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Abhishek A, Tedeschi SK, Pascart T, Latourte A, Dalbeth N, Neogi T, Fuller A, Rosenthal A, Becce F, Bardin T, Ea HK, Filippou G, FitzGerald J, Iagnocco A, Lioté F, McCarthy GM, Ramonda R, Richette P, Sivera F, Andres M, Cipolletta E, Doherty M, Pascual E, Perez-Ruiz F, So A, Jansen TL, Kohler MJ, Stamp LK, Yinh J, Adinolfi A, Arad U, Aung T, Benillouche E, Bortoluzzi A, Dau J, Maningding E, Fang MA, Figus FA, Filippucci E, Haslett J, Janssen M, Kaldas M, Kimoto M, Leamy K, Navarro GM, Sarzi-Puttini P, Scirè C, Silvagni E, Sirotti S, Stack JR, Truong L, Xie C, Yokose C, Hendry AM, Terkeltaub R, Taylor WJ, Choi HK. The 2023 ACR/EULAR Classification Criteria for Calcium Pyrophosphate Deposition Disease. Arthritis Rheumatol 2023; 75:1703-1713. [PMID: 37494275 PMCID: PMC10543651 DOI: 10.1002/art.42619] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 03/08/2023] [Revised: 04/19/2023] [Accepted: 05/23/2023] [Indexed: 07/28/2023]
Abstract
OBJECTIVE Calcium pyrophosphate deposition (CPPD) disease is prevalent and has diverse presentations, but there are no validated classification criteria for this symptomatic arthritis. The American College of Rheumatology (ACR) and EULAR have developed the first-ever validated classification criteria for symptomatic CPPD disease. METHODS Supported by the ACR and EULAR, a multinational group of investigators followed established methodology to develop these disease classification criteria. The group generated lists of candidate items and refined their definitions, collected de-identified patient profiles, evaluated strengths of associations between candidate items and CPPD disease, developed a classification criteria framework, and used multi-criterion decision analysis to define criteria weights and a classification threshold score. The criteria were validated in an independent cohort. RESULTS Among patients with joint pain, swelling, or tenderness (entry criterion) whose symptoms are not fully explained by an alternative disease (exclusion criterion), the presence of crowned dens syndrome or calcium pyrophosphate crystals in synovial fluid are sufficient to classify a patient as having CPPD disease. In the absence of these findings, a score >56 points using weighted criteria, comprising clinical features, associated metabolic disorders, and results of laboratory and imaging investigations, can be used to classify as CPPD disease. These criteria had a sensitivity of 92.2% and specificity of 87.9% in the derivation cohort (190 CPPD cases, 148 mimickers), whereas sensitivity was 99.2% and specificity was 92.5% in the validation cohort (251 CPPD cases, 162 mimickers). CONCLUSION The 2023 ACR/EULAR CPPD disease classification criteria have excellent performance characteristics and will facilitate research in this field.
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Affiliation(s)
| | - Sara K Tedeschi
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts
| | - Tristan Pascart
- Department of Rheumatology, Lille Catholic University, Saint-Philibert Hospital, Lille, France
| | - Augustin Latourte
- Université de Paris, INSERM, UMR-S 1132 BIOSCAR, and Service de Rhumatologie, AP-HP, Lariboisière Hospital, Paris, France
| | - Nicola Dalbeth
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Tuhina Neogi
- Department of Medicine, Section of Rheumatology, Boston University School of Medicine, Boston, Massachusetts
| | - Amy Fuller
- Academic Rheumatology, University of Nottingham, Nottingham, UK
| | - Ann Rosenthal
- Department of Medicine, Medical College of Wisconsin, Milwaukee
| | - Fabio Becce
- Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Thomas Bardin
- Université de Paris, INSERM, UMR-S 1132 BIOSCAR, and Service de Rhumatologie, AP-HP, Lariboisière Hospital, Paris, France
| | - Hang Korng Ea
- Université de Paris, INSERM, UMR-S 1132 BIOSCAR, and Service de Rhumatologie, AP-HP, Lariboisière Hospital, Paris, France
| | - Georgios Filippou
- Rheumatology Department, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - John FitzGerald
- David Geffen School of Medicine, University of California, and Veterans Administration for Greater Los Angeles, Los Angeles, California
| | - AnnaMaria Iagnocco
- Academic Rheumatology Center, Università degli Studi di Torino, Turin, Italy
| | - Frédéric Lioté
- Université de Paris, INSERM, UMR-S 1132 BIOSCAR, Service de Rhumatologie, AP-HP, Lariboisière Hospital, and Université Paris Cité, Faculté de Santé, Paris, France
| | - Geraldine M McCarthy
- School of Medicine and Medical Science, University College Dublin, and Mater Misericordiae University Hospital, Dublin, Ireland
| | - Roberta Ramonda
- Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Pascal Richette
- Université de Paris, INSERM, UMR-S 1132 BIOSCAR, and Service de Rhumatologie, AP-HP, Lariboisière Hospital, Paris, France
| | - Francisca Sivera
- Department of Rheumatology, Hospital General Universitario Elda, Elda, Spain, and Department of Clinical Medicine, Universidad Miguel Hernandez, Elche, Spain
| | - Mariano Andres
- Department of Medicine, Rheumatology Section, Hospital General Universitario de Alicante, Universidad Miguel Hernández, Alicante, Spain
| | - Edoardo Cipolletta
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Michael Doherty
- Academic Rheumatology, University of Nottingham, Nottingham, UK
| | - Eliseo Pascual
- Rheumatology Division, Cruces University Hospital, Bilbao, Spain
| | - Fernando Perez-Ruiz
- Arthritis Investigation Group, Biocruces-Bizkaia Health Research Institute, Spain, Department of Medicine, Medicine and Nursing School, University of the Basque Country, and Basque Country Rheumatology Society, Bilbao, Spain
| | - Alexander So
- Lausanne University Hospital, Lausanne, Switzerland
| | - Tim L Jansen
- VieCuri Medical Centre, Venlo, The Netherlands, and Medical Cell BioPhysics Group, University of Twente, Enschede, The Netherlands
| | - Minna J Kohler
- Department of Medicine, Rheumatology Unit, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts
| | - Lisa K Stamp
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Janeth Yinh
- Department of Medicine, Rheumatology Unit, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts
| | | | - Uri Arad
- Department of Rheumatology, Te Whatu Ora-Health New Zealand Waikato, Hamilton, New Zealand
| | - Thanda Aung
- Division of Rheumatology, University of California, Los Angeles
| | - Eva Benillouche
- Department of Rheumatology, Lausanne University Hospital, Lausanne, Switzerland
| | - Alessandra Bortoluzzi
- Section of Rheumatology, Department of Medical Sciences, University of Ferrara, Ferrara, Italy, and Azienda Ospedaliera-Universitaria di Ferrara, Cona (FE), Italy
| | - Jonathan Dau
- Department of Medicine, Rheumatology Unit, Massachusetts General Hospital, Boston
| | | | - Meika A Fang
- David Geffen School of Medicine, University of California, and Veterans Administration for Greater Los Angeles, Los Angeles, California
| | - Fabiana A Figus
- Rheumatology Division, Local Health Unit (ASL), Turin-3, Collegno and Pinerolo, Italy
| | - Emilio Filippucci
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Janine Haslett
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | | | - Marian Kaldas
- David Geffen School of Medicine, University of California, Los Angeles
| | - Maryann Kimoto
- David Geffen School of Medicine, University of California, Los Angeles
| | - Kelly Leamy
- Mater Misericordiae University Hospital, Dublin, Ireland
| | | | | | - Carlo Scirè
- Epidemiology Unit, Italian Society for Rheumatology, Milan, Italy
| | - Ettore Silvagni
- Section of Rheumatology, Department of Medical Sciences, University of Ferrara, Ferrara, Italy, and Azienda Ospedaliera-Universitaria di Ferrara, Cona (FE), Italy
| | - Silvia Sirotti
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - John R Stack
- School of Medicine and Medical Science, University College Dublin, and Mater Misericordiae University Hospital, Dublin, Ireland
| | - Linh Truong
- Division of Rheumatology, University of California, Los Angeles, California
| | - Chen Xie
- Division of Rheumatology, University of California, Los Angeles, California
| | - Chio Yokose
- Harvard Medical School, Boston, Massachusetts
| | - Alison M Hendry
- Department of Medicine, General Medicine and Rheumatology, Middlemore Hospital, Counties Manukau Health District, New Zealand
| | - Robert Terkeltaub
- San Diego Veterans Administration Healthcare Service, and University of California, San Diego
| | - William J Taylor
- Department of Medicine, Rheumatology Unit, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts
| | - Hyon K Choi
- Department of Medicine, Rheumatology Unit, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts
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Goitia M, Andres M, Aquesolo L, Azkuenaga A, Cearsolo A, de los Bueis J, Diaz T, Diez S, Martinez Zilloniz N, Millan L, Silva J, Urquijo E. Tratamiento médico de los miomas uterinos. Del presente al futuro. Clínica e Investigación en Ginecología y Obstetricia 2023. [DOI: 10.1016/j.gine.2023.100845] [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] [Indexed: 02/24/2023]
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Nazir M, Murphy T, Poku N, Wheen P, Nowbar A, Andres M, Ramalingham S, Rosen S, Nicol E, Lyon A. Clinical Utility And Prognostic Value Of Coronary Computed Tomography Angiography In Cancer Patients. J Cardiovasc Comput Tomogr 2023. [DOI: 10.1016/j.jcct.2023.01.015] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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Andres M, Murphy TM, Poku N, Nazir S, Ramalingam S, Chambers V, Rosen SD, Lyon AR. Cardio-Oncology: a medical specialty in constant growth and evolution. the 10-year experience of the first cardio-oncology service in the United Kingdom. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Survivorship has increased significantly in cancer patients with the advent of novel therapies. However, this improvement has been at the cost of higher rates of cardiotoxicity. Cardiovascular disease has become the main cause of death or cancer therapy interruption in many of these patients. The need for specialist services to deal with these emerging problems has led to global development of many Cardio-Oncology services.
Objectives
To describe how a Cardio-Oncology service has grown and evolved over a 10 year period in response to the constantly changing oncological landscape.
Methods and results
Prospective, single center, study of cancer patients referred to our service from February 2011 to December 2021. 1499 patients were referred to the service. Mean age was 60 years (SD: 15) and 60% were female. CV risk factors including hypertension (32%), dyslipidaemia (12%) and diabetes (6%) were common.
The most frequent primary tumour location was breast (427 patients, 28%), followed by haematological (151, 10%) and gastrointestinal tract (114, 8%). The average number of referrals per month increased 6 fold from 2011, from 3.3 patients per month to 21 patients in 2021. In the last 5 years there was a 10 fold increase in the number of outpatient consultations from 189 consultations in 2016 to 1988 consultations in 2021.
The most frequent reason for referral was pre-treatment assessment (39%), followed by cancer therapy related cardiac dysfunction (CTRCD) (33%) and other acute cancer therapy related CV diseases (CTR-CVDs) (22%). From 2011 to 2017 CTRCD was the main CTR-CVD due to anthracycline and trastuzumab. This ratio changed in 2018 when other CTR-CVDs became the most frequent referral reason following pre-treatment assessment. Patients referred to our service were or had been, mostly under medical therapy alone or in combination with surgery or radiotherapy (1058 patients, 70%), anthracyclines being the predominant treatment (435 patients, 40%). Targeted therapies and immune check point inhibitors became more popular in the last two years (2020–2021). A multivariable logistic regression model was built to assess the relation between the medical treatment and the prevalence of CTRCD vs other CTR-CVDs. Anthracyclines and HER2 therapy are independently associated with a higher prevalence of CTRCD while tyrosine kinase inhibitors and immune checkpoint inhibitors increase the risk of other CTR-CVDs e.g. hypertension, arrhythmias and myocarditis.
