Frecuencia de comorbilidades en pacientes con artritis psoriásica y evaluación de la adherencia de los médicos a las recomendaciones de tratamiento de las Guías GRAPPA 2015 / Frequency of comorbidities in patients with psoriatic arthritis and evaluation of the adherence of physicians to the treatment recommendations of the GRAPPA 2015 Guidelines

Introducción: los pacientes con artritis psoriásica (APs) presentan más comorbilidades. Las guías del Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) establecen lineamientos para los tratamientos de acuerdo a ellas. Objetivos: describir la prevalencia de comorbilidades en pacientes con APs según el Rheumatic Disease Comorbidity Index (RDCI), analizar el efecto sobre la enfermedad y estudiar la adherencia a las guías GRAPPA. Materiales y métodos: estudio observacional. Se incluyeron pacientes con APs de la cohorte RAPSODIA. Se reportaron características sociodemográficas y clínicas. Las comorbilidades se valoraron por RDCI. Se estudiaron variables asociadas a RDCI ≥1 mediante análisis multivariado. Se analizó el cumplimiento de las recomendaciones de tratamiento en relación a las comorbilidades según las guías GRAPPA. Resultados: se incluyeron 170 pacientes. El 67,6% presentó al menos una comorbilidad (RDCI ≥1); estos eran de mayor edad (X 57,3±12,7 años vs. 48,2±13,2 años; p<0,0001), presentaban más sobrepeso u obesidad (84,3% vs. 67,3%; p=0,011) y peor calidad de vida (PsAQoL X 7,6±6,6 vs. 5,2±6; p=0,025). El análisis multivariado evidenció asociación de la edad y el uso de antiinflamatorios no esteroideos (AINEs) con RDCI ≥1. Contrariamente a las recomendaciones de GRAPPA, el 70% de los pacientes con cardiopatía utilizaba AINEs, y la mitad de aquellos con enfermedades hepáticas o renales tomaba AINEs o metotrexato. Conclusiones: la prevalencia de comorbilidades en los pacientes con APs es alta. En algunos casos no se cumplían las recomendaciones de tratamiento en relación a las comorbilidades.

Introduction: comorbidities are common in patients with psoriatic arthritis (PsA). The GRAPPA (Group for Research and Assessment of Psoriasis and Psoriatic Arthritis) guidelines strengthen the choice of treatments according to them. Objetives: to describe the prevalence of comorbidities in patients with psoriatic arthritis according to Rheumatic Disease Comorbidity Index (RDCI) and to analyze the influence of them on disease activity, functional capacity and quality life and to assess adherence to GRAPPA 2015 treatment recommendations according to the presence of comorbidities. Materials and methods: adult patients with PsA (CASPAR criteria) from the RAPSODIA cohort were included. Sociodemographic and clinical characteristics, disease activity and current treatment were recorded. Comorbidities were assessed by the RDCI. Variables associated with RDCI≥1 were studied by multivariate analysis. Adherence to treatment recommendations in relation to the reported comorbidities was analyzed according to the 2015 GRAPPA guidelines. Results: a total of 170 patients were included. Patients with RDCI ≥1 were reported by 67.6%. These patients were older (57±13 years vs 48±13 years, p<0.0001), had a higher frequency of overweight or obesity (84.3% vs 67.3%, p=0.011), and had a poorer quality of life (PsAQoL 7.6±6.6 vs 5.2±6, p=0.025). The multivariate analysis showed an association between age and the use of NSAIDs with RDCI≥1. Contrary to GRAPPA recommendations, 70% of patients with heart disease were using NSAIDs. Moreover, about half of those with hepatic or kidney disease took NSAIDs or methotrexate. Conclusions: most patients with PsA presented at least one comorbidity. GRAPPA recommendations were not followed in a considerable number of patients.

Adherencia al tratamiento con tofacitinib en pacientes con artritis reumatoide en la práctica clínica diaria / Adherence to Treatment with Tofacitinib in Patients with Rheumatoid Arthritis in Daily Clinical Practice

Objetivos: Evaluar la adherencia al tratamiento con tofacitinib en pacientes con artritis reumatoide (AR) mediante las dos versiones del autocuestionario Compliance Questionnaire Rheumatology, CQR19 y CQR5, determinar las variables asociadas a la adherencia a tofacitinib y comparar el rendimiento de ambos cuestionarios. Material y métodos: Estudio de corte transversal. Se incluyeron pacientes ≥18años de edad con AR (ACR/EULAR 2010) en tratamiento con tofacitinib. Se consignaron datos sociodemográficos, características clínicas de la enfermedad, tratamientos y datos sobre la evaluación de los pacientes. Todos los pacientes completaron los autocuestionarios CQR19 y CQR5. Análisis estadístico: Estadística descriptiva. T-test o Mann Whitney para variables continuas y test de chi cuadrado o test exacto de Fisher para las categóricas. Índice de concordancia kappa. Regresión logística múltiple. Resultados: Se incluyeron 52 pacientes, 82,7% mujeres, con una edad mediana (m) de 57,7años, tiempo de evolución de la enfermedad m 16años. El 63,5% presentaban comorbilidades. El 86,5% de los pacientes estaban tratados con tofacitinib (5mg dos veces/día) y el 48% recibía tofacitinib en monoterapia. El tiempo m de tratamiento con tofacitinib fue de 13meses. El 42,3% suspendieron el tratamiento y un solo paciente suspendió definitivamente por falta de provisión. La m de CQR19 fue del 89,5%, y el 84,6% de los pacientes presentaron una adherencia ≥80%. Las variables significativamente asociadas con adherencia ≥80% fueron la presencia de comorbilidades (p=0,014) y mayor edad (p=0,033). Considerando el CQR5, un porcentaje similar de pacientes (82,7%) fueron adherentes al tratamiento, aunque la concordancia con CQR19 fue baja (??: 0,227). En el análisis multivariado, mayor edad fue la única variable independientemente asociada a buena adherencia al tratamiento (p=0,037).(AU)

Objectives: To evaluate the adherence to treatment with tofacitinib in patients with rheumatoid arthritis (RA) using two versions of the self-questionnaire Compliance Questionnaire Rheumatology, CQR19 and CQR5, to determine the variables associated with adherence to tofacitinib and to compare the performance of both questionnaires. Material and methods: A cross-sectional study was carried out. We included patients ≥18years old, with RA (ACR/EULAR criteria 2010) under treatment with tofacitinib. Sociodemographic data, clinical characteristics, treatment and data on patient evaluation. All the patients completed self-questionnaires CQR19 and CQR5. Statistical analysis: Descriptive statistics. T-test or Mann Whitney to compare the continuous variables, chi2 test or Fisher's exact test for the categorical ones. Kappa concordance index. Multiple logistic regression. Results: We included 52 patients, 82.7% women, with a median (m) age of 57.7years, disease duration m 16years, 63.5% had comorbidities. Of the patients, 86.5% were treated with tofacitinib (5mg BID) and 48% received tofacitinib as monotherapy. The median time of tofacitinib treatment was 13months, 42.3% suspended treatment, and only one patient permanently stopped treatment due to lack of provision. Median CQR19 was 89.5%, and 84.6% had an adherence ≥80%. The variables significantly associated with adherence ≥80% were the presence of comorbidities (P=.014) and older age (P=.033). Considering the CQR5, a similar percentage of patients (82.7%) were adherents to treatment, however, the concordance with CQR19 was low. In the multivariate analysis, older age was the only variable independently associated with good adherence to treatment. Conclusions: Treatment adherence to tofacitinib was very good for both presentations. Older age was associated with higher adherence. The agreement between the questionnaires CQR19 and CQR5 was low.(AU)

Adherence to treatment with tofacitinib in patients with rheumatoid arthritis in daily clinical practice.

