Alejandro Balsa

Alejandro Balsa
Hospital Universitario La Paz · Servicio de Reumatología

About

408
Publications
40,098
Reads
How we measure 'reads'
A 'read' is counted each time someone views a publication summary (such as the title, abstract, and list of authors), clicks on a figure, or views or downloads the full-text. Learn more
11,508
Citations
Citations since 2017
117 Research Items
5384 Citations
201720182019202020212022202302004006008001,0001,200
201720182019202020212022202302004006008001,0001,200
201720182019202020212022202302004006008001,0001,200
201720182019202020212022202302004006008001,0001,200

Publications

Publications (408)
Article
Full-text available
Mobile health technology holds great promise for the clinical management of patients with chronic disease. However, evidence on the implementation of projects involving digital health solutions in rheumatology is scarce. We aimed to study the feasibility of a hybrid (virtual and face-to-face) monitoring strategy for personalized care in rheumatoid...
Article
Full-text available
Objectives To provide an update of the EULAR rheumatoid arthritis (RA) management recommendations addressing the most recent developments in the field. Methods An international task force was formed and solicited three systematic literature research activities on safety and efficacy of disease-modifying antirheumatic drugs (DMARDs) and glucocortic...
Article
p>Introduction: In Spain, few data have been reported on mortality and survival in rheumatoid arthritis with diffuse interstitial lung disease. Objectives: To estimate mortality and survival for patients with symptomatic diffuse interstitial lung disease and rheumatoid arthritis and to analyze the effect of clinical factors. Methods: We performe...
Article
Full-text available
Background Despite advances in the treatment of rheumatoid arthritis (RA) and the wide range of therapies available, there is a percentage of patients whose treatment presents a challenge for clinicians due to lack of response to multiple biologic and target-specific disease-modifying antirheumatic drugs (b/tsDMARDs). Objective To develop and vali...
Article
Full-text available
Difficult-to-treat rheumatoid arthritis is a heterogeneous term in which patients may present with difficulties in their management for different reasons. This can ultimately lead to patients being exposed to multiple treatments because of inefficacy (resulting from mechanisms intrinsic to rheumatoid arthritis or from non-inflammatory causes such a...
Article
Full-text available
We investigated B-cell-activating factor (BAFF) in relation to response to treatment with TNF inhibitors (TNFis) in rheumatoid arthritis (RA). This was a longitudinal study including 158 patients with RA treated with TNFis and followed up for 6 months. Clinical response at 6 months of treatment was defined according to the EULAR criteria for good r...
Article
Full-text available
The objectives of this review were to collect and summarise evidence on therapeutic drug monitoring (TDM) of biopharmaceuticals in inflammatory rheumatic and musculoskeletal diseases and to inform the EULAR Task Force for the formulation of evidence-based points to consider. A systematic literature review (SLR) was performed, covering technical asp...
Article
Objectives: Multiple failures to biologic or targeted specific disease-modifying anti-rheumatic drugs (b/tsDMARDs) that lead to difficult-to-treat rheumatoid arthritis (D2TRA) may be the result of multi-drug inefficacy or reflect treatment problems related to adverse events, comorbidities, and/or poor adherence. We aimed to characterise a cohort o...
Article
Full-text available
Objective: To develop EULAR points-to-consider for therapeutic drug monitoring (TDM) of biopharmaceuticals in inflammatory rheumatic and musculoskeletal diseases (RMDs). Methods: The points-to-consider were developed in accordance with EULAR standardised operation procedures by a multidisciplinary task force from eight European countries, based...
Article
Full-text available
Objectives The European Alliance of Associations for Rheumatology (EULAR) recommendations for the use of imaging in large vessel vasculitis establish that an imaging test supported by clinical pretest probability (PTP) is sufficient for the diagnosis of giant cell arteritis (GCA). Our objective was to determine the validity of the EULAR recommendat...
Article
Full-text available
Objectives To determine the frequency of sustained remission (R) or low diseas activity (LDA) in patients with axial spondyloarthritis (axSpA) undergoing long-term biological therapy and to analyse predictive factors for achieving these outcomes. Design Prospective, observational cohort study. Setting Spanish hospital. Participants Patients with...
