Update of the guidelines for the pharmacological treatment of rheumatoid arthritis by the Mexican College of Rheumatology 2023.

OBJECTIVE: To develop updated guidelines for the pharmacological management of rheumatoid arthritis (RA). METHODS: A group of experts representative of different geographical regions and various medical services catering to the Mexican population with RA was formed. Questions based on Population, Intervention, Comparison, and Outcome (PICO) were developed, deemed clinically relevant. These questions were answered based on the results of a recent systematic literature review (SLR), and the evidence's validity was assessed using the GRADE system, considered a standard for these purposes. Subsequently, the expert group reached consensus on the direction and strength of recommendations through a multi-stage voting process. RESULTS: The updated guidelines for RA treatment stratify various therapeutic options, including different classes of DMARDs (conventional, biologicals, and JAK inhibitors), as well as NSAIDs, glucocorticoids, and analgesics. By consensus, it establishes the use of these in different subpopulations of interest among RA patients and addresses aspects related to vaccination, COVID-19, surgery, pregnancy and lactation, and others. CONCLUSIONS: This update of the Mexican guidelines for the pharmacological treatment of RA provides reference points for evidence-based decision-making, recommending patient participation in joint decision-making to achieve the greatest benefit for our patients. It also establishes recommendations for managing a variety of relevant conditions affecting our patients.

Actualización de las guías para el tratamiento farmacológico de la artritis reumatoide del Colegio Mexicano de Reumatología 2023 / Update of the guidelines for the pharmacological treatment of rheumatoid arthritis by the Mexican College of Rheumatology 2023

Desarrollar guías actualizadas para el manejo farmacológico de la artritis reumatoide (AR). Se conformó un grupo de expertos que fueran representativos de las distintas regiones geográficas y los diferentes servicios médicos que atienden a la población mexicana con AR. Se desarrollaron preguntas basadas en Población, Intervención, Comparación y Desenlace [Outcome] (PICO) que fueron consideradas relevantes desde el punto de vista clínico; las preguntas encontraron su respuesta en los resultados de una revisión sistemática de la literatura (RSL) reciente y la validez de la evidencia fue evaluada mediante el sistema GRADE, considerado un estándar para estos fines. Posteriormente, el grupo de expertos desarrollaró un acuerdo en la dirección y fuerza de las recomendaciones mediante un proceso de votación en distintas etapas. Las guías actualizadas para el tratamiento de la AR categorizan en forma estratificada a las distintas opciones terapéuticas incluyendo las distintas familias de fármacos modificadores de la enfermedad (FARME): convencionales, biológicos e inhibidores de JAK), además de AINE, glucocorticoides y analgésicos. Establece por consenso el uso de todos ellos en distintas subpoblaciones de interés de pacientes con AR, y aborda, además, aspectos relacionados con la vacunación, la COVID-19, la cirugía, el embarazo y la lactancia entre otros. La presente actualización de las guías mexicanas para el tratamiento farmacológico de la AR brinda elementos de referencia en la toma de decisiones basados en la evidencia científica más reciente, y recomienda la participación del paciente para la toma de decisiones conjuntas en la búsqueda del mayor beneficio de nuestros pacientes; establece además, recomendaciones para el manejo de una diversidad de condiciones relevantes que afectan a nuestros pacientes.

Prevalence of Poor Sleep Quality and Associated Factors in Individuals with Rheumatoid Arthritis: A Cross-Sectional Study.

Background and Objectives: Poor sleep quality has been frequently observed in individuals with rheumatoid arthritis. In the present study, we analyzed the presence of poor sleep quality in a sample of Mexican individuals with rheumatoid arthritis; then, we compared sociodemographic and clinical characteristics among patients to determine risk factors for poor sleep quality. Materials and Methods: In this cross-sectional study, we included 102 individuals with rheumatoid arthritis from a hospital in Mexico. We evaluated disease activity (DAS28), quality of sleep using the Pittsburgh Sleep Quality Index, and the presence of depression and anxiety with the Hospital Anxiety and Depression Scale. We performed a Chi-square test and a t-test. Then, we performed a logistic regressions model of the associated features in a univariable analysis. Results: Poor sleep quality was observed in 41.75% of the individuals with rheumatoid arthritis. Being married was a proactive factor (OR 0.04, 95% CI 0.1-0.9, p = 0.04), whereas having one's hips affected or presenting with anxiety and depression was associated with poor sleep quality (OR 4.6, 95% CI 1.2-17.69, p = 0.02). After a multivariate analysis, having anxiety (OR 5.0, 95% CI 1.4-17.7, p < 0.01) and depression (OR 9.2, 95% CI 1.0-8.1, p < 0.01) remained associated with a higher risk of having poor sleep quality. Other clinical characteristics among patients were not significantly different. Conclusions: Our results showed that individuals with rheumatoid arthritis who also presented with depression or anxiety had a higher risk of suffering from poor sleep quality. However, more studies with larger samples are necessary to replicate these results in the Mexican population.

