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1.
Rheumatol Int ; 2019 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-31396685

RESUMO

To describe the clinical and therapeutic management of rheumatoid arthritis (RA) patients with biological disease-modifying antirheumatic drugs (bDMARDs), alone or in combination with conventional synthetic DMARDs (csDMARDs), as well as analysing changes over time in bDMARD use. An observational, retrospective, multicentre study was conducted in the rheumatology departments of 10 public Spanish hospitals. Patients with RA treated with bDMARDs at baseline who had medical records available in the data collection period 2013-2016 were included. All visits to rheumatology departments recording any type of bDMARD modification (dose, etc.) were collected. Clinical characteristics, concomitant treatment, resource use, work productivity and quality of life (QoL) were recorded. 128 patients were included: 81 received first-line bDMARD treatment, 28 second-line bDMARD treatment and 19 received third or later lines. Mean study follow-up was 4.1 years. Assessment of DAS28 was available in 54.6% of visits. At baseline, 48.7% of patients had moderate-high disease activity. At final observation, 69.5% of patients continued with the first bDMARD. Tumour necrosis factor blockers were administered to 85.2% of patients in first line, 45.7% in second line and 18.1% in third or later lines. At final observation, 80.2% of patients still felt pain/discomfort. As expected, those with higher disease activity had higher loss of work productivity and lower QoL, as assessed by DAS28, than patients with lower disease activity. Drugs represented 82.6% of the total cost. In this Spanish cohort of 128 patients, most patients remained on the first prescribed bDMARD, despite remaining signs and symptoms.

2.
Reumatol. clín. (Barc.) ; 15(2): 102-108, mar.-abr. 2019. tab, graf
Artigo em Inglês | LILACS-Express | ID: ibc-ET1-3371

RESUMO

Objectives: To describe the prevalence of comorbidities in patients with RA in Spain and discuss their management and implications using data from the Spanish cohort of the multinational study on COMOrbidities in Rheumatoid Arthritis (COMORA). Methods: This is a national sub-analysis of the COMORA study. We studied the demographics and disease characteristics of 200 adults patients diagnosed with RA (1987 ACR), and routine practices for screening and preventing the following selected comorbidities: cardiovascular, infections, cancer, gastrointestinal, pulmonary, osteoporosis and depression. Results: Patients had a mean age of 58 years and a mean RA duration of 10 years. Mean DAS28 score was 3.3 and approximately 25% of patients were in remission (DAS28 <2.6). Forty-four (22%) patients had ≥1 comorbidity, the most frequent being depression (27%) and obesity (26%). A history of myocardial infarction or stroke was observed in 5% and 1% of patients, respectively, and any solid tumor in 6%. Having a Framingham Risk Score >20% (51%), hypercholesterolemia (46%) or hypertension (41%) and smoking (25%) were the most common CV risk factors. For prostate, colon and skin cancers, only 9%, 10% and 18% of patients, respectively, were optimally monitored. Infections were also inadequately managed, with 7% and 17% of patients vaccinated against influenza and pneumococcal, respectively, as was osteoporosis, with 47% of patients supplemented with vitamin D and 56% with a bone densitometry performed. Conclusions: In Spain, the prevalence of comorbidities and CV risk factors in RA patients with established and advanced disease is relatively high, and their management in clinical daily practice remains suboptimal


