Selective serotonine reuptake inhibitors or dual antidepressants and syndrome of inapropriate antidiuretic hormone secretion: A systematic search

Introduction

Depression is a disease with high prevalence all over the world. Selective serotonine reuptake inhibitors (SSRIs) and dual antidepressants (DA) are worldwide used to treat the different types of depressive episodes. Between the adverse events of these compounds, an unusual but potentially severe side effect is the syndrome of inapropriate antidiuretic hormone secretion (SIADH).

Results and discussion

Several cases published, and an amount of cases series have documented the association of SIADH to the use of SSRIs and DA. All SSRIs and DA are at risk of producing SIADH (fluoxetine, paroxetine, fluvoxamine, sertraline, citalopram, escitalopram, venlafaxine and duloxetine). Old age has been found as a risk factor for developing SIADH. There are not enough data to conclude that other risk factors can play a role in the development of this adverse event. Treatment should include the immediate withdrawal of the antidepressant. The introduction of other antidepressants is controversial, as SIADH has been related with all antidepressive treatments; but the risk of relapse into a depressive episode must be considered also. Between symptomatic treatments, the control of water intake and the use of low doses of loop diuretics can be recommended. Severe cases can be treated with higher doses of loop diuretics and saline hypertonic solution.

Conclusions

SIADH has been related with SSRIs and DA antidepressants and it is an infrequent but severe adverse event. Its risk must be considered when prescribing treatment with them. If this adverse event is produced, the substitution of the antidepressant should be done.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Female sexual function and depression after kidney transplantation: comparison between deceased- and living-donor recipients

Disturbances in sexual function and depression are a common feature in women with chronic renal failure. Living-donor kidney transplantation seems to warrant better results than its cadaveric counterpart in many aspects but its impact on post-transplantation sexual function remains unknown. This study aimed to compare post-transplantation sexual function and depression in women receiving kidney grafts from living and deceased donors. From a single-center prospective database of 2016 renal transplantations between June 2011 and June 2013, we enrolled 50 sexually active women after kidney transplantation. Female sexual function was evaluated with the Female Sexual Function Index Questionnaire (FSFI) and depression was assessed using the Beck Depression Inventory-II (BDI-II) scale. Thirty-four patients referred the questionnaires. The sexual domains of satisfaction and desire were significantly better in living-donor receptors; in all other domains evaluated by FSFI no statistically significant difference was encountered between groups, although living-donor receptors tended to report better function. Total BDI-II was well correlated with total FSFI score in our study cohort (Spearman's rho = -0.80, P < .001). Only 34.6% of women referred to have discussed sexual issues with their physicians before transplantation, whereas 73.1% stated it would have been important. In conclusion, living-donor transplantation exerted a positive effect on women's sexual function.

Living versus cadaveric-donor renal transplant recipients: a comparison on sexual function

Erectile dysfunction is experienced by 50% of men with end-stage renal disease (ESRD) and uremia. The origin of this dysfunction is multifactorial. The aim of this study was to compare living donor versus cadaveric donor transplant recipients regarding male sexual function. Seventy-seven sexually active male kidney transplant recipients (44 from living donors; 33 from cadaveric donors) were randomly selected from our single-center prospective database of 2016 renal transplants. Epidemiological and clinical data were collected between June 2010 and June 2011. Male sexual function was evaluated with the International Index of Erectile Function questionnaire (IIEF-15). We assessed the prevalence of male sexual dysfunction according to established cutoff points for each of the IIEF-15 domains. Mann-Whitney and Pearson's chi- square statistical tests were used to compare continuous and categorical variables, respectively. The median age at the time of completion of the questionnaires was 43 and 51 years (P = .003) with median times from transplantation was of 36 and 42 months for living donor and cadaveric donor recipients, respectively (P = .31). Median durations of ESRD before surgery were 17.5 and 57 months for living donor and cadaveric donor recipients, respectively (P < .001). Living donor and cadaveric donor recipients had median creatinine clearance values of 55 and 57 mL/min, respectively (P = .44). Median time after renal transplantation for first sexual intercourse was 1 and 2 months for living donor and cadaveric donor recipients, respectively (P = .35). Median body mass indices for living donor and cadaveric donor recipients were 24.8 and 24, respectively (P = .31). Regarding sexual function domains, there were significant differences only for intercourse satisfaction. In our cohort, living donor recipients tended to be younger, have shorter time of ESRD, and less incidence of hypertension or diabetes mellitus but with greater tobacco use. In conclusion, living donor transplantation exerted a favorable impact on sexual function.

