Estimación de la prevalencia de infección tuberculosa latente en pacientes con psoriasis en placas moderada a grave en España. Estudio Latent / Estimation of the prevalence of latent tuberculosis infection in patients with moderate to severe plaque psoriasis in Spain: The Latent study

INTRODUCCIÓN Y OBJETIVO: Los agentes biológicos anti-TNF usados para el tratamiento de la psoriasis moderada y grave pueden incrementar el riesgo de desarrollar tuberculosis activa en pacientes con infección tuberculosa latente. El objetivo principal de este estudio fue estimar la prevalencia de infección tuberculosa latente en pacientes con psoriasis en placas moderada y grave en consultas de dermatología en España. MATERIAL Y MÉTODO: Estudio epidemiológico, no intervencionista, de corte transversal y ámbito nacional, realizado en España en 2011-2012. Se incluyeron pacientes con psoriasis en placas moderada y grave, a los que se les había realizado en los 2 años previos a su inclusión en el estudio al menos una prueba de tuberculina y/o una prueba de liberación de IFN-γ mediante la técnica de ELISA QuantiFERON®-TB gold In Tube. RESULTADOS: Se incluyeron 440 pacientes evaluables. Se había realizado una prueba de tuberculina al 97,7% de los pacientes, resultando positiva en el 23%. En 238 pacientes con una primera prueba negativa se realizó un booster, que fue positivo en el 5%. Se realizó la determinación del QuantiFERON®-TB al 16,8% de los pacientes, resultando positivo en el 20,5%; en 2 de estos pacientes la prueba de la tuberculina había sido negativa. En el total de la muestra, la prevalencia de infección tuberculosa latente fue del 26,6%. El grado de concordancia entre la prueba de tuberculina y el QuantiFERON®-TB fue medio (índice kappa = 0,516; p < 0,001). CONCLUSIONES: La prevalencia de infección tuberculosa latente estimada en este estudio fue similar a la comunicada previamente en España

BACKGROUND AND OBJECTIVE: Anti-tumor necrosis factor therapy for moderate to severe psoriasis can increase the risk of active tuberculosis in patients who have latent tuberculosis infection (LTBI). The main objective of this study was to estimate the prevalence of LTBI in patients with moderate to severe plaque psoriasis being treated in dermatology clinics in Spain. MATERIAL AND METHOD: Non-interventional, cross-sectional, national epidemiological study conducted in Spain in 2011-2012. Patients with moderate to severe plaque psoriasis were included if they had undergone at least one tuberculin skin test (TST) and/or been evaluated with an interferon-γ release assay (IGRA) based on enzyme-linked immunosorbent assay (QuantiFERON® TB Gold In-Tube) in the 2 years preceding the study. RESULTS: Data for 440 patients were valid for analysis. In total, 97.7% of the patients had undergone a TST, with a positive result in 23%. Of the 238 patients in whom the initial result was negative, 5% converted to positive on re-testing for a booster effect. IGRA results were available for 16.8%, 20.5% of them positive. Two of the patients with positive IGRA results had a negative TST. The prevalence of LTBI in the whole sample was 26.6%. The degree of concordance between the TST and the IGRA was moderate (Kappa=0.516; P<.001). CONCLUSIONS: The prevalence of LTBI in this study was similar to previous estimates for Spain

Estimation of the prevalence of latent tuberculosis infection in patients with moderate to severe plaque psoriasis in Spain: The Latent study.

BACKGROUND AND OBJECTIVE: Anti-tumor necrosis factor therapy for moderate to severe psoriasis can increase the risk of active tuberculosis in patients who have latent tuberculosis infection (LTBI). The main objective of this study was to estimate the prevalence of LTBI in patients with moderate to severe plaque psoriasis being treated in dermatology clinics in Spain. MATERIAL AND METHOD: Non-interventional, cross-sectional, national epidemiological study conducted in Spain in 2011-2012. Patients with moderate to severe plaque psoriasis were included if they had undergone at least one tuberculin skin test (TST) and/or been evaluated with an interferon-γ release assay (IGRA) based on enzyme-linked immunosorbent assay (QuantiFERON(®) TB Gold In-Tube) in the 2 years preceding the study. RESULTS: Data for 440 patients were valid for analysis. In total, 97.7% of the patients had undergone a TST, with a positive result in 23%. Of the 238 patients in whom the initial result was negative, 5% converted to positive on re-testing for a booster effect. IGRA results were available for 16.8%, 20.5% of them positive. Two of the patients with positive IGRA results had a negative TST. The prevalence of LTBI in the whole sample was 26.6%. The degree of concordance between the TST and the IGRA was moderate (κ=0.516; P<.001). CONCLUSIONS: The prevalence of LTBI in this study was similar to previous estimates for Spain.

Informe de expertos en psoriasis: opinión de los dermatólogos españoles sobre el manejo de la psoriasis moderada-grave con agentes biológicos en pacientes adultos / Expert Report on Psoriasis: Spanish Dermatologists’ Opinions on the Use of Biologic Agents to Manage Moderate to Severe Psoriasis in Adults

