BackgroundThe main manifestation of Behçet’s disease is oral aphthae. Treatment consists of topic... more BackgroundThe main manifestation of Behçet’s disease is oral aphthae. Treatment consists of topical corticosteroids and colchicine in recurrent cases. Drugs such as azathioprine, thalidomide, interferon-alpha, tumour necrosis factor-alpha inhibitors or apremilast should be considered in selected cases[1]. A phase 3, double-blind, placebo-controlled RELIEF study suggests that apremilast is an effective agent for the management of oral aphtae in Behçet’s disease and benefits were sustained up to 64 weeks. Its onset of action occurred within 2 weeks after treatment was started. Adverse events, including nausea, vomiting, and diarrhea, occurred more frequently with apremilast than with placebo[2]. It has also been shown to be effective in the treatment of psoriasis[3].ObjectivesTo assess the effectiveness of apremilast in the treatment of oral aphtosis.MethodsRetrospective descriptive multicentre study of patients treated with apremilast for oral aphtosis associated with Behçet’s diseas...
BackgroundSjögren’s Syndrome (SS) is a chronic systemic autoimmune disease characterized by invol... more BackgroundSjögren’s Syndrome (SS) is a chronic systemic autoimmune disease characterized by involvement of the exocrine glands in addition to a wide spectrum of systemic manifestations. At present, conventional biomarkers do not respond to unresolved needs regarding diagnosis, stratification of phenotypes and appropriate effective therapies[1]. SS is an orphan disease and new biomarkers could constitute potential future therapeutic targets[2].ObjectivesThe purpose of this study was to carry out an exploratory analysis in six serum and saliva samples from suspected SS patients to identify protein biomarkers to distinguish SS patients who were diagnosed with SS from those who were not.MethodsWe selected six patients from a cohort of 199 consecutive patients attended the rheumatology department for suspected SS: 3 patients who met SS classification criteria from 2002 and/or 2016 who were diagnosed with SS by a rheumatologist and 3 patients who did not meet SS classification criteria wh...
BackgroundIn recent decades, immunotherapy has changed the management and prognosis of cancer pat... more BackgroundIn recent decades, immunotherapy has changed the management and prognosis of cancer patients. Immune checkpoint inhibitors, such as those targeting PD-1 and PD-L1, are used for some types of cancer; however, their use has been associated with the appearance of immune-mediated adverse events. Among these, those related to the field of rheumatology are relatively frequent, joint involvement being the most common, followed by muscle involvement (myalgias 4%, myositis 1%).ObjectivesTo describe oncologic patients who developed immune checkpoint inhibitors- related myositis.MethodsAll patients from the oncology department of a tertiary hospital, referred to rheumatology and diagnosed with immune-mediated myositis due to immune checkpoint inhibitors were collected. A descriptive analysis was performed.ResultsFive patients were analyzed, 60% male, with a mean age of 65.8 years (56-78 years).The types of cancer were: melanoma (n=2), gastroesophageal junction cancer (n=1), cavum can...
BackgroundIncorporation of conventional synthetic (cs), biologic (b) and targeted synthetic (ts) ... more BackgroundIncorporation of conventional synthetic (cs), biologic (b) and targeted synthetic (ts) disease-modifying drugs (DMARDs) has enriched the therapeutic arsenal, but at the same time has complicated the decision-making process, since it requires considering not only the profile of each patient and the characteristics of each drug, but also the high cost of many of them and diverse administrative limitations.ObjectivesTo analyze the way of acting of Spanish rheumatologists in different clinical situations in order to understand the decision-making process in the treatment of rheumatoid arthritis (RA).MethodsA questionnaire that consisted of 15 questions was sent to several groups of rheumatologists country wide between October 19 and 26, 2022. Descriptive statistical analysis and Pearson’s Chi2 test were performed to compare responses to the items by the different groups, significance level 0.05 (p>0.05 N.S.)ResultsA total of 108 questionnaires were collected. Work experienc...
BackgroundSjögren syndrome (SS) is a chronic systemic autoimmune disease characterized by lymphoc... more BackgroundSjögren syndrome (SS) is a chronic systemic autoimmune disease characterized by lymphocytic infiltration of the exocrine glands, which alters their function producing dryness of the mouth, eyes and other mucous membranes. The method used to quantify glandular hypofunction is by whole saliva flow stimulated and unstimulated (UWSF) [1], which takes between 5 and 15 minutes (min).The Saxon test (St) [2], is another tool with the same objective but requires less time: 2 minutes. In the literature, we only have found one study that compared the Saxon test with other diagnostic methods although it is developed in patients without SS [3].ObjectivesTo compare the Saxon test and UWSF in a cohort of patients with suspected SS.MethodsIn a consecutive cohort of patients who attended the rheumatology department for suspected SS, UWSF was measured (mL/5 min) and the Saxon test (gr/2 min) was performed. The Index Reported by Patients with SS of the EULAR (ESSPRI) was collected too. This ...
