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Quintana RM, García M, Garcia L, Gobbi C, Alba P, Bellomio V, Roverano S, Alvarez AP, Graf CE, Pisoni C, Spindler A, Gomez C, Figueredo HM, Papasidero S, Paniego R, de la Vega MC, Civit E, Gonzalez Lucero L, Martire MV, Aguila Maldonado R, Gordon S, Micelli M, Nieto R, Rausch G, Alarcón GS, Pons-Estel B, Pons-Estel G. Active lupus in Argentina: Results of a multicenter and national registry. Lupus 2023; 32:1555-1560. [PMID: 37936393 DOI: 10.1177/09612033231209601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
OBJECTIVE To evaluate the association between patients' characteristics and disease activity in an Argentine lupus registry. METHODS Cross-sectional study. Disease activity was stratified into: Remission off-treatment: SLEDAI = 0, without prednisone and immunosuppressive drugs. Low disease activity Toronto Cohort (LDA-TC): SLEDAI ≤2, without prednisone or immunosuppressive drugs. Modified lupus low disease activity (mLLDAS): SLEDAI score of ≤4, with no activity in major organ systems and no new features, prednisone of ≤10 mg/day and/or immunosuppressive drugs (maintenance dose) and Active disease: SLEDAI score of >4 and prednisone >10 mg/day and immunosuppressive drugs. A descriptive analysis and logistic regression model were performed. RESULTS A total of 1346 patients were included. Of them, 1.6% achieved remission off steroids, 0.8% LDA-TC, 12.1% mLLDAS and the remaining 85.4% had active disease. Active disease was associated with younger age (p ≤ 0.001), a shorter time to diagnosis (p ≤ 0.001), higher frequency of hospitalizations (p ≤ 0.001), seizures (p = 0.022), serosal disease (p ≤ 0.001), nephritis (p ≤ 0.001), higher SDI (p ≤ 0.001), greater use of immunosuppressive therapies and higher doses of prednisone compared to those on mLLDAS. In the multivariable analysis, the variables associated with active disease were the presence of pleuritis (OR 2.1, 95% CI 1.2-3.9; p = 0.007), persistent proteinuria (OR 2.5, 95% CI 1.2-5.5; p ≤ 0.011), nephritis (OR 2.5, 95% CI 1.2-5.6; p = .018) and hospitalizations (OR 8.9, 95% CI 5.3-16.0; p ≤ 0.001) whereas age at entry into the registry was negatively associated with it (OR 0.9, 95% CI 0.9-1.0; p = 0.029). CONCLUSION Active disease was associated with shorter time to diagnosis, worse outcomes (SDI and hospitalizations) and renal, neurological and serosal disease.
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Affiliation(s)
- Rosana M Quintana
- Grupo Oroño, Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
| | - Mercedes García
- Department of Reumatologia, HIGA General San Martin, La Plata, Argentina
| | - Lucila Garcia
- Department of Reumatologia, HIGA General San Martin, La Plata, Argentina
| | - Carla Gobbi
- Department of Reumatologia, Sanatorio Allende, Córdoba, Argentina
| | - Paula Alba
- Department of Reumatologia, Hospital Córdoba, Córdoba, Argentina
| | - Verónica Bellomio
- Department of Reumatologia, Hospital Angel C. Padilla, Tucumán, Argentina
| | - Susana Roverano
- Department of Reumatologia, Hospital J.M. Cullen, Santa Fe, Argentina
| | | | | | | | - Alberto Spindler
- Department of Reumatologia, Centro de Investigaciones Médicas Tucumán, Tucumán, Argentina
| | - Catalina Gomez
- Department of Reumatologia, Hospital Central de Formosa, Formosa, Argentina
| | - Heber Matias Figueredo
- Department of Reumatologia, Hospital de Alta Complejidad Pte. Juan Domingo Perón, Formosa, Argentina
| | - Silvia Papasidero
- Department of Reumatologia, Hospital General de Agudos Dr Enrique Tornú, Buenos Aires, Argentina
| | - Raul Paniego
- Department of Reumatologia, CePReR, Santa Rosa, La Pampa, Argentina
| | | | - Emma Civit
- Department of Reumatologia, Hospital del Carmen, Godoy Cruz, Argentina
| | | | | | | | - Sergio Gordon
- Department of Reumatologia, HIGA Dr Alende, Mar del Plata, Argentina
| | - Marina Micelli
- Department of Reumatologia, Hospital General de Agudos José María Ramos Mejía, Buenos Aires, Argentina
