To analyze characteristics of clinical practice guidelines (CPGs) for the management of rheumatoid arthritis (RA) developed in Latin American (LA) countries and to describe the knowledge, use, and barriers for their implementation perceived among LA rheumatologists, a comprehensive literature search including Medline, PubMed, Cochrane Library, LILACS and Scielo was performed. The Appraisal of Guidelines for Research and Evaluation (AGREE) instrument was applied for evaluation. A survey was sent to PANLAR members containing questions related to knowledge about guidelines, application of the recommendations, and difficulties in implementing CPGs. Eight guidelines were identified. Most guidelines were evidence based (62 %), but in only 37 % a systematic literature search was done. None of the guidelines included patients’ views and preferences, and only few of them stated an updating procedure. Funding body independence and disclosure of conflicts of interest were rarely reported. The survey was answered by 214 rheumatologists from all Latin American countries. Most rheumatologist reported knowledge and use of clinical guidelines, mainly international ones. In general, rheumatologist felt that guidelines apply to only a minority of patients seen in daily clinical practice. Limited access expensive drugs, suggested by the guidelines, was the most frequent barrier to guidelines implementation that was reported. A good number of guidelines on the treatment of rheumatoid arthritis have been developed in Latin America. Most of them are lacking some of the components recognized for high-quality clinical guidelines development. In spite that most rheumatologist know and apply guidelines, access to drugs is still a very important barrier to their implementation in Latin America.
Background: Postmenopausal osteoporosis is a multifactorial disease. Genetic factors play an essential role in contributing to bone mineral density (BMD) variability, which ranges from 60 to 85%. Alendronate is used as the first line of pharmacological treatment for osteoporosis; however, some patients do not respond adequately to therapy with alendronate. Aim: The aim of this work was to investigate the influence of combinations of potential risk alleles (genetic profiles) associated with response to anti-osteoporotic treatment in postmenopausal women with primary osteoporosis. Methods: A total of 82 postmenopausal women with primary osteoporosis receiving alendronate (70 mg administered orally per week) for one year were observed. The bone mineral density (BMD; g/cm2) of the femoral neck and lumbar spine was measured. According to BMD change, patients were divided into two groups: responders and non-responders to alendronate therapy. Polymorphic variants in CYP19, ESR1, IL-6, PTHR1, TGFβ, OPG and RANKL genes were determined and profiles were generated from the combination of risk alleles. Results: A total of 56 subjects were responders to alendronate and 26 subjects were non-responders. Carriers of the G-C-G-C profile (constructed from rs700518, rs1800795, rs2073618 and rs3102735) were predisposed to response to alendronate treatment (p = 0.001). Conclusions: Our findings highlight the importance of the identified profiles for the pharmacogenetics of alendronate therapy in osteoporosis.
Background Rheumatoid arthritis (RA) patients have a higher risk for atherosclerosis mainly as a consequence of chronic systemic inflammation, notwithstanding, the implicated pathways have not been completely understood. CD36 is a scavenger receptor relevant for atherogenesis, there are still controversies about its role in this process and there is no clinical information about CD36 and subclinical atherosclerosis in human patients with RA. Objectives To Evaluate the relation between the membrane expression of CD36 in peripheral blood monocyte cells and carotid intima media thickness (cIMT) in patients with RA. Methods We included 37 patients with RA (ACR 1987) attending the rheumatology department of Hospital Civil “Dr. Juan I. Menchaca” Guadalajara, Jalisco, Mexico. The cIMT was assessed by high definition mode B ultrasound and patients were grouped as increased cIMT if >0.6 mm or as no increased cIMT if <0.6 mm. Disease activity was evaluated with the DAS28-cRP. Total cholesterol (TC), triglycerides (Tg), high density lipoprotein cholesterol (HDL-c) and low density lipoprotein cholesterol (LDL-c) were measured. The atherogenic index of plasma (AIP) was calculated. Anti-CCP antibodies, serum IL-6 and TNFa were measured by ELISA. Membrane expression of CD36 was measured by immunofluorescence flow cytometry in PMBC. Data was analyzed with the software WinMDI 2.9 and SPSS v. 22 IBM, Inc. Results Of the studied patients, 24 (65%) had increased cIMT, this group showed higher serum TC (p<0.001), Tg (p=0.006), oxLDL (p<0.001) and AIP (p<0.001) and lower serum HDL-c (p=0.005). Titers of hs-cRP, TNFα, IL-6 and anti-CCP also were higher in the increased cIMT group. Mean fluorescence intensity (MFI) for CD36 was lower in the increased cIMT compared with the no increased cIMT (46.84±40.46 vs. 122.70±34.71, p<0.001). The cIMT was negatively correlated with CD36 MFI. We observed negative correlations between CD36 and TNFa (-0.729, p<0.001) and IL-6 (-0.822, p<0.001). Conclusions Low membrane expression of CD36 is observed in RA patients with subclinical atherosclerosis, Further, studies are needed to validate our findings and clarify the regulation and role CD36 in subclinical atherosclerosis in RA Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.6032
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