Papers by Juan Carlos López Robledillo
Paediatric rheumatology, 2018
Note: the number above each bar represents the number of patients at that dose. The ACR Pediatric... more Note: the number above each bar represents the number of patients at that dose. The ACR Pediatric-30,-50, À70, and À90 responses were defined as an improvement of at least 30% (or 50%, 70%, 90% respectively) from baseline in at least 3 of the 6 signs and symptoms variables, with no more than 1 of the remaining variables worsening by >30%. JIA signs and symptoms variables: physician's global assessment of disease activity, CHAQ disability index score, CHAQ global assessment of well-being, number of joints with active arthritis, number of joints with limited range of motion, serum CRP or ESR. Conclusions: Improvement in JIA signs and symptoms occurred at most assessments and by month 6, the percentage of patients with an ACR Pediatric-30,-50,À70, and À90 Response was 47.1%, 38.2%, 32.4%, and 17.6%. No new safety signals were identified for the well-characterised components of this fixed dosed JIA treatment, which was developed to reduce the risk of gastric ulcers.
SLICC-2012 were low sensitivity and low specificity, respectively. To avoid misclassifications, a... more SLICC-2012 were low sensitivity and low specificity, respectively. To avoid misclassifications, a new set of classification criteria have been developed by the collaboration of the European League Against Rheumatism (EULAR) and the American College of Rheumatology (ACR) and the draft was presented at the 2017 ACR/ARHP Annual Meeting in San Diego, California. After application on 500 SLE patients and 500 controls, the sensitivity and specificity were found as 98% and 97%, respectively. Objectives: To compare the sensitivity of the new EULAR/ACR criteria with those of the 1997 American College of Rheumatology (ACR) criteria and 2012 Systemic Lupus International Collaborating Clinics criteria in juvenile-onset SLE patients. Methods: Patients initially were evaluated by ACR-1997, SLICC-2012 and EULAR/ACR classification criteria at baseline, when the diagnosis for the first time had been established by an expert paediatric rheumatologist (OK). All data were obtained from patient records. The diagnostic sensitivity of the three sets of classification criteria were further tested within 1 year of diagnosis and at last patient visit, longitudinally. Results: A total of 104 juvenile-onset SLE patients were enrolled for the sensitivity performance of classification criteria at diagnosis. Since the follow-up period was less than 1 year, 12 subjects excluded after baseline evaluation. Finally, 92 subjects were eligible for sensitivity evaluation within 1 year of diagnosis and at last visit. The median age at diagnosis of clinician was 13.0 years (range 3.1-17.9 years, interquartile range (IQR) 11.1-16.5 years) with a median disease duration of 5.0 years (IQR 3.0-8.0 years). The female-to-male ratio was 4.7:1. The newly developed EULAR/ACR classification criteria were more sensitive than SLICC-2012 and ACR-1997 at diagnosis (93.3% versus 91.3% and 85.6%, respectively), and at first year (95.7% versus 94.6% and 90.2%, respectively (p>0.05). At last visit the sensitivity of the new set of criteria and SLICC-2012 were same (97.8%), but higher compared to ACR-1997 criteria (95.7%). Conclusions: Juvenile-onset systemic lupus erythematosus was classified by the newly proposed EULAR/ACR criteria with higher sensitivity compared with SLICC-2012 and ACR-1997 at disease onset and within one year of diagnosis. However, last visit assessment demonstrated equal sensitivity between new EULAR/ACR criteria and SLICC-2012. Although the difference was not significant, the new set of criteria seem to be capable of recruiting more children with juvenile SLE to clinical trials.