Article
Objectives: To analyse the role of body mass index (BMI) in the clinical response to biologic dis-ease-modifying anti-rheumatic drugs (bDMARDs) in patients with rheumatoid arthritis (RA). To per-form an in-depth analysis of the pathophysiology of obesity by assessing serum adipokine levels and their potential changes according to treatment. Metho...
Article
Objectives: To analyse the influence of adipokines on attaining the clinical outcomes in patients with axial spondyloarthritis (axSpA) treated with TNF inhibitors (TNFi), and then, to investigate the association of patients' characteristics and adipokine concentrations. Methods: This was a longitudinal study including 110 patients with axSpA who...
Article
Full-text available
In rheumatoid arthritis (RA), the identification of biomarkers to adjust treatment intensity and to correctly diagnose the disease in early stages still constitutes a challenge and, as such, novel biomarkers are needed. We proposed that autoantibodies (aAbs) against CD26 (DPP4) might have both etiological importance and clinical value. Here, we per...
Article
Non-adherence challenges efficacy and costs of healthcare. Knowledge of the underlying factors is essential to design effective intervention strategies. Objectives To estimate the prevalence of treatment adherence in rheumatoid arthritis (RA) and to evaluate its predictors. Methods A 6-month prospective cohort study of patients with RA selected b...
Article
Full-text available
Mucin 1/Krebs von den Lungen-6 (KL-6) is proposed as a serum biomarker of several interstitial lung diseases (ILDs), including connective tissue disorders associated with ILD. However, it has not been studied in a large cohort of Caucasian antisynthetase syndrome (ASSD) patients. Consequently, we assessed the role of MUC1 rs4072037 and serum KL-6 l...
Article
Full-text available
Background Currently, there is contradictory evidence regarding the best strategy to follow after discontinuation of a first biological agent in patients with rheumatoid arthritis (RA). We aimed to compare the long-term efficacy of switching to a second tumor necrosis factor inhibitor (TNFi) versus biopharmaceuticals with other mechanisms of action...
Article
Full-text available
Objectives Interstitial lung disease (ILD) occurs in up to 30% of patients with rheumatoid arthritis (RA), resulting in increased morbidity and death in the absence of proven therapies. The aim of this study is to estimate the number of incident ILD cases reported through development studies with baricitinib in patients with RA.Methods Estimates we...
Article
Full-text available
To analyze the epidemiology, clinical features and costs of hospitalized patients with gout during the last decade in Spain. Retrospective observational study based on data from the Minimum Basic Data Set (MBDS) from the Spanish National Health Service database. Patients ≥ 18 years with any gout diagnosis at discharge who had been admitted to publi...
Article
Full-text available
Immunogenicity related to treatment with TNF inhibitors (TNFi) is one of the causes for the decreased attainment of clinical response in patients with rheumatoid arthritis (RA). The B-cell activating factor (BAFF) may be playing a role in the development of immunogenicity. The objective of this study was to analyse the association of baseline conce...
Article
Objective To assess the evolution of cost per patient/year and the cost per patient/year/drug in patients with rheumatoid arthritis (RA) receiving biological treatments. To analyze and quantify the factors influencing this evolution, such as the optimization of the biological drugs, the use of biosimilars, and official discounts and discounts obtai...
Article
Full-text available
Currently, there is an increasing interest in treating patients at risk of rheumatoid arthritis (RA) to prevent the development of this chronic disease. In this sense, research has focused attention on the early identification of predictive factors of this disease. Autoantibodies and markers of systemic inflammation can be present before clinical a...
Article
Full-text available
Biological therapies, such as TNF inhibitors (TNFi), are increasing remission (REM) rates in rheumatoid arthritis (RA) patients, although these are still limited. The aim of our study was to analyze changes in the profile of peripheral blood mononuclear cells (PBMC) in patients with RA treated with TNFi in relation to the clinical response. This is...
Article
Full-text available
Tumor necrosis factor inhibitors (TNFi) are widely used for the treatment of patients with rheumatoid arthritis (RA), however a considerable percentage of patients discontinued the therapy. The aim of this study is to explore real-world TNFi survival, stratified for seropositivity, and to determine the factors that may influence it. This is a retro...
Article
Full-text available
The initial management of rheumatoid arthritis (RA) has a high impact on disease prognosis. Therefore, we need to select the most appropriate treatment as soon as possible. This goal requires biomarkers of disease severity and prognosis. One such biomarker may be the presence of anti-carbamylated protein antibodies (ACarPA) because it is associated...
