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Spinal Diseases: HELP
Articles by Carlos Manuel González
Based on 12 articles published since 2008
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Between 2008 and 2019, C. González wrote the following 12 articles about Spinal Diseases.
 
+ Citations + Abstracts
1 Guideline Recommendations for the Use of Ultrasound and Magnetic Resonance in Patients With Spondyloarthritis, Including Psoriatic Arthritis, and Patients With Juvenile Idiopathic Arthritis. 2018

Uson, Jacqueline / Loza, Estibaliz / Möller, Ingrid / Acebes, Carlos / Andreu, Jose Luis / Batlle, Enrique / Bueno, Ángel / Collado, Paz / Fernández-Gallardo, Juan Manuel / González, Carlos / Jiménez Palop, Mercedes / Lisbona, María Pilar / Macarrón, Pilar / Maymó, Joan / Narváez, Jose Antonio / Navarro-Compán, Victoria / Sanz, Jesús / Rosario, M Piedad / Vicente, Esther / Naredo, Esperanza. ·Servicio de Reumatología, Hospital Universitario de Móstoles, Móstoles, Madrid, España. · Instituto de Salud Musculoesquelética, Madrid, España. Electronic address: estibaliz.loza@inmusc.eu. · Servicio de Reumatología, Instituto Poal de Reumatología, Barcelona, España. · Servicio de Reumatología, Hospital General de Villalba, Collado Villalba, Madrid, España. · Servicio de Reumatología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España. · Servicio de Reumatología, Hospital Universitario Sant Joan d'Alacant, Sant Joan d'Alacant, Alicante, España. · Servicio de Radiología, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España. · Servicio de Reumatología, Hospital Universitario Severo Ochoa, Leganés, Madrid, España. · Servicio de Radiología, Hospital Universitario Severo Ochoa, Leganés, Madrid, España. · Servicio de Reumatología, Hospital General Universitario Gregorio Marañón, Madrid, España. · Servicio de Reumatología, Hospital del Mar, Barcelona, España. · Servicio de Reumatología, Hospital Universitario Clínico San Carlos, Madrid, España. · Servicio de Radiodiagnóstico, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España. · Servicio de Reumatología, Hospital Universitario La Paz, IdiPAZ, Madrid, España. · Servicio Andaluz de Salud, Sevilla, España. · Servicio de Reumatología, Hospital Universitario de La Princesa, Madrid, España. ·Reumatol Clin · Pubmed #28277255.

ABSTRACT: OBJECTIVE: To develop evidence-based recommendations on the use of ultrasound (US) and magnetic resonance imaging in patients with spondyloarthritis, including psoriatic arthritis, and juvenile idiopathic arthritis. METHODS: Recommendations were generated following a nominal group technique. A panel of experts (15 rheumatologists and 3 radiologists) was established in the first panel meeting to define the scope and purpose of the consensus document, as well as chapters, potential recommendations and systematic literature reviews (we used and updated those from previous EULAR documents). A first draft of recommendations and text was generated. Then, an electronic Delphi process (2 rounds) was carried out. Recommendations were voted from 1 (total disagreement) to 10 (total agreement). We defined agreement if at least 70% of participants voted≥7. The level of evidence and grade or recommendation was assessed using the Oxford Centre for Evidence Based Medicine levels of evidence. The full text was circulated and reviewed by the panel. The consensus was coordinated by an expert methodologist. RESULTS: A total of 12 recommendations were proposed for each disease. They include, along with explanations of the validity of US and magnetic resonance imaging regarding inflammation and damage detection, diagnosis, prediction (structural damage progression, flare, treatment response, etc.), monitoring and the use of US guided injections/biopsies. CONCLUSIONS: These recommendations will help clinicians use US and magnetic resonance imaging in patients with spondyloarthritis and juvenile idiopathic arthritis.

