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To develop a joint proposal for screening criteria of interstitial lung disease (ILD) in patients with rheumatoid arthritis (RA) and vice versa, which serves as a guidelines in patient referral between the Rheumatology and Pneumology departments to early detection of these patients.A systematic literature review was carried out on the risk factors for the development of ILD in RA patients, and for the referral criteria to Rheumatology for suspected early RA. Based on the available evidence, screening criteria were agreed using the Delphi method by a panel of pneumologists and rheumatologists with expertise in these pathologies.Screening criteria for ILD in patients with RA and for the early detection of RA in cases with ILD of unknown etiology have been developed. In both cases, a detection strategy was based on clinical risk factors. Recommendations also included the complementary tests to be carried out in the different clinical scenarios and on the periodicity that screening should be repeated.A selective screening strategy is recommended for the first time in the early diagnosis of patients with ILD-RA. This multidisciplinary proposal aims to solve some common clinical questions and help decision-making, although its usefulness to identify these patients with good sensitivity must be confirmed in a validation study.

Resumen Objetivo Elaborar recomendaciones para la prevencion de infeccion en pacientes adultos con enfermedades reumaticas autoinmunes sistemicas (ERAS). Metodos Un panel de expertos, seleccionados con base en su curriculum y experiencia, identifico preguntas clinicas de investigacion relevantes para el objetivo del documento. Se realizaron revisiones sistematicas de la evidencia, que se graduo de acuerdo con los criterios del Scottish Intercollegiate Guidelines Network. Tras ello, se formularon las recomendaciones. Resultados Se seleccionaron cinco preguntas, referentes a la prevencion de infeccion por Pneumocystis jirovecii con trimetoprim-sulfametoxazol, medidas profilacticas contra el virus de la hepatitis B, vacunacion contra el virus del papiloma humano, vacunacion contra el Streptococcus pneumoniae y vacunacion contra el virus de la gripe. Se formularon un total de 18 recomendaciones, estructuradas por pregunta, con base en la evidencia encontrada para las diferentes ERAS y/o consenso de expertos. Conclusiones Existe suficiente evidencia sobre la seguridad y eficacia de las vacunaciones y otras medidas profilacticas frente a los microrganismos revisados en este documento como para ser recomendadas especificamente en pacientes con ERAS.

Objectives To develop recommendations for the prevention of infection in adult patients with systemic autoimmune rheumatic diseases (SARD). Methods Clinical research questions relevant to the objective of the document were identified by a panel of experts selected based on their experience in the field. Systematic reviews of the available evidence were conducted, and evidence was graded according to the Scottish Intercollegiate Guidelines Network criteria. Specific recommendations were made. Results Five questions were selected, referring to prevention of infection by Pneumocystis jirovecii with trimethoprim/sulfamethoxazole, primary and secondary prophylactic measures against hepatitis B virus, vaccination against human papillomavirus, vaccination against Streptococcus pneumoniae and vaccination against influenza virus, making a total of 18 recommendations, structured by question, based on the evidence found for the different SARD and/or expert consensus. Conclusions There is enough evidence on the safety and efficacy of vaccinations and other prophylactic measures against the microorganisms reviewed in this document to specifically recommend them for patients with SARD.

Resumen Antecedentes Dada la heterogeneidad clinica de la artritis psoriasica (APs), se han elaborado recomendaciones por grupos internacionales para orientar las decisiones terapeuticas del reumatologo. Esta revision sistematica (RS) tiene el objetivo de evaluar la evidencia sobre la eficacia de los FAME en APs. Metodos Busqueda bibliografica en Medline, Embase, Cochrane Library, desde 2008 hasta 2014. Se incluyeron RS, EC y estudios observacionales, en pacientes con APs con evaluacion de eficacia de FAME sinteticos (metotrexato, sulfasalazina y leflunomida), los siguientes desenlaces: sintomas perifericos; dano estructural radiologico periferico; sintomas axiales; entesopatia por ecografia o resonancia magnetica (numero de entesis antes y despues del estudio); dactilitis, y uveitis. Resultados Se recuperaron 1.662 documentos para revisar por titulo y «abstract» (Medline, n = 433; Embase n = 1.132; Cochrane, n = 97), se seleccionaron 48 estudios para su lectura detallada, y se incluyeron 8 estudios. Conclusiones Ya que los estudios incluidos no son consistentes, y hay argumentos para apoyar la eficacia del metotrexato, la evidencia observada con el tratamiento de FAME en APs no es concluyente.

