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Rua-Figueroa I, García de Yébenes MJ, Martinez-Barrio J, Galindo Izquierdo M, Calvo Alén J, Fernandez-Nebro A, Menor-Almagro R, Carmona L, Tejera Segura B, Tomero E, Freire-González M, Sangüesa C, Horcada L, Blanco R, Uriarte Itzazelaia E, Narváez J, Rosas Gómez de Salazar JC, Gómez-Sabater S, Morales CM, Andreu JL, Segarra VT, Aurrecoechea E, Perez A, Nóvoa Medina J, Salgado E, Lozano-Rivas N, Montilla C, Ruiz-Lucea E, Arevalo M, Iñiguez C, García-Villanueva MJ, Exposito L, Ibáñez-Barceló M, Bonilla G, Carrión-Barberà I, Erausquin C, Fragio Gil JJ, Pecondón A, Toyos FJ, Cobo T, Muñoz-Jiménez A, Oller J, Nolla JM, Pego-Reigosa JM. SLESIS-R: an improved score for prediction of serious infection in patients with systemic lupus erythematosus based on the RELESSER prospective cohort. Lupus Sci Med 2024; 11:e001096. [PMID: 38589223 PMCID: PMC11015315 DOI: 10.1136/lupus-2023-001096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 03/22/2024] [Indexed: 04/10/2024]
Abstract
OBJECTIVE To develop an improved score for prediction of severe infection in patients with systemic lupus erythematosus (SLE), namely, the SLE Severe Infection Score-Revised (SLESIS-R) and to validate it in a large multicentre lupus cohort. METHODS We used data from the prospective phase of RELESSER (RELESSER-PROS), the SLE register of the Spanish Society of Rheumatology. A multivariable logistic model was constructed taking into account the variables already forming the SLESIS score, plus all other potential predictors identified in a literature review. Performance was analysed using the C-statistic and the area under the receiver operating characteristic curve (AUROC). Internal validation was carried out using a 100-sample bootstrapping procedure. ORs were transformed into score items, and the AUROC was used to determine performance. RESULTS A total of 1459 patients who had completed 1 year of follow-up were included in the development cohort (mean age, 49±13 years; 90% women). Twenty-five (1.7%) had experienced ≥1 severe infection. According to the adjusted multivariate model, severe infection could be predicted from four variables: age (years) ≥60, previous SLE-related hospitalisation, previous serious infection and glucocorticoid dose. A score was built from the best model, taking values from 0 to 17. The AUROC was 0.861 (0.777-0.946). The cut-off chosen was ≥6, which exhibited an accuracy of 85.9% and a positive likelihood ratio of 5.48. CONCLUSIONS SLESIS-R is an accurate and feasible instrument for predicting infections in patients with SLE. SLESIS-R could help to make informed decisions on the use of immunosuppressants and the implementation of preventive measures.
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Affiliation(s)
- Iñigo Rua-Figueroa
- Department of Rheumatology, Hospital Universitario Gran Canaria Doctor Negrin, Las Palmas de Gran Canaria, Spain
| | | | - Julia Martinez-Barrio
- Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Jaime Calvo Alén
- Department of Rheumatology, Hospital Sierrallana, Vitoria, Spain
| | - Antonio Fernandez-Nebro
- UGC de Reumatología, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Malaga, Spain
| | | | - Loreto Carmona
- Instituto de Salud Musculoesquelética (INMUSC), Madrid, Spain
| | - Beatriz Tejera Segura
- Department of Rheumatology, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Eva Tomero
- Department of Rheumatology, Hospital Universitario de la Princesa, Instituto de Investigación La Princesa, Madrid, Spain
| | | | - Clara Sangüesa
- Department of Rheumatology, Hospital Germán Trias i Pujol, Barcelona, Spain
| | - Loreto Horcada
- Department of Rheumatology, Hospital de Navarra, Pamplona, Spain
| | - Ricardo Blanco
- Department of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | | | - Javier Narváez
- Department of Rheumatology, Hospital Universitario de Bellvitge, Barcelona, Spain
| | | | - Silvia Gómez-Sabater
- Department of Rheumatology, Hospital General Universitario de Alicante, Alicante, Spain
| | | | - Jose L Andreu
- Department of Rheumatology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | | | - Elena Aurrecoechea
- Department of Rheumatology, Hospital Universitario Sierrallana, Torrelavega, Spain
| | - Ana Perez
- Immune System Diseases and Oncology Service, University Hospital "Príncipe de Asturias", Alcala de Henares, Spain
| | - Javier Nóvoa Medina
- Department of Rheumatology, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas GC, Spain
| | - Eva Salgado
- Department of Rheumatology, Complejo Hospitalario de Orense, Ourense, Spain
| | - Nuria Lozano-Rivas
- Department of Rheumatology, Hospital Virgen de la Arrixaca, Murcia, Spain
| | - Carlos Montilla
- Department of Rheumatology, Hospital Clinico Universitario Salamanca, Salamanca, Spain
| | | | - Marta Arevalo
- Consorci Corporació Sanitària Parc Taulí, Sabadell, Spain
| | | | | | | | | | - Gema Bonilla
- Department of Rheumatology, La Paz University Hospital, Madrid, Spain
| | | | - Celia Erausquin
- Department of Rheumatology, Hospital Universitario Gran Canaria Doctor Negrin, Las Palmas de Gran Canaria, Spain
| | | | | | - Francisco J Toyos
- Department of Rheumatology, Hospital Virgen Macarena, Sevilla, Spain
| | | | | | - Jose Oller
- Doctor Peset University Hospital, Valencia, Spain
| | - Joan M Nolla
- Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
| | - J M Pego-Reigosa
- Department of Rheumatology, University Hospital Complex of Vigo, Vigo, Spain
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Altabás-González I, Pego-Reigosa JM, Mouriño C, Jiménez N, Hernández-Martín A, Casafont-Solé I, Urguelles JF, Román-Ivorra JA, Navarro MDLR, Galindo-Izquierdo M, Salman-Monte TC, Narváez J, Vidal-Montal P, García-Villanueva MJ, Garrote-Corral S, Blázquez-Cañamero MÁ, Marras C, Piqueras-García M, Martínez-Barrio J, Sánchez-Lucas M, Cortés-Hernández J, Penzo E, Calvo J, de Dios JR, Rodríguez BÁ, Vasques-Rocha M, Tomero E, Menor-Almagro R, Gandía M, Gómez-Puerta JA, Frade-Sosa B, Ramos-Giráldez C, Trapero-Pérez C, Diez E, Moriano C, Muñoz-Jiménez A, Rúa-Figueroa I. Thorough assessment of the effectiveness of belimumab in a large Spanish multicenter cohort of systemic lupus erythematosus patients. Rheumatology (Oxford) 2024:kead696. [PMID: 38490245 DOI: 10.1093/rheumatology/kead696] [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: 08/24/2023] [Revised: 10/11/2023] [Accepted: 11/05/2023] [Indexed: 03/17/2024] Open
Abstract
OBJECTIVES To provide an overview on the current use of belimumab (BLM) in SLE patients in clinical practice and to examine its efficacy in terms of standardized outcomes, drug survival, as well as patient and safety profiles. METHODS A longitudinal retrospective multicentre cohort including SLE patients treated with BLM at 18 Spanish centers. Data was collected upon initiation of BLM, at 6 and 12 months after initiation, and at the last recorded visit. Changes in SLEDAI-2K, the proportion of patients who achieved LLDAS and DORIS 2021, and number of flares were compared between visits. Changes in damage, glucocorticoids use and employment status pre-BLM and post-BLM were also assessed. RESULTS A total of 324 patients were included with a mean follow-up of 3.8 (±2.7) years. LLDAS was attained by 45.8%, 62% and 71% of patients, and DORIS by 24%, 36.2% and 52.5% on successive visits, respectively. Twenty-seven-point two percent of patients were in DORIS ≥ 50% of the visits and a 46% in LLDAS-50. Flares and number of flares were significantly lower one year after treatment with BLM and no changes in damage accrual were observed. Mean (±SD) prednisone dose was significantly reduced over time, with 70 (24%) patients discontinuing GC. CONCLUSION Our study not only demonstrates belimumab´s efficacy in attaining treat-to-target goals in SLE patients, but also confirms its GC-sparing effect, and its prevention of flares and organ damage accrual.
