This study aimed to assess the baseline characteristics and clinical outcomes of coronavirus disease 2019 (COVID-19) in pediatric patients with rheumatic and musculoskeletal diseases (RMD) and ...identify the risk factors associated with symptomatic or severe disease defined as hospital admission, intensive care admission or death.
An observational longitudinal study was conducted during the first year of the SARS-CoV-2 pandemic (March 2020-March 2021). All pediatric patients attended at the rheumatology outpatient clinics of six tertiary referral hospitals in Madrid, Spain, with a diagnosis of RMD and COVID-19 were included. Main outcomes were symptomatic disease and hospital admission. The covariates were sociodemographic and clinical characteristics and treatment regimens. We ran a multivariable logistic regression model to assess associated factors for outcomes.
The study population included 77 pediatric patients. Mean age was 11.88 (4.04) years Of these, 30 patients (38.96%) were asymptomatic, 41 (53.25%) had a mild-moderate COVID-19 and 6 patients (7.79%) required hospital admission. The median length of hospital admission was 5 (2-20) days, one patient required intensive care and there were no deaths. Previous comorbidities increased the risk for symptomatic disease and hospital admission. Compared with outpatients, the factor independently associated with hospital admission was previous use of glucocorticoids (OR 3.51; p = 0.00). No statistically significant risk factors for symptomatic COVID-19 were found in the final model.
No differences in COVID-19 outcomes according to childhood-onset rheumatic disease types were found. Results suggest that associated comorbidities and treatment with glucocorticoids increase the risk of hospital admission.
Rheumatic and musculoskeletal diseases (RMDs) are chronic diseases that may alternate between asymptomatic periods and flares. These conditions require complex treatments and close monitoring by ...rheumatologists to mitigate their effects and improve the patient's quality of life. Often, delays in outpatient consultations or the patient's difficulties in keeping appointments make such close follow-up challenging. For this reason, it is very important to have open communication between patients and health professionals. In this context, implementing telemonitoring in the field of rheumatology has great potential, as it can facilitate the close monitoring of patients with RMDs. The use of these tools helps patients self-manage certain aspects of their disease. This could result in fewer visits to emergency departments and consultations, as well as enable better therapeutic compliance and identification of issues that would otherwise go unnoticed.
The main objective of this study is to evaluate the implementation of a hybrid care model called the mixed attention model (MAM) in clinical practice and determine whether its implementation improves clinical outcomes compared to conventional follow-up.
This is a multicenter prospective observational study involving 360 patients with rheumatoid arthritis (RA) and spondylarthritis (SpA) from 5 Spanish hospitals. The patients will be followed up by the MAM protocol, which is a care model that incorporates a digital tool consisting of a mobile app that patients can use at home and professionals can review asynchronously to detect incidents and follow patients' clinical evolution between face-to-face visits. Another group of patients, whose follow-up will be conducted in accordance with a traditional face-to-face care model, will be assessed as the control group. Sociodemographic characteristics, treatments, laboratory parameters, assessment of tender and swollen joints, visual analog scale for pain, and electronic patient-reported outcome (ePRO) reports will be collected for all participants. In the MAM group, these items will be self-assessed via both the mobile app and during face-to-face visits with the rheumatologist, who will do the same for patients included in the traditional care model. The patients will be able to report any incidence related to their disease or treatment through the mobile app.
Participant recruitment began in March 2024 and will continue until December 2024. The follow-up period will be extended by 12 months for all patients. Data collection and analysis are scheduled for completion in December 2025.
This paper aims to provide a detailed description of the development and implementation of a digital solution, specifically an MAM. The goal is to achieve significant economic and psychosocial impact within our health care system by enhancing control over RMDs.
ClinicalTrials.gov NCT06273306; https://clinicaltrials.gov/ct2/show/NCT06273306.
PRR1-10.2196/55829.
Purpose
To describe the epidemiology and clinical characteristics of psoriatic arthritis (PsA) related uveitis in Madrid, Spain.
Methods
A case series nested in a retrospective single-center cohort ...of 494 patients with PsA was performed. Patients older than 18 years old whit a clinical diagnosis PsA-related uveitis who attended the Ramon y Cajal University Hospital in Madrid, Spain, between 1st January 2017 and 31st December 2019 were included in the study. Epidemiological and clinical data were retrieved from the electronic medical records.