Conclusions
Cardio-Oncology has rapidly evolved from its origin as a subspecialty of heart failure medicine, to a diverse medical specialty that encompasses many different domains of cardiology. Future cardio-oncology services should reflect this and be dynamic, collaborating with cardiac sub-specialities as necessary. Provision of cardio-oncology services requires a considerable knowledge and understanding of the ever growing and changing oncology therapies.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Andres
- Royal Brompton and Harefield Hospital , London , United Kingdom
| | - T M Murphy
- Royal Brompton and Harefield Hospital , London , United Kingdom
| | - N Poku
- Royal Brompton and Harefield Hospital , London , United Kingdom
| | - S Nazir
- Royal Brompton and Harefield Hospital , London , United Kingdom
| | - S Ramalingam
- Royal Brompton and Harefield Hospital , London , United Kingdom
| | - V Chambers
- Royal Brompton and Harefield Hospital , London , United Kingdom
| | - S D Rosen
- Royal Brompton and Harefield Hospital , London , United Kingdom
| | - A R Lyon
- Royal Brompton and Harefield Hospital , London , United Kingdom
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Tedeschi SK, Pascart T, Latourte A, Godsave C, Kundakci B, Naden RP, Taylor WJ, Dalbeth N, Neogi T, Perez-Ruiz F, Rosenthal A, Becce F, Pascual E, Andres M, Bardin T, Doherty M, Ea HK, Filippou G, FitzGerald J, Guitierrez M, Iagnocco A, Jansen TL, Kohler MJ, Lioté F, Matza M, McCarthy GM, Ramonda R, Reginato AM, Richette P, Singh JA, Sivera F, So A, Stamp LK, Yinh J, Yokose C, Terkeltaub R, Choi H, Abhishek A. Identifying Potential Classification Criteria for Calcium Pyrophosphate Deposition Disease: Item Generation and Item Reduction. Arthritis Care Res (Hoboken) 2022; 74:1649-1658. [PMID: 33973414 PMCID: PMC8578594 DOI: 10.1002/acr.24619] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [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: 01/12/2021] [Revised: 03/24/2021] [Accepted: 04/06/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Classification criteria for calcium pyrophosphate deposition (CPPD) disease will facilitate clinical research on this common crystalline arthritis. Our objective was to report on the first 2 phases of a 4-phase process for developing CPPD classification criteria. METHODS CPPD classification criteria development is overseen by a 12-member steering committee. Item generation (phase I) included a scoping literature review of 5 literature databases and contributions from a 35-member combined expert committee and 2 patient research partners. Item reduction and refinement (phase II) involved a combined expert committee meeting, discussions among clinical, imaging, and laboratory advisory groups, and an item-rating exercise to assess the influence of individual items toward classification. The steering committee reviewed the modal rating score for each item (range -3 [strongly pushes away from CPPD] to +3 [strongly pushes toward CPPD]) to determine items to retain for future phases of criteria development. RESULTS Item generation yielded 420 items (312 from the literature, 108 from experts/patients). The advisory groups eliminated items that they agreed were unlikely to distinguish between CPPD and other forms of arthritis, yielding 127 items for the item-rating exercise. Fifty-six items, most of which had a modal rating of +/- 2 or 3, were retained for future phases. As numerous imaging items were rated +3, the steering committee recommended focusing on imaging of the knee and wrist and 1 additional affected joint for calcification suggestive of CPP crystal deposition. CONCLUSION A data- and expert-driven process is underway to develop CPPD classification criteria. Candidate items comprise clinical, imaging, and laboratory features.
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Affiliation(s)
- Sara K. Tedeschi
- Division of Rheumatology, Inflammation and Immunity,
Brigham and Women’s Hospital and Harvard Medical School, Boston, United
States
| | - Tristan Pascart
- Department of Rheumatology, Lille Catholic University,
Lille, France
| | - Augustin Latourte
- Department of Rheumatology, Centre Viggo Petersen,
Hôpital Lariboisière, Université de Paris, Paris, France
| | - Cattleya Godsave
- Department of Academic Rheumatology, University of
Nottingham, Nottingham, United Kingdom
| | - Burak Kundakci
- Department of Academic Rheumatology, University of
Nottingham, Nottingham, United Kingdom
| | - Raymond P. Naden
- Department of Medicine, Auckland City Hospital, Auckland,
New Zealand
| | | | - Nicola Dalbeth
- Department of Medicine, University of Auckland, Auckland,
New Zealand
| | - Tuhina Neogi
- Section of Rheumatology, Boston University School of
Medicine, Boston, MA, United States
| | - Fernando Perez-Ruiz
- Osakidetza, OSI EE-Cruces, Cruces University Hospital,
Biocruces-Bizkaia Health Research Institute and University of the Basque Country,
Basque Country, Spain
| | - Ann Rosenthal
- Department of Rheumatology, Medical College of
Wisconsin, Milwaukee, United States
| | - Fabio Becce
- Department of Radiology, Lausanne University Hospital,
Lausanne, Switzerland
| | - Eliseo Pascual
- Department of Rheumatology, Hospital General
Universitario de Alicante, Alicante Institute of Sanitary and Biomedical Research,
Alicante, Spain
| | - Mariano Andres
- Department of Rheumatology, Hospital General
Universitario de Alicante, Alicante Institute of Sanitary and Biomedical Research,
Alicante, Spain
| | - Thomas Bardin
- Department of Rheumatology, Centre Viggo Petersen,
Hôpital Lariboisière, Université de Paris, Paris, France
| | - Michael Doherty
- Department of Academic Rheumatology, University of
Nottingham, Nottingham, United Kingdom
| | - Hang-Korng Ea
- Department of Rheumatology, Centre Viggo Petersen,
Hôpital Lariboisière, Université de Paris, Paris, France
| | - Georgios Filippou
- Division of Rheumatology, Luigi Sacco University
Hospital, Milan, Italy
| | - John FitzGerald
- Greater Los Angeles VA Healthcare Service and Division
of Rheumatology, David Geffen School of Medicine, University of California-Los
Angeles, Los Angeles, United States
| | - Marwin Guitierrez
- Division of Musculoskeletal and Rheumatic Disorders,
Instituto Nacional de Rehabilitacion, Mexico City, Mexico
| | - Annamaria Iagnocco
- Academic Rheumatology Centre, Dipartimento Scienze
Cliniche e Biologiche, Università degli Studi di Torino, Turin, Italy
| | - Tim L. Jansen
- Department of Rheumatology, VieCuri Medical Center,
Venlo, Noord-Limburg, and University of Twente, Faculty Science & Technology,
Enschede, Netherlands
| | - Minna J. Kohler
- Division of Rheumatology, Allergy, and Immunology,
Massachusetts General Hospital and Harvard Medical School, Boston, United
States
| | - Frédéric Lioté
- Department of Rheumatology, Centre Viggo Petersen,
Hôpital Lariboisière, Université de Paris, Paris, France
| | - Mark Matza
- Division of Rheumatology, Allergy, and Immunology,
Massachusetts General Hospital and Harvard Medical School, Boston, United
States
| | | | - Roberta Ramonda
- Rheumatology Unit, Department of Medicine-DIMED,
University of Padova, Padova, Italy
| | | | - Pascal Richette
- Department of Rheumatology, Centre Viggo Petersen,
Hôpital Lariboisière, Université de Paris, Paris, France
| | - Jasvinder A. Singh
- Division of Rheumatology, University of Alabama at
Birmingham, and Birmingham Veterans Affairs Medical Center, Birmingham, United
States
| | - Francisca Sivera
- Department of Rheumatology, Hospital General
Universitario Elda, Elda, Spain, and Departamento de Medicina, Universidad Miguel
Hernandez, Elche, Spain
| | - Alexander So
- Department of Musculoskeletal Medicine, University
Hospital of Lausanne, Lausanne, Switzerland
| | - Lisa K. Stamp
- Division of Medicine, University of Otago, Christchurch,
New Zealand
| | - Janeth Yinh
- Division of Rheumatology, Allergy, and Immunology,
Massachusetts General Hospital and Harvard Medical School, Boston, United
States
| | - Chio Yokose
- Division of Rheumatology, Allergy, and Immunology,
Massachusetts General Hospital and Harvard Medical School, Boston, United
States
| | - Robert Terkeltaub
- San Diego VA Healthcare Service, Division of
Rheumatology, Allergy and Immunology, University of California-San Diego, San Diego,
United States
| | - Hyon Choi
- Division of Rheumatology, Allergy, and Immunology,
Massachusetts General Hospital and Harvard Medical School, Boston, United
States
| | - Abhishek Abhishek
- Department of Academic Rheumatology, University of
Nottingham, Nottingham, United Kingdom
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Sivera F, Andres M, Dalbeth N. A glance into the future of gout. Ther Adv Musculoskelet Dis 2022; 14:1759720X221114098. [PMID: 35923650 PMCID: PMC9340313 DOI: 10.1177/1759720x221114098] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 06/29/2022] [Indexed: 12/03/2022] Open
Abstract
Gout is characterized by monosodium urate (MSU) crystal deposits in and within joints. These deposits result from persistent hyperuricaemia and most typically lead to recurrent acute inflammatory episodes (gout flares). Even though some aspects of gout are well characterized, uncertainties remain; this upcoming decade should provide further insights into many of these uncertainties. Synovial fluid analysis allows for the identification of MSU crystals and unequivocal diagnosis. Non-invasive methods for diagnosis are being explored, such as Raman spectroscopy and imaging modalities. Both ultrasound and dual-energy computed tomography (DECT) allow the detection of MSU crystals; this not only provides a mean of diagnosis, but also has furthered gout knowledge defining the presence of a preclinical deposition in asymptomatic hyperuricaemia. Scientific consensus establishes the beginning of gout as the beginning of symptoms (usually the first flare), but the concept is currently under review. For effective long-term gout management, the main goal is to promote crystal dissolution treatment by reducing serum urate below 6 mg/dL (or 5 mg/dL if faster crystal dissolution is required). Current urate-lowering therapies' (ULTs) options are limited, with allopurinol and febuxostat being widely available, and probenecid, benzbromarone, and pegloticase available in some regions. New xanthine oxidase inhibitors and, especially, uricosurics inhibiting urate transporter URAT1 are under development; it is probable that the new decade will see a welcomed increase in the gout therapeutic armamentarium. Cardiovascular and renal comorbidities are common in gout patients. Studies determining whether optimal treatment of gout will positively impact these comorbidities are currently lacking, but will hopefully be forthcoming. Overall, the single change that will most impact gout management is greater uptake of international rheumatology society recommendations. Innovative strategies, such as nurse-led interventions based on these recommendations have recently demonstrated treatment success for people with gout.
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Affiliation(s)
- Francisca Sivera
- Rheumatology Unit, Hospital General
Universitario Elda, Ctra Sax s/n, Elda 03600, Alicante, Spain
- Department Medicine, Universidad Miguel
Hernandez, Elche, Spain
| | - Mariano Andres
- Department Medicine, Universidad Miguel
Hernandez, Elche, Spain
- Rheumatology Unit, Hospital General
Universitario Alicante, Alicante, Spain
- Alicante Institute of Sanitary and Biomedical
Research (ISABIAL), Alicante, Spain
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Moreno‐Perez O, Merino E, Alfayate R, Torregrosa ME, Andres M, Leon‐Ramirez J, Boix V, Gil J, Pico A. Male pituitary-gonadal axis dysfunction in post-acute COVID-19 syndrome-Prevalence and associated factors: A Mediterranean case series. Clin Endocrinol (Oxf) 2022; 96:353-362. [PMID: 34160836 PMCID: PMC8444731 DOI: 10.1111/cen.14537] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 05/14/2021] [Accepted: 05/25/2021] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Severe acute respiratory syndrome coronavirus 2 through angiotensin-converting enzyme 2 receptor can harm testes function. The objectives were to analyse the prevalence of low serum testosterone (LT) and impaired fertility potential (Leydig and Sertoli cells dysfunction, respectively) in coronavirus disease 2019 (COVID-19) male survivors and to evaluate acute infection-related associated factors. Also, we explore its association with post-acute COVID-19 syndrome (PCS) and quality of life (QOL). MATERIALS AND METHODS Male adults recovered from polymerase chain reaction-confirmed COVID-19 were offered a structured evaluation 8-12 weeks after recovery. The main outcome measure(s) were as follows: LT, defined as total testosterone (TT) < 2 ng/ml or if TT levels 2-4 ng/ml as calculated free testosterone < 6.36 ng/dl; Sertoli cell dysfunction was defined as inhibin-B < 89 pg/ml. Secondary outcome-associated factors were analysed by multiple logistic regression (odds ratio; 95% confidence interval [CI]). QOL was evaluated by SF-36 v.2. RESULTS One hundred and forty-three patients were evaluated at a median (interquartile range) of 77 days (72-83) after disease onset; 72% of them recovered from severe pneumonia. LT was detected in 41 patients (28.7%; 95% CI: 21.8-36.5). Low levels of inhibin-B were detected in 25 patients (18.1%; 95% CI: 12.5-25.3). After multivariate adjustment, obesity and hypokalaemia were associated with LT, whereas age more than 65 was an independent predictor of Sertoli cell dysfunction. LT or Sertoli cell dysfunction was not associated with PCS. Patients with LT had a lower score in four domains of QOL. CONCLUSIONS Prevalence of male LT and impaired fertility potential in COVID-19 survivors is high in the medium term. Traditional risk factors and severity markers for COVID-19 could be predictive.
