L Mayordomo

Hospital Universitario Nuestra Señora de Valme, Hispalis, Andalusia, Spain

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Publications (14)53.89 Total impact

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    ABSTRACT: OBJECTIVE: To assess the responsiveness and repeatability of volumetric power Doppler ultrasound (PDUS) evaluation of synovitis and bone erosions in rheumatoid arthritis (RA). METHODS: Twenty-three patients with RA (19 women, mean age 52.7 ± 12.6 yrs, mean disease duration 10.1 ± 8.6 yrs) were prospectively enrolled. All patients were beginning therapy with rituximab because of disease activity despite therapy with synthetic disease-modifying antirheumatic drugs and tumor necrosis factor-blocking agents. Patients underwent clinical, laboratory, and volumetric PDUS examination at baseline, 6 months, and 12 months. Ten centers participated in the study. Four centers recruited the patients and performed the volumetric acquisitions of PDUS images, while the remaining 6 centers assessed the PDUS volumes, blinded to the identity of patients and date of the visits. The most symptomatic hand and foot were scored for B-mode synovitis, synovial PD signal, and bone erosions. The repeatability of the volumetric PDUS assessment was investigated. RESULTS: An overall improvement in clinical and PDUS measurements was found at the followup assessments. The mean indexes for synovial PD signal and bone erosions and the number of sites with abnormalities decreased significantly throughout the followup (p < 0.05). The intraacquisition, intrareader reliability was excellent for all PDUS measurements (intraclass correlation coefficients > 0.9). CONCLUSION: The results of our pilot study suggest that volumetric PDUS can be responsive and repeatable in multicenter cohort studies of RA. This technique may minimize assessment biases and reduce acquisition variability in open-label and observational studies.
    The Journal of Rheumatology 01/2013; · 3.26 Impact Factor
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    ABSTRACT: OBJECTIVES: Our objective was to describe the ultrasound features of patients with PsA in joints and skin and their changes after treatment with infliximab. METHODS: Eight hospitals recruited PsA active patients. Clinical (joint count for pain, TJC, and swelling, SJC, pain VAS, ESR, C-reactive protein and PASI) and US variables (plaque thickness, PD signal of dermal lesions, synovitis, erosions, and PD signal, assessed by 4-category ordinal scales) were independently recorded at baseline and 4, 12 and 24-week after starting treatment with infliximab. The results were analysed with paired T, Wilcoxon test, ANOVA and marginal homogeneity test. RESULTS: Changes in 24 patients from baseline to last available data were significant for clinical variables, pain VAS, TJC and SJC as well as for ESR, CRP (all p<0.0005). Dermatological PASI changed from 14.6±14.9 to 2.1±4.1 and plaque thickness from 3.34±1.75 mm to 1.74±0.96 mm (both p<0.0005); synovitis and PD signal improved (both p<0.0005). Psoriatic plaque PD improved across the study (p<0.0005) with no signal increasing from 36.4% to 88.9% and positive PD signal decreasing from 63.6% to 11.1% of the plaques. CONCLUSIONS: Treatment with anti-TNF-α infliximab improves the symptoms of patients with PsA at joint and psoriatic skin levels from a clinical and ultrasonographic perspective.
    Clinical and experimental rheumatology 09/2012; · 2.66 Impact Factor
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    ABSTRACT: To investigate the presence of synovitis, tenosynovitis and enthesitis with power Doppler (PD) ultrasonography (US) in patients with psoriasis without musculoskeletal diseases as compared with controls with other skin diseases without musculoskeletal disorders. A total of 162 patients with plaque psoriasis and 60 age-matched controls with other skin diseases, all without musculoskeletal diseases, were prospectively recruited at 14 centres. They underwent dermatological and rheumatological assessment and a blinded PDUS evaluation. Clinical assessment included demographics, comorbidities, severity of psoriasis, work and sport activities and musculoskeletal clinical examination. PDUS evaluation consisted of the detection of grey scale (GS) synovitis and synovial PD signal in 36 joints, GS tenosynovitis and tenosynovial PD signal at 22 sites, and GS enthesopathy and entheseal PD signal in 18 entheses. US synovitis and enthesopathy were significantly more frequent in psoriatic patients than in controls (P = 0.024 and 0.005, respectively). The percentage of joints with US synovitis was 3.2% in the psoriasis group and 1.3% in the control group (P < 0.0005). US enthesopathy was present in 11.6% of entheses in the psoriasis group and 5.3% of entheses in the control group (P < 0.0005). Entheseal PD signal was found in 10 (7.4%) psoriatic patients, whereas no controls showed this finding (P = 0.05). Among demographic and clinical data, having psoriasis was the only significant predictive variable of the presence of US synovitis [odds ratio (OR) 2.1; P = 0.007] and enthesopathy (OR 2.6; P = 0.027). Psoriatic patients showed a significant prevalence of asymptomatic US synovitis and enthesopathy, which may indicate a subclinical musculoskeletal involvement.
