[Approximation to the cost of pharmacological treatment of rheumatoid arthritis in Spain]. / Aproximación al coste del tratamiento farmacológico en la artritis reumatoide en España.

OBJECTIVE: To study the direct cost derived of utilization of pharmaceutical compounds in the treatment of rheumatoid arthritis(RA). MATERIAL AND METHODS: A prospective study with 150 patients (125 women/25 men) suffered of RA was carry out in Galicia-Spain public hospital. The mean age was 60.2 years, with a mean lengthy of disease of 11.2 years (1-53); the 64.4% come from rural areas. A personal interview was made with a complete registry of all data: demographic, activity score (ESR, Swollen joints), radiological status, functional class (ACR), extrarticular manifestations and co-morbid diseases. Such data was accomplished with all the medications employees with a calculation of monthly or annual cost for the different therapeutic groups and a final total cost. The statistical study was made with Excel's (Microsoft) and the Analysis Tool Pack. RESULTS: The 53% of patients was in functional class I and 52% in radiological stage I or II (Steinbrocker) whereas 16 patients was considered in remission. Non-steroideal ant-inflammatory drugs (NSAID) were used in the 82.7% of patients with a monthly cost of 12.71 [symbol: see text] (1.10-80). Corticosteroids at low doses were used in 90.7% with a monthly cost of 5.17 [symbol: see text] (1.24-33.7). The Disease Modifying Anti-rheumatic Drugs (DMARD) was used in 94% of cases, the most common methotrexate and association of two or more in 21%. The mean monthly cost for a single DMARD was 3.63 [symbol: see text] and for two, 13.75 [symbol: see text]. Gastroprotection and therapy for co-morbid diseases was employee in 80% and 95% of cases, with a monthly cost of 36.9 [symbol: see text] and year cost of 568.6 [symbol: see text], respectively. The study included 23 patients under treatment with anti-TNF therapy with a monthly mean cost of 933.8 [symbol: see text]. For pharmaceuticals exclusively for RA, annual cost was 342.8 [symbol: see text] excluding anti-TNF therapy, but with wide variation (6.4-2.910 [symbol: see text]). If we include all patients with anti-TNF therapy, gastro-protection and co-morbid situations in a calculation, the mean cost was 2.587 [symbol: see text] year. The most important cost was found in patients with 50-70 years-old and existing a good correlation between the final burden and use of medications for co-morbid conditions, gastro-protection, use of anti-TNF, age, lengthy of disease between 5-10 years and number of swollen joints, but not radiological stage. CONCLUSIONS: The economic burden for pharmaceuticals used in RA is very variable depending of some variables, including the proper disease and other related conditions. The most important cost occur in case of use of anti-TNF therapy. In the most frequent conditions, gastro-protection and therapy for co-morbid diseases lead the 62% of total annual burden, followed by the use of DMARD and in a minor load, the NSAIDs and corticosteroids.

Aproximación al coste del tratamientofarmacológico en la artritis reumatoide en España / Approximation to the cost of pharmacological treatment of rheumatoid arthritis in Spain

Objetivo: Estudiar el coste directo derivado de la utilización de fármacos en el tratamiento de la artritis reumatoide (AR) en España. Material y métodos: Un estudio prospectivo de 150 pacientes (125 mujeres/25 varones) con AR se realizó en un hospital público de la Comunidad de Galicia. La edad media fue de 60,2 años, con un tiempo de evolución de la enfermedad de 11,2 años (1-53); el 64,4 por ciento de los pacientes procedía de medio rural. Se realizó entrevista personal con registro completo de todos los datos: demográficos, actividad de la enfermedad (VSG, número de articulaciones inflamadas), estadio radiológico, estadío funcional (ACR), manifestaciones extrarticulares y enfermedades concomitantes, así como el coste mensual o anual y coste total final, según correspondiese. El estudio estadístico se realizó con el paquete Excel (Microsoft) y la herramienta Analisis Tool Pack del mismo. Resultados: El 53 por ciento de los pacientes estaban en clase funcional ACR I y 52 por ciento en estadio radiológico I o II de Steinbrocker. 16 pacientes estaban en remisión. El 82,7 por ciento de los pacientes usaban algún antinflamatorio no esteroideo, con un coste mensual de 12,71€ (1,10-80,1 €); Estaban recibiendo corticoides el 90,7 por ciento, con un coste mensual 5,17 € (1,24-33,7 €).Un 94 por ciento empleaban algún fármaco de acción lenta (FARAL), el más común de ellos, metotrexato y tratamiento combinado con más de un FARAL el 21 por ciento. El coste medio mensual para uso de un solo FARAL, en general MTX, fue de 3,63 €. El uso de combinaciones de 2 de estos fármacos supone 13,75 €/mes. El 80 por ciento de todos los pacientes usaban alguna vez fármacos gastroprotectores con un coste mensual medio de 36,9 y para otras patologías concomitantes recibían tratamiento con algún fármaco a lo largo de un año el 95 por ciento, cuyo coste sumado al de la gastroprotección supone por paciente y año 568,6 €. Se han incluido 23 pacientes que recibían anti-TNF, con un coste mensual medio de 933,8 €. El coste medio anual para una AR en fármacos exclusivos para artritis fue de 342,8 € sin el empleo de anti-TNF, aunque con amplias variaciones (6,47-2910 ). Con la inclusión de fármacos para enfermedades concomitantes, gastroprotección y aquellos que usan anti-TNF, el coste anual por paciente es de 2.587 €. El mayor gasto farmacéutico se produce en edades entre 50 y 70 años. Hemos encontrado una buena correlación entre un mayor coste total y el uso de fármacos para otras enfermedades diferentes de la artritis, el uso de gastroprotección, el uso de anti-TNF, la edad, el grupo de tiempo de evolución de la enfermedad de 5 a 10 años, el número de articulaciones inflamadas, pero no así el estadio radiológico. Conclusiones: La carga económica por consumo de fármacos en la AR es muy variable dependiendo de varias variables que incluyen la propia enfermedad y otras condiciones relacionadas. El mayor coste aparece con el uso de terapia anti-TNF. En los casos más frecuentes, la gastroprotección y la terapia para la comorbilidad suponen el 62 por ciento del gasto total anual, seguido por el uso de FARAL, y en menor medida por antinflamatorios y corticoides (AU)