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Affiliation(s)
- Oscar Moreno‐Perez
- Endocrinology and Nutrition DepartmentAlicante General University Hospital, Alicante Institute of Health and Biomedical Research (ISABIAL)AlicanteSpain
- Clinical Medicine DepartmentMiguel Hernández UniversityElcheSpain
| | - Esperanza Merino
- Unit of Infectious DiseasesAlicante General University Hospital, Alicante Institute of Health and Biomedical Research (ISABIAL)AlicanteSpain
| | - Rocio Alfayate
- Clinical Analysis DepartmentAlicante General University Hospital, Alicante Institute of Health and Biomedical Research (ISABIAL)AlicanteSpain
| | - Maria Eugenia Torregrosa
- Clinical Analysis DepartmentAlicante General University Hospital, Alicante Institute of Health and Biomedical Research (ISABIAL)AlicanteSpain
| | - Mariano Andres
- Clinical Medicine DepartmentMiguel Hernández UniversityElcheSpain
- Rheumatology DepartmentAlicante General University Hospital, Alicante Institute of Health and Biomedical Research (ISABIAL)AlicanteSpain
| | - Jose‐Manuel Leon‐Ramirez
- Pneumology DepartmentAlicante General University Hospital, Alicante Institute of Health and Biomedical Research (ISABIAL)AlicanteSpain
| | - Vicente Boix
- Clinical Medicine DepartmentMiguel Hernández UniversityElcheSpain
- Unit of Infectious DiseasesAlicante General University Hospital, Alicante Institute of Health and Biomedical Research (ISABIAL)AlicanteSpain
| | - Joan Gil
- Pneumology DepartmentAlicante General University Hospital, Alicante Institute of Health and Biomedical Research (ISABIAL)AlicanteSpain
| | - Antonio Pico
- Endocrinology and Nutrition DepartmentAlicante General University Hospital, Alicante Institute of Health and Biomedical Research (ISABIAL)AlicanteSpain
- Clinical Medicine DepartmentMiguel Hernández UniversityElcheSpain
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Dalbeth N, Alhilali M, Riordan P, Narang R, Chhana A, McGlashan S, Doyle A, Andres M. Vascular monosodium urate crystal deposition in gout: a dual-energy CT and microscopy study of cadaveric donors. Arthritis Rheumatol 2022; 74:1295-1296. [PMID: 35023635 DOI: 10.1002/art.42066] [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] [Received: 10/05/2021] [Revised: 12/01/2021] [Accepted: 12/18/2021] [Indexed: 11/07/2022]
Affiliation(s)
- Nicola Dalbeth
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Mariam Alhilali
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Peter Riordan
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Ravi Narang
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Ashika Chhana
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Sue McGlashan
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Anthony Doyle
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Mariano Andres
- Department of Medicine, Rheumatology Section, Hospital General Universitario de Alicante, Universidad Miguel Hernández, Alicante, Spain
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9
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Ramos‐Rincon J, Moreno‐Perez O, Pinargote‐Celorio H, Leon‐Ramirez J, Andres M, Reus S, Herrera‐García C, Martí‐Pastor A, Boix V, Gil J, Sanchez‐Martinez R, Merino E. Clinical Frailty Score vs Hospital Frailty Risk Score for predicting mortality and other adverse outcome in hospitalised patients with COVID-19: Spanish case series. Int J Clin Pract 2021; 75:e14599. [PMID: 34227196 PMCID: PMC8420333 DOI: 10.1111/ijcp.14599] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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] [Received: 02/14/2021] [Revised: 06/09/2021] [Accepted: 07/01/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Frailty can be used as a predictor of adverse outcomes in people with coronavirus disease 2019 (COVID-19). The aim of the study was to analyse the prognostic value of two different frailty scores in patients hospitalised for COVID-19. MATERIAL AND METHODS This retrospective cohort study included adult (≥18 years) inpatients with COVID-19 and took place from 3 March to 2 May 2020. Patients were categorised by Clinical Frailty Score (CFS) and Hospital Frailty Risk Score (HFRS). The primary outcome was in-hospital mortality, and secondary outcomes were tocilizumab treatment, length of hospital stay, admission in intensive care unit (ICU) and need for invasive mechanical ventilation. Results were analysed by multivariable logistic regression and expressed as odds ratios (ORs), adjusting for age, sex, kidney function and comorbidity. RESULTS Of the 290 included patients, 54 were frail according to the CFS (≥5 points; prevalence 18.6%, 95% confidence interval [CI]: 14.4-23.7) vs 65 by HFRS (≥5 points; prevalence: 22.4%, 95% CI 17.8-27.7). Prevalence of frailty increased with age according to both measures: 50-64 years, CFS 1.9% vs HFRS 12.3%; 65-79 years, CFS 31.5% vs HFRS 40.0%; and ≥80 years, CFS 66.7% vs HFRS 40.0% (P < .001). CFS-defined frailty was independently associated with risk of death (OR 3.67, 95% CI 1.49-9.04) and less treatment with tocilizumab (OR 0.28, 95% CI 0.08-0.93). HFRS-defined frailty was independently associated with length of hospital stay over 10 days (OR 2.89, 95% CI 1.53-5.44), ICU admission (OR 4.18, 95% CI 1.84-9.52) and invasive mechanical ventilation (OR 5.93, 95% CI 2.33-15.10). CONCLUSION In the spring 2020 wave of the COVID-19 pandemic in Spain, CFS-defined frailty was an independent predictor for death, while frailty as measured by the HFRS was associated with length of hospital stay over 10 days, ICU admission and use of invasive mechanical ventilation.
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Affiliation(s)
- Jose‐Manuel Ramos‐Rincon
- Internal Medicine DepartmentAlicante General University Hospital—Alicante Institute of Sanitary and Biomedical Research (ISABIAL)AlicanteSpain
- Clinical Medicine DepartmentMiguel Hernández UniversityElcheSpain
| | - Oscar Moreno‐Perez
- Clinical Medicine DepartmentMiguel Hernández UniversityElcheSpain
- Endocrinology and Nutrition DepartmentAlicante General University Hospital—Alicante Institute of Sanitary and Biomedical Research (ISABIAL)AlicanteSpain
| | - Hector Pinargote‐Celorio
- Infectious Diseases UnitAlicante General University Hospital—Alicante Institute of Sanitary and Biomedical Research (ISABIAL)AlicanteSpain
| | - Jose‐Manuel Leon‐Ramirez
- Pneumology DepartmentAlicante General University Hospital—Alicante Institute of Health and Biomedical Research (ISABIAL)AlicanteSpain
| | - Mariano Andres
- Clinical Medicine DepartmentMiguel Hernández UniversityElcheSpain
- Rheumatology DepartmentAlicante General University Hospital Alicante Institute of Health and Biomedical Research (ISABIAL)AlicanteSpain
| | - Sergio Reus
- Clinical Medicine DepartmentMiguel Hernández UniversityElcheSpain
- Infectious Diseases UnitAlicante General University Hospital—Alicante Institute of Sanitary and Biomedical Research (ISABIAL)AlicanteSpain
| | - Cristian Herrera‐García
- Internal Medicine DepartmentAlicante General University Hospital—Alicante Institute of Sanitary and Biomedical Research (ISABIAL)AlicanteSpain
| | - Ana Martí‐Pastor
- Internal Medicine DepartmentAlicante General University Hospital—Alicante Institute of Sanitary and Biomedical Research (ISABIAL)AlicanteSpain
| | - Vicente Boix
- Clinical Medicine DepartmentMiguel Hernández UniversityElcheSpain
- Infectious Diseases UnitAlicante General University Hospital—Alicante Institute of Sanitary and Biomedical Research (ISABIAL)AlicanteSpain
| | - Joan Gil
- Pneumology DepartmentAlicante General University Hospital—Alicante Institute of Health and Biomedical Research (ISABIAL)AlicanteSpain
| | - Rosario Sanchez‐Martinez
- Internal Medicine DepartmentAlicante General University Hospital—Alicante Institute of Sanitary and Biomedical Research (ISABIAL)AlicanteSpain
| | - Esperanza Merino
- Infectious Diseases UnitAlicante General University Hospital—Alicante Institute of Sanitary and Biomedical Research (ISABIAL)AlicanteSpain
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10
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Moreno-Pérez O, Ramos JM, Gimeno A, Rodríguez JC, Andres M, Leon-Ramirez JM, Valero B, Llorens P, Boix V, Gil J, Merino E. Medium-term serostatus in Spanish case series recovered from SARS-CoV-2 infection. J Med Virol 2021; 93:6030-6039. [PMID: 34138461 PMCID: PMC8426938 DOI: 10.1002/jmv.27135] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 06/14/2021] [Indexed: 11/08/2022]
Abstract
The medium-term serologic response of SARS-CoV-2 infection recovered individuals is not well known. The aims were to quantify the incidence of seropositive failure in the medium term in a cohort of patients with different COVID-19 severity and to analyze its associated factors. Patients who had recovered from mild and severe forms of SARS-CoV-2 infection in an Academic Spanish hospital (March 12-May 2, 2020), were tested for total anti-SARS-CoV-2 antibodies by electrochemiluminescence immunoassay (Elecsys Anti-SARS-CoV-2 test; Roche Diagnostics GmbH). The non-seropositive status (seropositive failure) incidence (95% CI) was determined. Associations were tested by multiple logistic regression in a global cohort and severe pneumonia subpopulation. Of 435 patients with PCR-confirmed SARS-CoV-2, a serological test was carried out in 325: 210 (64.6%) had severe pneumonia (hospitalized patients), 51 (15.7%) non-severe pneumonia (managed as outpatients), and 64 (19.7%) mild cases without pneumonia. After a median (IQR) of 76 days (70-83) from symptom onset, antibody responses may not consistently develop or reach levels sufficient to be detectable by antibody tests (non-seropositive incidence) in 6.9% (95% CI, 4.4-10.6) and 20.3% (95% CI, 12.2-31.7) of patients with and without pneumonia, respectively. Baseline independent predictors of seropositive failure were higher leukocytes and fewer days of symptoms before admission, while low glomerular filtrate and fever seem associated with serologic response. Age, comorbidity or immunosuppressive therapies (corticosteroids, tocilizumab) did not influence antibody response. In the medium-term, SARS-CoV-2 seropositive failure is not infrequent in COVID-19 recovered patients. Age, comorbidity or immunosuppressive therapies did not influence antibody response.
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Affiliation(s)
- Oscar Moreno-Pérez
- Endocrinology and Nutrition Department, Alicante General University Hospital - Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain.,Clinical Medicine Department, Miguel Hernández University, Elche, Spain
| | - Jose Manuel Ramos
- Clinical Medicine Department, Miguel Hernández University, Elche, Spain.,Internal Medicine Department, Alicante General University Hospital - Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Adelina Gimeno
- Microbiology Department, Alicante General University Hospital - Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Juan Carlos Rodríguez
- Microbiology Department, Alicante General University Hospital - Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain.,Miguel Hernández University, Elche, Spain
| | - Mariano Andres
- Clinical Medicine Department, Miguel Hernández University, Elche, Spain.,Rheumatology Department, Alicante General University Hospital - Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Jose-Manuel Leon-Ramirez
- Pneumology Department, Alicante General University Hospital - Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Beatriz Valero
- Internal Medicine Department, Alicante General University Hospital - Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Pere Llorens
- Clinical Medicine Department, Miguel Hernández University, Elche, Spain.,Emergency Department, Alicante General University Hospital - Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Vicente Boix
- Clinical Medicine Department, Miguel Hernández University, Elche, Spain.,Unit of Infectious Diseases, Alicante General University Hospital - Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Joan Gil
- Pneumology Department, Alicante General University Hospital - Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Esperanza Merino
- Unit of Infectious Diseases, Alicante General University Hospital - Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain
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11
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Diez-Lopez C, Perez-Contreras J, Andres M. Urate levels and clearance in renal patients under peritoneal dialysis. Nucleosides Nucleotides Nucleic Acids 2021; 40:720-731. [PMID: 34085590 DOI: 10.1080/15257770.2021.1934482] [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] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Hemodialysis adequately controls serum uric acid (UA) levels, making UA-lowering drugs unnecessary; scant data are available for peritoneal dialysis (PD). We analyzed blood, 24 h urine and dialysis fluid from twenty patients under PD, to assess UA levels and clearances, and factors associated with better performance and maintenance of target levels (<6mg/dL). Median serum UA was 5.4 mg/dL (p25-75 4.4-5.8), mainly achieved through peritoneal clearance (3.0 mL/min/1.73m2, 71.2% of total UA clearance); 75% of participants was on UA targets. Continuous cycling peritoneal dialysis showed highest UA clearance and target achievements. These findings may be of interest for end-stage renal patients with gout.
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Affiliation(s)
- Claudia Diez-Lopez
- Nephrology Service, General University Hospital of Alicante-ISABIAL, Alicante, Spain
| | - Javier Perez-Contreras
- Nephrology Service, General University Hospital of Alicante-ISABIAL, Alicante, Spain.,Department of Clinical Medicine, University Miguel Hernandez, Alicante, Spain
| | - Mariano Andres
- Department of Clinical Medicine, University Miguel Hernandez, Alicante, Spain.,Rheumatology Section, General University Hospital of Alicante-ISABIAL, Alicante, Spain
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12
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Riancho-Zarrabeitia L, Martínez-Taboada VM, Rúa-Figueroa I, Alonso F, Galindo-Izquierdo M, Ovalles J, Olivé-Marqués A, Mena Vázquez N, Calvo-Alén J, Menor Almagro R, Tomero Muriel E, Uriarte Isacelaya E, Boteanu A, Andres M, Freire González M, Santos Soler G, Ruiz-Lucea ME, Ibáñez-Barceló M, Castellví I, Galisteo C, Quevedo Vila V, Raya E, Narváez J, Expósito L, Hernández Beriaín JA, Horcada L, Aurrecoechea E, Pego Reigosa JM. Do all antiphospholipid antibodies confer the same risk for major organ involvement in systemic lupus erythematosus patients? Clin Exp Rheumatol 2021. [DOI: 10.55563/clinexprheumatol/9kxexc] [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)
| | - Víctor M. Martínez-Taboada
- Rheumatology Department, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Spain.
