Ecografía Doppler de arterias temporales superficiales en la arteritis de células gigantes en una cohorte con alta sospecha clínica / Doppler ultrasonography of superficial temporal artery in a cohort of patients with strong clinical suspicion of giant cell arteritis

Fundamento y objetivo: La arteritis de células gigantes (ACG) es la vasculitis sistémica más frecuente en adultos. En los últimos años, existe un interés creciente en evaluar la utilidad de la ecografía de arterias temporales superficiales (EATS), que permite valorar la inflamación de la pared vascular. Material y métodos: Estudio de cohorte observacional y descriptivo de 120 EATS a 60 pacientes con sospecha clínica de ACG según criterios clásicos de ACR (American College of Rheumatology). Resultados: De todos los pacientes a quienes se les realizó la EATS, el 42,3% presentó diagnóstico de ACG según los criterios de clasificación ACR. La sensibilidad y la especificidad de la ecografía en nuestra cohorte de pacientes con alta sospecha clínica fueron de 81,8 y 93,3%, respectivamente, con un VPP de 90,1% y un VPN de 87,5%. Conclusión: Los resultados avalan la ecografía de arteria temporal bilateral como una técnica útil, indolora, rápida, accesible, de alta especificidad y amplia validez diagnóstica

Background and objective: Giant cell arteritis (GCA) is the most frequent systemic vasculitis in adults. In recent years, the usefulness of temporal artery ultrasound (TAUS) as a diagnostic tool to assess the underlying inflammation of the vascular wall during the inflammatory process has been under clinical investigation. Material and methods: Observational and descriptive cohort study of 120 TAUS in 60 patients with clinical suspicions of GCA, according to the ACR (American College of Rheumatology) classification criteria. Results: Among all patients who underwent ultrasound, 42.3% met clinical criteria for GCA according to ACR. Sensitivity and specificity of TAUS in our cohort with clinical suspicion was 81.8% and 93.3%, respectively. A PPV of 90.1% and a VPN of 87.5% were observed. Conclusion: Our results showed that TAUS as a useful, indolent, fast, and accessible tool with high diagnostic specificity and diagnostic value

Doppler ultrasonography of superficial temporal artery in a cohort of patients with strong clinical suspicion of giant cell arteritis. / Ecografía Doppler de arterias temporales superficiales en la arteritis de células gigantes en una cohorte con alta sospecha clínica.

BACKGROUND AND OBJECTIVE: Giant cell arteritis (GCA) is the most frequent systemic vasculitis in adults. In recent years, the usefulness of temporal artery ultrasound (TAUS) as a diagnostic tool to assess the underlying inflammation of the vascular wall during the inflammatory process has been under clinical investigation. MATERIAL AND METHODS: Observational and descriptive cohort study of 120 TAUS in 60 patients with clinical suspicions of GCA, according to the ACR (American College of Rheumatology) classification criteria. RESULTS: Among all patients who underwent ultrasound, 42.3% met clinical criteria for GCA according to ACR. Sensitivity and specificity of TAUS in our cohort with clinical suspicion was 81.8% and 93.3%, respectively. A PPV of 90.1% and a VPN of 87.5% were observed. CONCLUSION: Our results showed that TAUS as a useful, indolent, fast, and accessible tool with high diagnostic specificity and diagnostic value.

Sjögren's syndrome-associated interstitial lung disease: a multicenter study / Enfermedad pulmonar instersticial asociada a síndrome de Sjögren: estudio multicéntrico

Primary Sjögren syndrome (PSS) is a chronic inflammatory autoimmune disease. Interstitial lung disease (ILD) can be an extraglandular complication. Objective. To evaluate the clinical characteristics of patients diagnosed with PSS with ILD. Methods. Multicentre cohort study with 25 patients diagnosed with PSS and ILD. Data of PSS, prognostic factors, pulmonary involvement variables, complementary tests that suggest a worse diagnosis and treatment given were collected. EULAR index was measured for Sjögren's syndrome. Results. We identified 25 patients. In 15/25 the diagnosis of ILD was done before the diagnosis of PSS. The histopathological patterns found were: 12 NSIP, 5 UIP, 4 OP, 2 LIP. PFRs showed restrictive pattern. The majority of the patients received glucocorticoid therapy, antimalarial or immunosuppressive treatment. Conclusions. Patients affected with PSS must be screened to catch a precocious diagnosis of ILD. The majority of the patients were diagnosed of ILD before being diagnosed of PSS. Multicenter cohorts are increasingly demanded and a multidisciplinary management is needed (AU)

