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Resumen Introduccion La gota es una artritis cristalina que se asocia con perdida importante de calidad de vida. Un tratamiento por objetivos y un seguimiento proactivo permiten obtener mejores desenlaces clinicos. La enfermeria especializada en reumatologia optimiza el seguimiento en pacientes con gota y la adherencia al tratamiento, pudiendo mejorar la calidad percibida de estos enfermos en relacion con la atencion sanitaria. Objetivo Determinar los factores que afectan a la calidad percibida y a la satisfaccion de los enfermos con gota atendidos en consultas de reumatologia e identificar areas de mejora, asi como explorar la influencia de enfermeria en la atencion y el seguimiento de estos pacientes. Metodologia Estudio observacional transversal en pacientes con gota seguidos en una consulta monografica mediante encuesta anonima basada en el modelo de calidad SERVQUAL, con datos demograficos y preguntas sobre aspectos asistenciales. Resultados Se recogieron 71 encuestas cumplimentadas de las 80 entregadas entre agosto de 2019 y enero de 2020. La mayoria de los participantes fueron varones de mas de 45 anos. El 39% se mostraron satisfechos con la atencion recibida, y el 55% muy satisfechos. Todos los encuestados se mostraron satisfechos con la consulta presencial conjunta con enfermeria especializada en reumatologia, y el 66% consideraron buena la consulta telefonica con el enfermero. Se identificaron posibles areas de mejora (tiempo de derivacion a consulta, identificacion y disponibilidad del personal sanitario). Conclusion Encontramos una alta satisfaccion global percibida por los pacientes atendidos en consulta de gota con enfermeria especializada en reumatologia. Conocer y sistematizar la opinion de los pacientes es esencial para mejorar la atencion ofrecida.

espanolObjetivo El objetivo de este estudio es describir los hallazgos de una evaluacion odontologica protocolizada en pacientes con sindrome de Sjogren primario (SSp) atendidos en las consultas de reumatologia de la Comunidad de Madrid. Metodos Estudio descriptivo multicentrico en el que se incluyeron pacientes con SSp clasificados segun criterios del consenso Europeo-Americano de 2002. Se recogieron datos demograficos, clinicos y serologicos. Se realizo una exploracion oral, se recogio el flujo salival y el indice de caries CAOD. Los pacientes rellenaron la escala visual analogica para xerostomia, el cuestionario Oral Health Impact Profile-14 y un cuestionario de salud oral. Resultados Se reclutaron 61 pacientes. El 98% fueron mujeres y la edad media fue de 57 anos. El 52,5% presentaban signos orales patologicos (flujo salival no estimulado/sialografia/gammagrafia de glandulas salivales) y el 90,2% antiRo/antiLa+. El 92% de los pacientes referian xerostomia y un 61% hiposialia. Treinta y cinco pacientes presentaron lesiones de la mucosa oral. El indice CAOD fue de 16,97 ± 7,93 y la escala visual analogica para la xerostomia fue de 46,69 ± 14,43. Los resultados del Oral Health Impact Profile-14 fueron de 23,13 ± 14,16. Los pacientes con signos orales patologicos obtuvieron una puntuacion en el Oral Health Impact Profile-14 significativamente mayor (p = 0,03), al igual que los pacientes con afectacion del sistema nervioso periferico (p = 0,001). Conclusiones La prevalencia de xerostomia en esta cohorte de pacientes con SSp fue muy elevada y el 61% de los enfermos presentaron hiposialia. Mas de la mitad de los pacientes sufrieron lesiones orales. La salud oral presento un impacto negativo en la calidad de vida de los pacientes con SSp, siendo mayor en aquellos pacientes con signos orales objetivos patologicos y en los que presentaban afectacion del sistema nervioso periferico. EnglishObjective The aim of this study is to describe the findings of a protocolised odontological evaluation of patients with primary Sjogren's syndrome (pSS) treated in rheumatology units in the Community of Madrid. Methods Multicentric descriptive study in which pSS patients classified according to the American-European consensus of 2002 criteria were included. We collected the demographic, clinical and serological data of each patient. A complete oral examination was performed and salivary flow and the CAOD caries index were collected. The patients completed the visual analogue scale for xerostomia, the Oral Health Impact Profile-14 questionnaire and an oral health questionnaire. Results Sixty-one patients were recruited. Ninety-eight percent were women and the mean age of the patients was 57 years. Pathological oral signs (unstimulated salivary flow/salivary glands sialography/scintigraphy) were present in 52.5% of the patients, anti-Ro/anti-La were positive in 90.2%. Ninety-two percent of the patients reported xerostomia and 61% of the patients suffered from hyposialia. Thirty-five patients presented oral mucosa lesions. CAOD index was 16.97 ± 7.93 and visual analogue scale for xerostomia was 46.69 ± 14.43. The results of the OHIP-14 questionnaire were 23.13 ± 14.16. Patients with pathological oral signs obtained a significantly higher Oral Health Impact Profile-14 score (P = .03). We also found that patients with peripheral nervous system involvement obtained a significantly higher Oral Health Impact Profile-14 score (P = .001) Conclusions The presence of xerostomia in this cohort of pSS patients was high and hyposialia was present in 61% of the patients. Oral lesions appeared in more than half of the subjects. Oral health had a negative impact on the quality of life of patients with pSS, being higher in those with pathological objective oral signs and in those with peripheral nervous system involvement.

