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1.
《Reumatología clinica》2014,10(6):360-363
IntroductionDifferent prediction rules have been applied to patients with undifferentiated arthritis (UA) to identify those that progress to rheumatoid arthritis (RA). The Leiden Prediction Rule (LPR) has proven useful in different UA cohorts.ObjectiveTo apply the LPR to a cohort of patients with UA of northeastern Mexico.MethodsWe included 47 patients with UA, LPR was applied at baseline. They were evaluated and then classified after one year of follow-up into two groups: those who progressed to RA (according to ACR 1987) and those who did not.Results43% of the AI patients developed RA. In the RA group, 56% of patients obtained a score ≤ 6 and only 15% ≥ 8. 70% who did not progress to RA had a score between 6 and ≤ 8. There was no difference in median score of LPR between groups, p = 0.940.ConclusionMost patients who progressed to RA scored less than 6 points in the LPR. Unlike what was observed in other cohorts, the model in our population did not allow us to predict the progression of the disease. 相似文献
2.
《Reumatología clinica》2014,10(1):32-36
AimTo evaluate the larynx involvement in patients with rheumatoid arthritis (RA) in a clinical setting and correlate with the different clinical features related to more aggressive disease.MethodsCross-sectional study including 36 consecutive patients with RA. Reflux symptoms were evaluated by the Reflux Symptom Index (RSI) and vocal cord impairment by the Voice Handicap Index-10 (VHI-10). Laryngeal involvement was done by videolaryngostroboscopy (VLS).ResultsThe mean age was 56,3 ± 14 years with a mean disease duration of 2,6 ± 3,1 years (range 0-16 years). Voice use was considered as professional users in 33%. Twenty-four (67%) out of 36 patients had abnormal findings of VLS. One patient had larynx nodules (bamboo nodules). Eleven patients (31%) were diagnosed with muscle tension dysphonia, and there were symptoms and signs of pharyngeal-laryngeal reflux in 23 (64%) patients. No signs of cricoarytenoid joint impairment was found.ConclusionsOrganic larynx involvement was uncommon in patients with RA. However symptoms and signs of pharyngeal-laryngeal reflux were seen in around 60% of patients. There was no correlation between the clinical phenotype, severity of disease, immunological profile or treatment with VLS findings. 相似文献
3.
Luis Ortega-Valín Isabel Mayorga-Bajo Carolina Prieto-Fernández Javier del Pozo-Ruiz Esperanza Gutiérrez-Gutiérrez Trinidad Pérez-Sandoval 《Reumatología clinica》2018,14(4):191-195
Objective
To analyze the changes in health-related quality of life (HRQoL) of patients with rheumatoid arthritis (RA) treated with biological therapies.Method
Observational prospective study performed from October 2006 to May 2011. The inclusion criteria were adult patients, diagnosed with RA, treated for at least one year with anti-tumor necrosis factor therapy (infliximab or etanercept), who had not received other biological treatments previously. A total of 41 patients who completed the study undertook the specific and validated questionnaire QoL-RA Scale 3 times: E1 (September 2006-February 2007), E2 (April 2008-January 2009) and E3 (July 2010- May 2011). Data analysis was conducted using Epi-Info version 3.3 2004 for Windows® and Excel 2007; mean comparisons were evaluated by Student's t-test and the relationship between the 3 outcomes for each patient by lineal regression.Results
Overall results show a downward trend which was not statistically significant: 7.09 (standard deviation [SD] = 1.15) in E1; 6.90 (SD = 1.60) in E2; and 6.52 (SD = 1.59) in E3. Items with higher scores were those related to psychosocial aspects (help from family, interaction with family and friends), whereas the physical dimension was valued more poorly (physical ability, arthritis pain, arthritis). Between E2 and E3 there was a significant increase in help from family (P=.0008), whereas level of tension (P=.0119) and mood (P=.0451) decreased significantly.Conclusions
In all, HRQoL reported by patients is good and has remained unchanged after approximately 6 years of study. The stability of HRQoL is probably partly attributable to treatment. 相似文献4.
《Reumatología clinica》2022,18(8):475-479
Background and objectivesKnowledge of the levels of anti-TNFα drugs can modify treatment in patients with rheumatoid arthritis (RA) and spondyloarthritis (SpA).ObjectivesTo compare the levels of anti-TNFα in patients with RA vs SpA, in different clinical situations.Materials and methodsA retrospective, observational study was conducted. Levels of anti-TNFα and the presence of anti-drug antibodies were measured in consecutively selected patients, using the ELISA technique.ResultsFifty-three, 73 and 78 patients treated with infliximab, adalimumab and etanercept were studied, respectively. The median drug levels in patients using standard doses were infliximab 2.2 μg/ml (1.4-5.2), adalimumab 4.9 μg/ml (0.8-8.9) and etanercept 3.1 μg/ml (2.3-4.4). There were no differences in drug levels according to disease activity but we found differences in etanercept and infliximab levels according to DMARD use.ConclusionsLevels of anti-TNFα drugs will change with DMARD treatment. 相似文献
5.
