Spanish Registry of Recent-onset Psoriatic Arthritis (REAPSER study): Aims and methodology. / Registro Español de Artritis Psoriásica de Reciente Comienzo (estudio REAPSER). Objetivos y metodología.

AIMS: To describe the methodology of REAPSER (Spanish Registry of Recent-onset Psoriatic Arthritis), its strengths and limitations. The aim of this study is to identify prognostic factors for the clinical and radiographic course in a cohort of patients with psoriatic arthritis (PsA) diagnosed within 2years of symptom evolution. METHODS: Multicenter, observational and prospective study (with 2-year follow-up including annual visits). Baseline visit intended to reflect patient situation before the disease course was modified by treatments prescribed in rheumatology departments. Patients were invited to participate consecutively in one of their routine visits to the rheumatologist. 211 patients were included. Following data were collected: sociodemographic variables; employment situation; family history; personal history and comorbidities; anthropometric data; lifestyle; use of healthcare services; clinical situation at the time of PsA diagnosis; joint involvement and spinal pain; pain and overall assessment; enthesitis, dactylitis and uveitis; skin and nail involvement; functional situation and quality of life; radiographic evaluation; analytical determinations; treatment; axial and peripheral flare-ups. CONCLUSIONS: The REAPSER study includes a cohort of patients with recent-onset PsA, before the disease course was modified by disease-modifying antirheumatic drugs prescribed in rheumatology departments. Exhaustive information collected in each visit is expected to be an important data source for future analysis.

Heel pain in psoriatic arthropathy: Analysis of a series of 291 patients. / La talalgia en la artropatía psoriásica. Análisis de una serie de 291 pacientes.

OBJECTIVE: To determine the prevalence of heel pain in a series of patients with psoriatic arthritis (PsA). MATERIAL AND METHODS: Cross-sectional, observational and retrospective study of a series of 347 patients. All patients fulfilled the CASPAR criteria for PsA and 291 had a clinically significant history of heel pain. The statistical analysis was performed using chi-square test, ANOVA and binary logistic regression. RESULTS: Thirty-five percent of the patients had clinically significant heel pain. A significant association was established between an early onset of skin and joint involvement in the disease and the development of heel pain. However, no significant correlation was found between disease duration and the presence of heel pain. History of dactylitis and PsA in first-degree family members was also statistically associated with this complication. CONCLUSIONS: Clinically significant heel pain was recorded in one third of the patients in this series. There was a statistically significant association with dactylitis, PsA in first-degree family members and an earlier onset of joint and skin disease.

Prevalence of Nasal Colonization with Staphylococcus aureus in Patients with Rheumatoid Arthritis.

Objetive: Patients with Rheumatoid Arthritis (RA) and nasal carriers of Staphylococcus aureus have an increased risk of developing infections caused by S. aureus. Our objective was to determine the prevalence of S. aureus nasal colonization in patients with RA and its relationship to RA treatments. METHODS: Two hundred and seven patients with RA and 37 healthy controls were prospectively included in a cross-sectional study. A nasal secretion sample was collected by swab from both anterior nostrils and was referred to the hospital's microbiology department for culturing. RESULTS: The mean age of the patients (168 women, 78%) was 61 ± 12 years old. The mean disease duration was 13 ± 10 years. Seventy-six percent of the patients were positive for Rheumatoid Factor (RF), and 71% were positive for Anti-citrullinated Peptides Antibodies (ACPA). Seventy percent had joint erosions. The mean DAS28 was 3.1 ± 2.2. S. aureus nasal colonization was found in 36% of the RA patients and 35% of the controls. Three patients and no controls were resistant to oxacilin/ mupirocin. The patients who were positive for ACPA had a higher prevalence of S. aureus colonization (43% vs. 17%; p < 0.05). The colonization prevalence in the patients treated with glucocorticoids was 32% (n: 133); methotrexate and/or leflunomide, 37% (n: 167); anti-TNF agents, 46% (n: 54), p < 0.05 versus patients not treated with anti-TNF agents; rituximab, 22% (n: 18); tocilizumab, 39% (n: 18). CONCLUSION: The prevalence of S. aureus nasal colonization in patients with RA does not appear to be greater than that of the general population. Anti-TNF agents might confer a higher prevalence of colonization.

