Syndemic and syndemogenesis of low back pain in Latin-American population: a network and cluster analysis.

INTRODUCTION: Although low back pain (LBP) is a high-impact health condition, its burden has not been examined from the syndemic perspective. OBJECTIVE: To compare and assess clinical, socioeconomic, and geographic factors associated with LBP prevalence in low-income and upper-middle-income countries using syndemic and syndemogenesis frameworks based on network and cluster analyses. METHODS: Analyses were performed by adopting network and cluster design, whereby interrelations among the individual and social variables and their combinations were established. The required data was sourced from the databases pertaining to the six Latin-American countries. RESULTS: Database searches yielded a sample of 55,724 individuals (mean age 43.38 years, SD = 17.93), 24.12% of whom were indigenous, and 60.61% were women. The diagnosed with LBP comprised 6.59% of the total population. Network analysis showed higher relationship individuals' variables such as comorbidities, unhealthy habits, low educational level, living in rural areas, and indigenous status were found to be significantly associated with LBP. Cluster analysis showed significant association between LBP prevalence and social variables (e.g. Gender inequality Index, Human Development Index, Income Inequality). CONCLUSIONS: LBP is a highly prevalent condition in Latin-American populations with a high impact on the quality of life of young adults. It is particularly debilitating for women, indigenous individuals, and those with low educational level, and is further exacerbated by the presence of comorbidities, especially those in the mental health domain. Thus, the study findings demonstrate that syndemic and syndemogenesis have the potential to widen the health inequities stemming from LBP in vulnerable populations. Key points • Syndemic and syndemogenesis evidence health disparities in Latin-American populations, documenting the complexity of suffering from a disease such as low back pain that is associated with comorbidities, unhealthy habits, and the social and regional context where they live. • The use of network and cluster analyses are useful tools for documenting the complexity and the multifaceted impact in health in large populations as well as the differences between countries. • The variability and impact of socioeconomic indicators (e.g., Gini index) related to low back pain and comorbidities could be felt through the use of cluster analysis, which generates evidence of regional inequality in Latin America. • Populations can be studied from different models (network and cluster analysis) and grouping, presenting new interpretations beyond geographical groupings, such as syndemic and inequity in health.

The Social Gap Index and the prevalence of osteoarthritis in the community: a cross-sectional multilevel study in Mexico.

Multilevel studies have gained importance for highlighting social inequalities in health. These associations have been reported previously in diseases such as arthritis and chronic pain. We conducted a cross-sectional study using multilevel analysis to identify individual and contextual factors associated with the variation of prevalence of osteoarthritis (OA) in the Mexican population. The sample included 17,566 individuals of which 10,666 (60.7%) were women. The relationship between individual and contextual factors and OA were analyzed with a multilevel strategy. From the total population, 1,681 individuals had OA. Multilevel analysis showed that individual variables such as female gender (odds ratio (OR) = 1.3, 95% confidence interval (CI) 1.1, 1.4), age range 55-65 years (OR = 1.6, 95% CI 1.3, 2.0), musculoskeletal pain in the last 7 days (OR = 2.6, 95% CI 2.3, 3.0), and use of pain treatments (OR = 1.4, 95% CI 1.2, 1.7) were associated with OA. At the regional level, the Social Gap Index (SGIx) was associated with the diagnosis of OA (coefficient 0.5, 95% CI 0.2-1.1). The SGIx contextual variable was positively associated with the regional prevalence of OA and the variation in prevalence of OA in different regions. The larger the social gap, the greater the variation in OA prevalence. These factors were independently associated with the prevalence of OA: female gender, pain intensity, physical limitation, and the use of pain treatments were individual variables associated with OA. The association between OA prevalence and regional variations with SGIx reflects inequities in health provisions that should be considered in health programs.

Factors associated with treatment of osteoarthritis: analysis of a COPCORD study in Nuevo León, México / Factores asociados al tratamiento de osteoartritis: análisis de un estudio COPCORD en Nuevo León, México

