Registry of the Spanish Network for Systemic Sclerosis: Survival, Prognostic Factors, and Causes of Death.

Systemic sclerosis (SSc) is a rare, multisystem disease showing a large individual variability in disease progression and prognosis. In the present study, we assess survival, causes of death, and risk factors of mortality in a large series of Spanish SSc patients. Consecutive SSc patients fulfilling criteria of the classification by LeRoy were recruited in the survey. Kaplan-Meier and Cox proportional-hazards models were used to analyze survival and to identify predictors of mortality. Among 879 consecutive patients, 138 (15.7%) deaths were registered. Seventy-six out of 138 (55%) deceased patients were due to causes attributed to SSc, and pulmonary hypertension (PH) was the leading cause in 23 (16.6%) patients. Survival rates were 96%, 93%, 83%, and 73% at 5, 10, 20, and 30 years after the first symptom, respectively. Survival rates for diffuse cutaneous SSc (dcSSc) and limited cutaneous SSc were 91%, 86%, 64%, and 39%; and 97%, 95%, 85%, and 81% at 5, 10, 20, and 30 years, respectively (log-rank: 67.63, P < 0.0001). The dcSSc subset, male sex, age at disease onset older than 65 years, digital ulcers, interstitial lung disease (ILD), PH, heart involvement, scleroderma renal crisis (SRC), presence of antitopoisomerase I and absence of anticentromere antibodies, and active capillaroscopic pattern showed reduced survival rate. In a multivariate analysis, older age at disease onset, dcSSc, ILD, PH, and SRC were independent risk factors for mortality. In the present study involving a large cohort of SSc patients, a high prevalence of disease-related causes of death was demonstrated. Older age at disease onset, dcSSc, ILD, PH, and SRC were identified as independent prognostic factors.

Systemic sclerosis sine scleroderma and limited cutaneous systemic sclerosis: similarities and differences.

OBJECTIVES: To compare a cohort of patients with systemic sclerosis sine scleroderma (ssSSc) vs. patients with limited cutaneous systemic sclerosis (lcSSc). METHODS: Forty-five patients with ssSSc and 186 patients with lcSSc were investigated. Demographic, clinical and immunologic features and survival were compared. RESULTS: There were no significant differences between ssSSc and lcSSc in gender, age at onset and interval between onset and diagnosis. ssSSc patients fulfilled the ACR criteria for SSc less than lcSSc patients (13%/77%, p<0.0001). There were no significant differences in articular involvement, myopathy, tendon friction rubs and gastrointestinal, pulmonary, cardiac and renal involvements. There was a trend to higher prevalence of pulmonary arterial hypertension (PAH) in ssSSc patients (29%/19%) but not reach significant difference. The prevalence of antinuclear and anticentromere antibodies and slow capilaroscopic pattern was similar. Sicca syndrome (13%/30%; p=0.024), digital ulcers (16%/50%; p<0.0001), calcinosis (11%/26%; p=0.047) and acroosteolysis (0% /10%; p=0.028) were more frequently in lcSSc. Survival at 5, 10, and 15 yr was not different in ssSSc and lcSSc patients (100%/98%, 100%/98%, and 92%/89%, respectively). CONCLUSIONS: ssSSc and lcSSc patients share demographic, clinical and immunologic features. Survival is also similar in both groups. Differences are mainly due to peripheral vascular manifestations. However, despite great similarities, we believe that ssSSc patients should be considered as a different subset in order to avoid misdiagnosis. ssSSc patients should be truly differentiated from early SSc using sensitive and specific studies looking for any asymptomatic organ involvement.

[An epidemiologic study of headache and its treatment in the general population of Catalonia]. / Estudio epidemiológico del dolor de cabeza y su tratamiento en la población general de Cataluña.

