ABSTRACT
Background: Given the progressive change in the management of infammatory diseases,an observational study was conducted on the management of Early Rheumatoid Arthritis (ERA) in Catalonia. Objectives: To know the management of ERA in Catalonia, to assess whether the recommendations of the EULAR/ACR guidelines are followed and to study the causes of management variability,to set improvement objectives. Methods: An observational,descriptive,and cross-sectional study was conduct-ed,with data collection from June 15 to 30, 2021.The rheumatologists' partners of the Catalan Society of Rheumatology were the object of study. An online survey was conducted with 304 members on the management of the ERA. Variables related to the characteristics of the respondents,the derivation and variables of the disease including clinical variables,type of treatment and outcomes used for follow-up including the impact of the SARS-CoV2 pandemic were included. The univariate study was performed using a study of proportions with Pearson's correlation. Results: A total of 105 members (34.5%) responded to the survey.11.6%>60 y, only 7.8% <30y. 99% were in public assistance.The number of rheuma-tologists per service is 7.2[1-17],but 34.2% had< 5 rheumatologists,with a reference population of 200,000-300,000p in 42% of respondents.The number of weekly visits made is 67.5[20-130].42.2% do not have a monographic RA or ERA dispensary and 30.4%not have specialized nursing.Characteristics of ERA:77.5% are derived from primary care(PC),52% have been between 6 weeks,42.1%>3 months.54.9% make a frst visit within 2-4 weeks of PC referral and 14.7%> 8 weeks.100%provide previous analysis,only 47% had had RX performed.98% were previously treated(50.4%NSAIDs + CG,36.1%NSAIDs,12.3% CG).4.3% had GC doses>10 mg/day,11.3%> to 20mg/day.The treatment:DMARDs of choice in 100% is MTX,44.1% start doses of 10mg/week and 3.9%7.5 mg/week.The route of choice is oral(55.9% vs 44.1%).92.2% associate GC and 31.7% have not withdrawn them after 6 m.57.8% consider the maximum of MTX 25mg/W.87.1% use doses<10 mg/day,with the most used dose being 5 mg/day(35.6%).Follow-up after the start of DMARDs is performed 72.5% between 4-6 weeks and 12.7% is performed by nursing.100% use DAS 28 and 53.5% also CDAI.31.4% perform PROs(HAQ 83.3%,RAPID 3 14.3%).The use of systematic ultrasound is collected in 33%, being himself who performs it in 59.9% and an expert rheu-matologist in 46.1%.Finally, when asked about incidence of pandemic in the follow-up,53.3% consider that it is doing the same as before. 46.1% consider that telephone visits are not suitable for the follow-up of the ERAvs14.7% who consider that Yes.When questioning the situations in which they consider them to be appropriate,75.9% that it was adequate in the control after the beginning of the DMARDs.Regarding the treatment of ERA, 66% delayed the onset of biological DMARDs, 72.1% due to difficulty of follow-up and only 8.8% due to an increased risk of infection. When performing the univariate analysis, it is evident that having a monographic dispensary is associated with earlier onset of MTX(p< 0.001)and at doses≥15 mg/W(p = 0.05),greater nursing intervention(p< 0.001),greater use of PROs(p = 0.008)and there is a tendency to a shorter waiting time for frst visits(p = 0.07).It is also associated with not considering telephone visits(p< 0.001), making them in less than 25%(p< 0.0001).Similarly,hospital level is directly proportional to initiation at higher doses of MTX(p< 0.0001),lower use of GC<10mg.Among the rest of the variables, no association has been found. Conclusion: The recommendations of EULAR/ACR in the treatment and follow-up of ERA are consistently followed,although the wide use of MTX orally is striking.It is evident that the variable that most influences the early onset of FAME and at higher doses,is a monographic dispensary,as well as greater presence of nursing and performance of PROs.
ABSTRACT
Background: Interstitial lung disease (ILD) in connective tissue diseases (CTD) is an important cause of morbidity and mortalitiy. Objectives: To evaluate ILD in CTD (systemic sclerosis, myositis, Sjögren syndrome, rheumatoid arthritis, mixed connective tissue disease), sarcoidosis and interstitial pneumonia with autoimmune features and its progression in 12 months evaluated through high resolution computed tomography (HRCT) and pulmonary function test (PFT). Methods: A retrospective single tertiary center cohort study in CTD-ILD outpatients seen between 2012 and 2021. Clinical, serological data, PFT and HRCT results were collected. ILD patterns were classifed into: usual interstitial pneumonia (UIP), inconsistent UIP, nonspecifc interstitial pneumonia (NSIP), fbrosing NSIP, organizing pneumonia, interstitial lymphoid pneumonia and associated to sarcoidosis. Progression of ILD was defned as:->10% decline in FVC in PFT.->15% decline in DLCO in PFT.-Progression of fbrosis in HRCT. IBM SPSS v23 was used for statistical analysis. Results: 51 patients were collected. Baseline characteristics are shown in Table 1. Figure 1 shows ILD progression in 1 year. During follow up, 1 patient with sarcoidosis died of COVID19 bilateral pneumonia. Conclusion: In our series most patients were middle aged women. Anti-Ro antibodies and smoking status (former or current) were common among patients. Common clinical features were Raynaud (45%), skin affection (45%) and arthritis (40%). 47% of the patients expressed dyspnea at ILD diagnosis. 29,4% were treated with MP pulses, 23,5% with rituximab, 31,4% with mycofenolate mophetil. Fibrosing pattern in HRCT (UIP and fb-NSIP) was the most prevalent. 20% of the patients had progressive fbrosis under PFT criteria and 18% under HCRT. More studies of ILD-CTD are necessary to identify factors for progression and response to treatment and throw out more conclusions of prediction and prognosis of disease.
