RESUMO
OBJECTIVES: To investigate the dynamics of response of synovitis to IL-17A inhibition with secukinumab in patients with active PsA using Power Doppler ultrasound. METHODS: The randomized, placebo-controlled, Phase III ULTIMATE study enrolled PsA patients with active ultrasound synovitis and clinical synovitis and enthesitis having an inadequate response to conventional DMARDs and naïve to biologic DMARDs. Patients were randomly assigned to receive either weekly subcutaneous secukinumab (300 or 150 mg according to the severity of psoriasis) or placebo followed by 4-weekly dosing thereafter. The primary outcome was the mean change in the ultrasound Global EULAR and OMERACT Synovitis Score (GLOESS) from baseline to week 12. Key secondary endpoints included ACR 20 and 50 responses. RESULTS: Of the 166 patients enrolled, 97% completed 12 weeks of treatment (secukinumab, 99%; placebo, 95%). The primary end point was met, and the adjusted mean change in GLOESS was higher with secukinumab than placebo [-9 (0.9) vs -6 (0.9), difference (95% CI): -3 (-6, -1); one-sided P=0.004] at week 12. The difference in GLOESS between secukinumab and placebo was significant as early as one week after initiation of treatment. All key secondary endpoints were met. No new or unexpected safety findings were reported. CONCLUSION: This unique ultrasound study shows that apart from improving the signs and symptoms of PsA, IL-17A inhibition with secukinumab leads to a rapid and significant reduction of synovitis in PsA patients. TRIAL REGISTRATION: ClinicalTrials.gov; NCT02662985.
Assuntos
Antirreumáticos , Artrite Psoriásica , Sinovite , Anticorpos Monoclonais/efeitos adversos , Anticorpos Monoclonais Humanizados , Antirreumáticos/uso terapêutico , Artrite Psoriásica/complicações , Artrite Psoriásica/diagnóstico por imagem , Artrite Psoriásica/tratamento farmacológico , Método Duplo-Cego , Humanos , Interleucina-17 , Sinovite/diagnóstico por imagem , Sinovite/tratamento farmacológico , Resultado do Tratamento , Ultrassonografia DopplerRESUMO
OBJECTIVE: To identify clusters of peripheral involvement according to the specific location of peripheral manifestations (ie, arthritis, enthesitis and dactylitis) in patients with spondyloarthritis (SpA) including psoriatic arthritis (PsA), and to evaluate whether these clusters correspond with the clinical diagnosis of a rheumatologist. METHODS: Cross-sectional study with 24 participating countries. Consecutive patients diagnosed by their rheumatologist as PsA, axial SpA or peripheral SpA were enrolled. Four different cluster analyses were conducted: one using information on the specific location from all the peripheral manifestations, and a cluster analysis for each peripheral manifestation, separately. Multiple correspondence analyses and k-means clustering methods were used. Distribution of peripheral manifestations and clinical characteristics were compared across the different clusters. RESULTS: The different cluster analyses performed in the 4465 patients clearly distinguished a predominantly axial phenotype (cluster 1) and a predominantly peripheral phenotype (cluster 2). In the predominantly axial phenotype, hip involvement and lower limb large joint arthritis, heel enthesitis and lack of dactylitis were more prevalent. In the predominantly peripheral phenotype, different subgroups were distinguished based on the type and location of peripheral involvement: a predominantly involvement of upper versus lower limbs joints, a predominantly axial enthesitis versus peripheral enthesitis, and predominantly finger versus toe involvement in dactylitis. A poor agreement between the clusters and the rheumatologist's diagnosis as well as with the classification criteria was found. CONCLUSION: These results suggest the presence of two main phenotypes (predominantly axial and predominantly peripheral) based on the presence and location of the peripheral manifestations.
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Artrite Psoriásica , Espondilartrite , Artrite Psoriásica/diagnóstico , Artrite Psoriásica/epidemiologia , Análise por Conglomerados , Estudos Transversais , Humanos , Fenótipo , Espondilartrite/diagnóstico , Espondilartrite/epidemiologiaRESUMO
OBJECTIVES: To characterise peripheral musculoskeletal involvement in patients with spondyloarthritis (SpA) including psoriatic arthritis (PsA), across the world. METHODS: Cross-sectional study with 24 participating countries. Patients with a diagnosis of axial SpA (axSpA), peripheral SpA (pSpA) or PsA according to their rheumatologist were included. The investigators were asked which diagnosis out of a list of six (axSpA, PsA, pSpA, inflammatory bowel disease-associated SpA, reactive arthritis or juvenile SpA (Juv-SpA)) fitted the patient best. Peripheral manifestations (ie, peripheral joint disease, enthesitis, dactylitis and root joint disease), their localisation and treatments were evaluated. RESULTS: A total of 4465 patients were included (61% men, mean age 44.5 years) from four geographic areas: Latin America (n=538), Europe plus North America (n=1677), Asia (n=975) and the Middle East plus North Africa (n=1275). Of those, 78% had ever suffered from at least one peripheral musculoskeletal manifestation; 57% had peripheral joint disease, 44% had enthesitis and 15% had dactylitis. Latin American had far more often peripheral joint disease (80%) than patients from other areas. Patients with PsA had predominantly upper limb and small joint involvement (52%).Hip and shoulder involvement was found in 34% of patients. The prevalence of enthesitis ranged between 41% in patients with axSpA and 65% in patients with Juv-SpA. Dactylitis was most frequent among patients with PsA (37%). CONCLUSION: These results suggest that all peripheral features can be found in all subtypes of SpA, and that differences are quantitative rather than qualitative. In a high proportion of patients, axial and peripheral manifestations coincided. These findings reconfirm SpA clinical subtypes are descendants of the same underlying disease, called SpA.
