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Antecedentes: Estudios observacionales han descrito una alta prevalencia de depresión y ansiedad en la artritis reumatoidea: los trastornos depresivos mayores se detectan en el 17 % de los pacientes con la patología, y la inflamación local y sistémica desempeña un papel importante en la ansiedad y la depresión. Objetivos: El objetivo general de esta investigación fue determinar la frecuencia de ansiedad, depresión y vulnerabilidad al estrés en pacientes con diagnóstico de artritis reumatoidea. Materiales y métodos: Este fue un estudio observacional, descriptivo de asociación cruzada y temporalmente prospectivo. El muestreo fue no probabilístico de casos consecutivos. Se incluyó a personas adultas con diagnóstico de artritis reumatoide que consultaron en el Departamento de Reumatología del Hospital de Clínicas, entre agosto y octubre del 2022. Para el diagnóstico psiquiátrico se utilizaron los siguientes instrumentos: Escala de Ansiedad Generalizada (GAD-7), Patient Health Questionnaire (PHQ-2) y Escala de Vulnerabilidad al Estrés de Smith y Miller. Resultados: Se incluyó a 36 pacientes, todas mujeres, con edades comprendidas entre los 20 y 77 años. El 27,8 % tenía depresión, según los puntos de corte del PHQ-2. El 22,2 % presentaba ansiedad, según los puntos de corte de GAD-7. En cuanto al estrés, el 22,2 % tenía vulnerabilidad a este y el 5,6 % era seriamente vulnerable. Conclusión: Depresión, ansiedad y vulnerabilidad al estrés son comorbilidades frecuentemente observadas en pacientes con artritis reumatoidea. Se requieren de intervenciones específicas de salud mental para abordar estas cuestiones y mejorar la calidad de vida de los pacientes afectados.
Background: Observational studies have described a high prevalence of depression and anxiety in rheumatoid arthritis: major depressive disorders are detected in 17 % of patients with the pathology, and local and systemic inflammation play an important role in anxiety and depression. Objectives: The overall objective of this research was to determine the frequency of anxiety, depression, and vulnerability to stress in patients diagnosed with rheumatoid arthritis. Materials and methods: This was an observational, descriptive, temporally prospective, cross-association study. Sampling was non-probabilistic of consecutive cases. We included adults with a diagnosis of rheumatoid arthritis who consulted at the Rheumatology Department of the Hospital de Clínicas between August and October 2022. The following instruments were used for psychiatric diagnosis: Generalized Anxiety Scale (GAD-7), Patient Health Questionnaire (PHQ-2) and Smith and Miller's Stress Vulnerability Scale. Results: Thirty-six patients, all women, aged between 20 and 77 years, were included in the study. The 27.8 % had depression, according to the cut-off points of the PHQ-2. Anxiety was present in 22.2 %, according to the GAD-7 cut-off points. Regarding stress, 22.2 % were vulnerable to stress and 5.6 % were seriously vulnerable. Conclusion: Depression, anxiety and vulnerability to stress are frequently observed comorbidities in patients with rheumatoid arthritis. Specific mental health interventions are required to address these issues and improve the quality of life of affected patients.
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Anxiety , Arthritis, Rheumatoid , Depression , Pathology , Patients , Quality of Life , Research , Rheumatology , Mental Health , Mental DisordersABSTRACT
ObjectiveTo explore the mechanism of Danggui Niantongtang （DGNTT） against adjuvant-induced arthritis （AA） in rats with wind-dampness-heat arthralgia （FSR） based on the variation of intestinal flora. MethodA total of 60 SD rats were randomized into normal （control） group， FSR group， low-， medium-， and high-dose DGNTT （5.67， 11.34， 22.68 g·kg-1） groups， and methotrexate （MTX） group （1.35 mg·kg-1）， with 10 rats in each group. The rats， except the control group， were injected with Mtb adjuvant and then exposed to artificial climatic chamber （hot and humid with wind） for 64 h for modeling. The rats were treated with water， DGNTT or MTX for 28 days from the day of injection. Arthritis index （AI） of rats was measured and paw volume was determined with a volume meter. The morphology of synovial tissues of the knees was observed based on hematoxylin-eosin （HE） staining and the changes of intestinal flora were analyzed based on 16S rRNA sequencing. ResultDGNTT can alleviate the hyperplasia of synovial tissue and inflammation of AA rats with FSR and inhibit the formation of pannus. The results of 16S rRNA sequencing showed that the relative abundance of Firmicutes， Lactobacillus， Prevotella 9， and Alloprevotella decreased （P<0.05， P<0.01） and the relative abundance of Bacteroidetes and Bacteroides increased （P<0.01） in FSR group compared those in the control group. Compared with the FSR group， all DGNTT groups and MTX group had high relative abundance of Lactobacillus （P<0.05， P<0.01） and low relative abundance of Bacteroidetes （P<0.01） and medium-dose and high-dose DGNTT groups and MTX group showed high abundance of Firmicutes， Prevotella 9， and Alloprevotella and low abundance of Bacteroides （P<0.05， P<0.01）. Spearman's correlation analysis suggested that the abundance of Bacteroides and Helicobacter was in positive correlation with AI （P<0.05）， while the abundance of Prevotella 9 and Candidatus Saccharimonas was in negative correlation with AI （P<0.01， P<0.05）. There was a negative correlation between the abundance of Prevotella 9 and paw volume （P<0.01）， and the abundance of Ruminococcaceae NK4A214 group， Christensenellaceae R-7 group， and Bacteroides was in negative correlation with spleen index （P<0.05）. The abundance of Prevotella 9 was in negative correlation with spleen index （P<0.01）. ConclusionDGNTT is effective for arthritis with FSR， as it can regulate the composition of intestinal flora in AA rats by increasing the abundance of probiotics and inhibiting the growth of pathogenic bacteria. The mechanism is the likelihood that it improves intestinal immune metabolism to ensure intestinal homeostasis.
