Mireia Moreno

Does Thrombolysis Benefit Patients with Lacunar Syndrome

The efficacy of thrombolysis in clinical stroke subtypes is unclear. We compared the benefit of intravenous rt-PA in 11 patients with lacunar syndrome with that in 33 patients with a non-lacunar syndrome. Patients were matched by NIHSS score and time to treatment. Although no statistically significant differences were detected in outcome, the benefit was greater in the non- lacunar syndrome group.

Déficit de vitamina D en la fractura osteoporótica de cadera y factores asociados

Fundamento Y Objetivo La hipovitaminosis D es frecuente entre los ancianos y especialmente prevalente en los pacientes con fractura de cadera. La prevalencia y los factores asociados a este deficit vitaminico son poco conocidos en nuestro medio. El objetivo del presente trabajo ha sido determinar la prevalencia de hipovitaminosis D en los pacientes con fractura osteoporotica de cadera y analizar los posibles factores que favorecen dicho deficit. Pacientes Y Metodo Se ha realizado un estudio transversal, en el que se incluyo de forma consecutiva a todos los pacientes mayores de 65 anos ingresados con fractura osteoporotica de cadera durante el periodo comprendido entre marzo de 2002 y febrero de 2003. Se investigo la prevalencia de hipovitaminosis D y de hiperparatiroidismo secundario. Se recogieron el grado de exposicion solar, la capacidad funcional, el estado nutricional y la presencia de comorbilidad. Resultados Se incluyo a 324 pacientes con una edad media (desviacion estandar) de 83 (7) anos; un 80% eran mujeres. Se observo hipovitaminosis D en 217 casos (67%; intervalo de confianza [IC] del 95%, 62-72%), de los que el 57% presentaba hiperparatiroidismo secundario. El mal estado nutricional –valores de albumina Conclusiones La prevalencia de hipovitaminosis D es alta en los pacientes con una fractura osteoporotica de cadera y en mas de la mitad de ellos condiciona la presencia de hiperparatiroidismo secundario. Este deficit es especialmente prevalente entre los individuos con poca exposicion solar, mal estado nutricional y baja capacidad funcional.

Utilidad del pamidronato en el tratamiento de la artropatía de Charcot

OBJECTIVE To investigate the usefulness of pamidronate in the management of active Charcots arthropathy. MATERIAL AND METHODS Open prospective study with a follow-up of 12 months, including patients with active neuroarthropathy seen over a period of 3 years in our rheumatology unit. Patients received three pamidronate infusions at 0, 2, and 4 months. Clinical assessment, serum and urine bone turnover markers, radiological exam, and scintigraphy were performed before and after treatment. RESULTS Seven patients were ncluded (4F/3M), mean age, 51.3 years (30-64). The underlying disease was diabetes mellitus in 4 cases, syringomyelia in 2, and sensory and autonomic neuropathy in 1. The joints affected were shoulder, ankle, tarsians, metacarpophalaneal, and metatarsophalangeal. All patients showed a rapid resolution of clinical symptoms, with a clear reduction of all bone remodeling markers that achieved statistical significance for urine NTX and urinary pyridoline (P=.04 and P=.03, respectively). Six of 7 patients disclosed at the end of follow-up a radiological healing. Quantitative scyntigraphy showed a clear reduction of the bone (99)Tm uptake. No important side affects were reported. CONCLUSIONS Pamidronate appears as a useful treatment for neuroarthropathy independently of the underlying disease. A rapid diagnosis and early pamidronate treatment could avoid severe articular consequences.Objetivo: Investigar la utilidad del pamidronato en el tratamiento de la neuroartropatia en fase activa. Material y metodos: Estudio prospectivo, abierto, con un seguimiento de 12 meses. En un periodo de 3 anos todos los pacientes con neuroartropatia activa visitados en la unidad de reumatologia recibieron tres infusiones de pamidronato a los 0, 2 y 4 meses. Se realizo valoracion clinica, de marcadores de remodelado oseo en sangre y orina, radiografia simple y gammagrafia osea cuantitativa antes y despues del tratamiento. Resultados: Se incluyo a 7 pacientes (4 varones y 3 mujeres), con una media de edad de 51,3 (30-64) anos. La enfermedad de base fue diabetes mellitus en 4 casos, siringomielia en 2 y neuropatia sensitiva autonomica en 1. Las articulaciones afectadas fueron hombro, tobillo, tarsianas, metatarsofalangicas y metacarpofalangicas. Todos los pacientes mostraron una rapida resolucion de los sintomas, con una clara reduccion de todos los marcadores de remodelado oseo siendo estadisticamente significativa en el caso del NTX y piridolina en orina (p = 0,04 y p = 0,03, respectivamente). Seis de los 7 pacientes mostraron una mejoria radiologica. La gammagrafia cuantitativa mostro una reduccion evidente de la captacion. No se observaron efectos adversos importantes. Conclusiones: El pamidronato parece un tratamiento util para la artropatia de Charcot independientemente de la enfermedad de base. El diagnostico precoz y la administracion rapida del tratamiento puede evitar complicaciones articulares graves

