Seminarios de la Fundación Espa?ola de Reumatología最新文献

The management of osteoarthritis (OA) is a major challenge. Most published recommendations aim to control OA symptoms, i.e. reduce pain and improve joint function. However, the main aim of the treatment of OA is to halt or delay disease progression. In line with this aim, the various therapies should help to preserve articular structure by controlling cartilage degradation, synovitis and sclerosis of subchondral bone, the three tissues involved in the physiopathology of OA. This aim should be kept in mind both in the development of future treatments and in currently available drugs. Chondroitin sulfate is a symptomatic slow-acting drug for osteoarthritis (SYSADOA). There is, however, an increasing body of evidence showing the effect of disease modifying osteoarthritis drugs (DMOAD), i.e. slow-acting drugs for OA able to modify structure. This review aims to synthesize the information on the protective effect of chondroitin sulfate on cartilage, as well as its ability to preserve the structure of subchondral bone.

Treatment of hand ostearthritis is currently insufficient. Education programs, acetanomiphen, nonsteroidal anti-inflammatory drugs and capsaicin are used. There is lack of studies concerning chondrointin sulphate in the treatment of hand osteoarthritis.

The present study examines the usefulness of chondroitin sulphate in the treatment of hand osteoarthritis.

The study was randomized, double blind and placebo controlled. All patients fulfilled the diagnostic criteria of the American College of Rheumatology. One hundred sixty patients were recruited and randomized in 2 arms : 82 patients received placebo and 80 patients chondroitin sulphate. Primary end points were visual analogue scale and functional index. Secondary end points were hand strength, morning stiffness, investigator's opinion and weekly consume of acatanomiphen. Duration of the study was 6 months. At the end of the study there was a significant difference between the group treated with chondroitin sulphate and placebo in visual analogue scale (VAS 2.14; p = 0.008),functional index (FIHOA:2.14; p = 0.008), morning stiffness (difference 5’1 minutes; p = 0.031) and investigators opinion (44% versus 33%; p = 0.043). Adverse reactions were similar between both groups.

The authors emphasize the usefulness of chondroitin sulphate in the treatment of hand osteoarthritis and the safety profile of the drug

The relationship between osteoartritis (OA) and metabolic disorders, such as diabetes or dyslipemia, and cardiovascular comorbidity has been well established in epidemiologic studies, especially in the case of knee OA. This association has also been observed between OA and the metabolic syndrome, which is a major risk factor for cardiovascular disease. The functional disability resulting from advanced joint disease as well as Joint overload related to obesity and the the frequent coexistence of cardiovascular morbidity in an aging population were the major factors though to be involved. However, this ssociation has also been found in younger patients and in hand OA, thus pointing to the possible existence of additional factors not related to joint overload, diasbility or age. In recent years several metabolic and inflammatory factors present both in OA and in the different cardiovascular risk factors have been implicated, such as lipid homeostasis dysregulation and especially the activity of adipocytokines, cytokines released from adipose tissue with a synergistic action with proinflammatory cytokines and other inflammatory mediators. The evidence for this associations and the possible mechanisms are reviewed.

The need for a consistent and standardized assessment of the therapeutic effectiveness of the drugs tested and / or used for treatment of osteoarthritis (OA) led to the creation of a series of response criteria in which it can be easily assessed which patients respond or not to a given therapy. The Osteoarthritis Research Society International (OARSI) criteria and subsequently the Outcome Measures in Arthritis Clinical Trials-Osteoarthritis Research Society International (OMERACT-OARSI) criteria seek this assessment primarily based on three aspects that are essential for the patient: pain, physical function and the patient's global assessment. Its interest, scope and weaknesses are a matter of discussion of this commentary.

The Primer documento de la Sociedad Española de Reumatología sobre el tratamiento farmacológico de la artrosis de rodilla (First Document of the Spanish Society of Rheumatology on the Pharmacological Treatment of Osteoarthritis of the Knee) was published in 2005 on the initiative of the SER with the intention of responding in a practical and substantiated manner to clinical questions that might arise in clinical practice and which were not made sufficiently clear in other guides available at the time.

