1
|
Gavilán-Carrera B, Soriano-Maldonado A, Mediavilla-García JD, Lavie CJ, Vargas-Hitos JA. Prescribing statin therapy in physically (in)active individuals vs prescribing physical activity in statin-treated patients: A four-scenario practical approach. Pharmacol Res 2023; 197:106962. [PMID: 37866703 DOI: 10.1016/j.phrs.2023.106962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 07/31/2023] [Accepted: 10/12/2023] [Indexed: 10/24/2023]
Abstract
Statins are among the most commonly prescribed medications worldwide. Statin-associated muscle symptoms (SAMS) represent a frequent statin-related adverse effect associated with statin discontinuation and increased cardiovascular disease (CVD) events. Emerging evidence indicate that the majority of SAMS might not be actually caused by statins, and the nocebo/drucebo effect (i.e. adverse effects caused by negative expectations) might also explain SAMS. Physical activity (PA) is a cornerstone in the management of CVD risk. However, evidence of increased creatine-kinase levels in statin-treated athletes exposed to a marathon has been generalized, at least to some extent, to the general population and other types of PA. This generalization is likely inappropriate and might induce fear around PA in statin users. In addition, the guidelines for lipid management focus on aerobic PA while the potential of reducing sedentary behavior and undertaking resistance training have been overlooked. The aim of this report is to provide a novel proposal for the concurrent prescription of statin therapy and PA addressing the most common and clinically relevant scenarios by simultaneously considering the different stages of statin therapy and the history of PA. These scenarios include i) statin therapy initiation in physically inactive patients, ii) PA/exercise initiation in statin-treated patients, iii) statin therapy initiation in physically active patients, and iv) statin therapy in athletes and very active individuals performing SAMS-risky activities.
Collapse
Affiliation(s)
- Blanca Gavilán-Carrera
- Department of Internal Medicine, Virgen de las Nieves University Hospital, Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain; PA-HELP "Physical Activity for HEaLth Promotion" Research Group, University of Granada, Granada, Spain; Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain
| | - Alberto Soriano-Maldonado
- Department of Education, Faculty of Education Sciences, University of Almería, Almería, Spain; SPORT Research Group (CTS-1024), CIBIS (Centro de Investigación para el Bienestar y la Inclusión Social) Research Center, University of Almería, Almería, Spain.
| | | | - Carl J Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-the UQ School of Medicine, New Orleans, LA, USA
| | - José Antonio Vargas-Hitos
- Department of Internal Medicine, Virgen de las Nieves University Hospital, Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| |
Collapse
|
2
|
Gavilán-Carrera B, Ruiz-Cobo A, Amaro-Gahete FJ, Soriano-Maldonado A, Vargas-Hitos JA. No Changes in Body Composition and Adherence to the Mediterranean Diet after a 12-Week Aerobic Training Intervention in Women with Systemic Lupus Erythematosus: The EJERCITA-LES Study. Nutrients 2023; 15:4424. [PMID: 37892499 PMCID: PMC10609990 DOI: 10.3390/nu15204424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/08/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023] Open
Abstract
Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease linked to high cardiovascular risk. To reach an adequate body composition status while maintaining proper dietary habits are effective strategies for reducing cardiovascular risk, both being potentially modified through exercise. This study aimed to evaluate the effects of a 12-week aerobic training intervention on anthropometry, body composition and adherence to the Mediterranean diet in women with SLE. A total of 58 women with SLE were assigned to either an exercise group (EG; n = 26) or a comparison group (CG; n = 32) in this non-randomized controlled trial. The EG comprised 12 weeks of aerobic exercise (two sessions/week) between 40-75% of the individual's heart rate reserve (calculated as maximum heart rate - resting heart rate) and the CG received usual care. At baseline and after the intervention, the anthropometry (i.e., weight, waist circumference, waist-to-hip ratio, and body mass index) and body composition (i.e., fat mass and lean mass) were assessed using a stadiometer, an anthropometric tape, and a bioimpedance device, respectively. Dietary habits were assessed with the Mediterranean Diet score. There were no between-group differences in neither anthropometric nor body composition parameters (all p > 0.05). Similarly, no between-group differences were obtained in the adherence to the Mediterranean diet after the exercise intervention (all p > 0.05). Contrary to the initial hypothesis, these results suggest that the 12-week aerobic training intervention performed in this study did not improve anthropometry, body composition or adherence to the Mediterranean diet in women with SLE.
Collapse
Affiliation(s)
- Blanca Gavilán-Carrera
- Departamento de Medicina Interna, Hospital Universitario Virgen de las Nieves, 18014 Granada, Spain;
- Instituto de Investigación Biosanitaria ibs.Granada, 18012 Granada, Spain;
- PA-HELP “Physical Activity for HEaLth Promotion” Research Group, University of Granada, 18071 Granada, Spain
- Sport and Health University Research Institute (iMUDS), University of Granada, 18071 Granada, Spain
| | - Alba Ruiz-Cobo
- Department of Physiology, Faculty of Medicine, University of Granada, 18001 Granada, Spain;
| | - Francisco José Amaro-Gahete
- Instituto de Investigación Biosanitaria ibs.Granada, 18012 Granada, Spain;
- Department of Physiology, Faculty of Medicine, University of Granada, 18001 Granada, Spain;
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, 28029 Granada, Spain
| | - Alberto Soriano-Maldonado
- Department of Education, Faculty of Education Sciences, University of Almería, 04120 Almería, Spain;
- SPORT Research Group (CTS-1024), CERNEP Research Center, University of Almería, 04120 Almería, Spain
| | - José Antonio Vargas-Hitos
- Departamento de Medicina Interna, Hospital Universitario Virgen de las Nieves, 18014 Granada, Spain;
- Instituto de Investigación Biosanitaria ibs.Granada, 18012 Granada, Spain;
| |
Collapse
|
3
|
Sola-Rodríguez S, Vargas-Hitos JA, Gavilán-Carrera B, Rosales-Castillo A, Ríos-Fernández R, Sabio JM, Soriano-Maldonado A. Physical Fitness Attenuates the Impact of Higher Body Mass and Adiposity on Inflammation in Women With Systemic Lupus Erythematosus. Front Immunol 2021; 12:729672. [PMID: 34721392 PMCID: PMC8552526 DOI: 10.3389/fimmu.2021.729672] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 09/20/2021] [Indexed: 11/30/2022] Open
Abstract
Aims Higher body mass and adiposity represent independent contributors to the systemic low-grade inflammatory state often observed in patients with systemic lupus erythematosus (SLE). This study assessed the role of physical fitness in the association of body mass and adiposity with inflammation in women with SLE. Methods A total of 77 women with SLE were included in this cross-sectional study. We obtained body mass index, waist-to-height ratio, and body fat percentage as indicators of body mass and adiposity. Inflammation was assessed through Serum levels of C-reactive protein, interleukin 6, and leptin. Cardiorespiratory fitness was assessed with the 6-minute walk test, range of motion with the back-scratch test, and muscular strength with handgrip dynamometry. Results Cardiorespiratory fitness attenuated the association of both body mass index and body fat percentage with interleukin 6 (all, P<0.05). Range of motion attenuated the association of body mass index with interleukin 6 (P<0.05) and the association of body fat percentage with C-reactive protein (P<0.05). These interactions indicated that higher fitness was associated with a lower increase in inflammation per unit increase of body mass or adiposity. Muscular strength showed a non-significant trend to attenuate the association of body fat percentage with interleukin 6 (P=0.057) but potentiated the association of body fat percentage with leptin (P<0.05). Conclusion These findings suggest that higher levels of cardiorespiratory fitness and range of motion might attenuate the impact of higher body mass and adiposity on inflammation in women with SLE. The role of muscular strength requires further investigation.
Collapse
Affiliation(s)
- Sergio Sola-Rodríguez
- Department of Education, Faculty of Education Sciences, University of Almería, Almería, Spain.,SPORT Research Group (CTS-1024), CERNEP Research Center, University of Almería, Almería, Spain
| | - José Antonio Vargas-Hitos
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, "Virgen de las Nieves" University Hospital, Granada, Spain
| | - Blanca Gavilán-Carrera
- Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Antonio Rosales-Castillo
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, "Virgen de las Nieves" University Hospital, Granada, Spain
| | - Raquel Ríos-Fernández
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, "San Cecilio" University Hospital, Granada, Spain
| | - José Mario Sabio
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, "Virgen de las Nieves" University Hospital, Granada, Spain
| | - Alberto Soriano-Maldonado
- Department of Education, Faculty of Education Sciences, University of Almería, Almería, Spain.,SPORT Research Group (CTS-1024), CERNEP Research Center, University of Almería, Almería, Spain
| |
Collapse
|
4
|
Sola-Rodríguez S, Vargas-Hitos JA, Gavilán-Carrera B, Rosales-Castillo A, Sabio JM, Hernández-Martínez A, Martínez-Rosales E, Ortego-Centeno N, Soriano-Maldonado A. Relative Handgrip Strength as Marker of Cardiometabolic Risk in Women with Systemic Lupus Erythematosus. Int J Environ Res Public Health 2021; 18:ijerph18094630. [PMID: 33925420 PMCID: PMC8123887 DOI: 10.3390/ijerph18094630] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 04/26/2021] [Accepted: 04/26/2021] [Indexed: 11/16/2022]
Abstract
This study aimed to examine the association of relative handgrip strength (rHGS) with cardiometabolic disease risk factors in women with systemic lupus erythematosus (SLE). Methods: Seventy-seven women with SLE (mean age 43.2, SD 13.8) and clinical stability during the previous six months were included. Handgrip strength was assessed with a digital dynamometer and rHGS was defined as absolute handgrip strength (aHGS) divided by body mass index (BMI). We measured blood pressure, markers of lipid and glucose metabolism, inflammation (high sensitivity C-reactive protein [hs-CRP]), arterial stiffness (pulse wave velocity [PWV]), and renal function. A clustered cardiometabolic risk index (z-score) was computed. Results: Pearson′s bivariate correlations revealed that higher rHGS was associated with lower systolic blood pressure (SBP), triglycerides, hs-CRP, PWV, and lower clustered cardiometabolic risk (rrange = from −0.43 to −0.23; all p < 0.05). Multivariable linear regression analyses adjusted for age, disease activity (SLEDAI), and accrual damage (SDI) confirmed these results (all p < 0.05) except for triglycerides. Conclusions: The findings suggest that higher rHGS is significantly associated with lower cardiometabolic risk in women with SLE.
