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Ruiz-Treviño AS, Miranda-González A, García-González OG, Martínez-Pérez R, González Ramírez GJ, Hernández Sepúlveda EU. [Clinical and radiographic factors associated with the severity of paraspinal fatty infiltration in patients with degenerative low back disease]. Acta Ortop Mex 2023; 37:137-142. [PMID: 38052433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
INTRODUCTION Degenerative lumbar disease (DLE) is a spectrum of pathological changes from disc degeneration, herniated disc, spondylolisthesis and lumbar canal stenosis. The pain associated with it is multifactorial. Muscle cramps are among the most frequent causes. The relationship between muscle degeneration and DLE has already been studied in the past in multiple studies, highlighting the one carried out by Kjaer & cols. OBJECTIVE to determine the prevalence and severity of fatty degeneration in mutifidus spinae, and to study its relationship with clinical and radiographic factors. MATERIAL AND METHODS observational and analytical study. Patients diagnosed with: herniated disc, lumbar canal stenosis or degenerative scoliosis were included. They were classified according to the Kjaer scale for paraspinal fatty infiltration in one of three groups. Clinical variables were analyzed: age, smoking, obesity, the presence of axial pain, temporality of pain, severity expressed with a visual analog scale (VAS); and radiographic: number of diseased segments, involved segments, diagnostic imaging and the presence of spondylolisthesis. RESULTS 56 patients with an average age of 52.5 years (16 to 80) with a predominance of females with 62.5% were included. The diagnoses were nonspecific low back pain (1.8%), herniated disc (42.9%), narrow lumbar duct (46.4%) and lumbar duct with degenerative scoliosis deformity (8.9%). The distribution among the three groups described by Kjaer was as follows: 44.6% were classified with a fat infiltration score of 2. In groups 1 and 0, 39.3% and 16.1% were classified respectively. The variables significantly related to greater fat infiltration were: age > 60 years, diagnoses of lumbar canal stenosis and herniated disc; obesity, spondylolisthesis < 2 vertebral segments involved. Axial pain and VAS > 8 points were not related to greater muscle degeneration. CONCLUSIONS fatty infiltration is present in all patients with some of the forms of DLE. Most patients > 60 years of age with advanced degenerative processes have a greater severity of infiltration. Other related variables are: obesity, spondylolisthesis and disease of < 2 vertebral segments. There is no relationship between a higher percentage of fatty infiltration and axial pain or higher VAS scores.
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Affiliation(s)
- A S Ruiz-Treviño
- Departamento de Neurociencias. Servicio de Cirugía de Columna. Hospital Regional de Alta Especialidad del Bajío, Universidad de Guanajuato. León, Gto., México
| | - A Miranda-González
- Departamento de Neurociencias. Servicio de Cirugía de Columna. Hospital Regional de Alta Especialidad del Bajío, Universidad de Guanajuato. León, Gto., México
| | - O G García-González
- Departamento de Neurociencias. Servicio de Cirugía de Columna. Hospital Regional de Alta Especialidad del Bajío, Universidad de Guanajuato. León, Gto., México
| | - R Martínez-Pérez
- Departamento de Neurociencias. Servicio de Cirugía de Columna. Hospital Regional de Alta Especialidad del Bajío, Universidad de Guanajuato. León, Gto., México
| | - G J González Ramírez
- Departamento de Neurociencias. Servicio de Cirugía de Columna. Hospital Regional de Alta Especialidad del Bajío, Universidad de Guanajuato. León, Gto., México
| | - E U Hernández Sepúlveda
- Departamento de Neurociencias. Servicio de Cirugía de Columna. Hospital Regional de Alta Especialidad del Bajío, Universidad de Guanajuato. León, Gto., México
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Martínez-Pérez R, Hardesty DA, Prevedello DM. The extradural extended eyebrow approach: A cadaveric feasibility study. Neurochirurgie 2020; 67:391-395. [PMID: 33279526 DOI: 10.1016/j.neuchi.2020.11.008] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 10/31/2020] [Accepted: 11/21/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Extradural anterior clinoidectomy (eAC) is key to expose the paraclinoid region. Several authors have pointed limitations of performing an eAC through a supraorbital craniotomy. In this article, we aim to provide educational material and discuss the technical nuances to successfully perform an eAC throughout a modification of the supraorbital approach, the extradural extended eyebrow approach (xEBA+eAC). METHODS Four embalmed heads were used for anatomic dissection and perform the xEBA+eAC. Additionally, one head was used for a video demonstration of the surgical approach. RESULTS The anterior clinoid process was successfully removed, and the ophthalmic artery and paraclinoid region were exposed in all specimens. Drilling the sphenoid wing until exposing the meningo-orbital band and further interdural dissection are vital steps to expose the anterior clinoid process. Removal of the anterior clinoid process can be simplified in 3 osteotomies, including the optic canal unroofing, detachment from the lateral pillar, and drilling of the optic strut. Sectioning of the distal dural ring facilitates the mobilization of the internal carotid artery and the surgical exposure of the ophthalmic artery. CONCLUSIONS xEBA+eAC is a technically feasible approach that provides exposure to the paraclinoid region, along with anterior and middle cranial fossa.
