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Patients with rheumatoid arthritis (RA) have a significantly increased risk of sexual dysfunction. However, it is not properly included in commonly used questionnaires to assess health-related quality of life in RA. Qualisex is a questionnaire developed in France to assess the impact of RA on patients ' sexual function. Our aim was to adapt and validate this questionnaire for use with Spanish RA patients. Two independent translations and a backward translation were obtained. The final version was tested in a pilot study with 10 RA patients to detect any aspects that could hinder interpretation. The validity and reliability of the linguistically validated questionnaire were studied in a multicenter cross-sectional study, with a longitudinal component for reliability estimation. 125 RA patients were included. The response process, discrimination, internal consistency, internal structure, convergent validity (correlation with MGH-SFQ questionnaire, DAS-28, physician global assessment, patient global health assessment, RAID, HAQ, HADS and SF-12(C)) and reliability were analyzed. The inclusion of two extra items was proposed in the pilot study. The validity analysis detected responses for item 10 that were not coherent with responses for the rest of items. The Cronbach alpha coefficient was 0.971. The highest correlation (0.665) was obtained with MGH-SFQ (questionnaire measuring sexual functioning), followed by RAID (0.516). The intra-class correlation was 0.880 (95% CI 0.815; 0.923), higher than 0.85, which indicates excellent reliability. All parameters used to assess this questionnaire show highly acceptable values. Qualisex allows for a global score of RA patients' sexual functioning and can be self-administered.

Objectives: To explore current evidence on the management of poor prognostic factors in rheumatoid arthritis (RA) and to investigate whether this evidence is taken into account by clinicians when deciding on treatment in daily clinical practice. Methods: We performed a systematic literature review (SLR) to analyse the effects of currently available biologic disease-modifying antirheumatic drugs (bDMARDs) and Janus kinase inhibitors (JAKi) on the classically accepted poor prognostic factors of RA. All randomized controlled trials reporting subgroup analyses about effects on prognostic factors were identified and synthesized. In a second phase, a two round Delphi survey was carried out to contrast the SLR results with the grade of agreement of a large group of rheumatologists about the effectiveness of each drug class on each prognostic factor. Results: According to the Delphi results, the only prognostic factor that significantly influenced the selection of treatment was the presence of interstitial lung disease (ILD), being the preferred treatment in this scenario abatacept or rituximab. The rest of the poor prognostic factors (including high disease activity at baseline, disability as measured by the Health Assessment Questionnaire index, seropositivity, elevated acute-phase reactants, and evidence of erosions based on plain radiography or ultrasonography) did not seem to significantly influence rheumatologists when choosing a treatment. The results of the SLR results did not show solid evidence regarding the use of any specific therapy in the management of patients with specific poor factors, except in the case of RA-ILD, although the data in the literature in this regard are not free of bias. Conclusions: The only prognostic factor that seems to significantly influence the selection of treatment is the presence of RA-ILD. (C) 2021 Societe francaise de rhumatologie. Published by Elsevier Masson SAS.

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 = 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. (C) 2020 Elsevier Inc. All rights reserved.

Objectives: In the ARCO study, adherence to subcutaneous biological agents by patients with rheumatoid arthritis improved with monthly administration. We assess whether adherence can be related to fulfillment of expectations and satisfaction with treatment. Patients and methods: Adherence was assessed by calculating the Medication Possession Ratio, and satisfaction and fulfillment of expectations using the EXPRESAR group questionnaire. Results: In 346 patients, those who were satisfied/very satisfied with efficacy and tolerability were >80% and 64.4%, with no differences between weekly, biweekly or monthly administration regimens. Regarding the fulfillment of expectations, 59.9% considered the effect of the treatment greater than expected and 52.6% reported lower/much lower than expected discomfort; the latter percentage was higher in patients with monthly administration (P=.049). The percentages for nonadherence were 15.6% (discomfort greater than expected), 18.5% (expected discomfort) and 11.1% (lower than expected or no discomfort) (P=.189). Conclusions: Satisfaction and fulfillment of expectations were high. Fulfillment of expectations of tolerability was better with monthly administration, which could contribute to better adherence. 2018 Sociedad Espanola de Reumatologia y Colegio Mexicano de Reumatologia. Published by Elsevier Espana, S.L.U. All rights reserved.