Introducción: Aunque se dispone de directrices nacionales sobre el tratamiento de la psoriasis moderada-grave del adulto con biológicos, es esencial ampliar el conocimiento sobre aspectos prácticos en el uso de estos agentes. Objetivo: El objetivo de este estudio fue recoger la opinión de los dermatólogos españoles expertos en el manejo de la psoriasis sobre aspectos prácticos de su tratamiento con biológicos. Material y métodos: Encuesta on-line remitida a 309 dermatólogos pertenecientes al Grupo Español de Psoriasis o miembros de la Academia Española de Dermatología. La encuesta diseñada específicamente para el estudio incluía preguntas sobre diferentes aspectos del tratamiento de la psoriasis en su práctica clínica. Seis coordinadores, representativos de las diferentes zonas geográficas, elaboraron el informe final de expertos. Resultados: La tasa de respuesta fue del 97% (n = 300). Los biológicos considerados como opción preferida o más favorable por los encuestados (opción 4 de 4) fueron: infliximab por su eficacia a corto plazo (74%) y rapidez de acción (78%); ustekinumab por su conveniencia en la administración (73%) y etanercept por la posibilidad de administrarlo en ciclos (71%), seguridad a largo plazo (72%) y posibilidad de discontinuar en situaciones especiales (76%). En cuanto a la percepción clínica de seguridad y «supervivencia» otorgaron la máxima valoración (opción 5 de 5) a etanercept un 49 y 33% de los encuestados. Un 30% de los encuestados considera muy relevantes las guías de manejo terapéutico con biológicos. Conclusiones: Los resultados de este estudio proporcionan una perspectiva inédita sobre la opinión de una amplia muestra de dermatólogos españoles en España, respecto al uso actual de biológicos en el tratamiento de la psoriasis (AU)

Background: Although national guidelines on biologic agents for treating moderate to severe psoriasis in adults have been published in several countries, increased knowledge on the practical aspects of their implementation is required. Objective: The objective of this study was to survey Spanish dermatologists to determine their expert opinions on practical aspects of psoriasis treatment with biologics. Materials and methods: An online survey was sent to 309 dermatologists who belong to the Spanish Psoriasis Group and/or the Spanish Academy of Dermatology and Venereology (AEDV). The questionnaire was designed specifically for the study and included items on various aspects of the treatment of psoriasis in clinical practice. Six coordinators in different geographic areas worked together to write the final expert report. Results: The response rate was 97% (300 returned questionnaires). The biologics preferred, or considered to be the best option (median score 4 out of 4 points) by respondents, were infliximab for its short-term efficacy (74% of the respondents) and rapid onset of action (78%); ustekinumab for convenience of administration (73%); and etanercept because of its suitability for cyclic treatment (71%), safety in long-term use (72%), and the possibility of temporary interruption of treatment under certain circumstances (76%). Etanercept was assigned the highest evaluations for safety and expected survival time (scored 5 on each item by 49% and 33% of the respondents, respectively). Thirty percent of the respondents considered that clinical guidelines contain important information for therapeutic management of psoriasis. Conclusions: This study provides a unique perspective on the opinions of a large sample of dermatologists as regards current treatment of psoriasis with biologics in Spain (AU)

Expert report on psoriasis: Spanish dermatologists' opinions on the use of biologic agents to manage moderate to severe psoriasis in adults.

BACKGROUND: Although national guidelines on biologic agents for treating moderate to severe psoriasis in adults have been published in several countries, increased knowledge on the practical aspects of their implementation is required. OBJECTIVE: The objective of this study was to survey Spanish dermatologists to determine their expert opinions on practical aspects of psoriasis treatment with biologics. MATERIALS AND METHODS: An online survey was sent to 309 dermatologists who belong to the Spanish Psoriasis Group and/or the Spanish Academy of Dermatology and Venereology (AEDV). The questionnaire was designed specifically for the study and included items on various aspects of the treatment of psoriasis in clinical practice. Six coordinators in different geographic areas worked together to write the final expert report. RESULTS: The response rate was 97% (300 returned questionnaires). The biologics preferred, or considered to be the best option (median score 4 out of 4 points) by respondents, were infliximab for its short-term efficacy (74% of the respondents) and rapid onset of action (78%); ustekinumab for convenience of administration (73%); and etanercept because of its suitability for cyclic treatment (71%), safety in long-term use (72%), and the possibility of temporary interruption of treatment under certain circumstances (76%). Etanercept was assigned the highest evaluations for safety and expected survival time (scored 5 on each item by 49% and 33% of the respondents, respectively). Thirty percent of the respondents considered that clinical guidelines contain important information for therapeutic management of psoriasis. CONCLUSIONS: This study provides a unique perspective on the opinions of a large sample of dermatologists as regards current treatment of psoriasis with biologics in Spain.

Evaluación clínica y terapéutica de los pacientes con psoriasis moderada o grave en España. Estudio Secuence / Clinical and Therapeutic Evaluation of Patients with Moderate to Severe Psoriasis in Spain: The Secuence Study

Introducción: La evaluación de la gravedad de la psoriasis se considera esencial en el manejo terapéutico óptimo de los pacientes. Objetivos: Descripción de las características clínicas y perfil terapéutico de los pacientes con psoriasis moderada a grave en el ámbito español, evaluando su impacto en la calidad de vida de los pacientes. Material y métodos: Estudio observacional, de corte transversal, realizado en 90 unidades dermatológicas en España en 2009. Se incluyeron 442 pacientes diagnosticados de psoriasis moderada a grave que habían iniciado tratamiento con fármacos sistémicos, fototerapia y/o tratamientos tópicos entre 2004 y 2006. Resultados: Los pacientes con psoriasis más grave presentaron de forma significativa un mayor tiempo de evolución de la enfermedad, mayor prevalencia de enfermedades concomitantes y mayor afectación ungueal, del cuero cabelludo, de las flexuras y de la zona palmo-plantar, así como peor calidad de vida. Durante los 5 años previos al inicio del estudio el 68% de los pacientes recibieron tratamientos sistémicos convencionales, el 39,1% fármacos biológicos y el 22,3% fototerapia. En la actualidad el 57,5% estaban siendo tratados con algún fármaco biológico, el 32,6% recibían fármacos sistémicos convencionales y el 11% fototerapia. Conclusiones: La gravedad de la psoriasis se asoció en nuestro estudio con una marcada afectación de la calidad de vida. Independientemente de la gravedad de la psoriasis, el mayor predictor de mala calidad de vida fue la comorbilidad psiquiátrica. El tiempo medio de permanencia en otros tratamientos, incluyendo sistémicos convencionales o fototerapia, hasta el cambio a un primer biológico fue superior a los 2 años (AU)

