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Albayrak F, Gür M, Karataş A, Koca SS, Kısacık B. Is the use of secukinumab after anti-TNF therapy greater than expected for the risk of developing inflammatory bowel disease? Reumatol Clin (Engl Ed) 2024; 20:123-127. [PMID: 38494303 DOI: 10.1016/j.reumae.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 11/16/2023] [Indexed: 03/19/2024]
Abstract
OBJECTIVE In this study, our objective was to present real-life data on the incidence of inflammatory bowel disease (IBD) among patients receiving secukinumab treatment. METHODS The study consisted of 209 patients who had prior exposure to anti-tumor necrosis factor (TNF) or were biologically naive. Patients with a pre-existing history of IBD were excluded from the study. RESULTS Of the 209 patients in the study, 176 (84.3%) had ankylosing spondylitis, while 33 (15.7%) had psoriatic arthritis. 112 (53.6%) patients had prior exposure to at least one anti-TNF treatment before initiating secukinumab. IBD developed in 10 (4.8%) of the 209 patients. The incidence of IBD among patients who initiated secukinumab as their first biologic agent was 1%. For patients who had previously received any anti-TNF treatment and subsequently transitioned to secukinumab, the incidence of IBD was 8% (p=0.018, odds ratio (OR): 8.38, 95% CI: 1.04-67.45). A mean of 3.67 months (±4.3) after anti-TNF use, whereas IBD symptoms developed in the biologically naive patient after 15 months. CONCLUSION Our study observed IBD incidence in 4.8% of patients using secukinumab. Patients who initiated secukinumab after previous anti-TNF treatment exhibited a significantly higher rate and risk of developing IBD. The onset of IBD occurred earlier in these patients (mean 3.67 months), whereas a single case of IBD showed a longer duration (15 months). Further studies with larger patient numbers are warranted to provide a more comprehensive understanding of our findings.
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Affiliation(s)
- Fatih Albayrak
- Department of Internal Medicine, Division of Rheumatology, Dr. Ersin Arslan Training and Research Hospital, Şehitkamil, Gaziantep, Turkey.
| | - Mustafa Gür
- Department of Internal Medicine, Division of Rheumatology, Fırat University Faculty of Medicine, Elazığ, Turkey
| | - Ahmet Karataş
- Department of Internal Medicine, Division of Rheumatology, Fırat University Faculty of Medicine, Elazığ, Turkey
| | - Süleyman Serdar Koca
- Department of Internal Medicine, Division of Rheumatology, Fırat University Faculty of Medicine, Elazığ, Turkey
| | - Bünyamin Kısacık
- Department of Rheumatology, Gaziantep Sanko Hospital, Şehitkamil, Gaziantep, Turkey
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Belinchón-Romero I, López-Ferrer A, Ferrán I Farrés M, Rivera-Díaz R, Vidal-Sarro D, Rodríguez Fernández-Freire L, de la Cueva-Dobao P, Santos-Juanes J, Rocamora-Durán V, Martín-Vázquez V, Gómez-Labradror L, Queiro-Silva R. Validation of the Spanish Version of the PURE-4 Questionnaire for the Early Detection of Psoriatic Arthritis in Psoriatic Patients. Actas Dermosifiliogr 2024:S0001-7310(24)00153-4. [PMID: 38382746 DOI: 10.1016/j.ad.2024.02.012] [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: 11/20/2023] [Revised: 12/19/2023] [Accepted: 02/12/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND AND OBJECTIVE Psoriasis often precedes the onset of psoriatic arthritis (PsA), so dermatologists often face the challenge of early identifying signs of PsA in patients with psoriasis. Our aim was to validate the Spanish version of the PURE-4 questionnaire as a screening tool for PsA, evaluate its performance in terms of sensitivity, specificity, feasibility, reliability, and build validity. METHODS This was a cross-sectional, observational, multicenter trial of adult patients with psoriasis. Initially, patients were assessed by a dermatologist and completed 2 self-administered versions (in print and online) of the PURE-4 questionnaire. Afterwards, the rheumatologist, blinded to the PURE-4 results, assessed the presence/absence of PsA, being the reference to determine the performance of the PURE-4 questionnaire. RESULTS A total of 268 patients were included (115 [42.9%] women; mean age, 47.1±12.6). The prevalence of PsA according to rheumatologist diagnosis was 12.7% (34 patients). The mean PURE-4 score for patients with psoriasis diagnosed with PsA was 2.3±1.1, and 1.3±1.3 for patients without PsA (P<.001). The cutoff value ≥2 demonstrated the best performance for detecting PsA, with a negative predictive value of 95.1% (95% confidence interval, 90.3-97.6). CONCLUSIONS The PURE-4 questionnaire demonstrated good performance in detecting PsA, with an optimal cutoff point ≥2. This simple tool could facilitate early referral of patients to the rheumatology unit.
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Affiliation(s)
- I Belinchón-Romero
- Departamento de Dermatología, Hospital General Universitario Dr. Balmis de Alicante-ISABIAL, Universidad Miguel Hernández, Alicante, España.
| | - A López-Ferrer
- Departamento de Dermatología, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | | | - R Rivera-Díaz
- Departamento de Dermatología, Hospital 12 de Octubre, Universidad Complutense, Madrid, España
| | - D Vidal-Sarro
- Departamento de Dermatología, Hospital de Sant Joan Despí Moisés Broggi, Barcelona, España
| | | | - P de la Cueva-Dobao
- Departamento de Dermatología, Hospital Universitario Infanta Leonor, Madrid, España
| | - J Santos-Juanes
- Departamento de Dermatología, Hospital Universitario Central de Asturias, Oviedo, España
| | - V Rocamora-Durán
- Departamento de Dermatología, Hospital de Manacor, Palma de Mallorca, Islas Baleares, España
| | | | | | - R Queiro-Silva
- División de Reumatología, Hospital Universitario Central de Asturias, Oviedo, España
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Pinto Tasende JA, Iñiguez Ubiaga CL, Quevedo Vila VE, Fernández Dominguez L, Maceiras Pan FJ, García Porrúa C. The activity of psoriatic arthritis with axial involvement correlates with the PsAID12. Reumatol Clin (Engl Ed) 2024; 20:80-83. [PMID: 38342739 DOI: 10.1016/j.reumae.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 08/11/2023] [Indexed: 02/13/2024]
Abstract
OBJECTIVE To determine the impact of the disease in patients with PsA in daily clinical practice and to evaluate its relationship with its axial activity. METHODS A cross-sectional study was conducted in consecutive patients attended from January 2021 to December 2021 who met the CASPAR criteria, with clinical of inflammatory back pain and positive axial imaging, with or without peripheral involvement. Demographic, clinical, analytical data, HAQ index, PsAID12 and activity index (BASDAI and ASDAS-PCR) were also collected. Patients were divided into two groups, those with high impact and those with low impact according to PsAID results. Continuous variables are shown as median (Q1-Q3) and categorical variables as percentages and frequencies. RESULTS Of the 269 patients evaluated with PsA, 72 patients with axial involvement were included, 40 men (55.6%), with a median age of 54.1 years and disease duration of 7 years. 28.3% of the patients were obese and serum CRP level was 0.45 mg/dl (0.08-1.10). BASDAI was 4.2 (2.0-6.2) and ASDAS-PCR was 2.4 (1.5-3.2), which translates into 39.6% of patients in low activity or remission. The median PsAID total score was 3.9 (1.6-5.4), evaluated in 61 patients. The patients who achieved a PsAID12 ≤ 4 were 63%, mostly men and with lower CRP levels than PsAID ≥ 4 patients. In addition, low impact measured by the PsAID12 was associated with low results in BASDAI and ASDAS-PCR. CONCLUSIONS Axial involvement reflected lower impact of the disease measured by PsAID12 and it is correlated with low activity measured by BASDAI and ASDAS-PCR.
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Wahba MAWA, El-Gazzar NM, Elsharaby RM, Tabra SA. DKK-1 in psoriatic arthritis: Correlation with disease activity and enthesopathy. Reumatol Clin (Engl Ed) 2024; 20:14-19. [PMID: 38233008 DOI: 10.1016/j.reumae.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 06/08/2023] [Indexed: 01/19/2024]
Abstract
BACKGROUND Psoriatic arthritis (PsA) is a complex inflammatory disease with varied clinical characteristics. A pathognomonic characteristic of PsA is enthesitis. Entheseal inflammation ultimately leads to the production of new bone (enthesophytes). Dickkopf-related protein-1 (DKK-1) is a wingless (Wnt) inhibitor that inhibits osteoblast function. OBJECTIVES Assessment of the serum level of DKK-1 and its association with disease activity and enthesopathy in PsA patients. METHODS This observational case-control study included 50 PsA patients and 50 healthy volunteers matched for age and gender. All participants were subjected to full medical history, clinical assessment, PSA activity using Disease Activity Index for Psoriatic Arthritis (DAPSA) score, the severity and extent of psoriasis were determined by the Psoriasis Area and Severity Index (PASI). Ultrasonographic assessment of the entheses was done in accordance with the Madrid Sonographic Enthesitis Index (MASEI). Serum level of DKK-1 and correlation with disease activity and enthesopathy in PsA patients were assessed. RESULTS There was no significant difference between patients and controls regarding age and sex. The mean value of SPARCC index, DAPSA score and PASI score were 6.74±4.58, 33.24±15.26, and 8.35±10.93, respectively. There was significant difference between patients and controls regarding the serum levels of DKK-1 and MASEI score (p<0.0001). There was a significant positive correlation between serum DKK-1 and MASEI (r: 0.43527, p: 0.00158), MASEI inflammatory (r: 0.37958, p: 0.00655), and MASEI damage (r: 0.38384, p: 0.00593). CONCLUSIONS Serum DKK-1 levels were elevated in PsA patients and were found to be correlated with MASEI score for enthesopathy.
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Gratacós-Masmitja J, Beltrán Catalán E, Álvarez Vega JL, Urruticoechea-Arana A, Fito C, Maceiras F, Belzunegui Otano JM, Fernández Melón J, Chamizo Carmona E, Abad Hernández MÁ, Ros Vilamajó I, Castro Oreiro S, Pascual Alfonso E, Torre Alonso JC. Real-world apremilast use in biologic-naïve psoriatic arthritis patients. Data from Spanish clinical practice. Reumatol Clin (Engl Ed) 2024; 20:24-31. [PMID: 38233009 DOI: 10.1016/j.reumae.2023.09.004] [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] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 06/15/2023] [Indexed: 01/19/2024]
Abstract
INTRODUCTION Apremilast is approved for treatment of psoriasis and psoriatic arthritis (PsA). Real-world evidence on apremilast effectiveness in clinical practice is limited. METHODS Observational study enrolling adult patients, across 21 Spanish centres, who had initiated apremilast in the prior 6 (±1) months and were biologic naive. Data were collected at routine follow-up visits 6 and 12 months after apremilast initiation. Primary outcome was 6 and 12-month persistence to apremilast. Secondary outcomes included Disease Activity for PsA (DAPSA), joint erosions, enthesitis, dactylitis, and patient-reported quality of life (QoL, measured using the PsA impact of disease [PsAID] questionnaire). RESULTS We included 59 patients. Most had oligoarticular PsA, moderate disease activity, and high comorbidity burden. Three-quarters were continuing apremilast at 6 months and two-thirds at 12 months; mean (SD) apremilast treatment duration was 9.43 (1.75) months. DAPSA scores showed improved disease activity: one-third of patients in remission or low activity at apremilast initiation versus 62% and 78% at 6 and 12 months, respectively. Eleven of 46 patients with radiographic assessments had joint erosions at apremilast initiation and none at month 12. Median (Q1, Q3) number of swollen joints was 4.0 (2.0, 6.0) at apremilast initiation versus 0.0 (0.0, 2.0) at 12 months. Incidence of dactylitis and enthesitis decreased between apremilast initiation (35.6% and 28.8%, respectively) and month 12 (11.6% and 2.4%, respectively). Over two-thirds of patients had a PSAID-9 score <4 (cut-off for patient-acceptable symptom state) at month 12. CONCLUSIONS In Spanish clinical practice, two-thirds of PsA patients continued apremilast at 12 months, with clinical benefits at the joint level, no radiographic progression of erosions, and a positive impact on patient-reported QoL. Trial registration number Clinicaltrials.gov: NCT03828045.
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Affiliation(s)
- Jordi Gratacós-Masmitja
- Rheumatology Service, University Hospital Parc Taulí (I3PT), Medicine Department UAB, Barcelona, Spain
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Martínez-Vidal MP, Jovani V, Noguera-Pons JR, Álvarez-Cienfuegos A. Osteoporosis in psoriatic arthritis: Risk factors, insufficiency fractures and its association with the disease activity. Reumatol Clin (Engl Ed) 2024; 20:8-13. [PMID: 38233011 DOI: 10.1016/j.reumae.2023.05.007] [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] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 05/16/2023] [Indexed: 01/19/2024]
Abstract
OBJECTIVE The prevalence of osteoporosis (OP) and insufficiency fractures in psoriatic arthritis (PsA) remains controversial. The aim of this study was to describe the prevalence of OP and insufficiency fractures in a representative cohort of patients with PsA, and to analyse its association with general risk factors and characteristics of the psoriatic disease in our geographical area. METHODS Multi-centric, descriptive study of patients with PsA. We recorded clinical characteristics, as well as protective and risk factors for OP and insufficiency fractures. Hip and lumbar densitometry and lateral X-ray of the spine were evaluated. Descriptive statistics for OP and risk factors were calculated. The patients with OP were compared to those without by univariate analyses, and results were adjusted by age and sex. The association of OP and fractures with clinical characteristics was analysed by logistic regression. RESULTS 166 patients (50 men; 116 women) were included. OP was present in 26.5%, and it was more frequent in women and patients above 50 years old. Insufficiency fractures occurred in 5.4% of the total sample. In the logistic regression, OP was associated with age over 50 [OR 3.7; 95% CI (1.2-11.6); p=.02]. No association with clinical parameters was found. The most frequent risk factors among patients with OP were vitamin D insufficiency, sedentary behaviour, low calcium intake, and active smoking. In the logistic regression, OP was associated with early menopause [OR 11.7; 95% CI (1.29-106.0); p=.029] and sedentary behaviour [OR 2.3; 95% CI (1.0-5.2); p=.049]. CONCLUSIONS In patients with PsA, OP is more frequent in women and patients over 50 years old. A sedentary lifestyle and early menopause may add extra risk for OP. Type, duration disease, and treatments are not associated with OP or insufficiency fractures.
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Affiliation(s)
| | - Vega Jovani
- Rheumatology Division, Hospital General Universitario de Alicante, Alicante, Spain
| | | | - Antonio Álvarez-Cienfuegos
- Rheumatology Division, Hospital Vega Baja de Orihuela, Alicante, Spain; UCAM University Medical Faculty, Murcia, Spain.
