Publications by authors named "Vicenç Torrente-Segarra"

41 Publications

Belimumab in subacute cutaneous lupus erythematosus.

Lupus 2021 Jul 20:9612033211033989. Epub 2021 Jul 20.

Rheumatology Department, Hospital Consorci Sanitari Alt Penedès Garraf (CSAPG), Vilafranca del Penedès, Spain Dermatology Department, Hospital Consorci Sanitari Alt Penedès Garraf (CSAPG), Vilafranca del Penedès, Spain.

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http://dx.doi.org/10.1177/09612033211033989DOI Listing
July 2021

Belimumab in refractory systemic lupus erythematosus pleural effusion.

Med Clin (Barc) 2021 Mar 23. Epub 2021 Mar 23.

Rheumatology Department; Hospital Comarcal Alt Penedès-Garraf (CSAPG), Vilafranca del Penedès, Spain.

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http://dx.doi.org/10.1016/j.medcli.2020.12.036DOI Listing
March 2021

The importance of nailfold capillaroscopy in children with rheumatic diseases.

Clin Exp Rheumatol 2021 Jan-Feb;39 Suppl 128(1):35. Epub 2021 Feb 19.

Paediatric Rheumatology Unit, Hospital Sant Joan de Déu, Esplugues de Llobregat (Barcelona), Spain.

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May 2021

Body Mass Index and Disease Activity in Chronic Inflammatory Rheumatic Diseases: Results of the Cardiovascular in Rheumatology (Carma) Project.

J Clin Med 2021 Jan 20;10(3). Epub 2021 Jan 20.

Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, University of Cantabria, 39008 Santander, Spain.

Objective: Since obesity has been associated with a higher inflammatory burden and worse response to therapy in patients with chronic inflammatory rheumatic diseases (CIRD), we aimed to confirm the potential association between body mass index (BMI) and disease activity in a large series of patients with CIRDs included in the Spanish CARdiovascular in rheuMAtology (CARMA) registry.

Methods: Baseline data analysis of patients included from the CARMA project, a 10-year prospective study of patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS), and psoriatic arthritis (PsA) attending outpatient rheumatology clinics from 67 Spanish hospitals. Obesity was defined when BMI (kg/m) was >30 according to the WHO criteria. Scores used to evaluate disease activity were Disease Activity Score of 28 joints (DAS28) in RA, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) in AS, and modified DAS for PsA.

Results: Data from 2234 patients (775 RA, 738 AS, and 721 PsA) were assessed. The mean ± SD BMI at the baseline visit were: 26.9 ± 4.8 in RA, 27.4 ± 4.4 in AS, and 28.2 ± 4.7 in PsA. A positive association between BMI and disease activity in patients with RA (β = 0.029; 95%CI (0.01- 0.05); = 0.007) and PsA (β = 0.036; 95%CI (0.015-0.058); = 0.001) but not in those with AS (β = 0.001; 95%CI (-0.03-0.03); = 0.926) was found. Disease activity was associated with female sex and rheumatoid factor in RA and with Psoriasis Area Severity Index and enthesitis in PsA.

Conclusions: BMI is associated with disease activity in RA and PsA, but not in AS. Given that obesity is a potentially modifiable factor, adequate control of body weight can improve the outcome of patients with CIRD and, therefore, weight control should be included in the management strategy of these patients.
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http://dx.doi.org/10.3390/jcm10030382DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7864025PMC
January 2021

Multifocal osteonecrosis in systemic lupus erythematosus: Two case reports and literature review.

Eur J Rheumatol 2021 Jan 5;8(1):46-47. Epub 2020 Nov 5.

Department of Rheumatology, Hospital Comarcal Alt Penedès-Garraf (CSAPG), Vilafranca del Penedès, Spain.

Multifocal osteonecrosis (MFO) is an uncommon and disabling condition. A few cases have been described in association of systemic lupus erythematosus (SLE). We describe 2 clinical cases of patients with SLE along with MFO and also perform review of the literature.
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http://dx.doi.org/10.5152/eurjrheum.2020.20013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7861645PMC
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.

Hospital Universitario de Donostia, Guipúzcoa, 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

A comparative study on clinical and serological characteristics between patients with rhupus and those with systemic lupus erythematosus and rheumatoid arthritis.

Lupus 2020 Sep 6;29(10):1216-1226. Epub 2020 Jul 6.

Rheumatology Department, Hospital Clínic, Barcelona, Spain.

Background: The concomitant presence of two autoimmune diseases - systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) - in the same patient is known as rhupus. We evaluated a group of patients with rhupus to clarify further their clinical, serological and immunogenic features in a multi-centre cohort. In addition, the study aimed to explore the utility of the 2019 European League Against Rheumatism/American College of Rheumatology (EULAR/ACR) SLE classification criteria in our group of patients with rhupus.