Reumatología clínica, Sep 1, 2017
Annals of the Rheumatic Diseases, Jun 1, 2016
Background: Currently we have biological treatments for control juvenile idiopathic arthritis (JI... more Background: Currently we have biological treatments for control juvenile idiopathic arthritis (JIA), we have specific protocols that help us to handle, and do not know the exact time they keep these treatment, which conducted this study survival the biological agent. Objectives: The purpose this work is describe the survival time of biological drugs used in patients diagnosed with JIA, excluding the form systemic, in a pediatric unit of a children's hospital in the last 5 years. Methods: Descriptive analytic study of patients diagnosed with JIA (non-systemic) (as proposed by ILAR nomenclature, Edmonton 2001), who received biological treatment from 1 January 2010 to 30 June 2015. It considered as an event end the suspension of treatment by state remission or change to regimen decrease. Statistical analysis performed using the Kaplan-Meier and log rank test with SPSS.19.0 program. Results: Total 90 patients diagnosed with JIA with biological treatment in the last 5 years, 2/3 female (60 girls, 66.7%), 1/3 male (30 boys, 33.3%), mean age 5 years 2 months (minimum: 1 year 11 months, maximum: 15 years 6 months). The distribution of JIA: Oligoarticular arthritis 40% (42 patients). Polyarticular RF negative arthritis 22.9% (24 patients). Enthesitis-Related arthritis 15.2% (16 patients). Polyarticular RF positive arthritis 3.8% (4 patients). Psoriatic arthritis 3.8% (4 patients). Total 100 treatments: 49% adalimumab, 46% etanercept, 5% Tocilizumab. Median time of 36 months overall monitoring (SD ± 21.8). Continue with the drug 45 patients, 45 achieved remission or regimen decrease (23 adalimumab, 20 etanercept, 2 tocilizumab), replaced by inefficiency 7, suspended for toxicity 3. Namely 45 and 55 censored events cases. Medians for survival time: 56 months adalimumab (95% CI 46.5-65.5), 48 months etanercept (95% CI 38.8-57.2), Tocilizumab 46 months. The comparison between the survival curves of etanercept and adalimumab (Logrank) was 0.092 (p=0.762). Conclusions: The time when "survive" (remain) biological treatment are significantly prolonged, over 4 years, with little difference between the two treatments used (etanercept and adalimumab). In addition, it can be deduced that serious side effects are rare, since in this cohort were replaced only in three cases by significant adverse effects. No significant differences in the comparison of the survival curves of the main biological treatments used were found.
PubMed, Jun 1, 2021
Introduction: Lupus nephritis is an early manifestation in the development of systemic lupus eryt... more Introduction: Lupus nephritis is an early manifestation in the development of systemic lupus erythematosus that worsens the morbidity and mortality of these patients. Objective: To study the form of presentation in patients with lupus nephritis, the clinical and immunological characteristics, and their relationship with renal histology. Patients and method: Retrospective study in children under 18 years of age, with lupus nephritis, in follow-up in a third level children's hospital in Madrid, between January 2012 and May 2020. We recorded demographic, clinical, and laboratory data (blood count, renal function, liver function, protein, ionogram, blood glucose, uric acid, lactate dehydrogenase, coagulation, and urine analysis), as well as immunological data (immunoglobulins, antinuclear antibodies, comple ment, and lupus anticoagulant), and histological classification data. Descriptive analysis and analysis of associations between variables was performed, with a significant p < 0.05. Results: 16 patients (11 women) were included, the median age at presentation was 10.6 ± 2.3 years (5.7-15.3). The median time between symptoms onset and renal involvement was 6.3 months ± 10.5 (range 0 - 33.6). Renal involvement was the initial manifestation in 37.5% of patients. 50% had arthralgias or arthritis prior to diagnosis, and 25% had fever and constitutional symptoms (asthenia, anorexia, and/or weight loss). The most frequent form of renal involvement was microhematuria associated with proteinuria in non-nephrotic range. In the renal anatomo-pathological study, according to the ISN/RPS 2003 classification, grades III (46.6%) and IV (33.3%) predominated. Conclusions: Six patients presented renal involvement at baseline with musculoskeletal involvement being more frequent. Most patients (86.6%) presented advanced lupus nephritis in the histological study at diagnosis. Immunologic in volvement was the only marker that correlated with systemic involvement.
