Publications by authors named "Antonio Naranjo"

48 Publications

Fracture liaison service model: treatment persistence 5 years later.

Arch Osteoporos 2021 04 4;16(1):60. Epub 2021 Apr 4.

Rheumatology, Hospital Universitario de Gran Canaria Dr. Negrín, Barranco de la Ballena, 35011, Las Palmas, Spain.

We analyzed the long-term persistence of treatment in a FLS. During follow-up, 15.2% of patients had a refracture and 23.8% died. At the 5-year checkup, 74% had started treatment (associated with female sex, previous use of bisphosphonate, and referral to an osteoporosis clinic). Persistence at 1 and 5 years was 70.6% and 46.5%, respectively.

Introduction: To analyze the long-term persistence of treatment in a fracture liaison service (FLS).

Methods: Patients ≥ 50 years with a fragility fracture attended between 2012 and 2016 who were recommended for treatment to prevent new fractures were included. Baseline data included demographics, type of fracture, previous treatment, and FRAX® items. Five years later, patient records were reviewed and the following data were collected: [1] survival; [2] refracture; [3] initiation of treatment, persistence, and medication possession ratio (MPR) > 80%.

Results: We included 888 patients, mean age 75 years, 83% women, and mean follow-up 56 months. During follow-up, 135 patients (15.2%) had a refracture (109 major fractures, 50 hip refractures) and 212 patients died (23.8%); at the 5-year checkup, 657 patients (74%) had started some type of treatment. Factors associated with the start of treatment were female sex (OR 2.10; 95% CI: 1.42-3.11), previous use of bisphosphonate (OR 3.91; 95% CI: 2.23-6.86), and referral to an osteoporosis clinic (OR 1.46; 95% CI: 1.02-2.07). Persistence decreased from 70.6% at 12 months to 46.5% at 60 months. An MPR > 80% was confirmed in 449 patients, 68.3% of whom were under treatment. A total of 521 and 447 patients received treatment for at least 24 and 36 months, respectively (79.3% and 68.0% of those who started treatment).

Conclusions: Patients with fragility fractures attended at an FLS showed optimal long-term persistence of treatment. These data can help healthcare managers better calculate the cost-effectiveness of implementing the FLS model.
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http://dx.doi.org/10.1007/s11657-021-00925-6DOI Listing
April 2021

Impact of confinement during the SARS-CoV-2 pandemic on the incidence of fragility fractures.

Med Clin (Engl Ed) 2021 Mar 20. Epub 2021 Mar 20.

Departamento de Métodos Cuantitativos, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Las Palmas, Spain.

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http://dx.doi.org/10.1016/j.medcle.2020.12.013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7980208PMC
March 2021

Impact of confinement during the SARS-CoV-2 pandemic on the incidence of fragility fracture.

Med Clin (Barc) 2021 Jan 29. Epub 2021 Jan 29.

Departamento de Métodos Cuantitativos, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Las Palmas, España.

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http://dx.doi.org/10.1016/j.medcli.2020.12.010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7846244PMC
January 2021

Digestive involvement in primary Sjögren's syndrome: analysis from the Sjögrenser registry.

Clin Exp Rheumatol 2020 Jul-Aug;38 Suppl 126(4):110-115. Epub 2020 Oct 1.

Rheumatology Department, Hospital Universitario Doce de Octubre, Madrid, Spain.

Objectives: Digestive involvement (DI) has been reported in 10-30% of primary Sjögren's syndrome (pSS) patients, and few studies have systematically analysed the prevalence of DI in pSS patients. The aim of this study was to describe DI prevalence in pSS patients from the Sjögrenser Study, and to analyse its clinical associations.

Methods: All patients included in the Sjögrenser study, a Spanish multicentre randomised cohort, containing demographic, clinical and histologic data, have been analysed retrospectively. Patients were classified according to the presence of DI (oesophageal, gastric, intestinal, hepatic and pancreatic), and we have performed DI clinical associations, descriptive statistics, Student t or χ2 test, and uni and multivariate logistic regression.

Results: From 437 included patients, 95% were women, with a median age of 58 years, 71 (16.2%) presented DI: 21 (29.5%) chronic atrophic gastritis, 12 (16.9%) oesophageal motility dysfunction, 3 (4.2%) lymphocytic colitis, 18 (25.3%) primary biliary cholangitis, 15 (21.1%) autoimmune hepatitis, 7 (9.8%) pancreatic involvement and 5 (7%) coeliac disease. Half of them developed DI at the same time or after pSS diagnosis. Patients with DI were significantly older at pSS diagnosis (p=0.032), more frequently women (p=0.009), presented more autoimmune hypothyroidism and C3 hypocomplementaemia (p=0.040), and were treated more frequently with glucocorticoids, immunosuppressant and biologic therapies. Patients with pancreatic involvement presented more central nervous system and renal involvement, Raynaud's phenomenon, lymphoma and C3/C4 hypocomplementaemia.

Conclusions: DI is frequent in Sjögrenser patients, mainly in the form of autoimmune disorders, and seem to be associated with a more severe phenotype. Our results suggest that DI should be evaluated in pSS patients, especially those with more severe disease.
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October 2020

The evolution of an FLS in search of excellence: the experience of Gran Canaria.

Arch Osteoporos 2020 07 22;15(1):108. Epub 2020 Jul 22.

Rheumatology, Hospital Universitario de Gran Canaria Dr. Negrín, Barranco de la Ballena, 35011, Las Palmas, Spain.

We present the achievements and difficulties of our pioneering FLS within the Spanish public health system over an 8-year period. Despite implementing consolidating measures at the unit, the addition of a support nurse, the establishment of a solid alliance with primary care, the involvement of primary care nurses, and starting initial prescriptions at the hospital are pending.

Purpose: To assess the consolidation of an FLS after its implementation as well as the problems that have arisen over time.

Methods: The program for secondary fracture prevention was implemented in 2012. Initially manned by the same staff assigned to the rheumatology department, a part-time support nurse was added in 2016. Patients were identified from the emergency registry and, more recently, from among those admitted for hip fracture and treated in a monographic osteoporosis clinic. The baseline visit consisted of a consultation with the nurse, as well as DXA and bone metabolism analytics. Patients were referred to their primary care physician to start treatment.

