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1.
Z Rheumatol ; 78(10): 979-986, 2019 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-31346705

RESUMO

BACKGROUND: In Germany, the numbers of patients with spondylarthritides (SpA) and rheumatoid arthritis (RA) have increased. This rise was possibly promoted by the introduction of new classification criteria (CC) that enable an earlier recognition and the inclusion of less severe cases. The study explores how the new CC for axial SpA (axSpA) are incorporated into the clinical practice, compared with the CC for RA and systemic lupus erythematosus (SLE). In addition, the study investigated whether the new entity of non-radiographic axSpA (nr-axSpA) is accepted and used in Germany. MATERIAL AND METHODS: In 2016, an online survey was performed among all rheumatologists registered in the German Society of Rheumatology (DGRh). In addition, 150 rheumatologists were invited to the survey at the national meeting of the DGRh in 2016. RESULTS: Among 119 participating rheumatologists, 99% were familiar with the new CC for SpA and 82% applied them in practice (RA 99% and 80%, SLE 50% and 56%). 78% differentiated between radiographic and nr-axSpA and 80% believed that a significant proportion of patients with nr-axSpA will never develop radiographic changes. 91% agreed that the new CC facilitated an earlier treatment start and 58% that the CC enabled more patients to receive biologicals. 50% shared the opinion that the criterion "chronic back pain" could lead to the classification of too many patients as having axSpA. It deemed possible to 65% that patients with nr-axSpA would be treated with biologicals in whom the diagnosis of axSpA could not be confirmed later on. 81% voted against the initiation of TNF inhibitors in nr-axSpA patients with normal CRP levels and normal MRI. 67% interpreted the MRI themselves and 30% stated that the MRI is evaluated according to validated standards by the radiologists. Among all axSpA criteria, HLA B27 and inflammatory back pain received the highest significance and the response to NSAID the lowest. CONCLUSION: The new CC and the entity of nr-axSpA are accepted by German rheumatologists. A relevant proportion saw weaknesses of the new CC in the differentiation between nr-axSpA and non-specific chronic back pain. In practise, the interpretation of the CC with respect to the start of biologics is relatively strict, especially in cases with normal CRP and MRI. A ranking of axSpA criteria is commonly applied, although this was not initially intended in the CC.


Assuntos
Artrite Reumatoide , Lúpus Eritematoso Sistêmico , Espondilartrite , Espondilite Anquilosante , Artrite Reumatoide/diagnóstico , Artrite Reumatoide/terapia , Alemanha , Humanos , Lúpus Eritematoso Sistêmico/diagnóstico , Lúpus Eritematoso Sistêmico/terapia , Reumatologistas , Espondilartrite/diagnóstico , Espondilartrite/terapia , Espondilite Anquilosante/diagnóstico , Espondilite Anquilosante/terapia
2.
Z Rheumatol ; 78(8): 713-721, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31273459

RESUMO

BACKGROUND: The objective of the research consortium PROCLAIR was to gain population level knowledge on the treatment of patients with rheumatoid arthritis (RA), axial spondylarthritis (axSpA) and osteoarthritis (OA) in Germany. AIMS: A main question of the consortium was whether it is possible to identify groups of people who were exposed to a particular risk of undersupply or oversupply of treatment. In addition, the study investigated the validity of claims data for these diseases as a basis for further studies. PATIENTS AND METHODS: Cross-sectional surveys were carried out among insurees of the BARMER statutory health insurance fund whose claims data included RA, axSpA and OA diagnoses. The questionnaire data were linked with the claims data of the insured persons if they agreed. RESULTS: In all three diseases risk groups for care deficits could be identified. Persons with RA who are not treated by a specialist have less access to drug treatment. Physical therapy is prescribed for all three diagnoses at a low level, even for people undergoing joint replacement surgery. A connection between depressive symptoms and disease activity or function in axSpA was shown. In addition to the results relevant to care, the PROCLAIR network has also made contributions to critically assess the quality of health insurance data. DISCUSSION: The combination of billing data with survey data enables a comprehensive description of the treatment of musculoskeletal diseases. Particularly relevant factors are the specialization of the physician, sociodemographic parameters of the patients and the region of residence. In particular, access to treatment cannot be investigated in randomized clinical trials.