Relación entre las concentraciones de la leptina y la actividad de la enfermedad en pacientes con artritis reumatoide / Relationship between leptin concentrations and disease activity in patients with rheumatoid arthritis

Introducción y objetivo: Múltiples estudios han encontrado una relación directa entre las concentraciones de leptina y la actividad de la enfermedad en artritis reumatoide. Pacientes y métodos: Se estudiaron 77 pacientes con artritis reumatoide, la determinación de la leptina fue a través de inmunoanálisis enzimático. Se evaluó la actividad de la enfermedad mediante el DAS-28 PCR. Se realizó un modelo de regresión logística multivariante para determinar la asociación entre las variables significativas y las concentraciones de leptina. Resultados: El 40,3% de los pacientes estaban en remisión, el 41,6% actividad leve, el 11,7% actividad moderada y el 6,5% actividad grave. Se encontró una relación independiente entre mayores concentraciones de leptina y la actividad de la enfermedad (RR 1,7; IC al 95%: 1,4-3,2; p = 0,03), el número de articulación tumefactas (RR 4,6; IC al 95%: 1,7-8,3; p = 0,000), el número de articulaciones dolorosas (RR 3,4; IC al 95%: 1,6-4,6; p = 0,000) y a presencia de síndrome metabólico (RR 1,3; IC al 95%: 1,2-1,9; p = 0,045). Conclusiones: Los datos obtenidos sugieren que la leptina sérica está elevada en pacientes con AR activa

Background and objective: Multiple studies have found a direct relationship between leptin concentrations and disease activity in rheumatoid arthritis. Patients and methods: We studied 77 patients with the diagnosis of rheumatoid arthritis; the leptin determination was through an enzyme immunoassay. Disease activity was assessed by the DAS-28 CRP. A multivariate logistic regression model was used to determine the association between significant variables and leptin concentrations. Results: 40.3% of the patients were in remission, 41.6% were mildly active, 11.7% were moderately active and 6.5% were severely active. The results show an independent association between higher concentrations of leptin and disease activity (OR 1.7; 95% CI 1.4-3.2; p .03), the number of swollen joints (OR 4.6; 95% CI 1.7-8.3; p .000), the number of painful joints (OR 3.4; 95% CI 1.6-4.6; p .000), and the presence of metabolic syndrome (OR 1.3; 95% IC 1.2-1,9; p .045). Conclusion: The data suggest that serum leptin is elevated in patients with active RA

Relationship between leptin concentrations and disease activity in patients with rheumatoid arthritis. / Relación entre las concentraciones de la leptina y la actividad de la enfermedad en pacientes con artritis reumatoide.

BACKGROUND AND OBJECTIVE: Multiple studies have found a direct relationship between leptin concentrations and disease activity in rheumatoid arthritis. PATIENTS AND METHODS: We studied 77 patients with the diagnosis of rheumatoid arthritis; the leptin determination was through an enzyme immunoassay. Disease activity was assessed by the DAS-28 CRP. A multivariate logistic regression model was used to determine the association between significant variables and leptin concentrations. RESULTS: 40.3% of the patients were in remission, 41.6% were mildly active, 11.7% were moderately active and 6.5% were severely active. The results show an independent association between higher concentrations of leptin and disease activity (OR 1.7; 95% CI 1.4-3.2; p .03), the number of swollen joints (OR 4.6; 95% CI 1.7-8.3; p .000), the number of painful joints (OR 3.4; 95% CI 1.6-4.6; p .000), and the presence of metabolic syndrome (OR 1.3; 95% IC 1.2-1,9; p .045). CONCLUSION: The data suggest that serum leptin is elevated in patients with active RA.

Dislipidemia y riesgo aterogénico en pacientes con lupus eritematoso sistémico / Dyslipidaemia and atherogenic risk in patients with systemic lupus erythematosus

Introducción: La dislipidemia es una comorbilidad frecuente en los pacientes con lupus eritematoso sistémico. Pacientes y métodos: Se incluyeron 51 pacientes. Se registraron variables asociadas a la enfermedad y los fármacos empleados. Se calculó el riesgo aterogénico. Se empleó la prueba de Chi cuadrado para las variables categóricas. Se realizó ANOVA y un modelo de regresión logística para determinar la asociación de las variables con la presencia de dislipidemia. Resultados: El 68,6% presentó dislipidemia. Se encontró diferencia significativa entre la presencia de dislipidemia y el índice de actividad medido por SLEDAI, la presencia de nefropatía lúpica, el uso de prednisona ≥ 20 mg/día, la evolución de la enfermedad < 3 años y entre la ausencia de dislipidemia y el empleo de hidroxicloroquina. SLEDAI ≥ 4 y el uso de prednisona ≥ 20 mg/día se asociaron independientemente con la presencia de dislipidemia. La media del índice de Castelli fue de 5,02, la del de Kannel fue de 2,97 y la de triglicéridos/c-HDL fue de 5,24. Conclusiones: Los pacientes con lupus eritematoso sistémico presentan una gran prevalencia de dislipidemia y un alto índice aterogénico, lo cual aumenta el riesgo cardiovascular (AU)

