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1.
Arthritis Care Res (Hoboken) ; 73(6): 856-860, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-32100954

RESUMO

OBJECTIVE: To describe the radiographic phenotype of axial spondyloarthritis (SpA) according to the presence of HLA-B27. METHODS: An international collaboration compared the radiographic phenotype of axial SpA according to HLA-B27 status. Patients with ankylosing spondylitis (AS) and axial psoriatic arthritis (PsA) were collected. Radiographs were read centrally, blinded to clinical details. The symmetry of the sacroiliac joints and lumbar syndesmophytes and the morphology of syndesmophytes (typical marginal versus atypical chunky), together with the modified Stoke Ankylosing Spondylitis Spine Score and the Psoriatic Arthritis Spondylitis Radiographic Index, were recorded. RESULTS: A total of 244 patients with PsA and 198 patients with AS were included. In PsA, 60 patients (25%) were HLA-B27 positive while in AS, 148 patients (75%) were HLA-B27 positive. Patients with HLA-B27 were younger and more often male and had a longer duration of disease. In multivariable logistic regression, HLA-B27 was significantly associated with syndesmophyte symmetry (odds ratio [OR] 3.02 [95% confidence interval (95% CI) 1.38, 6.61]) and marginal syndesmophytes (OR 1.97 [95% CI 1.16, 3.36]) but not with sacroiliac symmetry. Mean radiographic scores were higher for patients with HLA-B27. CONCLUSION: Patients with axial SpA who are positive for HLA-B27 have more severe radiographic damage, more marginal syndesmophytes, and more frequent syndesmophyte symmetry compared to patients who are negative for HLA-B27.


Assuntos
Artrite Psoriásica/diagnóstico por imagem , Antígeno HLA-B27/análise , Articulação Sacroilíaca/diagnóstico por imagem , Espondilite Anquilosante/diagnóstico por imagem , Adulto , Idoso , Artrite Psoriásica/imunologia , Canadá , Estudos Transversais , Europa (Continente) , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fenótipo , Valor Preditivo dos Testes , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Espondilite Anquilosante/imunologia
2.
Reumatol. clín. (Barc.) ; 16(5,pt.1): 333-338, sept.-oct. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-195889

RESUMO

OBJETIVO: Desarrollar un documento de consenso para estandarizar los términos, abreviaturas y acrónimos en español empleados en el campo de las espondiloartritis (EspA). MÉTODOS: Se creó un grupo de trabajo internacional compuesto por todos los miembros de Assessment of SpondyloArthritis International Society (ASAS) nativos de habla española, miembros del comité ejecutivo del Grupo para el estudio de la Espondiloartritis de la Sociedad Española de Reumatología (GRESSER), 2 metodólogos, 2 lingüistas de la Real Academia Nacional de Medicina de España (RANM) y 2 pacientes de la Coordinadora Española de Asociaciones de Espondilitis (CEADE). Se realizó una revisión de la literatura de los últimos 15 años (publicaciones, el CIE y CIF, guías, consensos y recomendaciones) para identificar los términos, abreviaturas y acrónimos discrepantes. Mediante un Delphi de 3 rondas y una reunión presencial, se discutieron, seleccionaron y acordaron los términos, abreviaturas y acrónimos a utilizar. Durante todo este proceso se siguieron las recomendaciones de la RANM basadas en el Diccionario panhispánico de términos médicos. RESULTADOS: Se consensuaron 46 términos, abreviaturas y acrónimos. Se aceptó la traducción al español para 6 términos y 6 abreviaturas empleados para nombrar o clasificar la enfermedad y para 6 términos y 4 abreviaturas relacionados con las EspA. Se acordó no traducir 15 acrónimos por estar ya establecidos, pero al mencionarlos, se recomendó seguir esta estructura: tipo de acrónimo en español y acrónimo y forma extensa en inglés. Con respecto a 7 términos o abreviaturas asociados a acrónimos, se acordó traducir solo la forma extensa y se consensuó una traducción. CONCLUSIONES: Con esta estandarización del lenguaje de las EspA se pretende establecer un uso común de la nomenclatura en español para las EspA. Su implementación será muy beneficiosa, evitando malentendidos y consumo de recursos