2 Article Recommendations for the Management of Comorbidity in Patients With Axial Spondyloarthritis in Clinical Practice. 2018

González, Carlos / Curbelo Rodríguez, Rafael / Torre-Alonso, Juan Carlos / Collantes, Eduardo / Castañeda, Santos / Hernández, M Victoria / Urruticoechea-Arana, Ana / Nieto-González, Juan Carlos / García, Javier / Abad, Miguel Ángel / Ramírez, Julio / Suárez, Carmen / Dalmau, Regina / Martín-Arranz, Maria Dolores / León, Leticia / Hermosa, Juan Carlos / Obaya, Juan Carlos / Otón, Teresa / Carmona, Loreto. ·Servicio de Reumatología, Hospital Universitario Gregorio Marañón, Madrid, España. · Instituto de Salud Musculoesquelética, Madrid, España. · Servicio de Reumatología, Hospital Universitario Monte Naranco, Oviedo, Asturias, España. · Servicio de Reumatología, Hospital Universitario Reina Sofía, Córdoba, España. · Servicio de Reumatología, Hospital Universitario La Princesa IIS-Princesa, Madrid, España. · Servicio de Reumatología, Hospital Clínic, Barcelona, España. · Servicio de Reumatología, Hospital Can Misses, Ibiza, España. · Servicio de Reumatología, Hospital Universitario 12 de Octubre, Madrid, España. · Unidad de Reumatología, Hospital Virgen del Puerto, Plasencia, España. · Servicio de Medicina Interna, Hospital Universitario de La Princesa, Madrid, España. · Servicio de Cardiología, Hospital Universitario La Paz, Madrid, España. · Servicio de Gastroenterología, Hospital Universitario La Paz, Madrid, España. · IdISSC Servicio de Reumatología, Hospital Clínico San Carlos, Madrid, España. · Centro de Salud Ciudades, Getafe, Madrid, España. · Centro de Salud Alcobendas, Alcobendas, Madrid, España. · Instituto de Salud Musculoesquelética, Madrid, España. Electronic address: loreto.carmona@inmusc.eu. ·Reumatol Clin · Pubmed #28461161.

ABSTRACT: OBJECTIVES: To identify priorities among comorbidities in axial spondyloarthritis (AxSpA) and recommend how to follow them from an eminently practical perspective. METHODS: A multidisciplinary group was selected (10 rheumatologists-six of them experts in AxSpA-, 2 general practitioners, an internist, a cardiologist, a gastroenterologist and a psychologist). In a first discussion meeting, the scope and users were established and a list of comorbidities was voted based on frequency and impact. The panelists had to defend the inclusion of each comorbidity/item in the document with consistent arguments. Four panelists and two methodologists developed systematic reviews on controversial topics. In a second meeting, the results of the reviews and the arguments concerning the items to be included were presented. After the meeting, the final document was drafted. RESULTS: The final document includes two checklists, one for health professionals and another for patients; they incorporate cardiovascular risk, renal comorbidities, gastrointestinal risk, lifestyle, risk of infections and vaccinations, pulmonary involvement, concomitant medication, psycho-affective disorders, osteoporosis, and risk of fracture. In addition, the document reflects the arguments favoring the inclusion of each item and how to record the items for subsequent collection. The panel considered it also appropriate to likewise establish «practices to avoid» applicable to comorbidity in AxSpA. CONCLUSIONS: Two checklists and a list of situations to avoid were generated to facilitate the management of comorbidities in AxSpA. In a future step, their utility and acceptance will be tested by a broad group of users that includes doctors, patients and nurses.

3 Article Two-year incidence of psoriasis, uveitis and inflammatory bowel disease in patients with spondyloarthritis: A study in the AQUILES cohort. 2016

García-Vicuña, Rosario / Zarco, Pedro / González, Carlos M / Vanaclocha, Francisco / Marín-Jiménez, Ignacio / Cea-Calvo, Luis. ·Departamento de Reumatología, Hospital Universitario La Princesa, IIS-IP, Madrid, España. Electronic address: vicuna111@gmail.com. · Departamento de Reumatología, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España. · Departamento de Reumatología, Hospital Universitario Gregorio Marañón, Madrid, España. · Departamento de Dermatología, Hospital Universitario 12 de Octubre, Madrid, España. · Departamento de Gastroenterología, Hospital Universitario Gregorio Marañón, Madrid, España. · Departamento de Medical Affairs, Merck Sharp & Dohme de España, S. A., Madrid, España. ·Reumatol Clin · Pubmed #25683367.

