PurposeTo analyse trends in hip fracture (HF) rates in patients with rheumatoid arthritis (RA) over an extended time period (17 years).MethodsThis observational retrospective survey was performed by reviewing data from the National Surveillance System for Hospital Data, which includes more than 98% of Spanish hospitals. All hospitalisations of patients with RA and HF that were reported from 1999 to 2015 were analysed. Codes were selected using the Ninth International Classification of Diseases, Clinical Modification: ICD-9-CM: RA 714.0 to 714.9 and HF 820.0 to 820.3. The crude and age-adjusted incidence rate of HF was calculated by age and sex strata over the last 17 years. General lineal models were used to analyse trends.ResultsBetween 1999 and 2015, 6656 HFs occurred in patients with RA of all ages (84.25% women, mean age 77.5 and 15.75% men, mean age 76.37). The age-adjusted osteoporotic HF rate was 221.85/100 000 RA persons/ year (women 227.97; men 179.06). The HF incidence rate increased yearly by 3.1% (95% CI 2.1 to 4.0) during the 1999–2015 period (p<0.001) and was more pronounced in men (3.5% (95% CI 2.1 to 4.9)) than in women (3.1% (95% CI 2.3 to 4.1)). The female to male ratio decreased from 1.54 in 1999 to 1.14 in 2015. The average length of hospital stays (ALHS) decreased (p<0.001) from 16.76 days (SD 15.3) in 1999 to 10.78 days (SD 7.72) in 2015. Age at the time of hospitalisation increased (p<0.001) from 75.3 years (SD 9.33) in 1999 to 79.92 years (SD 9.47) in 2015. There was a total of 326 (4.9%) deaths during admission, 247 (4.4%) in women and 79 (7.5%) in men (p<0.001).ConclusionIn Spain, despite the advances that have taken place in controlling disease activity and in treating osteoporosis, the incidence rate of HF increased in both male and female patients with RA.

In this Southern region, hip fracture incidence exhibits a seasonal pattern different from those communicated in Northern regions. There is short-term association with different weather conditions that partly explain this seasonal pattern.

These findings suggest a downward trend in the incidence of hip fracture in Alcorcón, both in men and in women. Possible explanations are discussed, including the effectiveness of osteoporosis diagnosis and treatment campaigns over the last 20 years, and the so-called "cohort effect."

ObjectiveTo assess the incidence of amyloidosis and trends therein in patients with spondyloarthritis (SpA) over a long period (17 years).MethodsAn observational retrospective population-based matched cohort study was conducted. All the admissions of patients with SpA, including ankylosing spondylitis (AS), psoriatic arthritis (PsA), arthritis associated with inflammatory bowel disease (SpA-IBD) and reactive arthritis (ReA), reported between 1999 and 2015, were analysed and a control group matched by age, sex and year of admission was selected. Incidence rates for amyloidosis were calculated. Generalised linear models were used for trend analysis and unconditional logistic regression for calculating crude and adjusted ORs (AOR) to assess the association between amyloidosis and SpA.ResultsThe study database contained data on 107 140 admissions in each group. Between 1999 and 2015, 792 patients in the SpA cohort (0.7% of all admissions) had a diagnosis of amyloidosis versus 68 in the non-SpA cohort (0.1%) (p<0.001). From 1999 to 2015, incidence rates of amyloidosis tended to decrease in the SpA cohort (−4.63%/year overall), while they increased in the Non-SpA cohort (+10.25%/year overall). We found strong associations of amyloidosis with all SpAs (AOR 10.4; 95% CI 8.2 to 13.3) and with each type studied (AORs 10.05 (7.84 to 12. 88) for AS, 9.5 (7.3 to 12.4) for PsA, 22.9 (16.6 to 31.7) for SpA-IBD and 10.1 (6.1 to 16.7) for ReA).ConclusionsIncidence of amyloidosis among patients with SpA has strongly decreased in Spain. Amyloidosis is most strongly associated with SpA-IBD while the strength of association with PsA and ReA is similar to that with AS.