Introduction: Dyslipidaemia is a common comorbidity in patients with systemic lupus erythematosus. Patients and methods: Fifty-one patients were included. Variables associated with the disease and the drugs used were recorded. Atherogenic risk was calculated. Chi square was used for categorical variables. ANOVA was performed and a logistic regression model to determine the association of the variables with the presence of dyslipidaemia. Results: A percentage of 68.6 had dyslipidaemia. A significant difference between the presence of dyslipidaemia and activity index measured by SLEDAI was found, the presence of lupus nephritis, use of prednisone ≥ 20 mg/day, evolution of the disease < 3 years. Significance between the absence of dyslipidaemia and use of hydroxychloroquine was found. SLEDAI ≥ 4 and the use of prednisone ≥ 20 mg/day were independently associated with the presence of dyslipidaemia. The average of Castelli rate was 5.02, the Kannel index was 2.97 and triglyceride/HDL-C ratio was 5.24. Conclusions: Patients with systemic lupus erythematosus have a high prevalence of dyslipidaemia and a high atherogenic rate, which increases cardiovascular risk significantly (AU)

Dislipidemia y riesgo aterogénico en pacientes con artritis reumatoide / Dyslipidemia and atherogenic risk in patients with rheumatoid arthritis

Introducción: Los pacientes con artritis reumatoide tienen 2 a 3 veces mayor riesgo cardiovascular; se debe en parte al patrón de los lípidos los cuales aumentan el índice aterogénico. Métodos: Se incluyó a 82 pacientes, a quienes se les determinó el perfil lipídico. Se registraron variables asociadas a la enfermedad y los fármacos empleados. Se calculó el riesgo aterogénico. Se empleó la chi al cuadrado para las variables categóricas y la prueba de Mann-Whitney para las continuas. Se realizó ANOVA para determinar relación entre las medias del perfil lipídico y un modelo de regresión logística para determinar la asociación de las variables con la presencia de dislipidemia. Resultados: El 54,9% presentó dislipidemia. Se encontró diferencia significativa entre la presencia de dislipidemia y factor reumatoide positivo (p = 0,005), obesidad (p = 0,007), remisión de la enfermedad (p = 0,037) y PCR mayor or igual a 2 mg/dl (p = 0,024); no se encontró diferencia significativa entre la presencia de dislipidemia y el género, la edad y la evolución de la enfermedad. La obesidad (RR 4,79, IC del 95%, 1,5-5,1; p = 0,008) se asoció independientemente a la presencia de dislipidemia. El uso de hidroxicloroquina (RR 0,31, IC del 95%, 0,1-0,92; p = 0,035) se asoció independientemente a la ausencia de dislipidemia. La media del índice aterogénico de Castellí fue 4,36, la del índice de Kannel fue 2,59 y la del índice triglicéridos/c-HDL fue 3,83. El 61% presentó síndrome metabólico. Conclusiones: Los pacientes con artritis reumatoide presentan un perfil de lípidos proaterogénico; es importante conocerlo y tratarlo para disminuir el riesgo cardiovascular

Introduction: Dyslipidaemia is one of the main risk factors for atherosclerotic cardiovascular disease. Patients with rheumatoid arthritis have 2-3 times more cardiovascular risk, which is partly due to the pattern of lipids which increase the atherogenic index. Methods: A descriptive, cross-sectional, observational and prospective study was conducted on 82 patients, selected for their lipid profile. Variables associated with the disease and the drugs used were recorded. Atherogenic risk was calculated, with Chi square being used for categorical variables, and the Mann-Whitney test for the continuous ones. Results: The dyslipidaemia frequency was 54.9%. The most frequent age range of dyslipidaemia was between 51 and 60 years. Patients with type i obesity had a higher frequency of dyslipidaemia. Less dyslipidaemia was found with a lower rate of disease activity. Patients with cyclic citrullinated anti-peptide antibodies and positive rheumatoid factor, erythrocyte sedimentation rate > 13 mm or CRP > 2 mg/L had a higher frequency of dyslipidaemia. The mean Castelli atherogenic index was 4.36, the index of Kannel was 2.59, and triglycerides/HDL-c ratio was 3.83.Patients with dyslipidaemia showed a higher frequency of positive rheumatoid factor (P=.0008), and those patients who were taking hydroxychloroquine had a lower frequency of dyslipidaemia P=.03. Conclusions: Patients with rheumatoid arthritis have a pro-atherogenic lipid profile. It is important to know this and treat it to reduce cardiovascular risk

[Dyslipidaemia and atherogenic risk in patients with systemic lupus erythematosus]. / Dislipidemia y riesgo aterogénico en pacientes con lupus eritematoso sistémico.