OBJECTIVES: To evaluate the adherence to treatment with Tofacitinib in patients with Rheumatoid Arthritis (RA) using two versions of the self-questionnaire Compliance Questionnaire Rheumatology, CQR19 and CQR5, to determine the variables associated with adherence to Tofacitinib and to compare the performance of both questionnaires. MATERIAL AND METHODS: A cross-sectional study was carried out. We included patients ≥18 years old, with RA (ACR/EULAR criteria 2010) under treatment with Tofacitinib. Sociodemographic data, clinical characteristics, treatment and data on patient evaluation. All the patients completed self-questionnaires CQR19 and CQR5. STATISTICAL ANALYSIS: Descriptive statistics. t-Test or Mann Whitney to compare the continuous variables, Chi2 test or Fisher's exact test for the categorical ones. Kappa concordance index. Multiple logistic regression. RESULTS: We included 52 patients, 82.7% women, with a median (m) age of 57.7 years, disease duration m 16 years, 63.5% had comorbidities. Of the patients, 86.5% were treated with Tofacitinib (5 mg BID) and 48% received Tofacitinib as monotherapy. The median time of Tofacitinib treatment was 13 months, 42.3% suspended treatment, and only one patient permanently stopped treatment due to lack of provision. Median CQR19 was 89.5% and 84.6% had an adherence ≥ 80%. The variables significantly associated with adherence ≥ 80% were the presence of comorbidities (p = .014) and older age (p = .033). Considering the CQR5, a similar percentage of patients (82.7%) were adherents to treatment, however, the concordance with CQR19 was low. In the multivariate analysis, older age was the only variable independently associated with good adherence to treatment. CONCLUSIONS: Treatment adherence to Tofacitinib was very good for both presentations. Older age was associated with higher adherence. The agreement between the questionnaires CQR19 and CQR5 was low.

Adherence to Treatment with Tofacitinib in Patients with Rheumatoid Arthritis in Daily Clinical Practice. / Adherencia al tratamiento con tofacitinib en pacientes con artritis reumatoide en la práctica clínica diaria.

OBJECTIVES: To evaluate the adherence to treatment with tofacitinib in patients with rheumatoid arthritis (RA) using two versions of the self-questionnaire Compliance Questionnaire Rheumatology, CQR19 and CQR5, to determine the variables associated with adherence to tofacitinib and to compare the performance of both questionnaires. MATERIAL AND METHODS: A cross-sectional study was carried out. We included patients ≥18years old, with RA (ACR/EULAR criteria 2010) under treatment with tofacitinib. Sociodemographic data, clinical characteristics, treatment and data on patient evaluation. All the patients completed self-questionnaires CQR19 and CQR5. STATISTICAL ANALYSIS: Descriptive statistics. T-test or Mann Whitney to compare the continuous variables, chi2 test or Fisher's exact test for the categorical ones. Kappa concordance index. Multiple logistic regression. RESULTS: We included 52 patients, 82.7% women, with a median (m) age of 57.7years, disease duration m 16years, 63.5% had comorbidities. Of the patients, 86.5% were treated with tofacitinib (5mg BID) and 48% received tofacitinib as monotherapy. The median time of tofacitinib treatment was 13months, 42.3% suspended treatment, and only one patient permanently stopped treatment due to lack of provision. Median CQR19 was 89.5%, and 84.6% had an adherence ≥80%. The variables significantly associated with adherence ≥80% were the presence of comorbidities (P=.014) and older age (P=.033). Considering the CQR5, a similar percentage of patients (82.7%) were adherents to treatment, however, the concordance with CQR19 was low. In the multivariate analysis, older age was the only variable independently associated with good adherence to treatment. CONCLUSIONS: Treatment adherence to tofacitinib was very good for both presentations. Older age was associated with higher adherence. The agreement between the questionnaires CQR19 and CQR5 was low.

Depression Is a Major Determinant of Functional Capacity in Rheumatoid Arthritis.

OBJECTIVE: The aim of this study was to determine the prevalence of depression among rheumatoid arthritis (RA) Argentinean patients and its association with sociodemographic and clinical factors. METHODS: We performed a cross-sectional study of consecutive adults with RA. Sociodemographic data, comorbidities, RA disease activity, and current treatment were assessed. The following instruments were used to evaluate quality of life (EQ-5D-3 L [EURO Quality 5-dimension 3 lines], QOL-RA [Quality of Life-Rheumatoid Arthritis]), functional capacity (HAQ-A [Health Assessment Questionnaire-Argentinean version]), and depression (PHQ-9 [Patient Health Questionnaire 9]; scores 5-9: mild, 10-14: moderate, 15-19: moderate-severe, and ≥20: severe depression, a cutoff value ≥10 is diagnostic of major depression). RESULTS: Two hundred fifty-eight patients were included, with a median disease duration of 9 years (interquartile range, 3.6-16.7 years). The m PHQ-9 score was 6 (interquartile range, 2-12.3 years). The prevalence of major depression was 33.8%. The frequency of mild, moderate, moderate/severe, and severe depression was 66 (25.6%), 42 (16.3%), 27 (10.5%), and 18 (7%), respectively. Patients with major depression had worse functional capacity (HAQ-A: mean ± SD, 1.6 ± 0.8 vs. 0.7 ± 0.7; p < 0.0001), poorer quality of life (QOL-RA: mean ± SD, 5.4 ± 1.8 vs. 7.3 ± 1.6; p < 0.0001), greater pain (visual analog scale: mean ± SD, 56.2 ± 27.5 mm vs. 33.4 ± 25.7 mm; p < 0.0001), higher disease activity (Disease Activity Score in 28 joints: mean ± SD, 4.3 ± 1.4 vs. 3.3 ± 1.3; p < 0.0001), higher frequency of comorbidities (67% vs. 33%; p = 0.017), and lower frequency of physical activity (22% vs. 35%; p = 0.032). In the multivariate analysis, patients with moderate and severe depression had worse functional capacity (odds ratio, 2.1; 95% confidence interval, 1.6-4.3; p < 0.0001) and quality of life (odds ratio, 0.7; 95% confidence interval, 0.5-0.8; p < 0.0001), independently of disease activity. CONCLUSIONS: A third of RA patients in this Argentinean cohort had major depression. In those patients, depression was associated with worst functional capacity and quality of life.

