Pub Date : 2024-10-01DOI: 10.1016/j.reuma.2024.04.004
Hakan Apaydin , Serdar Can Güven , Rezan Koçak Ulucaköy , Hakan Babaoğlu , Esra Kayacan Erdoğan , Kevser Orhan , Berkan Armağan
Aims
Evidence evaluating the association between pre-frailty and frailty, and risk of adverse health outcomes in patients with Behçet's syndrome (BS) is limited in the literature. The aim of this study was to characterize the prevalence of frailty and associated factors in a single-centre cohort of patients with BS.
Methods
Based on the International Study Group's criteria, this was a monocentric cross-sectional study of BS patients. The Fried frailty criteria were used to define frailty. The Turkish version of the Behçet's Disease Current Activity Form was used to measure the disease activity of BS. Damage index was assessed with the Behçet's Syndrome Overall Damage Index.
Results
Forty-four patients were enrolled. According to Fried frailty criteria, patients were classified as 13.6% frail, 59% pre-frail, and 27.2% robust, respectively. Compared to pre-frail and robust patients, frail patients had higher levels of inflammatory markers at the time of diagnosis. CRP levels at time of diagnosis and at the last visit were higher in the frail group than in the pre-frail and robust groups (p = 0.039 and p = 0.023, respectively). When active drugs for BS were evaluated, systemic glucocorticoid (50%, p = 0.030) and cyclophosphamide (33.3%, p = 0.006) treatments were higher in the frail group.
Conclusions
Frailty and pre-frailty are commonly detected even in younger patients with BS. Inflammation can be described as potential determinants of frailty status.
{"title":"Frailty assessment in patients with Behçet's syndrome: A cross-sectional monocentric study","authors":"Hakan Apaydin , Serdar Can Güven , Rezan Koçak Ulucaköy , Hakan Babaoğlu , Esra Kayacan Erdoğan , Kevser Orhan , Berkan Armağan","doi":"10.1016/j.reuma.2024.04.004","DOIUrl":"10.1016/j.reuma.2024.04.004","url":null,"abstract":"<div><h3>Aims</h3><div>Evidence evaluating the association between pre-frailty and frailty, and risk of adverse health outcomes in patients with Behçet's syndrome (BS) is limited in the literature. The aim of this study was to characterize the prevalence of frailty and associated factors in a single-centre cohort of patients with BS.</div></div><div><h3>Methods</h3><div>Based on the International Study Group's criteria, this was a monocentric cross-sectional study of BS patients. The Fried frailty criteria were used to define frailty. The Turkish version of the Behçet's Disease Current Activity Form was used to measure the disease activity of BS. Damage index was assessed with the Behçet's Syndrome Overall Damage Index.</div></div><div><h3>Results</h3><div>Forty-four patients were enrolled. According to Fried frailty criteria, patients were classified as 13.6% frail, 59% pre-frail, and 27.2% robust, respectively. Compared to pre-frail and robust patients, frail patients had higher levels of inflammatory markers at the time of diagnosis. CRP levels at time of diagnosis and at the last visit were higher in the frail group than in the pre-frail and robust groups (<em>p</em> <!-->=<!--> <!-->0.039 and <em>p</em> <!-->=<!--> <!-->0.023, respectively). When active drugs for BS were evaluated, systemic glucocorticoid (50%, <em>p</em> <!-->=<!--> <!-->0.030) and cyclophosphamide (33.3%, <em>p</em> <!-->=<!--> <!-->0.006) treatments were higher in the frail group.</div></div><div><h3>Conclusions</h3><div>Frailty and pre-frailty are commonly detected even in younger patients with BS. Inflammation can be described as potential determinants of frailty status.</div></div>","PeriodicalId":47115,"journal":{"name":"Reumatologia Clinica","volume":"20 8","pages":"Pages 409-415"},"PeriodicalIF":1.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142357999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/j.reuma.2024.05.007
José María Álvaro-Gracia Álvaro , Petra Díaz del Campo Fontecha , José Luis Andréu Sánchez , Alejandro Balsa Criado , Rafael Cáliz Cáliz , Isabel Castrejón Fernández , Hèctor Corominas , José A. Gómez Puerta , Sara Manrique Arija , Natalia Mena Vázquez , Ana Ortiz García , Chamaida Plasencia Rodríguez , Lucía Silva Fernández , Jesús Tornero Molina
Objective
To update the consensus document of the Spanish Society of Rheumatology (SER) regarding the use of targeted biological and synthetic therapies in rheumatoid arthritis (RA) with the aim of assisting clinicians in their therapeutic decisions.
