No abstract

BackgroundThere is a lack of expertise in rheumatoid arthritis (RA) diagnosis in primary level of Colombian medical centers, leading to misdiagnosis; many times osteoarthritis (OA) and another rheumatic diseases are misdiagnosed as RA which derives in wrong treatment for patients with clinical and health economics implications.ObjectivesThe objective of this study was to describe demographic and clinical characteristics of a cohort of patients derived to a specialized RA center with presumptive RA diagnosis and finally diagnosed as osteoarthritis.MethodsA descriptive, cross sectional study. Were included patients who were referred from primary care centers to a RA specialized center in a 36 month period with presumptive diagnosis of this disease. Each patient was evaluated to confirm or rule-out diagnosis of RA as follows: a rheumatologist fulfilled a complete medical record, including joint counts; it was assessed rheumatoid factor and anti-citrullinated antibodies, and other laboratories depending on each case. Also were made x-rays of hands and feet, and in some cases of persistent doubt about the diagnosis was requested comparative MRI of hands or/and feet. Frequencies and percentages were calculated for the demographic and clinical characteristics of the cohort of patients in which the diagnosis of RA was ruled-out.ResultsOf the 4780 patients evaluated, in 2905 patients (60.7%) diagnosis of RA was confirmed, the remaining 1875 patients (39.3%) had a wrong diagnosis of RA. Of these misdiagnosed patients, 1377 (73.5%) were women, and 498 (26.5%) men, with an average age of 57.6 (±12 years). Between differential diagnosis which were found in this cohort of misdiagnosed patients: osteoarthritis in 1108 patients (50.1%), systemic lupus erythematosus (SLE) in 84 patients (4.5%), Sjögren syndrome in 62 patients (3.3%), spondyloarthropathies in 21 patients (1.1%), gout in 31 patients (1.7%), and (39,3%) other diagnoses in of the remaining population.ConclusionsAlmost half patients with presumptive RA diagnosis in primary care centers in Colombia are misdiagnosed as shown in this large cohort. The most important cofounding diagnosis was osteoarthritis and many patients were receiving DMARDs for treatment. For this reason there is an urgent need of education strategies for primary care physicians and the implementation of centers of excellence in RA, in order to conduct a proper diagnose and avoid clinical and health economics consequences of misdiagnosis.Disclosure of InterestNone declared

No abstract

Introduction:This systematic review is to provide evidence for the guideline for the treatment of interictal psychosis in epilepsy for Kempenhaeghe, a categorical epilepsy treatment center in Heeze, the Netherlands.Objectives:Life-time prevalence of psychosis in patients with epilepsy ranges from 2-7% of which 10-30% interictal.Typical and atypical antipsychotic drugs are widely used to treat.The combination with epilepsy, drug-interaction and the effect of anti-psychotic medication on the seizure threshold are complicating factors.Evidence for the efficacy of pharmacological treatment is lacking.Aim:The research question is: Which antipsychotic medication is effective and safe in the treatment of interictal psychosis?Methods:We searched in: Medline, Embase, Psychinfo and the Cochrane database.Two independent reviewers made a first selection from the titles and abstracts. If necessary the selection was made with the full text version. In case of disagreement, a third reviewer decided.Data extraction:Study, patient, intervention characteristicsQuality assessment:Cohort studies and Case control studies were assessed with the appropriate CASP (Critical Appraisal Skills Program) assessment tools.Results:The search yielded 206 articles. After final selection 6 articles remained. 3 prospective cohort studies, 1 case series and 2 case reports.Conclusions:Anti-psychotic medication can be effective (grade 3)Possibly the dose needed can be lower. (grade 3)Possibly clozapine lowers the seizure threshold. (grade 3)No other anti-psychotics lower the seizure threshold (grade4)No anti-psychotic is especially effective (grade 4)There is no evidence for length of treatment.The review and the guideline will be presented.

Aan de hand van een casus worden persoonlijkheids- en gedragsverandering na epilepsiechirurgie besproken. Verschillende syndromen worden beschreven in relatie tot de operatielocatie. (H)erkenning van deze veranderingen na epilepsiechirurgie gedurende het hele traject wordt aanbevolen en betrokkenheid van een neuropsychiater met ervaring met de gevolgen van hersenletsel wordt voorgesteld.