SLESIS-R: an improved score for prediction of serious infection in patients with systemic lupus erythematosus based on the RELESSER prospective cohort.

OBJECTIVE: To develop an improved score for prediction of severe infection in patients with systemic lupus erythematosus (SLE), namely, the SLE Severe Infection Score-Revised (SLESIS-R) and to validate it in a large multicentre lupus cohort. METHODS: We used data from the prospective phase of RELESSER (RELESSER-PROS), the SLE register of the Spanish Society of Rheumatology. A multivariable logistic model was constructed taking into account the variables already forming the SLESIS score, plus all other potential predictors identified in a literature review. Performance was analysed using the C-statistic and the area under the receiver operating characteristic curve (AUROC). Internal validation was carried out using a 100-sample bootstrapping procedure. ORs were transformed into score items, and the AUROC was used to determine performance. RESULTS: A total of 1459 patients who had completed 1 year of follow-up were included in the development cohort (mean age, 49±13 years; 90% women). Twenty-five (1.7%) had experienced ≥1 severe infection. According to the adjusted multivariate model, severe infection could be predicted from four variables: age (years) ≥60, previous SLE-related hospitalisation, previous serious infection and glucocorticoid dose. A score was built from the best model, taking values from 0 to 17. The AUROC was 0.861 (0.777-0.946). The cut-off chosen was ≥6, which exhibited an accuracy of 85.9% and a positive likelihood ratio of 5.48. CONCLUSIONS: SLESIS-R is an accurate and feasible instrument for predicting infections in patients with SLE. SLESIS-R could help to make informed decisions on the use of immunosuppressants and the implementation of preventive measures.

Prevalence and Incidence of Uveitis: A Systematic Review and Meta-analysis.

Background: Although the impact of uveitis on people's lives is clear, the frequency of this condition is unclear.Objective: To estimate the prevalence and incidence of uveitis.Methods: A systematic review with meta-analysis was conducted. Medline, Embase, and Cochrane Library were searched from inception to January 2019. The quality of the included studies was critically appraised with a grading system based on the Oxford Levels of Evidence. A detailed description of the populations studied and of factors affecting estimates was undertaken. Pooled analyses were conducted using a random-effects approach and expressed as incidence rates per 100,000 with 95% confidence intervals. Subgroup analyses by geographical region were conducted along with meta-regression to analyze possible factors for heterogeneity.Results: A total of 49 studies were included and critically appraised. Twenty-two were population-based, and 27 hospital-based. Heterogeneity was substantial in terms of populations studied, methods for ascertaining uveitis, including definitions, and reporting of results. This was especially important in prevalence studies, with data ranging from 9 to 730 cases per 100,000. For incidence studies, the meta-analysis yielded a pooled incidence of 50.45 per 100.000. The meta-regression showed the geographic region as an important explanatory factor of the heterogeneity between studies.Conclusion: Population-based estimates of the epidemiology of uveitis vary widely, owing to methodologies employed, definitions of uveitis and geographical regions; the representativeness and generalizability of many epidemiological studies of uveitis are limited.

Índices de gravedad en la artritis reumatoide: una revisión sistemática / Severity indices in rheumatoid arthritis: A systematic review

Objetivo: Identificar herramientas diseñadas para evaluar la gravedad global de los pacientes con artritis reumatoide (AR) para su uso en la investigación de marcadores pronósticos de artritis precoz. Métodos: Revisión sistemática de estudios cuyo objetivo fuera el desarrollo o validación de índices de gravedad en AR. Se valoró la calidad metodológica mediante la lista de comprobación COSMIN. Además, se evaluó la claridad de definición, viabilidad y probabilidad de estar presente durante los 2 primeros años de evolución. Resultados: Después de revisar 3.519 artículos, se identificaron 3 índices de gravedad. La Patient Activity Scale (PAS) valoró si el tratamiento previo o actual predecía la gravedad de la AR, medida mediante el patient-reported PAS. Las variables de tratamiento no permitieron distinguir entre los cuartiles superior e inferior de la PAS. El CIRAS incluye las variables edad, sexo, síndrome de Felty, número de visitas al reumatólogo y al rehabilitador, factor reumatoide (FR), recuento de plaquetas, marcadores inflamatorios y paneles bioquímicos solicitados. Su correlación fue baja (r=0,56), con un índice previamente validado por el mismo grupo investigador, el RARBIS, con el DAS28-PCR (r = 0,07) y el Multidimensional Health Assesment Questionnaire (MD-HAQ) (r=0,008). Por último, el RARBIS, utilizado para validar el CIRAS, fue ideado como un índice de gravedad de AR basado en registros médicos. Incluye como dominios cirugía, radiología, manifestaciones extraarticulares, clínica y variables de laboratorio, elegidas previamente por un panel de expertos. Este índice presentó una correlación débil con la intensidad de tratamiento (r = 0,35) y con el DAS 28 (r = 0,41). Conclusión: No existe ningún índice para valorar la gravedad de la AR sobre la base del curso evolutivo de los 2 primeros años de seguimiento y que se adapte a la estrategia terapéutica actual. Por lo tanto, creemos razonable el desarrollo de un nuevo índice de gravedad ad hoc para pacientes con artritis de reciente comienzo

