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Carmona EG, Callejas-Rubio JL, Raya E, Ríos-Fernández R, Villanueva-Martín G, Cid MC, Hernández-Rodríguez J, Ballestar E, Timmermann B, Ortego-Centeno N, Martín J, Márquez A. Single-cell transcriptomic profiling reveals a pathogenic role of cytotoxic CD4 + T cells in giant cell arteritis. J Autoimmun 2024; 142:103124. [PMID: 37952293 DOI: 10.1016/j.jaut.2023.103124] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 09/27/2023] [Accepted: 10/04/2023] [Indexed: 11/14/2023]
Abstract
Giant cell arteritis (GCA) is a systemic vasculitis mediated by an aberrant immunological response against the blood vessel wall. Although the pathogenic mechanisms that drive GCA have not yet been elucidated, there is strong evidence that CD4+ T cells are key drivers of the inflammatory process occurring in this vasculitis. The aim of this study was to further delineate the role of CD4+ T cells in GCA by applying single-cell RNA sequencing and T cell receptor (TCR) repertoire profiling to 114.799 circulating CD4+ T cells from eight GCA patients in two different clinical states, active and in remission, and eight healthy controls. Our results revealed an expansion of cytotoxic CD4+ T lymphocytes (CTLs) in active GCA patients, which expressed higher levels of cytotoxic and chemotactic genes when compared to patients in remission and controls. Accordingly, differentially expressed genes in CTLs of active patients were enriched in pathways related to granzyme-mediated apoptosis, inflammation, and the recruitment of different immune cells, suggesting a role of this cell type in the inflammatory and vascular remodelling processes occurring in GCA. CTLs also exhibited a higher clonal expansion in active patients with respect to those in remission. Drug repurposing analysis prioritized maraviroc, which targeted CTLs, as potentially repositionable for this vasculitis. In addition, effector regulatory T cells (Tregs) were decreased in GCA and showed lower expression of genes involved in their suppressive activity. These findings provide further insights into the pathogenic role of CD4+ T cells in GCA and suggest targeting CTLs as a potential therapeutic option.
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Affiliation(s)
- Elio G Carmona
- Institute of Parasitology and Biomedicine López-Neyra (IPBLN), Spanish National Research Council (CSIC), Granada, Spain; Systemic Autoimmune Diseases Unit, Hospital Universitario Clínico San Cecilio, Instituto de Investigación Biosanitaria de Granada ibs.GRANADA, Granada, Spain
| | - José Luis Callejas-Rubio
- Systemic Autoimmune Diseases Unit, Hospital Universitario Clínico San Cecilio, Instituto de Investigación Biosanitaria de Granada ibs.GRANADA, Granada, Spain
| | - Enrique Raya
- Rheumatology Department, Hospital Universitario Clínico San Cecilio, Instituto de Investigación Biosanitaria de Granada ibs.GRANADA, Granada, Spain
| | - Raquel Ríos-Fernández
- Systemic Autoimmune Diseases Unit, Hospital Universitario Clínico San Cecilio, Instituto de Investigación Biosanitaria de Granada ibs.GRANADA, Granada, Spain
| | - Gonzalo Villanueva-Martín
- Institute of Parasitology and Biomedicine López-Neyra (IPBLN), Spanish National Research Council (CSIC), Granada, Spain
| | - María C Cid
- Vasculitis Research Unit, Department of Autoimmune Diseases, Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - José Hernández-Rodríguez
- Vasculitis Research Unit, Department of Autoimmune Diseases, Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Esteban Ballestar
- Epigenetics and Immune Disease Group, Josep Carreras Research Institute (IJC), Badalona, Barcelona, Spain
| | | | - Norberto Ortego-Centeno
- Department of Medicine, University of Granada, Instituto de Investigación Biosanitaria de Granada ibs.GRANADA, Granada, Spain
| | - Javier Martín
- Institute of Parasitology and Biomedicine López-Neyra (IPBLN), Spanish National Research Council (CSIC), Granada, Spain
| | - Ana Márquez
- Institute of Parasitology and Biomedicine López-Neyra (IPBLN), Spanish National Research Council (CSIC), Granada, Spain.
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Joven B, Manteca CF, Rubio E, Raya E, Pérez A, Hernández R, Manrique S, Núñez M, Díaz-Cerezo S, Moyano S, Lacetera A, García-Vicuña R. Real-World Persistence and Treatment Patterns in Patients with Psoriatic Arthritis Treated with Anti-IL17 Therapy in Spain: The PerfIL-17 Study. Adv Ther 2023; 40:5415-5431. [PMID: 37804475 PMCID: PMC10611868 DOI: 10.1007/s12325-023-02693-w] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 09/22/2023] [Indexed: 10/09/2023]
Abstract
INTRODUCTION Given the growing interest and use of interleukin-17 inhibitors (anti-IL17) for the treatment of psoriatic arthritis (PsA), an observational study has been conducted to characterize the patient profile, treatment patterns, and persistence of ixekizumab or secukinumab in patients with PsA receiving them as first anti-IL17. METHODS This is a multicenter retrospective study, conducted at eight Spanish hospitals where data from adult patients with PsA were collected from electronic medical records. Three cohorts of patients, initiating treatment with an anti-IL17 [secukinumab 150 mg (SECU150), secukinumab 300 mg (SECU300), or ixekizumab (IXE)] between January 2019 and March 2021, were included. Demographic and clinical patient characteristics, treatment patterns, and persistence were analyzed descriptively. Continuous data were presented as mean [standard deviation (SD)] and categorical variables as frequencies with percentages. Persistence rates at 3, 6, and 12 months were calculated. RESULTS A total of 221 patients with PsA were included in the study [SECU150, 103 (46.6%); SECU300, 38 (17.2%); and IXE, 80 (36.2%)]. Treatment patterns differed by clinical characteristics: SECU150 was initiated more frequently in patients with moderate PsA and less peripheral joint involvement, while patients on SECU300 included those with a higher rate of enthesitis and active skin psoriasis, and patients on IXE showed a longer time since PsA diagnosis, more frequent comorbidities, joint involvement, and diagnosed skin psoriasis. Conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) were previously administered in 88.2% of patients and biologic or targeted synthetic disease-modifying anti-rheumatic drugs (b/tsDMARDs) were administered in 72.9%. The mean number of previous b/tsDMARDs was 2.4 (SD 1.5) in the IXE cohort, 1.7 (SD 0.9) in the SECU300 cohort, and 1.6 (SD 1.0) for those in the SECU150 cohort. The global persistence on all anti-IL17 was 97.2%, 88.4%, and 81.0% at 3, 6, and 12 months, respectively. The most frequent reason for discontinuation across the three cohorts was lack of effectiveness (16.7%; 37/221). CONCLUSIONS Most of the patients with PsA treated with anti-IL17 in Spain had moderate to severe disease activity, high peripheral joint and skin involvement, and had received previous b/tsDMARDs. More than 80% of patients with a 1-year follow-up persisted on anti-IL17, with the highest rate observed in the IXE cohort, followed by the SECU150 then SECU300 cohorts.
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Affiliation(s)
- Beatriz Joven
- Rheumatology Department, Hospital 12 de Octubre, Madrid, Spain
| | | | - Esteban Rubio
- Rheumatology Department, Hospital Virgen del Rocío, Seville, Spain
| | - Enrique Raya
- Rheumatology Department, Hospital Universitario Clínico San Cecilio de Granada, Granada, Spain
| | - Alba Pérez
- Rheumatology and Traumatology Department Hospital Puerta del Mar, Cádiz, Spain
| | - Raquel Hernández
- Rheumatology Department, Hospital Universitario de Valme, Seville, Spain
| | - Sara Manrique
- Rheumatology Department, Hospital Carlos Haya, Málaga, Spain
| | - Mercedes Núñez
- Medical Department, Eli Lilly and Company, Av. de la Industria, 30, Alcobendas, 28108, Madrid, Spain
| | - Silvia Díaz-Cerezo
- Medical Department, Eli Lilly and Company, Av. de la Industria, 30, Alcobendas, 28108, Madrid, Spain.
| | - Sebastián Moyano
- Medical Department, Eli Lilly and Company, Av. de la Industria, 30, Alcobendas, 28108, Madrid, Spain
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Laíño-Piñeiro MC, Rúa-Figueroa I, Jiménez N, Lozano MJC, Martínez-Barrio J, Serrano B, Galindo-Izquierdo M, Nack A, Loricera J, Tomero-Muriel E, Ibáñez-Barceló M, Vázquez NM, Manrique-Arija S, Lorenzo NA, Narváez J, Rosas J, Menor-Almagro R, Martínez-Taboada VM, Aurrecoechea-Aguinaga E, Horcada L, Ruiz-Lucea E, Raya E, Toyos FJ, Expósito L, Vela P, Freire-González M, Moriano-Morales C, Bonilla-Hernán G, Ibáñez TC, Lozano-Rivas N, Moreno M, Andreu JL, Ubiaga CLI, Torrente-Segarra V, Valls E, Velloso-Feijoo ML, Alcázar JL, Pego-Reigosa JM. Pregnancy outcomes in 1869 pregnancies in a large cohort from the Spanish Society of Rheumatology Lupus Register (RELESSER). Semin Arthritis Rheum 2023; 61:152232. [PMID: 37348350 DOI: 10.1016/j.semarthrit.2023.152232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/15/2023] [Accepted: 06/11/2023] [Indexed: 06/24/2023]
Abstract
INTRODUCTION Obstetric complications are more common in women with systemic lupus erythematosus (SLE) than in the general population. OBJECTIVE To assess pregnancy outcomes in women with SLE from the RELESSER cohort after 12 years of follow-up. METHODS A multicentre retrospective observational study was conducted. In addition to data from the RELESSER register, data were collected on obstetric/gynaecological variables and treatments received. The number of term pregnancies was compared between women with pregnancies before and after the diagnosis of SLE. Further, clinical and laboratory characteristics were compared between women with pregnancies before and after the diagnosis, on the one hand, and with and without complications during pregnancy, on the other. Bivariate and multivariate analyses were carried out to identify factors potentially associated with complications during pregnancy. RESULTS A total of 809 women were included, with 1869 pregnancies, of which 1395 reached term. Women with pregnancies before the diagnosis of SLE had more pregnancies (2.37 vs 1.87) and a higher rate of term pregnancies (76.8% vs 69.8%, p < 0.001) compared to those with pregnancies after the diagnosis. Women with pregnancies before the diagnosis were diagnosed at an older age (43.4 vs 34.1 years) and had more comorbidities. No differences were observed between the groups with pregnancies before and after diagnosis in antibody profile, including anti-dsDNA, anti-Sm, anti-Ro, anti-La, lupus anticoagulant, anticardiolipin or anti-beta-2-glycoprotein. Overall, 114 out of the 809 women included in the study experienced complications during pregnancy, including miscarriage, preeclampsia/eclampsia, foetal death, and/or preterm birth. Women with complications had higher rates of antiphospholipid syndrome (40.5% vs 9.9%, p < 0.001) and higher rates of positivity for IgG anticardiolipin (33.9% vs 21.3%, p = 0.005), IgG anti-beta 2 glycoprotein (26.1% vs 14%, p = 0.007), and IgM anti-beta 2 glycoprotein (26.1% vs 16%, p = 0.032) antibodies, although no differences were found regarding lupus anticoagulant. Among the treatments received, only heparin was more commonly used by women with pregnancy complications. We did not find differences in corticosteroid or hydroxychloroquine use. CONCLUSIONS The likelihood of term pregnancy is higher before the diagnosis of SLE. In our cohort, positivity for anticardiolipin IgG and anti-beta-2- glycoprotein IgG/IgM, but not lupus anticoagulant, was associated with a higher risk of poorer pregnancy outcomes.
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Affiliation(s)
| | - Iñigo Rúa-Figueroa
- Department of Rheumatology, Hospital Universitario Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - Norman Jiménez
- IRIDIS Group (Investigation in Rheumatology and Immune-Diseases), Galicia Sur Health Research Institute (IISGS), Vigo, Spain
| | | | | | - Belén Serrano
- Department of Rheumatology, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | | | - Annika Nack
- Department of Rheumatology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Javier Loricera
- Department of Rheumatology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Eva Tomero-Muriel
- Department of Rheumatology, Hospital Universitario La Princesa, Madrid, Spain
| | | | - Natalia Mena Vázquez
- Department of Rheumatology, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Sara Manrique-Arija
- Department of Rheumatology, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Nerea Alcorta Lorenzo
- Department of Rheumatology, Hospital Universitario de Donostia, San Sebastián, Spain
| | - Javier Narváez
- Department of Rheumatology, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - José Rosas
- Department of Rheumatology, Hospital Marina Baixa, Alicante, Spain
| | - Raúl Menor-Almagro
- Department of Rheumatology, Hospital Jerez de la Frontera, Jerez de la Frontera, Spain
| | | | | | - Loreto Horcada
- Department of Rheumatology, Hospital Universitario de Navarra, Pamplona, Spain
| | | | - Enrique Raya
- Department of Rheumatology, Hospital Universitario Clínico San Cecilio, Granada, Spain
| | - F Javier Toyos
- Department of Rheumatology, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Lorena Expósito
- Department of Rheumatology, Hospital Universitario de Canarias, Tenerife, Spain
| | - Paloma Vela
- Department of Rheumatology, Hospital General Universitario de Alicante, Alicante, Spain
| | | | | | | | - Tatiana Cobo Ibáñez
- Department of Rheumatology, Hospital Universitario Infanta Sofía, Madrid, Spain
| | - Nuria Lozano-Rivas
- Department of Rheumatology, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Mireia Moreno
- Department of Rheumatology, Hospital Universitario Parc Taulí, Sabadell, Spain
| | - José Luis Andreu
- Department of Rheumatology, Hospital Puerta de Hierro-Majadahonda, Madrid, Spain
| | | | - Vicenç Torrente-Segarra
- Department of Rheumatology, Hospital Comarcal Alt Penedès-Garraf, Vilafranca del Penedès, Spain
| | - Elia Valls
- Department of Rheumatology, Hospital Dr. Peset, Valencia, Spain
| | - M L Velloso-Feijoo
- Department of Rheumatology, Hospital Universitario de Valme, Sevilla, Spain
| | - Juan Luis Alcázar
- Department of Obstetrics and Gynecology, Clínica Universidad de Navarra, Pamplona, Spain
| | - José M Pego-Reigosa
- IRIDIS Group (Investigation in Rheumatology and Immune-Diseases), Galicia Sur Health Research Institute (IISGS), Vigo, Spain; Department of Rheumatology, Complejo Hospitalario Universitario de Vigo, Vigo, Spain
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Rybakowska P, van Gassen S, Perez-Sanchez C, Ibañez-Costa A, Varela N, Ortega Castro R, Fernández-Roldán C, Jiménez-Moleón I, Ortego N, Raya E, Aguilar Quesada R, Lopez-Pedrera C, Collantes Estevez E, Saeys Y, Alarcon-Riquelme M, Marañón C. OP0231 MASS CYTOMETRY DATA RECLASSIFY SYSTEMIC AUTOIMMUNE DISEASE PATIENTS IN PHENOTYPICALLY DISTINCTIVE GROUPS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundSystemic lupus erythematosus (SLE), rheumatoid arthritis (RA), systemic sclerosis (SSC), Sjögren’s syndrome (SJS), mixed connective tissue disease (MCTD), primary antiphospholipid syndrome (PAPS) and undifferentiated connective tissue disease (UCTD) are classified as systemic autoimmune diseases (SADs). They are diagnosed based on different clinical and laboratory criteria. Due to their high internal heterogeneity and overlapping symptoms, SADs are difficult to diagnose. Therefore, molecular and cellular-based studies need to be undertaken to precisely classify the patients. Mass cytometry is a single-cell proteomics technology that measures approximately 50 markers per cell, thus it is a suitable tool to perform deep-phenotyping studies in SADs.ObjectivesExplore differences and similarities between SADs and build reclassification framework using high-dimensional cytometry data.MethodsThe whole blood samples collected from 129 individuals, including patients and controls were stained with a 39-plex antibody panel and acquired in 9 batches on a CyTOF (HELIOS) instrument. Data were cleaned, and normalized for batch effects using semi-automated cytof analysis pipeline. Cell frequencies and median signal intensities (MSI) for each population were extracted using FlowSOM for mononuclear cells (PBMC) and Phenograph for granulocytes. Secretion of 44 cytokines and chemokines were analyzed using a multiplexed luminex assay. Diseases were compared by Kruskal-Wallis analysis and hierarchical clustering and reclassification was done using unsupervised k-means clustering. Cytokine analysis across clusters was performed using Kruskal-Wallis test.ResultsDifferently expressed features were observed between patient groups, regarding frequency of classical monocytes, B and T cells subpopulations, mature and immature granulocytes and intensities of CD38, HLA-DR and CD95 across various populations. However, none of them were disease specific. K-means clustering identified four patient clusters, which were composed by a mixture of different diagnosis. Cluster C1 was characterized by increased levels of circulating cells from PBMC compartment, and lower activation of different populations of the T cell compartment. It presented lower frequency in multiple granulocyte populations and the highest expression of CD95 and CD38. This cluster was also associated with antimalarial and steroid treatment. Clusters C1 and C2 were exactly opposite to each other, cluster C3 was characterized by intermediate features between C1 and C2 and cluster C4 could be considered as undifferentiated, mixed group. Higher production of TNFα, IL-10 and IP-10 were found in patients from C1 compared to C2, suggesting more active phenotype in C1 and physiological one in C2. The cytokine levels were independent of the treatment.ConclusionWe constructed a patient reclassification framework using cell frequencies and expression levels of functional markers. To our knowledge this is the first time when 7 different SADs were compared using mass cytometry. In agreement with other reports we did not detect any disease-specific cellular markers. Distribution of diagnosis across different clusters confirms diseases heterogeneity. Patients can be classified into phenotypically similar groups, that could potentially benefit from the same line of treatment.AcknowledgementsThis project has received funding from the Innovative Medicines Initiative 2 Joint Undertaking (JU) under grant agreement No 831434 (3TR) and The JU receives support from the European Union’s Horizon 2020 research and innovation programme and EFPIA. Also from No 115565 PRECISESADS.Disclosure of InterestsNone declared
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Prieto-Peña D, Loricera J, Castañeda S, Moriano C, Bernabéu P, Vela-Casasempere P, Narváez J, Aldasoro V, Maíz O, Fernández-López C, Freire González M, Melero R, Villa-Blanco I, González-Alvarez B, Solans-Laqué R, Callejas-Rubio JL, Fernández-Díaz C, Rubio Romero E, García Morillo S, Minguez M, Fernández-Carballido C, De Miguel E, Sanchez-Martin J, Fernández E, Melchor S, Salgado-Pérez E, Bravo B, Romero-Yuste S, Galíndez-Agirregoikoa E, Sivera F, Ferraz-Amaro I, Hidalgo C, Romero-Gómez C, Galisteo C, Moya P, Alvarez-Rivas N, Mendizabal J, Nieto González JC, De Dios JR, Andreu JL, Pérez de Pedro I, Revenga M, Alonso Valdivieso JL, Rosa RM, De la Morena I, Fernández-Llanio N, Labrador E, Roman-Ivorra JA, Ortiz-Sanjuán F, García-Valle A, Gallego A, Iñiguez C, Garrido-Puñal N, De la Torre R, López-González R, Collado P, Raya E, Navarro F, Mas AJ, Ordás C, Boquet MD, Velloso Feijoo ML, Campos Fernández C, Rúa-Figueroa I, Conesa A, Manrique Arija S, González-Gay MA, Blanco R. POS0804 TOCILIZUMAB IN LARGE-VESSEL GIANT CELL ARTERITIS AND TAKAYASU ARTERITIS: MULTICENTRIC OBSERVATIONAL COMPARATIVE STUDY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundTocilizumab (TCZ) has shown to be effective for large vessel vasculitis including giant cell arteritis (GCA) and Takayasu arteritis (TAK) (1-5). However, LVV-GCA and TAK show different demographic and clinical features that may influence on TCZ therapeutic response.ObjectivesTo compare the effectiveness of TCZ in patients with LVV-GCA and patients with TAK.MethodsObservational multicenter study of patients with LVV-GCA and TAK who received TCZ. Outcome variables were: a) proportion of patients who achieved complete clinical improvement along with normalization of laboratory markers (CRP ≤0.5mg/dL and/or ESR ≤ 20 mm/1st hour) at 12 months b) complete improvement in imaging techniques. A comparative study between patients with LVV-GCA and TAK was performed.ResultsWe evaluated 70 LVV-GCA and 57 TAK patients who received TCZ. Main clinical and demographic characteristic are described in Table 1. Patients with TAK were younger, had longer disease duration, had received more commonly previous biologic therapy and were receiving higher doses of prednisone at baseline. TCZ intravenous administration was more common in TAK patients (80.7% vs 48.6%; p<0.01). Follow-up time after TCZ onset was similar in both groups. At 12 months, about 75% of patients achieved complete clinical improvement and ESR/CRP normalization in both groups. A follow-up imaging technique was performed in 37 LVV-GCA patients after a mean time of 12.9±6.0 months and 38 TAK patients after 9.5±5.0 months. Complete improvement in imaging techniques was only observed in 18.9% and 21.1% of patients with LVV-GCA and TAK, respectively (Figure 1).Table 1.LVV-GCA (n=70)TAK (n=57)pGeneral featuresAge (years), mean ± SD67.2 ± 10.540.5 ± 16.3< 0.01Sex (female), n (%)51 (72.9)49 (86)0.07Disease evolution before TCZ onset (months), median [IQR]5 [2-15]12 [3-37]<0.01Baseline laboratory parametersESR (mm/1st hour), median [IQR]32 [12.5-54.7]31 [10-52]0.82CRP (mg/dL), median [IQR]1.4 [0.5-2.4]1.4 [0.5-3.5]0.41Baseline prednisone dose (mg/day), median [IQR]15 [10-20]30 [15-50]< 0.01Previous therapyConventional DMARDs, n(%)45 (64.3)44(77.2)0.51Biologic therapy, n (%)0(0)12 (21.1)<0.01TCZ therapyIntravenous, n (%)34 (48.6)46 (80.7)< 0.01Combined with MTX, n(%)24 (34.3)24 (42.1)0.37Follow-up time after TCZ onset, median [IQR]20 [10-36]18 [7-41]0.73Complete clinical improvement and ESR/CRP normalization at 12 months, n/N (%)35/47 (74.4)30/39 (76.9)0.79Complete improvement in imaging techniques, n/N(%)7/37 (18.9)8/38 (21.1)0.85CRP: C-reactive protein; DMARDs: Disease-modifying anti-rheumatic drugs ESR: erythrocyte sedimentation rate; GCA: giant cell arteritis; IQR: interquartile range; LVV: large vessel; MTX: methotrexate; n: Number of patients; N: total number of patients: TCZ: tocilizumab; TAK:takayasuFigure 1.ConclusionThe effectiveness of TCZ was similar in patients with LVV-GCA and TAK, despite a more refractory disease in TAK patients. A discordance between clinical and imaging activity improvement was observed in both LVV-GCA and TAK, as reported in previous studies (3).References[1]Calderón-Goercke M, et al. Semin Arthritis Rheum 2019; 49:126-35. https://doi.org/10.1016/j.semarthrit.2019.01.003[2]Prieto-Peña D et al. Ther Adv Musculoskelet Dis. 2021;13:175. PMID: 34211589.[3]Prieto Peña D et al. Clin Exp Rheumatol. 2021;39 Suppl 129:69-75. PMID: 33253103.[4]González-Gay MA, et al. Expert Opin Biol Ther. 2019;19:65-72. doi: 10.1080/14712598.2019.1556256.[5]Prieto-Peña D, et al. Semin Arthritis Rheum. 2019;48(4):720-727. doi: 10.1016/j.semarthrit.2018.05.007Disclosure of InterestsNone declared
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Herrero-Morant A, Martín-Varillas JL, Castañeda S, Maiz-Alonso O, Sanchez-Martin J, Ortego N, Raya E, Prior-Español Á, Moriano C, Melero R, Graña J, Urruticoechea-Arana A, Ramos Calvo A, Loredo Martínez M, Salgado-Pérez E, Sivera F, Torre-Salaberri I, Narváez J, Andréu Sánchez JL, Martínez González O, Gómez de la Torre R, Fernández S, Romero-Yuste S, Gonzalez-Mazon I, Álvarez-Reguera C, Martínez-López D, Hernández JL, González-Gay MÁ, Blanco R. POS0828 BIOLOGIC THERAPY IN REFRACTORY PARENCHYMAL AND NON-PARENCHYMAL NEUROBEHÇET DISEASE: NATIONAL MULTICENTER STUDY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundOcular and Neurobehçet’s Disease (NBD) are the most severe manifestations of Behcet’s disease (1-4). NBD can be classified as a) primary neural parenchymal lesions, also known as parenchymal NBD (p-NBD) or b) secondary to vascular involvement or non-parenchymal NBD (np-NBD) (4). Response to biologic therapy (BT) in these two refractory subtypes of NBD is unknown.ObjectivesTo assess efficacy and safety of BT in refractory subtypes of NBD.MethodsOpen-label multicenter study of refractory NBD from 21 different referral National Hospitals. NBD diagnosis was based on the International Consensus Recommendation criteria (4). Efficacy was determined by complete or partial response and no-response. Complete, partial or no response was defined according to the resolution of the neurological syndrome (signs and/or symptoms) after the BT onset.ResultsWe studied 41 patients (21 women/20 men; mean age: 40.6±10.8 years). NBD was classified as p-NBD (n= 33, 80.5%) and np-NBD (n=17, 41.5%). There were no significant differences in baseline general features and in neurological clinical response in both subgroups (Table 1 and Figure 1). The first BT used in p-NBD were Infliximab (IFX) (n=15), Adalimumab (ADA) (n=11), Golimumab (GLM) (n=3), Tocilizumab (TCZ) (n=2) and Etanercept (ETN) (n=2) and in np-NBD were IFX (n=9), ADA (n=6), TCZ (n=1) and ETN (n=1).Table 1.Main features of p-NBD and np-NBDTotalp-NBDnp-NBDP p-NBD vs np-NBDAge at biological therapy initiation, years (mean±SD)44±13.941.4±9.639.4±10.60.412Gender, n (m/f) (%)21/20 (48.8/52.2)18/15 (54.5/45.5)5/12 (29.4/70.6)0.091HLAB51 +/ patients tested, n (%)15/31 (57.7)14/25 (58.3)4/10 (40)0.391Oral aphthae, n (%)40 (97.6)32 (97)15 (88.2)0.323Cutaneous involvement, n (%)28 (63.4)23 (69.7)10 (58.8)0.603Ocular involvement, n (%)21 (48.8)15 (45.5)9 (52.9)0.616Vascular involvement, n (%)9 (22)10 (30.3)7 (41.2)0.442Articular involvement, n (%)9 (22)7 (21.2)3 (17.6)0.765Previous conventional Immunosuppressive drugs to BTAzathioprine24 (58.5)20 (60.6)10 (58.8)-Methotrexate16 (39.0)12 (36.4)3 (17.6)-Cyclophosphamide13 (31.7)13 (39.4)5 (29.4)-Cyclosporine A9 (22.0)8 (24.2)3 (17.6)-Mycophenolate Mofetil2 (4.9)2 (6.1)0-Figure 1.Response to biological therapy according to NBD subtypes.After an overall mean follow-up of 57.5±50.9 months BT was switched in 22 patients due to inefficacy (n=16) or Adverse Effects (AE) (n=6) and in 4 cases was definitively discontinued because of complete prolonged remission (n=3) or AE (n=1). AE were observed in 7 (17.1%) patients. Severe AE were observed in 2 cases, one due to demyelinating disease and the other due to pulmonary tuberculosis, both in patients undergoing IFX therapy. The other 6 AE were infusion reaction to IFX (n=1), IFX-induced psoriasis (n=1), IFX-induced acneiform eruption (n=1), infusion reaction to TCZ (n=1), intolerance to IFX and recurrent mild infections (n=1) and erosive lichen planus and bullous impetigo (n=1).ConclusionIn our series, BT seems equally effective and safe in both refractory p-NBD and np-NBD.References[1]Martín-Varillas JL, et al. Ophthalmology 2018 Sep;125(9):1444-1451. doi: 10.1016/j.ophtha.2018.02.020.[2]Atienza-Mateo B, et al. Arthritis Rheumatol 2019 Dec;71(12):2081-2089. doi: 10.1002/art.41026.[3]Santos-Gómez M, et al. Clin Exp Rheumatol 2016 Sep-Oct;34(6 Suppl 102): S34-S40.[4]Kalra S, et al. Diagnosis and management of Neuro-Behçet’s disease: international consensus recommendations. J Neurol. 2014 Sep;261(9):1662–76.Disclosure of InterestsAlba Herrero-Morant: None declared, José Luis Martín-Varillas Grant/research support from: AbbVie, Pfizer, Lilly, Janssen, UCB, and Celgene, Santos Castañeda Paid instructor for: Assistant professor of the Cátedra UAM-ROCHE, EPID-Future, UAM, Madrid, Spain, Olga Maiz-Alonso: None declared, Julio Sanchez-Martin: None declared, Norberto Ortego: None declared, Enrique Raya: None declared, Águeda Prior-Español: None declared, Clara Moriano: None declared, Rafael Melero: None declared, Jenaro Graña: None declared, ANA URRUTICOECHEA-ARANA: None declared, Angel Ramos Calvo: None declared, Marta Loredo Martínez: None declared, Eva Salgado-Pérez: None declared, Francisca Sivera: None declared, Ignacio Torre-Salaberri: None declared, J. Narváez Speakers bureau: Bristol-Myers Squibb, José Luis Andréu Sánchez: None declared, Olga Martínez González: None declared, Ricardo Gómez de la Torre: None declared, Sabela Fernández: None declared, Susana Romero-Yuste: None declared, Iñigo Gonzalez-Mazon: None declared, Carmen Álvarez-Reguera: None declared, David Martínez-López: None declared, J. Luis Hernández: None declared, Miguel Á. González-Gay Speakers bureau: Abbvie, Roche, Sanofi, Lilly, Celgene, Sobi, and MSD, Grant/research support from: Abbvie, MSD, Janssen, and Roche, Ricardo Blanco Speakers bureau: Abbvie, Lilly, Pfizer, Roche, BMS, Janssen, and MSD, Grant/research support from: Abbvie, MSD, and Roche
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Herrero-Morant A, Martín-Varillas JL, Castañeda S, Maíz O, Sánchez J, Ortego N, Raya E, Prior-Español Á, Moriano C, Melero-González RB, Graña-Gil G, Urruticoechea-Arana A, Ramos-Calvo Á, Loredo-Martínez M, Salgado-Pérez E, Sivera F, Torre I, Narváez J, Andreu JL, Martínez-González O, Gómez-de la Torre R, Fernández-Aguado S, Romero-Yuste S, González-Mazón Í, Álvarez-Reguera C, Hernández JL, González-Gay MÁ, Blanco R. Biologic therapy in refractory Neurobehçet's disease: a multicenter study of 41 patients and literature review. Rheumatology (Oxford) 2022; 61:4427-4436. [PMID: 35166821 DOI: 10.1093/rheumatology/keac097] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/17/2022] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To assess efficacy and safety of biologic therapy (BT) in Neurobehçet's disease (NBD) refractory to glucocorticoids and at least one conventional immunosuppressive drug. METHODS Open-label, national, multicenter study. NBD diagnosis was based on the International Consensus Recommendation criteria. Outcome variables were efficacy and safety. Main efficacy outcome was clinical remission. Other outcome variables analyzed were glucocorticoid-sparing effect and improvement in laboratory parameters. RESULTS We studied 41 patients (21 women; age 40.6±10.8 years). Neurological damage was parenchymal (n = 33, 80.5%) and non-parenchymal (n = 17, 41.5%). First BTs used were infliximab (n = 19), adalimumab (n = 14), golimumab (n = 3), tocilizumab (n = 3) and etanercept (n = 2). After 6 months of BT, neurological remission was complete (n = 23, 56.1%), partial (n = 15, 37.6%), no response (n = 3, 7.3%). In addition, mean dose of oral prednisone decreased from 60 [30-60] mg/day at the initial visit to 5 [3.8-10] mg/day after 6 months, p < 0.001). It was also the case for mean erythrocyte sedimentation rate (31.5±25.6 to 15.3±11.9 mm/1st hour, p = 0.005) and median [IQR] C-reactive protein (1.4 [0.2-12.8] to 0.3 [0.1-3] mg/dL, p = 0.002). After a mean follow-up of 57.5 months, partial or complete neurological remission persisted in 37 patients (90.2%). BT was switched in 22 cases (53.6%) due to inefficacy (n = 16) or adverse events (AEs) (n = 6) and discontinued due to complete prolonged remission (n = 3) or severe AE (n = 1). Serious AEs were observed in 2 patients under infliximab treatment. CONCLUSIONS BT appears to be effective and relatively safe in refractory NBD.