Article
Full-text available
Comorbidities in patients with rheumatoid arthritis (RA) are often associated with poor health outcomes and increased mortality. Treatment decisions should take into account these comorbidities due to known or suspected associations with certain drug classes. In clinical practice, it is critical to balance potential treatment benefit against the po...
Article
Objectives We aimed to identify MHC susceptibility factors for the anti‐carbamylated protein (anti‐CarP) antibody‐positive RA. Previously, only the HLA‐DRB1 alleles have been assessed. Methods The analysis was restricted to the anti‐CCP‐ patients because the anti‐CCP status dominates it otherwise. The genotypes for about 8000 MHC biallelic variant...
Article
Full-text available
Background Biological therapies have improved the clinical course and quality of life of rheumatoid arthritis (RA) patients. Despite the availability and effectiveness of these treatments, some patients experience multiple failures to biologic disease-modifying antirheumatic drugs (bDMARDs), constituting a particular challenge to clinicians. Objec...
Article
Full-text available
Aims First, to compare clinical features and biological disease modifying anti-rheumatic drugs (bDMARDs) response in patients with axial spondyloarthritis (axSpA) and axial psoriatic arthritis (axPsA). Second, to identify possible predictors of treatment response in both entities. Methods One-year follow-up, observational, single-center study incl...
Article
Full-text available
The presence of rheumatoid factor (RF) or anti-cyclic citrullinated peptide (anti-CCP) autoantibodies contributes to the current rheumatoid arthritis (RA) classification criteria. These criteria involve stratification on antibody levels, which limits reproducibility, and underperform in the RA patients without RF and anti-CCP. Here, we have explore...
Preprint
Full-text available
Background: Immunogenicity related to treatment with TNF inhibitors (TNFi) is one of the causes for the decreased attainment of clinical response in patients with rheumatoid arthritis (RA). The B-cell activating factor (BAFF) may be playing a role in the development of immunogenicity. The objective of this study was to analyse the association of ba...
Article
Full-text available
Background: Rheumatoid arthritis (RA) is one of the leading chronic inflammatory rheumatism. First-line therapy with synthetic disease-modifying antirheumatic drugs (sDMARD) is insufficiently effective in 40% of cases and these patients are treated with biotherapies. The increased use of these drugs each year is becoming a public health issue with...
Preprint
Full-text available
Background: The aim of our study is to evaluate whether serum infliximab trough levels (ITL) during the early stages of treatment are predictive of long-term clinical failure in patients with axial spondyloarthritis (axSpA). Methods: Longitudinal observational study involving 81 patients with axSpA recruited from the SpA-Paz cohort and monitored du...
Article
Full-text available
Background: TNF inhibitors (TNFis) are widely used for the treatment of rheumatoid arthritis (RA), although the response rates to this therapy in patients with RA remains heterogeneous and < 50% achieve remission (REM). Objective: To analyze baseline peripheral blood leukocytes profiles in order to search for biomarkers identifying patients who wil...
Article
Full-text available
Objective Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory disorder with a global prevalence of approximately 0.5–1%. Patients with RA are at an increased risk of developing comorbidities (eg, cardiovascular disease, pulmonary disease, diabetes and depression). Despite this, there are limited recommendations for the management and imp...
Article
Objective: The protagonism of regulatory B cells seems to vary along the course of the disease in murine models of inflammatory conditions. Decreased numbers of circulating regulatory CD19+CD24hiCD38hi transitional (cTr) B cells have been described in patients with long-standing RA, thus our objective was to examine the frequency and evolution of...
Preprint
Full-text available
Background: Rheumatoid arthritis (RA) is one of the leading chronic inflammatory rheumatism. First-line therapy with synthetic disease modifying anti-rheumatic drugs (sDMARD) is insufficiently effective in 40% of cases and these patients are treated with biotherapies. The increases use of these drugs each year is becoming a public health issue with...
Article
Full-text available
The major environmental risk factor for rheumatoid arthritis (RA) is smoking, which according to a widely accepted model induces protein citrullination in the lungs, triggering the production of anti-citrullinated protein antibodies (ACPA) and RA development. Nevertheless, some research findings do not fit this model. Therefore, we obtained six ind...
