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1.
Semin Arthritis Rheum ; 45(4): 386-90, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26254548

RESUMO

OBJECTIVE: To identify predictors of early response to tocilizumab (TCZ) in patients with active rheumatoid arthritis (RA) seen in daily routine clinical practice. METHODS: A multicenter ambispective observational study of 126 RA patients treated with TCZ as a first- or second-line biological therapy. The variables associated to achieve the therapeutic goal (remission defined as a DAS28-ESR < 2.6) at 3 and 6 months were identified using regression analysis. RESULTS: TCZ was administered as the first biologic in 26% of patients. Overall, 34% of patients received TCZ as monotherapy. EULAR response and remission were obtained in 82% and 31% of patients at 3 months and in 86% and 40% at 6 months. In the multivariate analysis, the predictive factors increasing the likelihood of clinical remission at 3 months were baseline ESR > 30 mm/h (OR = 19.07, 95% CI: 2.720-133.716), baseline CRP > 10 mg/L (OR = 4.95; 95% CI: 1.464-13.826), and the presence of extra-articular manifestations of the disease (OR = 15.45, 95% CI: 2.334-102.319). The factors that decreased it were higher concentrations of hemoglobin (OR = 0.53, 95% CI: 0.319-0.910), higher baseline DAS28-ESR (OR = 0.30, 95% CI: 0.145-0.635) and the number of previous DMARDs (OR = 0.41, 95% CI: 0.221-0.779), and biological therapies used (OR = 0.33, 95% CI: 0.155-0.734). The only factor that remained statistically significant at 6 months was higher baseline DAS28-ESR (OR = 0.55, 95% CI: 0.347-0.877). No relationship was found with the neutrophil count or with the RF or ACPA positivity. CONCLUSION: In routine clinical practice, strong acute phase response, the presence of extra-articular manifestations, and the number of previous DMARDs and biological therapies used may help to identify patients who will have a rapid response to TCZ. However, it is likely that no parameter will predict response if taken separately.


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Antirreumáticos/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Indução de Remissão , Resultado do Tratamento
2.
PLoS One ; 10(4): e0123392, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25830224

RESUMO

OBJECTIVE: In agreement with EULAR recommendations, a DMARD in combination with a biotherapy is the reference treatment because of the superior long-term clinical and radiographic outcomes. Methotrexate (MTX) is the cornerstone of combination therapy but is in some cases contra-indicated or poorly tolerated. This observational study aimed to compare the effectiveness and safety of TCZ in combination with either MTX or leflunomide (LEF) in the treatment of patients with active rheumatoid arthritis (RA) and an inadequate response to one or more DMARDs and/or biological agents in a real-world setting. METHODS: We performed an ambispective review of 91 patients with active RA who were routinely treated with TCZ plus MTX or LEF. A comparative study between the two combinations of treatment was performed at 6 months of follow-up considering 3 outcomes: improvement of RA disease activity, evolution of functional disability, and tolerability and side effect profile. RESULTS: Of the 91 patients, 62 received TCZ with MTX and 29 received TCZ with LEF. Eighty-one patients were followed for 6 months, and the remaining 10 patients discontinued treatment due to serious adverse events. At baseline, there were no significant differences between the groups in terms of the main clinical and laboratory data or in the number of previous DMARDs and biological agents used. At 6 months, there were no significant differences between the combinations in terms of disease activity and functional disability. Serious adverse events occurred in 11% and 10% of the patients treated in combination with MTX and LEF, respectively. CONCLUSION: Our preliminary data support the argument that LEF is an effective and safe (equivalent) alternative to MTX for combination treatment with TCZ.


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Antirreumáticos/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Isoxazóis/uso terapêutico , Metotrexato/uso terapêutico , Idoso , Anticorpos Monoclonais Humanizados/efeitos adversos , Relação Dose-Resposta a Droga , Quimioterapia Combinada , Feminino , Humanos , Isoxazóis/efeitos adversos , Leflunomida , Masculino , Metotrexato/efeitos adversos , Pessoa de Meia-Idade , Neutropenia/induzido quimicamente , Estudos Retrospectivos , Resultado do Tratamento
3.
J Rheumatol ; 42(2): 222-7, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25399393