Reumatología Clínica, Sep 1, 2017
Reumatología Clínica, Nov 1, 2013
Objetivos: En la Comunidad de Madrid (CM): a) describir la distribución de reumatólogos del secto... more Objetivos: En la Comunidad de Madrid (CM): a) describir la distribución de reumatólogos del sector público; b) identificar las variables de las que depende la carga de trabajo en Reumatología, y c) construir un modelo predictivo sobre la necesidad de reumatólogos para los próximos 10 años. Metodología: La información se obtuvo mediante cuestionarios estructurados enviados a todos los servicios/unidades de Reumatología de los hospitales públicos de la CM. Las cifras y estimaciones de la población se obtuvieron del Instituto Nacional de Estadística. Se construyó un modelo predictivo que se basa en información sobre la oferta actual y previsible, la demanda actual y previsible, y las asunciones y criterios utilizados para adaptar la oferta a la demanda. La incertidumbre subyacente en el modelo se evaluó mediante análisis de sensibilidad. Resultados: En la CM en 2011 había 150 reumatólogos de plantilla y 49 residentes distribuidos en 27 centros, que equivale a un reumatólogo activo por cada 33.280 habitantes en la población general, y por cada 4.996 habitantes mayores de 65 años. Para mantener el nivel de asistencia de 2011 en 2021 en la población general, solo sería necesario formar más residentes o contratar más reumatólogos en escenarios de aumento de la demanda superior al 15%. Sin embargo, para mantenerlo en la población mayor de 65 años, sería necesario formar más residentes o contratar más especialistas, aún sin aumento de la demanda. Conclusiones: El modelo desarrollado es muy útil para planificar con los responsables de la CM las necesidades de recursos humanos en Reumatología en los próximos años.
appointments before and after transition of care was evaluated in a scale of 0 to 10. Variables w... more appointments before and after transition of care was evaluated in a scale of 0 to 10. Variables were analysed as means, medians and frequencies as appropriate. Univariate analysis was performed with student t-test and Qui-square. Results: 126 patients were included. Of these, 77 (61.1%) had juvenile idiopathic arthritis (JIA, see table I for list of diagnosis), 78 (61%) were female with a mean age of 23.1±3.2 years and a mean disease duration of 12.7±5.3 years. During the transition of care, 92 patients were treated with conventional disease modifying antirheumatic drugs (73%) and 35 with biologic therapy (27.8%). 69 patients (54.7%) missed at least one clinical appointment with a dropout rate of 9%. This was associated with longer disease duration (15.9 vs 12.3 years, p=0.024). 11 patients (8.7%) had worsened clinical activity: 5 patients with polyarticular JIA with arthritis flare (ΔDAS28 2.14 ± 0.83); 4 patients with oligoarticular JIA with new onset uveitis and 2 patients with juvenile systemic lupus erythematosus with a SLEDAI increase from 5 to 16 points. 4 patients abandoned DMARDs. Regarding patient satisfaction questionnaire, paediatric rheumatology appointments had a median evaluation of 9 (7-10), adult rheumatology appointments of 8 (5-10) and the transition process had an evaluation of 8 (5-10). The majority of patients reported the longer appointment waiting time as the major negative aspect after transition. Conclusion: In our centre the transition of care had a small percentage of dropping out from the clinic, which was associated with longer disease duration, a slight worsening of disease activity and a 10% decrease in patient satisfaction.
Revista española de pediatría, 2003
Reumatología clínica, Nov 1, 2013
Objectives: To: (1) describe the distribution of the public sector rheumatologists; (2) identify ... more Objectives: To: (1) describe the distribution of the public sector rheumatologists; (2) identify variables on which the workload in Rheumatology depends; and (3) build a predictive model on the need of rheumatologists for the next 10 years, in the Community of Madrid (CM). Methodology: The information was obtained through structured questionnaires sent to all services/units of Rheumatology of public hospitals in the CM. The population figures, current and forecasted, were obtained from the National Statistics Institute. A predictive model was built based on information about the current and foreseeable supply, current and foreseeable demand, and the assumptions and criteria used to match supply with demand. The underlying uncertainty in the model was assessed by sensitivity analysis. Results: In the CM in 2011 there were 150 staff rheumatologists and 49 residents in 27 centers, which is equivalent to one rheumatologist for every 33 280 inhabitants in the general population, and one for every 4996 inhabitants over 65 years. To keep the level of assistance of 2011 in 2021 in the general population, it would be necessary to train more residents or hire more rheumatologists in scenarios of demand higher than 15%. However, to keep the level of assistance in the population over 65 years of age it would be necessary to train more residents or hire more specialists even without increased demand. Conclusions: The model developed may be very useful for planning, with the CM policy makers, the needs of human resources in Rheumatology in the coming years.
Annals of the Rheumatic Diseases, May 23, 2022
Reumatología clínica, May 1, 2020
Pyomyositis is an acute bacterial infection of the striated muscle which is occasionally accompan... more Pyomyositis is an acute bacterial infection of the striated muscle which is occasionally accompanied by the formation of abcesses 1 not secondary to adjacent infection of the skin or bone. Its association with septic arthritis is exceptional. We present the case of a two-year-old child with no remarkable medical history who presented with left gonalgia of major functional limitation of 20 days onset, who was stated to have suffered trauma and a catarrhal process the previous week.
