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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. REUMATOLOGIA CLINICA 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] [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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Amutio A, Franco C, Sánchez-Sánchez LC, Pérez-Fuentes MDC, Gázquez-Linares JJ, Van Gordon W, Molero-Jurado MDM. Effects of Mindfulness Training on Sleep Problems in Patients With Fibromyalgia. Front Psychol 2018; 9:1365. [PMID: 30147666 PMCID: PMC6096902 DOI: 10.3389/fpsyg.2018.01365] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 07/16/2018] [Indexed: 12/13/2022] Open
Abstract
Fibromyalgia syndrome (FMS) is a complex psychosomatic pain condition. In addition to generalized pain and various cognitive difficulties, new FMS diagnostic criteria acknowledge fatigue and sleep problems as core aspects of this condition. Indeed, poor sleep quality has been found to be a significant predictor of pain, fatigue, and maladaptive social functioning in this patient group. While there is promising evidence supporting the role of mindfulness as a treatment for FMS, to date, mindfulness intervention studies have principally focused on dimensions of pain as the primary outcome with sleep problems either not being assessed or included as a secondary consideration. Given the role of sleep problems in the pathogenesis of FMS, and given that mindfulness has been shown to improve sleep problems in other clinical conditions, the present study explored the effects of a mindfulness-based intervention known as Flow Meditation (Meditación-Fluir) on a range of sleep-related outcomes (subjective insomnia, sleep quality, sleepiness, and sleep impairment) in individuals with FMS. Adult women with FMS (n = 39) were randomly assigned to the 7 weeks mindfulness treatment or a waiting list control group. Results showed that compared to the control group, individuals in the mindfulness group demonstrated significant improvements across all outcome measures and that the intervention effects were maintained at a 3 month follow-up assessment. The Meditación-Fluir program shows promise for alleviating sleep problems relating to FMS and may thus have a role in the treatment of FMS as well as other pain disorders in which sleep impairment is a central feature of the condition.
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Affiliation(s)
- Alberto Amutio
- Department of Social Psychology and Methodology of the Behavioral Sciences, University of the Basque Country (UPV/EHU), Bilbao, Spain
| | - Clemente Franco
- Department of Psychology, University of Almería, Almería, Spain
| | | | | | | | - William Van Gordon
- Centre for Psychological Research, University of Derby, Derbyshire, United Kingdom
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Low Doses of Etanercept Can Be Effective to Maintain Remission in Psoriatic Arthritis Patients. J Clin Rheumatol 2018; 24:127-131. [DOI: 10.1097/rhu.0000000000000617] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Gratacós J, Luelmo J, Rodríguez J, Notario J, Marco TN, de la Cueva P, Busquets MP, Font MG, Joven B, Rivera R, Vega JLA, Álvarez AJC, Parera RS, Carrascosa JCR, Martínez FJR, Sánchez JP, Olmos CF, Pujol C, Galindez E, Barrio SP, Arana AU, Hergueta M, Coto P, Queiro R. Standards of care and quality indicators for multidisciplinary care models for psoriatic arthritis in Spain. Rheumatol Int 2018; 38:1115-1124. [PMID: 29417210 DOI: 10.1007/s00296-018-3986-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 01/17/2018] [Indexed: 11/25/2022]
Abstract
To define and give priority to standards of care and quality indicators of multidisciplinary care for patients with psoriatic arthritis (PsA). A systematic literature review on PsA standards of care and quality indicators was performed. An expert panel of rheumatologists and dermatologists who provide multidisciplinary care was established. In a consensus meeting group, the experts discussed and developed the standards of care and quality indicators and graded their priority, agreement and also the feasibility (only for quality indicators) following qualitative methodology and a Delphi process. Afterwards, these results were discussed with 2 focus groups, 1 with patients, another with health managers. A descriptive analysis is presented. We obtained 25 standards of care (9 of structure, 9 of process, 7 of results) and 24 quality indicators (2 of structure, 5 of process, 17 of results). Standards of care include relevant aspects in the multidisciplinary care of PsA patients like an appropriate physical infrastructure and technical equipment, the access to nursing care, labs and imaging techniques, other health professionals and treatments, or the development of care plans. Regarding quality indicators, the definition of multidisciplinary care model objectives and referral criteria, the establishment of responsibilities and coordination among professionals and the active evaluation of patients and data collection were given a high priority. Patients considered all of them as important. This set of standards of care and quality indicators for the multidisciplinary care of patients with PsA should help improve quality of care in these patients.
