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Rua-Figueroa I, García de Yébenes MJ, Martinez-Barrio J, Galindo Izquierdo M, Calvo Alén J, Fernandez-Nebro A, Menor-Almagro R, Carmona L, Tejera Segura B, Tomero E, Freire-González M, Sangüesa C, Horcada L, Blanco R, Uriarte Itzazelaia E, Narváez J, Rosas Gómez de Salazar JC, Gómez-Sabater S, Morales CM, Andreu JL, Segarra VT, Aurrecoechea E, Perez A, Nóvoa Medina J, Salgado E, Lozano-Rivas N, Montilla C, Ruiz-Lucea E, Arevalo M, Iñiguez C, García-Villanueva MJ, Exposito L, Ibáñez-Barceló M, Bonilla G, Carrión-Barberà I, Erausquin C, Fragio Gil JJ, Pecondón A, Toyos FJ, Cobo T, Muñoz-Jiménez A, Oller J, Nolla JM, Pego-Reigosa JM. SLESIS-R: an improved score for prediction of serious infection in patients with systemic lupus erythematosus based on the RELESSER prospective cohort. Lupus Sci Med 2024; 11:e001096. [PMID: 38589223 PMCID: PMC11015315 DOI: 10.1136/lupus-2023-001096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 03/22/2024] [Indexed: 04/10/2024]
Abstract
OBJECTIVE To develop an improved score for prediction of severe infection in patients with systemic lupus erythematosus (SLE), namely, the SLE Severe Infection Score-Revised (SLESIS-R) and to validate it in a large multicentre lupus cohort. METHODS We used data from the prospective phase of RELESSER (RELESSER-PROS), the SLE register of the Spanish Society of Rheumatology. A multivariable logistic model was constructed taking into account the variables already forming the SLESIS score, plus all other potential predictors identified in a literature review. Performance was analysed using the C-statistic and the area under the receiver operating characteristic curve (AUROC). Internal validation was carried out using a 100-sample bootstrapping procedure. ORs were transformed into score items, and the AUROC was used to determine performance. RESULTS A total of 1459 patients who had completed 1 year of follow-up were included in the development cohort (mean age, 49±13 years; 90% women). Twenty-five (1.7%) had experienced ≥1 severe infection. According to the adjusted multivariate model, severe infection could be predicted from four variables: age (years) ≥60, previous SLE-related hospitalisation, previous serious infection and glucocorticoid dose. A score was built from the best model, taking values from 0 to 17. The AUROC was 0.861 (0.777-0.946). The cut-off chosen was ≥6, which exhibited an accuracy of 85.9% and a positive likelihood ratio of 5.48. CONCLUSIONS SLESIS-R is an accurate and feasible instrument for predicting infections in patients with SLE. SLESIS-R could help to make informed decisions on the use of immunosuppressants and the implementation of preventive measures.
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Affiliation(s)
- Iñigo Rua-Figueroa
- Department of Rheumatology, Hospital Universitario Gran Canaria Doctor Negrin, Las Palmas de Gran Canaria, Spain
| | | | - Julia Martinez-Barrio
- Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Jaime Calvo Alén
- Department of Rheumatology, Hospital Sierrallana, Vitoria, Spain
| | - Antonio Fernandez-Nebro
- UGC de Reumatología, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Malaga, Spain
| | | | - Loreto Carmona
- Instituto de Salud Musculoesquelética (INMUSC), Madrid, Spain
| | - Beatriz Tejera Segura
- Department of Rheumatology, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Eva Tomero
- Department of Rheumatology, Hospital Universitario de la Princesa, Instituto de Investigación La Princesa, Madrid, Spain
| | | | - Clara Sangüesa
- Department of Rheumatology, Hospital Germán Trias i Pujol, Barcelona, Spain
| | - Loreto Horcada
- Department of Rheumatology, Hospital de Navarra, Pamplona, Spain
| | - Ricardo Blanco
- Department of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | | | - Javier Narváez
- Department of Rheumatology, Hospital Universitario de Bellvitge, Barcelona, Spain
| | | | - Silvia Gómez-Sabater
- Department of Rheumatology, Hospital General Universitario de Alicante, Alicante, Spain
| | | | - Jose L Andreu
- Department of Rheumatology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | | | - Elena Aurrecoechea
- Department of Rheumatology, Hospital Universitario Sierrallana, Torrelavega, Spain
| | - Ana Perez
- Immune System Diseases and Oncology Service, University Hospital "Príncipe de Asturias", Alcala de Henares, Spain
| | - Javier Nóvoa Medina
- Department of Rheumatology, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas GC, Spain
| | - Eva Salgado
- Department of Rheumatology, Complejo Hospitalario de Orense, Ourense, Spain
| | - Nuria Lozano-Rivas
- Department of Rheumatology, Hospital Virgen de la Arrixaca, Murcia, Spain
| | - Carlos Montilla
- Department of Rheumatology, Hospital Clinico Universitario Salamanca, Salamanca, Spain
| | | | - Marta Arevalo
- Consorci Corporació Sanitària Parc Taulí, Sabadell, Spain
| | | | | | | | | | - Gema Bonilla
- Department of Rheumatology, La Paz University Hospital, Madrid, Spain
| | | | - Celia Erausquin
- Department of Rheumatology, Hospital Universitario Gran Canaria Doctor Negrin, Las Palmas de Gran Canaria, Spain
| | | | | | - Francisco J Toyos
- Department of Rheumatology, Hospital Virgen Macarena, Sevilla, Spain
| | | | | | - Jose Oller
- Doctor Peset University Hospital, Valencia, Spain
| | - Joan M Nolla
- Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
| | - J M Pego-Reigosa
- Department of Rheumatology, University Hospital Complex of Vigo, Vigo, Spain
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Benito N, Martínez-Pastor JC, Lora-Tamayo J, Ariza J, Baeza J, Belzunegui-Otano J, Cobo J, Del-Toro MD, Fontecha CG, Font-Vizcarra L, Horcajada JP, Morata L, Murillo O, Nolla JM, Núñez-Cuadros E, Pigrau C, Portillo ME, Rodríguez-Pardo D, Sobrino-Díaz B, Saavedra-Lozano J. Executive summary: Guidelines for the diagnosis and treatment of septic arthritis in adults and children, developed by the GEIO (SEIMC), SEIP and SECOT. Enferm Infecc Microbiol Clin (Engl Ed) 2024; 42:208-214. [PMID: 37919201 DOI: 10.1016/j.eimce.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 07/14/2023] [Indexed: 11/04/2023]
Abstract
Infection of a native joint, commonly referred to as septic arthritis, is a medical emergency because of the risk of joint destruction and subsequent sequelae. Its diagnosis requires a high level of suspicion. These guidelines for the diagnosis and treatment of septic arthritis in children and adults are intended for use by any physician caring for patients with suspected or confirmed septic arthritis. They have been developed by a multidisciplinary panel with representatives from the Bone and Joint Infections Study Group (GEIO) belonging to the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), the Spanish Society of Paediatric Infections (SEIP) and the Spanish Society of Orthopaedic Surgery and Traumatology (SECOT), and two rheumatologists. The recommendations are based on evidence derived from a systematic literature review and, failing that, on the opinion of the experts who prepared these guidelines. A detailed description of the background, methods, summary of evidence, the rationale supporting each recommendation, and gaps in knowledge can be found online in the complete document.
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Affiliation(s)
- Natividad Benito
- Unidad de Enfermedades Infecciosas - Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB), Universitat Autònoma de Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC-CIBER de Enfermedades Infecciosas), ISCIII, Madrid, Spain; The University of Queensland, UQ Centre for Clinical Research, Australia.
| | - Juan Carlos Martínez-Pastor
- Servicio de Cirugía Ortopédica y Traumatología - Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Jaime Lora-Tamayo
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC-CIBER de Enfermedades Infecciosas), ISCIII, Madrid, Spain; Servicio de Medicina Interna, Hospital Univ. 12 de Octubre, Instituto de Investigación Biomédica "imas12" Hospital 12 de Octubre, Madrid, Spain
| | - Javier Ariza
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC-CIBER de Enfermedades Infecciosas), ISCIII, Madrid, Spain; Servicio de Enfermedades Infecciosas - Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, Spain
| | - José Baeza
- Servicio de Cirugía Ortopédica, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | - Javier Cobo
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC-CIBER de Enfermedades Infecciosas), ISCIII, Madrid, Spain; Servicio de Enfermedades Infecciosas - Hospital Ramón y Cajal, IRYCIS, Madrid, Spain
| | - María-Dolores Del-Toro
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC-CIBER de Enfermedades Infecciosas), ISCIII, Madrid, Spain; Unidad Clínica de Enfermedades Infecciosas y Microbiología - Hospital Universitario Virgen Macarena, Instituto de Biomedicina de Sevilla (IBIS)/CSIC, Universidad de Sevilla, Seville, Spain
| | - Cesar G Fontecha
- Servicio de Ortopedia y Traumatología pediátricas - Hospital Sant Joan de Déu, Barcelona, Spain
| | - Lluís Font-Vizcarra
- Servicio de Cirugía Ortopédica y Traumatología - Hospital Moisés Broggi-Hospital general d'Hospitalet, Consorcio Sanitari Integral, Barcelona, Spain
| | - Juan P Horcajada
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC-CIBER de Enfermedades Infecciosas), ISCIII, Madrid, Spain; The University of Queensland, UQ Centre for Clinical Research, Australia; Servicio de Enfermedades Infecciosas - Hospital del Mar, IMIM, Universitat Pompeu Fabra, Barcelona, Spain
| | - Laura Morata
- Servicio de Enfermedades Infecciosas - Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Oscar Murillo
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC-CIBER de Enfermedades Infecciosas), ISCIII, Madrid, Spain; Servicio de Enfermedades Infecciosas - Hospital Universitari de Bellvitge, IDIBELL, l'Hospitalet de Llobregat, Barcelona, Spain
| | - Joan M Nolla
- Servicio de Reumatología - Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, Barcelona, Spain
| | - Esmeralda Núñez-Cuadros
- Servicio de Pediatría, Unidad de Reumatología Pediátrica - Hospital Regional Universitario de Málaga, Spain
| | - Carlos Pigrau
- Servicio de Enfermedades Infecciosas - Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain; Clínica Creu Blanca, Barcelona, Spain
| | | | - Dolors Rodríguez-Pardo
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC-CIBER de Enfermedades Infecciosas), ISCIII, Madrid, Spain; Servicio de Enfermedades Infecciosas - Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Beatriz Sobrino-Díaz
- Servicio de Enfermedades Infecciosas - Hospital Regional Universitario de Málaga, IBIMA, Málaga, Spain
| | - Jesús Saavedra-Lozano
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC-CIBER de Enfermedades Infecciosas), ISCIII, Madrid, Spain; Servicio de Pediatría, Sección de Enfermedades Infecciosas - Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain
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Garreta-Catala I, Suarez-Perez M, Gonzalez-Cañas L, Covaro A, Videla S, Nolla JM, Agullo-Ferre JL. Radiculopathy with motor deficit: a cross-sectional study of the impact of the surgeon's experience on the indication and timing of surgical treatment. Eur J Orthop Surg Traumatol 2024; 34:191-199. [PMID: 37395861 DOI: 10.1007/s00590-023-03632-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 06/21/2023] [Indexed: 07/04/2023]
Abstract
PURPOSE The optimal management of patients with compressive radiculopathy with motor deficit (CRMD) is controversial. Our goal was to provide evidence on the impact of the spine surgeons' experience on surgical planning and timing. METHODS Spine surgeons were invited to participate in a 5-item online survey. A literature review was carried out. RESULTS Of the 94 spine surgeons who responded to the survey, 70% would operate early on a patient with acute CRMD, but only 48% would do so if the radicular pain had resolved. Surgeons with more than 15 years of experience chose more conservative options. Twenty published studies were selected in the literature review. CONCLUSION The optimal management of patients with compressive radiculopathy associated with a non-progressive motor loss remains unknown. The results of our survey show that surgeons with extensive surgical experience take a more conservative and cautious approach.
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Affiliation(s)
- Iago Garreta-Catala
- Orthopedic Surgery and Traumatology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Moises Suarez-Perez
- Orthopedic Surgery and Traumatology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Lluis Gonzalez-Cañas
- Orthopedic Surgery and Traumatology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Augusto Covaro
- Orthopedic Surgery and Traumatology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Sebastián Videla
- Pharmacology Unit, Department of Pathology and Experimental Therapeutics, School of Medicine and Health Sciences, IDIBELL, Barcelona University, Barcelona, Spain
- Clinical Research Support Unit, Clinical Pharmacology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Joan M Nolla
- Rheumatology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Jose-Luis Agullo-Ferre
- Orthopedic Surgery and Traumatology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
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Garreta-Catala I, Planas-Balagué R, Abouzari R, Carnaval T, Nolla JM, Videla S, Agulló-Ferré JL. Feasibility of a multidisciplinary group videoconferencing approach for chronic low back pain: a randomized, open-label, controlled, pilot clinical trial (EN-FORMA). BMC Musculoskelet Disord 2023; 24:642. [PMID: 37558990 PMCID: PMC10410913 DOI: 10.1186/s12891-023-06763-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 07/28/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Low back pain is a common condition that becomes even more prevalent with aging. A non-pharmacological multidisciplinary approach for chronic non-specific low back pain (CNSLBP) has been recommended, but integrating different healthcare professionals is challenging. A multidisciplinary group videoconferencing approach (MGVA) can be helpful. Our aim was to provide evidence on MGVA's feasibility in managing CNSLBP and its impact on clinical practice. METHODS We conducted an open-label, randomized, controlled, parallel-group pilot clinical trial with CNSLBP patients irresponsive to conservative treatment. Patients between 18 and 67 years of age were randomly assigned (1:1) to either Standard-of-Care + MGVA (experimental group) or Standard-of-Care alone (control group). MGVA consisted of integrated sessions for physical rehabilitation/physiotherapy, psychology, and social work treatments. The control group received standard clinical practice treatment. The feasibility was assessed by the number of study procedures completed to at least 80% as planned. The impact on clinical practice was evaluated by the number of patients who changed their status from "candidate" to "non-candidate" to low back surgery as the treatment of choice for CNSLBP. The SF-36, Oswestry Disability Index, and TMMS-24 questionnaires were used. We performed a whole population-based descriptive analysis. RESULTS We included 20 patients, but only 18 were randomized (2 withdrew consent before randomization). The mean (SD) age was 53.1 (5.9) years, and mostly women (13/18); 7 were actively employed. In the experimental group, 6/9 (67%, 95%CI:35-88%) patients attended at least 80% of the scheduled procedures, while in the control group, 8/9 (89%, 95%CI:57-98%) did. Additionally, 1 out of 4 (25%) patients in the experimental group changed their status from "candidate" for low back surgery to "non-candidate". None of the 2 patients in the control group did so. We found differences between groups in the SF-36 mental health component (p-value:0.061), Oswestry Disability Index (p-value:0.032), and TMMS-24 Repair component (p-value:0.014) at the end of the trial favoring MGVA. CONCLUSIONS The multidisciplinary group videoconferencing approach to managing chronic non-specific low back pain was feasible, suggesting overall beneficial effects on patients' health and could play a role in changing a patient's status from "candidate" to "non-candidate" for surgery. TRIAL REGISTRATION NCT05093543 (ClinicalTrials.gov), first registered in 26/10/2021.
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Affiliation(s)
- Iago Garreta-Catala
- Orthopedic Surgery and Traumatology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Rosa Planas-Balagué
- Rehabilitation and Physical Medicine Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Reza Abouzari
- Rehabilitation and Physical Medicine Department, Delta del Llobregat Primary Care Center, Barcelona, El Prat de Llobregat, Spain
| | - Thiago Carnaval
- Pharmacology Unit, Department of Pathology and Experimental Therapeutics, School of Medicine and Health Sciences, IDIBELL, Barcelona University, Barcelona, Spain
| | - Joan M Nolla
- Rheumatology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Sebastián Videla
- Pharmacology Unit, Department of Pathology and Experimental Therapeutics, School of Medicine and Health Sciences, IDIBELL, Barcelona University, Barcelona, Spain
- Clinical Research Support Unit, Clinical Pharmacology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - José-Luis Agulló-Ferré
- Orthopedic Surgery and Traumatology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
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Narváez J, Estrada P, Vidal-Montal P, Sánchez-Rodríguez I, Sabaté-Llobera A, Nolla JM, Cortés-Romera M. Impact of previous glucocorticoid therapy on diagnostic accuracy of [18F] FDG PET-CT in giant cell arteritis. Semin Arthritis Rheum 2023; 60:152183. [PMID: 36841055 DOI: 10.1016/j.semarthrit.2023.152183] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/12/2023] [Accepted: 02/14/2023] [Indexed: 02/21/2023]
Abstract
OBJECTIVE To evaluate the impact of prior glucocorticoid (GC) treatment on the diagnostic accuracy of 18F-FDG PET-CT in giant cell arteritis (GCA). METHODS Retrospective study of a consecutive cohort of 85 patients with proven GCA who received high-dose GC before PET-CT. RESULTS Thirty-nine patients previously treated with methylprednisolone (MP) boluses, of whom 37% were PET-CT (uptakes grade 3 or 2) positive. The positivity rate was 80% with MP doses of 125 mg, 33% with 250 or 500 mg, and 0% with doses of 1 g. If we also classify as positive those cases with a grade 1 uptake (with a circumferencial uptake and smooth linear or long segmental pattern, possibly indicative of "apparently inactive" vasculitis), the positivity rate increases to 62% (100%, 50-60%, and 33% for the different MP doses, respectively). In patients with new-onset GCA treated with high-dose oral GC, PET-CT positivity was 54.5% in patients treated for less than two weeks, 38.5% in those treated for 2 to 4 weeks, and 25% in those treated for 4 to 6 weeks (increasing to 91%, 77%, and 50%, respectively, if we include cases with grade 1 uptake and these characteristics). In patients with relapsing/refractory GCA, or who developed GCA having a prior history of PMR, PET-CT positivity reached 54% despite long-term treatment with low-to-moderate doses of GC (68% including cases with a grade 1 uptake). CONCLUSION A late 18F-FDG PET-CT (beyond the first 10 days of treatment) can also be informative in a considerable percentage of cases.
