Validation and adaptation of the Spanish version of the systemic lupus activity questionnaire (S-SLAQ) in an Argentinean population.

OBJECTIVES: To validate the systemic lupus activity questionnaire (SLAQ) in Spanish language. METHODS: The SLAQ questionnaire was translated and adapted in Spanish. Consecutive SLE patients from 8 centers in Argentina were included. A rheumatologist completed a Systemic Lupus Activity Measure (SLAM), Systemic Lupus Erythematosus Disease Activity Index (SLEDAI)-2K, and a physician's assessment. Reliability was assessed by internal consistency (Cronbach's alpha), stability by test-retest reliability (intraclass correlation coefficient), and construct validity by evaluating the correlation with clinically relevant scores. Sensitivity and specificity for clinically significant disease activity (SLEDAI ≥6) of different S-SLAQ cut-off points were evaluated. RESULTS: We included 97 patients ((93% female, mean age: 40 years (SD14.7)). Internal consistency was excellent (Cronbach's alpha = 0.84, p < 0.001), and the intraclass correlation coefficient was 0.95 (p < 0.001). Mean score of S-SLAQ was 8.2 (SD 7.31). Correlation of S-SLAQ was moderate with Patient NRS (r= 0.63 p< 0.001), weak with SLAM-no lab (r = 0.42, p <0.001) and SLAM (r = 0.38, p < 0.0001), and very weak with SLEDAI-2K (r = 0.15, p =0.1394). Using the S-SLAQ cutoff of five points, the sensitivity was 72.2% and specificity was 37.9%, for clinically significant disease activity. CONCLUSIONS: The S-SLAQ showed good validity and reliability. A good correlation, similar to the original instrument, was observed with patient´s global disease activity. No correlation was found between S-SLAQ and gold standard disease activity measures like SLEDAI-2K and SLAM. The S-SLAQ cutoff point of 5 showed a good sensitivity to identify the active SLE population and therefore could be an appropriate screening instrument for disease activity in clinical and epidemiological studies.

Effects of cigarette smoking on early arthritis: a cross-sectional study-data from the Argentine Consortium for Early Arthritis (CONAART).

Our objective was to analyze the effects of cigarette smoking on disease activity, functional capacity, radiographic damage, serology and presence of extraarticular manifestations in patients with rheumatoid arthritis and undifferentiated arthritis. This is a cross-sectional study of 1,305 patients (729 with rheumatoid arthritis and 576 with undifferentiated arthritis) from CONAART, the Argentine Consortium for Early Arthritis that includes patients older than 16 years with <2 years of disease. Sociodemographic data, clinical characteristics of the disease and smoking history were collected. In patients with rheumatoid arthritis the disease activity score of 28 joints was 5.4 ± 1.3 in current smokers, 5.2 ± 1.4 in former smokers and 5.1 ± 1.4 in never smokers (p = 0.011). The simple erosion narrowing score was higher in current smokers and former smokers than in never smokers (M 14.0, R Q 6.0-21.0; M 15.0, R Q 7.0-24.0; M 10.0, R Q 5.0-17.0; p = 0.006). Current smokers had higher rheumatoid factor titer (M 160.0, R Q 80.0-341.0) than former smokers (M 146.8, R Q 6.03-255.5) and never smokers (M 15.0, R Q 9.0-80.0) (p = 0.004). The variable independently associated with tobacco exposure was simple erosion narrowing score (OR = 1.03, 95 % CI 1.00-1.05; p = 0.012). In patients with undifferentiated arthritis, an association between smoking status and parameters of activity or radiographic damage was not observed. Neither was tobacco exposure related to the presence of extraarticular manifestations or to the degree of disability in any of the two groups of patients. No relation was found between disease activity and severity, and number of packs smoked per year. Tobacco.

Adaptación de la versión para pacientes de las recomendaciones para el tratamiento hacia un objetivo (T2T) en artritis reumatoidea para su uso en Argentina / Adaptation of the treat to target patients versión in Argentinean patients with rheumatoid arthritis

En el año 2008 fueron publicadas las recomendaciones para eltratamiento hacia el objetivo en artritis reumatoidea (treat to target:T2T). Originalmente diseñadas como recomendaciones para guiar areumatólogos en el tratamiento de la AR, en el año 2011 se publicóla primera versión para pacientes de estas recomendaciones eninglés.Objetivo: validar la versión para pacientes de las recomendacionesT2T para su uso en Argentina a través de la adaptación transculturalde la versión original.Método: Se realizó un proceso de adaptación transcultural a partirde la versión original. De este proceso de traducción y retraduccióny del análisis por parte de un comité de expertos, se obtuvo unaversión prefinal.Esta versión fue sometida a una prueba de campo mediante unaentrevista a pacientes alfabetos consecutivos con diagnósticode AR en diferentes centros de Buenos Aires, Ciudad de BuenosAires y Santa Fe. En esta entrevista se evaluó validez de forma,equivalencia conceptual, interpretabilidad y aceptabilidad. Elresultado obtenido de estas entrevistas fue discutido con el comitédesignado de investigadores para desarrollar una versión final dela pieza validada.Durante la entrevista se permitió leer la versión en español prefinaly se invitó a calificar de 0 a 10 cada oración de acuerdo al gradode comprensión del texto. A su vez se exploró el grado de acuerdoy de adaptabilidad a su problema de salud y se reemplazaron laspalabras que ofrecieron mayores dificultades...