Background and objectives Influenza vaccine is recommended for patients with autoimmune inflammatory rheumatic diseases who receive biological therapy. To evaluate if biological therapy impairs immunization after seasonal influenza vaccine. Material and methods Patients with inflammatory arthopathies, psoriasis, inflammatory bowel disease or connective tissue diseases who were receiving or were going to initiate biological therapy were included and vaccinated during 2014–2015 influenza season. ELISA was used to measure influenza antigen A and B antibodies, before and after vaccination. Demographic parameters, diagnosis and kind of treatment were recorded and their influence on the final serological status against influenza was studied. Results 253 subjects were analyzed. After vaccination, 77% of participants presented detectable antibodies against antigen A and 50.6% of them had detectable antibodies against antigen B. Final seropositivity rate against antigen B antibodies increased from baseline (50.6% vs 43.5%, p

Introduction Gout is a crystal arthropathy that is associated with significant loss of quality of life. A treat-to-target approach and proactive monitoring yield superior outcomes to standard care. The Clinical Nurse Specialist enhances follow-up and adherence to treatment in patients with gout, improving their perceived healthcare quality. Objective To determine the factors that affect the perceived quality and satisfaction of patients with gout treated in a rheumatology clinic and to identify areas for improvement, as well as to explore the influence of nurses’ work in the care and management of these patients. Methods Cross-sectional observational study in patients with gout monitored in a monographic clinic by anonymous survey based on the SERVQUAL quality model, with demographic data and questions about aspects of care. Results 71 completed surveys were collected from the 80 delivered between August 2019 and January 2020. Most of the participants were males over 45 years of age. A total of 39% were satisfied with the care received, and 55% were very satisfied. All the respondents were satisfied with the face-to-face consultation with the Clinical Nurse Specialist and 66% considered the telephone consultation with the nurse to be good. Possible areas for improvement (referral time to consultation, identification, and availability of health providers) were identified. Conclusion We found high overall satisfaction perceived by the patients attended in a gout consultation with the Clinical Nurse Specialist. Understanding and systematizing the patients’ opinion is essential to improve clinical care.

ObjectivesTo analyse the effect of targeted therapies, either biological (b) disease-modifying antirheumatic drugs (DMARDs), targeted synthetic (ts) DMARDs and other factors (demographics, comorbidities or COVID-19 symptoms) on the risk of COVID-19 related hospitalisation in patients with inflammatory rheumatic diseases.MethodsThe COVIDSER study is an observational cohort including 7782 patients with inflammatory rheumatic diseases. Multivariable logistic regression was used to estimate ORs and 95% CIs of hospitalisation. Antirheumatic medication taken immediately prior to infection, demographic characteristics, rheumatic disease diagnosis, comorbidities and COVID-19 symptoms were analysed.ResultsA total of 426 cases of symptomatic COVID-19 from 1 March 2020 to 13 April 2021 were included in the analyses: 106 (24.9%) were hospitalised and 19 (4.4%) died. In multivariate-adjusted models, bDMARDs and tsDMARDs in combination were not associated with hospitalisation compared with conventional synthetic DMARDs (OR 0.55, 95% CI 0.24 to 1.25 of b/tsDMARDs, p=0.15). Tumour necrosis factor inhibitors (TNF-i) were associated with a reduced likelihood of hospitalisation (OR 0.32, 95% CI 0.12 to 0.82, p=0.018), whereas rituximab showed a tendency to an increased risk of hospitalisation (OR 4.85, 95% CI 0.86 to 27.2). Glucocorticoid use was not associated with hospitalisation (OR 1.69, 95% CI 0.81 to 3.55). A mix of sociodemographic factors, comorbidities and COVID-19 symptoms contribute to patients’ hospitalisation.ConclusionsThe use of targeted therapies as a group is not associated with COVID-19 severity, except for rituximab, which shows a trend towards an increased risk of hospitalisation, while TNF-i was associated with decreased odds of hospitalisation in patients with rheumatic disease. Other factors like age, male gender, comorbidities and COVID-19 symptoms do play a role.