A useful tool to assess quality of LIFE in rheumatoid arthritis patients that does not require a license: QOL-RA II.

To validate the Quality of Life-Rheumatoid Arthritis Scale II (QOL-RA II) in an Argentinean cohort of patients with rheumatoid arthritis (RA). Patients ≥ 18 years old, with a diagnosis of RA according to ACR-EULAR 2010 criteria, were included in a cross-sectional study. Sociodemographic data, comorbidities, RA characteristics, disease activity, and current treatment were registered. Questionnaires were administered, including EQ-5D-3 L, QOL-RA II, HAQ-A, and PHQ-9. The QOL-RA II was re-administered in 20 patients to evaluate reproducibility. Four hundred and thirty patients were included. Median QOL-RA was 6.6 (IQR 5.3-8). Mean time to complete it was 1.7 ± 0.57 min and to calculate it was 12 ± 1.7 s. It showed very good reliability (Cronbach's alpha 0.97), reproducibility (ICC, 0.96), and good correlation between the different items and the total questionnaire, without evidence of redundancy. Besides, QOL-RA II presented good correlation with EQ-5D-3L (Rho, 0.6) and moderate with DAS28 (Rho, 0.38), and CDAI (Rho, 0.46). Worse quality of life was observed in patients not doing physical activity, unemployed, and current smokers. Patients with higher disease activity had a significant poorer quality of life. Adjusting by age, sex and disease duration, unemployment, higher disease activity, disability, and the presence of depression were independently associated to worse quality of life. QOL-RA II demonstrated good construct validity, reproducibility, and reliability. It was easy to complete and calculate and does not require a license for its use, thus making it the optimal tool for assessing the quality of life in Spanish-speaking patients with RA. Key Points • The evaluation of quality of life is very important in patients with Rheumatoid Arthritis. • Most of the questionnaires used to assess the quality of life require a license to use. • QOL-RA II is a valid and simple questionnaire to evaluate the quality of life of patients with RA and does not require a license for its use.

La depresión es un determinante mayor de la capacidad funcional en pacientes con artritis reumatoidea, independientemente de la actividad de la enfermedad / Depression is a major driver of functional capacity in patients with rheumatoid arthritis regardless of disease activity

La depresión es una de las comorbilidades más frecuentemente reportadas en pacientes con Artritis Reumatoidea (AR). Su presencia se asocia a mayores costos de salud, mayor mortalidad y reduce las probabilidades de alcanzar una buena respuesta al tratamiento. Objetivo: Evaluar la prevalencia de depresión en pacientes argentinos con AR y establecer su relación con diferentes factores sociodemográficos y clínicos. Material y métodos: Se incluyeron pacientes ≥18 años de edad, con diagnóstico de AR según criterios ACR-EULAR 2010. Se consignaron datos sociodemográficos, comorbilidades, características clínicas, actividad de la enfermedad y tratamiento actual. Se administraron los cuestionarios EQ-5D-3L, QOL-RA, HAQ-A y PHQ-9. Los valores de PHQ-9 de 5-9, 10-14, 15-19 y ≥20 determinan la presencia de depresión leve, moderada, moderada/severa y severa, respectivamente y un valor de corte ≥10, depresión mayor. Análisis estadístico: Test T de Student, ANOVA y Chi². Regresión lineal múltiple. Resultados: Se incluyeron 258 pacientes, con un tiempo mediano (m) de evolución de la enfermedad de 9 años (RIC 3,6-16,7). La m de depresión valorada por PHQ-9 de 6 (RIC 2-12,5). La prevalencia de depresión mayor fue de 33,8%. Sesenta y seis (25,6%), 42 (16,3%), 27 (10,5%) y 18 (7%) pacientes presentaron depresión leve, moderada, moderada/severa y severa, respectivamente. Los pacientes con depresión mayor mostraron menor capacidad funcional (HAQ-A X1,6±0,8 vs X0,7±0,7, p <0,0001), peor calidad de vida (QOL-RA X5,4±1,8 vs X7,3±1,6, p <0,0001), más dolor (EVN X56,2±27,5 mm vs X33,4±25,7 mm, p <0,0001), mayor actividad de la enfermedad (DAS28-ERS X4,3±1,4 vs X3,3±1,3, p <0,0001), mayor frecuencia de desempleo (71% vs 29%, p=0,015 ) y de comorbilidades (67% vs 33%, p=0,017) y menor frecuencia de actividad física (22% vs 35%, p=0,032). En el análisis multivariado, peor capacidad funcional (OR: 2,1, IC 95%: 1,6-4,3, p <0,0001) y calidad de vida (OR: 0,7, IC 95%: 0,5-0,8, p <0,0001) se asociaron independientemente a la presencia de depresión mayor. Conclusiones: La prevalencia de depresión mayor medida por PHQ-9 en esta cohorte argentina de pacientes con AR fue de 33,8%. La presencia de depresión tiene un impacto negativo sobre la capacidad funcional y la calidad de vida de estos pacientes, independientemente de la actividad de la enfermedad.

Depression is one of the most frequent comorbidity in patients with Rheumatoid Arthritis (RA). It's presence is associated with higher healthcare costs, mortality rate and reduced odds of achieving a good treatment response. Objective: To determine the prevalence of depression in Argentinean patients with RA and to establish its relationship with different sociodemographic and clinical factors. Material and methods: Consecutive patients ≥18 years old, with a diagnosis of RA according to ACR-EULAR 2010 criteria were included. Sociodemographic data, comorbidities, RA characteristics, disease activity and current treatment were registered. Questionnaires were administered: EQ-5D-3L, QOL-RA, HAQ-A and PHQ-9. PHQ-9 scores of 5-9, 10-14, 15-19, ≥20 represent mild, moderate, moderate/severe and severe depression, respectively and a cut-off value ≥10, major depression. Statistical analysis: Student's T, ANOVA and Chi² tests. Multiple logistic regression. Results: 258 patients were included, with a median (m) disease duration of 9 years (IQR 3.6-16.7). The m PHQ-9 score was 6 (IQR 2-12.3). The prevalence of major depression was 33.8%. 66 (25.6%), 42 (16.3%), 27 (10.5%) and 18 (7%) patients presented mild, moderate, moderate/severe and severe depression, respectively. Patients with mayor depression had worse functional capacity (HAQ-A X 1.6±0.8 vs X 0.7±0.7, p <0.0001), poorer quality of life (QOL-RA X 5.4±1.8 vs X 7.3±1.6, p <0.0001), greater pain (NVS X 56.2±27.5 mm vs X 33.4±25.7 mm, p <0.0001), higher disease activity (DAS28-ESR X 4.3±1.4 vs X 3.3±1.3, p <0.0001), higher frequency of unemployment (71% vs 29%, p=0.015 ) and comorbidities (67% vs 33%, p=0.017) and lower frequency of physical activity (22% vs 35%, p=0.032). In the multivariate analysis, patients with moderate and severe depression had worse functional capacity (OR: 2.1, 95% CI: 1.6-4.3, p <0.0001) and quality of life (OR: 0.7, 95% CI: 0.5-0.8, p <0.0001), independently of disease activity. Conclusion: The prevalence of mayor depression in this Argentinean cohort of patients with RA was 33.8%. The presence of depression had a negative impact on functional capacity and quality of life regardless of disease activity.

