Search

Background: Symptom management in rheumatoid arthritis (RA) remains a complex challenge. Widespread use of cannabis-based medicines for a myriad of symptoms has fostered rheumatology patients' interest. However, their safety and efficacy in RA remain unclear., Objective: The aim of this study was to perform a structured summary of the body of evidence in order to determine whether cannabis, cannabis-derived products, and synthetic cannabinoids are an effective treatment for rheumatoid arthritis., Methods: An electronic search in Epistemonikos database was performed to identify systematic reviews and their primary studies that addressed our clinical question. The body of evidence was collected in a pivot table in Epistemonikos. Information and data from the primary studies were extracted from the identified reviews. Finally, extracted data were reanalyzed, and a summary of findings table was generated using the Grading of Recommendations Assessment, Development and Evaluation approach., Results: Twenty-six systematic reviews were identified which included in total only 1 randomized trial assessing our clinical question., Conclusions: Cannabis, cannabis-derived products and synthetic cannabinoids may slightly reduce disease activity in patients with RA. Its use may result in little to no difference in pain reduction and may slightly increase nervous system adverse events. The evidence is very uncertain about the effect of cannabis, cannabis-derived products, and synthetic cannabinoids on serious adverse events risk., Competing Interests: The authors declare no conflict of interest., (Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc.)

Objective: The aim of this study was to evaluate the psychometric properties of the Chilean version of the Fibromyalgia Survey Questionnaire (FSQ)., Methods: Women with fibromyalgia (FM; n = 214), women with rheumatoid arthritis (RA; n = 97), and women without chronic pain (being followed by Gynecology, G; n = 117) from the Red de Salud UC CHRISTUS (Santiago, Chile) participated. Women with FM completed the FSQ, Fibromyalgia Impact Questionnaire (Revised Version), Numerical Pain Rating Scale, Pain Catastrophizing Scale, Pain Vigilance and Awareness Questionnaire, Patient Health Questionnaire 15, and Short-Form Health Survey. Two weeks later, they completed the FSQ again by phone (n = 120)., Results: The FSQ total scale showed excellent to good internal consistency at T1 (α = 0.91, ω = 0.91) and T2 (α = 0.78, ω = 0.78), and good test-retest reliability (intraclass correlation coefficient, 0.79; 95% confidence interval [CI], 0.72-0.85). It showed medium to large correlations with the other measures. Discriminant analysis between the FM group and the control group (RA and G) revealed that the FSQ total scale reached a classification accuracy of 81.3%. Receiver operating characteristic curve (adjusted area under the curve, 0.88; 95% CI, 0.85-0.92) showed that the best FSQ cutoff was 17, resulting in sensitivity of 89% (95% CI, 0.84-0.93) and specificity of 75% (95% CI, 0.69-0.80). Considering the FM diagnosis performed by a rheumatologist as the criterion standard, sensitivity and specificity of the modified 2010 American College of Rheumatology preliminary criteria for FM were 92.8% (95% CI, 0.88-0.96) and 63.4% (95% CI, 0.57-0.70), respectively., Conclusions: The Chilean version of the FSQ presents good psychometric properties and is a useful tool in clinical settings to assist in FM diagnosis and symptom assessment. A cutoff score of 17 or higher seems to be the most appropriate for Chilean population., Competing Interests: This study is supported by the Chilean National Commission for Scientific and Technological Research (CONYCIT, Comisión Nacional de Investigación Científica y Tecnológica), FONIS Regular SA16I0305 (Lydia Gómez-Pérez, Principal Investigator). This study was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

Objectives: Chronic musculoskeletal pain (CMP) causes significant health loss worldwide. Given that cultural factors may affect pain processing, it is key to have more information regarding CMP epidemiology in Latin America. In this study, we aimed to determine the prevalence of CMP and chronic widespread pain (CWP) in Chile., Methods: This was a cross-sectional survey study. We used data recollected in the 2016-2017 Chilean National Health Survey, a nationwide household survey. Our study population included subjects older than 14 years living in urban and rural Chile. We defined CMP as nontraumatic pain with a duration of longer than 3 months. Chronic widespread pain was defined by the presence of CMP in 5 body regions. The association between CMP and CWP and potential risk factors was investigated through univariate and multivariate logistic regression models., Results: After excluding subjects with missing information our final sample constituted 4045 subjects. Chronic musculoskeletal pain was present in 21.8% (95% confidence interval, 19.6%-24.1%) and CWP in 4.2% (95% confidence interval, 3.3%-5.1%). Significant risk factors in multivariate analysis were older age, female sex, lower educational level, and depressive symptoms. Factors associated with a reduced risk of CMP were not being married and moderate alcohol consumption., Conclusions: One of 5 Chilean people has chronic pain, and 1 of 20 has CWP. Data regarding alcohol and pain have been controversial in previous studies; therefore, this decreased risk in moderate consumers should be further explored. Chronic widespread pain shared risk factors and protective factors with CMP but with a higher magnitude of association., Competing Interests: The authors declare no conflict of interest., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

The classical manifestations of Behçet disease are mouth ana genital ulcers, cutaneous lesions ana ocular involvement. The central nervous system is affected in 5 to 59% of the cases, usually in the form of meningoencephalitis or sinus venous thrombosis. We report a 17-year-old femóle presenting with a two weeks history of progressive headache, nausea and blurred vision. An initial magnetic resonance was normal. Fifteen days later she was admitted to the hospital due to progression of visual impairment. She gave a history of oral ulcers and arthralgias. A new magnetic resonance was normal. A lumbar puncture showed a cerebrospinal fluid with a protein concentration of 14 mg/dl, a glucose concentration of 64 mg/dl, 20 fresh red blood cells and a pressure of 26 cm H(2)0. The diagnosis of a pseudotumor cerebri, secondary to Behçet disease was raised and the patient was treated with colchicine and acetazolamide. The evolution was torpid and an anterior uveitis was also found. After discharge, she continued with oral and genital ulcers and was treated with infliximab. Despite treatment, headache persists.

Coronary thrombosis as a manifestation of the antiphospholipid syndrome is very uncommon. We report a 25 year-old male without known cardiovascular risk factors that suffered an acute myocardial infarction as the initial manifestation of the antiphospholipid syndrome. His coronary angiogram demonstrated a single thrombotic lesion in the anterior descending artery without coronary atheromatosis. Anticardiolipin, anti B2 Glycoprotein I antibodies, and lupus anticoagulant were all positive. Besides the usual management of the coronary thrombosis, the patient was treated with permanent oral anticoagulation. Three months later, a CT coronary angiogram showed complete reperfusion of the involved artery .