Federico Navarro Sarabia

Un acercamiento bibliométrico a la investigación en fibromialgia

OBJECTIVES To obtain a general and updated vision of research into fibromyalgia for its better understanding. A productivity analysis (by year and author) and a content analysis (by journal and topic) was carried out. METHODOLOGY The computer databases of the Web of Knowledge: Science Citation Index Expanded (SCIEXPANDED) and Social Sciences Citation Index (SSCI) of the Web of Science were used. For the exploration of the topics a content analysis was done on a sample of 356 articles, obtained using a simple randomized procedure based on a random number table (risk α=0.05; z(α)=1.96≈2; p=q=0.5) with a sample error of 5%, with the purpose of reaching some general conclusions in the study of this topic area. RESULTS AND CONCLUSIONS Overall, 3,201 article references have been obtained. In the years 1998 to 2003 the production of scientific articles increased considerably (43.5%) in comparison to the previous period, from 1992 to 1997 (27.4%). In the past decade (1996-2005) the production of articles tripled with respect to the first fifteen years (1980-1995). There is an overall 306 different journals that publish on this subject. The topic area that received most attention has been the study of the physiopathologic mechanisms (31.01%). There is an increment in the articles of psychiatry and psycology in the last few years.Objetivos: Obtener una vision generica actualizada de la investigacion en fibromialgia para entenderla mejor. Se presenta un analisis de productividad (por anos y autores) y un analisis de materias (por revistas y areas tematicas). Metodo: Se ha utilizado las bases computarizadas de la Web of Knowledge: Science Citation Index Expanded (SCI-EXPANDED) y Social Sciences Citation Index (SSCI) de la Web of Science. Para la exploracion de las areas tematicas se ha realizado un analisis de contenido de una muestra de 356 articulos, obtenida por medio del procedimiento aleatorio simple, utilizando la tabla de numeros al azar (riesgo a = 0,05; za = 1,96 = 2; p = q = 0,5) con un error muestral del 5%, con el proposito de llegar a algunas conclusiones generalizables del estudio de este campo tematico. Resultados y conclusiones: Se han obtenido un total de 3.201 referencias de articulos. En el periodo 1998-2003 aumenta de forma considerable la produccion de articulos (43,5%) con respecto al periodo anterior 1992-1997 (27,4%). En la ultima decada (1996-2005) se triplica la produccion de articulos con respecto a los primeros 15 anos (1980-1995). Hay un total de 306 revistas diferentes que publican sobre esta area. El area tematica mas trabajada ha sido el estudio de los potenciales mecanismos patofisiologicos (31,01%). Hay un incremento de articulos de psiquiatria y psicologia en los ultimos anos.

El uso de abatacept en artritis reumatoide: revisión de la evidencia y recomendaciones

OBJECTIVE To review the clinical evidence on abatacept and to formulate recommendations in order to clear up points related to its use in rheumatology. METHOD An expert panel of rheumatologists objectively summarized the evidence on the mechanism of action, practicalities, effectiveness and safety of abatacept, and formulated recommendations following a literature review. The level of evidence and degree of recommendation was established. RESULTS The document presents 21 statements focused on evidence or recommendations on abatacept (14 evidence summaries and 9 recommendations). The level of evidence was 2b or higher according to the Oxford Centre for Evidence-Based Medicine scale on 14 occasions. The degree of the recommendation was A in two recommendations, C in one, and D in the rest. It was considered important to make recommendations on aspects with lower levels of evidence. CONCLUSIONS This is a practical document to supplement the summary of product characteristics.

Association between serum dickkopf-1 levels and disease duration in axial spondyloarthritis.

BACKGROUND Axial spondyloarthritis (axSpA) is characterized by new bone formation. The complex systems underlying this process involve Wnt-signaling pathway. It has been observed that serum levels of dickkopf-1 (DKK-1), an important inhibitor of Wnt-signaling, are decreased in patients with axSpA. However, these data are from studies including only patients with long-standing disease. The aim of this study is to investigate if symptom duration influences on serum DKK-1 levels in patients with axSpA. MATERIAL AND METHODS A cross-sectional study including consecutive patients with axSpA (ASAS criteria) naïve for anti-TNF therapy. Collected data included demographic and disease characteristics, time since first symptom onset, assessment of disease activity and function, and determination of DKK-1 serum levels. Patients were classified as early axSpA (symptom duration ≤5 years) and established axSpA (>5 years). Linear regression models were employed to investigate the variables related to DKK-1 serum levels. RESULTS In total, 90 patients were included. Sixty-eight patients had early axSpA and 22 had established disease. Serum levels of DKK-1 were significantly higher in patients with early axSpA compared with established axSpA (22.1±12.6 vs 16.4±10.7pM; p=0.04). Among all tested variables, only symptom duration was significantly and inversely correlated with DKK-1 serum levels (beta: -0.041; p=0.01). CONCLUSION Serum DKK-1 levels in axSpA depend on disease duration. As disease duration increases, DKK-1 serum levels decrease. Based on this, an intensive treatment at early stages of the disease could have a better outcome on inhibiting/slowing radiographic progression in patients with axSpA.

Documento práctico para el uso de abatacept subcutáneo

OBJECTIVE To review the clinical evidence on subcutaneous (sc) abatacept and to formulate recommendations in order to clear up points related to its use in rheumatology. METHOD An expert panel of rheumatologists objectively summarized the evidence on the mechanism of action, practicality, effectiveness, and safety of abatacept sc and formulated recommendations after a literature review. RESULTS The efficacy and safety of abatacept sc was studied in 7 clinical trials, 3 double-blind, 3 open, and one mixed, with the following endpoints: comparison against abatacept iv, impact on immunogenicity, effect of replacing iv by sc, abatacept sc in monotherapy, and non-inferiority to adalimumab. No significant differences were found between sc and iv abatacept on efficacy or safety. The development of sc abatacept has allowed a complementary study to the iv, formulation, thus making the abatacept profile better defined. CONCLUSIONS This is a practical document to supplement the summary of product characteristics. In summary, abatacept sc is presented as an effective and safe drug and, therefore, as an alternative for use within the broad armamentarium the rheumatologist has to treat RA. It also has the advantage of being the only biological agent that can be administered iv and sc which can facilitate its use in certain patients.