Syndemic and syndemogenesis of low back pain in Latin-American population: a network and cluster analysis

Clinical Rheumatology - Although low back pain (LBP) is a high-impact health condition, its burden has not been examined from the syndemic perspective. To compare and assess clinical,...     

Prevalence and risk factors for urolithiasis in primary gout: is a reappraisal needed?

OBJECTIVE: To assess the prevalence and risk factors for urolithiasis in primary gout. METHODS: One hundred forty patients with primary gout were studied. Urolithiasis was defined as a history of urolithiasis, or nephrolithiasis detected via ultrasonography in patients with no previous record of urolithiasis. Patient age, duration of gout, presence of tophi, obesity, alcoholism, high blood pressure, diabetes, hyperlipidemia, family history of urolithiasis, daily urine output, uricemia, urine pH, FeNa, FeUrate, urine pH/FeUrate index, and daily urine excretion of urate, sodium, calcium and potassium were compared between lithiasic and non-lithiasic subjects. RESULTS: Fifty-five (39%; 95% CI 31-47) patients had urolithiasis, of which 37 (26%) were diagnosed by clinical history and 18 (13%) by ultrasonography. Patients with a silent kidney stone diagnosed by ultrasound tended to have shorter evolution of gout. Aside from urinary H+ ion concentration (lithiasic subjects 5.17 +/- 3.9 microM/l; non-lithiasic subjects 3.80 +/- 3.01 microM/l; p = 0.02), no difference was found between lithiasic and non-lithiasic subjects for the other variables studied. CONCLUSION: Ultrasonography increased the probability of diagnosing urolithiasis by 50%, meaning the prevalence of urolithiasis in gout is likely higher than previously reported. A higher urinary H+ ion concentration was the only variable associated with urolithiasis. Due to advances in diagnosis of gout and urolithiasis, as well as biochemical assays, the prevalence and risk factors for urolithiasis in gout require reassessment.     

Factors associated with musculoskeletal disability and chronic renal failure in clinically diagnosed primary gout

OBJECTIVE:. To assess the association between a set of sociodemographic, clinical, and biochemical variables and the presence of musculoskeletal (MSK) disability and chronic renal failure in patients with primary gout defined using Wallace criteria. METHODS: Subjects were 90 patients with primary gout (98% male, age 54 +/- 12 years, 11.3 +/- 9.8 years with gout). A cohort nested case-control design was used. Analysis was done of the association between MSK disability or renal failure and a series of variables: age; duration of gout; body mass index; education level; income; serum glucose, cholesterol, triglycerides, and uric acid; Health Assessment Questionnaire score; obesity; family history of gout; high blood pressure; alcoholism; smoking habit; presence of tophi; ischemic cardiopathy; and use of colchicine, glucocorticoids, nonsteroidal antiinflammatory drug, or allopurinol. RESULTS: Forty-two patients (47%) had MSK disability, and 25/80 (31%) had renal failure. On logistic regression, presence of tophi (relative risk 4.3, 95% confidence interval 1.2-15.1), hypertriglyceridemia (RR 3.4, 95% CI 1.1-10), and history of ischemic heart disease (RR 8.3, 95% CI 1.6-41) were associated with MSK disability. Patient age was the only variable associated with renal failure. CONCLUSION: Optimal medical control of gout and its comorbidities may improve prognosis of gout, as suggested by our findings, in which a marker for poorly controlled gout such as presence of tophi in addition to high blood triglyceride levels and ischemic heart disease were associated with MSK disability. Older age was the only factor associated with renal failure, although this may only reflect declining renal function in the elderly.     

A randomized, double-blind, multicenter, controlled clinical trial of cyclosporine plus chloroquine vs. cyclosporine plus placebo in early-onset rheumatoid arthritis

BACKGROUND: Our objective was to assess the efficacy and safety of cyclosporine-A (CsA) plus chloroquine (Clq) in early-onset rheumatoid arthritis (RA) compared to CsA plus placebo. METHODS: We conducted a prospective, 12-month follow-up, multicenter, double-blind, placebo-controlled study of CsA (2.5-5 mg/kg/day[d]) plus Clq (150 mg/d) vs. CsA plus placebo in active RA of <2 years of evolution. RESULTS: A total of 149 patients were included; 111 patients (74.4%) completed the 12-month follow-up period. Evaluation at 6 and 12 months showed improvement for all clinical disease parameters. In both groups there was a decrease in tender joint count, swollen joint count, pain, assessment of efficacy by both investigator and patient, functional assessment, and morning stiffness, all differences statistically significant. With an intention-to-treat analysis, there was 64% in the CsA plus Clq group (CsA/Clq) and 63% in the CsA plus placebo group (CsA/Plac) at 12 months in the American College of Rheumatology (ACR)-20 criteria of improvement. Response rate for ACR-50 was 48 and 47%, and for ACR-70 it was 29% in both groups; the difference was not statistically significant between study groups. Gastrointestinal complaints were common in both groups. Four patients in CsA/Clq group and five patients in CsA/placebo group increased creatinine levels; two patients in each group discontinued treatment due to this reason. CONCLUSIONS: There was no advantage to adding chloroquine to cyclosporine in patients with RA.     

