Fernando Ortiz-Márquez

Objective: to assess the prognostic impact of clusters of hematologic and biochemical indices on interstitial lung disease (ILD) and respiratory damage associated with systemic sclerosis (SSc)Methods: Design: We conducted a cross-sectional, uncontrolled study. Participants and Settings: a cohort of patients with SSc (2013 ACR/EULAR criteria) were enrolled in the rheumatology unit of a tertiary hospital in southern Spain. Primary and secondary outcome measures: The primary outcomes were the presence of SSc-ILD and respiratory damage, assessed via the Scleroderma Clinical Trials Consortium Damage Index (SCTC-DI). Inflammatory biomarkers, including both CRP and hematological indices, were obtained. Patients were grouped based on inflammatory phenotypes derived from longitudinal CRP averages and through principal component analysis (PCA) with K-means clustering of cross-sectional variables. Multivariate models were constructed to identify factors associated with SSc-ILD and respiratory damage.Results: Among 83 patients with SSc, 33.7% had ILD, 30.1% had respiratory damage, and 28.9% were receiving immunosuppressive therapy. A persistent inflammatory phenotype during follow-up was associated with non-Caucasian ethnicity (OR 14.0) and SSc-ILD (OR 17.9). Cross-sectional inflammatory clusters were linked to SSc-ILD (OR 12.8) and damage measured by SCTC-DI (OR 1.2). PC-2, derived from CRP-based variables, was a better predictor of SSc-ILD (OR 3.0) than PC-1, which was based on hematological indices (OR 0.5, non-significant), especially in the presence of anti-Scl70+ antibodies (OR 19.1) and immunosuppressants (OR 42.2). The only variables associated with respiratory damage were average CRP during follow-up (OR 1.2), anti-Scl70+ (OR 7.7), and glucocorticoids (OR 0.2).Conclusion: CRP-based variables seem to be better predictors of SSc-ILD and respiratory damage than hematological indices.

Objectives: To evaluate cognitive improvement in patients with rheumatoid arthritis (RA) after 6 months of treatment with tumor necrosis factor (TNF) inhibitors, analyze associated factors, and determine the percentage of patients achieving cognitive improvement.Methods: This was a single-center prospective observational study conducted over 12 months on 70 RA patients initiating their first biologic disease-modifying antirheumatic drug (bDMARD) with a TNF inhibitor. Cognitive function was assessed at baseline and after 6 months using validated neuropsychological tests, including the Montreal Cognitive Assessment (MoCA) for global cognitive function, the digit span forward and backward tests for attention and working memory, and the Stroop-W, Stroop-C, and Stroop-CW tests for executive function and processing speed. Patient-reported outcomes were assessed using the Hospital Anxiety and Depression Scale (HADS) and the Quality of Life-Rheumatoid Arthritis Scale-II (QOL-RA II). Clinical variables, disease activity measured by the 28-joint Disease Activity Score based on C-reactive protein (DAS28-CRP), inflammatory markers including C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), and patient-reported outcomes were recorded. Associations with average CRP and Health Assessment Questionnaire (HAQ) scores were analyzed throughout the follow-up period. Cognitive improvement was defined as a ≥20% increase in MoCA test scores. Logistic regression was performed to identify factors associated with improvement.Results: A total of 70 patients (mean age, 56.2 years; 81.4% female) were included. After 6 months, patients showed significant cognitive improvement in a validated questionnaire, namely, the Montreal Cognitive Assessment (MoCA test 23.1 ± 3.6 to 24.1 ± 3.3; p = 0.001), particularly in the executive and memory domains. Significant improvements were also observed in the digit span forward test (p = 0.003), digit span backward test (p = 0.021), Stroop-W test (p = 0.040), Stroop-C test (p = 0.014), and Stroop-CW test (p = 0.035). Improvements in the MoCA were associated with educational level (B = 2.628; p < 0.001), average CRP (B = −0.154; p = 0.002), and average HAQ (B = −0.303; p = 0.022). Similar associations were found for the other tests.Conclusion: TNF inhibitor therapy in RA patients is associated with significant cognitive improvement, particularly in executive function and memory. These findings highlight the potential cognitive benefits of effective RA treatment and underscore the importance of addressing modifiable risk factors to enhance patient quality of life.

Recent studies point to intestinal permeability as an important factor in the establishment and development of rheumatoid arthritis (RA). Tight junctions (TJs) play a major role in intestinal homeostasis. The alteration of this homeostasis is related to RA. Furthermore, RA patients present dysbiosis and a lower microbiota diversity compared to healthy individuals. A cross-sectional study including RA patients and sex- and age-matched healthy controls was performed. The quantification of TJ proteins was carried out by ELISA. Gut microbiota was evaluated by NGS platform Ion Torrent S. The inflammatory variables included were DAS28, CRP, inflammatory cytokines (IL-6, IL-1, TNF-α) and oxidised LDL. Claudin-1 levels showed significant differences between groups. Results evidenced a correlation between claudin-1 values and age (r: −0.293; p < 0.05), IL6 (r: −0.290; p < 0.05) and CRP (r: −0.327; p < 0.05), and between zonulin values and both age (r: 0.267; p < 0.05) and TNFα (r: 0.266; p < 0.05). Moreover, claudin-1 and CRP levels are related in RA patients (β: −0.619; p: 0.045), and in patients with high inflammatory activity, the abundance of the genus Veillonella is positively associated with claudin-1 levels (β: 39.000; p: 0.004).

