Pub Date : 2024-11-05DOI: 10.1016/j.reumae.2024.10.003
Lilia Andrade-Ortega, Daniel Xibillé-Friedmann, Dionicio A Galarza-Delgado, Miguel Ángel Saavedra, José Alvarez-Nemegyei, Mary-Carmen Amigo-Castañeda, Hilda Fragoso-Loyo, María Vanessa Gordillo-Huerta, Fedra Irazoque-Palazuelos, Luis Javier Jara-Quezada, Javier Merayo-Chalico, Margarita Portela-Hernández, Sandra Sicsik-Ayala, Carlos Abud-Mendoza, Deshire Alpizar-Rodriguez, José Luis Amaya-Estrada, Yaneth R Barragán-Navarro, Sandra M Carrillo-Vázquez, Zully Castro-Colín, Luis Javier Cruz-Álvarez, Sergio Durán-Barragán, Jorge A Esquivel-Valerio, Jorge Iván Gamez-Nava, Conrado García-García, Laura Gonzalez-Lopez, Jaime Hadid-Smeke, Alina Hernández-Bedolla, María Fernanda Hernández-Cabrera, David A Herrera-VanOostdam, Gabriel Horta-Baas, Alberto E Iturbide-Escamilla, Sandra Muñoz-Lopez, Cesar Pacheco-Tena, Mario Pérez-Cristóbal, Rafael R Pimentel-Leon, Mercedes Pinto-Ortiz, María Azucena Ramos-Sánchez, Diana V Sandoval-Cabrera, Karina Santana de Anda, Luis H Silveira, Leonor A Barile-Fabris
Herein we present the update for the Mexican Guidelines for the Treatment of Systemic Lupus Erythematosus. It involves the participation of several experts along the country, following the GRADE system. We included aspects regarding vaccines, pregnancy and cardiovascular risk which were not presented in the previous guidelines in 2017.
{"title":"Clinical Practice Mexican Guidelines for the Treatment of Systemic Lupus Erythematosus: 2024 Update.","authors":"Lilia Andrade-Ortega, Daniel Xibillé-Friedmann, Dionicio A Galarza-Delgado, Miguel Ángel Saavedra, José Alvarez-Nemegyei, Mary-Carmen Amigo-Castañeda, Hilda Fragoso-Loyo, María Vanessa Gordillo-Huerta, Fedra Irazoque-Palazuelos, Luis Javier Jara-Quezada, Javier Merayo-Chalico, Margarita Portela-Hernández, Sandra Sicsik-Ayala, Carlos Abud-Mendoza, Deshire Alpizar-Rodriguez, José Luis Amaya-Estrada, Yaneth R Barragán-Navarro, Sandra M Carrillo-Vázquez, Zully Castro-Colín, Luis Javier Cruz-Álvarez, Sergio Durán-Barragán, Jorge A Esquivel-Valerio, Jorge Iván Gamez-Nava, Conrado García-García, Laura Gonzalez-Lopez, Jaime Hadid-Smeke, Alina Hernández-Bedolla, María Fernanda Hernández-Cabrera, David A Herrera-VanOostdam, Gabriel Horta-Baas, Alberto E Iturbide-Escamilla, Sandra Muñoz-Lopez, Cesar Pacheco-Tena, Mario Pérez-Cristóbal, Rafael R Pimentel-Leon, Mercedes Pinto-Ortiz, María Azucena Ramos-Sánchez, Diana V Sandoval-Cabrera, Karina Santana de Anda, Luis H Silveira, Leonor A Barile-Fabris","doi":"10.1016/j.reumae.2024.10.003","DOIUrl":"https://doi.org/10.1016/j.reumae.2024.10.003","url":null,"abstract":"<p><p>Herein we present the update for the Mexican Guidelines for the Treatment of Systemic Lupus Erythematosus. It involves the participation of several experts along the country, following the GRADE system. We included aspects regarding vaccines, pregnancy and cardiovascular risk which were not presented in the previous guidelines in 2017.</p>","PeriodicalId":94193,"journal":{"name":"Reumatologia clinica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142592352","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}
Background: The exposure to artificial gravity (AG) through human centrifugation is the basis of the treatment called gravity therapy (GT), in which the mechanical stimulation over the vessel wall, induces the synthesis and release of prostacyclin. It has been used for more than four decades in Uruguay in the treatment of different vascular-based pathologies. In patients with systemic sclerosis (SSc) it has shown good benefits and excellent safety profile over the years. However, there is a lack of knowledge in the scientific community about GT and its results.