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Affiliation(s)
- R Martínez-Pérez
- Department of Neurological Surgery, The Ohio State University, Wexner Medical Center, 410W. 10th Ave., N-1049 Doan Hall, Columbus, OH 43210, United States.
| | - D A Hardesty
- Department of Neurological Surgery, The Ohio State University, Wexner Medical Center, 410W. 10th Ave., N-1049 Doan Hall, Columbus, OH 43210, United States; Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Wexner Medical Center, Columbus, OH, United States
| | - D M Prevedello
- Department of Neurological Surgery, The Ohio State University, Wexner Medical Center, 410W. 10th Ave., N-1049 Doan Hall, Columbus, OH 43210, United States; Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Wexner Medical Center, Columbus, OH, United States.
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Martínez-Pérez R, Vergara C, Rayo N, Mura J. Recurrent supplementary motor area syndrome in relapsed parasagittal meningiomas: from the onset to the origin. Neurologia 2020; 35:606-608. [PMID: 31780324 DOI: 10.1016/j.nrl.2019.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 07/13/2019] [Accepted: 07/31/2019] [Indexed: 11/17/2022] Open
Affiliation(s)
- R Martínez-Pérez
- Departamento de Neurocirugía, Instituto de Neurociencias Clínicas, Universidad Austral de Chile, Valdivia, Chile.
| | - C Vergara
- Departamento de Neurocirugía, Instituto de Neurociencias Clínicas, Universidad Austral de Chile, Valdivia, Chile
| | - N Rayo
- University of Western Ontario, London, Ontario, Canadá
| | - J Mura
- Instituto de Neurocirugía Dr. Asenjo, Universidad de Chile, Santiago, Chile; Departamento de Neurocirugía, Clínica las Condes, Santiago, Chile
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Mireles-Cano JN, Escoto-Venegas E, García-González OG, Miranda-González A, González-Ramírez J, Hernández-Sepúlveda E, Martínez-Pérez R. A management algorithm for vertebral destruction syndrome by multiple myeloma and metastatic spinal cord compression. Acta Ortop Mex 2020; 34:293-297. [PMID: 33634632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Multiple myeloma represents 1% of all cancers and 10% of hematological cancers. Up to 80-90% of cases will have skeletal involvement and the spine is the most frequently involved site. Any intervention must be aimed to improve the patients functional prognosis and will impact their quality of life. OBJECTIVE To describe the clinical presentation of vertebral destruction syndrome due to multiple myeloma and to present the management algorithm used for the study and decision-making in treatment. MATERIAL AND METHODS Study design: Retrospective cross-sectional. A search was made in the hospitals clinical file in search of patients with a histological diagnosis of multiple myeloma attended by the Spinal Surgery Service. Clinical characteristics of the initial presentation were obtained such as: presence of pain, ASIA scale and it was categorized according to the Durie-Salmon classification at diagnosis; the levels involved and type of surgery were described. RESULTS The study included ten patients with an average age of 61.4 years, 70% were male subjects. All patients were approach according to the modified protocol for vertebral destruction syndrome and fluoroscopy-guided percutaneous biopsy. Most had pain at diagnosis, after neurologic examination only 30% were classified as ASIA A. Most of the patients were staged III according to Durie Salomon. The most frequently vertebral segment involved was thoracic. In only one patient more than two vertebrae were involved. After diagnosis of multiple myeloma, nine patients were managed according to a NOMS framework. In the majority they were treated with fusion by posterior approach, six of them were augmented with vertebroplasty. Only one patient of the total, was treated with vertebroplasty alone. CONCLUSIONS The use of systematized management algorithms will allow better decisions to be made in conjunction with a multidisciplinary group for the care of multiple myeloma with vertebral involvement.
