Analysis of disease activity and response to treatment in a large Spanish cohort of patients with systemic lupus erythematosus.

OBJECTIVES: The objectives of this paper are to study the impact of disease activity in a large cohort of patients with systemic lupus erythematosus (SLE) and estimate the rate of response to therapies. METHODS: We conducted a nationwide, retrospective, multicenter, cross-sectional cohort study of 3658 SLE patients. Data on demographics, disease characteristics: activity (SELENA-SLEDAI), damage, severity, hospitalizations and therapies were collected. Factors associated with refractory disease were identified by logistic regression. RESULTS: A total of 3658 patients (90% female; median SLE duration (interquartile range): 10.4 years (5.3-17.1)) were included. At the time of their last evaluation, 14.7% of the patients had moderate-severe SLE (SELENA-SLEDAI score ≥6). There were 1954 (53.4%) patients who were hospitalized for activity at least once over the course of the disease. At some stage, 84.6% and 78.8% of the patients received glucocorticoids and antimalarials, respectively, and 51.3% of the patients received at least one immunosuppressant. Owing to either toxicity or ineffectiveness, cyclophosphamide was withdrawn in 21.5% of the cases, mycophenolate mofetil in 24.9%, azathioprine in 40.2% and methotrexate in 46.8%. At some stage, 7.3% of the patients received at least one biologic. A total of 898 (24.5%) patients had refractory SLE at some stage. Renal, neuropsychiatric, vasculitic, hematological and musculoskeletal involvement, a younger age at diagnosis and male gender were associated with refractory disease. CONCLUSIONS: A significant percentage of patients have moderately-to-severely active SLE at some stage. Disease activity has a big impact in terms of need for treatment and cause of hospitalization. The effectiveness of the standard therapies for reducing disease activity is clearly insufficient. Some clinical features are associated with refractory SLE.

Guía práctica para el manejo de las espondiloartritis (ESPOGUIA): metodología y datos generales del documento / Management of spondyloarthritis (ESPOGUIA): methodology and general data from the document

Antecedentes: La necesidad de una guía de práctica clínica en espondiloartritis (SpA) surge de la complejidad de su manejo junto con el gran avance que tanto su tratamiento como su diagnóstico han experimentado. La variabilidad existente en el manejo de la SpA va más allá de lo aceptable. El objetivo de la ESPOGUIA es reducir la variabilidad en el manejo de las SpA y mejorar la calidad asistencial mediante unas recomendaciones prácticas adaptadas al medio y basadas en la mejor evidencia disponible. Métodos: Para el desarrollo de la ESPOGUÍA se han utilizado los siguientes métodos: grupo nominal, revisión sistemática y encuestas Delphi. El panel de expertos es voluntario, multidisciplinario y basado en criterios de selección. Por primera vez en un documento de recomendaciones de la Sociedad Española de Reumatología (SER), se incluye la opinión del paciente. En una reunión de grupo nominal se establecieron alcance, objetivos, usuarios, organización y necesidades de revisión sistemática. La elaboración de la guía y sus recomendaciones se realizó de forma paralela a las revisiones sistemáticas, mediante una reunión de puesta en común. El nivel de evidencia y la fuerza de la recomendación se establecieron a partir de los niveles del Oxford Center of Evidence-Based Medicine y el grado de acuerdo se obtuvo mediante un ejercicio Delphi a dos rondas. Resultados: Hemos producido una guía de práctica clínica cuyo objeto son todas las SpA, aunque contiene dos subguías, una en espondilitis anquilosante y otra en artritis psoriásica. Los usuarios diana son principalmente los reumatólogos, pero también otros especialistas e implicados, como las enfermeras o las asociaciones de pacientes. El contenido abarca todos los aspectos del manejo de las SpA, desde la sospecha diagnóstica al tratamiento, el seguimiento y el día a día del paciente. Conclusiones: La ESPOGUIA puede convertirse en un instrumento muy útil para el manejo de las SpA y en un referente interactivo (AU)

