Digestive involvement in primary Sjögren's syndrome: analysis from the Sjögrenser registry.

OBJECTIVES: Digestive involvement (DI) has been reported in 10-30% of primary Sjögren's syndrome (pSS) patients, and few studies have systematically analysed the prevalence of DI in pSS patients. The aim of this study was to describe DI prevalence in pSS patients from the Sjögrenser Study, and to analyse its clinical associations. METHODS: All patients included in the Sjögrenser study, a Spanish multicentre randomised cohort, containing demographic, clinical and histologic data, have been analysed retrospectively. Patients were classified according to the presence of DI (oesophageal, gastric, intestinal, hepatic and pancreatic), and we have performed DI clinical associations, descriptive statistics, Student t or χ2 test, and uni and multivariate logistic regression. RESULTS: From 437 included patients, 95% were women, with a median age of 58 years, 71 (16.2%) presented DI: 21 (29.5%) chronic atrophic gastritis, 12 (16.9%) oesophageal motility dysfunction, 3 (4.2%) lymphocytic colitis, 18 (25.3%) primary biliary cholangitis, 15 (21.1%) autoimmune hepatitis, 7 (9.8%) pancreatic involvement and 5 (7%) coeliac disease. Half of them developed DI at the same time or after pSS diagnosis. Patients with DI were significantly older at pSS diagnosis (p=0.032), more frequently women (p=0.009), presented more autoimmune hypothyroidism and C3 hypocomplementaemia (p=0.040), and were treated more frequently with glucocorticoids, immunosuppressant and biologic therapies. Patients with pancreatic involvement presented more central nervous system and renal involvement, Raynaud's phenomenon, lymphoma and C3/C4 hypocomplementaemia. CONCLUSIONS: DI is frequent in Sjögrenser patients, mainly in the form of autoimmune disorders, and seem to be associated with a more severe phenotype. Our results suggest that DI should be evaluated in pSS patients, especially those with more severe disease.

Prevalence and factors associated with osteoporosis and fragility fractures in patients with primary Sjögren syndrome.

This study aimed at determining socio-demographic and clinical factors of primary Sjögren syndrome (pSS) associated with osteoporosis (OP) and fragility fracture. SJOGRENSER is a cross-sectional study of patients with pSS, classified according to American European consensus criteria developed in 33 Spanish rheumatology departments. Epidemiological, clinical, serological and treatment data were collected and a descriptive analysis was conducted. Bivariate and multivariate analyses were performed using a binomial logistic regression to study the factors associated with OP and fragility fracture in pSS. 437 patients were included (95% women, with a median age of 58.6 years). 300 women were menopausal (76.4%). Prevalence of OP was 18.5% [in men (N = 21) this measured 19%]. A total of 37 fragility fractures were recorded. In the multivariate analysis, there was an association between OP and age: in the 51-64 age range (menopausal women), the OR measured 9.993 (95% CI 2301-43,399, p = 0.002); In the age > 64 years group, OR was 20.610 (4.679-90.774, p < 0.001); between OP and disease duration, OR was 1.046 (1.008-1085, p = 0.017); past treatment with corticosteroids, OR 2.548 (1.271-5.105, p = 0.008). Similarly, an association was found between fragility fractures and age: in the 51-64 age group, OR measured 5.068 (1.117-22,995, p = 0.035), age > 64 years, OR was 7.674 (1.675-35,151, p < 0.009); disease duration, OR 1.049 (CI 1.003-1097, p < 0.036) and the ESSDAI index, OR 1.080 (1.029-1134, p = 0.002). Patients with pSS can develop osteoporosis and fragility fractures over the course of the disease. Age, corticosteroids treatment and disease duration were associated with the development of OP. Disease duration and ESSDAI were associated with the development of fractures in patients with pSS.

[Are calcium and vitamin D supplements for everyone?: Pro]. / Suplementos de calcio y vitamina D ¿para todos?: Pros.

Calcium and vitamin D are essential for the health of our bones and various scientific societies recommend an intake of 1,000 mg of calcium and 800 IU of vitamin D daily. Most people with osteoporosis do not eat food with this amount of calcium and also have insufficient levels of vitamin D, so supplements are recommended to provide osteoporotic patients with these amounts. Calcium supplements and vitamin D improve the effectiveness of anabolic and anti-catabolic agents and may have a small effect in reducing the number of fractures. Calcium supplements alone have not shown efficacy preventing fractures in patients with osteoporosis and may increase cardiovascular risk in healthy elderly women and is therefore not recommended for widespread use. Vitamin D supplements are recommended in persons with 25-OH vitamin D levels below 30 ng/ml, in particular the elderly and osteoporotic patients, due to its ability to halt the remodeling resulting from secondary hyperparathyroidism and reduce the loss of bone mass. Vitamin D supplements could help reduce falls and fractures in the institutionalized elderly. In addition, supplements of vitamin D may have other beneficial effects due to extra-osseous regulatory functions on the immune response and cell differentiation and proliferation that is associated with vitamin D. Trials begun in recent years clearly indicate a beneficial effect of vitamin D supplements on mortality, cardiovascular risk,development of tumors and prevention of infections.

