La artrosis en España: prevalencia, definición de fenotipos y descripción de las características clínicas

[Resumen] La artrosis (OA) es un grupo heterogéneo de enfermedades que en los últimos años se están intentando subdividir en base a fenotipos clínicos y endotipos fisiopatológicos. En esta tesis se describen los fenotipos de los pacientes con OA cervical, lumbar, cadera, rodilla y mano del estudio EPISER 2016, que es un estudio transversal de base poblacional para estimar la prevalencia de enfermedades reumáticas en España. En todas las localizaciones la OA aumenta con la edad y es más frecuente en mujeres, sujetos con menor nivel de estudios y obesos. También caracterizamos el fenotipo axial en estos pacientes, diferenciando dos grupos, el que sólo presenta OA axial y el que puede presentar también OA periférica. De forma paralela se realiza una descripción de los fenotipos de pacientes de la cohorte PROCOAC y en concreto del fenotipo de OA erosiva de manos. A pesar de toda la investigación activa en este campo, aún no existe ningún tratamiento que modifique la progresión de la enfermedad o que sea altamente efectiva en el alivio sintomático. En este contexto realizamos un estudio de búsqueda de biomarcadores para predecir la respuesta terapéutica en pacientes con OA de rodilla a la combinación de condroitin sulfato y clorhidrato de glucosamina.[Resumo] A artrose (OA) é un grupo heteroxéneo de enfermidades que nos últimos anos están a subdividirse en función dos fenotipos clínicos e dos endotipos fisiopatolóxicos. Esta tese describe os fenotipos dos pacientes con OA cervical, lumbar, cadeira, xeonllo e man no estudo EPISER 2016, que é un estudo transversal de base poboacional para estimar a prevalencia de enfermidades reumáticas en España. En todas as localizacións, a OA aumenta coa idade e é máis frecuente en mulleres, suxeitos con menor nivel educativo e obesidade. Tamén caracterizamos o fenotipo axial nestes pacientes, diferenciando dous grupos, o que só presenta OA axial e o que pode presentar tamén OA periférica. Paralelamente, faise unha descrición dos fenotipos dos pacientes da cohorte PROCOAC e concretamente do fenotipo de OA erosiva das mans. A pesar de tódalas investigacións activas neste campo, aínda non existe un tratamento que modifique a progresión da enfermidade ou que sexa altamente efectivo no alivio sintomático. Neste contexto realizamos un estudo para buscar biomarcadores para predecir a resposta terapéutica en pacientes con OA de xeonllo á combinación de sulfato de condroitina e clorhidrato de glucosamina.[Abstract] Osteoarthritis (OA) is a heterogeneous group of diseases that in recent years are being subdivided based on clinical phenotypes and pathophysiological endotypes. This thesis describes the phenotypes of patients with cervical, lumbar, hip, knee and hand OA in the EPISER 2016 study, which is a population-based cross-sectional study to estimate the prevalence of rheumatic diseases in Spain. In all locations, OA increases with age and is more frequent in women, subjects with a lower level of education and obesity. We also characterize the axial phenotype in these patients, differentiating between two groups, the one that only presents axial OA and the one that may also present peripheral OA. In parallel, a description of the phenotypes of patients in the PROCOAC cohort and specifically of the phenotype of erosive OA of the hands is made. Despite all the active research in this field, there is still no treatment that modifies the progression of the disease or that is highly effective in symptomatic relief. In this context we carried out a study to search for biomarkers to predict the therapeutic response in patients with knee OA to the combination of chondroitin sulfate and glucosamine hydrochloride.Programa Oficial de Doutoramento en Ciencias da Saúde. 5007V0

Descripción de la cohorte PROCOAC (PROspective COhort of A Coruña): Cohorte prospectiva española para el estudio de la osteoartritis

