To identify the risk of relapse and subclinical inflammatory stages of systemic autoimmune diseases, new tools are needed. In the recent years, choroidal thickness and retinal thickness measured with ...ocular coherence tomography (OCT) have been proposed as an inflammatory marker for different systemic diseases, especially for conditions with a vascular component. Our aim in this article is to review the literature regarding the role of choroidal and retinal thickness as a potential inflammatory marker in systemic autoimmune and inflammatory diseases measured by OCT. Current literature suggests that the choroid of patients thickens in active phases of inflammatory diseases with vascular involvement. This pattern is observed in lupus, systemic sclerosis, Behçet disease, spondylitis, and familial Mediterranean fever. Choroidal thickness may decrease with biological treatments, along with systemic inflammation. Repeated flares and long-term disease, however, may thin the choroid, as a result of prolonged insult to the microvasculature and subsequent atrophy. Less is known about the effect of these diseases on retinal thickness. In summary, choroidal and retinal thickness measured by OCT may be promising markers for inflammation in systemic autoimmune and inflammatory diseases; however, more studies are warranted before generalizing choroidal thickness measurements by OCT as a marker for disease activity. The role of retinal thickness is more unclear due to a lack of studies in this field.
Abstract Objective To analyse the efficacy and safety of rituximab in the treatment of non-renal systemic lupus erythematosus (SLE). Methods We systematically searched MEDLINE, EMBASE and the ...Cochrane Central Register of Controlled Trials up to June 2013. The following were the selection criteria: (1) adult patients with SLE, (2) rituximab treatment, (3) placebo or active comparator, (4) outcome measures assessing efficacy and/or (5) safety. Meta-analysis, systematic literature reviews, randomised control trials (RCT), open clinical trials and cohort studies were included. Independent extraction of articles by 2 authors using predefined data fields was performed. The quality of each study was graded using the Oxford Levels of Evidence and Jadad׳s scale. Results A total of 26 articles met our inclusion criteria: one RCT and its exploratory analysis, 2 open studies and 22 cohort studies, which analysed 1,231 patients. Overall, patients had active disease refractory to steroids and/or immunosuppressant drugs. Acceptable evidence suggested improvements in disease activity, arthritis, thrombocytopaenia, complement and anti-dsDNA, with a steroid-sparing effect. But relapses of disease were demonstrated too. Weak evidence suggested a response in anaemia, cutaneous and neuropsychiatric manifestations. Available evidence revealed few major adverse events. Studies had medium methodological quality and in general were applicable to current practice. Conclusion Rituximab has been shown to be safe and effective in the treatment of non-renal SLE, especially in terms of disease activity, immunologic parameters and steroid-sparing effect. However, it can only be recommended for organ-specific manifestations such as arthritis and thrombocytopaenia. High-quality studies are needed in order to consider the long-term effects of re-treatment on different organ-specific manifestations.
To compare demographic and clinical characteristics of patients with axial spondyloarthritis (axSpA) across geographic regions.
PROOF is an observational study that enrolled recently diagnosed (≤1 ...year) axSpA patients fulfilling the Assessment of SpondyloArthritis international Society classification criteria from rheumatology clinical practices in 29 countries across 6 geographic regions. Demographics and disease-related parameters were collected. Here we present baseline data for patients who had classification as radiographic (r-)axSpA or non-radiographic (nr-axSpA) confirmed by central reading.
Of the 2170 patients enrolled, 1553 were classified based on central evaluation of sacroiliac radiographs (r-axSpA: 1023 66%; nr-axSpA: 530 34%). Patients with nr-axSpA had significantly higher occurrence of enthesitis (40% vs 33%), psoriasis (10% vs 5%), and inflammatory bowel disease (IBD, 4% vs 2%) vs r-axSpA patients. Significant differences in axSpA characteristics were observed between geographic regions. The highest occurrence of peripheral arthritis (60%), enthesitis (52%), and dactylitis (12%) was in Latin America and the lowest in Canada (9%, 9%, and 2% respectively). Occurrence of uveitis (18%) and psoriasis (14%) was highest in Canada and lowest in China (6% and <1%). IBD was highest in Arabia (21%); no cases were observed in China. In multivariable analysis adjusted for factors potentially affecting peripheral and extra-musculoskeletal manifestations, geographic regions still exhibited significant differences in frequencies of uveitis (p<0.01), psoriasis (p<0.0001) and peripheral arthritis (p<0.0001).
