APARICIÓN TEMPRANA DEL PATRÓN DE DOLOR CRÓNICO EN PACIENTES MUSCULOESQUELÉTICOS SUBAGUDOS

The chronic pain pattern implies high levels of negative emotions, pain and perceived disability disability perceived. Up to date few studies have assessed when this chronic pain pattern appears. This study is aimed at exploring this issue. Methods: were evaluated  146 subjects with 4 weeks sick leave due to musculoskeletal diseases (MSDs) and 95 with Rheumatoid Arthritis (RA). All patients completed the following assessment instruments: the Sadness and Depression Questionnaire (CTD), Anxiety situations and responses. Inventory –Brief form- (ISRA-B), Health Assessment Questionnaire (HAQ), a visual analogy scale for intensity of pain and a likert type scale for the frequency of pain. The analyses included a comparison on the scores of the tests between patients on sick leave due to MD compared to RA patients. Descriptive and bivariate analyses were performed. Results: Patients on sick leave due to MD and RA patients reported similar perception of their disability, showing a high HAQ score mean. Patients on sick leave due to MD reported more perceived frequency and intensity of pain than RA patients. In relation to negative emotions, both groups reported similar high levels with some poorer levels for RA patients compared to patients on sick leave due to MD for cognitive, evaluation and life situations anxiety. Depression scores presented the same levels for both patients groups. Conclusions: Our study shows that patients with subacute pain/disability and chronic pain/disability report very similar pattern for negative emotions and perception of pain and disability, suggesting that these factors appear in an early stage and contributing to the transition from acute to chronic pain/disability.El patrón de dolor crónico implica altos niveles de emociones negativas, dolor y discapacidad percibida. Pocos estudios han evaluado el patrón de aparición del dolor crónico  y éste era nuestro objetivo. Método: fueron evaluados 146 participantes con 4 semanas la Baja Laboral por enfermedades musculoesqueléticas (DsMS) y 95 con artritis reumatoide (AR) mediante los siguientes instrumentos: el Cuestionario de Tristeza y Depresión (CTD), el  Inventario de Situaciones y Respuestas de Ansiedad–forma breve-. (ISRA-B), Cuestionario de Evaluación de Salud (HAQ), una escala analógica visual para la intensidad del dolor y una escala tipo Likert para la frecuencia del dolor. Los análisis (descriptivos y bivariados) incluyeron una comparación de las puntuaciones de las pruebas entre los pacientes con baja laboral por EM en comparación con los pacientes con AR.  Resultados: Los pacientes con Baja Laboral por enfermedades musculoesqueléticas y los pacientes con AR informaron de una percepción similarde su discapacidad, según el HAQ. Pacientes con Baja Laboral por enfermedades musculoesqueléticas informaron mayor frecuencia percibida y más intensidad de dolor que los pacientes con AR. En relación a las emociones negativas, ambos grupos presentaron niveles altos y similares, con algunos niveles más pobres de los pacientes con AR en comparación con Pacientes con Baja Laboral por enfermedades musculoesqueléticas para la ansiedad cognitiva, la ansiedad de evaluación y la de la vida cotidiana (en  ISRA-B). Las puntuaciones en depresión presentan los mismos niveles en ambos grupos de pacientes.Conclusión. Nuestro estudio muestra que los pacientes con dolor subagudo/discapacidad y dolor crónico/discapacidad reportan un patrón muy similar para las emociones negativas y la percepción del dolor y la discapacidad, lo que sugiere que estos factores aparecen en una etapa temprana y favorecen, por tanto, la transición de dolor agudo a crónico/discapacidad

Positive airway pressure longer than 24 h is associated with histopathological volutrauma in severe COVID-19 pneumonia—an ESGFOR based narrative case-control review

