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Hernández Cruz B, Alonso F, Calvo Alén J, Pego-Reigosa JM, López-Longo FJ, Galindo-Izquierdo M, Olivé A, Tomero E, Horcada L, Uriarte E, Erausquin C, Sánchez-Atrio A, Montilla C, Santos Soler G, Fernández-Nebro A, Blanco R, Rodríguez-Gómez M, Vela P, Freire M, Díez-Álvarez E, Boteanu AL, Narváez J, Martínez Taboada V, Ruiz-Lucea E, Andreu JL, Fernández-Berrizbeitia O, Hernández-Beriain JÁ, Gantes M, Pérez-Venegas JJ, Ibáñez-Barceló M, Pecondón-Español Á, Marras C, Bonilla G, Castellví I, Moreno M, Raya E, Quevedo Vila VE, Vázquez T, Ruán JI, Muñoz S, Rúa-Figueroa Í. Differences in clinical manifestations and increased severity of systemic lupus erythematosus between two groups of Hispanics: European Caucasians versus Latin American mestizos (data from the RELESSER registry). Lupus 2019; 29:27-36. [DOI: 10.1177/0961203319889667] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background Systemic lupus erythematosus (SLE) is regarded as a prototype autoimmune disease because it can serve as a means for studying differences between ethnic minorities and sex. Traditionally, all Hispanics have been bracketed within the same ethnic group, but there are differences between Hispanics from Spain and those from Latin America, not to mention other Spanish-speaking populations. Objectives This study aimed to determine the demographic and clinical characteristics, severity, activity, damage, mortality and co-morbidity of SLE in Hispanics belonging to the two ethnic groups resident in Spain, and to identify any differences. Methods This was an observational, multi-centre, retrospective study. The demographic and clinical variables of patients with SLE from 45 rheumatology units were collected. The study was conducted in accordance with Good Clinical Practice guidelines. Hispanic patients from the registry were divided into two groups: Spaniards or European Caucasians (EC) and Latin American mestizos (LAM). Comparative univariate and multivariate statistical analyses were carried out. Results A total of 3490 SLE patients were included, 90% of whom were female; 3305 (92%) EC and 185 (5%) LAM. LAM patients experienced their first lupus symptoms four years earlier than EC patients and were diagnosed and included in the registry younger, and their SLE was of a shorter duration. The time in months from the first SLE symptoms to diagnosis was longer in EC patients, as were the follow-up periods. LAM patients exhibited higher prevalence rates of myositis, haemolytic anaemia and nephritis, but there were no differences in histological type or serositis. Anti-Sm, anti-Ro and anti-RNP antibodies were more frequently found in LAM patients. LAM patients also had higher levels of disease activity, severity and hospital admissions. However, there were no differences in damage index, mortality or co-morbidity index. In the multivariate analysis, after adjusting for confounders, in several models the odds ratio (95% confidence interval) for a Katz severity index >3 in LAM patients was 1.45 (1.038–2.026; p = 0.02). This difference did not extend to activity levels (i.e. SLEDAI >3; 0.98 (0.30–1.66)). Conclusion SLE in Hispanic EC patients showed clinical differences compared to Hispanic LAM patients. The latter more frequently suffered nephritis and higher severity indices. This study shows that where lupus is concerned, not all Hispanics are equal.
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Affiliation(s)
- B Hernández Cruz
- Rheumatology Department, Virgen Macarena University Hospital, Seville, Spain
| | - F Alonso
- Research Unit, Spanish Society of Rheumatology, Madrid, Spain
| | - J Calvo Alén
- Rheumatology Department, Araba University Hospital, Vitoria, Spain
| | - J M Pego-Reigosa
- Rheumatology Department, University Hospital Complex, Instituto de Investigación Biomédica de Vigo, Vigo, Spain
| | - F J López-Longo
- Rheumatology Department, Gregorio Marañón University Hospital, Madrid, Spain
| | | | - A Olivé
- Rheumatology Department, Germans Trías i Pujol University Hospital, Badalona, Spain
| | - E Tomero
- Rheumatology Department, La Princesa University Hospital, Madrid, Spain
| | - L Horcada
- Rheumatology Department, Navarra Hospital, Navarra, Spain
| | - E Uriarte
- Rheumatology Department, Donosti Hospital, Guipuzcoa, Spain
| | - C Erausquin
- Rheumatology Department, Dr Negrín University Hospital, Las Palmas de Gran Canaria, Spain
| | - A Sánchez-Atrio
- Rheumatology Department, Príncipe de Asturias University Hospital, Madrid, Spain
| | - C Montilla
- Rheumatology Department, Salamanca Clinic University Hospital, Salamanca, Spain
| | - G Santos Soler
- Rheumatology Department, Marina Baixa Hospital, Alicante, Spain
| | - A Fernández-Nebro
- Rheumatology Department, Carlos Haya University Hospital, Malaga, Spain
| | - R Blanco
- Rheumatology Department, Marqués de Valdecilla University Hospital, Santander, Spain
| | - M Rodríguez-Gómez
