The inflammatory role of silent urate crystal deposition in intercritical gout.

OBJECTIVE: To study subclinical inflammation in intercritical gout patients and its relation to the estimated size of monosodium urate crystal deposition and cardiovascular risk factors. METHODS: We performed a secretome analysis and the quantification of cytokine and adipokine plasma levels [IL-1ß, IL-18, IL-6, soluble IL-6 receptor (sIL-6R), TNF-α, C-X-C motif chemokine 5, RANTES (Regulated upon Activation, Normal T Cell Expressed and Presumably Secreted), leptin, resistin and adiponectin] to analyse subclinical inflammation in intercritical gout patients. Since it is currently not feasible to determinate the whole body deposit of monosodium urate crystals, we created an indirect clinical classification to estimate it. Then we compared cytokine levels in controls and gout patients and in patients with different crystal deposition sizes. We also studied the association between cytokine-levels and the number of cardiovascular risk factors. RESULTS: Ninety consecutive patients attending a crystal arthritis unit were studied. IL-18, sIL-6R, RANTES, leptin and adiponectin were higher in intercritical gout patients than in controls. An association was observed between IL-18, sIL6-R and RANTES levels and the size of crystal deposition. IL-18, sIL6-R, RANTES and leptin were higher in patients with no cardiovascular risk factors compared with controls with no risk factors. CONCLUSION: Our results showed that the levels of some pro-inflammatory cytokines and metabolic proteins are elevated in intercritical gout patients. The levels of certain cytokines were related to the estimated size of the monosodium urate crystal deposition and to the number of cardiovascular risk factors. These cytokine changes may help to explain the increase in cardiovascular events in gout patients.

Impact of the COVID-19 pandemic on rheumatology nursing consultation.

OBJECTIVE: The COVID-19 pandemic has brought major changes to the model of patient care in Rheumatology. Our aim was to compare the change in the care delivered in a rheumatology nursing consultation before and during the pandemic. MATERIAL AND METHODS: Descriptive and observational study. Patient care was registered before and during the COVID-19 outbreak. The variables collected were age, sex, prevalent rheumatic disease, type of visit and reason for consultation. RESULTS: 254 consecutive patients were included before the COVID-19 pandemic for 20 days and 251 patients during COVID-19 for 10 working days. The mean age was 61 years before and 57 during the pandemic. Of both groups, 74% were women. The most frequently attended pathologies before and during COVID-19 were rheumatoid arthritis and spondyloarthropathies. Scheduled face-to-face visits decreased during COVID-19 (46.5% versus 1.6%), with an increased number of phone scheduled visits (2.8% versus 52.2%) and spontaneous consultations either by phone or e-mail (28.3% versus 45%). The type of scheduled visits during COVID-19 were for stable diseases (20% versus 37%) and monitoring (12% versus 38%). The reason for spontaneous consultation increased during COVID-19 and were mainly doubts regarding prevention measures and treatment optimization (13.8% versus 31.1%). CONCLUSIONS: The first wave of COVID-19 brought to rheumatology nursing consultation a global increase in all activities in the number of visits per day, in the number of stable patient controls, in monitoring and answering patient concerns.

Impact of the COVID-19 Pandemic on Rheumatology Nursing Consultation. / Impacto de la COVID-19 en la consulta de enfermería reumatológica.

OBJECTIVE: The COVID-19 pandemic has brought major changes to the model of patient care in Rheumatology. Our aim was to compare the change in the care delivered in a rheumatology nursing consultation before and during the pandemic. MATERIAL AND METHODS: Descriptive and observational study in 254 patients before and in 251 during the pandemic outbreak. RESULTS: The type of scheduled face-to-face visit decreased during COVID-19 (46.5% vs. 1.6%), with the number of scheduled telephone visits increasing (2.8% vs. 52.2%) and spontaneous consultations over the phone or email (28.3% vs. 45%). The functions performed in the programmed ones were the stable patient control (20% vs. 37%) and management (12% vs. 38%). The reason for spontaneous consultation increased during COVID-19, especially doubts regarding prevention measures and treatment optimization (13.8% vs. 31.1%). CONCLUSIONS: The first wave of COVID-19 brought to rheumatology nursing consultation a global increase in all activities in the number of visits per day, in the number of stable patient controls, in monitoring and answering patient concerns.

