Reumatologia clinica最新文献

{"title":"Does human microbiota interact with immunosuppressive treatment of systemic autoimmune rheumatological diseases? A systematic review","authors":"Noemí Franco-Domingo ,&nbsp;Patricia Saiz-López ,&nbsp;Loreto Carmona-Ortells","doi":"10.1016/j.reumae.2025.501938","DOIUrl":"10.1016/j.reumae.2025.501938","url":null,"abstract":"<div><h3>Objective</h3><div>To collect and analyse studies evaluating the interaction between the human microbiota (HM) and immunosuppressive (IS) treatments for systemic autoimmune rheumatological diseases (ARDs), and their impact on the disease.</div></div><div><h3>Methods</h3><div>A systematic review was performed based on an electronic search strategy in Medline, Embase, and Cochrane Library (inception-02/2024). We included papers studying the interaction of HM and IS treatments in adult patients with ARDs in which parameters of diversity and taxonomic composition were measured. We excluded spondyloarthritis for which more extensive knowledge is available. Studies of any language were allowed, prioritising clinical trials but also including observational longitudinal prospective and retrospective, and case-control studies.</div></div><div><h3>Results</h3><div>Of 2570 papers identified, 20 were included (15 from rheumatoid arthritis, 3 from systemic lupus erythematosus, 1 from primary Sjögren's syndrome and 1 from systemic sclerosis), overall, with a moderate risk of bias. The paucity of studies and niche specificity limited the study to the gut microbiota. A trend towards decreased diversity and compositional changes in gut microbiota and partial restitution in patients responding to IS treatment was identified. The heterogeneity observed in the design and outcome measures of the studies precluded a metaanalysis; however, the results point to a possible relationship between HM alterations and response to IS treatments in ARDs.</div></div><div><h3>Conclusions</h3><div>Available studies suggest a potential association between the HM and the response to IS therapies in ARDs. However, the overall moderate quality of evidence and substantial methodological heterogeneity limit the strength of combined conclusions. Standardization of microbiota-related studies is needed to enable data integration and support more robust inferences.</div></div>","PeriodicalId":94193,"journal":{"name":"Reumatologia clinica","volume":"21 7","pages":"Article 501938"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144984466","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}

{"title":"Achlorophyllic algae and chronic bursitis: An exceptional association","authors":"Pablo González del Pozo,&nbsp;Paula Álvarez Peñalba,&nbsp;Stefanie Burger,&nbsp;Norma Alejandra Callejas Pineda,&nbsp;Rubén Queiro Silva,&nbsp;Sara Alonso Castro","doi":"10.1016/j.reumae.2025.501920","DOIUrl":"10.1016/j.reumae.2025.501920","url":null,"abstract":"<div><div>We describe a case about a 79-year-old woman with rheumatoid arthritis with chronic left olecranon bursitis refractory to conventional therapy. Following appropriate diagnostic workup, Prototheca spp alga was identified as the causative agent. The exceptional nature of the case is emphasized.</div></div>","PeriodicalId":94193,"journal":{"name":"Reumatologia clinica","volume":"21 7","pages":"Article 501920"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144984448","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}

