ABSTRACT
OBJECTIVES: To study the prevalence of liver fibrosis (LF) measured by FibroScan and APRI index in patients with rheumatoid arthritis (AR) undergoing treatment with methotrexate (MTX). METHODS: We included 59 patients with RA on MTX. Medical records, FibroScan measures and serological markers of liver damage were compared on the basis of cumulative methotrexate dose. RESULTS: Mean treatment duration was 82.4±65.1 months and mean cumulative dose was 5214.5±4031.9mg. Five patients met LF criteria by fibroscan, while only one patient had a suggestive APRI score. No statistically significant differences were found in terms of LF measured by both APRI and fibroScan between patients with cumulative doses above and below 4000mg. There was also no relationship between LF and treatment duration. CONCLUSIONS: The occurrence of LF in patients with RA on MTX is a multifactorial process that does not seem directly related to its cumulative dose. FibroScan may be a useful technique in clinical practice to screen for this complication.
Subject(s)
Arthritis, Rheumatoid , Elasticity Imaging Techniques , Humans , Methotrexate/adverse effects , Arthritis, Rheumatoid/drug therapy , Arthritis, Rheumatoid/complications , Liver Cirrhosis/complications , Liver Cirrhosis/drug therapy , Elasticity Imaging Techniques/adverse effects , Elasticity Imaging Techniques/methods , BiomarkersABSTRACT
Objectives: To study the prevalence of liver fibrosis (LF) measured by FibroScan and APRI index in patients with rheumatoid arthritis (AR) undergoing treatment with methotrexate (MTX). Methods: We included 59 patients with RA on MTX. Medical records, FibroScan measures and serological markers of liver damage were compared on the basis of cumulative methotrexate dose. Results: Mean treatment duration was 82.4±65.1 months and mean cumulative dose was 5214.5±4031.9mg. Five patients met LF criteria by fibroscan, while only one patient had a suggestive APRI score. No statistically significant differences were found in terms of LF measured by both APRI and fibroScan between patients with cumulative doses above and below 4000mg. There was also no relationship between LF and treatment duration. Conclusions: The occurrence of LF in patients with RA on MTX is a multifactorial process that does not seem directly related to its cumulative dose. FibroScan may be a useful technique in clinical practice to screen for this complication. (AU)
Objetivos: Estudiar la prevalencia de la fibrosis hepática (FH) medida por FibroScan e índice APRI en pacientes con artritis reumatoide (AR) en tratamiento con metotrexato (MTX). Métodos: Se incluyeron 59 pacientes con AR en tratamiento con MTX. Se compararon las historias clínicas, las mediciones de FibroScan y los marcadores serológicos de daño hepático en función de la dosis acumulada de MTX. Resultados: La duración media del tratamiento fue de 82,4±65,1 meses y la dosis media acumulada de 5214,5±4031,9mg. Cinco pacientes cumplían criterios de FH por FibroScan y un solo paciente por APRI. No se encontraron diferencias estadísticamente significativas en cuanto a FH tanto por APRI como por FibroScan en base a dosis acumuladas superiores o inferiores a 4000mg. Tampoco hubo relación entre FH y duración del tratamiento. Conclusiones: La FH en pacientes con AR tratados con MTX es un proceso multifactorial sin aparente relación directa con la dosis acumulada. El FibroScan puede ser una técnica útil en la práctica clínica para detectar esta complicación. (AU)
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Liver Cirrhosis/epidemiology , Arthritis, Rheumatoid/drug therapy , Methotrexate/therapeutic use , Prevalence , Elasticity Imaging Techniques , Liver DiseasesABSTRACT
