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Albert G, Narváez J, Ricse M, Estrada P, Zacarías A, Pestaña M, Mora C, Rozadilla A, Fulladosa X, Nolla J, Rubio Rivas M. FRI0403 Mesangial Proliferative Lupus Nephritis (ISN/RPS CLASS II): Clinical and Prognosis in A Cohort of 45 Patients. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.5317] [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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Loricera J, Blanco R, Castañeda S, Humbría A, Ortego-Centeno N, Narváez J, Mata C, Melchor S, Aurrecoechea E, Calvo-Alén J, Lluch P, Moll C, Mínguez M, Herrero-Beaumont G, Bravo B, Rubio E, Freire M, Peirό E, González-Vela M, Rueda-Gotor J, Pina T, Calvo-Río V, Ortiz-Sanjuán F, González-Gay M. SAT0279 Tocilizumab in Refractory Aortitis: Study on 16 Patients and Literature Review. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.2984] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Alegre Sancho J, Narváez J, Castellví I, Herrera S, Molina M, Castillo D, Oller Rodríguez J, De la Morena Barrio I, Robustillo Villarino M, Valls Pascual E, Ybáñez García D, Martínez Ferrer Ά, Vicens Bernabéu E, Vergara Dangond C, Feced Olmos C, Llobet J, Nolla J, Gil Latorre F. FRI0485 Long-Term Efficacy of Rituximab in Systemic Sclerosis. A Spanish Multicentric Analysis. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.5629] [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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Ricse M, Narváez J, Albert G, Estrada P, Armengol E, Giménez C, Roset A, De Lama E, Torras J, Rodríguez J, Mitjavila F, Nolla J. AB0536 Renal Biopsy in Patients with Systemic Lupus Erythematosus and Proteinuria Less than 0.5 G/24Hrs: Table 1. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.5662] [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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Fernández-Nebro A, Marenco JL, López-Longo F, Galindo M, Hernández-Cruz BE, Narváez J, Rúa-Figueroa ÍI, Raya-Alvarez E, Zea A, Freire M, Sánchez-Atrio AI, García-Vicuña R, Pego-Reigosa JM, Manrique-Arija S, Nieves-Martín L, Carreño L. The effects of rituximab on the lipid profile of patients with active systemic lupus erythematosus: results from a nationwide cohort in Spain (LESIMAB). Lupus 2014; 23:1014-22. [DOI: 10.1177/0961203314534909] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Patients with systemic lupus erythematosus (SLE) have increased cardiovascular risk related to lipid changes induced by inflammatory activity, proteinuria and treatments. Our objective was to analyse lipid changes in a cohort of patients with SLE resistant to standard treatments who were treated with rituximab. Methods The study population comprised a retrospective multicentre, national cohort of patients with SLE resistant to standard treatments who were treated with rituximab. The basic lipid profile, concomitant treatment and disease activity were analysed at the start of the treatment, 24 weeks later, and at the end of the follow-up period. The effects of the main lupus variables and therapy on the lipid changes were analysed. Results Seventy-nine patients with active lupus treated with rituximab were assessed during 149.3 patient-years. Prior to the treatment, 69% had dyslipidaemia. The most frequent abnormalities were a low-density lipoprotein (LDL) level of ≥100 mg/dl (34%) and a high-density lipoprotein (HDL) level of <50 mg/dl (27%). Baseline total cholesterol (TC) and LDL levels correlated with the degree of proteinuria, while the concentration of triglycerides (TGs) correlated with the SLE Disease Activity Index (SLEDAI). TGs were reduced at short- and long-term follow-up after rituximab treatment. A multiple linear regression analysis identified that the reduction of the lupus inflammatory activity, particularly changes in proteinuria, was the only independent variable that was positively associated with the reduction in TGs after 24 weeks ( p = 0.001) and with TC ( p = 0.005) and TGs ( p < 0.001) at the end of the follow-up period. Conclusion Our results suggest that rituximab may improve the long-term lipid profile of patients with SLE refractory to standard treatment, mainly by reducing inflammatory activity.