Objective: To identify tools designed to evaluate the severity of patients with rheumatoid arthritis (RA) in order to use them in the investigation of prognostic markers in early arthritis. Methods: We conducted a systematic review of studies that developed/validated an index for RA disease severity. They were analyzed using the COSMIN checklist to assess their methodological quality. In addition, all the variables included were evaluated for their clarity of definition, feasibility and probability of being present in each outcome during the first 2 years of the disease course. To estimate redundancy, variables were grouped by domains. Results: After reviewing 3,519 articles, 3 studies were included. The first study, the PAS, assessed whether current and lifetime treatment with disease-modifying antirheumatic drugs and/or biologics accurately predicted RA severity, as measured by the patient-reported PAS. Treatment variables did not fully distinguish patients in the highest and lowest quartiles of PAS scores. Another severity index, the Claims-Based Index for RA Severity (CIRAS), included the variables age, sex, Felty's syndrome, number of rehabilitation and rheumatology visits, test for inflammatory markers, number of chemistry panels/platelet counts ordered and rheumatoid factor test. The correlation was low (r=0.56) with an index previously validated by the same research group, the RA medical records-based index of severity (RARBIS), with Disease Activity Score-C-reactive protein (DAS28-PCR) (r=0.07) and Multidimensional Health Assessment Questionnaire (MD-HAQ) (r=0.008). Finally, the RARBIS, used to validate the CIRAS, was devised as an RA severity index based on medical records. It includes as domains surgery, radiology, extra-articular manifestations, clinical and laboratory variables, previously chosen by an expert panel. RARBIS had a weak correlation with treatment intensity (r=0.35) and with DAS28 (r=0.41). Conclusion: There is no index to assess the severity of RA based on the course of the first 2 years of follow-up that is adapted to the current strategy of therapeutic management of this disease. Therefore, we believe it is reasonable to develop a new ad hoc severity index for patients with early arthritis

Severity indices in rheumatoid arthritis: A systematic review. / Índices de gravedad en la artritis reumatoide: una revisión sistemática.

OBJECTIVE: To identify tools designed to evaluate the severity of patients with rheumatoid arthritis (RA) in order to use them in the investigation of prognostic markers in early arthritis. METHODS: We conducted a systematic review of studies that developed/validated an index for RA disease severity. They were analyzed using the COSMIN checklist to assess their methodological quality. In addition, all the variables included were evaluated for their clarity of definition, feasibility and probability of being present in each outcome during the first 2 years of the disease course. To estimate redundancy, variables were grouped by domains. RESULTS: After reviewing 3,519 articles, 3 studies were included. The first study, the PAS, assessed whether current and lifetime treatment with disease-modifying antirheumatic drugs and/or biologics accurately predicted RA severity, as measured by the patient-reported PAS. Treatment variables did not fully distinguish patients in the highest and lowest quartiles of PAS scores. Another severity index, the Claims-Based Index for RA Severity (CIRAS), included the variables age, sex, Felty's syndrome, number of rehabilitation and rheumatology visits, test for inflammatory markers, number of chemistry panels/platelet counts ordered and rheumatoid factor test. The correlation was low (r=0.56) with an index previously validated by the same research group, the RA medical records-based index of severity (RARBIS), with Disease Activity Score-C-reactive protein (DAS28-PCR) (r=0.07) and Multidimensional Health Assessment Questionnaire (MD-HAQ) (r=0.008). Finally, the RARBIS, used to validate the CIRAS, was devised as an RA severity index based on medical records. It includes as domains surgery, radiology, extra-articular manifestations, clinical and laboratory variables, previously chosen by an expert panel. RARBIS had a weak correlation with treatment intensity (r=0.35) and with DAS28 (r=0.41). CONCLUSION: There is no index to assess the severity of RA based on the course of the first 2 years of follow-up that is adapted to the current strategy of therapeutic management of this disease. Therefore, we believe it is reasonable to develop a new ad hoc severity index for patients with early arthritis.

