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Quartuccio L, Corazza L, Ramos-Casals M, Retamozo S, Ragab G, Ferraccioli G, Gremese E, Tzioufas A, Voulgarelis M, Vassilopoulos D, Koutsianas C, Scarpato S, Salvarani C, Guillevin L, Terrier B, Cacoub P, Saccardo F, Gabrielli A, Fraticelli P, Tomsic M, Tavoni A, Nishimoto N, Filippini D, Scaini P, Zignego A, Ferri C, Sansonno D, Monti G, Pietrogrande M, Galli M, Bombardieri S, De Vita S. OP0274 Cryoglobulinemic Vasculitis and Primary sjögren's Syndrome are Independent Risk Factors for Lymphoma in a Large Worldwide Population of Patients with Positive Serum Cryoglobulins. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.3300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Brito-Zerón P, Kostov B, Solans R, Fraile G, Suárez-Cuervo C, Casanovas A, Rascón FJ, Qanneta R, Pérez-Alvarez R, Ripoll M, Akasbi M, Pinilla B, Bosch JA, Nava-Mateos J, Díaz-López B, Morera-Morales ML, Gheitasi H, Retamozo S, Ramos-Casals M. Systemic activity and mortality in primary Sjögren syndrome: predicting survival using the EULAR-SS Disease Activity Index (ESSDAI) in 1045 patients. Ann Rheum Dis 2014; 75:348-55. [PMID: 25433020 DOI: 10.1136/annrheumdis-2014-206418] [Citation(s) in RCA: 105] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 11/07/2014] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To score systemic activity at diagnosis and correlate baseline activity with survival in a large cohort of patients with primary Sjögren syndrome (SS). PATIENTS AND METHODS We include 1045 consecutive patients who fulfilled the 2002 classification criteria for primary SS. The clinical and immunological characteristics and level of activity (EULAR-SS Disease Activity Index (ESSDAI) scores) were assessed at diagnosis as predictors of death using Cox proportional hazards regression analysis adjusted for age at diagnosis. The risk of death was calculated at diagnosis according to four different predictive models. RESULTS After a mean follow-up of 117 months, 115 (11%) patients died. The adjusted standardised mortality ratio for the total cohort was 4.66 (95% CI 3.85 to 5.60), and survival rates at 5, 10, 20 and 30 years were 96%, 90%, 81% and 60%, respectively. The main baseline factors associated with overall mortality in the multivariate analysis were male gender, cryoglobulins and low C4 levels. Baseline activity in the constitutional, pulmonary and biological domains was associated with a higher risk of death. High activity in at least one ESSDAI domain (HR 2.14), a baseline ESSDAI score ≥14 (HR 1.85) and more than one laboratory predictive marker (lymphopenia, anti-La, monoclonal gammopathy, low C3, low C4 and/or cryoglobulins) (HR 2.82) were associated with overall mortality; these HRs increased threefold to 10-fold when the analysis was restricted to mortality associated with systemic disease. CONCLUSIONS Patients with primary SS, who present at diagnosis with high systemic activity (ESSDAI ≥14) and/or predictive immunological markers (especially those with more than one), are at higher risk of death.
