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1.
Clin Epidemiol ; 9: 627-632, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-29238225

RESUMEN

OBJECTIVES: In Denmark, patients with rheumatoid arthritis (RA) are registered in the nationwide clinical DANBIO quality register and the Danish National Patient Registry (DNPR). The aim was to study the validity of the RA diagnosis and to estimate the completeness of relevant RA cases in each registry. STUDY DESIGN AND SETTING: Patients registered for the first time in 2011 with a diagnosis of RA were identified in DANBIO and DNPR in January 2013. For DNPR, filters were applied to reduce false-positive cases. The diagnosis was verified by a review of patient records. We calculated the positive predictive values (PPVs) of the RA diagnosis registrations in DANBIO and DNPR, and estimated the registry completeness of relevant RA cases for both DANBIO and DNPR. Updated data from 2011 to 2015 from DANBIO were retrieved to identify patients with delayed registration, and the registry completeness and PPV was recalculated. RESULTS: We identified 1,678 unique patients in DANBIO or in DNPR. The PPV (2013 dataset) was 92% in DANBIO and 79% in DNPR. PPV for DANBIO on the 2015 update was 96%. The registry completeness of relevant RA cases was 43% in DANBIO, increasing to 91% in the 2015 update and 90% in DNPR. CONCLUSION: DANBIO held a high proportion of true RA cases (96%) and was found to be superior to the DNPR (79%) with regard to the validity of the diagnosis. Both registries were estimated to have a high completeness of RA cases treated in hospital care (~90%).

2.
J Rheumatol ; 44(1): 59-69, 2017 01.
Artículo en Inglés | MEDLINE | ID: mdl-27909080

RESUMEN

OBJECTIVE: To compare baseline disease activity and treatment effectiveness in biologic-naive patients with nonradiographic axial spondyloarthritis (nr-axSpA) and ankylosing spondylitis (AS) who initiate tumor necrosis factor inhibitor (TNFi) treatment and to study the role of potential confounders (e.g., HLA-B27 status). METHODS: Observational cohort study based on prospectively registered data in the nationwide DANBIO registry. We used Kaplan-Meier plots, Cox, and logistic regression analyses to study the effect of diagnosis (nr-axSpA vs AS) and potential confounders (sex/age/start yr/HLA-B27/disease duration/TNFi-type/smoking/baseline disease activity) on TNFi adherence and response [e.g., Bath Ankylosing Spondylitis Activity Index (BASDAI) 50%/20 mm]. RESULTS: The study included 1250 TNFi-naive patients with axSpA (29% nr-axSpA, 50% AS, 21% lacked radiographs of sacroiliac joints). Patients with nr-axSpA were more frequently women (50%/27%) and HLA-B27-negative (85/338 = 25%), compared to AS (81/476 = 17%; p < 0.01). At TNFi start patients with nr-axSpA had higher visual analog scale scores [median (quartiles)] for pain: 72 mm (55-84)/65 mm (48-77); global: 76 mm (62-88)/68 mm (50-80); fatigue: 74 mm (55-85)/67 mm (50-80); and BASDAI: 64 (54-77)/59 (46-71); all p < 0.01. However, patients with nr-axSpA had lower C-reactive protein: 7 mg/l (3-17)/11 mg/l (5-22); and BAS Metrology Index: 20 (10-40)/40 (20-50); all p < 0.01. Median (95% CI) treatment adherence was poorer in nr-axSpA than in AS: 1.59 years (1.15-2.02) versus 3.67 years (2.86-4.49), p < 0.0001; but only in univariate and not confounder-adjusted analyses (p > 0.05). Response rates were similar in AS and nr-axSpA (p > 0.05). HLA-B27 negativity was associated with poorer treatment adherence [HLA-B27 negative/positive, nr-axSpA: HR 1.74 (1.29-2.36), AS: HR 2.04 (1.53-2.71), both p < 0.0001]; and lower response rates (nr-axSpA: 18/61 = 30% vs 93/168 = 55%; AS: 17/59 = 29% vs 157/291 = 54%, both p < 0.05). CONCLUSION: In this nationwide cohort, patients with nr-axSpA had higher subjective disease activity at start of first TNFi treatment, but similar outcomes to patients with AS after confounder adjustment. HLA-B27 positivity was associated with better outcomes irrespective of axSpA subdiagnosis.