Objective. To examine the grade of agreement between very low disease activity (VLDA) and Disease Activity Index for Psoriatic Arthritis (DAPSA) remission, as well as their association with the effect of the disease as assessed by the Psoriatic Arthritis Impact of Disease (PsAID) questionnaire in patients with psoriatic arthritis in routine clinical practice. Methods. Posthoc analysis of data from a cross-sectional multicenter study. Patients were included who fulfilled the Classification for Psoriatic Arthritis (CASPAR) criteria with at least 1 year of disease duration and were treated with biological and/or conventional synthetic disease-modifying antirheumatic drugs according to routine clinical practice in Spain. Patients were considered in VLDA if they met 7/7 of the minimal disease activity criteria. DAPSA and clinical (c) DAPSA score

The objective of this study was to evaluate the impact of digital ulcers (DUs) in daily life of systemic sclerosis (SSc) Spanish patients. We developed a multicenter observational study to compare functional disability in SSc patients with active DUs vs. those without DUs. An additional correlation between perception of patients and physicians on disability due to DUs was performed. A total of 199 patients were enrolled, 70 (35%) with DUs. Patients with DUs were younger (48 vs. 58 years; p < 0.001) and had more frequently the diffuse subtype of SSc (45 vs. 24%; p = 0.004) than patients without DUs. Patients with DUs showed significantly higher scores in the Cochin Hand Function Scale overall (p < 0.002) and for each of its five dimensions. They also showed higher scores in the Systemic Sclerosis Health Assessment Questionnaire items related to hand function such as, dress and self-care (p < 0.013), eat (p < 0.013) and grip (p < 0.03), and higher Visual Analogic Scale scores for pain (p < 0.013), trouble related with Raynaud's Phenomenon (p < 0.001) and sense of severity (p < 0.004). Impact on daily activities was significantly higher in patients with DUs (p = 0.002), with a non-significant trend to experience higher impact on work productivity (p = 0.07). A high correlation was found between DUs patients and physicians opinion on the impact of DUs (daily life: Pearson R = 0.86; work productivity: Pearson R = 0.87). Study findings show an impaired hand function and increased disability for daily life activities and work productivity in SSc patients with DUs compared with patients without DUs in Spanish population.

Objective Cardiovascular (CV) disease is one of the main causes of morbi-mortality in spondyloarthritis (SpA), partially explained by traditional CV risk factors. Information on lipoprotein(a) [Lp(a)], a non-conventional risk factor, in SpA is scarce. In this study we assessed the prevalence of hyperlipoproteinaemia(a) in SpA patients and analysed the possible related factors. Methods A baseline analysis was made of ankylosing spondylitis (AS) and psoriatic arthritis (PsA) patients and controls included in the CARMA project (CARdiovascular in RheuMAtology), a 10-year prospective study evaluating the risk of CV events in chronic inflammatory rheumatic diseases. A multivariate logistic regression model was performed using hyperlipoproteinaemia( a) (Lp(a) >50 mg/dl) as a dependent variable and adjusting for confounding factors. Results 19.2% (95% CI: 16.80-22.05) of the SpA patients [20.7% (95% CI: 16.91-24.82) of those with AS and 17.7% (95% CI: 14.15-21.75) of those with PsA] and 16.7% (95% CI: 13.23-20.86) of the controls had hyperlipoproteinaemia(a) (p=0.326). Adjusting for age and sex, SpA patients were more likely to have hyperlipoproteinaemia(a) than controls (OR: 1.43, 95% CI: 1.00-2.04; p=0.05), especially those with AS (OR: 1.81, 95% CI: 1.18-2.77; p=0.007). In the adjusted model, apolipoprotein B in all patients, non-steroidal anti-inflammatory drugs in AS, and female sex in PsA, were associated with hyperlipoproteinaemia(a). No disease-specific factors associated with hyperlipoproteinaemia(a) were identified. Conclusion SpA patients show a moderately increased risk of hyperlipoproteinaemia(a) compared to controls, especially those with AS. Lp(a) determination may be of interest to improve the CV risk assessment in SpA patients.

Objective: To evaluate the impact of gender in the quality of life (QOL) of rheumatoid arthritis (RA) patients and the factors associated with such effect. Methods: Seventy RA patients of each gender were cross-sectionally evaluated as per pre-established protocol: medical history review, standardized disease severity measurements, and comprehensive psychological and disease-related behaviors and coping strategies assessment. QOL was assessed with the SF-36 questionnaire. Univariable and multivariable analyses were performed to examine the contribution of gender and other variables to QOL. Results: Both groups were comparable regarding age at diagnosis, disease duration, disease activity, and radiological damage. Women showed higher functional impairment (mHAQ: 0.89 ± 2.6 vs. 0.22±0.9, p=0.04), higher prevalence of depression and of osteoporosis, as well as higher scores in the Beck scale (10.7 ± 7.52 vs. 7.8 ± 6.8, p=0.016) but not in other psychological and behavioral variables. In the SF-36, women also showed a greater impairment than men in physical functioning (PF) (57.7 ± 22.1 vs. 67.3 ± 22.7; p=0.01), general health (GH) (41.3 ± 21.7 vs. 50.0 ± 24.3, p=0.02), mental health (MH) (63.7 ± 22.0 vs. 71.8 ± 21.1, p=0.02) and physical component summary score (PCS) (39.3 ± 8.9 vs. 42.4 ± 9.3, p=0.04). Female gender remained significantly associated with poorer PF in multivariable analysis even after adjusting for the Beck Scale (p=0.08), and osteoporosis (p=0.09). Conclusions: Female RA patients have lower QOL levels than their male counterparts. Depression and osteoporosis may play an important role in this effect. These data should be taken into account in the management of these patients. Main findings -Gender medicine is a new paradigm of studying chronic diseases. -RA patients of both genders present similar biological and immunological features but women experience poorer QOL. -This is the first study on gender differences in RA examining two sets of RA patients evaluated comprehensively using a standardized protocol inclusive of clinical, ancillary, functional, QOL and psychosocial variables.

