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        "titulo" => "Desarrollo de un cuadro de actuaci&#243;n para la evaluaci&#243;n de pacientes con espondiloartritis axial y artritis psori&#225;sica en la pr&#225;ctica diaria&#58; proyecto ONLY TOOLS"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Checklist for the evaluation of patients with axial spondyloarthritis and psoriatic arthritis&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">In routine clinical practice&#44; it is recommended that patients with spondyloarthritis &#40;SpA&#41; be evaluated according to clinical signs&#44; symptoms and acute-phase reactants&#44;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">1&#44;2</span></a> for example the Bath Ankylosing Spondylitis Disease Activity Index&#44; C-reactive protein or the Ankylosing Spondylitis Disease Activity Score&#44; which combines the 2 aspects &#40;both subjective assessment of the patient and the acute-phase reactants&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">3</span></a> The same occurs with psoriatic arthritis &#40;PsA&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">However&#44; despite the availability of a number of Spanish and international guidelines for the evaluation of SpA including PsA&#44; the EmAR II study&#44; conducted in Spain&#44;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">4</span></a> demonstrated that&#44; in the assessment of SpA patients&#44; approximately 60&#37; of their medical records do not include an assessment of possible joint involvement or overall evaluation of the patient&#46; In 87&#37;&#44; no joint score is recorded and&#44; in 84&#37;&#44; there is no mention of a functional score&#46; Distinct factors may contribute to this situation&#46; At the present time&#44; there is great pressure on health professionals that does not favor the evaluation and systematic collection of data&#46; Moreover&#44; there is a great variability in the assessment variables recorded for these patients &#40;number&#44; characteristics&#44; feasibility&#44; validation&#44; etc&#46;&#41;&#46; This means that the outpatient follow-up of these individuals may not be optimal&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">These facts justify the need to design realistic strategies that contribute to improving the quality of clinical practice in order that these patients receive integrated care&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">4</span></a> On the basis of the above aspects&#44; the purpose of this project was to draw up a normalization tool &#40;a framework for action&#44; in the form of a checklist of items to be considered in visits to the rheumatologist&#44; for an adequate assessment of the patient&#41; to enhance the evaluation in routine practice of patients with axial SpA and PsA&#44; for the aim of standardizing and achieving a stricter control of the disease&#44; favoring the identification of high-risk factors and responses&#44; as well as control of comorbidities&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Study Design</span><p id="par0020" class="elsevierStylePara elsevierViewall">We designed a qualitative study based on the methodology of the nominal group and a review of the literature promoted by the Work Group for the Study of Spondyloarthritis of the Spanish Society of Rheumatology&#44; which comprises 2 projects&#58; <span class="elsevierStyleItalic">APROXIMA</span> &#40;&#8220;Approximate&#8221;&#41; and <span class="elsevierStyleItalic">PERSONALIZA</span> &#40;&#8220;Personalize&#8221;&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Participant Selection</span><p id="par0025" class="elsevierStylePara elsevierViewall">We selected a group of 18 experts &#40;with interest and demonstrated experience in the subject of the project&#41; from all the regions of Spain&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Drafting the Checklist</span><p id="par0030" class="elsevierStylePara elsevierViewall">We performed a literature review that included PubMed&#44; as well as Spanish and international guidelines and consensus documents&#46; For this&#44; we selected all of the variables employed for the evaluation of axial SpA and PsA patients &#40;sociodemographic&#44; clinical and treatment-related&#41;&#46; We then organized 2 focus groups&#44; 1 with rheumatologists &#40;to explore the barriers and facilitators in the management of patients with axial SpA and PsA&#44; as well as the most relevant aspects of their routine evaluation in the rheumatology department&#41; and another with patients &#40;to assess the needs that they detected in their visits to their physician&#44; so that they subsequently be evaluated by the experts&#41;&#46; The list of variables and the results of the focus groups were presented and discussed in a nominal group of experts&#44; which prepared a provisional list of variables&#44; both for the first visit and for successive appointments&#46; The experts the assessed each of these variables in terms of their&#58; &#40;1&#41; relevance &#40;impact on the patient&#44; decision making&#44; prognostic factor&#44; etc&#46;&#41; from 1 &#40;little relevant&#41; to 10 &#40;very relevant&#41;&#59; &#40;2&#41; feasibility in the outpatient office from 1 &#40;difficult to implement&#41; to 10 &#40;very feasible&#41;&#59; &#40;3&#41; periodicity of the evaluation&#59; and 4&#41; method&#47;s of measurement &#40;direct question&#44; questionnaire&#44; scale&#44; etc&#46;&#41;&#46; Once all the variables had been evaluated&#44; the experts selected them for inclusion in the first visit and for successive appointments &#40;together with their periodicity&#41; those that had achieved the best scores and that they considered important for the evaluation of these patients&#46; Next&#44; they defined&#58; &#40;1&#41; measures of excellence &#40;those that&#44; by taking into account the characteristics of routine clinical practice&#44; may be more complicated to measure&#41;&#59; variables considered prognostic factors&#44; on the basis of the literature&#59; &#40;3&#41; variables that predict the response to biological therapies&#44; according to published reports&#59; and 94&#41; common variables and those specific for axial SpA and PsA&#46; These specifications were included in the checklist&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Finally&#44; this checklist and its specifications were presented and analyzed in local meetings throughout Spain by an extensive and representative group of rheumatologists &#40;see ONLY TOOLS work group in <a class="elsevierStyleCrossRef" href="#sec0075">Appendix A</a>&#41;&#46; All of the recommendations proposed in these local meetings were conveyed to the experts&#44; who drafted the definitive checklist and