El síndrome de Sjögren primario (SSP) es una enfermedad inflamatoria autoinmune. La enfermedad pulmonar intersticial (EPI) puede ser una complicación extraglandular. Objetivo. Evaluar las características clínicas de los pacientes diagnosticados de SSP con EPI. Métodos. Estudio de cohortes multicéntrico con 25 pacientes diagnosticados de SSP y EPI. Se recopilaron datos propios del SSP, factores pronóstico, variables de medida de la afectación pulmonar, pruebas complementarias que sugieren un peor pronóstico, así como el tratamiento recibido. Se calculó el índice EULAR para el síndrome de Sjögren. Resultados. Se identificaron 25 pacientes. Quince de ellos fueron diagnosticados de EPI antes que de SSP. Los patrones histopatológicos encontrados fueron 12 con neumonía intersticial inespecífica, 5 con neumonía intersticial común, 4 con neumonía organizada, 2 con neumonía intersticial linfocítica. Las pruebas de función respiratoria mostraron un patrón restrictivo. La mayoría de los pacientes recibió un tratamiento con glucocorticoides, antipalúdicos o inmunodepresores. Conclusiones. Los pacientes afectados por SSP deben ser sometidos a pruebas para detectar un diagnóstico precoz de EPI. La mayoría de los pacientes fueron diagnosticados de EPI antes que de SSP. Los estudios de cohortes multicéntricos son cada vez más demandados y se precisa una gestión multidisciplinar (AU)

Retraso diagnóstico y terapéutico de la artritis reumatoide y su relación con dispositivos asistenciales en Catalunya. Estudio AUDIT / Diagnostic and therapeutic delay of rheumatoid arthritis and its relationship with health care devices in Catalonia. The AUDIT study

OBJETIVO: Analizar el retraso diagnóstico y terapéutico en pacientes con AR de reciente comienzo en 19 centros de Catalunya. MÉTODOS: Encuesta epidemiológica en 183 pacientes en que se cuantificaron los tiempos en relación con el retraso diagnostico midiendo: 1) aparición del primer síntoma hasta la primera visita a Reumatología; 2) desde la derivación hasta la primera visita de Reumatología; 3) entre aparición del primer síntoma hasta el diagnóstico, y 4) entre aparición del primer síntoma hasta el inicio del primer FAME. Se definió la existencia de 6 dispositivos asistenciales diferenciados. RESULTADOS: El tiempo medio desde el inicio de los síntomas hasta la instauración de un FAME en pacientes con AR en Catalunya es muy largo (11 meses). Pacientes atendidos en dispositivos como consultas de AR, consultas especializadas en atención primaria y sobre todo en consultas de artritis de inicio son tratados de manera más temprana con FAME. Conclusión. La existencia de determinados dispositivos asistenciales es fundamental para mejorar la atención precoz en la AR

OBJECTIVE: Diagnosis and therapy of patients with early onset rheumatoid arthritis (RA) is influenced by accessibility to specialized care devices. We attempted to analyze the impact of their availability. METHODS: We analyzed time related to diagnosis delay measuring: 1) Time from first clinical symptoms to the first visit with the Rheumatologist; 2) Time from referral to the first visit of Rheumatology; 3) Time between first symptom until final diagnosis; 4) time between first symptom until the initiation of the first disease-modifying antirheumatic drug (DMARD). The presence of these 6 rheumatology devices was defined: 1) early arthritis monographic clinics, 2) RA monographic clinics, 3) Mechanisms for fast programming, 4) Algorithms for referral from primary care (PC), 5) rheumatology consultation services in PC and 6) consulting services in PC. RESULTS: The mean time from onset of symptoms to diagnosis or the establishment of a DMARD in RA patients in Catalonia is very long (11 months). Patients seen in rheumatology devices such as RA monographic clinics, rheumatology consultation in PC and specially in early arthritis clinics are treated early with DMARDs. Conclusion. the existence of monographic clinics or consulting in primary care centers is essential to improve early care of RA patients

Diagnostic and therapeutic delay of rheumatoid arthritis and its relationship with health care devices in Catalonia. The AUDIT study. / Retraso diagnóstico y terapéutico de la artritis reumatoide y su relación con dispositivos asistenciales en Catalunya. Estudio AUDIT.

