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Abstract: One of the most critical time periods in childhood is from birth to five years of age. Children exposed to alcohol and/or tobacco via family members and neighborhood are at risk for childhood developmental delays. This study evaluated the association of early childhood development with the prevalence of alcohol consumption and tobacco use in Mexican municipalities. This is a cross-sectional study. Early childhood development information from 2,345 children aged from 36 to 59 months was obtained from the 2015 Mexican National Survey of Boys, Girls, and Women (ENIM). Data on alcohol consumption and tobacco use come from the 2016 Mexican National Survey on Drugs, Alcohol, and Tobacco Consumption (ENCODAT). Multilevel logistic models were fitted to evaluate the association of the prevalence of alcohol consumption and tobacco use with the inadequacy of early childhood development. Children living in municipalities with high prevalence of alcohol consumption (OR = 13.410; 95%CI: 2.986; 60.240) and tobacco use (OR = 15.080; 95%CI: 2.040; 111.400) were less likely to be developmentally on track regarding early childhood development after adjustment for individual variables related to the child’s development and other environmental variables at municipal level. Childhood exposure to alcohol and tobacco in the neighborhood may directly contribute to inadequate early childhood development. These findings suggest that there is an urgent need to develop effective interventions aimed at reducing alcohol consumption and tobacco use in municipalities to ensure adequate early childhood development.

Objective To investigate the influence of COVID-19 vaccination on disease activity in rheumatoid arthritis (RA) and psoriatic arthritis (PsA) patients under targeted therapies.Patients and methods 1765 vaccinated patients COVID-19, 1178 (66.7%) with RA and 587 (33.3%) with PsA from the COVID-19 registry in patients with rheumatic diseases (COVIDSER) project, were included. Demographics, disease characteristics, Disease Activity Score in 28 joints (DAS28) and targeted treatments were collected. DAS28-based flare rates and categorised disease activity distribution prevaccination and post vaccination were analysed by log-linear regression and contingency analyses, respectively. The influence of vaccination on DAS28 variation as a continuous measure was evaluated using a random coefficient model.Results The distribution of categorised disease activity and flare rates was not significantly modified by vaccination. Log-linear regression showed no significant changes in the rate of flares in the 6-month period after vaccination compared with the same period prior to vaccination in neither patients with RA nor patients with PsA. When DAS28 variations were analysed using random coefficient models, no significant variations in disease activity were detected after vaccination for both groups of patients. However, patients with RA treated with Janus kinase inhibitors (JAK-i) (1) and interleukin-6 inhibitor (IL-6-i) experienced a worsening of disease activity (1.436±0.531, p=0.007, and 1.201±0.550, p=0.029, respectively) in comparison with those treated with tumour necrosis factor inhibitor (TNF-i). Similarly, patients with PsA treated with interleukin-12/23 inhibitor (IL-12/23-i) showed a worsening of disease activity (4.476±1.906, p=0.019) compared with those treated with TNF-i.Conclusion COVID-19 vaccination was not associated with increased rate of flares in patients with RA and PsA. However, a potential increase in disease activity in patients with RA treated with JAK-i and IL-6-i and in patients with PsA treated with IL-12/23-i warrants further investigation.

Background: Among COVID-19–associated deaths reported in the United States (U.S.), minority communities were disproportionately represented. The objective was to assess differences in mortality by race and ethnicity among patients with coronavirus disease 2019 (COVID-19) in the U.S. Methods: This is a retrospective case series study with information extracted from the U.S. Centers for Disease Control and Prevention between January 20 and December 29, 2020. Clinical and sociodemographic data were analyzed by race and ethnicity from non-hospitalized and hospitalized patients with COVID-19. Binary logistic models were fitted to evaluate factors associated with COVID-19-related mortality. Results: A total of 434,076 patients with COVID-19 were characterized; 284,574 cases were Non-Hispanic White, 10,468 cases were Non-Hispanic Asian, and 949,022 cases were Non-Hispanic Black, and 89,407 cases were Hispanic/Latino. For non-hospitalized patients, Hispanic/Latino with pneumonia (OR 3.34, 95%CI: 1.70-6.58) and Non-Hispanic Asian with comorbidities (OR 3.88, 95%CI: 0.99-15.2) had the highest odds for mortality. For hospitalized patients, Non-Hispanic Black with comorbidities (OR 3.02, 95%CI: 2.24-4.08) and Non-Hispanic Asian and Non-Hispanic Black with pneumonia (OR 2.98, 95%CI: 2.09-4.26; and OR 2.97, 95%CI: 2.60-3.38, respectively) had the highest odds for mortality. Conclusion: Racial/ethnic disparities in mortality persist among patients with COVID-19 in the U.S. These findings support the assertion that racial and ethnic minorities are disproportionately affected by COVID-19 in the U.S.

