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Background: Giant cell arteritis (GCA) is a heterogeneous disease with diverse clinical presentations and varying degrees of severity. This study aimed to assess the incidence of 3 clinical subsets in GCA and analyze associated severe complications and survival rates. By identifying distinct clinical patterns, the goal is to customize treatment approaches and minimize severe complications during follow-up. Methods: This retrospective study classified clinical manifestations of GCA into 3 major phenotypes based on the reason for consultation: i) cranial, ii) extracranial, and iii) occult GCA. These groups were analyzed and compared for acute complications, including severe ischemic complications, "true" occlusive disease, and late complications such as aortic aneurysm. Survival data were also collected during follow-up. Results: Visual disturbances were more common in the cranial GCA group compared to other subsets (P < .001). Blindness and stroke showed a clinically relevant trend, although statistical differences were not significant between the cranial GCA groups. Limb claudication was significantly more prevalent in the extracranial subset compared to the cranial or occult GCA subsets (12% vs. 2.6% vs. 0% respectively). Severe ischemic complications and true occlusive disease were more frequent in the cranial GCA groups (60%, P = .005 and 40%, P = 1.64 respectively). Regarding mortality, there were no statistically significant differences in survival among the different clinical subsets. However, the occult GCA subset showed a trend towards a higher prevalence of deaths, both overall and specifically due to GCA. Conclusion: Clinical subsets in GCA present distinct complications and survival outcomes, with the cranial subset showing a higher incidence of severe ischemic events and the occult subset associated with delayed diagnosis and increased mortality. Recognizing these subsets is crucial for tailored treatment approaches and improving patient prognosis. Further prospective studies are needed to refine diagnostic and therapeutic strategies. [ABSTRACT FROM AUTHOR]

Objectives: The aims of this study are to evaluate the level of fear of post-injection pain prior to the administration, the difficulty in handling the device, and the level of satisfaction of patients using a pre-filled syringe versus an etanercept pen, as well as to evaluate the usefulness of the training given by nursing staff prior to starting with the pen, and the preferences of patients after using both devices., Method: A prospective study was designed to follow-up a cohort of patients during a 6 months period. The data was collected using questionnaires and analyzed with SPSS 18.00. Rank and McNemar tests were performed. Statistical significance was pre-set at an α level of 0.05., Results: A total of 29 patients were included, of whom 69% female, and with a mean age 52.5±10.9 years. Of these, 48% had rheumatoid arthritis, 28% psoriatic arthritis, 21% ankylosing spondylitis, and 3% undifferentiated spondyloarthropathy. There were no statistically significant differences either with the fear or pain or handling of the device between the syringe and the pen (P=.469; P=.812; P=.169 respectively). At 6 months, 59% of patients referred to being satisfied or very satisfied with the pen. Almost all (93%) found useful or very useful the training given by nursing staff prior to using the pen, and 55% preferred the pen over the pre-filled syringe., Conclusions: The etanercept pen is another subcutaneous device option for patients with chronic arthritis. According to the present study, nursing educational workshops before starting this therapy are recommended., (Copyright © 2012 Elsevier España, S.L. All rights reserved.)

Background and Objective: To assess the effect of the application in routine clinical practice of a proposal of thresholds for the indication of bone densitometry in Spanish postmenopausal women., Patients and Methods: We determined the risk of major fracture (RMF) by FRAX(®) of the patients referred to a bone densitometry unit from Primary Care who were untreated. We calculated how many scans would have been avoided if they had been performed only to women ≥ 65 years with a RMF < 10% or women<65 years with a RMF ≥ 3.6%., Results: We included 643 women with a mean age of 61 (9) years. Twenty-three percent had a normal bone mineral density, 56% had osteopenia, and 21% osteoporosis. The RMF was 5.9 (5.5)%. Eighty of 217 (37%) bone scans in women ≥ 65 years and 273 of 426 (64%) in women<65 years would have been avoided. As a whole, 55% of the scans would have been avoided. The sensitivity of the threshold of 3.6% of RMF for the diagnosis of osteoporosis was 51%, specificity 68%, positive predictive value 20%, and negative predictive value 20%., Conclusions: The application of the proposed thresholds for the indication of bone densitometry in Spanish postmenopausal women, based on age and risk of fracture calculated by FRAX(®) would result in a significant decrease of the activity of the bone densitometry unit., (Copyright © 2011 Elsevier España, S.L. All rights reserved.)