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Affiliation(s)
- Jordi Gratacós
- Servicio de Reumatología, Rheumatology Department, Hospital universitario Parc Taulí de Sabadell, I3PT, UAB, Parc Taulí, 1 Sabadell, 08208, Barcelona, Spain.
| | - Jesús Luelmo
- Servicio de Dermatología, Hospital universitario Parc Taulí de Sabadell, I3PT, UAB, Barcelona, Spain
| | - Jesús Rodríguez
- Servicio de Reumatología, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Jaume Notario
- Servicio de Dermatología, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Teresa Navío Marco
- Servicio de Reumatología, Universitario el Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Pablo de la Cueva
- Servicio de Dermatología, Universitario el Hospital Universitario Infanta Leonor, Madrid, Spain
| | | | - Mercè García Font
- Servicio de Dermatología, Hospital Mutua de Terrassa, Barcelona, Spain
| | - Beatriz Joven
- Servicio de Reumatología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Raquel Rivera
- Servicio de Dermatología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | | | - Ricardo Sánchez Parera
- Servicio de Reumatología, Complejo Hospitalario Universitario de Granada, Granada, Spain
| | | | | | - José Pardo Sánchez
- Servicio de Dermatología, Hospital General Universitario Santa Lucía, Cartagena, Murcia, Spain
| | - Carlos Feced Olmos
- Servicio de Reumatología, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Conrad Pujol
- Servicio de Dermatología, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Eva Galindez
- Servicio de Reumatología, Hospital de Basurto, Bilbao, Bizkaia, Spain
| | | | | | | | - Pablo Coto
- Servicio de dermatología, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Rubén Queiro
- Servicio de Reumatología, Hospital Universitario Central de Asturias, Oviedo, Spain
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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] [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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Points to Consider in the Foundation of Multidisciplinary Units for Psoriatic Arthritis: A Delphi Study and a Systematic Review of the Literature. Adv Ther 2017; 33:2150-2159. [PMID: 27757814 DOI: 10.1007/s12325-016-0429-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION In numerous clinical practice guidelines, emphasis is placed on the need for coordinated care of psoriatic arthritis (PsA) between rheumatologists and the objective was to develop experience-based points to consider facilitating the implementation of multidisciplinary units (Dermatology/Rheumatology) for the management of patients with PsA. METHODS A scientific committee of rheumatology and dermatology experts in the management of PsA, and with experience in joint care, discussed the critical aspects of multidisciplinary PsA Units. The discussion became the basis for a Delphi survey in two rounds submitted to a panel of 24 specialists in rheumatology and dermatology not involved in PsA units. The statements and practices that reached a consensus were summarized and further elaborated. RESULTS After two Delphi rounds, agreement was reached for 49 of the 50 proposed statements. These included a justification of the units, objectives, and utilities, as well as operational aspects of the units, such as the minimal and ideal premises, referral criteria, and necessary resources. The statements were compiled in 11 points to consider. CONCLUSIONS This consensus offers some points to consider, including premises and recommendations, for the development of specialized Units in the management of PsA based on expert opinion. We trust these guidelines may facilitate their implementation in the future. FUNDING Pfizer.