Background: The need for clinical practice guidelines for spondyloarthritis (SpA) comes from the complexity of its management and the great advances that both its treatment and its diagnosis have experiences, which come accompanied by a great variability in its management that exceeds what is considered acceptable. The objective of the ESPOGUIA is to reduce the variability in the management of SA, improving the quality of care through clinical recommendations adapted to their particular environment and based on the best available evidence. Methods: For the development of ESPOGUÍA the following methods have been employed: nominal group, systematic review and Delphi surveys. The expert panel is voluntary, with multiple disciplines participating and based on selection criteria. For the first time in a SER recommendation document, the opinion of the patient was included. In a meeting of the nominal group, the reach, objective, users, organization and needs of the systematic review were established. The elaboration of the guideline, along with its recommendations, was performed in parallel to the systematic reviews, with a meeting for agreement held afterward. The scoring of the degree of evidence and the level of the recommendation was established from the evidence levels proposed by the Oxford Center of Evidence-Based Medicine and the degree of agreement was obtained through a two-round Delphi exercise. Results: We have produced a clinical guideline that encompasses all of the SpA, although it has two sub-guidelines, one for ankylosing spondylitis and the other one for psoriatic arthritis. The target users are mainly rheumatologists, although other specialists and paramedical staff, such as nurses or patient associations, might benefit. Its content envelops all of the management aspects of SpA, from clinical suspicion to treatment, follow-up and day-to-day activities of the patient. Conclusions: ESPOGUIA can become a very useful instrument for the management of SA and an interactive reference (AU)

Recuperación funcional en la lumbalgia incapacitante: eficacia de una intervención cognitivo-conductal temprana / Functional recovery in low back pain: efficacy of an early cognitive behavioral intervention

Objetivos: El objetivo de este trabajo fue analizar la eficacia de una intervención cognitivo-conductual temprana en la recuperación funcional de la lumbalgia. Pacientes y metodología: se estudiaron 85 pacientes con 102 episodios de lumbalgia incapacitante (IT), 32% varones, con una edad media de 46 años, distribuidos en Grupo Control, 41 episodios y 33 pacientes que siguieron tratamiento habitual y Grupo Intervención, 61 episodios y 52 pacientes que además tuvieron un soporte cognitivo- conductual temprano. Se incluyeron variables de eficacia y una evaluación económica y subjetiva del paciente. Resultados: La duración media de los episodios de IT en el total de pacientes fue de 108 días, en el Grupo Control fue de 120 días y en el Grupo Intervención de 99 días, la diferencia no resultó significativa (p< 0,32). La duración media de los episodios de recaída en el Grupo Control fue 181 días y en el Grupo Intervención de 62 días (p < 0,02). Los pacientes del Grupo Control gastaron una media de 639 € en costes directos y el Grupo Intervención 412 €. Los costes indirectos en el Grupo Control fueron 6.617 € y en el Grupo Intervención 5.439 €, sin diferencias significativas entre ambos grupos. Conclusiones: La eficacia de esta intervención cognitivo-conductual temprana se obtuvo principalmente en los episodios de recaída (AU)

Objectives:The purpose of this study was to analyze the efficacy of an early cognitive behavioral intervention in the functional recovery of the low back pain. Patients and methods: Subjects with an episode of Temporary Work Disability (TWD) of 4 weeks of duration due to low back pain were selected. Efficacy variables included duration of TWD episodes, duration of TWD relapse episodes, an economic evaluation and the own patient perception of disability, health and quality of life. Results: 85 patients were included (33 in control and 52 in intervention), generating 102 episodes of TWD. The duration was reduced in the intervention group (99 versus 120 days), with a relative efficacy of 17%, without differences in the duration of the total of episodes. The episodes of relapse were significantly shorter in the intervention group (62 versus 181 days; p=0,02). Costs were also lower in the intervention group, with a net benefit of 48,028€. Moreover, the intervention patients improved their health and disability perceived. Conclusions: The efficacy of this cognitive behavioral early intervention was mainly obtained in the relapse episodes (AU)