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"tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "279" "paginaFinal" => "280" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Mario H. Cardiel" "autores" => array:1 [ 0 => array:4 [ "nombre" => "Mario H." "apellidos" => "Cardiel" "email" => array:1 [ 0 => "mhcardiel@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Unidad de Investigación Dr. Mario Alvizouri Muñoz, Hospital General Dr. Miguel Silva, Secretaría de Salud del Estado de Michoacán, Morelia, Mich., Mexico" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Presente y futuro de las enfermedades reumáticas en Iberoamérica. ¿Estamos preparados para hacerles frente?" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Rheumatic diseases are a major cause of morbidity in the general population. There are over two hundred diseases that produce varying degrees of pain, disability and deformity. In general, these diseases do not increase short-term mortality and, therefore, are not taken into account as health and education priorities. However, their influence on the deterioration of the quality of life<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> is increasingly recognized.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Latin America has undergone an epidemiological transition for a number of years. Having not overcome health problems, education and social needs related to poverty, they now address both this challenge and that of developing pathology. The latter includes chronic degenerative diseases and, especially relevant, rheumatic diseases. This phenomenon imposes major challenges on health systems and scarce resources are often used to address urgent needs and attention is diverted to emerging problems.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Rheumatologists are no strangers to the overwhelming numbers that reflect the overall impact of musculoskeletal diseases. It is estimated that approximately 10% of the general population suffers from rheumatic disease. These diseases are among the top ten reasons for total disability in countries like the United States, Canada and Mexico. In the Mexican Social Security Institute, the disability rate has been calculated at 1.38 per 1000 beneficiaries.</p><p id="par0020" class="elsevierStylePara elsevierViewall">There are methodological problems in measuring the overall impact of rheumatic diseases. There is only fragmentary information about other equally important aspects such as the impact on quality of life (pain, suffering, progressive deformity and inability to perform activities of daily living). It is also important to measure other variables such as social isolation, loss of work opportunities, employment promotion and education, economic dependence and undesirable changes in life plans. We should not forget either the consequences on the family or caregivers. Therefore, it should be emphasized that the study of rheumatic diseases should be part of a list of health priorities due to the personal, family, social and work impact they can produce.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The World Health Organization dedicated the years from 2000 to 2010 as the Bone and Joint decade. This is in order to highlight the importance of musculoskeletal diseases. Four diseases have been considered particularly relevant: a) rheumatoid arthritis, b) osteoporosis, c) osteoarthritis and d) lower back pain.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The impact of this decade should be assessed critically in different regions of the world. In Latin America it seems to have been particularly successful.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Information from COPCORD surveys and the EPISER<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> studies in Latin America<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4–7</span></a> revealed several relevant issues that clearly emphasize the importance of these diseases. The prevalence of musculoskeletal pain during the last week is about 25% of individuals surveyed at the community level. Many of these patients are not served by health systems. General practitioners, who often prescribe only NSAIDs, often treat patients who need specialized medical care. Several of these diseases should be diagnosed and managed by the rheumatologist. The delay in the diagnosis of diseases such as rheumatoid arthritis has been associated to a poor prognosis.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,9</span></a> Spain has been successful in experimenting with education programs for general practitioners in order to improve diagnostic quality and timely referral of patients to specialized treatment. They have also shown a reduction in the time needed for beginning treatment with disease modifying antirheumatic drug in rheumatoid arthritis.