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Alonso S, Morante I, Braña I, Queiro R. Altered sleep in axial spondyloarthritis and psoriatic arthritis: Post hoc comparative study based on a sleep-specific question from the ASAS health index. Reumatol Clin (Engl Ed) 2023; 19:430-435. [PMID: 37805256 DOI: 10.1016/j.reumae.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 01/23/2023] [Indexed: 10/09/2023]
Abstract
BACKGROUND AND AIMS Sleep problems are common in spondyloarthritis (SpA), but the factors associated with them are only partially known. In this study, responses to item #16 from the Assessment of SpondyloArthritis international Society-Health Index (ASAS HI) that explores the sleep category according to the International Classification of Functioning, Disability and Health (ICF) were compared between psoriatic arthritis (PsA) and axial SpA (axSpA). METHODS Post hoc analysis of a multicentre cross-sectional study included a total of 201 consecutive patients. The prevalence, correlations, and disease factors associated with a positive response to item #16 were analyzed in both SpA populations. RESULTS Forty-eight/111 (43.2%) patients with axSpA and 42/90 (46.7%) with PsA reported sleep problems. There was a moderate-high correlation between item #16 and the ASAS HI sum score in both populations (r≥.59). In axSpA, poor sleep was associated with disease activity (OR 8.45, p<.001), biological therapy use (OR .24, p<.05) and CRP levels (OR .16, p<.05). In PsA, disturbed sleep was independently associated with disease activity showing a dose-response effect (OR 1.16, p<.001). Taking both populations together, disease severity (OR 6.33, p<.001) and axSpA (OR .50, p<.05) were independently associated with a positive response to item #16. Correlations between the different components of the ASAS HI and item #16 were markedly different in both populations. CONCLUSIONS A positive response to item #16 was common in both SpA phenotypes. However, the link between inflammatory burden and disturbed sleep was higher in axSpA than in PsA.
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Affiliation(s)
- Sara Alonso
- Rheumatology Division, Hospital Universitario Central de Asturias (HUCA), Oviedo-Asturias, Spain.
| | - Isla Morante
- Rheumatology Division, Hospital de Sierrallana, Torrelavega-Cantabria, Spain
| | - Ignacio Braña
- Rheumatology Division, Hospital Universitario Central de Asturias (HUCA), Oviedo-Asturias, Spain
| | - Rubén Queiro
- Rheumatology Division, Hospital Universitario Central de Asturias (HUCA), Oviedo-Asturias, Spain; ISPA Translational Immunology Division, Oviedo, Spain; Oviedo University School of Medicine, Spain
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Robustillo-Villarino M, Alegre-Sancho JJ, Martínez-Ferrer MDLÁ. Evaluation of the sexual sphere in patients with psoriatic arthritis. Reumatol Clin (Engl Ed) 2023; 19:249-254. [PMID: 37087380 DOI: 10.1016/j.reumae.2022.06.007] [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] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 06/03/2022] [Indexed: 04/24/2023]
Abstract
INTRODUCTION Psoriatic arthritis (PsA) is a chronic inflammatory disorder that primarily affects the joints and entheses. In addition, it is associated with depressive syndrome (DS), cardiovascular disease, hypertension (HT), diabetes mellitus (DM), obesity and psoriasis (Pso). There are few studies aimed to analyze the association of the involvement of the musculoskeletal system with sexual function (SF). METHODS A cross-sectional observational study was proposed in patients diagnosed with PsA, to whom self-administered validated questionnaires were applied to determine alterations in SF: MGH-SFQ and CSFQ-14, which assess the 4 domains of sexual function; Qualisex and DLQI designed for joint and dermatological pathology respectively, which explore sexual aspects. The objective was to describe the existence of altered sexual function in patients with PsA; analyze the association between sociodemographic characteristics, comorbidities (Pso, DS, cardiovascular risk factors) and the treatments of patients on SF; and describe differences of SF according to gender. RESULTS 72 patients were evaluated. It was observed that the variables of patients with PsA that were associated with lower scores in SF were gender and age in the CSFQ-14 and MGH-SFQ; annual incomes, treatment with NSAIDs, DL and depression were associated with worse results in some domains of the sexual sphere. CONCLUSIONS Patients with PsA had impaired SF, especially women, elder patiens, those with low annual incomes, DL and emotional disorders. Anti-inflammatory treatments were associated with better SF. Globally, the chronic disease and the psychological burden behaved as factors associated with sexual dysfunction.
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Loza E, Plazuelo P. Patients with spondyloarthritis including psoriatic arthritis: Current needs, impact, and perspective. Reumatol Clin (Engl Ed) 2023; 19:273-278. [PMID: 37087379 DOI: 10.1016/j.reumae.2022.08.006] [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] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 08/29/2022] [Indexed: 04/24/2023]
Abstract
OBJECTIVE To analyse the current needs of patients with spondyloarthritis (SpA) and psoriatic arthritis (PsA), and the impact of the conditions. METHODS National survey in electronic format for patients with SpA and PsA. The survey was launched on April 28, 2021, using the channels of the Coordinadora Española de Asociaciones de Espondiloartritis (Spanish Coordinator of Associations of Spondyloarthritis) to communicate with members and followers, and was closed on June 30, 2021. Sociodemographic and clinical variables were collected (age, sex, disease duration, treatments), and variables related to the objectives. A descriptive analysis was performed. RESULTS A total of 543 patients with SpA and 291 with PsA were included. In the previous month, on a scale from 0 to 10 (0: none; 10: very high) the mean scores of fatigue, morning stiffness, and sleep problems were all >8. Almost 80% of the patients with SpA reported low back pain and 82.5% of the patients with PsA reported involvement of the knees, ankles, feet and/or hands, and 51% dactylitis. The level of satisfaction with the treatment was low, mean 5.5 in SpA and 6.2 in PsA (scale 0-10). It was higher with biological therapies. We found that 70.2% of patients with SpA and 66% with PsA were used to living with pain every day. Finally, 43.8% of participants with SpA and 31.2% of those with PsA reported that they did not set the treatment goals with their doctors. CONCLUSIONS Currently the impact of SpA and PsA on multiple aspects of daily life is still very high. There are areas for improvement in the doctor-patient relationship and in treatments.
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Affiliation(s)
| | - Pedro Plazuelo
- Coordinadora Española de Asociaciones de Espondiloartritis, Fuenlabrada, Madrid, Spain
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Gratacós J, Pablos JL, de Miguel E, Juanola X, Fernández-Carballido C, Ariza R, Terradas-Montana P, Sastré C, Sanabra C. Disease control in patients with psoriatic arthritis in real clinical practice in Spain: MiDAS study. Reumatol Clin (Engl Ed) 2023; 19:204-210. [PMID: 37061282 DOI: 10.1016/j.reumae.2022.03.008] [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] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 03/29/2022] [Indexed: 04/17/2023]
Abstract
OBJECTIVE MiDAS study assessed the percentage of psoriatic arthritis (PsA) patients treated in routine clinical practice who achieved control of disease activity according to Disease Activity in Psoriatic Arthritis (DAPSA) and Minimal Disease Activity (MDA). METHODS Observational, non-interventional, cross-sectional, multicenter study conducted under conditions of routine clinical practice in 36 centers with outpatient rheumatology clinics in Spanish public hospitals. Patients included were adults (≥18 years) with ≥6 months PsA diagnosis according to classification for PsA (CASPAR) criteria and undergoing treatment ≥3 months. The main variable evaluated was the percentage of patients under remission and low disease activity, assessed through DAPSA and MDA. RESULTS 313 patients with PsA were included: 54.3% male; with mean age of 54.1±12.2 years and mean disease duration of 10.5±9.0 years. Mean C-reactive protein (CRP) serum levels were 4.9±7.3mg/L. At the study visit, 58.5% of patients were in monotherapy (17.6% biological and 40.9% non-biological) and 41.2% were receiving biological and non-biological therapy. 59.4% of patients showed low disease activity (DAPSA≤14) and 19.8% were on remission (DAPSA≤4). Moreover, 51.4% of the patients reached an MDA status (≥5 MDA). CONCLUSIONS Around 40% of PsA patients presented uncontrolled disease, highlighting the need to improve the management of these patients in clinical practice.
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Affiliation(s)
- Jordi Gratacós
- Rheumatology Department, Hospital Universitario Parc Taulí Sabadell, Departamento Medicina UAB, Spain
| | - José L Pablos
- Rheumatology Department, Hospital 12 de Octubre, Madrid, Spain
| | - Eugenio de Miguel
- Rheumatology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Xavier Juanola
- Rheumatology Department, Hospital Universitari Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Rafael Ariza
- Rheumatology Department, Hospital Universitario Virgen de Macarena, Sevilla, Spain
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Almodóvar R, Cañete JD, Collantes E, de Miguel E, Fernández Carballido C, Gratacós J, Juanola X, Pinto JA, Queiro R, Zarco P. Strategies and resources to optimise the management of Psoriatic Arthritis patients: The CREA Project. Reumatol Clin (Engl Ed) 2023; 19:159-167. [PMID: 36068162 DOI: 10.1016/j.reumae.2022.01.002] [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] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/27/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND AIM Psoriatic arthritis (PsA) is a chronic immune-mediated inflammatory disease that affects the musculoskeletal system and skin, and manifests heterogeneously, with a variable course. In current clinical practice, variability and limitations in its follow-up have been observed. The aim of the CREA project was to agree on strategies to improve the initial assessment and follow-up of patients with PsA in Spain. MATERIALS AND METHODS A survey was conducted among a representative sample of expert rheumatologists in Spain, containing 33 questions on current clinical practice, available resources, and current limitations in the follow-up of patients with PsA. The results were discussed in regional meetings and 105 strategies were proposed and finally evaluated by 85 experts in a Delphi consensus. RESULTS The most important limitations in the follow-up of PsA were lack of consultation time, lack of nursing staff, and delays in performing imaging tests. A total of 108 strategies were proposed related to the assessment of quality of life and disease-impact indices; comorbidities and extra-articular manifestations; laboratory tests; imaging tests; physical examination and metrology; and activity and function indices. Of the total, 53 were considered highly advisable, with no regional differences in consensus values. DISCUSSION AND CONCLUSIONS The proposals offered in the current study are applicable to the entire country, respond to the unmet needs detected in the initial survey, form a minimum action framework, and ensure optimal follow-up of patients with PsA.
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Affiliation(s)
- Raquel Almodóvar
- Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain.
| | | | - Eduardo Collantes
- Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Córdoba, Spain
| | | | | | - Jordi Gratacós
- Hospital Universitario Parc Taulí, Sabadell, Spain; Grupo investigación A8G2 del I3PT, Departamento de Medicina de la UAB, Barcelona, Spain
| | | | - José A Pinto
- Complejo Hospitalario Universitario, de A Coruña, INIBIC, A Coruña, Spain
| | - Rubén Queiro
- Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Pedro Zarco
- Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
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Torre Alonso JC, Almodóvar González R, Montilla Morales C, Sanz Sanz J, Díaz González F, Pascual Alfonso E, Gratacós J. Expert recommendations for the use of apremilast in psoriatic arthritis. Reumatol Clin (Engl Ed) 2023; 19:34-44. [PMID: 35537933 DOI: 10.1016/j.reumae.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 01/07/2022] [Indexed: 01/10/2023]
Abstract
INTRODUCTION AND OBJECTIVES Despite the evidence, there are doubts about the positioning of apremilast in the psoriatic arthritis (PsA) treatment algorithm. The objective of this project was to collect the scientific evidence and the experience of a group of rheumatologists who are experts in the management of PsA with apremilast in clinical practice in Spain. MATERIAL AND METHODS A scientific committee made up of 6 experts proposed 5 clinical scenarios where the evidence on the use of apremilast in PsA was controversial: (i) Efficacy in peripheral PsA; (ii) Efficacy in enthesitis and dactylitis; (iii) Efficacy in PsA with skin involvement; (iv) Comorbidities; and (v) Apremilast safety. After this, a panel of 17 rheumatologists with expertise in PsA management discussed these scenarios and generated a questionnaire with 50 questions and 156 items following the Delphi methodology. This questionnaire was anonymously answered by the panel. RESULTS After 2 voting rounds, the panel of experts reached consensus in 93 of the 156 items raised (59.6%) (67 in agreement and 26 in disagreement). The degree of consensus was 53.3% in the area of "Efficacy in peripheral PsA"; 60.0% in "Efficacy in enthesitis and dactylitis"; 50.0% in "Efficacy in PsA with skin involvement"; 57.1% in "Management of comorbidities in patients with PsA"; and 67.3% in "Implications of safety in the use of apremilast". CONCLUSIONS The structured opinion of the experts complements the available evidence and contributes to the establishment of consensual guidelines for the use of apremilast in PsA.
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13
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Lorenzo Martín JA, Pardo Campo E, Pino Martinez M, Colazo Burlato M, Queiro Silva MR. Psoriatic arthritis: interaction between cardiometabolic diseases and inflammatory burden of the disease. Reumatol Clin (Engl Ed) 2022; 18:387-392. [PMID: 34799299 DOI: 10.1016/j.reumae.2021.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 05/26/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND AND OBJETIVES Psoriatic arthritis is accompained by several cardiometabolic comorbidities. Obesity causes a low-grade systemic inflammation and is a negative predictor of treatment response. We wanted to evaluate if there are interactions between metabolic status, inflammatory parameters and disease activity; and whether metabolic or cardiovascular diseases have any association with the reduction of the inflammatory burden by treating the psoriatic arthritis. MATERIAL AND METHODS We have carried out a cross-sectional descriptive study of 160 patients with psoriatic arthritis. Sociodemographic, clinical and analytical variables were collected, as well as the presence of dactylitis and enthesitis; and HAQ, DAPSA and Minimal Disease Activity criteria. Chi-square test and the H of Kruskall Wallis were used to carry out comparisons, considering P < .05 as statistically significant. To establish correlations, Pearson correlation coefficient was used. RESULTS BMI and waist circumference correlate with CRP and ESR (significance: < .05) although the correlation strenght is low (Pearson <.4), but there is no such relationship with DAPSA or meeting MDA criteria. Using biologic therapies is associated with a lower prevalence of cardiovascular events (P = 0.047; OR: 0.12, 95% CI: 0.01-0.9) and enthesitis (P = .008; OR: 0.3, CI 95%: 0.16-0.56); and normal levels of CRP (P = .029; OR: 0.25, 95% CI: 0.07-0.87) and ESR (P = 0.024; OR: 0.36, 95% CI: 0.16-0.82) when comparing to conventional therapies. DISCUSSION AND CONCLUSIONS Anti-TNFα treatment could reduce cardiovascular risk in patients with psoriatic arthritis. There may be higher levels of CRP and ESR in obese individuals without this necessarily implying higher disease activity.