Background Due to the clinical heterogeneity of psoriatic arthritis (PsA), recommendations have been developed by international groups to guide therapeutic decisions of the rheumatologist. The objective of the current systematic review (RS) was to evaluate the evidence of efficacy of disease-modifying antirheumatic drugs (DMARDs) in PsA. Methods Literature search in Medline, EMBASE, Cochrane Library, from 2008 to 2014. We included RS, randomized clinical trials and observational studies, in patients with PsA and an evaluation of efficiency of conventional DMARDs (methotrexate, sulfasalazine, leflunomide), according to the following outcomes: peripheral and axial symptoms; peripheral radiological damage; enthesitis according to power Doppler ultrasound or magnetic resonance imaging (enthesitis count before and after therapy); dactylitis; uveitis. Results Title and abstract were used to retrieve 1662 documents for this review (Medline, n = 433; EMBASE n = 1132; Cochrane, n = 97), and 48 studies were selected for detailed reading; finally, 8 studies were included. Conclusions Since the studies included are not robust, and there are arguments to support the effectiveness of methotrexate, the evidence observed with the treatment of DMARDs in PsA is not conclusive.

Background There is a wide variability in the diagnostic and therapeutic methods in rheumatoid arthritis (AR) in Spain, according to prior studies. The quality of care could benefit from the application of appropriate clinical practice standards; we present a study on the variability of clinical practice. Methods Descriptive review of clinical records (CR) of patients aged 16 or older diagnosed with RA, selected by stratified sampling of the Autonomous Communities in two stages per Hospital Center and patient. Collected analysis of sociodemographic data, evolution, follow-up, joint count, reactants, function, job history, Visual Analogue Scales (VAS) and other. Results We obtained valid information of 1272 RA patients. The ESR, CRP and rheumatoid factor (RF) were the regularly used parameters. The percentages of missing data in tender (TJN) and swollen (SJN) joint counts were 8.2% and 9.6%, respectively; regarding the VAS we found 53.6% (patient), 59.1% (pain), and 72% in the physician VAS. Conclusions Despite having clinical practice guidelines on RA, there still exists a significant variability in RA management in our country.

Resumen Fundamento Los resultados de estudios previos muestran una amplia variabilidad en los medios diagnosticos y terapeuticos en artritis reumatoide (AR) en Espana. La calidad asistencial se beneficiaria al aplicar estandares de practica apropiados; se presenta un estudio sobre variabilidad en el manejo de la AR en Espana. Metodos Estudio descriptivo de revision de historias clinicas (HC) de pacientes con AR de edad mayor de 16 anos, seleccionados por muestreo estratificado por comunidades autonomas y bietapico por centro hospitalario y paciente. Se recogio datos sociodemograficos, evolucion, seguimiento, recuento articular, reactantes, funcion, vida laboral, escalas visuales analogicas (EVA) y otros. Resultados Se obtuvo informacion valida de 1.272 pacientes con AR. Se empleo mayoritariamente la VSG, PCR y factor reumatoide (FR). Los porcentajes de ausencia de datos en los recuentos de articulaciones dolorosas (NAD) y tumefactas (NAT) son el 8,2 y el 9,6%; se utilizaron poco las EVA. Conclusiones A pesar de tener una guia de practica clinica sobre la AR, existe variabilidad en su manejo.

Objectives To analyze the effectiveness of immunosuppressants and biological therapies in autoimmune posterior uveitis, chronic anterior uveitis associated with juvenile idiopathic arthritis, and macular edema. Methods Systematic review. We conducted a sensitive literature search in Medline (from 1961) and EMBASE (from 1980) until October 2007. Selection criteria were as follows: (1) population: autoimmune posterior uveitis, chronic anterior uveitis in juvenile idiopathic arthritis, and macular edema; (2) intervention: immunosuppressive and biologic therapies; (3) outcomes: visual acuity, Tyndall, vitreous haze, macular edema, pars planitis, and retinal vasculitis. There were no limitations regarding study design. The quality of each study was evaluated using the Jadad's scale and Oxford Levels of Evidence. Results Two hundred sixty-five articles were selected for detailed review of the 4235 found in the initial search: 128 records were on immunosuppressants, 105 on biological therapies, and 32 on macular edema. Overall, both the immunosuppressive and the biologic therapies appeared effective in the treatment of autoimmune posterior uveitis, except for daclizumab in uveitis related to Behcet's disease, and for etanercept in any uveitis. In the treatment of macular edema, the drugs tested were also effective. Conclusions Based on the evidence collated, immunosuppressants and biological therapies (except for daclizumab in Behcet and etanercept) may be effective in autoimmune uveitis and macular edema. No superiority may be inferred from this review.