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Affiliation(s)
- Alba Herrero-Morant
- Rheumatology, Hospital Universitario Marqués de Valdecilla,IDIVAL,University of Cantabria, Santander, Spain
| | | | - Santos Castañeda
- Rheumatology, Hospital Universitario La Princesa, IIS-Princesa, Madrid, Spain
| | - Olga Maíz
- Rheumatology and Ophthalmology, Hospital Universitario de Donostia, San Sebastián, Spain
| | | | - Norberto Ortego
- Rheumatology and Internal Medicine, Hospital San Cecilio, Granada, Spain
| | - Enrique Raya
- Rheumatology and Internal Medicine, Hospital San Cecilio, Granada, Spain
| | | | | | | | - Genaro Graña-Gil
- Rheumatology, Hospital Universitario de A Coruña, A Coruña, Spain
| | | | | | | | - Eva Salgado-Pérez
- Rheumatology, Complejo Hospitalario Universitario de Ourense, Ourense, Spain
| | - Francisca Sivera
- Rheumatology, Hospital General Universitario de Elda, Elda, Spain
| | | | | | - José Luis Andreu
- Rheumatology, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | | | | | | | - Susana Romero-Yuste
- Rheumatology, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| | - Íñigo González-Mazón
- Rheumatology, Hospital Universitario Marqués de Valdecilla,IDIVAL,University of Cantabria, Santander, Spain
| | - Carmen Álvarez-Reguera
- Rheumatology, Hospital Universitario Marqués de Valdecilla,IDIVAL,University of Cantabria, Santander, Spain
| | - José Luis Hernández
- Internal Medicine, Hospital Universitario Marqués de Valdecilla,IDIVAL, Santander, Spain
| | - Miguel Ángel González-Gay
- Rheumatology, Hospital Universitario Marqués de Valdecilla,IDIVAL,University of Cantabria, Santander, Spain
| | - Ricardo Blanco
- Rheumatology, Hospital Universitario Marqués de Valdecilla,IDIVAL,University of Cantabria, Santander, Spain
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Herrero-Morant A, Martín-Varillas JL, Castañeda S, González-Mazón I, Maiz O, Blanco A, Sánchez J, Ortego N, Raya E, Olive A, Brandy-Garcia A, Prior-Español Á, Moriano C, Diez Alvarez E, Melero R, Graña J, Seijas-López Á, Urruticoechea-Arana A, Ramos Calvo A, Delgado Beltrán C, Loredo Martínez M, Salgado-Pérez E, Sivera F, Torre-Salaberri I, Narváez J, Andréu Sánchez JL, Martínez González O, Gómez de la Torre R, Fernández S, Romero-Yuste S, Espinosa G, González-Gay MÁ, Blanco R. POS1371 BIOLOGICAL THERAPY IN REFRACTORY NEUROBEHÇET’S DISEASE. MULTICENTER STUDY OF 42 PATIENTS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.3407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Neuro-Behçet’s disease (NBD) is a severe complication of Behcet’s disease (BD). Despite well-established therapies with glucocorticoids and conventional immunosuppressants (cIS), a significant proportion of patients are refractory.Objectives:To assess efficacy and safety of biologic therapy (BT) in NBD refractory to glucocorticoids and at least one cIS.Methods:Open-label multicenter study of refractory NBD from 23 different referral Spanish Hospitals. Main outcome was neurological response. Secondarily, analytical efficacy was measured by Erythrocyte Sedimentation Rate (ESR), C-Reactive Protein (CRP) and Hemoglobin (Hb) at baseline, 6 months, 1 year and 2 years.Results:We studied 42 patients (21 women/ 21 men; mean age 40.4±10.8 years). HLA B51 was positive in 15 out of 37 (40.5%) patients tested. Non-neurological manifestations were oral ulcers (n=41, 97.6%), genital ulcers (n=31, 73.8%), skin lesions (n=28, 66.7%), arthralgia (n=27, 64.3%), uveitis (n=21, 50.0%), arthritis (n=9, 21.4%), venous thrombosis (n=9, 21.4%) and arterial thrombosis (n=4, 9.5%). The underlying neurologic manifestation were parenchymal (n=34, 81.0 %) and non-parenchymal (n=17, 40.5%) involvement (Table 1). The first BT used was infliximab (n=20), adalimumab (n=13), golimumab (n=3), tocilizumab (n=3) and etanercept (n=2).After 58.2±51.4 months since initiation of BT, neurological response was complete (n=27; 64.3%), or partial (n=11, 26.1%) (Figure 1). Only 4 (9.5%) patients did not respond. After 6 months of BT, ESR improved from.31.5±25.6 to 15.3±11.9 mm/h (p=0.005), CRP from 1.4 [0.2-12.8] to 0.3[0.1-3] mg/dL (p= 0.002) and Hb from 13.1±1.6 to 13.8±1.3 g/dL (p=0.005).Figure 1.Neurological clinical response to biological therapy.Primary failure was observed in 16 (38.1%) patients due to inefficacy (n=11, 68.8%) or adverse effects (n=5, 31.3%). Similarly, causes of secondary failure (n=6, 14.3%) were inefficacy (n=5, 83.3%) and adverse effects (n=1, 16.7%). No serious adverse effects were observed.Conclusion:BT, especially monoclonal anti-TNF drugs, seems to be effective and safe in refractory NBD.Table 1.Neurologic manifestation of 42 patients with refractory neurobehçet's disease treated with biologic therapy.Parenchymal subtype, n (%)34 (81.0)-Hemiparesis8 (19.1)-Polineuropathy8 (19.1)-Encephalopathy6 (14.3)-Cognitive impairments4 (9.5)-Optic neuropathy4 (9.5)-Ophtalmoparesis4 (9.5)-Other cranial nerve involvement3 (7.1)-Hemihypoesthesia3 (7.1)-Cerebellar dysphasia1 (2.4)-Cerebellar involvement1 (2.4)-Non-steroidal psicosis1 (2.4)Non-parenchymal subtype, n (%)17 (40.5)-Aseptic meningitis12(28.6)-Thrombosis4 (9.5)-Intracranial hypertension1 (2.4)Disclosure of Interests:Alba Herrero-Morant: None declared, José Luis Martín-Varillas Grant/research support from: AbbVie, Pfizer, Lilly, Janssen, and Celgene, Santos Castañeda: None declared, Iñigo González-Mazón: None declared, Olga Maiz: None declared, Ana Blanco Speakers bureau: AbbVie, Julio Sánchez: None declared, Norberto Ortego: None declared, Enrique Raya Speakers bureau: MSD, Grant/research support from: AbbVie, Alejandro Olive: None declared, Anahy Brandy-Garcia: None declared, Águeda Prior-Español: None declared, Clara Moriano: None declared, Elvira Diez Alvarez: None declared, Rafael Melero: None declared, Jenaro Graña: None declared, Álvaro Seijas-López: None declared, ANA URRUTICOECHEA-ARANA: None declared, Angel Ramos Calvo: None declared, Concepción Delgado Beltrán: None declared, Marta Loredo Martínez: None declared, Eva Salgado-Pérez: None declared, Francisca Sivera: None declared, Ignacio Torre-Salaberri: None declared, J. Narváez Speakers bureau: Bristol-Myers Squibb, José Luis Andréu Sánchez: None declared, Olga Martínez González: None declared, Ricardo Gómez de la Torre: None declared, Sabela Fernández: None declared, Susana Romero-Yuste: None declared, Gerard Espinosa: None declared, Miguel Á. González-Gay Speakers bureau: AbbVie, Pfizer, Roche, Sanofi, Lilly, Celgene and MSD, Grant/research support from: AbbVie, MSD, Jansen and Roche, Ricardo Blanco Speakers bureau: AbbVie, Pfizer, Roche, Bristol-Myers, Janssen, Sanofi, Lilly and MSD, Grant/research support from: AbbVie, MSD, and Roche
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Sanchez-Bilbao L, Loricera J, Aldasoro V, Valdivieso-Achá JP, Villa-Blanco I, Maiz O, Melero R, Moriano C, Sánchez J, De Miguel E, Perez-Pampín E, De Dios JR, Nieto González JC, Galíndez-Agirregoikoa E, Moya P, Sivera F, Andréu Sánchez JL, Pinillos V, García-Valle A, Vela-Casasempere P, Alvarez-Rivas N, Revenga M, Manrique Arija S, Fernández-López C, Raya E, Hidalgo C, López-González R, Campos Fernández C, Juan-Mas A, Arca B, Rua-Figueroa I, Boquet MD, García A, Gallego A, Salgado-Pérez E, González-Gay MA, Blanco R. OP0064 TOCILIZUMAB IN CRANIAL AND EXTRACRANIAL REFRACTORY GIANT CELL ARTERITIS: A MULTICENTER STUDY OF 312 CASES. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Giant cell arteritis (GCA) may be divided into cranial, and extracranial GCA. Tocilizumab (TCZ) has shown efficacy and safety in GCA and other large-vessel vasculitis (LVV) (1-5).Objectives:To compare the efficacy of TCZ in cranial and extracranial GCA.Methods:Multicenter observational study of 312 patients with GCA treated with TCZ. They were divided into 3 groups a) only cranial (cGCA), b) only extracranial (ecGCA), c) mixed affection (mixGCA). GCA was diagnosed by a) ACR criteria, and/or b) positive temporal artery biopsy, and/or c) LVV by imaging. Remission and sustained remission was defined according to EULAR definitions (1). In ecGCA and mixGCA we also studied the improvement (complete or partial) by imaging techniques.Results:We studied 312 patients (218 females; mean age, 73.4±9.6 years). TABLE shows the main features of the 3 groups. Remission at month 6 was higher in cGCA, as well as the sustained remission at month12 (FIGURE). At 18 and 24months, were similar in the 3 groups. Improvement by imaging techniques was partial/complete at 6,12,18 and 24 months, in 50%/0%,71%/0%, 61%/15% and 67%/17% respectively, in ecGCA, and in 75%/0%,53%/18%, 64%/12% and 50%/28% in mixGCA.Table 1.Main features of 312 patients at TCZ onset.Cranial GCA(n=152)Extracranial GCA(n=49)Mixed GCA(n=111)Cranial vs Extracranial GCApAge at TCZ onset, years, mean± SD76.0±8.265.4±12.273.5±8.10.000*Sex, female/male, n (% female)105/47 (69)33/16 (67)80/31 (72)0.960Time from diagnosis to TCZ onset (months, median [IQR]6 [2-21]7 [2-20]9 [3-25]0.765Biopsy-proven GCA, n (%)87/128 (68)0 (0)50/87 (57)0.000*Systemic manifestations at TCZ onset109 (72)32 (65)84 (76)0.501Fever, n (%)18 (12)1 (2)8 (7)0.048*Constitutional syndrome, n (%)52 (34)16 (33)47 (42)0.933PmR, n (%)88 (58)29 (59)71 (64)0.999Ischemic manifestations at TCZ onset117 (77)0 (0)70 (63)0.000*Visual involvement, n (%)31 (20)0 (0)16 (14)0.000*Headache, n (%)103 (85)0 (0)63 (57)0.000*Jaw claudication, n (%)39 (26)0 (0)21 (19)0.000*Acute phase reactantsESR, mm/1st hour, median [IQR]28 [9-53]24 [10-43]28 [15-48]0.462CRP, mg/dL, median [IQR]1.2 [0.3-3.4]0.7 [0.4-1.8]1.6 [0.4-3.8]0.153Prednisone dose at TCZ onset, mean ± SD26.2±17.615.4±14.220.1±14.90.000*TCZmono/TCZcombo, n (% TCZ mono)116/36 (76)26/23 (53)69/42 (62)0.003*Follow-up (months), mean ± SD27.3±21.132.7±23.327.9±22.00.143Figure 1.Remission and sustained remission of cGCA, ecGCA and mixGCA according to EULAR (1). In the first 3 months we only could assess cGCA because in ecGCA and mixGCA a control imaging was not performedConclusion:TCZ seems to be effective in all phenotypes but it is faster in cGCA in reaching remission. However, improvement by imaging techniques was partial and very rarely complete in ecGCA and mixGCA.References:[1]Hellmich B, et al. Ann Rheum Dis. 2020; 79: 19-30.[2]Stone JH, et al. N Engl J Med. 2017; 377: 317-28.[3]Calderón-Goercke M, et al. Semin Arthritis Rheum 2019; 49:126-35. https://doi.org/10.1016/j.semarthrit.2019.01.003.[4]Prieto Peña D et al. Clin Exp Rheumatol 2020 Nov 27. PMID: 33253103.[5]Loricera J, et al. Clin Exp Rheumatol 2016; 34:S44-53. PMID: 27050507Disclosure of Interests:Lara Sanchez-Bilbao: None declared, Javier Loricera: None declared, Vicente Aldasoro: None declared, Juan Pablo Valdivieso-Achá: None declared, Ignacio Villa-Blanco: None declared, Olga Maiz: None declared, Rafael Melero: None declared, Clara Moriano: None declared, Julio Sánchez: None declared, Eugenio de Miguel: None declared, Eva Perez-Pampín: None declared, Juan Ramón De Dios: None declared, Juan Carlos Nieto González: None declared, Eva Galíndez-Agirregoikoa: None declared, Patricia Moya: None declared, Francisca Sivera: None declared, José Luis Andréu Sánchez: None declared, Valvanera Pinillos: None declared, Andrea García-Valle: None declared, Paloma Vela-Casasempere: None declared, Noelia Alvarez-Rivas: None declared, Marcelino Revenga: None declared, Sara Manrique Arija: None declared, Carlos Fernández-López: None declared, Enrique Raya: None declared, Cristina Hidalgo: None declared, Ruth López-González: None declared, Cristina Campos Fernández: None declared, Antonio Juan-Mas: None declared, Beatriz Arca: None declared, Iñigo Rua-Figueroa: None declared, María Dolors Boquet: None declared, Antonio García: None declared, Adela Gallego: None declared, Eva Salgado-Pérez: None declared, Miguel A González-Gay Speakers bureau: Abbvie, Pfizer, Roche, Sanofi, Lilly, Celgene and MSD, Grant/research support from: Abbvie, MSD, Jansen and Roche, Ricardo Blanco Speakers bureau: Abbvie, Lilly, Pfizer, Roche, Bristol-Myers, Janssen, UCB Pharma and MSD, Grant/research support from: Abbvie, MSD and Roche
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Riancho-Zarrabeitia L, Martínez-Taboada VM, Rúa-Figueroa I, Alonso F, Galindo-Izquierdo M, Ovalles J, Olivé-Marqués A, Mena Vázquez N, Calvo-Alén J, Menor Almagro R, Tomero Muriel E, Uriarte Isacelaya E, Boteanu A, Andres M, Freire González M, Santos Soler G, Ruiz-Lucea ME, Ibáñez-Barceló M, Castellví I, Galisteo C, Quevedo Vila V, Raya E, Narváez J, Expósito L, Hernández Beriaín JA, Horcada L, Aurrecoechea E, Pego Reigosa JM. Do all antiphospholipid antibodies confer the same risk for major organ involvement in systemic lupus erythematosus patients? Clin Exp Rheumatol 2021. [DOI: 10.55563/clinexprheumatol/9kxexc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
| | - Víctor M. Martínez-Taboada
- Rheumatology Department, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Spain.
| | - Iñigo Rúa-Figueroa
- Rheumatology Department, Hospital Universitario Doctor Negrín, Las Palmas, Spain
| | - Fernando Alonso
- Unidad de Investigación, Sociedad Española de Reumatología, Madrid, Spain
| | | | - Juan Ovalles
- Rheumatology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | | | - Jaime Calvo-Alén
- Rheumatology Department, Hospital Universitario Araba, Álava, Spain
| | | | - Eva Tomero Muriel
- Rheumatology Department, Hospital Universitario La Princesa, Madrid, Spain
| | | | - Alina Boteanu
- Rheumatology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Mariano Andres
- Rheumatology Department, Hospital General Universitario de Alicante, Spain
| | | | | | | | | | - Iván Castellví
- Rheumatology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Carlos Galisteo
- Rheumatology Department, Hospital Universitario Parc Taulí, Barcelona, Spain
| | | | - Enrique Raya
- Rheumatology Department, Hospital Universitario Clínico San Cecilia, Granada, Spain
| | - Javier Narváez
- Rheumatology Department, Hospital Universitario de Bellvitge, Barcelona, Spain
| | - Lorena Expósito
- Rheumatology Department, Hospital Universitario Canaries, Tenerife, Spain
| | | | - Loreto Horcada
- Rheumatology Department, Complejo Hospitalario Universitario de Navarra, Spain
| | - Elena Aurrecoechea
- Rheumatology Department, Hospital Sierrallana, IDIVAL, Torrelavega, Spain
| | - José M. Pego Reigosa
- Complejo Hospitalario Universitario de Vigo IRIDIS Group, Instituto de Investigación Sanitaria Galicia Sur (IISGS), Vigo, Spain
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Barturen G, Babaei S, Català-Moll F, Martínez-Bueno M, Makowska Z, Martorell-Marugán J, Carmona-Sáez P, Toro-Domínguez D, Carnero-Montoro E, Teruel M, Kerick M, Acosta-Herrera M, Le Lann L, Jamin C, Rodríguez-Ubreva J, García-Gómez A, Kageyama J, Buttgereit A, Hayat S, Mueller J, Lesche R, Hernandez-Fuentes M, Juarez M, Rowley T, White I, Marañón C, Gomes Anjos T, Varela N, Aguilar-Quesada R, Garrancho FJ, López-Berrio A, Rodriguez Maresca M, Navarro-Linares H, Almeida I, Azevedo N, Brandão M, Campar A, Faria R, Farinha F, Marinho A, Neves E, Tavares A, Vasconcelos C, Trombetta E, Montanelli G, Vigone B, Alvarez-Errico D, Li T, Thiagaran D, Blanco Alonso R, Corrales Martínez A, Genre F, López Mejías R, Gonzalez-Gay MA, Remuzgo S, Ubilla Garcia B, Cervera R, Espinosa G, Rodríguez-Pintó I, De Langhe E, Cremer J, Lories R, Belz D, Hunzelmann N, Baerlecken N, Kniesch K, Witte T, Lehner M, Stummvoll G, Zauner M, Aguirre-Zamorano MA, Barbarroja N, Castro-Villegas MC, Collantes-Estevez E, de Ramon E, Díaz Quintero I, Escudero-Contreras A, Fernández Roldán MC, Jiménez Gómez Y, Jiménez Moleón I, Lopez-Pedrera R, Ortega-Castro R, Ortego N, Raya E, Artusi C, Gerosa M, Meroni PL, Schioppo T, De Groof A, Ducreux J, Lauwerys B, Maudoux AL, Cornec D, Devauchelle-Pensec V, Jousse-Joulin S, Jouve PE, Rouvière B, Saraux A, Simon Q, Alvarez M, Chizzolini C, Dufour A, Wynar D, Balog A, Bocskai M, Deák M, Dulic S, Kádár G, Kovács L, Cheng Q, Gerl V, Hiepe F, Khodadadi L, Thiel S, de Rinaldis E, Rao S, Benschop RJ, Chamberlain C, Dow ER, Ioannou Y, Laigle L, Marovac J, Wojcik J, Renaudineau Y, Borghi MO, Frostegård J, Martín J, Beretta L, Ballestar E, McDonald F, Pers JO, Alarcón-Riquelme ME. Integrative Analysis Reveals a Molecular Stratification of Systemic Autoimmune Diseases. Arthritis Rheumatol 2021; 73:1073-1085. [PMID: 33497037 DOI: 10.1002/art.41610] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 12/01/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Clinical heterogeneity, a hallmark of systemic autoimmune diseases, impedes early diagnosis and effective treatment, issues that may be addressed if patients could be classified into groups defined by molecular pattern. This study was undertaken to identify molecular clusters for reclassifying systemic autoimmune diseases independently of clinical diagnosis. METHODS Unsupervised clustering of integrated whole blood transcriptome and methylome cross-sectional data on 955 patients with 7 systemic autoimmune diseases and 267 healthy controls was undertaken. In addition, an inception cohort was prospectively followed up for 6 or 14 months to validate the results and analyze whether or not cluster assignment changed over time. RESULTS Four clusters were identified and validated. Three were pathologic, representing "inflammatory," "lymphoid," and "interferon" patterns. Each included all diagnoses and was defined by genetic, clinical, serologic, and cellular features. A fourth cluster with no specific molecular pattern was associated with low disease activity and included healthy controls. A longitudinal and independent inception cohort showed a relapse-remission pattern, where patients remained in their pathologic cluster, moving only to the healthy one, thus showing that the molecular clusters remained stable over time and that single pathogenic molecular signatures characterized each individual patient. CONCLUSION Patients with systemic autoimmune diseases can be jointly stratified into 3 stable disease clusters with specific molecular patterns differentiating different molecular disease mechanisms. These results have important implications for future clinical trials and the study of nonresponse to therapy, marking a paradigm shift in our view of systemic autoimmune diseases.
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Affiliation(s)
- Guillermo Barturen
- Pfizer-University of Granada-Junta de Andalucía Centre for Genomics and Oncological Research, Granada, Spain
| | | | | | - Manuel Martínez-Bueno
- Pfizer-University of Granada-Junta de Andalucía Centre for Genomics and Oncological Research, Granada, Spain
| | | | - Jordi Martorell-Marugán
- Pfizer-University of Granada-Junta de Andalucía Centre for Genomics and Oncological Research, Granada, Spain
| | - Pedro Carmona-Sáez
- Pfizer-University of Granada-Junta de Andalucía Centre for Genomics and Oncological Research, Granada, Spain
| | - Daniel Toro-Domínguez
- Pfizer-University of Granada-Junta de Andalucía Centre for Genomics and Oncological Research, Granada, Spain
| | - Elena Carnero-Montoro
- Pfizer-University of Granada-Junta de Andalucía Centre for Genomics and Oncological Research, Granada, Spain
| | - María Teruel
- Pfizer-University of Granada-Junta de Andalucía Centre for Genomics and Oncological Research, Granada, Spain
| | - Martin Kerick
- Institute of Parasitology and Biomedicine "López Neyra", Spanish National Research Council, Granada, Spain
| | - Marialbert Acosta-Herrera
- Institute of Parasitology and Biomedicine "López Neyra", Spanish National Research Council, Granada, Spain
| | - Lucas Le Lann
- Université de Brest, Centre Hospitalier Universitaire de Brest, INSERM, and Labex IGO, Brest, France
| | - Christophe Jamin
- Université de Brest, Centre Hospitalier Universitaire de Brest, INSERM, and Labex IGO, Brest, France
| | | | | | | | | | | | | | | | | | | | | | | | - Concepción Marañón
- Pfizer-University of Granada-Junta de Andalucía Centre for Genomics and Oncological Research, Granada, Spain
| | - Tania Gomes Anjos
- Pfizer-University of Granada-Junta de Andalucía Centre for Genomics and Oncological Research, Granada, Spain
| | - Nieves Varela
- Pfizer-University of Granada-Junta de Andalucía Centre for Genomics and Oncological Research, Granada, Spain
| | | | | | | | | | | | | | | | | | - Ana Campar
- Centro Hospitalar do Porto, Porto, Portugal
| | | | | | | | | | | | | | - Elena Trombetta
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Gaia Montanelli
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Barbara Vigone
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Tianlu Li
- Bellvitge Biomedical Research Institute, Barcelona, Spain
| | | | - Ricardo Blanco Alonso
- Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | | | - Fernanda Genre
- Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Raquel López Mejías
- Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Miguel A Gonzalez-Gay
- Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Sara Remuzgo
- Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Begoña Ubilla Garcia
- Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Ricard Cervera
- Hospital Clínic and Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Gerard Espinosa
- Hospital Clínic and Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Ignasi Rodríguez-Pintó
- Hospital Clínic and Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Ellen De Langhe
- Katholieke Universiteit Leuven and Universitair Ziekenhuis Leuven, Leuven, Belgium
| | - Jonathan Cremer
- Katholieke Universiteit Leuven and Universitair Ziekenhuis Leuven, Leuven, Belgium
| | - Rik Lories
- Katholieke Universiteit Leuven and Universitair Ziekenhuis Leuven, Leuven, Belgium
| | - Doreen Belz
- Klinikum der Universitaet zu Koeln, Cologne, Germany
| | | | | | | | | | | | | | | | | | - Nuria Barbarroja
- Reina Sofia University Hospital and University of Cordoba, Cordoba, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Aurélie De Groof
- Université Catholique de Louvain and Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Julie Ducreux
- Université Catholique de Louvain and Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Bernard Lauwerys
- Université Catholique de Louvain and Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Anne-Lise Maudoux
- Université Catholique de Louvain and Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Divi Cornec
- Université de Brest, Centre Hospitalier Universitaire de Brest, INSERM, and Labex IGO, Brest, France
| | | | - Sandrine Jousse-Joulin
- Université de Brest, Centre Hospitalier Universitaire de Brest, INSERM, and Labex IGO, Brest, France
| | | | - Bénédicte Rouvière
- Université de Brest, Centre Hospitalier Universitaire de Brest, INSERM, and Labex IGO, Brest, France
| | - Alain Saraux
- Université de Brest, Centre Hospitalier Universitaire de Brest, INSERM, and Labex IGO, Brest, France
| | - Quentin Simon
- Université de Brest, Centre Hospitalier Universitaire de Brest, INSERM, and Labex IGO, Brest, France
| | | | | | | | | | | | | | | | | | | | | | - Qingyu Cheng
- Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Velia Gerl
- Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Falk Hiepe
- Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - Silvia Thiel
- Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | | | | | | | | | | | - Laurence Laigle
- Institut de Recherches Internationales Servier, Suresnes, France
| | | | | | - Yves Renaudineau
- Université de Brest, Centre Hospitalier Universitaire de Brest, INSERM, and Labex IGO, Brest, France
| | | | | | - Javier Martín
- Institute of Parasitology and Biomedicine "López Neyra", Spanish National Research Council, Granada, Spain
| | - Lorenzo Beretta
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | | | - Jacques-Olivier Pers
- Université de Brest, Centre Hospitalier Universitaire de Brest, INSERM, and Labex IGO, Brest, France
| | - Marta E Alarcón-Riquelme
- Pfizer-University of Granada-Junta de Andalucía Centre for Genomics and Oncological Research, Granada, Spain, and Karolinska Institutet, Stockholm, Sweden
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Riancho-Zarrabeitia L, Martínez-Taboada V, Rúa-Figueroa I, Alonso F, Galindo-Izquierdo M, Ovalles J, Olivé-Marqués A, Fernández-Nebro A, Calvo-Alén J, Menor-Almagro R, Tomero-Muriel E, Uriarte-Isacelaya E, Botenau A, Andres M, Freire-González M, Santos Soler G, Ruiz-Lucea E, Ibáñez-Barceló M, Castellví I, Galisteo C, Quevedo Vila V, Raya E, Narváez-García J, Expósito L, Hernández-Beriaín JA, Horcada L, Aurrecoechea E, Pego-Reigosa JM. Antiphospholipid syndrome (APS) in patients with systemic lupus erythematosus (SLE) implies a more severe disease with more damage accrual and higher mortality. Lupus 2020; 29:1556-1565. [PMID: 32807021 DOI: 10.1177/0961203320950477] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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: 12/11/2022]
Abstract
INTRODUCTION Antiphospholipid antibodies (aPL) have been associated with organ damage and certain features in systemic lupus erythematosus(SLE) patients. Our aim was to investigate the differences between SLE patients according to the presence of aPL and/or clinical antiphospholipid syndrome (APS). MATERIALS AND METHODS Patients from the RELESSER-T registry were included. RELESSER-T is a Spanish multicenter, hospital-based, retrospective, SLE registry. RESULTS We included 2398 SLE patients, 1372 of whom were positive for aPL. Overall 1026 patients were classified as SLE, 555 as SLE-APS and817 as SLE-aPL. Regarding cardiovascular risk factors, SLE-APS patients had higher rates of hypertension, dyslipidemia and diabetes than those with SLE-aPL and SLE (p < 0.001). SLE-APS patients showed higher rates of neuropsychiatric, cardiac, pulmonary, renal and ophthalmological manifestations than the other groups (p < 0.001). SLE-APS patients presented greater damage accrual with higher SLICC values (1.9 ± 2.2 in SLE-APS, 0.9 ± 1.4 in SLE-aPL and 1.1 ± 1.6 in SLE, p < 0.001) and more severe disease as defined by the Katz index (3 ± 1.8 in SLE-APS, 2.7 ± 1.7 in SLE-aPL and 2.6 ± 1.6 in SLE, p < 0.001). SLE-APS patients showed higher mortality rates (p < 0.001). CONCLUSIONS SLE-APS patients exhibited more severe clinical profiles with higher frequencies of major organ involvement, greater damage accrual and higher mortality than SLE-aPL and SLE patients.
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Affiliation(s)
| | - Victor Martínez-Taboada
- Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | | | - Fernando Alonso
- Unidad de Investigación. Sociedad Española de Reumatología, Madrid, Spain
| | | | - Juan Ovalles
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | | | | | | | | | | | | | - Mariano Andres
- Hospital General Universitario de Alicante, Valenciana, Spain
| | | | | | | | | | | | | | | | - Enrique Raya
- Hospital Universitario Clínico San Cecilio, Andalucía, Spain
| | | | | | | | - Loreto Horcada
- Complejo Hospitalario Universitario de Navarra, Pamplona, Spain
| | - Elena Aurrecoechea
- Rheumatology Department, Hospital Sierrallana, IDIVAL, Torrelavega, Spain
| | - Jose M Pego-Reigosa
- Complejo Hospitalario Universitario de Vigo IRIDIS Group, Instituto de Investigación Sanitaria Galicia Sur (IISGS), Vigo, Spain
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13
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Melchor S, Sánchez-Piedra C, Fernández Castro M, Andreu JL, Martínez Taboada V, Olivé A, Rosas J, Menor R, García-Aparicio Á, López Longo FJ, Manrique-Arija S, García Vadillo JA, López González R, Narváez J, Galisteo C, González Martín J, Naranjo A, Illera Ó, Moreira B, Raya E, Rodríguez López M, Júdez E, Moriano C, Torrente-Segarra V, García Magallón B, Guillén Astete C, Castellvi I, Bohórquez C, Loricera J, Belzunegui J, Carreira PE. Digestive involvement in primary Sjögren's syndrome: analysis from the Sjögrenser registry. Clin Exp Rheumatol 2020; 38 Suppl 126:110-115. [PMID: 33025900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 09/14/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES Digestive involvement (DI) has been reported in 10-30% of primary Sjögren's syndrome (pSS) patients, and few studies have systematically analysed the prevalence of DI in pSS patients. The aim of this study was to describe DI prevalence in pSS patients from the Sjögrenser Study, and to analyse its clinical associations. METHODS All patients included in the Sjögrenser study, a Spanish multicentre randomised cohort, containing demographic, clinical and histologic data, have been analysed retrospectively. Patients were classified according to the presence of DI (oesophageal, gastric, intestinal, hepatic and pancreatic), and we have performed DI clinical associations, descriptive statistics, Student t or χ2 test, and uni and multivariate logistic regression. RESULTS From 437 included patients, 95% were women, with a median age of 58 years, 71 (16.2%) presented DI: 21 (29.5%) chronic atrophic gastritis, 12 (16.9%) oesophageal motility dysfunction, 3 (4.2%) lymphocytic colitis, 18 (25.3%) primary biliary cholangitis, 15 (21.1%) autoimmune hepatitis, 7 (9.8%) pancreatic involvement and 5 (7%) coeliac disease. Half of them developed DI at the same time or after pSS diagnosis. Patients with DI were significantly older at pSS diagnosis (p=0.032), more frequently women (p=0.009), presented more autoimmune hypothyroidism and C3 hypocomplementaemia (p=0.040), and were treated more frequently with glucocorticoids, immunosuppressant and biologic therapies. Patients with pancreatic involvement presented more central nervous system and renal involvement, Raynaud's phenomenon, lymphoma and C3/C4 hypocomplementaemia. CONCLUSIONS DI is frequent in Sjögrenser patients, mainly in the form of autoimmune disorders, and seem to be associated with a more severe phenotype. Our results suggest that DI should be evaluated in pSS patients, especially those with more severe disease.
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Affiliation(s)
- Sheila Melchor
- Rheumatology Department, Hospital Universitario Doce de Octubre, Madrid, Spain.
| | | | | | - Jose Luis Andreu
- Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Víctor Martínez Taboada
- Hospital Universitario Marqués de Valdecilla, Facultad de Medicina Universidad de Cantabria, Santander, Spain
| | | | | | - Raúl Menor
- Hospital General Jerez de la Frontera, Cádiz, Spain
| | | | | | | | | | | | | | | | | | | | - Óscar Illera
- Hospital Universitario Infanta Sofía, Madrid, Spain
| | | | - Enrique Raya
- Hospital Clínico Universitario San Cecilio, Granada, Spain
| | | | | | | | | | | | | | - Iván Castellvi
- Hospital Universitario Santa Creu y Sant Pau, Barcelona, Spain
| | | | - Javier Loricera
- Hospital Universitario Marqués de Valdecilla, Facultad de Medicina Universidad de Cantabria, Santander, Spain
| | | | - Patricia E Carreira
- Rheumatology Department, Hospital Universitario Doce de Octubre, Madrid, Spain
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14
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Salman-Monte TC, Sanchez-Piedra C, Fernandez Castro M, Andreu JL, Martinez Taboada V, Olivé A, Rosas J, Menor R, Rodríguez B, Garcia Aparicio A, Lopez Longo FJ, Manrique-Arija S, Garcia Vadillo JA, Gil Barato S, López-González R, Galisteo C, Gonzalez Martin J, Ruiz Lucea E, Erausquin C, Melchor S, Moreira B, Raya E, Pego-Reigosa JM, Cid N, Júdez E, Moriano C, Narváez FJ, Corominas H, Garcia Magallon B, Guillen Astete C, Castellvi I, Bohórquez C, Loricera J, Belzunegui J, Illera Ó, Torrente-Segarra V. Prevalence and factors associated with osteoporosis and fragility fractures in patients with primary Sjögren syndrome. Rheumatol Int 2020; 40:1259-1265. [PMID: 32533289 DOI: 10.1007/s00296-020-04615-3] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 05/31/2020] [Indexed: 02/07/2023]
Abstract
This study aimed at determining socio-demographic and clinical factors of primary Sjögren syndrome (pSS) associated with osteoporosis (OP) and fragility fracture. SJOGRENSER is a cross-sectional study of patients with pSS, classified according to American European consensus criteria developed in 33 Spanish rheumatology departments. Epidemiological, clinical, serological and treatment data were collected and a descriptive analysis was conducted. Bivariate and multivariate analyses were performed using a binomial logistic regression to study the factors associated with OP and fragility fracture in pSS. 437 patients were included (95% women, with a median age of 58.6 years). 300 women were menopausal (76.4%). Prevalence of OP was 18.5% [in men (N = 21) this measured 19%]. A total of 37 fragility fractures were recorded. In the multivariate analysis, there was an association between OP and age: in the 51-64 age range (menopausal women), the OR measured 9.993 (95% CI 2301-43,399, p = 0.002); In the age > 64 years group, OR was 20.610 (4.679-90.774, p < 0.001); between OP and disease duration, OR was 1.046 (1.008-1085, p = 0.017); past treatment with corticosteroids, OR 2.548 (1.271-5.105, p = 0.008). Similarly, an association was found between fragility fractures and age: in the 51-64 age group, OR measured 5.068 (1.117-22,995, p = 0.035), age > 64 years, OR was 7.674 (1.675-35,151, p < 0.009); disease duration, OR 1.049 (CI 1.003-1097, p < 0.036) and the ESSDAI index, OR 1.080 (1.029-1134, p = 0.002). Patients with pSS can develop osteoporosis and fragility fractures over the course of the disease. Age, corticosteroids treatment and disease duration were associated with the development of OP. Disease duration and ESSDAI were associated with the development of fractures in patients with pSS.
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Affiliation(s)
- Tarek Carlos Salman-Monte
- Rheumatology Department, Hospital del Mar/Parc de Salut Mar-IMIM, Passeig Maritim 25-29, 08005, Barcelona, Spain.