Background Metabolic syndrome (MS) is a cluster of interrelated components: central adiposity or higher waist circumference (WC), high values of triglycerides (TG), elevated blood pressure (BP), impaired fasting glucose and decreased HDL-cholesterol (HDL-c). It is associated with a higher incidence of developing diabetes (DM), as well as with other cardiovascular diseases (CVD). A direct relationship between serum uric acid (sUA) and the risk of develop MS has been reported in several studies of patients with hyperuricemia and gout. Objectives To study the prevalence of MS and associated CVD in patients with gout attended in a specialized outpatient unit, comparing with other local and national studies. Methods Retrospective observational study with consecutive patients diagnosed with gout according to EULAR/ACR criteria between August and December 2018. We analyzed the presence of MS according to the 2015 International Diabetes Federation criteria (central obesity as BMI ≥30 kg/m2 or WC ≥94 cm (≥80 in women), with ≥2 of the following: TG ≥1.71 mmol/l, HDL-c Results 57 patients with gout were included. Average age 62 years (39-90), 48 years (18-90) at the time of gout onset. 94.7% males. 40.3% with FH of gout, tophi in 52.6%. Clinical pattern: monoarticular 15.8%, oligoarticular 56.1%, polyarticular 28.1%. 68.4% received urate-lowering therapy: 45.6% Allopurinol, 22.8% Febuxostat. SUA at the time of inclusion 6.7 mg/dl (2.6-11.3). Total cholesterol 186 mg/dl (4.84 mmol/l; 96-350 mg/dl/2.5-9.1 mmol/l). TG 185 mg/dl (2.11 mmol/l; 68-742 mg/dl/0.78-8.46 mmol/l). BMI 31.8 kg/m2 (24-58.1). MS was found in 66.7% and premorbid metabolic syndrome (pMS; excluding patients with previously diagnosed CVD or DM) in 26.3%. Obesity 57.9% and overweight 38.6%. HT 80.7%; 10.5% diagnosed in our unit. DM 22.8%. Dyslipidemia (DL: hypercholesterolemia or high levels of TG) 64.9%; 14% diagnosed in our unit. 29.8% smokers, 49.1% formers. Alcohol consumers 54.4%. Chronic kidney disease (CKD) 42.1%; 12.3% diagnosed in our unit. Ischemic heart disease (IHD) 14%. Stroke 24.6%. FH of CVD 24.6%. Comparing with the general population the prevalence of MS and pMS was higher (DARIOS: 31% and 24%, respectively; ENRICA: 22.7% and 16.9%; SIMETAP: 41% and 25%), as well as with the presence of CKD (11.5% in SIMETAP) and CVD (SIMETAP: HT 38%, T2DM 16%, obesity 28%, IHD 4.8% and stroke 3.8%). Conclusion There is a very significant percentage of MS and pMS in patients with gout compared to the general population, with important presence of CKD and CVD, sometimes underdiagnosed. Nursing guidelines were established with healthy lifestyle and periodic controls directed at all patients, with special emphasis on those newly diagnosed of HT or DL, as well as those of higher cardiovascular risk. References [1] Fernandez-Berges D, et al. Metabolic syndrome in Spain: prevalence and coronary risk associated with harmonized definition and WHO proposal. DARIOS study. Rev Esp Cardiol. 2012;65(3):241-8 [2] Guallar-Castillon P, et al. Magnitude and management of metabolic syndrome in Spain in 2008-2010: the ENRICA study [3] Ruiz-Garcia A, et al. Population and methodology of the SIMETAP study: Prevalence of cardiovascular risk factors, cardiovascular diseases, and related metabolic diseases. Clin Investig Arterioscler. 2018;30(5):197-208 Disclosure of Interests Enrique Calvo-Aranda Speakers bureau: Gruhnental, SOBI, Menarini, fernando manuel sanchez-aranda: None declared, Laura Cebrian: None declared, maria angeles matias de la mano: None declared, elena garcia-lorenzo: None declared, maria teresa navio marco: None declared