Introduction: Osteoarthritis (OA) is the most prevalent rheumatic disease in Mexico. Treatment involves pharmacological and non-pharmacological strategies. Objective: To describe the factors associated with treatment of osteoarthritis in the urban and rural population of Nuevo León. Methods: Analysis of a cross-sectional study of patients with OA from a COPCORD study database. Univariate and multivariate analyses of the variables associated with treatment of OA. Results: We included 696 patients with OA with an average age of 58 years (SD 14.1), 484 (69.5%) women. Pain with a visual analog scale (VAS) ≥ 4 was present in 507 (72.8%) patients. Functional disability was present in 133 (19%) patients and a mean HAQ of 0.37 (IQR 0.75) was found. The most frequent place of OA was knee in 356 (51.1%) patients; 259 (37%) patients already knew their diagnosis. The most employed treatments were non-steroidal anti-inflammatory drugs (289 patients, 58.5%). The variables associated with treatment were age >58 years (OR 1.3, 95% CI 1.0–1.5), female gender (OR 1.17, 95% CI 1.0–1.3), VAS pain ≥ 4 (OR 1.3, 95% CI 1.1–1.4), functional disability (OR 2.6, 95% CI 1.6–4.1), HAQ >0.375 (OR 1.9, 95% CI 1.5–2.4), and past diagnosis of OA (OR 5.1, 95% CI 3.3–8.0). In the multivariate analysis, VAS pain ≥ 4 (OR 1.9, 95% CI 1.2–2.8), kneeling disability (OR 3.15, 95% CI 1.3–7.4) and previous diagnosis of OA (OR 7.6, 95% CI 4.5–12.9) had statistical significance. Conclusion: factors associated with treatment of OA are VAS pain ≥ 4, kneeling disability and previous diagnosis of OA (AU)

Introducción. La osteoartritis (OA) es la enfermedad reumática más prevalente en México. El tratamiento involucra intervenciones farmacológicas y no farmacológicas. Objetivo. Describir los factores asociados al tratamiento de osteoartritis en comunidades urbanas y rurales de Nuevo León. Métodos. Estudio transversal analítico de pacientes con OA, obtenido de la base de datos del estudio COPCORD. Análisis univariado y multivariado de las variables asociadas al uso de tratamiento. Resultados. Se incluyó a 696 pacientes, edad media ± desviación estándar de 58 ± 14,1 años, 484 (69.5%) mujeres. El dolor con intensidad ≥ 4 en escala visual analógica (EVA) se presentó en 507 (72,8%) individuos. En 133 (19%) individuos se presentó limitación física, con una mediana en HAQ de 0,37 (RIQ 0,75). La localización más frecuente de OA fue rodilla en 356 (51,1%) pacientes; 259 (37%) individuos ya tenían el diagnóstico de OA. El tratamiento más empleado fueron los antiinflamatorios no esteroideos en 289 (58,5%) individuos. Las variables asociadas al uso de tratamiento fueron edad > 58 años (OR = 1,3, IC del 95%, 1,0-1,5), género femenino (OR = 1,1, IC del 95%, 1,0-1,3), dolor con EVA ≥ 4 (OR = 1,3, IC del 95%, 1,1-1,4), limitación fisica (OR = 2,6, IC del 95%, 1,6-4,1), HAQ > 0,375 (OR = 1,9, IC del 95%, 1,5-2,4) y antecedente de diagnóstico de OA (OR = 5,1, IC del 95%, 3,3-8,0). En el multivariado, el dolor con EVA ≥ 4 (OR = 1,9, IC del 95%, 1,2-2,8), la incapacidad para arrodillarse (OR = 3,1, IC del 95%, 1,3-7,4) y el antecedente de diagnóstico de OA (OR = 7,6, IC del 95%, 4,5-12,9) permanecieron significativos. Conclusión. Los factores asociados al tratamiento de OA son EVA del dolor ≥ 4, la incapacidad para arrodillarse y el antecedente de diagnóstico de OA (AU)

Coping strategies for health and daily-life stressors in patients with rheumatoid arthritis, ankylosing spondylitis, and gout: STROBE-compliant article.

This article aims to identify the strategies for coping with health and daily-life stressors of Mexican patients with chronic rheumatic disease. We analyzed the baseline data of a cohort of patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS), and gout. Their strategies for coping were identified with a validated questionnaire. Comparisons between health and daily-life stressors and between the 3 clinical conditions were made. With regression analyses, we determined the contribution of individual, socioeconomic, educational, and health-related quality-of-life variables to health status and coping strategy. We identified several predominant coping strategies in response to daily-life and health stressors in 261 patients with RA, 226 with AS, and 206 with gout. Evasive and reappraisal strategies were predominant when patients cope with health stressors; emotional/negative and evasive strategies predominated when coping with daily-life stressors. There was a significant association between the evasive pattern and the low short-form health survey (SF-36) scores and health stressors across the 3 diseases. Besides some differences between diagnoses, the most important finding was the predominance of the evasive strategy and its association with low SF-36 score and high level of pain in patients with gout. Patients with rheumatic diseases cope in different ways when confronted with health and daily-life stressors. The strategy of coping differs across diagnoses; emotional/negative and evasive strategies are associated with poor health-related quality of life. The identification of the coping strategies could result in the design of psychosocial interventions to improve self-management.

Factors associated with treatment of osteoarthritis: Analysis of a COPCORD study in Nuevo León, México.

