Síndrome de Parsonage-Turner. Revisión bibliográfica

Brachial plexus neuropathy or Parsonage-Turner Syndrome (PTS) is a form of neuritis that affects mainly the shoulder girdle and upper arm. The syndrome is bilateral in 25% of patients. The incidence is 1.5/100,000 inhabitants with a peak rate between the third and fifth decades of life and a slight predominance in males. The typical form of PTS is of unknown cause (although triggering factors have been described and the syndrome sometimes coexists with immune processes). There are several phases. The neuritis phase is characterized by sudden and severe shoulder and upper arm pain, paralysis and amyotrophy (especially the supraspinatus, infraspinatus, serratus anterior, and deltoid muscles) and a recovery phase, lasting between 6 and 12 months, without sequelae, although muscular wasting and weakness may sometimes be permanent. On rare occasions, the muscles of the hands and fingers can be affected.PTS is a rare disease but should be considered when there is pain in the upper extremity or cervical spine or there are neuromuscular signs and symptoms. Magnetic resonance imaging can reveal muscle changes associated with PTS: high signal intensity in the muscles of the shoulder girdle with atrophy, compatible with muscle edema associated with denervation. Prognosis is generally favorable, with about 75% of patients showing complete recovery within 2 years. Treatment is symptomatic and is based on analgesic drugs and physical therapy.     

Propuesta de norma de certificación de calidad «SpACE» para unidades de tratamiento de pacientes con espondiloartritis axial

Background and objectiveAxial spondyloarthritis is an immune-mediated disease with a high cost, diagnostic delay and associated complications that makes it a particularly important condition. This work aims to establish a certification standard (SpACE Project) for monographic consultations in its diagnosis and treatment.Materials and methodsQualitative study of consensus, through the technique of the nominal group. First, a pragmatic review of the literature was carried out. Second, professionals involved throughout the care process (rheumatology, ophthalmology, gastroenterology, traumatology, family medicine, physical therapy, and nursing) were included.ResultsThirty-seven possible standards were extracted from the pragmatic review of the literature. During the consensus phase only those standards with high feasibility and importance in the care process were prioritized. Finally, the group of 26 experts agreed on the inclusion of 14 standards.Discussion and conclusionsSpaCE is a consensus-based certification standard that seeks to improve health outcomes and more integrated care.     

Criterios de cribado de enfermedad inflamatoria intestinal y espondiloartritis para derivación de pacientes entre Reumatología y Gastroenterología

Objective

To define clinical screening criteria for spondyloarthritis (SpA) in patients with inflammatory bowel disease (IBD) and vice versa, which can be used as a reference for referring them to the rheumatology or gastroenterology service.

Criterios de cribado de enfermedad inflamatoria intestinal y espondiloartritis para derivación de pacientes entre Reumatología y Gastroenterología

Objective

To define clinical screening criteria for spondyloarthritis (SpA) in patients with inflammatory bowel disease (IBD) and vice versa, which can be used as a reference for referring them to the rheumatology or gastroenterology service.

Posición técnica sobre la leche y derivados lácteos en la salud y en la enfermedad del adulto de la Asociación Mexicana de Gastroenterología y la Asociación Mexicana de Gerontología y Geriatría

Milk is a liquid food that possesses an important quantity of highly bioavailable macronutrients. In addition, it is readily accessible, as well as relatively inexpensive. Given that the knowledge of physicians about nutrition and food composition is deficient, in general, many of the dietary interventions recommended in diverse clinical settings lack a scientific basis. The aim of the present review was to produce a technical opinion that serves as a frame of reference to best sustain recommendations for consuming milk and dairy products as daily nutrition in the adult and older adult. The effects of milk and dairy products during the pediatric stage are not addressed in the present work. The Asociación Mexicana de Gastroenterología and the Asociación Mexicana de Gerontología y Geriatría jointly discussed and analyzed topics dealing with the legal designation of milk, the classification and nutritional profile of cow's milk, its nutritional characteristics, its consumption in the adult, intolerance to cow's milk, and associations of milk consumption with digestive tract alterations and other conditions. Finally, certain aspects of milk consumption in the older adult and its relation to overall health are briefly discussed.     