Collapse
Affiliation(s)
- Sergio Sola-Rodríguez
- Department of Education, Faculty of Education Sciences, University of Almería, 04120 Almería, Spain; (A.H.-M.); (E.M.-R.); (A.S.-M.)
- SPORT Research Group (CTS-1024), CERNEP Research Center, University of Almería, 04120 Almería, Spain
- Correspondence: ; Tel.: +34-675-109-317
| | - José Antonio Vargas-Hitos
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (J.A.V.-H.); (A.R.-C.); (J.M.S.)
| | - Blanca Gavilán-Carrera
- Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, 18071 Granada, Spain;
| | - Antonio Rosales-Castillo
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (J.A.V.-H.); (A.R.-C.); (J.M.S.)
| | - José Mario Sabio
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (J.A.V.-H.); (A.R.-C.); (J.M.S.)
| | - Alba Hernández-Martínez
- Department of Education, Faculty of Education Sciences, University of Almería, 04120 Almería, Spain; (A.H.-M.); (E.M.-R.); (A.S.-M.)
- SPORT Research Group (CTS-1024), CERNEP Research Center, University of Almería, 04120 Almería, Spain
| | - Elena Martínez-Rosales
- Department of Education, Faculty of Education Sciences, University of Almería, 04120 Almería, Spain; (A.H.-M.); (E.M.-R.); (A.S.-M.)
- SPORT Research Group (CTS-1024), CERNEP Research Center, University of Almería, 04120 Almería, Spain
| | - Norberto Ortego-Centeno
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, “San Cecilio” University Hospital, 18016 Granada, Spain;
| | - Alberto Soriano-Maldonado
- Department of Education, Faculty of Education Sciences, University of Almería, 04120 Almería, Spain; (A.H.-M.); (E.M.-R.); (A.S.-M.)
- SPORT Research Group (CTS-1024), CERNEP Research Center, University of Almería, 04120 Almería, Spain
| |
Collapse
|
5
|
Pestaña-Fernández M, Rubio-Rivas M, Tolosa-Vilella C, Guillén-Del-Castillo A, Colunga-Argüelles D, Argibay A, Marí-Alfonso B, Marín-Ballvé A, Pla-Salas X, Chamorro AJ, Castro-Salomó A, Madroñero-Vuelta AB, Sánchez-García ME, Sáez-Comet L, González-Echávarri C, Ortego-Centeno N, Vargas-Hitos JA, Todolí-Parra JA, Trapiella-Martínez L, Lledó GM, Freire M, Fonollosa-Pla V, Simeón-Aznar CP. The incidence rate of pulmonary arterial hypertension and scleroderma renal crisis in systemic sclerosis patients with digital ulcers on endothelin antagonist receptors (ERAs) and phosphodiesterase-5 inhibitors (PDE5i). Rheumatology (Oxford) 2021; 60:872-880. [PMID: 32844220 DOI: 10.1093/rheumatology/keaa401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 06/03/2020] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Endothelin antagonist receptors (ERAs) and phosphodiesterase-5 inhibitors (PDE5i) are beneficial in pulmonary arterial hypertension (PAH) and digital ulcers (DU) and prevent from DU recurrences. Our study aimed to determine the difference in the incidence rate of PAH and scleroderma renal crisis (SRC) in patients with SSc and DU (SSc-DU) under ERAs/PDE5i or without treatment. METHODS We conducted a retrospective cohort study including SSc-DU patients from the Spanish Scleroderma Registry (RESCLE). The primary outcome was the incidence rate of PAH and SRC in patients under ERAs/PDE5i or not. RESULTS Some 544 patients out of 1817 (29.9%) in the RESCLE database had DU, 221 (40.6%) under ERAs/PDE5i and 323 (59.4%) not. The incidence rate (95% CI) difference between patients under treatment or not under did not reach statistical significance in PAH [-0.1 (-4.8, 4.69), P = 0.988] or in SRC [0.7 (-2.2, 3.7), P = 0.620]. However, the time from the first DU to the diagnosis of SRC was delayed in treated patients [mean (s.d.) 7.6 (5.8) years vs 2.9 (5.3); P = 0.021]. The dcSSc subset was more prevalent in the treatment group (36 vs 26%; P = 0.018), along with anti-topoisomerase I antibodies (34 vs 18%; P < 0.001) and tendon friction rubs (12 vs 6%; P = 0.038), whereas the lcSSc subset was more prevalent in the no-treatment group (57 vs 66%; P = 0.031) along with ACA (37 vs 46%; P = 0.031). CONCLUSION There was no difference in the incidence rate of PAH and SRC between groups. However, treatment with ERAs and/or PDE5i appeared to delay the occurrence of SRC.
Collapse
Affiliation(s)
- Melani Pestaña-Fernández
- Unit of Autoimmune Diseases, Department of Internal Medicine, Hospital Universitario de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Manuel Rubio-Rivas
- Unit of Autoimmune Diseases, Department of Internal Medicine, Hospital Universitario de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Carles Tolosa-Vilella
- Department of Internal Medicine, Parc Taulí, Hospital Universitario, Sabadell, Barcelona, Spain
| | - Alfredo Guillén-Del-Castillo
- Unit of Autoimmune Diseases, Department of Internal Medicine, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Dolores Colunga-Argüelles
- Department of Internal Medicine, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Ana Argibay
- Unit of Systemic Autoimmune Diseases and Thrombosis, Department of Internal Medicine, Complejo Hospitalario Universitario de Vigo, Vigo, Pontevedra, Spain
| | - Begoña Marí-Alfonso
- Department of Internal Medicine, Parc Taulí, Hospital Universitario, Sabadell, Barcelona, Spain
| | - Adela Marín-Ballvé
- Unit of Autoimmune Diseases, Department of Internal Medicine, Hospital Clínico Universitario Lozano Blesa, IIS Aragón, Zaragoza, Spain
| | - Xavier Pla-Salas
- Unit of Systemic Autoimmune Diseases, Department of Internal Medicine, Consorci Hospitalari de Vic, Vic, Barcelona, Spain
| | - Antonio-J Chamorro
- Department of Internal Medicine, Hospital Clínico Universitario de Salamanca, Universidad de Salamanca-IBSAL, Salamanca, Spain
| | - Antoni Castro-Salomó
- Department of Internal Medicine. Hospital Universitario Sant Joan, Reus, Tarragona, Spain
| | | | | | - Luis Sáez-Comet
- Department of Internal Medicine, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Cristina González-Echávarri
- Autoimmune Diseases Research Unit, Department of Internal Medicine, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo, Spain
| | - Norberto Ortego-Centeno
- Inst. Invest. Biosanitaria Ibs Granada, Department of Internal Medicine, Unit of Systemic Autoimmune Diseases, Department of Medicine, Facultad de Medicina, Hospital Universitario San Cecilio, Granada, Spain
| | | | | | - Luis Trapiella-Martínez
- Unit of Systemic Autoimmune Diseases, Department of Internal Medicine, Hospital de Cabueñes, Gijón, Asturias, Spain
| | - Gema María Lledó
- Department of Autoimmune Diseases, Hospital Clinic, Barcelona, Spain
| | - Mayka Freire
- Unit of Autoimmune Diseases, Department of Internal Medicine, Hospital Clínico Universitario de Santiago, Santiago de Compostela, A Coruña, Spain
| | - Vicent Fonollosa-Pla
- Unit of Autoimmune Diseases, Department of Internal Medicine, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Carmen Pilar Simeón-Aznar
- Unit of Autoimmune Diseases, Department of Internal Medicine, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | | |
Collapse
|
6
|
Martínez-Rosales E, Sola-Rodríguez S, Vargas-Hitos JA, Gavilán-Carrera B, Rosales-Castillo A, Hernández-Martínez A, Artero EG, Sabio JM, Soriano-Maldonado A. Heart Rate Variability in Women with Systemic Lupus Erythematosus: Association with Health-Related Parameters and Effects of Aerobic Exercise. Int J Environ Res Public Health 2020; 17:ijerph17249501. [PMID: 33352985 PMCID: PMC7766283 DOI: 10.3390/ijerph17249501] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/11/2020] [Accepted: 12/12/2020] [Indexed: 12/19/2022]
Abstract
Abnormal heart rate variability (HRV) has been observed in patients with systemic lupus erythematosus (SLE). In a combined cross-sectional and interventional study approach, we investigated the association of HRV with inflammation and oxidative stress markers, patient-reported outcomes, and the effect of 12 weeks of aerobic exercise in HRV. Fifty-five women with SLE (mean age 43.5 ± 14.0 years) were assigned to either aerobic exercise (n = 26) or usual care (n = 29) in a non-randomized trial. HRV was assessed using a heart rate monitor during 10 min, inflammatory and oxidative stress markers were obtained, psychological stress (Perceived Stress Scale), sleep quality (Pittsburg Sleep Quality Index), fatigue (Multidimensional Fatigue Inventory), depressive symptoms (Beck Depression Inventory), and quality of life (36-item Short-Form Health Survey) were also assessed. Low frequency to high frequency power (LFHF) ratio was associated with physical fatigue (p = 0.019). Sample entropy was inversely associated with high-sensitivity C-reactive protein (p = 0.014) and myeloperoxidase (p = 0.007). There were no significant between-group differences in the changes in HRV derived parameters after the exercise intervention. High-sensitivity C-reactive protein and myeloperoxidase were negatively related to sample entropy and physical fatigue was positively related to LFHF ratio. However, an exercise intervention of 12 weeks of aerobic training did not produce any changes in HRV derived parameters in women with SLE in comparison to a control group.
Collapse
Affiliation(s)
- Elena Martínez-Rosales
- Department of Education, Faculty of Education Sciences, University of Almería, 04120 Almería, Spain; (S.S.-R.); (A.H.-M.); (E.G.A.); (A.S.-M.)