Objetivos: Describir la prevalencia de comorbilidades en pacientes con AR en España y discutir sobre su manejo en la clínica diaria utilizando los datos de la cohorte española del estudio internacional COMORA. Métodos: Subanálisis nacional del estudio COMORA en el que se analizaron las características demográficas y clínicas de 200 pacientes con AR (1987 ACR) y las prácticas rutinarias para el cribado y la prevención de eventos cardiovasculares (CV), gastrointestinales y pulmonares, infecciones, cáncer, osteoporosis y depresión. Resultados: Los pacientes tenían una edad media de 58 años, una duración media de la enfermedad de 10 años, un DAS28 de 3,3 y el 25% estaba en remisión (DAS28 <2,6). El 22% de los pacientes presentaba al menos una comorbilidad, principalmente depresión (27%) y obesidad (26%). El 5% tenía historia de infarto de miocardio, el 1% de ictus y el 6% de tumor sólido. Una puntuación de Framingham >20% (51%), tener hipercolesterolemia (46%), hipertensión (41%) y fumar (25%) fueron los factores de riesgo CV más comunes. En relación con el cáncer de próstata, colon y piel, solo el 9, 10 y el 18% de los pacientes, respectivamente, estaban óptimamente controlados. Las infecciones tampoco se manejaban de forma óptima, con solo el 7 y el 17% de los pacientes vacunados contra la influenza y neumococo, respectivamente, al igual que la osteoporosis, con el 47% suplementados con la vitamina D y el 56% con una densitometría realizada. Conclusiones: En España, la prevalencia de comorbilidades y factores de riesgo CV en pacientes con AR establecida y avanzada es relativamente alta, y su manejo en la clínica diaria continúa siendo subóptimo

3.
Heliyon ; 3(11): e00452, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29264411

RESUMO

Background: Reducing the dose of biological therapy (BT) when patients with immune-mediated arthritis achieve a sustained therapeutic goal may help to decrease costs for national health services and reduce the risk of serious infection. However, there is little information about whether such a decision can be applied universally. Therefore, the objective of this study was to develop appropriateness criteria for reducing the dose of BT in patients with rheumatoid arthritis (RA), axial spondyloarthritis (axSpA), and peripheral spondyloarthritis (pSpA). Methods: The RAND/UCLA appropriateness method was coordinated by experts in the methodology. Five rheumatologists with clinical research experience in RA and/or SpA selected and precisely defined the variables considered relevant when deciding to reduce the dose of BT in the 3 diseases, in order to define patient profiles. Ten rheumatologists with experience in prescribing BT anonymously rated each profile on a scale of 1 (completely inappropriate) to 9 (completely appropriate) after revising a summary of the evidence obtained from 4 systematic literature reviews carried out specifically for this project. Findings: A total of 2,304 different profiles were obtained for RA, 768 for axSpA, and 3,072 for pSpA. Only 327 (14.2%) patient profiles in RA, 80 (10.4%) in axSpA, and 154 (5%) in pSpA were considered appropriate for reducing the dose of BT. By contrast, 749 (32.5%) patient profiles in RA, 270 (35.3%) in axSpA, and 1,243 (40.5%) in pSpA were considered inappropriate. The remaining profiles were considered uncertain. Interpretation: Appropriateness criteria for reducing the dose of BT were developed in 3 inflammatory conditions. These criteria can help clinicians treating these disorders to optimize the BT dose. However, further research is needed, since more than 50% of the profiles were considered uncertain and the real prevalence of each profile in daily clinical practice remains unknown.

4.
Reumatol. clín. (Barc.) ; 13(6): 313-317, nov.-dic. 2017. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-167204

RESUMO

Introducción. El Sistema Nacional de Salud ofrece en España la atención reumatológica. Más de una cuarta parte del gasto sanitario se realiza en medicina privada. En la actualidad no existen datos sobre el número de reumatólogos con actividad privada en España. Objetivos. Evaluar los reumatólogos con actividad privada en España describiendo su perfil y localización. Material y métodos. Desde la Comisión de Práctica Privada de la SER, se elaboró una encuesta que se envió a todos los socios reumatólogos en activo. La recogida de datos finalizó en diciembre del 2014. Se analizaron los datos mediante estadística descriptiva y se realizó una comparación de los resultados. Resultados. Se obtuvieron 759 respuestas de un total de 980 encuestas enviadas (77,45%). El 38% de los reumatólogos españoles tienen actividad privada; el 13% en exclusiva (privada) y el 25% compartida con su actividad pública (mixta). El perfil del reumatólogo que trabaja en la medicina privada es: género masculino, 49 años de edad con 19 años de experiencia, su jornada laboral es de 42h semanales. Existe un claro predominio de la práctica privada en la CC.AA. de Cataluña (28% del total), seguida por las CC.AA. de Madrid con un 18%, Andalucía con un 12% y Valencia con un 8%. Conclusiones. El 38% de los reumatólogos españoles trabajan en la medicina privada. El perfil profesional en reumatología privada es distinto del que trabaja exclusivamente en la sanidad pública. Existe reumatología privada en todas las CC.AA, aunque la mayoría de reumatólogos privados se localizan en las CC.AA. de Cataluña, Madrid, Valenciana y Andalucía, representando más del 50% del total (AU)


