Withdrawal of infliximab therapy in ankylosing spondylitis in persistent clinical remission, results from the REMINEA study

Altres ajuts: This work is conducted under the umbrella of the Rheumatology Society of Catalonia and supported by Merck Research Laboratories.Background: Recent data suggest that anti-TNF doses can be reduced in ankylosing spondylitis (AS) patients. Some authors even propose withdrawing treatment in patients in clinical remission; however, at present there is no evidence to support this. Objective: To assess how long AS patients with persistent clinical remission remained free of flares after anti-TNF withdrawal and to evaluate the effects of treatment reintroduction. We also analyze the characteristics of patients who did not present clinical relapse. Methods: Multicenter, prospective, observational study of a cohort of patients with active AS who had received infliximab as a first anti-TNF treatment and who presented persistent remission (more than 6 months). We recorded at baseline and every 6-8 weeks over the 12-month period the age, gender, disease duration, peripheral arthritis or enthesitis, HLA-B27 status, BASDAI, CRP, ESR, BASFI, and three visual analogue scales, spine global pain, spinal night time pain, and patient's global assessment. Results: Thirty-six out of 107 patients (34%) presented persistent remission and were included in our study. After treatment withdrawal, 21 of these 36 patients (58%) presented clinical relapse during follow-up. Infliximab therapy was reintroduced and only 52% achieved clinical remission, as they had before the discontinuation of infliximab; in an additional 10%, reintroduction of infliximab was ineffective, obliging us to change the anti-TNF therapy. No clinical or biological factors were associated with the occurrence of relapse during the follow-up. Conclusions: Two thirds of patients in clinical remission presented clinical relapse shortly after infliximab withdrawal. Although the reintroduction of infliximab treatment was safe, half of the patients did not present the same clinical response that they had achieved prior to treatment withdrawal

Cut-offs and response criteria for the Hospital Universitario la Princesa Index (HUPI) and their comparison to widely-used indices of disease activity in rheumatoid arthritis

Objective To estimate cut-off points and to establish response criteria for the Hospital Universitario La Princesa Index (HUPI) in patients with chronic polyarthritis. Methods Two cohorts, one of early arthritis (Princesa Early Arthritis Register Longitudinal PEARL] study) and other of long-term rheumatoid arthritis (Estudio de la Morbilidad y Expresión Clínica de la Artritis Reumatoide EMECAR]) including altogether 1200 patients were used to determine cut-off values for remission, and for low, moderate and high activity through receiver operating curve (ROC) analysis. The areas under ROC (AUC) were compared to those of validated indexes (SDAI, CDAI, DAS28). ROC analysis was also applied to establish minimal and relevant clinical improvement for HUPI. Results The best cut-off points for HUPI are 2, 5 and 9, classifying RA activity as remission if =2, low disease activity if >2 and =5), moderate if >5 and <9 and high if =9. HUPI''s AUC to discriminate between low-moderate activity was 0.909 and between moderate-high activity 0.887. DAS28''s AUCs were 0.887 and 0.846, respectively; both indices had higher accuracy than SDAI (AUCs: 0.832 and 0.756) and CDAI (AUCs: 0.789 and 0.728). HUPI discriminates remission better than DAS28-ESR in early arthritis, but similarly to SDAI. The HUPI cut-off for minimal clinical improvement was established at 2 and for relevant clinical improvement at 4. Response criteria were established based on these cut-off values. Conclusions The cut-offs proposed for HUPI perform adequately in patients with either early or long term arthritis

Azúcar y caries: aproximación a la situación epidemiológica en Catalunya y resultados de un estudio transversal

Se revisan las tendencias epidemiológicas de caries y de consumo de azúcar en Catalunya y España, así como el papel de la dieta en la etiopatogenia de la caries dental, y se presentan los principales resultados de un estudio epidemiológico sobre una muestra aleatoria de 890 escolares de las ciudades de Girona y Figueres. En este estudio se practicó un cuestionario de frecuencia de consumo de alimentos que reveló una relación positiva entre la presencia de caries y la frecuencia de consumo de helados, bollería, pastelería, pan de molde, por un lado, y chicles y caramelos duros sin azúcar y edulcorantes artificiales por el otro, y negativa con la leche descremada. Estos resultados reflejan tanto el papel de algunos alimentos en la etiopatogenia de la caries, como el fruto de una intervención dietética en individuos con alto riesgo de caries

Azúcar y caries: aproximación a la situación epidemiológica en Catalunya y resultados de un estudio transversal

Se revisan las tendencias epidemiológicas de caries y de consumo de azúcar en Catalunya y España, así como el papel de la dieta en la etiopatogenia de la caries dental, y se presentan los principales resultados de un estudio epidemiológico sobre una muestra aleatoria de 890 escolares de las ciudades de Girona y Figueres. En este estudio se practicó un cuestionario de frecuencia de consumo de alimentos que reveló una relación positiva entre la presencia de caries y la frecuencia de consumo de helados, bollería, pastelería, pan de molde, por un lado, y chicles y caramelos duros sin azúcar y edulcorantes artificiales por el otro, y negativa con la leche descremada. Estos resultados reflejan tanto el papel de algunos alimentos en la etiopatogenia de la caries, como el fruto de una intervención dietética en individuos con alto riesgo de caries

Azúcar y caries: aproximación a la situación epidemiológica en Catalunya y resultados de un estudio transversal

Se revisan las tendencias epidemiológicas de caries y de consumo de azúcar en Catalunya y España, así como el papel de la dieta en la etiopatogenia de la caries dental, y se presentan los principales resultados de un estudio epidemiológico sobre una muestra aleatoria de 890 escolares de las ciudades de Girona y Figueres. En este estudio se practicó un cuestionario de frecuencia de consumo de alimentos que reveló una relación positiva entre la presencia de caries y la frecuencia de consumo de helados, bollería, pastelería, pan de molde, por un lado, y chicles y caramelos duros sin azúcar y edulcorantes artificiales por el otro, y negativa con la leche descremada. Estos resultados reflejan tanto el papel de algunos alimentos en la etiopatogenia de la caries, como el fruto de una intervención dietética en individuos con alto riesgo de caries