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López-Medina C, Ladehesa-Pineda L, Puche-Larrubia MÁ, Escudero-Contreras A, Font-Ugalde P, Collantes-Estévez E. Which factors explain the patient global assessment in patients with ankylosing spondylitis? A hierarchical cluster analysis on REGISPONSER-AS. Semin Arthritis Rheum 2021; 51:875-879. [PMID: 34198145 DOI: 10.1016/j.semarthrit.2021.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 06/11/2021] [Accepted: 06/15/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To determine groups of factors (clusters) potentially associated with the patient global assessment (measured with the Bath Ankylosing Spondylitis Patient Global Score (BAS-G)), and to quantify the contribution of each cluster to the patient's well-being. METHODS This was a cross-sectional study in patients with a diagnosis of ankylosing spondylitis (AS) from the national, multicentre Spanish REGISPONSER-AS registry. A hierarchical cluster analysis was conducted to group the potential factors (sociodemographic, socioeconomic, patient-reported outcomes, physical exploration variables and depression) associated with the BAS-G. The contribution of each cluster to the variability of the BAS-G was evaluated using a multivariate linear regression model and the determination coefficient (R2) for each cluster. RESULTS A total of 681 patients with complete data were included. Three clusters of variables potentially associated with the BAS-G were found: cluster 1 contained the Maastricht Ankylosing Spondylitis Enthesitis Score (MASES), depression, sex (female) and university studies; cluster 2 included the Graffar scale, age and body mass index; and cluster 3 contained the Bath Ankylosing Spondylitis Functional Index (BASFI), the individual items of the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), pain during the last week, nocturnal pain and the number of swollen joints. A total of 6.8% of the variability of the BAS-G was explained by cluster 1, 0.5% was explained by cluster 2, and 60.8% was explained by cluster 3. CONCLUSION The BAS-G is mostly explained by pain and function, while demographic and socioeconomic factors are weakly associated with the BAS-G. Depression also has a weak effect on this score.
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Affiliation(s)
- Clementina López-Medina
- Rheumatology Department, Reina Sofia University Hospital, Cordoba, Spain; Maimonides Institute of Biomedical Research of Cordoba (IMIBIC), Cordoba, Spain; University of Cordoba, Cordoba, Spain; Rheumatology Department, Cochin Hospital, Paris, France.
| | - Lourdes Ladehesa-Pineda
- Rheumatology Department, Reina Sofia University Hospital, Cordoba, Spain; Maimonides Institute of Biomedical Research of Cordoba (IMIBIC), Cordoba, Spain; University of Cordoba, Cordoba, Spain
| | - M Ángeles Puche-Larrubia
- Rheumatology Department, Reina Sofia University Hospital, Cordoba, Spain; Maimonides Institute of Biomedical Research of Cordoba (IMIBIC), Cordoba, Spain; University of Cordoba, Cordoba, Spain
| | - Alejandro Escudero-Contreras
- Rheumatology Department, Reina Sofia University Hospital, Cordoba, Spain; Maimonides Institute of Biomedical Research of Cordoba (IMIBIC), Cordoba, Spain; University of Cordoba, Cordoba, Spain
| | - Pilar Font-Ugalde
- Rheumatology Department, Reina Sofia University Hospital, Cordoba, Spain; Maimonides Institute of Biomedical Research of Cordoba (IMIBIC), Cordoba, Spain; University of Cordoba, Cordoba, Spain
| | - Eduardo Collantes-Estévez
- Rheumatology Department, Reina Sofia University Hospital, Cordoba, Spain; Maimonides Institute of Biomedical Research of Cordoba (IMIBIC), Cordoba, Spain; University of Cordoba, Cordoba, Spain
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Liew JW, Bhana S, Costello W, Hausmann JS, Machado PM, Robinson PC, Sirotich E, Sufka P, Wallace ZS, Yazdany J, Grainger R. The COVID-19 Global Rheumatology Alliance: evaluating the rapid design and implementation of an international registry against best practice. Rheumatology (Oxford) 2021; 60:353-358. [PMID: 32789449 PMCID: PMC7454885 DOI: 10.1093/rheumatology/keaa483] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 07/10/2020] [Indexed: 12/23/2022] Open
Abstract
