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García-Vicuña R, Juanola X, Navarro-Compán V, Moreno-Ramos MJ, Castillo-Gallego C, Moreno M, Galíndez E, Montoro M, Gómez I, Rebollo-Laserna FJ, Loza E. Management of Specific Clinical Profiles in Axial Spondyloarthritis: An Expert's Document Based on a Systematic Literature Review and Extended Delphi Process. Rheumatol Ther 2023; 10:1215-1240. [PMID: 37450194 PMCID: PMC10468481 DOI: 10.1007/s40744-023-00575-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 06/14/2023] [Indexed: 07/18/2023] Open
Abstract
INTRODUCTION The management of specific clinical scenarios is not adequately addressed in national and international guidelines for axial spondyloarthritis (axSpA). Expert opinions could serve as a valuable complement to these documents. METHODS Seven expert rheumatologists identified controversial areas or gaps of current recommendations for the management of patients with axSpA. A systematic literature review (SLR) was performed to analyze the efficacy and safety of non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroids, conventional synthetic, biologic and targeted synthetic disease-modifying antirheumatic drugs (csDMARDs, b/tsDMARDs) in axSpA regarding controversial areas or gaps. In a nominal group meeting, the results of the SLR were discussed and a set of statements were proposed. A Delphi process inviting 150 rheumatologists was followed to define the final statements. Agreement was defined as if at least 70% of the participants voted ≥ 7 (from 1, totally disagree, to 10, totally agree). RESULTS Three overarching principles and 17 recommendations were generated. All reached agreement. According to them, axSpA care should be holistic and individualized, taking into account objective findings, comorbidities, and patients' opinions and preferences. Integrating imaging and clinical assessment with biomarker analysis could also help in decision-making. Connected to treatments, in refractory enthesitis, b/tsDMARDs are recommended. If active peripheral arthritis, csDMARD might be considered before b/tsDMARDs. The presence of significant structural damage, long disease duration, or HLA-B27-negative status do not contraindicate for the use of b/tsDMARDs. CONCLUSIONS These recommendations are intended to complement guidelines by helping health professionals address and manage specific groups of patients, particular clinical scenarios, and gaps in axSpA.
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Affiliation(s)
- Rosario García-Vicuña
- Servicio de Reumatología, Hospital Universitario La Princesa, IIS-Princesa, Madrid, Spain
| | - Xavier Juanola
- Servicio de Reumatología, Hospital Universitario de Bellvitge, Universidad de Barcelona, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
| | | | - Manuel José Moreno-Ramos
- Servicio de Reumatología, Hospital Clínico Universitario Virgen de La Arrixaca, El Palmar, Murcia, Spain
| | | | - Mireia Moreno
- Servicio de Reumatología, Universitari Parc Taulí Hospital, Institut d’Investigació i Innovació Parc Taulí (I3PT), Sabadell, Spain
| | - Eva Galíndez
- Servicio de Reumatología, Hospital Universitario de Basurto, Bilbao, Spain
| | - María Montoro
- Pfizer Medical Department, Alcobendas, Madrid, Spain
| | - Ismael Gómez
- Pfizer Medical Department, Alcobendas, Madrid, Spain
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Loza E, Plazuelo P. Patients with spondyloarthritis including psoriatic arthritis: Current needs, impact, and perspective. REUMATOLOGIA CLINICA 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] [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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Gaffney K, Webb D, Sengupta R. Delayed diagnosis in axial spondyloarthritis-how can we do better? Rheumatology (Oxford) 2021; 60:4951-4952. [PMID: 34244705 DOI: 10.1093/rheumatology/keab496] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 06/04/2021] [Accepted: 06/07/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Karl Gaffney
- Department of Rheumatology, Norfolk & Norwich University Hospitals NHS Foundation Trust, Norwich
| | - Dale Webb
- The National Axial Spondyloarthritis Society, London
| | - Raj Sengupta
- Department of Rheumatology, Royal National Hospital for Rheumatic Diseases, Bath, UK
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García EI, Martin-Delgado J, Queiro R, Pérez Venegas JJ, Gratacos J, Sanz J, Torrés A, Mira JJ. Quality certification standard proposal "SpACE" for axial spondyloarthritis treatment units. ACTA ACUST UNITED AC 2021; 18:299-303. [PMID: 34736873 DOI: 10.1016/j.reumae.2021.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 04/05/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVE Axial spondyloarthritis is an immune-mediated disease with a high cost, diagnostic delay and associated complications that makes it a particularly important condition. This work aims to establish a certification standard (SpACE Project) for monographic consultations in its diagnosis and treatment. MATERIALS AND METHODS Qualitative study of consensus, through the technique of the nominal group. First, a pragmatic review of the literature was carried out. Second, professionals involved throughout the care process (rheumatology, ophthalmology, gastroenterology, traumatology, family medicine, physical therapy, and nursing) were included. RESULTS Thirty-seven possible standards were extracted from the pragmatic review of the literature. During the consensus phase only those standards with high feasibility and importance in the care process were prioritized. Finally, the group of 26 experts agreed on the inclusion of 14 standards. DISCUSSION AND CONCLUSIONS SpACE is a consensus-based certification standard that seeks to improve health outcomes and more integrated care.
