Prevalence of symptomatic axial osteoarthritis phenotypes in Spain and associated socio-demographic, anthropometric, and lifestyle variables.

OBJECTIVE: Axial osteoarthritis (OA) is a common cause of back and neck pain, however, few studies have examined its prevalence. The aim was to estimate the prevalence and the characteristics of symptomatic axial OA in Spain. METHODS: EPISER2016 is a cross-sectional multicenter population-based study of people aged 40 years or older. Subjects were randomly selected using multistage stratified cluster sampling. Participants were contacted by telephone to complete rheumatic disease screening questionnaires. Two phenotypes were analyzed, patients with Non-exclusive axial OA (NEA-OA) and Exclusive axial OA (EA-OA). To calculate the prevalence and its 95% confidence interval (CI), the sample design was considered and weighting was calculated according to age, sex and geographic origin. RESULTS: Prevalence of NEA-OA by clinical or clinical-radiographic criteria was 19.17% (95% CI: 17.82-20.59). The frequency of NEA-OA increased with age (being 3.6 times more likely in patients aged 80 s or more than in those between 40 and 49 years) and body mass index. It was significantly more frequent in women, as well as in the center of Spain. It was less frequent in those with a higher level of education. Lumbar OA was more frequent than cervical OA. This difference grew with increasing age and was not associated with gender. It was also greater in overweight and obese subjects. CONCLUSIONS: This is the first study on the prevalence of axial OA phenotypes in Europe describing the associated socio-demographic, anthropometric, and lifestyle variables.

Prevalence of symptomatic osteoarthritis in Spain: EPISER2016 study.

INTRODUCTION: The Spanish Society of Rheumatology carried out the EPISER2000 study in 2000 to determine the prevalence of osteoarthritis and other rheumatic diseases in the Spanish population. Recent sociodemographic changes and lifestyle habits in Spain justified updating the epidemiological data on osteoarthritis and other rheumatic diseases (EPISER2016-study). OBJECTIVE: To estimate the prevalence of symptomatic osteoarthritis of the cervical spine, lumbar spine, hip, knee and hand in the adult population in Spain. MATERIAL AND METHODS: Cross-sectional population-based study. A multistage and stratified random cluster sampling was carried out. The participants were contacted by telephone to complete an osteoarthritis screening questionnaire. A rheumatologist confirmed or discarded the diagnosis. The ACR-clinical-criteria were used to diagnose hand-osteoarthritis and the ACR-clinical-radiological criteria to diagnose knee- and hip-osteoarthritis. To estimate the prevalence and its 95% confidence interval, weights were calculated according to the probability of selection in each of the sampling stages. RESULTS: The prevalence of osteoarthritis in Spain in one or more of the locations studied was 29.35%. The prevalence of cervical-osteoarthritis was 10.10% and of lumbar-osteoarthritis 15.52%. Both are more frequent in women and at older ages, as well as in people with low levels of education and obesity. The prevalence of hip-osteoarthritis was 5.13%, that of knee-osteoarthritis 13.83%, these are associated with female sex, overweight and obesity. The prevalence of hand osteoarthritis was 7.73%. It is more frequent in women, who are obese, with a low educational level and who are older. CONCLUSION: The EPISER2016 study is the first to analyse the prevalence of symptomatic osteoarthritis in 5 locations (cervical, lumbar, knee, hip and hands) in Spain. Lumbar spine osteoarthritis is the most prevalent.

The prevalence of rheumatoid arthritis in Spain.

Rheumatoid arthritis (RA) prevalence is believed to be around 1% worldwide, although it varies considerably among different populations. The aim of EPISER2016 study was to estimate the prevalence of RA in the general adult population in Spain. We designed a population-based cross-sectional study. A national survey was conducted between November 2016 and October 2017 involving a probabilistic sample from the general population aged 20 years or older. Subjects were randomly selected for phone screening using a computer-assisted telephone interviewer system. Positive RA screening results were evaluated by a rheumatologist. Cases fulfilled the 1987 ACR and/or the 2010 ACR/EULAR criteria; previous diagnosis established by a rheumatologist and clearly identified in medical records were also accepted regardless of the criteria used. Prevalence estimates with 95% CI were calculated taking into account the design of the sample (weighting based on age, sex, and geographic origin using as a reference the distribution of the population in Spain). 4916 subjects participated in the study and 39 RA cases were confirmed. RA estimated prevalence was 0.82% (95% CI 0.59-1.15). Mean age of RA cases was 60.48 (14.85) years, they were more frequently women (61.5%), from urban areas (74.4%), non-smokers (43.6%), and with a high body mass index (53.8% with overweight). Extrapolating to the population in Spain (approximately 37 million are ≥ 20 years old), it was estimated that there were between 220,000 and 430,000 people aged 20 years or older with RA. No undiagnosed cases were detected, which could be related to the establishment of early arthritis clinics around the country, increasing the rates of diagnosis during early phases of RA.