specifications&#46; This entire process was done with the aid of methodological advice&#44; that helped both in the organization of the focus groups and in the subsequent discussion of the elements to be included in the checklist&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Statistical Analysis</span><p id="par0040" class="elsevierStylePara elsevierViewall">This analysis was based on a descriptive study&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Results</span><p id="par0045" class="elsevierStylePara elsevierViewall">We drafted a checklist to evaluate SpA patients&#44; with differentiated markers for patients with axial SpA and PsA&#44; and their periodicity&#44; as well as other specifications &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; It includes sociodemographic variables&#44; like the date of birth and sex &#40;risk factor for the risk of radiographic progression and a determinant of a good response to biological therapy&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">Concerning personal history&#44; we documented&#44; among other data&#44; allergies&#44; profession&#47;employment status and use of tobacco &#40;another risk factor affecting radiographic progression&#41;&#46; Likewise&#44; we recorded the date of symptom onset&#44; the date of the diagnosis&#44; related family history&#44; enthesitis&#44; dactylitis&#44; extra-articular manifestations and the presence of inflammatory lower back pain&#46; In the group of PsA patients&#44; we included peripheral involvement&#44; cutaneous symptoms and nail involvement&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">With respect to comorbidities&#44; we considered only those that had been diagnosed&#44; such as hypertension&#44; gastric ulcers and osteoporosis&#46; As biomarkers&#44; we included human leukocyte antigen &#40;HLA&#41; B27 and&#44; specifically&#44; in PsA&#44; rheumatoid factor and anti-cyclic citrullinated peptide antibodies&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">For patients with PsA&#44; the physical examination included a study of synovitis in an upper and a lower limb and dactylitis&#44; as well as a study of the skin and nails&#46; Those with axial SpA underwent examinations of hip mobility&#44; modified Sch&#246;ber test&#44; chest expansion and cervical rotation&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">On the other hand&#44; patient weight&#44; height&#44; body mass index&#44; abdominal circumference and arterial blood pressure should be determined yearly in PsA patients and&#44; as a measure of &#8220;excellence&#8221;&#44; in the case of those with SpA&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">With respect to clinical control&#44; for axial SpA&#44; the checklist includes the physician global assessment&#44; the Bath Ankylosing Spondylitis Functional Index and the Disease Activity Score in 28 joints in the case of polyarticular involvement&#44; aside from the Ankylosing Spondylitis Disease Activity Score and the Bath Ankylosing Spondylitis Disease Activity Index as determinants of a good response to biological therapy&#44; and the former&#44; moreover&#44; as a risk factor of radiographic progression&#46; In the case of PsA&#44; the patient global assessment and morning joint stiffness are also evaluated&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Ancillary tests that should be performed in the control of axial SpA are complete blood count&#44; erythrocyte sedimentation rate&#44; routine laboratory tests&#44; urinalysis and C-reactive protein &#40;a determining factor of a good response to biological therapy and of radiographic progression&#41;&#46; As a measure of excellence&#44; it was decided to include 25-OH vitamin D and bone densitometry&#46; In PsA patients&#44; urinary uric acid should also be determined and&#44; as a measure of excellence&#44; the lipid profile&#44; as well&#46; With regard to imaging studies&#44; plain radiography of the pelvis&#44; spine and sacroiliac joints &#40;and peripheral joints in patients with PsA&#41; helps to monitor risk factors for radiographic progression&#46; A radiograph of the pelvis enables a proper assessment of the sacroiliac joints and the hips&#44; making it unnecessary to X-ray these structures&#46; Magnetic resonance of the sacroiliac joints serves as a marker of radiographic progression&#44; and is also related to the response to biological therapy&#46; Thus&#44; the decision was made to include it&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Finally&#44; this checklist incorporates a section on treatments&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Discussion</span><p id="par0085" class="elsevierStylePara elsevierViewall">The work group for the study of SpA of the Spanish Society of Rheumatology has developed a practical and simple checklist&#44; achieved by consensus&#46; It is adapted to the characteristics of Spanish outpatient clinics&#44; and is based on a review of the literature and the opinion of experts for the assessment of patients with axial SpA and PsA in routine clinical practice&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">A number of studies have shown that adherence to the recommendations for the evaluation of patients with SpA and PsA is highly variable&#44; either because of a lack of time&#44; motivation or knowledge&#44; or because of the considerable number of the variables and their characterists&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">2&#44;5&#8211;8</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">In addition to standardizing routine clinical practice&#44; the drafting of this checklist was to facilitate the identification of different risk profiles in patients &#40;response to biological therapies&#44;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">9</span></a> radiographic progression&#44;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">10&#44;11</span></a>&#44; etc&#46;&#41; and aid in improving our approach to their comorbidities&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">12</span></a> With these &#8220;warning signs&#8221; the effort is made to stress the need for greater awareness and control in these patients&#46; It includes all the variables recommended in the Spanish and international guidelines and is presented in a simple form so that its use is feasible&#44; either printed out or incorporated into the electronic medical record&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">1&#44;2</span></a> Thus&#44; although these items are familiar to rheumatologists&#44; providing them in an orderly and accessible way that is easy to employ should be an incentive for its implementation&#46; This should contribute to a better control&#44; adaptation of the resources utilized and