SARS-CoV-2; Post-mortem microbiology; VolutraumaSARS-CoV-2; Microbiología post mortem; VolutraumaSARS-CoV-2; Microbiologia post mortem; VolutraumaBackground and Objective: A thorough understanding of the pathogenic mechanisms elicited by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) still requires further research. Until recently, only a restricted number of autopsies have been performed, therefore limiting the accurate knowledge of the lung injury associated with SARS-CoV-2. A multidisciplinary European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group of Forensic and Post-mortem Microbiology-ESGFOR team conducted a non-systematic narrative literature review among coronavirus 2019 disease (COVID-19) pneumonia cases assessing the histopathological (HP) effects of positive airways pressure. HP lung features were recorded and compared between mechanically ventilated (>24 hours) and control (ventilation <24 hours) patients. A logistic regression analysis was performed to identify associations between mechanical ventilation (MV) and HP findings. Methods: A PubMed and MEDLINE search was conducted in order to identify studies published between March 1st 2020 and June 30th 2021. Key Content and Findings: Seventy patients (median age: 69 years) from 24 studies were analysed, among whom 38 (54.2%) underwent MV longer than 24 hours. Overall, main HP features were: diffuse alveolar damage (DAD) in 53 (75.7%), fibrosis (interstitial/intra-alveolar) in 43 (61.4%), vascular damage—including thrombosis/emboli- in 41 (58.5%), and endotheliitis in only 8 (11.4%) patients. Association of DAD, fibrosis and vascular damage was detected in 30 (42.8%) patients. Multivariate analysis, adjusted by age and gender, identified MV >24 hours as an independent variable associated with DAD (OR =5.40, 95% CI: 1.48–19.62), fibrosis (OR =3.88, 95% CI: 1.25–12.08), vascular damage (OR =5.49, 95% CI: 1.78–16.95) and association of DAD plus fibrosis plus vascular damage (OR =6.99, 95% CI: 2.04–23.97). Conclusions: We identified that patients mechanically ventilated >24 hours had a significantly higher rate of pulmonary injury on histopathology independently of age and gender. Our findings emphasize the importance of maintaining a protective ventilator strategy when subjects with COVID-19 pneumonia undergo intubation

Development and validation of a multivariate predictive model for rheumatoid arthritis mortality using a machine learning approach

We developed and independently validated a rheumatoid arthritis (RA) mortality prediction model using the machine learning method Random Survival Forests (RSF). Two independent cohorts from Madrid (Spain) were used: the Hospital Cl&iacute;nico San Carlos RA Cohort (HCSC-RAC; training; 1,461 patients), and the Hospital Universitario de La Princesa Early Arthritis Register Longitudinal study (PEARL; validation; 280 patients). Demographic and clinical-related variables collected during the first two years after disease diagnosis were used. 148 and 21 patients from HCSC-RAC and PEARL died during a median follow-up time of 4.3 and 5.0&nbsp;years, respectively. Age at diagnosis, median erythrocyte sedimentation rate, and number of hospital admissions showed the higher predictive capacity. Prediction errors in the training and validation cohorts were 0.187 and 0.233, respectively. A survival tree identified five mortality risk groups using the predicted ensemble mortality. After 1 and 7 years of follow-up, time-dependent specificity and sensitivity in the validation cohort were 0.79&ndash;0.80 and 0.43&ndash;0.48, respectively, using the cut-off value dividing the two lower risk categories. Calibration curves showed overestimation of the mortality risk in the validation cohort. In conclusion, we were able to develop a clinical prediction model for RA mortality using RSF, providing evidence for further work on external validation

Influence of Mesenchymal Stem Cell Sources on Their Regenerative Capacities on Different Surfaces

Current gold-standard strategies for bone regeneration do not achieve the optimal recovery of bone biomechanical properties. To bypass these limitations, tissue engineering techniques based on hybrid materials made up of osteoprogenitor cells—such as mesenchymal stem cells (MSCs)—and bioactive ceramic scaffolds—such as calcium phosphate-based (CaPs) bioceramics—seem promising. The biological properties of MSCs are influenced by the tissue source. This study aims to define the optimal MSC source and construct (i.e., the MSC–CaP combination) for clinical application in bone regeneration. A previous iTRAQ analysis generated the hypothesis that anatomical proximity to bone has a direct effect on MSC phenotype. MSCs were isolated from adipose tissue, bone marrow, and dental pulp, then cultured both on a plastic surface and on CaPs (hydroxyapatite and β-tricalcium phosphate), to compare their biological features. On plastic, MSCs isolated from dental pulp (DPSCs) presented the highest proliferation capacity and the greatest osteogenic potential. On both CaPs, DPSCs demonstrated the greatest capacity to colonise the bioceramics. Furthermore, the results demonstrated a trend that DPSCs had the most robust increase in ALP activity. Regarding CaPs, β-tricalcium phosphate obtained the best viability results, while hydroxyapatite had the highest ALP activity values. Therefore, we propose DPSCs as suitable MSCs for cell-based bone regeneration strategies