| | - Iñigo Rúa-Figueroa
- Rheumatology Department, Hospital Universitario Doctor Negrín, Las Palmas, Spain
| | - Fernando Alonso
- Unidad de Investigación, Sociedad Española de Reumatología, Madrid, Spain
| | | | - Juan Ovalles
- Rheumatology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | | | - Jaime Calvo-Alén
- Rheumatology Department, Hospital Universitario Araba, Álava, Spain
| | | | - Eva Tomero Muriel
- Rheumatology Department, Hospital Universitario La Princesa, Madrid, Spain
| | | | - Alina Boteanu
- Rheumatology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Mariano Andres
- Rheumatology Department, Hospital General Universitario de Alicante, Spain
| | | | | | | | | | - Iván Castellví
- Rheumatology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Carlos Galisteo
- Rheumatology Department, Hospital Universitario Parc Taulí, Barcelona, Spain
| | | | - Enrique Raya
- Rheumatology Department, Hospital Universitario Clínico San Cecilia, Granada, Spain
| | - Javier Narváez
- Rheumatology Department, Hospital Universitario de Bellvitge, Barcelona, Spain
| | - Lorena Expósito
- Rheumatology Department, Hospital Universitario Canaries, Tenerife, Spain
| | | | - Loreto Horcada
- Rheumatology Department, Complejo Hospitalario Universitario de Navarra, Spain
| | - Elena Aurrecoechea
- Rheumatology Department, Hospital Sierrallana, IDIVAL, Torrelavega, Spain
| | - José M. Pego Reigosa
- Complejo Hospitalario Universitario de Vigo IRIDIS Group, Instituto de Investigación Sanitaria Galicia Sur (IISGS), Vigo, Spain
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13
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Moreno-Pérez O, Merino E, Leon-Ramirez JM, Andres M, Ramos JM, Arenas-Jiménez J, Asensio S, Sanchez R, Ruiz-Torregrosa P, Galan I, Scholz A, Amo A, González-delaAleja P, Boix V, Gil J. Post-acute COVID-19 syndrome. Incidence and risk factors: A Mediterranean cohort study. J Infect 2021; 82:378-383. [PMID: 33450302 PMCID: PMC7802523 DOI: 10.1016/j.jinf.2021.01.004] [Citation(s) in RCA: 345] [Impact Index Per Article: 115.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 12/15/2020] [Accepted: 01/07/2021] [Indexed: 01/21/2023]
Abstract
OBJECTIVES This study aims to analyze the incidence of Post-acute COVID-19 syndrome (PCS) and its components, and to evaluate the acute infection phase associated risk factors. METHODS A prospective cohort study of adult patients who had recovered from COVID-19 (27th February to 29th April 2020) confirmed by PCR or subsequent seroconversion, with a systematic assessment 10-14 weeks after disease onset. PCS was defined as the persistence of at least one clinically relevant symptom, or abnormalities in spirometry or chest radiology. Outcome predictors were analyzed by multiple logistic regression (OR; 95%CI). RESULTS Two hundred seventy seven patients recovered from mild (34.3%) or severe (65.7%) forms of SARS-CoV-2 infection were evaluated 77 days (IQR 72-85) after disease onset. PCS was detected in 141 patients (50.9%; 95%CI 45.0-56.7%). Symptoms were mostly mild. Alterations in spirometry were noted in 25/269 (9.3%), while in radiographs in 51/277 (18.9%). No baseline clinical features behaved as independent predictors of PCS development. CONCLUSIONS A Post-acute COVID-19 syndrome was detected in a half of COVID19 survivors. Radiological and spirometric changes were mild and observed in less than 25% of patients. No baseline clinical features behaved as independent predictors of Post-acute COVID-19 syndrome development.
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Affiliation(s)
- Oscar Moreno-Pérez
- Endocrinology and Nutrition department, Alicante General University Hospital - Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain; Clinical Medicine department, Miguel Hernández University, Elche, Spain.
| | - Esperanza Merino
- Unit of Infectious Diseases, Alicante General University Hospital, Alicante Institute of Health and Institute of Sanitary and Biomedical Research (ISABIAL), Alicante, Spain.
| | - Jose-Manuel Leon-Ramirez
- Pneumology department, Alicante General University Hospital - Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Mariano Andres
- Clinical Medicine department, Miguel Hernández University, Elche, Spain; Rheumatology department, Alicante General University Hospital Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Jose Manuel Ramos
- Clinical Medicine department, Miguel Hernández University, Elche, Spain; Internal Medicine department, Alicante General University Hospital - Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain.
| | - Juan Arenas-Jiménez
- Radiology department, Alicante General University Hospital - Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Santos Asensio
- Pneumology department, Alicante General University Hospital - Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain.
| | - Rosa Sanchez
- Neurology department, Alicante General University Hospital - Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain.
| | - Paloma Ruiz-Torregrosa
- Pneumology department, Alicante General University Hospital - Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Irene Galan
- Pneumology department, Alicante General University Hospital - Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Alexander Scholz
- Internal Medicine department, Alicante General University Hospital - Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Antonio Amo
- Internal Medicine department, Alicante General University Hospital - Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Pilar González-delaAleja
- Internal Medicine department, Alicante General University Hospital - Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Vicente Boix
- Clinical Medicine department, Miguel Hernández University, Elche, Spain; Unit of Infectious Diseases, Alicante General University Hospital, Alicante Institute of Health and Institute of Sanitary and Biomedical Research (ISABIAL), Alicante, Spain.
| | - Joan Gil
- Pneumology department, Alicante General University Hospital - Alicante Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain
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14
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Zaidi F, Narang RK, Phipps-Green A, Gamble GG, Tausche AK, So A, Riches P, Andres M, Perez-Ruiz F, Doherty M, Janssen M, Joosten LAB, Jansen TL, Kurreeman F, Torres RJ, McCarthy GM, Miner JN, Stamp LK, Merriman TR, Dalbeth N. Systematic genetic analysis of early-onset gout: ABCG2 is the only associated locus. Rheumatology (Oxford) 2021; 59:2544-2549. [PMID: 31998961 DOI: 10.1093/rheumatology/kez685] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [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: 08/18/2019] [Revised: 12/12/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE The aim of this study was to examine whether serum urate-associated genetic variants are associated with early-onset gout. METHODS Participants with gout in the Genetics of Gout in Aotearoa study with available genotyping were included (n = 1648). Early-onset gout was defined as the first presentation of gout <40 years of age. Single nucleotide polymorphisms (SNPs) for the 10 loci most strongly associated with serum urate were genotyped. Allelic association of the SNPs with early-onset gout was tested using logistic regression in an unadjusted model and in a model adjusted for sex, body mass index, tophus presence, flare frequency, serum creatinine and highest serum urate. The analysis was also done in two replication cohorts: Eurogout (n = 704) and Ardea (n = 755), and data were meta-analysed. RESULTS In the Genetics of Gout in Aotearoa study, there were 638 (42.4%) participants with early-onset gout. The ABCG2 rs2231142 gout risk T-allele was present more frequently in participants with early-onset gout compared with the later-onset group. For the other SNPs tested, no differences in risk allele number were observed. In the allelic association analysis, the ABCG2 rs2231142 T-allele was associated with early-onset gout in unadjusted and adjusted models. Analysis of the replication cohorts confirmed the association of early-onset gout with the ABCG2 rs2231142 T-allele, but not with other serum urate-associated SNPs. In the meta-analysis, the odds ratio (95% CI) for early-onset gout for the ABCG2 rs2231142 T-allele was 1.60 (1.41, 1.83). CONCLUSION In contrast to other serum urate-raising variants, the ABCG2 rs2231142 T-allele is strongly associated with early-onset gout.
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Affiliation(s)
- Faseeh Zaidi
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, AucklandNew Zealand
| | - Ravi K Narang
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, AucklandNew Zealand
| | | | - Greg G Gamble
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, AucklandNew Zealand
| | | | - Alexander So
- Department of Medicine, Service of Rheumatology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Philip Riches
- Rheumatology and Bone Disease Unit, Centre for Genomic and Experimental Medicine, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Mariano Andres
- Department of Medicine, Sección de Reumatología, Hospital General Universitario de Alicante, Alicante, Spain
| | - Fernando Perez-Ruiz
- Rheumatology Division, Hospital Universitario Cruces, Baracaldo, Biscay, Spain
| | - Michael Doherty
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Matthijs Janssen
- Department of Rheumatology, VieCuri Medical Center, Venlo, The Netherlands
| | - Leo A B Joosten
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Medical Genetics, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Tim L Jansen
- Department of Rheumatology, VieCuri Medical Center, Venlo, The Netherlands
| | - Fina Kurreeman
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Rosa J Torres
- Department of Biochemistry, La Paz University Hospital Health Research Institute (FIBHULP), IdiPaz, Madrid, Spain.,Center for Biomedical Network Research on Rare Diseases (CIBERER), ISCIII, Madrid, Spain
| | - Geraldine M McCarthy
- Department of Rheumatology, School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
| | | | - Lisa K Stamp
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Tony R Merriman
- Department of Biochemistry, University of Otago, Dunedin, New Zealand
| | - Nicola Dalbeth
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, AucklandNew Zealand
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15
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Moreno-P O, Leon-Ramirez JM, Fuertes-Kenneally L, Perdiguero M, Andres M, Garcia-Navarro M, Ruiz-Torregrosa P, Boix V, Gil J, Merino E. Hypokalemia as a sensitive biomarker of disease severity and the requirement for invasive mechanical ventilation requirement in COVID-19 pneumonia: A case series of 306 Mediterranean patients. Int J Infect Dis 2020; 100:449-454. [PMID: 32950739 PMCID: PMC7497734 DOI: 10.1016/j.ijid.2020.09.033] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [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: 07/24/2020] [Revised: 09/02/2020] [Accepted: 09/13/2020] [Indexed: 12/22/2022] Open
Abstract
Objectives Serum levels of potassium (K+) appear to be significantly lower in severe cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and the clinical significance of this is unknown. The objective was to investigate whether hypokalemia acts as a biomarker of severity in coronavirus disease 2019 (COVID-19) pneumonia and is associated with major clinical outcomes. Methods A retrospective cohort study of inpatients with COVID-19 pneumonia (March 3 to May 2, 2020) was performed. Patients were categorized according to nadir levels of K+ in the first 72 h of admission: hypokalemia (K+ ≤3.5 mmol/l) and normokalemia (K+ >3.5 mmol/l). The main outcomes were all-cause mortality and the need for invasive mechanical ventilation (IMV); these were analyzed by multiple logistic regression (odds ratio (OR), 95% confidence interval (CI)). Results Three hundred and six patients were enrolled. Ninety-four patients (30.7%) had hypokalemia and these patients showed significantly higher comorbidity (Charlson comorbidity index ≥3, 30.0% vs 16.3%; p = 0.02) and CURB65 scores (median (interquartile range): 1.5 (0.0–3.0) vs 1.0 (0.0–2.0); p = 0.04), as well as higher levels of some inflammatory parameters at baseline. After adjustment for confounders, hypokalemia was independently associated with requiring IMV during the admission (OR 8.98, 95% CI 2.54–31.74). Mortality was 15.0% (n = 46) and was not influenced by low K+. Hypokalemia was associated with longer hospital and ICU stays. Conclusions Hypokalemia is prevalent in patients with COVID-19 pneumonia. Hypokalemia is an independent predictor of IMV requirement and seems to be a sensitive biomarker of severe progression of COVID-19.
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Affiliation(s)
- Oscar Moreno-P
- Endocrinology and Nutrition Department, Alicante General University Hospital - Alicante Institute of Sanitary and Biomedical Research (ISABIAL), Alicante, Spain; Clinical Medicine Department, Miguel Hernández University, Elche, Spain.
| | - Jose-Manuel Leon-Ramirez
- Pneumology Department, Alicante General University Hospital - Alicante Institute of Sanitary and Biomedical Research (ISABIAL), Alicante, Spain.
| | - Laura Fuertes-Kenneally
- Cardiology Department, Alicante General University Hospital - Alicante Institute of Sanitary and Biomedical Research (ISABIAL), Alicante, Spain.
| | - Miguel Perdiguero
- Nephrology Department, Alicante General University Hospital - Alicante Institute of Sanitary and Biomedical Research (ISABIAL), Alicante, Spain.
| | - Mariano Andres
- Clinical Medicine Department, Miguel Hernández University, Elche, Spain; Rheumatology Department, Alicante General University Hospital - Alicante Institute of Sanitary and Biomedical Research (ISABIAL), Alicante, Spain.
| | - Mar Garcia-Navarro
- Internal Medicine Department, Alicante General University Hospital - Alicante Institute of Sanitary and Biomedical Research (ISABIAL), Alicante, Spain.
| | - Paloma Ruiz-Torregrosa
- Pneumology Department, Alicante General University Hospital - Alicante Institute of Sanitary and Biomedical Research (ISABIAL), Alicante, Spain.
| | - Vicente Boix
- Clinical Medicine Department, Miguel Hernández University, Elche, Spain; Unit of Infectious Diseases, Alicante General University Hospital - Alicante Institute of Sanitary and Biomedical Research (ISABIAL), Alicante, Spain.
| | - Joan Gil
- Pneumology Department, Alicante General University Hospital - Alicante Institute of Sanitary and Biomedical Research (ISABIAL), Alicante, Spain.
| | - Esperanza Merino
- Unit of Infectious Diseases, Alicante General University Hospital - Alicante Institute of Sanitary and Biomedical Research (ISABIAL), Alicante, Spain.
