Psoriatic arthritis in patients with psoriasis: A clinical-epidemiological study at a dermatology center in western Mexico.

BACKGROUND/OBJECTIVE: Psoriatic arthritis (PsA) is a chronic inflammatory illness. Approximately, 15% of psoriasis patients have undiagnosed PsA. In Mexico, we found no related studies. Our objective was to investigate the clinical-epidemiological characteristics of PsA in psoriasis patients in western Mexico. METHODS: A cross-sectional study including Mexican patients with clinical and histopathological diagnosis of psoriasis. Physical examination, rheumatoid factor analysis and radiographies of axial and peripheral skeleton were performed. The prevalence of PsA using the CASPAR criteria, age, sex; clinical variants of PsA, psoriasis type and the Psoriasis Area and Severity Index (PASI), were assessed. Descriptive and inferential statistics were used. RESULTS: Of 90 patients with psoriasis, 48 met the criteria for PsA, with a prevalence of 53%, and average age of 50 ± 15 years. Predominating were, the female sex in 29 (60%), the axial variant of PsA in 24 (50%), and psoriasis plaques in 40 (83%). The average PASI was 12 ± 11. All cases were rheumatoid factor negative. These variables were not significantly different when comparing subjects with and without PsA, except for the female sex (60% vs. 7%; P < 0.001). CONCLUSIONS: Patients with psoriasis should intentionally be evaluated jointly Dermatologists and Rheumatologists searching joint involvement given the high prevalence of PsA previously undiagnosed.

Mapping the nutrition transition in Peru: evidence for decentralized nutrition policies.

The study objectives were to map the different stages of the nutrition transition for each department within Peru, and to determine the nutrition policy needs for each geographic area based on their current stage in the nutrition transition. Results show that most of the country is suffering from a double-burden of malnutrition, with high rates of stunting among children less than 5 years of age and high rates of overweight and obesity among women of reproductive age. Currently, Peru has only country-wide nutrition policies, administered by the Ministry of Health, that are primarily focused on stunting prevention. This study argues for the need to have decentralized nutrition policies that vary according to what type of malnutrition is being experienced in each geographic area.

Mapping the nutrition transition in Peru: evidence for decentralized nutrition policies / Cartografía de la transición nutricional en el Perú: datos que avalan la necesidad de políticas nutricionales descentralizadas

The study objectives were to map the different stages of the nutrition transition for each departmentwithin Peru, and to determine the nutrition policy needs for each geographic areabased on their current stage in the nutrition transition. Results show that most of the countryis suffering from a double-burden of malnutrition, with high rates of stunting among childrenless than 5 years of age and high rates of overweight and obesity among women of reproductiveage. Currently, Peru has only country-wide nutrition policies, administered by the Ministryof Health, that are primarily focused on stunting prevention. This study argues for the need tohave decentralized nutrition policies that vary according to what type of malnutrition is beingexperienced in each geographic area.

Los objetivos de este estudio consistían en trazar un mapa por departamentos yetapas de la transición nutricional en el Perú y determinar las políticas nutricionalesnecesarias en las distintas zonas geográficas en función de sus etapas en la transición.Los resultados demuestran que la mayor parte del país está sufriendo la llamada“doble carga de la malnutrición”, en la que coexisten tasas elevadas de desnutricióncrónica entre los menores de 5 años y tasas elevadas de sobrepeso y obesidad en lasmujeres en edad fecunda. En el Perú actual, las políticas nutricionales, gestionadaspor el Ministerio de Salud, están centralizadas y su prioridad es prevenir la detencióndel crecimiento. Este estudio aboga por la necesidad de contar con políticas nutricionalesdescentralizadas que varíen en función del tipo de malnutrición que se estépadeciendo en cada zona geográfica.

Catastrophic health expenses and impoverishment of households of patients with rheumatoid arthritis.

