Background:Systemic lupus erythematosus (SLE) is characterized by fluctuating activity and unpredictable flares that contribute to cumulative organ damage. Biomarkers capable of identifying patients at risk of near-term disease reactivation are needed. Interleukin-6 (IL-6) has been associated with SLE activity, but its prospective predictive value remains uncertain. Methods:We conducted a prospective, longitudinal, single-center study (2017-2023) including 188 adult with SLE. Serum IL-6 levels were measured at routine and unscheduled visits. Patients were categorized using a prespecified cutoff of 5 pg/mL. Disease activity was assessed using SLEDAI-2K (with values >4 suggesting active disease) and organ-specific manifestations. Prospective (lagged) associations were analyzed using the log-rank test. Discriminative performance was evaluated using ROC analyses and multivariable models adjusted for clinical confounders. IL-6 was compared with anti-double-stranded DNA antibodies and complement components C3 and C4. Results:During follow-up, 48% of patients had IL-6 levels >5 pg/mL. IL-6 >5 pg/mL was associated with a shorter time to subsequent flare, with a median time to SLEDAI-2K >4 that was 10 months shorter. Elevated IL-6 also predicted arthritis, nephritis, serositis, and hematologic manifestations. Concurrently, IL-6 demonstrated greater discriminative performance than anti-dsDNA, C3, and C4. Conclusions:Elevated circulating IL-6 levels are associated with short-term disease reactivation in SLE and may complement established biomarkers in longitudinal disease assessment.
Background Suicide attempt survivors have higher risk of reattempt in the weeks following hospitalization, yet evidence-based psychological interventions targeting this acute phase remain scarce. The Suicide Attempt Multi-Component Intervention Treatment (SAMIT) was designed to intervene immediately after hospitalization for a medically serious suicide attempt (MSSA). This study aims to evaluate the effect of SAMIT on psychopathological symptoms related to suicidal behaviour. Methods We conducted a randomized controlled trial involving patients hospitalized after an MSSA at two tertiary hospitals in Barcelona. Participants were assigned to an eight-session psychological intervention (SAMIT) or treatment-as-usual. Of 189 patients assessed for eligibility, 75 were randomized, and 54 completed the study. Outcomes were self-reported affective symptoms, suicidality-related measures, and impulsivity. Treatment effects were estimated with linear mixed-effects models on an intention-to-treat basis. Results Results showed significant differences in the SAMIT group, observing a decrease of depression symptomatology ( β , -2.80; 95% CI -4.93 to -0.68; p = 0.011), psychache ( β , -9.01; 95% CI -15.95 to -2.08; p = 0.012) and motor impulsivity ( β , -2.79; 95% CI -5.36 to -0.23; p = 0.034). In all cases, participants who received SAMIT treatment showed a decrease in symptom scores. In exploratory subgroup analyses, women showed better responses to SAMIT than men, while in patients with comorbid substance use disorders only depressive symptoms improved significantly. Conclusions These findings highlight the importance of psychotherapeutic interventions in patients with MSSA during hospitalization or recent hospital discharge period, as they may help reduce psychological symptom severity. Future research should replicate these results in larger samples, explore longer-term trajectories of clinical responses, and examine personalized intervention approaches. Trial registration The trial was prospectively registered on the U.S. National Institutes of Health ClinicalTrials.gov registry NCT06238414 (https//clinicaltrials.gov/study/NCT06238414). Date of registration November 20th, 2023.
