{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T20:19:42Z","timestamp":1783369182666,"version":"3.54.6"},"reference-count":24,"publisher":"Colegio Mexicano de Inmunologia Clinica y Alergia, A. C.","issue":"4","license":[{"start":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T00:00:00Z","timestamp":1766102400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Rev Alerg Mex"],"abstract":"<jats:p>Objetivo: Determinar los factores asociados con mal pron\u00f3stico de pacientes con artritis reumatoide de un hospital de tercer nivel de atenci\u00f3n de Puebla.\nM\u00e9todos: Estudio observacional, anal\u00edtico, longitudinal, efectuado en una cohorte de pacientes con artritis reumatoide. Se siguieron durante un a\u00f1o, y se evaluaron como factores de mal pron\u00f3stico: sexo, comorbilidades, tabaquismo, DAS 28 (actividad de la enfermedad), VSG (velocidad de sedimentaci\u00f3n globular), PCR (prote\u00edna C reactiva), ACCP (anticuerpo anti-p\u00e9ptido citrulinado), FR (factor reumatoide) y erosiones \u00f3seas. Para el an\u00e1lisis de los factores de mal pron\u00f3stico se realiz\u00f3 un an\u00e1lisis de riesgos proporcionales de Cox.\nResultados: Se incluyeron 260 pacientes; se registraron 26 fallas y 234 censuras. El g\u00e9nero predominante fueron las mujeres, y la edad media se report\u00f3 de 47 \u00b1 11.7 a\u00f1os. Los factores de mal pron\u00f3stico fueron: ACCP, inicio de FARME (f\u00e1rmacos antirreum\u00e1ticos modificares de la enfermedad) tard\u00edo y tabaquismo. El ACCP positivo report\u00f3 5.8 mayor riesgo de escalar tratamiento, FARME tard\u00edo 4.6 veces y los que fumaban 7.7 veces el riesgo.\nConclusiones: Definir los factores de mal pron\u00f3stico sigue siendo un gran reto para los investigadores; sin embargo, resulta ser imperioso identificarlos para predecir la respuesta al tratamiento y con ello limitar el da\u00f1o funcional y de vida de los pacientes.\nPalabras clave: Pron\u00f3stico; Artritis reumatoide; Velocidad de sedimentaci\u00f3n globular; Prote\u00edna C reactiva; Anticuerpo anti-p\u00e9ptido citrulinado; Factor reumatoide; Tabaquismo.<\/jats:p>","DOI":"10.29262\/ram.v72i4.1508","type":"journal-article","created":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T23:29:56Z","timestamp":1767828596000},"page":"296-304","source":"Crossref","is-referenced-by-count":0,"title":["&lt;b&gt;Factores de mal pron\u00f3stico en pacientes con artritis reumatoide &lt;\/b&gt;","&lt;b&gt;Poor prognostic factors in rheumatoid arthritis patients &lt;\/b&gt;"],"prefix":"10.29262","volume":"72","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5779-138X","authenticated-orcid":false,"given":"Mar\u00eda del Roc\u00edo","family":"Hern\u00e1ndez-Morales","sequence":"first","affiliation":[{"name":"Hospital General SSA de Puebla"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7588-3846","authenticated-orcid":false,"given":"Edna Elisa","family":"Garcia-Vences","sequence":"additional","affiliation":[{"name":"Secretaria de la Defensa Nacional, Escuela Militar de Graduados en Sanidad, Ciudad de M\u00e9xico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-4534-426X","authenticated-orcid":false,"given":"C\u00e9sar Leonardo","family":"Garc\u00eda-L\u00f3pez","sequence":"additional","affiliation":[{"name":"Hospital General SSA de Puebla"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-0885-4867","authenticated-orcid":false,"given":"Ana Karen","family":"Castellanos-Guerrero","sequence":"additional","affiliation":[{"name":"Hospital General SSA de Puebla"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-7505-8567","authenticated-orcid":false,"given":"Pedro","family":"Crist\u00f3bal-Jim\u00e9nez","sequence":"additional","affiliation":[{"name":"Hospital General SSA de Puebla"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-8308-9926","authenticated-orcid":false,"given":"Itzel Victoria","family":"Rojas-Guzm\u00e1n","sequence":"additional","affiliation":[{"name":"Hospital General SSA de Puebla"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"11808","published-online":{"date-parts":[[2025,12,19]]},"reference":[{"key":"65265","doi-asserted-by":"crossref","unstructured":"1. Deane KD, Holers VM. The Natural History of Rheumatoid Arthritis. Clin Ther 2019; 41 (7): 1256-1269. doi: 10.1016\/j.clinthera.2019.04.028","DOI":"10.1016\/j.clinthera.2019.04.028"},{"key":"65266","doi-asserted-by":"crossref","unstructured":"2. Gui Y, Zhao J, Xie W, Huang H, et al. The universal presence of poor prognostic factors based on EULAR recommendations: A real-world study in 1164 Chinese RA patients. Joint Bone Spine 2023; 90 (6): 105633. doi: 10.1016\/j.jbspin.2023.105633","DOI":"10.1016\/j.jbspin.2023.105633"},{"key":"65267","doi-asserted-by":"crossref","unstructured":"3. Rom\u00e3o VC, Fonseca JE. Etiology and