Methods
A panel of 13 experts was assembled through an open call by SER. We employed a mixed adaptation-elaboration-update methodology starting from the 2015 Consensus Document of the Spanish Society of Rheumatology on the use of biological therapies in RA. Starting with systematic reviews (SR) of recommendations from EULAR 2019, American College of Rheumatology 2021, and GUIPCAR 2017, we updated the search strategies for the PICO questions of GUIPCAR. An additional SR was conducted on demyelinating disease in relation to targeted biological and synthetic therapies. Following the analysis of evidence by different panelists, consensus on the wording and level of agreement for each recommendation was reached in a face-to-face meeting.
Results
The panel established 5 general principles and 15 recommendations on the management of RA. These encompassed crucial aspects such as the importance of early treatment, therapeutic goals in RA, monitoring frequency, the use of glucocorticoids, the application of conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), biological DMARDs (bDMARDs), and targeted synthetic DMARDs. Additionally, recommendations on dose reduction of these drugs in stable patients were included. This update also features recommendations on the use of bDMARDs and Janus Kinase inhibitors in some specific clinical situations, such as patients with lung disease, a history of cancer, heart failure, or demyelinating disease.
Conclusions
This update provides recommendations on key aspects in the management of RA using targeted biological and synthetic therapies.
目的更新西班牙风湿病学会（SER）关于类风湿性关节炎（RA）使用靶向生物和合成疗法的共识文件，以协助临床医生做出治疗决策。方法通过西班牙风湿病学会的公开征集，组建了一个由 13 位专家组成的小组。我们从 2015 年西班牙风湿病学会关于在 RA 中使用生物疗法的共识文件开始，采用了改编-阐述-更新的混合方法。从 EULAR 2019、American College of Rheumatology 2021 和 GUIPCAR 2017 建议的系统回顾（SR）开始，我们更新了 GUIPCAR PICO 问题的检索策略。我们还就脱髓鞘疾病与靶向生物和合成疗法的关系进行了额外的SR研究。不同的专家组成员对证据进行分析后，在一次面对面的会议上就每项建议的措辞和一致程度达成了共识。这些建议包括早期治疗的重要性、RA 的治疗目标、监测频率、糖皮质激素的使用、常规合成改善病情抗风湿药（csDMARDs）、生物 DMARDs（bDMARDs）和靶向合成 DMARDs 的应用等重要方面。此外，还包括对病情稳定的患者减少这些药物剂量的建议。本更新版还就在某些特殊临床情况下使用生物DMARDs和Janus激酶抑制剂提出了建议，如患有肺部疾病、癌症病史、心力衰竭或脱髓鞘疾病的患者。结论本更新版就使用靶向生物和合成疗法治疗RA的关键方面提出了建议。
{"title":"Actualización del Documento de Consenso de la Sociedad Española de Reumatología sobre el uso de terapias biológicas y sintéticas dirigidas en la artritis reumatoide","authors":"José María Álvaro-Gracia Álvaro , Petra Díaz del Campo Fontecha , José Luis Andréu Sánchez , Alejandro Balsa Criado , Rafael Cáliz Cáliz , Isabel Castrejón Fernández , Hèctor Corominas , José A. Gómez Puerta , Sara Manrique Arija , Natalia Mena Vázquez , Ana Ortiz García , Chamaida Plasencia Rodríguez , Lucía Silva Fernández , Jesús Tornero Molina","doi":"10.1016/j.reuma.2024.05.007","DOIUrl":"10.1016/j.reuma.2024.05.007","url":null,"abstract":"<div><h3>Objective</h3><div>To update the consensus document of the Spanish Society of Rheumatology (SER) regarding the use of targeted biological and synthetic therapies in rheumatoid arthritis (RA) with the aim of assisting clinicians in their therapeutic decisions.</div></div><div><h3>Methods</h3><div>A panel of 13 experts was assembled through an open call by SER. We employed a mixed adaptation-elaboration-update methodology starting from the 2015 Consensus Document of the Spanish Society of Rheumatology on the use of biological therapies in RA. Starting with systematic reviews (SR) of recommendations from EULAR 2019, American College of Rheumatology 2021, and GUIPCAR 2017, we updated the search strategies for the PICO questions of GUIPCAR. An additional SR was conducted on demyelinating disease in relation to targeted biological and synthetic therapies. Following the analysis of evidence by different panelists, consensus on the wording and level of agreement for each recommendation was reached in a face-to-face meeting.