- SPORT Research Group (CTS-1024), CERNEP Research Center, University of Almería, 04120 Almería, Spain
- Correspondence:
| | - Sergio Sola-Rodríguez
- Department of Education, Faculty of Education Sciences, University of Almería, 04120 Almería, Spain; (S.S.-R.); (A.H.-M.); (E.G.A.); (A.S.-M.)
- SPORT Research Group (CTS-1024), CERNEP Research Center, University of Almería, 04120 Almería, Spain
| | - José Antonio Vargas-Hitos
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (J.A.V.-H.); (A.R.-C.); (J.M.S.)
| | - Blanca Gavilán-Carrera
- Physical Activity for Health Promotion Research Group (PAHELP), Sport and Health University Research Institute (iMUDS), Department of Physical Education and Sports Faculty of Sport Sciences, University of Granada, 18071 Granada, Spain;
| | - Antonio Rosales-Castillo
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (J.A.V.-H.); (A.R.-C.); (J.M.S.)
| | - Alba Hernández-Martínez
- Department of Education, Faculty of Education Sciences, University of Almería, 04120 Almería, Spain; (S.S.-R.); (A.H.-M.); (E.G.A.); (A.S.-M.)
- SPORT Research Group (CTS-1024), CERNEP Research Center, University of Almería, 04120 Almería, Spain
| | - Enrique G. Artero
- Department of Education, Faculty of Education Sciences, University of Almería, 04120 Almería, Spain; (S.S.-R.); (A.H.-M.); (E.G.A.); (A.S.-M.)
- SPORT Research Group (CTS-1024), CERNEP Research Center, University of Almería, 04120 Almería, Spain
| | - José Mario Sabio
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (J.A.V.-H.); (A.R.-C.); (J.M.S.)
| | - Alberto Soriano-Maldonado
- Department of Education, Faculty of Education Sciences, University of Almería, 04120 Almería, Spain; (S.S.-R.); (A.H.-M.); (E.G.A.); (A.S.-M.)
- SPORT Research Group (CTS-1024), CERNEP Research Center, University of Almería, 04120 Almería, Spain
| |
Collapse
|
7
|
Gavilán-Carrera B, Vargas-Hitos JA, Soriano-Maldonado A. Comment on: Physical activity, sedentary behaviour and their associations with cardiovascular risk in systemic lupus erythematosus. Rheumatology (Oxford) 2020; 59:e151-e152. [DOI: 10.1093/rheumatology/keaa493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 07/03/2020] [Indexed: 11/12/2022] Open
Affiliation(s)
- Blanca Gavilán-Carrera
- Physical Activity for Health Promotion Research Group (PA-HELP), Sport and Health University Research Institute (iMUDS), Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada,
| | - José Antonio Vargas-Hitos
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, “Virgen de las Nieves” University Hospital, Granada
| | - Alberto Soriano-Maldonado
- Department of Education, Faculty of Education Sciences
- SPORT Research Group (CTS-1024), CERNEP Research Center, University of Almería, Almería, Spain
| |
Collapse
|
8
|
Gavilán-Carrera B, Vargas-Hitos JA, Morillas-de-Laguno P, Rosales-Castillo A, Sola-Rodríguez S, Callejas-Rubio JL, Sabio JM, Soriano-Maldonado A. Effects of 12-week aerobic exercise on patient-reported outcomes in women with systemic lupus erythematosus. Disabil Rehabil 2020; 44:1863-1871. [PMID: 32878503 DOI: 10.1080/09638288.2020.1808904] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE To evaluate the effects of aerobic exercise on patient-reported outcomes (PROs) in women with systemic lupus erythematosus (SLE), and whether changes in cardiorespiratory fitness (CRF) mediate the changes in PROs. METHODS A total of 58 women with SLE were assigned to either an exercise group (EG; n = 26) or a control group (CG; n = 32) in this non-randomized clinical trial. The EG comprised 12 weeks of aerobic exercise (2 sessions/week) between 40%-75% of the individual's heart rate reserve. At baseline, and at week 12, CRF (Bruce test) and PROs were assessed including psychological stress (Perceived Stress Scale), sleep quality (Pittsburg Sleep Quality Index), fatigue (Multidimensional Fatigue Inventory), depressive symptoms (Beck Depression Inventory), and quality of life (36-item Short-Form Health Survey). RESULTS In comparison to the CG, the EG showed a significant reduction in general fatigue (mean difference (MD) -2.86 units; 95%CI -5.70 to -0.01; p = 0.049), physical fatigue (MD -4.33 units; 95%CI -7.02 to -1.65; p = 0.002) and a non-significant reduction of reduced motivation (MD - 1.29 units; 95%CI -2.60 to 0.03; p = 0.055). There were no significant between-group differences in the changes in psychological stress, sleep quality, depressive symptoms, quality of life, or other fatigue dimensions (all p > 0.05). Changes in CRF mediated the effects of the exercise intervention on general fatigue by 53.8%. CONCLUSION The results suggest that 12 weeks of progressive aerobic exercise might improve relevant dimensions of fatigue in women with SLE, despite the absence of effects on other PROs. Improvements in CRF seem to mediate the effect of exercise on general fatigue.Implications for rehabilitationAerobic exercise could be safely introduced in rehabilitation programs for inactive patients with SLE with mild disease activity.Including physical activity recommendations as part of rehabilitation could improve relevant aspects of fatigue in women with SLE.When rehabilitation aims at reducing fatigue, cardiorespiratory fitness improvements derived from physical activity might enhance benefits.
Collapse
Affiliation(s)
- Blanca Gavilán-Carrera
- PA-HELP "Physical Activity for Health Promotion" Research Group, Sport and Health University Research Institute (iMUDS), Department of Physical and Sports Education, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - José Antonio Vargas-Hitos
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, "Virgen de las Nieves" University Hospital, Granada, Spain
| | - Pablo Morillas-de-Laguno
- Department of Physical and Sports Education, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Antonio Rosales-Castillo
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, "Virgen de las Nieves" University Hospital, Granada, Spain
| | - Sergio Sola-Rodríguez
- Department of Education, Faculty of Education Sciences, University of Almería, Almería, Spain
| | - José Luis Callejas-Rubio
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, "San Cecilio" University Hospital, Granada, Spain
| | - José Mario Sabio
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, "Virgen de las Nieves" University Hospital, Granada, Spain
| | - Alberto Soriano-Maldonado
- Department of Education, Faculty of Education Sciences, University of Almería, Almería, Spain.,SPORT Research Group (CTS-1024), CERNEP Research Center, University of Almería, Almería, Spain
| |
Collapse
|
9
|
Abstract
Objective The objective of this study was to determine the safety of tattoos in patients with systemic lupus erythematosus (SLE). Methods Patients ( N = 147; ≤55 years; 92% women) were asked if they had tattoos. The characteristics of the tattoos and the immediate complications were investigated and compared with those of a matched control group. We examined retrospectively after the tattoo was completed whether there had been flare-ups or increased organ damage (Systemic Lupus International Collaborating Clinics/American Collage of Rheumatology Damage Index (SDI)). Finally, we compared the SLE-related characteristics of patients with and without tattoos. Results Twenty-eight patients (19%, 26 women, median (interquartile range) age 33 (25–42) years, 65 tattoos in total) had ≥1 tattoo. At the time the tattoo was done the median (interquartile range) SLEDAI and SDI were 2 (0–2) and 0 (0–1), respectively. The characteristics of the tattoos were similar to those of controls. No patients experienced acute complications. After a median follow-up of 17 (12–20) months (3 (2–4) visits/year) four patients had five mild-to-moderate flare-ups. The median time between the tattoo and the flare-up was 9 (6–14) months. No increase in SDI was observed. The SLE-related characteristics of patients with and without tattoos were similar. Conclusion Tattoos seem to be safe in SLE patients with inactive or low active disease.
Collapse
Affiliation(s)
- J M Sabio
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, ‘Virgen de las Nieves’ University Hospital, Granada, Spain
| | | | - J A Vargas-Hitos
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, ‘Virgen de las Nieves’ University Hospital, Granada, Spain
| |
Collapse
|
10
|
Vargas-Hitos JA, Jiménez-Jáimez J, Molina Navarro E, Salmerón Ruiz A, López Milena G, Jiménez-Alonso J. Takayasu arteritis, malignant hypertension and severe left ventricular hypertrophy. Int J Rheum Dis 2019; 22:951-955. [PMID: 30861323 DOI: 10.1111/1756-185x.13541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 02/12/2019] [Accepted: 02/15/2019] [Indexed: 11/30/2022]
Affiliation(s)
- José Antonio Vargas-Hitos
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, Virgen de las Nieves¨ University Hospital, Granada, Spain
| | - Juan Jiménez-Jáimez
- Cardiology Department, ¨Virgen de las Nieves¨ University Hospital, Granada, Spain
| | | | - Angela Salmerón Ruiz
- Radiology Department, ¨Virgen de las Nieves¨ University Hospital, Granada, Spain
| | - Genaro López Milena
- Radiology Department, ¨Virgen de las Nieves¨ University Hospital, Granada, Spain
| | - Juan Jiménez-Alonso
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, Virgen de las Nieves¨ University Hospital, Granada, Spain
| |
Collapse
|
11
|
Sabio JM, Vargas-Hitos JA, Martínez-Bordonado J, Mediavilla-García JD. Association between non-dipper hypertension and vitamin D deficiency in women with systemic lupus erythematosus. Clin Exp Rheumatol 2019; 37:286-292. [PMID: 30183606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 06/04/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES Blood pressure (BP) physiologically declines more than 10% at night. Subjects who do not experience this drop are classified as non-dippers. They have a higher risk of cardiovascular diseases (CVD). Vitamin D deficiency and non-dipper pattern have been associated in the general population. Patients with systemic lupus erythematosus (SLE) are more likely to have vitamin D deficiency, a non-dipper pattern and CVD. We aimed to evaluate a possible relationship between vitamin D deficiency and non-dipper pattern in patients with SLE. METHODS Using 24-hour ambulatory BP monitoring, 77 women with SLE were divided into dippers and non-dippers. 25-hydroxyvitamin D (25(OH)D) levels were compared between both groups. A multivariate analysis was used to determine which variables were independently associated with non-dipper pattern. RESULTS 62% of patients were non-dippers. They had lower levels of 25(OH)D than dippers (19.4±8.9 vs. 25.9±10.1 ng/ml, p=0.005). Patients with lower 25(OH)D levels were more likely to be non-dippers (OR 3.7, 95%CI 1.2-11.4; p=0.025). The nocturnal decline of mean BP correlated with levels of 25(OH)D (r=0.227, p=0.047). Night-time systolic, diastolic and mean BP inversely correlated with the levels of 25(OH)D (r=-0.274, p=0.016; r=-0.238, p=0.037, and r=-0.260, p=0.022, respectively), but only night- time systolic BP remained significant after adjustment for age and body mass index (r=-0.228, p=0.049). 25(OH)D levels and the use of mycophenolate were found to be independently associated with non-dipper pattern in SLE patients. CONCLUSIONS Vitamin D deficiency may contribute to the development of a non-dipper pattern in patients with SLE.
