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Abstract As the coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continues to spread rapidly, there are still many unresolved questions of how this virus would impact on autoimmune inflammatory joint diseases and autoinflammatory disorders. The main aim of this paper is to describe the main studies focusing their attention on COVID-19 incidence and outcomes of rheumatoid arthritis (RA), spondylarthritis (SpA), and autoinflammatory disease cohorts. We also revised possible pathogenic mechanisms associated with. Available data suggest that, in patients with RA and SpA, the immunosuppressive therapy, older age, male sex, and the presence of comorbidities (hypertension, lung disease, diabetes, CVD, and chronic renal insufficiency/end-stage renal disease) could be associated with an increased risk of infections and high rate of hospitalization. Other studies have shown that lower odds of hospitalization were associated with bDMARD or tsDMARDs monotherapy, driven largely by anti-TNF therapies. For autoinflammatory diseases, considering the possibility that COVID-19 could be associated with a cytokine storm syndrome, the question of the susceptibility and severity of SARS-CoV-2 infection in patients displaying innate immunity disorders has been raised. In this context, data are very scarce and studies available did not clarify if having an autoinflammatory disorder could be or not a risk factor to develop a more severe COVID-19. Taking together these observations, further studies are likely to be needed to fully characterize these specific patient groups and associated SARS-CoV-2 infection.
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Introducción: El Qualisex es un cuestionario desarrollado y validado para evaluar la sexualidad en pacientes con artritis reumatoidea. Hasta el momento, según nuestro conocimiento, no se ha desarrollado un cuestionario que evalúe específicamente la sexualidad en pacientes que padecen Espondiloartritis axial (EsPax). Por este motivo, nuestro objetivo fue validar y adaptar el cuestionario Qualisex en pacientes con EsPax y evaluar el impacto de su enfermedad en la sexualidad. Material y métodos: Estudio de corte transversal. Se incluyeron pacientes ≥21 años de edad con diagnóstico de EsPax según criterios ASAS '09, en forma consecutiva. Se consignaron datos sociodemográficos, tiempo de evolución de la enfermedad, síntomas relacionados con la enfermedad, comorbilidades y tratamiento recibido. Se evaluó la salud sexual de los pacientes utilizando el cuestionario Qualisex. El mismo consta de 10 preguntas con respuestas categorizadas en una escala de 11 puntos (0-10); el resultado surge del promedio de las mismas y su rango es de 0-10, las puntuaciones más altas indican un mayor impacto en la sexualidad. La versión original del Qualisex fue traducida y adaptada para EsPax. Para el análisis estadístico, se utilizó estadística descriptiva, test de Mann-Whitney y test de Chi² y test exacto de Fisher. Regresión lineal. Correlación de Spearman. Coeficiente de correlación intraclase (CCI) para evaluar la reproducibilidad del cuestionario. Resultados: Se invitó a participar a 61 pacientes, 11 de los cuales se negaron. 50 pacientes fueron incluidos, 40 (80%) eran de sexo masculino, con una edad mediana de 47 años (RIC 21-72), y un tiempo mediano de evolución de 13 años (RIC 1-46). La mediana de Qualisex fue de 2,5 (RIC 1,1-4,2), el tiempo mediano para completar el cuestionario fue de 2,1 minutos (RIC 1,7-3,1). La reproducibilidad fue excelente con un CCI de 0,99 (IC 95% 0,65-1). Se hallaron algunas preguntas redundantes con correlación intraítem mayor a 0,8. El Qualisex presentó buena correlación con las medidas de evaluación de la enfermedad: ASQoL (Rho: 0,52, p=0,001), BASDAI (Rho: 0,57, p<0,0001), BASFI (Rho: 0,53, p=0,001), PsAQoL (Rho: 0,69, p=0,01). El Qualisex fue significativamente mayor en el sexo femenino (5,4 en mujeres vs 2,5 en varones, p=0,02), en los desocupados (4,7 en desocupados vs 2,3 ocupados, p=0,01), en pacientes con mayor actividad de la enfermedad evaluado por BASDAI >4 (4,2 pacientes activos vs 1,6 en pacientes inactivos, p=0,01) y menor en los pacientes en tratamiento biológico (TB) (1,9 con TB vs 3,8 sin TB, p=0,01). En el análisis multivariado, sexo femenino, mayor tiempo de evolución de la enfermedad y mayor actividad de la enfermedad se mantuvieron independientemente asociadas a mayor impacto en la sexualidad. Conclusión: El Qualisex adaptado a EsPax es un cuestionario válido y confiable, aunque presenta algunas preguntas redundantes. Los pacientes con EsPax de sexo femenino, con mayor tiempo de evolución y mayor actividad de la enfermedad presentaron peor calidad de vida sexual.