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Artrite Psoriásica , Espondilartrite , Espondilite Anquilosante , Adulto , Artrite Psoriásica/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Prevalência , Espondilartrite/epidemiologiaRESUMO
INTRODUCTION: Physician-patient misalignment may exist in real-life clinical practice. We aimed to assess physician and patient treatment satisfaction levels and associated degree of misalignment in psoriatic arthritis (PsA). METHOD: Data from a cross-sectional survey of patients and their physicians conducted in Latin America were analyzed. Physician-reported and patient-reported satisfaction levels with current PsA treatment, alignment in satisfaction levels, and factors associated with satisfaction misalignment were assessed through bivariable and multivariable regression analyses. RESULTS: A total of 179 physician-patient pairs were analyzed. Physicians reported satisfaction with current disease control in 87.7% (n = 157) of cases; patients reported satisfaction in 91.1% (n = 163 of cases). A total of 82.1% of physician-patient pairs were aligned. Compared with aligned patients, misaligned patients were older and more likely to have moderate or severe disease, deteriorating or unstable disease, a past hospital procedure, current or past psoriasis symptoms, greater current pain, a current acute episode, poorer health and quality of life, greater impairment, poorer medication compliance, to consider PsA a major daily burden, and to believe that PsA treatments were ineffective. Misaligned patients were less likely to be in remission. Logistic regression analysis revealed that misaligned patients were older, and more likely to consider PsA a major daily burden and PsA treatments as ineffective. CONCLUSIONS: High levels of treatment satisfaction and alignment were observed among PsA patients and their physicians in Latin America. Patients in this study nevertheless experienced a considerable clinical and quality-of-life burden, especially the misaligned patients. Addressing misalignment may lead to improved PsA disease control.Key points⢠High treatment satisfaction was observed among PsA patients and their treating physicians in Latin America.⢠Patients experienced a considerable clinical and quality-of-life burden, especially the misaligned patients.⢠One-fifth of physician-patient pairs were misaligned regarding satisfaction.⢠Understanding and addressing misalignment may improve outcomes in this patient population.
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Antirreumáticos/uso terapêutico , Artrite Psoriásica/tratamento farmacológico , Satisfação do Paciente , Relações Médico-Paciente , Adolescente , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , América Latina , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Indução de Remissão , Índice de Gravidade de Doença , Adulto JovemRESUMO
OBJECTIVE: Sarilumab is a human monoclonal antibody that blocks IL-6 from binding to membrane-bound and soluble IL-6 receptor-α. We assessed the long-term safety of sarilumab in patients from eight clinical trials and their open-label extensions. METHODS: Data were pooled from patients with rheumatoid arthritis who received at least one dose of sarilumab in combination with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs; combination group) or as monotherapy (monotherapy group). Treatment-emergent adverse events (AEs) and AEs and laboratory values of special interest were assessed. RESULTS: 2887 patients received sarilumab in combination with csDMARDs and 471 patients received sarilumab monotherapy, with mean exposure of 2.8 years and 1.7 years, maximum exposure 7.3 and 3.5 years, and cumulative AE observation period of 8188 and 812 patient-years, respectively. Incidence rates per 100 patient-years in the combination and monotherapy groups, respectively, were 9.4 and 6.7 for serious AEs, 3.7 and 1.0 for serious infections, 0.6 and 0.5 for herpes zoster (no cases were disseminated), 0.1 and 0 for gastrointestinal perforations, 0.5 and 0.2 for major adverse cardiovascular events, and 0.7 and 0.6 for malignancy. Absolute neutrophil counts <1000 cells/mm3 were recorded in 13% and 15% of patients, respectively. Neutropenia was not associated with increased risk of infection or serious infection. Analysis by 6-month interval showed no signal for increased rate of any AE over time. CONCLUSION: The long-term safety profile of sarilumab, either in combination with csDMARDs or as monotherapy, remained stable and consistent with the anticipated profile of a molecule that inhibits IL6 signalling.
