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Validation of a Prediction Rule for the Diagnosis of Rheumatoid Arthritis in Patients with Recent Onset Undifferentiated Arthritis
Zaida Bedran,Cristian Quiroz,Javier Rosa,Luis J. Catoggio
International Journal of Rheumatology , 2013, DOI: 10.1155/2013/548502
Abstract:
Actualización en polimialgia reumática Polymyalgia rheumatica revisited
Pablo Przygoda,Luis J. Catoggio,Enrique R. Soriano,Patricia M. Imamura
Medicina (Buenos Aires) , 2002,
Abstract: La polimialgia reumática (PMR) es una enfermedad inflamatoria que afecta generalmente a personas mayores de 50 a os y se caracteriza por dolor y entumecimiento doloroso de los músculos proximales junto con la elevación de la velocidad de sedimentación globular en la 1o hora. Si bien cada vez se diagnostica más frecuentemente, la PMR sigue siendo un diagnóstico de exclusión y los criterios diagnósticos propuestos no son universalmente aceptados. Si bien es reconocida la asociación de PMR con arteritis de células gigantes (ACG), la biopsia sistemática de la arteria temporal no está indicada en los pacientes con PMR que no presentan síntomas de ACG. El diagnóstico precoz y el tratamiento con esteroides en dosis bajas provocan una mejoría muy importante en los síntomas y la capacidad funcional de los pacientes con PMR. El tratamiento suele durar entre 12 y 24 meses y un alto porcentaje de los pacientes logra la suspensión definitiva del mismo. Polymyalgia rheumatica is an inflammatory disorder that usually affects persons over the age of 50 causing proximal muscle pain and stiffness, and an elevated erythrocyte sedimentation rate. Although increasingly recognized in this age group, it remains a diagnosis of exclusion and although several diagnostic criteria have been proposed, none has been clearly accepted. While polymyalgia rheumatica is associated with giant cell arteritis, obtaining a temporal artery biopsy is not recommended in patients with polymyalgia rheumatica without symptoms of giant cell arteritis. Early diagnosis and low dose corticosteroid therapy improve patients' clinical features and functional status. Treatment usually lasts between 12 and 24 months and the majority of patients manage to discontinue treatment completely.
Validation of a Prediction Rule for the Diagnosis of Rheumatoid Arthritis in Patients with Recent Onset Undifferentiated Arthritis
Zaida Bedran,Cristian Quiroz,Javier Rosa,Luis J. Catoggio,Enrique R. Soriano
International Journal of Rheumatology , 2013, DOI: 10.1155/2013/548502
Abstract: Objectives. To validate van der Helm-van Mil score (vHvM) and new ACR/EULAR criteria for the diagnosis of rheumatoid arthritis (RA) in patients with undifferentiated arthritis (UA). Patients and Methods. Adult patients with UA (swelling ≥2 joints of less than 6 months duration, without diagnosis, and never treated with disease modifying drugs). Results. Ninety-one patients were included. Mean age: 55.6 years (SD: 17.4), 74% females. Median symptoms duration was 2 months (IR: 1–4 months). Mean van der Helm-van Mil score was 6.9 (SD: 2). After a mean followup of 6.2 months (SD: 6), 40.7% patients fulfilled ACR 1987 RA classification criteria, 28.6% fulfilled other diagnostic criteria, and 31% remained as UA. Receiver operator characteristic curve's (ROC's) area under the curve (AUC) for the vHvM score for diagnosis of RA was 0.83. A cutoff value of 6.94 showed sensitivity of 81% and 79.7% specificity. For the new ACR/EULAR criteria, the ROC AUC was 0.93, and a value equal to or greater than 6 showed 86.5% sensitivity and 87% specificity. Conclusion. van der Helm-van Mil prediction score and the new ACR/EULAR criteria proved to be valuable for the diagnosis of RA in patients with early UA. 1. Introduction Rheumatoid arthritis (RA) is a systemic disease characterized by chronic inflammation that often leads to joint destruction. A greater awareness of RA [1, 2] has led to new efforts in order to establish a definitive diagnosis as early as possible after onset of symptoms [1–4]. Identifying patients with early arthritis at risk of developing persistent and/or erosive arthritis is mandatory for selecting a treatment strategy, according to the current early aggressive treatment approach [4]. The American College of Rheumatology (ACR) 1987 [5] classification criteria for RA were developed for clinical trials and research purposes, and it is not an appropriate tool for applying in the very early phase of the disease, mainly because of low sensitivity [6]. On the other hand, the majority of patients who present with recent onset arthritis have undifferentiated arthritis (UA) which is a form of arthritis that does not fulfill the classification criteria for a more definitive diagnosis. It is known that around 40%–50% of them may experience spontaneous remission, whereas RA develops in one-third of patients with UA [7, 8]. Therefore, finding predictors of the disease to take individualized decisions regarding treatment is one of the most important challenges in RA. According to the UA evolution mentioned previously, we believe that the consequences of over- or
