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Papers by gregorio soler

Supplemental material, sj-pdf-2-lup-10.1177_0961203320950477 for Antiphospholipid syndrome (APS) ... more Supplemental material, sj-pdf-2-lup-10.1177_0961203320950477 for Antiphospholipid syndrome (APS) in patients with systemic lupus erythematosus (SLE) implies a more severe disease with more damage accrual and higher mortality by Leyre Riancho-Zarrabeitia, Victor Martínez-Taboada, Iñigo Rúa-Figueroa, Fernando Alonso, María Galindo-Izquierdo, Juan Ovalles, Alejandro Olivé-Marqués, Antonio Fernández-Nebro, Jaime Calvo-Alén, Raúl Menor-Almagro, Eva Tomero-Muriel, Esther Uriarte-Isacelaya, Alina Botenau, Mariano Andres, Mercedes Freire-González, Gregorio Santos Soler, Esther Ruiz-Lucea, Mónica Ibáñez-Barceló, Iván Castellví, Carlos Galisteo, Víctor Quevedo Vila, Enrique Raya, Javier Narváez-García, Lorena Expósito, José A Hernández-Beriaín, Loreto Horcada, Elena Aurrecoechea and Jose M. Pego-Reigosa in Lupus

Lupus, 2020

Introduction Antiphospholipid antibodies (aPL) have been associated with organ damage and certain... more Introduction Antiphospholipid antibodies (aPL) have been associated with organ damage and certain features in systemic lupus erythematosus(SLE) patients. Our aim was to investigate the differences between SLE patients according to the presence of aPL and/or clinical antiphospholipid syndrome (APS). Materials and methods Patients from the RELESSER-T registry were included. RELESSER-T is a Spanish multicenter, hospital-based, retrospective, SLE registry. Results We included 2398 SLE patients, 1372 of whom were positive for aPL. Overall 1026 patients were classified as SLE, 555 as SLE-APS and817 as SLE-aPL. Regarding cardiovascular risk factors, SLE-APS patients had higher rates of hypertension, dyslipidemia and diabetes than those with SLE-aPL and SLE ( p < 0.001). SLE-APS patients showed higher rates of neuropsychiatric, cardiac, pulmonary, renal and ophthalmological manifestations than the other groups ( p < 0.001). SLE-APS patients presented greater damage accrual with higher...

Se presenta el caso de una mujer, de 47 años, premenopáusica, con LES de más de 20 años de evoluc... more Se presenta el caso de una mujer, de 47 años, premenopáusica, con LES de más de 20 años de evolución, que consulta por dolor al apoyo en pie derecho. Había recibido tratamiento con inmunosupresores y prednisona a dosis variables de 10-20 mg/día. En el momento de la consulta recibía tratamiento con hidroxicloroquina, azatioprina y belimumab, además de prednisona 7,5 mg/día, calcio y vitamina D. Se realiza radiografía simple sin observar alteraciones (Imagen 1). Ante la persistencia de la clínica se realiza ecografía que detecta fractura metatarsiana (Imagen 2) que se confirma mediante resonancia magnética (Imagen 3). El vídeo de la ecografía se puede consultar en el siguiente enlace: http://airemb.es/fractura-metatarsiano-sin-alteraciones-enla-radiografia/

La osteopetrosis es un termino que engloba a un grupo heterogeneo y poco frecuente de enfermedade... more La osteopetrosis es un termino que engloba a un grupo heterogeneo y poco frecuente de enfermedades heredables caracterizados por un aumento de la densidad osea resultante de una anormal diferenciacion o disfuncion osteoclastica. Existen multiples variantes de la enfermedad con presentacion clinica hetero- genea: desde el paciente asintomatico hasta formas fatales en la infancia. En muchos casos el diagnostico es guiado por los hallaz- gos caracteristicos radiologicos, como en el caso que presentamos a continuacion.