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Anticorpos Monoclonais Humanizados/uso terapêutico , Antirreumáticos/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Adulto , Idoso , Anticorpos Monoclonais Humanizados/efeitos adversos , Antirreumáticos/efeitos adversos , Quimioterapia Combinada , Eritema/induzido quimicamente , Eritema/epidemiologia , Feminino , Seguimentos , Humanos , Incidência , Masculino , Metotrexato/efeitos adversos , Metotrexato/uso terapêutico , Pessoa de Meia-Idade , Neutropenia/induzido quimicamente , Neutropenia/epidemiologia , Infecções Respiratórias/induzido quimicamente , Infecções Respiratórias/epidemiologia , Resultado do TratamentoRESUMO
OBJECTIVE: Increased risk of comorbidities has been reported in spondyloarthritis (SpA). The objective of this study was to determine the prevalence and risk of developing comorbidities in patients with SpA in 3 Latin American (LA) countries, and to compare that prevalence with the general population. METHODS: Data were analyzed from 390 patients with SpA enrolled in the Assessment of SpondyloArthritis international Society of Comorbidities in SpA study from Argentina, Colombia, and Mexico. Age- and sex-standardized prevalence (95% CI) was estimated for arterial hypertension (AHT), tuberculosis (TB), and malignancies. Age- and sex-specific data from the general population were obtained from the Cardiovascular Risk Factor Multiple Evaluation in Latin America (CARMELA) study for AHT, the Global TB report, and the GLOBOCAN project for malignancies. Data analyzed for AHT were confined to Colombia and Mexico. The prevalence in patients with SpA was compared with the prevalence in the general population per age- and sex-specific stratum, resulting in standardized risk ratios (SRR). RESULTS: In total, 64% of the patients with SpA were male, with a mean age of 45 years (SD 14.7). The most common comorbidities in the 3 LA countries were AHT (25.3%, 95% CI 21.2-30.0), hypercholesterolemia (21.5%, 95% CI 17.6-26.0), and osteoporosis (9.4%, 95% CI 6.8-12.9). AHT prevalence in Colombia and Mexico was 21.4% (95% CI 15.4-28.9) and was higher than the general population (12.5%, 95% CI 11.4-13.7), resulting in an SRR of 1.5. TB prevalence in the 3 LA countries was 3.3% (95% CI 1.8-5.7), which was significantly higher than in the general population (0.32%), leading to an SRR of 10.3. The prevalence of malignancies was not increased. CONCLUSION: Patients with SpA in LA are at increased risk of AHT and TB in comparison to the general population. While this sample of patients may not be entirely representative of the patient population in each country, a systematic evaluation of these comorbidities in all patients with SpA still may help to monitor these conditions better.
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Hipertensão/epidemiologia , Neoplasias/epidemiologia , Espondilartrite/epidemiologia , Tuberculose/epidemiologia , Adulto , Comorbidade , Estudos Transversais , Feminino , Gastroenteropatias/epidemiologia , Humanos , Hipercolesterolemia/epidemiologia , América Latina/epidemiologia , Masculino , Pessoa de Meia-Idade , Osteoporose/epidemiologia , Prevalência , Risco , Fatores de Risco , Úlcera/epidemiologiaRESUMO
Psoriatic arthritis (PsA) is the second most common chronic inflammatory joint disease. Ankylosing spondylitis (AS) is another less common but equally chronic and disabling spondyloarthritis (SpA). Therapeutic agents for the treatment of these diseases have been somewhat lacking as compared with those available for rheumatoid arthritis, which represents a significant challenge for both the treating physician and the pharmaceutical industry. A promising development for our understanding of the physiopathology of PsA and AS involves new targets to interrupt IL-17 and IL-12/IL-23 pathways. Up to 30-40 % of SpA patients have inadequate or poor response, or are intolerant to anti-TNF therapies. Therefore, there has been a clear unmet medical need in an important group of these patients. As a result, new therapeutic targets have emerged for the treatment of both axial and peripheral SpA. Interleukin 17 (IL-17) is a pro-inflammatory cytokine that is increased in psoriatic lesions as well as in the synovial fluid of patients with PsA and in sites of enthesitis in SpA. IL-23 has been shown to play an important role in the polarization of CD4+ T-cells to become IL-17 producers. Based on these evidences, blockade of the cytokine IL-17 or its receptors was considered to have therapeutic implications for the treatment of psoriasis, as well as PsA and AS.This article presents a thorough review of an IL-17 A blocking agent, its mechanism of action, its clinical efficacy and its therapeutic safety.
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Anticorpos Monoclonais/uso terapêutico , Antirreumáticos/uso terapêutico , Espondilartrite/tratamento farmacológico , Anticorpos Monoclonais Humanizados , Artrite Psoriásica/tratamento farmacológico , Humanos , Interleucina-17/antagonistas & inibidores , Espondilite Anquilosante/tratamento farmacológico , Resultado do TratamentoRESUMO
BACKGROUND: Increased risk of some comorbidities has been reported in spondyloarthritis (SpA). Recommendations for detection/management of some of these comorbidities have been proposed, and it is known that a gap exists between these and their implementation in practice. OBJECTIVE: To evaluate (1) the prevalence of comorbidities and risk factors in different countries worldwide, (2) the gap between available recommendations and daily practice for management of these comorbidities and (3) the prevalence of previously unknown risk factors detected as a result of the present initiative. METHODS: Cross-sectional international study with 22 participating countries (from four continents), including 3984 patients with SpA according to the rheumatologist. STATISTICAL ANALYSIS: The prevalence of comorbidities (cardiovascular, infection, cancer, osteoporosis and gastrointestinal) and risk factors; percentage of patients optimally monitored for comorbidities according to available recommendations and percentage of patients for whom a risk factor was detected due to this study. RESULTS: The most frequent comorbidities were osteoporosis (13%) and gastroduodenal ulcer (11%). The most frequent risk factors were hypertension (34%), smoking (29%) and hypercholesterolaemia (27%). Substantial intercountry variability was observed for screening of comorbidities (eg, for LDL cholesterol measurement: from 8% (Taiwan) to 98% (Germany)). Systematic evaluation (eg, blood pressure (BP), cholesterol) during this study unveiled previously unknown risk factors (eg, elevated BP (14%)), emphasising the suboptimal monitoring of comorbidities. CONCLUSIONS: A high prevalence of comorbidities in SpA has been shown. Rigorous application of systematic evaluation of comorbidities may permit earlier detection, which may ultimately result in an improved outcome of patients with SpA.
