EPIREUMAPT PROTOCOL - PORTUGUESE EPIDEMIOLOGIC STUDY OF THE RHEUMATIC DISEASES

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A review through the lens of causal inference

Funding Information: Competing interests AS: Consulting/speaking fees from MSD, UCB, Novartis. SR: Research grant from MSD; Consultancy/speaking fees from AbbVie, Eli Lilly, MSD, Novartis, UCB, Sanofi. DvdH: Consulting fees AbbVie, Amgen, Astellas, AstraZeneca, Bayer, BMS, Boehringer Ingelheim, Celgene, Cyxone, Daiichi, Eisai, Eli-Lilly, Galapagos, Gilead, Glaxo-Smith-Kline, Janssen, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi, Takeda, UCB Pharma Director of Imaging Rheumatology bv. RL: Consulting fees from AbbVie, BMS, Celgene, Eli-Lilly, Galapagos, Gilead, Glaxo-Smith-Kline, Janssen, Merck, Novartis, Pfizer, Roche, UCB and is Director of Rheumatology Consultancy bv Publisher Copyright: ©Axial spondyloarthritis (axSpA) is a chronic rheumatic disease characterised by inflammation predominantly involving the spine and the sacroiliac joints. In some patients, axial inflammation leads to irreversible structural damage that in the spine is usually quantified by the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS). Available therapeutic options include biological disease-modifying antirheumatic drugs (bDMARDs), which have been proven effective in suppressing inflammation in several randomised controlled trials (RCT), the gold standard for evaluating causal treatment effects. RCTs are, however, unfeasible for testing structural effects in axSpA mainly due to the low sensitivity to change of the mSASSS. The available literature therefore mainly includes observational research, which poses serious challenges to the determination of causality. Here, we review the studies testing the effect of bDMARDs on spinal radiographic progression, making use of the principles of causal inference. By exploring the assumptions of causality under counterfactual reasoning (exchangeability, positivity and consistency), we distinguish between studies that likely have reported confounded treatment effects and studies that, on the basis of their design, have more likely reported causal treatment effects. We conclude that bDMARDs might, indirectly, interfere with spinal radiographic progression in axSpA by their effect on inflammation. Innovations in imaging are expected, so that placebo-controlled trials can in the future become a reality. In the meantime, causal inference analysis using observational data may contribute to a better understanding of whether disease modification is possible in axSpA.publishersversionpublishe

Youth have a voice : qualitative exploration of a participatory action-research program

© Under License of Creative Commons Attribution 3.0 LicenseAlthough the participatory action-research programs with young people are increasingly common around the world, their inclusion in the evaluation of intervention programs in the area of health promotion is still not a rule. This study presents youths’ assessment of strengths, weaknesses, opportunities and threats of the Dream Teens project, along with its impact on their development as a person, the development of their individual action and their social support (family, school and community). Two studies are presented: study 1, referring to individual interviews, including a total of 12 young people, with a mean age of 18.5 years (± 1.62), mostly girls (83.3%) attending secondary school (41.67%), higher education (33.33%) and third grade (25%); and study 2, referring to a focus group that involved 8 young people, mostly girls (75%), age 18.5 years ( ± 2) attending higher education (37.5%), secondary school (37.5%) and third grade (25%). The NVivo software was used for the analysis and processing of data. Overall, young people identify the establishment of goals in the project, the relationships established, the acquired knowledge and face-to-face meetings as forces; their difficulty in dealing with empowerment, and weak participation of some young people as weaknesses; the availability of local authorities and some teachers to listen to young people as opportunities; and the necessary bureaucracy in order for a project to be implemented, the lack of support from the educational community and some teachers, along with the lack of support of political power as threats. In terms of impact on the participants, there is an increase in their capacity for the development of the person, in the promotion of their self-esteem, personal goals, a sense of community participation, communication skills and respect for themselves and for others; and their development of individual action, a greater political empowerment, development of skills and confidence for research-action, and relationships established. The opportunities created include the establishment of new contacts and the feeling of support from some political bodies at a social support level; promotion of active listening, capacity for argumentation and development of new interests at the family level; at school, these include better relationships with teachers and colleagues, better academic performance, easier coping with frustration, better acceptance of the other; and in the community, although they have not noticed significant changes, they believe that their work will have future repercussions. This work is expected to contribute to an increase in the number of research-action programs with the participation of young people, enhancing their effectiveness as a way to promote their health and wellbeing.Branquinho, C. receives a PhD grant from The University of Lisbon (UL) (Grant Number 800178), and Matos, M. G. receives a Sabbatical grant from the Foundation for Science and Technology (FCT) (SFRH / BSAB / 135160 / 2017).info:eu-repo/semantics/publishedVersio