In 2008 recommendations for the treatment towards the targetin rheumatoid arthritis (treat to target: T2T) were published.Originally designed as recommendations to guide rheumatologistsin the treatment of RA, in 2011 the first patient version of theserecommendations was published in English.Objective: To validate the Spanish version of the patient version ofthe T2T recommendations through cross-cultural adaptation of theoriginal version.Method: A cross-cultural adaptation process was made from theoriginal version. In this process of translation and back translationand analysis by a committee of experts, a prefinal version wasobtained.This version was subjected to a field test by interviewing alphabetsconsecutive patients diagnosed with RA at different centers inBuenos Aires, CABA and Santa Fe. Construct validity, cross-culturaladaptability, interpretation and acceptability were evaluated andlater discussed with the committee to get the final version.After reading patients had to point each sentence from 0 to 10according to the degree of understanding of the text. The degreeof agreement and adaptability to their health problem was exploredand words that offered greater difficulties were replaced...

Adherencia al tratamiento de pacientes con artritis reumatoidea que reciben medicamentos biológicos / Treatment adherence in patients with rheumatoid arthritis receiving biologics

Introducción: Al igual que en otras enfermedades crónicas, la adherencia al régimen terapéutico de los pacientes con artritis reumatoidea (AR) es baja (entre 30 y 80%), dependiendo de la definición de adherencia y de la metodología empleada para medirla. En este estudio se propone determinar el nivel de adherencia al tratamiento en pacientes con AR que reciben DMAR biológicas e identificar factores asociados a la falta de cumplimiento a la terapia. Material y métodos: Se realizó un estudio analítico, observacional de corte transversal en donde se incluyeron pacientes consecutivos con AR según criterios de clasificación (ACR’87) que se encontraban recibiendo fármacos biológicos para el tratamiento de su enfermedad en los últimos seis meses y que asistieron a la consulta ambulatoria. Para la valoración de la adherencia a DMAR se utilizaron los cuestionarios CQR (Compliance Questionnaire on Rheumatology) y el cuestionario SMAQ (Simplified Medication Adherence Questionnaire). Resultados: Se encuestaron 345 pacientes. Mediante el cuestionario SMAQ se observó una adherencia del 50% (159 pacientes). El Cuestionario CQR tuvo un puntaje mediano de 78 puntos (RIC 67-86). El 47% (147 pacientes) fueron adherentes (CQR >80). Sobre los pacientes incluidos, 151 (48%) refirieron no haber tenido ningún retraso, pérdida o adelanto de la dosis del biológico en los últimos 6 meses de tratamiento. El 52% no adherentes tuvo como causas: 146 (46%) pérdida de al menos una dosis del biológico con una mediana de dosis perdidas de 2 (RIQ: 1-3); 117 (37%) tuvo al menos un retraso en las dosis del biológico y 8 (2%) delantó la dosis. Los factores asociados al no cumplimiento de la terapia biológica fueron el tipo de cobertura médica, que el paciente no haya notado mejoría y la esperanza de una rápida respuesta al tratamiento, y la falta de adherencia a DMAR

Introduction: As in other chronic diseases, adherence to the therapeutic regimen of patients with rheumatoid arthritis (RA) is low (between 30 and 80%), depending on the definition of adherence and the methodology used to measure it. This study aims to determine the level of adherence to treatment in patients with RA who receive biological DMARs and to identify factors associated with non-compliance with therapy. MATERIAL AND METHODS: An observational, cross-sectional, observational study was performed in which consecutive patients with RA according to classification criteria (ACR'87) who were receiving biological drugs for the treatment of their disease in the last six months were included Attended the outpatient appointment. The CQR (Compliance Questionnaire on Rheumatology) and SMAQ (Simplified Medication Adherence Questionnaire) questionnaires were used to assess adherence to DMAR. Results: A total of 345 patients were surveyed. A 50% adherence (159 patients) was observed through the SMAQ questionnaire. The CQR Questionnaire had a median score of 78 points (RIC 67-86). 47% (147 patients) were adherent (CQR> 80). Regarding the patients included, 151 (48%) reported not having had any delay, loss or advancement of the biological dose in the last 6 months of treatment. The 52% of non-adherents had as causes: 146 (46%) loss of at least one dose of the biological with a median of doses lost of 2 (RIQ: 1-3); 117 (37%) had at least one biological dose delay and 8 (2%) delayed the dose. Factors associated with non-compliance with biological therapy were the type of medical coverage, the patient's perceived improvement and the expectation of a rapid response to treatment, and lack of adherence to DMAR.

Work productivity in rheumatoid arthritis: relationship with clinical and radiological features.

