RESUMO
Long-term glucocorticoid (GC) therapy is frequently indicated to treat autoimmune and chronic inflammatory diseases in daily clinical practice. Two of the most devastating untoward effects are bone loss and fractures. Doses as low as 2.5 mg of prednisone for more than 3 months can impair bone integrity. Population at risk is defined based on the dose and duration of GC therapy and should be stratified according to FRAX (Fracture Risk Assessment Tool), major osteoporotic fracture, prior fractures, and bone mineral density values (BMD). General measures include to prescribe the lowest dose of GC to control the underlying disease for the shortest possible time, maintain adequate vitamin D levels and calcium intake, maintain mobility, and prescribe a bone acting agent in patients at high risk of fracture. These agents include oral and intravenous bisphosphonates, denosumab, and teriparatide.
Assuntos
Conservadores da Densidade Óssea , Osteoporose , Fraturas por Osteoporose , Densidade Óssea , Conservadores da Densidade Óssea/efeitos adversos , Glucocorticoides/efeitos adversos , Humanos , Osteoporose/induzido quimicamente , Osteoporose/tratamento farmacológico , Fraturas por Osteoporose/induzido quimicamente , Fraturas por Osteoporose/prevenção & controleRESUMO
OBJECTIVE: To define whether Amerindian genetic ancestry correlates with clinical and therapeutic variables in admixed individuals with rheumatoid arthritis (RA) from Latin America. METHODS: Patients with RA (n = 1347) and healthy controls (n = 1012) from Argentina, Mexico, Chile, and Peru were included. Samples were genotyped for the Immunochip v1 using the Illumina platform. Clinical data were obtained through interviews or the clinical history. RESULTS: Percentage of Amerindian ancestry was comparable between cases and controls. Morning stiffness (p < 0.0001, OR 0.05), rheumatoid factor (RF; p < 0.0001, OR 0.22), radiographic changes (p < 0.0001, OR 0.05), and higher number of criteria were associated with lower Amerindian ancestry after Bonferroni correction. Higher Amerindian ancestry correlated only with weight loss (pBonferroni < 0.0001, OR 2.85). Increased Amerindian ancestry correlated with higher doses of azathioprine (p < 0.0001, OR 163.6) and sulfasalazine (p < 0.0001, OR 48.6), and inversely with methotrexate (p = 0.001, OR 0.35), leflunomide (p = 0.001, OR 0.16), and nonsteroidal antiinflammatory drugs (pBonferroni = 0.001, OR 0.37). Only the presence of RF and weight loss were modified after confounders adjustment. CONCLUSION: Amerindian ancestry protects against most major clinical criteria of RA, but regarding the association of RF with increased European ancestry, age, sex, and smoking are modifiers. Ancestry also correlates with the therapeutic profiles.
Assuntos
Anti-Inflamatórios não Esteroides/uso terapêutico , Antirreumáticos/uso terapêutico , Artrite Reumatoide/genética , Genótipo , Fator Reumatoide/genética , Adulto , Fatores Etários , Idoso , Alelos , Argentina , Artrite Reumatoide/diagnóstico por imagem , Artrite Reumatoide/tratamento farmacológico , Chile , Feminino , Humanos , Indígenas Norte-Americanos , Indígenas Sul-Americanos , Isoxazóis/uso terapêutico , Leflunomida , Masculino , Metotrexato/uso terapêutico , México , Pessoa de Meia-Idade , Peru , Radiografia , Fatores Sexuais , Sulfassalazina/uso terapêuticoRESUMO
La osteoporosis es una enfermedad en constante crecimiento y que afecta a más de 200 millones de personas a nivel mundial. Nuestras recomendaciones son guías para el diagnóstico, la prevención y tratamiento, pero no normas para las decisiones clínicas en casos individuales. El médico debe adaptarlas a situaciones en la práctica clínica cotidiana, incorporando factores personales que trascienden los límites de estas guías y hacen al saber y al arte de la práctica médica. Como todo conocimiento científico, deben ser actualizadas periódicamente a medida que se adquieran nuevas, mejores y más efectivas herramientas diagnósticas y terapéuticas. (AU)
Osteoporosis is an evolving disease which affects over 200 million people worldwide. Our recommendations are guidelines for its diagnosis, prevention and treatment, but they do not constitute standards for clinical decisions in individual cases. The physician must adapt them to individual special situations, incorporating personal factors that transcend the limits of these guidelines and are dependent on the knowledge and art of the practice of Medicine. These guidelines should be reviewed and updated periodically as new, better and more effective diagnostic and therapeutic tools become available. (AU)