    Rheumatology (Oxford, England) 06/2011; 50(10):1838-48. · 4.24 Impact Factor
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    ABSTRACT: Objectives Systemic autoimmune disease can have neurologic manifestations. The following study analyses the awareness among neurologists on this topic.Materials and methodsDescriptive study: The authors have reviewed the clinical history of patients between 15 and 45 years old, with neurologic events between codes 433 and 438 of the ICD-19 (mainly ischemic events, bleeding, motors disorders…). The authors have collected demographic data and analytical.Results143 patients, 95 male (66.43%) and 48 female (33.57%). The majority of admissions were patients between 40 and 45 years old (42.7%). Under 30 years old admitted 20.98% and only five patients (3.5%) under 20 years old.In all patients were requested general analytic study. Hypercoagulability study in 72 patients (50.35%), antinuclear antibody (ANA) in 70 (48.95%), C3 and C4 in 26 (18.18%), anti-neutrophil cytoplasmic antibodies (ANCAs) in 20 (13.99%), lupus anticoagulant in 7 (4.9%) and cryoglobulins in 5 (3.50%).When performing an analysis by age, the authors found the hypercoagulability study was requested in 60% of patients under 30 years old, while only in 37.76% of patients between 31 and 45 years old. The seven patients who requested lupus anticoagulant were over 35 years old. ANA were requested in 56.67% of patients under 30 years old. In none of the five patients under 20 years old requested this study. Between 31 and 45 years old, the neurologists investigated the presence of ANAs in 37.06%. Only four of the patients under 30 years old (13.33%) requested the study of ANCAs. This study was requested in 14.16% of patients between 30 and 45 years old.As for the analytical data, leucopoenia was detected in nine patients (6.29%), neutropoenia in five (3.50%), thrombocytopenia in five (3.50%) elongated APTT in six (4.2%) alterations in urinary sediment in eight patients (5.59%). The authors identified three patients (2.1%) with systemic lupus erythematosus according to American College of Rheumatology criteria (two patients were diagnosed prior to admissions, an one was diagnosed during hospitalisation).Conclusions The sensitivity of neurologists regarding the involvement of autoimmune phenomena in neurological processes is lower than expected. Hypercoagulability study and ANA are the most requested, and the percentage of their request is higher in individuals under than 30 years. It seems that there is greater awareness about these diseases in younger patients.It would be of interest to establish measures in collaboration between neurologists-rheumatologists to improve the diagnostic approach to these patients.
    Annals of The Rheumatic Diseases - ANN RHEUM DIS. 01/2011; 70(2).
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    ABSTRACT: To compare the interobserver reliability of three-dimensional (3D) volumetric ultrasonography (US) and 2D real-time US in detecting inflammatory and destructive changes in rheumatoid arthritis (RA) wrist and hand. Two RA patients were selected by a rheumatologist who performed independently a grey-scale and power Doppler (PD) volumetric acquisition at three anatomic sites in their more symptomatic wrist/hand using two identical scanners equipped with 3D volumetric probe. Twelve rheumatologists expert in MSUS were randomly assigned to a US scanner and a patient. In the first part of the study, each group of experts blindly, independently, and consecutively performed a 2D real-time grey-scale and PD US investigation of inflammatory changes and/or bone erosions at the three anatomic sites. In the second part of the study, each group of investigators blindly evaluated the same pathologic changes in the 6 volumes from the patient not scanned by them. The kappa values were higher for 3D volumetric US than for 2D US in the detection of synovitis/tenosyno-vitis (0.41 vs. 0.37) and PD signal (0.82 vs 0.45) and in the PD signal grading (0.81 vs. 0.55). 3D volumetric US may improve the interobserver reliability in RA multicentre studies.