Axial involvement according to ASAS criteria in an observational psoriatic arthritis cohort.

The definition of axial involvement in psoriatic arthritis (PsA) is still under debate. Currently, the axial spondyloarthritis (SpA) criteria defined by Assessment of Spondyloarthritis International Society (ASAS) may be the most adequate.(1) The aims of present study were to assess axial involvement according to ASAS criteria in an observational PsA cohort and define the clinical characteristics more associated with this kind of involvement. Our study included consecutive patients who had a visit in a tertiary Rheumatology centre. All patients included fulfill ClASsification criteria for Psoriatic Arthritis (CASPAR) criteria for PsA and all of them had a recent radiographic assessment of sacroiliitis. Clinical and laboratorial data were taken into account to classify patients as fulfilling or not ASAS criteria for axial SpA. Clinical and demographic data were analyzed about their association with presence of ASAS criteria of axial SpA in an univariable logistic regression analysis. Variables with a p-value <0.05 were re-tested in a multivariable logistic regression. Those variables that maintained statistical significance were tested alone in another multivariable model. Analyses were performed with IBM SPSS Statistics (version 20.0). Regarding the 233 patients included, only 42 patients (19.4%) fulfilled ASAS criteria for axial SpA. However, 22 patients had asymptomatic radiographic sacroiliitis according to modified New York criteria. The prevalence of asymptomatic sacroiliitis was 15.7% between patients without axial symptoms. In multivariable analysis, inflammatory back pain (IBP) [OR=25.111; 95% confidence interval (CI) = 8.770, 71.900, p-value <0.001], presence of HLA-B27 [OR=9.072; 95% CI=2.756, 29.860; p-value <0.001] and male gender [OR=3.767; 95% CI=1.264, 11.232; p-value = 0.017] were associated to axial involvement according to ASAS criteria. Axial SpA ASAS criteria are useful to identify axial involvement in PsA patients. This type of involvement is more common in males, in the presence of HLA-B27 and IBP. Axial disease should be systematically assessed in clinical practice, mainly in patients presenting with this clinical features.

Cardiovascular disease in immune-mediated inflammatory diseases: A cross-sectional analysis of 6 cohorts.

To analyze in several immune-mediated inflammatory diseases (IMIDs) the influence of demographic and clinical-related variables on the prevalence of cardiovascular disease (CVD), and compare their standardized prevalences.Cross-sectional study, including consecutive patients diagnosed with rheumatoid arthritis, psoriatic arthritis, psoriasis, systemic lupus erythematosus, Crohn disease, or ulcerative colitis, from rheumatology, gastroenterology, and dermatology tertiary care outpatient clinics located throughout Spain, between 2007 and 2010. Our main outcome was defined as previous diagnosis of angina, myocardial infarction, peripheral vascular disease, and/or stroke. Bivariate and multivariate logistic and mixed-effects logistic regression models were performed for each condition and the overall cohort, respectively. Standardized prevalences (in subjects per 100 patients, with 95% confidence intervals) were calculated using marginal analysis.We included 9951 patients. For each IMID, traditional cardiovascular risk factors had a different contribution to CVD. Overall, older age, longer disease duration, presence of traditional cardiovascular risk factors, and male sex were independently associated with a higher CVD prevalence. After adjusting for demographic and traditional cardiovascular risk factors, systemic lupus erythematosus exhibited the highest CVD standardized prevalence, followed by rheumatoid arthritis, psoriasis, Crohn disease, psoriatic arthritis, and ulcerative colitis (4.5 [95% confidence interval (CI): 2.2, 6.8], 1.3 [95% CI: 0.8, 1.8], 0.9 [95% CI: 0.5, 1.2], 0.8 [95% CI: 0.2, 1.3], 0.6 [95% CI: 0.2, 1.0], and 0.5 [95% CI: 0.1, 0.8], respectively).Systemic lupus erythematosus, rheumatoid arthritis, and psoriasis are associated with higher prevalence of CVD compared with other IMIDs. Specific prevention programs should be established in subjects affected with these conditions to prevent CVD.