Background: Evaluation of disease severity is considered essential in the optimal management of psoriasis. Objectives: To describe the clinical characteristics and therapeutic profile of patients with moderate to severe psoriasis in Spain and to assess the impact of the disease on the patients’quality of life. Materials and methods: This was an observational, cross-sectional study carried out in 90 dermatology units in Spain in 2009. We included 442 patients diagnosed with moderate to severe psoriasis who had started treatment with systemic agents, phototherapy, and/or topical treatments between 2004 and 2006. Results: More severe psoriasis was significantly associated with the following: longer disease duration; higher prevalence of concomitant disease; greater involvement of the nails, scalp, flexures, palms, and soles; and poorer quality of life. In the 5 years before the start of the study,68% of the patients had received conventional systemic treatments, 39.1% biologic agents, and22.3% phototherapy. At present, 57.5% of the patients are being treated with biologic agents,32.6% with conventional systemic treatments, and 11% with phototherapy. Conclusions: Severity of psoriasis was associated with a marked impact on quality of life. Regardless of disease severity, psychiatric comorbidity was the strongest predictor of poor quality of life. On average, patients had received other treatments, such as conventional systemic treatments or phototherapy, for more than 2 years before switching to biologic agents for the first time (AU)

Clinical and therapeutic evaluation of patients with moderate to severe psoriasis in Spain: the secuence study.

BACKGROUND: Evaluation of disease severity is considered essential in the optimal management of psoriasis. OBJECTIVES: To describe the clinical characteristics and therapeutic profile of patients with moderate to severe psoriasis in Spain and to assess the impact of the disease on the patients' quality of life. MATERIALS AND METHODS: This was an observational, cross-sectional study carried out in 90 dermatology units in Spain in 2009. We included 442 patients diagnosed with moderate to severe psoriasis who had started treatment with systemic agents, phototherapy, and/or topical treatments between 2004 and 2006. RESULTS: More severe psoriasis was significantly associated with the following: longer disease duration; higher prevalence of concomitant disease; greater involvement of the nails, scalp, flexures, palms, and soles; and poorer quality of life. In the 5 years before the start of the study, 68% of the patients had received conventional systemic treatments, 39.1% biologic agents, and 22.3% phototherapy. At present, 57.5% of the patients are being treated with biologic agents, 32.6% with conventional systemic treatments, and 11% with phototherapy. CONCLUSIONS: Severity of psoriasis was associated with a marked impact on quality of life. Regardless of disease severity, psychiatric comorbidity was the strongest predictor of poor quality of life. On average, patients had received other treatments, such as conventional systemic treatments or phototherapy, for more than 2 years before switching to biologic agents for the first time.

Clinical and Therapeutic Evaluation of Patients with Moderate to Severe Psoriasis in Spain: The Secuence Study. / Evaluación clínica y terapéutica de los pacientes con psoriasis moderada o grave en España. Estudio Secuence.

BACKGROUND: Evaluation of disease severity is considered essential in the optimal management of psoriasis. OBJECTIVES: To describe the clinical characteristics and therapeutic profile of patients with moderate to severe psoriasis in Spain and to assess the impact of the disease on the patients' quality of life. MATERIALS AND METHODS: This was an observational, cross-sectional study carried out in 90 dermatology units in Spain in 2009. We included 442 patients diagnosed with moderate to severe psoriasis who had started treatment with systemic agents, phototherapy, and/or topical treatments between 2004 and 2006. RESULTS: More severe psoriasis was significantly associated with the following: longer disease duration; higher prevalence of concomitant disease; greater involvement of the nails, scalp, flexures, palms, and soles; and poorer quality of life. In the 5 years before the start of the study, 68% of the patients had received conventional systemic treatments, 39.1% biologic agents, and 22.3% phototherapy. At present, 57.5% of the patients are being treated with biologic agents, 32.6% with conventional systemic treatments, and 11% with phototherapy. CONCLUSIONS: Severity of psoriasis was associated with a marked impact on quality of life. Regardless of disease severity, psychiatric comorbidity was the strongest predictor of poor quality of life. On average, patients had received other treatments, such as conventional systemic treatments or phototherapy, for more than 2 years before switching to biologic agents for the first time.

Percepción del médico y paciente de la gravedad de la psoriasis, su impacto en la calidad de vida y satisfacción con la atención y el tratamiento recibido. Estudio observacional en España / Physician and Patient Perception of Disease Severity, Quality of Life, and Treatment Satisfaction in Psoriasis: An Observational Study in Spain