Objective Regular physical activity is associated with decreased morbidity and mortality. Traditionally, patients with rheumatoid arthritis (RA) have been advised to limit physical exercise. We studied the prevalence of physical activity and associations with demographic and disease-related variables in patients with RA from 21 countries. Methods The Questionnaires in Standard Monitoring of Patients with Rheumatoid Arthritis (QUEST-RA) is a cross-sectional study that includes a self-report questionnaire and clinical assessment of nonselected consecutive outpatients with RA who are receiving usual clinical care. Frequency of physical exercise (≥30 minutes with at least some shortness of breath, sweating) is queried with 4 response options: ≥3 times weekly, 1–2 times weekly, 1–2 times monthly, and no exercise. Results Between January 2005 and April 2007, a total of 5,235 patients from 58 sites in 21 countries were enrolled in QUEST-RA: 79% were women, >90% were white, mean age was 57 years, and mean disease duration was 11.6 years. Only 13.8% of all patients reported physical exercise ≥3 times weekly. The majority of the patients were physically inactive with no regular weekly exercise: >80% in 7 countries, 60–80% in 12 countries, and 45% and 29% in 2 countries, respectively. Physical inactivity was associated with female sex, older age, lower education, obesity, comorbidity, low functional capacity, and higher levels of disease activity, pain, and fatigue. Conclusion In many countries, a low proportion of patients with RA exercise. These data may alert rheumatologists to motivate their patients to increase physical activity levels.

Objective. To evaluate the utility of the duration of morning stiffness (MS), as a patient-reported outcome (PRO), in assessing rheumatoid arthritis (RA) disease activity. Methods. We acquired information on 5439 patients in QUEST-RA, an international database of patients with RA evaluated by a standard protocol. MS duration was assessed from time of waking to time of maximal improvement. Ability of MS duration to differentiate RA activity states, based on Disease Activity Score (DAS)28, was assessed by analysis of variance; and a receiver-operating characteristic (ROC) curve was plotted for discriminating clinically active (DAS28 > 3.2) from less active (DAS28 ≤ 3.2) RA. Mixed-effect analysis of covariance (ANCOVA) models were used to assess the utility of adding MS duration to Routine Assessment of Patient Index Data (RAPID)3, a PRO index based on physical function, pain, and general health (GH), in predicting the 3-variable DAS28 (DAS28v3). Results. MS duration had moderate correlation (r = 0.41-0.48) with pain, Health Assessment Questionnaire, and GH; and weak correlation (r = 0.23-0.39) with joint counts and erythrocyte sedimentation rate. MS duration differed significantly among patients with different RA activity (p < 0.001). The area under the ROC curve of 0.74 (95% CI 0.72-0.75) showed moderate ability of MS duration to differentiate clinically active from less active RA. ANCOVA showed significant interactive effects between RAPID3 and theMS duration categories (p = 0.0005) in predicting DAS28v3. The effect of MS was found to be clinically important in patients with the low RAPID3 scores (< 6) in whom the presence of MS may indicate clinically active disease (DAS28v3 > 3.2). Conclusion. MS duration has a moderate correlation with RA disease activity. Assessment of MS duration may be clinically helpful in patients with low RAPID3 scores. The Journal of Rheumatology Copyright © 2009. All rights reserved.

Annual European Congress of Rheumatology (EULAR 2006), Jun 21-24, 2006, Amsterdam, Netherlands

Temporal artery (TA) biopsy is required for the evaluation of several clinical scenarios because of the therapeutic implications of a positive result. We describe the experience of our department, which is the center for this technique in our hospital.A retrospective study was made of all TA biopsies performed in the Department of Otolaryngology, Hospital Sierrallana, from January 1995 to April 1997.Thirty-four biopsies of the TA artery were performed in 33 patients for possible temporal arteritis. Mean age was 76 years (range: 61-87 years). Twelve were male and 21 female. Twenty-two patients (66.6%) had recent onset cephalalgia, 11 (33.3%) polymyalgia rheumatica, 5 (15.1%) mandibular claudication, and 8 (24.2%) ocular symptoms. In 75.8% ESR was elevated. An abnormal TA exam was observed in 9 cases (27.3%), 6 of which had a positive biopsy. Only 1 of the 15 patients without local findings at the physical examination had a positive TA biopsy. No information on the physical exam was recorded for the other 2 patients with a positive biopsy.TA biopsy is a relatively easy surgical procedure with a very low rate of complications. An abnormal physical TA examination correlates with a positive histopathological study.