Article
Full-text available
MUC5B rs35705950 (G/T) is strongly associated with idiopathic pulmonary fibrosis (IPF) and also contributes to the risk of interstitial lung disease (ILD) in rheumatoid arthritis (RA-ILD) and chronic hypersensitivity pneumonitis (CHP). Due to this, we evaluated the implication of MUC5B rs35705950 in antisynthetase syndrome (ASSD), a pathology chara...
Article
Full-text available
Objectives To provide an update of the European League Against Rheumatism (EULAR) rheumatoid arthritis (RA) management recommendations to account for the most recent developments in the field. Methods An international task force considered new evidence supporting or contradicting previous recommendations and novel therapies and strategic insights...
Article
Objectives: To describe the frequency and causes for the presence of a halo sign on the ultrasound of patients without a diagnosis of GCA. Methods: In total, 305 patients with temporal artery colour Doppler ultrasound showing the presence of halo sign (intima-media thickness ≥0.34 mm for temporal arteries [TAs] and ≥1 mm for axillary arteries) w...
Article
Full-text available
Background: The patients with RA benefit from early identification soon after the first clinical symptoms appear. The 2010 ACR/EULAR classification criteria were developed to fulfill this need and their application has been demonstrated to be effective. However, there is still room for improvement. Therefore, we aimed to evaluate the potential of...
Article
Objective: To assess the evolution of cost per patient/year and the cost per patient/year/drug in patients with rheumatoid arthritis (RA) receiving biological treatments. To analyze and quantify the factors influencing this evolution, such as the optimization of the biological drugs, the use of biosimilars, and official discounts and discounts obt...
Article
Full-text available
Treat-to-target (T2T) and dose tapering after obtaining the therapeutic objective (called “treat-to-budget”-T2B-in this Commentary) are the two most commonly used therapeutic strategies in rheumatoid arthritis. In theory, both strategies could add value to the healthcare system, although they are focused on different objectives: T2T strategy improv...
Article
Objectives Issue recommendations on practical aspects of the monitoring of levels of biological drugs that may be useful for rheumatologists. Methods We conducted a systematic review of studies in which drug and anti-drug antibody levels were determined in patients with rheumatoid arthritis (RA) or spondyloarthritis (SpA) to study whether they cou...
Article
Full-text available
Objectives: To explore the remission concept in rheumatoid arthritis (RA) and the implications of the existing definitions when applied to clinical practice among rheumatologists with different profiles. Methods: A qualitative study through focus groups was conducted. Three focus groups were organised from February to March 2016. Each group was...
Article
Objective: A novel population of B helper cells, phenotypically CD4+CXCR5-PD-1hi, has been described in the synovial tissues and peripheral blood of seropositive RA patients, and termed 'peripheral helper T' (Tph) cells. Contrary to CD4+CXCR5+PD-1hi follicular helper T (Tfh), Tph cells are not located in lymphoid organs but accumulate in inflamed...
Conference Paper
Full-text available
Background The most common biological agents used as disease-modifying treatment in rheumatoid arthritis (RA) are TNF inhibitors (TNFi). Although these new strategies to treat RA have improved the course of the disease, approximately 30-50% of patients do not respond to this therapy. Early identification of optimal responders is crucial in the clin...
Conference Paper
Background Chronic kidney disease is associated with an increased risk of fractures. However, the existing evidence investigating the incidence of fractures after kidney transplant is scarce. Objectives To evaluate the incidence of clinical fractures in patients with kidney transplant and analyze the possible factors that may influence its occurre...
Conference Paper
Background CD19+CD24hiCD38hi B cells have a regulatory capacity and their frequency is altered in the peripheral blood of patients with various autoimmune conditions, including RA. Objectives To determine the frequency of circulating CD19+CD24hiCD38hi regulatory B cells (cBreg) in ACPA+ vs ACPA- patients with RA, and its possible modification by I...
Conference Paper
Background Giant cell arteritis (GCA) is the most common systemic vasculitis in the elderly. The halo sign has been shown as an accepted valid test in the diagnosis of GCA in trained units¹⁻². However, to further improve the specificity, the sonographer should know some pathologies that can mimic halo signs since they also produce a hypoechoic incr...
Conference Paper
Background The availability of oral janus kinase inhibitors, as tofacitinib, has extended the treatment pathways for management of patients with rheumatoid arthritis (RA) Objectives To assess the cost-effectiveness of tofacitinib as second-line treatment compared to treatment sequences containing standard biological-therapies in patients with mode...