Medicine - Programa De Formación Médica Continuada Acreditado, Sep 1, 2018
La artritis idiopática juvenil (AIJ) y especialmente las conectivopatías son un grupo heterogéneo... more La artritis idiopática juvenil (AIJ) y especialmente las conectivopatías son un grupo heterogéneo de enfermedades poco frecuentes en la adolescencia. Son enfermedades ocasionadas por la inflamación de diversas estructuras corporales debido a una desregulación del sistema inmune. Los síntomas y signos pueden ser inespecíficos y aparecer durante el transcurso de semanas o meses. Mientras que en la artritis idiopática juvenil predomina la afectación articular, la presencia de una afectación en múltiples órganos sin una causa aparente asociada a ciertas manifestaciones clínicas específicas (exantema malar, pápulas de Gottron, fenómeno de Raynaud, esclerodactilia) debe hacer sospechar una conectivopatía. El diagnóstico se establece mediante una combinación de criterios clínicos y analíticos, como la presencia de anticuerpos antinucleares, factor reumatoide o marcadores genéticos como el HLA B27. Es importante iniciar un tratamiento adecuado lo antes posible, en el que se incluya el uso de corticoides, fármacos inmunosupresores y tratamientos biológicos.
Anales De Pediatria, 2001
Se expone el caso clínico de una niña de 2 años y 8 meses de edad que presentó monoartritis de ro... more Se expone el caso clínico de una niña de 2 años y 8 meses de edad que presentó monoartritis de rodilla de instauración y resolución lentas, poco después de haber presentado una faringitis aguda y un proceso diarreico entre 1 y 2 semanas antes, respectivamente. Los datos complementarios sugieren que se trata de una artritis reactiva tras una infección estreptocócica, demostrándose además Salmonella en heces. La artritis reactiva postestreptocócica, a diferencia de la fiebre reumática, suele tener un curso clínico lento y no cumple los criterios de Jones. La coincidencia en el tiempo con el padecimiento de una infección gastrointestinal por Salmonella plantea la posibilidad de que la asociación de ambos gérmenes, productores por sí mismos de artritis reactiva, posean una actuación sinérgica en el paciente referido.
Annals of the Rheumatic Diseases, May 30, 2023
Background: Dermatomyosis is an autoimmune disease that can present in children, adolescents (juv... more Background: Dermatomyosis is an autoimmune disease that can present in children, adolescents (juvenile dermatomyosis JDM), and adults (adult dermatomyositis DM). The pathological hallmarks of DM are similar between JDM and adult DM, including skin rashes and proximal muscle weakness, however, the manifestations and prevalence of associated autoantibodies vary, depending on age of onset. Myositis specific antibodies (MSA) have been used as a prognostic tool to aid management of disease in both adult DM and JDM. In JDM, anti-TIF1γ is highly prevalent, and is the most common MSA in Caucasian patients. This MSA is associated with malignancy in adult DM [1]. We have previously shown that adult DM patients with cancer have significantly higher frequency and serological level of anti-TIF1γ IgG2 isotype [2]. However, there are limited data on anti-TIF1γ isotypes in JDM. Objectives: To investigate anti-TIF1γ isotypes as a potential biomarker for clinical manifestations in JDM. Methods: We conducted a retrospective study to evaluate clinical features of anti-TIF1γ positive patients. This cohort includes 20 patients from French healthcare centres and 11 patients from the UK healthcare centres. Serum samples were first tested for anti-TIF1γ using either lineblot or immunoprecipitation. Within those with anti-TIF1γ antibodies, anti-TIF1γ isotypes including IgG1, IgG2, IgG3 and IgG4 were measured using a multiplex ALBIA assay developed by Aussy et al. (2019) [2].
Anales De Pediatria, Oct 1, 2020
phenotypes were associated with specific MSA. After 5 years, 2/3 of patients had an inactive dise... more phenotypes were associated with specific MSA. After 5 years, 2/3 of patients had an inactive disease, but about half of all patients still received MTX and GC therapy.
Medicine - Programa De Formación Médica Continuada Acreditado, Sep 1, 2014
Andes pediatrica, Jun 22, 2021
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Papers by Juan Carlos López Robledillo