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To perform a transcultural adaptation and validation of a Spanish version of the compliance questionnaire in rheumatology (sCQR). In this transversal study of transcultural adaptation of the sCQR, validity was evaluated in patients with rheumatoid arthritis (RA) and a minimum 6-month follow-up by determining compliance with the electronic prescription system in consuming steroids or nonbiologic disease-modifying antirheumatic drugs. A two-week retest was proposed to all patients. All patients completed the health assessment questionnaire (HAQ), and the Morisky-Green test was also performed. Reliability was analyzed using Cronbach's alpha and the intraclass correlation coefficient (ICC). Convergent construct validity was tested in the electronic prescription system using discriminative analysis, and divergent construct validity was tested by comparing it to the HAQ. Sensitivity, specificity and ROC curves were evaluated for the sCQR and the Morisky-Green test. Of 123 recruited patients, 101 fulfilled the inclusion criteria, and 61 were on biologic therapy. 23 performed the retest. Test-retest reliability (ICC) was 0.76 (Cronbach's alpha 0.86). Multiple regression analysis showed correlation with each item of the sCQR as independent variables (r = 0.60). No correlation was seen between total score punctuation of the sCQR and the HAQ (r = 0.22). Discriminative analysis weighting each sCQR item showed a cutoff point of - 0.9991 (sensibility and 58.8%, specificity 98.3%). The likelihood ratio of the sCQR to detect ≤ 80% adherence with electronic prescriptions was 35.3. The Morisky-Green test revealed sensibility and specificity were 29.4 and 83.3%, respectively. This study validates the transcultural adaptation of sCQR in RA patients. A high reliability of sCQR for measuring adherence was found. Its predictive value suggests that it could be used as a screening instrument.

Objective: To evaluate adherence to treatment in a cohort of patients with rheumatoid arthritis in Spain and to identify potential predictors of adherence. Methods: An observational, cross-sectional, multicenter study in outpatient clinics of Rheumatology Departments from 41 centers was conducted. A validated Spanish version of the compliance questionnaire in Rheumatology was used to measure adherence in a cohort of patients with rheumatoid arthritis, representative of the Spanish population. Univariate and multivariate analyses were performed to detect predictors of adherence. Results: A total of 859 patients were recruited. An adherence rate of 79% was established. No differences were detected in adherence in patients receiving biologic disease-modifying antirheumatic drugs compared to conventional disease-modifying antirheumatic drugs, in patients receiving intravenous therapies compared to other routes of administration and in patients treated in specific day hospitals compared to polyvalent day hospitals. The number of drugs and cohabitation were independent predictors of adherence. Conclusion: An inexpensive and useful method was used to measure adherence in Spanish population. The adherence rate in rheumatoid arthritis is still suboptimal. Simpler, more convenient dosing regimens may improve compliance. Increased knowledge of compliance in patients with rheumatoid arthritis and the identification of possible predictors of adherence will allow to develop effective intervention strategies.

In the original published article, the family name was incorrectly tagged for two co-authors. The correct family names of authors José Ramón Maneiro Fernández is Maneiro Fernández and Alejandro Souto Vilas is Souto Vilas.

BackgroundChronic inflammatory immune-mediated diseases, as rheumatoid arthritis (RA), psoriatic arthritis (PsA), psoriasis (Ps), ankylosing spondylitis (AS), ulcerative colitis (UC) and Crohn’s disease (CD), have higher risks of morbidity and mortality and a great impact on quality of life of patients1. Drug inhibitors of tumor necrosis factor (TNF inhibitors) have demonstrated an adequate efficacy and security profile in these patients when classical treatments (as disease-modifying antirheumatic drugs) have been failed or patients were intolerant. TNF inhibitors are used to control inflammatory response and to improve quality of life, pain, functional capacity and progression of the disease2. Studies in RA show that smoking habit is related to more articular and extra-articular damage, worse prognosis, higher basal activity and higher risk of seropositive RA. It has been related also to greater number of different treatments and higher doses needed for patients by pharmacokinetic and pharmacodynamic processes. Data published until now suggest that smoking habit decreases efficacy of TNF inhibitors3.ObjectivesTo analyze the smoking habit influence on the efficacy of TNF inhibitors in patients diagnosed of chronic inflammatory immune-mediated diseases (RA, PsA, Ps, AS, UC, CD).MethodsIt was made a systematic literature search using Cochrane Library, Medline, the Web of Science and Embase databases. Meta-analyses were performed using a random-effects model.Results37 of 3677 identified articles met the inclusion criteria. No documents with GOL were found. The analysis of all the diseases together gives a significant decrease on the response to TNF inhibitors in smoking patients [OR 0.812 (0.662-0.996), p=0.046]. This response also has a significant decrease in IBD maintained response in smoking patients [OR 0.467 (0.257-0.848), p=0.012]. A non-significant decrease in the treatment response of smoking patients with IBD clinical remission was found, in smoking patients versus ex-smoking and never smoking patients with IBD response, in ex-smoking patients versus never smoking patients with IBD partial response, in current and ex-smoking patients versus never smoking patients with IBD partial response, in current smoking patients versus ex-smoking patients with IBD partial response, in current smoking patients versus never and ex-smoking patients with IBD partial response, in current smoking patients versus never smoking patients with IBD partial response, in patients with AR EULAR and in patients with AR EULAR moderate response.ConclusionSmoking habit is a poor prognosis factor in RA, AS, Ps, PsA, UC and CD. Its leaving will decrease cardiovascular risk, joint and bowel damage, will increase the efficacy of TNF inhibitors and will benefit the health of patients, not only in their particular disease, and it can be the first step on their treatment.References[1] Gabriel SE. Cardiovascular morbidity and mortality in rheumatoid arthritis. Am J Med 2008;121(10):9-14.[2] Seymour HE. Anti-TNF agents for rheumatoid arthritis....