</div></div><div><h3>Results</h3><div>The panel established 5 general principles and 15 recommendations on the management of RA. These encompassed crucial aspects such as the importance of early treatment, therapeutic goals in RA, monitoring frequency, the use of glucocorticoids, the application of conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), biological DMARDs (bDMARDs), and targeted synthetic DMARDs. Additionally, recommendations on dose reduction of these drugs in stable patients were included. This update also features recommendations on the use of bDMARDs and Janus Kinase inhibitors in some specific clinical situations, such as patients with lung disease, a history of cancer, heart failure, or demyelinating disease.</div></div><div><h3>Conclusions</h3><div>This update provides recommendations on key aspects in the management of RA using targeted biological and synthetic therapies.</div></div>","PeriodicalId":47115,"journal":{"name":"Reumatologia Clinica","volume":"20 8","pages":"Pages 423-439"},"PeriodicalIF":1.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141688982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/j.reuma.2024.05.002
Pedro Alfonso Domínguez Vera , Luis Carrasco Páez
Background and objective
The use of SYmptomatic Slow-Acting Drugs for Osteoarthritis (SYSADOA) in the treatment of osteoarthritis (OA) has been a topic of debate in the scientific community and public entities regarding their public financing in Spain. The objective of this study was to describe and analyze the main positions of media outlets, public entities, regarding the use and financing of SYSADOA in Spain.
Methods
A qualitative and quantitative analysis of the content regarding the use and financing of SYSADOA was conducted in general media outlets (El País, El Mundo, La Vanguardia, ABC, and 20minutos), public statements, and Twitter® publications.
Results
A total of 15 articles in general media outlets, 872 tweets, and 7 public entity statements were identified. Mostly, media outlets (91%) and social media platforms (78%) exhibited a favorable trend towards funding.
Discussion and conclusions
The use of SYSADOA in OA patients continues to be controversial in the scientific community. However, there is consensus among patient associations in favor of public funding and use as a treatment for OA patients.
背景和目的在西班牙，骨关节炎慢作用药物 SYSADOA（SYmptomatic Slow-Acting Drugs for Osteoarthritis）在治疗骨关节炎（OA）方面的应用一直是科学界和公共实体就其公共融资问题争论不休的话题。本研究旨在描述和分析媒体、公共实体对西班牙使用和资助 SYSADOA 的主要立场。研究方法对一般媒体（El País、El Mundo、La Vanguardia、ABC 和 20minutos）、公共声明和 Twitter® 出版物中有关 SYSADOA 使用和资助的内容进行了定性和定量分析。结果共发现 15 篇一般媒体文章、872 条微博和 7 份公共实体声明。大多数媒体（91%）和社交媒体平台（78%）对资助表现出了积极的趋势。讨论与结论在 OA 患者中使用 SYSADOA 在科学界仍存在争议。然而，患者协会已达成共识，赞成公共资助并将其用作治疗 OA 患者的方法。
{"title":"Controversia en el uso y en la financiación de SYSADOA para la osteoartritis en España: un análisis del debate científico-social en los medios de comunicación","authors":"Pedro Alfonso Domínguez Vera , Luis Carrasco Páez","doi":"10.1016/j.reuma.2024.05.002","DOIUrl":"10.1016/j.reuma.2024.05.002","url":null,"abstract":"<div><h3>Background and objective</h3><div>The use of SYmptomatic Slow-Acting Drugs for Osteoarthritis (SYSADOA) in the treatment of osteoarthritis (OA) has been a topic of debate in the scientific community and public entities regarding their public financing in Spain. The objective of this study was to describe and analyze the main positions of media outlets, public entities, regarding the use and financing of SYSADOA in Spain.</div></div><div><h3>Methods</h3><div>A qualitative and quantitative analysis of the content regarding the use and financing of SYSADOA was conducted in general media outlets (<em>El País</em>, <em>El Mundo, La Vanguardia, ABC,</em> and <em>20minutos</em>), public statements, and Twitter® publications.</div></div><div><h3>Results</h3><div>A total of 15 articles in general media outlets, 872 tweets, and 7 public entity statements were identified. Mostly, media outlets (91%) and social media platforms (78%) exhibited a favorable trend towards funding.</div></div><div><h3>Discussion and conclusions</h3><div>The use of SYSADOA in OA patients continues to be controversial in the scientific community. However, there is consensus among patient associations in favor of public funding and use as a treatment for OA patients.</div></div>","PeriodicalId":47115,"journal":{"name":"Reumatologia Clinica","volume":"20 8","pages":"Pages 416-422"},"PeriodicalIF":1.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141695971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/j.reuma.2024.06.006