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Affiliation(s)
- J Narváez
- Department of Rheumatology, Hospital Universitario de Bellvitge, Barcelona, Spain.
| | - P Estrada
- Department of Rheumatology, Hospital de Sant Joan Despí Moisès Broggi, Barcelona, Spain
| | - P Vidal-Montal
- Department of Rheumatology, Hospital Universitario de Bellvitge, Barcelona, Spain
| | - I Sánchez-Rodríguez
- Department of Nuclear Medicine - PET IDI, Hospital Universitario de Bellvitge, Barcelona, Spain
| | - A Sabaté-Llobera
- Department of Nuclear Medicine - PET IDI, Hospital Universitario de Bellvitge, Barcelona, Spain
| | - J M Nolla
- Department of Rheumatology, Hospital Universitario de Bellvitge, Barcelona, Spain
| | - M Cortés-Romera
- Department of Nuclear Medicine - PET IDI, Hospital Universitario de Bellvitge, Barcelona, Spain
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Morales-Ivorra I, Narváez J, Gómez-Vaquero C, Moragues C, Nolla JM, Narváez JA, Marín-López MA. A Thermographic Disease Activity Index for remote assessment of rheumatoid arthritis. RMD Open 2022; 8:rmdopen-2022-002615. [PMID: 36410775 PMCID: PMC9680322 DOI: 10.1136/rmdopen-2022-002615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 10/20/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Remote assessment of patients with rheumatoid arthritis (RA) has increased during recent years. However, telematic consultations preclude the possibility of carrying out a physical examination and obtaining objective inflammation. In this study, we developed and validated two novel composite disease activity indexes (Thermographic Disease Activity Index (ThermoDAI) and ThermoDAI-CRP) based on thermography of hands and machine learning, in order to assess disease activity easily, rapidly and without formal joint counts. METHODS ThermoDAI was developed as the sum of Thermographic Joint Inflammation Score (ThermoJIS), a novel joint inflammation score based on the analysis of thermal images of the hands by machine learning, the Patient Global Assessment (PGA) and, for ThermoDAI-CRP, the C reactive protein (CRP). Construct validity was tested in 146 patients with RA by using Spearman's correlation with ultrasound-determined grey-scale synovial hypertrophy (GS) and power Doppler (PD) scores, CDAI, SDAI and DAS28-CRP. RESULTS Correlations of ultrasound scores with ThermoDAI (GS=0.52; PD=0.56) and ThermoDAI-CRP (GS=0.58; PD=0.61) were moderate to strong, while the correlations of ultrasound scores with PGA (GS=0.35; PD=0.39) and PGA+CRP (GS=0.44; PD=0.46) were weak to moderate. ThermoDAI and ThermoDAI-CRP also showed strong correlations with Clinical Disease Activity Index (ρ>0.83), Simplified Disease Activity Index (ρ>0.85) and Disease Activity Score with 28-Joint Counts-CRP (ρ>0.81) and high sensitivity for detecting active synovitis using remission criteria. CONCLUSIONS ThermoDAI and ThermoDAI-CRP showed stronger correlations with ultrasound-determined synovitis than PGA and PGA + CRP, thus presenting an opportunity to improve remote consultations with patients with RA.
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Affiliation(s)
| | - Javier Narváez
- Rheumatology Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Carmen Gómez-Vaquero
- Rheumatology Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Carmen Moragues
- Rheumatology Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Joan M Nolla
- Rheumatology Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - José A Narváez
- Radiodiagnosis Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
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Larrosa Padró M, Inoriza JM, Valls Garcia R, Armengol Pérez E, Nolla JM, Coderch de Lassaletta J, Perez Berruezo X. Prevalence of rheumatic diseases in Baix Empordà. Reumatol Clin (Engl Ed) 2022; 18:551-556. [PMID: 35523639 DOI: 10.1016/j.reumae.2021.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 07/07/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND In Spain, the prevalence of different rheumatic diseases is known mainly through the EPISER studies coordinated by the Spanish Society of Rheumatology and based on surveys in a population sample. The aim of our study is to describe the prevalence in 2016 of different rheumatic diseases in the population residing in Baix Empordà according to healthcare coding records. MATERIALS AND METHODS Observational, descriptive and cross-sectional study carried out on the population attended from 2016 to 2017 in SIBBE (Serveis de Salut Integrats del Baix Empordà), an organizational service that includes all the healthcare facilities in the Baix Empordà area with a unique information system. Patients ≥ 20 years of age were selected and the ICD9-CM coding of all their healthcare contacts was analysed according to 11 entities and 28 diseases. The entities were: polyarthritis, spondyloarthritis, microcrystalline arthritis, osteoarthritis, soft tissue rheumatism, fibromyalgia, chronic spinal pain, osteoporosis, connective tissue diseases, vasculitis and others. The studied population was assigned to the categories: "with rheumatic disease", "possible rheumatic disease" and "without rheumatic disease". RESULTS In total, 71,785 patients were distributed as: 36.2% "with rheumatic disease (n = 25,990); 6.1% with "possible rheumatic disease" (n = 4406) and 57.7% "without rheumatic disease" (n = 41,389). The group "with rheumatic disease" showed a predominance of women (59.7% vs. 44.9%) and older age (59.1 ± 17.7 vs. 45.1 ± 16.2; p < .001) compared to the group "without rheumatic disease". The presence of rheumatic disease increased progressively with age, being maximum in the group between 55-75 years. CONCLUSIONS 36.2% of our population has some type of rheumatic disease. The estimated prevalence of some rheumatic diseases in the Baix Empordà population is partially consistent with that estimated by the EPISER 2016 study. Rheumatic disease affects women in a greater proportion and is more frequent in patients over 45 years of age.
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Affiliation(s)
- Marta Larrosa Padró
- Pla Director de Malalties Reumàtiques i de l'Aparell Locomotor, Departament de Salut, Generalitat de Cataluña, Barcelona, Spain.
| | - José Maria Inoriza
- Grup de Recerca en Serveis Sanitaris i Resultats en Salut (GRESSIRES), Serveis de Salut Integrats Baix Empordà (SSIBE), Palamós, Spain
| | | | | | - Joan M Nolla
- Servei de Reumatologia, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Jordi Coderch de Lassaletta
- Grup de Recerca en Serveis Sanitaris i Resultats en Salut (GRESSIRES), Serveis de Salut Integrats Baix Empordà (SSIBE), Palamós, Spain
| | - Xavier Perez Berruezo
- Grup de Recerca en Serveis Sanitaris i Resultats en Salut (GRESSIRES), Serveis de Salut Integrats Baix Empordà (SSIBE), Palamós, Spain
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8
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Morales-Ivorra I, Narváez J, Gómez-Vaquero C, Moragues C, Nolla JM, Narváez JA, Marín-López MA. Assessment of inflammation in patients with rheumatoid arthritis using thermography and machine learning: a fast and automated technique. RMD Open 2022; 8:rmdopen-2022-002458. [PMID: 35840312 PMCID: PMC9295660 DOI: 10.1136/rmdopen-2022-002458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 06/30/2022] [Indexed: 11/28/2022] Open
Abstract
Objectives Sensitive detection of joint inflammation in rheumatoid arthritis (RA) is crucial to the success of the treat-to-target strategy. In this study, we characterise a novel machine learning-based computational method to automatically assess joint inflammation in RA using thermography of the hands, a fast and non-invasive imaging technique. Methods We recruited 595 patients with arthritis and osteoarthritis, as well as healthy subjects at two hospitals over 4 years. Machine learning was used to assess joint inflammation from the thermal images of the hands using ultrasound as the reference standard, obtaining a Thermographic Joint Inflammation Score (ThermoJIS). The machine learning model was trained and tuned using data from 449 participants with different types of arthritis, osteoarthritis or without rheumatic disease (development set). The performance of the method was evaluated based on 146 patients with RA (validation set) using Spearman’s rank correlation coefficient, area under the receiver-operating curve (AUROC), average precision, sensitivity, specificity, positive and negative predictive value and F1-score. Results ThermoJIS correlated moderately with ultrasound scores (grey-scale synovial hypertrophy=0.49, p<0.001; and power Doppler=0.51, p<0.001). The AUROC for ThermoJIS for detecting active synovitis was 0.78 (95% CI, 0.71 to 0.86; p<0.001). In patients with RA in clinical remission, ThermoJIS values were significantly higher when active synovitis was detected by ultrasound. Conclusions ThermoJIS was able to detect joint inflammation in patients with RA, even in those in clinical remission. These results open an opportunity to develop new tools for routine detection of joint inflammation.
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Affiliation(s)
| | - Javier Narváez
- Rheumatology Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Carmen Gómez-Vaquero
- Rheumatology Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Carmen Moragues
- Rheumatology Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Joan M Nolla
- Rheumatology Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - José A Narváez
- Radiodiagnosis Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
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9
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Grados Canovas D, Martínez-Morillo M, Olivé Marques A, Retamero A, Nolla JM, Guanyabens N. Rheumatology manpower in the public system in Catalonia (Spain). Reumatol Clin (Engl Ed) 2021; 17:607-610. [PMID: 34823829 DOI: 10.1016/j.reumae.2020.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 06/17/2020] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To determine the current state of Rheumatology in Catalonia and to update the information regarding previous studies. MATERIAL AND METHODS DESIGN Observational, descriptive and cross-sectional study. Data collection from January to June 2017. SAMPLE Rheumatologists practising public healthcare activity in Catalonia. An online questionnaire was sent to gather individual data and data from rheumatology services/sections. RESULTS Information was obtained on 109 rheumatologists: 39 men and 70 women; mean age: 47±9 years. The number of rheumatologists has increased by 8% over the past 5 years. One hundred and one (92.7%) doctors qualified as rheumatologists through the MIR. Rheumatology practice was mostly in a hospital setting: 68 (62.4%) physicians. Ninety-six (88.1%) rheumatologists were full-time practitioners. Fifty-four (50%) rheumatologists also practiced in the private sector. Clinical practice was predominant: 76% of daily time was devoted to this area. Of note, it was found that most of the rheumatology services, 24 (705), were dependent hierarchically on other services, namely internal medicine and orthopaedic surgery. There are still 6 hospitals in Catalonia without a rheumatologist. CONCLUSIONS The number of rheumatologists in the public health sector of Catalonia has increased over the past 5 years. The mean age of rheumatologists is advanced and there is a clear predominance of female practitioners in the specialty. Many rheumatology services depend on other services. Rheumatology activity is primarily focussed in the city of Barcelona.
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Affiliation(s)
- Dolors Grados Canovas
- Servicio de Reumatología, Hospital d'Igualada, Consorci Sanitari de l'Anoia, Igualada, Barcelona, Spain.
| | - Melania Martínez-Morillo
- Servicio de Reumatología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Alejandro Olivé Marques
- Servicio de Reumatología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Alexandra Retamero
- Servicio de Farmacia, Hospital d'Igualada, Consorci Sanitari de l'Anoia, Igualada, Barcelona, Spain
| | - Joan M Nolla
- Servicio de Reumatología, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Presidente de la Sociedad Catalana de Reumatología
| | - Núria Guanyabens
- Servicio de Reumatología, Hospital Clínic, Barcelona, Spain; Expresidenta de la Sociedad Catalana de Reumatología
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10
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Cruz-Jentoft AJ, Romero-Yuste S, Chamizo Carmona E, Nolla JM. Sarcopenia, immune-mediated rheumatic diseases, and nutritional interventions. Aging Clin Exp Res 2021; 33:2929-2939. [PMID: 33566325 PMCID: PMC8595168 DOI: 10.1007/s40520-021-01800-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 01/15/2021] [Indexed: 12/27/2022]
Abstract
Introduction Sarcopenia is defined by a loss of muscle mass and function associated with mortality, decreased physical performance, falls, and disability. Since chronic inflammation and decreased physical activity are risk factors for developing sarcopenia, it is critical to assess the role of sarcopenia in immune-mediated rheumatic diseases (IMRDs). Moreover, nutritional interventions are emerging as key modifiable and affordable options to improve physical performance in sarcopenia. Objective The aim of this review is to critically summarize current information on the evidence linking nutritional interventions and sarcopenia in IMRDs. Methods The search and selection of articles was performed in Medline, Dimensions.ai, Google Scholar, Cochrane Library, Epistemonikos, and Trip Database. The results were clustered into three areas: sarcopenia and IMRDs, sarcopenia and biological disease-modifying antirheumatic drugs (bDMARDs), and nutritional interventions for sarcopenia. Findings Several cross-sectional studies have shown a higher prevalence of sarcopenia in IMRDs, such as rheumatoid arthritis. Although not fully established, evidence linking sarcopenia and other IMRDs (ankylosing spondylitis and systemic sclerosis) has been also described. For secondary sarcopenia prevention and treatment, bDMARDs’ administration proved efficacy in patients with rheumatoid arthritis. Furthermore, there is growing evidence linking nutrition to the prevention and treatment of sarcopenia. Evidence linking unfavourable results in nutritional risk assessment, insufficient intake of protein, vitamin D, antioxidant nutrients, and long-chain polyunsaturated fatty acids and sarcopenia have been reported. Conclusion Given that sarcopenia and IMRDs have strong links, further research is needed to improve patient care.
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11
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Narváez J, LLuch J, Ruiz-Majoral A, Sánchez-Corral MA, Claver E, Nolla JM. Increased Prevalence of Moderate to Severe Mitral and Aortic Valve Dysfunction in Systemic Sclerosis: A Case-control Study. J Rheumatol 2020; 48:394-401. [PMID: 33191275 DOI: 10.3899/jrheum.201025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2020] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To investigate the prevalence, severity, and associated clinical factors of mitral and aortic valvular involvement in patients with systemic sclerosis (SSc). METHODS Our case-control study included 172 patients with SSc and 172 non-SSc adults without known cardiac disease matched by age, sex, and prevalence of cardiovascular (CV) risk factors. The screening of mitral and aortic valvular involvement was performed by transthoracic Doppler echocardiogram. The prevalence of aortic stenosis (AS) was also compared with that reported in a population-based study performed in our community during the same period. RESULTS Patients with SSc showed an almost 5-fold increased prevalence of moderate to severe mitroaortic valve dysfunction compared to non-SSc controls (OR 4.60, 95% CI 1.51-13.98; P = 0.003). The most common lesion was mitral regurgitation (MR), which was observed in 5.2% of patients, followed by AS in 3.5%, and aortic regurgitation (AR) in 1.7%. Analyzing the different types of valvular lesion separately, we observed a significantly higher frequency of MR compared to controls (OR 4.69, 95% CI 1.12-22.04; P = 0.032), as well as a higher frequency of AS in the 65-75 (OR 7.51, 95% CI 1.22-46.23, P = 0.01) and 76-85 age groups (OR 3.53, 95% CI 1.03-12.22, P = 0.043) when compared to the general population in our community. CONCLUSION We found an increased prevalence of moderate to severe MR and AS in SSc compared to age-matched non-SSc controls with similar CV comorbidities. While results from this study do not allow for establishing a direct causal relationship, they strongly support the contribution of SSc-specific factors in the development of these complications.
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Affiliation(s)
- Javier Narváez
- J. Narváez, MD, PhD, J. LLuch, MD, J.M. Nolla, MD, PhD, Department of Rheumatology, Hospital Universitario de Bellvitge;
| | - Judit LLuch
- J. Narváez, MD, PhD, J. LLuch, MD, J.M. Nolla, MD, PhD, Department of Rheumatology, Hospital Universitario de Bellvitge
| | - Alejandro Ruiz-Majoral
- A. Ruiz-Majoral, MD, M.A. Sánchez-Corral, MD, E. Claver, MD, Department of Cardiology, Hospital Universitario de Bellvitge, Barcelona, Spain
| | - Miguel Angel Sánchez-Corral
- A. Ruiz-Majoral, MD, M.A. Sánchez-Corral, MD, E. Claver, MD, Department of Cardiology, Hospital Universitario de Bellvitge, Barcelona, Spain
| | - Eduard Claver
- A. Ruiz-Majoral, MD, M.A. Sánchez-Corral, MD, E. Claver, MD, Department of Cardiology, Hospital Universitario de Bellvitge, Barcelona, Spain
| | - Joan M Nolla
- J. Narváez, MD, PhD, J. LLuch, MD, J.M. Nolla, MD, PhD, Department of Rheumatology, Hospital Universitario de Bellvitge
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12
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Robles-Pérez A, Luburich P, Bolivar S, Dorca J, Nolla JM, Molina-Molina M, Narváez J. A prospective study of lung disease in a cohort of early rheumatoid arthritis patients. Sci Rep 2020; 10:15640. [PMID: 32973236 PMCID: PMC7515904 DOI: 10.1038/s41598-020-72768-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 09/02/2020] [Indexed: 01/26/2023] Open
Abstract
Lung disease is common in patients with rheumatoid arthritis (RA). The onset of lung involvement in RA is not well known. The objective is to describe the features and evolution of lung involvement in early RA, its relationship with disease activity parameters, smoking and treatments. Consecutive patients with early RA without respiratory symptoms were included and tracked for 5 years. Lung assessment included clinical, radiological and pulmonary function tests at diagnosis and during follow-up. Peripheral blood parameters (erythrocyte sedimentation rate, C reactive protein, rheumatoid factor and anti-citrullinated peptide autoantibodies) and scales of articular involvement, such as DAS28-CRP, were evaluated. 40 patients were included and 32 completed the 5-year follow up. 13 patients presented lung involvement in the initial 5 years after RA diagnosis, 3 of them interstitial lung disease. Significant decrease of diffusion lung transfer capacity of carbon monoxide over time was observed in six patients, 2 of them developed interstitial lung disease. DLCO decrease was correlated with higher values of CRP and ESR at diagnosis. Methotrexate was not associated with DLCO deterioration or lung disease development. Subclinical progressive lung disease correlates with RA activity parameters. Smoking status and methotrexate were not associated with development or progression of lung disease.
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Affiliation(s)
- A Robles-Pérez
- ILD Unit, Department of Pneumology, Hospital Universitari de Bellvitge, Universitat de Barcelona, Feixa Llarga S/N, 08907, Barcelona, Spain
| | - P Luburich
- Servei de Diagnòstic Per La Imatge El Prat (SDPI El Prat), Department of Radiology, Hospital Universitari de Bellvitge, Universitat de Barcelona, Barcelona, Spain
| | - S Bolivar
- Servei de Diagnòstic Per La Imatge El Prat (SDPI El Prat), Department of Radiology, Hospital Universitari de Bellvitge, Universitat de Barcelona, Barcelona, Spain
| | - J Dorca
- ILD Unit, Department of Pneumology, Hospital Universitari de Bellvitge, Universitat de Barcelona, Feixa Llarga S/N, 08907, Barcelona, Spain
| | - J M Nolla
- Department of Rheumatology, Hospital Universitari de Bellvitge, Universitat de Barcelona, Barcelona, Spain
| | - M Molina-Molina
- ILD Unit, Department of Pneumology, Hospital Universitari de Bellvitge, Universitat de Barcelona, Feixa Llarga S/N, 08907, Barcelona, Spain.
| | - J Narváez
- Department of Rheumatology, Hospital Universitari de Bellvitge, Universitat de Barcelona, Barcelona, Spain
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13
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Grados Canovas D, Martínez-Morillo M, Olivé Marques A, Retamero A, Nolla JM, Guanyabens N. Rheumatology Manpower in the Public System in Catalonia (Spain). Reumatol Clin (Engl Ed) 2020; 17:S1699-258X(20)30165-0. [PMID: 32798175 DOI: 10.1016/j.reuma.2020.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 06/10/2020] [Accepted: 06/17/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine the current state of Rheumatology in Catalonia and to update the information regarding previous studies. MATERIAL AND METHODS DESIGN Observational, descriptive and cross-sectional study. Data collection from January to June 2017. SAMPLE Rheumatologists practising public healthcare activity in Catalonia. An online questionnaire was sent to gather individual data and data from rheumatology services/sections. RESULTS Information was obtained on 109 rheumatologists: 39 men and 70 women; mean age: 47±9 years. The number of rheumatologists has increased by 8% over the past 5 years. One hundred and one (92.7%) doctors qualified as rheumatologists through the MIR. Rheumatology practice was mostly in a hospital setting: 68 (62.4%) physicians. Ninety-six (88.1%) rheumatologists were full-time practitioners. Fifty-four (50%) rheumatologists also practiced in the private sector. Clinical practice was predominant: 76% of daily time was devoted to this area. Of note, it was found that most of the rheumatology services, 24 (705), were dependent hierarchically on other services, namely internal medicine and orthopaedic surgery. There are still 6 hospitals in Catalonia without a rheumatologist. CONCLUSIONS The number of rheumatologists in the public health sector of Catalonia has increased over the past 5 years. The mean age of rheumatologists is advanced and there is a clear predominance of female practitioners in the specialty. Many rheumatology services depend on other services. Rheumatology activity is primarily focussed in the city of Barcelona.