Objective: To evaluate the effectiveness of GT in cutaneous and vascular involvement, in the quality of life and functional capacity and its safety profile in patients with SSc.
Methodology: It is a descriptive and retrospective study of patients with SSc assisted in an autoimmunity center in Montevideo, treated with GT in the last 10 years.
Results: Fifty patients were included, 48 women (96%) and 2 men (4%) with a mean age of 62 ± 12 years. The mean time of evolution of SSc at the time of inclusion in the study at the beginning of GT was 6.8 ± 3.2 years and 2.8 ± 3.2 years respectively. After GT, a significant improvement in the modified Rodnan skin score (mRSS) was observed (pre-GT 19.2 ± 8.7 vs. post-GT 5.4 ± 5.0, p < 0.05), which was not related to the time of disease progression at the beginning of GT nor to the skin extension or immunological profile. The degree of improvement post-GT was related to a higher initial mRSS (R = 0.84, p < 0.05). Also, a significant improvement was observed in the number of patients with puffy fingers (pre-GT 50% vs. post-GT 20% patients, p < 0.05), but not in telangiectasias, pitting scars or sclerodactyly. The severity of Raynaud's phenomenon significantly decreased (pre-GT: grade 3-4, 43/48 (89.6%) patients vs. post-GT: grade ≤2, 42/47 (89.4%) patients, p < 0.05) as well as the vascular pain measured with VAS (0-10 scale) (pre-GT: 7.6 ± 2.2 vs. post-TG: 1.4 ± 1.2, p < 0.05). The healing of digital ulcers was also recorded. Regarding the results reported by patients, 97% reported improvement in the quality of life and 89.5% improvement in the ability to carry out activities of daily living. No significant adverse effects were recorded.
Conclusions: GT improved cutaneous and vascular involvement, the quality of life and the functional capacity in patients with SSc with an excellent safety profile. Randomized, controlled clinical trials are needed to corroborate these observational results.
{"title":"Evaluation of the efficacy and safety of gravitational therapy in a cohort of patients with systemic sclerosis.","authors":"Luisa Fernanda Servioli, Eugenia Isasi, Alejandra Pérez, Silvia Pouquette, María Eloísa Isasi","doi":"10.1016/j.reumae.2024.10.004","DOIUrl":"https://doi.org/10.1016/j.reumae.2024.10.004","url":null,"abstract":"<p><strong>Background: </strong>The exposure to artificial gravity (AG) through human centrifugation is the basis of the treatment called gravity therapy (GT), in which the mechanical stimulation over the vessel wall, induces the synthesis and release of prostacyclin. It has been used for more than four decades in Uruguay in the treatment of different vascular-based pathologies. In patients with systemic sclerosis (SSc) it has shown good benefits and excellent safety profile over the years. However, there is a lack of knowledge in the scientific community about GT and its results.</p><p><strong>Objective: </strong>To evaluate the effectiveness of GT in cutaneous and vascular involvement, in the quality of life and functional capacity and its safety profile in patients with SSc.</p><p><strong>Methodology: </strong>It is a descriptive and retrospective study of patients with SSc assisted in an autoimmunity center in Montevideo, treated with GT in the last 10 years.