Jose Luis Vicente-Escudero
The presence of anxiety and depression symptoms in patients with lupus is common, and some research reports that psychological interventions can reduce them, therefore we conducted a systematic review and meta-analysis of the efficacy of psychological interventions in adults with systemic lupus erythematosus. Randomized and non-randomized clinical trials with adult population diagnosed with lupus, treated with psychological intervention, and compared with similar groups were selected. Several databases were searched in July 2023. Fourteen studies were included in the meta-analysis, with moderate effect sizes for anxiety and depression in group intervention modalities. Factors such as percentage of sample with lupus, gender, medication, and interventions with relaxation components influenced the results. Group psychological intervention programs are effective in reducing symptoms in patients with lupus, although further research on treatment modulating variables is needed.
{"title":"Efficacy of psychological interventions to reduce anxiety and depression in patients with lupus. A systematic review and meta-analysis","authors":"Jose Luis Vicente-Escudero","doi":"10.1016/j.reuma.2024.06.006","DOIUrl":"10.1016/j.reuma.2024.06.006","url":null,"abstract":"<div><div>The presence of anxiety and depression symptoms in patients with lupus is common, and some research reports that psychological interventions can reduce them, therefore we conducted a systematic review and meta-analysis of the efficacy of psychological interventions in adults with systemic lupus erythematosus. Randomized and non-randomized clinical trials with adult population diagnosed with lupus, treated with psychological intervention, and compared with similar groups were selected. Several databases were searched in July 2023. Fourteen studies were included in the meta-analysis, with moderate effect sizes for anxiety and depression in group intervention modalities. Factors such as percentage of sample with lupus, gender, medication, and interventions with relaxation components influenced the results. Group psychological intervention programs are effective in reducing symptoms in patients with lupus, although further research on treatment modulating variables is needed.</div></div>","PeriodicalId":47115,"journal":{"name":"Reumatologia Clinica","volume":"20 8","pages":"Pages 440-451"},"PeriodicalIF":1.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142357984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/j.reuma.2024.05.008
Santiago Campbell-Silva , Iyuleisa Castro-González , Santiago Campbell-Quintero , Sebastián Campbell-Quintero
{"title":"Carta al editor en respuesta a: «Neumomediastino espontáneo: una manifestación extramuscular de la dermatomiositis anti-MDA5. Reporte de 2 casos»","authors":"Santiago Campbell-Silva , Iyuleisa Castro-González , Santiago Campbell-Quintero , Sebastián Campbell-Quintero","doi":"10.1016/j.reuma.2024.05.008","DOIUrl":"10.1016/j.reuma.2024.05.008","url":null,"abstract":"","PeriodicalId":47115,"journal":{"name":"Reumatologia Clinica","volume":"20 8","pages":"Pages 454-455"},"PeriodicalIF":1.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142357985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/j.reuma.2024.06.003
Fatih Tastekin, Kenan Aksu
In this article, we present a case of resistant chondrocalcinosis who had a good response with 40 mg subcutaneous adalimumab. To our knowledge, this is the first report using adalimumab successfully in severe CPDD. Anti-TNF therapy can be a good therapeutic option for second line therapy in CPPD.
