Premios Armando Laffon 2009

Prognostic Factors in Short-Term Disability Due to Musculoskeletal Disorders.

Abásolo L, Carmona L, Lajas C, Candelas G, Blanco M, Loza E, Hernández-García C and Jover JA. Arthritis & Rheumatism (Arthritis Care & Research) 2008 Vol. 59, No. 4(15): 489–496

Objective: To identify factors associated with poor outcome in temporary work disability (TWD) due to musculoskeletal disorders (MSDs).

Methods: We conducted a secondary data analysis of a 2-year randomized controlled trial in which all patients with TWD due to MSDs in 3 health districts of Madrid (Spain) were included. Analyses refer to the patients in the intervention group. Primary outcome variables were duration of TWD and recurrence. Diagnoses, sociodemographic, work-related administrative, and occupational factors were analyzed by Cox proportional hazards models.

Results: We studied 3,311 patients with 4,424 TWD episodes. The following were independently associated with slower return to work: age (hazard ratio [HR] 0.99, 95% confi dence interval [95% CI] 0.98–0.99), female sex (HR 0.84, 95% CI 0.78–0.90), married (HR 0.90, 95% CI 0.83–0.97), peripheral osteoarthritis (HR 0.77, 95% CI 0.6–0.9), sciatica (HR 0.59, 95% CI 0.54–0.65), selfemployment (HR 0.56, 95% CI 0.48–0.65), unemployment (HR 0.41, 95% CI 0.28–0.58), manual worker (HR 0.86, 95% CI 0.79–0.94), and work position covered during sick leave (HR 0.84, 95% CI 0.77–0.92). The factors that better predicted recurrence were peripheral osteoarthritis (HR 1.75, 95% CI 1.14–2.6), infl ammatory diseases (HR 1.66, 95% CI 1.009–2.72), sciatica (HR 1.30, 95% CI 1.08–1.56), indefi nite work contract (HR 1.43, 95% CI 1.14–1.75), frequent kneeling (HR 1.39, 95% CI 1.15–1.69), manual worker (HR 1.19, 95% CI 1.003–1.42), and duration of previous episodes (HR 1.003, 95% CI 1.001–1.005).

Conclusion: Sociodemographic, work-related administrative factors, diagnosis, and, to a lesser extent, occupational factors may explain the duration and recurrence of TWD related to MSD.

Observed and Expected Frequency of Comorbid Chronic Diseases in Rheumatic Patients.

Loza E, Jover JA, Rodríguez-Rodríguez L, Carmona L and The Episer Study Group. Ann Rheum Dis 2008;67:418–421.
Objective: To estimate and compare the observed and expected prevalence of the co-existence of rheumatic diseases (RD) with other chronic conditions.

Methods: The self-reported diagnosis of chronic conditions was obtained from the 2192 participants in a national health survey (Spain, 1999–2000) We compared the estimated prevalence of the coexistence of a RD with other chronic conditions, to the expected prevalence using two-sample test of proportion.

Results: The observed (O) prevalence was signifi cantly higher than expected (E) in the following combination of self-reported diseases: RD+arterial hypertension (O/E ratio=1.88), RD+diabetes mellitus (O/E ratio=2.07), RD+hypercholesterolemia (O/E ratio=1.87), RD+cardiological (O/E ratio= 1.83), and RD+digestive diseases (O/E ratio=2.07). The prevalence of selected co-existent pairs of diseases is more frequent with increasing age and differs between women and men.

Conclusions: The excess in prevalence of some combinations of diseases may serve as a reminder to the rheumatologists that many of their patients will have coexistent disease of which they need to be aware to properly plan their management. It may also be a sign of common risk factors between diseases or of adverse events.

Burden of Disease Across Chronic Diseases: A Health Survey That Measured Prevalence,
Function, and Quality of Life.

Loza E, Abásolo L, Jover JA, Carmona L and The Episer Study Group. J Rheumatol 2008;35:159–65

Objective: To assess health related quality of life (HRQOL) and functional ability across groups of chronic diseases in Spain.

Methods: A national health survey was conducted during 1999-2000. Participants were randomly selected from city censuses among persons aged over 20 years. All 2192 participants (response rate 73%) completed generic instruments measuring functional ability in activities of daily living [Health Assessment Questionnaire (HAQ)] and HRQOL [Short-Form 12 (SF-12)]. Chronic diseases were defined by self-report and elicited from 2 specifi c questions: “Have you ever been told you have a chronic disease by a physician?” and “Are you taking any chronic medication?”. Only diagnoses present for ≥ 3 months were included as chronic. We estimated mean HAQ and SF-12 scores for the different groups of chronic diseases. We then adjusted the scores for covariates and compared them between diseases by multiple linear regressions.