[Churg-Strauss syndrome: a disabling disease]

Churg-Strauss syndrome (CSS) is an infrequent vasculitis that affects small to medium-sized vessels. We describe a 51 year-old-female admitted to our inpatient unit with bullae on her right foot and forearm with pain, paresthesias and impotence of the foot. There was rapid clinical deterioration with lost of gait and peripheral eosinophilia. Histopathology showed many extravascular eosinophils. Bone marrow had an increased number of eosinophils and their precursors with no neoplastic cells infiltration. Electromyogram revealed mononeuritis multiplex with bilateral sciatic and right femoral nerve involvement. She fulfilled the eligibility criteria of American College of Rheumatology (ACR) and Chapell Hill Conference Consensus (CHCC) of CSS so corticosteroids and cyclophosphamide and rehabilitation program were begun with good clinical and laboratorial response. This report illustrates the importance of identifying atypical cutaneous features of CSS for the early diagnosis of this rare condition and the role of a multidisciplinary team in this multissystemic disease.

Vital status after five-year follow-up of nonagenarians with functional and/or cognitive impairment at baseline: the NonaSantfeliu study

OBJECTIVES

To evaluate vital status after five years of follow-up in a cohort of nonagenarians with functional and/or cognitive impairment at baseline.

DESIGN

Prospective cohort study.

SETTING

A community-based study.

PARTICIPANTS

Nonagenarians enrolled in the NonaSantfeliu study.

MEASUREMENTS

Functional status was determined by the Lawton-Brody and Barthel indexes (BI), while cognition was assessed using the Spanish version of the Mini-Mental State Examination (MEC). Nonagenarians scoring up to 59 points on the BI were defined as individuals with significant functional impairment. Nonagenarians with cognitive decline were defined as those individuals with a score of 23 or less on the MEC. Subjects scoring < 60 on the BI and < 24 on the MEC were considered to show combined impairment (both functional and cognitive).

RESULTS

Sixty-three of 71 (88.8%) subjects with a BI < 60 and 73 of 84 (86.9%) with a MEC score < 24 had died after five years. Forty-eight of 53 nonagenarians (90%) with combined impairment died during the same follow-up period. A prior diagnosis of heart failure was the only variable associated with higher mortality in the three groups of subjects.

CONCLUSION

Most of the nonagenarian subjects with functional and/or cognitive impairment at baseline had died at five-year follow-up.

Infections in outpatients with systemic lupus erythematosus: a prospective study

The objective of this study was to assess the incidence and risk factors of infections in 200 SLE outpatients. All outpatients with active or inactive SLE without infections in the previous month were included. They were assessed every 3 months. Major infections were those requiring hospitalization and parental antibiotic therapy; minor infections required oral or topical therapy. Sociodemographic, disease activity using the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), therapy and laboratory variables were evaluated. After a follow-up of 22+/-7 months, 65 (32%) patients had infections; 35% of those were major. The most common sites for infection were urinary (26%), skin (23%), systemic (12%), and vaginal (9%). At infection onset, 50 of 65 patients (77%) had disease activity, with a mean SLEDAI score of 6.1. The variables significantly associated with infection in the univariate analyses were the presence of disease activity, SLEDAI score, renal activity, prednisone dose, and IV cyclophosphamide. The only variable associated with infection in the multivariate analyses was a SLEDAI score of 4 or higher. Most infections in SLE outpatients were single, minor, non-life threatening, and associated with disease activity independently of sociodemographic and therapeutic factors.

