Subclinical synovitis impact on the progression of lupus joint disease: A 10-year longitudinal multicenter study.

OBJECTIVE: To determine the effect of subclinical synovitis on the progression of joint disease in a cohort of patients with systemic lupus erythematosus over a mean follow-up of 10 years. METHODS: A longitudinal follow-up of 96 patients diagnosed with lupus was performed. All patients were considered clinically free of joint disease or with minimal joint impairment at baseline and were studied through ultrasound study of their dominant hand to assess the prevalence of subclinical synovitis. Now, over 10 years after we contacted them and reviewed their evolution to determine the impact of had or had not been diagnosed with subclinical synovitis in their current joint condition. RESULTS: Thirty-one of the 91 reached patients developed clinical progression in their joint manifestations (at least one ordinal degree of worsening). Of these, 23 (74,9%) had demonstrated subclinical synovitis at baseline. In the group of patients who did not progress clinically, 46 (76,6%) did not have this finding at the start of follow-up (p < .01, OR 9,44 95%CI 3,46-25,74). The patients in whom clinical progression was demonstrated had worse combined ultrasound scores than the rest of the patients: 6,41 SD 1,45 vs. 1,15 SD 0,97 (p < .01). CONCLUSIONS: The finding of subclinical synovitis in patients with systemic lupus erythematosus is associated with the development of joint disease progression both clinically and ultrasonographically.

Validation and incorporation of digital entheses into a preliminary GLobal OMERACT Ultrasound DActylitis Score (GLOUDAS) in psoriatic arthritis.

OBJECTIVES: The main objective was to generate a GLobal OMERACT Ultrasound DActylitis Score (GLOUDAS) in psoriatic arthritis and to test its reliability. To this end, we assessed the validity, feasibility and applicability of ultrasound assessment of finger entheses to incorporate them into the scoring system. METHODS: The study consisted of a stepwise process. First, in cadaveric specimens, we identified enthesis sites of the fingers by ultrasound and gross anatomy, and then verified presence of entheseal tissue in histological samples. We then selected the entheses to be incorporated into a dactylitis scoring system through a Delphi consensus process among international experts. Next, we established and defined the ultrasound components of dactylitis and their scoring systems using Delphi methodology. Finally, we tested the interobserver and intraobserver reliability of the consensus- based scoring systemin patients with psoriatic dactylitis. RESULTS: 32 entheses were identified in cadaveric fingers. The presence of entheseal tissues was confirmed in all cadaveric samples. Of these, following the consensus process, 12 entheses were selected for inclusion in GLOUDAS. Ultrasound components of GLOUDAS agreed on through the Delphi process were synovitis, tenosynovitis, enthesitis, subcutaneous tissue inflammation and periextensor tendon inflammation. The scoring system for each component was also agreed on. Interobserver reliability was fair to good (κ 0.39-0.71) and intraobserver reliability good to excellent (κ 0.80-0.88) for dactylitis components. Interobserver and intraobserver agreement for the total B-mode and Doppler mode scores (sum of the scores of the individual abnormalities) were excellent (interobserver intraclass correlation coefficient (ICC) 0.98 for B-mode and 0.99 for Doppler mode; intraobserver ICC 0.98 for both modes). CONCLUSIONS: We have produced a consensus-driven ultrasound dactylitis scoring system that has shown acceptable interobserver reliability and excellent intraobserver reliability. Through anatomical knowledge, small entheses of the fingers were identified and histologically validated.

Impact of ultrasound on the perception of health quality in adult patients with rheumatoid arthritis / Impacto de la ecografía en la percepción de la calidad en salud de pacientes adultos con artritis reumatoide

