OBJECTIVES:Juvenile idiopathic arthritis (JIA) leads to significant long-term morbidity from articular and extra-articular complications, yet the burden of comorbidities in adults with long-standing disease is not well characterised. This study aimed to determine the prevalence and incidence of key comorbidities in adults with JIA and assess their association with demographic and clinical features. METHODS:We performed a national multicentre retrospective cohort study using data from adults with JIA, defined by the 2001 ILAR criteria, enrolled in the Portuguese Rheumatic Diseases Register (Reuma.pt). Demographic and clinical data, along with comorbidities, were collected. Comorbidities included cardiovascular disease, hypertension, dyslipidaemia, diabetes, thyroid disease, amyloidosis, inflammatory bowel disease, allergy and asthma, osteoporosis, psychiatric disease, and autoimmune disease. Rare conditions were grouped into broader categories. Extra-articular JIA manifestations were excluded. Incidence rates were calculated as the number of new events per 1,000 person-years (95% CI), and prevalence was assessed using frequencies. RESULTS:The cohort included 748 patients, 65.6% female, with a median age of 27.7 years and a median disease duration of 20.6 years. Oligoarticular JIA was the most common subtype (29.9%). Autoimmune diseases had the highest incidence rate (7.1/1,000 person-years), followed by hypertension (5.1/1,000 person-years) and psychiatric disease (4.0/1,000 person-years). Hypertension (9%), psychiatric disease (8%), and osteoporosis (5%) were the most prevalent comorbidities. Biologic DMARD use was associated with reduced risk of psychiatric disease (OR=0.38, p=0.03), and no significant association with malignancy or infection was found. CONCLUSIONS:JIA patients with long-standing disease frequently develop comorbidities, particularly hypertension. Biologic therapy seems to reduce the risk of comorbidities. Long-term monitoring of comorbidities in JIA patients is paramount.
Objective: To determine the proportion of axial psoriatic arthritis (axPsA), describe how it is diagnosed in clinical practice, and identify clinical and demographic characteristics independently associated with axPsA. Methods : A multicentre retrospective observational study was conducted using data from patients registered in the Rheumatic Diseases Portuguese Registry (Reuma.pt) with a diagnosis of PsA or spondyloarthritis with psoriasis. Peripheral involvement was defined as the presence of peripheral joint disease. Axial involvement was defined by the presence of physician-reported spondylitis and/or imaging findings suggestive of axial disease. Patients were divided into four non-exclusive groups: axPsA, axial involvement with or without peripheral joint disease; ax-PsA_only, axial involvement exclusively; peripheral PsA (pPsA)_only, peripheral joint disease, without axial involvement; pPsA, peripheral joint disease with or without axial disease. Results : This study included 2,304 patients. axPsA was present in 37.1% of patients and axPsA_only in 8.1%. The diagnosis was made based on suggestive imaging findings in 30.1%, and on physician judgement in 69.9%. axPsA was independently associated with HLA-B27 positivity (odds ratio [OR]=2.90; p<0.001), enthesitis (OR=1.64; p<0.001), and younger age at symptom onset (OR=0.97; p<0.001); pPsA_only with dactylitis (OR=1.89; p<0.001) and nail dystrophy (OR=1.42; p=0.010). axPsA_only was independently associated HLA-B27 positivity (OR=3.35; p<0.001) and uveitis (OR=2.56; p=0.004); pPsA with nail dystrophy (OR=2.11; p=0.002), dactylitis (OR=18.18; p<0.001), and enthesitis (OR=1.74; p=0.031). Conclusion : Axial involvement is present in over one-third of PsA patients, often in association with peripheral joint disease. ax-PsA patients demonstrate distinct clinical and demographic characteristics compared to those without axial disease.
Background Olea (olive) is an economically important tree species, and its pollen allergens are the most common cause of pollen sensitization and allergic disease in Mediterranean Europe. This study aims to examine temporal variations in airborne Olea pollen in the Alentejo Region, Southern Portugal, and its agronomic, environmental and clinical implications. Method Daily average airborne Olea pollen concentrations, meteorological data and agronomic data from Alentejo (2001–2021) were used. Results The amount of airborne Olea pollen recorded annually increased significantly over the study period. There were also significant increases in peak values and duration of the Olea pollen season, as well as the number of days above the thresholds of 50, 100 and 200 Olea pollen grains /m 3 that are deemed sufficient to trigger symptoms of pollen allergy in susceptible individuals. Atmospheric concentrations of Olea pollen recorded in Évora have seen simultaneous increases in olive production, and statistically significant correlations (p < 0.001) exist between airborne Olea pollen levels and the quantity of olive fruit and olive oil produced in Alentejo during the period 2001–2021. Conclusion This is the first time that the phenology of olive trees, in the form of temporal changes in airborne pollen, has been related to the amount of olive fruit and olive oil produced in Alentejo in Portugal. The modernization of agricultural production systems and improvements to irrigation have led to increases in olive pollen, olive fruit and olive oil produced in the region. These changes are reflected in increased airborne concentrations of Olea pollen in Évora, and a subsequent increase in the allergenic risk to the sensitized population.