Collapse
Affiliation(s)
- José Mario Sabio
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, University Hospital Virgen de las Nieves, Granada, Spain.
| | - José Antonio Vargas-Hitos
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, University Hospital Virgen de las Nieves, Granada, Spain
| | | | - Juan Diego Mediavilla-García
- Hypertension and Lipids Unit, Department of Internal Medicine, University Hospital Virgen de las Nieves, Granada, Spain
| |
Collapse
|
12
|
Sola-Rodríguez S, Gavilán-Carrera B, Vargas-Hitos JA, Sabio JM, Morillas-de-Laguno P, Soriano-Maldonado A. Physical Fitness and Body Composition in Women with Systemic Lupus Erythematosus. Medicina (Kaunas) 2019; 55:E57. [PMID: 30795629 PMCID: PMC6410128 DOI: 10.3390/medicina55020057] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 02/13/2019] [Accepted: 02/18/2019] [Indexed: 11/17/2022]
Abstract
Background and objectives: Higher physical fitness is associated with a more favorable weight and body composition in the general population, although this association has not been studied in patients with systemic lupus erythematosus (SLE). The aim of the present study was to examine the association of different components of physical fitness with body composition in women with SLE with mild disease activity. Materials and Methods: This cross-sectional study included 77 women with SLE (43.2 ± 13.8 years old) and clinical stability during the previous 6 months. Body composition (including body mass index (BMI), fat mass index (FMI), waist circumference, waist-to-height ratio and waist-to-hip ratio) was assessed using a stadiometer, an anthropometric tape, and a bioimpedance device. Physical fitness included cardiorespiratory fitness (Siconolfi step test and 6 min walk test), muscular strength (handgrip strength test as upper body measure and 30 s chair stand as lower body measure), and flexibility (back-scratch test). Participants with a fitness level equal or above the median of the study sample were categorized as "fit" and those below the median were categorized as "unfit". Linear regression assessed the association of physical fitness with body composition parameters. Results: Cardiorespiratory fitness and upper body muscular strength were negatively associated with BMI, FMI, waist circumference, and waist-to-height ratio (all, p < 0.05). Lower body muscular strength and flexibility were negatively related to FMI, waist circumference, waist-to-height ratio, and waist-to-hip ratio (all, p < 0.05). These relationships were still significant after controlling for age, disease duration, accrual damage, and SLE activity. Overall, fit patients presented significantly lower values in all body composition parameters compared to unfit patients (all, p < 0.05). Conclusions: The main findings of the present study suggest that physical fitness is inversely associated with body composition in women with SLE. Given the cross-sectional nature of this study, future clinical trials should study the causal pathways underlying these relationships.
Collapse
Affiliation(s)
- Sergio Sola-Rodríguez
- Department of Education, Faculty of Education Sciences, University of Almería, Almería 04120, Spain.
| | - Blanca Gavilán-Carrera
- Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Granada 18071, Spain.
| | - José Antonio Vargas-Hitos
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, "Virgen de las Nieves" University Hospital, Granada 18014, Spain.
| | - José Mario Sabio
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, "Virgen de las Nieves" University Hospital, Granada 18014, Spain.
| | - Pablo Morillas-de-Laguno
- Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Granada 18071, Spain.
| | - Alberto Soriano-Maldonado
- Department of Education, Faculty of Education Sciences, University of Almería, Almería 04120, Spain.
- SPORT Research Group (CTS-1024), CERNEP Research Center, University of Almería, Almería, 04120, Spain.
| |
Collapse
|
13
|
Vargas-Hitos JA, Soriano-Maldonado A, Fernández-Bergés D, Sabio JM. Systemic Low-Grade Inflammation and Cardiovascular Disease in Systemic Lupus Erythematosus: Reply. Angiology 2018; 70:376-377. [PMID: 30261737 DOI: 10.1177/0003319718802637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- José Antonio Vargas-Hitos
- 1 Systemic Autoimmune Diseases Unit, Department of Internal Medicine, Virgen de las Nieves University Hospital, Granada, Spain
| | - Alberto Soriano-Maldonado
- 2 Department of Education, Faculty of Education Sciences, University of Almería, Almería, Spain.,3 SPORT Research Group (CTS-1024), CERNEP Research Center, University of Almería, Almería, Spain
| | - Daniel Fernández-Bergés
- 4 Area de Salud Don Benito-Villanueva, Unidad de Investigación, Programa de Enfermedades Cardiovasculares (PERICLES), Grupo Investigación Multidisciplinar Extremeño (GRIMEX), Villanueva de la Serena, Badajoz, Spain
| | - José Mario Sabio
- 1 Systemic Autoimmune Diseases Unit, Department of Internal Medicine, Virgen de las Nieves University Hospital, Granada, Spain
| |
Collapse
|
14
|
Vargas-Hitos JA, Soriano-Maldonado A, Martínez-Bordonado J, Sánchez-Berná I, Fernández-Bergés D, Sabio JM. Association of Resting Heart Rate With Arterial Stiffness and Low-Grade Inflammation in Women With Systemic Lupus Erythematosus. Angiology 2017; 69:672-676. [PMID: 29232972 DOI: 10.1177/0003319717746525] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Resting heart rate (RHR) is associated with arterial stiffness, inflammation, and cardiovascular (CV) and all-cause mortality in the general population and in patients at high CV risk. We assessed the association of RHR with arterial stiffness and low-grade inflammation (LGI) in a cross-sectional study that included 101 women with systemic lupus erythematosus (SLE) without a history of CV disease or arrhythmia or who were under treatment that may cause bradycardia. Pulse wave velocity (PWV; a measure of arterial stiffness), RHR, and markers of LGI (ie, C-reactive protein, fibrinogen, erythrocyte sedimentation rate, insulin, and homeostatic model assessment index) were measured. The patients with the highest RHR (quartile 4; mean RHR = 87.2 bpm) had a PWV 0.61 m/s (95% confidence interval [CI]: 0.08-1.14; P = .024) greater than patients with the lowest RHR (quartile 1; RHR = 63.0 bpm), independent of age, systolic blood pressure, disease activity, smoking, and being physically inactive. Similarly, patients with the highest RHR (quartile 4) showed a significantly less favorable clustered LGI index than patients in quartile 1 ( b = .58; 95% CI: 0.212-0.948; P = .002). Higher RHR is associated with greater arterial stiffness and LGI in women with SLE. Further research to determine the prognostic value of RHR in this population is warranted.
Collapse
Affiliation(s)
- José Antonio Vargas-Hitos
- 1 Systemic Autoimmune Diseases Unit, Department of Internal Medicine, Virgen de las Nieves University Hospital, Granada, Spain.,* Dr Vargas-Hitos and Dr Soriano-Maldonado contributed equally to this work
| | - Alberto Soriano-Maldonado
- 2 Department of Education, Faculty of Education Sciences, University of Almería, Almería, Spain.,3 SPORT Research Group (CTS-1024), CERNEP Research Center, University of Almería, Almería, Spain.,* Dr Vargas-Hitos and Dr Soriano-Maldonado contributed equally to this work
| | - Josefa Martínez-Bordonado
- 1 Systemic Autoimmune Diseases Unit, Department of Internal Medicine, Virgen de las Nieves University Hospital, Granada, Spain
| | - Isabel Sánchez-Berná
- 1 Systemic Autoimmune Diseases Unit, Department of Internal Medicine, Virgen de las Nieves University Hospital, Granada, Spain
| | - Daniel Fernández-Bergés
- 4 Area de Salud Don Benito-Villanueva, Unidad de Investigación, Programa de Enfermedades Cardiovasculares (PERICLES), Grupo Investigación Multidisciplinar Extremeño (GRIMEX), Villanueva de la Serena, Badajoz, Spain
| | - José Mario Sabio
- 1 Systemic Autoimmune Diseases Unit, Department of Internal Medicine, Virgen de las Nieves University Hospital, Granada, Spain
| |
Collapse
|
15
|
Vargas-Hitos JA, Sáez-Urán LM, Rosales-Castillo A, Jiménez-Alonso J. Constitutional syndrome and chest pain as clinical onset feature of necrotizing myopathy with myocardial involvement. Int J Rheum Dis 2017; 20:1767-1769. [PMID: 28960839 DOI: 10.1111/1756-185x.13158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- José Antonio Vargas-Hitos
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, 'Virgen de las Nieves' University Hospital, Granada, Spain
| | - Luis Manuel Sáez-Urán
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, 'Virgen de las Nieves' University Hospital, Granada, Spain
| | - Antonio Rosales-Castillo
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, 'Virgen de las Nieves' University Hospital, Granada, Spain
| | - Juan Jiménez-Alonso
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, 'Virgen de las Nieves' University Hospital, Granada, Spain
| |
Collapse
|
16
|
Sabio JM, Rivero-Rodriguez M, Vargas-Hitos JA. Demographic and Clinical Characteristics Associated with Central Nervous System Hemorrhage in Patients with Eosinophilic Granulomatosis with Polyangiitis: A Case Report and Review of the Literature. J Rheumatol 2017; 44:1413-1415. [PMID: 28864668 DOI: 10.3899/jrheum.160886] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- José Mario Sabio
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, Virgen de las Nieves University Hospital, and Virgen de las Nieves University Hospital, Granada, Spain;
| | - Mar Rivero-Rodriguez
- Department of Internal Medicine, Virgen de las Nieves University Hospital, and Virgen de las Nieves University Hospital, Granada, Spain
| | - José Antonio Vargas-Hitos
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, Virgen de las Nieves University Hospital, and Virgen de las Nieves University Hospital, Granada, Spain
| |
Collapse
|
17
|
Rubio-Rivas M, Simeón-Aznar CP, Velasco C, Marí-Alfonso B, Espinosa G, Corbella X, Colunga-Argüelles D, Egurbide-Arberas MV, Ortego-Centeno N, Vargas-Hitos JA, Freire M, Ríos-Blanco JJ, Trapiella-Martínez L, Rodríguez-Carballeira M, Fonollosa-Pla V. Changes in the pattern of death of 987 patients with systemic sclerosis from 1990 to 2009 from the nationwide Spanish Scleroderma Registry (RESCLE). Clin Exp Rheumatol 2017; 35 Suppl 106:40-47. [PMID: 28229826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 11/07/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To determine the changes in the pattern of death of patients with systemic sclerosis (SSc) throughout 20 years. METHODS Data were collected from the Spanish Scleroderma Registry (RESCLE), retrospective multicentre database from 1990 to 2009. SSc-related and SSc-non related causes of death were assessed. RESULTS 987 patients were recruited. Overall standardised mortality ratio (SMR) was 2.34 (2.24-2.44). SSc-related causes of death were responsible of 72% of all deaths of those patients diagnosed within 1990-99 vs. 48% within 2000-09 (p=0.006). Relative pulmonary death rate was stable over time (68.1% within 1990-99 vs. 63.9% within 2000-09, p=0.815). Relative renal death rate was decreasing over time (17% within 1990-99 vs. 5.5% within 2000-09, p=0.175). Heart distribution tripled its ratio (12.8% within 1990-99 vs. 30.6% within 2000-09, p=0.058). CONCLUSIONS SSc-related causes of death were decreasing over time and, among them, pulmonary involvement was the leading cause of death in both decades. The ratio of renal causes decreased since 1990 at the time that the ratio of cardiac causes increased.