Objetivo: Conocer la existencia de diferencias en la estratificacion de la actividad inflamatoria... more Objetivo: Conocer la existencia de diferencias en la estratificacion de la actividad inflamatoria en la CoAR-SVR segun se emplee el DAS28- VSG o el DAS28-PCR. Material y metodos: Se analizaron 381 pacientes de la CoAR-SVR. Se evaluo la relacion entre los valores medidos de DAS28-VSG y DAS28- PCR para la estratificacion de la actividad de la enfermedad segun los criterios establecidos por la EULAR. Para ello se cotejaron las mediciones DAS28 VSG y PCR existentes de forma apareada por cada paciente en el mismo momento temporal. Se obtuvieron un total de 241 lecturas apareadas y se estratificaron segun los criterios EULAR de actividad. Resultados: Los pacientes que cumplieron los criterios de remision (DAS 28<2.6) en el grupo DAS28-VSG fueron el 36% versus el 48% en el grupo DAS28-PCR. El numero de pacientes que cumplian los criterios de actividad baja (DAS28 2.6 a 3.2) en el grupo DAS28-VSG fue del 17% versus el 16% en el grupo DAS28-PCR. El 30% y el 29% de los pacientes cumplieron...

Annals of the Rheumatic Diseases, 2019

Background Antiphospholipid antibodies (aPL) have been associated with organ damage and certain f... more Background Antiphospholipid antibodies (aPL) have been associated with organ damage and certain features in SLE patients. Objectives To investigate the association between the different aPL and SLE manifestations as well as to elucidate the influence of the load of antibodies. Methods Patients from the RELESSER-T registry were included. RELESSER-T is a multicenter, hospital-based registry, with retrospective cross-sectional collection of data adult non-selected patients with SLE attending Spanish rheumatology services from the public national health system. Results Out of a total of 3651 SLE patients, 1368 were positive for aPL (44.9% of patients were positive for anticardiolipin (aCL) antibodies, 27.3% for anti b2glycoprotein I (aB2GPI) and 24% for lupus anticoagulant (LA)). Regarding the load of antibodies, 20.6%, 12.1% and 4.8% were positive for one, two and three antibodies, respectively. The association between the different aPL, the number of positive antibodies and antiphosph...

Objetivos: Conocer el uso de la ecografia musculo-esqueletica (EME) entre los reumatologos de la ... more Objetivos: Conocer el uso de la ecografia musculo-esqueletica (EME) entre los reumatologos de la Comunidad Valenciana, la disponibilidad de equipamiento en el lugar de trabajo y sus aplicaciones en la practica clinica diaria. Metodos: Todos los reumatologos miembros de la Sociedad Valenciana de Reumatologia fueron invitados por correo electronico a participar en una encuesta de 22 preguntas acerca de datos demograficos, disponibilidad de equipos en el lugar de trabajo, uso clinico y entrenamiento especifico en EME. Resultados: 27 reumatologos de 16 hospitales de la Comunidad Valenciana, respondieron la encuesta, el 33% eran mujeres y la edad media de 46 anos (25-65). La mayoria trabajaban en centros publicos (92%). El 45,8% tuvo acceso a un equipo de EME durante su residencia y el 83,3 % lo tenia en su puesto de trabajo actual. Un 26% no solia realizar ninguna EME a la semana y un 52% realizaba mas de 5/semana. Un 48% utilizaba la EME para realizar punciones guiadas, pero solo un 35...

Reumatología Clínica, 2020

Seminars in Arthritis and Rheumatism, 2020

This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Rheumatology International, 2019