- Rheumatology Department, Hospital Complex of Ourense, Ourense, Spain
| | - P Vela
- Rheumatology Department, Alicante General Hospital, Alicante, Spain
| | - M Freire
- Rheumatology Department, Juan Canalejo University Hospital, La Coruña, Spain
| | | | - A L Boteanu
- Rheumatology Department, Ramon y Cajal University Hospital, Madrid, Spain
| | - J Narváez
- Rheumatology Department, Bellvitge Hospital, Barcelona, Spain
| | - V Martínez Taboada
- Rheumatology Department, Marqués de Valdecilla University Hospital, Santander, Spain
| | - E Ruiz-Lucea
- Rheumatology Department, Basurto Hospital, Bilbao, Spain
| | - JL Andreu
- Rheumatology Department, Puerta del Hierro-Majadahonda Hospital, Madrid, Spain
| | | | | | - M Gantes
- Rheumatology Department, Tenerife Clinic Hospital, Tenerife, Spain
| | - J J Pérez-Venegas
- Rheumatology Department, Jerez de la Frontera University Hospital, Cadiz, Spain
| | | | - Á Pecondón-Español
- Rheumatology Department, Miguel Servet University Hospital, Zaragoza, Spain
| | - C Marras
- Rheumatology Department, Virgen de la Arrixaca University Hospital, Murcia, Spain
| | - G Bonilla
- Rheumatology Department, La Paz University Hospital, Madrid, Spain
| | - I Castellví
- Rheumatology Unit, L’Alt Penedés District Hospital, Barcelona, Spain
| | - M Moreno
- Rheumatology Department, Parc Taulí Hospital, Barcelona, Spain
| | - E Raya
- Rheumatology Department, San Cecilio Hospital, Granada, Spain
| | | | - T Vázquez
- Rheumatology Department, Lucus Augusti Hospital, Lugo, Spain
| | - J Ibáñez Ruán
- Rheumatology Unit, POVISA Medical Centre, Vigo, Spain
| | - S Muñoz
- Rheumatology Service, Infanta Sofía University Hospital, San Sebastián de los Reyes, Madrid, Spain
| | - Í Rúa-Figueroa
- Rheumatology Department, Doctor Negrín University Hospital of Gran Canaria, Las Palmas de Gran Canaria, Spain
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Peña-Sagredo JL, Fariñas MC, Perez-Zafrilla B, Cruz-Valenciano A, Crespo M, Joven-Ibañez B, Riera E, Manero-Ruiz FJ, Chalmeta I, Hernández MV, Rodríguez-Gómez M, Maíz O, López R, Cobo T, Pita J, Carmona L, Gonzalez-Gay MA. Non-typhi Salmonella infection in patients with rheumatic diseases on TNF-alpha antagonist therapy. Clin Exp Rheumatol 2009; 27:920-925. [PMID: 20149306] [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] [Indexed: 05/28/2023]
Abstract
OBJECTIVES The morbidity and mortality of patients with rheumatic diseases has improved considerably following the use of biologic therapies. However, an increase in the frequency of bacterial infections has been observed in patients receiving these drugs. In the present study we aimed to establish the incidence and clinical manifestations of non-typhi Salmonella infection in a large cohort of patients with rheumatic diseases undergoing TNF-alpha antagonist therapy due to severe rheumatic diseases refractory to conventional therapies. METHODS The rate of non-typhi Salmonella infection found in the Spanish Registry of Adverse Events of Biological Therapies in Rheumatic Diseases (BIOBADASER) was compared with that observed in a cohort of rheumatoid arthritis (RA) patients from the EMECAR (Morbidity and Clinical Expression of Rheumatoid Arthritis) Study, who were not treated with TNF-alpha antagonists. The rate found in the BIOBADASER registry was also compared with that available in a non-RA historic control cohort reported in a population from Huesca (Northern Spain). RESULTS Seventeen cases of non-typhi Salmonella infection were observed in the series of patients exposed to anti-TNF-alpha therapies. The incidence rate of non-typhi Salmonella in BIOBADASER was 0.73 per 1000 patient-years (95% confidence interval [CI]: 0.45-1.17). The incidence rate in the EMECAR cohort was 0.44 per 1000 patient-years. The relative risk for non-typhi salmonellosis in RA patients exposed to TNF-alpha inhibitors compared to those not treated with biological therapies was 2.07 (95% CI: 0.27-15.73) (p=0.480) whereas the relative risk of non-typhi Salmonella infections in patients with rheumatic diseases undergoing TNF-alpha antagonist therapy compared with the non-RA Spanish control cohort was 0.63 (95% CI: 0.38-1.04) (p=0.07). Nine of the 17 patients with non-typhi salmonellosis presented a severe systemic infection. CONCLUSION Incidence of non-typhi Salmonella infection is not increased significantly in rheumatic patients undergoing anti-TNF-alpha therapy when compared with RA patients undergoing conventional DMARD therapy or with the general population. Nevertheless, at least 50% of patients on TNF-alpha have severe complications once they develop non-typhi Salmonella infection. This fact suggests that anti-TNF-alpha therapies may predispose to salmonella dissemination rather than to infection.
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Affiliation(s)
- J L Peña-Sagredo
- Division of Rheumatology, Hospital Universitario Marques de Valdecilla, University of Cantabria, Santander, Spain
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