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García-Aparicio A, Alonso Martín L, Quirós Zamorano R, López Lancho R, Del Olmo Pérez L, Sánchez Fernández S, García de Yébenes MJ, Jiménez Escribano R, González Del Valle F, Muñoz-Fernández S. Complications of uveitis in a Spanish population, UveCAM study. Arch Soc Esp Oftalmol (Engl Ed) 2022; 97:244-250. [PMID: 35469772 DOI: 10.1016/j.oftale.2022.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 10/23/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To estimate the population frequency of uveitis complications and to evaluate their main risk factors in the patients with uveitis from the UVECAM study. PATIENTS AND METHODS Development of complications in 386 patients with uveitis in the whole health area of the province of Toledo (UVECAM study) during a period of 1 year. Description of complications and study of their possible determinants by means of multivariate regression models. RESULTS Information on the development of complications was available in 371 of the 386 patients of the UVECAM study. The most frequent complications were posterior synechiae (19.0%), ocular hypertension (14.0%), macular edema (7.5%), epirretinal membrane (6.9%), glaucoma (6.6%), iridian atrophy (5.6%) and cataract (5.5%). The risk of complications increases with age, intermediate and panuveitis locations, and those of chronic or recurrent evolution. CONCLUSION Uveitis is associated with a high frequency of complications, especially in older patients, with intermediate or posterior localization of the inflammatory process and chronic or recurrent evolution.
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Affiliation(s)
- A García-Aparicio
- Sección de Reumatología, Hospital Virgen de la Salud, Complejo Hospitalario Universitario de Toledo, Toledo, Spain.
| | - L Alonso Martín
- Servicio de Oftalmología, Hospital Virgen de la Salud, Complejo Hospitalario Universitario de Toledo, Toledo, Spain
| | - R Quirós Zamorano
- Sección de Oftalmología, Hospital Nuestra Señora del Prado, Talavera de la Reina, Toledo, Spain
| | - R López Lancho
- Sección de Oftalmología, Hospital Nuestra Señora del Prado, Talavera de la Reina, Toledo, Spain
| | - L Del Olmo Pérez
- Sección de Reumatología, Hospital Nuestra Señora del Prado, Talavera de la Reina, Toledo, Spain
| | - S Sánchez Fernández
- Sección de Reumatología, Hospital General La Mancha-Centro, Alcázar de San Juan, Ciudad Real, Spain
| | | | - R Jiménez Escribano
- Servicio de Oftalmología, Hospital Virgen de la Salud, Complejo Hospitalario Universitario de Toledo, Toledo, Spain
| | - F González Del Valle
- Servicio de Oftalmología, Hospital General La Mancha-Centro, Alcázar de San Juan, Ciudad Real, Spain
| | - S Muñoz-Fernández
- Servicio de Reumatología, Hospital Universitario Infanta Sofía, Facultad de Ciencias Biomédicas y de la Salud, Universidad Europea, San Sebastián de los Reyes, Madrid, Spain
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Fernández-Díaz C, Castañeda S, Melero-González RB, Ortiz-Sanjuán F, Juan-Mas A, Carrasco-Cubero C, Casafont-Solé I, Olivé A, Rodríguez-Muguruza S, Almodóvar-González R, Castellanos-Moreira R, Rodríguez-García SC, Aguilera-Cros C, Villa I, Ordóñez-Palau S, Raya-Alvarez E, Morales-Garrido P, Ojeda-García C, Moreno-Ramos MJ, Bonilla Hernán MG, Hernández Rodríguez I, López-Corbeto M, Andreu JL, Jiménez de Aberásturi JRD, Ruibal-Escribano A, Expósito-Molinero R, Pérez-Sandoval T, López-Robles AM, Carreira-Delgado P, Mena-Vázquez N, Urruticoechea-Arana A, Peralta-Ginés C, Arboleya-Rodríguez L, Narváez García FJ, Palma-Sánchez D, Cervantes Pérez EC, Maiz-Alonso O, Alvarez-Rivas MN, Fernández-Melón J, Vela Casasempere P, Cabezas-Rodríguez I, Castellvi-Barranco I, González-Montagut C, Blanco-Madrigal J, Del Val-Del Amo N, Fito MC, Rodríguez-Gómez M, Salgado-Pérez E, García-Magallón B, Hidalgo-Calleja C, López-Sánchez R, Fernández-Aguado S, Fernández-López JC, Castro-Oreiro S, Serrano-García I, García-Valle A, Romero-Yuste S, Expósito-Pérez L, Pérez-Albadalejo L, García-Aparicio A, Quillis-Marti N, Bernal-Vidal JA, Loricera-García J, Hernández JL, González-Gay MA, Blanco R. Abatacept in interstitial lung disease associated with rheumatoid arthritis: national multicenter study of 263 patients. Rheumatology (Oxford) 2020; 59:3906-3916. [DOI: 10.1093/rheumatology/keaa621] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/01/2020] [Indexed: 01/11/2023] Open
Abstract
Abstract
Objective
To assess the efficacy of abatacept (ABA) in RA patients with interstitial lung disease (ILD) (RA-ILD).