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Affiliation(s)
- Irene Altabás-González
- Department of Rheumatology, Complexo Hospitalario Universitario de Vigo, Galicia Sur Health Research Institute, Rheumatology and Inmuno-Mediated Diseases Reasearch Group (IRIDIS), Vigo, Spain
| | - José María Pego-Reigosa
- Department of Rheumatology, Complexo Hospitalario Universitario de Vigo, Galicia Sur Health Research Institute, Rheumatology and Inmuno-Mediated Diseases Reasearch Group (IRIDIS), Vigo, Spain
| | - Coral Mouriño
- Deparment of Rheumatology, Galicia Sur Health Research Institute, Rheumatology and Inmuno-Mediated Diseases Reasearch Group (IRIDIS), Vigo, Spain
| | - Norman Jiménez
- Deparment of Rheumatology, Galicia Sur Health Research Institute, Rheumatology and Inmuno-Mediated Diseases Reasearch Group (IRIDIS), Vigo, Spain
| | - Andrea Hernández-Martín
- Department of Rheumatology, Hospital Universitario Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - Ivette Casafont-Solé
- Department of Rheumatology, Germans Trias i Pujol University Hospital, LCMN, Germans Trias i Pujol Research Institute (IGTP), Barcelona, Spain
| | - Judit Font Urguelles
- Department of Rheumatology, Germans Trias i Pujol University Hospital, LCMN, Germans Trias i Pujol Research Institute (IGTP), Barcelona, Spain
| | - José Andrés Román-Ivorra
- Department of Rheumatology, Hospital Universitari i Politècnic La Fe. Facultad de Medicina y Ciencias de la Salud. Universidad Católica de Valencia, Valencia, Spain
| | | | | | | | - Javier Narváez
- Deparment of Rheumatology, Hospital Universitario de Bellvitge-Instituto de Investigación Biomédica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, España
| | - Paola Vidal-Montal
- Department of Rheumatology, Hospital Universitario de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | | | - Sandra Garrote-Corral
- Department of Rheumatology, Hospital Universitario de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | | | - Carlos Marras
- Department of Rheumatology, Hospital Universitario Virgen de Arrixaca, Murcia, Spain
| | - María Piqueras-García
- Department of Rheumatology, Hospital Universitario Virgen de Arrixaca, Murcia, Spain
| | - Julia Martínez-Barrio
- Deparment of Rheumatology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Biomédica, Universidad Complutense de Madrid, Hospital Gregorio, Madrid, Spain
| | - Marina Sánchez-Lucas
- Deparment of Rheumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Eleonora Penzo
- Department of Rheumatology, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Jaime Calvo
- Department of Rheumatology, Hospital Universitario de Araba, Vitoria, Spain
| | - Juan Ramón de Dios
- Department of Rheumatology, Hospital Universitario de Araba, Vitoria, Spain
| | | | | | - Eva Tomero
- Department of Rheumatology, Hospital Universitario de la Princesa, Madrid, Spain
| | - Raúl Menor-Almagro
- Deparment of Rheumatology, Hospital Universitario de Jerez, Cádiz, Spain
| | - Myriam Gandía
- Deparment of Rheumatology, Hospital Universitario de Jerez, Cádiz, Spain
| | | | - Beatriz Frade-Sosa
- Department of Rheumatology, Hospital Clinic and IDIBAPS, Barcelona, Spain
| | | | - Carmen Trapero-Pérez
- Department of Rheumatology, Hospital Universitario Virgen de Valme, Sevilla, Spain
| | - Elvira Diez
- Deparment of Rheumatology, Complejo Asistencial Universitario de León, León, Spain
| | - Clara Moriano
- Deparment of Rheumatology, Complejo Asistencial Universitario de León, León, Spain
| | | | - Iñigo Rúa-Figueroa
- Department of Rheumatology, Hospital Universitario Doctor Negrín, Las Palmas de Gran Canaria, Spain
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Altabás-González I, Rúa-Figueroa Í, Rubiño F, Mouriño C, Hernández-Rodriguez Í, Menor-Almagro R, Uriarte-Isacelaya E, Tomero E, Salman-Monte TC, Carrión-Barberá I, Galindo-Izquierdo M, Rodriguez-Almaraz ME, Inês LS, Jiménez N, Pego-Reigosa JM. Does remission in systemic lupus erythematosus according to the 2021 DORIS definition match the treating rheumatologist's judgement? Rheumatology (Oxford) 2024; 63:72-78. [PMID: 37039851 PMCID: PMC10765144 DOI: 10.1093/rheumatology/kead159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 02/20/2023] [Accepted: 03/05/2023] [Indexed: 04/12/2023] Open
Abstract
OBJECTIVES To assess agreement between the 2021 Definition Of Remission In SLE (DORIS) and physician-judged lupus activity. METHODS A cross-sectional analysis was conducted of data from a Spanish prospective multicentre study of SLE patients. We applied the 2021 DORIS criteria and assessed whether remission status based on this definition agreed with remission as per physician clinical judgement and reasons for disagreement between them. RESULTS Out of 508 patients [92% women; mean age (s.d.): 50.4 years (13.7)] studied, 267 (54.4%) met the criteria for 2021 DORIS remission. Based on physicians' judgement, 277 (55.9%) patients were classified as in remission or serologically active clinically quiescent (SACQ). The overall rate of agreement between these assessments was 81.2% (95% CI: 79.9, 82.9%) with a Cohen's kappa of 0.62 (0.55-0.69). Overall, 46 (9.1%) patients were classified as in remission/SACQ by rheumatologists but did not meet the 2021 DORIS criteria for remission. The main reasons for discrepancies were a clinical SLE Disease Activity Index (cSLEDAI) score >0 in 39 patients, a Physician Global Assessment score >0.5 in five patients, and prednisone >5 mg/day in another five patients. CONCLUSIONS The 2021 DORIS remission is an achievable target in clinical practice. There is substantial agreement between the DORIS definition and physician-judged remission. The discordance was mainly due to physicians classifying some patients with ongoing mild disease activity as in remission. Thus, the standardized DORIS definition should be used to define the target in a treat-to-target strategy for the management of SLE.
