Impact of multimorbidity on the first ts/bDMARD effectiveness and retention rate after two years of follow-up in patients with rheumatoid arthritis from the BIOBADASER registry.

BACKGROUND: Patients with Rheumatoid Arthritis (RA) have a higher prevalence of comorbidities compared to the general population. However, the implications of multimorbidity on therapeutic response and treatment retention remain unexplored. OBJECTIVES: (a) To evaluate the impact of multimorbidity on the effectiveness of the first targeted synthetic or biologic disease-modifying antirheumatic drug (ts/bDMARD), in patients with RA after 2-year follow-up; (b) to investigate the influence of multimorbidity on treatment retention rate. METHODS: Patients with RA from the BIOBADASER registry exposed to a first ts/bDMARDs were included. Patients were categorized based on multimorbidity status at baseline, defined as a Charlson Comorbidity index (CCI) score ≥ 3. A linear regression model, adjusted for sex and age, was employed to compare the absolute DAS28 score over time after ts/bDMARD initiation between the two groups. The Log-Rank test and Kaplan-Meier curve were used to compare the retention rates of the first ts/bDMARD between the groups. RESULTS: A total of 1128 patients initiating ts/bDMARD were included, with 107 (9.3%) exhibiting multimorbidity. The linear regression model showed significantly higher DAS28 (beta coefficient 0.33, 95%CI:0.07-0.58) over a two-year period in patients with multimorbidity, even after adjusting for age and sex. Finally, no differences in the ts/bDMARD retention rate were found between groups (median 6.94-6.96 years in CCI < 3 vs. 5.68-5.62 in CCI ≥ 3; p = 0.610). CONCLUSIONS: Multimorbidity in patients with RA was associated with greater DAS28 scores within the first two years after ts/bDMARD initiation, in comparison with patients without multimorbidity. A slightly shorter retention rate was found in patients with multimorbidity, although the difference was non-significant.

Risk of Ischemic Stroke Associated with Calcium Supplements and Interaction with Oral Bisphosphonates: A Nested Case-Control Study.

Conflicting results about the association of calcium supplements (CS) with ischemic stroke (IS) have been reported. We tested this hypothesis by differentiating between CS alone (CaM) and CS with vitamin D (CaD) and between cardioembolic and non-cardioembolic IS. We examined the potential interaction with oral bisphosphonates (oBs). A nested case-control study was carried out. We identified incident IS cases aged 40-90 and randomly sampled five controls per case matched by age, sex, and index date. Current users were compared to non-users. An adjusted odds ratios (AOR) and 95% CI were computed through conditional logistic regression. Only new users were considered. We included 13,267 cases (4400 cardioembolic, 8867 non-cardioembolic) and 61,378 controls (20,147 and 41,231, respectively). CaM use was associated with an increased risk of cardioembolic IS (AOR = 1.88; 95% CI: 1.21-2.90) in a duration-dependent manner, while it showed no association with non-cardioembolic IS (AOR = 1.05; 95% CI: 0.74-1.50); its combination with oBs increased the risk of cardioembolic IS considerably (AOR = 2.54; 95% CI: 1.28-5.04), showing no effect on non-cardioembolic. CaD use was not associated with either cardioembolic (AOR = 1.08; 95% CI: 0.88-1.31) or non-cardioembolic IS (AOR = 0.98; 95% CI: 0.84-1.13) but showed a small association with cardioembolic IS when combined with oBs (AOR = 1.35; 95% CI: 1.03-1.76). The results support the hypothesis that CS increases the risk of cardioembolic IS, primarily when used concomitantly with oBs.

Association of oral bisphosphonates with cardioembolic ischemic stroke: a nested case-control study.