《Reumatología clinica》2022,18(2):114-123
ObjectiveTo develop and assess the feasibility in daily practice of four comorbidity checklists, for common use in rheumatoid arthritis (RA), axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA).MethodsA multidisciplinary panel of experts on comorbidity was established. Data from the GECOAR, GECOAX and GECOAP projects were analysed and a narrative literature review in Medline on RA, axSpA and PsA comorbidity was performed in order to select the most relevant and common comorbidities across the three diseases. With these results and those obtained from a focus group of patients, in a nominal group meeting, the experts generated preliminary checklists. These were afterwards modified by an external evaluation by two associations, a patients’ association and an association of health professionals related to rheumatology. As a result, the final checklists were generated. A cross-sectional study was conducted to test the feasibility of three of the checklists in daily practice, in which eight health professionals evaluated the checklists in five patients with RA, five with axSpA and five with SpA.ResultsFour comorbidity checklists were designed, three for health professionals (one to assess current comorbidity, one on prevention/health promotion and one with the referral criteria to other health professionals), and another for patients. The feasibility study showed them to be simple, clear, and useful for use in routine clinical practice.ConclusionsThe use of specific and common checklists for patients with RA, axSpA and PsA is feasible and might contribute favorably to their prognosis as well as in daily practice. 相似文献
6.
Rheumatoid arthritis is a chronic systemic inflammatory disease that causes significant morbidity and mortality. The combined use of methotrexate and biological agents directed against tumor necrosis factor (TNF) has achieved significant improvement in clinical, radiographic and functional parameters not seen previously and has revolutionized the therapeutic goal of achieving remission in clinical, structural and functional parameters. The next goal should be to achieve remission without the use of biological drugs and later without medication. Although there is evidence about the efficacy and safety of TNF inhibitors, there is none on remission without the use of biological agents or disease modifying drugs. 相似文献
7.
《Reumatología clinica》2022,18(10):587-596
AimsInterstitial lung disease (ILD) is frequent in patients with rheumatoid arthritis (RA) and is associated with significant morbidity and mortality. The aim of this review was to identify the different screening methods for ILD in patients with RA.MethodsWe ran a systematic search in Pubmed, Embase and Cochrane Library up to April 2020 and did a hand search of the references of the retrieved articles. The search was limited to humans and articles published in English, Spanish or French. We selected studies with any design where: a) the population included adult patients with RA; b) the intervention was any screening method for ILD; and c) validity or reliability of the screening method were evaluated, or a screening method was described. Two reviewers independently screened the articles by title and abstract and subsequently extracted the information using a specific data extraction form.Results25 studies were included with a total of 2,593 patients. The most frequently used tool for ILD screening was high resolution computed tomography (HRCT) of the lung. Electronic auscultation, biochemical markers, bronchoalveolar lavage (BAL), pulmonary function tests (PFTs) and lung ultrasonography were also evaluated. Across the different studies, electronic auscultation and lung ultrasonography achieved higher accuracy than PFTs, BAL and biochemical markers.ConclusionsHRCT resulted as the most sensitive tool for ILD screening in patients with RA. Given its harmlessness and high sensitivity, lung ultrasonography may become the first-choice tool in the future. 相似文献
8.
Villaverde García V Balsa A Carmona L Sanmartí R Maese J Pascual D Ivorra J;Grupo Proar 《Reumatología clinica》2009,5(3):115-120
ObjectiveTo identify factors present in recent onset arthritis that may help to predict rheumatoid arthritis (RA), and to describe a cohort of recent onset RA.Patients and methodA 5 year prospective cohort of patients with early oligo and polyarthritis (< 1 year of evolution) from 34 rheumatology units, was studied. Sociodemographic, clinical features and RA risk factors were recorded. Rheumatoid factor (RF), anti-CCP determinations and radiographs of hands and feet were analyzed too. After three years, a diagnosis of certainty and the variables that determined the evolution to RA, were evaluated.ResultsOne hundred and seventy one patients were included; 161 (94.2%) fulfilled RA diagnostic criteria; most of them (157; 97.5%) in the first visit. Factors associated with RA diagnosis were: positive RF, anti-CCP and DAS-28; 65% of the patients had radiological erosions in the first visit.ConclusionsPositive RF, anti-CCP and the disease activity are predictive factors of RA. Radiological damage exists very early in most of patients, that's why it is more important to treat the disease aggressively instead than achieving an RA diagnosis of certainty. 相似文献
9.
