Validation of UVEDAI: An Index for Evaluating the Level of Inflammatory Activity in Uveitis

Introduction Uveitis is the inflammation of the middle layer of the eye, the uvea, and is a major cause of blindness. None of the instruments used in clinical practice are, in themselves, sufficient to evaluate the course of uveitis. Therefore, it is necessary to develop instruments enabling standardized measurement of inflammatory activity. We developed a composite disease activity index for patients with uveitis known as UVEDAI, which considers the overall activity of the eye. The objective of this study was to validate the composite index of ocular inflammation, UVEDAI. Methods A multicenter cross-sectional study involving eight Spanish tertiary hospitals. Sixty-two patients aged ≥ 18 years with acute uveitis were recruited. Participants gave informed consent before participating in the study. A full ophthalmological examination was performed by two ophthalmologists to determine inflammatory activity: one used the UVEDAI score and the other used clinical judgment. The ophthalmologists did not share their findings with each other to avoid introducing bias into the analysis. Construct validity was established by means of factor analysis. The criterion validity of the index was determined using an ordinal multivariate regression model, in which the dependent variable was the degree of uveal inflammation (mild, moderate, or high/severe). Cut-off points were determined for the UVEDAI and for the receiver operating characteristic (ROC) curves. Results Sixty-two patients were included. Total variance with the three components accounted for 80.32% of the construct validity. Each of the three components identified one type of eye involvement. The discriminatory capacity of UVEDAI was 0.867 (95% CI 0.778; 0.955 p < 0.001) for mild versus moderate–high and 0.946 (95% CI 0.879; 1.000 p < 0.001) for high versus mild–moderate. Conclusions The variables included in UVEDAI enable ocular inflammatory activity to be described with a high degree of accuracy. The index may be used to evaluate and classify this activity with considerable discriminatory power.We would like to acknowledge the support of Abbvie: this study was conducted with an unrestricted grant from Abbvie. The Spanish Society of Rheumatology is the sponser and funder of this study and the journal's Rapid Service Fee, and has participated in the study design; in the analysis, and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication. The corresponding author had full access to all study data and had final responsibility for the decision to submit the manuscript for publication

Development of an activity disease score in patients with uveitis (UVEDAI)

To develop a disease activity index for patients with uveitis (UVEDAI) encompassing the relevant domains of disease activity considered important among experts in this field. The steps for designing UVEDAI were: (a) Defining the construct and establishing the domains through a formal judgment of experts, (b) A two-round Delphi study with a panel of 15 experts to determine the relevant items, (c) Selection of items: A logistic regression model was developed that set ocular inflammatory activity as the dependent variable. The construct "uveitis inflammatory activity" was defined as any intraocular inflammation that included external structures (cornea) in addition to uvea. Seven domains and 15 items were identified: best-corrected visual acuity, inflammation of the anterior chamber (anterior chamber cells, hypopyon, the presence of fibrin, active posterior keratic precipitates and iris nodules), intraocular pressure, inflammation of the vitreous cavity (vitreous haze, snowballs and snowbanks), central macular edema, inflammation of the posterior pole (the presence and number of choroidal/retinal lesions, vascular inflammation and papillitis), and global assessment from both (patient and physician). From all the variables studied in the multivariate model, anterior chamber cell grade, vitreous haze, central macular edema, inflammatory vessel sheathing, papillitis, choroidal/retinal lesions and patient evaluation were included in UVEDAI. UVEDAI is an index designed to assess the global ocular inflammatory activity in patients with uveitis. It might prove worthwhile to motorize the activity of this extraarticular manifestation of some rheumatic diseases