RESUMO

OBJECTIVE: To determine whether there is an association between different capillaroscopic findings and pulmonary function tests in systemic sclerosis (SSc). METHODS: We did a retrospective observational study in a cohort of patients with SSc and early SSc. Patients with at least 1 nailfold videocapillaroscopy (NVC) magnified 120× were included. Pathological findings were giant capillaries, angiogenesis, and density loss. Findings were compared with lung function values: percent expected value of forced vital capacity (FVC), DLCO, and FVC/DLCO ratio. Other variables collected were sex and SSc type, and the presence of digital ulcers (DU), interstitial lung disease (ILD), scleroderma renal crisis, and/or pulmonary hypertension (PH). RESULTS: Of 136 patients with SSc, 85 had undergone an NVC. The frequency of ILD, DU, and PH was 24.1%, 28.7%, and 17.2%, respectively. Data analysis showed that patients with density loss had worse FVC% (86.91 ± 19.42 vs 101.13 ± 16.06, p < 0.01) and DLCO% (71.43 ± 21.19 vs 85.9 ± 19.81, p < 0.01) compared to those without. CONCLUSION: Patients with loss of density present worse FVC and DLCO values. Prospective studies are warranted to determine whether NVC is useful for studying pulmonary function in SSc.


Assuntos
Pulmão/fisiopatologia , Unhas/irrigação sanguínea , Fluxo Sanguíneo Regional/fisiologia , Escleroderma Sistêmico/fisiopatologia , Adulto , Idoso , Feminino , Humanos , Masculino , Angioscopia Microscópica , Pessoa de Meia-Idade , Testes de Função Respiratória , Estudos Retrospectivos
6.
BMC Public Health ; 9: 202, 2009 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-19555475

RESUMO

BACKGROUND: The main objective of this study is to measure the relationship between morbidity, direct health care costs and the degree of clinical effectiveness (resolution) of health centres and health professionals by the retrospective application of Adjusted Clinical Groups in a Spanish population setting. The secondary objectives are to determine the factors determining inadequate correlations and the opinion of health professionals on these instruments. METHODS/DESIGN: We will carry out a multi-centre, retrospective study using patient records from 15 primary health care centres and population data bases. The main measurements will be: general variables (age and sex, centre, service [family medicine, paediatrics], and medical unit), dependent variables (mean number of visits, episodes and direct costs), co-morbidity (Johns Hopkins University Adjusted Clinical Groups Case-Mix System) and effectiveness.The totality of centres/patients will be considered as the standard for comparison. The efficiency index for visits, tests (laboratory, radiology, others), referrals, pharmaceutical prescriptions and total will be calculated as the ratio: observed variables/variables expected by indirect standardization.The model of cost/patient/year will differentiate fixed/semi-fixed (visits) costs of the variables for each patient attended/year (N = 350,000 inhabitants). The mean relative weights of the cost of care will be obtained. The effectiveness will be measured using a set of 50 indicators of process, efficiency and/or health results, and an adjusted synthetic index will be constructed (method: percentile 50).The correlation between the efficiency (relative-weights) and synthetic (by centre and physician) indices will be established using the coefficient of determination. The opinion/degree of acceptance of physicians (N = 1,000) will be measured using a structured questionnaire including various dimensions. STATISTICAL ANALYSIS: multiple regression analysis (procedure: enter), ANCOVA (method: Bonferroni's adjustment) and multilevel analysis will be carried out to correct models. The level of statistical significance will be p < 0.05.


Assuntos
Grupos Diagnósticos Relacionados/economia , Custos de Cuidados de Saúde , Atenção Primária à Saúde/economia , Risco Ajustado , Adulto , Assistência Ambulatorial , Análise de Variância , Custos e Análise de Custo , Feminino , Humanos , Classificação Internacional de Doenças , Masculino , Análise de Regressão , Estudos Retrospectivos , Espanha , Inquéritos e Questionários
8.
J Rheumatol ; 31(7): 1352-5, 2004 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-15229956

RESUMO

OBJECTIVE: Sjögren's syndrome (SS) is a chronic inflammatory autoimmune disease. It can be primary (pSS) or secondary (sSS) and is observed 90% more in women than in men, mainly in the fourth and fifth decades of life. We investigated the prevalence of serological and clinical manifestations in male and female patients with primary SS. METHODS: We analyzed 521 female and 28 male patients with pSS between 1993 and 2001. All patients fulfilled > or = 4 of the 1993 European Community Study Group criteria. RESULTS: Men presented higher concentrations of IgA, rheumatoid factor, and antinuclear antibodies than women. A higher percentage of women than men reported fibromyalgia, thyroidal manifestations, and carpal tunnel syndrome. There were no statistical differences between the 2 groups in relation to the presence of Raynaud's phenomenon, arthritis, erosive osteoarthritis, liver disease, or other visceral manifestations. CONCLUSION: The pattern of SS in our cohort of patients reveals a difference between male and female patients, in contrast with earlier studies.