ABSTRACT Introduction: Ultrasound has shown its usefulness in multiple aspects in the management of inflammatory joint disease and in particular of rheumatoid arthritis (RA). The evidence using patient outcomes and its aspects related to quality of health care is scarce. The aim of this study is to determine the level of satisfaction in the perception of the quality of health care in a group of patients with RA who underwent ultrasound during the consultation, and whether it is higher than those who did not have the ultrasound. Methods: An observational, cross-sectional descriptive study was performed. Patients older than 18 years with a diagnosis of RA using the ACR/EULAR classification criteria were included. One group underwent skeletal muscle ultrasound to study RA during the out-patient medical consultation, as decided by the attending physician. After the completion of the medical action according to prior verbal acceptance by the patient, the Servqhos questionnaire and an ultrasound questionnaire were completed. A satisfied patient was defined as one who had 70% or more in the responses in the Servqhos questionnaire greater than or equal to 4, and a score of 5 in this questionnaire was defined as maximum satisfaction. There were no significant differences between the number of satisfied patients in the two groups. Univariate analysis was performed according to the distribution in the ultrasound or non-performing groups. Subsequently, a bivariate analysis of the different questions was carried out according to the distribution in the satisfaction and very high satisfaction groups. It was established if there was any degree of association using the Chi squared test for categorical variables, and the parametric tests (Mann Whitney U) or non-parametric tests (Kruskal-Wallis test) for the numerical variables were performed according to the distribution. Results: A total of 126 patients were obtained, of whom 62 corresponded to the group of patients who underwent ultrasound during the consultation and 62 to the control group in whom no ultrasound was performed. The majority were women (91%). Ultrasound was mostly performed to study joint disease (93%), with a third of the time to assess more than one aspect. In those on whom the ultrasound was performed, the number of satisfied patients was 56 (90%) and for the control group it was 48 (77%). The difference in the proportion of satisfied patients (13%) was statistically significant (P = .05). A difference was found between the groups in the number of patients with the highest level of satisfaction in the questions regarding presentation of staff and technology (P < .05). The vast majority of patients considered that ultrasound was useful during the consultation (93%), and that it generates greater confidence in the treatments and the doctor (93%). Conclusions: Performing skeletal muscle ultrasound during consultation in patients with RA improves satisfaction rates of health care, perception of the doctor, and treatments.

RESUMEN Introducción: La ecografía ha mostrado su utilidad en múltiples aspectos del manejo de la enfermedad articular inflamatoria, particularmente en la artritis reumatoide (AR). Su utilidad usando desenlaces derivados de pacientes y relacionados con aspectos de la calidad de la atención en salud es escasa. El objetivo del estudio es determinar si el grado de satisfacción de la calidad de la atención en un grupo de pacientes con AR, en quienes se realizó ecografía durante la consulta, es superior al de un grupo en los que esta no se llevó a cabo. Métodos: Se realizó un estudio observacional, descriptivo transversal. Se incluyeron pacientes mayores de 18 años con diagnóstico de AR por criterios clasificatorios ACR/EULAR que posteriormente a la finalización del acto médico respondieron las preguntas del cuestionario Servqhos. Quienes se sometieron a ecografía musculoesquelética para estudio de AR durante la consulta ambulatoria, según decisión del médico tratante, respondieron adicionalmente el cuestionario de ecografía. Se define paciente satisfecho como aquel que tiene un 70% o más en las respuestas del cuestionario Servqhos con un puntaje mayor o igual a 4, y se define como la máxima satisfacción al puntaje de 5 en una pregunta de dicho cuestionario. Se determinó si había diferencias significativas entre las proporciones de pacientes satisfechos en los dos grupos con y sin ecografía. Se realizó un análisis univariado según la distribución en los grupos, y posteriormente se hizo un análisis bivariado de las diferentes preguntas según la distribución en los grupos de satisfacción y muy alta satisfacción. Se estableció si había algún grado de asociación con las pruebas de chi-cuadrado para las variables categóricas, en tanto que para las variables numéricas se llevaron a cabo pruebas paramétricas (U de Mann Whitnney) y no paramétricas (test de Kruskal-Wallis), según la distribución. Resultados: Se obtuvo un total de 126 pacientes, de los cuales 62 corresponden al grupo de aquellos en quienes se realizó ecografía durante la consulta, mientras que otros 62 hacen parte del grupo control, en quienes no se realizó ecografía. La mayoría eran mujeres (91%). En quienes se hizo la ecografía, el número de pacientes satisfechos fue de 56 (90%), en tanto que para el grupo control fue de 48 (77%). La diferencia en la proporción de pacientes satisfechos entre los grupos fue del 13%, siendo estadísticamente significativa (p = 0,05). Se encontró diferencia entre los grupos en las preguntas referentes a presentación del personal y la tecnología de los equipos (p < 0,05). La gran mayoría de los pacientes consideró que la ecografía fue útil durante la consulta (93%) y que genera mayor seguridad en los tratamientos y en el criterio médico (93%). Conclusiones: La realización de ecografía musculoesquelética durante la consulta en pacientes con AR mejora los índices de satisfacción de atención en salud, así como la percepción del criterio médico y de los tratamientos.