Risk Factors for Rheumatoid Arthritis: A State-of-the-Art Review. Front Med (Lausanne) 2021; 8: 689698. doi: 10.3389\/fmed.2021.689698","DOI":"10.3389\/fmed.2021.689698"},{"key":"65268","doi-asserted-by":"crossref","unstructured":"4. Alemao E, Litman HJ, Connolly SE, et al. Do Poor Prognostic Factors in Rheumatoid Arthritis Affect Treatment Choices and Outcomes? Analysis of a US Rheumatoid Arthritis Registry. J Rheumatol 2018; 45 (10): 1353-1360. doi: 10.3899\/jrheum.171050","DOI":"10.3899\/jrheum.171050"},{"key":"65269","doi-asserted-by":"crossref","unstructured":"5. Fraenkel L, Bathon JM, England BR, et al. 2021 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2021; 73 (7): 924-939. doi: 10.1002\/acr.24596","DOI":"10.1002\/acr.24596"},{"key":"#cr-split#-65270.1","unstructured":"6. Smolen JS, Landew\u00e9 RBM, Bergstra SA, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2022 update [published correction appears in Ann Rheum Dis 2023"},{"key":"#cr-split#-65270.2","doi-asserted-by":"crossref","unstructured":"82 (3): e76. doi: 10.1136\/ard-2022-223356corr1.]. 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Rheumatol Ther 2021; 8 (1): 1-16. doi: 10.1007\/s40744-020-00252-1","DOI":"10.1007\/s40744-020-00252-1"},{"key":"65274","doi-asserted-by":"crossref","unstructured":"10. Baganz L, Richter A, Albrecht K, et al. Are prognostic factors adequately selected to guide treatment decisions in patients with rheumatoid arthritis? A collaborative analysis from three observational cohorts. Semin Arthritis Rheum 2019; 48 (6): 976-982. doi: 10.1016\/j.semarthrit.2018.09.003","DOI":"10.1016\/j.semarthrit.2018.09.003"},{"key":"65275","doi-asserted-by":"crossref","unstructured":"11. Ajeganova S, Huizinga T. Sustained remission in rheumatoid arthritis: latest evidence and clinical considerations. Ther Adv Musculoskelet Dis 2017; 9 (10): 249-262. doi: 10.1177\/1759720X17720366","DOI":"10.1177\/1759720X17720366"},{"key":"65276","doi-asserted-by":"crossref","unstructured":"12. Vittecoq O, Brevet P, Gerard B, Lequerre T. On difficulties to define prognostic factors for clinical practice in rheumatoid arthritis. RMD Open 2024; 10 (3): e004472. doi: 10.1136\/rmdopen-2024-004472","DOI":"10.1136\/rmdopen-2024-004472"},{"key":"65277","unstructured":"13. Gobierno de M\u00e9xico.Diagn\u00f3stico y tratamiento de artritis reumatoide del adulto. Ciudad de M\u00e9xico; Gov mex 2015. www.cenetec.salud.gov.mx"},{"key":"65278","doi-asserted-by":"crossref","unstructured":"14. Weinstein A, McEVILLY B, Dervieux T. Reevaluating Serologic Markers of Poor Prognostic Factors in Rheumatoid Arthritis. J Rheumatol 2019; 46 (6): 657-658. doi: 10.3899\/jrheum.181246","DOI":"10.3899\/jrheum.181246"},{"key":"65279","unstructured":"15. Conigliaro P, Triggianese P, Chimenti MS, et al. Factors Predicting 2 Years of Remission and Low Disease Activity in Rheumatoid Arthritis Patients Treated with TNF-inhibitors. Isr Med Assoc J 2017; 19 (8): 467-472."},{"key":"65280","doi-asserted-by":"crossref","unstructured":"16. 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Ann Rheum Dis. 2011; 70 (3): 469-475. doi: 10.1136\/ard.2010.139212","DOI":"10.1136\/ard.2010.139212"},{"key":"65283","doi-asserted-by":"crossref","unstructured":"19. Niewold TB, Harrison MJ, Paget SA. Anti-CCP antibody testing as a diagnostic and prognostic tool in rheumatoid arthritis. QJM. 2007; 100 (4): 193-201. doi: 10.1093\/qjmed\/hcm015","DOI":"10.1093\/qjmed\/hcm015"},{"key":"65284","doi-asserted-by":"crossref","unstructured":"20. Harrold LR, Bryson J, Lehman T, et al. Association Between Baseline Anti-cyclic Citrullinated Peptide Antibodies and 6-Month Clinical Response Following Abatacept or TNF Inhibitor Treatment: A Real-World Analysis of Biologic-Experienced Patients with RA. Rheumatol Ther. 2021; 8 (2): 937-953. doi: 10.1007\/s40744-021-00310-2","DOI":"10.1007\/s40744-021-00310-2"},{"key":"65285","doi-asserted-by":"crossref","unstructured":"21. Frazzei G, Musters A, de Vries N, Tas SW, et al. Prevention of rheumatoid arthritis: A systematic literature review of preventive strategies in at-risk individuals. Autoimmun Rev. 2023; 22 (1): 103217. doi: 10.1016\/j.autrev.2022.103217","DOI":"10.1016\/j.autrev.2022.103217"},{"key":"65286","doi-asserted-by":"crossref","unstructured":"22. Javaid U, Mahmud TH, Rasheed A, Javaid AUR, et al. Factors Leading to Diagnostic and Therapeutic Delay of Rheumatoid Arthritis and Their Impact on Disease Outcome. Cureus. 2023; 15 (1): e34481. doi: 10.7759\/cureus.34481","DOI":"10.7759\/cureus.34481"},{"key":"65287","doi-asserted-by":"crossref","unstructured":"23. Maska LB, Sayles HR, O'Dell JR, et al. Serum cotinine as a biomarker of tobacco exposure and the association with treatment response in early rheumatoid arthritis. 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