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 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., (Copyright © 2011 Elsevier España, S.L. All rights reserved.)

Background and Objective: To estimate the fracture risk with the FRAX in patients treated and not treated in clinical practice., Material and Methods: From a database of risk factors for osteoporosis and fracture, that included absorptiometry measurements, we selected all patients who met the following criteria: 1) Age between 40 and 90 years, 2) to have the weight and size, 3) To have the first study by DXA scan after September 2005, 4) To know the therapeutic intervention made after bone densitometry, and 5) Not have done any treatment before the first densitometry. The calculation of the fracture risk was achieved with the application available on the Web during June 2008., Results: One hundred and ninety two people (45 men) were included, 81 of which received treatment after densitometry. Treated patients had more risk factors (1,06 + or - 0,97 [IC 95% 0,88-1,24] vs. 1,49 + or - 1,03 [IC 95% 1,27-1,71], p=0,003). Fracture risk was higher in treated patients in all groups (major osteoporotic fracture and hip fracture, with and without bone absorptiometry). In all cases, fracture risk was lower when using the densitometric value. In patients younger than 65 years, the fracture risk was significantly lower than in patients over 64 years in all cases., Conclusions: The risk of fracture measured by the FRAX is higher in patients receiving treatment, although there is a significant overlap between the two groups., (Copyright 2009 Elsevier España, S.L. All rights reserved.)

Objective: To characterize rheumatoid arthritis patients seen in Rheumatology Units at different health care levels., Material and Methods: Questionnaire and clinical examination of rheumatoid arthritis patients seen as outpatients in Rheumatology Units from Primary Care, county Hospitals and Reference Hospitals. Demographic, social, labour and disease data were collected. Statistical study included a description of the variables and a multiple correspondence analysis to define patient profiles., Results: Eight hundred and twelve patients with rheumatoid arthritis were included. There were significant differences in patient profiles at the different care level. In Primary Care, patients were older, with basic studies, and with short duration and generally mild rheumatoid arthritis. In local hospitals the typical patient was a man, qualified worker, with low income, and an erosive disease with extraarticular manifestations. At reference Hospitals prevailing patients were young women with a long duration disease and requiring biological therapy., Conclusion: There are significant differences in rheumatoid arthritis patient profiles at different health care levels., (Copyright © 2008 Elsevier España, S.L. All rights reserved.)

Background and Objective: The study is aimed at improving our knowledge about the functional impairment of the psoriatic arthritis through a multicentral series., Patients and Method: We have designed a transversal and multicentral study (centers of the same geographical area), including 343 patients with psoriatic arthritis. Eight medical centers have participated. Patients have been divided depending on the assistential level where they are visited. We have collected the following data: sex, age, assistential level, duration of psoriasis and arthritis, age at onset of psoriasis and arthritis, clinical form, ARA functional impairment, number of tender and swollen joints, presence of dactylitis, distal interphalangeal affection, axial involvement, ostheolisis or nail lesions, erithrocyte sedimentation rate (ESR), C-reactive protein, hemoglobine, leucocites, platelets, HLA-B27 and rheumatoid factor., Results: 7.14% of the patients were significatly disabled (ARA functional class III and IV). 30.32% were patients visited in a primary assistential level, 30.90% in a secondary assistential level and 38.78% a tertiary and universitary hospital. We found statistically significant correlation between III and IV functional classes and age, assistential level, ostheolisis, corticoid treatment, ESR, leucocites, platelets and number of tender joints., Conclusions: We find a better functional capacity in our patients than in other studies. The inclusion of patients from different assistential levels instead of just patients visited in a tertiary hospital might be the cause of this difference.