RESUMO
Psoriatic arthritis (PsA) is the second most common chronic inflammatory joint disease. Ankylosing spondylitis (AS) is another less common but equally chronic and disabling spondyloarthritis (SpA). Therapeutic agents for the treatment of these diseases have been somewhat lacking as compared with those available for rheumatoid arthritis, which represents a significant challenge for both the treating physician and the pharmaceutical industry. A promising development for our understanding of the physiopathology of PsA and AS involves new targets to interrupt IL-17 and IL-12/IL-23 pathways. Up to 30-40 % of SpA patients have inadequate or poor response, or are intolerant to anti-TNF therapies. Therefore, there has been a clear unmet medical need in an important group of these patients. As a result, new therapeutic targets have emerged for the treatment of both axial and peripheral SpA. Interleukin 17 (IL-17) is a pro-inflammatory cytokine that is increased in psoriatic lesions as well as in the synovial fluid of patients with PsA and in sites of enthesitis in SpA. IL-23 has been shown to play an important role in the polarization of CD4+ T-cells to become IL-17 producers. Based on these evidences, blockade of the cytokine IL-17 or its receptors was considered to have therapeutic implications for the treatment of psoriasis, as well as PsA and AS.This article presents a thorough review of an IL-17 A blocking agent, its mechanism of action, its clinical efficacy and its therapeutic safety.
Assuntos
Anticorpos Monoclonais/uso terapêutico , Antirreumáticos/uso terapêutico , Espondilartrite/tratamento farmacológico , Anticorpos Monoclonais Humanizados , Artrite Psoriásica/tratamento farmacológico , Humanos , Interleucina-17/antagonistas & inibidores , Espondilite Anquilosante/tratamento farmacológico , Resultado do TratamentoRESUMO
Musculoskeletal symptoms are the most frequent extra-intestinal manifestations of inflammatory bowel disease (IBD), ranging between 10 and 40 % of cases. Pathogenesis is still unclear, although several factors have been associated (genetic, environmental, and immunologic pathways). Rheumatic manifestations in IBD patients are heterogeneous, including axial and peripheral involvement, dactylitis, enthesitis, uveitis, as well as skin involvement. Currently, magnetic resonance imaging and ultrasonography are important tools for detecting early pathological changes in IBD patients with suspected rheumatic disease. New advances into the genetics and pathophysiology have provided more effective and targeted therapy for IBD patients with rheumatic manifestations. Given the high prevalence, awareness of the musculoskeletal symptoms is essential to avoid a misdiagnosis. Finally, an interdisciplinary approach of IBD patients, including rheumatologist and gastroenterologist, will improve the quality of life these patients.
Assuntos
Doenças Inflamatórias Intestinais/complicações , Doenças Reumáticas/etiologia , HumanosRESUMO
Introducción: Al igual que en otras enfermedades crónicas, la adherencia al régimen terapéutico de los pacientes con artritis reumatoidea (AR) es baja (entre 30 y 80%), dependiendo de la definición de adherencia y de la metodología empleada para medirla. En este estudio se propone determinar el nivel de adherencia al tratamiento en pacientes con AR que reciben DMAR biológicas e identificar factores asociados a la falta de cumplimiento a la terapia. Material y métodos: Se realizó un estudio analítico, observacional de corte transversal en donde se incluyeron pacientes consecutivos con AR según criterios de clasificación (ACR87) que se encontraban recibiendo fármacos biológicos para el tratamiento de su enfermedad en los últimos seis meses y que asistieron a la consulta ambulatoria. Para la valoración de la adherencia a DMAR se utilizaron los cuestionarios CQR (Compliance Questionnaire on Rheumatology) y el cuestionario SMAQ (Simplified Medication Adherence Questionnaire). Resultados: Se encuestaron 345 pacientes. Mediante el cuestionario SMAQ se observó una adherencia del 50% (159 pacientes). El Cuestionario CQR tuvo un puntaje mediano de 78 puntos (RIC 67-86). El 47% (147 