</p><p><strong>Results: </strong>Fifty patients were included, 48 women (96%) and 2 men (4%) with a mean age of 62 ± 12 years. The mean time of evolution of SSc at the time of inclusion in the study at the beginning of GT was 6.8 ± 3.2 years and 2.8 ± 3.2 years respectively. After GT, a significant improvement in the modified Rodnan skin score (mRSS) was observed (pre-GT 19.2 ± 8.7 vs. post-GT 5.4 ± 5.0, p < 0.05), which was not related to the time of disease progression at the beginning of GT nor to the skin extension or immunological profile. The degree of improvement post-GT was related to a higher initial mRSS (R = 0.84, p < 0.05). Also, a significant improvement was observed in the number of patients with puffy fingers (pre-GT 50% vs. post-GT 20% patients, p < 0.05), but not in telangiectasias, pitting scars or sclerodactyly. The severity of Raynaud's phenomenon significantly decreased (pre-GT: grade 3-4, 43/48 (89.6%) patients vs. post-GT: grade ≤2, 42/47 (89.4%) patients, p < 0.05) as well as the vascular pain measured with VAS (0-10 scale) (pre-GT: 7.6 ± 2.2 vs. post-TG: 1.4 ± 1.2, p < 0.05). The healing of digital ulcers was also recorded. Regarding the results reported by patients, 97% reported improvement in the quality of life and 89.5% improvement in the ability to carry out activities of daily living. No significant adverse effects were recorded.</p><p><strong>Conclusions: </strong>GT improved cutaneous and vascular involvement, the quality of life and the functional capacity in patients with SSc with an excellent safety profile. Randomized, controlled clinical trials are needed to corroborate these observational results.</p>","PeriodicalId":94193,"journal":{"name":"Reumatologia clinica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142565050","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}
Pub Date : 2024-10-28DOI: 10.1016/j.reumae.2024.10.002
Deysi Andrea Hernández-Rivero, Lisette Bazán-Rodríguez, María Del Pilar Cruz-Domínguez, Gabriela Medina, Ana Lilia Peralta Amaro, Olga Vera-Lastra
Inclusion body myositis is a idiopathic inflammatory myopathy characterized by muscle weakness and dysphagia, with muscle biopsy showing inflammation and rimmed vacuoles. We present the case of a patient who was diagnosed with polymyositis but due to lack of response to treatment, a new biopsy revealed inclusion body myositis.
{"title":"Inclusion Body Myositis: A Late Diagnosis Case Report.","authors":"Deysi Andrea Hernández-Rivero, Lisette Bazán-Rodríguez, María Del Pilar Cruz-Domínguez, Gabriela Medina, Ana Lilia Peralta Amaro, Olga Vera-Lastra","doi":"10.1016/j.reumae.2024.10.002","DOIUrl":"https://doi.org/10.1016/j.reumae.2024.10.002","url":null,"abstract":"<p><p>Inclusion body myositis is a idiopathic inflammatory myopathy characterized by muscle weakness and dysphagia, with muscle biopsy showing inflammation and rimmed vacuoles. We present the case of a patient who was diagnosed with polymyositis but due to lack of response to treatment, a new biopsy revealed inclusion body myositis.</p>","PeriodicalId":94193,"journal":{"name":"Reumatologia clinica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142549884","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}
Pub Date : 2024-10-28DOI: 10.1016/j.reumae.2024.06.002
Natalia de la Torre Rubio, Jose Campos Esteban, José Luis Andréu Sánchez, Jesús Sanz Sanz
{"title":"Prevalence of occipital enthesophyte in non-inflammatory and inflammatory rheumatic diseases.","authors":"Natalia de la Torre Rubio, Jose Campos Esteban, José Luis Andréu Sánchez, Jesús Sanz Sanz","doi":"10.1016/j.reumae.2024.06.002","DOIUrl":"https://doi.org/10.1016/j.reumae.2024.06.002","url":null,"abstract":"","PeriodicalId":94193,"journal":{"name":"Reumatologia clinica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142549885","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}
Objetive: Evaluate response to treatment and progression to rheumatoid arthritis (RA) in patients with fibromyalgia (FM) associated with elevated rheumatoid factor (RF).