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14
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Abstract
Psoriatic arthritis (PsA) is a type of inflammatory arthritis that is included within the spondyloarthritis, a group of rheumatological diseases characterized by different clinical manifestations and associated comorbidities, that can compromise the quality of life of patients. The diagnosis of PsA is sometimes difficult due to an enormous clinical and radiological variability, including six different domains of involvement: peripheral joint, axial skeleton, skin psoriasis, nail psoriasis, enthesitis and dactylitis. Currently, there are no biomarkers that allow the detection of PsA in patients with psoriasis, so a high level of suspicion is important, mainly by dermatologists, but also by other specialists, such as family doctors. Advances in the knowledge of new immunological mechanisms and joint management by rheumatologists and dermatologists have made it possible to improve the therapeutic approach in patients with PsA.
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15
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Castañeda S, González C, Villaverde V, Lajas Petisco C, Castro MC, Jirout F, Obaya JC, Hermosa JC, Suárez C, García S, Rodero M, León L, López Esteban A, Gobbo M, Alcaide L, Torre-Alonso JC. Development and feasibility of 4 checklists for the evaluation of comorbidity in patients with rheumatoid arthritis, axial spondyloarthritis and psoriatic arthritis: GECOAI Project. Reumatol Clin (Engl Ed) 2022; 18:114-123. [PMID: 35153034 DOI: 10.1016/j.reumae.2020.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 09/03/2020] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To develop and assess the feasibility in daily practice of four comorbidity checklists, for common use in rheumatoid arthritis (RA), axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA). METHODS A multidisciplinary panel of experts on comorbidity was established. Data from the GECOAR, GECOAX and GECOAP projects were analysed and a narrative literature review in Medline on RA, axSpA and PsA comorbidity was performed in order to select the most relevant and common comorbidities across the three diseases. With these results and those obtained from a focus group of patients, in a nominal group meeting, the experts generated preliminary checklists. These were afterwards modified by an external evaluation by two associations, a patients' association and an association of health professionals related to rheumatology. As a result, the final checklists were generated. A cross-sectional study was conducted to test the feasibility of three of the checklists in daily practice, in which eight health professionals evaluated the checklists in five patients with RA, five with axSpA and five with SpA. RESULTS Four comorbidity checklists were designed, three for health professionals (one to assess current comorbidity, one on prevention/health promotion and one with the referral criteria to other health professionals), and another for patients. The feasibility study showed them to be simple, clear, and useful for use in routine clinical practice. CONCLUSIONS The use of specific and common checklists for patients with RA, axSpA and PsA is feasible and might contribute favorably to their prognosis as well as in daily practice.
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Affiliation(s)
- Santos Castañeda
- Servicio de Reumatología, Hospital Universitario de la Princesa, IIS-Princesa, Cátedra UAM-ROCHE, EPID-Futuro, Universidad Autónoma de Madrid (UAM), Madrid, Spain.
| | - Carlos González
- Servicio de Reumatología, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | | | - Cristina Lajas Petisco
- Servicio de Reumatología, IDISSC, Hospital Universitario Clínico de San Carlos, Madrid, Spain
| | - María Carmen Castro
- Servicio de Reumatología, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Fernando Jirout
- Servicio de Reumatología, Hospital Monte Naranco, Oviedo, Spain
| | | | | | - Carmen Suárez
- Servicio de Medicina Interna, Hospital Universitario de La Princesa, IIS-Princesa, Madrid, Spain
| | - Silvia García
- Servicio de Reumatología, Hospital Moises Broggi, Sant Joan Despí, Barcelona, Spain
| | - María Rodero
- Servicio de Reumatología, IDISSC, Hospital Universitario Clínico de San Carlos, Madrid, Spain
| | - Leticia León
- Servicio de Reumatología, IDISSC, Hospital Universitario Clínico de San Carlos, Madrid, Spain
| | - Amparo López Esteban
- Servicio de Reumatología, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Milena Gobbo
- Positivamente Centro de Psicología, Madrid, Spain
| | - Laly Alcaide
- Coordinadora Nacional de Artritis, Madrid, Spain
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16
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Casasola-Vargas J, Flores-Alvarado D, Silveira LH, Sicsik-Ayala S, Reyes-Cordero G, Villanueva Quintero G, Amaya Guerra M, Reyes Orozco SG, Zazueta Montiel BE, Hernández-Paz R, Mendoza-Fuentes A, Bernard-Medina AG, López Rodriguez A, Barbosa Cobos RE, Burgos-Vargas R, Pacheco-Tena C. Recommendations of the Mexican College of Rheumatology for the management of psoriatic arthritis. Reumatol Clin (Engl Ed) 2021; 17:611-621. [PMID: 34305032 DOI: 10.1016/j.reumae.2020.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 12/03/2020] [Indexed: 11/13/2022]
Abstract
Psoriatic arthritis is a chronic systemic inflammatory disease that affects the skin, musculoskeletal structures and other organs and systems compromising functionality, quality of life and reducing the life expectancy of patients. It is a complex disease that requires specialist and timely care and management. The alternatives for treating the manifestations of psoriatic arthritis have increased and the effect of the different agents on specific manifestations has been clarified in recent studies. Therefore, we should incorporate the available evidence to build a strategy for the treatment of these patients. The Mexican College of Rheumatology selected a committee to evaluate these different alternatives and make recommendations. METHODS The study group included 16 rheumatologists and 3 certified dermatologists, selected from different health institutions and regions of the country. An executive committee was formed to coordinate the meetings and a committee of experts selected the literature search criteria, prepared the research questions, rated the quality of the evidence, and produced the recommendations in the different disease domains based on the GRADE methodology. RESULTS 24 updated recommendations were generated for the treatment of patients with psoriatic arthritis. The recommendations establish the role of the drugs currently available in our country. The importance of adequate disease control is emphasized, individualizing the level of involvement of each patient in each of the six domains potentially affected by the disease. In addition, the sequence in the choice of treatments available for each domain is established, based on their efficacy, safety profile and accessibility. CONCLUSIONS With this consensus document, it will be possible to improve the care of patients with psoriatic arthritis. The recommendations were generated based on the best available information and in consideration of the Mexican health system.
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Affiliation(s)
- Julio Casasola-Vargas
- Servicio de Reumatología, Hospital General de México Dr. Eduardo Liceaga, Mexico City, Mexico
| | - Diana Flores-Alvarado
- Facultad de Medicina y Hospital Universitario de la Universidad Autónoma de Monterrey, Nuevo León, Nuevo León, Mexico
| | - Luis H Silveira
- Departamento de Reumatología, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Sandra Sicsik-Ayala
- Hospital De Especialidades 71, Unidad Médica De Alta Especialidad, Instituto Mexicano del Seguro Social, Torreón, Coahuila, Mexico
| | - Greta Reyes-Cordero
- Hospital Ángeles Chihuahua, Facultad de Medicina y Ciencias Biomédicas, Universidad Autónoma de Chihuahua, Chihuahua, Mexico
| | | | - Mario Amaya Guerra
- Centro de Salud y Desarrollo, Universidad de Monterrey, Monterrey, Nuevo León, Mexico
| | - Sara G Reyes Orozco
- Facultad de Medicina y Ciencias Biomédicas, Universidad Autónoma de Chihuahua, Chihuahua, Mexico
| | - Beatriz E Zazueta Montiel
- Centro Médico del Ángel S.C. Centro de Investigación de Enfermedades Reumáticas, Mexicali, Baja California, Mexico
| | | | | | | | | | | | - Rubén Burgos-Vargas
- Servicio de Reumatología, Hospital General de México Dr. Eduardo Liceaga, Mexico City, Mexico
| | - César Pacheco-Tena
- Facultad de Medicina y Ciencias Biomédicas, Universidad Autónoma de Chihuahua, Chihuahua, Mexico.
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Jiménez-Morales A, Cáliz R, Aceituno S, Prades M, Blanch C. A cost-consequence analysis of the preferential use of secukinumab versus adalimumab for the treatment of psoriatic arthritis. ACTA ACUST UNITED AC 2021; 17:536-542. [PMID: 34756316 DOI: 10.1016/j.reumae.2020.05.009] [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: 01/17/2020] [Accepted: 05/13/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To assess the efficiency of secukinumab compared to adalimumab as first biologic treatment for psoriatic arthritis (PsA) from the Spanish National Health System (SNHS) perspective. METHODS A cost-consequence analysis of the cost and clinical response of two treatment strategies was conducted over a 2-year time horizon. A hypothetical cohort of 10 patients with PsA initiated treatment with secukinumab 150mg (cohort A) or adalimumab 40mg (cohort B), respectively. Patients achieving clinical response (ACR20/50/70) at week 24 continued the initial treatment, while patients with inadequate response switched to secukinumab 300mg. Pharmacological costs were calculated based on SmPC (notified ex-factory price). The lowest cost of adalimumab biosimilar was considered. Data on clinical response were extracted from the two matching-adjusted indirect comparison (MAIC) published comparing secukinumab vs adalimumab. Results were expressed as the cost difference between the two cohorts (€, 2019) and were calculated for each clinical response criteria (ACR20/50/70) and for each MAIC. Sensitivity analysis assessed the impact of potential discounts on the cost of adalimumab while maintaining the cost of secukinumab unchanged. RESULTS Depending on the MAIC used, the cost of initiating biologic treatment for PsA with secukinumab 150mg was 18-33% lower than the one estimated for adalimumab 40mg, for ACR20, 18-28% for ACR50, and 16-23% for ACR70 response rate. Sensitivity analysis showed that it would be necessary a discount of 40-60%, 40-65% and 50-75% over the adalimumab cost to compensate for the differences in efficacy observed for ACR20/50/70, respectively, depending on the MAIC used. CONCLUSION In patients with PsA, secukinumab could be considered a more efficient first-line biologic treatment compared to adalimumab, from the SNHS perspective.
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Affiliation(s)
| | - Rafael Cáliz
- Virgen de las Nieves University Hospital, Granada, Spain
| | | | | | - Carles Blanch
- Novartis Pharmaceuticals, Novartis Farmacéutica, Barcelona, Spain.
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18
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Vidal Alejandre B, Tovar Sugrañes E, López Poza R, Andrés M, Martínez-Vidal MP. Human papilloma virus screening: evaluation of testing and surveillance in rheumatoid arthritis, psoriatic arthritis and systemic lupus erythematosus. ACTA ACUST UNITED AC 2021; 17:494-498. [PMID: 34756309 DOI: 10.1016/j.reumae.2020.05.007] [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: 12/08/2019] [Accepted: 05/14/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVES Immunosuppression is a known risk factor for cervical cancer. Women with rheumatic conditions are immunosuppressed due to the disease and the treatments. One of the main risk factors for this neoplasm is the lack of adherence to early detection programmes for human papillomavirus. The objectives of this study were to evaluate the adherence to the screening programme of patients in the Rheumatology Clinic, as well as to evaluate the prevalence of cervical lesions and their association with the different disease characteristics and the treatments received. METHODS A descriptive retrospective study. The electronic medical history of patients actively being followed up in a tertiary hospital with rheumatoid arthritis (RA), psoriatic arthritis (PSA) and systemic lupus erythematosus (SLE) were reviewed. RESULTS Finally, 307 patients were included. No data were found for screening programme attendance in up to 42.4% of the patients (39.6% in RA, 43.8% in PSA and 46% in SLE). Among the patients who attended the screening programme at least once (57.6%), the prevalence of cervical dysplasia was 5.1%. No cases of neoplasia were found. In the simple logistic regression analysis, there was no association between attending the screening programme and any variable. The study also showed no association between the variables collected and the presence of infection and dysplasia. CONCLUSION These results are influenced by the absence of screening data in a significant percentage of patients and by the low prevalence of dysplasia found in this series of patients with rheumatic diseases.
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Affiliation(s)
| | | | | | - Mariano Andrés
- Sección de Reumatología, Hospital General Universitario de Alicante, Alicante, Spain
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19
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Guillen Astete CA, Gaite Gonzalez I, Zurita Prada PA, Urrego Laurin C. Delay and diagnostic pathway of patients with psoriatic arthritis in Spain. ACTA ACUST UNITED AC 2021; 17:525-9. [PMID: 34756314 DOI: 10.1016/j.reumae.2020.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 05/13/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION AND OBJECTIVES Delayed diagnosis results in a worse prognosis in patients with psoriatic arthritis. Our objective is to determine the diagnostic delay, the specialties consulted and the referral points of patients with psoriatic arthritis in our environment. PATIENTS AND METHODS We distributed a survey to members of the Spanish association Acción Psoriasis inquiring about the objectives of the study. RESULTS A total of 503 surveys were analysed. The diagnostic delay was 4.01 ± 1.42 years. The proportion of patients who had consulted, before diagnosis, primary care was 79.9%, traumatology 33.8% and the emergency department was 30.2%. The proportion of referrals that eventually led to diagnosis came from primary care in 29.3% of cases, traumatology 15.8% and the emergency department 3.5%. DISCUSSION AND CONCLUSIONS The delay in diagnosis far outweighs other European results. Emergency departments are an important transit point for these patients, but the proportion of referrals is very low. We believe that focusing on the importance of early diagnosis in this particular medical sector could resolve a large part of diagnostic delay.
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20
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Lorenzo Martín JA, Pardo Campo E, Pino Martinez M, Colazo Burlato M, Queiro Silva MR. Psoriatic arthritis: interaction between cardiometabolic diseases and inflammatory burden of the disease. Reumatol Clin (Engl Ed) 2021; 18:S1699-258X(21)00153-4. [PMID: 34275767 DOI: 10.1016/j.reuma.2021.05.005] [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] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 04/11/2021] [Accepted: 05/26/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND OBJETIVES Psoriatic arthritis is accompained by several cardiometabolic comorbidities. Obesity causes a low-grade systemic inflammation and is a negative predictor of treatment response. We wanted to evaluate if there are interactions between metabolic status, inflammatory parameters and disease activity; and whether metabolic or cardiovascular diseases have any association with the reduction of the inflammatory burden by treating the psoriatic arthritis. MATERIAL AND METHODS We have carried out a cross-sectional descriptive study of 160 patients with psoriatic arthritis. Sociodemographic, clinical and analytical variables were collected, as well as the presence of dactylitis and enthesitis; and HAQ, DAPSA and Minimal Disease Activity criteria. Chi-square test and the H of Kruskall Wallis were used to carry out comparisons, considering P<.05 as statistically significant. To establish correlations, Pearson correlation coefficient was used. RESULTS BMI and waist circumference correlate with CRP and ESR (significance: <.05) although the correlation strenght is low (Pearson<.4), but there is no such relationship with DAPSA or meeting MDA criteria. Using biologic therapies is associated with a lower prevalence of cardiovascular events (P=0.047; OR: 0.12, 95% CI: 0.01-0.9) and enthesitis (P=.008; OR: 0.3, CI 95%: 0.16-0.56); and normal levels of CRP (P=.029; OR: 0.25, 95% CI: 0.07-0.87) and ESR (P=0.024; OR: 0.36, 95% CI: 0.16-0.82) when comparing to conventional therapies. DISCUSSION AND CONCLUSIONS Anti-TNFα treatment could reduce cardiovascular risk in patients with psoriatic arthritis. There may be higher levels of CRP and ESR in obese individuals without this necessarily implying higher disease activity.