Fundamento y objetivo Los estudios bibliometricos mostraron su utilidad en la evaluacion de la produccion cientifica, por lo que se evalua la produccion reumatologica espanola en el periodo de 1997 a 2006. Metodo Se crearon frases de busqueda para las bases de datos utilizadas (PubMed, Science Citation Index [SCI], Indice Medico Espanol [IME]). El analisis se baso en los resultados de SCI con indicadores bibliometricos de produccion cientifica, colaboracion, tipo de documento, citas recibidas y factor de impacto (FI). Resultados La produccion cientifica espanola en Reumatologia, segun la base bibliografica, fue de 602 documentos en PubMed, 1.073 documentos en SCI, y 627 documentos en IME. La distribucion geografica es parecida a otros estudios (Madrid, Cataluna, Galicia). Los «items citables» (articulos y revisiones) aumentaron de 54 a 98 documentos y la colaboracion internacional aumento de 3 a 33 documentos, de 1997 a 2006. El FI para todos los documentos de 1997 a 2001 fue de 6,79 ± 0,54 y de 9,60 ± 1,24 para el periodo de 2002 a 2006. Conclusiones La produccion cientifica espanola reumatologica continua el ascenso de estudios previos

Fundamento y objetivo Identificacion de factores presentes en la artritis de reciente comienzo que puedan ayudar a predecir el desarrollo o no de artritis reumatoide (AR). Descripcion de las caracteristicas clinicas de una cohorte de AR de inicio. Pacientes y metodo Cohorte de inicio prospectiva de 5 anos de duracion en 34 servicios de reumatologia espanoles formada por pacientes con oligoartritis y poliartritis de menos de 1 ano de evolucion no tratados previamente. A todos los pacientes se les realizo al inicio una valoracion de la actividad inflamatoria, capacidad funcional y factores de riesgo de AR. Ademas se realizaron radiografias de manos y pies y determinaciones de factor reumatoide (FR) y de anticuerpos anti-CCP. Tras 3 anos, se evaluo el diagnostico definitivo y las variables que determinaron la evolucion hacia AR. Resultados Se incluyo a 171 pacientes, de los que 161 (94,2%) acabaron cumpliendo criterios diagnosticos de AR, la mayoria (157; 97,5%) en la visita inicial. Los factores relacionados con el diagnostico de AR fueron: el FR positivo (odds ratio [OR]=8,5; intervalo de confianza [IC] del 95%, 1�69,8), los anti-CCP (OR=8,5; IC del 95%, 0,96�75,7) y el DAS28 (OR=1,9; IC del 95%, 1,1�3,3). El 65% de los pacientes presentaban erosiones en la visita basal. Conclusiones Tanto la extension de la afeccion articular como tener un FR positivo y anticuerpos anti-CCP permiten predecir la evolucion a AR. El dano radiologico, en muchos pacientes, ya esta al inicio, por lo que es mas importante un tratamiento contundente precoz que esperar a tener un diagnostico de AR.

Objective To estimate the direct and indirect osteoarthritis (OA)–attributable costs and predictors of costs of knee and hip OA in Spain. Methods This study included consecutive patients age ≥50 years with symptomatic and radiologic knee and/or hip OA who were seen at primary care centers in all provinces of Spain. Information on demographics, health status (Short Form 12 Health Survey), comorbidities (Charlson Index), clinical (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]) and radiologic OA severity (Kellgren/Lawrence [K/L] scale), data related to OA health resources utilization (medical and nonmedical), and subjects' and caregivers' expenses and time lost in the previous 6 months were collected in 2 separate, structured, and detailed interviews. Costs in euros were assigned using market prices and official sources if available, and were annualized (to 2007). The predictors of costs were assessed in multivariate regression models. Costs were log-transformed before being modeled. Results A total of 1,071 subjects were analyzed (74% women, mean ± SD age 71 ± 9 years). Average total annual costs were €1,502 per patient. Direct costs accounted for 86% of the total cost. We estimated a national cost of €4,738 million, representing 0.5% of the gross national product. Higher total costs were associated with comorbidity (Charlson Index odds ratio [OR] 1.27, 95% confidence interval [95% CI] 1.03–1.58), poorer health status (P < 0.050), worse WOMAC scores (OR 1.05, 95% CI 1.03–1.08), and grade 4 K/L scores (OR 1.76, 95% CI 1.15–2.69). Conclusion The economic burden of knee and hip OA is substantial. Costs increased with comorbidity, poorer health status, and clinical and radiologic OA severity.