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Pro-inflammatory macrophages play key regulatory role in the occurrence and development of rheumatoid arthritis (RA). In this study, we constructed a celastrol (Cel)-loaded polyamide-amine dendrimer (PAMAM) drug delivery system, which could target folate receptor and mitochondria. It could target inflammatory macrophages and realize chemo-photothermal synergistic therapy. Using PAMAM as the nano-carrier, folate receptor-targeting group folic acid (FA) and mitochondria-targeting group IR808 (also known as the photothermal agent) were conjugated with PAMAM through amide reaction, and then complexed with anti-inflammatory drug Cel to prepare the FA-PAMAM-IR808/Cel nanocomplex. In vitro characterization results showed that the drug loading efficiency of the nanocomplex was 50.90%, particle size was between 130 and 160 nm, average potential was between 1.0 and 3.5 mV, the drug release showed pH sensitivity, temperature reached to 42.5 ℃ after near-infrared (NIR) light irradiation for 10 min. In vitro cellular uptake experiments showed that the nanocomplex had obvious folate receptor-targeting and mitochondria-targeting ability. Following irradiation with NIR light, the cytotoxicity and cellular apoptosis enhanced. The secretion of pro-inflammatory factors tumor necrosis factor α (TNF-α), interleukin (IL)-1β, IL-6 and nitric oxide (NO) decreased in a concentration-dependent manner. This study provided insights for the development of novel anti-RA nanomedicines.
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Rheumatoid arthritis （RA） is a refractory autoimmune disease that can cause symmetrical polyarticular disease. The key mechanism of its occurrence and development is the dysequilibrium of helper T cell 17 （Th17）/regulatory T cell （Treg） balance. Therefore， reconstructing Th17/Treg balance may be a new strategy for the treatment of RA. Traditional Chinese medicine has significant advantages in the treatment of RA such as integrity， multi-target， multi-link and multi-path. This paper summarizes the basic and clinical studies on the regulation of Th17/Treg balance in the treatment of RA by traditional Chinese medicine in the past five years， and finds that the active components/sites of traditional Chinese medicine such as flavonoids， alkaloids and terpenes have unique advantages in the regulation of Th17/Treg balance. The traditional Chinese medicine compound formula interferes with Th17/Treg balance by exerting the effects of dispelling wind， dehumidifying， removing blood stasis， unblocking collaterals， relieving pain， dispersing cold and strengthening health. The effect of external treatment of traditional Chinese medicine is obvious and can be used as a clinical adjuvant therapy for RA； related mechanisms of action include regulating the production of inflammatory factors， regulating the expression of transcription factors and interfering with the activation of signaling pathways. However， the existing research has the shortcomings of insufficient mechanism research， few clinical research， limited external treatment research of traditional Chinese medicine， and lack of combination therapy research， which need to be improved by follow- up research.
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ObjectiveTo explore the "efficacy-toxicity" association mechanisms of Tripterygium wilfordii polyglycoside tablets （TWPT） by establishing and analyzing an interaction network associated with the clinical efficacy of TWPT in the treatment of rheumatoid arthritis （RA） and TWPT-induced liver injury. MethodOn the basis of the TWPT efficacy-related gene expression profile and TWPT-induced liver injury-related protein expression profile which were both obtained from our clinical cohorts， the "efficacy-toxicity" association network of TWPT was constructed， and the key network targets were identified by calculating the topological values of the nodes， including the degree， closeness and betweenness. After that， the biological functions and pathways of the key network targets were investigated by enrichment analysis. ResultA total of 119 differentially expressed genes （58 up-regulated and 61 down-regulated） between RA patients with TWPT well and weak response were identified as TWPT efficacy-related genes by clinical transcriptomics， and 49 differentially expressed proteins （36 up-regulated and 13 down-regulated） were demonstrated to be TWPT-induced liver injury-related proteins by clinical proteomics. In addition， the clinical symptom enrichment analysis indicated that the TWPT efficacy-related genes were significantly associated with various clinical symptoms of arthralgia in traditional Chinese medicine and clinical phenotypes of modern medicine， and most of the TWPT-induced liver injury-related proteins were involved in digestive system abnormalities. Therefore， the aforementioned multi-omics data represented the main clinical symptoms of TWPT treating RA and inducing liver injury. Mechanically， the "efficacy-toxicity" association network revealed that both TWPT efficacy-related genes and TWPT-induced liver injury-related core proteins were involved in the "immune-inflammatory" imbalance， especially playing an important role in neutrophil degranulation， complement cascade reaction， and immune-inflammatory response mediated by protein post-translational modification. Notably， the above genes and proteins were also enriched in various signaling pathways related to cell proliferation and cell cycle regulation， such as RAS and mitogen-activated protein kinase （MAPK） signaling pathway， and in several liver functional processes， such as glycogen metabolism and redox reaction. ConclusionThis study systematically explained the "efficacy-toxicity" association characteristics and molecular mechanisms of TWPT by applying a research strategy integrating clinical phenomics， transcriptomics and proteomics， laying a good data foundation for exploring the "efficacy enhancing and toxicity-reducing" mechanisms of TWPT.
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ObjectiveTo evaluate the effect of Tripterygium wilfordii polyglycoside tablets （TWPT） combined with conventional synthetic disease-modifying antirheumatic drugs （csDMARDs） including methotrexate （MTX） and/or leflunomide （LEF） on autoantibodies in rheumatoid arthritis （RA） patients. MethodPubMed， EMBASE， Web of Science， Cochrane Library， China National Knowledge Infrastructure （CNKI）， VIP， Wanfang Data， and China Biomedical Literature Service System （SinoMed） were searched for randomized controlled trials （RCTs） of TWPT combined with MTX and/or LEF in the treatment of RA patients from database inception to December 1， 2021. Primary outcome indicators included rheumatoid factor （RF） and anti-citrullinated protein antibody （ACPA）， and secondary outcome indicators included immunoglobulin （IgA， IgG， and IgM） and adverse drug events （ADE）. ResultThirty-one RCTs， involving 2 643 adult patients， were included， including 20 RCTs of TWPT combined with MTX， 10 of TWPT combined with LEF， and one of TWPT combined with MTX and TWPT. The follow-up time ranged from two weeks to 13 months. Compared with csDMARDs alone， TWPT combined with other drugs significantly improved serum RF of RA patients ［SMD=-2.45， 95% CI ［-2.97， -1.93］， P<0.000 01］， anti-CCP ［SMD=-1.41， 95% CI （-2.35， -0.48）， P=0.003］， IgM ［SMD=-1.90， 95% CI （-3.03， -0.76）， P=0.001］， and IgA ［SMD=-1.18， 95% CI （-2.23， -0.12）， P=0.03］. There were no significant effects on IgG ［SMD=-1.02， 95% CI （-2.04， 0.01）， P=0.05］ and ADE ［RR=0.87， 95% CI （0.66， 1.15）， P=0.32］. ConclusionThe results of this study show that compared with csDMARDs alone， TWPT combined with csDMARDs can effectively improve the levels of autoantibodies in RA patients without increasing the incidence of ADE. However， due to the limited quality and quantity of the included RCTs， the relevant conclusions are only used as a reference for the clinical diagnosis and treatment of RA， and more high-quality studies are still needed to further confirm their efficacy.