facilitation of an integrated management of complex patients and serve as a tool to resolve the detected needs&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">5</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">The project has several limitations&#46; For example&#44; a possible limitation could be derived from the representativeness of the panelists&#44; making it difficult to generalize and compare the suggested ideas&#46; To avoid these limitations&#44; we contacted rheumatologists from different centers in Spain to ensure demographic representativeness&#46; Another limitation could be derived from the election of the items included in the checklist&#59; although the failure to mention a relevant variable does not appear to be probable&#44; new ones can be defined during every patient visit&#46; We have not performed a real implementation of the checklist to determine whether or not its use is truly feasible and whether it enhances the care of patients with axial SpA&#44; but this will be the object of future projects&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">The design of a checklist as a tool for standardization might improve normalization and evaluation in the outpatient clinic&#46; It could lead to a stricter control of the disease&#44; identification of risk profiles and the control of comorbidities in routine clinical practice&#46; At the present time&#44; a project is underway for the introduction and assessment of the use of this checklist&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Ethical Disclosures</span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Protection of human and animal subjects</span><p id="par0110" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Confidentiality of data</span><p id="par0115" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Right to privacy and informed consent</span><p id="par0120" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Financing</span><p id="par0125" class="elsevierStylePara elsevierViewall">The project was financed by the <span class="elsevierStyleGrantSponsor" id="gs1">Spanish Foundation of Rheumatology</span>&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Conflict of Interest</span><p id="par0130" class="elsevierStylePara elsevierViewall">EL has received funding for research projects from AbbVie&#44; Roche&#44; MSD&#44; Pfizer&#44; Gebro&#44; UCB&#44; Gr&#252;nenthal&#44; Sobi&#44; Celgene and Eisai&#46; The remaining authors declare they have no conflicts of interest&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To standardize clinical evaluation of patients with axial spondyloarthritis &#40;SpA&#41; and psoriatic arthritis &#40;PsA&#41; using a checklist&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Qualitative study that included&#58; &#40;1&#41; nominal group &#40;18 experts&#41;&#59; &#40;2&#41; literature reviews of measures used in the assessment of patients with axial SpA or PsA&#59; and &#40;3&#41; focus groups&#44; one with rheumatologists and another with patients&#44; organized to become familiar with their opinion on medical assistance&#46; Taking this into account&#44; the experts selected the measures to be included in the checklist based on their relevance&#44; feasibility&#44; and the outcome type&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The checklist includes measures for the evaluation of personal history&#44; physical examination&#44; activity and function&#44; laboratory tests&#44; imaging studies and treatments&#46; It also defines risk factors of radiographic progression&#44; predictors of the response to biological therapies&#44; and comprises measures of excellence&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">This checklist for patients with axial SpA and PsA could help standardize daily clinical practice and improve clinical management and patient prognosis&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Estandarizar la evaluaci&#243;n cl&#237;nica de pacientes con espondiloartritis &#40;EspA&#41; axial y artritis psori&#225;sica &#40;APs&#41;&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio cualitativo que incluy&#243;&#58; 1&#41; grupo nominal &#40;18 expertos&#41;&#59; 2&#41; revisi&#243;n de la literatura sobre variables empleadas en la evaluaci&#243;n de los pacientes con EspA axial o APs&#44; y 3&#41; grupo focal con reumat&#243;logos y otro con pacientes con EspA axial o APs para analizar la evaluaci&#243;n de las EspA en las consultas de reumatolog&#237;a&#46; Los expertos seleccionaron las variables a incluir en el cuadro de actuaci&#243;n con base en su relevancia&#44; factibilidad en consulta y m&#233;todo&#47;s de medici&#243;n&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">El cuadro de actuaci&#243;n incluye las variables para valorar antecedentes personales&#44; exploraci&#243;n f&#237;sica&#44; actividad y funci&#243;n&#44; pruebas complementarias y tratamientos&#46; Detalla factores de riesgo de progresi&#243;n radiogr&#225;fica&#44; factores predictores de respuesta a terapia biol&#243;gica&#44; e incluye variables de excelencia&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Este cuadro de actuaci&#243;n para pacientes con EspA axial y APs podr&#225; ayudar a homogeneizar la pr&#225;ctica cl&#237;nica diaria y a mejorar el manejo y el pron&#243;stico de estos pacientes&#46;</p></span>"
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        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Almodovar R&#44; Torre Alonso JC&#44; Batlle E&#44; Castillo C&#44; Collantes-Estevez E&#44; de Miguel E&#44; et al&#46; Desarrollo de un cuadro de actuaci&#243;n para la evaluaci&#243;n de pacientes con espondiloartritis axial y artritis psori&#225;sica en la pr&#225;ctica diaria&#58; proyecto ONLY TOOLS&#46; Reumatol Clin&#46; 2018&#59;14&#58;155&#8211;159&#46;</p>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">The names of the components of the ONLY TOOLS working group are available in <a class="elsevierStyleCrossRef" href="#sec0075">Appendix A</a>&#46;</p>"