{"title":"Adalimumab treatment of resistant chondrocalcinosis","authors":"Fatih Tastekin, Kenan Aksu","doi":"10.1016/j.reuma.2024.06.003","DOIUrl":"10.1016/j.reuma.2024.06.003","url":null,"abstract":"<div><div>In this article, we present a case of resistant chondrocalcinosis who had a good response with 40<!--> <span>mg subcutaneous adalimumab<span><span>. To our knowledge, this is the first report using adalimumab successfully in severe CPDD. Anti-TNF therapy can be a good therapeutic option for second line therapy in </span>CPPD.</span></span></div></div>","PeriodicalId":47115,"journal":{"name":"Reumatologia Clinica","volume":"20 8","pages":"Pages 452-453"},"PeriodicalIF":1.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141848226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Gastrointestinal intolerance is common in rheumatoid arthritis (RA) patients using methotrexate and may lead to treatment discontinuation.
Aim
To study the prevalence of gastrointestinal symptoms in a sample of RA methotrexate users as well as its possible association with clinical and epidemiological variables.
Methods
Cross-sectional study of 192 patients with gastrointestinal symptoms using the MISS (methotrexate intolerance severity score). Clinical and epidemiological variables were collected through chart review and direct questioning. Patients’ adherence to methotrexate was evaluated through Moriski–Green–Levin questionnaire.
Results
The prevalence of gastrointestinal complaints was high with 55.7% of the sample classified as intolerant. Nausea and pain after drug ingestion were the most common reported complaints. This intolerance was associated with afro-descendant background (p = 0.02); presence of associated fibromyalgia (p = 0.04), concomitant use of glucocorticoids (p = 0.03) and Jak inhibitors (0.03). A tendency towards association with leflunomide use was observed (p = 0.06). Logistic regression was used to test drug associations with methotrexate intolerance, and showed that glucocorticoid use was independently associated with methotrexate intolerance OR = 1.85; 95% CI = 1.01–3.44; p = 0.04. Route of administration, presence of previous gastric complaints, age and methotrexate dose did not interfere with MISS. MISS results were associated with moderate adherence to the drug.
Conclusions
There is a high rate of methotrexate intolerance that is more common in afro-descendants, those with associated fibromyalgia, glucocorticoid and Jak inhibitors users.
背景胃肠道不耐受在使用甲氨蝶呤的类风湿性关节炎（RA）患者中很常见，可能会导致治疗中断。目的研究胃肠道症状在RA甲氨蝶呤使用者样本中的流行率及其与临床和流行病学变量的可能关联。通过病历审查和直接询问收集临床和流行病学变量。结果胃肠道不适的发生率很高，55.7%的样本被归类为不耐受。恶心和服药后疼痛是最常见的主诉。这种不耐受与非洲裔背景（p = 0.02）、伴有纤维肌痛（p = 0.04）、同时使用糖皮质激素（p = 0.03）和 Jak 抑制剂（0.03）有关。观察到与使用来氟米特相关的趋势（p = 0.06）。逻辑回归用于检验药物与甲氨蝶呤不耐受的相关性，结果显示使用糖皮质激素与甲氨蝶呤不耐受独立相关，OR = 1.85; 95% CI = 1.01-3.44; p = 0.04。给药途径、既往是否有胃部不适、年龄和甲氨蝶呤剂量均不影响 MISS。结论甲氨蝶呤不耐受的发生率很高，在非洲裔、伴有纤维肌痛、糖皮质激素和 Jak 抑制剂使用者中更为常见。
{"title":"Gastrointestinal symptoms in patients using methotrexate: A cross-sectional study in a sample with rheumatoid arthritis","authors":"Carina Albuquerque Roberto, Isabela Stachevski, Barbara Stadler Kahlow, Renato Nisihara, Thelma Skare","doi":"10.1016/j.reuma.2024.03.006","DOIUrl":"10.1016/j.reuma.2024.03.006","url":null,"abstract":"<div><h3>Background</h3><div>Gastrointestinal intolerance is common in rheumatoid arthritis (RA) patients using methotrexate and may lead to treatment discontinuation.</div></div><div><h3>Aim</h3><div>To study the prevalence of gastrointestinal symptoms in a sample of RA methotrexate users as well as its possible association with clinical and epidemiological variables.