The multinational PROOF study of axSpA patients showed significant regional differences in peripheral and extra-musculoskeletal manifestations of SpA, which could be considered in management guidelines and clinical trials.
•The real estate bubble: the main cause of Spain’s current economic crisis.•Political corruption and the lack of transparency and participation: the principal driver of the real estate ...bubble.•Popular movements: vital with regard to responding to the crisis.
How have the recent real estate, mortgage and financial crises affected different countries, territories and cities? How have the different public and private stakeholders behaved and how accountable have they been for the origin and development thereof? What links are there among the local, national and global contexts in the crises? Recent geographic research ought to attempt to answer these questions, but there have, however, been few in-depth studies on the link between urbanisation, financial markets and the global crisis. The present paper analyses one of the principal causes of Spain’s recent evolution: urbanisation of the territory, the start and consequences of housing bubble; our study emphasises the differential elements in relation to the crisis in other countries. We study in greater depth the municipality of Torrelodones, which constitutes a reference due to the appearance of a residents’ movement opposed to the development process and which is a perfect example of the dynamics that led to the economic and social crisis. We describe in detail the lack of any strategic vision, participation or transparency in town planning decision-making, the processes by which reports and inspections were doctored, and the mechanisms of corruption of public decision-making in town planning. Finally, we analyse the concrete manner in which huge losses in mortgage markets occurred, with the collapse of the real estate bubble and the financial markets, which subsequently forced a State bailout.
To determine the sensitivity and specificity of enthesis ultrasound for the diagnostic classification of early spondyloarthritis.
A cross-sectional, blinded and controlled study. Standardised ...bilateral ultrasound of six entheses (Madrid sonography enthesitis index (MASEI)) was performed. Accepted diagnostic classification criteria were used as the gold standard. Validity was analysed by receiver operating characteristic (ROC) curves. Values of p<0.05 were considered significant.
113 early spondyloarthritis patients were included (58 women/55 men), 57 non-inflammatory control individuals (29 women/28 men) and 24 inflammatory control individuals (11 women/13 men). The evolution time of spondyloarthritis was 10.9±7.1 months. At least some grade of sacroiliitis on x-ray was present in 59 patients, but only five fulfilled the radiographic sacroiliitis New York criteria. Human leucocyte antigen B27 (HLA-B27) was positive in 42% of patients. No statistical differences were found for the enthesis score among diagnostic spondyloarthritis subtypes form of presentation (axial, peripheral or mixed) or HLA-B27 positivity. The MASEI score achieved statistical significance for gender. The ultrasound score was 23.36±11.40 (mean±SD) in spondyloarthritis patients and 12.26±6.85 and 16.04±9.94 in the non-inflammatory and inflammatory control groups (p<0.001), respectively. The ROC area under the curve was 0.82, and a cut-off point of ≥20 points achieved a likelihood ratio of 5.30 and a specificity of 89.47%.
Entheses are affected early in spondyloarthritis, and the incidence of involvement is higher in men and independent of the spondyloarthritis diagnostic subtype, HLA-B27 status or presentation pattern. The enthesis ultrasound score seems to have diagnostic accuracy and may be useful for improving the diagnostic accuracy of early spondyloarthritis.
