Tolerancia, sobrevida y adherencia al tratamiento con Metotrexato en pacientes con artritis reumatoidea

Introducción: Metotrexato (MTX) es la medicación más utilizada en pacientes con Artritis Reumatoidea (AR). Sin embargo, varios autores han cuestionado su éxito debido a la frecuente presencia de eventos adversos y la consiguiente falta de adherencia al tratamiento. Objetivos: determinar la sobrevida al tratamiento con MTX, eventos adversos y causas de discontinuación en pacientes con AR. Material y métodos: se incluyeron pacientes ≥18 años de edad con diagnóstico de AR (criterios ACR/EULAR 2010), en forma consecutiva, que hubiesen iniciado en algún momento tratamiento con MTX. Se consignaron datos sociodemográficos, clínicos y terapéuticos. Se determinó fecha de inicio y suspensión de MTX, forma de administración, tratamientos concomitantes, consumo de café y tabaco, como también presencia de eventos adversos (EA). La adherencia se evaluó utilizando el cuestionario Compliance Questionnaire Rheumatology de 5 ítems (CQR5). Análisis estadístico: estadística descriptiva. Test Chi2 o test exacto de Fisher. Sobrevida del tratamiento por Kaplan-Meier y log Rank. Regresión logística múltiple. Una p <0,05 se consideró significativa

Preferencias del tratamiento en pacientes con Espondiloartritis axial

Introducción: una de las premisas del Treat to Target (T2T) es la decisión conjunta del tratamiento entre el reumatólogo y el paciente. Por esta razón las preferencias del paciente juegan un rol fundamental en el éxito del tratamiento a corto y largo plazo. El objetivo de este estudio fue evaluar las preferencias de tratamiento de los pacientes con Espondiloartritis axial (EsPax) e identificar factores asociados a su elección

Prevalencia y características de uveítis como manifestación extraarticular en Espondiloartritis Axial

Introducción: la Uveítis Anterior Aguda (UAA) es la manifestación extraarticular más frecuente en la Espondiloartritis axial (EsPax), con una prevalencia global de 32,7%. El objetivo de este estudio fue determinar la prevalencia de UAA en una cohorte Argentina de pacientes con EsPax, describir sus características clínicas, frecuencia de episodios, respuesta al tratamiento y pronóstico a largo plazo, así como su asociación con características generales de la enfermedad

Peripheral arthritis and higher disease activity lead to more functional impairment in axial spondyloarthritis: Longitudinal analysis from ESPAXIA

Objetive: The aim of this study was to investigate whether peripheral arthritis together with disease activity independently contribute to functional impairment over time in patients with axSpA and to evaluate if there are contextual factors modifying this relationship.Material and methods: Patients with axial spondyloarthritis from the ESPAXIA cohort were followed-up annually over a mean of 3.7 years. Physical function was assessed by the self-reported questionnaire BASFI, disease activity by ASDAS and peripheral arthritis was also recorded. Generalized estimating equations (GEE) were used to investigate longitudinal association between peripheral arthritis, ASDAS and BASFI as the outcome. Autoregressive models (adjusted for BASFI 1 year earlier) were run to allow for a truly longitudinal interpretation. Interactions between each of ASDAS and peripheral arthritis with contextual factors (age, gender, educational level, smoking, job type) were tested.Results: 185 patients (77 % male, mean (SD) age 42 (13) years old and mean disease duration (SD) of 9.4 (9.6) years) were included. ASDAS and peripheral arthritis independently contributed to explaning BASFI over time. Contextual factors did not modify either of the relationships. A true longitudinal relation was proven with the autoregressive GEE model, showing that, adjusted for age, gender, spinal mobility and use of NSAIDs, an increase of one ASDAS unit led to a BASFI 0.48 units higher (ss 0.48 [95%CI 0.39, 0.57]), and the presence of peripheral arthritis, to a BASFI 0.44 units higher (ss 0.44 [95%CI 0.08, 0.8]). Conclusion: Peripheral arthritis and higher disease activity independently lead to more functional impairment in axSpA over time. Contextual factors do not modify these relationships.(c) 2021 Elsevier Inc. All rights reserved.Pathophysiology and treatment of rheumatic disease

Treating spondyloarthritis early: does it matter? Results from a systematic literature review

Objective To summarize evidence on the relationship between early treatment (definition based on symptom/disease duration or radiographic damage) and treatment clinical response in patients with SpA. Methods A systematic literature review was conducted in studies on SpA patients treated with NSAIDs or biological/targeted synthetic DMARDs addressing the impact of symptom/disease duration or presence of radiographic damage on treatment response assessed by any disease activity outcome. For categorical outcomes, relative risk, relative risk ratio and number needed to treat were calculated, and for continuous outcomes, differences in differences, to compare groups stratified based on symptom/disease duration or the presence of radiographic damage. Results From the 8769 articles retrieved, 25 were included and 2 added by hand-search, all in axial SpA (axSpA), most of them with low risk of bias. Twenty-one studies compared groups based on symptom duration (n = 6) or disease duration (n = 15) and seven studies based on absence/presence of radiographic damage (two studies used two comparisons). When early axSpA was defined by symptom duration (<5 years) in randomized controlled trials, early treatment was associated with better outcomes in patients with non-radiographic axSpA [n = 2, ASAS40 relative risk ratio 5.24 (95% CI 1.12, 24.41) and 1.52 (0.60, 3.87)] but not in radiographic axSpA (n = 1) [ASAS20 0.96 (0.53-1.73)]. When early axSpA was defined based on disease duration or radiographic damage, no differences were found between groups. Conclusion Evidence towards better outcomes in early axSpA is very limited and restricted to non-radiographic axSpA and <5 years symptom duration. When early axSpA is defined based on disease duration or radiographic damage, no differences in response to treatment are found.Pathophysiology and treatment of rheumatic disease

ASAS CONSENSUS DEFINITION OF EARLY AXIAL SPONDYLOARTHRITIS

Navarro-Compán V, Benavent D, Capelusnik D, et al. ASAS CONSENSUS DEFINITION OF EARLY AXIAL SPONDYLOARTHRITIS. Annals of the Rheumatic Diseases. 2023;82(Suppl. 1):35-36