Latitude gradient influences the age of onset in rheumatoid arthritis patients.

The mean age of rheumatoid arthritis (RA) onset is around 50 years as reported in several clinical trials involving Caucasian patients. However, clinical observations suggest that Mexican RA patients' disease is initiated at a younger age. The objective of the study was to assess whether the age of onset of RA is different in Mexican and in Canadian RA patients. Certified rheumatologists from Canada and Mexico directly interviewed consecutive RA patients attending their clinics regarding the date patients first noticed a swollen joint. None of the participant rheumatologists were aware of the primary aim of this exploratory study at the time of the interviews. Data was gathered from 161 Mexican (91% women) and 130 Canadian (77% women) RA patients collected by three rheumatologists in each country. Duration since disease onset was not different within countries (mean 95% confidence interval [CI] for differences -10 to 16 years, p = 0.12 for Canadians, and -6 to 10 years, p = 0.26, for Mexicans). However, there was a significant difference between the two countries. Mexicans patients on average developed RA almost 12 years younger than Canadians (95% CI for difference 9 to 15 years, p < 0.001). Frequency distribution showed that 35.5% of Canadians but only 4% of Mexicans had the onset of the disease after the age of 55 (all p < 0.001). It appears that RA begins at a much younger age in Mexican than Canadian patients. If this were confirmed after controlling for different confounders and biases, it would have important societal, economic, and therapeutic implications.

[Diagnostic value of limited research in patients with irritable bowel syndrome]. / El valor diagnóstico de la investigación limitada en pacientes con síndrome de intestino irritable.

BACKGROUND: It is a common practice in irritable bowel syndrome (IBS) patients, to perform multiple diagnostic tests to rule out organic diseases. However, its usefulness has not yet been evaluated in Mexico. OBJECTIVES: a) To know frequency of an abnormal test; b) to know prevalence of organic diseases, and c) to identify subgroups with high risk of organic disease among IBS patients. METHODS: IBS patients (Rome II) were evaluated by using limited investigation that include: a) complete blood cell count, erytrocyte sedimentation rate, fecal examination for ova and parasites, fecal occult blood test, and serum thyroidstimulating hormone in all patients; b) colonic visualization with colonoscopy, barium enema, and/or flexible sigmoidoscopy in all patients > or = 45 years, and c) left colon and rectum biopsies with diarrhea patients of all ages. Organic disease was diagnosed by compatible signs and symptoms, abnormal test, confirmatory test, and other specialists opinion. RESULTS: Three hundred ten with IBS patients were included (77% women, mean age 41.6 years). One hundred ninety nine had patients at least one abnormal test (64%) and organic disease was diagnosed in 88 subjects (28%). Diarrhea and mixed-habit patients more had organic disease than constipated patients (OR 3.55). No cases of neoplasia were detected. CONCLUSIONS: Among IBS patients in whom limited investigation was performed, 64% of patients had one abnormal test and 28% had an organic disease. Diarrhea and mixed-habit patients have more risk of organic disease than constipated patients.

Association of mortality with disease severity in rheumatoid arthritis, independent of comorbidity.