Methods: This was a cross-sectional study. We included rhupus patients from 11 different rheumatology departments, and compared them to SLE and RA patients at a ratio of 2:1. All information was recorded following a pre-established protocol.

Results: A total of 200 patients were included: 40 rhupus patients and 80 each of SLE and RA patients as controls. Disease duration was similar among SLE and rhupus groups (around 13 years), but the RA group had a significantly lower disease duration. Main clinical manifestations were articular (94.2%), cutaneous (77.5%) and haematological (72.5%). Rhupus patients had articular manifestations similar to those expected in RA. Only 10% of rhupus patients had renal involvement compared with 25% of those with SLE ( < 0.05), while interstitial lung disease was more common in patients affected by RA. The 2019 EULAR/ACR SLE criteria were met in 92.5% of the rhupus patients and in 96.3% of the SLE cohort ( > 0.05). Excluding the joint domain, there were no differences between the numbers of patients who met the classification criteria.

Conclusion: Rhupus patients follow a particular clinical course, with full expression of both SLE and RA in terms of organ involvement, except for a lower prevalence of kidney affection. The new 2019 EULAR/ACR SLE criteria are not useful for differentiating SLE and rhupus patients. A new way of classifying autoimmune diseases is needed to identify overlapping clusters.
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http://dx.doi.org/10.1177/0961203320938456DOI Listing
September 2020

Prevalence and factors associated with osteoporosis and fragility fractures in patients with primary Sjögren syndrome.

Rheumatol Int 2020 Aug 12;40(8):1259-1265. Epub 2020 Jun 12.

Rheumatology Department, Hospital Ramón y Cajal, Madrid, Spain.

This study aimed at determining socio-demographic and clinical factors of primary Sjögren syndrome (pSS) associated with osteoporosis (OP) and fragility fracture. SJOGRENSER is a cross-sectional study of patients with pSS, classified according to American European consensus criteria developed in 33 Spanish rheumatology departments. Epidemiological, clinical, serological and treatment data were collected and a descriptive analysis was conducted. Bivariate and multivariate analyses were performed using a binomial logistic regression to study the factors associated with OP and fragility fracture in pSS. 437 patients were included (95% women, with a median age of 58.6 years). 300 women were menopausal (76.4%). Prevalence of OP was 18.5% [in men (N = 21) this measured 19%]. A total of 37 fragility fractures were recorded. In the multivariate analysis, there was an association between OP and age: in the 51-64 age range (menopausal women), the OR measured 9.993 (95% CI 2301-43,399, p = 0.002); In the age > 64 years group, OR was 20.610 (4.679-90.774, p < 0.001); between OP and disease duration, OR was 1.046 (1.008-1085, p = 0.017); past treatment with corticosteroids, OR 2.548 (1.271-5.105, p = 0.008). Similarly, an association was found between fragility fractures and age: in the 51-64 age group, OR measured 5.068 (1.117-22,995, p = 0.035), age > 64 years, OR was 7.674 (1.675-35,151, p < 0.009); disease duration, OR 1.049 (CI 1.003-1097, p < 0.036) and the ESSDAI index, OR 1.080 (1.029-1134, p = 0.002). Patients with pSS can develop osteoporosis and fragility fractures over the course of the disease. Age, corticosteroids treatment and disease duration were associated with the development of OP. Disease duration and ESSDAI were associated with the development of fractures in patients with pSS.
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http://dx.doi.org/10.1007/s00296-020-04615-3DOI Listing
August 2020

Associated factors to serious infections in a large cohort of juvenile-onset systemic lupus erythematosus from Lupus Registry (RELESSER).

Semin Arthritis Rheum 2020 08 30;50(4):657-662. Epub 2020 May 30.

Rheumatology Department, Complexo Hospitalario Universitario de A Coruña, A Coruña, Spain. Electronic address:

Objective: To assess the incidence of serious infection (SI) and associated factors in a large juvenile-onset systemic lupus erythematosus (jSLE) retrospective cohort.

Methods: All patients in the Spanish Rheumatology Society Lupus Registry (RELESSER) who meet ≥4 ACR-97 SLE criteria and disease onset <18 years old (jSLE), were retrospectively investigated for SI (defined as either the need for hospitalization with antibacterial therapy for a potentially fatal infection or death caused by the infection). Standardized SI rate was calculated per 100 patient years. Patients with and without SI were compared. Bivariate and multivariate logistic and Cox regression models were built to calculate associated factors to SI and relative risks.