Validation of the 2013 American College of Rheumatology/European League Against Rheumatism classification criteria for systemic sclerosis in patients from a capillaroscopy clinic.

OBJECTIVE: To validate the 2013 ACR/EULAR classification criteria for systemic sclerosis (SSc) in patients from a capillaroscopy clinic. METHODS: All patients attended in a capillaroscopy clinic were included. Sociodemographic and SSc-related variables were collected. Using as gold standard for SSc the clinical judgement, the performance (sensitivity, specificity, predictive values, and likelihood ratios) of the 2013 ACR/EULAR criteria were analyzed. Receiver operating characteristic (ROC) curve and the area under the curve (AUC) were calculated for the global score and individual items, and the best cutoffs were obtained. RESULTS: We included 327 patients (84% women, mean age at capillaroscopy 48 years). Main reasons for capillaroscopy referral were Raynaud's phenomenon (39%) and SSc evaluation (27%). The most frequent final clinical diagnosis were SSc (32.4%) and primary Raynaud's phenomenon (25.7%). The 2013 ACR/EULAR SSc classification criteria were met by 116 patients (35.5%). Sensitivity and specificity of the new criteria were 98.1% and 94.6%, respectively, and positive and negative predictive values were 89.7% and 99.1%. The individual variables with the best sensitivity were Raynaud's phenomenon (99.1%) and abnormal nailfold capillaries (81.1%). All the individual variables, except Raynaud's phenomenon, puffy fingers and sclerodactily showed high specificity values, over 90%. The best cutoffs of the total score were ≥8, ≥9, and ≥10, and the AUC = 0.993. CONCLUSIONS: We validated the new ACR/EULAR classification criteria for SSc in unselected patients from a capillaroscopy clinic. Global score and individual items included in the new criteria show high diagnostic accuracy and discriminatory capacity.

Registro nacional de pacientes con lupus eritematoso sistémico de la Sociedad Española de Reumatología: objetivos y metodología / National registry of patients with systemic lupus erythematosus of the Spanish Society of Rheumatology: objectives and methodology

Objetivo. Describir en detalle los objetivos y aspectos metodológicos del registro de lupus eritematoso sistémico (LES) de la Sociedad Española de Reumatología (RELESSER). Métodos. Registro multicéntrico, de base hospitalaria, con recogida retrospectiva de datos de una amplia muestra representativa de adultos con LES (criterios ACR 1997) procedentes de servicios de reumatología españoles. Incluye datos demográficos, manifestaciones clínicas frecuentes e infrecuentes (< 1%), actividad, daño, gravedad, comorbilidad, tratamientos y mortalidad, totalizando 359 variables por paciente, con definiciones altamente estandarizadas. Se ha realizado un análisis descriptivo preliminar de los datos. Resultados. Han participado 45 centros e incluido 4.024 pacientes con LES o LES incompleto (91% con ≥ 4 criterios ACR). El 90% son mujeres y el 93% caucásicos, con una mediana de edad al diagnóstico de 33 años; mediana de duración de la enfermedad: 120 meses; seguimiento medio: 104 meses. Se encuentran en seguimiento activo 3.222 pacientes (81%) y 591 (14%) han sido perdidos para seguimiento. Las medianas del índice de actividad SELENA-SLEDAI, índice de daño de SLICC/ACR y de gravedad de Katz han sido 2, 1 y 2, respectivamente. Un total de 211 pacientes (6%) han fallecido. Conclusiones. RELESSER representa el registro de LES europeo con mayor número de pacientes construido hasta la fecha, disponiendo de abundante información actualizada y fiable sobre manifestaciones del LES, situación de enfermedad, comorbilidad y tratamientos en condiciones de práctica clínica real. RELESSER se constituye como herramienta de gran potencialidad para la investigación clínica multicéntrica en el LES(AU)

