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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The landscape in the treatment of chronic inflammatory arthropathies has radically changed when the first biological agents appeared at the end of the 1990s&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">1&#8211;4</span></a> Uhlig et al&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">5</span></a> have conducted a study in the Oslo Rheumatoid Arthritis Register &#40;ORAR&#41;&#44; on the evolution over time of clinical management of rheumatoid arthritis &#40;RA&#41;&#44; between 1994 and 2004&#46; These authors demonstrate&#44; after an analysis adjusted by age&#44; gender&#44; comorbidities&#44; duration of the disease and treatments received&#44; how the clinical impact of RA has become milder in the new millennium&#46; They observe statistically significant improvements in the health of the studied population&#44; especially in the physical dimensions&#44; the pain and the global health&#44; probably due to a better access to health care systems and to the availability of new and better treatments&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Kievitt et al&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">6</span></a> have also studied the evolution over time &#40;1989&#8211;2008&#41; of the clinical control of the activity of the disease in the cohort of Nijmegen&#44; which includes patients with RA&#46; The analysis showed &#40;after adjustment by age&#44; gender&#44; serum rheumatoid factor and duration of the disease&#41; a clear improvement in DAS28 and HAQ scores&#44; a less need for orthopaedic surgery and an increase &#40;during this period&#41; of the methotrexate and biological drugs use and dose&#46; At the end of the studied period&#44; 20&#37; of the patients included in the cohort were receiving treatment with biological therapies&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">It was described that up to a third part of the patients with ankylosing spondylitis &#40;AS&#41; showed signs of depression&#46; This phenomenon has been related to the impact of physical disability and pain suffering&#44; but it has also been related to the potential psychopathological effects of proinflammatory cytokines &#40;interleukin-1&#44; TNF-alpha&#41; released during the disease&#46; In patients with AS&#44; the administration of anti-TNF biological therapies can quickly improve&#44; from the 2nd week of initiated the therapy&#44; the scores obtained for anxiety and depression in the Hamilton rating scale&#44; and simultaneously improve the clinical activity assessed by the BASDAI&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">7</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The biological therapies have also demonstrated to have a very important impact on the prevention and&#47;or the attenuation of the organic joint injury triggered by the inflammatory arthropathy&#46; &#216;rnbjerg et al&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">8</span></a> have demonstrated&#44; in patients with RA treated with biological drugs after an inadequate response to DMARD therapy coming from DANBIO registry&#44; a reduction in the advance of the mean for total Sharp score &#40;TSS&#41; from the 1&#46;8 units&#47;year &#40;during DMARD period&#41; to 0&#46;7 units&#47;year during the biological therapy period&#46; A multivariate regression analysis&#44; adjusted by baseline predictors&#44; the use of steroids and DMARD therapy&#44;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">9</span></a> performed in the cohort of Wichita &#40;USA&#41; of patients with RA&#44; clearly demonstrates that the fact the RA is currently less severe &#40;regarding the smaller progression of the damage and the functional disability&#41; is due to the more effective treatments of the disease and not to a change in the natural evolution of the process&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The effect of biological therapies on the structural component in AS is more controversial&#46; However&#44; a recent investigation<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">10</span></a> studied the progression of the radiological damage measured by the modified Stokes Ankylosing Spondylitis Spine Score &#40;mSASSS&#41;&#46; According to this study&#44; the treatment with anti-TNF reduces the risk of progression of the disease by 50&#37; &#40;OR&#61;0&#46;52&#59; 95&#37; CI&#44; 0&#46;30&#8211;0&#46;88&#59; <span class="elsevierStyleItalic">P</span>&#61;&#46;02&#41;&#46; In addition&#44; a delay of 10 years in the beginning of the biological treatment significantly increases the risk of developing structural injuries in opposition to early beginning of treatment &#40;OR&#61;2&#46;4&#59; 95&#37; CI&#44; 1&#46;09&#8211;5&#46;3&#59; <span class="elsevierStyleItalic">P</span>&#61;&#46;03&#41;&#46; A systematic review of the evidence and a meta-analysis analysed the effect of anti-TNF drugs on the radiological progression of the structural damage in psoriatic arthritis&#44;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">11</span></a> concluding that 84&#46;5&#37; of