Results: A total of 353 jSLE patients were included: 88.7% female, 14.3 years (± 2.9) of age at diagnosis, 16.0 years (± 9.3) of disease duration and 31.5 years (±10.5) at end of follow-up. A total of 104 (29.5%) patients suffered 205 SI (1, 55.8%; 2-5, 38.4%; and ≥6, 5.8%). Incidence rate was 3.7 (95%CI: 3.2-4.2) SI per 100 patient years. Respiratory location and bacterial infections were the most frequent. Higher number of SLE classification criteria, SLICC/ACR DI score and immunosuppressants use were associated to the presence of SI. Associated factors to shorter time to first infection were higher number of SLE criteria, splenectomy and immunosuppressants use.

Conclusions: The risk of SI in jSLE patients is significant and higher than aSLE. It is associated to higher number of SLE criteria, damage accrual, some immunosuppressants and splenectomy.
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http://dx.doi.org/10.1016/j.semarthrit.2020.05.016DOI Listing
August 2020

Correlation of fatigue with other disease related and psychosocial factors in patients with rheumatoid arthritis treated with tocilizumab: ACT-AXIS study.

Medicine (Baltimore) 2019 Jun;98(26):e15947

Medical Department, Roche Farma S.A., Spain.

To assess the hypothesis if tocilizumab (TCZ) is effective on disease activity, and also its effect in fatigue and other clinical and psychological disease-related factors in patients with rheumatoid arthritis (RA) treated with TCZ.A 24-week, multicenter, prospective, observational study in patients with moderate to severe RA receiving TCZ after failure or intolerance to disease-modifying antirheumatic drugs or tumor necrosis factor-alpha was conducted.Of the 122 patients included, 85 were evaluable for effectiveness (85% female, 51.9 ± 12.5 years, disease duration 8.7 ± 7.4 years). Mean change in C-reactive protein level from baseline to week 12 was -11.2 ± 4.0 (P < .001). Mean Disease Activity Index score (DAS28) decreased from 5.5 ± 1.0 at baseline to 2.7 ± 1.3 (P < .001) at week 24. Mean change in Functional Assessment of Chronic Illness Therapy score was -5.4 ± 11.2 points at week 24. Multiple regression analysis showed that the improvement in DAS28, sleep, and depression explained 56% and 47% of fatigue variance at week 12 and 24, respectively.Tocilizumab is effective in reducing disease activity and results in a clinically significant improvement in fatigue, pain, swollen joint count, morning stiffness, sleepiness, depression, and DAS28; the last 3 were specifically identified as factors explaining fatigue variance with the use of TCZ in RA patients.
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http://dx.doi.org/10.1097/MD.0000000000015947DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6617279PMC
June 2019

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

Arthritis Res Ther 2019 04 5;21(1):88. Epub 2019 Apr 5.

Rheumatology Department, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain.

Background: Recent data suggest that anti-TNF doses can be reduced in ankylosing spondylitis (AS) patients. Some authors even propose withdrawing treatment in patients in clinical remission; however, at present there is no evidence to support this.

Objective: To assess how long AS patients with persistent clinical remission remained free of flares after anti-TNF withdrawal and to evaluate the effects of treatment reintroduction. We also analyze the characteristics of patients who did not present clinical relapse.

Methods: Multicenter, prospective, observational study of a cohort of patients with active AS who had received infliximab as a first anti-TNF treatment and who presented persistent remission (more than 6 months). We recorded at baseline and every 6-8 weeks over the 12-month period the age, gender, disease duration, peripheral arthritis or enthesitis, HLA-B27 status, BASDAI, CRP, ESR, BASFI, and three visual analogue scales, spine global pain, spinal night time pain, and patient's global assessment.

Results: Thirty-six out of 107 patients (34%) presented persistent remission and were included in our study. After treatment withdrawal, 21 of these 36 patients (58%) presented clinical relapse during follow-up. Infliximab therapy was reintroduced and only 52% achieved clinical remission, as they had before the discontinuation of infliximab; in an additional 10%, reintroduction of infliximab was ineffective, obliging us to change the anti-TNF therapy. No clinical or biological factors were associated with the occurrence of relapse during the follow-up.

Conclusions: Two thirds of patients in clinical remission presented clinical relapse shortly after infliximab withdrawal. Although the reintroduction of infliximab treatment was safe, half of the patients did not present the same clinical response that they had achieved prior to treatment withdrawal.
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http://dx.doi.org/10.1186/s13075-019-1873-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6451276PMC
April 2019

Spanish Registry of Recent-onset Psoriatic Arthritis (REAPSER study): Aims and methodology.

Reumatol Clin (Engl Ed) 2019 Sep - Oct;15(5):252-257. Epub 2018 Dec 3.

Servicio de Reumatología, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, España.

