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García-Vicuña R, Juanola X, Navarro-Compán V, Moreno-Ramos MJ, Castillo-Gallego C, Moreno M, Galíndez E, Montoro M, Gómez I, Rebollo-Laserna FJ, Loza E. Management of Specific Clinical Profiles in Axial Spondyloarthritis: An Expert's Document Based on a Systematic Literature Review and Extended Delphi Process. Rheumatol Ther 2023; 10:1215-1240. [PMID: 37450194 PMCID: PMC10468481 DOI: 10.1007/s40744-023-00575-9] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 06/14/2023] [Indexed: 07/18/2023] Open
Abstract
INTRODUCTION The management of specific clinical scenarios is not adequately addressed in national and international guidelines for axial spondyloarthritis (axSpA). Expert opinions could serve as a valuable complement to these documents. METHODS Seven expert rheumatologists identified controversial areas or gaps of current recommendations for the management of patients with axSpA. A systematic literature review (SLR) was performed to analyze the efficacy and safety of non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, conventional synthetic, biologic and targeted synthetic disease-modifying antirheumatic drugs (csDMARDs, b/tsDMARDs) in axSpA regarding controversial areas or gaps. In a nominal group meeting, the results of the SLR were discussed and a set of statements were proposed. A Delphi process inviting 150 rheumatologists was followed to define the final statements. Agreement was defined as if at least 70% of the participants voted ≥ 7 (from 1, totally disagree, to 10, totally agree). RESULTS Three overarching principles and 17 recommendations were generated. All reached agreement. According to them, axSpA care should be holistic and individualized, taking into account objective findings, comorbidities, and patients' opinions and preferences. Integrating imaging and clinical assessment with biomarker analysis could also help in decision-making. Connected to treatments, in refractory enthesitis, b/tsDMARDs are recommended. If active peripheral arthritis, csDMARD might be considered before b/tsDMARDs. The presence of significant structural damage, long disease duration, or HLA-B27-negative status do not contraindicate for the use of b/tsDMARDs. CONCLUSIONS These recommendations are intended to complement guidelines by helping health professionals address and manage specific groups of patients, particular clinical scenarios, and gaps in axSpA.
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Affiliation(s)
- Rosario García-Vicuña
- Servicio de Reumatología, Hospital Universitario La Princesa, IIS-Princesa, Madrid, Spain
| | - Xavier Juanola
- Servicio de Reumatología, Hospital Universitario de Bellvitge, Universidad de Barcelona, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
| | | | - Manuel José Moreno-Ramos
- Servicio de Reumatología, Hospital Clínico Universitario Virgen de La Arrixaca, El Palmar, Murcia, Spain
| | | | - Mireia Moreno
- Servicio de Reumatología, Universitari Parc Taulí Hospital, Institut d’Investigació i Innovació Parc Taulí (I3PT), Sabadell, Spain
| | - Eva Galíndez
- Servicio de Reumatología, Hospital Universitario de Basurto, Bilbao, Spain
| | - María Montoro
- Pfizer Medical Department, Alcobendas, Madrid, Spain
| | - Ismael Gómez
- Pfizer Medical Department, Alcobendas, Madrid, Spain
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Sanz Sanz J, Beltrán E, Díaz-Miguel Pérez MC, Fernández-Carballido C, Galíndez E, García Porrua C, Gratacós J, Medina J, Queiro R, Ramírez J, Reina D, Rodríguez Lozano C, Rodríguez Martínez FJ, Rubio E, Veroz R. Norma de calidad para el manejo del paciente con artritis psoriásica: proyecto QUANTUM. ACTA ACUST UNITED AC 2020; 16:203-215. [DOI: 10.1016/j.reuma.2018.06.011] [Citation(s) in RCA: 4] [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: 04/04/2018] [Revised: 06/12/2018] [Accepted: 06/26/2018] [Indexed: 12/27/2022]
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Gratacós J, Galíndez E, Otón T. Is obesity a predictor for lack of response to treatment in psoriatic arthritis? A systematic review. ACTA ACUST UNITED AC 2019; 17:268-278. [PMID: 31708450 DOI: 10.1016/j.reuma.2019.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 02/14/2019] [Revised: 04/23/2019] [Accepted: 06/05/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To update the study of the association between obesity and treatment response in psoriatic arthritis. METHODS Updating a systematic review of clinical trials, prospective or retrospective longitudinal studies and case-control studies in psoriatic arthritis in which obesity was assessed as a predictor of efficacy or toxicity. Risks of bias were assessed with validated scales. A meta-analysis of the results of studies with similar outcome variables and weight measurements was performed. RESULTS Twenty-one studies were included (6 review of clinical trials, 6 longitudinal studies, 7 registers and one case-control studie), with moderate quality. The risk of achieving an ACR20 response if weight≥100kg was estimated at OR=1.42 (1-2.08) and that of withdrawing treatment in an OR of 1.60 (95% CI: 1.34 - 1.92). CONCLUSIONS There seems to be a greater risk of withdrawal of treatment due to inefficacy and difficulty in achieving remission in patients with psoriatic arthritis if they are obese.
