Reumatologia Clinica最新文献

Introduction

Many patients diagnosed with rheumatoid arthritis (RA) report relief of symptoms after consuming certain foods. Diet plays a vital role in rheumatoid arthritis-related inflammation regulation. This study investigates the relationship between dietary inflammation index (DII) scores and RA disease activity.

Materials and methods

Forty-one RA patients were enrolled in the study. The general inflammatory index of the diet was analyzed by recording the 24-h food consumption of the patients, and the nutrients were analyzed using the Nutrition Information Systems Package Program. Dietary inflammatory indices were calculated for each patient using the patients’ macro and micronutrient intake levels. RA disease activity was assessed using the Disease Activity Score-28 (DAS-28).

Results

The DAS-28 score was lower in the anti-inflammatory diet group compared to the pro-inflammatory diet group (p = 0.163). A weak but significant relationship was found between diet inflammation index score and DAS-28 (r = 0.3468, p = 0.0263). The effect of the dietary inflammatory index on the DAS-28 was 12.02%. Dietary iron, vitamin C, niacin, and magnesium intakes were statistically significantly higher in the quartile group that received an anti-inflammatory diet than in the quartile group that received a pro-inflammatory diet. The intake of some micronutrients, such as iron, zinc, magnesium, and folic acid, was significantly lower than the recommended values in all RA quartile groups.

Conclusion

Our results suggest that reducing inflammation through the diet may have a weak but significant effect in controlling disease activity in RA patients.

Introduction and objectives

The Colegio Mexicano de Reumatología (CMR) is a corporation whose brand has two elements—image and identity—that differentiate it from other corporations. We evaluated aspects of CMR's corporate image and identity.

Subjects and methods

To assess corporate image, we designed a survey using proof-of-concept and discrete-choice-experiments approaches. It assessed which definition (orthopedist, rheumatologist, or rehabilitator) was most meaningful in four pain scenarios in healthy adults from the country's Western region.

We used discourse analysis and five readability indices of the CMR website to assess corporate identity.

Results

In total, 700 respondents were included. For every rheumatologist chosen in the hand scenario, respondents chose 1.13 orthopedists and 0.70 rehabilitators. For every rheumatologist chosen in the knee scenario, respondents chose 2.36 orthopedists and 0.64 rehabilitators, whereas 0.85 orthopedists and 0.58 rehabilitators were chosen in the arthritis scenario. Only 38% of the respondents preferred the CMR's definition of a rheumatologist to describe a rheumatologist.

The younger age group preferred orthopedists to rheumatologists (50% vs. 31%, p < 0.001). In the arthritis scenario, the choice of rheumatologist increased from 27% in the elementary school group to 49% in the university group (p < 0.001). Mother was the most influential in healthcare seeking.

The discursive analysis revealed that the CMR is positioned as a “we” restricted to “colleagues;” the patient did not have agentive representation. The semiotic structure of the CMR's mission/vision was deemed imprecise and lacking in statements of value and purpose; the readability scores indicated that the text was challenging and dry.

Conclusions

The CMR's corporate image does not differentiate it from other health providers. CMR's identity seems ambiguous with restricted directionality. It seems pertinent to redefine the CMR.

Introduction

Interstitial lung disease is a leading cause of mortality in patients with systemic sclerosis. Currently, there is a lack of consensus regarding screening, rescreening, diagnosis, and follow-up practices in interstitial lung disease associated with systemic sclerosis (SSc-ILD) in Colombia.

Methods

A structured survey focused on clinical practices in patients with SSc-ILD was conducted. Members of the Asociación Colombiana de Neumología y Cirugía de Tórax (Asoneumocito) and the Asociación Colombiana de Reumatología (Asoreuma) were invited to participate from March 2023 to May 2023.

Results

We surveyed 51 pulmonologists and 44 rheumatologists. Overall, 51.6% reported having access to multidisciplinary team discussion in ILD. Among the 95 participants, 78.9% would routinely perform a high-resolution computed tomography scan of the chest once a diagnosis of systemic sclerosis was established. This practice is more frequent among rheumatologists (84.1%) than among pulmonologists (74.5%). Approximately half of the participants would rescreen patients annually with computed tomography scan (56.8%) if baseline images were negative.

Spirometry (81.1%), diffusing capacity of the lung for carbon monoxide (80.0%), and 6-min walk test (55.8%) were the most frequently performed tests upon diagnosis of systemic sclerosis. During follow-up, participants would consider repeating pulmonary function tests mostly every 6 months.