INTRODUCTION: Headache is one of the most frequent symptoms that people suffer in their daily life. However, the available studies have been made in populations who ask for medical advice or in small geographical areas. OBJECTIVES: The present survey was devoted to establish the prevalence of headache in the general population of Catalonia, as well as to establish its characteristics, the therapeutic behavior that was followed by those affected and the consequences for the sufferers. PATIENTS AND METHODS: The survey included a sample of 1,964 people, who were representative of the population older than 18 years, and was obtained from the census. The data were obtained by means of a telephone interview. The prevalence of pain in the last six months was established. Among the sufferers of headaches, additional information was obtained concerning its characteristics, its relationship with socio demographic characteristics and the therapeutic behaviors used by patients. The degree of impairment and disability secondary to headache was also determined. RESULTS: The prevalence was 42%, and it was the highest in women (52.8 vs 31.1%) young people (mean age of 43.4 16 years), unskilled manual workers, middle level managers and technicians and those with university studies. Headaches had a long duration (84.4%, more than 3 years); the episodes were frequent, of short duration and or severe intensity (61.2% were severe unbearable). Self medication was the therapeutic behavior most commonly used (52.3%, being acetylsalicylic acid the most employed), followed by visit to the physician (47.4%, being the prescription of paracetamol the preferred treatment) and some alternative medical treatments (16.1%). Headaches limited the daily activities of the sufferers (31.4%), forced to bed rest (23.4%) and even resulted in time off work (4.6%). All personal, social and work impairments had short duration in most individuals. CONCLUSIONS: Headache has a high prevalence in the general population. Although the episodes had a brief duration and self medication was commonly used, pain is frequently severe, limits the daily activities and sufferers often visit the physicians to obtain relief. Headaches should not be considered as a minor health disorder.

Estudio epidemiológico del dolor de cabeza y su tratamiento en la población general de Cataluña / An epidemiologic study of headache and its treatment in the general population of Catalonia

Introducción. El dolor de cabeza constituye uno de los síntomas más frecuentes que afectan a las personas en su vida cotidiana. Sin embargo, los estudios disponibles se refieren a poblaciones que solicitan asistencia sanitaria o en áreas geográficas restringidas. Objetivos. El presente estudio se dirigió a establecer la prevalencia de dolor de cabeza en la población general adulta de Cataluña, así como sus características, la conducta terapéutica seguida y las consecuencias para quienes lo sufren. Pacientes y métodos. Estudio descriptivo de una muestra de 1.964 personas, representativa de la población mayor de 18 años y obtenida a partir del censo. Los datos se obtuvieron mediante una entrevista telefónica. Se determinó la prevalencia de dolor en general durante los últimos seis meses. En los entrevistados que refirieron haber sufrido dolor de cabeza, se analizaron sus características, se investigó su relación con las variables sociodemográficas, y se determinaron las conductas terapéuticas empleadas para aliviarlo y las consecuencias personales, sociales y laborales. Resultados. La prevalencia fue del 42 por ciento, más elevada en mujeres (52,8 frente 31,1 por ciento) y jóvenes (edad media de 43,4 ñ 16 años), en trabajadores manuales, técnicos medios y en personas con estudios superiores. Fue de larga evolución (84,4 por ciento más de 3 años), los episodios frecuentes, de corta duración y de intensidad considerable (61,2 por ciento intensa-insoportable). La automedicación fue la conducta más habitual (52,3 por ciento, ácido acetilsalicílico el más empleado), seguido de la visita médica (47,4 por ciento, paracetamol el más prescrito) y algún tratamiento no convencional (16,1 por ciento). La cefalea limitó la actividad habitual (31,3 por ciento), obligó a guardar reposo en cama (23,4 por ciento) y fue causa de baja laboral en un 4,6 por ciento. Las repercusiones personales, sociales y laborales fueron, en general, de corta duración. Conclusiones. La cefalea tiene una elevada prevalencia en la población general. Aunque los episodios son breves y predomina la automedicación, a menudo su intensidad aumenta, limita las actividades cotidianas, genera visitas médicas y no debería considerarse como un dolor banal (AU)

[General analysis of the Tumor Registry of the Hospital de Sta. Caterina de Girona. Description of the series and study of the diagnostic and therapeutic delay]. / Análisis general del Registro de Tumores del Hospital de Sta. Caterina de Girona. Descripción de la serie y estudio del retardo diagnóstico y terapéutico.

This work presents the epidemiological and clinical data of 2521 tumor cases registered in the Servicio de Oncología of the Hospital Provincial Sta. Caterina (Girona), analyzing the time intervals between the first symptoms, the diagnosis, and the beginning of treatment.