Reumatologia clinica最新文献

{"title":"Patient-journey of fibromyalgia patients: A scoping review","authors":"Teresa Otón ,&nbsp;Loreto Carmona ,&nbsp;Javier Rivera","doi":"10.1016/j.reumae.2023.07.005","DOIUrl":"https://doi.org/10.1016/j.reumae.2023.07.005","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":94193,"journal":{"name":"Reumatologia clinica","volume":"20 2","pages":"Pages 96-103"},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139914996","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":"Response to Letter to the Editor: Thresholds based on bone mineral density for therapeutic decision-making in postmenopausal women and men older than 50 years old under glucocorticoid therapy","authors":"María Lorena Brance ,&nbsp;María Silvia Larroudé ,&nbsp;Luis Fernando Somma ,&nbsp;Luis Agustín Ramirez Stieben ,&nbsp;Lucas R. Brun","doi":"10.1016/j.reumae.2023.09.005","DOIUrl":"https://doi.org/10.1016/j.reumae.2023.09.005","url":null,"abstract":"","PeriodicalId":94193,"journal":{"name":"Reumatologia clinica","volume":"20 2","pages":"Pages 114-115"},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139915016","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.reumae.2023.06.002","DOIUrl":"https://doi.org/10.1016/j.reumae.2023.06.002","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":94193,"journal":{"name":"Reumatologia clinica","volume":"20 2","pages":"Pages 59-66"},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139915017","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":"Clinical features of patients with hands arthralgia referred from primary care physicians to rheumatologists: A cohort study","authors":"Gabriel Figueroa-Parra,&nbsp;Martha Mariana Castañeda-Martinez,&nbsp;Pablo Herrera-Sandate,&nbsp;Diana Daniela Castañeda-Martinez,&nbsp;Jorge Antonio Esquivel-Valerio,&nbsp;David Vega-Morales","doi":"10.1016/j.reumae.2023.09.003","DOIUrl":"https://doi.org/10.1016/j.reumae.2023.09.003","url":null,"abstract":"<div><h3>Purpose</h3><p>Early referral of patients with suspicious of rheumatoid arthritis (RA) has an impact on prognosis. Our study aimed to evaluate the clinical characteristics of patients with hands arthralgia who were referred from primary care physicians (PCP) to the rheumatologist.</p></div><div><h3>Methods</h3><p>A descriptive, observational, prospective cohort study was performed. We included patients who visited a PCP for the first time for hands arthralgia. Demographics and the European Alliance of Associations for Rheumatology criteria for arthralgia suspicious for progression to RA plus seven complementary questions, the time to referral, the pressure needed to provoke pain with an automatic squeeze test machine in the metacarpophalangeal joints of both hands, and the diagnoses established at the last review of medical charts from patients on follow-up were documented. The primary outcome was the referral to a rheumatologist.</p></div><div><h3>Results</h3><p>A total of 109 patients were included. The mean age was 49.9 years, 81.6% were women. 30.3% were referred to the rheumatologist. The time to referral was a median of 38 days. The main clinical characteristics associated with referral to the rheumatologist were the “most severe symptoms are present after midnight” (OR<!--> <!-->=<!--> <!-->6.29) and the “difficulty with making a fist” (OR<!--> <!-->=<!--> <!-->3.67). An isolated “positive squeeze test of metacarpophalangeal joints” was not associated with a referral to the rheumatologist.</p></div><div><h3>Conclusions</h3><p>Among patients with hands arthralgia who attended PCP, those with most severe symptoms after midnight and difficulty making a fist were more likely to be referred to the rheumatology clinic. Isolated positive squeeze tests are not a parameter for referral, it should only be performed if arthralgia is clinically suspected.</p></div>","PeriodicalId":94193,"journal":{"name":"Reumatologia clinica","volume":"20 2","pages":"Pages 67-72"},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139914995","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":"Comments about treatment of glucocorticoid-induced osteoporosis","authors":"Osvaldo Daniel Messina","doi":"10.1016/j.reumae.2023.07.006","DOIUrl":"10.1016/j.reumae.2023.07.006","url":null,"abstract":"","PeriodicalId":94193,"journal":{"name":"Reumatologia clinica","volume":"20 2","pages":"Page 113"},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139708924","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":"The activity of psoriatic arthritis with axial involvement correlates with the PsAID12","authors":"Jose Antonio Pinto Tasende ,&nbsp;Carlota Laura Iñiguez Ubiaga ,&nbsp;Victor Eliseo Quevedo Vila ,&nbsp;Luis Fernández Dominguez ,&nbsp;Francisco Jose Maceiras Pan ,&nbsp;Carlos García Porrúa","doi":"10.1016/j.reumae.2023.08.003","DOIUrl":"10.1016/j.reumae.2023.08.003","url":null,"abstract":"<div><h3>Objective</h3><p>To determine the impact of the disease in patients with PsA in daily clinical practice and to evaluate its relationship with its axial activity.