[Abstract] Introduction and objective: The use of well characterized osteoarthritis (OA) cohorts is mandatory for the study and knowledge of this disease. Currently, there is no prospective cohort in this pathology in Spain. The objective of this work is to describe the first osteoarthritis cohort in Spain, PROCOAC (Cohort PROspectiva de A Coruña). Methods: The Unit of Rheumatology of the University Hospital of A Coruña started a prospective follow-up study in 2006. The patient inclusion criteria were: I) Patients older than 55 years who underwent an abdominal x-ray to study both hips II) Patients diagnosed with radiographic hand OA according to ACR criteria III) Patients diagnosed with radiographic knee or hip OA according to ACR criteria. Follow-up was performed every two years collecting clinical, analytical, genetic and radiographic information. Results: The cohort consists of 937 patients, 873 have radiographic knee OA, 783 hip OA and 679 hand OA. The mean age of the population is 63.9±8.9 years and the average BMI is 29.6±5.1. More than half of the population has high blood pressure and 17% diabetes. The predominant osteoarthritis in the hand is nodular (78.1%), followed by trapeziometacarpal (55.3%) and erosive (18.4%). Twenty-one point four percent and 43.1% are healthy at knee and hip level respectively; observing a grade 1 in 26% and 37%; a grade 2 in 26.7% and 11.5%; a grade 3 in 14.9% and 4%; and a grade 4 in 9.4% and 3.7% respectively. Of the population, 44.1% has only 1 joint affected, 39.9% has 2 and 13.4% has 3 joints affected. Age (OR=1.11; p<.001), BMI (OR=1.11; p=.002) and total WOMAC (OR=1.03; p=.005) are the only risk factors if we compare the involvement of a single location versus three. A discrepancy between pain and radiographic damage at the joint level was also detected in patients with KL≤2 grade, and therefore a significantly higher percentage of patients with knee OA experienced pain (66.1%) compared to patients with OA hip (21.1%) (p<.001). Conclusions: The PROCOAC cohort is an instrument that allows studies of incidence and progression in hand, knee and hip OA; as well as determining factors that are associated with the different OA phenotypes.[Resumen] Introducción y objetivo. El uso de cohortes de Osteoartritis (OA) bien caracterizadas es obligatorio para estudiar y profundizar en el conocimiento en esta enfermedad. En España no existe actualmente ninguna cohorte prospectiva en esta patología; así el objetivo de este trabajo es describir la primera cohorte de Osteoartritis en España, la PROCOAC (PROspective COhort of A Coruña). Material y métodos. El Servicio de Reumatología del Hospital Universitario de A Coruña inició un estudio de seguimiento prospectivo en el año 2006. Los criterios de inclusión fueron: I) Pacientes mayores de 55 años a los que se les realizó una radiografía abdominal que permitiese estudiar ambas caderas II) Pacientes diagnosticados de OA radiográfica de mano según los criterios ACR III) Pacientes diagnosticados de OA radiográfica de rodilla y/o cadera según los criterios ACR. Se realizó seguimiento cada dos años recogiendo información clínica, analítica, genética y radiográfica. Resultados. La cohorte consta de 937 individuos, 873 tienen OA radiográfica de rodilla, 783 de cadera y 679 de mano. La edad media de la población es 63,9 ± 8,9 años y el IMC promedio de 29,6 ± 5,1. Más de la mitad de la población tiene hipertensión arterial y el 17% diabetes. La osteoartritis predominate en la mano es la nodular (78,1%), seguida de la rizartrosis (55,3%) y la erosiva (18,4%). El 21,4% y el 43,1% son sanos a nivel de rodilla y cadera respectivamente; observando un grado 1 en el 26% y 37%; un grado 2 en el 26,7% y 11,5%; un grado 3 en el 14,9% y 4%; y un grado 4 en el 9,4% y 3,7% respectivamente. El 44,1% de la población tiene 1 articulación afectada, el 39,9% tiene 2 y el 13,4% tiene 3 articulaciones afectadas. La edad (OR = 1,11; p < 0,001), el IMC (OR = 1,11; p = 0,002) y el WOMAC total (OR = 1,03; p = 0,005) son los únicos factores de riesgo si comparamos la afectación de una sola ubicación frente a tres. También se detectó una discrepancia entre el dolor y el daño radiográfico a nivel articular en pacientes con grado KL ≤ 2, de modo que un porcentaje significativamente mayor de pacientes con OA de rodilla experimentaron dolor (66,1%) en comparación con pacientes con OA de cadera (21,1%) (p < 0,001). Conclusión. La cohorte PROCOAC es un instrumento que permite realizar estudios de incidencia y pro-gresión en la osteoartritis de mano, rodilla y cadera, así como conocer factores que se asocian con losdiferentes fenotipos de osteoartritis