Prevalence of hospital PCR-confirmed COVID-19 cases in patients with chronic inflammatory and autoimmune rheumatic diseases

[Abstract] Background: The susceptibility of patients with rheumatic diseases and the risks or benefits of immunosuppressive therapies for COVID-19 are unknown. Methods: We performed a retrospective study with patients under follow-up in rheumatology departments from seven hospitals in Spain. We matched updated databases of rheumatology patients with severe acute respiratory syndrome coronavirus 2-positive PCR tests performed in the hospital to the same reference populations. Rates of PCR+ confirmed COVID-19 were compared among groups. Results: Patients with chronic inflammatory diseases had 1.32-fold higher prevalence of hospital PCR+ COVID-19 than the reference population (0.76% vs 0.58%). Patients with systemic autoimmune or immune-mediated disease (AI/IMID) showed a significant increase, whereas patients with inflammatory arthritis (IA) or systemic lupus erythematosus did not. COVID-19 cases in some but not all diagnostic groups had older ages than cases in the reference population. Patients with IA on targeted-synthetic or biological disease-modifying antirheumatic drugs (DMARDs), but not those on conventional-synthetic DMARDs, had a greater prevalence despite a similar age distribution. Conclusion: Patients with AI/IMID show a variable risk of hospital-diagnosed COVID-19. Interplay of ageing, therapies and disease-specific factors seem to contribute. These data provide a basis to improve preventive recommendations to rheumatic patients and to analyse the specific factors involved in COVID-19 susceptibility.Instituto de Salud Carlos III; RD16/0012 RETICS Progra

A predominant involvement of the triple seropositive patients and others with rheumatoid factor in the association of smoking with rheumatoid arthritis

The major environmental risk factor for rheumatoid arthritis (RA) is smoking, which according to a widely accepted model induces protein citrullination in the lungs, triggering the production of anticitrullinated protein antibodies (ACPA) and RA development. Nevertheless, some research findings do not fit this model. Therefore, we obtained six independent cohorts with 2253 RA patients for a detailed analysis of the association between smoking and RA autoantibodies. Our results showed a predominant association of smoking with the concurrent presence of the three antibodies: rheumatoid factor (RF), ACPA and anti-carbamylated protein antibodies (ACarPA) (3 Ab vs. 0 Ab: OR = 1.99, p = 2.5 × 10?8). Meta-analysis with previous data (4491 patients) confirmed the predominant association with the concurrent presence of the three antibodies (3 Ab vs. 0 Ab: OR = 2.00, p = 4.4 ×10?16) and revealed that smoking was exclusively associated with the presence of RF in patients with one or two antibodies (RF+ 1+2 vs. RF? 0+1+2: OR = 1.32, p = 0.0002). In contrast, no specific association with ACPA or ACarPA was found. Therefore, these results showed the need to understand how smoking favors the concordance of RA specific antibodies and RF triggering, perhaps involving smoking-induced epitope spreading and other hypothesized mechanisms

Incidence and clinical manifestations of giant cell arteritis in Spain: results of the ARTESER register