| | - Romina Nieto
- Hospital Provincial de Rosario, Rosario, Argentina
| | - Gretel Rausch
- Department of Reumatologia, Consultorio Privado, Rio Grande, Tierra del Fuego, Rio Grande, Argentina
| | - Graciela S Alarcón
- Division of Clinical Immunology and Rheumatology, Department of Medicine, Marnix E Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Bernardo Pons-Estel
- Grupo Oroño, Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
| | - Guillermo Pons-Estel
- Grupo Oroño, Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
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García MA, Alba P, Del Campo-Perez V, Roverano S, Quintana RM, Alvarez AP, Graf CE, Pisoni C, Spindler A, Gomez C, Figueredo HM, Papasidero S, Paniego R, de la Vega MC, Civit E, Gonzalez Lucero L, Martire MV, Aguila Maldonado R, Gordon S, Gobbi C, Micelli M, Nieto R, Rausch G, Gongora V, Damico A, Dubinsky D, Orden A, Zacariaz J, Romero J, Pera M, Goñi M, Rillo O, Baez R, Arturi V, Gonzalez A, Vivero F, Bedoya ME, Shmid MM, Caputo V, Larroude MS, Dominguez N, Gómez GN, Rodriguez GN, Marin J, Collado V, Jorfen M, Bedran Z, Curti A, Gazzoni MV, Sarano J, Zelaya M, Sacnun M, Finucci Curi P, Rojas Tessel R, Arias Saavedra M, Sattler ME, Machado Escobar MA, Astesana P, Paris U, Virasoro BM, Santa Cruz MJ, Allievi A, Vandale JM, Hojberg NG, Pons-Estel B. Multicenter lupus register from Argentina, the RELESSAR database: Influence of ethnicity on disease phenotype. Lupus 2022; 31:637-645. [PMID: 35382633 DOI: 10.1177/09612033221083267] [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] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The objective is to describe the main characteristics of patients with systemic lupus erythematosus (SLE) in Argentina and to examine the influence of ethnicity on the expression of the disease. PATIENTS AND METHODS RELESSAR is a multicentre register carried out by 106 researchers from 67 rheumatologic Argentine centres. It is a cross-sectional study of SLE (1982/1997 ACR) patients. RELESSAR electronic database includes demographic, cumulative SLE manifestations, SELENA-SLEDAI, SLICC-SDI, Katz's severity and Charlson's comorbidity indexes and treatment patterns. RESULTS We included 1,610 patients, 91.7% were female with a median age at diagnosis of 28.1 ± 12.8; 96.2% met ≥4 ACR 1982/97 criteria. Frequent manifestations were arthritis (83.5%), malar rash (79.5%), photosensitivity (75.3%), haematological (63.8%) and renal disease (47.4%), antinuclear antibodies (96%), anti-dsDNA (66.5%) and anti-Smith antibodies (29%). The mean Selena-SLEDAI score at last visit was 3.18 (SD 4.3) and mean SDI was 1 (SD 1.3). The accumulated treatments most frequently used were antimalarials (90.4%), corticosteroids (90%), azathioprine (31.8%), intravenous cyclophosphamide (30.2%), mycophenolate mofetil or mycophenolic acid (24.5%), methotrexate (19.3%), belimumab 5.3% and rituximab 5.1%. Refractory lupus was diagnosed in 9.3% of the cases. The main causes of death were lupus activity (25.0%), activity and concomitant infections (25.0%), infections (18.2%), vascular disease (13.6%) and cancer (4.5%). Mortality was associated with higher SLEDAI, Katz, damage indexes and comorbidities. Of the 1610 patients included, 44.6% were Caucasian, 44.5% Mestizo, 8.1% Amerindian and 1.2% Afro-Latin American. Mestizo patients had higher male representation, low socioeconomic status, more inadequate medical coverage, fewer formal years of education and shorter disease duration. Polyadenopathies and Raynaud's phenomenon were more frequent in Caucasians. In the logistic regression analysis higher damage index (OR 1.28, CI 95% 1.02-1.61, p = 0.03) remained associated to mestizo ethnicity. CONCLUSIONS This study represents the largest number of adult patients with SLE studied in Argentina. Caucasian patients were differentiated by having Raynaud's phenomenon and polyadenopathy more frequently, while patients of Mestizo origin had higher damage indexes.