Conclusions

Screening of SSc-ILD is high among pulmonologists and rheumatologists. Decision-making on diagnosis and follow-up is similar between specialties, but there are variations in their frequency and indications. Further research is needed to evaluate how to adapt recommendations for assessing SSc-ILD in different settings.

Introduction and objectives

In this study, we aimed to evaluate LIF levels and its possible relationship with disease activity in patients with Takayasu's (TAK) and Giant cell arteritis (GCA) patients.

Materials and methods

23 Takayasu's arteritis, 9 Giant cell arteritis patients and 25 healthy volunteers were included in the study. Serum LIF levels were measured ELISA.

Results

The mean age of Giant cell arteritis patients was statistically significantly higher than the other groups (p < 0.001). The rate of women was found to be higher in Takayasu's arteritis (p = 0.021). When healthy control, patients with GCA and Takayasu arteritis were compared, there was a difference in LIF values (p = 0.018). In subgroup analyzes, LIF values were found to be higher in GCA patients compared to healthy controls (p < 0.05). There was no statistically significant correlation between LIF and CRP (Rho = −0.038, p = 0.778), ESR (Rho = 0.114, p = 0.399) and ITAS (Rho = −0.357, p = 0.094). While CRP was statistically significantly higher in patients with disease activity (p = 0.003), there was no statistically significant difference between patients in terms of ESR and LIF values. While there was a statistically significant relationship between CRP (OR = 1.19 [1.03–1.37], p = 0.018) and disease activity in univariate analyses, no statistically significant variable was found in multivariable analyses.

Conclusions

LIF values were significantly higher in patients with Giant cell arteritis compared to healthy controls.

Objective

To design a care protocol in chronic inflammatory arthritis during the pre-conceptional period, pregnancy, postpartum and lactation. This protocol aims to be practical and applicable in consultations where patients with chronic inflammatory rheumatological diseases are treated, thus helping to better control these patients. Likewise, recommendations are offered on when patients could be consulted/referred to a specialized center by the physician.

Methods

A multidisciplinary panel of expert physicians from different specialties identified the key points, analyzed the scientific evidence, and met to develop the care protocol.

Results

The recommendations prepared have been divided into three blocks: rheumatology, gynecology and pediatrics. The first block has been divided into pre-pregnancy, pregnancy and postpartum visits.

Conclusions

This protocol tries to homogenize the follow-up of the patients from the moment of the gestational desire until the year of life of the infants. It is important to perform tests in patients of childbearing age and use drugs compatible with pregnancy. If appropriate, the patient should be referred to specialized units. Multidisciplinarity (rheumatology, gynecology and pediatrics) is essential to improve the control and monitoring of these patients and their offspring.

VEXAS syndrome is a rare entity secondary to UBA1 gene mutations, located on the X chromosome. This mutation generates, as a consequence, a characteristic vacuolation on haematopoietic stem-cells. It is characterized by multiple autoinflammatory and haematologic manifestations, which respond and end up being dependent on corticosteroid treatment. In this publication we present a 2-case series diagnosed at our hospital and make a brief literature review of the published evidence so far.

Objective

To develop updated guidelines for the pharmacological management of rheumatoid arthritis (RA).

Methods

A group of experts representative of different geographical regions and various medical services catering to the Mexican population with RA was formed. Questions based on Population, Intervention, Comparison, and Outcome (PICO) were developed, deemed clinically relevant. These questions were answered based on the results of a recent systematic literature review (SLR), and the evidence's validity was assessed using the GRADE system, considered a standard for these purposes. Subsequently, the expert group reached consensus on the direction and strength of recommendations through a multi-stage voting process.

Results

The updated guidelines for RA treatment stratify various therapeutic options, including different classes of DMARDs (conventional, biologicals, and JAK inhibitors), as well as NSAIDs, glucocorticoids, and analgesics. By consensus, it establishes the use of these in different subpopulations of interest among RA patients and addresses aspects related to vaccination, COVID-19, surgery, pregnancy and lactation, and others.

Conclusions

This update of the Mexican guidelines for the pharmacological treatment of RA provides reference points for evidence-based decision-making, recommending patient participation in joint decision-making to achieve the greatest benefit for our patients. It also establishes recommendations for managing a variety of relevant conditions affecting our patients.