</div></div><div><h3>Methods</h3><div>Cross-sectional study of 192 patients with gastrointestinal symptoms using the MISS (methotrexate intolerance severity score). Clinical and epidemiological variables were collected through chart review and direct questioning. Patients’ adherence to methotrexate was evaluated through Moriski–Green–Levin questionnaire.</div></div><div><h3>Results</h3><div>The prevalence of gastrointestinal complaints was high with 55.7% of the sample classified as intolerant. Nausea and pain after drug ingestion were the most common reported complaints. This intolerance was associated with afro-descendant background (<em>p</em> <!-->=<!--> <!-->0.02); presence of associated fibromyalgia (<em>p</em> <!-->=<!--> <!-->0.04), concomitant use of glucocorticoids (<em>p</em> <!-->=<!--> <!-->0.03) and Jak inhibitors (0.03). A tendency towards association with leflunomide use was observed (<em>p</em> <!-->=<!--> <!-->0.06). Logistic regression was used to test drug associations with methotrexate intolerance, and showed that glucocorticoid use was independently associated with methotrexate intolerance OR<!--> <!-->=<!--> <!-->1.85; 95% CI<!--> <!-->=<!--> <!-->1.01–3.44; <em>p</em> <!-->=<!--> <!-->0.04. Route of administration, presence of previous gastric complaints, age and methotrexate dose did not interfere with MISS. MISS results were associated with moderate adherence to the drug.</div></div><div><h3>Conclusions</h3><div>There is a high rate of methotrexate intolerance that is more common in afro-descendants, those with associated fibromyalgia, glucocorticoid and Jak inhibitors users.</div></div>","PeriodicalId":47115,"journal":{"name":"Reumatologia Clinica","volume":"20 8","pages":"Pages 403-408"},"PeriodicalIF":1.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142358072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01DOI: 10.1016/j.reuma.2024.04.001
Yasser El Miedany , Sherif Ismail , Mary Wadie , Ulf Müller-Ladneru , Roberto Giacomelli , Vasiliki Liakouli , Walter Hermann , Nihal Fathy , Maha El Gaafary , Nermin A. Fouad , Sally Saber , Mohamed Hassan Abu-Zaid
Background
The peripheral microangiopathy may be well evaluated and studied by nailfold capillaroscopy (NFC) which is a safe and non-invasive technique. NFC has been reported to have both diagnostic and prognostic values in patients presenting with Raynaud's phenomenon.
Objective
The overarching objective of this work was to make a consensus on what domains should be included in a capillaroscopy report and that it can be used in daily clinical practice and clinical research in the area of rheumatology.
Methods
A Delphi questionnaire was developed regarding capillaroscopy report from a literature review and expert consensus. The first Delphi round included 14 core areas, its 18 domains with 50 subdomains, derived from a systematic literature review. The level of evidence was determined for each core set using the Oxford Centre for Evidence-based Medicine (CEBM) system. Nine response categories have been set per each item ranging between 1 and 9. Round 2, aimed to reach preliminary consensus “in” or “out” for domains. It included all items that were rated “critical” by at least 80% of the participants as well as any new domains proposed in round 1.
Results
The participants to the first, and second round were 11 experts. Fourteen domains were discussed in the two rounds. At the end of the survey, the final report template of NFC in rheumatology reached a consensus.
Conclusion
A nailfold capillaroscopy report template has been developed by this study, based on outcomes of a Delphi process, by international participants panel. All domains met the 80% voting threshold set in this work. The reporting template can be used for both clinical research as well as day to day practice to provide guidance and standardize the NFC reporting.