Material and methods: Prospective cohort study. The sample consisted of 124 patients with FM: 62 with high RF (>20 U/mL) and 62 with negative RF (0-20 U/mL). All patients were evaluated using FM treatment improvement score (FIQR) and progression to RA according to EULAR/ACR 2010 criteria at 6 and 12 months. Pearson's χ2 test for homogeneity was used to relate variables of improvement to FM treatment and progression to RA.
Results: The response to treatment was lower in the high RF group (24 and 20 patients improved at 6 and 12 months, respectively, compared to 45 and 38 patients in the negative RF group), with a significant difference. Progression to rheumatoid arthritis was similar in both groups (5 in the high RF group and 4 in the negative RF group), with a non-significant relationship.
Conclusions: FM with elevated RF is associated with a poor therapeutic response but not with progression to RA.
{"title":"Fibromyalgia with elevated rheumatoid factor is associated with poor therapeutic response but not with progression to rheumatoid arthritis. Prospective cohort study.","authors":"Freddy Liñán Ponce, Juan Leiva Goicochea, David Sevilla Rodríguez, Elmer Hidalgo Bravo, Ginna Obregón Atanacio, Inés Loyola Macalapú, Paola Jáuregui Rojas, Jackeline Yampufe Canani","doi":"10.1016/j.reumae.2024.10.001","DOIUrl":"https://doi.org/10.1016/j.reumae.2024.10.001","url":null,"abstract":"<p><strong>Objetive: </strong>Evaluate response to treatment and progression to rheumatoid arthritis (RA) in patients with fibromyalgia (FM) associated with elevated rheumatoid factor (RF).</p><p><strong>Material and methods: </strong>Prospective cohort study. The sample consisted of 124 patients with FM: 62 with high RF (>20 U/mL) and 62 with negative RF (0-20 U/mL). All patients were evaluated using FM treatment improvement score (FIQR) and progression to RA according to EULAR/ACR 2010 criteria at 6 and 12 months. Pearson's χ<sup>2</sup> test for homogeneity was used to relate variables of improvement to FM treatment and progression to RA.</p><p><strong>Results: </strong>The response to treatment was lower in the high RF group (24 and 20 patients improved at 6 and 12 months, respectively, compared to 45 and 38 patients in the negative RF group), with a significant difference. Progression to rheumatoid arthritis was similar in both groups (5 in the high RF group and 4 in the negative RF group), with a non-significant relationship.</p><p><strong>Conclusions: </strong>FM with elevated RF is associated with a poor therapeutic response but not with progression to RA.</p>","PeriodicalId":94193,"journal":{"name":"Reumatologia clinica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142515627","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}
Pub Date : 2024-10-01DOI: 10.1016/j.reumae.2024.09.004
Background
Gastrointestinal intolerance is common in rheumatoid arthritis (RA) patients using methotrexate and may lead to treatment discontinuation.
Aim
To study the prevalence of gastrointestinal symptoms in a sample of RA methotrexate users as well as its possible association with clinical and epidemiological variables.
Methods
Cross-sectional study of 192 patients with gastrointestinal symptoms using the MISS (methotrexate intolerance severity score). Clinical and epidemiological variables were collected through chart review and direct questioning. Patients’ adherence to methotrexate was evaluated through Moriski–Green–Levin questionnaire.
Results
The prevalence of gastrointestinal complaints was high with 55.7% of the sample classified as intolerant. Nausea and pain after drug ingestion were the most common reported complaints. This intolerance was associated with afro-descendant background (p = 0.02); presence of associated fibromyalgia (p = 0.04), concomitant use of glucocorticoids (p = 0.03) and Jak inhibitors (0.03). A tendency towards association with leflunomide use was observed (p = 0.06). Logistic regression was used to test drug associations with methotrexate intolerance, and showed that glucocorticoid use was independently associated with methotrexate intolerance OR = 1.85; 95% CI = 1.01–3.44; p = 0.04. Route of administration, presence of previous gastric complaints, age and methotrexate dose did not interfere with MISS. MISS results were associated with moderate adherence to the drug.
Conclusions
There is a high rate of methotrexate intolerance that is more common in afro-descendants, those with associated fibromyalgia, glucocorticoid and Jak inhibitors users.