BackgroundEPISER study has confirmed the great burden of rheumatic diseases, which represent almo... more BackgroundEPISER study has confirmed the great burden of rheumatic diseases, which represent almost 30% of primary care medical consultations in Spain[1,2]. Electronic consultation could be an alternative response[3]as well as rheumatologist-led update programmes and joint case discussion with primary care physicians have shown to reduce the burden of care and waiting times in rheumatology units[4].ObjectivesTo analyze the demand from primary care to the rheumatology service of a tertiary hospital.MethodsRetrospective descriptive study of the data consecutively collected from 15 to 30 May 2022 from new rheumatology consultations at the reference hospital requested from primary care (PC) health centers in the area. The following variables were collected: waiting time (median and range in days), referral route (ordinary, preferential or e-consultation), reason for derivation, type of visit (discharge or follow-up), suspicion of inflammatory disease by the specialist in Family and Comm...
BackgroundSome rheumatological diseases may involve the lungs. This is something that the rheumat... more BackgroundSome rheumatological diseases may involve the lungs. This is something that the rheumatologist and pulmonologist must take into account in their clinical practice.ObjectivesTo describe the characteristics of a group of patients with diffuse interstitial lung disease (ILD) that are being followed-up in a Rheumatology-Pneumology monographic consultation and study the usefulness of this consultation.MethodsWe reviewed the medical records of patients with a diagnosis of ILD that were being studied by both services in a monographic consultation in a tertiary hospital. A descriptive study was performed.ResultsA total of 40 patients were studied: 16 with nonspecific interstitial pneumonia (NSIP), 15 with usual interstitial pneumonia (UIP), 5 with fibrotic NSIP, 2 with cryptogenic organizing pneumonia (COP) and 2 with undefined ILD. 60% were women and the mean age was 64 years (40-80 years).Twenty patients with ILD were referred from pneumology to rheumatology. The primary reason ...
BackgroundPolymyalgia rheumatica is a common inflammatory rheumatic disease affecting people olde... more BackgroundPolymyalgia rheumatica is a common inflammatory rheumatic disease affecting people older than 50. It is characterized by simmetrical pain and stiffness of the neck, shoulder, and pelvic girdle and associated with an increase in the concentration of positive acute phase reactants. The diagnosis is based on a clinical picture. Initial treatment consists of corticosteroids, and initial doses of 15 to 20 mg of prednisone or equivalent are usually adequate in most cases. The subgroup of patients that responds only partially to corticosteroids or develops corticosteroid resistance usually requires the introduction of a corticosteroid-sparing drug, methotrexate being the most widely used in routine clinical practice.ObjectivesTo evaluate the efficacy and safety of methotrexate in patients with steroid-resistant polymyalgia rheumatica in real clinical practice.MethodsRetrospective multicenter descriptive study of patients diagnosed with polymyalgia rheumatica in three hospitals in...
BackgroundThe exostosis of occipital protuberance was described recently in non-inflammatory proc... more BackgroundThe exostosis of occipital protuberance was described recently in non-inflammatory processes[1]. Despite of enthesophytes are usually seen in radiographs of older asymptomatic population, in the last few years the presence of occipital protuberance enthesophyte (OPE) has been observed frequently in young patients, with a prevalence of 41% in adults younger than 30-year-old[2]. To our knowledge OPE has not been described in inflammatory rheumatic diseases.ObjectivesTo determine the prevalence of OPE in non-inflammatory processes (NIP), psoriatic arthritis (PsA), spondyloarthritis (SpA) and rheumatoid arthritis (RA).MethodsRetrospective descriptive and comparative study of cervical radiographs randomly collected from patients older than 18 years old attended in a rheumatology consult of a tertiary hospital from July 2022 to January 2023 until 30 patients per group were completed (total of 120 patients). We classified patients in four groups by diagnosis: NIP (traffic acciden...
BackgroundRituximab (RTX) is a murine/human chimeric monoclonal antibody directed against the CD2... more BackgroundRituximab (RTX) is a murine/human chimeric monoclonal antibody directed against the CD20 receptor expressed on pre-B and mature B cells. Rituximab is used effectively in the treatment of different rheumatic diseases, but it can induce hypogammaglobulinemia as a side effect.ObjectivesTo analyze the prevalence of hypogammaglobulinemia and its association with infections in patients with rheumatic diseases treated with RTX.MethodsMulticenter, retrospective, observational study. Patients with rheumatic diseases treated with RTX in 4 centers in Madrid, in which serum immunoglobulin counts were available, were included. Demographic and clinical variables of the sample were analyzed, and changes in immunoglobulin G concentrations during treatment from baseline were assessed. The chi-square test was used to examine the relationship between variables, considering a P value <0.05 as statistically significant. Logistic regression models were used to analyze the association between...
