The comparative responsiveness of Hospital Universitario Princesa Index and other composite indices for assessing rheumatoid arthritis activity

Objective To evaluate the responsiveness in terms of correlation of the Hospital Universitario La Princesa Index (HUPI) comparatively to the traditional composite indices used to assess disease activity in rheumatoid arthritis (RA), and to compare the performance of HUPI-based response criteria with that of the EULAR response criteria. Methods Secondary data analysis from the following studies: ACT-RAY (clinical trial), PROAR (early RA cohort) and EMECAR (pre-biologic era long term RA cohort). Responsiveness was evaluated by: 1) comparing change from baseline (Delta) of HUPI with Delta in other scores by calculating correlation coefficients; 2) calculating standardised effect sizes. The accuracy of response by HUPI and by EULAR criteria was analyzed using linear regressions in which the dependent variable was change in global assessment by physician (Delta GDA-Phy). Results Delta HUPI correlation with change in all other indices ranged from 0.387 to 0.791); HUPI's standardized effect size was larger than those from the other indices in each database used. In ACT-RAY, depending on visit, between 65 and 80% of patients were equally classified by HUPI and EULAR response criteria. However, HUPI criteria were slightly more stringent, with higher percentage of patients classified as non-responder, especially at early visits. HUPI response criteria showed a slightly higher accuracy than EULAR response criteria when using Delta GDA-Phy as gold standard. Conclusion HUPI shows good responsiveness in terms of correlation in each studied scenario (clinical trial, early RA cohort, and established RA cohort). Response criteria by HUPI seem more stringent than EULAR''s

Fractura-luxación de columna cervical tras accidente de tráfico. Presentación de un caso

En la actualidad en los servicios de urgencias hospitalarios es frecuente la atención a pacientes con sintomatología cervical tras accidente de tráfico. Aunque en la mayoría de los casos las lesiones son leves no por ello debemos descuidar su atención tanto en el nivel extrahospitalario como en el hospitalario. En el presente trabajo describimos el caso de una paciente, mujer de 48 años de edad, que tras sufrir un accidente de tráfico con vuelco del vehículo refería dolor a nivel de columna cervical. A la exploración objetivamos paresia de extremidad superior izquierda y parestesias en extremidad superior derecha. La Tomografía Axial Computadorizada cervical de urgencias, ante la imposibilidad de la completa visualización de la columna cervical en la radiología simple, nos confirmó el diagnóstico de fractura-luxación de la columna cervical en el nivel C7-D1