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Riancho-Zarrabeitia L, Martínez-Taboada V, Rúa-Figueroa I, Alonso F, Galindo-Izquierdo M, Ovalles J, Olivé-Marqués A, Fernández-Nebro A, Calvo-Alén J, Menor-Almagro R, Tomero-Muriel E, Uriarte-Isacelaya E, Botenau A, Andres M, Freire-González M, Santos Soler G, Ruiz-Lucea E, Ibáñez-Barceló M, Castellví I, Galisteo C, Quevedo Vila V, Raya E, Narváez-García J, Expósito L, Hernández-Beriaín JA, Horcada L, Aurrecoechea E, Pego-Reigosa JM. Antiphospholipid syndrome (APS) in patients with systemic lupus erythematosus (SLE) implies a more severe disease with more damage accrual and higher mortality. Lupus 2020; 29:1556-1565. [PMID: 32807021 DOI: 10.1177/0961203320950477] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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: 12/11/2022]
Abstract
INTRODUCTION Antiphospholipid antibodies (aPL) have been associated with organ damage and certain features in systemic lupus erythematosus(SLE) patients. Our aim was to investigate the differences between SLE patients according to the presence of aPL and/or clinical antiphospholipid syndrome (APS). MATERIALS AND METHODS Patients from the RELESSER-T registry were included. RELESSER-T is a Spanish multicenter, hospital-based, retrospective, SLE registry. RESULTS We included 2398 SLE patients, 1372 of whom were positive for aPL. Overall 1026 patients were classified as SLE, 555 as SLE-APS and817 as SLE-aPL. Regarding cardiovascular risk factors, SLE-APS patients had higher rates of hypertension, dyslipidemia and diabetes than those with SLE-aPL and SLE (p < 0.001). SLE-APS patients showed higher rates of neuropsychiatric, cardiac, pulmonary, renal and ophthalmological manifestations than the other groups (p < 0.001). SLE-APS patients presented greater damage accrual with higher SLICC values (1.9 ± 2.2 in SLE-APS, 0.9 ± 1.4 in SLE-aPL and 1.1 ± 1.6 in SLE, p < 0.001) and more severe disease as defined by the Katz index (3 ± 1.8 in SLE-APS, 2.7 ± 1.7 in SLE-aPL and 2.6 ± 1.6 in SLE, p < 0.001). SLE-APS patients showed higher mortality rates (p < 0.001). CONCLUSIONS SLE-APS patients exhibited more severe clinical profiles with higher frequencies of major organ involvement, greater damage accrual and higher mortality than SLE-aPL and SLE patients.
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Affiliation(s)
| | - Victor Martínez-Taboada
- Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | | | - Fernando Alonso
- Unidad de Investigación. Sociedad Española de Reumatología, Madrid, Spain
| | | | - Juan Ovalles
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | | | | | | | | | | | | | - Mariano Andres
- Hospital General Universitario de Alicante, Valenciana, Spain
| | | | | | | | | | | | | | | | - Enrique Raya
- Hospital Universitario Clínico San Cecilio, Andalucía, Spain
| | | | | | | | - Loreto Horcada
- Complejo Hospitalario Universitario de Navarra, Pamplona, Spain
| | - Elena Aurrecoechea
- Rheumatology Department, Hospital Sierrallana, IDIVAL, Torrelavega, Spain
| | - Jose M Pego-Reigosa
- Complejo Hospitalario Universitario de Vigo IRIDIS Group, Instituto de Investigación Sanitaria Galicia Sur (IISGS), Vigo, Spain
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Pascual E, Andres M, Sivera F. Gout. J Clin Rheumatol 2020; 26:208-212. [DOI: 10.1097/rhu.0000000000001492] [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] [Indexed: 11/25/2022]
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Affiliation(s)
- Eliseo Pascual
- Department of Medicine, University Miguel Hernandez, Elche; and Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante;
| | - Francisca Sivera
- Department of Medicine, University Miguel Hernandez, and Department of Rheumatology, Hospital General Universitario Elda, Elda
| | - Mariano Andres
- Department of Medicine, University Miguel Hernandez, and ISABIAL, and Department of Rheumatology, Hospital General Universitario Alicante, Alicante, Spain
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Moreno-Pérez O, Andres M, Leon-Ramirez JM, Sánchez-Payá J, Rodríguez JC, Sánchez R, García-Sevila R, Boix V, Gil J, Merino E. Experience with tocilizumab in severe COVID-19 pneumonia after 80 days of follow-up: A retrospective cohort study. J Autoimmun 2020; 114:102523. [PMID: 32690352 PMCID: PMC7365106 DOI: 10.1016/j.jaut.2020.102523] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/08/2020] [Accepted: 07/09/2020] [Indexed: 01/20/2023]
Abstract
OBJECTIVES To describe the clinical characteristics and predictors of major outcomes in patients treated with tocilizumab (TCZ) for severe COVID-19 pneumonia. PATIENTS AND METHODS Case series of all sequential patients with severe COVID-19 pneumonia treated with TCZ at an Academic Spanish hospital (March 12 - May 2, 2020). Clinical outcomes: death, length of hospital stay. An early clinical response to TCZ (48-72 h after the administration) was assessed by variations in respiratory function markers, Brescia COVID Respiratory Severity Scale (BCRSS), inflammatory parameters, and patients' and physicians' opinion. Associations were tested by multiple logistic regression. RESULTS From a cohort of 236 patients, 77 patients treated with TCZ were included (median age 62 years (IQR 53.0-72.0), 64.9% were males), 42.9% had Charlson index ≥3; hypertension (41.6%), obesity (34.7%), and diabetes (20.8%). Median follow-up was 83.0 days (78.0-86.5), no patient was readmitted. ICU admission was required for 42 (54.5%), invasive mechanical ventilation in 38 (49.4%) and 10 patients died (12.9% global, 23.8% at ICU admitted). After multivariate adjustment, TCZ response by BCRSS (OR 0.03 (0.01-0.68), p = 0.028), and Charlson index (OR 3.54 (1.20-10.44), p = 0.022) has been identified as independent factors associated with mortality. Median of hospital stay was 16.0 days (11.0-23.0); BCRSS, physician subjective and D-dimer response were associated with shorter hospitalization stay. CONCLUSIONS In a Mediterranean cohort, use of tocilizumab for severe COVID-19 show 12.9% of mortality. Early TCZ-response by BCRSS and low comorbidity were associated with increased survival. Early TCZ-response was related to shorter median hospital stay.
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MESH Headings
- Adult
- Aged
- Antibodies, Monoclonal, Humanized/administration & dosage
- Antiviral Agents/administration & dosage
- Betacoronavirus/immunology
- Betacoronavirus/pathogenicity
- COVID-19
- Coronavirus Infections/diagnosis
- Coronavirus Infections/immunology
- Coronavirus Infections/mortality
- Coronavirus Infections/therapy
- Drug Therapy, Combination
- Female
- Fibrin Fibrinogen Degradation Products/analysis
- Follow-Up Studies
- Hospital Mortality
- Humans
- Infusions, Intravenous
- Interleukin-6/immunology
- Interleukin-6/metabolism
- Length of Stay/statistics & numerical data
- Male
- Middle Aged
- Pandemics
- Pneumonia, Viral/diagnosis
- Pneumonia, Viral/immunology
- Pneumonia, Viral/mortality
- Pneumonia, Viral/therapy
- Prognosis
- Receptors, Interleukin-6/antagonists & inhibitors
- Receptors, Interleukin-6/metabolism
- Respiration, Artificial/statistics & numerical data
- Respiratory Function Tests/statistics & numerical data
- Retrospective Studies
- SARS-CoV-2
- Severity of Illness Index
- Spain/epidemiology
- Survival Analysis
- Time Factors
- Time-to-Treatment
- Treatment Outcome
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Affiliation(s)
- Oscar Moreno-Pérez
- Endocrinology and Nutrition Department, Alicante General University Hospital - Alicante Institute of Sanitary and Biomedical Research (ISABIAL), Alicante, Spain; Clinical Medicine Department, Miguel Hernández University, Elche, Spain.
| | - Mariano Andres
- Clinical Medicine Department, Miguel Hernández University, Elche, Spain; Rheumatology Department, Alicante General University Hospital Alicante Institute of Sanitary and Biomedical Research (ISABIAL), Alicante, Spain.
| | - Jose-Manuel Leon-Ramirez
- Pneumology Department, Alicante General University Hospital - Alicante Institute of Sanitary and Biomedical Research (ISABIAL), Alicante, Spain.
| | - José Sánchez-Payá
- Preventive Department, Alicante General University Hospital - Alicante Institute of Sanitary and Biomedical Research (ISABIAL), Alicante, Spain.
| | - Juan Carlos Rodríguez
- Microbiology Department, Alicante General University Hospital - Alicante Institute of Sanitary and Biomedical Research (ISABIAL), Alicante, Spain; Miguel Hernández University, Elche, Spain.
| | - Rosario Sánchez
- Internal Medicine Department, Alicante General University Hospital - Alicante Institute of Sanitary and Biomedical Research (ISABIAL), Alicante, Spain.
| | - Raquel García-Sevila
- Pneumology Department, Alicante General University Hospital - Alicante Institute of Sanitary and Biomedical Research (ISABIAL), Alicante, Spain.
| | - Vicente Boix
- Clinical Medicine Department, Miguel Hernández University, Elche, Spain; Unit of Infectious Diseases, Alicante General University Hospital - Alicante Institute of Sanitary and Biomedical Research (ISABIAL), Alicante, Spain.
| | - Joan Gil
- Pneumology Department, Alicante General University Hospital - Alicante Institute of Sanitary and Biomedical Research (ISABIAL), Alicante, Spain.
| | - Esperanza Merino
- Unit of Infectious Diseases, Alicante General University Hospital - Alicante Institute of Sanitary and Biomedical Research (ISABIAL), Alicante, Spain.
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López Salguero S, Andres M, Vela-Casasempere P, Esteban Rodriguez A, Martínez-Vidal MP, Bernal JA, Alvarez de Cienfuegos A, Sivera F. THU0354 CHARACTERIZATION OF ANTI-MYOSITIS ANTIBODY RELATED MYOPATHIES. DESCRIPTIVE STUDY IN A MULTICENTRIC COHORT. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.6125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Idiopathic inflammatory myopathies (IIM) are a group of rare diseases consisting on immune-mediated muscle damage. About 40 to 60% show specific-myositis antibodies; aditionally, 20-40% can show myositis-related (non-specific) antibodies. The profile of antibodies can help to divide patients into subgroups with more homogeneous clinical characteristics and prognosis.Objectives:This study characterizes patients with IIM with specific or related anti-myositis antibodies, in five hospitals in the Alicante health area.Methods:This is an observational study, carried out in five hospitals with a reference population of 1.083.463 people. Patients with positive anti-myositis antibodies between October 2015 and May 2018 were selected from the database of the Clinical Laboratory of the University Hospital of Alicante. We considered the following antiboides: anti-myositis specific antibodies (anti-TIF1y, anti-MDA5, anti-Mi-2, anti-PmScl75, anti-PMScl100, anti-NXP2, anti-SRP), anti-synthetase antibodies (anti-PL7, anti-PL12, anti-Jo1, anti-OJ), myositis-related antibodies (anti-Ro52, anti-Ku). Clinical records were examined, identifying those patients with a diagnosis of IIM acording to their clinician, rheumatologist. Epidemiological and clinical data were obtained.Results:291 patients with positive anti-myositis antibodies were identified. Among them, 40 patients had a diagnosis of IIM. Median age was 59.5 (IQR 41.5, 70) years and 68% were women. Within the subgroups, the most frequent diagnosis were dermatomyositis (n=22; 55%) and polimyositis (n=9; 22%). The most common antibody detected was anti-TIF-y among specific antibodies, and anti-Jo-1 among the anti-synthetase antibodies. The most common extramuscular feature was skin involvement. The presence of interstitial lung disease was reported in about one third of patients, being UIP the most commong pattern. Regarding treatment, the use of steroids was generalized; methotrexate was the most used inmunosupresant agent. Eight patients had a cancer related myopathy.DM (N=22)PM (n=9)DMJ (N=3)IMNM (n=1)AS (n=5)Age, median (IQR)65,5(46, 76)57(34, 66)15,7 (14, 18)83 (-)61(56, 64)Femalen(%)15(68,2)6(66,6)2(66,6)1(100)3(60)Muscular feat. n(%)16(77,7)9(100)1(33,3)1(100)5(100)ILD n(%)1(4,5)3(33,3)005(100)Disfagia n(%)3(13,6)1(11,1)000Skin feat n(%)17(77,3)02(66,6)01(20)arthritis n(%)1(4,5)02(66,6)04(80)Raynaud n(%)4(19)1(11,1)001(20)Calcinosis n(%)1(4,5)1(11,1)(66,6)00Puffy hands n (%)2(9)0002(40)Sicca synd n(%)3(13,6)1(11,1)000Cáncer n(%)7(31,8)1(11,1)000Ck máx(UI/l), median (IQR)432(171, 706)809(350, 1653)--665(396, 2300)Conclusion:This register allows us to characterise patients with inflammatory myositis in our area. It is important to make multicentric and prospective registers in infrequent diseases such as IIM in order to have more detailed and representative information about clinical and socio-demographic characteristic as well as prognostic data from these patients.References:[1]Dalakas M. Inflammatory Muscle Diseasees. N Engl J Med 2015;372:1734-47.[2]Lündberg IE, Tjärnlund A, Bottai M, et al. 2017 Ann Rheum Dis2017;76:1955–1964.[3]Betteridge Z, McHugh N. J. Intern Med, 2016 Jul;280(1):8-23.[4]Nuño L et al. Reumatol Clin. 2017;13(6):331-337[5]Lilleker JB, Vencovsky J, Wang G, et al.. Ann Rheum Dis 2018;77:30-39Disclosure of Interests:None declared