BackgroundSjögren syndrome (SS) is a chronic systemic autoimmune disease characterized by lymphoc... more BackgroundSjögren syndrome (SS) is a chronic systemic autoimmune disease characterized by lymphocytic infiltration of the exocrine glands, which alters their function producing dryness of the mouth, eyes and other mucous membranes. The method used to quantify glandular hypofunction is by whole saliva flow stimulated and unstimulated (UWSF) [1], which takes between 5 and 15 minutes (min). The Saxon test [2], is another tool with the same objective but requires less time: 2 minutes. In the literature, we only have found one study that compares the Saxon test with other diagnostic methods although it is developed in patients without SS [3].ObjectivesTo compare the Saxon test and UWSF in a cohort of patients with suspected SS.MethodsIn a consecutive cohort of patients who attended the rheumatology department for suspected SS, UWSF was measured (mL/5 min) and the Saxon test (gr/2 min) was performed. The Index Reported by Patients with Sjögren’s Syndrome of the EULAR (ESSPRI) was collecte...
BackgroundThe development of targeted biologic (bDMARDs) and targeted synthetic disease-modifying... more BackgroundThe development of targeted biologic (bDMARDs) and targeted synthetic disease-modifying drugs (tsDMARDS) has made a substantial change in the control of our patients, and has allowed an increasing number of patients to achieve clinical remission.ObjectivesTo gain understanding of patients’ experiences of starting treatment with b/tsDMARDs, and explore their attitudes in order to improve the doctor-patient relationship, adherence to treatment, compliance, and knowledge about the experience of using b/tsDMARDs.MethodsA qualitative study was carried out. A consecutive sample of 130 patients attended in the rheumatology units of four Madrid hospitals, from August 29th, 2021 to January 21st, 2022 completed a questionnaire that consisted of 31 questions, a subsequent qualitative analysis of discourse and content through focus groups with patients was carried out. Descriptive statistical analysis was performed. Chi-squared tests were applied to explore the dependency relationship...
Background: The MSK components of the BILAG and SLEDAI have limited sensitivity, specificity and ... more Background: The MSK components of the BILAG and SLEDAI have limited sensitivity, specificity and responsiveness. Objectives: To develop a better disease activity tool for MSK lupus. Methods: "LAMDA" was derived using data from the multicentre USEFUL study (PMID:33792659); 133 patients with inflammatory MSK pain received intramuscular depomedrone then were assessed for 66/68 SJC/ TJC, BILAG-2004, SLEDAI-2K, physician MSK-VAS, inflammatory markers, patient pain and disease-activity-VAS and MSK-ultrasound. Baseline variables were modelled against US using penalized (Lasso) regression. For validation we evaluated: (i) responsiveness at week 6 in USEFUL and (ii) association with quality of life and treatment decision in an independent study (n=100). Results: LAMDA was a composite of SJC, patient-MSK-pain-VAS, physician-MSK-disease-activity-VAS and ESR ranging from 0 to 26.5. Response effect size was greater for the LAMDA (0.37) than the BILAG-MSK (0.31), SLE-DAI-MSK (0.27) and total US score (0.33). With active US at baseline, LAMDA's effect size was 0.42. In the validation study LAMDA score correlated with better physical function (R =-0.49, p<0.001), pain (R =-0.44, p=0.002) and Burden to Others (R =-0.38, p=0.009). LAMDA was higher when therapy was increased (mean (95% CI) difference 12.9 (5.8, 19.9), p<0.001). Conclusion: LAMDA is a continuous disease activity instrument for MSK lupus that is sensitive to imaging-synovitis without swelling, more responsive than other instruments and correlates with quality of life and treatment decision. LAMDA may improve the ability of clinicians to monitor and treat MSK lupus, and determine the efficacy of therapies in clinical trials.
BackgroundThe rate of psoriatic arthritis progression is increased in those patients presenting w... more BackgroundThe rate of psoriatic arthritis progression is increased in those patients presenting with established disease greater than 2 years duration, so it is necessary to find tools that allow early diagnosis to prevent joint damage1. Prevalence of psoriatic arthritis varies according to the screening strategies used. The COMPAQ study compared four screening questionnaires for psoriatic arthritis (PEST, ToPAS, PASE and EARP), whose sensitivities ranged from 44 to 91%, with the EARP questionnaire showing the highest sensitivity2. A new, shorter questionnaire, PURE-4 scale, has been developed, with a sensitivity of 85.7%3.ObjectivesTo evaluate the usefulness of PURE-4 scale in real clinical practice conditions to identify patients with psoriatic arthritis in patients with psoriasis referred from a dermatology department to a rheumatology department.MethodsRetrospective descriptive study of patients diagnosed with psoriasis who have been referred from the Dermatology Department in t...