Francisco Javier García-Alonso María Hernández Tejero Elvira Rubio Benito Paz Valer Iván Guerra Victoria Gema García Ceballos Mar Noguerol Victoria Llinares Fernando Bermejo 《Gastroenterologia y hepatologia》2017,40(5):331-338
Introduction
Dyspepsia is a common disorder in both Primary (PC) and Specialised Care (SC). Gastroscopy is recommended at the start of the study if there are warning signs, although it is not always available in PC.Objectives and methods
We developed a pilot project establishing an early gastroscopy programme for patients with dyspepsia and warning signs in PC, subsequently extending it to the entire healthcare area. The aim was to evaluate the requirements, impact and opinion of this service at the PC level. Demographic, symptomatic and endoscopic variables on the patients referred to SC from the pilot centre were recorded. A satisfaction survey was conducted among the PC physicians.Results
The one-year pilot study and the first year of implementation of the programme were evaluated. A total of 355 patients were included (median age 56.4 years; IQR 45.5-64.3); 61.2% (56.1-66.3%) were women. The waiting time for examination was 1.5 weeks (IQR 1.5-2.5). Gastroscopy was correctly indicated in 82.7% (78.4-86.3%) of patients. The median number of requests per month was 1.1 per 10,000 adults (range 0.8-1.6). Monthly referrals to SC clinics from the pilot centre fell by 11 subjects (95% CI 5.9-16) with respect to the previous median of 58 (IQR 48-64.5). Almost all those polled (98.4%) considered the programme useful in routine practice.Conclusions
The availability of an early gastroscopy programme in PC for patients with dyspepsia and warning signs reduced the number of referrals to SC. 相似文献10.
Ana Lois Iglesias Walter Alberto Sifuentes Giraldo Javier Bachiller Corral Ana Saiz González Elia Brito Brito Antonio Zea Mendoza 《Reumatología clinica》2012,8(6):365-367
Large granular lymphocyte leukemia is a rare entity belonging to same spectrum of diseases than Felty's syndrome, which might occur in patients with long-standing rheumatoid arthritis. It is clinically characterized by persistent neutropenia and recurrent bacterial infections associated with the presence in both peripheral blood and bone marrow of clonal expansion of atypic lymphocytes with a cytotoxic T cell phenotype, or less frequently an NK-cell phenotype, as well as splenomegaly. It is more frequently diagnosed in seropositive rheumatoid arthritis, with significant structural damage, extra-articular manifestations and persistently elevated values of ESR, despite them havubg low inflammatory joint activity. We report the case of a 70 year old male with a long-standing rheumatoid arthritis, who developed septic shock secondary to prosthetic hip infection by Salmonella spp. He showed persistent neutropenia, and an aberrant monoclonal T cell population was detected in both peripheral blood and bone marrow, consistent with large granular lymphocyte leukemia. 相似文献
11.
《Reumatología clinica》2022,18(4):236-245
ObjectiveTo evaluate the validity, reliability, and performance of the Health Assessment Questionnaire-II(HAQ-II) Spanish version questionnaire to measure physical function.MethodsA cross-sectional study of 496 patients with rheumatoid arthritis, distributed in 2 samples. The construct validity was evaluated employing the confirmatory factor analysis and the validity based on the relationship with other variables. Cronbach's alpha (α) and McDonald's omega (ω) coefficient were used to determine reliability. Item performance was analysed by fitting different models of item response theory.ResultsThe one-factor model presented a poor fit in the confirmatory factor analysis; an exploratory factor analysis was carried out, which suggested a 2-factor structure. The confirmatory factor analysis in the second sample confirmed that the second-order model had a good fit to the data. The general factor explained more than 70% of the variance. The reliability indices showed adequate internal consistency (α = .92-.95; ω = .88-.93). Ninety-three percent of the contrasting hypotheses about the relationship of the HAQ-II scores with other variables were confirmed, demonstrating their convergent, divergent, and known group validity. The multidimensional graduated response model was the one that best predicted person's interaction with the items.ConclusionThe Spanish version of the HAQ-II presents adequate validity and reliability for measuring Mexican patients’ physical function with rheumatoid arthritis. 相似文献
12.
