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Reyes-Cordero G, Enríquez-Sosa F, Gomez-Ruiz C, Gonzalez-Diaz V, Castillo-Ortiz JD, Duran-Barragán S, Duran-Ortiz JS, Espinosa-Morales R, Gamez-Nava JI, Gonzalez-Lopez L, Julian-Martínez B, Mendoza-Fuentes A, Ramos-Remus C, Pacheco-Tena C, Burgos-Vargas R. Recommendations of the Mexican College of Rheumatology for the Management of Spondyloarthritis. REUMATOLOGIA CLINICA 2021; 17:37-45. [PMID: 31285162 DOI: 10.1016/j.reuma.2019.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 03/31/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To update the recommendations for the management of patients with Spondyloarthritis (SpA) in the Mexican population, and identify which variables could influence patient management. MATERIAL AND METHODS A group of 15 experts in SpA translated, analyzed and modified the recommendations of the Mexican College of Rheumatology (CMR) and the International Society for the Assessment of Spondyloarthritis (ASAS)/European League Against Rheumatism (EULAR) 2016 group through a systematic review of the literature by two external reviewers during the period from 2015 to 2018 using the grade of recommendation, Oxford levels of evidence, percentage of concordance (Delphi). RESULTS Compared to previous recommendations, there were no significant changes from the year 2015. However, we modified the five fundamental principles and reduced the number of recommendations to ten by incorporating the first item in the text and combining five recommendations into two and adding a further recommendation. We confirmed the tendency to use glucocorticoids for patients with inflammatory activity and scarce access to biologicals. We identified the sociodemographic and clinical characteristics of patients with SpA and their influence on the application of the recommendations. CONCLUSIONS The ten recommendations of the CMR and the analysis of the characteristics of the Mexican patients with SpA focussed on step therapy, including pharmacological and non-pharmacological therapies, in a spectrum from easily accessible to high-tech substances available to a small percentage of the population.
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Affiliation(s)
- Greta Reyes-Cordero
- Hospital Ángeles Chihuahua, Facultad de Medicina y Ciencias Biomédicas, Universidad Autónoma de Chihuahua, Chihuahua, México
| | - Favio Enríquez-Sosa
- Hospital Regional «General Ignacio Zaragoza», ISSSTE, Ciudad de México, México
| | | | - Verónica Gonzalez-Diaz
- Antiguo Hospital Civil de Guadalajara «Fray Antonio Alcalde», Guadalajara, Jalisco, México
| | | | - Sergio Duran-Barragán
- Clínica de Investigación en Reumatología y Obesidad S.C. Instituto de Investigación en Reumatología y del Sistema Musculoesquelético, Departamento de Clínicas Médicas, Universidad de Guadalajara, Guadalajara, Jalisco, México
| | - J Santos Duran-Ortiz
- Servicio de Reumatología, Hospital General de Zona N.(o) 1, Instituto Mexicano del Seguro Social, Tepic, Nayarit, México
| | - Rolando Espinosa-Morales
- Servicio de Reumatología, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Ciudad de México, México
| | - Jorge I Gamez-Nava
- Unidad de Investigación Biomédica 02, UMAE, Hospital de Especialidades Centro Médico Nacional de Occidente, IMSS, Guadalajara, Jalisco, México; Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, México
| | - Laura Gonzalez-Lopez
- Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jalisco, México
| | - Bernardo Julian-Martínez
- Servicio de Reumatología, Hospital General de Zona N.(o) 1, Instituto Mexicano del Seguro Social Delegación Hidalgo, Pachuca, Hidalgo, México
| | | | - Cesar Ramos-Remus
- Unidad de Investigación en Enfermedades Crónico-Degenerativas, Guadalajara, Jalisco, México
| | - Cesar Pacheco-Tena
- Facultad de Medicina y Ciencias Biomédicas, Universidad Autónoma de Chihuahua, Chihuahua, México
| | - Ruben Burgos-Vargas
- Hospital General de México «Dr. Eduardo Liceaga», Universidad Nacional Autónoma de México, Ciudad de México, México.