Higher prevalence of psoriatic arthritis in the adult population in Spain? A population-based cross-sectional study.

OBJECTIVE: The prevalence of psoriatic arthritis (PsA) is very heterogeneous. There are no data on its frequency in the general population in Spain. The aim of EPISER2016 study was to estimate the prevalence of PsA in people aged ≥20 years in Spain. METHODS: Cross-sectional multicenter population-based study. Subjects from all the autonomous communities in Spain were randomly selected using multistage stratified cluster sampling. Participants in each of the municipalities randomly selected for the study were administered a telephone-based questionnaire to screen for the study diseases. If the participant reported being previously diagnosed, rheumatologists from the participant's reference hospital confirmed the diagnosis based on a review of the clinical history. Subjects not previously diagnosed but whose screening result was positive based on symptoms received a second telephone call from the investigating rheumatologist in order to evaluate the suspicion. If the suspicion remained, an appointment was made at the reference hospital to complete the diagnostic confirmation process according to CASPAR criteria. To calculate the prevalence and its 95% confidence interval (CI), the sample design was taken into account and weighing was calculated considering age, sex and geographic origin. RESULTS: The sample comprised 4916 subjects. The prevalence of PsA was 0.58% (95%CI: 0.38-0.87). All but 1 of the 27 cases (96.30%) had been diagnosed prior to EPISER2016. CONCLUSION: The prevalence of PsA in Spain was among the highest reported to date, only below that reported in Norway (0.67%) and slightly higher than that reported in Italy (0.42%).

Prevalence of symptomatic osteoarthritis in Spain: EPISER2016 study. / Prevalencia de artrosis sintomática en España: Estudio EPISER2016.

INTRODUCTION: The Spanish Society of Rheumatology carried out the EPISER2000 study in 2000 to determine the prevalence of osteoarthritis and other rheumatic diseases in the Spanish population. Recent sociodemographic changes and lifestyle habits in Spain justified updating the epidemiological data on osteoarthritis and other rheumatic diseases (EPISER2016-study). OBJECTIVE: To estimate the prevalence of symptomatic osteoarthritis of the cervical spine, lumbar spine, hip, knee and hand in the adult population in Spain. MATERIAL AND METHODS: Cross-sectional population-based study. A multistage and stratified random cluster sampling was carried out. The participants were contacted by telephone to complete an osteoarthritis screening questionnaire. A rheumatologist confirmed or discarded the diagnosis. The ACR-clinical-criteria were used to diagnose hand-osteoarthritis and the ACR-clinical-radiological criteria to diagnose knee- and hip-osteoarthritis. To estimate the prevalence and its 95% confidence interval, weights were calculated according to the probability of selection in each of the sampling stages. RESULTS: The prevalence of osteoarthritis in Spain in one or more of the locations studied was 29.35%. The prevalence of cervical-osteoarthritis was 10.10% and of lumbar-osteoarthritis 15.52%. Both are more frequent in women and at older ages, as well as in people with low levels of education and obesity. The prevalence of hip-osteoarthritis was 5.13%, that of knee-osteoarthritis 13.83%, these are associated with female sex, overweight and obesity. The prevalence of hand osteoarthritis was 7.73%. It is more frequent in women, who are obese, with a low educational level and who are older. CONCLUSION: The EPISER2016 study is the first to analyse the prevalence of symptomatic osteoarthritis in 5 locations (cervical, lumbar, knee, hip and hands) in Spain. Lumbar spine osteoarthritis is the most prevalent.