Impacto de la COVID-19 en la consulta de enfermería reumatológica / Impact of the COVID-19 Pandemic on Rheumatology Nursing Consultation

Objetivo: Comparar el cambio en la actividad asistencial realizada en una consulta de enfermería reumatológica antes y durante la pandemia. Material y métodos: Estudio descriptivo y observacional de 254 pacientes consecutivos antes y 251 durante. Resultados: El tipo de visita programada presencial disminuyó durante la COVID-19 (46,5% vs. 1,6%), aumentando la visita programada telefónica (2,8% vs. 52,2%) y las consultas espontáneas a través del teléfono o email (28,3% vs. 45%). Las funciones realizadas en las programadas fueron el control del paciente estable (20% vs. 37%) y la gestión (12% vs. 38%). El motivo de consulta espontánea incrementó durante la COVID-19, sobre todo: dudas respecto a medidas de prevención y optimización de tratamiento (13,8% vs. 31,1%). Conclusiones: La primera ola de la COVID-19 generó en la consulta de enfermería un incremento global de todas las actividades: en el número de visitas/día, en el número de controles de pacientes estables, en gestión y en la resolución de dudas.(AU)

Objective: The COVID-19 pandemic has brought major changes to the model of patient care in Rheumatology. Our aim was to compare the change in the care delivered in a rheumatology nursing consultation before and during the pandemic. Material and methods: Descriptive and observational study in 254 patients before and in 251 during the pandemic outbreak. Results: The type of scheduled face-to-face visit decreased during COVID-19 (46.5% vs. 1.6%), with the number of scheduled telephone visits increasing (2.8% vs. 52.2%) and spontaneous consultations over the phone or email (28.3% vs. 45%). The functions performed in the programmed ones were the stable patient control (20% vs. 37%) and management (12% vs. 38%). The reason for spontaneous consultation increased during COVID-19, especially doubts regarding prevention measures and treatment optimization (13.8% vs. 31.1%). Conclusions: The first wave of COVID-19 brought to rheumatology nursing consultation a global increase in all activities in the number of visits per day, in the number of stable patient controls, in monitoring and answering patient concerns.(AU)

The activity of rheumatology nurses in Spain. / Actividad de la enfermera de reumatología en España.

OBJECTIVE: Describe and analyze nursing activity in rheumatology. MATERIAL AND METHODS: A cross-sectional study was performed in Spanish rheumatology departments. Results were based on surveys administered to rheumatology nurses. We included variables on socio-demographics, the setting and available resources, and the activities they carried out. Each activity was compared in terms of workplace, available resources and dedication exclusively to one field. RESULTS: Sixty-seven surveys were collected from 57 hospitals in 17 Spanish autonomous communities. 97% of the nurses were women, with an average age of 48.9 years and an average nursing experience of 6 years. 56% of the professionals had gained their experience in outpatient clinics, 35% in day hospitals and 9% in inpatient and primary care. As for the availability of resources, 59% had their own office, 77.3% had a phone listing and 60% scheduled and conducted patient visits. Of the 19 activities included, those performed by the highest number of nurses were managing, monitoring and coordinating the use of biological drugs (90.9%), therapy monitoring (89.4%) and training patients in self-medication (89.4%). The activity in which nurses most frequently collaborated with physicians was the administration of local injections (51.5%). Other activities were teaching (50%) and research (78.8%) in their departments and studies in the nursing field (51.5%). Work in outpatient clinics versus day hospitals showed statistically significant differences for health education, nutrition, splinting and bandaging, and collaboration in ultrasound studies. CONCLUSION: These professionals performed a greater number of activities when they worked in outpatient clinics, had their own office and worked exclusively in rheumatology.