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            "apendice" => "<p id="par0140" class="elsevierStylePara elsevierViewall">Carlos Faced Olmos&#44; Elia Valls Pascual&#44; Javier Calvo Catal&#225;&#44; Cristina Campos Fern&#225;ndez&#44; Amelia Rueda Cid&#44; Rosa Negueroles Albuixech&#44; Luis Gonz&#225;lez Puig&#44; Roxana Gonz&#225;lez Mazario&#44; M&#46; Teresa Buades Soriano&#44; Juan Antonio Castellano Cuesta&#44; Alejandra Begazo Cruz&#44; Juan Alberto Paz Solarte&#44; Jorge Fragio Gil&#44; Ana Urruticoechea Arana&#44; Teresa Font Gay&#225;&#44; Luis Espadaler Poch&#44; Inmaculada Ros Vilamaj&#243;&#44; Andr&#233;s Ponce Fern&#225;ndez&#44; Lourdes Mateo Soria&#44; Ana Laiz Alonso&#44; Patricia Moya Alvarado&#44; Jer&#243;nima Ca&#241;ellas Oliver&#44; Melania Mart&#237;nez Morillo&#44; Sandra Farietta Varela&#44; Meritxell Salles Lizarzaburu&#44; Mar&#237;a Bonet Llorach&#44; Estefan&#237;a Moreno Ruzafa&#44; Alba Erra Duran&#44; M&#46; Elena Mart&#237;nez Castro&#44; M&#46; Jos&#233; Gonz&#225;lez Fern&#225;ndez&#44; Marta Valls Roc&#44; Patricia Reyner Echevarria&#44; Eulalia de Cendra Morera&#44; Ram&#243;n Valls Garc&#237;a&#44; Juan de Dios Ca&#241;ete Crespillo&#44; Andres Cuervo Aguilera&#44; Silvia Mart&#237;nez Pardo&#44; Georgina Salvador Alarc&#243;n&#44; Carmen Garc&#237;a G&#243;mez&#44; Delia Reina&#44; Dolores Beteta Fern&#225;ndez&#44; M&#46; Roc&#237;o Gonz&#225;lez Molina&#44; Antonia Hern&#225;ndez Balibrea&#44; Javier Jos&#233; Mart&#237;nez Ferr&#237;n&#44; M&#46; Jos&#233; Moreno Mart&#237;nez&#44; Juan Moreno Morales&#44; M&#46; Rosario Oliva Ruiz&#44; Encarnaci&#243;n Pag&#225;n Garc&#237;a&#44; Deseada Palma S&#225;nchez&#44; Elena Pe&#241;as Mart&#237;nez&#44; M&#46; Francisca Pina P&#233;rez&#44; Fernando Jos&#233; Rodr&#237;guez Mart&#237;nez&#44; Encarnaci&#243;n Saiz Cuenca&#44; Edgar Enrique Soriano Navarro&#44; Esther Toledano Mart&#237;nez&#44; M&#46; Concepci&#243;n Morado Qui&#241;oa&#44; Javier Quir&#243;s Donate&#44;&#160;Alberto Diaz Oca&#44; Alicia Humbr&#237;a&#44; Marta Valero Exp&#243;sito&#44; Carmen de la Cruz Tapiador&#44; M&#46; Teresa Gonzalez Hernandez&#44; Javier Rivera Redondo&#44;&#160;M&#46; Hildegarda Godoy Tundidor&#44; Carmen Barbadillo Mateo&#44;&#160;Laura Cebri&#225;n M&#233;ndez&#44; Leticia Lojo Oliveira&#44; Beatriz Joven&#44; M&#46; Cruz Fern&#225;ndez Espartero&#44; Mar&#237;a Ahij&#243;n Lana&#44; Alejandro Jes&#250;s Gonz&#225;lez Guti&#233;rrez&#44; Cristina Redondo Romero&#44; Bryan Josue Flores Robles&#44; Julia Mart&#237;nez Barrio&#44; Cristina Fern&#225;ndez Carballido&#44; Vega Jovani Casano&#44; Teresa Pedraz Penalva&#44; Cintia Romera L&#243;pez&#44; Gregorio Santos Soler&#44; Mariano Andr&#233;s Collado&#44; Jos&#233; Antonio Bernal Vidal&#44; Ra&#250;l Noguera Pons&#44; Gaspar Panadero Tendero&#44; Elisa Trujillo Mart&#237;n&#44; Juan Jos&#233; Bethencourt Baute&#44; M&#46; Vanesa Hern&#225;ndez Hern&#225;ndez&#44; Iv&#225;n Alejandro Ferraz Amaro&#44; M&#46; Garc&#237;a Gonz&#225;lez&#44; Esmeralda Delgado Fr&#237;as&#44; Beatriz Tejera Segura&#44; M&#46; &#193;ngeles Gantes Mora&#44; Lorena Exp&#243;sito P&#233;rez&#44; Valeriano Miguel Flores Rodr&#237;guez&#44; F&#225;tima &#193;lvarez Reyes&#44; Cristina Luna G&#243;mez&#44; Laura Magdalena Armas&#44; Laura Casas Hern&#225;ndez&#44; Aaron Fari&#241;a Gonz&#225;lez&#44; Luis Coronel Taranc&#243;n&#44; Jos&#233; Luis &#193;lvarez Vega&#44; Ra&#250;l Veroz Gonz&#225;lez&#44; Juan Jos&#233; Aznar S&#225;nchez&#44; Jos&#233; Garc&#237;a Tor&#243;n&#44; Esther del Rinc&#243;n Padilla&#44; Puerto Moreno Gil&#44; Fernando Gamero Ru&#237;z&#44; Antonio Cardenal Escarcena&#44; Antonia Ferreiro Conejo&#44; Piter Jos&#233; Cossio Jim&#233;nez&#44; Sara M&#46; Rojas Herrera&#44; Manuel Fern&#225;ndez Prada&#44; Jos&#233; Rey Rey&#44; Sim&#243;n S&#225;nchez Fern&#225;ndez&#44; Jimena Zalazar&#44; Andr&#233;s Ariza Hern&#225;ndez&#44; Rebeca Belmonte G&#243;mez&#44; Pastora Granados Bautista&#44; &#193;ngel Garc&#237;a Aparicio&#44; David Castro Corredor&#44; Carmen Amelia Ordas Calvo&#44; Jes&#250;s Babio Herr&#225;iz&#44; M&#46; Edilia Garc&#237;a Fern&#225;ndez&#44; M&#46; Trinidad P&#233;rez Sandoval&#44; Carolina &#193;lvarez Castro&#44; M&#46; Elvira D&#237;ez &#193;lvarez&#44; Alejandra L&#243;pez Robles&#44; Clara Moriano Morales&#44; Miriam Retuerto Guerrero&#44; Marta Garijo Bufort&#44; Luc&#237;a Pantoja Zarza&#44; M&#46; Carolina D&#237;ez Morrondo&#44; I&#241;igo Hern&#225;ndez Rodr&#237;guez&#44; Luis Fern&#225;ndez Rodr&#237;guez&#44; Jos&#233; Antonio Pinto Tasende&#44; Ceferino Barbaz&#225;n &#193;lvarez&#44; Francisco Maceiras Pan&#44; Marina Rodr&#237;guez L&#243;pez&#44; Jos&#233; M&#46; Pego Reigosa&#44; Jes&#250;s Ib&#225;&#241;ez Ruan&#44; Rafael Melero Gonz&#225;lez&#44; Susana Romero Yuste&#44; Jos&#233; Antonio Mosquera Mart&#237;nez&#44; Manuel Rodr&#237;guez G&#243;mez&#44; Jos&#233; Luis Ferreiro Seoane&#44; Antonio Fern&#225;ndez Nebro&#44; Jos&#233; Javier P&#233;rez Venegas&#44; Francisco Gabriel Jim&#233;nez Nu&#241;ez&#44; Carmen Castro Villegas&#44; Yolanda Cabello Fern&#225;ndez&#44; Carmen Romero Barco&#44; M&#46; del Carmen Ord&#243;nez Ca&#241;izares&#44; Inmaculada Ure&#241;a Garnica&#44; M&#46; Victoria Irigoyen Oyarzabal&#44; Angelines Belmonte L&#243;pez&#44; Virginia Coret Cagigal&#44; Concepci&#243;n Aranda Varela&#44; Marta Rojas Jim&#233;nez&#44; Clara Cienfuegos Garc&#237;a&#44; Antonio Ponce Vargas&#44; Concepci&#243;n Castillo Gallego&#44; Montserrat G&#243;mez Romero&#44; Jerusal&#233;n Calvo Guti&#233;rrez&#44; Pilar Font Ugalde&#44; Rafaela Ortega Castro&#44; Clementina L&#243;pez Medina&#44; Laura Bautista Aguilar&#44; Clara Ojeda Garc&#237;a&#44; Isabel Garc&#237;a Hern&#225;ndez&#44; Carmen Vargas Lebr&#243;n&#44; Julio Garc&#237;a Feito&#44; Juan Salvatierra Ossorio&#44; Pilar Morales Garrido&#44; Inmaculada Jim&#233;nez Mole&#243;n&#44; Mar L&#243;pez-Ib&#225;&#241;ez&#44; Antonio Garc&#237;a S&#225;nchez&#44; Susana Quirosa Flores&#44; Teresa Garc&#237;a Contreras&#44; Alfonso Gonz&#225;lez Utrilla&#44; Antonio Romero P&#233;rez&#44; Irati Urionaguena Onaindia&#44; Ioana Atxotegi Saez de Buruaga&#44; M&#46; Luz Garc&#237;a Vivar&#44; Eva Gal&#237;ndez Agirregoikoa&#44; M&#46; Elena Garmendia S&#225;nchez&#44; Jos&#233; Francisco Garc&#237;a Llorente&#44; Rosa M&#46; Morla Novell&#44; Jes&#250;s Rodr&#237;guez Moreno&#44; Mar&#237;a Aparicio Espinar&#44; Elena Sirvent Alierta&#44; Sonia Castro Oreiro&#44; Milagros Ricse Salcedo&#44; Mer&#231;e L&#243;pez de Recalde&#44; Helena Borrell Pa&#241;os&#44; Patricia Corzo Garc&#237;a&#44; Mar&#237;a Pascual Pastor and Fabiola Ojeda Morillo&#46;</p>"
            "etiqueta" => "Appendix A"
            "titulo" => "ONLY TOOLS Work Group"
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Brief Report
Development of a Checklist for Patients With Axial Spondyloarthritis and Psoriatic Arthritis in Daily Practice: ONLY TOOLS Project
Desarrollo de un cuadro de actuación para la evaluación de pacientes con espondiloartritis axial y artritis psoriásica en la práctica diaria: proyecto ONLY TOOLS
Raquel Almodovara, Juan C. Torre Alonsob, Enrique Batllec, Concepción Castillod, Eduardo Collantes-Esteveze, Eugenio de Miguelf, Senén Gonzálezg, Jordi Gratacósh, Azucena Hernándezi, Xavier Juanolaj, Luis F. Linaresk, Manuel J. Morenok, Mireia Morenoh, Victoria Navarro-Compánf, Carlos Rodríguez Lozanol, Jesus Sanzm, Agustí Sellasn, Estíbaliz Lozao,
Corresponding author
estibaliz.loza@inmusc.eu

Corresponding author.