{"title":"Development of a core domain set for nailfold capillaroscopy reporting","authors":"Yasser El Miedany , Sherif Ismail , Mary Wadie , Ulf Müller-Ladneru , Roberto Giacomelli , Vasiliki Liakouli , Walter Hermann , Nihal Fathy , Maha El Gaafary , Nermin A. Fouad , Sally Saber , Mohamed Hassan Abu-Zaid","doi":"10.1016/j.reuma.2024.04.001","DOIUrl":"10.1016/j.reuma.2024.04.001","url":null,"abstract":"<div><h3>Background</h3><p>The peripheral microangiopathy may be well evaluated and studied by nailfold capillaroscopy (NFC) which is a safe and non-invasive technique. NFC has been reported to have both diagnostic and prognostic values in patients presenting with Raynaud's phenomenon.</p></div><div><h3>Objective</h3><p>The overarching objective of this work was to make a consensus on what domains should be included in a capillaroscopy report and that it can be used in daily clinical practice and clinical research in the area of rheumatology.</p></div><div><h3>Methods</h3><p>A Delphi questionnaire was developed regarding capillaroscopy report from a literature review and expert consensus. The first Delphi round included 14 core areas, its 18 domains with 50 subdomains, derived from a systematic literature review. The level of evidence was determined for each core set using the Oxford Centre for Evidence-based Medicine (CEBM) system. Nine response categories have been set per each item ranging between 1 and 9. Round 2, aimed to reach preliminary consensus “in” or “out” for domains. It included all items that were rated “critical” by at least 80% of the participants as well as any new domains proposed in round 1.</p></div><div><h3>Results</h3><p>The participants to the first, and second round were 11 experts. Fourteen domains were discussed in the two rounds. At the end of the survey, the final report template of NFC in rheumatology reached a consensus.</p></div><div><h3>Conclusion</h3><p>A nailfold capillaroscopy report template has been developed by this study, based on outcomes of a Delphi process, by international participants panel. All domains met the 80% voting threshold set in this work. The reporting template can be used for both clinical research as well as day to day practice to provide guidance and standardize the NFC reporting.</p></div>","PeriodicalId":47115,"journal":{"name":"Reumatologia Clinica","volume":"20 7","pages":"Pages 345-352"},"PeriodicalIF":1.2,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141961684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01DOI: 10.1016/j.reuma.2024.05.004
Ana Martins , Sofia Pimenta , Daniela Oliveira , Raquel Miriam Ferreira , Miguel Bernardes , Lúcia Costa , Georgina Terroso
Introduction
Systemic sclerosis (SSc) is characterized by progressive fibrosis of the skin and internal organs, microvascular damage and cellular and humoral immunity abnormalities. Microvascular damage can be easily detected through nailfold videocapillaroscopy (NVC).
Materials and methods
A retrospective study of patients with SSc and a NVC performed within the first 6 months after diagnosis was conducted. Visceral involvement in the first 3 years of the disease and NVC findings were collected. The severity of microvascular damage was classified into four categories, according to the worsening of the NVC patterns. The severity of organ involvement was assessed by the disease severity scale of Medsger for each organ and as a global measure of disease severity, the simple summation was used.
Results
A total of 86 patients with SSc were included. A moderate correlation was found between the severity of microvascular damage and the global measure of disease severity (r = 0.55, p < 0.001), the severity of peripheral vascular involvement (r = 0.43, p < 0.001) and the severity of skin involvement (r = 0.34, p = 0.001).
The presence of a late scleroderma pattern in NVC were predictive in univariate analysis of digital ulcers (OR 6.03, 95% CI 1.52–23.86, p = 0.01), muscular involvement (OR 13.09, 95% CI 1.09–156.78, p = 0.04), calcinosis (OR 27.22, 95% CI 5.56–133.33, p < 0.001) and worse global disease severity score (OR 1.67, 95% CI 1.17–2.38, p = 0.005). Multivariate analysis adjusted for disease duration and gender confirmed late pattern as an independent predictor of calcinosis (OR 42.89, 95% CI 5.53–332.85, p < 0.001).
Discussion and conclusion
In this study, the worsening of NVC pattern in SSc was associated with the overall disease severity, the severity of peripheral vascular involvement and extension of skin involvement. This study highlights the importance of NVC as a prognostic tool and a possible predictor of systemic visceral involvement.