Collapse
Affiliation(s)
- Manuel Rubio-Rivas
- Autoimmune Diseases Unit, Department of Internal Medicine, Bellvitge University Hospital-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.
| | | | - César Velasco
- Clinic Hospital, Department of Epidemiology Medicine, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Begoña Marí-Alfonso
- Department of Internal Medicine, Corporación Sanitaria Universitaria Parc Taulí, Sabadell, Barcelona, Spain
| | - Gerard Espinosa
- Department of Autoimmune Diseases, Institut Clinic de Medicina i Dermatología, Hospital Clínic, Barcelona, Spain
| | - Xavier Corbella
- Department of Internal Medicine, Bellvitge University Hospital-IDIBELL, L'Hospitalet de Llobregat, Barcelona, and Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
| | | | | | | | | | - Mayka Freire
- Department of Internal Medicine, Complejo Hospitalario Universitario de Vigo, Spain
| | | | | | | | - Vicent Fonollosa-Pla
- Vall d'Hebron University Hospital, Department of Internal Medicine, Barcelona, Spain
| |
Collapse
|
18
|
Vargas-Hitos JA, Sabio JM, Navarrete-Navarrete N, Zamora-Pasadas M, Jiménez-Alonso J. Severe digital necrosis as the clinical onset of antiphospholipid syndrome. Intern Emerg Med 2016; 11:761-2. [PMID: 26494470 DOI: 10.1007/s11739-015-1335-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 10/05/2015] [Indexed: 11/28/2022]
Affiliation(s)
- José Antonio Vargas-Hitos
- Systemic Autoimmune Diseases Unit, Internal Medicine Department, Virgen de las Nieves University Hospital, 9th Floor. Avda. Fuerzas Armadas Nº 2, 18014, Granada, Spain.
| | - José Mario Sabio
- Systemic Autoimmune Diseases Unit, Internal Medicine Department, Virgen de las Nieves University Hospital, 9th Floor. Avda. Fuerzas Armadas Nº 2, 18014, Granada, Spain
| | - Nuria Navarrete-Navarrete
- Systemic Autoimmune Diseases Unit, Internal Medicine Department, Virgen de las Nieves University Hospital, 9th Floor. Avda. Fuerzas Armadas Nº 2, 18014, Granada, Spain
| | - Mónica Zamora-Pasadas
- Systemic Autoimmune Diseases Unit, Internal Medicine Department, Virgen de las Nieves University Hospital, 9th Floor. Avda. Fuerzas Armadas Nº 2, 18014, Granada, Spain
| | - Juan Jiménez-Alonso
- Systemic Autoimmune Diseases Unit, Internal Medicine Department, Virgen de las Nieves University Hospital, 9th Floor. Avda. Fuerzas Armadas Nº 2, 18014, Granada, Spain
| |
Collapse
|
19
|
|
20
|
Rivera-López R, Jiménez-Jáimez J, Sabio JM, Zamora-Pasadas M, Vargas-Hitos JA, Martínez-Bordonado J, Navarrete-Navarrete N, Fernández RR, Sanchez-Cantalejo E, Jiménez-Alonso J. Relationship between QT Interval Length and Arterial Stiffness in Systemic Lupus Erythematosus (SLE): A Cross-Sectional Case-Control Study. PLoS One 2016; 11:e0152291. [PMID: 27064990 PMCID: PMC4827799 DOI: 10.1371/journal.pone.0152291] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 03/12/2016] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES The QT interval on the electrocardiogram has been shown to be longer in patients with systemic lupus erythematosus (SLE) compared to that of the general population. The clinical significance of this finding is unknown. The aim of this study was to assess the relationship between QT interval and subclinical atherosclerosis, measured by carotid-femoral pulse-wave velocity. MATERIAL AND METHODS 93 patients with SLE and 109 healthy women with similar basal characteristics were studied. All patients underwent a 12- lead electrocardiogram, and corrected QT interval (QTc) was measured using the Bazett's formula. The presence of atherosclerosis was evaluated by carotid-femoral pulse-wave velocity. RESULTS Clinical basal characteristics were similar in both groups. QTc interval was 415 ± 21.4 milliseconds in all patients, and 407 ± 19.1 milliseconds in the control group (p = 0.007). There was a positive correlation between QTc interval and carotid-femoral pulse-wave velocity (r = 0.235; p = 0.02) in patients with SLE. This association was independent of hypertension and age in a multivariate analysis. CONCLUSION QTc interval measured by electrocardiogram is prolonged in SLE patients; it is related to subclinical atherosclerosis, measured by carotid-femoral pulse-wave velocity. This measure may help stratify risk in routine clinical practice and select the patients that might benefit from a more aggressive therapy in the prevention of cardiovascular events.
Collapse
Affiliation(s)
- Ricardo Rivera-López
- Cardiology Clinical Management Unit, Granada University Hospitals; Granada Institute of Biohealth Research.Granada. Spain
- * E-mail:
| | - Juan Jiménez-Jáimez
- Cardiology Clinical Management Unit, Granada University Hospitals; Granada Institute of Biohealth Research.Granada. Spain
| | - José Mario Sabio
- Systemic Autoinmune Diseases Unit. Department of Internal Medicine. Granada University Hospitals; Granada Institute of Biohealth Research.Granada. Spain
| | - Mónica Zamora-Pasadas
- Systemic Autoinmune Diseases Unit. Department of Internal Medicine. Granada University Hospitals; Granada Institute of Biohealth Research.Granada. Spain
| | - José Antonio Vargas-Hitos
- Systemic Autoinmune Diseases Unit. Department of Internal Medicine. Granada University Hospitals; Granada Institute of Biohealth Research.Granada. Spain
| | - Josefina Martínez-Bordonado
- Systemic Autoinmune Diseases Unit. Department of Internal Medicine. Granada University Hospitals; Granada Institute of Biohealth Research.Granada. Spain
| | - Nuria Navarrete-Navarrete
- Systemic Autoinmune Diseases Unit. Department of Internal Medicine. Granada University Hospitals; Granada Institute of Biohealth Research.Granada. Spain
| | | | - E. Sanchez-Cantalejo
- Andalusian School of Public Health, Granada, Spain
- CIBER de Epidemiología y Salud Publica (CIBERESP), Madrid, Spain
- Instituto de Investigación Biosanitaria de Granada (Granada. ibs), Granada, Spain
| | - Juan Jiménez-Alonso
- Systemic Autoinmune Diseases Unit. Department of Internal Medicine. Granada University Hospitals; Granada Institute of Biohealth Research.Granada. Spain
| |
Collapse
|
21
|
Soriano-Maldonado A, Vargas-Hitos JA, Sabio JM. Cardiovascular training vs. resistance training for improving quality of life and physical function in patients with systemic lupus erythematosus: a randomized controlled trial: comments on the article by Abrãhao et al. Scand J Rheumatol 2016; 45:253-4. [PMID: 27053372 DOI: 10.3109/03009742.2016.1138319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- A Soriano-Maldonado
- a Department of Physical Education and Sport, Faculty of Sport Sciences , University of Granada , Granada , Spain
| | - J A Vargas-Hitos
- b Systemic Autoimmune Diseases Unit, Department of Internal Medicine , Virgen de las Nieves University Hospital , Granada , Spain
| | | |
Collapse
|
22
|
Affiliation(s)
- J A Vargas-Hitos
- From the Systemic Autoimmune Diseases Unit, Internal Medicine Department,
| | - R Roa-Chamorro
- From the Systemic Autoimmune Diseases Unit, Internal Medicine Department
| | - J M Sabio
- From the Systemic Autoimmune Diseases Unit, Internal Medicine Department
| | | | - A Martín-Castro
- Histopathology Department, Virgen de las Nieves, University Hospital, Granada, Spain
| | - J Jiménez-Alonso
- From the Systemic Autoimmune Diseases Unit, Internal Medicine Department
| |
Collapse
|
23
|
Sabio JM, Vargas-Hitos JA, Martínez-Bordonado J, Navarrete-Navarrete N, Díaz-Chamorro A, Olvera-Porcel C, Jiménez-Alonso J. Cumulated organ damage is associated with arterial stiffness in women with systemic lupus erythematosus irrespective of renal function. Clin Exp Rheumatol 2016; 34:53-57. [PMID: 26812222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 07/07/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES To determine whether there is an association between cumulated organ damage and arterial stiffness in women with systemic lupus erythematosus (SLE) with normal renal function and without renal damage. METHODS Eighty-eight SLE women with normal renal function and without renal damage, and 102 sex- and age-matched controls with no history of coronary heart disease or peripheral arterial disease were studied. Cumulated organ damage and arterial stiffness were measured using the SLICC/ACR Damage Index (SDI) and pulse wave velocity (PWV), respectively. Patients were categorised as with (SDI ≥1) or without cumulated organ damage (SDI=0) and bivariate analyses were performed to compare both groups. A multivariate logistic regression was carried out to analyse the independent factors associated with cumulated organ damage. A multiple linear regression analysis was used to investigate the correlation between SDI and PWV, adjusted for appropriate confounders. RESULTS PWV was significantly higher in patients with respect to controls (p=0.007). Also, patients with SDI ≥1 had significantly higher PWV than those with SDI=0 (p=0.007). In the multivariate analysis, cumulated organ damage was significantly associated with PWV (p=0.006) and obesity (p=0.003). Furthermore, PWV correlated with SDI after adjustment for age, SLE duration, systolic blood pressure, body mass index, renal function, prednisone and homocysteine (r=0.283, p=0.011). Patients with increased PWV were more likely to have organ damage (SDI ≥1) than those with normal PWV (67% vs. 36%, p=0.023). CONCLUSIONS Cumulated organ damage was found to be independently associated with the arterial stiffness in SLE women without renal involvement.