the patients treated with anti-TNF therapy did not show progression of the damage&#44; in opposition to the 68&#46;6&#37; of those who received placebo &#40;OR&#61;2&#46;68&#59; 95&#37; CI&#44; 1&#46;99&#8211;3&#46;60&#59; <span class="elsevierStyleItalic">p</span>&#60;&#46;001&#41;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Krishnan et al&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">12</span></a> have recently observed how biological therapies reduce the disability in patients with RA&#44; studied prospectively between 1983 and 2006&#46; The biological treatments are also reducing the need of orthopaedic surgeries in patients with chronic inflammatory arthropathies&#46; Louie and Wards<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">13</span></a> have analysed the need of orthopaedic surgery in patients with RA&#44; residents of California &#40;USA&#41;&#44; of 40 years of age or older&#44; between 1983 and 2007&#46; During this period&#44; the rate of total knee replacement was reduced by 19&#37; and hip replacement was reduced by 40&#37; in patients between 40 and 50 years of age&#46; It has been observed greater reduction rates in ankle and wrist surgery&#46; In contrast to this reduction&#44; the evolution of the rate in general surgery for the global population&#44; between 1998 and 2007&#44; goes from 260&#47;100 000 to 360&#47;100 000 interventions&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">In Japan&#44; the observational cohort IORRA<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">14&#44;15</span></a> of patients with RA shows a constant reduction in the number of interventions&#44; globally&#44; and specially in prosthesis replacement interventions&#44; since the years 2002&#8211;2003&#46; In contrast to this&#44; the total rate of joint replacement has increased&#44; for the same period&#44; from 2 to 10 times in the general population&#46; In the same way&#44; the need for performing knee synovectomies in patients with RA has been reduced&#46; Leon et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">16</span></a> in Spain&#44; have also detected a reduction in the orthopaedic surgery procedures in patients with RA in the biological treatments era&#44; which they relate to the better control of the disease&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Biological therapies are expensive&#44; but the intensive control of the articular inflammation obtained through them has a positive effect on the cardiovascular events<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">17</span></a> reducing the mortality caused by such cause&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">18</span></a> In addition&#44; biological therapies drastically diminish work disabilities&#44; reducing them by 50&#37;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">19</span></a> and increasing in almost 9<span class="elsevierStyleHsp" style=""></span>h the weekly capacity to work<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">20</span></a> &#40;which would compensate 40&#37; of the annual payments of anti-TNF drugs&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">In conclusion&#44; biological therapies have significantly improved the clinical control of rheumatic diseases and have reduced the progression of structural damage and of disability&#44; triggered by the disease itself&#46; At the same time&#44; they have provided the adequate approach and clinical management of the chronic articular inflammatory processes by the early diagnosis&#44; the measurement of the disease activity&#44; the definition of control objectives and the assessments of guidelines for treatment&#46; All of the above together with a favourable cost-benefit relation&#46; All these evidences allow us to affirm that our patients are nowadays better controlled in the inflammatory activity of the disease&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of Interest</span><p id="par0050" class="elsevierStylePara elsevierViewall">Jesus Tornero-Molina has received funds from Abvie&#44; Pfizer&#44; Roche and UCB for research&#46;</p></span></span>"
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Editorial
Clinical Repercussions of Introducing Biological Therapies: The Well-controlled Patient
Repercusiones clínicas de la introducción de las terapias biológicas: el paciente bien controlado
Jesús Tornero-Molinaa,b
a Sección de Reumatología, Hospital Universitario de Guadalajara, Guadalajara, Spain