Objective: To study the direct cost derived of utilization of pharmaceutical compounds in the treatment of rheumatoid arthritis(RA). Material and methods: A prospective study with 150 patients (125 women/25 men) suffered of RA was carry out in Galicia-Spain public hospital. The mean age was 60,2 years , with a mean lengthy of disease of 11,2 years (1-53); the 64,4% come from rural areas. A personal interview was made with a complete registry of all data: demographic, activity score (ESR, Swollen joints), radiological status, functional class (ACR), extrarticular manifestations and co-morbid diseases. Such data was accomplished with all the medications employees with a calculation of monthly or annual cost for the different therapeutic groups and a final total cost. The statistical study was made with Excel´s (Microsoft) and the Analysis Tool Pack. Results: The 53% of patients was in functional class I and 52% in radiological stage I or II (Steinbrocker) whereas 16 patients was considered in remission. Non-steroideal ant-inflammatory drugs (NSAID) were used in the 82.7% of patients with a monthly cost of 12.71 € (1.10-80). Corticosteroids at low doses were used in 90.7% with a monthly cost of 5.17 € (1.24-33.7). The Disease Modifying Anti-rheumatic Drugs (DMARD) was used in 94% of cases, the most common methotrexate and association of two or more in 21%. The mean monthly cost for a single DMARD was 3,63 € and for two, 13.75 €. Gastroprotection and therapy for co-morbid diseases was employee in 80% and 95% of cases, with a monthly cost of 36,9€ and year cost of 568.6 €, respectively. The study included 23 patients under treatment with anti-TNF therapy with a monthly mean cost of 933.8 €. For pharmaceuticals exclusively for RA, annual cost was 342.8 € excluding anti-TNF therapy, but with wide variation (6.4-2.910). If we include all patients with anti-TNF therapy, gastro-protection and co-morbid situations in a calculation, the mean cost was 2,587 year. The most important cost was found in patients with 50-70 years-old and existing a good correlation between the final burden and use of medications for co-morbid conditions, gastro-protection, use of anti-TNF, age, lengthy of disease between 5-10 years and number of swollen joints, but not radiological stage. Conclusions: The economic burden for pharmaceuticals used in RA is very variable depending of some variables, including the proper disease and other related conditions. The most important cost occur in case of use of anti-TNF therapy. In the most frequent conditions, gastro-protection and therapy for co-morbid diseases lead the 62% of total annual burden, followed by the use of DMARD and in a minor load, the NSAIDs and corticosteroids (AU)

Serum interleukin-12, interleukin-15, soluble CD26, and adenosine deaminase in patients with rheumatoid arthritis.

CD26, a transmembrane ectoenzyme, is overexpressed on rheumatoid arthritis (RA) peripheral blood T cells. As it has been recently described that IL-12 and IL-15 upregulate CD26 in vitro, we hypothesized that this CD26 overexpression might be interleukin dependent. The concentrations of IL-12 and IL-15, and soluble CD26 and adenosine deaminase (enzymes related to CD26) were analyzed in the serum of 35 patients with active and inactive RA and of healthy control subjects. IL-12 and IL-15 levels were significantly higher in patients' serum, independently of disease activity, even in patients on steroid therapy, i.e., the present therapies cannot eradicate their origin. Soluble CD26 was significantly reduced and related to the disease activity. In particular, it correlated inversely with the number of swollen joints. Although these data did not support our hypothesis, they support that interleukins not only initiate RA pathology but they can also participate in the maintenance of this immune response.