pacientes) fueron adherentes (CQR >80). Sobre los pacientes incluidos, 151 (48%) refirieron no haber tenido ningún retraso, pérdida o adelanto de la dosis del biológico en los últimos 6 meses de tratamiento. El 52% no adherentes tuvo como causas: 146 (46%) pérdida de al menos una dosis del biológico con una mediana de dosis perdidas de 2 (RIQ: 1-3); 117 (37%) tuvo al menos un retraso en las dosis del biológico y 8 (2%) delantó la dosis. Los factores asociados al no cumplimiento de la terapia biológica fueron el tipo de cobertura médica, que el paciente no haya notado mejoría y la esperanza de una rápida respuesta al tratamiento, y la falta de adherencia a DMAR
Introduction: As in other chronic diseases, adherence to the therapeutic regimen of patients with rheumatoid arthritis (RA) is low (between 30 and 80%), depending on the definition of adherence and the methodology used to measure it. This study aims to determine the level of adherence to treatment in patients with RA who receive biological DMARs and to identify factors associated with non-compliance with therapy. MATERIAL AND METHODS: An observational, cross-sectional, observational study was performed in which consecutive patients with RA according to classification criteria (ACR'87) who were receiving biological drugs for the treatment of their disease in the last six months were included Attended the outpatient appointment. The CQR (Compliance Questionnaire on Rheumatology) and SMAQ (Simplified Medication Adherence Questionnaire) questionnaires were used to assess adherence to DMAR. Results: A total of 345 patients were surveyed. A 50% adherence (159 patients) was observed through the SMAQ questionnaire. The CQR Questionnaire had a median score of 78 points (RIC 67-86). 47% (147 patients) were adherent (CQR> 80). Regarding the patients included, 151 (48%) reported not having had any delay, loss or advancement of the biological dose in the last 6 months of treatment. The 52% of non-adherents had as causes: 146 (46%) loss of at least one dose of the biological with a median of doses lost of 2 (RIQ: 1-3); 117 (37%) had at least one biological dose delay and 8 (2%) delayed the dose. Factors associated with non-compliance with biological therapy were the type of medical coverage, the patient's perceived improvement and the expectation of a rapid response to treatment, and lack of adherence to DMAR.
Assuntos
Artrite Reumatoide , Tratamento BiológicoRESUMO
This study aimed to develop a simplified version of the Ankylosing Spondylitis Disease Activity Score (ASDAS). The study included consecutive patients with ankylosing spondylitis according to modified New York and/or Assessment in Ankylosing Spondylitis 2009 criteria. Sociodemographic data and characteristics of the disease (Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), and Ankylosing Spondylitis Quality of Life (ASQoL)) and erythrocyte sedimentation rate (ESR) were collected. ASDAS simplified version (SASDAS) was calculated as the simple linear sum of the five components of ASDAS which include: patient global assessment using visual analogue scale, back pain (BASDAI question no. 2), peripheral pain and swelling (BASDAI question no. 3), morning stiffness (BASDAI question no. 6), and ESR in millimeters per hour, divided by 10 so as to make it equivalent to the other scale's components. Eighty-six patients were included: 69 (80.2 %) were men with a median age of 46 years and median disease duration of 19 years. SASDAS showed an excellent correlation with the ASDAS (r = 0.93). SASDAS also showed a good correlation with night pain (r = 0.60), global pain (r = 0.69), ASQoL (r = 0.70), BASFI (r = 0.75), and BASDAI (r = 0.96). Using ASDAS cut-off values previously suggested, the corresponding cut-off values for SASDAS were as follows: from 0 to 7.8 (inactive disease), from 7.9 to 13.8 (moderate disease activity), from 13.9 to 27.6 (high disease activity), and above 27.6 (very high disease activity) with optimum sensitivity and specificity. SASDAS showed an excellent correlation with conventional clinical measures of disease activity, and it can be easily calculated and is simple to use in daily clinical practice.