Una nueva herramienta para valorar la calidad de vida de pacientes con artritis reumatoidea que no requiere licencia: el cuestionario QOL-RA II (Quality of Life-Rheumatoid Arthritis Scale-II) / A new tool to assess quality of life in patients with rheumatoid arthritis that does not require a license: QOL-RA II (Quality of Life-Rheumatoid Arthritis Scale-II)

Recientemente, validamos el cuestionario Quality of Life-Rheumatoid Arthritis Scale (QOL-RA) y detectamos la presencia de algunas limitaciones. Por esta razón, con la autorización de la autora, cambiamos dos preguntas y desarrollamos una nueva versión en español: el QOL-RA II. Objetivo: Validar el QOL-RA II en una cohorte argentina de pacientes con Artritis Reumatoidea (AR). Material y métodos: Estudio de corte transversal. Se incluyeron pacientes ≥18 años de edad, con diagnóstico de AR según criterios ACR-EULAR 2010. Se consignaron datos sociodemográficos, comorbilidades, características clínicas y actividad de la enfermedad. Se administraron los cuestionarios EQ-5D-3L, QOL-RA II, HAQ-A y PHQ-9. A 20 pacientes se les re-administró el cuestionario a los 7 días de haber completado el primero para evaluar reproducibilidad. Análisis estadístico: Test T de Student, ANOVA, Chi². Correlación de Spearman. Alpha de Cronbach. Coeficiente de correlación intraclase. Regresión Logística Multinomial con modelo factorial completo. Regresión lineal múltiple. Resultados: Se incluyeron 430 pacientes, con un tiempo mediano (m) de evolución de 9 años (RIC: 4-16). La m del QOL-RA II fue 6,7 (RIC: 5,3-8). El tiempo promedio para completarlo fue de 1,7±0,57 minutos y para su cálculo de 12±1,7 segundos. Solo 9 (2,1%) pacientes no contestaron alguna pregunta. El cuestionario presentó excelente confiabilidad (α de Cronbach 0,97), reproducibilidad (CCI: 0,96) y buena correlación entre los diferentes ítems y el cuestionario total, sin evidencia de redundancia. QOL-RA II presentó además, buena correlación con EQ-5D-3L (Rho: 0,6), HAQ-A (Rho: 0,55) y PHQ-9 (Rho: 0,56) y moderada con los índices de actividad de la enfermedad DAS28-ERS (Rho: 0,38) y CDAI (Rho: 0,46). Se evidenció peor calidad de vida en aquellos pacientes que no realizaban actividad física (X 6,4±1,9 vs. 7±1,8, p <0,0001), en los desocupados (X 6,1±1,9 vs. 7±1,8, p <0,0001) y en los tabaquistas (X 6,2±1,7 vs. 6,7±1,9, p=0,03). Se observó una tendencia significativa a empeorar la calidad de vida a mayor actividad de la enfermedad. Ajustando por edad, sexo y tiempo de evolución de la enfermedad, las variables que se asociaron significativamente a peor calidad de vida fueron la desocupación, la mayor actividad de la enfermedad, la discapacidad funcional y la presencia de depresión. Conclusión: El QOL-RA II demostró buena validez de constructo, reproducibilidad. Fue fácil de completar y calcular. No se observó redundancia entre las preguntas ni influencia por la edad ni el tiempo de evolución de la enfermedad.

We have recently validated the Quality of Life-Rheumatoid Arthritis Scale (QOL-RA). We have found some limitations, that is why, with the author's permission, we have changed two questions and developed a new Spanish version, QOL-RA II. Objective: To validate the QOL-RA II in an Argentinean cohort of patients with Rheumatoid Arthritis (RA). Material and methods: Cross-sectional study. Patients ≥18 years old, with a diagnosis of RA according to ACR-EULAR 2010 criteria were included. Sociodemographic data, comorbidities, RA characteristics, disease activity current treatment were registered. Questionnaires were administered: EQ-5D-3L, QOL-RA, HAQ-A and PHQ-9. The QOL-RA II was re-administered in 20 patients to evaluate reproducibility. Statistical analysis: Student's T, ANOVA and Chi² tests. Spearman correlation. Cronbach's alpha. Reproducibility using ICC. Multinomial logistic regression with completed factorial model. Multiple linear regression. Results: 430 patients were included, with a median (m) disease duration of 8.9 years (IQR: 4-16). QOL-RA was m 6.6 (IQR: 5.3-8). Mean time to complete it was 1.7±0.57 minutes and to calculate it 12±17 seconds. Only 2.1% of the questionnaires presented missing answers. It showed very good reliability (Cronbach's alpha 0.97), reproducibility (ICC: 0.96) and good correlation between the different items and the total questionnaire, without evidence of redundancy. Besides, QOL-RA II presented good correlation with EQ-5D-3L (Rho: 0.6), HAQ-A (Rho: 0.55) and PHQ-9 (Rho: 0.56) and moderate with DAS28-ESR (Rho: 0.38) and CDAI (Rho: 0.46). Worse quality of life was observed in patients not doing physical activity (X 6.4±1.9 vs. 7±1.8, p <0.0001), unemployed (X 6.1±1.9 vs. 7±1.8, p <0.0001) and current smokers (X 6.2±1.7 vs. 6.7±1.9, p=0.03). Patients with higher disease activity had a significant poorer quality of life. Adjusting by age, sex and disease duration, unemployment, higher disease activity, disability and the presence of depression were independently associated to worse quality of life. Conclusions: QOL-RA II demonstrated good construct validity, reproducibility and reliability. It was easy to complete and calculate. There were no redundancy between questions and it was not influenced by age and disease duration.

Tuberculin test conversion in patients with chronic inflammatory arthritis receiving biological therapy.