Assuntos
Humanos , Osteoporose/prevenção & controle , Guias de Prática Clínica como Assunto , Osteoporose/diagnóstico , Osteoporose/tratamento farmacológico , Padrões de Prática Médica/tendências , Conservadores da Densidade Óssea/uso terapêutico , Tomada de Decisão ClínicaRESUMO
Osteoporosis is an evolving disease which affects over 200 million people worldwide. Our recommendations are guidelines for its diagnosis, prevention and treatment, but they do not constitute standards for clinical decisions in individual cases. The physician must adapt them to individual special situations, incorporating personal factors that transcend the limits of these guidelines and are dependent on the knowledge and art of the practice of Medicine. These guidelines should be reviewed and updated periodically as new, better and more effective diagnostic and therapeutic tools become available.
Assuntos
Fraturas Ósseas/etiologia , Osteoporose , Argentina , Conservadores da Densidade Óssea/uso terapêutico , Fraturas Ósseas/prevenção & controle , Humanos , Osteoporose/diagnóstico , Osteoporose/tratamento farmacológico , Osteoporose/prevenção & controle , Fatores de RiscoRESUMO
La osteoporosis es una enfermedad en constante crecimiento y que afecta a más de 200 millones de personas en todo el mundo. Nuestras recomendaciones son guías para el diagnóstico, la prevención y tratamiento, pero no normas para las decisiones clínicas en casos individuales. El médico debe adaptarlas a situaciones en la práctica clínica cotidiana, incorporando factores personales que trascienden los límites de estas guías y hacen al saber y al arte de la práctica médica. Como todo conocimiento científico, deben ser actualizadas periódicamente a medida que se adquieran nuevas, mejores y más efectivas herramientas diagnósticas y terapéuticas.
Osteoporosis is an evolving disease which affects over 200 million people worldwide. Our recommendations are guidelines for its diagnosis, prevention and treatment, but they do not constitute standards for clinical decisions in individual cases. The physician must adapt them to individual special situations, incorporating personal factors that transcend the limits of these guidelines and are dependent on the knowledge and art of the practice of Medicine. These guidelines should be reviewed and updated periodically as new, better and more effective diagnostic and therapeutic tools become available.
Assuntos
Humanos , Osteoporose/diagnóstico , Osteoporose/prevenção & controle , Osteoporose/tratamento farmacológico , Fraturas Ósseas/etiologia , Argentina , Fatores de Risco , Fraturas Ósseas/prevenção & controle , Conservadores da Densidade Óssea/uso terapêuticoRESUMO
OBJECTIVE: To assess the transcultural equivalency of the Spanish version of the Fibromyalgia Rapid Screening Tool (FiRST) and its discriminatory ability in different Latin American samples. DESIGN: Validation study. SETTING: Departments of Rheumatology in general hospitals and private centers; fibromyalgia unit in a university hospital. SUBJECTS: 350 chronic pain patients from Spain, Argentina, Mexico, Peru, and Ecuador. METHODS: The cultural relevance of the Spanish version of the FiRST was evaluated. The ability of the FiRST as a screening tool for fibromyalgia was assessed by logistic regression analysis. To determine the degree to which potential confounders, such as differences in demographics, pain, affective distress, catastrophizing, and disability, might affect the discriminatory ability, the tool was reassessed by hierarchical multivariate logistic regression. RESULTS: Slightly different versions of the FiRST were recommended for use in each Latin American subsample. The FiRST showed acceptable criterion validity and was able to discriminate between fibromyalgia and non-fibromyalgia patients even after controlling for the effect of potential confounders. However, low specificities were observed in samples from Spain and Mexico. CONCLUSIONS: The Spanish version of the FiRST may be used as a screening tool for fibromyalgia in several Latin American subsamples, even in those patients with high scores on potential confounders. In Spain and Mexico, the low specificity of the FiRST suggests, however, that it would be best used to support a suspected diagnosis of fibromyalgia, rather than to exclude the diagnosis.
