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Introduction: The development of recommendations for the treatment of rheumatoid arthritis (RA) in the Cuban context may be one of the ways to achieve better control of this disease. Objective: To reach a consensus and update relevant aspects of conventional and biological RA modifier therapy in Cuba. Methods: 18 specialists from 8 Cuban provinces, experts in RA care, were summoned, according to the years of dedication to the specialty, the conferences on this topic and their publications. The first meeting took place in March 2016 in the provincial hospital of Villa Clara, Cuba, with the participation of all the experts. A review of the literature on conventional and biological therapy previously collected by the participants was developed, and two teams were formed: the first would address everything related to conventional therapy in RA (HRCT) and the other, biological therapy in RA (TBAR). Three questionnaires related to the use of corticosteroids, HRCT and TBAR, were prepared, answered by the participants via email. In a second meeting, held in October 2016 in Havana, the analysis of all the responses provided was carried out. Questions with a response of 90% or more votes were considered as recommendations. Results: The questionnaires were answered by 95% of the participants. 9 recommendations and 1 algorithm were established. The recommendations are as follows: methotrexate is the drug of choice in the treatment of RA after diagnosis; The administration of another conventional drug (DMARDc) (azathioprine, salazosulfapyridine, antimalarials and leflunomide) is recommended in patients with a diagnosis of active RA in whom methotrexate is contraindicated or there is a failure in response - consider the administration of low doses of prednisone or equivalent (<7.5 mg/d) associated with DMARDc in patients with active moderate to severe RA, for the shortest possible time; perform serological control including tests for hepatitis B and C viruses and screening for HIV in all patients diagnosed with RA before starting treatment with DMARDc and biologics; in patients in remission or, at least, with a DAS-28 below 3.2, consideration should be given to withdrawing one of the DMARDs or reducing, to the minimum possible expression, the dose of both disease modifiers; if methotrexate fails, tocilizumab in combination with methotrexate or as monotherapy will be indicated. Conclusions: Aspects related to conventional therapy with methotrexate, azathioprine, salazosulfapyridine, antimalarials and leflunomide were agreed. The value of early diagnosis and immediate initiation of DMARDc therapy and the use of glucocorticoids was analyzed. Treatment with tocilizumab, the only biological available in Cuba against RA, will be administered when there is a failure in the response to conventional therapy and combinations between these drugs. It is recommended to hold educational conferences through the mass media aimed at patientshttp(AU)
Subject(s)
Humans , Arthritis, Rheumatoid/drug therapy , Biological Therapy/methods , Antimalarials/therapeutic use , Arthritis, Rheumatoid/therapyABSTRACT
En 1959 surgió en Cuba lo que se conoce hoy como la Actividad de Diabetes y Embarazo. El objetivo de este informe es describir su origen y desarrollo. Esta labor tuvo su inicio en el Hospital General Calixto García, por quien puede considerarse el pionero en este campo, el Dr. Antonio Márquez Guillén. En 1970, se fundó en el Hospital Ramón González Coro la primera sala hospitalaria destinada a atender específicamente a mujeres embarazadas con diabetes. Esta sala ha estado funcionando bajo la égida del Dr. Lemay Valdés Amador. La atención preconcepcional a la mujer con diabetes se estableció en 1992 en el Instituto Nacional de Endocrinología y uno de sus adeptos más genuinos fue el Dr. Jacinto Lang Prieto. A partir del 2001 la actividad de diabetes y embarazo inició un proceso de consolidación, que tuvo como punto de partida la fundación de un programa nacional y terminó con la realización en 2007 del I Consenso Cubano de Diabetes y Embarazo. El proyecto de colaboración con la Fundación Mundial de la Diabetes, iniciado en el 2007, contribuyó a la extensión de esta actividad a todo el país y a evidenciar los logros de Cuba en la atención de embarazadas diabéticas, lo que motivó que la Federación Internacional de Diabetes nombrara Centro de Excelencia en la atención a la mujer embarazada con Diabetes y Embarazo al Servicio de Diabetes y Embarazo del Hospital Ramón González Coro. Recién en 2017, se realizó el II Consenso Cubano de Diabetes y Embarazo, y se continúa trabajando para mantener los logros alcanzados(AU)
In 1959 arose in Cuba what is known today as the Activity of Diabetes and Pregnancy. The objective of this report is to describe its origin and development. This work had its beginning in General Calixto García Hospital by who can be regarded as a pioneer in this field, Dr. Antonio Márquez Guillén. In 1970, it was founded in Ramón González Coro Hospital the first hospital room designed to attend specifically pregnant women with diabetes. This room has been operated under the aegis of Dr. Lemay Valdés Amador. The preconceptional care to women with diabetes was established in 1992 at the National Institute of Endocrinology and one of its most genuine supporters was Dr. Jacinto Lang Prieto. From 2001, the activity of diabetes and pregnancy began a process of consolidation, which took as its starting point the foundation of a national program and ended with the execution in 2007 of the First Cuban Consensus of Diabetes and Pregnancy. The collaborative project with the World Diabetes Foundation initiated in 2007 contributed to the extension of this activity throughout the country and to demonstrate the achievements of Cuba in the care of pregnant women with diabetes, which prompted that the International Diabetes Federation appointed the service of Diabetes and Pregnancy of Ramón González Coro Hospital as a Center of Excellence in the attention to pregnant women with Diabetes and Pregnancy. Recently in 2017, the Second Cuban Consensus of Diabetes and Pregnancy was carried out, and the work to maintain the achievements continues(AU)