Aims: To describe the methodology of REAPSER (Spanish Registry of Recent-onset Psoriatic Arthritis), its strengths and limitations. The aim of this study is to identify prognostic factors for the clinical and radiographic course in a cohort of patients with psoriatic arthritis (PsA) diagnosed within 2years of symptom evolution.

Methods: Multicenter, observational and prospective study (with 2-year follow-up including annual visits). Baseline visit intended to reflect patient situation before the disease course was modified by treatments prescribed in rheumatology departments. Patients were invited to participate consecutively in one of their routine visits to the rheumatologist. 211 patients were included. Following data were collected: sociodemographic variables; employment situation; family history; personal history and comorbidities; anthropometric data; lifestyle; use of healthcare services; clinical situation at the time of PsA diagnosis; joint involvement and spinal pain; pain and overall assessment; enthesitis, dactylitis and uveitis; skin and nail involvement; functional situation and quality of life; radiographic evaluation; analytical determinations; treatment; axial and peripheral flare-ups.

Conclusions: The REAPSER study includes a cohort of patients with recent-onset PsA, before the disease course was modified by disease-modifying antirheumatic drugs prescribed in rheumatology departments. Exhaustive information collected in each visit is expected to be an important data source for future analysis.
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http://dx.doi.org/10.1016/j.reuma.2018.09.008DOI Listing
April 2020

Effectiveness and Safety of Rituximab in Systemic Lupus Erythematosus: A Case Series Describing the Experience of 2 Centers.

Reumatol Clin (Engl Ed) 2020 Sep - Oct;16(5 Pt 2):391-395. Epub 2018 Dec 3.

Servicio de Reumatología, Hospital del Mar/Parc de Salut-Mar/IMIM, Barcelona, España.

Background: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that affects multiple organs and systems. B cells have a critical role in the pathogenesis of SLE. Rituximab (RTX) is a drug composed of chimeric monoclonal antibodies against the CD20 protein, producing a depletion of B lymphocytes.

Objective: To analyze the effectiveness and safety of RTX in patients with SLE in clinical practice.

Methods: Collection of retrospective variables of the medical records of 20 patients with SLE treated with RTX in 2hospitals (Hospital de la Santa Creu i Sant Pau, and Hospital del Mar, in Barcelona, Spain). We evaluated demographic, clinical, serological and treatment variables.

Results: There was a statistically significant association in the following variables collected in the study before and after treatment: there was a decrease in the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) (P<.001), erythrocyte sedimentation rate (P=.017), use of glucocorticoids (P=.025) and IgM values (P=.031), as well as an increase in the C4 values (P=.014) after treatment with RTX. A patient with SLE, antiphospholipid syndrome, complex comorbidity and multiorgan lupus involvement died after developing a septic process, months after receiving a single treatment cycle with RTX.

Conclusions: Although RTX currently has no official indication approved for SLE, our data suggest that it may be effective in reducing the activity of the disease and as a steroid-sparing agent, with an acceptable safety profile. However, larger follow-up periods with a greater number of patients are needed to solve the remaining doubts about the use of RTX in SLE.
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http://dx.doi.org/10.1016/j.reuma.2018.08.012DOI Listing
September 2021

Musculoskeletal involvement and ultrasonography update in systemic lupus erythematosus: New insights and review.

Eur J Rheumatol 2018 Jul;5(2):127-130

Rheumatology Unit, Hospital Universitari de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.

Ultrasonography has been rarely used to measure musculoskeletal and joint activity in systemic lupus erythematosus (SLE). The aim of this review is to discuss the utility and reliability of this non-invasive diagnostic tool for the assessment of joint disease in SLE patients. In the last decade, several reports have highlighted the role of ultrasonography for a better evaluation of SLE-related musculoskeletal symptoms. The symptoms have also been associated with worse outcomes in SLE; therefore, it is essential to seek useful and accessible techniques for better understanding of such patients who are insufficiently assessed by standard physical examination.
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http://dx.doi.org/10.5152/eurjrheum.2017.17198DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6072693PMC
July 2018

Linear localized morphea associated with golimumab in a patient with spondyloarthritis.

Reumatol Clin (Engl Ed) 2020 Jul - Aug;16(4):303-305. Epub 2018 Aug 14.

Servicio de Reumatología, Hospital Comarcal Alt Penedès, Vilafranca del Penedès, Barcelona, España.

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http://dx.doi.org/10.1016/j.reuma.2018.06.003DOI Listing
August 2021

Common measure of quality of life for people with systemic sclerosis across seven European countries: a cross-sectional study.

Ann Rheum Dis 2018 07 20;77(7):1032-1038. Epub 2018 Feb 20.

Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.

Objectives: The aim of this study was to adapt the Systemic Sclerosis Quality of Life Questionnaire (SScQoL) into six European cultures and validate it as a common measure of quality of life in systemic sclerosis (SSc).