Aims: Telemedicine used in nephrology has demonstrated non-inferiority to traditional care and acceptance by healthcare professionals and patients; however, cost effectiveness was less commonly reported. We aim to describe our centre's experience with virtual consultations (VCs) and estimate cost reduction, as well as assess general practitioners’ (GPs) perspectives. Methods: Retrospective study of the patients referred for VC between January 2020 and December 2022 at Unidade Local de Saúde de Santo António (ULSSA). We analyzed patients’ demographics, including distance to hospital and autonomy, and estimated economic savings related to nephrologist's time, patient transport and lost workdays. To assess GPs’ perspective, we administered a brief, closed-question survey to GPs to assess awareness, use, and satisfaction with VCs. Results: A total of 456 patients were included, of which 260 (57%) were female and median age was 80 years old (IQR 72–87). Distance from the hospital varied between one and 540 km, with a median distance of 16 km (IQR 6–19). Estimated total savings were €16,697.89, equivalent to €36.62 per patient per consult. The nephrologist time cost was estimated at €966.11 for virtual consultations compared with €3622.92 for initial face-to-face consultations, resulting in a time-related cost reduction of €2656.81. Forty-seven GPs of a total of 236 GPs (20%) completed the survey; from the responders, 28% had used VCs and 77% reported satisfaction with the response. Prescription guidance was the most identified strength of VC. Lack of awareness was the main barrier to use. Conclusions: In this single-center experience, VCs reduced costs and travel burden while being acceptable to GPs. However, many GPs were unaware of this pathway, underscoring the need for promotion and integration in primary-care workflows. Future multicentre studies should evaluate clinical outcomes including avoidable face-to-face visits, hospitalizations, time to advice) and include patient and nephrologist perspective. Resumen: Objetivos: La telemedicina utilizada en nefrología ha demostrado no inferioridad a la atención tradicional y aceptación por parte de los profesionales de la salud y los pacientes; sin embargo, la relación costo-efectividad se informó con menos frecuencia. Nuestro objetivo es describir la experiencia de nuestro centro con las consultas virtuales (CV) y estimar la reducción de costos, así como evaluar las perspectivas de los médicos generales. Métodos: Estudio retrospectivo de los pacientes remitidos para CV entre enero de 2020 y diciembre de 2022 en la Unidad Local de Salud de Santo António (ULSSA). Se analizaron los datos demográficos de los pacientes, incluida la distancia al hospital y la autonomía, y se estimaron los ahorros económicos relacionados con el tiempo del nefrólogo, el transporte de pacientes y los días de trabajo perdidos. Para evaluar la perspectiva de los médicos de cabecera, administramos una breve encuesta de preguntas cerradas a los médicos de cabecera para evaluar el conocimiento, el uso y la satisfacción con las CV. Resultados: Se incluyeron un total de 456 pacientes, de los cuales 260 (57%) eran mujeres y la mediana de edad era de 80 años (RIC: 72-87). La distancia desde el hospital varió entre uno y 540 km, con una distancia mediana de 16 km (RIC: 6-19). El ahorro total estimado fue de 16.697,89 €, equivalente a 36,62 € por paciente y consulta. El costo del tiempo del nefrólogo se estimó en 966,11 € para las CV, en comparación con 3.622,92 € para las consultas presenciales iniciales, lo que resultó en una reducción de costos relacionados con el tiempo de 2.656,81 €. Cuarenta y siete médicos de cabecera de un total de 236 médicos de cabecera (20%) completaron la encuesta. De los encuestados, el 28% había utilizado CV y el 77% informó satisfacción con la respuesta. La guía de prescripción fue la fortaleza más identificada de CV. La falta de conciencia fue la principal barrera para el uso. Conclusiones: En esta experiencia de un solo centro, los CV redujeron los costos y la carga de viaje, al tiempo que fueron aceptables para los médicos de cabecera. Sin embargo, muchos médicos de cabecera desconocían esta vía, lo que subraya la necesidad de promoción e integración en los flujos de trabajo de atención primaria. Los estudios multicéntricos futuros deben evaluar los resultados clínicos, incluidas las visitas presenciales evitables, las hospitalizaciones, el tiempo hasta el asesoramiento, e incluir la perspectiva del paciente y del nefrólogo.
Acute heart failure (AHF) presents significant clinical and economic challenges that require a comprehensive, evidence-based strategy extending from in-hospital management to post-discharge care. Patients with AHF usually require prompt initiation or intensification of HF-directed treatment, which commonly includes intravenous diuretics, and frequently culminates in unplanned hospitalization. Despite therapeutic advances, AHF is still associated with poor outcomes, with in-hospital mortality in Portugal reaching 12.4%. Based on the expertise and clinical experience of a panel of cardiology and internal medicine specialists, this paper provides a practical guide to AHF management over the patient journey, which has been adapted to align with the specificities of the Portuguese national healthcare system: hospital admission, initial management of AHF, in-hospital management of stable phase, pre-discharge and transition of care. This practical guide highlights the importance of optimizing guideline-directed medical therapy by tailoring and rapidly uptitrating treatments to reduce mortality and readmissions. It is equally essential that structured, multidisciplinary transition-of-care programs are established that promote continuity and coordination across care settings.