Assuntos
Comparação Transcultural , Fibromialgia/diagnóstico , Fibromialgia/etnologia , Internacionalidade , Medição da Dor/normas , Inquéritos e Questionários/normas , Adulto , Idoso , Argentina/etnologia , Equador/etnologia , Humanos , México/etnologia , Pessoa de Meia-Idade , Medição da Dor/métodos , Peru/etnologia , Reprodutibilidade dos Testes , Espanha/etnologiaRESUMO
Osteoporosis is a constantly growing disease which affects over 200 million people worldwide. The present recommendations are guidelines for its diagnosis, prevention and treatment, but they do not constitute standards for clinical decisions in individual patients. The physician must adapt them to individual patients and special situations, incorporating personal factors that transcend the limits of these guidelines and are dependent on the knowledge and art of the physician. These guidelines should be reviewed and updated periodically as new, better and more effective diagnostic and therapeutic tools become available.
Assuntos
Osteoporose/diagnóstico , Osteoporose/terapia , Argentina , Conservadores da Densidade Óssea/uso terapêutico , Fatores de Risco , Fraturas Ósseas/prevenção & controle , Humanos , Osteoporose/prevenção & controle , Vitamina D/administração & dosagemRESUMO
Osteoporosis is a constantly growing disease which affects over 200 million people worldwide. The present recommendations are guidelines for its diagnosis, prevention and treatment, but they do not constitute standards for clinical decisions in individual patients. The physician must adapt them to individual patients and special situations, incorporating personal factors that transcend the limits of these guidelines and are dependent on the knowledge and art of the physician. These guidelines should be reviewed and updated periodically as new, better and more effective diagnostic and therapeutic tools become available.
Assuntos
Osteoporose/diagnóstico , Osteoporose/terapia , Argentina , Conservadores da Densidade Óssea/uso terapêutico , Fraturas Ósseas/prevenção & controle , Humanos , Osteoporose/prevenção & controle , Fatores de Risco , Vitamina D/administração & dosagemRESUMO
Osteoporosis is a constantly growing disease which affects over 200 million people worldwide. The present recommendations are guidelines for its diagnosis, prevention and treatment, but they do not constitute standards for clinical decisions in individual patients. The physician must adapt them to individual patients and special situations, incorporating personal factors that transcend the limits of these guidelines and are dependent on the knowledge and art of the physician. These guidelines should be reviewed and updated periodically as new, better and more effective diagnostic and therapeutic tools become available.
Assuntos
Osteoporose/diagnóstico , Osteoporose/terapia , Argentina , Conservadores da Densidade Óssea/uso terapêutico , Fraturas Ósseas/prevenção & controle , Humanos , Osteoporose/prevenção & controle , Fatores de Risco , Vitamina D/administração & dosagemRESUMO
OBJECTIVE: The objective of this study was to assess the prevalence of rheumatoid arthritis (RA) in the population of a city of 70,000 inhabitants located in Buenos Aires, Argentina. METHODS: Based on the hypothesis that RA is an underdiagnosed disease in Argentina, a capture-recapture method was applied. A local registry of RA patients of Luján City was taken as the primary source; a telephone survey was specifically carried out as a secondary source of information. Patients suspected of having RA were referred to a local hospital to be examined by a team of 12 rheumatologists. Anamnesis and physical examination were followed by hand and foot radiography and erythrocyte sedimentation rate and rheumatoid factor measurements. RESULTS: According to the American College of Rheumatology criteria, a prevalence rate of 0.94% (95% confidence interval [CI], 0.86%-1.02%) was found in the surveyed population; in agreement with other studies, this prevalence was higher in women when compared with men (for female, 1.54% [95% CI, 1.40%-1.69%]; for male, 0.40% [95% CI, 0.32%-0.49%]). CONCLUSION: The prevalence of RA in a representative sample of the population of a city from the central region of Argentina seems to be close to 1%.