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Serrano A, Márquez A, Mackie SL, Carmona FD, Solans R, Miranda-Filloy JA, Hernández-Rodríguez J, Cid MC, Castañeda S, Morado IC, Narváez J, Blanco R, Sopeña B, García-Villanueva MJ, Monfort J, Ortego-Centeno N, Unzurrunzaga A, Marí-Alfonso B, Sánchez Martín J, de Miguel E, Magro C, Raya E, Braun N, Latus J, Molberg O, Lie BA, Moosig F, Witte T, Morgan AW, González-Gay MA, Martín J. Identification of the PTPN22 functional variant R620W as susceptibility genetic factor for giant cell arteritis. Ann Rheum Dis 2013; 72:1882-1886. [PMID: 23946333 DOI: 10.1136/annrheumdis-2013-203641] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To analyse the role of the PTPN22 and CSK genes, previously associated with autoimmunity, in the predisposition and clinical phenotypes of giant cell arteritis (GCA). METHODS Our study population was composed of 911 patients diagnosed with biopsy-proven GCA and 8136 unaffected controls from a Spanish discovery cohort and three additional independent replication cohorts from Germany, Norway and the UK. Two functional PTPN22 polymorphisms (rs2476601/R620W and rs33996649/R263Q) and two variants of the CSK gene (rs1378942 and rs34933034) were genotyped using predesigned TaqMan assays. RESULTS The analysis of the discovery cohort provided evidence of association of PTPN22 rs2476601/R620W with GCA (PFDR=1.06E-04, OR=1.62, CI 95% 1.29 to 2.04). The association did not appear to follow a specific GCA subphenotype. No statistically significant differences between allele frequencies for the other PTPN22 and CSK genetic variants were evident either in the case/control or in stratified case analysis. To confirm the detected PTPN22 association, three replication cohorts were genotyped, and a consistent association between the PTPN22 rs2476601/R620W variant and GCA was evident in the overall meta-analysis (PMH=2.00E-06, OR=1.51, CI 95% 1.28 to 1.79). CONCLUSIONS Our results suggest that the PTPN22 polymorphism rs2476601/R620W plays an important role in the genetic risk to GCA.
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Silva L, Otόn T, Askanase A, Carreira P, Rodríguez-Almaraz E, Lόpez-Longo J, Rúa-Figueroa I, Narváez J, Ruiz E, Calvo E, Toyos F, Alegre J, Tomero E, Montilla C, Zea A, Uriarte E, Marras C, Martínez-Taboada V, Belmonte Ά, Rosas J, Raya E, Bonilla G, Freire M, Calvo J. SAT0209 Characterization of pure membranous lupus nephritis: A cohort of 134 patients. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.3156] [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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Ricse M, Albert G, Narváez J, Nolla J, Domínguez M, Gόmez C. AB0409 Prevalence of nasal colonization by staphylococcus aureus in patients with rheumatoid arthritis. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.409] [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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Nieves-Martín L, Pego J, Marenco J, Carreño L, Galindo M, Tomero E, Rúa-Figueroa I, Hernández B, Narváez J, Úcar E, Olivé A, Zea A, Fernández-Castro M, Raya-Άlvarez E, Freire M, Martínez-Taboada V, Pérez-Venegas J, Sánchez-Atrio A, Villa I, Manrique-Arija S, Rodríguez-García V, Romero-Barco C, Lόpez-Longo F, Carreira P, Martínez Pérez R, García-Vicuña R, Fernández-Nebro A. AB0625 Effect of one cycle of rituximab in the lipid profile of patients with refractory systemic lupus erythematosus (SLE):. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.625] [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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Montes A, Perez-Pampin E, Navarro-Sarabia F, Moreira V, Rodríguez de la Serna A, Magallanes B, Vasilopoulos Y, Sarafidou T, Fernández-Nebro A, Ordóñez MDC, Narváez J, Cañete JD, Isaacs J, Morgan A, Barton A, Wilson AG, Gomez-Reino JJ, González A. THU0009 Reduced Clinical Improvement in Rheumatoid Arthritis Patients Showing IgG1 Allotype -Infliximab Incompatibility. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.537] [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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Bianchi M, Santo P, Estrada P, Lόpez L, Aparicio M, Narváez J, Valverde J, Nolla J. AB0690 Pulmonary arterial hypertension (PAH) in a cohort of systemic lupus erythematosus (SLE). Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.690] [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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Garcia-Melchor E, Grados D, González-Roca E, Riera E, Juan M, Yagüe J, Arostegui JI, Narváez J, Olivé A. AB0002 Analysis of nlrp3 and nod2 genes in adult onset still’s disease. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.2325] [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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Gόmez Caballero M, Corominas H, Narváez J, Torrente V, de la Fuente de Dios D, Campoy E, Clavaguera T, Morlà R, Roig-Vilaseca D, Arasa X, Díaz-Torné C, Salvador G, Gόmez Puerta J, Moller I, Alegre C, Graell E, Ponce A, Lisbona M, Pérez García C, Sirvent E, Figuls R, Poca V, Sanmartí R. AB1361 Diagnostic and therapeutic delay of rheumathoid artritis patients in catalonia (spain) and their relationship with specialized healthcare units. The audit study. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.1355] [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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Bejerano C, Blanco R, Calvo J, Narváez J, Peirό E, Pérez-Martín I, Alonso J, Rueda-Gotor J, Corrales A, Peña J, Martínez I, Carril J, González-Gay M. AB1245 Aortitis: Diagnosis by positron emission tomography (PET):. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.1241] [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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Narváez J. Lack of response to teriparatide therapy for bisphosphonate-associated osteonecrosis of the jaw: reply to Subramanian and Quek. Osteoporos Int 2013; 24:737. [PMID: 22581291 DOI: 10.1007/s00198-012-1996-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Accepted: 03/27/2012] [Indexed: 10/28/2022]
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Narváez J, Narváez JA, Gómez-Vaquero C, Nolla JM. Lack of response to teriparatide therapy for bisphosphonate-associated osteonecrosis of the jaw. Osteoporos Int 2013; 24:731-3. [PMID: 22398853 DOI: 10.1007/s00198-012-1918-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Accepted: 01/23/2012] [Indexed: 10/28/2022]
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Fernández-Nebro A, de la Fuente JLM, Carreño L, Izquierdo MG, Tomero E, Rúa-Figueroa I, Hernández-Cruz BE, Narváez J, Ucar E, Olivé A, Zea A, Fernández-Castro M, Raya-Álvarez E, Pego-Reigosa JM, Freire M, Martínez-Taboada VM, Pérez-Venegas J, Sánchez-Atrio AI, Villa-Blanco I, Manrique-Arija S, López-Longo FJ, Carreira PE, Martínez-Pérez R, García-Vicuña R. Multicenter longitudinal study of B-lymphocyte depletion in refractory systemic lupus erythematosus: the LESIMAB study. Lupus 2012; 21:1063-76. [PMID: 22786985 DOI: 10.1177/0961203312446627] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This study aimed to investigate the effectiveness and safety of single and repeated courses of rituximab in patients with refractory lupus. METHODS LESIMAB is a multicenter, retrospective, longitudinal study of lupus patients who have not responded to standard therapy and have been treated with rituximab. Response rates at six months and at follow-up were defined as efficacy outcomes. Complete response was defined as a SELENA-SLEDAI score ≤ two and a SELENA-SLEDAI Flare Index of zero. Partial response was defined as a reduction in the SELENA-SLEDAI score of ≥four points with no new or worsening of symptoms. Adverse events were collected. RESULTS Seventy-three (62.9%) of 116 patients achieved a response at six months (complete in 22 and partial in 51). Ninety-seven (77.6%) of 128 patients achieved a response after a mean follow-up of 20.0 ± 15.2 months (complete in 50 and partial in 47). High baseline SLEDAI score, previous treatment with ≥100 mg/day prednisone, and no history of severe hematologic flare were associated with response after the first treatment course. The median time to response was 6.5 months (95% CI, 5.0-8.0). Thirty-seven patients (38.1%) relapsed after the first infusion. The flare was severe in seven cases and mild to moderate in 29 cases. Serious infection rate was 12.6/100 patient-years. A schedule of four weekly doses was associated with more serious infections. Six patients died: two of infection and four of lupus complications. CONCLUSION Rituximab can be an effective treatment option for patients who have refractory lupus with severe or life-threatening disease with an acceptable tolerance profile.