Assuntos
Artrite Reumatoide , Osteoartrite , Espondilartrite , Artrite Reumatoide/diagnóstico , Artrite Reumatoide/terapia , Produtos Biológicos/uso terapêutico , Estudos Transversais , Alemanha , Humanos , Osteoartrite/diagnóstico , Osteoartrite/terapia , Modalidades de Fisioterapia , Espondilartrite/diagnóstico , Espondilartrite/terapia , Inquéritos e Questionários
3.
Z Rheumatol ; 78(9): 865-874, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31172266

RESUMO

BACKGROUND: Only very few data are available on the comprehensive care in patients with axial spondylarthritis (axSpA), one of the most frequent inflammatory rheumatic disease. OBJECTIVE: Description of the comprehensive care and common prescription patterns of medications and other therapies in patients with axSpA depending on the type of medical care by rheumatologists or nonrheumatologists. METHODS: A cross-sectional analysis was performed based on claims data of the BARMER health insurance company (in 2015) and a questionnaire, which was sent to a representative sample of patients with axSpA (International Classification of Diseases, 10th revision, German modification, ICD-10-GM, code M45) aged 18-79 years. A stratified sample of 5000 patients was used. The patients received a postal questionnaire including questions regarding the disease, health-related and psychological parameters and socioeconomic factors. Claims data consisted of demographic factors, medicinal and nonmedicinal treatment and the extra-articular manifestations inflammatory bowel disease, psoriasis and uveitis. RESULTS: A total of 1741 patients (mean age 55.9 years, female 46.4%, 86.2% Human Leucocyte Antigen[HLA]-B27 positive) confirmed the diagnosis and answered the questionnaire. The mean Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) was 4.5 and the mean Bath Ankylosing Spondylitis Functional Index (BASFI) 4.1. Of the patients 46% were treated by rheumatologists. There was a substantial difference between patients in rheumatological care and those who were not in rheumatological care regarding prescriptions for drug treatment of axSpA (91.8% versus 66.4%). This difference was especially prominent for prescriptions of biologic disease-modifying antirheumatic drugs: 34.1% of patients in rheumatological care versus 3.1% of patients treated by nonrheumatologists (p < 0.0001), despite similar disease activity in both groups. CONCLUSION: The data show that the majority of patients diagnosed with axSpA did not receive regular care from rheumatologists. This seemed to be associated with insufficient medicinal care at least in some of these patients.


Assuntos
Produtos Biológicos/uso terapêutico , Qualidade da Assistência à Saúde , Reumatologia/normas , Espondilartrite , Espondilite Anquilosante , Adolescente , Adulto , Idoso , Estudos Transversais , Feminino , Alemanha , Antígeno HLA-B27/sangue , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Espondilartrite/terapia , Inquéritos e Questionários , Adulto Jovem
4.
Reumatol. clín. (Barc.) ; 15(supl.1): 35-38, abr. 2019.
Artigo em Espanhol | IBECS | ID: ibc-184214

RESUMO

La ausencia de consenso sobre la evaluación óptima de la actividad de la espondiloartritis obstaculiza el desarrollo de un tratamiento por objetivos. Es cierto que existen medidas de respuesta, tanto para la afectación axial como para la periférica, como ASAS, BASDAI o ASDAS, DAS28 o DAPSA, basadas esencialmente en las manifestaciones clínicas. Esta medidas valoran función e inflamación aunque excluyen progresión radiográfica, por lo que parece importante el apoyo de determinadas pruebas de imagen para una valoración más objetiva del resultado. Entre ellas, las pruebas que han demostrado más utilidad son la ecografía y la resonancia magnética. La ecografía se utiliza fundamentalmente en la afectación periférica (articular, entesis y dactilitis) para evaluar inflamación y progresión radiográfica, y la resonancia fundamentalmente en la afectación axial. Por todo ello se requiere más formación para la autosuficiencia del reumatólogo en la utilización de la ecografía, así como protocolos bien establecidos con el servicio de radiología para una mejor disposición de pruebas, como la resonancia magnética


The lack of consensus on optimal assessment of disease activity in spondyloarthritis has hampered the development of targeted therapy. Although there are response measures, both for axial and peripheral involvement, such as ASAS, BASDAI or ASDAS, DAS28 or DAPSA, which are principally symptom-based and assess functional status and inflammation but exclude radiographic progression, imaging studies are an important support for more objective assessment of the results. Among them, the techniques that have been shown to be most useful are ultrasound and magnetic resonance. Ultrasound is mainly useful in peripheral involvement (joints, enthesis, dactilitis) to assess inflammation and radiological progression and magnetic resonance to assess mainly axial involvement. Consequently, more training is required for rheumatologists to be self-sufficient in the use of ultrasound, as well as well-established protocols with the radiology service for better provision of tests such as magnetic resonance


Assuntos
Humanos , Espondilartrite/diagnóstico por imagem , Radiografia/métodos , Espectroscopia de Ressonância Magnética/métodos , Ultrassonografia/métodos , Tomografia Computadorizada por Raios X/métodos , Espondilartrite/terapia , Resultado do Tratamento , Diagnóstico por Imagem/métodos , Progressão da Doença
5.
Reumatol. clín. (Barc.) ; 15(2): 77-83, mar.-abr. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-184353