OBJECTIVE: The blockade of inflammatory mediators produced by biological therapies is associated with an increased risk of opportunistic infections, as for example Mycobacterium tuberculosis (MT). Given the endemic situation of tuberculosis (TB) in some countries and immunosuppression/anergy of patients with chronic inflammatory arthritis, we wonder whether it is necessary to monitor the MT infection after starting the biological treatment. To evaluate the frequency of the tuberculin skin test (TST) conversion and its association with an active TB infection and other disease variables. METHODS: Patients with rheumatoid arthritis (RA), juvenile idiopathic arthritis (JIA), and spondyloarthritis (SpA) receiving treatment with anti-TNF, tocilizumab, and/or abatacept agents were included into the study. Patients had to have a negative TST (<5 mm) at the baseline, and a second TST was performed 2-22 months after the initiation of biologic therapy. The TST conversion was considered as a variation ≥5 mm between the two TSTs performed within an interval between 2 months and 2 years. RESULTS: A total of 85 patients were included into the study, and 78.8% were women, with a median schooling duration of 12 years. A total of 74.1% of patients had RA, 16.5% psoriatic arthritis, and 4.7% AIJ and ankylosing spondylitis. Regarding treatment, 75.3% received anti-TNF therapy (31.8% etanercept, 21.2% adalimumab, 17.6% infliximab, 3.5% golimumab, and 1.2% certolizumab), 15.3% tocilizumab, and 9.4% abatacept. Eight patients (9.4%) developed a TST conversion. The shift was more frequent in men (62.5%) than in women (37.5%) (p=0.009), and in those with a prolonged disease duration (X 226±109 vs X130±105 [p=0.017]). This association remained after adjusting for other variables. All patients who developed a TST conversion received prophylactic isoniazid, and only one patient with other risk factors developed active TB. CONCLUSION: The frequency of a TST conversion in patients with chronic inflammatory arthritis was low and was associated with male gender and longer disease duration.

Validation and cultural adaptation of the qualisex questionnaire in patients with axial spondyloarthritis in Argentina.

The Qualisex questionnaire was developed and validated to assess sexuality in patients with rheumatoid arthritis. To the best of our knowledge, there is no instrument to evaluate sexuality in axial spondyloarthritis (axSpA). For this reason, the objective of this study was to validate and adapt the Qualisex questionnaire in axSpA and evaluate the impact of the disease on patients' sexuality. Cross sectional study. Consecutive patients, with ≥ 21 years of age, diagnosed with axSpA according to ASAS'09 criteria were included. Sexual health was assessed using the Qualisex questionnaire. The original version was translated to Spanish and adapted to axSpA. Internal consistency, and test re-test reliability was calculated. Criterion and construct validity were assessed by comparing the Qualisex with parameters of disease activity functional capacity and quality of life. 61 patients were invited to participate in the study, 11 of whom refused. 50 patients were included; 40 (80%) were males, with a median age of 47 years (IQR 21-72) and a median disease duration of 13 years (IQR 1-46). Reproducibility was excellent with an ICC of 0.99 (95% CI 0.65-1). The Qualisex had a good correlation with different disease evaluation parameters. The Qualisex was significantly higher among women (5.4 in women vs. 2.5 in men, p = 0.02), unemployed (4.7 in unemployed vs. 2.3 in employed, p = 0.01), in patients with higher disease activity (4.2 in active patients vs. 1.6 in inactive patients, p = 0.01), and it was lower in patients receiving biologic therapy (BT) (1.9 with BT vs. 3.8 without BT, p = 0.01). Multivariable analysis showed that female sex, longer disease duration and higher disease activity were independently associated with a greater impact on sexuality. The Qualisex adapted to axSpA is a valid and reliable questionnaire. Female axSpA patients, those with longer disease duration and higher disease activity presented a worse sexual life.

Validación del índice QOL-RA (Quality of Life-RheumatoidArthritis) en una cohorte argentina de pacientes con artritis reumatoidea / Validation of the Quality of Life-Rheumatoid Arthritis Scale (QOL-RA) in argentinean cohort of patients with rheumatoid arthritis

El autocuestionario QOL-RA es una herramienta diseñada para valorar la calidad de vida de los pacientes con Artritis Reumatoidea (AR). No requiere licencia para su uso. Objetivo: Validar el cuestionario QOL-RA en una cohorte de pacientes con AR en Argentina. Material y métodos: Estudio de corte transversal. Se incluyeron pacientes ≥18 años de edad con diagnóstico de AR según criterios ACR-EuLAR 2010. Se consignaron datos sociodemográficos, comorbilidades, características de la enfermedad. Se completaron los cuestionarios QOL-RA, EQ 5D-3L, HAQ-A, PHQ-9. Se midió el tiempo para completar y calcular el QOL-RA. Análisis estadístico: Estadística descriptiva. Test T de Student, ANOvA, Chi2. Correlación de Spearman. Alpha de Cronbach. Coeficiente de correlación intraclase. Regresión Logística multinomial con modelo factorial completo. Regresión Lineal múltiple. Resultados: Se incluyeron 258 pacientes, 85,7% eran mujeres, con una edad mediana de 54 años (RIC 45-62). La mediana del QOL-RA fue 6,75 (RIC 5,4-8,1), presentando buena correlación con EQ 5D-3L (Rho: 0,63), HAQ-A (Rho: -0,56), PHQ9 (Rho: -0,54), SDAI (Rho: -0,45) y DAS28-ERS (Rho: -0,44). Peor calidad de vida se asoció con la presencia de comorbilidades (x6,4 ± 2 vs 7 ± 1,7, p=0,01) y no realizar actividad física (x6,7 ± 1,9 vs 7,1 ± 1,7, p=0,004). El tiempo para completar el cuestionario fue de x1,7 ± 0,42 minutos y para calcularlo de x12± 2,1 segundos. La confiabilidad y la reproducibilidad fueron buenas. Sin embargo, 4,3% de los cuestionarios presentaban alguna pregunta faltante y se observó redundancia entre las preguntas 3 y 6. En el análisis de regresión lineal múltiple usando QOL-RA como variable dependiente y ajustando para edad y tiempo de evolución, las variables que se asociaron independientemente a peor calidad de vida fueron: la discapacidad funcional, la actividad de la enfermedad y la presencia de depresión y comorbilidades. Conclusión: El cuestionario QOL-RA demostró buena validez de constructo, reproducibilidad y confiabilidad. Es fácil de completar y calcular. Sin embargo, dada la redundancia entre dos preguntas proyectamos cambiar una de ellas y re-testearlo

Mortality in patients with ankylosing spondylitis in Argentina.

