Implant treatment in patients with osteoporosis.

Osteoporosis is very common, particularly in post-menopausal women and is characterized by a decrease in bone mass and strength. Osteoporosis also affects the jawbone and it is considered a potential contraindication to placement of dental implants. The present paper reviews the literature regarding the effect of osteoporosis on osseointegration of implants. Experimental models have shown that osteoporosis affects the process of osseointegration, which can be reversed by treatment. However, studies in subjects with osteoporosis have shown no differences in survival of the implants compared to healthy individuals. Therefore, osteoporosis cannot be considered a contraindication for implant placement. Oral bisphosphonates are the most commonly used pharmacological agents in the treatment of osteoporosis. Although there have been cases of osteonecrosis of the jaw in patients treated with bisphosphonates, they are very rare and it is more usually associated with intravenous bisphosphonates in patients with neoplasms or other serious diseases. Nevertheless, patients treated with bisphosphonates must be informed in writing about the possibility of this complication and must give informed consent. Ceasing to use bisphosphonates before implant placement does not seem to be necessary.

Prospective multicentre study of experience in real-world clinical practice in monitoring reported outcome measures (PROMs) of patient with a diagnosis of psoriatic and/or spondyloarthritis and initiating treatment with secukinumab. / Estudio prospectivo multicéntrico de experiencia en práctica clínica real en el control de medidas de desenlace reportadas por el paciente (PRO) diagnosticado de artritis psoriásica y/o espondiloartritis y que inicia tratamiento con secukinumab.

OBJECTIVE: To analyse the effect of secukinumab on self-reported variables of patients diagnosed with psoriatic arthritis and/or ankylosing spondylitis in relation to their health status, pain, fatigue, sleep and quality of life. METHODS: A six-month, observational, longitudinal, prospective, multicentre study was conducted with 39 patients who initiated treatment with secukinumab as therapy for psoriatic arthritis and/or spondylitis. The main variables were changes in patient-reported measures and they were evaluated by means of the questionnaires: FACIT-fatigue, Insomnia Severity Index, EuroQol-3L-5D and PsAQoL. In addition, depending on the type of disease (peripheral psoriasis or spondyloarthritis) the DAS28 with ESR or the BASDAI were calculated, respectively. RESULTS: Levels of fatigue, moderate and severe insomnia significantly reduced after 6months of treatment with secukinumab. At the same time, patient-reported quality of life increased significantly (P=.006). Data on pain and discomfort also show significant improvement after the treatment. CONCLUSIONS: Patients with psoriatic arthritis and/or ankylosing spondylitis who start treatment with secukinumab show improvement at 6months in all effect sizes of the treatment, particularly in sleep, fatigue and quality of life. Furthermore, patient-reported outcome measures are of additional clinical value and allow more accurate and closer assessment of their real status of health and well-being.

[Efficacy of adalimumab in Behçet's disease. Description of 6 cases]. / Eficacia del adalimumab en la enfermedad de Behçet: descripción de 6 casos.

Behçet's disease (BD) is a systemic vasculitis, with a more aggressive course in young males. Orogenital ulcers, uveitis and cutaneous lesions are the most frequent manifestations. We analyzed the effects of adalimumab on six patients with BD pretreated with inmunosupressive therapy, two of whom had received infliximab. We observed a good clinical response in all patients. To date, after a mean follow-up of 26.8 months, patients continue receiving adalimumab, with good clinical control, no adverse effects have been reported with adalimumab.

[2011 Up-date of the consensus statement of the Spanish Society of Rheumatology on osteoporosis]. / Actualización 2011 del consenso Sociedad Española de Reumatología de osteoporosis.

OBJECTIVE: Due to increasing improvement in the diagnosis, evaluation and management of osteoporosis and the development of new tools and drugs, the Spanish Society of Rheumatology (SER) has promoted the development of recommendations based on the best evidence available. These recommendations should be a reference to rheumatologists and other health professionals involved in the treatment of patients with osteoporosis. METHODS: Recommendations were developed following a nominal group methodology and based on a systematic review. The level of evidence and degree of recommendation were classified according to the model proposed by the Center for Evidence Based Medicine at Oxford. The level of agreement was established through Delphi technique. Evidence from previous consensus and available clinical guidelines was used. RESULTS: We have produced recommendations on diagnosis, evaluation and management of osteoporosis. These recommendations include the glucocorticoid-induced osteoporosis, premenopausal and male osteoporosis. CONCLUSIONS: We present the SER recommendations related to the biologic therapy risk management.

[Current status of day care units where rheumatology treatments are administered in the autonomous community of Valencia]. / Estado actual de los hospitales de día donde se administran los tratamientos de reumatología en la Comunidad Valenciana.

OBJECTIVE: To evaluate and characterize the current status of the Rheumatology Day Hospital Care units in the Autonomous Community of Valencia. MATERIAL AND METHOD: A structured brainstorming meeting was organized with 12 rheumatologists and a nurse and, after that, a questionnaire was sent to 20 rheumatologists to know more about the centers. RESULTS: Variability was found in the services that the day care units have for their own operation and for patient care. Rheumatologists place more importance on having some services that are not present in all centers at the moment: specialized nursing, quick drug delivery from the pharmacy and administration supervision by a rheumatologist. The following deficiencies were identified: sharing the workspaces with other specialties, drug delivery delays from the pharmacy, few resources (few spaces, few locations and little time for drug administration), lack of specialized nursing, lack of some services for patients (i.e. hot-line telephone service or patient education), few clinical sessions and lack of some procedures. CONCLUSIONS: It is necessary to establish measures that lead to the resolution of deficiencies and improve the services offered to patients.