nbsp;Carlos Guillen-Astete","doi":"10.1016/j.reuma.2023.09.007","DOIUrl":"10.1016/j.reuma.2023.09.007","url":null,"abstract":"<div><h3>Objective</h3><p>The purpose of the present study is to identify the extent to which rheumatological musculoskeletal ultrasound affects clinical decisions in a single-centre observational retrospective study.</p></div><div><h3>Method</h3><p>The results of 801 requests and 1174 consecutive individual ultrasound examinations performed over 10 months were analysed.</p></div><div><h3>Results</h3><p>The most frequent indication was diagnostic assistance (39%) followed by assessment of inflammatory activity (34%). By topography, the hand was the most frequently studied region (51%), followed by the foot (18.1%). Of all requests, 67% had an impact on decision-making. The impact on clinical decision-making was associated with a shorter waiting time for the evaluation of the results, being the greatest in those ultrasound scans performed on demand on the same day of the request. In 73% of bilateral ultrasound studies, findings in one of the joints exemplified the overall result reported.</p></div><div><h3>Conclusions</h3><p>Rheumatological musculoskeletal ultrasound has proven to be a useful decision-making technique, the greater the impact of which is seen the shorter the waiting time before it is performed.</p></div>","PeriodicalId":47115,"journal":{"name":"Reumatologia Clinica","volume":"20 3","pages":"Pages 147-149"},"PeriodicalIF":1.5,"publicationDate":"2024-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139631970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of combined treatment with prednisone and methotrexate versus prednisone alone over laboratory parameters in giant cell arteritis","authors":"Ines Perez-Sancristobal ,&nbsp;Paula Alvarez-Hernandez ,&nbsp;Cristina Lajas-Petisco ,&nbsp;Benjamin Fernandez-Gutierrez","doi":"10.1016/j.reuma.2023.09.011","DOIUrl":"https://doi.org/10.1016/j.reuma.2023.09.011","url":null,"abstract":"<div><h3>Objective</h3><p>To compare the effect of combined treatment with prednisone and methotrexate (MTX) versus prednisone alone over laboratory parameters in giant cell arteritis (GCA).</p></div><div><h3>Patients and methods</h3><p><span>We performed a double-blind, placebo-controlled, randomized clinical trial about usefulness of treatment with prednisone and MTX versus prednisone and placebo in GCA (Ann Intern Med 2001;134:106–114). As a part of follow-up of patients (</span><em>n</em> <!-->=<!--> <!-->42), we performed laboratory analysis in 20 time points during the two-year period of follow-up. To analyze differences, we calculated the area under the curve (AUC) for erythrocyte sedimentation rate (ESR), hemoglobin, and platelets, and compared the results in both groups adjusting by time of follow-up, existence of relapses and dose of prednisone.</p></div><div><h3>Results</h3><p>A total of 724 laboratory measurements were done. Median value of ESR was 33 [18–56] in patients with placebo and 26 [15–44] in patients with MTX (<em>P</em> <!-->=<!--> <!-->0.0002). No significant differences were observed in ESR during relapses. The mean ESR value followed a parallel course in both groups, but was lower in the group with MTX than in the group with placebo in 18 of 20 time points of follow-up. The AUC of ESR by time of follow-up was 28,461.7<!--> <!-->±<!--> <!-->12,326 in the group with placebo and 19,598.4<!--> <!-->±<!--> <!-->8,117 in the group with MTX (mean difference 8,863, 95% CI 1.542–16.184; <em>P</em> <!-->=<!--> <!-->0.019). The course of other laboratory parameters paralleled, without statistical significance, those observed for ESR.</p></div><div><h3>Conclusions</h3><p>These data, along with clinical data, suggest that MTX might play a role as a disease-modifying agent in the treatment of GCA.</p></div>","PeriodicalId":47115,"journal":{"name":"Reumatologia Clinica","volume":"20 2","pages":"Pages 108-112"},"PeriodicalIF":1.5,"publicationDate":"2024-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139473207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comentarios sobre el tratamiento de la osteoporosis por corticoides","authors":"Osvaldo Daniel Messina","doi":"10.1016/j.reuma.2023.07.005","DOIUrl":"https://doi.org/10.1016/j.reuma.2023.07.005","url":null,"abstract":"","PeriodicalId":47115,"journal":{"name":"Reumatologia Clinica","volume":"20 2","pages":"Page 113"},"PeriodicalIF":1.5,"publicationDate":"2024-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139473237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quality