ABSTRACT
Objetivos: Conocer el impacto de la introducción de rofecoxib sobre la satisfacción de pacientes y médicos y sobre la coprescripción de fármacos gastrointestinales, en pacientes con artrosis sintomática, en un entorno de práctica clínica en centros de atención primaria españoles. Pacientes y métodos: Estudio prospectivo, multicéntrico y observacional de seguimiento de una cohorte de 562 pacientes diagnosticados de artrosis en tratamiento con antiinflamatorios no esteroideos (AINE) no selectivos, en el que han participado 29 centros de atención primaria españoles. El período de seguimiento incluye 3 meses en tratamiento con AINE no selectivos y 3 meses tras el cambio a rofecoxib. Resultados: Durante el período en tratamiento con rofecoxib, se observa una reducción del 67,8 por ciento en la aparición de efectos adversos gastrointestinales atribuibles al antiinflamatorio y una reducción próxima al 50 por ciento en la utilización de fármacos gastrointestinales. Más del 80 por ciento de los pacientes refiere encontrarse satisfecho con el tratamiento durante el período con rofecoxib frente a un 48 por ciento durante el tratamiento con AINE. El porcentaje de médicos y pacientes que valoran como bueno o muy bueno el estado de salud del paciente aumenta tras la inclusión de rofecoxib: el 59 y el 52 por ciento, respectivamente, frente al 27 y el 21 por ciento con AINE. Asimismo, las puntuaciones del cuestionario WOMAC evidencian una mejoría en la sintomatología de los pacientes. Conclusiones: En los pacientes con artrosis sintomática, la introducción de rofecoxib produce disminución de los efectos adversos gastrointestinales, reducción de la coprescripción de medicación profiláctica y terapéutica gastrointestinal, así como un incremento de los Impacto de la introducción de rofecoxib en el tratamiento de la artrosis: resultados del estudio VICOXX valores de satisfacción de pacientes y médicos. Estos hechos, tomados en su conjunto, deberán tenerse en cuenta al analizar el coste comparativo de las diferentes intervenciones terapéuticas. (AU)
Subject(s)
Adult , Aged , Female , Male , Middle Aged , Aged, 80 and over , Humans , Gastrointestinal Diseases/chemically induced , Cyclooxygenase Inhibitors/therapeutic use , Cyclooxygenase Inhibitors/adverse effects , Joint Diseases/drug therapy , Prospective Studies , Follow-Up Studies , Cohort Studies , Treatment Outcome , Patient SatisfactionABSTRACT
BACKGROUND: To perform a systematic review, completed with a meta-analysis, of the published evidences about the effect of oral alendronate on bone mineral density and the incidence of fractures in postmenopausal women with low bone mass. METHODS: We search for all alendronate clinical trials in postmenopausal women with low bone mass which were randomized, double blind, placebo controlled, with a duration of one year or more and with bone mineral density measurement and/or fractures as outcomes. We used the weighted average of individual study results as an estimation of the global effect. RESULTS: Seven studies meet all the inclusion criteria. Relative Risks (RR) with 95% Confidence Intervals (CI 95%) for the combined effect under fixed effects model were: RR 0.54 (CI 95%: 0.45 to 0.66) for vertebral fractures, RR 0.81 (CI 95%: 0.72 to 0.92) for non vertebral fractures and RR 0.64 (CI 95%: 0.40 to 1.01) for hip fractures. CONCLUSIONS: Our results demonstrate that alendronate reduces the risk of vertebral, non vertebral and hip fractures in postmenopausal women with low bone mass. This meta-analysis allows the classification of alendronate anti-fracture evidences in the highest level.
Subject(s)
Alendronate/therapeutic use , Bone Density/drug effects , Hip Fractures/epidemiology , Osteoporosis, Postmenopausal/drug therapy , Alendronate/pharmacology , Calcification, Physiologic , Female , Humans , Middle Aged , Randomized Controlled Trials as TopicABSTRACT
BACKGROUND: Hip fracture is the most severe consequence of osteoporosis. The aim of the present study was to know the incidence of osteoporotic hip fracture in the Palencia province, its direct economical consequences and characteristics associated with the origin episode. PATIENTS AND METHODS: All patients aged over 49 years who had a nontraumatic hip fracture during the second semester of 1994 and the first semester of 1995 were included in the study. An analysis of costs was performed and each patient received a questionnaire to know the circumstances associated with the episode. RESULTS: During the study period the overall incidence of hip fracture was 83/100,000 inhabitants/year, which corresponds to an adjusted incidence of 240.9/100,000 inhabitants older than 49 years (336.8 women and 120.7 men). There was an exponential growth, with peak values starting at 80 years. The female/male ratio was 2.8 and the mean age 80.8 years. Twenty-four percent of fractures occurred in institutionalized persons, with an adjusted incidence of 1,107/100,000 inhabitants/year, which corresponds to a relative risk of 13.57 (95% CI: 10.06-18.28). No significant differences were observed between trochanteric and neck fractures. Ninety-seven percent of fractures occurred after a fall, usually in the morning or afternoon (86%), with lateral direction and impact on the greater trochanter (89%). The mortality rate during admission was 5.9%. The mean cost of care during admission was 1,170,000 pesetas. CONCLUSIONS: The incidence of hip fracture in Palencia is slightly higher than the national mean, probably due to populational ageing. The risk of fracture reaches alarming proportions in the institutionalized population. The implementation of efficient preventive measures, particularly among the exposed populations, is necessary.
Subject(s)
Hip Fractures/epidemiology , Osteoporosis/complications , Accidental Falls/statistics & numerical data , Aged , Aged, 80 and over , Cause of Death , Female , Hip Fractures/etiology , Hip Fractures/mortality , Humans , Male , Middle Aged , Spain/epidemiologyABSTRACT
A 51-year-old woman with advanced rheumatoid arthritis developed a Goodpasture's syndrome during treatment with penicillamine and carbimazole. Circulating antiglomerular basement membrane antibodies (anti-GBM) were present. Renal biopsy showed focal necrotizing glomerulonephritis with crescents, and HLA typing showed the presence of DR3 and DR4. The patient responded dramatically to pulse methylprednisolone and cyclophosphamide, with both clinical remission and disappearance of anti-GBM antibodies.