Background: Bisphosphonates have been reported to increase the risk of atrial fibrillation. Therefore, it is conceivable that they may increase the risk of cardioembolic ischemic stroke (IS). However, most epidemiological studies carried out thus far have not shown an increased risk of IS, though none separated by the main pathophysiologic IS subtype (cardioembolic and non-cardioembolic) which may be crucial. In this study, we tested the hypothesis that the use of oral bisphosphonates increases specifically the risk of cardioembolic IS, and explored the effect of treatment duration, as well as the potential interaction between oral bisphosphonates and calcium supplements and anticoagulants. Methods: We performed a case-control study nested in a cohort of patients aged 40-99 years, using the Spanish primary healthcare database BIFAP, over the period 2002-2015. Incident cases of IS were identified and classified as cardioembolic or non-cardioembolic. Five controls per case were randomly selected, matched for age, sex, and index date (first recording of IS) using an incidence-density sampling. The association of IS (overall and by subtype) with the use of oral bisphosphonates within the last year before index date was assessed by computing the adjusted odds ratios (AOR) and their 95% CI using a conditional logistic regression. Only initiators of oral bisphosphonates were considered. Results: A total of 13,781 incident cases of IS and 65,909 controls were included. The mean age was 74.5 (SD ± 12.4) years and 51.6% were male. Among cases, 3.15% were current users of oral bisphosphonates, while among controls they were 2.62%, yielding an AOR of 1.15 (95% CI:1.01-1.30). Of all cases, 4,568 (33.1%) were classified as cardioembolic IS (matched with 21,697 controls) and 9,213 (66.9%) as non-cardioembolic IS (matched with 44,212 controls) yielding an AOR of 1.35 (95% CI:1.10-1.66) and 1.03 (95% CI: 0.88-1.21), respectively. The association with cardioembolic IS was clearly duration-dependent (AOR≤1 year = 1.10; 95% CI:0.82-1.49; AOR>1-3 years = 1.41; 95% CI:1.01-1.97; AOR>3 years = 1.81; 95% CI:1.25-2.62; p for trend = 0.001) and completely blunted by anticoagulants, even in long-term users (AOR>1 year = 0.59; 0.30-1.16). An interaction between oral bisphosphonates and calcium supplements was suggested. Conclusion: The use of oral bisphosphonates increases specifically the odds of cardioembolic IS, in a duration-dependent manner, while leaves materially unaffected the odds of non-cardioembolic IS.

Using Twitter Data Analysis to Understand the Perceptions, Beliefs, and Attitudes about Pharmacotherapy Used in Rheumatology: An Observational Study.

Twitter has become an important platform for disseminating information about rheumatology drugs by patients, health professionals, institutions, and other users. The aim of this study was to analyze tweets related to 16 drugs used in rheumatology, including their volume, content, and type of user (patients, patients' relatives, health professionals, health institutions, pharmaceutical industry, general press, scientific journals and patients' associations), and to detect inappropriate medical content. A total of 8829 original tweets were obtained, with a random sample of 25% of the total number of tweets for each drug (at least 100 tweets) analyzed. Methotrexate (MTX) accounted for a quarter of all tweets, and there were significant differences in the proportion of tweets issued according to the type of user. Patients and their relatives mainly tweeted about MTX, while professionals, institutions, and patient associations posted more about TNF inhibitors. In contrast, the pharmaceutical industry focused on IL-17 inhibitors. Medical content prevailed in all drugs except anti-CD20 and IL-1 inhibitors and the most discussed medical topic was efficacy, followed by posology and adverse effects. Inappropriate or fake content was found to be very low. In conclusion, the majority of the tweets were about MTX, which is a first-line treatment for several diseases. The distribution of medical content varied according to the type of user. In contrast to other studies, the amount of medically inappropriate content was very low.

Real-World Effectiveness and Treatment Retention of Secukinumab in Patients with Psoriatic Arthritis and Axial Spondyloarthritis: A Descriptive Observational Analysis of the Spanish BIOBADASER Registry.