导言系统性硬化症（SSc）的特征是皮肤和内脏器官进行性纤维化、微血管损伤以及细胞和体液免疫异常。材料与方法 对确诊后 6 个月内接受过甲折视频脑底镜检查的系统性硬化症患者进行了一项回顾性研究。收集了发病头 3 年的内脏受累情况和 NVC 结果。根据 NVC 模式的恶化程度，将微血管损伤的严重程度分为四类。器官受累的严重程度由 Medsger 的疾病严重程度量表对每个器官进行评估，作为疾病严重程度的整体衡量标准，则采用简单求和法。微血管损伤的严重程度与疾病严重程度的总体衡量（r = 0.55，p = 0.001）、外周血管受累的严重程度（r = 0.43，p = 0.001）和皮肤受累的严重程度（r = 0.34，p = 0.001）之间存在中度相关性。在单变量分析中，NVC 中出现晚期硬皮病模式可预测数字溃疡（OR 6.03，95% CI 1.52-23.86，p = 0.01）、肌肉受累（OR 13.09，95% CI 1.09-156.78，p = 0.04）、钙化（OR 27.22，95% CI 5.56-133.33，p <0.001）和总体疾病严重程度评分恶化（OR 1.67，95% CI 1.17-2.38，p = 0.005）。根据病程和性别进行调整后的多变量分析证实，晚期模式是钙化的独立预测因素（OR 42.89，95% CI 5.53-332.85，p <0.001）。本研究强调了 NVC 作为预后工具的重要性，以及作为系统性内脏受累的可能预测因子的重要性。
{"title":"Can microvascular damage predict disease severity in patients with systemic sclerosis?","authors":"Ana Martins , Sofia Pimenta , Daniela Oliveira , Raquel Miriam Ferreira , Miguel Bernardes , Lúcia Costa , Georgina Terroso","doi":"10.1016/j.reuma.2024.05.004","DOIUrl":"10.1016/j.reuma.2024.05.004","url":null,"abstract":"<div><h3>Introduction</h3><p>Systemic sclerosis (SSc) is characterized by progressive fibrosis of the skin and internal organs, microvascular damage and cellular and humoral immunity abnormalities. Microvascular damage can be easily detected through nailfold videocapillaroscopy (NVC).</p></div><div><h3>Materials and methods</h3><p>A retrospective study of patients with SSc and a NVC performed within the first 6 months after diagnosis was conducted. Visceral involvement in the first 3 years of the disease and NVC findings were collected. The severity of microvascular damage was classified into four categories, according to the worsening of the NVC patterns. The severity of organ involvement was assessed by the disease severity scale of Medsger for each organ and as a global measure of disease severity, the simple summation was used.</p></div><div><h3>Results</h3><p>A total of 86 patients with SSc were included. A moderate correlation was found between the severity of microvascular damage and the global measure of disease severity (<em>r</em> <!-->=<!--> <!-->0.55, <em>p</em> <!--><<!--> <!-->0.001), the severity of peripheral vascular involvement (<em>r</em> <!-->=<!--> <!-->0.43, <em>p</em> <!--><<!--> <!-->0.001) and the severity of skin involvement (<em>r</em> <!-->=<!--> <!-->0.34, <em>p</em> <!-->=<!--> <!-->0.001).</p><p>The presence of a late scleroderma pattern in NVC were predictive in univariate analysis of digital ulcers (OR 6.03, 95% CI 1.52–23.86, <em>p</em> <!-->=<!--> <!-->0.01), muscular involvement (OR 13.09, 95% CI 1.09–156.78, <em>p</em> <!-->=<!--> <span>0.04), calcinosis (OR 27.22, 95% CI 5.56–133.33, </span><em>p</em> <!--><<!--> <!-->0.001) and worse global disease severity score (OR 1.67, 95% CI 1.17–2.38, <em>p</em> <!-->=<!--> <span>0.005). Multivariate analysis adjusted for disease duration and gender confirmed late pattern as an independent predictor of calcinosis (OR 42.89, 95% CI 5.53–332.85, </span><em>p</em> <!--><<!--> <!-->0.001).</p></div><div><h3>Discussion and conclusion</h3><p>In this study, the worsening of NVC pattern in SSc was associated with the overall disease severity, the severity of peripheral vascular involvement and extension of skin involvement. This study highlights the importance of NVC as a prognostic tool and a possible predictor of systemic visceral involvement.</p></div>","PeriodicalId":47115,"journal":{"name":"Reumatologia Clinica","volume":"20 7","pages":"Pages 366-371"},"PeriodicalIF":1.2,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141961687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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