OBJECTIVE: Diagnosis and therapy of patients with early onset rheumatoid arthritis (RA) is influenced by accessibility to specialized care devices. We attempted to analyze the impact of their availability. METHODS: We analyzed time related to diagnosis delay measuring: 1) Time from first clinical symptoms to the first visit with the Rheumatologist; 2) Time from referral to the first visit of Rheumatology; 3) Time between first symptom until final diagnosis; 4) time between first symptom until the initiation of the first disease-modifying antirheumatic drug (DMARD). The presence of these 6 rheumatology devices was defined: 1) early arthritis monographic clinics, 2) RA monographic clinics, 3) Mechanisms for fast programming, 4) Algorithms for referral from primary care (PC), 5) rheumatology consultation services in PC and 6) consulting services in PC. RESULTS: The mean time from onset of symptoms to diagnosis or the establishment of a DMARD in RA patients in Catalonia is very long (11 months). Patients seen in rheumatology devices such as RA monographic clinics, rheumatology consultation in PC and specially in early arthritis clinics are treated early with DMARDs. CONCLUSION: the existence of monographic clinics or consulting in primary care centers is essential to improve early care of RA patients.

Sjögren's syndrome-associated interstitial lung disease: A multicenter study.

UNLABELLED: Primary Sjögren syndrome (PSS) is a chronic inflammatory autoimmune disease. Interstitial lung disease (ILD) can be an extraglandular complication. OBJECTIVE: To evaluate the clinical characteristics of patients diagnosed with PSS with ILD. METHODS: Multicentre cohort study with 25 patients diagnosed with PSS and ILD. Data of PSS, prognostic factors, pulmonary involvement variables, complementary tests that suggest a worse diagnosis and treatment given were collected. EULAR index was measured for Sjögren's syndrome. RESULTS: We identified 25 patients. In 15/25 the diagnosis of ILD was done before the diagnosis of PSS. The histopathological patterns found were: 12 NSIP, 5 UIP, 4 OP, 2 LIP. PFRs showed restrictive pattern. The majority of the patients received glucocorticoid therapy, antimalarial or immunosuppressive treatment. CONCLUSIONS: Patients affected with PSS must be screened to catch a precocious diagnosis of ILD. The majority of the patients were diagnosed of ILD before being diagnosed of PSS. Multicenter cohorts are increasingly demanded and a multidisciplinary management is needed.

Bone mineral density status and frequency of osteoporosis and clinical fractures in 155 patients with psoriatic arthritis followed in a university hospital / Estado de la densidad mineral ósea y frecuencia de osteoporosis y de fracturas clínicas en 155 pacientes con artritis psoriásica evaluados en un hospital universitario

Objective: To assess the bone mineral density (BMD) and the frequency of osteoporosis and clinical fractures in a large group of Spanish patients with psoriatic arthritis (PsA). Patients and methods: BMD was determined by DXA in all the patients who were willing to participate and had peripheral PsA regularly evaluated in a tertiary university hospital. All patients underwent a physical examination and general laboratory analysis. We gathered demographic and clinical variables related with BMD and risk of fractures. We also recorded the history of clinical low impact fractures. The population of reference to calculate T-score and Z-score came from a Spanish database. Results: One hundred and fifty-five patients were included (64 postmenopausal women, 26 premenopausal women and 65 men). The clinical forms of PsA were: 46% oligoarticular and 54% polyarticular. Mean disease duration was 13.7±9.4 years and mean ESR was 21.8±13.9mm/h; 66% of patients had received glucocorticoid treatment. We found no differences in BMD status between the patients and the Spanish general population, neither in the whole series nor in each defined subgroup. Frequency of osteoporosis was 16%; it was higher in postmenopausal women (28%) than in men (9%) or premenopausal women (4%). Frequency of clinical fractures was 13%; it accounted specially in postmenopausal women

