Association of spondyloarthritis and sarcoidosis: A retrospective observational population-based matched cohort study.

OBJECTIVES: To investigate the association between spondyloarthritis (SpA) and sarcoidosis. METHODS: An observational retrospective population-based matched cohort study was conducted. Using data from the Spanish Minimum Basic Data Set. All the admissions of patients with SpA reported between 1999 and 2015 were analysed and a control group matched by age, sex and year of admission was selected. Crude and age- and sex-adjusted incidence rates for sarcoidosis were calculated. Generalized linear models were used for trend analysis and unconditional logistic regression models for calculating crude and adjusted odds ratios (ORs) to assess the association between sarcoidosis and SpA. RESULTS: The study database contained data on 214,280 hospitalisations: 107,140 admissions of patients with SpA and 107,140 of patients without SpA. Overall, 220 of the admissions were of patients with sarcoidosis: 133 (0.12%) in the SpA group and 87 (0.08%) in the non-SpA group (P<0.05). The incidence rates of sarcoidosis were 2.68 and 1.64 per 100,000 per year in the SpA and non-SpA groups, respectively. The trend was similar in the two cohorts. Regarding potential associations between SpA and sarcoidosis, the crude and adjusted ORs were 1.52 (95% CI: 1.16-2.01) and 1.50 (95% CI: 1.14-1.97) overall in patients with SpA, with adjusted ORs of 1.42 (95% CI: 1.03-1.94) and 1.81 (95% CI: 1.29-2.55) in patients with ankylosing spondylitis and psoriatic arthritis, respectively. CONCLUSIONS: There is a relationship that is not due to chance between sarcoidosis and SpA and specifically that sarcoidosis is significantly associated with ankylosing spondylitis and psoriatic arthritis.

Trends in fractures in patients with spondyloarthritis: a nationwide population-based study (TREND-EspA study).

Our aim was to analyze trends in fracture rates in SpA patients over an extended time period. Only an increase of axial fractures, more specifically vertebral fractures, is observed in SpA. PURPOSE: To analyze fracture incidence and trend in patients with spondyloarthritis (SpA) over an extended time period. METHODS: Retrospective observational population-based study with matched cohorts. Data from the Minimum Basic Data Set (MBDS) of Spain were reviewed. All SpA patient hospitalizations reported from 1999 to 2015 (SpA cohort) were analyzed. A control cohort (non-SpA cohort) matched by age, sex, region, and year of hospitalization was recruited. The age and sex-adjusted crude incidence rate was calculated for any fractures (axial and peripheral). Generalized linear models (GLM) were used for trend analysis. Association between fracture type and SpA (and its subtypes) was assessed using unconditional logistic regression models. RESULTS: In the SpA cohort, the age and sex-adjusted rates per 100,000 inhabitants/year of total fracture and different types of fracture were 45.72 any fractures, 17.64 axial, and 28.02 peripheral; 29.42 osteoporotic (12.67 vertebra, 12.29 hip, 1.50 pelvis, 1.82 humerus and 2.09 radius). In the non-SpA cohort, they were 65.79 any, 12.08 axial, 51.52 peripheral; 31.17 osteoporotic (4.94 vertebra, 16.15 hip, 2.29 pelvis, 3.64 humerus, 5.38 radius). Between 1999 and 2015, the trend in incidence rate for total fracture and different types of fracture increased similarly for both cohorts. In the SpA cohort, an increase of axial fractures was found (AOR 1.444; 95%CI 1.297-1.609), and specifically of vertebral fractures (AOR 2.440; 95%CI 2.097-2.839). Other types of fractures did not increase. CONCLUSIONS: Only an increase of axial fractures, more specifically vertebral fractures, is observed in SpA. Trend in incidence is similar in both cohorts.

Trends in amyloidosis in spondyloarthritis: results from the Spanish National Inpatient Registry over a 17-year period (1999-2015)-TREND-EspA study.