ABSTRACT: OBJECTIVES: To describe the 2-year incidence of new extra-articular manifestations (uveitis, psoriasis, inflammatory bowel disease) in a cohort of patients with spondyloarthritis included in the AQUILES study. PATIENTS: Over a period of 2 years, 513 patients with spondyloarthritis (62.5% males, mean age 48 years) diagnosed with ankylosing spondylitis (AS) (55.6%), psoriatic arthritis (25.3%), undifferentiated spondyloarthritis (16.2%), enteropathic arthritis (2.5%), and other diseases (0.4%) were followed. New diagnoses were based on reports of the corresponding specialists (ophthalmologists, dermatologists, gastroenterologists). RESULTS: During the 2-year follow-up, 22 new diagnoses of the extra-articular manifestations were established, with a cumulative incidence of 4.3% (95% confidence interval 2.4-6.1) and an incidence rate of 17 cases per 10,000 patient-year. Uveitis was the most frequent diagnosis (cumulative incidence 3.1%), predominantly in patients with AS. In the multivariate analysis, the diagnosis of AS was the only predictive variable associated to the development of new extra-articular disease. CONCLUSIONS: In patients with spondyloarthritis, the 2-year global incidence of uveitis, psoriasis and inflammatory bowel disease (IMID) was 4.3%, particularly due to new diagnoses of uveitis in patients with AS.

4 Article A deletion at ADAMTS9-MAGI1 locus is associated with psoriatic arthritis risk. 2015

Julià, Antonio / Pinto, José Antonio / Gratacós, Jordi / Queiró, Rubén / Ferrándiz, Carlos / Fonseca, Eduardo / Montilla, Carlos / Torre-Alonso, Juan Carlos / Puig, Lluís / Pérez Venegas, José Javier / Fernández Nebro, Antonio / Fernández, Emilia / Muñoz-Fernández, Santiago / Daudén, Esteban / González, Carlos / Roig, Daniel / Sánchez Carazo, José Luís / Zarco, Pedro / Erra, Alba / López Estebaranz, José Luís / Rodríguez, Jesús / Ramírez, David Moreno / de la Cueva, Pablo / Vanaclocha, Francisco / Herrera, Enrique / Castañeda, Santos / Rubio, Esteban / Salvador, Georgina / Díaz-Torné, César / Blanco, Ricardo / Willisch Domínguez, Alfredo / Mosquera, José Antonio / Vela, Paloma / Tornero, Jesús / Sánchez-Fernández, Simón / Corominas, Héctor / Ramírez, Julio / López-Lasanta, María / Tortosa, Raül / Palau, Nuria / Alonso, Arnald / García-Montero, Andrés C / Gelpí, Josep Lluís / Codó, Laia / Day, Kenneth / Absher, Devin / Myers, Richard M / Cañete, Juan D / Marsal, Sara. ·Rheumatology Research Group, Vall d'Hebron Research Institute, Barcelona, Spain. · Rheumatology Department, Complejo Hospitalario Juan Canalejo, A Coruña, Spain. · Rheumatology Department, Hospital Parc Taulí, Sabadell, Barcelona, Spain. · Rheumatology Department, Hospital Universitario Central de Asturias, Oviedo, Spain. · Dermatology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain. · Dermatology Department, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain. · Rheumatology Department, Hospital Virgen de la Vega, Salamanca, Spain. · Rheumatology Department, Hospital Monte Naranco, Oviedo, Spain. · Dermatology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. · Rheumatology Department, Hospital de Jerez de la Frontera, Cádiz, Spain. · UGC Reumatología, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga, Málaga, Spain. · Department of Dermatology, Hospital Universitario de Salamanca, Salamanca, Spain. · Rheumatology Department, Hospital Universitario Infanta Sofía, Madrid, Spain. · Dermatology Department, Hospital Universitario La Princesa, Madrid, Spain. · Rheumatology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain. · Rheumatology Service, Hospital Moisès Broggi, Barcelona, Spain. · Dermatology Department, Hospital General Universitario de Valencia, Valencia, Spain. · Rheumatology Department, Hospital Universitario Fundación Alcorcón, Madrid, Spain. · Rheumatology Department, Hospital Sant Rafael, Barcelona, Spain. · Dermatology Department, Hospital Universitario Fundación Alcorcón, Madrid, Spain. · Rheumatology Department, Hospital Universitari de Bellvitge, Barcelona, Spain. · Dermatology Department, Hospital Universitario Virgen Macarena, Sevilla, Spain. · Department of Dermatology, Hospital Universitario Infanta Leonor, Madrid, Spain. · Dermatology Department, Hospital Universitario 12 de Octubre, Madrid, Spain. · Dermatology Department, Hospital Universitario Virgen de la Victoria, Málaga, Spain. · Rheumatology Department, Hospital Universitario de La Princesa, IIS-Princesa, Madrid, Spain. · Rheumatology Department, Centro de Salud Virgen de los Reyes, Sevilla, Spain. · Rheumatology Department, Hospital Mútua de Terrassa, Terrassa, Spain. · Rheumatology Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. · Rheumatology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain. · Rheumatology Department, Complexo Hospitalario de Ourense, Ourense, Spain. · Rheumatology Department, Complejo Hospitalario Hospital Provincial de Pontevedra, Pontevedra, Spain. · Rheumatology Department, Hospital General Universitario de Alicante, Alicante, Spain. · Rheumatology Department, Hospital Universitario Guadalajara, Guadalajara, Spain. · Rheumatology Department, Hospital La Mancha Centro, Alcázar de San Juan, Spain. · Rheumatology Department, Hospital Clínic de Barcelona and IDIBAPS, Barcelona, Spain. · Banco Nacional de ADN Carlos III, University of Salamanca, Salamanca, Spain. · Life Sciences, Barcelona Supercomputing Centre, National Institute of Bioinformatics, Barcelona, Spain. · HudsonAlpha Institute for Biotechnology, Alabama, USA. ·Ann Rheum Dis · Pubmed #25990289.

