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RESUMEN Introducción: El uso de TNFi es cada vez más frecuente en los pacientes con espondiloartritis. Identificar tempranamente aquellos que los requerirán o poder predecir su uso puede ayudar a hacer un tratamiento más efectivo y oportuno racionalizando su uso. Objetivo: Determinar los factores qué mejor explican la indicación de TNFi en la población en estudio. Material y métodos: La asociación entre el uso de medicamentos anti-TNFα y las variables categóricas demográficas, clínicas, de laboratorio, radiológicas y de tratamiento se exploró por prueba exacta de Fisher. La asociación con las variables cuantitativas fue evaluada con t de Student o U de Mann Withney, de acuerdo con su distribución. Aquellas variables con p < 0,25 fueron ingresadas a modelos univariante de regresión logística explicativa para construir los OR crudos; aquellas con p < 0,25 se incluyeron en el modelo multivariante para construir OR ajustados. Resultados y discusión: La población está constituida por 181 pacientes. Modelo univariante: la artritis reactiva, uretritis y compromiso periférico fueron factores protectores para el uso de TNFi. Espondiloartritis axial, lumbalgia inflamatoria, dolor glúteo alternante, rigidez matinal sacroilitis demostrada por cualquier método, tratamiento con inhibidores COX-2, tiempo de evolución de tres arios o más y los puntajes de BASDAI y BASFI se asociaron con el uso de TNFi. Modelo multivariante: artritis reactiva (OR 0,1, IC 95% 0,012-0,86, p = 0,036), lumbalgia inflamatoria (OR 13,63, IC 95% 1,36-136, p = 0,026), sacroilitis (OR 7,71, IC 95% 1,04-57, p = 0,045, uso de coxib (OR 10,1, IC 95% 2,71-37,62, p = 0,001) y el puntaje máximo de BASDAI (4-6: OR 6,1, IC 95% 1,3-28,7, p = 0,022, mayor de 6: OR 15,8, IC 95% 2,2-113, p = 0,006) se asociaron independientemente con el uso de TNFi. El uso de coxib se asoció con la indicación de usar TNFi tanto en los pacientes con espondiloartritis axial (OR 4,2, IC 95% 1,74-10,11, p = 0,001) como periférica (OR 4, IC 95% 1,85-8,62, p < 0,001). Conclusiones: El inicio de la enfermedad en la forma de artritis reactiva se comportó como un factor protector para la necesidad posterior de usar TNFi, mientras que presentar lumbalgia inflamatoria, sacroilitis demostrada por cualquier método, el tratamiento con coxib y el puntaje máximo de BASDAI mayor de 4 se asociaron con el uso de estos medicamentos.
ABSTRACT Introduction: The use of tumor necrosis factor (TNF) alpha inhibitors is increasing in patients with spondyloarthritis. Early identification of those that would require them, or the ability to predict their use, could lead to a more effective and timely treatment by rationalizing their use. Objective: To determine factors that better explain the indication of TNFi in the study population. Material and methods: The association between anti-TNFα use and categorical demographic, clinical, laboratory, radiological and treatment variables was explored using Pearson's Chi2 or Fisher's exact test. The association with the quantitative variables was evaluated using Student's t test or Mann Whitney U test, depending on their distribution. Those variables with P < 0.25 were entered into univariate models of explanatory logistic regression to cons truct crude ORs, and those with P < 0.25 were included in the multivariate model to construct adjusted ORs. Results and discussion: The study population includes 181 patients. In the univariate model: reactive arthritis, urethritis, and peripheral involvement were protective factors for the use of TNFi. Axial spondyloarthritis, inflammatory lumbalgia, alternating gluteal pain, morning stiffness, sacroiliitis demonstrated by any method, treatment with COX-2 inhibitors, evolu tion time of three years or more, and BASDAI and BASFI scores were associated with the use of TNFi. Multivariate model: reactive arthritis (P = 0.036), inflammatory back pain (P = 0.026), sacroiliitis (P = 0.045), use of coxibs (P = 0.001) and the maximum score of BASDAI (P = 0.022, P = 0.006) were independently associated with the use of TNFi. The use of coxibs was associa ted with the indication of using TNFi in both patients with axial spondyloarthritis (P = 0.001) and peripheral (P < 0.001). Conclusions: The onset of the disease in the form of reactive arthritis behaved as a protective factor for the subsequent need to use TNFi, while presenting with inflammatory back pain, sacroiliitis, demonstrated by any method, treatment with coxibs, and the maximum score of BASDAI greater than 4 associated with the use of these medications.