Summary: Background: During the Covid-19 pandemic, children and adolescents faced poverty, potentially dying from preventable causes, or missing out essential vaccines. The aim of this study was to assess potential environmental and individual factors associated to COVID-19 mortality in children and adolescents in Mexico. Methods: This cross-sectional study analysed the official data of 131,001 children under 10 years of age and adolescents between 10 and 19 years of age with COVID-19 disease, in Mexico. Participants were diagnosticated between March 2020 and June 13, 2021. The environmental variables such as malnutrition, vaccination coverage and social lag index were evaluated at the state level. Multilevel models were fitted to evaluate the association between environmental and individual factors and COVID-19 mortality. Findings: A total of 773 (0.6%) children and adolescents died due to COVID-19. Younger age (OR = 0.878, 95%CI: 0.869-0.888), diabetes (OR = 3.898, 95%CI: 2.596-5.851), immunosuppression (OR = 5.410, 95%CI: 4.088-7.158), obesity (OR = 1.876, 95%CI: 1.397-2.521), hypertension (OR = 1.906, 95%CI: 1.239-2.932), cardiovascular disease (OR = 2.288, 95%CI: 1.482-3.531), and chronic kidney disease (OR = 13.250, 95%CI: 9.066-19.350) were associated with mortality. COVID-19 mortality was directly associated with social lag index and malnutrition (ORvery high = 2.939, 95%CI: 1.111-7.775, and OR = 1.390, 95%CI: 1.073-1.802, respectively), and inversely associated with population density (OR = 0.374, 95%CI: 0.204-0.688). Finally, children and adolescents living in areas with a higher percentage of people with incomplete education (OR = 1.045, 95%CI: 1.011-1.081), of children of school age of 6–14 years who do not attend school (OR = 1.266, 95%CI: 1.032-1.554), and of illiterate population aged 15 and over (OR = 1.086, 95%CI: 0.999-1.179) were associated with a higher risk of COVID-19 mortality. Interpretation: Malnutrition, social lag index and population density are key factors to understand COVID-19 mortality in children and adolescents. Also, age and pre-existing comorbidities were also associated with worse COVID-19 prognosis. Funding: No funding was secured for this study.

Abstract Objectives To assess whether age, at the beginning of biologic treatment, is associated with the time a first adverse event (AE) appears in patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS), or psoriatic arthritis (PsA). Methods All patients in the BIOBADASER registry diagnosed with RA, AS, and PsA, and classified as young ( 75 years old) at start of biological treatment were included. Factors associated with the appearance of a first AE using adjusted incidence rate ratios (IRR) (Poisson regression) were analyzed. Survival to first AE was studied by Kaplan-Meier analysis and hazard ratios (HR) by Cox regression. Results 2483 patients were included: 1126 RA, 680 PsA, and 677 AS. Age group stratification was as follows: 63 young, 2127 adults, 237 elderly, and 56 very elderly. Regression model revealed an increased probability of suffering a first AE at age 65 years or older [IRR elderly: 1.42 (CI95% 1.13–1.77)]. Other characteristics associated with AE were female gender, the use of DMARDs, including methotrexate, the presence of comorbidities, and the time of disease duration. Factors that had the greatest impact on survival over a first AE were age > 75 years [HR 1.50 (1.01–2.24)] and female gender [HR 1.42 (1.22–1.64)]. Conclusion Age at the start of treatment and female gender are key factors associated with the appearance of a first AE with biologics. Other factors related to patient status and treatment were also associated with a first AE in rheumatic patients treated with biologics.