ABSTRACT: OBJECTIVE: Copy number variants (CNVs) have been associated with the risk to develop multiple autoimmune diseases. Our objective was to identify CNVs associated with the risk to develop psoriatic arthritis (PsA) using a genome-wide analysis approach. METHODS: A total of 835 patients with PsA and 1498 healthy controls were genotyped for CNVs using the Illumina HumanHap610 BeadChip genotyping platform. Genomic CNVs were characterised using CNstream analysis software and analysed for association using the χ(2) test. The most significant genomic CNV associations with PsA risk were independently tested in a validation sample of 1133 patients with PsA and 1831 healthy controls. In order to test for the specificity of the variants with PsA aetiology, we also analysed the association to a cohort of 822 patients with purely cutaneous psoriasis (PsC). RESULTS: A total of 165 common CNVs were identified in the genome-wide analysis. We found a highly significant association of an intergenic deletion between ADAMTS9 and MAGI1 genes on chromosome 3p14.1 (p=0.00014). Using the independent patient and control cohort, we validated the association between ADAMTS9-MAGI1 deletion and PsA risk (p=0.032). Using next-generation sequencing, we characterised the 26 kb associated deletion. Finally, analysing the PsC cohort we found a lower frequency of the deletion compared with the PsA cohort (p=0.0088) and a similar frequency to that of healthy controls (p>0.3). CONCLUSIONS: The present genome-wide scan for CNVs associated with PsA risk has identified a new deletion associated with disease risk and which is also differential from PsC risk.

5 Article Comparison between full and tapered dosages of biologic therapies in psoriatic arthritis patients: clinical and ultrasound assessment. 2015

Janta, Iustina / Martínez-Estupiñán, Lina / Valor, Lara / Montoro, María / Baniandres Rodriguez, Ofelia / Hernández Aragüés, Ignacio / Bello, Natalia / Hernández-Flórez, Diana / Hinojosa, Michelle / Martínez-Barrio, Julia / Nieto-González, Juan Carlos / Ovalles-Bonilla, Juan Gabriel / González, Carlos Manuel / López-Longo, Francisco Javier / Monteagudo, Indalecio / Naredo, Esperanza / Carreño, Luis. ·Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain, iustinajanta@yahoo.com. ·Clin Rheumatol · Pubmed #25636779.

ABSTRACT: The primary objective of this study was to describe and compare clinical and musculoskeletal (MS) ultrasound (US) features between psoriatic arthritis (PsA) patients treated with full and tapered dosage of biologic (b) disease-modified antirheumatic drugs (DMARDs). The secondary objective was to compare clinical and MSUS features between PsA patients treated with bDMARDs with and without concomitant synthetic (s) DMARDs. We evaluated 102 patients with PsA treated with bDMARDs. The bDMARD dosage tapering had been made in patients with a maintained remission or minimal disease activity (MDA) according to their attending rheumatologist and with the patient acceptance. The bDMARD tapering consisted of the following: increase the interval between doses for subcutaneous bDMARDs or reduction of the dose for intravenous bDMARDs. The clinical evaluation consisted of a dermatologic and rheumatologic assessment of disease activity. The presence of B-mode and Doppler synovitis, tenosynovitis, enthesopathy, and paratenonitis was investigated by a rheumatologist blinded to drug dosage, clinical assessments, and laboratory results. Seventy-four (72.5 %) patients received full dosage of bDMARDs and 28 (27.5 %) received tapered dosage. The duration with biologic therapy and with current biologic therapy was significantly higher in patients with tapered dosages (p = 0.008 and p = 0.001, respectively). We found no significant differences between clinical, laboratory, and US variables, both for BM and CD between patients with full and tapered dosage and between patients with and without concomitant sDMARD. Clinical assessment, MSUS variables, and MDA status are similar in patients receiving full and tapered dosage of bDMARDs.