Our aim was to assess the relationship between serum adalimumab levels, anti-drug antibodies (ADA... more Our aim was to assess the relationship between serum adalimumab levels, anti-drug antibodies (ADA) and disease activity in patients with axial spondylarthritis (SpA). We have carried out a single-centre cross-sectional study. adalimumab and ADA levels were analysed with ELISA and correlated with SpA activity using BASDAI and ASDAS scores. Adalimumab cutoff value was calculated to discriminate inactive disease/low disease activity (BASDAI < 4; ASDAS < 2.1) from moderate/high disease activity (BASDAI ≥ 4; ASDAS ≥ 2.1), using a receiver operating characteristic (ROC) curve. Up to January 2016, 51 consecutive patients were included. The median (range) age was 46.6 (18-68) and 47.1% were women. ADA prevalence was 27.5%, with none detected in the 21.6% receiving concomitant disease-modifying antirheumatic drugs (DMARDs) (p = 0.021). Adalimumab level was normal (> 3 mg/l) in 36 patients (70.6%), all without ADA. Fifteen patients (29.4%) had subtherapeutic adalimumab levels (< 3 mg/l), with ADA in 14 (93%). Median adalimumab (mg/l) was significantly higher in patients with inactive disease/low disease activity: BASDAI < 4 vs ≥ 4: 9.5 vs 2.6 (p < 0.01); ASDAS-CRP < 2.1 vs ≥ 2.1: 9.3 vs 0.3 (p < 0.001); ASDAS-ESR < 2.1 vs ≥ 2.1: 9.9 vs 3.0 (p < 0.001), and this finding was consistent with the result of the multivariate model. Patients with inactive disease/low disease activity presented significantly lower ADA levels. The adalimumab level cutoffs and area under the curve (AUC) obtained in the ROC curves were: ASDAS-CRP (< 2.1) 4.6 mg/l (AUC 81.2%; 95% CI 67.5-94.9; p < 0.001); ASDAS-ESR (< 2.1) 7.7 mg/l (AUC 82.4%; 95% CI 69.3-95.5; p < 0.001); BASDAI (< 4) 6.4 mg/l (AUC 73.5%; 95% CI 58.6-88.3; p < 0.01). In conclusion, presence of ADA in axial SpA patients treated with adalimumab was associated with lower serum drug levels. ADA levels were lower and adalimumab levels were higher in patients with inactive disease/low disease activity based on BASDAI and ASDAS indices. Concomitant treatment with MTX reduces de likelihood of finding ADA. Serum adalimumab levels above 4.6 mg/l are recommended to avoid compromising efficacy.

Abstracts Accepted for Publication, 2019

Objectives: To know the characteristics of patients with rheumatoid arthritis (RA), in treatment ... more Objectives: To know the characteristics of patients with rheumatoid arthritis (RA), in treatment with baricitinib (BARI), who have failed to conventional synthetic DMARD (DMARDcs) and/or biological DMARDs (DMARD). Methods: Prospective observational study, in real life, of patients with RA, under treatment with BARI. General data of the patients, (age, gender, comorbidity), RA and treatment were collected (time of evolution, presence of RF and ACPA, efficacy indexes at the beginning of BARI and the last visit: DAS28-VSG and CDAI, previous or concomitant treatment with DMARDcs and/or DMARDb, end of treatment and cause, time in BARI, serious adverse effects during treatment with BARI. Results: Of 529 patients in follow-up, who have received at least one dose of DMARDb, 224 (42%) are diagnosed with RA, and 58 (26%) of them receive some drug inhibitor of the JAK pathway; 40/224 (18%) of them BARI. The patients treated with BARI, 77% were women, mean age of 58.95 ± 10.8 years and mean evolution of RA of 9.6 ± 8.8 years. The mean BMI is 28.8 ± 1.8. The FR and ACPA are positive at 86% and 89%, respectively. 94% of patients continued concomitant treatment with some DMARDcs. BARI is the first drug after failure of DMARDcs (F1) in 24/40 (60%) patients, and in 16/40 (40%), after failure to some DMARDb: second drug after failure to DMARDb (F2) in 2 (6%), third (F3) in 5 (13%) patients, fourth (F4) in 6 patients (17%) and fifth (F5) in 3 (9%) patients. The mean global time in BARI is 9.6 ± 3.2 months, being for F1, F2,

Oral Presentations, 2019

Table 2. Type of flare after IS discontinuation in 105 SLE remitted patients. Type of flare Numbe... more Table 2. Type of flare after IS discontinuation in 105 SLE remitted patients. Type of flare Number (%) Severe flare, number (% of all flares) Arthritis 5 (19.2) 2 (7.7) Skin manifestations 6 (23.1) 1 (3.9) Serosal involvement 2 (7.7) 0 Haematological involvement 5 (19.2) 2 (7.7) Lupus nephritis 8 (30.8) 8 (30.8) Total 26 13 (50) Conclusion: In our SLE cohort, the withdrawal of IS therapy in remitted patients did not seem to influence damage progression in the medium-term.