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Affiliation(s)
| | - Jimmy Martin-Delgado
- Grupo de Investigación Atenea, Fundación para el Fomento de la Investigación Sanitaria y Biomédica (FISABIO), Sant Joan d'Alacant, Alicante, Spain.
| | - Ruben Queiro
- Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | | | - Jordi Gratacos
- Consorci Corporació Sanitària Parc Taulí, Sabadell, Barcelona, Spain
| | - Jesús Sanz
- Hospital Puerta de Hierro, Majadahonda, Madrid, Spain
| | | | - José Joaquín Mira
- Departamento de Salud Alicante-Sant Joan d'Alacant, Sant Joan d'Alacant, Alicante, Spain; Universidad Miguel Hernández, Elche, Alicante, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Alicante, Spain
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Almodovar R, Bueno A, Garcia Monco C, De Miguel E, Tornero C, Moreno M, Gratacos J, Zarco P, Mazzucchelli R. Quantification of Bone Marrow Edema by MRI of the Sacroiliac Joints in Patients Diagnosed with Axial Spondyloarthritis: Results from the ESPeranza Cohort. Scand J Rheumatol 2021; 51:374-381. [PMID: 34472387 DOI: 10.1080/03009742.2021.1946995] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objective: To evaluate whether the quantification of bone marrow edema (BMO) of the sacroiliac (SI) joints by magnetic resonance imaging (MRI) improves capacity for axial spondyloarthritis (axSpA) classification in comparison with the assessment of sacroiliitis by Assessment of SpondyloArthritis international Society (ASAS) classification criteria.Method: This prospective study from the ESPeranza cohort involved 66 subjects with an available MRI of the SI joints at baseline. This subgroup includes patients with axSpA (n = 28), peripheral spondyloarthritis (n = 10), and other diagnoses that were not spondyloarthritis (n = 28). Measures of diagnostic usefulness [area under the curve (AUC), sensitivity, specificity, Youden's J statistic, positive and negative likelihood ratios (LR+ and LR-)] were calculated for MRI of the SI joints according to ASAS criteria and for MRI quantified by means of SCAISS (Spanish tool for semi-automatic quantification of sacroiliac inflammation by MRI in spondyloarthritis). This analysis was stratified in patients who were human leucocyte antigen (HLA)-B27 positive and negative.Results: The AUC value with BMO quantification was 0.919 [95% confidence interval (CI) 0.799-1] for HLA-B27-positive patients and 0.884 (95% CI 0.764-1) for HLA-B27-negative patients. A SCAISS cut-off point of 80 units obtained a specificity of 94.4% and LR+ 7.5, while assessment by ASAS criteria showed a specificity value of 90% and LR+ 6.4.Conclusion: For patients with suspected axSpA, quantification of BMO improves the predictive capacity of MRI of the SI joints, for both HLA-B27-positive and HLA-B27-negative patients.Axial spondyloarthritis (axSpA) has a dramatic impact on physical function and quality of life (1). Despite its significant impact, patients with axSpA are normally diagnosed several years after presenting symptoms (2). In this respect, magnetic resonance imaging (MRI) of the sacroiliac (SI) joints has gained significance over the past decade, particularly in the early stages of the disease. Nowadays, imaging tests and human leucocyte antigen (HLA)-B27 testing are among the most important diagnostic procedures for patients with suspected axSpA.
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Affiliation(s)
- R Almodovar
- Rheumatology Unit, Hospital Universitario Fundación Alcorcon, Alcorcon, Madrid, Spain.,Department of Epidemiology and Public Health, Universidad Rey Juan Carlos, Madrid, Spain
| | - A Bueno
- Radiology Unit, Hospital Universitario Fundación Alcorcon, Madrid, Spain
| | - C Garcia Monco
- Radiology Unit, Hospital Universitario Fundación Alcorcon, Madrid, Spain
| | - E De Miguel
- Rheumatology Unit, Hospital Universitario La Paz, Madrid, Spain
| | - C Tornero
- Rheumatology Unit, Hospital Universitario La Paz, Madrid, Spain
| | - M Moreno
- Rheumatology Unit, Hospital Universitario Parc Taulí, Barcelona, Spain
| | - J Gratacos
- Rheumatology Unit, Hospital Universitario Parc Taulí, Barcelona, Spain
| | - P Zarco
- Rheumatology Unit, Hospital Universitario Fundación Alcorcon, Alcorcon, Madrid, Spain
| | - R Mazzucchelli
- Rheumatology Unit, Hospital Universitario Fundación Alcorcon, Alcorcon, Madrid, Spain.,Department of Epidemiology and Public Health, Universidad Rey Juan Carlos, Madrid, Spain
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Fernández-Carballido C, Tornero C, Castro-Villegas MC, Galindez E, García-Llorente JF, García-Vivar ML, Joven-Ibáñez B, Juanola X, Urrego-Laurín C, López-Medina C, Almodovar R, Martínez-Alberola N, Ruiz-Jimeno T, de Miguel E. No radiographic sacroiliitis progression was observed in patients with early spondyloarthritis at 6 years: results of the Esperanza multicentric prospective cohort. RMD Open 2021; 6:rmdopen-2020-001345. [PMID: 32907882 PMCID: PMC7520544 DOI: 10.1136/rmdopen-2020-001345] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/30/2020] [Accepted: 08/21/2020] [Indexed: 12/05/2022] Open
Abstract
Objective To estimate the 6-year radiographic progression of sacroiliitis in patients with early spondyloarthritis (SpA). Patients and methods Sacroiliac joint (SIJ) radiographs (baseline and 6 years) of 94 patients with recent-onset SpA from the Esperanza cohort were scored, blindly and in a random order, by nine readers. The modified New York criteria were used to define the presence of sacroiliitis. As the gold standard for radiographic (r) sacroiliitis, the categorical opinion of at least five readers was used. Progression was defined as the shift from non-radiographic (nr) to r-sacroiliitis. Results In the 94 SIJ radiographs (baseline and 6 years), 78/94 (83%) pairs of radiographs had not changed from baseline to 6 years. Sacroiliitis was present in 20 patients at baseline (21.3%) and in 18 (19.2%) patients at 6 years; 11 patients had sacroiliitis at both the baseline and final visits; 9 patients changed from baseline r-sacroiliitis to nr-sacroiliitis at 6 years, and 7 changed from baseline nr-sacroiliitis to r-sacroiliitis at 6 years. The mean continuous change score (range: −8 to +8) was 2.80 at baseline and 2.55 at 6 years (mean net progression of −0.25). The reliability of the readers was fair (mean inter-reader kappa of 0.375 (0.146–0.652) and mean agreement of 73.7% (58.7–90%)). Conclusion In the early SpA Esperanza cohort, progression from nr-axSpA to r-axSpA over 6 years was not observed, although the SIJ radiographs scoring has limitations to detect low levels of radiographic progression.