b Departamento de Medicina, Universidad de Alcalá, Alcalá de Henares, Madrid, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The landscape in the treatment of chronic inflammatory arthropathies has radically changed when the first biological agents appeared at the end of the 1990s&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">1&#8211;4</span></a> Uhlig et al&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">5</span></a> have conducted a study in the Oslo Rheumatoid Arthritis Register &#40;ORAR&#41;&#44; on the evolution over time of clinical management of rheumatoid arthritis &#40;RA&#41;&#44; between 1994 and 2004&#46; These authors demonstrate&#44; after an analysis adjusted by age&#44; gender&#44; comorbidities&#44; duration of the disease and treatments received&#44; how the clinical impact of RA has become milder in the new millennium&#46; They observe statistically significant improvements in the health of the studied population&#44; especially in the physical dimensions&#44; the pain and the global health&#44; probably due to a better access to health care systems and to the availability of new and better treatments&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Kievitt et al&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">6</span></a> have also studied the evolution over time &#40;1989&#8211;2008&#41; of the clinical control of the activity of the disease in the cohort of Nijmegen&#44; which includes patients with RA&#46; The analysis showed &#40;after adjustment by age&#44; gender&#44; serum rheumatoid factor and duration of the disease&#41; a clear improvement in DAS28 and HAQ scores&#44; a less need for orthopaedic surgery and an increase &#40;during this period&#41; of the methotrexate and biological drugs use and dose&#46; At the end of the studied period&#44; 20&#37; of the patients included in the cohort were receiving treatment with biological therapies&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">It was described that up to a third part of the patients with ankylosing spondylitis &#40;AS&#41; showed signs of depression&#46; This phenomenon has been related to the impact of physical disability and pain suffering&#44; but it has also been related to the potential psychopathological effects of proinflammatory cytokines &#40;interleukin-1&#44; TNF-alpha&#41; released during the disease&#46; In patients with AS&#44; the administration of anti-TNF biological therapies can quickly improve&#44; from the 2nd week of initiated the therapy&#44; the scores obtained for anxiety and depression in the Hamilton rating scale&#44; and simultaneously improve the clinical activity assessed by the BASDAI&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">7</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The biological therapies have also demonstrated to have a very important impact on the prevention and&#47;or the attenuation of the organic joint injury triggered by the inflammatory arthropathy&#46; &#216;rnbjerg et al&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">8</span></a> have demonstrated&#44; in patients with RA treated with biological drugs after an inadequate response to DMARD therapy coming from DANBIO registry&#44; a reduction in the advance of the mean for total Sharp score &#40;TSS&#41; from the 1&#46;8 units&#47;year &#40;during DMARD period&#41; to 0&#46;7 units&#47;year during the biological therapy period&#46; A multivariate regression analysis&#44; adjusted by baseline predictors&#44; the use of steroids and DMARD therapy&#44;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">9</span></a> performed in the cohort of Wichita &#40;USA&#41; of patients with RA&#44; clearly demonstrates that the fact the RA is currently less severe &#40;regarding the smaller progression of the damage and the functional disability&#41; is due to the more effective treatments of the disease and not to a change in the natural evolution of the process&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The effect of biological therapies on the structural component in AS is more controversial&#46; However&#44; a recent investigation<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">10</span></a> studied the progression of the radiological damage measured by the modified Stokes Ankylosing Spondylitis Spine Score &#40;mSASSS&#41;&#46; According to this study&#44; the treatment with anti-TNF reduces the risk of progression of the disease by 50&#37; &#40;OR&#61;0&#46;52&#59; 95&#37; CI&#44; 0&#46;30&#8211;0&#46;88&#59; <span class="elsevierStyleItalic">P</span>&#61;&#46;02&#41;&#46; In addition&#44; a delay of 10 years in the beginning of the biological treatment significantly increases the risk of developing structural injuries in opposition to early beginning of treatment &#40;OR&#61;2&#46;4&#59; 95&#37; CI&#44; 1&#46;09&#8211;5&#46;3&#59; <span class="elsevierStyleItalic">P</span>&#61;&#46;03&#41;&#46; A systematic review of the evidence and a meta-analysis analysed the effect of anti-TNF drugs on the radiological progression of the structural damage in psoriatic arthritis&#44;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">11</span></a> concluding that 84&#46;5&#37; of the patients treated with anti-TNF therapy did not show progression of the damage&#44; in opposition to the 68&#46;6&#37; of those who received placebo &#40;OR&#61;2&#46;68&#59; 95&#37; CI&#44; 1&#46;99&#8211;3&#46;60&#59; <span class="elsevierStyleItalic">p</span>&#60;&#46;001&#41;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Krishnan et al&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">12</span></a> have recently observed how biological therapies reduce the disability in patients with RA&#44; studied prospectively between 1983 and 2006&#46; The biological treatments are also reducing the need of orthopaedic surgeries in patients with