Abstracts Accepted for Publication, 2019

Objectives: To know the impact of obesity on the risk of fracture. Methods: Observational study, ... more Objectives: To know the impact of obesity on the risk of fracture. Methods: Observational study, during 2010-2018, of patients referred for bone densitometry (BMD), to the Bone Densitometry Unit of Rheumatology. BMD performed by Rheumatology nursing, collect several data (age, gender); osteoporosis (OP) risk factors: age of menopause, smoking and current alcohol intake, hip fracture parents, body mass index (BMI), diseases-drugs that reduce bone mass, fractures, treatment; BMD in lumbar spine (LS), femoral neck (FN); FRAX with BMD. BMI result was as WHO recommendations in kg/m 2 : Normal: 18.5-24.99; Obesity: 30; type I: 30-34.99, type II: 35.39.99, type III: 40. Results: A first BMD in 6.943 postmenopausal women was done. 2.196 (32%) had normal BMI, low weight (BMI <18.5 kg/m 2) 103 (1.5%) patients, overweight (BMI 25-29.99 kg/m 2) 2.643 (38%) and obesity 2.001 (29%). Obesity (BMI 30 kg/m 2) vs normal BMI, are older (65±13 vs 61±13, p=0.005), lower current smokers (12% vs 27%) P <0.0001), more treated for OP (37% vs 29%, p=0.002), higher percentage of fractures (44% vs 29%), especially distal radius (DR) (30% vs 11%), p<0.001) and vertebral (19% vs 7%, p=0.002), lower mean T score in LS (-1.1±1.5 vs 1.8±1.5, p <0.0001) and FN (-1.1±1.5 vs-1.6 ± 1.5, p<0.0001) and lower mean FRAX hip fracture with BMD (1.9±3.6 vs 2.4±3.6, p <0.0001). In table, obesity groups are compared with normal BMI. Conclusion: In postmenopausal women referred for BMD, obese women vs normal BMI are 1. Older. 2. Overall, with higher percentage of fractures. 3. But, women with BMI 40 kg/m 2 do not have a higher overall percentage of fracture, except in DR.

Poster Presentations, 2019

Saturday, 15 June 2019, 2019

Background: Musculoskeletal stiffness is reported to be frequent following chikungunya infection ... more Background: Musculoskeletal stiffness is reported to be frequent following chikungunya infection and can persist for many months after infection. However, stiffness severity and its impact is not well characterised in this disease. A stiffness patient reported outcome instrument has been developed for use in rheumatoid arthritis. Objectives: Our objective was to assess the use of this questionnaire and importance of musculoskeletal stiffness in a cohort of chikungunya