Collapse
Affiliation(s)
- José Mario Sabio
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, Virgen de las Nieves University Hospital, Granada, Spain.
| | - José Antonio Vargas-Hitos
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, Virgen de las Nieves University Hospital, Granada, Spain
| | - Josefina Martínez-Bordonado
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, Virgen de las Nieves University Hospital, Granada, Spain
| | - Nuria Navarrete-Navarrete
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, Virgen de las Nieves University Hospital, Granada, Spain
| | - Antonio Díaz-Chamorro
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, Virgen de las Nieves University Hospital, Granada, Spain
| | - Carmen Olvera-Porcel
- Department of Statistics, Investigación Biosanitaria de Andalucía Oriental Foundation, Granada, Spain
| | - Juan Jiménez-Alonso
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, Virgen de las Nieves University Hospital, Granada, Spain
| |
Collapse
|
24
|
Sabio JM, Martinez-Bordonado J, Sánchez-Berná I, Vargas-Hitos JA, Mediavilla JD, Navarrete-Navarrete N, Zamora-Pasadas M, Ruíz ME, Jiménez-Alonso J. Nighttime Blood Pressure Patterns and Subclinical Atherosclerosis in Women with Systemic Lupus Erythematosus. J Rheumatol 2015; 42:2310-7. [DOI: 10.3899/jrheum.150531] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective.To compare 24-h ambulatory blood pressure (BP) monitoring (ABPM) values and patterns in women with systemic lupus erythematosus (SLE) with those of a matched control group and their relationship with the presence of subclinical atherosclerosis.Methods.ABPM was assessed in 70 women with SLE and in 65 sex- and age-matched controls without a history of clinic cardiovascular disease (CVD). Carotid-femoral pulse wave velocity (PWV), which is a marker of subclinical atherosclerosis and a predictor of future CVD, was measured. Multivariate logistic analysis was used to determine which explanatory variables were independently associated with the non-dipper pattern and the presence of nocturnal hypertension (HTN) in women with SLE.Results.No differences in PWV were found between patients and controls [median 7.3, interquartile range (IQR) 6.5–8.1 m/s vs median 7.1, IQR 6.5–7.8 m/s, p = 0.474]. The frequency of nondipper pattern (p = 0.025) and nocturnal HTN (p = 0.004) was significantly higher in women with SLE than in controls. White-coat and masked HTN were present in 10% and 11% of patients and in 20% and 8% of controls, respectively (p > 0.05 in all cases). The concordance between office and ambulatory HTN in the SLE and control groups was modest (κ = 0.325 and κ = 0.451, respectively). PWV and chronic kidney disease, and PWV and the Systemic Lupus Erythematosus Disease Activity Index were found to be independently associated with nocturnal HTN and nondipper pattern, respectively.Conclusion.Women with SLE were more likely to have an altered nighttime BP pattern than controls. In women with SLE, nondipper pattern and nocturnal HTN were independently associated with increased subclinical atherosclerosis measured by PWV.
Collapse
|
25
|
Sáez-Comet L, Simeón-Aznar CP, Pérez-Conesa M, Vallejo-Rodríguez C, Tolosa-Vilella C, Iniesta-Arandia N, Colunga-Argüelles D, Egurbide-Arberas MV, Ortego-Centeno N, Vargas-Hitos JA, Freire-Dapena M, Rubio-Rivas M, Ríos-Blanco JJ, Trapiella-Martínez L, Fonollosa-Pla V. Applying the ACR/EULAR Systemic Sclerosis Classification Criteria to the Spanish Scleroderma Registry Cohort. J Rheumatol 2015; 42:2327-31. [PMID: 26472418 DOI: 10.3899/jrheum.150144] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To compare American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) classification criteria for systemic sclerosis (SSc) with previous American Rheumatology Association (ARA) criteria. METHODS This was a cross-sectional multicenter study comparing sensitivity of both criteria in the cutaneous subsets in the Spanish scleroderma registry (RESCLE) cohort. RESULTS In 1222 patients with SSc, the most prevalent items were Raynaud phenomenon (95%), skin thickening (91%), and abnormal capillaroscopy (89%). ARA criteria classified as SSc 63.5% of all patients, and 63%, 100%, 11.2%, and 0% in the limited, diffuse, sine, and pre-SSc subsets, respectively. ACR/EULAR criteria classified 87.5% of all patients and 98.5%, 100%, 41.8%, and 15.9% in the same subsets, respectively. CONCLUSION ACR/EULAR criteria are more sensitive than ARA criteria, especially in limited, sine, and pre-SSc subsets.
Collapse
|
26
|
Vargas-Hitos JA, Sabio JM, Navarrete-Navarrete N, Arenas-Miras MDM, Zamora-Pasadas M, Jiménez-Alonso J. Cat scratch disease in an immunosuppressed patient with systemic lupus erythematosus. Lupus 2015; 25:310-1. [PMID: 26453661 DOI: 10.1177/0961203315610207] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 09/11/2015] [Indexed: 11/15/2022]
Abstract
Cat scratch disease is an infectious disorder transmitted by cats that typically affects children and young adults. Immunosuppression is a well-known risk factor for the development of severe and atypical forms of the disease; hence it is under-diagnosed in patients with compromised immunity. We are reporting the first case of cat scratch disease, which presented as fever and fatigue, in a patient with systemic lupus erythematosus while receiving immunosuppressant therapy after a kidney transplant.
Collapse
Affiliation(s)
- J A Vargas-Hitos
- Systemic Autoimmune Diseases Unit. Internal Medicine Department, Virgen de las Nieves University Hospital, Granada, Spain
| | - J M Sabio
- Systemic Autoimmune Diseases Unit. Internal Medicine Department, Virgen de las Nieves University Hospital, Granada, Spain
| | - N Navarrete-Navarrete
- Systemic Autoimmune Diseases Unit. Internal Medicine Department, Virgen de las Nieves University Hospital, Granada, Spain
| | - M del M Arenas-Miras
- Systemic Autoimmune Diseases Unit. Internal Medicine Department, Virgen de las Nieves University Hospital, Granada, Spain
| | - M Zamora-Pasadas
- Systemic Autoimmune Diseases Unit. Internal Medicine Department, Virgen de las Nieves University Hospital, Granada, Spain
| | - J Jiménez-Alonso
- Systemic Autoimmune Diseases Unit. Internal Medicine Department, Virgen de las Nieves University Hospital, Granada, Spain
| |
Collapse
|
27
|
Simeón-Aznar CP, Fonollosa-Plá V, Tolosa-Vilella C, Espinosa-Garriga G, Campillo-Grau M, Ramos-Casals M, García-Hernández FJ, Castillo-Palma MJ, Sánchez-Román J, Callejas-Rubio JL, Ortego-Centeno N, Egurbide-Arberas MV, Trapiellla-Martínez L, Caminal-Montero L, Sáez-Comet L, Velilla-Marco J, Camps-García MT, de Ramón-Garrido E, Esteban-Marcos EM, Pallarés-Ferreres L, Navarrete-Navarrete N, Vargas-Hitos JA, Torre RGDL, Salvador-Cervello G, Rios-Blanco JJ, Vilardell-Tarrés M. Registry of the Spanish Network for Systemic Sclerosis: Survival, Prognostic Factors, and Causes of Death. Medicine (Baltimore) 2015; 94:e1728. [PMID: 26512564 PMCID: PMC4985378 DOI: 10.1097/md.0000000000001728] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Systemic sclerosis (SSc) is a rare, multisystem disease showing a large individual variability in disease progression and prognosis. In the present study, we assess survival, causes of death, and risk factors of mortality in a large series of Spanish SSc patients. Consecutive SSc patients fulfilling criteria of the classification by LeRoy were recruited in the survey. Kaplan-Meier and Cox proportional-hazards models were used to analyze survival and to identify predictors of mortality. Among 879 consecutive patients, 138 (15.7%) deaths were registered. Seventy-six out of 138 (55%) deceased patients were due to causes attributed to SSc, and pulmonary hypertension (PH) was the leading cause in 23 (16.6%) patients. Survival rates were 96%, 93%, 83%, and 73% at 5, 10, 20, and 30 years after the first symptom, respectively. Survival rates for diffuse cutaneous SSc (dcSSc) and limited cutaneous SSc were 91%, 86%, 64%, and 39%; and 97%, 95%, 85%, and 81% at 5, 10, 20, and 30 years, respectively (log-rank: 67.63, P < 0.0001). The dcSSc subset, male sex, age at disease onset older than 65 years, digital ulcers, interstitial lung disease (ILD), PH, heart involvement, scleroderma renal crisis (SRC), presence of antitopoisomerase I and absence of anticentromere antibodies, and active capillaroscopic pattern showed reduced survival rate. In a multivariate analysis, older age at disease onset, dcSSc, ILD, PH, and SRC were independent risk factors for mortality. In the present study involving a large cohort of SSc patients, a high prevalence of disease-related causes of death was demonstrated. Older age at disease onset, dcSSc, ILD, PH, and SRC were identified as independent prognostic factors.