Objetivo: Analizar el estado de la densidad mineral ósea (DMO) así como la frecuencia de osteoporosis y de fracturas clínicas en una serie de pacientes con artritis psoriásica (APs). Pacientes y Método: Se determinó la DMO, mediante DXA, en todos los pacientes con APs periférica, evaluados de forma periódica en un hospital universitario, que aceptaron participar en el estudio. Se les practicó una exploración física y un estudio analítico y se recabó información acerca de variables clínicas relacionadas con la DMO y con el riesgo de fractura. Asimismo, se analizó si existía el antecedente de haber presentado una fractura de bajo impacto. El cálculo del T-score y del Z-score se realizó a partir de una base de datos de población española. Resultados: Se incluyeron 155 pacientes (64 mujeres posmenopáusicas, 26 mujeres premenopáusicas y 65 varones). En el 46% de los casos la APS adoptó un patrón oligoarticular y en el 54% poliarticular. La duración media de la enfermedad fue 13.7 ± 9.4 años, el valor medio de la VSG fue de 21.8 ± 13.9 mm/h; el 66% de los pacientes habían recibido tratamiento con glucocorticoides. No se observaron diferencias entre la DMO de los pacientes y la de la población general, ni en la globalidad de la serie, ni en ninguno de los tres grupos. La frecuencia global de osteoporosis se situó en el 16%; fue más alta en las mujeres posmenopáusicas (28%) que en los varones (9%) y que en las mujeres premenopáusicas (4%). La frecuencia de fracturas clínicas fue del 13%; acontecieron fundamentalmente en las mujeres posmenopáusicas (AU)

[Preference for etanercept pen versus syringe in patients with chronic arthritis. Nurse education workshop]. / Preferencia de pluma de etanercept respecto a jeringa en pacientes con artritis crónica. Taller educativo por enfermería.

OBJECTIVES: The aims of this study are to evaluate the level of fear of post-injection pain prior to the administration, the difficulty in handling the device, and the level of satisfaction of patients using a pre-filled syringe versus an etanercept pen, as well as to evaluate the usefulness of the training given by nursing staff prior to starting with the pen, and the preferences of patients after using both devices. METHOD: A prospective study was designed to follow-up a cohort of patients during a 6 months period. The data was collected using questionnaires and analyzed with SPSS 18.00. Rank and McNemar tests were performed. Statistical significance was pre-set at an α level of 0.05. RESULTS: A total of 29 patients were included, of whom 69% female, and with a mean age 52.5±10.9 years. Of these, 48% had rheumatoid arthritis, 28% psoriatic arthritis, 21% ankylosing spondylitis, and 3% undifferentiated spondyloarthropathy. There were no statistically significant differences either with the fear or pain or handling of the device between the syringe and the pen (P=.469; P=.812; P=.169 respectively). At 6 months, 59% of patients referred to being satisfied or very satisfied with the pen. Almost all (93%) found useful or very useful the training given by nursing staff prior to using the pen, and 55% preferred the pen over the pre-filled syringe. CONCLUSIONS: The etanercept pen is another subcutaneous device option for patients with chronic arthritis. According to the present study, nursing educational workshops before starting this therapy are recommended.

Evaluación de una propuesta de criterios de indicación de densitometría ósea en mujeres posmenopáusicas españolas basados en la herramienta FRAX ® / Assessment of a set of FRAX ®-based criteria for the indication of bone densitometry in Spanish postmenopausal women