[Assessment of an intervention on cardiovascular risk factors in patients with rheumatoid arthritis]. / Evaluación de una intervención sobre los factores de riesgo cardiovascular en pacientes con artritis reumatoide.

OBJECTIVES: To evaluate the effectiveness of an intervention on cardiovascular risk factors (CVRF) in patients with rheumatoid arthritis. METHODS: After determining their CVRF and cardiovascular risk (CVR) by modified SCORE, we gave the patients a letter for their general practitioners in which they were requested for their cooperation in controlling CVRF and where the therapeutic goal for LDL cholesterol was specified. Three months later, any therapeutic intervention was recorded as well as the results. RESULTS: We included 211 patients, 29% with a high CVR. There were new diagnoses of CVRF in 100 patients (47%). The general practitioner changed the treatment in 2/12 diabetes, 30/84 HBP, 74/167 with elevation of LDL cholesterol and 21/51 with hypertriglyceridemia. The percentage of patients with good control over CVRF was: a) in HBP, 25 to 73%; b) elevation of LDL cholesterol from 10 to 17%; and c) in hypertriglyceridemia, 25 to 38%. CONCLUSIONS: Through this intervention, a new CVRF was diagnosed in nearly half of the patients. The effectiveness of the intervention on CVRF was low.

Specific cutaneous involvement in Whipple disease.

Cutaneous lesions in Whipple disease (WD) are infrequent, and the histological findings are usually nonspecific. Specific cutaneous lesions have rarely been described and usually involve the subcutaneous fat. We report a patient diagnosed with WD, who developed multiple small subcutaneous nodules after antibiotic treatment was administered. In addition to septal panniculitis, the cutaneous biopsy showed a mild granulomatous dermal reaction with PAS-positive macrophages characteristic of WD. A positive polymerase chain reaction in the cutaneous sample confirmed the presence of Tropheryma whipplei in the skin. Dermatopathologists should be aware that not only subcutaneous lesions but also dermal lesions may exhibit specific findings of WD.

Mutilating/resorptive arthritis. A study of 24 patients in a series of 360 patients with psoriatic arthritis.

OBJECTIVE: To describe a large series of patients with mutilans/resorptive arthritis (AM) of a representative population of patients with psoriatic arthritis (PsA) and analyze the associated variables. METHODS: Multicenter cross-sectional study of consecutive patients affected by PsA in 8 centers. In patients with swelling or deformity of the hands or feet we performed an anteroposterior rx. The patient was affected by AM if erosive disorder affecting both articular surfaces completely was present. RESULTS: Of the 360 patients studied, 24 had PsA and AM (6.7%). The duration of their disease was significantly higher, and they exhibited a worse functional capacity as well as more DIP joint affection (P<.05). 30% had radiological changes indistinguishable from nodular osteoarthritis. CONCLUSIONS: AM in PA is associated with a worse functional capacity. Its possible association with nodular hand osteoarthritis deserves further study.

Assessment of cardiovascular risk in rheumatoid arthritis: impact of the new EULAR recommendations on the score cardiovascular risk index.

To assess the impact of the application of the European League against Rheumatism (EULAR) task force recommendations in the cardiovascular (CV) risk of a series of Spanish patients diagnosed with rheumatoid arthritis (RA). Two hundred consecutive RA patients seen at the rheumatology outpatient clinics of Bellvitge Hospital, Barcelona, were studied. Information on clinical features of the disease, classic CV risk factors, and history of CV events was assessed. Both the systematic coronary risk evaluation (SCORE) CV risk index and the modified SCORE (mSCORE) according to the last EULAR recommendations were calculated. Based on the classic CV risk factors, the mean ± standard deviation SCORE was 2.1 ± 2.3% (median, 2; interquartile range [IQR], 1-3). Twenty-three (11%) patients were above the threshold of high CV risk for the Spanish population (≥5%). Following the EULAR recommendations, a change in the score was required in 119 (59%) patients. Therefore, the mean mSCORE was 2.7 ± 2.9% (median, 2; IQR, 1-3) and, due to this, 28 (14%) patients were above the threshold of high CV risk. Nine (5%) had at least one ischemic CV event. Patients with CV events were older and had more CV risk factors and higher SCORE and mSCORE than those without CV events. Although a large proportion of patients from this series fulfilled the criteria for the application of the EULAR recommendations, the final impact on the calculated CV risk was low and clinically significant in only a few patients. However, an association between the mSCORE and the presence of ischemic CV events was observed.