Assuntos
Síndrome de Sjogren/sangue , Síndrome de Sjogren/fisiopatologia , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Sexuais
9.
Med Clin (Barc) ; 122(19): 748-52, 2004 May 22.
Artigo em Espanhol | MEDLINE | ID: mdl-15171910

RESUMO

BACKGROUND AND OBJECTIVE: Our goal was to analyze the epidemiological and clinical findings, as well as the diagnostic approach in a group of patients in whom uveitis was the first manifestation of sarcoidosis. PATIENTS AND METHOD: Retrospective study (between March 1998 and July 2002) including 31 patients diagnosed with sarcoidosis after an episode of uveitis. The group consisted of 19 females (61%) and 12 males (39%). Mean follow-up was 34.5 months. Age, sex, ocular and systemic clinical findings were recorded. Angiotensin converting enzyme (ACE) levels were measured and radiological studies of the thorax were conducted including simple radiography (Rx), computerized axial tomography (CT) and gallium scan (67Ga). Biopsy was carried out in 14 patients. RESULTS: Mean age was 59.6 years. Six different clinical presentations of uveitic sarcoidosis were observed, the most common being bilateral panuveitis in 13 patients (42%) and chronic anterior bilateral uveitis in 11 (35%). Gallium scan, thoracic CT and chest radiography were positive in 88%, 77% and 33% cases, respectively. ACE levels were raised in 7 of the 27 patients analyzed (26%). Histological confirmation of disease was obtained in all 14 patients biopsied with a specificity and sensitivity of 100%. CONCLUSIONS: Uveitis may be the presenting manifestation of sarcoidosis, especially in women over 60 years of age. Bilateral panuveitis and chronic bilateral anterior uveitis are the most common clinical presentations. The sensitivity of gallium scan and thoracic CT is greater than simple chest radiography in diagnosing pulmonary and mediastinal lesions of sarcoidosis. The need for biopsy should be individualized in each case depending on complementary exams, age and potential morbidity of the procedure.


Assuntos
Sarcoidose/diagnóstico , Uveíte/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Uveíte/epidemiologia
10.
Med. clín (Ed. impr.) ; 122(19): 748-752, mayo 2004.
Artigo em Espanhol | IBECS | ID: ibc-32148

RESUMO

FUNDAMENTO Y OBJETIVO: Analizar las características epidemiológicas y clínicas, así como los métodos diagnósticos empleados en un grupo de pacientes en el que la uveítis es la primera manifestación de la sarcoidosis. PACIENTES Y MÉTODO: Estudio descriptivo y retrospectivo de 31 pacientes diagnosticados de sarcoidosis a partir de un cuadro de uveítis en el período comprendido entre marzo de 1998 y julio de 2002. La muestra está formada por 19 mujeres (61 por ciento) y 12 varones (39 por ciento). El seguimiento medio ha sido de 34,5 meses. Se evaluaron la edad, el sexo y las manifestaciones clínicas oculares y sistémicas. Se realizó un estudio radiológico del tórax mediante radiografía simple, tomografía computarizada y gammagrafía con 67Ga, así como la determinación de los valores de la enzima de conversión de la angiotensina. Se indicó biopsia en 14 enfermos. RESULTADOS: La edad media fue de 59,6 años. Se han podido establecer 6 formas diferentes de presentación de la uveítis sarcoidótica, cuyos 2 patrones más frecuentes han sido la panuveítis bilateral, que se observó en 13 pacientes (42 por ciento), y la uveítis anterior crónica bilateral, en 11 (35 por ciento). Se objetivó clínica sistémica en 13 pacientes (42 por ciento), principalmente de tipo respiratorio. La positividad de la gammagrafía con 67Ga, la tomografía computarizada torácica y la radiografía de tórax ha sido del 88, el 77 y el 33 por ciento, respectivamente. La enzima de conversión de la angiotensina resultó elevada en el 26 por ciento. La confirmación histológica se realizó en 14 pacientes con sensibilidad y especificidad del 100 por ciento. CONCLUSIONES: La uveítis puede ser la primera manifestación clínica de la sarcoidosis, principalmente en el grupo de mujeres mayores de 60 años. Los 2 patrones oculares de presentación más frecuentes son la panuveítis bilateral y la uveítis anterior crónica bilateral. La sensibilidad de la gammagrafía con 67Ga y la tomografía computarizada es superior a la de la radiografía de tórax para objetivar lesiones pulmonares y mediastínicas debidas a la sarcoidosis. La biopsia debe individualizarse en función de las exploraciones complementarias, la edad del paciente y su morbilidad potencial (AU)


Assuntos
Idoso , Pessoa de Meia-Idade , Masculino , Humanos , Feminino , Adulto , Idoso de 80 Anos ou mais , Uveíte , Sarcoidose , Estudos Retrospectivos , Biópsia
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