Combined use of QRISK3 and SCORE2 increases identification of ankylosing spondylitis patients at high cardiovascular risk: Results from the CARMA Project cohort after 7.5 years of follow-up.

OBJECTIVE: To establish the predictive value of the QRESEARCH risk estimator version 3 (QRISK3) algorithm in identifying Spanish patients with ankylosing spondylitis (AS) at high risk of cardiovascular (CV) events and CV mortality. We also sought to determine whether to combine QRISK3 with another CV risk algorithm: the traditional SCORE, the modified SCORE (mSCORE) EULAR 2015/2016 or the SCORE2 may increase the identification of AS patients with high-risk CV disease. METHODS: Information of 684 patients with AS from the Spanish prospective CARdiovascular in ReuMAtology (CARMA) project who at the time of the initial visit had no history of CV events and were followed in rheumatology outpatient clinics of tertiary centers for 7.5 years was reviewed. The risk chart algorithms were retrospectively tested using baseline data. RESULTS: After 4,907 years of follow-up, 33 AS patients had experienced CV events. Linearized rate=6.73 per 1000 person-years (95 % CI: 4.63, 9.44). The four CV risk scales were strongly correlated. QRISK3 correctly discriminated between people with lower and higher CV risk, although the percentage of accumulated events over 7.5 years was clearly lower than expected according to the risk established by QRISK3. Also, mSCORE EULAR 2015/2016 showed the same discrimination ability as SCORE, although the percentage of predicted events was clearly higher than the percentage of actual events. SCORE2 also had a strong discrimination capacity according to CV risk. Combining QRISK3 with any other scale improved the model. This was especially true for the combination of QRISK3 and SCORE2 which achieved the lowest AIC (406.70) and BIC (415.66), so this combination would be the best predictive model. CONCLUSIONS: In patients from the Spanish CARMA project, the four algorithms tested accurately discriminated those AS patients with higher CV risk and those with lower CV risk. Moreover, a model that includes QRISK3 and SCORE2 combined the best discrimination ability of QRISK3 with the best calibration of SCORE2.

Prevalencia de las enfermedades reumáticas en el Baix Empordà / Prevalence of rheumatic diseases in Baix Empordà

Introducción: En España, la prevalencia de diferentes enfermedades reumáticas se conoce principalmente a través de los estudios EPISER coordinados desde la Sociedad Española de Reumatología y que parten de encuestas en una muestra poblacional. Nuestro estudio tiene por objetivo describir la prevalencia en 2016 de las distintas enfermedades reumáticas en la población residente en el Baix Empordà según registros de codificación asistencial. Materiales y métodos: Estudio observacional, descriptivo y transversal realizado sobre la población residente durante los años 2016-2017 en la comarca del Baix Empordà, donde una organización sanitaria integrada (Serveis de Salut Integrats Baix Empordà) gestiona todos los dispositivos asistenciales públicos con un sistema de información unificado. Se seleccionaron los pacientes ≥ 20 años y se analizó la codificación CIE-9-CM de sus contactos asistenciales en función de 11 agrupaciones diagnósticas de 28 enfermedades reumáticas. Las agrupaciones fueron: poliartritis, espondiloartritis, artritis microcristalinas, artrosis (excepto localización vertebral), reumatismos de partes blandas, fibromialgia, dolor vertebral crónico (incluyendo artrosis), osteoporosis, enfermedades del tejido conectivo, vasculitis y otros. La población estudiada se asignó a tres categorías: «con enfermedad reumática», «posible enfermedad reumática» y «sin enfermedad reumática». Resultados: La muestra final fue de 71.785 personas, así distribuidas: «con enfermedad reumática» (n=25.990; 36,2%); «posible enfermedad reumática» (n=4.406; 6,1%) y «sin enfermedad reumática» (n=41.389; 57,7%). El grupo «con enfermedad reumática» mostró un predominio de mujeres (59,8% vs. 44,9%) y mayor edad (59,1±17,7 vs. 45,1±16,2; p<0,001) en comparación al grupo «sin enfermedad reumática». Conclusiones: El 36,2% de nuestra población presenta algún tipo de enfermedad reumática.(AU)