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21
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Casasola-Vargas J, Flores-Alvarado D, Silveira LH, Sicsik-Ayala S, Reyes-Cordero G, Villanueva Quintero G, Amaya Guerra M, Reyes Orozco SG, Zazueta Montiel BE, Hernández-Paz R, Mendoza-Fuentes A, Bernard-Medina AG, López Rodriguez A, Barbosa Cobos RE, Burgos-Vargas R, Pacheco-Tena C. Recommendations of the Mexican College of Rheumatology for the management of psoriatic arthritis. Reumatol Clin (Engl Ed) 2021; 17:S1699-258X(21)00029-2. [PMID: 33931333 DOI: 10.1016/j.reuma.2020.12.004] [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] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 10/20/2020] [Accepted: 12/03/2020] [Indexed: 11/15/2022]
Abstract
Psoriatic arthritis is a chronic systemic inflammatory disease that affects the skin, musculoskeletal structures and other organs and systems compromising functionality, quality of life and reducing the life expectancy of patients. It is a complex disease that requires specialist and timely care and management. The alternatives for treating the manifestations of psoriatic arthritis have increased and the effect of the different agents on specific manifestations has been clarified in recent studies. Therefore, we should incorporate the available evidence to build a strategy for the treatment of these patients. The Mexican College of Rheumatology selected a committee to evaluate these different alternatives and make recommendations. METHODS The study group included 16 rheumatologists and 3 certified dermatologists, selected from different health institutions and regions of the country. An executive committee was formed to coordinate the meetings and a committee of experts selected the literature search criteria, prepared the research questions, rated the quality of the evidence, and produced the recommendations in the different disease domains based on the GRADE methodology. RESULTS 24 updated recommendations were generated for the treatment of patients with psoriatic arthritis. The recommendations establish the role of the drugs currently available in our country. The importance of adequate disease control is emphasized, individualizing the level of involvement of each patient in each of the six domains potentially affected by the disease. In addition, the sequence in the choice of treatments available for each domain is established, based on their efficacy, safety profile and accessibility. CONCLUSIONS With this consensus document, it will be possible to improve the care of patients with psoriatic arthritis. The recommendations were generated based on the best available information and in consideration of the Mexican health system.
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Affiliation(s)
- Julio Casasola-Vargas
- Servicio de Reumatología. Hospital General de México Dr. Eduardo Liceaga, Ciudad de México, México
| | - Diana Flores-Alvarado
- Facultad de Medicina y Hospital Universitario de la Universidad Autónoma de Monterrey, Nuevo León, Nuevo León, México
| | - Luis H Silveira
- Departamento de Reumatología. Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | - Sandra Sicsik-Ayala
- Hospital de Especialidades 71. Unidad Médica De Alta Especialidad, Instituto Mexicano del Seguro Social, Torreón, Coahuila, México
| | - Greta Reyes-Cordero
- Hospital Ángeles Chihuahua, Facultad de Medicina y Ciencias Biomédicas, Universidad Autónoma de Chihuahua, Chihuahua, México
| | | | - Mario Amaya Guerra
- Centro de Salud y Desarrollo. Universidad de Monterrey, Monterrey, Nuevo León, México
| | - Sara G Reyes Orozco
- Facultad de Medicina y Ciencias Biomédicas, Universidad Autónoma de Chihuahua, Chihuahua, México
| | - Beatriz E Zazueta Montiel
- Centro Médico del Ángel S.C. Centro de Investigación de Enfermedades Reumáticas, Mexicali, Baja California, México
| | | | | | | | | | - Rosa E Barbosa Cobos
- Departamento de Reumatología, Hospital Juárez de México, Ciudad de México, México
| | - Rubén Burgos-Vargas
- Servicio de Reumatología. Hospital General de México Dr. Eduardo Liceaga, Ciudad de México, México
| | - César Pacheco-Tena
- Facultad de Medicina y Ciencias Biomédicas, Universidad Autónoma de Chihuahua, Chihuahua, México.
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22
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García Porrúa C, Maceiras Pan FJ, Mosquera Martínez JA, Carmona L, Correa Rey B, Fernández Domínguez L, Álvarez Rivas MN, Pinto Tasende JA. Epidemiological Characteristics and Adverse Events of Patients with Psoriatic Arthritis Undergoing Treatment with Biological Therapies in Galicia. Reumatol Clin (Engl Ed) 2021; 17:150-154. [PMID: 31257022 DOI: 10.1016/j.reuma.2019.04.006] [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] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 03/13/2019] [Accepted: 04/30/2019] [Indexed: 06/09/2023]
Abstract
UNLABELLED Patients with severe forms of psoriatic arthritis (PsA) usually require treatment with biological agents. A greater knowledge of this subgroup of patients and their treatment enables better decision making in real clinical practice. METHODS Longitudinal, multicentric observational study. We included all patients older than 16 years diagnosed with PsA in treatment with biological therapies from January 1, 2011 to December 31, 2015 treated in 6 Galician hospitals. RESULTS Six hundred and fourpatients with PsA received biological therapies. Etanercept was the most used biological treatment. The average time of follow-up was 2.5 years and 67.9% were being treated with the first biological treatment. They were mostly patients with the peripheral subtype and met the criteria for clinical remission. Thirty-two percent had positive HLA-B27 and it was associated with axial PA subtypes. The prevalence of tuberculosis treated previously was 5.9%, and 23% of patients received chemoprophylaxis for latent tuberculosis. Twenty-four patients had undergone a prosthetic replacement. Hip prosthesis was the most frequent. Ninety-nine cases were treated for affective disorders. A diagnosis of fibromyalgia was established in 11 cases mostly women. Of the cases, 6.6% had episodes of serious infections, with respiratory infections being the most frequent. Sixteen tumours were detected (2.9%). Prostate cancer and gynaecological tumours were the most frequent. As with infections, the greater the age the greater the risk of presenting a tumour. CONCLUSIONS We describe the epidemiological and safety characteristics in real life of a Galician multicentre cohort of patients with psoriatic arthritis under biological treatment.
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Affiliation(s)
- Carlos García Porrúa
- Servicio de Reumatología, Hospital Universitario Lucus Augusti (HULA), Lugo, España.
| | | | | | | | - Blanca Correa Rey
- Servicio de Reumatología, Complexo Hospitalario Universitario de Ferrol, Ferrol, España
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23
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Podoswa-Ozerkovsky N, Amaya-Guerra M, Barba-Gómez JF, Estrada-Aguilar L, Gómez-Flores M, Lopeztello-Santillan AL, Maldonado-García CA, Rivera-Gómez MI, Villanueva-Quintero DG, León-Dorantes G. Expert recommendations for biological treatment in patients with psoriasis. GAC MED MEX 2020; 156:446-453. [PMID: 33372929 DOI: 10.24875/gmm.m20000441] [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] [Indexed: 11/17/2022] Open
Abstract
In recent years, the introduction of a series of biological drugs for the treatment of psoriasis has considerably increased the therapeutic armamentarium of doctors, and thus a strongly positive impact on the control of this condition has been achieved. With the purpose to provide the best recommendations for the use of these biological agents in patients with psoriasis, the Mexican group of psoriasis experts, PSOMEX, has developed recommendations in order to improve the understanding and therapeutic positioning of this type of medications.
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Affiliation(s)
- Nancy Podoswa-Ozerkovsky
- Dermatology Department, Regional General Hospital No. 1, Instituto Mexicano del Seguro Social, Mexico City. Mexico
| | - Mario Amaya-Guerra
- Dermatology Department, Health and Development Center, Universidad de Monterrey, Nuevo León. Mexico
| | - José F Barba-Gómez
- Instituto Dermatológico de Jalisco Dr. José Barba Rubio, Jalisco. Mexico
| | - Lorena Estrada-Aguilar
- Dermatology Department, Hospital Regional "Lic. Adolfo López Mateos", Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Mexico City. Mexico
| | - Minerva Gómez-Flores
- Dermatology Department, University Hospital, Universidad Autónoma de Nuevo León, Nuevo León. Mexico
| | | | - César A Maldonado-García
- Psoriasis Clinic Head Office, Centro Dermatológico "Dr. Ladislao de la Pascua", Mexico City. Mexico
| | - Mónica I Rivera-Gómez
- Dermatology Department, Specialty Hospital, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Mexico City. Mexico
| | | | - Gladys León-Dorantes
- Unidad de Innovación Clínica y Epidemiológica del Estado de Guerrero, Guerrero. Mexico
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Castañeda S, González C, Villaverde V, Lajas Petisco C, Castro MC, Jirout F, Obaya JC, Hermosa JC, Suárez C, García S, Rodero M, León L, López Esteban A, Gobbo M, Alcaide L, Torre-Alonso JC. Development and feasibility of 4 checklists for the evaluation of comorbidity in patients with rheumatoid arthritis, axial spondyloarthritis and psoriatic arthritis: GECOAI Project. Reumatol Clin (Engl Ed) 2020; 18:S1699-258X(20)30225-4. [PMID: 33293243 DOI: 10.1016/j.reuma.2020.09.003] [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] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 07/28/2020] [Accepted: 09/03/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To develop and assess the feasibility in daily practice of four comorbidity checklists, for common use in rheumatoid arthritis (RA), axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA). METHODS A multidisciplinary panel of experts on comorbidity was established. Data from the GECOAR, GECOAX and GECOAP projects were analysed and a narrative literature review in Medline on RA, axSpA and PsA comorbidity was performed in order to select the most relevant and common comorbidities across the three diseases. With these results and those obtained from a focus group of patients, in a nominal group meeting, the experts generated preliminary checklists. These were afterwards modified by an external evaluation by two associations, a patients' association and an association of health professionals related to rheumatology. As a result, the final checklists were generated. A cross-sectional study was conducted to test the feasibility of three of the checklists in daily practice, in which eight health professionals evaluated the checklists in five patients with RA, five with axSpA and five with SpA. RESULTS Four comorbidity checklists were designed, three for health professionals (one to assess current comorbidity, one on prevention/health promotion and one with the referral criteria to other health professionals), and another for patients. The feasibility study showed them to be simple, clear, and useful for use in routine clinical practice. CONCLUSIONS The use of specific and common checklists for patients with RA, axSpA and PsA is feasible and might contribute favorably to their prognosis as well as in daily practice.
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Affiliation(s)
- Santos Castañeda
- Servicio de Reumatología, Hospital Universitario de la Princesa, IIS-Princesa, Cátedra UAM-ROCHE, EPID-Futuro, Universidad Autónoma de Madrid (UAM), Madrid, España.
| | - Carlos González
- Servicio de Reumatología, Hospital Universitario Gregorio Marañón, Madrid, España
| | - Virginia Villaverde
- Servicio de Reumatología, Hospital Universitario de Móstoles, Madrid, España
| | - Cristina Lajas Petisco
- Servicio de Reumatología, IDISSC, Hospital Universitario Clínico de San Carlos, Madrid, España
| | - María Carmen Castro
- Servicio de Reumatología, Hospital Universitario Reina Sofía, Córdoba, España
| | - Fernando Jirout
- Servicio de Reumatología, Hospital Monte Naranco, Oviedo, España
| | | | | | - Carmen Suárez
- Servicio de Medicina Interna, Hospital Universitario de La Princesa, IIS-Princesa, Madrid, España
| | - Silvia García
- Servicio de Reumatología, Hospital Moises Broggi, Sant Joan Despí, Barcelona, España
| | - María Rodero
- Servicio de Reumatología, IDISSC, Hospital Universitario Clínico de San Carlos, Madrid, España
| | - Leticia León
- Servicio de Reumatología, IDISSC, Hospital Universitario Clínico de San Carlos, Madrid, España
| | - Amparo López Esteban
- Servicio de Reumatología, Hospital Universitario Gregorio Marañón, Madrid, España
| | - Milena Gobbo
- Positivamente Centro de Psicología, Madrid, España
| | - Laly Alcaide
- Coordinadora Nacional de Artritis, Madrid, España
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Belinchón I, Salgado-Boquete L, López-Ferrer A, Ferran M, Coto-Segura P, Rivera R, Vidal D, Rodríguez L, de la Cueva P, Queiro R. Dermatologists' Role in the Early Diagnosis of Psoriatic Arthritis: Expert Recommendations. Actas Dermosifiliogr (Engl Ed) 2020; 111:835-846. [PMID: 32659259 PMCID: PMC7351070 DOI: 10.1016/j.ad.2020.06.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/25/2020] [Accepted: 06/29/2020] [Indexed: 12/31/2022] Open
Abstract
Psoriatic arthritis is a common type of inflammatory arthritis found in up to 40% of patients with psoriasis. Because skin involvement usually precedes joint involvement, dermatologists play a key role in early detection. Early diagnosis is important for reducing the risk of irreversible structural damage, attenuating the deterioration of physical function, and improving patients' quality of life. This consensus statement was drafted by a group of 9 dermatologists and 1 rheumatologist to provide simple recommendations to help dermatologists screen for psoriatic arthritis in patients with psoriasis. The experts offer consensus-based guidelines that draw on a review of available scientific evidence and on experience acquired in routine clinical practice.
