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Objective: To develop and assess the feasibility in daily practice of four comorbidity checklists, for common use in rheumatoid arthritis (RA), axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA). Methods: A multidisciplinary panel of experts on comorbidity was established. Data from the GECOAR, GECOAX and GECOAP projects were analysed and a narrative literature review in Medline on RA, axSpA and PsA comorbidity was performed in order to select the most relevant and common comorbidities across the three diseases. With these results and those obtained from a focus group of patients, in a nominal group meeting, the experts generated preliminary checklists. These were afterwards modified by an external evaluation by two associations, a patients’ association and an association of health professionals related to rheumatology. As a result, the final checklists were generated. A cross-sectional study was conducted to test the feasibility of three of the checklists in daily practice, in which eight health professionals evaluated the checklists in five patients with RA, five with axSpA and five with SpA. Results: Four comorbidity checklists were designed, three for health professionals (one to assess current comorbidity, one on prevention/health promotion and one with the referral criteria to other health professionals), and another for patients. The feasibility study showed them to be simple, clear, and useful for use in routine clinical practice. Conclusions: The use of specific and common checklists for patients with RA, axSpA and PsA is feasible and might contribute favorably to their prognosis as well as in daily practice., Este proyecto fue financiado por Merck Sharp & Dohme® España y avalado por las siguientes asociaciones/sociedades: CONARTRITIS (Coordinadora Nacional de Artritis asociación, de pacientes que representa a las personas afectadas por AR, APs, AIJ y EspA), OPENREUMA (Asociación de otros profesionales sanitarios dedicados a la reumatología) y SORCOM (Sociedad de Reumatología de la Comunidad de Madrid)

Resumen Objetivos Identificar las comorbilidades prioritarias en la espondiloartritis axial (EspAx) y recomendar como hacer su seguimiento desde una perspectiva eminentemente practica. Metodos Se selecciono a un grupo multidisciplinar (10 reumatologos [6 expertos en EspAx], 2 medicos de familia, una internista, una cardiologa, una gastroenterologa y una psicologa). En una primera reunion de discusion, se establecieron el alcance y los usuarios, y se voto una lista de comorbilidades sobre la base de la frecuencia y el impacto. Los panelistas debian defender con argumentos consistentes la inclusion de cada comorbilidad/item en el documento. Cuatro panelistas y 2 metodologos, desarrollaron revisiones sistematicas en temas controvertidos. En una segunda reunion se presentaron los resultados de las revisiones y los argumentos de todos los items a incluir. Tras esta reunion se redacto el documento final. Resultados El documento final incluye 2 listas de comprobacion (checklist), una para profesionales sanitarios y otra para pacientes, que recogen: riesgo cardiovascular, comorbilidad renal, riesgo gastrointestinal, estilo de vida, riesgo de infecciones y vacunacion, afectacion pulmonar, medicacion concomitante, trastornos psicoafectivos, osteoporosis y riesgo de fractura. Ademas, el documento refleja los argumentos para incluir cada item y la manera de recoger los items. Asimismo, el panel considero oportuno establecer unas «practicas a evitar» aplicables a la comorbilidad de la EspAx. Conclusiones Se generaron 2 listas de comprobacion y un listado de escenarios a evitar para facilitar el manejo de las comorbilidades de la EspAx. En pasos posteriores probaremos su utilidad y su aceptacion por un grupo amplio de usuarios que incluya medicos, pacientes y enfermeras.

Resumen Objetivo Estimar los costes medicos directos en los pacientes con artritis reumatoide (AR) y los factores predictores en los pacientes tratados con farmacos biologicos y sin biologicos. Metodos Se realizo un estudio transversal en una muestra incluyendo pacientes de toda la geografia nacional. Se obtuvieron datos sociodemograficos y de tratamiento. Se registro la utilizacion de recursos para los 2 anos de estudio y se hizo imputacion de costes. Se realizaron analisis de correlacion en todos los pacientes con AR y en los tratados con y sin biologicos, para estimar las diferencias entre los grupos. Los predictores de costes se analizaron mediante modelos de regresion lineal. Resultados Se incluyeron 1.095 pacientes con AR, el 26% hombres, con una edad media de 62 ± 14 anos. La media de los costes medicos directos por paciente fue de 24.291 ± 45.382 €. Excluyendo los farmacos biologicos, el coste medio por paciente fue de 3.742 ± 3.711 €. Despues de ajustar, los factores predictores de costes medicos directos para todos los pacientes con AR fueron los farmacos biologicos (p = 0,00), la comorbilidad (p = 0,00) y la edad del paciente (p = 0,01). En el grupo sin biologicos, los predictores fueron la comorbilidad (p = 0,00) y la edad del paciente (p = 0,01). En el grupo con biologicos los predictores fueron el sexo del paciente (p = 0,03) y la actividad de la enfermedad (p = 0,02). Conclusion Los datos muestran un notable impacto economico de la AR. Es importante identificar y estimar los factores asociados a mayor coste para desarrollar estrategias de reduccion de costes y aumentar la calidad de la atencion.