Abstract Objective Relapses and failure are frequent in systemic vasculitis (SV) patients. Biological agents have been prescribed as rescue therapies. The aim of this systematic review is to analyze ...the current evidence on the therapeutic use of biological agents for SV. Methods MEDLINE, EMBASE, the Cochrane Database of Systematic Reviews, and the Cochrane Central Register of Controlled Trials were searched up to the end of April 2013. Systematic reviews and meta-analysis, clinical trials, cohort studies, and case series with >3 patients were included. Independent article review and study quality assessment was done by 2 investigators with consensus resolution of discrepancies. Results Of 3447 citations, abstracts, and hand-searched studies screened, 90 were included. Most of the studies included ANCA-associated vasculitis (AAV) patients and only a few included large vessel vasculitis (LVV) patients. Rituximab was the most used agent, having demonstrated efficacy for remission induction in patients with AAV. A number of studies used different anti-TNFα agents with contrasting results. A few uncontrolled studies on the use of abatacept, alemtuzumab, mepolizumab, and tocilizumab were found. Conclusion Current evidence on the use of biological therapies for SV is mainly based on uncontrolled, observational data. Rituximab is not inferior to cyclophosphamide for remission induction in AAV and might be superior in relapsing disease. Infliximab and adalimumab are effective as steroid-sparing agents. Etanercept is not effective to maintain remission in patients with granulomatosis with polyangiitis, and serious adverse events have been reported. For LVV, both infliximab and etanercept had a role as steroid-sparing agents, and tocilizumab might be effective also for remission induction in LVV.
Verbal fluency tests are easy and quick to use in neuropsychological assessments. The aim of this study is to explore their relevance through a bibliometric analysis. We performed a search in the Web ...of Science, involving documents published between 1960 and 2021. We used bibliometric indicators to explore articles distribution, doubling time, and annual growth. We calculated the participation index of the different countries and institutions. Through bibliometric mapping, we explored the co-occurrence networks for the most frequently used terms in verbal fluency research. 1718 articles were found, distributed in two different periods (1960–1995 and 1995 to 2021), the second one containing more than 88% of the documents. Price's law shows an exponential growing. Literature on verbal fluency has grown at a rate of 6,7% per year, doubling its size every 10.7 years. Bradford's law shows a high concentration of articles published in a small core of specialized journals. Finally, the map network visualization shows a change in the most important topic related to verbal fluency during the most recent period analysed. Verbal fluency task has undergone an exponential growth. Its easy application, its sensitivity to different brain dysfunction, the possibility of implementation with neuroimaging studies, and the potential analysis of more complex components (clustering or switching) might have played a key role in its growing interest.
•Verbal fluency test is a simple and quick task usually included in neuropsychological assessment.•Verbal fluency test requires activation of multiple cognitive processes.•Verbal Fluency tests is typically used in clinical and research practice.•Research on verbal fluency test has undergone an exponential growth.
Background: Although the impact of uveitis on people's lives is clear, the frequency of this condition is unclear.Objective: To estimate the prevalence and incidence of uveitis.Methods: A systematic ...review with meta-analysis was conducted. Medline, Embase, and Cochrane Library were searched from inception to January 2019. The quality of the included studies was critically appraised with a grading system based on the Oxford Levels of Evidence. A detailed description of the populations studied and of factors affecting estimates was undertaken. Pooled analyses were conducted using a random-effects approach and expressed as incidence rates per 100,000 with 95% confidence intervals. Subgroup analyses by geographical region were conducted along with meta-regression to analyze possible factors for heterogeneity.Results: A total of 49 studies were included and critically appraised. Twenty-two were population-based, and 27 hospital-based. Heterogeneity was substantial in terms of populations studied, methods for ascertaining uveitis, including definitions, and reporting of results. This was especially important in prevalence studies, with data ranging from 9 to 730 cases per 100,000. For incidence studies, the meta-analysis yielded a pooled incidence of 50.45 per 100.000. The meta-regression showed the geographic region as an important explanatory factor of the heterogeneity between studies.Conclusion: Population-based estimates of the epidemiology of uveitis vary widely, owing to methodologies employed, definitions of uveitis and geographical regions; the representativeness and generalizability of many epidemiological studies of uveitis are limited.
PDF