OBJECTIVE: To assess the incidence of amyloidosis and trends therein in patients with spondyloarthritis (SpA) over a long period (17 years). METHODS: An observational retrospective population-based matched cohort study was conducted. All the admissions of patients with SpA, including ankylosing spondylitis (AS), psoriatic arthritis (PsA), arthritis associated with inflammatory bowel disease (SpA-IBD) and reactive arthritis (ReA), reported between 1999 and 2015, were analysed and a control group matched by age, sex and year of admission was selected. Incidence rates for amyloidosis were calculated. Generalised linear models were used for trend analysis and unconditional logistic regression for calculating crude and adjusted ORs (AOR) to assess the association between amyloidosis and SpA. RESULTS: The study database contained data on 107 140 admissions in each group. Between 1999 and 2015, 792 patients in the SpA cohort (0.7% of all admissions) had a diagnosis of amyloidosis versus 68 in the non-SpA cohort (0.1%) (p<0.001). From 1999 to 2015, incidence rates of amyloidosis tended to decrease in the SpA cohort (-4.63%/year overall), while they increased in the Non-SpA cohort (+10.25%/year overall). We found strong associations of amyloidosis with all SpAs (AOR 10.4; 95% CI 8.2 to 13.3) and with each type studied (AORs 10.05 (7.84 to 12. 88) for AS, 9.5 (7.3 to 12.4) for PsA, 22.9 (16.6 to 31.7) for SpA-IBD and 10.1 (6.1 to 16.7) for ReA). CONCLUSIONS: Incidence of amyloidosis among patients with SpA has strongly decreased in Spain. Amyloidosis is most strongly associated with SpA-IBD while the strength of association with PsA and ReA is similar to that with AS.

[Democracy and Covid-19 mortality in Europe.] / Democracia y mortalidad por Covid-19 en Europa.

OBJECTIVE: In Europe there is a great variability in mortality by Covid-19 among different countries. While some countries, such as Greece, Belarus or Ukraine, have a mortality rate of less than 5 cases/100,000 inhabitants, other countries such as Belgium, Spain or the United Kingdom have a mortality rate of well over 50 cases/100,000 inhabitants. It is generally considered that the reason for this variability is multifactorial (including political reasons), but there are few studies that associate factors related to this variability. The objective of this work was to analyse political risk factors/markers that could explain the variability in mortality due to Covid-19 among different European countries. METHODS: This is a retrospective, multinational, ecological study based on the exploitation of the database provided by the European Centre for Disease Prevention and Control which collects daily information worldwide on new cases and deaths. The accumulated mortality of Covid-19 in European countries (with more than 100 deaths on 01/05/2020) was calculated up to 29/05/2020. Political variables were compiled from different sources in the countries included in the study. The variables analysed were: the democracy index and the different factors included in it, the country's political system and the country's corruption index. On the other hand, specific political measures implemented in the different countries were collected, such as the number of days elapsed from the notification of the first infected person to 100 infected persons, to lockdown, to the closure of schools or the cancelation of meetings. The number of people infected up to the date of lockdown was also registered. For the statistical analysis of the association between the dependent variable (mortality) and the factors studied, correlation index were calculated, and the association was studied through univariate and multivariate linear regression models. RESULTS: At May 1 2020, 27 European countries had at least 100 deaths. The mean mortality was 19.83 cases/100,000 inhabitants (SD 22.4) and a median of 7.95. Mortality varied from a minimum of 1.49 cases/100,000 population in Ukraine to 82.19 cases/100,000 population in Belgium. About factors analyzed both the democracy index (as well as the factors included in it), the political system (full democracy vs. no) and the corruption index were statistically associated with mortality. Also, the time until the implementation of the political measures was associated with mortality. CONCLUSIONS: In Europe, there is a west to east (from highest to lowest) gradient in the mortality of Covid-19. Some of the observed mortality variability can be explained by political factors.