That document was agreed on by a panel of experts following a suitable methodology and a thorough review of the evidence available so far. This article discusses and comments on whether said document has served its purpose and whether it continues doing so at the present time, as well as whether a review should be considered due, or if instead it might be more appropriate to create a new and more extensive document, for instance including non-pharmacological therapies or osteoarthritis affecting other locations.

Osteoarthritis cannot be considered a single disease but rather a heterogeneous group of ailments with similar clinical symptoms and analogous radiological and pathological changes, which makes it difficult to establish uniform recommendations for them all.

Given this disparity it is necessary to establish recommendations that will make a series of criteria available for professionals in order to unify their attitudes.

The American College of Rheumatology (ACR) established the first criteria for the classification of osteoarthritis of the hand, hip and knee, but it was not until 2000 that its recommendations for the medical treatment of osteoarthritis of the hip and knee were published, followed by the European recommendations in 2001, subsequently revised in 2003 and 2005. In 2007 the recommendations for the treatment of osteoarthritis of the hands were published. Finally, in 2008, the Osteoarthritis Research Society International (OARSI) recommendations for the treatment of osteoarthritis of the hip and knee, result of consensus between European League Against Rheumatism (EULAR) and ACR, were published.

A second review of new evidence gathered from January 2006, when the OARSI recommendations were made, until January 2009, showed variations in the range of the effect of the different forms of treatment. Adherence to the recommendations is in general low, and it seems necessary to create strategies to make it easier for professionals to follow the recommendations, as well as to design and conduct clinical trials, which meet a set of minimum parameters, sufficiently specific and sensitive, in order to assess their effect on the disease. Only by regularly updating this knowledge can we help improve our clinical practice, as long as strategies are developed to facilitate adherence to the recommendations from the professionals involved.

The prevalence of antiphospholipid antibodies (aPL) in the general population is 1%. Not all asymptomatic patients with aPL antibodies have the same risk for thrombosis, and consequently routine prophylaxis with acetylsalicylic acid (ASA) is not justified in terms of risk-benefit in all asymptomatic carriers. Based on current evidence, primary prevention is indicated only in high-risk groups including the following: a) in patients with anticardiolipin antibodies (aCL) at persistently high titers, repeatedly positive lupus anticoagulant (LA) or aCL positivity, LA and anti-beta2 glycoprotein I (triple positivity) regardless of titer; b) in situations of high thrombotic risk due to the concomitant presence of other thrombotic risk factors (hypertension, immobilization, surgery, etc.); c) in the presence of a systemic autoimmune disease, particularly systemic lupus erythematosus, and d) during pregnancy. Prophylactic treatment in these patients is based on the use of ASA. In specific situations, low-molecular-weight heparin and hydroxychloroquine are also useful.

Diabetic foot includes a group of syndromes in which the interaction among loss of protective sensation due to sensory peripheral neuropathy, a change in pressure spots due to motor neuropathy, autonomic dysfunction, and decreased blood supply due to peripheral vascular disease can lead to the occurrence of wounds or ulcers usually related to minimal injuries that are usually unnoticed. Diabetic foot is associated with higher morbidity and a high risk of amputation of the foot or limb. These situations can be avoided with an appropriate prevention program, based on the early detection of diabetic neuropathy and assessment of the associated risk factors in addition to structured patient education. Also important are optimal treatment of the acute injury, with specific antibiotics and foot care measures that encourage early and effective healing.

Metatarsalgia is a clinical syndrome characterized by pain in the forefoot. To understand the physiopathogenesis and treatment of this condition, an understanding of the anatomy and biomechanics of the foot is essential. There are a large number of causes of metatarsalgia and some, such as rheumatoid arthritis, may be highly complex. The use of ortheses should be individualized and adjusted to the diagnosis. To prevent this condition, the use of appropriate footwear is essential.