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Affiliation(s)
- Irene Altabás-González
- Rheumatology Department, Complejo Hospitalario Universitario de Vigo, Vigo, Spain
- IRIDIS (Investigation in Rheumatology and Immune-Mediated Diseases) Group, Galicia Sur Health Research Institute, Vigo, Spain
| | - Íñigo Rúa-Figueroa
- Rheumatology Department, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | - Francisco Rubiño
- Rheumatology Department, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | - Coral Mouriño
- Rheumatology Department, Complejo Hospitalario Universitario de Vigo, Vigo, Spain
- IRIDIS (Investigation in Rheumatology and Immune-Mediated Diseases) Group, Galicia Sur Health Research Institute, Vigo, Spain
| | | | - Raúl Menor-Almagro
- Rheumatology Department, Hospital Universitario de Jerez de la Frontera, Cádiz, Spain
| | | | - Eva Tomero
- Rheumatology Department, Hospital Universitario de la Princesa, Madrid, Spain
| | | | | | | | | | - Luís S Inês
- Rheumatology Department, Centro Hospitalar e Universitario de Coimbra, Coimbra, Portugal
| | - Norman Jiménez
- IRIDIS (Investigation in Rheumatology and Immune-Mediated Diseases) Group, Galicia Sur Health Research Institute, Vigo, Spain
| | - José María Pego-Reigosa
- Rheumatology Department, Complejo Hospitalario Universitario de Vigo, Vigo, Spain
- IRIDIS (Investigation in Rheumatology and Immune-Mediated Diseases) Group, Galicia Sur Health Research Institute, Vigo, Spain
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Laíño-Piñeiro MC, Rúa-Figueroa I, Jiménez N, Lozano MJC, Martínez-Barrio J, Serrano B, Galindo-Izquierdo M, Nack A, Loricera J, Tomero-Muriel E, Ibáñez-Barceló M, Vázquez NM, Manrique-Arija S, Lorenzo NA, Narváez J, Rosas J, Menor-Almagro R, Martínez-Taboada VM, Aurrecoechea-Aguinaga E, Horcada L, Ruiz-Lucea E, Raya E, Toyos FJ, Expósito L, Vela P, Freire-González M, Moriano-Morales C, Bonilla-Hernán G, Ibáñez TC, Lozano-Rivas N, Moreno M, Andreu JL, Ubiaga CLI, Torrente-Segarra V, Valls E, Velloso-Feijoo ML, Alcázar JL, Pego-Reigosa JM. Pregnancy outcomes in 1869 pregnancies in a large cohort from the Spanish Society of Rheumatology Lupus Register (RELESSER). Semin Arthritis Rheum 2023; 61:152232. [PMID: 37348350 DOI: 10.1016/j.semarthrit.2023.152232] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/15/2023] [Accepted: 06/11/2023] [Indexed: 06/24/2023]
Abstract
INTRODUCTION Obstetric complications are more common in women with systemic lupus erythematosus (SLE) than in the general population. OBJECTIVE To assess pregnancy outcomes in women with SLE from the RELESSER cohort after 12 years of follow-up. METHODS A multicentre retrospective observational study was conducted. In addition to data from the RELESSER register, data were collected on obstetric/gynaecological variables and treatments received. The number of term pregnancies was compared between women with pregnancies before and after the diagnosis of SLE. Further, clinical and laboratory characteristics were compared between women with pregnancies before and after the diagnosis, on the one hand, and with and without complications during pregnancy, on the other. Bivariate and multivariate analyses were carried out to identify factors potentially associated with complications during pregnancy. RESULTS A total of 809 women were included, with 1869 pregnancies, of which 1395 reached term. Women with pregnancies before the diagnosis of SLE had more pregnancies (2.37 vs 1.87) and a higher rate of term pregnancies (76.8% vs 69.8%, p < 0.001) compared to those with pregnancies after the diagnosis. Women with pregnancies before the diagnosis were diagnosed at an older age (43.4 vs 34.1 years) and had more comorbidities. No differences were observed between the groups with pregnancies before and after diagnosis in antibody profile, including anti-dsDNA, anti-Sm, anti-Ro, anti-La, lupus anticoagulant, anticardiolipin or anti-beta-2-glycoprotein. Overall, 114 out of the 809 women included in the study experienced complications during pregnancy, including miscarriage, preeclampsia/eclampsia, foetal death, and/or preterm birth. Women with complications had higher rates of antiphospholipid syndrome (40.5% vs 9.9%, p < 0.001) and higher rates of positivity for IgG anticardiolipin (33.9% vs 21.3%, p = 0.005), IgG anti-beta 2 glycoprotein (26.1% vs 14%, p = 0.007), and IgM anti-beta 2 glycoprotein (26.1% vs 16%, p = 0.032) antibodies, although no differences were found regarding lupus anticoagulant. Among the treatments received, only heparin was more commonly used by women with pregnancy complications. We did not find differences in corticosteroid or hydroxychloroquine use. CONCLUSIONS The likelihood of term pregnancy is higher before the diagnosis of SLE. In our cohort, positivity for anticardiolipin IgG and anti-beta-2- glycoprotein IgG/IgM, but not lupus anticoagulant, was associated with a higher risk of poorer pregnancy outcomes.
