Armando Calvo

Defining Quality of Rheumatologic Care: Peru

P erú’ s population in 2015 was estimated to be approximately 31 million, 7% of which was older than 60 years; this is more than double that in 1960 when this age group represented only approximately 3% of the population. This change has resulted in a greater demand for rheumatologic care. The Peruvian College of Physicians’ register includes 231 active rheumatologists; this number is insufficient to provide adequate care to all patients, especially if access to health care improves over time. Article 7 of the Peruvian Constitution guarantees the right to health for all its citizens; furthermore, the Universal Health Insurance Framework Law guarantees that all residents should have access to a minimum health care according to the Essential Health Insurance Plan; the first step toward achieving this goal in Perú, in terms of rheumatological care, is to provide complete coverage for osteoporosis, osteoarthritis, rheumatoid arthritis, and back pain; however, because the health system is fragmented and national guidelines on the treatment of these conditions are generally lacking, the care patients receive is quite fragmentary and inequitable, and it is heavily influenced by the individual’s socioeconomic status. Furthermore, more complex rheumatologic diseases are not even part of this basic menu. As a corollary, the access to advanced therapies (biologicals) is quite uneven among Peruvians (vide infra).

Arteritis de Takayasu

Revisamos los casos de Arteritis de Takayasu (AT) diagnosticados en el Hospital Cayetano Heredia entre 1970 y 1988. Reportamos 7 pacientes con diagnostico angiografico de AT, todas mujeres, seis de raza mestiza y una blanca. El tiempo de enfermedad promedio al diagnostico fue de 7 anos (rango: 4 meses a 15 anos). Los pacientes tuvieron sintomas sistemicos (fiebre, artralgias, cefalea); sintomas y signos de estenosis vascular (claudicacion, hipertension), todos presentaron soplos vasculares y seis ausencias de pulsos. Se documento por estudio angiografico varias zonas de compromiso arterial con diferentes combinaciones de lesiones: irregularidad, estenosis y obstruccion del lumen. Con el uso de esteroides y citotoxicos se logro el control y una buena evolucion. Una paciente requirio “by pass” coronario y tuvo seguimiento satisfactorio por 5 anos.

Dolor abdominal en LES.

Desde 1895 cuando Osler describio 11 casos con cuadro doloroso abdominal y hallazgos patologicos de lo que el denomino “Eritema exudativo multiforme con crisis abdominal” (1), se reconoce al dolor abdominal como una frecuente manifestacion del Lupus Erimatoso Sistemico (LES), llegando a ocurrir en mas del 20% de los pacientes, segun algunos reportes: con una serie de mecanismos etiopatogenicos implicados, entre ellos la vasculitis intraabdominal, que siendo la menos frecuente, es la mas devastadora, con una mortalidad de hasta 50% (2-5); lo cual refleja la dificultad de establecer un diagnostico temprano, como para instaurar un tratamiento adecuado y revertir el proceso.