ABSTRACT
Background: This tertiary hospital is the referall centre of 360.000 inhabitants, population with a Covid seroprevalence of 8,4% at final 2020. Since march, we have had a special concern for rheumatologic patients with systemic diseases and under inmunosupressive agents, including disease modifying antirheumatic drugs (DMARDs) and biological therapy (BT). This is why a special protocol for this population was set. It included performance of serology (CLIA test) for patients under BT and PCR and CLIA testing prior to new treatments. PCR testing was also generally performed: if symptomatology consistent with Covid;before hospitalisation;to tight contacts of infected people;and before procedures. Objectives: To evaluate the impact of COVID-19 in our SpA patients in terms of severity of viral infection and its effect on SpA. Methods: Data of 665 SpA patients and confirmed Covid infection seen in our center from March 15th to December 15th was crossed. 3 miscoded patients with rheumatoid arthritis and 2 with non definite CLIA positivity were excluded. Finally 49 patients' clinical records were reviewed. Data regarding epidemiologic features, SpA characteristics, comorbidities, therapy received, clinical activity before and after Covid, and severity of the infection was collected. IBM SPSS v23 was used for statistical analysis. Results: Among 49 SpA patients, 59% were male, mean aged 56,63 years (range 23-79). 62,2% presented at least 1 comorbidity. 65% were psoriatic arthritis. They mostly had longstanding disease (median 10,5 years -range-1-35). Previously 63% had received DMARDs, mainly methotrexate, and 32 % BT. When Covid was diagnosed 37,2% were under DMARDs and 53% under BT (69,2% TNF inhibitors, 26,9% anti-Il 17, 3,9% ustekinumab). At this point, disease activity was controlled in 82% of patients (39% in remission, and 43% in low disease activity state). Only 18% showed moderate activity. Within the 49 patients, 34 were diagnosed by PCR and 15 by CLIA tests. 9 required hospitalisation, of whom 4 developed more severe disease (3 received glucocorticoid pulses and 2 tocilizumab). A woman with PsA under secukinumab presented pneumonia and PE. None required mechanical ventilation. There were no exitus. Due to Covid infection 9 patients (50%) stopped DMARDs treatment, (5 of them hospitalised). 9 patients withdrew BT after Covid diagnosis;60% of the BT-hospitalised, and 28.5% of the BT-non-hospitalised. 1 suffered a flow with severe disease activity after withdrawal of Il-17 inhibitor. Conclusion: Prevalence of SARS cov 2 infection in SpA patients was not greater than in general population. Most were asymptomatic or suffered mild disease. Only 9 were hospitalised. Factors related to hospitalisation seem similar to those of general population, even if statistical significance was not found due to the small sample. BT does not seem to relate to hospitalisation in SpA and we had no deaths to date in them.
ABSTRACT
Background and importance Baricitinib is an immunosuppressive agent included as one of the therapeutic options for COVID-19 in the Spanish protocol Agencia Española del Medicamento y Productos Sanitarios. Aim and objectives The objective was to assess the effectiveness of this drug in hospitalised but non-critically ill patients. Material and methods An observational retrospective study was conducted in a third level hospital from 26 March to 5 May. Inclusion criteria were: hospitalised patients diagnosed with COVID-19 pneumonia and treated with baricitinib. Data collected were: age, gender, comorbidities, severe pneumonia diagnosis, ferritin and interleukin 6 (IL-6) prior to the beginning of treatment with baricitinib, standard of care according to the hospital's protocol, concomitant treatment with anakinra, duration of treatment with baricitinib, average hospital stay (AHS), deaths and hospital discharges. The data were collected from the electronic medical records and the hospital's management department. Results 171 patients treated with baricitinib were included, with an average age of 69.5 (34-96) years. 71.3% (122) were men. 87.1% (149) had comorbidities and 73.1% (125) were diagnosed with a severe pneumonia, with 25% of them dying (31). Median duration of treatment with baricitinib was 5 days (1- 12). AHS for the baricitinib group was 14.60 (3-47) days, and AHS for the whole sample of patients diagnosed with COVID- 19 pneumonia was 17.2 days. 23.4% (40) of patients had high levels of ferritin (>2500 UI/L). Among them, 87.5% (35) were discharged and 12.5% (5) died. IL-6 levels were high (>40 U/ L) in 29.8% (51) of patients, <40 U/L in 37.4% (64) and not measured in 32.7% (56). In the group with high IL-6 levels, 70.6% (36) were discharged and 29.4% (15) died. Among those with normal levels of IL-6, 93.8% (60) were discharged and 6.3% (4) died. 84.2% (144) of baricitinib patients were also treated with the SoC. During the hospital stay, 31.0% (53) of patients were treated with anakinra and baricitinib, 83.0% (44) were discharged and 17.0% (9) died. Global mortality of the whole sample of patients diagnosed with COVID-19 pneumonia was 18.1% (31). Conclusion and relevance AHS for baricitinib patients was shorter than for the whole sample of COVID-19 patients. The percentage of patients with high levels of IL-6 was superior to that of patients with high ferritin, with mortality greater in patients with IL-6 >40 UI/L. Hence IL-6 level appears to be a better prognostic factor of mortality than ferritin. This could also be related to a greater patient's immune response. Regarding treatment effectiveness, mortality of patients who were treated with SoC plus baricitinib was similar to that of patients treated with anakinra plus baricitinib.