Evidence for the Use of Secukinumab in Patients with Radiographic and Non-radiographic Axial Spondyloarthritis in the Last 5 Years.

Axial spondyloarthritis (axSpA) is an inflammatory rheumatic disorder that causes chronic pain, primarily in the spine and sacroiliac joints. It is characterized by the presence of type 1 major histocompatibility complex HLA-B27 genetic marker, arthritis in peripheral joints, enthesitis and/or dactylitis and extra-articular manifestations. Current guidelines recommend biological therapy when first-line therapy is not sufficiently effective. The finding that the interleukin (IL)-17 axis is vital for the pathogenesis of axSpA propelled the development of secukinumab, a fully human monoclonal antibody directed against IL-17A. The present review provides evidence on the efficacy and safety of secukinumab in the treatment of radiographic and non-radiographic axSpA from nine randomized controlled phase III trials, as well as evidence from real-world observational analyses. The primary endpoint in six clinical trials was the proportion of patients meeting the Assessment of SpondyloArthritis international Society criteria for either 20% or 40% improvement (ASAS20, ASAS40) at week 16. Significantly more patients achieved the primary endpoint with secukinumab compared with placebo in all the studies except MEASURE 4. Both clinical trials and real-world studies showed significant improvements in the secondary endpoints of disease activity, quality of life, and pain and fatigue relative to placebo. The benefits of secukinumab were generally sustained during longer-term (up to 5 years) treatment. Overall, secukinumab was well tolerated with a low frequency of adverse events and treatment persistence was high in the real-world setting. Although indirect comparisons suggest that secukinumab and adalimumab have comparable efficacy and safety, they are being directly compared in the ongoing SURPASS study. During the current coronavirus disease 2019 (COVID-19) pandemic, it is advisable to continue biological therapy in patients who do not have severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection, but interrupt treatment during an infection, reinitiating once the patient has recovered from the infection. In conclusion, secukinumab is a largely safe and effective treatment for radiographic and non-radiographic axSpA.

Risk of Severe COVID-19 Infection in Patients With Inflammatory Rheumatic Diseases.

OBJECTIVE: To describe the cohort of patients with inflammatory rheumatic diseases (IRD) hospitalized due to SARS-CoV-2 infection in the Ramón y Cajal Hospital, and to determine the increased risk of severe coronavirus disease 2019 (COVID-19) in patients with no IRD. METHODS: This is a retrospective single-center observational study of patients with IRD actively monitored in the Department of Rheumatology who were hospitalized due to COVID-19. RESULTS: Forty-one (1.8%) out of 2315 patients admitted due to severe SARS-CoV-2 pneumonia suffered from an IRD. The admission OR for patients with IRD was 1.91 against the general population, and it was considerably higher in patients with Sjögren syndrome, vasculitis, and systemic lupus erythematosus. Twenty-seven patients were receiving treatment for IRD with corticosteroids, 23 with conventional DMARDs, 12 with biologics (7 rituximab [RTX], 4 anti-tumor necrosis factor [anti-TNF], and 1 abatacept), and 1 with Janus kinase inhibitors. Ten deaths were registered among patients with IRD. A higher hospitalization rate and a higher number of deaths were observed in patients treated with RTX (OR 12.9) but not in patients treated with anti-TNF (OR 0.9). CONCLUSION: Patients with IRD, especially autoimmune diseases and patients treated with RTX, may be at higher risk of severe pneumonia due to SARS-CoV-2 compared to the general population. More studies are needed to analyze this association further in order to help manage these patients during the pandemic.

Point of care ultrasound knowledge among resident doctors in Madrid's university hospitals. Influence of the induction in emergency departments with point of care ultrasound practice / Grado de conocimiento de la ecografía a pie de cama, entre una muestra de médicos residentes de hospitales universitarios de Madrid. Influencia de la inducción en los servicios de urgencias con uso habitual de ecografía a pie de cama