Objective To evaluate cognitive function in patients with rheumatoid arthritis (RA) and inflammatory activity. Patients and methods We performed a cross-sectional study of a cohort of patients with RA initiating their first biological treatment due to moderate-to-high inflammation and a healthy control group (no inflammatory diseases) matched for age, sex and educational level. All participants underwent a comprehensive neuropsychological assessment, with cognitive impairment defined as a Montreal Cognitive Assessment (MoCA) scoreResults The study population comprised 140 participants, 70 patients with RA and 70 controls. Patients more frequently experienced cognitive impairment than controls (60% vs 40%; p=0.019) and had lower mean (SD) values in the MoCA (23.6 (3.9) vs 25.1 (3.4); p=0.019. As for subtests of the MoCA, involvement was more marked in patients than in controls for the visuospatial-executive (p=0.030), memory (p=0.026) and abstraction (p=0.039) domains. Additionally, patients scored lower on executive function, as assessed by the backward digit span test (4.0 (1.7) vs 4.7 (1.9); p=0.039). Cognitive impairment is associated with age and a lower educational level in the general population, and among patients with RA with educational level, obesity and average inflammatory activity (DAS28, CRP, and IL-6). Conclusions Patients with RA with high inflammatory activity are more susceptible to cognitive impairment, which specifically affects the domains of visuospatial, memory, abstraction and executive function.

Objectives To describe the severity and impact of gastrointestinal involvement in patients with systemic sclerosis (SSc) and identify associated factors. Patients and methods Non-controlled cross-sectional study of patients with SSc (2013 American College of Rheumatology/European League Against Rheumatism criteria). The main variables were severity of gastrointestinal involvement according to the University of California, Los Angeles Scleroderma Clinical Trials Consortium Gastrointestinal Tract 2.0 instrument (UCLA SCTC GIT 2.0) and dysphagia according to the Eating Assessment Tool-10 (EAT-10). We evaluated reflux, distension, diarrhoea, faecal soilage, constipation, emotional well-being and social functioning, as well as dysphagia. Clinical and epidemiological data were collected using the Mini Nutritional Assessment Short Form (MNA-SF) and the EuroQol-5D-3L. The degree of skin fibrosis was assessed using the modified Rodnan skin score (mRSS). Multivariate models were constructed to analyse factors associated with gastrointestinal involvement and dysphagia. Results Of the 75 patients with SSc included, 58.7% had moderate, severe or very severe reflux, 57.4% had constipation according to UCLA SCTC GIT 2.0 and 49.7% had abdominal distension. Gastrointestinal symptoms interfered significantly with social functioning (42.7%) and emotional well-being (40.0%). Dysphagia (EAT-10≥3) was recorded in 52% of patients, and according to MNA-SF poor nutrition in 30.7%, and clear malnutrition requiring a nutritional intervention in 5.3%. Multivariate adjustment revealed an association between severity of gastrointestinal symptoms according to the mRSS (β=0.249; p=0.002) and Visual Analogue Scale 3-Level EuroQol-5D (VAS-EQ-5D-3L) (β=–0.302; p=0.001), whereas presence of dysphagia was associated with the mRSS (OR=2.794; p=0.015), VAS-EQ-5D-3L (OR=0.950; p=0.005) and malnutrition (MNA-SF≤7; OR=3.920; p=0.041). Conclusions Patients with SSc frequently present severe gastrointestinal symptoms. These are associated with poor quality of life, more severe skin involvement and malnutrition.

Objective: To evaluate sleep disorders and associated factors in patients with rheumatoid-arthritis-associated interstitial lung disease (RA-ILD). Methods: We performed an observational study of 35 patients with RA-ILD (cases) and 35 age- and sex-matched RA patients without ILD (controls). We evaluated sleep disorders (Oviedo Sleep Questionnaire), positive psychological factors (resilience using the Wagnild and Young Resilience Scale, emotional intelligence using the 24-item Trait Meta-Mood Scale), anxiety and depression (Hospital Anxiety and Depression Scale), quality of life (36-item short-form survey), and fatigue (Functional Assessment of Chronic Illness Therapy Questionnaire). Other variables studied included the Charlson Comorbidity Index (CCI) and RA activity according to the DAS28-ESR. Results: Compared to the controls, the cases were characterized by poorer sleep quality with a higher prevalence of insomnia (42% vs. 20%; p = 0.039), greater severity of insomnia (p = 0.001), and lower sleep satisfaction (p = 0.033). They also had poorer resilience and emotional recovery and more severe anxiety and depression. A diagnosis of ILD was the only factor independently associated with the three dimensions of sleep quality. The predictors of poorer sleep satisfaction in patients with RA-ILD were age (β = −0.379), DAS28-ESR (β = −0.331), and usual interstitial pneumonia pattern (β = −0.438). The predictors of insomnia were DAS28-ESR (β = 0.294), resilience (β = −0.352), and CCI (β = 0.377). Conclusions: RA-ILD is associated with significant sleep disorders. RA-ILD seems to be an independent risk factor for sleep alterations, with a greater impact on insomnia. Age, disease activity, and comorbidity also play a role in sleep disorders in patients with RA-ILD.