</p></div><div><h3>Methods</h3><p>A cross-sectional study was conducted in consecutive patients attended from January 2021 to December 2021 who met the CASPAR criteria, with clinical of inflammatory back pain and positive axial imaging, with or without peripheral involvement. Demographic, clinical, analytical data, HAQ index, PsAID12 and activity index (BASDAI and ASDAS-PCR) were also collected. Patients were divided into two groups, those with high impact and those with low impact according to PsAID results. Continuous variables are shown as median (Q1–Q3) and categorical variables as percentages and frequencies.</p></div><div><h3>Results</h3><p>Of the 269 patients evaluated with PsA, 72 patients with axial involvement were included, 40 men (55.6%), with a median age of 54.1 years and disease duration of 7 years. 28.3% of the patients were obese and serum CRP level was 0.45 mg/dl (0.08–1.10). BASDAI was 4.2 (2.0–6.2) and ASDAS-PCR was 2.4 (1.5–3.2), which translates into 39.6% of patients in low activity or remission. The median PsAID total score was 3.9 (1.6–5.4), evaluated in 61 patients. The patients who achieved a PsAID12 ≤ 4 were 63%, mostly men and with lower CRP levels than PsAID ≥ 4 patients. In addition, low impact measured by the PsAID12 was associated with low results in BASDAI and ASDAS-PCR.</p></div><div><h3>Conclusions</h3><p>Axial involvement reflected lower impact of the disease measured by PsAID12 and it is correlated with low activity measured by BASDAI and ASDAS-PCR.</p></div>","PeriodicalId":94193,"journal":{"name":"Reumatologia clinica","volume":"20 2","pages":"Pages 80-83"},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139718188","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":"Termination of pregnancy in lupus nephritis: A bioethical analysis with the integrative method","authors":"Tábata Cano-Gámez ,&nbsp;Adriana Concepción Lobato-Belmonte ,&nbsp;Ingris Peláez-Ballestas ,&nbsp;Gabriel Medrano-Ramírez ,&nbsp;Juan Carlos de León-Carbajal ,&nbsp;Amaranta Manrique de Lara","doi":"10.1016/j.reumae.2023.07.001","DOIUrl":"10.1016/j.reumae.2023.07.001","url":null,"abstract":"<div><h3>Background and objective</h3><p><span>Termination of pregnancy in patients with </span>rheumatic diseases<span> is controversial and a bioethical analysis is rarely performed. In this study we analysed the case of a pregnant patient with lupus nephritis<span> unresponsive to treatment, for whom termination of pregnancy is considered.</span></span></p></div><div><h3>Methods</h3><p>The integrative model was applied combining different normative ethical theories.</p></div><div><h3>Results</h3><p>From a utilitarian perspective, termination of pregnancy is justifiable, seeking the greatest benefit for the greatest number of stakeholders. Deontology justifies both terminating and continuing the pregnancy, focusing on the action itself and on autonomy. In virtue ethics the importance of decisions rests with the person who performs the action seeking flourishing; termination of pregnancy would be justifiable.</p></div><div><h3>Discussion and conclusions</h3><p>Interruption of pregnancy is a justifiable solution following the integrative model. Bioethical analysis of paradigmatic cases is essential to ensure the best possible action and as a precedent for future similar situations in rheumatology.</p></div>","PeriodicalId":94193,"journal":{"name":"Reumatologia clinica","volume":"20 1","pages":"Pages 20-23"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9853734","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":"VEXAS syndrome: Clinical manifestations, diagnosis, and treatment","authors":"Michelle Patricia Loeza-Uribe ,&nbsp;Andrea Hinojosa-Azaola ,&nbsp;Beatriz E. Sánchez-Hernández ,&nbsp;José C. Crispín ,&nbsp;Elia Apodaca-Chávez ,&nbsp;Marcela A. Ferrada ,&nbsp;Eduardo Martín-Nares","doi":"10.1016/j.reumae.2023.12.004","DOIUrl":"10.1016/j.reumae.2023.12.004","url":null,"abstract":"<div><p><span><span>VEXAS (Vacuoles, E1 enzyme, X-linked, Autoinflammatory, Somatic) syndrome is an adult-onset autoinflammatory syndrome characterized by </span>somatic mutations in the </span><em>UBA1</em><span><span> gene and is considered the prototype of hematoinflammatory diseases. Patients with VEXAS syndrome exhibit inflammatory and hematological manifestations that can lead to clinical diagnoses such as relapsing polychondritis, </span>polyarteritis nodosa<span>, Sweet syndrome, and myelodysplastic syndrome. Diagnosis requires bone marrow evaluation to identify cytoplasmic vacuoles in myeloid and erythroid precursors. However, genetic confirmation of mutations in </span></span><em>UBA1</em><span><span> is necessary. Treatment is challenging and often involves </span>glucocorticoids<span><span> and immunosuppressants with variable responses. </span>Hypomethylating agents<span> and allogenic haemopoietic stem cell transplant are considered promising therapies. Prognosis is influenced by genetic and clinical factors. The aim of this review is to provide an overview of the pathogenesis, clinical presentation, treatment, and prognosis of VEXAS syndrome for the Latin American medical community.