Gota. ¿Qué hay de nuevo, doctor? / Gout. What's up doc?

En las 2décadas de este siglo, se ha desarrollado un amplio conocimiento sobre la gota. Hemos definido la enfermedad, los estados y las situaciones clínicas y cambiado su nomenclatura, así como asentado el concepto de enfermedad por depósito «curable» o «remisible».Conocemos ya su alta prevalencia en España y los factores asociados a la enfermedad, la genética que condiciona mayoritariamente la predisposición a la hiperuricemia y la estructura y las funciones del complejo transportoma implicado en el manejo renal e intestinal del ácido úrico.Las técnicas de imagen han aportado nuevos medios al diagnóstico. Hemos establecido las distintas dianas terapéuticas según la carga de enfermedad y las dianas de prevención secundaria, y aprendido a emplear mejor los medicamentos disponibles, a optimizar su prescripción y a prevenir los acontecimientos adversos.Finalmente, hemos comprendido como mejorar la adherencia, educar e implicar a los pacientes en su tratamiento y a no culpabilizarlos. (AU)

A considerable improvement in the knowledge of gout has taken place in the 2decades of the XXIth century. Definitions of disease, estate, and clinical situations, along with a new nomenclature, have been agreed. More importantly, the concept of gout as a “curable” or “controllable” disease has been settled.We know for the first time its prevalence in Spain. Factors associated to disease, the genetics that condition the predisposition to develop hyperuricemia and the structure and functions of the transportome complex that control the renal and intestinal handling of urate have been examined.Imaging techniques have come to support diagnosis. Different primary therapeutic targets have been defined depending on the burden of disease, and targets for secondary prevention considered. We know how to best prescribe available medications and prevent the risk of adverse events.Finally, we have understood the importance of adherence, education, and empower patients during treatment instead of blaming them. (AU)

Gout. What's up doc? / Gota. ¿Qué hay de nuevo, doctor?

A considerable improvement in the knowledge of gout has taken place in the 2decades of the XXIth century. Definitions of disease, estate, and clinical situations, along with a new nomenclature, have been agreed. More importantly, the concept of gout as a "curable" or "controllable" disease has been settled. We know for the first time its prevalence in Spain. Factors associated to disease, the genetics that condition the predisposition to develop hyperuricemia and the structure and functions of the transportome complex that control the renal and intestinal handling of urate have been examined. Imaging techniques have come to support diagnosis. Different primary therapeutic targets have been defined depending on the burden of disease, and targets for secondary prevention considered. We know how to best prescribe available medications and prevent the risk of adverse events. Finally, we have understood the importance of adherence, education, and empower patients during treatment instead of blaming them.

Recomendaciones SER sobre la utilización de fármacos biológicos en el síndrome de Sjögren primario / SER recommendations on the use of biological drugs in primary Sjögren's syndrome

OBJETIVO: Elaborar recomendaciones SER sobre el uso de agentes biológicos en el síndrome de Sjögren primario (SSp). MÉTODOS: Se identificaron preguntas clínicas de investigación relevantes sobre el uso de agentes biológicos en el SSp. Las preguntas clínicas se reformularon en 4 preguntas PICO. Se diseñó una estrategia de búsqueda y se realizó una revisión de la evidencia científica de estudios publicados hasta mayo de 2017. Se revisó sistemáticamente la evidencia científica disponible. Se evaluó el nivel global de la evidencia científica utilizando los niveles de evidencia del SIGN. Tras ello, se formularon recomendaciones específicas. RESULTADOS: Se recomienda rituximab como el fármaco biológico de elección para las manifestaciones extraglandulares refractarias al tratamiento convencional. Se desaconseja el uso de agentes anti-TNF. La evidencia científica es escasa con belimumab y abatacept, por lo que deberían considerarse solamente en los casos resistentes a rituximab. CONCLUSIONES: El rituximab es el fármaco biológico de elección en las manifestaciones graves extraglandulares del SSp. Belimumab o abatacept podrían ser de utilidad en casos seleccionados