Methods
This was an observational, multicentre study of RA-ILD patients treated with at least one dose of ABA. ILD was diagnosed by high-resolution CT (HRCT). We analysed the following variables at baseline (ABA initiation), 12 months and at the end of the follow-up: Modified Medical Research Council (MMRC) scale (1-point change), forced vital capacity (FVC) or diffusion lung capacity for carbon monoxide (DLCO) (improvement or worsening ≥10%), HRCT, DAS on 28 joints evaluated using the ESR (DAS28ESR) and CS-sparing effect.
Results
We studied 263 RA-ILD patients [150 women/113 men; mean (s.d.) age 64.6 (10) years]. At baseline, they had a median duration of ILD of 1 (interquartile range 0.25–3.44) years, moderate or severe degree of dyspnoea (MMRC grade 2, 3 or 4) (40.3%), FVC (% of the predicted) mean (s.d.) 85.9 (21.8)%, DLCO (% of the predicted) 65.7 (18.3) and DAS28ESR 4.5 (1.5). The ILD patterns were: usual interstitial pneumonia (UIP) (40.3%), non-specific interstitial pneumonia (NSIP) (31.9%) and others (27.8%). ABA was prescribed at standard dose, i.v. (25.5%) or s.c. (74.5%). After a median follow-up of 12 (6–36) months the following variables did not show worsening: dyspnoea (MMRC) (91.9%); FVC (87.7%); DLCO (90.6%); and chest HRCT (76.6%). A significant improvement of DAS28ESR from 4.5 (1.5) to 3.1 (1.3) at the end of follow-up (P < 0.001) and a CS-sparing effect from a median 7.5 (5–10) to 5 (2.5–7.5) mg/day at the end of follow-up (P < 0.001) was also observed. ABA was withdrawn in 62 (23.6%) patients due to adverse events (n = 30), articular inefficacy (n = 27), ILD worsening (n = 3) and other causes (n = 2).
Conclusion
ABA may be an effective and safe treatment for patients with RA-ILD.
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Affiliation(s)
| | - Santos Castañeda
- Rheumatology Cátedra UAM-Roche (EPID-Future) HU La Princesa, IIS-Princesa, UAM, Madrid
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - José L Hernández
- Rheumatology, HU Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander
| | | | - Ricardo Blanco
- Rheumatology, HU Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander
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García-Aparicio A, Alonso Martín L, López Lancho R, Quirós Zamorano R, Del Olmo Perez L, Sánchez Fernández S, Otón T, Jiménez Escribano R, González Del Valle F, Muñoz-Fernández S. Epidemiology of Uveitis in a Spanish Region: Prevalence and Etiology. Ophthalmic Epidemiol 2020; 28:227-236. [PMID: 32893701 DOI: 10.1080/09286586.2020.1815802] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To estimate the prevalence of uveitis and to describe its etiologic and anatomical patterns based on a population study carried out in a Spanish region. MATERIAL AND METHODS A cross-sectional, descriptive, population-based multicenter study was conducted. The selection criteria consisted of having a diagnosis of uveitis. All data were collected from existing information in medical records.Clinical information was collected in all cases that had a diagnosis of uveitis, regardless of its etiology, in participating centers from the date of the study to the end of the following year. All patients underwent a complete ophthalmological examination, which included assessment of their visual acuity, biomicroscopy, applanation tonometry, and indirect ophthalmoscopy. RESULTS During the study, 389 cases of uveitis were registered. The prevalence was 58.7 (95% confidence interval [CI] 53.0-64.9). The mean age was 47.0 ± 20.6 years and 57.8% were women. The most prevalent anatomical pattern was anterior uveitis (54.2; 95% CI 48.1-60.8). For adults, the idiopathic group constituted the highest prevalence (31.7; 95% CI: 27.1-36.9), while autoimmune etiology was most frequent for children (10.6; 95% CI: 5.8-17.7). CONCLUSION The results of this population-based study offer a representative estimate of the magnitude of uveitis in this area of Spain.