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Affiliation(s)
- Dolors Grados Canovas
- Servicio de Reumatología, Hospital d'Igualada, Consorci Sanitari de l'Anoia, Igualada, Barcelona, España.
| | - Melania Martínez-Morillo
- Servicio de Reumatología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España
| | - Alejandro Olivé Marques
- Servicio de Reumatología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España
| | - Alexandra Retamero
- Servicio de Farmacia, Hospital d'Igualada, Consorci Sanitari de l'Anoia, Igualada, Barcelona, España
| | - Joan M Nolla
- Servicio de Reumatología, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España; Presidente de la Sociedad Catalana de Reumatología
| | - Núria Guanyabens
- Servicio de Reumatología, Hospital Clínic, Barcelona, España; Expresidenta de la Sociedad Catalana de Reumatología
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14
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Narváez J, LLuch J, Molina-Molina M, Vicens-Zygmunt V, Luburich P, Yañez MA, Nolla JM. Rituximab as a rescue treatment added on mycophenolate mofetil background therapy in progressive systemic sclerosis associated interstitial lung disease unresponsive to conventional immunosuppression. Semin Arthritis Rheum 2020; 50:977-987. [PMID: 32911289 DOI: 10.1016/j.semarthrit.2020.08.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/28/2020] [Accepted: 08/05/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To test whether the use of rituximab (RTX) is effective and safe as a rescue therapy add-on treatment to mycophenolate (MMF) in patients with progressive systemic sclerosis-associated interstitial lung disease (SSc-ILD) in whom conventional immunosuppressants (IS) have failed. METHODS Longitudinal retrospective observational study of a cohort of patients with SSc-ILD that started treatment with RTX due to ongoing lung function impairment despite treatment with glucocorticoids and IS (cyclophosphamide and/or MMF). All patients were treated with 2 or more cycles of RTX and evaluated for at least 12 months. RESULTS Twenty-four patients were included. Before initiation of RTX the mean decline in%pFVC and %pDLCO during the previous 2 years (delta) was -12.9% and -12.5%, respectively. After 1 year of treatment with RTX, a significant improvement in %pFVC (∆+8.8% compared to baseline, 95% CI: -13.7 to -3.9; p = 0.001) and%pDLCO (∆+4.6%, 95% CI: -8.2 to -0.8; p = 0.018) was observed. In addition, there was a significant reduction in the median dose of prednisone and it could be suspended in 25% of patients. At 2 years of treatment, RTX had been discontinued in 9 patients (due to adverse events in 3 cases and inefficacy in 6). In the 15 patients (62.5%) that completed 24 months of therapy, the statistically significant amelioration in pulmonary function test parameters was maintained: ∆%pFVC: +11.1% (95% CI: -17.6 to -4.5; p = 0.003) and ∆%pDLCO: +8.7% (95% CI: -13.9 to -8.3; p = 0.003). CONCLUSION Based on our results, RTX's use as an add-on treatment to MMF appears to be effective as a rescue therapy in patients with a more aggressive SSc-ILD phenotype.
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Affiliation(s)
- Javier Narváez
- Department of Rheumatology, Hospital Universitario de Bellvitge. Barcelona, Spain.
| | - Judit LLuch
- Department of Rheumatology, Hospital Universitario de Bellvitge. Barcelona, Spain
| | - Maria Molina-Molina
- Department of Pneumology (Unit of Interstitial Lung Diseases), Hospital Universitario de Bellvitge, Barcelona, Spain
| | - Vanesa Vicens-Zygmunt
- Department of Pneumology (Unit of Interstitial Lung Diseases), Hospital Universitario de Bellvitge, Barcelona, Spain
| | - Patricio Luburich
- Department of Radiology, Hospital Universitario de Bellvitge, Barcelona, Spain
| | - Marcos Anibal Yañez
- Department of Rheumatology, Hospital Universitario de Bellvitge. Barcelona, Spain; Department of Radiology, Hospital Altos de Salta, Salta, Argentina
| | - Joan M Nolla
- Department of Rheumatology, Hospital Universitario de Bellvitge. Barcelona, Spain
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15
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Gomez-Vaquero C, Valencia L, Nolla JM, Boquet D, Martínez Pardo S, Mihaylov Grigorov M, Lafont A, Segalés N, Roig Vilaseca D, Cerdà D, Casado E, Oncins X, Sallés M, Mínguez S, García Mira Y, Holgado S, López Louzao A, Pitarch C, Castellanos Moreira R, Florez H, Tebé C. The incidence of clinical fractures in adults aged 50 years and older in Spain. Rheumatol Adv Pract 2020. [DOI: 10.1093/rap/rkaa050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Objective
The aim of this study was to quantify the incidence of all clinical fractures, including traumatic and fragility fractures, in patients aged 50 years and older, and to describe their distribution by fracture location, sex and age.
Methods
The incidence of clinical fractures at 10 hospitals in Catalonia, with a reference population of 3 155 000 inhabitants, was studied. For 1 week, from 30 May to 5 June 2016, we reviewed the discharge reports of the Traumatology section of the Emergency Department to identify all fractures diagnosed in patients ≥50 years of age. As a validation technique, data collection was carried out for 1 year at one of the centres, from 1 December 2015 to 30 November 2016. The fracture incidence, including the 95% CI, was estimated for the entire sample and grouped by fracture type, location, sex and age.
Results
A total of 283 fractures were identified. Seventy per cent were in women, with a mean age of 72 years. The overall fracture incidence was 11.28 per 1000 person-years (95% CI: 11.10, 11.46), with an incidence of traumatic and fragility fractures of 4.15 (95% CI: 4.04, 4.26) and 7.13 per 1000 person-years (95% CI: 6.99, 7.28), respectively. The incidence of fractures observed in the validation sample coincided with that estimated for the whole of Catalonia. The most common fragility fractures were of the hip, forearm, humerus and vertebrae.
Conclusion
The results of this study are the first to estimate the incidence of clinical fragility fractures in Spain, grouped by location, age and sex.
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Affiliation(s)
- Carmen Gomez-Vaquero
- Osteoporosis Working Group of the Catalonian Society for Rheumatology (OsCat)
- Rheumatology Department, Hospital Universitari de Bellvitge, L’Hospitalet
| | - Lidia Valencia
- Osteoporosis Working Group of the Catalonian Society for Rheumatology (OsCat)
- Rheumatology Department, Hospital Universitari de Bellvitge, L’Hospitalet
| | - Joan M Nolla
- Osteoporosis Working Group of the Catalonian Society for Rheumatology (OsCat)
- Rheumatology Department, Hospital Universitari de Bellvitge, L’Hospitalet
| | - Dolors Boquet
- Osteoporosis Working Group of the Catalonian Society for Rheumatology (OsCat)
- Rheumatology Department, Hospital Universitari Arnau de Vilanova, Lleida
| | - Silvia Martínez Pardo
- Osteoporosis Working Group of the Catalonian Society for Rheumatology (OsCat)
- Rheumatology Department, Hospital Universitari Mútua Terrassa, Terrassa
| | - Mihail Mihaylov Grigorov
- Osteoporosis Working Group of the Catalonian Society for Rheumatology (OsCat)
- Rheumatology Department, Hospital Universitari Mútua Terrassa, Terrassa
| | - Anna Lafont
- Osteoporosis Working Group of the Catalonian Society for Rheumatology (OsCat)
- Rheumatology Department, Hospital de Mataró, Mataró
| | - Nuria Segalés
- Osteoporosis Working Group of the Catalonian Society for Rheumatology (OsCat)
- Rheumatology Department, Hospital de Mataró, Mataró
| | - Daniel Roig Vilaseca
- Osteoporosis Working Group of the Catalonian Society for Rheumatology (OsCat)
- Rheumatology Department, Hospital de Sant Joan Despí Moisès Broggi, Sant Joan Despí
| | - Dacia Cerdà
- Osteoporosis Working Group of the Catalonian Society for Rheumatology (OsCat)
- Rheumatology Department, Hospital de Sant Joan Despí Moisès Broggi, Sant Joan Despí
| | - Enrique Casado
- Osteoporosis Working Group of the Catalonian Society for Rheumatology (OsCat)
- Rheumatology and Orthopedics Departments, Parc Taulí Hospital Universitari, Sabadell
| | - Xavier Oncins
- Rheumatology and Orthopedics Departments, Parc Taulí Hospital Universitari, Sabadell
| | - Meritxell Sallés
- Osteoporosis Working Group of the Catalonian Society for Rheumatology (OsCat)
- Rheumatology Department, Hospital Sant Joan de Déu de Manresa, Manresa
| | - Sonia Mínguez
- Osteoporosis Working Group of the Catalonian Society for Rheumatology (OsCat)
- Rheumatology Department, Hospital Sant Joan de Déu de Manresa, Manresa
| | - Yaiza García Mira
- Osteoporosis Working Group of the Catalonian Society for Rheumatology (OsCat)
- Rheumatology Department, Hospital Universitari Germans Trias i Pujol, Badalona
| | - Susana Holgado
- Osteoporosis Working Group of the Catalonian Society for Rheumatology (OsCat)
- Rheumatology Department, Hospital Universitari Germans Trias i Pujol, Badalona
| | - Ana López Louzao
- Rheumatology and Orthopedics Departments, Hospital de l’Esperit Sant, Santa Coloma de Gramenet
| | - Conxita Pitarch
- Osteoporosis Working Group of the Catalonian Society for Rheumatology (OsCat)
- Rheumatology and Orthopedics Departments, Hospital de l’Esperit Sant, Santa Coloma de Gramenet
| | - Raúl Castellanos Moreira
- Osteoporosis Working Group of the Catalonian Society for Rheumatology (OsCat)
- Rheumatology Department, Hospital Clínic de Barcelona, Barcelona
| | - Helena Florez
- Osteoporosis Working Group of the Catalonian Society for Rheumatology (OsCat)
- Rheumatology Department, Hospital Clínic de Barcelona, Barcelona
| | - Cristian Tebé
- Statistical Advisory Service, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet, Spain
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Cañete JD, Nolla JM, Queiro R, Rodríguez MJ, Ruiz M, Lizán L. Expert Consensus on a Set of Outcomes to Assess the Effectiveness of Biologic Treatment in Psoriatic Arthritis: The MERECES Study. J Rheumatol 2020; 47:1637-1643. [DOI: 10.3899/jrheum.191056] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2020] [Indexed: 02/06/2023]
Abstract
Objective.To reach a consensus on the instruments to be used in clinical practice to evaluate the effectiveness of biological disease-modifying antirheumatic drug (bDMARD) treatment in patients with psoriatic arthritis (PsA) in the short to medium term (3–6 mos), and to establish the minimum health outcomes for treatment continuation.Methods.A 2-round Delphi questionnaire was developed based on both the information gathered in the literature review and 4 discussion groups. The suitability and feasibility of the proposed sets of instruments were assessed on a 7-point Likert scale. Consensus was established when at least 75% of healthcare professionals (HCP) reached agreement. To define a minimum health outcome to continue treatment, a combination of 4 disease activity states and 3 health-related quality of life states were defined for 3 hypothetical patient profiles. HCP were given a dichotomous choice (yes/no) to respond to whether they would continue treatment in each case.Results.The second round was completed by 106 HCP. Consensus was reached on the use of (1) Disease Activity in Psoriatic Arthritis + Psoriatic Arthritis Impact of Disease (PsAID12) or minimal disease activity + PsAID12 + C-reactive protein, in peripheral PsA; and (2) Ankylosing Spondylitis Disease Activity Score + PsAID12, in axial PsA. Health outcomes considered sufficient to continue treatment were stricter for bDMARD-naive patients than for patients who failed several bDMARD.Conclusion.To the best of our knowledge, this is the first multidisciplinary consensus on a set of outcomes for the evaluation of bDMARD effectiveness in PsA, in routine clinical practice.
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Atienza-Mateo B, Martín-Varillas JL, Calvo-Río V, Demetrio-Pablo R, Beltrán E, Sánchez-Bursón J, Mesquida M, Adan A, Hernández MV, Hernández-Garfella M, Valls-Pascual E, Martínez-Costa L, Sellas-Fernández A, Cordero-Coma M, Díaz-Llopis M, Gallego R, García-Serrano JL, Ortego-Centeno N, Herreras JM, Fonollosa A, Garcia-Aparicio ÁM, Maíz-Alonso O, Blanco A, Torre-Salaberri I, Fernandez-Espartero C, Jovaní V, Peiteado D, Pato E, Cruz J, Férnandez-Cid C, Aurrecoechea E, García-Arias M, Castañeda S, Caracuel-Ruiz MA, Montilla-Morales CA, Atanes-Sandoval A, Francisco F, Insua S, González-Suárez S, Sanchez-Andrade A, Gamero F, Linares Ferrando LF, Romero-Bueno F, García-González AJ, González RA, Muro EM, Carrasco-Cubero C, Olive A, Prior Á, Vázquez J, Ruiz-Moreno O, Jiménez-Zorzo F, Manero J, Muñoz Fernandez S, Fernández-Carballido C, Rubio-Romero E, Pages FA, Toyos-Sáenz de Miera FJ, Martinez MG, Díaz-Valle D, López Longo FJ, Nolla JM, Álvarez ER, Martínez MR, González-López JJ, Rodríguez-Cundin P, Hernández JL, González-Gay MA, Blanco R. Comparative Study of Infliximab Versus Adalimumab in Refractory Uveitis due to Behçet's Disease: National Multicenter Study of 177 Cases. Arthritis Rheumatol 2019; 71:2081-2089. [PMID: 31237427 DOI: 10.1002/art.41026] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 06/19/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To compare the efficacy of infliximab (IFX) versus adalimumab (ADA) as a first-line biologic drug over 1 year of treatment in a large series of patients with refractory uveitis due to Behçet's disease (BD). METHODS We conducted an open-label multicenter study of IFX versus ADA for BD-related uveitis refractory to conventional nonbiologic treatment. IFX or ADA was chosen as the first-line biologic agent based on physician and patient agreement. Patients received 3-5 mg/kg intravenous IFX at 0, 2, and 6 weeks and every 4-8 weeks thereafter, or 40 mg subcutaneous ADA every other week without a loading dose. Ocular parameters were compared between the 2 groups. RESULTS The study included 177 patients (316 affected eyes), of whom 103 received IFX and 74 received ADA. There were no significant baseline differences between treatment groups in main demographic features, previous therapy, or ocular sign severity. After 1 year of therapy, we observed an improvement in all ocular parameters in both groups. However, patients receiving ADA had significantly better outcomes in some parameters, including improvement in anterior chamber inflammation (92.31% versus 78.18% for IFX; P = 0.06), improvement in vitritis (93.33% versus 78.95% for IFX; P = 0.04), and best-corrected visual acuity (mean ± SD 0.81 ± 0.26 versus 0.67 ± 0.34 for IFX; P = 0.001). A nonsignificant difference was seen for macular thickness (mean ± SD 250.62 ± 36.85 for ADA versus 264.89 ± 59.74 for IFX; P = 0.15), and improvement in retinal vasculitis was similar between the 2 groups (95% for ADA versus 97% for IFX; P = 0.28). The drug retention rate was higher in the ADA group (95.24% versus 84.95% for IFX; P = 0.042). CONCLUSION Although both IFX and ADA are efficacious in refractory BD-related uveitis, ADA appears to be associated with better outcomes than IFX after 1 year of follow-up.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ana Blanco
- Hospital Universitario de Donostia, San Sebastián, Spain
| | | | | | - Vega Jovaní
- Hospital General de Alicante, Alicante, Spain
| | | | | | - Juan Cruz
- Hospital de Pontevedra, Pontevedra, Spain
| | | | | | | | - Santos Castañeda
- Hospital Universitario de la Princesa, IIS-Princesa, Madrid, Spain
| | | | | | | | | | - Santos Insua
- Hospital Universitario Santiago de Compostela, A Coruña, Spain
| | | | | | | | | | - F Romero-Bueno
- Jiménez Díaz Foundation University Hospital, Madrid, Spain
| | | | | | | | | | | | - Águeda Prior
- Germans Trias i Pujol Hospital, Barcelona, Spain
| | | | | | | | - Javier Manero
- Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | | | | | | | | | | | | | | | - Joan M Nolla
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | | | | | | | | | | | | | - Ricardo Blanco
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
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Balsa A, Lojo-Oliveira L, Alperi-López M, García-Manrique M, Ordóñez-Cañizares C, Pérez L, Ruiz-Esquide V, Corrales A, Narváez J, Rey-Rey J, Rodríguez-Lozano C, Ojeda S, Muñoz-Fernández S, Nolla JM, García-Torrón J, Gamero F, García-Vicuña R, Hernández-Cruz B, Campos J, Rosas J, García-Llorente JF, Gómez-Centeno A, Cáliz R, Sanmartí R, Bermúdez A, Abasolo-Alcázar L, Fernández-Nebro A, Rodríguez-Rodríguez L, Marras C, González-Gay MÁ, Hmamouchi I, Martín-Mola E. Prevalence of comorbidities in rheumatoid arthritis and evaluation of their monitoring in clinical practice: the spanish cohort of the COMORA study. ACTA ACUST UNITED AC 2019; 15:102-108. [DOI: 10.1016/j.reuma.2017.06.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 06/08/2017] [Accepted: 06/08/2017] [Indexed: 12/19/2022]
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Narváez J, Mora-Limiñana M, Ros I, Ibañez M, Valldeperas J, Crémer D, Nolla JM, Juan-Mas A. Pulmonary arterial hypertension in adult-onset Still's disease: A case series and systematic review of the literature. Semin Arthritis Rheum 2018; 49:162-170. [PMID: 30580885 DOI: 10.1016/j.semarthrit.2018.11.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 11/02/2018] [Accepted: 11/20/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To investigate the prevalence, clinical characteristics and prognosis of pulmonary arterial hypertension (PAH) in adult onset Still's disease (AOSD). METHODS We retrospectively reviewed all patients with AOSD diagnosed during a 33-year period in 2 referral tertiary care hospitals, selecting for analysis those who presented PAH confirmed as by right heart catheterization. A systematic review of the literature (PubMed 1990 to July 2018) was also performed, in order to determine the prognosis and the most appropriate treatment strategy for this complication. RESULTS The overall prevalence of PAH in our AOSD population was 4.8% (2/41). Including our 2 cases, 20 well-documented patients have been reported. PAH may complicate AOSD at any time during its course, and usually occurs in patients who have persistent and severe disease, with a considerable frequency (35%) of previous or concomitant severe clinical complications. In all cases, the etiology of pulmonary hypertension was a group 1 PAH based on the 2015 ESC/ERS guidelines. Most patients in this series had advanced WHO functional classes III-IV at the time of PAH diagnosis, reflecting an important diagnostic delay. Thirty-three percent of patients had a poor outcome despite the therapy, with a mortality rate that reached 22%. The therapeutic strategy that achieved the best results was the use of glucocorticoids, immunosuppression and PAH-specific vasodilator therapy. CONCLUSION HAP is an under-recognized complication of AOSD that should be kept in mind in the differential diagnosis of those patients who experience dyspnea on exertion or a decrease in exercise tolerance.