Prevalence of Symptomatic Axial Osteoarthritis Phenotypes in Spain and Associated Socio-Demographic, Anthropometric, and Lifestyle Variables

Epidemiology of RMDFinanciado para publicación en acceso aberto: Universidade da Coruña/CISUG[Abstract] Objective. Axial osteoarthritis (OA) is a common cause of back and neck pain, however, few studies have examined its prevalence. The aim was to estimate the prevalence and the characteristics of symptomatic axial OA in Spain. Methods. EPISER2016 is a cross-sectional multicenter population-based study of people aged 40 years or older. Subjects were randomly selected using multistage stratified cluster sampling. Participants were contacted by telephone to complete rheumatic disease screening questionnaires. Two phenotypes were analyzed, patients with Non-exclusive axial OA (NEA-OA) and Exclusive axial OA (EA-OA). To calculate the prevalence and its 95% confidence interval (CI), the sample design was considered and weighting was calculated according to age, sex and geographic origin. Results. Prevalence of NEA-OA by clinical or clinical-radiographic criteria was 19.17% (95% CI: 17.82–20.59). The frequency of NEA-OA increased with age (being 3.6 times more likely in patients aged 80 s or more than in those between 40 and 49 years) and body mass index. It was significantly more frequent in women, as well as in the center of Spain. It was less frequent in those with a higher level of education. Lumbar OA was more frequent than cervical OA. This difference grew with increasing age and was not associated with gender. It was also greater in overweight and obese subjects. Conclusions. This is the first study on the prevalence of axial OA phenotypes in Europe describing the associated socio-demographic, anthropometric, and lifestyle variables.Open Access funding provided thanks to the CRUE-CSIC agreement with Springer Nature. EPISER2016 was supported by Celgene, Gebro Pharma, Merck Sharp & Dohme in Spain, Pfizer, and Sanofi-Aventis, none of whom had any role in the study design, data collection, data analysis, interpretation, or writing of this manuscript. MS was financed via the Rio Hortega Contract—Health Research Fund (CM17/00101), the Sanitary Research Fund integrated in the National Plan of Scientific Program, Technological Development and Innovation 2013–2016 and funded by the ISCIII-Subdirectorate General Evaluation and Promotion of Research-European Regional Development Fund (ERDF) "A way of making Europe

Haemogram in sheep with antibodies against <i>Oestrus ovis</i>

The main goal in this study was to analyze the haemogram in sheep with antibodies against L2 O. ovis excretory/secretory antigens. This investigation was carried out in Galicia (NW Spain), a European region with Atlantie clima te where warmer summers occur

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

18F-FDG-PET/CT Scan for Detection of Large Vessel Involvement in Giant Cell Arteritis: Arteser Spanish Registry

Background/Objectives: Imaging studies have transformed the diagnosis of large vessel vasculitis (LVV) involvement in giant cell arteritis (GCA). A positron emission tomography/computed tomography (PET/CT) scan with 18-fluorodeoxyglucose (18F-FDG) has emerged as a valuable tool for assessing LVV. We aimed to determine the utility of an 18F-FDG-PET/CT scan in detecting LVV in GCA in the ARTESER registry. Methods: The ARTESER study is a large multicenter, retrospective, longitudinal, and observational study, promoted by the Spanish Society of Rheumatology. It included patients newly diagnosed with GCA across 26 tertiary hospitals from 1 June 2013 to 29 March 2019. Patients with a diagnosis of incidental GCA were included if they fulfilled specific criteria, including the ACR 1990 criteria, positive imaging examinations, or the expert clinical opinion of investigators. Differences between patients with positive and negative 18F-FDG-PET/CT scan results were analyzed using a bivariate model. A regression model assessed associations in patients with a positive scan, and the predictive capacity of the cumulative dose of glucocorticoids (GC) on PET scan outcomes was evaluated using ROC curve analysis. Results: Out of 1675 GCA patients included in the registry, 377 met the inclusion criteria of having an 18F-FDG-PET/CT scan. The majority were diagnosed with a cranial GCA phenotype, and 65% had LVV. The thoracic aorta was the most frequently affected. Cardiovascular disease, diabetes, and older age had a negative association with a positive scan outcome. The OR for having a positive 18F-FDG-PET/CTC scan was lower as the number of days increased. Depending on the cumulative dosage of the GC, the 18F-FDG-PET/CT scan showed an AUC of 0.74, with a Youden index > 60 mg/day. Conclusions: Younger patients showed a higher probability of presenting LVV as detected by the 18F-FDG-PET/CT scan. The timing of the examination and the cumulative dosage of the GC influenced the likelihood of a positive result, with earlier tests being more likely to detect inflammation