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Riera E, Olivé A, Narváez J, Holgado S, Santo P, Mateo L, Bianchi MM, Nolla JM. Adult onset Still's disease: review of 41 cases. Clin Exp Rheumatol 2011; 29:331-336. [PMID: 21385548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Accepted: 12/02/2010] [Indexed: 05/30/2023]
Abstract
OBJECTIVES To describe the clinical, laboratory and radiological features, treatment and prognosis of patients with adult onset Still's disease (AOSD). METHODS Specific clinical features were retrospectively recorded in 41 patients fulfilling the Yamaguchi criteria. Patients were reviewed in two academic hospitals with a referral area of 700,000-1,000,000 inhabitants. Laboratory tests including haemogram, ferritin, biochemistry and autoimmunity were reviewed. Radiological studies, treatment and ACR functional class were determined. RESULTS Forty-one patients with AOSD were identified, 25 of whom were female. Mean age at diagnosis: 38.19 years (range 17-68). Feverish polyarthritis was the most common clinical presentation. Acute phase reactants were invariably high in all patients. Serum ferritin levels were elevated in 86% of patients. Anti-cyclic citrullinated peptide antibodies (anti-CCP antibodies) were negative in all patients except one. The course of the disease was monocyclic in 44% of the patients, polycyclic in 26%, and chronic articular in 30%. ACR class was as follows: 29 (72.5%) class I, 7 (17.5%) class II, 2 (5%) class III and 2 (5%) class IV. As for the treatment received, aspirin or NSAIDs controlled the disease in eight patients (19.5%) and high-dose corticosteroids (0.5-1 mg/kg/day) in 32 (78%). Almost half of the patients (49%) required an additional diseasemodifying agent, usually methotrexate. Finally, in seven of them (17%) a biological treatment with TNF-α or specially anti-IL-1 had to be added to control the disease. CONCLUSIONS The clinical and laboratory findings were similar to previous studies. Anti-CCP antibodies were almost always negative. A monocyclic course was associated with a good prognosis. Most of the patients were in ACR functional class I and II. Biological agents were required in 7 patients (17%).
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Narváez J, Díaz-Torné C, Juanola X, Geli C, Llobet JM, Nolla JM, Díaz-López C. Rituximab therapy for refractory systemic-onset juvenile idiopathic arthritis. Ann Rheum Dis 2009; 68:607-8. [PMID: 19286909 DOI: 10.1136/ard.2008.092106] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Narváez JA, Narváez J, Serrallonga M, De Lama E, de Albert M, Mast R, Nolla JM. Cervical spine involvement in rheumatoid arthritis: correlation between neurological manifestations and magnetic resonance imaging findings. Rheumatology (Oxford) 2008; 47:1814-9. [PMID: 18927193 DOI: 10.1093/rheumatology/ken314] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To evaluate the correlation between neurological deficits indicative of compressive myelopathy and MRI findings in a series of patients with RA and symptomatic involvement of the cervical spine. METHODS Forty-one consecutive patients with RA were studied using cervical spine MRI. Unconditional logistic regression analysis was used to identify MRI parameters of cervical spine involvement associated with the development of neurological dysfunction. RESULTS The mean age of the 41 patients (33 women and 8 men) was 59 yrs (range 23-82 yrs), while the median disease duration was 18 +/- 9 yrs (range 4-40 yrs). According to Ranawat's classification, 17 (42%) patients were in Class I, 21 (51%) in Class II and 3 (7%) in Class III. Thus, patients with clinical manifestations of compressive myelopathy (Ranawat's Class II + III) represented 58% (24/41) of all cases. Among the different MRI parameters of cervical spine involvement analysed, only the presence of atlantoaxial spinal canal stenosis [odds ratio (OR) 4.55; 95% CI 1.14-18.15], atlantoaxial cervical cord compression (OR 9.6; 95% CI 1.08-85.16) and subaxial myelopathy changes (OR 11.43; 95% CI 1.3-100.81) were associated with a significantly increased risk for neurological dysfunction (Ranawat's Class II or III). CONCLUSION In RA patients with symptomatic cervical spine involvement, there is a strong correlation between the development of neurological dysfunction and MRI identification of atlantoaxial spinal canal stenosis, especially in those cases with evidence of upper cervical cord or brainstem compression and subaxial myelopathy changes.