Objectives As the coronavirus disease 2019 pandemic developed there was a paucity of data relevant to people living with rheumatic disease. This led to the development of a global, online registry to meet these information needs. This manuscript provides a detailed description of the coronavirus disease 2019 Global Rheumatology Alliance registry development, governance structure, and data collection, and insights into new ways of rapidly establishing global research collaborations to meet urgent research needs. Methods We use previously published recommendations for best practices for registry implementation and describe the development of the Global Rheumatology Alliance registry in terms of these steps. We identify how and why these steps were adapted or modified. In Phase 1 of registry development, the purpose of the registry and key stakeholders were identified on online platforms, Twitter and Slack. Phase 2 consisted of protocol and data collection form development, team building and the implementation of governance and policies. Results All key steps of the registry development best practices framework were met, though with the need for adaptation in some areas. Outputs of the registry, two months after initial conception, are also described. Conclusion The Global Rheumatology Alliance registry will provide highly useful, timely data to inform clinical care and identify further research priorities for people with rheumatic disease with coronavirus disease 2019. The formation of an international team, easily able to function in online environments and resulting in rapid deployment of a registry is a model that can be adapted for other disease states and future global collaborations.
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Affiliation(s)
- Jean W Liew
- Division of Rheumatology, University of Washington, Seattle, WA
| | - Suleman Bhana
- Rheumatologist, Crystal Run Health, Middletown, NY, USA
| | | | - Jonathan S Hausmann
- Division of Rheumatology, Beth Israel Deaconess Medical Center, and Program in Rheumatology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Pedro M Machado
- Centre for Rheumatology & Department of Neuromuscular Diseases, University College London, London.,Department of Rheumatology and Queen Square Centre for Neuromuscular Diseases, University College London Hospitals NHS Foundation Trust.,Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
| | - Philip C Robinson
- University of Queensland, Faculty of Medicine, Brisbane, QLD, Australia
| | - Emily Sirotich
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton.,Canadian Arthritis Patient Alliance, Toronto, ON, Canada
| | - Paul Sufka
- Department of Rheumatology, HealthPartners, St Paul, MN
| | - Zachary S Wallace
- Clinical Epidemiology Program, Division of Rheumatology, Allergy, and Immunology, Mongan Institute, Department of Medicine, Massachusetts General Hospital.,Harvard Medical School, Boston, MA
| | - Jinoos Yazdany
- Division of Rheumatology, University of California, San Francisco, CA, USA
| | - Rebecca Grainger
- Department of Medicine and Department of Pathology and Molecular Medicine, University of Otago, Wellington, New Zealand
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Aranda-Valera IC, Garrido-Castro JL, Ladehesa-Pineda L, Vazquez-Mellado J, Zarco P, Juanola X, Gonzalez-Navas C, Font-Ugalde P, Castro-Villegas MC. How to calculate the ASDAS based on C-reactive protein without individual questions from the BASDAI: the BASDAI-based ASDAS formula. Rheumatology (Oxford) 2020; 59:1545-1549. [PMID: 31628804 DOI: 10.1093/rheumatology/kez480] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 08/29/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To develop a new equation to calculate the Ankylosing Spondylitis Disease Activity Score based on CRP (ASDAS-CRP) using only the BASDAI total score and CRP. METHODS Axial SpA (axSpA) patients from the Cordoba Spondyloarthritis Registry cohort were recruited as a derivation cohort, while a retrospective sample from the Spanish Rheumatology Society National Registry of Spondyloarthropathies and Ibero American Spondyloarhtritis Registry registers was used as a validation cohort. We built a new equation based only on the BASDAI and CRP, defining a new formula: the BASDAI-based ASDAS (BASDAS). Linear regression analysis was used to determine the coefficients of the equation in the derivation cohort and it was subsequently validated in the validation cohort. RESULTS A total of 52 axSpA patients in the derivation cohort and 3359 patients in the validation cohort were included. In the derivation cohort, the mean BASDAS [2.24 (s.d. 0.90)] was very similar to the ASDAS-CRP [2.23 (s.d. 0.95)], with a very strong correlation (r = 0.96, P < 0.001). In the validation cohort, the mean BASDAS was 3.31 (s.d. 1.37) and the ASDAS-CRP was 3.19 (s.d. 1.27), which also had a very strong correlation (r = 0.95, P < 0.001). Intraclass correlation coefficients were excellent in both cohorts (0.963 and 0.947, respectively). CONCLUSION The BASDAS performs similarly to the ASDAS-CRP and can be calculated with only the BASDAI total score and CRP, allowing evaluation of disease activity in retrospective studies where the individual items of the BASDAI are not available.