Abstracts, 2019

Background OBJECTIVE: Estimate the frequency of the association of SLE with other autoimmune dise... more Background OBJECTIVE: Estimate the frequency of the association of SLE with other autoimmune diseases in a large Spanish cohort of patients with systemic lupus erythematosus (SLE) and investigate the main risk factors for polyatoimmunity. Methods Design: RELESSER is a nationwide multicentre, hospitalbased registry of SLE patients. This is a cross-sectional study. Patients: Unselected consecutive adult patients with SLE, classified according to the American College of Rheumatology (ACR) 1997 criteria. All patients had been attended upon and followed at Spanish rheumatology departments. The first patient was enrolled in October 2011 and the last in August 2012. Main outcome: Polyautoimmunity was defined as patients who fulfilled criteria for SLE and other autoimmune disease: (1) autoimmune thyroiditis (alteration of thyroid function with the presence of anti-thyroid autoantibodies), (2) other connective tissue disease (rheumatoid arthritis, systemic sclerosis or inflammatory myopathy) and (3) mixed connective tissue disease. Multiple autoimmune syndrome (MAS) was defined as patients who meet SLE criteria and at least two other autoimmune diseases. Other variables: Demographic and clinical variables, Sjogren's syndrome, antiphospholipid syndrome and family history of autoimmune systemic disease were collected. Statistical analysis: Descriptive, Chi-square test and ANOVA or Kruskal-Wallis for comparison between groups of patients. Multiple logistic regression analysis was performed to investigate the possible risk factors for polyautoimmunity in patients with SLE. Results From all patients included in the registry, 3679 (91.4%) patients met 4 or more SLE criteria. Of these, 501 (13.6%) patients had Polyautoimmunity. The characteristics of this group are showed in table 1. The most frequent polyautoimmunity types associated with SLE were (in descending order over the total cohort of patients with SLE): autoimmune thyroiditis (7.5%), other connective tissue disorders (4.4%) and mixed connective tissue disease (2.7%). The percentage of patients a family history of SLE was 12.4%. Multiple autoimmune syndrome was observed in 10.2% of patients with Polyautoimmunity. The multivariate analysis identified age (odds ratio [95% confidence interval], 1.01 [1.00-1.02]), sex (3.00 [1.48-6.04]), Raynaud's phenomenon (1.79 [1.34-2.39]), pulmonary fibrosis (2.88 [1.32-6.30]), Ro-La autoantibodies (1.68 [1.20-2.36]), antiRNP (1.79 [1.32-2.42]) and treatment with methotrexate (1.54 [1.08-2.18]) or with antimalarials (0.57 [0.41-0.78]) as factors associated with polyautoimmunity. Conclusions SLE patients frequently associate other autoimmune diseases, detecting poliautoimmunity in 14%, MAS in 2%, family history of SLE in 12.4% and others such as Sjogren's syndrome and secondary SAF in 12.8% and 12.7% respectively. More studies are needed to better understand the increase of polyautoimmunity that seems to be observed in SLE.

Reumatología Clínica, 2018

(REAPSER), así como sus fortalezas y limitaciones. El objetivo principal del proyecto es identifi... more (REAPSER), así como sus fortalezas y limitaciones. El objetivo principal del proyecto es identificar factores pronósticos de la evolución clínica y radiográfica en una cohorte de pacientes que padecen artritis psoriásica (APs) diagnosticada con menos de 2 años de evolución. Material y método: Estudio observacional, prospectivo (2 años de seguimiento; periodicidad anual de las visitas), multicéntrico. La intención en la visita basal fue reflejar la situación del paciente antes de que la evolución de la enfermedad se viese modificada por los tratamientos pautados en los servicios de reumatología. Los pacientes fueron invitados a participar consecutivamente en una de sus visitas habituales al reumatólogo. El tamaño muestral finalmente alcanzado fue de 211 pacientes. Se recogen datos sociodemográficos; de situación laboral; historia familiar; antecedentes personales y comorbilidad; antropométricos; estilo de vida; uso de los servicios de salud; situación clínica al diagnóstico de APs; afectación articular y dolor espinal; dolor y valoración global de la enfermedad; entesitis, dactilitis y uveítis; afectación cutánea y ungueal; situación funcional y calidad de vida; evaluación radiográfica; determinaciones analíticas; tratamiento; brotes en esqueleto axial y periférico. Conclusiones: El estudio REAPSER incluye una cohorte de pacientes con APs de inicio reciente reclutados antes de que la evolución de la enfermedad se viese modificada por la prescripción de FAME en los servicios de reumatología. Se espera que la información exhaustiva recogida en las visitas suponga una amplia fuente de datos para futuros análisis.

Lupus, 2020

Annals of the Rheumatic Diseases, 2019

Reumatología Clínica, 2020

Seminars in Arthritis and Rheumatism, 2020

Rheumatology International, 2019

Abstracts Accepted for Publication, 2019

Oral Presentations, 2019

Abstracts Accepted for Publication, 2019

Poster Presentations, 2019

Saturday, 15 June 2019, 2019

Abstracts, 2019

Reumatología Clínica, 2018