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ObjectiveTo investigate the effect of Xinfeng capsules on immunoinflammatory indicators in patients with rheumatoid arthritis （RA） due to spleen deficiency and dampness exuberance. MethodA total of 102 patients were randomly divided into control group and observation group according to the random number table method， with 51 cases in each group. All patients were treated with methotrexate tablets， while those in the observation group received additional Xinfeng capsules. The course of treatment in both groups was 12 weeks. The 28-joint disease activity score （DAS28）， visual analogue scale （VAS） scores， morning stiffness time， erythrocyte sedimentation rate （ESR）， high-sensitivity C-reactive protein （hs-CRP）， rheumatoid factor （RF）， anti-cyclic citrullinated peptide （anti-CCP） antibody， vascular endothelial growth factor （VEGF）， and serum amyloid A （SAA） of the two groups before and after treatment were compared. The efficacy and incidence of adverse events were compared between the two groups. The Apriori association rule model and random walk model were constructed to evaluate the effect of Xinfeng capsules in improving hs-CRP， ESR， RF， SAA， VEGF， and anti-CCP. ResultThere were no dropouts in this study. There was no statistical difference in the indicators between the two groups before treatment. After 12 weeks of treatment， the total effective rate in the observation group was 90.19% （46/51）， which was higher than 74.51% （38/51） in the control group （χ2＝4.320，P<0.05）. DAS28， VAS score， and morning stiffness time in the observation group were improved compared with those in the control group （P<0.05）. Apriori association rule model results showed that the application of Xinfeng capsules in the observation group had a strong correlation with the reduction of RF， ESR， hs-CRP， SAA， and VEGF. The results of the random walk model showed that the improvement coefficients of hs-CRP， ESR， RF， SAA， and VEGF in the observation group were all better than those of the control group， and the improvement coefficient of anti-CCP in the control group was better than that of the observation group. The improvement degree of hs-CRP， ESR， RF， SAA， and VEGF in the observation group was superior to that of the control group （P<0.05）. The incidence of adverse reactions in the observation group was lower than in the control group （χ2＝4.057，P<0.05）. ConclusionOn the basis of the treatment with methotrexate tablets， Xinfeng capsules can effectively improve the immunoinflammatory level in RA due to spleen deficiency and dampness exuberance and reduce the incidence of adverse reactions.
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Abstract Objective: We aimed to reveal whether there is nasal involvement by examining the Nasal Mucociliary Clearance (NMC) and the relationship between this activity and disease severity in Rheumatoid Arthritis (RA) patients. Methods: In this prospective study, NMC time, disease activity (Disease Activity Score 28) and blood parameters of RA patients (n = 87) were investigated and compared with the healthy control group (n = 50). In addition, the relationship between DAS 28 and NMC was investigated. Results: The mean NMC of the RA group was 9.51 ± 3.54 min, the mean NMC of the control group was 8.69 ± 2.85 min, and there was no significant difference between the two groups. There was no correlation between NMC and disease duration, and DAS 28. The mean NMC of the RA patients with Anti Cyclic Citrulled Peptide (Anti-CCP) positive was significantly higher than the negative ones. Conclusion: Although there was no significant difference in NMC values between the RA and control group, the NMC of the Anti-CCP positive patients was higher. Level of evidence: Level 2.
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RESUMEN Introducción: La relación entre eventos adversos y aplicación de medicamentos biológicos en pacientes con diagnóstico de artritis reumatoide ha sido documentada a escala mundial, pero con escasa evidencia en Colombia. Si se asume que los eventos adversos o reacciones medicamentosas con hallazgos clínicos relevantes en la salud, como consecuencia de este tratamiento terapéutico, recaen sobre la calidad de vida del paciente e influyen en los indicadores de salud a escala nacional y en los recursos del sistema, se hace importante evaluar su impacto. Objetivos: Determinar la frecuencia de eventos adversos o reacciones adversas relacionados con el uso de medicamentos biológicos en una cohorte de pacientes con diagnóstico de artritis reumatoide de una aseguradora nacional, en el periodo comprendido entre los arios 2000 y 2019. Metodología: Se realizó un estudio descriptivo, transversal y retrospectivo, con alcance analítico, en pacientes diagnosticados de artritis reumatoide, con terapia biológica, en una aseguradora a escala nacional, con registros en historias clínicas del año 2000 al 2019. Resultados: Se analizaron 252 registros clínicos de usuarios con diagnóstico de artritis reumatoide y terapia biológica. El 62,7% presentó al menos una reacción adversa y se evaluaron 9 fármacos: tocilizumab, etanercept, adalimumab, abatacept, certolizumab, golimumab, infliximab, rituximab y tofacitinib. Este último es un fármaco incluido en este estudio por solicitud de la aseguradora fuente de la información. Conclusiones: En la terapia biológica de pacientes con artritis reumatoide las reacciones adversas son frecuentes, y en un 27,3% resultan severas, lo cual describe una situación previamente desconocida en Colombia.