OBJETIVO: En Europa hay una gran variabilidad en la mortalidad por Covid-19 entre los diferentes países. Mientras que algunos países, como Grecia, Bielorrusia o Ucrania, la mortalidad no alcanza los 5 casos por cada 100.000 habitantes actualmente, otros países como Bélgica, España o Reino Unido sobrepasan marcadamente los 50 casos por cada 100.000 habitantes. En general, se especula en que el motivo de esta variabilidad es multifactorial (entre ellos, motivos de índole política), pero existen escasos estudios que asocien factores relacionados con esta variabilidad. El objetivo de este trabajo fue analizar los factores/marcadores de riesgo de índole político que pudieran explicar la variabilidad en la mortalidad por Covid-19 entre los diferentes países europeos. METODOS: Estudio ecológico, observacional retrospectivo, de ámbito multinacional, basado en la explotación de la base de datos proporcionada por el European Centre for Disease Prevention and Control que recoge la información diaria a nivel mundial de los nuevos casos y fallecidos. Se calculó la mortalidad acumulada de Covid-19 en países europeos (con más de 100 fallecidos a fecha de 1 de mayo de 2020), hasta el 29 de mayo de 2020. Se recogieron variables de carácter político de los países incluidos en el estudio de diferentes fuentes. Las variables analizadas fueron: índice de democracia y los diferentes factores incluidos en él, sistema político del país e índice de corrupción del país. Por otra parte, se recogieron medidas políticas específicas implementadas en los distintos países, como los días transcurridos desde la notificación del primer infectado hasta llegar a los 100 infectados, así como los días transcurridos hasta el confinamiento, hasta el cierre de colegios o hasta el cese de reuniones. También se recogió el número de infectados hasta la fecha de confinamiento. Para el análisis estadístico de la asociación entre la variable dependiente (mortalidad) y los factores estudiados se calcularon índices de correlación, y la asociación se estudió a través de modelos de regresión lineal univariante y multivariante. RESULTADOS: A fecha de 1 de mayo de 2020, 27 países europeos contaban con al menos 100 fallecidos. La media de la mortalidad fue de 19,83 casos por cada 100.000 hab. (DE 22,4) y una mediana de 7,95. La mortalidad varió desde un mínimo de 1,49 casos por cada 100.000 hab. en Ucrania hasta 82,19 casos por cada 100.000 hab. en Bélgica. De los factores analizados, tanto el índice de democracia (como los factores incluidos en él) como el sistema político (democracia plena frente a no) y el índice de corrupción se asociaron estadísticamente con la mortalidad. También, el tiempo transcurrido hasta la implantación de las medidas políticas se asoció con mortalidad. CONCLUSIONES: En Europa, existe un degradado de oeste a este (de mayor a menor) en la mortalidad por Covid-19. Parte de la variabilidad de la mortalidad observada puede explicarse por factores de índole política.

Orthopedic Surgery in Rheumatoid Arthritis: Results from the Spanish National Registry of Hospitalized Patients over 17 Years.

OBJECTIVE: To analyze the trend of orthopedic surgery (OS) rates on patients with rheumatoid arthritis (RA). METHODS: Retrospective observational study based on information provided by the Spanish National System of Hospital Data Surveillance. All hospitalizations of patients with RA for orthopedic surgery [total hip arthroplasty (THA), total knee arthroplasty (TKA), arthrodesis, and upper limb arthroplasty (ULA)] during 1999-2015 were analyzed. The age-adjusted rate was calculated. Generalized linear models were used for trend analysis. RESULTS: There were 21,088 OS in patients over 20 years of age (77.9% women). OS rate adjusted by age was 754.63/100,000 RA patients/year (women 707.4, men 861.1). Neither an increasing nor a decreasing trend was noted for the total OS. However, trend and age interacted, so in the age ranges 20-40 years and 40-60 years, an annual reduction of 2.69% and 2.97%, respectively, was noted. In the age ranges over 80 years and 60-80 years, we noted an annual increase of 5.40% and 1.09%, respectively. The average age at time of OS increased 5.5 years during the period analyzed. For specific surgeries, a global annual reduction was noted in rates for arthrodesis. In THA, there was an annual reduction in patients under 80 years. In TKA and ULA, there was an annual reduction in patients under 60 years. CONCLUSION: Although the overall OS rate has not changed, there is a decrease in the rate of arthrodesis at all ages, THA in patients under 80 years of age, as well as TKA and ULA in patients under 60 years of age.

Democracia y mortalidad por COVID-19 en Europa / Democracy and Covid-19 mortality in Europe