[Systemic lupus erythematosus with retractile mesenteritis and catastrophic antiphospholipid syndrome]. / Lupus eritematoso sistémico con mesenteritis retráctil y síndrome antifosfolípido catastrófico.

The Antiphospholipid Syndrome coexisting with Lupus has been associated to wide variety of clinical manifestations, mostly linked to focal ischaemia or infarction. Acute multi-organ failure occurring in patients with these autoantibodies is named Catastrophic Antiphospholipid Syndrome because the high mortality. On the other hand, the term Retractile Mesenteritis is applied to the circumstance in which, an chronic inflammatory process with thickening and infiltration of the mesenterium occur, due to ischaemic mechanism, among many other multiple causes. We describe one patient with concomitance of Antiphospholipid Syndrome, evidence of abdominal ischaemia and Retractile Mesenteritis. The patient developed Catastrophic Antiphospholipid Syndrome, probably due to infectious process and, antithrombotic therapy suppression because upper gastrointestinal bleeding, and dead.

A comparison between septic bursitis caused by Staphylococcus aureus and those caused by other organisms.

Septic bursitis is an infection that usually involves olecranon and prepatellar bursae. Staphylococcus aureus is responsible for around 80% of cases. However, information regarding bursitis caused by non-Staphylococcus aureus microorganisms (NSAB) is scant. In this paper we describe the characteristics of NSAB and emphasise differences between these and Staphylococcus aureus bursitis (SAB). A retrospective study of all cases with septic bursitis seen between January 1991 and June 1998 at one university hospital was conducted. Only cases in which bursal fluid culture yielded growth of a microorganism were analysed. A literature review was conducted for completeness. Fifty-seven episodes of septic bursitis in 56 patients were studied: 47 of these were caused by Staphylococcus aureus and 11 by non-Staphylococcus aureus microorganisms. Forty-three SAB patients were male (91%). Mean age at diagnosis was 50 years (range 20-85 years). The presentation of bursitis had a seasonal trend, with a peak in the summer. Twenty-three patients (51%) had occupations involving frequent or sustained pressure on the bursae. Other risk factors were recent trauma in 11 (23%), alcoholism in six (13%), pre-existing bursal disease in five (11%), and chronic obstructive pulmonary disease in four (9%). There were 20 cases of olecranon bursitis (43%), 25 of prepatellar bursitis (53%) and two of first metatarsophalangeal bursitis. Characteristics of patients from the literature review were similar. Eight NSAB patients (73%) were male. Mean age at diagnosis was 46.9 (range 29-83 years). Two patients were plumbers and one a stonemason. Five (45%) had neither putative systemic nor local risk factors. There were five olecranon (45%), five prepatellar (45%), and one external malleolus bursitis. Infection by a mixed flora was common. Unlike SAB, the presentation of cases did not have a seasonal trend. The clinical spectrum of non-Staphylococcus aureus bursitis (NSAB) differs from that of Staphylococcus Aureus bursitis (SAB), and this should be considered in the initial diagnosis of septic bursitis.

Lupus eritematoso sistémico con mesenteritis retráctil y síndrome antifosfolípido catastrófico / Systemic lupus erythematosus with retractil mesente ritis and catasthrophic antiphospholipid syndrome

El Síndrome Antifosfolípido coexistiendo con Lupus se ha asociado a una amplia variedad de manifestaciones clínicas, la mayor parte de éstas, ligadas a la isquemia o el infarto focal. El fracaso agudo multiorgánico que ocurre en los pacientes con estos anticuerpos se ha llamado Síndrome Antifosfolípido Catastrófico por la alta mortalidad. Por otra parte, el término Mesenteritis Retráctil se aplica a aquella circunstancia en la que un proceso inflamatorio crónico con engrosamiento e infiltración del mesenterio abdominal ocurre, debido a un mecanismo isquémico entre varias múltiples causas. Presentamos un paciente en el que existió la concomitancia de Síndrome Antifosfolípido, isquemia de órganos abdominales y Mesenteritis Retráctil. El paciente desarrolló un síndrome antifosfolípido catastrófico, probablemente secundario a un proceso infeccioso, y tras la supresión de la terapia antitrombótica debido a la presencia de una hemorragia digestiva alta, falleciendo. (AU)

Giant cell arteritis limited to the prostate.

We describe a 66-year-old man with giant cell arteritis (GCA) limited to the prostate. His symptoms, which resembled prostatic neoplasia, resolved with systemic steroid therapy. Pathology studies revealed no clinical or histologic data indicating temporal artery involvement. To our knowledge this is the first described case of GCA involving the prostate.

[Hypophosphatemic osteomalacia secondary to a vascular fibrous histiocytoma]. / Osteomalacia hipofosfatémica secundaria a histiocitoma fibroso vascular.

Management of an adult woman with a 3 years untractable low back pain, allowed us to discover the existence of hypophosphatemic osteomalacia, due to a benign mesenchymal tumor (vascular fibrous histiocytoma). The prognosis of this form of osteomalacia, as in the present case, is excellent after total removal of the tumor.