La vitamina D no es útil como biomarcador para la actividad de la enfermedad en artritis reumatoide / Vitamin D is not useful as a biomarker for disease activity in rheumatoid arthritis

OBJETIVO: Determinar si existe asociación entre los niveles séricos de vitamina D y el índice de actividad de la enfermedad en pacientes con artritis reumatoide (AR). METODOLOGÍA: Estudio transversal, analítico, retrospectivo realizado en el Hospital Luis Vernaza y el Centro de Reumatología y Rehabilitación. Se incluyó a pacientes entre 18 a 75 años con diagnóstico de AR según los criterios de clasificación 2010 y examen 25-hidroxivitamina D en los últimos 3 meses. La actividad de la enfermedad se evaluó con el 28-joint Desease Activity Score (DAS28) y la proteína C reactiva (PCR) como reactante de fase aguda. Para establecer asociación entre las variables se realizó por el coeficiente de correlación de Spearman. RESULTADOS: Se estudió a un total de 100 pacientes con AR. La media de vitamina D fue de 32,9 ± 11,5ng/ml, el 45% presentó insuficiencia de 25(OH)D y el 55% niveles normales; no se hallaron valores deficientes de vitamina D. De acuerdo con el DAS28-PCR, los pacientes en baja, moderada y alta actividad tuvieron una media de vitamina D de 30,4 ± 10,7, 31,9 ± 10,7 y 31,8 ±12,1 ng/ml, respectivamente. La actividad de la enfermedad y el nivel sérico de vitamina D no se correlacionaron significativamente (p = 0,60). CONCLUSIONES: En nuestro grupo de pacientes con AR no hubo correlación estadísticamente significativa entre los niveles de vitamina D y la actividad de la enfermedad; tampoco se asociaron otras variables determinantes a los niveles de vitamina D

OBJECTIVE: To determine whether there is an association between serum vitamin D levels and the Disease Activity Index in patients with rheumatoid arthritis (RA). METHODOLOGY: An analytical, retrospective, cross-sectional study was performed at the Hospital Luis Vernaza and Center for Rheumatology and Rehabilitation. We included 18 to 75-year-old patients with a diagnosis of RA according to the 2010 classification criteria, and with a 25-hydroxyvitamin D (25 [OH] D) test within the last 3 months. The activity of the disease was assessed with the 28-joint Disease Activity Score (DAS28) and C-reactive protein (CRP) as an acute-phase reactant. Spearman's rank correlation coefficient was used to establish association between the variables. RESULTS: A total of 100 RA patients were studied. The mean vitamin D levels were 32.9 ± 11.5 ng/mL. In all, 45% showed insufficient 25 (OH) D and 55% had normal levels; no deficient vitamin D values were found. According to the DAS28-CRP, patients with low, moderate and high activity had an average vitamin D level of 30.4 ± 10.7, 31.9 ± 10.7, and 31.8 ± 12.1 ng/mL, respectively. There were no significant correlations between the disease activity and the serum vitamin D level (P=.60). CONCLUSION: In our group of RA patients, there was no statistically significant correlation between the levels of vitamin D and the activity of the disease, nor were other determining variables associated with vitamin D levels

Vitamin D is not useful as a biomarker for disease activity in rheumatoid arthritis. / La vitamina D no es útil como biomarcador para la actividad de la enfermedad en artritis reumatoide.

OBJECTIVE: To determine whether there is an association between serum vitamin D levels and the Disease Activity Index in patients with rheumatoid arthritis (RA). METHODOLOGY: An analytical, retrospective, cross-sectional study was performed at the Hospital Luis Vernaza and Center for Rheumatology and Rehabilitation. We included 18 to 75-year-old patients with a diagnosis of RA according to the 2010 classification criteria, and with a 25-hydroxyvitamin D (25 [OH] D) test within the last 3 months. The activity of the disease was assessed with the 28-joint Disease Activity Score (DAS28) and C-reactive protein (CRP) as an acute-phase reactant. Spearman's rank correlation coefficient was used to establish association between the variables. RESULTS: A total of 100 RA patients were studied. The mean vitamin D levels were 32.9 ± 11.5 ng/mL. In all, 45% showed insufficient 25 (OH) D and 55% had normal levels; no deficient vitamin D values were found. According to the DAS28-CRP, patients with low, moderate and high activity had an average vitamin D level of 30.4 ± 10.7, 31.9 ± 10.7, and 31.8 ± 12.1 ng/mL, respectively. There were no significant correlations between the disease activity and the serum vitamin D level (P=.60). CONCLUSION: In our group of RA patients, there was no statistically significant correlation between the levels of vitamin D and the activity of the disease, nor were other determining variables associated with vitamin D levels.

Pan-American League of Associations for Rheumatology (PANLAR) capillaroscopy study group consensus for the format and content of the report in capillaroscopy in rheumatology.

OBJECTIVE: The aim of this work was to produce a consensus-based report for capillaroscopy in rheumatology to be used in daily clinical practice. METHODS: A written Delphi questionnaire regarding capillaroscopy report was developed from a literature review and expert consensus. The Delphi questionnaire was sent to an international panel including 25 rheumatologists experts in capillaroscopy, asking them to rate their level of agreement or disagreement with each statement. The exercise consisted of three online rounds and a face-to-face (live meeting) that took place in the PANLAR 2018 congress held in Buenos Aires, Argentina. RESULTS: The participants to the first, second, third, and face-to-face round were 22, 21, 21, and 16 rheumatologists, respectively. Fifty-five items were discussed in the first round, 58 in the second, 22 in the third, and 9 in the face-to-face meeting. At the end of the exercise, 46 recommendations for the capillaroscopy report in rheumatology reached a consensus. CONCLUSION: This is the first consensus-based report in capillaroscopy. It will be useful in daily clinical practice and to address the effort of the standardization in the technique. KEY POINTS: • The current lack of consensus for the capillaroscopy report makes difficult the interpretation of findings as well as follow-up of rheumatic diseases. • This study produced the first international consensus for the format and content of the naifold capillaroscopy report in rheumatology. • The report is an integral part of the capillaroscopy examination and its use in a homogeneous form can help in the correct interpretation of findings in daily practice.