Collapse
Affiliation(s)
- C P Simeón-Aznar
- From the Department of Internal Medicine, Hospital Valld'Hebron (CPS-A, VF-P, MV-T); Department of Internal Medicine, Hospital Parc Taulí, Sabadell (CT-V); Department of Autoimmune Diseases, Hospital Clinic (GE-G, MR-C); Laboratori of Computacional Medicine, Bioestatistics Unit, Universitat Autònoma de Barcelona, Bellaterra, Barcelona (MC-G); Unit of Connective Tissue Diseases, Department of Internal Medicine, Hospital Virgen del Rocio, Sevilla (FJG-H, MJC-P, JS-R); Unit of Autoimmune Systemic Diseases, Department of Internal Medicine, Hospital Clínico San Cecilio, Granada (JLC-R, NO-C); Department of Internal Medicine, Hospital de Cruces, Galdakano, Bilbao (MVE-A); Department of Internal Medicine, Hospital de Cabueñes, Gijón (LT-M); Department of Internal Medicine, Hospital Universitario Central de Asturias, Oviedo (LC-M); Department of Internal Medicine, Hospital Miguel Servet, Zaragoza (LS-C, JV-M); Department of Internal Medicine, Hospital Carlos Haya, Málaga (MTC-G, ER-G); Department of Internal Medicine, Hospital Son Espases, Palma de Mallorca (EME-M, LP-F); Department of Internal Medicine, Hospital Virgen de las Nieves, Granada (NN-N, JAV-H); Department of Internal Medicine, Hospital San Agustín, Avilés (RGT); Department of Internal Medicine, Hospital La Fe, Valencia (GS-C); and Department of Internal Medicine, Hospital La Paz, Madrid (JJR-B), Systemic Autoimmune Diseases Group (GEAS), Spanish Scleroderma Study Group (SSSG), Spanish Society of Internal Medicine, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Sabio JM, Sánchez-Berná I, Martinez-Bordonado J, Vargas-Hitos JA, Navarrete-Navarrete N, Expósito Ruíz M, Jiménez-Alonso J. Prevalence of and Factors Associated With Increased Arterial Stiffness in Patients With Primary Sjögren's Syndrome. Arthritis Care Res (Hoboken) 2015; 67:554-62. [DOI: 10.1002/acr.22493] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 10/07/2014] [Indexed: 01/22/2023]
|
29
|
Sabio JM, Vargas-Hitos JA, Martinez-Bordonado J, Navarrete-Navarrete N, Díaz-Chamorro A, Olvera-Porcel C, Zamora-Pasadas M, Jiménez-Alonso J. Relationship between homocysteine levels and hypertension in systemic lupus erythematosus. Arthritis Care Res (Hoboken) 2015; 66:1528-35. [PMID: 24692389 DOI: 10.1002/acr.22340] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 03/25/2014] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Homocysteine has been linked to atherosclerosis and hypertension (HT) in the general population. However, there is limited evidence regarding the effect of homocysteine on blood pressure and arterial stiffness in systemic lupus erythematosus (SLE). We examined whether homocysteine is associated with HT and arterial stiffness in women with SLE. METHODS In total, 99 women with SLE without a history of cardiovascular disease or diabetes mellitus and 101 matched controls were included in this cross-sectional study. Participants were analyzed for homocysteine levels, cardiovascular risk factors, and arterial stiffness assessed by means of carotid-femoral pulse wave velocity (PWV). Associations between homocysteine, systolic blood pressure (SBP), PWV, and HT were tested using univariate and multivariate analyses. RESULTS Homocysteine levels (mean ± SD 12.3 ± 4.8 versus 9.3 ± 3.8 μmoles/liter), PWV (mean ± SD 7.54 ± 1.1 versus 7.10 ± 1.1 meters/second), SBP (mean ± SD 119 ± 13 versus 115 ± 12 mm Hg), and the prevalence of hyperhomocysteinemia (23% versus 7%) and HT (43% versus 12%) were significantly higher in women with SLE (P < 0.050 for all). In the univariate analysis, homocysteine correlated positively with SBP (P = 0.001) and PWV (P = 0.023) in women with SLE but not in controls. In the multiple linear regression analysis, SBP was independently associated with homocysteine and body mass index (BMI) in women with SLE. Similarly, in the multivariate logistic regression analysis, homocysteine levels (or hyperhomocysteinemia), BMI, and daily prednisone dose were independently associated with HT in women with SLE. CONCLUSION Homocysteine was independently associated with SBP and HT in women with SLE, but not in controls. Elevated homocysteine levels could increase the risk of HT in SLE.
Collapse
|
30
|
Sabio JM, Vargas-Hitos JA, Martínez-Bordonado J, Navarrete-Navarrete N, Jiménez-Alonso J. Effect of mycophenolate mofetil on active hepatitis C virus in a woman with lupus nephritis after two years of follow-up. Clin Exp Rheumatol 2015; 33:128. [PMID: 25437640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 07/16/2014] [Indexed: 06/04/2023]
Affiliation(s)
- José Mario Sabio
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, ¨Virgen de las Nieves¨ University Hospital, Granada, Spain
| | - José Antonio Vargas-Hitos
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, ¨Virgen de las Nieves¨ University Hospital, Granada, Spain
| | - Josefa Martínez-Bordonado
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, ¨Virgen de las Nieves¨ University Hospital, Granada, Spain
| | - Nuria Navarrete-Navarrete
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, ¨Virgen de las Nieves¨ University Hospital, Granada, Spain
| | - Juan Jiménez-Alonso
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, ¨Virgen de las Nieves¨ University Hospital, Granada, Spain
| |
Collapse
|
31
|
Affiliation(s)
- F Jaén-Águila
- Internal Medicine Department, "Virgen de las Nieves" University Hospital, 9th Floor, Avda, Fuerzas Armadas No 2, 18014 Granada, Spain
| | - J A Vargas-Hitos
- Internal Medicine Department, "Virgen de las Nieves" University Hospital, 9th Floor, Avda, Fuerzas Armadas No 2, 18014 Granada, Spain.
| | - J Jiménez-Alonso
- Internal Medicine Department, "Virgen de las Nieves" University Hospital, 9th Floor, Avda, Fuerzas Armadas No 2, 18014 Granada, Spain
| |
Collapse
|
32
|
Sabio JM, Vargas-Hitos JA, Martinez-Bordonado J, Navarrete-Navarrete N, Díaz-Chamorro A, Olvera-Porcel C, Zamora M, Jiménez-Alonso J. Association between low 25-hydroxyvitamin D, insulin resistance and arterial stiffness in nondiabetic women with systemic lupus erythematosus. Lupus 2014; 24:155-63. [DOI: 10.1177/0961203314551811] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective The objective of this paper is to examine if there is an association between low levels of 25-hydroxyvitamin D (25(OH)D) and insulin resistance (IR) in nondiabetic women with systemic lupus erythematosus (SLE) and to evaluate its impact on arterial stiffness. Patients and methods In this cross-sectional study 25(OH)D, insulin, insulin resistance measured by the homeostatic model assessment (HOMA-IR), homocysteine, fibrinogen, characteristics of SLE, medications and pulse-wave velocity (PWV) were measured in 106 nondiabetic women with SLE and 101 matched controls. Results Women with SLE tended to have lower 25(OH)D levels ( p = 0.078) and a higher frequency of 25(OH)D deficiency (defined as <10 ng/ml) than controls ( p = 0.058). Patients from the lowest quartile of the 25(OH)D range had higher PWV ( p = 0.043), fasting glucose ( p = 0.035), insulinemia ( p ≤ 0.001), HOMA-IR ( p = 0.006), C4 ( p = 0.012), as well as more frequent IR ( p = 0.002) and metabolic syndrome ( p = 0.052) than those in the upper quartile, and no differences were found in age, body mass index (BMI), blood pressure, lipid levels and renal function. In women with SLE, 25(OH)D inversely correlated with insulin ( p = 0.006), HOMA-IR ( p = 0.008) and C4 ( p = 0.048) and tended to correlate with fibrinogen ( p = 0.060) after adjustment for BMI, age, SLEDAI, prednisone dose, renal function, inflammation markers and seasonal variation, but not with PWV. In controls, 25(OH)D correlated only with homocysteine after the same adjustment, and the correlation with PWV tended to be significant after adjustment for BMI and age ( r = −0.190, p = 0.10). Conclusion Low 25(OH)D levels were found to be associated with increased IR in nondiabetic women with SLE independently of BMI. Low 25(OH)D levels, but not IR, could be associated with increased arterial stiffness in these patients.
