Disease-modifying antirheumatic drug prescription patterns in adult rheumatoid arthritis patients in routine clinical practice in Spain.

OBJECTIVE: To describe disease-modifying antirheumatic drug (DMARD) patterns in routine clinical practice in adult rheumatoid arthritis (RA) patients and to ascertain the reasons for methotrexate (MTX) discontinuation. METHODS: A cross-sectional observational study was conducted from March to October 2014 at the Rheumatology Units of seven hospitals in Spain. In a single visit, the treating rheumatologist completed an online case report form. This report contained sociodemographic and RA variables. This study was conducted in accordance with Good Clinical Practice and local and national research legislations. RESULTS: A total of 301 patients (71% women) with a mean age of 56.7±14.0 years and disease duration of 3.6±1.5 years were examined. The patients had RA with moderate disease activity, at least one poor prognostic factor, and comorbidities. The mean time between RA diagnosis and prescription of the first conventional synthetic DMARD (csDMARD) was 2.4±6.0 months. A total of 295 patients (98%) started the first csDMARD on monotherapy. MTX was the most-prescribed first-line drug (n=233, 79%). The mean treatment time of the first-line csDMARD was 27.0±19.4 months. Of these patients, 98% progressed to a second-line csDMARD; 118 patients were changed to another DMARD, mainly due to inefficacy (51, 37%), adverse events (AEs, 37, 27%), or intolerance (18, 13%). The use of MTX as second-line therapy reduced from 79% to 51%. At the time of the study, 200 patients (66%) received a csDMARD as monotherapy and 45 (15%) a combination of ≥2 csDMARDs. Fifty-five (18%) patients were being treated with a biological drug in monotherapy (16, 29%) or in a combination with a csDMARD (39, 71%), mainly MTX, 147 patients (57%) received steroids. Biological DMARD were prescribed as the second line for 42% of patients and 51% of patients received the third-line therapy or beyond. The rate of AEs that motivated a change in the csDMARD was 34%. CONCLUSION: MTX was the most-used csDMARD as first and second-line therapy together with corticosteroids. The combination of two or more csDMARDs as first-line treatment was very infrequent. MTX toxicity and intolerance were higher and more significant than inefficacy but progressively decreased with use.

Spatial Distribution of Heavy Metals and the Environmental Quality of Soil in the Northern Plateau of Spain by Geostatistical Methods.

The environmental quality of soil in the central part of the Northern Plateau of Spain has been analyzed by studying the heavy metal content of 166 samples belonging to the horizons A, B and C of 89 soil profiles. The analysis to assess the environmental risk of heavy metals in the soil was carried out by means of the spatial distribution of nine heavy metals and the use of several pollution indices. The results showed that the concentration values of heavy metals (x ± S) in the superficial soil horizons were the following: With a total of 6.71 ± 3.51 mg kg -1, the contents of Cd is 0.08 ± 0.06 mg kg-1, Co is 6.49 ± 3.21 mg kg-1, Cu is 17.19 ± 10.69 mg kg-1, Cr is 18.68 ± 12.28 mg kg-1, Hg is 0.083 ± 0.063 mg kg-1, Ni is 12.05 ± 6.76 mg kg-1, Pb is 14.10 ± 11.32 mg kg-1 and Zn is 35.31 ± 14.63 mg kg-1. These nine metals exceed the values of the natural geological background level of Tertiary period sediments and rocks that form part of the Northern Plateau in Spain. Nemerow and Potential Ecological Risk indices were calculated, with the "improved" Nemerow index allowing pollution within the soil superficial horizons to be determined. The data obtained indicated that the majority of the soil (54.61%) showed low to moderate contamination, 22.31% showed moderate contamination and 21.54% of the samples were not contaminated. If we consider the Potential of Ecological Risk Index (RI), the largest percentage of soil samples showed low (70.79%) to moderate (25.38%) ecological risk of potential contamination, where the rest of the soil presented a considerable risk of contamination. The nine trace elements were divided into three principal components: PC1 (Cu, Cr, Ni, Co and Zn), PC2 (As and Hg) and PC3 (Cd). All metals accumulated in the soil came from parent rock, agricultural practices and the run-off of residual waters towards rivers and streams caused by industrial development and an increase in population density. Finally, cartography of the spatial distribution of the heavy metal contents in the soil of the Northern Plateau of Spain was generated using Kriging interpolation methods. Furthermore, the total heavy metal contents in three soil orders present in the area, namely Entisols, Inceptisols, and Alfisols, were analyzed. Other soil parameters, such as the organic matter content, pH, clay content and cation exchange capacity, was measured to determine their influence on and correlation with the heavy metal contents.

Pharmacogenetics of osteoporosis: towards novel theranostics for personalized medicine?

Osteoporosis is a complex multifactorial bone disorder with a strong genetic basis. It is the most common, severe, progressive skeletal illness that has been increasing, particularly in developed countries. Osteoporosis will no doubt constitute a serious clinical burden in healthcare management in the coming decades. The genetics of osteoporosis should be analyzed from both the disease susceptibility and the pharmacogenetic treatment perspectives. The former has been widely studied and discussed, while the latter still requires much more information and research. This article provides a synthesis of the literature on the genetics of osteoporosis and an update on progress made in pharmacogenetics of osteoporosis in recent years, specifically regarding the new molecular targets for antiresorptive drugs. In-depth translation of osteoporosis pharmacogenetics approaches to clinical practice demands a new vision grounded on the concept of "theranostics," that is, the integration of diagnostics for both disease susceptibility testing, as well as for prediction of health intervention outcomes. In essence, theranostics signals a broadening in the scope of inquiry in diagnostics medicine. The upcoming wave of theranostics medicine also suggests more distributed forms of science and knowledge production, both by experts and end-users of scientific products. Both the diagnosis and personalized treatment of osteoporosis could conceivably benefit from the emerging postgenomics field of theranostics.