Prevalencia de enfermedades reumáticas en población adulta en España (estudio EPISER 2016). Objetivos y metodología / Prevalence of rheumatic diseases in adult population in Spain (EPISER 2016 study): Aims and methodology

Objetivos: Describir la metodología del estudio de prevalencia de las enfermedades reumáticas en la población adulta en España, EPISER 2016, así como sus fortalezas y limitaciones. El objetivo del proyecto es estimar la prevalencia de artritis reumatoide (AR), artropatía psoriásica (APs), espondilitis anquilosante (EA), lupus eritematoso sistémico (LES), síndrome de Sjögren (SS), artrosis (de rodilla, cadera, manos, columna cervical y lumbar), fibromialgia, gota y fractura osteoporótica clínica. Material y método: Estudio transversal multicéntrico de base poblacional en el que participan 45 municipios de las 17 comunidades autónomas. La población de referencia está compuesta por adultos de 20 o más años residentes en España. La recogida de información se llevará a cabo mediante encuesta telefónica empleando el sistema Computer Assisted Telephone Interview (CATI). Las sospechas diagnósticas y los diagnósticos autorreferidos serán estudiadas por reumatólogos del hospital de referencia de los municipios seleccionados. Análisis estadístico: se calcularán las prevalencias de enfermedades reumáticas mediante estimadores y sus IC del 95%. Se calcularán factores de ponderación en función de la probabilidad de selección en cada una de las etapas del muestreo. Se tendrá en cuenta la distribución de la población en España según datos del Instituto Nacional de Estadística. Conclusiones: Los cambios sociodemográficos y en hábitos de vida durante los últimos 16 años justifican la realización de EPISER 2016. El estudio ofrecerá datos actualizados de prevalencia en AR, EA, APs, LES, SS, artrosis, fibromialgia, gota y fractura osteoporótica clínica. Los resultados permitirán comparar los datos con estudios de otros países y con el EPISER 2000

Aims: To describe the methodology of the EPISER 2016 (study of the prevalence of rheumatic diseases in adult population in Spain), as well its strengths and limitations. The aim of this study is to estimate the prevalence of rheumatoid arthritis (RA), psoriatic arthritis (PsA), ankylosing spondylitis (AS), systemic lupus erythematosus (SLE), Sjögren's syndrome (SS), osteoarthritis (knee, hip, hands, and cervical and lumbar spine), fibromyalgia, gout and clinical osteoporotic fracture. Material and method: Population-based, multicenter, cross-sectional study, with the participation of 45 municipalities in the 17 Spanish autonomous communities. The reference population will consist of adults aged 20 years and over residing in Spain. A computer-assisted telephone interview (CATI) system will be used for data collection. Diagnostic suspicions and diagnoses received by the participants will be studied by rheumatologists in the referral hospitals in the selected municipalities. Statistical analysis: the prevalence of the rheumatic diseases will be calculated using estimators and their 95% confidence intervals. Weights will be calculated in each of the sampling stages in accordance with the probability of selection. The distribution of the population in Spain will be obtained from the Spanish Statistics Institute. Conclusions: Sociodemographic and lifestyle changes over the last 16 years justify EPISER 2016. This study will provide current data about the prevalences of RA, AS, PsA, SLE, SS, osteoarthritis, fibromyalgia, gout and clinical osteoporotic fracture. The results will allow comparisons with studies from other countries and EPISER 2000

Prevalence of rheumatic diseases in adult population in Spain (EPISER 2016 study): Aims and methodology. / Prevalencia de enfermedades reumáticas en población adulta en España (estudio EPISER 2016). Objetivos y metodología.

AIMS: To describe the methodology of the EPISER 2016 (study of the prevalence of rheumatic diseases in adult population in Spain), as well its strengths and limitations. The aim of this study is to estimate the prevalence of rheumatoid arthritis (RA), psoriatic arthritis (PsA), ankylosing spondylitis (AS), systemic lupus erythematosus (SLE), Sjögren's syndrome (SS), osteoarthritis (knee, hip, hands, and cervical and lumbar spine), fibromyalgia, gout and clinical osteoporotic fracture. MATERIAL AND METHOD: Population-based, multicenter, cross-sectional study, with the participation of 45 municipalities in the 17 Spanish autonomous communities. The reference population will consist of adults aged 20 years and over residing in Spain. A computer-assisted telephone interview (CATI) system will be used for data collection. Diagnostic suspicions and diagnoses received by the participants will be studied by rheumatologists in the referral hospitals in the selected municipalities. STATISTICAL ANALYSIS: the prevalence of the rheumatic diseases will be calculated using estimators and their 95% confidence intervals. Weights will be calculated in each of the sampling stages in accordance with the probability of selection. The distribution of the population in Spain will be obtained from the Spanish Statistics Institute. CONCLUSIONS: Sociodemographic and lifestyle changes over the last 16 years justify EPISER 2016. This study will provide current data about the prevalences of RA, AS, PsA, SLE, SS, osteoarthritis, fibromyalgia, gout and clinical osteoporotic fracture. The results will allow comparisons with studies from other countries and EPISER 2000.