Documento de consenso para la formación en ecografía en la especialidad de Nefrología

Ultrasound is an essential tool in the management of the nephrological patient allowing the diagnosis, monitoring and performance of kidney intervention. However, the usefulness of ultrasound in the hands of the nephrologist is not limited exclusively to the ultrasound study of the kidney. By ultrasound, the nephrologist can also optimize the management of arteriovenous fistula for hemodialysis, measure cardiovascular risk (mean intimate thickness), implant central catheters for ultrasound-guided HD, as well as the patient's volemia using basic cardiac ultrasound, ultrasound of the cava inferior vein and lungs.From the Working Group on Interventional Nephrology (GNDI) of the Spanish Society of Nephrology (SEN) we have prepared this consensus document that summarizes the main applications of ultrasound to Nephrology, including the necessary basic technical requirements, the framework normative and the level of training of nephrologists in this area. The objective of this work is to promote the inclusion of ultrasound, both diagnostic and interventional, in the usual clinical practice of the nephrologist and in the Nephrology Services portfolio with the final objective of offering diligent, efficient and comprehensive management to the nephrological patient.     

Utilidad de la valoración ecográfica previa a la realización del primer acceso vascular para hemodiálisis

IntroductionTraditionally, the indication of the type of vascular access (VA) has been based on the surgeon's physical examination, but it is now suggested that imaging methods could provide a clinical benefit. Our aim was to determine whether or not preoperative Doppler ultrasound modifies outcomes of the first VA for haemodialysis.Patients and methodsProspective cohort of patients undergoing a first VA from June 2014 to July 2017 who had a preoperative Doppler ultrasound (ECO group). They were compared to a historical cohort (January 2012-May 2014) of first VA indicated exclusively by clinical assessment (CLN group).ResultsA total of 86 patients from the CLN group were compared to 92 from the ECO group, which was younger (68.4 vs 64.0, P = .038).The primary patency (CLN/ECO) at 1 and 2 years was 59.5%/71.9% and 53.1%/57.8% respectively, marginally better in the ECO group (P = .057). The assisted patency at 1 and 2 years was 63.2%/80.7% and 58.1%/70.2%, respectively, significantly better for the ECO group (P = .010).Due to lack of patency/utility of the initial VA, 26.7% in the CLN group and 7.6% in the ECO group (P < .001) required a new VA during the first 6 months. An average of 1.39 interventions were performed to achieve a useful VA in the CLN group and 1.08 in the ECO group (P < .001), the first VA being useful at the radiocephalic level in 31.0%/45.1% (P = .039).ConclusionThe indication of the first VA according to a preoperative Doppler ultrasound examination could decrease the need for new VA, enable them to be made more distal, and significantly improve patency.     

Desarrollo de un cuadro de actuación para la evaluación de pacientes con espondiloartritis axial y artritis psoriásica en la práctica diaria: proyecto ONLY TOOLS

Objective

To standardize clinical evaluation of patients with axial spondyloarthritis (SpA) and psoriatic arthritis (PsA) using a checklist.

Guías y recomendaciones para el diagnóstico y tratamiento de la artrosis: en busca del consenso

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.     

Prurito en pacientes en diálisis. Revisión de la literatura y nuevas perspectivas

Uremic pruritus (UP) is one of the most uncomfortable symptoms for patients in dialysis. UP has a great impact on dialysis patients’ quality of life and has a great prevalence between those (28–70%). Physiopathology of UP is unknown and usually is unnoticed for most nephrologists (in more than 65% of centers is underdiagnosed). This lack of awareness drives to the unsuccessful treatment of this symptom. Moreover, the fact that most studies have been carried out on small populations and the difficulty assessing UP complicates a correct therapeutical approach. For this reason, we have designed treatment algorithms based on the efficacy of the drugs but also its safeness to avoid adverse effects.     

Guía de práctica clínica 2021 para la detección temprana,el diagnóstico,el tratamiento y el seguimiento de los pacientes con espondiloartritis axial. Asociación Colombiana de Reumatología