BACKGROUND: The cost of certain diseases may lead to catastrophic expenses and impoverishment of households without full financial support by the state and other organizations. OBJECTIVE: To determine the socioeconomic impact of the rheumatoid arthritis (RA) cost in the context of catastrophic expenses and impoverishment. PATIENTS AND METHODS: This is a cohort-nested cross-sectional multicenter study on the cost of RA in Mexican households with partial, full, or private health care coverage. Catastrophic expenses referred to health expenses totaling >30% of the total household income. Impoverishment defined those households that could not afford the Mexican basic food basket (BFB). RESULTS: We included 262 patients with a mean monthly household income (US dollars) of $376 (0­18,890.63). In all, 50.8%, 35.5%, and 13.7% of the patients had partial, full, or private health care coverage, respectively. RA annual cost was $ 5534.8 per patient (65% direct cost, 35% indirect). RA cost caused catastrophic expenses in 46.9% of households, which in the logistic regression analysis were significantly associated with the type of health care coverage (OR 2.7, 95%CI 1.6­4.7) and disease duration (OR 1.024, 95%CI 1.002­1.046). Impoverishment occurred in 66.8% of households and was associated with catastrophic expenses (OR 3.6, 95%CI 1.04­14.1), high health assessment questionnaire scores (OR 4.84 95%CI 1.01­23.3), and low socioeconomic level (OR 4.66, 95%CI 1.37­15.87). CONCLUSION: The cost of RA in Mexican households, particularly those lacking full health coverage leads to catastrophic expenses and impoverishment. These findings could be the same in countries with fragmented health care systems.

Lupus relapse presented as frosted branch retinal angiitis: case report.

PURPOSE: To describe a systemic lupus erythematosus (SLE) relapse, which presented as frosted branch retinal angiitis. DESIGN: Clinical case report. METHODS: A 16-year-old female patient had an SLE relapse that appeared as frosted branch angiitis while being treated with deflazacort and azathioprine. RESULTS: Complete resolution of the vasculitis was achieved with a 3-day course of pulsed intravenous methylprednisolone and oral prednisone 3 weeks later. CONCLUSIONS: Even with proper immunosuppressive treatment, SLE can relapse. This case presented as frosted branch retinal angiitis, which is a clinical picture that is rarely described in SLE.

[Appropriate use of non-steroidal anti-inflammatory drugs in rheumatology: guidelines from the Spanish Society of Rheumatology and the Mexican College of Rheumatology]. / Uso apropiado de los antiinflamatorios no esteroideos en reumatología: documento de consenso de la Sociedad Española de Reumatología y el Colegio Mexicano de Reumatología.

OBJECTIVE: To develop guidelines for the appropriate use of NSAIDs in rheumatology. METHODS: We used a methodology modified from the one developed by RAND/UCLA. Two groups of panellists were selected, one by the CMR and another by the SER. Recommendations were proposed from nominal groups and the agreement to them was tested among rheumatologists from both societies by a tworound Delphi survey. The analysis of the second Delphi round supported the generation of the final set of recommendations and the assignment of a level of agreement to each of them. Systematic reviews of five recommendations in which the agreement was low or was divided were also carried out. RESULTS: Here we present recommendations for the safe use of NSAIDs in rheumatic diseases, based on the best available evidence, expert opinion, the agreement among rheumatologists, and literature review. The trend is to reduce the frequency, duration and dose of NSAIDs in favour of non-pharmacological measures, analgesic drugs or disease modifying drugs. In addition, the recommendations help to identify profiles for increased toxicity, with an emphasis on gastrointestinal and cardiovascular risks. The recommendations deal with the course of action and monitoring in different risk groups and in patients using antiplatelet or anticoagulant drugs. The overall level of agreement is high. CONCLUSIONS: The NSAIDs are safe and effective drugs for the treatment of rheumatic diseases. However, it is necessary to individualize its use according to their risk profile.

[Social costs of the most common inflammatory rheumatic diseases in Mexico from the patient's perspective]. / El costo de las principales enfermedades reumáticas inflamatorias desde la perspectiva del paciente en México.