Introduction. Rheumatologic care is offered by the National Health System in Spain. However, more than a quarter of health spending is carried out in private medicine. Currently, there are no data about the number of rheumatologists with private activity in Spain. Objectives. To evaluate the number of rheumatologists with private activity in Spain and to describe the profile and location of these professionals. Material and methods. A survey was developed and sent from the SER Commission on Private Practice to all SER active members. Data collection ends in December 2014. A descriptive statistical analysis and comparison of results was done. Results. 759 answers from a total of 980 surveys sent (77.45%) were obtained; 38% of Spanish rheumatologists have private activity; 13% exclusively private practice and 25% private practice shared with his or her public activity. The private practice rheumatologist profile is: male, 49 years old with 19 years of experience after finishing the specialty and with a working day of 42hours per week. There is a clear predominance of private practice in the Autonomous Community of Catalonia with 28% of the total, followed by Madrid 18%, Andalusia 12% and Valencia 8%. Conclusions. 38% of Spanish rheumatologists are working in private practice. The profile of professionals working in private practice is different from that of those who work exclusively in public health. Private rheumatology is located in all regions, although most private rheumatologists are located in the regions of Catalonia, Madrid, Valencia and Andalusia, representing more than 50% of the total (AU)


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Reumatologia , Instituições Privadas de Saúde/normas , Prática Privada/normas , Hospitais Privados/organização & administração , Inquéritos e Questionários
5.
Reumatol Clin ; 2017 Jul 12.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-28711461

RESUMO

OBJECTIVES: To describe the prevalence of comorbidities in patients with RA in Spain and discuss their management and implications using data from the Spanish cohort of the multinational study on COMOrbidities in Rheumatoid Arthritis (COMORA). METHODS: This is a national sub-analysis of the COMORA study. We studied the demographics and disease characteristics of 200 adults patients diagnosed with RA (1987 ACR), and routine practices for screening and preventing the following selected comorbidities: cardiovascular, infections, cancer, gastrointestinal, pulmonary, osteoporosis and depression. RESULTS: Patients had a mean age of 58 years and a mean RA duration of 10 years. Mean DAS28 score was 3.3 and approximately 25% of patients were in remission (DAS28 <2.6). Forty-four (22%) patients had ≥1 comorbidity, the most frequent being depression (27%) and obesity (26%). A history of myocardial infarction or stroke was observed in 5% and 1% of patients, respectively, and any solid tumor in 6%. Having a Framingham Risk Score >20% (51%), hypercholesterolemia (46%) or hypertension (41%) and smoking (25%) were the most common CV risk factors. For prostate, colon and skin cancers, only 9%, 10% and 18% of patients, respectively, were optimally monitored. Infections were also inadequately managed, with 7% and 17% of patients vaccinated against influenza and pneumococcal, respectively, as was osteoporosis, with 47% of patients supplemented with vitamin D and 56% with a bone densitometry performed. CONCLUSIONS: In Spain, the prevalence of comorbidities and CV risk factors in RA patients with established and advanced disease is relatively high, and their management in clinical daily practice remains suboptimal.

