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Este capítulo se centra en intentar revisar y desarrollar de forma esquemática lo que refleja el título: ¿cuál es o debe ser el papel del médico de familia en el control y seguimiento del paciente con artritis reumatoide en tratamiento con sarilumab?, dado que tanto las indicaciones actualizadas del tratamiento, dosis, pautas de utilización y otras características del tratamiento ya se han abordado de forma exhaustiva en los capítulos anteriores. Las terapias biológicas son ya una realidad imparable en el abordaje terapéutico de múltiples enfermedades, entre ellas las enfermedades reumatológicas, lo que supone una gran innovación terapéutica en el presente, pero con una gran potencialidad de desarrollo e implantación en un futuro inmediato. Por ello, el médico de familia no solo no debe permanecer al margen de esta corriente de tratamiento con terapias biológicas, sino que debe incorporarse a ella, adquirir y mantener actualizados los conocimiento de todos los aspectos relacionados con el correcto control y administración de la medicación por parte del paciente (en este caso el sarilumab), valorar la presencia de comorbilidades, polifarmacia y posibles interacciones, realizar una detección precoz de aparición de efectos adversos, hacer un seguimiento del grado de adherencia y cumplimiento del tratamiento, etc. Todo ello redundará en una mayor eficacia y seguridad del tratamiento y en lo que se puede definir como una mayor calidad asistencial al paciente con artritis reumatoide

In this article, we focus on schematically reviewing and developing the topic: What should the role of general practitioners (GPs) be in monitoring patients with rheumatoid arthritis (RA) treated with sarilumab? Updated treatment indications, doses, indications for use, and other characteristics of treatment have been exhaustively addressed in previous articles. Biological therapies are a reality that cannot be ignored in the therapeutic approach to several diseases, including rheumatic diseases. This represents a significant therapeutic innovation in the present as well as strong potential for development and implementation in the immediate future. Consequently, GPs should tend towards treatment with biological therapies, including them in their therapeutic resources. They should therefore become familiar with every aspect concerning the correct management and administration of the patient's medication (in this case sarilumab) and remain up-to-date on the topic. Furthermore, they should also evaluate the presence of comorbidities, polypharmacy, and possible interactions through early detection of adverse reactions and monitoring the degree of treatment adherence, etc. Overall, all of this enhances the efficacy and safety of the treatment, resulting in a higher quality of care for patients with rheumatoid arthritis

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Ante un paciente en tratamiento con metotrexato, desde la consulta del médico de familia se debe contemplar no solo una atención puntual frente a un problema aislado con su medicación o con su enfermedad, sino que se deben desarrollar actividades que abarquen e integren dimensiones como la promoción de la salud, la educación sanitaria, la prevención de la enfermedad y la atención sanitaria accesible y continuada. Se podrían resumir de una forma esquemática cuáles serían las actividades básicas a desarrollar desde la consulta del médico de familia: 1) detección y registro codificado de los pacientes en tratamiento con metotrexato; 2) administración de la medicación según protocolos establecidos; 3) seguimiento del paciente con un plan de carácter individualizado, adaptado a las necesidades de cada caso, con 3 objetivos fundamentales: detección precoz de complicaciones, control del tratamiento (pauta de administración, grado de adherencia, educación, información, autocuidados), y actividades de seguimiento y control planificadas (AU)

In patients receiving methotrexate, the activities carried out by family physicians should not only include the provision of periodic attention when there is a problem with their medication or disease but should also include dimensions such as health promotion and education, disease prevention, and continued and accessible healthcare. The basic activities that should be provided by family physicians can be summarised as follows: 1) detection and anonymised registration of patients under methotrexate therapy; 2) drug administration following established protocols; 3) individualised follow-up adapted to the needs of each patient. The latter activity has three main goals: early detection of complications, treatment monitoring (dosing schedule, degree of adherence, education, information, self-care) and scheduled follow-up (AU)

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Objetivos: Evaluar si una intervención aplicada a médicos de familia para evitar la inercia clínica tuvo un impacto en el dolor, funcionalidad y calidad de vida relacionada con la salud (CVRS) de los pacientes con artritis de cadera y/o rodilla. Diseño: Estudio de grupos paralelos de cluster, multicéntrico, prospectivo, aleatorizado. Los médicos fueron asignados a 2 grupos, el grupo 1 recibió una sesión de entrenamiento, el grupo 2, no. Emplazamiento: Centros de salud representativos del territorio español. Participantes: Médicos de familia de 329 centros de salud. Intervenciones: Consistieron en una sesión motivadora para proponer una atención proactiva, basada en recomendaciones actualizadas. Mediciones principales: Escala analógica visual (EVA); funcionalidad (escala WOMAC) y percepción global de salud mediante SF-12 en 2 visitas separadas por 6 meses. Resultados: Participaron 1.361 médicos y 4.076 pacientes. No se observaron diferencias significativas en el beneficio clínico obtenido entre los pacientes asignados al grupo 1 y grupo 2. Sin embargo, se observó una mejora significativa en la población total (grupos 1 + 2) en la EVA (p<0,001), WOMAC (p<0,0001) y el SF-12V2 (p<0,001) en la visita 2 en comparación con la visita 1. Conclusiones: Esta intervención sobre médicos de familia no proporcionó un beneficio clínico adicional a los pacientes. Se observó en ambos grupos una mayor conciencia de la enfermedad del paciente por el uso novedoso de índices de funcionalidad y CVRS, que parece mejorar el dolor percibido, la funcionalidad y la calidad de vida relacionada con la salud(AU)