背景胃肠道不耐受在使用甲氨蝶呤的类风湿性关节炎（RA）患者中很常见，可能会导致治疗中断。目的研究胃肠道症状在RA甲氨蝶呤使用者样本中的流行率及其与临床和流行病学变量的可能关联。通过病历审查和直接询问收集临床和流行病学变量。结果胃肠道不适的发生率很高，55.7%的样本被归类为不耐受。恶心和服药后疼痛是最常见的主诉。这种不耐受与非洲裔背景（p = 0.02）、伴有纤维肌痛（p = 0.04）、同时使用糖皮质激素（p = 0.03）和 Jak 抑制剂（0.03）有关。观察到与使用来氟米特相关的趋势（p = 0.06）。逻辑回归用于检验药物与甲氨蝶呤不耐受的相关性，结果显示使用糖皮质激素与甲氨蝶呤不耐受独立相关，OR = 1.85; 95% CI = 1.01-3.44; p = 0.04。给药途径、既往是否有胃部不适、年龄和甲氨蝶呤剂量均不影响 MISS。结论甲氨蝶呤不耐受的发生率很高，在非洲裔、伴有纤维肌痛、糖皮质激素和 Jak 抑制剂使用者中更为常见。
{"title":"Gastrointestinal symptoms in patients using methotrexate: A cross-sectional study in a sample with rheumatoid arthritis","authors":"","doi":"10.1016/j.reumae.2024.09.004","DOIUrl":"10.1016/j.reumae.2024.09.004","url":null,"abstract":"<div><h3>Background</h3><div>Gastrointestinal intolerance is common in rheumatoid arthritis (RA) patients using methotrexate and may lead to treatment discontinuation.</div></div><div><h3>Aim</h3><div>To study the prevalence of gastrointestinal symptoms in a sample of RA methotrexate users as well as its possible association with clinical and epidemiological variables.</div></div><div><h3>Methods</h3><div>Cross-sectional study of 192 patients with gastrointestinal symptoms using the MISS (methotrexate intolerance severity score). Clinical and epidemiological variables were collected through chart review and direct questioning. Patients’ adherence to methotrexate was evaluated through Moriski–Green–Levin questionnaire.</div></div><div><h3>Results</h3><div>The prevalence of gastrointestinal complaints was high with 55.7% of the sample classified as intolerant. Nausea and pain after drug ingestion were the most common reported complaints. This intolerance was associated with afro-descendant background (<em>p</em> <!-->=<!--> <!-->0.02); presence of associated fibromyalgia (<em>p</em> <!-->=<!--> <!-->0.04), concomitant use of glucocorticoids (<em>p</em> <!-->=<!--> <!-->0.03) and Jak inhibitors (0.03). A tendency towards association with leflunomide use was observed (<em>p</em> <!-->=<!--> <!-->0.06). Logistic regression was used to test drug associations with methotrexate intolerance, and showed that glucocorticoid use was independently associated with methotrexate intolerance OR<!--> <!-->=<!--> <!-->1.85; 95% CI<!--> <!-->=<!--> <!-->1.01–3.44; <em>p</em> <!-->=<!--> <!-->0.04. Route of administration, presence of previous gastric complaints, age and methotrexate dose did not interfere with MISS. MISS results were associated with moderate adherence to the drug.</div></div><div><h3>Conclusions</h3><div>There is a high rate of methotrexate intolerance that is more common in afro-descendants, those with associated fibromyalgia, glucocorticoid and Jak inhibitors users.</div></div>","PeriodicalId":94193,"journal":{"name":"Reumatologia clinica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142421122","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}
Pub Date : 2024-10-01DOI: 10.1016/j.reumae.2024.09.007
In this article, we present a case of resistant chondrocalcinosis who had a good response with 40 mg subcutaneous adalimumab. To our knowledge, this is the first report using adalimumab successfully in severe CPDD. Anti-TNF therapy can be a good therapeutic option for second line therapy in CPPD.