Relationship between psoriatic arthritis and moderate-severe psoriasis: analysis of a series of 166 psoriatic arthritis patients selected from a hospital population.

The aim of the study was to assess the prevalence of moderate to severe psoriasis (MS-P) in patients with psoriatic arthritis (PsA) and the relationship between MS-P and other variables related to arthritis. One hundred sixty-six consecutive patients with PsA periodically monitored at a university hospital's PsA unit in northeastern Spain were included in the study. Patients with psoriasis were classified as having MS-P when systemic treatment for skin was required. Clinical criteria for treatment indication was BSA >10 and/or PASI >14 and/or psoriasis affecting a very sensitive area of the body. Demographic and clinical data related to arthritis were assessed, including PsA pattern, age of onset of psoriasis and arthritis, disease activity index, and treatment required over the course of the disease. Moderate-severe psoriasis were more prevalent in women (p = 0.027). One hundred nine patients (65.7%) had psoriatic nail disease, and MS-P was more frequent in these patients (40 (77%) vs. 69 (61%), p = 0.028). Patients with spondyloarthropathy were significantly associated with MS-P (7 (16%) vs. 3 (3%), p = 0.014). No statistical association was observed between severe psoriasis and the age of onset of psoriasis or arthritis, involvement of distal interphalangeal joints, laboratory findings (HLA B27, RF), functional class, or disease activity indices. We report a high prevalence of severe psoriasis among patients with psoriatic arthritis, higher in women and patients with psoriatic nail disease and axial spondyloarthropathy.

[Are useful prognostic factors in rheumatoid arthritis?]. / Son útiles los factores pronóstico en la artritis reumatoide?

Rheumatoid arthritis (RA) is an inflammatory disease of unknown etiology, which predominantly affects joints and that confers poor functional and vital outcome. In many patients the inflammatory process is maintained for years, and results in joint destruction and long-term functional disability. Prognostic factors (PF) are demographic, clinical, laboratory and/or radiographic and should be evaluated at the onset of the disease, providing the physician prospective information on patient outcome. The challenge for the rheumatologist is to identify patients who present a poor prognosis in early rheumatoid arthritis and formulate treatment accordingly.

Effect of stopping risedronate after long-term treatment on bone turnover.

CONTEXT: Determining how quickly bisphosphonate treatment effects begin to regress is crucial when considering termination of treatment. OBJECTIVE: Our objective was to assess the effects of 1 yr discontinuation of risedronate use in postmenopausal women with osteoporosis who had previously received risedronate for 2 or 7 yr. DESIGN AND SETTING: Before initiation of the current study, placebo/5-mg-risedronate patients had received placebo for 5 yr and risedronate for 2 yr, whereas 5-mg-risedronate patients had received risedronate for a total of 7 yr. Risedronate was then discontinued for 1 yr (yr 8). PATIENTS: Postmenopausal women with osteoporosis who had previously completed the 3-yr Vertebral Efficacy with Risedronate Therapy MultiNational (VERT-MN) pivotal trial, plus a 2-yr extension comparing risedronate or placebo for a total of 5 yr, followed by 2 yr of open-label risedronate treatment were enrolled in these trial extensions. MAIN OUTCOME MEASURES: Evaluations included changes in type I collagen cross-linked N-telopeptide (NTX)/creatinine (Cr) and bone mineral density (BMD) values, fracture incidence, and adverse events. RESULTS: After 1 yr of risedronate discontinuation, NTX/Cr levels increased toward baseline in both patient groups vs. the values at the end of yr 7. In both treatment groups, off-treatment total hip and femoral trochanter BMD values decreased, whereas lumbar spine and femoral neck BMD were maintained or slightly increased. The adverse event profiles were similar between the two treatment groups during yr 8. CONCLUSIONS: One year of discontinuation of risedronate treatment in patients who had received 2 or 7 yr of risedronate therapy led to increases in NTX/Cr levels toward baseline and decreases in femoral trochanter and total hip BMD.