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Affiliation(s)
- Javier Narváez
- Departments of Rheumatology, Hospital Universitario de Bellvitge, Barcelona, 08907, Spain.
| | - Maribel Mora-Limiñana
- Departments of Rheumatology, Hospital Universitario de Bellvitge, Barcelona, 08907, Spain
| | - Inmaculada Ros
- Departments of Rheumatology, Hospital Son Llàtzer, Palma de Mallorca, Spain
| | - Mónica Ibañez
- Departments of Rheumatology, Hospital Son Llàtzer, Palma de Mallorca, Spain
| | - Joan Valldeperas
- Departments of Pneumology, Hospital Universitario de Bellvitge, Barcelona, Spain
| | - David Crémer
- Departments of Cardiology, Hospital Son Llàtzer, Palma de Mallorca, Spain
| | - Joan M Nolla
- Departments of Rheumatology, Hospital Universitario de Bellvitge, Barcelona, 08907, Spain
| | - Antonio Juan-Mas
- Departments of Rheumatology, Hospital Son Llàtzer, Palma de Mallorca, Spain
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Albert G, Ricse M, Narvaez J, Rodriguez-Moreno J, Nolla JM, Dominguez-Luzon MA, Gomez-Vaquero C. Prevalence of Nasal Colonization with Staphylococcus aureus in Patients with Rheumatoid Arthritis. Curr Rheumatol Rev 2018; 14:78-83. [PMID: 29057725 DOI: 10.2174/1573397113666171020102300] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 11/11/2016] [Accepted: 11/14/2016] [Indexed: 11/22/2022]
Abstract
Objetive: Patients with Rheumatoid Arthritis (RA) and nasal carriers of Staphylococcus aureus have an increased risk of developing infections caused by S. aureus. Our objective was to determine the prevalence of S. aureus nasal colonization in patients with RA and its relationship to RA treatments. METHODS Two hundred and seven patients with RA and 37 healthy controls were prospectively included in a cross-sectional study. A nasal secretion sample was collected by swab from both anterior nostrils and was referred to the hospital's microbiology department for culturing. RESULTS The mean age of the patients (168 women, 78%) was 61 ± 12 years old. The mean disease duration was 13 ± 10 years. Seventy-six percent of the patients were positive for Rheumatoid Factor (RF), and 71% were positive for Anti-citrullinated Peptides Antibodies (ACPA). Seventy percent had joint erosions. The mean DAS28 was 3.1 ± 2.2. S. aureus nasal colonization was found in 36% of the RA patients and 35% of the controls. Three patients and no controls were resistant to oxacilin/ mupirocin. The patients who were positive for ACPA had a higher prevalence of S. aureus colonization (43% vs. 17%; p < 0.05). The colonization prevalence in the patients treated with glucocorticoids was 32% (n: 133); methotrexate and/or leflunomide, 37% (n: 167); anti-TNF agents, 46% (n: 54), p < 0.05 versus patients not treated with anti-TNF agents; rituximab, 22% (n: 18); tocilizumab, 39% (n: 18). CONCLUSION The prevalence of S. aureus nasal colonization in patients with RA does not appear to be greater than that of the general population. Anti-TNF agents might confer a higher prevalence of colonization.
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Affiliation(s)
- Gloria Albert
- Department of Rheumatology, Hospital Universitario de Bellvitge-IDIBELL, L'Hospitalet de Llobregat Barcelona, Spain
| | - Milagros Ricse
- Department of Rheumatology, Hospital Universitario de Bellvitge-IDIBELL, L'Hospitalet de Llobregat Barcelona, Spain
| | - Javier Narvaez
- Department of Rheumatology, Hospital Universitario de Bellvitge-IDIBELL, L'Hospitalet de Llobregat Barcelona, Spain
| | - Jesus Rodriguez-Moreno
- Department of Rheumatology, Hospital Universitario de Bellvitge-IDIBELL, L'Hospitalet de Llobregat Barcelona, Spain
| | - Joan M Nolla
- Department of Rheumatology, Hospital Universitario de Bellvitge-IDIBELL, L'Hospitalet de Llobregat Barcelona, Spain
| | - MAngeles Dominguez-Luzon
- Department of Microbiology, Hospital Universitario de Bellvitge-IDIBELL, L'Hospitalet de Llobregat Barcelona, Spain
| | - Carmen Gomez-Vaquero
- Department of Rheumatology, Hospital Universitario de Bellvitge-IDIBELL, L'Hospitalet de Llobregat Barcelona, Spain
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Martín-Varillas JL, Calvo-Río V, Beltrán E, Sánchez-Bursón J, Mesquida M, Adán A, Hernandez MV, Garfella MH, Pascual EV, Martínez-Costa L, Sellas-Fernández A, Cordero-Coma M, Díaz-Llopis M, Gallego R, Salom D, Ortego N, García-Serrano JL, Callejas-Rubio JL, Herreras JM, García-Aparicio Á, Maíz O, Blanco A, Torre I, Díaz-Valle D, Pato E, Aurrecoechea E, Caracuel MA, Gamero F, Minguez E, Carrasco-Cubero C, Olive A, Vázquez J, Ruiz-Moreno O, Manero J, Muñoz-Fernández S, Martinez MG, Rubio-Romero E, Toyos-Sáenz de Miera FJ, López Longo FJ, Nolla JM, Revenga M, González-Vela C, Loricera J, Atienza-Mateo B, Demetrio-Pablo R, Hernández JL, González-Gay MA, Blanco R. Successful Optimization of Adalimumab Therapy in Refractory Uveitis Due to Behçet's Disease. Ophthalmology 2018; 125:1444-1451. [DOI: 10.1016/j.ophtha.2018.02.020] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 02/07/2018] [Accepted: 02/13/2018] [Indexed: 12/30/2022] Open
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Julià A, López-Longo FJ, Pérez Venegas JJ, Bonàs-Guarch S, Olivé À, Andreu JL, Aguirre-Zamorano MÁ, Vela P, Nolla JM, de la Fuente JLM, Zea A, Pego-Reigosa JM, Freire M, Díez E, Rodríguez-Almaraz E, Carreira P, Blanco R, Taboada VM, López-Lasanta M, Corbeto ML, Mercader JM, Torrents D, Absher D, Marsal S, Fernández-Nebro A. Genome-wide association study meta-analysis identifies five new loci for systemic lupus erythematosus. Arthritis Res Ther 2018; 20:100. [PMID: 29848360 PMCID: PMC5977506 DOI: 10.1186/s13075-018-1604-1] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 04/23/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) is a common systemic autoimmune disease with a complex genetic inheritance. Genome-wide association studies (GWAS) have significantly increased the number of significant loci associated with SLE risk. To date, however, established loci account for less than 30% of the disease heritability and additional risk variants have yet to be identified. Here we performed a GWAS followed by a meta-analysis to identify new genome-wide significant loci for SLE. METHODS We genotyped a cohort of 907 patients with SLE (cases) and 1524 healthy controls from Spain and performed imputation using the 1000 Genomes reference data. We tested for association using logistic regression with correction for the principal components of variation. Meta-analysis of the association results was subsequently performed on 7,110,321 variants using genetic data from a large cohort of 4036 patients with SLE and 6959 controls of Northern European ancestry. Genetic association was also tested at the pathway level after removing the effect of known risk loci using PASCAL software. RESULTS We identified five new loci associated with SLE at the genome-wide level of significance (p < 5 × 10- 8): GRB2, SMYD3, ST8SIA4, LAT2 and ARHGAP27. Pathway analysis revealed several biological processes significantly associated with SLE risk: B cell receptor signaling (p = 5.28 × 10- 6), CTLA4 co-stimulation during T cell activation (p = 3.06 × 10- 5), interleukin-4 signaling (p = 3.97 × 10- 5) and cell surface interactions at the vascular wall (p = 4.63 × 10- 5). CONCLUSIONS Our results identify five novel loci for SLE susceptibility, and biologic pathways associated via multiple low-effect-size loci.
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Affiliation(s)
- Antonio Julià
- Rheumatology Research Group, Vall d'Hebron Research Institute, 08035, Barcelona, Spain.
| | | | - José J Pérez Venegas
- Department of Rheumatology, Hospital del SAS de Jerez de la Frontera, 11407, Cádiz, Spain
| | - Silvia Bonàs-Guarch
- Barcelona Supercomputing Center. Joint BSC-CRG-IRB Research Program in Computational Biology, 08034, Barcelona, Spain
| | - Àlex Olivé
- Department of Rheumatology, Hospital Universitari Germans Trias i Pujol, 08916, Badalona, Spain
| | - José Luís Andreu
- Department of Rheumatology, Hospital Universitario Puerta de Hierro, 28222, Madrid, Spain
| | | | - Paloma Vela
- Department of Rheumatology, Hospital General Universitario de Alicante, 03010, Alicante, Spain
| | - Joan M Nolla
- Department of Rheumatology, Hospital Universitari de Bellvitge, 08907, Barcelona, Spain
| | | | - Antonio Zea
- Department of Rheumatology, Hospital Universitario Ramón y Cajal, 28034, Madrid, Spain
| | - José María Pego-Reigosa
- Department of Rheumatology, Hospital do Meixoeiro, Grupo IRIDIS, Instituto de Investigación sanitaria Galicia Sur (IISGS), 36312, Vigo, Spain
| | - Mercedes Freire
- Department of Rheumatology, Hospital Universitario A Coruña, 15006, A Coruña, Spain
| | - Elvira Díez
- Department of Rheumatology, Hospital Complejo Asistencial Universitario de León, 24071, León, Spain
| | | | - Patricia Carreira
- Department of Rheumatology, Hospital Universitario 12 de Octubre, 28041, Madrid, Spain
| | - Ricardo Blanco
- Department of Rheumatology, Hospital Universitario Marqués de Valdecilla, 39008, Santander, Spain
| | - Víctor Martínez Taboada
- Department of Rheumatology, Hospital Universitario Marqués de Valdecilla, 39008, Santander, Spain
| | - María López-Lasanta
- Rheumatology Research Group, Vall d'Hebron Research Institute, 08035, Barcelona, Spain
| | - Mireia López Corbeto
- Rheumatology Research Group, Vall d'Hebron Research Institute, 08035, Barcelona, Spain
| | - Josep M Mercader
- Barcelona Supercomputing Center. Joint BSC-CRG-IRB Research Program in Computational Biology, 08034, Barcelona, Spain
| | - David Torrents
- Barcelona Supercomputing Center. Joint BSC-CRG-IRB Research Program in Computational Biology, 08034, Barcelona, Spain.,Institució Catalana de Recerca i Estudis Avançats (ICREA), 08010, Barcelona, Spain
| | - Devin Absher
- HudsonAlpha Institute for Biotechnology, Huntsville, AL, 35806, USA
| | - Sara Marsal
- Rheumatology Research Group, Vall d'Hebron Research Institute, 08035, Barcelona, Spain.
| | - Antonio Fernández-Nebro
- Department of Rheumatology, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga, 29011, Málaga, Spain
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Nogués X, Nolla JM, Casado E, Jódar E, Muñoz-Torres M, Quesada-Gómez JM, Canals L, Balcells M, Lizán L. Spanish consensus on treat to target for osteoporosis. Osteoporos Int 2018; 29:489-499. [PMID: 29177559 PMCID: PMC5818595 DOI: 10.1007/s00198-017-4310-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 11/08/2017] [Indexed: 01/08/2023]
Abstract
UNLABELLED To reach a Spanish expert consensus on a treat-to-target strategy in osteoporosis, a Delphi Consensus Study has been developed. Most of the experts (59.8%) were rheumatologist with a mean clinical experience of 21.3 years (SD 8.5). Consensus was achieved for 70% of the items. Therapeutic objectives, patient follow-up scheme, treatment failure criteria, and appropriate treatment choice for use in T2T strategy in Spain have been defined. INTRODUCTION The paper aims to achieve a Spanish expert consensus on a treat-to-target (T2T) strategy in osteoporosis. METHODS A scientific committee led the project and was involved in expert panel identification and Delphi questionnaire development. Two Delphi rounds were completed. The first-round questionnaire included 24 items and assessed, using a seven-point Likert scale, the experts' wish (W) and prognosis (P) in 5 years for each topic (applicability, therapeutic objectives, patient follow-up, and possible treatment to be prescribed). Items for which there was no consensus in the first round were included in the second round. Consensus was defined as ≥75% agreement (somewhat/mostly/entirely agree) or disagreement (somewhat/mostly/entirely disagree) responses. RESULTS Of the experts, 112 and 106 completed the first and second rounds, respectively. 59.8% were rheumatologists with a mean clinical experience of 21.3 years (SD 8.5). Consensus was achieved for 70% of the items, and was established regarding the utility of a T2T strategy to define therapeutic objectives, optimal follow-up, and therapeutic algorithm. Participants agreed on the utility of the bone mineral density (BMD) value (T-score >-2.5 SD for spine and >-2.5/-2.0 SD for femoral neck), lack of fractures, and fracture risk (FRAX) as therapeutic objectives. For measuring BMD changes, consensus was achieved on the suitability of hip and femoral neck locations. Experts agreed to consider treatment failure as when a significant BMD gain could not be achieved, or when a new fracture occurs within 2-3 years. There was consensus that all proposed therapies should achieve a therapeutic target through T2T strategy (treatments with the highest consensus scores were denosumab and teriparatide). CONCLUSION The therapeutic objectives, patient follow-up scheme, treatment failure criteria, and appropriate treatment choice for use in T2T strategy in Spain have been established by a panel of experts. Some aspects nevertheless still require further analysis.
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Affiliation(s)
- X Nogués
- Mar Institute of Medical Research (IMIM), Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Universitat Autonòma de Barcelona , Barcelona, Spain.
| | - J M Nolla
- IDIBELL-University Hospital Bellvitge, L'Hospitalet de Llobregat, Spain
| | - E Casado
- Parc Taulí Universtiy Hospital, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain
| | - E Jódar
- University Hospital Quirón Salud, Universidad Europea de Madrid, Madrid, Spain
| | - M Muñoz-Torres
- Bone Metabolic Unit, UGC Endocrinología y Nutrición, Hospital Universitario Campus de la Salud de Granada, Instituto de Investigación Biosanitaria ibs, Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Granada, Spain
| | - J M Quesada-Gómez
- UGC Endocrinología y Nutrición, Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), University Hospital Reina Sofía & IMIBIC, Córdoba, Spain
| | | | | | - L Lizán
- Outcomes'10, Department of Medicine, University Jaume I, Castelló de la Plana, Spain
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Labad J, Rozadilla A, Garcia-Sancho P, Nolla JM, Montanya E. Limited Joint Mobility Progression in Type 1 Diabetes: A 15-Year Follow-Up Study. Int J Endocrinol 2018; 2018:1897058. [PMID: 29853876 PMCID: PMC5954902 DOI: 10.1155/2018/1897058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 12/28/2017] [Accepted: 01/03/2018] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To assess the evolution of joint mobility over a period of 15 years in type 1 diabetic patients and healthy controls and to determine whether microalbuminuria is associated with a different evolution of joint mobility. METHODS Joint mobility of hand and wrist was determined in 63 patients with type 1 diabetes and 63 healthy subjects. Fifteen years later, 37 (58.7%) diabetic patients and 16 (25.4%) healthy subjects were studied again. Joint mobility was assessed with the Prayer sign and by measuring the angle of maximal flexion of the fifth and third metacarpophalangeal (MCP) joints and wrist. Patients with diabetes were visited 2-4 times every year with regular assessment of glycated hemoglobin (HbA1c), urinary albumin excretion (UAE), and ophthalmoscopy. RESULTS Fifteen years after the initial exam, diabetic patients showed reduced flexion of the fifth MCP joint (82.6 ± 5.8 versus 76.0 ± 6.4 degrees, p < 0.001) and wrist (75.9 ± 8.1 versus 73.2 ± 7.4 degrees, p = 0.015) compared to baseline examination. Joint mobility did not change significantly in healthy subjects. Patients with microalbuminuria showed greater reduction in hand joint mobility than diabetic patients with normal UAE or than healthy subjects (p < 0.001). CONCLUSIONS In type 1 diabetic patients, the severity of LJM progresses with time, and the progression is enhanced in patients with microalbuminuria.
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Affiliation(s)
- Javier Labad
- Endocrine Unit, Hospital Universitari Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
- Parc Tauli Hospital Universitari, I3PT, Universitat Autònoma, CIBERSAM, Barcelona, Spain
| | - Antoni Rozadilla
- Rheumatology Section, Hospital Universitari Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Paula Garcia-Sancho
- Endocrine Unit, Hospital Universitari Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Joan M. Nolla
- Rheumatology Section, Hospital Universitari Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
- Institut d'Investigació Biomedical de Bellvitge (IDIBELL), Barcelona, Spain
- Department of Clinical Sciences, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Eduard Montanya
- Endocrine Unit, Hospital Universitari Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
- Institut d'Investigació Biomedical de Bellvitge (IDIBELL), Barcelona, Spain
- Department of Clinical Sciences, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain
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Gómez-Vaquero C, Bianchi M, Santo P, Roig-Vilaseca D, Narváez J, Nolla JM. Erratum to "The activity of a Spanish bone densitometry unit revisited under the point of view of FRAX" <[Reumatol Clin 8 (2012) 179-183]>. Reumatol Clin 2017; 13:248. [PMID: 28668196 DOI: 10.1016/j.reuma.2017.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 06/01/2017] [Indexed: 06/07/2023]
Affiliation(s)
- Carmen Gómez-Vaquero
- Rheumatology Service, IDIBELL-Hospital Universitari de Bellvitge, L'Hospitalet, Barcelona, España.
| | - María Bianchi
- Rheumatology Service, IDIBELL-Hospital Universitari de Bellvitge, L'Hospitalet, Barcelona, España
| | - Pilar Santo
- Rheumatology Service, IDIBELL-Hospital Universitari de Bellvitge, L'Hospitalet, Barcelona, España
| | | | - Javier Narváez
- Rheumatology Service, IDIBELL-Hospital Universitari de Bellvitge, L'Hospitalet, Barcelona, España
| | - Joan M Nolla
- Rheumatology Service, IDIBELL-Hospital Universitari de Bellvitge, L'Hospitalet, Barcelona, España
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Aterido A, Julià A, Carreira P, Blanco R, López-Longo JJ, Venegas JJP, Olivé À, Andreu JL, Aguirre-Zamorano MÁ, Vela P, Nolla JM, Marenco-de la Fuente JL, Zea A, Pego JM, Freire M, Díez E, López-Lasanta M, López-Corbeto M, Palau N, Tortosa R, Gelpí JL, Absher D, Myers RM, Fernández-Nebro A, Marsal S. Genome-wide pathway analysis identifies VEGF pathway association with oral ulceration in systemic lupus erythematosus. Arthritis Res Ther 2017; 19:138. [PMID: 28619073 PMCID: PMC5471877 DOI: 10.1186/s13075-017-1345-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 05/22/2017] [Indexed: 02/06/2023] Open
Abstract
Background Systemic lupus erythematosus (SLE) is a genetically complex rheumatic disease characterized by heterogeneous clinical manifestations of unknown etiology. Recent studies have suggested the existence of a genetic basis for SLE heterogeneity. The objective of the present study was to identify new genetic variation associated with the clinically relevant phenotypes in SLE. Methods A two-stage pathway-based approach was used to identify the genetic variation associated with the main clinical phenotypes in SLE. In the discovery stage, 482 SLE patients were genotyped using Illumina Human Quad610 microarrays. Association between 798 reference genetic pathways from the Molecular Signatures Database and 11 SLE phenotypes was tested using the set-based method implemented in PLINK software. Pathways significantly associated after multiple test correction were subsequently tested for replication in an independent cohort of 425 SLE patients. Using an in silico approach, we analyzed the functional effects of common SLE therapies on the replicated genetic pathways. The association of known SLE risk variants with the development of the clinical phenotypes was also analyzed. Results In the discovery stage, we found a significant association between the vascular endothelial growth factor (VEGF) pathway and oral ulceration (P value for false discovery rate (PFDR) < 0.05), and between the negative regulation signaling pathway of retinoic acid inducible gene-I/melanoma differentiation associated gene 5 and the production of antinuclear antibodies (PFDR < 0.05). In the replication stage, we validated the association between the VEGF pathway and oral ulceration. Therapies commonly used to treat mucocutaneous phenotypes in SLE were found to strongly influence VEGF pathway gene expression (P = 4.60e-4 to 5.38e-14). Analysis of known SLE risk loci identified a strong association between PTPN22 and the risk of hematologic disorder and with the development of antinuclear antibodies. Conclusions The present study has identified VEGF genetic pathway association with the risk of oral ulceration in SLE. New therapies targeting the VEGF pathway could be more effective in reducing the severity of this phenotype. These findings represent a first step towards the understanding of the genetic basis of phenotype heterogeneity in SLE. Electronic supplementary material The online version of this article (doi:10.1186/s13075-017-1345-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Adrià Aterido
- Rheumatology Research Group, Vall d'Hebron Research Institute, Barcelona, 08035, Spain.,Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, 08005, Spain
| | - Antonio Julià
- Rheumatology Research Group, Vall d'Hebron Research Institute, Barcelona, 08035, Spain.