OBJECTIVE: To develop a consensus to standardize the use of Spanish terms, abbreviations and acronyms in the field of spondyloarthritis (SpA). METHODS: An international task force comprising all native Spanish-speaking Assessment of SpondyloArthritis International Society (ASAS) members, the executive committee of Grupo para el estudio de la Espondiloartritis de la Sociedad Española de Reumatología (GRESSER), two methodologists, two linguists from the Real Academia Nacional de Medicina de España (RANM) and two patients from the Spanish Coordinator of Spondylitis Associations (CEADE) was established. A literature review was performed to identify the conflicting terms/abbreviations/acronyms in SpA. This review examined written sources in Spanish including manuscripts, ICF and ICD, guidelines, recommendations and consensuses. This was followed by a nominal group meeting and a three-round Delphi. The recommendations from the RANM based on the Panhispanic dictionary were followed throughout the process. RESULTS: Consensus was reached for 46 terms, abbreviations or acronyms related to the field of SpA. A Spanish translation was accepted for 6 terms and 6 abbreviations to name or classify the disease, and for 6 terms and 4 abbreviations related to SpA. It was agreed not to translate 15 acronyms into Spanish. However, when mentioning them, it was recommended to follow this structure: type of acronym in Spanish and acronym and expanded form in English. With regard to 7 terms or abbreviations attached to acronyms, it was agreed to translate only the expanded form and a translation was also selected for each of them. CONCLUSIONS: Through this standardization, it is expected to establish a common use of the Spanish nomenclature for SpA. The implementation of this consensus across the community will be of substantial benefit, avoiding misunderstandings and time-consuming processes


Assuntos
Humanos , Consenso , Espondilartrite/diagnóstico , Abreviaturas como Assunto , Dicionários Médicos como Assunto , Traduções , Terminologia como Assunto , Padrões de Referência , Espanha
3.
Reumatol Clin (Engl Ed) ; 16(5 Pt 1): 333-338, 2020.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30193774

RESUMO

OBJECTIVE: To develop a consensus to standardize the use of Spanish terms, abbreviations and acronyms in the field of spondyloarthritis (SpA). METHODS: An international task force comprising all native Spanish-speaking Assessment of SpondyloArthritis International Society (ASAS) members, the executive committee of Grupo para el estudio de la Espondiloartritis de la Sociedad Española de Reumatología (GRESSER), two methodologists, two linguists from the Real Academia Nacional de Medicina de España (RANM) and two patients from the Spanish Coordinator of Spondylitis Associations (CEADE) was established. A literature review was performed to identify the conflicting terms/abbreviations/acronyms in SpA. This review examined written sources in Spanish including manuscripts, ICF and ICD, guidelines, recommendations and consensuses. This was followed by a nominal group meeting and a three-round Delphi. The recommendations from the RANM based on the Panhispanic dictionary were followed throughout the process. RESULTS: Consensus was reached for 46 terms, abbreviations or acronyms related to the field of SpA. A Spanish translation was accepted for 6 terms and 6 abbreviations to name or classify the disease, and for 6 terms and 4 abbreviations related to SpA. It was agreed not to translate 15 acronyms into Spanish. However, when mentioning them, it was recommended to follow this structure: type of acronym in Spanish and acronym and expanded form in English. With regard to 7 terms or abbreviations attached to acronyms, it was agreed to translate only the expanded form and a translation was also selected for each of them. CONCLUSIONS: Through this standardization, it is expected to establish a common use of the Spanish nomenclature for SpA. The implementation of this consensus across the community will be of substantial benefit, avoiding misunderstandings and time-consuming processes.


Assuntos
Espondilartrite/classificação , Espondilartrite/diagnóstico , Terminologia como Assunto , Abreviaturas como Assunto , Técnica Delphi , Humanos , Cooperação Internacional , Pesquisa Qualitativa , Espanha
4.
Int J Rheum Dis ; 22(8): 1529-1537, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31119895

RESUMO

AIM: Tumor necrosis factor inhibitors (TNFi) are effective in controlling disease activity in spondyloarthritis (SpA). However, in a proportion of patients these treatments are ineffective or lead to adverse events. Recently, alternative therapies, such as interleukin (IL)-17 or IL-23 inhibitors, have emerged in the treatment of these pathologies. This study aimed to determine clinical and genetic predictors of non-response to TNFi treatment in 118 spondyloarthritis patients diagnosed according to Assessment in SpondyloArthritis International Society (ASAS) criteria. METHOD: From the literature, 41 single nucleotide polymorphisms (SNPs) were selected that had previously been associated with TNFi treatment response in spondyloarthropathies, rheumatoid arthritis and psoriasis. A clinical non-response was defined as a decrease of <50% of initial Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) in axial involvement, or a reduction of less than 1.2 of initial Disease Activity Score of 28 joints-C-reactive protein (DAS28-CRP) in patients with only peripheral involvement. Univariate and multivariate hazard ratios (HR) were determined using Cox proportional hazard models to analyze the potential prognostic factors affecting non-response to TNFi treatment. RESULTS: The clinical factors that significantly increased the non-response rate were: global visual analog scale (VAS), CRP, BASDAI, Bath Ankylosing Spondylitis Functional Index (BASFI), and the number of TNFi used. Only rs11591741 SNP showed an association with non-response. In the multivariate analysis, females had a non-response rate 4.46 times higher than males; each one-point increase in the BASFI index increased the non-response rate by 75%, and being a genotype GG vs GC or CC carrier was associated with an almost 4 times greater non-response rate. CONCLUSION: We developed a clinical-genetic model to identify SpA patients with a long-term non-response to TNFi therapy.