</span></span></span></p></div>","PeriodicalId":94193,"journal":{"name":"Reumatologia clinica","volume":"20 1","pages":"Pages 47-56"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139072479","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":"The patient journey of fibromyalgia in Latin America","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.reumae.2023.12.002","DOIUrl":"10.1016/j.reumae.2023.12.002","url":null,"abstract":"<div><h3>Objectives</h3><p>To explore the patient journey of people with fibromyalgia<span> (FM) in Latin American countries in order to identify problems in health care and other areas that may be resolvable.</span></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":94193,"journal":{"name":"Reumatologia clinica","volume":"20 1","pages":"Pages 32-42"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139107029","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":"Real-world apremilast use in biologic-naïve psoriatic arthritis patients. Data from Spanish clinical practice","authors":"Jordi Gratacós-Masmitja ,&nbsp;Emma Beltrán Catalán ,&nbsp;José Luis Álvarez Vega ,&nbsp;Ana Urruticoechea-Arana ,&nbsp;Concepción Fito ,&nbsp;Francisco Maceiras ,&nbsp;Joaquín María Belzunegui Otano ,&nbsp;Julia Fernández Melón ,&nbsp;Eugenio Chamizo Carmona ,&nbsp;Miguel Ángel Abad Hernández ,&nbsp;Inmaculada Ros Vilamajó ,&nbsp;Sonia Castro Oreiro ,&nbsp;Eva Pascual Alfonso ,&nbsp;Juan Carlos Torre Alonso ,&nbsp;on behalf of the PREVAIL team","doi":"10.1016/j.reumae.2023.09.004","DOIUrl":"https://doi.org/10.1016/j.reumae.2023.09.004","url":null,"abstract":"<div><h3>Introduction</h3><p>Apremilast is approved for treatment of psoriasis and psoriatic arthritis (PsA). Real-world evidence on apremilast effectiveness in clinical practice is limited.</p></div><div><h3>Methods</h3><p>Observational study enrolling adult patients, across 21 Spanish centres, who had initiated apremilast in the prior 6 (±1) months and were biologic naive. Data were collected at routine follow-up visits 6 and 12 months after apremilast initiation. Primary outcome was 6 and 12-month persistence to apremilast. Secondary outcomes included Disease Activity for PsA (DAPSA), joint erosions, enthesitis, dactylitis, and patient-reported quality of life (QoL, measured using the PsA impact of disease [PsAID] questionnaire).</p></div><div><h3>Results</h3><p>We included 59 patients. Most had oligoarticular PsA, moderate disease activity, and high comorbidity burden. Three-quarters were continuing apremilast at 6 months and two-thirds at 12 months; mean (SD) apremilast treatment duration was 9.43 (1.75) months. DAPSA scores showed improved disease activity: one-third of patients in remission or low activity at apremilast initiation versus 62% and 78% at 6 and 12 months, respectively. Eleven of 46 patients with radiographic assessments had joint erosions at apremilast initiation and none at month 12. Median (<em>Q</em>1, <em>Q</em>3) number of swollen joints was 4.0 (2.0, 6.0) at apremilast initiation versus 0.0 (0.0, 2.0) at 12 months. Incidence of dactylitis and enthesitis decreased between apremilast initiation (35.6% and 28.8%, respectively) and month 12 (11.6% and 2.4%, respectively). Over two-thirds of patients had a PSAID-9 score &lt;4 (cut-off for patient-acceptable symptom state) at month 12.</p></div><div><h3>Conclusions</h3><p>In Spanish clinical practice, two-thirds of PsA patients continued apremilast at 12 months, with clinical benefits at the joint level, no radiographic progression of erosions, and a positive impact on patient-reported QoL.</p><p>Trial registration number Clinicaltrials.gov: <span>NCT03828045</span><svg><path></path></svg>.</p></div>","PeriodicalId":94193,"journal":{"name":"Reumatologia clinica","volume":"20 1","pages":"Pages 24-31"},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2173574323001338/pdfft?md5=db2797dbf0e53ce0f79e76f5e9128bb5&pid=1-s2.0-S2173574323001338-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139467865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}