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Affiliation(s)
| | | | - Victor Del Campo-Perez
- Servicio de Medicina Preventiva y Epidemiología, 96682Complexo Hospitalario Universitario de Vigo, Vigo, España
| | | | - Rosana M Quintana
- Centro Regional de Enfermedades Autoinmunes y Reumáticas (CREAR), Rosario, Argentina
| | | | | | | | | | | | - Heber M Figueredo
- Hospital de Alta Complejidad Pte. Juan Domingo Perón, Formosa, Argentina
| | - Silvia Papasidero
- Hospital General de Agudos Dr. Enrique Tornú580023, Buenos Aires, Argentina
| | | | | | - Emma Civit
- Hospital del Carmen, Godoy Cruz, Argentina
| | | | | | | | | | | | - Marina Micelli
- 541318Hospital General de Agudos José María Ramos Mejía, Buenos Aires, Argentina
| | - Romina Nieto
- Hospital Provincial de Rosario, Rosario, Argentina
| | | | | | | | | | - Alberto Orden
- Hospital Aeronáutico Central, 433287 Buenos Aires, Argentina
| | - Johana Zacariaz
- Hospital Italiano de Buenos Aires, 37533 Buenos Aires, Argentina
| | | | - Mariana Pera
- 198367HIGA General San Martin, La Plata, Argentina
| | - Mario Goñi
- Centro de Especialidades Médicas Ambulatorias de Rosario, Rosario, Argentina
| | - Oscar Rillo
- 58783Hospital General de Agudos Dr Ignacio Pirovano, Buenos Aires, Argentina
| | - Roberto Baez
- Hospital De General Roca, General Roca, Argentina
| | | | | | | | | | - Maria M Shmid
- Hospital Angela Iglesia de Llano, Corrientes, Argentina
| | | | | | - Nadia Dominguez
- 541318Hospital General de Agudos José María Ramos Mejía, Buenos Aires, Argentina
| | - Graciela N Gómez
- Instituto de Investigaciones Médicas Alfredo Lanari, 207909 Buenos Aires, Argentina
| | | | - Josefina Marin
- Hospital Italiano de Buenos Aires, 37533 Buenos Aires, Argentina
| | - Victoria Collado
- Instituto de Investigaciones Médicas Alfredo Lanari, 207909 Buenos Aires, Argentina
| | - Marisa Jorfen
- Centro de Especialidades Médicas Ambulatorias, Rosario, Argentina
| | - Zaida Bedran
- Hospital Escuela de Agudos Dr. Ramón Madariaga, Posadas, Argentina
| | - Ana Curti
- Hospital Luis Carlos Lagomaggiore, 297830 Mendoza, Argentina
| | | | - Judith Sarano
- Instituto de Investigaciones Médicas Alfredo Lanari, 207909 Buenos Aires, Argentina
| | - Marcos Zelaya
- 541318Hospital General de Agudos José María Ramos Mejía, Buenos Aires, Argentina
| | - Monica Sacnun
- Hospital Provincial del Centenario, 541448 Rosario, Argentina
| | | | | | - Maira Arias Saavedra
- 541318Hospital General de Agudos José María Ramos Mejía, Buenos Aires, Argentina
| | | | | | | | - Ursula Paris
- Hospital Escuela de Agudos Dr. Ramón Madariaga, Posadas, Argentina
| | | | - Maria J Santa Cruz
- Hospital General de Agudos Dr. Enrique Tornú580023, Buenos Aires, Argentina
| | - Alberto Allievi
- 28213Universidad del Salvador, Autoinmunidad, Buenos Aires, Argentina
| | - Juan M Vandale
- Hospital Privado de la Comunidad, Mar del Plata, Argentina
| | - Noelia G Hojberg
- 541318Hospital General de Agudos José María Ramos Mejía, Buenos Aires, Argentina
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Serrano R, Pons-Estel GJ, Espinosa G, Quintana RM, Reverter JC, Tassies D, Monteagudo J, Cervera R. Long-term follow-up of antiphospholipid syndrome: real-life experience from a single center. Lupus 2020; 29:1050-1059. [PMID: 32536318 DOI: 10.1177/0961203320933009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 11/15/2022]
Abstract