Assuntos
Modelos Genéticos , Testes Farmacogenômicos , Variantes Farmacogenômicos , Polimorfismo de Nucleotídeo Único , Espondilartrite/tratamento farmacológico , Inibidores do Fator de Necrose Tumoral/uso terapêutico , Adulto , Feminino , Humanos , Quinase I-kappa B/genética , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Medição de Risco , Fatores de Risco , Fatores Sexuais , Espondilartrite/diagnóstico , Espondilartrite/genética , Espondilartrite/imunologia , Fatores de Tempo , Falha de Tratamento , Inibidores do Fator de Necrose Tumoral/efeitos adversos
5.
Clin Exp Rheumatol ; 37(2): 215-221, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30299251

RESUMO

OBJECTIVES: The aim of this study was to assess the clinical and genetic characteristics associated with the presence of peripheral arthritis (PA) at disease onset in patients with ankylosing spondylitis (AS). METHODS: 456 Spanish AS patients, diagnosed according to the modified New York Criteria, who had at least ten years of follow-up since initial disease onset were selected from the National Spondyloarthropathies Registry (REGISPONSER). 18.9% of AS patients initially presented PA. Clinical variables and 384 single nucleotide polymorphisms (SNPs) distributed in 190 genes were analysed. SNP genotyping was performed using the Illumina GoldenGate genotyping platform. Association tests for allele frequencies and for categorical clinical variables were performed by the χ2 test and with the unpaired t-test for continuous variables. p-values of <0.05 were considered statistically significant. RESULTS: AS patients with PA showed an earlier age of disease onset (p=0.021), longer disease duration (p=0.020) and longer duration of AS symptoms from onset (p=0.034) than AS patients without PA. We found significant associations with the presence of PA at disease onset in 14 SNPs located in 10 genes: HLA-DQB2 (rs2857210 and rs9276615), HLA-DOB (rs2857151, rs2621332 and rs1383261), JAK2 (rs7857730), IL-23R (rs11209008 and rs10489630), CYP1B1 (rs1056836), NELL1 (rs8176786), KL (rs564481), and MEFV (rs224204), IL-2RB (rs743777) and IL-1A (rs1800587). CONCLUSIONS: Both clinical and genetic factors are associated with the presence of PA at disease onset in Spanish AS patients. The results suggest that this subset of AS patients with PA at disease onset might have differentiation factors involved in disease pathogenesis.


Assuntos
Polimorfismo de Nucleotídeo Único , Espondilite Anquilosante , Frequência do Gene , Predisposição Genética para Doença , Antígeno HLA-B27 , Humanos , Pirina , Sistema de Registros , Espondilite Anquilosante/genética
6.
J Rheumatol ; 45(10): 1383-1388, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29907675

RESUMO

OBJECTIVE: Conventional measures of spinal mobility used in the assessment of patients with axial spondyloarthritis (axSpA), such as the Bath Ankylosing Spondylitis Metrology Index and its components, are subject to interobserver variability. The University of Córdoba Ankylosing Spondylitis Metrology Index (UCOASMI) is a validated composite index based on a motion video-capture system, UCOTrack. Our objective was to assess its reproducibility in clinical practice settings. METHODS: We carried out an observational study of repeated measures in 3 centers. Video-capture systems were installed and adapted to clinical rooms. Patients with axSpA and stable disease were selected by consecutive stratified sampling [disease duration, sex, and the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI)]. Intraobserver reliability of the UCOASMI and of conventional measures was tested 3-5 days apart. For interobserver reliability, 3 patients from each center were evaluated in the other centers, within 3-7 days. The intraclass correlation coefficients (ICC) were calculated. RESULTS: Thirty patients were included (73% men, mean age 53 yrs, mean BASDAI 3.0). Interobserver and intraobserver ICC of the UCOASMI was 0.98. Conventional measurements showed lower but adequate reproducibility as well, except for interobserver reliability of lateral flexion (0.41), cervical rotation (0.61), and Schöber test (0.07), and intraobserver reliability of tragus-to-wall distance (0.30). CONCLUSION: Reproducibility of the UCOASMI seems very high, and apparently more reliable than conventional measures of mobility.