BACKGROUND: Point of care ultrasound study (POCUS) is a relatively new technique in Spanish Emergency Departments (EDs). Nonetheless, its use is increasing, and the number of emergency doctors and the number of papers published in our country has skyrocketed in last decade. Despite this fact, there is still no evidence of how POCUS is taught in our medical schools. OBJECTIVE: To ascertain the level of knowledge about POCUS in first year resident doctors of three hospitals in Madrid, and one year after having worked in ED with POCUS practice. METHODS AND STUDY DESIGN: The study looked at demographic aspects, POCUS knowledge, and opinions about its usefulness in the ED, prior to and after working in ED with routine use of POCUS. RESULTS: Of the 265 questionnaires, 197 were first-year residents (Group 1) and 68 second-year residents (Group 2). Another 55 senior medical students completed the questionnaire (Group 3). The majority of Groups 1 and 3 stated to have a very low POCUS level. Almost three-quarters (73%) of Group 2 stated having an intermediate or high level, and 26% even declared having full knowledge. More than half of the students agreed that POCUS was a useful tool in ED. CONCLUSIONS: There is a low level of knowledge about POCUS among first-year residents. After working in POCUS qualified EDs, these resident doctors state both the importance and their higher level of knowledge of POCUS

INTRODUCCIÓN: La ecografía a pie de cama (EPC) es una técnica diagnóstica cada día más utilizada por los médicos urgenciólogos en los servicios de urgencias hospitalarios españoles. No obstante, desconocemos el nivel de la EPC de nuestros médicos residentes de primer año (R1). OBJETIVO: Determinar el nivel de conocimientos sobre la EPC de los R1, en 3 hospitales universitarios de Madrid, y el conocimiento un año después de haber trabajado en servicios de urgencias con utilización habitual de la EPC. MÉTODOS: Nuestra encuesta investigaba datos demográficos, nivel previo de conocimiento de la EPC y opinión acerca de su utilidad en el servicio de urgencias. También se aplicó la encuesta a 55 estudiantes de medicina del último curso (EM6). RESULTADOS: De 265 encuestas: 197 fueron de R1 y 68 de R2. También se pasó la encuesta a otros 55 estudiantes de medicina del último curso (EM6). La mayoría de los R1 y EM6, revelaron un nivel previo muy bajo de conocimientos de la EPC. En cambio, el 73% de los R2, manifestaron un nivel intermedio o alto, e incluso un 26% declararon un conocimiento amplio. Más de la mitad de los encuestados manifestó estar de acuerdo en que la EPC era una herramienta muy útil en el servicio de urgencias. CONCLUSIONES: Existe un bajo nivel de conocimientos sobre la EPC entre los R1. Después de haber trabajado en servicios de urgencias con práctica habitual de EPC, estos mismos médicos residentes, reconocieron tanto la importancia de la EPC como su alto nivel de conocimientos de la EPC

Prevalence of subclinical synovitis of the hand in patients with systemic lupus erythematosus.

OBJECTIVES: To determine the prevalence of subclinical synovitis in Lupus patients without peripheral joint symptoms, in those with arthralgias without arthritis and those with episodic arthritis but without radiological structural damage. METHODS: We conducted a multicentre cross-sectional study. Patients with lupus from those three categories were recruited to take part in a greyscale ultrasound scan performed by an expert blinded rheumatologist. Data from a historical control group from a previous study was also included for comparisons. Images were assessed separately in order to determine the presence and level of synovitis following Eular recommendations. RESULTS: Ninety-six patients (88.5% female) with an average age of 40 ± 6.2 years old, were included. SLICC/ACR score was 0.6 ± 0.3 in the group without joint symptoms (group 0), 0.8 ± 0.3 in the group with arthralgias (group I) and 1.1 ± 0.4 in the group with episodic arthritis. The global prevalence of subclinical synovitis was 38.5%. In group 0, that prevalence was 30%. The time since onset of symptoms of patients with subclinical synovitis was longer than the rest of the patients (9.4 ± 2.2 vs 6.5 ± 4.0 years, P < 0.001). No other remarkable association was founded with clinical features of the disease. CONCLUSIONS: This is the first study focused on subclinical synovitis in patients with lupus. Other previous studies had included patients with different levels of arthropathy. Subclinical synovitis does exist in lupus patients in over a third of patients. Its meaning remains unclear and must be a topic of further studies.

Tapentadol versus tramadol in the management of low back pain in the emergency department: Impact of use on the need for reassessments.

