Reumatologia Clinica最新文献

{"title":"El viaje del paciente con fibromialgia en Latinoamérica","authors":"Teresa Otón ,&nbsp;Osvaldo Daniel Messina ,&nbsp;Daniel G. Fernández Ávila ,&nbsp;Manuel Robles San Román ,&nbsp;Darío Mata ,&nbsp;Constanza Arguissain ,&nbsp;Jorge Miguel Galindo Guzmán ,&nbsp;Marina Pérez ,&nbsp;Loreto Carmona ,&nbsp;Grupo Fibrojourney Latam","doi":"10.1016/j.reuma.2023.07.003","DOIUrl":"10.1016/j.reuma.2023.07.003","url":null,"abstract":"<div><h3>Objectives</h3><p>To explore the patient journey of people with fibromyalgia (FM) in Latin American countries in order to identify problems in health care and other areas that may be resolvable.</p></div><div><h3>Methods</h3><p>Qualitative study with phenomenological and content analysis approach through focus groups and patient journey (Ux; User Experience) methodology. Nine virtual focus groups were conducted with FM patients and healthcare professionals in Argentina, Mexico and Colombia recruited from key informants and social networks.</p></div><div><h3>Results</h3><p>Forty-three people participated (33 were clinicians and 10 were patients). The agents interacting with the patient in their disease journey are found in three spheres: healthcare (multiple medical specialists and other professionals), support and work life (including patient associations) and socioeconomic context. The line of the journey presents two large sections, two loops and a thin dashed line. The two major sections represent the time from first symptoms to medical visit (characterized by self-medication and denial) and the time from diagnosis to follow-up (characterized by high expectations and multiple contacts to make life changes that are not realized). The two loop phases include (1) succession of misdiagnoses and mistreatments and referrals to specialists and (2) new symptoms every so often, visits to specialists, diagnostic doubts, and impatience. Very few patients manage to reach the final phase of autonomy.</p></div><div><h3>Conclusion</h3><p>The journey of a person with FM in Latin America is full of obstacles and loops. The desired goal is for all the agents involved to understand that self-management by the patient with FM is an essential part of success, and this can only be achieved with early access to resources and guidance from professionals.</p></div>","PeriodicalId":47115,"journal":{"name":"Reumatologia Clinica","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2023-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135654475","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":"Recomendaciones SER sobre la gestión de riesgo del tratamiento con FAME biológicos o sintéticos dirigidos en pacientes con artritis reumatoide","authors":"Alejandro Balsa ,&nbsp;Petra Díaz del Campo Fontecha ,&nbsp;Lucía Silva Fernández ,&nbsp;José Valencia Martín ,&nbsp;Virginia Nistal Martínez ,&nbsp;Fernando León Vázquez ,&nbsp;M. Vanesa Hernández Hernández ,&nbsp;Héctor Corominas ,&nbsp;Rafael Cáliz Cáliz ,&nbsp;José María Aguado García ,&nbsp;Gloria Candelas Rodríguez ,&nbsp;Nora Ibargoyen Roteta ,&nbsp;Arturo Martí Carvajal ,&nbsp;M. Nieves Plana Farras ,&nbsp;Janet Puñal Riobóo ,&nbsp;Hye Sang Park ,&nbsp;Yolanda Triñanes Pego ,&nbsp;Virginia Villaverde García","doi":"10.1016/j.reuma.2023.07.001","DOIUrl":"https://doi.org/10.1016/j.reuma.2023.07.001","url":null,"abstract":"<div><h3>Objective</h3><p>To present recommendations based on the available evidence and the consensus of experts, for risk management of biological treatment and JAK inhibitors in patients with rheumatoid arthritis.</p></div><div><h3>Methods</h3><p>Clinical research questions relevant to the purpose of the document were identified. These questions were reformulated in PICO format (patient, intervention, comparison, outcome) by a panel of experts, selected based on their experience in the area. A systematic review of the evidence was carried out, grading according to the GRADE criteria (Grading of Recommendations Assessment, Development, and Evaluation). Specific recommendations were then formulated.</p></div><div><h3>Results</h3><p>Six PICO questions were proposed by the panel of experts based on their clinical relevance and the existence of recent information regarding the risk of occurrence of serious infections, the risk of reactivation of the hepatitis<!--> <!-->B virus, the risk of reactivation of the virus varicella-zoster, the risk of appearance of skin (melanoma and non-melanoma) or hematological cancer, the risk of appearance of thromboembolic disease and the risk of progression of the human papilloma virus.</p><p>A total of 29 recommendations were formulated, structured by question, based on the evidence found and the consensus of the experts.