    Clinical and experimental rheumatology 01/2010; 28(1):79-82. · 2.66 Impact Factor
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    ABSTRACT: To develop education guidelines for the conduct of future European League Against Rheumatism (EULAR) musculoskeletal ultrasound (MSUS) courses. We undertook a consensus-based, iterative process using two consecutive questionnaires sent to 29 senior ultrasonographer rheumatologists who comprised the faculty of the 14th EULAR ultrasound course (June 2007). The first questionnaire encompassed the following issues: type of MSUS educational model; course timing; course curriculum; course duration; number of participants per teacher in practical sessions; time spent on hands-on sessions; and the requirements and/or restrictions for attendance at the courses. The second questionnaire consisted of questions related to areas where consensus had not been achieved in the first questionnaire, and to the topics and pathologies to be assigned to different educational levels. The response rate was 82.7% from the first questionnaire and 87.5% from the second questionnaire. The respondents were from 11 European countries. The group consensus on guidelines and curriculum was for a three-level education model (basic, intermediate and advanced) with timing and location related to the annual EULAR Congresses. The topics and pathologies to be included in each course were agreed. The course duration will be 20 h. There will be a maximum of six participants per teacher and 50-60% of total time will be spent on practical sessions. There was also agreement on prerequisite experience before attending the intermediate and advanced courses. We have developed European agreed guidelines for the content and conduct of EULAR ultrasound courses, which may also be recommended to national and local MSUS training programmes.
    Annals of the rheumatic diseases 08/2008; 67(7):1017-22. · 8.11 Impact Factor
  • Clinical and experimental rheumatology 01/2007; 25(1):116. · 2.66 Impact Factor
  • Osteoarthritis and Cartilage 01/2007; 15. · 4.26 Impact Factor
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    ABSTRACT: To assess the interobserver reliability of the main periarticular and intra-articular ultrasonographic pathologies and to establish the principal disagreements on scanning technique and diagnostic criteria between a group of experts in musculoskeletal ultrasonography. The shoulder, wrist/hand, ankle/foot, or knee of 24 patients with rheumatic diseases were evaluated by 23 musculoskeletal ultrasound experts from different European countries randomly assigned to six groups. The participants did not reach consensus on scanning method or diagnostic criteria before the investigation. They were unaware of the patients' clinical and imaging data. The experts from each group undertook a blinded ultrasound examination of the four anatomical regions. The ultrasound investigation included the presence/absence of joint effusion/synovitis, bony cortex abnormalities, tenosynovitis, tendon lesions, bursitis, and power Doppler signal. Afterwards they compared the ultrasound findings and re-examined the patients together while discussing their results. Overall agreements were 91% for joint effusion/synovitis and tendon lesions, 87% for cortical abnormalities, 84% for tenosynovitis, 83.5% for bursitis, and 83% for power Doppler signal; kappa values were good for the wrist/hand and knee (0.61 and 0.60) and fair for the shoulder and ankle/foot (0.50 and 0.54). The principal differences in scanning method and diagnostic criteria between experts were related to dynamic examination, definition of tendon lesions, and pathological v physiological fluid within joints, tendon sheaths, and bursae. Musculoskeletal ultrasound has a moderate to good interobserver reliability. Further consensus on standardisation of scanning technique and diagnostic criteria is necessary to improve musculoskeletal ultrasonography reproducibility.
    Annals of the Rheumatic Diseases 02/2006; 65(1):14-9. · 9.11 Impact Factor
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    ABSTRACT: To evaluate the clinical response and safety profile of infliximab in refractory ankylosing spondylitis patients. Patients with active ankylosing spondylitis, despite methotrexate therapy, were included in an open-label, single-centre study. Patients were given 3-5 mg/kg infliximab infusions at Weeks 0, 2, 6, and q8 etc up to Week 30, together with methotrexate at the dosage taken prior to study inclusion, and were followed-up for a 34-week period. Nine patients with mean age 43 years and mean disease duration 7 years, diagnosed with pure axial ankylosing spondylitis were included. Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), duration of morning stiffness, physician's global assessment of disease activity (PhGADA), visual analogue scale (VAS) pain, enthesis index, occiput-to-wall test, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and Bath Ankylosing Spondylitis Functional Index (BASFI) significantly improved by Week 6. No adverse events related with the drug were recorded during the 34-week follow-up period. Efficacy results are similar to those previously published. No adverse events were seen during therapy, and antinuclear antibody profiles were negative. The association of methotrexate with infliximab can improve the safety profile.