INTRODUCTION: Osteoarthritis (OA) is the most prevalent rheumatic disease in Mexico. Treatment involves pharmacological and non-pharmacological strategies. OBJECTIVE: To describe the factors associated with treatment of osteoarthritis in the urban and rural population of Nuevo León. METHODS: Analysis of a cross-sectional study of patients with OA from a COPCORD study database. Univariate and multivariate analyses of the variables associated with treatment of OA. RESULTS: We included 696 patients with OA with an average age of 58 years (SD 14.1), 484 (69.5%) women. Pain with a visual analog scale (VAS) ≥4 was present in 507 (72.8%) patients. Functional disability was present in 133 (19%) patients and a mean HAQ of 0.37 (IQR 0.75) was found. The most frequent place of OA was knee in 356 (51.1%) patients; 259 (37%) patients already knew their diagnosis. The most employed treatments were non-steroidal anti-inflammatory drugs (289 patients, 58.5%). The variables associated with treatment were age >58 years (OR 1.3, 95% CI 1.0-1.5), female gender (OR 1.17, 95% CI 1.0-1.3), VAS pain ≥4 (OR 1.3, 95% CI 1.1-1.4), functional disability (OR 2.6, 95% CI 1.6-4.1), HAQ >0.375 (OR 1.9, 95% CI 1.5-2.4), and past diagnosis of OA (OR 5.1, 95% CI 3.3-8.0). In the multivariate analysis, VAS pain ≥4 (OR 1.9, 95% CI 1.2-2.8), kneeling disability (OR 3.15, 95% CI 1.3-7.4) and previous diagnosis of OA (OR 7.6, 95% CI 4.5-12.9) had statistical significance. CONCLUSION: factors associated with treatment of OA are VAS pain ≥4, kneeling disability and previous diagnosis of OA.

Developing Community-Based Rehabilitation Programs for Musculoskeletal Diseases in Low-Income Areas of Mexico: The Community-Based Rehabilitation for Low-Income Communities Living With Rheumatic Diseases (CONCORD) Protocol.

BACKGROUND: The negative impact of musculoskeletal diseases on the physical function and quality of life of people living in developing countries is considerable. This disabling effect is even more marked in low-socioeconomic communities within developing countries. In Mexico, there is a need to create community-based rehabilitation programs for people living with musculoskeletal diseases in low-socioeconomic areas. These programs should be directed to prevent and decrease disability, accommodating the specific local culture of communities. OBJECTIVE: The objective of this paper is to describe a research protocol designed to develop, implement, and evaluate culturally sensitive community-based rehabilitation programs aiming to decrease disability of people living with musculoskeletal diseases in two low-income Mexican communities. METHODS: A community-based participatory research approach is proposed, including multi and transdisciplinary efforts among the community, medical anthropology, and the health sciences. The project is structured in 4 main stages: (1) situation analysis, (2) program development, (3) program implementation, and (4) program evaluation. Each stage includes the use of quantitative and qualitative methods (mixed method program). RESULTS: So far, we obtained resources from a Mexican federal agency and completed stage one of the project at Chankom, Yucatán. We are currently receiving funding from an international agency to complete stage two at this same location. We expect that the project at Chankom will be concluded by December of 2017. On the other hand, we just started the execution of stage one at Nuevo León with funding from a Mexican federal agency. We expect to conclude the project at this site by September of 2018. CONCLUSIONS: Using a community-based participatory research approach and a mixed method program could result in the creation of culturally sensitive community-based rehabilitation programs that promote community development and decrease the disabling effects of musculoskeletal diseases within two low-income Mexican communities.

Barriers to implementing the «2008 Mexican Clinical Practice Guideline recommendations for the management of hip and knee osteoarthritis» in primary healthcare practice / Barreras para la implementación de la «Guía Mexicana de Práctica Clínica para el manejo de osteoartritis de cadera y rodilla en el primer nivel de atención 2008» en la práctica de atención primaria

Objective: To evaluate the implementability of the «2008 Mexican Clinical Practice Guideline for the management of hip and knee osteoarthritis at the primary level of care» within primary healthcare of three Mexican regions using the Guideline Implementability Appraisal methodology version 2 (GLIA.v2). Methods: Six family physicians, representing the South, North, and Central Mexico, and one Mexican physiatrist evaluated the 45 recommendations stated by the Mexican guideline. The GLIA.v2 methodology includes the execution of qualitative and semi-quantitative techniques. Results: Reviewers’ agreement was between moderate to near complete in most cases. Sixty-nine percent of the recommendations were considered difficult to implement within clinical practice. Eight recommendations did not have an appropriate format. Only 6 recommendations were judged as able to be consistently applied to clinical practice. Barriers related to the context of one or more institutions/regions were identified in 25 recommendations. These barriers are related to health providers/patients’ beliefs, processes of care within each institution, and availability of some treatments recommended by the guideline. Conclusions: The guideline presented problems of conciseness and clarity that negatively affect its application within the Mexican primary healthcare context. We identified individual, organizational and system characteristics, which are common to the 3 institutions/regions studied and constitute barriers for implementing the guideline to clinical practice. It is recommended that the 2008-Mexican-CPG-OA be thoroughly revised and restructured to improve the clarity of the actions implied by each recommendation. We propose some strategies to accomplish this and to overcome some of the identified regional/institutional barriers (AU)