{"title":"Cognitive dysfunction in systemic lupus erythematosus: Insights from a two-year longitudinal study in a Brazilian cohort","authors":"Eduarda Scoto Dias ,&nbsp;José Henrique Tercziany Vanzin ,&nbsp;Eduardo Augusto Borba ,&nbsp;Mahara Freitas dos Santos ,&nbsp;Thiago Alberto F.G. dos Santos ,&nbsp;Thelma Skare ,&nbsp;Renato Nisihara","doi":"10.1016/j.reumae.2025.501941","DOIUrl":"10.1016/j.reumae.2025.501941","url":null,"abstract":"<div><h3>Objectives</h3><div>The objective of this study was to examine cognitive dysfunction in a Brazilian sample of SLE patients for two years.</div></div><div><h3>Methods</h3><div>A sample of 50 individuals with SLE was assessed at baseline for epidemiological and treatment data, disease activity by SLEDAI 2K (SLE disease activity 2000), cumulative damage by SLICC/ACR DI (Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index), depression by CES-D (Center for Epidemiological Studies-Depression) and cognitive function through MoCA (Montreal Cognitive Assessment). The same assessment was repeated after two years.</div></div><div><h3>Results</h3><div>The prevalence of cognitive impairment at baseline was 68%. The baseline cognitive assessment showed impairment in visuospatial/executive function (<em>p</em> <!-->=<!--> <!-->0.002), naming (<em>p</em> <!-->=<!--> <!-->0.04), attention (<em>p</em> <!-->&lt;<!--> <!-->0.0001) and delayed recall (<em>p</em> <!-->&lt;<!--> <!-->0.0001). The median MoCA results did not change in two years (<em>p</em> <!-->=<!--> <!-->0.45), but 6 individuals (12%) that had normal cognitive function at baseline developed mild cognitive impairment and two (4%) that had mild cognitive impairment, improved. When considering the MoCA domains the only significant difference was improvement in abstraction (<em>p</em> <!-->=<!--> <!-->0.001). No correlations between MoCA delta (difference between second and first value) and delta SLEDAI, delta SLICC and delta CES-D were found (all with <em>p</em> <!-->&gt;<!--> <!-->0.05). Also, no associations were found with used treatment or autoantibodies profile.</div></div><div><h3>Conclusions</h3><div>Cognitive dysfunction in SLE is dynamic and may require periodic re-assessments. Changes in cognition were not associated with disease activity, depression or cumulative damage in this sample.</div></div>","PeriodicalId":94193,"journal":{"name":"Reumatologia clinica","volume":"21 7","pages":"Article 501941"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145005302","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}

{"title":"Effectiveness of a checklist for the control of the disease activity in patients with axial spondyloarthritis","authors":"Raquel Almodóvar ,&nbsp;Elia Pérez-Fernández ,&nbsp;Marta Valero ,&nbsp;Virginia Villaverde ,&nbsp;Laura González ,&nbsp;Beatriz Joven Ibáñez ,&nbsp;Eva Tomero Muriel ,&nbsp;Alejandro Prada Ojeda ,&nbsp;M.a Teresa Navio ,&nbsp;Laura Cebrián Méndez ,&nbsp;Leticia Lojo ,&nbsp;Ramón Mazzucchelli ,&nbsp;Pedro Zarco Montejo","doi":"10.1016/j.reumae.2025.501918","DOIUrl":"10.1016/j.reumae.2025.501918","url":null,"abstract":"<div><h3>Objectives</h3><div>To assess the effectiveness of a checklist for disease activity and comorbidity control in patients with axial spondyloarthritis (axSpA).</div></div><div><h3>Method</h3><div>A quasi-experimental retrospective multicentre pre-post intervention study was carried out in Spain between 2016 and 2022. Improvement in disease activity and comorbidity status was determined before and after the implementation of a checklist control in patients diagnosed with axSpA. Disease activity was determined by means of Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and C-reactive protein (CRP) levels. Comorbidity status was determined by analysing several risk factors (blood pressure, body weight, blood test, etc.). An analysis of variance with mixed models between pre and post collected values was performed. The change in therapeutic level and disease status (low activity, remission) was determined by means of the Mc-Nemar asymmetry test.</div></div><div><h3>Results</h3><div>A total of 108 patients with axSpA were included in the study. After checklist implementation, a statistically significant reduction in BASDAI of 0.44 (95%CI: 0.06–0.82, <em>p</em> <!-->=<!--> <!-->0.023) and a significant reduction of 3.82<!--> <!-->mg/L (<em>p</em> <!-->=<!--> <!-->0.001) in CRP was observed. Besides, an increase in uricemia of 0.24<!--> <!-->mg/dl was found (95%CI: 1.49–6.14, <em>p</em> <!-->=<!--> <!-->0.001), while no other statistically significant change in comorbidities was observed.</div></div><div><h3>Conclusions</h3><div>The implementation of a checklist in daily clinical practice leads to a significant improvement in the control of disease activity in patients with axSpA.</div></div>","PeriodicalId":94193,"journal":{"name":"Reumatologia clinica","volume":"21 7","pages":"Article 501918"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145005436","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}