OBJECTIVE The objective of this paper is to assess the prevalence of the main clinical manifestations and laboratory features at disease onset and during the ensuing 10 years of a large cohort of patients with antiphospholipid syndrome (APS) from a single center. METHODS The study included all consecutive APS patients followed longitudinally in our center from 2003 to 2013. Descriptive statistics for demographics, clinical and laboratory features and mortality were performed. RESULTS A total of 160 patients were included. Most of them, 128 (78.8%), were women and the mean (SD) age at diagnosis was 39.1 (14.0) years. The majority of them, 104 (65.0%), had primary APS, 36 (22.5%) had APS associated with systemic lupus erythematous, and 20 (12.5%) had APS associated with other autoimmune disease. During the study period, thrombotic events occurred in 27 (16.9%) patients, the most common being strokes, nonbacterial thrombotic endocarditis and deep venous thrombosis. Regarding obstetric morbidity, 18 women (14.3%) became pregnant and 90% of pregnancies succeeded in having live births. The most common obstetric complication was early pregnancy loss (15% of pregnancies). Prematurity (11.1% of live births) and intrauterine growth restriction (5.6% of live births) were the most frequent fetal morbidities. Ten (6.3%) patients died and the most frequent causes of death were severe thrombosis, hemorrhage, and cancer. Three (0.9%) cases of catastrophic APS occurred. The survival probability at 10 years was 93.8%. CONCLUSIONS Patients with APS develop significant morbidity and mortality despite current treatment. It is imperative to identify prognostic factors and therapeutic measures to prevent these complications.
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Affiliation(s)
- Rosa Serrano
- Department of Autoimmune Diseases, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Catalonia, Spain
| | - Guillermo J Pons-Estel
- Department of Autoimmune Diseases, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Catalonia, Spain.,Departamento de Medicina Interna, Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
| | - Gerard Espinosa
- Department of Autoimmune Diseases, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Catalonia, Spain
| | - Rosana M Quintana
- Department of Autoimmune Diseases, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Catalonia, Spain.,Departamento de Medicina Interna, Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
| | - Joan C Reverter
- Department of Hemotherapy and Hemostasis, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Catalonia, Spain
| | - Dolors Tassies
- Department of Hemotherapy and Hemostasis, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Catalonia, Spain
| | - Joan Monteagudo
- Department of Hemotherapy and Hemostasis, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Catalonia, Spain
| | - Ricard Cervera
- Department of Autoimmune Diseases, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Catalonia, Spain
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4
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Pons-Estel BA, Bonfa E, Soriano ER, Cardiel MH, Izcovich A, Popoff F, Criniti JM, Vásquez G, Massardo L, Duarte M, Barile-Fabris LA, García MA, Amigo MC, Espada G, Catoggio LJ, Sato EI, Levy RA, Acevedo Vásquez EM, Chacón-Díaz R, Galarza-Maldonado CM, Iglesias Gamarra AJ, Molina JF, Neira O, Silva CA, Vargas Peña A, Gómez-Puerta JA, Scolnik M, Pons-Estel GJ, Ugolini-Lopes MR, Savio V, Drenkard C, Alvarellos AJ, Ugarte-Gil MF, Babini A, Cavalcanti A, Cardoso Linhares FA, Haye Salinas MJ, Fuentes-Silva YJ, Montandon de Oliveira E Silva AC, Eraso Garnica RM, Herrera Uribe S, Gómez-Martín D, Robaina Sevrini R, Quintana RM, Gordon S, Fragoso-Loyo H, Rosario V, Saurit V, Appenzeller S, Dos Reis Neto ET, Cieza J, González Naranjo LA, González Bello YC, Collado MV, Sarano J, Retamozo S, Sattler ME, Gamboa-Cárdenas RV, Cairoli E, Conti SM, Amezcua-Guerra LM, Silveira LH, Borba EF, Pera MA, Alba Moreyra PB, Arturi V, Berbotto GA, Gerling