BackgroundAt the end of 2011 we established a protocol in dose reduction of biological therapy in patients with imflammatory diseases. Those who achieved remission by clinical and laboratory tests and showed no radiographic progression or Doppler activity by ultrasound examination, received reduction of dosing. Patients with etanercept (ETN) reduced dose to 25 mg, and patients with adalimumab (ADA) increased injection interval to 3 weeks. Tocilizumab (TCZ) was tapered from 8 to 6 mg/kg. We have achieved optimization rates of 20% in 2012, close to 40% at the end of 2013.ObjectivesThe aim of this study is to take account of activity flares in optimized patients and their characteristics, in order to describe predictive factors of flare if possible.MethodsRetrospective analysis data from clinical records and database of 105 patients treated with ETN, ADA and TCZ, optimized from January 2012 to June 2013 considering lab tests (ESR, RCP), disease activity (DAS 28, BASDAI),functional capacity indexes (HAQ, BASFI), and GPE (general patient evaluation), at optimization, 6 and 12 months visits. We used SPSS 21.0 for statistical analysis.ResultsTable 1ParameterBasal6 months12 monthsESR12,5 (2–64)16,3 (1–52)17,20 (1–78)RCP0,23 (0,02–1,3)0,43 (0,1–1,4)0,30 (0,1–2,06)DAS282,04 (0,11–4,03)2,51 (1,13–4,88)2,38 (0,56–4,17)HAQ0,5 (0–2)0,5 (0–2)0,5 (0–2)BASDAI1,45 (0–4,2)2,37 (0–4,3)2,480 (0,5–6,4)BASFI1,85 (0–9)2,9 (0–9,5)2,67 (0–9,6)EGP21,03 (0–100)27,07 (0–100)21,83 (0–80)105 patients (53 female and 52 male), 31% rheumatoid arthritis (RA), 27,5% ankylosing spondylitis (AS), 37,7% psoriatic arthritis (PA), and 3,8% juvenile idiopatic arthritis (JIA), most of them with longstanding disease, (150 months (18-638)). All of them were considered to keep remission by second visit, but at 12 months 32% were diagnosed of flare (24,5% under ADA and 39,2% under ETN; none with TCZ). Patients who flared were RA (30%), AS (29%), PA (37%) and one JIA. Half of the patients with RA, 27,6% of AS and 21,6% of PA. Clinical response was good to increasing of DMARD dosing in 25% and to increasing of biological dosing in 68,7%, but 3 patients (9,3%) required switching to another biological drug.We applied an univariate regression logistic model using parameters at visit 2, and we found modestly risk of flare related with ESR, DAS 28, number of swelling and tender joints. An increase of one tender joint at visit 2 means OR 3,56 (95% CI: 1,28-9,91), increase of one swelling joint means OR 11,26 (95% CI: 2,23-43,23). Increase of DAS 28 over 0,6 means OR 8 (95% CI: 1,85-34,6), and an increase over 1,2 means OR 60 (95% CI: 6,41-561,96).Conclusions1/3 of patients suffered flares of disease activity, mostly happened in RA patients, most of them in the ETN group (not statistically significant). Patients who flared had increased DAS 28 at visit 2, but were considered at clinical remission then. Response to increasing in treatment dosing is usually good. We consider optimization as cost-effective practice among biological treated population. We need wider popula...
