Adherencia a las recomendaciones actuales de inmunización en pacientes con artritis reumatoide en México / Adherence to Current Vaccination Recommendations for Patients With Rheumatoid Arthritis in Mexico

Antecedentes: Los pacientes con artritis reumatoide (AR) presentan un incremento de 2 a 4 veces del riesgo de infecciones comparado con la población general. Por esta razón existen recomendaciones sobre la aplicación de vacunas de gripe, neumococo y herpes zóster en todos los pacientes con AR, previo al inicio del tratamiento. Varios estudios han demostrado la baja prevalencia de vacunación, así como la adherencia a las recomendaciones actuales de inmunización por los reumatólogos. Objetivo: El objetivo de este estudio fue determinar el conocimiento de las recomendaciones actuales de inmunización en pacientes con AR por los reumatólogos miembros del Colegio Mexicano de Reumatología, así como identificar las barreras en su aplicación en dicha población. Métodos: Se realizó un estudio transversal por medio de una encuesta a 577 reumatólogos de México en enero 2017. Resultados: Se obtuvieron 122 respuestas, representando el 21,14% de los 577 reumatólogos. El 50,82% respondió que recomendaba al 76-100% de sus pacientes la vacuna de la gripe, el 36,07% recomendaba al 76-100% de sus pacientes la vacuna de neumococo y con respecto a la vacuna del herpes zóster el 69,67% respondió que no la recomendaba rutinariamente a sus pacientes. Conclusiones: De acuerdo a los datos obtenidos en este estudio, no existe información adecuada acerca de la importancia de la vacunación en pacientes con AR. También muestra que el grado de adherencia a las recomendaciones de vacunación, así como el conocimiento sobre seguridad y tiempo óptimo de administración de las vacunas son bajos en México.(AU)

Background: Patients with RA have a two to four-fold increased risk of developing infections compared to the general population. For this reason, the administration of influenza, pneumococcal and shingles vaccines is recommended for all patients with RA, preferably prior to initiating treatment, Previous studies have demonstrated the low prevalence of vaccination as well as adherence to current recommendations by rheumatologists in other regions. Objective: To determine the knowledge and adherence to the current vaccination recommendations for patients with RA by rheumatology members of the Mexican College of Rheumatology (MCR), and to identify barriers to their application in this population. Methods:mA cross-sectional study was conducted through a survey sent to 577 rheumatologists from Mexico in January 2017. Results: We received completed surveys from 122 individuals, representing 21.14% of the 577 rheumatologists in our registry. Fifty percent responded that they recommended immunization against influenza to 76%-100% of their patients, 36.07% recommended immunization against pneumococcus to 76%-100% of their patients, and 69.67% of the survey responders did not recommend shingles immunization routinely to their patients. Conclusions: The data collected in this study show there is poor adherence to immunization schedules recommended for the RA population. This data suggests there is misinformation about the effectiveness, safety and optimal timing of immunization in patients with RA in Mexico.(AU)

Adherence to Current Vaccination Recommendations for Patients With Rheumatoid Arthritis in Mexico. / Adherencia a las recomendaciones actuales de inmunización en pacientes con artritis reumatoide en México.

BACKGROUND: Patients with RA have a two to four-fold increased risk of developing infections compared to the general population. For this reason, the administration of influenza, pneumococcal and shingles vaccines is recommended for all patients with RA, preferably prior to initiating treatment, Previous studies have demonstrated the low prevalence of vaccination as well as adherence to current recommendations by rheumatologists in other regions. OBJECTIVE: To determine the knowledge and adherence to the current vaccination recommendations for patients with RA by rheumatology members of the Mexican College of Rheumatology (MCR), and to identify barriers to their application in this population. METHODS: A cross-sectional study was conducted through a survey sent to 577 rheumatologists from Mexico in January 2017. RESULTS: We received completed surveys from 122 individuals, representing 21.14% of the 577 rheumatologists in our registry. Fifty percent responded that they recommended immunization against influenza to 76%-100% of their patients, 36.07% recommended immunization against pneumococcus to 76%-100% of their patients, and 69.67% of the survey responders did not recommend shingles immunization routinely to their patients. CONCLUSIONS: The data collected in this study show there is poor adherence to immunization schedules recommended for the RA population. This data suggests there is misinformation about the effectiveness, safety and optimal timing of immunization in patients with RA in Mexico.