RICORS2040 : The need for collaborative research in chronic kidney disease

Chronic kidney disease (CKD) is a silent and poorly known killer. The current concept of CKD is relatively young and uptake by the public, physicians and health authorities is not widespread. Physicians still confuse CKD with chronic kidney insufficiency or failure. For the wider public and health authorities, CKD evokes kidney replacement therapy (KRT). In Spain, the prevalence of KRT is 0.13%. Thus health authorities may consider CKD a non-issue: very few persons eventually need KRT and, for those in whom kidneys fail, the problem is 'solved' by dialysis or kidney transplantation. However, KRT is the tip of the iceberg in the burden of CKD. The main burden of CKD is accelerated ageing and premature death. The cut-off points for kidney function and kidney damage indexes that define CKD also mark an increased risk for all-cause premature death. CKD is the most prevalent risk factor for lethal coronavirus disease 2019 (COVID-19) and the factor that most increases the risk of death in COVID-19, after old age. Men and women undergoing KRT still have an annual mortality that is 10- to 100-fold higher than similar-age peers, and life expectancy is shortened by ~40 years for young persons on dialysis and by 15 years for young persons with a functioning kidney graft. CKD is expected to become the fifth greatest global cause of death by 2040 and the second greatest cause of death in Spain before the end of the century, a time when one in four Spaniards will have CKD. However, by 2022, CKD will become the only top-15 global predicted cause of death that is not supported by a dedicated well-funded Centres for Biomedical Research (CIBER) network structure in Spain. Realizing the underestimation of the CKD burden of disease by health authorities, the Decade of the Kidney initiative for 2020-2030 was launched by the American Association of Kidney Patients and the European Kidney Health Alliance. Leading Spanish kidney researchers grouped in the kidney collaborative research network Red de Investigación Renal have now applied for the Redes de Investigación Cooperativa Orientadas a Resultados en Salud (RICORS) call for collaborative research in Spain with the support of the Spanish Society of Nephrology, Federación Nacional de Asociaciones para la Lucha Contra las Enfermedades del Riñón and ONT: RICORS2040 aims to prevent the dire predictions for the global 2040 burden of CKD from becoming true

Morbi-mortalidad y riesgo cardiovascular en enfermedades reumatológicas inflamatorias crónicas

Introducción: La enfermedad cardiovascular (CV) es más común en pacientes con enfermedades inflamatorias reumáticas crónicas (ERIC) [Artritis Reumatoide (AR), Espondilitis Anquilosante (EA), Artritis Psoriásica (AP)] que en la población general. El aumento del riesgo de eventos cardiovasculares (ECV) resulta de la sinergia de los factores de riesgo cardiovascular (FRCV) tradicionales con otros parámetros secundarios a un proceso de inflamación crónica y a componentes genéticos. Objetivos: Estimar la incidencia y FR del primer ECV en pacientes con ERIC atendidos en consultas de Reumatología a los 2,5 y 5 años de seguimiento. Como objetivo secundario se propone evaluar la hiperlipoproteinemia (a) [(hiperLipo(a)] en pacientes con EA y APs. Métodos: Análisis de datos después de 2,5 y 5 años de seguimiento de un estudio prospectivo observacional [CARdiovascular en reuMAtología (CARMA)] el cual incluye una cohorte de pacientes con ERIC y una cohorte control de pacientes sin ERIC atendidos en 67 hospitales españoles. Se estimó la incidencia acumulada (IA) por 1000 pacientes del primer ECV a los 2,5 y a los 5 años desde el inicio del estudio. Se utilizó un modelo de riesgo proporcional de Weibull para calcular el Hazard Ratio (HR) e intervalo de confianza al 95% (IC95%) de los FRCV.Para la determinación de la (hiperLipo(a) en pacientes con EA y APs se realizó un análisis de la visita basal y se realizó un modelo de regresión logística multivariante. Resultados: El total de pacientes que completaron el seguimiento a los 2,5 y 5 años fue de 2598 y de 2382 de un total de 2910 pacientes incluidos. Siete pacientes fallecieron de ECV y 23 de causas no CV, a los 2,5 años de seguimiento. La IA del primer ECV a los 2,5 años fue 15,3 casos por 1000 pacientes (IC95%: 12,9-17,7), siendo mayor en el grupo de pacientes con EA (22,03; IC95%: 11,01-33,04). El mayor riesgo de desarrollar el primer ECV a los 2,5 años de seguimiento fue el grupo de EA (HR: 4,11; IC95%: 1,07-15,8; p=0,04), aquellos con mayor edad (HR:1,09; IC95%: 1,05-1,13; p<0,001), hipertensión arterial (HTA) sistólica (HR: 1,02; IC95%: 1,0-1,04; p=0,01) y mayor duración de la enfermedad (HR: 1,07; IC95%: 1,03-1,12; p<0,01). Quince pacientes fallecieron de ECV a los 5 años, y 60 de causas no CV. La IA del primer ECV a los 5 años fue mayor en el grupo de pacientes con ERIC (40,5; IC95%: 36,2-44,8) que en los controles (28,3; IC95%: 21,8-34,8). El mayor riesgo de desarrollar el primer ECV a 5 años fue el grupo de EA (HR: 4,60; IC95%: 1,32-15,99; p=0,016), aquellos con HTA (HR: 2,64; IC95%: 1,32-5,25; p=0,006), mayor edad al inicio (HR: 1,09; IC95%: 1,05-1,13; p<0,001) y mayor tiempo de evolución (HR: 1,07; IC95%: 1,03-1,12; p=0,002). El 19,2% (IC 95%: 16,80-22,05) de los pacientes con EA y APs [20,7% (IC 95%: 16,91-24,82) de pacientes con EA y 17,7% de pacientes con APs (IC 95%: 14,15- 21,75)] presentaron hiperLipo(a). Estos resultados fueron superiores a los hallados en el grupo control, 16,7% (IC 95%: 13,23-20,86), aunque las diferencias no fueron significativas (p=0,326). Al ajustar por edad y sexo, los pacientes con EA y APs tenían más probabilidades de tener hiperLipo(a) que los controles [Odds Ratio (OR): 1,43, IC 95%: 1,00-2,04; p=0,05], especialmente aquellos con EA (OR: 1,81, IC 95%: 1,18-2,77; p=0,007). Conclusiones: Los pacientes con EA seguidos, prospectivamente, en las consultas de Reumatología mostraron mayor riesgo de desarrollar un primer ECV que el grupo control. Además de los FRCV clásicos, la mayor duración de la enfermedad es un factor de riesgo para el desarrollo de ECV en los pacientes con ERIC. La mortalidad por ECV a los 5 años fue inferior a la estimada. Los pacientes con EspA mostraron mayor hiperLipo(a) que los pacientes sin ERIC, al igual que mayor alteración del perfil lipídico. Por el contrario, la actividad inflamatoria no se asoció con el desarrollo de hiperLipo(a) en estos pacientes

