La brujería en el Sur de Francia y el Norte de España durante los siglos XVI y XVII.

El trabajo presentado pretende dar una visión del fenómeno de la brujería en los siglos XVI y XVII, centrándose en la región colindante a los Pirineos como foco más concreto de estudio dada la amplitud del tema. Durante el desarrollo del mismo se tratan diferentes aspectos del personaje de la bruja, sus actos, poderes, reuniones y la concepción de la misma desde diferentes ópticas y estudios. Más adelante, se analiza la "brujomanía" o fiebre de la caza de brujas intentando esclarecer porqué acontecieron episodios de con esa clase repercusiones o resoluciones así como la metodología empleada en el ámbito judicial. Por último, se exponen y analizan los casos más paradigmáticos de brujería a ambos lados de los Pirineos: Zugarramurdi en Navarra y el País de Labourd en el País Vasco francés

Innovación en las espondiloartropatías: evidencias desde el análisis de género

Antecedentes/Objetivos: Recientes estudios muestran una prevalencia de Espondiloartritis (EA) similar en ambos sexos. Históricamente se consideró una prevalencia mayor en hombres (H), contribuyendo al sub-diagnóstico o detección tardía en mujeres (M). Objetivo: determinar la evidencia y la calidad de los estudios sobre retraso diagnóstico de las EA en M y las manifestaciones clínicas al inicio y durante su curso, comparado con la EA en H. Métodos: Revisión sistemática en Medline. Ecuación de búsqueda: Spondyloarthropathies AND: sex OR gender OR women OR woman. Criterios inclusión: artículos donde la EA es tema principal, analicen retraso diagnóstico e incluyan M. Criterios exclusión: editorial, revisión, casos, validación cuestionarios, técnicas diagnósticas/quirúrgicas. Revisión por pares: 824 resúmenes. Selección: 43 artículos. Evaluación de su calidad mediante criterios ad hoc basados en Guía STROBE y propuesta de Smith KE, Bambra C y cols en J Public Health (Oxf) 2009;31:210-21. Resultados: Se estudiaron 22.982 pacientes-65% H, con EA axial (H: 11% y M: 8%) y axial y periférica (H: 51% y M: 26%). El retraso diagnóstico desde el comienzo de los síntomas se redujo en H y M con las modificaciones de los criterios diagnósticos, 1983: de 12,8 años en M y 10,3 en H a 2012: 4,8 y 4,6 años respectivamente (9/11 artículos muestran > retraso en M que en H). El HLA-B27 según sexo se muestra en 8 artículos: 50% la prevalencia de HLA-B27 es mayor en M, y en el restante 50% en H. 7 artículos aportan información por sexo sobre dolor lumbar/dorsal o artritis periférica como forma más frecuente del debut de la EA, siendo la frecuencia superior en H que en M en 4 de los7 artículos que comparan ambos sexos, e inversamente 4/7 presentan mayor frecuencia de artritis periférica en M. En su evolución la sintomatología es: dolor lumbar/dorsal (82%M vs 91%H), artritis periférica (46%M vs 40%H), entesitis (48%M vs 33%H), uveítis (37%M vs 16%H). 81% de los estudios presentan calidad suficiente, mejorando después de 1980. Pero, 97% son retrospectivos, 86% de ámbito hospitalario/historias clínicas. 24% sin estrategia de reclutamiento adecuada, y 19% de las muestras no son representativas. 42% Sin grupo control adecuado. 17% no ajusta por factores de confusión, y 48% detalla las limitaciones. Conclusiones: Ni el debut ni la evolución de la EA son iguales por sexo. El riesgo de mayor retraso diagnóstico disminuyó en ambos sexos con el cambio de los criterios diagnósticos de EA, siguiendo más elevado en M. Faltan datos consistentes sobre HLA-B27 por sexo. La calidad de las investigaciones sobre EA ha mejorado pero precisan estudios prospectivos, en atención 1ª, y mejorar los métodos de diseño y análisis

¿Espondiloartropatías atípicas? ¿o simplemente las típicas de las mujeres?