Introducción: El objetivo de este estudio fue evaluar el impacto de la psoriasis en la calidad de vida del paciente, las diferencias entre médicos y pacientes en las percepciones sobre la calidad de vida, los tratamientos y las necesidades de los pacientes y la relación médico-paciente. Material y métodos: Estudio observacional, multicéntrico, de corte transversal, en el cual un grupo de dermatólogos representativos de toda la geografía española, con ejercicio tanto en el ámbito hospitalario como ambulatorio, y de pacientes con diagnóstico de psoriasis, cumplimentaron una encuesta especialmente diseñada para el estudio. La encuesta incluía preguntas sobre datos demográficos del paciente, características de la enfermedad, impacto de esta sobre la calidad de vida, manejo terapéutico de la psoriasis y relación paciente-dermatólogo. Resultados: Un total de 151 dermatólogos de toda España incluyeron una media de 5 pacientes cada uno. Se incluyeron en el análisis un total de 771 encuestas cumplimentadas por los dermatólogos y 732 encuestas cumplimentadas por los pacientes. Dos terceras partes de los pacientes presentaban una enfermedad moderada a grave con una importante repercusión en la calidad de vida, en especial sobre el estado emocional. No obstante, la calidad de vida sóloe ra evaluada de forma sistemática y rutinaria por el 19,9% de los dermatólogos. El 47% de los pacientes estaba muy satisfecho o bastante satisfecho con el tratamiento que recibía. No se encontraron diferencias relevantes entre las percepciones del paciente y del médico sobre los aspectos evaluados. Conclusiones: Nuestros resultados señalan el importante impacto que tiene la psoriasis sobre la calidad de vida del paciente y la necesidad de evaluar este parámetro de forma sistemática. Los pacientes refieren un buen grado de satisfacción con la atención recibida por los dermatólogos y los tratamientos administrados. Existe bastante concordancia entre los pacientes y los dermatólogos en la valoración de los parámetros evaluados (AU)

Objectives: The aims of this study were to determine the impact of psoriasis on patient quality of life, to analyze differences in perception between patients and physicians regarding quality of life, treatment satisfaction, and patient needs, and to assess the physician—patient relationship. Material and methods: A multicenter, observational, cross-sectional study was undertaken in which a representative group of dermatologists—–working in hospitals and outpatient clinics throughout Spain—–and their patients with a diagnosis of psoriasis completed specifically designed questionnaires. The questionnaires covered patient demographics, disease characteristics, impact of the disease on quality of life, treatment of psoriasis, and the relationship between patient and dermatologist. Results: A total of 151 dermatologists from throughout Spain included a mean of 5 patients each. The analysis included 771 questionnaires completed by dermatologists and 732 completed by patients. Two-thirds of patients had moderate-to-severe psoriasis with a major impact on quality of life, particularly in relation to emotional wellbeing. Nevertheless, quality of life was only assessed routinely and systematically by 19.9% of dermatologists. Overall, 47% of patients reported being quite satisfied or very satisfied with the treatment they received. No significant differences were observed between patients and dermatologists on the aspects analyzed. Conclusions: Our results highlight the substantial impact of psoriasis on patient quality of life and the consequent need for systematic quality-of-life assessment in affected patients. Patients reported a high level of satisfaction with the care provided by dermatologists and the treatment received. There was good agreement between patients and dermatologists in their assessment of the variables analyzed (AU)

[Physician and patient perception of disease severity, quality of life, and treatment satisfaction in psoriasis: an observational study in Spain]. / Percepción del médico y paciente de la gravedad de la psoriasis, su impacto en la calidad de vida y satisfacción con la atención y el tratamiento recibido. Estudio observacional en España.

OBJECTIVES: The aims of this study were to determine the impact of psoriasis on patient quality of life, to analyze differences in perception between patients and physicians regarding quality of life, treatment satisfaction, and patient needs, and to assess the physician-patient relationship. MATERIAL AND METHODS: A multicenter, observational, cross-sectional study was undertaken in which a representative group of dermatologists-working in hospitals and outpatient clinics throughout Spain-and their patients with a diagnosis of psoriasis completed specifically designed questionnaires. The questionnaires covered patient demographics, disease characteristics, impact of the disease on quality of life, treatment of psoriasis, and the relationship between patient and dermatologist. RESULTS: A total of 151 dermatologists from throughout Spain included a mean of 5 patients each. The analysis included 771 questionnaires completed by dermatologists and 732 completed by patients. Two-thirds of patients had moderate-to-severe psoriasis with a major impact on quality of life, particularly in relation to emotional wellbeing. Nevertheless, quality of life was only assessed routinely and systematically by 19.9% of dermatologists. Overall, 47% of patients reported being quite satisfied or very satisfied with the treatment they received. No significant differences were observed between patients and dermatologists on the aspects analyzed. CONCLUSIONS: Our results highlight the substantial impact of psoriasis on patient quality of life and the consequent need for systematic quality-of-life assessment in affected patients. Patients reported a high level of satisfaction with the care provided by dermatologists and the treatment received. There was good agreement between patients and dermatologists in their assessment of the variables analyzed.

[Clinical management of psoriatic arthritis in Spain: the CALIPSO study]. / Manejo clínico de la artritis psoriásica en España: estudio Calipso.

OBJECTIVE: To describe the clinical management of psoriatic arthritis for patients being treated by dermatologists and rheumatologists in Spain. METHODS: Multicenter, retrospective, naturalistic observational study in which demographic and clinical variables were recorded for patients diagnosed with psoriatic arthritis. Data referred to the previous 12 months and were collected during a single visit with the physician. RESULTS: A total of 266 patients were enrolled; 78.1% were being treated by rheumatologists and 21.9% by dermatologists. The data covered 1138 visits. The main reason for consulting a physician was to monitor psoriatic arthritis (82.7% of the visits). The most widely used examination was to determine the tender- and swollen-joint count (73.1%). The tests most frequently ordered were acute-phase reactants: erythrocyte sedimentation rate (79.8%) and C reactive protein level (74.5%). Affected body surface area and the Psoriasis Area and Severity Index were the main assessments used by dermatologists. Rheumatologists tended to examine the joints and record biochemical markers. A disease-modifying antirheumatic drug was prescribed for 71.1% of the patients; 51.8% were prescribed a biologic agent (61.5% in combination with another treatment). Treatment approach differed by specialty and was modified if response was nil or partial (the rationale for 45.1% of all changes). CONCLUSION: Differences in the management of psoriatic arthritis in dermatology and rheumatology were evident in both diagnostic and treatment approaches. These 2 specialties should cooperate to establish common practice guidelines for use in Spain.