RESUMO

Objetivos: Desarrollar recomendaciones sobre la actividad física y el ejercicio para pacientes con espondiloartritis (EspA) basadas en la opinión de expertos. Métodos: Dos grupos de expertos, uno de fisioterapeutas, rehabilitadores y profesionales de la actividad física y deporte y otro de reumatólogos con interés en EspA, se reunieron para discutir los resultados de grupos focales con pacientes sobre barreras al ejercicio y de una encuesta a reumatólogos sobre ejercicio en EspA. A continuación se redactaron unas recomendaciones preliminares que fueron sometidas a la opinión de los expertos de ambos grupos mediante metodología Delphi a dos rondas. Resultados: Se emitieron 21 recomendaciones que cubren el ejercicio físico, la adaptación al paciente, el modo de dar los mensajes, el manejo del dolor, el tipo de ejercicios indicado y el seguimiento. El grado de acuerdo varía ligeramente entre los grupos de expertos pero en general fue alto. Los ítems discordantes o con poco acuerdo fueron eliminados del consenso. Conclusiones: Se han emitido recomendaciones sobre cuándo y cómo prescribir ejercicio físico y monitorizarlo en pacientes con EspA basadas en la opinión de expertos en espondilitis y en la prescripción de ejercicio. Deberemos confirmar si estas recomendaciones son útiles para la práctica clínica y tienen efecto en los pacientes con EspA atendidos por reumatólogos


Objective: To develop expert-based recommendations on physical activity and exercise for patients with spondyloarthritis (SpA). Methods: Two discussion groups, one of physical therapists, rehabilitation physicians, and professionals of physical activity and sports, and another of rheumatologists interested in SpA, were held to discuss the results of a survey of rheumatologists on exercise and two focus groups with patients on barriers to exercise. Preliminary recommendations were drafted. These were submitted to the opinion of the experts in both groups according to a two round Delphi methodology. Results: Twenty one recommendations covering general aspects of exercise, adaptation to patient, how to deliver messages, pain management, and type of exercise and monitoring were issued. The level of agreement varied slightly between expert groups but it was high overall. Items with poor agreement were removed from the consensus. Conclusions: We present recommendations on when and how to prescribe and monitor exercise in patients with SpA based on the opinion of experts in exercise and in SpA. We must now test whether these recommendations are useful for clinical practice and have an effect on patients with SpA seen by rheumatologists


Assuntos
Humanos , Espondilartrite/terapia , Terapia por Exercício/métodos , Dor Crônica/terapia , Padrões de Prática Médica , Manejo da Dor/métodos , Limitação da Mobilidade , Resultado do Tratamento
6.
Int J Rheum Dis ; 22(2): 234-241, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30187695

RESUMO

AIM: To evaluate the impact of an aerobic fitness program on disease activity, defined by the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and on C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and the Bath Ankylosing Spondylitis Functional Index (BASFI) in case of axial spondyloarthritis. METHODS: A systematic review of the literature, following the Prisma recommendations, was performed by two reviewers on the PubMed and Embase databases. Controlled trials assessing the efficacy of aerobic exercises compared to physiotherapy on axial spondyloarthritis disease activity were included. The diagnosis of axial spondyloarthritis was meeting the New York criteria and/or the Assessment in Axial Spondyloarthritis International Working Group criteria. Aerobic fitness was defined as an exercise performed at 50%-90% of the maximal heart rate or between 50% and 80% oxygen consumption (VO2 ) peak. RESULTS: Five hundred and twenty abstracts were identified and 93 abstracts were analyzed. Eight studies met the selection criteria and 6 were finally included in this study because of the presence of a control group. Both groups were similar in terms of age, sex ratio, disease duration. Aerobic exercise provided a positive impact on the BASDAI in the intervention group (148 patients) (weighted mean difference [WMD]: -0.52 [95% CI: -0.9 to -0.13]) (I2 : 10.3%, P = 0.35). However, when compared to a control group (152 patients), the improvement of BASDAI didn't reach significance (WMD: -0.25 [95% CI: -0.83 to 0.32]) (I2 : 0%, P = 0.41). Aerobic exercise did not improve BASFI, CRP or ESR. CONCLUSION: Aerobic exercise did not provide beneficial effects either on disease activity or on physical function and biological parameters when compared to a control group in axial spondyloarthritis.


Assuntos
Terapia por Exercício/métodos , Modalidades de Fisioterapia , Espondilartrite/terapia , Espondilite Anquilosante/terapia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Índice de Gravidade de Doença , Espondilartrite/diagnóstico , Espondilartrite/fisiopatologia , Espondilite Anquilosante/diagnóstico , Espondilite Anquilosante/fisiopatologia , Resultado do Tratamento
7.
Clin Rheumatol ; 38(1): 3-10, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30338414

RESUMO

Spondyloartrhitis (SpA) are a group of diseases characterized by inflammation at articular and entheseal sites. Moreover, patients with SpA suffer from impaired articular function and reduced quality of life. Beyond the articular involvement, SpA and in particular psoriatic arthritis (PsA) are associated with extra-articular manifestations and comorbidities that might increase the burden of the disease. The aim of this article was to review the available evidences on the presence of comorbidities in SpA, including PsA, focusing the attention on the cardiovascular, metabolic aspects, as well as other comorbidities, and their possible management in an integrated manner. Comorbidities in SpA should be carefully evaluated because of their important impact.