[Functional impairment in psoriatic arthritis. Multicentric study of 343 patients]. / Capacidad funcional en la artropatía psoriásica: análisis de 343 pacientes.

BACKGROUND AND OBJECTIVE: The study is aimed at improving our knowledge about the functional impairment of the psoriatic arthritis through a multicentral series. PATIENTS AND METHOD: We have designed a transversal and multicentral study (centers of the same geographical area), including 343 patients with psoriatic arthritis. Eight medical centers have participated. Patients have been divided depending on the assistential level where they are visited. We have collected the following data: sex, age, assistential level, duration of psoriasis and arthritis, age at onset of psoriasis and arthritis, clinical form, ARA functional impairment, number of tender and swollen joints, presence of dactylitis, distal interphalangeal affection, axial involvement, ostheolisis or nail lesions, erithrocyte sedimentation rate (ESR), C-reactive protein, hemoglobine, leucocites, platelets, HLA-B27 and rheumatoid factor. RESULTS: 7.14% of the patients were significatly disabled (ARA functional class III and IV). 30.32% were patients visited in a primary assistential level, 30.90% in a secondary assistential level and 38.78% a tertiary and universitary hospital. We found statistically significant correlation between III and IV functional classes and age, assistential level, ostheolisis, corticoid treatment, ESR, leucocites, platelets and number of tender joints. CONCLUSIONS: We find a better functional capacity in our patients than in other studies. The inclusion of patients from different assistential levels instead of just patients visited in a tertiary hospital might be the cause of this difference.

Influence of previous corticosteroid therapy on temporal artery biopsy yield in giant cell arteritis.

OBJECTIVE: To determine the impact of prior corticosteroid treatment on temporal artery biopsy (TAB) yield to establish the diagnosis of giant cell arteritis (GCA). METHODS: Retrospective study of a consecutive cohort of 78 patients clinically diagnosed and managed as GCA, who received corticosteroids before TAB. RESULTS: Among the 78 patients, TAB was positive in 57 (73%) and negative in 21 (27%). No significant differences in the length of the specimen were found between the positive and negative biopsies. We grouped patients according to treatment duration before TAB. In those with newly diagnosed GCA treated with high-dose steroid therapy, the biopsy results were positive in 78% (35/45) of patients treated for less than 2 weeks, in 65% of those treated for 2 to 4 weeks (13/20), and in 40% of those treated for more than 4 weeks (2/5). We also observed 8 patients that developed GCA on a background of a prior history of polymyalgia rheumatica (PMR); in this group biopsy was positive in 88% of the cases, after a median duration of treatment of 180 +/- 172 days and an average daily dose of 7.1 +/- 1.4 mg/d. CONCLUSION: The performance of TAB should not delay the prompt institution of steroid therapy on diagnosis of GCA, since the diagnostic yield of TAB seems valuable within 4 weeks of starting high-dose steroid treatment. In patients that developed GCA on a background of a prior history of PMR, a late TAB is also generally informative despite long-term treatment with low doses of corticosteroids.

Frequency of osteoporosis in 187 men with rheumatoid arthritis followed in a university hospital.

OBJECTIVE: Although there is relevant information on frequency of osteoporosis in women with rheumatoid arthritis (RA), data about male patients are limited. We evaluated the frequency of osteoporosis in a group of Spanish men with RA followed in a university hospital. METHODS: From the database of our bone densitometry unit, we searched for men with RA evaluated between January 1991 and December 2004 and identified 187 patients, 156 of whom were older than 50 years. Previously recorded demographic, disease, and treatment-related variables were collected. Bone mineral density (BMD) was measured by dual x-ray absorptiometry (DEXA). Osteoporosis was defined according to the criteria of the World Health Organization (WHO), recommended for postmenopausal Caucasian women, as a T score