Vertebral fractures are increased in rheumatoid arthritis despite recent therapeutic advances: a case-control study.

Prevalence and risk factors of vertebral fractures in postmenopausal RA women were assessed in 323 patients and compared with 660 age-matched women. Of patients, 24.15% had at least one vertebral fracture vs.16.06% of controls. Age, glucocorticoids and falls were the main fracture risks. Vertebral fractures were associated with disease severity. INTRODUCTION: There is little quality data on the updated prevalence of fractures in rheumatoid arthritis (RA) that may have changed due to advances in the therapeutic strategy in recent years. This study was aimed at analysing the prevalence and risk factors of vertebral fractures in postmenopausal women with RA and comparing it with that of the general population. METHODS: We included 323 postmenopausal women diagnosed with RA from 19 Spanish Rheumatology Departments, randomly selected and recruited in 2018. Lateral radiographs of the thoracic and lumbar spine were obtained to evaluate morphometric vertebral fractures and the spinal deformity index. We analysed subject characteristics, factors related to RA, and fracture risk factors. The control group consisted of 660 age-matched Spanish postmenopausal women from the population-based Camargo cohort. RESULTS: Seventy-eight (24.15%) RA patients had at least one vertebral fracture. RA patients had increased fracture risk compared with controls (106 of 660, 16.06%) (p = 0.02). Logistic regression analysis showed that age (OR 2.17; 95% CI 1.27-4.00), glucocorticoids (OR 3.83; 95% CI 1.32-14.09) and falls (OR 3.57; 95% CI 1.91-6.86) were the independent predictors of vertebral fractures in RA patients. The subgroup with vertebral fractures had higher disease activity (DAS28: 3.15 vs. 2.78, p = 0.038) and disability (HAQ: 0.96 vs. 0.63, p = 0.049), as compared with those without vertebral fractures. CONCLUSION: The risk of vertebral fracture in RA is still high in recent years, when compared with the general population. The key determinants of fracture risk are age, glucocorticoids and falls. Patients with vertebral fractures have a more severe RA.

Estudio descriptivo de los donantes de órganos en el hospital Torrecardenas de Almería durante el periodo comprendido entre los años 1996-2002 / Descriptive study of organ donors in Torrecárdenas Hospital, Almería, Spain, from 1996 to 2002

El trasplante de órganos es el mejor tratamiento disponible para los estadios finales del fallo de la mayoría de los órganos vitales. El único factor limitante que existe para una mayor desarrollo de los diversos programas de trasplantes de órganos es la escasez de donantes en muerte encefálica. Por ello el fin principal de las coordinaciones intrahospitalarias de trasplantes, es la detección de posibles donantes y la generación de órganos para trasplantes. Material y método: se revisa la actividad de la Coordinación de Trasplantes del hospital Torrecardenas de Almería en cuanto a la detección de los pacientes en muerte encefálica y los potenciales donantes de órganos. Para ello se revisan de forma retrospectiva las historias de los pacientes diagnosticados de muerte encefálica durante el período de tiempo comprendido entre los años 1996 a 2002. Las variables analizadas han sido la edad, el sexo, etiología de la muerte encefálica, número de donantes reales, contraindicación médica y negativas familiares a la donación de órganos. Resultados: Se han detectado 250 pacientes diagnosticados de muerte encefálica, de los cuales 58 fueron rechazados como posibles donantes por contraindicación médica y 63 no fueron donantes por negativa familiar, lo cual supone un total de 129 donantes reales. Las principales causas de muerte encefálica fueron las hemorragias cerebrales y los traumatismos craneoencefálicos. Conclusiones: En el Hospital de Torrecárdenas, al igual que esta ocurriendo en el resto de los Hospitales Andaluces se esta produciendo una serie de cambios en las características de los donantes de órganos, con un aumento de la edad media y un cambio progresivo en la etiología de la muerte encefálica a favor de las hemorragias cerebrales y en detrimento de los traumatismos craneoencefálicos

Organ transplant is the best available treatment in the last stages of failure of most vital organs. The only limiting factor in order to get a bigger development of organ transplantation programs is the lack of brain death donors. The main purpose in the transplant coordination between hospitals is the detection of potential donors in order to generate organs for transplantation. Material and methods: The activity of Transplant Coordination in Torrecárdenas hospital is revised as regards detection of patients with brain death and potential organ donors. Histories of patients diagnosed as having brain death, number of actual donors, medical contraindications and family refusal to organ donation. Results: A total number of 250 patients with brain death was diagnosed. Fifty-eight of them were rejected as potential donors due to medical contraindications and 63 were not donors due to the family refusal. It means 129 actual donors. Main reasons of brain death were cerebral hemorrhage and traumatic brain injuries (TBI). Conclusions: In Torrecárdenas Hospital, as it happens in the rest of Andalusian hospitals, a series of changes is taking place regarding features of organ donors. There is an increase in mean age and a gradual change in the etiology of brain death (AU)