Assuntos
Doenças Cardiovasculares/epidemiologia , Doenças Transmissíveis/epidemiologia , Gastroenteropatias/epidemiologia , Neoplasias/epidemiologia , Osteoporose/epidemiologia , Espondilartrite/epidemiologia , Adulto , Doenças Cardiovasculares/etiologia , Doenças Transmissíveis/etiologia , Comorbidade , Estudos Transversais , Feminino , Gastroenteropatias/etiologia , Humanos , Masculino , Programas de Rastreamento/métodos , Programas de Rastreamento/estatística & dados numéricos , Pessoa de Meia-Idade , Neoplasias/etiologia , Osteoporose/etiologia , Prevalência , Fatores de Risco , Espondilartrite/etiologiaRESUMO
In psoriatic arthritis (PsA), genetic factors play a substantial role in disease susceptibility as well as in its expression. This study aims to determine the distribution of class I and class II HLA antigens in PsA patients and secondly to analyze the influence of genetic factors in the clinical expression of the disease. Consecutive PsA patients (CASPAR criteria) with less than 1 year of disease duration were included. Sociodemographic and clinical data were recorded. Blood samples were obtained, DNA was extracted by polymerase chain reaction (PCR), and class I (A, B, and C) and class II (DR) HLA antigens were determined by oligotyping. A control group of 100 nonrelated healthy controls from the general population served as control. p values were corrected (pc) according to the number of alleles tested. A total of 73 patients were included, 37 were females (50.7 %) with a median disease duration of 72 months (interquartile range (IQR) 24-149). Thirty-three patients (45.2 %) had a family history of psoriasis. When analyzing all the class I and class II HLA antigens, a significantly higher frequency of B38 (odds ratio (OR) 2.95, p = 0.03) and Cw6 (OR 2.78, p = 0.009) was found in PsA patients compared to the control group. On the contrary, the HLA-A11 (OR 0.14, p = 0.04) and B7 (OR 0.31, p = 0.03) were significantly more frequent among healthy controls. Furthermore, B18 was significantly more frequent in patients with early arthritis onset (less than 40 years): seven patients (22.6 %) with early onset compared to two patients (4.8 %) with late onset (p = 0.03). No association between HLA-B27 and spondylitis or HLA-DR4 with polyarticular involvement was observed. The HLA-B38 and Cw6 alleles are associated with a greater PsA susceptibility in Argentine population.
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Artrite Psoriásica/genética , Antígenos HLA/genética , Espondilite/genética , Adulto , Alelos , Artrite Psoriásica/sangue , Artrite Psoriásica/imunologia , Feminino , Predisposição Genética para Doença , Humanos , Imunogenética , Masculino , Pessoa de Meia-Idade , Espondilite/sangue , Espondilite/imunologia , Adulto JovemRESUMO
The aim of this study is to determine the prevalence of psoriatic arthritis (PsA) according to CASPAR criteria, ASAS peripheral and axial SpA criteria, and New York criteria for AS. The first 100 patients consecutively attending a psoriasis dermatology clinic were assessed. Demographic and clinical data were collected; all patients were questioned and examined for joint manifestations. Rheumatoid factor and radiographies of hands, feet, cervical spine, and pelvis for sacroiliac joints were obtained. X-rays were read independently by two experienced observers in blind fashion. Patients with objective joint manifestations, both axial and peripheral, were evaluated for fulfillment of CASPAR, ASAS peripheral and axial, and New York criteria. Median age 48 years; 93 % of patients had psoriasis vulgaris and 56 % nail involvement. Seventeen patients had peripheral arthritis as follows: nine mono/oligoarticular and eight polyarthritis. Median arthritis duration was 8 years. Seventeen percent of patients fulfilled CASPAR and ASAS peripheral criteria, 6 % New York, and 5 % ASAS axial criteria. Patients who met CASPAR criteria showed a significantly higher psoriasis duration compared to those without arthritis (M 16 vs. 10 years, p = 0.02), and a higher frequency of nail involvement (88.2 vs. 49.4 %, p = 0.003). Five patients (29.4 %) fulfilled ASAS axial criteria; all of them had peripheral involvement as follows: mono/oligoarticular in three patients and polyarticular in two. Patients with peripheral and axial involvement presented a significantly higher frequency of erythrodermic psoriasis compared to the other patients (35.3 vs. 1.2 %, p = 0.0006 and 80 vs. 16.7 %, p = 0.02). Prevalence of PsA, for CASPAR and ASAS peripheral criteria, was of 17 %. Five percent of patients met ASAS axial criteria, while 6 % met New York criteria. Worth noting, few patients without signs or symptoms of arthritis had radiological changes, both axial and peripheral, precluding a proper classification.