6.
Reumatol Clin ; 13(6): 313-317, 2017 Nov - Dec.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-27769699

RESUMO

INTRODUCTION: Rheumatologic care is offered by the National Health System in Spain. However, more than a quarter of health spending is carried out in private medicine. Currently, there are no data about the number of rheumatologists with private activity in Spain. OBJECTIVES: To evaluate the number of rheumatologists with private activity in Spain and to describe the profile and location of these professionals. MATERIAL AND METHODS: A survey was developed and sent from the SER Commission on Private Practice to all SER active members. Data collection ends in December 2014. A descriptive statistical analysis and comparison of results was done. RESULTS: 759 answers from a total of 980 surveys sent (77.45%) were obtained; 38% of Spanish rheumatologists have private activity; 13% exclusively private practice and 25% private practice shared with his or her public activity. The private practice rheumatologist profile is: male, 49 years old with 19 years of experience after finishing the specialty and with a working day of 42hours per week. There is a clear predominance of private practice in the Autonomous Community of Catalonia with 28% of the total, followed by Madrid 18%, Andalusia 12% and Valencia 8%. CONCLUSIONS: 38% of Spanish rheumatologists are working in private practice. The profile of professionals working in private practice is different from that of those who work exclusively in public health. Private rheumatology is located in all regions, although most private rheumatologists are located in the regions of Catalonia, Madrid, Valencia and Andalusia, representing more than 50% of the total.


Assuntos
Prática Privada/estatística & dados numéricos , Reumatologia/estatística & dados numéricos , Adulto , Idoso , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Masculino , Corpo Clínico Hospitalar , Pessoa de Meia-Idade , Admissão e Escalonamento de Pessoal , Prática Privada/organização & administração , Reumatologia/organização & administração , Espanha , Local de Trabalho/estatística & dados numéricos
7.
RMD Open ; 2(2): e000302, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27933206

RESUMO

Treating to target by monitoring disease activity and adjusting therapy to attain remission or low disease activity has been shown to lead to improved outcomes in chronic rheumatic diseases such as rheumatoid arthritis and spondyloarthritis. Patient-reported outcomes, used in conjunction with clinical measures, add an important perspective of disease activity as perceived by the patient. Several validated PROs are available for inflammatory arthritis, and advances in electronic patient monitoring tools are helping patients with chronic diseases to self-monitor and assess their symptoms and health. Frequent patient monitoring could potentially lead to the early identification of disease flares or adverse events, early intervention for patients who may require treatment adaptation, and possibly reduced appointment frequency for those with stable disease. A literature search was conducted to evaluate the potential role of patient self-monitoring and innovative monitoring of tools in optimising disease control in inflammatory arthritis. Experience from the treatment of congestive heart failure, diabetes and hypertension shows improved outcomes with remote electronic self-monitoring by patients. In inflammatory arthritis, electronic self-monitoring has been shown to be feasible in patients despite manual disability and to be acceptable to older patients. Patients' self-assessment of disease activity using such methods correlates well with disease activity assessed by rheumatologists. This review also describes several remote monitoring tools that are being developed and used in inflammatory arthritis, offering the potential to improve disease management and reduce pressure on specialists.

8.
Reumatol. clín. (Barc.) ; 10(6): 380-388, nov.-dic. 2014. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-128365

RESUMO

Antecedentes. En los últimos años, las Unidades de Hospitalización de Día (UHdD) en Reumatología han experimentado un amplio desarrollo. Sin embargo, existe escasa documentación respecto a estándares de calidad, que mayoritariamente se limita a la estructura y no incluye aspectos específicos de la especialidad. Objetivo. Desarrollar estándares de calidad específicos para las UHdD en Reumatología. Métodos. Tras una revisión sistemática de la literatura y de documentos relacionados, un grupo de trabajo (GT) de 8 reumatólogos, bajo la supervisión de un metodólogo experto, elaboró una primera propuesta de estándares de calidad. Se realizó una segunda ronda para su revisión y sugerencias por todo el GT. Consensuado el contenido, se realizó un informe final. Resultados. Se definieron 17 estándares de estructura, 25 de proceso y 10 de resultados, con especial énfasis en aspectos específicos de una UHdD de Reumatología. La propuesta incluye: 1) estándares imprescindibles; 2) estándares de excelencia; 3) cartera de servicios de una UHdD reumatológica, y 4) criterios de funcionamiento. Conclusiones. Los estándares de calidad propuestos son la base para la elaboración de indicadores y de otras herramientas de gestión para las UHdD reumatológicas que garanticen una práctica homogénea, centrada en el paciente y basada en la evidencia y en la experiencia (AU)