Assuntos
Artrite Psoriásica/epidemiologia , Espondilartrite/epidemiologia , Espondilite Anquilosante/epidemiologia , Artrite Psoriásica/terapia , Doenças Cardiovasculares/epidemiologia , Comorbidade , Humanos , Osteoporose/epidemiologia , Qualidade de Vida , Espondilartrite/classificação , Espondilartrite/terapia , Espondilite Anquilosante/terapia
8.
Clin Exp Rheumatol ; 37(4): 575-584, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30557127

RESUMO

OBJECTIVES: The aim of this study was to develop a Delphi consensus statement between rheumatologists and radiologists for the diagnosis and monitoring of axial spondyloarthritis (axial-SpA). METHODS: Following an extensive literature search to identify unmet needs and potential goals for a multidisciplinary approach, a scientific board comprising 28 Italian hospital-based rheumatologists (n=19) and radiologists (n=9) identified 8 "starting points", resulting in the development of 23 consensus statements covering issues from current practice guidelines to specific MRI protocols for the assessment of axial-SpA. Each participant anonymously expressed a level of agreement for each statement using a 5-point Likert scale (1="strongly disagree"; 5="strongly agree") via an online Delphi method.Total cumulative agreement (TCA) was defined as the sum of the percentage of response to items 4 ("agree") and 5 ("absolutely agree"). Consensus was defined as ≥80% total cumulative agreement for each statement. RESULTS: After the first round of voting (28 participants), positive consensus was reached for 28/31 (90.3%) statements. Statements without consensus (n=3) were discussed in a face-to-face plenary session prior to the second vote (28 participants). After the second round voting, positive consensus was attained for all 31 statements, with mean final TCA of 95.5% (range 82.1-100%). CONCLUSIONS: This Delphi consensus statement provides an aid to rheumatologists and radiologists for the diagnosis and monitoring of axial-SpA.


Assuntos
Radiologistas , Reumatologistas , Espondilartrite , Consenso , Técnica Delfos , Humanos , Comunicação Interdisciplinar , Itália , Radiologistas/psicologia , Reumatologistas/psicologia , Espondilartrite/diagnóstico , Espondilartrite/terapia
9.
Scand J Rheumatol ; 48(3): 178-184, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30444168

RESUMO

OBJECTIVES: Touch screens for entering patient-reported outcomes (PROs) are available at all Danish departments of rheumatology reporting to the nationwide DANBIO registry. This project comprises two substudies in patients with rheumatoid arthritis (RA) or axial spondyloarthritis (AxSpA), aiming to (A) investigate the feasibility of first line patient recruitment for research via touch screens, and (B) compare PROs collected at hospital versus at home, including patient preferences. METHOD: Substudy A: using a touch screen, patients answered whether we could contact them about a clinical research project (yes/no). Characteristics of patients who accepted/declined were explored using chi-squared and Mann-Whitney U-tests. Substudy B (randomized crossover agreement study): a random sample of patients from the accepting group in substudy A was contacted by telephone. According to prespecified power and sample size estimation, 56 patients were included. After randomization, 50% of patients entered PROs and information on comorbidities and lifestyle from home and then at hospital, and 50% first from hospital and then at home. Finally, they stated their preference for data entry (hospital/home/equally good). Differences in PROs entered from home and in the hospital were compared (limits of agreement, 95% confidence intervals, and intraclass correlation coefficients). RESULTS: The touch-screen invitation was accepted by 428/952 patients (45%). Patients who accepted and those who declined had similar PROs and demographics. Substudy B was completed by 42 patients (22 RA, 20 AxSpA). They had no significant differences between PROs and lifestyle/comorbidity data entered from home and hospital, except for AxSpA patients on the Bath Ankylosing Spondylitis Functional Index and Bath Ankylosing Spondylitis Disease Activity Index item 5. The preferred method of data entry was hospital (10%), home (50%), and equally good (40%). CONCLUSION: Touch screens seem feasible for first line research recruitment. PROs collected from home were similar to the touch-screen solution. Patients preferred data entry from home.