Background. Axial spondyloarthritis (axSpA) is a chronic inflammatory disease in which long-term non-pharmacological management —including structured exercise, patient education and behavioural support— is endorsed by ASAS–EULAR recommendations alongside pharmacological control. The long-term sustainability of these benefits in real-world community settings, and the integration of community-based rehabilitation with primary care and specialist pain medicine, remain under-documented. The aim of this study was to characterise the range of long-term functional, disease-activity and coping trajectories observable among purposively selected participants with axSpA engaged in a community-based interdisciplinary rehabilitation programme coordinated with primary care and pain medicine. Methods. Retrospective longitudinal observational case series (STROBE-compliant) of five purposively selected participants with axSpA (three men, two women; four ankylosing spondylitis, one non-radiographic axSpA) drawn from the documented axSpA cohort of the ARPER community-based rehabilitation programme (5 of 43 documented cases, all with sustained engagement and favourable evolution). Cases were purposively selected to represent favourable, sustained-engagement trajectories and are not representative of the full programme cohort, which includes drop-outs and unfavourable outcomes. Follow-up ranged from 23 to 125 months. Standardised instruments included the Bath Ankylosing Spondylitis Functional Index (BASFI), the standard six-item Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Visual Analogue Scale for pain (VAS-pain), Health Assessment Questionnaire–Disability Index (HAQ-DI), EuroQol 5-Dimension 5-Level (EQ-5D-5L), the Symptom Checklist-90-Revised Global Severity Index (SCL-90-R GSI, baseline only), the Chronic Pain Coping Questionnaire (CAD), and the Mediterranean Diet Adherence Screener (MEDAS), supplemented by a digital daily self-monitoring system. Changes from baseline (M0) to last evaluation were anchored in established minimal clinically important differences (MCID). Results. Clinically meaningful changes exceeding established MCID in at least one functional or disease-activity domain were documented in four of five cases (AL and NA across all instruments; AN in BASDAI; SA in BASDAI and VAS-pain); the fifth case (MI) showed floor-level scores throughout, documenting patient-reported sustained functional remission. SA, managed without biologic therapy, was subsequently medically discharged by the consulting rheumatologist following demonstrable improvement. Predominantly active coping profiles were documented in three of four participants with CAD data, with one mixed profile (AL) modulated by emotion-focused (religious) coping coexisting with maximal functional improvement. Five long-term trajectory typologies were identified, ranging from progressive consolidation and patient-reported sustained functional remission to early regulation with medical discharge and oscillating regulation in long-standing chronicity. Daily self-monitoring (> 6,000 entries) corroborated periodic assessment and revealed dimensions invisible to disease-specific instruments. A sixth participant managed with concurrent biologic therapy is reported as an illustrative contrast case in the supplementary material. Conclusions. In this purposively selected series of favourable trajectories, sustained participation in a community-based interdisciplinary rehabilitation programme coordinated with primary care and pain medicine was associated with clinically meaningful long-term functional, disease-activity and coping outcomes in axSpA when pharmacological management remained stable. These findings are illustrative of trajectories observable under sustained engagement and are not interpretable as evidence of programme efficacy or generalisability to all axSpA patients. The findings support integrated chronic-care models that articulate non-pharmacological community-based rehabilitation with formal healthcare-system coordination, and the value of complementary daily self-monitoring to capture dimensions not reflected in periodic disease-specific assessment.
PATIENTS AND METHODS:In this multicenter longitudinal study, data from the Spanish Register in AS (AEU-PIEM/2014/0001) were reviewed. The study focused on a cohort of AS patients registered between 2014 and 2019, featuring open inclusion criteria and diverse follow-up strategies. RESULTS:A total of 3315 AS patients were recruited, with 2881 and 434 categorized into the low and intermediate risk groups based on NCCN grouping at inclusion. The median age was 67 years, and only 11% underwent diagnostic biopsy guided by MRI. The median time between follow-up visits was 6.03 months. Over a median follow-up of 62 months (Q1-3: 43.78-85.58), 37% remained in AS, while 8% transitioned to watchful waiting due to aging or intercurrent disease. Death occurred in 199 (6%) of patients, with 3 due to prostate cancer progression and 196 attributed to other causes. At 2 and 5 years, pathological progression-free survival, metastasis-free survival, and active treatment-free survival were 68% and 51%, 99% and 99%, and 70% and 50%, respectively. CONCLUSIONS:Midterm oncological outcomes of AS in Spain align with major international series. We denote underuse of guideline recommendations such as use of MRI or TP Bx for initial PCa characterization. Collaborative efforts are crucial in the search for algorithms, new imaging, or biomarkers to refine indications and transition to active treatments. TRIAL REGISTRATION:ClinicalTrials.gov identifier: NCT02865330.