A systematic literature review

Publisher Copyright: © The Author 2014. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved.Objective. The aim of this study was to systematically review outcome domains and measurement tools used in gout trials and their accordance with the preliminary OMERACT gout recommendations published in 2005.Methods. Randomized controlled trials (RCTs) and quasi-RCTs investigating any intervention for gout published up to February 2013 were included. Recruitment start dates and all measured outcomes were extracted. Risk of bias (RoB) was assessed with the Cochrane Collaboration tool. Numbers of OMERACT domains were compared for trials at low vs unclear/high RoB and for recruitment start date before 2005 or 2005 and later.Results. Of 9784 articles screened, 38 acute and 30 chronic gout trials were included. Mean (s.d.) number of OMERACT outcomes was 2.9 (1.1) (out of 5) and 2.5 (1.2) (out of 9) for acute and chronic gout trials, respectively. Health-related quality of life, participation and joint damage imaging were not assessed in any trial. Tools used to measure individual domains varied widely. There were no differences in the number of OMERACT outcomes reported in acute or chronic gout trials recruiting before 2005 vs 2005 or later [mean (s.d.): 3.0 (1.1) vs 3.5 (1.3), P = 0.859 and 2.7 (1.1) vs 2.8 (1.4), P = 0.960, respectively]. While both acute and chronic trials at low RoB reported more OMERACT domains than trials at unclear/high RoB, these differences were not significant. Industry-funded trials and trials performed by OMERACT investigators reported more OMERACT outcome domains.Conclusion. We found no appreciable impact of the OMERACT recommendations for gout trials to date.publishersversionpublishe

Measures of Adult Shoulder Function

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/163413/2/acr24230.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/163413/1/acr24230_am.pd

ASAS-EULAR recommendations for the management of axial spondyloarthritis: 2022 update

Objectives: To update the Assessment of SpondyloArthritis international Society (ASAS)-EULAR recommendations for the management of axial spondyloarthritis (axSpA). Methods: Following the EULAR Standardised Operating Procedures, two systematic literature reviews were conducted on non-pharmacological and pharmacological treatment of axSpA. In a task force meeting, the evidence was presented, discussed, and overarching principles and recommendations were updated, followed by voting. Results: Five overarching principles and 15 recommendations with a focus on personalised medicine were agreed: eight remained unchanged from the previous recommendations; three with minor edits on nomenclature; two with relevant updates (#9, 12); two newly formulated (#10, 11). The first five recommendations focus on treatment target and monitoring, non-pharmacological management and non-steroidal anti-inflammatory drugs (NSAIDs) as first-choice pharmacological treatment. Recommendations 6-8 deal with analgesics and discourage long-term glucocorticoids and conventional synthetic disease-modifying antirheumatic drugs (DMARDs) for pure axial involvement. Recommendation 9 describes the indication of biological DMARDs (bDMARDs, that is, tumour necrosis factor inhibitors (TNFi), interleukin-17 inhibitors (IL-17i)) and targeted synthetic DMARDs (tsDMARDs, ie, Janus kinase inhibitors) for patients who have Ankylosing Spondylitis Disease Activity Score ≥2.1 and failed ≥2 NSAIDs and also have either elevated C reactive protein, MRI inflammation of sacroiliac joints or radiographic sacroiliitis. Current practice is to start a TNFi or IL-17i. Recommendation 10 addresses extramusculoskeletal manifestations with TNF monoclonal antibodies preferred for recurrent uveitis or inflammatory bowel disease, and IL-17i for significant psoriasis. Treatment failure should prompt re-evaluation of the diagnosis and consideration of the presence of comorbidities (#11). If active axSpA is confirmed, switching to another b/tsDMARD is recommended (#12). Tapering, rather than immediate discontinuation of a bDMARD, can be considered in patients in sustained remission (#13). The last recommendations (#14, 15) deal with surgery and spinal fractures. Conclusions: The 2022 ASAS-EULAR recommendations provide up-to-date guidance on the management of patients with axSpA. Keywords: Biological Therapy; Spondyloarthritis; Therapeutic

Estado auditivo de los estudiantes de clínica integral de la Facultad de Odontología de la Universidad de Cuenca, agosto 2022-febrero 2023