| | - Patricia Carreira
- Rheumatology Department, Hospital Universitario 12 de Octubre, Madrid, 28041, Spain
| | - Ricardo Blanco
- Rheumatology Department, Hospital Universitario Marqués de Valdecilla, Santander, 39008, Spain
| | | | | | - Àlex Olivé
- Rheumatology Department, Hospital Universitari Germans Trias i Pujol, Badalona, 08916, Spain
| | - José Luís Andreu
- Rheumatology Department, Hospital Universitario Puerta de Hierro, Madrid, 28222, Spain
| | | | - Paloma Vela
- Rheumatology Department, Hospital General Universitario de Alicante, Alicante, 03010, Spain
| | - Joan M Nolla
- Rheumatology Department, Hospital Universitari de Bellvitge, Barcelona, 08907, Spain
| | | | - Antonio Zea
- Rheumatology Department, Hospital Universitario Ramón y Cajal, 28034, Madrid, Spain
| | - José María Pego
- Instituto de Investigación Biomédica de Vigo, Ourense y Pontevedra, 36204, Spain
| | - Mercedes Freire
- Rheumatology Department, Hospital Universitario A Coruña, A Coruña, 15006, Spain
| | - Elvira Díez
- Rheumatology Department, Hospital Complejo Asistencial Universitario de León, León, 24001, Spain
| | - María López-Lasanta
- Rheumatology Research Group, Vall d'Hebron Research Institute, Barcelona, 08035, Spain
| | - Mireia López-Corbeto
- Rheumatology Research Group, Vall d'Hebron Research Institute, Barcelona, 08035, Spain
| | - Núria Palau
- Rheumatology Research Group, Vall d'Hebron Research Institute, Barcelona, 08035, Spain
| | - Raül Tortosa
- Rheumatology Research Group, Vall d'Hebron Research Institute, Barcelona, 08035, Spain
| | - Josep Lluís Gelpí
- Life Sciences, Barcelona Supercomputing Centre, Barcelona, 08034, Spain
| | - Devin Absher
- HudsonAlpha Institute for Biotechnology, Huntsville, Alabama, 35806, USA
| | - Richard M Myers
- HudsonAlpha Institute for Biotechnology, Huntsville, Alabama, 35806, USA
| | - Antonio Fernández-Nebro
- Rheumatology Department, Hospital Regional Universitario de Málaga, Málaga, 29010, Spain. .,Instituto de Investigación Biomédica de Málaga, Universidad de Málaga, Málaga, 29010, Spain.
| | - Sara Marsal
- Rheumatology Research Group, Vall d'Hebron Research Institute, Barcelona, 08035, Spain
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Narváez Garcia FJ, Pascual M, López de Recalde M, Juarez P, Morales-Ivorra I, Notario J, Jucglà A, Nolla JM. Adult-onset Still's disease with atypical cutaneous manifestations. Medicine (Baltimore) 2017; 96:e6318. [PMID: 28296747 PMCID: PMC5369902 DOI: 10.1097/md.0000000000006318] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The diagnosis of adult-onset Still's disease (AOSD) can be very difficult. There are no specific tests available, and diagnosis is usually based on a symptom complex and the well-described typical evanescent rash seen in the majority of patients. However, in recent years, other atypical cutaneous manifestations of AOSD have been reported. These atypical skin eruptions often present in addition to the typical evanescent rash but may also be the only skin manifestation, resulting in delayed diagnosis because of under-recognition.In this study, we present 3 new cases of AOSD with atypical cutaneous manifestations diagnosed during a 30-year period in our department and review 78 additional cases previously reported (PubMed 1990-2016). These 81 patients form the basis of the present analysis.The overall prevalence of atypical cutaneous manifestations in our AOSD population was 14%. These manifestations may appear at any time over the course of the disease, and usually occur in patients who have persistent and severe disease, with a considerable frequency of clinical complications (23%), including serositis, myopericarditis, lung involvement, abdominal pain, neurologic involvement, and reactive hemophagocytic syndrome.The most representative and frequent lesion among the nonclassical skin rashes is the development of persistent pruritic papules and/or plaques. Interestingly, these lesions show a distinctive histological pattern. Other, less frequently observed lesions include urticaria and urticaria-like eruptions, generalized or widespread non-pruritic persistent erythema, vesiculopustular eruptions, a widespread peau d'orange appearance of the skin, and edema of the eyelids mimicking dermatomyositis without any accompanying skin lesion.The great majority of these patients required medium or high doses of glucocorticoids (including intravenous methylprednisolone pulse therapy in some cases) and, in nearly 40%, a more potent or maintenance immunotherapy with immunosuppressant drugs and/or biologic agents (mainly anakinra or tocilizumab) to control or manage symptoms because of a polycyclic or chronic course. The development of atypical cutaneous manifestations seems to be associated with a potentially worse prognosis, with a mortality rate reaching 8% primarily because of infectious complications related to immunosuppressive therapy.In conclusion, the appearance of atypical cutaneous manifestations is not uncommon in AOSD. Recognition of this clinical variant is crucial for the early diagnosis of AOSD, as it might imply persistent disease activity and the need for more aggressive treatment.
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Affiliation(s)
| | | | | | | | | | - Jaime Notario
- Department of Dermatology, Hospital Universitario de Bellvitge-IDIBELL, Barcelona, Spain
| | - Anna Jucglà
- Department of Dermatology, Hospital Universitario de Bellvitge-IDIBELL, Barcelona, Spain
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Tornero Molina J, Calvo Alen J, Ballina J, Belmonte MÁ, Blanco FJ, Caracuel MÁ, Carbonell J, Corominas H, Chamizo E, Hidalgo C, Ivorra JR, Marenco JL, Moreno Muelas JV, Muñoz-Fernández S, Nolla JM, Pérez T, Sanmarti R, Trenor P, Urrego C, Vidal J, Rosas Gomez de Salazar J. Recommendations for the use of parenteral methotrexate in rheumatic diseases. ACTA ACUST UNITED AC 2017; 14:142-149. [PMID: 28082032 DOI: 10.1016/j.reuma.2016.12.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 11/22/2016] [Accepted: 12/01/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To develop recommendations for the use of parenteral methotrexate (MTX) in rheumatic diseases, mainly rheumatoid arthritis, based on best evidence and experience. METHODS A group of 21 experts on parenteral MTX use was selected. The coordinator formulated 13 questions about parenteral MTX (indications, efficacy, safety and cost-effectiveness). A systematic review was conducted to answer the questions. Using this information, inclusion and exclusion criteria were established, as were the search strategies (involving Medline, EMBASE and the Cochrane Library). Three different reviewers selected the articles. Evidence tables were created. Abstracts from the European League Against Rheumatism (EULAR) and American College of Rheumatology (ACR) were evaluated. Based on this evidence, the coordinator proposed preliminary recommendations that the experts discussed and voted in a nominal group meeting. The level of evidence and grade of recommendation were established using the Oxford Center for Evidence-Based Medicine and the level of agreement with the Delphi technique (2 rounds). Agreement was established if at least 80% of the experts voted yes (yes/no). RESULTS Most of the evidence involved rheumatoid arthritis. A total of 13 preliminary recommendations on the use of parenteral MTX were proposed; 11 of them were accepted. Two of the 13 were not voted and are commented on in the main text. CONCLUSIONS The manuscript aims to solve frequent questions and help in decision-making strategies when treating patients with parenteral MTX.
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Affiliation(s)
| | | | - Javier Ballina
- Hospital Universitario Central de Asturias, Oviedo, España
| | | | | | | | | | | | | | - Cristina Hidalgo
- Complejo Asistencial Universitario de Salamanca, Salamanca, España
| | | | | | | | | | - Joan M Nolla
- Hospital Universitari de Bellvitge, Barcelona, España
| | | | | | | | | | - Javier Vidal
- Servicio de Reumatología, Hospital de Guadalajara, Guadalajara, España
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Narváez J, García-Gómez C, Álvarez L, Santo P, Aparicio M, Pascual M, López de Recalde M, Borrell H, Nolla JM. Efficacy of bosentan in patients with refractory thromboangiitis obliterans (Buerger disease): A case series and review of the literature. Medicine (Baltimore) 2016; 95:e5511. [PMID: 27902617 PMCID: PMC5134796 DOI: 10.1097/md.0000000000005511] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The cornerstone of therapy in thromboangiitis obliterans (TAO) is complete abstinence from tobacco. In addition to discontinuation of cigarette smoking, very few pharmacological and surgical options of controversial efficacy are available to date. New therapeutic options with greater efficacy are clearly needed to properly manage these patients.In this preliminary study, we assessed the effectiveness and safety of bosentan in a case series of 8 adults with TAO and severe ischemic ulceronecrotic lesions who were treated with bosentan after inadequate response to platelet inhibitors, vasodilators, and intravenous alprostadil. Additionally, we reviewed 18 well-documented patients with refractory TAO treated with bosentan, which was previously reported (PubMed 1965-2015). These 26 patients formed the basis of our present analysis. All were current smokers.The median duration of bosentan treatment (SD) was 4.5 ± 4 months (range 3-16). Eleven patients (42%) were unable to completely abstain from smoking during their follow-up. With bosentan treatment, no new ischemic lesions were observed in the target extremities. A complete therapeutic response was achieved in 80% of patients, whereas a partial response was observed in 12%. Two patients (8%) ultimately required amputation despite treatment.After discontinuation of bosentan, patients were followed for a median of 20 ± 14 months (range 3-60). Two patients whose trophic lesions had healed relapsed.When comparing patients who gave up smoking with those who were unable to completely abstain from smoking during follow-up, no significant differences were found in efficacy outcomes. Four patients (15%) developed adverse events, requiring bosentan discontinuation in 1 case.These preliminary data suggest that bosentan may be considered a therapeutic option for treatment of cases of severe TAO refractory to conventional treatment, and merit further evaluation in larger controlled, randomized clinical studies.
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Affiliation(s)
- Javier Narváez
- Department of Rheumatology. Hospital Universitario de Bellvitge-IDIBELL
| | | | - Lorenzo Álvarez
- Department of Angiology and Vascular Surgery, Consorci Sanitari de Terrassa
| | - Pilar Santo
- Department of Rheumatology, Parc Sanitari Sant Joan de Déu, Sant Boi, Barcelona, Spain
| | - María Aparicio
- Department of Rheumatology. Hospital Universitario de Bellvitge-IDIBELL
| | - María Pascual
- Department of Rheumatology. Hospital Universitario de Bellvitge-IDIBELL
| | | | - Helena Borrell
- Department of Rheumatology. Hospital Universitario de Bellvitge-IDIBELL
| | - Joan M. Nolla
- Department of Rheumatology. Hospital Universitario de Bellvitge-IDIBELL
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Kassebaum NJ, Arora M, Barber RM, Bhutta ZA, Brown J, Carter A, Casey DC, Charlson FJ, Coates MM, Coggeshall M, Cornaby L, Dandona L, Dicker DJ, Erskine HE, Ferrari AJ, Fitzmaurice C, Foreman K, Forouzanfar MH, Fullman N, Gething PW, Goldberg EM, Graetz N, Haagsma JA, Hay SI, Johnson CO, Kemmer L, Khalil IA, Kinfu Y, Kutz MJ, Kyu HH, Leung J, Liang X, Lim SS, Lozano R, Mensah GA, Mikesell J, Mokdad AH, Mooney MD, Naghavi M, Nguyen G, Nsoesie E, Pigott DM, Pinho C, Rankin Z, Reinig N, Salomon JA, Sandar L, Smith A, Sorensen RJD, Stanaway J, Steiner C, Teeple S, Troeger C, Truelsen T, VanderZanden A, Wagner JA, Wanga V, Whiteford HA, Zhou M, Zoeckler L, Abajobir AA, Abate KH, Abbafati C, Abbas KM, Abd-Allah F, Abraham B, Abubakar I, Abu-Raddad LJ, Abu-Rmeileh NME, Achoki T, Ackerman IN, Adebiyi AO, Adedeji IA, Adsuar JC, Afanvi KA, Afshin A, Agardh EE, Agarwal A, Agarwal SK, Ahmed MB, Kiadaliri AA, Ahmadieh H, Akseer N, Al-Aly Z, Alam K, Alam NKM, Aldhahri SF, Alegretti MA, Aleman AV, Alemu ZA, Alexander LT, Ali R, Alkerwi A, Alla F, Allebeck P, Allen C, Alsharif U, Altirkawi KA, Martin EA, Alvis-Guzman N, Amare AT, Amberbir A, Amegah AK, Amini H, Ammar W, Amrock SM, Anderson GM, Anderson BO, Antonio CAT, Anwari P, Ärnlöv J, Arsenijevic VSA, Artaman A, Asayesh H, Asghar RJ, Avokpaho EFGA, Awasthi A, Quintanilla BPA, Azzopardi P, Bacha U, Badawi A, Balakrishnan K, Banerjee A, Barac A, Barker-Collo SL, Bärnighausen T, Barregard L, Barrero LH, Basu S, Bayou TA, Beardsley J, Bedi N, Beghi E, Bell B, Bell ML, Benjet C, Bennett DA, Bensenor IM, Berhane A, Bernabé E, Betsu BD, Beyene AS, Bhala N, Bhansali A, Bhatt S, Biadgilign S, Bienhoff K, Bikbov B, Abdulhak AAB, Biryukov S, Bisanzio D, Bjertness E, Blore JD, Borschmann R, Boufous S, Bourne RRA, Brainin M, Brazinova A, Breitborde NJK, Brugha TS, Buchbinder R, Buckle GC, Butt ZA, Calabria B, Campos-Nonato IR, Campuzano JC, Carabin H, Carapetis JR, Cárdenas R, Carrero JJ, Castañeda-Orjuela CA, Rivas JC, Catalá-López F, Cavalleri F, Chang JC, Chiang PPC, Chibalabala M, Chibueze CE, Chisumpa VH, Choi JYJ, Choudhury L, Christensen H, Ciobanu LG, Colistro V, Colomar M, Colquhoun SM, Cortinovis M, Crump JA, Damasceno A, Dandona R, Dargan PI, das Neves J, Davey G, Davis AC, Leo DD, Degenhardt L, Gobbo LCD, Derrett S, Jarlais DCD, deVeber GA, Dharmaratne SD, Dhillon PK, Ding EL, Doyle KE, Driscoll TR, Duan L, Dubey M, Duncan BB, Ebrahimi H, Ellenbogen RG, Elyazar I, Endries AY, Ermakov SP, Eshrati B, Esteghamati A, Estep K, Fahimi S, Farid TA, Farinha CSES, Faro A, Farvid MS, Farzadfar F, Feigin VL, Fereshtehnejad SM, Fernandes JG, Fernandes JC, Fischer F, Fitchett JRA, Foigt N, Fowkes FGR, Franklin RC, Friedman J, Frostad J, Fürst T, Futran ND, Gabbe B, Gankpé FG, Garcia-Basteiro AL, Gebrehiwot TT, Gebremedhin AT, Geleijnse JM, Gibney KB, Gillum RF, Ginawi IAM, Giref AZ, Giroud M, Gishu MD, Giussani G, Godwin WW, Gomez-Dantes H, Gona P, Goodridge A, Gopalani SV, Gotay CC, Goto A, Gouda HN, Gugnani H, Guo Y, Gupta R, Gupta R, Gupta V, Gutiérrez RA, Hafezi-Nejad N, Haile D, Hailu AD, Hailu GB, Halasa YA, Hamadeh RR, Hamidi S, Hammami M, Handal AJ, Hankey GJ, Harb HL, Harikrishnan S, Haro JM, Hassanvand MS, Hassen TA, Havmoeller R, Hay RJ, Hedayati MT, Heredia-Pi IB, Heydarpour P, Hoek HW, Hoffman DJ, Horino M, Horita N, Hosgood HD, Hoy DG, Hsairi M, Huang H, Huang JJ, Iburg KM, Idrisov BT, Innos K, Inoue M, Jacobsen KH, Jauregui A, Jayatilleke AU, Jeemon P, Jha V, Jiang G, Jiang Y, Jibat T, Jimenez-Corona A, Jin Y, Jonas JB, Kabir Z, Kajungu DK, Kalkonde Y, Kamal R, Kan H, Kandel A, Karch A, Karema CK, Karimkhani C, Kasaeian A, Katibeh M, Kaul A, Kawakami N, Kazi DS, Keiyoro PN, Kemp AH, Kengne AP, Keren A, Kesavachandran CN, Khader YS, Khan AR, Khan EA, Khang YH, Khoja TAM, Khubchandani J, Kieling C, Kim CI, Kim D, Kim YJ, Kissoon N, Kivipelto M, Knibbs LD, Knudsen AK, Kokubo Y, Kolte D, Kopec JA, Koul PA, Koyanagi A, Defo BK, Kuchenbecker RS, Bicer BK, Kuipers EJ, Kumar GA, Kwan GF, Lalloo R, Lallukka T, Larsson A, Latif AA, Lavados PM, Lawrynowicz AEB, Leasher JL, Leigh J, Leung R, Li Y, Li Y, Lipshultz SE, Liu PY, Liu Y, Lloyd BK, Logroscino G, Looker KJ, Lotufo PA, Lucas RM, Lunevicius R, Lyons RA, Razek HMAE, Mahdavi M, Majdan M, Majeed A, Malekzadeh R, Malta DC, Marcenes W, Martinez-Raga J, Masiye F, Mason-Jones AJ, Matzopoulos R, Mayosi BM, McGrath JJ, McKee M, Meaney PA, Mehari A, Melaku YA, Memiah P, Memish ZA, Mendoza W, Meretoja A, Meretoja TJ, Mesfin YM, Mhimbira FA, Millear A, Miller TR, Mills EJ, Mirarefin M, Mirrakhimov EM, Mitchell PB, Mock CN, Mohammad KA, Mohammadi A, Mohammed S, Monasta L, Hernandez JCM, Montico M, Moradi-Lakeh M, Mori R, Mueller UO, Mumford JE, Murdoch ME, Murthy GVS, Nachega JB, Naheed A, Naldi L, Nangia V, Newton JN, Ng M, Ngalesoni FN, Nguyen QL, Nisar MI, Pete PMN, Nolla JM, Norheim OF, Norman RE, Norrving B, Obermeyer CM, Ogbo FA, Oh IH, Oladimeji O, Olivares PR, Olusanya BO, Olusanya JO, Oren E, Ortiz A, Ota E, Oyekale AS, PA M, Park EK, Parsaeian M, Patten SB, Patton GC, Pedro JM, Pereira DM, Perico N, Pesudovs K, Petzold M, Phillips MR, Piel FB, Pillay JD, Pishgar F, Plass D, Polinder S, Popova S, Poulton RG, Pourmalek F, Prasad NM, Qorbani M, Rabiee RHS, Radfar A, Rafay A, Rahimi K, Rahimi-Movaghar V, Rahman M, Rahman MHU, Rahman SU, Rai D, Rai RK, Rajsic S, Raju M, Ram U, Ranganathan K, Refaat AH, Reitsma MB, Remuzzi G, Resnikoff S, Reynolds A, Ribeiro AL, Ricci S, Roba HS, Rojas-Rueda D, Ronfani L, Roshandel G, Roth GA, Roy A, Sackey BB, Sagar R, Sanabria JR, Sanchez-Niño MD, Santos IS, Santos JV, Sarmiento-Suarez R, Sartorius B, Satpathy M, Savic M, Sawhney M, Schmidt MI, Schneider IJC, Schutte AE, Schwebel DC, Seedat S, Sepanlou SG, Servan-Mori EE, Shahraz S, Shaikh MA, Sharma R, She J, Sheikhbahaei S, Shen J, Sheth KN, Shibuya K, Shigematsu M, Shin MJ, Shiri R, Sigfusdottir ID, Silva DAS, Silverberg JI, Simard EP, Singh A, Singh JA, Singh PK, Skirbekk V, Skogen JC, Soljak M, Søreide K, Sorensen RJD, Sreeramareddy CT, Stathopoulou V, Steel N, Stein DJ, Stein MB, Steiner TJ, Stovner LJ, Stranges S, Stroumpoulis K, Sunguya BF, Sur PJ, Swaminathan S, Sykes BL, Szoeke CEI, Tabarés-Seisdedos R, Tandon N, Tanne D, Tavakkoli M, Taye B, Taylor HR, Ao BJT, Tegegne TK, Tekle DY, Terkawi AS, Tessema GA, Thakur JS, Thomson AJ, Thorne-Lyman AL, Thrift AG, Thurston GD, Tobe-Gai R, Tonelli M, Topor-Madry R, Topouzis F, Tran BX, Truelsen T, Dimbuene ZT, Tsilimbaris M, Tura AK, Tuzcu EM, Tyrovolas S, Ukwaja KN, Undurraga EA, Uneke CJ, Uthman OA, van Gool CH, van Os J, Vasankari T, Vasconcelos AMN, Venketasubramanian N, Violante FS, Vlassov VV, Vollset SE, Wagner GR, Wallin MT, Wang L, Weichenthal S, Weiderpass E, Weintraub RG, Werdecker A, Westerman R, Wijeratne T, Wilkinson JD, Williams HC, Wiysonge CS, Woldeyohannes SM, Wolfe CDA, Won S, Xu G, Yadav AK, Yakob B, Yan LL, Yano Y, Yaseri M, Ye P, Yip P, Yonemoto N, Yoon SJ, Younis MZ, Yu C, Zaidi Z, Zaki MES, Zeeb H, Zodpey S, Zonies D, Zuhlke LJ, Vos T, Lopez AD, Murray CJL. Global, regional, and national disability-adjusted life-years (DALYs) for 315 diseases and injuries and healthy life expectancy (HALE), 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 2016; 388:1603-1658. [PMID: 27733283 PMCID: PMC5388857 DOI: 10.1016/s0140-6736(16)31460-x] [Citation(s) in RCA: 1387] [Impact Index Per Article: 173.