{"title":"Adalimumab treatment of resistant chondrocalcinosis","authors":"","doi":"10.1016/j.reumae.2024.09.007","DOIUrl":"10.1016/j.reumae.2024.09.007","url":null,"abstract":"<div><div>In this article, we present a case of resistant chondrocalcinosis who had a good response with 40<!--> <!-->mg subcutaneous adalimumab. To our knowledge, this is the first report using adalimumab successfully in severe CPDD. Anti-TNF therapy can be a good therapeutic option for second line therapy in CPPD.</div></div>","PeriodicalId":94193,"journal":{"name":"Reumatologia clinica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142421118","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}
Pub Date : 2024-10-01DOI: 10.1016/j.reumae.2024.09.002
Objective
To update the consensus document of the Spanish Society of Rheumatology (SER) regarding the use of targeted biological and synthetic therapies in rheumatoid arthritis (RA) with the aim of assisting clinicians in their therapeutic decisions.
Methods
A panel of 13 experts was assembled through an open call by SER. We employed a mixed adaptation-elaboration-update methodology starting from the 2015 Consensus Document of the Spanish Society of Rheumatology on the use of biological therapies in RA. Starting with systematic reviews (SR) of recommendations from EULAR 2019, American College of Rheumatology 2021, and GUIPCAR 2017, we updated the search strategies for the PICO questions of GUIPCAR. An additional SR was conducted on demyelinating disease in relation to targeted biological and synthetic therapies. Following the analysis of evidence by different panelists, consensus on the wording and level of agreement for each recommendation was reached in a face-to-face meeting.
Results
The panel established 5 general principles and 15 recommendations on the management of RA. These encompassed crucial aspects such as the importance of early treatment, therapeutic goals in RA, monitoring frequency, the use of glucocorticoids, the application of conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), biological DMARDs (bDMARDs), and targeted synthetic DMARDs. Additionally, recommendations on dose reduction of these drugs in stable patients were included. This update also features recommendations on the use of bDMARDs and Janus Kinase inhibitors in some specific clinical situations, such as patients with lung disease, a history of cancer, heart failure, or demyelinating disease.
Conclusions
This update provides recommendations on key aspects in the management of RA using targeted biological and synthetic therapies.
目的：更新西班牙风湿病学会（SER）关于在类风湿关节炎（RA）中使用靶向生物和合成疗法的共识文件，以协助临床医生做出治疗决定：方法：SER 公开征集 13 位专家组成专家小组。我们从 2015 年西班牙风湿病学会关于在 RA 中使用生物疗法的共识文件开始，采用了改编-阐述-更新的混合方法。从 EULAR 2019、American College of Rheumatology 2021 和 GUIPCAR 2017 建议的系统回顾（SR）开始，我们更新了 GUIPCAR PICO 问题的检索策略。我们还就脱髓鞘疾病与靶向生物和合成疗法的关系进行了额外的SR研究。不同的专家组成员对证据进行分析后，在一次面对面的会议上就每项建议的措辞和一致程度达成了共识：结果：专家小组就 RA 的管理制定了 5 项一般原则和 15 项建议。这些建议包括早期治疗的重要性、RA 的治疗目标、监测频率、糖皮质激素的使用、常规合成改善病情抗风湿药（csDMARDs）、生物 DMARDs（bDMARDs）和靶向合成 DMARDs 的应用等重要方面。此外，还包括对病情稳定的患者减少这些药物剂量的建议。本次更新还包括关于在某些特殊临床情况下使用生物DMARDs和Janus激酶抑制剂的建议，如患有肺部疾病、癌症病史、心力衰竭或脱髓鞘疾病的患者：本更新就使用靶向生物和合成疗法治疗RA的关键方面提出了建议。
{"title":"Update of the Consensus Statement of the Spanish Society of Rheumatology on the use of biological and synthetic targeted therapies in rheumatoid arthritis","authors":"","doi":"10.1016/j.reumae.2024.09.002","DOIUrl":"10.1016/j.reumae.2024.09.002","url":null,"abstract":"<div><h3>Objective</h3><div>To update the consensus document of the Spanish Society of Rheumatology (SER) regarding the use of targeted biological and synthetic therapies in rheumatoid arthritis (RA) with the aim of assisting clinicians in their therapeutic decisions.</div></div><div><h3>Methods</h3><div>A panel of 13 experts was assembled through an open call by SER. We employed a mixed adaptation-elaboration-update methodology starting from the 2015 Consensus Document of the Spanish Society of Rheumatology on the use of biological therapies in RA. Starting with systematic reviews (SR) of recommendations from EULAR 2019, American College of Rheumatology 2021, and GUIPCAR 2017, we updated the search strategies for the PICO questions of GUIPCAR. An additional SR was conducted on demyelinating disease in relation to targeted biological and synthetic therapies. Following the analysis of evidence by different panelists, consensus on the wording and level of agreement for each recommendation was reached in a face-to-face meeting.