Vacunación antigripal y antineumocócica 23 valencias en pacientes reumáticos en tratamiento con inmunosupresores / Influenza and pneumococcal (23-valent) vaccination in rheumatic patients on treatment with immunosuppressants

Objetivo: determinar la evolución de la tasa de vacunación antigripal y antineumocócica (23 valencias) entre los años 2010 y 2014 en pacientes reumáticos en tratamiento con inmunosupresores y evaluar la magnitud de infecciones respiratorias documentadas en el año posterior a la vacunación. Método: estudio descriptivo longitudinal retrospectivo. Se reclutaron por conveniencia 200 pacientes con artritis reumatoide o espondiloartropatías en tratamiento con fármacos antirreumáticos modificadores de la enfermedad (FAME) sintético, FAME biológico o corticoides. Se conformaron dos grupos de 100 pacientes (2010 y 2014) en los que se revisaron historias clínicas para recoger variables demográficas, comorbilidades, hábitos tóxicos, diagnóstico reumatológico y años de evolución de este, tratamiento, administración de la vacuna antigripal y antineumocócica 23v y número de infecciones respiratorias en el año posterior. Resultados: en la muestra un 66% fue mujer, la edad media fue de 66 años y 12 de evolución de la enfermedad. El 43,5% había recibido vacunación antigripal y el 30% vacunación neumocócica 23v. El 21,5% presentó infección respiratoria en el tiempo de seguimiento. Hubo una mayor tasa de vacunación antigripal y antineumocócica en 2014 frente a 2010 (49 y 29% vs. 38% y 21%, respectivamente), siendo solo estadísticamente significativo el aumento en la cobertura antineumocócica. Los pacientes mayores de 65 años y alguna comorbilidad o hábito tóxico son más vacunados (p< 0,05). No hubo diferencias en las vacunaciones ni en el número de infecciones respiratorias, ni en función del diagnóstico reumatológico, ni del tratamiento recibido por el paciente. Conclusiones: la tasa de vacunación mejoró en 2014 respecto a 2010. No obstante, el profesional enfermero ha de intervenir en mejorar la tasa de vacunación en estos pacientes

Objective: to determine the evolution in the rate of influenza and pneumococcal (23-valent) vaccination between the years 2010 and 2014 in rheumatic patients on treatment with immunosuppressants, and to evaluate the extent of documented respiratory infections within the year after vaccination. Method: a retrospective cross-sectional descriptive study. Two hundred (200) patients were recruited by convenience sampling, with rheumatoid arthritis or spondyloarthropathy, on treatment with synthetic disease modifying antirheumatic drugs (DMARDs), biologic DMARDs or corticosteroids. Two arms of 100 patients were formed (2010 and 2014), and clinical records were reviewed in order to collect demographical variables, comorbidities, toxic habits, rheumatology diagnosis and years of disease evolution, treatment, administration of the influenza and the pneumococcal 23 vaccine, and number of respiratory infections during the following year. Results: in the sample, 66% were women, their mean age was 66 years, with 12 years of disease evolution; 43.5% had received influenza vaccination, and 30% pneumococcal 23v vaccination; 21.5% presented respiratory infection within the time of follow-up. There was a higher rate of influenza and pneumococcal vaccination in 2014 vs. 2010 (49 and 29% vs. 38% and 21%, respectively); only the increase in pneumococcal coverage was statistically significant. Patients >65-year-old and with some comorbidity or toxic habit were more vaccinated (p< 0.05). There were no differences in vaccinations or in the number of respiratory infections based on the rheumatology diagnosis or the treatment received by the patient. Conclusions: the vaccination rate improved in 2014 vs. 2010. However, the nursing professional must be involved in the improvement of the vaccination rate for these patients