Desempeño del índice de masa corporal para el diagnóstico de obesidad por medio de absorciometría de rayos X de energía dual (DEXA) en pacientes con artritis reumatoide / Value of body mass index in the diagnosis of obesity according to DEXA in well-controlled RA patients

Introducción. La artritis reumatoide (AR) tiene un efecto indirecto en la composición corporal. El índice de masa corporal (IMC) no se considera un predictor válido de la grasa corporal en pacientes con AR. Objetivo. Evaluar el IMC para identificar la obesidad mediante absorciometría dual por rayos X (DEXA) en pacientes con AR bien controlados. Métodos. Estudio observacional, transversal, descriptivo y analítico. Se utilizaron 3 definiciones de obesidad por DEXA:>35% de grasa total, >40% de grasa total y obesidad central>35%. Resultados. Se incluyó a 101 pacientes. Se encontró un IMC de 24kg/m2 para obesidad >35% con una sensibilidad del 90% y una especificidad del 75% (área bajo la curva [AUC] 0,917), un IMC de 25kg/m2 para obesidad >40% con una sensibilidad del 86% y una especificidad del 39% (AUC 0,822) y un IMC de 22kg/m2 para 35% de la grasa central con una sensibilidad de 97% y una especificidad del 84% (AUC 0,951). Conclusión. Existe un subdiagnóstico de obesidad con el uso de los valores de tradicionales de IMC en pacientes con AR bien controlados (AU)

Background. Rheumatoid arthritis (RA) has an indirect effect on body composition. Body mass index (BMI) is not a valid predictor of body fat in RA patients. Objective. To evaluate the accuracy of BMI in identifying obesity diagnosed according to dual energy X-ray absorptiometry (DXA) in well-controlled RA patients. Methods. An observational, cross-sectional, descriptive, analytical study. We used 3 different cutoffs for obesity as determined by DXA: >35% total fat, >40% total fat, and >35% central fat mass (central obesity). Results. One hundred one patients were included. We found that 35% total fat corresponded to a BMI of 24kg/m2, with a sensitivity of 90% and specificity of 75% (area under the curve [AUC] 0.917); 40% total fat to a BMI of 25kg/m2, with a sensitivity of 86% and specificity of 39% (AUC 0.822); and 35% central fat mass to a BMI of 22kg/m2, with a sensitivity of 97% and specificity of 84% (AUC 0.951). Conclusion. Obesity according to DXA was underdiagnosed when the classic BMI cutoffs were used in well-controlled RA patients (AU)

Value of body mass index in the diagnosis of obesity according to DEXA in well-controlled RA patients. / Desempeño del índice de masa corporal para el diagnóstico de obesidad por medio de absorciometría de rayos X de energía dual (DEXA) en pacientes con artritis reumatoide.

BACKGROUND: Rheumatoid arthritis (RA) has an indirect effect on body composition. Body mass index (BMI) is not a valid predictor of body fat in RA patients. OBJECTIVE: To evaluate the accuracy of BMI in identifying obesity diagnosed according to dual energy X-ray absorptiometry (DXA) in well-controlled RA patients. METHODS: An observational, cross-sectional, descriptive, analytical study. We used 3 different cutoffs for obesity as determined by DXA: >35% total fat, >40% total fat, and >35% central fat mass (central obesity). RESULTS: One hundred one patients were included. We found that 35% total fat corresponded to a BMI of 24kg/m2, with a sensitivity of 90% and specificity of 75% (area under the curve [AUC] 0.917); 40% total fat to a BMI of 25kg/m2, with a sensitivity of 86% and specificity of 39% (AUC 0.822); and 35% central fat mass to a BMI of 22kg/m2, with a sensitivity of 97% and specificity of 84% (AUC 0.951). CONCLUSION: Obesity according to DXA was underdiagnosed when the classic BMI cutoffs were used in well-controlled RA patients.

[Rituximab: a new therapeutic alternative in Grave's disease]. / Rituximab: una nueva opción terapéutica en la enfermedad de Graves?

Graves' disease is the most frequent cause of hyperthyroidism, affecting mainly young aged women, with an etiology of autoimmune basis. One of its manifestations, Graves' ophthalmopathy whose pathophysiology is unknown, represents one of the greatest therapeutic challenges in these patients, because they require aggressive treatment with steroids and multiple subsequent reconstructive surgeries in certain cases. It also represents a high burden to the health system. Drugs targeting B cells have been very effective for many autoimmune diseases. Rituximab is a murine humanized monoclonal antibody against CD20 + cells currently being studied in various autoimmune diseases including Graves' disease. The objective of this paper is to expose possible mechanisms by which rituximab could act in both hyperthyroidism and ophthalmopathy of Graves' disease, as well as the experience with its use acquired so far. The employment of rituximab in recently diagnosed patients or with mild ophthalmopathy is questionable with the evidence available today however, we think that it may have a role in refractory cases or those who have a contraindication for steroid use.