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Resumen Objetivo Analizar el cumplimiento de las directrices t2t en la practica clinica. Metodos Estudio observacional transversal en pacientes consecutivos con artritis reumatoide (AR) de 5 hospitales canarios. Los pacientes cumplimentaron escalas de actividad, el HAQ y respondieron si el medico les habia explicado el objetivo del tratamiento. El medico recogio ademas: visitas en el ultimo ano, empleo de indices y HAQ, DAS28 de la visita actual y fecha de la siguiente consulta. Se analizo el porcentaje de cumplimiento de las recomendaciones t2t (R) 1, 3, 5-7 y 10. Resultados Se recluto a 343 pacientes, 77% mujeres, con edad promedio de 57 anos y duracion de la AR de 10 anos. La mediana de visitas en el ultimo ano fue de 3 y el promedio de meses entre la visita anterior y la actual de 5,6. El 93% estaba en tratamiento con FAME y el 44% en remision por DAS (R1). Se habia realizado recuento articular en la visita previa al 85%, HAQ al 19%, EVA actividad del paciente al 41% y DAS28 al 35% (R6). La siguiente visita se programo en un promedio entre uno y 3 meses (R5) al 64% de los pacientes con DAS28 > 3,2. El 96% de los pacientes dijo haber sido informado del objetivo del tratamiento (R10). La variabilidad entre centros era moderada, pero existia. El unico factor que determinaba la realizacion de un DAS28 en la ultima consulta era el centro de procedencia del paciente. Conclusiones Los centros canarios estudiados logran altas cotas de remision y baja actividad en sus pacientes; la realizacion de indices compuestos y la frecuencia de seguimiento recomendado por el t2t se cumplen, aunque hay oportunidad de mejora.

espanolObjetivos: El objetivo del estudio fue analizar el empleo de bisfosfonatos en mujeres con artritis reumatoide (AR) de las Islas Canarias. Material y metodos: Estudio observacional multicentrico en el que se incluyeron mujeres con una edad igual o superior a 50 anos. En una unica visita se recogieron variables demograficas y de la AR, antecedente de fractura por fragilidad, uso de corticoides, realizacion de densitometria osea (DXA) y tratamiento actual con bisfosfonatos. Se empleo una herramienta FRAX® simplificada y se aplico la recomendacion de profilaxis de osteoporosis por corticoides del American College of Rheumatology (ACR). Resultados: Se incluyeron 192 mujeres con edad promedio de 62 anos. Un total de 91 (48%) pacientes recibian corticoides; 17 de ellas (9%) habian sufrido fractura; a 123 se les habia realizado DXA (66%); y 52 (28%) tomaban bisfosfonatos (el 70% de las pacientes con osteoporosis o fractura y el 45% de aque- llas con criterios de profilaxis de osteoporosis por corticoides). Los factores asociados de manera significativa con el empleo de bisfosfonatos fueron la edad, la duracion de la enfermedad, el cuestionario de capacidad funcional HAQ, el riesgo de fractura determinado por FRAX®, el tratamiento con corticoides, el antecedente de fractura y la realizacion previa de DXA. En el estudio multivariante solo se asociaron de manera significativa la DXA (p=0,03) y el antecedente de fractura (p=0,02). Conclusiones: En las mujeres postmenopausicas con AR de las Islas Canarias la prescripcion de bisfosfonatos podria adecuarse mejor a las guias, especialmente en pacientes que reciben tratamiento con corticoides. EnglishObjective: The objective of this study was to analyse the use of bisphosphonates in women with rheumatoid arthritis (RA) in the Canary Islands. Material and methods: This multicentre observational study included women aged 50 years or over. At a single visit, demographic variables and those relating to the RA, history of fragility fractures, use of corticoids, performance of bone densitometry (DXA) and current treatment with bisphosphonates were recorded. The simplified FRAX ® tool was used and the recommendations of the American College of Rheumatology (ACR) for the prophylaxis of osteoporosis with corticoids were applied. Results: 192 women were included, with an average age of 62 years. A total of 91 (48%) patients were receiving corticoids; 17 of these (9%) had suffered a fracture; 123 (66%) had had a DXA; and 52 (28%) were taking bisphosphonates (70% of the patients with osteoporosis or fracture and 45% of those with criteria for prophylactic use of corticoids for osteoporosis). Those factors having a significant association with the use of bisphosphonates were age, duration of the disease, the HAQ functional capacity questionnaire, the risk of fracture determined by FRAX®, treatment with corticoids, history of fracture and the previous performance of DXA. In the multivariate study only the DXA (p=0.03) and history of fracture (p=0.02) were significantly associated. Conclusions: In postmenopausal women from the Canary Islands with RA the prescription of bisphosphonates could conform better to the guidelines, especially in patients receiving treatment with corticoids.

The National Commission of Rheumatology has developed a satisfaction survey for residents concerning their training period. 37% of the 176 invited to participate answered the survey. 71% said they were satisfied or very satisfied with the influence of the assistance activities during their training. 38% were dissatisfied or very dissatisfied with supervision by staff. 39% were dissatisfied or very dissatisfied with their training in polarized light microscopy. 52% said no regular meetings were structured to monitor their training. 66% said that there had been no effective evaluation of their training. 39% were dissatisfied or very dissatisfied on the tools they were given to publish at their teaching unit. Overall satisfaction on classroom training for residents of Rheumatology is high. There are opportunities for improvement relating to training in certain techniques, monitoring and evaluation of the training period and training in research skills.

