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Objective: To generate a quality standard for the management of patients with psoriatic arthritis (PsA)., Methods: We employed qualitative methodology that included: 1) Two focus groups (one with patients with PsA and another with non-rheumatologist specialists involved in the care of PsA patients); 2) A narrative literature review of published documents related to the quality of care in PsA; 3) A nominal group meeting in which 15 expert rheumatologists generated and reached a consensus on a series of quality criteria, as well as formulas or quantifiable objective measures to evaluate them; 4) The Delphi method to establish the feasibility, priority and agreement with the quality criteria; 5) A final generation of standards of care and their attributes. A descriptive analysis of the results was carried out., Results: A total of 59 standards of care was generated, 18 of mandatory compliance, grouped into 4 blocks according to specific objectives: 1) early diagnosis (n=6); 2) optimizing the management of the disease (n=26); 3) multidisciplinary collaboration (n=9); 4) monitoring improvement (n=18). To assess compliance with these standards of care, in many cases, the medical records will be reviewed. Other sources will be the records of the service and hospital and bibliographic databases. Regarding the level of compliance, for some of the standards of care this is yes/no; for others, compliance ranges from 50% to 100% and, in this range, in many cases, compliance was 80%., Conclusions: This set of standards of care should help improve quality of care in PsA patients., (Copyright © 2018. Publicado por Elsevier España, S.L.U.)

Objective: To study the prevalence of osteoporosis and fracture probability in patients diagnosed with prostate cancer., Design: Observational descriptive transversal study. SITE: Study performed from Primary Care of Lugo in collaboration with Rheumatology and Urology Services of our referral hospital., Participants: Patients diagnosed with prostate cancer without bone metastatic disease from January to December 2012., Main Measurements: Epidemiologic, clinical, laboratory and densitometric variables involved in osteoporosis were collected. The likelihood of fracture was estimated by FRAX ® Tool., Results: Eighty-three patients met the inclusion criteria. None was excluded. The average age was 67 years. The Body Mass Index was 28.28. Twenty-five patients (30.1%) had previous osteoporotic fractures. Other prevalent risk factors were alcohol (26.5%) and smoking (22.9%). Eighty-two subjects had vitamin D below normal level (98.80%). Femoral Neck densitometry showed that 8.9% had osteoporosis and 54% osteopenia. The average fracture risk in this population, estimated by FRAX ® , was 2.63% for hip fracture and 5.28% for major fracture. Cut level for FRAX ® major fracture value without DXA >5% and ≥7.5% proposed by Azagra et al. showed 24 patients (28.92%) and 8 patients (9.64%) respectively., Conclusions: The prevalence of osteoporosis in this population was very high. The more frequent risk factors associated with osteoporosis were: previous osteoporotic fracture, alcohol consumption, smoking and family history of previous fracture. The probability of fracture using femoral neck FRAX ® tool was low. Vitamin D deficiency was very common (98.8%)., (Copyright © 2017 Elsevier España, S.L.U. All rights reserved.)

Objective: To study the clinical and epidemiological characteristics of all adults patients as having synovial sarcoma in the Hospital Xeral-Calde (Lugo) between 2002 and 2006., Patients and Method: We conducted a retrospective study of the case records of all adults patients diagnosed with synovial sarcoma from January 2002 through December 2006. Patients were considered to be adults if they were more than 18. In all cases a tissue-biopsy sample showing synovial sarcoma was required. The Hospital Xeral-Calde is the only referral center for a population of almost 250.000 people., Results: Four cases (3 women) met the classification criteria for this study. The mean age was 35 years old (range, 22-41). The most common presentation was a palpable mass (mean 6.7cm.) associated with pain in lower extremities. The mean delay for the diagnosis was 17 months, but in one case has been noted as long as 2.5 years. Unlike the neck synovial sarcoma case, a long delay in the diagnosis implied a major tumor size and a higher histologic grade. The mean follow-up was 25.5 months; one patient died 1.5 years after the diagnosis., Conclusions: The overall annual incidence rate of synovial sarcoma in the Lugo region between January 2002 and 2006 for the population older than 18 years was a minimum estimate 0.32/10(5). Better physician awareness may contribute to the progressive increase in the recognition of this condition, especially in young people presenting with palpable mass. A long delay at the diagnosis implied a poor prognosis., (Copyright © 2008 Elsevier España, S.L. All rights reserved.)

Scleroderma or systemic sclerosis (Ssc) is a connective tissue disease which frequently involves the esophagus. Motility disorders, such as a low pressure level in the Lower Esophageal Sphincter (LES), and disturbed esophageal peristalsis cause a higher acid exposition and mucosal damage. We study twenty Ssc patients using computerized esophageal manometry, endoscopy and clinical interview looking for prevalence of symptoms, esophageal dysmotility and erosive esophagitis, and trying to find risk factors involved in esophageal damage. Esophagitis was found in 40% of patients. Clinical presentation (diffuse or limited), age and time since diagnosis wer'nt accurate predictors of esophageal involvement. Symptoms such as dysphagia and heartburn had not any significant difference in those with and without esophagitis, so 25% of patients with mucosal damage had no symptoms and 60% of healthy ones complained about them. LES values were not significantly different between the two groups, with a great degree of overlap with normal values. Disturbed motility pattern of aperistalsis was the only factor that identified high and low risk groups for esophagitis, with a high statistical significance (p > 0.02). Mucosal sensitivity in severe esophagitis and pharyngeal and upper esophageal functions were normal in all patients. Impaired peristalsis, with a delayed clearance of acid is the most important factor for mucosal damage in scleroderma. Symptoms of gastroesophageal reflux are not a reliable predictor of erosive esophagitis. Endoscopy should be the usual method of diagnosis, in order to make a proper use of therapeutic weapons.