of life of patients with rheumatic diseases","authors":"Lourdes Villalobos-Sánchez ,&nbsp;Boris Blanco-Cáceres ,&nbsp;Javier Bachiller-Corral ,&nbsp;María Teresa Rodríguez-Serrano ,&nbsp;Mónica Vázquez-Díaz ,&nbsp;Pablo Lázaro y de Mercado","doi":"10.1016/j.reuma.2023.06.004","DOIUrl":"https://doi.org/10.1016/j.reuma.2023.06.004","url":null,"abstract":"<div><h3>Objective</h3><p>Health-related quality of life (HRQoL) is an important indicator of population health and can measure the impact of medical actions. The main objective of this study was to determine the HRQoL of patients with rheumatic diseases (RD) and compare it with that of the general population.</p></div><div><h3>Methods</h3><p>Observational, cross-sectional, single-center study, with consecutive inclusion of outpatients over 18 years of age seen at a Rheumatology hospital-based outpatient clinic in Madrid. Sociodemographic, clinical variables and HRQoL were recorded. HRQoL was measured with the 5-dimension, 5-level EuroQoL (EQ-5D-5L), which includes the EQ-Index (0–1 scale) and a visual analog scale (VAS, 0–100 scale). A descriptive analysis and a comparison with the HRQoL of the Spanish general population were performed.</p></div><div><h3>Results</h3><p>1144 patients were included, 820 (71.68%) women, with a mean age of 56.1 years (range 18–95), of whom 241 (25.44%) were new patients. In patients with RD, the HRQoL measured with the EQ-Index and with the VAS, was 0.186 and 12 points lower, respectively, than in the general population. The decrease in HRQoL affected the 5 health dimensions, especially “pain/discomfort”, followed by “daily activities” and “mobility”. This reduction in HRQoL was observed in both men and women, and in all age ranges, although it was greater between 18 and 65 years of age. The reduction in HRQoL affected all RD subtypes, especially the “peripheral and axial mechanical pathology” and the “soft tissue pathology” group.</p></div><div><h3>Conclusions</h3><p>Patients with rheumatic diseases report worse HRQoL when compared to the general population in all dimensions of HRQoL.</p></div>","PeriodicalId":47115,"journal":{"name":"Reumatologia Clinica","volume":"20 2","pages":"Pages 59-66"},"PeriodicalIF":1.5,"publicationDate":"2024-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139473205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tuberculosis pleural y endocarditis como complicaciones de origen multifactorial en granulomatosis con poliangítis. Reporte de caso clínico","authors":"Jesús Anguamea-Maldonado,&nbsp;Eduardo Sanchez-Zazueta,&nbsp;Rene Vidal-Morales","doi":"10.1016/j.reuma.2023.08.002","DOIUrl":"10.1016/j.reuma.2023.08.002","url":null,"abstract":"<div><p>We present the case of a 36-year-old woman with a history of granulomatosis with polyangiitis, chronic kidney disease, and systemic arterial hypertension. Debut with dyspnea, weakness, and hemoptysis, she was suspected in atypical pneumonia, discarded, persisting with tachypnea, tachycardia, and chest pain. The protocol for pulmonary tuberculosis was started with negative sputum samples, positive blood culture for <em>Staphylococcus haemolyticus</em>, chest tomography with left pneumothorax and ipsilateral pleural effusion, exudate-type pleural fluid was obtained, acid-fast staining, negative PCR for <em>Mycobacterium tuberculosis</em>. A follow-up echocardiogram was performed due to a new murmur, reporting valvular vegetation, concluding a diagnosis of pleural tuberculosis and endocarditis as complications of multifactorial origin associated with immunosuppression in granulomatosis with polyangiitis.</p></div>","PeriodicalId":47115,"journal":{"name":"Reumatologia Clinica","volume":"20 2","pages":"Pages 104-107"},"PeriodicalIF":1.5,"publicationDate":"2023-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139188888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"External validation of the 2017 ACR/EULAR classification criteria for inflammatory myopathies in a Mexican cohort: Role of autoantibodies in the diagnosis and classification of patients with inflammatory myopathies","authors":"Grisel Guadalupe Sánchez-Mendieta,&nbsp;David Vega-Morales,&nbsp;Miguel Ángel Villarreal-Alarcón,&nbsp;Jesús Eduardo Compean-Villegas,&nbsp;Ilse Andrea Moreno-Arquieta,&nbsp;Dionicio Ángel Galarza-Delgado","doi":"10.1016/j.reuma.2023.11.002","DOIUrl":"10.1016/j.reuma.2023.11.002","url":null,"abstract":"<div><h3>Objective</h3><p>This retrospective study aimed to perform the first external validation of the ACR/EULAR classification criteria for inflammatory myopathy (IIM) in a Mexican dynamic cohort where the patients were evaluated with clinical and laboratory values. As secondary objectives, we presented the clinical characteristics of the patients and included antibodies other than anti Jo1 to evaluate their impact on our population.