ABSTRACT Introduction: The relationship between adverse events and the application of biological drugs in patients with a diagnosis of rheumatoid arthritis has been documented worldwide, but with little evidence of the situation in Colombia. If adverse events and / or drug reactions with relevant clinical findings in health because of this therapeutic treatment affect the patient's quality of life and influence health indicators at the national level and system resources, it is important to assess their impact. Objectives: To determine the frequency of adverse events and / or adverse reactions related to the use of biological drugs in a cohort of patients diagnosed with rheumatoid arthritis from a national insurer, in the period from 2000 to 2019. Methodology: A descriptive, cross-sectional, and retrospective study with analytical scope was carried out in patients diagnosed with rheumatoid arthritis, on biological therapy, under a nationwide insurer, with records in their medical records from 2000 to 2019. Results: 252 clinical records of users with a rheumatoid arthritis diagnosis and biological therapy were analysed; 62.7% had at least one adverse reaction; nine drugs were evaluated in this study: Tocilizumab, Etanercept, Adalimumab, Abatacept, Certolizumab, Golimumab, Infliximab, Rituximab, and Tofacitinib. Tofacitinib was included in this study at the request of the insurer providing the information. Conclusions: Adverse reactions with biological therapy in patients with rheumatoid arthritis are frequent and were severe in 27.3%. This is a situation previously unknown in Colombia.
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Resumen Introducción: se ha reportado que la prevalencia de artritis reumatoidea (AR) en la comunidad Wichí representa la más alta informada por el Grupo Latinoamericano para el Estudio de las Enfermedades Reumáticas en los Pueblos Originarios (GLADERPO). El objetivo de este estudio fue describir la experiencia sobre el proceso de salud-enfermedad-atención de pacientes con AR de la comunidad Wichí de Misión Chaqueña "El Algarrobal", Salta. Materiales y métodos: estudio narrativo. Diseño de corte etnográfico. Se realizaron entrevistas semi-estructuradas y observaciones registradas. Se utilizaron guías de entrevistas y observación. Los aspectos incluidos fueron: concepción del proceso salud-enfermedad, percepción de la AR en la vida diaria, el acceso al sistema de salud, utilización de recursos tradicionales y de medicina tradicional. Resultados: se realizaron 10 entrevistas. Los aspectos más relevantes fueron la concepción del proceso salud-enfermedad asociado al trauma social pasado y al concepto de voluntad Wichí. Se evidenció la combinación de estrategias para mejorar el dolor (biomedicina, medicina tradicional y acompañamiento religioso). Además, se observó una relación unidireccional con el sistema de salud. Conclusiones: la AR es una enfermedad con un impacto negativo en la comunidad Wichí. Se requieren otras actividades, desde otras disciplinas, para mejorar el acceso al sistema de salud y la continuidad de los tratamientos.
Abstract Introduction: the prevalence of rheumatoid arthritis (RA) in the Wichí community has already been published, representing the highest reported by the Grupo Latinoamericano para el Estudio de las Enfermedades Reumáticas en los Pueblos Originarios (GLADERPO). The objective was to describe the experience of the health-disease-care process of patients with RA from the Wichí community of Misión Chaqueña "El Algarrobal", Salta. Materials and methods: study with ethnographic design. Semi-structured interviews and recorded observations were conducted. Interview and observation guides were used. The aspects included were: conception of the health-disease process; perception of RA in daily life, access to the health system, use of traditional resources and traditional medicine. Results: ten interviews were conducted. The most relevant aspects were the conception of the health-disease process, associated with past social trauma and the concept of "Wichí good will". The combination of strategies to improve pain (biomedicine, traditional medicine and religious accompaniment) was evidenced. In addition, a unidirectional relationship with the health system was observed. Conclusions: RA is a disease with a negative impact on the Wichí community. Other activities from other disciplines are necessary to improve access to the health system and continuity of treatment.
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RESUMEN Introducción: Las enfermedades reumáticas se caracterizan por la presencia de manifestaciones articulares y extraarticulares. Entre estas últimas, uno de los sistemas menos estudiados es el reproductor. Objetivo: Caracterizar las manifestaciones ginecológicas que con mayor frecuencia se presentan en el curso de las enfermedades reumáticas. Métodos: Se realizó una investigación básica, no experimental, descriptiva y longitudinal que incluyó un total de 117 pacientes femeninas con diagnóstico de varias enfermedades reumáticas según los criterios del Colegio Americano de Reumatología. La muestra quedó conformada por 108 pacientes. Durante la realización del estudio se identificó la incidencia de manifestaciones ginecológicas en las pacientes reumáticas y el tipo de manifestación que se notifica con mayor frecuencia. Resultados: Pacientes con un promedio de edad de 61,19 años, predominio de procedencia urbana (61,11 %) y con diagnóstico de artritis reumatoide (61,11 %). El 39,81 % de ellas refirió tiempo de evolución de la enfermedad entre 3 y 5 años. El 62,04 % de las pacientes presentó algún tipo de manifestación extraarticular ginecológica. La secreción vaginal (50,75 %), vulvovaginitis (25,37 %), cervicitis (20,90 %) y la dispareunia (14,92 %) fueron las de mayor frecuencia de presentación. Conclusiones: Las manifestaciones ginecológicas son frecuentes en las pacientes con enfermedades reumáticas. Las manifestaciones ginecológicas de origen inflamatorio fueron las de mayor presentación y fueron más frecuente en la artritis reumatoide y el lupus eritematoso. En la esclerosis sistémica las manifestaciones neoplásicas fueron las más frecuentes.
ABSTRACT Introduction: Rheumatic diseases are characterized by the presence of articular and extra-articular manifestations. Within the latter, one of the least studied systems. Objective: To characterize the gynecological manifestations that most frequently occur in the course of rheumatic diseases. Methods: A basic, non-experimental, descriptive and longitudinal research was carried out that included a total of 117 female patients diagnosed with various rheumatic diseases according to the criteria of the American College of Rheumatology. The sample was made up of 108 patients. During the study, the incidence of gynecological manifestations in rheumatic patients and the type of manifestation that is most frequently reported were identified. Result: average age of 61.19 years, predominance of patients of urban origin (61.11%) and with a diagnosis of rheumatoid arthritis (61.11%). 39.81% of the patients reported disease evolution time between three and five years. 62.04% of the patients presented some type of extra-articular gynecological manifestation. Vaginal secretion (50.75%), vulvovaginitis (25.37%), cervicitis (20.90%) and dyspareunia (14.92%) were the ones with the highest frequency of presentation. Conclusions: Gynecological manifestations are frequently found in patients with rheumatic diseases. Gynecological manifestations of inflammatory origin were those with the highest frequency of presentation and were more frequent in rheumatoid arthritis and lupus erythematosus. In systemic sclerosis, neoplastic manifestations were the most frequent.