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Seror R, Gottenberg J, Bootsma H, Saraux A, Theander E, Ramos-Casals M, Bowman S, Le Guern V, Dörner T, Tzioufas A, Goeb V, Vitali C, Ravaud P, Mariette X. OP0217 Defining Disease Activity Sates and Minimal Clinically Important Improvement (MCII) with the EULAR Primary SjÖGren's Syndrome Disease Activity Index (ESSDAI). Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.4399] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Brito Zeron P, Kostov B, Solans R, de Luna G, Casanovas A, Díaz-Lόpez B, Rascόn F, Qanneta R, Pérez-Alvarez R, García-Sánchez I, Ripoll M, Pinilla B, Gheitasi H, Retamozo S, Ramos-Casals M. OP0211 Association between Systemic Activity and Lymphoma in Primary Sjogren Syndrome: Baseline Essdai Predictors in 921 Spanish Patients (GEAS-SS Registry). Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.5008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Brito Zeron P, Retamozo S, Bové A, Kostov B, Gheitasi H, Ligero M, Sisό-Almirall A, Alόs L, Ramos-Casals M. SAT0206 Minimally-Invasive Technique for the Biopsy of Minor Salivary Glands: Searching for Systemic Infiltrative Diseases in Patients Presenting with SICCA Symptoms. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.5132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Brito Zeron P, Caminal-Montero L, Chamorro A, de la Hera Fernández J, Gato A, Marín-Ballvé A, Robles A, Rodríguez-Carballeira M, Salvador G, Saez L, Ruiz-Irastorza G, Gheitasi H, Retamozo S, Ramos-Casals M. AB0542 Blocking the Human B Lymphocyte Stimulator Molecule (BLYS) Using A Monoclonal Antibody (Belimumab) in Systemic Lupus Erythematosus: First Results in Real-Life Spanish Patients with Refractory Disease (Biogeas-Semi Registry). Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.5447] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Brito Zeron P, Retamozo S, Solans R, Fraile G, Morera-Morales L, Suárez-Cuervo C, Rascόn F, Qanneta R, Pérez-de-Lis M, Akasbi M, Ripoll M, Pinilla B, Kostov B, Gheitasi H, Ramos-Casals M. OP0213 The Degree of Activity Measured with the EULAR-SS Disease Activity Index (ESSDAI) Strongly Correlated with Death in Patients with Primary Sjogren Syndrome (GEAS-SS REGISTRY). Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.4342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Brito Zeron P, Mañá J, Pérez-Alvarez R, Retamozo S, Gheitasi H, Fernández-Martín J, Pérez-de-Lis M, Bosch X, Ramos-Casals M. THU0397 Clinical Presentation and Characterization of Neurosarcoidosis: Analysis in 719 Patients (Sarcogeas-Semi Registry). Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.5374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Brito Zeron P, Cajamarca L, Perez-Alvarez R, Real de Asua D, Benito Conejero S, Beamud F, Martinez-Valle F, Bosch X, Villaverde I, Fonseca E, Acevedo L, Gonzalez Vazquez L, de la Red G, Santiago C, Gonzalez Vazquez E, Inglada L, Robles Marhuenda A, Castro Salomo A, Jordana R, Fernandez Martin J, Perez de Lis M, Retamozo S, Gheitasi H, Lopez Soto A, Ramos-Casals M. THU0399 Systemic Amyloidosis as A Multi-Organ, Life-Threatening Disease: Predictive Baseline Factors Associated to Mortality in 570 Patients (Ramyd-Geas-Semi Registry). Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.5896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Brito Zeron P, Retamozo S, Gheitasi H, Bové A, Kostov B, Sisό-Almirall A, Ramos-Casals M, Stone J. THU0396 Igg4-Related Disease or Primary Sjogren Syndrome? Organ-Specific Involvement and Immunological Profile Are Clues in Differentiating Two Diseases with A Common Clinical Presentation. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.5099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Brito Zeron P, Kaveri S, Bové A, Retamozo S, Gheitasi H, Akasbi M, Gandía M, Soto-Cárdenas M, Pérez-de-Lis M, Pérez-Alvarez R, Kostov B, Sisό-Almirall A, Londoño M, Forns X, Ramos-Casals M. THU0298 Are Anti-La Antibodies A Potential Protection for Hepatitis C Virus Infection in SjÖGren Syndrome? Analysis in 663 Patients. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.4158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Brito-Zerón P, Retamozo S, Akasbi M, Gandía M, Perez-De-Lis M, Soto-Cardenas MJ, Diaz-Lagares C, Kostov B, Bove A, Bosch X, Perez-Alvarez R, Siso A, Ramos-Casals M. Annular erythema in primary Sjögren’s syndrome: description of 43 non-Asian cases. Lupus 2013; 23:166-75. [DOI: 10.1177/0961203313515764] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Objective The objective of this paper is to evaluate the prevalence and characterize the main epidemiological, clinical and immunological features of annular erythema (AE) in non-Asian patients with primary Sjögren’s syndrome (SS). Methods We carried out a retrospective study searching for AE in 377 Spanish patients with primary SS fulfilling the 2002 American-European criteria. In addition, we searched PubMed (1994–2012) using the MeSH terms “annular erythema” and “primary Sjögren’s syndrome” for additional cases. All cases with AE reported in patients with SS associated with systemic lupus erythematosus were excluded. Results In our Spanish cohort, we found 35 (9%) patients diagnosed with AE. All were white females, with a mean age of 47 years at diagnosis of AE. AE preceded diagnosis of SS in 27 (77%) patients. Cutaneous AE lesions involved principally the face and upper extremities. All patients reported photosensitivity, with cutaneous flares being reported during the warmest months in 93% of patients. Immunological markers consisted of anti-Ro/La antibodies in 31 (89%) patients. In the literature search, we identified eight additional non-Asian patients with primary SS diagnosed with AE. In comparison with 52 Asian patients, the 43 non-Asian patients with AE related to primary SS were more frequently women (100% vs 78%, p = 0.008), and cutaneous lesions were less frequently reported in the face (55% vs 81%, p = 0.045) and more frequently in the neck (40% vs 14%, p = 0.041). Immunologically, non-Asian patients had a lower frequency of anti-Ro antibodies and a higher frequency of negative Ro/La antibodies, although the differences were not statistically significant. Conclusion AE is not an exclusive cutaneous feature of Asian patients with primary SS. In addition to the characteristic cutaneous expression, AE has a very specific clinical and immunological profile: often presenting before the fulfillment of SS criteria, overwhelmingly associated with anti-Ro antibodies but weakly associated with other immunological markers and the main systemic SS-related features.
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Ramos-Casals M, Brito-Zeron P, Solans R, Camps MT, Casanovas A, Sopena B, Diaz-Lopez B, Rascon FJ, Qanneta R, Fraile G, Perez-Alvarez R, Callejas JL, Ripoll M, Pinilla B, Akasbi M, Fonseca E, Canora J, Nadal ME, Red GDL, Fernandez-Regal I, Jimenez-Heredia I, Bosch JA, Ayala MDM, Morera-Morales L, Maure B, Mera A, Ramentol M, Retamozo S, Kostov B. Systemic involvement in primary Sjogren's syndrome evaluated by the EULAR-SS disease activity index: analysis of 921 Spanish patients (GEAS-SS Registry). Rheumatology (Oxford) 2013; 53:321-31. [DOI: 10.1093/rheumatology/ket349] [Citation(s) in RCA: 140] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Seror R, Theander E, Brun J, Ramos-Casals M, valim V, Dörner T, Mariette X, bootsma H, Tzioufas A, Solans Laqué R, Mandl T, Gottenberg JE, Hachulla E, Ng WF, Bombardieri S, Gerli R, sumida T, saraux A, tomsic M, caporali R, Priori R, Moser K, Kruize AA, Vollenweider C, Ravaud P, Praprotnik S, Scofield H, Valesini G, Montecucco C, Fauchais AL, Vitali C, Bowman S. FRI0303 Validation of eular primary sjögren’s syndrome disease activity and patient indexes. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.1430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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van Vollenhoven R, Mild M, Jacobsen S, Wallace DJ, Hanley JG, Petri MA, Bernatsky SR, Bae SC, Ramos-Casals M, Garcia-Hernandez F, Ayala-Guiterrez MDM, Ramsey-Goldman R, Doria A, Mosca M. THU0283 Two Year Follow-Up on Biologics Use in 13 Centers - Data from the International Registry for Biologics in SLE (IRBIS). Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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De Vita S, Quartuccio L, Isola M, Corazza L, Ramos-Casals M, Retamozo S, Ragab G, Zoheir N, El Menyawi MM, Salem M, Sansonno D, Conteduca V, Ferraccioli G, Gremese E, Tzioufas A, Voulgarelis M, Vassilopoulos D, Koutsianas C, Zignego AL, Urraro T, Pipitone N, Salvarani C, Ghinoi A, Guillevin L, Terrier B, Cacoub P, Filippini D, Saccardo F, Gabrielli A, Fraticelli P, Tomsic M, Ferri C, Sebastiani M, Tavoni A, Catarsi E, Mazzaro C, Pioltelli P, Nishimoto N, Scaini P, Monti G, Pietrogrande M, Galli M, Bombardieri S. SAT0175 Results of the Classification Criteria for Cryoglobulinemic Vasculitis Validation Study. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.1901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Ramos-Casals M, Ruiz-Irastorza G, Jiménez-Alonso J, Khamashta MA. [Belimumab in systemic lupus erythematosus: a guide for its use in the daily practice]. Rev Clin Esp 2013; 213:66-67. [PMID: 23565550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Ramos-Casals M, Ruiz-Irastorza G, Jiménez-Alonso J, Khamashta MA. [Recommendations on the use of belimumab in systemic lupus erythematosus. GEAS-SEMI Clinical Practice Guide]. Rev Clin Esp 2012; 213:42-58. [PMID: 23266125 DOI: 10.1016/j.rce.2012.10.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Accepted: 10/10/2012] [Indexed: 12/23/2022]
Abstract
Biological therapies are based on the administration of various types of synthetic molecules related to the immune response. Their use has spread in recent years to the field of systemic autoimmune diseases, particularly to systemic lupus erythematosus (SLE). Until 2011, these diseases were not included in the therapeutic indications approved by international regulatory agencies. Therefore, the use of biological therapies was restricted to clinical trials and to compassionate use for cases refractory to standard treatments (off-label use), which require the approval of the Health Ministry. In 2011, belimumab, a human monoclonal antibody that specifically binds to the soluble form of the protein human B lymphocyte stimulator BlyS, was approved for use in patients with SLE. Because the clinical information on the use of this new drug in patients with SLE has only been obtained from the results of randomized trials, the Study Group of Autoimmune Diseases (GEAS) of the Spanish Society of Internal Medicine (SEMI) has developed therapeutic guidelines. These guidelines are based on the current scientific evidence on the use of belimumab in SLE patients in the clinical practice.
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Ramos-Casals M. The B-lymphocyte stimulator connection in Sjogren's syndrome. Rheumatology (Oxford) 2012; 52:223-5. [DOI: 10.1093/rheumatology/kes235] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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Akasbi M, Berenguer J, Saiz A, Brito-Zerón P, Pérez-De-Lis M, Bové A, Diaz-Lagares C, Retamozo S, Blanco Y, Perez-Alvarez R, Bosch X, Sisó A, Graus F, Ramos-Casals M. White matter abnormalities in primary Sjögren syndrome. QJM 2012; 105:433-43. [PMID: 22156707 DOI: 10.1093/qjmed/hcr218] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To describe the main characteristics of patients with primary Sjögren syndrome (SS) and white matter abnormalities (WMA) seen by a specialist SS unit. METHODS The study cohort included 321 consecutive patients fulfilling the 2002 classification criteria for primary SS. We retrospectively analyzed the results of neuroimaging studies performed in patients who presented with neurological symptoms. Patients were further evaluated by three neurologists to determine fulfillment of the McDonald criteria for the diagnosis of multiple sclerosis (MS). RESULTS Fifty-one (16%) patients had at least one neuroimaging study, and 25 of these had WMA. WMA were classified as vascular pathological changes in 21 patients: 10 had multiple small focal lesions, 7 had beginning confluence of lesions and 4 had diffuse involvement of the entire region. WMA were classified as inflammatory/demyelinating lesions (MS-like) in 4 patients who fulfilled the MRI Barkhof criteria. Patients with inflammatory/demyelinating lesions were younger (53.7 vs. 73.5 years, P = 0.001) and had a lower frequency of hypertension (25% vs. 86%, P = 0.031) and altered glomerular filtration rate (0% vs. 70%, P = 0.047) in comparison with patients with vascular lesions. The multivariate age-sex adjusted model including the seven variables which were statistically significant in the univariate analysis (antimalarial therapy, leukopenia, anti-La/SSB antibodies, diabetes, hypertension, metabolic syndrome and HDL-c levels) identified hypertension (P = 0.019) and HDL-c levels (P = 0.032) as independent predictors of WMA in primary SS patients. CONCLUSION Neuroimaging studies disclosed WMA in 49% of patients with primary SS and suspected neurological involvement. WMA were identified as vascular pathological changes in 80% of the patients, and hypertension and HDL-c levels as predictive factors for this association.
