Rheumatoid arthritis (RA) prevalence is believed to be around 1% worldwide, although it varies considerably among different populations. The aim of EPISER2016 study was to estimate the prevalence of ...RA in the general adult population in Spain. We designed a population-based cross-sectional study. A national survey was conducted between November 2016 and October 2017 involving a probabilistic sample from the general population aged 20 years or older. Subjects were randomly selected for phone screening using a computer-assisted telephone interviewer system. Positive RA screening results were evaluated by a rheumatologist. Cases fulfilled the 1987 ACR and/or the 2010 ACR/EULAR criteria; previous diagnosis established by a rheumatologist and clearly identified in medical records were also accepted regardless of the criteria used. Prevalence estimates with 95% CI were calculated taking into account the design of the sample (weighting based on age, sex, and geographic origin using as a reference the distribution of the population in Spain). 4916 subjects participated in the study and 39 RA cases were confirmed. RA estimated prevalence was 0.82% (95% CI 0.59-1.15). Mean age of RA cases was 60.48 (14.85) years, they were more frequently women (61.5%), from urban areas (74.4%), non-smokers (43.6%), and with a high body mass index (53.8% with overweight). Extrapolating to the population in Spain (approximately 37 million are ≥ 20 years old), it was estimated that there were between 220,000 and 430,000 people aged 20 years or older with RA. No undiagnosed cases were detected, which could be related to the establishment of early arthritis clinics around the country, increasing the rates of diagnosis during early phases of RA.
Correspondence to Dr Martin Greco, Rheumatology Department, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria 35010, Spain; martin-greco@hotmail.com The presence of muscle ...weakness and anti-Jo1 anti-aminoacyl transfer RNA synthetase (ARS) autoantibodies are evaluated in the new European League Against Rheumatism/American College of Rheumatology (EULAR/ACR) proposed classification criteria for adult and juvenile idiopathic inflammatory myopathies (IIM), as well as in the Solomon proposed criteria for antisynthetase syndrome (ASSD) diagnosis.1 2 That favours an overlapping in both criteria fulfilment; however, ASSD is not considered among the IIM subgroups classification. Furthermore, anti-PL7 and anti-PL12 ARS were found to be strongly associated with IIM during the criteria development; however, the low number of observations limited their reliability analysis, and they were not finally included.1 3 Anti-EJ, anti-OJ and other ARS were not considered at all due to the limited availability of detection methods at the start of the criteria development.3 On the other hand, any ARS positivity is considered in Solomon’s criteria. ...according to other authors, we purpose that IIM and ASSD classification criteria might need a revision to better homogenise patient groups.3–6 Therefore, we designed this study to evaluate if the detection of ARS other than anti-Jo1 could improve the EULAR/ACR criteria performance, and additionally to contribute to a better classification of the antisynthetase syndromes. ...the main limitations of this study are the retrospective design, the relatively small size of the sample and the absence of a comparator group.
Diabetes is a common cardiovascular risk factor in psoriatic arthritis (PsA). Although the prevalence of diabetes is high, the factors associated with it in PsA are poorly understood. We aimed to ...analyse the prevalence of type II diabetes and diabetes-associated factors in a hospital-based population with PsA. This cross-sectional study included 340 consecutive patients attended in a tertiary care hospital. The prevalence of diabetes was compared to that of 600 outpatients without inflammatory conditions. To analyse diabetes-associated factors, odds ratio (OR) values were calculated by conditional logistic regression analysis. Significant variables in the univariate analysis were then introduced in a multivariate analysis with a backward stepwise approach. Diabetes was more prevalent among PsA patients (13.8 vs. 5%, OR 2.8, 95% CI: 1.7–4.3,
p
< 0.0001). Diabetes-associated factors in the univariate analysis (
p
< 0.05) were the following: an age of onset of psoriasis > 40 years, an age of onset of arthritis > 40 years, a low educational level, family history of psoriasis, pustular psoriasis, high number of swollen joints during follow-up, hypertension, dyslipidemia, obesity, and cardiovascular events. After controlling for several confounders, diabetes was significantly associated with late-onset psoriasis (OR 8.2, 95% CI: 1.9–12.4,
p
= 0.002) and hypertension (OR 7.5, 95% CI: 1.5–13.3,
p
= 0.008). Diabetes risk should be carefully evaluated in patients with PsA whose psoriasis begins after 40 years.