High frequency of association of rheumatic/autoimmune diseases and untreated male hypogonadism with severe testicular dysfunction

Our goal in the present work was to determine whether male patients with untreated hypogonadism have an increased risk of developing rheumatic/autoimmune disease (RAD), and, if so, whether there is a relation to the type of hypogonadism. We carried out neuroendocrine, genetic, and rheumatologic investigations in 13 such patients and 10 healthy male 46,XY normogonadic control subjects. Age and body mass index were similar in the two groups. Nine of the 13 patients had hypergonadotropic hypogonadism (five of whom had Klinefelter's syndrome [karyotype 47,XXY]) and 4 of the 13 had hypogonadotropic hypogonadism (46,XY). Of these last four, two had Kallmann's syndrome and two had idiopathic cryptorchidism. Eight (61%) of the 13 patients studied had RADs unrelated to the etiology of their hypogonadism. Of these, four had ankylosing spondylitis and histocompatibility B27 antigen, two had systemic lupus erythematosus (in one case associated with antiphospholipids), one had juvenile rheumatoid arthritis, and one had juvenile dermatomyositis. In comparison with the low frequencies of RADs in the general population (about 0.83%, including systemic lupus erythematosus, 0.03%; dermatomyositis, 0.04%; juvenile rheumatoid arthritis, 0.03%; ankylosing spondylitis, 0.01%; rheumatoid arthritis, 0.62%; and other RAD, 0.1%), there were surprisingly high frequencies of such disorders in this small group of patients with untreated hypogonadism (P < 0.001) and very low serum testosterone levels (P = 0.0005). The presence of RADs in these patients was independent of the etiology of their hypogonadism and was associated with marked gonadal failure with very low testosterone levels.

The antiquity of rheumatoid arthritis: a reappraisal

OBJECTIVE

To demonstrate the existence of rheumatoid arthritis (RA) before the 19th century.

METHODS

Survey of primary and secondary references on the history of rheumatic diseases.

RESULTS

Paleopathological evidence suggests the existence of RA in America since 8000 BC and in Europe since the 7th century. Descriptions and representations of a symmetric chronic polyarthritis producing characteristic deformities can be found in Rome since 100 BC and India since 500 BC. The first clinical distinction between RA and gout was published in Mexico in 1578. Different historical conditions contributed to lack of recognition of RA by official medicine before 1800. The recognition of RA as a distinct entity in the 19th century was influenced by socioeconomic circumstances.

CONCLUSION

RA is not a recent disease. Historical investigation can provide useful clues on its pathogeny.

Herbal therapies in rheumatology: the persistence of ancient medical practices

OBJECTIVE

To determine how frequently herbal remedies are employed as alternative therapies in rheumatic diseases, and the historical justification for their use.

METHODS

We conducted a survey in 250 outpatients in the rheumatology clinic of a teaching hospital in México. We registered general demographic information and the previous use of herbal remedies for rheumatic conditions, how effective they were, and the presence of adverse effects during their use. We identified the herbs employed, and cross-checked them with medical texts from the 16th through the 18th centuries on the use of herbal remedies.

RESULTS

Of 250 surveyed patients, 126 (51%) had used herbal remedies for their rheumatic conditions. 63% of all users reported them to be effective for the purpose they had been prescribed. 12% reported adverse effects, none of them life-threatening. Being a user had no relation with the patients' formal education. Three patients did not answer the survey. We were able to identify 67 plants. One third of these are either prescribed for rheumatic conditions in the consulted bibliography, or else were used for the same purpose by ancient Mexican cultures.

CONCLUSION

Herbal remedies are frequently used for rheumatic conditions. Some of them have an historical antecedent for their use in rheumatic conditions. They deserve a cautious evaluation as adjunctive therapies in rheumatic diseases.

Tamale foot: deposit of acid mucopolysaccharides in the synovial sheaths of extensor tendons of the foot, resembling tendinitis, in a patient with juvenile ankylosing spondylitis

We describe a clinical case of juvenile ankylosing spondylitis (AS) that developed "pseudo-chronic tendinitis" of the foot. A 20-year-old male patient had HLA-B27 positive juvenile AS since he was 13 years old. At the age of 19 he presented chronic pain in the dorsum of the left foot. Examination disclosed an increased volume of the tarsal dorsum, with rubbery consistency, with no evidence of venous or lymphatic insufficiency, godette, or inflammation in laboratory tests, giving the foot the appearance of a tamale. Synovectomy of the foot extensor tendon sheath was followed by relief of pain and swelling. Histopathological study showed a deposit of acid mucopolysaccharides (MPS) with no inflammatory cell infiltrate. Tamale foot in juvenile AS may develop as a consequence of acid MPS deposit with no evidence of synovial inflammation. The good response to synovectomy suggests this is the preferred treatment for tamale foot.