How is the ultrasound in rheumatology used, implemented, and applied in Latin American centers? Results from a multicenter study.

This study aimed to perform an overview of how ultrasound (US) is being used, implemented, and applied in rheumatologic centers in Latin America (LA). A retrospective, multicenter 1-year experience study was undertaken. Eighteen centers from eight countries were involved. The following information were collected: demographic data, indication to perform an US examination, physician that required the examination, and the anatomical region required for the examination. A total of 7167 patients underwent an US examination. The request for US examinations came most frequently from their own institution (5981 (83.45 %)) than from external referral (1186 (16.55 %)). The services that more frequently requested an US examination were rheumatology 5154 (71.91 %), followed by orthopedic 1016 (14.18 %), and rehabilitation 375 (5.23 %). The most frequently scanned area was the shoulder in 1908 cases (26.62 %), followed by hand 1754 (24.47 %), knee 1518 (21.18 %), ankle 574 (8.01 %), and wrist 394 (5.50 %). Osteoarthritis was the most common disease assessed (2279 patients (31.8 %)), followed by rheumatoid arthritis (2125 patients (29.65 %)), psoriatic arthritis (869 patients (12.1 %)), painful shoulder syndrome (545 (7.6 %)), connective tissue disorders (systemic sclerosis 339 (4.7 %), polymyositis/dermatomyositis 107 (1.4 %), Sjögren's syndrome 60 (0.8 %), and systemic lupus erythematosus 57 (0.8 %)). US evaluation was more frequently requested for diagnostic purposes (3981 (55.5 %)) compared to follow-up studies (2649 (36.9 %)), research protocols (339 (4.73 %)), and invasive guided procedures (198 (2.76 %)). US registered increasing applications in rheumatology and highlighted its positive impact in daily clinical practice. US increases the accuracy of the musculoskeletal clinical examination, influence the diagnosis, and the disease management.

Infliximab en pacientes con enfermedad ocular inflamatoria, refractarios a DARMES / Infliximab in patients with inflammatory DMARDs-refractory eye disease

Se describe la experiencia con infliximab (anticuerpo monoclonal con una potente acción antiinflamatoria) en el tratamiento de enfermedades oculares inflamatorias secundarias a patologías reumáticas y refractarias a drogas antirreumáticas modificadoras de la enfermedad (DARMES). Se evaluó el caso de una paciente de 50 años con artritis reumatoide (AR) de fondo activo y una paciente de 37 años con vasculitis anticuerpos anticitoplasma de neutrófilos especifico para mieloperoxidasa (ANCA MPO) sin compromiso de órgano noble, ambas con escleritis bilateral y perforación con prolapso de iris del ojo izquierdo. Ellas recibieron infliximab EV en dosis de 3 a 5 mg/kg/dosis, según el esquema, a las 0, 2, 6 y 8 semanas. Infliximab resultó eficaz y seguro para el tratamiento de escleritis asociada a AR y vasculitis ANCA MPO positivo, refractaria a tratamiento con DARMES y corticoides en dosis altas. Los injertos de tejido esclerocorneal evolucionaron favorablemente con infliximab.

Experience with infliximab (monoclonal antibody with strong anti-inflammatory action) for treatment of ocular inflammatory disease secondary to rheumatic diseases and refractory to disease-modifying antirheumatic drugs (DMARDs) is described. We evaluated the cases of a 50 year-old patient with active rheumatoid arthritis (RA) and a 37 year-old patient with myeloperoxidase antineutrophil cytoplasmic vasculitis antibody (MPO ANCA) without noble organ affectation, both with bilateral scleritis and left eye corneal perforation with iris prolapse. They received infliximab 3-5 mg/kg IV at 0, 2, 6, and 8 weeks. Infliximab was effective and safe for treatment of scleritis associated to RA and MPO ANCA positive vasculitis refractory to treatment with both DMARDs and high dose corticosteroids. Corneoscleral tissue grafts developed favorably with infliximab.

Obesity is independently associated with impaired quality of life in patients with rheumatoid arthritis.

Obesity is a modifiable major cause of morbidity and mortality in the general population, but little is known about the association of obesity and quality of life in patients with rheumatoid arthritis (RA). Thus, we set out a study to test the hypothesis that obesity is independently associated with lower quality of life in patients with RA. Three hundred and fifty nine patients with RA underwent an interview, physical exam, and all clinical charts were reviewed. Based on body mass index (BMI), patients were classified as normal (BMI < 25 kg/m(2)), overweight (BMI = 25-29.9 kg/m(2)), and obese (BMI > or = 30 kg/m(2)). Quality of life was quantified with the Medical Outcomes Study Short Form 36 (SF-36). Data obtained included demographic variables, extra-articular disease, comorbidities, presence of X-ray erosions, rheumatoid factor, and depression. The association between obesity and quality of life was examined with the use of multiple lineal regression models. One hundred and seventy-two patients (47.9%) had normal BMI, 126 (35.1%) were overweight, and 61 patients (17%) were obese. Obese patients had lower quality of life (30.8 +/- 18.1) than overweight patients (43.3 +/- 20.1) and patients with normal weight (43.8 +/- 22.2), P < 0.001. The association between obesity and impaired quality of life was confirmed with a linear regression model (Coef = -12.9, P < 0.001) and remained significant after adjustment for age, sex, disease activity, extra-articular disease, comorbidities, X-ray erosions, presence of rheumatoid factor, depression, education, and disease duration (Coef = -5.3, P = 0.039). In conclusion, obesity is independently associated with the impaired quality of life in patients with rheumatoid arthritis.

