Associated factors with disease remission or low activity in individuals with rheumatoid arthritis within the healthcare system in Colombia

Objetivo: identificar los factores asociados con la remisión o baja actividad en las personas con AR en Colombia. Materiales y métodos: estudio longitudinal retrospectivo basado en información del registro administrativo de AR en Colombia. Se utilizó un modelo de supervivencia paramétrico flexible de Royston Parmar para evaluar el tiempo al evento, definido como la diferencia entre el diagnóstico de AR y el logro de la primera remisión o baja actividad medida con el índice DAS28. Resultados: Se analizaron 24.914 casos incidentes de AR. La mayoría de los casos mujeres, con una mediana de edad al diagnóstico de 54 años. Al momento del diagnóstico, 35,9 % presentaba una actividad moderada a alta de la enfermedad medida por DAS28. En el primer año, la probabilidad de alcanzar la remisión o baja actividad fue del 25 %, aumentando aproximadamente hasta 50 % a los 5 años. Las personas mayores de 60 años presentaron una probabilidad de remisión o baja actividad un 19 % mayor en comparación con los más jóvenes (p = 0,001). Conclusiones: este estudio identificó factores demográficos y clínicos relacionados con la remisión o baja actividad en AR. La edad al diagnóstico, el tratamiento, la oportunidad de la atención y la seropositividad de marcadores fueron aspectos relevantes. Estos hallazgos podrían contribuir a la identificación de pacientes con mayor riesgo de recaída y al diseño de estrategias de tratamiento personalizadas para mejorar los resultados terapéuticos.Objective: to identify factors associated with remission or low disease activity in individuals with rheumatoid arthritis (RA) in Colombia. Materials and methods: a retrospective longitudinal study based on information from the administrative registry of RA in Colombia was conducted. A flexible parametric survival model by Royston Parmar was used to evaluate the time to event, defined as the difference between the diagnosis of RA and achievement of the first remission or low disease activity measured with the Disease Activity Score in 28 joints (DAS28). Results: a total of 24.914 incident cases of RA were analyzed. Most cases were women, with a median age at diagnosis of 54 years. At the time of diagnosis, 35.9 % had moderate to high disease activity measured by DAS28. In the first year, the probability of achieving remission or low disease activity was 25 %, increasing to approximately 50 % at 5 years. Individuals over 60 years old had a 19 % higher probability of remission or low disease activity compared to younger individuals (p = 0.001). Conclusions: this study identified demographic and clinical factors related to remission or low disease activity in RA. Age at diagnosis, treatment, timing of care, and seropositivity of markers were significant factors. These findings could contribute to the identification of patients at higher risk of relapse and the design of personalized treatment strategies to improve therapeutic outcomes.Especialista en ReumatologíaEspecializaciónhttps://orcid.org/0000-0002-5983-1461https://scholar.google.com/citations?user=KpttqSwAAAAJ&hl=eshttps://scienti.minciencias.gov.co/cvlac/visualizador/generarCurriculoCv.do?cod_rh=0001395826&lang=e

Chronic Joint Pain 3 Years after Chikungunya Virus Infection Largely Characterized by Relapsing-remitting Symptoms

OBJECTIVE: To determine the frequency of chronic joint pain and stiffness 3 years after infection with chikungunya virus (CHIKV) in a Latin American cohort. METHODS: A cross-sectional followup of 120 patients from an initial cohort of 500 patients who reported joint pain 2 years after infection from the Atlántico Department, Colombia. Patients were clinically diagnosed as having CHIKV during the 2014-2015 epidemic, and baseline and followup symptoms at 40 months were evaluated in serologically confirmed cases. RESULTS: Of the initial 500 patients enrolled in the study, 482 had serologically confirmed chikungunya infection. From this group, 123 patients reported joint pain 20 months after infection, and 54% of those patients reported continued joint pain 40 months after infection. Therefore, 1 out of every 8 people who tested serologically positive for CHIKV infection had persistent joint pain 3 years after infection. Participants who followed up in person were predominantly adult (mean ± SD age 51 ± 14 yrs) and female (86%). The most common type of pain reported in these patients at 40 months post-infection was pain with periods of relief and subsequent reoccurrence, and over 75% reported stiffness after immobility, with 39% experiencing morning stiffness. CONCLUSION: To our knowledge, this is the first report to describe persistent joint pain and stiffness 40 months after viral infection. The high frequency of chronic disease highlights the need to develop prevention and treatment methods. Further studies should be conducted to understand the similarities between post-chikungunya joint pain and rheumatoid arthritis

Long-term clinical outcomes of Zika-associated Guillain-Barré syndrome

Zika virus infection has been associated with the development of a spectrum of neurologic disease including Guillain–Barré syndrome (GBS)1. GBS is an autoimmune disorder of the peripheral nervous system often triggered by a preceding infection. The mechanism of Zika-associated GBS (Z-GBS) and the long-term clinical course is unknown. The purpose of this study was to describe the 2-year clinical course of Z-GBS in order to provide further insights into disease pathogenesis and prognosis