| | | | | | - Jose Luis Andreu
- Rheumatology Department, Hospital Puerta de Hierro, Madrid, Spain
| | | | - Alejandro Olivé
- Rheumatology Department, Hospital Germans Trias i Pujol, Barcelona, Spain
| | - José Rosas
- Rheumatology Department, Hospital Marina Baixa, Alicante, Spain
| | - Raúl Menor
- Rheumatology Department, Hospital General Jerez de la Frontera, Madrid, Spain
| | - Beatriz Rodríguez
- Rheumatology Department, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | | | | | | | | | - Susana Gil Barato
- Rheumatology Department, Hospital General de Alicante, Alicante, Spain
| | | | - Carlos Galisteo
- Rheumatology Department, Hospital Parc-Taulí, Sabadell, Spain
| | | | | | - Celia Erausquin
- Rheumatology Department, Hospital de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - Sheila Melchor
- Rheumatology Department, Hospital Doce de Octubre, Madrid, Spain
| | - Begoña Moreira
- Rheumatology Department, Complejo hospitalario de Pontevedra, Pontevedra, Spain
| | - Enrique Raya
- Rheumatology Department, Hospital Clínico San Cecilio, Granada, Spain
| | - Jose María Pego-Reigosa
- Rheumatology Department, Hospital Universitario de Vigo, IRIDIS-VIGO Group, Galicia Sur Health Research, Vigo, Spain
| | - Natalia Cid
- Rheumatology Department, Hospital de Valme, Seville, Spain
| | - Enrique Júdez
- Rheumatology Department, Hospital de Albacete, Albacete, Spain
| | - Clara Moriano
- Rheumatology Department, Hospital de León, León, Spain
| | | | - Hèctor Corominas
- Rheumatology Department, Hospital Sant Joan Despí Moisès Broggi, Barcelona, Spain
| | | | | | - Ivan Castellvi
- Rheumatology Department, Hospital San Pau y Santa Creu, Barcelona, Spain
| | - Cristina Bohórquez
- Rheumatology Department, Hospital Príncipe de Asturias, Alcalá de Henares, Spain
| | - Javier Loricera
- Rheumatology Department, Hospital Marqués de Valdecilla, Santander, Spain
| | - Joaquín Belzunegui
- Rheumatology Department, Hospital de Donostia, Donostia-San Sebastián, Spain
| | - Óscar Illera
- Rheumatology Department, Hospital Infanta Sofía, Madrid, Spain
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15
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Calderón-Goercke M, Prieto-Peña D, Castañeda S, Moriano C, Becerra-Fernández E, Revenga M, Alvarez-Rivas N, Galisteo C, Prior-Español Á, Galindez E, Hidalgo C, Manrique Arija S, De Miguel E, Salgado-Pérez E, Aldasoro V, Villa-Blanco I, Romero-Yuste S, Narváez J, Gomez-Arango C, Perez-Pampín E, Melero R, Sivera F, Fernández-Díaz C, Olive A, Álvarez del Buergo M, Marena Rojas L, Fernández-López C, Navarro F, Raya E, Arca B, Solans-Laqué R, Conesa A, Vázquez C, Román-Ivorra JA, Lluch P, Vela-Casasempere P, Torres-Martín C, Nieto JC, Ordas-Calvo C, Luna-Gomez C, Toyos Sáenz de Miera FJ, Fernández-Llanio N, García A, González-Vela C, García-Fernández J, Vicente-Gómez P, García-Manzanares Á, Ortego N, Ortiz-Sanjuán F, Corteguera M, Hernández JL, González-Gay MA, Blanco R. THU0297 SERIOUS INFECTIONS IN 134 PATIENTS WITH GIANT CELL ARTERITIS WITH TOCILIZUMAB IN CLINICAL PRACTICE. FREQUENCY, TYPE AND CLINICAL ASSOCIATIONS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.2583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Infections are the most common adverse event of Tocilizumab (TCZ) in Giant Cell Arteritis (GCA). In GiACTA study(1),serious infections were observed in 7% (9.6/100 patient-years) of patients who received TCZ weekly. Randomized clinical trials (RCTs) are conducted under highly standardized design excluding some real-world patients. Therefore, adverse events may be underestimated in RCTs. In our series of real-life, serious infections occurred in 11.9% (10.6/100 patient-years)(2).Objectives:In a wide series of GCA of clinical practice treated with TCZ, we assess the frequency, type and predisposing factors of serious infections.Methods:Multicenter study of 134 patients diagnosed with GCA, all of them refractory to conventional therapy, treated with TCZ. Serious infection was considered when a life-threatening infection, fatal, or requiring hospitalization occurred, intravenous antibiotics were required, or the infectious process led to persistent or significant disability.Results:16 of 134 (11.9%, 10.6/100 patient-years) patients developed serious infections during follow-up. The most frequent infections were pneumonia (n=4), urinary tract infection (n=4), and facial herpes zoster (n=2). At TCZ onset, serious infections were more frequent in older patients (74.3±9.6 vs 72.9±8.7 years), with a longer GCA evolution (20 [4.3-45.6] vs 13 [5-29.3] months), with visual manifestations (43.75% vs 17.8%) and a higher dose of prednisone at TCZ onset (30.4±15.5 vs 21.1±16.1 mg/day) (TABLE). Presence of comorbidities were similar in both groups. 13 of the 16 patients who had infections received a dose of prednisone greater than 15 mg/day (16.3/100 patient-years) compared to 3 patients under treatment with less than 15 mg/day of prednisone (4.2/100 patient-years).Conclusion:The age, GCA duration, ocular involvement and the dose of glucocorticoids, at TCZ onset, seem to be predisposing factors related to an increased risk of developing serious infections in GCA patients.References:[1]Stone JH, et al. N Engl J Med. 2017; 377:317-28.[2]Calderón-Goercke M et al. Semin Arthritis Rheum 2019 Aug;49(1): 126-135.TABLESERIOUS INFECTIONS(n=16)WITHOUT SERIOUS INFECTIONS(n=118)pBASAL FEATURES AT TCZ ONSETGENERAL FEATURES Age, years, mean± SD74.3±9.672.9±8.70.552 Sex, female/male n(%)13/388/300.760 Time from GCA diagnosis to TCZ onset (months), median [IQR]20[4.3-45.6]13[5-29.3]0.604COMORBIDITIES Hypertension, n(%)9(56)86(73)0.551 Diabetes, n(%)3(19)39(33)0.677 Chronic kidney disease, n(%)3(19)27(23)0.512CLINICAL FEATURES OF GCA PMR, n(%)9(56.25)64(54.2)0.879 Aortitis, n(%)5(31.25)53(45)0.301 Visual manifestations, n(%)7(43.75)21(17.8)0.017CORTICOSTEROIDS AT TCZ ONSET Prednisone dose mg/d, mean (SD)30.4±15.521.1±16.10.031Disclosure of Interests:Monica Calderón-Goercke: None declared, D. Prieto-Peña: None declared, Santos Castañeda: None declared, Clara Moriano: None declared, Elena Becerra-Fernández: None declared, Marcelino Revenga: None declared, Noelia Alvarez-Rivas: None declared, Carles Galisteo: None declared, Águeda Prior-Español: None declared, E. Galindez: None declared, Cristina Hidalgo: None declared, Sara Manrique Arija: None declared, Eugenio de Miguel Grant/research support from: Yes (Abbvie, Novartis, Pfizer), Consultant of: Yes (Abbvie, Novartis, Pfizer), Paid instructor for: yes (AbbVie, Novartis, Pfizer, MSD, BMS, UCB, Roche, Grunental, Janssen, Sanofi), Speakers bureau: yes (AbbVie, Novartis, Pfizer, MSD, BMS, UCB, Roche, Grunental, Janssen, Sanofi), Eva Salgado-Pérez: None declared, Vicente Aldasoro Speakers bureau: Roche, Abbvie, MSD, UCB, Pfizer, Menarini, Grunenthal, Gebro, Novartis, Janssen, Ignacio Villa-Blanco Consultant of: UCB, Speakers bureau: Novartis, MSD, Lilly, Susana Romero-Yuste: None declared, J. Narváez: None declared, Catalina Gomez-Arango: None declared, Eva Perez-Pampín: None declared, Rafael Melero: None declared, Francisca Sivera: None declared, Carlos Fernández-Díaz Speakers bureau: Brystol Meyers Squibb, Alejandro Olive: None declared, María Álvarez del Buergo: None declared, Luisa Marena Rojas: None declared, Carlos Fernández-López: None declared, Francisco Navarro: None declared, Enrique Raya: None declared, Beatriz Arca: None declared, Roser Solans-Laqué: None declared, Arantxa Conesa: None declared, Carlos Vázquez: None declared, Jose Andrés Román-Ivorra: None declared, Pau Lluch: None declared, Paloma Vela-Casasempere: None declared, Carmen Torres-Martín: None declared, Juan Carlos Nieto Speakers bureau: Pfizer, Abbvie, MSD, Novartis, Janssen, Lilly, Nordic Pharma, BMS, Gebro, FAES Farma, Roche, Sanofi, Carmen Ordas-Calvo: None declared, Cristina Luna-Gomez: None declared, Francisco J. Toyos Sáenz de Miera: None declared, Nagore Fernández-Llanio: None declared, Antonio García: None declared, Carmen González-Vela: None declared, Javier García-Fernández: None declared, Patricia Vicente-Gómez: None declared, Ángel García-Manzanares: None declared, Norberto Ortego: None declared, Francisco Ortiz-Sanjuán: None declared, Montserrat Corteguera: None declared, J. Luis Hernández: None declared, Miguel A González-Gay Grant/research support from: Pfizer, Abbvie, MSD, Speakers bureau: Pfizer, Abbvie, MSD, Ricardo Blanco Grant/research support from: AbbVie, MSD, and Roche, Speakers bureau: AbbVie, Pfizer, Roche, Bristol-Myers, Janssen, and MSD
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Calderón-Goercke M, Prieto-Peña D, Castañeda S, Moriano C, Becerra-Fernández E, Revenga M, Alvarez-Rivas N, Galisteo C, Prior-Español Á, Galindez E, Hidalgo C, Manrique Arija S, De Miguel E, Salgado-Pérez E, Aldasoro V, Villa-Blanco I, Romero-Yuste S, Narváez J, Gomez-Arango C, Perez-Pampín E, Melero R, Sivera F, Olive A, Álvarez del Buergo M, Marena Rojas L, Fernández-López C, Navarro F, Raya E, Arca B, Solans-Laqué R, Conesa A, Vázquez C, Román-Ivorra JA, Lluch P, Vela-Casasempere P, Torres-Martín C, Nieto JC, Ordas-Calvo C, Luna-Gomez C, Toyos Sáenz de Miera FJ, Fernández-Llanio N, García A, Hernández JL, González-Gay MA, Blanco R. OP0033 OPTIMIZATION OF TOCILIZUMAB THERAPY IN GIANT CELL ARTERITIS. A MULTICENTER REAL-LIFE STUDY OF 134 PATIENTS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.2574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Tocilizumab (TCZ) is the only biological agent approved in Giant Cell Arteritis (GCA). There is general agreement on the initial and the standard maintenance dose of TCZ. However, information on duration and optimization of TCZ in GCA is scarce.Objectives:Our aim was to assess efficacy and safety of TCZ therapy optimization in an unselected wide series of GCA in clinical practice.Methods:Multicenter study, 134 patients with GCA who received TCZ due to inefficacy/adverse events of previous therapy. Once complete remission was reached and based on a shared decision between patient and physician TCZ was optimized in some cases. Optimization was done by decreasing the dose and/or prolonging the TCZ dosing interval progressively.Results:134 GCA patients treated with TCZ (101w/33m); mean age 73.0±8.8 years. TCZ was administered IV to 106 (79.1%) patients and SC to 28 (20.9%). TCZ was optimized in 43 (32.1%) patients. No demographic, clinical manifestations or laboratory data differences had been found at TCZ onset (TABLE). After a follow up of 12 [6-15.5] months, and a complete remission for 6 [3-12] months; the first TCZ optimization was performed. Median prednisone dose at first TCZ optimization was 2.5 [0-5] mg/day. TCZ IV was optimized from 8 to 4 mg/kg/4weeks in 12 of 106 (11.3%) and from 162 mg/SC/week to 162 mg/SC/2weeks in 9 of 28 (32.1%) cases. Five (11.6%) of the 43 optimized cases relapsed. In 4 cases, the relapses were treated increasing TCZ up to the pre-optimization dose, in 1 case the route of administration was change (4 mg/kg/4week to 162 mg/SC/week). In 8 of 43 optimized patients (18.6%), it was possible to withdraw TCZ after complete remission for 30 [16.25-45.75] months. Regarding adverse events and severe infections were similar in both groups. The mean TCZ treatment costs were lower in the optimized group.Conclusion:Once remission is reached in GCA patients under TCZ treatment, optimization of TCZ may be performed. Based on our experience it could be performed by reducing the dose with IV TCZ or by prolonging dosing interval with SC TCZ.References:[1]Calderón-Goercke M et al. Semin Arthritis Rheum 2019 Aug;49(1): 126-135.TABLE.OPTIMIZED-TCZ GROUP (n=43)NON-OPTIMIZED TCZ GROUP (n=91)pBASAL FEATURES AT TCZ ONSETGENERAL FEATURESAge, years, mean± SD68.9±8.771.4±8.50.125Sex, female/male n(%)32/1068/240.779Time from GCA diagnosis to TCZ onset (months), median [IQR]19.5[7.75-45]10.5[4 – 25]0.047SYSTEMIC MANIFESTATIONSFever, n(%)1(2.4)8(8.7)0.176Constitutional syndrome, n(%)11(26.2)19(20.7)0.476PMR, n(%)18(42.9)56(60.9)0.052ISCHEMIC MANIFESTATIONSVisual involvement, n(%)5(11.9)23(25)0.084Headache, n(%)26(61.9)42(45.7)0.081Jaw claudication, n(%)1(2.4)11(12)0.072CORTICOSTEROIDS AT TCZ ONSETPrednisone dose, mg/d mean (SD)15.1±11.125±17.40.001FOLLOW-UP ON TCZ THERAPY (MONTHS), MEDIAN [IQR]24[18-27]6 [3-18]0.000Relapses, n(%)5(11.6)5(5.5)0.207End follow-up remission, n(%)40(93)84(92)0.99Severe side efects, n(%)14(32.6)22(24.2)0.307Seriuos infections, n(%)6(14)10(11)0.878Cost, (mean) euros per yearIVSC7 538.47 329.011 726.411 726.4--Disclosure of Interests:Monica Calderón-Goercke: None declared, D. Prieto-Peña: None declared, Santos Castañeda: None declared, Clara Moriano: None declared, Elena Becerra-Fernández: None declared, Marcelino Revenga: None declared, Noelia Alvarez-Rivas: None declared, Carles Galisteo: None declared, Águeda Prior-Español: None declared, E. Galindez: None declared, Cristina Hidalgo: None declared, Sara Manrique Arija: None declared, Eugenio de Miguel Grant/research support from: Yes (Abbvie, Novartis, Pfizer), Consultant of: Yes (Abbvie, Novartis, Pfizer), Paid instructor for: yes (AbbVie, Novartis, Pfizer, MSD, BMS, UCB, Roche, Grunental, Janssen, Sanofi), Speakers bureau: yes (AbbVie, Novartis, Pfizer, MSD, BMS, UCB, Roche, Grunental, Janssen, Sanofi), Eva Salgado-Pérez: None declared, Vicente Aldasoro Speakers bureau: Roche, Abbvie, MSD, UCB, Pfizer, Menarini, Grunenthal, Gebro, Novartis, Janssen, Ignacio Villa-Blanco Consultant of: UCB, Speakers bureau: Novartis, MSD, Lilly, Susana Romero-Yuste: None declared, J. Narváez: None declared, Catalina Gomez-Arango: None declared, Eva Perez-Pampín: None declared, Rafael Melero: None declared, Francisca Sivera: None declared, Alejandro Olive: None declared, María Álvarez del Buergo: None declared, Luisa Marena Rojas: None declared, Carlos Fernández-López: None declared, Francisco Navarro: None declared, Enrique Raya: None declared, Beatriz Arca: None declared, Roser Solans-Laqué: None declared, Arantxa Conesa: None declared, Carlos Vázquez: None declared, Jose Andrés Román-Ivorra: None declared, Pau Lluch: None declared, Paloma Vela-Casasempere: None declared, Carmen Torres-Martín: None declared, Juan Carlos Nieto Speakers bureau: Pfizer, Abbvie, MSD, Novartis, Janssen, Lilly, Nordic Pharma, BMS, Gebro, FAES Farma, Roche, Sanofi, Carmen Ordas-Calvo: None declared, Cristina Luna-Gomez: None declared, Francisco J. Toyos Sáenz de Miera: None declared, Nagore Fernández-Llanio: None declared, Antonio García: None declared, J. Luis Hernández: None declared, Miguel A González-Gay Grant/research support from: Pfizer, Abbvie, MSD, Speakers bureau: Pfizer, Abbvie, MSD, Ricardo Blanco Grant/research support from: AbbVie, MSD, and Roche, Speakers bureau: AbbVie, Pfizer, Roche, Bristol-Myers, Janssen, and MSD
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Raya E, Morales-Garrido P, Jiménez-Moleón I. AB0826 PROBABILITY OF SURVIVAL OF USTEKINUMAB IN PSORIATIC ARTHRITIS: A REAL CLINICAL PRACTICE COHORT COMPOSED OF 64 PATIENTS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.4922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Psoriatic arthritis (PsA) is an inflammatory disorder of unknown etiology. Several domains are affected as peripheral or axial joints, enthesitis, dactylitis, nails as well as skin. Diverse cytokines have been described in the pathology of PsA as TNFα, IL-17 and IL-23. Ustekinumab (UST) is a fully human IgG1κ monoclonal antibody to interleukin 12/23. Its efficacy and safety have been tested in several clinical trials and registries. Nevertheless data from real word evidence studies is needed to understand the effectiveness, safety and behavior of UST in a different population of patients from randomized controlled trialsObjectives:Analyze the persistence of UST 45 and 90 mg along 52 weeks of treatmentMethods:Drug survival, effectiveness and security of UST were studied in a population of 64 PsA patients treated in the period between August 2014 to October 2019. Drug survival was defined as the time from initiation to discontinuation (stop/switch) of bDMARDs. For the determination of drug survival, Kaplan-Meier survival curves and Cox-regression analyses were used. Effectiveness was described as a reduction in the use of corticosteroids and in the levels of CRP along the study. All adverse events were recorded during the studyResults:64 patients were included with a mean follow-up of 57,2 weeks. At baseline the mean age was 47,8 years (8,9). 54,7% of patients were women and 45,3% were male. 31,3% were obese. Mean disease duration was 7,9 (5,0) years. 45,3% presented peripheric arthritis; 32,8% axial involvement; 31,3% enthesitis; 80% psoriasis. Patients were 45% bDMARDs-naïve; had a previous bDMARDs in 20,3% and ≥ than two bDMARDs in 34,4%. 30% of the patients had co-therapy with methotrexate and 29,7% of patients received corticosteroid therapy. Mean CRP was 7,9 (12,7) mg/L. The global probability of survival for UST was 96%, 83,9% and 60% at week 12, 24 and 52 respectively. High UST dosage was associated with favorable drug survival (at 52W: UST 45 mg=40,1%; UST 90 mg=75,8%; UST 45 to 90 mg*=88,9%) (p=0,008). The bDMARDS-naïve population also correlated with favorable UST survival (at 52W: bDMARDS-naïve=66,1% vs bDMARDS-experienced=56,7%), however no statistical significance was found (p=0,196). No difference in survival was observed among patients with or without axial involvement (W52: axial=58,2% vs non-axial=61,6; p=0,869). UST produced a reduction in the use of corticosteroids (30% vs 16%) and CRP levels (8,7 vs 7,7). Differences were greater in patients treated more than 28 weeks (maximum efficiency described for UST) (corticosteroids: 26% vs 16%; CRP levels: 8,5 vs 4,4). 4,9% of the patients suffered an AE. Most of them were non-serious AE: infections (3,3%) or headache (1,6%). The main cause of treatment discontinuation was lack of efficacy (30%), followed by primary failure (9,4%) and just a 3% due to AEConclusion:The persistence of UST was dose-dependent and greater for the UST 90 mg dosage and for the population of bDMARD-naïve patientsDrug survival of UST in the population of patients with axial involvement seems similar to the population of patients without axial affection which provide evidence of the efficacy of the IL23 inhibition in the axial domain of PsAUST decreased the use of corticosteroids and CRP levels along treatmentThe security profile of UST was to the drug. Only few non-serious AE reported during this study*UST 45 to 90 mg, patients who change from UST 45 to UST 90 mg dosageReferences:[1]Ritchlin C. Efficacy and safety of the anti-IL-12/23 p40 monoclonal antibody, ustekinumab, in patients with active psoriatic arthritis despite conventional non-biological and biological anti-tumour necrosis factor therapy: 6-month and 1-year results of the phase 3. Ann Rheum Dis 2014;73:990–9[2]McInnes IB. Efficacy and safety of ustekinumab in patients with active psoriatic arthritis: 1 year results of the phase 3, multicentre, double-blind, placebo-controlled PSUMMIT 1 trial. Lancet 2013;382:780–9Disclosure of Interests:None declared
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Torrente-Segarra V, Salman-Monte TC, Rúa-Figueroa Í, Del Campo V, López-Longo FJ, Galindo-Izquierdo M, Calvo-Alén J, Olivé-Marqués A, Mouriño-Rodríguez C, Horcada L, Bohórquez C, Montilla C, Salgado E, Díez-Álvarez E, Blanco R, Andreu JL, Fernández-Berrizbeitia O, Expósito L, Gantes M, Hernández-Cruz B, Pecondón-Español Á, Lozano-Rivas N, Bonilla G, Lois Iglesias A, Rubio-Muñoz P, Ovalles J, Tomero E, Boteanu A, Narvaez J, Freire M, Vela P, Quevedo-Vila V, Juan Mas A, Muñoz-Fernández S, Raya E, Moreno M, Velloso-Feijoo ML, Soler G, Vázquez-Rodríguez TR, Pego-Reigosa JM. Associated factors to serious infections in a large cohort of juvenile-onset systemic lupus erythematosus from Lupus Registry (RELESSER). Semin Arthritis Rheum 2020; 50:657-662. [PMID: 32505871 DOI: 10.1016/j.semarthrit.2020.05.016] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 05/09/2020] [Accepted: 05/11/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To assess the incidence of serious infection (SI) and associated factors in a large juvenile-onset systemic lupus erythematosus (jSLE) retrospective cohort. METHODS All patients in the Spanish Rheumatology Society Lupus Registry (RELESSER) who meet ≥4 ACR-97 SLE criteria and disease onset <18 years old (jSLE), were retrospectively investigated for SI (defined as either the need for hospitalization with antibacterial therapy for a potentially fatal infection or death caused by the infection). Standardized SI rate was calculated per 100 patient years. Patients with and without SI were compared. Bivariate and multivariate logistic and Cox regression models were built to calculate associated factors to SI and relative risks. RESULTS A total of 353 jSLE patients were included: 88.7% female, 14.3 years (± 2.9) of age at diagnosis, 16.0 years (± 9.3) of disease duration and 31.5 years (±10.5) at end of follow-up. A total of 104 (29.5%) patients suffered 205 SI (1, 55.8%; 2-5, 38.4%; and ≥6, 5.8%). Incidence rate was 3.7 (95%CI: 3.2-4.2) SI per 100 patient years. Respiratory location and bacterial infections were the most frequent. Higher number of SLE classification criteria, SLICC/ACR DI score and immunosuppressants use were associated to the presence of SI. Associated factors to shorter time to first infection were higher number of SLE criteria, splenectomy and immunosuppressants use. CONCLUSIONS The risk of SI in jSLE patients is significant and higher than aSLE. It is associated to higher number of SLE criteria, damage accrual, some immunosuppressants and splenectomy.
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Affiliation(s)
- Vicenç Torrente-Segarra
- Department of Rheumatology. Hospital Comarcal de l'Alt Penedès-Garraf., Vilafranca del Penedès (Spain), C/ de l'Espirall, s/n, 08720, Vilafranca del Penedès, Spain.
| | | | - Íñigo Rúa-Figueroa
- Rheumatology Department, Doctor Negrín University Hospital of Gran Canaria, Spain.
| | | | | | | | | | | | - Coral Mouriño-Rodríguez
- Rheumatology Department, Complexo Hospitalario Universitario de Vigo (Spain), IRIDIS Group, Instituto de Investigación Sanitaria Galicia Sur (IISGS), Vigo, Spain.
| | - Loreto Horcada
- Rheumatology Department, Navarra Hospital, Navarra, Pamplona, Spain
| | - Cristina Bohórquez
- Rheumatology Department, Hospital Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - Carlos Montilla
- Rheumatology Department, Salamanca Clinic University Hospital, Castilla y León, Salamanca, Spain
| | - Eva Salgado
- Rheumatology Department, Hospital Complex of Ourense, Ourense, Spain.
| | | | - Ricardo Blanco
- Rheumatology Department, Marqués de Valdecilla University Hospital, Cantabria, Santander, Spain.
| | - José Luis Andreu
- Rheumatology Department, Puerta de Hierro-Majadahonda Hospital, Madrid, Spain.
| | | | - Lorena Expósito
- Rheumatology Department, Hospital Univ. De Canarias, Tenerife, Tenerife, Spain
| | - Marian Gantes
- Rheumatology Department, Tenerife Clinic Hospital, Islas Canarias, Santa Cruz de Tenerife, Spain
| | | | | | - Nuria Lozano-Rivas
- Rheumatology Department, Virgen de la Arrixaca University Hospital, Murcia, Murcia, Spain
| | - Gema Bonilla
- Rheumatology Department, La Paz University Hospital, Madrid, Madrid, Spain.
| | - Ana Lois Iglesias
- Rheumatology Department, Complexo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Paula Rubio-Muñoz
- Rheumatology Department, Germans Trias i Pujol University Hospital, Badalona, Spain
| | - Juan Ovalles
- Rheumatology Department, Hospital Gregorio Marañón, Madrid, Spain
| | - Eva Tomero
- Rheumatology Department, Hospital de la Princesa, Madrid, Spain
| | - Alina Boteanu
- Rheumatology Department, Hospital Ramon y Cajal, Madrid, Spain
| | - Javier Narvaez
- Rheumatology Department, Hospital de Bellvitge, Hospitalet Llobregat, Spain.
| | - Mercedes Freire
- Rheumatology Department, Complexo Hospitalario Universitario de A Coruña, A Coruña, Spain.
| | - Paloma Vela
- Rheumatology Department, Hospital Universitario de Alicante, Alicante, Spain
| | | | - Antonio Juan Mas
- Rheumatology Department, Hospital Son Llatzer de Mallorca, Mallorca, Spain.
| | | | - Enrique Raya
- Rheumatology Department, Hospital Clínico San Cecilio de Granada, Granada, Spain
| | - Mireia Moreno
- Rheumatology Department, Parc Taulí de Sabadell, Sabadell, Spain
| | - M L Velloso-Feijoo
- Rheumatology Department, Hospital Universitario de Valme, Sevilla, Spain
| | - Gregorio Soler
- Rheumatology Department, Hospital de Marinabaixa, Villajoyosa, Spain
| | | | - José M Pego-Reigosa
- Rheumatology Department, University Hospital Complex, IRIDIS Group, Instituto de Investigación Sanitaria Galicia Sur (IISGS), Vigo, Spain.
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Calderón-Goercke M, Castañeda S, Aldasoro V, Villa I, Prieto-Peña D, Atienza-Mateo B, Patiño E, Moriano C, Romero-Yuste S, Narváez J, Gómez-Arango C, Pérez-Pampín E, Melero R, Becerra-Fernández E, Revenga M, Álvarez-Rivas N, Galisteo C, Sivera F, Olivé-Marqués A, Álvarez Del Buergo M, Marena-Rojas L, Fernández-López C, Navarro F, Raya E, Galindez-Agirregoikoa E, Arca B, Solans-Laqué R, Conesa A, Hidalgo C, Vázquez C, Román-Ivorra JA, Loricera J, Lluch P, Manrique-Arija S, Vela P, De Miguel E, Torres-Martín C, Nieto JC, Ordas-Calvo C, Salgado-Pérez E, Luna-Gomez C, Toyos-Sáenz de Miera FJ, Fernández-Llanio N, García A, Larena C, González-Vela C, Corrales A, Varela-García M, Aurrecoechea E, Dos Santos R, García-Manzanares Á, Ortego N, Fernández S, Ortiz-Sanjuán F, Corteguera M, Hernández JL, González-Gay MÁ, Blanco R. Tocilizumab in giant cell arteritis: differences between the GiACTA trial and a multicentre series of patients from the clinical practice. Clin Exp Rheumatol 2020; 38 Suppl 124:112-119. [PMID: 32441643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 04/06/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES A potential point of concern among clinicians is whether results derived from the clinical trials can be reasonably applied or generalised to a definable group of patients seen in real world. It can be the case of the GiACTA study that is a phase III randomised controlled trial of tocilizumab (TCZ) in giant cell arteritis (GCA). To address this question, we compared the clinical features and the responses to TCZ from the GiACTA trial patients with those from a series of GCA seen in the daily clinical practice. METHODS Comparative study of clinical features between patients from the GiACTA trial (overall n=251) and those from a multicentre series of real-world GCA patients undergoing TCZ therapy (n=134). The diagnosis of GCA in the GiACTA trial was established by the ACR modified criteria whereas in the series of real-world patients it was made by using the ACR criteria, a positive biopsy of temporal artery or the presence of imaging techniques consistent with large-vessel vasculitis in individuals who presented cranial symptoms of GCA. GiACTA trial patients received subcutaneous TCZ (162 mg every 1 or 2 weeks) whereas those from the clinical practice series were treated using standard IV dose (8 mg/kg/month) or subcutaneous (162 mg/week). RESULTS Real-life patients undergoing TCZ were older with longer disease duration and higher values of ESR and had received conventional immunosuppressive therapy (mainly methotrexate) more commonly than those included in the GiACTA trial. Despite clinical differences, TCZ was equally effective in both GiACTA trial and clinical practice patients. However, serious infections were more commonly observed in GCA patients recruited from the clinical practice. CONCLUSIONS Despite clinical differences with patients recruited in clinical trials, data from real-life patients confirm the efficacy of TCZ in GCA.
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Affiliation(s)
- Mónica Calderón-Goercke
- Departments of Rheumatology, Internal Medicine and Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Santos Castañeda
- Department of Rheumatology, Hospital Universitario de La Princesa, IIS-Princesa, Madrid; Cátedra UAM-Roche, EPID-Future, Universidad Autónoma (UAM), Madrid, Spain
| | - Vicente Aldasoro
- Department of Rheumatology, Complejo Hospitalario de Navarra, Spain
| | - Ignacio Villa
- Department of Rheumatology, Hospital de Sierrallana, Torrelavega, Cantabria, Spain
| | - Diana Prieto-Peña
- Departments of Rheumatology, Internal Medicine and Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Belén Atienza-Mateo
- Departments of Rheumatology, Internal Medicine and Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Esther Patiño
- Department of Rheumatology, Hospital Universitario de La Princesa, IIS-Princesa, Madrid; Cátedra UAM-Roche, EPID-Future, Universidad Autónoma (UAM), Madrid, Spain
| | - Clara Moriano
- Department of Rheumatology, Complejo Asistencial Universitario de León, Spain
| | - Susana Romero-Yuste
- Department of Rheumatology, Complejo Hospitalario Universitario Pontevedra, Spain
| | - Javier Narváez
- Department of Rheumatology, Hospital de Bellvitge, Barcelona, Spain
| | | | - Eva Pérez-Pampín
- Department of Rheumatology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - Rafael Melero
- Department of Rheumatology, Complexo Hospitalario Universitario de Vigo, Spain
| | | | | | | | - Carles Galisteo
- Department of Rheumatology, Hospital Parc Taulí, Barcelona, Spain
| | - Francisca Sivera
- Department of Rheumatology, Hospital Universitario de Elda, Alicante, Spain
| | | | | | - Luisa Marena-Rojas
- Department of Rheumatology, Hospital La Mancha Centro, Alcázar de San Juan, Spain
| | | | - Francisco Navarro
- Department of Rheumatology, Hospital General Universitario de Elche, Alicante, Spain
| | - Enrique Raya
- Department of Rheumatology and Internal Medicine, Hospital San Cecilio, Granada, Spain
| | | | - Beatriz Arca
- Department of Rheumatology, Hospital Universitario San Agustín, Avilés, Spain
| | - Roser Solans-Laqué
- Department of Internal Medicine, Hospital Valle de Hebrón, Barcelona, Spain
| | - Arantxa Conesa
- Department of Rheumatology, Hospital General Universitario de Castellón, Spain
| | - Cristina Hidalgo
- Department of Rheumatology, Complejo Asistencial Universitario de Salamanca, Spain
| | - Carlos Vázquez
- Department of Rheumatology, Hospital Miguel Servet, Zaragoza, Spain
| | | | - Javier Loricera
- Departments of Rheumatology, Internal Medicine and Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Pau Lluch
- Department of Rheumatology, Hospital Mateu Orfila, Menorca, Spain
| | | | - Paloma Vela
- Department of Rheumatology, Hospital General Universitario de Alicante, Spain
| | | | | | - Juan Carlos Nieto
- Department of Rheumatology, Hospital Gregorio Marañón, Madrid, Spain
| | | | - Eva Salgado-Pérez
- Department of Rheumatology, Complejo Hospitalario Universitario de Ourense, Spain
| | - Cristina Luna-Gomez
- Department of Rheumatology, Hospital Universitario Nuestra Señora de la Candelaria, Tenerife, Spain
| | | | | | - Antonio García
- Department of Rheumatology, Hospital Virgen de las Nieves, Granada, Spain
| | - Carmen Larena
- Department of Rheumatology, Hospital Ramón y Cajal, Madrid, Spain
| | - Carmen González-Vela
- Departments of Rheumatology, Internal Medicine and Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Alfonso Corrales
- Departments of Rheumatology, Internal Medicine and Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | - María Varela-García
- Department of Rheumatology, Hospital Universitario de La Princesa, IIS-Princesa, Madrid; Cátedra UAM-Roche, EPID-Future, Universidad Autónoma (UAM), Madrid, Spain
| | - Elena Aurrecoechea
- Department of Rheumatology, Hospital de Sierrallana, Torrelavega, Cantabria, Spain
| | - Raquel Dos Santos
- Department of Rheumatology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | | | - Norberto Ortego
- Department of Rheumatology and Internal Medicine, Hospital San Cecilio, Granada, Spain
| | - Sabela Fernández
- Department of Rheumatology, Hospital Universitario San Agustín, Avilés, Spain
| | | | | | - José L Hernández
- Departments of Rheumatology, Internal Medicine and Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Miguel Á González-Gay
- Departments of Rheumatology, Internal Medicine and Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain.
| | - Ricardo Blanco
- Departments of Rheumatology, Internal Medicine and Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain.
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20
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Cobo-Ibáñez T, Urruticoechea-Arana A, Rúa-Figueroa I, Martín-Martínez MA, Ovalles-Bonilla JG, Galindo M, Calvo-Alén J, Olivé A, Fernández-Nebro A, Menor-Almagro R, Tomero E, Horcada L, Uriarte-Itzazelaia E, Martínez-Taboada VM, Andreu JL, Boteanu A, Narváez J, Bohorquez C, Montilla C, Santos G, Hernández-Cruz B, Vela P, Salgado E, Freire M, Hernández-Beriain JÁ, Díez-Álvarez E, Expósito L, Fernández-Berrizbeitia O, Velloso-Feijoo ML, Ibáñez-Barceló M, Lozano-Rivas N, Bonilla G, Moreno M, Raya E, Quevedo-Vila VE, Vázquez-Rodríguez TR, Ibáñez-Ruan J, Muñoz-Fernández S, Sánchez-Alonso F, Pego-Reigosa JM. Hormonal Dependence and Cancer in Systemic Lupus Erythematosus. Arthritis Care Res (Hoboken) 2020; 72:216-224. [PMID: 31529686 DOI: 10.1002/acr.24068] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 09/10/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To estimate the incidence and analyze any cancer-associated factors in patients with systemic lupus erythematosus (SLE), differentiating between hormone-sensitive (HS) and non-HS cancers. METHODS This was a retrospective multicenter study of a patient cohort from the Systemic Lupus Erythematosus Registry of the Spanish Society of Rheumatology. Included were the first cancer post-SLE diagnosis, clinical and sociodemographic information, cumulative damage, severity, comorbidities, treatments, and refractoriness. Cancers were classified as HS (prostate, breast, endometrium, and ovarian) and non-HS (the remainder). The standardized incidence ratio (SIR) was calculated and logistic regression models were built. RESULTS A total of 3,539 patients (90.4% women) were included, 154 of whom had cancer (91% female), and 44 had HS cancer (100% female). The cancer SIR was 1.37 (95% confidence interval [95% CI] 1.15-1.59), with higher values in women age <65 years (SIR 2.38 [95% CI 1.84-2.91]). The SIR in women with HS versus non-HS cancer was 1.02 (95% CI 0.13-1.91) and 1.93 (95% CI 0.98-2.89). In HS versus non-HS cancers, SLE diagnostic age (odds ratio [OR] 1.04 [P = 0.002] versus 1.04 [P = 0.019]), and period of disease evolution (OR 1.01 [P < 0.001] versus 1.00 [P = 0.029]) were associated with cancer. The Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (OR 1.27 [P = 0.022]) and angiotensin-converting enzyme (ACE) inhibitor prescriptions (OR 2.87 [P = 0.048]) were associated with non-HS cancers. CONCLUSION Cancer incidence in patients with SLE was higher than in the Spanish population, particularly among young women. This increase might be due to non-HS cancers, which would be associated with SLE involving greater cumulative damage where more ACE inhibitors are prescribed.
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Affiliation(s)
| | | | | | | | | | | | - Jaime Calvo-Alén
- Hospital Universitario Araba, Universidad del País Vasco, Vitoria, Spain
| | - Alejandro Olivé
- Hospital Universitario Germans Trias i Pujol, Barcelona, Spain
| | | | | | - Eva Tomero
- Hospital Universitario de la Princesa, Madrid, Spain
| | | | | | | | - José Luis Andreu
- Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | | | | | | | | | | | | | - Paloma Vela
- Hospital General Universitario Alicante, Universidad Miguel Hernández, Alicante, Spain
| | - Eva Salgado
- Complejo Hospitalario Universitario de Orense, Orense, Spain
| | - Mercedes Freire
- Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | | | | | | | | | | | | | | | | | | | - Enrique Raya
- Hospital Universitario San Cecilio, Granada, Spain
| | | | | | | | | | | | - José María Pego-Reigosa
- Complejo Hospitalario Universitario de Vigo, Instituto de Investigación Biomédica de Vigo, Vigo, Spain
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21
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Hernández Cruz B, Alonso F, Calvo Alén J, Pego-Reigosa JM, López-Longo FJ, Galindo-Izquierdo M, Olivé A, Tomero E, Horcada L, Uriarte E, Erausquin C, Sánchez-Atrio A, Montilla C, Santos Soler G, Fernández-Nebro A, Blanco R, Rodríguez-Gómez M, Vela P, Freire M, Díez-Álvarez E, Boteanu AL, Narváez J, Martínez Taboada V, Ruiz-Lucea E, Andreu JL, Fernández-Berrizbeitia O, Hernández-Beriain JÁ, Gantes M, Pérez-Venegas JJ, Ibáñez-Barceló M, Pecondón-Español Á, Marras C, Bonilla G, Castellví I, Moreno M, Raya E, Quevedo Vila VE, Vázquez T, Ruán JI, Muñoz S, Rúa-Figueroa Í. Differences in clinical manifestations and increased severity of systemic lupus erythematosus between two groups of Hispanics: European Caucasians versus Latin American mestizos (data from the RELESSER registry). Lupus 2019; 29:27-36. [DOI: 10.1177/0961203319889667] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background Systemic lupus erythematosus (SLE) is regarded as a prototype autoimmune disease because it can serve as a means for studying differences between ethnic minorities and sex. Traditionally, all Hispanics have been bracketed within the same ethnic group, but there are differences between Hispanics from Spain and those from Latin America, not to mention other Spanish-speaking populations. Objectives This study aimed to determine the demographic and clinical characteristics, severity, activity, damage, mortality and co-morbidity of SLE in Hispanics belonging to the two ethnic groups resident in Spain, and to identify any differences. Methods This was an observational, multi-centre, retrospective study. The demographic and clinical variables of patients with SLE from 45 rheumatology units were collected. The study was conducted in accordance with Good Clinical Practice guidelines. Hispanic patients from the registry were divided into two groups: Spaniards or European Caucasians (EC) and Latin American mestizos (LAM). Comparative univariate and multivariate statistical analyses were carried out. Results A total of 3490 SLE patients were included, 90% of whom were female; 3305 (92%) EC and 185 (5%) LAM. LAM patients experienced their first lupus symptoms four years earlier than EC patients and were diagnosed and included in the registry younger, and their SLE was of a shorter duration. The time in months from the first SLE symptoms to diagnosis was longer in EC patients, as were the follow-up periods. LAM patients exhibited higher prevalence rates of myositis, haemolytic anaemia and nephritis, but there were no differences in histological type or serositis. Anti-Sm, anti-Ro and anti-RNP antibodies were more frequently found in LAM patients. LAM patients also had higher levels of disease activity, severity and hospital admissions. However, there were no differences in damage index, mortality or co-morbidity index. In the multivariate analysis, after adjusting for confounders, in several models the odds ratio (95% confidence interval) for a Katz severity index >3 in LAM patients was 1.45 (1.038–2.026; p = 0.02). This difference did not extend to activity levels (i.e. SLEDAI >3; 0.98 (0.30–1.66)). Conclusion SLE in Hispanic EC patients showed clinical differences compared to Hispanic LAM patients. The latter more frequently suffered nephritis and higher severity indices. This study shows that where lupus is concerned, not all Hispanics are equal.
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Affiliation(s)
- B Hernández Cruz
- Rheumatology Department, Virgen Macarena University Hospital, Seville, Spain
| | - F Alonso
- Research Unit, Spanish Society of Rheumatology, Madrid, Spain
| | - J Calvo Alén
- Rheumatology Department, Araba University Hospital, Vitoria, Spain
| | - J M Pego-Reigosa
- Rheumatology Department, University Hospital Complex, Instituto de Investigación Biomédica de Vigo, Vigo, Spain
| | - F J López-Longo
- Rheumatology Department, Gregorio Marañón University Hospital, Madrid, Spain
| | | | - A Olivé
- Rheumatology Department, Germans Trías i Pujol University Hospital, Badalona, Spain
| | - E Tomero
- Rheumatology Department, La Princesa University Hospital, Madrid, Spain
| | - L Horcada
- Rheumatology Department, Navarra Hospital, Navarra, Spain
| | - E Uriarte
- Rheumatology Department, Donosti Hospital, Guipuzcoa, Spain
| | - C Erausquin
- Rheumatology Department, Dr Negrín University Hospital, Las Palmas de Gran Canaria, Spain
| | - A Sánchez-Atrio
- Rheumatology Department, Príncipe de Asturias University Hospital, Madrid, Spain
| | - C Montilla
- Rheumatology Department, Salamanca Clinic University Hospital, Salamanca, Spain
| | - G Santos Soler
- Rheumatology Department, Marina Baixa Hospital, Alicante, Spain
| | - A Fernández-Nebro
- Rheumatology Department, Carlos Haya University Hospital, Malaga, Spain
| | - R Blanco
- Rheumatology Department, Marqués de Valdecilla University Hospital, Santander, Spain
| | - M Rodríguez-Gómez
- Rheumatology Department, Hospital Complex of Ourense, Ourense, Spain
| | - P Vela
- Rheumatology Department, Alicante General Hospital, Alicante, Spain
| | - M Freire
- Rheumatology Department, Juan Canalejo University Hospital, La Coruña, Spain
| | | | - A L Boteanu
- Rheumatology Department, Ramon y Cajal University Hospital, Madrid, Spain
| | - J Narváez
- Rheumatology Department, Bellvitge Hospital, Barcelona, Spain
| | - V Martínez Taboada
- Rheumatology Department, Marqués de Valdecilla University Hospital, Santander, Spain
| | - E Ruiz-Lucea
- Rheumatology Department, Basurto Hospital, Bilbao, Spain
| | - JL Andreu
- Rheumatology Department, Puerta del Hierro-Majadahonda Hospital, Madrid, Spain
| | | | | | - M Gantes
- Rheumatology Department, Tenerife Clinic Hospital, Tenerife, Spain
| | - J J Pérez-Venegas
- Rheumatology Department, Jerez de la Frontera University Hospital, Cadiz, Spain
| | | | - Á Pecondón-Español
- Rheumatology Department, Miguel Servet University Hospital, Zaragoza, Spain
| | - C Marras
- Rheumatology Department, Virgen de la Arrixaca University Hospital, Murcia, Spain
| | - G Bonilla
- Rheumatology Department, La Paz University Hospital, Madrid, Spain
| | - I Castellví
- Rheumatology Unit, L’Alt Penedés District Hospital, Barcelona, Spain
| | - M Moreno
- Rheumatology Department, Parc Taulí Hospital, Barcelona, Spain
| | - E Raya
- Rheumatology Department, San Cecilio Hospital, Granada, Spain
| | | | - T Vázquez
- Rheumatology Department, Lucus Augusti Hospital, Lugo, Spain
| | - J Ibáñez Ruán
- Rheumatology Unit, POVISA Medical Centre, Vigo, Spain
| | - S Muñoz
- Rheumatology Service, Infanta Sofía University Hospital, San Sebastián de los Reyes, Madrid, Spain
| | - Í Rúa-Figueroa
- Rheumatology Department, Doctor Negrín University Hospital of Gran Canaria, Las Palmas de Gran Canaria, Spain
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Rúa-Figueroa I, López-Longo FJ, Del Campo V, Galindo-Izquierdo M, Uriarte E, Torre-Cisneros J, Vela P, Tomero E, Narváez J, Olivé A, Freire M, Salgado E, Andreu JL, Martínez-Taboada V, Calvo-Alén J, Hernández-Cruz B, Raya E, Quevedo V, Expósito Pérez L, Fernández-Nebro A, Ibañez M, Pascual-Valls È, Rúa-Figueroa D, Naranjo A, Pego-Reigosa JM. Bacteremia in Systemic Lupus Erythematosus in Patients from a Spanish Registry: Risk Factors, Clinical and Microbiological Characteristics, and Outcomes. J Rheumatol 2019; 47:234-240. [PMID: 30988123 DOI: 10.3899/jrheum.180882] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To describe the incidence of bacteremia in a large multicentric cohort of patients with systemic lupus erythematosus (SLE) and their clinical characteristics and to identify risk factors. METHODS All bacteremic episodes from the Spanish RELESSER registry were included. Clinical and laboratory characteristics concerning bacteremia and SLE status, as well as comorbidities at the time of infection, were retrospectively collected. A comparison with sex- and age-matched SLE controls without bacteremia was made. A logistic regression was conducted. RESULTS The study included 114 episodes of bacteremia in 83 patients. The incidence rate was 2.7/1000 patient-years. At the time of bacteremia, the median age was 40.5 (range: 8-90) years, and 88.6% of patients were female. The Safety of Estrogens in Lupus Erythematosus National Assessment-Systemic Lupus Erythematosus Disease Activity Index was 4 [interquartile range (IQR) 8]; 41% had an SLE flare (66% severe); Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index was 3 (IQR 4). A comorbidity was recorded in 64% of cases. At the time of bacteremia, 88.6% received corticosteroids (68.6% > 10 mg/day) and 57% immunosuppressors. Gram-negative bacilli, most frequently Escherichia coli (29.8%), caused 52.6% of the episodes. The bacteremia-related mortality was 14% and bacteremia was recurrent in 27.2% of cases. A dose-response relationship was found between corticosteroids and bacteremia risk. In the multivariate analysis, these factors were associated with bacteremia: elevated creatinine (OR 1.31, 95% CI 1.01-1.70; p = 0.045), diabetes (OR 6.01, 95% CI 2.26-15.95; p < 0.001), cancer (OR 5.32, 95% CI 2.23-12.70; p < 0.001), immunosuppressors (OR 6.35, 95% CI 3.42-11.77; p < 0.001), and damage (OR 1.65, 95% CI 1.31-2.09; p < 0.001). CONCLUSION Bacteremia occurred mostly in patients with active SLE and was frequently associated with severe flares and corticosteroid use. Recurrence and mortality were high. Immunosuppressors, comorbidities, and disease-related damage were associated with bacteremia.