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Affiliation(s)
| | - Carolina Tornero
- Rheumatology Department, Hospital Universitario La Paz, Madrid, Spain
| | | | - Eva Galindez
- Rheumatology Department, Hospital Universitario de Basurto, Bilbao, Spain
| | | | | | | | - Xavier Juanola
- Rheumatology Department, Hospital Universitari de Bellvitge/IDIBELL, Barcelona, Spain
| | | | | | - Raquel Almodovar
- Rheumatology Department, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | | | - Teresa Ruiz-Jimeno
- Rheumatology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Eugenio de Miguel
- Rheumatology Department, Hospital Universitario La Paz, Madrid, Spain
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García EI, Martin-Delgado J, Queiro R, Pérez Venegas JJ, Gratacos J, Sanz J, Torrés A, Mira JJ. Quality Certification Standard Proposal "SpACE" for Axial Spondyloarthritis Treatment Units. REUMATOLOGIA CLINICA 2021; 18:S1699-258X(21)00126-1. [PMID: 34148827 DOI: 10.1016/j.reuma.2021.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 03/15/2021] [Accepted: 04/05/2021] [Indexed: 01/15/2023]
Abstract
BACKGROUND AND OBJECTIVE Axial spondyloarthritis is an immune-mediated disease with a high cost, diagnostic delay and associated complications that makes it a particularly important condition. This work aims to establish a certification standard (SpACE Project) for monographic consultations in its diagnosis and treatment. MATERIALS AND METHODS Qualitative study of consensus, through the technique of the nominal group. First, a pragmatic review of the literature was carried out. Second, professionals involved throughout the care process (rheumatology, ophthalmology, gastroenterology, traumatology, family medicine, physical therapy, and nursing) were included. RESULTS Thirty-seven possible standards were extracted from the pragmatic review of the literature. During the consensus phase only those standards with high feasibility and importance in the care process were prioritized. Finally, the group of 26 experts agreed on the inclusion of 14 standards. DISCUSSION AND CONCLUSIONS SpaCE is a consensus-based certification standard that seeks to improve health outcomes and more integrated care.
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Affiliation(s)
| | - Jimmy Martin-Delgado
- Grupo de Investigación Atenea, Fundación para el Fomento de la Investigación Sanitaria y Biomédica (FISABIO), Sant Joan d'Alacant, Alicante, España.
| | - Ruben Queiro
- Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | | | - Jordi Gratacos
- Consorci Corporació Sanitària Parc Taulí, Sabadell, Barcelona, España
| | - Jesús Sanz
- Hospital Puerta de Hierro, Majadahonda, Madrid, España
| | - Antonio Torrés
- Sociedad Española de Calidad Asistencial, Oviedo, España
| | - José Joaquín Mira
- Departamento de Salud Alicante-Sant Joan d'Alacant, Sant Joan d'Alacant, Alicante, España; Universidad Miguel Hernández, Elche, Alicante, España; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Alicante, España
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Boel A, Molto A, van der Heijde D, Ciurea A, Dougados M, Gensler LS, Santos MJ, De Miguel E, Poddubnyy D, Rudwaleit M, van Tubergen A, van Gaalen FA, Ramiro S. Do patients with axial spondyloarthritis with radiographic sacroiliitis fulfil both the modified New York criteria and the ASAS axial spondyloarthritis criteria? Results from eight cohorts. Ann Rheum Dis 2019; 78:1545-1549. [DOI: 10.1136/annrheumdis-2019-215707] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 06/21/2019] [Accepted: 07/11/2019] [Indexed: 01/16/2023]
Abstract
BackgroundPatients with spondyloarthritis with radiographic sacroiliitis are traditionally classified according to the modified New York (mNY) criteria as ankylosing spondylitis (AS) and more recently according to the Assessment of SpondyloArthritis international Society (ASAS) criteria as radiographic axial spondyloarthritis (r-axSpA).ObjectiveTo investigate the agreement between the mNY criteria for AS and the ASAS criteria for r-axSpA and reasons for disagreement.MethodsPatients with back pain ≥3 months diagnosed as axSpA with radiographic sacroiliitis (mNY radiographic criterion) were selected from eight cohorts (ASAS, Esperanza, GESPIC, OASIS, Reuma.pt, SCQM, SPACE, UCSF). Subsequently, we calculated the percentage of patients who fulfilled the ASAS r-axSpA criteria within the group of patients who fulfilled the mNY criteria and vice versa in six cohorts with complete information.ResultsOf the 3882 patients fulfilling the mNY criteria, 93% also fulfilled the ASAS r-axSpA criteria. Inversely, of the 3434 patients fulfilling the ASAS r-axSpA criteria, 96% also fulfilled the mNY criteria. The main cause for discrepancy between the two criteria sets was the reported age at onset of back pain.ConclusionAlmost all patients with axSpA with radiographic sacroiliitis fulfil both ASAS and mNY criteria, which supports the interchangeable use of the terms AS and r-axSpA.