Objective: To describe the frequency of malnutrition in older patients with rheumatoid arthritis (RA) and investigate associated risk factors. Methods: This multicenter, cross-sectional study included participants aged ≥65 years who met the 2010 ACR/EULAR criteria for RA. Nutritional status was assessed using the Mini Nutritional Assessment Short Form (MNA-SF) and based on variables, such as albumin level, the Geriatric Nutritional Risk Index (GNRI), and vitamin D. Data were also collected on epidemiological variables, inflammatory disease activity, quality of life, physical function, and frailty. Multivariate models were used to study factors associated with nutritional status. Results: The study population comprised 76 RA patients aged ≥65 years, of whom 68.4% had a normal nutritional status, and 31.5% had an impaired nutritional status: 28.9% were at risk of malnutrition, and 2.6% were malnourished. Additionally, 10% had albumin levels p = 0.035), DAS28-ESR (1.8 [1.0–3.2]; p = 0.024), and EuroQoL-5D-5L (0.9 [0.9–0.9]; p = 0.040). Furthermore, the GNRI was associated with the MNA score (0.06 [0.0–0.1]; p = 0.014). Conclusions: Approximately one-third of older patients with RA have impaired nutritional status. Older age, higher inflammatory disease activity, and decreased quality of life are associated with impaired nutritional status. The MNA and GNRI are valuable tools for assessing the nutritional status of patients with RA.

Background Digestive involvement is one of the most prevalent manifestations of systemic sclerosis (SSc) with great significance for the health and quality of life of patients. Objectives To describe the prevalence of dysphagia and the nutritional status of a series of patients with SSc. Methods Design: Cross-sectional descriptive study. Participants: consecutive recruitment of patients with SSc (ACR/EULAR 2013 criteria) followed up in our unit. Follow-up of these patients is carried out every 3 to 6 months in consultation and all patients were registered in a database. 90% of the patients accepted and signed the consent, the rest refused due to travel or work difficulties. Variables: The main variable was dysphagia, defined according to the EAT10 questionnaire (positive ≥3). The dysphagia risk factors evaluated were: malnutrition according to the Mini Nutritional Assessment (MNA) (continuous: 0-14, considering 14 better nutritional status), sarcopenia defined according to the European Working Group on Sarcopenia in Older People (EWGSOP) criteria, prealbumin, polypharmacy (if they take >3 drugs), weight loss of at least 1 kg in the last 3 months, quality of life according to EQ-5D and Steinbrocker functional status. Statistical analysis: descriptive and logistic regression (VD: dysphagia) to identify associated factors. Results 52 patients were included, of whom 51 (98.1%) were women, with a mean (SD) age of 60.8 (11.0) years. 32/52 patients (61.5%) had dysphagia (EAT≥3) and 12/52 patients (23.1%) were referred to endocrinology for severe dysphagia (EAT≥20) Table 1. Patients with dysphagia compared with the rest had sarcopenia more frequently (37.5% vs 0.0%; p=0.001), weight loss (65.6% vs 20.0%, p= 0.004) and more polymedicated (87.5% vs 60.0%, p=0.022). Likewise, patients with dysphagia (EAT≥3) had lower values (mean [SD]) of nutrition per MNA screening (11.0 [1.2] vs 13.1 [2.3]; p = 0.001), of EQ5D (0.5 [0.2] vs 0.7 [0.2]; p = 0.004), EVA-EQ5D (48.6 [22.3] vs 62.5 [17.6]; p = 0.023) and in Steinbrocker’s functional grade (2.3 [1.0] vs 1.3 [0.6]; p = 0.001). The multivariate analysis identified that MNA screening (0-14) (OR [95% CI], 0.511 [0.317-0.824]; p=0.006) and EQ5D (OR [95% CI], 0.965 [0.932-0.998]; p= 0.036) (R2=0.397) were independently associated with dysphagia (EAT ≥3). Conclusion Dysphagia is a common problem in systemic sclerosis and is associated with poorer quality of life and a lower probability of reaching a normal nutritional status. The serious nutritional implications associated with dysphagia must be diagnosed in order to intervene nutritionally in these patients. Clinical-epidemiological characteristics of the 52 patients in SSc REFERENCES: NIL. Acknowledgements: NIL. Disclosure of Interests None Declared.