Fundamento y objetivo: Evaluar el resultado de la aplicación en práctica clínica habitual de unos criterios para la indicación de densitometría ósea en mujeres posmenopáusicas. Pacientes y método: A las pacientes remitidas a una unidad de densitometría ósea desde Atención Primaria que no recibían tratamiento, se les determinó, mediante la herramienta FRAX®, el riesgo de fractura mayor (RFM). Se calculó cuántas exploraciones se hubieran evitado si se hubieran realizado densitometrías únicamente a mujeres ≥65 años con un RFM<10% y mujeres<65 años con un RFM≥3,6%.Resultados: Se incluyeron 643 mujeres con una edad media (DE) de 61 (9) años. El 23% tenía una densidad mineral ósea normal, el 56% tenían osteopenia y el 21%, osteoporosis. El RFM medio fue del 5,9 (5,5)%. En mujeres de edad<65 años, podrían haberse evitado el 64% (273/426) de las densitometrías practicadas. En mujeres≥65 años se podrían haber evitado el 37% (80/217) de las densitometrías realizadas. En total, se podrían haber evitado el 55% (353/643). La sensibilidad del umbral del 3,6% del RFM para el diagnóstico de osteoporosis fue del 51%, la especificidad del 68%, el valor predictivo positivo del 20% y el valor predictivo negativo del 90%. Conclusiones: La aplicación de una propuesta de criterios de indicación de densitometría ósea en mujeres posmenopáusicas basada en la edad y en el riesgo de fractura calculado por FRAX® tendría como consecuencia una disminución significativa de la actividad de la unidad de densitometría ósea (AU)

Background and objective: To assess the effect of the application in routine clinical practice of a proposal of thresholds for the indication of bone densitometry in Spanish postmenopausal women. Patients and methods: We determined the risk of major fracture (RMF) by FRAX® of the patients referred to a bone densitometry unit from Primary Care who were untreated. We calculated how many scans would have been avoided if they had been performed only to women≥65 years with a RMF<10% or women<65 years with a RMF≥3.6%. Results: We included 643 women with a mean age of 61 (9) years. Twenty-three percent had a normal bone mineral density, 56% had osteopenia, and 21% osteoporosis. The RMF was 5.9 (5.5)%. Eighty of 217 (37%) bone scans in women≥65 years and 273 of 426 (64%) in women<65 years would have been avoided. As a whole, 55% of the scans would have been avoided. The sensitivity of the threshold of 3.6% of RMF for the diagnosis of osteoporosis was 51%, specificity 68%, positive predictive value 20%, and negative predictive value 20%. Conclusions: The application of the proposed thresholds for the indication of bone densitometry in Spanish postmenopausal women, based on age and risk of fracture calculated by FRAX® would result in a significant decrease of the activity of the bone densitometry unit (AU)

Artritis mutilante/resortiva. Estudio de 24 pacientes de una serie de 360 artritis psoriásicas / Mutilating/resorptive arthritis. a study of 24 patients in a series of 360 patients with psoriatic arthritis

Objetivo. Describir una serie amplia de pacientes con artritis mutilante/resortiva (AM) de una población representativa de pacientes con artritis psoriásica (APs) y analizar las variables asociadas. Métodos. Estudio transversal multicéntrico que incluyó de forma consecutiva a los pacientes afectados de APs de 8 centros. A aquellos pacientes con tumefacción o deformidad de manos o pies sospechosa de se les realizó una radiografía antero-posterior. Se consideró que el paciente estaba afectado de AM si presentaba un trastorno erosivo que afectaba totalmente ambas superficies articulares. Resultados. De los 360 pacientes con APs estudiados, 24 presentaban AM (6,7%). La duración de la enfermedad fue significativamente mayor y presentaban una peor capacidad funcional, así como una mayor afección de IFD (p<0,05). En un 30% se detectaron cambios radiológicos indistinguibles de una osteoartritis nodular. Conclusiones. La AM en la APs se asocia a una peor capacidad funcional. Su posible asociación con la osteoartritis nodular de manos merece más estudios (AU)

Objective: To describe a large series of patients with mutilans/resorptive arthritis (AM) of a representative population of patients with psoriatic arthritis (PsA) and analyze the associated variables. Methods: Multicenter cross-sectional study of consecutive patients affected by PsA in 8 centers. In patients with swelling or deformity of the hands or feet we performed an anteroposterior rx. The patient was affected by AM if erosive disorder affecting both articular surfaces completely was present. Results: Of the 360 patients studied, 24 had PsA and AM (6.7%). The duration of their disease was significantly higher, and they exhibited a worse functional capacity as well as more DIP joint affection (P<.05). 30% had radiological changes indistinguishable from nodular osteoarthritis. Conclusions: AM in PA is associated with a worse functional capacity. Its possible association with nodular hand osteoarthritis deserves further study (AU)