a b s t r a c t Background: Bibliometric studies have shown their usefulness in the evaluation of science. This methodology was adopted for the analysis of Spanish rheumatologic scientific production during 1997–2006. Methods: Search phrases were constructed for databases (PubMed, Science Citation Index [SCI], Indice Medico Espanol [IME]). The analysis was based on the results of SCI with bibliometric indicators for scientific production, collaboration, type of document, times cited and the measure of impact factor (FI). Results: The scientific production in Spanish rheumatology recovered 602 documents in PubMed, 1073 in ISI, 627 in IME. The mapping of scientific productivity is similar to other studies (Madrid, Cataluna, Galicia). The “items citables” (citable items, articles and reviews) raised 54 to 98 and the international collaboration raised 3 to 33 documents (1997–2006). The FI for all documents in 1997–2001 was = 6.79 (0.54) and during 2002–2006 = 9.60 (1.24). Conclusions: This confirms an upward trend in Spanish scientific production in rheumatology with regard to previous studies.

To identify factors present in recent onset arthritis that may help to predict rheumatoid arthritis (RA), and to describe a cohort of recent onset RA.A 5 year prospective cohort of patients with early oligo and polyarthritis (1 year of evolution) from 34 rheumatology units, was studied. Sociodemographic, clinical features and RA risk factors were recorded. Rheumatoid factor (RF), anti-CCP determinations and radiographs of hands and feet were analyzed too. After three years, a diagnosis of certainty and the variables that determined the evolution to RA, were evaluated.One hundred and seventy one patients were included; 161 (94.2%) fulfilled RA diagnostic criteria; most of them (157; 97.5%) in the first visit. Factors associated with RA diagnosis were: positive RF, anti-CCP and DAS-28; 65% of the patients had radiological erosions in the first visit.Positive RF, anti-CCP and the disease activity are predictive factors of RA. Radiological damage exists very early in most of patients, that's why it is more important to treat the disease aggressively instead than achieving an RA diagnosis of certainty.

Objetivo: Evaluar la eficacia y la seguridad del anakinra en el tratamiento de la artritis reumatoide (AR) mediante una revision sistematica de la evidencia cientifica. Material y metodo: Busqueda en MEDLINE, EMBASE y el registro de estudios Cochrane desde el ano 2000 hasta febrero de 2006 segun una estrategia predisenada de perfil sensible que incluyo todos los estudios controlados y aleatorizados (ECA) que evaluaron la eficacia o la seguridad del anakinra en el tratamiento de la AR. Resultados: Se incluyo 4 estudios para evaluar la eficacia del anakinra y un estudio para evaluar su seguridad. En todas las mediciones de eficacia analizadas, se observo un efecto beneficioso del anakinra respecto a placebo y del anakinra + metotrexato (MTX) respecto a la monoterapia con MTX. La combinacion de anakinra y etanercept no fue mas eficaz que el etanercept en monoterapia y, en cambio, incremento la incidencia de infecciones graves. La tasa de suspensiones por reacciones adversas al anakinra fue discretamente superior a la del placebo, si bien se puede considerar que el anakinra es un farmaco bien tolerado y seguro a corto plazo cuyo efecto adverso mas frecuente es la inflamacion local en el punto de inyeccion. Conclusiones: El anakinra es una alternativa eficaz y segura para tratar a corto plazo la AR. Esta revision no permite extraer conclusiones sobre la eficacia y la seguridad de este farmaco a largo plazo.

Objective To perform a systematic review for evaluating efficacy and safety of anakinra in the treatment of rheumatoid arthritis (RA). Material and method The MedLine, Embase, and Cochrane Library databases were searched from January 2000 to February 2006 by using a high sensitive search that included every randomised controlled trial (RCTs) or controlled trial (CTs) that evaluated either efficacy or safety of Anakinra for the treatment of RA. Results The search identified four relevant studies to evaluate efficacy. Patients treated with anakinra achieved significantly better clinical responses than those treated with placebo. Anakinra combined with methotrexate provided significantly greater clinical benefit than methotrexate alone. Combination therapy with etanercept and anakinra provides no added benefit and an increased safety risk compared with etanercept alone. Results from a large, placebo-controlled safety study demonstrate that anakinra is safe and well tolerated. The most common adverse effect was a mild local inflammation over the puncture area. Conclusions This review confirmed both the efficacy and the safety of anakinra in the short term for the treatment of RA. Anakinra provides adequate clinical responses without major safety problems. This systematic review does not allow us to conclude on Anakinra responses in the long term.