Development and Validation of a New Instrument to Measure Health-related Quality of Life in Patients with Psoriatic Arthritis: The VITACORA-19

Objective. To develop/validate an instrument to measure health-related quality of life (HRQoL) in patients with psoriatic arthritis (PsA), for use in clinical studies. Methods. An item pool of 35 items was generated following standardized procedures. Item reduction was performed using clinimetric and psychometric approaches after administration to 66 patients with PsA. The resulting instrument, the VITACORA-19, consists of 19 items. Its validity content, internal consistency, test-retest reliability, known groups/convergent validity, and sensitivity to change were tested in a longitudinal and multicenter study conducted in 10 hospitals in Spain, with 323 patients who also completed the EuroQol 5-dimensional questionnaire (EQ-5D) and a health status transition item. There were 3 study groups: group A (n = 209, patients with PsA), group B (n = 71, patients with arthritis without psoriatic aspect, patients with arthrosis, and patients with dermatitis), and group C (n = 43, healthy controls). Results. The questionnaire was considered easy/very easy to answer by 94.7% of the patients with PsA. The factorial analysis clearly identified only 1 factor. Cronbach’s alpha coefficient and interclass correlation coefficients exceeded 0.90. Statistically significant differences (p < 0.001) were observed between groups: subjects from group C had better HRQoL, followed by group B, and finally group A had the worst HRQoL. The VITACORA-19 scores showed significant correlations (p < 0.001) to PsA disease activity, EQ-5D, and perceived health state, scoring the patients with better health state higher. The minimum important difference was established as an 8-point change in the global score. Conclusion. The Spanish-developed VITACORA-19, designed to measure HRQoL in patients with PsA, has good validity, reliability, and sensitivity to change.

Identification and management of comorbidity in psoriatic arthritis: evidence- and expert-based recommendations from a multidisciplinary panel from Spain

The objective is to establish recommendations, based on evidence and expert opinion, for the identification and management of comorbidities in patients with psoriatic arthritis (PsA). The following techniques were applied: discussion group, systematic review, and Delphi survey for agreement. A panel of professionals from four specialties defined the users, the sections of the document, possible recommendations, and what systematic reviews should be performed. A second discussion was held with the results of the systematic reviews. Recommendations were formulated in the second meeting and voted online from 1 (total disagreement) to 10 (total agreement). Agreement was considered if at least 70% voted ≥7. The level of evidence and grade of recommendation were assigned using the Oxford Centre for Evidence-Based Medicine guidance. The full document was critically appraised by the experts, and the project was supervised at all times by a methodologist. In a final step, the document was reviewed and commented by a patient and a health management specialist. Fourteen recommendations were produced, together with a checklist to facilitate the implementation. The items with the largest support from evidence were those related to cardiovascular disease and risk factors. The panel recommends paying special attention to obesity, smoking, and alcohol consumption, as they are all modifiable factors with an impact on treatment response or complications of PsA. Psychological and organizational aspects were also deemed important. We herein suggest practical recommendations for the management of comorbidities in PsA based on evidence and expert opinion.