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Bernal JA, Andres M, López Salguero S, Jovani V, Vela-Casasempere P, Pascual E. THU0414 ORDINARY LIGHT MICROSCOPY IS ABLE TO IDENTIFY MOST CRYSTAL-CONTAINING SYNOVIAL FLUIDS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.6071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Optical microscopy remains the gold standard for the diagnosis of crystal arthropathies. The complete protocol consists of three phases. In the first stage, microscopy with simple light provides information on the morphology of the crystal. The second stage, polarized light, allows detecting the intensity of the birefringence. Finally, with the first-order red compensator, the type of elongation is detected, positive for calcium pyrophosphate (CPP) crystals and negative for monosodium urate (MSU) crystals. Finally, with the obtained data, the presence and type of crystals is concluded.Objectives:Analyze the validity and agreement of each stage of microscopy regarding the conclusion, emphasizing ordinary light microscopy.Methods:Fifty consecutive samples of synovial fluid obtained in routine clinical practice were independently analyzed under the compensated polarized microscope by 5 observers blinded to clinical data (250 observations in total). Each observer recorded the presence and type of crystals at each stage and reached a conclusion after gathering all the information. To estimate the diagnostic yield of each microscope stage, sensitivity, specificity and positive and negative predictive values, as well as the accuracy (number of correct observations/number of total observations), were calculated; also, the total weighted kappa was used to assess the degree of agreement with the complete protocol.Results:Main results of the study are shown in Table 1. Regarding diagnostic yield, ordinary light microscopy showed excellent sensitivity, specificity and predictive values, similar to the results noted with simple and compensated polarized microscopy.Table 1.In parentheses, 95% confidence intervals.AccuracySensitivitySpecificityPositive predictive valueNegative predictive valueKappaOrdinary light96.8%(93.8-98.4)97.2%(93.1-98.9)96.2%(90.7-98.5)97.2%(93.1-98.9)96.2%(90.7-98.5)0.954(0.919-0.989)Simple polarized light92.0%(88.0-94.8)84.1%(76.8-89.5)100%(97.0-100)100%(96.5-100)86.1%(79.5-90.8)0.874(0.821-0.927)Compensated polarized light97.6 %(94.9-98.9)95.5%(89.8-98.0)99.3%(96.1-99.9)99.1%(94.8-99.8)96.5%(92.1-98.5)0.962(0.933-0.992)Diagnoses established by ordinary light microscopy matched conclusions (accuracy) in 242/250 (96.8%) observations. Discrepant cases were crystals missed under ordinary light in 4 cases (3 MSU, 1 CPP), and 4 samples with CPP crystals initially seen but later concluded their absence. Interestingly, lowest accuracy was seen with simple polarization; CPP crystals were not detected in 20 out of 93 observations with CPP (21.5%). The accuracy of compensated polarized light was similar to ordinary light. On 5 occasions no crystals were seen but finally they were present (1 MSU, 4 CPP); on the contrary, CPP was registered in one observation but the conclusion indicated no crystals.Regarding agreement with the complete protocol, the kappa with simple light is 0.954, similar to compensated polarized light (0.962), while simple polarized light showed the lowest agreement (0.874).Conclusion:Ordinary light microscopy is enough to correctly reach the majority of diagnoses, with a very high degree of agreement with the complete protocol. Results were comparable to using a compensated polarized microscopy. Thus, if a microscope with polarizer and first-order compensator was not available, using ordinary light would be enough on most occasions. Polarized light microscopy better identifies MSU crystals, but over 20% of CPP crystals were missed at this stage, reinforcing the value of the ordinary light microscopy.Acknowledgments:Thanks to Loreto Carmona for the help with the statistical aspects.Disclosure of Interests: :None declared
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Quilis Marti N, Mesa del Castillo P, Andres M, Juanola O, Boix P, Frances R. AB0174 T REGULATORY CELLS LEVEL IN PERIPHERAL BLOOD OF PATIENTS WITH JUVENILE IDIOPATHIC ARTHRITIS AND ITS RELATION WITH DISEASE ACTIVITY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.5427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:The most important T-cell subtype in maintenance of immune tolerance is T regulatory cells (Treg). These are characterized by CD4 and CD25 receptors on surface, and by showing FoxP3 regulatory factor, which is necessary for maintaining the suppressive activity of Treg cells in peripheral blood (PB). Previous studies have studied Treg cells in PB and synovial fluid in patients with Juvenile Idiopathic Arthritis (JIA). However, there was insufficient evidence to draw robust conclusions about Treg implication in JIA, due to small simple size and variable results across studies. A deeper understanding of regulatory mechanism in JIA may increase comprehension on variability among JIA subtypes and may help to stablish prognosis on the follow up.Objectives:To analyze Treg cells level in PB of JIA patients and its relation with disease activity.Methods:Descriptive, cross-sectional, observational study conducted in a regional reference centre for Pediatric Rheumatology. We included consecutive patients with JIA diagnosed by ILAR criteria. The primary variable was the Treg percentage in PB measured by flow cytometry. To assess JIA activity, we used disease activity indexes (JADAS10, 27, 71 – CRP/ESR and cJADAS), Wallace remission criteria, VAS disease activity by patient/parents and physicians, morning stiffness, multidimensional evaluation (JAMAR) and acute phase reactants (CRP and ESR). Assessment of long-term damage was evaluated with JADI. Association analyses among study variables and Treg levels were performed by Pearson’s correlation coefficient and Mann Whitney’s U test.Results:Ongoing study, we present a preliminary analysis with first 50 JIA patients. Mean age (SD) was 11.3 yr (4.6), being females 60%. Most common JIA subtype was persistent oligoarticular (42%) followed by RFneg polyarticular (24%). 42% patients were treated by csDMARD and 46% by biological agents. Mean levels of CRP and ESR were 0.18 mg/dl (0.3) and 6.3 mm/hr (5.4), respectively. At the time of the study, 84% of patients were in remission (Wallace criteria). Mean of JADAS 27-VSG, JADAS 27-PCR and cJADAS were 3.6 (5.1), 3.7 (5.1), and 3.7 (5.5), respectively. Mean long-term damage scores were 0.48 (1.1) for JADI-A and 0 for JADI-E. Mean levels of Treg cells in PB were 2.11% (1.1). The table shows the association between clinical variables and % of Treg. We can observe a significant, inverse and moderate correlation between Treg levels and disease activity by patient/parents, disability and quality of life (global and the physical component). Close to statistical significance, we found inverse and moderate correlation between Treg cells and all JADAS scores, cJADAS, disease activity by physician and morning stiffness. There was no association between Treg and acute phase reactants. Furthermore, there were no differences in Treg cells in Wallace remission (p=0.692) and regarding use of conventional or biological DMARD (p=0.984 and p=0.386, respectively).Conclusion:According to our preliminary data, higher levels of Treg cells in PB of patients with JIA could be related with lesser disease activity and better quality of life. Larger studies are needed to confirm whether this Treg-mediated regulatory mechanism can have prognostic implication JIA.Variablesrp valueCRP (mg/dl)-0.240.099ESR (mm/hour)-0.150.314VAS-disease activity (patient / parents)-0.280.049VAS-disease activity (physician)-0.250.081JADAS10 (VSG)-0.270.064JADAS27 (VSG)-0.270.064JADAS71 (VSG)-0.270.064JADAS10 (PCR)-0.280.054JADAS27 (PCR)-0.280.054JADAS71 (PCR)-0.280.054c JADAS10-0.260.065Disability (JAFS – JAMAR)-0.340.021Quality of lyfe (PRQL – JAMAR)-0.390.007Quality of life physical (PRQLPh – JAMAR)-0.460.001Quality of life psychosocial (PRQLPs-JAMAR)-0.210.156Morning Stiffness-0.270.066Disclosure of Interests:None declared
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Suarez-Fuentes D, Andres M, Porter E. Description of the Anatomical Landmarks for Measuring Intravertebral and Intervertebral Sagittal Diameter Ratios on Equine Cervical Radiographs. Vet Comp Orthop Traumatol 2019. [DOI: 10.1055/s-0039-1692250] [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: 10/26/2022]
Affiliation(s)
| | - M. Andres
- North Carolina State College of Veterinary Medicine, Raleigh, North Carolina, United States
| | - E.G. Porter
- University of Florida College of Veterinary Medicine, Gainesville, Florida, United States
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Calvo Aranda E, Andres M, Gonzalez Martin J, Abdelkader Abu-Sneimeh A, Carrion O, Sainz F, Garcia de la Peña P, Pascual E. Urate crystals and inflammation. Cardiovascular impact of gout. Int J Cardiol 2018; 271:295. [PMID: 30223359 DOI: 10.1016/j.ijcard.2018.05.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 05/23/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Enrique Calvo Aranda
- Rheumatology Unit of Hospital Universitario HM Sanchinarro, Madrid, Spain. https://twitter.com/enriquecalvoA
| | - Mariano Andres
- Rheumatology Unit of Hospital General Universitario, Alicante, Spain; Clinical Medicine Unit, Miguel Hernandez University, Alicante, Spain
| | | | | | - Ofelia Carrion
- Angiology and Vascular Surgery Unit Hospital Universitario HM Sanchinarro, Madrid, Spain
| | - Felipe Sainz
- Angiology and Vascular Surgery Unit Hospital Universitario HM Sanchinarro, Madrid, Spain
| | - Paloma Garcia de la Peña
- Rheumatology Unit of Hospital Universitario HM Sanchinarro, Madrid, Spain; Clinical and Medical Sciences Unit, San Pablo CEU University, Madrid, Spain
| | - Eliseo Pascual
- Rheumatology Unit of Hospital General Universitario, Alicante, Spain; Clinical Medicine Unit, Miguel Hernandez University, Alicante, Spain
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Arenas MD, Soriano R, Oliveira E, Trigo C, Andres M, Pascual E. SP673SERUM URIC ACID LEVELS REDUCTION UNDER HEMODIALYSIS REPLACEMENT THERAPY: URATE-LOWERING AGENTS APPEAR UNNECESSARY. Nephrol Dial Transplant 2018. [DOI: 10.1093/ndt/gfy104.sp673] [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: 11/14/2022] Open
Affiliation(s)
- M Dolores Arenas
- Nephrology, Hospital Vithas Perpetuo Internacional, Alicante, Spain
| | | | - Eloy Oliveira
- Analisis Clínicos, Hospital Universitario de Alicante, Alicante, Spain
| | - Celia Trigo
- Analisis Clínicos, Hospital Universitario de Alicante, Alicante, Spain
| | - Mariano Andres
- Reumatologia, Hospital Universitario de Alicante, Alicante, Spain
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Lissoni P, Barni S, Ardizzoia A, Andres M, Scardino E, Cardellini P, Della Bitta R, Tancini G. A Randomized Study of Low-Dose Interleukin-2 Subcutaneous Immunotherapy versus Interleukin-2 plus Interferon-Alpha as First Line Therapy for Metastatic Renal Cell Carcinoma. Tumori 2018; 79:397-400. [PMID: 8171738 DOI: 10.1177/030089169307900605] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims and Background IL-2 given subcutaneously in combination with interferon-alpha 2b (IFN) appears to induce a response rate comparable to that obtained with IL-2 intravenous injection in patients with metastatic renal cell carcinoma (RCC) but with lower toxicity. The role of IFN when combined with IL-2 has however still to be defined. The present study was performed to draw some preliminary conclusions about the effect of IFN in combination with IL-2 in metastatic RCC. Methods The study included 30 consecutive patients with metastatic RCC who were randomized to treatment with IL-2 subcutaneous therapy (3 million IU twice/daily for 5 days/week for 6 weeks) or with IL-2 plus IFN (5 million U/m2 subcutaneously thrice weekly). In patients without progressive disease, a second cycle was repeated after a 28-day rest period. Results No significant difference in partial response rate was found between patients treated with IL-2 alone and those given IL-2 plus IFN (5/15 vs 4/15). Similarly, no difference was seen in the percentage of stable disease (7/15 vs 7/15). Toxicity was higher in patients who received IL-2 plus IFN. Lymphocyte and eosinophil mean increase was higher in patients treated with IL-2 alone than in those treated with IL-2 plus IFN, without however any significant difference. Conclusions The present results, which require confirmation in a larger series, indicate that combination with IFN does not increase the efficacy of IL-2 subcutaneous immunotherapy in metastatic RCC but only the toxicity of treatment.
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Affiliation(s)
- P Lissoni
- Divisione di Radioterapia Oncologica, Ospedale S. Gerardo, Monza (Milano), Italy
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Paolorossi F, Villa S, Barni S, Tancini G, Andres M, Lissoni P. Second-Line Therapy with Interferon-Alpha plus Vinblastine in Metastatic Renal Cell Cancer Patients Progressed under Interleukin-2 Subcutaneous Immunotherapy. Tumori 2018; 81:45-7. [PMID: 7754541 DOI: 10.1177/030089169508100111] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims and background Interferon (IFN) ± vinblastine (VNB) has appeared to be effective as first–line therapy of metastatic renal cell cancer. This study was performed to establish the efficacy of IFN plus VNB in metastatic RCC previously treated with interleukin-2 (IL-2). Methods The study included 14 metastatic renal cell cancer patients who did not respond to IL-2 subcutaneous therapy or who relapsed after initial response or stable disease. IFN-alpha 2a was given subcutaneously at 3 million U thrice a week in association with VNB (0.1 mg/kg i.v. every 21 days) until progression or toxicity. Patients were considered as evaluable when they were treated for at least 1 month. Results Evaluable patients were 13/14. No patient had a complete response. Partial response was achieved in 2/13 (15%) patients. Stable disease was seen in 5/13 patients, and the last 6 progressed. Conclusions This study, by showing a tumor response rate comparable to that reported with first-line therapy, suggests that previous IL-2 immunotherapy does not influence negatively the efficacy of IFN + VNB in metastatic renal cell cancer.