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Affiliation(s)
| | - Iñigo Rúa-Figueroa
- Department of Rheumatology, Hospital Universitario Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - Norman Jiménez
- IRIDIS Group (Investigation in Rheumatology and Immune-Diseases), Galicia Sur Health Research Institute (IISGS), Vigo, Spain
| | | | | | - Belén Serrano
- Department of Rheumatology, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | | | - Annika Nack
- Department of Rheumatology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Javier Loricera
- Department of Rheumatology, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Eva Tomero-Muriel
- Department of Rheumatology, Hospital Universitario La Princesa, Madrid, Spain
| | | | - Natalia Mena Vázquez
- Department of Rheumatology, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Sara Manrique-Arija
- Department of Rheumatology, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Nerea Alcorta Lorenzo
- Department of Rheumatology, Hospital Universitario de Donostia, San Sebastián, Spain
| | - Javier Narváez
- Department of Rheumatology, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - José Rosas
- Department of Rheumatology, Hospital Marina Baixa, Alicante, Spain
| | - Raúl Menor-Almagro
- Department of Rheumatology, Hospital Jerez de la Frontera, Jerez de la Frontera, Spain
| | | | | | - Loreto Horcada
- Department of Rheumatology, Hospital Universitario de Navarra, Pamplona, Spain
| | | | - Enrique Raya
- Department of Rheumatology, Hospital Universitario Clínico San Cecilio, Granada, Spain
| | - F Javier Toyos
- Department of Rheumatology, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Lorena Expósito
- Department of Rheumatology, Hospital Universitario de Canarias, Tenerife, Spain
| | - Paloma Vela
- Department of Rheumatology, Hospital General Universitario de Alicante, Alicante, Spain
| | | | | | | | - Tatiana Cobo Ibáñez
- Department of Rheumatology, Hospital Universitario Infanta Sofía, Madrid, Spain
| | - Nuria Lozano-Rivas
- Department of Rheumatology, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Mireia Moreno
- Department of Rheumatology, Hospital Universitario Parc Taulí, Sabadell, Spain
| | - José Luis Andreu
- Department of Rheumatology, Hospital Puerta de Hierro-Majadahonda, Madrid, Spain
| | | | - Vicenç Torrente-Segarra
- Department of Rheumatology, Hospital Comarcal Alt Penedès-Garraf, Vilafranca del Penedès, Spain
| | - Elia Valls
- Department of Rheumatology, Hospital Dr. Peset, Valencia, Spain
| | - M L Velloso-Feijoo
- Department of Rheumatology, Hospital Universitario de Valme, Sevilla, Spain
| | - Juan Luis Alcázar
- Department of Obstetrics and Gynecology, Clínica Universidad de Navarra, Pamplona, Spain
| | - José M Pego-Reigosa
- IRIDIS Group (Investigation in Rheumatology and Immune-Diseases), Galicia Sur Health Research Institute (IISGS), Vigo, Spain; Department of Rheumatology, Complejo Hospitalario Universitario de Vigo, Vigo, Spain
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Altabás González I, Rua-Figueroa I, Jiménez N, Rubiño F, Mouriño Rodríguez C, Hernández I, Menor-Almagro R, Uriarte Isacelaya E, Tomero Muriel E, Salman Monte TC, Carrión Barberà I, Galindo M, Rodríguez Almaraz E, Inês L, Pego-Reigosa JM. POS0759 DOES LLDAS DEFINITION MATCH THE RHEUMATOLOGIST OPINION? THE FIRST VISIT EVALUATION OF A LONGITUDINAL SPANISH MULTICENTER STUDY TO ASSESS REASONS OF DISAGREEMENT. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3044] [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
BackgroundTreat to Target strategies are necessary in Systemic Lupus Erythematosus (SLE). They are difficult to establish due to the heterogeneity of the disease. The current definitions of Lupus Low Disease Activity State (LLDAS) according to the Asia Pacific Lupus Collaboration (APLC) and remission according to Definition of Remission in SLE (DORIS) 2021 are difficult to achieve and maintain over time.ObjectivesTo evaluate the concordance between the LLDAS and the clinical status according to the rheumatologist opinion and reasons of disagreement. To explore modifications in LLDAS definition that best fit with the expert´s opinion.MethodsProspective multicenter study of SLE patients (ACR 1997 Classification Criteria or clinical diagnosis by the physician) from seven Spanish Rheumatology Departments. Statistical analysis: descriptive cross-sectional (at the time of recruitment) analysis of the demographic and clinical characteristics, treatments; remission and LLDAS and the subjective evaluations of SLE activity by the rheumatologist. Analysis of the level of agreement between expert opinion and the definition of LLDAS and its modification were evaluated using Cohen’s kappa.ResultsDEMOGRAPHIC, DISEASE CHARACTERISTICS AND TREATMENTS. Five hundred and eight were included (92% women; mean age (±SD): 50.4 years (±13.7)). Mean SLEDAI-2K (±SD) was 2.84 (±3.31). A total of 406 (79.9%) patients presented SLEDAI-2K≤4. A total of 317 (74.1%) patients were on antimalarial treatment. Two hundred and twenty-two (43.7%) patients were on some type of immunosuppressive or biological therapy. More than half of patients were not taking glucocorticoids (n=310, 61%). A total of 38 patients (7.5%) were taking doses of prednisone higher than 7.5mg/day.REMISSION/LLDAS 267 (54.4%) patients were in remission and 304 (62.7%) patients were in LLDAS. According to the expert opinion of the rheumatologist, remission was the most frequent state considered (n=206, 41.6%); followed by low activity (n=153, 30.9%); serologically active (n=71, 14.3%); moderate activity (n=55, 11.1%) and high activity (n=10, 2%).AGREEMENT Overall agreement between expert opinion and the definition of LLDAS was 71.4 % with a Cohen’s kappa of 0.3. The majority of the cases (96.1%) that fulfilled the definition of LLDAS, were classified by the expert as remission, serologically active or low activity. Only 12 (3,9%) patients were classified by the expert as moderate or high activity. Of the patients that did not fulfill the definition of LLDAS, 126 out of 179 (70.4%) patients were classified by the expert as remission/low disease activity (Figure 1). The main reasons for discordance in the group that did not fulfill the definition of LLDAS were the presence of new clinical features compared to previous visit and a SLEDAI 2-K >4, in 74 (58.7%) and 59 (46.8%) patients, respectively. The LLDAS adjustment that meant a significant increase in the agreement was the exclusion of the comparative features with the previous visit, with an increase in the agreement to 82.6% (95% CI: 81.61-83.96%). The modification of prednisone to 5mg/daily dose, did not represent a significant change in agreement from the original definition.Figure 1.Comparison of LLDAS and expert opinionConclusionAt a given point in time, almost two thirds of SLE patients were in remission or in LLDAS. There is a good correlation between LLDAS and the physician’s opinion, particularly for those patients who fulfill LLDAS definition. However, the agreement is not so good for patients who don’t, these being excessively classified by the physician as remission or low activity. The main LLDAS items causing this disagreement were a SLEDAI-2K >4 and the appearance of different clinical manifestations from the previous evaluation. On the contrary, physician assessment by the PGA adequately fits the LLDAS definition. The modification of the LLDAS definition excluding the comparison with previous assessment increases the agreement with the expert opinion to 82.6%.Disclosure of InterestsNone declared