BackgroundThe EPISER study is the first Spanish epidemiological study that has confirmed the grea... more BackgroundThe EPISER study is the first Spanish epidemiological study that has confirmed the great burden of rheumatic diseases in the general population: they consume a large quantity of health resources (doctor visits, medical products) and imply a high social impact in terms of work absenteeism. Rheumatic diseases represent almost 30% of Primary Care medical consultations in Spain1,2. Electronic consultation could be an alternative response to the increase of this demand, both to make an early diagnosis and derivation and to improve communication with Primary Care physicians3,4.ObjectivesTo analyze the demand of Primary Care and its resolution through the electronic consultation system of the Rheumatology Department of a tertiary hospital.MethodsRetrospective descriptive study of the data collected in the request and information system (Sistema de Peticiones Electrónicas, SIPE) that supports electronic consultation between primary care physicians of the health area and the Rheuma...
BackgroundAnti-transcriptional intermediary factor 1γ (anti-TIF 1γ) antibody is robustly linked w... more BackgroundAnti-transcriptional intermediary factor 1γ (anti-TIF 1γ) antibody is robustly linked with cancer-associated dermatomyositis (DM) in adults, but its specificity varies widely between series. TIF 1γ can act either as a tumor promoter or suppressor and may behave as an autoantigen.ObjectivesInvestigate the association between anti-TIF 1γ antibody positivity and development of neoplasia.MethodsA retrospective chart review was conducted among patients with positive anti-TIF 1γ antibodies detected by immunoblot from March 2019 to December 2021 in three tertiary hospitals. Demographic variables, creatine kinase (CK) values, other autoantibodies, associated autoimmune diseases (AIDs) and existence or not of a cancer diagnosis were analyzed. To rule out malignancy, patients had to present a PET-CT scan without pathological findings or a chest CT scan, a gynecological study and a digestive study without alterations. A descriptive statistical analysis was performed.Results29 patient...
The effects of Lisuride, a dopaminergic agonist, on the levels of plasma prolactin (PRL), testost... more The effects of Lisuride, a dopaminergic agonist, on the levels of plasma prolactin (PRL), testosterone, luteinizing hormone (LH), follicle-stimulating hormone (FSH), and on the variations of libido and coital frequency of patients with chronic renal failure (CRF) have been investigated in a group of 20 male patients (ten normoprolactinemic and ten hyperprolactinemic). Ten patients were included in a hemodialysis program and another ten received conservation therapy (all had creatinine clearance rates below 15 mL/min). The response of PRL to TRH administration and that of LH and FSH to LH-RH administration have also been studied. Low levels of plasma testosterone found initially in all the patients, increased in both normoprolactinemic (P less than 0.05) and hyperprolactinemic patients (P less than 0.01) during Lisuride administration. PRL decreased (P less than 0.01) in both groups during therapy. The increase of plasma testosterone was greater in hyperprolactinemic patients (86% v 15% in normoprolactinemic) and was accompanied by a clear improvement in the studied parameters of sexual behaviors. The response of PRL to TRH was modified in hyperprolactinemic patients while that of LH and FSH to LH-RH was not modified, although Lisuride induced an increase of the basal value of LH (P less than 0.01) in the hyperprolactinemic group. The drug was fairly well tolerated, did not induce hypotension, and the overall incidence of side effects decreased along the study. These results stress the need for further studies with this agent in patients with chronic renal failure and sexual dysfunction.
The role of the tonic inhibitory effect of dopamine on aldosterone secretion has been investigate... more The role of the tonic inhibitory effect of dopamine on aldosterone secretion has been investigated in 10 patients with chronic renal failure (CRF) on hemodialysis, in 8 normotensive renal transplant recipients (Tx) with normal renal function and in 8 normotensive volunteers (NV). The following tests were performed: the response of plasma aldosterone (PA) to metoclopramide administration; the response of plasma prolactin (PRL) to TRH administration, and the changes induced by Lisuride (a dopaminergic agonist, on the values of PA and PRL). The basal values of PA and PRL were higher in CRF than in NV and Tx. The inverse was true for plasma renin activity (PRA) values. The response of PA and PRL to metoclopramide showed blunted increases in CRF when compared to NV, in the absence of changes of PRA, cortisol and potassium. After TRH administration, PRL increase in CRF was also inferior. Lisuride induced a decrease of both PA and PRL both in CRF and NV. In Tx, basal values of PA and PRL w...