Assuntos
Artrite Reumatoide/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Argentina/epidemiologia , Artrite Reumatoide/diagnóstico , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Sistema de Registros , Distribuição por Sexo , Saúde da População Urbana , Adulto JovemRESUMO
The efficacy of new pharmacological agents for the prevention of osteoporotic fractures and the clinical decision to intervene with that purpose in daily medical practice have been guided by the evaluation of bone mineral density (BMD). However, given the multifactorial nature of the proposed endpoint, a new calculator has been proposed: Fracture Risk Assessment Tool FRAX, which follows the same objectives of previous models, but integrates and combines several of those factors according to their relative weight. It can estimate absolute risk of hip fracture (or a combination of osteoporotic fractures) for the following 10 years. The calculator could be adapted for use in any country by the incorporation of hip fracture incidence and age- and sex-adjusted life expectancy in the same country. This instrument has been presented as a new paradigm to assist in clinical and therapeutic decision-making. In the present review some of its characteristics are discussed, such as: the purported applicability to different populations, the convenience of using 10-year absolute fracture risk for the whole age range under consideration, and whether the efficacy of pharmacological treatment for the prevention of bone fractures in osteoporotic patients can be expected to be equally effective among patients selected for treatment on the basis of this model. Finally, we would like to call attention to the fact that risk thresholds for intervention are not yet clearly defined; those thresholds can obviously be expected to have a profound impact on the number of patients amenable to treatment.
Assuntos
Fraturas Ósseas/etiologia , Osteoporose/complicações , Medição de Risco/métodos , Absorciometria de Fóton , Densidade Óssea , Feminino , Fraturas Ósseas/prevenção & controle , Humanos , Masculino , Valor Preditivo dos TestesRESUMO
La eficacia de nuevos agentes farmacológicos para la prevención de fracturas osteoporóticas y la decisión de intervención con la misma finalidad en la práctica clínica han sido guiadas por la evaluación de la densitometría ósea (DMO). Sin embargo, reconociendo la naturaleza multifactorial de ese desenlace, recientemente se dio a conocer el calculador Fracture Risk Assessment Tool (FRAX) que persiguiendo los mismos objetivos de modelos previos, integra y combina varios de esos factores ponderadamente para estimar el riesgo absoluto de fractura de cadera o un combinado de fracturas osteoporóticas para los siguientes 10 años. El mismo sería ajustable a cualquier país incorporando al modelo la incidencia de fractura de cadera y las expectativas de vida edad- y sexo-específicas para la población a que pertenece el individuo. Este instrumento es presentado como un nuevo paradigma para ayudar en la toma de decisiones terapéuticas, especialmente farmacológicas. En la presente revisión se discuten algunas de sus características, como ser: la pretendida aplicabilidad a poblaciones de distintos países, la conveniencia de utilizar el riesgo absoluto a 10 años para todo el espectro etario de interés y si la eficacia de los tratamientos farmacológicos para la prevención de fracturas óseas en pacientes osteoporóticos podrá comprobarse también en pacientes seleccionados para tratamiento en base a este modelo. Finalmente, se llama la atención sobre el hecho de que aún no están claramente determinados los umbrales de riesgo orientadores para la toma de decisiones, los que obviamente tendrán un relevante impacto en el número de pacientes pasibles de tratamiento.