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RESUMEN Introducción: Se han investigado y descrito numerosos tipos de artritis con el fin de clasificarlos en artritis no inflamatoria (osteoartritis) y artritis inflamatoria causada por cristales de depósito (seudogota, enfermedad del fosfato de calcio básico y gota), por bacterias e infecciones virales (Staphylococcus aureus, Neisseria gonorrohae, complicaciones de la enfermedad de Lyme, Parvovirus y Enterovirus) o por procesos autoinmunes. Objetivo: Presentar una visión global de la artritis reumatoide, con énfasis en el diagnóstico, fisiopatología y biomarcadores diagnósticos, pronósticos y predictivos en la artritis reumatoide, con el fin de contribuir la mejor atención de pacientes con enfermedades crónicas. Método: Se realizó una búsqueda bibliográfica relacionada con las palabras clave "artritis reumatoide" y otras variables de artritis. Se recuperaron 76 documentos que las incluían, de ellos utilizamos 42 que fueron útiles para el objetivo de la investigación. Conclusiones: El primer paso para un manejo efectivo de la enfermedad es un diagnóstico temprano y correcto, relacionado con que varios signos y síntomas también están asociados con otras enfermedades. Se debe incluir para este objetivo las estrategias de prevención de enfermedades, así como los programas de detección de personas en riesgo de desarrollarlas como el caso de la artritis reumatoide y la información de la enfermedad proporcionada a la población que pueden mejorar significativamente los parámetros epidemiológicos.
ABSTRACT Introduction: Numerous types of arthritis have been investigated and described in order to classify them into non-inflammatory arthritis (osteoarthritis) and inflammatory arthritis caused by deposition crystals (pseudogout, basic calcium phosphate disease, gout), by bacteria and viral infections (Staphylococcus aureus, Neisseria gonorrohae, complications of Lyme disease, Parvovirus, Enterovirus) or autoimmune processes. Objective: research is to present aspects related to the management of Digital Ulcers (DU) in scleroderma based on the experience of different authors, establishing a basis on which future research studies can be designed and improve the patient's quality of life. Method: A bibliographic search related to the keywords rheumatoid arthritis and other arthritis variables was carried out, recovering 76 documents that included them, of which we used 42 that were useful for the objective that we proposed, exposing the most prominent data in the investigation. Conclusions: The first step for an effective management of the disease is an early and correct diagnosis, related to the fact that several signs and symptoms are also associated with other diseases, disease prevention strategies as well as prevention programs should be included for this objective. detection of people at risk of developing them, as in the case of rheumatoid arthritis, monographs of the disease provided to the population can significantly improve epidemiological parameters.
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RESUMEN La artritis reumatoide se clasifica como una enfermedad articular autoinmune crónica poliarticular sistémica que afecta principalmente a manos y pies. El objetivo de este trabajo es mostrar información publicada que contribuye a direccionar el manejo de la artritis reumatoide con nuevos fármacos, a partir del conocimiento de aspectos novedosos relacionados con la fisiopatología y los avances recientes sobre un grupo importante de dianas para el tratamiento de esta enfermedad. Las modificaciones epigenéticas pueden regular la expresión génica sin alterar la secuencia del ADN. La regulación de los ARN no codificantes (ncRNA), la metilación del ADN, la metilación del ARN y las modificaciones de las histonas se consideran los principales mecanismos de las regulaciones epigenéticas. Numerosas investigaciones han establecido que varias anomalías en estos mecanismos terminan en el desarrollo de la AR. Este trabajo resume nuevas dianas, que incluyen proteínas, pequeños metabolitos moleculares y reguladores de la epigenética. Son dianas moleculares prometedoras para el descubrimiento de fármacos que alivien la aparición de enfermedades y resuelvan la falta de respuesta y las respuestas parciales, así como los efectos adversos de los FARME actuales. Es innegable que aún se necesitan mayores esfuerzos para definir con mayor precisión las vías de señalización subyacentes afectadas por estas moléculas recién descubiertas y para desarrollar métodos de terapia apropiados.
ABSTRACT Rheumatoid arthritis is classified as a systemic polyarticular chronic autoimmune joint disease that mainly affects the hands and feet. The objective of this work is to show published information that contributes to directing the management of RA with new drugs. Epigenetic modifications can regulate gene expression without altering the DNA sequence. Regulation of non-coding RNAs (ncRNAs), DNA methylation, RNA methylation, and histone modifications are considered the main mechanisms of epigenetic regulations. Numerous investigations have established that various abnormalities in these mechanisms lead to the development of RA. This work summarizes new targets, including proteins, small molecular metabolites and regulators of epigenetics. They are promising molecular targets for drug discovery to alleviate disease onset and resolve non-response and partial responses, as well as adverse effects of current DMARDs. It is undeniable that further efforts are still needed to further define the underlying signaling pathways affected by these newly discovered molecules and to develop appropriate therapy methods.
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RESUMEN Las enfermedades reumáticas son un grupo de afecciones que se caracterizan por la presencia de manifestaciones y complicaciones sistémicas derivadas del proceso inflamatorio mantenido. Los reactantes de fase aguda, como es el caso de la proteína C reactiva constituyen un marcador de actividad de la enfermedad. Sin embargo, su utilidad se magnifica en los pacientes reumáticos que tienen que ser sometidos a una intervención quirúrgica, circunstancia en la que se tornan un marcador eficiente que muestra la magnitud del proceso inflamatorio. Se presenta el caso de una paciente femenina de 53 años edad, con diagnóstico de artritis reumatoide y síndrome de Sjögren secundario, que tuvo que ser sometida a intervención quirúrgica por diagnóstico de apendicitis aguda. Se realizó seguimiento clínico y de laboratorio utilizando la proteína C reactiva como marcador de elección para monitorear la intensidad del proceso inflamatorio resultante de la intervención quirúrgica y de los efectos de esta en la actividad clínica de las enfermedades reumáticas de base. Después del tratamiento quirúrgico y medicamentoso, la paciente fue dada de alta hospitalaria sin manifestaciones articulares, digestivas ni alteraciones de los exámenes de laboratorio.