6 Article Extra-articular disease in patients with spondyloarthritis. Baseline characteristics of the spondyloarthritis cohort of the AQUILES study. 2015

Zarco, Pedro / González, Carlos M / Rodríguez de la Serna, Arturo / Peiró, Enriqueta / Mateo, Isabel / Linares, Luis / Calvo, Jerusalem / Cea-Calvo, Luis / Arteaga, María J / Vanaclocha, Francisco / Marín-Jiménez, Ignacio / García-Vicuña, Rosario. ·Hospital Universitario Fundación de Alcorcón, Alcorcón, Madrid, España. Electronic address: PZarco@fhalcorcon.es. · Hospital Gregorio Marañón, Madrid, España. · Hospital de Sant Pau, Barcelona, España. · Hospital Marqués de Valdecilla, Santander, Cantabria, España. · Hospital 12 de Octubre, Madrid, España. · Hospital Virgen de la Arrixaca, Murcia, España. · Hospital Universitario Reina Sofía/Instituto Maimónides de Investigación Biomédica de Córdoba/Universidad de Córdoba, Córdoba, España. · Medical Affairs Merck Sharp & Dohme de España. ·Reumatol Clin · Pubmed #25441489.

ABSTRACT: OBJECTIVES: To describe the prevalence of extra-articular disease (uveitis, psoriasis and inflammatory bowel disease [IBD]), in a cohort of patients with spondyloarthritis (SpA). PATIENTS AND METHODS: AQUILES is an observational, prospective and multicentric study of three cohorts of patients with one of the following immune-mediated inflammatory diseases (IMID): SpA, psoriasis, or IBD. In the present cohort, patients ≥18 years of age with SpA were enrolled from Rheumatology clinics. The main objective was to assess the coexistence of these diseases and of uveitis, based on the patients' clinical history up to the study entry. RESULTS: A total of 601 patients with SpA (men: 63.1%; women: 36.9%) were enrolled. The specific diagnoses were: ankylosing spondylitis (55.1%), psoriatic arthritis (25.1%), undifferentiated spondyloarthritis (16.1%), enteropathic arthritis (2.5%), and others (1.3%). In 43.6% (95% CI: 39.7-47.6) of the patients, at least one of the three abovementioned diseases was encountered, predominantly psoriasis (prevalence 27.8%, 95% CI: 24.4-31.5), uveitis (13.6%, CI 95%: 11.1-16.6) and IBD (5.1%, 95% CI: 3.7-7.2). In patients with ankylosing spondylitis the proportion of other disease was 25.3% (IBD: 3.9%, psoriasis: 5.4%, uveitis: 19.0%) whilst it was 94.7% in psoriatic arthritis, due to the presence of psoriasis (94.0%). The coexistence of these diseases was associated with age, female gender and the presence of other extra-articular manifestations associated with SpA. CONCLUSIONS: Extra-articular disease in patients with SpA is common and, in this study, it was associated to age, female gender and the presence of other SpA-related extra-articular manifestations.

7 Article Comparison of two ELISA versions for infliximab serum levels in patients diagnosed with ankylosing spondylitis. 2015

Hernández-Flórez, Diana / Valor, Lara / de la Torre, Inmaculada / Nieto, Juan Carlos / Martínez-Estupiñán, Lina / González, Carlos / López-Longo, Francisco Javier / Monteagudo, Indalecio / Garrido, Jesús / Naredo, Esperanza / Carreño, Luis. ·Department of Rheumatology, Gregorio Marañón University General Hospital, Dr. Esquerdo 46, 28007, Madrid, Spain. ·Rheumatol Int · Pubmed #25410014.