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Artrite Psoriásica/complicações , Artrite Psoriásica/diagnóstico , Psoríase/complicações , Psoríase/diagnóstico , Adulto , Artrite Psoriásica/classificação , Artrite Psoriásica/epidemiologia , Artrografia , Vértebras Cervicais/diagnóstico por imagem , Estudos de Coortes , Feminino , Pé/diagnóstico por imagem , Mãos/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Pelve/diagnóstico por imagem , Prevalência , Psoríase/epidemiologia , Fator Reumatoide/sangue , Reumatologia/normas , Articulação Sacroilíaca/diagnóstico por imagemRESUMO
Introducción: Al igual que en otras enfermedades crónicas, la adherencia al régimen terapéutico de los pacientes con artritis reumatoidea (AR) es baja (entre 30 y 80%), dependiendo de la definición de adherencia y de la metodología empleada para medirla. En este estudio se propone determinar el nivel de adherencia al tratamiento en pacientes con AR que reciben DMAR biológicas e identificar factores asociados a la falta de cumplimiento a la terapia. Material y métodos: Se realizó un estudio analítico, observacional de corte transversal en donde se incluyeron pacientes consecutivos con AR según criterios de clasificación (ACR87) que se encontraban recibiendo fármacos biológicos para el tratamiento de su enfermedad en los últimos seis meses y que asistieron a la consulta ambulatoria. Para la valoración de la adherencia a DMAR se utilizaron los cuestionarios CQR (Compliance Questionnaire on Rheumatology) y el cuestionario SMAQ (Simplified Medication Adherence Questionnaire). Resultados: Se encuestaron 345 pacientes. Mediante el cuestionario SMAQ se observó una adherencia del 50% (159 pacientes). El Cuestionario CQR tuvo un puntaje mediano de 78 puntos (RIC 67-86). El 47% (147 pacientes) fueron adherentes (CQR >80). Sobre los pacientes incluidos, 151 (48%) refirieron no haber tenido ningún retraso, pérdida o adelanto de la dosis del biológico en los últimos 6 meses de tratamiento. El 52% no adherentes tuvo como causas: 146 (46%) pérdida de al menos una dosis del biológico con una mediana de dosis perdidas de 2 (RIQ: 1-3); 117 (37%) tuvo al menos un retraso en las dosis del biológico y 8 (2%) delantó la dosis. Los factores asociados al no cumplimiento de la terapia biológica fueron el tipo de cobertura médica, que el paciente no haya notado mejoría y la esperanza de una rápida respuesta al tratamiento, y la falta de adherencia a DMAR
Introduction: As in other chronic diseases, adherence to the therapeutic regimen of patients with rheumatoid arthritis (RA) is low (between 30 and 80%), depending on the definition of adherence and the methodology used to measure it. This study aims to determine the level of adherence to treatment in patients with RA who receive biological DMARs and to identify factors associated with non-compliance with therapy. MATERIAL AND METHODS: An observational, cross-sectional, observational study was performed in which consecutive patients with RA according to classification criteria (ACR'87) who were receiving biological drugs for the treatment of their disease in the last six months were included Attended the outpatient appointment. The CQR (Compliance Questionnaire on Rheumatology) and SMAQ (Simplified Medication Adherence Questionnaire) questionnaires were used to assess adherence to DMAR. Results: A total of 345 patients were surveyed. A 50% adherence (159 patients) was observed through the SMAQ questionnaire. The CQR Questionnaire had a median score of 78 points (RIC 67-86). 47% (147 patients) were adherent (CQR> 80). Regarding the patients included, 151 (48%) reported not having had any delay, loss or advancement of the biological dose in the last 6 months of treatment. The 52% of non-adherents had as causes: 146 (46%) loss of at least one dose of the biological with a median of doses lost of 2 (RIQ: 1-3); 117 (37%) had at least one biological dose delay and 8 (2%) delayed the dose. Factors associated with non-compliance with biological therapy were the type of medical coverage, the patient's perceived improvement and the expectation of a rapid response to treatment, and lack of adherence to DMAR.
