La presente investigación tuvo como propósito central evaluar la insatisfacción por la imagen corporal y su relación con la baja autoestima por la apariencia física en estudiantes de la Facultad de Medicina de La Universidad de Los Andes en Mérida Venezuela. El estudio fue de tipo no experimental correlacional. La muestra estuvo constituida por 189 estudiantes, 27% masculino y 73% femenino, con una edad promedio de 19,58 años ±1,57 (varones 19,81 años ± 1,74 y para las mujeres 20,24 años ± 1,76). Los participantes fueron seleccionados de los cursos del primer año de las carreras de: Medicina, Enfermería y Nutrición, los cuales fueron seleccionados de forma intencional. El instrumento empleado para determinar la Insatisfacción por la Imagen Corporal fue el Body Shape Questionnaire (Cooper y Taylor, 1987). El método de Graffar Modificado fue utilizado para determinar el estrato socioeconómico de los participantes (Méndez y Méndez, 1994). A los datos se les aplicó el análisis descriptivo (frecuencia, porcentajes, media) e inferencial (ANOVA de un solo factor a través del paquete estadístico SPSS versión 9.0). Entre los principales hallazgos en el estudio se pudo determinar una asociación estadísticamente significativa entre la insatisfacción con la imagen corporal, la baja autoestima por la apariencia física con el género χ2 (2, N= 189) = 9,686, p=0,008. A través de ANOVA se pudo determinar que las diferencias en las medias para los niveles de insatisfacción y baja autoestima con la imagen corporal y el género son estadísticamente significativas, F=11,236; p=0,008, F=10,23; p=0,002 respectivamente. Conclusiones: los resultados obtenidos permiten sugerir sobre la relación que existe entre la insatisfacción y la baja autoestima por la apariencia física, existiendo un rechazo por la propia imagen corporal causada por la percepción distorsionada o no de la misma, lo que podría afectar la autoestima por la apariencia física.
BackgroundThe prevalence of late-onset psoriatic arthritis (PsA) is increasing in parallel with the progressive aging of the population. The elderly population presents a greater functional deterioration and a greater number of comorbidities than the young people. With this study we aim to find clinically relevant differences to predict the evolution and prognosis of the disease depending on the onset of the symptoms to carry out a more exhaustive follow-up.ObjectivesTo evaluate the association of the age at onset of PsA symptoms with the characteristics and burden of the disease.MethodsObservational study that includes a subgroup of 231 patients with Psoriatic Arthritis (PsA) from the REGISPONSER study (Registry of Spondyloarthritis of Spanish Rheumatology) and the RESPONDIA study (Ibero-American Registry of Spondyloarthropathies). Patients with less than 10 years of disease duration (since the first symptom) were selected so that the sample was homogeneous. Patients were divided into two groups according to the age of PsA onset (early-onset: ≤40 years old and late-onset: ≥60 years old). The characteristics and burden of the disease were compared using the Student’s t-test/Mann-Whitney U test for quantitative variables or using the chi-square/Fisher test for qualitative variables.Results411 patients were included [early-onset 179 (77.5%); late-onset 52 (22.5%)]. There was a higher percentage of men in the late-onset group compared to the early-onset group [94 (62.3%) vs. 38 (86.4%), p = 0.003]. The diagnostic delay was shorter in those whose onset of the disease was late [1.5 (2.7) vs 4 (7.7), p=0.036], as well as the duration of the disease [2.9 (2.4) vs 4.2 (2.7), p= 0.012]. A lower presence of sacroiliitis was found in patients with late-onset PsA [6 (12.2%) vs 58 (32.6%), p=0.005] as well as enthesitis [5 (9.8%) vs 44 (24.6%), p =0.023]. Regarding the comorbidities, there was a higher frequency of heart disease among patients with late-onset PsA [4 (7.8) vs 0 (0), p=0.000]. No statistically significant differences were found between kidney and lung disease. Regarding the outcome measures, the BASFI score was higher in the late-onset group [3.3 (2.5) vs. 2.2 (2.2), p=0.002]. The late-onset group had a lower FSF12 component [34.6 (8.7) vs. 38.7 (10.5), p = 0.001]. The radiographic indices measured by BASRI showed worse results in those patients with late-onset disease both in the spine [2.9 (3) vs 1.6 (2), p=0.020] and in the total BASRI [3.4 (3 .4) vs 1.9 (2.4), p=0.012].ConclusionOur study suggests that the age of onset of PsA was associated with the different characteristics of the disease. Patients with late-onset PsA were more frequently males, showed worse functionality and more structural damage in comparison with early-onset PsA. Sacroiliitis and enthesitis were found less frequently in the late-onset group. Quality of life, disease activity and treatments taken were not associated significantly with age of onset.Table 1.Description of different characteristics across two groups: early and late onsetEarly-onset N=179 n (%)=77.5Late-onset N=52 n (%)=22.5p-valueSex (male)94 (62.3)38 (86.4)0.003Age (SD)38.7 (9.3)71.3 (7.5)0.000Enthesitis44 (24.6)5 (9.8)0.023Dactilytis36 (20.1)9 (17.6)0.695Sacroiliitis58 (32.6)6 (12.2)0.005Diagnostic Delay, mean (SD)4 (7.7)1.5 (2.7)0.036Disease Duration, mean (SD)4.2 (2.7)2.9 (2.4)0.012Arthritis (lower limbs)118 (65.9)33 (64.7)0.872Arthritis (upper limbs)82 (45.8)31 (60.8)0.059BASDAI, mean (SD)3.9 (2.5)3.8 (2.4)0.932BASFI, mean (SD)2.2 (2.2)3.3 (2.5)0.002ASDAS, mean (SD)2.3 (1.1)2.3 (0.9)0.894FSF12, mean (SD)38.7 (10.5)34.6 (8.7)0.001MSF12, mean (SD)47.7 (10.6)49.3 (9.2)0.341BASRI spine1.6 (2)2.9 (3)0.020BASRI total1.9 (2.4)3.4 (3.4)0.012ESR mm/h, mean (SD)17.2 (14.2)23.9 (19.1)0.005csDMARDs (ever)111 (62.7)31 (63.3)0.943bDMARDs (ever)21 (11.9)3 (6)0.234Disclosure of InterestsNone declared
Background:The presence of cardiovascular disease in psoriatic arthritis (PsA) is of particular concern, as it is considered the leading cause of mortality in PsA. Thus, it is essential to recognize those appropriate therapies that could target this comorbidity, reducing the risk of cardiovascular disease and metabolic alterations.Objectives:To evaluate the efficacy of methotrexate (MTX) and apremilast as monotherapies or in combination, in the clinical manifestations of the disease and the reduction of cardiovascular risk factors in PsA.Methods:Prospective longitudinal study in 30 PsA patients diagnosed according to CASPAR criteria: 10 patients were treated with MTX (12 ± 2,58 mg/week), 10 patients with apremilast (60 mg/day) and 10 were treated with combined therapy for 6 months, recruited in the routine clinical practice at the Reina Sofia Hospital of Cordoba and University Hospital of Jaen, Spain. Clinical and analytical parameters were collected at baseline and after 6 months of treatment: lipid profile (cholesterol, HDL, LDL, TG, ApoA and ApoB), glucose and insulin, body surface area (BSA) affected by psoriasis, number of tender and swollen joints, DAS28, DAPSA, VAS, CRP and ESR.The presence of cardiometabolic risk factors such as metabolic syndrome (MetSyn) was evaluated according to National Cholesterol Education Program (NCEP) adult treatment panel III (ATP III) criteria, meeting 3 of the following characteristics: abdominal obesity (men (>102 cm); women (>88 cm), TG > 150 mg/dL, HDL (men (<40 mg/dL); women (<50 mg/dL), blood pressure > 130/85 mmHg, glucose levels > 110 mg/dL). Insulin resistance (HOMA-IR > 2,5), body mass index (BMI), ApoB/ApoA ratio, atherogenic index (AI) and SCORE (age, gender, cholesterol, HDL, smoking habit and diabetes) were also studied.Results:Apremilast or MTX monotherapies caused a moderate reduction of the clinical inflammatory markers (CRP and ESR) and disease activity (VAS, DAPSA and DAS28) after 6 months of treatment. On the other hand, while apremilast significantly reduced the affected BSA, MTX had no significant effect. All those parameters were more significantly reduced after the combined treatment (MTX+ apremilast).Apremilast monotherapy significantly improved alterations in the lipid profile (reducing cholesterol and LDL levels, ApoB/ApoA ratio and AI), insulin resistance and decreased BMI, thus reducing the number of patients with MetSyn. MTX monotherapy treatment had no positive effect on these parameters. None of the treatments had significant effects on SCORE values.The beneficial effects of apremilast on the lipid profile were mitigated after the combination with MTX. Nevertheless, the number of patients with MetSyn decreased even more after the combined therapy of MTX with apremilast compared to apremilast monotherapy.Conclusion:1) In patients with moderate disease activity, treatment with apremilast monotherapy might have some advantages compared to the MTX monotherapy, since it can decrease the percentage of BSA with psoriasis, the lipid profile alteration, IR and weight, thus improving the cardiovascular risk profile. 2) Combined therapy (MTX+ apremilast) can induce a deeper reduction in the disease activity compared to the monotherapies, maintaining, in turn, the positive effects of apremilast on the cardiovascular risk.Funded by ISCIII (PI17/01316 and RIER RD16/0012/0015) co-funded with FEDER.Disclosure of Interests:Nuria Barbarroja Puerto Grant/research support from: ROCHE and Pfizer., Speakers bureau: ROCHE and Celgene., Iván Arias de la Rosa: None declared, Carmen Torres-Granados: None declared, Maria del Carmen Abalos-Aguilera: None declared, Gómez García Ignacio: None declared, Isabel Añón Oñate: None declared, María José Pérez Galán: None declared, Desiree Ruiz: None declared, Alejandra M. Patiño-Trives: None declared, María Luque-Tévar: None declared, Eduardo Collantes Estevez Grant/research support from: ROCHE and Pfizer, Speakers bureau: ROCHE, Lilly, Bristol and Celgene, Chary Lopez-Pedrera Grant/research support from: ROCHE and Pfizer., Alejandro Escudero Contreras Grant/research support from: ROCHE and Pfizer, Speakers bureau: ROCHE, Lilly, Bristol and Celgene., María Dolores López Montilla Speakers bureau: Celgene
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