Assuntos
Imageamento Tridimensional/métodos , Amplitude de Movimento Articular , Espondilite Anquilosante/fisiopatologia , Atividades Cotidianas , Adulto , Idoso , Feminino , Seguimentos , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Coluna Vertebral/fisiopatologia
7.
J Pain Palliat Care Pharmacother ; 31(1): 52-56, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28287351

RESUMO

Primary bone marrow edema syndrome (BMES) is characterized by the combination of joint pain and distinctive magnetic resonance imaging changes. It has been suggested that the use of bisphosphonate drugs reduce symptom severity. Our objective was to review cases of patients diagnosed with BMES in the last 7 years who had been treated with zoledronic acid. Access to a pharmaceutical database was gained in order to obtain a list of zoledronic acid prescriptions. Based on clinical and MRI criteria for BMES, patients were selected. Baseline pain intensity was evaluated on a scale of 0 to 3 and was also assessed after 3 and 12 months. Functional recovery was evaluated by noting if a patient had returned to carrying out his or her normal daily activities. Out of 633 patients, 17 cases of BMES were identified (8 men), with a median age of 54 ± 14.1 years. The most frequently affected joint was the ankle (9), followed by the hip. Sixteen patients presented with moderate to severe pain initially. Of those patients, 13 had no pain after 12 months. Zoledronic acid is a option in the management of BMES, since 75% of patients treated with it presented with a complete response.


Assuntos
Artralgia/tratamento farmacológico , Medula Óssea/efeitos dos fármacos , Difosfonatos/uso terapêutico , Edema/tratamento farmacológico , Imidazóis/uso terapêutico , Adulto , Idoso , Conservadores da Densidade Óssea/uso terapêutico , Bases de Dados Factuais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Síndrome , Ácido Zoledrônico
8.
PLoS One ; 11(7): e0158905, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27415816

RESUMO

The aim of this study was to identify new genetic variants associated with the severity of ankylosing spondylitis (AS). We sequenced the exome of eight patients diagnosed with AS, selected on the basis of the severity of their clinical parameters. We identified 27 variants in exons and regulatory regions. The contribution of candidate variants found to AS severity was validated by genotyping two Spanish cohorts consisting of 180 cases/300 controls and 419 cases/656 controls. Relationships of SNPs and clinical variables with the Bath Ankylosing Spondylitis Disease Activity and Functional Indices BASDAI and BASFI were analyzed. BASFI was standardized by adjusting for the duration of the disease since the appearance of the first symptoms. Refining the analysis of SNPs in the two cohorts, we found that the rs4819554 minor allele G in the promoter of the IL17RA gene was associated with AS (p<0.005). This variant was also associated with the BASFI score. Classifying AS patients by the severity of their functional status with respect to BASFI/disease duration of the 60th, 65th, 70th and 75th percentiles, we found the association increased from p60 to p75 (cohort 1: p<0.05 to p<0.01; cohort 2: p<0.01 to p<0.005). Our findings indicate a genetic role for the IL17/ILRA axis in the development of severe forms of AS.


Assuntos
Polimorfismo de Nucleotídeo Único/genética , Receptores de Interleucina-17/genética , Espondilite Anquilosante/genética , Alelos , Estudos de Casos e Controles , Exoma/genética , Feminino , Técnicas de Genotipagem , Humanos , Masculino , Pessoa de Meia-Idade , Regiões Promotoras Genéticas/genética , Receptores de Interleucina-17/fisiologia , Análise de Sequência de DNA , Índice de Gravidade de Doença
9.
Clin Rheumatol ; 35(9): 2293-305, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27068737

RESUMO

The authors aimed to test potential relations between osteoarthritis (OA) features, disability and health-related quality of life (HR-QoL) at different body locations. Outpatients consulting for pain associated to self-reported OA at varied healthcare settings were evaluated in a 3-month observational non-controlled follow-up study. Socio-demographic/anthropometric and medical data were collected at three time points. Lequesne's indices, quick-disabilities of arm, shoulder and hand (DASH) and Oswestry questionnaires provided measures of physical function and disability. HR-QoL measures were obtained with EuroQol-5 Dimensions. Multivariate analyses were used to evaluate the differences of pain severity across body regions and the correlates of disability and HR-QoL. Six thousand patients were evaluated. Pain lasted 2 years or more in 3995 patients. The mean pain severity at baseline was moderate (6.4 points). On average, patients had pain in 1.9 joints/areas. The pain was more severe when OA involved the spine or all body regions. Pain severity explained much of the variance in disability and HR-QoL; this association was less relevant in patients with OA in the upper limbs. There were considerable improvements at follow up. Pain severity improved as did disability, which showed particularly strong associations with HR-QoL improvements. Pain severity is associated with functional limitations, disability and poor HR-QoL in patients with self-reported OA. Functional limitations might have particular relevance when OA affects the upper limbs. Improvements are feasible in many patients who consult because of their pain.