Manejo clínico de la artritis psoriásica en España: estudio Calipso / Clinical Management of Psoriatic Arthritis in Spain: The CALIPSO Study

Objetivo: Conocer el manejo clínico de los pacientes con artritis psoriásica atendidos en consultas de dermatología y reumatología en España. Método: Estudio observacional, multicéntrico, naturalístico, retrospectivo, en el que se recogieron parámetros demográficos y clínicos de pacientes diagnosticados de artritis psoriásica. Se realizó una única visita; los datos se refirieron a los 12 meses anteriores. Resultados: Participaron 266 pacientes, 78,1% procedentes de consultas de reumatología y 21,9% de dermatología. Se registró información de 1.138 visitas. El principal motivo de consulta fue el control de la artritis psoriásica (82,7% de las visitas). La exploración más utilizada fue el recuento de articulaciones dolorosas e inflamadas (73,1%) y las pruebas complementarias más frecuentes fueron la determinación de reactantes de fase aguda (velocidad sedimentación y proteína C reactiva) (79,8%; 74,5%). En dermatología destacó el uso del body surface area y el psoriasis area severity index como pruebas de evaluación habituales. En reumatología se utilizaron sobretodo criterios de evaluación articular y bioquímicos. El 71,1% de pacientes fueron tratados con algún fármaco modificador de la enfermedad, y el 51,8% con terapia biológica (61,5% con tratamiento combinado), observándose diferencias según la especialidad. La obtención de respuesta parcial o nula al tratamiento fue el principal motivo de modificación del mismo (45,1% de pacientes en los que hubo cambios). Conclusión: Se evidencian diferencias en el manejo de la artritis psoriásica según especialidad, tanto en el diagnóstico como el tratamiento de la enfermedad, considerándose imprescindible la colaboración entre dermatólogos y reumatólogos para establecer protocolos de actuación comunes en el ámbito asistencial español (AU)

Objective: To describe the clinical management of psoriatic arthritis for patients being treated by dermatologists and rheumatologists in Spain. Methods: Multicenter, retrospective, naturalistic observational study in which demographic and clinical variables were recorded for patients diagnosed with psoriatic arthritis. Data referred to the previous 12 months and were collected during a single visit with the physician. Results: A total of 266 patients were enrolled; 78.1% were being treated by rheumatologists and 21.9% by dermatologists. The data covered 1138 visits. The main reason for consulting a physician was to monitor psoriatic arthritis (82.7% of the visits). The most widely used examination was to determine the tender- and swollen-joint count (73.1%). The tests most frequently ordered were acute-phase reactants: erythrocyte sedimentation rate (79.8%) and C reactive protein level (74.5%). Affected body surface area and the Psoriasis Area and Severity Index were the main assessments used by dermatologists. Rheumatologists tended to examine the joints and record biochemical markers. A disease-modifying antirheumatic drug was prescribed for 71.1% of the patients; 51.8% were prescribed a biologic agent (61.5% in combination with another treatment). Treatment approach differed by specialty and was modified if response was nil or partial (the rationale for 45.1% of all changes). Conclusion: Differences in the management of psoriatic arthritis in dermatology and rheumatology were evident in both diagnostic and treatment approaches. These 2 specialties should cooperate to establish common practice guidelines for use in Spain (AU)

Clinical Management of Psoriatic Arthritis in Spain: The CALIPSO Study. / Manejo clínico de la artritis psoriásica en España: estudio Calipso.

OBJECTIVE: To describe the clinical management of psoriatic arthritis for patients being treated by dermatologists and rheumatologists in Spain. METHODS: Multicenter, retrospective, naturalistic observational study in which demographic and clinical variables were recorded for patients diagnosed with psoriatic arthritis. Data referred to the previous 12 months and were collected during a single visit with the physician. RESULTS: A total of 266 patients were enrolled; 78.1% were being treated by rheumatologists and 21.9% by dermatologists. The data covered 1138 visits. The main reason for consulting a physician was to monitor psoriatic arthritis (82.7% of the visits). The most widely used examination was to determine the tender- and swollen-joint count (73.1%). The tests most frequently ordered were acute-phase reactants: erythrocyte sedimentation rate (79.8%) and C reactive protein level (74.5%). Affected body surface area and the Psoriasis Area and Severity Index were the main assessments used by dermatologists. Rheumatologists tended to examine the joints and record biochemical markers. A disease-modifying antirheumatic drug was prescribed for 71.1% of the patients; 51.8% were prescribed a biologic agent (61.5% in combination with another treatment). Treatment approach differed by specialty and was modified if response was nil or partial (the rationale for 45.1% of all changes). CONCLUSION: Differences in the management of psoriatic arthritis in dermatology and rheumatology were evident in both diagnostic and treatment approaches. These 2 specialties should cooperate to establish common practice guidelines for use in Spain.

