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 geografical 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.
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.
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.
[Show abstract][Hide abstract] ABSTRACT: Objetivo Determinar las características de los pacientes con artritis reumatoide (AR) que acuden a consultas de reumatología en diferentes niveles asistenciales. Material y métodos Entrevista y evaluación clínica a pacientes con AR en consultas de reumatología de centros de especialidades, de atención primaria y de hospitales comarcales y de tercer nivel. Se recogieron datos generales, sociolaborales y de la enfermedad. Se realizó un estudio descriptivo y un análisis de correspondencias múltiples para establecer perfiles característicos. Resultados Se entrevistaron 812 pacientes. Se observaron diferencias significativas entre las características de los pacientes de cada nivel asistencial. En las consultas de reumatología de atención primaria predominan los pacientes de edad avanzada (mayores de 75 años), con estudios básicos y con un tipo de enfermedad de poco tiempo de evolución y, en general, poco grave. En los hospitales comarcales predominan los pacientes varones, obreros cualificados, con ingresos bajos, enfermedad erosiva y manifestaciones extraarticulares. En los hospitales de tercer nivel predominan las mujeres jóvenes con estudios, que padecen una enfermedad de larga evolución y que requieren tratamiento biológico. Conclusión Hay diferencias significativas en las características de los pacientes que acuden a cada uno de los niveles asistenciales.
[Show abstract][Hide abstract] ABSTRACT: To characterize rheumatoid arthritis patients seen in Rheumatology Units at different health care levels.
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.
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.
There are significant differences in rheumatoid arthritis patient profiles at different health care levels.
[Show abstract][Hide abstract] ABSTRACT: The aim of the study was to assess the prevalence of moderate to severe psoriasis (MS-P) in patients with psoriatic arthritis (PsA) and the relationship between MS-P and other variables related to arthritis. One hundred sixty-six consecutive patients with PsA periodically monitored at a university hospital's PsA unit in northeastern Spain were included in the study. Patients with psoriasis were classified as having MS-P when systemic treatment for skin was required. Clinical criteria for treatment indication was BSA >10 and/or PASI >14 and/or psoriasis affecting a very sensitive area of the body. Demographic and clinical data related to arthritis were assessed, including PsA pattern, age of onset of psoriasis and arthritis, disease activity index, and treatment required over the course of the disease. Moderate-severe psoriasis were more prevalent in women (p = 0.027). One hundred nine patients (65.7%) had psoriatic nail disease, and MS-P was more frequent in these patients (40 (77%) vs. 69 (61%), p = 0.028). Patients with spondyloarthropathy were significantly associated with MS-P (7 (16%) vs. 3 (3%), p = 0.014). No statistical association was observed between severe psoriasis and the age of onset of psoriasis or arthritis, involvement of distal interphalangeal joints, laboratory findings (HLA B27, RF), functional class, or disease activity indices. We report a high prevalence of severe psoriasis among patients with psoriatic arthritis, higher in women and patients with psoriatic nail disease and axial spondyloarthropathy.
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