Nontraumatic musculoskeletal disorders are the main reason for presentation to the emergency department (ED), with rachialgia (back pain) being the most common reason to request medical assessment among them. This also generates the highest demand for reassessments due to poor pain control or onset of adverse reactions to the treatment prescribed in the initial assessment.A retrospective observational study based on usual clinical practice was conducted in patients attending the ED due to low back pain during a period of 24 months. The primary objective was to determine the demand for reassessments in the ED by these patients in the following 30 days, according to the type of therapeutic approach used in the initial assessment.A total of 732 patients who requested medical assessment due to back pain in the ED of our hospital were analyzed, 91 of whom were treated with tapentadol whereas 641 received another treatment. In the first month after the initial assessment, reassessments were less common in the tapentadol group; this difference was significant from days 8 to 15 (P = 0.001, odds ratio [OR] 0.252 with 95% confidence interval [CI] 0.100-0.635) and days 15 to 30 (P < 10, OR 0.277 with 95% CI 0.136-0.563). Patients who received tapentadol also had a better clinical evolution of pain compared to those who did not receive it (P < 10) and to those who received tramadol (P < 10).In this study in patients with back pain, tapentadol shows clear advantages over the other analgesics analyzed, in terms of pain control and less need for reassessments.

Demanda asistencial urgente en pacientes con fracturas vertebrales en función de la administración de buprenofrina transdérmica u otros tratamientos analgésicos / Demand for emergency department care for vertebral fractures treated with transdermal buprenorphine vs. other analgesics

Objetivo: Comparar los resultados del manejo del dolor axial en pacientes con fracturas vertebrales, atendidos en un servicio de urgencias (SU) según hayan sido tratados con buprenorfina transdérmica u otro tratamiento analgésico, en términos de necesidad de nuevas consultas, aparición de efectos adversos a los 90 días o de necesidad de hospitalización por mal control analgésico a los 6 meses de la primera consulta. Método: Estudio observacional de cohortes retrospectivo desde en una base de datos prospectiva de 18 meses, en un SU. Se incluyeron todos los pacientes mayores de 60 años, con diagnóstico radiológico de fractura/aplastamiento vertebral de más de 3 meses de evolución. Los registros fueron agrupados según el escalón analgésico de la OMS (Organización Mundial de la Salud) con el que fueron tratados los pacientes. Las variables de efectividad fueron: reconsulta al mes, tiempo de reconsulta en días y necesidad de hospitalización. Resultados: Se incluyeron 180 pacientes, 39 tratados con fármacos del primer escalón analgésico de la OMS, 74 con fármacos del segundo escalón (fundamentalmente tramadol) y 67 con buprenorfina transdérmica (tercer escalón). El 50% de los pacientes tratados con buprenorfina reconsultaron a los 50 días o más (rango intercuartílico -RIC-: 41-60), mientras que en el grupo tratado con primer escalón a los 19 (RIC 10-37) y con el segundo escalón a los 28 (RIC 21-53) (p < 0,001). Al ajustar el tratamiento por el resto de las variables se determinó que los pacientes tratados con el primer escalón incrementaban la tasa de reconsulta en 4,19 veces (IC95%: 2,57-6,80; p < 0,001) y en los tratados con el segundo escalón 1,91 veces (IC95%: 1,22-2,99; p = 0,005) frente a los pacientes tratados con buprenorfina transdérmica. Conclusiones: La administración de buprenorfina transdérmica en el control sintomático del dolor axial parece disminuir significativamente la necesidad de nuevas consultas repetidas comparada con terapias de primer y segundo escalón analgésico (AU)

Objective: To compare the results of emergency department management of spinal pain from vertebral fractures (in terms of revisits, adverse effects at 90 days, or need for hospitalization because of poor pain control at 6 months) in patients treated with transdermal buprenorphine or another analgesic. Methods: Retrospective observational study of cohorts in an emergency department database compiled prospectively over a period of 18 months. We included all patients over the age of 60 with a radiologic diagnosis of vertebral fracture or compression causing pain for more than 3 months. Records were stratified according to the World Health Organization (WHO) analgesic scale, which was used when the patients were treated. Variables related to effectiveness were revisits at 1 month, time between visits in days, and the need for hospitalization. Results: A total of 180 patients were included; 39 were treated with drugs on the first step of the WHO's analgesic ladder, 74 with second-step drugs (mainly tramadol), and 67 with transdermal buprenorphine, a third-step drug. Half the patients treated with buprenorphine had revisited at 50 days or later (interquartile range [IQR, 41-60 days); half those treated with first-step analgesics had revisited by 19 days IQR, 10-37 days), and half those on second-step drugs had revisited by 28 days (IQR, 21-53 days) (P<001). After adjustment for other variables, patients treated with first-step drugs revisited 4.19-fold more (95% CI, 2.57–6.80; P< 001) and those treated with second-step drugs revisited 1.91-fold more (95% CI, 1.22–2.99; P=.005) more than patients treated with transdermal buprenorphine. Conclusions: Transdermal buprenorphine used to manage spinal pain seems to significantly reduce the need for revisits in comparison with treatments with first- or second-step analgesics (AU)