Some reports describe an increased mortality in patients with ankylosing spondylitis (AS) compared to the general population. The aims of this study were to evaluate the cumulative survival in patients with AS and to establish possible factors associated with mortality. In cross-sectional retrospective study, AS patients were included according to 1984 modified NY criteria, in the 2000-2010 period, the prevalence of mortality was determined by review of medical records, telephone contact, family reports, and death certificates, and it was compared with mortality in Argentina's general population. One hundred twenty-seven patients were studied, 96 (75.6 %) were male, median age 49 years (interquartile range (IQR) 34-60) and median disease duration 8 years (IQR 4-17). During the follow-up period, 9 patients died (7.1 %). The median estimated survival from diagnosis of AS was 39 years (IQR 34-50) and median cumulative survival was 76 years (IQR 74-85). Cardiovascular disease was the most frequent cause of death (5/9 patients). Deceased patients had a mean age and a mean AS disease duration significantly higher than living patients (68.1 ± 12.4 years vs 46.4 ± 15.09 years, p = 0.0001 and 33 ± 13.7 years vs 12 ± 10.7 years, p = 0.001, respectively), higher frequency of total surgeries [3/5 (60 %) vs 5/105 (4.76 %), p = 0.002] and cauda equina syndrome [3/6 (50 %) vs 2/116 (1.72 %), p = 0.001], respectively. Frequency of mortality in AS patients was higher than the crude mortality rate of Argentina's general population in the same period, with cardiovascular cause being the most frequent one.

Viraje tuberculínico en pacientes con artritis inflamatorias crónicas y terapia biológica / Tuberculin test conversión in patients with chronic inflammatory arthritis and biological therapy

Introducción: El bloqueo de los mediadores inflamatorios producido por las terapias biológicas se asocia a un aumento de las infecciones oportunistas, como infección por Mycobacterium tuberculosis (MT), por lo que se recomienda realizar intradermorreacción de derivado proteico purificado (PPD) antes de iniciar dicho tratamiento. Teniendo en cuenta la situación endémica de tuberculosis (TBC) en nuestro país y la inmunosupresión/anergia de los pacientes con artritis inflamatorias crónicas, nos planteamos si es necesario monitorear la infección de MT luego de iniciado el tratamiento biológico. Objetivos: Evaluar la frecuencia de viraje de PPD y la asociación del viraje con infección activa por MT u otras variables. Materiales y métodos: Se incluyeron pacientes con Artritis Reumatoidea (AR), Artritis Idiopática Juvenil (AIJ) y Espondiloartritis (EsP) en tratamiento con agentes Anti-TNFα, Tocilizumab y/o Abatacept. Los pacientes debían tener una PPD negativa (<5 mm) basal y una segunda PPD realizada entre los 2 y 22 meses posteriores. Se consignaron datos sociodemográficos (edad, género, estatus social, hacinamiento), antecedentes patológicos (desnutrición, alcoholismo, tuberculosis y sus contactos), tipo de enfermedad reumática y tiempo de evolución, índices de actividad (RAPID-3, BASDAI), de función (BASFI, HAQ-II) y tratamiento concomitante con corticoides (CT), drogas modificadoras de la enfermedad (DME) y terapia biológica (TB). Se consideró viraje de PPD a una variación ≥ a 5 mm entre dos pruebas realizadas con intervalo entre 2 meses y 2 años. En caso de viraje se recomendó seguimiento por Neumonología e Infectología. Análisis estadístico: las variables categóricas se compararon por Chi2 y test exacto de Fisher y las continuas por T-test o Mann-Whitney. Regresión logística múltiple. Resultados: Se incluyeron 85 pacientes, 78,8% eran mujeres, con una escolaridad mediana de 12 años. El 98,8% tenía residencia urbana, 12,9% tenía criterios de hacinamiento y 8,2% ingresos inferiores a la línea de pobreza. 5,9% de los pacientes había padecido TBC con cumplimiento de tratamiento completo y 2,4% reportó contactos con TBC. En cuanto al tipo de artropatía inflamatoria crónica, el 74,1% de los pacientes tenían AR, el 16,5% Artritis Psoriásica (APs) y 4,7% tanto AIJ como Espondilitis Anquilosante. Con respecto al tratamiento, 18,8% recibía más de 10 mg diarios de esteroides orales, el 91,8% DME, (84,7% Metotrexato y 21,2% Leflunomida). El 75,3% recibía terapia Anti-TNFα (31,8% Etanercept, 21,2% Adalimumab, 17,6% Infliximab, 3,5% Golimumab y 1,2% Certolizumab), el 15,3% Tocilizumab y el 9,4% Abatacept. De los 85 pacientes, 8 viraron (9,4%). El viraje fue más frecuente en varones 62,5% vs mujeres 37,5% (p=0,009) y en aquellos con mayor tiempo de evolución de enfermedad en meses [X226±109 vs X130±105 (p=0,017)]. Esta asociación se mantuvo luego de ajustar para otras variables. Todos los pacientes que presentaron viraje recibieron isoniacida (INH) profiláctica y sólo un paciente, con factores de riesgo, desarrolló tuberculosis activa. Conclusión: La frecuencia del viraje tuberculínico en pacientes con artritis inflamatorias crónicas fue baja y se asoció a sexo masculino y mayor tiempo de evolución de la enfermedad

Validación del cuestionario RAPID3 en la cohorte argentina ESPAXIA de pacientes con espondiloartritis axial / Validation of RAPID3 questionnaire in ESPAXIA Argentina cohort of patients with axial spondyloarthritis