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Affiliation(s)
- Jordi Gratacós
- Servicio de Reumatología, Hospital Universitari Parc Taulí, Universitat Autònoma de Barcelona, Sabadell (Barcelona), España
| | - Eva Galíndez
- Servicio de Reumatología, Hospital Universitario Basurto, Bilbao, Vizcaya, España
| | - Teresa Otón
- Instituto de Salud Musculoesquelética, Madrid, España.
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Deza G, Notario J, Ferran M, Beltrán E, Almirall M, Alcalá R, Ruiz-Carrascosa JC, Sánchez R, Pérez S, García-Vivar ML, Galíndez E, Mora M, Rodríguez J, Gallardo F. Long-term etanercept survival in patients with psoriatic arthritis: a multicenter retrospective analysis in daily clinical practice in Spain. Rheumatol Int 2018; 38:2037-2043. [PMID: 30143818 DOI: 10.1007/s00296-018-4144-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 07/11/2018] [Accepted: 08/21/2018] [Indexed: 01/04/2023]
Abstract
Although several randomized clinical trials and observational studies have evaluated the effectiveness, safety and drug survival of etanercept (ETN) in the treatment of psoriatic arthritis (PsA), long-term data regarding these aspects are currently scarce. For this reason, we sought to investigate the long-term survival and safety of ETN in PsA patients in 4 tertiary care Spanish hospitals over a 13-year observation period (from 2004 to 2017). The records of 85 PsA patients were reviewed. ETN showed an excellent survival profile, with rates of treatment discontinuation at 1, 3, 5 and 10 years of 15, 37, 46 and 59%, respectively. In our cohort, a trend toward longer drug survival in patients with shorter disease duration and those who were treated with ETN as their first biologic agent was observed. On the other hand, combination therapy with conventional disease-modifying antirheumatic drugs did not provide greater improvement on the long-term drug survival. Only 12% of the patients reported adverse events (AEs) during therapy, being most of them of mild to moderate intensity, and in only 7% AEs led to drug discontinuation. To the best of our knowledge, the present study shows the largest follow-up period of ETN-treated population analyzed in a real-life setting, and these results demonstrate the positive safety profile and long-term effectiveness of this biologic agent in the management of PsA patients.
