Search

Objective To update the recommendations on osteoporosis (OP) of the Spanish Society of Rheumatology (SER) based on the best possible evidence. Methods A panel of nine expert rheumatologists in OP was created, previously selected by the SER through an open call. The phases of the work were: identification of the key areas for updating the previous consensus, analysis and synthesis of the scientific evidence (using the SIGN levels of evidence) and formulation of recommendations based on this evidence and consensus techniques. Results This revision of the recommendations implies an update in the diagnostic evaluation and treatment of OP. It proposes some criteria to consider the high risk of fracture and some indications to start treatment. The recommendations also address issues related to the safety of treatments and the management of special situations such as inflammatory diseases and treatment with glucocorticoids. Conclusions We present an update of SER recommendations on OP.

To update the recommendations on osteoporosis (OP) of the Spanish Society of Rheumatology (SER) based on the best possible evidence.A panel of nine expert rheumatologists in OP was created, previously selected by the SER through an open call. The phases of the work were: identification of the key areas for updating the previous consensus, analysis and synthesis of the scientific evidence (using the SIGN levels of evidence) and formulation of recommendations based on this evidence and consensus techniques.This revision of the recommendations implies an update in the diagnostic evaluation and treatment of OP. It proposes some criteria to consider the high risk of fracture and some indications to start treatment. The recommendations also address issues related to the safety of treatments and the management of special situations such as inflammatory diseases and treatment with glucocorticoids.We present an update of SER recommendations on OP.

Objective To assess the efficacy of abatacept (ABA) in RA patients with interstitial lung disease (ILD) (RA-ILD). Methods This was an observational, multicentre study of RA-ILD patients treated with at least one dose of ABA. ILD was diagnosed by high-resolution CT (HRCT). We analysed the following variables at baseline (ABA initiation), 12 months and at the end of the follow-up: Modified Medical Research Council (MMRC) scale (1-point change), forced vital capacity (FVC) or diffusion lung capacity for carbon monoxide (DLCO) (improvement or worsening ≥10%), HRCT, DAS on 28 joints evaluated using the ESR (DAS28ESR) and CS-sparing effect. Results We studied 263 RA-ILD patients [150 women/113 men; mean (s.d.) age 64.6 (10) years]. At baseline, they had a median duration of ILD of 1 (interquartile range 0.25–3.44) years, moderate or severe degree of dyspnoea (MMRC grade 2, 3 or 4) (40.3%), FVC (% of the predicted) mean (s.d.) 85.9 (21.8)%, DLCO (% of the predicted) 65.7 (18.3) and DAS28ESR 4.5 (1.5). The ILD patterns were: usual interstitial pneumonia (UIP) (40.3%), non-specific interstitial pneumonia (NSIP) (31.9%) and others (27.8%). ABA was prescribed at standard dose, i.v. (25.5%) or s.c. (74.5%). After a median follow-up of 12 (6–36) months the following variables did not show worsening: dyspnoea (MMRC) (91.9%); FVC (87.7%); DLCO (90.6%); and chest HRCT (76.6%). A significant improvement of DAS28ESR from 4.5 (1.5) to 3.1 (1.3) at the end of follow-up (P Conclusion ABA may be an effective and safe treatment for patients with RA-ILD.

Cogan's syndrome is a rare autoimmune disease that usually affects young Caucasian adults and is classically defined as the combination of nonsyphilitic interstitial keratitis and audiovestibular symptoms resembling Meniere's disease, both of them developed in an interval of less than two years. Nevertheless, cases with atypical ophthalmologic and audiovestibular features, with systemic manifestations or affecting children and older patients have also been reported, expanding the clinical spectrum of Cogan's syndrome. Herein, we present the case of a late-onset Cogan's syndrome associated with a large-vessel vasculitis.

Objective Due to increasing improvement in the diagnosis, evaluation and management of osteoporosis and the development of new tools and drugs, the Spanish Society of Rheumatology (SER) has promoted the development of recommendations based on the best evidence available. These recommendations should be a reference to rheumatologists and other health professionals involved in the treatment of patients with osteoporosis. Methods Recommendations were developed following a nominal group methodology and based on a systematic review. The level of evidence and the degree of recommendation were classified according to the model proposed by the Center for Evidence Based Medicine at Oxford. The level of agreement was established through Delphi technique. Evidence from previous consensus and available clinical guidelines was used. Results We have produced recommendations on diagnosis, evaluation and management of osteoporosis. These recommendations include the glucocorticoid-induced osteoporosis, premenopausal and male osteoporosis. Conclusions We present the SER recommendations related to the biologic therapy risk management.