Objetivo. Evaluar las barreras de implementación de la guía de práctica clínica para el manejo de osteoartritis de cadera y rodilla en el primer nivel de atención 2008 dentro de la práctica clínica de 3 regiones mexicanas, usando la metodología Guideline Implementability Appraisal version 2 (GLIA v2). Métodos. Seis médicos familiares, representantes del sur, norte y centro de México, y un médico rehabilitador mexicano evaluaron las 45 recomendaciones propuestas en la guía de práctica clínica. La metodología GLIA v2 incluye la ejecución de técnicas cualitativas y semicuantitativas. Resultados. En su mayoría, el acuerdo entre revisores fue de moderado a casi completo. El 69% de las recomendaciones fueron consideradas como difíciles de implementar en la práctica clínica. Ocho recomendaciones no tienen un formato apropiado. Únicamente 6 recomendaciones pueden ser aplicadas consistentemente en la práctica clínica. En 25 recomendaciones, se detectaron barreras de implementación relacionadas al contexto de una o más de las instituciones/regiones exploradas. Estas barreras se relacionan con las creencias de proveedores de salud y pacientes, procesos de atención en cada institución y disponibilidad de algunos de los tratamientos recomendados en la guía. Conclusiones. La guía contiene recomendaciones poco claras y concisas, lo que afecta negativamente a su aplicación dentro del primer nivel de atención mexicano. Identificamos características individuales, organizacionales y sistemáticas, comunes a las 3 instituciones/organizaciones estudiadas, que significan barreras para implementar la guía en México. Se recomienda que esta guía sea revisada y reestructurada con el fin de mejorar la claridad de sus recomendaciones. Proponemos algunas estrategias para hacer esto y atacar algunas de las barreras identificadas relacionadas dentro de las regiones exploradas (AU)

Barriers to implementing the "2008 Mexican Clinical Practice Guideline recommendations for the management of hip and knee osteoarthritis" in primary healthcare practice.

OBJECTIVE: To evaluate the implementability of the "2008 Mexican Clinical Practice Guideline for the management of hip and knee osteoarthritis at the primary level of care" within primary healthcare of three Mexican regions using the Guideline Implementability Appraisal methodology version 2 (GLIA.v2). METHODS: Six family physicians, representing the South, North, and Central Mexico, and one Mexican physiatrist evaluated the 45 recommendations stated by the Mexican guideline. The GLIA.v2 methodology includes the execution of qualitative and semi-quantitative techniques. RESULTS: Reviewers' agreement was between moderate to near complete in most cases. Sixty-nine percent of the recommendations were considered difficult to implement within clinical practice. Eight recommendations did not have an appropriate format. Only 6 recommendations were judged as able to be consistently applied to clinical practice. Barriers related to the context of one or more institutions/regions were identified in 25 recommendations. These barriers are related to health providers/patients' beliefs, processes of care within each institution, and availability of some treatments recommended by the guideline. CONCLUSIONS: The guideline presented problems of conciseness and clarity that negatively affect its application within the Mexican primary healthcare context. We identified individual, organizational and system characteristics, which are common to the 3 institutions/regions studied and constitute barriers for implementing the guideline to clinical practice. It is recommended that the 2008-Mexican-CPG-OA be thoroughly revised and restructured to improve the clarity of the actions implied by each recommendation. We propose some strategies to accomplish this and to overcome some of the identified regional/institutional barriers.

Impact of genetic ancestry and sociodemographic status on the clinical expression of systemic lupus erythematosus in American Indian-European populations.