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 08/11/2016] [Accepted: 08/16/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND Healthy life expectancy (HALE) and disability-adjusted life-years (DALYs) provide summary measures of health across geographies and time that can inform assessments of epidemiological patterns and health system performance, help to prioritise investments in research and development, and monitor progress toward the Sustainable Development Goals (SDGs). We aimed to provide updated HALE and DALYs for geographies worldwide and evaluate how disease burden changes with development. METHODS We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015) for all-cause mortality, cause-specific mortality, and non-fatal disease burden to derive HALE and DALYs by sex for 195 countries and territories from 1990 to 2015. We calculated DALYs by summing years of life lost (YLLs) and years of life lived with disability (YLDs) for each geography, age group, sex, and year. We estimated HALE using the Sullivan method, which draws from age-specific death rates and YLDs per capita. We then assessed how observed levels of DALYs and HALE differed from expected trends calculated with the Socio-demographic Index (SDI), a composite indicator constructed from measures of income per capita, average years of schooling, and total fertility rate. FINDINGS Total global DALYs remained largely unchanged from 1990 to 2015, with decreases in communicable, neonatal, maternal, and nutritional (Group 1) disease DALYs offset by increased DALYs due to non-communicable diseases (NCDs). Much of this epidemiological transition was caused by changes in population growth and ageing, but it was accelerated by widespread improvements in SDI that also correlated strongly with the increasing importance of NCDs. Both total DALYs and age-standardised DALY rates due to most Group 1 causes significantly decreased by 2015, and although total burden climbed for the majority of NCDs, age-standardised DALY rates due to NCDs declined. Nonetheless, age-standardised DALY rates due to several high-burden NCDs (including osteoarthritis, drug use disorders, depression, diabetes, congenital birth defects, and skin, oral, and sense organ diseases) either increased or remained unchanged, leading to increases in their relative ranking in many geographies. From 2005 to 2015, HALE at birth increased by an average of 2·9 years (95% uncertainty interval 2·9-3·0) for men and 3·5 years (3·4-3·7) for women, while HALE at age 65 years improved by 0·85 years (0·78-0·92) and 1·2 years (1·1-1·3), respectively. Rising SDI was associated with consistently higher HALE and a somewhat smaller proportion of life spent with functional health loss; however, rising SDI was related to increases in total disability. Many countries and territories in central America and eastern sub-Saharan Africa had increasingly lower rates of disease burden than expected given their SDI. At the same time, a subset of geographies recorded a growing gap between observed and expected levels of DALYs, a trend driven mainly by rising burden due to war, interpersonal violence, and various NCDs. INTERPRETATION Health is improving globally, but this means more populations are spending more time with functional health loss, an absolute expansion of morbidity. The proportion of life spent in ill health decreases somewhat with increasing SDI, a relative compression of morbidity, which supports continued efforts to elevate personal income, improve education, and limit fertility. Our analysis of DALYs and HALE and their relationship to SDI represents a robust framework on which to benchmark geography-specific health performance and SDG progress. Country-specific drivers of disease burden, particularly for causes with higher-than-expected DALYs, should inform financial and research investments, prevention efforts, health policies, and health system improvement initiatives for all countries along the development continuum. FUNDING Bill & Melinda Gates Foundation.
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Zacarías A, Narváez J, Rodríguez Moreno J, Jordana M, Nolla JM, Gómez Vaquero C. Evaluación de una intervención sobre los factores de riesgo cardiovascular en pacientes con artritis reumatoide. Med Clin (Barc) 2016; 147:109-12. [DOI: 10.1016/j.medcli.2016.03.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Revised: 02/29/2016] [Accepted: 03/03/2016] [Indexed: 11/30/2022]
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Borrell H, Narváez J, Alegre JJ, Castellví I, Mitjavila F, Aparicio M, Armengol E, Molina-Molina M, Nolla JM. Shrinking lung syndrome in systemic lupus erythematosus: A case series and review of the literature. Medicine (Baltimore) 2016; 95:e4626. [PMID: 27537601 PMCID: PMC5370827 DOI: 10.1097/md.0000000000004626] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Shrinking lung syndrome (SLS) is a rare and less known complication mainly associated with systemic lupus erythematosus (SLE). In this study, we analyze the clinical features, investigation findings, approaches to management, and outcome in a case series of 9 adult patients with SLE and SLS diagnosed during a 35-year period in 3 referral tertiary care hospitals in Spain. Additionally, we reviewed 80 additional cases previously reported (PubMed 1965-2015). These 80 cases, together with our 9 patients, form the basis of the present analysis.The overall SLS prevalence in our SLE population was 1.1% (9/829). SLS may complicate SLE at any time over its course, and it usually occurs in patients without previous or concomitant major organ involvement. More than half of the patients had inactive lupus according to SELENA-systemic lupus erythematosus disease activity index (SLEDAI) scores. Typically, it presents with progressive exertional dyspnea of variable severity, accompanied by pleuritic chest pain in 76% of the cases.An important diagnostic delay is common. The diagnostic tools that showed better yield for SLS detection are the imaging techniques (chest x-ray and high-resolution computed tomography) along with pulmonary and diaphragmatic function tests. Evaluation of diaphragm dome motion by M-mode ultrasonography and phrenic nerve conduction studies are less useful.There are no standardized guidelines for the treatment of SLS in SLE. The majority of patients were treated with medium or high doses of glucocorticoids. Several immunosuppressive agents have been used in conjunction with steroids either if the patient fails to improve or since the beginning of the treatment. Theophylline and beta-agonists, alone or in combination with glucocorticoids, have been suggested with the intent to increase diaphragmatic strength.The overall long-term prognosis was good. The great majority of patients had significant clinical improvement and stabilization, or mild to moderate improvement on pulmonary function tests. The mortality rate was very low.
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Affiliation(s)
- Helena Borrell
- Department of Rheumatology, Hospital Universitario de Bellvitge-IDIBELL, Barcelona
| | - Javier Narváez
- Department of Rheumatology, Hospital Universitario de Bellvitge-IDIBELL, Barcelona
- Correspondence: Dr Francisco Javier Narváez García, Department of Rheumatology (Planta 10–2), Hospital Universitario de Bellvitge, Feixa Llarga, s/n, Hospitalet de Llobregat, Barcelona 08907, Spain (e-mail: )
| | - Juan José Alegre
- Department of Rheumatology, Hospital Universitario Dr. Peset, Valencia
| | | | | | - María Aparicio
- Department of Rheumatology, Hospital Universitario de Bellvitge-IDIBELL, Barcelona
| | - Eulàlia Armengol
- Department of Rheumatology, Hospital Universitario de Bellvitge-IDIBELL, Barcelona
| | - María Molina-Molina
- Department of Pneumology, Hospital Universitario de Bellvitge-IDIBELL, Barcelona, Spain
| | - Joan M. Nolla
- Department of Rheumatology, Hospital Universitario de Bellvitge-IDIBELL, Barcelona
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Nolla JM, Murillo O, Narvaez J, Vaquero CG, Lora-Tamayo J, Pedrero S, Cabo J, Ariza J. Pyogenic arthritis of native joints due to Bacteroides fragilis: Case report and review of the literature. Medicine (Baltimore) 2016; 95:e3962. [PMID: 27336895 PMCID: PMC4998333 DOI: 10.1097/md.0000000000003962] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Pyogenic arthritis of native joints due to Bacteroides fragilis seems to be an infrequent disease. We analyzed the cases diagnosed in a tertiary hospital during a 22-year period and reviewed the literature to summarize the experience with this infectious entity.In our institution, of 308 patients with pyogenic arthritis of native joints, B fragilis was the causative organism in 2 (0.6%) cases. A MEDLINE search (1981-2015) identified 19 additional cases.Of the 21 patients available for review (13 men and 8 women, with a mean age, of 54.4 ± 17 years), 19 (90%) presented a systemic predisposing factor for infection; the most common associated illness was rheumatoid arthritis (8 patients). Bacteremia was documented in 65% (13/20) of cases. In 5 patients (24%), 1 or more concomitant infectious process was found. Metronidazole was the most frequently used antibiotic. Surgical drainage was performed in 11 cases (52%). The overall mortality rate was 5%.Pyogenic arthritis of native joints due to B fragilis is an infrequent disease that mainly affects elderly patients with underlying medical illnesses and in whom bacteremia and the presence of a concomitant infectious process are frequent conditions.
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Affiliation(s)
- Joan M. Nolla
- Rheumatology Department, IDIBELL-Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Oscar Murillo
- Infectious Diseases Department, IDIBELL-Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Javier Narvaez
- Rheumatology Department, IDIBELL-Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Carmen Gómez Vaquero
- Rheumatology Department, IDIBELL-Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Jaime Lora-Tamayo
- Infectious Diseases Department, IDIBELL-Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Salvador Pedrero
- Orthopedic Surgery Department, IDIBELL-Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Javier Cabo
- Orthopedic Surgery Department, IDIBELL-Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Javier Ariza
- Infectious Diseases Department, IDIBELL-Hospital Universitari de Bellvitge, Barcelona, Spain
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Murillo O, Gomez-Junyent J, Grau I, Ribera A, Cabrera C, Pedrero S, Tubau F, Nolla JM, Ariza J, Pallares R. Clinical findings of bacteremic septic arthritis according to the site of acquisition: The overlap between health care-related and community- and nosocomial-acquired cases. Eur J Intern Med 2016; 28:38-42. [PMID: 26639050 DOI: 10.1016/j.ejim.2015.11.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Revised: 11/07/2015] [Accepted: 11/11/2015] [Indexed: 12/27/2022]
Abstract
BACKGROUND The site of acquisition of infection may have a major impact on outcome. The health care-related (HCR) environment has recently come under scrutiny. In a group of patients with bacteremic septic arthritis (SA), we compared their characteristics, type of SA, microbiology and prognosis according to the site of acquisition: community-acquired (CA), nosocomial-acquired (NA), and HCR. METHODS We studied all patients with bacteremic SA seen at our institution between 1985 and 2013. Data were obtained from a protocol of prospectively recorded bacteremia cases. RESULTS There were 273 cases of bacteremic SA (CA: 51%; NA: 31%; and HCR: 18%). NA and HCR sites were more frequent in older and fragile patients. SA of peripheral joints was the most common presentation; infections of the axial skeleton predominated in CA and HCR (24%), and prosthetic joint infection in NA (44%). MRSA and Pseudomonas aeruginosa were mainly found in NA (21% and 6% respectively) and HCR (14% and 8% respectively), whereas Streptococcus spp. was more frequent in CA (30%) and HCR (28%). The 30-day mortality rates were: CA 7%, HCR 18%, and NA 26%. CONCLUSION The characteristics of HCR-SA overlapped with those of the CA or NA-SA cases. The HCR and NA cases presented more advanced age, greater fragility, and the predominance of difficult-to-treat microorganisms, while the HCR and CA cases presented an involvement of the axial skeleton, streptococcal etiology, and a lower number of prosthetic joint infections. Our data show that the site of acquisition should be considered when planning diagnostic and therapeutic management for SA.
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Affiliation(s)
- Oscar Murillo
- Infectious Disease Department, Hospital Bellvitge, Feixa Llarga s/n, 08907 L'Hospitalet, Barcelona, Spain.
| | - Joan Gomez-Junyent
- Infectious Disease Department, Hospital Bellvitge, Feixa Llarga s/n, 08907 L'Hospitalet, Barcelona, Spain
| | - Imma Grau
- Infectious Disease Department, Hospital Bellvitge, Feixa Llarga s/n, 08907 L'Hospitalet, Barcelona, Spain
| | - Alba Ribera
- Infectious Disease Department, Hospital Bellvitge, Feixa Llarga s/n, 08907 L'Hospitalet, Barcelona, Spain
| | - Celina Cabrera
- Infectious Disease Department, Hospital Bellvitge, Feixa Llarga s/n, 08907 L'Hospitalet, Barcelona, Spain
| | - Salvador Pedrero
- Orthopaedic Surgery Department, Hospital Bellvitge, Barcelona, Spain
| | - Fe Tubau
- Microbiology Department, Hospital Bellvitge, Barcelona, Spain
| | - Joan M Nolla
- Rheumatology Department, Hospital Bellvitge, Barcelona, Spain
| | - Javier Ariza
- Infectious Disease Department, Hospital Bellvitge, Feixa Llarga s/n, 08907 L'Hospitalet, Barcelona, Spain
| | - Roman Pallares
- Infectious Disease Department, Hospital Bellvitge, Feixa Llarga s/n, 08907 L'Hospitalet, Barcelona, Spain
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Nolla JM, Martínez C, García-Vicuña R, Seoane-Mato D, Rosario Lozano MP, Alonso A, Alperi M, Barbazán C, Calvo J, Delgado C, Fernández-Nebro A, Mateo L, Pérez Sandoval T, Pérez Venegas J, Rodríguez Lozano C, Rosas J. Quality standards for rheumatology outpatient clinic. The EXTRELLA project. ACTA ACUST UNITED AC 2016; 12:248-55. [PMID: 26775226 DOI: 10.1016/j.reuma.2015.11.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 11/02/2015] [Accepted: 11/06/2015] [Indexed: 11/18/2022]
Abstract
INTRODUCTION In recent years, outpatient clinics have undergone extensive development. At present, patients with rheumatic diseases are mainly assisted in this area. However, the quality standards of care are poorly documented. OBJECTIVE To develop specific quality criteria and standards for an outpatient rheumatology clinic. METHOD The project was based on the two-round Delphi method. The following groups of participants took part: scientific committee (13 rheumatologists), five nominal groups (45 rheumatologists and 12 nurses) and a group of discussion formed by 9 patients. Different drafts were consecutively generated until a final document was obtained that included the standards that received a punctuation equal or over 7 in at least 70% of the participants. RESULTS 148 standards were developed, grouped into the following 9 dimensions: a) structure (22), b) clinical activity and relationship with the patients (34), c) planning (7), d) levels of priority (5), e) relations with primary care physicians, with Emergency Department and with other clinical departments, f) process (26), g) nursing (13), h) teaching and research (13) and i) activity measures (8). CONCLUSION This study established specific quality standards for rheumatology outpatient clinic. It can be a useful tool for organising this area in the Rheumatology Department and as a reference when proposing improvement measures to health administrators.