Preferencias de Reumatólogos del Ecuador sobre el tratamiento de la artritis reumatoide

RESUMEN Introducción: los medicamentos para el manejo de la artritis reumatoide (AR), especialmente los biológicos y los aprobados recientemente, están en un proceso de disminuir la invasividad de su vía de administración. La investigación terapéutica avanza cada día en el desarrollo de nuevas fórmulas que se basan en mayor efectividad y seguridad, sin embargo, también se están haciendo esfuerzos en vías de administración menos invasivas y menos requirentes de servicios de salud (autoadministrables) por lo tanto, es necesario conocer la opinión de los especialistas. Objetivo: Determinar las preferencias sobre la vía de administración de medicamentos para el tratamiento de AR por parte de médicos reumatólogos. Metodología: se realizó un estudio de corte transversal en reumatólogos del Ecuador en 2017. La información fue recolectada a través de una encuesta diseñada para esta investigación. Resultados: el 61,5% de los médicos prefieren la vía subcutánea, principalmente la autoadministrada. El 73% de los médicos cree que el paciente está preparado para la autoadministración sin embargo perciben que el nivel educativo puede ser un factor importante en su contra. La mayoría de profesionales basa su preferencia en el confort y seguridad del paciente. Conclusiones: la percepción de los médicos en general se baja en la disminución de la invasividad y el incremento de la seguridad, la percepción de los profesionales sobre las vías autoadministrables se centra en la preparación de los pacientes como una barrera, la vía oral es un objetivo importante y esperable por los profesionales.

ABSTRACT Introduction: Drugs for the management of rheumatoid arthritis (RA), especially the biological and recently approved, are in a process of reducing the invasiveness of its route of administration. Therapeutic research advances every day in the development of new formulas that are based on greater effectiveness and safety, however, efforts are also being made in less invasive administration routes and less demanding of health services (self-administered). Therefore, it is necessary to know the opinion of the specialists. Objective: To determine the preferences on the route of administration of medications for the treatment of RA by rheumatologists. Methodology: A cross-sectional study was carried out in rheumatologists from Ecuador in 2017. The information was collected through a survey designed for this research. Results: The subcutaneous route was preferred by 61.5% of doctors, mainly self-administered. Seventy three percent of doctors believe that the patient is prepared for self-administration, however, they perceive that the educational level can be an important factor against it. Most professionals base their preference on patient comfort and safety. Conclusions: The perception of physicians in general is based on the decrease of invasiveness and the increase of safety. The perception of professionals on self-administered routes is focused on the preparation of patients as a barrier while the oral route is a important and expected objective of the professionals.

Utilidad de la capilaroscopia en esclerodermia / Utility of capilaroscopy in scleroderma

La esclerosis sistémica (SSc) es una enfermedad del tejido conectivo caracterizado por una reactividad autoinmune, disfunción vascular generalizada y fibrosis progresiva de la piel y órganos internos asociado a la producción de anticuerpos específicos. Durante los últimos años, la capilaroscopia ha demostrado ser una herramienta útil, reproducible y confiable para la evaluación inicial del fenómeno de Raynaud y enfermedades del tejido conectivo, en especial de la esclerodermia, siendo esta técnica incluida en los criterios diagnósticos de la esclerodermia, lo que deja en evidencia la utilidad de esta técnica. A su vez la capilaroscopia asume un rol importante en la evaluación del compromiso sistémico, transición de la enfermedad, manejo y predictor de mortalidad de la esclerodermia, aspectos que serán discutidos en esta revisión

REAL-PANLAR Project for the Implementation and Accreditation of Centers of Excellence in Rheumatoid Arthritis Throughout Latin America: A Consensus Position Paper From REAL-PANLAR Group on Improvement of Rheumatoid Arthritis Care in Latin America Establishing Centers of Excellence.

OBJECTIVE: A consensus meeting of representatives of 16 Latin American and Caribbean countries and the REAL-PANLAR group met in the city of Bogota to provide recommendations for improving quality of care of patients with rheumatoid arthritis (RA) in Latin America, defining a minimum standards of care and the concept of center of excellence in RA. METHODS: Twenty-two rheumatologists from 16 Latin American countries with a special interest in quality of care in RA participated in the consensus meeting. Two RA Colombian patients and 2 health care excellence advisors were also invited to the meeting. A RAND-modified Delphi procedure of 5 steps was applied to define categories of centers of excellence. During a 1-day meeting, working groups were created in order to discuss and validate the minimum quality-of-care standards for the 3 proposed types of centers of excellence in RA. Positive votes from at least 60% of the attending leaders were required for the approval of each standard. RESULTS: Twenty-two opinion leaders from the PANLAR countries and the REAL-PANLAR group participated in the discussion and definition of the standards. One hundred percent of the participants agreed with setting up centers of excellence in RA throughout Latin America. Three types of centers of excellence and its criteria were defined, according to indicators of structure, processes, and outcomes: standard, optimal, and model. The standard level should have basic structure and process indicators, the intermediate or optimal level should accomplish more structure and process indicators, and model level should also fulfill outcome indicators and patient experience. CONCLUSIONS: This is the first Latin American effort to standardize and harmonize the treatment provided to RA patients and to establish centers of excellence that would offer to RA patients acceptable clinical results and high levels of safety.