Results: Of the 2416 attended patients, 30% presented forearm fractures, 27% hip, 20% humerus, 10% spine, and 11% other fractures. In comparison with 2012, in 2019, the monthly average of patients had doubled, with an increased in the number of hip and spine fractures and an increase in the percentage of captured patients. The performance of DXA fell from 100 to 52%, and fewer patients were referred to the osteoporosis clinic. One in four patients was referred to a fall prevention school. Despite implementing consolidating measures at the unit (the addition of a support nurse and the establishment of a solid alliance with primary care), the involvement of primary care nurses and starting initial prescriptions at the hospital are pending.

Conclusions: We present herein the achievements made by our FLS and the difficulties within the Spanish public health system over an 8-year period.
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http://dx.doi.org/10.1007/s11657-020-00729-0DOI Listing
July 2020

Comparable effects of traditional cardiovascular risk factors on subclinical atherosclerosis in systemic lupus erythematosus and rheumatoid arthritis.

Clin Exp Rheumatol 2020 Sep-Oct;38(5):917-924. Epub 2020 Jan 20.

Division of Rheumatology, Hospital Universitario de Canarias, Tenerife, Spain.

Objectives: Patients with rheumatoid arthritis (RA) or systemic lupus erythematosus (SLE) have an increased premature prevalence of atherosclerosis. We aimed to determine whether there are differences in the prevalence of classic cardiovascular risk factors between SLE and RA. We also analysed the effect of traditional cardiovascular risk factors on the development of subclinical atherosclerosis in both conditions and if some disease-characteristic features are associated with these traditional cardiovascular risk factors.

Methods: This was a cross-sectional study encompassing 602 individuals, 276 SLE and 326 RA patients. Subclinical atherosclerosis (presence of carotid plaques and carotid intima-media thickness [cIMT]) was determined by carotid ultrasonography. A multivariable regression analysis was performed to evaluate whether classic cardiovascular-related risk factors differentially influence subclinical carotid atherosclerosis in SLE compared to RA patients.

Results: Age (interaction factor [if] p=0.000), hypertension (if p=0.034), and diabetes (if p=0.037) had a higher effect on cIMT in RA than in SLE subjects. However, these traditional cardiovascular factors did not yield different effects on the presence of carotid plaques in RA and SLE when the univariate interaction was analysed. In addition, no differences were found in the influence of hypertension, diabetes, dyslipidaemia or current smoking on cIMT or carotid plaque after adjusting for demographics, the presence of other traditional cardiovascular factors, and disease-related data. Moreover, the additive effect of several cardiovascular risk factors on the subclinical carotid atherosclerosis did not differ between the two diseases.

Conclusions: The influence of traditional cardiovascular risk factors on cIMT and carotid plaque is similar in RA and SLE.
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October 2020

Organisational and Clinical Approach to Osteoporosis in Rheumatology: OP-SER-Excellence Survey and Consensus.

Reumatol Clin 2019 Dec 8. Epub 2019 Dec 8.

Departamento de Organización de Empresas y Marketing, Universidad Complutense de Madrid, Madrid, España.

Objective: To determine and analyse the organisational approach adopted by Spanish rheumatologists to osteoporosis (OP) to define strategic priorities.

Material And Method: A group of experts designed a questionnaire on OP in the rheumatologist practice. The survey was sent to the Spanish Society of Rheumatology (SER) members. Through the Delphi round, strategic priorities were agreed upon in OP.

Results: The priorities are: 1) The SER should promote the inclusion of OP in 100% of the services and expand the training offer; 2) Rheumatology services should promote the role of the nurse in OP, promote quality indicators and referral protocols agreed with primary care in addition to promoting their training in this area; 3) The SER and Rheumatology services should promote electronic consultation, OP monographic clinics and participation in Fracture Liaison Service units.

Conclusions: Strategic priorities in OP help identify areas of improvement at organisational, structural and quality standards level in this pathology.
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http://dx.doi.org/10.1016/j.reuma.2019.11.002DOI Listing
December 2019

Tobacco smoking is an independent factor associated with retinal damage in systemic lupus erythematosus: a cross-sectional and retrospective study.

Rheumatol Int 2020 Mar 27;40(3):367-374. Epub 2019 Nov 27.

Rheumatology Service, Hospital Universitario de Gran Canaria Doctor Negrin, Las Palmas, GC, Spain.

To analyze the influence of tobacco smoking on systemic lupus erythematosus (SLE) clinical features and damage. Cross-sectional and retrospective, case-control study comparing SLE patients with and without tobacco exposure. Cumulative clinical data and comorbidities were collected, and severity (Katz index) and damage (SLICC/ACR damage index) (SDI) indices were calculated. Pack-years (PY) was used to estimate lifetime tobacco exposure. A logistic regression was carried out to explore the impact of tobacco use on retinal damage. 216 patients were included. The mean age was 49 years (± 12.7), 93% were females, and median disease duration was 17 years [interquartile range (IQR):9-25]. Fifty-three percent of patients were smokers at some point. The median PY was 13 (IQR: 6-20.5). Only 54.8% of active smokers recalled having been informed of the negative effects of smoking, versus 83.3% of never smokers (< 0.001). In a bivariant analysis, an association between tobacco use at any time and discoid lupus [OR: 3.5(95%CI 1.5-8.9); p = 0.002] photosensitivity [OR: 2.06(95%CI 1.16-3.7); p = 0.01] and peripheral arteriopathy (p = 0.007) was found. Considering SDI item by item, a significant association with retinal damage, adjusted for age [OR: 1.03(95%CI 1-1.07); p = 0.04], was found. Using PYs, an association was found with discoid lupus (p = 0.01), photosensitivity (p = 0.03) and peripheral arteriopathy (p = 0.01), global SDI > 0 (p = 0.002) and retinal damage (p = 0.02). In a multivariate analysis exploring factors associated with retinal damage, any previous smoking history and SDI remained associated with retinal damage. Tobacco smoking is associated with cutaneous manifestations and damage and is an independent predictor of retinal damage in SLE patients.
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http://dx.doi.org/10.1007/s00296-019-04473-8DOI Listing
March 2020

Cardiovascular disease in the QUEST-RA study, 10 years later.

Arthritis Res Ther 2019 11 14;21(1):242. Epub 2019 Nov 14.

Division of Rheumatology, Hospital Universitario de Canarias, Tenerife, Spain.

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http://dx.doi.org/10.1186/s13075-019-2025-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6857219PMC
November 2019

Application of the recommendations of the Spanish Society of Rheumatology on osteoporosis in a Fracture Liaison Service unit.