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Artrite Reumatoide , Tratamento BiológicoRESUMO
OBJECTIVE: To compare the clinical, demographic, and serologic characteristics and the treatment of patients diagnosed with ankylosing spondylitis (AS) from Europe (EU) and Latin America (LA). METHODS: We included 3439 patients from national registries: the Spanish Registry of Spondyloarthritis (REGISPONSER), the Belgian registry (ASPECT), and the Latin American Registry of Spondyloarthropathies (RESPONDIA). We selected patients with diagnosis of AS who met the modified New York classification criteria. Demographic, clinical, disease activity, functional, and metrological measurement data were recorded. Current treatment was recorded. The population was classified into 2 groups: patients with disease duration < 10 years and those with disease duration ≥ 10 years. A descriptive and comparative analysis of variables of both groups was carried out. RESULTS: There were 2356 patients in EU group and 1083 in LA group. Prevalence of HLA-B27 was 71% in LA group and 83% in EU group (p < 0.001). We found a greater frequency of peripheral arthritis and enthesitis (p < 0.001) in the LA population; prevalence of arthritis was 57% in LA and 42% in EU, and for enthesitis, 54% and 38%. Except for treatment with anti-tumor necrosis factor (anti-TNF), the use of nonsteroidal antiinflammatory drugs (NSAID), corticosteroids, and disease-modifying antirheumatic drugs (DMARD), and the association of anti-TNF and methotrexate use showed a significant difference (p < 0.001) in the 2 populations. CONCLUSION: The principal differences in the clinical manifestations of patients with AS from EU and LA were the greater frequency of peripheral arthritis and enthesitis in LA group, the higher percentage of HLA-B27 in EU group, and the form of treatment, with a greater use of NSAID, steroids, and DMARD in the LA group.
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Artrite Reumatoide/etnologia , Artrite Reumatoide/genética , Predisposição Genética para Doença , Antígeno HLA-B27/genética , Espondilite Anquilosante/etnologia , Espondilite Anquilosante/genética , Adulto , Antirreumáticos/uso terapêutico , Artrite Reumatoide/fisiopatologia , Bélgica/etnologia , Comorbidade , Avaliação da Deficiência , Quimioterapia Combinada , Feminino , Nível de Saúde , Humanos , América Latina/etnologia , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Sistema de Registros , Índice de Gravidade de Doença , Espanha/etnologia , Espondilite Anquilosante/fisiopatologia , Inquéritos e QuestionáriosRESUMO
Objetivos: Determinar la prevalencia de factores de riesgo y enfermedad cardiovascular en pacientes con EA, estimar el riesgo cardiovascular a 10 años a través del score de Framingham/ATPIII y evaluar la asociación entre actividad inflamatoria de la enfermedad y el riesgo de un evento cardiovascular. Métodos: Se incluyeron pacientes consecutivos con diagnóstico de EA según criterios de New York modificados. Se consignaron datos sobre factores de riesgo cardiovascular, evaluación clinimétrica, índice de actividad medida por BASDAI y tratamiento farmacológico. Se utilizó el score de Framingham/ATPIII para estimar el riesgo cardiovascular a 10 años. Resultados: Se evaluaron 44 pacientes con EA y 44 controles, con una edad mediana de 38,5 años, 86,4% varones. Los pacientes tuvieron una mediana de índice de BASDAI de 3,8 (RIC 2,10-5,81). La frecuencia de factores de riesgo cardiovascular y marcadores de inflamación fue similar en ambos grupos. La enfermedad cardiovascular fue más frecuente en el grupo con EA (13,6% vs. 2,3%, p= 0,11). No hubo diferencia en el riesgo cardiovascular estimado a 10 años entre pacientes y controles. La actividad de la enfermedad no se asoció con mayor riesgo cardiovascular. Conclusión: Los pacientes con EA tienen mayor frecuencia de enfermedad cardiovascular y su riesgo puede estar asociado con factores diferentes a los observados en la población general.
Objectives: To estimate the prevalence of cardiovascular risk factorsand cardiovascular disease in patients with AS; to determine the 10 yearcardiovascular risk by Framingham/ATPIII score, and to establish an associationbetween disease activity and increased cardiovascular risk.Methods: Consecutive patients with AS diagnosed by the modifiedNew York classification criteria were included. Data about cardiovascularrisk factors, clinimetry, BASDAI activity score and pharmacologicaltreatment were registered.Results: 44 patients and 44 controls were included, with a medianage of 38.5 years, 86.4% were men. BASDAI score was 3.85 (IQR0-8). Patients and controls had similar frequency of cardiovascularrisk factors and inflammatory markers. Cardiovascular disease wasmore frequent in AS patients (13.6% vs. 2.3%, p = 0.11). No differencewas found in the estimated cardiovascular risk at 10 yearsbetween patients and controls. Disease activity did not associate withan increased cardiovascular risk.Conclusion: Patients with AS have more cardiovascular disease andthe risk may be associated with factors different than those observedin the general population.