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Affiliation(s)
| | | | | | | | - Pedro Zarco
- Rheumatology Department, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Xavier Juanola
- Rheumatology Department, Hospital Universitario de Bellvitge, Universitat de Barcelona, Barcelona, Spain
| | | | - Pilar Font-Ugalde
- Department of Rheumatology, Reina Sofia University Hospital, Cordoba, Spain
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Ruiz-Cantero MT, Blasco-Blasco M. [Gender perspective in clinical epidemiology. Learning from spondyloarthritis]. GACETA SANITARIA 2018; 34:83-86. [PMID: 30541679 DOI: 10.1016/j.gaceta.2018.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 09/05/2018] [Accepted: 09/05/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To illustrate some gender challenges and contributions which are more frequent in research and health care through a chronic disease such as spondyloarthritis. METHOD Using two of the main identified gender biases in research and health care (de-contextualization of diseases, especially in women, and problem definition and knowledge production in women's health), a cross-sectional study was used with 96 men and 54 women with spondyloarthritis of the Rheumatology Department of the Alicante University General Hospital, whose sources of information were semi-structured patient interviews and clinical records. RESULTS We show how the gender perspective can contribute to contextualise the differences by sex of functional alterations and other social and health indicators, and highlight inequalities in the socioeconomic repercussions between patients of both sexes. It can contribute towards re-conceptualizing diseases, especially of women, specifying the profile of differential diagnosis according to sex, and provide knowledge about methodological challenges related to diagnostic tests. CONCLUSIONS Achieving scientific and professional excellence in health care is also a gender issue. Analysing from a gender perspective the history of the diseases, how their diagnosis criteria were established and the normality and abnormality cut-off points, especially identified diseases of men, such as spondyloarthritis, is a priority to re-conceptualize medicine; as well as providing information on how the gender norms and values of the context interact with the lives of those who suffer these diseases.
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Affiliation(s)
- María Teresa Ruiz-Cantero
- Departamento de Enfermería Comunitaria, Medicina Preventiva y Salud Pública e Historia de la Ciencia, Grupo de Investigación de Salud Pública, Universidad de Alicante, Alicante, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España
| | - Mar Blasco-Blasco
- Departamento de Enfermería Comunitaria, Medicina Preventiva y Salud Pública e Historia de la Ciencia, Grupo de Investigación de Salud Pública, Universidad de Alicante, Alicante, España.