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Affiliation(s)
- Iñigo Rúa-Figueroa
- From the Department of Rheumatology, Doctor Negrín University Hospital of Gran Canaria, Las Palmas; Department of Rheumatology, Gregorio Marañón University Hospital, Madrid; Department of Preventive Medicine, University Hospital Complex, and Department of Rheumatology, Biomedical Research Institute of Vigo, Vigo; Department of Rheumatology, Doce de Octubre University Hospital, Madrid; Department of Rheumatology, Donostia Hospital, Guipuzcoa; Infectious Diseases Department, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Córdoba; Department of Rheumatology, General University Hospital of Alicante, Miguel Hernandez University, Alicante; Department of Rheumatology, La Princesa University Hospital, Madrid; Department of Rheumatology, Bellvitge Hospital, Barcelona; Department of Rheumatology, Germans Trías i Pujol University Hospital, Badalona; Department of Rheumatology, University Hospital of A Coruña, A Coruña; Department of Rheumatology, University Hospital Complex of Ourense, Ourense; Department of Rheumatology, Puerta del Hierro-Majadahonda University Hospital, Majadahonda; Department of Rheumatology, Marqués de Valdecilla University Hospital, Cantabria University, Santander; Department of Rheumatology, University Hospital Araba, Victoria; Department of Rheumatology, Virgen Macarena Hospital, Seville; Department of Rheumatology, San Cecilio Hospital, Granada; Department of Rheumatology, Monforte Hospital, Lugo; Department of Rheumatology, Tenerife Clinic Hospital, Tenerife; Department of Rheumatology, Carlos Haya Hospital, Málaga; Department of Rheumatology, Son Llatzer Hospital, Palma de Mallorca; Department of Rheumatology, Doctor Peset Hospital, Valencia; University of Las Palmas, Gran Canaria, Las Palmas, Spain. .,I. Rúa-Figueroa, MD, Department of Rheumatology, Doctor Negrín University Hospital of Gran Canaria; F.J. López-Longo, MD, PhD, Department of Rheumatology, Gregorio Marañón University Hospital; V. Del Campo, MD, PhD, Department of Preventive Medicine, University Hospital Complex, Biomedical Research Institute of Vigo; M. Galindo-Izquierdo, MD, PhD, Department of Rheumatology, Doce de Octubre University Hospital; E. Uriarte, MD, Department of Rheumatology, Donostia Hospital, J. Torre-Cisneros, MD, PhD, Infectious Diseases Department, IMIBIC, Reina Sofia University Hospital, University of Córdoba; P. Vela, MD, PhD, Department of Rheumatology, General University Hospital of Alicante, Miguel Hernandez University Alicante; E. Tomero, MD, Department of Rheumatology, La Princesa University Hospital; J. Narváez, MD, PhD, Department of Rheumatology, Bellvitge Hospital; A. Olivé, MD, PhD, Department of Rheumatology, Germans Trías i Pujol University Hospital; M. Freire, MD, Department of Rheumatology, University Hospital of A Coruña; E. Salgado, MD, PhD, Department of Rheumatology, University Hospital Complex of Ourense; J.L. Andreu, MD, PhD, Department of Rheumatology, Puerta del Hierro-Majadahonda University Hospital; V. Martínez-Taboada, MD, PhD, Department of Rheumatology, Marqués de Valdecilla University Hospital, Cantabria University; J. Calvo-Alén, MD, PhD, Department of Rheumatology, University Hospital Araba; B. Hernández-Cruz, MD, PhD, Department of Rheumatology, Virgen Macarena Hospital; E. Raya, MD, Department of Rheumatology, San Cecilio Hospital; V. Quevedo, MD, Department of Rheumatology, Monforte Hospital; L. Expósito Pérez, PhD, Department of Rheumatology, Tenerife Clinic Hospital; A. Fernández-Nebro, MD, PhD, Department of Rheumatology, Carlos Haya Hospital; M. Ibañez, MD, Department of Rheumatology, Son Llatzer Hospital; È. Pascual-Valls, MD, Department of Rheumatology, Doctor Peset Hospital; D. Rúa-Figueroa, MD, University of Las Palmas; A. Naranjo, MD, PhD, Department of Rheumatology, Doctor Negrín University Hospital of Gran Canaria; J.M. Pego-Reigosa, Department of Rheumatology, University Hospital Complex, Biomedical Research Institute of Vigo.
| | - Francisco J López-Longo
- From the Department of Rheumatology, Doctor Negrín University Hospital of Gran Canaria, Las Palmas; Department of Rheumatology, Gregorio Marañón University Hospital, Madrid; Department of Preventive Medicine, University Hospital Complex, and Department of Rheumatology, Biomedical Research Institute of Vigo, Vigo; Department of Rheumatology, Doce de Octubre University Hospital, Madrid; Department of Rheumatology, Donostia Hospital, Guipuzcoa; Infectious Diseases Department, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Córdoba; Department of Rheumatology, General University Hospital of Alicante, Miguel Hernandez University, Alicante; Department of Rheumatology, La Princesa University Hospital, Madrid; Department of Rheumatology, Bellvitge Hospital, Barcelona; Department of Rheumatology, Germans Trías i Pujol University Hospital, Badalona; Department of Rheumatology, University Hospital of A Coruña, A Coruña; Department of Rheumatology, University Hospital Complex of Ourense, Ourense; Department of Rheumatology, Puerta del Hierro-Majadahonda University Hospital, Majadahonda; Department of Rheumatology, Marqués de Valdecilla University Hospital, Cantabria University, Santander; Department of Rheumatology, University Hospital Araba, Victoria; Department of Rheumatology, Virgen Macarena Hospital, Seville; Department of Rheumatology, San Cecilio Hospital, Granada; Department of Rheumatology, Monforte Hospital, Lugo; Department of Rheumatology, Tenerife Clinic Hospital, Tenerife; Department of Rheumatology, Carlos Haya Hospital, Málaga; Department of Rheumatology, Son Llatzer Hospital, Palma de Mallorca; Department of Rheumatology, Doctor Peset Hospital, Valencia; University of Las Palmas, Gran Canaria, Las Palmas, Spain.,I. Rúa-Figueroa, MD, Department of Rheumatology, Doctor Negrín University Hospital of Gran Canaria; F.J. López-Longo, MD, PhD, Department of Rheumatology, Gregorio Marañón University Hospital; V. Del Campo, MD, PhD, Department of Preventive Medicine, University Hospital Complex, Biomedical Research Institute of Vigo; M. Galindo-Izquierdo, MD, PhD, Department of Rheumatology, Doce de Octubre University Hospital; E. Uriarte, MD, Department of Rheumatology, Donostia Hospital, J. Torre-Cisneros, MD, PhD, Infectious Diseases Department, IMIBIC, Reina Sofia University Hospital, University of Córdoba; P. Vela, MD, PhD, Department of Rheumatology, General University Hospital of Alicante, Miguel Hernandez University Alicante; E. Tomero, MD, Department of Rheumatology, La Princesa University Hospital; J. Narváez, MD, PhD, Department of Rheumatology, Bellvitge Hospital; A. Olivé, MD, PhD, Department of Rheumatology, Germans Trías i Pujol University Hospital; M. Freire, MD, Department of Rheumatology, University Hospital of A Coruña; E. Salgado, MD, PhD, Department of Rheumatology, University Hospital Complex of Ourense; J.L. Andreu, MD, PhD, Department of Rheumatology, Puerta del Hierro-Majadahonda University Hospital; V. Martínez-Taboada, MD, PhD, Department of Rheumatology, Marqués de Valdecilla University Hospital, Cantabria University; J. Calvo-Alén, MD, PhD, Department of Rheumatology, University Hospital Araba; B. Hernández-Cruz, MD, PhD, Department of Rheumatology, Virgen Macarena Hospital; E. Raya, MD, Department of Rheumatology, San Cecilio Hospital; V. Quevedo, MD, Department of Rheumatology, Monforte Hospital; L. Expósito Pérez, PhD, Department of Rheumatology, Tenerife Clinic Hospital; A. Fernández-Nebro, MD, PhD, Department of Rheumatology, Carlos Haya Hospital; M. Ibañez, MD, Department of Rheumatology, Son Llatzer Hospital; È. Pascual-Valls, MD, Department of Rheumatology, Doctor Peset Hospital; D. Rúa-Figueroa, MD, University of Las Palmas; A. Naranjo, MD, PhD, Department of Rheumatology, Doctor Negrín University Hospital of Gran Canaria; J.M. Pego-Reigosa, Department of Rheumatology, University Hospital Complex, Biomedical Research Institute of Vigo
| | - Víctor Del Campo
- From the Department of Rheumatology, Doctor Negrín University Hospital of Gran Canaria, Las Palmas; Department of Rheumatology, Gregorio Marañón University Hospital, Madrid; Department of Preventive Medicine, University Hospital Complex, and Department of Rheumatology, Biomedical Research Institute of Vigo, Vigo; Department of Rheumatology, Doce de Octubre University Hospital, Madrid; Department of Rheumatology, Donostia Hospital, Guipuzcoa; Infectious Diseases Department, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Córdoba; Department of Rheumatology, General University Hospital of Alicante, Miguel Hernandez University, Alicante; Department of Rheumatology, La Princesa University Hospital, Madrid; Department of Rheumatology, Bellvitge Hospital, Barcelona; Department of Rheumatology, Germans Trías i Pujol University Hospital, Badalona; Department of Rheumatology, University Hospital of A Coruña, A Coruña; Department of Rheumatology, University Hospital Complex of Ourense, Ourense; Department of Rheumatology, Puerta del Hierro-Majadahonda University Hospital, Majadahonda; Department of Rheumatology, Marqués de Valdecilla University Hospital, Cantabria University, Santander; Department of Rheumatology, University Hospital Araba, Victoria; Department of Rheumatology, Virgen Macarena Hospital, Seville; Department of Rheumatology, San Cecilio Hospital, Granada; Department of Rheumatology, Monforte Hospital, Lugo; Department of Rheumatology, Tenerife Clinic Hospital, Tenerife; Department of Rheumatology, Carlos Haya Hospital, Málaga; Department of Rheumatology, Son Llatzer Hospital, Palma de Mallorca; Department of Rheumatology, Doctor Peset Hospital, Valencia; University of Las Palmas, Gran Canaria, Las Palmas, Spain.,I. Rúa-Figueroa, MD, Department of Rheumatology, Doctor Negrín University Hospital of Gran Canaria; F.J. López-Longo, MD, PhD, Department of Rheumatology, Gregorio Marañón University Hospital; V. Del Campo, MD, PhD, Department of Preventive Medicine, University Hospital Complex, Biomedical Research Institute of Vigo; M. Galindo-Izquierdo, MD, PhD, Department of Rheumatology, Doce de Octubre University Hospital; E. Uriarte, MD, Department of Rheumatology, Donostia Hospital, J. Torre-Cisneros, MD, PhD, Infectious Diseases Department, IMIBIC, Reina Sofia University Hospital, University of Córdoba; P. Vela, MD, PhD, Department of Rheumatology, General University Hospital of Alicante, Miguel Hernandez University Alicante; E. Tomero, MD, Department of Rheumatology, La Princesa University Hospital; J. Narváez, MD, PhD, Department of Rheumatology, Bellvitge Hospital; A. Olivé, MD, PhD, Department of Rheumatology, Germans Trías i Pujol University Hospital; M. Freire, MD, Department of Rheumatology, University Hospital of A Coruña; E. Salgado, MD, PhD, Department of Rheumatology, University Hospital Complex of Ourense; J.L. Andreu, MD, PhD, Department of Rheumatology, Puerta del Hierro-Majadahonda University Hospital; V. Martínez-Taboada, MD, PhD, Department of Rheumatology, Marqués de Valdecilla University Hospital, Cantabria University; J. Calvo-Alén, MD, PhD, Department of Rheumatology, University Hospital Araba; B. Hernández-Cruz, MD, PhD, Department of Rheumatology, Virgen Macarena Hospital; E. Raya, MD, Department of Rheumatology, San Cecilio Hospital; V. Quevedo, MD, Department of Rheumatology, Monforte Hospital; L. Expósito Pérez, PhD, Department of Rheumatology, Tenerife Clinic Hospital; A. Fernández-Nebro, MD, PhD, Department of Rheumatology, Carlos Haya Hospital; M. Ibañez, MD, Department of Rheumatology, Son Llatzer Hospital; È. Pascual-Valls, MD, Department of Rheumatology, Doctor Peset Hospital; D. Rúa-Figueroa, MD, University of Las Palmas; A. Naranjo, MD, PhD, Department of Rheumatology, Doctor Negrín University Hospital of Gran Canaria; J.M. Pego-Reigosa, Department of Rheumatology, University Hospital Complex, Biomedical Research Institute of Vigo
| | - María Galindo-Izquierdo
- From the Department of Rheumatology, Doctor Negrín University Hospital of Gran Canaria, Las Palmas; Department of Rheumatology, Gregorio Marañón University Hospital, Madrid; Department of Preventive Medicine, University Hospital Complex, and Department of Rheumatology, Biomedical Research Institute of Vigo, Vigo; Department of Rheumatology, Doce de Octubre University Hospital, Madrid; Department of Rheumatology, Donostia Hospital, Guipuzcoa; Infectious Diseases Department, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Córdoba; Department of Rheumatology, General University Hospital of Alicante, Miguel Hernandez University, Alicante; Department of Rheumatology, La Princesa University Hospital, Madrid; Department of Rheumatology, Bellvitge Hospital, Barcelona; Department of Rheumatology, Germans Trías i Pujol University Hospital, Badalona; Department of Rheumatology, University Hospital of A Coruña, A Coruña; Department of Rheumatology, University Hospital Complex of Ourense, Ourense; Department of Rheumatology, Puerta del Hierro-Majadahonda University Hospital, Majadahonda; Department of Rheumatology, Marqués de Valdecilla University Hospital, Cantabria University, Santander; Department of Rheumatology, University Hospital Araba, Victoria; Department of Rheumatology, Virgen Macarena Hospital, Seville; Department of Rheumatology, San Cecilio Hospital, Granada; Department of Rheumatology, Monforte Hospital, Lugo; Department of Rheumatology, Tenerife Clinic Hospital, Tenerife; Department of Rheumatology, Carlos Haya Hospital, Málaga; Department of Rheumatology, Son Llatzer Hospital, Palma de Mallorca; Department of Rheumatology, Doctor Peset Hospital, Valencia; University of Las Palmas, Gran Canaria, Las Palmas, Spain.,I. Rúa-Figueroa, MD, Department of Rheumatology, Doctor Negrín University Hospital of Gran Canaria; F.J. López-Longo, MD, PhD, Department of Rheumatology, Gregorio Marañón University Hospital; V. Del Campo, MD, PhD, Department of Preventive Medicine, University Hospital Complex, Biomedical Research Institute of Vigo; M. Galindo-Izquierdo, MD, PhD, Department of Rheumatology, Doce de Octubre University Hospital; E. Uriarte, MD, Department of Rheumatology, Donostia Hospital, J. Torre-Cisneros, MD, PhD, Infectious Diseases Department, IMIBIC, Reina Sofia University Hospital, University of Córdoba; P. Vela, MD, PhD, Department of Rheumatology, General University Hospital of Alicante, Miguel Hernandez University Alicante; E. Tomero, MD, Department of Rheumatology, La Princesa University Hospital; J. Narváez, MD, PhD, Department of Rheumatology, Bellvitge Hospital; A. Olivé, MD, PhD, Department of Rheumatology, Germans Trías i Pujol University Hospital; M. Freire, MD, Department of Rheumatology, University Hospital of A Coruña; E. Salgado, MD, PhD, Department of Rheumatology, University Hospital Complex of Ourense; J.L. Andreu, MD, PhD, Department of Rheumatology, Puerta del Hierro-Majadahonda University Hospital; V. Martínez-Taboada, MD, PhD, Department of Rheumatology, Marqués de Valdecilla University Hospital, Cantabria University; J. Calvo-Alén, MD, PhD, Department of Rheumatology, University Hospital Araba; B. Hernández-Cruz, MD, PhD, Department of Rheumatology, Virgen Macarena Hospital; E. Raya, MD, Department of Rheumatology, San Cecilio Hospital; V. Quevedo, MD, Department of Rheumatology, Monforte Hospital; L. Expósito Pérez, PhD, Department of Rheumatology, Tenerife Clinic Hospital; A. Fernández-Nebro, MD, PhD, Department of Rheumatology, Carlos Haya Hospital; M. Ibañez, MD, Department of Rheumatology, Son Llatzer Hospital; È. Pascual-Valls, MD, Department of Rheumatology, Doctor Peset Hospital; D. Rúa-Figueroa, MD, University of Las Palmas; A. Naranjo, MD, PhD, Department of Rheumatology, Doctor Negrín University Hospital of Gran Canaria; J.M. Pego-Reigosa, Department of Rheumatology, University Hospital Complex, Biomedical Research Institute of Vigo
| | - Esther Uriarte
- From the Department of Rheumatology, Doctor Negrín University Hospital of Gran Canaria, Las Palmas; Department of Rheumatology, Gregorio Marañón University Hospital, Madrid; Department of Preventive Medicine, University Hospital Complex, and Department of Rheumatology, Biomedical Research Institute of Vigo, Vigo; Department of Rheumatology, Doce de Octubre University Hospital, Madrid; Department of Rheumatology, Donostia Hospital, Guipuzcoa; Infectious Diseases Department, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Córdoba; Department of Rheumatology, General University Hospital of Alicante, Miguel Hernandez University, Alicante; Department of Rheumatology, La Princesa University Hospital, Madrid; Department of Rheumatology, Bellvitge Hospital, Barcelona; Department of Rheumatology, Germans Trías i Pujol University Hospital, Badalona; Department of Rheumatology, University Hospital of A Coruña, A Coruña; Department of Rheumatology, University Hospital Complex of Ourense, Ourense; Department of Rheumatology, Puerta del Hierro-Majadahonda University Hospital, Majadahonda; Department of Rheumatology, Marqués de Valdecilla University Hospital, Cantabria University, Santander; Department of Rheumatology, University Hospital Araba, Victoria; Department of Rheumatology, Virgen Macarena Hospital, Seville; Department of Rheumatology, San Cecilio Hospital, Granada; Department of Rheumatology, Monforte Hospital, Lugo; Department of Rheumatology, Tenerife Clinic Hospital, Tenerife; Department of Rheumatology, Carlos Haya Hospital, Málaga; Department of Rheumatology, Son Llatzer Hospital, Palma de Mallorca; Department of Rheumatology, Doctor Peset Hospital, Valencia; University of Las Palmas, Gran Canaria, Las Palmas, Spain.,I. Rúa-Figueroa, MD, Department of Rheumatology, Doctor Negrín University Hospital of Gran Canaria; F.J. López-Longo, MD, PhD, Department of Rheumatology, Gregorio Marañón University Hospital; V. Del Campo, MD, PhD, Department of Preventive Medicine, University Hospital Complex, Biomedical Research Institute of Vigo; M. Galindo-Izquierdo, MD, PhD, Department of Rheumatology, Doce de Octubre University Hospital; E. Uriarte, MD, Department of Rheumatology, Donostia Hospital, J. Torre-Cisneros, MD, PhD, Infectious Diseases Department, IMIBIC, Reina Sofia University Hospital, University of Córdoba; P. Vela, MD, PhD, Department of Rheumatology, General University Hospital of Alicante, Miguel Hernandez University Alicante; E. Tomero, MD, Department of Rheumatology, La Princesa University Hospital; J. Narváez, MD, PhD, Department of Rheumatology, Bellvitge Hospital; A. Olivé, MD, PhD, Department of Rheumatology, Germans Trías i Pujol University Hospital; M. Freire, MD, Department of Rheumatology, University Hospital of A Coruña; E. Salgado, MD, PhD, Department of Rheumatology, University Hospital Complex of Ourense; J.L. Andreu, MD, PhD, Department of Rheumatology, Puerta del Hierro-Majadahonda University Hospital; V. Martínez-Taboada, MD, PhD, Department of Rheumatology, Marqués de Valdecilla University Hospital, Cantabria University; J. Calvo-Alén, MD, PhD, Department of Rheumatology, University Hospital Araba; B. Hernández-Cruz, MD, PhD, Department of Rheumatology, Virgen Macarena Hospital; E. Raya, MD, Department of Rheumatology, San Cecilio Hospital; V. Quevedo, MD, Department of Rheumatology, Monforte Hospital; L. Expósito Pérez, PhD, Department of Rheumatology, Tenerife Clinic Hospital; A. Fernández-Nebro, MD, PhD, Department of Rheumatology, Carlos Haya Hospital; M. Ibañez, MD, Department of Rheumatology, Son Llatzer Hospital; È. Pascual-Valls, MD, Department of Rheumatology, Doctor Peset Hospital; D. Rúa-Figueroa, MD, University of Las Palmas; A. Naranjo, MD, PhD, Department of Rheumatology, Doctor Negrín University Hospital of Gran Canaria; J.M. Pego-Reigosa, Department of Rheumatology, University Hospital Complex, Biomedical Research Institute of Vigo
| | - Julián Torre-Cisneros
- From the Department of Rheumatology, Doctor Negrín University Hospital of Gran Canaria, Las Palmas; Department of Rheumatology, Gregorio Marañón University Hospital, Madrid; Department of Preventive Medicine, University Hospital Complex, and Department of Rheumatology, Biomedical Research Institute of Vigo, Vigo; Department of Rheumatology, Doce de Octubre University Hospital, Madrid; Department of Rheumatology, Donostia Hospital, Guipuzcoa; Infectious Diseases Department, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Córdoba; Department of Rheumatology, General University Hospital of Alicante, Miguel Hernandez University, Alicante; Department of Rheumatology, La Princesa University Hospital, Madrid; Department of Rheumatology, Bellvitge Hospital, Barcelona; Department of Rheumatology, Germans Trías i Pujol University Hospital, Badalona; Department of Rheumatology, University Hospital of A Coruña, A Coruña; Department of Rheumatology, University Hospital Complex of Ourense, Ourense; Department of Rheumatology, Puerta del Hierro-Majadahonda University Hospital, Majadahonda; Department of Rheumatology, Marqués de Valdecilla University Hospital, Cantabria University, Santander; Department of Rheumatology, University Hospital Araba, Victoria; Department of Rheumatology, Virgen Macarena Hospital, Seville; Department of Rheumatology, San Cecilio Hospital, Granada; Department of Rheumatology, Monforte Hospital, Lugo; Department of Rheumatology, Tenerife Clinic Hospital, Tenerife; Department of Rheumatology, Carlos Haya Hospital, Málaga; Department of Rheumatology, Son Llatzer Hospital, Palma de Mallorca; Department of Rheumatology, Doctor Peset Hospital, Valencia; University of Las Palmas, Gran Canaria, Las Palmas, Spain.,I. Rúa-Figueroa, MD, Department of Rheumatology, Doctor Negrín University Hospital of Gran Canaria; F.J. López-Longo, MD, PhD, Department of Rheumatology, Gregorio Marañón University Hospital; V. Del Campo, MD, PhD, Department of Preventive Medicine, University Hospital Complex, Biomedical Research Institute of Vigo; M. Galindo-Izquierdo, MD, PhD, Department of Rheumatology, Doce de Octubre University Hospital; E. Uriarte, MD, Department of Rheumatology, Donostia Hospital, J. Torre-Cisneros, MD, PhD, Infectious Diseases Department, IMIBIC, Reina Sofia University Hospital, University of Córdoba; P. Vela, MD, PhD, Department of Rheumatology, General University Hospital of Alicante, Miguel Hernandez University Alicante; E. Tomero, MD, Department of Rheumatology, La Princesa University Hospital; J. Narváez, MD, PhD, Department of Rheumatology, Bellvitge Hospital; A. Olivé, MD, PhD, Department of Rheumatology, Germans Trías i Pujol University Hospital; M. Freire, MD, Department of Rheumatology, University Hospital of A Coruña; E. Salgado, MD, PhD, Department of Rheumatology, University Hospital Complex of Ourense; J.L. Andreu, MD, PhD, Department of Rheumatology, Puerta del Hierro-Majadahonda University Hospital; V. Martínez-Taboada, MD, PhD, Department of Rheumatology, Marqués de Valdecilla University Hospital, Cantabria University; J. Calvo-Alén, MD, PhD, Department of Rheumatology, University Hospital Araba; B. Hernández-Cruz, MD, PhD, Department of Rheumatology, Virgen Macarena Hospital; E. Raya, MD, Department of Rheumatology, San Cecilio Hospital; V. Quevedo, MD, Department of Rheumatology, Monforte Hospital; L. Expósito Pérez, PhD, Department of Rheumatology, Tenerife Clinic Hospital; A. Fernández-Nebro, MD, PhD, Department of Rheumatology, Carlos Haya Hospital; M. Ibañez, MD, Department of Rheumatology, Son Llatzer Hospital; È. Pascual-Valls, MD, Department of Rheumatology, Doctor Peset Hospital; D. Rúa-Figueroa, MD, University of Las Palmas; A. Naranjo, MD, PhD, Department of Rheumatology, Doctor Negrín University Hospital of Gran Canaria; J.M. Pego-Reigosa, Department of Rheumatology, University Hospital Complex, Biomedical Research Institute of Vigo
| | - Paloma Vela
- From the Department of Rheumatology, Doctor Negrín University Hospital of Gran Canaria, Las Palmas; Department of Rheumatology, Gregorio Marañón University Hospital, Madrid; Department of Preventive Medicine, University Hospital Complex, and Department of Rheumatology, Biomedical Research Institute of Vigo, Vigo; Department of Rheumatology, Doce de Octubre University Hospital, Madrid; Department of Rheumatology, Donostia Hospital, Guipuzcoa; Infectious Diseases Department, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Córdoba; Department of Rheumatology, General University Hospital of Alicante, Miguel Hernandez University, Alicante; Department of Rheumatology, La Princesa University Hospital, Madrid; Department of Rheumatology, Bellvitge Hospital, Barcelona; Department of Rheumatology, Germans Trías i Pujol University Hospital, Badalona; Department of Rheumatology, University Hospital of A Coruña, A Coruña; Department of Rheumatology, University Hospital Complex of Ourense, Ourense; Department of Rheumatology, Puerta del Hierro-Majadahonda University Hospital, Majadahonda; Department of Rheumatology, Marqués de Valdecilla University Hospital, Cantabria University, Santander; Department of Rheumatology, University Hospital Araba, Victoria; Department of Rheumatology, Virgen Macarena Hospital, Seville; Department of Rheumatology, San Cecilio Hospital, Granada; Department of Rheumatology, Monforte Hospital, Lugo; Department of Rheumatology, Tenerife Clinic Hospital, Tenerife; Department of Rheumatology, Carlos Haya Hospital, Málaga; Department of Rheumatology, Son Llatzer Hospital, Palma de Mallorca; Department of Rheumatology, Doctor Peset Hospital, Valencia; University of Las Palmas, Gran Canaria, Las Palmas, Spain.,I. Rúa-Figueroa, MD, Department of Rheumatology, Doctor Negrín University Hospital of Gran Canaria; F.J. López-Longo, MD, PhD, Department of Rheumatology, Gregorio Marañón University Hospital; V. Del Campo, MD, PhD, Department of Preventive Medicine, University Hospital Complex, Biomedical Research Institute of Vigo; M. Galindo-Izquierdo, MD, PhD, Department of Rheumatology, Doce de Octubre University Hospital; E. Uriarte, MD, Department of Rheumatology, Donostia Hospital, J. Torre-Cisneros, MD, PhD, Infectious Diseases Department, IMIBIC, Reina Sofia University Hospital, University of Córdoba; P. Vela, MD, PhD, Department of Rheumatology, General University Hospital of Alicante, Miguel Hernandez University Alicante; E. Tomero, MD, Department of Rheumatology, La Princesa University Hospital; J. Narváez, MD, PhD, Department of Rheumatology, Bellvitge Hospital; A. Olivé, MD, PhD, Department of Rheumatology, Germans Trías i Pujol University Hospital; M. Freire, MD, Department of Rheumatology, University Hospital of A Coruña; E. Salgado, MD, PhD, Department of Rheumatology, University Hospital Complex of Ourense; J.L. Andreu, MD, PhD, Department of Rheumatology, Puerta del Hierro-Majadahonda University Hospital; V. Martínez-Taboada, MD, PhD, Department of Rheumatology, Marqués de Valdecilla University Hospital, Cantabria University; J. Calvo-Alén, MD, PhD, Department of Rheumatology, University Hospital Araba; B. Hernández-Cruz, MD, PhD, Department of Rheumatology, Virgen Macarena Hospital; E. Raya, MD, Department of Rheumatology, San Cecilio Hospital; V. Quevedo, MD, Department of Rheumatology, Monforte Hospital; L. Expósito Pérez, PhD, Department of Rheumatology, Tenerife Clinic Hospital; A. Fernández-Nebro, MD, PhD, Department of Rheumatology, Carlos Haya Hospital; M. Ibañez, MD, Department of Rheumatology, Son Llatzer Hospital; È. Pascual-Valls, MD, Department of Rheumatology, Doctor Peset Hospital; D. Rúa-Figueroa, MD, University of Las Palmas; A. Naranjo, MD, PhD, Department of Rheumatology, Doctor Negrín University Hospital of Gran Canaria; J.M. Pego-Reigosa, Department of Rheumatology, University Hospital Complex, Biomedical Research Institute of Vigo
| | - Eva Tomero
- From the Department of Rheumatology, Doctor Negrín University Hospital of Gran Canaria, Las Palmas; Department of Rheumatology, Gregorio Marañón University Hospital, Madrid; Department of Preventive Medicine, University Hospital Complex, and Department of Rheumatology, Biomedical Research Institute of Vigo, Vigo; Department of Rheumatology, Doce de Octubre University Hospital, Madrid; Department of Rheumatology, Donostia Hospital, Guipuzcoa; Infectious Diseases Department, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Córdoba; Department of Rheumatology, General University Hospital of Alicante, Miguel Hernandez University, Alicante; Department of Rheumatology, La Princesa University Hospital, Madrid; Department of Rheumatology, Bellvitge Hospital, Barcelona; Department of Rheumatology, Germans Trías i Pujol University Hospital, Badalona; Department of Rheumatology, University Hospital of A Coruña, A Coruña; Department of Rheumatology, University Hospital Complex of Ourense, Ourense; Department of Rheumatology, Puerta del Hierro-Majadahonda University Hospital, Majadahonda; Department of Rheumatology, Marqués de Valdecilla University Hospital, Cantabria University, Santander; Department of Rheumatology, University Hospital Araba, Victoria; Department of Rheumatology, Virgen Macarena Hospital, Seville; Department of Rheumatology, San Cecilio Hospital, Granada; Department of Rheumatology, Monforte Hospital, Lugo; Department of Rheumatology, Tenerife Clinic Hospital, Tenerife; Department of Rheumatology, Carlos Haya Hospital, Málaga; Department of Rheumatology, Son Llatzer Hospital, Palma de Mallorca; Department of Rheumatology, Doctor Peset Hospital, Valencia; University of Las Palmas, Gran Canaria, Las Palmas, Spain.,I. Rúa-Figueroa, MD, Department of Rheumatology, Doctor Negrín University Hospital of Gran Canaria; F.J. López-Longo, MD, PhD, Department of Rheumatology, Gregorio Marañón University Hospital; V. Del Campo, MD, PhD, Department of Preventive Medicine, University Hospital Complex, Biomedical Research Institute of Vigo; M. Galindo-Izquierdo, MD, PhD, Department of Rheumatology, Doce de Octubre University Hospital; E. Uriarte, MD, Department of Rheumatology, Donostia Hospital, J. Torre-Cisneros, MD, PhD, Infectious Diseases Department, IMIBIC, Reina Sofia University Hospital, University of Córdoba; P. Vela, MD, PhD, Department of Rheumatology, General University Hospital of Alicante, Miguel Hernandez University Alicante; E. Tomero, MD, Department of Rheumatology, La Princesa University Hospital; J. Narváez, MD, PhD, Department of Rheumatology, Bellvitge Hospital; A. Olivé, MD, PhD, Department of Rheumatology, Germans Trías i Pujol University Hospital; M. Freire, MD, Department of Rheumatology, University Hospital of A Coruña; E. Salgado, MD, PhD, Department of Rheumatology, University Hospital Complex of Ourense; J.L. Andreu, MD, PhD, Department of Rheumatology, Puerta del Hierro-Majadahonda University Hospital; V. Martínez-Taboada, MD, PhD, Department of Rheumatology, Marqués de Valdecilla University Hospital, Cantabria University; J. Calvo-Alén, MD, PhD, Department of Rheumatology, University Hospital Araba; B. Hernández-Cruz, MD, PhD, Department of Rheumatology, Virgen Macarena Hospital; E. Raya, MD, Department of Rheumatology, San Cecilio Hospital; V. Quevedo, MD, Department of Rheumatology, Monforte Hospital; L. Expósito Pérez, PhD, Department of Rheumatology, Tenerife Clinic Hospital; A. Fernández-Nebro, MD, PhD, Department of Rheumatology, Carlos Haya Hospital; M. Ibañez, MD, Department of Rheumatology, Son Llatzer Hospital; È. Pascual-Valls, MD, Department of Rheumatology, Doctor Peset Hospital; D. Rúa-Figueroa, MD, University of Las Palmas; A. Naranjo, MD, PhD, Department of Rheumatology, Doctor Negrín University Hospital of Gran Canaria; J.M. Pego-Reigosa, Department of Rheumatology, University Hospital Complex, Biomedical Research Institute of Vigo
| | - Javier Narváez
- From the Department of Rheumatology, Doctor Negrín University Hospital of Gran Canaria, Las Palmas; Department of Rheumatology, Gregorio Marañón University Hospital, Madrid; Department of Preventive Medicine, University Hospital Complex, and Department of Rheumatology, Biomedical Research Institute of Vigo, Vigo; Department of Rheumatology, Doce de Octubre University Hospital, Madrid; Department of Rheumatology, Donostia Hospital, Guipuzcoa; Infectious Diseases Department, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Córdoba; Department of Rheumatology, General University Hospital of Alicante, Miguel Hernandez University, Alicante; Department of Rheumatology, La Princesa University Hospital, Madrid; Department of Rheumatology, Bellvitge Hospital, Barcelona; Department of Rheumatology, Germans Trías i Pujol University Hospital, Badalona; Department of Rheumatology, University Hospital of A Coruña, A Coruña; Department of Rheumatology, University Hospital Complex of Ourense, Ourense; Department of Rheumatology, Puerta del Hierro-Majadahonda University Hospital, Majadahonda; Department of Rheumatology, Marqués de Valdecilla University Hospital, Cantabria University, Santander; Department of Rheumatology, University Hospital Araba, Victoria; Department of Rheumatology, Virgen Macarena Hospital, Seville; Department of Rheumatology, San Cecilio Hospital, Granada; Department of Rheumatology, Monforte Hospital, Lugo; Department of Rheumatology, Tenerife Clinic Hospital, Tenerife; Department of Rheumatology, Carlos Haya Hospital, Málaga; Department of Rheumatology, Son Llatzer Hospital, Palma de Mallorca; Department of Rheumatology, Doctor Peset Hospital, Valencia; University of Las Palmas, Gran Canaria, Las Palmas, Spain.,I. Rúa-Figueroa, MD, Department of Rheumatology, Doctor Negrín University Hospital of Gran Canaria; F.J. López-Longo, MD, PhD, Department of Rheumatology, Gregorio Marañón University Hospital; V. Del Campo, MD, PhD, Department of Preventive Medicine, University Hospital Complex, Biomedical Research Institute of Vigo; M. Galindo-Izquierdo, MD, PhD, Department of Rheumatology, Doce de Octubre University Hospital; E. Uriarte, MD, Department of Rheumatology, Donostia Hospital, J. Torre-Cisneros, MD, PhD, Infectious Diseases Department, IMIBIC, Reina Sofia University Hospital, University of Córdoba; P. Vela, MD, PhD, Department of Rheumatology, General University Hospital of Alicante, Miguel Hernandez University Alicante; E. Tomero, MD, Department of Rheumatology, La Princesa University Hospital; J. Narváez, MD, PhD, Department of Rheumatology, Bellvitge Hospital; A. Olivé, MD, PhD, Department of Rheumatology, Germans Trías i Pujol University Hospital; M. Freire, MD, Department of Rheumatology, University Hospital of A Coruña; E. Salgado, MD, PhD, Department of Rheumatology, University Hospital Complex of Ourense; J.L. Andreu, MD, PhD, Department of Rheumatology, Puerta del Hierro-Majadahonda University Hospital; V. Martínez-Taboada, MD, PhD, Department of Rheumatology, Marqués de Valdecilla University Hospital, Cantabria University; J. Calvo-Alén, MD, PhD, Department of Rheumatology, University Hospital Araba; B. Hernández-Cruz, MD, PhD, Department of Rheumatology, Virgen Macarena Hospital; E. Raya, MD, Department of Rheumatology, San Cecilio Hospital; V. Quevedo, MD, Department of Rheumatology, Monforte Hospital; L. Expósito Pérez, PhD, Department of Rheumatology, Tenerife Clinic Hospital; A. Fernández-Nebro, MD, PhD, Department of Rheumatology, Carlos Haya Hospital; M. Ibañez, MD, Department of Rheumatology, Son Llatzer Hospital; È. Pascual-Valls, MD, Department of Rheumatology, Doctor Peset Hospital; D. Rúa-Figueroa, MD, University of Las Palmas; A. Naranjo, MD, PhD, Department of Rheumatology, Doctor Negrín University Hospital of Gran Canaria; J.M. Pego-Reigosa, Department of Rheumatology, University Hospital Complex, Biomedical Research Institute of Vigo
| | - Alejandro Olivé