Methods: This was a seven-country (Germany, France, Italy, Poland, Spain, Sweden and UK) cross-sectional study. A forward-backward translation process was used to adapt the English SScQoL into target languages. SScQoL was completed by patients with SSc, then data were validated against the Rasch model. To correct local response dependency, items were grouped into the following subscales: function, emotion, sleep, social and pain and reanalysed for fit to the model, unidimensionality and cross-cultural equivalence.

Results: The adaptation of the SScQoL was seamless in all countries except Germany. Cross-cultural validation included 1080 patients with a mean age 58.0 years (SD 13.9) and 87% were women. Local dependency was evident in individual country data. Grouping items into testlets corrected the local dependency in most country specific data. Fit to the model, reliability and unidimensionality was achieved in six-country data after cross-cultural adjustment for Italy in the social subscale. The SScQoL was then calibrated into an interval level scale.

Conclusion: The individual SScQoL items have translated well into five languages and overall, the scale maintained its construct validity, working well as a five-subscale questionnaire. Measures of quality of life in SSc can be directly compared across five countries (France, Poland Spain, Sweden and UK). Data from Italy are also comparable with the other five countries although require an adjustment.
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http://dx.doi.org/10.1136/annrheumdis-2017-212412DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6029637PMC
July 2018

Bone mineral density and vitamin D status in systemic lupus erythematosus (SLE): A systematic review.

Autoimmun Rev 2017 Nov 9;16(11):1155-1159. Epub 2017 Sep 9.

Hospital del Mar/Parc de Salut-Mar/IMIM, Barcelona, Spain. Electronic address:

Despite the improvement in the quality of life of patients with SLE due to scientific and technological advances, SLE remains a disease that over the years may produce irreversible damage to patients. Osteoporosis and secondary bone fractures are two of the major causes of irreparable injury in patients with SLE. Vitamin D insufficiency may play a vital role both in reduced bone mineral density (BMD) and in the appearance of fractures, although its mechanisms of action are still unclear. We performed a systematic review of the literature in order to determine the prevalence and predictors of reduced vitamin D plasma levels, bone loss and the presence of fractures in SLE patients. Our review encompassed all English-language publications using Medline and EMBase electronic databases from their inception (1966 and 1980, respectively) to December 2016. We included all intervention studies and observational studies in which vitamin D plasma levels, BMD and bone loss were measured and applied to patients with SLE. Previous studies suggested an increase in bone loss and fracture in patients with SLE compared with general population and although there is a high prevalence of vitamin D insufficiency in the general population, previous studies had demonstrated lower vitamin D levels in patients with SLE compared to age-matched controls. The etiology of reduced bone mass and reduced vitamin D plasma levels in SLE is multifactorial and includes a variety of intrinsic factors related to the disease itself and treatment side effects. SLE patients are at risk for developing these two comorbidities (reduced vitamin D plasma levels and low BMD) and it is therefore essential to study, monitor, prevent and treat bone metabolism disorders in SLE patients.
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http://dx.doi.org/10.1016/j.autrev.2017.09.011DOI Listing
November 2017

Juvenile- and adult-onset systemic lupus erythematosus: a comparative study in a large cohort from the Spanish Society of Rheumatology Lupus Registry (RELESSER).

Clin Exp Rheumatol 2017 Nov-Dec;35(6):1047-1055. Epub 2017 Jun 12.

Department of Rheumatology, Complexo Hospitalario Universitario de Vigo, Instituto de Investigación Sanitaria Galicia Sur (IISGS), Vigo, Spain.

Objectives: We aimed to describe juvenile-onset systemic lupus erythematosus (jSLE) features and to establish its differences compared to adult-onset SLE (aSLE) from a large national database.

Methods: Data from patients (≥4 ACR criteria) included in Spanish Society of Rheumatology Lupus Registry (RELESSER) were analysed. Sociodemographic, clinical, serological, activity, treatment, cumulative damage, comorbidities and severity data were collected. Patients with disease onset <18 years were described and compared to those with disease onset ≥18 years.

Results: We reviewed 3,428 aSLE patients (89.6% women) and 484 jSLE patients (89.8% girls), 93% Caucasian (both groups). Mean age at diagnosis was 38.1±14 and 16.6±6.3 years (p<0.001) and mean age at the end of follow-up was 48.8±14.3 and 31.5±30 years (p<0.001), respectively. jSLE showed significantly more clinical (including lymphadenopathy, fever, malar rash, mucosal ulcers, pericarditis, pleuritis, Raynaud's phenomenon, lupus nephritis, recurrent nephritis, histologic nephritis changes, thrombocytopenia, haemolytic anaemia, thrombotic thrombocytopenic purpura, seizures, lupus headache and organic brain syndrome) and immunological (a-dsDNA and a-Sm antibodies, hypocomplementaemia) involvement than did aSLE, except for secondary Sjögren's syndrome, a-Ro antibodies, fibromyalgia and osteoporosis. jSLE also showed more SLE family history, longer diagnosis delay, higher SLEDAI and Katz scores, but lower Charlson scores than aSLE. Several specific domains were more frequently involved in SLICC/ACR DI in jSLE. jSLE patients more frequently underwent all SLE-related treatment and procedures, as well as dialysis and kidney transplantations.