Resumen La Comision Nacional de Reumatologia ha elaborado una encuesta sobre la satisfaccion de los residentes respecto a su periodo formativo. Contestaron un 37% de los 176 invitados a participar. Un 71% manifesto que estaba satisfecho o muy satisfecho de la influencia de la actividad asistencial en su formacion. El 38% estaba insatisfecho o muy insatisfecho de la supervision por parte de la plantilla. El 39% estaba insatisfecho o muy insatisfecho del adiestramiento en microscopia de luz polarizada. El 52% contesto que no existian reuniones periodicas estructuradas de monitorizacion de su formacion. El 66% declaro que no habia existido ningun tipo de evaluacion efectiva de su formacion. El 39% se mostro insatisfecho o muy insatisfecho respecto a las facilidades para publicar que le brindo su unidad docente. La satisfaccion global sobre la formacion asistencial de los residentes de reumatologia es elevada. Existen oportunidades de mejora referentes al entrenamiento en determinadas tecnicas, la monitorizacion y evaluacion del periodo formativo y la formacion en habilidades de investigacion.

The aim of the present study was to analyse the patterns of treatment adjustment in rheumatoid arthritis (RA) patients with active disease in routine clinical care. This was a cross-sectional study of consecutive patients with RA conducted in five hospitals. Activity scales (DAS28-ESR) and function (HAQ) were measured, as well as whether ultrasound was performed as part of the assessment. Treatment decision (no changes/reduction/intensification) and time to the next scheduled visit were the outcomes variables. Associated factors were analysed by multilevel regression models. A total of 343 patients were included (77 % women, mean age 57 years, mean RA duration 10 years), of whom 44 % were in remission by DAS28. Treatment was continued in 202 (59 %) patients, reduced in 57 (16 %), and intensified in 83 (24 %). In the 117 patients with active RA (DAS28 ≥ 3.2), treatment was intensified in 61 (52 %). Factors associated with treatment intensification were physician and patient VAS, and DAS28, but not the centre. In the multilevel regression analysis with intensification of treatment as dependent variable, the following factors were significantly associated: DAS28 [OR 3.67 (95 % CI 2.43–5.52)], patient VAS [OR 1.04 (95 % CI 1.01–1.08)], and have performed an ultrasound [OR 3.36 (95 % CI 1.47–7.68)]. Factors associated with time to the next scheduled visit (an average of 4.3 months) were patient and physician VAS, DAS28, and centre. In clinical practice, half of the patients with active RA maintain or reduce the treatment. The decision to intensify treatment in active RA as recommended by a treat-to-target strategy is complex in practice.

The National Rheumatology Board is responsible for postgraduate formation in rheumatology. Herein we present the new criteria for accreditation of teaching units. These criterion contemplate four domains, namely: structure, clinical work, teaching and research. Each domain is divided in subdomains and items. Some of them are of an obligatory nature. This document serves as reference for future applications. The document may be reviewed in the future.

Background The decision to intensify treatment when arthritis is active is more complex in practice than make management guidelines and treat to target (T2T) Objectives To analyze the habits of intensified treatment of rheumatoid arthritis (RA) in patients with active disease in routine clinical care. Methods Cross-sectional study conducted in five hospitals in consecutive patients with RA. Inclusion criteria were patients over 18 years treated at rheumatology clinic with a diagnosis of RA (criteria 1997 and/or 2010). In the current visit the following data were collected: parameters to calculate the DAS28-ESR, active treatments (including glucocorticoids, DMARDs and biological), performed ultrasonography, therapeutic decision in the visit and the time of the next visit. The therapeutic decision was divided into three options: 1) maintenance of treatment; 2) reduction of treatment; and 3) increased treatment. Any change of DMARD or biologic was considered increased treatment. Results 343 patients were included, 77% female, mean age 57 years and mean duration of RA 10 years. 44% of patients were in remission by DAS28. After the current visit the same treatment was recommended in 60% of patients, was reduced in 16%, and was intensified in 24%. Of the 117 patients with active RA (DAS28≥3.2) treatment was intensified in 52%; 61% if we exclude active RA in biological therapy with no difference between hospitals. In patients with active RA and biological, treatment was intensified in 16 of 44 cases (36%). Factors associated with treatment intensification were patient and physician VAS, DAS28 and performing ultrasonography. The next visit was scheduled at an average of 4.3 months. 64% of patients with active RA had a scheduled visit between 1 and 3 months. Factors associated with the time for next visit were patient VAS, physician VAS and DAS28 in this order. Conclusions In clinical practice half of patients with active RA the treatment is maintained or reduced. Factors associated with treatment intensification were disease activity and performing ultrasonography. The decision to intensify treatment in active RA as T2T recommend is complex in practice. Acknowledgements This study was supported by a grant from AbbVie (ACA-SPAI-12-17). AbbVie had no role in the writing of the abstract or the decision to submit it Disclosure of Interest None declared