Assuntos
Artrite Reumatoide , Sistemas On-Line/organização & administração , /métodos , Medidas de Resultados Relatados pelo Paciente , Seleção de Pacientes , Espondilartrite , Adulto , Artrite Reumatoide/epidemiologia , Artrite Reumatoide/terapia , Dinamarca/epidemiologia , Estudos de Viabilidade , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais , Preferência do Paciente , Sistema de Registros , Espondilartrite/epidemiologia , Espondilartrite/terapia
10.
Rheumatology (Oxford) ; 57(suppl_6): vi18-vi22, 2018 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-30445481

RESUMO

Treat-to-target (T2T) is an emerging treatment paradigm in axial spondyloarthritis (axSpA), originally based on evidence from other inflammatory conditions, which aims to direct therapy to a clear target such as disease remission or low disease activity, with the ultimate goal of maximizing quality of life in affected individuals. The 2016 update of the Assessment of Spondyloarthritis International Society/EULAR guidelines for axSpA have recommended that treatment should be guided according to a predefined target but controversy remains as to what this target should be. An international task force has recommended remission or inactive disease as the desired outcome; however, there are many disease outcome measures developed for use in clinical practice in axSpA and the question remains of which is the most appropriate to use. Another important consideration when discussing the T2T paradigm is when to intervene. Although evidence is limited in this respect, the available data suggest that therapy should be commenced at an early stage of the disease, when the process of bone repair expected to occur after an inflammatory phase has not yet started. It has also been argued that the success of the T2T paradigm may depend more on the treatment strategy than the individual therapies utilized. This article will explore the feasibility of using a T2T approach in axSpA clinical practice, the utilization of new composite outcome measures of disease activity such as the ASDAS, and the validity of different treatment strategies to allow for a T2T intervention in these patients.


Assuntos
Monitoramento de Medicamentos/normas , /normas , Índice de Gravidade de Doença , Espondilartrite/terapia , Comitês Consultivos , Monitoramento de Medicamentos/métodos , Humanos , /métodos
11.
Rheumatology (Oxford) ; 57(suppl_6): vi29-vi34, 2018 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-30445484

RESUMO

Axial SpA (axSpA) can affect diverse elements of an individual's life. The areas affected can be much more wide-ranging than the historical medical model of SpA, causing increased disease activity (pain and stiffness) and disability (reduced range of movement and physical function). A more holistic view of the individual results in the realization that many other areas of life can be adversely affected by axSpA, from the ability to work effectively and function socially, to effects on quality of life and the onset of worsening fatigue or mood disturbance. A good understanding of these areas outside the medical model allows for an improved understanding of the overall life impact of axSpA. This highlights the importance of understanding how to measure these elements of life using patient-reported outcome measures that can truly reflect an individual's experience of axSpA. These measures can then provide a better insight into the risks and benefits of interventions and medications used to treat axSpA.


Assuntos
Prestação Integrada de Cuidados de Saúde/métodos , Saúde Holística , Medidas de Resultados Relatados pelo Paciente , Espondilartrite/terapia , Espondilite Anquilosante/terapia , Humanos , Qualidade de Vida , Espondilartrite/psicologia , Espondilite Anquilosante/psicologia
12.
Rheumatology (Oxford) ; 57(suppl_6): vi10-vi17, 2018 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-30445485

RESUMO

The aim of this article is to explore the benefits and limitations of the established treatments for axial SpA (axSpA), including physiotherapy, NSAIDs, conventional synthetic DMARDs and biologic DMARDs such as TNF inhibitors (TNFis). It also briefly discusses the emerging role of anti-IL-17 therapy, which could be used as a valuable alternative to first-line biologic DMARD treatment or as a second-line treatment for patients who are inadequate responders to TNFi therapy, as evidenced by various studies. Exercise programmes improve health-related quality of life and hydrotherapy improves disease activity and functional parameters in AS. NSAIDs have been proven to substantially relieve symptoms in 70-80% of patients and enhance physiotherapy by reducing pain and stiffness. The role of NSAIDs in preventing radiographic progression remains unclear. The use of conventional synthetic DMARDs (csDMARDs) is limited to peripheral arthritis; there is insufficient evidence to support the use of csDMARDs for axial disease. TNFi therapy reduces the disease activity of axSpA, however, as not all patients respond to treatment in the same way, it is good to have other therapeutic options available. Finally, this article explores the potential for IL-17 inhibition in AS and introduces clinical data for secukinumab, a fully human monoclonal antibody targeting IL-17A.


Assuntos
Anti-Inflamatórios não Esteroides/uso terapêutico , Antirreumáticos/uso terapêutico , Espondilartrite/terapia , Padrão de Cuidado , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Anticorpos Monoclonais/uso terapêutico , Anticorpos Monoclonais Humanizados , Humanos , Espondilartrite/imunologia
13.
Clin Exp Rheumatol ; 36 Suppl 114(5): 35-42, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30296971

RESUMO

Axial spondyloarthritis (axSpA) is a chronic rheumatic disease characterised by inflammatory back pain and several other disease manifestations and comorbidities. The 2009 ASAS classification criteria differentiate between the classical ankylosing spondylitis or radiographic axSpA and non-radiographic axSpA based on the presence or absence of definite radiographic changes in the sacroiliac joints. Importantly, back pain in patients with axSpA may well have reasons other than axial inflammation or new bone formation. There are several important differential diagnoses such as diffuse idiopathic skeletal hyperostosis and osteitis condensans. This review summarises recent publications concerning the performance of imaging modalities in the field, such as conventional radiography, magnetic resonance imaging, computed tomography and dual energy x-ray absorptiometry including the trabecular bone score.