, Pedro Zarcoa, the ONLY TOOLS working group 1
a Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
b Hospital Monte Naranco, Oviedo, Asturias, Spain
c Hospital Universitario Sant Joan d’Alacant, Sant Joan d’Alacant, Alicante, Spain
d Complejo Hospitalario Torrecárdenas, Almería, Spain
e Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Córdoba, Spain
f Hospital Universitario La Paz, Instituto de Investigación Hospital Universitario La Paz (IdiPaz), Madrid, Spain
g Hospital Universitario de Cabueñes, Gijón, Asturias, Spain
h Hospital Universitari Parc Taulí, Institut d’Investigació i Innovació Parc Taulí I3PT, UAB, Sabadell, Barcelona, Spain
i Hospital Virgen de la Salud, Toledo, Spain
j Hospital Universitario de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
k Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
l Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Las Palmas, Spain
m Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
n Hospital Universitari Vall d’Hebron, Barcelona, Spain
o Instituto de Salud Musculoesquelética, Madrid, Spain
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        "titulo" => "Desarrollo de un cuadro de actuaci&#243;n para la evaluaci&#243;n de pacientes con espondiloartritis axial y artritis psori&#225;sica en la pr&#225;ctica diaria&#58; proyecto ONLY TOOLS"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">In routine clinical practice&#44; it is recommended that patients with spondyloarthritis &#40;SpA&#41; be evaluated according to clinical signs&#44; symptoms and acute-phase reactants&#44;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">1&#44;2</span></a> for example the Bath Ankylosing Spondylitis Disease Activity Index&#44; C-reactive protein or the Ankylosing Spondylitis Disease Activity Score&#44; which combines the 2 aspects &#40;both subjective assessment of the patient and the acute-phase reactants&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">3</span></a> The same occurs with psoriatic arthritis &#40;PsA&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">However&#44; despite the availability of a number of Spanish and international guidelines for the evaluation of SpA including PsA&#44; the EmAR II study&#44; conducted in Spain&#44;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">4</span></a> demonstrated that&#44; in the assessment of SpA patients&#44; approximately 60&#37; of their medical records do not include an assessment of possible joint involvement or overall evaluation of the patient&#46; In 87&#37;&#44; no joint score is recorded and&#44; in 84&#37;&#44; there is no mention of a functional score&#46; Distinct factors may contribute to this situation&#46; At the present time&#44; there is great pressure on health professionals that does not favor the evaluation and systematic collection of data&#46; Moreover&#44; there is a great variability in the assessment variables recorded for these patients &#40;number&#44; characteristics&#44; feasibility&#44; validation&#44; etc&#46;&#41;&#46; This means that the outpatient follow-up of these individuals may not be optimal&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">These facts justify the need to design realistic strategies that contribute to improving the quality of clinical practice in order that these patients receive integrated care&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">4</span></a> On the basis of the above aspects&#44; the purpose of this project was to draw up a normalization tool &#40;a framework for action&#44; in the form of a checklist of items to be considered in visits to the rheumatologist&#44; for an adequate assessment of the patient&#41; to enhance the evaluation in routine practice of patients with axial SpA and PsA&#44; for the aim of standardizing and achieving a stricter control of the disease&#44; favoring the identification of high-risk factors and responses&#44; as well as control of comorbidities&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Study Design</span><p id="par0020" class="elsevierStylePara elsevierViewall">We designed a qualitative study based on the methodology of the nominal group and a review of the literature promoted by the Work Group for the Study of Spondyloarthritis of the Spanish Society of Rheumatology&#44; which comprises 2 projects&#58; <span class="elsevierStyleItalic">APROXIMA</span> &#40;&#8220;Approximate&#8221;&#41; and <span class="elsevierStyleItalic">PERSONALIZA</span> &#40;&#8220;Personalize&#8221;&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Participant Selection</span><p id="par0025" class="elsevierStylePara elsevierViewall">We selected a group of 18 experts &#40;with interest and demonstrated experience in the subject of the project&#41; from all the regions of Spain&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Drafting the Checklist</span><p id="par0030" class="elsevierStylePara elsevierViewall">We performed a literature review that included PubMed&#44; as well as Spanish and international guidelines and consensus documents&#46; For this&#44; we selected all of the variables employed for the evaluation of axial SpA and PsA patients &#40;sociodemographic&#44; clinical and treatment-related&#41;&#46; We then organized 2 focus groups&#44; 1 with rheumatologists &#40;to explore the barriers and facilitators in the management of patients with axial SpA and PsA&#44; as well as the most relevant aspects of their routine evaluation in the rheumatology department&#41; and another with patients &#40;to assess the needs that they detected in their visits to their physician&#44; so that they subsequently be evaluated by the experts&#41;&#46; The list of variables and the results of the focus groups were presented and discussed in a nominal group of experts&#44; which prepared a provisional list of variables&#44; both for the first visit and for successive appointments&#46; The experts the assessed each of these variables in terms of their&#58; &#40;1&#41; relevance &#40;impact on the patient&#44; decision making&#44; prognostic factor&#44; etc&#46;&#41; from 1 &#40;little relevant&#41; to 10 &#40;very relevant&#41;&#59; &#40;2&#41; feasibility in the outpatient office from 1 &#40;difficult to implement&#41; to 10 &#40;very feasible&#41;&#59; &#40;3&#41; periodicity of the evaluation&#59; and 4&#41; method&#47;s of measurement &#40;direct question&#44; questionnaire&#44; scale&#44; etc&#46;&#41;&#46; Once all the variables had been evaluated&#44; the experts selected them for inclusion in the first visit and for successive appointments &#40;together with their periodicity&#41; those that had achieved the best scores and that they considered important for the evaluation of these patients&#46; Next&#44; they defined&#58; &#40;1&#41; measures of excellence &#40;those that&#44; by taking into account the characteristics of routine clinical practice&#44; may be more