Introduction: The Qualisex is a questionnaire developed and validated to evaluate sexuality in patients with Rheumatoid Arthritis. According to our knowledge, a questionnaire that specifically assesses sexuality in patients with axial spondyloarthritis (AxSpA) has not been developed. For this reason, our objective was to validate and adapt the Qualisex questionnaire in patients with AxSpA and evaluate the impact of their disease on sexuality. Material and methods: Cross-sectional study. We included patients ≥21 years of age with a diagnosis of AxSpA according to ASAS '09 criteria. Sociodemographic data were recorded, time of evolution of the disease, symptoms related to the disease, comorbidities and treatment received. The sexual health of the patients was evaluated using the Qualisex questionnaire. It consists of 10 questions with answers categorized on a scale of 11 points (0-10). Qualisex's score is the mean of the results for the 10 questions, the highest scores indicate a greater impact on sexuality. The original version of the Qualisex was translated and adapted for AxSpA. For the statistical analysis, descriptive statistics, Mann-Whitney test and Chi² test and Fisher's exact test were used. Linear regression. Spearman correlation. Intraclass correlation coefficient (ICC) was used to evaluate the reproducibility of the questionnaire. Results: 61 patients were invited to participate, 11 of whom refused. 50 patients were included, 40 (80%) were male, with a median age of 47 years (IR 21-72), and a median time of evolution of 13 years (IR 1-46). The median of Qualisex was 2.5 (IR 1.1-4.2), the median time to complete the questionnaire was 2.1 minutes (IR 1.7-3.1). Reproducibility was excellent with a ICC of 0.99 (95% CI 0.65-1). Some redundant questions were found. The Qualisex presented good correlation with the evaluation measures of the disease: ASQoL (Rho: 0.52, p=0.001), BASDAI (Rho: 0.57, p<0.0001), BASFI (Rho: 0.53, p=0.001), PsAQoL (Rho: 0.69, p=0.01). The Qualisex was significantly higher in the female sex (5.4 in women vs 2.5 in males, p=0.02), in the unemployed (4.7 in unemployed vs 2.3 occupied, p=0.01), in patients with greater activity of the disease evaluated by BASDAI >4 (4.2 active patients vs 1.6 in inactive patients, p=0.01) and lower in patients on biological treatment (BT) (1.9 with BT vs 3.8 without BT, p=0.01). In the multivariate analysis, female sex, longer time of evolution of the disease and greater activity of the disease were independently associated with greater impact on sexuality. Conclusion: The Qualisex adapted to AxSpA is a valid and reliable questionnaire, although it presents some redundant questions. The patients with AxSpA of female sex, with longer time of evolution and greater activity of the disease presented worse quality of sexual life.
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Sexualidad , EspondiloartritisRESUMEN
Alrededor de un tercio de los afectados por espondiloartropatías hará uveítis. Casi siempre serán uveítis anteriores, agudas, unilaterales y autolimitadas, que alter-narán entre uno y otro ojo. El tratamiento de elección es el corticoide tópico du-rante la crisis, que habitualmente resolverá en un plazo no mayor a doce semanas. Hay varias estrategias para reducir la frecuencia e intensidad de las crisis, las que han sido evaluadas en pequeños estudios en sujetos con tres o más episodios anuales. Han sido beneficiosos el metotrexato, sulfasalazina y antiinflamatorios no esteroidales (AI-NEs), estos últimos en dosis de dos veces por día, no así los AINEs en toma única diaria. Los agentes biológicos anti factor de necrosis tumoral (anti-TNF por su sigla en in-glés), excepto el etanercept, se asocian a muy altos índices de prevención de recidivas en estudios observacionales, pero los estudios comparativos sólo se han hecho para uveítis no-anteriores.
About one third of all subjects affected by spondiloarthropaties will suffer from uve-itis. These will happen to be acute, anterior, unilateral and self-limited uveitis attacks, alternating between one and other eye. First choice treatment consists of topical cor-ticosteroid during the episode that will usually resolve in no more than twelve weeks. There are several useful strategies to reduce the frequency and intensity of the uveitis at-tacks. These have been studied in small trials with reduced number of subjects suffering from three or more episodes per year. They have shown a beneficial effect for methotrex-ate, sulfasalazine and non-steroidal anti-inflammatory drugs (NSAIDs), these last when prescribed twice a day, without proven benefit from taking single daily doses of NSAIDs. Anti-tumor necrosis factor (anti-TNF) biologic agents, except for etanercept, are asso-ciated to a huge reduction in the frequency of uveitis attacks in observational studies, but comparative trials available have addressed non-anterior uveitis exclusively.