Abstract Background Biologic therapy has changed the prognosis of patients with juvenile idiopathic arthritis (JIA). The aim of this study was to examine the pattern of use, drug survival, and adverse events of biologics in patients with JIA during the period from diagnosis to adulthood. Methods All patients included in BIOBADASER (Spanish Registry for Adverse Events of Biological Therapy in Rheumatic Diseases), a multicenter prospective registry, diagnosed with JIA between 2000 and 2015 were analyzed. Proportions, means, and SDs were used to describe the population. Incidence rates and 95% CIs were calculated to assess adverse events. Kaplan-Meier analysis was used to compare the drug survival rates. Results A total of 469 patients (46.1% women) were included. Their mean age at diagnosis was 9.4 ± 5.3 years. Their mean age at biologic treatment initiation was 23.9 ± 13.9 years. The pattern of use of biologics during their pediatric years showed a linear increase from 24% in 2000 to 65% in 2014. Biologic withdrawal for disease remission was higher in patients who initiated use biologics prior to 16 years of age than in those who were older (25.7% vs 7.9%, p

Abstract Post-COVID-19 interstitial lung disease (ILD) is a new entity that frequently causes pulmonary fibrosis and can become chronic. We performed a single-center parallel-group open-label pilot randomized clinical trial to investigate the efficacy and safety of cyclosporine A (CsA) in the development of ILD in the medium term among patients hospitalized with COVID-19 pneumonia. Patients were randomized 1:1 to receive CsA plus standard of care or standard of care alone. The primary composite outcome was the percentage of patients without ILD 3 months after diagnosis of pneumonia and not requiring invasive mechanical ventilation (IMV) (response without requiring IMV). The key secondary composite outcomes were the percentage of patients who achieve a response requiring IMV or irrespective of the need for IMV, and adverse events. A total of 33 patients received at least one dose of CsA plus standard of care (n = 17) or standard of care alone (n = 16). No differences were found between the groups in the percentage of patients who achieved a response without requiring IMV or a response requiring IMV. A higher percentage of patients achieved a response irrespective of the need for IMV in the CsA plus standard of care group although the RR was almost significant 2.833 (95% CI, 0.908–8.840; p = 0.057). No differences were found between the groups for adverse events. In hospitalized patients with COVID-19 pneumonia, we were unable to demonstrate that CsA achieved a significant effect in preventing the development of ILD. (EU Clinical Trials Register; EudraCT Number: 2020-002123-11; registration date: 08/05/2020).

Abstract Background Patients with rheumatoid arthritis (RA) have an increased risk of infection and malignancy compared with the general population. Infection risk is increased further with the use of disease-modifying antirheumatic drugs (DMARDs), whereas evidence on whether the use of biologic DMARDs increases cancer risk remains equivocal. This single-arm, post-marketing study estimated the incidence of prespecified infection and malignancy outcomes in patients with RA treated with intravenous or subcutaneous abatacept. Methods Data were included from seven European RA quality registries: ATTRA (Anti-TNF Therapy in Rheumatoid Arthritis [Czech Republic]), DANBIO (Danish Rheumatologic Database), ROB-FIN (National Registry of Antirheumatic and Biological Treatment in Finland), ORA (Orencia and Rheumatoid Arthritis [France]), GISEA (Italian Group for the Study of Early Arthritis), BIOBADASER (Spanish Register of Adverse Events of Biological Therapies in Rheumatic Diseases), and the SCQM (Swiss Clinical Quality Management) system. Each registry is unique with respect to design, data collection, definition of the study cohort, reporting, and validation of outcomes. In general, registries defined the index date as the first day of abatacept treatment and reported data for infections requiring hospitalization and overall malignancies; data for other infection and malignancy outcomes were not available for every cohort. Abatacept exposure was measured in patient-years (p-y). Incidence rates (IRs) were calculated as the number of events per 1000 p-y of follow-up with 95% confidence intervals. Results Over 5000 patients with RA treated with abatacept were included. Most patients (78–85%) were female, and the mean age range was 52–58 years. Baseline characteristics were largely consistent across registries. Among patients treated with abatacept, IRs for infections requiring hospitalization across the registries ranged from 4 to 100 events per 1000 p-y, while IRs for overall malignancy ranged from 3 to 19 per 1000 p-y. Conclusions Despite heterogeneity between registries in terms of design, data collection, and ascertainment of safety outcomes, as well as the possibility of under-reporting of adverse events in observational studies, the safety profile of abatacept reported here was largely consistent with previous findings in patients with RA treated with abatacept, with no new or increased risks of infection or malignancy.