Assuntos
Espondilite Anquilosante/diagnóstico , Espondilite Anquilosante/fisiopatologia , Adolescente , Adulto , Sedimentação Sanguínea , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Psicometria/métodos , Qualidade de Vida , Reumatologia/métodos , Reumatologia/normas , Índice de Gravidade de Doença , Inquéritos e QuestionáriosRESUMO
Objetivos: Determinar la prevalencia de factores de riesgo y enfermedad cardiovascular en pacientes con EA, estimar el riesgo cardiovascular a 10 años a través del score de Framingham/ATPIII y evaluar la asociación entre actividad inflamatoria de la enfermedad y el riesgo de un evento cardiovascular. Métodos: Se incluyeron pacientes consecutivos con diagnóstico de EA según criterios de New York modificados. Se consignaron datos sobre factores de riesgo cardiovascular, evaluación clinimétrica, índice de actividad medida por BASDAI y tratamiento farmacológico. Se utilizó el score de Framingham/ATPIII para estimar el riesgo cardiovascular a 10 años. Resultados: Se evaluaron 44 pacientes con EA y 44 controles, con una edad mediana de 38,5 años, 86,4% varones. Los pacientes tuvieron una mediana de índice de BASDAI de 3,8 (RIC 2,10-5,81). La frecuencia de factores de riesgo cardiovascular y marcadores de inflamación fue similar en ambos grupos. La enfermedad cardiovascular fue más frecuente en el grupo con EA (13,6% vs. 2,3%, p= 0,11). No hubo diferencia en el riesgo cardiovascular estimado a 10 años entre pacientes y controles. La actividad de la enfermedad no se asoció con mayor riesgo cardiovascular. Conclusión: Los pacientes con EA tienen mayor frecuencia de enfermedad cardiovascular y su riesgo puede estar asociado con factores diferentes a los observados en la población general.
Objectives: To estimate the prevalence of cardiovascular risk factorsand cardiovascular disease in patients with AS; to determine the 10 yearcardiovascular risk by Framingham/ATPIII score, and to establish an associationbetween disease activity and increased cardiovascular risk.Methods: Consecutive patients with AS diagnosed by the modifiedNew York classification criteria were included. Data about cardiovascularrisk factors, clinimetry, BASDAI activity score and pharmacologicaltreatment were registered.Results: 44 patients and 44 controls were included, with a medianage of 38.5 years, 86.4% were men. BASDAI score was 3.85 (IQR0-8). Patients and controls had similar frequency of cardiovascularrisk factors and inflammatory markers. Cardiovascular disease wasmore frequent in AS patients (13.6% vs. 2.3%, p = 0.11). No differencewas found in the estimated cardiovascular risk at 10 yearsbetween patients and controls. Disease activity did not associate withan increased cardiovascular risk.Conclusion: Patients with AS have more cardiovascular disease andthe risk may be associated with factors different than those observedin the general population.
Assuntos
Doenças Cardiovasculares , Espondilite AnquilosanteRESUMO
Objetivos: Determinar la prevalencia de factores de riesgo y enfermedad cardiovascular en pacientes con EA, estimar el riesgo cardiovascular a 10 años a través del score de Framingham/ATPIII y evaluar la asociación entre actividad inflamatoria de la enfermedad y el riesgo de un evento cardiovascular. Métodos: Se incluyeron pacientes consecutivos con diagnóstico de EA según criterios de New York modificados. Se consignaron datos sobre factores de riesgo cardiovascular, evaluación clinimétrica, índice de actividad medida por BASDAI y tratamiento farmacológico. Se utilizó el score de Framingham/ATPIII para estimar el riesgo cardiovascular a 10 años. Resultados: Se evaluaron 44 pacientes con EA y 44 controles, con una edad mediana de 38,5 años, 86,4% varones. Los pacientes tuvieron una mediana de índice de BASDAI de 3,8 (RIC 2,10-5,81). La frecuencia de factores de riesgo cardiovascular y marcadores de inflamación fue similar en ambos grupos. La enfermedad cardiovascular fue más frecuente en el grupo con EA (13,6% vs. 2,3%, p= 0,11). No hubo diferencia en el riesgo cardiovascular estimado a 10 años entre pacientes y controles. La actividad de la enfermedad no se asoció con mayor riesgo cardiovascular. Conclusión: Los pacientes con EA tienen mayor frecuencia de enfermedad cardiovascular y su riesgo puede estar asociado con factores diferentes a los observados en la población general.(AU)