Valve Abnormalities, Risk Factors for Heart Valve Disease and Valve Replacement Surgery in Spondyloarthritis. A Systematic Review of the Literature

Objective: Evaluate the evidence on the abnormalities of the aortic root and heart valves, risk and prognostic factors for heart valve disease and valve replacement surgery in spondyloarthritis. Methods: A systematic literature review was performed using Medline, EMBASE and Cochrane databases until July 2021. Prevalence, incidence, risk and prognostic factors for heart valve disease; dimension, morphology, and pathological abnormalities of the valves were analyzed. Patient characteristics (younger age, history of cardiac disease or longer disease duration) and period of realization were considered for the analysis. The SIGN Approach was used for rating the quality of the evidence of the studies. Results: In total, 37 out of 555 studies were included. Overall, the level of evidence was low. The incidence of aortic insufficiency was 2.5-3.9 parts per thousand. Hazard Ratio for aortic insufficiency was 1.8-2.0. Relative risk for aortic valve replacement surgery in ankylosing spondylitis patients was 1.22-1.46. Odds ratio for aortic insufficiency was 1.07 for age and 1.05 for disease duration. Mitral valve abnormalities described were mitral valve prolapse, calcification, and thickening. Aortic valve abnormalities described were calcification, thickening and an echocardiographic "subaortic bump." Abnormalities of the aorta described were thickening of the wall and aortic root dilatation. The most common microscopic findings were scarring of the adventitia, lymphocytic infiltration, and intimal proliferation. Conclusions: A higher prevalence and risk of aortic valve disease is observed in patients with ankylosing spondylitis. Studies were heterogeneous and analysis was not adjusted by potential confounders. Most studies did not define accurate outcomes and may have detected small effects as being statistically significant

Comparative study of pulsed laser cleaning applied to weathered marble surfaces

The removal of unwanted matter from surface stones is a demanding task in the conservation of cultural heritage. This paper investigates the effectiveness of near-infrared (IR) and ultraviolet (UV) laser pulses for the cleaning of surface deposits, iron oxide stains and different types of graffiti (black, red and green sprays and markers, and black cutting-edge ink) on dolomitic white marble. The performance of the laser techniques is compared to common cleaning methods on the same samples, namely pressurized water and chemical treatments. The degree of cleaning achieved with each technique is assessed by means of colorimetric measurements and X-ray microfluorescence. Eventual morphological changes induced on the marble substrate are monitored with optical and electronic microscopy. It is found that UV pulsed laser ablation at 266 nm manages to clean all the stains except the cutting-edge ink, although some degree of surface erosion is produced. The IR laser pulses at 1064 nm can remove surface deposits and black spray acceptably, but a yellowing is observed on the stone surface after treatment. An economic evaluation shows that pulsed laser cleaning techniques are advantageous for the rapid cleaning of small or inaccessible surface areas, although their extensive application becomes expensive due to the long operating times required