Feasibility and efficacy of a multidisciplinary health care programme for patients with knee osteoarthritis.

OBJECTIVES: To examine the feasibility and efficacy of a multidisciplinary health care programme for patients with knee OA. METHODS: A 12-month follow-up care programme for knee OA, based on clinical evidence and expert opinion was implemented in primary care settings. It included recommendations on diagnosis, management and follow-up. Consecutive patients with knee OA and pain were included, classified into mild (21-39 score), moderate (40-69 score), severe disease (70-100 score) in WOMAC pain subscale, and managed according to the programme. Data were recorded using electronic devices or internet at each visit. Primary end points were: OMERACT-OARSI responder criteria; 70% compliance rate of the recommendations. RESULTS: We included 226 patients, 75% women, mean age 63 years, mean disease duration of 2.4 years, 76% reported Kellgren-Lawrence grade 3-4, and were classified as mild: 17%, moderate: 54% and severe disease: 29%. At the end of the study, 78% of patients achieved pain relief of ≥ 20 points in the WOMAC pain subscale, and 80% OMERACT-OARSI response criteria. Almost 90% of physicians followed the recommendations. WOMAC and SF-36 subscales/dimensions improved (p<0.050), 14% remained classified as moderate or severe disease, 85% of patients attended the exercise training course, and more than 80% of patients and professionals were satisfied with the programme. Compared to usual care the programme seems to use fewer resources. CONCLUSIONS: The implementation of multidisciplinary health care programmes could be very effective and viable for the management of knee OA, could increase patients' and health professional's satisfaction, and optimise health care resources use.

El etanercept, hoy / No disponible

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Bone histomorphometry in 22 male patients with normocalciuric idiopathic osteoporosis.

Osteoporosis is associated with increased bone resorption together with a decrease in bone formation. In women, there is an increase of resorption surfaces and in the number of osteoclasts. These changes, however, are not found in males. This purpose of this study was to examine clinical, laboratory, and histomorphometric data in a series of 22 male patients with primary osteoporosis and normocalciuria undergoing transiliac bone biopsy. All of them gave written informed consent for bone biopsy. Automated biochemical profile, urinary calcium excretion, and bone marker assays were performed. Histomorphometric studies were carried out in transiliac bone biopsies obtained with a Bordier-Lepine needle with previous tetracycline labeling. The histomorphometric values of cancellous bone showed significantly lower values of bone volume and values of osteoid surface (OS/BS) and osteoblast surface (Ob.S/BS), and a modest increase in osteoid thickness (O.Th) without changes in the mineralization lag time or eroded surface in patients compared with controls. In cortical bone, there was a low cortical volume (Ct.V/TV) and cortical width (Ct.Wi) in patients compared with controls, without differences in cortical porosity (Po.V/TV). These results suggest that normocalciuric idiopathic osteoporosis in men is characterized by decreased cancellous osteoblasts and bone turnover.

Situación laboral de los reumatólogos formados en España entre 1990 y 1999 / Employment patterns among rheumatologists trained in Spain between 1990 and 1999

Fundamento: Durante los últimos 20 años la reumatología española ha experimentado un importante desarrollo científico y asistencial. Sin embargo, la presencia de reumatólogos en paro ha sido una preocupación constante.Método: En otoño de 2000 la Sociedad Española de Reumatología (SER) realizó un estudio descriptivo transversal de la situación laboral de los reumatólogos españoles, mediante una encuesta dirigida a los jefes de las unidades docentes en que se había formado a los reumatólogos que terminaron su período MIR entre 1990 y 1999.Resultados: Durante los últimos 10 años se formaron 324 reumatólogos, oscilando entre 27 y 37 por año (media, 32,4); Madrid (108), Cataluña (65) y Andalucía (54) formaron al 70 por ciento. La situación laboral de los 324 reumatólogos era: 192 (59,3 por ciento) trabajaban como reumatólogos en el sector público, 51 (15,7 por ciento) en la reumatología privada, 11 (3,4 por ciento) eran becarios, 38 (11,7 por ciento) realizaban un trabajo no reumatológico, 24 (7,4 por ciento) estaban en paro y 8 (2,5 por ciento) en otras situaciones laborales. El 62,5 por ciento (15 de 24) de los reumatólogos en paro y un 63,6 por ciento (7 de 11) de los becarios habían terminado la especialidad en los últimos 2 años.Discusión: Este estudio cuantifica por primera vez la situación laboral de los reumatólogos que terminaron la especialidad en los últimos 10 años. El porcentaje de paro era del 7,4 por ciento, si bien el número de los becarios o los que no trabajaban como reumatólogos fue más elevado. Es recomendable monitorizar estas cifras y valorar la posibilidad de realizar estudios sobre la calidad del trabajo en reumatología. (AU)

Sociedad española de reumatología. Uso de coxibs / Sociedad Española de Reumatología. Use of cyclo-oxygenase-2 inhibitors (coxibis)

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