ABSTRACT Rheumatic diseases are a group of conditions characterized by the presence of systemic manifestations and complications derived from the sustained inflammatory process. Acute phase reactants, such as C-reactive protein, constitute a marker of disease activity. However, its usefulness is magnified in those rheumatic patients who have to undergo surgery, being an efficient marker that shows the magnitude of the inflammatory process. We present the case of a 53-year-old female patient diagnosed with rheumatoid arthritis and secondary Sjögren's syndrome who had to undergo surgery due to a diagnosis of acute appendicitis. Clinical and laboratory follow-up was performed using C-reactive protein as the marker of choice to monitor the intensity of the inflammatory process resulting from the surgical intervention and its effects on the clinical activity of underlying rheumatic diseases.
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ABSTRACT Background: Rheumatoid arthritis (RA) is an autoimmune disease characterized by chronic synovial joint inflammation, progressive disability, premature immune aging, and telomere length (TL) shortening. Objective: The objective of the study was to study TL changes in patients at early disease onset and after follow-up. Methods: Relative leukocyte TL (rLTL) was measured by quantitative polymerase chain reaction (qPCR) in 88 at-admission patients (AAP) with < 1 year of symptoms onset, self-compared after follow-up, and a reference group of sex- and age-matched healthy individuals. Correlations between rLTL percentage change after variable disease exposure time (DET) and clinical laboratory disease activity markers and treatments were assessed. Non-parametrical statistics were applied, considering < 0.05 p-value significant. Results: The median (p25, p75) rLTL was lower in patients after DET (0.61, 0.49-0.70) than in AAP (0.64, 0.50-0.77), p = 0.017. Furthermore, telomeres at early stages of RA were shorter than in the reference group (0.77, 0.59-0.92; p = 0.003). HLA-DRB1*04 allele carrier status did not significantly affect rLTL at an early stage and after follow-up. The patients' rLTL shortening was mainly associated with longer at-admission telomeres (OR 16.2, 95%CI: 3.5-74.4; p < 0.0001). Conclusion: At follow-up, RA patients showed significantly shorter rLTL than AAP, particularly in those AAP with longer telomeres, disregarding disease activity and treatments, denoting an rLTL shortening effect influenced by age, DET, and native rLTL.
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Abstract Alterations in saliva, temporomandibular joint disorders, dysphagia, Sjogrens syndrome, dental caries, periodontal disease, and tooth loss have been identified in patients with Rheumatoid Arthritis. The aims of this research were 1) to study the association between newly diagnosed rheumatoid arthritis and dental caries and 2) to identify most frequent teeth with caries in study groups. A descriptive pilot study was performed. A total of 620 participants were evaluated, 29 met the selection criteria. The subjects were divided into 2 groups: 13 subjects with newly diagnosed rheumatoid arthritis and 16 subjects without rheumatoid arthritis. Salivary parameters, DMFT index, care index, FS-T index and Treatment Needs Index were evaluated in all participants. The Fishers Exact test and Mann-Whitney U test we used to establish the differences between groups. Low mean in all salivary parameters and a high caries frequency were observed in subjects with newly diagnosed rheumatoid arthritis compared to a control group (p<0.01). The right maxillary second premolar (n=6, 46%, p=0.0100); right mandibular second premolar (n=7,54%, p=0.0462) and left mandibular second molar (n=10,77%, p=0.0001) were the most frequent teeth with caries. Early diagnosis and early treatment of rheumatoid arthritis can improve the prognosis in most of patients. The development of new public health policies and care based on the prevention are necessary to improve the quality of patients lives.
Resumen Alteraciones en la saliva, trastornos de la articulación temporomandibular, disfagia, síndrome de Sjogren, caries dental, enfermedad periodontal y pérdida de dientes son algunas patologías que se han identificado en pacientes con artritis reumatoide. Los objetivos de este estudio fueron (1) Asociar la artritis reumatoide recientemente diagnosticada con la caries dentales e (2) Identificar los dientes más frecuentes con caries en los grupos de estudio. Se realizó un estudio piloto descriptivo. 620 participantes fueron evaluados, 29 sujetos cumplieron con los criterios de selección. Los sujetos se dividieron en 2 grupos: 13 sujetos con artritis reumatoide recién diagnosticados y 16 sujetos sin artritis reumatoide. En todos los participantes se evaluaron parámetros salivales, el índice CPOD, el índice IC, el índice FS-T y el índice INT. La prueba exacta de Fisher y U de Mann-Whitney se utilizaron para establecer diferencias entre grupos. En los resultados se observó un bajo promedio de los parámetros salivales y una alta frecuencia de caries en sujetos con artritis reumatoide recién diagnosticados comparados con un grupo control (p<0.01). El segundo premolar superior derecho (n=6,46%, p=0,0100); el segundo premolar mandibular derecho (n=7,54%, p=0.0462) y el segundo molar mandibular izquierdo (n=10,77%, p=0.0001) fueron los dientes más frecuentes con caries dental. El diagnóstico y el tratamiento temprano de la artritis reumatoide pueden mejorar el pronóstico en la mayoría de los pacientes. El desarrollo de nuevas políticas de salud pública basadas en la prevención de la cavidad bucal son necesarias para mejorar la calidad de vida de los pacientes.