Conclusions: jSLE shares many clinical and serological features with aSLE. However, jSLE patients typically manifested more activity, severity, cumulative damage in certain areas, than their aSLE counterparts.
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March 2018

Fibromyalgia prevalence and associated factors in primary Sjögren's syndrome patients in a large cohort from the Spanish Society of Rheumatology registry (SJOGRENSER).

Clin Exp Rheumatol 2017 May-Jun;35 Suppl 105(3):28-34. Epub 2017 Feb 24.

Research Unit, Spanish Society of Rheumatology, Madrid, Spain.

Objectives: To assess fibromyalgia (FM) prevalence in a large cohort of primary Sjögren's syndrome patients (pSS) from a National Database.

Methods: Data included in the national retrospective register of pSS patients of the Spanish Society of Rheumatology (SJOGRENSER) were analysed.

Results: 437 pSS patients were included and a 14.6% of FM prevalence was found. FM-pSS patients significantly showed more constitutional, fatigue and arthralgia symptoms, splenomegaly, genital, skin and ear involvement and dyslipidaemia (p<0.05), as well as higher ESSPRI and SSDAI scores (p<0.01). Several symptomatic treatments were more frequently used in FM-pSS patients. No differences were observed in laboratory markers, imaging techniques or histologic inflammatory findings. Patients with FM showed statistically more fatigue than pSS without FM. In the multivariate logistic regression analysis several features were associated to pSS-FM patients.

Conclusions: We show data on a reliable prevalence of FM in pSS patients and its multiple associated factors along with the presence of higher disease activity scores than patients who did not show FM. The presence of fatigue, arthralgia, constitutional symptoms and dyslipidaemia were more likely to coexist in pSS-FM patients.
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August 2017

Suitability of High-resolution Ultrasound-guided Puncture in the Diagnosis of a Soft Tissue Mass Infected With Mycobacterium tuberculosis.

Reumatol Clin (Engl Ed) 2018 May - Jun;14(3):171-172. Epub 2017 Feb 13.

Servei de Reumatologia, Hospital Moisès Broggi/Hospital General de L'Hospitalet, Consorci Sanitari Integral (CSI), Sant Joan Despí/L'Hospitalet, Barcelona, España.

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http://dx.doi.org/10.1016/j.reuma.2016.12.005DOI Listing
May 2019

Prevalence and predictors of vitamin D insufficiency in supplemented and non-supplemented women with systemic lupus erythematosus in the Mediterranean region.

Rheumatol Int 2016 Jul 27;36(7):975-85. Epub 2016 May 27.

Rheumatology Department, Parc de Salut Mar, IMIM, Department of Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Catalunya, Spain.

It has been previously reported that vitamin D deficiency is more prevalent among SLE patients than in the general population. We sought to determine the prevalence of vitamin D insufficiency and deficiency and their related factors, its relationship to SLE symptoms and disease activity on a group of supplemented and non-supplemented female SLE patients from the Mediterranean region. We performed a cross-sectional study including female SLE patients who regularly attended the outpatient Lupus Unit at Parc de Salut Mar-IMAS in Barcelona, from January 2012 to May 2014. Collected data were sociodemographics, vitamin D supplementation, fatigue degree visual analog scale, pharmacological treatment, main SLE serological markers, indexes, scales and plasma levels of 25-hydroxyvitamin D. One hundred and two consecutive female SLE patients were included. Vitamin D overall insufficiency and deficiency were exhibited by 46 and 22.5 % of patients, respectively. Vitamin D insufficiency was found in 50 % of supplemented and 60 % of non-supplemented patients. Among non-supplemented female SLE patients, it was found that patients with vitamin D insufficiency showed more fatigue (p = 0.009) and received more oral corticosteroids (p = 0.02) than those with normal levels. Patients with vitamin D insufficiency (supplemented and non-supplemented) received more oral corticosteroids than those without insufficiency (p = 0.008). Vitamin D insufficiency is highly prevalent among female SLE patients, even in southern regions. Non-supplemented female SLE patients showed more fatigue and received more oral corticosteroids than those with normal levels of vitamin D. These data were not found in supplemented patients although having a high prevalence of vitamin D insufficiency (up to 50 %). Further studies with longer follow-up and larger population are needed to confirm our observations.
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http://dx.doi.org/10.1007/s00296-016-3497-0DOI Listing
July 2016

Nailfold Capillary Patterns in a Patient With Multicentric Reticulohistiocytosis and Raynaud Phenomenon.