Reumatol Clin 2021 Feb 24;17(2):122-123. Epub 2019 Apr 24.

Servicio de Reumatología, Hospital Universitario de Gran Canaria Doctor Negrín, España, Las Palmas de Gran Canaria, Las Palmas, España.

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http://dx.doi.org/10.1016/j.reuma.2019.03.009DOI Listing
February 2021

Bacteremia in Systemic Lupus Erythematosus in Patients from a Spanish Registry: Risk Factors, Clinical and Microbiological Characteristics, and Outcomes.

J Rheumatol 2020 02 15;47(2):234-240. Epub 2019 Apr 15.

From the Department of Rheumatology, Doctor Negrín University Hospital of Gran Canaria, Las Palmas; Department of Rheumatology, Gregorio Marañón University Hospital, Madrid; Department of Preventive Medicine, University Hospital Complex, and Department of Rheumatology, Biomedical Research Institute of Vigo, Vigo; Department of Rheumatology, Doce de Octubre University Hospital, Madrid; Department of Rheumatology, Donostia Hospital, Guipuzcoa; Infectious Diseases Department, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Córdoba; Department of Rheumatology, General University Hospital of Alicante, Miguel Hernandez University, Alicante; Department of Rheumatology, La Princesa University Hospital, Madrid; Department of Rheumatology, Bellvitge Hospital, Barcelona; Department of Rheumatology, Germans Trías i Pujol University Hospital, Badalona; Department of Rheumatology, University Hospital of A Coruña, A Coruña; Department of Rheumatology, University Hospital Complex of Ourense, Ourense; Department of Rheumatology, Puerta del Hierro-Majadahonda University Hospital, Majadahonda; Department of Rheumatology, Marqués de Valdecilla University Hospital, Cantabria University, Santander; Department of Rheumatology, University Hospital Araba, Victoria; Department of Rheumatology, Virgen Macarena Hospital, Seville; Department of Rheumatology, San Cecilio Hospital, Granada; Department of Rheumatology, Monforte Hospital, Lugo; Department of Rheumatology, Tenerife Clinic Hospital, Tenerife; Department of Rheumatology, Carlos Haya Hospital, Málaga; Department of Rheumatology, Son Llatzer Hospital, Palma de Mallorca; Department of Rheumatology, Doctor Peset Hospital, Valencia; University of Las Palmas, Gran Canaria, Las Palmas, Spain.

Objective: To describe the incidence of bacteremia in a large multicentric cohort of patients with systemic lupus erythematosus (SLE) and their clinical characteristics and to identify risk factors.

Methods: All bacteremic episodes from the Spanish RELESSER registry were included. Clinical and laboratory characteristics concerning bacteremia and SLE status, as well as comorbidities at the time of infection, were retrospectively collected. A comparison with sex- and age-matched SLE controls without bacteremia was made. A logistic regression was conducted.

Results: The study included 114 episodes of bacteremia in 83 patients. The incidence rate was 2.7/1000 patient-years. At the time of bacteremia, the median age was 40.5 (range: 8-90) years, and 88.6% of patients were female. The Safety of Estrogens in Lupus Erythematosus National Assessment-Systemic Lupus Erythematosus Disease Activity Index was 4 [interquartile range (IQR) 8]; 41% had an SLE flare (66% severe); Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index was 3 (IQR 4). A comorbidity was recorded in 64% of cases. At the time of bacteremia, 88.6% received corticosteroids (68.6% > 10 mg/day) and 57% immunosuppressors. Gram-negative bacilli, most frequently (29.8%), caused 52.6% of the episodes. The bacteremia-related mortality was 14% and bacteremia was recurrent in 27.2% of cases. A dose-response relationship was found between corticosteroids and bacteremia risk. In the multivariate analysis, these factors were associated with bacteremia: elevated creatinine (OR 1.31, 95% CI 1.01-1.70; p = 0.045), diabetes (OR 6.01, 95% CI 2.26-15.95; p < 0.001), cancer (OR 5.32, 95% CI 2.23-12.70; p < 0.001), immunosuppressors (OR 6.35, 95% CI 3.42-11.77; p < 0.001), and damage (OR 1.65, 95% CI 1.31-2.09; p < 0.001).

Conclusion: Bacteremia occurred mostly in patients with active SLE and was frequently associated with severe flares and corticosteroid use. Recurrence and mortality were high. Immunosuppressors, comorbidities, and disease-related damage were associated with bacteremia.
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http://dx.doi.org/10.3899/jrheum.180882DOI Listing
February 2020

Biological Treatment Patterns in Patients with Inflammatory Joint Diseases. Retrospective Study with 4 Years Follow-up.

Reumatol Clin 2020 Nov - Dec;16(6):447-454. Epub 2019 Jan 28.

Departamento de Reumatología, Instituto de Investigación Biomédica (IBIMA), Hospital Regional Universitario de Málaga, Universidad de Málaga, Málaga, España.

Objectives: To describe the therapeutic management of Rheumatoid Arthritis (RA), Psoriatic Arthritis (PsA) and Ankylosing Spondylitis (AS) in patients initiating treatment with biological agents.

Materials And Methods: Observational, retrospective, longitudinal study in 33 Spanish hospitals. Patients with RA, PsA and AS starting treatment with biological agents between September 2009 and August 2010 and a follow-up longer than 3 years were included. Clinical-demographic characteristics, drugs, biological therapy survival, and reasons for discontinuation or switching were analyzed.

Results: Four hundred and sixty-three patients were included (183 RA, 119 PsA and 161 AS), with a mean follow-up of 3.8 years. At the end of follow-up, a high proportion continued with the first biological prescribed (41.0% of RA, 59.7% of PsA and 51.6% of AS), 31.1%, 47.9% and 42.9% of RA, PsA and AS patients requiring dosage adjustments, respectively. There was temporary discontinuation in 8.2%, 8.4% and 15.5% of patients, and a switch of biologic agent was required in 37.7%, 26.1% and 24.2%. Definitive discontinuation occurred in 13.1%, 5.9% and 8.7% of RA, PsA and AS patients, respectively. Mean time to discontinuation or switching was 30.1 months for RA and 35.7 months for PsA and AS.

Conclusions: Our results suggest that, in practice, half of patients with RA and two thirds with PsA or AS maintained the first biological, but with frequent dose adjustments.
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http://dx.doi.org/10.1016/j.reuma.2018.11.007DOI Listing
January 2019

Prognostic Factors for Sustained Remission in a "Real Life" Cohort of Rheumatoid Arthritis Patients.