Objectives: Evaluate whether an intervention applied to general practitioners to prevent clinical inertia had an impact on pain, functionality, and health-related quality of life (HRQoL) of patients with hip and/or knee osteoarthritis. Design: This was a cluster-based, multicentre, prospective, randomized, parallel-group study. Clusters of physicians working were assigned to one of two study groups. Physicians in Group 1 received a training session while those in Group 2 did not. Setting: Primary Care Health centers representative of the entire Spanish territory. Participants: 329 general practitioners of primary healthcare centre. Interventions: The intervention consists of a motivational session to propose a proactive care, based on current recommendations. Measurements: Visual analogue scale (VAS); functionality (WOMAC scale) and global perception of health by SF-12. Effects were measured in two visits six months apart. Results: A total of 1361 physicians, and 4076 patients participated in the study. No significant differences were observed in the clinical benefit obtained between patients assigned to Group 1 and Group 2. Nevertheless, a significant improvement was observed in the combined population (Groups 1 + 2) in the VAS (p<0.001), WOMAC (p<0.0001) and SF-12v2 (p<0.001) questionnaires in Visit 2 compared to Visit 1. Conclusions: The results indicate that, although this specific intervention carried out on physicians did not provide an additional clinical benefit to patients with knee and/or hip osteoarthritis, an increased awareness of the patient's disease through the use of functionality indexes, as well as the mere fact of being observed, seem to improve patient-reported pain, functionality and HRQoL(AU)

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OBJECTIVES: Evaluate whether an intervention applied to general practitioners to prevent clinical inertia had an impact on pain, functionality, and health-related quality of life (HRQoL) of patients with hip and/or knee osteoarthritis. DESIGN: This was a cluster-based, multicentre, prospective, randomized, parallel-group study. Clusters of physicians working were assigned to one of two study groups. Physicians in Group 1 received a training session while those in Group 2 did not. SETTING: Primary Care Health centers representative of the entire Spanish territory. PARTICIPANTS: 329 general practitioners of primary healthcare centre. INTERVENTIONS: The intervention consists of a motivational session to propose a proactive care, based on current recommendations. MEASUREMENTS: Visual analogue scale (VAS); functionality (WOMAC scale) and global perception of health by SF-12. Effects were measured in two visits six months apart. RESULTS: A total of 1361 physicians, and 4076 patients participated in the study. No significant differences were observed in the clinical benefit obtained between patients assigned to Group 1 and Group 2. Nevertheless, a significant improvement was observed in the combined population (Groups 1 + 2) in the VAS (p<0.001), WOMAC (p<0.0001) and SF-12v2 (p<0.001) questionnaires in Visit 2 compared to Visit 1. CONCLUSIONS: The results indicate that, although this specific intervention carried out on physicians did not provide an additional clinical benefit to patients with knee and/or hip osteoarthritis, an increased awareness of the patient's disease through the use of functionality indexes, as well as the mere fact of being observed, seem to improve patient-reported pain, functionality and HRQoL.

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OBJECTIVES: The aims of this paper are to generate estimates of the association between the severity and frequency of pain in Spain and (i) labor force participation and workforce status and (ii) patterns of absenteeism and presenteeism for the employed workforce. METHODS: Data are from the internet-based 2010 National Health and Wellness Survey (NHWS). This survey covers both those who report experiencing pain in the last month as well as the no-pain population. An estimated 17.25% of adults in Spain report experiencing pain in the past month. A series of regression models are developed with the no-pain group as the reference category. The impact of pain, categorized by severity and frequency, is assessed within a labor supply framework for (i) labor force participation and (ii) absenteeism and presenteeism. Both binomial and multinomial logistic models are estimated. RESULTS: The results demonstrate that severe and moderate pain has a significant, substantive, and negative association with labor force participation and, together with the experience of mild pain, a substantive impact on absenteeism and presenteeism within the employed workforce. Compared to no-pain controls, the strongest association is seen in the case of severe pain, notably severe daily pain and labor force participation (odds ratio 0.363; 95% CI: 0.206-0.637). The association of severe pain with labor force participation is also significant (odds ratio 0.356; 95% CI: 0.217-0.585). There is a clear gradient in the association of pain severity and frequency with labor force participation. The impact of pain is far greater than the potential impact of other health status measures (e.g., chronic comorbidities and BMI). Labor force participation is also adversely associated with pain experience. Persons reporting severe daily pain are far more likely not to be in the labor force (relative probabilities 0.339 vs 0.611). The experience of pain, notably severe and frequent pain, also outstrips the impact of other health status factors in absenteeism and presenteeism. In the former case, the odds ratio associated with severe daily pain is 16.216 (95% CI: 5.127-51.283), which contrasts to the odds ratio for the Charlson comorbidity index of 1.460 (95%CI: 1.279-1.666). Similar results hold for presenteeism. The contribution of moderate and mild pain to absenteeism and presenteeism is more marked than for labor force participation. CONCLUSIONS: The experience of pain, in particular severe daily pain, has a substantial negative impact both on labor force participation in Spain as well as reported absenteeism and presenteeism. As a measure of health status, it clearly has an impact that outstrips other health status measures. Whether or not pain is considered as a disease in its own right, the experience of chronic pain, as defined here, presents policy-makers with a major challenge. Programs to relieve the burden of pain in the community clearly have the potential for substantial benefits from societal, individual, and employer perspectives.

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