complicated to measure&#41;&#59; variables considered prognostic factors&#44; on the basis of the literature&#59; &#40;3&#41; variables that predict the response to biological therapies&#44; according to published reports&#59; and 94&#41; common variables and those specific for axial SpA and PsA&#46; These specifications were included in the checklist&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Finally&#44; this checklist and its specifications were presented and analyzed in local meetings throughout Spain by an extensive and representative group of rheumatologists &#40;see ONLY TOOLS work group in <a class="elsevierStyleCrossRef" href="#sec0075">Appendix A</a>&#41;&#46; All of the recommendations proposed in these local meetings were conveyed to the experts&#44; who drafted the definitive checklist and specifications&#46; This entire process was done with the aid of methodological advice&#44; that helped both in the organization of the focus groups and in the subsequent discussion of the elements to be included in the checklist&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Statistical Analysis</span><p id="par0040" class="elsevierStylePara elsevierViewall">This analysis was based on a descriptive study&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Results</span><p id="par0045" class="elsevierStylePara elsevierViewall">We drafted a checklist to evaluate SpA patients&#44; with differentiated markers for patients with axial SpA and PsA&#44; and their periodicity&#44; as well as other specifications &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; It includes sociodemographic variables&#44; like the date of birth and sex &#40;risk factor for the risk of radiographic progression and a determinant of a good response to biological therapy&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">Concerning personal history&#44; we documented&#44; among other data&#44; allergies&#44; profession&#47;employment status and use of tobacco &#40;another risk factor affecting radiographic progression&#41;&#46; Likewise&#44; we recorded the date of symptom onset&#44; the date of the diagnosis&#44; related family history&#44; enthesitis&#44; dactylitis&#44; extra-articular manifestations and the presence of inflammatory lower back pain&#46; In the group of PsA patients&#44; we included peripheral involvement&#44; cutaneous symptoms and nail involvement&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">With respect to comorbidities&#44; we considered only those that had been diagnosed&#44; such as hypertension&#44; gastric ulcers and osteoporosis&#46; As biomarkers&#44; we included human leukocyte antigen &#40;HLA&#41; B27 and&#44; specifically&#44; in PsA&#44; rheumatoid factor and anti-cyclic citrullinated peptide antibodies&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">For patients with PsA&#44; the physical examination included a study of synovitis in an upper and a lower limb and dactylitis&#44; as well as a study of the skin and nails&#46; Those with axial SpA underwent examinations of hip mobility&#44; modified Sch&#246;ber test&#44; chest expansion and cervical rotation&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">On the other hand&#44; patient weight&#44; height&#44; body mass index&#44; abdominal circumference and arterial blood pressure should be determined yearly in PsA patients and&#44; as a measure of &#8220;excellence&#8221;&#44; in the case of those with SpA&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">With respect to clinical control&#44; for axial SpA&#44; the checklist includes the physician global assessment&#44; the Bath Ankylosing Spondylitis Functional Index and the Disease Activity Score in 28 joints in the case of polyarticular involvement&#44; aside from the Ankylosing Spondylitis Disease Activity Score and the Bath Ankylosing Spondylitis Disease Activity Index as determinants of a good response to biological therapy&#44; and the former&#44; moreover&#44; as a risk factor of radiographic progression&#46; In the case of PsA&#44; the patient global assessment and morning joint stiffness are also evaluated&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Ancillary tests that should be performed in the control of axial SpA are complete blood count&#44; erythrocyte sedimentation rate&#44; routine laboratory tests&#44; urinalysis and C-reactive protein &#40;a determining factor of a good response to biological therapy and of radiographic progression&#41;&#46; As a measure of excellence&#44; it was decided to include 25-OH vitamin D and bone densitometry&#46; In PsA patients&#44; urinary uric acid should also be determined and&#44; as a measure of excellence&#44; the lipid profile&#44; as well&#46; With regard to imaging studies&#44; plain radiography of the pelvis&#44; spine and sacroiliac joints &#40;and peripheral joints in patients with PsA&#41; helps to monitor risk factors for radiographic progression&#46; A radiograph of the pelvis enables a proper assessment of the sacroiliac joints and the hips&#44; making it unnecessary to X-ray these structures&#46; Magnetic resonance of the sacroiliac joints serves as a marker of radiographic progression&#44; and is also related to the response to biological therapy&#46; Thus&#44; the decision was made to include it&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Finally&#44; this checklist incorporates a section on treatments&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Discussion</span><p id="par0085" class="elsevierStylePara elsevierViewall">The work group for the study of SpA of the Spanish Society of Rheumatology has developed a practical and simple checklist&#44; achieved by consensus&#46; It is adapted to the characteristics of Spanish outpatient clinics&#44; and is based on a review of the literature and the opinion of experts for the assessment of patients with axial SpA and PsA in routine clinical practice&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">A number of studies have shown that adherence to the recommendations for the evaluation of patients with SpA and PsA is highly variable&#44; either because of a lack of time&#44; motivation or knowledge&#44; or because of the considerable number of the variables and their characterists&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">2&#44;5&#8211;8</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">In addition to standardizing routine clinical practice&#44; the drafting of this checklist was to facilitate the identification of different risk profiles in patients &#40;response to biological therapies&#44;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">9</span></a> radiographic progression&#44;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">10&#44;11</span></a>&#44; etc&#46;&#41; and aid in improving our approach to their comorbidities&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">12</span></a> With