OBJECTIVE: American Indian-Europeans, Asians, and African Americans have an excess morbidity from systemic lupus erythematosus (SLE) and a higher prevalence of lupus nephritis than do Caucasians. The aim of this study was to analyze the relationship between genetic ancestry and sociodemographic characteristics and clinical features in a large cohort of American Indian-European SLE patients. METHODS: A total of 2,116 SLE patients of American Indian-European origin and 4,001 SLE patients of European descent for whom we had clinical data were included in the study. Genotyping of 253 continental ancestry-informative markers was performed on the Illumina platform. Structure and Admixture software were used to determine genetic ancestry proportions of each individual. Logistic regression was used to test the association between genetic ancestry and sociodemographic and clinical characteristics. Odds ratios (ORs) were calculated with 95% confidence intervals (95% CIs). RESULTS: The average American Indian genetic ancestry of 2,116 SLE patients was 40.7%. American Indian genetic ancestry conferred increased risks of renal involvement (P < 0.0001, OR 3.50 [95% CI 2.63- 4.63]) and early age at onset (P < 0.0001). American Indian ancestry protected against photosensitivity (P < 0.0001, OR 0.58 [95% CI 0.44-0.76]), oral ulcers (P < 0.0001, OR 0.55 [95% CI 0.42-0.72]), and serositis (P < 0.0001, OR 0.56 [95% CI 0.41-0.75]) after adjustment for age, sex, and age at onset. However, age and sex had stronger effects than genetic ancestry on malar rash, discoid rash, arthritis, and neurologic involvement. CONCLUSION: In general, American Indian genetic ancestry correlates with lower sociodemographic status and increases the risk of developing renal involvement and SLE at an earlier age.

Epidemiology of the rheumatic diseases in Mexico. A study of 5 regions based on the COPCORD methodology.

OBJECTIVE: To estimate the prevalence of musculoskeletal (MSK) disorders and to describe predicting variables associated with rheumatic diseases in 5 regions of México. METHODS: This was a cross-sectional, community-based study performed in 5 regions in México. The methodology followed the guidelines proposed by the Community Oriented Program for the Control of the Rheumatic Diseases (COPCORD). A standardized methodology was used at all sites, with trained personnel following a common protocol of interviewing adult subjects in their household. A "positive case" was defined as an individual with nontraumatic MSK pain of > 1 on a visual analog pain scale (0 to 10) during the last 7 days. All positive cases were referred to internists or rheumatologists for further clinical evaluation, diagnosis, and proper treatment. RESULTS: The study included 19,213 individuals; 11,602 (68.8%) were female, and their mean age was 42.8 (SD 17.9) years. The prevalence of MSK pain was 25.5%, but significant variations (7.1% to 43.5%) across geographical regions occurred. The prevalence of osteoarthritis was 10.5%, back pain 5.8%, rheumatic regional pain syndromes 3.8%, rheumatoid arthritis 1.6%, fibromyalgia 0.7%, and gout 0.3%. The prevalence of MSK manifestations was associated with older age and female gender. CONCLUSION: The prevalence of MSK pain in our study was 25.5%. Geographic variations in the prevalence of MSK pain and specific diagnoses suggested a role for geographic factors in the prevalence of rheumatic diseases.

Epidemiology of rheumatic diseases. A community-based study in urban and rural populations in the state of Nuevo Leon, Mexico.

OBJECTIVE: To estimate the prevalence of rheumatic diseases in rural and urban populations using the WHO-ILAR COPCORD questionnaire. METHODS: We conducted a cross-sectional home survey in subjects > 18 years of age in the Mexican state of Nuevo Leon. Results were validated locally against physical examination in positive cases according to an operational definition by 2 rheumatologists. We used a random, balanced, and stratified sample by region of representative subjects. RESULTS: We surveyed 4713 individuals with a mean age of 43.6 years (SD 17.3); 55.9% were women and 87.1% were from urban areas. Excluding trauma, 1278 individuals (27.1%, 95% CI 25.8%-28.4%) reported musculoskeletal pain in the last 7 days; the prevalence of this variable was almost twice as frequent in women (33% vs 17% in men); 529 (11.2%) had pain associated with trauma. The global prevalence of pain was 38.3%. Mean pain score was 2.4 (SD 3.4) on a pain scale of 0-10. Most subjects classified as positive according to case definition (99%) were evaluated by a rheumatologist. Main diagnoses were osteoarthritis in 17.3% (95% CI 16.2-18.4), back pain in 9.8% (95% CI 9.0-10.7), undifferentiated arthritis in 2.4% (95% CI 2.0-2.9), rheumatoid arthritis in 0.4% (95% CI 0.2-0.6), fibromyalgia in 0.8% (95% CI 0.6-1.1), and gout in 0.3% (95% CI 0.1-0.5). CONCLUSION: This is the first regional COPCORD study in Mexico performed with a systematic sampling, showing a high prevalence of pain. COPCORD is a useful tool for the early detection of rheumatic diseases as well as for accurately referring patients to different medical care centers and to reduce underreporting of rheumatic diseases.

Prevalence of rheumatic regional pain syndromes in adults from Mexico: a community survey using COPCORD for screening and syndrome-specific diagnostic criteria.