</p></div><div><h3>Conclusions</h3><p>The SER recommendations on risk management of treatment with biologic therapies and JAK inhibitors in rheumatoid arthritis are presented.</p></div>","PeriodicalId":47115,"journal":{"name":"Reumatologia Clinica","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2023-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72284213","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":"Percepción del profesional sanitario sobre el paciente con síndrome de sensibilidad central-fibromialgia","authors":"Gastón A. Ghio ,&nbsp;Angels Jaen Manzanera ,&nbsp;Julia Torguet Carbonell ,&nbsp;Camila Inés Donoso Isla ,&nbsp;Alirio José Falcón Marchena ,&nbsp;Silvia Martínez Pardo","doi":"10.1016/j.reuma.2023.07.004","DOIUrl":"10.1016/j.reuma.2023.07.004","url":null,"abstract":"<div><h3>Background and objectives</h3><p>Fibromyalgia is characterized by musculoskeletal pain and asthenia of chronic course. Fibromyalgia patients are often a challenge for the health care community as a whole. Existing studies are often limited to the opinion of rheumatologists or family physicians. With this study we seek to know what are the actions, perceptions and knowledge of health professionals as a whole when caring for patients with this disease.</p></div><div><h3>Materials and methods</h3><p>Descriptive cross-sectional study, by means of a self-administered and anonymous survey. Distributed mainly in hospital wards and primary care centers. Statistical analysis of the variables collected was performed (<em>P</em> <!-->˂<!--> <!-->.05).</p></div><div><h3>Results</h3><p>Two hundred surveys were collected, most of them physicians (63.5%; n<!--> <!-->=<!--> <!-->127) or nurses (25.5%; n<!--> <!-->=<!--> <!-->51). 71% of physicians reported using the WHO analgesic scale. 53% (n<!--> <!-->=<!--> <!-->59) use NSAIDs or paracetamol. Antidepressants are the third drug of choice. Most believe that the referral specialists should be rheumatologists or primary care physicians, a similar percentage, that management should be multidisciplinary. Fifty two percent feel discouraged or annoyed when dealing with these patients. Physicians have more negative connotations and believe that the care that the patient receives is mostly influenced by the diagnosis of fibromyalgia, compared to nurses and other professionals.</p></div><div><h3>Conclusions</h3><p>Our study shows that the lack of knowledge and therapeutic tools generates, to a large extent, frustration and discomfort in health personnel. It is important to develop new approaches to this entity.</p></div>","PeriodicalId":47115,"journal":{"name":"Reumatologia Clinica","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2023-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135568222","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":"Neurological manifestations of rheumatoid arthritis – Nearly 50 years of experience","authors":"Beatriz Samões ,&nbsp;Ana Paula Sousa ,&nbsp;Raquel Samões ,&nbsp;Ernestina Santos","doi":"10.1016/j.reuma.2023.09.005","DOIUrl":"10.1016/j.reuma.2023.09.005","url":null,"abstract":"","PeriodicalId":47115,"journal":{"name":"Reumatologia Clinica","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2023-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135568220","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":"Trastornos de la pigmentación como signo guía de enfermedades autoinmunitarias","authors":"Beatriz Clemente Hernández,&nbsp;Itziar Muelas Rives,&nbsp;Adrián Ballano Ruiz,&nbsp;Tamara Gracia Cazaña","doi":"10.1016/j.reuma.2023.09.003","DOIUrl":"10.1016/j.reuma.2023.09.003","url":null,"abstract":"","PeriodicalId":47115,"journal":{"name":"Reumatologia Clinica","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2023-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134934271","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":"Comparación de biomarcadores inflamatorios plasmáticos en pacientes con SIM-PedS versus infecciones potencialmente graves en pacientes pediátricos","authors":"Núria Visa-Reñé,&nbsp;Adriana Rubio-Páez,&nbsp;Núria Mitjans-Rubies,&nbsp;Fernando Paredes-Carmona","doi":"10.1016/j.reuma.2023.09.004","DOIUrl":"10.1016/j.reuma.2023.09.004","url":null,"abstract":"<div><h3>Background</h3><p>Inflammatory biomarkers have been used for the diagnosis and management of multisystemic inflammatory syndrome in children (MIS-C). We aimed to compare the clinical and laboratory findings of MIS-C cases versus other febrile cases cataloged as potentially suspected bacterial infection (non-MIS-C).</p></div><div><h3>Methods</h3><p>Unicentric ambispective observational cohort study (June 2020 to February 2022). We analyzed demographics, clinical symptoms and laboratory findings in MIS-C cases and in non-MIS-C cases with febrile processes of patients under 15 years of age admitted to hospital.