Adherence to Mediterranean diet and bone health.

INTRODUCTION: Several studies have concluded that incidences of osteoporosis and osteoporosis-related fractures vary across the European Union, the lowest incidence being reported in the Mediterranean area. The beneficial effect is mainly attributed to a specific eating pattern. The Mediterranean diet contain a complex array of naturally occurring bioactive molecules with antioxidant, anti-inflammatory and alkalinising properties that may contribute to the bone-sparing effect of the Mediterranean diet. OBJECTIVE: The purpose of this review is to examine the evidence to date on the effects of Mediterranean diet on bone health. METHODS: The search for articles came from extensive research in the following databases: PubMed, Scopus and Web of Science. We used the search terms "Mediterranean diet", "adherence", "fruit and vegetable", "olive oil", "fish" "legume", "cereal" "alcohol", "bone", "osteoporosis", "fracture", and combinations, such as "Mediterranean diet and bone" or "Mediterranean diet and fracture". RESULTS: A limited number of studies have examined the relationship between Mediterranean Diet and bone health, and they have reported conflicting results. On the one hand, adherence to a traditional MeDi has been associated with higher bone mineral density and lower fracture risk. The results of these studies could be attributed to the combined beneficial effects of individual components of the Mediterranean diet. On the contrary, several studies failed to show any association between adherence to the MeDi and indices of bone mass. CONCLUSIONS: Further large-scale studies are required to clarify the effect of Mediterranean diet on bone health, in order to establish the role of this diet in the prevention of osteoporosis.

Introducción: Se han encontrado diferencias en los valores de incidencia de osteoporosis y fracturas relacionadas entre los países de la Unión Europea, siendo menor en los países de la zona mediterránea. Este hecho se atribuye principalmente a un patrón de alimentación específica común. La dieta mediterránea contiene un complejo conjunto de componentes bioactivos con propiedades antioxidantes, anti-inflamatorias y alcalinizantes que pueden contribuir al efecto de esta dieta en la salud ósea. Objetivo: El propósito de esta revisión es examinar la evidencia hasta la fecha sobre los efectos de la dieta mediterránea sobre la salud ósea. Métodos: Se realizó una búsqueda en la literatura científica utilizando las siguientes base de datos: PubMed, Scopus and Web of Science. Utilizamos los términos de búsqueda "Dieta Mediterránea", "adhesión", "frutas y verduras", "aceite de oliva", "pescado" "legumbres", "cereal", "alcohol", "hueso", "osteoporosis","fractura", y combinaciones, como "Dieta Mediterránea y el hueso" o "Dieta mediterránea y fracturas". Resultados: Existe un número limitado de estudios que analicen la relación entre el seguimiento de la Dieta Mediterránea y la salud ósea, mostrando resultados contradictorios. Diversos trabajos han mostrado que la adherencia a una dieta mediterránea tradicional se asociado con una mayor densidad mineral ósea y un menor riesgo de fractura en población adulta. Los resultados de estos estudios podrían atribuirse a un efecto beneficioso combinado de los componentes individuales de la dieta mediterránea. Por el contrario, en otros trabajos no se ha encontrado ninguna asociación entre la adherencia a la dieta mediterránea y los índices de masa ósea. Conclusiones: Se requieren más estudios a gran escala para aclarar el efecto de la dieta mediterránea sobre la salud ósea, con el fin de establecer el papel de la dieta en la prevención de la osteoporosis.

Adherence to Mediterranean diet and bone health / Adherencia a la dieta mediterránea y salud ósea

Introduction: Several studies have concluded that incidences of osteoporosis and osteoporosis-related fractures vary across the European Union, the lowest incidence being reported in the Mediterranean area. The beneficial effect is mainly attributed to a specific eating pattern. The Mediterranean diet contain a complex array of naturally occurring bioactive molecules with antioxidant, anti-inflammatory and alkalinising properties that may contribute to the bone-sparing effect of the Mediterranean diet. Objective: The purpose of this review is to examine the evidence to date on the effects of Mediterranean diet on bone health. Methods: The search for articles came from extensive research in the following databases: PubMed, Scopus and Web of Science. We used the search terms «Mediterranean diet», «adherence», «fruit and vegetable», «olive oil», «fish», «legume», «cereal», «alcohol», «bone», «osteoporosis», «fracture», and combinations, such as «Mediterranean diet and bone» or «Mediterranean diet and fracture». Results: A limited number of studies have examined the relationship between Mediterranean Diet and bone health, and they have reported conflicting results. On the one hand, adherence to a traditional MeDi has been associated with higher bone mineral density and lower fracture risk. The results of these studies could be attributed to the combined beneficial effects of individual components of the Mediterranean diet. On the contrary, several studies failed to show any association between adherence to the MeDi and indices of bone mass. Conclusions: Further large-scale studies are required to clarify the effect of Mediterranean diet on bone health, in order to establish the role of this diet in the prevention of osteoporosis (AU)