Abstract Background The objectives of this study were to assess the discontinuation of biologic therapy in patients who achieve remission and identify predictors of discontinuation of biologics in patients with inflammatory arthritis in remission. Methods An observational retrospective study from the BIOBADASER registry comprising adult patients diagnosed with rheumatoid arthritis (RA), ankylosing spondylitis (AS), or psoriatic arthritis (PsA) and receiving 1 or 2 biological disease-modifying drugs (bDMARDs) between October 1999 and April 2021. Patients were followed yearly after initiation of therapy or until discontinuation of treatment. Reasons for discontinuation were collected. Patients who discontinued bDMARDs because of remission as defined by the attending clinician were studied. Predictors of discontinuation were explored using multivariable regression models. Results The study population comprised 3,366 patients taking 1 or 2 bDMARDs. Biologics were discontinued owing to remission by 80 patients (2.4%): 30 with RA (1.7%), 18 with AS (2.4%), and 32 with PsA (3.9%). The factors associated with a higher probability of discontinuation on remission were shorter disease duration (OR: 0.95; 95% CI: 0.91–0.99), no concomitant use of classic DMARDs (OR: 0.56; 95% CI: 0.34–0.92), and longer usage of the previous bDMARD (before the decision to discontinue biological therapy) (OR: 1.01; 95% CI: 1.01–1.02); in contrast, smoking status (OR: 2.48; 95% CI: 1.21–5.08) was associated with a lower probability. In patients with RA, positive ACPA was associated with a lower probability of discontinuation (OR: 0.11; 95% CI: 0.02–0.53). Conclusions Discontinuation of bDMARDs in patients who achieve remission is uncommon in routine clinical care. Smoking and positive ACPA in RA patients were associated with a lower probability of treatment discontinuation because of clinical remission.

Abstract The better understanding of the safety of biologic DMARDs (bDMARDs), as well as the emergence of new bDMARDs against different therapeutic targets and biosimilars have likely influenced the use patterns of these compounds over time. The aim of this study is to assess changes in demographic characteristics, disease activity and treatment patterns in patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), or ankylosing spondylitis (AS) who started a first- or second-line biologic between 2007 and mid-2020. Patients diagnosed with RA, PsA or AS included in the BIOBADASER registry from January 2007 to July 2020 were included. According to the start date of a first- or second-line biologic therapy, patients were stratified into four time periods: 2007–2009; 2010–2013; 2014–2017; 2018–2020 and analyzed cross-sectionally in each period. Demographic and clinical variables, as well as the type of biologic used, were assessed. Generalized linear models were applied to study the evolution of the variables of interest over time periods, the diagnosis, and the interactions between them. A total of 4543 patients initiated a first biologic during the entire time frame of the study. Over the four time periods, disease evolution at the time of biologic initiation (p