BackgroundThe main manifestation of Behçet’s disease is oral aphthae. Treatment consists of topic... more BackgroundThe main manifestation of Behçet’s disease is oral aphthae. Treatment consists of topical corticosteroids and colchicine in recurrent cases. Drugs such as azathioprine, thalidomide, interferon-alpha, tumour necrosis factor-alpha inhibitors or apremilast should be considered in selected cases[1]. A phase 3, double-blind, placebo-controlled RELIEF study suggests that apremilast is an effective agent for the management of oral aphtae in Behçet’s disease and benefits were sustained up to 64 weeks. Its onset of action occurred within 2 weeks after treatment was started. Adverse events, including nausea, vomiting, and diarrhea, occurred more frequently with apremilast than with placebo[2]. It has also been shown to be effective in the treatment of psoriasis[3].ObjectivesTo assess the effectiveness of apremilast in the treatment of oral aphtosis.MethodsRetrospective descriptive multicentre study of patients treated with apremilast for oral aphtosis associated with Behçet’s diseas...
BackgroundSjögren’s Syndrome (SS) is a chronic systemic autoimmune disease characterized by invol... more BackgroundSjögren’s Syndrome (SS) is a chronic systemic autoimmune disease characterized by involvement of the exocrine glands in addition to a wide spectrum of systemic manifestations. At present, conventional biomarkers do not respond to unresolved needs regarding diagnosis, stratification of phenotypes and appropriate effective therapies[1]. SS is an orphan disease and new biomarkers could constitute potential future therapeutic targets[2].ObjectivesThe purpose of this study was to carry out an exploratory analysis in six serum and saliva samples from suspected SS patients to identify protein biomarkers to distinguish SS patients who were diagnosed with SS from those who were not.MethodsWe selected six patients from a cohort of 199 consecutive patients attended the rheumatology department for suspected SS: 3 patients who met SS classification criteria from 2002 and/or 2016 who were diagnosed with SS by a rheumatologist and 3 patients who did not meet SS classification criteria wh...
BackgroundIn recent decades, immunotherapy has changed the management and prognosis of cancer pat... more BackgroundIn recent decades, immunotherapy has changed the management and prognosis of cancer patients. Immune checkpoint inhibitors, such as those targeting PD-1 and PD-L1, are used for some types of cancer; however, their use has been associated with the appearance of immune-mediated adverse events. Among these, those related to the field of rheumatology are relatively frequent, joint involvement being the most common, followed by muscle involvement (myalgias 4%, myositis 1%).ObjectivesTo describe oncologic patients who developed immune checkpoint inhibitors- related myositis.MethodsAll patients from the oncology department of a tertiary hospital, referred to rheumatology and diagnosed with immune-mediated myositis due to immune checkpoint inhibitors were collected. A descriptive analysis was performed.ResultsFive patients were analyzed, 60% male, with a mean age of 65.8 years (56-78 years).The types of cancer were: melanoma (n=2), gastroesophageal junction cancer (n=1), cavum can...
BackgroundIncorporation of conventional synthetic (cs), biologic (b) and targeted synthetic (ts) ... more BackgroundIncorporation of conventional synthetic (cs), biologic (b) and targeted synthetic (ts) disease-modifying drugs (DMARDs) has enriched the therapeutic arsenal, but at the same time has complicated the decision-making process, since it requires considering not only the profile of each patient and the characteristics of each drug, but also the high cost of many of them and diverse administrative limitations.ObjectivesTo analyze the way of acting of Spanish rheumatologists in different clinical situations in order to understand the decision-making process in the treatment of rheumatoid arthritis (RA).MethodsA questionnaire that consisted of 15 questions was sent to several groups of rheumatologists country wide between October 19 and 26, 2022. Descriptive statistical analysis and Pearson’s Chi2 test were performed to compare responses to the items by the different groups, significance level 0.05 (p>0.05 N.S.)ResultsA total of 108 questionnaires were collected. Work experienc...
BackgroundSjögren syndrome (SS) is a chronic systemic autoimmune disease characterized by lymphoc... more BackgroundSjögren syndrome (SS) is a chronic systemic autoimmune disease characterized by lymphocytic infiltration of the exocrine glands, which alters their function producing dryness of the mouth, eyes and other mucous membranes. The method used to quantify glandular hypofunction is by whole saliva flow stimulated and unstimulated (UWSF) [1], which takes between 5 and 15 minutes (min).The Saxon test (St) [2], is another tool with the same objective but requires less time: 2 minutes. In the literature, we only have found one study that compared the Saxon test with other diagnostic methods although it is developed in patients without SS [3].ObjectivesTo compare the Saxon test and UWSF in a cohort of patients with suspected SS.MethodsIn a consecutive cohort of patients who attended the rheumatology department for suspected SS, UWSF was measured (mL/5 min) and the Saxon test (gr/2 min) was performed. The Index Reported by Patients with SS of the EULAR (ESSPRI) was collected too. This ...