Resumen Objetivo Dado el creciente avance en el diagnostico como evaluacion y tratamiento de la osteoporosis, y la incorporacion de nuevas herramientas y medicamentos, desde la Sociedad Espanola de Reumatologia (SER) se ha impulsado el desarrollo de recomendaciones basadas en la mejor evidencia posible. Estas deben de servir de referencia para reumatologos y otros profesionales de la salud implicados en el tratamiento de pacientes con osteoporosis. Metodos Las recomendaciones se emitieron siguiendo la metodologia de grupos nominales. El nivel de evidencia y el grado de recomendacion se clasificaron segun el modelo del Center for Evidence Based Medicine de Oxford y el grado de acuerdo se extrajo por tecnica Delphi. Se utilizo toda la informacion de consensos previos y guias de practica clinica disponibles. Resultados Se realizan recomendaciones sobre el diagnostico, la evaluacion y el tratamiento en pacientes con osteoporosis. Estas recomendaciones incluyen la osteoporosis secundaria a glucocorticoides, la osteoporosis premenopausica y la del varon. Conclusiones Se presentan las recomendaciones SER sobre el diagnostico, la evaluacion y el manejo de pacientes con osteoporosis.

secondly, not even the protective effect of aspirin, that in clinically controlled trials was found to have a maximal reduction close to 30%, could explain the magnitude in the excess risk for MI observed in those exposed to rofecoxib in VIGOR. The withdrawal of rofecoxib in 2004 was motivated by the results of another study, APPROVe, which was not specifically designed to evaluate cardiovascular safety of the drug, but to study its hypothetical protective effect against the recurrence of intestinal polyps. 8 This study was prematurely stopped due to an excess in the atherothrombotic events in the group with rofecoxib, compared to the placebo group. Nonetheless, another clinical trial in patients with Alzheimer did not show an increase in the cardiovascular risk associated with this The cardiovascular safety profile of non-steroidal anti- inflammatory drugs (NSAID) is being questioned since the publication of the results of several clinical trials and observational studies. True, at the beginning research focused exclusively on selective inhibitors of cyclo- oxygenase 2 (COX-2, also known as coxib, but the results of some recent studies indicate that the increase in the risk of cardiovascular disease could more or less be shared with some traditional NSAID (NSAIDt). The use of NSAID has been associated with a larger risk of hipertension 1 and heart failure, 2,3 and its possible association with the development of atherothrombotic disease emerged towards the end of the nineties. In 2000 the first epidemiological study that showed a small increment in the risk of myocardial infarction (MI) associated with the chronic use of NSAIDt was published. 4 Around the same time, coxibs started to be commercialized worldwide. The unexpected rise in the cardiovascular risk observed in patients that had been treated with high doses of rofecoxib in the VIGOR 5 study, together with the results of 2 other previous pharmacologic studies on coxibs 6,7 seemed to point at a class effect regarding cardiovascular damage, as a consequence of the suppression of prostacyclin in the absence of thromboxane A 2 (TXA 2 ) inhibition. In this way, a selective inhibition of COX-2 could reduce the cardioprotective effects of prostacyclin in the vascular endothelium, whose synthesis of mediated by this enzyme, without inhibiting the proaggregation effects of TXA 2 , whose production is primarily controlled by the isoenzyme cyclo-oxygenase 1 (COX-1). Nonetheless, there where those who postulated that the observed result did not correspond to a rofecoxib-associated increment in the risk, but to a hypothetical cardioprotective effect of the drug it was being compared to, namely naproxen, because this NSAID has a long half-life and a greater affinity for COX-1 in a reversible manner, different from aspirin which irreversibly acetylates the enzyme and

The main objective of this work was to evaluate the characteristics of sleep in patients diagnosed with fibromyalgia syndrome. Sleep architecture in 32 patients with fibromyalgia and 20 healthy controls was evaluated. Following the recommendations of the International Federation of Clinical Neurophysiology, polysomnographies were conducted with fibromyalgia patients and the control subjects. The fibromyalgia patients showed alterations in cyclic organization of sleep and an increased number of periodic leg movements associated with cortical arousals. No significant differences were found in respiratory and oximetry variables or in alpha-delta sleep. The results support that fibromyalgia patients present an increase of superficial sleep at the expense of deep sleep and also an increase of periodic leg movements, which could have a pathogenic effect, facilitating the onset of the illness. Lastly, we discuss the results and propose some future lines of research.

To the Editor: Rheumatoid arthritis (RA) is a complex disease with a strong immune inflammatory component. Recent progress in defining the role of genetic factors in RA has been remarkable. It has been proposed that the shared epitope (SE) is a primary genetic element of susceptibility. Citrullination is a post-translational protein modification that is accomplished by deimination of arginine by peptidyl-arginine deiminases. Interestingly, polymorphisms in one member of the family, PADI4, have been associated with RA in Asian populations1, although this association could not be reproduced in Caucasian populations2,3. An association has been described between the presence of the SE and anti-cyclic citrullinated peptide antibody (anti-CCP) levels, and of each variable with disease severity4,5. Also, anti-CCP-positive has been reported to be immunogenetically distinct from anti-CCP-negative disease, with the former subgroup being primarily responsible for association and linkage to HLA-DRB1 SE6. In this cross-sectional study we aimed at analyzing whether the presence of the SE and anti-CCP caused an acceleration in disease development that could be reflected in an earlier age at onset. This acceleration might be considered a sign of a worse prognosis. We analyzed 411 Spanish patients with RA … Address reprint requests to Dr. Martinez. E-mail: alfmdoncel{at}terra.es