</p></div><div><h3>Results</h3><p>We enrolled 54 patients with potential suspected bacterial infection and 20 patients with MIS-C for analysis. Fever (100%), gastrointestinal (80%) and mucocutaneous findings (35%) were common in MIS-C patients, also hypotension (36.8%) and tachycardia (55%). Laboratory findings showed significantly elevated proBNP (70%), ferritin (35%), D-dimer (80%) and lymphopenia (55%) and thrombocytopenia (27.8%) in MIS-C cases. IL-6 values were high in non-MIS-C patients (92.6%).</p></div><div><h3>Conclusions</h3><p>In the management of MIS-C patients, the dynamic monitoring of proBNP, ferritin, D-dimer, lymphocytes and platelets could be helpful to pediatricians to effectively evaluate the progress of MIS-C in the early phases, not IL-6 values. The applicability of the IL-6 level as a prognostic biomarker in MIS-C patients may require closer discussion. In addition, the optimal laboratory markers, as stated in our study, can help establish a biomarkers model to early distinguish the MIS-C versus non-MIS-C in patients who are admitted to febrile syndrome.</p></div>","PeriodicalId":47115,"journal":{"name":"Reumatologia Clinica","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2023-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134934504","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":"Documento de consenso sobre los medicamentos biosimilares en enfermedades inmunomediadas en España","authors":"Emilio Monte-Boquet ,&nbsp;Ángeles Florez ,&nbsp;Guillermo José Alcaín Martínez ,&nbsp;Agustí Sellas","doi":"10.1016/j.reuma.2022.12.001","DOIUrl":"10.1016/j.reuma.2022.12.001","url":null,"abstract":"<div><h3>Objective</h3><p>To improve knowledge about biosimilar medicines and to generate a consensus framework on their use.</p></div><div><h3>Methods</h3><p>Qualitative study. A multidisciplinary group of experts in biosimilar medicines was established (1<!--> <!-->dermatologist, 1<!--> <!-->hospital pharmacist, 1<!--> <!-->rheumatologist, and 1<!--> <!-->gastroenterologist) who defined the sections and topics of the document. A narrative literature review was performed in Medline to identify articles on biosimilar medicines. Systematic reviews, controlled, pre-clinical, clinical, and real-life studies were selected. Based on the results of the review, several general principles and recommendations were generated. The level of agreement was tested in a Delphi that was extended to 66 health professionals who voted from 1 (totally disagree) to 10 (totally agree). Agreement was defined if at least 70% of the participants voted ≥<!--> <!-->7.</p></div><div><h3>Results</h3><p>The literature review included 555 articles. A total of 10 general principles and recommendations were voted upon. All reached the level of agreement established. The document includes data on the main characteristics of biosimilar medicines (definition, development, approval, indication extrapolation, interchangeability, financing, and traceability); published evidence (biosimilarity, efficacy, effectiveness, safety, immunogenicity, efficiency, switch); barriers and facilitators to its use; and data on information for patients.</p></div><div><h3>Conclusions</h3><p>Authorized biosimilar medicines meet all the characteristics of quality, efficacy, and safety. They also significantly help improve patient access to biological therapies and contribute to health system sustainability.</p></div>","PeriodicalId":47115,"journal":{"name":"Reumatologia Clinica","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47751357","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 del ultrasonido para el diagnóstico de enfermedad pulmonar intersticial en enfermedades difusas del tejido conectivo","authors":"Bruno Alexander Velazquez Guevara,&nbsp;Carlos Abud Mendoza,&nbsp;Lesly Rocío de Jesús Avilés Ramírez,&nbsp;Eva Santillán Guerrero","doi":"10.1016/j.reuma.2022.12.006","DOIUrl":"10.1016/j.reuma.2022.12.006","url":null,"abstract":"<div><p>Patients with diffuse connective tissue diseases frequently develop interstitial lung disease, which carries a worse prognosis and shortens survival. High-resolution computed tomography is the first-choice test, and is competitive with histopathology, however, the cost and radiation may limit its use, particularly for screening. Lung ultrasound is a rapid, accessible, reproducible, and inexpensive study that is useful for diagnosis of interstitial lung disease. Furthermore, extensive training is not required to identify the alterations associated with these lung diseases. B lines and pleural irregularities compose the ultrasonographic interstitial syndrome, although it must be kept in mind that it is not specific, and it is necessary to rule out haemodynamic, cardiovascular, and infectious abnormalities. This review highlights the elevated prevalence of this lung condition in the main rheumatological diseases, with emphasis on the usefulness of pulmonary ultrasound.