Background Plasma concentrations of lipoprotein (a) (Lp(a)), a lipoprotein with atherogenic and thrombogenic properties, have a strong genetic basis, although high concentrations of Lp(a) have also been reported in the context of inflammation, as in rheumatoid arthritis (RA). Few studies evaluate the impact of biologic therapies (BT) on Lp(a) in RA, taking into account that with these new therapies a better control of inflammation is achieved. Objective The aim of the study was to evaluate the plasma concentrations of Lp(a) in Spanish RA patients on BT attending rheumatology outpatient clinics. Methods Baseline analysis of the CARdiovascular in rheuMAtology project, a 10-year prospective study, evaluating the risk of cardiovascular events in RA and other forms of inflammatory arthritis. RA patients were classified according to treatment: no biologic, anti-tumor necrosis factor, anti-interleukin-6 receptor tocilizumab (TCZ), and other biologic (rituximab or abatacept). A model of linear multivariate regression was built in which the dependent variable was Lp(a) concentration and the explanatory variable was BT. The model was adjusted for confounding factors. Results Seven hundred and seventy-five RA patients were analyzed. Plasma concentrations of total cholesterol and triglyceride were significantly higher in TCZ-treated patients. Nevertheless, no significant difference in the atherogenic index between TCZ-treated patients and patients without BT was found. After adjusting for confounding factors, patients with BT had lower concentrations of Lp(a) than those without BT; however, only TCZ-treated patients achieved statistically significant differences (?: ?0.303, 95% confidence interval: ?0.558 to ?0.047; P = .02). Conclusions RA patients treated with TCZ show lower plasma concentrations of Lp(a) compared with patients without BT. This project has been supported by an unrestricted grant from Abbvie, Spain. The design, analysis, interpretation of results, and preparation of the article have been done independently of Abbvie. Dr González-Gay's studies have been supported by grants from “Fondo de Investigaciones Sanitarias” PI06/0024, PS09/00748, and PI12/00060 and RD12/0009/0013 (RIER) from “Instituto de Salud Carlos III” (ISCIII) (Spain).

Objetivos Analizar la evolucion de la epidemia de VIH y VHC en drogadictos de reciente inicio. Pacientes Casos remitidos a una unidad de tratamiento de adicciones que han iniciado uso de drogas intravenosas (iv) a partir de enero de 1994. Metodos Cuestionarios estandarizados sobre caracteristicas demograficas y del uso de drogas. Serologias de VIH y VHC durante el ingreso. Resultados 90 pacientes (74 H, 16 M) iniciaron drogas iv a partir de enero de 1994. Caracteristicas al ingreso: edad (mediana) 27 anos, fecha de inicio drogadiccion iv (mediana) Julio 1995, duracion de la drogadiccion iv (mediana) 16 meses, edad de inicio de la drogadiccion iv (mediana) 25 anos. Globalmente, la prevalencia de infeccion por el VIH y VHC es 17% (15/87) y 79% (60/76) respectivamente, sin que se observen diferencias entre generos, fecha de inicio de la drogadiccion iv, antecedente de encarcelamiento y edad de inicio. Segun la duracion de la drogadiccion iv (hasta 16 meses, mas de 16 meses ) se observan diferencias en la prevalencia de VHC (p = 0,04), pero no en la de VIH. El 100% de los DI VIH(+) resultan VHC (+). Entre los DI VHC (+) un 90% presentan Genotipo I y el 86% muestran PCR-VHC cualitativa positiva. Conclusiones El VHC se adquiere rapidamente al inicio de la drogadiccion intravenosa. La elevada prevalencia de VHC sugiere que el habito de compartir material de inyeccion y la transmision de virus continua en los DI de corta duracion.