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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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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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Cooper M, Rouhi A, Barber CEH. A Systematic Review of Quality Measures for Inflammatory Arthritis. J Rheumatol 2017; 45:274-283. [PMID: 29142026 DOI: 10.3899/jrheum.170157] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To conduct a systematic review and quality appraisal of quality measures for inflammatory arthritis, including rheumatoid arthritis (RA), spondyloarthritis, psoriatic arthritis (PsA), and juvenile idiopathic arthritis (JIA). METHODS Embase, MEDLINE, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched from January 1, 2000, to October 23, 2016, using Medical Subject Headings terms for inflammatory arthritis and quality measures. A "grey literature" search of international arthritis organizations and quality measure libraries was also conducted. Two reviewers independently considered the papers for inclusion, with disagreements resolved by consensus. A modified guideline appraisal tool (AGREE II) was used to appraise the measure development process, which determined final inclusion. Measures were abstracted in duplicate and categorized into themes, measure type, and domains of quality. RESULTS Thirteen measurement sets were included from 4 countries (United States, Canada, United Kingdom, Netherlands) and 1 European consortium. They included 10 sets on RA and 1 each for PsA, inflammatory arthritis, and JIA. There were 161 unique individual measures (136 process, 20 structure, and 5 outcome). Major themes included assessment, medications, and comorbidities. Measure development methods were varied, including RAND/University of California, Los Angeles appropriateness methodology, prioritization exercises, or other modified-Delphi methods. Inclusion of patients occurred in 77% of development groups. Discussion of barriers to measurement was infrequent. CONCLUSION Inflammatory arthritis quality measures cover a diversity of themes encompassing process, structure, and outcomes of care across the 6 domains of quality. However, between organizations, measure development is not standardized. Local assessment of measurement feasibility before use outside the original development context is recommended.
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Affiliation(s)
- Matthew Cooper
- From the Department of Medicine, and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary; Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta; Arthritis Research Canada, Richmond, British Columbia, Canada.,M. Cooper, MD, FRCPC, Rheumatology Resident, Department of Medicine, Cumming School of Medicine, University of Calgary; A. Rouhi, BHSc, MD program student, Faculty of Medicine and Dentistry, University of Alberta; C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, and Scientist, Arthritis Research Canada
| | - Azin Rouhi
- From the Department of Medicine, and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary; Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta; Arthritis Research Canada, Richmond, British Columbia, Canada.,M. Cooper, MD, FRCPC, Rheumatology Resident, Department of Medicine, Cumming School of Medicine, University of Calgary; A. Rouhi, BHSc, MD program student, Faculty of Medicine and Dentistry, University of Alberta; C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, and Scientist, Arthritis Research Canada
| | - Claire E H Barber
- From the Department of Medicine, and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary; Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta; Arthritis Research Canada, Richmond, British Columbia, Canada. .,M. Cooper, MD, FRCPC, Rheumatology Resident, Department of Medicine, Cumming School of Medicine, University of Calgary; A. Rouhi, BHSc, MD program student, Faculty of Medicine and Dentistry, University of Alberta; C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, and Scientist, Arthritis Research Canada.
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Diagnostic delay in axial spondyloarthritis: A cross-sectional study of 432 patients. Joint Bone Spine 2017; 84:467-471. [DOI: 10.1016/j.jbspin.2016.06.005] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 06/12/2016] [Indexed: 02/06/2023]
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Joven BE, Navarro-Compán V, Rosas J, Fernandez Dapica P, Zarco P, de Miguel E. Diagnostic Value and Validity of Early Spondyloarthritis Features: Results From a National Spanish Cohort. Arthritis Care Res (Hoboken) 2017; 69:938-942. [PMID: 28129460 DOI: 10.1002/acr.23017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 07/05/2016] [Accepted: 08/16/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To evaluate the validity of different spondyloarthritis (SpA) features included in the Berlin diagnostic algorithm and the Assessment of SpondyloArthritis international Society (ASAS) classification criteria in an early SpA cohort. METHODS This was a longitudinal multicenter study including patients from the ESPeranza program cohort who were suspected to have SpA. Subjects were ≤45 years old, and SpA symptom duration was 3-24 months. Patients with axial SpA symptoms were selected and categorized according to diagnosis (yes/no) of axial SpA. Descriptive analysis was performed, and the sensitivity, specificity, predictive value, and likelihood ratio (LR) of each feature were calculated. RESULTS Of 775 patients suspected to have SpA, 665 had predominantly axial symptoms and 516 of these patients were diagnosed with axial SpA. The most useful SpA features were sacroiliitis on magnetic resonance imaging (positive LR 6.6) or radiograph (positive LR 31.1) and peripheral arthritis (positive LR 8.9). The features with the lowest diagnostic utility were a family history of SpA (positive LR 1.5) and good response to nonsteroidal antiinflammatory drugs (positive LR 1.6). Inflammatory back pain (IBP; according to ASAS criteria) was described in only 27% of SpA patients, with a positive LR of 2.3. HLA-B27 positivity was present in 245 (48%), and the positive LR was 2.8. CONCLUSION The diagnostic value of SpA features in patients with early axial SpA seems to be different than in patients with longstanding disease. Chronic back pain is better than IBP as an entry point to the diagnostic algorithm. Sacroiliitis on imaging is very important for early diagnosis, while the use of HLA-B27 status as a key factor is questionable.