</p></div><div><h3>Methodology</h3><p>This study included 70 patients with IIM and 70 patients with differential diagnoses of IIM, according to the absolute score of the classification criteria. We obtained sensitivity and specificity in the modality without biopsy, and as an exploratory analysis, we added other antibodies from the myositis extended panel. We analyzed the area under the curve (AUC) of three models: score without antibodies, with anti Jo1 and with any antibody.</p></div><div><h3>Results</h3><p>The ACR/EULAR criteria showed increased specificity and at least similar sensitivity to that of the original cohort (85% sensitivity and 92% specificity), with a cohort point of &gt;55%. When we classified patients into definite, probable, possible, and no IIM categories, by adding the extended myopathy panel, 6 of the 10 patients initially classified as “no IIM” changed their classification to “Probable IIM” and 4 to “Definite IIM”; of the 16 patients classified as “probable IIM,” 15 changed their classification to “Definite IIM.”</p></div><div><h3>Conclusion</h3><p>Considering the limitations of this study, we concluded that the 2017 EULAR/ACR criteria for IIM classification are sensitive and specific for classifying patients with IIM in the Mexican population. Additionally, the addition of antibodies other than anti-Jo1 may improve performance in certain populations.</p></div>","PeriodicalId":47115,"journal":{"name":"Reumatologia Clinica","volume":"20 3","pages":"Pages 142-146"},"PeriodicalIF":1.5,"publicationDate":"2023-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139021171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evento cardiovascular en una cohorte de pacientes con artritis reumatoide en Castilla-La Mancha, utilidad de la ecografía carotídea","authors":"Marco Aurelio Ramírez Huaranga ,&nbsp;David Velasco Sánchez ,&nbsp;Luis Ángel Calvo Pascual ,&nbsp;David Castro Corredor ,&nbsp;María Dolores Mínguez Sánchez ,&nbsp;Verónica Salas Manzanedo ,&nbsp;Eva Revuelta Evrard ,&nbsp;Rocío Arenal López ,&nbsp;Joaquín Anino Fernández ,&nbsp;Marina González Peñas ,&nbsp;Lourdes Martin de la Sierra López ,&nbsp;Laura María Jiménez Rodríguez ,&nbsp;Alberto López Menchero Mora ,&nbsp;Marcos Paulino Huertas","doi":"10.1016/j.reuma.2023.11.001","DOIUrl":"10.1016/j.reuma.2023.11.001","url":null,"abstract":"<div><p>Rheumatoid arthritis (RA) has a mortality rate 1.3–3 times higher than the general population, with cardiovascular mortality accounting for 40%–50% of cases. Currently, cardiovascular disease is considered an extra-articular manifestation of RA (OR: 1.5–4.0). Ultrasound measurement of the intima-media thickness (IMT) of the common carotid artery and the presence of atherosclerotic plaques is a non-invasive method and a surrogate marker of subclinical arteriosclerosis.</p></div><div><h3>Objective</h3><p>To determine if subclinical arteriosclerosis findings through carotid ultrasound can serve as a good predictor of cardiovascular events (CVE) development in a cohort of RA patients over a 10-year period.</p></div><div><h3>Methodology</h3><p>A cohort of RA patients seen in the rheumatology outpatient clinic of a hospital in Castilla-La Mancha in 2013 was evaluated. A prospective evaluation for the development of CVE over the following 10 years was conducted, and its correlation with previous ultrasound findings of IMT and atherosclerotic plaques was analyzed.</p></div><div><h3>Results</h3><p>Eight (24%) patients experienced a CVE. Three (9%) had heart failure, three (9%) had a stroke, and two (6%) experienced acute myocardial infarction. RA patients who developed a CVE had a higher IMT (0.97<!--> <!-->±<!--> <!-->0.08<!--> <!-->mm) compared to the RA patients without cardiovascular complications (0.74<!--> <!-->±<!--> <!-->0.15<!--> <!-->mm) (<em>P</em> <!-->=<!--> <!-->.003). The presence of IMT<!--> <!-->≥<!--> <!-->0.9<!--> <!-->mm and atherosclerotic plaques had a relative risk of 12.25 (<em>P</em> <!-->=<!--> <!-->.012) and 18.66 (<em>P</em> <!-->=<!--> <!-->.003), respectively, for the development of a CVE.</p></div><div><h3>Conclusions</h3><p>Carotid ultrasound in RA patients may allow for early detection of subclinical atherosclerosis before the development of CVE, with IMT<!