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Alexeeva E, Kozlova A, Valieva S, Bzarova T, Chomahizde A, Isaeva K, Denisova R, Slepcova T, Starkova A, Amirdzhanova V, Alexandrova E, Avdeeva A, Novikov A, Panasyuk E, Cherkasova M, Klimova N, Nasonov E, Aggarwal A, Sharma A, Bhatnagar A, Dubula T, Mody GM, Abdel-Wahab N, Tayseer Khedr S, Rashad E, Alkady E, Mosad, Owino L, Ubeer A, Pan Z, Liu X, Xu J, Zhang Y, Omurzakova NA, Volkava M, Kundzer A, Generalov I, Tan W, Wu H, Zhao J, Derber LA, Lee DM, Shadick NA, Conn DL, Smith EA, Gersuk VH, Nepom GT, Moreland LW, Furst DE, Thompson SD, Jonas BL, Michael Holers V, Glass DN, Chen PP, Louis Bridges S, Weinblatt ME, Paulus HE, Tsao BP, Umar S, Ahmad S, Kant Katiyar C, Khan HA, Munoz A, Martinez R, Rodriguez S, Luis Marenco J, Lu Z, Guo-chun W, Shah D, Bhatnagar A, Wanchu A, Sherif Suliman YA, Budhoo A, Mody GM, Hristova M, Kamenarska Z, Dourmishev L, Baleva M, Kaneva R, Savov A, Retamozo S, Diaz-Lagares C, Brito-Zeron P, Gomez ME, Bosch X, Bove A, Forns X, Yague J, Ramos-Casals M, Chen Z, Li XM, Wang GS, Qian L, Li XP, Zu N, Zhao H, Xu B, Li HY, Xiang Q, Wang GC, Mazur-Nicorici L, Mazur M, Crib L, Ding H, Chen S, Ye S, Fedorenko E, Lukina G, Sigidin Y, Hammam N, Orabi H, Lue TF, Goel R, Danda D, Eapen C, Mathew J, Kumar S. Abstracts from EIR School ES01-ES25. Rheumatology (Oxford) 2012. [DOI: 10.1093/rheumatology/ker439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Hanly JG, Urowitz MB, Su L, Bae SC, Gordon C, Clarke A, Bernatsky S, Vasudevan A, Isenberg D, Rahman A, Wallace DJ, Fortin PR, Gladman D, Romero-Diaz J, Romero-Dirz J, Sanchez-Guerrero J, Dooley MA, Bruce I, Steinsson K, Khamashta M, Manzi S, Ramsey-Goldman R, Sturfelt G, Nived O, van Vollenhoven R, Ramos-Casals M, Aranow C, Mackay M, Kalunian K, Alarcón GS, Fessler BJ, Ruiz-Irastorza G, Petri M, Lim S, Kamen D, Peschken C, Farewell V, Thompson K, Theriault C, Merrill JT. Autoantibodies as biomarkers for the prediction of neuropsychiatric events in systemic lupus erythematosus. Ann Rheum Dis 2011; 70:1726-32. [PMID: 21893582 PMCID: PMC4664555 DOI: 10.1136/ard.2010.148502] [Citation(s) in RCA: 110] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Neuropsychiatric events occur unpredictably in systemic lupus erythematosus (SLE) and most biomarker associations remain to be prospectively validated. This study examined a disease inception cohort of 1047 SLE patients to determine which autoantibodies at enrolment predicted subsequent neuropsychiatric events. METHODS Patients with a recent SLE diagnosis were assessed prospectively for up to 10 years for neuropsychiatric events using the American College of Rheumatology case definitions. Decision rules of graded stringency determined whether neuropsychiatric events were attributable to SLE. Associations between the first neuropsychiatric event and baseline autoantibodies (lupus anticoagulant (LA), anticardiolipin, anti-β(2) glycoprotein-I, anti-ribosomal P and anti-NR2 glutamate receptor) were tested by Cox proportional hazards regression. RESULTS Disease duration at enrolment was 5.4 ± 4.2 months, follow-up was 3.6 ± 2.6 years. Patients were 89.1% female with mean (±SD) age 35.2 ± 13.7 years. 