Objectives:
We aimed to evaluate the drug retention rate and safety of secukinumab (SEC) in patients with axial spondyloarthritis (AxSpA) and psoriatic arthritis (PsA) in a real clinical setting.
...Methods:
This multicenter retrospective observational study included all AxSpA and PsA patients who received at least one dose of SEC. Adverse events (AE) and the drug retention rate were the main study outcomes. Drug survival was analyzed by Kaplan-Meier curves while predictive factors of discontinuation were evaluated using a Cox regression analysis. The weight of these associations was estimated by hazard ratio (HR) values.
Results:
We included 154 patients (59 PsA and 95 AxSpA). Mean disease duration was 6.5 years (IQR 2-8). Sixty-one percent of patients were treated with two or more biologics prior to SEC. The 1 and 2-year retention rates for SEC were 66 and 43%, respectively. The main causes of discontinuation were inefficacy (59%) and AE (36%). The factors associated with lower risk of discontinuation were male gender (HR 0.54, 95% CI 0.38-0.78
p
= 0.001), obesity (HR 0.53, 95% CI 0.30-0.93
p
= 0.027), hypertension (HR 0.55, 95% CI 0.30-0.93
p
= 0.008), and diabetes (HR 0.42 95% CI 0.18-0.99
p
= 0.047) while number of previous biologics and depression were predictors of discontinuation (HR 1.18, 95% CI 1.04-1.34
p
= 0.011 and HR 2.53, 95% CI 1.61-3.96
p
< 0.001).
Conclusions:
SEC showed a good retention rate in a population previously exposed to several biological therapies. As a novelty, cardiometabolic comorbidities were associated with better drug survival.
Spondyloarthritis is a group of immune-mediated rheumatic disorders that significantly impact patients' physical function and quality of life. Patients with spondyloarthritis experience a greater ...prevalence of cardiometabolic disorders, such as obesity, hypertension, dyslipidemia and diabetes mellitus, and these comorbidities are associated with increased spondyloarthritis disease activity and risk of cardiovascular events. This narrative review summarizes the evidence for a physiological link between inflammatory status and cardiometabolic comorbidities in spondyloarthritis, as well as the impact of interleukin (IL)-17 blockade versus other molecular mechanisms in patients with cardiometabolic conditions. The IL-23/IL-17 axis plays a pivotal role in the pathophysiology of spondyloarthritis by promoting inflammation and tissue remodeling at the affected joints and entheses. The importance of the IL-23/IL-17 signaling cascade in underlying sub-clinical inflammation in common cardiometabolic disorders suggests the existence of shared pathways between these processes and spondyloarthritis pathophysiology. Thus, a bidirectional relationship exists between the effects of biologic drugs and patients' cardiometabolic profile, which must be considered during treatment decision making. Biologic therapy may induce changes in patients' cardiometabolic status and cardiometabolic conditions may conversely impact the clinical response to biologic therapy. Available evidence regarding the impact of IL-17 blockade with secukinumab on cardiometabolic parameters suggests this drug does not interfere with traditional cardiovascular risk markers and could be associated with a decreased risk of cardiovascular events. Additionally, the efficacy and retention rates of secukinumab do not appear to be negatively affected by obesity, with some studies reporting a positive impact on clinical outcomes, contrary to that described with other approaches, such as tumor necrosis factor blockade. In this article, we also review evidence for this bidirectional association with other treatments for spondyloarthritis. Current evidence suggests that IL-17-targeted therapy with secukinumab is highly effective in spondyloarthritis patients with cardiometabolic comorbidities and may provide additional cardiometabolic benefits.
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