--> <!-->≥<!--> <!-->0.9<!--> <!-->mm being the most closely associated finding with CVE, unaffected by age.</p></div>","PeriodicalId":47115,"journal":{"name":"Reumatologia Clinica","volume":"20 3","pages":"Pages 150-154"},"PeriodicalIF":1.5,"publicationDate":"2023-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139019914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is the use of secukinumab after anti-TNF therapy greater than expected for the risk of developing inflammatory bowel disease?","authors":"Fatih Albayrak ,&nbsp;Mustafa Gür ,&nbsp;Ahmet Karataş ,&nbsp;Süleyman Serdar Koca ,&nbsp;Bünyamin Kısacık","doi":"10.1016/j.reuma.2023.11.004","DOIUrl":"10.1016/j.reuma.2023.11.004","url":null,"abstract":"<div><h3>Objective</h3><p>In this study, our objective was to present real-life data on the incidence of inflammatory bowel disease (IBD) among patients receiving secukinumab treatment.</p></div><div><h3>Methods</h3><p>The study consisted of 209 patients who had prior exposure to anti-tumor necrosis factor (TNF) or were biologically naive. Patients with a pre-existing history of IBD were excluded from the study.</p></div><div><h3>Results</h3><p>Of the 209 patients in the study, 176 (84.3%) had ankylosing spondylitis, while 33 (15.7%) had psoriatic arthritis. 112 (53.6%) patients had prior exposure to at least one anti-TNF treatment before initiating secukinumab. IBD developed in 10 (4.8%) of the 209 patients. The incidence of IBD among patients who initiated secukinumab as their first biologic agent was 1%. For patients who had previously received any anti-TNF treatment and subsequently transitioned to secukinumab, the incidence of IBD was 8% (<em>p</em> <!-->=<!--> <!-->0.018, odds ratio (OR): 8.38, 95% CI: 1.04–67.45). A mean of 3.67 months (±4.3) after anti-TNF use, whereas IBD symptoms developed in the biologically naive patient after 15 months.</p></div><div><h3>Conclusion</h3><p>Our study observed IBD incidence in 4.8% of patients using secukinumab. Patients who initiated secukinumab after previous anti-TNF treatment exhibited a significantly higher rate and risk of developing IBD. The onset of IBD occurred earlier in these patients (mean 3.67 months), whereas a single case of IBD showed a longer duration (15 months). Further studies with larger patient numbers are warranted to provide a more comprehensive understanding of our findings.</p></div>","PeriodicalId":47115,"journal":{"name":"Reumatologia Clinica","volume":"20 3","pages":"Pages 123-127"},"PeriodicalIF":1.5,"publicationDate":"2023-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139017561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient-journey of fibromyalgia patients: A scoping review","authors":"Teresa Otón ,&nbsp;Loreto Carmona ,&nbsp;Javier Rivera","doi":"10.1016/j.reuma.2023.07.006","DOIUrl":"https://doi.org/10.1016/j.reuma.2023.07.006","url":null,"abstract":"<div><h3>Background</h3><p>Fibromyalgia (FM) is a chronic disease characterized by widespread pain. Although much is known about this disease, research has focused on diagnosis and treatment, leaving aside factors related to patient's experience and the relationship with healthcare system.</p></div><div><h3>Objectives</h3><p>The aim was to analyze the available evidence on the experience of FM patients from the first symptoms to diagnosis, treatment, and follow-up.</p></div><div><h3>Methods</h3><p>A scoping review was carried out. Medline and the Cochrane Library were searched for original studies or reviews dealing with FM and focusing on “patient journey”. Results were organized using a deductive classification of themes.</p></div><div><h3>Results</h3><p>Fifty-four articles were included in the qualitative synthesis. Five themes were identified: the patient journey, the challenge for the health systems, a complex doctor–patient relationship, the importance of the diagnosis, and the difficulty of standardizing the treatment.</p></div><div><h3>Conclusions</h3><p>This scoping review confirms the negative impact of FM on the patient, their social environment, and health systems. It is necessary to minimize the difficulties encountered throughout the diagnosis and follow-up of patients with FM.</p></div>","PeriodicalId":47115,"journal":{"name":"Reumatologia Clinica","volume":"20 2","pages":"Pages 96-103"},"PeriodicalIF":1.5,"publicationDate":"2023-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139473206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}