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Affiliation(s)
- J N Mireles-Cano
- Neurosurgery Department. Hospital Regional de Alta Especialidad del Bajío, Universidad de Guanajuato. León, Gto., México
| | - E Escoto-Venegas
- Neurosurgery Department. Hospital Regional de Alta Especialidad del Bajío, Universidad de Guanajuato. León, Gto., México
| | - O G García-González
- Neurosurgery Department. Hospital Regional de Alta Especialidad del Bajío, Universidad de Guanajuato. León, Gto., México
| | - A Miranda-González
- Neurosurgery Department. Hospital Regional de Alta Especialidad del Bajío, Universidad de Guanajuato. León, Gto., México
| | - J González-Ramírez
- Neurosurgery Department. Hospital Regional de Alta Especialidad del Bajío, Universidad de Guanajuato. León, Gto., México
| | - E Hernández-Sepúlveda
- Neurosurgery Department. Hospital Regional de Alta Especialidad del Bajío, Universidad de Guanajuato. León, Gto., México
| | - R Martínez-Pérez
- Neurosurgery Department. Hospital Regional de Alta Especialidad del Bajío, Universidad de Guanajuato. León, Gto., México
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Ortiz-Díaz LG, Magallanes-Durán E, Martínez-Pérez R. [Unreduced posterior dislocation of the shoulder with an associated reverse Hill-Sachs injury treated with a modified McLaughlin technique]. Acta Ortop Mex 2019; 33:333-336. [PMID: 32253858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Posterior shoulder dislocations are rare (2%) and are associated with seizures, electrocutions and high-energy trauma. They may be associated with a reverse Hill-Sachs lesion. One of the treatment principles consists of the subscapular tendon transfer to the injury area or McLaughlin procedure. CLINICAL CASE A case of a man with a reverse Hill-Sachs defect treated with a modification of McLaughlins original technique is presented. The functional results after 13 months of surgery are reported. RESULTS Currently with a Constant Score of 98 points. CONCLUSION The technical modification used for the surgical treatment of the reverse Hill-Sachs lesion presented in this patient demonstrated good functional results with low cost material.
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Affiliation(s)
- L G Ortiz-Díaz
- Centenario Hospital Miguel Hidalgo. Servicio de Traumatología y Ortopedia. Módulo de cirugía articular. Aguascalientes, Ags. México
| | - E Magallanes-Durán
- Centenario Hospital Miguel Hidalgo. Servicio de Traumatología y Ortopedia. Módulo de cirugía articular. Aguascalientes, Ags. México
| | - R Martínez-Pérez
- Centenario Hospital Miguel Hidalgo. Servicio de Traumatología y Ortopedia. Módulo de cirugía articular. Aguascalientes, Ags. México
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Chávez-Galván CR, Martínez-Pérez R. [Humeral anterograde nailing. Functional results. A 5 years experience]. Acta Ortop Mex 2019; 33:36-38. [PMID: 31480124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE The purpose of this study was to investigate the clinical impact on the global function of the shoulder of the use of the anterolateral approach for nailing. MATERIAL AND METHODS A retrospective cohort at the public sector of Centenario Hospital Miguel Hidalgo in Aguascalientes, Mexico between 2011 and 2016 was analysed. Inclusion criteria were: patients with anterolateral humeral nailing approach. Clinical assessment using the Constant-Murley score, shoulder range of motion and quick DASH questionnaire. RESULTS Seventeen patients, 16 treated for humeral shaft fracture and one for humeral fibrous dyslasia were obtained. Mean score on Constant-Murley scale was 84.05 with 76.4% of patients achieving excellent result ( 75 points). One patient had a poor functional outcome. The mean quickDASH score was 17.5 points. CONCLUSIONS The anterolateral approach for humeral nailing has good functional outcome in our series.