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Humans , Arthritis, Rheumatoid/diagnosis , Dental Caries/prevention & controlABSTRACT
Artrite reumatoide é doença reumática autoimune e crônica. Acredita-se que a obesidade pode intervir nos seus parâmetros inflamatórios. O objetivo deste estudo foi verificar se existe correlação entre atividade inflamatória dela e o índice de massa corporal (IMC).É estudo transversal retrospectivo nos quais foram obtidos dados de biometria (peso e altura) para cálculo do IMC e de atividade inflamatória. Estudaram-se 676 pacientes (87,5% mulheres com mediana de idade de 59,6 anos). Nesta população, 1,3% estava abaixo do peso normal; 28,1% dentro do peso normal; 35,3% sobrepeso; 31% obesidade grau I e 4,1% obesidade grau 2. Encontrou-se fraca correlação entre o DAS 28-PCR com o IMC. Correlações com os demais parâmetros de inflamação foram não significantes. Em conclusão existe alta proporção de pacientes com artrite reumatoide acima do peso normal e fraca correlação entre IMC e DAS28-PCR
Rheumatoid arthritis is an autoimmune and chronic rheumatic disease. It is believed that obesity can intervene in its inflammatory parameters. The objective of this study was to verify if there is a correlation between her inflammatory activity and the body mass index (BMI). It is a retrospective cross-sectional study in which biometric data (weight and height) were obtained to calculate BMI and inflammatory activity. We studied 676 patients (87.5% women with a median age of 59.6 years). In this population, 1.3% were underweight; 28.1% within normal weight; 35.3% overweight; 31% grade I obesity and 4.1% grade 2 obesity. We found a weak correlation between DAS 28-CRP and BMI. Correlations with the other inflammation parameters were not significant. In conclusion, there is a high proportion of patients with rheumatoid arthritis above normal weight and a weak correlation between BMI and DAS28-CRP
Subject(s)
Adult , Arthritis, Rheumatoid , Body Mass Index , Inflammation , Obesity , Cross-Sectional Studies , BiometryABSTRACT
RESUMEN Introducción: El síndrome de Felty es una rara complicación extraarticular de la artritis reumatoide, descrito por primera vez en 1924. Felty describió 5 pacientes que se caracterizaban por la presencia de una tríada clínica de artritis reumatoide, esplenomegalia y neutropenia, que aparece fundamentalmente en los pacientes con largos años de evolución de su enfermedad. Es una entidad clínica con alto grado de mortalidad, dado a que es poco diagnosticada y por tanto, no tratada. Objetivo: Presentar un paciente con síndrome de Felty, sus características clínicas y el procedimiento terapéutico empleado. Caso clínico: Paciente femenina de 64 años de edad, con antecedentes de artritis reumatoide e hipotiroidismo; ambas enfermedades sin tratamiento regular. Asistió al servicio de urgencias con fiebre y presencia de lesiones ulcerativas en miembro inferior izquierdo, con fondo necrótico. Debido a leucopenia acompañada de esplenomegalia se le diagnosticó neutropenia febril (sepsis), secundaria a síndrome de Felty. Se instauró tratamiento oportuno y se logró paulatinamente la cicatrización de las lesiones ulcerativas, la erradicación de la infección con recuperación de los valores normales de neutrófilos y la posterior recuperación de la paciente. Conclusiones: Al realizar el diagnóstico de síndrome de Felty, lo esencial es alcanzar un control inmediato de la enfermedad de base, de las comorbilidades y a través del tratamiento obtener un incremento de la supervivencia de los pacientes.
ABSTRACT Introduction: Felty's syndrome is a rare extra-articular complication of rheumatoid arthritis, first described in 1924. Felty described 5 patients who were characterized by the presence of a clinical triad of rheumatoid arthritis, splenomegaly, and neutropenia that appears fundamentally in patients with long years of evolution of their disease. It is a clinical entity with a high degree of mortality, given that it is a poorly diagnosed disease and therefore not treated. Objective: Present a clinical case of Felty´s syndrome, its clinical characteristics and the therapeutic procedure used. Clinical case: 64-year-old female patient with a history of rheumatoid arthritis and hypothyroidism; both diseases without regular treatment. She attended to emergency with fever and the presence of ulcerative lesions on the left lower limb with a necrotic background. Due to leukopenia accompanied by splenomegaly, she was diagnosed with febrile neutropenia (sepsis) secondary to Felty's syndrome. Treatment was established and healing of the ulcerative lesions was gradually achieved, the eradication of the infection with recovery of normal neutrophil values and the subsequent recovery of the patient. Conclusions: When diagnosing Felty's syndrome, the essential thing is to achieve immediate control of the underlying disease and the comorbidities; and through treatment obtain an increase in patient survival.
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ABSTRACT Introduction: Ultrasound has shown its usefulness in multiple aspects in the management of inflammatory joint disease and in particular of rheumatoid arthritis (RA). The evidence using patient outcomes and its aspects related to quality of health care is scarce. The aim of this study is to determine the level of satisfaction in the perception of the quality of health care in a group of patients with RA who underwent ultrasound during the consultation, and whether it is higher than those who did not have the ultrasound. Methods: An observational, cross-sectional descriptive study was performed. Patients older than 18 years with a diagnosis of RA using the ACR/EULAR classification criteria were included. One group underwent skeletal muscle ultrasound to study RA during the out-patient medical consultation, as decided by the attending physician. After the completion of the medical action according to prior verbal acceptance by the patient, the Servqhos questionnaire and an ultrasound questionnaire were completed. A satisfied patient was defined as one who had 70% or more in the responses in the Servqhos questionnaire greater than or equal to 4, and a score of 5 in this questionnaire was defined as maximum satisfaction. There were no significant differences between the number of satisfied patients in the two groups. Univariate analysis was performed according to the distribution in the ultrasound or non-performing groups. Subsequently, a bivariate analysis of the different questions was carried out according to the distribution in the satisfaction and very high satisfaction groups. It was established if there was any degree of association using the Chi squared test for categorical variables, and the parametric tests (Mann Whitney U) or non-parametric tests (Kruskal-Wallis test) for the numerical variables were performed according to the distribution. Results: A total of 126 patients were obtained, of whom 62 corresponded to the group of patients who underwent ultrasound during the consultation and 62 to the control group in whom no ultrasound was performed. The majority were women (91%). Ultrasound was mostly performed to study joint disease (93%), with a third of the time to assess more than one aspect. In those on whom the ultrasound was performed, the number of satisfied patients was 56 (90%) and for the control group it was 48 (77%). The difference in the proportion of satisfied patients (13%) was statistically significant (P = .05). A difference was found between the groups in the number of patients with the highest level of satisfaction in the questions regarding presentation of staff and technology (P < .05). The vast majority of patients considered that ultrasound was useful during the consultation (93%), and that it generates greater confidence in the treatments and the doctor (93%). Conclusions: Performing skeletal muscle ultrasound during consultation in patients with RA improves satisfaction rates of health care, perception of the doctor, and treatments.
