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Abstract Background Patients with psoriatic arthritis (PsA) experience reduced physical function and impaired quality of life. Better patient-reported functional outcomes are found when lower disease activity is achieved. Objectives To evaluate the variation of physical function by HAQ-DI over time in PsA patients treated with standard therapy in a real-life setting: to verify predictors of achieving a minimum clinically important difference (MCID) in function by HAQ-DI (ΔHAQ-DI ≤ − 0.35) and to measure the impact of achieving REM/LDA on long-term function by HAQ-DI. Methods This is a longitudinal analysis of a real-life retrospective cohort. Data from PsA patients with at least 4 years of follow-up in the PsA clinic from 2011 to 2019 were extracted from electronic medical records. The variations of physical function by HAQ-DI and disease activity by DAPSA over time were calculated. A multivariate hierarchical regression model was applied to verify predictors of MCID in HAQ-DI. A comparison of HAQ-DI variation between patients with DAPSA REM, LDA, moderate and high disease activity was made using the generalized estimating equation model (GEE), adjusted by Bonferroni test. The Spearman correlation method was applied to verify the correlation of ΔDAPSA and ΔHAQ-DI over time. Statistical analysis was performed in SPSS program version 21.0. Results Seventy-three patients were included in the analysis. Physical function measured by HAQ-DI was determined by PsA disease activity measured by DAPSA (p < 0.000). A moderate and statistically significant correlation between ΔDAPSA and ΔHAQ-DI was observed (rs = 0.60; p < 0.001). Only patients in DAPSA REM demonstrated a constant decline in HAQ-DI scores during the follow-up. White ethnicity and older age at baseline were predictors for not achieving MCID in HAQ-DI [RR 0.33 (0.16-0.6795% CI p = 0.002) and RR 0.96 (0.93-0.9895% CI p < 0.000), respectively, while higher scores of HAQ-DI at baseline were predictors of achieving MCID [RR 1.71 (1.12-2.6095%CI p = 0.013)]. Conclusion In PsA, patients who maintained DAPSA REM/LDA over time had better long-term functional outcomes. Higher HAQ-DI scores at baseline, non-white ethnicity and younger age were predictors for achieving a clinical meaningful improvement of HAQ-DI.
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Background: Diabetes mellitus and admission blood glucose are important risk factors for mortality in ST segment elevation myocardial infarction patients, but their relative and individual role remains on debate. Objective: To analyze the influence of diabetes mellitus and admission blood glucose on the mortality of ST segment elevation myocardial infarction patients submitted to primary coronary percutaneous intervention. Methods: Prospective cohort study including every ST segment elevation myocardial infarction patient submitted to primary coronary percutaneous intervention in a tertiary cardiology center from December 2010 to May 2012. We collected clinical, angiographic and laboratory data during hospital stay, and performed a clinical follow-up 30 days after the ST segment elevation myocardial infarction. We adjusted the multivariate analysis of the studied risk factors using the variables from the GRACE score. Results: Among the 740 patients included, reported diabetes mellitus prevalence was 18%. On the univariate analysis, both diabetes mellitus and admission blood glucose were predictors of death in 30 days. However, after adjusting for potential confounders in the multivariate analysis, the diabetes mellitus relative risk was no longer significant (relative risk: 2.41, 95% confidence interval: 0.76 - 7.59; p-value: 0.13), whereas admission blood glucose remained and independent predictor of death in 30 days (relative risk: 1.05, 95% confidence interval: 1.02 - 1.09; p-value ≤ 0.01). Conclusion: In ST segment elevation myocardial infarction patients submitted to primary coronary percutaneous intervention, the admission blood glucose was a more accurate and robust independent predictor of death than the previous diagnosis of diabetes. This reinforces the important role of inflammation on the outcomes of this group of patients. .
Fundamento: Diabetes Mellitus e glicemia de admissão são importantes fatores de risco para mortalidade em pacientes com infarto agudo do miocárdio com elevação do segmento ST, mas a contribuição relativa e independente de cada um deles permanece em debate na literatura. Objetivo: Analisar a influência de diabetes mellitus e da glicemia de admissão na mortalidade de pacientes com infarto agudo do miocárdio com elevação do segmento ST submetidos à intervenção coronariana percutânea primária. Métodos: Estudo de coorte prospectivo incluindo todos os pacientes com infarto agudo do miocárdio com elevação do segmento ST submetidos à intervenção coronariana percutânea primária em um centro terciário de cardiologia no período de dezembro de 2010 a maio de 2012. Foram coletados dados clínicos, laboratoriais e angiográficos, com seguimento clínico de 30 dias após o evento. A análise multivariada dos fatores de risco estudados foi ajustada para as variáveis do escore GRACE. Resultados: Dentre os 740 pacientes incluídos, a prevalência de diabetes mellitus relatada foi de 18%. Na análise simples, tanto diabetes mellitus quanto glicemia de admissão foram preditores de mortalidade em 30 dias. Entretanto, após ajuste de potenciais confundidores na análise multivariada, o risco proporcionado pelo diabetes mellitus deixou de ser significativo (risco relativo: 2,41, intervalo de confiança de 95%: 0,76 - 7,59; p = 0,13) enquanto a glicemia de admissão permaneceu como preditor independente de mortalidade em 30 dias (risco relativo: 1,05, intervalo de confiança de 95%: 1,02 - 1,09; p ≤ 0,01) Conclusão: Em pacientes com infarto agudo do miocárdio com elevação do segmento ST submetidos à intervenção ...