Ultrasound Findings in Patients With Femoracetabular Impingement Without Radiographic Osteoarthritis: A Pilot Study

To assess ultrasound (US) abnormalities in patients with clinical and radiographic features of femoracetabular impingement (FAI) without radiologic osteoarthritis.

Influence of HLA-B27 on the Ankylosing Spondylitis phenotype: results from the REGISPONSER database

ObjectiveTo assess HLA-B27 influence on the clinical phenotype of Ankylosing Spondylitis (AS) patients.MethodAn observational, cross-sectional and descriptive study of AS patients from the Spanish REGISPONSER database was performed. Demographic, clinical, disease activity (Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP)), and radiographic data (Bath Ankylosing Spondylitis Radiology Index (BASRI) score) were compared regarding HLA-B27 status. A univariate and multivariate analysis was performed to identify variables independently related to the presence of HLA-B27.ResultsData from 1235 patients (74.8% male) were analyzed; 1029 were HLA-B27 positive (83%). HLA-B27-positive patients showed higher family aggregation and an earlier onset of disease compared with those who were HLA-B27 negative. HLA-B27-negative patients presented statistically higher BASDAI and BASFI scores and higher prevalence of arthritis, dactylitis, and extra-articular manifestations (psoriasis and inflammatory bowel disease (IBD)) but not anytime uveitis compared with those who were HLA-B27 positive.In the multivariate analysis, family history (odds ratio (OR) 2.10, 95% confidence interval (CI) 1.27–3.49), younger age at diagnosis (OR 0.97, 95% CI 0.96–0.98), presence of peripheral arthritis (OR 0.53, 95% CI 0.32–0.89), dactylitis (OR 0.16, 95% CI 0.05–0.56), psoriasis (OR 0.45, 95% CI 0.26–0.78), and IBD (OR 0.22, 95% CI 0.12–0.40) were the main variables independently related to the presence or not of HLA-B27.ConclusionIn Caucasian AS patients, the presence of HLA-B27 is related to an earlier disease onset and higher family aggregation. Absence of HLA-B27 is related to a higher frequency of peripheral arthritis, dactylitis, and extra-articular manifestations. Being HLAB27 positive is not related to a higher burden of disease or anytime uveitis.

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.

Dermatitis intersticial granulomatosa asociada al lupus: a propósito de un caso

Recently, we treated a patient with interstitial granulomatous dermatitis (IGD) associated with systemic lupus erythematosus (SLE). Given the refractoriness of the condition to standard therapy, treatment with belimumab was begun, and the response was satisfactory. In view of the absence of data in the literature on the efficacy of belimumab in IGD associated with SLE, the report of this case was considered to be interesting, as it would enable us to examine new therapeutic lines in refractory IGD. The patient was a 40-year-old white man who had been diagnosed with SLE at the age of 35 on the basis of leukopenia, oral and nasal ulcers, arthritis of the hands, myositis and cutaneous involvement in the form of diffuse alopecia. He was also positive for immunological markers (antinuclear, anti-Smith, anti-Ro and anti-double-stranded DNA antibodies) and had decreased complement levels. Given the predominance of joint involvement, at first, he was treated with prednisone at 10 mg/day and hydroxychloroquine at 400 mg/day. There was a partial response in the joints, but none with respect to the skin. He had a substantial deterioration of the cutaneous manifestations, developing patches of alopecia areata, palpebral edema and nonpruritic, erythematous violaceous macular lesions on his face, torso and proximal portion of extremities, producing a serious physical and psychological distress for the patient. In addition, he had constitutional symptoms, with fever and an elevation of serum markers of lupus activity. A biopsy of the skin lesions revealed an interstitial lymphohistiocytic infiltrate in superficial and deep dermis, with the presence of mucin deposits arranged around collagen fibers, corresponding histopathologically to IGD (Fig. 1). It was decided to treat the patient