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Challenges to conquer from the gender perspective in medicine: The case of spondyloarthritis. PLoS One 2018; 13:e0205751. [PMID: 30312342 PMCID: PMC6185841 DOI: 10.1371/journal.pone.0205751] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 10/01/2018] [Indexed: 12/24/2022] Open
Abstract
Background Diagnostic delay is well-known in spondyloarthritis and studies have demonstrated a longer deferral in women. The aim of this study was to explore whether diagnostic delay of spondyloarthritis depends on clinical manifestations expressed by patients according to sex or whether it is related to a doctor’s misdiagnosis bias. Methods A cross-sectional study of 96 men and 54 women with spondyloarthritis was performed at Alicante University General Hospital in Spain using a semistructured interview and clinical records. Comparative sex analysis were done via Student’s T and Mann-Whitney U tests for parametric and nonparametric continuous variables, chi-square and Fisher’s exact tests for unpaired categorical variables, and McNemar’s test for paired ones. Findings The median diagnostic delay in women 7.5 (11.5) years is higher than men 4 (11) years, with a difference close to statistical significance (p = 0.053). A total of 30.2% of men received a first correct diagnosis of spondyloarthritis versus 11.1% of women (p = 0.016), indicating that men have higher probability of not having a misdiagnosis of spondyloarthritis (odds ratio = 3.5; 1.3–9). Eleven different health services referred male patients to the rheumatology clinic but only six in the case of female. No sex differences were detected in patients’ manifestations of back pain at onset. However, medical records registered differences (women 44.4%, men 82.1%; p < 0.001). There were differences between patients (women 57.7%, men 35.2%; p = 0.008) and medical records in peripheral signs/symptoms at onset (women 55.6%, men 17.9%; p < 0.001). Conclusion The few differences of self-reported manifestations between both sexes with spondyloarthritis as compared with their clinical records (more axial pain in men and more peripheral pain in women) suggests that the professionals’ annotations reflect what they expect according to Literature, which could explain the higher misdiagnosis and diagnostic delay in women with spondyloarthritis.
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Valent F, Busolin A, Boscutti G. Inception and utility of a renal replacement registry using administrative health data in North-East Italy. J Ren Care 2017; 43:121-127. [PMID: 28097800 DOI: 10.1111/jorc.12192] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Disease registries are useful tools for public health planning, evaluating clinical practice and providing information on cohorts of patients. METHODS The administrative databases of the regional health information system of Friuli Venezia Giulia, Italy were used to build a regional registry of the resident population in renal replacement therapy (including dialysis and renal transplantation), through an algorithm taking into account hospital discharge and outpatient ambulatory care data. The registry includes an anonymous univocal identifier, the start date for the replacement therapy and changes of status (haemodialysis, peritoneal dialysis, renal transplantation). Data from the registry were used to estimate incidence rate, prevalence and mortality of patients receiving renal replacement therapy in 2014. In addition, we described an example of how the registry can be used to assess the prevalence of selected comorbidities. RESULTS In Friuli Venezia Giulia in 2014, we estimated an incidence rate of renal replacement therapy of 166 per million inhabitants and a prevalence of 1,400 per million inhabitants. A total of 10% of the patients died in the study year. Hypertension, heart disease and diabetes mellitus were common co-morbidities. CONCLUSION The registry allows us to estimate the incidence rate and prevalence of renal replacement therapy and also to investigate specific issues regarding these patients through record linkage with other administrative health databases.