Collapse
Affiliation(s)
- J M Sabio
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, University Hospital Virgen de las Nieves, Granada, Spain
| | - J A Vargas-Hitos
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, University Hospital Virgen de las Nieves, Granada, Spain
| | - J Martinez-Bordonado
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, University Hospital Virgen de las Nieves, Granada, Spain
| | - N Navarrete-Navarrete
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, University Hospital Virgen de las Nieves, Granada, Spain
| | - A Díaz-Chamorro
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, University Hospital Virgen de las Nieves, Granada, Spain
| | - C Olvera-Porcel
- Department of Statistics, Fundación para la Investigación Biosanitaria de Andalucía Oriental (FIBAO), Granada, Spain
| | - M Zamora
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, University Hospital Virgen de las Nieves, Granada, Spain
| | - J Jiménez-Alonso
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, University Hospital Virgen de las Nieves, Granada, Spain
| |
Collapse
|
33
|
Vargas-Hitos JA, Manzano-Gamero MV, Jiménez-Alonso J. Erythema multiforme associated with Mycoplasma pneumoniae. Infection 2014; 42:797-8. [PMID: 24728737 DOI: 10.1007/s15010-014-0620-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Accepted: 03/31/2014] [Indexed: 10/25/2022]
Affiliation(s)
- J A Vargas-Hitos
- Internal Medicine Department, Virgen de las Nieves University Hospital, 9th floor, Avda. Fuerzas Armadas Nº 2, 18014, Granada, Spain,
| | | | | |
Collapse
|
34
|
Vargas-Hitos JA, Sabio JM, Martínez-Egea I, Jiménez-Jáimez E, Rodríguez-Guzmán M, Navarrete-Navarrete N, López-Lozano E, Romero-Alegría Á, de la Calle C, Jáimez-Gámiz L, Baños-Piñero P, Nebrera-Navarro F, Fidalgo A, Caminal L, de Ramón Garrido E, Ortego-Centeno N, Expósito M, Zamora-Pasadas M, Jiménez-Alonso J. Influence of psychological stress on headache in patients with systemic lupus erythematosus. J Rheumatol 2014; 41:453-7. [PMID: 24488423 DOI: 10.3899/jrheum.130535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To compare the prevalence and disability of headache in patients with systemic lupus erythematosus (SLE) with the general population and to assess the role of chronic psychological stress (CPS) in headache development. METHODS One hundred seventy patients with SLE and 102 control subjects matched for age, sex, and level of education were included in this multicenter, cross-sectional study. CPS, headache-related disability, and chronic analgesic intake (CAI) were evaluated in all participants. RESULTS No statistical differences in the prevalence of headache between both groups were observed but headache disability was significantly higher in patients with SLE. In addition, a higher average score in the Cohen Perceived Stress Scale (CPSS) and a higher prevalence of patients with CAI were observed in patients with SLE. In multivariate analysis, CPSS score was positively (OR 1.09; 95% CI: 1.03-1.14; p = 0.001) and CAI negatively (OR 0.43; 95% CI: 0.19-0.99; p = 0.049) associated with headache in patients with SLE. CONCLUSION Despite the prevalence of headache in patients with SLE and the general population being similar, headache-related disability may be higher in patients with SLE. Moreover, CPS might play a role in the pathogenesis of SLE headache, whereas CAI might have a protective effect against it.
Collapse
Affiliation(s)
- José Antonio Vargas-Hitos
- From the Systemic Autoimmune Diseases Unit, Internal Medicine Department, the Clinical Analysis Department, and the Department of Statistics, Virgen de las Nieves University Hospital; Occupational Medicine, MAZ Department, Granada; Internal Medicine Department, Asturias Central Hospital, Oviedo; Internal Medicine Department, Carlos Haya University Hospital, Málaga; Internal Medicine Department, San Cecilio University Hospital, Granada, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
|
36
|
Vargas-Hitos JA, Ateka-Barrutia O, Sangle S, Khamashta MA. Efficacy and safety of long-term low molecular weight heparin in patients with antiphospholipid syndrome. Ann Rheum Dis 2011; 70:1652-4. [PMID: 21628306 DOI: 10.1136/ard.2011.150268] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Evaluation of the effectiveness and safety of long-term low molecular weight heparin (LMWH) in patients with antiphospholipid syndrome (APS) that had not previously responded to or tolerated oral vitamin K antagonists. METHODS 23 patients with confirmed diagnosis of APS were retrospectively recruited. All patients were receiving LMWH as a result of intolerance and/or lack of response to warfarin therapy. The type of LMWH, the duration of treatment, the reason for switching to LMWH and the adverse effects were recorded. Outcomes were classified as no improvement, partial improvement or total improvement after at least 1 year of using LMWH. RESULTS The average duration of LMWH treatment was 36 months. Most of the patients were on treatment with enoxaparin (n=16, 69%) and were switched to LMWH from warfarin mainly because of thrombosis despite therapeutic international normalised ratio (n=9, 39%). Good quality of life with no evidence of recurrent thrombotic events was noted in nine patients (39%), whereas 11 (48%) showed partial clinical improvement but no evidence of recurrent thrombotic episodes. Osteoporosis was reported in five patients (23%), all of whom were also receiving treatment with corticosteroids. CONCLUSIONS Long-term LMWH may be a safe and effective alternative to warfarin for APS patients.
Collapse
Affiliation(s)
- José Antonio Vargas-Hitos
- Systemic Autoimmune Diseases Unit, Internal Medicine Department, Virgen de las Nieves University Hospital, Granada, Spain
| | | | | | | |
Collapse
|
37
|
Sabio JA, Vargas-Hitos JA, Mario J. Metabolic syndrome, endothelial injury, and subclinical atherosclerosis in patients with systemic lupus erythematosus: comments on the article by Mok et al. Scand J Rheumatol 2010; 39:527; author reply 527. [PMID: 21110795 DOI: 10.3109/03009742.2010.489907] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
38
|
Vargas-Hitos JA, Zamora-Pasadas M, Manzano-Gamero V, Hidalgo-Tenorio C. [Lower limb bone pain as clinical onset of secondary syphilis]. Enferm Infecc Microbiol Clin 2010; 28:750-1. [PMID: 20646791 DOI: 10.1016/j.eimc.2010.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2009] [Revised: 02/21/2010] [Accepted: 03/03/2010] [Indexed: 10/19/2022]
|
39
|
Sabio JM, Vargas-Hitos JA, Navarrete N, Hidalgo-Tenorio C, Jiménez-Alonso J. Effects of low or medium-dose of prednisone on insulin resistance in patients with systemic lupus erythematosus. Clin Exp Rheumatol 2010; 28:483-489. [PMID: 20497628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2009] [Accepted: 02/01/2010] [Indexed: 05/29/2023]
Abstract
OBJECTIVES To determine the effect of low (< or =7.5 mg/day; LD-PRD group) or medium (>7.5 mg/day; MD-PRD group) doses of prednisone over the past 4 months on insulin levels and insulin resistance (IR) in SLE patients. METHODS SLE patients were categorised in prednisone non-users (No PRD) (n=41), LD-PRD (n=71) and MD-PRD (n=16) users. We compared insulin levels, presence of increased IR using homeostasis model assessment (HOMA index), metabolic syndrome (MetS), and other clinical, metabolic and inflammatory parameters in the 3 groups. A Spearman's rho test was used to identify independent associations between daily prednisone dose, HOMA index and insulin levels and other parameters, after adjusting for confounders. RESULTS No differences in increased IR, HOMA index and insulin between No PRD and LD-PRD were found. In contrast, the MD-PRD group was younger (p=0.001) and had higher insulin (p=0.015), higher HOMA index (p=0.019) and increased IR (OR 5.8, 95% CI (1.7-20), p=0.007) in comparison with the LD-PRD group. The HOMA index strongly correlated with body mass index (BMI) (rs=0.460, p<0.001) but not with clinical activity or inflammatory state after adjusting for confounders. Prednisone dose correlated with the HOMA index and insulin but not with inflammatory parameters (erythrocyte sedimentation rate p=0.075) after adjusting for confounder. CONCLUSIONS Daily medium-dose prednisone use (>7.5 mg/d) but not low-dose (< or =7.5 mg/d) use increased insulin levels and IR in SLE, which may contribute to increased CV risk experienced by these patients.
Collapse
Affiliation(s)
- J M Sabio
- Systemic Autoimmune Diseases Unit, Internal Medicine Service, Virgen de las Nieves University Hospital, Granada, Spain.
| | | | | | | | | |
Collapse
|
40
|
Sabio JM, Vargas-Hitos JA, Mediavilla JD, Navarrete-Navarrete N, Zamora-Posadas M, Pérez-Vicente S, Hidalgo-Tenorio C, Díaz-Chamorro A, Jáimez L, Jiménez-Alonso J. Correlation of asymptomatic hyperuricaemia and serum uric acid levels with arterial stiffness in women with systemic lupus erythematosus without clinically evident atherosclerotic cardiovascular disease. Lupus 2010; 19:591-8. [PMID: 20179170 DOI: 10.1177/0961203309355301] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The objective of this article was to evaluate whether serum uric acid (SUA) correlates with arterial stiffness and inflammation markers in a cohort of women with systemic lupus erythematosus (SLE) without overt atherosclerotic cardiovascular diseases, who attended a community hospital. One hundred and two women with SLE were assessed as part of this cross-sectional study. Carotid-femoral pulse wave velocity (PWV) was measured using an automatic device (Complior). C-reactive protein (CRP), fibrinogen and homocysteine levels as well as other metabolic results were recorded. Duration and activity of SLE, damage accrual and treatments were recorded. SLE women were categorized as having or not having hyperuricaemia (HU) according to SUA levels (greater than or up to 6.2 mg/dl, respectively). A multiple linear regression analysis was used to determine the independent link between SUA levels and other variables. Women with SLE and HU (n = 15, 15%) had a worse cardiovascular risk profile that included ageing, hypertension, obesity, higher total cholesterol levels, renal failure and presence of metabolic syndrome. Also, the duration of SLE was increased and damage accrual was greater. In the unadjusted analysis, SUA levels correlated with PWV, CRP, fibrinogen and homocysteine. However, in a multivariate linear regression analysis, SUA levels independently correlated with the duration of SLE, creatinine, total cholesterol and homocysteine levels but did not correlate with PWV. In conclusion, SUA was associated with arterial stiffness, but not independently of age and homocysteine levels. Nevertheless, SUA might be an ancillary indicator of subclinical atherosclerosis in SLE women without clinically evident atherosclerotic cardiovascular disease.
Collapse
Affiliation(s)
- J M Sabio
- Systemic Autoimmune Diseases Unit, Service of Internal Medicine, Virgen de las Nieves University Hospital, Granada, Spain.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|