Assuntos
Doenças Cardiovasculares , Espondilite AnquilosanteRESUMO
OBJECTIVE: To describe differential characteristics of axial involvement in ankylosing spondylitis (AS) as compared with that seen in psoriatic arthritis (PsA) and inflammatory bowel disease (IBD) in a cohort of Ibero-American patients. METHODS: This study included 2044 consecutive patients with spondyloarthritis (SpA; ESSG criteria). Demographic, clinical, disease activity, functional ability, quality of life, work status, radiologic, and therapeutic data were evaluated and collected by RESPONDIA members from different Ibero-American countries between June and December 2006. Patients selected for analysis met modified New York criteria (mNY) for AS. RESULTS: A total of 1264 patients met the New York criteria for AS: 1072 had primary AS, 147 had psoriatic, and 45 had IBD-associated spondylitis. Median disease duration was comparable among the 3 patient groups. Patients with primary AS were significantly younger (p = 0.01) and presented a higher frequency of males (p = 0.01) than the other 2 groups. Axial manifestations such as inflammatory back pain and sacroiliac pain were significantly more frequent in patients with primary AS (p = 0.05) versus other groups, whereas frequency of dactylitis, enthesitis, and peripheral arthritis was more common in patients with psoriatic spondylitis (p = 0.05). Spinal mobility was significantly more limited in patients with primary AS versus the other 2 groups (p = 0.0001). Radiologic changes according to BASRI total score were equally significant in primary AS. Disease activity (BASDAI), functional ability (BASFI), and quality of life (ASQoL) scores were comparable in the 3 groups. CONCLUSION: Patients with primary AS had more severe axial involvement than those with spondylitis associated with psoriasis or IBD. Functional capacity, disease activity, and quality of life were comparable among the groups studied.
Assuntos
Artrite Psoriásica/complicações , Artrite Psoriásica/fisiopatologia , Doenças Inflamatórias Intestinais/complicações , Doenças Inflamatórias Intestinais/fisiopatologia , Espondilartrite/etiologia , Espondilartrite/fisiopatologia , Espondilite Anquilosante/fisiopatologia , Adulto , Artrite Psoriásica/patologia , Estudos Transversais , Bases de Dados Factuais , Feminino , Humanos , Doenças Inflamatórias Intestinais/patologia , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Espondilartrite/patologia , Espondilite Anquilosante/patologia , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: The aim of the present study is to describe the general characteristics of a cohort of patients with early arthritis in Argentina. METHODS: CONAART (Consorcio Argentino de Artritis Temprana--Argentine Consortium for Early Arthritis) is an initiative of seven rheumatology centres across Argentina. Patients were included if they had at least one or more swollen joints and <2 years of disease duration. Social, demographic, familiar, hereditary, clinical and laboratory data were recollected. At first visit and every year, X-rays of hands and feet were performed and working characteristics and pharmaco-economic data were re-collected. RESULTS: A total of 413 patients were included. Of them, 327 (79.2%) were women with a median age of 49 years and a median disease duration of 6 months. Of the total, 183 (44.3%) had RA (ACR 1987) and 167 (40.4%) undifferentiated arthritis (UA). Other diagnoses included: 12 crystalics, 11 PsA, 6 uSpA, 6 other CTD, 1 AS and 27 other diagnosis. As 85% of our population had RA and UA, we only compared these two groups of patients. Patients with RA had significantly worse activity parameters of the disease (DAS of 28 joints), functional capacity (HAQ) and quality of life (Rheumatoid Arthritis Quality of Life) than patients with UA. The frequency of RF and anti-CCP, and symmetrical distribution were also significantly higher in patients with RA compared with UA patients. All patients with RA initiated early specific treatment, in a period no longer than 6 months from the beginning of the disease. CONCLUSION: Early arthritis clinics are a useful tool to identify and treat patients with different forms of joint involvement.
Assuntos
Artrite/fisiopatologia , Reumatologia/educação , Índice de Gravidade de Doença , Adulto , Argentina , Estudos de Coortes , Avaliação da Deficiência , Educação Médica Continuada , Feminino , Humanos , Articulações , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Fatores de TempoRESUMO
Introducción: El RAPID3 es un índice de actividad que incluye tres medidasauto-reportadas por el paciente: la función física, el dolor y la evaluación global de la enfermedad por el paciente. Objetivos: Validar el cuestionario RAPID3 en pacientes con AR temprana y establecida, evaluar su correlación con otros índices de actividad y medidas de evaluación y determinar el tiempo en completar y calcular el cuestionario.Métodos: Se incluyeron pacientes con diagnóstico de AR temprana (<2 años de evolución) y establecida. Todos los pacientes completaron HAQ-A, RAPID3 y RAQoL. Se determinó evaluación global de la enfermedad por el paciente y el médico por EVA. Se midió ERS el día de la visita. Se calculó DAS28, CDAI e IAS. Se cronometró el tiempo en completar y calcular el cuestionario. Resultados: Se evaluaron 112 pacientes. RAPID3 presentó un buena correlación con DAS28 (r=0,60), CDAI (r=0,60) e IAS (r=0,62) y una muy buena correlación con HAQ-A (r=0,83) y RAQoL (r=0,75). La mediana en completar el cuestionario fue de 139 segundos y la mediana en calcularlo fue de 11 segundos. Discusión: RAPID3 es un cuestionario válido, sencillo, fácil de completar y de rápido cálculo. Presentó una buena correlación con otros índices de actividad como así también con HAQ-A y RAQoL.