ABSTRACT: There are various immunosorbent assays which can be used to determine infliximab (IFX) levels. Results vary between assays complicating reliability in everyday clinical practice. The aim of this study was to determine whether quantitative or qualitative assay data prove more accurate in the assessment of infliximab levels in AS patients. We analyzed 40 serum samples, taken prior to infusion, from AS patients who had been undergoing IFX therapy as a first-line of biological treatment for more than a year. IFX levels and IFX-anti-drug antibodies (ADA) were measured using two different ELISA assays [Promonitor IFX R1 and R2 (version 1), Promonitor IFX and anti-IFX (version 2) (Progenika Biopharma, Spain)] strictly following the manufacturer's guidelines. Cohen's unweighted kappa and the intraclass correlation coefficient determined qualitative and quantitative agreement for serum levels in version 1 and version 2. Bland-Altman plots were drawn to compare both assays. The comparison of data measuring IFX levels for version 1 and version 2 resulted in questionable quantitative agreement (ICC 0.659; 95% CI 0.317-0.830) and moderate qualitative agreement (κ 0.607; 95% CI 0.387-0.879) owing to systematically higher values in version 2 than version 1. Version 2 consistently detected higher levels of infliximab, particularly when analyzed in a quantitative context. Further research is needed to synchronize cutoff levels between essays and diseases so therapeutic drug ranges can be established.

8 Article Comparison of 2 referral strategies for the diagnosis of axial spondyloarthritis in Spain. The RADAR study. 2013

Juanola, Xavier / Fernández-Sueiro, José Luis / Torre-Alonso, Juan Carlos / Miguélez, Roberto / Muñoz-Fernández, Santiago / Ballina, Javier / González, Carlos / Juliá, Berta / Cea-Calvo, Luis / Collantes, Eduardo. ·Servicio de Reumatología, Hospital Universitari de Bellvitge, IDIBELL, Barcelona, España. ·Reumatol Clin · Pubmed #23735223.

ABSTRACT: OBJECTIVES: Improving referral of patients with back pain to rheumatologists could accelerate the diagnosis of axial spondyloarthritis. The RADAR study compared two strategies in the referral of patients with chronic back pain (>3 months) with an onset before the age of 45 years from primary care centers to rheumatology departments, in relation to the diagnosis of axial spondyloarthritis. PATIENTS AND METHODS: Each primary care center was assigned a referral strategy for its patients: (a) strategy 1, patients who had one of the 3 following criteria: inflammatory back pain, HLA-B27 positivity or sacroiliitis in imaging; or (b) strategy 2, patients who had 2 of the following 6: inflammatory back pain, HLA-B27 positivity, sacroiliitis in imaging, family history of axial spondyloarthritis, extra-articular manifestations or good response to nonsteroidal antiinflammatory drugs. The rheumatologist established the final diagnosis. RESULTS: Eighty-eight Spanish patients (mean age 36.8 years [SD 8.7], 55.7% females and 44.3% males) were referred for evaluation, 60 patients under strategy 1 and 28 under strategy 2. A definitive diagnosis of axial spondyloarthritis was established in 25.4% with strategy 1 and in 28.6% with strategy 2 (p=NS). Inflammatory back pain was the criterion most commonly used for referral, and the agreement rate between the primary care physician and rheumatologist was 75%. CONCLUSIONS: A simple referral strategy based on one of three3 criteria proved as effective as a strategy based on two of 6 criteria in diagnosing axial spondyloarthritis. Inflammatory back pain was the criterion most commonly used for patient referral.

9 Article High-dose etanercept in ankylosing spondylitis: results of a 12-week randomized, double blind, controlled multicentre study (LOADET study). 2011

Navarro-Sarabia, Federico / Fernández-Sueiro, José L / Torre-Alonso, Juan C / Gratacos, Jordi / Queiro, Rubén / Gonzalez, Carlos / Loza, Eduardo / Linares, Luis / Zarco, Pedro / Juanola, Xavier / Román-Ivorra, José / Martín-Mola, Emilio / Sanmartí, Raimon / Mulero, Juan / Diaz, Gema / Armendáriz, Yolanda / Collantes, Eduardo. ·Rheumatology Department, Hospital Universitario Virgen Macarena, Avenida Dr Fedriani 3, 41009 Sevilla, Spain. federico.navarro.sarabia@juntadeandalucia.es ·Rheumatology (Oxford) · Pubmed #21700683.