Introducción: Se han encontrado diferencias en los valores de incidencia de osteoporosis y fracturas relacionadas entre los países de la Unión Europea, siendo menor en los países de la zona mediterránea. Este hecho se atribuye principalmente a un patrón de alimentación específica común. La dieta mediterránea contiene un complejo conjunto de componentes bioactivos con propiedades antioxidantes, anti-inflamatorias y alcalinizantes que pueden contribuir al efecto de esta dieta en la salud ósea. Objetivo: El propósito de esta revisión es examinar la evidencia hasta la fecha sobre los efectos de la dieta mediterránea sobre la salud ósea. Métodos: Se realizó una búsqueda en la literatura científica utilizando las siguientes base de datos: PubMed, Scopus and Web of Science. Utilizamos los términos de búsqueda «Dieta Mediterránea», «adhesión», «frutas y verduras», «aceite de oliva», «pescado», «legumbres», «cereal», «alcohol», «hueso», «osteoporosis», «fractura», y combinaciones, como «Dieta Mediterránea y el hueso» o «Dieta mediterránea y fracturas». Resultados: Existe un número limitado de estudios que analicen la relación entre el seguimiento de la Dieta Mediterránea y la salud ósea, mostrando resultados contradictorios. Diversos trabajos han mostrado que la adherencia a una dieta mediterránea tradicional se asociado con una mayor densidad mineral ósea y un menor riesgo de fractura en población adulta. Los resultados de estos estudios podrían atribuirse a un efecto beneficioso combinado de los componentes individuales de la dieta mediterránea. Por el contrario, en otros trabajos no se ha encontrado ninguna asociación entre la adherencia a la dieta mediterránea y los índices de masa ósea. Conclusiones: Se requieren más estudios a gran escala para aclarar el efecto de la dieta mediterránea sobre la salud ósea, con el fin de establecer el papel de la dieta en la prevención de la osteoporosis (AU)

Sintomatología osteoarticular: como manifestación inicial de enfermedad tumoral / Osteoarticular symptomatology as an initial manifestation of tumor disease

La clínica músculo esquelética puede constituir manifestación de debut de muchos tumores. Pretendemos mostrar datos epidemiológicos relevantes que presentan pacientes diagnosticados de neoplasia en una sala de reumatología. Estudio retrospectivo longitudinal protocolizado de historiales de pacientes diagnosticados de neoplasia en el período 1996-1998. 653 ingresos en reumatología de 12 320 consultas externas en dicho período; 5 por ciento con diagnóstico de cáncer (2,7 por ciento del total). Media de edad de 69 años. Tiempo desde inicio de síntomas hasta diagnóstico: 2 a 6 meses en 80 por ciento de casos; clínica osteoarticular presentada: dolor inflamatorio en el esqueleto axial (12 casos; 36 por ciento) lumbalgia (7/ 21 por ciento), dorso-lumbalgia (2/0,6 por ciento), cervicobraquialgia (1/0,3 por ciento), raquialgia global (1/0,3 por ciento); poliartralgias de ritmo continuo (24 por ciento), coxalgia (4/0,12 por ciento), hombro doloroso (3/0,9 por ciento), escapulalgia (1/0,3 por ciento), síndrome polimiálgico en artritis reumatoide (2/0,6 por ciento) y dermatomiositis (1/0,3 por ciento). Tumores diagnosticados: mieloma (10 casos), carcinoma de próstata (9), tumores digestivos (2), pulmón (2), urogenitales (2), mama (1), leucemia (1), endometrio (1) metastáticos (5). Las proteínas C reactiva, y velocidad de sedimentación globular elevadas en el 90 por ciento de pacientes. 5 por ciento de pacientes ingresados en reumatología se diagnostican de cáncer. El perfil epidemiológico que presenta el paciente suele corresponder a adulto mayor de 60 años, con clínica de dolor inflamatorio axial o poliarticular con más de 2 meses de evolución, elevaciones de PCR y VSG suelen estar presentes en la mayoría de casos.