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Affiliation(s)
- I Belinchón
- Servicio de Dermatología, Hospital General Universitario de Alicante-ISABIAL-UMH, Alicante, España
| | - L Salgado-Boquete
- Servicio de Dermatología, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, España
| | - A López-Ferrer
- Servicio de Dermatología, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - M Ferran
- Servicio de Dermatología, Hospital del Mar, Barcelona, España
| | - P Coto-Segura
- Servicio de Dermatología, Hospital Álvarez-Buylla, Mieres, Asturias, España
| | - R Rivera
- Servicio de Dermatología, Hospital Universitario 12 de Octubre, Madrid, España
| | - D Vidal
- Servicio de Dermatología, Hospital de Sant Joan Despí Moisès Broggi, Sant Joan Despí, Barcelona, España
| | - L Rodríguez
- Servicio de Dermatología, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - P de la Cueva
- Servicio de Dermatología, Hospital Universitario Infanta Leonor, Madrid, España.
| | - R Queiro
- Servicio de Reumatología, Hospital Universitario Central de Asturias, Oviedo, España
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Vidal Alejandre B, Tovar Sugrañes E, López Poza R, Andrés M, Martínez-Vidal MP. Human Papiloma Virus Screening: Evaluation Of Testing And Surveillance In Rheumatoid Arthritis, Psoriatic Arthritis And Systemic Lupus Erythematosus. Reumatol Clin (Engl Ed) 2020; 17:S1699-258X(20)30135-2. [PMID: 32709510 DOI: 10.1016/j.reuma.2020.05.007] [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] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 02/23/2020] [Accepted: 05/14/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVES Immunosuppression is a known risk factor for cervical cancer. Women with rheumatic conditions are immunosuppressed due to the disease and the treatments. One of the main risk factors for this neoplasm is the lack of adherence to early detection programmes for human papillomavirus. The objectives of this study were to evaluate the adherence to the screening programme of patients in the Rheumatology Clinic, as well as to evaluate the prevalence of cervical lesions and their association with the different disease characteristics and the treatments received. MATERIAL AND METHODS A descriptive retrospective study. The electronic medical history of patients actively being followed up in a tertiary hospital with rheumatoid arthritis, psoriatic arthritis and systemic lupus erythematosus were reviewed. RESULTS Finally, 307 patients were included. No data were found for screening programme attendance in up to 42.4% of the patients (39.6% in rheumatoid arthritis, 43.8% in psoriatic arthritis and 46% in systemic lupus erythematosus). Among the patients who attended the screening programme at least once (57.6%), the prevalence of cervical dysplasia was 5.1%. No cases of neoplasia were found. In the simple logistic regression analysis, there was no association between attending the screening programme and any variable. The study also showed no association between the variables collected and the presence of infection and dysplasia. CONCLUSION These results are influenced by the absence of screening data in a significant percentage of patients and by the low prevalence of dysplasia found in this series of patients with rheumatic diseases.
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Affiliation(s)
| | | | - Raquel López Poza
- Facultad de Medicina, Universidad Miguel Hernández, Alicante, España
| | - Mariano Andrés
- Sección de Reumatología, Hospital General Universitario de Alicante, Alicante, España
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Jiménez-Morales A, Cáliz R, Aceituno S, Prades M, Blanch C. A Cost-Consequence Analysis of the Preferential Use of Secukinumab Versus Adalimumab for the Treatment of Psoriatic Arthritis. Reumatol Clin (Engl Ed) 2020; 17:S1699-258X(20)30132-7. [PMID: 32693948 DOI: 10.1016/j.reuma.2020.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 05/11/2020] [Accepted: 05/13/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To assess the efficiency of secukinumab compared to adalimumab as first biologic treatment for psoriatic arthritis (PsA) from the Spanish National Health System (SNHS) perspective. METHODS A cost-consequence analysis of the cost and clinical response of two treatment strategies was conducted over a 2-year time horizon. A hypothetical cohort of 10 patients with PsA initiated treatment with secukinumab 150mg (cohort A) or adalimumab 40mg (cohort B), respectively. Patients achieving clinical response (ACR20/50/70) at week 24 continued the initial treatment, while patients with inadequate response switched to secukinumab 300mg. Pharmacological costs were calculated based on SmPC (notified ex-factory price). The lowest cost of adalimumab biosimilar was considered. Data on clinical response were extracted from the two matching-adjusted indirect comparison (MAIC) published comparing secukinumab vs adalimumab. Results were expressed as the cost difference between the two cohorts (€, 2019) and were calculated for each clinical response criteria (ACR20/50/70) and for each MAIC. Sensitivity analysis assessed the impact of potential discounts on the cost of adalimumab while maintaining the cost of secukinumab unchanged. RESULTS Depending on the MAIC used, the cost of initiating biologic treatment for PsA with secukinumab 150mg was 18-33% lower than the one estimated for adalimumab 40mg, for ACR20, 18-28% for ACR50, and 16-23% for ACR70 response rate. Sensitivity analysis showed that it would be necessary a discount of 40-60%, 40-65% and 50-75% over the adalimumab cost to compensate for the differences in efficacy observed for ACR20/50/70, respectively, depending on the MAIC used. CONCLUSION In patients with PsA, secukinumab could be considered a more efficient first-line biologic treatment compared to adalimumab, from the SNHS perspective.
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Affiliation(s)
| | - Rafael Cáliz
- Virgen de las Nieves University Hospital, Granada, Spain
| | | | | | - Carles Blanch
- Novartis Pharmaceuticals, Novartis Farmacéutica, Barcelona, Spain.
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Guillen Astete CA, Gaite Gonzalez I, Zurita Prada PA, Urrego Laurin C. Delay and Diagnostic Pathway of Patients with Psoriatic Arthritis in Spain. Reumatol Clin (Engl Ed) 2020; 17:S1699-258X(20)30137-6. [PMID: 32646842 DOI: 10.1016/j.reuma.2020.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 05/08/2020] [Accepted: 05/13/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION AND OBJECTIVES Delayed diagnosis results in a worse prognosis in patients with psoriatic arthritis. Our objective is to determine the diagnostic delay, the specialties consulted and the referral points of patients with psoriatic arthritis in our environment. PATIENTS AND METHODS We distributed a survey to members of the Spanish association Acción Psoriasis inquiring about the objectives of the study. RESULTS A total of 503 surveys were analysed. The diagnostic delay was 4.01±1.42 years. The proportion of patients who had consulted, before diagnosis, primary care was 79.9%, traumatology 33.8% and the emergency department was 30.2%. The proportion of referrals that eventually led to diagnosis came from primary care in 29.3% of cases, traumatology 15.8% and the emergency department 3.5%. DISCUSSION AND CONCLUSIONS The delay in diagnosis far outweighs other European results. Emergency departments are an important transit point for these patients, but the proportion of referrals is very low. We believe that focusing on the importance of early diagnosis in this particular medical sector could resolve a large part of diagnostic delay.
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Affiliation(s)
- Carlos Antonio Guillen Astete
- Servicio de Reumatología, Hospital Universitario Ramón y Cajal, Madrid, España; Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, España; Unidad de Reumatología, Hospital Universitario HLA Moncloa, Madrid, España.
| | | | - Pablo Antonio Zurita Prada
- Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, España; Unidad de Reumatología, Hospital Universitario HLA Moncloa, Madrid, España
| | - Claudia Urrego Laurin
- Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, España; Unidad de Reumatología, Hospital Universitario HLA Moncloa, Madrid, España
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29
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Almodovar R, Joven B, Rodríguez Almaraz E, Melchor S, Rabadán E, Villaverde V, Navío T, Cebrián Méndez L, Lojo Oliveira L, Prada A, González L, García Martos Á, Navarro-Compán V, Loza E, Zarco P. Comparative results of the implementation in daily practice of an evaluation checklist for patients with axial spondyloarthritis and psoriatic arthritis. ACTA ACUST UNITED AC 2020; 17:392-396. [PMID: 34301382 DOI: 10.1016/j.reumae.2019.11.002] [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: 03/26/2019] [Accepted: 11/21/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To analyse and compare changes in the collection of clinical variables after the implementation in daily practice of an evaluation checklist for patients with axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA). METHODS An observational study was performed based on medical records review. The number and type of variables of the evaluation checklist in the medical records were collected. The first review was made before the implementation of the checklist, and the second one 6 months after the implementation (in different patients). A descriptive and bivariate analysis was carried out. RESULTS Six hospitals and 11 rheumatologists participated. A total of 83 and 68 medical records were reviewed before and after the implementation of the checklist. After the implementation, in the axSpA patients, a significant increase was recorded in alcohol consumption, diarrhoea or IBD and urethritis, diabetes mellitus, hyperlipidaemia, depression, obesity or gout/hyperuricaemia, weight, height, blood pressure, patient and physician global assessments of disease activity, BASDAI and DAS28. And, in the PsA patients, alcohol consumption, hypertension, diabetes mellitus, hyperlipidaemia, disease, gout/hyperuricaemia, thoracic expansion, cervical rotation, weight, height, blood pressure, patient and physician global assessments of disease, ASDAS, BASDAI, and BASFI were recorded. In general, there was a trend towards greater recording in axSpA compared with PsA. CONCLUSIONS The implementation of a specific checklist in daily practice improves the evaluation of patients with axSpA and PsA. More efforts are necessary to continue improving the evaluation of patients with axSpA, but especially of those with PsA.
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Affiliation(s)
- Raquel Almodovar
- Unidad de Reumatología, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain.
| | - Beatriz Joven
- Servicio de Reumatología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Sheila Melchor
- Servicio de Reumatología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Elena Rabadán
- Servicio de Reumatología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Virginia Villaverde
- Servicio de Reumatología, Hospital Universitario de Móstoles, Móstoles, Madrid, Spain
| | - Teresa Navío
- Servicio de Reumatología, Hospital Universitario Infanta Leonor, Madrid, Spain
| | | | | | - Alejandro Prada
- Servicio de Reumatología, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, Spain
| | - Laura González
- Servicio de Reumatología, Hospital del Tajo, Aranjuez, Madrid, Spain
| | | | | | | | - Pedro Zarco
- Unidad de Reumatología, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
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30
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Belinchón I, Queiro R, Salgado-Boquete L, López-Ferrer A, Ferran M, Coto-Segura P, Rivera R, Vidal D, Rodríguez L, de la Cueva P, Guinea G, Martin Vazquez V. Linguistic and Cultural Adaptation to Spanish of the Screening Tool Psoriatic Arthritis UnclutteRed Screening Evaluation (PURE4). Actas Dermosifiliogr (Engl Ed) 2020; 111:655-664. [PMID: 32401721 DOI: 10.1016/j.ad.2020.03.004] [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: 12/27/2019] [Revised: 03/23/2020] [Accepted: 03/27/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND AND OBJECTIVE The 4-item Psoriatic arthritis UnclutteRed screening Evaluation (PURE-4) questionnaire is a useful tool for identifying patients with suspected psoriatic arthritis before referring them to a rheumatology department for confirmation. The original English version has good discriminant validity (sensitivity, 85.7%; specificity, 83.6%). We aimed to produce an adapted Spanish version of the PURE-4 for validation and use in Spain. MATERIAL AND METHOD We applied the method recommended by the International Society for Pharmacoeconomic and Outcome Research for the cultural adaptation of patient-centered measurement tools. The phases in the processes involved forward translation, reconciliation, back translation review, harmonization, cognitive debriefing and review, and proofreading. RESULTS We obtained the permission of the author of the original questionnaire. Two native-speaking translators translated the questionnaire into Spanish. Small changes, mainly in the way the items were expressed, were then made in order to reconcile the 2 translations. The questionnaire was then back translated to English and revised to achieve a version equivalent to the original. A Spanish translation derived from the revision was tested for understandability in 7 patients, and the final Spanish version was then produced. During the translation phases, the project manager and a scientific committee made up of a dermatologist and a rheumatologist reviewed the different versions. Team members exchanged information throughout the process, providing for harmonization and the quality control that guaranteed conceptual equivalence. CONCLUSIONS This adaptation of the PURE-4 questionnaire for use in Spain has been the first step toward using it in routine clinical practice. The standardized method we used ensures that the Spanish and the original versions are equivalent.
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Affiliation(s)
- I Belinchón
- Servicio de Dermatología, Hospital General Universitario de Alicante-ISABIAL, Universidad Miguel Hernández, Alicante, España.
| | - R Queiro
- Servicio de Reumatología, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | - L Salgado-Boquete
- Servicio de Dermatología, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, España
| | - A López-Ferrer
- Servicio de Dermatología, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - M Ferran
- Servicio de Dermatología, Hospital del Mar, Barcelona, España
| | - P Coto-Segura
- Servicio de Dermatología, Hospital Álvarez-Buylla, Asturias, España
| | - R Rivera
- Servicio de Dermatología, Hospital 12 de Octubre, Madrid, España
| | - D Vidal
- Servicio de Dermatología, Hospital de Sant Joan Despí Moisés Broggi, Barcelona, España
| | - L Rodríguez
- Servicio de Dermatología, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - P de la Cueva
- Servicio de Dermatología, Hospital Universitario Infanta Leonor, Madrid, España
| | - G Guinea
- Novartis pharmaceuticals Spain, Barcelona, España
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Urrea-Pineda LY, Gómez-Jiménez S, Jaramillo-Arroyave D, Muñoz-Vahos CH, Vanegas-García AL, Vasquéz G, Restrepo-Escobar M, González-Naranjo LA. Cryoglobulinemic vasculitis and psoriatic arthritis: Case report of an unusual association. Reumatol Clin (Engl Ed) 2020; 16:242-244. [PMID: 29789229 DOI: 10.1016/j.reuma.2018.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 03/07/2018] [Indexed: 06/08/2023]
Abstract
We report the case of a 47-year-old man with a 9-year history of psoriatic arthritis (PsA) in whom we detected renal involvement, hypocomplementemia, peripheral neuropathy, acral necrotic lesions and positive cryoglobulins. The results of the diagnosis led us to conclude that the clinical picture corresponded to cryoglobulinemic vasculitis concomitant with PsA. In addition, we present a review of the literature on the presence of these two diseases in a single patient.
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Affiliation(s)
| | | | - Daniel Jaramillo-Arroyave
- Servicio de Reumatología, IPS Universitaria, Clínica León XIII, Medellín, Colombia; Sección de Reumatología, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia; Grupo de Epidemiología y Bioestadística, Facultad de Medicina, Universidad CES, Medellín, Colombia.
| | - Carlos Horacio Muñoz-Vahos
- Servicio de Reumatología, IPS Universitaria, Clínica León XIII, Medellín, Colombia; Sección de Reumatología, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia; Servicio de Reumatología, Hospital San Vicente Fundación, Medellín, Colombia
| | - Adriana Lucía Vanegas-García
- Sección de Reumatología, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia; Servicio de Reumatología, Hospital San Vicente Fundación, Medellín, Colombia
| | - Gloria Vasquéz
- Sección de Reumatología, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
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Almodóvar R, Cañete JD, de Miguel E, Pinto JA, Queiro R. Definition of Remission and Disease Activity Assessment in Psoriatic Arthritis: Evidence and Expert-Based Recommendations. ACTA ACUST UNITED AC 2019; 17:343-350. [PMID: 31859154 DOI: 10.1016/j.reuma.2019.10.003] [Citation(s) in RCA: 5] [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: 06/21/2019] [Revised: 09/10/2019] [Accepted: 10/10/2019] [Indexed: 12/23/2022]
Abstract
OBJECTIVE We aimed to reach a consensus on the best instruments to monitor disease activity in patients with psoriatic arthritis (PsA) and to develop a consensus definition of remission. METHODS A modified Delphi approach was used. A scientific committee provided statements addressing the definition of remission and the monitoring of PsA in clinical practice. The questionnaire was evaluated in 2 rounds by rheumatologists with experience in managing PsA patients. RESULTS A panel of 77 rheumatologists reached agreement on 62 out of the 86 proposed items (72.0%). The most recommended index for monitoring disease activity was DAPSA (cut-off values: ≤4 for remission and >4-14 for low disease activity ([LDA]), MDA (at least 5/7 criteria). In cases with axial involvement, ASDAS was the preferred index (cut-off values: <1.3 for remission and <2.1 for LDA). BASDAI (cut-off values: ≤2 for remission and ≤4 for LDA) may be used as an alternative. PsAID was the preferred tool to assess disease impact. CONCLUSION We propose a definition of remission in PsA as the absence of disease activity evaluated by DAPSA or MDA (ASDAS and/or BASDAI in patients with axial involvement), which would imply absence of signs or symptoms of inflammation, physical well-being, lack of disease impact, and absence of inflammation as measured by biological markers.