Actualización en polimialgia reumática
Przygoda,Pablo; Catoggio,Luis J.; Soriano,Enrique R.; Imamura,Patricia M.; Camera,Luis A.; Kaplan,Roberto; Mayorga,Luis M.;
Medicina (Buenos Aires) , 2002,
Abstract: polymyalgia rheumatica is an inflammatory disorder that usually affects persons over the age of 50 causing proximal muscle pain and stiffness, and an elevated erythrocyte sedimentation rate. although increasingly recognized in this age group, it remains a diagnosis of exclusion and although several diagnostic criteria have been proposed, none has been clearly accepted. while polymyalgia rheumatica is associated with giant cell arteritis, obtaining a temporal artery biopsy is not recommended in patients with polymyalgia rheumatica without symptoms of giant cell arteritis. early diagnosis and low dose corticosteroid therapy improve patients' clinical features and functional status. treatment usually lasts between 12 and 24 months and the majority of patients manage to discontinue treatment completely.
Are There Clinical Differences in Limited Systemic Sclerosis according to Extension of Skin Involvement?
Marina Scolnik,Luis J. Catoggio,Eliana Lancioni,Mirtha R. Sabelli,Carla M. Saucedo,Josefina Marin,Enrique R. Soriano
International Journal of Rheumatology , 2014, DOI: 10.1155/2014/716358
Abstract: Objectives. To examine the characteristics of our patients with limited systemic sclerosis (lSSc) for differences between Barnett Type 1 (sclerodactyly only) and Type 2 or intermediate (acrosclerosis-distal but may reach up to elbows and/or knees plus face) subsets. Methods. Records of patients between January 1, 2000, and December 31, 2011, with SSc or those with anti-Scl-70, anticentromere, or antinucleolar antibodies were reviewed. Only cases fulfilling ACR 1980 criteria were included and classified as diffuse or limited according to LeRoy’s criteria. Limited SSc was separated into sclerodactyly and acrosclerosis (Barnett’s Types 1 and 2). Results. 234 SSc patients (216 females) fulfilled criteria. Female/male ratio was 12？:？1; 24% had dSSc and 76% lSSC (64% Type 1 and 12% Type 2). Total follow-up was 688 patient-years. Within lSSC, the Type 2 group had significantly shorter duration of Raynaud’s and more anti-Scl-70 and less anticentromere antibodies. In particular, interstitial lung disease (ILD) was significantly more prevalent in Type 2 group and similar to Type 3. Conclusions. These results appear to confirm that extension of skin involvement within limited SSc may identify two different subsets with clinical and serologic characteristics. 1. Introduction There appears to have been consensus in the past decades in classifying systemic sclerosis (SSc) according to extension of skin involvement as limited and diffuse, using the elbows and knees as “limits” to distinguish between them. However, although this has been used to “dissect” two more or less distinct clinical subsets, there are patients who do not fit this classification and several others have been proposed [1, 2]. The growing demonstration that autoantibodies specific for SSc such as anticentromere, anti-Scl-70 (anti-topoisomerase 1), and more recently a variety of antinucleolar antibodies, particularly anti-RNA polymerase 3, correlate with these subsets and/or visceral manifestations has led to them being used to “predict” clinical subsets in early disease and also raise awareness for the possibility of certain organ involvement (anti-Scl-70 and interstitial lung disease [3, 4], anticentromere associated with digital ulcers [5], debatably pulmonary hypertension [6], and anti-RNA polymerase 3 with renal crisis [7]). Decades ago, Barnett classified SSc as Type 1 (only sclerodactyly), Type 2 (acrosclerosis-distal but may reach up to elbows and/or knees plus face), and Type 3 (diffuse skin involvement) (Figure 1). Patients with Type 2 had an intermediate degree of both skin and organ
Las raíces ilustradas de la hermenéutica filosófica
Catoggio,Leandro;
Eidos , 2010,
Abstract: gadamer's philosophical hermeneutics has restored the global history of hermeneutics for contemporary thought. his philosophical project is in line with a history that includes thinkers as heidegger, dilthey or schleiermacher. but in this historical line hermeneutics during his enlightened stage has remained forgotten. the enlightened hermeneutics of the xvii and xviii centuries has not been taken into account by the contemporary hermeneutical projects. our interest lies in observing how this stage, in spite of having been relegated, influences the contemporary project of the gadamerian hermeneutics. according to this, we will aim at explaining how the nascent secular hermeneutics operates during modernity. for doing that we will focus on some modern authors like chladenius and dannhauer for looking at the problems that they worked in the hermeneutic field and their attempts of solution. and finally we will try to outline the contributions due to these authors in gadamer's contemporary project.