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Affiliation(s)
- Gustavo Deza
- Department of Dermatology, Hospital del Mar-Institut Mar d'Investigacions Mèdiques, Passeig Marítim, 25-29, 08003, Barcelona, Spain
| | - Jaime Notario
- Department of Dermatology, Hospital de Bellvitge, Hospitalet de Llobregat, Spain
| | - Marta Ferran
- Department of Dermatology, Hospital del Mar-Institut Mar d'Investigacions Mèdiques, Passeig Marítim, 25-29, 08003, Barcelona, Spain
| | - Emma Beltrán
- Department of Reumatology, Hospital del Mar, Barcelona, Spain
| | - Miriam Almirall
- Department of Reumatology, Hospital del Mar, Barcelona, Spain
| | - Rebeca Alcalá
- Department of Dermatology, Hospital del Mar-Institut Mar d'Investigacions Mèdiques, Passeig Marítim, 25-29, 08003, Barcelona, Spain
| | | | - Ricardo Sánchez
- Department of Reumatology, Hospital San Cecilio, Granada, Spain
| | - Silvia Pérez
- Department of Reumatology, Hospital de Basurto, Bilbao, Spain
| | | | - Eva Galíndez
- Department of Reumatology, Hospital de Basurto, Bilbao, Spain
| | - Maribel Mora
- Department of Reumatology, Hospital de Bellvitge, Hospitalet de Llobregat, Spain
| | - Jesús Rodríguez
- Department of Reumatology, Hospital de Bellvitge, Hospitalet de Llobregat, Spain
| | - Fernando Gallardo
- Department of Dermatology, Hospital del Mar-Institut Mar d'Investigacions Mèdiques, Passeig Marítim, 25-29, 08003, Barcelona, Spain.
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Flórez MT, Almodóvar R, García Pérez F, Rodríguez Cambrón AB, Carmona L, Pérez Manzanero MÁ, Aboitiz Cantalapiedra J, Urruticoechea-Arana A, Rodríguez Lozano CJ, Castro C, Fernández-Carballido C, de Miguel E, Galíndez E, Álvarez Vega JL, Torre Alonso JC, Linares LF, Moreno M, Navarro-Compán V, Juanola X, Zarco P. The EJES-3D tool for personalized prescription of exercise in axial spondyloarthritis through multimedia animations: pilot study. Rheumatol Int 2018; 38:1277-1284. [PMID: 29786781 DOI: 10.1007/s00296-018-4049-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 05/10/2018] [Indexed: 10/16/2022]
Abstract
To develop and evaluate a web application based on multimedia animations, combined with a training program, to improve the prescription of exercises in spondyloarthritis (SpA). After a review of exercises included in the main clinical trials and recommendations of international societies, a multidisciplinary team-rehabilitators, rheumatologists, physiotherapists, computer scientists and graphic designers-developed a web application for the prescription of exercises (EJES-3D). Once completed, this was presented to 12 pairs of rehabilitators-rheumatologists from the same hospital in a workshop. Knowledge about exercise was tested in rheumatologists before and 6 months after the workshop, when they also evaluated the application. The EJES-3D application includes 38 multimedia videos and allows prescribing predesigned programs or customizing them. A patient can consult the prescribed exercises at any time from a device with internet connection (mobile, tablet, or computer). The vast majority of the evaluators (89%) were satisfied or very satisfied and considered that their expectations regarding the usefulness of the web application had been met. They highlighted the ability to tailor exercises adapted to the different stages of the disease and the quality and variety of the videos. They also indicated some limitations of the application and operational problems. The EJES-3D tool was positively evaluated by experts in SpA, potentially the most demanding group of users with the most critical capacity. This allows a preliminary validation of the contents, usefulness, and ease of use. Analyzing and correcting the errors and limitations detected is allowing us to improve the EJES-3D tool.
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Affiliation(s)
- Mariano Tomás Flórez
- Unidad de Rehabilitación, Hospital Universitario Fundación Alcorcón, Calle Budapest, 1, 28922, Alcorcón, Madrid, Spain.
