Juan Carlos Torre Alonso

Documento SER de consenso sobre el uso de terapias biológicas en la artritis psoriásica

OBJECTIVE Due to the amount and quality variability regarding the use of biologic therapy (BT) in psoriatic arthritis (PsA) patients, the Spanish Society of Rheumatology (SER) has promoted the generation of recommendations based on the best evidence available. These recommendations should serve as reference to rheumatologists and those involved in the treatment of patients with PsA, who are using, or about to use BT. METHODS Recommendations were developed following a nominal group methodology and based on systematic reviews. The level of evidence and degree of recommendation was classified according to the model proposed by the Center for Evidence Based Medicine at Oxford. The level of agreement was established through Delphi technique. RESULTS We have produced recommendations for the use of TB currently available for PsA in our country. These recommendations include disease assessment, treatment objectives, therapeutic scheme and switching. CONCLUSIONS We present an update on the SER recommendations for the use of BT in patients with PsA.

Consensus statement of the Spanish Society of Rheumatology on the management of biologic therapies in psoriatic arthritis

Abstract Objective Due to the amount and quality variability regarding the use of biologic therapy (BT) in psoriatic arthritis (PsA) patients, the Spanish Society of Rheumatology (SER) has promoted the generation of recommendations based on the best evidence available. These recommendations should serve as reference to rheumatologists and those involved in the treatment of patients with PsA, who are using, or about to use BT. Methods Recommendations were developed following a nominal group methodology and based on systematic reviews. The level of evidence and degree of recommendation was classified according to the model proposed by the Center for Evidence Based Medicine at Oxford. The level of agreement was established through Delphi technique. Results We have produced recommendations for the use of TB currently available for PsA in our country. These recommendations include disease assessment, treatment objectives, therapeutic scheme and switching. Conclusions We present an update on the SER recommendations for the use of BT in patients with PsA.

Standards of care for patients with spondyloarthritis

To define and give priory to standards of care in patients with spondyloarthritis (SpA). A systematic literature review on SpA standards of care and a specific search in relevant and related sources was performed. An expert panel was established who developed the standards of care and graded their priority (high, mild, low, or no priority) following qualitative methodology and Delphi process. An electronic survey was sent to a representative sample of 167 rheumatologists all around the country, who also gave priority to the standards of care (same scale). A descriptive analysis is presented. The systematic literature review retrieved no article specifically related to SpA patients. A total of 38 standards of care were obtained—12 related to structure, 20 to process, and 6 to result. Access to care, treatment, and safety standards of care were given a high priority by most of rheumatologists. Standards not directly connected to daily practice were not given such priority, as standards which included a time framework. The standards generated for the performance evaluation (including patient and professionals satisfaction) were not considered especially important in general. This set of standards of care should help improve the quality of care in SpA patients.

Fatal acute pancreatitis complicated by pancreatic pseudocysts in a patient with systemic lupus erythematosus

Pancreatitis is a relatively rare but severe manifestation in systemic lupus erythematosus (SLE) patients. We report a case of a 39-year-old woman with previous SLE diagnose treated with prednisone and mycophenolate mofetil who developed an acute pancreatitis complicated by pancreatic pseudocysts within the context of a severe lupus flare. Elevated serum amylase and computerized tomography confirmed the diagnosis and mechanical obstruction or toxic-metabolic etiologies were ruled out. In the present case, we opted for the clinical surveillance of pancreatic pseudocyst and not perform invasive medical procedures to drainage. A steroid therapy was started in order to achieve SLE and pancreatitis remission, however, it was unable to avoid the development of multiorgan failure and patient died a few days after diagnosis was made.

Dactilitis: evaluación, implicaciones pronósticas y abordaje terapéutico

dísticamente superior, tanto como manifestación de inicio como en el curso de la propia enfermedad. Así el 10,2% de los pacientes con artritis psoriásica presenta al menos una dactilitis al inicio de la enfermedad frente al 5,4% de los pacientes con artritis reactivas o el 4,4% de los que tienen espondiloartropatías indiferenciadas (p < 0,001). Algo similar obtenemos cuando valoramos la dactilitis como signo en cualquier momento de la enfermedad, ya que se presenta en el 34,3% de las artritis psoriásicas frente al 21,8% de las artritis reactivas o el 11,1% de las espondiloartropatías indiferenciadas. La dactilitis también ocurre en otras enfermedades que aunque no son objeto de esta revisión recordaremos muy brevemente. Las manifestaciones reumáticas de la sarcoidosis incluyen, además de artritis, las lesiones óseas y musculares y la dactilitis3. Ésta puede ocurrir en el 17% de los pacientes y se observa con más frecuencia en pacientes con sarcoidosis crónica acompañando a otras lesiones cutáneas. La dactilitis tuberculosa, rara entidad que se observa en menos del 5% de los pacientes con tuberculosis extrapulmonar, se caracteriza porque las tumefacción de las partes blandas es secundaria a la osteomielitis, habitualmente de una falange del dedo4. La dactilitis sifilítica, aún más rara, remeda en alguna manera a la tuberculosa, sobre todo en su imagen radiológica, aunque aquella con mucha más reacción perióstica5. La infección piógena, generalmente estreptocócica, de las partes blandas del dedo se manifiesta también como dactilitis6. Mucho más habitual, en nuestro medio, es la tenosinovitis que se presenta en el curso de la enfermedad gotosa, normalmente avanzada7.

Desarrollo de un cuadro de actuación para la evaluación de pacientes con espondiloartritis axial y artritis psoriásica en la práctica diaria: proyecto ONLY TOOLS

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.

Recomendaciones de la Sociedad Española de Reumatología sobre el tratamiento y uso de terapias sistémicas biológicas y no biológicas en artritis psoriásica

OBJECTIVE The main purpose of this recommendation statement is to provide clinicians with the best available evidence and the best opinion agreed upon by the panelists for a rational use of synthetic disease modifying antirheumatic drugs (DMARDs) and biologicals in psoriatic arthritis (PsA) patients. The present document also focuses on important aspects in the management of PsA, such as early diagnosis, therapeutic objectives, comorbidities and optimization of treatment. METHODS The recommendations were agreed by consensus by a panel of 8 expert rheumatologists, previously selected by the Spanish Society of Rheumatology (SER) through an open call. The phases of the work were: identification of key areas for updating the previous consensus, analysis and synthesis of scientific evidence (modified Oxford system, Centre for Evidence-based Medicine, 2009) and formulation of recommendations based on this evidence and by consensus techniques. RESULTS Seventeen recommendations were issued for the treatment of PsA patients. Six of them were of general nature, ranging from the early diagnosis and treatment to the importance of assessing comorbidities. The other 11 were focused on the indications for DMARDs and biological therapy in the distinct clinical forms of the disease. Likewise, the situation of failure of the first biological is addressed and treatment algorithms and a table with the different biological therapies are also included. CONCLUSIONS We present the update of SER recommendations for the treatment of PsA with DMARDs and biologics.