El principio de indisponibilidad del lenguaje y la fusión de horizontes en la hermenéutica filosófica de Hans-Georg Gadamer
Catoggio,Leandro;
Ideas y Valores , 2008,
Abstract: the replacement of the heideggerian idea of being-toward-death with the gadamerian notion of being-for-the-text imposes important changes in the philosophical hermeneutics. the present paper analyses the "principle of unavailability of language" taking into account the idea of a fusion of horizons regarding text interpretation. it considers the function of this last idea for different natural languages, and ends with the thesis that gadamer's hermeneutics has in fact two possible meanings.
LENGUAJE Y RETóRICA EN LA HERMENéUTICA DE HANS-GEORG GADAMER
Catoggio,Leandro;
Praxis Filosófica , 2008,
Abstract: the present work has as aim to describe to the relation between rhetoric and hermeneutic in the work of hans-georg gadamer. a first step consists of really recognizing the elements of the rhetoric in the context and method. from it will be tried there to show what gadamer understands by the hermeneutic recovery of the old rhetoric on the base of three topics. first it is in showing that the rhetoric like the hermeneutic reaches status ontological. secondly, that the rhetoric is fundamental part in the formation of the concepts by means of the element of the analogy. and thirdly, the intimate relation that maintains the hermeneutic with the rhetoric at a level of rational argumentation on the base of the probability notion (eikós).
La enfermedad histórica de la hermenéutica y su transformación dialéctica. El pensamiento débil entre Gadamer y Benjamin The historic disease of hermeneutics and its dialectical transformation. The weak thought between Gadamer and Benjamin.
Leandro Catoggio
HYBRIS : Revista de Filsofía , 2013,
Abstract: El presente trabajo tiene por fin mostrar cómo la hermenéutica nihilista de Gianni Vattimo mediante su crítica a la hermenéutica ontológica de Gadamer recupera la figura de Walter Benjamin y la asocia al proyecto de Heidegger. Esto lleva a que el presente trabajo, en primer lugar, describa cuáles son las críticas que Vattimo le realiza a Gadamer; y, en segundo lugar, muestre cómo es posible aunar la filosofía de Heidegger con el pensamiento crítico de Benjamin. Por último, se indica mediante la congruencia de estos autores cómo es posible la construcción de un sujeto post-metafísico The present work aims to show how the hermeneutics of nihilistic Gianni Vattimo using his criticism of the ontological hermeneutic of Gadamer retrieves the figure of Walter Benjamin and the associated with the project of Heidegger. This leads to the present work, in the first place, describe which are the criticisms that Vattimo you performed to Gadamer; and, secondly, show how it is possible combine the philosophy of Heidegger with the critical thinking of Benjamin. Finally, it is indicated by the consistency of these authors as is possible the construction of a subject post-metaphysical
The Principle of Unavailability of Language and the Fusion of Horizons in Hans-Georg Gadamer's Philosophical Hermeneutics
Leandro Catoggio
Ideas y Valores , 2008,
Abstract: The replacement of the Heideggerian Idea of Being-toward-Death with the Gadamerian notion of Being-for-the-Text imposes important changes in the Philosophical Hermeneutics. The present paper analyses the “principle of unavailability of language” taking into account the idea of a fusion of horizons regarding text interpretation. It considers the function of this last idea for different natural languages, and ends with the thesis that Gadamer’s Hermeneutics has in fact two possible meanings.
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