Results
Thirteen cases of psoriatic arthritis-related uveitis (6 men and 7 women) were included. PsA-related uveitis showed an incidence of 0.05 cases per 100,000 persons/year (CI95 0.00–0.35), and a prevalence of 2.19 cases per 100,000 persons (CI95 1.24–3.79). The prevalence of active uveitis in the cohort of PsA patients was 2.6%. The first episode of uveitis (mean age of 48.15 ± 15.41 years) was anterior and unilateral in 92.31% of the cases. Most of the patients had a recurrent course (69.2%) with 0.92 flare-ups per patient/year (CI95 0.85–0.96). The uveitis preceded the diagnosis of psoriatic arthritis in 62.5% of the patients. In patients with PsA-related uveitis, HLA-B27 was present in 23.1%, HLA-Cw6 in 7.7%.
Conclusions
Uveitis is a PsA manifestation that affects roughly 1 in 37 PsA patients, and that may precede the articular symptoms. It generally presents as a unilateral acute anterior uveitis and has a recurrent course. The most frequent observed complications are elevated intraocular pressure and cataracts.
Uno de cada 10 pacientes con hiperuricemia desarrolla gota. Estudios recientes apoyan la ecografía para detección de gota en pacientes con hiperuricemia asintomática (HUA), pues el depósito articular ...de urato suele ser asintomático en etapas iniciales. Las lesiones con mejor especificidad y valor predictivo positive son doble contorno (DC) y tofo. En enfermedad renal crónica (ERC), hiperuricemia y gota son más frecuentes que en población general, especialmente en pacientes con filtrado glomerular (FGE) < 60, asociándose a peor pronóstico renal, aunque el tratamiento de HUA en ERC no aparece recomendado en todos los documentos de consenso. Las lesiones ecográficas de gota aparecen más frecuentemente en pacientes con HUA (hasta 35%) que en normouricémicos, pero se desconoce si esto también ocurre en ERC.
Nuestro objetivo es evaluar prevalencia de depósito articular asintomático de urato en ERC estadio 3-5, y analizar si existen diferencias entre hiperuricémicos y normouricémicos.
Estudio transversal multicéntrico con pacientes con HUA y ERC estadio 3-5, incliuyendo grupo comparador de normouricémicos. Se excluyeron pacientes con diagnóstico previo de gota o tofos en exploración. Se definió hiperuricemia como ácido úrico sérico (AUS) > 7 mg/dL en ≥ 2 analíticas en últimos 12 meses. Se realizó ecografía bilateral de rodilla y primera metatarsofalángica (1MTF). Se registraron datos demográficos, clínicos y de laboratorio. Se realizó análisis descriptivo de la muestra, evaluándose frecuencia de lesiones ecográficas de gota. Se definió la variable de resultado como presencia/ausencia de gota preclínica (GPC), DC y/o tofo, utilizándose pruebas de X2 y Fisher para comparación de variables cualitativas, y U de Mann-Whitney para cuantitativas. Nivel de significatividad p < 0,05 (SPSS v21).
Se reclutaron 53 pacientes con ERC: 38 (71,7%) con HUA y 15 normouricémicos; 37 pacientes eran varones (69,8%), mediana de edad 73 años (64,5-77,5). Se detectaron tofos en 16 pacientes (30,2%), DC en 11 (20,8%) y GPC en 20 (37,7%). Se observó mayor prevalencia de hallazgos en hiperuricémicos que en normouricémicos (DC: 23,7 vs. 13,3%; tofo: 31,6 vs. 26,7%; GPC: 39,5 vs. 33,3%), aunque las diferencias no fueron estadísticamente significativas. Los normouricémicos tenían ERC de mayor duración que los hiperuricémicos (11 7,2-13,5 vs. 6 2-9,2 años; p = 0,02), sin diferencias en sexo, edad, comorbilidades, tratamiento de reductor de uricemia (TRU) (66,7 vs. 44,7%; p = 0,05) u otros fármacos; 70% de normouricémicos con TRU tenía hiperuricemia previamente a su inicio. En pacientes con tofos observamos tendencia a menor duración de ERC y del tratamiento con TRU frente aquellos sin tofos (3,5 2-6,7 vs. 7 3-12 años; p = 0,05) y (22 12-44 vs. 39 29-73 meses; p = 0,08), respectivamente. Esta tendencia también se observó en GPC, no así en DC; 90% de los pacientes (100% en no dializados) con GPC tenían mediana de uricemia ≥ 5 mg/dL en últimos 12 meses.