Objective This study aimed to estimate the incidence of giant cell arteritis (GCA) in Spain and to analyse its clinical manifestations, and distribution by age group, sex, geographical area and season.Methods We included all patients diagnosed with GCA between 1 June 2013 and 29 March 2019 at 26 hospitals of the National Health System. They had to be aged >= 50 years and have at least one positive results in an objective diagnostic test (biopsy or imaging techniques), meet 3/5 of the 1990 American College of Rheumatology classification criteria or have a clinical diagnosis based on the expert opinion of the physician in charge. We calculated incidence rate using Poisson regression and assessed the influence of age, sex, geographical area and season.Results We identified 1675 cases of GCA with a mean age at diagnosis of 76.9 +/- 8.3 years. The annual incidence was estimated at 7.42 (95% CI 6.57 to 8.27) cases of GCA per 100 000 people >= 50 years with a peak for patients aged 80-84 years (23.06 (95% CI 20.89 to 25.4)). The incidence was greater in women (10.06 (95% CI 8.7 to 11.5)) than in men (4.83 (95% CI 3.8 to 5.9)). No significant differences were found between geographical distribution and incidence throughout the year (p=0.125). The phenotypes at diagnosis were cranial in 1091 patients, extracranial in 337 patients and mixed in 170 patients.Conclusions This is the first study to estimate the incidence of GCA in Spain at a national level. We found a predominance among women and during the ninth decade of life with no clear variability according to geographical area or seasons of the year

A bibliometric study of the scientific publications on patient-reported outcomes in rheumatology

Introduction We have conducted a bibliometric study of the scientific publications on patient-reported outcomes in the field of rheumatology. Methods SCOPUS was the database used in this bibliometric study. We performed two searches. The main search involved selecting the documents published between 2000 and 2014 limited to top-tier journals addressing rheumatic and musculoskeletal diseases, using specific descriptors together with the operator and main descriptor “patient-reported outcomes” (PROs), and we performed a secondary search, with the following specific descriptors: “pain,” “functional capacity,” and “fatigue.” We used bibliometric indicators for articles distribution (Price’s law for the increase of scientific literature and Bradford’s law for dispersion of articles). We also calculated the participation index of the different countries. Results A total of 983 original articles were published between 2000 and 2014. Our results confirmed the fulfilment of Price’s law (correlation coefficient r = 0.9385 after linear adjustment). The average number of articles per Bradford Zone was 327.6. A total of 30 different journals were published. The type of growth for the descriptors “pain” (r2 = 0.5417 compared to r2 = 0.4839) and “fatigue” (r2 = 06276 compared to r2 = 0.5544) is exponential, whereas it is linear for the descriptor “functional capacity” (r2 = 0.6769 compared to r2 = 0.3779). Discussion This study revealed significant linear growth of patient-related outcomes in global terms, as well as upward trends for most of the citation-based bibliometric indices, especially significant from 2010 to 2014. Pain and fatigue have greater growth as PRO concepts

Influence of Mesenchymal Stem Cell Sources on Their Regenerative Capacities on Different Surfaces

Current gold-standard strategies for bone regeneration do not achieve the optimal recovery of bone biomechanical properties. To bypass these limitations, tissue engineering techniques based on hybrid materials made up of osteoprogenitor cells—such as mesenchymal stem cells (MSCs)—and bioactive ceramic scaffolds—such as calcium phosphate-based (CaPs) bioceramics—seem promising. The biological properties of MSCs are influenced by the tissue source. This study aims to define the optimal MSC source and construct (i.e., the MSC–CaP combination) for clinical application in bone regeneration. A previous iTRAQ analysis generated the hypothesis that anatomical proximity to bone has a direct effect on MSC phenotype. MSCs were isolated from adipose tissue, bone marrow, and dental pulp, then cultured both on a plastic surface and on CaPs (hydroxyapatite and β-tricalcium phosphate), to compare their biological features. On plastic, MSCs isolated from dental pulp (DPSCs) presented the highest proliferation capacity and the greatest osteogenic potential. On both CaPs, DPSCs demonstrated the greatest capacity to colonise the bioceramics. Furthermore, the results demonstrated a trend that DPSCs had the most robust increase in ALP activity. Regarding CaPs, β-tricalcium phosphate obtained the best viability results, while hydroxyapatite had the highest ALP activity values. Therefore, we propose DPSCs as suitable MSCs for cell-based bone regeneration strategies