</p></div>","PeriodicalId":47115,"journal":{"name":"Reumatologia Clinica","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45232126","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":"Assessment of liver fibrosis in patients with rheumatoid arthritis treated with methotrexate: Utility of fibroscan and biochemical markers in routine clinical practice","authors":"Andrea de Diego-Sola ,&nbsp;Agustín Castiella Eguzkiza ,&nbsp;Luis María López Domínguez ,&nbsp;Iratxe Urreta Barallobre ,&nbsp;María José Sánchez Iturri ,&nbsp;Joaquín María Belzunegui Otaño ,&nbsp;Eva María Zapata Morcillo","doi":"10.1016/j.reuma.2022.12.003","DOIUrl":"https://doi.org/10.1016/j.reuma.2022.12.003","url":null,"abstract":"<div><h3>Objectives</h3><p>To study the prevalence of liver fibrosis (LF) measured by FibroScan and APRI index in patients with rheumatoid arthritis (AR) undergoing treatment with methotrexate (MTX).</p></div><div><h3>Methods</h3><p>We included 59 patients with RA on MTX. Medical records, FibroScan measures and serological markers of liver damage were compared on the basis of cumulative methotrexate dose.</p></div><div><h3>Results</h3><p>Mean treatment duration was 82.4<!--> <!-->±<!--> <!-->65.1 months and mean cumulative dose was 5214.5<!--> <!-->±<!--> <!-->4031.9<!--> <!-->mg. Five patients met LF criteria by fibroscan, while only one patient had a suggestive APRI score. No statistically significant differences were found in terms of LF measured by both APRI and fibroScan between patients with cumulative doses above and below 4000<!--> <!-->mg. There was also no relationship between LF and treatment duration.</p></div><div><h3>Conclusions</h3><p>The occurrence of LF in patients with RA on MTX is a multifactorial process that does not seem directly related to its cumulative dose. FibroScan may be a useful technique in clinical practice to screen for this complication.</p></div>","PeriodicalId":47115,"journal":{"name":"Reumatologia Clinica","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49906445","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":"Implementation of the recommendations for the psychological management of patients with spondyloarthritis and inflammatory bowel disease","authors":"Ana Urruticoechea-Arana ,&nbsp;Jesús Sanz ,&nbsp;Daniel Ginard ,&nbsp;Yago González-Lama ,&nbsp;Xavier Juanola ,&nbsp;Miriam Almirall ,&nbsp;Natalia Borruel ,&nbsp;Jordi Gratacós ,&nbsp;Estíbaliz Loza","doi":"10.1016/j.reuma.2023.03.003","DOIUrl":"https://doi.org/10.1016/j.reuma.2023.03.003","url":null,"abstract":"<div><h3>Objective</h3><p>To assess and improve the level of implementation of the recommendations for the psychological management of patients with spondyloarthritis (SpA) and associated inflammatory bowel disease (IBD).</p></div><div><h3>Methods</h3><p>Qualitative study. We performed a narrative literature review to identify the recommendations for the psychological management of SpA and associated IBD and to explore their level of implementation. Based on the findings, we developed a national survey to assess: (1) current level of knowledge and implementation of the recommendations; (2) attitudes towards the recommendations; and (3) barriers and facilitators to their implementation. The results of the review and survey were discussed by a multidisciplinary group of 9 expert rheumatologists and gastroenterologists, who defined implementation strategies to increase the uptake of the recommendations.</p></div><div><h3>Results</h3><p>The review included 4 articles, 2 of them included direct recommendations on the identification and management of psychological problems in patients with SpA and IBD. None assessed the level of implementation of the recommendations in routine clinical practice. Our survey showed a great lack of awareness and implementation of the recommendations, even though psychological issues are very relevant for health professionals. Lack of time, resources, and knowledge are considered the main barriers to adherence to the recommendations. We propose several implementation strategies related to educational activities, clinical practice, and others to increase the uptake of reported recommendations.</p></div><div><h3>Conclusions</h3><p>Further research and efforts are required to achieve behaviour changes in clinical practice to improve the identification and management of psychological problems and needs in patients with SpA and IBD.</p></div>","PeriodicalId":47115,"journal":{"name":"Reumatologia Clinica","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49889893","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}