Background. In recent years, the Rheumatology Day-Care Hospital Units (DHUs) have undergone extensive development. However, the quality standards are poorly documented and mainly limited to structure items rather than including broad and specific areas of this specialty. Objective. To develop specific quality standards for Rheumatology DHUs. Methods. After a systematic review of the literature and related documents, a working group (WG) involving 8 DHU-experienced rheumatologists developed an initial proposal of the quality standards, under the supervision of an expert methodologist. A second round was held by the WG group to review the initial proposal and to consider further suggestions. Once the content was agreed upon by consensus, a final report was prepared. Results. Seventeen structure standards, 25 process standards and 10 results standards were defined, with special emphasis on specific aspects of the Rheumatology DHU. The proposal includes: (1) essential standards to (2) excellent standards, (3) a Rheumatology DHU services portfolio and (4) performance criteria. Conclusions. The proposed quality standards are the basis for developing the indicators and other management tools for Rheumatology DHU, thereby ensuring a patient-oriented practice based on both the evidence and the experience (AU)


Assuntos
Humanos , Masculino , Feminino , /normas , Hospital Dia , Unidades Hospitalares , Sociedades Médicas , Controle de Qualidade , Qualidade da Assistência à Saúde
9.
Reumatol Clin ; 10(6): 380-8, 2014 Nov-Dec.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-24856641

RESUMO

BACKGROUND: In recent years, the Rheumatology Day-Care Hospital Units (DHU have undergone extensive development. However, the quality standards are poorly documented and mainly limited to structure items rather than including broad and specific areas of this specialty. OBJECTIVE: To develop specific quality standards for Rheumatology DHU. METHODS: After a systematic review of the literature and related documents, a working group (WG) involving 8 DHU-experienced rheumatologists developed an initial proposal of the quality standards, under the supervision of an expert methodologist. A second round was held by the WG group to review the initial proposal and to consider further suggestions. Once the content was agreed upon by consensus, a final report was prepared. RESULTS: 17 structure standards, 25 process standards and 10 results standards were defined, with special emphasis on specific aspects of the Rheumatology DHU. The proposal includes: 1) essential standards to 2) excellent standards, 3) a Rheumatology DHU services portfolio and 4) performance criteria. CONCLUSIONS: The proposed quality standards are the basis for developing the indicators and other management tools for Rheumatology DHU, thereby ensuring a patient-oriented practice based on both the evidence and the experience.


Assuntos
Hospital Dia/normas , Unidades Hospitalares/normas , Qualidade da Assistência à Saúde/normas , Reumatologia/normas , Humanos , Assistência Centrada no Paciente/normas , Indicadores de Qualidade em Assistência à Saúde , Espanha
10.
J Rheumatol ; 38(12): 2536-9, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-22045838

RESUMO

OBJECTIVE: To analyze the effects of cigarette smoking on disease activity and radiographic damage in patients with early rheumatoid arthritis (RA). METHODS: Study subjects were 156 patients with early RA (< 2 yrs). Disease activity, therapeutic response, and radiographic progression were compared in smokers and nonsmokers at 24 months. RESULTS: At baseline, ever-smokers had earlier disease onset and a closer association with the shared epitope (SE), but not more seropositive disease. No significant differences were observed in disease activity and European League Against Rheumatism therapeutic responses between smokers and nonsmokers. Multivariate analysis showed that baseline Larsen score, the HLA-DRB*04 genotype, being female, and current smoking were associated with radiographic progression. CONCLUSION: In patients with early RA, smoking was associated with earlier disease onset and the SE. Smoking was an independent factor of radiographic progression.