Background: In Spain, the prevalence of different rheumatic diseases is known mainly through the EPISER studies coordinated by the Spanish Society of Rheumatology and based on surveys in a population sample. The aim of our study is to describe the prevalence in 2016 of different rheumatic diseases in the population residing in Baix Empordà according to healthcare coding records. Materials and methods: Observational, descriptive and cross-sectional study carried out on the population attended from 2016-2017 in Serveis de Salut Integrats del Baix Empordà, an organizational service that includes all the healthcare facilities in the Baix Empordà area with a unique information system. Patients ≥ 20 years of age were selected and the ICD9-CM coding of all their healthcare contacts was analysed according to 11 entities and 28 diseases. The entities were: polyarthritis, spondyloarthritis, microcrystalline arthritis, osteoarthritis, soft tissue rheumatism, fibromyalgia, chronic spinal pain, osteoporosis, connective tissue diseases, vasculitis and others. The studied population was assigned to the categories: “with rheumatic disease”, “possible rheumatic disease” and “without rheumatic disease”. Results: In total, 71,785 patients were distributed as: 36.2% “with rheumatic disease (n=25,990); 6.1% with “possible rheumatic disease” (n=4,406) and 57.7% “without rheumatic disease” (n=41,389). The group “with rheumatic disease” showed a predominance of women (59.8% vs. 44.9%) and older age (59.1±17.7 vs. 45.1±16.2; P <.001) compared to the group “without rheumatic disease”. The presence of rheumatic disease increased progressively with age, being maximum in the group between 55-75 years. Conclusions: 36.2% of our population has some type of rheumatic disease.(AU)

Prevalence of rheumatic diseases in Baix Empordà.

BACKGROUND: In Spain, the prevalence of different rheumatic diseases is known mainly through the EPISER studies coordinated by the Spanish Society of Rheumatology and based on surveys in a population sample. The aim of our study is to describe the prevalence in 2016 of different rheumatic diseases in the population residing in Baix Empordà according to healthcare coding records. MATERIALS AND METHODS: Observational, descriptive and cross-sectional study carried out on the population attended from 2016 to 2017 in SIBBE (Serveis de Salut Integrats del Baix Empordà), an organizational service that includes all the healthcare facilities in the Baix Empordà area with a unique information system. Patients ≥ 20 years of age were selected and the ICD9-CM coding of all their healthcare contacts was analysed according to 11 entities and 28 diseases. The entities were: polyarthritis, spondyloarthritis, microcrystalline arthritis, osteoarthritis, soft tissue rheumatism, fibromyalgia, chronic spinal pain, osteoporosis, connective tissue diseases, vasculitis and others. The studied population was assigned to the categories: "with rheumatic disease", "possible rheumatic disease" and "without rheumatic disease". RESULTS: In total, 71,785 patients were distributed as: 36.2% "with rheumatic disease (n = 25,990); 6.1% with "possible rheumatic disease" (n = 4406) and 57.7% "without rheumatic disease" (n = 41,389). The group "with rheumatic disease" showed a predominance of women (59.7% vs. 44.9%) and older age (59.1 ±â€¯17.7 vs. 45.1 ±â€¯16.2; p < .001) compared to the group "without rheumatic disease". The presence of rheumatic disease increased progressively with age, being maximum in the group between 55-75 years. CONCLUSIONS: 36.2% of our population has some type of rheumatic disease. The estimated prevalence of some rheumatic diseases in the Baix Empordà population is partially consistent with that estimated by the EPISER 2016 study. Rheumatic disease affects women in a greater proportion and is more frequent in patients over 45 years of age.

Body Mass Index and Disease Activity in Chronic Inflammatory Rheumatic Diseases: Results of the Cardiovascular in Rheumatology (Carma) Project.

OBJECTIVE: Since obesity has been associated with a higher inflammatory burden and worse response to therapy in patients with chronic inflammatory rheumatic diseases (CIRD), we aimed to confirm the potential association between body mass index (BMI) and disease activity in a large series of patients with CIRDs included in the Spanish CARdiovascular in rheuMAtology (CARMA) registry. METHODS: Baseline data analysis of patients included from the CARMA project, a 10-year prospective study of patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS), and psoriatic arthritis (PsA) attending outpatient rheumatology clinics from 67 Spanish hospitals. Obesity was defined when BMI (kg/m2) was >30 according to the WHO criteria. Scores used to evaluate disease activity were Disease Activity Score of 28 joints (DAS28) in RA, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) in AS, and modified DAS for PsA. RESULTS: Data from 2234 patients (775 RA, 738 AS, and 721 PsA) were assessed. The mean ± SD BMI at the baseline visit were: 26.9 ± 4.8 in RA, 27.4 ± 4.4 in AS, and 28.2 ± 4.7 in PsA. A positive association between BMI and disease activity in patients with RA (ß = 0.029; 95%CI (0.01- 0.05); p = 0.007) and PsA (ß = 0.036; 95%CI (0.015-0.058); p = 0.001) but not in those with AS (ß = 0.001; 95%CI (-0.03-0.03); p = 0.926) was found. Disease activity was associated with female sex and rheumatoid factor in RA and with Psoriasis Area Severity Index and enthesitis in PsA. CONCLUSIONS: BMI is associated with disease activity in RA and PsA, but not in AS. Given that obesity is a potentially modifiable factor, adequate control of body weight can improve the outcome of patients with CIRD and, therefore, weight control should be included in the management strategy of these patients.