OBJECTIVE: To assess the prevalence of rheumatic regional pain syndromes (RRPS) in 3 geographical areas of México using the Community Oriented Program in the Rheumatic Diseases (COPCORD) screening methodology and validate by expert consensus on case-based definitions. METHODS: By means of an address-based sample generated through a multistage, stratified, randomized method, a cross-sectional survey was performed on adult residents (n = 12,686; age 43.6 ± 17.3 yrs; women 61.9%) of the states of Nuevo León, Yucatán, and México City. Diagnostic criteria for specific upper (Southampton group criteria) and lower limb (ad hoc expert consensus) RRPS were applied to all subjects with limb pain as detected by COPCORD questionnaire. RESULTS: The overall prevalence of RRPS was 5.0% (95% CI 4.7-5.4). The most frequent syndrome was rotator cuff tendinopathy (2.36%); followed by inferior heel pain (0.64%); lateral epicondylalgia (0.63%); medial epicondylalgia (0.52%); trigger finger (0.42%); carpal tunnel syndrome (0.36%); anserine bursitis (0.34%); de Quervain's tendinopathy (0.30%); shoulder bicipital tendinopathy (0.27%); trochanteric syndrome (0.11%); and Achilles tendinopathy (0.10%). There were anatomic regional variations in the prevalence of limb pain: Yucatán 3.1% (95% CI 2.5-3.6); Nuevo León 7.0% (95% CI 6.3-7.7); and México City 10.8% (95% CI 9.8-11.8). Similarly, the prevalence of RRPS showed marked geographical variation: Yucatán 2.3% (95% CI 1.8-2.8); Nuevo León 5.6% (95% CI 5.0-6.3); and México City 6.9% (95% CI 6.2-7.7). CONCLUSION: The overall prevalence of RRPS in México was 5.0%. Geographical variations raise the possibility that the prevalence of RRPS is influenced by socioeconomic, ethnic, or demographic factors.

Prevalence of back pain in the community. A COPCORD-based study in the Mexican population.

OBJECTIVE: Back pain (BP) is frequent in the community; its prevalence in México is 6%. Our objective was to determine the prevalence of BP in Mexican communities and determine its most important characteristics. METHODS: A cross-sectional study of individuals aged > 18 years was conducted in Mexico City and in urban communities in the state of Nuevo León. Sampling in Mexico City was based on community census and in Nuevo León, on stratified, balanced, and random sampling. Procedures included a door-to-door survey, using the Community Oriented Program for the Control of Rheumatic Diseases, to identify individuals with BP > 1 on a visual analog scale in the last 7 days. General practitioners/rheumatology fellows confirmed and characterized BP symptoms. RESULTS: In all, 8159 individuals (mean age 43.7 yrs, two-thirds female) were surveyed and 1219 had BP. The prevalence of nontraumatic BP in the last 7 days was 8.0% (95% CI 7.5-8.7). The mean age of these individuals was 42.7 years, and 61.9% were female. Thirty-seven percent had inflammatory BP [prevalence of 3.0% (95% CI 2.7-3.4)]. Compared with the state of Nuevo Léon, the characteristics and consequences of BP in Mexico City were more severe. In logistic regression analysis, living in Mexico City, having a paid job, any kind of musculoskeletal pain, high pain intensity, and obesity among other variables were associated with BP. CONCLUSION: The prevalence of nontraumatic BP in the last 7 days in urban communities in México is 8.0%. However, clinical features and consequences differed among the communities studied, suggesting a role for local factors in BP.

Validity of the COPCORD core questionnaire as a classification tool for rheumatic diseases.

OBJECTIVE: Rheumatic diseases are vastly underdiagnosed and undertreated, particularly among minorities and those of low socioeconomic status. The WHO-ILAR Community Oriented Program in the Rheumatic Diseases (COPCORD) advocates screening of musculoskeletal complaints in the community. The objective of this study was to evaluate the performance of the COPCORD Core Questionnaire (CCQ) as a diagnostic tool for rheumatic diseases. METHODS: We conducted a cross-sectional study designed in parallel with a large COPCORD survey in Mexico. A subsample of 17,566 questionnaires, selected from 4 of the 5 states included in a national COPCORD survey were included in the analysis as a diagnostic test to evaluate sensitivity, specificity, receiver operating characteristics curve (ROC), and positive likelihood ratio (LR+) of the CCQ as a case-detection tool for rheumatic diagnosis and for the most frequent diagnoses identified in the survey, osteoarthritis, regional rheumatic pain syndromes, and rheumatoid arthritis (RA). Logistic regression with the questions with LR+ ≥ 1 was performed to identify the strength of association (OR) for each question. RESULTS: Pain in the last 7 days, high pain score (> 4), and previous diagnosis were the questions with highest LR+ for diagnosis, and for diagnosis of RA treatment with NSAID. The variables that contributed most to the model were pain in the last 7 days (OR 2.0, 95% CI 1.8-2.3), NSAID treatment (OR 3.3, 95% CI 3.0-3.7), a high pain score (OR 1.15, 95% CI 1.13-1.17), and having a previous diagnosis (OR 1.4, 95% CI 1.3-1.6). These 4 questions had R(2) = 0.24, p < 0.01, for detection of any rheumatic diagnosis. The single variable that explains 16% (OR 1.33, 95% CI 1.31-134) of variance was a high pain score in the last 7 days. CONCLUSION: Some variables were identified in the CCQ that could be combined in a brief version for case detection of rheumatic diseases in community surveys. The validity of this proposal has to be tested against the original version.