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How many patients with rheumatic diseases and TNF inhibitors treatment have latent tuberculosis? ACTA ACUST UNITED AC 2016; 13:282-286. [PMID: 27394672 DOI: 10.1016/j.reuma.2016.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Revised: 04/08/2016] [Accepted: 05/13/2016] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Spanish clinical guidelines recommend screening patients for tuberculosis (TB) before TNF inhibitors (TNFi) treatment. Our objective was to estimate the prevalence of TST seroconversion as an estimation of the prevalence of latent TB in patients with rheumatic diseases and TNFi treatment that have already been screened for tuberculosis. METHODS TST, booster and chest x-ray were performed to patients with rheumatic diseases, TNFi treatment, negative tuberculin skin tests before treatment and that were attending the rheumatology Department of three different hospitals in Barcelona. According to the Spanish Society Rheumatology guidelines, these patients had not received TB prophylaxis treatment. RESULTS One hundred and forty patients were included in the study. The tuberculin skin test was positive in 4.28% (n=6) of the patients. 50% of the patients were undergoing TNFi ≤ 2 years, being two of the patients only one year on the TNFi when a positive TST was detected. This shows that a conversion of the TST can occur even few months or years after the TNFi is started. CONCLUSIONS The present study observed that 4.28% of patients with rheumatic diseases on TNFi who did not have performed a pre-treatment TB prophylaxis, had a conversion of the TST. Moreover, the conversion of the TST had been within the first two years of treatment in half of the patients of our cohort. In spite of these results, false TST positives in the diagnosis of latent TB cannot be excluded as an explanation for our results.
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8
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Betteridge N, Boehncke W, Bundy C, Gossec L, Gratacós J, Augustin M. Promoting patient-centred care in psoriatic arthritis: a multidisciplinary European perspective on improving the patient experience. J Eur Acad Dermatol Venereol 2016; 30:576-85. [PMID: 26377041 PMCID: PMC5049610 DOI: 10.1111/jdv.13306] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 06/15/2015] [Indexed: 01/05/2023]
Abstract
Patients with psoriatic arthritis (PsA) may not be optimally treated. The impact of the disease extends beyond skin and joint symptoms, impairing quality of life. This indicates that the adoption of a patient-focused approach to PsA management is necessary. An expert multidisciplinary working group was convened, with the objective of developing an informed perspective on current best practice and needs for the future management of PsA. Topics of discussion included the barriers to current best practice and calls to action for the improvement of three areas in PsA management: early and accurate diagnosis of PsA, management of disease progression and management of the impact of the condition on the patient. The working group agreed that, to make best use of the available of diagnostic tools, clinical care recommendations and effective treatments, there is a clear need for healthcare professionals from different disciplines to collaborate in the management of PsA. By facilitating appropriate and rapid referral, providing high quality information about PsA and its treatment to patients, and actively involving patients when choosing management plans and setting treatment goals, management of PsA can be improved. The perspective of the working group is presented here, with recommendations for the adoption of a multidisciplinary, patient-focused approach to the management of PsA.
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Affiliation(s)
| | - W.‐H. Boehncke
- Department of DermatologyGeneva University HospitalGenevaSwitzerland
- Department of Pathology and ImmunologyUniversity of GenevaGenevaSwitzerland
| | - C. Bundy
- Centre for Dermatology ResearchInstitute for Inflammation and RepairUniversity of Manchester and Manchester Academic Health Sciences CentreManchesterUK
| | - L. Gossec
- Sorbonne UniversitésUPMC Univ Paris 06ParisFrance
- Pitie‐Salpétrière Hospital AP‐HPParisFrance
| | - J. Gratacós
- Rheumatology Service, Hospital Universitari Parc Taulí of SabadellUABBarcelonaSpain
