Apart from the common causes of thyrotoxicosis, such as Graves' disease and functioning nodular goiters, there are more than 20 less common causes of elevated free thyroid hormones that produce the symptoms and signs of thyrotoxicosis. This review describes these rarer conditions and includes 14 illustrative patients. Thyrotropin and free thyroxine should be measured and, when the latter is normal, the free triiodothyronine level should be obtained. Measurement of the uptake of 123 I is recommended for most patients.
NEAR results may be optimised by considering the type of population analysed, ITT or PP. Meta-analyses using NEAR as effect size provide new insights into CT results. Last, correcting certain deficits in adverse drug reactions reporting is required in CT risk assessment.
Background:Spondyloarthritis refers to a family of diseases, of which ankylosing spondylitis and non-radiographic axial spondyloarthritis are responsible for axial impairment. Previously, the only treatment available were NSAIDs, which control activity and stop radiological progression, but at the expense of increased adverse effects, such as cardiovascular risk, dyspepsia and chronic renal failure. For the past 2 decades, biological therapy has been available, which means an increase in care costs.Objectives:The objective of this study is to perform a budget impact analysis of biologic therapy.Methods:To do a budget impact analysis from the perspective of the payer, comparing biological therapy with coventional therapy for the treatment of spondyloarthritis. Demographic characterization of the population attended at the Central Military Hospital. Time horizon from 2012 to 2018, taking the activity count according to the hospital’s billing and the prices of the activities of the state body SISMED. Exchange rates at the end of 2018.Results:The patients attended were 117, mostly men (63, 25%), average age 46, 4 years (SD 13), with disease diagnosis time of 9, 8 years (SD 9, 6). In the budget impact analysis, it is observed that 25% of patients were on DMARDs therapy, 22% with NSAIDs and 96% with biologic therapy. The average year/patient cost with NSAIDs alone would be EUR 381, with DMARDs only EUR 9,318 and, if only biological therapy was used, EUR 423. Within the total number of patients, the average annual cost, including the possibility of combining these drugs, amounted to EUR 5,403Conclusion:Including biological therapy in the care of patients with spondyloarthritis can increase up to 24 times the annual cost per patient. This increase is not only due to higher market value, it also relates to the need for more medical procedures and diagnostic follow-up tests.References:[1]Strömbeck, et al. Cost of Illness from the Public Payers’ Perspective in Patients with Ankylosing Spondylitis in Rheumatological Care. J Rheumatol 2010;37;2348-2355.Disclosure of Interests:None declared
Ácido úrico y síndrome metabólico en una población masculina de pilotos de líneas aéreas
A 74 year old woman was found to have elevated serum thyroid-stimulating hormone (TSH) levels and elevated serum thyroid hormone levels, with clinical euthyroidism. There was no evidence of a pitui-
BackgroundAdherence to treatment in rheumatoid arthritis (RA) is influenced by numerous factors. Although patients with RA are aware that compliance is important for disease control, there is evidence that they often drop out the prescribed use of synthetic DMARDs.ObjectivesThe OBSERVAR Study aims to confirm the lack of adherence to synthetic DMARDs in patients with RA and look for the main reasons for dropping out.MethodsBetween July and August 2014, 18 Spanish consultant rheumatologists were asked, using a two-round Delphi process, to determine the degree of agreement with multiple causes of non-compliance. These reasons were selected by a systematic literature search in PubMed and Google Scholar, based on scientific publications. 66 reasons were selected, divided into 3 blocks, related to patients, to healthcare professionals and inherent to the DMARD treatment itself. The degree of agreement with each of these was identified on a scale from 1 to 9 (minimum and maximum agreement). The consistency of these agreements was determined by two criteria: based on the group mean, and based on simultaneous observance of mean and median ≥7, standard deviation and interquartile range ≤1.00, and coefficient of variation ≤0.25.ResultsThere was agreement with most of the statements selected (75.76%) and only one disagreement. Most frequent among the patient-related reasons were insufficient knowledge of the disease and importance of treatment adherence. The main reasons related to healthcare professionals were insufficient follow-up, lack of screening for non-compliant patients and lack of implementation of procedures aimed at improving adherence. With respect to