[Differences in the management of early and established rheumatoid arthritis]. / Diferencias en el manejo de la artritis reumatoide precoz y establecida.

OBJECTIVE: To assess the differences in the clinical and therapeutic management of early and established rheumatoid arthritis (RA) in clinical practice. METHODS: Retrospective and multicentre study including 360 patients diagnosed with RA. During the 12 months prior to the study, onset, sociodemographic, clinical and therapeutic data were collected by clinical chart review. RESULTS: A total of 152 patients with early RA and 208 with established RA were studied. 97.5% had received disease-modifying anti-rheumatic drugs (DMARDs) and 43.6% a TNFa blocker between the diagnosis and the start of the study. Established RA patients used TNFa blockers more frequently than early RA patients (60,1% vs 21,1%, p<0,001). Methotrexate was the most commonly used drug (70.6%). A treatment change was seen in 79% of patients with early RA and 60.6% of those with established RA. A dose change was the most frequent modification and an inadequate response the most frequent reason. A 25.8% of treatments were stopped due to adverse events. The mean (SD) decrease on DAS28 score was 0.9 (1.5) on early RA and 0.2 (1.0) on established RA patients. A 35.8% of early RA patients showed a good EULAR response, while only 16.2% among established RA patients (p<0.001). Rheumatoid factor and radiological progression assessment were the most requested determinations in early RA (p<0.05). CONCLUSIONS: Spanish rheumatologists used biological drugs with a higher frequency in patients with more advanced disease, as recommended in the main clinical practice guidelines.

[Prevalence of symptoms of anxiety and depression in patients with psoriatic arthritis attending rheumatology clinics]. / Prevalencia de síntomas de ansiedad y de depresión en pacientes con artritis psoriásica en consultas de reumatología.

UNLABELLED: FUNDAMENTAL AND OBJECTIVE: Psychological impairment is frequent in patients with rheumatic diseases. The aim of the study was to assess the prevalence of symptoms of anxiety and depression in patients with psoriatic arthritis attending rheumatology clinics. PATIENTS AND METHOD: Multicentre cross-sectional study conducted in rheumatology clinics. Patients with psoriatic arthritis were recruited; variables retrieved were sociodemographic, clinical and patient centered (Hospital Anxiety and Depression scale o HADs, EQ-5D questionnaire, etc.). Prevalence in the study population was calculated as anxiety or depression symptoms by an HADs score ≥11 or those receiving pharmacological treatment. A logistics regression model was used to know which variables were related to symptoms of anxiety or depression. RESULTS: A total of 495 patients were included, 42.8% were women and median (SD) age was 50.4 (12.7) years. Prevalence of symptoms of anxiety were 29.7% and prevalence of symptoms of depression was 17,6%. Patients with anxiety or depression symptoms had all EQ-5D dimensions affected (p<0.01). Higher prevalence of anxiety was related to being a woman, a mixed onset pattern with respect to peripheral joints and those treated with DMARD alone with respect to DMARD+NSAID or biologic alone. A higher depression prevalence was related to being a woman and a mixed onset pattern with respect to peripheral joints. CONCLUSION: The prevalence of anxiety symptoms and the prevalence of depression symptoms are high among patients suffering psoriatic arthritis in the studied population.

Diagnostic evaluation and classification criteria in Sjögren's Syndrome.

OBJECTIVES: Our objective is to carry out a clinical study of the performance of the preliminary European classification criteria for Sjögren Syndrome and that of the criteria proposed by the American European Consensus Group. METHODS: Eighty-eight patients who had undergone a biopsy of the salivary gland on suspicion that they were suffering from Sjögren Syndrome were studied by two independent rheumatologists. Two pathologists independently revised the biopsies without knowing the diagnosis. With all of this information, the clinicians established, or did not establish, a diagnosis of primary Sjögren Syndrome or secondary Sjögren Syndrome. Finally, it was analysed whether or not the patients met the American European Consensus Group classification criteria and the preliminary European criteria for primary Sjögren Syndrome and secondary Sjögren Syndrome, and their sensitivity and specificity with respect to the clinical diagnosis were determined. RESULTS: Clinicians estimated that 35 cases (39.8%) had primary Sjögren Syndrome (kappa 0.718) and 17 cases (19.3%) had secondary Sjögren Syndrome (kappa 0.761). The specificity and sensitivity of American European Consensus Group criteria, with regard to the clinical diagnosis, for primary Sjögren Syndrome were 97.2% and 48.6%, respectively. For secondary Sjögren Syndrome, the specificity was 97.2% and the sensitivity 64.7%. The preliminary European criteria for primary Sjögren Syndrome demonstrated a lesser specificity (75%), but a higher sensitivity (65.7%). In secondary Sjögren Syndrome the specificity reached 97.2% with sensitivity at 70.6%. CONCLUSIONS: These results underline the difficulty in applying the Sjögren Syndrome classification criteria from the American European Consensus Group and the preliminary European criteria, in the diagnosis of individual patients.