| | - M. Augustin
- University Medical Center Hamburg‐EppendorfHamburgGermany
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9
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Etanercept en el tratamiento de la artritis psoriásica. ACTAS DERMO-SIFILIOGRAFICAS 2015; 106:252-9. [DOI: 10.1016/j.ad.2014.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 09/07/2014] [Accepted: 09/14/2014] [Indexed: 12/20/2022] Open
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10
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Puig L, López-Ferrer A, Laiz A. Etanercept in the Treatment of Psoriatic Arthritis. ACTAS DERMO-SIFILIOGRAFICAS 2015. [DOI: 10.1016/j.adengl.2014.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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11
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Carrascosa J, Belinchón I, de-la-Cueva P, Izu R, Luelmo J, Ruiz-Villaverde R. Expert Recommendations on Treating Psoriasis in Special Circumstances. ACTAS DERMO-SIFILIOGRAFICAS 2015. [DOI: 10.1016/j.adengl.2015.03.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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12
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Janta I, Martínez-Estupiñán L, Valor L, Montoro M, Baniandres Rodriguez O, Hernández Aragüés I, Bello N, Hernández-Flórez D, Hinojosa M, Martínez-Barrio J, Nieto-González JC, Ovalles-Bonilla JG, González CM, López-Longo FJ, Monteagudo I, Naredo E, Carreño L. Comparison between full and tapered dosages of biologic therapies in psoriatic arthritis patients: clinical and ultrasound assessment. Clin Rheumatol 2015; 34:935-42. [DOI: 10.1007/s10067-015-2880-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2014] [Revised: 01/18/2015] [Accepted: 01/18/2015] [Indexed: 12/28/2022]
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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 DERMO-SIFILIOGRAFICAS 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] [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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14
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¿Cómo comparar fármacos biológicos? ACTA ACUST UNITED AC 2014; 10:353-9. [DOI: 10.1016/j.reuma.2014.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 06/04/2014] [Accepted: 06/15/2014] [Indexed: 12/17/2022]
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15
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Cañete J, Daudén E, Queiro R, Aguilar M, Sánchez-Carazo J, Carrascosa J, Carretero G, García-Vivar M, Lázaro P, López-Estebaranz J, Montilla C, Ramírez J, Rodríguez-Moreno J, Puig L. Elaboración mediante el método Delphi de recomendaciones para el manejo coordinado (reumatólogo/dermatólogo) de la artritis psoriásica. ACTAS DERMO-SIFILIOGRAFICAS 2014. [DOI: 10.1016/j.ad.2013.07.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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16
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Recommendations for the coordinated management of psoriatic arthritis by rheumatologists and dermatologists: a Delphi study. ACTAS DERMO-SIFILIOGRAFICAS 2014; 105:216-32. [PMID: 24657018 DOI: 10.1016/j.adengl.2013.07.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2013] [Accepted: 07/18/2013] [Indexed: 12/23/2022] Open
Abstract
Psoriatic arthritis, a chronic inflammatory musculoskeletal disease that is associated with psoriasis, causes joint erosions, accompanied by loss of function and quality-of-life. The clinical presentation is variable, with extreme phenotypes that can mimic rheumatoid arthritis or ankylosing spondylitis. Because psoriasis usually presents before psoriatic arthritis, the dermatologist plays a key role in early detection of the latter. As many treatments used in psoriasis are also used in psoriatic arthritis, treatment recommendations should take into consideration the type and severity of both conditions. This consensus paper presents guidelines for the coordinated management of psoriatic arthritis by rheumatologists and dermatologists. The paper was drafted by a multidisciplinary group (6rheumatologists, 6dermatologists, and 2epidemiologists) using the Delphi method and contains recommendations, tables, and algorithms for the diagnosis, referral, and treatment of patients with psoriatic arthritis.