Background:The aim of the present study was to evaluate whether ankylosing spondylitis (AS) and non-radiographic axial spondyloartritis (nr-axSpA) are subsets of a single disease from a genetic perspective. Methods:We analyzed from a clinical and genetic perspective 62 patients from the University Hospital of Basurto (Bilbao, Spain) diagnosed with axial spondyloarthritis. Forty three SNPs previously associated with spondyloarthritis (SpA) were selected. The DNA samples were genotyped through SNP Type Assay, using the BioMark HD platform of Fluidigm. Results:Regarding clinical characteristic we found statistically significant differences between the patients with AS and nr-axSpA in the age at diagnosis, the disease duration, the presence of syndesmophytes and the BASMI index. In relation to genetic markers, we only found statistically significant differences in HLA-B27 allele frequency between the two groups. Regarding the frequencies of the SNPs, no statistically significant differences were found between the two groups. Despite the high genetic heterogeneity observed among the patients, it is worth highlighting that some of the most important risk SNPs associated with AS, located in genes (ERAP1, ERAP2, IL-23R, GPR25) and intergenic region (2p15), appeared at high frequencies in all the patients.Conclusion:We have observed that AS and nr-axSpA have a common genetic background associated with the pathogenic development of these diseases; therefore, we suggest that the two entities constitute two different expressions of the same disease. Among the genetic factors, the present study shows the importance of genes involved in the pathogenesis of AS, such as HLA-B27, ERAP1, ERAP2, IL-23R, GPR25 and intergenic region 2p15, whose role may influence the onset, development and severity of the disease. However, the pathogenesis of SpA is very complex, indicating the involvement of environmental factors (smoking and obesity), in the triggering of the disease, so that patients with different genotypes would have the same pathogenic phenotype.
BackgroundOsteoporosis (OP) in male under 70 years is less common than postmenopausal and senile OP, but causes important social and health costs associated with morbidity and mortality from fractures. It's common in patients with inflammatory rheumatic diseases, enteric and endocrine diseases, also in COPD patients and in those undergoing chronic corticosteroid therapy.Sometimes clinical risk factors of male OP go unnoticed, so the diagnosis is done when one or more low energy mechanism fractures have already occurred (failure in early detection).Bone Metabolism Unit at Basurto University Hospital values from years ago male patients referred from different specialties with suspected OP.ObjectivesTo describe main demographic and clinical characteristics of men aged 70 years or less, visited in our monographic OP consultation, with previous to 2013 protocols established with Primary Care (PC) and rheumatology (derivation according to risk factors).MethodsRetrospective descriptive study based on a review of medical records and database of these patients. We analyze origin of derivation, risk factors, presence of fractures at moment of diagnosis, primary diagnoses and occurrence of refractures.The analysis was performed using statistical system SPSSv22.Results127 patients, mean aged 58.17 years (18–70), up to 74% of the total derived from PC (47), and general rheumatology (47); 10 patients (7.9%) from traumatology; 8 from endocrinology (6.3%); 7 from gastroenterology (5.5%).55.9% were smokers or former smokers, 22% kept drinking habit. 19.7% had received prednisone doses ≥7.5 mg for more than 3 months.9 patients had family history of fracture (6.3%), and 46 themselves presented with one or more fractures (36.2%): 36 with one or more vertebral fractures, 4 hip fracture and 12 wrist fracture. 64 patients were diagnosed of OP with treatment indication by bone agent.61% have secondary OP, the main cause (19%) enteric disorders (malabsorption syndromes and inflammatory bowel disease); 13% endocrine disorders and rheumatic inflammatory diseases by 13%. No primary cause was found in 39% of cases.The presence of fractures was associated with decreased DXA lumbar spine (p=0.027) and DXA hip (p=0.004). A very weak correlation between higher fracture FRAX and number of risk factors was detected, on the other hand a moderate correlation was observed with the number of fractures (Spearman Rho =0.472; p<0.001). So does to the hip FRAX (Spearman Rho =0.417; p<0.001).Of the 46 patients with previous fractures, only 12 (26%) had received prior treatment with bone agent. Only 5 patients suffered refracture after starting treatment and during follow-up (94.06 months) (25–129).ConclusionsAlmost 1/3 of men were referred for fractures caused by low energy impact, what means a late diagnose of male OP.It's important to establish protocols with other medical specialties for men at risk to be identified and referred, in order to make an early diagnose.It highlights the lack of patients derived from pneumologists, although vertebral fractures...
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