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Rúa-Figueroa I, Rúa-Figueroa D, Pérez-Veiga N, Anzola AM, Galindo-Izquierdo M, Calvo-Alén J, Fernández-Nebro A, Sangüesa C, Menor-Almagro R, Tomero E, Del Val N, Uriarte-Isazelaya E, Blanco R, Andreu JL, Boteanu A, Narváez J, Cobo T, Bohórquez C, Montilla C, Salas E, Toyos FJ, Bernal JA, Salgado E, Freire M, Mas AJ, Expósito L, Hernández-Beriain JA, Ibarguengoitia O, Velloso-Feijoo ML, Lozano-Rivas N, Bonilla G, Moreno M, Jiménez I, Quevedo-Vila V, Pecondón A, Aurrecoechea E, Valls E, Mouriño C, Vázquez-Rodríguez T, Pego-Reigosa JM. Antimalarials exert a cardioprotective effect in lupus patients: Insights from the Spanish Society of Rheumatology Lupus Register (RELESSER) analysis of factors associated with heart failure. Semin Arthritis Rheum 2022; 52:151946. [PMID: 35033377 PMCID: PMC8720299 DOI: 10.1016/j.semarthrit.2021.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 08/12/2021] [Revised: 11/23/2021] [Accepted: 11/24/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND/OBJECTIVES Factors associated with chronic heart failure (CHF) in patients with systemic lupus erythematosus (SLE) have received little attention. Recent data on the use of hydroxychloroquine in the treatment of SARS-CoV-2 infection have cast doubt on its cardiac safety. The factors associated with CHF, including therapy with antimalarials, were analyzed in a large multicenter SLE cohort. METHODS Cross-sectional study including all patients with SLE (ACR-1997 criteria) included in the Spanish Society of Rheumatology Lupus Register (RELESSER), based on historically gathered data. Patients with CHF prior to diagnosis of SLE were excluded. A multivariable analysis exploring factors associated with CHF was conducted. RESULTS The study population comprised 117 patients with SLE (ACR-97 criteria) and CHF and 3,506 SLE controls. Ninety percent were women. Patients with CHF were older and presented greater SLE severity, organ damage, and mortality than those without CHF. The multivariable model revealed the factors associated with CHF to be ischemic heart disease (7.96 [4.01-15.48], p < 0.0001), cardiac arrhythmia (7.38 [4.00-13.42], p < 0.0001), pulmonary hypertension (3.71 [1.84-7.25], p < 0.0002), valvulopathy (6.33 [3.41-11.62], p < 0.0001), non-cardiovascular damage (1.29 [1.16-1.44], p < 0.000) and calcium/vitamin D treatment (5.29 [2.07-16.86], p = 0.0015). Female sex (0.46 [0.25-0.88], p = 0.0147) and antimalarials (0.28 [0.17-0.45], p < 0.000) proved to be protective factors. CONCLUSIONS Patients with SLE and CHF experience more severe SLE. Treatment with antimalarials appears to confer a cardioprotective effect.
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Affiliation(s)
| | - David Rúa-Figueroa
- Hospital Universitario de Gran Canaria Doctor Negrin, Las Palmas GC, Spain.
| | | | - Ana M Anzola
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | | | | | | | | | | | | | | | - Ricardo Blanco
- Hospital Universitario Marqués de Valdecilla, Santander, Spain.
| | - José L Andreu
- Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | | | | | | | - Cristina Bohórquez
- Hospital Universitario Príncipe de Asturias (Alcalá de Henares), Madrid, Spain.
| | | | - Esteban Salas
- Hospital Marina Baixa, Villajoyosa, Alicante, Spain.
| | | | - José A Bernal
- Hospital General Universitario de Alicante, Alicante, Spain
| | - Eva Salgado
- Complejo Hospitalario De Orense, Orense, Spain.
| | | | | | - Lorena Expósito
- Hospital Universitario de Canarias, La Laguna (Tenerife), Spain
| | | | | | | | | | | | | | | | | | | | | | - Elia Valls
- Hospital Universitario Doctor Peset, Valencia, Spain
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Tejera Segura B, Altabás González I, Rúa-Figueroa I, Pérez Veiga N, Del Campo Pérez V, Olivé-Marqués A, Galindo M, Calvo J, Ovalles-Bonilla JG, Fernández-Nebro A, Menor-Almagro R, Tomero E, Del Val Del Amo N, Uriarte IE, Martínez-Taboada VM, Andreu JL, Boteanu A, Narváez J, Movasat A, Montilla C, Senabre Gallego JM, Hernández-Cruz B, Andrés M, Salgado E, Freire M, Machín García S, Moriano C, Expósito L, Pérez Velásquez C, Velloso-Feijoo ML, Cacheda AP, Lozano-Rivas N, Bonilla G, Arévalo M, Jiménez I, Quevedo-Vila V, Manero-Ruiz FJ, de la Peña Lefebvre G, Vázquez-Rodríguez TR, Ibañez-Ruan J, Cobo-Ibañez T, Pego-Reigosa JM. Relevance of gastrointestinal manifestations in a large Spanish cohort of patients with systemic lupus erythematosus: what do we know? Rheumatology (Oxford) 2021; 60:5329-5336. [PMID: 33950249 DOI: 10.1093/rheumatology/keab401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 04/28/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) can affect any part of the gastrointestinal (GI) tract. GI symptoms are reported to occur in more than 50% of SLE patients. AIMS To describe the GI manifestations of SLE in the RELESSER (Registry of Systemic Lupus Erythematosus Patients of the Spanish Society of Rheumatology) cohort and to determine if these are associated with a more severe disease, damage accrual and a worse prognosis. METHODS We conducted a nationwide, retrospective, multicenter, cross-sectional cohort study of 3658 SLE patients who fulfill ≥ 4 ACR-97 criteria. Data on demographics, disease characteristics, activity (SLEDAI-2K or BILAG), damage (SLICC/ACR/DI) and therapies were collected. Demographic and clinical characteristics were compared between lupus patients with and without GI damage to establish whether GI damage is associated with a more severe disease. RESULTS From 3654 lupus patients, 3.7% developed GI damage. Patients in this group (group 1) were older, they had longer disease duration, and were more likely to have vasculitis, renal disease and serositis than patients without GI damage (group 2). Hospitalizations and mortality were significantly higher in group 1. Patients in group 1 had higher modified SDI. The presence of oral ulcers reduced risk of developing damage in 33% of patients. CONCLUSIONS Having GI damage is associated with a worse prognosis. Patients on high dose of glucocorticoids are at higher risk of developing GI damage which reinforces the strategy of minimizing glucocorticoids. Oral ulcers appear to decrease the risk of GI damage.