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Affiliation(s)
- Francesca Valent
- Servizio Epidemiologia e Flussi Informativi-Direzione Centrale Salute, Integrazione Sociosanitaria, Politiche Sociali e Famiglia-Regione Autonoma Friuli Venezia Giulia, Udine, Italy
| | - Anna Busolin
- Servizio Epidemiologia e Flussi Informativi-Direzione Centrale Salute, Integrazione Sociosanitaria, Politiche Sociali e Famiglia-Regione Autonoma Friuli Venezia Giulia, Udine, Italy
| | - Giuliano Boscutti
- Struttura Complessa di Nefrologia e Dialisi-Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy.,Direttore del Registro Regionale dei Pazienti in Terapia Renale Sostitutiva-Direzione Centrale Salute, Integrazione Sociosanitaria, Politiche Sociali e Famiglia-Regione Autonoma Friuli Venezia Giulia, Udine, Italy
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Schiotis R, Sánchez A, Escudero A, Bartolomé N, Szczypiorska M, Font P, Martínez A, Tejedor D, Artieda M, Mulero J, Buzoianu A, Collantes-Estévez E. Candidate's single-nucleotide polymorphism predictors of treatment nonresponse to the first anti-TNF inhibitor in ankylosing spondylitis. Rheumatol Int 2013; 34:793-801. [PMID: 24337767 DOI: 10.1007/s00296-013-2913-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Accepted: 11/26/2013] [Indexed: 12/22/2022]
Abstract
The objective of this study is to identify single-nucleotide polymorphisms (SNPs) predictors of treatment nonresponse to the first anti-TNF-alpha agent in ankylosing spondylitis (AS). Patients were classified as "nonresponders" if they failed to achieve improvement ≥50 % of the initial BASDAI. We selected candidate SNPs previously reported, associated with susceptibility or pathogenesis of AS and with other spondylarthropaties (SpAs). The predictors of nonresponse were modeled with multiple logistic regression. The predictive power of the genetic model of nonresponse to treatment was tested with AUC-ROC. One hundred and twenty-one (121) AS patients fulfilled the inclusion criteria. Of the candidate SNPs tested for association with treatment effectiveness, five independent predictors were identified: rs917997, rs755622, rs1800896, rs3740691, and rs1061622. The genetic model of nonresponse to treatment had a predictive power of 0.77 (95 % CI 0.68-0.86). Our study identified several polymorphisms which could be the useful genetic biomarkers in predicting nonresponse to anti-TNF-alpha therapy.
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Affiliation(s)
- Ruxandra Schiotis
- Department of Pharmacology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania,
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Pérez Alamino R, Maldonado Cocco JA, Citera G, Arturi P, Vazquez-Mellado J, Sampaio-Barros PD, Flores D, Burgos-Vargas R, Santos H, Chavez-Corrales JE, Palleiro D, Gutierrez MA, Vieira-Sousa E, Pimentel-Santos FM, Paira S, Berman A, Moreno-Alvarez M, Collantes-Estevez E. Differential features between primary ankylosing spondylitis and spondylitis associated with psoriasis and inflammatory bowel disease. J Rheumatol 2011; 38:1656-60. [PMID: 21632676 DOI: 10.3899/jrheum.101049] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To describe differential characteristics of axial involvement in ankylosing spondylitis (AS) as compared with that seen in psoriatic arthritis (PsA) and inflammatory bowel disease (IBD) in a cohort of Ibero-American patients. METHODS This study included 2044 consecutive patients with spondyloarthritis (SpA; ESSG criteria). Demographic, clinical, disease activity, functional ability, quality of life, work status, radiologic, and therapeutic data were evaluated and collected by RESPONDIA members from different Ibero-American countries between June and December 2006. Patients selected for analysis met modified New York criteria (mNY) for AS. RESULTS A total of 1264 patients met the New York criteria for AS: 1072 had primary AS, 147 had psoriatic, and 45 had IBD-associated spondylitis. Median disease duration was comparable among the 3 patient groups. Patients with primary AS were significantly younger (p = 0.01) and presented a higher frequency of males (p = 0.01) than the other 2 groups. Axial manifestations such as inflammatory back pain and sacroiliac pain were significantly more frequent in patients with primary AS (p = 0.05) versus other groups, whereas frequency of dactylitis, enthesitis, and peripheral arthritis was more common in patients with psoriatic spondylitis (p = 0.05). Spinal mobility was significantly more limited in patients with primary AS versus the other 2 groups (p = 0.0001). Radiologic changes according to BASRI total score were equally significant in primary AS. Disease activity (BASDAI), functional ability (BASFI), and quality of life (ASQoL) scores were comparable in the 3 groups. CONCLUSION Patients with primary AS had more severe axial involvement than those with spondylitis associated with psoriasis or IBD. Functional capacity, disease activity, and quality of life were comparable among the groups studied.
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Affiliation(s)
- Rodolfo Pérez Alamino
- Section of Rheumatology, Instituto de Rehabilitación Psicofísica, Buenos Aires, Argentina
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