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Sellas I Fernandez A, Juanola Roura X, Alonso Ruiz A, Rosas J, Medina Luezas J, Collantes Estevez E, Abad Hernández MÁ, Carrasco Benitez V, Fisac C. Clinical utility of the ASDAS index in comparison with BASDAI in patients with ankylosing spondylitis (Axis Study). Rheumatol Int 2017; 37:1817-1823. [PMID: 28918450 DOI: 10.1007/s00296-017-3814-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 09/06/2017] [Indexed: 11/25/2022]
Abstract
The objective of the study was to study the clinical utility of the Ankylosing Spondylitis Disease Activity Score (ASDAS) for the assessment of disease activity in ankylosing spondylitis (AS) patients, compared to the Bath Ankylosing Spondylitis Activity Index (BASDAI). This was a prospective longitudinal observational study in patients with AS (NY-modified criteria) from 23 Spanish centers. Physical and analytical data; global, lumbar, and nocturnal pain; ASDAS, BASDAI and minimally acceptable clinical status (PASS) were collected. Psychometric characteristics of both indexes were analyzed: construct validity (convergent and divergent), discriminant capacity, criterion validity (global physician and patient assessment), and sensitivity to change. The study involved 127 patients (19.7% attrition). Both BASDAI and ASDAS showed a higher correlation with patient's global assessment (r = 0.76 and 0.70, respectively) than with physician's global assessment (r = 0.67 and 0.57). Both scores allowed discriminating patients with an acceptable clinical status, although BASDAI to a greater extent than ASDAS (Cohen δ 1.72 vs 0.88 for the medical PASS). Both scores showed sensitivity to change in patients who changed from an unacceptable symptomatic state to acceptable according to PASS criteria (physician and patient) and by BASDAI 50 response criteria (Cohen δ > 0.80). BASDAI showed better criterion validity than ASDAS, both for the patient PASS (AUC 0.85 vs 0.79) and for the physician's (AUC 0.90 vs 0.79). ASDAS shows adequate performance for disease activity in patients with AS; however, in this study, its psychometric properties do not present advantages over BASDAI in terms of criterion validity, sensitivity to change or discriminative capacity; replacement of BASDAI by ASDAS is not supported by the data.
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Affiliation(s)
| | - Xavier Juanola Roura
- Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - José Rosas
- Hospital Marina Baixa Villajoyosa, Alicante, Spain
| | | | | | | | | | - Cesar Fisac
- Medical Department, Abbvie Spain, Avenida de Burgos, 91, 28050, Madrid, Spain.
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Narváez J, Bueno Horcajadas A, de Miguel Mendieta E, Sanz Sanz J. Guidelines for magnetic resonance imaging in axial spondyloarthritis: A Delphi study. RADIOLOGIA 2015. [DOI: 10.1016/j.rxeng.2015.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Rosales-Alexander JL, Balsalobre Aznar J, Pérez-Vicente S, Magro-Checa C. Drug survival of anti-tumour necrosis factor α therapy in spondyloarthropathies: results from the Spanish emAR II Study. Rheumatology (Oxford) 2015; 54:1459-63. [PMID: 25767155 DOI: 10.1093/rheumatology/kev001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE To assess drug survival and the reasons for switching anti-TNF-α therapy in SpA patients in a Spanish nationwide study. METHODS A cross-sectional study was performed. Sample size was calculated to represent all regions and hospitals throughout the country. Demographic data, patient characteristics and disease activity parameters were obtained. Drug survival and reasons for switching anti-TNF therapy were also recorded. RESULTS A total of 467 SpA patients receiving at least one anti-TNF agent were identified. Among patients who received a first, second and third anti-TNF course, 39.4%, 37.4% and 23.1% discontinued treatment, respectively. The main reasons for switching anti-TNF agents in the first course were lack or loss of efficacy (LOE) and adverse events (AEs) in 40% and 30% of switchers, respectively. Similarly, reasons for switching during the second anti-TNF course were LOE in 48% and AEs in 28% of switchers. Of the 467 SpA patients starting anti-TNF therapy, 28% switched to a second and 8% switched to a third therapy. Mean drug survival for the first, second and third anti-TNF courses were 84.4 (95% CI 78.4, 90.5), 70.2 (95% CI 61.6, 78.9) and 64.8 (95% CI 51.1, 78.5) months, respectively (P = 0.315). CONCLUSION Twenty-eight per cent of SpA patients starting anti-TNF therapy switched to a second anti-TNF agent. Drug survival did not differ among anti-TNF courses. The main reason for switching anti-TNF therapy was LOE. Switchers were more frequently women and had higher disease activity parameters at the time of the study than non-switchers.