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Affiliation(s)
| | | | - Jose Rosas
- Hospital Marina Baixa, Villajoyosa, Alicante, Spain
| | | | - Pedro Zarco
- University Hospital Fundación Alcorcón, Madrid, Spain. Members of the ESPeranza Working Group are listed in Appendix A
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Fernández-Carballido C, Navarro-Compán V, Castillo-Gallego C, Castro-Villegas MC, Collantes-Estévez E, de Miguel E. Disease Activity As a Major Determinant of Quality of Life and Physical Function in Patients With Early Axial Spondyloarthritis. Arthritis Care Res (Hoboken) 2016; 69:150-155. [DOI: 10.1002/acr.22908] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 03/17/2016] [Accepted: 04/05/2016] [Indexed: 11/06/2022]
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Widdifield J, Tu K, Carter Thorne J, Bombardier C, Michael Paterson J, Liisa Jaakkimainen R, Wing L, Butt DA, Ivers N, Hofstetter C, Lyddiatt A, Ahluwalia V, Bernatsky S. Patterns of Care Among Patients Referred to Rheumatologists in Ontario, Canada. Arthritis Care Res (Hoboken) 2016; 69:104-114. [PMID: 27110847 DOI: 10.1002/acr.22910] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 03/17/2016] [Accepted: 04/05/2016] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Our aim was to characterize referrals to rheumatologists, the early care management of patients with rheumatic diseases, and timeliness of care and treatment. METHODS We conducted a retrospective observational study involving patients with first-time rheumatology referrals between 2000 and 2013 in the primary care Electronic Medical Record Administrative data Linked Database (EMRALD) in Ontario, Canada. Referrals were characterized in terms of diagnoses, patient demographics, diagnostic tests, treatment initiated by family physicians and rheumatologists, and other specialists seen prior to rheumatology consultation. Timeliness of referrals, rheumatologist consultations, and treatment were determined overall and for each diagnostic category. RESULTS Among 2,430 patients referred to a rheumatologist, 69% were female, with an average age of 53 years. The principal diagnosis associated with the referral included osteoarthritis (32%), systemic inflammatory rheumatic diseases (31%), regional musculoskeletal conditions (16%), chronic pain conditions (14%), osteoporosis (2%), and other/miscellaneous (5%). Family physicians most frequently prescribed nonsteroidal antiinflammatory drugs/cyclooxygenase 2 inhibitors (38%), and their pre-referral diagnostic testing practice varied considerably. The duration of time from symptom onset to rheumatology consultation varied by diagnoses, with the shortest being for patients with systemic rheumatic diseases; for rheumatoid arthritis (RA), the median time to consultation was 327 days. Most of the delay occurred prior to referral; 36% of RA patients initiated a disease-modifying antirheumatic drug within 6 months of symptom onset. CONCLUSION Approximately 1 in 3 referrals to rheumatologists were for a systemic inflammatory rheumatic disease. We observed substantial delays to rheumatology consultations and variations in patterns of care that could be amenable to quality improvement interventions.
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Affiliation(s)
- Jessica Widdifield
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada, and McGill University, Montreal, Quebec, Canada
| | - Karen Tu
- Institute for Clinical Evaluative Sciences, University of Toronto, and University Health Network, Toronto Western Hospital Family Health Team, Toronto, Ontario, Canada
| | | | | | - J Michael Paterson
- Institute for Clinical Evaluative Sciences and University of Toronto, Toronto, Ontario, Canada, and McMaster University, Hamilton, Ontario, Canada
| | - R Liisa Jaakkimainen
- Institute for Clinical Evaluative Sciences and University of Toronto, Toronto, Ontario, Canada
| | - Laura Wing
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Debra A Butt
- University of Toronto and Scarborough Hospital, Toronto, Ontario, Canada
| | - Noah Ivers
- Institute for Clinical Evaluative Sciences and Women's College Hospital, Toronto, Ontario, Canada
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Juanola X, Loza Santamaría E, Cordero-Coma M. Description and Prevalence of Spondyloarthritis in Patients with Anterior Uveitis. Ophthalmology 2016; 123:1632-1636. [DOI: 10.1016/j.ophtha.2016.03.010] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 03/02/2016] [Accepted: 03/07/2016] [Indexed: 11/25/2022] Open
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del Río-Martínez P, Navarro-Compán V, Díaz-Miguel C, Almodóvar R, Mulero J, De Miguel E. Similarities and differences between patients fulfilling axial and peripheral ASAS criteria for spondyloarthritis: Results from the Esperanza Cohort. Semin Arthritis Rheum 2016; 45:400-3. [DOI: 10.1016/j.semarthrit.2015.09.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 06/28/2015] [Accepted: 09/11/2015] [Indexed: 02/03/2023]
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Navarro-Compán V, de Miguel E, van der Heijde D, Landewé R, Almodóvar R, Montilla C, Beltrán E, Zarco P. Sponyloarthritis features forecasting the presence of HLA-B27 or sacroiliitis on magnetic resonance imaging in patients with suspected axial spondyloarthritis: results from a cross-sectional study in the ESPeranza Cohort. Arthritis Res Ther 2015; 17:265. [PMID: 26395086 PMCID: PMC4580040 DOI: 10.1186/s13075-015-0779-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 09/07/2015] [Indexed: 11/10/2022] Open