chronic inflammatory arthropathies&#46; Louie and Wards<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">13</span></a> have analysed the need of orthopaedic surgery in patients with RA&#44; residents of California &#40;USA&#41;&#44; of 40 years of age or older&#44; between 1983 and 2007&#46; During this period&#44; the rate of total knee replacement was reduced by 19&#37; and hip replacement was reduced by 40&#37; in patients between 40 and 50 years of age&#46; It has been observed greater reduction rates in ankle and wrist surgery&#46; In contrast to this reduction&#44; the evolution of the rate in general surgery for the global population&#44; between 1998 and 2007&#44; goes from 260&#47;100 000 to 360&#47;100 000 interventions&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">In Japan&#44; the observational cohort IORRA<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">14&#44;15</span></a> of patients with RA shows a constant reduction in the number of interventions&#44; globally&#44; and specially in prosthesis replacement interventions&#44; since the years 2002&#8211;2003&#46; In contrast to this&#44; the total rate of joint replacement has increased&#44; for the same period&#44; from 2 to 10 times in the general population&#46; In the same way&#44; the need for performing knee synovectomies in patients with RA has been reduced&#46; Leon et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">16</span></a> in Spain&#44; have also detected a reduction in the orthopaedic surgery procedures in patients with RA in the biological treatments era&#44; which they relate to the better control of the disease&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Biological therapies are expensive&#44; but the intensive control of the articular inflammation obtained through them has a positive effect on the cardiovascular events<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">17</span></a> reducing the mortality caused by such cause&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">18</span></a> In addition&#44; biological therapies drastically diminish work disabilities&#44; reducing them by 50&#37;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">19</span></a> and increasing in almost 9<span class="elsevierStyleHsp" style=""></span>h the weekly capacity to work<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">20</span></a> &#40;which would compensate 40&#37; of the annual payments of anti-TNF drugs&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">In conclusion&#44; biological therapies have significantly improved the clinical control of rheumatic diseases and have reduced the progression of structural damage and of disability&#44; triggered by the disease itself&#46; At the same time&#44; they have provided the adequate approach and clinical management of the chronic articular inflammatory processes by the early diagnosis&#44; the measurement of the disease activity&#44; the definition of control objectives and the assessments of guidelines for treatment&#46; All of the above together with a favourable cost-benefit relation&#46; All these evidences allow us to affirm that our patients are nowadays better controlled in the inflammatory activity of the disease&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of Interest</span><p id="par0050" class="elsevierStylePara elsevierViewall">Jesus Tornero-Molina has received funds from Abvie&#44; Pfizer&#44; Roche and UCB for research&#46;</p></span></span>"
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Article information
ISSN: 21735743
Original language: English
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2023 May 47 29 76
2023 April 20 15 35
2023 March 60 35 95
2023 February 45 30 75
2023 January 32 30 62
2022 December 56 35 91
2022 November 68 23 91
2022 October 51 41 92
2022 September 27 43 70
2022 August 46 42 88
2022 July 35 41 76
2022 June 35 30 65
2022 May 33 34 67
2022 April 36 37 73
2022 March 43 49 92
2022 February 26 37 63
2022 January 30 32 62
2021 December 22 34 56
2021 November 30 37 67
2021 October 35 40 75
2021 September 27 31 58
2021 August 26 42 68
2021 July 29 24 53
2021 June 32 41 73
2021 May 29 37 66
2021 April 36 69 105
2021 March 32 28 60
2021 February 26 19 45
2021 January 24 20 44
2020 December 30 18 48
2020 November 32 16 48
2020 October 12 9 21
2020 September 41 25 66
2020 August 25 17 42
2020 July 22 18 40
2020 June 32 16 48
2020 May 22 20 42
2020 April 22 13 35
2020 March 15 6 21
2020 February 1 0 1
2018 May 4 0 4
2018 April 103 6 109
2018 March 115 6 121
2018 February 124 6 130
2018 January 43 4 47
2017 December 111 12 123
2017 November 67 11 78
2017 October 27 5 32
2017 September 47 10 57
2017 August 54 12 66
2017 July 56 14 70
2017 June 49 9 58
2017 May 60 13 73
2017 April 44 10 54
2017 March 45 15 60
2017 February 18 7 25
2017 January 17 10 27
2016 December 63 17 80
2016 November 43 12 55
2016 October 55 13 68
2016 September 46 3 49
2016 August 37 7 44
2016 July 22 4 26
2015 December 2 0 2
2015 November 1 15 16
2015 October 1 24 25
2015 September 3 0 3
2015 August 1 10 11
2015 July 24 7 31
2015 June 56 11 67
2015 May 79 40 119
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