Rheumatic diseases are extensively managed with biological disease-modifying antirheumatic drugs (bDMARDs), but a notable proportion of patients withdraw in the long term because of lack of effectiveness, adverse events, or the patient's decision. The present real-world analysis showed the effectiveness, retention, and safety data collected in the Spanish BIOBADASER registry for patients with psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA, including ankylosing spondylitis (AS) and non-radiographic axSpA) treated with secukinumab, a human antibody against interleukin-17A (IL-17A), for more than 12 months. Six hundred and thirty-nine patients were analysed (350, 262, and 27 PsA, AS, and nr-axSpA patients, respectively). The results showed an improvement in the disease activity after 1 year of treatment, in terms of decreases of the mean Disease Activity Score 28 using C-reactive protein (DAS28-CRP), the mean Disease Activity Psoriatic Arthritis (DAPSA) score, swollen joint counts (SJC), and tender joint counts (TJC) in PsA patients and decreases in the mean Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the mean Ankylosing Spondylitis Disease Activity Score (ASDAS) in axSpA patients. This improvement was maintained or increased after 2 and 3 years of treatment, indicating that secukinumab is effective in both naïve and non-responder patients. Retention rates were higher when secukinumab was used as the first-line biological treatment, although they were also adequate in the second and third lines of treatment. Collected safety data were consistent with previous reports.

Myo-Spain: Spanish Registry of patients with idiopathic inflammatory myopathy. Methodology.

OBJECTIVES: To describe the methods of the Spanish Registry of patients with idiopathic inflammatory myopathy (IIM) (Myo-Spain), as well as its strengths and limitations. The main objective of the project is to analyse the evolution and clinical management of a cohort of patients with IIM. METHODS: Observational, longitudinal, ambispective and multicentre study of a cohort of patients with IIM seen in rheumatology units in Spain. All patients with a diagnosis of IMM will be included in the regular follow-up of the participating centres, regardless of age on initiation of the process. Incident cases will be all patients who at the beginning of the study have been diagnosed for less than 12 months and prevalent cases for more than 12 months. The registry will include data from the visit at baseline, one year and two years. Socio-demographic, clinical, analytical variables, complications, comorbidities, association with other rheumatic diseases, hospital admissions, mortality and treatments will be collected. In addition, indices, scales and questionnaires of activity, muscle involvement, damage, disability, and quality of life will be determined. The recruitment period will be 23 months. The purpose is to obtain a cohort of 400 patients with IMM. CONCLUSIONS: Myo-Spain registry provides the opportunity to develop a cohort of incident and prevalent patients with IMM in Spain. Myo-Spain will be able to assess in detail the clinical characteristics of the disease at different times. The comprehensive information collected during the visits is expected to provide a broad source of data for future analysis.

Analysis of Tweets Containing Information Related to Rheumatological Diseases on Twitter.

BACKGROUND: Tweets often indicate the interests of Twitter users. Data from Twitter could be used to better understand the interest in and perceptions of a variety of diseases and medical conditions, including rheumatological diseases which have increased in prevalence over the past several decades. The aim of this study was to perform a content analysis of tweets referring to rheumatological diseases. METHODS: The content of each tweet was rated as medical (including a reference to diagnosis, treatment, or other aspects of the disease) or non-medical (such as requesting help). The type of user and the suitability of the medical content (appropriate content or, on the contrary, fake content if it was medically inappropriate according to the current medical knowledge) were also evaluated. The number of retweets and likes generated were also investigated. RESULTS: We analyzed a total of 1514 tweets: 1093 classified as medical and 421 as non-medical. The diseases with more tweets were the most prevalent. Within the medical tweets, the content of these varied according to the disease (some more focused on diagnosis and others on treatment). The fake content came from unidentified users and mostly referred to the treatment of diseases. CONCLUSIONS: According to our results, the analysis of content posted on Twitter in regard to rheumatological diseases may be useful for investigating the public's prevailing areas of interest, concerns and opinions. Thus, it could facilitate communication between health care professionals and patients, and ultimately improve the doctor-patient relationship. Due to the interest shown in medical issues it seems desirable to have healthcare institutions and healthcare workers involved in Twitter.

Myo-Spain: Spanish Registry of Patients with Idiopathic Inflammatory Myopathy. Methodology. / Myo-Spain: Registro de pacientes con miopatía inflamatoria idiopática de España. Metodología.