OBJECTIVE: To measure the extent to which mortality in rheumatoid arthritis (RA) is associated with disease severity, independent of the presence of coexistent diseases (comorbidity). METHODS: We measured disease severity and comorbidity among RA patients attending scheduled appointments at a rheumatology clinic. We used the Duke Severity of Illness Checklist (DUSOI), a clinical judgment-based measure of the severity of disease. We disaggregated the DUSOI into an RA component (RADUSOI), which we used to measure RA disease severity, together with a physician-rated 10-point global RA severity assessment. We measured comorbidity using the non-RA component of the DUSOI (COMDUSOI) and using the Charlson Comorbidity Index. Patients were contacted periodically for up to 6 years, during which we recorded deaths. We estimated the effect of disease severity and comorbidity on mortality using Kaplan-Meier survival curves, Cox proportional hazards models, and logistic regression with receiver operating characteristics (ROC) curve analysis. RESULTS: The sample comprised 779 patients. Followup ranged from 0.1 year to 6.3 years (mean 2.52 years), for an observation period of 2,315 patient-years. Seventy-five patients died (9.6%), for a total mortality of 3.2 per 100 patient-years (95% confidence interval 2.6-4.1). Both disease severity and comorbidity displayed significant bivariate associations with mortality. In multivariate Cox models adjusted for age, sex, and disease duration, the RADUSOI and global RA severity scores were associated with mortality independent of either the COMDUSOI or Charlson Comorbidity scores. The area under the ROC curve for a logistic model on mortality increased from 0.79 with age, sex, and disease duration included, to 0.84 after adding RA severity and comorbidity (P < or = 0.005 for the increase in ROC area). CONCLUSION: RA disease severity is significantly associated with mortality regardless of the presence of comorbid disease. Combined with each patient's age, sex, and disease duration, information on RA severity and comorbidity allows an accurate prediction of mortality among patients with RA.

[Prevalence of Helicobacter pylori infection in patients with reflux esophagitis. A case-control study]. / La prevalencia de infección por Helicobacter pylori en pacientes con esofagitis por reflujo gastroesofágico. Estudio de casos y controles.

BACKGROUND: The association between Helicobacter pylori (Hp) infection and gastroesophageal reflux disease (GERD) has been extensively studied with controversial results. There is not sufficient information on this relationship in populations with high prevalence of Hp infection. OBJECTIVES: a) To know prevalence of Hp infection in patients with reflux esophagitis, b) to compare this prevalence in subjects with reflux esophagitis and without GERD, and c) to study the relationship between infection and the severity of esophagitis. MATERIALS AND METHODS: Patients with digestive symptoms were studied using a questionnaire, upper-gastrointestinal endoscopy, and rapid urease test. Two groups were conformed: cases (subjects with heartburn, acid regurgitations, and erosive esophagitis or Barrett's esophagus), and controls (subjects with epigastric pain, without heartburn, acid regurgitations, or erosive esophagitis). Prevalence of Hp infection, hiatal hernia and peptic ulcer disease was compared in both groups. The relationship between frequency of Hp infection and severity of esophagitis was analyzed. RESULTS: Five hundred eighty three patients were studied (226 cases, 357 controls). Hp infection was detected in 65% of cases and 66% of controls (p = NS). Hiatal hernia was more frequently detected in patients with esophagitis; however, prevalence of peptic ulcer disease was similar in both groups. Proportion of Hp-infected patients was similar regardless of severity of esophagitis (Los Angeles grade A-B, 64%; grade C-D, 69%) and Barrett's esophagus, 63%; p = NS). CONCLUSIONS: Prevalence of Hp infection in patients with reflux esophagitis is 65% and very similar in patients without GERD. No relationship was founded between Hp infection and severity of esophagitis.

[Percutaneous endoscopic gastrostomy. Is it safe to start eating immediately?]. / Gastrostomía endoscópica percutánea. Es seguro iniciar la alimentación inmediatamente?

BACKGROUND: Percutaneous endoscopic gastrostomy (PEG) is a simple procedure with few associated complications. Traditionally, diet can be initiated 24 after the placement of the probe, but there is no information concerning safety with immediate feeding. OBJECTIVE: To compare safety of immediate feeding against late feeding after placement of PEG. MATERIALS AND METHODS: A total of 62 patients referred for placement of a PEG were assigned alternatively to start feeding during the first 30 min after the procedure was finished (group A), or 24 h later (group B). All patients received the same formula and remained hospitalized for three days. During follow-up, data for local infection and mild or severe complications were intentionally sought. RESULTS: Each group was composed of 31 patients; both groups were similar in age, gender, indication for placement of PEG, presence of infections, and use of antibiotics. Two patients of group A and six of group B developed local infections (six vs. 19%, p = NS value). Mild complications were found in three patients of group A and two A of group B (10 vs. 6%, p = NS). Severe complications were found in one patient of group A and two of group B (3 vs. 6%, p = NS). CONCLUSIONS: Immediate feeding after placement of a PEG is a safe practice.