Antecedentes/Objetivos: El desconocimiento de la diferente semiología de las espondiloartropatías (EA) en las mujeres, respecto a su variante en hombres, está en el origen de una menor sospecha diagnóstica y errores diagnósticos en las mujeres; influyendo en la infra-estimación de su prevalencia y desigualdad de género en el acceso al tratamiento. Objetivo: reforzar las diferencias por sexo en los signos/síntomas (S/S) de la EA, la diversidad de errores diagnósticos previos, y el retraso diagnóstico. Métodos: Diseño observacional y análisis de comparación de 2 grupos de pacientes: 96 hombres (H) y 54 mujeres (M) con EA, atendidos durante 1 año (2013-2014) en las consultas de Reumatología del Hospital General Universitario de Alicante. Fuente de información: Cuestionario semi-estructurado e historia clínica (HC) sobre: S/S previos al diagnóstico, retraso diagnóstico e itinerarios sanitarios, y diagnósticos previos alternativos/erróneos. Resultados: Las EA se han confundido con 56 opciones diagnósticas alternativas/erróneas (en un 70,8% de los H y 93,8% de las M). Con los últimos criterios diagnósticos, hay más M: 31,5% que H diagnosticados de EA: 16,7%. El debut de la EA es con 25 síntomas diferentes referidos por los H (11 según HC clínica) y 20 por M (9 en HC), 18 comunes según los referidos por pacientes (7 comunes por HC). Más frecuentes en H: dolor lumbar 25%, de espalda 20,8% y cadera 8,3% vs en M: dolor espalda 22,2%, lumbar 18,5% y pies 14,8%. Los H tardan una media de 14 meses y las M 10, en demandar asistencia sanitaria tras la aparición de los síntomas. Mientras, la media del retraso en la atención médica hasta el diagnóstico de EA es de 7 y 9,75 años en hombres y mujeres, respectivamente; siendo más los especialistas que refieren a los H a Reumatología (n = 14) junto con la atención 1ª, que en las M (n = 8), las cuales son atendidas a petición de ellas (5,6%) y por urgencias 16,7% con > frecuencia que los H (a petición de ellos 1% y por urgencias 6,3%). Conclusiones: No todos los signos y síntomas de las Espondiloatropatías son referidos con la misma frecuencia en uno y otro sexo. Aplicando los nuevos criterios diagnósticos de 2009 se reducen las diferencias por sexo en el diagnóstico de EA. Pero, pese al conocimiento existente, la mímesis de prácticas profesionales diagnósticas obsoletas, como la aplicación de criterios diagnósticos sobrepasados induce a la no sospecha diagnóstica, confusión con diagnósticos erróneos y al retraso en la asistencia sanitaria. Son sesgos de género en el esfuerzo diagnóstico con consecuencias en los itinerarios complejos de los/las pacientes previos al diagnóstico de EA, en el esfuerzo terapéutico y en la prevalencia de las EA, especialmente en mujeres.Instituto Salud Carlos III PI11/00865

Understanding How the Diagnostic Delay of Spondyloarthritis Differs Between Women and Men: A Systematic Review and Metaanalysis

Objective. To identify empirical evidence of diagnostic delay in spondyloarthritis (SpA), determine whether sex-related differences persist, and conduct an analysis from that perspective of the possible causes, including the influence of quality research, in this group of inflammatory rheumatic diseases. Methods. A systematic review was done of delay in diagnosis of SpA in MEDLINE and EMBASE and other sources. Study quality was determined in line with the Strengthening The Reporting of OBservational studies in Epidemiology (STROBE) statement. A metaanalysis of 13 papers reporting sex-disaggregated data was performed to evaluate sex-related differences in diagnostic delay. The global effect of diagnostic delay by sex was calculated using means difference (D) through a fixed effects model. Results. The review included 23,883 patients (32.3% women) from 42 papers. No significant differences between the sexes were detected for symptoms at disease onset or during evolution. However, the mean for delay in diagnosis of SpA showed sex-related differences, being 8.8 years (7.4–10.1) for women and 6.5 (5.6–7.4) for men (p = 0.01). Only 40% of papers had high quality. A metaanalysis included 12,073 participants (31.2% women). The mean global effect was D = 0.6 years (0.31–0.89), indicating that men were diagnosed 0.6 year (7 months) before women. Conclusion. Delay in diagnosis of SpA persists, and is longer in women than in men. There are no significant sex-related differences in symptoms that could explain sex-related differences in diagnostic delay. Methodological and possible publication bias could result in sex-biased medical practice.Supported by FEDER-Instituto de Salud Carlos III, Ministerio de Ciencia e Innovación, Spain (grant PI11/00865)

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ABSTRACT. Objective. To identify empirical evidence of diagnostic delay in spondyloarthritis (SpA), determine whether sex-related differences persist, and conduct an analysis from that perspective of the possible causes, including the influence of quality research, in this group of inflammatory rheumatic diseases. Methods. A systematic review was done of delay in diagnosis of SpA in MEDLINE and EMBASE and other sources. Study quality was determined in line with the Strengthening The Reporting of OBservational studies in Epidemiology (STROBE) statement. A metaanalysis of 13 papers reporting sex-disaggregated data was performed to evaluate sex-related differences in diagnostic delay. The global effect of diagnostic delay by sex was calculated using means difference (D) through a fixed effects model. Results. The review included 23,883 patients (32.3% women) from 42 papers. No significant differences between the sexes were detected for symptoms at disease onset or during evolution. However, the mean for delay in diagnosis of SpA showed sex-related differences, being 8.8 years (7.4-10.1) for women and 6.5 (5.6-7.4) for men (p = 0.01). Only 40% of papers had high quality. A metaanalysis included 12,073 participants (31.2% women). The mean global effect was D = 0.6 years (0.31-0.89), indicating that men were diagnosed 0.6 year (7 months) before women. Conclusion. Delay in diagnosis of SpA persists, and is longer in women than in men. There are no significant sex-related differences in symptoms that could explain sex-related differences in diagnostic delay. Methodological and possible publication bias could result in sex-biased medical practice. (J Rheumatol Firs

Challenges to conquer from the gender perspective in medicine: The case of spondyloarthritis