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Affiliation(s)
- F Paolorossi
- Divisione di Radioterapia Oncologica, Ospedale San Gerardo, Milano, Italy
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Ranieri L, Contero C, Peral ML, Calabuig I, Zapater P, Andres M. Impact of diuretics on the urate lowering therapy in patients with gout: analysis of an inception cohort. Arthritis Res Ther 2018; 20:53. [PMID: 29566736 PMCID: PMC5863897 DOI: 10.1186/s13075-018-1559-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 03/06/2018] [Indexed: 11/26/2022] Open
Abstract
Background Diuretics have been associated with impaired response and refractoriness in gout, but whether this effect is still present with new urate-lowering drugs (ULD) and treat-to-target strategies is unknown. The aim of the present study was to assess the impact of the diuretics on the response to ULD in patients with gout. Methods This was a retrospective analysis of an inception cohort. Participants were classified according to the type of ULD prescribed. We analysed the maximal dose of ULD (primary outcome variable), serum urate (SU) reduction, and the achievement of different SU targets (6 mg/dL, 5 mg/dL, and 4 mg/dL), according to the type of ULD prescribed and use of diuretics (loop and/or thiazide). We adjusted for confounders using multiple linear regression analysis. Results We included 245 patients: 208 treated with allopurinol (66 on diuretics, 31.7%), 35 with febuxostat (19 on diuretics, 57.6%), and 2 with benzbromarone. Significantly fewer participants in the allopurinol plus diuretics subgroup achieved SU levels of less than 5 mg/dL, but we found no other significant differences in SU targets associated with diuretics. Regarding the maximum ULD dose, a simple linear regression suggested an inverse relationship with diuretics (beta = − 0.125, p = 0.073), but this did not hold in the multivariable analysis (beta = − 0.47, p = 0.833). There was no association with febuxostat (beta = − 0.116, p = 0.514). Conclusion Diuretics do not appear to have a significant impact on managing gout. Electronic supplementary material The online version of this article (10.1186/s13075-018-1559-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Laura Ranieri
- Rheumatology Deparment, Hospital General Universitario de Alicante-ISABIAL, Pintor Baeza 12, 03010, Alicante, Spain
| | | | - Maria-Luisa Peral
- Rheumatology Deparment, Hospital General Universitario de Alicante-ISABIAL, Pintor Baeza 12, 03010, Alicante, Spain
| | - Irene Calabuig
- Rheumatology Deparment, Hospital General Universitario de Alicante-ISABIAL, Pintor Baeza 12, 03010, Alicante, Spain
| | - Pedro Zapater
- Universidad Miguel Hernández, Elche, Alicante, Spain.,Clinical Pharmacology Deparment, Hospital General Universitario de Alicante-ISABIAL, Alicante, Spain
| | - Mariano Andres
- Rheumatology Deparment, Hospital General Universitario de Alicante-ISABIAL, Pintor Baeza 12, 03010, Alicante, Spain. .,Universidad Miguel Hernández, Elche, Alicante, Spain.
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Perez-Ruiz F, Andres M, Diaz-Torne C, de Miguel E, Moragues C, Sivera F, Jimenez-Palop M, Sanchez-Piedra C. THU0508 Improvement in Treat To Target Serum Urate Levels: Results from A Comparison between The Gema and The Gema-II Audits: Table 1. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.5270] [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] [Indexed: 11/04/2022]
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Ordόñez J, Andres M, Bernal J, Sivera F, Carmona L, Vela P, Pascual E. THU0518 New Cardiovascular Risk Factors Screening in Patients with Gout. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.5647] [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] [Indexed: 11/03/2022]
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Castrejon I, Carmona L, Agrinier N, Andres M, Briot K, Caron M, Christensen R, Consolaro A, Curbelo R, Ferrer M, Foltz V, Gonzalez C, Guillemin F, Machado PM, Prodinger B, Ravelli A, Scholte-Voshaar M, Uhlig T, van Tuyl LHD, Zink A, Gossec L. The EULAR Outcome Measures Library: development and an example from a systematic review for systemic lupus erythematous instruments. Clin Exp Rheumatol 2015; 33:910-916. [PMID: 25797345] [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: 08/22/2014] [Accepted: 01/09/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVES Patient reported outcomes (PROs) are relevant in rheumatology. Variable accessibility and validity of commonly used PROs are obstacles to homogeneity in evidence synthesis. The objective of this project was to provide a comprehensive library of "validated PROs". METHODS A launch meeting with rheumatologists, PROs methodological experts, and patients, was held to define the library's aims and scope, and basic requirements. To feed the library we performed systematic reviews on selected diseases and domains. Relevant information on PROs was collected using standardised data collection forms based on the COSMIN checklist. RESULTS The EULAR Outcomes Measures Library (OML), whose aims are to provide and to advise on PROs on a user-friendly manner albeit based on scientific grounds, has been launched and made accessible to all. PROs currently included cover any domain and, are generic or specifically target to the following diseases: rheumatoid arthritis, osteoarthritis, spondyloarthritis, low back pain, systemic lupus erythematosus, gout, osteoporosis, juvenile idiopathic arthritis, and fibromyalgia. Up to 236 instruments (106 generic and 130 specific) have been identified, evaluated, and included. The systematic review for SLE, which yielded 10 specific instruments, is presented here as an example. The OML website includes, for each PRO, information on the construct being measured and the extent of validation, recommendations for use, and available versions; it also contains a glossary on common validation terms. CONCLUSIONS The OML is an in progress library led by rheumatologists, related professionals and patients, that will help to better understand and apply PROs in rheumatic and musculoskeletal diseases.
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Affiliation(s)
- I Castrejon
- Division of Rheumatology, Rush University Medical Center, Chicago, USA.
| | - L Carmona
- Instituto de Salud Musculoesquelética, Madrid, Spain
| | - N Agrinier
- University of Lorraine, APEMAC EA 4360, Nancy, F-54500; France & Inserm CIC-EC, 1433, Nancy, F-54500, France
| | - M Andres
- Seccion de Reumatologia. Hospital, General Universitario de Alicante, Alicante, Spain
| | - K Briot
- Paris-Descartes University, Medicine Faculty, Cochin Hospital, Paris, France
| | | | - R Christensen
- Musculoskeletal Statistics Unit, The Parker Institute, Department of Rheumatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
| | | | - R Curbelo
- Instituto de Salud Musculoesquelética and Universidad de Valladolid, Spain
| | - Montserrat Ferrer
- Health Services Research Group, Medical Research Institute (Hospital del Mar), Barcelona, Spain. Coordinator of BiblioPRO
| | - Violaine Foltz
- UPMC Univ Paris 06, GRC-UPMC 08 (EEMOIS); AP-HP, Pitié Salpêtrière Hospital, Department of Rheumatology, Paris, France
| | - C Gonzalez
- Universidad Camilo José Cela, Madrid, Spain
| | - F Guillemin
- University of Lorraine, APEMAC EA 4360, Nancy, F-54500; France & Inserm CIC-EC, 1433, Nancy, F-54500, France
| | - P M Machado
- Coimbra University Hospital, Coimbra, Portugal; and MRC Centre for Neuromuscular Diseases, University College London, London, UK
| | | | - A Ravelli
- University of Genoa and Institute Giannina Gaslini, Genoa, Italy
| | - M Scholte-Voshaar
- Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands
| | - T Uhlig
- National Resource Center for Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - L H D van Tuyl
- Department of Rheumatology, VU University Medical Center, Amsterdam, The Netherlands
| | - A Zink
- German Rheumatism Research Centre and Charité University Medicine, Berlin, Germany
| | - L Gossec
- UPMC Univ Paris 06, GRC-UPMC 08 (EEMOIS); AP-HP, Pitié Salpêtrière Hospital, Department of Rheumatology, Paris, France
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Martínez Alberola N, Sivera F, Andres M, Fernández-Carballido C, Martín-Domenech R, Martinez-Vidal M, San Martín-Alvarez A. OP0140-HPR The Role of a Nurse-Clinic in the Assessment and Prevention of Cardio-Vascular Risk. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.4770] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Martínez S, Minguez A, Garcia JJ, Andres M, Goitia V, Martinez C. CP-077 Analysis of costs and prescription guidelines of etanercept and adalimumab in patients of rheumatology, dermatology and gastroenterology services on the pharmacy outpatient unit: Abstract CP-077 Table 1. Eur J Hosp Pharm 2015. [DOI: 10.1136/ejhpharm-2015-000639.73] [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] [Indexed: 11/03/2022] Open
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Merriman T, Topless R, Day R, Kannangara D, Williams K, Bradbury L, Brown M, Harrison A, Hill C, Jones G, Lester S, Littlejohn G, Rischmueller M, Shenstone B, Smith M, Andres M, Bardin T, Doherty M, Janssen M, Jansen T, Joosten L, Perez-Ruiz F, Radstake T, Riches P, Roddy E, Tausche AK, Stamp L, Dalbeth N, Liote F, So A, Rasheed H. THU0493 Association of the Toll-Like Receptor 4 (TLR4) Gene with Gout. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.4781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Andres M, Sivera F, Vela P, Pérez-Vicente S. AB0706 Centre-Related Features Determine Variability of Hospital Admissions of Patients with Spondyloarthritides in Spain: Table 1. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.1693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Andres M, Sivera F, Carmona L, van der Heijde D, Falzon L. AB1066 Quality of life and disability assessment in gout: A systematic literature review. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.1065] [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] [Indexed: 11/04/2022]
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Andres M, Vela P, Begazo A, Pascual E. AB0710 Igg4-related disease managed with mycophenolate: a single-centre experience. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.3032] [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] [Indexed: 11/04/2022]
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Pardo V, Andres M, Caturla J, Pascual E. OP0104 Hypouricemia due to high urate renal excretion in septic systemic inflammatory response syndrome. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.1787] [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] [Indexed: 11/03/2022]
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Sivera F, Andres M, Carmona L, van der Heijde D, Falzon L. AB1065 Diagnosing gout without joint fluid aspiration: A systematic literature review using monosodium urate crystals as a reference standard. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.1064] [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] [Indexed: 11/03/2022]
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Hui M, Garner R, Rees F, Bavakunji R, Daniel P, Varughese S, Srikanth A, Andres M, Pearce F, Leung J, Lim K, Regan M, Lanyon P. Lupus nephritis: a 15-year multi-centre experience in the UK. Lupus 2013; 22:328-32. [PMID: 23386411 DOI: 10.1177/0961203312474084] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Our aim was to audit the outcome of lupus nephritis (LN) at three East Midlands centres. METHODS We undertook a retrospective review of all biopsy-proven LN types III-V 1995-2010. RESULTS In total, 61 patients with LN were identified, with a median follow-up of 68 months. LN was present at the time of systemic lupus erythematosus (SLE) diagnosis in 20 patients. The median time from SLE diagnosis to the first LN episode was 5.3 years. Some 35 patients received IV cyclophosphamide and 17 received mycophenolate mofetil (MMF) as induction therapy; 81.8% of those treated with cyclophosphamide and 81.3% with MMF had at least 'improved' according to the ACR-response criteria 6 months from induction; 33.3% and 37.5%, respectively, had a 'complete' response. MMF and azathioprine were the most frequently used maintenance therapy. We found that 32.8% experienced a flare after a mean post-induction time of 3.5 years, irrespective of the maintenance therapy used, and 43.8% of partial responders flared compared with 4.8% of complete responders. End-stage renal failure developed in 8.2%. CONCLUSIONS Overall, outcomes (response, flare-rate, end-stage renal failure) were comparable with European clinical studies. Partial responders are more likely to flare compared with complete responders. The results highlight that LN can occur, and flare, after many years of SLE, emphasizing the importance of continued vigilance for LN in all patients.
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Affiliation(s)
- M Hui
- Department of Rheumatology, Nottingham University Hospitals NHS Trust, UK.
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Gridley D, Slater J, Yonemoto L, Miller D, Rossi C, Archambeau J, Andres M, Oey M. Pilot study of cytokine profiles in prostate cancer patients undergoing proton or conventional radiotherapy. Int J Oncol 2012; 8:175-81. [PMID: 21544347 DOI: 10.3892/ijo.8.1.175] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The mechanisms responsible for normal tissue late effects following radiotherapy are largely unknown and currently no method for predicting such risks is available. Abnormal levels of cytokine production induced by radiation has been suggested as a contributing factor by multiple investigators. The purpose of the present study was to evaluate plasma levels of transforming growth factor-beta 1 (TGF-beta 1), basic fibroblast growth factor (bFGF), tumor necrosis factor-alpha (TNF-alpha), and interleukin-1 beta (IL-1 beta) in patients with prostate cancer scheduled for radiotherapy (protons, photons, or combination of both). It has been recently shown that ionizing radiation can increase expression of these cytokines and there are indications that they may be associated with morbidity. Blood samples were obtained from 20 subjects (age 51-80) before, during the first week, and immediately after the end of therapy; 3 healthy volunteers served as controls. Significant positive correlations (p<0.05) were obtained between bFGF, IL-1 beta, and TNF-alpha and the integral dose of radiation during the first week of treatment. Correlations approaching significance (p<0.1) were obtained with bFGF and acute treatment-related morbidity. A higher integral dose (due to larger irradiated volumes) was delivered with conventional photon compared to proton irradiation. No significance was obtained with any of the cytokines and pretreatment prostate specific antigen (PSA) levels, patient age, grade or stage of disease, or the integral dose by the end of radiation treatment. These results show that large changes occur in the plasma levels of certain cytokines early after initiation of radiotherapy and that treatment of larger volumes is more likely to induce these changes. Our data support further investigation of the role of cytokines during radiotherapy.