J Clin Rheumatol 2016 Jun;22(4):220-1

From the *Servei de Reumatologia and †Servei de Dermatologia; and Hospital Moisès Broggi (CSI), Sant Joan Despí, Barcelona, Catalonia, Spain.

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http://dx.doi.org/10.1097/RHU.0000000000000270DOI Listing
June 2016

Relationship between damage clustering and mortality in systemic lupus erythematosus in early and late stages of the disease: cluster analyses in a large cohort from the Spanish Society of Rheumatology Lupus Registry.

Rheumatology (Oxford) 2016 07 27;55(7):1243-50. Epub 2016 Mar 27.

Rheumatology Department, University Hospital Complex of Vigo.

Objectives: To identify patterns (clusters) of damage manifestations within a large cohort of SLE patients and evaluate the potential association of these clusters with a higher risk of mortality.

Methods: This is a multicentre, descriptive, cross-sectional study of a cohort of 3656 SLE patients from the Spanish Society of Rheumatology Lupus Registry. Organ damage was ascertained using the Systemic Lupus International Collaborating Clinics Damage Index. Using cluster analysis, groups of patients with similar patterns of damage manifestations were identified. Then, overall clusters were compared as well as the subgroup of patients within every cluster with disease duration shorter than 5 years.

Results: Three damage clusters were identified. Cluster 1 (80.6% of patients) presented a lower amount of individuals with damage (23.2 vs 100% in clusters 2 and 3, P < 0.001). Cluster 2 (11.4% of patients) was characterized by musculoskeletal damage in all patients. Cluster 3 (8.0% of patients) was the only group with cardiovascular damage, and this was present in all patients. The overall mortality rate of patients in clusters 2 and 3 was higher than that in cluster 1 (P < 0.001 for both comparisons) and in patients with disease duration shorter than 5 years as well.

Conclusion: In a large cohort of SLE patients, cardiovascular and musculoskeletal damage manifestations were the two dominant forms of damage to sort patients into clinically meaningful clusters. Both in early and late stages of the disease, there was a significant association of these clusters with an increased risk of mortality. Physicians should pay special attention to the early prevention of damage in these two systems.
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http://dx.doi.org/10.1093/rheumatology/kew049DOI Listing
July 2016

VARIAR Study: Assessment of short-term efficacy and safety of rituximab compared to an tumor necrosis factor alpha antagonists as second-line drug therapy in patients with rheumatoid arthritis refractory to a first tumor necrosis factor alpha antagonist.

Reumatol Clin 2016 Nov - Dec;12(6):319-322. Epub 2016 Jan 29.

Hospital Santa Creu i Sant Pau, Barcelona, España.

Objective: to compare the short-term efficacy and safety of rituximab (RTX) therapy versus anti-TNF in rheumatoid arthritis (RA) patients after discontinuation of a first anti-TNF agent.

Methods: prospective observational multicenter study in the clinical practice setting, involving patients with severe RA refractory to a first anti-TNF agent, who received either RTX or a second anti-TNF (2TNF), comparing the efficacy endpoints, EULAR response (Good/Moderate) and safety at 6 months.

Results: 103 patients enrolled, 82 completed 6-month follow-up, 73.7% women. Baseline data for RTX and 2TNF groups, respectively: TJC, 8.6 and 6.6; SJC, 8.8 and 7.5; DAS28 score, 5.45 (±1.28) and 5.18 (±1.21) (p=0.048), ESR, 41 and 38.7mmHg; and HAQ, 1.2 and 1.0. Improvement was observed in all parameters, with no significant differences (except for a more marked reduction in ESR with RTX). There were no serious adverse events.

Conclusions: RTX use as second-line therapy after anti-TNF failure led to improvements in the efficacy and functional variables at 6 months, with no serious adverse events. These results were comparable to those observed in patients who used a second anti-TNF agent in the same clinical scenario.
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http://dx.doi.org/10.1016/j.reuma.2015.11.019DOI Listing
April 2017

Active tenosynovitis of the palmar flexor tendon in psoriatic arthritis in clinical remission.

Reumatol Clin 2016 Jul-Aug;12(4):230-2. Epub 2016 Jan 6.

Servicio de Reumatología, Hospital Moisès Broggi-General, Hospitalet del Llobregat, Barcelona, España.

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http://dx.doi.org/10.1016/j.reuma.2015.10.005DOI Listing
April 2017

Tuberculosis in pediatric patients treated with anti-TNFα drugs: a cohort study.