OBJECTIVE: To formulate SER recommendations for the use of biological agents in primary Sjögren's syndrome (pSS). METHODS: Relevant clinical research questions were identified on the use of biological agents in pSS. The clinical questions were reformulated into 4 PICO questions. A search strategy was designed and a review of the scientific evidence of studies published until May 2017 was carried out. The scientific evidence available was systematically reviewed. The overall level of scientific evidence was assessed using the SIGN evidence levels. After that, specific recommendations were made. RESULTS: Rituximab is recommended as the biological agent of choice for extraglandular manifestations refractory to conventional treatment. The use of anti-TNF agents is discouraged. The scientific evidence with belimumab and abatacept is scarce, so they should be considered only in cases refractory to rituximab. CONCLUSIONS: Rituximab is the biological agent of choice in severe extraglandular manifestations of pSS. Belimumab or abatacept may be useful in selected cases

SER recommendations on the use of biological drugs in primary Sjögren's syndrome. / Recomendaciones SER sobre la utilización de fármacos biológicos en el síndrome de Sjögren primario.

OBJECTIVE: To formulate SER recommendations for the use of biological agents in primary Sjögren's syndrome (pSS). METHODS: Relevant clinical research questions were identified on the use of biological agents in pSS. The clinical questions were reformulated into 4PICO questions. A search strategy was designed and a review of the scientific evidence of studies published until May 2017 was carried out. The scientific evidence available was systematically reviewed. The overall level of scientific evidence was assessed using the SIGN evidence levels. After that, specific recommendations were made. RESULTS: Rituximab is recommended as the biological agent of choice for extraglandular manifestations refractory to conventional treatment. The use of anti-TNF agents is discouraged. The scientific evidence with belimumab and abatacept is scarce, so they should be considered only in cases refractory to rituximab. CONCLUSIONS: Rituximab is the biological agent of choice in severe extraglandular manifestations of pSS. Belimumab or abatacept may be useful in selected cases.

Glucocorticoides en artritis reumatoide: ¿casi siempre o casi nunca? / Glucocorticoids in rheumatoid arthritis: almost always or hardly ever?

El uso de los glucocorticoides en la artritis reumatoide ha sido objeto de debate en las últimas décadas. Parece existir evidencia probada, en cuanto a su capacidad antiinflamatoria y su poder de disminuir la progresión radiológica, principalmente si se utiliza en artritis reumatoide de inicio reciente. Sin embargo, sigue cuestionándose su uso debido a sus potenciales efectos secundarios, sobre todo cuando se utilizan en altas dosis y/o durante periodos prolongados. En esta revisión, intentaremos resumir la evidencia existente sobre este aspecto desde los inicios, allá por los años cincuenta del siglo xx, hasta las últimas publicaciones (AU)

The use of glucocorticoids in rheumatoid arthritis has been the source of frequent debate in the last decades. There is evidence on its anti-inflammatory capacity and its power to decrease radiologic progression, particularly if used in recent onset rheumatoid arthritis. However, there are still some voices questioning its use. Their arguments are its potential side-effects, especially when the glucocorticoids are used in high doses and/or for extended periods of time. In this review, we will try to summarize the evidence regarding this issue, from the beginning of the discussion in the fifties to the last releases (AU)

[Glucocorticoids in rheumatoid arthritis: almost always or hardly ever?]. / Glucocorticoides en artritis reumatoide: ¿casi siempre o casi nunca?

The use of glucocorticoids in rheumatoid arthritis has been the source of frequent debate in the last decades. There is evidence on its anti-inflammatory capacity and its power to decrease radiologic progression, particularly if used in recent onset rheumatoid arthritis. However, there are still some voices questioning its use. Their arguments are its potential side-effects, especially when the glucocorticoids are used in high doses and/or for extended periods of time. In this review, we will try to summarize the evidence regarding this issue, from the beginning of the discussion in the fifties to the last releases.