Background:Studies suggest that radiographic damage is associated with cardiovascular (CV) risk in axial spondyloarthritis (axSpA). However, the relationship among disease characteristics directly related to structural damage and CV risk has not yet been fully clarified.Objectives:To analyze the association of structural damage with the presence of atherosclerotic plaques via carotid ultrasound (US) and the increased CV risk in a registry of patients with SpA.Methods:Eighty-five patients with SpA (ASAS criteria) from the SpA registry from Cordoba (CoSpaR) were selected for a cross-sectional study and underwent a complete clinical history, physical examination and biochemical analysis. Variables about demographics, clinical parameters and CV risk factors were collected. CV risk was evaluated by estimating SCORE index and assessing presence of atherosclerotic plaques through carotid US performed by a qualified radiologist. Independent-samples t test was used to evaluate the association between radiological characteristics and presence of atherosclerosis. Multiple lineal regression (MLR) was performed to assess the variables potentially associated with increased SCORE. All comparisons were bilateral.Results:Baseline characteristics are shown in the table. Values are mean±SD for quantitative and N (%) for qualitative variables. Regarding characteristics related with radiographic damage and CV risk, they exhibited a mSASSS of 14.84±18.4 (7.27±9.64 in cervical spine and 7.72±10.14 in lumbar spine). Average BMI 26.88±4.13, 33 (38.8%) were smokers, 16 (18.8%) had diagnosis of arterial hypertension, 1 (1.2%) of diabetes mellitus, 13 (15.3%) of hyperlipidemia, and 8 (9.4%) took lipid lowering drugs. Examination with carotid US found that 14 (16.5%) patients had previously unknown atherosclerotic plaques. After classification according to SCORE index, 60 (76.9%) had low CV risk, 10 (12.8%) moderate, and both high and very high CV risk categories had 4 (5.1%) patients each.In patients with atherosclerotic plaques, age, disease duration and variables related to radiographic damage (mSASSS [total, cervical and lumbar], and bone bridges) were significantly higher (p<0.05). In addition, mSASSS in cervical spine (p=0.063) and age (p<0.001) were associated with the SCORE and were predictors of increased CV risk in MLR analysis.Age (years) (N=85)44.5±12.2Sex (males) (N=85)59 (69.4)HLA B27 (N=83)71 (83.5)axSpA (N=85)79 (92.9)Radiographic axSpA (N=77)63 (74.1)BMI (kg/m2) (N=80)26,9±4.13Disease duration (years) (N=82)18.01±13.62Smokers (N=84)33 (38.8)ASDAS-CRP3.13±1.05ASAS HI (N=82)4.05±3.8Conclusion:Presence of atherosclerosis is associated with age, disease duration and radiographic damage in SpA. Age and structural damage especially in the cervical spine predicted a greater CV risk. Thus, it is important to identify these patients in order to maintain tight control and avoid development of CV disease.Acknowledgement: Funded by: JA PI-0139-2017 Disclosure of interests:Ladehesa Pineda Lourdes: None declared, Gómez García Ignacio: None...
Background:Objectives:To analyse the effect of a teaching intervention for the technical performance of a reduced index of ultrasound synovitis by nurses without previous experience in musculoskeletal ultrasound (MSUS).Methods:Design: Quasi-experimental study of the before-after type. Protocol: The nurses received a theoretical-practical, face-to-face and intensive training of 8 hours, by an expert rheumatologist in musculoskeletal ultrasound (MSUS), to perform the Perricone index, which assesses the presence of grey-scale synovitis (GS) and quantifies the presence of a power-doppler (PD) signal semiquantitatively (0-3), in 6 joints (Wrists, 2nd Metacarpophalangeal (MCP) joints and knees). The theoretical knowledge acquired was assessed by an exam test type at the end of the training, and the technical skills were assessed by an ultrasound examination in patients with rheumatoid arthritis, immediately after the teaching session and at 18 months later. Variables: Illumination of the consultation, protection of privacy and unequivocal identification of the patient, technique (explorer ergonomics, bilateral comparison, use of both hands, measurement, marking and saving data), GS (probe position, centred image, cortical-cartilage-tendon display, depth, focus, frequency, gain), PD (probe pressure, PRF, position-width-depth of the box, focus, frequency, gain), synovial recesses (dorsal and palmar examination of the wrist, 2nd Metacarpophalangeal (MCP) joints and supra and parapatellar medial and lateral examination of the knees) and semi-quantitative gradation of synovitis in GS and PD. Statistical analysis: descriptive analysis, and in relation to the statistical significance tests for paired variables (pre and post teaching intervention) the McNemar test was used for dichotomous qualitative variables and McNemar-Bowker test for those of more than two categories.Results:5 nurses, 80% women, aged between 36 and 54 years participated. They adequately answered 100% of the 4-student test questions, and the remaining one matched 80% of them. The average time of baseline exploration was 45,2 ±3,8 minutes and the final time was 32,6 ± 3,5, improving the 5 students in an average of 12,6± 4,4 minutes. The technical aspects not performed correctly in the baseline ultrasound examination were the bilateral comparative, centred image, grey scale gain, measuring, correct anatomical image of the synovial recess of the wrist and position-width-depth of the Doppler box. An improvement was observed at 18 months in the unequivocal identification of the patient, adequate illumination of the consultation, bilateral comparison, correct anatomical acquisition of synovial recesses and the quantification of GS synovitis, but no statistically significant differences were observed, before and after the teaching intervention, in possible relation with the difficulty to use the ultrasound in their respective Rheumatology Units in clinical practice, but mainly because the aspects correctly performed in the baseline exploration were numerous.Conclusion:A formal training of rheumatology nurses in musculoskeletal ultrasound (MSUS) could be very useful, and cost-efficient, in the health care of patients with rheumatoid arthritis.Disclosure of Interests:None declared