Assuntos
Artrite Reumatoide/diagnóstico por imagem , Artrite Reumatoide/patologia , Artrite Reumatoide/fisiopatologia , Progressão da Doença , Fumar/efeitos adversos , Adulto , Idoso , Antirreumáticos/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Feminino , Antígenos HLA-DR/genética , Antígenos HLA-DR/imunologia , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Radiografia , Índice de Gravidade de Doença
12.
Semin Arthritis Rheum ; 32(6): 378-87, 2003 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-12833246

RESUMO

OBJECTIVES: To assess the diagnostic usefulness of the systematic analysis of synovial vascular morphology in various inflammatory, early, and longstanding arthropathies, and to examine the validity of the vascular patterns in predicting the evolution of a group of patients with undifferentiated arthritis (UA). METHODS: One hundred patients who underwent rheumatologic arthroscopy of a symptomatic joint (85 knees, 11 wrists, 3 elbows, 1 metacarpophalangeal joint) were evaluated. The same observer, blinded to patient diagnosis, analyzed the video recordings of the arthroscopies. Vascular morphology was classified into 3 patterns: straight, tortuous, and mixed. RESULTS: Eighty-one patients had inflammatory arthritis: 35 rheumatoid arthritis (RA), 16 psoriatic arthritis (PsA), 13 spondyloarthropathies (SpA), and 17 UA. Forty-nine percent of patients with RA had a straight pattern, 28% a mixed, and 23% a tortuous one. The sensitivity rate of the straight pattern for RA was 77% and the specificity rate was 70%. Seventy-six percent of RA patients with a straight pattern were rheumatoid factor positive (RF+) against 25% of RA patients with a tortuous pattern. The odds ratio for RA associated to straight compared with tortuous pattern was 57.3 (95% confidence interval, 6.6 to 499.5; P <.001). Patients with PsA and SpA shared the same pattern and were analyzed as 1 group. Ninety-three percent of patients with PsA/SpA had a tortuous pattern, 4% a straight pattern, and 3% a mixed pattern. The sensitivity rate of the tortuous pattern for PsA/SpA was 61% and the specificity rate was 95%. During 2 years of follow-up, 6 of 17 patients with UA were definitely diagnosed: 4 RA (2 RF+ and straight pattern; 2 with a tortuous pattern, 1 with RF+ and HLA-B27+); 1 SpA and 1 PsA, both with a tortuous pattern. No differences in vascular patterns were observed according to disease duration. Our results indicate that vascular patterns are not modified by disease modifying antirheumatic drug (DMARD) treatment. The other 19 patients had osteoarthritis (n = 8) and calcium pyrophosphate dihydrate crystal deposition disease (n = 11) and their predominant vascular pattern was tortuous-like. CONCLUSIONS: Arthroscopic assessment of synovial vascular changes in chronic arthritis may be of diagnostic and pathogenetic interest, although differences between published studies suggest a need for consensus in evaluating vascular patterns. A straight pattern is strongly associated with RF + RA whereas a tortuous pattern is generally associated with PsA or SpA; these associations are independent of disease duration. The vascular pattern likely does not change qualitatively with DMARD therapy. The application of this technique to the diagnosis or prognosis of patients with UA may be a complementary tool for the treatment of these patients, but larger, prospective studies are necessary to confirm this hypothesis.


Assuntos
Artrite/diagnóstico , Artroscopia , Vasos Sanguíneos/patologia , Articulações/patologia , Membrana Sinovial/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antirreumáticos/uso terapêutico , Artrite/tratamento farmacológico , Feminino , Humanos , Articulações/irrigação sanguínea , Masculino , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Método Simples-Cego , Membrana Sinovial/irrigação sanguínea
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