OBJECTIVES: To describe the methods of the Spanish Registry of patients with idiopathic inflammatory myopathy (IIM) (Myo-Spain), as well as its strengths and limitations. The main objective of the project is to analyse the evolution and clinical management of a cohort of patients with IIM. METHODS: Observational, longitudinal, ambispective and multicentre study of a cohort of patients with IIM seen in rheumatology units in Spain. All patients with a diagnosis of IMM will be included in the regular follow-up of the participating centres, regardless of age on initiation of the process. Incident cases will be all patients who at the beginning of the study have been diagnosed for less than 12 months and prevalent cases for more than 12 months. The registry will include data from the visit at baseline, one year and two years. Socio-demographic, clinical, analytical variables, complications, comorbidities, association with other rheumatic diseases, hospital admissions, mortality and treatments will be collected. In addition, indices, scales and questionnaires of activity, muscle involvement, damage, disability, and quality of life will be determined. The recruitment period will be 23 months. The purpose is to obtain a cohort of 400 patients with IMM. CONCLUSIONS: Myo-Spain registry provides the opportunity to develop a cohort of incident and prevalent patients with IMM in Spain. Myo-Spain will be able to assess in detail the clinical characteristics of the disease at different times. The comprehensive information collected during the visits is expected to provide a broad source of data for future analysis.

Factors associated with long-term retention of treatment with golimumab in rheumatoid arthritis, axial spondyloarthritis, and psoriatic arthritis: an analysis of the Spanish BIOBADASER registry.

BACKGROUND: Retention of biological treatment provides a marker of drug effectiveness and patient satisfaction. Retention of golimumab was high in clinical trial extensions and real-world studies up to 5 years in patients with immune-mediated rheumatic diseases. OBJECTIVE: To assess the probability of real-world long-term retention of treatment with golimumab up to 7 years after treatment initiation. METHODS: This retrospective noninterventional study involved analysis of the Spanish biological drugs registry, BIOBADASER. Adults who had ever received golimumab for rheumatoid arthritis (RA), axial spondyloarthritis (SpA), or psoriatic arthritis (PsA), and had initiated it > 6 months before the analysis date, were included. RESULTS: Among 685 patients (28.5% RA, 42.9% SpA, 28.6% PsA), the overall probability of retention of golimumab treatment since initiation was 71.7% (95% confidence interval 68.1-74.9) at year 1, 60.5% (56.5-64.2%) at year 2, 55.6% (51.5-59.5%) at year 3, 50.6% (46.2-54.8%) at year 4, 45.1% (40.1-50.0%) at year 5, 44.2% (39.0-49.3) at year 6, and 39.5% (32.8-46.2) at year 7. Retention was greater in patients with axial SpA or PsA versus RA (p < 0.001) and when golimumab was used as first-line treatment versus third or later lines (p < 0.001). Factors associated with greater golimumab retention in Cox regression included use as first-line biological therapy, having axial SpA or PsA rather than RA, and concomitant methotrexate therapy. Steroids were associated with lower retention. CONCLUSION: In this real-world study of RA, axial SpA, and PsA patients, the retention rate of golimumab was 39.5% at year 7. Key Points • Retention of biological treatment provides a marker of drug effectiveness and patient satisfaction. • This real-world study of 685 patients with rheumatoid arthritis (RA), axial spondyloarthritis (SpA), or psoriatic arthritis (PsA) showed that golimumab treatment had a retention rate up to 39.5% at year 7. • Greater golimumab retention was associated with use as first-line biological therapy, having axial SpA or PsA rather than RA, and concomitant methotrexate therapy.

Perfil de consumo y costo de bebidas habituales y recomendadas en méxico, 2012-2018 / Profile of consumption and cost of usual and recommended drinks in mexico, 2012-2018