Metabolic syndrome is not associated with erosive hand osteoarthritis: a cross-sectional study using data from the PROCOAC cohort

Abstract To delineate the phenotype of erosive hand osteoarthritis (EHOA) in a Spanish population and assess its correlation with metabolic syndrome. We conducted a cross-sectional study using baseline data from the Prospective Cohort of Osteoarthritis from A Coruña (PROCOAC). Demographic and clinical variables, obtained through questionnaires, clinical examinations, and patient analytics, were compared among individuals with hand OA, with and without EHOA. We performed appropriate univariate and multivariate stepwise regression analyses using SPSS v28. Among 1039 subjects diagnosed with hand OA, 303 exhibited EHOA. Multivariate logistic regression analysis revealed associations with inflamed joints, nodular hand OA, and total AUSCAN. Furthermore, the association with a lower prevalence of knee OA remained significant. The influence of metabolic syndrome (MetS) on EHOA patients was analyzed by including MetS as a covariate in the model. It was observed that MetS does not significantly impact the presence of EHOA, maintaining the effect size of other factors. In conclusion, in the PROCOAC cohort, EHOA is associated with nodular hand OA, inflammatory hand OA, and a higher total AUSCAN. However, EHOA is linked to a lower prevalence of knee OA. Importantly, in our cohort, no relationship was found between EHOA and MetS

Prevalencia de artrosis sintomática en España: Estudio EPISER2016

Introduction: The Spanish Society of Rheumatology carried out the EPISER2000 study in 2000 to determine the prevalence of osteoarthritis and other rheumatic diseases in the Spanish population. Recent sociodemographic changes and lifestyle habits in Spain justified updating the epidemiological data on osteoarthritis and other rheumatic diseases (EPISER2016-study). Objective: To estimate the prevalence of symptomatic osteoarthritis of the cervical spine, lumbar spine, hip, knee and hand in the adult population in Spain. Material and methods: Cross-sectional population-based study. A multistage and stratified random cluster sampling was carried out. The participants were contacted by telephone to complete an osteoarthritis screening questionnaire. A rheumatologist confirmed or discarded the diagnosis. The ACR-clinical-criteria were used to diagnose hand-osteoarthritis and the ACR-clinical-radiological criteria to diagnose knee- and hip-osteoarthritis. To estimate the prevalence and its 95% confidence interval, weights were calculated according to the probability of selection in each of the sampling stages. Results: The prevalence of osteoarthritis in Spain in one or more of the locations studied was 29.35%. The prevalence of cervical-osteoarthritis was 10.10% and of lumbar-osteoarthritis 15.52%. Both are more frequent in women and at older ages, as well as in people with low levels of education and obesity. The prevalence of hip-osteoarthritis was 5.13%, that of knee-osteoarthritis 13.83%, these are associated with female sex, overweight and obesity. The prevalence of hand osteoarthritis was 7.73%. It is more frequent in women, who are obese, with a low educational level and who are older. Conclusion: The EPISER2016 study is the first to analyse the prevalence of symptomatic osteoarthritis in 5 locations (cervical, lumbar, knee, hip and hands) in Spain. Lumbar spine osteoarthritis is the most prevalent

Fecundidad y migración internacional en Colombia

Este video presenta el recorrido por la página web del proyecto de investigación INV - ECO 2968 "Fecundidad y migración internacional en Colombia", vigencia 2019, es un estudio desarrollado por el Grupo de Estudios Macroeconómicos (GESMA) dentro de la línea de demografía y economía laboral y financiado por la Vicerrectoría de Investigaciones de la Universidad Militar Nueva Granada