[Demand for emergency department care for vertebral fractures treated with transdermal buprenorphine vs. other analgesics]. / Demanda asistencial urgente en pacientes con fracturas vertebrales en función de la administración de buprenofrina transdérmica u otros tratamientos analgésicos.

OBJECTIVES: To compare the results of emergency department management of spinal pain from vertebral fractures (in terms of revisits, adverse effects at 90 days, or need for hospitalization because of poor pain control at 6 months) in patients treated with transdermal buprenorphine or another analgesic. MATERIAL AND METHODS: Retrospective observational study of cohorts in an emergency department database compiled prospectively over a period of 18 months. We included all patients over the age of 60 with a radiologic diagnosis of vertebral fracture or compression causing pain for more than 3 months. Records were stratified according to the World Health Organization (WHO) analgesic scale, which was used when the patients were treated. Variables related to effectiveness were revisits at 1 month, time between visits in days, and the need for hospitalization. RESULTS: A total of 180 patients were included; 39 were treated with drugs on the first step of the WHO's analgesic ladder, 74 with second-step drugs (mainly tramadol), and 67 with transdermal buprenorphine, a third-step drug. Half the patients treated with buprenorphine had revisited at 50 days or later (interquartile range [IQR, 41-60 days); half those treated with first-step analgesics had revisited by 19 days IQR, 10-37 days), and half those on second-step drugs had revisited by 28 days (IQR, 21-53 days) (P<.001). After adjustment for other variables, patients treated with first-step drugs revisited 4.19-fold more (95% CI, 2.57-6.80; P<.001) and those treated with second-step drugs revisited 1.91-fold more (95% CI, 1.22-2.99; P=.005) more than patients treated with transdermal buprenorphine. CONCLUSION: Transdermal buprenorphine used to manage spinal pain seems to significantly reduce the need for revisits in comparison with treatments with first- or second-step analgesics.

OBJETIVO: Comparar los resultados del manejo del dolor axial en pacientes con fracturas vertebrales, atendidos en un servicio de urgencias (SU) según hayan sido tratados con buprenorfina transdérmica u otro tratamiento analgésico, en términos de necesidad de nuevas consultas, aparición de efectos adversos a los 90 días o de necesidad de hospitalización por mal control analgésico a los 6 meses de la primera consulta. METODO: Estudio observacional de cohortes retrospectivo desde en una base de datos prospectiva de 18 meses, en un SU. Se incluyeron todos los pacientes mayores de 60 años, con diagnóstico radiológico de fractura/aplastamiento vertebral de más de 3 meses de evolución. Los registros fueron agrupados según el escalón analgésico de la OMS (Organización Mundial de la Salud) con el que fueron tratados los pacientes. Las variables de efectividad fueron: reconsulta al mes, tiempo de reconsulta en días y necesidad de hospitalización. RESULTADOS: Se incluyeron 180 pacientes, 39 tratados con fármacos del primer escalón analgésico de la OMS, 74 con fármacos del segundo escalón (fundamentalmente tramadol) y 67 con buprenorfina transdérmica (tercer escalón). El 50% de los pacientes tratados con buprenorfina reconsultaron a los 50 días o más (rango intercuartílico ­RIC­: 41- 60), mientras que en el grupo tratado con primer escalón a los 19 (RIC 10-37) y con el segundo escalón a los 28 (RIC 21-53) (p < 0,001). Al ajustar el tratamiento por el resto de las variables se determinó que los pacientes tratados con el primer escalón incrementaban la tasa de reconsulta en 4,19 veces (IC95%: 2,57-6,80; p < 0,001) y en los tratados con el segundo escalón 1,91 veces (IC95%: 1,22-2,99; p = 0,005) frente a los pacientes tratados con buprenorfina transdérmica. CONCLUSIONES: La administración de buprenorfina transdérmica en el control sintomático del dolor axial parece disminuir significativamente la necesidad de nuevas consultas repetidas comparada con terapias de primer y segundo escalón analgésico.