Abstract
Introduction Chronic back pain (CBP) is frequently the presenting symptom in patients with suspected axial spondyloarthritis (axSpA). Presence of sacroiliitis on magnetic-resonance-imaging (MRI) or HLA-B27 adds to diagnostic certainty. However, these costly tests cannot be applied in all patients with CBP. This study aims to investigate which SpA features increase the likelihood of a positive HLA-B27 or positive MRI of the sacroiliac-joints (MRI-SI) in patients with suspected axSpA. Methods Data from 665 patients with CBP within the ESPeranza Programme were analysed. Diagnostic utility measures (LR+, LR−) for a positive MRI-SI or HLA-B27 were calculated for various definitions of inflammatory back pain (IBP), their separate items and for other SpA features. Results Pretest probabilityies of a positive result was 41 % for MRI-SI and 40 % for HLA-B27. For a positive MRI-SI result the most useful IBP characteristic was alternating buttock pain (LR + =2.6). Among the IBP-criteria, fulfillment of the ‘ASAS criteria’ (LR + =2.1) was most contributory. Interestingly, the addition of alternating buttock pain to the Calin/ASAS-IBP criteria (LR + =6.0 and 5.5, respectively) or the addition of awakening at second half of night to the Calin-IBP criteria (LR + =5.5) increased the pre-test probability of MRI-sacroiliitis from 41 % to 79–80 %. Dactylitis (LR + =4.1) and inflammatory bowel disease (IBD) (LR + =6.4) increased this probability to 73 % and 81 %, respectively. To forecast HLA-B27 positivity, awakening at the second half of the night, fulfillment of the ASAS-IBP definition and uveitis were the most useful, but only marginally predictive (LR + = 1.3, 1,6 and 2.6, respectively). Conclusions If patients with suspected axial SpA have either 1) IBP according to Calin/ASAS definition plus alternating buttock pain, or 2) IBP according to Calin definition plus awakening at night, or 3) dactylitis or 4) IBD, the probability of finding a positive MRI-SI increases significantly.
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Affiliation(s)
- Victoria Navarro-Compán
- Department of Rheumatology, IdiPaz, University Hospital La Paz, Madrid, Spain. .,Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
| | - Eugenio de Miguel
- Department of Rheumatology, IdiPaz, University Hospital La Paz, Madrid, Spain.
| | | | - Robert Landewé
- Department of Clinical Immunology & Rheumatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. .,Department of Rheumatology, Atrium Medical Center Heerlen, Heerlen, The Netherlands.
| | - Raquel Almodóvar
- Department of Rheumatology, University Hospital Foundation Alcorcón, Madrid, Spain.
| | - Carlos Montilla
- Department of Rheumatology, Hospital Clínico Universitario de Salamanca, Salamanca, Spain.
| | - Emma Beltrán
- Department of Rheumatology, Hospital Universitario General de Valencia, Valencia, Spain.
| | - Pedro Zarco
- Department of Rheumatology, University Hospital Foundation Alcorcón, Madrid, Spain.
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Falcao S, Castillo-Gallego C, Peiteado D, Branco J, Martín Mola E, de Miguel E. Can we use enthesis ultrasound as an outcome measure of disease activity in spondyloarthritis? A study at the Achilles level. Rheumatology (Oxford) 2014; 54:1557-62. [DOI: 10.1093/rheumatology/keu399] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Indexed: 01/15/2023] Open
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Sørensen J, Hetland ML. Diagnostic delay in patients with rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis: results from the Danish nationwide DANBIO registry. Ann Rheum Dis 2014; 74:e12. [PMID: 24534758 PMCID: PMC4345887 DOI: 10.1136/annrheumdis-2013-204867] [Citation(s) in RCA: 119] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background/purpose Early diagnosis of inflammatory rheumatic diseases is important in order to improve long-term outcome. We studied whether delay in diagnosis (time between onset of symptoms and establishment of diagnosis) in patients with rheumatoid arthritis (RA), psoriatic arthritis (PSA) and ankylosing spondylitis (AS) changed from year 2000 to 2011. Methods Month and year of initial symptoms and diagnosis, gender, hospital, year of birth and date of first data entry were obtained for 13 721 patients with RA, PSA or AS who had been registered in the DANBIO registry. Time between symptom onset and diagnosis was modelled using generalised linear regression to predict the average duration for each calendar year of initial symptoms with adjustments for gender, year of birth and date of DANBIO entry. Results Patients with valid data (RA: 10 416 (73%); PSA: 1970 (68%); AS: 1335 (65%)) did not differ significantly from the whole DANBIO population, except more missing data in early years. The regression model showed that the mean duration from initial symptoms to diagnosis for RA, PSA and AS declined steadily from 30, 53 and 66 months (year 2000), respectively, to 3–4 months (year 2011). Sensitivity analyses including patients who were included after 2005, patients who had received biological treatment or had symptom onset less than 2 and 5 years prior to first entry into DANBIO showed similar results. Conclusion Since the year 2000, a significant reduction in diagnostic delay was observed in this large cohort of patients with RA, PSA or AS, probably reflecting a stronger awareness of the importance of early diagnosis.