Objectives: To estimate the prevalence of cardiovascular risk factorsand cardiovascular disease in patients with AS; to determine the 10 yearcardiovascular risk by Framingham/ATPIII score, and to establish an associationbetween disease activity and increased cardiovascular risk.Methods: Consecutive patients with AS diagnosed by the modifiedNew York classification criteria were included. Data about cardiovascularrisk factors, clinimetry, BASDAI activity score and pharmacologicaltreatment were registered.Results: 44 patients and 44 controls were included, with a medianage of 38.5 years, 86.4% were men. BASDAI score was 3.85 (IQR0-8). Patients and controls had similar frequency of cardiovascularrisk factors and inflammatory markers. Cardiovascular disease wasmore frequent in AS patients (13.6% vs. 2.3%, p = 0.11). No differencewas found in the estimated cardiovascular risk at 10 yearsbetween patients and controls. Disease activity did not associate withan increased cardiovascular risk.Conclusion: Patients with AS have more cardiovascular disease andthe risk may be associated with factors different than those observedin the general population.(AU)
Assuntos
Espondilite Anquilosante , Doenças CardiovascularesRESUMO
OBJECTIVE: To describe differential characteristics of axial involvement in ankylosing spondylitis (AS) as compared with that seen in psoriatic arthritis (PsA) and inflammatory bowel disease (IBD) in a cohort of Ibero-American patients. METHODS: This study included 2044 consecutive patients with spondyloarthritis (SpA; ESSG criteria). Demographic, clinical, disease activity, functional ability, quality of life, work status, radiologic, and therapeutic data were evaluated and collected by RESPONDIA members from different Ibero-American countries between June and December 2006. Patients selected for analysis met modified New York criteria (mNY) for AS. RESULTS: A total of 1264 patients met the New York criteria for AS: 1072 had primary AS, 147 had psoriatic, and 45 had IBD-associated spondylitis. Median disease duration was comparable among the 3 patient groups. Patients with primary AS were significantly younger (p = 0.01) and presented a higher frequency of males (p = 0.01) than the other 2 groups. Axial manifestations such as inflammatory back pain and sacroiliac pain were significantly more frequent in patients with primary AS (p = 0.05) versus other groups, whereas frequency of dactylitis, enthesitis, and peripheral arthritis was more common in patients with psoriatic spondylitis (p = 0.05). Spinal mobility was significantly more limited in patients with primary AS versus the other 2 groups (p = 0.0001). Radiologic changes according to BASRI total score were equally significant in primary AS. Disease activity (BASDAI), functional ability (BASFI), and quality of life (ASQoL) scores were comparable in the 3 groups. CONCLUSION: Patients with primary AS had more severe axial involvement than those with spondylitis associated with psoriasis or IBD. Functional capacity, disease activity, and quality of life were comparable among the groups studied.
Assuntos
Artrite Psoriásica/complicações , Artrite Psoriásica/fisiopatologia , Doenças Inflamatórias Intestinais/complicações , Doenças Inflamatórias Intestinais/fisiopatologia , Espondilartrite/etiologia , Espondilartrite/fisiopatologia , Espondilite Anquilosante/fisiopatologia , Adulto , Artrite Psoriásica/patologia , Estudos Transversais , Bases de Dados Factuais , Feminino , Humanos , Doenças Inflamatórias Intestinais/patologia , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Espondilartrite/patologia , Espondilite Anquilosante/patologia , Inquéritos e QuestionáriosRESUMO
INTRODUCTION: Spondyloarthritis (SpA) includes a group of diseases that share immunogenetic, clinical and radiologic findings, with a particular involvement of the axial skeleton and the entheses. METHODS: SpA patients attending ambulatory care in 11 rheumatology services located in 6 Argentine provinces were included in a prospective, observational multicentre cohort of SpA in Argentina (Iberoamerican Spondyloarthritis Registry [RESPONDIA]). Data collected were transmitted online and stored in the Spanish spondyloarthritis registry (REGISPONSER) Web site. Sociodemographic, clinical features and diagnosis, disease activity, functional status, quality of life, work status, radiographic changes and treatment data were collected by means of validated tools. RESULTS: A total of 402 patients were included; 59% were male, with median age of 48.3 years and median disease duration of 8 years; 68.7% of patients belonged to middle and lower-middle social classes. Eighty-six patients were diagnosed with ankylosing spondylitis (AS), 242 with psoriatic arthritis, 25 with reactive arthritis, 10 with SpA associated with inflammatory bowel disease, 33 with undifferentiated SpA and 6 with juvenile AS. The median score was 2.6 for the Bath AS Functional Index, 3.8 for the Bath AS Disease Activity Index and 5 for the Bath AS Radiology Index. The lower social class patients achieved a worse Bath AS Functional Index than other social classes and a worse Bath AS Disease Activity Index, compared with upper-middle class. CONCLUSIONS: The sociodemographic distribution pattern observed in these SpA patients was similar to that expected in the general population of Argentina, with worse functional capacity and higher disease activity observed in the lower social classes.