| | - Raquel Almodóvar
- Unidad de Reumatología, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
| | - Fernando García Pérez
- Unidad de Rehabilitación, Hospital Universitario Fundación Alcorcón, Calle Budapest, 1, 28922, Alcorcón, Madrid, Spain
| | | | - Loreto Carmona
- Instituto de Salud Musculoesquelética (InMusc), Madrid, Spain
| | - María Ángeles Pérez Manzanero
- Unidad de Rehabilitación, Hospital Universitario Fundación Alcorcón, Calle Budapest, 1, 28922, Alcorcón, Madrid, Spain
| | - Juan Aboitiz Cantalapiedra
- Unidad de Rehabilitación, Hospital Universitario Fundación Alcorcón, Calle Budapest, 1, 28922, Alcorcón, Madrid, Spain
| | | | | | - Carmen Castro
- Servicio de Reumatología, Hospital Universitario Reina Sofía, Córdoba, Spain
| | | | - Eugenio de Miguel
- Servicio de Reumatología, Hospital Universitario La Paz, Madrid, Spain
| | - Eva Galíndez
- Servicio de Reumatología, Hospital Universitario de Basurto, Bilbao, Spain
| | - José Luis Álvarez Vega
- Servicio de Reumatología, Hospital Regional Universitario Infanta Cristina, Badajoz, Spain
| | | | - Luis F Linares
- Servicio de Reumatología, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Mireia Moreno
- Servicio de Reumatología, Corporació Sanitària Parc Taulí, Barcelona, Spain
| | | | - Xavier Juanola
- Servicio de Reumatología, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Pedro Zarco
- Unidad de Reumatología, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
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Torre-Alonso JC, Carmona L, Moreno M, Galíndez E, Babío J, Zarco P, Linares L, Collantes-Estevez E, Barrial MF, Hermosa JC, Coto P, Suárez C, Almodóvar R, Luelmo J, Castañeda S, Gratacós J. Identification and management of comorbidity in psoriatic arthritis: evidence- and expert-based recommendations from a multidisciplinary panel from Spain. Rheumatol Int 2017; 37:1239-1248. [DOI: 10.1007/s00296-017-3702-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 03/14/2017] [Indexed: 02/08/2023]
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7
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Torre-Alonso J, Carmona L, Moreno M, Galíndez E, Babío J, Zarco P, Linares L, Collantes E, Fernández-Barrial M, Hermosa J, Coto P, Suárez C, Almodόvar R, Luelmo J, Cárcaba V, Castañeda S, Gratacόs J. FRI0457 Recommendations for The Management of Comorbidities in Psoriatic Disease: Table 1. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3440] [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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8
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Carmona L, Torre-Alonso J, Moreno M, Galíndez E, Babío J, Zarco P, Linares L, Collantes E, Fernández-Barrial M, Hermosa J, Coto P, Suárez C, Almodόvar R, Luelmo J, Cárcaba V, Castañeda S, Otόn T, Curbelo R, Gratacόs J. FRI0458 Assessment of Comorbidity in Psoriatic Disease: How Often Should Be Performed?: Table 1. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3484] [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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9
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Díaz-Andrade MC, Galíndez E, Estecondo S. The ovary of the bignose fanskate Sympterygia acuta Garman, 1877 (Chondrichthyes, Rajidae) in the Bahía Blanca estuary, Argentina: morphology and reproductive features. BRAZ J BIOL 2009; 69:405-13. [DOI: 10.1590/s1519-69842009000200025] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2007] [Accepted: 09/10/2007] [Indexed: 11/22/2022] Open
Abstract
Chondrichthyes have become an important economic resource in recent years. In spite of this importance, there is little knowledge about their reproductive biology, especially of species from the south-western Atlantic. In this work, we study the morphology and histology of the ovary of Sympterygia acuta. The results show that oogonia were present only in the immature females (stage I of maturity scale), whereas specimens in stages II and III of maturity displayed oocytes in all developmental steps. The most important histological features that vary throughout oocyte development are the presence or absence of yolk, the number of types and layers of follicular cells and the degree of development of the thecae. Follicular cells are, at least, of two different types. Finally, a new point of view for the determination of maturity stages in the field based on the size of follicles is discussed.