- From the Department of Rheumatology, Doctor Negrín University Hospital of Gran Canaria, Las Palmas; Department of Rheumatology, Gregorio Marañón University Hospital, Madrid; Department of Preventive Medicine, University Hospital Complex, and Department of Rheumatology, Biomedical Research Institute of Vigo, Vigo; Department of Rheumatology, Doce de Octubre University Hospital, Madrid; Department of Rheumatology, Donostia Hospital, Guipuzcoa; Infectious Diseases Department, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Córdoba; Department of Rheumatology, General University Hospital of Alicante, Miguel Hernandez University, Alicante; Department of Rheumatology, La Princesa University Hospital, Madrid; Department of Rheumatology, Bellvitge Hospital, Barcelona; Department of Rheumatology, Germans Trías i Pujol University Hospital, Badalona; Department of Rheumatology, University Hospital of A Coruña, A Coruña; Department of Rheumatology, University Hospital Complex of Ourense, Ourense; Department of Rheumatology, Puerta del Hierro-Majadahonda University Hospital, Majadahonda; Department of Rheumatology, Marqués de Valdecilla University Hospital, Cantabria University, Santander; Department of Rheumatology, University Hospital Araba, Victoria; Department of Rheumatology, Virgen Macarena Hospital, Seville; Department of Rheumatology, San Cecilio Hospital, Granada; Department of Rheumatology, Monforte Hospital, Lugo; Department of Rheumatology, Tenerife Clinic Hospital, Tenerife; Department of Rheumatology, Carlos Haya Hospital, Málaga; Department of Rheumatology, Son Llatzer Hospital, Palma de Mallorca; Department of Rheumatology, Doctor Peset Hospital, Valencia; University of Las Palmas, Gran Canaria, Las Palmas, Spain.,I. Rúa-Figueroa, MD, Department of Rheumatology, Doctor Negrín University Hospital of Gran Canaria; F.J. López-Longo, MD, PhD, Department of Rheumatology, Gregorio Marañón University Hospital; V. Del Campo, MD, PhD, Department of Preventive Medicine, University Hospital Complex, Biomedical Research Institute of Vigo; M. Galindo-Izquierdo, MD, PhD, Department of Rheumatology, Doce de Octubre University Hospital; E. Uriarte, MD, Department of Rheumatology, Donostia Hospital, J. Torre-Cisneros, MD, PhD, Infectious Diseases Department, IMIBIC, Reina Sofia University Hospital, University of Córdoba; P. Vela, MD, PhD, Department of Rheumatology, General University Hospital of Alicante, Miguel Hernandez University Alicante; E. Tomero, MD, Department of Rheumatology, La Princesa University Hospital; J. Narváez, MD, PhD, Department of Rheumatology, Bellvitge Hospital; A. Olivé, MD, PhD, Department of Rheumatology, Germans Trías i Pujol University Hospital; M. Freire, MD, Department of Rheumatology, University Hospital of A Coruña; E. Salgado, MD, PhD, Department of Rheumatology, University Hospital Complex of Ourense; J.L. Andreu, MD, PhD, Department of Rheumatology, Puerta del Hierro-Majadahonda University Hospital; V. Martínez-Taboada, MD, PhD, Department of Rheumatology, Marqués de Valdecilla University Hospital, Cantabria University; J. Calvo-Alén, MD, PhD, Department of Rheumatology, University Hospital Araba; B. Hernández-Cruz, MD, PhD, Department of Rheumatology, Virgen Macarena Hospital; E. Raya, MD, Department of Rheumatology, San Cecilio Hospital; V. Quevedo, MD, Department of Rheumatology, Monforte Hospital; L. Expósito Pérez, PhD, Department of Rheumatology, Tenerife Clinic Hospital; A. Fernández-Nebro, MD, PhD, Department of Rheumatology, Carlos Haya Hospital; M. Ibañez, MD, Department of Rheumatology, Son Llatzer Hospital; È. Pascual-Valls, MD, Department of Rheumatology, Doctor Peset Hospital; D. Rúa-Figueroa, MD, University of Las Palmas; A. Naranjo, MD, PhD, Department of Rheumatology, Doctor Negrín University Hospital of Gran Canaria; J.M. Pego-Reigosa, Department of Rheumatology, University Hospital Complex, Biomedical Research Institute of Vigo
| | - Mercedes Freire
- From the Department of Rheumatology, Doctor Negrín University Hospital of Gran Canaria, Las Palmas; Department of Rheumatology, Gregorio Marañón University Hospital, Madrid; Department of Preventive Medicine, University Hospital Complex, and Department of Rheumatology, Biomedical Research Institute of Vigo, Vigo; Department of Rheumatology, Doce de Octubre University Hospital, Madrid; Department of Rheumatology, Donostia Hospital, Guipuzcoa; Infectious Diseases Department, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Córdoba; Department of Rheumatology, General University Hospital of Alicante, Miguel Hernandez University, Alicante; Department of Rheumatology, La Princesa University Hospital, Madrid; Department of Rheumatology, Bellvitge Hospital, Barcelona; Department of Rheumatology, Germans Trías i Pujol University Hospital, Badalona; Department of Rheumatology, University Hospital of A Coruña, A Coruña; Department of Rheumatology, University Hospital Complex of Ourense, Ourense; Department of Rheumatology, Puerta del Hierro-Majadahonda University Hospital, Majadahonda; Department of Rheumatology, Marqués de Valdecilla University Hospital, Cantabria University, Santander; Department of Rheumatology, University Hospital Araba, Victoria; Department of Rheumatology, Virgen Macarena Hospital, Seville; Department of Rheumatology, San Cecilio Hospital, Granada; Department of Rheumatology, Monforte Hospital, Lugo; Department of Rheumatology, Tenerife Clinic Hospital, Tenerife; Department of Rheumatology, Carlos Haya Hospital, Málaga; Department of Rheumatology, Son Llatzer Hospital, Palma de Mallorca; Department of Rheumatology, Doctor Peset Hospital, Valencia; University of Las Palmas, Gran Canaria, Las Palmas, Spain.,I. Rúa-Figueroa, MD, Department of Rheumatology, Doctor Negrín University Hospital of Gran Canaria; F.J. López-Longo, MD, PhD, Department of Rheumatology, Gregorio Marañón University Hospital; V. Del Campo, MD, PhD, Department of Preventive Medicine, University Hospital Complex, Biomedical Research Institute of Vigo; M. Galindo-Izquierdo, MD, PhD, Department of Rheumatology, Doce de Octubre University Hospital; E. Uriarte, MD, Department of Rheumatology, Donostia Hospital, J. Torre-Cisneros, MD, PhD, Infectious Diseases Department, IMIBIC, Reina Sofia University Hospital, University of Córdoba; P. Vela, MD, PhD, Department of Rheumatology, General University Hospital of Alicante, Miguel Hernandez University Alicante; E. Tomero, MD, Department of Rheumatology, La Princesa University Hospital; J. Narváez, MD, PhD, Department of Rheumatology, Bellvitge Hospital; A. Olivé, MD, PhD, Department of Rheumatology, Germans Trías i Pujol University Hospital; M. Freire, MD, Department of Rheumatology, University Hospital of A Coruña; E. Salgado, MD, PhD, Department of Rheumatology, University Hospital Complex of Ourense; J.L. Andreu, MD, PhD, Department of Rheumatology, Puerta del Hierro-Majadahonda University Hospital; V. Martínez-Taboada, MD, PhD, Department of Rheumatology, Marqués de Valdecilla University Hospital, Cantabria University; J. Calvo-Alén, MD, PhD, Department of Rheumatology, University Hospital Araba; B. Hernández-Cruz, MD, PhD, Department of Rheumatology, Virgen Macarena Hospital; E. Raya, MD, Department of Rheumatology, San Cecilio Hospital; V. Quevedo, MD, Department of Rheumatology, Monforte Hospital; L. Expósito Pérez, PhD, Department of Rheumatology, Tenerife Clinic Hospital; A. Fernández-Nebro, MD, PhD, Department of Rheumatology, Carlos Haya Hospital; M. Ibañez, MD, Department of Rheumatology, Son Llatzer Hospital; È. Pascual-Valls, MD, Department of Rheumatology, Doctor Peset Hospital; D. Rúa-Figueroa, MD, University of Las Palmas; A. Naranjo, MD, PhD, Department of Rheumatology, Doctor Negrín University Hospital of Gran Canaria; J.M. Pego-Reigosa, Department of Rheumatology, University Hospital Complex, Biomedical Research Institute of Vigo
| | - Eva Salgado
- From the Department of Rheumatology, Doctor Negrín University Hospital of Gran Canaria, Las Palmas; Department of Rheumatology, Gregorio Marañón University Hospital, Madrid; Department of Preventive Medicine, University Hospital Complex, and Department of Rheumatology, Biomedical Research Institute of Vigo, Vigo; Department of Rheumatology, Doce de Octubre University Hospital, Madrid; Department of Rheumatology, Donostia Hospital, Guipuzcoa; Infectious Diseases Department, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Córdoba; Department of Rheumatology, General University Hospital of Alicante, Miguel Hernandez University, Alicante; Department of Rheumatology, La Princesa University Hospital, Madrid; Department of Rheumatology, Bellvitge Hospital, Barcelona; Department of Rheumatology, Germans Trías i Pujol University Hospital, Badalona; Department of Rheumatology, University Hospital of A Coruña, A Coruña; Department of Rheumatology, University Hospital Complex of Ourense, Ourense; Department of Rheumatology, Puerta del Hierro-Majadahonda University Hospital, Majadahonda; Department of Rheumatology, Marqués de Valdecilla University Hospital, Cantabria University, Santander; Department of Rheumatology, University Hospital Araba, Victoria; Department of Rheumatology, Virgen Macarena Hospital, Seville; Department of Rheumatology, San Cecilio Hospital, Granada; Department of Rheumatology, Monforte Hospital, Lugo; Department of Rheumatology, Tenerife Clinic Hospital, Tenerife; Department of Rheumatology, Carlos Haya Hospital, Málaga; Department of Rheumatology, Son Llatzer Hospital, Palma de Mallorca; Department of Rheumatology, Doctor Peset Hospital, Valencia; University of Las Palmas, Gran Canaria, Las Palmas, Spain.,I. Rúa-Figueroa, MD, Department of Rheumatology, Doctor Negrín University Hospital of Gran Canaria; F.J. López-Longo, MD, PhD, Department of Rheumatology, Gregorio Marañón University Hospital; V. Del Campo, MD, PhD, Department of Preventive Medicine, University Hospital Complex, Biomedical Research Institute of Vigo; M. Galindo-Izquierdo, MD, PhD, Department of Rheumatology, Doce de Octubre University Hospital; E. Uriarte, MD, Department of Rheumatology, Donostia Hospital, J. Torre-Cisneros, MD, PhD, Infectious Diseases Department, IMIBIC, Reina Sofia University Hospital, University of Córdoba; P. Vela, MD, PhD, Department of Rheumatology, General University Hospital of Alicante, Miguel Hernandez University Alicante; E. Tomero, MD, Department of Rheumatology, La Princesa University Hospital; J. Narváez, MD, PhD, Department of Rheumatology, Bellvitge Hospital; A. Olivé, MD, PhD, Department of Rheumatology, Germans Trías i Pujol University Hospital; M. Freire, MD, Department of Rheumatology, University Hospital of A Coruña; E. Salgado, MD, PhD, Department of Rheumatology, University Hospital Complex of Ourense; J.L. Andreu, MD, PhD, Department of Rheumatology, Puerta del Hierro-Majadahonda University Hospital; V. Martínez-Taboada, MD, PhD, Department of Rheumatology, Marqués de Valdecilla University Hospital, Cantabria University; J. Calvo-Alén, MD, PhD, Department of Rheumatology, University Hospital Araba; B. Hernández-Cruz, MD, PhD, Department of Rheumatology, Virgen Macarena Hospital; E. Raya, MD, Department of Rheumatology, San Cecilio Hospital; V. Quevedo, MD, Department of Rheumatology, Monforte Hospital; L. Expósito Pérez, PhD, Department of Rheumatology, Tenerife Clinic Hospital; A. Fernández-Nebro, MD, PhD, Department of Rheumatology, Carlos Haya Hospital; M. Ibañez, MD, Department of Rheumatology, Son Llatzer Hospital; È. Pascual-Valls, MD, Department of Rheumatology, Doctor Peset Hospital; D. Rúa-Figueroa, MD, University of Las Palmas; A. Naranjo, MD, PhD, Department of Rheumatology, Doctor Negrín University Hospital of Gran Canaria; J.M. Pego-Reigosa, Department of Rheumatology, University Hospital Complex, Biomedical Research Institute of Vigo
| | - José Luis Andreu
- From the Department of Rheumatology, Doctor Negrín University Hospital of Gran Canaria, Las Palmas; Department of Rheumatology, Gregorio Marañón University Hospital, Madrid; Department of Preventive Medicine, University Hospital Complex, and Department of Rheumatology, Biomedical Research Institute of Vigo, Vigo; Department of Rheumatology, Doce de Octubre University Hospital, Madrid; Department of Rheumatology, Donostia Hospital, Guipuzcoa; Infectious Diseases Department, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Córdoba; Department of Rheumatology, General University Hospital of Alicante, Miguel Hernandez University, Alicante; Department of Rheumatology, La Princesa University Hospital, Madrid; Department of Rheumatology, Bellvitge Hospital, Barcelona; Department of Rheumatology, Germans Trías i Pujol University Hospital, Badalona; Department of Rheumatology, University Hospital of A Coruña, A Coruña; Department of Rheumatology, University Hospital Complex of Ourense, Ourense; Department of Rheumatology, Puerta del Hierro-Majadahonda University Hospital, Majadahonda; Department of Rheumatology, Marqués de Valdecilla University Hospital, Cantabria University, Santander; Department of Rheumatology, University Hospital Araba, Victoria; Department of Rheumatology, Virgen Macarena Hospital, Seville; Department of Rheumatology, San Cecilio Hospital, Granada; Department of Rheumatology, Monforte Hospital, Lugo; Department of Rheumatology, Tenerife Clinic Hospital, Tenerife; Department of Rheumatology, Carlos Haya Hospital, Málaga; Department of Rheumatology, Son Llatzer Hospital, Palma de Mallorca; Department of Rheumatology, Doctor Peset Hospital, Valencia; University of Las Palmas, Gran Canaria, Las Palmas, Spain.,I. Rúa-Figueroa, MD, Department of Rheumatology, Doctor Negrín University Hospital of Gran Canaria; F.J. López-Longo, MD, PhD, Department of Rheumatology, Gregorio Marañón University Hospital; V. Del Campo, MD, PhD, Department of Preventive Medicine, University Hospital Complex, Biomedical Research Institute of Vigo; M. Galindo-Izquierdo, MD, PhD, Department of Rheumatology, Doce de Octubre University Hospital; E. Uriarte, MD, Department of Rheumatology, Donostia Hospital, J. Torre-Cisneros, MD, PhD, Infectious Diseases Department, IMIBIC, Reina Sofia University Hospital, University of Córdoba; P. Vela, MD, PhD, Department of Rheumatology, General University Hospital of Alicante, Miguel Hernandez University Alicante; E. Tomero, MD, Department of Rheumatology, La Princesa University Hospital; J. Narváez, MD, PhD, Department of Rheumatology, Bellvitge Hospital; A. Olivé, MD, PhD, Department of Rheumatology, Germans Trías i Pujol University Hospital; M. Freire, MD, Department of Rheumatology, University Hospital of A Coruña; E. Salgado, MD, PhD, Department of Rheumatology, University Hospital Complex of Ourense; J.L. Andreu, MD, PhD, Department of Rheumatology, Puerta del Hierro-Majadahonda University Hospital; V. Martínez-Taboada, MD, PhD, Department of Rheumatology, Marqués de Valdecilla University Hospital, Cantabria University; J. Calvo-Alén, MD, PhD, Department of Rheumatology, University Hospital Araba; B. Hernández-Cruz, MD, PhD, Department of Rheumatology, Virgen Macarena Hospital; E. Raya, MD, Department of Rheumatology, San Cecilio Hospital; V. Quevedo, MD, Department of Rheumatology, Monforte Hospital; L. Expósito Pérez, PhD, Department of Rheumatology, Tenerife Clinic Hospital; A. Fernández-Nebro, MD, PhD, Department of Rheumatology, Carlos Haya Hospital; M. Ibañez, MD, Department of Rheumatology, Son Llatzer Hospital; È. Pascual-Valls, MD, Department of Rheumatology, Doctor Peset Hospital; D. Rúa-Figueroa, MD, University of Las Palmas; A. Naranjo, MD, PhD, Department of Rheumatology, Doctor Negrín University Hospital of Gran Canaria; J.M. Pego-Reigosa, Department of Rheumatology, University Hospital Complex, Biomedical Research Institute of Vigo
| | - Víctor Martínez-Taboada
- From the Department of Rheumatology, Doctor Negrín University Hospital of Gran Canaria, Las Palmas; Department of Rheumatology, Gregorio Marañón University Hospital, Madrid; Department of Preventive Medicine, University Hospital Complex, and Department of Rheumatology, Biomedical Research Institute of Vigo, Vigo; Department of Rheumatology, Doce de Octubre University Hospital, Madrid; Department of Rheumatology, Donostia Hospital, Guipuzcoa; Infectious Diseases Department, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Córdoba; Department of Rheumatology, General University Hospital of Alicante, Miguel Hernandez University, Alicante; Department of Rheumatology, La Princesa University Hospital, Madrid; Department of Rheumatology, Bellvitge Hospital, Barcelona; Department of Rheumatology, Germans Trías i Pujol University Hospital, Badalona; Department of Rheumatology, University Hospital of A Coruña, A Coruña; Department of Rheumatology, University Hospital Complex of Ourense, Ourense; Department of Rheumatology, Puerta del Hierro-Majadahonda University Hospital, Majadahonda; Department of Rheumatology, Marqués de Valdecilla University Hospital, Cantabria University, Santander; Department of Rheumatology, University Hospital Araba, Victoria; Department of Rheumatology, Virgen Macarena Hospital, Seville; Department of Rheumatology, San Cecilio Hospital, Granada; Department of Rheumatology, Monforte Hospital, Lugo; Department of Rheumatology, Tenerife Clinic Hospital, Tenerife; Department of Rheumatology, Carlos Haya Hospital, Málaga; Department of Rheumatology, Son Llatzer Hospital, Palma de Mallorca; Department of Rheumatology, Doctor Peset Hospital, Valencia; University of Las Palmas, Gran Canaria, Las Palmas, Spain.,I. Rúa-Figueroa, MD, Department of Rheumatology, Doctor Negrín University Hospital of Gran Canaria; F.J. López-Longo, MD, PhD, Department of Rheumatology, Gregorio Marañón University Hospital; V. Del Campo, MD, PhD, Department of Preventive Medicine, University Hospital Complex, Biomedical Research Institute of Vigo; M. Galindo-Izquierdo, MD, PhD, Department of Rheumatology, Doce de Octubre University Hospital; E. Uriarte, MD, Department of Rheumatology, Donostia Hospital, J. Torre-Cisneros, MD, PhD, Infectious Diseases Department, IMIBIC, Reina Sofia University Hospital, University of Córdoba; P. Vela, MD, PhD, Department of Rheumatology, General University Hospital of Alicante, Miguel Hernandez University Alicante; E. Tomero, MD, Department of Rheumatology, La Princesa University Hospital; J. Narváez, MD, PhD, Department of Rheumatology, Bellvitge Hospital; A. Olivé, MD, PhD, Department of Rheumatology, Germans Trías i Pujol University Hospital; M. Freire, MD, Department of Rheumatology, University Hospital of A Coruña; E. Salgado, MD, PhD, Department of Rheumatology, University Hospital Complex of Ourense; J.L. Andreu, MD, PhD, Department of Rheumatology, Puerta del Hierro-Majadahonda University Hospital; V. Martínez-Taboada, MD, PhD, Department of Rheumatology, Marqués de Valdecilla University Hospital, Cantabria University; J. Calvo-Alén, MD, PhD, Department of Rheumatology, University Hospital Araba; B. Hernández-Cruz, MD, PhD, Department of Rheumatology, Virgen Macarena Hospital; E. Raya, MD, Department of Rheumatology, San Cecilio Hospital; V. Quevedo, MD, Department of Rheumatology, Monforte Hospital; L. Expósito Pérez, PhD, Department of Rheumatology, Tenerife Clinic Hospital; A. Fernández-Nebro, MD, PhD, Department of Rheumatology, Carlos Haya Hospital; M. Ibañez, MD, Department of Rheumatology, Son Llatzer Hospital; È. Pascual-Valls, MD, Department of Rheumatology, Doctor Peset Hospital; D. Rúa-Figueroa, MD, University of Las Palmas; A. Naranjo, MD, PhD, Department of Rheumatology, Doctor Negrín University Hospital of Gran Canaria; J.M. Pego-Reigosa, Department of Rheumatology, University Hospital Complex, Biomedical Research Institute of Vigo
| | - Jaime Calvo-Alén
- From the Department of Rheumatology, Doctor Negrín University Hospital of Gran Canaria, Las Palmas; Department of Rheumatology, Gregorio Marañón University Hospital, Madrid; Department of Preventive Medicine, University Hospital Complex, and Department of Rheumatology, Biomedical Research Institute of Vigo, Vigo; Department of Rheumatology, Doce de Octubre University Hospital, Madrid; Department of Rheumatology, Donostia Hospital, Guipuzcoa; Infectious Diseases Department, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Córdoba; Department of Rheumatology, General University Hospital of Alicante, Miguel Hernandez University, Alicante; Department of Rheumatology, La Princesa University Hospital, Madrid; Department of Rheumatology, Bellvitge Hospital, Barcelona; Department of Rheumatology, Germans Trías i Pujol University Hospital, Badalona; Department of Rheumatology, University Hospital of A Coruña, A Coruña; Department of Rheumatology, University Hospital Complex of Ourense, Ourense; Department of Rheumatology, Puerta del Hierro-Majadahonda University Hospital, Majadahonda; Department of Rheumatology, Marqués de Valdecilla University Hospital, Cantabria University, Santander; Department of Rheumatology, University Hospital Araba, Victoria; Department of Rheumatology, Virgen Macarena Hospital, Seville; Department of Rheumatology, San Cecilio Hospital, Granada; Department of Rheumatology, Monforte Hospital, Lugo; Department of Rheumatology, Tenerife Clinic Hospital, Tenerife; Department of Rheumatology, Carlos Haya Hospital, Málaga; Department of Rheumatology, Son Llatzer Hospital, Palma de Mallorca; Department of Rheumatology, Doctor Peset Hospital, Valencia; University of Las Palmas, Gran Canaria, Las Palmas, Spain.,I. Rúa-Figueroa, MD, Department of Rheumatology, Doctor Negrín University Hospital of Gran Canaria; F.J. López-Longo, MD, PhD, Department of Rheumatology, Gregorio Marañón University Hospital; V. Del Campo, MD, PhD, Department of Preventive Medicine, University Hospital Complex, Biomedical Research Institute of Vigo; M. Galindo-Izquierdo, MD, PhD, Department of Rheumatology, Doce de Octubre University Hospital; E. Uriarte, MD, Department of Rheumatology, Donostia Hospital, J. Torre-Cisneros, MD, PhD, Infectious Diseases Department, IMIBIC, Reina Sofia University Hospital, University of Córdoba; P. Vela, MD, PhD, Department of Rheumatology, General University Hospital of Alicante, Miguel Hernandez University Alicante; E. Tomero, MD, Department of Rheumatology, La Princesa University Hospital; J. Narváez, MD, PhD, Department of Rheumatology, Bellvitge Hospital; A. Olivé, MD, PhD, Department of Rheumatology, Germans Trías i Pujol University Hospital; M. Freire, MD, Department of Rheumatology, University Hospital of A Coruña; E. Salgado, MD, PhD, Department of Rheumatology, University Hospital Complex of Ourense; J.L. Andreu, MD, PhD, Department of Rheumatology, Puerta del Hierro-Majadahonda University Hospital; V. Martínez-Taboada, MD, PhD, Department of Rheumatology, Marqués de Valdecilla University Hospital, Cantabria University; J. Calvo-Alén, MD, PhD, Department of Rheumatology, University Hospital Araba; B. Hernández-Cruz, MD, PhD, Department of Rheumatology, Virgen Macarena Hospital; E. Raya, MD, Department of Rheumatology, San Cecilio Hospital; V. Quevedo, MD, Department of Rheumatology, Monforte Hospital; L. Expósito Pérez, PhD, Department of Rheumatology, Tenerife Clinic Hospital; A. Fernández-Nebro, MD, PhD, Department of Rheumatology, Carlos Haya Hospital; M. Ibañez, MD, Department of Rheumatology, Son Llatzer Hospital; È. Pascual-Valls, MD, Department of Rheumatology, Doctor Peset Hospital; D. Rúa-Figueroa, MD, University of Las Palmas; A. Naranjo, MD, PhD, Department of Rheumatology, Doctor Negrín University Hospital of Gran Canaria; J.M. Pego-Reigosa, Department of Rheumatology, University Hospital Complex, Biomedical Research Institute of Vigo
| | - Blanca Hernández-Cruz
- From the Department of Rheumatology, Doctor Negrín University Hospital of Gran Canaria, Las Palmas; Department of Rheumatology, Gregorio Marañón University Hospital, Madrid; Department of Preventive Medicine, University Hospital Complex, and Department of Rheumatology, Biomedical Research Institute of Vigo, Vigo; Department of Rheumatology, Doce de Octubre University Hospital, Madrid; Department of Rheumatology, Donostia Hospital, Guipuzcoa; Infectious Diseases Department, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Córdoba; Department of Rheumatology, General University Hospital of Alicante, Miguel Hernandez University, Alicante; Department of Rheumatology, La Princesa University Hospital, Madrid; Department of Rheumatology, Bellvitge Hospital, Barcelona; Department of Rheumatology, Germans Trías i Pujol University Hospital, Badalona; Department of Rheumatology, University Hospital of A Coruña, A Coruña; Department of Rheumatology, University Hospital Complex of Ourense, Ourense; Department of Rheumatology, Puerta del Hierro-Majadahonda University Hospital, Majadahonda; Department of Rheumatology, Marqués de Valdecilla University Hospital, Cantabria University, Santander; Department of Rheumatology, University Hospital Araba, Victoria; Department of Rheumatology, Virgen Macarena Hospital, Seville; Department of Rheumatology, San Cecilio Hospital, Granada; Department of Rheumatology, Monforte Hospital, Lugo; Department of Rheumatology, Tenerife Clinic Hospital, Tenerife; Department of Rheumatology, Carlos Haya Hospital, Málaga; Department of Rheumatology, Son Llatzer Hospital, Palma de Mallorca; Department of Rheumatology, Doctor Peset Hospital, Valencia; University of Las Palmas, Gran Canaria, Las Palmas, Spain.,I. Rúa-Figueroa, MD, Department of Rheumatology, Doctor Negrín University Hospital of Gran Canaria; F.J. López-Longo, MD, PhD, Department of Rheumatology, Gregorio Marañón University Hospital; V. Del Campo, MD, PhD, Department of Preventive Medicine, University Hospital Complex, Biomedical Research Institute of Vigo; M. Galindo-Izquierdo, MD, PhD, Department of Rheumatology, Doce de Octubre University Hospital; E. Uriarte, MD, Department of Rheumatology, Donostia Hospital, J. Torre-Cisneros, MD, PhD, Infectious Diseases Department, IMIBIC, Reina Sofia University Hospital, University of Córdoba; P. Vela, MD, PhD, Department of Rheumatology, General University Hospital of Alicante, Miguel Hernandez University Alicante; E. Tomero, MD, Department of Rheumatology, La Princesa University Hospital; J. Narváez, MD, PhD, Department of Rheumatology, Bellvitge Hospital; A. Olivé, MD, PhD, Department of Rheumatology, Germans Trías i Pujol University Hospital; M. Freire, MD, Department of Rheumatology, University Hospital of A Coruña; E. Salgado, MD, PhD, Department of Rheumatology, University Hospital Complex of Ourense; J.L. Andreu, MD, PhD, Department of Rheumatology, Puerta del Hierro-Majadahonda University Hospital; V. Martínez-Taboada, MD, PhD, Department of Rheumatology, Marqués de Valdecilla University Hospital, Cantabria University; J. Calvo-Alén, MD, PhD, Department of Rheumatology, University Hospital Araba; B. Hernández-Cruz, MD, PhD, Department of Rheumatology, Virgen Macarena Hospital; E. Raya, MD, Department of Rheumatology, San Cecilio Hospital; V. Quevedo, MD, Department of Rheumatology, Monforte Hospital; L. Expósito Pérez, PhD, Department of Rheumatology, Tenerife Clinic Hospital; A. Fernández-Nebro, MD, PhD, Department of Rheumatology, Carlos Haya Hospital; M. Ibañez, MD, Department of Rheumatology, Son Llatzer Hospital; È. Pascual-Valls, MD, Department of Rheumatology, Doctor Peset Hospital; D. Rúa-Figueroa, MD, University of Las Palmas; A. Naranjo, MD, PhD, Department of Rheumatology, Doctor Negrín University Hospital of Gran Canaria; J.M. Pego-Reigosa, Department of Rheumatology, University Hospital Complex, Biomedical Research Institute of Vigo
| | - Enrique Raya
- From the Department of Rheumatology, Doctor Negrín University Hospital of Gran Canaria, Las Palmas; Department of Rheumatology, Gregorio Marañón University Hospital, Madrid; Department of Preventive Medicine, University Hospital Complex, and Department of Rheumatology, Biomedical Research Institute of Vigo, Vigo; Department of Rheumatology, Doce de Octubre University Hospital, Madrid; Department of Rheumatology, Donostia Hospital, Guipuzcoa; Infectious Diseases Department, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Córdoba; Department of Rheumatology, General University Hospital of Alicante, Miguel Hernandez University, Alicante; Department of Rheumatology, La Princesa University Hospital, Madrid; Department of Rheumatology, Bellvitge Hospital, Barcelona; Department of Rheumatology, Germans Trías i Pujol University Hospital, Badalona; Department of Rheumatology, University Hospital of A Coruña, A Coruña; Department of Rheumatology, University Hospital Complex of Ourense, Ourense; Department of Rheumatology, Puerta del Hierro-Majadahonda University Hospital, Majadahonda; Department of Rheumatology, Marqués de Valdecilla University Hospital, Cantabria University, Santander; Department of Rheumatology, University Hospital Araba, Victoria; Department of Rheumatology, Virgen Macarena Hospital, Seville; Department of Rheumatology, San Cecilio Hospital, Granada; Department of Rheumatology, Monforte Hospital, Lugo; Department of Rheumatology, Tenerife Clinic Hospital, Tenerife; Department of Rheumatology, Carlos Haya Hospital, Málaga; Department of Rheumatology, Son Llatzer Hospital, Palma de Mallorca; Department of Rheumatology, Doctor Peset Hospital, Valencia; University of Las Palmas, Gran Canaria, Las Palmas, Spain.,I. Rúa-Figueroa, MD, Department of Rheumatology, Doctor Negrín University Hospital of Gran Canaria; F.J. López-Longo, MD, PhD, Department of Rheumatology, Gregorio Marañón University Hospital; V. Del Campo, MD, PhD, Department of Preventive Medicine, University Hospital Complex, Biomedical Research Institute of Vigo; M. Galindo-Izquierdo, MD, PhD, Department of Rheumatology, Doce de Octubre University Hospital; E. Uriarte, MD, Department of Rheumatology, Donostia Hospital, J. Torre-Cisneros, MD, PhD, Infectious Diseases Department, IMIBIC, Reina Sofia University Hospital, University of Córdoba; P. Vela, MD, PhD, Department of Rheumatology, General University Hospital of Alicante, Miguel Hernandez University Alicante; E. Tomero, MD, Department of Rheumatology, La Princesa University Hospital; J. Narváez, MD, PhD, Department of Rheumatology, Bellvitge Hospital; A. Olivé, MD, PhD, Department of Rheumatology, Germans Trías i Pujol University Hospital; M. Freire, MD, Department of Rheumatology, University Hospital of A Coruña; E. Salgado, MD, PhD, Department of Rheumatology, University Hospital Complex of Ourense; J.L. Andreu, MD, PhD, Department of Rheumatology, Puerta del Hierro-Majadahonda University Hospital; V. Martínez-Taboada, MD, PhD, Department of Rheumatology, Marqués de Valdecilla University Hospital, Cantabria University; J. Calvo-Alén, MD, PhD, Department of Rheumatology, University Hospital Araba; B. Hernández-Cruz, MD, PhD, Department of Rheumatology, Virgen Macarena Hospital; E. Raya, MD, Department of Rheumatology, San Cecilio Hospital; V. Quevedo, MD, Department of Rheumatology, Monforte Hospital; L. Expósito Pérez, PhD, Department of Rheumatology, Tenerife Clinic Hospital; A. Fernández-Nebro, MD, PhD, Department of Rheumatology, Carlos Haya Hospital; M. Ibañez, MD, Department of Rheumatology, Son Llatzer Hospital; È. Pascual-Valls, MD, Department of Rheumatology, Doctor Peset Hospital; D. Rúa-Figueroa, MD, University of Las Palmas; A. Naranjo, MD, PhD, Department of Rheumatology, Doctor Negrín University Hospital of Gran Canaria; J.M. Pego-Reigosa, Department of Rheumatology, University Hospital Complex, Biomedical Research Institute of Vigo
| | - Víctor Quevedo
- From the Department of Rheumatology, Doctor Negrín University Hospital of Gran Canaria, Las Palmas; Department of Rheumatology, Gregorio Marañón University Hospital, Madrid; Department of Preventive Medicine, University Hospital Complex, and Department of Rheumatology, Biomedical Research Institute of Vigo, Vigo; Department of Rheumatology, Doce de Octubre University Hospital, Madrid; Department of Rheumatology, Donostia Hospital, Guipuzcoa; Infectious Diseases Department, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Córdoba; Department of Rheumatology, General University Hospital of Alicante, Miguel Hernandez University, Alicante; Department of Rheumatology, La Princesa University Hospital, Madrid; Department of Rheumatology, Bellvitge Hospital, Barcelona; Department of Rheumatology, Germans Trías i Pujol University Hospital, Badalona; Department of Rheumatology, University Hospital of A Coruña, A Coruña; Department of Rheumatology, University Hospital Complex of Ourense, Ourense; Department of Rheumatology, Puerta del Hierro-Majadahonda University Hospital, Majadahonda; Department of Rheumatology, Marqués de Valdecilla University Hospital, Cantabria University, Santander; Department of Rheumatology, University Hospital Araba, Victoria; Department of Rheumatology, Virgen Macarena Hospital, Seville; Department of Rheumatology, San Cecilio Hospital, Granada; Department of Rheumatology, Monforte Hospital, Lugo; Department of Rheumatology, Tenerife Clinic Hospital, Tenerife; Department of Rheumatology, Carlos Haya Hospital, Málaga; Department of Rheumatology, Son Llatzer Hospital, Palma de Mallorca; Department of Rheumatology, Doctor Peset Hospital, Valencia; University of Las Palmas, Gran Canaria, Las Palmas, Spain.,I. Rúa-Figueroa, MD, Department of Rheumatology, Doctor Negrín University Hospital of Gran Canaria; F.J. López-Longo, MD, PhD, Department of Rheumatology, Gregorio Marañón University Hospital; V. Del Campo, MD, PhD, Department of Preventive Medicine, University Hospital Complex, Biomedical Research Institute of Vigo; M. Galindo-Izquierdo, MD, PhD, Department of Rheumatology, Doce de Octubre University Hospital; E. Uriarte, MD, Department of Rheumatology, Donostia Hospital, J. Torre-Cisneros, MD, PhD, Infectious Diseases Department, IMIBIC, Reina Sofia University Hospital, University of Córdoba; P. Vela, MD, PhD, Department of Rheumatology, General University Hospital of Alicante, Miguel Hernandez University Alicante; E. Tomero, MD, Department of Rheumatology, La Princesa University Hospital; J. Narváez, MD, PhD, Department of Rheumatology, Bellvitge Hospital; A. Olivé, MD, PhD, Department of Rheumatology, Germans Trías i Pujol University Hospital; M. Freire, MD, Department of Rheumatology, University Hospital of A Coruña; E. Salgado, MD, PhD, Department of Rheumatology, University Hospital Complex of Ourense; J.L. Andreu, MD, PhD, Department of Rheumatology, Puerta del Hierro-Majadahonda University Hospital; V. Martínez-Taboada, MD, PhD, Department of Rheumatology, Marqués de Valdecilla University Hospital, Cantabria University; J. Calvo-Alén, MD, PhD, Department of Rheumatology, University Hospital Araba; B. Hernández-Cruz, MD, PhD, Department of Rheumatology, Virgen Macarena Hospital; E. Raya, MD, Department of Rheumatology, San Cecilio Hospital; V. Quevedo, MD, Department of Rheumatology, Monforte Hospital; L. Expósito Pérez, PhD, Department of Rheumatology, Tenerife Clinic Hospital; A. Fernández-Nebro, MD, PhD, Department of Rheumatology, Carlos Haya Hospital; M. Ibañez, MD, Department of Rheumatology, Son Llatzer Hospital; È. Pascual-Valls, MD, Department of Rheumatology, Doctor Peset Hospital; D. Rúa-Figueroa, MD, University of Las Palmas; A. Naranjo, MD, PhD, Department of Rheumatology, Doctor Negrín University Hospital of Gran Canaria; J.M. Pego-Reigosa, Department of Rheumatology, University Hospital Complex, Biomedical Research Institute of Vigo
| | - Lorena Expósito Pérez
- From the Department of Rheumatology, Doctor Negrín University Hospital of Gran Canaria, Las Palmas; Department of Rheumatology, Gregorio Marañón University Hospital, Madrid; Department of Preventive Medicine, University Hospital Complex, and Department of Rheumatology, Biomedical Research Institute of Vigo, Vigo; Department of Rheumatology, Doce de Octubre University Hospital, Madrid; Department of Rheumatology, Donostia Hospital, Guipuzcoa; Infectious Diseases Department, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Córdoba; Department of Rheumatology, General University Hospital of Alicante, Miguel Hernandez University, Alicante; Department of Rheumatology, La Princesa University Hospital, Madrid; Department of Rheumatology, Bellvitge Hospital, Barcelona; Department of Rheumatology, Germans Trías i Pujol University Hospital, Badalona; Department of Rheumatology, University Hospital of A Coruña, A Coruña; Department of Rheumatology, University Hospital Complex of Ourense, Ourense; Department of Rheumatology, Puerta del Hierro-Majadahonda University Hospital, Majadahonda; Department of Rheumatology, Marqués de Valdecilla University Hospital, Cantabria University, Santander; Department of Rheumatology, University Hospital Araba, Victoria; Department of Rheumatology, Virgen Macarena Hospital, Seville; Department of Rheumatology, San Cecilio Hospital, Granada; Department of Rheumatology, Monforte Hospital, Lugo; Department of Rheumatology, Tenerife Clinic Hospital, Tenerife; Department of Rheumatology, Carlos Haya Hospital, Málaga; Department of Rheumatology, Son Llatzer Hospital, Palma de Mallorca; Department of Rheumatology, Doctor Peset Hospital, Valencia; University of Las Palmas, Gran Canaria, Las Palmas, Spain.,I. Rúa-Figueroa, MD, Department of Rheumatology, Doctor Negrín University Hospital of Gran Canaria; F.J. López-Longo, MD, PhD, Department of Rheumatology, Gregorio Marañón University Hospital; V. Del Campo, MD, PhD, Department of Preventive Medicine, University Hospital Complex, Biomedical Research Institute of Vigo; M. Galindo-Izquierdo, MD, PhD, Department of Rheumatology, Doce de Octubre University Hospital; E. Uriarte, MD, Department of Rheumatology, Donostia Hospital, J. Torre-Cisneros, MD, PhD, Infectious Diseases Department, IMIBIC, Reina Sofia University Hospital, University of Córdoba; P. Vela, MD, PhD, Department of Rheumatology, General University Hospital of Alicante, Miguel Hernandez University Alicante; E. Tomero, MD, Department of Rheumatology, La Princesa University Hospital; J. Narváez, MD, PhD, Department of Rheumatology, Bellvitge Hospital; A. Olivé, MD, PhD, Department of Rheumatology, Germans Trías i Pujol University Hospital; M. Freire, MD, Department of Rheumatology, University Hospital of A Coruña; E. Salgado, MD, PhD, Department of Rheumatology, University Hospital Complex of Ourense; J.L. Andreu, MD, PhD, Department of Rheumatology, Puerta del Hierro-Majadahonda University Hospital; V. Martínez-Taboada, MD, PhD, Department of Rheumatology, Marqués de Valdecilla University Hospital, Cantabria University; J. Calvo-Alén, MD, PhD, Department of Rheumatology, University Hospital Araba; B. Hernández-Cruz, MD, PhD, Department of Rheumatology, Virgen Macarena Hospital; E. Raya, MD, Department of Rheumatology, San Cecilio Hospital; V. Quevedo, MD, Department of Rheumatology, Monforte Hospital; L. Expósito Pérez, PhD, Department of Rheumatology, Tenerife Clinic Hospital; A. Fernández-Nebro, MD, PhD, Department of Rheumatology, Carlos Haya Hospital; M. Ibañez, MD, Department of Rheumatology, Son Llatzer Hospital; È. Pascual-Valls, MD, Department of Rheumatology, Doctor Peset Hospital; D. Rúa-Figueroa, MD, University of Las Palmas; A. Naranjo, MD, PhD, Department of Rheumatology, Doctor Negrín University Hospital of Gran Canaria; J.M. Pego-Reigosa, Department of Rheumatology, University Hospital Complex, Biomedical Research Institute of Vigo