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Affiliation(s)
- D Gridley
- LOMA LINDA UNIV,SCH MED,DEPT RADIAT MED,LOMA LINDA,CA 92350. LOMA LINDA UNIV,MED CTR,INDEPENTENT ORDER FORESTERS CANC RES LAB,LOMA LINDA,CA 92350
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Heathfield S, Parker B, Zeef L, Bruce I, Alexander Y, Collins F, Stone M, Wang E, Williams AS, Wright HL, Thomas HB, Moots RJ, Edwards SW, Bullock C, Chapman V, Walsh DA, Mobasheri A, Kendall D, Kelly S, Bayley R, Buckley CD, Young SP, Rump-Goodrich L, Middleton J, Chen L, Fisher R, Kollnberger S, Shastri N, Kessler BM, Bowness P, Nazeer Moideen A, Evans L, Osgood L, Williams AS, Jones SA, Nowell MA, Mahadik Y, Young S, Morgan M, Gordon C, Harper L, Giles JL, Paul Morgan B, Harris CL, Rysnik OJ, McHugh K, Kollnberger S, Payeli S, Marroquin O, Shaw J, Renner C, Bowness P, Nayar S, Cloake T, Bombardieri M, Pitzalis C, Buckley C, Barone F, Barone F, Nayar S, Cloake T, Lane P, Coles M, Buckley C, Williams EL, Edwards CJ, Cooper C, Oreffo RO, Dunn S, Crawford A, Wilkinson M, Le Maitre C, Bunning R, Daniels J, Phillips KLE, Chiverton N, Le Maitre CL, Kollnberger S, Shaw J, Ridley A, Wong-Baeza I, McHugh K, Keidel S, Chan A, Bowness P, Gullick NJ, Abozaid HS, Jayaraj DM, Evans HG, Scott DL, Choy EH, Taams LS, Hickling M, Golor G, Jullion A, Shaw S, Kretsos K, Bari SF, Rhys-Dillon B, Amos N, Siebert S, Phillips KLE, Chiverton N, Bunning RD, Haddock G, Cross AK, Le Maitre CL, Kate I, Phillips E, Cross A, Chiverton N, Haddock G, Bunning RAD, Le Maitre CL, Ceeraz S, Spencer J, Choy E, Corrigall V, Crilly A, Palmer H, Lockhart J, Plevin R, Ferrell WR, McInnes I, Hutchinson D, Perry L, DiCicco M, Humby F, Kelly S, Hands R, Buckley C, McInnes I, Taylor P, Bombardieri M, Pitzalis C, Mehta P, Mitchell A, Tysoe C, Caswell R, Owens M, Vincent T, Hashmi TM, Price-Forbes A, Sharp CA, Murphy H, Wood EF, Doherty T, Sheldon J, Sofat N, Goff I, Platt PN, Abdulkader R, Clunie G, Ismajli M, Nikiphorou E, Young A, Tugnet N, Dixey J, Banik S, Alcorn D, Hunter J, Win Maw W, Patil P, Hayes F, Main Wong W, Borg FA, Dasgupta B, Malaviya AP, Ostor AJ, Chana JK, Ahmed AA, Edmonds S, Hayes F, Coward L, Borg F, Heaney J, Amft N, Simpson J, Dhillon V, Ayalew Y, Khattak F, Gayed M, Amarasena RI, McKenna F, Amarasena RI, McKenna F, Mc Laughlin M, Baburaj K, Fattah Z, Ng N, Wilson J, Colaco B, Williams MR, Adizie T, Dasgupta B, Casey M, Lip S, Tan S, Anderson D, Robertson C, Devanny I, Field M, Walker D, Robinson S, Ryan S, Hassell A, Bateman J, Allen M, Davies D, Crouch C, Walker-Bone K, Gainsborough N, Gullick NJ, Lutalo PM, Davies UM, Walker-Bone K, Mckew JR, Millar AM, Wright SA, Bell AL, Thapper M, Roussou T, Cumming J, Hull RG, Thapper M, Roussou T, McKeogh J, O'Connor MB, Hassan AI, Bond U, Swan J, Phelan MJ, Coady D, Kumar N, Farrow L, Bukhari M, Oldroyd AG, Greenbank C, McBeth J, Duncan R, Brown D, Horan M, Pendleton N, Littlewood A, Cordingley L, Mulvey M, Curtis EM, Cole ZA, Crozier SR, Georgia N, Robinson SM, Godfrey KM, Sayer AA, Inskip HM, Cooper C, Harvey NC, Davies R, Mercer L, Galloway J, Low A, Watson K, Lunt M, Symmons D, Hyrich K, Chitale S, Estrach C, Moots RJ, Goodson NJ, Rankin E, Jiang CQ, Cheng KK, Lam TH, Adab P, Ling S, Chitale S, Moots RJ, Estrach C, Goodson NJ, Humphreys J, Ellis C, Bunn D, Verstappen SM, Symmons D, Fluess E, Macfarlane GJ, Bond C, Jones GT, Scott IC, Steer S, Lewis CM, Cope A, Mulvey MR, Macfarlane GJ, Symmons D, Lovell K, Keeley P, Woby S, Beasley M, McBeth J, Viatte S, Plant D, Lunt M, Fu B, Parker B, Galloway J, Solymossy C, Worthington J, Symmons D, Dixey J, Young A, Barton A, Williams FM, Osei-Bordom DC, Popham M, MacGregor A, Spector T, Little J, Herrick A, Pushpakom S, Ennis H, McBurney H, Worthington J, Newman W, Ibrahim I, Plant D, Hyrich K, Morgan A, Wilson A, Isaacs J, Barton A, Sanderson T, Hewlett S, Calnan M, Morris M, Raza K, Kumar K, Cardy CM, Pauling JD, Jenkins J, Brown SJ, McHugh N, Nikiphorou E, Mugford M, Davies C, Cooper N, Brooksby A, Bunn D, Symmons D, MacGregor A, Dures E, Ambler N, Fletcher D, Pope D, Robinson F, Rooke R, Hewlett S, Gorman CL, Reynolds P, Hakim AJ, Bosworth A, Weaver D, Kiely PD, Skeoch S, Jani M, Amarasena R, Rao C, Macphie E, McLoughlin Y, Shah P, Else S, Semenova O, Thompson H, Ogunbambi O, Kallankara S, Patel Y, Baguley E, Jani M, Halsey J, Severn A, Bukhari M, Selvan S, Price E, Husain MJ, Brophy S, Phillips CJ, Cooksey R, Irvine E, Siebert S, Lendrem D, Mitchell S, Bowman S, Price E, Pease CT, Emery P, Andrews J, Bombardieri M, Sutcliffe N, Pitzalis C, Lanyon P, Hunter J, Gupta M, McLaren J, Regan M, Cooper A, Giles I, Isenberg D, Griffiths B, Foggo H, Edgar S, Vadivelu S, Coady D, McHugh N, Ng WF, Dasgupta B, Taylor P, Iqbal I, Heron L, Pilling C, Marks J, Hull R, Ledingham J, Han C, Gathany T, Tandon N, Hsia E, Taylor P, Strand V, Sensky T, Harta N, Fleming S, Kay L, Rutherford M, Nicholl K, Kay L, Rutherford M, Nicholl K, Eyre T, Wilson G, Johnson P, Russell M, Timoshanko J, Duncan G, Spandley A, Roskell S, Coady D, West L, Adshead R, Donnelly SP, Ashton S, Tahir H, Patel D, Darroch J, Goodson NJ, Boulton J, Ellis B, Finlay R, Lendrem D, Mitchell S, Bowman S, Price E, Pease CT, Emery P, Andrews J, Bombardieri M, Sutcliffe N, Pitzalis C, Lanyon P, Hunter J, Gupta M, McLaren J, Regan M, Cooper A, Giles I, Isenberg D, Vadivelu S, Coady D, McHugh N, Griffiths B, Foggo H, Edgar S, Ng WF, Murray-Brown W, Priori R, Tappuni T, Vartoukian S, Seoudi N, Picarelli G, Fortune F, Valesini G, Pitzalis C, Bombardieri M, Ball E, Rooney M, Bell A, Merida AA, Isenberg D, Tarelli E, Axford J, Giles I, Pericleous C, Pierangeli SS, Ioannou J, Rahman A, Alavi A, Hughes M, Evans B, Bukhari M, Parker B, Zaki A, Alexander Y, Bruce I, Hui M, Garner R, Rees F, Bavakunji R, Daniel P, Varughese S, Srikanth A, Andres M, Pearce F, Leung J, Lim K, Regan M, Lanyon P, Oomatia A, Petri M, Fang H, Birnbaum J, Amissah-Arthur M, Gayed M, Stewart K, Jennens H, Braude S, Gordon C, Sutton EJ, Watson KD, Gordon C, Yee CS, Lanyon P, Jayne D, Isenberg D, Rahman A, Akil M, McHugh N, Ahmad Y, Amft N, D'Cruz D, Edwards CJ, Griffiths B, Khamashta M, Teh LS, Zoma A, Bruce I, Dey ID, Kenu E, Isenberg D, Pericleous C, Garza-Garcia A, Murfitt L, Driscoll PC, Isenberg D, Pierangeli S, Giles I, Ioannou Y, Rahman A, Reynolds JA, Ray DW, O'Neill T, Alexander Y, Bruce I, Segeda I, Shevchuk S, Kuvikova I, Brown N, Bruce I, Venning M, Mehta P, Dhanjal M, Mason J, Nelson-Piercy C, Basu N, Paudyal P, Stockton M, Lawton S, Dent C, Kindness K, Meldrum G, John E, Arthur C, West L, Macfarlane MV, Reid DM, Jones GT, Macfarlane GJ, Yates M, Loke Y, Watts R, MacGregor A, Adizie T, Christidis D, Dasgupta B, Williams M, Sivakumar R, Misra R, Danda D, Mahendranath KM, Bacon PA, Mackie SL, Pease CT. Basic science * 232. Certolizumab pegol prevents pro-inflammatory alterations in endothelial cell function. Rheumatology (Oxford) 2012. [DOI: 10.1093/rheumatology/kes108] [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] [Indexed: 11/13/2022] Open
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Chang L, Andres M, Sadino J, Jiang CS, Nakama H, Miller E, Ernst T. Impact of apolipoprotein E ε4 and HIV on cognition and brain atrophy: antagonistic pleiotropy and premature brain aging. Neuroimage 2011; 58:1017-27. [PMID: 21803164 PMCID: PMC3171637 DOI: 10.1016/j.neuroimage.2011.07.010] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [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: 01/25/2011] [Revised: 06/20/2011] [Accepted: 07/04/2011] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE The apolipoprotein E (APOE) ε4 allele may accelerate the progression of HIV disease, and increase the risk for developing HIV-associated neurocognitive disorder (HAND). Whether APOEε4 allele(s) and age may influence brain atrophy in HIV patients is unknown and was evaluated. METHODS Automated morphometry on magnetic resonance images, using FreeSurfer analyses, neuropsychological testing and APOE genotyping were performed in 139 subjects [70 seronegative controls (SN); 69 clinically-stable HIV subjects]. RESULTS Compared to SN, HIV subjects had smaller volumes throughout the brain regardless of their HAND status. Compared to APOEε4- subjects, SN controls with APOEε4 had better memory and larger global brain volumes (cerebral white matter and cortex) while HIV subjects with the APOEε4 allele(s) had poorer cognition (verbal fluency, learning, executive function and memory) and smaller cerebral and cerebellar white matter and subcortical structures. Further stratification of age showed that younger (<50 years) APOEε4+SN subjects had larger putamen and cerebral white matter, while younger APOEε4+HIV subjects had poorer performance on verbal fluency and smaller brain volumes [3-way (HIV-status×APOEε4×Age) interaction-p-values=0.005 to 0.03]. INTERPRETATION These findings suggest that APOEε4 allele(s) may show antagonistic pleiotropy on cognition and brain atrophy in SN controls, but may lead to premature aging with neurodegeneration in younger HIV patients prior to the development of HAND. Potential mechanisms for such interactions may include stronger neuro-inflammation or greater amyloid deposition in younger HIV subjects with APOEε4 allele(s). Early screening for the APOEε4 allele and brain atrophy with morphometry may guide neuroprotective intervention of cognitively normal HIV subjects prior to the development of HAND. Longitudinal follow-up studies and larger sample sizes are needed to validate these cross-sectional results.
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Affiliation(s)
- L Chang
- Department of Medicine, John A. Burns School of Medicine, The Queen's Medical Center, Honolulu, Hawaii 96813, USA.
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Andres M, Agullo A, Negrete R, Batlle E, Martinez A. Lepromatous leprosy presenting as an acute polyarthritis in a Colombian immigrant in Spain. Joint Bone Spine 2011; 79:203-4. [PMID: 21944977 DOI: 10.1016/j.jbspin.2011.08.001] [Citation(s) in RCA: 2] [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] [Received: 04/13/2011] [Accepted: 08/02/2011] [Indexed: 11/16/2022]
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Andres M, Courtney P. No hepatitis B reactivation in a patient with refractory antisynthetase syndrome successfully treated with rituximab. Joint Bone Spine 2011; 78:653-4. [PMID: 21807545 DOI: 10.1016/j.jbspin.2011.05.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Accepted: 05/11/2011] [Indexed: 12/11/2022]
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Hui M, Andres M, Latief K, Courtney P. Small muscle myositis in a patient with systemic lupus erythematosus successfully treated with rituximab. Lupus 2011; 20:1340-1. [PMID: 21768178 DOI: 10.1177/0961203311409271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Alarcon G, Cortes V, Victorio R, Andres M, Monfort L, Peñaranda N. P16.2 Pediatric muscular weakness: a case report. Clin Neurophysiol 2011. [DOI: 10.1016/s1388-2457(11)60461-6] [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] [Indexed: 11/30/2022]
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