Albeit a disproportionate rate of atrophy in the medial temporal lobe (MTA) represents a reliable marker of Alzheimer’s disease (AD) pathology, the measurement of MTA is not being widely used in daily clinical practice. This is mainly because the methods available to date are sophisticated and diffiult to implement (volumetric methods) or lack objectivity (visual rating scales). Here, we aimed to assess the reproducibility of computing the 2D-yrA-MTL and the efforts needed to start the usage of 2D-yrA-MTL. A series of 290 1.5T-MRI studies on 230 subjects in the age range of 65–85 years, including patients with AD (n = 100), MCI (n = 100) and matched controls (n = 90) were examined by experienced tracers (ET) and inexperienced tracers (IT). The IT got suffiiently trained by attending to a minimum of 3 cases before being able to perform the 2D-yrA-MTL on their own and without mistakes according to the corrections made by the ET. After training, the IT needed 5 minutes to perform the 2D-yrA-MTL on a new case. The intrarater and interrater reproducibility of 2D-yrAMTL was good. In conclusion, the 2D-yrA-MTL is a simple, objective and reproducible method that could be easily implemented in clinical practice.

There is a wide variability in the diagnostic and therapeutic methods in rheumatoid arthritis (AR) in Spain, according to prior studies. The quality of care could benefit from the application of appropriate clinical practice standards; we present a study on the variability of clinical practice.Descriptive review of clinical records (CR) of patients aged 16 or older diagnosed with RA, selected by stratified sampling of the Autonomous Communities in two stages per Hospital Center and patient. Collected analysis of sociodemographic data, evolution, follow-up, joint count, reactants, function, job history, Visual Analogue Scales (VAS) and other.We obtained valid information of 1,272 RA patients. The ESR, CRP and rheumatoid factor (RF) were regularly used parameters. The percentages of missing data in tender (TJN) and swollen (SJN) joint counts were 8.2% and 9.6% respectively; regarding the VAS we found 53.6% (patient), 59.1% (pain), and 72% in the physician VAS.Despite having clinical practice guidelines on RA, there still exists a significant variability in RA management in our country.

Objective To examine the efficacy of available drugs in undifferentiated spondyloarthritis (u-SpA). Methods Systematic review of studies retrieved from Medline (1961-July 2009), Embase (1961-July 2009), and Cochrane Library (up to July 2009). A complementary hand search was also performed. The selection criteria were as follows: (population) u-SpA patients; (intervention) nonsteroidal anti-inflammatory agents, disease-modifying antirheumatic drugs, anti-tumor necrosis factor α, anakinra, abatacept, biphosphonates, or thalidomide; (outcome) pain, function, structural damage and quality of life; (study design) randomized controlled trials (RCT), cohort studies, and case reports; (level of evidence) according to The Oxford Centre for Evidence-based Medicine (update 2009). An additional narrative review was performed to analyze the effects of drug therapies in patients with spondyloarthritis according new Assessment of Spondyloarthritis International Society criteria. Results The following 7 studies were included: 2 RCT, 1 cohort study, and 4 case reports, which included 117 patients with u-SpA (mostly young men). No evidence related to the effect of nonsteroidal anti-inflammatory agents or disease-modifying antirheumatic drugs on u-SpA patients was found. Infliximab and etanercept showed some benefit regarding clinical outcomes, function, and quality of life. Two RCT reported important benefit of infliximab and adalimumab also in patients with predominantly axial spondyloarthritis. Rifampicin plus doxycycline improved some clinical outcomes but ciprofloxacin had no benefit. Anecdotal positive evidence was reported with pamidronate. No serious adverse events were reported in the retrieved studies. Conclusion Low-quality evidence suggests a benefit of tumor necrosis factor α blockers in u-SpA and good-quality evidence in predominantly axial spondyloarthritis. The use of antibiotics remains controversial. High-quality trials are needed to definitively assess the effect of available drugs in these patients.