Background: Several studies have reported that the use of chondroitin sulphate (CS) and glucosamine may reduce the risk of acute myocardial infarction. Although it is thought that this potential benefit could be extended to ischaemic stroke (IS), the evidence is scarce. Objective: To test the hypothesis that the use of prescription glucosamine or CS reduces the risk of IS. Design: Case–control study nested in an open cohort. Methods: Patients aged 40–99 years registered in a Spanish primary healthcare database (BIFAP) during the 2002–2015 study period. From this cohort, we identified incident cases of IS, applying a case-finding algorithm and specific validation procedures, and randomly sampled five controls per case, individually matched with cases by exact age, gender and index date. Adjusted odds ratios (AORs) and 95% confidence interval (CI) were computed through a conditional logistic regression. Only new users of glucosamine or CS were considered. Results: A total of 13,952 incident cases of IS and 69,199 controls were included. Of them, 106 cases (0.76%) and 803 controls (1.16%) were current users of glucosamine or CS at index date, yielding an AOR of 0.66 (95% CI: 0.54–0.82) (for glucosamine, AOR: 0.55; 95% CI: 0.39–0.77; and for CS, AOR: 0.77; 95% CI: 0.60–0.99). The reduced risk among current users was observed in both sexes (men, AOR: 0.69; 95% CI: 0.49–0.98; women, AOR: 0.65; 95% CI: 0.50–0.85), in individuals above and below 70 years of age (AOR: 0.69; 95% CI: 0.53–0.89 and AOR: 0.59; 95% CI: 0.41–0.85, respectively), in individuals with vascular risk factors (AOR: 0.53; 95% CI: 0.39–0.74) and among current/recent users of nonsteroidal anti-inflammatory drugs (NSAIDs) (AOR: 0.71; 95% CI: 0.55–0.92). Regarding duration, the reduced risk was observed in short-term users (<365 days, AOR: 0.61; 95% CI: 0.48–0.78) while faded and became nonsignificant in long-term users (>364 days AOR: 0.86; 95% CI: 0.57–1.31). Conclusions: Our results support a protective effect of prescription CS and glucosamine in IS, which was observed even in patients at vascular risk. Mini abstract Our aim was to analyse whether the use of glucosamine or chondroitin sulphate (CS) reduces the risk of ischaemic stroke (IS). We detected a significant decrease.

Objective.To analyze the trend of orthopedic surgery (OS) rates on patients with rheumatoid arthritis (RA).Methods.Retrospective observational study based on information provided by the Spanish National System of Hospital Data Surveillance. All hospitalizations of patients with RA for orthopedic surgery [total hip arthroplasty (THA), total knee arthroplasty (TKA), arthrodesis, and upper limb arthroplasty (ULA)] during 1999–2015 were analyzed. The age-adjusted rate was calculated. Generalized linear models were used for trend analysis.Results.There were 21,088 OS in patients over 20 years of age (77.9% women). OS rate adjusted by age was 754.63/100,000 RA patients/year (women 707.4, men 861.1). Neither an increasing nor a decreasing trend was noted for the total OS. However, trend and age interacted, so in the age ranges 20–40 years and 40–60 years, an annual reduction of 2.69% and 2.97%, respectively, was noted. In the age ranges over 80 years and 60–80 years, we noted an annual increase of 5.40% and 1.09%, respectively. The average age at time of OS increased 5.5 years during the period analyzed. For specific surgeries, a global annual reduction was noted in rates for arthrodesis. In THA, there was an annual reduction in patients under 80 years. In TKA and ULA, there was an annual reduction in patients under 60 years.Conclusion.Although the overall OS rate has not changed, there is a decrease in the rate of arthrodesis at all ages, THA in patients under 80 years of age, as well as TKA and ULA in patients under 60 years of age.