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Affiliation(s)
| | | | | | - César Magro-Checa
- Rheumatology Department, San Cecilio University Hospital, Granada, Spain
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Narváez JA, Bueno Horcajadas A, de Miguel Mendieta E, Sanz Sanz J. Guidelines for magnetic resonance imaging in axial spondyloarthritis: A Delphi study. RADIOLOGIA 2015; 57:512-22. [PMID: 25627428 DOI: 10.1016/j.rx.2014.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 09/27/2014] [Accepted: 11/24/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The term axial spondyloarthritis refers to a group of chronic inflammatory rheumatic diseases with a common genetic basis that course with axial and peripheral involvement and enthesitis. Recently, the Assessment of SpondyloArthritis international Society (ASAS) established some diagnostic criteria, including for the first time magnetic resonance imaging (MRI) findings. Given the difficulties of obtaining MRI in some environments and the lack of experience with axial spondyloarthritis, a group of radiologists and rheumatologists sought to establish some practical guidelines to ensure the correct use of MRI in this disease. MATERIAL AND METHODS Using the Delphi method, we used a questionnaire with 49 items stratified into 4 blocks to survey 46 experts in the MRI diagnosis of axial spondyloarthritis. RESULTS The experts agreed on 82% of the items. The degree of agreement was 100% in the block "Importance of early diagnosis of axial spondyloarthritis", 69% in the block "Optimization of the use of MRI in the diagnosis of axial spondyloarthritis", 93% in the block "Use of MRI in axial spondyloarthritis: Technical aspects", and 57% in the block "Usefulness of MRI in the prognosis, follow-up, and evaluation of the response to treatment in axial spondyloarthritis". CONCLUSIONS Despite the importance of MRI in the early diagnosis of axial spondyloarthritis, this study shows the need for standardization and points to relative disagreement about how to use MRI in the follow-up of the disease and evaluation of the response to treatment. The results of this study can help improve the use of MRI in axial spondyloarthritis.
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Affiliation(s)
- J A Narváez
- Servicio de Radiodiagnóstico, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España.
| | - A Bueno Horcajadas
- Servicio de Radiodiagnóstico, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | | | - J Sanz Sanz
- Servicio de Reumatología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
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Jovani V, Loza E, García de Yébenes MJ, Descalzo MÁ, Barrio JM, Carmona L, Hernández-García C. Variability in resource consumption in patients with spondyloarthritis in Spain. Preliminary descriptive data from the emAR II study. REUMATOLOGIA CLINICA 2012; 8:114-119. [PMID: 22503152 DOI: 10.1016/j.reuma.2012.01.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Revised: 12/08/2011] [Accepted: 01/11/2012] [Indexed: 05/31/2023]
Abstract
OBJECTIVE Our objective was to describe the variability in the management of spondyloarthritis (SA) in Spain in terms of healthcare resources and their use. METHODS A review of 1168 medical files of patients seen in randomly selected Spanish hospital rheumatology departments. We analyzed demographic variables and variables related to the consumption of health resources. RESULTS The total number of visits to rheumatology were 5,908 with a rate of 254 visits/100 patient-years. The total number of visits to rheumatology specialty nurses was 775, with a rate of 39 visits/100 patient-years, and there were 446 hospitalizations, representing a rate of 22 per 100 patient-years. The number of admissions due to SA was 89, with a rate of 18 admissions/100 patient-years. Total visits to other specialists was 4,307 with a rate of 200/100 patient-years. The total number of orthopedic surgeries was 41, which leads to a rate of 1.8 surgeries/100 patient-years. CONCLUSIONS The data regarding visits to the rheumatologist and prosthetic surgery of patients with in Spain is similar to most studies published in our environment, however, other aspects concerning the use of health resources are different compared to other countries. This data may help to understand and improve organizational aspects of management of SA in Spanish hospitals.
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Affiliation(s)
- Vega Jovani
- Servicio de Reumatología, Hospital General Universitario de Alicante, Alicante, España.