Reumatol Clin 2020 Sep - Oct;16(5 Pt 2):405-409. Epub 2018 Nov 24.

Hospital Universitario de Gran Canaria Dr. Negrín, Rheumatology Department, Las Palmas de Gran Canaria, Las Palmas 35011, Spain.

Introduction: Rheumatoid arthritis (RA) is the most frequent chronic polyarthritis. The current goal of RA treatment is to achieve clinical remission.

Objective: The goal of this study was to determine the prevalence of remission in a cohort of patients from clinical practice, and to identify potentially modifiable factors associated with remission.

Methods: A retrospective study was performed on a cohort of RA patients seen at the first consultation at the HUGC Rheumatology Service Dr. Negrín (HUGCDN) between first of January 2000 and thirtieth of April 2014. Sustained remission was defined as DAS28 less than 2.6 in the last two available visits in the medical history.

Results: A total of 463 patients were consecutively included, most (75%) women, with a mean age at the onset of RA of 50 years and a mean duration of the disease at follow-up of 8 years. 46% of the patients achieved sustained remission. Multiple logistic regression analyses found male sex (P=.031, OR 1.7, 95% CI 1.05-2.82), diagnosis in the first year of symptoms (P=.023, OR 1.7, 95% CI 1.07-2.69) and the initial DAS28 (P=.035) to be independent predictors for sustained remission.

Conclusions: The 46% of the patients with RA followed in the HUGC Dr. Negrín are in persistent remission, being the early diagnosis a modifiable factor predictor of remission. Thus, an objective of the Rheumatology Service should be to improve the diagnostic delay of RA in the health area.
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http://dx.doi.org/10.1016/j.reuma.2018.10.002DOI Listing
November 2018

Impact of the implementation of a Fracture Liaison Service on pharmaceutical expenses for osteoporosis compared to an area without an FLS.

Expert Rev Pharmacoecon Outcomes Res 2019 Feb 6;19(1):81-87. Epub 2018 Sep 6.

b Department of Quantitative Methods , University of Las Palmas de Gran Canaria , Las Palmas de Gran Canaria , pain.

Introduction: Fracture Liaison Service (FLS) model for secondary prevention of fractures has demonstrated its cost-effectiveness using decision models. We analyze the impact of a FLS on pharmaceutical expenditures for osteoporosis (OP) in real-world circumstances.

Methods: Expenditures on OP medications from January 2011 to January 2017 were compiled. Pharmaceutical expenditures in the southern area of Gran Canaria were used as a control group to measure the impact of implementing an FLS in the northern area. We estimated generalized least squares regressions with interrupted time-series analysis where two interventions were considered: March 2012 (implementation of the FLS) and March 2016 (incorporation of nursing staff for inpatients with hip fracture).

Results: The northern area incurred greater expenditures for group I and II drugs. The difference in bisphosphonates expenditures between areas varied from 10.5% higher in the northern area pre-FLS to 11.2% post-FLS and 18.3% since March 2016. However, interrupted time series models do not find a significant impact of implementation of FLS on the pharmaceutical expenditures for either drug group.

Conclusion: The implantation of an FLS did not lead to an increase in pharmaceutical expenditures for OP over the 5-year period compared to the standard care provided for secondary fracture preventions.
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http://dx.doi.org/10.1080/14737167.2018.1513791DOI Listing
February 2019

Preventing future fractures: effectiveness of an orthogeriatric fracture liaison service compared to an outpatient fracture liaison service and the standard management in patients with hip fracture.

Arch Osteoporos 2017 Dec 11;12(1):112. Epub 2017 Dec 11.

Internal Medicine, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain.

An observational study was carried out in two hospitals in patients > 65 years admitted for hip fracture. At 6 months, 15% of patients in the hospital with orthogeriatric standard care and 75% in the hospital with fracture liaison service were receiving bisphosphonates.

Purpose: Many patients with fractures are discharged without preventive therapy against further fractures. We sought to compare the effectiveness of an orthogeriatric fracture liaison service (FLS), outpatient FLS, and the standard care after hip fractures in prevention of future fractures.

Methods: An observational study was carried out in two hospitals in patients > 65 years of age, admitted between March and July 2016 for fractures. The Candelaria hospital (HUNSC) has no specific protocol for secondary prevention, while at the Negrin Hospital (HUGCDN), an FLS nurse visits the inpatients, gathers metabolic history, instructs regarding the diet, exercises, and fall prevention, and completes a discharge report regarding osteoporosis treatment. The prescription rate of osteoporosis treatment was analyzed at admission, discharge, and 6 months after discharge. We also analyzed the data of patients with hip fractures who attended the outpatient FLS before March 2016.

Results: We included a total of 185 inpatients with a mean age of 82 years and 73% were women. At admission, 8% of the patients in HUNSC and 10% in HUGCDN were receiving bisphosphonates. At discharge, the percentages were 8 and 96%, while at 6 months they were 15 and 75%, respectively (p < 0.001). The outpatient FLS recorded 206 hip fractures (27% of discharges for fractures), with 77% adherence to treatment at 6 months.

Conclusions: Compared with the conventional management, the FLS model for inpatients with hip fractures achieved a fivefold increase in the adherence to treatment at 6 months, similar to the rates of outpatient FLS.
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http://dx.doi.org/10.1007/s11657-017-0373-9DOI Listing
December 2017

Recommendations for the use of methotrexate in psoriatic arthritis.

Reumatol Clin 2018 Jul - Aug;14(4):183-190. Epub 2017 Oct 17.

Departamento de Reumatología, Hospital de Guadalajara, Guadalajara, España; Departamento de Medicina y Especialidades Médicas, Universidad de Alcalá, Madrid, España.

Objectives: To develop recommendations for the management of methotrexate (MTX) in psoriatic arthritis (PsA), based on best evidence and experience.

Methods: A group of 12 experts on MTX use was selected. The coordinators formulated 14 questions about the use of MTX in PsA patients (indications, efficacy, safety and cost-effectiveness). A systematic review was conducted to answer the questions. Using this information, inclusion and exclusion criteria were established, as were the search strategies (Medline, EMBASE and the Cochrane Library were searched). Two different reviewers selected the articles. Evidence tables were created. At the same time, European League Against Rheumatism and American College of Rheumatology abstracts were evaluated. Based on this evidence, the coordinators proposed 12 preliminary recommendations that the experts discussed and voted on in a nominal group meeting. The level of evidence and grade of recommendation were established using the Oxford Centre for Evidence Based Medicine and the level of agreement with the Delphi technique (2 rounds). Agreement was established if at least 80% of the experts voted yes (yes/no).

