Association of apolipoprotein B/apolipoprotein A1 ratio and cardiovascular events in rheumatoid arthritis: results of the CARMA study.

OBJECTIVES: To assess the plasma apolipoprotein B/apolipoprotein A1 ratio and its potential association with cardiovascular events (CVE) in patients with rheumatoid arthritis (RA). METHODS: A baseline analysis was made of the CARdiovascular in rheuMAtology Project (CARMA), a 10-year prospective study evaluating the presence of at least one CVE in 775 Spanish patients with RA. Of them, 29 had already experienced CVE prior to the inclusion in the study. We assessed the association between the elevation of the apoB/apoA1 ratio with the presence of CVE according to a logistic regression model for possible confounding factors. We also analysed the main parameters of activity of RA and parameters related to lipid metabolism. RA patients were classified according to treatment: patients treated with disease-modifying anti-rheumatic drugs without biologics and those undergoing biologic therapy (anti-TNF-α, anti-IL-6 receptor, and other biologic agents). RESULTS: The apoB/apoA1 ratio of patients who had experienced CVE was higher than that of patients without previous CVE (0.65 vs. 0.60). However, the difference between both subgroups did not reach statistical significance (p=0.197). It was also the case after the multivariate analysis [OR: 1.48 (95% CI: 0.15-14.4); p=0.735]. RA patients from the group with CVE were more commonly receiving lipid-lowering treatment with statins than those without CVE history (41.4% vs. 20%, p=0.005). High HAQ and high atherogenic index were significantly associated with the presence of CVE. There was no statistical association between the type of biologic therapy used in RA and the presence of CVE. CONCLUSIONS: No association between ApoB/apoA1 ratio and CVE was found at the baseline visit of patients with RA from the CARMA study.

Perceived quality in patients with gout treated in a rheumatology clinic with a clinical nurse specialist.

INTRODUCTION: Gout is a crystal arthropathy that is associated with significant loss of quality of life. A treat-to-target approach and proactive monitoring yield superior outcomes to standard care. The Clinical Nurse Specialist enhances follow-up and adherence to treatment in patients with gout, improving their perceived healthcare quality. OBJECTIVE: To determine the factors that affect the perceived quality and satisfaction of patients with gout treated in a rheumatology clinic and to identify areas for improvement, as well as to explore the influence of nurses' work in the care and management of these patients. METHODS: Cross-sectional observational study in patients with gout monitored in a monographic clinic by anonymous survey based on the SERVQUAL quality model, with demographic data and questions about aspects of care. RESULTS: 71 completed surveys were collected from the 80 delivered between August 2019 and January 2020. Most of the participants were males over 45 years of age. A total of 39% were satisfied with the care received, and 55% were very satisfied. All the respondents were satisfied with the face-to-face consultation with the Clinical Nurse Specialist and 66% considered the telephone consultation with the nurse to be good. Possible areas for improvement (referral time to consultation, identification, and availability of health providers) were identified. CONCLUSION: We found high overall satisfaction perceived by the patients attended in a gout consultation with the Clinical Nurse Specialist. Understanding and systematizing the patients' opinion is essential to improve clinical care.

Perceived Quality in Patients With Gout Treated in a Rheumatology Clinic With a Clinical Nurse Specialist. / Estudio de calidad percibida en pacientes con gota atendidos en una consulta de reumatología con enfermería especializada.

INTRODUCTION: Gout is a crystal arthropathy that is associated with significant loss of quality of life. A treat-to-target approach and proactive monitoring yield superior outcomes to standard care. The Clinical Nurse Specialist enhances follow-up and adherence to treatment in patients with gout, improving their perceived healthcare quality. OBJECTIVE: To determine the factors that affect the perceived quality and satisfaction of patients with gout treated in a rheumatology clinic and to identify areas for improvement, as well as to explore the influence of nurses' work in the care and management of these patients. METHODS: Cross-sectional observational study in patients with gout monitored in a monographic clinic by anonymous survey based on the SERVQUAL quality model, with demographic data and questions about aspects of care. RESULTS: 71 completed surveys were collected from the 80 delivered between August 2019 and January 2020. Most of the participants were males over 45years of age. A total of 39% were satisfied with the care received, and 55% were very satisfied. All the respondents were satisfied with the face-to-face consultation with the Clinical Nurse Specialist and 66% considered the telephone consultation with the nurse to be good. Possible areas for improvement (referral time to consultation, identification, and availability of health providers) were identified. CONCLUSION: We found high overall satisfaction perceived by the patients attended in a gout consultation with the Clinical Nurse Specialist. Understanding and systematizing the patients' opinion is essential to improve clinical care.

Role of targeted therapies in rheumatic patients on COVID-19 outcomes: results from the COVIDSER study.