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Affiliation(s)
- C R Chávez-Galván
- Servicio de Traumatología y Ortopedia. Centenario Hospital «Miguel Hidalgo». Aguascalientes, Aguascalientes, México
| | - R Martínez-Pérez
- Servicio de Traumatología y Ortopedia. Centenario Hospital «Miguel Hidalgo». Aguascalientes, Aguascalientes, México
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Martínez-Pérez R, Paredes I, Munarriz PM, Paredes B, Alén JF. Chronic traumatic encephalopathy: The unknown disease. Neurologia 2014; 32:185-191. [PMID: 25534950 DOI: 10.1016/j.nrl.2014.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 06/06/2014] [Accepted: 08/08/2014] [Indexed: 11/18/2022] Open
Abstract
Chronic traumatic encephalopathy is a neurodegenerative disease produced by accumulated minor traumatic brain injuries; no definitive premortem diagnosis and no treatments are available for chronic traumatic encephalopathy. Risk factors associated with chronic traumatic encephalopathy include playing contact sports, presence of the apolipoprotein E4, and old age. Although it shares certain histopathological findings with Alzheimer disease, chronic traumatic encephalopathy has a more specific presentation (hyperphosphorylated tau protein deposited as neurofibrillary tangles, associated with neuropil threads and sometimes with beta-amyloid plaques). Its clinical presentation is insidious; patients show mild cognitive and emotional symptoms before progressing to parkinsonian motor signs and finally dementia. Results from new experimental diagnostic tools are promising, but these tools are not yet available. The mainstay of managing this disease is prevention and early detection of its first symptoms.
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Affiliation(s)
- R Martínez-Pérez
- Servicio de Neurocirugía, Hospital 12 de Octubre, Madrid, España; Facultad de Medicina, Universidad Complutense, Madrid, España.
| | - I Paredes
- Servicio de Neurocirugía, Hospital Virgen de la Salud, Toledo, España
| | - P M Munarriz
- Servicio de Neurocirugía, Hospital 12 de Octubre, Madrid, España; Facultad de Medicina, Universidad Complutense, Madrid, España
| | - B Paredes
- Departamento de Psicología, Universidad Nacional de Educación a Distancia (UNED), España
| | - J F Alén
- Servicio de Neurocirugía, Hospital 12 de Octubre, Madrid, España; Facultad de Medicina, Universidad Complutense, Madrid, España
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Martínez-Pérez R, Paredes I, Cepeda S, Ramos A, Castaño-León AM, García-Fuentes C, Lobato RD, Gómez PA, Lagares A. Spinal cord injury after blunt cervical spine trauma: correlation of soft-tissue damage and extension of lesion. AJNR Am J Neuroradiol 2014; 35:1029-34. [PMID: 24335539 DOI: 10.3174/ajnr.a3812] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [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: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE In patients with spinal cord injury after blunt trauma, several studies have observed a correlation between neurologic impairment and radiologic findings. Few studies have been performed to correlate spinal cord injury with ligamentous injury. The purpose of this study was to retrospectively evaluate whether ligamentous injury or disk disruption after spinal cord injury correlates with lesion length. MATERIALS AND METHODS We retrospectively reviewed 108 patients diagnosed with traumatic spinal cord injury after cervical trauma between 1990-2011. Plain films, CT, and MR imaging were performed on patients and then reviewed for this study. MR imaging was performed within 96 hours after cervical trauma for all patients. Data regarding ligamentous injury, disk injury, and the extent of the spinal cord injury were collected from an adequate number of MR images. We evaluated anterior longitudinal ligaments, posterior longitudinal ligaments, and the ligamentum flavum. Length of lesion, disk disruption, and ligamentous injury association, as well as the extent of the spinal cord injury were statistically assessed by means of univariate analysis, with the use of nonparametric tests and multivariate analysis along with linear regression. RESULTS There were significant differences in lesion length on T2-weighted images for anterior longitudinal ligaments, posterior longitudinal ligaments, and ligamentum flavum in the univariate analysis; however, when this was adjusted by age, level of injury, sex, and disruption of the soft tissue evaluated (disk, anterior longitudinal ligaments, posterior longitudinal ligaments, and ligamentum flavum) in a multivariable analysis, only ligamentum flavum showed a statistically significant association with lesion length. Furthermore, the number of ligaments affected had a positive correlation with the extension of the lesion. CONCLUSIONS In cervical spine trauma, a specific pattern of ligamentous injury correlates with the length of the spinal cord lesion in MR imaging studies. Ligamentous injury detected by MR imaging is not a dynamic finding; thus it proved to be useful in predicting neurologic outcome in patients for whom the MR imaging examination was delayed.
