BackgroundOsteoarthritis is the most common chronic joint disease. In the absence of an effective medical treatment and due to the chronic nature of this condition, an osteoarthritis medical diagnosis may finally result in decreased health-related quality of life. Therefore, the aim of this study was to measure the impact of the osteoarthritis medical labelling on physical and mental health-related quality of life.MethodsSubjects (n = 1132, 58.7% women) were approached as participants of an urban population-based cohort (EPIPorto). Self-reported information on previous diagnosis of knee, hip or hand osteoarthritis was obtained and rheumatologists established knee, hip or hand osteoarthritis clinical diagnosis in symptomatic individuals. Physical and mental dimensions of health-related quality of life were evaluated using the self-administered Medical Outcomes Study: 36-Item Short Form Survey. Crude and adjusted linear regression coefficients (beta) and the corresponding 95% confidence intervals (95% CI) were computed to estimate the associations between being labelled as an osteoarthritis case and health-related quality of life.ResultsRegardless of disease medical labelling, individuals with osteoarthritis scored significantly lower physical health-related quality of life when compared to those without joint disease (kneeunexposed: beta = −5.3, 95% CI: −7.6, −3.1; kneeexposed: beta = −6.0, 95% CI: −8.4, −3.7; hipunexposed: beta = −6.0, 95% CI: −9.8, −2.3; hipexposed: beta = −11.0, 95% CI: −15.6, −6.4; handunexposed: beta = −4.3, 95% CI: −6.5, −2.0; handexposed: beta = −4.3, 95% CI: −6.6, −2.1). The same was not observed regarding mental health-related quality of life. Among subjects with clinically confirmed osteoarthritis, the medical labelling of this joint disease was not significantly associated to health-related quality of life.ConclusionsThe labelling of knee, hip and hand osteoarthritis diagnosis may not add specific benefit to osteoarthritis patients in terms of its capability to improve health-related quality of life.
This work was performed as part of the Portuguese participation in the 3E Initiative 2007-2008, dedicated to the use of methotrexate (MTX) in rheumatic conditions. Three questions raised by Portuguese rheumatologists and considered relevant to clinical practice remained out of the selection of a set of ten key questions formulated to further establish multinational recommendations on the use of MTX in rheumatic diseases. The authors collected and analyzed all the evidence available by using a systematic literature search methodology and selection criteria concerning the following issues in rheumatoid arthritis (RA): (1) the management of MTX after clinical remission; (2) the management of MTX during infections and (3) the screening and treatment of tuberculosis in patients on MTX treatment. A total of 1,862 references were identified, of which 163 were selected for detailed analysis and 12 included in the final review. The evidence was appraised according to the Oxford Centre for Evidence-based Medicine (EBM) levels of evidence. Although with limited evidence, the authors concluded that: (1) extending the interval for MTX therapy may be a valid alternative regimen in a subset of RA patients in clinical remission (EBM level 2b); (2) MTX may be safe during some common infections in RA patients (EBM level 3b/4); (3) screening and treatment of TB in patients on MTX should be similar to the general population (EBM level 4). The evidence available to support clinical decisions in this area is very limited in number and quality. There is a need for further research and while that is unavailable, practical decisions have to rely on experience and expert opinion.
In a previous study, we found that synovial immunopathology differs between Behçet disease (BD) and psoriatic arthritis (PsA). The objective of this study is to describe the macroscopic features of early untreated knee synovitis in BD and PsA. Fourteen consecutive patients with active early knee synovitis (seven BD and seven PsA) undergoing rheumatologic arthroscopy were assessed. The following macroscopic synovial features were evaluated and scored by analyzing the video recordings of each procedure: capillary hyperaemia, morphology of synovitis, vascular pattern, fibrinoid membranes, and topographic distribution of these features. Video-recording of 35 early untreated arthritis patients with different diagnoses were also studied looking for BD-like macroscopic features. Six out of seven BD patients had extensive fibrinoid membranes and large areas of erythematous synovitis without villi or a distinctive vascular pattern, while PsA patients had diffuse erythematous villous synovitis with a tortuous vascular morphology. None of the 35 patients with early untreated arthritis exhibited all the characteristic features of BD synovitis. This exploratory study shows some distinctive features between BD and PsA knee synovitis that confirm macroscopic differences in patients with previously reported immunopathological differences.
Camurati-Engelmann Disease or progressive diaphyseal dysplasia is a rare disease, characterized by limb pain and muscular weakness, and cortical thickening of the diaphyses of long bones. The authors report a case of a male patient with manifestations since his childhood, whose diagnosis was established later on, when he was an adult, with the disease already progressed, and when the same manifestations began in one of his sons. The importance of the differential diagnosis regarding other diseases concurrent with osteosclerotic and/or hyperostotic changes is emphasized here. Description of its evolution along the years is rarely found in the literature.
BackgroundThe evaluation of the quality of medical practice and the implementation of corresponding measures to improve it are crucial steps for the development of Rheumatology in Europe. Herein we describe the implementation of a national program, Rheuma Space, aiming at quality improvement in the field of Rheumatology.ObjectivesTo develop standards for the quality of care accepted by most of the rheumatology services in Portugal.MethodsQuality indicators were obtained through a four-step RAND-modified Delphi methodology. The first step involved a literature search for international benchmarking of quality of care initiatives and indicators, followed by a pre-selection of a initial set of criteria by a task force. The final steps, aiming at defining a smaller set of criteria that could best analyze rheumatology quality of care, encompassed an online Delphi round with all Portuguese rheumatologists and a consensus meeting with a panel of invited experts representing all the Portuguese Rheumatology Departments of the National Health Service.ResultsA total of 412 different indicators were collected throughout the first project phase and the final set of 26 quality indicators was defined, within the three Donabedian dimensions of healthcare quality: nine “structure”, eleven “processes” and seven “outcome” indicators. These criteria cover eleven domains of quality of care: personnel and organizational structure, training and research, facilities, equipment and IT, budgeting and financial resources, access to care, clinical records, patient communication, multidisciplinary management, clinical outcomes, and patient and personnel satisfaction.ConclusionsThe 26 quality indicators set constitutes the basis for a quality management tool, which is now being implemented in all the Portuguese Rheumatology Departments of the National Health Service. Direct surveys derived from the 26 quality indicators are being applied to health professionals and patients allowing to benchmark departments and to identify strengths and weakness for future improvement. This initiative is deemed to improve the process of care for Portuguese rheumatic patients, thereby ensuring quality standards of structure and process criteria, for a patient-oriented clinical practice, favouring desirable continuous quality improvement on health outcomes.AcknowledgementPortuguese Rheumatology participating in the online Delphi and all the participants in the expert consensus meetingDisclosure of InterestNone declared
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