[Assessment of a set of FRAX(®)-based criteria for the indication of bone densitometry in Spanish postmenopausal women]. / Evaluación de una propuesta de criterios de indicación de densitometría ósea en mujeres posmenopáusicas españolas basados en la herramienta FRAX(®)

BACKGROUND AND OBJECTIVE: To assess the effect of the application in routine clinical practice of a proposal of thresholds for the indication of bone densitometry in Spanish postmenopausal women. PATIENTS AND METHODS: We determined the risk of major fracture (RMF) by FRAX(®) of the patients referred to a bone densitometry unit from Primary Care who were untreated. We calculated how many scans would have been avoided if they had been performed only to women ≥ 65 years with a RMF < 10% or women<65 years with a RMF ≥ 3.6%. RESULTS: We included 643 women with a mean age of 61 (9) years. Twenty-three percent had a normal bone mineral density, 56% had osteopenia, and 21% osteoporosis. The RMF was 5.9 (5.5)%. Eighty of 217 (37%) bone scans in women ≥ 65 years and 273 of 426 (64%) in women<65 years would have been avoided. As a whole, 55% of the scans would have been avoided. The sensitivity of the threshold of 3.6% of RMF for the diagnosis of osteoporosis was 51%, specificity 68%, positive predictive value 20%, and negative predictive value 20%. CONCLUSIONS: The application of the proposed thresholds for the indication of bone densitometry in Spanish postmenopausal women, based on age and risk of fracture calculated by FRAX(®) would result in a significant decrease of the activity of the bone densitometry unit.

Mutilating/resorptive arthritis. A study of 24 patients in a series of 360 patients with psoriatic arthritis.

OBJECTIVE: To describe a large series of patients with mutilans/resorptive arthritis (AM) of a representative population of patients with psoriatic arthritis (PsA) and analyze the associated variables. METHODS: Multicenter cross-sectional study of consecutive patients affected by PsA in 8 centers. In patients with swelling or deformity of the hands or feet we performed an anteroposterior rx. The patient was affected by AM if erosive disorder affecting both articular surfaces completely was present. RESULTS: Of the 360 patients studied, 24 had PsA and AM (6.7%). The duration of their disease was significantly higher, and they exhibited a worse functional capacity as well as more DIP joint affection (P<.05). 30% had radiological changes indistinguishable from nodular osteoarthritis. CONCLUSIONS: AM in PA is associated with a worse functional capacity. Its possible association with nodular hand osteoarthritis deserves further study.

The activity of a Spanish bone densitometry unit revisited under the point of view of FRAX

Objetivo. Analizar el riesgo de fractura calculado por FRAX y sus determinantes en los pacientes remitidos a una unidad de densitometría ósea para evaluación de la densidad mineral ósea (DMO). Métodos. Los pacientes remitidos desde Atención Primaria a la Unidad de Densitometría para evaluación de la DMO rellenaron un cuestionario autoadministrado acerca de los factores de riesgo clínicos incluidos en el FRAX; se les realizó una densitometría ósea. Con los datos del cuestionario, se analizó el riesgo absoluto de presentar una fractura mayor (MFR) y de cadera (HFR). Ambos riesgos se calcularon con o sin la inclusión de la DMO en el algoritmo: MFR+, MFR-, HFR+ y HFR-. Resultados. Se analizaron los datos de 853 mujeres con una edad media de 61,9 (8,9) años y un índice de masa corporal medio de 27,0 (4,2) kg/m2. El 20% de las pacientes tenía una DMO normal, el 55% tenía osteopenia y el 25%, osteoporosis. Excluyendo la edad y el índice de masa corporal, el número de factores de riesgo de fractura fue bajo. El MFR+ medio fue de 5,4 (4,8)%; el MFR- de 6,3 (5,5)%; el HFR+, de 1,5 (2,9)%; y el HFR- de 2,1 (3,3)%. Cuando se incluyeron los valores densitométricos en el algoritmo de cálculo del riesgo de fractura, éste fue significativamente menor (p < 0,001), especialmente en pacientes con mejor DMO. Conclusiones. En nuestro medio, el riesgo de fractura calculado por FRAX en las pacientes remitidas a la unidad de densitometría para evaluación de la DMO es bajo. El riesgo de fractura es inferior cuando se introduce la DMO en el algoritmo de cálculo (AU)