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García-Gómez C, Nolla JM, Valverde J, Narváez J, Corbella E, Pintó X. High HDL-cholesterol in women with rheumatoid arthritis on low-dose glucocorticoid therapy. Eur J Clin Invest 2008; 38:686-92. [PMID: 18837746 DOI: 10.1111/j.1365-2362.2008.01994.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Dyslipidaemia has been described in non-treated rheumatoid arthritis (RA), and improves after therapy with disease modifying anti-rheumatic drugs or glucocorticoids; however, it has generally been perceived that glucocorticoids adversely affect lipid metabolism. The association of low dose glucocorticoid therapy with plasma lipid levels was evaluated in female RA patients. MATERIALS AND METHODS A cross-sectional study was conducted in 78 female RA patients [mean age: 60 (12) years; mean disease duration: 13 (9) years]. Sixty-five (83%) were on glucocorticoid therapy [total equivalent mean prednisone dose: 5.1 (1.7) mg d(-1)]. Each patient was assessed through a self-reported questionnaire, structured interview and physical examination. Blood samples were obtained for routine biochemistry, lipid profile and haematological tests. Lipid profiles of RA patients who were and were not on glucocorticoid therapy were compared. RESULTS Clinical and laboratory features of the two groups of patients were similar, except for the Health Assessment Questionnaire and body mass index, which were significantly higher in the patients on glucocorticoid therapy. These patients had 14.7% higher serum high-density lipoprotein cholesterol (HDL-c) levels than untreated patients (P = 0.043), mainly at the expense of HDL2 subfraction, which was 24.4% higher (P < 0.039), whereas HDL3-c was only 7.4% higher (P = 0.219). Serum levels of glucose and total cholesterol, triglyceride, low-density lipoprotein cholesterol (LDL -c), very low-density lipoprotein cholesterol, apolipoproteins A-I and B were not increased in patients on glucocorticoid therapy. CONCLUSIONS Low dose glucocorticoid therapy in RA patients is associated with an increase in HDL-c, without increasing LDL-c or triglyceride. These lipid changes may overall be considered favourable.
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Narváez J, Bernad B, Gómez-Vaquero C, García-Gómez C, Roig-Vilaseca D, Juanola X, Rodriguez-Moreno J, Nolla JM, Valverde J. Impact of antiplatelet therapy in the development of severe ischemic complications and in the outcome of patients with giant cell arteritis. Clin Exp Rheumatol 2008; 26:S57-S62. [PMID: 18799055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To evaluate whether concomitant treatment with low-dose aspirin or other antiplatelet agents have an impact on the risk of severe ischemic complications and in the outcome of patients with giant cell arteritis (GCA). METHODS A retrospective follow-up study of an unselected population of 121 patients with GCA. RESULTS Thirty-seven patients (30.5%) received antiplatelet therapy before the onset of GCA symptoms and continued taking it during the corticosteroid treatment (30 received aspirin and 7 other antiplatelet agents). No statistically significant reduction in the incidence of ischemic manifestations (including jaw claudication, visual manifestations, cerebrovascular accidents, ischemic heart disease, and limb claudication due to large artery stenosis) was observed in this group compared with the remaining patients. When we analyzed follow-up data, we found no significant differences between groups in terms of frequency of relapses and percentage of patients recovered from GCA. Corticosteroid requirements among patients in long-lasting remission were lower in those under antiplatelet therapy, but this reduction was fairly modest, statistically non significant and thus of uncertain clinical significance. Similar results were found when only aspirin exposed patients (n=30) were compared to non-exposed patients. Logistic regression analysis showed that antiplatelet therapy (p=0.54, OR 1.31; 95% CI: 0.54-3.19) had not an independent protective effect against ischemic events when adjusted for age, sex, and the presence of atherosclerotic risk factors. CONCLUSION We did not observe a significant benefit derived from the use of antiplatelet therapy in either the incidence of severe ischemic events or the disease outcome. Although our results do not discard a potential therapeutic effect of high-dose aspirin, they do not confirm its suggested protective effect in preventing ischemic complications when used at antiplatelet doses.