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Affiliation(s)
- Joan M Nolla
- Servicio de Reumatología, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España.
| | - Carmen Martínez
- Unidad de Investigación, Sociedad Española de Reumatología, Madrid, España
| | - Rosario García-Vicuña
- Servicio de Reumatología, Hospital Universitario de la Princesa, IIS-IP, Madrid, España
| | - Daniel Seoane-Mato
- Unidad de Investigación, Sociedad Española de Reumatología, Madrid, España
| | | | - Alberto Alonso
- Servicio de Reumatología, Hospital Universitario de Cruces, Baracaldo, Vizcaya, España
| | - Mercedes Alperi
- Servicio de Reumatología, Hospital Universitario Central de Asturias, Oviedo, España
| | - Ceferino Barbazán
- Servicio de Reumatología, Complexo Hospitalario Universitario de Vigo, Vigo, Pontevedra, España
| | - Jaime Calvo
- Servicio de Reumatología, Hospital Sierrallana, Torrelavega, Cantabria, España
| | - Concepción Delgado
- Servicio de Reumatología, Hospital Clínco Universitario Lozano Blesa, Zaragoza, España
| | | | - Lourdes Mateo
- Servicio de Reumatología, Hospital Universitari Germans Trías i Pujol, Badalona, Barcelona, España
| | | | - José Pérez Venegas
- Servicio de Reumatología, Hospital de Jerez de la Frontera, Jerez de la Frontera, Cádiz, España
| | - Carlos Rodríguez Lozano
- Servicio de Reumatología, Hospital Universitario Dr. Negrín, Las Palmas de Gran Canaria, España
| | - José Rosas
- Servicio de Reumatología, Hospital de la Marina Baixa, Villajoyosa, Alicante, España
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Nolla JM, Rodríguez M, Martin-Mola E, Raya E, Ibero I, Nocea G, Aragon B, Lizán L, Prades M. Patients' and rheumatologists' preferences for the attributes of biological agents used in the treatment of rheumatic diseases in Spain. Patient Prefer Adherence 2016; 10:1101-13. [PMID: 27382258 PMCID: PMC4920238 DOI: 10.2147/ppa.s106311] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To define importance values assigned to attributes of biological agents (BAs) by Spanish patients with rheumatic diseases (rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis) and rheumatologists. PATIENTS AND METHODS This was an observational, cross-sectional design based upon a rank-based full-profile conjoint analysis. A literature review and four focus groups were undertaken to identify attributes and levels. An orthogonal matrix, combining the selected levels of attributes, was used to define scenarios. Participants ranked eight scenarios from 1 (most preferred) to 8 (least preferred). The relative importance (RI) of attributes was calculated. Multivariate regression analysis was performed to identify the characteristics that influenced the values of RI. A total of 488 patients (male 50.9%, mean age 50.6 [standard deviation {SD} 12.06] years, rheumatoid arthritis 33.8%, ankylosing spondylitis 32.4%, psoriatic arthritis 33.8%; mean time since diagnosis 12.6 [SD 8.2] years) and 136 rheumatologists (male 50.4%, mean age 46.4 [SD 9.1] years, mean time of practice 16.7 [SD 8.8] years) participated. RESULTS The ideal BAs for patients and physicians, respectively, should allow pain relief and improvement of functional capacity (RI 39% and 44.7%), with low risk of adverse events (RI 24.9% and 30.5%), a long time prior to perceiving the need for a new dose (RI 16.4% and 12.4%), and self-administration at home (RI 19.7% and 12.5%), as identified through their preferences. CONCLUSION Although efficacy and safety are paramount for patients and rheumatologists to make a choice regarding BAs, the need for a low frequency of administration and the administration method also play a role as preference attributes for BAs.
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Affiliation(s)
- Joan M Nolla
- Department of Rheumatology, Hospital Universitari de Bellvitge, Barcelona, Spain
- Correspondence: Joan Miquel Nolla, Department of Rheumatology, Hospital Universitari de Bellvitge, Feixa Llarga, L’Hospitalet de Llobregat, Barcelona 08907, Spain, Tel +34 932 607 615, Email
| | - Manuel Rodríguez
- Department of Rheumatology, Complejo Hospitalario de Ourense, Ourense, Spain
| | - Emilio Martin-Mola
- Department of Rheumatology, Hospital Universitario La Paz, Madrid, Spain
| | - Enrique Raya
- Department of Rheumatology, Hospital Universitario San Cecilio, Granada, Spain
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Forouzanfar MH, Alexander L, Anderson HR, Bachman VF, Biryukov S, Brauer M, Burnett R, Casey D, Coates MM, Cohen A, Delwiche K, Estep K, Frostad JJ, Astha KC, Kyu HH, Moradi-Lakeh M, Ng M, Slepak EL, Thomas BA, Wagner J, Aasvang GM, Abbafati C, Abbasoglu Ozgoren A, Abd-Allah F, Abera SF, Aboyans V, Abraham B, Abraham JP, Abubakar I, Abu-Rmeileh NME, Aburto TC, Achoki T, Adelekan A, Adofo K, Adou AK, Adsuar JC, Afshin A, Agardh EE, Al Khabouri MJ, Al Lami FH, Alam SS, Alasfoor D, Albittar MI, Alegretti MA, Aleman AV, Alemu ZA, Alfonso-Cristancho R, Alhabib S, Ali R, Ali MK, Alla F, Allebeck P, Allen PJ, Alsharif U, Alvarez E, Alvis-Guzman N, Amankwaa AA, Amare AT, Ameh EA, Ameli O, Amini H, Ammar W, Anderson BO, Antonio CAT, Anwari P, Argeseanu Cunningham S, Arnlöv J, Arsenijevic VSA, Artaman A, Asghar RJ, Assadi R, Atkins LS, Atkinson C, Avila MA, Awuah B, Badawi A, Bahit MC, Bakfalouni T, Balakrishnan K, Balalla S, Balu RK, Banerjee A, Barber RM, Barker-Collo SL, Barquera S, Barregard L, Barrero LH, Barrientos-Gutierrez T, Basto-Abreu AC, Basu A, Basu S, Basulaiman MO, Batis Ruvalcaba C, Beardsley J, Bedi N, Bekele T, Bell ML, Benjet C, Bennett DA, Benzian H, Bernabé E, Beyene TJ, Bhala N, Bhalla A, Bhutta ZA, Bikbov B, Bin Abdulhak AA, Blore JD, Blyth FM, Bohensky MA, Bora Başara B, Borges G, Bornstein NM, Bose D, Boufous S, Bourne RR, Brainin M, Brazinova A, Breitborde NJ, Brenner H, Briggs ADM, Broday DM, Brooks PM, Bruce NG, Brugha TS, Brunekreef B, Buchbinder R, Bui LN, Bukhman G, Bulloch AG, Burch M, Burney PGJ, Campos-Nonato IR, Campuzano JC, Cantoral AJ, Caravanos J, Cárdenas R, Cardis E, Carpenter DO, Caso V, Castañeda-Orjuela CA, Castro RE, Catalá-López F, Cavalleri F, Çavlin A, Chadha VK, Chang JC, Charlson FJ, Chen H, Chen W, Chen Z, Chiang PP, Chimed-Ochir O, Chowdhury R, Christophi CA, Chuang TW, Chugh SS, Cirillo M, Claßen TKD, Colistro V, Colomar M, Colquhoun SM, Contreras AG, Cooper C, Cooperrider K, Cooper LT, Coresh J, Courville KJ, Criqui MH, Cuevas-Nasu L, Damsere-Derry J, Danawi H, Dandona L, Dandona R, Dargan PI, Davis A, Davitoiu DV, Dayama A, de Castro EF, De la Cruz-Góngora V, De Leo D, de Lima G, Degenhardt L, del Pozo-Cruz B, Dellavalle RP, Deribe K, Derrett S, Des Jarlais DC, Dessalegn M, deVeber GA, Devries KM, Dharmaratne SD, Dherani MK, Dicker D, Ding EL, Dokova K, Dorsey ER, Driscoll TR, Duan L, Durrani AM, Ebel BE, Ellenbogen RG, Elshrek YM, Endres M, Ermakov SP, Erskine HE, Eshrati B, Esteghamati A, Fahimi S, Faraon EJA, Farzadfar F, Fay DFJ, Feigin VL, Feigl AB, Fereshtehnejad SM, Ferrari AJ, Ferri CP, Flaxman AD, Fleming TD, Foigt N, Foreman KJ, Paleo UF, Franklin RC, Gabbe B, Gaffikin L, Gakidou E, Gamkrelidze A, Gankpé FG, Gansevoort RT, García-Guerra FA, Gasana E, Geleijnse JM, Gessner BD, Gething P, Gibney KB, Gillum RF, Ginawi IAM, Giroud M, Giussani G, Goenka S, Goginashvili K, Gomez Dantes H, Gona P, Gonzalez de Cosio T, González-Castell D, Gotay CC, Goto A, Gouda HN, Guerrant RL, Gugnani HC, Guillemin F, Gunnell D, Gupta R, Gupta R, Gutiérrez RA, Hafezi-Nejad N, Hagan H, Hagstromer M, Halasa YA, Hamadeh RR, Hammami M, Hankey GJ, Hao Y, Harb HL, Haregu TN, Haro JM, Havmoeller R, Hay SI, Hedayati MT, Heredia-Pi IB, Hernandez L, Heuton KR, Heydarpour P, Hijar M, Hoek HW, Hoffman HJ, Hornberger JC, Hosgood HD, Hoy DG, Hsairi M, Hu G, Hu H, Huang C, Huang JJ, Hubbell BJ, Huiart L, Husseini A, Iannarone ML, Iburg KM, Idrisov BT, Ikeda N, Innos K, Inoue M, Islami F, Ismayilova S, Jacobsen KH, Jansen HA, Jarvis DL, Jassal SK, Jauregui A, Jayaraman S, Jeemon P, Jensen PN, Jha V, Jiang F, Jiang G, Jiang Y, Jonas JB, Juel K, Kan H, Kany Roseline SS, Karam NE, Karch A, Karema CK, Karthikeyan G, Kaul A, Kawakami N, Kazi DS, Kemp AH, Kengne AP, Keren A, Khader YS, Khalifa SEAH, Khan EA, Khang YH, Khatibzadeh S, Khonelidze I, Kieling C, Kim D, Kim S, Kim Y, Kimokoti RW, Kinfu Y, Kinge JM, Kissela BM, Kivipelto M, Knibbs LD, Knudsen AK, Kokubo Y, Kose MR, Kosen S, Kraemer A, Kravchenko M, Krishnaswami S, Kromhout H, Ku T, Kuate Defo B, Kucuk Bicer B, Kuipers EJ, Kulkarni C, Kulkarni VS, Kumar GA, Kwan GF, Lai T, Lakshmana Balaji A, Lalloo R, Lallukka T, Lam H, Lan Q, Lansingh VC, Larson HJ, Larsson A, Laryea DO, Lavados PM, Lawrynowicz AE, Leasher JL, Lee JT, Leigh J, Leung R, Levi M, Li Y, Li Y, Liang J, Liang X, Lim SS, Lindsay MP, Lipshultz SE, Liu S, Liu Y, Lloyd BK, Logroscino G, London SJ, Lopez N, Lortet-Tieulent J, Lotufo PA, Lozano R, Lunevicius R, Ma J, Ma S, Machado VMP, MacIntyre MF, Magis-Rodriguez C, Mahdi AA, Majdan M, Malekzadeh R, Mangalam S, Mapoma CC, Marape M, Marcenes W, Margolis DJ, Margono C, Marks GB, Martin RV, Marzan MB, Mashal MT, Masiye F, Mason-Jones AJ, Matsushita K, Matzopoulos R, Mayosi BM, Mazorodze TT, McKay AC, McKee M, McLain A, Meaney PA, Medina C, Mehndiratta MM, Mejia-Rodriguez F, Mekonnen W, Melaku YA, Meltzer M, Memish ZA, Mendoza W, Mensah GA, Meretoja A, Mhimbira FA, Micha R, Miller TR, Mills EJ, Misganaw A, Mishra S, Mohamed Ibrahim N, Mohammad KA, Mokdad AH, Mola GL, Monasta L, Montañez Hernandez JC, Montico M, Moore AR, Morawska L, Mori R, Moschandreas J, Moturi WN, Mozaffarian D, Mueller UO, Mukaigawara M, Mullany EC, Murthy KS, Naghavi M, Nahas Z, Naheed A, Naidoo KS, Naldi L, Nand D, Nangia V, Narayan KMV, Nash D, Neal B, Nejjari C, Neupane SP, Newton CR, Ngalesoni FN, Ngirabega JDD, Nguyen G, Nguyen NT, Nieuwenhuijsen MJ, Nisar MI, Nogueira JR, Nolla JM, Nolte S, Norheim OF, Norman RE, Norrving B, Nyakarahuka L, Oh IH, Ohkubo T, Olusanya BO, Omer SB, Opio JN, Orozco R, Pagcatipunan RS, Pain AW, Pandian JD, Panelo CIA, Papachristou C, Park EK, Parry CD, Paternina Caicedo AJ, Patten SB, Paul VK, Pavlin BI, Pearce N, Pedraza LS, Pedroza A, Pejin Stokic L, Pekericli A, Pereira DM, Perez-Padilla R, Perez-Ruiz F, Perico N, Perry SAL, Pervaiz A, Pesudovs K, Peterson CB, Petzold M, Phillips MR, Phua HP, Plass D, Poenaru D, Polanczyk GV, Polinder S, Pond CD, Pope CA, Pope D, Popova S, Pourmalek F, Powles J, Prabhakaran D, Prasad NM, Qato DM, Quezada AD, Quistberg DAA, Racapé L, Rafay A, Rahimi K, Rahimi-Movaghar V, Rahman SU, Raju M, Rakovac I, Rana SM, Rao M, Razavi H, Reddy KS, Refaat AH, Rehm J, Remuzzi G, Ribeiro AL, Riccio PM, Richardson L, Riederer A, Robinson M, Roca A, Rodriguez A, Rojas-Rueda D, Romieu I, Ronfani L, Room R, Roy N, Ruhago GM, Rushton L, Sabin N, Sacco RL, Saha S, Sahathevan R, Sahraian MA, Salomon JA, Salvo D, Sampson UK, Sanabria JR, Sanchez LM, Sánchez-Pimienta TG, Sanchez-Riera L, Sandar L, Santos IS, Sapkota A, Satpathy M, Saunders JE, Sawhney M, Saylan MI, Scarborough P, Schmidt JC, Schneider IJC, Schöttker B, Schwebel DC, Scott JG, Seedat S, Sepanlou SG, Serdar B, Servan-Mori EE, Shaddick G, Shahraz S, Levy TS, Shangguan S, She J, Sheikhbahaei S, Shibuya K, Shin HH, Shinohara Y, Shiri R, Shishani K, Shiue I, Sigfusdottir ID, Silberberg DH, Simard EP, Sindi S, Singh A, Singh GM, Singh JA, Skirbekk V, Sliwa K, Soljak M, Soneji S, Søreide K, Soshnikov S, Sposato LA, Sreeramareddy CT, Stapelberg NJC, Stathopoulou V, Steckling N, Stein DJ, Stein MB, Stephens N, Stöckl H, Straif K, Stroumpoulis K, Sturua L, Sunguya BF, Swaminathan S, Swaroop M, Sykes BL, Tabb KM, Takahashi K, Talongwa RT, Tandon N, Tanne D, Tanner M, Tavakkoli M, Te Ao BJ, Teixeira CM, Téllez Rojo MM, Terkawi AS, Texcalac-Sangrador JL, Thackway SV, Thomson B, Thorne-Lyman AL, Thrift AG, Thurston GD, Tillmann T, Tobollik M, Tonelli M, Topouzis F, Towbin JA, Toyoshima H, Traebert J, Tran BX, Trasande L, Trillini M, Trujillo U, Dimbuene ZT, Tsilimbaris M, Tuzcu EM, Uchendu US, Ukwaja KN, Uzun SB, van de Vijver S, Van Dingenen R, van Gool CH, van Os J, Varakin YY, Vasankari TJ, Vasconcelos AMN, Vavilala MS, Veerman LJ, Velasquez-Melendez G, Venketasubramanian N, Vijayakumar L, Villalpando S, Violante FS, Vlassov VV, Vollset SE, Wagner GR, Waller SG, Wallin MT, Wan X, Wang H, Wang J, Wang L, Wang W, Wang Y, Warouw TS, Watts CH, Weichenthal S, Weiderpass E, Weintraub RG, Werdecker A, Wessells KR, Westerman R, Whiteford HA, Wilkinson JD, Williams HC, Williams TN, Woldeyohannes SM, Wolfe CDA, Wong JQ, Woolf AD, Wright JL, Wurtz B, Xu G, Yan LL, Yang G, Yano Y, Ye P, Yenesew M, Yentür GK, Yip P, Yonemoto N, Yoon SJ, Younis MZ, Younoussi Z, Yu C, Zaki ME, Zhao Y, Zheng Y, Zhou M, Zhu J, Zhu S, Zou X, Zunt JR, Lopez AD, Vos T, Murray CJ. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2015; 386:2287-323. [PMID: 26364544 PMCID: PMC4685753 DOI: 10.1016/s0140-6736(15)00128-2] [Citation(s) in RCA: 1715] [Impact Index Per Article: 190.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The Global Burden of Disease, Injuries, and Risk Factor study 2013 (GBD 2013) is the first of a series of annual updates of the GBD. Risk factor quantification, particularly of modifiable risk factors, can help to identify emerging threats to population health and opportunities for prevention. The GBD 2013 provides a timely opportunity to update the comparative risk assessment with new data for exposure, relative risks, and evidence on the appropriate counterfactual risk distribution. METHODS Attributable deaths, years of life lost, years lived with disability, and disability-adjusted life-years (DALYs) have been estimated for 79 risks or clusters of risks using the GBD 2010 methods. Risk-outcome pairs meeting explicit evidence criteria were assessed for 188 countries for the period 1990-2013 by age and sex using three inputs: risk exposure, relative risks, and the theoretical minimum risk exposure level (TMREL). Risks are organised into a hierarchy with blocks of behavioural, environmental and occupational, and metabolic risks at the first level of the hierarchy. The next level in the hierarchy includes nine clusters of related risks and two individual risks, with more detail provided at levels 3 and 4 of the hierarchy. Compared with GBD 2010, six new risk factors have been added: handwashing practices, occupational exposure to trichloroethylene, childhood wasting, childhood stunting, unsafe sex, and low glomerular filtration rate. For most risks, data for exposure were synthesised with a Bayesian meta-regression method, DisMod-MR 2.0, or spatial-temporal Gaussian process regression. Relative risks were based on meta-regressions of published cohort and intervention studies. Attributable burden for clusters of risks and all risks combined took into account evidence on the mediation of some risks such as high body-mass index (BMI) through other risks such as high systolic blood pressure and high cholesterol. FINDINGS All risks combined account for 57·2% (95% uncertainty interval [UI] 55·8-58·5) of deaths and 41·6% (40·1-43·0) of DALYs. Risks quantified account for 87·9% (86·5-89·3) of cardiovascular disease DALYs, ranging to a low of 0% for neonatal disorders and neglected tropical diseases and malaria. In terms of global DALYs in 2013, six risks or clusters of risks each caused more than 5% of DALYs: dietary risks accounting for 11·3 million deaths and 241·4 million DALYs, high systolic blood pressure for 10·4 million deaths and 208·1 million DALYs, child and maternal malnutrition for 1·7 million deaths and 176·9 million DALYs, tobacco smoke for 6·1 million deaths and 143·5 million DALYs, air pollution for 5·5 million deaths and 141·5 million DALYs, and high BMI for 4·4 million deaths and 134·0 million DALYs. Risk factor patterns vary across regions and countries and with time. In sub-Saharan Africa, the leading risk factors are child and maternal malnutrition, unsafe sex, and unsafe water, sanitation, and handwashing. In women, in nearly all countries in the Americas, north Africa, and the Middle East, and in many other high-income countries, high BMI is the leading risk factor, with high systolic blood pressure as the leading risk in most of Central and Eastern Europe and south and east Asia. For men, high systolic blood pressure or tobacco use are the leading risks in nearly all high-income countries, in north Africa and the Middle East, Europe, and Asia. For men and women, unsafe sex is the leading risk in a corridor from Kenya to South Africa. INTERPRETATION Behavioural, environmental and occupational, and metabolic risks can explain half of global mortality and more than one-third of global DALYs providing many opportunities for prevention. Of the larger risks, the attributable burden of high BMI has increased in the past 23 years. In view of the prominence of behavioural risk factors, behavioural and social science research on interventions for these risks should be strengthened. Many prevention and primary care policy options are available now to act on key risks. FUNDING Bill & Melinda Gates Foundation.