Results: A total of 12 preliminary recommendations on the use of MTX were proposed, 9 of which were accepted. One was included in a different recommendation and another 2 were not voted on and were thereafter clarified in the main text.

Conclusions: These recommendations aim to answer frequent questions and help in decision making strategies when treating PsA patients with MTX.
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http://dx.doi.org/10.1016/j.reuma.2017.08.011DOI Listing
December 2018

Blau Syndrome-Associated Uveitis: Preliminary Results From an International Prospective Interventional Case Series.

Am J Ophthalmol 2018 03 6;187:158-166. Epub 2017 Sep 6.

Department of Pediatric Rheumatology, Catholic University of Leuven (KU Leuven), Leuven, Belgium.

Purpose: Provide baseline and preliminary follow-up results in a 5-year longitudinal study of Blau syndrome.

Design: Multicenter, prospective interventional case series.

Methods: Baseline data from 50 patients from 25 centers worldwide, and follow-up data for patients followed 1, 2, or 3 years at the end of study enrollment. Ophthalmic data were collected at baseline and yearly visits by means of a standardized collection form.

Results: Median age at onset of eye disease was 60 months and duration of eye disease at baseline 145 months. At baseline 38 patients (78%) had uveitis, which was bilateral in 37 (97%). Eight patients (21%) had moderate to severe visual impairment. Panuveitis was found in 38 eyes (51%), with characteristic multifocal choroidal infiltrates in 29 eyes (39%). Optic disc pallor in 9 eyes (12%) and peripapillary nodules in 9 eyes (12%) were the commonest signs of optic nerve involvement. Active anterior chamber inflammation was noted in 30 eyes (40%) at baseline and in 16 (34%), 17 (57%), and 11 (61%) eyes at 1, 2, and 3 years, respectively. Panuveitis was associated with longer disease duration. At baseline, 56 eyes (75%) were on topical corticosteroids. Twenty-six patients (68%) received a combination of systemic corticosteroids and immunomodulatory therapy.

Conclusions: Blau uveitis is characterized by progressive panuveitis with multifocal choroiditis, resulting in severe ocular morbidity despite continuous systemic and local immunomodulatory therapy. The frequency and severity of Blau uveitis highlight the need for close ophthalmologic surveillance as well as a search for more effective therapies.
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http://dx.doi.org/10.1016/j.ajo.2017.08.017DOI Listing
March 2018

Intercentre variance in patient reported outcomes is lower than objective rheumatoid arthritis activity measures: a cross-sectional study.

Rheumatology (Oxford) 2017 08;56(8):1395-1400

University of Eastern Finland, Faculty of Health Sciences, Kuopio and Jyvaskyla Central Hospital, Jyvaskyla, Finland.

Objective: To assess intercentre variability in the ACR core set measures, DAS28 based on three variables (DAS28v3) and Routine Assessment of Patient Index Data 3 in a multinational study.

Methods: Seven thousand and twenty-three patients were recruited (84 centres; 30 countries) using a standard protocol in the Quantitative Standard Monitoring of Patients with RA study. Analysis of variance (ANOVA) and mixed-effect analysis of covariance models were used to model the relationship between study centre and different patient-reported and physician-reported RA activity measures. These models were built to adjust for the remaining ACR core set measure (for each ACR core set measure or each composite index), socio-demographics and medical characteristics. ANOVA and analysis of covariance models yielded similar results, and ANOVA tables were used to present variance attributable to recruiting centre.

Results: The proportion of variances attributable to recruiting centre was lower for patient reported outcomes (PROs: pain, HAQ, patient global) compared with objective measures (joint counts, ESR, physician global) in all models. In the full model, variance in PROs attributable to recruiting centre ranged from 1.53% for patient global to 3.71% for HAQ compared with objective measures that ranged from 5.92% for physician global to 9.25% for ESR; and was lower for Routine Assessment of Patient Index Data 3 (2.6%) compared with DAS28v3 (11.75%).

Conclusion: Intercentre variability in PROs is lower than objective measures of RA activity demonstrating that PROs may be more comparable across centres, and the need for standardization of objective measures.
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http://dx.doi.org/10.1093/rheumatology/kex076DOI Listing
August 2017

Prevalence of severe esophagitis in Spain. Results of the PRESS study (Prevalence and Risk factors for Esophagitis in Spain: A cross-sectional study).

United European Gastroenterol J 2016 Apr 24;4(2):229-35. Epub 2015 Jul 24.

Department of Gastroenterology, Hospital Universitario La Fe, Valencia, Spain.

Background: *N.P. and M.P. contributed equally to this study.The current prevalence of esophagitis in southern Europe is unknown. In addition, the risk factors for reflux esophagitis are not fully understood.

Objective: The objective of this article is to assess the prevalence and risk factors for esophagitis in Spain.

Methods: A prospective, observational, cross-sectional, multicenter study (PRESS study) was conducted among 31 gastrointestinal endoscopy units throughout Spain. A total of 1361 patients undergoing upper gastrointestinal endoscopy were enrolled. Sociodemographic, clinical and treatment data were recorded.

Results: A total of 95% of patients were Caucasian and 52% were male (mean age: 53 ± 17 years). The most frequent symptoms prompting endoscopy were heartburn (40%), regurgitation (26%) and dysphagia (15%). Fifty-four percent of patients undergoing endoscopy were receiving proton pump inhibitor (PPI) treatment. Esophagitis (mainly mild-moderate) was present in 154 (12.4%) patients. The severe form was recorded in only 11 (0.8%) patients. Multivariate analysis results indicated that the likelihood of esophagitis was higher in men (OR = 1.91, 95% CI = 1.31-2.78), in patients with high GERD-Q scores (OR = 1.256, 95% CI = 1.176-1.343), weight increase (OR = 1.014, 95% CI = 1.003-1.025) and high alcohol consumption (OR = 2.49, 95% CI = 1.16-5.36).

