Recommendations by the Spanish Society of Rheumatology on risk management of biological treatment and JAK inhibitors in patients with rheumatoid arthritis.

OBJECTIVE: To present recommendations based on the available evidence and the consensus of experts, for risk management of biological treatment and JAK inhibitors in patients with rheumatoid arthritis. METHODS: Clinical research questions relevant to the purpose of the document were identified. These questions were reformulated in PICO format (patient, intervention, comparison, outcome or outcome) by a panel of experts, selected based on their experience in the area. A systematic review of the evidence was carried out, grading according to the GRADE criteria (Grading of Recommendations Assessment, Development, and Evaluation). Specific recommendations were then formulated. RESULTS: 6 PICO questions were proposed by the panel of experts based on their clinical relevance and the existence of recent information regarding the risk of occurrence of serious infections, the risk of reactivation of the hepatitis B virus, the risk of reactivation of the virus varicella-zoster, the risk of appearance of skin (melanoma and non-melanoma) or haematological cancer, the risk of appearance of thromboembolic disease and the risk of progression of the human papilloma virus. A total of 28 recommendations were formulated, structured by question, based on the evidence found and the consensus of the experts. CONCLUSIONS: The SER recommendations on risk management of treatment with biologic therapies and JAK inhibitors in rheumatoid arthritis are presented.

[The efficacy of scheduled cardioversion in atrial fibrillation. Comparison of two schemes of treatment: electrical versus pharmacological cardioversion]. / Eficacia de la cardioversión programada en la fibrilación auricular. Comparación de dos esquemas de tratamiento: cardioversión eléctrica frente a cardioversión farmacológica.

INTRODUCTION AND OBJECTIVES: Atrial fibrillation is an arrhythmia with high morbidity and mortality. Restoring sinus rhythm is one of the principle objectives in its management. The present study aimed to assess the efficacy of scheduled cardioversion on atrial fibrillation by comparing two different therapeutic approaches: electrical vs. pharmacological cardioversion. PATIENTS AND METHOD: Two hundred thirty patients with atrial fibrillation of more than 48 hours duration and requiring sinus rhythm restoration were included. One hundred forty-four patients underwent external electrical cardioversion and 86 patients received quinidine. We analyzed the rate of success, duration of hospital stay, complications and clinical and echocardiographic variable that might predict success. RESULTS: Sinus rhythm was restored in 181 of 230 patients (79%). The rate of success was 77% (111/144 patients) in the electrical group and 81% (70 of 86 patients) in the pharmacological group (ns). In 13 pharmacological group patients for whom the first attempt failed attempt, a second attempt with electrical cardioversion was made and was successful in 8 patients (61%). No embolic complication was recorded and only two electrical disturbances were seen. Only atrial fibrillation lasting less than 8 weeks was associated with a higher success rate (p < 0.01). CONCLUSIONS: Scheduled cardioversion in atrial fibrillation is an effective technique with a high success rate and a very low rate of complication. Electrical cardioversion and pharmacological cardioversion with quinidine are similarly effective, although the latter involves a longer hospital stay.

Eficacia de la cardioversión programada en la fibrilación auricular. comparación de dos esquemas de tratamiento: cardioversión eléctrica frente a cardioversión farmacológica / The Efficacy of Scheduled Cardioversion in Atrial Fibrillation. Comparison of Two Schemes of Treatment: Electrical versus Pharmacological Cardioversion

Introducción y objetivos. La fibrilación auricular es una arritmia con una elevada morbimortalidad. Restablecer el ritmo sinusal es uno de los objetivos principales en su manejo. El objetivo del presente estudio es evaluar la eficacia de la cardioversión programada en la fibrilación auricular comparando dos estrategias: la cardioversión eléctrica y la farmacológica. Pacientes y método. Se incluyeron 230 pacientes consecutivos con fibrilación auricular de más de 48 h de evolución tributarios de intento de reversión a ritmo sinusal. En 144 casos se realizó cardioversión eléctrica externa y en 86 farmacológica con quinidina, analizándose el porcentaje de éxito alcanzado, la estancia hospitalaria, las complicaciones y una serie de variables clínicas y ecocardiográficas que permitieran predecir un mayor éxito en la cardioversión. Resultados. Se consiguió restablecer el ritmo sinusal en 181 de 230 pacientes (79 por ciento). En el grupo eléctrico el porcentaje de éxito fue del 77 por ciento (111/144 casos) y en el grupo farmacológico del 81 por ciento (70/86 casos; p = NS).En 13 pacientes del grupo farmacológico en los que fracasó el primer intento se realizó posteriormente cardioversión eléctrica, que fue eficaz en 8 casos (61 por ciento). No se produjo ninguna complicación embólica y sólo dos eléctricas. Únicamente la presencia de una duración de la fibrilación auricular menor de 8 semanas se asoció a un mayor éxito (p < 0,01).Conclusiones. La cardioversión programada en la fibrilación auricular es una técnica eficaz, con una alta tasa de éxitos y un muy bajo índice de complicaciones. La eficacia es similar entre la cardioversión eléctrica y la farmacológica, aunque con una mayor estancia hospitalaria en el grupo farmacológico (AU)