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Affiliation(s)
- Raquel Almodóvar
- Department of Rheumatology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Juan D Cañete
- Department of Rheumatology, Hospital Clínic e IDIBAPS, Barcelona, Spain
| | - Eugenio de Miguel
- Department of Rheumatology, Hospital Universitario La Paz, Madrid, Spain
| | - José Antonio Pinto
- Department of Rheumatology, Complexo Hospitalario Universitario de A Coruña, Spain
| | - Rubén Queiro
- Department of Rheumatology, Hospital Universitario Central de Asturias, Spain.
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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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Pinto Tasende JA, Maceiras Pan FJ, Mosquera Martínez JA, Fernández Dominguez L, Correa Rey B, García Porrúa C. Secukinumab as Biological Treatment for Psoriatic Arthritis in Real Clinical Practice. ACTA ACUST UNITED AC 2019; 17:203-206. [PMID: 31492601 DOI: 10.1016/j.reuma.2019.07.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 06/01/2019] [Accepted: 07/17/2019] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Clinical trials of secukinumab have demonstrated their efficacy and safety in psoriatic arthritis as biological first choice or after inadequate response to other biological treatments. OBJECTIVE To analyze the efficacy and safety of secukinumab in peripheral psoriatic arthritis over 12 months in real clinical practice. MATERIAL AND METHODS Patients with active peripheral psoriatic arthritis who started treatment with secukinumab according to the technical specifications were included. Efficacy and safety were evaluated from baseline to 12 months comparing naive and non-naive to biological therapy patients. RESULTS A total of 76 patients were included (22 naive and 54 non-naive to biological) with an age of 51.9 years (10.3) and duration of the disease of 9.5 years (7.1). Of them, 31.6% with dactylitis, 51.3% with enthesitis and the baseline DAPSA was 19.0 (9.8). The retention rate was high, 90.9% in naive and 81.5% in non-naïve patients, and the percentage of patients with a DAPSA less than or equal to 14 was higher in the naive patients even after adjusting for age, sex and FAMEsc (P=.016). The safety data were similar to those described in the clinical trials. CONCLUSIONS Secukinumab is effective and safe in 12-month treatment in peripheral active psoriatic arthritis in real clinical practice, after inadequate response to TNF or as first biological treatment.
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Affiliation(s)
- José A Pinto Tasende
- Servicio de Reumatología, Centro Hospitalario Universitario A Coruña-INIBIC, La Coruña, España.
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Cañete JD, Naranjo A, Calvo J, Ordás C, Aragón B, Nocea G, Roset M, Fernández-Nebro A. Biological Treatment Patterns in Patients with Inflammatory Joint Diseases. Retrospective Study with 4 Years Follow-up. ACTA ACUST UNITED AC 2019; 16:447-454. [PMID: 30704919 DOI: 10.1016/j.reuma.2018.11.007] [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: 06/25/2018] [Revised: 10/22/2018] [Accepted: 11/08/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To describe the therapeutic management of Rheumatoid Arthritis (RA), Psoriatic Arthritis (PsA) and Ankylosing Spondylitis (AS) in patients initiating treatment with biological agents. MATERIALS AND METHODS Observational, retrospective, longitudinal study in 33 Spanish hospitals. Patients with RA, PsA and AS starting treatment with biological agents between September 2009 and August 2010 and a follow-up longer than 3 years were included. Clinical-demographic characteristics, drugs, biological therapy survival, and reasons for discontinuation or switching were analyzed. RESULTS Four hundred and sixty-three patients were included (183 RA, 119 PsA and 161 AS), with a mean follow-up of 3.8 years. At the end of follow-up, a high proportion continued with the first biological prescribed (41.0% of RA, 59.7% of PsA and 51.6% of AS), 31.1%, 47.9% and 42.9% of RA, PsA and AS patients requiring dosage adjustments, respectively. There was temporary discontinuation in 8.2%, 8.4% and 15.5% of patients, and a switch of biologic agent was required in 37.7%, 26.1% and 24.2%. Definitive discontinuation occurred in 13.1%, 5.9% and 8.7% of RA, PsA and AS patients, respectively. Mean time to discontinuation or switching was 30.1 months for RA and 35.7 months for PsA and AS. CONCLUSIONS Our results suggest that, in practice, half of patients with RA and two thirds with PsA or AS maintained the first biological, but with frequent dose adjustments.
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Affiliation(s)
- Juan D Cañete
- Servicio de Reumatología, Hospital Clínic e IDIBAPS, Barcelona, España.
| | - Antonio Naranjo
- Departamento de Reumatología, Hospital Dr. Negrín, Universidad de las Palmas de Gran Canaria, Las Palmas de Gran Canaria, España
| | - Javier Calvo
- Departamento de Reumatología, Hospital General Universitario de Valencia, Valencia, España
| | - Carmen Ordás
- Departamento de Reumatología, Hospital de Cabueñes, Gijón, España
| | - Belén Aragón
- Departamento de Health Economics and Outcomes Research, MSD, Madrid, España
| | - Gonzalo Nocea
- Departamento de Health Economics and Outcomes Research, MSD, Madrid, España
| | - Montse Roset
- Departamento de Health Economics and Outcomes Research, IQVIA, Barcelona, España
| | - Antonio Fernández-Nebro
- Departamento de Reumatología, Instituto de Investigación Biomédica (IBIMA), Hospital Regional Universitario de Málaga, Universidad de Málaga, Málaga, España
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Queiro R, Laiz A, Seoane-Mato D, Galindez Agirregoikoa E, Montilla C, Park HS, Bethencourt Baute JJ, Bustabad S, Pinto Tasende JA, Tejón P, Joven Ibáñez B, Ramírez J, Cuervo A, Cañete JD, Trenor Larraz P, Ordás C, Alonso S, García-Fernández E, Toniolo E, Moreno Ramos MJ, Beteta MD, Lojo Oliveira L, Navío Marco T, Cebrián L, Barbazán C, Maceiras F, Rodriguez-Moreno J, Steiner M, Muñoz-Fernández S, Nóvoa Medina FJ, León M, Rubio E, Medina Luezas J, Sánchez-González MD, Arévalo M, Gratacós J, Senabre JM, Rosas JC, Santos Soler G, Nieto-González JC, González C, López Robles A, Álvarez Castro C, Ruiz Montesino MD, Torrente-Segarra V, Fernández-Carballido C, Martínez-Vidal MP, Jovani V, Urruticoechea-Arana A, Cabello Fernández Y, Toledo MD, Almodóvar R, Belmonte-Serrano MÁ, Notario Ferreira I, Raya Álvarez E; Grupo de Trabajo del Proyecto REAPSER. Spanish Registry of Recent-onset Psoriatic Arthritis (REAPSER study): Aims and methodology. ACTA ACUST UNITED AC 2019; 15:252-7. [PMID: 30522944 DOI: 10.1016/j.reuma.2018.09.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 09/04/2018] [Accepted: 09/10/2018] [Indexed: 12/30/2022]
Abstract
AIMS To describe the methodology of REAPSER (Spanish Registry of Recent-onset Psoriatic Arthritis), its strengths and limitations. The aim of this study is to identify prognostic factors for the clinical and radiographic course in a cohort of patients with psoriatic arthritis (PsA) diagnosed within 2years of symptom evolution. METHODS Multicenter, observational and prospective study (with 2-year follow-up including annual visits). Baseline visit intended to reflect patient situation before the disease course was modified by treatments prescribed in rheumatology departments. Patients were invited to participate consecutively in one of their routine visits to the rheumatologist. 211 patients were included. Following data were collected: sociodemographic variables; employment situation; family history; personal history and comorbidities; anthropometric data; lifestyle; use of healthcare services; clinical situation at the time of PsA diagnosis; joint involvement and spinal pain; pain and overall assessment; enthesitis, dactylitis and uveitis; skin and nail involvement; functional situation and quality of life; radiographic evaluation; analytical determinations; treatment; axial and peripheral flare-ups. CONCLUSIONS The REAPSER study includes a cohort of patients with recent-onset PsA, before the disease course was modified by disease-modifying antirheumatic drugs prescribed in rheumatology departments. Exhaustive information collected in each visit is expected to be an important data source for future analysis.
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Hernández-Collazo AA, Villanueva-Quintero G, Rodríguez-Castellanos MA, Poletti-Vázquez ED, Alvarado-Navarro A. Ácido úrico sérico como marcador de gravedad clínica y comorbilidad en psoriasis en placas. GAC MED MEX 2018; 154:427-431. [PMID: 30250329 DOI: 10.24875/gmm.17003515] [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] [Indexed: 11/17/2022] Open
Abstract
Introducción La hiperuricemia es común en pacientes con psoriasis. Se ha sugerido que la elevación de ácido úrico en psoriasis está fuertemente asociada con morbilidad cardiovascular. Objetivo Determinar la relación entre niveles de ácido úrico, gravedad clínica medida por Psoriasis Area Severity Index (PASI), Body Surface Area (BSA) y static Physician's Global Assessment (sPGA) en pacientes con psoriasis en placas y comorbilidades ungueales y artritis psoriásica. Método Determinación de ácido úrico sérico en 45 pacientes con psoriasis en placas y 45 controles pareados por sexo, edad e índice de masa corporal; medición de índices de gravedad clínica en pacientes y presencia de manifestaciones ungueales y articulares. Resultados Los pacientes con psoriasis presentaron niveles más elevados de ácido úrico (7.03 ± 1.47 versus 5.32 ± 1.17, p < 0.01) y mayor prevalencia de hiperuricemia asintomática (68 versus 17.8 %, p < 0.01) que los controles. Existió correlación proporcional significativa entre gravedad determinada por PASI y ácido úrico (r2 = 0.70) y entre manifestaciones articulares e hiperuricemia en pacientes con psoriasis en placas (p < 0.01; RM = 2.85, IC 95 % = 1.52-5.33). Conclusiones Los niveles séricos de ácido úrico tuvieron correlación proporcional con PASI y se asociaron con manifestaciones articulares en pacientes con psoriasis en placas. Introduction Hyperuricemia is common in patients with psoriasis. Uric acid elevation in psoriasis has been suggested to be strongly associated with cardiovascular morbidity. Objective To determine the relationship between uric acid levels and clinical severity as measured by the Psoriasis Area Severity Index (PASI), body surface area (BSA) and static Physician’s Global Assessment (sPGA) in patients with plaque psoriasis and nail comorbidities and psoriatic arthritis. Method Determination of serum uric acid in 45 patients with plaque psoriasis and 45 controls matched by gender, age and body mass index; measurement of patient clinical severity indices and presence of nail and joint manifestations. Results Patients with psoriasis had higher levels of uric acid (7.03 ± 1.47 versus 5.32 ± 1.17, p < 0.01), and higher prevalence of asymptomatic hyperuricemia than controls (68% versus 17.8%, p < 0.01). There was significant proportional correlation between PASI-determined severity and uric acid (r2 = 0.70), and between joint manifestations and hyperuricemia in patients with plaque psoriasis (p < 0.01; OR = 2.85, 95% CI = 1.52-5.33). Conclusions Serum uric acid levels had a proportional correlation with PASI and were associated with joint manifestations in patients with plaque psoriasis.
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Almodóvar R, Zarco P, Otón T, Carmona L. Effect of weight loss on activity in psoriatic arthritis: A systematic review. Reumatol Clin (Engl Ed) 2018; 14:207-210. [PMID: 28262478 DOI: 10.1016/j.reuma.2017.01.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 12/16/2016] [Accepted: 01/26/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To evaluate the association between weight loss and changes in disease activity in patients with psoriatic arthritis (PsA). METHODS We performed a systematic review of the literature, with searches in Medline, Embase and Cochrane Central Library from inception until April 2015. INCLUSION CRITERIA 1) randomized controlled trials (RCT); 2) PsA patients; 3) interventions were any intervention aimed at weight control; and 4) a PsA activity-related outcome measure was evaluated. Risks of bias were assessed by the Cochrane Collaboration scale. RESULTS Of the 215 articles identified, only 2 RCT met the inclusion criteria, 1 in abstract format. Both showed moderate risk of bias. Patients who managed to lose weight-by any method-had better results in terms of activity and inflammation. The percentage of weight loss correlated moderately with changes in inflammatory outcomes. CONCLUSION Weight loss in PsA could be associated with less inflammation; however, the evidence to support this is limited.
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Affiliation(s)
| | - Pedro Zarco
- Hospital Universitario Fundación Alcorcón, Madrid, España
| | - Teresa Otón
- Instituto de Salud Musculoesquelética, InMusc, Madrid, España
| | - Loreto Carmona
- Instituto de Salud Musculoesquelética, InMusc, Madrid, España
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Torre Alonso JC, Díaz Del Campo Fontecha P, Almodóvar R, Cañete JD, Montilla Morales C, Moreno M, Plasencia-Rodríguez C, Ramírez García J, Queiro R. Recommendations of the Spanish Society of Rheumatology on treatment and use of systemic biological and non-biological therapies in psoriatic arthritis. ACTA ACUST UNITED AC 2017; 14:254-268. [PMID: 29111261 DOI: 10.1016/j.reuma.2017.08.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [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: 07/22/2017] [Accepted: 08/21/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The main purpose of this recommendation statement is to provide clinicians with the best available evidence and the best opinion agreed upon by the panelists for a rational use of synthetic disease modifying antirheumatic drugs (DMARDs) and biologicals in psoriatic arthritis (PsA) patients. The present document also focuses on important aspects in the management of PsA, such as early diagnosis, therapeutic objectives, comorbidities and optimization of treatment. METHODS The recommendations were agreed by consensus by a panel of 8 expert rheumatologists, previously selected by the Spanish Society of Rheumatology (SER) through an open call. The phases of the work were: identification of key areas for updating the previous consensus, analysis and synthesis of scientific evidence (modified Oxford system, Centre for Evidence-based Medicine, 2009) and formulation of recommendations based on this evidence and by consensus techniques. RESULTS Seventeen recommendations were issued for the treatment of PsA patients. Six of them were of general nature, ranging from the early diagnosis and treatment to the importance of assessing comorbidities. The other 11 were focused on the indications for DMARDs and biological therapy in the distinct clinical forms of the disease. Likewise, the situation of failure of the first biological is addressed and treatment algorithms and a table with the different biological therapies are also included. CONCLUSIONS We present the update of SER recommendations for the treatment of PsA with DMARDs and biologics.