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Affiliation(s)
- Jan Sørensen
- Centre for Applied Health Services Research, University of Southern Denmark, Odense, Denmark
| | - Merete Lund Hetland
- DANBIO registry, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Glostrup Hospital, Glostrup, Denmark Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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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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Tomero E, Mulero J, de Miguel E, Fernandez-Espartero C, Gobbo M, Descalzo MA, Collantes-Estevez E, Zarco P, Munoz-Fernandez S, Carmona L. Performance of the Assessment of Spondyloarthritis International Society criteria for the classification of spondyloarthritis in early spondyloarthritis clinics participating in the ESPERANZA programme. Rheumatology (Oxford) 2013; 53:353-60. [DOI: 10.1093/rheumatology/ket359] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Comparación de 2 estrategias de derivación en el diagnóstico de la espondiloartritis axial en España. Estudio RADAR. ACTA ACUST UNITED AC 2013; 9:348-52. [DOI: 10.1016/j.reuma.2013.02.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Revised: 02/05/2013] [Accepted: 02/11/2013] [Indexed: 12/18/2022]
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Association of biomarkers of inflammation, cartilage and bone turnover with gender, disease activity, radiological damage and sacroiliitis by magnetic resonance imaging in patients with early spondyloarthritis. Clin Rheumatol 2013; 33:237-41. [PMID: 23917391 DOI: 10.1007/s10067-013-2349-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Revised: 07/08/2013] [Accepted: 07/21/2013] [Indexed: 12/26/2022]
Abstract
To assess the association between biomarkers of inflammation, cartilage and bone turnover with gender, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Spondylitis Disease Activity Score (ASDAS) and bone marrow oedema in resonance magnetic imaging (MRI) of sacroiliac joints (SIJs) and radiological damage in early spondyloarthritis (SpA). Cross-sectional study of 60 patients (56.7 % females; mean age, 32.4 years) with early SpA. Sociodemographic data, clinical features, serum matrix metalloproteinase 3 (MMP-3), high sensitivity C-reactive protein (hsCRP), C-terminal cross-linking telopeptides of type I collagen (CTX-I) and urinary deoxypyridinoline, ASDAS, BASDAI, BASFI, BASRI and MRI of the SIJs were collected. The mean (SD) disease duration was 12.4 (6.8 months). Twenty-two (68.7 %) of the 32 patients had active sacroiliitis by MRI. MMP-3 and CTX I correlated with swollen joint (r = 0.515, r = 0.386, p = 0.01). hsCRP correlated with ESR (r = 0.303, p = 0.05), with CRP (r = 0.455, p = 0.01) and with total BASRI (r = 0.95, p = 0.05). Biomarkers were unrelated with the rest of variables. Levels of MMP-3 (44.3 ± 52.4 vs 24.7 ± 33.4, p < 0.05) and CTX-I (0.53 ± 0.45 vs 0.24 ± 0.38; p < 0.05) were higher in men. Our study shows that CTX-I and MMP-3 are a marker of peripheral disease activity in early SpA. Male gender had higher levels of CTX-I and MMP-3, which may indicate higher disease activity. Higher hsCRP levels trended towards correlation with more baseline radiographic damage. Therefore, these biomarkers may help identify a subgroup of patients who will need closer monitoring and more intensive treatment.
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Fernández-Espartero C, de Miguel E, Loza E, Tomero E, Gobbo M, Descalzo MA, Collantes-Estévez E, Mulero J, Muñoz-Fernández S, Zarco P, Carmona L. Validity of the ankylosing spondylitis disease activity score (ASDAS) in patients with early spondyloarthritis from the Esperanza programme. Ann Rheum Dis 2013; 73:1350-5. [PMID: 23709245 DOI: 10.1136/annrheumdis-2012-202976] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To evaluate the validity of the Ankylosing Spondylitis Disease Activity Score (ASDAS) in early spondyloarthritis (SpA) in comparison with conventional clinical measures of disease activity. METHODS Six hundred and seventy-six incident cases of early SpA from the Esperanza programme were included. Patients were categorised into high and low disease activity states based on patient and physician global assessment scores and on the physician's decision to start treatment with a disease-modifying antirheumatic drug or tumour necrosis factor blocker. The discriminant ability of ASDAS-C-reactive protein (CRP) and ASDAS-erythrocyte sedimentation rate (ESR) was tested using standardised mean differences between patients with high and low disease activity. Convergent validity was tested by Pearson correlation between ASDAS versions and other measures of disease activity. RESULTS ASDAS-ESR and ASDAS-CRP showed good correlation with BASDAI (r=0.79 and 0.74, respectively). Both indices correlated well with the patient global assessment (r=0.70 in both indices) and moderately with the physician global score (r=0.46 and 0.47, respectively). CRP and ESR showed poor correlation with patient- and physician-derived measures. ASDAS performed similarly across the global SpA sample, ankylosing spondylitis (AS), non-radiographic axial SpA and peripheral SpA. CONCLUSIONS ASDAS performed as a valid activity score even being slightly better than the Bath Ankylosing Spondylitis Disease Activity Index in its ability to discriminate between high and low disease activity in early SpA. ASDAS performed similarly in AS, early forms of SpA, non-radiographic axial SpA and peripheral SpA.