Encontramos importante prevalencia de depósito articular asintomático de urato en pacientes con ERC estadio 3-5, predominantemente en aquellos con mediana de uricemia ≥ 5 mg/dL en últimos 12 meses. El diagnóstico precoz de GPC mediante ecografía en ERC puede ayudar a adelantar y optimizar el tratamiento con TRU. Es imprescindible potenciar la colaboración Nefrología-Reumatología.
One in 10 patients with hyperuricemia may develop gout over time, with urate deposition sometimes asymptomatic. Recent reviews and guidelines support ultrasound (US) to assess asymptomatic hyperuricemic (AH) patients to detect gout lesions, showing double contour (DC) and tophus the highest specificities and positive predictive values. Hyperuricemia and gout are common in chronic kidney disease (CKD), especially with glomerular filtration rate (GFR) <60, and both are associated with worse prognosis, although treatment of AH in CKD is not yet recommended in all guidelines. US gout lesions have been found more frequently in AH (up to 35%) than in normouricemic (NU) patients, but evidence is scarce in CKD.
To assess the prevalence of urate deposit in stages 3–5 CKD detected by US, and to investigate if there are differences between AH and NU patients.
Multicenter cross-sectional study, recruiting patients aged ≥18 years with AH and stages 3–5 CKD in four hospitals. A comparator group of NU patients with stages 3–5 CKD was included. Exclusion criteria: previous diagnosis of gout, tophi. Hyperuricemia was defined as serum uric acid (sUA) >7 mg/dl, documented at least twice during the last 12 months. A standardized US exam of the knees and bilateral first metatarsophalangeal joints was performed to assess patients for DC/tophus as defined by OMERACT. Demographic, clinical and laboratory data were recorded. A descriptive analysis was performed using SPSS. Pre-clinical gout (PCG: DC and/or tophus) was considered as outcome variable. Chi-square and Fisher's exact test were used for qualitative variables, and Mann–Whitney U test for quantitative variables; significant threshold p<0.05.
Fifty-three patients with stages 3–5 CKD (59.6% stage 3, 19.1% stage 4, 21.3% stage 5) were recruited, 38 AH (71.7%) and 15 NU. A higher prevalence of US findings was observed in HU patients compared to NU patients (DC 23.7% vs. 13.3%, tophus 31.6% vs. 26.7%, PCG 39.5% vs. 33.3%), although the differences were not statistically significant. NU patients had CKD of longer duration than HU patients 11 (7.2–13.5) vs. 6 (2–9.2) years; p = 0.02, with no differences in sex, age, comorbidities, or urate-lowering therapy (ULT) (66.7% vs. 44.7%; p = 0.05) and other treatments. Seventy percent of NU patients with TRU had AH before starting treatment. In patients with tophi, we observed a trend towards shorter duration of CKD and shorter duration of treatment with ULT compared to those without tophi 3.5 (2–6.7) vs. 7 (3–12) years; p = 0.05 and 22 (12–44) vs. 39 (29–73) months; p = 0.08, respectively. This trend was also observed in PCG, but not in DC, first US sign to disappear after initiation of ULT. Ninety percent of patients (100% in non-dialyzed patients) with PCG had a median uricemia ≥5 mg/dl in the past 12 months.
We found a significant prevalence of asymptomatic urate deposition in patients with stages 3–5 CKD, mostly in subjects with median uricemia ≥5 mg/dl in the last 12 months. Early diagnosis of PCG by musculoskeletal US in CKD may allow earlier introduction and optimization of ULT. This will probably contribute to slowing down the progression of this pathology, which makes it essential to promote collaboration between Nephrology and Rheumatology.
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