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Resumen Introduccion Las enfermedades cronicas impactan en la morbimortalidad y en la calidad de vida relacionada con la salud (CVRS) de los pacientes a nivel mundial. El impacto de las enfermedades reumaticas no ha sido totalmente reconocido. Objetivos Determinar la CVRS y evaluar areas especificas en artritis reumatoide (AR), osteoartritis (OA), diabetes mellitus, insuficiencia renal terminal, poblacion geriatrica y un grupo control. Pacientes y metodos Estudio transversal, realizado en el Hospital General de Morelia. Los sujetos cumplian criterios para AR, OA, diabetes mellitus, insuficiencia renal terminal, un grupo de poblacion geriatrica (≥ 65 anos) y un grupo control ≥ 30 anos. Se determinaron caracteristicas sociodemograficas y se aplicaron instrumentos: SF-36, escala visual analogica de dolor, valoracion global del paciente y medico, inventario para depresion de Beck, e instrumentos especificos (DAS-28, HAQ-Di, WOMAC, Diabetes Quality of Life [DQOL] y Kidney Disease Questionnaire of Life [KDQOL]). Mediciones bioquimicas: velocidad de sedimentacion globular (VSG), biometria hematica (BH), glucosa, HbA1C, creatinina y urea. Resultados Fueron evaluados 290 sujetos (un grupo control: 100, poblacion geriatrica 30 y 160 en los demas grupos). Se detectaron diferencias (p Conclusiones La CVRS en pacientes con AR es mala y equiparable a lo que sucede en pacientes con enfermedades cronicas (insuficiencia renal terminal y diabetes mellitus). Las enfermedades reumaticas deben considerarse padecimientos de alto impacto y por ello merecen mayor atencion.

Introduccion: El laboratorio en reumatologia tiene un papel importante en la evaluacion, el diagnostico y el seguimiento de diversos padecimientos. Los anticuerpos antinucleares (ANA), los anticuerpos anti-ADN de cadena sencilla o doble (ss o dsAnti-ADN) y anticuerpos anticardiolipinicos (AcACL) se usan frecuentemente y su utilidad diagnostica es bien conocida en centros de atencion de tercer nivel. Nuestro hospital es un centro de atencion de segundo nivel que implemento hace 2 anos estas pruebas. Despues de 1 ano de su introduccion, decidimos evaluar la frecuencia en su uso, quien solicita estas pruebas, su utilidad diagnostica en lupus eritematoso generalizado (LEG) y sindrome antifosfolipidico (SAF). Pacientes y metodo: Se evaluo a todos los pacientes con cuadro clinico de estas enfermedades y solicitud de estas pruebas del 1 de septiembre de 2005 al 30 de junio de 2006. De manera prospectiva, los analizo un evaluador con un formato estandarizado que contenia informacion clinica, diagnostico inicial, datos del medico solicitante, servicio, diagnostico tras resultado y los cambios en la terapeutica. Analisis estadistico: se utilizo estadistica descriptiva y tablas de 2 * 2 para evaluar la utilidad diagnostica en las indicaciones mas comunes. Resultados: De un total de 286 solicitudes recibidas, se analizaron 157. Reumatologia y medicina interna enviaron 63 y 31 solicitudes respectivamente. Con respecto a los ANA en LEG, se calculo la sensibilidad (70%); la especificidad (92%); el valor predictivo positivo (VPP) (81%); el valor predictivo negativo (VPN) (86%); la razon de verosimilitud positiva (RVsP) (8,73) y la razon de verosimilitud negativa (RVsN) (0,33). En relacion con los anti-ADN en LEG, la sensibilidad (78%); la especificidad (50%); el VPP (80%); el VPN (46%); la RVsP (1,56) y la RVsN (0,44). Respecto a los AcACL en SAF, la sensibilidad (78%); la especificidad (92%), el VPP (78%), el VPN (92%), la RVsP (10) y la RVsN (0,24). Conclusiones: En nuestro hospital hay poca frecuencia en la solicitud de estos estudios. La sensibilidad y la especificidad parecen no estar acordes con lo publicado. Es necesaria la elaboracion de lineamientos que en nuestro medio regulen la solicitud de estudios especializados en reumatologia y aumenten su utilidad clinica.

