NHS in Trouble? What’s true and what’s not?

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This is an article published in the Daily Mail 24 February. GPs claim that vital scans are performed late and this situation might delay cancer diagnosis. Cut budgets may be behind this situation.

Este artículo fue publicado en el Daily Mail el 24 de Febrero. En él, los médicos de AP británicos alegan que el retraso en pruebas vitales com Resonancias y TAC, están produciendo un retraso diagnóstico del cáncer, vital para muchos pacientes. El ajuste presupuestario y los recortes sanitarios podrían tener la culpa. ¿les suena de algo?

 

Copies. What’s a biologic copy?

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A copy is a biological agent that has been launched to the market claiming that has the same properties, in terms of efficacy and safety than those of the biological agent of reference. Nevertheless, the big difference with biosimilars, is that in no case have been developed with the standards of quality required for biosimilars. This is the main reason why these ‘copies’ have not been approved by the most important regulative agencies, as the EMA (European Union) and the FDA (USA); and therefore they will never be commercialized in these countries. Usually, they are produced in India or China and have managed to be commercialized in some countries. But at the present is very difficult for me to know exactly in which countries are available.

What’s a Biologic?

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A Biological is a protein that blocks another protein (cytokine) that plays an important role in the inflammation of some rheumatic diseases. The most well known are TNF and Interleukin 6 (IL-6). Not always, biologics block cytokines. They may also target cells that have an important role in inflammation or block the interaction of different cells, which, stimulates inflammation. The fundamental difference with other therapeutic agents is that most of the drugs are chemical compounds. However, biologics just for being proteins have a very complex structure and higher molecular weight, and they are degraded in the stomach quickly, which, prevent to administer orally. Therefore, biologics are only given intravenously or subcutaneously (such as insulin).

Note: Biological are not exclusive treatments for rheumatic diseases, other diseases, such as cancer and many others, also have biological treatment

See section Biologics, to find the topic in extend

Doc, do I have lupus?

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Systemic Lupus Erythematosus (SLE) is an autoimmune disorder that may affect the joints, skin, kidneys, central nervous system and other vital organs. SLE is much more frequent in women than men (9 w. to 1 m.). SLE is more severe in Afro-Americans than in white people
Many times the disease starts with pain and swelling joints with a distribution very similar to rheumatoid arthritis. Most of the times, the joint involvement is indistinguishable from RA. This similarity is one the most frequent consultations to the rheumatologist because the patient wants to know if he/she has RA or lupus. Other characteristics, like sun sensitive skin rash (or skin rash no-sun sensitive), kidney involvement, haematological manifestations may give the clue to diagnosing lupus instead of RA. A blood test in SLE patients may detect some hematological abnormalities that suggest the diagnosis. However, is the presence of some antibodies, like ANA (antinuclear antibodies) and especially anti-DNA what will help definitively to establish the diagnosis.
Nonetheless, there are many patients with mild lupus that only require hydroxychloroquine and sometimes low doses of steroids for long periods of his/her life. When lupus is severe and involves vital organs, high doses of steroids and immunosuppressive drugs are the gold standard of the treatment.

Doc, do I have Ankylosing spondylitis (AS)

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If you are between 16 and 45 years old and have persistent low back pain, you should consult your rheumatologist to exclude AS.Nonetheless, there are some characteristics of pain in this disease that may increase the probabilities of having AS.

Most of the patients with AS have inflammatory back pain. Pain usually presents as nocturnal pain that difficult the sleep. Patients wake up several times, and especially the patients feel very stiff early in the morning with a great difficulty to move. Pain improves during the day,and NSAIDs are usually effective to relieve pain.

Important: Don’t forget that back pain is one of the most common symptoms that will hurt any person along his/her life. Most back pains have nothing to do with AS. So, your rheumatologist is the target physician to gives you the right diagnosis.