Conference Paper
Background Circulating CD4 T cells that express CXCR5 together with PD-1 and/or ICOS are considered as counterparts of bona fide Tfh cells and function as B cell helpers. In addition, circulating CD4+CXCR5+ T cells can be subdivided into three subpopulations: CXCR5+CXCR3+CCR6- (Tfh-Th1), CXCR5+CXCR3-CCR6+ (Tfh-Th17) and CXCR5+CXCR3-CCR6- (Tfh-Th2)....
Conference Paper
Background A novel population of B helper cells, phenotypically CD4+CXCR5-PD-1hi, has been described in the synovial tissues and peripheral blood of seropositive RA patients with an established disease, and termed ‘peripheral helper’ (Tph) cells. Contrary to CD4+CXCR5+PD-1hi follicular helper T (Tfh) cells, Tph cells are not located in lymphoid org...
Conference Paper
Full-text available
Background Rheumatoid arthritis (RA) is a chronic inflammatory disease with the typical characteristic of synovitis of small-sized and medium-sized joints that leads to cartilage and bone damage. TNF inhibitors (TNFi) are widely used for the treatment of rheumatoid arthritis (RA) however, there are still no objective indicators of clinical response...
Conference Paper
Background In rheumatoid arthritis (RA) patients (pts) after discontinuation of tumour necrosis factor α inhibitors (TNFi) physicians can choose an alternative TNFi or a biological agent with another mode of action (non-TNFi), however little guidance on choosing one or another exists. Objectives To compare the long-term clinical response, survival...
Conference Paper
Background Patients with rheumatoid arthritis (RA) achieve the best response when they receive adequate treatment as soon as possible. This fact motivated the modification of the classification criteria by the ACR and the EULAR in 2010 to enable early detection. One of the changes is the increased weight conferred to the autoantibodies: rheumatoid...
Conference Paper
Background Nailfold videocapillaroscopy is a non-invasive technique used to assess Raynaud syndrome. It is mainly used for the early diagnosis of connective tissue disorders (CTD) such as systemic sclerosis. There is some evidence that capillaroscopy findings may be altered by microcirculation abnormalities in patients with cardiovascular risk fact...
Conference Paper
Background Gender has been lately suggested as influential in the response to treatment with biological drugs in spondyloarthritis, such as psoriatic arthritis (PsA). However, data about the association between gender and treatment response in axial PsA (axPsA) or peripheral PsA (pPsA) are scarce. Objectives To analyze the association between gend...
Conference Paper
Background The contribution of cigarette smoking to the risk of rheumatoid arthritis (RA) is larger for seropositive than for seronegative patients. Current pathogenic models explain this difference via the production of anti-citrullinated protein antibodies (ACPA) induced by protein citrullination in the lungs as a consequence of smoking. However,...
Conference Paper
Background The evolution of the disease is heterogeneous among patients with psoriatic arthritis (PsA). Specifically, the influence of gender on the disease outcomes (and the need of a more intensive treatment) has been pointed. However, data regarding this are scarce. Objectives: to analyse the disease profile in male and female patients with PsA...
Conference Paper
Background Scarce evidence exists on the assessment of bone mineral density (BMD ) in adult Hypophosphatasia (HPP). Recent studies suggest that dual-energy X-ray absorptiometry (DXA) could not appropriately predict their fracture risk and note the importance on further explore bone microstructure. Objectives To evaluate BMD at the lumbar spine (LS...
Conference Paper
Background There is great interest in the identification of prognostic biomarkers informing early therapeutic decisions for the improvement of rheumatoid arthritis (RA) evolution. Promising results in early arthritis (EA) patients indicate the anti-carbamylated protein antibodies (ACarPA) may serve this function. In effect, they are associated with...
Conference Paper
Background Infliximab (Ifx) has proven to be effective in patients with axial spondyloarthritis (axSpA). Several variables may affect pharmacokinetic-pharmacodynamic of Ifx and its relation with clinical response, such as: disease activity (inflammatory burden), the development of anti-drug antibodies (ADA) and the concomitant use of conventional s...
Article
Full-text available
Objective to evaluate the efficacy and safety of increasing the dose interval of subcutaneous tocilizumab in patients with rheumatoid arthritis (RA) who were in clinical remission. Methods patients with RA, active disease and an inadequate response to csDMARDS or one biological agent were entered into a single‐arm phase with 162 mg of subcutaneous...