Abstract Rheumatoid arthritis (RA) prevalence is believed to be around 1% worldwide, although it varies considerably among different populations. The aim of EPISER2016 study was to estimate the prevalence of RA in the general adult population in Spain. We designed a population-based cross-sectional study. A national survey was conducted between November 2016 and October 2017 involving a probabilistic sample from the general population aged 20 years or older. Subjects were randomly selected for phone screening using a computer-assisted telephone interviewer system. Positive RA screening results were evaluated by a rheumatologist. Cases fulfilled the 1987 ACR and/or the 2010 ACR/EULAR criteria; previous diagnosis established by a rheumatologist and clearly identified in medical records were also accepted regardless of the criteria used. Prevalence estimates with 95% CI were calculated taking into account the design of the sample (weighting based on age, sex, and geographic origin using as a reference the distribution of the population in Spain). 4916 subjects participated in the study and 39 RA cases were confirmed. RA estimated prevalence was 0.82% (95% CI 0.59–1.15). Mean age of RA cases was 60.48 (14.85) years, they were more frequently women (61.5%), from urban areas (74.4%), non-smokers (43.6%), and with a high body mass index (53.8% with overweight). Extrapolating to the population in Spain (approximately 37 million are ≥ 20 years old), it was estimated that there were between 220,000 and 430,000 people aged 20 years or older with RA. No undiagnosed cases were detected, which could be related to the establishment of early arthritis clinics around the country, increasing the rates of diagnosis during early phases of RA.

Resumen: Objetivo: Estimar la prevalencia de consultas médicas por problemas osteoarticulares en población general adulta en España y su asociación con variables sociodemográficas, antropométricas y de hábitos de vida. Método: Estudio transversal de base poblacional. Muestra de 4916 sujetos de 20 o más años de edad. Se realizó un cuestionario telefónico que incluía una pregunta sobre consulta médica por problemas osteoarticulares. Para la estimación de la prevalencia y su intervalo de confianza del 95% (IC95%) se calcularon los pesos en función de la probabilidad de selección en cada una de las etapas del muestreo. Resultados: El 28,9% (IC95%: 27,6-30,2) de las personas encuestadas refirieron haber consultado a algún médico por problemas osteoarticulares en el último año. Se ha observado una asociación con la edad, el sexo, el nivel de estudios y el índice de masa corporal. Abstract: Objective: To estimate the prevalence of medical visits due to osteoarticular problems by the adult general population in Spain and its association with sociodemographic, anthropometric and lifestyle variables. Method: Cross-sectional population-based study. Sample with 4916 subjects aged 20 years and over. A telephone questionnaire, with a question about medical visits due to osteoarticular problems, was used. To estimate the prevalence and its 95% confidence interval (95%CI), weights were calculated according to the probability of selection in each of the sampling stages. Results: 28.9% (95%CI: 27.6-30.2) of the people reported having consulted a doctor in the last year because of osteoarticular problems. We observed an association with age, sex, level of education, and body mass index.

Abstract Aim The aim of this study was to evaluate the association between periodontal parameters related with the periodontal disease severity and the presence and levels of anti-citrullinated protein antibodies (ACPAs) in rheumatoid arthritis (RA) patients. Materials and methods This cross-sectional study included 164 RA patients. Socio-demographics and RA disease characteristics, including ELISA-detected ACPA (anti-CCP-2), were recorded. Exposure was assessed by periodontal parameters: plaque index (PI), bleeding on probing (BoP), probing pocket depth, and clinical attachment levels (CAL). Presence and levels of ACPAs (outcome) and exposure variables were compared by both parametric and non-parametric tests and associations were evaluated by adjusted odds ratio (OR). Results A significant association was observed between the presence of anti-CCP antibodies and severity of periodontal outcomes such as the mean CAL (OR 1.483, p = 0.036), mean PI (OR 1.029, p = 0.012), and the number of pockets ≥ 5 mm (OR 1.021, p = 0.08). High anti-CCP antibodies levels were associated with mean CAL, mean PI, and number of pockets ≥ 5 mm with an OR of 1.593 (p = 0.043), 1.060 (p