Pediatr Rheumatol Online J 2015 Dec 3;13:54. Epub 2015 Dec 3.

Pediatric Infectious Diseases Unit, Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Passeig Sant Joan de Déu 2, 08950, Esplugues de Llobregat, Spain.

Background: Adult patients receiving anti-TNFα drugs are at increased risk of tuberculosis (TB), but studies in pediatric populations are limited, and the best strategy for latent tuberculosis infection (LTBI) screening in this population remains controversial. We describe the prevalence of LTBI prior to anti-TNFα therapy and the long-term follow-up after biological treatment initiation in a cohort of children and adolescents.

Methods: Cohort observational study in children and adolescents receiving anti-TNFα agents in a tertiary-care pediatric hospital. LTBI was ruled out prior to the implementation of anti-TNFα drugs by tuberculin skin test (TST), and, from March 2012 on, QuantiFERON Gold-In Tube test (QTF-G). During anti-TNFα treatment, patients were evaluated every 6 months for TB with history and physical examination. TST/QTF-G were not repeated unless signs or symptoms consistent with TB arose or there was proven TB contact.

Results: The final cohort consisted of 221 patients (56.1% female; 261 treatments), of whom 51.7%/30.0%/17.3% were treated with etanercept/adalimumab/infliximab, respectively, for a variety of rheumatic diseases (75.6%), inflammatory bowel disease (20.8%), and inflammatory eye diseases (3.6%). The median (IQR) age at diagnosis of the primary condition was 6.8 years (2.7-11.0) and the duration of the disease before implementing the anti-TNFα agent was 1.8 years (0.6-4.2). LTBI was diagnosed in 3 adolescent girls (prevalence rate: 1.4%; 95% CI: 0.4-4.2) affected with juvenile idiopathic arthritis: TST tested positive in only 1, while QTF-G was positive in all cases (including 2 patients already on etanercept). They all received antiTB chemoprophylaxis and were later (re)treated with etanercept for 24-29 months, without incidences. No incident cases of TB disease were observed during the follow-up period under anti-TNFα treatment of 641 patients-year, with a median (IQR) time per patient of 2.3 years (1.4-4.3).

Conclusions: In our study, the prevalence of LTBI (1.4%) was similar to that reported in population screening studies in Spain; no incident cases of TB disease were observed. In low-burden TB settings, initial screening for TB in children prior to anti-TNFα treatment should include both TST and an IGRA test, but systematic repetition of LTBI immunodiagnostic tests seems unnecessary in the absence of symptoms or known TB contact.
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http://dx.doi.org/10.1186/s12969-015-0054-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4669612PMC
December 2015

Nailfold capillaroscopic findings in primary Sjögren's syndrome with and without Raynaud's phenomenon and/or positive anti-SSA/Ro and anti-SSB/La antibodies.

Rheumatol Int 2016 Mar 23;36(3):365-9. Epub 2015 Nov 23.

Service of Rheumatology, Hospital de Sant Joan Despí Moisés Broggi-Hospital General Hospitalet, Consorci Sanitari Integral (CSI), Avda. Jacint Verdaguer 90, 08970, Sant Joan Despí, Barcelona, Catalonia, Spain.

The aim of this study was to assess nailfold capillaroscopic (NC) findings in patients with primary Sjögren's syndrome (PSS) with and without Raynaud's phenomenon (RP) as well as in the presence of positive anti-SSA/Ro and anti-SSB/La antibodies. Videocapillaroscopy was performed in 150 patients with PSS. Data collected included demographics, presence of RP, PSS symptoms, antinuclear antibodies, rheumatoid factor, anti-Ro, anti-La, anti-CCP, salivary scintigraphy, labial biopsy, and NC findings. RP was present in 32% of PSS, keratoconjunctivitis sicca in 91%, oral xerosis in 93%, and skin or genital xerosis in 53%. In patients with positive anti-SSA/Ro (75%) and positive anti-SSB/La (40%), NC showed normal findings in 53% of cases and non-specific in 36%. In patients with PSS, NC was normal in 51% of cases and non-specific in 34%. Scleroderma pattern was found in 14 patients. RP associated with PSS had non-specific capillaroscopy in 40% of cases (p = 0.1). Pericapillary haemorrhages (p = 0.06) and capillary thrombosis (p = 0.2) were not increased, but more dilated capillaries were detected in 48% of cases. Patients with positive anti-Ro and/or anti-La have not a distinct NC profile. Patients with RP associated with PSS had more dilated capillaries, but neither pericapillary haemorrhages nor capillary thrombosis was observed.
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http://dx.doi.org/10.1007/s00296-015-3396-9DOI Listing
March 2016
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