Facundo Vergara Santiago Ruta Javier Rosa Josefina Marín Ricardo García-Mónaco Enrique R. Soriano 《Reumatología clinica》2018,14(4):202-206
Objectives
The aim of the present study was to describe the ultrasound (US) findings in patients with rheumatoid arthritis (RA) in clinical remission, and to evaluate the ability of power Doppler (PD) US to reclassify disease activity in these patients.Material and methods
We included consecutive patients with RA according to 2010 American College of Rheumatology/European League Against Rheumatism criteria, who were in clinical remission by the Disease Activity Score (DAS28<2.6). Twenty joints of both hands were assessed by US. PD signal was evaluated on a semi-quantitative scale from 0 to 3. Three different US-modified DAS28 (US-DAS28) were constructed, replacing the clinical swollen joint count by the PD US joint count using PD score ≥1, ≥2 or ≥3, respectively.Results
Eighty-six patients were included. Twenty-three (26.7%) patients had at least one joint with abnormal US-positive PD signal. Thirteen percent of patients were reclassified to low disease activity by applying the US-DAS28 when joints were considered active with a PD signal ≥1; 12%, when a PD signal ≥2 was considered, and 2% of the patients were reclassified when a PD score of 3 was considered. No patients were reclassified to a level of moderate or high activity applying US-DAS28.Conclusions
Although around a quarter of patients with RA in clinical remission showed PD US features indicating residual activity, only a small percentage were reclassified to a state of low activity and none to a level of moderate or high activity, applying the proposed US-DAS28. 相似文献13.
14.
Raquel Almodovar Beatriz Joven Esther Rodríguez Almaraz Sheila Melchor Elena Rabadán Virginia Villaverde Teresa Navío Laura Cebrián Méndez Leticia Lojo Oliveira Alejandro Prada Laura González Álvaro García Martos Victoria Navarro-Compán Estíbaliz Loza Pedro Zarco 《Reumatología clinica》2021,17(7):392-396
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17.
《Enfermedades infecciosas y microbiología clínica》2023,41(5):298-300
IntroductionReactivation of cytomegalovirus can complicate the evolution of patients with gastritis induced by immune checkpoint inhibitors.MethodsThe experience in our center is described and a review of the literature is performed.ResultsA case of severe gastritis induced by treatment with a programmed cell death receptor-1 (anti-PD1) inhibitor, associated with reactivation of cytomegalovirus (CMV) is described. In the systematic review, we identified 5 cases of immune-related gastritis associated with CMV reactivation. Ganciclovir treatment contributed to clinical improvement in most patients.ConclusionThe early identification of a CMV infection in patients with severe or refractory immune-related gastritis will allow the initiation of targeted treatment, and may avoid increasing immunosuppressive therapy. 相似文献
18.
Ingrid Möller Estibaliz Loza Jacqueline Uson Carlos Acebes Jose Luis Andreu Enrique Batlle Ángel Bueno Paz Collado Juan Manuel Fernández-Gallardo Carlos González Mercedes Jiménez Palop María Pilar Lisbona Pilar Macarrón Joan Maymó Jose Antonio Narváez Victoria Navarro-Compán Jesús Sanz M. Piedad Rosario Esperanza Naredo 《Reumatología clinica》2018,14(1):9-19
Objective
To develop evidence-based recommendations on the use of ultrasound (US) and magnetic resonance imaging (MRI) in patients with rheumatoid arthritis (RA).Methods
Recommendations were generated following a nominal group technique. A panel of experts, consisting of 15 rheumatologists and 3 radiologists, was established in the first panel meeting to define the scope and purpose of the consensus document, as well as chapters, potential recommendations and systematic literature reviews (we used and updated those from previous EULAR documents). A first draft of recommendations and text was generated. Then, an electronic Delphi process (2 rounds) was carried out. Recommendations were voted from 1 (total disagreement) to 10 (total agreement). We defined agreement if at least 70% of experts voted ≥7. The level of evidence and grade or recommendation was assessed using the Oxford Centre for Evidence-based Medicine Levels of Evidence. The full text was circulated and reviewed by the panel. The consensus was coordinated by an expert methodologist.Results
A total of 20 recommendations were proposed. They include the validity of US and MRI regarding inflammation and damage detection, diagnosis, prediction (structural damage progression, flare, treatment response, etc.), monitoring and the use of US guided injections/biopsies.Conclusions
These recommendations will help clinicians use US and MRI in RA patients. 相似文献19.
20.
Almudena Amor-Salamanca Gonzalo Guzzo-Merello Esther González-López Fernando Domínguez Alejandra Restrepo-Córdoba Marta Cobo-Marcos Manuel Gómez-Bueno Javier Segovia-Cubero Luis Alonso-Pulpón Pablo García-Pavía 《Revista espa?ola de cardiología》2018,71(8):612-619