Assuntos
Diagnóstico por Imagem/métodos , Reumatologia/métodos , Articulação Sacroilíaca/diagnóstico por imagem , Espondilartrite/diagnóstico por imagem , Espondilite Anquilosante/diagnóstico por imagem , Dor nas Costas/diagnóstico por imagem , Dor nas Costas/etiologia , Diagnóstico Diferencial , Humanos , Valor Preditivo dos Testes , Prognóstico , Reprodutibilidade dos Testes , Articulação Sacroilíaca/fisiopatologia , Índice de Gravidade de Doença , Espondilartrite/complicações , Espondilartrite/fisiopatologia , Espondilartrite/terapia , Espondilite Anquilosante/complicações , Espondilite Anquilosante/fisiopatologia , Espondilite Anquilosante/terapia
14.
Scand J Clin Lab Invest ; 78(6): 483-489, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30176763

RESUMO

The chronic joint inflammation in axial spondyloarthritis (axSpA) is characterized by infiltration of activated macrophages. The haptoglobin-hemoglobin receptor CD163 and the mannose receptor CD206 are strongly expressed on M2c and M2a macrophages, respectively. We measured the soluble forms of the receptors (sCD163 and sCD206) in plasma (PL) in two axSpA cohorts. All patients fulfil the 2009 Assessment of SpondyloArthritis International Society (ASAS) classification criteria for axSpA and/or the 1984 modified New York criteria for ankylosing spondylitis. The first cohort included anti-TNF-α treated patients with active axSpA (n = 30); the second cohort included patients in early disease stages (n = 38). Plasma sCD163 and sCD206 were both within the reference interval of healthy controls (HC), but sCD163 decreased slightly during anti-TNF-α treatment [baseline: 1.49 mg/L (IQR: 1.22-1.77 mg/L, 12 weeks: 1.29 (IQR: 1.09-1.57) mg/L, 20 weeks: 1.25 (IQR: 0.99-1.75) mg/L, 52 weeks: 1.39 (IQR: 1.15-1.78) mg/L], while sCD206 increased [baseline: 0.17 (IQR: 0.13-0.21) mg/L, 12 weeks: 0.19 (0.16-0.23) mg/L, 20 weeks: 0.20 (0.14-0.24) mg/L, 52: 0.19 (IQR: 0.14-0.23) mg/L], pointing toward a shift in polarization of involved macrophages. Plasma levels of sCD206 proved significantly higher in patients with early disease stages and definite radiological sacroiliitis (n = 10). This was not the case for sCD163. A significant increase in response to anti-TNF-α treatment, could suggest sCD206 as a marker of response to anti-TNF-α treatment, however, the potential for the two macrophage markers as diagnostic and prognostic indicators of disease in axSpA is weak.


Assuntos
Antígenos CD/sangue , Antígenos de Diferenciação Mielomonocítica/sangue , Lectinas Tipo C/sangue , Macrófagos/imunologia , Lectinas de Ligação a Manose/sangue , Receptores de Superfície Celular/sangue , Sacroileíte/diagnóstico , Espondilartrite/diagnóstico , Adalimumab/uso terapêutico , Adulto , Anti-Inflamatórios/uso terapêutico , Antígenos CD/genética , Antígenos CD/imunologia , Antígenos de Diferenciação Mielomonocítica/genética , Antígenos de Diferenciação Mielomonocítica/imunologia , Biomarcadores/sangue , Movimento Celular , Estudos de Coortes , Diagnóstico Precoce , Feminino , Expressão Gênica , Humanos , Lectinas Tipo C/genética , Lectinas Tipo C/imunologia , Ativação de Macrófagos , Macrófagos/efeitos dos fármacos , Macrófagos/patologia , Masculino , Lectinas de Ligação a Manose/genética , Lectinas de Ligação a Manose/imunologia , Pessoa de Meia-Idade , Radiografia , Receptores de Superfície Celular/genética , Receptores de Superfície Celular/imunologia , Sacroileíte/imunologia , Sacroileíte/patologia , Sacroileíte/terapia , Solubilidade , Espondilartrite/imunologia , Espondilartrite/patologia , Espondilartrite/terapia , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Fator de Necrose Tumoral alfa/genética , Fator de Necrose Tumoral alfa/imunologia
16.
Reumatol. clín. (Barc.) ; 14(3): 155-159, mayo-jun. 2018. ilus
Artigo em Espanhol | IBECS | ID: ibc-174100