OBJECTIVE: To estimate the social costs of rheumatoid arthritis (RA), ankylosing spondylitis (AS), and gout from the patient's perspective. METHODS: We carried out a cross-sectional analysis of the cost and resource utilization of 690 RA, AS, and gout patients from 10 medical centers and private facilities in five cities of Mexico. The information was obtained from the baseline of a dynamic cohort. We estimated out-of-pocket expenses, institutional direct costs, and direct medical costs. RESULTS: The mean (SD) annual out-of-pocket expense (USD) was $610.0 ($302.2) for RA, $578.6 ($220.5) for AS, and $245.3 ($124.0) for gout. Figures correspond to 15%, 9.6%, and 2.5% of the family income. They also represented 26.1%, 25.3%, and 24.4% of the total annual cost per RA, AS, and gout patients, respectively. The expected direct institutional patient/year costs were 1,724.2 for RA, $1,710.8 for AS, and $760.7 for gout. The total patient annual costs were $2,334.3 for RA, $2,289.4 for AS, and $1,006.1 for gout. Most out-of-pocket expenses were used to purchase drugs, pay for laboratory tests, imaging studies, and alternative therapies. CONCLUSIONS: From the patient's perspective, the cost of RA, AS, and gout represents 25% of direct medical costs. The cost of RA is higher than that for AS and gout.

El costo de las principales enfermedades reumáticas inflamatorias desde la perspectiva del paciente en México / Social costs of the most common inflammatory rheumatic diseases in Mexico from the patient's perspective

Objetivo: Estimar el costo de la artritis reumatoide (AR), la espondilitis anquilosante (EA) y la gota, desde la perspectiva del paciente. Métodos: Análisis transversal de los costos y utilización de recursos de 690 pacientes con AR, EA y gota, de 10 departamentos de centros hospitalarios y consultorios privados de cinco ciudades del país, al momento de ser incluidos en una cohorte dinámica. Se incluye una estimación de los gastos de bolsillo, los costos médicos directos institucionales y el costo médico directo real. Resultados: El gasto de bolsillo promedio (SD) anual (en dólares) en pacientes con AR ascendió a $610.0 ($302.2), en EA a $578.6 ($220.5) y en gota a $245.3 ($124.0), lo que equivalió a 15, 9.6 y 2.5% del ingreso familiar, respectivamente. El gasto de bolsillo representó 26.1% del costo total anual por paciente con AR, 25.3% con EA y 24.4% con gota. Los costos directos institucionales esperados por paciente/año con AR fueron de $1724.2, con EA de $1710.8 y con gota de $760.7. El costo total anual por paciente con AR fue de $2334.3, con EA de $2289.4 y con gota de $1006.1. Los componentes del gasto de bolsillo de mayor cuantía fueron los medicamentos, exámenes de laboratorio y gabinete y las terapias alternativas. Conclusiones: Se concluye que desde la perspectiva del paciente, el costo de la AR, EA y gota equivale a la cuarta parte del costo médico directo. La AR es la enfermedad que mayor gasto implica.

OBJECTIVE: To estimate the social costs of rheumatoid arthritis (RA), ankylosing spondylitis (AS), and gout from the patient's perspective. METHODS: We carried out a cross-sectional analysis of the cost and resource utilization of 690 RA, AS, and gout patients from 10 medical centers and private facilities in five cities of Mexico. The information was obtained from the baseline of a dynamic cohort. We estimated out-of-pocket expenses, institutional direct costs, and direct medical costs. RESULTS: The mean (SD) annual out-of-pocket expense (USD) was $610.0 ($302.2) for RA, $578.6 ($220.5) for AS, and $245.3 ($124.0) for gout. Figures correspond to 15%, 9.6%, and 2.5% of the family income. They also represented 26.1%, 25.3%, and 24.4% of the total annual cost per RA, AS, and gout patients, respectively. The expected direct institutional patient/year costs were 1,724.2 for RA, $1,710.8 for AS, and $760.7 for gout. The total patient annual costs were $2,334.3 for RA, $2,289.4 for AS, and $1,006.1 for gout. Most out-of-pocket expenses were used to purchase drugs, pay for laboratory tests, imaging studies, and alternative therapies. CONCLUSIONS: From the patient's perspective, the cost of RA, AS, and gout represents 25% of direct medical costs. The cost of RA is higher than that for AS and gout.

[Cardiovascular risk of cyclooxygenase selective inhibitors]. / Riesgo cardiovascular derivado de los inhibidores selectivos de la ciclooxigenasa.