Antineutrophil cytoplasm autoantibodies in patients with tuberculosis are directed against bactericidal/permeability increasing protein and are detected after treatment initiation.

OBJECTIVES: To determine the prevalence of antineutrophil cytoplasm autoantibodies (ANCA) and its antigenic specificities in sera of patients with pulmonary tuberculosis (Tb) before and after treatment. PATIENTS AND METHODS: Sixty-eight patients with culture-proven Tb were studied for the presence of ANCA, both by indirect immunofluorescence (IIF) and ELISA against proteinase-3 (PR3), myeloperoxidase (MPO) and bactericidal/permeability increasing protein (BPI). They were sought before treatment and in 52 of them also after therapy for the infection. High sensitivity C-reactive protein (CRP) was also measured at both times. RESULTS: ANCA by IIF were found in 3/68 (4.4%) sera prior to treatment, one C-ANCA and two P-ANCA, all recognizing BPI. After treatment, this increased to 15/52 (28.8%), 3 C-ANCA and 12 P-ANCA, the majority directed against BPI (11/15, 73%). BPI-ANCA were positive in 6/68 (8.8%) and 15/52 (28.8%) before and after Tb after treatment initiation (p=0.003). PR3-ANCA and MPO-ANCA were negative in all Tb sera. A positive ANCA test correlated with CRP as inflammatory marker (p=0.001). CONCLUSIONS: The prevalence of ANCA in culture positive Tb patients is modified by Tb chemotherapy. BPI is the main target antigen for ANCA in tuberculosis and BPI-ANCA increase after treatment.

Registro Iberoamericano de Espondiloartritis (RESPONDIA): México / RESPONDIA. Iberoamerican Registry of Spondyloarthritis: México

Objetivo: Describir las características principales de las espondiloartritis en la población mexicana. Material y métodos: Se trata de un análisis descriptivo y transversal de la información recogida y almacenada entre enero de 2006 y diciembre de 2007, y almacenada en línea en la página electrónica del grupo de Registro de Espondiloartropatías de la Sociedad Española de Reumatología (REGISPONSER). La metodología general se expone en otro artículo de este número. Resultados: Se incluyó a 172 pacientes (102 varones, [59,3%] con una edad media desviación estándar de 38 14 años). La mayoría tenía espondilitis anquilosante; luego, espondiloartritis indiferenciada. La edad al inicio fue 28 14 años; el 30% empezó antes de los 16 años. El tiempo hasta el diagnóstico fue de 5 años. La forma de inicio más frecuente fue la combinación de artritis periférica y síntomas axiales (72,7%); el 18% había tenido uveítis. El tratamiento incluyó bloqueadores del factor de necrosis tumoral alfa en el 12%. El Bath Ankylosing Spondylitis Disease Activity Index fue de 4,5 y el Bath Ankylosing Spondylitis Functional Activity Index, de 4,0. Las diferencias entre espondilitis anquilosante, espondiloartritis indiferenciada y artritis psoriásica fueron: distribución por sexo, tiempo de evolución en el momento del diagnóstico, síntomas y signos por afección del esqueleto axial, artritis en las extremidades superiores, afección coxofemoral, tarsitis e intensidad del dolor. Conclusión: En pacientes mexicanos, las espondiloartropatías parecen tener un perfil caracterizado por la combinación de manifestaciones axiales y periféricas (AU)

Objective: To describe the main features of spondylarthritis (SpA) in Mexicans. Material and methods: This is a cross sectional, descriptive study of the information was collected and stored on-line in the Registro de Espondiloartropatías de la Sociedad Española de Reumatología (REGISPONSER) between January, 2006 and December, 2007. Methods are described elsewhere in this number. Results: We included 172 patients (102 males [59.3%]; mean age standard deviation 38 14 years). Most patients had ankylosing spondylitis; then, undifferentiated SpA. Age at onset was 28 14 years; 30% had onset < 16 years; time to diagnosis was 5 years. Combined peripheral arthritis and axial involvement was the commonest disease pattern at onset (72.7%); 18% had uveitis. Treatment included tumour necrosis factor in 12%. The Bath Ankylosing Spondylitis Disease Activity Index and Bath Ankylosing Spondylitis Functional Index were 4.5 and 4.0. Differences between ankylosing spondylitis, undifferentiated SpA, and psoriatic arthritis consisted of sex distribution, time to diagnosis, axial symptoms, upper limb arthritis, hip disease, tarsitis, and pain. Conclusion: The pattern of SpA in Mexicans is characterized by combined axial and peripheral involvement (AU)