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Affiliation(s)
- Beatriz Tejera Segura
- Rheumatology Department, Hospital Universitario Insular de Gran Canaria, Islas Canarias, Spain
| | - Irene Altabás González
- Rheumatology Department, Complejo Hospitalario Universitario de Vigo, Vigo, Galicia, Spain.,Rheumatology & Immuno-Mediated Diseases Research Group (IRIDIS), Galicia Sur Health Research Institute (IIS Galicia Sur), Spain
| | - Iñigo Rúa-Figueroa
- Rheumatology Department, Hospital Universitario de Gran Canaria Dr Negrin, Las Palmas de Gran Canaria, Islas Canarias, Spain
| | - Natalia Pérez Veiga
- Rheumatology & Immuno-Mediated Diseases Research Group (IRIDIS), Galicia Sur Health Research Institute (IIS Galicia Sur), Spain
| | | | - Alejandro Olivé-Marqués
- Rheumatology Department, Germans Trías i Pujol University Hospital, Badalona, Cataluña, Spain
| | - María Galindo
- Rheumatology Department, 12 de Octubre University Hospital, Madrid, Spain
| | - Jaime Calvo
- Rheumatology Department, Hospital Araba, Araba, Spain
| | | | - Antonio Fernández-Nebro
- Instituto de Investigación Biomédica de Málaga - IBIMA, Málaga. Spain.,Rheumatology Department, Hospital Regional Universitario de Málaga, Málaga.,Departamento de Medicina, Universidad de Málaga, Málaga
| | | | - Eva Tomero
- Rheumatology Department. Hospital Universitario de la Princesa. Madrid, Spain
| | | | | | | | - Jose L Andreu
- Rheumatology Department, Puerta de Hierro-Majadahonda Hospital, Madrid, Spain
| | - Alina Boteanu
- Rheumatology Department, Hospital Gregorio Marañón, Madrid, Spain.,Rheumatology Department, Hospital Ramon y Cajal, Madrid, Spain
| | - Javier Narváez
- Rheumatology Department, Hospital de Bellvitge, Hospitalet Llobregat, Cataluña, Spain
| | - Atusa Movasat
- Rheumatology Department, Hospital Universitario Príncipe de Asturias, Madrid, Spain
| | - Carlos Montilla
- Rheumatology Department, Salamanca Clinic University Hospital, Salamanca, Spain
| | | | | | - Mariano Andrés
- Rheumatology Department, Hospital General Universitario de Alicante, Elche, Alicante, Spain
| | - Eva Salgado
- Rheumatology Department, Hospital Universitario de Orense, Galicia, Spain
| | - Mercedes Freire
- Rheumatology Department, Hospital Juan Canalejo de La Coruña, A Coruna, Galicia, Spain
| | - Sergio Machín García
- Rheumatology Department, Hospital Universitario Insular de Gran Canaria, Islas Canarias, Spain
| | - Clara Moriano
- Rheumatology Department, Hospital Universitario de León, León, Spain
| | - Lorena Expósito
- Rheumatology Department, Hospital Universitario de Canarias, La Laguna, Tenerife, Spain
| | | | - M L Velloso-Feijoo
- Rheumatology Department, Hospital Universitario de Valme, Sevilla, Spain
| | - Ana Paula Cacheda
- Rheumatology Department, Hospital Son Llatzer, Mallorca, Islas Baleares, Spain
| | - Nuria Lozano-Rivas
- Rheumatology Department, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Gema Bonilla
- Rheumatology Department, La Paz University Hospital, Madrid, Spain
| | - Marta Arévalo
- Rheumatology Department, Consorci Sanitari Parc Taulí, Sabadell, Cataluña, Spain
| | | | | | | | | | | | | | - Tatiana Cobo-Ibañez
- Rheumatology Department, Hospital Universitario Infanta Sofía, Madrid, Spain
| | - Jose María Pego-Reigosa
- Rheumatology Department, Complejo Hospitalario Universitario de Vigo, Vigo, Galicia, Spain.,Rheumatology & Immuno-Mediated Diseases Research Group (IRIDIS), Galicia Sur Health Research Institute (IIS Galicia Sur), 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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Menor-Almagro R, Argentina García M, Rua-Figueroa I, Pons Estel G, Martin-Martinez MA, Muñoz Jimenez A, Galindo-Izquierdo M, Calvo-Alen J, Fernandez-Nebro A, Olive A, Pons-Estel B, Pego-Reigosa JM. AB0428 ASSOCIATION BETWEEN GEOGRAPHIC AND CLIMATOLOGICAL CONDITIONS AND CUTANEOUS MANIFESTATIONS IN LUPUS PATIENTS FROM THE SPANISH RHEUMATOLOGY SOCIETY LUPUS REGISTRY (RELESSER) AND ARGENTINE RHEUMATOLOGY SOCIETY LUPUS REGISTRY (RELESSAR) COHORT. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3848] [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:Climatological conditions and ethnicity impact on the course of the disease in systemic lupus erythematosus patients.Objectives:We carry out a study to analyze cutaneous manifestations in SLE patients from Argentina and Spain.Methods:Patients data from Spanish Rheumatology Society Lupus Registry (RELESSER) and Argentina Rheumatology Society Lupus Registry (RELESSAR) were retrospectively analyzed for presence of cutaneous lesions (alopecia, photosensitivity, malar rash, discoid lesions, oral ulcers and subacute lesions). RELESSER-T and RELESSAR-T are multicenter, hospital-based registries, with retrospective cross-sectional collection of data about patients with SLE attending Spanish and Argentinian rheumatology services from the public national health system. Data about climatological conditions throughout the Spanish and Argentinian geography were provided by the Spanish Meteorological Agency and Argentine Meteorological Services.Results:A total of 5604 patients were included, median age 44.6 ± 15.3, 90.4 % female. Current smokers were 28,9%. Other climatological, geographical, biological and clinical data are shown in table 1. In the multivariable model, the presence of cutaneous lesion were significantly associated with