Assuntos
Avaliação da Deficiência , Osteoartrite/diagnóstico , Dor/diagnóstico , Qualidade de Vida , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite/fisiopatologia , Dor/fisiopatologia , Medição da Dor , Índice de Gravidade de Doença , Inquéritos e Questionários
10.
Semin Arthritis Rheum ; 45(4): 400-3, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26601781

RESUMO

OBJECTIVES: To describe and compare the characteristics of patients fulfilling the ASAS criteria for axial Spondyloarthritis (SpA) versus peripheral SpA . METHODS: Baseline dataset from the ESPeranza cohort was used. In this programme, patients were referred to rheumatologist in case of (1) age <45 years, (2) symptoms duration 3-24 months and (3) inflammatory back pain (IBP) or asymmetrical arthritis or spinal/joint pain plus ≥1 SpA features. The programme was developed between April 2008 and June 2011. Data from 377 patients fulfilling the ASAS classification criteria for SpA were used. Descriptive analysis was employed to compare demographic and disease characteristics between patients with axial SpA versus peripheral SpA. RESULTS: Two hundred and ninety (77.2%) patients were classified as axial SpA (109 ankylosing spondylitis and 182 non-radiographic SpA) while 86 (22.8%) patients had peripheral SpA. Age, gender distribution and degree of disease activity were similar in both groups. Patients with axial SpA were referred after having symptoms for a longer period and had more frequently uveitis and positive HLA-B27. Patients with peripheral SpA had in a greater percentage more working disability and had more frequently enthesitis, psoriasis, dactylitis and inflammatory bowel disease (IBD). CONCLUSIONS: The ASAS classification criteria for SpA seem to classify patients within the same spectrum of disease beyond the predominant symptoms at onset. However, despite having similar degree of disease activity, time to be referred to rheumatologist is increased in axial SpA patients compared with peripheral SpA patients.


Assuntos
Espondilartrite/diagnóstico , Espondilite Anquilosante/diagnóstico , Adulto , Feminino , Antígeno HLA-B27/sangue , Humanos , Masculino , Espondilartrite/sangue , Espondilite Anquilosante/sangue , Avaliação de Sintomas
11.
Nat Commun ; 6: 7146, 2015 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-25994336

RESUMO

Ankylosing spondylitis (AS) is a common, highly heritable, inflammatory arthritis for which HLA-B*27 is the major genetic risk factor, although its role in the aetiology of AS remains elusive. To better understand the genetic basis of the MHC susceptibility loci, we genotyped 7,264 MHC SNPs in 22,647 AS cases and controls of European descent. We impute SNPs, classical HLA alleles and amino-acid residues within HLA proteins, and tested these for association to AS status. Here we show that in addition to effects due to HLA-B*27 alleles, several other HLA-B alleles also affect susceptibility. After controlling for the associated haplotypes in HLA-B, we observe independent associations with variants in the HLA-A, HLA-DPB1 and HLA-DRB1 loci. We also demonstrate that the ERAP1 SNP rs30187 association is not restricted only to carriers of HLA-B*27 but also found in HLA-B*40:01 carriers independently of HLA-B*27 genotype.


Assuntos
Aminopeptidases/genética , Antígeno HLA-B27/genética , Antígeno HLA-B40/genética , Espondilite Anquilosante/etiologia , Estudos de Casos e Controles , Epistasia Genética , Predisposição Genética para Doença , Humanos , Complexo Principal de Histocompatibilidade , Antígenos de Histocompatibilidade Menor , Polimorfismo de Nucleotídeo Único
13.
J Rheumatol ; 41(12): 2409-12, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25362657

RESUMO

OBJECTIVE: To evaluate clinical factors associated with the absence of radiographic progression in patients with spondylitis. METHODS: The cross-sectional study included 672 patients. All patients presented a disease evolution of more than 15 years. Patients were classified as with radiographic spinal involvement versus without radiographic spinal involvement. We included clinical variables potentially related to null radiological progression. RESULTS: Seventy-five patients had no radiographic involvement. These patients were predominantly female, had a lower erythrocyte sedimentation rate (ESR), and a lower C-reactive protein level. Multivariate analysis showed an association with the female sex and low ESR. CONCLUSION: Clinical factors associated with this lack of progression were female sex and low ESR.


Assuntos
Vértebra Cervical Áxis/fisiopatologia , Progressão da Doença , Espondilite Anquilosante/sangue , Espondilite Anquilosante/fisiopatologia , Adolescente , Adulto , Biomarcadores/sangue , Sedimentação Sanguínea , Proteína C-Reativa/metabolismo , Estudos Transversais , Feminino , Humanos , Masculino , Análise Multivariada , Radiografia , Sistema de Registros , Fatores Sexuais , Espanha , Espondilite Anquilosante/diagnóstico por imagem , Adulto Jovem
14.
Reumatol. clín. (Barc.) ; 10(4): 204-209, jul.-ago. 2014. tab, ilus
Artigo em Inglês | IBECS | ID: ibc-124007