Diferencias de género en el perfil clínico, respuesta y remisión de pacientes depresivos tratados con venlafaxina retard / Gender differences in clinical profile, response and remission of depressive patients treated with venlafaxine extended release

Introducción. El objetivo principal de este estudio es evaluar las diferencias específicas de género en el perfil clínico de pacientes depresivos tratados en atención primaria, así como en la respuesta y remisión clínica a venlafaxina retard. Métodos. Se ha analizado una muestra de 6.719 pacientes ambulatorios adultos (1.713 hombres y 4.925 mujeres)con diagnóstico de síndrome depresivo con síntomas asociados de ansiedad incluidos en un estudio observacional, abierto, prospectivo y multicéntrico. Se administró venlafaxina de liberación retardada durante 24 semanas a dosis de 75-225 mg/día. Resultados. No se han encontrado en este estudio diferencias globales en cuanto a la gravedad basal del episodio depresivo, según las evaluaciones de la HAM-D17 y escala de Impresión Clínica Global de Severidad (ICG-S). No obstante, las mujeres presentaron puntuaciones más altas en ítems de las escalas HAM-D17 y HAM-A relacionados con quejas somáticas y de ansiedad en las visitas basal y final. El porcentaje de remisión en la escala HAM-D17 fue del 75,4 % en hombres y 74,3 % en mujeres (p= 0,4339) en la semana 24. En el caso de la HAM-A fue 84,1 frente a 80,6% (hombres frente a mujeres, p=0,004).Conclusiones. No se observaron diferencias basales en la puntuación media de la HAM-D17 ni en las tasas de remisión entre hombres y mujeres (HAM-D17) en la visita final. Las mujeres presentaron tasas de remisión de ansiedad más bajas (HAM-A) y conservaron más quejas somáticas y de ansiedad a lo largo del estudio (AU)

Introduction. The primary objectives of this study are to evaluate gender-specific differences in the clinical profile of primary care depressive patients as well as in the clinical response and remission to venlafaxine extended release. Methods. We have analyzed a sample of 6,719 adult outpatients (1,713 men and 4,925 women) with diagnosis of depressive syndrome with associated anxiety symptoms included in an observational, prospective, multicenter and open study. Venlafaxine extended release was administered for 24 weeks at a dosage of 75-225 mg/day. Results. In this study, we have not found overall differences regarding the baseline severity of the depressive episode, as assessed by means of the HAM-D17 and Clinical Global Impression Scale of Severity (CGI-S). However, women showed higher scores on items of the HAMD17 and HAM-A scales related with anxious and somatic complaints at baseline and endpoint. The percentage of remission on the HAM-D17 scale reached 75.4 % for men and 74.3 % for women (p = 0.4339) at week 24. In the case of HAM-A: 84.1 % vs. 80.6 % (men vs. women, p=0.004).Conclusions. We did not observe baseline differences in the mean score of the HAM-D17 nor the remission rates between women and men (HAM-D17) at the final visit. Women showed lower anxiety remission rates (HAM-A) and maintained more anxious and somatic complaints throughout the study (AU)

[Gender differences in clinical profile, response and remission of depressive patients treated with venlafaxine extended release]. / Diferencias de género en el perfil clínico, respuesta y remisión de pacientes depresivos tratados con venlafaxina retard.

INTRODUCTION: The primary objectives of this study are to evaluate gender-specific differences in the clinical profile of primary care depressive patients as well as in the clinical response and remission to venlafaxine extended release. METHODS: We have analyzed a sample of 6,719 adult outpatients (1,713 men and 4,925 women) with diagnosis of depressive syndrome with associated anxiety symptoms included in an observational, prospective, multicenter and open study. Venlafaxine extended release was administered for 24 weeks at a dosage of 75-225 mg/day. RESULTS: In this study we have not found overall differences regarding the baseline severity of the depressive episode, as assessed by means of the HAM-D17 and Clinical Global Impression Scale of Severity (CGI-S). However, women showed higher scores on items of the HAM-D17 and HAM-A scales related with anxious and somatic complaints at baseline and endpoint. The percentage of remission on the HAM-D17 scale reached 75.4 % for men and 74.3 % for women (p = 0.4339) at week 24. In the case of HAM-A: 84.1% vs. 80.6% (men vs. women, p=0.004). CONCLUSIONS: We did not observe baseline differences in the mean score of the HAM-D17 nor the remission rates between women and men (HAM-D17) at the final visit. Women showed lower anxiety remission rates (HAM-A) and maintained more anxious and somatic complaints throughout the study.

Psychometric properties of the Spanish version of the screening scale for DSM-IV Generalized Anxiety Disorder of Carroll and Davidson.

INTRODUCTION: The aim was to validate the Spanish version of the screening scale for DSM-IV General Anxiety Disorder of Carroll and Davidson for use in research and clinical practice in Spain for screening and assessing specific anxiety symptoms of patients with Generalized Anxiety Disorder (GAD). METHODS: Observational, prospective, multisite, study comparing between patients with DSM-IV diagnosis of GAD (group A), starting or switching treatment (group A1) or stable patients (group A2), followed-up for 6 months (group A1) or 2 weeks (group A2) versus healthy control subjects (group B), assessed in a single visit. RESULTS: Among 223 valuable subjects the scale showed: a) adequate feasibility with a mean time of administration: 6.53 and 4.49 min (TD: 5.48 and 3.56) in groups A and B, and percentage of patients without response <5 %; b) adequate reliability (Kuder-Richardson coefficient: 0.85 and 0.79 in groups A1 and A2, and CCI coefficient: 0.89 in group A2); c) adequate validity, showing capability for discriminating between patients and controls, with area under curve AUC: 0.9713 (IC 95 %: 0.9510-0.9917), and obtaining a high correlation with HARS (r=0.88) and CGI-G (r=0.87) scales, y d) adequate sensitivity to clinical changes from start and end of treatment (SES: -1.6, -3.1 and -3.8 after 1, 3 and 6 months), spite of the high percentage of patients with highest score in group A1 (38.6 %). CONCLUSION: The Spanish version of the screening scale for DSM-IV GAD showed adequate psychometric properties for use in research and clinical practice in Spain as well as an screening as evaluative measure for patients with GAD, spite of the ceiling effect showed in severe patients.