Suplementos de calcio y vitamina D ¿para todos?: Pros / Are calcium and vitamin D supplements for everyone?: Pro

El calcio y la vitamina D son elementos esenciales en la salud de nuestros huesos por lo que las diferentes sociedades científicas recomiendan la necesidad de aportar diariamente 1.000mg de calcio y 800 UI de vitamina D. La mayoría de la población con osteoporosis no ingiere con los alimentos esta cantidad de calcio y además presenta niveles insuficientes de vitamina D, por lo que se recomienda aportar suplementos de estos elementos a los osteoporóticos deficitarios. Los suplementos de calcio y vitamina D mejoran la eficacia de los fármacos anabólicos y anticatabólicos y pueden tener por sí un pequeño efecto reductor en el número de fracturas. Los suplementos solo de calcio no han demostrado en los pacientes con osteoporosis eficacia antifractuaria y en las mujeres ancianas sanas pueden incrementar el riesgo cardiovascular, por lo que no se recomienda su utilización generalizada. Se recomienda aportar suplementos de vitamina D a las personas con niveles de 25-OH vitamina D inferiores a 30 ng/ml, en especial a los ancianos y a los pacientes osteoporóticos por su capacidad de frenar el remodelado producido por el hiperparatiroidismo secundario y disminuir la pérdida de masa ósea. Los suplementos de vitamina D pueden reducir las fracturas y disminuir las caídas en las personas ancianas institucionalizadas. Además, estos suplementos de vitamina D pueden tener otros efectos beneficiosos extraóseos debido a las funciones reguladoras de la respuesta inmunitaria y de la diferenciación y proliferación celular que la vitamina D realiza. Ensayos que han comenzado a realizarse en estos últimos años nos indicarán de forma evidente los efectos beneficiosos de los suplementos de vitamina D en mortalidad, riesgo cardiovascular, desarrollo de tumores y prevención de infecciones (AU)

Calcium and vitamin D are essential for the health of our bones and various scientific societies recommend an intake of 1,000mg of calcium and 800 IU of vitamin D daily. Most people with osteoporosis do not eat food with this amount of calcium and also have insufficient levels of vitamin D, so supplements are recommended to provide osteoporotic patients with these amounts. Calcium supplements and vitamin D improve the effectiveness of anabolic and anti-catabolic agents and may have a small effect in reducing the number of fractures. Calcium supplements alone have not shown efficacy preventing fractures in patients with osteoporosis and may increase cardiovascular risk in healthy elderly women and is therefore not recommended for widespread use. Vitamin D supplements are recommended in persons with 25-OH vitamin D levels below 30 ng/ml, in particular the elderly and osteoporotic patients, due to its ability to halt the remodeling resulting from secondary hyperparathyroidism and reduce the loss of bone mass. Vitamin D supplements could help reduce falls and fractures in the institutionalized elderly. In addition, supplements of vitamin D may have other beneficial effects due to extra-osseous regulatory functions on the immune response and cell differentiation and proliferation that is associated with vitamin D. Trials begun in recent years clearly indicate a beneficial effect of vitamin D supplements on mortality, cardiovascular risk, development of tumors and prevention of infections (AU)

El risedronato ¿una alternativa eficaz? / Risedronate. Is it an effective alternative?

No disponible

Costes económicos de la artritis reumatoide de corta evolución / The economic costs of rheumatoid arthritis of short evolution

Objetivo: Determinar los costes de la artritis reumatoide (AR) durante los primeros años de la enfermedad. Material y métodos: Como parte de un estudio observacional sobre la calidad asistencial en el tratamiento de la AR, se estimaron los costes directos, indirectos e intangibles en una cohorte de 85 pacientes con AR (de menos de 5 años de evolución) controlados de forma periódica desde el inicio de la enfermedad por nuestro servicio de reumatología. El tiempo medio de evolución de la enfermedad fue de 862 ñ 578 días y la valoración de los costes se realizó en el momento del diagnóstico y al finalizar el estudio en pesetas del año 1997. Resultados: La edad media de los enfermos fue de 54,5 ñ 15 años, el 76 por ciento eran mujeres y el 77,6 por ciento de las pacientes con AR eran seropositivas. En el momento del diagnóstico, los costes indirectos alcanzan el 67 por ciento de los costes debido, fundamentalmente, a la incapacidad laboral temporal en 11 pacientes (26 por ciento de la población activa). Los costes directos asistenciales del diagnóstico son de 41.785 ñ 105.701 pesetas por paciente. Durante el seguimiento los costes indirectos son también superiores a los directos y suponen el 61,5 por ciento de los costes totales. Los costes directos son el 38,5 por ciento (el 19,7 por ciento asistenciales, el 15,3 por ciento de medicación y el 3,5 por ciento otros costes directos). El 18,8 por ciento de los pacientes que requieren ingreso consumen el 77 por ciento de costes asistenciales. Los gastroprotectores ocasionan el 32,1 por ciento del gasto farmacéutico. Conclusiones: En nuestro medio, hemos observado el momento del diagnóstico y durante los primeros años de evolución de la AR unos elevados costes indirectos motivados por la incapacidad laboral producida por la enfermedad. Los pacientes que precisan ingreso hospitalario consumen la mayor parte de los costes asistenciales. La evaluación de los costes económicos es de máximo interés en los procesos reumatológicos crónicos para los reumatólogos y gestores, pues permite extraer conclusiones para la toma de decisiones clínicas generadoras de mejores niveles de calidad asistencial y efectividad (AU)