13. Pregunta Etica : tiene que poner en riesgo la vida una enfermedad para ser considerada importante?..... los efectos de una enfermedad cronica cuando no es controlada . Como puede esta persona caminar ????
20. Daño Radiologico es un determinante mayor de disabilidad en el tiempo Severidad (arbitrary units) 0 Duracion de la enfermedad (anos) 5 10 15 20 25 30 Early RA Intermediate Late Adapted from Kirwan et al. J Rheumatol 1999;26:720 – 725 Inflammation Disability Radiographs
32. RF y anti-CCP son los principales factores predictivos para rapida progresion radiografica (RRP) en pacientes con AR Riesgo de RPR como factor predictivo ,mostrando que RF, anti-CCP , PCR basal y score de erosion fueron predictores significativos independiente de RPR Adapted from Visser et al. EULAR 2009 50 Riesgo de RPR (%) 20–50 10–20 <10
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35. Beneficio del tratamiento con abatacept en la vida real Productividad Ganancia de 1 semana de actividad cada mes Calidad de vida global Aumento significativo en 8 dominios físicos y mentales Calidad del sueño ↑ 19% (MOS-sueño) Función física ↑ 25 % (HAQ) Fatigae ↓ 30% (EVA) UN DÍA TÍPICO Dolor ↓ 38% (EVA) ATTAIN: Genovese, et al. N Engl J Med 2005;353:1114. Russell et al. Ann Rheum Dis 2005;64(S3):397. EVA = escala visual análoga; MOS = Estudio de Evolución Médica, escala de sueño; HAQ = Cuestionario de Evaluación de la Salud Actividades diarias Comienzo del día Noche Sueño
Notas del editor
RA Progression The relationship between the development of radiographic joint destruction in rheumatoid arthritis (RA) and its long-term consequences for the patient is not well understood, but one view of the disease process is that inflammatory joint symptoms are the main determinant of disability early in disease while joint destruction dominates in late disease. Presentations and discussions at OMERACT IV are consistent with this view, suggesting a high correlation between inflammation and disability in early RA, but that the strength of this relationship declines over time. Discussions at OMERACT IV also indicated that fluctuations in disability will become less pronounced in later stage RA and become more closely correlated with radiographic evidence of joint damage. OMERACT (Outcome Measures in Rheumatology) has existed for 10 years and during that time has established itself as a group making a significant contribution to research and development of internationally recognized outcome measures in the rheumatic diseases. What is OMERACT? It is a concept, neither an institution nor a governing body. It is an organization composed of investigators from multiple disciplines (i.e., clinicians, statisticians, outcomes researchers, radiologists, etc) cooperating to evaluate the published evidence supporting the validity of specific outcome or response measures for use in clinical trials in rheumatic diseases. In the initial phases of the process, literature relating to a particular outcome measure is reviewed and evaluated for validity (to be defined below). The group discussing the issue then makes suggestions about what areas or outcomes need further validation. Later in the process the number of candidate outcome measures can be decreased to the leanest and best performing. The task of OMERACT is to “point the way.” It is not to mandate any task or designate anyone to do the task. Any individual or individuals can then decide on what and how to do the work; the people who do the work are the ones who reap the credit (i.e., publications, fame). Kirwan JR. Links between radiological change, disability, and pathology in rheumatoid arthritis. J Rheumatol. 2001;28:881-886.
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