BackgroundEPISER study has confirmed the great burden of rheumatic diseases, which represent almo... more BackgroundEPISER study has confirmed the great burden of rheumatic diseases, which represent almost 30% of primary care medical consultations in Spain[1,2]. Electronic consultation could be an alternative response[3]as well as rheumatologist-led update programmes and joint case discussion with primary care physicians have shown to reduce the burden of care and waiting times in rheumatology units[4].ObjectivesTo analyze the demand from primary care to the rheumatology service of a tertiary hospital.MethodsRetrospective descriptive study of the data consecutively collected from 15 to 30 May 2022 from new rheumatology consultations at the reference hospital requested from primary care (PC) health centers in the area. The following variables were collected: waiting time (median and range in days), referral route (ordinary, preferential or e-consultation), reason for derivation, type of visit (discharge or follow-up), suspicion of inflammatory disease by the specialist in Family and Comm...
BackgroundSome rheumatological diseases may involve the lungs. This is something that the rheumat... more BackgroundSome rheumatological diseases may involve the lungs. This is something that the rheumatologist and pulmonologist must take into account in their clinical practice.ObjectivesTo describe the characteristics of a group of patients with diffuse interstitial lung disease (ILD) that are being followed-up in a Rheumatology-Pneumology monographic consultation and study the usefulness of this consultation.MethodsWe reviewed the medical records of patients with a diagnosis of ILD that were being studied by both services in a monographic consultation in a tertiary hospital. A descriptive study was performed.ResultsA total of 40 patients were studied: 16 with nonspecific interstitial pneumonia (NSIP), 15 with usual interstitial pneumonia (UIP), 5 with fibrotic NSIP, 2 with cryptogenic organizing pneumonia (COP) and 2 with undefined ILD. 60% were women and the mean age was 64 years (40-80 years).Twenty patients with ILD were referred from pneumology to rheumatology. The primary reason ...
BackgroundPolymyalgia rheumatica is a common inflammatory rheumatic disease affecting people olde... more BackgroundPolymyalgia rheumatica is a common inflammatory rheumatic disease affecting people older than 50. It is characterized by simmetrical pain and stiffness of the neck, shoulder, and pelvic girdle and associated with an increase in the concentration of positive acute phase reactants. The diagnosis is based on a clinical picture. Initial treatment consists of corticosteroids, and initial doses of 15 to 20 mg of prednisone or equivalent are usually adequate in most cases. The subgroup of patients that responds only partially to corticosteroids or develops corticosteroid resistance usually requires the introduction of a corticosteroid-sparing drug, methotrexate being the most widely used in routine clinical practice.ObjectivesTo evaluate the efficacy and safety of methotrexate in patients with steroid-resistant polymyalgia rheumatica in real clinical practice.MethodsRetrospective multicenter descriptive study of patients diagnosed with polymyalgia rheumatica in three hospitals in...
BackgroundThe exostosis of occipital protuberance was described recently in non-inflammatory proc... more BackgroundThe exostosis of occipital protuberance was described recently in non-inflammatory processes[1]. Despite of enthesophytes are usually seen in radiographs of older asymptomatic population, in the last few years the presence of occipital protuberance enthesophyte (OPE) has been observed frequently in young patients, with a prevalence of 41% in adults younger than 30-year-old[2]. To our knowledge OPE has not been described in inflammatory rheumatic diseases.ObjectivesTo determine the prevalence of OPE in non-inflammatory processes (NIP), psoriatic arthritis (PsA), spondyloarthritis (SpA) and rheumatoid arthritis (RA).MethodsRetrospective descriptive and comparative study of cervical radiographs randomly collected from patients older than 18 years old attended in a rheumatology consult of a tertiary hospital from July 2022 to January 2023 until 30 patients per group were completed (total of 120 patients). We classified patients in four groups by diagnosis: NIP (traffic acciden...
BackgroundRituximab (RTX) is a murine/human chimeric monoclonal antibody directed against the CD2... more BackgroundRituximab (RTX) is a murine/human chimeric monoclonal antibody directed against the CD20 receptor expressed on pre-B and mature B cells. Rituximab is used effectively in the treatment of different rheumatic diseases, but it can induce hypogammaglobulinemia as a side effect.ObjectivesTo analyze the prevalence of hypogammaglobulinemia and its association with infections in patients with rheumatic diseases treated with RTX.MethodsMulticenter, retrospective, observational study. Patients with rheumatic diseases treated with RTX in 4 centers in Madrid, in which serum immunoglobulin counts were available, were included. Demographic and clinical variables of the sample were analyzed, and changes in immunoglobulin G concentrations during treatment from baseline were assessed. The chi-square test was used to examine the relationship between variables, considering a P value <0.05 as statistically significant. Logistic regression models were used to analyze the association between...