temperature OR 1.116 (95% CI:1.042-1.196 p=0,002), altitude OR 1.001 (95% CI:1.000-1.001, p=0.012), hemolytic anemia OR 1.401 (95% CI:1.017-1.931 p=0.039) and serositis OR 1.509 (95% CI:1.215-1.875 p=0.000). Negative associations were observed between females OR 0.392 (95% CI:0.297-0.518, p=0.000), latitude OR 0.994 (95% CI:0.988-0.999, p=0.000), oceanic climate OR 0.566 (95% CI:0.381-0.842, p=0.005), leukopenia OR 0.790 (95% CI:0.643-0.970, p=0.025), renal disorder OR 0.761 (95% CI:0.600-0.966, p=0.025), glucocorticoids treatment OR 0.571 (95% CI:0.456-0.715, p=0.000) and antimalarial drugs OR 0.439 (95% CI:0.342-0.563, p=0.000).Table 1.Geographical, climatological and clinical/laboratory variables.No cutaneous manifestationsCutaneous manifestationspLatitude, median (interqualite range)40.47 (38.35-41.63)40.37 (-31.41-41.34)0.001Altitude, median (interqualite range)192.0 (37.0-698.0)156.0 (25.0-609.0)0.000Temperature, mean monthly ± SD15.2 ± 3.515.3 ± 3.60.000Humidity, mean monthly ± SD66.9 ± 7.267.4 ± 7.10.108Oceanic climate, n (%)307 (11)2406 (89)0.000Subhumid/altitude climate, n (%)17 (7)240 (93)0.002Mediterranean climate, n (%)292 (17)1434 (83)0.000Arthritis, n (%)523 (12)3722 (88)0,003Serositis, n (%)254 (16)1368 (84)0,000Renal disorder, ever, n (%)206 (11)1576 (89)0.015Hemolytic anemia, n (%)90 (17)426 (83)0,002Leukopenia, n (%)345 (11)2669 (89)0.000Thrombocytopenia, n (%)170 (15)986 (85)0.076Antiphospholipid antibodies, n (%)293 (15)1606 (85)0.000Anti DNA, n (%)522 (14)3279 (86)0.044Anti-Ro/SSA, n (%)189 (11)1563 (89)0.000Hypocomplementemia, n (%)510 (12)3736 (88)0.000Glucocorticoids mucocutaneous cause, ever, n (%)499 (11)3928 (89)0.000Antimalarial drug: ever, n (%)500 (11)4034 (89)0.000Conclusion:In the current analysis, taking RELESSAR and RELESSER data together, we observe positive association between higher temperature and skin lesion and negative association with living in southern hemisphere latitudes.References:Influence of Solar Radiation in Cutaneous Manifestations of Lupus: Data from the Gladel Cohort [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10).Disclosure of Interests:Raúl Menor-Almagro: None declared, Mercedes Argentina García: None declared, Iñigo Rua-Figueroa: None declared, Guillermo Pons Estel: None declared, Maria Auxiliadora Martin-Martinez: None declared, Alejandro Muñoz Jimenez.: None declared, María Galindo-Izquierdo: None declared, Jaime Calvo-Alen: None declared, Antonio Fernandez-Nebro: None declared, Alejandro Olive: None declared, Bernardo Pons-Estel Grant/research support from: GSK, Janssen, Consultant of: GSK, Janssen, Speakers bureau: GSK, Janssen, Jose M Pego-Reigosa: None declared
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Cobo-Ibáñez T, Urruticoechea-Arana A, Rúa-Figueroa I, Martín-Martínez MA, Ovalles-Bonilla JG, Galindo M, Calvo-Alén J, Olivé A, Fernández-Nebro A, Menor-Almagro R, Tomero E, Horcada L, Uriarte-Itzazelaia E, Martínez-Taboada VM, Andreu JL, Boteanu A, Narváez J, Bohorquez C, Montilla C, Santos G, Hernández-Cruz B, Vela P, Salgado E, Freire M, Hernández-Beriain JÁ, Díez-Álvarez E, Expósito L, Fernández-Berrizbeitia O, Velloso-Feijoo ML, Ibáñez-Barceló M, Lozano-Rivas N, Bonilla G, Moreno M, Raya E, Quevedo-Vila VE, Vázquez-Rodríguez TR, Ibáñez-Ruan J, Muñoz-Fernández S, Sánchez-Alonso F, Pego-Reigosa JM. Hormonal Dependence and Cancer in Systemic Lupus Erythematosus. Arthritis Care Res (Hoboken) 2020; 72:216-224. [PMID: 31529686 DOI: 10.1002/acr.24068] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 09/10/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To estimate the incidence and analyze any cancer-associated factors in patients with systemic lupus erythematosus (SLE), differentiating between hormone-sensitive (HS) and non-HS cancers. METHODS This was a retrospective multicenter study of a patient cohort from the Systemic Lupus Erythematosus Registry of the Spanish Society of Rheumatology. Included were the first cancer post-SLE diagnosis, clinical and sociodemographic information, cumulative damage, severity, comorbidities, treatments, and refractoriness. Cancers were classified as HS (prostate, breast, endometrium, and ovarian) and non-HS (the remainder). The standardized incidence ratio (SIR) was calculated and logistic regression models were built. RESULTS A total of 3,539 patients (90.4% women) were included, 154 of whom had cancer (91% female), and 44 had HS cancer (100% female). The cancer SIR was 1.37 (95% confidence interval [95% CI] 1.15-1.59), with higher values in women age <65 years (SIR 2.38 [95% CI 1.84-2.91]). The SIR in women with HS versus non-HS cancer was 1.02 (95% CI 0.13-1.91) and 1.93 (95% CI 0.98-2.89). In HS versus non-HS cancers, SLE diagnostic age (odds ratio [OR] 1.04 [P = 0.002] versus 1.04 [P = 0.019]), and period of disease evolution (OR 1.01 [P < 0.001] versus 1.00 [P = 0.029]) were associated with cancer. The Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (OR 1.27 [P = 0.022]) and angiotensin-converting enzyme (ACE) inhibitor prescriptions (OR 2.87 [P = 0.048]) were associated with non-HS cancers. CONCLUSION Cancer incidence in patients with SLE was higher than in the Spanish population, particularly among young women. This increase might be due to non-HS cancers, which would be associated with SLE involving greater cumulative damage where more ACE inhibitors are prescribed.