RESUMO

Objective: To investigate which of the 2 ankylosing spondylitis (AS) disease activity instruments identifies better those patients with characteristics that have been associated with positive response to anti-TNF therapy. Methods: Data from patients with AS in the REGISPONSER registry were analyzed. Patients were categorized by disease activity using 3 different selection criteria: elevated Bath Ankylosing Spondylitis Disease Activity Index criteria (BASDAI≥4), high Ankylosing Spondylitis Disease Activity Score (ASDAS≥2.1), or very high ASDAS (ASDAS≥3.5). To determine which criterion selects for patients most likely to respond to anti-TNF therapy, the groups of patients selected with each criterion were compared on five disease characteristics that are associated with good response to anti-TNF therapy: lower age, lower function score, less enthesitis, higher C-reactive protein (CRP), and HLA-B27-positive status. Results: 50.9%, 66.3%, and 24.9% of 1156 patients had elevated BASDAI, high ASDAS, or very high ASDAS, respectively. Compared to patients selected with elevated BASDAI, more patients selected with high ASDAS had characteristics associated with good response to anti-TNF therapy. Patients with very high ASDAS had higher CRP and were younger, but more frequently had enthesitis and had higher function scores when compared to those with elevated BASDAI. Conclusions: Selection of AS patients with the ASDAS instrument results in patient sub-populations with different characteristics than those selected with the BASDAI instrument. Since some of these characteristics have been associated with response to anti-TNF therapy, further study should establish if the choice of selection instrument improves the outcome of therapy in the selected populations


Objetivo: Investigar cual de 2 instrumentos actividad de la enfermedad para espondilitis anquilosante (EA) identifica mejor a los pacientes con las características que se han asociado con una respuesta positiva a la terapia anti-TNF. Métodos: Se analizaron los datos de los pacientes con EA del registro REGISPONSER. Los pacientes fueron clasificados de acuerdo a la actividad de la enfermedad utilizando 3 criterios diferentes de selección: criterios de espondilitis anquilosante, Índice de Actividad de la Enfermedad elevado (BASDAI ≥ 4), puntuación alta de Actividad de la Enfermedad (ASDAS ≥ 2,1) o ASDAS muy elevado (ASDAS ≥ 3,5). Para determinar qué criterio seleccionaba a pacientes con más probabilidades de responder a terapia anti-TNF, se compararon cinco características de la enfermedad que se asocian con una buena respuesta a la terapia anti-TNF en los grupos de pacientes seleccionados con cada criterio: edad menor, calificación de la función, menorentesitis, mayor nivel de proteína C-reactiva (PCR), y la presencia de HLA-B27 positivo. Resultados: 50,9%, 66,3% y 24,9% de los 1.156 pacientes tenían BASDAI elevado, ASDAS alto, o muy altos, respectivamente. En comparación con los pacientes con BASDAI elevado seleccionados, más pacientes seleccionados con ASDAS altos tenían características asociadas con una buena respuesta a la terapia anti-TNF. Los pacientes con ASDAS altos tenía PCR más elevada y eran más jóvenes, pero con mayor frecuencia tenían entesitis y calificaciones de función más altos en comparación con aquellos con niveles elevados de BASDAI. Conclusiones: La selección de los pacientes mediante los resultados del instrumento ASDASresulta en sub-poblaciones de pacientes con características diferentes a las seleccionadas con el instrumento BASDAI. Dado que algunas de estas características se han asociado con la respuesta a la terapia anti-TNF, se requiere de mayor estudio para establecer si la elección del instrumento de selección mejora el resultado del tratamiento en las poblaciones seleccionadas (AU)


Assuntos
Humanos , Espondilite Anquilosante/fisiopatologia , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Espondilite Anquilosante/classificação , Estudos Transversais , Seleção de Pacientes
15.
Reumatol Clin ; 10(4): 204-9, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24598027

RESUMO

OBJECTIVE: To investigate which of the 2 ankylosing spondylitis (AS) disease activity instruments identifies better those patients with characteristics that have been associated with positive response to anti-TNF therapy. METHODS: Data from patients with AS in the REGISPONSER registry were analyzed. Patients were categorized by disease activity using 3 different selection criteria: elevated Bath Ankylosing Spondylitis Disease Activity Index criteria (BASDAI≥4), high Ankylosing Spondylitis Disease Activity Score (ASDAS≥2.1), or very high ASDAS (ASDAS≥3.5). To determine which criterion selects for patients most likely to respond to anti-TNF therapy, the groups of patients selected with each criterion were compared on five disease characteristics that are associated with good response to anti-TNF therapy: lower age, lower function score, less enthesitis, higher C-reactive protein (CRP), and HLA-B27-positive status. RESULTS: 50.9%, 66.3%, and 24.9% of 1156 patients had elevated BASDAI, high ASDAS, or very high ASDAS, respectively. Compared to patients selected with elevated BASDAI, more patients selected with high ASDAS had characteristics associated with good response to anti-TNF therapy. Patients with very high ASDAS had higher CRP and were younger, but more frequently had enthesitis and had higher function scores when compared to those with elevated BASDAI. CONCLUSIONS: Selection of AS patients with the ASDAS instrument results in patient sub-populations with different characteristics than those selected with the BASDAI instrument. Since some of these characteristics have been associated with response to anti-TNF therapy, further study should establish if the choice of selection instrument improves the outcome of therapy in the selected populations.