In March 2008, FRAX, developed by Kanis and collaborators in the University of Sheffield and supported by the World Health Organization, became available online to calculate absolute risk of osteoporotic fracture in the next 10 years. Objective. To analyze the risk of fracture calculated by FRAX and its determinants in the patients sent to a densitometry unit for bone mineral density (BMD) testing. Methods. All the patients submitted by Primary Care to the Densitometry Unit for BMD testing underwent a self administered questionnaire to assess the clinical risk factors included in FRAX and a bone densitometry of lumbar spine and proximal femur with a DXA densitometer Hologic QDR 4500. They were classified as having a normal BMD, osteopenia or osteoporosis along with the recommendations of the International Society for Clinical Densitometry. As the reference population to calculate the T and Z scores, we used the one from the NHANES III study for femoral neck and total hip and the one from the Study of the Spanish Population for total spine. With the data of the questionnaire, we calculated, by FRAX, the absolute risk in the next ten years of having a major fracture (MFR) or a hip fracture (HFR). Both risks were calculated with or without the inclusion in the algorithm of BMD: MFR+, MFR−, HFR+ and HFR−. The results were recorded in an Access 2003 database and analyzed with the statistical package SPSS 15.0 for Windows. Results. We analyzed the data from 853 women with a mean age of 61.9 (8.9) years and a mean body mass index of 27.0 (4.2)kg/m2. Mean BMD at lumbar spine was 0.873 (0.127)g/cm2; at femoral neck, 0.704 (0.105)g/cm2; and at total hip, 0.817 (0.107)g/cm2. Twenty percent of the patients had a normal BMD, 55% had osteopenia and 25%, osteoporosis. Yet excluding age and body mass index, the number of fracture risk factors seems low: 31% of the patients had no risk of fracture; 40%, had one; 22%, two; 6%, three; 1%, four; and one patient had five. Mean MFR+ was 5.4 (4.8)%; mean MFR−, 6.3 (5.5)%; mean HFR+, 1.5 (2.9)%; and HFR−, 2.1 (3.3)%. When BMD was included in the algorithm for the calculation of the risk of fracture, the risk was statistically lower (p<0.001), especially in patients with better BMD. Conclusions. The risk of fracture calculated by FRAX in the patients sent to a densitometry unit for bone BMD testing seems low and, probably, a better selection of the patients would detect a higher risk of fracture population. When the fracture risk is calculated with the introduction of BMD in the algorithm, it is lower than without including BMD (AU)

The activity of a Spanish bone densitometry unit revisited under the point of view of FRAX.

UNLABELLED: In March 2008, FRAX, developed by Kanis and collaborators in the University of Sheffield and supported by the World Health Organization, became available online to calculate absolute risk of osteoporotic fracture in the next 10 years. OBJECTIVE: To analyze the risk of fracture calculated by FRAX and its determinants in the patients sent to a densitometry unit for bone mineral density (BMD) testing. METHODS: All the patients submitted by Primary Care to the Densitometry Unit for BMD testing underwent a self administered questionnaire to assess the clinical risk factors included in FRAX and a bone densitometry of lumbar spine and proximal femur with a DXA densitometer Hologic QDR 4500. They were classified as having a normal BMD, osteopenia or osteoporosis along with the recommendations of the International Society for Clinical Densitometry. As the reference population to calculate the T and Z scores, we used the one from the NHANES III study for femoral neck and total hip and the one from the Study of the Spanish Population for total spine. With the data of the questionnaire, we calculated, by FRAX, the absolute risk in the next ten years of having a major fracture (MFR) or a hip fracture (HFR). Both risks were calculated with or without the inclusion in the algorithm of BMD: MFR+, MFR-, HFR+ and HFR-. The results were recorded in an Access 2003 database and analyzed with the statistical package SPSS 15.0 for Windows. RESULTS: We analyzed the data from 853 women with a mean age of 61.9 (8.9) years and a mean body mass index of 27.0 (4.2)kg/m(2). Mean BMD at lumbar spine was 0.873 (0.127)g/cm(2); at femoral neck, 0.704 (0.105)g/cm(2); and at total hip, 0.817 (0.107)g/cm(2). Twenty percent of the patients had a normal BMD, 55% had osteopenia and 25%, osteoporosis. Yet excluding age and body mass index, the number of fracture risk factors seems low: 31% of the patients had no risk of fracture; 40%, had one; 22%, two; 6%, three; 1%, four; and one patient had five. Mean MFR+ was 5.4 (4.8)%; mean MFR-, 6.3 (5.5)%; mean HFR+, 1.5 (2.9)%; and HFR-, 2.1 (3.3)%. When BMD was included in the algorithm for the calculation of the risk of fracture, the risk was statistically lower (p<0.001), especially in patients with better BMD. CONCLUSIONS: The risk of fracture calculated by FRAX in the patients sent to a densitometry unit for bone BMD testing seems low and, probably, a better selection of the patients would detect a higher risk of fracture population. When the fracture risk is calculated with the introduction of BMD in the algorithm, it is lower than without including BMD.

