Prevalence and clinical characteristics of patients with rheumatoid arthritis with interstitial lung disease using unstructured healthcare data and machine learning.

OBJECTIVES: Real-world data regarding rheumatoid arthritis (RA) and its association with interstitial lung disease (ILD) is still scarce. This study aimed to estimate the prevalence of RA and ILD in patients with RA (RAILD) in Spain, and to compare clinical characteristics of patients with RA with and without ILD using natural language processing (NLP) on electronic health records (EHR). METHODS: Observational case-control, retrospective and multicentre study based on the secondary use of unstructured clinical data from patients with adult RA and RAILD from nine hospitals between 2014 and 2019. NLP was used to extract unstructured clinical information from EHR and standardise it into a SNOMED-CT terminology. Prevalence of RA and RAILD were calculated, and a descriptive analysis was performed. Characteristics between patients with RAILD and RA patients without ILD (RAnonILD) were compared. RESULTS: From a source population of 3 176 165 patients and 64 241 683 EHRs, 13 958 patients with RA were identified. Of those, 5.1% patients additionally had ILD (RAILD). The overall age-adjusted prevalence of RA and RAILD were 0.53% and 0.02%, respectively. The most common ILD subtype was usual interstitial pneumonia (29.3%). When comparing RAILD versus RAnonILD patients, RAILD patients were older and had more comorbidities, notably concerning infections (33.6% vs 16.5%, p<0.001), malignancies (15.9% vs 8.5%, p<0.001) and cardiovascular disease (25.8% vs 13.9%, p<0.001) than RAnonILD. RAILD patients also had higher inflammatory burden reflected in more pharmacological prescriptions and higher inflammatory parameters and presented a higher in-hospital mortality with a higher risk of death (HR 2.32; 95% CI 1.59 to 2.81, p<0.001). CONCLUSIONS: We found an estimated age-adjusted prevalence of RA and RAILD by analysing real-world data through NLP. RAILD patients were more vulnerable at the time of inclusion with higher comorbidity and inflammatory burden than RAnonILD, which correlated with higher mortality.

The influence of patient´s perspective in therapeutic adherence in rheumatoid arthritis : a case study from Spain.

OBJECTIVES: The main objective is to study the contribution of illness and medication beliefs to treatment adherence in patients with rheumatoid arthritis. METHODS: the design was a cross-sectional study. The compliance Questionnaire for Rheumatology (CQR) was used to measure therapeutic adherence. The beliefs about medicines questionnaire (BMQ) and the brief illness perception questionnaire (IPQ-b) were used to assess patient's beliefs about medicines and about the disease. Other factors studied were treatment satisfaction, patient´s demographic and clinical characteristics. RESULTS: 144 patients were included in the study, 113 (78.4%) patients showed good treatment adherence. Patients with poor adherence presented higher scores in the BMQ harm domain (13±5 vs. 11±3, p= 0.013). Meanwhile, patients with good adherence presented higher scores in the necessity BMQ domain (21±3 vs. 20±3, p= 0.015), increased feeling of treatment control (8.8± 1.5 vs. 7.7± 2.1,p= 0.008), higher emotional response (6.2±3.1 vs. 4.8±3.4,p= 0.042) and a higher level of treatment satisfaction (77.2±12.4 vs. 69.9±12.5,p=0.004). In a multivariate analysis for each unit of increase in the score of BMQ´s harm domain, adherence was reduced by 20% (CI 95% 0.08-0.3, p= 0.001); for each unit of increase in treatment control item of the IPQ-b, adherence increased 1.4 times (CI 95% 1.1-1.8,p= 0.006); and for each unit of increase in the emotional response item of the IPQ-b, adherence increased 1.3 times (CI 95% 1.1-1.5,p= 0.002). CONCLUSION: in our cohort of RA patients, good adherence is associated with stronger treatment necessity perception, stronger feeling of treatment control, higher emotional response and higher level of treatment satisfaction; on the other side, patients with poor adherence had stronger beliefs of medicines as harmful substances.

Treatment of Raynaud phenomenon and ischemic ulcers associated to systemic sclerosis with hyperbaric oxygen.

We describe 4 patients with Raynaud's phenomenon associated with systemic sclerosis, 3 with ischaemic ulcers, successfully treated with hyperbaric oxygen. This therapy has been useful in the treatment of chronic wounds due to its anti-inflammatory, antimicrobial and angiogenic effects. Hyperbaric oxygen treatment could be a therapeutic option in patients with Raynaud's phenomenon refractory to conventional treatment.