Propiedades psicométricas de la versión española de la Escala de Detección del Trastorno de Ansiedad Generalizada según DSM-IV de Carroll y Davidson / Psychometric Properties of the Spanish Version of the Screening Scale for DSM-IV Generalized Anxiety Disorder of Carroll and Davidson

Introducción. El objetivo era validar en español la Escala del trastorno de ansiedad generalizada (TAG) de Carroll y Davidson para su uso en la práctica e investigación clínica en España para detectar y evaluar los síntomas específicos de ansiedad de los pacientes con TAG. Métodos. Estudio observacional, prospectivo, multicéntrico, comparativo entre pacientes con diagnóstico DSM-IV de TAG (grupo A) que iniciaron o cambiaron de tratamiento (grupo A1) o estables (grupo A2), seguidos durante 6 meses (grupo A1) o 2 semanas (grupo A2), frente a controles sanos (grupo B) evaluados en una ocasión. Resultados. La escala mostró en 223 sujetos valorables: a) adecuada factibilidad con tiempo de administración medio: 6,53 y 4,49 min (DT: 5,48 y 3,56) en grupos A y B, y porcentaje de pacientes sin respuesta<5%; b) adecuada fiabilidad (coeficientes Kuder-Richardson: 0,85 y 0,79 en grupos A1 y A2, y CCI: 0,89 en grupo A2); c) adecuada validez, confirmándose su capacidad discriminante entre pacientes y controles, con área bajo la curva AUC: 0,9713 (IC 95 %: 0,9510-0,9917), y su alta correlación con escalas HARS (r=0,88) y CGI-G (r=0,87), y d) adecuada sensibilidad para detectar cambios clínicos entre antes y después del tratamiento (SES: -1,6, -3,1 y -3,8 en meses 1, 3 y 6) pese al elevado porcentaje de pacientes con puntuación máxima en grupo A1 (38,6 %). Conclusiones. La Escala del TAG posee adecuadas propiedades psicométricas para su uso en la práctica e investigación clínica en España como instrumento de cribado y evaluativo con pacientes con TAG pese al efecto techo que presenta en pacientes graves

Introduction. The aim was to validate the Spanish version of the screening scale for DSM-IV General Anxiety Disorder of Carroll and Davidson for use in research and clinical practice in Spain for screening and assessing specific anxiety symptoms of patients with Generalized Anxiety Disorder (GAD). Methods. Observational, prospective, multisite, study comparing between patients with DSM-IV diagnosis of GAD (group A), starting or switching treatment (group A1) or stable patients (group A2), followed-up for 6 months (group A1) or 2 weeks (group A2) versus healthy control subjects (group B), assessed in a single visit. Results. Among 223 valuable subjects the scale showed: a) adequate feasibility with a mean time of administration: 6,53 and 4,49 min (TD: 5.48 and 3.56) in groups A and B, and percentage of patients without response < 5 %; b) adequate reliability (Kuder-Richardson coefficient: 0.85 and 0.79 in groups A1 and A2, and CCI coefficient: 0.89 in group A2); c) adequate validity, showing capability for discriminating between patients and controls, with area under curve AUC: 0.9713 (IC 95 %: 0.9510-0.9917), and obtaining a high correlation with HARS (r=0.88) and CGI-G (r=0.87) scales, y d) adequate sensitivity to clinical changes from start and end of treatment (SES: -1.6, -3.1 and -3.8 after 1, 3 and 6 months), spite of the high percentage of patients with highest score in group A1 (38.6 %). Conclusion. The Spanish version of the screening scale for DSM-IV GAD showed adequate psychometric properties for use in research and clinical practice in Spain as well as an screening as evaluative measure for patients with GAD, spite of the ceiling effect showed in severe patients

Depression in primary care: effectiveness of venlafaxine extended-release in elderly patients; Observational study.

Depression in the elderly is frequent but is often not recognized or treated as such. Few studies have assessed the effectiveness and tolerability of venlafaxine extended-release in patients over 60 years in primary care. This study aims to demonstrate the effectiveness and safety of venlafaxine extended-release in depressive disorders in this kind of population. Observational, multicenter and prospective study in an outpatient population over 60 years with depressive symptoms that needs pharmacological treatment and with a minimum score of 14 on the 17-items Hamilton rating scale for depression (HAM-D17). Effectiveness was assessed by HAM-D17. Physician's assessment of the patient's global status was also used and all the possible adverse effects were recorded. Venlafaxine extended-release was administered for 6 months at 75 mg per day dose, with the possibility of going up to 150 mg per day according to clinical criterion. Data of 1214 patients were obtained, with remission rates (HAM-D17

[Study of the incidence of invasive pneumococcal disease in neonates and childre aged less than 5 years in the Basque country and Navarre (Spain)]. / Estudio de la incidencia de enfermedad neumocócica invasora entre 0-5 años en el País Vasco y Navarra.