Assuntos
Artrite Reumatoide , Estudo de AvaliaçãoRESUMO
Objetivos: El objetivo de nuestro estudio fue desarrollar una versión argentina del cuestionario PsAQoL adaptada del inglés, con el fin de validar su uso en los pacientes con APs de nuestro país. Resultados: Se evaluaron 31 pacientes con diagnóstico de APs, 64% mujeres, con una mediana de edad de 52 años (RIC 39-60), y una mediana de tiempo de evolución de la artritis de 9 años (RIC 4-17). La reproducibilidad del PsAQoL fue excelente, con un CCI de 0,99 (IC 95% 0,98-0,99). No se hallaron preguntas redundantes en la Correlación Interítem. La confiabilidad según alfa de Cronbach fue de 0,75. La mediana de tiempo de respuesta fue de 195 segundos (RIC 153-222) y más del 70% de los pacientes entendió el 100% de las preguntas. El PsAQoL mostró una buena correlación con HAQ (r=0,85), DAS28 (r=0,7), EVA de dolor (r=0,66), EVA de actividad por paciente (r=0,61), EVA de fatiga (r=0,74) y Escala de Salud de EuroQoL (r=-0,83). No se observó correlación con las medidas de compromiso cutáneo (PASI, EVA de piel). En el modelo de regresión lineal, la principal variable asociada a calidad de vida fue el HAQ (coef. β=0,74, p=0,0001) seguida por EVA de dolor (coef. β=0,19) y EVA de piel (coef. β=0,10). Conclusiones: Nuestra versión argentina del PsAQoL demostró aceptabilidad, confiabilidad y reproducibilidad en nuestros pacientes con APs. Estos resultados validan esta versión adaptada al castellano, facilitando su implementación en futuros estudios.
Assuntos
Artrite Psoriásica , Estudo de AvaliaçãoRESUMO
La Espondilitis Anquilosante (EA) es una enfermedad inflamatoria crónica, con compromiso axial predominante que genera severa discapacidad. Las medidas destinadas a controlar la actividad de la enfermedad generan costos directos, y a su vez la incapacidad laboral y la alteración de la calidad de vida producen importantes costos indirectos. El objetivo de nuestro trabajo fue evaluar el impacto socioeconómico en pacientes con EA e identificar posibles factores sociodemográficos y/o clínicos asociados. Material y métodos: Se incluyeron pacientes con EA (criterios NY modificados) mayores de 16 años. Se recolectaron datos demográficos y clínicos, se determinó la actividad de la enfermedad, capacidad funcional y calidad de vida a través de los cuestionarios, BASDAI, BASFI y ASQol, respectivamente. Se evaluaron los costos anuales, tanto directos (medicación, terapias alternativas, atención profesional, estudios complementarios, internación, uso de ortesis, actividades recreativas, transporte, ayuda de terceros) como indirectos (costos generados por desocupación, ausentismo laboral, subsidio por discapacidad). Análisis estadístico: Análisis univariado (OR IC 95%) y regresión logística y lineal múltiple. Resultados: Se incluyeron 68 pacientes consecutivos, el 83,8% eran de sexo masculino. La edad de inicio y el tiempo de evolución tuvieron una mediana de 20 años. El compromiso articular periférico se observó en 41 pacientes (60,3%), de los cuales sólo un paciente requirió prótesis en el último año. El 64,7% de los pacientes presentaba enfermedades concomitantes y el 63,2% contaba con algún tipo de cobertura social. Las medianas de BASFI, BASDAI y ASQoL fueron 4,58 (RIC: 2,57-6,8), 4,55 (RIC: 2,35- 6,7) y 7,5 (RIC: 3,5-13,5), respectivamente.
Assuntos
Argentina , Fatores Socioeconômicos , Espondilite AnquilosanteRESUMO
Nuestro grupo demostró que la frecuencia de incapacidad laboral en Espondilitis Anquilosante (EA) es significativamente mayor que la de los controles sin esta enfermedad apareados por sexo, edad y clase social (J Clin Rheumatol 2008;14: 273277). Los cuestionarios de autoevaluación en EA (BASDAI, BASFI, HAQ-S) son instrumentos útiles para evaluar actividad y capacidad funcional. El objetivo del presente estudio fue determinar la capacidad de discriminación y los puntos de corte de estos cuestionarios para evaluar incapacidad laboral en pacientes con EA. Material y métodos: Se incluyeron pacientes consecutivos con EA según criterios de NY modificados. Se consignaron características demográficas y clínicas de la enfermedad. Se evaluó la actividad de la enfermedad, capacidad funcional, calidad de vida, depresión y fatiga por cuestionarios validados: BASDAI, BASFI, HAQ-S, ASQoL, CES-D, FSS, respectivamente. Se determinó a través de una entrevista personal el status laboral y las características del trabajo, excluyéndose a aquellos pacientes jubilados por edad y las amas de casa. Incapacidad laboral fue definida como la imposibilidad para trabajar relacionada exclusivamente con la enfermedad. Análisis estadístico: Las variables categóricas fueron comparadas por Chi cuadrado y las continuas por prueba de Mann Whitney. La discriminación y los puntos de corte de los cuestionarios fueron evaluados por curvas COR. Resultados: Se incluyeron 53 pacientes, 49 varones con una edad mediana de 45 años (RIQ: 37-56) y una duración mediana de la enfermedad de 15 años (RIQ: 11-21). Once pacientes (20,8%) estaban desocupados por la enfermedad. No observamos diferencias entre los pacientes ocupados vs. desocupados en cuanto a edad, sexo, duración de la enfermedad, comorbilidades u otras variables categóricas.