Assuntos
Espondilartrite/epidemiologia , Adulto , Argentina/epidemiologia , Artrite Psoriásica/epidemiologia , Artrite Reativa/epidemiologia , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Sistema de Registros , Fatores Socioeconômicos , Espondilite Anquilosante/epidemiologiaRESUMO
OBJECTIVE: The aim of the present study is to describe the general characteristics of a cohort of patients with early arthritis in Argentina. METHODS: CONAART (Consorcio Argentino de Artritis Temprana--Argentine Consortium for Early Arthritis) is an initiative of seven rheumatology centres across Argentina. Patients were included if they had at least one or more swollen joints and <2 years of disease duration. Social, demographic, familiar, hereditary, clinical and laboratory data were recollected. At first visit and every year, X-rays of hands and feet were performed and working characteristics and pharmaco-economic data were re-collected. RESULTS: A total of 413 patients were included. Of them, 327 (79.2%) were women with a median age of 49 years and a median disease duration of 6 months. Of the total, 183 (44.3%) had RA (ACR 1987) and 167 (40.4%) undifferentiated arthritis (UA). Other diagnoses included: 12 crystalics, 11 PsA, 6 uSpA, 6 other CTD, 1 AS and 27 other diagnosis. As 85% of our population had RA and UA, we only compared these two groups of patients. Patients with RA had significantly worse activity parameters of the disease (DAS of 28 joints), functional capacity (HAQ) and quality of life (Rheumatoid Arthritis Quality of Life) than patients with UA. The frequency of RF and anti-CCP, and symmetrical distribution were also significantly higher in patients with RA compared with UA patients. All patients with RA initiated early specific treatment, in a period no longer than 6 months from the beginning of the disease. CONCLUSION: Early arthritis clinics are a useful tool to identify and treat patients with different forms of joint involvement.
Assuntos
Artrite/fisiopatologia , Reumatologia/educação , Índice de Gravidade de Doença , Adulto , Argentina , Estudos de Coortes , Avaliação da Deficiência , Educação Médica Continuada , Feminino , Humanos , Articulações , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Fatores de TempoRESUMO
Introducción: El RAPID3 es un índice de actividad que incluye tres medidasauto-reportadas por el paciente: la función física, el dolor y la evaluación global de la enfermedad por el paciente. Objetivos: Validar el cuestionario RAPID3 en pacientes con AR temprana y establecida, evaluar su correlación con otros índices de actividad y medidas de evaluación y determinar el tiempo en completar y calcular el cuestionario.Métodos: Se incluyeron pacientes con diagnóstico de AR temprana (<2 años de evolución) y establecida. Todos los pacientes completaron HAQ-A, RAPID3 y RAQoL. Se determinó evaluación global de la enfermedad por el paciente y el médico por EVA. Se midió ERS el día de la visita. Se calculó DAS28, CDAI e IAS. Se cronometró el tiempo en completar y calcular el cuestionario. Resultados: Se evaluaron 112 pacientes. RAPID3 presentó un buena correlación con DAS28 (r=0,60), CDAI (r=0,60) e IAS (r=0,62) y una muy buena correlación con HAQ-A (r=0,83) y RAQoL (r=0,75). La mediana en completar el cuestionario fue de 139 segundos y la mediana en calcularlo fue de 11 segundos. Discusión: RAPID3 es un cuestionario válido, sencillo, fácil de completar y de rápido cálculo. Presentó una buena correlación con otros índices de actividad como así también con HAQ-A y RAQoL.