495/1047 (47.3%) developed one or more neuropsychiatric event (total 917 events). Neuropsychiatric events attributed to SLE were 15.4% (model A) and 28.2% (model B). At enrolment 21.9% of patients had LA, 13.4% anticardiolipin, 15.1% anti-β(2) glycoprotein-I, 9.2% anti-ribosomal P and 13.7% anti-NR2 antibodies. LA at baseline was associated with subsequent intracranial thrombosis (total n=22) attributed to SLE (model B) (HR 2.54, 95% CI 1.08 to 5.94). Anti-ribosomal P antibody was associated with subsequent psychosis (total n=14) attributed to SLE (model B) (HR 3.92, 95% CI 1.23 to 12.5, p=0.02). Other autoantibodies did not predict neuropsychiatric events. CONCLUSION In a prospective study of 1047 recently diagnosed SLE patients, LA and anti-ribosomal P antibodies are associated with an increased future risk of intracranial thrombosis and lupus psychosis, respectively.
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Hanly JG, Urowitz MB, Jackson D, Bae SC, Gordon C, Wallace DJ, Clarke A, Bernatsky S, Vasudevan A, Isenberg D, Rahman A, Sanchez-Guerrero J, Romero-Diaz J, Merrill JT, Fortin PR, Gladman DD, Bruce IN, Steinsson K, Khamashta M, Alarcón GS, Fessler B, Petri M, Manzi S, Nived O, Sturfelt G, Ramsey-Goldman R, Dooley MA, Aranow C, Van Vollenhoven R, Ramos-Casals M, Zoma A, Kalunian K, Farewell V. SF-36 summary and subscale scores are reliable outcomes of neuropsychiatric events in systemic lupus erythematosus. Ann Rheum Dis 2011; 70:961-7. [PMID: 21342917 PMCID: PMC3795436 DOI: 10.1136/ard.2010.138792] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To examine change in health-related quality of life in association with clinical outcomes of neuropsychiatric events in systemic lupus erythematosus (SLE). METHODS An international study evaluated newly diagnosed SLE patients for neuropsychiatric events attributed to SLE and non-SLE causes. The outcome of events was determined by a physician-completed seven-point scale and compared with patient-completed Short Form 36 (SF-36) health survey questionnaires. Statistical analysis used linear mixed-effects regression models with patient-specific random effects. RESULTS 274 patients (92% female; 68% Caucasian), from a cohort of 1400, had one or more neuropsychiatric event in which the interval between assessments was 12.3 ± 2 months. The overall difference in change between visits in mental component summary (MCS) scores of the SF-36 was significant (p<0.0001) following adjustments for gender, ethnicity, centre and previous score. A consistent improvement in neuropsychiatric status (N=295) was associated with an increase in the mean (SD) adjusted MCS score of 3.66 (0.89) in SF-36 scores. Between paired visits when the neuropsychiatric status consistently deteriorated (N=30), the adjusted MCS score decreased by 4.00 (1.96). For the physical component summary scores the corresponding changes were +1.73 (0.71) and -0.62 (1.58) (p<0.05), respectively. Changes in SF-36 subscales were in the same direction (p<0.05; with the exception of role physical). Sensitivity analyses confirmed these findings. Adjustment for age, education, medications, SLE disease activity, organ damage, disease duration, attribution and characteristics of neuropsychiatric events did not substantially alter the results. CONCLUSION Changes in SF-36 summary and subscale scores, in particular those related to mental health, are strongly associated with the clinical outcome of neuropsychiatric events in SLE patients.