treatment, general aspects were agreed such as the total number of pills or lack of reminder tools. When we applied the criterion of consistency of agreement, three reasons were highlighted (4.5%): not knowing what to do when the patient suffered an adverse event with the DMARD, lack of screening to detect non-compliant patients and lack of implementation of procedures to improve therapeutic compliance.ConclusionsThe lack of strict adherence by patients in the treatment of RA with synthetic DMARDs is relatively common. Most of the reasons given for this have been confirmed in our study. The situation must be improved by: establishing objectives agreed with the patient; teaching them properly about the disease, treatment, expected side effects, the importance of adherence and its consequences; and by trying to identify potentially non-compliant patients early and subsequent continuous monitoring of their adherence.AcknowledgementsRoche Farma SpainDisclosure of InterestNone declared
BackgroundPsoriatic Arthritis (PsA) is a chronic inflammatory musculoeskeletal disease highly associated with Psoriasis (Pso), with a substantial morbidity and disability. (1,2) Initially considered as a type of Rheumatoid arthritis but afterwards was defined as a distinct entity (3). PsA can cause damage to joints which lead patients to great impairment.(4)The estimated prevalence is variable according to the geographical zone, but it has been established in general population between 0,2-1%, meanwhile in Pso patients could be as frequent as 6-42% (5,6). Patients with PsA present pain and stiffness in the affected joints, they even can have axial skeleton compromise, peripheral arthritis, several nail changes, enthesitis and dactylitis (5,6). A delay in diagnosis as much as 6 months is associated with a much lower treatment response, meanwhile early treatment with anti-inflamatory or immune-modulating drugs improves clinical and radiological outcomes (7). There are several useful tools which allow us to establish easily prevalence, incidence or even chronic associations or acute diseases in public healthcare, these tools are known as administrative databases.(8) In the last few years, there has been developed multiple algorithms for the diagnosis of different pathologies using the information gathered from diagnostic codes, pharmacy reports and surgical procedures in order to identify relevant information for example a disease prevalence of an specific population.(9)ObjectivesDetermine the accuracy of the 10th International Classification of diseases (CIE-10) for Psoriatic Arthritis (PsA) diagnosis in the hospital Militar of Bogotá administrative database and to examine the effects of adding specific pharmacy data to CIE 10 on accuracy of PsA diagnosis.MethodsWe drew a random sample of patients from all ambulatory patients who had at least 1 clinic visit to the hospital between January 1 2015 and February 1 2020 who are 18 years or older. Charts of 972 patients were reviewed. The gold standard for PsA diagnosis was chart documentation of PsA diagnosis by a Rheumatologist. The data definitions of PsA diagnosis included presence of CIE-10 alone or various combinations of CIE-10 an the addition of specific pharmacy data to the algorithm. Accuracy of data definitions of PsA was assessed by calculating sensitivity, specificity, positive and negative predictive values, plausibility reasons and area under the receiver operator characteristics curve (ROC). We used Python and R studio software for the database analysis.ResultsFrom the administrative database we had a prevalence of 5.2% patients with PsA, and was determined the diagnosis algorithm using CIE-10 code L40.5 had a correct classification rate by the algorithm of 97.9%, with 84.3% sensitivity CI 95% (71.4-93), and a higher specificity of 99.3% CI 95% (98.7-99,8). Evaluating positive predictive value of the test was 89.6% CI 95% (77.3 -96.5), while the negative predictive value was 99.1% CI 95% (98.3-99.6). In these results the number of false negatives are higher than the number of false positives, when compared with the gold standard (physician diagnosis in clinical chart). Through a statistical analysis we calculate the ROC curve and the area under the curve which was 0.92 CI 95% (0.868-0.969) when used the CIE-10 code L40.5 for PsA diagnosis. Indicating that the test, taking into account the CIE-10 code L40.5, has a very good performance classifying correctly the PsA patients.ConclusionCIE-10 code L40.5 in the administrative database is a very sensitive and specific screening tool for identifying patients with PsA in the general clinic population. This can be used to evaluate large population samples and classified them for public health research using this kind of databases.Disclosure of InterestsNone declared
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