BACKGROUND: Streptococcus pneumoniae is the most commonly reported bacterial cause of bacteremia and bacteremic pneumonia and the second most frequent cause of meningitis. OBJECTIVE: To establish the incidence, characteristics and serotypes causing invasive pneumococcal disease in children aged less than 5 years in two Autonomous Communities in Spain, the Basque country and Navarre, between 31 May 1988 and 1 June 2001. PATIENTS AND METHODS: We performed a descriptive, observational and retrospective study. The study population was composed of children diagnosed with invasive pneumococcal disease in the public and private hospitals with a pediatrics departments. Invasive pneumococcal disease was defined as isolation of S. pneumoniae in blood, cerebrospinal fluid or any other sterile biological fluid. Medical records were reviewed and demographic and diagnostic variables were analyzed. Age-adjusted frequency rates were established for both regions using direct standardization. Confidence intervals were obtained by Poisson distribution. SPSS for Windows 10.0 and Epidat 2.1 were used for the analysis. Data were obtained from the 1999 municipal population census. RESULTS: One hundred seventy-one children aged 0-5 years were included. A total of 40.9 % (70 patients) were aged less than 12 months and 68.4 % were aged 0-2 years; 16.4 % had received drug therapy before diagnosis. The most common forms of presentation were occult bacteremia (45.6 %), bacteremic pneumonia (27.5 %) and meningitis (14.6 %). The most frequent complications involved the respiratory tract, with pleural effusion in 23 % of cases of pneumonia. The standardized annual incidence rate of invasive pneumococcal disease (cases per 100,000) in children aged 0-59 months was 58.82 (95 % CI: 27.99-89.65) in Navarre and 55.35 (95 % CI: 38.81-71.88) in the Basque Country. In children aged 0-23 months, the overall incidence was 93.49 cases per 100,000 children (95 % CI: 77.32-112.04) and in infants aged 0-11 months, it was 110,21 cases per 100,000 children (95 % CI: 85.91-139.24). The incidence rates for meningitis and bacteremia in children aged 0-23 months was 15.98 (95 % CI: 9.76-24.68) and 51.14 (95 % IC: 39.38-65.30) cases per 100.000 children. Fifty-nine strains were serotyped. The most frequent serotypes/groups were 1, 4, 6B, 14, 18C, 19 and 23F. A total of 52.15 % of the serotypes were penicillin-susceptible and 93 % were cefotaxime-susceptible. The serotypes/groups with the highest rates of resistance were 6B, 14,19, 23F and 35. CONCLUSION: Our incidence rates are similar to those observed in other countries such as the United States and are higher than those reported for the rest of Europe. Vaccine coverage is similar to that described in other articles.

Estudio de la incidencia de enfermedad neumocócica invasora entre 0-5 años en el País Vasco y Navarra / Study of the incidence of invasive pneumococcal disease in neonates and children aged less than 5 years in the basque country and navarre (spain)

Antecedentes: Streptococcus pneumoniae es la causa más frecuente de bacteriemia y neumonía y la segunda causa de meningitis bacteriana en la edad pediátrica. Objetivo: Establecer la incidencia, las características y los serotipos predominantes de enfermedad neumónica invasora (ENI) en niños menores de 5 años en 2 comunidades autónomas: País Vasco y Navarra. El período de estudio comprendió del 31 de mayo de 1998 al 1 de junio de 2001. Pacientes y métodos: Estudio descriptivo, observacional y retrospectivo. La población de estudio incluyó a los niños diagnosticados de ENI en los hospitales públicos y privados con servicio de pediatría. Se definió la ENI por el aislamiento de S. pneumoniae en hemocultivo, líquido cefalorraquídeo (LCR) u otros sitios estériles. Se revisaron las historias clínicas y se analizaron las características demográficas y diagnósticas. Se establecieron las frecuencias ajustadas por edades de ambas áreas, mediante estandarización directa. Los intervalos de confianza (IC) de las frecuencias se obtuvieron por la distribución de Poisson. Se utilizaron los paquetes informáticos SPSS para Windows 10.0 y Epidat 2.1. Se empleó la revisión poblacional del padrón municipal de 1999. Resultados: Se incluyeron 171 niños con edades entre 0 y 5 años. El 40,9% (70 niños) eran menores de 12 meses y el 68,4% (117 niños) entre 0 y 2 años y predominaban los varones. El 16,4% habían recibido antibioticoterapia previa al diagnóstico. Las formas de presentación más frecuentes fueron bacteriemia oculta (45,6%), neumonía bacteriémica (27,5%) y meningitis (14,6%). Las complicaciones más frecuentes fueron las respiratorias, con derrame pleural en el 23% de las neumonías. La incidencia anual estandarizada de ENI (casos por cada 100.000) en los niños entre 0 y 59 meses fue de 58,82 (IC 95%, 27,99-89,65) en Navarra y de 55,35 casos (IC 95%, 38,81-71,88) en el País Vasco. En el caso de niños entre 0 y 23 meses se observaron globalmente 93,49 casos/año/100.000 niños (IC 95%, 77,32112,04) y en los niños entre 0 y 11 meses se alcanzaron los 110,21 casos/año/100.000 niños (IC 95%, 85,91-139,24). La incidencia de meningitis y bacteriemia en los niños entre 0 y 23 meses fue de 15,98 (IC 95%, 9,76-24,68) y 51,14 (IC 95%, 39,38-65,30) casos/año/100.000 niños, respectivamente. Se serotipificaron 59 cepas, y los serotipos/serogrupos más frecuentes fueron el 1, 4, 6B, 14, 18C, 19 y 23F. El 52,15% de las cepas fueron sensibles a penicilina y el 93% a cefotaxima. Los serotipos/serogrupos más resistentes fueron el 6B, 14, 19, 23F y 35. Conclusión: La incidencia observada en este estudio es similar a la reportada en otros países, como Estados Unidos, y superior a la comunicada en el resto de Europa. La cobertura de la vacuna es similar a la descrita en otros artículos (AU)

Impacto teórico de la vacunación neumocócica sobre la morbimortalidad de la meningitis neumocócica en España / Theoretical impact of the pneumococcal vaccination on the morbidilty mortality of pneumococcal meningitis in Spain

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