INTRODUCTION: Dyslipidaemia is a common comorbidity in patients with systemic lupus erythematosus. PATIENTS AND METHODS: Fifty-one patients were included. Variables associated with the disease and the drugs used were recorded. Atherogenic risk was calculated. Chi square was used for categorical variables. ANOVA was performed and a logistic regression model to determine the association of the variables with the presence of dyslipidaemia. RESULTS: A percentage of 68.6 had dyslipidaemia. A significant difference between the presence of dyslipidaemia and activity index measured by SLEDAI was found, the presence of lupus nephritis, use of prednisone≥20mg/day, evolution of the disease<3 years. Significance between the absence of dyslipidaemia and use of hydroxychloroquine was found. SLEDAI≥4 and the use of prednisone≥20mg/day were independently associated with the presence of dyslipidaemia. The average of Castelli rate was 5.02, the Kannel index was 2.97 and triglyceride/HDL-C ratio was 5.24. CONCLUSIONS: Patients with systemic lupus erythematosus have a high prevalence of dyslipidaemia and a high atherogenic rate, which increases cardiovascular risk significantly.

[Dyslipidemia and atherogenic risk in patients with rheumatoid arthritis]. / Dislipidemia y riesgo aterogénico en pacientes con artritis reumatoide.

INTRODUCTION: Dyslipidaemia is one of the main risk factors for atherosclerotic cardiovascular disease. Patients with rheumatoid arthritis have 2-3 times more cardiovascular risk, which is partly due to the pattern of lipids which increase the atherogenic index. METHODS: A descriptive, cross-sectional, observational and prospective study was conducted on 82 patients, selected for their lipid profile. Variables associated with the disease and the drugs used were recorded. Atherogenic risk was calculated, with Chi square being used for categorical variables, and the Mann-Whitney test for the continuous ones. RESULTS: The dyslipidaemia frequency was 54.9%. The most frequent age range of dyslipidaemia was between 51 and 60 years. Patients with type i obesity had a higher frequency of dyslipidaemia. Less dyslipidaemia was found with a lower rate of disease activity. Patients with cyclic citrullinated anti-peptide antibodies and positive rheumatoid factor, erythrocyte sedimentation rate>13mm or CRP>2mg/L had a higher frequency of dyslipidaemia. The mean Castelli atherogenic index was 4.36, the index of Kannel was 2.59, and triglycerides/HDL-c ratio was 3.83.Patients with dyslipidaemia showed a higher frequency of positive rheumatoid factor (P=.0008), and those patients who were taking hydroxychloroquine had a lower frequency of dyslipidaemia P=.03. CONCLUSIONS: Patients with rheumatoid arthritis have a pro-atherogenic lipid profile. It is important to know this and treat it to reduce cardiovascular risk.

Mielitis longitudinal asociada a lupus eritematososistémico / Longitudinal myelitis associated with systemic lupus erythematosus

Se presenta el caso de una mujer de 33 anos ˜ de edad con el diagnóstico de mielitis longitudinalsecundaria a lupus eritematoso sistémico. Presentó paraplejía e hipoestesia parasensibilidad térmica y dolorosa a nivel del dermatoma T6, recibió manejo con pulsos demetilprednisolona y ciclofosfamida con respuesta parcial al tratamiento. La mielitis es unaenfermedad inflamatoria que produce una lesión en la médula espinal, la mielitis longitudinalhace referencia a la participación continua de la médula espinal, con implicación de 3o más segmentos medulares contiguos. El tratamiento consiste en dosis altas de glucocorticoidescombinados o no con inmunosupresores o plasmaféresis...

Circulating vascular endothelial growth factor concentrations in a case of pulmonary hypertrophic osteoarthropathy. Correlation with disease activity.

Vascular endothelial growth factor (VEGF) is a cytokine overexpressed in hypoxic and malignant pathologies. VEGF induces vascular hyperplasia, new bone formation, and edema. These histological abnormalities characterize hypertrophic osteoarthropathy. We describe a case of pulmonary hypertrophic osteoarthropathy with high circulating VEGF levels. Removal of the lung tumor led to a dramatic disappearance of the skeletal abnormalities and to reduction of circulating VEGF levels. Histochemical studies of the excised tumor confirmed abnormal VEGF production.