Conclusion: Severe esophagitis is a rare finding in the Spanish population. Male gender, high GERD-Q score, weight increase and high alcohol consumption are main risk factors for its appearance.
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http://dx.doi.org/10.1177/2050640615595916DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4804364PMC
April 2016

Factors associated with the intensification of treatment in rheumatoid arthritis in clinical practice.

Rheumatol Int 2015 Nov 4;35(11):1851-5. Epub 2015 Aug 4.

Department of Rheumatology, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Calle Barranco de La Ballena s/n, 35010, Las Palmas de Gran Canaria, Spain.

The aim of the present study was to analyse the patterns of treatment adjustment in rheumatoid arthritis (RA) patients with active disease in routine clinical care. This was a cross-sectional study of consecutive patients with RA conducted in five hospitals. Activity scales (DAS28-ESR) and function (HAQ) were measured, as well as whether ultrasound was performed as part of the assessment. Treatment decision (no changes/reduction/intensification) and time to the next scheduled visit were the outcomes variables. Associated factors were analysed by multilevel regression models. A total of 343 patients were included (77 % women, mean age 57 years, mean RA duration 10 years), of whom 44 % were in remission by DAS28. Treatment was continued in 202 (59 %) patients, reduced in 57 (16 %), and intensified in 83 (24 %). In the 117 patients with active RA (DAS28 ≥ 3.2), treatment was intensified in 61 (52 %). Factors associated with treatment intensification were physician and patient VAS, and DAS28, but not the centre. In the multilevel regression analysis with intensification of treatment as dependent variable, the following factors were significantly associated: DAS28 [OR 3.67 (95 % CI 2.43-5.52)], patient VAS [OR 1.04 (95 % CI 1.01-1.08)], and have performed an ultrasound [OR 3.36 (95 % CI 1.47-7.68)]. Factors associated with time to the next scheduled visit (an average of 4.3 months) were patient and physician VAS, DAS28, and centre. In clinical practice, half of the patients with active RA maintain or reduce the treatment. The decision to intensify treatment in active RA as recommended by a treat-to-target strategy is complex in practice.
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http://dx.doi.org/10.1007/s00296-015-3332-zDOI Listing
November 2015

Secondary fracture prevention after femur fractures in the Gran Canaria North Health Area: A 2004-2014 comparison.

Reumatol Clin 2016 Jan-Feb;12(1):58. Epub 2015 May 27.

Unidad de Ortogeriatría Hospital Universitario de Gran Canaria Dr. Negrín Las Palmas de Gran Canaria, España.

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http://dx.doi.org/10.1016/j.reuma.2015.04.003DOI Listing
February 2017

Adjustment in the clinical practice of treat-to-target guidelines for rheumatoid arthritis: Results of the ToARCan study.

Reumatol Clin 2016 Jan-Feb;12(1):34-8. Epub 2015 Apr 11.

Servicio de Reumatología, Hospital Universitario de Gran Canaria Dr. Negrín, Gran Canaria, España. Universidad de Las Palmas de Gran Canaria, Gran Canaria, España.

Objective: To analyze compliance with t2t clinical practice guidelines.

Methods: Cross-sectional observational study in consecutive patients with rheumatoid arthritis (RA) in 5 hospitals in the Canary Islands. Patients filled out activity scales, HAQ and answered the question of whether the doctor had explained the treatment target. The rheumatologist also collected: visits in the past year, use of activity indices and HAQ, DAS28 of current visit and date of the next visit. The percentage of compliance to indicators based on the t2t recommendations (R) 1, 3, 5-7 and 10 was analyzed.

Results: A total of 343 patients were recruited, 77% female, mean age 57, RA duration of 10 years. Median visits in the last year were 3 and mean time between last and current visit was 5.6 months. A total of 93% of the patients were treated with DMARDs and 44% were in remission by DAS (R1). In the previous visit, documented joint count was present in 85%, a HAQ in 19%, patient VAS in 41%, and a DAS28 in 35% of the patients (R6). The next visit was scheduled at an average of 4.3 months (R5). In 64% of patients with DAS28> 3.2 a visit between one and 3 months was scheduled (R5). A total of 96% of patients said they had been informed of the treatment target (R10). Variability between centers existed but was moderate. The only factor determining the performance of a DAS28 in the last visit was the patient's center of origin.

Conclusions: The Canary Island centers studied achieved high levels of remission and low activity in their patients. The performance of composite indices and follow-up frequency recommended by the t2t are met, although there is room for improvement.
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http://dx.doi.org/10.1016/j.reuma.2015.03.003DOI Listing
February 2017

The teaching of rheumatology at the University. The journey from teacher based to student-centered learning.

Reumatol Clin 2015 Jul-Aug;11(4):196-203. Epub 2015 Feb 2.

Servicio de Reumatología, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Universidad de Barcelona, Barcelona, España.

In recent years, university education has undergone profound changes as a result of the creation of the European Space for Higher Education. It has gone from a teacher-centered model, based on the transmission of knowledge through lectures, to being student-centered, based on the acquisition of skills and attaching great importance to independent learning. This transformation involves the need to reorganize academic activity and employ new teaching tools, such as active learning methodologies, more in line with current requirements. In this article, the backbones of the European Space for Higher Education are presented, and diverse experiences of teaching innovation described under Reumacademia and from three Spanish universities.
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http://dx.doi.org/10.1016/j.reuma.2014.12.006DOI Listing
January 2017

Blau syndrome: cross-sectional data from a multicentre study of clinical, radiological and functional outcomes.

Rheumatology (Oxford) 2015 Jun 20;54(6):1008-16. Epub 2014 Nov 20.

Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA, Department of Radiology, Department of Ophthalmology, Catholic University of Leuven (KU Leuven), Leuven, Belgium, Unidad de Reumatologia Pediatrica, Universidad de Barcelona, Barcelona, Spain, Unité d'Immunologie, Hématologie et Rhumatologie Pediatrique, Hospital Necker-Enfants Malades, Inserm U 768, Imagine Foundation, Paris, Rheumatology Practice, Neuilly-sur-Seine, France, Dipartimento di Pediatria, Universita degli Studi di Firenze, Firenze, Italy, Seccion Reumatologia, Universidad de Buenos Aires, Buenos Aires, Argentina, Fundación Biomédica Galicia Sur Hospital Meixoeiro, Hospital do Meixoeiro, Vigo, Spain, Service de Médecine Interne, Hôpital Claude Huriez, Lille, France, Department of Rheumatology, University of Zagreb, Zagreb, Croatia, Department of Paediatrics, Jaslok Hospital, Mumbai, India, Interdisciplinary Uveitis Center, Universitat Klinikum Heidelberg, Heidelberg, Germany, Unidad de Reumatologia Pediatrica, Hospital La Paz, Madrid, Servicio de Rheumatologia, Hospital de Gran Canarias Dr Negrin, Las Palmas, Spain, Instituto de Puericultura e Pediatria Martagao Gesteira (IPPMG), Universidad Federal do Rio de Janeiro, Rio de Janeiro, Brazil, Pédiatrie - Néphrologie, Médecine Interne et Hypertension, Hôpital des Enfants, Toulouse, France, Servicio de Immunologia/Reumatologia, University of Buenos Aires, Buenos Aires, Argentina, Pediatric Clinic, Centre Hospitalier de Luxemburg, Luxembourg, Luxembourg, Division of Pediatrics, Department of Pediatric Immunology and Rheumatology, UMC Utrecht, Utrecht, The Netherlands, Department of Immunology-CDB, Hospital Clinic Barcelona, Spain, Pattern Recognition Receptor Discovery Performance Unit, Immuno-inflammation Therapeutic Area, GlaxoSmithKline, Collegeville, Pennsylvania, USA and Department of Pediatric Rheumatology, Catholic University of Leuven (KU Leuven), Leuven, Belgium

Objective: To report baseline articular, functional and ocular findings of the first international prospective cohort study of Blau syndrome (BS).

Methods: Three-year, multicentre, observational study on articular, functional (HAQ, Childhood HAQ and VAS global and pain), ophthalmological, therapeutic and radiological data in BS patients.

Results: Baseline data on the first 31 recruited patients (12 females and 19 males) from 18 centres in 11 countries are presented. Of the 31 patients, 11 carried the p.R334W NOD2 mutation, 9 the p.R334Q and 11 various other NOD2 missense mutations; 20 patients were sporadic and 11 from five BS pedigrees. Median disease duration was 12.8 years (1.1-57). Arthritis, documented in all but one patient, was oligoarticular in 7, polyarticular in 23. The median active joint count was 21. Functional capacity was normal in 41%, mildly impaired in 31% and moderate-severe in 28% of patients. The most frequently involved joints at presentation were wrists, ankles, knees and PIPs. On radiographs, a symmetrical non-erosive arthropathy was shown. Previously unknown dysplastic bony changes were found in two-thirds of patients. Ocular disease was documented in 25 of 31 patients, with vitreous inflammation in 64% and moderate-severe visual loss in 33%. Expanded manifestations (visceral, vascular) beyond the classic clinical triad were seen in 52%.

Conclusion: BS is associated with severe ocular and articular morbidity. Visceral involvement is common and may be life-threatening. Bone dysplastic changes may show diagnostic value and suggest a previously unknown role of NOD2 in bone morphogenesis. BS is resistant to current drugs, suggesting the need for novel targeted therapies.
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http://dx.doi.org/10.1093/rheumatology/keu437DOI Listing
June 2015

Clinical and immunogenetic factors associated with pneumonia in patients with systemic lupus erythematosus: a case-control study.

J Rheumatol 2014 Sep 1;41(9):1801-7. Epub 2014 Aug 1.

From the Departments of Rheumatology, Respiratory Diseases and Immunology Services and Department of Statistics, Research Unit, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain.I. Rúa-Figueroa, MD; J. Nóvoa, MD, Rheumatology Service; M.I. García-Laorden, PhD, Immunology Service; C. Erausquin, MD, Rheumatology Service; M. García-Bello, PhD, Statistical Department; F. Rodríguez de Castro, MD, Respiratory Diseases Service; E. Herrera-Ramos, PhD, Immunology Service; S. Ojeda, MD; J.C. Quevedo, MD; F. Francisco, MD; A. Naranjo, MD; C. Rodríguez-Lozano, MD, Rheumatology Service; C. Rodríguez-Gallego, PhD, Immunology Service, Hospital Universitario de Gran Canaria Doctor Negrín.

Objective: To determine the incidence of pneumonia and associated factors in a single-center systemic lupus erythematosus (SLE) cohort.

Methods: We included all our SLE patients [1997 American College of Rheumatology (ACR) criteria] with ≥ 1 pneumonia event, and 196 age and sex-matched SLE controls with no pneumonia events. Cumulative clinical data, weighted Systemic Lupus International Collaborating Clinics/ACR damage index (wSLICC/ACR-DI), comorbidities, and risk factors for pneumonia were retrospectively collected. The standardized incidence ratio (SIR) of pneumonia was estimated. Polymorphisms at genes coding for mannose binding lectin (MBL), MBL-associated serine protease 2, Fc-gamma receptors, and surfactant proteins A1, A2, and D were determined, and their potential association with pneumonia was analyzed. Patients with and without pneumonia were compared using a multivariate logistic regression model for adjustment of pneumonia-associated factors.

Results: Thirty-six of 232 patients with SLE had experienced ≥ 1 pneumonia event. SIR for pneumonia was 5.1 (95% CI 3.5-7.4; p < 0.0001). Excluding patients receiving immunosuppressive therapy at the time of pneumonia (13%), associations were found for Katz Severity Index (KSI) (p = 0.016), wSLICC/ACR-DI (p = 0.044), number of SLE criteria (p = 0.005), hospital admissions (p < 0.001), FCGR2A HH genotype (p = 0.03), previous use of immunosuppressive therapy (p = 0.049), cutaneous ulcers (p < 0.001), and vasculitis (p = 0.008) in bivariate analyses. In the multivariate analysis adjusted to previous immunosuppressive treatment, only KSI and FCGR2A HH genotype remained statistically significant (p = 0.05 and p = 0.03, respectively).

Conclusion: The incidence of pneumonia in patients with SLE is higher than that in the general population, and particularly high in severe SLE, regardless of immunosuppressive therapy. The HH genetic variant of FCGR2A appears to predispose patients with SLE to pneumonia.
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http://dx.doi.org/10.3899/jrheum.131470DOI Listing
September 2014

Smoking cessation advice by rheumatologists: results of an international survey.

Rheumatology (Oxford) 2014 Oct 19;53(10):1825-9. Epub 2014 May 19.