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Affiliation(s)
- R Martínez-Pérez
- From the Departments of Neurosurgery (R.M.-P., I.P., S.C., AM.C.-L., R.D.L., P.A.G., A.L.)
| | - I Paredes
- From the Departments of Neurosurgery (R.M.-P., I.P., S.C., AM.C.-L., R.D.L., P.A.G., A.L.)
| | - S Cepeda
- From the Departments of Neurosurgery (R.M.-P., I.P., S.C., AM.C.-L., R.D.L., P.A.G., A.L.)
| | | | - A M Castaño-León
- From the Departments of Neurosurgery (R.M.-P., I.P., S.C., AM.C.-L., R.D.L., P.A.G., A.L.)
| | - C García-Fuentes
- Intensive Care Unit (C.G.-F.), Hospital 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
| | - R D Lobato
- From the Departments of Neurosurgery (R.M.-P., I.P., S.C., AM.C.-L., R.D.L., P.A.G., A.L.)
| | - P A Gómez
- From the Departments of Neurosurgery (R.M.-P., I.P., S.C., AM.C.-L., R.D.L., P.A.G., A.L.)
| | - A Lagares
- From the Departments of Neurosurgery (R.M.-P., I.P., S.C., AM.C.-L., R.D.L., P.A.G., A.L.)
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Martínez-Pérez R, Rejón Gieb E, Rodríguez Montero S, León M, Marenco de la Fuente JL. A2.6 Enthesis inflammation in inflammatory bowel diseases without spondyloarthritis. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2013-205124.91] [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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Fernández-Nebro A, de la Fuente JLM, Carreño L, Izquierdo MG, Tomero E, Rúa-Figueroa I, Hernández-Cruz BE, Narváez J, Ucar E, Olivé A, Zea A, Fernández-Castro M, Raya-Álvarez E, Pego-Reigosa JM, Freire M, Martínez-Taboada VM, Pérez-Venegas J, Sánchez-Atrio AI, Villa-Blanco I, Manrique-Arija S, López-Longo FJ, Carreira PE, Martínez-Pérez R, García-Vicuña R. Multicenter longitudinal study of B-lymphocyte depletion in refractory systemic lupus erythematosus: the LESIMAB study. Lupus 2012; 21:1063-76. [PMID: 22786985 DOI: 10.1177/0961203312446627] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This study aimed to investigate the effectiveness and safety of single and repeated courses of rituximab in patients with refractory lupus. METHODS LESIMAB is a multicenter, retrospective, longitudinal study of lupus patients who have not responded to standard therapy and have been treated with rituximab. Response rates at six months and at follow-up were defined as efficacy outcomes. Complete response was defined as a SELENA-SLEDAI score ≤ two and a SELENA-SLEDAI Flare Index of zero. Partial response was defined as a reduction in the SELENA-SLEDAI score of ≥four points with no new or worsening of symptoms. Adverse events were collected. RESULTS Seventy-three (62.9%) of 116 patients achieved a response at six months (complete in 22 and partial in 51). Ninety-seven (77.6%) of 128 patients achieved a response after a mean follow-up of 20.0 ± 15.2 months (complete in 50 and partial in 47). High baseline SLEDAI score, previous treatment with ≥100 mg/day prednisone, and no history of severe hematologic flare were associated with response after the first treatment course. The median time to response was 6.5 months (95% CI, 5.0-8.0). Thirty-seven patients (38.1%) relapsed after the first infusion. The flare was severe in seven cases and mild to moderate in 29 cases. Serious infection rate was 12.6/100 patient-years. A schedule of four weekly doses was associated with more serious infections. Six patients died: two of infection and four of lupus complications. CONCLUSION Rituximab can be an effective treatment option for patients who have refractory lupus with severe or life-threatening disease with an acceptable tolerance profile.
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Affiliation(s)
- A Fernández-Nebro
- Rheumatology Service, Hospital Regional Universitario Carlos Haya, Spain.
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Martínez-Pérez R, Fernández-Nebro A, López-Lasanta M, Velloso-Feijoo ML, Muñoz-Jiménez A, López Longo J, Marenco JL. Rituximab reduces the hospitalization in patients with systemic lupus erythematosus. Lab Invest 2010. [PMCID: PMC3007818 DOI: 10.1186/1479-5876-8-s1-p70] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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