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Vera-Recabarren MA, García-Carrasco M, Ramos-Casals M, Herrero C. Cutaneous lupus erythematosus: clinical and immunological study of 308 patients stratified by gender. Clin Exp Dermatol 2010; 35:729-35. [PMID: 20015282 DOI: 10.1111/j.1365-2230.2009.03764.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Numerous studies involving systemic lupus erythematosus (SLE) have attempted to identify gender differences in patients with lupus erythematosus (LE). However, few reports on cutaneous lupus erythematous (CLE) have identified gender differences. AIM To analyse and compare the prevalence and characteristics of the main clinical and immunological features of male and female patients with CLE. METHODS The medical records of 103 (33.4%) male and 205 (66.6%) female patients with CLE who were treated as inpatients or outpatients between January 1985 and December 2000 were retrospectively studied. All patients were reviewed in detail stratified by a predefined protocol. RESULTS Female patients had a higher prevalence of Raynaud's phenomenon (P < 0.01), chilblain lupus (P = 0.005), arthralgias (P = 0.001) and SLE (P < 0.01). Female patients were also more likely to have an increased erythrocyte sedimentation rate (P < 0.005), higher levels of antinuclear antibodies (P < 0.001) and decreased levels of C3 (P < 0.001), C4 (P < 0.01) and CH50 (P < 0.01). There was a higher prevalence of clinical and laboratory abnormalities in female patients who had both SLE and CLE than in male patients with both conditions. Conclusions. In our series, differences in the expression of CLE existed between male and female patients with respect to the type of lesions, systemic features, and immunological findings.
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Soto-Cardenas MJ, Perez-De-Lis M, Bove A, Navarro C, Brito-Zeron P, Diaz-Lagares C, Gandia M, Akasbi M, Siso A, Ballester E, Torres A, Ramos-Casals M. Bronchiectasis in primary Sjögren's syndrome: prevalence and clinical significance. Clin Exp Rheumatol 2010; 28:647-653. [PMID: 20883638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2009] [Accepted: 03/22/2010] [Indexed: 05/29/2023]
Abstract
OBJECTIVES To analyse the prevalence and clinical significance of bronchiectasis in a large series of patients with primary Sjögren's syndrome (SS) and evaluate its impact on disease expression and outcomes. METHODS The study cohort included 507 patients with primary SS. Bronchiectasis were diagnosed according to pulmonary computed tomography (CT). As a control group, we included 37 consecutive SS patients evaluated by pulmonary CT during the same study period without pulmonary involvement. RESULTS Fifty primary SS patients had bronchiectasis according to the pulmonary CT. Nine patients were excluded due to non-autoimmune processes and 41 were classified as bronchiectasis associated with primary SS (40 women, mean age of 64 years). All cases of bronchiectasis were of the cylindrical type and were located in the inferior lobes in 29 cases (71%). Patients with bronchiectasis were older at diagnosis of SS (60.39 vs. 52.54 years, p=0.022) and had a higher frequency of hiatus hernia (41% vs. 16%, p=0.024) in comparison with controls. Immunologically, patients with bronchiectasis had a lower frequency of anti-Ro/SS-A antibodies (27% vs. 54%, p=0.022) but a higher frequency of anti-smooth muscle--SMAantibodies (82% vs. 60%, p=0.043). During follow-up, patients with bronchiectasis had a higher frequency of respiratory infections (56% vs. 3%, p<0.001) and pneumonia (29% vs. 3%, p=0.002) in comparison with those without. CONCLUSIONS Patients with primary SS and bronchiectasis are characterised by an older age, a high frequency of hiatus hernia, a specific immunologic pattern (low frequency of anti-Ro/SS-A and high frequency of anti-SMA) and during follow-up a much higher frequency of respiratory infections and pneumonia.
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