Objective: To describe the objectives, design and methods of the Spanish Society of Rheumatology systemic lupus erythematosus (SLE) registry (RELESSER). Methods: Multicenter, hospital-based registry, with retrospective collection of data from a large representative sample of adult patients with SLE (1997 ACR criteria) attending Spanish rheumatology services. The registry includes demographic data, frequent and infrequent (< 1%) clinical manifestations, information about activity, damage, severity, comorbidity, treatments and mortality, collecting 359 variables per patient, with highly standardized definitions. We performed a preliminary descriptive analysis of the data. Results: Forty-five centers were involved and 4,024 SLE patients (91% with >= 4 ACR criteria) have been included; 90% are women and 93% caucasians, with a median age at diagnosis of 33 years, median disease duration: 120 months, median follow-up duration: 104 months; 3,222 (81%) of the patients are in active follow-up and 591 (14%) were lost to follow-up. The median values of the SELENA-SLEDAI score, SLICC/ACR damage index and Katz severity index have been 2, 1 and 2, respectively. A total of 211 patients (6%) died. Conclusions: RELESSER represents the largest European SLE registry built to date, providing comprehensive and reliable information on SLE manifestations, disease status, comorbid conditions and treatments in daily clinical practice. RELESSER is constituted as a tool of great potential for multicenter clinical research in SLE (AU)

National registry of patients with systemic lupus erythematosus of the Spanish Society of Rheumatology: objectives and methodology.

OBJECTIVE: To describe the objectives, design and methods of the Spanish Society of Rheumatology systemic lupus erythematosus (SLE) registry (RELESSER). METHODS: Multicenter, hospital-based registry, with retrospective collection of data from a large representative sample of adult patients with SLE (1997 ACR criteria) attending Spanish rheumatology services. The registry includes demographic data, frequent and infrequent (<1%) clinical manifestations, information about activity, damage, severity, comorbidity, treatments and mortality, collecting 359 variables per patient, with highly standardized definitions. We performed a preliminary descriptive analysis of the data. RESULTS: Forty-five centers were involved and 4,024 SLE patients (91% with ≥ 4 ACR criteria) have been included; 90% are women and 93% caucasians, with a median age at diagnosis of 33 years, median disease duration: 120 months, median follow-up duration: 104 months; 3,222 (81%) of the patients are in active follow-up and 591 (14%) were lost to follow-up. The median values of the SELENA-SLEDAI score, SLICC/ACR damage index and Katz severity index have been 2, 1 and 2, respectively. A total of 211 patients (6%) died. CONCLUSIONS: RELESSER represents the largest European SLE registry built to date, providing comprehensive and reliable information on SLE manifestations, disease status, comorbid conditions and treatments in daily clinical practice. RELESSER is constituted as a tool of great potential for multicenter clinical research in SLE.

Variabilidad en el consumo de recursos en pacientes con espondiloartritis en España. Datos descriptivos preliminares del estudio emAR II / Variability in resource consumption in patients with spondyloarthritis in Spain. Preliminary descriptive data from the emAR II study

Objetivo. Describir la variabilidad en el manejo de las espondiloartritis (EsA) en España en términos de consumo de recursos sanitarios y la utilización de técnicas. Métodos. Revisión de 1.168 historias clínicas de pacientes con EsA atendidos en servicios de reumatología de hospitales españoles, seleccionadas aleatoriamente. Se analizaron las variables sociodemográficas y las variables relacionadas con el consumo de recursos sanitarios. Resultados. El número total de visitas médicas a reumatología fue de 5.908, con una tasa de 254 consultas/100 pacientes-año. El número total de visitas a enfermería reumatológica fue de 775, con una tasa de 39 visitas/100 pacientes-año, y se produjeron 446 ingresos, lo que representa una tasa de 22 por 100 pacientes-año. El número de ingresos debidos a la EsA fue de 89, con una tasa de 18 ingresos/100 pacientes-año. El total de visitas a otros especialistas fue de 4.307, con una tasa de 200/100 pacientes-año. El número total de cirugías ortopédicas fue de 41, lo que da lugar a una tasa de 1,8 cirugías/100 pacientes-año. Conclusiones. Los datos de visita al reumatólogo y de cirugía protésica de pacientes con EsA en España son similares a la mayoría de los estudios publicados en nuestro entorno; sin embargo, otros aspectos referentes al uso de recursos sanitarios son diferentes en comparación con otros países. Estos datos pueden contribuir para conocer y mejorar aspectos organizativos del manejo de la EsA en los hospitales españoles (AU)