BackgroundSjögren syndrome (SS) is a chronic systemic autoimmune disease characterized by lymphoc... more BackgroundSjögren syndrome (SS) is a chronic systemic autoimmune disease characterized by lymphocytic infiltration of the exocrine glands, which alters their function producing dryness of the mouth, eyes and other mucous membranes. The method used to quantify glandular hypofunction is by whole saliva flow stimulated and unstimulated (UWSF) [1], which takes between 5 and 15 minutes (min). The Saxon test [2], is another tool with the same objective but requires less time: 2 minutes. In the literature, we only have found one study that compares the Saxon test with other diagnostic methods although it is developed in patients without SS [3].ObjectivesTo compare the Saxon test and UWSF in a cohort of patients with suspected SS.MethodsIn a consecutive cohort of patients who attended the rheumatology department for suspected SS, UWSF was measured (mL/5 min) and the Saxon test (gr/2 min) was performed. The Index Reported by Patients with Sjögren’s Syndrome of the EULAR (ESSPRI) was collecte...
BackgroundThe development of targeted biologic (bDMARDs) and targeted synthetic disease-modifying... more BackgroundThe development of targeted biologic (bDMARDs) and targeted synthetic disease-modifying drugs (tsDMARDS) has made a substantial change in the control of our patients, and has allowed an increasing number of patients to achieve clinical remission.ObjectivesTo gain understanding of patients’ experiences of starting treatment with b/tsDMARDs, and explore their attitudes in order to improve the doctor-patient relationship, adherence to treatment, compliance, and knowledge about the experience of using b/tsDMARDs.MethodsA qualitative study was carried out. A consecutive sample of 130 patients attended in the rheumatology units of four Madrid hospitals, from August 29th, 2021 to January 21st, 2022 completed a questionnaire that consisted of 31 questions, a subsequent qualitative analysis of discourse and content through focus groups with patients was carried out. Descriptive statistical analysis was performed. Chi-squared tests were applied to explore the dependency relationship...
Background: The MSK components of the BILAG and SLEDAI have limited sensitivity, specificity and ... more Background: The MSK components of the BILAG and SLEDAI have limited sensitivity, specificity and responsiveness. Objectives: To develop a better disease activity tool for MSK lupus. Methods: "LAMDA" was derived using data from the multicentre USEFUL study (PMID:33792659); 133 patients with inflammatory MSK pain received intramuscular depomedrone then were assessed for 66/68 SJC/ TJC, BILAG-2004, SLEDAI-2K, physician MSK-VAS, inflammatory markers, patient pain and disease-activity-VAS and MSK-ultrasound. Baseline variables were modelled against US using penalized (Lasso) regression. For validation we evaluated: (i) responsiveness at week 6 in USEFUL and (ii) association with quality of life and treatment decision in an independent study (n=100). Results: LAMDA was a composite of SJC, patient-MSK-pain-VAS, physician-MSK-disease-activity-VAS and ESR ranging from 0 to 26.5. Response effect size was greater for the LAMDA (0.37) than the BILAG-MSK (0.31), SLE-DAI-MSK (0.27) and total US score (0.33). With active US at baseline, LAMDA's effect size was 0.42. In the validation study LAMDA score correlated with better physical function (R =-0.49, p<0.001), pain (R =-0.44, p=0.002) and Burden to Others (R =-0.38, p=0.009). LAMDA was higher when therapy was increased (mean (95% CI) difference 12.9 (5.8, 19.9), p<0.001). Conclusion: LAMDA is a continuous disease activity instrument for MSK lupus that is sensitive to imaging-synovitis without swelling, more responsive than other instruments and correlates with quality of life and treatment decision. LAMDA may improve the ability of clinicians to monitor and treat MSK lupus, and determine the efficacy of therapies in clinical trials.
BackgroundThe rate of psoriatic arthritis progression is increased in those patients presenting w... more BackgroundThe rate of psoriatic arthritis progression is increased in those patients presenting with established disease greater than 2 years duration, so it is necessary to find tools that allow early diagnosis to prevent joint damage1. Prevalence of psoriatic arthritis varies according to the screening strategies used. The COMPAQ study compared four screening questionnaires for psoriatic arthritis (PEST, ToPAS, PASE and EARP), whose sensitivities ranged from 44 to 91%, with the EARP questionnaire showing the highest sensitivity2. A new, shorter questionnaire, PURE-4 scale, has been developed, with a sensitivity of 85.7%3.ObjectivesTo evaluate the usefulness of PURE-4 scale in real clinical practice conditions to identify patients with psoriatic arthritis in patients with psoriasis referred from a dermatology department to a rheumatology department.MethodsRetrospective descriptive study of patients diagnosed with psoriasis who have been referred from the Dermatology Department in t...