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> Similar examples should be promoted in Latin America and are part of a set of recommendations issued by the GLADAR and PANLAR<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> groups.</p><p id="par0035" class="elsevierStylePara elsevierViewall">COPCORD studies in several countries show the prevalence rates of common rheumatic diseases that cause pain and disability. A recent effort in five regions of Mexico by the Epidemiological Study of Muscle-Articular Diseases (Group GEEEMA), using survey methodology with a standardized questionnaire, physical examination and diagnostic validation, show significant regional differences regarding the prevalence of pain, disability and various diagnoses. The regional representation is expected in countries with heterogeneous population types, climate, customs, health, economy and education. The cost and complexity of regional surveys should be balanced and an assessment of the advantages of the information that can be used for regional purposes<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> needs support. The impact of this information in health policy is likely to be reflected after several years of coordinated and intense work.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Rheumatology is often regarded as a specialty that treats vague diseases of adulthood and especially the elderly. Rheumatoid arthritis, osteoporosis, crystal deposition disease, osteoarthritis, musculoskeletal diseases associated with drugs and the proper management of comorbidities are of special interest in rheumatology in the latter age group. Future trends draw our attention to the urgent need to seriously consider the aging population. Some authors in the field of aging have pointed out that this phenomenon has special features in Latin America and the Caribbean, namely: a) the rate of aging is particularly rapid in this region. It is thought that in 2030, the population over 60 will be 2.5–3.5 times higher when compared with 2000 figures, b) this region shows a gap between aging and the appropriate standards of life. Compared with other populations, such as Europe, the population of Latin America and the Caribbean will reach adulthood without having enjoyed living standards of other populations and it is postulated that aging may be associated with less favorable standards; c) the socio-political and institutional volatility significantly limit more optimistic predictions. It is thought that we have not adequately prepared to cope up with the challenges that population aging will impose on our region.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> You cannot ignore the efforts made thus far in different countries, but an increase in social awareness, political and economic planning as well as predictive efforts are recommended. We as a society need to train more rheumatologists, ensure better training for primary care physicians, promote communication and the formation of health teams and facilitate the incorporation of patients in discussion forums. Planning and needs change from one country to another and will require individualized efforts to meet a common agenda. Rheumatology Societies should play a visionary role in a future that gets closer each day.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The Latin American agenda must emphasize the study of indigenous people, who constitute a large group of citizens who have not received, in most cases, the cultural, economic, educational and development conditions they deserve. The health implications are obvious and rheumatic diseases are no exception. Recent studies have shown that Amerindian genes predisposing to systemic lupus erythematosus<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> and the prevalence of rheumatoid arthritis in Native American groups seems to be increased in a population studied in the Maya of Yucatan.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> The ability to provide these groups with health services in rheumatology should be a part of comprehensive care.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Our region has a high frequency of obesity and diabetes. Health campaigns have emphasized the risks of this new pandemic in Latin America. The success of those campaigns certainly has a positive effect on the frequency of gout, knee osteoarthritis and back pain. Rheumatology in Latin America must adjust its services to meet the growing number of these pathologies.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Rheumatology Societies in Latin America now recognize that the number of rheumatologists is insufficient to meet the demands imposed by rheumatic diseases.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Immediate adjustments are required to change an unflattering future for rheumatic patient care in our countries. May this document lead us to careful reflection and purposeful action to achieve what we all seek, timely and efficient care for our patients.