Manifestaciones reumatológicas en pacientes con infección por virus de la inmunodeficiencia humana / Rheumatic manifestations in AIDS

En el presente la infección por virus de la inmunodeficiencia humana (VIH) es considerada como una de las grandes mimetizadoras de otras enfermedades. Un número variable de hallazgos clínicos asociados con esta infección pueden ser descritos como afección autoinmune y/o reumática. Estos incluyen enfermedades del tejido conectivo (linfocitosis infiltrativa difusa, síndrome de Sjögren),síndromes articulares (sépticos, psoriásicos, Reiter), miopatías (por zidovudina, síndrome de desgaste, asociada a VIH, infecciones oportunistas), síndromes vasculíticos (necrotizante sistémica, hipersensibilidad, lesiones angiocéntricas inmuno-proliferativas) y alteración en estudios de laboratorio (anticuerpos anticardiolipina, anticuerpos anticelulares, anticuerpos antinucleares, complejos inmunes circulantes, hipergammaglobulinemia, factor reumatoide). El tratamiento de esta afección incluye terapia antiretroviral, esteroides, antinflamatorios no esteroideos y terapia inmunosupresora. La coexistencia de infección por VIH y enfermedad reumática ofrece nuevos conocimientos acerca de la patogénesis de ambas condiciones.

Supresión adrenal grave en pacientes reumatológicos: análisis de 25 casos consecutivos / Severe adrenal insuficiency in rheumatological patients: analysis of 25 consecutive cases

Los corticoesteroides (CE) son piedra angular en tratamiento del paciente con enfemedades difusas del tejido conjuntivo (EDTC); la supresión o aumento de los requerimientos de estos sin la terapia sustitutiva adecuada, se asocia a incremento en morbimortalidad. Pacientes y métodos. Se incluyeron en el presente análisis pacientes con EDTC, bajo tratamiento con CE, los que fueron suspendidos bruscamente por diversas causas; esto tradujo problema que requirió hospitalización. Resultados. Nuestro estudio incluye 25 pacientes consecutivos con EDTC y suspensión de CE que requirieron de internamiento a través del Servicio de Urgencias. La edad de los pacientes fue de 54 años en promedio (15 a 78). La mayoría fueron del género femenino (68 por ciento), con tiempo de empleo de los CE de 10 meses a 18 años y promedio de 8 años. El 60 por ciento de los pacientes recibían prednisona, 4 por ciento betametasona de depósito, 28 por ciento combinación de indometacina con betametasona y 8 por ciento dexametasona. El 28 por ciento de los pacientes tomaban este tratamiento por prescripción de reumatólogos, 36 por ciento por indicación de médicos generales, 12 por ciento por internistas, 4 por ciento por ortopedistas y 20 por ciento se autoprescribieron los CE. El 48 por ciento suspendió los CE por imposibilidad para la ingesta (vómito), 8 por ciento por falta de medicamento, 20 por ciento por indicación médica al tener el paciente algún proceso infeccioso concomitante, 12 por ciento por cambio de tratamiento y 12 por ciento por indicación médica ignorando que el paciente recibía CE. Todos presentaron taquipnea, mialgias, astenia y adinamia, 92 por ciento fiebre, 92 por ciento artralgias, 88 por ciento hipotensión arterial y 84 por ciento taquicardia. El 84 por ciento se presentó con hipoglucemia, 76 por ciento tuvieron leucocitosis, 56 por ciento hiponatremia y 48 por ciento hiperkaliemia. Un paciente falleció con cuadro concomitante de suboclusión intestinal y otro con neumonía, el que por prescripción de su médico suspendió el CE