BackgroundThe EPISER study is the first Spanish epidemiological study that has confirmed the grea... more BackgroundThe EPISER study is the first Spanish epidemiological study that has confirmed the great burden of rheumatic diseases in the general population: they consume a large quantity of health resources (doctor visits, medical products) and imply a high social impact in terms of work absenteeism. Rheumatic diseases represent almost 30% of Primary Care medical consultations in Spain1,2. Electronic consultation could be an alternative response to the increase of this demand, both to make an early diagnosis and derivation and to improve communication with Primary Care physicians3,4.ObjectivesTo analyze the demand of Primary Care and its resolution through the electronic consultation system of the Rheumatology Department of a tertiary hospital.MethodsRetrospective descriptive study of the data collected in the request and information system (Sistema de Peticiones Electrónicas, SIPE) that supports electronic consultation between primary care physicians of the health area and the Rheuma...
BackgroundAnti-transcriptional intermediary factor 1γ (anti-TIF 1γ) antibody is robustly linked w... more BackgroundAnti-transcriptional intermediary factor 1γ (anti-TIF 1γ) antibody is robustly linked with cancer-associated dermatomyositis (DM) in adults, but its specificity varies widely between series. TIF 1γ can act either as a tumor promoter or suppressor and may behave as an autoantigen.ObjectivesInvestigate the association between anti-TIF 1γ antibody positivity and development of neoplasia.MethodsA retrospective chart review was conducted among patients with positive anti-TIF 1γ antibodies detected by immunoblot from March 2019 to December 2021 in three tertiary hospitals. Demographic variables, creatine kinase (CK) values, other autoantibodies, associated autoimmune diseases (AIDs) and existence or not of a cancer diagnosis were analyzed. To rule out malignancy, patients had to present a PET-CT scan without pathological findings or a chest CT scan, a gynecological study and a digestive study without alterations. A descriptive statistical analysis was performed.Results29 patient...
The effects of Lisuride, a dopaminergic agonist, on the levels of plasma prolactin (PRL), testost... more The effects of Lisuride, a dopaminergic agonist, on the levels of plasma prolactin (PRL), testosterone, luteinizing hormone (LH), follicle-stimulating hormone (FSH), and on the variations of libido and coital frequency of patients with chronic renal failure (CRF) have been investigated in a group of 20 male patients (ten normoprolactinemic and ten hyperprolactinemic). Ten patients were included in a hemodialysis program and another ten received conservation therapy (all had creatinine clearance rates below 15 mL/min). The response of PRL to TRH administration and that of LH and FSH to LH-RH administration have also been studied. Low levels of plasma testosterone found initially in all the patients, increased in both normoprolactinemic (P less than 0.05) and hyperprolactinemic patients (P less than 0.01) during Lisuride administration. PRL decreased (P less than 0.01) in both groups during therapy. The increase of plasma testosterone was greater in hyperprolactinemic patients (86% v 15% in normoprolactinemic) and was accompanied by a clear improvement in the studied parameters of sexual behaviors. The response of PRL to TRH was modified in hyperprolactinemic patients while that of LH and FSH to LH-RH was not modified, although Lisuride induced an increase of the basal value of LH (P less than 0.01) in the hyperprolactinemic group. The drug was fairly well tolerated, did not induce hypotension, and the overall incidence of side effects decreased along the study. These results stress the need for further studies with this agent in patients with chronic renal failure and sexual dysfunction.
The role of the tonic inhibitory effect of dopamine on aldosterone secretion has been investigate... more The role of the tonic inhibitory effect of dopamine on aldosterone secretion has been investigated in 10 patients with chronic renal failure (CRF) on hemodialysis, in 8 normotensive renal transplant recipients (Tx) with normal renal function and in 8 normotensive volunteers (NV). The following tests were performed: the response of plasma aldosterone (PA) to metoclopramide administration; the response of plasma prolactin (PRL) to TRH administration, and the changes induced by Lisuride (a dopaminergic agonist, on the values of PA and PRL). The basal values of PA and PRL were higher in CRF than in NV and Tx. The inverse was true for plasma renin activity (PRA) values. The response of PA and PRL to metoclopramide showed blunted increases in CRF when compared to NV, in the absence of changes of PRA, cortisol and potassium. After TRH administration, PRL increase in CRF was also inferior. Lisuride induced a decrease of both PA and PRL both in CRF and NV. In Tx, basal values of PA and PRL w...
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