El objetivo de este estudio fue medir y comparar el comportamiento inflacionario del costo de las Bebidas Habituales y del costo de la Jarra de Bebidas Recomendada para la población mexicana. Basados en información sobre el consumo de bebidas en adultos (Encuesta Nacional de Salud y Nutrición) y de los precios promedio mensuales (Instituto Nacional de Estadística y Geografía) para cada bebida durante enero 2012 - Junio 2017, se calcularon los costos del consumo y la inflación de bebidas habitual y recomendado. El costo de las Bebidas Recomendadas es consistentemente mayor que el de las Bebidas Habituales. Las tasas de inflación son similares excepto en 2014 cuando se introdujo el impuesto a las bebidas azucaradas. Se encuentra que los precios y la inflación de las bebidas con azucares añadidos y de las bebidas habituales responden menos que proporcionalmente. Una inflación del costo de las bebidas recomendadas más alta que las habituales puede incrementar la demanda por bebidas habituales. El comportamiento de la inflación revela que el impuesto a bebidas azucaradas puede ser efectivo pero transitorio(AU)

The aim of this study was to measure and compare the inflationary behavior of the Usual Drinks Intake cost and the Recommended Drinks Intake Jar cost for the Mexican population. Based on information about the consumption of drinks in adults (National Health and Nutrition Survey) and of the average monthly prices (National Institute for Statistic and Geography) for each specific drink during January 2012-June 2017, we calculate consumption costs and inflation of usual and recommended drink intakes. The cost of the recommended drinks is consistently higher than the usual drinks cost. Inflation rates are similar in both drink intakes except in 2014, when the tax to sugary drinks was implemented. Prices and inflation of sugary drinks and usual drinks respond less than proportionally. A higher inflation of recommended drink costs compared to the usual drinks inflation could increase the demand for usual drinks. The behavior of inflation reveals that the tax to sugary drinks can be effective, but transitory(AU)

ABC para los cuidados de enfermería a pacientes con enfermedad terminal en Atención Primaria de Salud / ABC for Nursing Care to Terminal Patients in Primary Health Care

Fundamento: el enfermo terminal padece un proceso agudo o crónico que lo sumerge en una situación crítica y lo conduce a la muerte. Cuando curar ya no es posible, el objetivo se centra en proporcionar al moribundo bienestar y alivio, por eso es muy importante la adecuada orientación a las enfermeras encargadas de cuidar a estos enfermos. Objetivo: elaborar un ABC para los cuidados de enfermería a pacientes con enfermedad terminal en Atención Primaria de Salud. Métodos: investigación realizada en el Policlínico Docente Área VI del municipio de Cienfuegos, en el periodo de enero a junio de 2012, para confeccionar el ABC para cuidados de enfermería a pacientes con enfermedad terminal en Atención Primaria de Salud. Se emplearon los métodos teóricos de análisis y síntesis e inducción deducción y empíricos: análisis de documentos y tormenta de ideas. Resultados: el ABC para el cuidado de enfermería al enfermo terminal quedó conformado para las etapas: inicial o de estabilidad, sintomática o de estado, de declive y final de agonía; en cada una de ellas se incluyeron los posibles diagnósticos, objetivos y acciones. El documento está confeccionado para que pueda ser utilizado por todo el personal de enfermería que atienda a estos pacientes, independientemente de su categoría ocupacional. Conclusiones: el ABC confeccionado pudiera ser de utilidad para facilitar los cuidados de enfermería al enfermo terminal en la atención primaria de salud.

Background: Terminal patients suffer from an acute or chronic process that immerses them in a critical situation leading to death. When providing a cure is no longer possible, the focus is on providing comfort and relief for the dying. Therefore, it is very important to provide an appropriate orientation to the staff nurses taking care of these patients. Objective: To develop an ABC for nursing care to terminally ill patients in Primary Health Care. Methods: A research was conducted in Area VI Polyclinic, in the municipality of Cienfuegos, from January to June 2012, in order to conform the ABC for nursing care to terminally ill patients in Primary Health Care. Theoretical methods of analysis and synthesis and induction-deduction as well as empirical methods were used: document analysis and brainstorming. Results: The ABC for nursing care to terminal patients was conformed for the following stages: initial or stability, symptomatic or state, and decline and final agony. In each of them possible diagnoses, objectives and actions were included. The document was created in such a way that it can be used by all nurses who attend these patients, regardless of their occupational category. Conclusions: This ABC could be useful to facilitate nursing care to terminally ill patients in primary health care.