Pamidronato endovenoso en espondilitis anquilosante refractaria a antiinflamatorios no esteroideos (AINES) y sulfasalazina / Intravenous pamidronate in refractory ankylosing spondylitis

Objetivo: Evaluar la terapia con pamidronato, en pacientes con espondilitis anquilosante (EA) activa, con respuesta subóptima o falla a los antiinflamatorios no-esteroideos (AINES) y sulfasalazina. Diseño: Estudio clínico comparativo. Lugar: Hospital Nacional Edgardo Rebagliati Martins, EsSalud, Lima, Perú. Participantes: Pacientes con espondilitis anquilosante. Intervenciones. Se incluyó 9 pacientes con EA (6 varones), con enfermedad activa (BASDAI mayor igual que 4), actividad axial y falta de respuesta a los Aines y sulfasalazina a dosis de 3g/d. Todos los pacientes recibieron 60 mg de pamidronato mensual, en infusión endovenosa, durante 6 meses, y continuaron tomando AINES y sulfasalazina. La mejoría clínica fue evaluada usando el Asas 20. En forma secundaria se evaluó el ASAS 40, BASDAI 50, BASDAI, BASFI Y BASMI, a las 24 y 48 semanas (32 a 86 semanas). La diferencia entre el índice de pre y postratamiento fue evaluada usando la prueba de Wilcoxon. Principales medidas de resultados: Evaluación del ASAS 20. Resultados. El 67 por ciento alcanzó un Asas 20 a las 24 semanas y 78 por ciento a las 48 semanas; 33,3 por ciento y 55,6 por ciento tuvieron ASAS 40 y 33,3 por ciento; y 44,4 por ciento alcanzó BASDAI 50 a las 24 y 48 semanas, respectivamente. Un paciente recayó a la semana 20. Tres pacientes (33,3 por ciento) permanecieron sin cambios. A las 24 y 48 semanas, la media de BASDAI disminuyó en 45,1 por ciento (p=0,007) y en 52,1 por ciento (p=0,01), la media de BASFI en 38,2 por ciento (p=0,007) y en 52,3 por ciento (p=0,007), y la media de BASMI en 39,2 por ciento (p=0,01) y 39,2 por ciento (p=0,01), respectivamente. Los eventos adversos no fueron importantes con esta terapia. Conclusiones. El tratamiento con pamidronato demostró ser efectivo en este grupo de pacientes con EA, refractaria a AINES y a sulfasalazina.

Objective: To determine the response of an aminobisphosphonate (pamidronate) in patients with ankylosing spondylitis (AS) who had suboptimal or no response to nonsteroidal anti inflammatory drugs (NSAIDs) and sulfasalazine. Design: Comparative clinical study. Setting: Hospital Nacional Edgardo Rebagliati Martins, EsSalud, Lima, Peru. Participants: Patients with ankylosing spondylitis. Intervenciones: Nine patients with AS (6 males), with active disease [BASDAI major 4] and no response to NSAIDs and sulfasalazine up to 3g/day entered the study. All patients received monthly infusions of 60 mg of pamidronate for 6 months and remained taking NSAID and sulfasalazine. Clinical improvement was evaluated using the Assessments in Ankylosing Spondylitis 20 (ASAS 20). Secondary evaluations included ASAS 40, BASDAI 50, BASDAI, BASFI, and BASMI at 24 weeks and at last observation [48 weeks (32 to 86 weeks)]. Differences between pre and post treatment distributions of all continuous indices were evaluated using the Wilcoxon signed rank test. Main outcome measures: Evaluated of ASAS 20. Results: Sixty-seven percent achieved ASAS 20 at 24 weeks and 78 per cent at 48 weeks; 33,3 per cent and 55,6 per cent achieved ASAS 40 at 24 and 48 weeks, respectively, and 33,3 per cent and 44,4 per cent achieved BASDAI 50 at weeks 24 and 48, respectively. One patient relapsed at week 20. In three patients (33,3 per cent) the scores remained unchanged. At weeks 24 and 48 mean BASDAI decreased by 45,1 per cent (p=0,007) and by 52,1 per cent (p=0,01), mean BASFI decreased by 38,2 per cent (p=0,007) and by 52,3 per cent (p=0.007), and mean BASMI decreased by 39,2 per cent (p=0,01) and 39,2 per cent (p=0,01), respectively. There were no significant adverse events with this therapy. Conclusions: Our data provide further evidence of pamidronate therapy effectiveness in patients with AS who are refractory to NSAIDs and sulfasalazine.