Factores psicosociales diferenciales de género en la artritis reumatoide: su influencia en el pronóstico de la enfermedad

RESUMEN: Estudio trasversal comparativo entre dos grupos de pacientes homogéneos de mujeres y hombres con Artritis Reumatoide, intentando abarcar todos los aspectos relacionados con dicha enfermedad, los puramente biológicos, demográficos, manejo de la enfermedad, comorbilidades y diversos factores psicosociales para evaluar si existen diferencias pronósticas medidas en calidad de vida y discapacidad entre ambos géneros y cuáles de esos factores si los hubiere se asocian a dichas diferencias. En nuestro estudio, no hemos encontrado diferencias a nivel biológico, pero si en ciertos factores demográficos como diferencias significativas en la jubilación precoz de los hombres y mayor realización de tareas domésticas en las mujeres, también en el perfil de comorbilidades entre ambos grupos, así como una menor calidad de vida en las mujeres y mayor discapacidad posiblemente asociada a la depresión y osteoporosis mayor en este grupo y quizá un afrontamiento peor de la enfermedad de las mismas respecto a los hombres.ABSTRACT: This is a cross sectional study between two homogeneous groups of male and female Rheumatoid Arthritis patients, trying to comprise all the different aspects related to this disease, pure biological factors, demographical ones, treatments, comorbidities, and other psychological issues to evaluate if there are gender differences in the quality of life or disability between both groups and which factors are the cause of these differences. In our study, we have not found any differences in the biological aspects of the disease but we have found differences in various demographical data and a different comorbid profile between them and a worse quality of life and more disability in the female group maybe associated to the depression or osteoporosis more prevalent in this group and maybe a worse illness behaviour in this group with respect to the male patient group

TNF inhibitors exert a "hidden" beneficial effect in the cardiovascular lipoprotein profile of RA patients

Purpose: A high cardiovascular risk has been described in patients with rheumatoid arthritis (RA); the effects of different biological agents have also been described in these patients. The aim of the present study is to examine the effects of tumor necrosis factor inhibitors (TNFi) in the lipoprotein profile of RA patients using a broad laboratory assessment including a large number of non-routine tests. Patients and Methods: RA patients treated with and without TNFi (70 patients in each group) were cross-sectionally compared regarding a broad spectrum of lipoprotein parameters including serum levels of total and HDL, LDL and VLDL cholesterol triglycerides, lipoprotein A (LpA), apolipoprotein A1 (Apo A), B100 (Apo B) and paroxonase. For each lipoprotein subfraction (HDL, LDL and VLDL), we assess specific concentrations of cholesterol, triglycerides, phospholipids and proteins and total mass of each one. Additionally, HDL Apo A, LDL and VLDL Apo B concentrations and number of particles of LDL and VLDL were also determined. Exploratory univariate and multivariate analyses of the different variables were performed. Results: Seventy patients in each subset were enrolled. Patients on treatment with TNFi showed a trend to be younger and to have a longer disease duration. Regarding the lipoprotein analyses, borderline significant higher levels of serum Apo A were detected and an independent association with lower HDL mass, LDL triglyceride, VLDL cholesterol, VLDL Apo B, VLDL mass, number of VLDL cholesterol molecules and number of particles of VLDL was clearly observed. Conclusion: TNFi treatment was associated with beneficial atherogenic effects at the lipoprotein level especially centered in the VLDL-related parameters consistent with a reduction of the atherogenic risk.Funding: This study was carried out with the support of Instituto de Salud Carlos III (ISCIII) (grant number PI0810119)

Anti-IL6-Receptor Tocilizumab in Refractory and Noninfectious Uveitic Cystoid Macular Edema: Multicenter Study of 25 Patients

PURPOSE: Cystoid macular edema (CME) is a leading cause of blindness. This study assessed the efficacy and safety of tocilizumab (TCZ) in refractory CME. DESIGN: Retrospective case series. METHODS: Patients with CME secondary to noninfectious uveitis who had inadequate response to corticosteroids and at least 1 conventional immunosuppressive drug, and in most cases to other biological agents, were studied. CME was defined as central retinal thickness greater than 300 ?m. The primary outcome measure was macular thickness. Intraocular inflammation, best-corrected visual acuity (BCVA), and corticosteroid-sparing effect were also analyzed. RESULTS: A total of 25 patients (mean ± standard deviation age 33.6 ± 18.9 years; 17 women) with CME were assessed. Underlying diseases associated with uveitis-related CME are juvenile idiopathic arthritis (n = 9), Behçet disease (n = 7), birdshot retinochoroidopathy (n = 4), idiopathic (n = 4), and sarcoidosis (n = 1). The ocular patterns were panuveitis (n = 9), anterior uveitis (n = 7), posterior uveitis (n = 5), and intermediate uveitis (n = 4). Most patients had CME in both eyes (n = 24). TCZ was used in monotherapy (n = 11) or combined with conventional immunosuppressive drugs. Regardless of the underlying disease, compared to baseline, a statistically significant improvement in macular thickness (415.7 ± 177.2 vs 259.1 ± 499.5 ?m; P = .00009) and BCVA (0.39 ± 0.31 vs 0.54 ± 0.33; P = .0002) was obtained, allowing us to reduce the daily dose of prednisone (15.9 ± 13.6 mg/day vs 3.1 ± 2.3 mg/day; P = .002) after 12 months of therapy. Remission was achieved in 14 patients. Only minor side effects were observed after a mean follow-up of 12.7 ± 8.34 months. CONCLUSION: Macular thickness is reduced following administration of TCZ in refractory uveitis-related CME.Funding/Support: The study was partially supported by RETICS Programs, 3 RD08/0075 (RIER) and RD12/0009/0013 from ‘‘Instituto de Salud Carlos III’’ 4 (ISCIII) (Spain)