| | - Antonio Fernández-Nebro
- From the Department of Rheumatology, Doctor Negrín University Hospital of Gran Canaria, Las Palmas; Department of Rheumatology, Gregorio Marañón University Hospital, Madrid; Department of Preventive Medicine, University Hospital Complex, and Department of Rheumatology, Biomedical Research Institute of Vigo, Vigo; Department of Rheumatology, Doce de Octubre University Hospital, Madrid; Department of Rheumatology, Donostia Hospital, Guipuzcoa; Infectious Diseases Department, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Córdoba; Department of Rheumatology, General University Hospital of Alicante, Miguel Hernandez University, Alicante; Department of Rheumatology, La Princesa University Hospital, Madrid; Department of Rheumatology, Bellvitge Hospital, Barcelona; Department of Rheumatology, Germans Trías i Pujol University Hospital, Badalona; Department of Rheumatology, University Hospital of A Coruña, A Coruña; Department of Rheumatology, University Hospital Complex of Ourense, Ourense; Department of Rheumatology, Puerta del Hierro-Majadahonda University Hospital, Majadahonda; Department of Rheumatology, Marqués de Valdecilla University Hospital, Cantabria University, Santander; Department of Rheumatology, University Hospital Araba, Victoria; Department of Rheumatology, Virgen Macarena Hospital, Seville; Department of Rheumatology, San Cecilio Hospital, Granada; Department of Rheumatology, Monforte Hospital, Lugo; Department of Rheumatology, Tenerife Clinic Hospital, Tenerife; Department of Rheumatology, Carlos Haya Hospital, Málaga; Department of Rheumatology, Son Llatzer Hospital, Palma de Mallorca; Department of Rheumatology, Doctor Peset Hospital, Valencia; University of Las Palmas, Gran Canaria, Las Palmas, Spain.,I. Rúa-Figueroa, MD, Department of Rheumatology, Doctor Negrín University Hospital of Gran Canaria; F.J. López-Longo, MD, PhD, Department of Rheumatology, Gregorio Marañón University Hospital; V. Del Campo, MD, PhD, Department of Preventive Medicine, University Hospital Complex, Biomedical Research Institute of Vigo; M. Galindo-Izquierdo, MD, PhD, Department of Rheumatology, Doce de Octubre University Hospital; E. Uriarte, MD, Department of Rheumatology, Donostia Hospital, J. Torre-Cisneros, MD, PhD, Infectious Diseases Department, IMIBIC, Reina Sofia University Hospital, University of Córdoba; P. Vela, MD, PhD, Department of Rheumatology, General University Hospital of Alicante, Miguel Hernandez University Alicante; E. Tomero, MD, Department of Rheumatology, La Princesa University Hospital; J. Narváez, MD, PhD, Department of Rheumatology, Bellvitge Hospital; A. Olivé, MD, PhD, Department of Rheumatology, Germans Trías i Pujol University Hospital; M. Freire, MD, Department of Rheumatology, University Hospital of A Coruña; E. Salgado, MD, PhD, Department of Rheumatology, University Hospital Complex of Ourense; J.L. Andreu, MD, PhD, Department of Rheumatology, Puerta del Hierro-Majadahonda University Hospital; V. Martínez-Taboada, MD, PhD, Department of Rheumatology, Marqués de Valdecilla University Hospital, Cantabria University; J. Calvo-Alén, MD, PhD, Department of Rheumatology, University Hospital Araba; B. Hernández-Cruz, MD, PhD, Department of Rheumatology, Virgen Macarena Hospital; E. Raya, MD, Department of Rheumatology, San Cecilio Hospital; V. Quevedo, MD, Department of Rheumatology, Monforte Hospital; L. Expósito Pérez, PhD, Department of Rheumatology, Tenerife Clinic Hospital; A. Fernández-Nebro, MD, PhD, Department of Rheumatology, Carlos Haya Hospital; M. Ibañez, MD, Department of Rheumatology, Son Llatzer Hospital; È. Pascual-Valls, MD, Department of Rheumatology, Doctor Peset Hospital; D. Rúa-Figueroa, MD, University of Las Palmas; A. Naranjo, MD, PhD, Department of Rheumatology, Doctor Negrín University Hospital of Gran Canaria; J.M. Pego-Reigosa, Department of Rheumatology, University Hospital Complex, Biomedical Research Institute of Vigo
| | - Mónica Ibañez
- From the Department of Rheumatology, Doctor Negrín University Hospital of Gran Canaria, Las Palmas; Department of Rheumatology, Gregorio Marañón University Hospital, Madrid; Department of Preventive Medicine, University Hospital Complex, and Department of Rheumatology, Biomedical Research Institute of Vigo, Vigo; Department of Rheumatology, Doce de Octubre University Hospital, Madrid; Department of Rheumatology, Donostia Hospital, Guipuzcoa; Infectious Diseases Department, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Córdoba; Department of Rheumatology, General University Hospital of Alicante, Miguel Hernandez University, Alicante; Department of Rheumatology, La Princesa University Hospital, Madrid; Department of Rheumatology, Bellvitge Hospital, Barcelona; Department of Rheumatology, Germans Trías i Pujol University Hospital, Badalona; Department of Rheumatology, University Hospital of A Coruña, A Coruña; Department of Rheumatology, University Hospital Complex of Ourense, Ourense; Department of Rheumatology, Puerta del Hierro-Majadahonda University Hospital, Majadahonda; Department of Rheumatology, Marqués de Valdecilla University Hospital, Cantabria University, Santander; Department of Rheumatology, University Hospital Araba, Victoria; Department of Rheumatology, Virgen Macarena Hospital, Seville; Department of Rheumatology, San Cecilio Hospital, Granada; Department of Rheumatology, Monforte Hospital, Lugo; Department of Rheumatology, Tenerife Clinic Hospital, Tenerife; Department of Rheumatology, Carlos Haya Hospital, Málaga; Department of Rheumatology, Son Llatzer Hospital, Palma de Mallorca; Department of Rheumatology, Doctor Peset Hospital, Valencia; University of Las Palmas, Gran Canaria, Las Palmas, Spain.,I. Rúa-Figueroa, MD, Department of Rheumatology, Doctor Negrín University Hospital of Gran Canaria; F.J. López-Longo, MD, PhD, Department of Rheumatology, Gregorio Marañón University Hospital; V. Del Campo, MD, PhD, Department of Preventive Medicine, University Hospital Complex, Biomedical Research Institute of Vigo; M. Galindo-Izquierdo, MD, PhD, Department of Rheumatology, Doce de Octubre University Hospital; E. Uriarte, MD, Department of Rheumatology, Donostia Hospital, J. Torre-Cisneros, MD, PhD, Infectious Diseases Department, IMIBIC, Reina Sofia University Hospital, University of Córdoba; P. Vela, MD, PhD, Department of Rheumatology, General University Hospital of Alicante, Miguel Hernandez University Alicante; E. Tomero, MD, Department of Rheumatology, La Princesa University Hospital; J. Narváez, MD, PhD, Department of Rheumatology, Bellvitge Hospital; A. Olivé, MD, PhD, Department of Rheumatology, Germans Trías i Pujol University Hospital; M. Freire, MD, Department of Rheumatology, University Hospital of A Coruña; E. Salgado, MD, PhD, Department of Rheumatology, University Hospital Complex of Ourense; J.L. Andreu, MD, PhD, Department of Rheumatology, Puerta del Hierro-Majadahonda University Hospital; V. Martínez-Taboada, MD, PhD, Department of Rheumatology, Marqués de Valdecilla University Hospital, Cantabria University; J. Calvo-Alén, MD, PhD, Department of Rheumatology, University Hospital Araba; B. Hernández-Cruz, MD, PhD, Department of Rheumatology, Virgen Macarena Hospital; E. Raya, MD, Department of Rheumatology, San Cecilio Hospital; V. Quevedo, MD, Department of Rheumatology, Monforte Hospital; L. Expósito Pérez, PhD, Department of Rheumatology, Tenerife Clinic Hospital; A. Fernández-Nebro, MD, PhD, Department of Rheumatology, Carlos Haya Hospital; M. Ibañez, MD, Department of Rheumatology, Son Llatzer Hospital; È. Pascual-Valls, MD, Department of Rheumatology, Doctor Peset Hospital; D. Rúa-Figueroa, MD, University of Las Palmas; A. Naranjo, MD, PhD, Department of Rheumatology, Doctor Negrín University Hospital of Gran Canaria; J.M. Pego-Reigosa, Department of Rheumatology, University Hospital Complex, Biomedical Research Institute of Vigo
| | - Èlia Pascual-Valls
- From the Department of Rheumatology, Doctor Negrín University Hospital of Gran Canaria, Las Palmas; Department of Rheumatology, Gregorio Marañón University Hospital, Madrid; Department of Preventive Medicine, University Hospital Complex, and Department of Rheumatology, Biomedical Research Institute of Vigo, Vigo; Department of Rheumatology, Doce de Octubre University Hospital, Madrid; Department of Rheumatology, Donostia Hospital, Guipuzcoa; Infectious Diseases Department, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Córdoba; Department of Rheumatology, General University Hospital of Alicante, Miguel Hernandez University, Alicante; Department of Rheumatology, La Princesa University Hospital, Madrid; Department of Rheumatology, Bellvitge Hospital, Barcelona; Department of Rheumatology, Germans Trías i Pujol University Hospital, Badalona; Department of Rheumatology, University Hospital of A Coruña, A Coruña; Department of Rheumatology, University Hospital Complex of Ourense, Ourense; Department of Rheumatology, Puerta del Hierro-Majadahonda University Hospital, Majadahonda; Department of Rheumatology, Marqués de Valdecilla University Hospital, Cantabria University, Santander; Department of Rheumatology, University Hospital Araba, Victoria; Department of Rheumatology, Virgen Macarena Hospital, Seville; Department of Rheumatology, San Cecilio Hospital, Granada; Department of Rheumatology, Monforte Hospital, Lugo; Department of Rheumatology, Tenerife Clinic Hospital, Tenerife; Department of Rheumatology, Carlos Haya Hospital, Málaga; Department of Rheumatology, Son Llatzer Hospital, Palma de Mallorca; Department of Rheumatology, Doctor Peset Hospital, Valencia; University of Las Palmas, Gran Canaria, Las Palmas, Spain.,I. Rúa-Figueroa, MD, Department of Rheumatology, Doctor Negrín University Hospital of Gran Canaria; F.J. López-Longo, MD, PhD, Department of Rheumatology, Gregorio Marañón University Hospital; V. Del Campo, MD, PhD, Department of Preventive Medicine, University Hospital Complex, Biomedical Research Institute of Vigo; M. Galindo-Izquierdo, MD, PhD, Department of Rheumatology, Doce de Octubre University Hospital; E. Uriarte, MD, Department of Rheumatology, Donostia Hospital, J. Torre-Cisneros, MD, PhD, Infectious Diseases Department, IMIBIC, Reina Sofia University Hospital, University of Córdoba; P. Vela, MD, PhD, Department of Rheumatology, General University Hospital of Alicante, Miguel Hernandez University Alicante; E. Tomero, MD, Department of Rheumatology, La Princesa University Hospital; J. Narváez, MD, PhD, Department of Rheumatology, Bellvitge Hospital; A. Olivé, MD, PhD, Department of Rheumatology, Germans Trías i Pujol University Hospital; M. Freire, MD, Department of Rheumatology, University Hospital of A Coruña; E. Salgado, MD, PhD, Department of Rheumatology, University Hospital Complex of Ourense; J.L. Andreu, MD, PhD, Department of Rheumatology, Puerta del Hierro-Majadahonda University Hospital; V. Martínez-Taboada, MD, PhD, Department of Rheumatology, Marqués de Valdecilla University Hospital, Cantabria University; J. Calvo-Alén, MD, PhD, Department of Rheumatology, University Hospital Araba; B. Hernández-Cruz, MD, PhD, Department of Rheumatology, Virgen Macarena Hospital; E. Raya, MD, Department of Rheumatology, San Cecilio Hospital; V. Quevedo, MD, Department of Rheumatology, Monforte Hospital; L. Expósito Pérez, PhD, Department of Rheumatology, Tenerife Clinic Hospital; A. Fernández-Nebro, MD, PhD, Department of Rheumatology, Carlos Haya Hospital; M. Ibañez, MD, Department of Rheumatology, Son Llatzer Hospital; È. Pascual-Valls, MD, Department of Rheumatology, Doctor Peset Hospital; D. Rúa-Figueroa, MD, University of Las Palmas; A. Naranjo, MD, PhD, Department of Rheumatology, Doctor Negrín University Hospital of Gran Canaria; J.M. Pego-Reigosa, Department of Rheumatology, University Hospital Complex, Biomedical Research Institute of Vigo
| | - David Rúa-Figueroa
- From the Department of Rheumatology, Doctor Negrín University Hospital of Gran Canaria, Las Palmas; Department of Rheumatology, Gregorio Marañón University Hospital, Madrid; Department of Preventive Medicine, University Hospital Complex, and Department of Rheumatology, Biomedical Research Institute of Vigo, Vigo; Department of Rheumatology, Doce de Octubre University Hospital, Madrid; Department of Rheumatology, Donostia Hospital, Guipuzcoa; Infectious Diseases Department, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Córdoba; Department of Rheumatology, General University Hospital of Alicante, Miguel Hernandez University, Alicante; Department of Rheumatology, La Princesa University Hospital, Madrid; Department of Rheumatology, Bellvitge Hospital, Barcelona; Department of Rheumatology, Germans Trías i Pujol University Hospital, Badalona; Department of Rheumatology, University Hospital of A Coruña, A Coruña; Department of Rheumatology, University Hospital Complex of Ourense, Ourense; Department of Rheumatology, Puerta del Hierro-Majadahonda University Hospital, Majadahonda; Department of Rheumatology, Marqués de Valdecilla University Hospital, Cantabria University, Santander; Department of Rheumatology, University Hospital Araba, Victoria; Department of Rheumatology, Virgen Macarena Hospital, Seville; Department of Rheumatology, San Cecilio Hospital, Granada; Department of Rheumatology, Monforte Hospital, Lugo; Department of Rheumatology, Tenerife Clinic Hospital, Tenerife; Department of Rheumatology, Carlos Haya Hospital, Málaga; Department of Rheumatology, Son Llatzer Hospital, Palma de Mallorca; Department of Rheumatology, Doctor Peset Hospital, Valencia; University of Las Palmas, Gran Canaria, Las Palmas, Spain.,I. Rúa-Figueroa, MD, Department of Rheumatology, Doctor Negrín University Hospital of Gran Canaria; F.J. López-Longo, MD, PhD, Department of Rheumatology, Gregorio Marañón University Hospital; V. Del Campo, MD, PhD, Department of Preventive Medicine, University Hospital Complex, Biomedical Research Institute of Vigo; M. Galindo-Izquierdo, MD, PhD, Department of Rheumatology, Doce de Octubre University Hospital; E. Uriarte, MD, Department of Rheumatology, Donostia Hospital, J. Torre-Cisneros, MD, PhD, Infectious Diseases Department, IMIBIC, Reina Sofia University Hospital, University of Córdoba; P. Vela, MD, PhD, Department of Rheumatology, General University Hospital of Alicante, Miguel Hernandez University Alicante; E. Tomero, MD, Department of Rheumatology, La Princesa University Hospital; J. Narváez, MD, PhD, Department of Rheumatology, Bellvitge Hospital; A. Olivé, MD, PhD, Department of Rheumatology, Germans Trías i Pujol University Hospital; M. Freire, MD, Department of Rheumatology, University Hospital of A Coruña; E. Salgado, MD, PhD, Department of Rheumatology, University Hospital Complex of Ourense; J.L. Andreu, MD, PhD, Department of Rheumatology, Puerta del Hierro-Majadahonda University Hospital; V. Martínez-Taboada, MD, PhD, Department of Rheumatology, Marqués de Valdecilla University Hospital, Cantabria University; J. Calvo-Alén, MD, PhD, Department of Rheumatology, University Hospital Araba; B. Hernández-Cruz, MD, PhD, Department of Rheumatology, Virgen Macarena Hospital; E. Raya, MD, Department of Rheumatology, San Cecilio Hospital; V. Quevedo, MD, Department of Rheumatology, Monforte Hospital; L. Expósito Pérez, PhD, Department of Rheumatology, Tenerife Clinic Hospital; A. Fernández-Nebro, MD, PhD, Department of Rheumatology, Carlos Haya Hospital; M. Ibañez, MD, Department of Rheumatology, Son Llatzer Hospital; È. Pascual-Valls, MD, Department of Rheumatology, Doctor Peset Hospital; D. Rúa-Figueroa, MD, University of Las Palmas; A. Naranjo, MD, PhD, Department of Rheumatology, Doctor Negrín University Hospital of Gran Canaria; J.M. Pego-Reigosa, Department of Rheumatology, University Hospital Complex, Biomedical Research Institute of Vigo
| | - Antonio Naranjo
- From the Department of Rheumatology, Doctor Negrín University Hospital of Gran Canaria, Las Palmas; Department of Rheumatology, Gregorio Marañón University Hospital, Madrid; Department of Preventive Medicine, University Hospital Complex, and Department of Rheumatology, Biomedical Research Institute of Vigo, Vigo; Department of Rheumatology, Doce de Octubre University Hospital, Madrid; Department of Rheumatology, Donostia Hospital, Guipuzcoa; Infectious Diseases Department, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Córdoba; Department of Rheumatology, General University Hospital of Alicante, Miguel Hernandez University, Alicante; Department of Rheumatology, La Princesa University Hospital, Madrid; Department of Rheumatology, Bellvitge Hospital, Barcelona; Department of Rheumatology, Germans Trías i Pujol University Hospital, Badalona; Department of Rheumatology, University Hospital of A Coruña, A Coruña; Department of Rheumatology, University Hospital Complex of Ourense, Ourense; Department of Rheumatology, Puerta del Hierro-Majadahonda University Hospital, Majadahonda; Department of Rheumatology, Marqués de Valdecilla University Hospital, Cantabria University, Santander; Department of Rheumatology, University Hospital Araba, Victoria; Department of Rheumatology, Virgen Macarena Hospital, Seville; Department of Rheumatology, San Cecilio Hospital, Granada; Department of Rheumatology, Monforte Hospital, Lugo; Department of Rheumatology, Tenerife Clinic Hospital, Tenerife; Department of Rheumatology, Carlos Haya Hospital, Málaga; Department of Rheumatology, Son Llatzer Hospital, Palma de Mallorca; Department of Rheumatology, Doctor Peset Hospital, Valencia; University of Las Palmas, Gran Canaria, Las Palmas, Spain.,I. Rúa-Figueroa, MD, Department of Rheumatology, Doctor Negrín University Hospital of Gran Canaria; F.J. López-Longo, MD, PhD, Department of Rheumatology, Gregorio Marañón University Hospital; V. Del Campo, MD, PhD, Department of Preventive Medicine, University Hospital Complex, Biomedical Research Institute of Vigo; M. Galindo-Izquierdo, MD, PhD, Department of Rheumatology, Doce de Octubre University Hospital; E. Uriarte, MD, Department of Rheumatology, Donostia Hospital, J. Torre-Cisneros, MD, PhD, Infectious Diseases Department, IMIBIC, Reina Sofia University Hospital, University of Córdoba; P. Vela, MD, PhD, Department of Rheumatology, General University Hospital of Alicante, Miguel Hernandez University Alicante; E. Tomero, MD, Department of Rheumatology, La Princesa University Hospital; J. Narváez, MD, PhD, Department of Rheumatology, Bellvitge Hospital; A. Olivé, MD, PhD, Department of Rheumatology, Germans Trías i Pujol University Hospital; M. Freire, MD, Department of Rheumatology, University Hospital of A Coruña; E. Salgado, MD, PhD, Department of Rheumatology, University Hospital Complex of Ourense; J.L. Andreu, MD, PhD, Department of Rheumatology, Puerta del Hierro-Majadahonda University Hospital; V. Martínez-Taboada, MD, PhD, Department of Rheumatology, Marqués de Valdecilla University Hospital, Cantabria University; J. Calvo-Alén, MD, PhD, Department of Rheumatology, University Hospital Araba; B. Hernández-Cruz, MD, PhD, Department of Rheumatology, Virgen Macarena Hospital; E. Raya, MD, Department of Rheumatology, San Cecilio Hospital; V. Quevedo, MD, Department of Rheumatology, Monforte Hospital; L. Expósito Pérez, PhD, Department of Rheumatology, Tenerife Clinic Hospital; A. Fernández-Nebro, MD, PhD, Department of Rheumatology, Carlos Haya Hospital; M. Ibañez, MD, Department of Rheumatology, Son Llatzer Hospital; È. Pascual-Valls, MD, Department of Rheumatology, Doctor Peset Hospital; D. Rúa-Figueroa, MD, University of Las Palmas; A. Naranjo, MD, PhD, Department of Rheumatology, Doctor Negrín University Hospital of Gran Canaria; J.M. Pego-Reigosa, Department of Rheumatology, University Hospital Complex, Biomedical Research Institute of Vigo
| | - José M Pego-Reigosa
- From the Department of Rheumatology, Doctor Negrín University Hospital of Gran Canaria, Las Palmas; Department of Rheumatology, Gregorio Marañón University Hospital, Madrid; Department of Preventive Medicine, University Hospital Complex, and Department of Rheumatology, Biomedical Research Institute of Vigo, Vigo; Department of Rheumatology, Doce de Octubre University Hospital, Madrid; Department of Rheumatology, Donostia Hospital, Guipuzcoa; Infectious Diseases Department, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Córdoba; Department of Rheumatology, General University Hospital of Alicante, Miguel Hernandez University, Alicante; Department of Rheumatology, La Princesa University Hospital, Madrid; Department of Rheumatology, Bellvitge Hospital, Barcelona; Department of Rheumatology, Germans Trías i Pujol University Hospital, Badalona; Department of Rheumatology, University Hospital of A Coruña, A Coruña; Department of Rheumatology, University Hospital Complex of Ourense, Ourense; Department of Rheumatology, Puerta del Hierro-Majadahonda University Hospital, Majadahonda; Department of Rheumatology, Marqués de Valdecilla University Hospital, Cantabria University, Santander; Department of Rheumatology, University Hospital Araba, Victoria; Department of Rheumatology, Virgen Macarena Hospital, Seville; Department of Rheumatology, San Cecilio Hospital, Granada; Department of Rheumatology, Monforte Hospital, Lugo; Department of Rheumatology, Tenerife Clinic Hospital, Tenerife; Department of Rheumatology, Carlos Haya Hospital, Málaga; Department of Rheumatology, Son Llatzer Hospital, Palma de Mallorca; Department of Rheumatology, Doctor Peset Hospital, Valencia; University of Las Palmas, Gran Canaria, Las Palmas, Spain.,I. Rúa-Figueroa, MD, Department of Rheumatology, Doctor Negrín University Hospital of Gran Canaria; F.J. López-Longo, MD, PhD, Department of Rheumatology, Gregorio Marañón University Hospital; V. Del Campo, MD, PhD, Department of Preventive Medicine, University Hospital Complex, Biomedical Research Institute of Vigo; M. Galindo-Izquierdo, MD, PhD, Department of Rheumatology, Doce de Octubre University Hospital; E. Uriarte, MD, Department of Rheumatology, Donostia Hospital, J. Torre-Cisneros, MD, PhD, Infectious Diseases Department, IMIBIC, Reina Sofia University Hospital, University of Córdoba; P. Vela, MD, PhD, Department of Rheumatology, General University Hospital of Alicante, Miguel Hernandez University Alicante; E. Tomero, MD, Department of Rheumatology, La Princesa University Hospital; J. Narváez, MD, PhD, Department of Rheumatology, Bellvitge Hospital; A. Olivé, MD, PhD, Department of Rheumatology, Germans Trías i Pujol University Hospital; M. Freire, MD, Department of Rheumatology, University Hospital of A Coruña; E. Salgado, MD, PhD, Department of Rheumatology, University Hospital Complex of Ourense; J.L. Andreu, MD, PhD, Department of Rheumatology, Puerta del Hierro-Majadahonda University Hospital; V. Martínez-Taboada, MD, PhD, Department of Rheumatology, Marqués de Valdecilla University Hospital, Cantabria University; J. Calvo-Alén, MD, PhD, Department of Rheumatology, University Hospital Araba; B. Hernández-Cruz, MD, PhD, Department of Rheumatology, Virgen Macarena Hospital; E. Raya, MD, Department of Rheumatology, San Cecilio Hospital; V. Quevedo, MD, Department of Rheumatology, Monforte Hospital; L. Expósito Pérez, PhD, Department of Rheumatology, Tenerife Clinic Hospital; A. Fernández-Nebro, MD, PhD, Department of Rheumatology, Carlos Haya Hospital; M. Ibañez, MD, Department of Rheumatology, Son Llatzer Hospital; È. Pascual-Valls, MD, Department of Rheumatology, Doctor Peset Hospital; D. Rúa-Figueroa, MD, University of Las Palmas; A. Naranjo, MD, PhD, Department of Rheumatology, Doctor Negrín University Hospital of Gran Canaria; J.M. Pego-Reigosa, Department of Rheumatology, University Hospital Complex, Biomedical Research Institute of Vigo
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López-Mejías R, Carmona FD, Genre F, Remuzgo-Martínez S, González-Juanatey C, Corrales A, Vicente EF, Pulito-Cueto V, Miranda-Filloy JA, Ramírez Huaranga MA, Blanco R, Robustillo-Villarino M, Rodríguez-Carrio J, Alperi-López M, Alegre-Sancho JJ, Mijares V, Lera-Gómez L, Pérez-Pampín E, González A, Ortega-Castro R, López-Pedrera C, García Vivar ML, Gómez-Arango C, Raya E, Narvaez J, Balsa A, López-Longo FJ, Carreira P, González-Álvaro I, Rodríguez-Rodríguez L, Fernández-Gutiérrez B, Ferraz-Amaro I, Gualillo O, Castañeda S, Martín J, Llorca J, González-Gay MA. Identification of a 3'-Untranslated Genetic Variant of RARB Associated With Carotid Intima-Media Thickness in Rheumatoid Arthritis: A Genome-Wide Association Study. Arthritis Rheumatol 2019; 71:351-360. [PMID: 30251476 PMCID: PMC6590191 DOI: 10.1002/art.40734] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 09/18/2018] [Indexed: 02/06/2023]
Abstract
Objective To investigate the genetic background influencing the development of cardiovascular (CV) disease in patients with rheumatoid arthritis (RA). Methods We performed a genome‐wide association study (GWAS) in which, after quality control and imputation, a total of 6,308,944 polymorphisms across the whole genome were analyzed in 2,989 RA patients of European origin. Data on subclinical atherosclerosis, obtained through assessment of carotid intima‐media thickness (CIMT) and presence/absence of carotid plaques by carotid ultrasonography, were available for 1,355 individuals. Results A genetic variant of the RARB gene (rs116199914) was associated with CIMT values at the genome‐wide level of significance (minor allele [G] β coefficient 0.142, P = 1.86 × 10−8). Interestingly, rs116199914 overlapped with regulatory elements in tissues related to CV pathophysiology and immune cells. In addition, biologic pathway enrichment and predictive protein–protein relationship analyses, including suggestive GWAS signals of potential relevance, revealed a functional enrichment of the collagen biosynthesis network related to the presence/absence of carotid plaques (Gene Ontology no. 0032964; false discovery rate–adjusted P = 4.01 × 10−3). Furthermore, our data suggest potential influences of the previously described candidate CV risk loci NFKB1,MSRA, and ZC3HC1 (P = 8.12 × 10−4, P = 5.94 × 10−4, and P = 2.46 × 10−4, respectively). Conclusion The present findings strongly suggest that genetic variation within RARB contributes to the development of subclinical atherosclerosis in patients with RA.
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Affiliation(s)
| | | | - Fernanda Genre
- Instituto de Investigación Sanitaria Valdecilla, Santander, Spain
| | | | | | - Alfonso Corrales
- Instituto de Investigación Sanitaria Valdecilla, Santander, Spain
| | | | | | | | | | - Ricardo Blanco
- Instituto de Investigación Sanitaria Valdecilla, Santander, Spain
| | | | - Javier Rodríguez-Carrio
- University of Oviedo, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | - Mercedes Alperi-López
- Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | | | - Verónica Mijares
- Instituto de Investigación Sanitaria Valdecilla, Santander, Spain
| | | | - Eva Pérez-Pampín
- Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
| | - Antonio González
- Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
| | | | | | | | | | - Enrique Raya
- Hospital Universitario San Cecilio, Granada, Spain
| | | | | | | | | | | | | | | | | | - Oreste Gualillo
- Servizo Galego de Saude and Instituto de Investigación Sanitaria de Santiago, Santiago, University Clinical Hospital, Santiago de Compostela, Spain
| | | | - Javier Martín
- Instituto de Parasitología y Biomedicina López-Neyra, Granada, Spain
| | - Javier Llorca
- University of Cantabria and CIBER Epidemiología y Salud Pública, Instituto de Investigación Sanitaria Valdecilla, Santander, Spain
| | - Miguel A González-Gay
- Instituto de Investigación Sanitaria Valdecilla and University of Cantabria, Santander, Spain, and University of the Witwatersrand, Johannesburg, South Africa
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Calderón-Goercke M, Loricera J, Aldasoro V, Castañeda S, Villa I, Humbría A, Moriano C, Romero-Yuste S, Narváez J, Gómez-Arango C, Pérez-Pampín E, Melero R, Becerra-Fernández E, Revenga M, Álvarez-Rivas N, Galisteo C, Sivera F, Olivé-Marqués A, Álvarez Del Buergo M, Marena-Rojas L, Fernández-López C, Navarro F, Raya E, Galindez-Agirregoikoa E, Arca B, Solans-Laqué R, Conesa A, Hidalgo C, Vázquez C, Román-Ivorra JA, Lluch P, Manrique-Arija S, Vela P, De Miguel E, Torres-Martín C, Nieto JC, Ordas-Calvo C, Salgado-Pérez E, Luna-Gomez C, Toyos-Sáenz de Miera FJ, Fernández-Llanio N, García A, Larena C, Palmou-Fontana N, Calvo-Río V, Prieto-Peña D, González-Vela C, Corrales A, Varela-García M, Aurrecoechea E, Dos Santos R, García-Manzanares Á, Ortego N, Fernández S, Ortiz-Sanjuán F, Corteguera M, Hernández JL, González-Gay MÁ, Blanco R. Tocilizumab in giant cell arteritis. Observational, open-label multicenter study of 134 patients in clinical practice. Semin Arthritis Rheum 2019; 49:126-135. [PMID: 30655091 DOI: 10.1016/j.semarthrit.2019.01.003] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 12/14/2018] [Accepted: 01/02/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Tocilizumab (TCZ) has shown efficacy in clinical trials on giant cell arteritis (GCA). Real-world data are scarce. Our objective was to assess efficacy and safety of TCZ in unselected patients with GCA in clinical practice Methods: Observational, open-label multicenter study from 40 national referral centers of GCA patients treated with TCZ due to inefficacy or adverse events of previous therapy. Outcomes variables were improvement of clinical features, acute phase reactants, glucocorticoid-sparing effect, prolonged remission and relapses. A comparative study was performed: (a) TCZ route (SC vs. IV); (b) GCA duration (≤6 vs. >6 months); (c) serious infections (with or without); (d) ≤15 vs. >15 mg/day at TCZ onset. RESULTS 134 patients; mean age, 73.0 ± 8.8 years. TCZ was started after a median [IQR] time from GCA diagnosis of 13.5 [5.0-33.5] months. Ninety-eight (73.1%) patients had received immunosuppressive agents. After 1 month of TCZ 93.9% experienced clinical improvement. Reduction of CRP from 1.7 [0.4-3.2] to 0.11 [0.05-0.5] mg/dL (p < 0.0001), ESR from 33 [14.5-61] to 6 [2-12] mm/1st hour (p < 0.0001) and decrease in patients with anemia from 16.4% to 3.8% (p < 0.0001) were observed. Regardless of administration route or disease duration, clinical improvement leading to remission at 6, 12, 18, 24 months was observed in 55.5%, 70.4%, 69.2% and 90% of patients. Most relevant adverse side-effect was serious infections (10.6/100 patients-year), associated with higher doses of prednisone during the first three months of therapy. CONCLUSION In clinical practice, TCZ yields a rapid and maintained improvement of refractory GCA. Serious infections appear to be higher than in clinical trials.
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Affiliation(s)
- Mónica Calderón-Goercke
- Departments of Rheumatology, Internal Medicine and Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Javier Loricera
- Departments of Rheumatology, Internal Medicine and Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Vicente Aldasoro
- Department of Rheumatology, Complejo Hospitalario de Navarra, Navarra, Spain
| | - Santos Castañeda
- Department of Rheumatology, Hospital Universitario de La Princesa, IIS-Princesa, Madrid, Spain
| | - Ignacio Villa
- Department of Rheumatology, Hospital de Sierrallana, Torrelavega, Spain
| | - Alicia Humbría
- Department of Rheumatology, Hospital Universitario de La Princesa, IIS-Princesa, Madrid, Spain
| | - Clara Moriano
- Department of Rheumatology, Complejo Asistencial Universitario de León, León, Spain
| | - Susana Romero-Yuste
- Department of Rheumatology, Complejo Hospitalario Universitario Pontevedra, Spain
| | - Javier Narváez
- Department of Rheumatology, Hospital de Bellvitge, Barcelona, Spain
| | | | - Eva Pérez-Pampín
- Department of Rheumatology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | - Rafael Melero
- Department of Rheumatology, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | | | | | | | - Carles Galisteo
- Department of Rheumatology, Hospital Parc Taulí, Barcelona, Spain
| | - Francisca Sivera
- Department of Rheumatology, Hospital Universitario de Elda, Alicante, Spain
| | | | | | - Luisa Marena-Rojas
- Department of Rheumatology, Hospital La Mancha Centro, Alcázar de San Juan, Spain
| | | | - Francisco Navarro
- Department of Rheumatology, Hospital General Universitario de Elche, Alicante, Spain
| | - Enrique Raya
- Department of Rheumatology and Internal Medicine, Hospital San Cecilio, Granada, Spain
| | | | - Beatriz Arca
- Department of Rheumatology, Hospital Universitario San Agustín, Avilés, Spain
| | - Roser Solans-Laqué
- Department of Internal Medicine, Hospital Valle de Hebrón, Barcelona, Spain
| | - Arantxa Conesa
- Department of Rheumatology, Hospital General Universitario de Castellón, Spain
| | - Cristina Hidalgo
- Department of Rheumatology, Complejo Asistencial Universitario de Salamanca, Spain
| | - Carlos Vázquez
- Department of Rheumatology, Hospital Miguel Servet, Zaragoza, Spain
| | | | - Pau Lluch
- Department of Rheumatology, Hospital Mateu Orfila, Menorca, Spain
| | | | - Paloma Vela
- Department of Rheumatology, Hospital General Universitario de Alicante, Alicante, Spain
| | | | | | - Juan Carlos Nieto
- Department of Rheumatology, Hospital Gregorio Marañón, Madrid, Spain
| | | | - Eva Salgado-Pérez
- Department of Rheumatology, Complejo Hospitalario Universitario de Ourense, Ourense, Spain
| | - Cristina Luna-Gomez
- Department of Rheumatology, Hospital Universitario Nuestra Señora de la Candelaria, Tenerife, Spain
| | | | | | - Antonio García
- Department of Rheumatology, Hospital Virgen de las Nieves, Granada, Spain
| | - Carmen Larena
- Department of Rheumatology, Hospital Ramón y Cajal, Madrid, Spain
| | - Natalia Palmou-Fontana
- Departments of Rheumatology, Internal Medicine and Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Vanesa Calvo-Río
- Departments of Rheumatology, Internal Medicine and Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Diana Prieto-Peña
- Departments of Rheumatology, Internal Medicine and Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Carmen González-Vela
- Departments of Rheumatology, Internal Medicine and Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Alfonso Corrales
- Departments of Rheumatology, Internal Medicine and Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | - María Varela-García
- Department of Rheumatology, Complejo Hospitalario de Navarra, Navarra, Spain
| | | | - Raquel Dos Santos
- Department of Rheumatology, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | | | - Norberto Ortego
- Department of Rheumatology and Internal Medicine, Hospital San Cecilio, Granada, Spain
| | - Sabela Fernández
- Department of Rheumatology, Hospital Universitario San Agustín, Avilés, Spain
| | | | | | - José L Hernández
- Departments of Rheumatology, Internal Medicine and Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Miguel Á González-Gay
- Departments of Rheumatology, Internal Medicine and Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain.
| | - Ricardo Blanco
- Departments of Rheumatology, Internal Medicine and Pathology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain.