INTRODUCCIÓN: los usuarios de drogas por vía parenteral (UDVP) son una población con alta prevalencia de infección por virus de la hepatitis C (VHC) y con grandes dificultades para el acceso a los tratamientos. Los programas de terapia sustitutiva con opioides realizan un seguimiento regular de estas personas. OBJETIVO: tratar de manera efectiva a esta población a través de un tratamiento directamente observado (TDO), acercando los recursos al centro de dispensación de metadona de Guipúzcoa (Bitarte). MÉTODOS: se incluyen todos los usuarios de metadona con anticuerpos positivos frente al VHC. A través de un circuito simplificado, el hepatólogo se desplaza al centro con el Fibroscan® y, tras la valoración, solicita el tratamiento. El tratamiento se dispensa en el centro de adicciones supervisado por el psiquiatra y personal de enfermería. Analizamos la prevalencia, las características de la población y la efectividad del circuito. RESULTADOS: Bitarte realiza seguimiento a 660 individuos. El 73,6 % tiene anticuerpos positivos para el VHC. La prevalencia de infección virémica es del 62,5 %. El genotipo predominante es el 1a seguido del 3. El 38,5 % tiene fibrosis avanzada (F3 y F4). El 38 % de usuarios mantiene un consumo de heroína activo. Se ha tratado al 82,07 % (174/212) de la población, con respuesta viral sostenida (RVS) a las 12 semanas del 97 %. No se han registrado reinfecciones. CONCLUSIONES: la prevalencia de VHC virémica en UDVP en terapia con metadona es del 62 %. La estrategia de enlace ha sido efectiva y se ha tratado hasta la fecha > 80 % de la población con infección activa
No disponible
Subject(s)
Humans , Male , Female , Young Adult , Adult , Middle Aged , Aged , Substance Abuse, Intravenous/drug therapy , Substance Abuse, Intravenous/complications , Methadone/therapeutic use , Hepatitis C/prevention & control , Hepatitis C/etiology , Substance Abuse, Intravenous/epidemiology , Hepatitis C/epidemiology , Spain/epidemiology , PrevalenceABSTRACT
INTRODUCTION: parenteral drug users (PDUs) are a population with a high prevalence of infection with the hepatitis C virus (HCV) and significant difficulties to access to treatment. Opioid replacement therapy programs regularly monitor these individuals. OBJECTIVE: to effectively treat this population using a directly observed therapy (DOT) and bringing resources closer to the methadone dispensing center in Gipuzkoa (Bitarte). METHODS: all methadone users that were positive for anti-HCV antibodies were included in the study. Using a simplified circuit, a hepatologist visits the center with a Fibroscan® device and requests treatment following assessment. Treatment is dispensed at the addict center, under the supervision of a psychiatrist and nursing staff. Prevalence, population characteristics and circuit effectiveness were assessed. RESULTS: Bitarte monitors 660 individuals. Of these, 73.6 % were positive for antibodies against HCV. The prevalence of viremic infection is 62.5 %. The predominant genotype was 1a, followed by 3. A total of 38.5 % had advanced fibrosis (F3 and F4) and 38 % of users admitted to active heroin use. In all, 82.07 % (174/212) of the population received treatment and 97 % had sustained viral response (SVR) after 12 weeks. No re-infections were recorded. CONCLUSIONS: the prevalence of viremic HCV infection among PDUs under treatment with methadone is 62 %. The linkage to care strategy was effective and > 80 % of the population with an active infection have been treated so far.
Subject(s)
Drug Users , Hepatitis C , Antiviral Agents/therapeutic use , Hepacivirus , Hepatitis C/drug therapy , Hepatitis C/epidemiology , Humans , Methadone/therapeutic use , Opiate Substitution TreatmentSubject(s)
Humans , Female , Middle Aged , Parkinsonian Disorders/chemically induced , Parkinson Disease, Secondary/chemically induced , Antiparkinson Agents/administration & dosage , Antiparkinson Agents/adverse effects , Dopamine Agonists/adverse effects , Risk Factors , Gastroscopy/methods , Dyspepsia/complications , Abdomen/pathology , Abdomen , Gastroscopy/trends , Gastroscopy , Primary Health Care/methodsSubject(s)
Antipsychotic Agents/adverse effects , Chemical and Drug Induced Liver Injury/etiology , Chlorpromazine/adverse effects , Dopamine Antagonists/adverse effects , Aged , Bile Duct Diseases/chemically induced , Bile Duct Diseases/diagnosis , Chemical and Drug Induced Liver Injury/diagnosis , Hiccup/drug therapy , Humans , MaleABSTRACT
No disponible