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10
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Naredo E, Rodríguez M, Campos C, Rodríguez-heredia JM, Medina JA, Giner E, Martínez O, Toyos FJ, Ruíz T, Ros I, Pujol M, Miquel X, García L, Aznar JJ, Chamizo E, Páez M, Morales P, Rueda A, Tuneu R, Corominas H, de Agustín JJ, Moragues C, Mínguez D, Willisch A, González-cruz I, Aragón A, Iglesias G, Armas C, Pablo valdazo J, Vargas C, Calvo-alén J, Juan-mas A, Salvador G, Puigdollers A, Galíndez E, Garrido N, Salaberri J, Raya E, Salles M, Díaz C, Cuadra JL, Garrido J. Validity, reproducibility, and responsiveness of a twelve-joint simplified power doppler ultrasonographic assessment of joint inflammation in rheumatoid arthritis. ACTA ACUST UNITED AC 2008; 59:515-22. [DOI: 10.1002/art.23529] [Citation(s) in RCA: 233] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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11
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de Márquez ML, Galíndez E, Camacho G, Carvajal R, Mata M, Tombazzi C, Castro E, Marques F, Escudero J, Lecuna V. [Epidemiology of viral hepatitis in Venezuela: preliminary results of phase 1. Prevalence in the metropolitan area]. G E N 1993; 47:215-20. [PMID: 8050698] [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] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Two different areas of metropolitan zone in Venezuela were studied in relationship to the immunological condition associated with A, B, C and D viral hepatitis in 557 healthy subjects. We performed clinical history with personal information, that was subsequently correlated with results of the hepatitis markers. General results show prevalence different from previous reports: Anti-HAV: 90.84%, HBsAg: 1.62%, Anti-HBc: 10.6%, Anti-HCV: 0.36% y Anti HDV: 0%.
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Affiliation(s)
- M L de Márquez
- Unidad de investigación, Escuela Luis Razetti, Facultad de Medicina, Hospital Universitario de Caracas
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12
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Neirotti R, Kreutzer G, Galíndez E, Becú L, Ross D. Supravalvular mitral stenosis associated with ventricular septal defect. Am J Dis Child 1977; 131:862-5. [PMID: 888800 DOI: 10.1001/archpedi.1977.02120210040009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
We describe three patients with supravalvular mitral stenosis caused by a diaphragm located just above the mitral valve and associated with a ventricular septal defect. Two of our three patients also had an associated coarctation of the aorta. The physical signs, ECGs, chest roentgenograms, and cardiac catheterization data are described. Points helpful in the differential diagnosis of this malformation are emphasized. All three patients were treated successfully by surgery.
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13
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Kreutzer G, Neirotti R, Galíndez E, Coronel AR, Kreutzer E. Anatomic correction of transposition of the great arteries. J Thorac Cardiovasc Surg 1977; 73:538-42. [PMID: 839843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Complete anatomic correction of transposition of the great arteries (TGA) and ventricular septal defect (VSD) was performed on 2 infants with high pulmonary arterial resistance. Both patients were operated upon under deep surface-induced hypothermia and limited cardiopulmonary bypass. Direct repair of the anomaly was accomplished by switching the aorta and the pulmonary artery with reattachment of the coronary arteries. The clinical result in the first patient was satisfactory. The postoperative cardiac catheterization and angiogram demonstrated no gradient across either outflow tracts and normal arrangement of the great vessels. The second patient died in the operating room, probably owing to compression or kinking of the left coronary artery.
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14
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Kreutzer G, Galíndez E, Schlichter A, Neirotti R, González Parente A. [Truncus arteriosus: correction with deep hypothermia]. Arch Inst Cardiol Mex 1974; 44:776-81. [PMID: 4411373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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15
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Kreutzer G, Schlichter A, Galíndez E, Neirotti R, Rodríguez Coronel A. Surgery for hemodynamic correction of transposition. A procedure that preserves atrial conduction pathways. J Thorac Cardiovasc Surg 1974; 68:203-8. [PMID: 4276394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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16
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Kreutzer G, Galíndez E, Bono H, De Palma C, Laura JP. An operation for the correction of tricuspid atresia. J Thorac Cardiovasc Surg 1973; 66:613-21. [PMID: 4518787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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17
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Galíndez E. [Statistical method in scientific investigation. Its use in the investigation of dental materials]. Acta Odontol Venez 1973; 11:115-23. [PMID: 4143791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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