Experience and Evidence, Key to Clinical Research

By :
    Estefanía Fajardo
    Periodista científica de Global Rheumatology by PANLAR.

30 August, 2021
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Dr. Luis Javier Jara talks about his participation in PANLAR 2021 with oral presentations, controversies, and development of research on different diseases.

 


 

Transcript

 

EF: Hello everyone and welcome to a new Global Rheumatology videoblog, where we will be addressing in a series of interviews what will be the PANLAR 2021 Congress. We are with Dr. Luis Javier Jara. Doctor, welcome. 

 

LJ: Thank you very much, Estefania, for this opportunity to address all the people who see us through Global Rheumatology who are listening to us, and who are going to participate in this next congress, which I believe will be, by the way, a success, given its organization.

 

EF: Let's talk a little bit about some of the several participations in this PANLAR 2021 Congress…

 

LJ: Yes, we are a group of people, physicians, students, research social services, and internal residents of Rheumatology who have prepared several papers for the Congress and I also had the honor of being invited to participate in a session that, I think is a very important, very relevant topic, because PANLAR has organized controversy sessions and this topic is called Controversies in the management of antiphospholipid antibody syndrome, the topic is whether the new anticoagulants have a place in the treatment of antiphospholipid body syndrome.

 

For example, there is a paper that describes the clinical course of 12 patients with systemic sclerosis and who were infected by covid-19, and then there is the clinical course, the radiological course and an analysis of the treatments that have been received for this syndrome, considering their rheumatic disease. 

 

Another important work that we also present is the experience of dermatovatous vasculitis in relation to the clinical course also over many years of observation. In this group of patients, we analyze all aspects, prognostic factors, good prognostic factors, poor prognostic factors. And, of course, it is clear that early diagnosis of these diseases is the key to timely treatment and better survival and clinical course.

 

In relation to the first topic of controversy, antiphospholipid antibodies, it is necessary to remind the audience, which is very varied, that this is a relatively new syndrome, it was described in the 80's, at the beginning of the 80's, of the last century, by Professor Graham Hughes and collaborators from the United Kingdom who found that in patients with lupus there was a group that had developed repeated thrombosis and had antibodies called antiphospholipid antibodies, including anticardiolipin antibodies, anti-beta-2 glycoprotein antibodies, lupus anticoagulant, in short, several antibodies that are present in these patients with lupus, first and/or only with the syndrome, without any disease. And the controversy is that with the arrival of the new anticoagulants, they began to be used indiscriminately with all these patients, whose treatment is based on prolonged anticoagulation, and it was observed that a group of patients receiving these treatments with the new anticoagulants developed more thrombosis than those receiving the conventional treatment, the treatment based on vitamin K inhibitors. 

 

That is the central point of the discussion where evidence for and against will be presented, and this is a great idea proposed by Paula Alba, Sabrina Porta and Guillermo Pons-Estel, and they invited me to participate in this controversy.

 

I believe that it will be of great interest to all of us, we are all going to learn because that is the objective of one of these meetings, that we all learn what there is about this syndrome, about its treatment and what is going to be the best treatment, or the most appropriate at this time to manage this type of patients who, as I said, have recurrent thrombosis, have maternal-fetal complications. And, therefore, they can be seen by any specialist at any time, a general practitioner may encounter a patient with recurrent thrombosis at a young age who does not have any risk factor, a woman who becomes pregnant may have a recurrent fetal loss, two, three losses, and you have to know for what reason it is, ruling out other common causes, an ophthalmologist may see retinal thrombosis and thus we can see a series of conditions, decreased platelets, it may be the beginning of a syndrome, recurrent deep vein thrombosis, cerebral vascular events, all of which I believe will be of great interest to everyone. 

 

I sincerely invite you to participate with your questions, especially to enrich this topic.

 

EF: Doctor, there is a point that you touched on at the beginning of your answer and that is teamwork and also observational work over the years. Tell us a little bit about the importance of this. 

 

LJ: Clinical research, which is what we predominantly do, is born in the daily visit, in the patient's daily visit. I learned this many years ago with my professors, with Professor Luis Espinoza, for example, from the United States, when I had the opportunity to work with him, before that Antonio Fraga, in Mexico, when he was the director of the hospital, he visited us and said, well, let's see patient, show me this patient, show me this patient, let's see. We can see a patient with a special skin lesion, and he would say, let's see how many cases of this have been described? How many are there in the literature? Let's look in the literature and in this way we gather the evidence for a case that may be exceptional for us, but when we review the literature it is no longer exceptional, or sometimes a case that seems common to us and when we review the literature it is not true, there are very few cases of it..

 

And so we are enriching our knowledge, first with experience and then with evidence, but if we do not publish the experience we have, that experience remains just locked up in our circle, whereas if we have the courage, because we must have the courage to write that case, from describing it in that exceptional case or that group of patients, or doing a controlled clinical study, or testing it in a treatment, if we do not have the courage to do so, nobody will find out what we know and it is our obligation to transmit that knowledge, to transmit what we see. To transmit what we do on a daily basis so that in any part of the world someone can read what we have seen, what we have arrived at. Well, in Colombia they just saw a case like this, look how they treated it, it is similar to ours because we are in Russia, because we are in Turkey, no, so this one, but why do they do that? Because that case has already been published. 

 

That is why clinical research is so important, since it is born in daily visits; basic research is done in laboratories and epidemiological research is done in population groups, in diseases that affect large groups. 

 

EF: Doctor, you mentioned a couple of specialties that do not have to do with Rheumatology, but that can see cases close to that, so I invite you to call on all specialists, all physicians to also be interested in what we are presenting here at PANLAR 2021. 

 

LJ: Ah, of course, you can find an angiologist, you can find a patient with arterial thrombosis and he says, we are going to anticoagulate him, and he has signs of antiphospholipid antibodies and if he is going to give him the direct oral anticoagulants that we currently have, because they are the modern ones, they are the current ones, and if they do not learn that they are not the appropriate ones to manage this patient, that what we have to do is to manage them with the classic antifreeze because there is a previous study done by the Italians showing that direct oral anticoagulants are associated with a greater number of thrombosis than classic anticoagulants, they are going to give them precisely what is going to cause thrombosis because they did not find out at this congress that this agreement was reached. That is why it is important, angiologists, gynecologists, obstetricians, neurologists, ophthalmologists, in short, multiple specialists, the general practitioner, of course, has to be interested, he is the first contact, he is the one who sees the patient for the first time, and he has to train himself to see what is really going to be very relevant for the patient's life.

 

EF: Doctor, thank you very much for this space for Global Rheumatology. 

 

LJ: Thank you very much, Estefania. Our presentation will take place on the 13th of this month. I think around noon, you can check the program and we will be there listening to your questions and comments.

 

When?

August 13th.

Time

16:34 - 16:44 Colombia

17:34 a 18:44 Miami

15:34 a 15:44 Costa Rica

18:34 a 18:44 Argentina

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