Objective. Our objective was to describe the variability in the management of spondyloarthritis (SA) in Spain in terms of healthcare resources and their use. Methods. A review of 1168 medical files of patients seen in randomly selected Spanish hospital rheumatology departments. We analyzed demographic variables and variables related to the consumption of health resources. Results. The total number of visits to rheumatology were 5,908 with a rate of 254 visits/100 patient-years. The total number of visits to rheumatology specialty nurses was 775, with a rate of 39 visits/100 patient-years, and there were 446 hospitalizations, representing a rate of 22 per 100 patient-years. The number of admissions due to SA was 89, with a rate of 18 admissions/100 patient-years. Total visits to other specialists was 4,307 with a rate of 200/100 patient-years. The total number of orthopedic surgeries was 41, which leads to a rate of 1.8 surgeries/100 patient-years. Conclusions. The data regarding visits to the rheumatologist and prosthetic surgery of patients with in Spain is similar to most studies published in our environment, however, other aspects concerning the use of health resources are different compared to other countries. This data may help to understand and improve organizational aspects of management of SA in Spanish hospitals (AU)

Variability in resource consumption in patients with spondyloarthritis in Spain. Preliminary descriptive data from the emAR II study.

OBJECTIVE: Our objective was to describe the variability in the management of spondyloarthritis (SA) in Spain in terms of healthcare resources and their use. METHODS: A review of 1168 medical files of patients seen in randomly selected Spanish hospital rheumatology departments. We analyzed demographic variables and variables related to the consumption of health resources. RESULTS: The total number of visits to rheumatology were 5,908 with a rate of 254 visits/100 patient-years. The total number of visits to rheumatology specialty nurses was 775, with a rate of 39 visits/100 patient-years, and there were 446 hospitalizations, representing a rate of 22 per 100 patient-years. The number of admissions due to SA was 89, with a rate of 18 admissions/100 patient-years. Total visits to other specialists was 4,307 with a rate of 200/100 patient-years. The total number of orthopedic surgeries was 41, which leads to a rate of 1.8 surgeries/100 patient-years. CONCLUSIONS: The data regarding visits to the rheumatologist and prosthetic surgery of patients with in Spain is similar to most studies published in our environment, however, other aspects concerning the use of health resources are different compared to other countries. This data may help to understand and improve organizational aspects of management of SA in Spanish hospitals.

[Association of cardiovascular disease with overweight and obesity in Spain]. / Asociación de la enfermedad cardiovascular con el sobrepeso y la obesidad en España.

BACKGROUND: Our purpose was to examine the relationship of overweight and obesity with cardiovascular disorders. PATIENTS AND METHOD: Data from the 1993 Spanish National Health Survey (16,692 subjects with a body mass index [BMI] >= 18.5 kg/m2). RESULTS: After adjustment for age, residence city size and tobacco consumption, we observed a positive dose-response relationship (p linear trend < 0.05) of BMI >= 18.5 kg/m2 with hypertension, hypercholesterolemia and diabetes in both sexes, as well as with heart diseases in women. These associations decreased with age. CONCLUSIONS: Overweight and obesity are associated with a greater frequency of cardiovascular disorders in Spain.

Asociación de la enfermedad cardiovascularcon el sobrepeso y la obesidad en España / Association of cardiovascular disease with overweight and obesity in Spain

FUNDAMENTO: Examinar la relación del exceso de peso con la presencia de trastornos cardiovasculares. PACIENTES Y MÉTODO: Los datos proceden de la Encuesta Nacional de Salud de España de 1993 (16.692 sujetos con índice de masa corporal ([IMC] 18,5 kg/m2). RESULTADOS: Después de ajustar por edad, consumo de tabaco y tamaño del municipio, se observó una relación dosis-respuesta positiva (p para la tendencia lineal < 0,05) del IMC 18,5 kg/m2 con la hipertensión, la hipercolesterolemia y la diabetes en varones y mujeres, y con las enfermedades del corazón en las mujeres. Estas asociaciones disminuían con la edad. CONCLUSIONES: El exceso de peso se asocia a mayor frecuencia de trastornos cardiovasculares en España. (AU)