Introducción: El RAPID3 (Routine Assessment of Patient Index Data 3) es un cuestionario sencillo, rápido y de cálculo simple que mostró un buen rendimiento en Artritis Reumatoidea, siendo capaz de reflejar el estado de enfermedad y la calidad de vida en estos pacientes. Objetivo: Validar el cuestionario RAPID3 en una cohorte de pacientes con EsP axial y evaluar su asociación con otras medidas de evaluación de la enfermedad. Materiales y métodos: Se incluyeron pacientes consecutivos ≥18 años de edad con diagnóstico de EsP axial (según criterios NY modificados 1987 y/o ASAS 2009). Todos los pacientes completaron los cuestionarios RAPID3, ASQoL, BASDAI y BASFI. La evaluación global de la enfermedad, tanto por el paciente como por el médico, se determinó mediante escala visual análoga (EVA). Se realizó examen físico con recuento articular (44) y evaluación de entesis (MASES). Se obtuvieron muestras de sangre para determinación de HLA-B27 y ERS. Se calculó ASDAS-ERS y SASDAS-ERS. Evaluación radiológica por BASRI por un evaluador ciego al estado clínico de los pacientes (CCI=>0,92). Se utilizó la versión traducida y validada en Argentina del RAPID3, el cual consiste en 10 preguntas acerca de capacidad funcional y 2 preguntas acerca de dolor y evaluación global de la enfermedad, con sus puntos de corte preestablecidos. Se determinó el tiempo para completar el cuestionario por parte del paciente y el tiempo para calcularlo por parte del médico. Resultados: Se incluyeron 51 pacientes, 39 de sexo masculino (76,5%), con una edad mediana 42 años (RIC 33-51) y tiempo mediano de evolución de la enfermedad de 20 años (RIC 10,3-27,6). El 90,5% presentaba HLA-B27. La mediana del RAPID3 fue 9 (RIC 3-12,8), BASDAI 3,35 (RIC 1,6-6), BASFI 3,4 (RIC 1,1-5,6), ASQoL 5 (RIC 1-9), SASDAS-ERS 15,9 (RIC 8-22,6), MASES 1 (RIC 0-3) y BASRI 4,5 (RIC 0-11). El cuestionario tuvo excelente reproducibilidad (CCI=0,97). El tiempo mediano para completar el RAPID3 fue de 2 minutos (RIC 0,91-3), y para calcularlo de 10 segundos (RIC 6-15). Se observó muy buena correlación del RAPID3 con SASDAS ERS (r:0,87), BASDAI (r:0,89), BASFI (r:0,8) y ASQoL (r:0,83) y buena con el MASES (r:0,58). Al evaluar los puntos de corte preestablecidos del RAPID3 y el SASDAS ERS, observamos buena concordancia entre los mismos (Kappa:0,5, p=0,0001). También encontramos muy buena asociación de los puntos de corte del RAPID3 y el BASDAI (p=0,0001). En la regresión lineal múltiple, utilizando como variable dependiente el puntaje total RAPID-3, ajustando por edad, sexo y tiempo de evolución de la enfermedad, se observó una asociación significativa con BASDAI (coef β: 0,55, p=0,0001), BASFI (coef β0,25, p=0,008), ASQoL (coef β: 0,22, p=0,02), como también con SASDAS ERS (coef β: 0,42, p=0,001). Conclusión: El RAPID3 es un cuestionario válido, confiable y reproducible para ser utilizado en EsP axial, simple para completar y calcular. Y además, tiene la ventaja de reflejar el estado de tres aspectos importantes de la enfermedad: actividad, capacidad funcional y calidad de vida.

Introduction: RAPID3 (Routine Assessment of Patient Index Data 3) is a simple, quick and simple calculation questionnaire that showed good performance in patients with rheumatoid arthritis, being able to reflect the state of disease and quality of life in these patients. Objective: To validate the RAPID3 questionnaire in a cohort of patients with axial spondyloarthritis (axSpa) and assess its association with other measures of the disease. Materials and methods: We included consecutive patients ≥18 years of age diagnosed with axSpa (according to modified NY criteria 1987 and/or ASAS 2009). All patients completed the RAPID3, ASQoL, BASDAI and BASFI questionnaires. The overall assessment of the disease both by the patient and the doctor was determined by visual analog scale (VAS). Physical examination was performed with joint count (44) and evaluation of enthesis (MASES). Blood samples for determination of HLA-B27 and ERS were obtained. ASDAS-ERS and SASDAS-ERS were calculated. X-rays were evaluated by BASRI by a blinded reader (CCI=>0.92). The translated and validated in Argentina RAPID3 version was calculated. Time to complete the questionnaire by the patient and time to calculate by the doctor were determined. Results: 51 patients were included, 39 were male (76.5%), median age 42 years (IQR 33-51) and median disease duration of 20 years (IQR 10.3-27.6). 90.5% had HLA-B27. Median RAPID3 was 9 (IQR 3-12.8), BASDAI 3.35 (IQR 1.6-6), BASFI 3.4 (IQR 1.1-5.6), ASQoL 5 (IQR 1-9), SASDAS-ESR 15.9 (IQR 8-22.6), MASES 1 (IQR 0-3) and BASRI 4.5 (IQR 0-11). The questionnaire had excellent reproducibility (ICC = 0.97). The median time to complete the RAPID3 was 2 minutes (IQR 0.91 to 3), and to calculate 10 seconds (IQR 6-15). RAPID3 had very good correlation with SASDAS ESR (r:0.87), BASDAI (r:0.89), BASFI (r=0.8) and ASQoL (r=0.83) and good with MASES (r:0.58). In multiple linear regression, using total RAPID score as dependent variable and adjusting for age, sex and disease duration, a significant association was observed with BASFI (β coeff 0.25, p=0.008), ASQoL (β coeff: 0.22, p=0.02), and mainly with SASDAS ERS (β coeff: 0.42, p=0.001) and BASDAI (0.55, p=0.0001). Conclusion: RAPID3 is a valid, reliable and reproducible questionnaire to be used in axSpa. It is simple to complete by the patient and to evaluate by the rheumatologist.

Clinical and immunogenetic characterization in psoriatic arthritis patients.

In psoriatic arthritis (PsA), genetic factors play a substantial role in disease susceptibility as well as in its expression. This study aims to determine the distribution of class I and class II HLA antigens in PsA patients and secondly to analyze the influence of genetic factors in the clinical expression of the disease. Consecutive PsA patients (CASPAR criteria) with less than 1 year of disease duration were included. Sociodemographic and clinical data were recorded. Blood samples were obtained, DNA was extracted by polymerase chain reaction (PCR), and class I (A, B, and C) and class II (DR) HLA antigens were determined by oligotyping. A control group of 100 nonrelated healthy controls from the general population served as control. p values were corrected (pc) according to the number of alleles tested. A total of 73 patients were included, 37 were females (50.7 %) with a median disease duration of 72 months (interquartile range (IQR) 24-149). Thirty-three patients (45.2 %) had a family history of psoriasis. When analyzing all the class I and class II HLA antigens, a significantly higher frequency of B38 (odds ratio (OR) 2.95, p = 0.03) and Cw6 (OR 2.78, p = 0.009) was found in PsA patients compared to the control group. On the contrary, the HLA-A11 (OR 0.14, p = 0.04) and B7 (OR 0.31, p = 0.03) were significantly more frequent among healthy controls. Furthermore, B18 was significantly more frequent in patients with early arthritis onset (less than 40 years): seven patients (22.6 %) with early onset compared to two patients (4.8 %) with late onset (p = 0.03). No association between HLA-B27 and spondylitis or HLA-DR4 with polyarticular involvement was observed. The HLA-B38 and Cw6 alleles are associated with a greater PsA susceptibility in Argentine population.

Fatigue assessment and its impact in the quality of life of patients with ankylosing spondylitis.