{"title":"Transcultural adaptation and validation of the Transition Readiness Assessment Questionnaire (TRAQ) into Mexican Spanish","authors":"Sara G. Rosiles-De la Garza ,&nbsp;Ingris Pelaez-Ballestas ,&nbsp;Fernando García-Rodríguez ,&nbsp;Ana V. Villarreal-Treviño ,&nbsp;Elisa L. Dávila-Sotelo ,&nbsp;Leonor G. Hinojosa-Amaya ,&nbsp;Jesús E. Treviño-Alvarado ,&nbsp;Óscar González-Llano ,&nbsp;Laura Villarreal-Matínez ,&nbsp;Yajaira V. Jiménez-Antolínez ,&nbsp;Julia E. Colunga-Pedraza ,&nbsp;Nadina E. Rubio-Pérez","doi":"10.1016/j.reumae.2025.501917","DOIUrl":"10.1016/j.reumae.2025.501917","url":null,"abstract":"<div><h3>Purpose</h3><div>The aim of the present study was to translate and perform a transcultural adaptation and validation of the TRAQ into Mexican Spanish.</div></div><div><h3>Methodology</h3><div>Transversal and observational study. First, the TRAQ was translated and transculturally adapted into Mexican Spanish. Then, the adapted TRAQ was administered to patients of any gender between 12 and 21 years of age and a chronic disease diagnosis. Correlation matrices for the questionnaire were obtained and their reliability was measured through homogeneity and internal consistency.</div></div><div><h3>Results</h3><div>The TRAQ was successfully translated and transculturally adapted into Mexican Spanish. After this, a pilot test of the questionnaire was performed with 40 patients. Lastly, the final validation phase was undertaken with 141 patients, with a median age of 13.9 years. The internal consistency analysis revealed a Cronbach's alpha global evaluation of 0.76, while the results organized through domains varied from 0.47 to 0.60.</div></div><div><h3>Conclusions</h3><div>The translated and transculturally adapted TRAQ revealed a good internal consistency, similar to other transcultural adoptions previously described in the medical literature. This process will allow us to ensure cultural and linguistic relevance for Mexican patients, particularly given the unique socio-cultural context of the Mexican population.</div></div>","PeriodicalId":94193,"journal":{"name":"Reumatologia clinica","volume":"21 7","pages":"Article 501917"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145005307","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}

{"title":"Usefulness of ultrasound in the assessment of the efficacy of apremilast in psoriatic arthritis: Articular, enthesitic and nail index","authors":"Juan José de Agustin ,&nbsp;Gustavo Adolfo Añez ,&nbsp;Delia Reina ,&nbsp;Sergi Heredia ,&nbsp;Julio Ramirez ,&nbsp;Andrea Mireya Cuervo ,&nbsp;Jesus Rodriguez ,&nbsp;Carmen Moragues ,&nbsp;Patricia Moya ,&nbsp;Ana Maria Laiz Alonso ,&nbsp;Mireia Moreno ,&nbsp;Marta Arevalo ,&nbsp;Manel Pujol ,&nbsp;Georgina Salvador ,&nbsp;Noemi Busquets ,&nbsp;Andres Ponce ,&nbsp;Maria Pascual Pastor","doi":"10.1016/j.reumae.2025.501921","DOIUrl":"10.1016/j.reumae.2025.501921","url":null,"abstract":"<div><h3>Background</h3><div>Psoriatic arthritis (PsA) affects joints and entheses. The objective is to use ultrasound (US) to see inflammatory changes in joints and entheses in patients with active PsA starting Apremilast. Primary objective: 20% reduction in the US index (UIC) at 12 months.</div></div><div><h3>Methodology</h3><div>Multicenter, prospective, open-label study. Patients with PsA (≥2 swollen joints) and ≥2 US synovitis in joints and ≥1 US enthesitis at screening were recruited. Follow-up was 52 weeks (baseline and 1, 6, 9, 12 months). US (joint, tendon, and entheses), clinical (SJC, TJC, LEI, PGA, PtGA), and biological (ESR and CRP) parameters were recorded.</div></div><div><h3>Results</h3><div>48 patients were evaluated, 46 were included in the follow-up and 26 completed the 52-week study. The primary endpoint was achieved, with reductions of up to 40%. All clinical and ultrasound variables decreased significantly after 12 months. 75 adverse events (AEs) were recorded in 33 patients, and only one serious event (SAE). Reasons for withdrawal included AEs (6 patients), lack of efficacy (8 patients), and other reasons (loss to follow-up, withdrawal of consent) for 6 patients.</div></div><div><h3>Conclusions</h3><div>Changes in different domains of PsA in patients treated with Apremilast can be best identified by ultrasound. Ultrasound is an excellent tool to study joints, tendons, and entheses in PsA. Apremilast is a safe, well-tolerated, and effective treatment for several patterns of PsA (joints, entheses) as demonstrated by ultrasound. Ultrasound can also identify nail diseases in patients with PsA.</div></div>","PeriodicalId":94193,"journal":{"name":"Reumatologia clinica","volume":"21 7","pages":"Article 501921"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145005301","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}