BackgroundAxial spondyloarthritis is a rheumatic condition affecting young patients with social and occupational consequences. Diagnosis delay is associated with functional impairment and impact on quality of life, requiring a multidisciplinary approach.ObjectiveTo develop a set of recommendations based on the best available evidence for the early detection, diagnosis, treatment, and monitoring of adult patients with axial spondyloarthritis.MethodsA working group was established, questions were developed, outcomes were graded, and a systematic search for evidence was conducted. A multidisciplinary panel of members was established (including patient representatives), minimizing bias in relation to conflicts of interest. The GRADE approach Grading of Recommendations Assessment, Development and Evaluation was used to assess the quality of the evidence as well as the direction and strength of recommendations. In total, 11 recommendations on diagnosis (n=2), pharmacological treatment (n=6), non-pharmacological treatment (n=2) and monitoring (n=1) are presented.ResultsSacroiliac joint radiography as the first diagnostic method, and the use of disease activity scales for patient monitoring (ASDAS or BASDAI), are recommended. Nonsteroidal anti-inflammatory drugs are the first treatment option; in case of intolerance or residual pain, acetaminophen or opioids are recommended. In patients with axial involvement, it is recommended not to use conventional disease-modifying antirheumatic drugs or systemic or local glucocorticoids. In patients with failure to non-steroidal anti-inflammatory drugs, anti-TNF or anti-IL17A is recommended. In those patients presenting with anti-TNF failure, starting an anti-IL17A is recommended. Exercise, physical and occupational therapy are recommended as part of treatment. It is recommended not to use unconventional therapies as the only treatment option.ConclusionsThis set of recommendations provides an updated guideline for the diagnosis, treatment, and monitoring of patients with axial spondyloarthritis.     

Recomendaciones para el manejo de la comorbilidad en la práctica clínica en pacientes con espondiloartritis axial

Objectives

To identify priorities among comorbidities in axial spondyloarthritis (AxSpA) and recommend how to follow them from an eminently practical perspective.

Comparación de 2 estrategias de derivación en el diagnóstico de la espondiloartritis axial en España. Estudio RADAR

ObjectivesImproving referral of patients with back pain to rheumatologists could accelerate the diagnosis of axial spondyloarthritis. The RADAR study compared two strategies in the referral of patients with chronic back pain (> 3 months) with an onset before the age of 45 years from primary care centers to rheumatology departments, in relation to the diagnosis of axial spondyloarthritis.Patients and methodsEach primary care center was assigned a referral strategy for its patients: (a) strategy 1, patients who had one of the 3 following criteria: inflammatory back pain, HLA-B27 positivity or sacroiliitis in imaging; or (b) strategy 2, patients who had 2 of the following 6: inflammatory back pain, HLA-B27 positivity, sacroiliitis in imaging, family history of axial spondyloarthritis, extra-articular manifestations or good response to nonsteroidal antiinflammatory drugs. The rheumatologist established the final diagnosis.ResultsEighty-eight Spanish patients (mean age 36.8 years [SD 8.7], 55.7% females and 44.3% males) were referred for evaluation, 60 patients under strategy 1 and 28 under strategy 2. A definitive diagnosis of axial spondyloarthritis was established in 25.4% with strategy 1 and in 28.6% with strategy 2 (p = NS). Inflammatory back pain was the criterion most commonly used for referral, and the agreement rate between the primary care physician and rheumatologist was 75%.ConclusionsA simple referral strategy based on one of three3 criteria proved as effective as a strategy based on two of 6 criteria in diagnosing axial spondyloarthritis. Inflammatory back pain was the criterion most commonly used for patient referral     

Documento de información y consenso para la detección y manejo de la enfermedad renal crónica

Chronic kidney disease (CKD) is a major public health problem worldwide that affects more than 10% of the Spanish population. CKD is associated with high comorbidity rates, poor prognosis and major consumption of health system resources. Since the publication of the last consensus document on CKD seven years ago, little evidence has emerged and few clinical trials on new diagnostic and treatment strategies in CKD have been conducted, apart from new trials in diabetic kidney disease. Therefore, CKD international guidelines have not been recently updated. The rigidity and conservative attitude of the guidelines should not prevent the publication of updates in knowledge about certain matters that may be key in detecting CKD and managing patients with this disease. This document, also prepared by 10 scientific societies, provides an update on concepts, clarifications, diagnostic criteria, remission strategies and new treatment options.The evidence and the main studies published on these aspects of CKD have been reviewed. This should be considered more as an information document on CKD. It includes an update on CKD detection, risk factors and screening; a definition of renal progression; an update of remission criteria with new suggestions in the older population; CKD monitoring and prevention strategies; management of associated comorbidities, particularly in diabetes mellitus; roles of the Primary Care physician in CKD management; and what not to do in Nephrology.The aim of the document is to serve as an aid in the multidisciplinary management of the patient with CKD based on current recommendations and knowledge.