Introduction Chronic diseases have a great impact on the morbidity and mortality and on the health-related quality of life (HRQoL) of patients around the world. The impact of rheumatic diseases has not been fully recognized. We conducted a comparative study to evaluate the HRQoL in different chronic diseases. Objectives The aim of the present study was to assess the HRQoL and identify specific areas affected in patients with rheumatoid arthritis (RA), osteoarthritis (OA), diabetes mellitus, and end-stage renal disease, in geriatric subjects and in a control group. Patients and methods We conducted a cross-sectional study, in a General Hospital in Morelia, Mexico. All patients met the classification criteria for RA, OA, diabetes mellitus, and end-stage renal disease; the geriatric subjects group was aged ≥65 years and the control group ≥30 years. Demographic characteristics were recorded, different instruments were applied: SF-36, visual analog scale for pain, patient's and physician's global assessments, Beck Depression Inventory and specific instruments (DAS-28, HAQ-Di, WOMAC, Diabetes Quality of Life [DQOL] and Kidney Disease Questionnaire of Life [KDQOL]). Biochemical measures: erythrocyte sedimentation rate, blood count, glucose, HbA 1 C, serum creatinine and urea. Results We evaluated 290 subjects (control group: 100; geriatric subjects: 30 and the rest of groups: 160). Differences were detected in baseline characteristics ( P P =.007). The worst HRQoL was observed in the end-stage renal disease group (SD: 48.06±18.84 x /SD). General health was the principal affected area in RA. Pain was higher in rheumatic diseases: OA (5.2±2.4) and RA (5.1±3). HAQ was higher in OA compared to RA (1.12±.76 vs .82±.82, respectively; P =.001). Forty-five percent of all subjects had depression. Conclusions The HRQoL in RA patients is poor and comparable to that of other chronic diseases (end-stage renal disease and diabetes mellitus). Rheumatic diseases should be considered as high impact diseases and therefore should receive more attention.

Introduction Laboratory tests have an important role in rheumatology for evaluation, diagnosis, and follow up in several diseases. Specialized tests such as antinuclear antibodies (ANA), anti single, or double stranded DNA antibodies (anti-DNA), and anticardiolipin antibodies (ACL) are frequently used and its diagnostic performance is well known in tertiary care centers. Our setting is a secondary care center that implemented these tests 2 years ago. After 1 year of implementation, we decided to evaluate the frequency of use, who orders these tests, and their diagnostic properties for the diagnosis of systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APLS). Patienst and method All patients with clinical charts and a request for these tests were evaluated from September 1, 2005 to June 30, 2006. These evaluations were done prospectively by a single, trained evaluator following a standardized format looking at pretest clinical information such as pretest diagnosis, physician's level of training, service, and posttest results as well as therapeutic changes after results. Statistical analysis: descriptive statistics and 2 by 2 tables to estimate diagnostic performance of most common indications. Results Two hundred and eighty-six requests were reviewed and only 157 were evaluated. Rheumatology and Internal Medicine services sent 63 and 31 requests for these tests respectively. Diagnostic properties of ANA for SLE were sensitivity (sen) 70%, specificity (spec): 92%, positive predictive value (PPV): 81%, negative predictive value (NPP): 86%, positive likelihood ratio (PLR): 8.73, and negative likelihood ratio (NLR): 0.33. Anti-double stranded DNA, Sen: 78%, spec: 50%, PPV: 80%, NPP: 46%, PLR: 1.56, NLR: 0.44; ACACL y Sen: 78%, spec: 92%, PPV: 78%, NPV 92%, PLR: 10, NLR 0,24. Conclusions These specialized tests are not frequently used in our setting. Their diagnostic properties are not as accurate as those published in medical literature. Guidelines are needed in our hospital to improve their diagnostic performance.