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Affiliation(s)
| | | | | | | | | | | | - Jaime Calvo-Alén
- Hospital Universitario Araba, Universidad del País Vasco, Vitoria, Spain
| | - Alejandro Olivé
- Hospital Universitario Germans Trias i Pujol, Barcelona, Spain
| | | | | | - Eva Tomero
- Hospital Universitario de la Princesa, Madrid, Spain
| | | | | | | | - José Luis Andreu
- Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | | | | | | | | | | | | | - Paloma Vela
- Hospital General Universitario Alicante, Universidad Miguel Hernández, Alicante, Spain
| | - Eva Salgado
- Complejo Hospitalario Universitario de Orense, Orense, Spain
| | - Mercedes Freire
- Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | | | | | | | | | | | | | | | | | | | - Enrique Raya
- Hospital Universitario San Cecilio, Granada, Spain
| | | | | | | | | | | | - José María Pego-Reigosa
- Complejo Hospitalario Universitario de Vigo, Instituto de Investigación Biomédica de Vigo, Vigo, Spain
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Galindo-Izquierdo M, Rodriguez-Almaraz E, Pego-Reigosa JM, López-Longo FJ, Calvo-Alén J, Olivé A, Fernández-Nebro A, Martinez-Taboada V, Vela-Casasempere P, Freire M, Narváez FJ, Rosas J, Ibáñez-Barceló M, Uriarte E, Tomero E, Zea A, Horcada L, Torrente V, Castellvi I, Calvet J, Menor-Almagro R, Zamorano MAA, Raya E, Díez-Álvarez E, Vázquez-Rodríguez T, García de la Peña P, Movasat A, Andreu JL, Richi P, Marras C, Montilla-Morales C, Hernández-Cruz B, Marenco de la Fuente JL, Gantes M, Úcar E, Alegre-Sancho JJ, Manero J, Ibáñez-Ruán J, Rodríguez-Gómez M, Quevedo V, Hernández-Beriaín J, Silva-Fernández L, Alonso F, Pérez S, Rúa-Figueroa I. Characterization of Patients With Lupus Nephritis Included in a Large Cohort From the Spanish Society of Rheumatology Registry of Patients With Systemic Lupus Erythematosus (RELESSER). Medicine (Baltimore) 2016; 95:e2891. [PMID: 26945378 PMCID: PMC4782862 DOI: 10.1097/md.0000000000002891] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The aim of the study was to profile those patients included in the RELESSER registry with histologically proven renal involvement in order to better understand the current state of lupus nephritis (LN) in Spain. RELESSER-TRANS is a multicenter cross-sectional registry with an analytical component. Information was collected from the medical records of patients with systemic lupus erythematosus who were followed at participating rheumatology units. A total of 359 variables including demographic data, clinical manifestations, disease activity, severity, comorbidities, LN outcome, treatments, and mortality were recorded. Only patients with a histological confirmation of LN were included. We performed a descriptive analysis, chi-square or Student's t tests according to the type of variable and its relationship with LN. Odds ratio and confidence intervals were calculated by using simple logistic regression. LN was histologically confirmed in 1092/3575 patients (30.5%). Most patients were female (85.7%), Caucasian (90.2%), and the mean age at LN diagnosis was 28.4 ± 12.7 years. The risk for LN development was higher in men (M/F:47.85/30.91%, P < 0.001), in younger individuals (P < 0.001), and in Hispanics (P = 0.03). Complete response to treatment was achieved in 68.3% of patients; 10.35% developed ESRD, which required a kidney transplant in 45% of such cases. The older the patient, the greater was the likelihood of complete response (P < 0.001). Recurrences were associated with persistent lupus activity at the time of the last visit (P < 0.001) and with ESRD (P < 0.001). Thrombotic microangiopathy was a risk factor for ESRD (P = 0.04), as for the necessity of dialysis (P = 0.01) or renal transplantation (P = 0.03). LN itself was a poor prognostic risk factor of mortality (OR 2.4 [1.81-3.22], P < 0.001). Patients receiving antimalarials had a significantly lower risk of developing LN (P < 0.001) and ESRD (P < 0.001), and responded better to specific treatments for LN (P = 0.014). More than two-thirds of the patients with LN from a wide European cohort achieved a complete response to treatment. The presence of positive anti-Sm antibodies was associated with a higher frequency of LN and a decreased rate of complete response to treatment. The use of antimalarials reduced both the risk of developing renal disease and its severity, and contributed to attaining a complete renal response.
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Affiliation(s)
- María Galindo-Izquierdo
- From the Rheumatology Department, Hospital 12 Octubre, Madrid (MG-I, ER-A); Rheumatology (JMP-R), University Hospital Complex, Instituto de Investigación Biomédica, Vigo, Spain; Rheumatology Department (FJL-L), Gregorio Marañón University Hospital, Madrid; Rheumatology Department (JC-A), Sierrallana Hospital, Torrelavega; Rheumatology Department (AO), Germans Trías i Pujol University Hospital, Badalona; Rheumatology Department (AF-N), Hospital Regional Universitario de Málaga, Málaga; Rheumatology Department (VM-T), Marques de Valdecilla Hospital, Santander; Rheumatology Department (PV-C), Hospital General de Alicante, Alicante; Rheumatology Department (MF), Hospital Universitario Juan Canalejo, Coruña; Rheumatology Department (FJN), Hospital Universitario de Bellvitge, Barcelona; Rheumatology Department (JR), Hospital Marina Baixa, Villajoyosa; Rheumatology Department (MI-B), Hospital Son Llatzer, Palma de Mallorca; Rheumatology Department (EU), Hospital de Donosti, San Sebastián; Rheumatology Department (ET), Hospital Universitario de La Princesa; Rheumatology Department (AZ), Hospital Universitario Ramón y Cajal, Madrid; Rheumatology Department (LH), Complejo Hospitalario de Navarra, Pamplona; Rheumatology Department (VT), Hospital Moisés Broggi; Rheumatology Department (IC), Hospital de la Santa Creu i Sant Pau, Barcelona; Rheumatology Department (JC), Hospital Parc Taulí. Sabadell; Rheumatology Department (RM-A), Hospital de Jerez, Jerez de la Frontera; Rheumatology Department (MAAZ), IMIBIC-Reina Sofia Hospital, Cordoba; Rheumatology Department (ER), University Hospital San Cecilio, Granada; Rheumatology Department (ED-Á), Leon Hospital, Leon; Rheumatology Department (TV-R), Hospital Lucus Augusti, Lugo; Rheumatology Department (PGDlP), Hospital Norte Sanchinarro, Madrid; Rheumatology Department (AM), Hospital Universitario Príncipe de Asturias, Alcalá de Henares; Rheumatology Department (JLA), Hospital Puerta de Hierro, Majadahonda, Madrid; Rheumatology Department (PR), Hospital Infanta Sofía, San Sebastián de los Reyes, Madrid; Rheumatology Department (CM), Hospital Virgen de la Arrixaca, Murcia, Spain; Rheumatology Department (CM-M), Hospital Clínico Universitario de Salamanca, Salamanca; Rheumatology Department (BH-C), University Hospital Virgen Macarena; Rheumatology Department (JLMDlF), Hospital de Valme, Sevilla; Rheumatology Department (MG), Hospital Universitario de Canarias, Tenerife; Rheumatology Department (EÚ), Hospital de Basurto, Bilbao; Rheumatology Department (JJA-S), Hospital Universitario Dr Peset, Valencia; Rheumatology Department (JM), Hospital Miguel Servet Zaragoza; Rheumatology Department (JI-R), Clínica POVISA, Vigo; Rheumatology Department (MR-G), Complejo Hospitalario Universitario de Ourense, Ourense; Rheumatology Department (VQ), Hospital de Monforte, Lugo; Rheumatology Department (JH-B), Hospital Insular de Gran Canaria, Las Palmas de Gran Canaria; Rheumatology Department (LSF), Hospital Universitario de Guadalajara, Guadalajara; Statistical Department (FA, SP), Research Unit, Spanish Society of Rheumatology (SER), Madrid; and Rheumatology Department (IR-F), Doctor Negrín University Hospital, Gran Canaria, Spain
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