BackgroundThe lack of efficacy of biological therapies in rheumatic patients causes a change of treatment, usually to another biological therapy. A significant number of studies have been published in relation to the reasons that cause this inefficacy, (1,2,3); however, no studies have evaluated the involvement of the weight and lipid profile of patients in this process.ObjectivesTo analyze the influence of weight and lipid profile in the relapse and change of biological therapy.MethodsRetrospective-descriptive study. Rheumatic patients in treatment with biological therapies were recruited from January 2016 to December 2018. Sociodemographic data were collected (age and sex), along with anthropometric variables (weight, height, waist circumference and hip perimeter), toxic habits, comorbidities and variables related to the treatment. Associations between variables were analyzed using a Chi-square and T student. P-values < 0.05 were considered statistically significant. The spss v.19 program was used for data analysis.ResultsTwo hundred and nine patients were enrolled, of which 80 (38.3%) were male and 129 (61.7%) were female. The mean age (SD) was 48.9 12.8 years. One hundred and twenty patients (57.4%) suffered rheumatoid arthritis, 35 (16.7%) spondylitis, 29 (13.9%) psoriatic arthritis and 10 (4.8%) spondyloarthritis. One hundred and fifty-three (73.2%) had not switches of biological therapy, 51 (24.4%) switched of biological therapy once and 5 (2.4%) three or more times. Statistically significant differences were found in the obese males who switched of biological therapy in relation to obese males who not switched (35.6% vs. 11.1%). Accordingly, the percentage of patients with hyperlipemia that switched of biological therapy was significantly higher than those who did not (29.4% vs. 13.1%).The years of evolution and diagnosis we also involved, so that patients with more years of evolution and more years from the diagnosis had a higher percentage of switched (p = 0.006 IC 95% -17.22, - 0.96 and p = 0.042 -18, 32; -037 respectively).ConclusionBeing obese male and with hyperlipidemia could be a risk factor that would condition the lack of response to a biological therapy and thus the need of switching to another.References[1] Glintborg B1, stergaard M, Krogh NS, Tarp U, Manilo N, Loft AG, Hansen A, Schlemmer A, Fana V, Lindegaard HM, Nordin H, Rasmussen C, Ejstrup L, Jensen DV, Petersen PM, Hetland ML. Clinical response, drug survival and predictors thereof in 432 ankylosing spondylitis patients after switching tumour necrosis factor α inhibitor therapy: results from the Danish nationwide DANBIO registry. Ann Rheum Dis. 2013Jul;72(7):1149-55. doi: 10.1136/annrheumdis-2012-201933. Epub 2012 Aug 31.[2] Navarro-Compn V, Plasencia-Rodrguez C, de Miguel E, Diaz Del Campo P, Balsa A, Gratacs J. Switching biological disease-modifying antirheumatic drugs in patients with axial spondyloarthritis: results from a systematic literature review. RMD Open. 2017 Oct 10;3(2):e000524. doi: 10.1136/rmdopen-2017-000524. eCollection ...
BackgroundFew papers analyze the health benefits of living with companion animals (1). A significant number of studies have been published in relation to dog-assisted therapies for people with Alzheimer’s or people with brain injuries, but all of them analyzed a reduced sample number (2) or did not show a good methodological structure (3). Regarding the reduction of pain and quality of life, different studies showed positive results in the use of assisted therapies with dog (4). However, this subject has not been evaluated yet in patients suffering Rheumatologic diseases.ObjectivesThe main objective of this study is to evaluate the influence of companion animals on the perception of outbreaks in rheumatological diseases. Secondary objective: to analyze if having companion animals affected the general state of health or the degree of physical activity.MethodsProspective descriptive study. Consecutive patients attending rheumatology consultation were recruited during the month of October 2018. Sociodemographic data were collected (age, sex, cohabitation with companion animals, type of exercise performed) along with Beck questionnaires to assess depression, SF-12 to assess quality of life, and VREM (Spanish Short Version of the Minnesota Leisure Time Physical Activity Questionnaire) to assess the degree of physical activity. Associations between variables were analyzed using a Chi-square and T student. P-values < 0.05 were considered statistically significant. The main variables: dog, cat and other animals, were analyzed separately and then unified in a new variable called companion animals. The spss v.19 program was used for data analysis.ResultsSeventy one patients were enrolled, of which 30 (42.3%) were male and 41 (57.7%) were female. The mean age (SD) was 58.78 15.31 years. Thirty two patients (45.1%) suffered rheumatoid arthritis, 8 (11.3%) spondylitis, 8 (11.3%) osteoarthritis, and patients with fibromyalgia, becet, gout and scleroderma were present in a lower percentage. Regarding the coexistence with companion animals, 19 (26.8%) lived with dogs and 7 (9.9%) with cats.The results of this study did not demonstrate any significant relationship between the duration of the outbreaks, the depressive state or the degree of physical activity and the coexistence with companion animals. However, statistically significant differences were found in the quality of live perceived by patients living with dogs in relation to patients without companion animals, so that we found higher scores in the mental SF-12 (56.5 vs 44), (p = 0.036, 95% CI - 24.41, - 0.80), the physical SF-12 (51.7 vs 39), (p = 0.042, 95% CI -25; -0.5) and total SF-12 (56.11 vs 43.8), (p = 0.018, 95% CI 22.4, -2.2).ConclusionCoexistence with dogs improves the perception of the quality of life of patients, both physically and mentally.References[1] Saito T, Okada M, Ueji M, Kikuchi K, Kano K. [Relationship between keeping a companion animal and instrumental activity of daily living (IADL). A study of Japanese elderly living at home in Satomi Village. Nih...
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