Background: Diagnostic delay is well-known in spondyloarthritis and studies have demonstrated a longer deferral in women. The aim of this study was to explore whether diagnostic delay of spondyloarthritis depends on clinical manifestations expressed by patients according to sex or whether it is related to a doctor’s misdiagnosis bias. Methods: A cross-sectional study of 96 men and 54 women with spondyloarthritis was performed at Alicante University General Hospital in Spain using a semistructured interview and clinical records. Comparative sex analysis were done via Student’s T and Mann-Whitney U tests for parametric and nonparametric continuous variables, chi-square and Fisher’s exact tests for unpaired categorical variables, and McNemar’s test for paired ones. Findings: The median diagnostic delay in women 7.5 (11.5) years is higher than men 4 (11) years, with a difference close to statistical significance (p = 0.053). A total of 30.2% of men received a first correct diagnosis of spondyloarthritis versus 11.1% of women (p = 0.016), indicating that men have higher probability of not having a misdiagnosis of spondyloarthritis (odds ratio = 3.5; 1.3–9). Eleven different health services referred male patients to the rheumatology clinic but only six in the case of female. No sex differences were detected in patients’ manifestations of back pain at onset. However, medical records registered differences (women 44.4%, men 82.1%; p < 0.001). There were differences between patients (women 57.7%, men 35.2%; p = 0.008) and medical records in peripheral signs/symptoms at onset (women 55.6%, men 17.9%; p < 0.001). Conclusion: The few differences of self-reported manifestations between both sexes with spondyloarthritis as compared with their clinical records (more axial pain in men and more peripheral pain in women) suggests that the professionals’ annotations reflect what they expect according to Literature, which could explain the higher misdiagnosis and diagnostic delay in women with spondyloarthritis.This study was supported with funding FEDER-Instituto de Salud Carlos III. Ministerio de Ciencia e Innovación. España (Grant PI11/00865)

Ultrasound-detected musculoskeletal urate crystal deposition: Which joints and what findings should be assessed for diagnosing gout?

Objective: The primary objective of this prospective case-control study was to assess the diagnostic value of several intra-articular and periarticular ultrasound (US)- detected abnormalities in the upper and lower limbs in gout. The secondary objective was to test the concurrent validity of US abnormalities using as gold standard the microscopic demonstration of monosodium urate (MSU) crystals. Methods: Ninety-one men with gout and 42 agematched controls were prospectively recruited. All patients with gout and controls underwent US assessment of several US abnormalities in 26 joints, six bursae, eight tendons, 20 tendon compartments, four ligaments, and 18 articular cartilages by experts in US blinded to the patients' group. Patients with gout and controls with US abnormalities were asked to undergo US-guided aspiration for microscopic identification of MSU crystals. Interobserver and intraobserver reliability of the US assessment was evaluated in a web-based exercise. Results: The assessment of one joint (ie, radiocarpal joint) for hyperechoic aggregates (HAGs), two tendons (ie, patellar tendon and triceps tendon) for HAGs and three articular cartilages (ie, first metatarsal, talar and second metacarpal/femoral) for double contour sign showed the best balance between sensitivity and specificity (84.6% and 83.3%, respectively). Intraobserver reliability was good (mean κ 0.75) and interobserver reliability was moderate (κ 0.52). The aspirated material from HAGs was positive for MSU crystals in 77.6% of patients with gout and negative in all controls. Conclusions: Our results suggest that US bilateral assessment of one joint, three articular cartilages and two tendons may be valid for diagnosing gout with acceptable sensitivity and specificit

The 2023 ACR/EULAR Classification Criteria for Calcium Pyrophosphate Deposition Disease

ObjectiveCalcium pyrophosphate deposition (CPPD) disease is prevalent and has diverse presentations, but there are no validated classification criteria for this symptomatic arthritis. The American College of Rheumatology (ACR) and EULAR have developed the first-ever validated classification criteria for symptomatic CPPD disease.MethodsSupported by the ACR and EULAR, a multinational group of investigators followed established methodology to develop these disease classification criteria. The group generated lists of candidate items and refined their definitions, collected de-identified patient profiles, evaluated strengths of associations between candidate items and CPPD disease, developed a classification criteria framework, and used multi-criterion decision analysis to define criteria weights and a classification threshold score. The criteria were validated in an independent cohort.ResultsAmong patients with joint pain, swelling, or tenderness (entry criterion) whose symptoms are not fully explained by an alternative disease (exclusion criterion), the presence of crowned dens syndrome or calcium pyrophosphate crystals in synovial fluid are sufficient to classify a patient as having CPPD disease. In the absence of these findings, a score >56 points using weighted criteria, comprising clinical features, associated metabolic disorders, and results of laboratory and imaging investigations, can be used to classify as CPPD disease. These criteria had a sensitivity of 92.2% and specificity of 87.9% in the derivation cohort (190 CPPD cases, 148 mimickers), whereas sensitivity was 99.2% and specificity was 92.5% in the validation cohort (251 CPPD cases, 162 mimickers).ConclusionThe 2023 ACR/EULAR CPPD disease classification criteria have excellent performance characteristics and will facilitate research in this field