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Silva-Fernández L, Otón T, Askanase A, Carreira P, López-Longo FJ, Olivé A, Rúa-Figueroa Í, Narváez J, Ruiz-Lucea E, Andrés M, Calvo E, Toyos F, Alegre-Sancho JJ, Tomero E, Montilla C, Zea A, Uriarte E, Calvo-Alén J, Marras C, Martínez-Taboada VM, Belmonte-López MÁ, Rosas J, Raya E, Bonilla G, Freire M, Pego-Reigosa JM, Millán I, Hughes-Morley A, Andreu JL. Pure Membranous Lupus Nephritis: Description of a Cohort of 150 Patients and Review of the Literature. ACTA ACUST UNITED AC 2019; 15:34-42. [DOI: 10.1016/j.reuma.2017.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 03/22/2017] [Accepted: 04/13/2017] [Indexed: 12/13/2022]
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26
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Cea-Calvo L, Raya E, Marras C, Salman-Monte TC, Ortiz A, Salvador G, Monteagudo I, Carmona L, Fernandez S, Arteaga MJ, Calvo-Alén J. Correction to: The beliefs of rheumatoid arthritis patients in their subcutaneous biological drug: strengths and areas of concern. Rheumatol Int 2018; 38:1741. [DOI: 10.1007/s00296-018-4113-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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González-Serna D, Ortiz-Fernández L, Vargas S, García A, Raya E, Fernández-Gutierrez B, López-Longo FJ, Balsa A, González-Álvaro I, Narvaez J, Gómez-Vaquero C, Sabio JM, García-Portales R, González-Escribano MF, Tolosa C, Carreira P, Kiemeney L, Coenen MJH, Witte T, Schneider M, González-Gay MÁ, Martín J. Association of a rare variant of the TNFSF13B gene with susceptibility to Rheumatoid Arthritis and Systemic Lupus Erythematosus. Sci Rep 2018; 8:8195. [PMID: 29844438 PMCID: PMC5974315 DOI: 10.1038/s41598-018-26573-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 05/14/2018] [Indexed: 12/29/2022] Open
Abstract
A rare variant (BAFF-var) of the tumor necrosis factor superfamily 13b (TNFSF13B) gene has been recently associated with multiple sclerosis (MS) and systemic lupus erythematosus (SLE). The aim of this study was to investigate the association between TNFSF13B BAFF-var and susceptibility to rheumatoid arthritis (RA) and replicate that association in SLE. 6,218 RA patients, 2,575 SLE patients and 4,403 healthy controls from three different countries were included in the study. TNFSF13B BAFF-var was genotyped using TaqMan allelic discrimination assay. PLINK software was used for statistical analyses. TNFSF13B BAFF-var was significantly associated with RA (p = 0.015, OR = 1.21, 95% CI = 1.03-1.41) in the Spanish cohort. A trend of association was observed in the Dutch (p = 0.115) and German (p = 0.228) RA cohorts. A meta-analysis of the three RA cohorts included in this study revealed a statistically significant association (p = 0.002, OR = 1.24, 95% CI = 1.10-1.38). In addition, TNFSF13B BAFF-var was significantly associated with SLE in the Spanish (p = 0.001, OR = 1.41, 95% CI = 1.14-1.74) and the German cohorts (p = 0.030, OR = 1.86, 95% CI = 1.05-3.28), with a statistically significant p-value obtained in the meta-analysis (p = 0.0002, OR = 1.46, 95% CI = 1.09-2.32). The results obtained confirm the known association of TNFSF13B BAFF-var with SLE and, for the first time, demonstrate that this variant contributes to susceptibility to RA.
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Affiliation(s)
| | | | - Sofía Vargas
- Institute of Parasitology and Biomedicine López-Neyra, CSIC, Granada, Spain
| | - Antonio García
- Rheumatology Department, Hospital Virgen de las Nieves, Granada, Spain
| | - Enrique Raya
- Systemic Autoimmune Diseases Unit, Hospital Campus de la Salud, Granada, Spain
| | | | | | - Alejandro Balsa
- Rheumatology Department, Instituto de Investigación Hospital Universitario La Paz (IDIPAZ), Madrid, Spain
| | - Isidoro González-Álvaro
- Rheumatology Department, Instituto de Investigación del Hospital de La Princesa (IIS-IP), Madrid, Spain
| | - Javier Narvaez
- Rheumatology Service, Hospital Universitario de Bellvitge, Barcelona, Spain
| | | | - José Mario Sabio
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, Hospital Virgen de las Nieves, Granada, Spain
| | | | | | - Carles Tolosa
- Department of Internal Medicine, Hospital Parc Taulí, Sabadell, Spain
| | - Patricia Carreira
- Rheumatology Service, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Lambertus Kiemeney
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands
| | - Marieke J H Coenen
- Department of Human Genetics, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands
| | - Torsten Witte
- Department for Clinical Immunology and Rheumatology, Hannover Medical School, Hannover, Germany
| | - Matthias Schneider
- Policlinic and Hiller Research Unit for Rheumatology, UKD, Heinrich-Heine-University Dusseldorf, Dusseldorf, Germany
| | - Miguel Ángel González-Gay
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases IDIVAL, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Javier Martín
- Institute of Parasitology and Biomedicine López-Neyra, CSIC, Granada, Spain.
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28
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Lopez-Rodriguez R, Perez-Pampin E, Marquez A, Blanco FJ, Joven B, Carreira P, Ferrer MA, Caliz R, Valor L, Narvaez J, Cañete JD, Ordoñez MDC, Manrique-Arija S, Vasilopoulos Y, Balsa A, Pascual-Salcedo D, Moreno-Ramos MJ, Alegre-Sancho JJ, Navarro-Sarabia F, Moreira V, Garcia-Portales R, Raya E, Magro-Checa C, Martin J, Gomez-Reino JJ, Gonzalez A. Validation study of genetic biomarkers of response to TNF inhibitors in rheumatoid arthritis. PLoS One 2018; 13:e0196793. [PMID: 29734345 PMCID: PMC5937760 DOI: 10.1371/journal.pone.0196793] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 04/19/2018] [Indexed: 11/19/2022] Open
Abstract
Genetic biomarkers are sought to personalize treatment of patients with rheumatoid arthritis (RA), given their variable response to TNF inhibitors (TNFi). However, no genetic biomaker is yet sufficiently validated. Here, we report a validation study of 18 previously reported genetic biomarkers, including 11 from GWAS of response to TNFi. The validation was attempted in 581 patients with RA that had not been treated with biologic antirheumatic drugs previously. Their response to TNFi was evaluated at 3, 6 and 12 months in two ways: change in the DAS28 measure of disease activity, and according to the EULAR criteria for response to antirheumatic drugs. Association of these parameters with the genotypes, obtained by PCR amplification followed by single-base extension, was tested with regression analysis. These analyses were adjusted for baseline DAS28, sex, and the specific TNFi. However, none of the proposed biomarkers was validated, as none showed association with response to TNFi in our study, even at the time of assessment and with the outcome that showed the most significant result in previous studies. These negative results are notable because this was the first independent validation study for 12 of the biomarkers, and because they indicate that prudence is needed in the interpretation of the proposed biomarkers of response to TNFi even when they are supported by very low p values. The results also emphasize the requirement of independent replication for validation, and the need to search protocols that could increase reproducibility of the biomarkers of response to TNFi.
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Affiliation(s)
- Rosario Lopez-Rodriguez
- Experimental and Observational Rheumatology and Rheumatology Unit, Instituto de Investigación Sanitaria, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
| | - Eva Perez-Pampin
- Experimental and Observational Rheumatology and Rheumatology Unit, Instituto de Investigación Sanitaria, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
| | - Ana Marquez
- Instituto de Parasitología y Biomedicina López-Neyra, CSIC, Granada, Spain
| | - Francisco J. Blanco
- Rheumatology Department, Instituto de Investigacion Biomedica–Complejo Hospitalario Universitario A Coruna, Coruna, Spain
| | | | | | - Miguel Angel Ferrer
- Rheumatology Unit, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Rafael Caliz
- Rheumatology Unit, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Lara Valor
- Rheumatology Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Javier Narvaez
- Department of Rheumatology, Hospital Universitario de Bellvitge, Barcelona, Spain
| | - Juan D. Cañete
- Arthritis Unit, Rheumatology Dpt, Hospital Clinic and IDIBAPS, Barcelona, Spain
| | - Maria del Carmen Ordoñez
- Servicio de Reumatología, HRU Carlos Haya, Universidad de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga Spain
| | - Sara Manrique-Arija
- Servicio de Reumatología, HRU Carlos Haya, Universidad de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga Spain
| | - Yiannis Vasilopoulos
- Department of Biochemistry and Biotechnology, University of Thessaly, Larissa, Greece
| | - Alejandro Balsa
- Rheumatology Unit, Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdiPAZ), Hospital Universitario La Paz, Madrid, Spain
| | - Dora Pascual-Salcedo
- Department of Immunology, Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
| | | | | | | | - Virginia Moreira
- Rheumatology Unit, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | - Enrique Raya
- Department of Rheumatology, Hospital Clínico San Cecilio, Granada, Spain
| | - Cesar Magro-Checa
- Department of Rheumatology, Hospital Clínico San Cecilio, Granada, Spain
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Javier Martin
- Instituto de Parasitología y Biomedicina López-Neyra, CSIC, Granada, Spain
| | - Juan J. Gomez-Reino
- Experimental and Observational Rheumatology and Rheumatology Unit, Instituto de Investigación Sanitaria, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
| | - Antonio Gonzalez
- Experimental and Observational Rheumatology and Rheumatology Unit, Instituto de Investigación Sanitaria, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
- * E-mail:
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29
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Marras C, Monteagudo I, Salvador G, de Toro FJ, Escudero A, Alegre-Sancho JJ, Raya E, Ortiz A, Carmona L, Mestre Y, Cea-Calvo L, Calvo-Alén J. Identification of patients at risk of non-adherence to oral antirheumatic drugs in rheumatoid arthritis using the Compliance Questionnaire in Rheumatology: an ARCO sub-study. Rheumatol Int 2017; 37:1195-1202. [PMID: 28516236 DOI: 10.1007/s00296-017-3737-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 05/05/2017] [Indexed: 11/25/2022]
Abstract
The ARCO study (Study on Adherence of Rheumatoid Arthritis patients to SubCutaneous and Oral Drugs), a multicenter, non-interventional retrospective study, was primarily designed to assess the percentage of patients [aged ≥18 years with an established rheumatoid arthritis (RA) diagnosis] with non-adherence to prescribed subcutaneous biologicals. This paper reports data for the secondary objective from a subset of patients, namely to evaluate non-adherence to prescribed oral antirheumatic drugs in RA patients in Spain using the validated Compliance Questionnaire Rheumatology (CQR). Patients also completed the Morisky-Green Medication Adherence Questionnaire, Beliefs about Medicines Questionnaire, and a questionnaire (developed and validated in Spain) on patient satisfaction with RA treatment and preferences. A total of 271 patients (76.7% females; mean age 55.6 years) were being treated with oral drugs for RA, of which 234 completed the CQR questionnaire. Non-adherence was reported in 49/234 (20.9%) patients. The proportion of non-adherence in younger patients (aged ≤48 years; 37.5%) was double that recorded in patients aged >48 years (p = 0.006). Patients with a perception of lower efficacy also had a higher risk of non-adherence (p = 0.012). Multivariable analysis showed that younger age and male gender were independently associated with risk of non-adherence. There was only slight agreement between the CQR and Morisky-Green assessment tools (kappa coefficient = 0.186), possibly reflecting the fact that both questionnaires measure slightly different aspects of medication adherence. In conclusion, one out of five RA patients was identified as at risk for non-adherence with the CQR, and this was more frequent in younger patients and in males.
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Affiliation(s)
- Carlos Marras
- Hospital Universitario Virgen de Arrixaca, Calle Polideportivo, 5, 30120, Murcia, Spain.
| | | | | | | | | | | | - Enrique Raya
- Hospital Universitario San Cecilio, Granada, Spain
| | - Ana Ortiz
- Hospital Universitario La Princesa, IIS La Princesa, Madrid, Spain
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30
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Calvo-Alén J, Monteagudo I, Salvador G, Vázquez-Rodríguez TR, Tovar-Beltrán JV, Vela P, Maceiras F, Bustabad S, Román-Ivorra JA, Díaz-Miguel C, Rosas J, Raya E, Carmona L, Cea-Calvo L, Arteaga MJ, Fernández S, Marras C. Non-adherence to subcutaneous biological medication in patients with rheumatoid arthritis: a multicentre, non-interventional study. Clin Exp Rheumatol 2017; 35:423-430. [PMID: 28032846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 09/29/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To evaluate non-adherence to prescribed subcutaneous biologicals in rheumatoid arthritis (RA) patients in Spain. METHODS ARCO (Study on Adherence of Rheumatoid Arthritis patients to SubCutaneous and Oral Drugs) was a multicentre, non-interventional retrospective study involving 42 rheumatology clinics from representative hospitals throughout Spain. The primary objective was to assess the percentage of patients (aged ≥18 years with an established RA diagnosis) with non-adherence to prescribed subcutaneous biologicals using clinical records and hospital pharmacy dispensing logs as the primary information sources. Adherence was assessed using the Medication Possession Ratio (MPR). Additionally, patients completed the Morisky-Green Medication Adherence Questionnaire. RESULTS A total of 364 patients (77.5% females, mean age 54.9 years, median RA duration since diagnosis 7.8 years) were enrolled in ARCO. Non-adherence (MPR ≤80%) was reported in 52/363 evaluable patients (14.3%), and was lower in patients receiving initial monthly drug administration (6.4%) than with weekly (17.4%; p=0.034) or every two weeks (14.4%; p=0.102) administration. By multivariate analysis, non-adherence was positively associated with RA duration above the median and with using induction doses. Monthly administration, compared to weekly administration, was inversely associated with non-adherence. Age, gender, order of administration, and changes in the interval of administration, showed no association with non-adherence. Compared with the MPR, the Morisky-Green questionnaire performed poorly in detecting non-adherence. CONCLUSIONS Non-adherence to the prescribed subcutaneous biological drug occurred in 14.3% of patients with RA. Patients using the most convenient administration period (i.e. monthly) had better adherence than those using more frequent dosing schedules.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - José Rosas
- Hospital Marina Baixa, Villajoyosa, Alicante, Spain
| | - Enrique Raya
- Hospital Universitario San Cecilio de Granada, Spain
| | | | | | | | | | - Carlos Marras
- Hospital Universitario Virgen de Arrixaca, Murcia, Spain
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31
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Rúa-Figueroa Í, López-Longo J, Galindo-Izquierdo M, Calvo-Alén J, Del Campo V, Olivé-Marqués A, Pérez-Vicente S, Fernández-Nebro A, Andrés M, Erausquin C, Tomero E, Horcada L, Uriarte E, Freire M, Montilla C, Sánchez-Atrio A, Santos G, Boteanu A, Díez-Álvarez E, Narváez J, Martínez-Taboada V, Silva-Fernández L, Ruiz-Lucea E, Andreu JL, Hernández-Beriain JÁ, Gantes M, Hernández-Cruz B, Pérez-Venegas J, Pecondón-Español Á, Marras C, Ibáñez-Barceló M, Bonilla G, Torrente V, Castellví I, Alegre JJ, Calvet J, Marenco JL, Raya E, Vázquez T, Quevedo V, Muñoz-Fernández S, Rodríguez-Gómez M, Ibáñez J, Pego-Reigosa JM. Incidence, associated factors and clinical impact of severe infections in a large, multicentric cohort of patients with systemic lupus erythematosus. Semin Arthritis Rheum 2017; 47:38-45. [PMID: 28259425 DOI: 10.1016/j.semarthrit.2017.01.010] [Citation(s) in RCA: 104] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Revised: 01/16/2017] [Accepted: 01/23/2017] [Indexed: 01/25/2023]
Abstract
OBJECTIVES To estimate the incidence of severe infection and investigate the associated factors and clinical impact in a large systemic lupus erythematosus (SLE) retrospective cohort. METHODS All patients in the Spanish Rheumatology Society Lupus Registry (RELESSER) who meet ≥4 ACR-97 SLE criteria were retrospectively investigated for severe infections. Patients with and without infections were compared in terms of SLE severity, damage, comorbidities, and demographic characteristics. A multivariable Cox regression model was built to calculate hazard ratios (HRs) for the first infection. RESULTS A total of 3658 SLE patients were included: 90% female, median age 32.9 years (DQ 9.7), and mean follow-up (months) 120.2 (±87.6). A total of 705 (19.3%) patients suffered ≥1 severe infection. Total severe infections recorded in these patients numbered 1227. The incidence rate was 29.2 (95% CI: 27.6-30.9) infections per 1000 patient years. Time from first infection to second infection was significantly shorter than time from diagnosis to first infection (p < 0.000). Although respiratory infections were the most common (35.5%), bloodstream infections were the most frequent cause of mortality by infection (42.0%). In the Cox regression analysis, the following were all associated with infection: age at diagnosis (HR = 1.016, 95% CI: 1.009-1.023), Latin-American (Amerindian-Mestizo) ethnicity (HR = 2.151, 95% CI: 1.539-3.005), corticosteroids (≥10mg/day) (HR = 1.271, 95% CI: 1.034-1.561), immunosuppressors (HR = 1.348, 95% CI: 1.079-1.684), hospitalization by SLE (HR = 2.567, 95% CI: 1.905-3.459), Katz severity index (HR = 1.160, 95% CI: 1.105-1.217), SLICC/ACR damage index (HR = 1.069, 95% CI: 1.031-1.108), and smoking (HR = 1.332, 95% CI: 1.121-1.583). Duration of antimalarial use (months) proved protective (HR = 0.998, 95% CI: 0.997-0.999). CONCLUSIONS Severe infection constitutes a predictor of poor prognosis in SLE patients, is more common in Latin-Americans and is associated with age, previous infection, and smoking. Antimalarials exerted a protective effect.
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Affiliation(s)
- Íñigo Rúa-Figueroa
- Rheumatology Department, Doctor Negrín University Hospital Las Palmas de Gran Canaria, Bco. de la Ballena s/n, 35020 Las Palmas, Spain.
| | - Javier López-Longo
- Rheumatology Department, Gregorio Marañón University Hospital, Madrid, Spain
| | | | - Jaime Calvo-Alén
- Rheumatology Department, Sierrallana Hospital, Torrelavega, Spain
| | - Víctor Del Campo
- Preventive Medicine Service, Biomedical Research Institute of Vigo (IBIV), University Hospital Complex of Vigo, Vigo, Spain
| | | | - Sabina Pérez-Vicente
- Statistical Department, Research Unit, Spanish Society of Rheumatology (SER), Madrid, Spain
| | | | - Mariano Andrés
- Rheumatology Department, Hospital of Alicante, Alicante, Spain
| | - Celia Erausquin
- Rheumatology Department, Doctor Negrín University Hospital Las Palmas de Gran Canaria, Bco. de la Ballena s/n, 35020 Las Palmas, Spain
| | - Eva Tomero
- Rheumatology Department, La Princesa University Hospital, Madrid, Spain
| | - Loreto Horcada
- Rheumatology Department, Hospital of Navarra, Pamplona, Spain
| | - Esther Uriarte
- Rheumatology Department, Donostia Hospital, Donostia, Guipuzcoa, Spain
| | - Mercedes Freire
- Rheumatology Department, University Hospital Complex of A Coruña, A Coruña, Spain
| | - Carlos Montilla
- Rheumatology Department, Salamanca University Hospital, Salamanca, Spain
| | - Ana Sánchez-Atrio
- System Diseases and Oncology Service, Príncipe de Asturias University Hospital Alcalá de Henares, Madrid, Spain
| | - Gregorio Santos
- Rheumatology Department, Marina Baixa Hospital, Alicante, Spain
| | - Alina Boteanu
- Rheumatology Department, Ramon y Cajal University Hospital, Madrid, Spain
| | | | - Javier Narváez
- Rheumatology Department, Bellvitge Hospital, Barcelona, Spain
| | | | | | | | - José Luis Andreu
- Rheumatology Department, Puerta de Hierro-Majadahonda Hospital, Madrid, Spain
| | | | - Marian Gantes
- Rheumatology Department, University Hospital of Canarias, Tenerife, Spain
| | | | - José Pérez-Venegas
- Rheumatology Department, Jerez de la Frontera University Hospital, Cádiz, Spain
| | | | - Carlos Marras
- Rheumatology Department, Virgen de la Arrixaca University Hospital, Murcia, Spain
| | | | - Gema Bonilla
- Rheumatology Department, La Paz University Hospital, Madrid, Spain
| | - Vicente Torrente
- Rheumatology Department, Hospital of Hospitalet-Moisés Broggi CSI, Barcelona, Spain
| | - Iván Castellví
- Rheumatology Unit, Santa Creu i Sant Pau Hospital, Barcelona, Spain
| | | | - Joan Calvet
- Rheumatology Department, Parc Taulí Hospital, Barcelona, Spain
| | - Jose Luis Marenco
- Rheumatology Department, Virgen de Valme University Hospital, Sevilla, Spain
| | - Enrique Raya
- Rheumatology Department, San Cecilio Hospital, Granada, Spain
| | - Tomás Vázquez
- Rheumatology Department, Lucus Augusti Hospital, Lugo, Spain
| | | | | | | | - Jesús Ibáñez
- Rheumatology Unit, POVISA Medical Center, Vigo, Spain
| | - José M Pego-Reigosa
- Rheumatology Department, Biomedical Research Institute of Vigo (IBIV), University Hospital Complex of Vigo, Vigo, Spain
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López-Mejías R, Corrales A, Vicente E, Robustillo-Villarino M, González-Juanatey C, Llorca J, Genre F, Remuzgo-Martínez S, Dierssen-Sotos T, Miranda-Filloy JA, Huaranga MAR, Pina T, Blanco R, Alegre-Sancho JJ, Raya E, Mijares V, Ubilla B, Ferraz-Amaro I, Gómez-Vaquero C, Balsa A, López-Longo FJ, Carreira P, González-Álvaro I, Ocejo-Vinyals JG, Rodríguez-Rodríguez L, Fernández-Gutiérrez B, Castañeda S, Martín J, González-Gay MA. Influence of coronary artery disease and subclinical atherosclerosis related polymorphisms on the risk of atherosclerosis in rheumatoid arthritis. Sci Rep 2017; 7:40303. [PMID: 28059143 PMCID: PMC5216400 DOI: 10.1038/srep40303] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 12/05/2016] [Indexed: 11/09/2022] Open
Abstract
A genetic component influences the development of atherosclerosis in the general population and also in rheumatoid arthritis (RA). However, genetic polymorphisms associated with atherosclerosis in the general population are not always involved in the development of cardiovascular disease (CVD) in RA. Accordingly, a study in North-American RA patients did not show the association reported in the general population of coronary artery disease with a series of relevant polymorphisms (TCF21, LPA, HHIPL1, RASD1-PEMT, MRPS6, CYP17A1-CNNM2-NT5C2, SMG6-SRR, PHACTR1, WDR12 and COL4A1-COL4A2). In the present study, we assessed the potential association of these polymorphisms with CVD in Southern European RA patients. We also assessed if polymorphisms implicated in the increased risk of subclinical atherosclerosis in non-rheumatic Caucasians (ZHX2, PINX1, SLC17A4, LRIG1 and LDLR) may influence the risk for CVD in RA. 2,609 Spanish patients were genotyped by TaqMan assays. Subclinical atherosclerosis was determined in 1,258 of them by carotid ultrasonography (assessment of carotid intima media thickness and presence/absence of carotid plaques). No statistically significant differences were found when each polymorphism was assessed according to the presence/absence of cardiovascular events and subclinical atherosclerosis, after adjustment for potential confounder factors. Our results do not show an association between these 15 polymorphisms and atherosclerosis in RA.
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Affiliation(s)
- Raquel López-Mejías
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology Department, IDIVAL, Santander, Spain
| | - Alfonso Corrales
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology Department, IDIVAL, Santander, Spain
| | - Esther Vicente
- Rheumatology Department, Hospital Universitario la Princesa, IIS-IP, Madrid, Spain
| | | | | | - Javier Llorca
- Department of Epidemiology and Computational Biology, School of Medicine, University of Cantabria, and CIBER Epidemiología y Salud Pública (CIBERESP), IDIVAL, Santander, Spain
| | - Fernanda Genre
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology Department, IDIVAL, Santander, Spain
| | - Sara Remuzgo-Martínez
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology Department, IDIVAL, Santander, Spain
| | - Trinidad Dierssen-Sotos
- Department of Epidemiology and Computational Biology, School of Medicine, University of Cantabria, and CIBER Epidemiología y Salud Pública (CIBERESP), IDIVAL, Santander, Spain
| | | | | | - Trinitario Pina
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology Department, IDIVAL, Santander, Spain
| | - Ricardo Blanco
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology Department, IDIVAL, Santander, Spain
| | | | - Enrique Raya
- Rheumatology Department, Hospital Clínico San Cecilio, Granada, Spain
| | - Verónica Mijares
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology Department, IDIVAL, Santander, Spain
| | - Begoña Ubilla
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology Department, IDIVAL, Santander, Spain
| | - Iván Ferraz-Amaro
- Rheumatology Division, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | | | - Alejandro Balsa
- Department of Rheumatology, Hospital Universitario La Paz, Madrid, Spain
| | | | - Patricia Carreira
- Department of Rheumatology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | | | | | | | - Santos Castañeda
- Rheumatology Department, Hospital Universitario la Princesa, IIS-IP, Madrid, Spain
| | - Javier Martín
- Instituto de Parasitología y Biomedicina 'López-Neyra', CSIC, PTS Granada, Granada, Spain
| | - Miguel A González-Gay
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology Department, IDIVAL, Santander, Spain.,School of Medicine, University of Cantabria, Santander, Spain.,Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Carmona FD, Vaglio A, Mackie SL, Hernández-Rodríguez J, Monach PA, Castañeda S, Solans R, Morado IC, Narváez J, Ramentol-Sintas M, Pease CT, Dasgupta B, Watts R, Khalidi N, Langford CA, Ytterberg S, Boiardi L, Beretta L, Govoni M, Emmi G, Bonatti F, Cimmino MA, Witte T, Neumann T, Holle J, Schönau V, Sailler L, Papo T, Haroche J, Mahr A, Mouthon L, Molberg Ø, Diamantopoulos AP, Voskuyl A, Brouwer E, Daikeler T, Berger CT, Molloy ES, O’Neill L, Blockmans D, Lie BA, Mclaren P, Vyse TJ, Wijmenga C, Allanore Y, Koeleman BP, Barrett JH, Cid MC, Salvarani C, Merkel PA, Morgan AW, González-Gay MA, Martín J, Callejas JL, Caminal-Montero L, Corbera-Bellalta M, de Miguel E, López JBD, García-Villanueva MJ, Gómez-Vaquero C, Guijarro-Rojas M, Hidalgo-Conde A, Marí-Alfonso B, Berriochoa AM, Zapico AM, Martínez-Taboada VM, Miranda-Filloy JA, Monfort J, Ortego-Centeno N, Pérez-Conesa M, Prieto-González S, Raya E, Fernández RR, Sánchez-Martín J, Sopeña B, Tío L, Unzurrunzaga A, Gough A, Isaacs JD, Green M, McHugh N, Hordon L, Kamath S, Nisar M, Patel Y, Yee CS, Stevens R, Nandi P, Nandagudi A, Jarrett S, Li C, Levy S, Mollan S, Salih A, Wordsworth O, Sanders E, Roads E, Gill A, Carr L, Routledge C, Culfear K, Nugaliyadde A, James L, Spimpolo J, Kempa A, Mackenzie F, Fong R, Peters G, Rowbotham B, Masqood Z, Hollywood J, Gondo P, Wood R, Martin S, Rashid LH, Robinson JI, Morgan M, Sorensen L, Taylor J, Carette S, Chung S, Cuthbertson D, Forbess LJ, Gewurz-Singer O, Hoffman GS, Koening CL, Maksimowicz-McKinnon KM, McAlear CA, Moreland LW, Pagnoux C, Seo P, Specks U, Spiera RF, Sreih A, Warrington KJ, Weisman M. A Genome-wide Association Study Identifies Risk Alleles in Plasminogen and P4HA2 Associated with Giant Cell Arteritis. Am J Hum Genet 2017; 100:64-74. [PMID: 28041642 DOI: 10.1016/j.ajhg.2016.11.013] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 11/18/2016] [Indexed: 02/07/2023] Open
Abstract
Giant cell arteritis (GCA) is the most common form of vasculitis in individuals older than 50 years in Western countries. To shed light onto the genetic background influencing susceptibility for GCA, we performed a genome-wide association screening in a well-powered study cohort. After imputation, 1,844,133 genetic variants were analyzed in 2,134 case subjects and 9,125 unaffected individuals from ten independent populations of European ancestry. Our data confirmed HLA class II as the strongest associated region (independent signals: rs9268905, p = 1.94 × 10-54, per-allele OR = 1.79; and rs9275592, p = 1.14 × 10-40, OR = 2.08). Additionally, PLG and P4HA2 were identified as GCA risk genes at the genome-wide level of significance (rs4252134, p = 1.23 × 10-10, OR = 1.28; and rs128738, p = 4.60 × 10-9, OR = 1.32, respectively). Interestingly, we observed that the association peaks overlapped with different regulatory elements related to cell types and tissues involved in the pathophysiology of GCA. PLG and P4HA2 are involved in vascular remodelling and angiogenesis, suggesting a high relevance of these processes for the pathogenic mechanisms underlying this type of vasculitis.
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López-Mejías R, Genre F, Remuzgo-Martínez S, González-Juanatey C, Robustillo-Villarino M, Llorca J, Corrales A, Vicente E, Miranda-Filloy JA, Magro C, Tejera-Segura B, Ramírez Huaranga MA, Pina T, Blanco R, Alegre-Sancho JJ, Raya E, Mijares V, Ubilla B, Mínguez Sánchez MD, Gómez-Vaquero C, Balsa A, Pascual-Salcedo D, López-Longo FJ, Carreira P, González-Álvaro I, Rodríguez-Rodríguez L, Fernández-Gutiérrez B, Ferraz-Amaro I, Castañeda S, Martín J, González-Gay MA. Influence of elevated-CRP level-related polymorphisms in non-rheumatic Caucasians on the risk of subclinical atherosclerosis and cardiovascular disease in rheumatoid arthritis. Sci Rep 2016; 6:31979. [PMID: 27534721 PMCID: PMC4989194 DOI: 10.1038/srep31979] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 08/01/2016] [Indexed: 12/30/2022] Open
Abstract
Association between elevated C-reactive protein (CRP) serum levels and subclinical atherosclerosis and cardiovascular (CV) events was described in rheumatoid arthritis (RA). CRP, HNF1A, LEPR, GCKR, NLRP3, IL1F10, PPP1R3B, ASCL1, HNF4A and SALL1 exert an influence on elevated CRP serum levels in non-rheumatic Caucasians. Consequently, we evaluated the potential role of these genes in the development of CV events and subclinical atherosclerosis in RA patients. Three tag CRP polymorphisms and HNF1A, LEPR, GCKR, NLRP3, IL1F10, PPP1R3B, ASCL1, HNF4A and SALL1 were genotyped in 2,313 Spanish patients by TaqMan. Subclinical atherosclerosis was determined in 1,298 of them by carotid ultrasonography (by assessment of carotid intima-media thickness-cIMT-and presence/absence of carotid plaques). CRP serum levels at diagnosis and at the time of carotid ultrasonography were measured in 1,662 and 1,193 patients, respectively, by immunoturbidimetry. Interestingly, a relationship between CRP and CRP serum levels at diagnosis and at the time of the carotid ultrasonography was disclosed. However, no statistically significant differences were found when CRP, HNF1A, LEPR, GCKR, NLRP3, IL1F10, PPP1R3B, ASCL1, HNF4A and SALL1 were evaluated according to the presence/absence of CV events, carotid plaques and cIMT after adjustment. Our results do not confirm an association between these genes and CV disease in RA.
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Affiliation(s)
- Raquel López-Mejías
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Division of Rheumatology, IDIVAL, Santander, Spain
| | - Fernanda Genre
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Division of Rheumatology, IDIVAL, Santander, Spain
| | - Sara Remuzgo-Martínez
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Division of Rheumatology, IDIVAL, Santander, Spain
| | | | | | - Javier Llorca
- Department of Epidemiology and Computational Biology, School of Medicine, University of Cantabria, and CIBER Epidemiología y Salud Pública (CIBERESP), IDIVAL, Santander, Spain
| | - Alfonso Corrales
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Division of Rheumatology, IDIVAL, Santander, Spain
| | - Esther Vicente
- Division of Rheumatology, Hospital Universitario la Princesa, IIS-IPrincesa, Madrid, Spain
| | | | - César Magro
- Division of Rheumatology, Hospital Clínico San Cecilio, Granada, Spain
| | - Beatriz Tejera-Segura
- Rheumatology Division, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | | | - Trinitario Pina
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Division of Rheumatology, IDIVAL, Santander, Spain
| | - Ricardo Blanco
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Division of Rheumatology, IDIVAL, Santander, Spain
| | | | - Enrique Raya
- Division of Rheumatology, Hospital Clínico San Cecilio, Granada, Spain
| | - Verónica Mijares
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Division of Rheumatology, IDIVAL, Santander, Spain
| | - Begoña Ubilla
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Division of Rheumatology, IDIVAL, Santander, Spain
| | | | | | - Alejandro Balsa
- Department of Rheumatology, Hospital Universitario La Paz, Madrid, Spain
| | | | | | - Patricia Carreira
- Department of Rheumatology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | | | | | - Iván Ferraz-Amaro
- Rheumatology Division, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - Santos Castañeda
- Division of Rheumatology, Hospital Universitario la Princesa, IIS-IPrincesa, Madrid, Spain
| | - Javier Martín
- Institute of Parasitology and Biomedicine López-Neyra, IPBLN-CSIC, Granada, Spain
| | - Miguel A González-Gay
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Division of Rheumatology, IDIVAL, Santander, Spain.,School of Medicine, University of Cantabria, Santander, Spain.,Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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García-Rodríguez S, Arias-Santiago S, Blasco-Morente G, Orgaz-Molina J, Rosal-Vela A, Navarro P, Magro-Checa C, Martínez-López A, Ruiz JC, Raya E, Naranjo-Sintes R, Sancho J, Zubiaur M. Increased expression of microRNA-155 in peripheral blood mononuclear cells from psoriasis patients is related to disease activity. J Eur Acad Dermatol Venereol 2016; 31:312-322. [DOI: 10.1111/jdv.13861] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 06/10/2016] [Indexed: 12/11/2022]
Affiliation(s)
- S. García-Rodríguez
- Department of Cellular Biology and Immunology; Instituto de Parasitología y Biomedicina López-Neyra, IPBLN-CSIC, Parque Tecnológico de la Salud de Granada (PTS Granada); Av. Conocimiento, 17, Granada-18016 Spain
| | - S. Arias-Santiago
- Department of Dermatology; Instituto de Investigación Biosanitaria de Granada, “ibs.GRANADA”, Hospitales Universitarios de Granada (H. U. Granada)/Universidad de Granada (UGR); Granada Spain
| | - G. Blasco-Morente
- Department of Dermatology; Instituto de Investigación Biosanitaria de Granada, “ibs.GRANADA”, Hospitales Universitarios de Granada (H. U. Granada)/Universidad de Granada (UGR); Granada Spain
| | - J. Orgaz-Molina
- Department of Dermatology; Instituto de Investigación Biosanitaria de Granada, “ibs.GRANADA”, Hospitales Universitarios de Granada (H. U. Granada)/Universidad de Granada (UGR); Granada Spain
| | - A. Rosal-Vela
- Department of Cellular Biology and Immunology; Instituto de Parasitología y Biomedicina López-Neyra, IPBLN-CSIC, Parque Tecnológico de la Salud de Granada (PTS Granada); Av. Conocimiento, 17, Granada-18016 Spain
| | - P. Navarro
- Department of Cellular Biology and Immunology; Instituto de Parasitología y Biomedicina López-Neyra, IPBLN-CSIC, Parque Tecnológico de la Salud de Granada (PTS Granada); Av. Conocimiento, 17, Granada-18016 Spain
| | - C. Magro-Checa
- Department of Rheumatology; Instituto de Investigación Biosanitaria de Granada, “ibs.GRANADA”, Hospitales Universitarios de Granada (H. U. Granada)/Universidad de Granada (UGR); Granada Spain
| | - A. Martínez-López
- Department of Dermatology; Instituto de Investigación Biosanitaria de Granada, “ibs.GRANADA”, Hospitales Universitarios de Granada (H. U. Granada)/Universidad de Granada (UGR); Granada Spain
| | - J.-C. Ruiz
- Department of Dermatology; Instituto de Investigación Biosanitaria de Granada, “ibs.GRANADA”, Hospitales Universitarios de Granada (H. U. Granada)/Universidad de Granada (UGR); Granada Spain
| | - E. Raya
- Department of Rheumatology; Instituto de Investigación Biosanitaria de Granada, “ibs.GRANADA”, Hospitales Universitarios de Granada (H. U. Granada)/Universidad de Granada (UGR); Granada Spain
| | - R. Naranjo-Sintes
- Department of Dermatology; Instituto de Investigación Biosanitaria de Granada, “ibs.GRANADA”, Hospitales Universitarios de Granada (H. U. Granada)/Universidad de Granada (UGR); Granada Spain
| | - J. Sancho
- Department of Cellular Biology and Immunology; Instituto de Parasitología y Biomedicina López-Neyra, IPBLN-CSIC, Parque Tecnológico de la Salud de Granada (PTS Granada); Av. Conocimiento, 17, Granada-18016 Spain
| | - M. Zubiaur
- Department of Cellular Biology and Immunology; Instituto de Parasitología y Biomedicina López-Neyra, IPBLN-CSIC, Parque Tecnológico de la Salud de Granada (PTS Granada); Av. Conocimiento, 17, Granada-18016 Spain
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Lopez-Mejías R, Genre F, Remuzgo-Martínez S, Robustillo-Villarino M, Ubilla B, Llorca J, Mijares V, Corrales A, González-Juanatey C, Miranda-Filloy J, Pina T, Blanco R, Vicente E, Alegre-Sancho J, Magro C, Raya E, Tejera-Segura B, Ramírez Huaranga M, Gόmez-Vaquero C, Balsa A, Pascual-Salcedo D, Lόpez-Longo F, Carreira P, González-Άlvaro I, Rodríguez-Rodríguez L, Fernández-Gutiérrez B, Ferraz-Amaro I, Castañeda S, Martín J, González-Gay M. SAT0016 Role of PCR, GCKR, HNF1A, LEPR, ASCL1 and NLRP3 in Atherosclerosis in Patients with Rheumatoid Arthritis. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.2654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Genre F, Lόpez-Mejías R, Remuzgo-Martínez S, Robustillo-Villarino M, Castañeda S, González-Juanatey C, Llorca J, Corrales A, Ubilla B, Mijares V, Miranda-Filloy J, Pina T, Gόmez-Vaquero C, Rodríguez-Rodríguez L, Fernández-Gutiérrez B, Balsa A, Pascual-Salcedo D, Lόpez-Longo F, Carreira P, Blanco R, González-Άlvaro I, Alegre-Sancho J, Magro C, Raya E, Martín J, González-Gay M. SAT0008 Il-17a Gene Implication in spanish Patients with Rheumatoid Arthritis. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.2690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Pego-Reigosa JM, Lois-Iglesias A, Rúa-Figueroa Í, Galindo M, Calvo-Alén J, de Uña-Álvarez J, Balboa-Barreiro V, Ibáñez Ruan J, Olivé A, Rodríguez-Gómez M, Fernández Nebro A, Andrés M, Erausquin C, Tomero E, Horcada Rubio L, Uriarte Isacelaya E, Freire M, Montilla C, Sánchez-Atrio AI, Santos-Soler G, Zea A, Díez E, Narváez J, Blanco-Alonso R, Silva-Fernández L, Ruiz-Lucea ME, Fernández-Castro M, Hernández-Beriain JÁ, Gantes-Mora M, Hernández-Cruz B, Pérez-Venegas J, Pecondón-Español Á, Marras Fernández-Cid C, Ibáñez-Barcelo M, Bonilla G, Torrente-Segarra V, Castellví I, Alegre JJ, Calvet J, Marenco de la Fuente JL, Raya E, Vázquez-Rodríguez TR, Quevedo-Vila V, Muñoz-Fernández S, Otón T, Rahman A, López-Longo FJ. Relationship between damage clustering and mortality in systemic lupus erythematosus in early and late stages of the disease: cluster analyses in a large cohort from the Spanish Society of Rheumatology Lupus Registry. Rheumatology (Oxford) 2016; 55:1243-50. [DOI: 10.1093/rheumatology/kew049] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Indexed: 02/01/2023] Open
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Galindo-Izquierdo M, Rodriguez-Almaraz E, Pego-Reigosa JM, López-Longo FJ, Calvo-Alén J, Olivé A, Fernández-Nebro A, Martinez-Taboada V, Vela-Casasempere P, Freire M, Narváez FJ, Rosas J, Ibáñez-Barceló M, Uriarte E, Tomero E, Zea A, Horcada L, Torrente V, Castellvi I, Calvet J, Menor-Almagro R, Zamorano MAA, Raya E, Díez-Álvarez E, Vázquez-Rodríguez T, García de la Peña P, Movasat A, Andreu JL, Richi P, Marras C, Montilla-Morales C, Hernández-Cruz B, Marenco de la Fuente JL, Gantes M, Úcar E, Alegre-Sancho JJ, Manero J, Ibáñez-Ruán J, Rodríguez-Gómez M, Quevedo V, Hernández-Beriaín J, Silva-Fernández L, Alonso F, Pérez S, Rúa-Figueroa I. Characterization of Patients With Lupus Nephritis Included in a Large Cohort From the Spanish Society of Rheumatology Registry of Patients With Systemic Lupus Erythematosus (RELESSER). Medicine (Baltimore) 2016; 95:e2891. [PMID: 26945378 PMCID: PMC4782862 DOI: 10.1097/md.0000000000002891] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The aim of the study was to profile those patients included in the RELESSER registry with histologically proven renal involvement in order to better understand the current state of lupus nephritis (LN) in Spain. RELESSER-TRANS is a multicenter cross-sectional registry with an analytical component. Information was collected from the medical records of patients with systemic lupus erythematosus who were followed at participating rheumatology units. A total of 359 variables including demographic data, clinical manifestations, disease activity, severity, comorbidities, LN outcome, treatments, and mortality were recorded. Only patients with a histological confirmation of LN were included. We performed a descriptive analysis, chi-square or Student's t tests according to the type of variable and its relationship with LN. Odds ratio and confidence intervals were calculated by using simple logistic regression. LN was histologically confirmed in 1092/3575 patients (30.5%). Most patients were female (85.7%), Caucasian (90.2%), and the mean age at LN diagnosis was 28.4 ± 12.7 years. The risk for LN development was higher in men (M/F:47.85/30.91%, P < 0.001), in younger individuals (P < 0.001), and in Hispanics (P = 0.03). Complete response to treatment was achieved in 68.3% of patients; 10.35% developed ESRD, which required a kidney transplant in 45% of such cases. The older the patient, the greater was the likelihood of complete response (P < 0.001). Recurrences were associated with persistent lupus activity at the time of the last visit (P < 0.001) and with ESRD (P < 0.001). Thrombotic microangiopathy was a risk factor for ESRD (P = 0.04), as for the necessity of dialysis (P = 0.01) or renal transplantation (P = 0.03). LN itself was a poor prognostic risk factor of mortality (OR 2.4 [1.81-3.22], P < 0.001). Patients receiving antimalarials had a significantly lower risk of developing LN (P < 0.001) and ESRD (P < 0.001), and responded better to specific treatments for LN (P = 0.014). More than two-thirds of the patients with LN from a wide European cohort achieved a complete response to treatment. The presence of positive anti-Sm antibodies was associated with a higher frequency of LN and a decreased rate of complete response to treatment. The use of antimalarials reduced both the risk of developing renal disease and its severity, and contributed to attaining a complete renal response.