RESUMO

Objetivo. Estandarizar la evaluación clínica de pacientes con espondiloartritis (EspA) axial y artritis psoriásica (APs). Métodos. Estudio cualitativo que incluyó: 1) grupo nominal (18 expertos); 2) revisión de la literatura sobre variables empleadas en la evaluación de los pacientes con EspA axial o APs, y 3) grupo focal con reumatólogos y otro con pacientes con EspA axial o APs para analizar la evaluación de las EspA en las consultas de reumatología. Los expertos seleccionaron las variables a incluir en el cuadro de actuación con base en su relevancia, factibilidad en consulta y método/s de medición. Resultados. El cuadro de actuación incluye las variables para valorar antecedentes personales, exploración física, actividad y función, pruebas complementarias y tratamientos. Detalla factores de riesgo de progresión radiográfica, factores predictores de respuesta a terapia biológica, e incluye variables de excelencia. Conclusiones. Este cuadro de actuación para pacientes con EspA axial y APs podrá ayudar a homogeneizar la práctica clínica diaria y a mejorar el manejo y el pronóstico de estos pacientes


Objective. To standardize clinical evaluation of patients with axial spondyloarthritis (SpA) and psoriatic arthritis (PsA) using a checklist. Methods. Qualitative study that included: 1) nominal group (18 experts); 2) literature reviews of measures used in the assessment of patients with axial SpA or PsA; and 3) focus groups, one with rheumatologists and another with patients, organized to become familiar with their opinion on medical assistance. Taking this into account, the experts selected the measures to be included in the checklist based on their relevance, feasibility, and the outcome type. Results. The checklist includes measures for the evaluation of personal history, physical examination, activity and function, laboratory tests, imaging studies and treatments. It also defines risk factors of radiographic progression, predictors of the response to biological therapies, and comprises measures of excellence. Conclusions. This checklist for patients with axial SpA and PsA could help standardize daily clinical practice and improve clinical management and patient prognosis


Assuntos
Humanos , Literatura de Revisão como Assunto , Espondilartrite/diagnóstico , Artrite Psoriásica/diagnóstico , Exame Físico/métodos , Fatores de Risco , Prognóstico , Avaliação de Programas e Projetos de Saúde , Análise Qualitativa , Projetos , Espondilartrite/terapia , Artrite Psoriásica/terapia , Epidemiologia Descritiva , Análise Estatística
17.
Rheumatol Int ; 38(7): 1277-1284, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29786781

RESUMO

To develop and evaluate a web application based on multimedia animations, combined with a training program, to improve the prescription of exercises in spondyloarthritis (SpA). After a review of exercises included in the main clinical trials and recommendations of international societies, a multidisciplinary team-rehabilitators, rheumatologists, physiotherapists, computer scientists and graphic designers-developed a web application for the prescription of exercises (EJES-3D). Once completed, this was presented to 12 pairs of rehabilitators-rheumatologists from the same hospital in a workshop. Knowledge about exercise was tested in rheumatologists before and 6 months after the workshop, when they also evaluated the application. The EJES-3D application includes 38 multimedia videos and allows prescribing predesigned programs or customizing them. A patient can consult the prescribed exercises at any time from a device with internet connection (mobile, tablet, or computer). The vast majority of the evaluators (89%) were satisfied or very satisfied and considered that their expectations regarding the usefulness of the web application had been met. They highlighted the ability to tailor exercises adapted to the different stages of the disease and the quality and variety of the videos. They also indicated some limitations of the application and operational problems. The EJES-3D tool was positively evaluated by experts in SpA, potentially the most demanding group of users with the most critical capacity. This allows a preliminary validation of the contents, usefulness, and ease of use. Analyzing and correcting the errors and limitations detected is allowing us to improve the EJES-3D tool.


Assuntos
Terapia por Exercício , Multimídia , Espondilartrite/terapia , Gerenciamento Clínico , Humanos , Internet , Projetos Piloto
18.
Semin Musculoskelet Radiol ; 22(2): 127-146, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29672803

RESUMO

Both the fields of rheumatology and radiology are changing rapidly. Effective medication has become available for rheumatoid arthritis (RA) and transformed it from a progressive disabling disease into a chronic disease. Indications for magnetic resonance imaging (MRI) have changed accordingly, shifting toward early detection. There is also an overall increased clinical demand for high-end imaging. Together with improvement of MRI units and sequences, MRI protocols are adapted based on clinical indications. This article addresses (1) the clinical background and present role of MRI in early disease detection, (2) RA involvement of peripheral joints, (3) RA involvement of the spine, and (4) state-of-the-art RA MRI protocols. The key toward cost-effective MRI examination in RA is communication between radiologist and rheumatologist as well as awareness and knowledge of the basics and advancements in both fields.