{"title":"Autoimmune inner ear disease and localized scleroderma in childhood: A case report","authors":"Pilar del Rosario Guarnizo Zuccardi ,&nbsp;Jacqueline de los Ángeles Piñeros Haiek ,&nbsp;Natalia Rodríguez Bonilla ,&nbsp;Sara Patricia Romero Orjuela ,&nbsp;Sara Juliana Guerrero León","doi":"10.1016/j.reumae.2025.501912","DOIUrl":"10.1016/j.reumae.2025.501912","url":null,"abstract":"<div><div>Autoimmune inner ear disease is frequently characterized by progressive bilateral hearing loss, which is not necessarily symmetrical. Vertigo, aural fullness, and tinnitus may also accompany it. There are 2 ways that the inner ear might be impacted: either as a primary disorder when the immune response directly attacks inner ear cells or as a secondary symptom of a systemic autoimmune disease.</div><div>We describe the case of an 11-year-old boy with morphea, who was diagnosed with autoimmune inner ear disease after he developed hearing loss. This relationship in children has not yet been documented in any prior reports. To improve diagnosis, management, and treatment and avoid long-term consequences, further research is required.</div></div>","PeriodicalId":94193,"journal":{"name":"Reumatologia clinica","volume":"21 6","pages":"Article 501912"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144791068","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}

{"title":"Major cardiovascular events associated factors in a cohort of patients with rheumatoid arthritis","authors":"Pedro Arbey Quevedo Mayorga ,&nbsp;Jhon Sebastián Giraldo ,&nbsp;Jhon Jairo Tipasoca Pineda ,&nbsp;Cristhian Camilo Guzmán Gualteros ,&nbsp;Julián Esteban Romero ,&nbsp;Isabel Cristina Gonzalez ,&nbsp;Maria Camila Hernandez ,&nbsp;Viviana Carolina Pachón ,&nbsp;Daniel Sarmiento","doi":"10.1016/j.reumae.2025.501915","DOIUrl":"10.1016/j.reumae.2025.501915","url":null,"abstract":"<div><h3>Introduction</h3><div>Rheumatoid arthritis (RA) is a systemic autoimmune disease with articular and extra-articular manifestations. Mortality in RA is influenced by an increased risk of cardiovascular events by up to 48% (RR: 1.48, 95% CI 1.36–1.62), with a higher standardized mortality rate (SMR) due to cardiovascular causes compared to the general population. Our main objective was to examine the effect of clinical and serological variables on the risk of major cardiovascular events (MCE) in a cohort of RA patients.</div></div><div><h3>Materials and methods</h3><div>This was a retrospective cohort study. Patients more tha 18 years old and active follow-up in the RA care models of Hospital Universitario Clínica San Rafael and Clínica Nogales were included. Patients with prior major cardiovascular events or polyautoimmunity syndromes before the RA diagnosis were excluded. Survival analysis was performed to evaluate the probability of remaining free of MCEs, along with Cox proportional hazards analysis and structural equation modeling using a PATH analysis to assess direct and indirect effects.</div></div><div><h3>Results</h3><div>A total of 406 patients were included, 342 (84%) of whom were women, with a mean age of 44.8<!--> <!-->±<!--> <!-->13.1 years and a disease duration of 13<!--> <!-->±<!--> <!-->13.4 months. The average DAS28 activity score was 2.5<!--> <!-->±<!--> <!-->1.78, with 48.7% having active disease (DAS28<!--> <!-->&gt;<!--> <!-->2.6). Nineteen patients experienced MCEs, resulting in a cumulative incidence (CI) of 4.68% (4.4% myocardial infarction and 1.4% stroke). The most frequent risk factors were hypertension (23.7%) and smoking (24.8%). Bivariate analysis showed that heart failure (RR<!--> <!-->=<!--> <!-->1.58, 95% CI 1.12–2.23, p<!--> <!-->=<!--> <!-->0.01), and hypertension (RR<!--> <!-->=<!--> <!-->2.36, 95% CI 1.22–4.60, p<!--> <!-->&lt;<!--> <!-->0.01) were significantly associated with MCEs. The probability of MCE-free survival at six months post-diagnosis was 50%. In the Cox model, only hypertension and age at diagnosis were significantly associated with MCE outcomes. In the PATH analysis, dyslipidemia was significantly associated with myocardial infarction without a mediating effect from corticosteroids (coef<!--> <!-->=<!--> <!-->1.83, p<!--> <!-->&lt;<!--> <!-->0.001).</div></div><div><h3>Conclusion</h3><div>Traditional risk factors increase the risk of MCEs in RA patients. Additionally, dyslipidemia acts as an independent risk factor without mediation by other variables, making it a therapeutic target for preventing these outcomes.</div></div>","PeriodicalId":94193,"journal":{"name":"Reumatologia clinica","volume":"21 6","pages":"Article 501915"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144796584","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}