Antecedentes: Las afecciones a nivel auditivo por exposición prolongada a ruidos fuertes generados por equipos utilizados diariamente en el campo odontológico puede causar una variedad de problemas en el sistema auditivo de los profesionales, alterando la fisiología del oído y afectando su calidad de vida. Objetivo General: Conocer el estado auditivo de los estudiantes de la Facultad de Odontología de la Universidad de Cuenca que cursan o han cursado la asignatura de Clínica Integral, durante el período agosto 2022, febrero 2023. Metodología: Estudio descriptivo, transversal a 73 estudiantes de odontología. El nivel de ruido del laboratorio odontológico se midió utilizando un sonómetro. En una ficha se registró los datos demográficos y los resultados de la audiometría. El programa SPSS v25.0 permitió el análisis de datos y la presentación de resultados. Resultados: El nivel medio de ruido en el laboratorio fue de 91,6 dB. De los 73 estudiantes de odontología, el 65,8% eran mujeres. Todos residen en la zona urbana (Cuenca) y presentan otoscopia normal. Su edad es de 21-23 años (79,5%). La audiometría reveló que un 84,9% presentan audición normal, el 13,7% hipoacusia conductiva unilateral leve derecha y el 1,4% hipoacusia neurosensorial moderada unilateral derecha. Conclusión: La mayoría de los participantes no experimentaron problemas auditivos, no obstante, se manifestó la presencia de un diagnóstico auditivo relacionado a este factor de riesgo, donde la evidencia menciona que la exposición prolongada a ruidos fuertes puede convertirse en un problema en el futuro.Background: Auditory conditions due to prolonged exposure to loud noise generated by equipment used daily in the dental field may cause a variety of problems in the auditory system of professionals, altering the physiology of the ear and affecting their quality of life. General Objective: To know the hearing status of the students of the Faculty of Odontology of the University of Cuenca, who are taking or have taken the subject of Comprehensive Clinic, during the period August 2022, February 2023. Methodology: Cross-sectional descriptive study of 73 odontology students. The noise level in the odonatological laboratory was measured using a sound level meter. Demographic data and audiometry results were recorded in a variable tab. The SPSS v25.0 program allowed data analysis and presentation of results. Results: The average noise level in the laboratory was 91,6 dB. Of the 73 odontological students, 65,8% were women. All reside in the urban area (Cuenca) and present normal otoscopy. Her age is 21-23 (79,5%) years old. Audiometry revealed that 84.9% had normal hearing, 13,7% mild unilateral conductive hearing loss on the right and 1,4% moderate unilateral sensorineural hearing loss on the right. Conclusion: Most of the participants did not experience hearing problems, however, the presence of an auditory diagnosis related to this risk factor was reported, where the evidence mentions that prolonged exposure to loud noise may become a problem in the future.0000-0002-7313-5251Licenciado en FonoaudiologíaCuenc

Do Smoking and Socioeconomic Factors Influence Imaging Outcomes in Axial Spondyloarthritis? Five-Year Data From the DESIR Cohort

Objective: To investigate the relationship between smoking and imaging outcomes over 5 years in axial spondyloarthritis (SpA) and to assess whether socioeconomic factors influence these relationships. Methods: Axial SpA patients from the Devenir des Spondylarthropathies Indifferérenciées Récentes cohort were included. The following 4 imaging outcomes were assessed by 3 central readers at baseline, 2 years, and 5 years: spine radiographs (using the modified Stoke Ankylosing Spondylitis Spine Score [mSASSS]), sacroiliac (SI) joint radiographs (using the modified New York criteria), magnetic resonance imaging (MRI) of the spine (using the Spondyloarthritis Research Consortium of Canada [SPARCC] score), and MRI of the SI joint (using the SPARCC score). The explanatory variable of interest was smoking status at baseline. Interactions between smoking and socioeconomic factors (i.e., job type [blue-collar or manual work versus white-collar or nonmanual work] and education [low versus high]) were first tested, and if significant, analyses were run using separate strata. Generalized estimating equations models were used, with adjustments for confounders. Results: In total, 406 axial SpA patients were included (52% male, 40% smokers, and 18% blue collar). Smoking was independently associated with more MRI-detected SI joint inflammation at each visit over the 5 years, an effect that was seen only in patients with blue-collar professions (β = 5.41 [95% confidence interval (95% CI) 1.35, 9.48]) and in patients with low education levels (β = 2.65 [95% CI 0.42,4.88]), using separate models. Smoking was also significantly associated with spinal inflammation (β = 1.69 [95% CI 0.45, 2.93]) and SI joint damage (β = 0.57 [95% CI 0.18, 0.96]) across all patients, irrespective of socioeconomic factors and other potential confounders. Conclusion: Strong associations were found between smoking at baseline and MRI-detected SI joint inflammation at each visit over a time period of 5 years in axial SpA patients with a blue-collar job or low education level. These findings suggest a possible role for mechanical stress amplifying the effect of smoking on axial inflammation in axial SpA.publishersversionpublishe

the EMEUNET Peer Review Mentoring Program

Although peer review plays a central role in the maintenance of high standards in scientific research, training of reviewing skills is not included in the common education programmes. The Emerging EULAR (European League Against Rheumatism) Network (EMEUNET) developed a programme to address this unmet need. The EMEUNET Peer Review Mentoring Program for Rheumatology Journals promotes a systematic training of reviewing skills by engaging mentees in a 'real world' peer review experience supervised by experienced mentors with support from rheumatology journals. This viewpoint provides an overview of this initiative and its outcomes, and discusses its potential limitations. Over 4 years, 18 mentors and 86 mentees have participated. Among the 33 participants who have completed the programme, 13 (39.3%) have become independent reviewers forAnnals of the Rheumatic Diseasesafter the training. This programme has been recently evaluated by a survey and qualitative interviews, revealing a high interest in this initiative. The main strengths (involvement of a top journal and learning opportunities) and weaknesses of the programme (limited number of places and insufficient dissemination) were identified. Overall, this programme represents an innovative and successful approach to peer review training. Continuous evaluation and improvement are key to its functioning. The EMEUNET Peer Review Mentoring Program may be used as a reference for peer review training in areas outside rheumatology.publishersversionpublishe