ABSTRACT: OBJECTIVES: Etanercept 50 mg a week is approved in the treatment of AS. Increasing the etanercept dose to 100 mg/week improves efficacy in cutaneous psoriasis, a clinical manifestation related to the spondylarthritis family, while maintaining its safety profile. The purpose of this study was to evaluate the efficacy and safety of etanercept 100 vs 50 mg/week in patients with AS. METHODS: Adult patients with AS were randomized to receive etanercept 50 mg twice a week (biw), or etanercept 50 mg once a week (qw) for 12 weeks. The primary efficacy endpoint was Ankylosing Spondylitis Assessment Study (ASAS20) response at Week 12; secondary endpoints included ASAS40, ASAS50, ASAS70 and ASAS5/6 responses, partial remission and quality of life. Safety was assessed until 15 days after the last visit. RESULTS: A total of 108 patients were randomly selected and treated, 54 in each arm. At 12 weeks, ASAS20 response was achieved by 34 (71%) out of 48 patients of the etanercept 50 mg biw group and by 37 (76%) out of 49 patients of the etanercept 50 mg qw group (not statistically significant differences). Other efficacy variables improved significantly over time, but not between treatment groups. Fifty-six patients experienced at least one adverse event (generally, infections and infestations, gastrointestinal disorders and injection site reactions), most of them mild or moderate. CONCLUSIONS: High-dose (100 mg/week) etanercept in the treatment of AS for 12 weeks is as safe as the standard dose (50 mg/week). However, it does not significantly increase its efficacy. Trial Registration. Clinicaltrials.gov, http://clinicaltrials.gov/, NCT00873730.

10 Article Prevalence of vertebral fractures by semiautomated morphometry in patients with ankylosing spondylitis. 2011

Montala, Nuria / Juanola, Xavier / Collantes, Eduardo / Muñoz-Gomariz, Elisa / Gonzalez, Carlos / Gratacos, Jordi / Zarco, Pedro / Fernandez Sueiro, Jose Luis / Mulero, Juan / Torre-Alonso, Juan Carlos / Batlle, Enrique / Carmona, Loreto. ·Department of Rheumatology, Hospital Santa Maria, Lleida, c/Alcalde Rovira Roure 44, Lleida, Spain. nmontala@gmail.com ·J Rheumatol · Pubmed #21362760.

ABSTRACT: OBJECTIVE: Ankylosing spondylitis (AS) is a chronic inflammatory disease mainly affecting the axial skeleton and characterized by ossification of the spinal disc, joints, and ligaments leading to progressive ankylosis. Vertebral osteoporosis is a recognized feature of AS. Studies have confirmed a moderate to high prevalence of vertebral fractures with extremely varying ranges in patients with AS. Our objective was to estimate the prevalence of vertebral fractures in a representative Spanish population of patients with AS using a validated semiquantitative method, MorphoXpress(®). METHODS: Patients were randomly selected from the 10 initial participating centers of the Spanish National Registry of Spondyloarthropathies (REGISPONSER) by consecutive sampling. All patients fulfilled the New York modified criteria for AS and had a baseline thoracolumbar radiograph. A prevalent vertebral fracture was defined according to the Genant classification criteria. RESULTS: The estimated prevalence of vertebral fractures was 32.4% (95% CI 25.5%-39.3%). The majority of fractures were localized in the thoracic segment (n = 100; 82.%) and were mild (n = 79; 64.8%). In logistic regression analysis, age (odds ratio per year 1.05, 95% CI 1.03-1.08, p < 0.001), disease duration (OR per year 1.03, 95% CI 1.01-1.06, p = 0.011), Bath Ankylosing Spondylitis Functional Index score (OR per score 1.16, 95% CI 1.03-1.30, p = 0.015), Bath Ankylosing Spondylitis Radiographic Index-TS (OR per score 1.25, 95% CI 1.12-1.39, p < 0.001), and wall-occiput distance (OR per cm 1.15, 95% CI 1.08-1.23, p < 0.001) were all associated with prevalent fracture. CONCLUSION: Semiquantitative methods are needed to improve the diagnosis of vertebral fractures in AS in order to start early treatment and to avoid complications arising from osteoporosis.