</div></div><div><h3>Results</h3><div>The panel established 5 general principles and 15 recommendations on the management of RA. These encompassed crucial aspects such as the importance of early treatment, therapeutic goals in RA, monitoring frequency, the use of glucocorticoids, the application of conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), biological DMARDs (bDMARDs), and targeted synthetic DMARDs. Additionally, recommendations on dose reduction of these drugs in stable patients were included. This update also features recommendations on the use of bDMARDs and Janus Kinase inhibitors in some specific clinical situations, such as patients with lung disease, a history of cancer, heart failure, or demyelinating disease.</div></div><div><h3>Conclusions</h3><div>This update provides recommendations on key aspects in the management of RA using targeted biological and synthetic therapies.</div></div>","PeriodicalId":94193,"journal":{"name":"Reumatologia clinica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142335477","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}
Pub Date : 2024-10-01DOI: 10.1016/j.reumae.2024.09.008
{"title":"Multicentric reticulohistiocytosis: A 20-year diagnosis beneath the surface","authors":"","doi":"10.1016/j.reumae.2024.09.008","DOIUrl":"10.1016/j.reumae.2024.09.008","url":null,"abstract":"","PeriodicalId":94193,"journal":{"name":"Reumatologia clinica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142421146","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}
Pub Date : 2024-10-01DOI: 10.1016/j.reumae.2024.09.006
The presence of anxiety and depression symptoms in patients with lupus is common, and some research reports that psychological interventions can reduce them, therefore we conducted a systematic review and meta-analysis of the efficacy of psychological interventions in adults with systemic lupus erythematosus. Randomized and non-randomized clinical trials with adult population diagnosed with lupus, treated with psychological intervention, and compared with similar groups were selected. Several databases were searched in July 2023. Fourteen studies were included in the meta-analysis, with moderate effect sizes for anxiety and depression in group intervention modalities. Factors such as percentage of sample with lupus, gender, medication, and interventions with relaxation components influenced the results. Group psychological intervention programs are effective in reducing symptoms in patients with lupus, although further research on treatment modulating variables is needed.
{"title":"Efficacy of psychological interventions to reduce anxiety and depression in patients with lupus. A systematic review and meta-analysis","authors":"","doi":"10.1016/j.reumae.2024.09.006","DOIUrl":"10.1016/j.reumae.2024.09.006","url":null,"abstract":"<div><div>The presence of anxiety and depression symptoms in patients with lupus is common, and some research reports that psychological interventions can reduce them, therefore we conducted a systematic review and meta-analysis of the efficacy of psychological interventions in adults with systemic lupus erythematosus. Randomized and non-randomized clinical trials with adult population diagnosed with lupus, treated with psychological intervention, and compared with similar groups were selected. Several databases were searched in July 2023. Fourteen studies were included in the meta-analysis, with moderate effect sizes for anxiety and depression in group intervention modalities. Factors such as percentage of sample with lupus, gender, medication, and interventions with relaxation components influenced the results. Group psychological intervention programs are effective in reducing symptoms in patients with lupus, although further research on treatment modulating variables is needed.</div></div>","PeriodicalId":94193,"journal":{"name":"Reumatologia clinica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142421144","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}
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