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Castro Villegas MDC, Escudero Contreras A, Miranda García MD, Collantes Estévez E. [How to optimize the antiTNF alpha therapy in spondylitis?]. REUMATOLOGIA CLINICA 2012; 8 Suppl 1:S26-S31. [PMID: 22418285 DOI: 10.1016/j.reuma.2012.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Revised: 12/31/2011] [Accepted: 01/18/2012] [Indexed: 05/31/2023]
Abstract
TNFalpha inhibitors have been a major advance in the treatment of spondyloarthropathies, having demonstrated their safety and efficacy, with higher response and survival rates than those observed in patients with rheumatoid arthritis. The fact that disease modifying anti-arthritic drugs (DMARD) have shown utility in the treatment of this disease, especially in the axial forms, gives them greater importance, since it is known that up to 30%of patients do not respond to treatment with non-steroidal anti-inflammatory drugs. However, we must take into account that these drugs are expensive and not without side effects, so it is necessary to optimize their use. We intend to review the use of antiTNF alpha in spondyloarthropathies and review the available evidence on strategies that can help with their rational use.
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Affiliation(s)
- Maria del Carmen Castro Villegas
- Servicio de Reumatología, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, Córdoba, España.
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Cobo-Ibáñez T, Muñoz-Fernández S, De Miguel E, Díez Sebastián J, Steiner M, Martín-Mola E. Seguimiento clínico y ecográfico a 1 año del EStudio PIloto de Derivación de pacientes con Espondiloartritis Precoz (ESPIDEP). ACTA ACUST UNITED AC 2011; 7:230-5. [DOI: 10.1016/j.reuma.2010.11.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2010] [Revised: 11/14/2010] [Accepted: 11/25/2010] [Indexed: 01/21/2023]
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9
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Fernández Sueiro JL, Juanola Roura X, Cañete Crespillo JDD, Torre Alonso JC, García de Vicuña R, Queiro Silva R, Ariza Ariza R, Batlle Gualda E, Loza Santamaría E. Documento SER de consenso sobre el uso de terapias biológicas en la artritis psoriásica. ACTA ACUST UNITED AC 2011; 7:179-88. [DOI: 10.1016/j.reuma.2011.02.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2010] [Revised: 01/15/2011] [Accepted: 02/02/2011] [Indexed: 10/28/2022]
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10
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Documento SER de consenso sobre el uso de terapias biológicas en la espondilitis anquilosante y otras espondiloartritis, excepto la artritis psoriásica. ACTA ACUST UNITED AC 2011; 7:113-23. [DOI: 10.1016/j.reuma.2010.12.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Revised: 12/10/2010] [Accepted: 12/10/2010] [Indexed: 12/17/2022]
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Juanola Roura X, Zarco Montejo P, Sanz Sanz J, Muñoz Fernández S, Mulero Mendoza J, Linares Ferrando LF, Gratacós Masmitja J, de Vicuña RG, Fernandez Carballido C, Collantes Estevez E, Batlle Gualda E, Ariza Ariza R, Loza Santamaría E. Consensus Statement of the Spanish Society of Rheumatology on the management of biologic therapies in Spondyloarthritis except for Psoriatic Arthritis. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/s2173-5743(11)70022-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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12
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Castro Villegas MDC, Batlle Gualda E. [Measuring spondyloarthritis]. ACTA ACUST UNITED AC 2010; 6 Suppl 1:11-7. [PMID: 21794747 DOI: 10.1016/j.reuma.2010.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2010] [Accepted: 01/13/2010] [Indexed: 10/19/2022]
Abstract
The ASAS group recommendations as well as those from the SER consensus for the treatment of spondyloarthritis with TNF inhibitors advise for the performance of spinal motility tests among the response to treatment measures. The clinical variability between rheumatologists when performing these types of measurements is well documented. Recently, the GRESSER group in our country has created a school to improve knowledge in the area of spondyloarthritis among rheumatologists. One of their objectives is the standardization in the ways measurements are performed in this group of diseases. This document summarizes the activities developed in a recent workshop with a detailed description of the procedures followed to perform each one of the important measurements affecting the axial skeleton. With this we hope to contribute to the much desired standardization in the field of metrology in spondyloarthritis.
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