The most frequently reported symptoms by patients with ankylosing spondylitis (AS) are pain, stiffness, and fatigue. Previous studies have estimated a 63% prevalence of fatigue in AS, with a low correlation of fatigue with pain and functional capacity. The objective of this study is to assess fatigue prevalence in AS patients and establish the main associated factors. A case-control study including AS patients according to New York modified criteria was carried out. The control group included individuals of the general population without rheumatic conditions, matched by gender, age, and socioeconomic level. Disease-related variables were recorded. Functional capacity, disease activity, and quality of life were assessed using Bath Ankylosing Spondylitis Funcional Index (BASFI), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and ankylosing spondylitis quality of life (ASQoL). CES-D questionnaire was used to evaluate depression and fatigue severity scale (FSS) to evaluate fatigue. Sixty-four consecutive AS patients and 95 controls were included. Patients' median age was 44 years (interquartile range (IQR), 33.25-53), 89.1% were male, and had a median disease duration of 17 years (IQR, 10.3-25). Fatigue prevalence in AS was 73.4% compared to 30.5% in the control group (p < 0.001; OR, 2.08 (95% CI, 1.53-2.83)). Furthermore, fatigue in AS correlated with ASQoL (r = 0.65), BASFI (r = 0.52), BASDAI (r = 0.52), and depression (r = 0.51), whereas no correlation with age or disease duration was found. In the linear regression analysis using fatigue as the dependent variable, depression was the only associated variable (p = 0.01). No association with age, gender, disease duration, BASDAI, BASFI, or presence of comorbidities was found. Finally, BASDAI fatigue question correlated with the FSS (r = 0.55). Fatigue was significantly more prevalent in AS than in healthy controls. The main determinant factor of fatigue was the presence of depression, explaining 30% of its variability. Recognizing these factors could have important therapeutic implications.

Frecuencia de mortalidad en pacientes con artritis reumatoidea en un centro de reumatología de Argentina / Mortality rate in patients with rheumatoid arthritis in a rheumatology center of Argentina

La Artritis Reumatoidea (AR) es una enfermedad inflamatoria crónica que se asocia a disminución de la capacidad funcional, de la calidad de vida y aumento de la mortalidad. El objetivo de este estudio fue evaluar la mortalidad en una cohorte de pacientes con AR, y la influencia de factores sociodemográficos, clínicos y de laboratorio. Pacientes y métodos: Se analizó una cohorte de pacientes con diagnóstico de AR, (criterios ACR’ 87), evaluados entre los años 2004 y 2010. Se recolectaron datos sociodemográficos, características de la enfermedad, clínicas, analíticas, tratamientos recibidos y comorbilidades. Radiografías de manos y pies fueron leídas por medio del índice de Sharp van der Heijde por 3 observadores independientes ciegos (CCI ≥0,8). En caso de discontinuación del seguimiento, se realizó contacto telefónico. Se identificaron los pacientes fallecidos durante el período estudiado y se determinó la causa de muerte. Análisis estadístico: Estadística descriptiva, para la comparación de datos categóricos se utilizó test de Chi2 o test exacto de Fisher y para las variables continuas test t de Student o Mann Whitney según la distribución de la muestra. Los factores asociados a mortalidad se analizaron por regresión logística múltiple. Se consideró significativa una p <0,05. Resultados: Se evaluaron 307 pacientes, de los cuales 45 perdieron seguimiento y 262 pudieron ser reevaluados a los 5 años de seguimiento. De los 262 pacientes, 86,3% eran de sexo femenino, la edad mediana fue de 58 años (RIC 50-67), la edad mediana al inicio de la AR fue de 40 años (RIC 31-50) con un tiempo mediano de evolución de 15 años (RIC 10-21). 17 pacientes (6,5%) fallecieron. En el análisis univariado, mayor edad, menor escolaridad, presencia de comorbilidades gastrointestinales y uso de tratamiento biológico, estuvieron significativamente asociados con mayor mortalidad...

Rheumatoid arthritis (RA) is a chronic inflammatory disease that isassociated with decreased functional capacity, quality of life andincreased mortality. The aim of this study was to assess mortality ina cohort of patients with RA, and the influence of sociodemographic,clinical and laboratory factors.Patients and methods: A cohort of patients diagnosed withRA was evaluated (ACR' 87 criteria) between 2004 and 2010.Sociodemographic data, disease characteristics, clinical, laboratory,treatment received and comorbidities were collected. Radiographsof hands and feet were read by the Sharp van der HeijdeScore by 3 independent observers (ICC ≥0.8) blinded for diseasecharacteristics. If discontinuation of follow-up was present,telephone contact was made. Deceased patients were identifiedduring the study period and the cause of death was determined.Statistical analysis: Chi2 test or Fisher exact test were used forcategorical variables and Student t test or Mann Whitney forcontinues variables. Factors associated with mortality wereanalyzed by multiple logistic regression. P value <0.05 wasconsidered significative.Results: 307 patients were evaluated, of whom 45 were lost tofollow-up and 262 were reassessed after 5 years of follow-up. Of the262 patients, 86.3% were female, median age was 58 years (IQR 50-67), the median age at onset of RA was 40 years (IQR 31-50) with amedian disease duration of 15 years (IQR 10-21). Seventeen patients(6.5%) died. In univariate analysis, older age, lower education, presenceof gastrointestinal comorbidities and use of biological treatmentwere significantly associated with higher mortality. In multiple logisticregression analysis, worse educational level and use of biologicaltreatment were significantly associated with mortality...

Adherence to treatment in patients with ankylosing spondylitis.

This study aims to determine the level of adherence to treatment in ankylosing spondylitis (AS) patients and to identify possible factors associated to lack of adherence. We included consecutive AS patients (NY modified criteria). Sociodemographic and clinical data were collected. Patients answered auto-reported questionnaires: Bath Ankylosing Spondylitis Disease Activity Index, Bath Ankylosing Spondylitis Functional Index, Ankylosing Spondylitis Quality of Life, and Center for Epidemiological Studies Depression scale. Patients with rheumatoid arthritis (RA) (ACR'87 criteria) were assessed as the control group. The adherence of the studied groups to medical treatment and exercises was measured by means of two questionnaires: Compliance Questionnaire on Rheumatology (CQR) and Exercise Attitude Questionnaire-18 (EAQ-18). The study included 59 patients with AS and 53 patients with RA. Of the AS patients, 43 (72.9%) were male, median age 47 years (interquartile range (IQR) 33-57) and median disease duration of 120 months (IQR 33-57). Of the RA patients, 37 (69.8%) were female, had a median age of 56 years (IQR 43.5-60) and a median disease duration of 156 months (IQR 96-288). There were no significant differences in the results of the adherence questionnaires between both groups, with a total median of 68.42 for the CQR in both groups and of 40.7 in AS vs. 42.6 in RA for the EAQ. When dichotomizing patients as adherent and non-adherent, taking as good adherence a cut value in the CQR and EAQ higher than 60, adherence to pharmacological treatment was significantly higher in RA vs. AS (92.5 vs. 74.6%, p = 0.01) and there were no differences in the EAQ. On the uni- and multivariate analysis, lack of adherence to treatment was not associated to sex, age, disease duration, education, health insurance, depressive status, and disease activity parameters in neither group of patients. AS have an acceptable adherence to pharmacological treatment, although it is lower than RA patients; nonetheless, both groups show a lack of adherence to exercise.