    Scandinavian Journal of Rheumatology 01/2004; 33(5):323-6. · 2.22 Impact Factor
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    ABSTRACT: High frequency ultrasonography is an accurate non-invasive imaging technique for evaluating patients with painful shoulder. To compare the clinical diagnosis established by a physical examination with high frequency ultrasonographic findings in patients with painful shoulder. Thirty one consecutive patients with a first flare of shoulder pain were prospectively included in the study. All had a physical examination performed by two blinded rheumatologists. Ultrasonographic examination was carried out within one week of the physical examination by a third rheumatologist experienced in this technique who had no knowledge of the clinical findings. Ultrasonography was considered the optimal diagnostic technique. Clinical assessment showed low accuracy in the diagnosis of periarticular shoulder lesions. Ultrasonography should be used wherever possible to improve diagnosis and treatment of painful shoulder.
    Annals of the Rheumatic Diseases 03/2002; 61(2):132-6. · 9.11 Impact Factor
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    ABSTRACT: No difference in the number of serious adverse events was reported in previous clinical trials in rheumatoid arthritis (RA) and inflammatory bowel disease (IBD) patients treated with TNF-alpha blockade, but a patient died because of disseminated tuberculosis. A tuberculosis reactivation in a patient with IBD and anti-TNF-alpha treatment has been recently reported. Very recently 70 cases of tuberculosis were reported from the FDA Adverse Event Reporting System. We report a case of pulmonary miliary tuberculosis in a RA patient treated with TNF-alpha blockade. The important role of TNF-alpha in defence against tuberculosis and possible mechanisms of anti-TNF-alpha agents impairing tuberculosis immune response are discussed.
    Scandinavian Journal of Rheumatology 02/2002; 31(1):44-5. · 2.22 Impact Factor
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    ABSTRACT: We studied the ultrasonographic (US) features of the pes anserinus insersion (PA) and subcutaneous medial knee fat in patients clinically diagnosed of pes anserinus tendino-bursitis (PATB) syndrome. Thirty seven consecutive patients with suspected PATB were clinically evaluated and their knees examined using a 7.5 MHz linear probe. In twenty-three patients with unilateral clinical PATB (group A) the painful knee was compared with their painless opposite knee. Six patients with bilateral clinical PATB (group B) were compared with 6 healthy controls (group C). All patients were women with radiographic knee osteoarthritis in 93% and body mass index > 27 in 75%. US pes anserinus tendinitis was found in one symptomatic knee and pes anserinus bursitis in two symptomatic knees and in one asymptomatic knee. No US signs of panniculitis were found in patients and controls. In conclusion, patients diagnosed of PATB syndrome in rheumatology rarely have US tendinitis or bursitis of the PA.
    Scandinavian Journal of Rheumatology 01/2000; 29(3):184-6. · 2.22 Impact Factor
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    ABSTRACT: The recent improvement of musculoskeletal imaging achieved by high-frequency ultrasonography (US) and its important advantages as a routine dynamic imaging tool-providing results rapidly, absence of secondary effects, and low cost-make US a very useful tool in rheumatologic practice. We prospectively compared high-frequency US with magnetic resonance imaging (MRI) in patients with painful shoulder syndrome.Thirty-four consecutive patients (36 shoulders) with a first flare of shoulder pain were included in the study. US and MRI shoulder examination were performed within 2 weeks. US shoulder examinations were performed by a rheumatologist experienced in US, without knowledge of the MRI results. The MRI results were considered the gold standard. US showed high sensitivity, specificity, and positive and negative predictive values (range 85.7%-100%) in the diagnosis of tendinitis, partial-thickness, and full-thickness tear of the rotator cuff and degenerative changes of the acromio-clavicular joint. Rotator cuff calcifications were detected only by US. We highly recommend that for many painful shoulders, appropriately trained rheumatologists can perform US examinations to establish an accurate diagnosis and, thereby, improve therapy.
    JCR Journal of Clinical Rheumatology 09/1999; 5(4):184-92. · 1.18 Impact Factor