these &#8220;warning signs&#8221; the effort is made to stress the need for greater awareness and control in these patients&#46; It includes all the variables recommended in the Spanish and international guidelines and is presented in a simple form so that its use is feasible&#44; either printed out or incorporated into the electronic medical record&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">1&#44;2</span></a> Thus&#44; although these items are familiar to rheumatologists&#44; providing them in an orderly and accessible way that is easy to employ should be an incentive for its implementation&#46; This should contribute to a better control&#44; adaptation of the resources utilized and facilitation of an integrated management of complex patients and serve as a tool to resolve the detected needs&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">5</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">The project has several limitations&#46; For example&#44; a possible limitation could be derived from the representativeness of the panelists&#44; making it difficult to generalize and compare the suggested ideas&#46; To avoid these limitations&#44; we contacted rheumatologists from different centers in Spain to ensure demographic representativeness&#46; Another limitation could be derived from the election of the items included in the checklist&#59; although the failure to mention a relevant variable does not appear to be probable&#44; new ones can be defined during every patient visit&#46; We have not performed a real implementation of the checklist to determine whether or not its use is truly feasible and whether it enhances the care of patients with axial SpA&#44; but this will be the object of future projects&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">The design of a checklist as a tool for standardization might improve normalization and evaluation in the outpatient clinic&#46; It could lead to a stricter control of the disease&#44; identification of risk profiles and the control of comorbidities in routine clinical practice&#46; At the present time&#44; a project is underway for the introduction and assessment of the use of this checklist&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Ethical Disclosures</span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Protection of human and animal subjects</span><p id="par0110" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Confidentiality of data</span><p id="par0115" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Right to privacy and informed consent</span><p id="par0120" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Financing</span><p id="par0125" class="elsevierStylePara elsevierViewall">The project was financed by the <span class="elsevierStyleGrantSponsor" id="gs1">Spanish Foundation of Rheumatology</span>&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Conflict of Interest</span><p id="par0130" class="elsevierStylePara elsevierViewall">EL has received funding for research projects from AbbVie&#44; Roche&#44; MSD&#44; Pfizer&#44; Gebro&#44; UCB&#44; Gr&#252;nenthal&#44; Sobi&#44; Celgene and Eisai&#46; The remaining authors declare they have no conflicts of interest&#46;</p></span></span>"
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            0 => "Espondiloartritis axial"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To standardize clinical evaluation of patients with axial spondyloarthritis &#40;SpA&#41; and psoriatic arthritis &#40;PsA&#41; using a checklist&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Qualitative study that included&#58; &#40;1&#41; nominal group &#40;18 experts&#41;&#59; &#40;2&#41; literature reviews of measures used in the assessment of patients with axial SpA or PsA&#59; and &#40;3&#41; focus groups&#44; one with rheumatologists and another with patients&#44; organized to become familiar with their opinion on medical assistance&#46; Taking this into account&#44; the experts selected the measures to be included in the checklist based on their relevance&#44; feasibility&#44; and the outcome type&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The checklist includes measures for the evaluation of personal history&#44; physical examination&#44; activity and function&#44; laboratory tests&#44; imaging studies and treatments&#46; It also defines risk factors of radiographic progression&#44; predictors of the response to biological therapies&#44; and comprises measures of excellence&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">This checklist for patients with axial SpA and PsA could help standardize daily clinical practice and improve clinical management and patient prognosis&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Estandarizar la evaluaci&#243;n cl&#237;nica de pacientes con espondiloartritis &#40;EspA&#41; axial y artritis psori&#225;sica &#40;APs&#41;&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio cualitativo que incluy&#243;&#58; 1&#41; grupo nominal &#40;18 expertos&#41;&#59; 2&#41; revisi&#243;n de la literatura sobre variables empleadas en la evaluaci&#243;n de los pacientes con EspA axial o APs&#44; y 3&#41; grupo focal con reumat&#243;logos y otro con pacientes con EspA axial o APs para analizar la evaluaci&#243;n de las EspA en las consultas de reumatolog&#237;a&#46; Los expertos seleccionaron las variables a incluir en el cuadro de actuaci&#243;n con base en su relevancia&#44; factibilidad en consulta y m&#233;todo&#47;s de medici&#243;n&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">El cuadro de actuaci&#243;n incluye las variables para valorar antecedentes personales&#44; exploraci&#243;n f&#237;sica&#44; actividad y funci&#243;n&#44; pruebas complementarias y tratamientos&#46; Detalla factores de riesgo de progresi&#243;n radiogr&#225;fica&#44; factores predictores de respuesta a terapia biol&#243;gica&#44; e incluye variables de excelencia&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Este cuadro de actuaci&#243;n para pacientes con EspA axial y APs podr&#225; ayudar a homogeneizar la pr&#225;ctica cl&#237;nica diaria y a mejorar el manejo y el pron&#243;stico de estos pacientes&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Almodovar R&#44; Torre Alonso JC&#44; Batlle E&#44; Castillo C&#44; Collantes-Estevez E&#44; de Miguel E&#44; et al&#46; Desarrollo de un cuadro de actuaci&#243;n para la evaluaci&#243;n de pacientes con espondiloartritis axial y artritis psori&#225;sica en la pr&#225;ctica diaria&#58; proyecto ONLY TOOLS&#46; Reumatol Clin&#46; 2018&#59;14&#58;155&#8211;159&#46;</p>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">The names of the components of the ONLY TOOLS working group are available in <a class="elsevierStyleCrossRef" href="#sec0075">Appendix A</a>&#46;</p>"