Objective. To assess the relationship between work productivity with disease activity, functional capacity, life quality and radiological damage in patients with rheumatoid arthritis (RA). Methods. The study included consecutive employed patients with RA (ACR'87), aged over 18. Demographic, disease-related, and work-related variables were determined. The reduction of work productivity was assessed by WPAI-RA. Results. 90 patients were evaluated, 71% women. Age average is 50 years old, DAS28 4, and RAQoL 12. Median SENS is 18 and HAQ-A 0.87. Mean absenteeism was of 14%, presenting an average of 6.30 work hours wasted weekly. The reduction in performance at work or assistance was of 38.4% and the waste of productivity was of 45%. Assistance correlated with DAS28 (r = 0.446; P < 0.001), HAQ-A (r = 0.545; P < 0.001) and RAQoL (r = 0.475; P < 0.001). Lower total productivity was noticed in higher levels of activity and functional disability. Patients with SENS > 18 showed lower work productivity than those with SENS < 18 (50 versus 34; P = 0.04). In multiple regression analysis, variables associated with reduction of total work productivity were HAQ-A and RAQoL. Conclusion. RA patients with higher disease severity showed higher work productivity compromise.

Factors associated with disability in patients with rheumatoid arthritis.

OBJECTIVE: Analyze disability determinants in a cohort of Argentine patients with rheumatoid arthritis (RA). MATERIAL AND METHODS: Consecutive patients with RA, according to ACR'87 criteria, were recruited from 6 rheumatology centers. Demographic and socioeconomic data, family history, comorbid diseases, extra-articular manifestations and information about received treatments were provided. Disease activity was assessed using Disease Activity Score 28 (DAS 28) and the Health Assessment Questionnaire (HAQ)-A was used for the functional capacity. Hand and feet radiographs were assessed using Sharp-van der Heijde score. RESULTS: A total of 640 patients with RA were included, of which 85.2% were females. Mean age was 53 years (interquartile range [IQR], 44-62) and mean disease duration was 8 years (IQR, 4-14). DAS 28 mean was 2.72 (IQR, 1.7-3.7) and HAQ-A mean was 0.62 (IQR, 0.13-1.25). Multiple linear regression showed that the main variables associated with disability were DAS 28, radiologic damage and age. Main predictors of functional disability in the multiple logistic regression using severe HAQ (>2) as dependent variable were DAS 28 (OR, 2; P < 0.0001); age (OR, 1; P = 0.008); and structural damage (OR, 1; P = 0.001). CONCLUSIONS: In this population, the disease activity was the variable that showed the highest impact on the physical function. Radiologic damage affected HAQ as the disease progressed.

Evaluación de puntos de corte del Índice de Actividad Simplificado (IAS) mediante su comparación con DAS28 / Evaluation of cut-off points of the “Índice de Actividad Simplificado” (IAS) through comparison with DAS28

Introducción: El IAS es un índice de actividad desarrollado en el 2005 para Artritis Reumatoidea, el cual consiste en la suma de articulaciones dolorosas y tumefactas (de un recuento de 28 articulaciones), el valor en centímetros de la evaluación de actividad de la enfermedad realizada por el paciente y por el médico mediante Escala Analógica Visual (EVA), y el valor de la Velocidad de Sedimentación Globular (VSG) dividido en 10. Objetivo: Identificar puntos de corte del IAS para las categorías de actividad de la AR (remisión, baja, moderada y severa) en base a los puntos de cortes establecidos para DAS28. Métodos: Se incluyeron pacientes consecutivos con AR (ACR´87). Se evaluaron las siguientes variables: recuento de articulaciones dolorosas (28) y tumefactas (28), rigidez matinal, EVA del dolor, EVA global paciente y médico, HAQ-A, proteína C reactiva (PCR) en mg/dl y VSG. Se calcularon DAS28, Clinical Disease Activity Index (CDAI) y el IAS. Análisis estadístico: Correlación por test de Spearman (rs). Análisis por curvas ROC. Análisis de Varianza No Paramétrica de Kruskall- Wallis. Prueba No Paramétrica de Mann-Whitney. Un valor de p ≤0.05 fue considerado significativo. Resultados: Se incluyeron para el análisis 336 pacientes (86% mujeres). El IAS presentó una correlación positiva con CDAI y DAS28 (rs 0.9), recuento articular (rs 0.8), EVA global paciente y médico (rs 0.7), EVA del dolor (rs 0.6), HAQ-A y rigidez matinal (rs 0.5). Un valor de IAS de 5.5 diferenció remisión de baja actividad de la AR (Sensibilidad 90%, Especificidad 66%; Área Bajo la Curva - AUC - 0.78); un valor de 10 separó baja de moderada actividad (Sensibilidad 91%, Especificidad 73% - AUC 0.93); y 25 puntos diferenciaron actividad moderadade severa (Sensibilidad 91%, Especificidad 87% - AUC 0.96). Conclusiones: El IAS presenta buena correlación con otros índices de actividad (DAS28, CDAI).