Treatment of Raynaud Phenomenon and Ischemic Ulcers Associated to Systemic Sclerosis with Hyperbaric Oxygen. / Tratamiento con oxígeno hiperbárico en el fenómeno de Raynaud y las úlceras digitales asociadas a esclerosis sistémicas.

We describe 4patients with Raynaud's phenomenon associated with systemic sclerosis, 3with ischaemic ulcers, successfully treated with hyperbaric oxygen. This therapy has been useful in the treatment of chronic wounds due to its anti-inflammatory, antimicrobial and angiogenic effects. Hyperbaric oxygen treatment could be a therapeutic option in patients with Raynaud's phenomenon refractory to conventional treatment.

RENACER study: Assessment of 12-month efficacy and safety of 168 certolizumab PEGol rheumatoid arthritis-treated patients from a Spanish multicenter national database.

OBJECTIVE: To assess effectiveness and safety of certolizumab PEGol (CZP) in rheumatoid arthritis (RA) patients after 12 months of treatment and to detect predictors of response. METHODS: Observational longitudinal prospective study of RA patients from 35 sites in Spain. Variables (baseline, 3- and 12-month assessment): sociodemographics, previous Disease Modifying Anti-Rheumatic Drug (DMARD) and previous Biological Therapies (BT) use; TJC, SJC, ESR, CRP, DAS28, SDAI. Response variables: TJC, SJC, CRP, ESR, and steroids dose reductions, EULAR Moderate/Good Response, SDAI response and remission, DAS28 remission. Safety variables: discontinuation due to side-effects. Descriptive, comparative and Logistic regression analyses were performed. RESULTS: We included 168 patients: 79.2% women, mean age 54.5 years (±13.2 SD), mean disease duration 7.5 years (±7.3 SD). Mean number of prior DMARD: 1.4 (±1.2 SD), mean number of prior BT was 0.8 (±1.1). Mean time on CZP was 9.8 months (±3.4 SD). A total of 71.4% were receiving CZP at 12-month assessment. Baseline predictors of response: lower prior number DMARD; low number prior BT; higher CRP, ESR, TJC, SJC, DAS28 and SDAI (p < 0.05) scores. A 25/46.4% Moderate/Good Response, a 20% SDAI remission, and a 44% DAS28 remission were observed. We observed 48 discontinuations (28.6%), 31 due to partial or complete ineffectiveness, and 17 due to side-effects. CONCLUSIONS: CZP showed benefit in severe RA patients, with significant reduction of all effectiveness parameters, despite the high prevalence of previous BT exposure in our series. We found CRP, ESR, prior DMARD/BT number, TJC, SJC, DAS28, and SDAI as baseline predictors of response. CZP was mostly well tolerated.

Gout, hyperuricaemia, sleep apnoea-hypopnoea syndrome and vascular risk.

OBJECTIVE: This study aimed to evaluate cardiovascular (CV) and atherothrombosis risk factors in patients with gout and hyperuricaemia with suspected sleep apnoea-hypopnoea syndrome (SAHS) compared with a control group of subjects with knee OA and SAHS. METHODS: Clinical information on CV risk factors and atherothrombosis was collected in a rheumatology department in patients with gout and hyperuricaemia and suspicion of SAHS. Confirmation polysomnography that registered apnoea-hypopnoea index (AHI) and oxygen saturation during sleep (SaO2) was performed. The control group consisted of patients with OA and polysomnographically confirmed SAHS. RESULTS: In the gout patient group (54 patients, 48 men), CV risk factors were found in 77.8% and evidence of atherothrombosis in 46.3%. In the OA group (36 patients, 27 men), CV risk factors were found in 66.7% and evidence of atherothrombosis in 0%. SAHS diagnosis was confirmed by polysomnography in 88.9% of patients. AHI showed mild, moderate and severe SAHS in 12%, 26% and 66% of the gout patients and 45%, 24% and 30% of the OA patients, respectively. SaO2 was 90.18% in the gout group and 91.26% in the OA group. CONCLUSION: Patients with gout and hyperuricaemia and suspicion of SAHS had polysomnographically confirmed SAHS in 88.9% of cases. These patients had more severe forms of SAHS and a greater prevalence of documented atherothrombotic disease compared with a control group with OA.