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            "apendice" => "<p id="par0140" class="elsevierStylePara elsevierViewall">Carlos Faced Olmos&#44; Elia Valls Pascual&#44; Javier Calvo Catal&#225;&#44; Cristina Campos Fern&#225;ndez&#44; Amelia Rueda Cid&#44; Rosa Negueroles Albuixech&#44; Luis Gonz&#225;lez Puig&#44; Roxana Gonz&#225;lez Mazario&#44; M&#46; Teresa Buades Soriano&#44; Juan Antonio Castellano Cuesta&#44; Alejandra Begazo Cruz&#44; Juan Alberto Paz Solarte&#44; Jorge Fragio Gil&#44; Ana Urruticoechea Arana&#44; Teresa Font Gay&#225;&#44; Luis Espadaler Poch&#44; Inmaculada Ros Vilamaj&#243;&#44; Andr&#233;s Ponce Fern&#225;ndez&#44; Lourdes Mateo Soria&#44; Ana Laiz Alonso&#44; Patricia Moya Alvarado&#44; Jer&#243;nima Ca&#241;ellas Oliver&#44; Melania Mart&#237;nez Morillo&#44; Sandra Farietta Varela&#44; Meritxell Salles Lizarzaburu&#44; Mar&#237;a Bonet Llorach&#44; Estefan&#237;a Moreno Ruzafa&#44; Alba Erra Duran&#44; M&#46; Elena Mart&#237;nez Castro&#44; M&#46; Jos&#233; Gonz&#225;lez Fern&#225;ndez&#44; Marta Valls Roc&#44; Patricia Reyner Echevarria&#44; Eulalia de Cendra Morera&#44; Ram&#243;n Valls Garc&#237;a&#44; Juan de Dios Ca&#241;ete Crespillo&#44; Andres Cuervo Aguilera&#44; Silvia Mart&#237;nez Pardo&#44; Georgina Salvador Alarc&#243;n&#44; Carmen Garc&#237;a G&#243;mez&#44; Delia Reina&#44; Dolores Beteta Fern&#225;ndez&#44; M&#46; Roc&#237;o Gonz&#225;lez Molina&#44; Antonia Hern&#225;ndez Balibrea&#44; Javier Jos&#233; Mart&#237;nez Ferr&#237;n&#44; M&#46; Jos&#233; Moreno Mart&#237;nez&#44; Juan Moreno Morales&#44; M&#46; Rosario Oliva Ruiz&#44; Encarnaci&#243;n Pag&#225;n Garc&#237;a&#44; Deseada Palma S&#225;nchez&#44; Elena Pe&#241;as Mart&#237;nez&#44; M&#46; Francisca Pina P&#233;rez&#44; Fernando Jos&#233; Rodr&#237;guez Mart&#237;nez&#44; Encarnaci&#243;n Saiz Cuenca&#44; Edgar Enrique Soriano Navarro&#44; Esther Toledano Mart&#237;nez&#44; M&#46; Concepci&#243;n Morado Qui&#241;oa&#44; Javier Quir&#243;s Donate&#44;&#160;Alberto Diaz Oca&#44; Alicia Humbr&#237;a&#44; Marta Valero Exp&#243;sito&#44; Carmen de la Cruz Tapiador&#44; M&#46; Teresa Gonzalez Hernandez&#44; Javier Rivera Redondo&#44;&#160;M&#46; Hildegarda Godoy Tundidor&#44; Carmen Barbadillo Mateo&#44;&#160;Laura Cebri&#225;n M&#233;ndez&#44; Leticia Lojo Oliveira&#44; Beatriz Joven&#44; M&#46; Cruz Fern&#225;ndez Espartero&#44; Mar&#237;a Ahij&#243;n Lana&#44; Alejandro Jes&#250;s Gonz&#225;lez Guti&#233;rrez&#44; Cristina Redondo Romero&#44; Bryan Josue Flores Robles&#44; Julia Mart&#237;nez Barrio&#44; Cristina Fern&#225;ndez Carballido&#44; Vega Jovani Casano&#44; Teresa Pedraz Penalva&#44; Cintia Romera L&#243;pez&#44; Gregorio Santos Soler&#44; Mariano Andr&#233;s Collado&#44; Jos&#233; Antonio Bernal Vidal&#44; Ra&#250;l Noguera Pons&#44; Gaspar Panadero Tendero&#44; Elisa Trujillo Mart&#237;n&#44; Juan Jos&#233; Bethencourt Baute&#44; M&#46; Vanesa Hern&#225;ndez Hern&#225;ndez&#44; Iv&#225;n Alejandro Ferraz Amaro&#44; M&#46; Garc&#237;a Gonz&#225;lez&#44; Esmeralda Delgado Fr&#237;as&#44; Beatriz Tejera Segura&#44; M&#46; &#193;ngeles Gantes Mora&#44; Lorena Exp&#243;sito P&#233;rez&#44; Valeriano Miguel Flores Rodr&#237;guez&#44; F&#225;tima &#193;lvarez Reyes&#44; Cristina Luna G&#243;mez&#44; Laura Magdalena Armas&#44; Laura Casas Hern&#225;ndez&#44; Aaron Fari&#241;a Gonz&#225;lez&#44; Luis Coronel Taranc&#243;n&#44; Jos&#233; Luis &#193;lvarez Vega&#44; Ra&#250;l Veroz Gonz&#225;lez&#44; Juan Jos&#233; Aznar S&#225;nchez&#44; Jos&#233; Garc&#237;a Tor&#243;n&#44; Esther del Rinc&#243;n Padilla&#44; Puerto Moreno Gil&#44; Fernando Gamero Ru&#237;z&#44; Antonio Cardenal Escarcena&#44; Antonia Ferreiro Conejo&#44; Piter Jos&#233; Cossio Jim&#233;nez&#44; Sara M&#46; Rojas Herrera&#44; Manuel Fern&#225;ndez Prada&#44; Jos&#233; Rey Rey&#44; Sim&#243;n S&#225;nchez Fern&#225;ndez&#44; Jimena Zalazar&#44; Andr&#233;s Ariza Hern&#225;ndez&#44; Rebeca Belmonte G&#243;mez&#44; Pastora Granados Bautista&#44; &#193;ngel Garc&#237;a Aparicio&#44; David Castro Corredor&#44; Carmen Amelia Ordas Calvo&#44; Jes&#250;s Babio Herr&#225;iz&#44; M&#46; Edilia Garc&#237;a Fern&#225;ndez&#44; M&#46; Trinidad P&#233;rez Sandoval&#44; Carolina &#193;lvarez Castro&#44; M&#46; Elvira D&#237;ez &#193;lvarez&#44; Alejandra L&#243;pez Robles&#44; Clara Moriano Morales&#44; Miriam Retuerto Guerrero&#44; Marta Garijo Bufort&#44; Luc&#237;a Pantoja Zarza&#44; M&#46; Carolina D&#237;ez Morrondo&#44; I&#241;igo Hern&#225;ndez Rodr&#237;guez&#44; Luis Fern&#225;ndez Rodr&#237;guez&#44; Jos&#233; Antonio Pinto Tasende&#44; Ceferino Barbaz&#225;n &#193;lvarez&#44; Francisco Maceiras Pan&#44; Marina Rodr&#237;guez L&#243;pez&#44; Jos&#233; M&#46; Pego Reigosa&#44; Jes&#250;s Ib&#225;&#241;ez Ruan&#44; Rafael Melero Gonz&#225;lez&#44; Susana Romero Yuste&#44; Jos&#233; Antonio Mosquera Mart&#237;nez&#44; Manuel Rodr&#237;guez G&#243;mez&#44; Jos&#233; Luis Ferreiro Seoane&#44; Antonio Fern&#225;ndez Nebro&#44; Jos&#233; Javier P&#233;rez Venegas&#44; Francisco Gabriel Jim&#233;nez Nu&#241;ez&#44; Carmen Castro Villegas&#44; Yolanda Cabello Fern&#225;ndez&#44; Carmen Romero Barco&#44; M&#46; del Carmen Ord&#243;nez Ca&#241;izares&#44; Inmaculada Ure&#241;a Garnica&#44; M&#46; Victoria Irigoyen Oyarzabal&#44; Angelines Belmonte L&#243;pez&#44; Virginia Coret Cagigal&#44; Concepci&#243;n Aranda Varela&#44; Marta Rojas Jim&#233;nez&#44; Clara Cienfuegos Garc&#237;a&#44; Antonio Ponce Vargas&#44; Concepci&#243;n Castillo Gallego&#44; Montserrat G&#243;mez Romero&#44; Jerusal&#233;n Calvo Guti&#233;rrez&#44; Pilar Font Ugalde&#44; Rafaela Ortega Castro&#44; Clementina L&#243;pez Medina&#44; Laura Bautista Aguilar&#44; Clara Ojeda Garc&#237;a&#44; Isabel Garc&#237;a Hern&#225;ndez&#44; Carmen Vargas Lebr&#243;n&#44; Julio Garc&#237;a Feito&#44; Juan Salvatierra Ossorio&#44; Pilar Morales Garrido&#44; Inmaculada Jim&#233;nez Mole&#243;n&#44; Mar L&#243;pez-Ib&#225;&#241;ez&#44; Antonio Garc&#237;a S&#225;nchez&#44; Susana Quirosa Flores&#44; Teresa Garc&#237;a Contreras&#44; Alfonso Gonz&#225;lez Utrilla&#44; Antonio Romero P&#233;rez&#44; Irati Urionaguena Onaindia&#44; Ioana Atxotegi Saez de Buruaga&#44; M&#46; Luz Garc&#237;a Vivar&#44; Eva Gal&#237;ndez Agirregoikoa&#44; M&#46; Elena Garmendia S&#225;nchez&#44; Jos&#233; Francisco Garc&#237;a Llorente&#44; Rosa M&#46; Morla Novell&#44; Jes&#250;s Rodr&#237;guez Moreno&#44; Mar&#237;a Aparicio Espinar&#44; Elena Sirvent Alierta&#44; Sonia Castro Oreiro&#44; Milagros Ricse Salcedo&#44; Mer&#231;e L&#243;pez de Recalde&#44; Helena Borrell Pa&#241;os&#44; Patricia Corzo Garc&#237;a&#44; Mar&#237;a Pascual Pastor and Fabiola Ojeda Morillo&#46;</p>"
            "etiqueta" => "Appendix A"
            "titulo" => "ONLY TOOLS Work Group"
            "identificador" => "sec0075"
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Article information
ISSN: 21735743
Original language: English
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