It has been estimated that 30 million people worldwide take an nonsteroidal antiinflammatory drug (NSAID) daily. The main clinical objectives of these drugs are both to reduce joint pain and to improve joint function. However, gastrointestinal adverse events lead to the development of cyclooxygenase selective inhibitors (COXIB) with a better gastrointestinal safety profile. Since 1999, COXIB shown capacity to develop cardiovascular adverse events. Subsequent discoveries confirm overall risk of cardiovascular events. The increased cardiovascular risk occurred both in patients who were taking aspirin and in those who were not. Similar results with different COXIB appears to be a class effect of the COX-2 inhibitors, so patient risk factors must be identified and used in treatment decision making. Patients with gastrointestinal risk factors and no cardiovascular risk may benefit from use of a gastroprotective agent plus a nonselective nonsteroidal antiinflammatory drugs as a COXIB. We review assays whose objective was to study cardiovascular security of nonsteroidal antiinflammatory drugs and COXIB for known advantages and limitations of these drugs.

Estudio clínico controlado de ciclosporina A y cloroquina en artritis reumatoide de inicio temprano. Reporte preliminar y revisión de la literatura / Controlled clinical trial with cyclosporine and chloroquine in early rheumatoid arthritis

Objetivo: Evaluar la eficacia y seguridad de ciclosporina A (CsA) + cloroquina (CLQ) o placebo en pacientes con AR de inicio temprano y comparar los resultados con una revisión de la literatura de la combinación de CsA con otras drogas modificadoras de la enfermedad (DMARD).Métodos: Reporte preliminar de un estudio doble ciego controlado, de 90 pacientes con AR de inicio temprano, comparando CsA + CLQ o placebo. Variable de desenlace ACR 20, 50 y 70. Revisión de la literatura de 10 estudios completos de terapia combinada que incluyeron a la CsA.Resultados: A los 6 meses de tratamiento, cumplieron los criterios de mejoría (ACR-20) 34 pacientes (83 por ciento) del grupo CsA + CLQ y 25 (61 por ciento) del grupo CsA + placebo (p=0.02). A los 12 meses, no hubo diferencia significativa en la mejoría con los criterios de ACR-20. La diferencia fue significativa con ACR-50 (54 por ciento vs 34 por ciento, p= 0.05) y con ACR-70 (51 por ciento vs 26 por ciento, p=0.05). No hubo diferencias significativas en los efectos adversos en ambos grupos. La revisión de la literatura mostró reportes de CsA en combinación con MTX, oro parenteral, HCQ, CLQ y SSZ. La combinación más estudiada y al parecer más eficaz fue CsA con MTX. Conclusión: La combinación de CsA + CLQ parece ser eficaz en pacientes con AR temprana. Aunque la literatura sugiere que la mejor combinación con CsA es MTX, la CLQ parece ser una opción útil en terapia combinada con CsA.

Calidad de la atención primaria para lumbalgia aguda. Estudio multicéntrico / Quality of care in low back pain. Comparative survey

Objetivo. Evaluar la calidad de atención para pacientes con lumbagia aguda proporcionada por médicos de atención primaria y estudiantes de medicina de 4 ciudades de México. Tipo de studio. Encuesta comparativa. Material y métodos. Se interrogó sobre acciones diagnóstico terapéuticas en lumbalgia aguda a médicos de atención primaria y a estudiantes de medicina. Las acciones consideradas como aciertos se tomaron de las guías emitidas por la Quebec Task Force on Spinal Disorders (QTFSD). Resultados. Fueron evaluables los datos de 211 de 213 pacientes (30 Cd. Obregón, 43 Morelia, 80 León y 60 Mérida); 79 por ciento de los participantes habrían proporcionado calidad de atención no adecuada generalmente debida a sobresolicitud de estudios de imagen. No hubo asociación entre haber cursado reumatología en la carrera de medicina y el tipo de atención proporcionadas; sin embargo, el tener la especialidad de Medicina Familiar se asocició con proporcionar atención adecuada y en contraste, el ser estudiante de medicina estuvo asociado con proporcionar atención no adecuada. Conclusiones. Parece existir una elevada prevalencia de calidad de atención no adecuada para pacientes con lumbalgia aguda por parte de médicos de atención primaria; ésto parece ser mas frecuente en médicos en formación