Abstract Background A high prevalence of periodontitis has been reported in rheumatoid arthritis (RA) patients, although the strength of this association, its temporal link and the possible relationship between the severity of periodontitis and RA disease activity remain unclear. The objective of this work was to investigate whether periodontitis is associated with RA and whether periodontitis severity is linked to RA disease activity. Methods This case–control study included 187 patients diagnosed with RA and 157 control patients without inflammatory joint disease. RA disease activity and severity were evaluated by the Disease Activity Score 28, the Simplified Disease Activity Index, the Clinical Disease Activity Index, rheumatoid factor, anti-citrullinated protein antibody titers, the erythrocyte sedimentation rate, C-reactive protein, presence of extra-articular manifestations and type of RA therapy. Exposure severity was assessed by the following periodontal parameters: plaque index, bleeding on probing, probing pocket depth and clinical attachment levels. Sociodemographic variables and comorbidities were evaluated as confounding variables. Outcome and exposure variables were compared by both parametric and nonparametric tests, and possible associations were assessed through regression analysis with a calculation for the adjusted odds ratio (OR). Results A significant association was demonstrated between periodontitis and RA with an adjusted OR of 20.57 (95% CI 6.02–70.27, p

ObjectiveThe prevalence of psoriatic arthritis (PsA) is very heterogeneous. There are no data on its frequency in the general population in Spain. The aim of EPISER2016 study was to estimate the prevalence of PsA in people aged ≥20 years in Spain.MethodsCross-sectional multicenter population-based study. Subjects from all the autonomous communities in Spain were randomly selected using multistage stratified cluster sampling. Participants in each of the municipalities randomly selected for the study were administered a telephone-based questionnaire to screen for the study diseases. If the participant reported being previously diagnosed, rheumatologists from the participant's reference hospital confirmed the diagnosis based on a review of the clinical history. Subjects not previously diagnosed but whose screening result was positive based on symptoms received a second telephone call from the investigating rheumatologist in order to evaluate the suspicion. If the suspicion remained, an appointment was made at the reference hospital to complete the diagnostic confirmation process according to CASPAR criteria. To calculate the prevalence and its 95% confidence interval (CI), the sample design was taken into account and weighing was calculated considering age, sex and geographic origin.ResultsThe sample comprised 4916 subjects. The prevalence of PsA was 0.58% (95%CI: 0.38-0.87). All but 1 of the 27 cases (96.30%) had been diagnosed prior to EPISER2016.ConclusionThe prevalence of PsA in Spain was among the highest reported to date, only below that reported in Norway (0.67%) and slightly higher than that reported in Italy (0.42%).

Fundamento: La insuficiencia cardiaca (IC) es un importante problema de salud pública debido a su creciente prevalencia y la descompensación que conlleva un ingreso hospitalario representa un aumento del riesgo de muerte. El objetivo de este trabajo fue comparar varios métodos para modelizar la variable hospitalizaciones y determinar el efecto de los factores asociados con los ingresos hospitalarios en casos incidentes de IC. Método: Se realizó un estudio de cohortes restrospectivo con información extraída de la historia clínica electrónica de Atención Primaria (AP). Se incluyeron pacientes mayores de 24 años que habían realizado al menos 1 consulta en AP durante el año 2006. Se analizaron las hospitalizaciones registradas de casos incidentes de IC entre 2006 y 2010 o hasta su fallecimiento y se compararon modelos de regresión de Poisson, Binomial Negativa (BN), inflados con ceros y de Hurdle para identificar factores asociados a las hospitalizaciones. Resultados: Se identificó a 3.061 personas con IC en una cohorte de 227.984 pacientes. Respecto a los factores asociados con las hospitalizaciones y según el modelo de regresión BN inflado con ceros, los pacientes con valvulopatías (OR=2,01; IC95%: 1,22-3,30) o en tratamiento con antitrombóticos (OR=3,45; IC95%: 1,61-7,42) o diuréticos (OR=2,28; IC95%:1,13-4,58) tuvieron mayor probabilidad de hospitalización. Los factores asociados a una mayor tasa de ingresos fueron tener valvulopatías (IRR=1,37; IC95%: 1,03-1,81) o diabetes mellitus (IRR=1,38, 1,07-1,78) y estar en tratamiento con calcioantagonistas (IRR=1,35; IC95%: 1,05-1,73) o IECAS (IRR=1,43; IC95%:1,06- 1,92). Haber tenido derivaciones a cardiología tuvo efecto protector (IRR=0,86; IC95%: 0,76-0,97). Conclusión: El modelo de regresión que tiene mejor ajuste es el BN inflado con ceros. Según este modelo los factores asociados con un incremento en los ingresos hospitalarios son las valvulopatías, la diabetes mellitus y el tratamiento con calcioantagonistas.