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Affiliation(s)
| | - E de Miguel
- Rheumatology Department, Hospital Universitario de la Paz, Madrid, Spain
| | - E Loza
- Institute for Musculoskeletal Health, Madrid, Spain
| | - E Tomero
- Rheumatology Department, Hospital Universitario de la Princesa, Instituto de Investigación La Princesa, Madrid, Spain
| | - M Gobbo
- Research Unit, Fundación Española de Reumatología, Madrid, Spain
| | - M A Descalzo
- Research Unit, Fundación Española de Reumatología, Madrid, Spain
| | - E Collantes-Estévez
- Rheumatology Department, Hospital Universitario Reina Sofía, Instituto Mainónides de Investigación Biomédica de Córdoba, Universidad de Córdoba, Córdoba, Spain
| | - J Mulero
- Rheumatology Department, Hospital Universitario de Puerta de Hierro-Majadahonda, Madrid, Spain
| | - S Muñoz-Fernández
- Rheumatology Department, Hospital Universitario Infanta Sofía, Madrid, Spain
| | - P Zarco
- Rheumatology Department, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - L Carmona
- Institute for Musculoskeletal Health, Madrid, Spain Universidad Camilo José Cela, Madrid, Spain
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Muñoz Fernández S, Lázaro y De Mercado P, Alegre López J, Almodóvar González R, Alonso Ruiz A, Ballina García FJ, Bilbao Cantarero AM, Cabañas Sáenz M, García-Vicuña R, Mínguez Vega M, Padró Blanch I, Román Ivorra JA, Roncal Marqueta E. Quality of care standards for nursing clinics in rheumatology. ACTA ACUST UNITED AC 2013; 9:206-15. [PMID: 23688844 DOI: 10.1016/j.reuma.2012.10.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Revised: 10/10/2012] [Accepted: 10/24/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND Nursing clinics in rheumatology (NCR) are organizational models in the field of nursing care. There are various NCR models, but there is no consensus on its operational definition. Our objective is to develop quality standards to define and characterize a NCR. METHOD Two-round Delphi method. The panel consisted of 67 experts: Rheumatologists and nurses of the nursing working group of the Spanish Society of Rheumatology (SSR). The Delphi questionnaire was developed after a literature and experience review from previous SSR projects. The questionnaire consists of 7 sections: general considerations, standards of structure, process, treatment and monitoring, health education, training and research and quality of care. Each item was scored from 1 (least important) to 9 (most important) or by assigning a number (e.g., waiting days). The degree of agreement among the experts was categorized according to the coefficient of variation (CoV) between very high (CoV≤25%) and very low (CoV>100%). RESULTS The second round questionnaire (182 items) was answered by 46 panelists (34 rheumatologists and 12 nurses). A very important agreement was reached on the general standards of structure, process, treatment and monitoring, health education and quality of care. Less agreement was observed on standards related to training time, number of recommended nurses' research projects and publications. CONCLUSION The standards developed in this study would be useful for establishing desirable quality standards of structure and process, and criteria for clinical work, research and teaching that can be used to develop and evaluate the NCRs.
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¿Se derivan adecuadamente las espondiloartropatías desde primaria a especializada? ACTA ACUST UNITED AC 2013; 9:90-3. [DOI: 10.1016/j.reuma.2012.06.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2012] [Revised: 06/12/2012] [Accepted: 06/23/2012] [Indexed: 01/18/2023]
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Decreased Th17 and Th1 cells in the peripheral blood of patients with early non-radiographic axial spondyloarthritis: a marker of disease activity in HLA-B27+ patients. Rheumatology (Oxford) 2012; 52:352-62. [DOI: 10.1093/rheumatology/kes267] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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Villaverde V, Carmona L, López Robledillo JC, Serrano S, Gobbo M. Motivations and objections to implement a spondyloarthritis integrated care pathway. A qualitative study with primary care physicians. ACTA ACUST UNITED AC 2012; 9:85-9. [PMID: 22940591 DOI: 10.1016/j.reuma.2012.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Revised: 05/04/2012] [Accepted: 06/12/2012] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVES Previous to the development of a clinical pathway (CP) for early spondyloarthritis (SpA), a qualitative study was performed to know the attitude of primary care physicians (PCP) with respect to CP implementation. METHODS 5 discussion groups (2 in Madrid, 2 in Barcelona and 1 in Sevilla) and 3 interviews in Bilbao, were performed. PCP with different profiles were included. Groups and interviews were carried out by experts on qualitative methodology. RESULTS PCP know little about CP. Motivations of professionals to work on a SpA CP were: to improve patients care, availability of a specialist consultant, possibility of learning and doing research, remuneration, and professional recognition. Objections to CP implementation were: extra work, excessive bureaucracy, absence of a specialist consultant, computer difficulties, and no remuneration. SpA knowledge by PCP was defective. PCP associated the term «spondylitis» with osteoarthritis, low-back pain, ankylosing spondylitis and psoriatic arthritis. They only referred patients to the rheumatologist to confirm the diagnosis, when patients complained and when treatment was ineffective. CONCLUSIONS For an optimal CP implementation, the following is deemed necessary: 1) a practical, simple program that eases the interaction with the rheumatologist without an increase on the PCP work load; 2) to provide continuous feedback by the specialist and 3) to provide knowledge on SpA to PCP.
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