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Humanos , Adulto , Doenças Ósseas , Doenças Musculoesqueléticas , EspondilartriteRESUMO
INTRODUCTION: Spondyloarthropathies (SpA) are disabling diseases with a prevalence of 1.9% in the general population. The indices designed for monitoring the disease should be valid, reliable and cross-culturally adapted for decision-making concerning the appropriate treatment. Changing an adjective or pronoun in a self-administered questionnaire could be the big difference in condensing an idea in a few words and transmitting that concept to all those who share the same language. OBJECTIVES: To develop a Venezuelan version of the original English version of the BASDAI/BASFI and to evaluate its reliability and validity in Venezuelan patients with SpA. METHODS: Certified linguists were needed for the translation of a Venezuelan version of the BASDAI/BASFI. The evaluation of reliability and validity was performed by calculating correlation coefficients in addition to Cronbach's alpha correlation between the BASDAI score and the clinical parameters (for example: erythrocyte sedimentation rate, C-reactive protein, modified Schöber test, occiput-to-wall distance and enthesis count). RESULTS: We studied 40 patients including 31 men (77.5%) and 9 women (22.5%). The mean age was 35.9 years ± standard deviation (SD) 12.01 and the disease duration was 11.5 years (± SD 9.5). The most common diagnoses were undifferentiated spondyloarthritis (45%), ankylosing spondylitis (27.5%) and psoriatic arthritis (20%). The incidences of reactive arthritis, ankylosing spondylitis and juvenile Reiter's syndrome were 2.5% each. The test-retest reliability of the BASDAI and BASFI was high (R = 0.99 and 0.99, respectively; P<.0001). The internal consistency for the BASDAI was high (Cronbach's alpha = 0.88; P=.002) and the intraclass correlation coefficient for internal consistency: 0.9867 (P=.001). Internal consistency for the BASFI: Cronbach's alpha = 0.7985 (P=.002), intraclass correlation coefficient for internal consistency: 0.9055 (P=.001). Construct validity of the BASDAI was high for general well-being of the patient (R = 0.84) and for enthesis count (R = 0.84). Low back pain showed moderate correlation with BASDAI (R = 0.69; P<.0001) and the erythrocyte sedimentation rate showed a low correlation (R = 0.39683; P=.0112). CONCLUSION: The Venezuelan version of the BASDAI/BASFI could be used in clinical research to assess and evaluate the course of disease activity in Venezuelan SpA patients.
Assuntos
Atividades Cotidianas , Autoavaliação Diagnóstica , Espondilite Anquilosante/diagnóstico , Espondilite Anquilosante/fisiopatologia , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Traduções , Venezuela , Adulto JovemRESUMO
OBJETIVO: Conduzir uma adaptação cultural cruzada do Índice Funcional de Espondilite Anquilosante de Bath (BASFI, Bath Ankylosing Spondylitis Functional Index) para o português do Brasil e avaliar suas propriedades de medição. MéTODOS: O BASFI foi traduzido por quatro reumatologistas e três professores de língua inglesa. O questionário traduzido foi aplicado a pacientes com espondilite anquilosante por observadores treinados e autoaplicado em três momentos, dias 1, 2 e 14. A validade foi estimada analisando-se a associação do BASFI e as medidas de capacidade funcional (rotação cervical, distância intermaleolar, teste de Schober e distância occipito-parede). A consistência interna foi testada pelo coeficiente α de Cronbach, e a confiabilidade pelo teste-reteste (coeficiente de correlação intraclasse [CCI]). RESULTADOS: Foram incluídos 60 pacientes com espondilite anquilosante: 85% do gênero masculino, com idade média de 47 ± 12 anos e duração média da doença de 20 ± 11 anos. A confiabilidade intraobservador no teste-reteste (intervalo de duas semanas) revelou alto ICC (0,999; 95% IC: 0,997-0,999), além de alta consistência interna (coeficiente α de Cronbach: 0,86; 95% IC: 0,80-0,90). Considerando-se a validade, os índices do BASFI foram correlacionados com a rotação cervical (0,53; P < 0,001) e a distância intermaleolar (0,50; P < 0,001). CONCLUSÃO: A versão do BASFI para o português do Brasil é confiável e válida para avaliação de pacientes com espondilite anquilosante.
OBJECTIVE: To conduct a cross-cultural adaptation of the Bath Ankylosing Spondylitis Functional Index (BASFI) into Brazilian-Portuguese language and to assess its measurement properties. METHODS: The BASFI was translated by four rheumatologists and three English teachers. The translated questionnaire was applied to ankylosing spondylitis patients by trained observers, and self-administered in three moments: days 1, 2, and 14. The validity was assessed analyzing the association of BASFI and functional capacity measures (cervical rotation, intermalleolar distance, Schober's test and occiput-to-wall distance). The internal consistence was tested by Cronbach's αcoefficient and the reliability by testretest (intraclass correlation coefficient - ICC). RESULTS: A total of 60 patients with ankylosing spondylitis was included: 85% male, mean age 47 ± 12 years, and mean disease duration 20 ± 11 years. The intra-observer test-retest (two-week interval) reliability showed a high ICC (0.999, 95% CI: 0.997-0.999) and a high internal consistency (Cronbach's α coefficient: 0.86, CI 95%: 0.80-0.90). Considering the validity, the BASFI indices were correlated with cervical rotation (0.53, P < 0.001) and with intermalleolar distance (0.50, P < 0.001). CONCLUSION: The BASFI Brazilian-Portuguese version is reliable and valid for assessment of patients with ankylosing spondylitis.