Results: Over half the population had at least one chronic disease [n = 1276 (58.2%)], and 22.6% had any rheumatic disease. Rheumatic diseases have an adverse effect on daily functioning [HAQ s-coeffi cient 0.11 (95% CI 0.06–0.15)] and HRQOL [SF-12 physical s-coeffi cient –5.78 (95% CI –6.27 to –4.28); SF-12 mental s-coeffi cient –2.61 (95% CI –3.79 to –1.41)]. Thus, the infl uence of the rheumatic diseases is greater when their prevalence is taken into account.

Conclusion: When the defi nition of burden of disease includes a measure of function and HRQOL that is weighted by disease prevalence, rheumatic diseases as a group can be ranked alongside neurological, cardiac, or pulmonary conditions as a major disease.

Concise Report. Accuracy of Physical Examination in Subacromial Impingement Syndrome.

Silva L, Andreu JL, Muñoz P, Pastrana M, Millán I, Sanz J, Barbadillo C and Fernández Castro M. Rheumatology 2008;47:679–683.

Objective: Shoulder pain is a common complaint, frequently caused by subacromial impingement syndrome (SIS). There are a number of physical examination (PE) manoeuvres that explore the subacromial space. MRI provides an accurate anatomic image of the subacromial space, being the current gold standard in the diagnosis of SIS. The aim of this study is to evaluate the accuracy of the PE in the diagnosis of SIS and/or subacromial–subdeltoid bursitis (SSB) confi rmed by MRI.

Methods: Consecutive outpatients with an episode of shoulder pain were prospectively included in the study. They were examined by a rheumatologist and, within 3 days, an MRI was done. Sensitivity, specifi city, positive and negative predictive values, and accuracy of PE manoeuvres were calculated using a 2_2 table.

Results: Fourteen males and 16 females were included. All the tests exhibited acceptable sensitivity. As a result Yocum manoeuvre was considered the most sensitive and most accurate for SIS. With regard to SSB, the Gerber test was the most sensitive. The majority of the PE manoeuvres showed low specifi city.

Conclusions: Most PE manoeuvres identify reasonably well subacromial impingement of the shoulder, although, in general, they have low specifi city. The Yocum test has the best sensitivity and precision. Our data suggest that imaging techniques should be recommended to better defi ne shoulder lesions.

Are the C-Reactive Protein Values and Erythrocyte Sedimentation Rate Equivalent When Estimating the 28-Joint Disease Activity Score in Rheumatoid Arthritis?

Castrejón I, Ortiz AM, García de Vicuña R, Lopez-Bote JP, Humbría A, Carmona L, González Álvaro I. Clinical And Experimental Rheumatology 2008; 26: 769-775.
Abstract: A formula for calculating disease activity score with 28 joint counts (DAS28) with C-reactive protein (CRP) instead of theerythrocyte sedimentation rate (ESR) has been proposed.

Objective: Here we analyze the factors that contribute to the differences in the DAS28 when calculated using either the ESR (DAS28-ESR) or the CRP values (DAS28-CRP).

Methods: We analyzed the data from 587 visits made by 220 patients with early arthritis. The age at the onset of the disease was 51±16 years old and 76.3% of the patients were women. The disease evolution at the fi rst visit was 5 months and at each visit information related to several variables was collected, including that necessary to calculate the DAS28-ESR and DAS28-CRP. We defi ned a new variable DIFDAS=DAS28-ESR – DAS28-CRP to analyze which independent variables account for differences between the two indexes.

Results: There was a correlation between the two indexes of 0.91 (p<0.0001), although the DAS28-ESR value obtained was higher than that of DAS28-CRP at approximately 90% of the visits. Signifi cantly, the difference between both indexes was higher than 0.6 in 44% of the visits studied. A multivariate analysis showed that female gender and disease duration were associated with the higher values obtained for DAS28-ESR when compared to those of DAS28-CRP.

Conclusion: Our data show that DAS28-ESR and DAS28-CRP are not fully equivalent, because the former usually produces higher values. This fi nding is particularly relevant in females and patients with a long disease duration.

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