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Affiliation(s)
| | | | - Raquel Almodóvar
- Unidad de Reumatología, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | - Juan D Cañete
- Unidad de Artritis, Servicio de Reumatología, Hospital Clínic, Barcelona, España
| | | | - Mireia Moreno
- Servicio de Reumatología, Parc Taulí Hospital Universitari, Sabadell, Barcelona, España
| | | | - Julio Ramírez García
- Unidad de Artritis, Servicio de Reumatología, IDIBAPS y Hospital Clínic, Barcelona, España
| | - Rubén Queiro
- Sección de Reumatología, Hospital Universitario Central de Asturias, Oviedo, España.
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García-Gavín J, Pérez-Pérez L, Tinazzi I, Vidal D, McGonagle D. Spanish Cultural Adaptation of the Questionnaire Early Arthritis for Psoriatic Patients. Actas Dermosifiliogr 2017; 108:924-930. [PMID: 28803615 DOI: 10.1016/j.ad.2017.06.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 01/25/2017] [Revised: 05/17/2017] [Accepted: 06/18/2017] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES The Early Arthritis for Psoriatic patients (EARP) questionnaire is a screening tool for psoriatic arthritis. The original Italian version has good measurement properties but the EARP required translation and adaptation for use in Spain. This article describes the cultural adaptation process as a step prior to validation. MATERIAL AND METHODS We used the principles of good practice for the cross-cultural adaptation of patient-reported outcomes measurement established by the International Society Pharmacoeconomics and Outcome Research. The steps in this process were preparation, forward translation, reconciliation, back-translation and review, harmonization, cognitive debriefing and review, and proofreading. During preparation the developers of the original questionnaire were asked for their permission to adapt the EARP for use in Spain and to act as consultants during the process. RESULTS The original questionnaire was translated into Spanish by native Spanish translators, who made slight changes that were approved by the questionnaire's developers. The Spanish version was then back-translated into Italian; that version was reviewed to confirm equivalence with the original Italian text. The reconciled Spanish EARP was then tested for comprehensibility and interpretation in a group of 35 patients. All the patients answered all items without making additional comments. CONCLUSION This cultural adaptation of the EARP questionnaire for Spanish populations is the first step towards its later use in routine clinical practice. The application of a cross-cultural adaptation method ensured equivalence between the original and Spanish versions of the EARP. The Spanish questionnaire will be validated in a second stage.
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Affiliation(s)
- J García-Gavín
- Clínica Pérez & Gavín dermatólogos, Vigo, Pontevedra, España.
| | - L Pérez-Pérez
- Clínica Pérez & Gavín dermatólogos, Vigo, Pontevedra, España
| | - I Tinazzi
- Unidad de Reumatología, Ospedale Sacro Cuore Don Calabria, Verona, Italia
| | - D Vidal
- Hospital de Sant Joan Despí Moisés Broggi, Barcelona, España
| | - D McGonagle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, Inglaterra
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Seoane-Mato D, Sánchez-Piedra C, Silva-Fernández L, Sivera F, Blanco FJ, Pérez Ruiz F, Juan-Mas A, Pego-Reigosa JM, Narváez J, Quilis Martí N, Cortés Verdú R, Antón-Pagés F, Quevedo Vila V, Garrido Courel L, Del Amo NDV, Paniagua Zudaire I, Añez Sturchio G, Medina Varo F, Ruiz Tudela MDM, Romero Pérez A, Ballina J, Brandy García A, Fábregas Canales D, Font Gayá T, Bordoy Ferrer C, González Álvarez B, Casas Hernández L, Álvarez Reyes F, Delgado Sánchez M, Martínez Dubois C, Sánchez-Fernández SÁ, Rojas Vargas LM, García Morales PV, Olivé A, Rubio Muñoz P, Larrosa M, Navarro Ricos N, Graell Martín E, Chamizo E, Chaves Chaparro L, Rojas Herrera S, Pons Dolset J, Polo Ostariz MÁ, Ruiz-Alejos Garrido S, Macía Villa C, Cruz Valenciano A, González Gómez ML, Morcillo Valle M, Palma Sánchez D, Moreno Martínez MJ, Mayor González M, Atxotegi Sáenz de Buruaga J, Urionagüena Onaindia I, Blanco Cáceres BA, Díaz-González F, Bustabad S. Prevalence of rheumatic diseases in adult population in Spain (EPISER 2016 study): Aims and methodology. ACTA ACUST UNITED AC 2017; 15:90-96. [PMID: 28774657 DOI: 10.1016/j.reuma.2017.06.009] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [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: 04/05/2017] [Revised: 05/17/2017] [Accepted: 06/16/2017] [Indexed: 11/25/2022]
Abstract
AIMS To describe the methodology of the EPISER 2016 (study of the prevalence of rheumatic diseases in adult population in Spain), as well its strengths and limitations. The aim of this study is to estimate the prevalence of rheumatoid arthritis (RA), psoriatic arthritis (PsA), ankylosing spondylitis (AS), systemic lupus erythematosus (SLE), Sjögren's syndrome (SS), osteoarthritis (knee, hip, hands, and cervical and lumbar spine), fibromyalgia, gout and clinical osteoporotic fracture. MATERIAL AND METHOD Population-based, multicenter, cross-sectional study, with the participation of 45 municipalities in the 17 Spanish autonomous communities. The reference population will consist of adults aged 20 years and over residing in Spain. A computer-assisted telephone interview (CATI) system will be used for data collection. Diagnostic suspicions and diagnoses received by the participants will be studied by rheumatologists in the referral hospitals in the selected municipalities. STATISTICAL ANALYSIS the prevalence of the rheumatic diseases will be calculated using estimators and their 95% confidence intervals. Weights will be calculated in each of the sampling stages in accordance with the probability of selection. The distribution of the population in Spain will be obtained from the Spanish Statistics Institute. CONCLUSIONS Sociodemographic and lifestyle changes over the last 16 years justify EPISER 2016. This study will provide current data about the prevalences of RA, AS, PsA, SLE, SS, osteoarthritis, fibromyalgia, gout and clinical osteoporotic fracture. The results will allow comparisons with studies from other countries and EPISER 2000.
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Affiliation(s)
- Daniel Seoane-Mato
- Unidad de Investigación, Sociedad Española de Reumatología, Madrid, España
| | | | - Lucía Silva-Fernández
- Servicio de Reumatología, Complexo Hospitalario Universitario de Ferrol, Ferrol, A Coruña, España
| | - Francisca Sivera
- Servicio de Reumatología, Hospital General Universitario de Elda, Elda, Alicante, España
| | - Francisco J Blanco
- Servicio de Reumatología, Complejo Hospitalario Universitario de A Coruña, A Coruña, España
| | - Fernando Pérez Ruiz
- Servicio de Reumatología, Hospital Universitario Cruces, Baracaldo, Vizcaya, España
| | - Antonio Juan-Mas
- Servicio de Reumatología, Hospital Son Llàtzer, Palma de Mallorca, Baleares, España
| | - José M Pego-Reigosa
- Servicio de Reumatología, Complejo Hospitalario Universitario de Vigo, Grupo IRIDIS, Instituto de Investigación Sanitaria Galicia Sur (IISGS), Vigo, Pontevedra, España
| | - Javier Narváez
- Servicio de Reumatología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - Neus Quilis Martí
- Servicio de Reumatología, Hospital General Universitario de Elda, Elda, Alicante, España
| | - Raúl Cortés Verdú
- Unidad de Reumatología, Hospital General de Ontinyent, Ontinyent, Valencia, España
| | - Fred Antón-Pagés
- Unidad de Reumatología, Complejo Asistencial Universitario de Palencia, Palencia, España
| | - Víctor Quevedo Vila
- Unidad de Reumatología, Hospital Comarcal de Monforte de Lemos, Monforte de Lemos, Lugo, España
| | - Laura Garrido Courel
- Servicio de Reumatología, Complejo Hospitalario de Navarra, Pamplona, Navarra, España
| | | | | | | | - Fermín Medina Varo
- Sección de Reumatología, Hospital Universitario Puerta del Mar, Cádiz, España
| | | | | | - Javier Ballina
- Servicio de Reumatología, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | - Anahy Brandy García
- Servicio de Reumatología, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | | | - Teresa Font Gayá
- Servicio de Reumatología, Hospital Comarcal de Inca, Inca, Baleares, España
| | | | - Beatriz González Álvarez
- Servicio de Reumatología, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, España
| | - Laura Casas Hernández
- Servicio de Reumatología, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, España
| | - Fátima Álvarez Reyes
- Servicio de Reumatología, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, España
| | - Mónica Delgado Sánchez
- Servicio de Reumatología, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, España
| | - Cristina Martínez Dubois
- Servicio de Reumatología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España
| | | | - Luisa Marena Rojas Vargas
- Servicio de Reumatología, Complejo Hospitalario Mancha Centro, Alcázar de San Juan, Ciudad Real, España
| | | | - Alejandro Olivé
- Servicio de Reumatología, Hospital Universitari Germans Trias i Pujol , Badalona, Barcelona, España
| | - Paula Rubio Muñoz
- Servicio de Reumatología, Hospital Universitari Germans Trias i Pujol , Badalona, Barcelona, España
| | - Marta Larrosa
- Servicio de Reumatología, Hospital Universitari Parc Taulí, Sabadell, Barcelona, España
| | - Noemí Navarro Ricos
- Servicio de Reumatología, Hospital Universitari Parc Taulí, Sabadell, Barcelona, España
| | - Eduard Graell Martín
- Servicio de Reumatología, Hospital Universitari Parc Taulí, Sabadell, Barcelona, España
| | - Eugenio Chamizo
- Servicio de Reumatología, Hospital de Mérida, Mérida, Badajoz, España
| | | | | | - Jordi Pons Dolset
- Unidad de Reumatología, Fundación Hospital Calahorra, Calahorra, La Rioja, España
| | | | | | - Cristina Macía Villa
- Sección de Reumatología, Hospital Universitario Severo Ochoa, Leganés, Madrid, España
| | - Ana Cruz Valenciano
- Sección de Reumatología, Hospital Universitario Severo Ochoa, Leganés, Madrid, España
| | | | | | - Deseada Palma Sánchez
- Servicio de Reumatología, Hospital General Universitario Rafael Méndez, Lorca, Murcia, España
| | | | - Marta Mayor González
- Servicio de Reumatología, Hospital General Universitario Rafael Méndez, Lorca, Murcia, España
| | | | | | | | - Federico Díaz-González
- Servicio de Reumatología, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, España; Universidad de La Laguna, Departamento de Medicina Interna, Dermatología y Psiquiatría, La Laguna, Santa Cruz de Tenerife, España
| | - Sagrario Bustabad
- Servicio de Reumatología, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, España.
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Morales Ivorra I, Juárez López P, López de Recalde M, Carvalho PD, Rodriguez Moreno J. Heel pain in psoriatic arthropathy: Analysis of a series of 291 patients. ACTA ACUST UNITED AC 2017; 14:290-293. [PMID: 28576643 DOI: 10.1016/j.reuma.2017.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 11/30/2016] [Revised: 02/04/2017] [Accepted: 03/09/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To determine the prevalence of heel pain in a series of patients with psoriatic arthritis (PsA). MATERIAL AND METHODS Cross-sectional, observational and retrospective study of a series of 347 patients. All patients fulfilled the CASPAR criteria for PsA and 291 had a clinically significant history of heel pain. The statistical analysis was performed using chi-square test, ANOVA and binary logistic regression. RESULTS Thirty-five percent of the patients had clinically significant heel pain. A significant association was established between an early onset of skin and joint involvement in the disease and the development of heel pain. However, no significant correlation was found between disease duration and the presence of heel pain. History of dactylitis and PsA in first-degree family members was also statistically associated with this complication. CONCLUSIONS Clinically significant heel pain was recorded in one third of the patients in this series. There was a statistically significant association with dactylitis, PsA in first-degree family members and an earlier onset of joint and skin disease.
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Affiliation(s)
- Isabel Morales Ivorra
- Servicio de Reumatología, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - Pablo Juárez López
- Servicio de Reumatología, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - Mercè López de Recalde
- Servicio de Reumatología, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - Pedro David Carvalho
- Servicio de Reumatología, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - Jesus Rodriguez Moreno
- Servicio de Reumatología, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España.
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Cabezas-Rodríguez I, Morante-Bolado I, Brandy-García A, Queiro-Silva R, Mozo L, Ballina-García FJ. Anti-MDA5 dermatomyositis mimicking psoriatic arthritis. ACTA ACUST UNITED AC 2016; 14:224-226. [PMID: 28040421 DOI: 10.1016/j.reuma.2016.10.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 10/24/2016] [Accepted: 10/28/2016] [Indexed: 10/20/2022]
Abstract
Dermatomyositis causes inflammation and damage of muscle and skin, and sometimes involves internal organs, especially lung parenchyma. Patients with dermatomyositis still represent a diagnostic challenge because of the rarity of this disease and the lack of specificity of some of its cutaneous manifestations. Herein, we describe the case of a patient with dermatomyositis, initially diagnosed as psoriatic arthritis, in which the performance of anti-melanoma differentiation-associated gene 5 (MDA5) antibodies was decisive to establish a definitive diagnosis.
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Affiliation(s)
| | - Isla Morante-Bolado
- Servicio de Reumatología, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Anahy Brandy-García
- Servicio de Reumatología, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Rubén Queiro-Silva
- Servicio de Reumatología, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Lourdes Mozo
- Servicio de Inmunología, Hospital Universitario Central de Asturias, Oviedo, Spain
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García-Cezón de la Cruz MDP, Almodóvar R, García Pérez J, Dhimes PF, Zarco P. Aortitis due to giant cell arteritis and psoriatic arthritis: An uncommon association. ACTA ACUST UNITED AC 2016; 13:230-232. [PMID: 27131857 DOI: 10.1016/j.reuma.2016.03.016] [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: 01/12/2016] [Revised: 03/17/2016] [Accepted: 03/18/2016] [Indexed: 11/18/2022]
Abstract
We report the case of a 65-year-old woman with psoriatic arthritis who developed aortitis secondary to giant cell arteritis. She presented with a 2-mounth history of dry cough, fever and fatigue. There was no evidence of tumor or infectious processes. Abdominal computed tomographic and computed tomography coronary angiographic findings were suggestive of aortitis. Histological study of a temporal artery biopsy confirmed temporal arteritis. We also review the available literature on this uncommon condition.