Objetivo: Describir la supervivencia de los pacientes con insuficiencia cardiaca (IC) con seguimiento en atención primaria (AP) y analizar el efecto del sexo, edad, factores clínicos, de utilización de servicios y nivel de renta, en la supervivencia. Diseño: Estudio observacional longitudinal de una cohorte retrospectiva de pacientes a partir de la historia clínica electrónica. Emplazamiento: Área 7 de AP de la Comunidad de Madrid. Participantes: Pacientes mayores de 24 años con una consulta en AP en el año 2006. Mediciones principales: Casos incidentes de IC desde 2006 a 2010 o hasta su fallecimiento. Análisis de supervivencia de Kaplan-Meier y de regresión multivariante de riesgos proporcionales de Cox. Resultados: Se identificaron 3.061 pacientes en una cohorte de 227.984. Su supervivencia fue del 65% a los 5 años. Fallecieron 519 pacientes con una supervivencia media de 49 meses. Los factores asociados a mayor riesgo de mortalidad fueron la edad (HR = 1,04; 1,03-1,05) y tener diagnóstico de cardiopatía isquémica (HR = 1,45; 1,15-1,78) o de diabetes (HR = 1,52; 1,17-1,95). Los factores con un efecto protector fueron ser mujer (HR = 0,72; 0,59-0,86), no pensionista (HR = 0,43; 0,23-0,84), haber recibido la vacunación de la gripe anualmente (HR = 0,01; 0,00-0,06), tener prescritos hipolipidemiantes (HR = 0,78; 0,61-0,99) o IECA (HR = 0,73; 0,60-0,88), así como que se le hubieran solicitado analíticas (HR = 0,98; 0,95-1), radiografías (HR = 0,81; 0,74-0,88) y electrocardiogramas (HR = 0,90; 0,81-0,99) en AP. Conclusiones: Los datos de los pacientes con IC seguidos en AP indican que su supervivencia es mejor que la obtenida en otros países, apoyando el argumento de la mejor evolución de la IC en los países mediterráneos.

Background: Reducing the dose of biological therapy (BT) when patients with immune-mediated arthritis achieve a sustained therapeutic goal may help to decrease costs for national health services and reduce the risk of serious infection. However, there is little information about whether such a decision can be applied universally. Therefore, the objective of this study was to develop appropriateness criteria for reducing the dose of BT in patients with rheumatoid arthritis (RA), axial spondyloarthritis (axSpA), and peripheral spondyloarthritis (pSpA). Methods: The RAND/UCLA appropriateness method was coordinated by experts in the methodology. Five rheumatologists with clinical research experience in RA and/or SpA selected and precisely defined the variables considered relevant when deciding to reduce the dose of BT in the 3 diseases, in order to define patient profiles. Ten rheumatologists with experience in prescribing BT anonymously rated each profile on a scale of 1 (completely inappropriate) to 9 (completely appropriate) after revising a summary of the evidence obtained from 4 systematic literature reviews carried out specifically for this project. Findings: A total of 2,304 different profiles were obtained for RA, 768 for axSpA, and 3,072 for pSpA. Only 327 (14.2%) patient profiles in RA, 80 (10.4%) in axSpA, and 154 (5%) in pSpA were considered appropriate for reducing the dose of BT. By contrast, 749 (32.5%) patient profiles in RA, 270 (35.3%) in axSpA, and 1,243 (40.5%) in pSpA were considered inappropriate. The remaining profiles were considered uncertain. Interpretation: Appropriateness criteria for reducing the dose of BT were developed in 3 inflammatory conditions. These criteria can help clinicians treating these disorders to optimize the BT dose. However, further research is needed, since more than 50% of the profiles were considered uncertain and the real prevalence of each profile in daily clinical practice remains unknown.