Objective To develop and assess the feasibility in daily practice of four comorbidity checklists, for common use in rheumatoid arthritis (RA), axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA). Methods A multidisciplinary panel of experts on comorbidity was established. Data from the GECOAR, GECOAX and GECOAP projects were analysed and a narrative literature review in Medline on RA, axSpA and PsA comorbidity was performed in order to select the most relevant and common comorbidities across the three diseases. With these results and those obtained from a focus group of patients, in a nominal group meeting, the experts generated preliminary checklists. These were afterwards modified by an external evaluation by two associations, a patients’ association and an association of health professionals related to rheumatology. As a result, the final checklists were generated. A cross-sectional study was conducted to test the feasibility of three of the checklists in daily practice, in which eight health professionals evaluated the checklists in five patients with RA, five with axSpA and five with SpA. Results Four comorbidity checklists were designed, three for health professionals (one to assess current comorbidity, one on prevention/health promotion and one with the referral criteria to other health professionals), and another for patients. The feasibility study showed them to be simple, clear, and useful for use in routine clinical practice. Conclusions The use of specific and common checklists for patients with RA, axSpA and PsA is feasible and might contribute favorably to their prognosis as well as in daily practice.

Objectives To identify priorities among comorbidities in axial spondyloarthritis (AxSpA) and recommend how to follow them from an eminently practical perspective. Methods A multidisciplinary group was selected (10 rheumatologists—6 of them experts in AxSpA—, 2 general practitioners, an internist, a cardiologist, a gastroenterologist and a psychologist). In a first discussion meeting, the scope and users were established and a list of comorbidities was voted based on frequency and impact. The panellists had to defend the inclusion of each comorbidity/item in the document with consistent arguments. Four panellists and two methodologists developed systematic reviews on controversial topics. In a second meeting, the results of the reviews and the arguments concerning the items to be included were presented. After the meeting, the final document was drafted. Results The final document includes two checklists, one for health professionals and another for patients; they incorporate cardiovascular risk, renal comorbidities, gastrointestinal risk, lifestyle, risk of infections and vaccinations, pulmonary involvement, concomitant medication, psycho-affective disorders, osteoporosis, and risk of fracture. In addition, the document reflects the arguments favouring the inclusion of each item and how to record the items for subsequent collection. The panel considered it also appropriate to likewise establish «practices to avoid» applicable to comorbidity in AxSpA. Conclusions Two checklists and a list of situations to avoid were generated to facilitate the management of comorbidities in AxSpA. In a future step, their utility and acceptance will be tested by a broad group of users that includes doctors, patients and nurses.

To analyze the resource utilization in rheumatoid arthritis (RA) patients and predictive factors in and patients treated with biological drugs and biologic-naïve.A cross-sectional study was performed in a sample including all regions and hospitals throughout the country. Sociodemographic data, disease activity parameters and treatment data were obtained. Resource utilization for two years of study was recorded and we made costs imputation. Correlation analyzes were performed on all RA patients and those treated with biological and biological naïve, to estimate the differences in resource utilization. Factors associated with increased resources utilization (costs) attending to treatment was analyzed by linear regression models.We included 1,095 RA patients, 26% male, mean age of 62±14 years. Mean of direct medical costs per patient was €24,291±€45,382. Excluding biological drugs, the average cost per patient was €3,742±€3,711. After adjustment, factors associated with direct medical costs for all RA patients were biologic drugs (P=.02) and disease activity (P=.004). In the biologic-naïve group, the predictor of direct medical costs was comorbidity (P.001). In the biologic treatment group predictors were follow-up length of the disease (P=.04), age (P=.02) and disease activity (P=.007).Our data show a remarkable economic impact of RA. It is important to identify and estimate the economic impact of the disease, compare data from other geographic samples and to develop improvement strategies to reduce these costs and increase the quality of care.

a b s t r a c t Objective: Patients with rheumatoid arthritis (RA) complain that weather conditions aggravate their symptoms. We investigated the short-term effects of weather conditions on worsening of RA and deter- mined possible seasonal fluctuations. Methods: We conducted a case-crossover study in Madrid, Spain. Daily cases of RA flares were collected from the emergency room of a tertiary level hospital between 2004 and 2007. Results: 245 RA patients who visited the emergency room 306 times due to RA related complaints as the main diagnostic reason were included in the study. Patients from 50 to 65 years old were 16% more likely to present a flare with lower mean temperatures. Conclusions: Our results support the belief that weather influences rheumatic pain in middle aged patients.

Introduction Data reporting mortality in rheumatic diseases vary widely. The objective of this systematic review and meta-analysis of published data is to provide an accurate overview of the current risk of mortality in rheumatic diseases. Methods Systematic review and meta-analysis of published studies identified by a sensitive search using free text and MeSH synonyms of “ mortality ” and of “ rheumatic diseases ”, in general and by specific diagnoses. Eligibility criteria were (1) study population with rheumatoid arthritis, systemic lupus erythemathosus, systemic sclerosis, vasculitis, osteoarthritis, osteoporosis, dermatomyositis, or spondyloarthritis; (2) outcome of interest mortality, reported as an standardized mortality ratio (SMR), or easily calculated from data reported; and (3) cohorts or longitudinal observational studies. Assessment of risk of bias relied on the New Castle-Ottawa scale for cohorts; only moderate to high quality studies were included. Separate meta-SMRs were calculated for specific diagnoses. Heterogeneity was studied with meta-regression. Results A total of 32 studies were included, none in spondyloarthritis or osteoarthritis. The overall pooled SMR was 2.03 (95% confidence interval (CI) 1.79–2.29), ranging from 1.36 in psoriatic arthritis to 4.80 in vasculitis. The largest individual overall SMR came from studies on inflammatory diseases, and the specific SMR were very high for infections and pulmonary events. Heterogeneity between studies was large; however, the analysis of such heterogeneity within diseases did not provide any association with the collected variables. Conclusions Based on our results and on the good quality of the included studies, we can conclude that rheumatic diseases increase in general the risk of death, and especially inflammatory diseases.