11 Article Fibromyalgia in patients with ankylosing spondylitis: prevalence and utility of the measures of activity, function and radiological damage. 2010

Almodóvar, R / Carmona, L / Zarco, P / Collantes, E / González, C / Mulero, J / Sueiro, J L F / Gratacós, J / Torre-Alonso, J C / Juanola, X / Batlle, E / Ariza, R / Font, P. ·Rheumatology Unit, Hospital Universitario Fundación Alcorcón, Madrid, Spain. ralmodovar@fhalcorcon.es ·Clin Exp Rheumatol · Pubmed #21176420.

ABSTRACT: OBJECTIVES: To determine the prevalence of fibromyalgia (FM) in ankylosing spondylitis (AS). To evaluate the effect of FM on the measures of activity in AS. To analyse predictive factors in order to identify this group of patients. PATIENTS AND METHODS: A cross-sectional study based on 462 patients with definite ankylosing spondylitis included in the REGISPONSER. Sociodemographic data, clinical features, Bath AS disease activity index (BASDAI), Bath AS functional index (BASFI), Bath AS radiology index (BASRI), Stoke modified index (Sasss-m), laboratory data, Short-Format 12 (SF-12), AS specific quality of life (ASQoL), Fibromyalgia Impact Questionnaire (FIQ) and treatments used were all documented. To diagnose FM, the ACR 1990 criteria had to be fulfilled. All statistical tests were performed using STATA. RESULTS: The prevalence of fibromyalgia in all AS was 4.11%. Among the women with AS, the prevalence of FM increased to 10.83%. The BASDAI, BASFI and total BASRI were strongly influenced by the presence of FM. The inverse relationship between BASDAI or BASFI and total BASRI was taken to generate a ratio. Accordingly, if the patient presented BASDAI/BASRI ≥1.5 or BASFI/BASRI ≥1.08, the probability of having FM was very high. CONCLUSIONS: There is an increased risk of FM in females with AS. The fact of having FM distorts the measures of activity and functional damage of AS. As a result, it is possible that some patients with AS and FM are being overtreated. The BASDAI/BASRI and BASFI/BASRI ratios are very useful to identify these patients.

12 Article Relationship between spinal mobility and disease activity, function, quality of life and radiology. A cross-sectional Spanish registry of spondyloarthropathies (REGISPONSER). 2009

Almodóvar, R / Zarco, P / Collantes, E / González, C / Mulero, J / Fernández-Sueiro, J L / Gratacós, J / Torres-Alonso, J C / Juanola, X / Batlle, E / Ariza, R / Muñoz, E. ·Department of Rheumatology, Alcorcon Foundation Universitary Hospital, Madrid, Spain. ralmodovar@fhalcorcon.es ·Clin Exp Rheumatol · Pubmed #19604436.

ABSTRACT: OBJECTIVE: To determine the relationship between anthropometric measurements and disease activity, functional capacity, quality of life and radiology in Spanish patients with ankylosing spondylitis (AS). PATIENTS AND METHODS: A cross-sectional study was made of 842 patients with definite ankylosing spondylitis (REGISPONSER). Sociodemographic data, spinal mobility measurements, Bath AS disease activity index (BASDAI), nocturnal pain, Bath AS radiology index (BASRI), Bath AS functional index (BASFI), the Short-Format 12 (SF-12) and the AS specific quality of life (ASQoL) questionnaire were applied. Pearson correlation coefficient analysis and regression models were constructed. RESULTS: There was moderate correlation between fingertip-to-floor distance and lateral cervical rotation with the BASFI (p<0.01). Good correlation was evident between wall-occiput distance and lateral cervical rotation with the BASRI (p<0.01). Moderate correlation was found between chest expansion, the Schober modified test and fingertip-to-floor distance with the total BASRI (p<0.01). The anthropometric measurement with the lowest correlation value was lateral lumbar flexion. Significant association was found between the Schober modified test and BASFI, BASDAI and BASRI (R(2) = 0.37; p<0.001); chest expansion and BASFI, BASDAI and BASRI (R(2) = 0.25; p<0.001); wall-occiput distance and BASFI, BASRI and ASQoL (R(2) = 0.44; p<0.001); fingertip-to-floor distance and BASFI and BASRI (R(2) = 0.30; p<0.001); and lateral cervical rotation and BASFI and BASRI (R(2) = 0.34; p<0.001). CONCLUSION: In our study, wall-occiput distance and lateral cervical rotation showed the strongest correlation to BASRI. Similarly, fingertip-to-floor distance and lateral cervical rotation exhibited the closest correlation to BASFI.