Actualización 2011 del consenso Sociedad Española de Reumatología de osteoporosis / 2011 Up-date of the consensus statement of the Spanish Society of Rheumatology on osteoporosis

Objetivo. Dado el creciente avance en el diagnóstico como evaluación y tratamiento de la osteoporosis, y la incorporación de nuevas herramientas y medicamentos, desde la Sociedad Española de Reumatología (SER) se ha impulsado el desarrollo de recomendaciones basadas en la mejor evidencia posible. Estas deben de servir de referencia para reumatólogos y otros profesionales de la salud implicados en el tratamiento de pacientes con osteoporosis. Métodos. Las recomendaciones se emitieron siguiendo la metodología de grupos nominales. El nivel de evidencia y el grado de recomendación se clasificaron según el modelo del Center for Evidence Based Medicine de Oxford y el grado de acuerdo se extrajo por técnica Delphi. Se utilizó toda la información de consensos previos y guías de práctica clínica disponibles. Resultados. Se realizan recomendaciones sobre el diagnóstico, la evaluación y el tratamiento en pacientes con osteoporosis. Estas recomendaciones incluyen la osteoporosis secundaria a glucocorticoides, la osteoporosis premenopáusica y la del varón. Conclusiones. Se presentan las recomendaciones SER sobre el diagnóstico, la evaluación y el manejo de pacientes con osteoporosis (AU)

Objective. Due to increasing improvement in the diagnosis, evaluation and management of osteoporosis and the development of new tools and drugs, the Spanish Society of Rheumatology (SER) has promoted the development of recommendations based on the best evidence available. These recommendations should be a reference to rheumatologists and other health professionals involved in the treatment of patients with osteoporosis. Methods. Recommendations were developed following a nominal group methodology and based on a systematic review. The level of evidence and degree of recommendation were classified according to the model proposed by the Center for Evidence Based Medicine at Oxford. The level of agreement was established through Delphi technique. Evidence from previous consensus and available clinical guidelines was used. Results. We have produced recommendations on diagnosis, evaluation and management of osteoporosis. These recommendations include the glucocorticoid-induced osteoporosis, premenopausal and male osteoporosis. Conclusions. We present the SER recommendations related to the biologic therapy risk management (AU)

[2011 Up-date of the consensus statement of the Spanish Society of Rheumatology on osteoporosis]. / Actualización 2011 del consenso Sociedad Española de Reumatología de osteoporosis.

OBJECTIVE: Due to increasing improvement in the diagnosis, evaluation and management of osteoporosis and the development of new tools and drugs, the Spanish Society of Rheumatology (SER) has promoted the development of recommendations based on the best evidence available. These recommendations should be a reference to rheumatologists and other health professionals involved in the treatment of patients with osteoporosis. METHODS: Recommendations were developed following a nominal group methodology and based on a systematic review. The level of evidence and degree of recommendation were classified according to the model proposed by the Center for Evidence Based Medicine at Oxford. The level of agreement was established through Delphi technique. Evidence from previous consensus and available clinical guidelines was used. RESULTS: We have produced recommendations on diagnosis, evaluation and management of osteoporosis. These recommendations include the glucocorticoid-induced osteoporosis, premenopausal and male osteoporosis. CONCLUSIONS: We present the SER recommendations related to the biologic therapy risk management.