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Affiliation(s)
- A García-Aparicio
- Department of Rheumatology, Hospital Virgen De La Salud, Complejo Hospitalario De Toledo, Toledo, Spain
| | - L Alonso Martín
- Department of Ophthalmology, Hospital Virgen De La Salud, Complejo Hospitalario De Toledo, Toledo, Spain
| | - R López Lancho
- Department of Ophthalmology, Hospital Nuestra Señora Del Prado, Talavera De La Reina, Toledo, Spain
| | - R Quirós Zamorano
- Department of Ophthalmology, Hospital Nuestra Señora Del Prado, Talavera De La Reina, Toledo, Spain
| | - L Del Olmo Perez
- Department of Rheumatology, Hospital Nuestra Señora Del Prado, Talavera De La Reina, Toledo, Spain
| | - S Sánchez Fernández
- Department of Rheumatology, Hospital General La Mancha-Centro, Alcázar De San Juan, Ciudad Real, Spain
| | - T Otón
- Instituto De Salud Musculoesquelética (Inmusc), Madrid, Spain
| | - R Jiménez Escribano
- Department of Ophthalmology, Hospital Virgen De La Salud, Complejo Hospitalario De Toledo, Toledo, Spain
| | - F González Del Valle
- Department of Ophthalmology, Hospital General La Mancha-Centro, Alcázar De San Juan, Ciudad Real, Spain
| | - S Muñoz-Fernández
- Department of Rheumatology, Infanta Sofía University Hospital, San Sebastián De Los Reyes, Madrid, Spain; Universidad Europea De Madrid, Madrid, Spain
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González-Álvaro I, Blasco AJ, Lázaro P, Sánchez-Piedra C, Almodovar R, Bachiller-Corral J, Balsa A, Caliz R, Candelas G, Fernández-Carballido C, García-Aparicio A, García-Magallón B, García-Vicuña R, Gómez-Centeno A, Ortiz AM, Sanmartí R, Sanz J, Tejera B. REDOSER project: optimising biological therapy dose for rheumatoid arthritis and spondyloarthritis patients. Heliyon 2017; 3:e00452. [PMID: 29264411 PMCID: PMC5727544 DOI: 10.1016/j.heliyon.2017.e00452] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 08/01/2017] [Accepted: 11/06/2017] [Indexed: 11/16/2022] Open
Abstract
Background Reducing the dose of biological therapy (BT) when patients with immune-mediated arthritis achieve a sustained therapeutic goal may help to decrease costs for national health services and reduce the risk of serious infection. However, there is little information about whether such a decision can be applied universally. Therefore, the objective of this study was to develop appropriateness criteria for reducing the dose of BT in patients with rheumatoid arthritis (RA), axial spondyloarthritis (axSpA), and peripheral spondyloarthritis (pSpA). Methods The RAND/UCLA appropriateness method was coordinated by experts in the methodology. Five rheumatologists with clinical research experience in RA and/or SpA selected and precisely defined the variables considered relevant when deciding to reduce the dose of BT in the 3 diseases, in order to define patient profiles. Ten rheumatologists with experience in prescribing BT anonymously rated each profile on a scale of 1 (completely inappropriate) to 9 (completely appropriate) after revising a summary of the evidence obtained from 4 systematic literature reviews carried out specifically for this project. Findings A total of 2,304 different profiles were obtained for RA, 768 for axSpA, and 3,072 for pSpA. Only 327 (14.2%) patient profiles in RA, 80 (10.4%) in axSpA, and 154 (5%) in pSpA were considered appropriate for reducing the dose of BT. By contrast, 749 (32.5%) patient profiles in RA, 270 (35.3%) in axSpA, and 1,243 (40.5%) in pSpA were considered inappropriate. The remaining profiles were considered uncertain. Interpretation Appropriateness criteria for reducing the dose of BT were developed in 3 inflammatory conditions. These criteria can help clinicians treating these disorders to optimize the BT dose. However, further research is needed, since more than 50% of the profiles were considered uncertain and the real prevalence of each profile in daily clinical practice remains unknown.