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Affiliation(s)
| | - Raquel Almodóvar
- Unidad de Reumatología, Hospital Universitario Fundación Alcorcón, Madrid, España.
| | - Javier García Pérez
- Unidad de Radiología Vascular Intervencionista, Hospital Universitario Fundación Alcorcón, Madrid, España
| | - Patricia Fanny Dhimes
- Unidad de Anatomía Patológica, Hospital Universitario Fundación Alcorcón, Madrid, España
| | - Pedro Zarco
- Unidad de Reumatología, Hospital Universitario Fundación Alcorcón, Madrid, España
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Galíndez E, Carmona L. Is obesity in psoriatic arthritis associated with a poorer therapeutic response and more adverse effects of treatment with an anchor drug? ACTA ACUST UNITED AC 2016; 12:307-12. [PMID: 26830438 DOI: 10.1016/j.reuma.2015.12.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Revised: 12/14/2015] [Accepted: 12/16/2015] [Indexed: 01/07/2023]
Abstract
OBJECTIVES To assess the association between obesity, control of inflammatory activity and increased adverse effects in psoriatic arthritis (PsA) with disease-modifying anti-inflammatory drugs (DMARD). METHODS A systematic literature review was performed using MEDLINE and EMBASE databases following the guidelines of the Meta-analysis Of Observational Studies in Epidemiology (MOOSE) consensus statement. Studies were selected if they included patients with PsA, obesity was studied as a predictive factor, and the outcome was adverse effects, including efficacy failure. Quality was assessed using an ad hoc risk of bias tool. A qualitative analysis was carried out by type of study and study population, quality and specific results. RESULTS We found 1043 articles, discarding most of them on the basis of title and abstract. Ten articles were studied in detail and finally excluded three. The majority concluded, with statistically significant results, that in patients with PsA and treated with TNFα inhibitors (TNFαi), obesity is associated with poorer chances of achieving and maintaining a minimal disease activity, higher treatment discontinuation rates, and lower skin response. Regarding conventional synthetic DMARD, a trend toward a moderate increase in transaminases with methotrexate (MTX) was observed in obese patients with PsA. CONCLUSIONS Obesity is a negative predictor of clinical response in patients with PsA being treated with TNFαi. Except MTX hepatotoxicity, no other adverse effects, either with TNFαi or other drugs, were found in relation to obesity in PsA.
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Mateo L, Sanint J, Rodríguez Muguruza S, Martínez Morillo M, Pérez Andrés R, Domenech Puigcerver S. SAPHO syndrome presenting as an osteolytic lesion of the neck. ACTA ACUST UNITED AC 2016; 13:44-47. [PMID: 26793990 DOI: 10.1016/j.reuma.2015.11.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 09/14/2015] [Accepted: 11/23/2015] [Indexed: 10/22/2022]
Abstract
We report a case of acute-onset multifocal vertebral osteitis with a marked impact on the patient's general health. The radiological, scintigraphic and magnetic resonance findings made it necessary to carry out a differential diagnosis to distinguish it from an infiltrative neoplastic process and determine whether it had an infectious or an inflammatory etiology. The presence of noninfectious multifocal osteitis and sternoclavicular arthritis and the subsequent development of plantar pustulosis pointed to SAPHO syndrome. Treatment with infliximab led to improvement in the clinical symptoms, laboratory values and radiological abnormalities.
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Affiliation(s)
- Lourdes Mateo
- Servicio de Reumatología, Hospital Universitari Germans Trias i Pujol, Barcelona, España.
| | - Juana Sanint
- Servicio de Reumatología, Hospital Universitari Germans Trias i Pujol, Barcelona, España
| | | | | | - Ricard Pérez Andrés
- Servicio de Radiodiagnóstico, Hospital Universitari Germans Trias i Pujol, Barcelona, España
| | - Sira Domenech Puigcerver
- Unidad de Resonancia magnética (IDI), Hospital Universitari Germans Trias i Pujol, Barcelona, España
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Raposo I, Torres T. Nail psoriasis as a predictor of the development of psoriatic arthritis. Actas Dermosifiliogr 2015; 106:452-7. [PMID: 26026773 DOI: 10.1016/j.ad.2015.02.005] [Citation(s) in RCA: 36] [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] [Received: 12/17/2014] [Revised: 02/27/2015] [Accepted: 02/28/2015] [Indexed: 10/23/2022] Open
Abstract
Psoriatic arthritis is a psoriasis-related spondyloarthropathy that occurs in 20-30% of patients with psoriasis. Various imaging studies have demonstrated that there is a considerable proportion of undiagnosed psoriatic arthritis among patients with psoriasis. Since early detection and treatment of psoriatic arthritis could, ultimately, allow the prevention of clinical and radiologic progression of the disease, there is the need to establish clinical indicators to detect this risk. Nail psoriasis has been proposed as a predictor for the development of psoriatic arthritis. The inflammation involving the entheses, called enthesitis, is an early inflammatory change seen in psoriatic arthritis, and nail changes appear to result from the close relationship between the nail and the enthesis of the distal interphalangeal extensor tendon, one of the main entheseal compartments affected in psoriatic arthritis. As skin lesions precede articular symptoms in more than 75-80% of patients with psoriatic arthritis, dermatologists may play a key role in the early detection and management of psoriatic arthritis.
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Affiliation(s)
- I Raposo
- Department of Dermatology, Centro Hospitalar do Porto, Portugal
| | - T Torres
- Department of Dermatology, Centro Hospitalar do Porto, Portugal; Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Portugal.
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Carrascosa JM, Belinchón I, de-la-Cueva P, Izu R, Luelmo J, Ruiz-Villaverde R. Expert recommendations on treating psoriasis in special circumstances. Actas Dermosifiliogr 2015; 106:292-309. [PMID: 25595327 DOI: 10.1016/j.ad.2014.11.005] [Citation(s) in RCA: 5] [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: 08/09/2014] [Revised: 10/26/2014] [Accepted: 11/09/2014] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES A great amount of information on systemic and biologic therapies for moderate to severe psoriasis is now available. However, applying the evidence in numerous clinical scenarios has engendered debate; under these circumstances, the consensus of experts is useful. MATERIAL AND METHODS A scientific committee systematically reviewed the literature relevant to 5 clinical scenarios. An online Delphi survey of dermatologists with experience treating moderate to severe psoriasis was then carried out in order to shed light on questions that remained unresolved by the available evidence. RESULTS Twenty-three dermatologists responded to the survey and consensus was reached on 37 (56%) of the 66 statements proposed. These results led to consensus on various clinical situations even though firm evidence was lacking. Thus, intermittent therapeutic regimens and strategies for reducing the intensity of treatment are considered appropriate for optimizing biologic treatment and reducing costs. The measurement of drug and antidrug antibody levels should be included routinely when following patients on biologics to treat psoriasis. Concomitant psoriatic arthritis or a history of cardiovascular conditions will influence the choice of biologic; in these situations, an agent with anti-tumor necrosis factor properties will be preferred. Tailored management is important when the patient is pregnant or intends to conceive; drug half-life and disease severity are important factors to take into consideration in these scenarios. CONCLUSIONS A combination of systematic review of the literature and structured discussion of expert opinion facilitates decision-making in specific clinical scenarios.
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Affiliation(s)
- J M Carrascosa
- Servei de Dermatologia, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España.
| | - I Belinchón
- Servicio de Dermatología, Hospital General Universitario de Alicante, Alicante, España
| | - P de-la-Cueva
- Servicio de Dermatología, Hospital Universitario Infanta Leonor, Madrid, España
| | - R Izu
- Servicio de Dermatología, Hospital Universitario Basurto, Universidad del País Vasco, Bilbao, España
| | - J Luelmo
- Servicio de Dermatología, Hospital Universitario ParcTaulí de Sabadell, Universidad Autónoma de Barcelona, Barcelona, España
| | - R Ruiz-Villaverde
- Servicio de Dermatología, Hospital Universitario Virgen de las Nieves, Granada, España
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Zarco P, González CM, Rodríguez de la Serna A, Peiró E, Mateo I, Linares L, Calvo J, Cea-Calvo L, Arteaga MJ, Vanaclocha F, Marín-Jiménez I, García-Vicuña R. Extra-articular disease in patients with spondyloarthritis. Baseline characteristics of the spondyloarthritis cohort of the AQUILES study. ACTA ACUST UNITED AC 2014; 11:83-9. [PMID: 25441489 DOI: 10.1016/j.reuma.2014.04.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [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: 01/08/2014] [Revised: 04/03/2014] [Accepted: 04/04/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To describe the prevalence of extra-articular disease (uveitis, psoriasis and inflammatory bowel disease [IBD]), in a cohort of patients with spondyloarthritis (SpA). PATIENTS AND METHODS AQUILES is an observational, prospective and multicentric study of three cohorts of patients with one of the following immune-mediated inflammatory diseases (IMID): SpA, psoriasis, or IBD. In the present cohort, patients ≥18 years of age with SpA were enrolled from Rheumatology clinics. The main objective was to assess the coexistence of these diseases and of uveitis, based on the patients' clinical history up to the study entry. RESULTS A total of 601 patients with SpA (men: 63.1%; women: 36.9%) were enrolled. The specific diagnoses were: ankylosing spondylitis (55.1%), psoriatic arthritis (25.1%), undifferentiated spondyloarthritis (16.1%), enteropathic arthritis (2.5%), and others (1.3%). In 43.6% (95% CI: 39.7-47.6) of the patients, at least one of the three abovementioned diseases was encountered, predominantly psoriasis (prevalence 27.8%, 95% CI: 24.4-31.5), uveitis (13.6%, CI 95%: 11.1-16.6) and IBD (5.1%, 95% CI: 3.7-7.2). In patients with ankylosing spondylitis the proportion of other disease was 25.3% (IBD: 3.9%, psoriasis: 5.4%, uveitis: 19.0%) whilst it was 94.7% in psoriatic arthritis, due to the presence of psoriasis (94.0%). The coexistence of these diseases was associated with age, female gender and the presence of other extra-articular manifestations associated with SpA. CONCLUSIONS Extra-articular disease in patients with SpA is common and, in this study, it was associated to age, female gender and the presence of other SpA-related extra-articular manifestations.
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Affiliation(s)
- Pedro Zarco
- Hospital Universitario Fundación de Alcorcón, Alcorcón, Madrid, España.
| | | | | | - Enriqueta Peiró
- Hospital Marqués de Valdecilla, Santander, Cantabria, España
| | | | | | - Jerusalem Calvo
- Hospital Universitario Reina Sofía/Instituto Maimónides de Investigación Biomédica de Córdoba/Universidad de Córdoba, Córdoba, España
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50
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Vanaclocha F, Crespo-Erchiga V, Jiménez-Puya R, Puig L, Sánchez-Carazo JL, Ferrán M, Sancho C, Juliá B, Cea-Calvo L, Marín-Jiménez I, García-Vicuña R. Immune-mediated inflammatory diseases and other comorbidities in patients with psoriasis: baseline characteristics of patients in the AQUILES study. Actas Dermosifiliogr 2014; 106:35-43. [PMID: 25091923 DOI: 10.1016/j.ad.2014.06.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [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: 05/07/2014] [Revised: 05/26/2014] [Accepted: 06/01/2014] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES Patients with psoriasis often have comorbidities, including other immune-mediated inflammatory diseases (IMIDs), and cardiovascular risk factors. In this article we describe the baseline prevalence of comorbidities-including other IMIDs-in a cohort of patients with psoriasis. PATIENTS AND METHODS AQUILES was a prospective observational multicenter study of 3 patient cohorts (patients with psoriasis, spondyloarthritis, or inflammatory bowel disease) undertaken to investigate the prevalence of comorbidities, including other IMIDs, in these settings. The psoriasis cohort comprised patients aged at least 18 years who were seen in hospital dermatology clinics. A predefined protocol was used to collect demographic and clinical data. RESULTS The study enrolled 528 patients with psoriasis (60.2% men and 39.8% women). Mean age was 46.7 years; 89.8% of the participants had plaque psoriasis, and the median Psoriasis Area Severity Index score (PASI) was 3.2 (1.5-7.4). Comorbid IMIDs were present in 82 (15.5%) of the patients (CI 95%, 12.7%-18.9%). Spondyloarthritis was observed in 14% of patients (95% CI, 11.3%-17.2%), mostly in the form of psoriatic arthritis, for which the overall prevalence was 13.1% (95% CI, 10.5%-16.2%). Inflammatory bowel disease was present in 1.3% (95% CI, 0.6%-2.7%) and uveitis in .2% (95% CI, 0.1%-1.4%). Psoriatic arthritis was associated with male sex (odds ratio, 1.75 [.98-2.98]) and a disease duration of over 8 years (OR, 4.17 [1.84-9.44] vs a duration of < 4 years). In 73.1%, at least 1 cardiovascular risk factor was identified: smoking (40.5%), obesity (26.0%), dyslipidemia (24.8%), hypertension (24.3%), and diabetes mellitus (12.3%). CONCLUSION In patients with psoriasis the prevalence of other IMIDs was 15.5%, a level slightly higher than that found in the general population. Nearly three-quarters of these patients had at least 1 cardiovascular risk factor.
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Affiliation(s)
- F Vanaclocha
- Servicio de Dermatología, Hospital Universitario 12 de Octubre, Madrid, España
| | - V Crespo-Erchiga
- Servicio de Dermatología, Hospital Regional Universitario Carlos Haya, Málaga, España
| | - R Jiménez-Puya
- Servicio de Dermatología, Hospital Universitario Reina Sofía, Córdoba, España
| | - L Puig
- Servicio de Dermatología, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - J L Sánchez-Carazo
- Servicio de Dermatología, Hospital General Universitario, Valencia, España
| | - M Ferrán
- Servicio de Dermatología, Hospital del Mar, Barcelona, España
| | - C Sancho
- Medical Affairs, Merck Sharp & Dohme, España
| | - B Juliá
- Medical Affairs, Merck Sharp & Dohme, España.
| | - L Cea-Calvo
- Medical Affairs, Merck Sharp & Dohme, España
| | - I Marín-Jiménez
- Servicio de Gastroenterología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - R García-Vicuña
- Servicio de Reumatología, Hospital Universitario La Princesa, IISP, Madrid, España
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