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Narváez J, Estrada P, López-Vives L, Ricse M, Zacarías A, Heredia S, Gómez-Vaquero C, Nolla JM. Prevalence of ischemic complications in patients with giant cell arteritis presenting with apparently isolated polymyalgia rheumatica. Semin Arthritis Rheum 2015; 45:328-33. [DOI: 10.1016/j.semarthrit.2015.06.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 04/18/2015] [Accepted: 06/12/2015] [Indexed: 10/23/2022]
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Nolla JM, Lora-Tamayo J, Gómez Vaquero C, Narváez J, Murillo O, Pedrero S, Cabo J, Ariza J. Pyogenic arthritis of native joints in non-intravenous drug users: A detailed analysis of 268 cases attended in a tertiary hospital over a 22-year period. Semin Arthritis Rheum 2015; 45:94-102. [DOI: 10.1016/j.semarthrit.2015.01.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Revised: 12/23/2014] [Accepted: 01/23/2015] [Indexed: 12/15/2022]
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Naranjo A, de Toro J, Nolla JM. La enseñanza de la reumatología en la universidad. La travesía desde el aprendizaje basado en el profesor al centrado en el alumno. ACTA ACUST UNITED AC 2015; 11:196-203. [DOI: 10.1016/j.reuma.2014.12.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 12/10/2014] [Accepted: 12/15/2014] [Indexed: 11/26/2022]
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Ribera A, Labori M, Hernández J, Lora-Tamayo J, González-Cañas L, Font F, Nolla JM, Ariza J, Narváez JA, Murillo O. Risk factors and prognosis of vertebral compressive fracture in pyogenic vertebral osteomyelitis. Infection 2015; 44:29-37. [PMID: 26048256 DOI: 10.1007/s15010-015-0800-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 05/25/2015] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To analyse the clinical, microbiological and radiological characteristics, and to identify risk factors of vertebral compressive fracture (VF) in spontaneous pyogenic vertebral osteomyelitis (VO). METHODS A retrospective clinical study and blinded radiological review of adult patients with VO. RESULTS Eighty-eight patients were included: 57 (65%) had a definitive diagnosis of VO (positive microbiology), and 31 (35%) had a probable diagnosis of VO. Of these, 27 (30.7%) presented with VF at diagnosis of VO, and 4 afterwards (total 31, 35.2%). Patients with VF were considered to be at higher risk of osteopenia--they were older (74 vs 66 years, p = 0.013), and included high percentage of women (33 vs 41%, NS)--; and presented more dorsal involvement (56 vs 21%; p < 0.007). Causal microorganisms were similar between groups (VF, no VF). The time to diagnosis of VO was longer in the presence of VF (65 vs 23 days, p = 0.001), and also in cases with no isolated organisms. All patients received antibiotics, and just one patient required spinal stabilisation (VF). After 357 median days of follow-up, all patients were cured. Clinical improvement (residual pain, functional recovery) tended to be slower in patients with VF (log-rank 0.19 and 0.15, respectively), but clinical symptoms were similar in most patients at the last follow-up (VF, no VF). CONCLUSIONS VF is a common complication in pyogenic VO that causes slower clinical recovery. Risk factors of VF are: osteopenia, a delayed diagnosis and dorsal involvement. Conservative management is probably appropriate for most cases, but spinal stabilisation should be considered in some specific cases.
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Affiliation(s)
- Alba Ribera
- Infectious Diseases Department, IDIBELL-Hospital Universitari de Bellvitge, Feixa Llarga s/n, 08907 L'Hospitalet de LLobregat, Barcelona, Spain.
| | - Maria Labori
- Infectious Diseases Department, IDIBELL-Hospital Universitari de Bellvitge, Feixa Llarga s/n, 08907 L'Hospitalet de LLobregat, Barcelona, Spain
| | - Javier Hernández
- Radiology Department, IDIBELL-Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Jaime Lora-Tamayo
- Infectious Diseases Department, IDIBELL-Hospital Universitari de Bellvitge, Feixa Llarga s/n, 08907 L'Hospitalet de LLobregat, Barcelona, Spain
| | - Lluís González-Cañas
- Orthopaedic Surgery Department, IDIBELL-Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Federic Font
- Orthopaedic Surgery Department, IDIBELL-Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Joan M Nolla
- Rheumatology Department, IDIBELL-Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Javier Ariza
- Infectious Diseases Department, IDIBELL-Hospital Universitari de Bellvitge, Feixa Llarga s/n, 08907 L'Hospitalet de LLobregat, Barcelona, Spain
| | - José A Narváez
- Radiology Department, IDIBELL-Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Oscar Murillo
- Infectious Diseases Department, IDIBELL-Hospital Universitari de Bellvitge, Feixa Llarga s/n, 08907 L'Hospitalet de LLobregat, Barcelona, Spain
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Narváez J, Narváez JA, Serrallonga M, de Lama E, Hernández-Gañan J, Gómez-Vaquero C, Nolla JM. Subaxial cervical spine involvement in symptomatic rheumatoid arthritis patients: Comparison with cervical spondylosis. Semin Arthritis Rheum 2015; 45:9-17. [PMID: 25841801 DOI: 10.1016/j.semarthrit.2015.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 02/27/2015] [Accepted: 02/27/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To investigate the frequency, location, characteristics, and clinical significance of subaxial involvement (below C1-C2) in a series of patients with rheumatoid arthritis (RA) and symptomatic involvement of the cervical spine. METHODS A total of 41 patients with RA were examined via cervical spine magnetic resonance imaging (MRI). A comparative analysis of the incidence of the different types of subaxial lesions was performed between these patients and 41 age- and sex-matched patients with symptomatic cervical spondylosis. RESULTS Stenosis of the spinal canal was found at the subaxial level in 85% of RA patients, and at the atlantoaxial level in 44%. Comparative analysis between these patients and the cervical spondylosis patients revealed significant differences in the types and frequencies of subaxial lesions. For both conditions, signs of discopathy and end-plate osteophytosis were the most common abnormalities observed on magnetic resonance imaging (MRI). However, in the RA patients these abnormalities coincided with subchondral bone and ligamentous acute inflammatory changes and with secondary destruction (vertebral instability) or repair (vertebral ankyloses). Only evidence of subaxial myelopathy was significantly associated with an increased risk of neurological dysfunction among the RA patients [Ranawat class II or III; P = 0.01; odds ratio (OR) = 11.43], although subaxial cord compression tended toward a significant association with the risk of neurological dysfunction (P = 0.06; OR = 3.95). CONCLUSION Subaxial stenosis seems to be the consequence of both the inflammatory process and mechanical-degenerative changes. Despite its frequency, it was not usually related to the occurrence of myelopathy symptoms, not even in cases with MRI evidence of spinal cord compression.
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Affiliation(s)
- Javier Narváez
- Department of Rheumatology (Planta 10-2), Hospital Universitario de Bellvitge-IDIBELL, Feixa Llarga s/n, Hospitalet de Llobregat, Barcelona 08907, Spain.
| | - José Antonio Narváez
- Department of Radiology, Hospital Universitario de Bellvitge-IDIBELL, Barcelona, Spain
| | - Marta Serrallonga
- Institut de Diagnostic per la Imatge (IDI), Centre Bellvitge, Barcelona, Spain
| | - Eugenia de Lama
- Department of Radiology, Hospital Universitario de Bellvitge-IDIBELL, Barcelona, Spain
| | | | - Carmen Gómez-Vaquero
- Department of Rheumatology (Planta 10-2), Hospital Universitario de Bellvitge-IDIBELL, Feixa Llarga s/n, Hospitalet de Llobregat, Barcelona 08907, Spain
| | - Joan M Nolla
- Department of Rheumatology (Planta 10-2), Hospital Universitario de Bellvitge-IDIBELL, Feixa Llarga s/n, Hospitalet de Llobregat, Barcelona 08907, Spain
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Narváez J, Díaz-Torné C, Magallares B, Hernández MV, Reina D, Corominas H, Sanmartí R, de la Serna AR, Llobet JM, Nolla JM. Comparative effectiveness of tocilizumab with either methotrexate or leflunomide in the treatment of rheumatoid arthritis. PLoS One 2015; 10:e0123392. [PMID: 25830224 PMCID: PMC4382296 DOI: 10.1371/journal.pone.0123392] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 02/18/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE In agreement with EULAR recommendations, a DMARD in combination with a biotherapy is the reference treatment because of the superior long-term clinical and radiographic outcomes. Methotrexate (MTX) is the cornerstone of combination therapy but is in some cases contra-indicated or poorly tolerated. This observational study aimed to compare the effectiveness and safety of TCZ in combination with either MTX or leflunomide (LEF) in the treatment of patients with active rheumatoid arthritis (RA) and an inadequate response to one or more DMARDs and/or biological agents in a real-world setting. METHODS We performed an ambispective review of 91 patients with active RA who were routinely treated with TCZ plus MTX or LEF. A comparative study between the two combinations of treatment was performed at 6 months of follow-up considering 3 outcomes: improvement of RA disease activity, evolution of functional disability, and tolerability and side effect profile. RESULTS Of the 91 patients, 62 received TCZ with MTX and 29 received TCZ with LEF. Eighty-one patients were followed for 6 months, and the remaining 10 patients discontinued treatment due to serious adverse events. At baseline, there were no significant differences between the groups in terms of the main clinical and laboratory data or in the number of previous DMARDs and biological agents used. At 6 months, there were no significant differences between the combinations in terms of disease activity and functional disability. Serious adverse events occurred in 11% and 10% of the patients treated in combination with MTX and LEF, respectively. CONCLUSION Our preliminary data support the argument that LEF is an effective and safe (equivalent) alternative to MTX for combination treatment with TCZ.
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Affiliation(s)
- Javier Narváez
- Department of Rheumatology, Hospital Universitario de Bellvitge-IDIBELL, Barcelona, Spain
| | - César Díaz-Torné
- Rheumatology Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Berta Magallares
- Rheumatology Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Delia Reina
- Deparment of Rheumatology, Hospital de Sant Joan Despí, Consorci Sanitari Integral, Barcelona, Spain
| | - Héctor Corominas
- Deparment of Rheumatology, Hospital de Sant Joan Despí, Consorci Sanitari Integral, Barcelona, Spain
| | - Raimon Sanmartí
- Department of Rheumatology, Hospital Clínic de Barcelona-IDIBAPS, Barcelona, Spain
| | | | - Josep Maria Llobet
- Rheumatology Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Joan M. Nolla
- Department of Rheumatology, Hospital Universitario de Bellvitge-IDIBELL, Barcelona, Spain
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Martin E, Rodriguez M, Ibero I, Raya E, Nolla JM, Nocea G, Aragon B, Lizán L, Paz S. Physicians' and Patients' Preferences Over the Attributes of Biological Agents Used In the Treatment of Rheumatic Diseases In Spain: A Conjoint Analysis. Value Health 2014; 17:A537. [PMID: 27201721 DOI: 10.1016/j.jval.2014.08.1717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
| | - M Rodriguez
- Complejo Hospitalario de Ourense, Ourense, Spain
| | - I Ibero
- Hospital General de Alicante, Alicante, Spain
| | - E Raya
- Hospital Universitario San Cecilio, Granada, Spain
| | - J M Nolla
- Hospital Universitario de Bellvitge, Barcelona, Spain
| | | | | | - L Lizán
- Outcomes'10, Castellon, Spain
| | - S Paz
- Outcomes'10, Castellon, Spain
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Rodriguez M, Ibero I, Martin E, Nolla JM, Raya E, Aragon B, Nocea G, Lizán L, Aceituno S. Preferences of Spanish Patients Over the Attributes of Biological Agents for the Treatment of Rheumatic Diseases Depending On the Administration Route. Value Health 2014; 17:A537. [PMID: 27201720 DOI: 10.1016/j.jval.2014.08.1718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- M Rodriguez
- Complejo Hospitalario de Ourense, Ourense, Spain
| | - I Ibero
- Hospital General de Alicante, Alicante, Spain
| | | | - J M Nolla
- Hospital Universitario de Bellvitge, Barcelona, Spain
| | - E Raya
- Hospital Universitario San Cecilio, Granada, Spain
| | | | | | - L Lizán
- Outcomes'10, Castellon, Spain
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Sànchez-Riera L, Carnahan E, Vos T, Veerman L, Norman R, Lim SS, Hoy D, Smith E, Wilson N, Nolla JM, Chen JS, Macara M, Kamalaraj N, Li Y, Kok C, Santos-Hernández C, March L. The global burden attributable to low bone mineral density. Ann Rheum Dis 2014; 73:1635-45. [DOI: 10.1136/annrheumdis-2013-204320] [Citation(s) in RCA: 107] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Farahmand P, Marin F, Hawkins F, Möricke R, Ringe JD, Glüer CC, Papaioannou N, Minisola S, Martínez G, Nolla JM, Niedhart C, Guañabens N, Nuti R, Martín-Mola E, Thomasius F, Peña J, Graeff C, Kapetanos G, Petto H, Gentzel A, Reisinger A, Zysset PK. Early changes in biochemical markers of bone formation during teriparatide therapy correlate with improvements in vertebral strength in men with glucocorticoid-induced osteoporosis. Osteoporos Int 2013; 24:2971-81. [PMID: 23740422 PMCID: PMC3838582 DOI: 10.1007/s00198-013-2379-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 04/23/2013] [Indexed: 01/19/2023]
Abstract
UNLABELLED Changes of the bone formation marker PINP correlated positively with improvements in vertebral strength in men with glucocorticoid-induced osteoporosis (GIO) who received 18-month treatment with teriparatide, but not with risedronate. These results support the use of PINP as a surrogate marker of bone strength in GIO patients treated with teriparatide. INTRODUCTION To investigate the correlations between biochemical markers of bone turnover and vertebral strength estimated by finite element analysis (FEA) in men with GIO. METHODS A total of 92 men with GIO were included in an 18-month, randomized, open-label trial of teriparatide (20 μg/day, n = 45) and risedronate (35 mg/week, n = 47). High-resolution quantitative computed tomography images of the 12th thoracic vertebra obtained at baseline, 6 and 18 months were converted into digital nonlinear FE models and subjected to anterior bending, axial compression and torsion. Stiffness and strength were computed for each model and loading mode. Serum biochemical markers of bone formation (amino-terminal-propeptide of type I collagen [PINP]) and bone resorption (type I collagen cross-linked C-telopeptide degradation fragments [CTx]) were measured at baseline, 3 months, 6 months and 18 months. A mixed-model of repeated measures analysed changes from baseline and between-group differences. Spearman correlations assessed the relationship between changes from baseline of bone markers with FEA variables. RESULTS PINP and CTx levels increased in the teriparatide group and decreased in the risedronate group. FEA-derived parameters increased in both groups, but were significantly higher at 18 months in the teriparatide group. Significant positive correlations were found between changes from baseline of PINP at 3, 6 and 18 months with changes in FE strength in the teriparatide-treated group, but not in the risedronate group. CONCLUSIONS Positive correlations between changes in a biochemical marker of bone formation and improvement of biomechanical properties support the use of PINP as a surrogate marker of bone strength in teriparatide-treated GIO patients.
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Affiliation(s)
- P Farahmand
- West German Osteoporosis Centre, Klinikum Leverkusen, University of Cologne, Am Gesundheitspark 11, 51375, Leverkusen, Germany,
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Gómez-Vaquero C, Roig-Vilaseca D, Narváez J, Nolla JM. Respuesta. Med Clin (Barc) 2013; 141:45. [DOI: 10.1016/j.medcli.2013.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Revised: 12/23/2012] [Accepted: 01/10/2013] [Indexed: 11/26/2022]
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Glüer CC, Marin F, Ringe JD, Hawkins F, Möricke R, Papaioannu N, Farahmand P, Minisola S, Martínez G, Nolla JM, Niedhart C, Guañabens N, Nuti R, Martín-Mola E, Thomasius F, Kapetanos G, Peña J, Graeff C, Petto H, Sanz B, Reisinger A, Zysset PK. Comparative effects of teriparatide and risedronate in glucocorticoid-induced osteoporosis in men: 18-month results of the EuroGIOPs trial. J Bone Miner Res 2013; 28:1355-68. [PMID: 23322362 PMCID: PMC3708101 DOI: 10.1002/jbmr.1870] [Citation(s) in RCA: 121] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Revised: 12/10/2012] [Accepted: 12/26/2012] [Indexed: 11/11/2022]
Abstract
Data on treatment of glucocorticoid-induced osteoporosis (GIO) in men are scarce. We performed a randomized, open-label trial in men who have taken glucocorticoids (GC) for ≥3 months, and had an areal bone mineral density (aBMD) T-score ≤ -1.5 standard deviations. Subjects received 20 μg/d teriparatide (n = 45) or 35 mg/week risedronate (n = 47) for 18 months. Primary objective was to compare lumbar spine (L1 -L3 ) BMD measured by quantitative computed tomography (QCT). Secondary outcomes included BMD and microstructure measured by high-resolution QCT (HRQCT) at the 12th thoracic vertebra, biomechanical effects for axial compression, anterior bending, and axial torsion evaluated by finite element (FE) analysis from HRQCT data, aBMD by dual X-ray absorptiometry, biochemical markers, and safety. Computed tomography scans were performed at 0, 6, and 18 months. A mixed model repeated measures analysis was performed to compare changes from baseline between groups. Mean age was 56.3 years. Median GC dose and duration were 8.8 mg/d and 6.4 years, respectively; 39.1% of subjects had a prevalent fracture, and 32.6% received prior bisphosphonate treatment. At 18 months, trabecular BMD had significantly increased for both treatments, with significantly greater increases with teriparatide (16.3% versus 3.8%; p = 0.004). HRQCT trabecular and cortical variables significantly increased for both treatments with significantly larger improvements for teriparatide for integral and trabecular BMD and bone surface to volume ratio (BS/BV) as a microstructural measure. Vertebral strength increases at 18 months were significant in both groups (teriparatide: 26.0% to 34.0%; risedronate: 4.2% to 6.7%), with significantly higher increases in the teriparatide group for all loading modes (0.005 < p < 0.015). Adverse events were similar between groups. None of the patients on teriparatide but five (10.6%) on risedronate developed new clinical fractures (p = 0.056). In conclusion, in this 18-month trial in men with GIO, teriparatide showed larger improvements in spinal BMD, microstructure, and FE-derived strength than risedronate.
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Affiliation(s)
- Claus-C Glüer
- Sektion Biomedizinische Bildgebung, Klinik für Diagnostische Radiologie, Universitätsklinikum Schleswig-Holstein, Kiel, Germany. ‐kiel.de
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Gómez-Vaquero C, Roig-Vilaseca D, Bianchi M, Santo P, Narváez J, Nolla JM. Evaluación de una propuesta de criterios de indicación de densitometría ósea en mujeres posmenopáusicas españolas basados en la herramienta FRAX®. Med Clin (Barc) 2013; 140:439-43. [DOI: 10.1016/j.medcli.2012.03.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Revised: 02/26/2012] [Accepted: 03/01/2012] [Indexed: 10/28/2022]
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