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Affiliation(s)
- Isidoro González-Álvaro
- Rheumatology Service, Hospital Universitario La Princesa, IIS-IP, c/Diego de León 62, Madrid 28006, Spain
- Corresponding author.
| | | | - Pablo Lázaro
- Independent Health Services Researcher, Madrid, Spain
| | - Carlos Sánchez-Piedra
- Research Unit, Spanish Society of Rheumatology, c/Marques del Duero 5, Madrid 28001, Spain
| | - Raquel Almodovar
- Rheumatology Section, Hospital Universitario Fundación Alcorcón, c/Budapest 1, Alcorcón 28922, Spain
| | - Javier Bachiller-Corral
- Rheumatology Service, Hospital Universitario Ramon y Cajal, C/Colmenar Viejo km 9.1, Madrid 28034, Spain
| | - Alejandro Balsa
- Rheumatology Service, Hospital Univeritario La Paz, IdIPaz, Paseo de la Castellana 261, Madrid 28046, Spain
| | - Rafael Caliz
- Rheumatology Service, Hospital Universitario Virgen de la Nieves, Avenida de las Fuerzas Armadas 2, Granada 18014, Spain
| | - Gloria Candelas
- Rheumatology Service, Hospital Clínico San Carlos, IdISSC, c/Profesor Martin Lagos s/n, Madrid 28040, Spain
| | | | - Angel García-Aparicio
- Rheumatology Service, Hospital Virgen de la Salud, Avda de Barber 30, Toledo 45004, Spain
| | - Blanca García-Magallón
- Rheumatology Unit, Hospital General San Jorge, Avda Martinez Velasco 36, Huesca 22004, Spain
| | - Rosario García-Vicuña
- Rheumatology Service, Hospital Universitario La Princesa, IIS-IP, c/Diego de León 62, Madrid 28006, Spain
| | - Antonio Gómez-Centeno
- Rheumatology Service, Hospital Universitario Parc Taulí, Parc Taulí 1, Sabadell 08208, Spain
| | - Ana M. Ortiz
- Rheumatology Service, Hospital Universitario La Princesa, IIS-IP, c/Diego de León 62, Madrid 28006, Spain
| | - Raimon Sanmartí
- Rheumatology Service, Hospital Clinic, c/Villarroel 170, Barcelona 08036, Spain
| | - Jesús Sanz
- Rheumatology Service, Hospital Universitario Puerta de Hierro, c/Manuel de Falla 1, Majadahonda 28222, Spain
| | - Beatriz Tejera
- Rheumatology Service, Hospital Universitario de Canarias, C/Ofra s/n, Santa Cruz de Tenerife 38320, Spain
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Beneyto P, Fernández MJ, García A, Ibáñez M, García-Aparicio A, Morente P. [Fuchs' heterochromic cyclitis without heterochromia: a diagnostic approach]. ACTA ACUST UNITED AC 2007; 82:355-9. [PMID: 17573645 DOI: 10.4321/s0365-66912007000600007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To obtain diagnostic guidelines of Fuchs' heterochromic cyclitis (FHC) in the absence of heterochromia using Bayesian methods. METHODS The pre-test and post-test likelihood that a certain patient without heterochromia (but with other characteristic symptoms of the disease such as iris nodules, cataracts, glaucoma or vitritis) has FCH, was assessed by the Bayes' theorem for conditioned likelihood. The prevalence values of FCH and the presentation rate of symptoms in FCH and in other forms of anterior uveitis were obtained from published literature data. RESULTS In the absence of heterochromia, the combination of iris nodules together with cataracts, vitritis or glaucoma, and the association of the last three symptoms in the absence of nodules, resulted in an accumulated likelihood of more than 50% of subjects having the disease. CONCLUSIONS The coincidence in one patient of several indicative symptoms, even in the absence of heterochromia, may make FCH a likely diagnostic option.
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Affiliation(s)
- P Beneyto
- Servicio de Oftalmología y Servicio de Reumatología, Hospital Virgen de la Salud, Toledo, España.
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