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17
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Standards of care for patients with spondyloarthritis. Rheumatol Int 2014; 34:165-70. [DOI: 10.1007/s00296-013-2934-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 12/21/2013] [Indexed: 10/25/2022]
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18
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Reduction of Biological Agent Dose in Rheumatic Diseases: Descriptive Analysis of 153 Patients in Clinical Practice Conditions. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.reumae.2013.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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19
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Inciarte-Mundo J, Hernández MV, Rosario V, Ruiz-Esquide V, Cabrera-Villalba S, Ramírez J, Cañete JD, Sanmartí R. Reduction of biological agent dose in rheumatic diseases: descriptive analysis of 153 patients in clinical practice conditions. ACTA ACUST UNITED AC 2013; 10:10-6. [PMID: 23876791 DOI: 10.1016/j.reuma.2013.04.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Revised: 03/28/2013] [Accepted: 04/06/2013] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To analyze the frequency and characteristics of dose reduction of biological agents in a cohort of patients with chronic arthritis, in clinical practice conditions in a tertiary level hospital. MATERIAL AND METHODS Descriptive, cross-sectional study, which included all patients, followed consecutively during 6 months (June 2011-November 2011), by one investigator, with patients who at least have received one dose of biological agents in 2011. RESULTS We included 153 patients: Rheumatoid arthritis (RA) (n=82), ankylosing spondylitis (n=29), psoriatic arthritis (n=20), and miscellaneous group (n=22). Mean disease duration was 14.9±7.7 years. At the time of analysis, 70 patients (45.7%) were receiving low doses of biological therapy (50% in miscellaneous group group, 50% in psoriatic arthritis, 48.2% in ankylosing spondylitis, and 42.6% in RA). Mean time of dosage reduction was 17.4±17.5 months. The most common biological agents used in low dose were: etanercept, adalimumab and tocilizumab; 57.6%, 54.9% and 40% respectively, in patients with a reduced dose of biological therapy. The patients at low dose of biological therapy compared with standard dose, had similar mean disease duration, but received significantly less DMARDs, glucocorticoids and NSAIDs, and similar biological agent duration. RA patients with reduced biological treatment, at the time of analysis, had higher remission rates versus patients receiving a standard dose (82.9% vs 34%, p<0.0001). The medical decision at the time of analysis was to maintain low-dosage biological treatment in almost all patients. CONCLUSION In our clinical practice, 45.7% of our chronic arthritis patients receive low dose of biological therapy, after achieving remission or low activity at standard doses, maintaining a good control of the disease.
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Affiliation(s)
- José Inciarte-Mundo
- Unidad de Artritis, Servicio de Reumatología, Hospital Clínic de Barcelona, Barcelona, España
| | - M Victoria Hernández
- Unidad de Artritis, Servicio de Reumatología, Hospital Clínic de Barcelona, Barcelona, España
| | - Violeta Rosario
- Unidad de Artritis, Servicio de Reumatología, Hospital Clínic de Barcelona, Barcelona, España
| | - Virginia Ruiz-Esquide
- Unidad de Artritis, Servicio de Reumatología, Hospital Clínic de Barcelona, Barcelona, España
| | - Sonia Cabrera-Villalba
- Unidad de Artritis, Servicio de Reumatología, Hospital Clínic de Barcelona, Barcelona, España
| | - Julio Ramírez
- Unidad de Artritis, Servicio de Reumatología, Hospital Clínic de Barcelona, Barcelona, España
| | - Juan D Cañete
- Unidad de Artritis, Servicio de Reumatología, Hospital Clínic de Barcelona, Barcelona, España
| | - Raimon Sanmartí
- Unidad de Artritis, Servicio de Reumatología, Hospital Clínic de Barcelona, Barcelona, España.
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Daudén E, Castañeda S, Suárez C, García-Campayo J, Blasco A, Aguilar M, Ferrándiz C, Puig L, Sánchez-Carazo J. Clinical practice guideline for an integrated approach to comorbidity in patients with psoriasis. J Eur Acad Dermatol Venereol 2012; 27:1387-404. [DOI: 10.1111/jdv.12024] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Queiro R, Ginard D. Ustekinumab en la artritis psoriásica y la enfermedad de Crohn. ACTAS DERMO-SIFILIOGRAFICAS 2012. [DOI: 10.1016/s0001-7310(12)70011-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Daudén E, Castañeda S, Suárez C, García-Campayo J, Blasco A, Aguilar M, Ferrándiz C, Puig L, Sánchez-Carazo J. Abordaje integral de la comorbilidad del paciente con psoriasis. ACTAS DERMO-SIFILIOGRAFICAS 2012; 103 Suppl 1:1-64. [DOI: 10.1016/s0001-7310(12)70001-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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