BackgroundIt is known that the mortality after a hip fracture is increased with respect to the general population. However, the trend of mortality is a controversial issue.ObjectivesThe objective of this study is to analyse the incidence, trend and factors associated with mortality in patients with osteoporotic hip fracture.MethodsThis is a retrospective cohort study using the Minimum Basic Data Set (MBDS) of our hospital that collects a minimum data set at hospital discharge. We identified patients older than 45 years who suffered an osteoporotic hip fracture during the period from 1999 to 2015. (3992 hip fractures). The demographic data and comorbidities were obtained from the exploitation of the MBDS and the Income Nursing Assessment Form (subgroup of 810 patients). The identification of the deceased was obtained by consulting the MBDS and the INDEF (National Death Index facilitated by the Ministry of Health). A survival analysis was performed (regression of Cox and Kaplan-Meier). The incidence rate, standardised mortality index (SMI) was calculated with respect to the mortality of the general population of Madrid (mortality data of the general population obtained INE), trend (Poisson regression) and risk (Hazard Ratio) for the different clinical and demographic variables.ResultsThe cumulative incidence of mortality was 72.69% in the study period. The crude mortality rate at 1, 3, 6 months and 1 and 3 years was 9.2%, 17.4%, 24.6%, 33% and 56%, respectively. In men it was 13.7%, 25%, 32.7%, 43.3% and 65.6% and in women 7.9%, 15.7%, 22.3%, 30%, 53.2%. The median overall survival was 886 days (95% CI: 836–951), with 576 for men and 998 for women. A statistically significant reduction in median survival was observed throughout the study period. The IME was 8.3 (95% CI: 7.98–8.59); (similar values in men and women). The clinical-demographic variables that showed a statistically significant association with mortality are shown in the following table 1 (HR and p-value):Other variables that showed statistical association were: presence of auditory and visual alterations, incontinence (urinary and faecal) and the total score on the Norton scale and the Downton scale.ConclusionsWe found an increase in mortality (or decrease in median survival) of patients with hip fracture during the last 17 years. An oncrease in mortality has been observed in patients with hip fracture related to age, male sex, diabetes, hepatic disease and living in a nursing home.Disclosure of InterestNone declared

BackgroundTreatment with biological agents is recognized as a potential risk factor for the development of Progressive Multifocal Leukoencephalopathy (PML), a rare and often fatal demyelinating disease of the CNS caused by John Cunningham Virus infection.ObjectivesAnalyze the incidence and trend of hospital admissions for PML in patients with RA, in Spain, during the period between 1999 and 2015.MethodsPopulation study based on the analysis of a national administrative database that includes a Minimum Basic Data Set (MBDS) of the income of patients with RA (ICD 9 714). Period: January 1, 1999, to December 31, 2015. The cases of PML were identified due to the presence in the primary and secondary diagnosis of the codes ICD 9 046.0 to 046.9. The population at risk was estimated through the population census of the National Institute of Statistics, with an estimated prevalence of RA of 0.5% in both sexes (0.2% in men and 0.8% in women). Crude and adjusted rates were calculated at national level. The trend was analyzed using Generalized Linear Models (MLG) using the variable year as the analysis variable.ResultsOf the total of 338,343 hospital admissions in patients with RA during the 17 years of the study period, only 14 cases (0.004%) of PML were recorded, nine (64.3%) were women and 5 (35.7%) men. The mean age was 69.5 years (SD 16.8); 74.56 (SD14.8) in women and 60 (SD18.1) in men (p = 0.145). Five patients (35.7%) died during admission (2 women and 3 men) (p = 0.266). The average of the Charlson index was 2.21 (SD 1.7); 3 (SD 2.5) in women and 1.78 (SD 1.1) in men (p = 0.227).The crude incidence rate of PML was 0.54/100,000 inhabitants * year, 0.85/100,000 inhabitants * year in men and 0.37/100,000 inhabitants * year in women. The Relative Risk male: female was 2.34. The gross rate of PML increased from 0.32/105 * year in the period 1999-2002, to 0.74 between 2011 and 2015, both in women (from 0.19 in the period 1999-2002 to 0.52 from 2011 to 2015) as well as men (from 0.82 in the period 1999-2002 to 1.64 during 2011-2015). It is estimated that this increase is of 19.7% per year.ConclusionIn Spain, between 1999 and 2015, there has been an increase in the incidence rate of PML in patients with RA. We estimate an annual increase of 19,7%. Disclosure of Interests: None declared