Assuntos
Algoritmos , Seleção de Pacientes , Espondilite Anquilosante/diagnóstico , Espondilite Anquilosante/tratamento farmacológico , Inquéritos e Questionários , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
16.
Rheumatol Int ; 34(2): 165-70, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24390635

RESUMO

To define and give priory to standards of care in patients with spondyloarthritis (SpA). A systematic literature review on SpA standards of care and a specific search in relevant and related sources was performed. An expert panel was established who developed the standards of care and graded their priority (high, mild, low, or no priority) following qualitative methodology and Delphi process. An electronic survey was sent to a representative sample of 167 rheumatologists all around the country, who also gave priority to the standards of care (same scale). A descriptive analysis is presented. The systematic literature review retrieved no article specifically related to SpA patients. A total of 38 standards of care were obtained-12 related to structure, 20 to process, and 6 to result. Access to care, treatment, and safety standards of care were given a high priority by most of rheumatologists. Standards not directly connected to daily practice were not given such priority, as standards which included a time framework. The standards generated for the performance evaluation (including patient and professionals satisfaction) were not considered especially important in general. This set of standards of care should help improve the quality of care in SpA patients.


Assuntos
Qualidade da Assistência à Saúde/normas , Reumatologia/normas , Espondilartrite/terapia , Padrão de Cuidado/normas , Consenso , Técnica Delphi , Humanos , Melhoria de Qualidade/normas , Espondilartrite/diagnóstico
17.
Rheumatology (Oxford) ; 53(2): 353-60, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24196385

RESUMO

OBJECTIVE: The objective of this study was to analyse the performance of the Assessment of SpondyloArthritis International Society (ASAS) criteria for the classification of SpA in early SpA clinics. METHODS: We used a cross-sectional study of patients referred to early SpA units within the ESPERANZA programme (a Spanish nationwide health management programme designed to provide excellence in diagnosis and care for early SpA). Patients were eligible if they were <45 years of age and had any of the following: (i) a 2-year history of inflammatory back pain; (ii) back or joint pain with psoriasis, anterior uveitis, radiographic sacroiliitis, family history of SpA or positive HLA-B27; or (iii) asymmetric arthritis. We excluded patients for whom imaging (X-rays/MRI) or HLA-B27 results were not available. We analysed the performance (sensitivity and specificity) of different classification criteria sets, taking the rheumatologist's opinion as the gold standard. RESULTS: The analysis included 775 patients [mean age 33 (s.d. 7) years; 55% men; mean duration of symptoms 11 (s.d. 6) months]; SpA was diagnosed in 538 patients (69.5%). A total of 274 (67.9%) patients with chronic back pain met the ASAS axial criteria, 76 (56.3%) patients with arthritis but not chronic back pain fulfilled the ASAS criteria for peripheral SpA and 350 (65.1%) fulfilled all the ASAS criteria. The sensitivity and specificity of the ASAS criteria set were 65% and 93%, respectively (axial criteria: sensitivity 68%, specificity 95%). The sensitivity and specificity for the ESSG and Amor criteria were 58% and 90% and 59% and 86%, respectively. CONCLUSION: Despite performing better than the Amor or ESSG criteria, the ASAS criteria may be limited to detection of early forms, particularly in populations in which MRI is not extensively available or in populations with a low prevalence of HLA-B27.


Assuntos
Programas Nacionais de Saúde , Espondilartrite/classificação , Espondilartrite/diagnóstico , Adulto , Biomarcadores/sangue , Classificação/métodos , Estudos de Coortes , Estudos Transversais , Gerenciamento Clínico , Feminino , Antígeno HLA-B27/sangue , Humanos , Masculino , Padrões de Referência , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Espanha , Espondilartrite/sangue , Espondilartrite/patologia
18.
Rheumatol Int ; 34(6): 793-801, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24337767

RESUMO

The objective of this study is to identify single-nucleotide polymorphisms (SNPs) predictors of treatment nonresponse to the first anti-TNF-alpha agent in ankylosing spondylitis (AS). Patients were classified as "nonresponders" if they failed to achieve improvement ≥50 % of the initial BASDAI. We selected candidate SNPs previously reported, associated with susceptibility or pathogenesis of AS and with other spondylarthropaties (SpAs). The predictors of nonresponse were modeled with multiple logistic regression. The predictive power of the genetic model of nonresponse to treatment was tested with AUC-ROC. One hundred and twenty-one (121) AS patients fulfilled the inclusion criteria. Of the candidate SNPs tested for association with treatment effectiveness, five independent predictors were identified: rs917997, rs755622, rs1800896, rs3740691, and rs1061622. The genetic model of nonresponse to treatment had a predictive power of 0.77 (95 % CI 0.68-0.86). Our study identified several polymorphisms which could be the useful genetic biomarkers in predicting nonresponse to anti-TNF-alpha therapy.