The efficacy of new pharmacological agents for the prevention of osteoporotic fractures and the clinical decision to intervene with that purpose in daily medical practice have been guided by the evaluation of bone mineral density (BMD). However, given the multifactorial nature of the proposed endpoint, a new calculator has been proposed: Fracture Risk Assessment Tool FRAX TM, which follows the same objectives of previous models, but integrates and combines several of those factors according to their relative weight. It can estimate absolute risk of hip fracture (or a combination of osteoporotic fractures) for the following 10 years. The calculator could be adapted for use in any country by the incorporation of hip fracture incidence and age- and sex-adjusted life expectancy in the same country. This instrument has been presented as a new paradigm to assist in clinical and therapeutic decision-making. In the present review some of its characteristics are discussed, such as: the purported applicability to different populations, the convenience of using 10-year absolute fracture risk for the whole age range under consideration, and whether the efficacy of pharmacological treatment for the prevention of bone fractures in osteoporotic patients can be expected to be equally effective among patients selected for treatment on the basis of this model. Finally, we would like to call attention to the fact that risk thresholds for intervention are not yet clearly defined; those thresholds can obviously be expected to have a profound impact on the number of patients amenable to treatment.
Assuntos
Feminino , Humanos , Masculino , Fraturas Ósseas/etiologia , Osteoporose/complicações , Medição de Risco/métodos , Absorciometria de Fóton , Densidade Óssea , Fraturas Ósseas/prevenção & controle , Valor Preditivo dos TestesRESUMO
Los síndromes de superposición son un conjunto de entidades clínicas que presentan aspectos de varias enfermedades del tejido conectivo en forma simultánea o sucesiva. La presencia de anticuerpos contra una ribonucleoproteína nuclear [nRNP] ha sido señalada por algunos autores como característica de un subgrupo particular dentro del vasto espectro de los síndromes de superposición y que denominaron Enfermedad Mixta del Tejido Conectivo. Con el objeto de determinar si la presencia de anticuerpos anti nRNP identifica a este particular subgrupo dentro de los síndromes de superposición se analizaron las características clínicas, serológicas y el curso evolutivo de 27 pacientes seguidos en nuestro servicio. Dichos pacientes fueron seleccionados por presentar manifestaciones clínicas de dos o más enfermedades del tejido conectivo independientemente de la existencia de anticuerpos anti nRNP y 10 no lo presentaban. Las diversas manifestaciones clínicas y la frecuencia de su presentación se observaron por igual en los pacientes con y sin anticuerpos anti nRNP, y sus características clínicas, fueron similares a las ya observadas por otros autores. Nuestros resultados apoyan la hipótesis de que el anticuerpo anti nRNP no identifica a una entidad o cuadro clínico particular, ya que los pacientes con un síndrome de superposición presentaron cuadros clínicos similares independientemente de la presencia o ausencia de anticuerpos anti nRNP. En nuestra opinión, la enfermedad mixta de tejido conectivo es un síndrome que no puede ser individualizado clínicamente dentro de los síndromes de superposición.
Assuntos
Doenças do Tecido ConjuntivoRESUMO
Los síndromes de superposición son un conjunto de entidades clínicas que presentan aspectos de varias enfermedades del tejido conectivo en forma simultánea o sucesiva. La presencia de anticuerpos contra una ribonucleoproteína nuclear [nRNP] ha sido señalada por algunos autores como característica de un subgrupo particular dentro del vasto espectro de los síndromes de superposición y que denominaron Enfermedad Mixta del Tejido Conectivo. Con el objeto de determinar si la presencia de anticuerpos anti nRNP identifica a este particular subgrupo dentro de los síndromes de superposición se analizaron las características clínicas, serológicas y el curso evolutivo de 27 pacientes seguidos en nuestro servicio. Dichos pacientes fueron seleccionados por presentar manifestaciones clínicas de dos o más enfermedades del tejido conectivo independientemente de la existencia de anticuerpos anti nRNP y 10 no lo presentaban. Las diversas manifestaciones clínicas y la frecuencia de su presentación se observaron por igual en los pacientes con y sin anticuerpos anti nRNP, y sus características clínicas, fueron similares a las ya observadas por otros autores. Nuestros resultados apoyan la hipótesis de que el anticuerpo anti nRNP no identifica a una entidad o cuadro clínico particular, ya que los pacientes con un síndrome de superposición presentaron cuadros clínicos similares independientemente de la presencia o ausencia de anticuerpos anti nRNP. En nuestra opinión, la enfermedad mixta de tejido conectivo es un síndrome que no puede ser individualizado clínicamente dentro de los síndromes de superposición. (AU)