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Affiliation(s)
- María Galindo-Izquierdo
- From the Rheumatology Department, Hospital 12 Octubre, Madrid (MG-I, ER-A); Rheumatology (JMP-R), University Hospital Complex, Instituto de Investigación Biomédica, Vigo, Spain; Rheumatology Department (FJL-L), Gregorio Marañón University Hospital, Madrid; Rheumatology Department (JC-A), Sierrallana Hospital, Torrelavega; Rheumatology Department (AO), Germans Trías i Pujol University Hospital, Badalona; Rheumatology Department (AF-N), Hospital Regional Universitario de Málaga, Málaga; Rheumatology Department (VM-T), Marques de Valdecilla Hospital, Santander; Rheumatology Department (PV-C), Hospital General de Alicante, Alicante; Rheumatology Department (MF), Hospital Universitario Juan Canalejo, Coruña; Rheumatology Department (FJN), Hospital Universitario de Bellvitge, Barcelona; Rheumatology Department (JR), Hospital Marina Baixa, Villajoyosa; Rheumatology Department (MI-B), Hospital Son Llatzer, Palma de Mallorca; Rheumatology Department (EU), Hospital de Donosti, San Sebastián; Rheumatology Department (ET), Hospital Universitario de La Princesa; Rheumatology Department (AZ), Hospital Universitario Ramón y Cajal, Madrid; Rheumatology Department (LH), Complejo Hospitalario de Navarra, Pamplona; Rheumatology Department (VT), Hospital Moisés Broggi; Rheumatology Department (IC), Hospital de la Santa Creu i Sant Pau, Barcelona; Rheumatology Department (JC), Hospital Parc Taulí. Sabadell; Rheumatology Department (RM-A), Hospital de Jerez, Jerez de la Frontera; Rheumatology Department (MAAZ), IMIBIC-Reina Sofia Hospital, Cordoba; Rheumatology Department (ER), University Hospital San Cecilio, Granada; Rheumatology Department (ED-Á), Leon Hospital, Leon; Rheumatology Department (TV-R), Hospital Lucus Augusti, Lugo; Rheumatology Department (PGDlP), Hospital Norte Sanchinarro, Madrid; Rheumatology Department (AM), Hospital Universitario Príncipe de Asturias, Alcalá de Henares; Rheumatology Department (JLA), Hospital Puerta de Hierro, Majadahonda, Madrid; Rheumatology Department (PR), Hospital Infanta Sofía, San Sebastián de los Reyes, Madrid; Rheumatology Department (CM), Hospital Virgen de la Arrixaca, Murcia, Spain; Rheumatology Department (CM-M), Hospital Clínico Universitario de Salamanca, Salamanca; Rheumatology Department (BH-C), University Hospital Virgen Macarena; Rheumatology Department (JLMDlF), Hospital de Valme, Sevilla; Rheumatology Department (MG), Hospital Universitario de Canarias, Tenerife; Rheumatology Department (EÚ), Hospital de Basurto, Bilbao; Rheumatology Department (JJA-S), Hospital Universitario Dr Peset, Valencia; Rheumatology Department (JM), Hospital Miguel Servet Zaragoza; Rheumatology Department (JI-R), Clínica POVISA, Vigo; Rheumatology Department (MR-G), Complejo Hospitalario Universitario de Ourense, Ourense; Rheumatology Department (VQ), Hospital de Monforte, Lugo; Rheumatology Department (JH-B), Hospital Insular de Gran Canaria, Las Palmas de Gran Canaria; Rheumatology Department (LSF), Hospital Universitario de Guadalajara, Guadalajara; Statistical Department (FA, SP), Research Unit, Spanish Society of Rheumatology (SER), Madrid; and Rheumatology Department (IR-F), Doctor Negrín University Hospital, Gran Canaria, Spain
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Zhao M, Zhou Y, Zhu B, Wan M, Jiang T, Tan Q, Liu Y, Jiang J, Luo S, Tan Y, Wu H, Renauer P, Del Mar Ayala Gutiérrez M, Castillo Palma MJ, Ortega Castro R, Fernández-Roldán C, Raya E, Faria R, Carvalho C, Alarcón-Riquelme ME, Xiang Z, Chen J, Li F, Ling G, Zhao H, Liao X, Lin Y, Sawalha AH, Lu Q. IFI44L promoter methylation as a blood biomarker for systemic lupus erythematosus. Ann Rheum Dis 2016; 75:1998-2006. [PMID: 26787370 DOI: 10.1136/annrheumdis-2015-208410] [Citation(s) in RCA: 132] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 12/11/2015] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Systemic lupus erythematosus (SLE) is a clinically heterogeneous disease with limited reliable diagnostic biomarkers. We investigated whether gene methylation could meet sensitivity and specificity criteria for a robust biomarker. METHODS IFI44L promoter methylation was examined using DNA samples from a discovery set including 377 patients with SLE, 358 healthy controls (HCs) and 353 patients with rheumatoid arthritis (RA). Two independent sets including 1144 patients with SLE, 1350 HCs, 429 patients with RA and 199 patients with primary Sjögren's syndrome (pSS) were used for validation. RESULTS Significant hypomethylation of two CpG sites within IFI44L promoter, Site1 (Chr1: 79 085 222) and Site2 (Chr1: 79 085 250; cg06872964), was identified in patients with SLE compared with HCs, patients with RA and patients with pSS. In a comparison between patients with SLE and HCs included in the first validation cohort, Site1 methylation had a sensitivity of 93.6% and a specificity of 96.8% at a cut-off methylation level of 75.5% and Site2 methylation had a sensitivity of 94.1% and a specificity of 98.2% at a cut-off methylation level of 25.5%. The IFI44L promoter methylation marker was also validated in an European-derived cohort. In addition, the methylation levels of Site1 and Site2 within IFI44L promoter were significantly lower in patients with SLE with renal damage than those without renal damage. Patients with SLE showed significantly increased methylation levels of Site1 and Site2 during remission compared with active stage. CONCLUSIONS The methylation level of IFI44L promoter can distinguish patients with SLE from healthy persons and other autoimmune diseases, and is a highly sensitive and specific diagnostic marker for SLE.
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Affiliation(s)
- Ming Zhao
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Yin Zhou
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Bochen Zhu
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Mengjie Wan
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Tingting Jiang
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Qiqun Tan
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Yan Liu
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Juqing Jiang
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Shuaihantian Luo
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Yixin Tan
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Haijing Wu
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Paul Renauer
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | | | | | | | - Concepción Fernández-Roldán
- Departament of Rheumatology, Unidad de Enfermedades Autoinmunes Sistémicas, Hospital Universitario San Cecilio, Granada, Spain
| | - Enrique Raya
- Departament of Rheumatology, Unidad de Enfermedades Autoinmunes Sistémicas, Hospital Universitario San Cecilio, Granada, Spain
| | - Raquel Faria
- Unidade de Imunologia Clínica/Centro Hospitalar do Porto, Porto, Portugal
| | - Claudia Carvalho
- Lab Imunogenetics & Autoimmu and NeuroScien, Unidade Multidisciplinar Invest Biomed, Inst Ciencias Biomed Abel Salazar/ Universidade do Porto, Porto, Portugal
| | - Marta E Alarcón-Riquelme
- Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA Centre for Genomics and Oncological Research (GENYO), Pfizer-University of Granada-Andalusian Regional Government, Health Sciences Technology Park, Granada, Spain
| | - Zhongyuan Xiang
- Department of Clinical Laboratory, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Jinwei Chen
- Department of Rheumatology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Fen Li
- Department of Rheumatology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Guanghui Ling
- Department of Rheumatology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Hongjun Zhao
- Department of Rheumatology, Xiangya Hospital of Central South University, Changsha, China
| | - Xiangping Liao
- Department of Nephropathy and Rheumatology, Chenzhou No.1 People's Hospital, Chenzhou, China
| | - Youkun Lin
- Department of Dermatology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Amr H Sawalha
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Qianjin Lu
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenomics, The Second Xiangya Hospital of Central South University, Changsha, China
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Nolla JM, Rodríguez M, Martin-Mola E, Raya E, Ibero I, Nocea G, Aragon B, Lizán L, Prades M. Patients' and rheumatologists' preferences for the attributes of biological agents used in the treatment of rheumatic diseases in Spain. Patient Prefer Adherence 2016; 10:1101-13. [PMID: 27382258 PMCID: PMC4920238 DOI: 10.2147/ppa.s106311] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To define importance values assigned to attributes of biological agents (BAs) by Spanish patients with rheumatic diseases (rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis) and rheumatologists. PATIENTS AND METHODS This was an observational, cross-sectional design based upon a rank-based full-profile conjoint analysis. A literature review and four focus groups were undertaken to identify attributes and levels. An orthogonal matrix, combining the selected levels of attributes, was used to define scenarios. Participants ranked eight scenarios from 1 (most preferred) to 8 (least preferred). The relative importance (RI) of attributes was calculated. Multivariate regression analysis was performed to identify the characteristics that influenced the values of RI. A total of 488 patients (male 50.9%, mean age 50.6 [standard deviation {SD} 12.06] years, rheumatoid arthritis 33.8%, ankylosing spondylitis 32.4%, psoriatic arthritis 33.8%; mean time since diagnosis 12.6 [SD 8.2] years) and 136 rheumatologists (male 50.4%, mean age 46.4 [SD 9.1] years, mean time of practice 16.7 [SD 8.8] years) participated. RESULTS The ideal BAs for patients and physicians, respectively, should allow pain relief and improvement of functional capacity (RI 39% and 44.7%), with low risk of adverse events (RI 24.9% and 30.5%), a long time prior to perceiving the need for a new dose (RI 16.4% and 12.4%), and self-administration at home (RI 19.7% and 12.5%), as identified through their preferences. CONCLUSION Although efficacy and safety are paramount for patients and rheumatologists to make a choice regarding BAs, the need for a low frequency of administration and the administration method also play a role as preference attributes for BAs.
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Affiliation(s)
- Joan M Nolla
- Department of Rheumatology, Hospital Universitari de Bellvitge, Barcelona, Spain
- Correspondence: Joan Miquel Nolla, Department of Rheumatology, Hospital Universitari de Bellvitge, Feixa Llarga, L’Hospitalet de Llobregat, Barcelona 08907, Spain, Tel +34 932 607 615, Email
| | - Manuel Rodríguez
- Department of Rheumatology, Complejo Hospitalario de Ourense, Ourense, Spain
| | - Emilio Martin-Mola
- Department of Rheumatology, Hospital Universitario La Paz, Madrid, Spain
| | - Enrique Raya
- Department of Rheumatology, Hospital Universitario San Cecilio, Granada, Spain
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Lois A, Rúa I, delCampo V, Lόpez F, Galindo M, Calvo J, Hernández I, Belmonte M, Erausquin C, Tomero E, Blanco R, Calvo V, Uriarte E, Vela P, Freire M, deToro J, Montilla C, Raya E, Fernández A, Horcada L, Pego J. AB0516 Thrombotic Thrombocytopenic Purpura in Patients from the SLE Registry of the Spanish Society of Rheumatology (Relesser). Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.2779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Fernandez Castro M, Andreu J, Olivé A, Rosas J, Martínez Taboada V, Sánchez-Piedra C, Romaní L, Melchor S, Moreira B, Raya E, Rodriguez Lόpez M, Cid N, Júdez E, Moriano C, Torrente V, Corominas H, García Magallόn B. SAT0412 Disease Activity in Patients with Primary SjÖgren's Syndrome Followed by Spanish Rheumatology Departments. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.2591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Ferreiro-Iglesias A, Montes A, Pérez-Pampín E, Carreira P, Joven B, Caliz R, Ferrer M, Moreno-Ramos M, Raya E, Magro C, Vasilopoulos Y, Sarafidou T, Balsa A, Pascual-Salcedo D, Fernández-Nebro A, Ordόñez M, Alegre-Sancho J, Márquez A, Navarro F, Moreira V, Blanco F, Narvaez J, Cañete J, Martin J, Gόmez-Reino J, Gonzalez A. OP0125 Replication of GWAS of Response to TNF Inhibitors in Patients with Rheumatoid Arthritis. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.4625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Ibero I, Raya E, Nolla J, Martin-Mola E, Rodriguez M, Nocea G, Aragon B. THU0344 Patient Preferences for the Attributes of Biological Agents in Rheumatic Diseases in Spain. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.3063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Magro-Checa C, Orgaz-Molina J, Lafèbre SR, Rosales-Alexander JL, Arias-Santiago S, Raya E. Morphea-like plaques, induration of the extremities, and eosinophilia. Cleve Clin J Med 2015; 82:283-4. [DOI: 10.3949/ccjm.82a.13126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Ferreiro-Iglesias A, Montes A, Perez-Pampin E, Cañete JD, Raya E, Magro-Checa C, Vasilopoulos Y, Sarafidou T, Caliz R, Ferrer MA, Joven B, Carreira P, Balsa A, Pascual-Salcedo D, Blanco FJ, Moreno-Ramos MJ, Fernández-Nebro A, Ordóñez MC, Alegre-Sancho JJ, Narváez J, Navarro-Sarabia F, Moreira V, Valor L, García-Portales R, Marquez A, Martin J, Gómez-Reino JJ, Gonzalez A. Replication of PTPRC as genetic biomarker of response to TNF inhibitors in patients with rheumatoid arthritis. Pharmacogenomics J 2015; 16:137-40. [PMID: 25896535 DOI: 10.1038/tpj.2015.29] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 02/16/2015] [Accepted: 03/02/2015] [Indexed: 01/21/2023]
Abstract
Genetic biomarkers could be useful for orienting treatment of patients with rheumatoid arthritis (RA), but none has been convincingly validated yet. Putative biomarkers include 14 single nucleotide polymorphisms that have shown association with response to TNF inhibitors (TNFi) in candidate gene studies and that we assayed here in 755 RA patients. Three of them, in the PTPRC, IL10 and CHUK genes, were significantly associated with response to TNFi. The most significant result was obtained with rs10919563 in PTPRC, which is a confirmed RA susceptibility locus. Its RA risk allele was associated with improved response (B=0.33, P=0.006). This is the second independent replication of this biomarker (P=9.08 × 10(-8) in the combined 3003 RA patients). In this way, PTPRC has become the most replicated genetic biomarker of response to TNFi. In addition, the positive but weaker replication of IL10 and CHUK should stimulate further validation studies.
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Affiliation(s)
- A Ferreiro-Iglesias
- Laboratorio de Investigacion 10 and Rheumatology Unit, Instituto de Investigacion Sanitaria-Hospital Clinico Universitario de Santiago, Santiago de Compostela, Spain
| | - A Montes
- Laboratorio de Investigacion 10 and Rheumatology Unit, Instituto de Investigacion Sanitaria-Hospital Clinico Universitario de Santiago, Santiago de Compostela, Spain
| | - E Perez-Pampin
- Laboratorio de Investigacion 10 and Rheumatology Unit, Instituto de Investigacion Sanitaria-Hospital Clinico Universitario de Santiago, Santiago de Compostela, Spain
| | - J D Cañete
- Rheumatology Unit, Hospital Clinic, IDIBAPS, Barcelona, Spain
| | - E Raya
- Department of Rheumatology, Hospital Clínico San Cecilio, Granada, Spain
| | - C Magro-Checa
- Department of Rheumatology, Hospital Clínico San Cecilio, Granada, Spain
| | - Y Vasilopoulos
- Department of Biochemistry and Biotechnology, University of Thessaly, Larissa, Greece
| | - T Sarafidou
- Department of Biochemistry and Biotechnology, University of Thessaly, Larissa, Greece
| | - R Caliz
- Rheumatology Unit, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - M A Ferrer
- Rheumatology Unit, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - B Joven
- Reumatology Department, Hospital 12 de Octubre, Madrid, Spain
| | - P Carreira
- Reumatology Department, Hospital 12 de Octubre, Madrid, Spain
| | - A Balsa
- Department of Rheumatology and Institute for Health Research (IdiPAZ), University Hospital La Paz. Madrid, Spain
| | - D Pascual-Salcedo
- Immunology Unit, Instituto de Investigación Hospital Universitario La Paz, Hospital Universitario La Paz, Madrid, Spain
| | - F J Blanco
- Servicio de Reumatología. Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade da Coruña (UDC), A Coruña, Spain.,Department of Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - M J Moreno-Ramos
- Department of Rheumatology, Hospital Virgen de la Arrixaca, Murcia, Spain
| | - A Fernández-Nebro
- UGC de Reumatología, Instituto deInvestigación Biomédica de Málaga (IBIMA), HRU de Málaga, Universidad de Málaga, Málaga, Spain
| | - M C Ordóñez
- UGC de Reumatología, Instituto deInvestigación Biomédica de Málaga (IBIMA), HRU de Málaga, Universidad de Málaga, Málaga, Spain
| | | | - J Narváez
- Department of Rheumatology, Hospital Universitario de Bellvitge, Barcelona, Spain
| | - F Navarro-Sarabia
- Rheumatology Unit, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - V Moreira
- Rheumatology Unit, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - L Valor
- Rheumatology Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - R García-Portales
- Department of Rheumatology, Hospital Virgen de la Victoria, Málaga, Spain
| | - A Marquez
- Instituto de Parasitología y Biomedicina López-Neyra, CSIC, Granada, Spain
| | - J Martin
- Instituto de Parasitología y Biomedicina López-Neyra, CSIC, Granada, Spain
| | - J J Gómez-Reino
- Laboratorio de Investigacion 10 and Rheumatology Unit, Instituto de Investigacion Sanitaria-Hospital Clinico Universitario de Santiago, Santiago de Compostela, Spain.,Department of Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - A Gonzalez
- Laboratorio de Investigacion 10 and Rheumatology Unit, Instituto de Investigacion Sanitaria-Hospital Clinico Universitario de Santiago, Santiago de Compostela, Spain
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Carmona F, Mackie S, Martín JE, Taylor J, Vaglio A, Eyre S, Bossini-Castillo L, Castañeda S, Cid M, Hernández-Rodríguez J, Prieto-González S, Solans R, Ramentol-Sintas M, González-Escribano M, Ortiz-Fernández L, Morado I, Narváez J, Miranda-Filloy J, Beretta L, Lunardi C, Cimmino MA, Gianfreda D, Santilli D, Ramirez GA, Soriano A, Muratore F, Pazzola G, Addimanda O, Wijmenga C, Witte T, Schirmer JH, Moosig F, Schönau V, Franke A, Palm Ø, Molberg Ø, Diamantopoulos AP, Carette S, Cuthbertson D, Forbess LJ, Hoffman GS, Khalidi NA, Koening CL, Langford CA, McAlear CA, Moreland L, Monach PA, Pagnoux C, Seo P, Spiera R, Sreih AG, Warrington KJ, Ytterberg SR, Gregersen PK, Pease CT, Gough A, Green M, Hordon L, Jarrett S, Watts R, Levy S, Patel Y, Kamath S, Dasgupta B, Worthington J, Koeleman BP, de Bakker PI, Barrett JH, Salvarani C, Merkel PA, González-Gay MA, Morgan AW, Martín J, Martínez-Berriochoa A, Unzurrunzaga A, Hidalgo-Conde A, Madroñero-Vuelta A, Fernández-Nebro A, Ordóñez-Cañizares M, Escalante B, Marí-Alfonso B, Sopeña B, Magro C, Raya E, Grau E, Román J, de Miguel E, López-Longo F, Martínez L, Gómez-Vaquero C, Fernández-Gutiérrez B, Rodríguez-Rodríguez L, Díaz-López J, Caminal-Montero L, Martínez-Zapico A, Monfort J, Tío L, Sánchez-Martín J, Alegre-Sancho J, Sáez-Comet L, Pérez-Conesa M, Corbera-Bellalta M, García-Villanueva M, Fernández-Contreras M, Sanchez-Pernaute O, Blanco R, Ortego-Centeno N, Ríos-Fernández R, Callejas J, Fanlo-Mateo P, Martínez-Taboada V. A large-scale genetic analysis reveals a strong contribution of the HLA class II region to giant cell arteritis susceptibility. Am J Hum Genet 2015; 96:565-80. [PMID: 25817017 DOI: 10.1016/j.ajhg.2015.02.009] [Citation(s) in RCA: 114] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 02/12/2015] [Indexed: 02/08/2023] Open
Abstract
We conducted a large-scale genetic analysis on giant cell arteritis (GCA), a polygenic immune-mediated vasculitis. A case-control cohort, comprising 1,651 case subjects with GCA and 15,306 unrelated control subjects from six different countries of European ancestry, was genotyped by the Immunochip array. We also imputed HLA data with a previously validated imputation method to perform a more comprehensive analysis of this genomic region. The strongest association signals were observed in the HLA region, with rs477515 representing the highest peak (p = 4.05 × 10(-40), OR = 1.73). A multivariate model including class II amino acids of HLA-DRβ1 and HLA-DQα1 and one class I amino acid of HLA-B explained most of the HLA association with GCA, consistent with previously reported associations of classical HLA alleles like HLA-DRB1(∗)04. An omnibus test on polymorphic amino acid positions highlighted DRβ1 13 (p = 4.08 × 10(-43)) and HLA-DQα1 47 (p = 4.02 × 10(-46)), 56, and 76 (both p = 1.84 × 10(-45)) as relevant positions for disease susceptibility. Outside the HLA region, the most significant loci included PTPN22 (rs2476601, p = 1.73 × 10(-6), OR = 1.38), LRRC32 (rs10160518, p = 4.39 × 10(-6), OR = 1.20), and REL (rs115674477, p = 1.10 × 10(-5), OR = 1.63). Our study provides evidence of a strong contribution of HLA class I and II molecules to susceptibility to GCA. In the non-HLA region, we confirmed a key role for the functional PTPN22 rs2476601 variant and proposed other putative risk loci for GCA involved in Th1, Th17, and Treg cell function.
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Montes A, Perez-Pampin E, Navarro-Sarabia F, Moreira V, de la Serna AR, Magallares B, Vasilopoulos Y, Sarafidou T, Fernández-Nebro A, Ordóñez MDC, Narváez J, Cañete JD, Marquez A, Pascual-Salcedo D, Joven B, Carreira P, Moreno-Ramos MJ, Caliz R, Ferrer MA, Garcia-Portales R, Blanco FJ, Magro C, Raya E, Valor L, Alegre-Sancho JJ, Balsa A, Martin J, Plant D, Isaacs J, Morgan AW, Barton A, Wilson AG, Gómez-Reino JJ, Gonzalez A. Rheumatoid arthritis response to treatment across IgG1 allotype - anti-TNF incompatibility: a case-only study. Arthritis Res Ther 2015; 17:63. [PMID: 25885039 PMCID: PMC4411723 DOI: 10.1186/s13075-015-0571-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 02/20/2015] [Indexed: 12/31/2022] Open
Abstract
Introduction We have hypothesized that incompatibility between the G1m genotype of the patient and the G1m1 and G1m17 allotypes carried by infliximab (INX) and adalimumab (ADM) could decrease the efficacy of these anti-tumor necrosis factor (anti-TNF) antibodies in the treatment of rheumatoid arthritis (RA). Methods The G1m genotypes were analyzed in three collections of patients with RA totaling 1037 subjects. The first, used for discovery, comprised 215 Spanish patients. The second and third were successively used for replication. They included 429 British and Greek patients and 393 Spanish and British patients, respectively. Two outcomes were considered: change in the Disease Activity Score in 28 joint (ΔDAS28) and the European League Against Rheumatism (EULAR) response criteria. Results An association between less response to INX and incompatibility of the G1m1,17 allotype was found in the discovery collection at 6 months of treatment (P = 0.03). This association was confirmed in the replications (P = 0.02 and 0.08, respectively) leading to a global association (P = 0.001) that involved a mean difference in ΔDAS28 of 0.4 units between compatible and incompatible patients (2.3 ± 1.5 in compatible patients vs. 1.9 ± 1.5 in incompatible patients) and an increase in responders and decrease in non-responders according to the EULAR criteria (P = 0.03). A similar association was suggested for patients treated with ADM in the discovery collection, but it was not supported by replication. Conclusions Our results suggest that G1m1,17 allotypes are associated with response to INX and could aid improved therapeutic targeting in RA. Electronic supplementary material The online version of this article (doi:10.1186/s13075-015-0571-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ariana Montes
- Laboratorio de Investigacion 10 and Rheumatology Unit, Instituto de Investigacion Sanitaria - Hospital Clinico Universitario de Santiago, Santiago de Compostela, Spain.
| | - Eva Perez-Pampin
- Laboratorio de Investigacion 10 and Rheumatology Unit, Instituto de Investigacion Sanitaria - Hospital Clinico Universitario de Santiago, Santiago de Compostela, Spain.
| | | | - Virginia Moreira
- Rheumatology Unit, Hospital Universitario Virgen Macarena, Sevilla, Spain.
| | | | - Berta Magallares
- Rheumatology Unit, Hospital Santa Creu e San Pau, Barcelona, Spain.
| | - Yiannis Vasilopoulos
- Department of Biochemistry and Biotechnology, University of Thessaly, Larissa, Greece.
| | - Theologia Sarafidou
- Department of Biochemistry and Biotechnology, University of Thessaly, Larissa, Greece.
| | - Antonio Fernández-Nebro
- Servicio de Reumatología, HRU Carlos Haya, Universidad de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain.
| | - María Del Carmen Ordóñez
- Servicio de Reumatología, HRU Carlos Haya, Universidad de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain.
| | - Javier Narváez
- Department of Rheumatology, Hospital Universitario de Bellvitge, Barcelona, Spain.
| | - Juan D Cañete
- Rheumatology Unit, Hospital Clinic, Barcelona, Spain.
| | - Ana Marquez
- Instituto de Parasitología y Biomedicina López-Neyra, CSIC, Granada, Spain.
| | - Dora Pascual-Salcedo
- Department of Immunology, Instituto de Investigación Hospital Universitario La Paz, Hospital La Paz, Madrid, Spain.
| | - Beatriz Joven
- Department of Rheumatology, Hospital 12 de Octubre, Madrid, Spain.
| | | | | | - Rafael Caliz
- Rheumatology Unit, Hospital Universitario Virgen de las Nieves, Granada, Spain.
| | - Miguel Angel Ferrer
- Rheumatology Unit, Hospital Universitario Virgen de las Nieves, Granada, Spain.
| | | | - Francisco J Blanco
- Rheumatology Department, Instituto de Investigacion Biomedica-Complejo Hospitalario Universitario A Coruna, A Coruna, Spain. .,Department of Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain.
| | - Cesar Magro
- Department of Rheumatology, Hospital Clínico San Cecilio, Granada, Spain.
| | - Enrique Raya
- Department of Rheumatology, Hospital Clínico San Cecilio, Granada, Spain.
| | - Lara Valor
- Rheumatology Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | | | - Alejandro Balsa
- Department of Rheumatology, Instituto de Investigación Hospital Universitario La Paz, Hospital Universitario La Paz, Madrid, Spain.
| | - Javier Martin
- Instituto de Parasitología y Biomedicina López-Neyra, CSIC, Granada, Spain.
| | - Darren Plant
- NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.
| | - John Isaacs
- Musculoskeletal Research Group, Institute of Cellular Medicine, The Medical School, Newcastle University, Newcastle, UK. .,National Institute for Health Research Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University, Newcastle upon Tyne, Newcastle, UK.
| | - Ann W Morgan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, St. James's University Hospital, University of Leeds, Leeds, UK. .,NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
| | - Anne Barton
- NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK. .,Arthritis Research UK-Centre for Genetics and Genomics, The University of Manchester, Manchester, UK.
| | | | | | - Juan J Gómez-Reino
- Laboratorio de Investigacion 10 and Rheumatology Unit, Instituto de Investigacion Sanitaria - Hospital Clinico Universitario de Santiago, Santiago de Compostela, Spain. .,Department of Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain.
| | - Antonio Gonzalez
- Laboratorio de Investigacion 10 and Rheumatology Unit, Instituto de Investigacion Sanitaria - Hospital Clinico Universitario de Santiago, Santiago de Compostela, Spain. .,Laboratorio Investigacion 10, Hospital Clinico Universitario de Santiago, Edificio de consultas, planta -2 Travesia de Choupana, sn, Santiago de Compostela, 15706, Spain.
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Rúa-Figueroa Í, Richi P, López-Longo FJ, Galindo M, Calvo-Alén J, Olivé-Marqués A, Loza-Santamaría E, Vicente SP, Erausquin C, Tomero E, Horcada L, Uriarte E, Sánchez-Atrio A, Rosas J, Montilla C, Fernández-Nebro A, Rodríguez-Gómez M, Vela P, Blanco R, Freire M, Silva L, Díez-Álvarez E, Ibáñez-Barceló M, Zea A, Narváez J, Martínez-Taboada V, Marenco JL, de Castro MF, Fernández-Berrizbeitia O, Hernández-Beriain JÁ, Gantes M, Hernández-Cruz B, Pérez-Venegas JJ, Pecondón Á, Marras C, Carreira P, Bonilla G, Torrente V, Castellví I, Alegre J, Moreno M, Raya E, de la Peña PG, Vázquez T, Aguirre Á, Quevedo V, Pego-Reigosa JM. Comprehensive description of clinical characteristics of a large systemic lupus erythematosus cohort from the Spanish Rheumatology Society Lupus Registry (RELESSER) with emphasis on complete versus incomplete lupus differences. Medicine (Baltimore) 2015; 94:e267. [PMID: 25569641 PMCID: PMC4602842 DOI: 10.1097/md.0000000000000267] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 10/22/2014] [Accepted: 10/23/2014] [Indexed: 10/26/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by multiple organ involvement and pronounced racial and ethnic heterogeneity. The aims of the present work were (1) to describe the cumulative clinical characteristics of those patients included in the Spanish Rheumatology Society SLE Registry (RELESSER), focusing on the differences between patients who fulfilled the 1997 ACR-SLE criteria versus those with less than 4 criteria (hereafter designated as incomplete SLE (iSLE)) and (2) to compare SLE patient characteristics with those documented in other multicentric SLE registries.RELESSER is a multicenter hospital-based registry, with a collection of data from a large, representative sample of adult patients with SLE (1997 ACR criteria) seen at Spanish rheumatology departments. The registry includes demographic data, comprehensive descriptions of clinical manifestations, as well as information about disease activity and severity, cumulative damage, comorbidities, treatments and mortality, using variables with highly standardized definitions.A total of 4.024 SLE patients (91% with ≥4 ACR criteria) were included. Ninety percent were women with a mean age at diagnosis of 35.4 years and a median duration of disease of 11.0 years. As expected, most SLE manifestations were more frequent in SLE patients than in iSLE ones and every one of the ACR criteria was also associated with SLE condition; this was particularly true of malar rash, oral ulcers and renal disorder. The analysis-adjusted by gender, age at diagnosis, and disease duration-revealed that higher disease activity, damage and SLE severity index are associated with SLE [OR: 1.14; 95% CI: 1.08-1.20 (P < 0.001); 1.29; 95% CI: 1.15-1.44 (P < 0.001); and 2.10; 95% CI: 1.83-2.42 (P < 0.001), respectively]. These results support the hypothesis that iSLE behaves as a relative stable and mild disease. SLE patients from the RELESSER register do not appear to differ substantially from other Caucasian populations and although activity [median SELENA-SLEDA: 2 (IQ: 0-4)], damage [median SLICC/ACR/DI: 1 (IQ: 0-2)], and severity [median KATZ index: 2 (IQ: 1-3)] scores were low, 1 of every 4 deaths was due to SLE activity.RELESSER represents the largest European SLE registry established to date, providing comprehensive, reliable and updated information on SLE in the southern European population.
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Affiliation(s)
- Íñigo Rúa-Figueroa
- From the Doctor Negrín University Hospital of Gran Canaria, Las Palmas GC, Las Plamas, Spain (ÍRF); Rheumatology Department Hospital Infanta Sofía, Madrid Spain (PR); Rheumatology Department Gregorio Marañón University Hospital, Madrid Spain (FJLL); Rheumatology Department Doce de Octubre University Hospital, Madrid Spain (MG); Rheumatology Department Sierrallana Hospital, Torrelavega Spain (JCA); Rheumatology Department Germans Trías i Pujol University Hospital, Badalona Spain (AOM); Research Unit Spanish Society of Rheumatology, Madrid Spain (ELS); Statistical Department Research Unit. Spanish Society of Rheumatology (SER); Madrid Spain (SPV); Rheumatology Department Dr Negrin General Hospital, Las Palmas de Gran Canaria, Spain (CE); Rheumatology Department La Princesa University Hospital, Madrid Spain (ET); Rheumatology Department Navarra Hospital Spain (LH); Rheumatology Department Donosti Hospital, Guipuzcoa Spain (EU); Rheumatology Department Príncipe de Asturias University Hospital, Madrid, Spain (ASA); Rheumatology Department H Marina Baixa, Alicante Spain (JR); Rheumatology Department Salamanca Clinic University Hospital Spain (CM); Rheumatology Department Carlos Haya University Hospital, Málaga, Spain (AFN); Rheumatology Department Hospital Complex of Ourense, Ourense Spain (MRG); Rheumatology Department Alicante General Hospital, Alicante, Spain (PV); Rheumatology Department Marqués de Valdecilla University Hospital, Santander Spain (RB); Rheumatology Department Juan Canalejo University Hospital, La Coruña Spain (MF); Rheumatology Department Guadalajara Hospital, Guadalajara Spain (LS); Rheumatology Department León Hospital, León Spain (EDÁ); Rheumatology Department Son Llatzer Hospital, Mallorca Spain (MIB); Rheumatology Department Ramon y Cajal, University Hospital, Madrid Spain (AZ); Rheumatology Department Bellvitge Hospital, Barcelona, Spain (JN); Rheumatology Department Marqués de Valdecilla University Hospital, Santander Spain (VMT); Rheumatology Department Valme Hospital, Sevilla Spain, (JLM); Rheumatology Department Puerta del Hierro-Majadahonda Hospital, Madrid Spain (MFC); Rheumatology Department Basurto Hospital, Basurto Spain (OFB); Rheumatology Department Hospital Insular of Gran Canaria, Gran Canaria Spain (JÁH); Rheumatology Department Tenerife Clinic Hospital, Tenerife Spain (MG); Rheumatology Department Virgen Macarena Hospital, Sevilla Spain (BHC); Rheumatology Department Jerez de la Frontera University Hospital, Cádiz Spain (JJPV); Rheumatology Department Miguel Servet University Hospital, Zaragoza Spain (ÁP); Rheumatology Department Virgen de la Arrixaca University Hospital, Murcia Spain (CM); Rheumatology Department Doce de Octubre University Hospital, Madrid Spain (PC); Rheumatology Department La Paz University Hospital, Madrid Spain (GB); MD, Rheumatology Department Hospitalet General Hospital, Hospitalet, Barcelona Spain (VT); Rheumatology Unit L'Alt Penedés District Hospital Spain (IC); Rheumatology Department Dr. Peset Hospital, Valencia Spain (JA); Rheumatology Department Parc Taulí Hospital, Barcelona Spain (MM); Rheumatology Department San Cecilio Hospital, Granada Spain (ER); Rheumatology Department Hospital Universitario Sanchinarro, Madrid Spain (PGP); Rheumatology Department Lucus Augusti, Kugo Spain (TV); Rheumatology Department Reina Sofía University Hospital, Cordoba Spain (ÁA); Rheumatology Unit Monforte Hospital, Lugo Spain (VQ); University Hospital Complex, Instituto de Investigación Biomédica de Vigo(IBIV) (Spain) Alto do Meixoeiro s/n, 36200 Vigo Spain (JMPR)
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