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflict of Interest</span><p id="par0060" class="elsevierStylePara elsevierViewall">The authors have no conflict of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflict of Interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Cardiel MH. Presente y futuro de las enfermedades reumáticas en Iberoamérica. ¿Estamos preparados para hacerles frente? Reumatol Clin. 2011. <span class="elsevierStyleInterRef" href="doi:10.1016/j.reuma.2010.12.009">doi:10.1016/j.reuma.2010.12.009</span>.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:14 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Multimorbidity: prevalence, effect on quality of life and daily functioning, and variation of this effect when one condition is a rheumatic disease" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "EPISER Study Group" "etal" => false "autores" => array:4 [ 0 => "E. Loza" 1 => "J.A. Jover" 2 => "L. Rodriguez" 3 => "L. 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Year/Month | Html | Total | |
---|---|---|---|
2024 November | 11 | 12 | 23 |
2024 October | 42 | 56 | 98 |
2024 September | 41 | 20 | 61 |
2024 August | 63 | 42 | 105 |
2024 July | 57 | 36 | 93 |
2024 June | 52 | 29 | 81 |
2024 May | 41 | 29 | 70 |
2024 April | 57 | 24 | 81 |
2024 March | 50 | 42 | 92 |
2024 February | 40 | 37 | 77 |
2024 January | 31 | 23 | 54 |
2023 December | 30 | 31 | 61 |
2023 November | 44 | 35 | 79 |
2023 October | 57 | 46 | 103 |
2023 September | 65 | 37 | 102 |
2023 August | 33 | 21 | 54 |
2023 July | 31 | 16 | 47 |
2023 June | 40 | 30 | 70 |
2023 May | 34 | 20 | 54 |
2023 April | 31 | 21 | 52 |
2023 March | 40 | 29 | 69 |
2023 February | 63 | 29 | 92 |
2023 January | 42 | 25 | 67 |
2022 December | 56 | 40 | 96 |
2022 November | 53 | 42 | 95 |
2022 October | 40 | 42 | 82 |
2022 September | 44 | 36 | 80 |
2022 August | 27 | 44 | 71 |
2022 July | 36 | 46 | 82 |
2022 June | 34 | 42 | 76 |
2022 May | 38 | 47 | 85 |
2022 April | 57 | 56 | 113 |
2022 March | 51 | 69 | 120 |
2022 February | 49 | 57 | 106 |
2022 January | 31 | 49 | 80 |
2021 December | 29 | 41 | 70 |
2021 November | 33 | 38 | 71 |
2021 October | 53 | 67 | 120 |
2021 September | 37 | 59 | 96 |
2021 August | 23 | 50 | 73 |
2021 July | 20 | 23 | 43 |
2021 June | 42 | 38 | 80 |
2021 May | 39 | 41 | 80 |
2021 April | 66 | 104 | 170 |
2021 March | 60 | 42 | 102 |
2021 February | 26 | 16 | 42 |
2021 January | 33 | 29 | 62 |
2020 December | 44 | 28 | 72 |
2020 November | 43 | 27 | 70 |
2020 October | 25 | 16 | 41 |
2020 September | 54 | 26 | 80 |
2020 August | 26 | 21 | 47 |
2020 July | 36 | 20 | 56 |
2020 June | 49 | 32 | 81 |
2020 May | 37 | 14 | 51 |
2020 April | 26 | 22 | 48 |
2020 March | 21 | 8 | 29 |
2020 February | 1 | 0 | 1 |
2020 January | 5 | 0 | 5 |
2019 September | 6 | 0 | 6 |
2019 June | 2 | 0 | 2 |
2019 March | 2 | 0 | 2 |
2019 January | 1 | 0 | 1 |
2018 May | 5 | 1 | 6 |
2018 April | 48 | 11 | 59 |
2018 March | 84 | 10 | 94 |
2018 February | 33 | 7 | 40 |
2018 January | 29 | 2 | 31 |
2017 December | 34 | 4 | 38 |
2017 November | 36 | 9 | 45 |
2017 October | 31 | 3 | 34 |
2017 September | 38 | 11 | 49 |
2017 August | 51 | 8 | 59 |
2017 July | 54 | 11 | 65 |
2017 June | 74 | 12 | 86 |
2017 May | 74 | 10 | 84 |
2017 April | 79 | 10 | 89 |
2017 March | 69 | 13 | 82 |
2017 February | 43 | 9 | 52 |
2017 January | 43 | 9 | 52 |
2016 December | 55 | 17 | 72 |
2016 November | 42 | 14 | 56 |
2016 October | 68 | 13 | 81 |
2016 September | 82 | 13 | 95 |
2016 August | 57 | 18 | 75 |
2016 July | 46 | 8 | 54 |
2016 June | 1 | 11 | 12 |
2016 May | 0 | 6 | 6 |
2016 April | 1 | 5 | 6 |
2016 March | 1 | 6 | 7 |
2016 February | 1 | 13 | 14 |
2016 January | 1 | 13 | 14 |
2015 December | 2 | 20 | 22 |
2015 November | 0 | 10 | 10 |
2015 October | 2 | 15 | 17 |
2015 August | 2 | 0 | 2 |
2015 July | 24 | 6 | 30 |
2015 June | 37 | 4 | 41 |
2015 May | 54 | 9 | 63 |
2015 April | 71 | 16 | 87 |
2015 March | 46 | 6 | 52 |
2015 February | 58 | 8 | 66 |
2015 January | 47 | 10 | 57 |
2014 December | 66 | 7 | 73 |
2014 November | 55 | 9 | 64 |
2014 October | 55 | 6 | 61 |
2014 September | 66 | 5 | 71 |
2014 August | 48 | 12 | 60 |
2014 July | 47 | 12 | 59 |
2014 June | 66 | 9 | 75 |
2014 May | 47 | 21 | 68 |
2014 April | 46 | 6 | 52 |
2014 March | 80 | 16 | 96 |
2014 February | 47 | 12 | 59 |
2014 January | 53 | 13 | 66 |
2013 December | 45 | 5 | 50 |
2013 November | 41 | 10 | 51 |
2013 October | 45 | 7 | 52 |
2013 September | 45 | 9 | 54 |
2013 August | 60 | 16 | 76 |
2013 July | 35 | 12 | 47 |
2013 June | 49 | 6 | 55 |
2013 May | 40 | 7 | 47 |
2013 April | 45 | 15 | 60 |
2013 March | 40 | 15 | 55 |
2013 February | 41 | 8 | 49 |
2013 January | 34 | 11 | 45 |
2012 December | 22 | 16 | 38 |
2012 November | 15 | 4 | 19 |
2012 October | 12 | 7 | 19 |
2012 September | 9 | 4 | 13 |
2012 June | 5 | 0 | 5 |
2012 May | 4 | 0 | 4 |
2012 April | 8 | 0 | 8 |
2012 March | 3 | 0 | 3 |
2012 February | 9 | 0 | 9 |
2012 January | 7 | 0 | 7 |
2011 December | 11 | 0 | 11 |
2011 November | 17 | 0 | 17 |
2011 October | 15 | 0 | 15 |