Efecto de la jalea real sobre la proliferación de los linfocitos humanos / Effect of royal jelly on the proliferation of human lymphocytes

Se estudió el efecto in vitro de la jalea real (JR) sobre los linfocitos de 10 donantes voluntarios del Banco de Sangre del Instituto de Hematología e Inmunología mediante la prueba de transformación linfoblástica con el empleo de timidina tritiada. Se cultivaron 100 mL de la muestra (2 ´ 106 linf/mL) en las siguientes condiciones experimentales: 100 mL de RPMI 1640 suplementado con suero fetal bovino al 20 %, diluciones dobles de la JR (tableta 100 mg) desde 1:2 hasta 1:4096 respectivamente. No se hallaron diferencias estadísticamente significativas entre los conteos por minuto de los linfocitos cultivados 120 horas sin y con diluciones de la JR.

The in vitro effect of royal jelly (RJ) on the lymphocytes of 10 voluntary donors from the Blood Bank of the Institute of Hematology and Immunology was studied by the lymphoblastic transformation test using titriated timidine. 100 mL of the sample (2 x 106 lym/mL) were cultivated under the following experimental conditions: 100 mL of RPMI 1640 supplemented with fetal bovine serum 20 %, double dilutions of RJ (tablet 100 mg) from 1:2 to 1:4096, respectively. No significant statistical differences were found between the counts per minute of the lymphocytes cultivated for 120 minutes with and without RJ dilutions.

Efecto de la jalea real sobre la proliferación de los linfocitos humanos / Effect of the real jelly on the proliferation of the human linfocitos

Se estudió el efecto in vitro de la jalea real (JR) sobre los linfocitos de 10 donantes voluntarios del Banco de Sangre del Instituto de Hematología e Inmunología mediante la prueba de transformación linfoblástica con el empleo de timidina tritiada. Se cultivaron 100 mL de la muestra (2 ´ 106 linf/mL) en las siguientes condiciones experimentales: 100 mL de RPMI 1640 suplementado con suero fetal bovino al 20 por ciento, diluciones dobles de la JR (tableta 100 mg) desde 1:2 hasta 1:4096 respectivamente. No se hallaron diferencias estadísticamente significativas entre los conteos por minuto de los linfocitos cultivados 120 horas sin y con diluciones de la JR(AU)

Estudio de las reacciones medicamentosas por hipersensibilidad retardadamediante la proliferación linfoblástica / Study of drug reactions due to delayed hypersensitivity by lymphoblactic proliferation

Se estudiaron 6 enfermos con el posible diagnóstico de reacciones medicamentosas por hipersensibilidad retardada (HR) mediante la prueba de transformación linfoblástica con criterio de incorporación de timidina tritiada. Se demostró que en 2 pacientes existían reacciones de HR a la carbamazepina, en uno al ácido acetil salicílico, en uno a la cloroquina y el sulfaprim y el otro paciente al ácido acetil salicílico en tabletas y a la materia prima. Se comprobó que la introducción de este método para la evaluación de la reacción de HR tipo IV en el estudio de las reacciones adversas a medicamentos es de gran utilidad en nuestro medio. Se modificó la conducta terapéutica en cada enfermo de acuerdo con los resultados obtenidos, lo que favoreció el pronóstico, la estadía hospitalaria y la curación

Estudio de las reacciones medicamentosas por hipersensibilidad retardadamediante la proliferación linfoblástica / Study of drug reactions due to delayed hypersensitivity by lymphoblactic proliferation

Se estudiaron 6 enfermos con el posible diagnóstico de reacciones medicamentosas por hipersensibilidad retardada (HR) mediante la prueba de transformación linfoblástica con criterio de incorporación de timidina tritiada. Se demostró que en 2 pacientes existían reacciones de HR a la carbamazepina, en uno al ácido acetil salicílico, en uno a la cloroquina y el sulfaprim y el otro paciente al ácido acetil salicílico en tabletas y a la materia prima. Se comprobó que la introducción de este método para la evaluación de la reacción de HR tipo IV en el estudio de las reacciones adversas a medicamentos es de gran utilidad en nuestro medio. Se modificó la conducta terapéutica en cada enfermo de acuerdo con los resultados obtenidos, lo que favoreció el pronóstico, la estadía hospitalaria y la curación(AU)