Assuntos
Artrite Reumatoide/diagnóstico por imagem , Articulações/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Espondilartrite/diagnóstico por imagem , Artrite Reumatoide/patologia , Artrite Reumatoide/terapia , Diagnóstico Precoce , Humanos , Articulações/patologia , Espondilartrite/patologia , Espondilartrite/terapia , Imagem Corporal Total
19.
Adv Ther ; 35(4): 545-562, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29516409

RESUMO

INTRODUCTION: Immune-mediated inflammatory diseases (IMIDs) are chronic autoimmune conditions that share common pathophysiologic mechanisms. The optimal management of patients with IMIDs remains challenging because the coexistence of different conditions requires the intervention of several specialists. The aim of this study was to develop a series of statements defining overarching principles that guide the implementation of a multidisciplinary approach for the management of spondyloarthritis (SpA)-related IMIDs including SpA, psoriasis, psoriatic arthritis, Crohn's disease, ulcerative colitis and uveitis. METHODS: A Delphi consensus-based approach was used to identify a core set of statements. The process included development of initial questions by a steering committee, an exhaustive search of the literature using complementary approaches to identify potential statements and two Delphi voting rounds for finalization of the statements. RESULTS: Consensus was achieved on the related nature of IMIDs, the existence of a high prevalence of multiple IMIDs in a single patient and the fact that a multidisciplinary approach can result in a more extensive evaluation and comprehensive approach to treatment. The goals of a multidisciplinary team should be to increase diagnosis of concomitant IMIDs, improve the decision-making process, and increase patient satisfaction and adherence. Early referral and diagnosis, early recognition of concomitant IMIDs and optimizing treatment to improve patient quality of life are some of the advantages of using multidisciplinary teams. To be effective, a multidisciplinary team should be equipped with the appropriate tools for diagnosis and follow-up, and at a minimum the multidisciplinary team should include a dermatologist, gastroenterologist and rheumatologist; providing psychologic support via a psychologist and involving an ophthalmologist, general practitioners and nurses in multidisciplinary care is also important. CONCLUSION: The present Delphi consensus identified a set of overarching principles that may be useful for implementation of a multidisciplinary approach for the management of SpA-related IMIDs. FUNDING: Aristea and Hippocrates.


Assuntos
Doenças Autoimunes/epidemiologia , Doenças Autoimunes/terapia , Espondilartrite/epidemiologia , Espondilartrite/terapia , Colite Ulcerativa/epidemiologia , Colite Ulcerativa/terapia , Doença de Crohn/epidemiologia , Doença de Crohn/terapia , Humanos , Comunicação Interdisciplinar , Planejamento de Assistência ao Paciente , Equipe de Assistência ao Paciente , Prevalência , Psoríase/epidemiologia , Psoríase/terapia , Qualidade de Vida , Encaminhamento e Consulta , Uveíte/epidemiologia , Uveíte/terapia
20.
Rheumatology (Oxford) ; 57(6): 987-996, 2018 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-29529295

RESUMO

Objectives: There have been significant advances in axial spondyloarthritis (axSpA), with implications for service delivery. We evaluated the state of axSpA rheumatology services and how people with axSpA perceive their care. Methods: An online patient survey was emailed to all members of the National Ankylosing Spondylitis Society and advertised widely via social media. Separately, a Web-based questionnaire about axSpA services was sent to rheumatologists at all 172 acute hospital trusts in the UK. Results: From the National Ankylosing Spondylitis Society survey, data for 1979 surveys (56% males) were available for analysis. The majority of respondents had longstanding disease and identified their diagnosis as AS, with only 44% aware of the term axSpA. Eighty-two per cent of respondents were currently attending a rheumatologist, with 43% on biologic agents. Satisfaction scores for rheumatology care were high. Respondents' concerns included access during disease flares and adverse effects of analgesics. From the rheumatology survey, the concept and terminology of axSpA was widely accepted by respondents (88%). The majority of centres had at least one rheumatologist with a specialist interest in axSpA (62%), dedicated axSpA clinics (58%) or a multidisciplinary team for axSpA (64%). BASDAI (99%), BASFI (74%) and BASMI (65%) were routinely performed. All centres had access to MRI scans, but scanning protocols varied and were often sub-optimal. Conclusion: Although overall satisfaction with rheumatology care was high, the results indicate significant unmet patient needs and discrepancies in service provision. This information will inform the development of quality standards for axSpA in order to improve quality and deliver equitable care for all patients.


Assuntos
Assistência à Saúde/normas , Satisfação do Paciente/estatística & dados numéricos , Qualidade da Assistência à Saúde/normas , Reumatologistas/estatística & dados numéricos , Reumatologia/estatística & dados numéricos , Espondilartrite/terapia , Inquéritos e Questionários , Adulto , Europa (Continente) , Feminino , Humanos , Internet , Masculino , Pessoa de Meia-Idade , Sociedades Médicas
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