Department of Rheumatology, Hospital Universitario de Gran Canaria Dr. Negrin, University of Las Palmas, Las Palmas, Spain, Department of Rheumatology, University of Arkansas for Medical Sciences, Little Rock, AR, USA, Department of Internal Medicine, University of Genova, Genova, Italy, Department of Rheumatology, Chonnam National University Hospital, Gwanju, Republic of Korea, Rheumatology Clinic, Riverside Professional Centre, Sydney, NS, Canada, Rheumatology Centre, East-Tallinn Central Hospital, Tallinn, Estonia, Rheumatic Disease Clinic, Vedanta Institute of Medical Sciences, Ahmedabad, India and Department of Rheumatology, Jyväskyä Central Hospital, Jyväskyä, Finland.

Objective: The aim of this study was to understand practices regarding smoking cessation among rheumatologists for patients with inflammatory rheumatic diseases.

Methods: A survey was sent to the rheumatologists participating in the multinational Quantitative Standard Monitoring of Patients with Rheumatoid Arthritis (QUEST-RA) group. The survey inquired about the clinical practice characteristics and practices regarding smoking cessation (proportion of smokers with inflammatory rheumatic diseases given smoking cessation advice, specific protocols and written advice material, availability of dedicated smoking cessation clinic).

Results: Rheumatologists from 44 departments in 25 countries (16 European) completed the survey. The survey involved 395 rheumatologists, of whom 25 (6.3%) were smokers, and 199 nurses for patient education, of whom 44 (22.1%) were smokers. Eight departments (18.1 %) had a specific protocol for smoking cessation; 255 (64.5%) rheumatologists reported giving smoking cessation advice to all or almost all smokers with inflammatory diseases. In a regression model, early arthritis clinics (P = 0.01) and high gross domestic product countries (P = 0.001) were both independently associated with advice by the rheumatologist. Nurse gives advice to most patients in 11 of the 36 (30.5%) departments with nurses for patient education.

Conclusion: Advice for smoking cessation within rheumatology departments is not homogeneous. In half of the departments, most doctors give advice to quit smoking to all or almost all patients with inflammatory diseases. However, only one in five departments have a specific protocol for smoking cessation. Our data highlight the need to improve awareness of the importance of and better practice implementation of smoking cessation advice for inflammatory rheumatic disease patients.
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http://dx.doi.org/10.1093/rheumatology/keu213DOI Listing
October 2014

Longitudinal practice patterns of prophylaxis of glucocorticoid-induced osteoporosis in patients with polymyalgia rheumatica.

Rheumatol Int 2014 Oct 12;34(10):1459-63. Epub 2014 Apr 12.

Department of Rheumatology, Hospital Universitario Gran Canaria Dr. Negrin, Universidad de Las Palmas de Gran Canaria, La Ballena s/n, 35010, Las Palmas, Spain,

The aim of this study was to analyze the longitudinal practice patterns of prophylaxis of glucocorticoid-induced osteoporosis in patients with polymyalgia rheumatica (PMR). Patients diagnosed with PMR were collected retrospectively in two rheumatology departments. In addition to demographic and diagnostic criteria, the chart review included the following information at baseline and at follow-up: doses of prednisone, prescription of calcium, vitamin D and bisphosphonates, bone mass measurement (BMD) and fragility fractures. We analyzed the percentage of patients undergoing BMD and were prescribed a bisphosphonate over the years. We evaluated 158 patients: 117 of them were women, mean age was 73 years, and they had an average follow-up of 4.8 years. 104 patients (66 %) received osteoporosis medication during the first visit, 44 of them were given bisphosphonate. During follow-up, another 30 treatments with bisphosphonate were added (46 % overall) while 37 cases (23 %) received no treatment with calcium or bisphosphonate. BMD was performed in 111 patients (69 %; 53 % of males and 76 % of females). Factors associated with the use of bisphosphonates were female sex (OR 4.4, 95 % CI 4.02-4.86), BMD (OR 2.4, 95 % CI 2.05-2.78) and commencement of treatment after the year 2005 (54 vs 37 %, OR 1.93, 95 % CI 1.60-2.26). No significant differences were found with age, initial doses of prednisone or the hospital. According to recent prevention guidelines, treatment with biphosphonate should have been administered in more than 90 % of patients. Although prophylaxis of glucocorticoid-induced osteoporosis in patients with PMR has increased in the recent years, many patients do not receive prophylaxis with bisphosphonate during the first visit.
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http://dx.doi.org/10.1007/s00296-014-3014-2DOI Listing
October 2014

[Spanish FRAX(®): pathing the way through walking].

Med Clin (Barc) 2015 Jan 11;144(1):21-3. Epub 2014 Mar 11.

Servicio de Reumatología, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, España.

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http://dx.doi.org/10.1016/j.medcli.2014.01.011DOI Listing
January 2015

Results of a model of secondary prevention for osteoporotic fracture coordinated by rheumatology and focused on the nurse and primary care physicians.

Reumatol Clin 2014 Sep-Oct;10(5):299-303. Epub 2014 Feb 17.

Servicio de Reumatología, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, España.

Objective: To assess the influence of the implementation of a program for secondary prevention of osteoporotic fractures on prescribing bisphosphonates and persistent short-term treatment.

Patients And Methods: Patients >50 years with fragility fracture attended in the emergency department were enrolled in an observational study. The program consisted of: 1) training of primary care physicians, 2) baseline visit: questionnaire on osteoporosis, bone densitometry and patient education, 3) patient referral to primary care, except those with multiple fractures or requiring special study or therapy, who were referred to a specialist, and 4) follow-up by checking prescriptions in electronic records, and a telephone survey. The outcome variable was the percentage of patients who, on having been prescribed bisphosphonates, still adhered to the treatment at 3 months.

Results: Of the 532 patients with inclusion criteria, 202 (39%) refused to participate. Those who refused to take part had a higher mean age (P<.01) and a higher frequency of hip fracture (P<.01) compared with patients who did participate. A total of 330 patients were included for intervention, with a mean age of 71 years, and 254(77%) were female. An antiresorptive was being used by 45 patients (13%) at baseline. After the baseline visit 223 patients (67%) were recommended a bisphosphonate. In the follow-up at 3 months 78% of patients who had been prescribed bisphosphonate were still receiving treatment.

Conclusions: We present a multidisciplinary program for secondary prevention of fractures coordinated by rheumatology in which the number of patients who were receiving bisphosphonate at 3 months increased by four times compared to baseline visit.
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http://dx.doi.org/10.1016/j.reuma.2013.12.007DOI Listing
June 2016