Asunto(s)
Antirreumáticos/uso terapéutico , Productos Biológicos/uso terapéutico , Antígeno HLA-B27/sangre , Espondiloartritis/tratamiento farmacológico , Espondilitis Anquilosante/tratamiento farmacológico , Adulto , Estudios de Cohortes , Femenino , Humanos , Masculino , Cumplimiento de la Medicación , Persona de Mediana Edad , Sistema de Registros , Articulación Sacroiliaca/diagnóstico por imagen , Índice de Severidad de la Enfermedad , Espondiloartritis/diagnóstico por imagen , Espondiloartritis/genética , Espondilitis Anquilosante/sangre , Espondilitis Anquilosante/diagnóstico por imagen , Resultado del Tratamiento , Factor de Necrosis Tumoral alfa/antagonistas & inhibidores
3.
Rheumatology (Oxford) ; 55(4): 659-68, 2016 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-26628579

RESUMEN

OBJECTIVES: To investigate the association between tobacco smoking and disease activity, treatment adherence and treatment responses in patients with AS treated with their first tumour necrosis factor-alpha inhibitor (TNFi) therapy in routine care. METHODS: Observational cohort study based on the Danish nationwide DANBIO registry. Kaplan-Meier plots, Cox and logistic regression analyses by smoking status (current/never/previous) were calculated for treatment adherence and BASDAI 50%/20 mm-response. Additional stratified analyses were performed for gender and TNFi-type. RESULTS: Of 1576 AS patients included in the study, 1425(90%) had known smoking status (current/never/previous: 43%/41%/16%). The median follow-up time was 2.02 years (IQR 0.69-5.01). At baseline, current smokers compared with never smokers had longer disease duration (4 years (1-12)/2 years (0-10)), higher BASDAI (61 mm (47-73)/58 mm (44-70)), BASFI (53 mm (35-69)/46 mm (31-66)) and BASMI (40 mm (20-60)/30 mm (10-50)) scores (all P < 0.01). Current and previous smokers had shorter treatment adherence than never smokers (current: 2.30 years (1.81-2.79) (median (95% CI)); previous: 2.48 years (1.56-3.40), never: 4.12 years (3.29-4.95)), P < 0.0001). Similar results were found in multivariate analyses (current versus never smokers, HR 1.41 (95% CI 1.21-1.65), P < 0.001), most pronounced among men. Current smokers had poorer 6 months' BASDAI50%/20 mm-response rate than never smokers (42%/58%, P < 0.001). In multivariate analyses, current smokers had lower odds of achieving BASDAI50%/20 mm-response than never smokers, both overall (OR 0.48 (95% CI 0.35-0.65), P < 0.0001) and for the different TNFi-types (adalimumab 0.45 (0.27-0.76)/etanercept 0.24 (0.10-0.61)/infliximab 0.57 (0.34-0.95)). CONCLUSION: In this study of TNFi-treated AS patients in clinical practice, current and previous smokers had significantly poorer patient-reported outcomes at baseline, shorter treatment adherence and poorer treatment response compared with never smokers.


Asunto(s)
Antirreumáticos/uso terapéutico , Fumar/epidemiología , Espondilitis Anquilosante/tratamiento farmacológico , Factor de Necrosis Tumoral alfa/antagonistas & inhibidores , Adulto , Dinamarca/epidemiología , Femenino , Humanos , Estimación de Kaplan-Meier , Masculino , Cumplimiento de la Medicación/estadística & datos numéricos , Persona de Mediana Edad , Sistema de Registros , Fumar/efectos adversos , Espondilitis Anquilosante/epidemiología , Resultado del Tratamiento
4.
J Rheumatol ; 35(5): 845-9, 2008 May.
Artículo en Inglés | MEDLINE | ID: mdl-18381788