Association of complementary or alternative medicine use with quality of life, functional status or cumulated damage in chronic rheumatic diseases

Quality of life, functional status, or cumulated damage were compared between users and non-users of complementary and alternative medicine (CAM) in 445 rheumatic patients (rheumatoid arthritis [RA]: 64; systemic lupus erythematosus [SLE]: 192; fibromyalgia [FM]: 34; and knee osteoarthritis [KOA]: 155). CAM use was reported by 249 subjects (55.9%; 95%CI; 51.4–60.6). After a general linear model was applied, CAM use was associated with lower scores in the physical function (p = 0.02) and bodily pain (p = 0.03) domains of the SF-36 survey. In FM, RA and KOA, functional status was not different between users and non-users. CAM use was associated with higher cumulated damage (p = 0.04) in SLE. In patients with chronic rheumatic diseases, CAM use was not associated with better quality of life. Additionally, in SLE patients, CAM use was associated with higher cumulated damage. More research on CAM use in chronic rheumatic diseases is needed to better delineate its risk/benefit profile.     

A survey of anatomical items relevant to the practice of rheumatology: pelvis,lower extremity,and gait

Clinical Rheumatology - This study aimed to generate a minimum list of structural and functional anatomical items about the pelvis/hip, knee, ankle/foot, gait, and lower limb innervation, which are...     

Culture-sensitive adaptation and validation of the Community-Oriented Program for the Control of Rheumatic Diseases methodology for rheumatic disease in Latin American indigenous populations

The purpose of the study is to validate a culturally sensitive adaptation of the community-oriented program for the control of rheumatic diseases (COPCORD) methodology in several Latin American indigenous populations. The COPCORD Spanish questionnaire was translated and back-translated into seven indigenous languages: Warao, Kariña and Chaima (Venezuela), Mixteco, Maya-Yucateco and Raramuri (Mexico) and Qom (Argentina). The questionnaire was administered to almost 100 subjects in each community with the assistance of bilingual translators. Individuals with pain, stiffness or swelling in any part of the body in the previous 7 days and/or at any point in life were evaluated by physicians to confirm a diagnosis according to criteria for rheumatic diseases. Overall, individuals did not understand the use of a 0–10 visual analog scale for pain intensity and severity grading and preferred a Likert scale comprising four items for pain intensity (no pain, minimal pain, strong pain, and intense pain). They were unable to discriminate between pain intensity and pain severity, so only pain intensity was included. For validation, 702 subjects (286 male, 416 female, mean age 42.7 ± 18.3 years) were interviewed in their own language. In the last 7 days, 198 (28.2 %) subjects reported having musculoskeletal pain, and 90 (45.4 %) of these had intense pain. Compared with the physician-confirmed diagnosis, the COPCORD questionnaire had 73.8 % sensitivity, 72.9 % specificity, a positive likelihood ratio of 2.7 and area under the receiver operating characteristic curve of 0.73. The COPCORD questionnaire is a valid screening tool for rheumatic diseases in indigenous Latin American populations.     

Prevalence and factors associated with musculoskeletal disorders and rheumatic diseases in indigenous Maya-Yucateco people: a cross-sectional community-based study

This study aimed to estimate the prevalence of musculoskeletal disorders and rheumatic diseases in indigenous Maya-Yucateco communities using Community-Oriented Program for Control of Rheumatic Diseases (COPCORD) methodology. The study population comprised subjects aged ≥18 years from 11 communities in the municipality of Chankom, Yucatan. An analytical cross-sectional study was performed, and a census was used. Subjects positive for musculoskeletal (MSK) pain were examined by trained physicians. A total of 1523 community members were interviewed. The mean age was 45.2 years (standard deviation (SD) 17.9), and 917 (60.2 %) were women. Overall, 592 individuals (38.8 %; 95 % CI 36.3–41.3 %) had experienced MSK pain in the last 7 days. The pain intensity was reported as “strong” to “severe” in 43.4 %. The diagnoses were rheumatic regional pain syndromes in 165 (10.8 %; 95 % CI 9.4–12.5), low back pain in 153 (10.0 %; 95 % CI 8.5–11.6), osteoarthritis in 144 (9.4 %; 95 % CI 8.0–11.0), fibromyalgia in 35 (2.2 %; 95 % CI 1.6–3.1), rheumatoid arthritis in 17 (1.1 %; 95 % CI 0.6–1.7), undifferentiated arthritis in 8 (0.5 %; 95 % CI 0.2–0.8), and gout in 1 (0.06 %; 95 % CI 0.001–0.3). Older age, being female, disability, and physically demanding work were associated with a greater likelihood of having a rheumatic disease. In conclusion, MSK pain and rheumatic diseases were highly prevalent. The high impact of rheumatic diseases on daily activities in this indigenous population suggests the need to organize culturally-sensitive community interventions for the prevention of disabilities caused by MSK disorders and diseases.