{"title":"Paradoxical reaction after switching between adalimumab biosimilars in a patient with psoriatic arthritis","authors":"Mariano F. Palatnik ,&nbsp;Emilce S. Fonseca ,&nbsp;María Lorena Brance","doi":"10.1016/j.reumae.2025.501913","DOIUrl":"10.1016/j.reumae.2025.501913","url":null,"abstract":"","PeriodicalId":94193,"journal":{"name":"Reumatologia clinica","volume":"21 6","pages":"Article 501913"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144828797","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}

{"title":"Survey to evaluate exposure to environmental factors in patients with rheumatoid arthritis","authors":"Alexandra Zúñiga ,&nbsp;Alba Luz León Álvarez ,&nbsp;Luisa Carbal-Reyes ,&nbsp;Daniel Rodríguez ,&nbsp;Juan-Camilo Díaz ,&nbsp;Gloria Vásquez ,&nbsp;Diana Castaño","doi":"10.1016/j.reumae.2025.501916","DOIUrl":"10.1016/j.reumae.2025.501916","url":null,"abstract":"<div><h3>Introduction and aims</h3><div>This study develops and validates an instrument to investigate and identify environmental factors associated with rheumatoid arthritis (RA), in order to improve the understanding of potential triggers.</div></div><div><h3>Methods</h3><div>Using an exhaustive review of the literature and the involvement of a panel of rheumatology experts, a survey was designed based mainly on environmental exposures that covered various dimensions. The distribution of the evaluated categories was assessed to determine their sufficiency, coherence, relevance, and clarity by Kruskal-Wallis test, Kendall’s W for concordance, and finally, it was subjected to content validation by experts and underwent pilot testing.</div></div><div><h3>Results</h3><div>The survey consisted of 89 items total divided in 7 dimensions (sociodemographic aspects, consumables –cigarette–, other consumables, occupational or pollutants, previous diagnoses, other factors, and questions for potential cases). The assessment conducted by the experts showed a high concordance among them with values between 0.76 and 0.96. The pilot test demonstrated that the survey can be satisfactorily applied to Spanish-speaking people with different levels of education.</div></div><div><h3>Discussion and conclusions</h3><div>The created and validated instrument offers a solid tool adapted to the Latin American culture to investigate environmental factors associated with RA. Its development contributes to filling a gap in the scientific literature and highlights the importance of considering these factors in the understanding and intervention of the disease, both in patients with RA and individuals at potential risk of developing this disease.</div></div>","PeriodicalId":94193,"journal":{"name":"Reumatologia clinica","volume":"21 6","pages":"Article 501916"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144791071","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}