RESUMEN Introducción: La ecografía ha mostrado su utilidad en múltiples aspectos del manejo de la enfermedad articular inflamatoria, particularmente en la artritis reumatoide (AR). Su utilidad usando desenlaces derivados de pacientes y relacionados con aspectos de la calidad de la atención en salud es escasa. El objetivo del estudio es determinar si el grado de satisfacción de la calidad de la atención en un grupo de pacientes con AR, en quienes se realizó ecografía durante la consulta, es superior al de un grupo en los que esta no se llevó a cabo. Métodos: Se realizó un estudio observacional, descriptivo transversal. Se incluyeron pacientes mayores de 18 años con diagnóstico de AR por criterios clasificatorios ACR/EULAR que posteriormente a la finalización del acto médico respondieron las preguntas del cuestionario Servqhos. Quienes se sometieron a ecografía musculoesquelética para estudio de AR durante la consulta ambulatoria, según decisión del médico tratante, respondieron adicionalmente el cuestionario de ecografía. Se define paciente satisfecho como aquel que tiene un 70% o más en las respuestas del cuestionario Servqhos con un puntaje mayor o igual a 4, y se define como la máxima satisfacción al puntaje de 5 en una pregunta de dicho cuestionario. Se determinó si había diferencias significativas entre las proporciones de pacientes satisfechos en los dos grupos con y sin ecografía. Se realizó un análisis univariado según la distribución en los grupos, y posteriormente se hizo un análisis bivariado de las diferentes preguntas según la distribución en los grupos de satisfacción y muy alta satisfacción. Se estableció si había algún grado de asociación con las pruebas de chi-cuadrado para las variables categóricas, en tanto que para las variables numéricas se llevaron a cabo pruebas paramétricas (U de Mann Whitnney) y no paramétricas (test de Kruskal-Wallis), según la distribución. Resultados: Se obtuvo un total de 126 pacientes, de los cuales 62 corresponden al grupo de aquellos en quienes se realizó ecografía durante la consulta, mientras que otros 62 hacen parte del grupo control, en quienes no se realizó ecografía. La mayoría eran mujeres (91%). En quienes se hizo la ecografía, el número de pacientes satisfechos fue de 56 (90%), en tanto que para el grupo control fue de 48 (77%). La diferencia en la proporción de pacientes satisfechos entre los grupos fue del 13%, siendo estadísticamente significativa (p = 0,05). Se encontró diferencia entre los grupos en las preguntas referentes a presentación del personal y la tecnología de los equipos (p < 0,05). La gran mayoría de los pacientes consideró que la ecografía fue útil durante la consulta (93%) y que genera mayor seguridad en los tratamientos y en el criterio médico (93%). Conclusiones: La realización de ecografía musculoesquelética durante la consulta en pacientes con AR mejora los índices de satisfacción de atención en salud, así como la percepción del criterio médico y de los tratamientos.
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ABSTRACT Objective: To determine the management results in a cohort of patients with rheumatoid arthritis in a specialized integral healthcare institution for this disease in Colombia. Materials and methods: Descriptive cross-sectional study based on a cohort of rheumatoid arthritis patients according to ACR/EULAR 2010 criteria. The information was analysed based on consolidated data from clinical records and national reports in the period 2015-2018. Administrative records related to medication authorizations and prescriptions were considered. Sociodemographic variables, outcome indicators related to disease activity status and medication use percentage were evaluated. Results: As of June 30th 2018, 698 patients were identified, of which the female sex represented 83.8%, the general average age was 55.47 years, and the highest number of cases were in the 60-64 year age group. Of the patients, 68.3% were between remission and low disease activity. Seventy-three point one percent were managed with conventional disease-modifying antirheumatic drugs and a reduction in the use of biological therapy was recorded from 27.2% in 2016 to 17.8% at the end of the period. Conclusions: This study presents the management results of a comprehensive care model for patients with rheumatoid arthritis in Colombia, which managed to maintain the highest proportion of patients in low activity and remission as they had a longer follow-up time, to decrease the percentage of biological DMARDs use, and establish conventional DMARDs as the main therapeutic alternative.
RESUMEN Objetivo: Conocer los resultados de gestión en una cohorte de pacientes con artritis reumatoide en una institución de atención integral especializada en esta enfermedad en Colombia. Materiales y métodos: Estudio descriptivo de corte transversal, a partir de una cohorte de pacientes de artritis reumatoide, según criterios ACR/EULAR 2010. La información se analizó con base en los datos consolidados de historia clínica y reportes nacionales en el periodo 2015-2018. Se tuvieron en cuenta los registros administrativos relacionados con autorizaciones y prescripciones de medicamentos. Se evaluaron variables sociodemográficas, indicadores de resultado relacionados con el estado de actividad de la enfermedad y porcentaje de uso de medicamentos. Resultados: A 30 de junio de 2018, se identificaron 698 pacientes, de los cuales el 83,8% correspondió a sexo femenino; el promedio general de edad fue de 55,47 años y el grupo de edad de 60 a 64 años concentró el mayor número de casos. El 68,3% se ubicó entre remisión y actividad baja de la enfermedad. El 73,1% se encontró manejado con fármacos antirreumáticos modificadores de enfermedad convencionales y se registró una reducción de uso de terapia biológica desde el 27,2% en 2016 al 17,8% al final del periodo. Conclusiones: Este estudio presenta los resultados de gestión de un modelo de atención integral para pacientes con artritis reumatoide en Colombia, que logró mantener la mayor proporción de pacientes en actividad baja y remisión a medida que estos contaban con mayor tiempo de seguimiento, también logró disminuir el porcentaje de uso de FARME biológicos y establecer los FARME convencionales como la principal alternativa terapéutica.