OBJETIVO: En Europa hay una gran variabilidad en la mortalidad por Covid-19 entre los diferentes países. Mientras que algunos países, como Grecia, Bielorrusia o Ucrania, la mortalidad no alcanza los 5 casos por cada 100.000 habitantes actualmente, otros países como Bélgica, España o Reino Unido sobrepasan marcadamente los 50 casos por cada 100.000 habitantes. En general, se especula en que el motivo de esta variabilidad es multifactorial (entre ellos, motivos de índole política), pero existen escasos estudios que asocien factores relacionados con esta variabilidad. El objetivo de este trabajo fue analizar los factores/marcadores de riesgo de índole político que pudieran explicar la variabilidad en la mortalidad por Covid-19 entre los diferentes países europeos. MÉTODOS: Estudio ecológico, observacional retrospectivo, de ámbito multinacional, basado en la explotación de la base de datos proporcionada por el European Centre for Disease Prevention and Control que recoge la información diaria a nivel mundial de los nuevos casos y fallecidos. Se calculó la mortalidad acumulada de Covid-19 en países europeos (con más de 100 fallecidos a fecha de 1 de mayo de 2020), hasta el 29 de mayo de 2020. Se recogieron variables de carácter político de los países incluidos en el estudio de diferentes fuentes. Las variables analizadas fueron: índice de democracia y los diferentes factores incluidos en él, sistema político del país e índice de corrupción del país. Por otra parte, se recogieron medidas políticas específicas implementadas en los distintos países, como los días transcurridos desde la notificación del primer infectado hasta llegar a los 100 infectados, así como los días transcurridos hasta el confinamiento, hasta el cierre de colegios o hasta el cese de reuniones. También se recogió el número de infectados hasta la fecha de confinamiento. Para el análisis estadístico de la asociación entre la variable dependiente (mortalidad) y los factores estudiados se calcularon índices de correlación, y la asociación se estudió a través de modelos de regresión lineal univariante y multivariante. RESULTADOS: A fecha de 1 de mayo de 2020, 27 países europeos contaban con al menos 100 fallecidos. La media de la mortalidad fue de 19,83 casos por cada 100.000 hab. (DE 22,4) y una mediana de 7,95. La mortalidad varió desde un mínimo de 1,49 casos por cada 100.000 hab. en Ucrania hasta 82,19 casos por cada 100.000 hab. en Bélgica. De los factores analizados, tanto el índice de democracia (como los factores incluidos en él) como el sistema político (democracia plena frente a no) y el índice de corrupción se asociaron estadísticamente con la mortalidad. También, el tiempo transcurrido hasta la implantación de las medidas políticas se asoció con mortalidad. CONCLUSIONES: En Europa, existe un degradado de oeste a este (de mayor a menor) en la mortalidad por Covid-19. Parte de la variabilidad de la mortalidad observada puede explicarse por factores de índole política

OBJECTIVE: In Europe there is a great variability in mortality by Covid-19 among different countries. While some countries, such as Greece, Belarus or Ukraine, have a mortality rate of less than 5 cases/100,000 inhabitants, other countries such as Belgium, Spain or the United Kingdom have a mortality rate of well over 50 cases/100,000 inhabitants. It is generally considered that the reason for this variability is multifactorial (including political reasons), but there are few studies that associate factors related to this variability. The objective of this work was to analyse political risk factors/markers that could explain the variability in mortality due to Covid-19 among different European countries. METHODS: This is a retrospective, multinational, ecological study based on the exploitation of the database provided by the European Centre for Disease Prevention and Control which collects daily information worldwide on new cases and deaths. The accumulated mortality of Covid-19 in European countries (with more than 100 deaths on 01/05/2020) was calculated up to 29/05/2020. Political variables were compiled from different sources in the countries included in the study. The variables analysed were: the democracy index and the different factors included in it, the country's political system and the country's corruption index. On the other hand, specific political measures implemented in the different countries were collected, such as the number of days elapsed from the notification of the first infected person to 100 infected persons, to lockdown, to the closure of schools or the cancelation of meetings. The number of people infected up to the date of lockdown was also registered. For the statistical analysis of the association between the dependent variable (mortality) and the factors studied, correlation index were calculated, and the association was studied through univariate and multivariate linear regression models. RESULTS: At May 1 2020, 27 European countries had at least 100 deaths. The mean mortality was 19.83 cases/100,000 inhabitants (SD 22.4) and a median of 7.95. Mortality varied from a minimum of 1.49 cases/100,000 population in Ukraine to 82.19 cases/100,000 population in Belgium. About factors analyzed both the democracy index (as well as the factors included in it), the political system (full democracy vs. no) and the corruption index were statistically associated with mortality. Also, the time until the implementation of the political measures was associated with mortality. CONCLUSIONS: In Europe, there is a west to east (from highest to lowest) gradient in the mortality of Covid-19. Some of the observed mortality variability can be explained by political factors