OBJECTIVES: To analyse the effect of targeted therapies, either biological (b) disease-modifying antirheumatic drugs (DMARDs), targeted synthetic (ts) DMARDs and other factors (demographics, comorbidities or COVID-19 symptoms) on the risk of COVID-19 related hospitalisation in patients with inflammatory rheumatic diseases. METHODS: The COVIDSER study is an observational cohort including 7782 patients with inflammatory rheumatic diseases. Multivariable logistic regression was used to estimate ORs and 95% CIs of hospitalisation. Antirheumatic medication taken immediately prior to infection, demographic characteristics, rheumatic disease diagnosis, comorbidities and COVID-19 symptoms were analysed. RESULTS: A total of 426 cases of symptomatic COVID-19 from 1 March 2020 to 13 April 2021 were included in the analyses: 106 (24.9%) were hospitalised and 19 (4.4%) died. In multivariate-adjusted models, bDMARDs and tsDMARDs in combination were not associated with hospitalisation compared with conventional synthetic DMARDs (OR 0.55, 95% CI 0.24 to 1.25 of b/tsDMARDs, p=0.15). Tumour necrosis factor inhibitors (TNF-i) were associated with a reduced likelihood of hospitalisation (OR 0.32, 95% CI 0.12 to 0.82, p=0.018), whereas rituximab showed a tendency to an increased risk of hospitalisation (OR 4.85, 95% CI 0.86 to 27.2). Glucocorticoid use was not associated with hospitalisation (OR 1.69, 95% CI 0.81 to 3.55). A mix of sociodemographic factors, comorbidities and COVID-19 symptoms contribute to patients' hospitalisation. CONCLUSIONS: The use of targeted therapies as a group is not associated with COVID-19 severity, except for rituximab, which shows a trend towards an increased risk of hospitalisation, while TNF-i was associated with decreased odds of hospitalisation in patients with rheumatic disease. Other factors like age, male gender, comorbidities and COVID-19 symptoms do play a role.

Estudio de calidad percibida en pacientes con gota atendidos en una consulta de reumatología con enfermería especializada / Perceived Quality in Patients With Gout Treated in a Rheumatology Clinic With a Clinical Nurse Specialist

Introducción: La gota es una artritis cristalina que se asocia con pérdida importante de calidad de vida. Un tratamiento por objetivos y un seguimiento proactivo permiten obtener mejores desenlaces clínicos. La enfermería especializada en reumatología optimiza el seguimiento en pacientes con gota y la adherencia al tratamiento, pudiendo mejorar la calidad percibida de estos enfermos en relación con la atención sanitaria. Objetivo: Determinar los factores que afectan a la calidad percibida y a la satisfacción de los enfermos con gota atendidos en consultas de reumatología e identificar áreas de mejora, así como explorar la influencia de enfermería en la atención y el seguimiento de estos pacientes. Metodología Estudio observacional transversal en pacientes con gota seguidos en una consulta monográfica mediante encuesta anónima basada en el modelo de calidad SERVQUAL, con datos demográficos y preguntas sobre aspectos asistenciales. Resultados: Se recogieron 71 encuestas cumplimentadas de las 80 entregadas entre agosto de 2019 y enero de 2020. La mayoría de los participantes fueron varones de más de 45años. El 39% se mostraron satisfechos con la atención recibida, y el 55% muy satisfechos. Todos los encuestados se mostraron satisfechos con la consulta presencial conjunta con enfermería especializada en reumatología, y el 66% consideraron buena la consulta telefónica con el enfermero. Se identificaron posibles áreas de mejora (tiempo de derivación a consulta, identificación y disponibilidad del personal sanitario). Conclusión: Encontramos una alta satisfacción global percibida por los pacientes atendidos en consulta de gota con enfermería especializada en reumatología. Conocer y sistematizar la opinión de los pacientes es esencial para mejorar la atención ofrecida.(AU)

Introduction: Gout is a crystal arthropathy that is associated with significant loss of quality of life. A treat-to-target approach and proactive monitoring yield superior outcomes to standard care. The Clinical Nurse Specialist enhances follow-up and adherence to treatment in patients with gout, improving their perceived healthcare quality. Objective: To determine the factors that affect the perceived quality and satisfaction of patients with gout treated in a rheumatology clinic and to identify areas for improvement, as well as to explore the influence of nurses’ work in the care and management of these patients. Methods: Cross-sectional observational study in patients with gout monitored in a monographic clinic by anonymous survey based on the SERVQUAL quality model, with demographic data and questions about aspects of care. Results: 71 completed surveys were collected from the 80 delivered between August 2019 and January 2020. Most of the participants were males over 45years of age. A total of 39% were satisfied with the care received, and 55% were very satisfied. All the respondents were satisfied with the face-to-face consultation with the Clinical Nurse Specialist and 66% considered the telephone consultation with the nurse to be good. Possible areas for improvement (referral time to consultation, identification, and availability of health providers) were identified. Conclusion: We found high overall satisfaction perceived by the patients attended in a gout consultation with the Clinical Nurse Specialist. Understanding and systematizing the patients’ opinion is essential to improve clinical care.(AU)