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Narváez J, Narváez JA, Nolla JM, Sirvent E, Reina D, Valverde J. Giant cell arteritis and polymyalgia rheumatica: usefulness of vascular magnetic resonance imaging studies in the diagnosis of aortitis. Rheumatology (Oxford) 2005; 44:479-83. [PMID: 15716321 DOI: 10.1093/rheumatology/keh513] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES One of the unresolved challenges posed in giant cell (temporal) arteritis (GCA) is the detection and monitoring of large-artery complications, particularly aortitis. Recent investigations support vascular magnetic resonance imaging (MRI) studies in this issue. We report our preliminary experience with this imaging technique in the study of the aorta and its proximal branches in patients with GCA and/or polymyalgia rheumatica (PMR). METHODS Between 2000 and 2003, six patients with GCA and/or PMR seen in our department were diagnosed with aortitis using vascular MRI studies. In all cases, the study was performed according to a specifically designed protocol that included MRI and MR angiography (MRA). RESULTS MRI was a hepful non-invasive method for diagnosis of aortitis in all cases, providing accurate information about its extent. In particular, MRI had a higher ability to detect earlier stages of vasculitis disclosing subclinical aortitis in five of the six patients. The main signs of early vascular inflammation observed were vessel wall thickness and oedema (six cases) and increased mural enhancement on postcontrast T1-weighted images (four cases). MRA disclosed lumen changes (stenosis) in two patients. On follow-up studies, whereas vascular stenosis and vessel wall thickness remained invariable, vascular wall oedema and contrast enhancement improved significantly when disease activity decreased. CONCLUSION MRI may be a useful technique for diagnosing patients with occult major artery involvement in GCA, whether presenting with classic symptoms of temporal arteritis or PMR. Its utility for monitoring the course of the disease and response to treatment requires further confirmation.
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Chavarro J, Villamor E, Narváez J, Hoyos A. Socio-demographic predictors of age at menarche in a group of Colombian university women. Ann Hum Biol 2004; 31:245-57. [PMID: 15204366 DOI: 10.1080/03014460310001652239] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Age at menarche is an important developmental milestone known to be modified by social and environmental factors. The determinants and potential change over time of age at menarche in Colombia are not well documented. AIMS To obtain a current estimate of age at menarche in Colombia and to examine the associations between socio-demographic characteristics and age at menarche. SUBJECTS AND METHODS Between 1998 and 2001, we obtained recalled age at menarche, socio-demographic characteristics, and physical activity information in a group of 3206 students at the National University of Colombia who completed a self-administered questionnaire. We examined the cross-sectional associations between mean age at menarche and migratory pattern, parental education, socio-economic status indicators, practice of physical activity, and year of birth using linear regression. RESULTS Mean age at menarche (+/- SD) was 12.68 +/- 1.31. In a multivariate adjusted regression model, age at menarche was positively associated with family size and the practice of at least 2 daily hours of physical activity, and was inversely related to urbanization level, socio-economic status, and year of birth. CONCLUSIONS Socio-economic status is a strong predictor of menarche in this population. There appears to be a trend towards earlier menarche by year of birth.
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