RESUMEN

OBJECTIVE: To compare sensitivity and specificity of autoantibodies to alpha-fodrin with conventional anti-Ro and anti-La antibodies in patients with primary Sjögren's syndrome (pSS). Data on internal organ manifestations were correlated with presence of autoantibodies. METHODS: We collected clinical and laboratory data from 321 patients with pSS (Copenhagen criteria), of which 205 fulfilled the new American-European 2002 consensus criteria. Sera were tested for autoantibodies against alpha-fodrin and recombinant Ro-52, Ro-60, and La proteins. RESULTS: Antibodies to alpha-fodrin were not diagnostically superior to conventional anti-Ro/La testing. IgG anti-La had the highest specificity (97%). A highly significant association was found between presence of anti-La and internal organ manifestations (OR 6, 95% CI 2.99-12.03) or hematological abnormalities. The pattern of autoantibodies was relatively independent of disease duration, indicating that these antibodies appeared early in pSS, probably even years before the first symptoms were manifest. CONCLUSION: We could not confirm that antibodies to alpha-fodrin had higher specificity or sensitivity than anti-Ro/La. Anti-La antibodies were strongly correlated to organ involvement and cytopenias, and thus could serve as a prognostic marker in pSS.


Asunto(s)
Anticuerpos Antinucleares/sangre , Anticuerpos/sangre , Proteínas Portadoras/inmunología , Proteínas de Microfilamentos/inmunología , Síndrome de Sjögren/sangre , Síndrome de Sjögren/diagnóstico , Biomarcadores/sangre , Humanos , Inmunoglobulina A/sangre , Inmunoglobulina G/sangre , Pronóstico , Estudios Prospectivos , Sensibilidad y Especificidad , Síndrome de Sjögren/inmunología
5.
Autoimmun Rev ; 4(5): 276-81, 2005 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-15990074

RESUMEN

In this study we imposed the recently described American-European consensus criteria for primary Sjögren's syndrome (pSS) on a large cohort of patients originally classified according to the Copenhagen set of criteria. Of the 321 patients fulfilling the Copenhagen criteria, 205 conformed to the Consensus criteria. When comparing clinical manifestations and laboratory findings between the two groups defined by different standards we found only small variations. Thus, the consequence of using the Consensus criteria in daily clinical practice will lead to the exclusion of a considerable proportion of patients with classical features of pSS. The main reason for this discrepancy is probably the absolute requirement of a positive test for anti-Ro/La or a characteristic lymphocytic infiltration in the labial gland biopsy. The sensitivity and specificity of testing for autoantibodies to Ro-52, Ro-60, and La were calculated for each set of criteria. Antibodies to La but not to Ro-52 or Ro-60 were strongly correlated to internal organ (kidney, lung, liver) dysfunction in pSS (OR 6; 95% CI 3-12), p<0.0001. Although presence of ANA was slightly more prevalent among patients with internal organ involvement it did not reach statistical significance. The fine speckled ANA pattern was most often found followed by the homogeneous and centromere pattern. Individual ANA patterns did not correlate with any particular organ manifestation.


Asunto(s)
Autoanticuerpos/sangre , Síndrome de Sjögren/clasificación , Síndrome de Sjögren/diagnóstico , Estudios de Cohortes , Dinamarca/epidemiología , Diagnóstico Diferencial , Europa (Continente)/epidemiología , Humanos , Guías de Práctica Clínica como Asunto , Síndrome de Sjögren/epidemiología , Síndrome de Sjögren/inmunología , Estados Unidos/epidemiología
6.
Ugeskr Laeger ; 164(15): 2048-9, 2002 Apr 08.
Artículo en Danés | MEDLINE | ID: mdl-11985007

RESUMEN

Chronically progressive (permanent) radiation myelopathy is a serious complication to irradiation of head/neck carcinoma. We describe four patients who developed stationary neurological deficits with a considerable reduction in function. One patient received a radiation dose below 50 Gy and the others up to 58 Gy against the cervical medulla. One patient developed an intramedullary syrinx.


Asunto(s)
Neoplasias de Cabeza y Cuello/radioterapia , Traumatismos por Radiación/etiología , Enfermedades de la Médula Espinal/etiología , Adulto , Síndrome de Brown-Séquard/etiología , Síndrome de Brown-Séquard/fisiopatología , Femenino , Marcha/fisiología , Humanos , Masculino , Persona de Mediana Edad , Traumatismos por Radiación/fisiopatología , Dosificación Radioterapéutica , Enfermedades de la Médula Espinal/fisiopatología , Vejiga Urinaria/fisiopatología
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