Assuntos
Antirreumáticos/uso terapêutico , Espondilite Anquilosante/tratamento farmacológico , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Adalimumab , Adulto , Anticorpos Monoclonais/uso terapêutico , Anticorpos Monoclonais Humanizados/uso terapêutico , Área Sob a Curva , Estudos de Coortes , Etanercepte , Feminino , Genótipo , Humanos , Imunoglobulina G/uso terapêutico , Infliximab , Modelos Logísticos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Polimorfismo de Nucleotídeo Único , Curva ROC , Receptores do Fator de Necrose Tumoral/uso terapêutico , Espondilite Anquilosante/genética , Falha de Tratamento
19.
Clin Exp Rheumatol ; 31(5): 739-48, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23899791

RESUMO

OBJECTIVES: This study aims to assess the impact of a structured education and home exercise programme in daily practice patients with ankylosing spondylitis. METHODS: A total of 756 patients with ankylosing spondylitis (72% males, mean age 45 years) participated in a 6-month prospective multicentre controlled study, 381 of whom were randomised to an education intervention (a 2-hour informative session about the disease and the implementation of a non-supervised physical activity programme at home) and 375 to standard care (controls). Main outcome measures included Bath Ankylosing Spondylitis Disease Activity and Functional Index (BASDAI, BASFI). Secondary outcome measures were 0-10 cm visual analog scale (VAS) for total pain, nocturnal pain and global disease activity and quality of life (ASQoL), knowledge of disease (self-evaluation ordinal scale) and daily exercise (diary card). RESULTS: At 6 months, the adjusted mean difference between control and educational groups for BASDAI was 0.32, 95% confidence interval (CI) 0.10-0.54, p=0.005, and for BASFI 0.31, 95%CI 0.12-0.51, p=0.002. Significant differences were found also in VAS for total pain, patient´s global assessment and in ASQoL. Patients in the education group increased their knowledge about the disease and its treatments significantly (p<0.001) and practised more regular exercise than controls (p<0.001). CONCLUSIONS: A structured education and home exercise programme for patients with ankylosing spondylitis in daily practice was feasible and helped to increase knowledge and exercise. Although statistically significant, the magnitudes of the clinical benefits in terms of disease activity and physical function were poor.


Assuntos
Terapia por Exercício , Conhecimentos, Atitudes e Prática em Saúde , Serviços de Assistência Domiciliar , Educação de Pacientes como Assunto , Espondilite Anquilosante/terapia , Atividades Cotidianas , Adulto , Análise de Variância , Distribuição de Qui-Quadrado , Avaliação da Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Estudos Prospectivos , Recuperação de Função Fisiológica , Espanha , Espondilite Anquilosante/diagnóstico , Espondilite Anquilosante/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
20.
Nat Genet ; 45(7): 730-8, 2013 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-23749187

RESUMO

Ankylosing spondylitis is a common, highly heritable inflammatory arthritis affecting primarily the spine and pelvis. In addition to HLA-B*27 alleles, 12 loci have previously been identified that are associated with ankylosing spondylitis in populations of European ancestry, and 2 associated loci have been identified in Asians. In this study, we used the Illumina Immunochip microarray to perform a case-control association study involving 10,619 individuals with ankylosing spondylitis (cases) and 15,145 controls. We identified 13 new risk loci and 12 additional ankylosing spondylitis-associated haplotypes at 11 loci. Two ankylosing spondylitis-associated regions have now been identified encoding four aminopeptidases that are involved in peptide processing before major histocompatibility complex (MHC) class I presentation. Protective variants at two of these loci are associated both with reduced aminopeptidase function and with MHC class I cell surface expression.


Assuntos
Loci Gênicos , Predisposição Genética para Doença/genética , Fenômenos do Sistema Imunitário/genética , Polimorfismo de Nucleotídeo Único , Espondilite Anquilosante/genética , Alelos , Estudos de Casos e Controles , Análise Mutacional de DNA/métodos , Loci Gênicos/imunologia , Predisposição Genética para Doença/etnologia , Estudo de Associação Genômica Ampla/métodos , Genótipo , Técnicas de Genotipagem/métodos , Antígeno HLA-B27/genética , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Fatores de Risco , Espondilite Anquilosante/etnologia , Espondilite Anquilosante/imunologia
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