C, Gobbi CA, Gervasoni VL, Scherbarth HR, Brenol JCT, Cavalcanti F, Costallat LTL, Da Silva NA, Monticielo OA, Seguro LPC, Xavier RM, Llanos C, Montúfar Guardado RA, Garcia de la Torre I, Pineda C, Portela Hernández M, Danza A, Guibert-Toledano M, Reyes GL, Acosta Colman MI, Aquino AM, Mora-Trujillo CS, Muñoz-Louis R, García Valladares I, Orozco MC, Burgos PI, Betancur GV, Alarcón GS. First Latin American clinical practice guidelines for the treatment of systemic lupus erythematosus: Latin American Group for the Study of Lupus (GLADEL, Grupo Latino Americano de Estudio del Lupus)-Pan-American League of Associations of Rheumatology (PANLAR). Ann Rheum Dis 2018; 77:1549-1557. [PMID: 30045853 PMCID: PMC6225798 DOI: 10.1136/annrheumdis-2018-213512] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 06/26/2018] [Accepted: 06/28/2018] [Indexed: 11/24/2022]
Abstract
Systemic lupus erythematosus (SLE), a complex and heterogeneous autoimmune disease, represents a significant challenge for both diagnosis and treatment. Patients with SLE in Latin America face special problems that should be considered when therapeutic guidelines are developed. The objective of the study is to develop clinical practice guidelines for Latin American patients with lupus. Two independent teams (rheumatologists with experience in lupus management and methodologists) had an initial meeting in Panama City, Panama, in April 2016. They selected a list of questions for the clinical problems most commonly seen in Latin American patients with SLE. These were addressed with the best available evidence and summarised in a standardised format following the Grading of Recommendations Assessment, Development and Evaluation approach. All preliminary findings were discussed in a second face-to-face meeting in Washington, DC, in November 2016. As a result, nine organ/system sections are presented with the main findings; an 'overarching' treatment approach was added. Special emphasis was made on regional implementation issues. Best pharmacologic options were examined for musculoskeletal, mucocutaneous, kidney, cardiac, pulmonary, neuropsychiatric, haematological manifestations and the antiphospholipid syndrome. The roles of main therapeutic options (ie, glucocorticoids, antimalarials, immunosuppressant agents, therapeutic plasma exchange, belimumab, rituximab, abatacept, low-dose aspirin and anticoagulants) were summarised in each section. In all cases, benefits and harms, certainty of the evidence, values and preferences, feasibility, acceptability and equity issues were considered to produce a recommendation with special focus on ethnic and socioeconomic aspects. Guidelines for Latin American patients with lupus have been developed and could be used in similar settings.
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Affiliation(s)
- Bernardo A Pons-Estel
- Departamento de Medicina Interna, Grupo Oroño-Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
| | - Eloisa Bonfa
- Rheumatology Division, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Enrique R Soriano
- Sección de Reumatología, Servicio de Clínica Médica, Instituto Universitario, Escuela de Medicina, and Fundación Dr Pedro M Catoggio para el Progreso de la Reumatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Mario H Cardiel
- Centro de Investigación Clínica de Morelia, SC, Morelia, México
| | - Ariel Izcovich
- Servicio de Clínica Médica del Hospital Alemán de Buenos Aires, Hospital Alemán de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - Federico Popoff
- Servicio de Clínica Médica del Hospital Alemán de Buenos Aires, Hospital Alemán de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - Juan M Criniti
- Servicio de Clínica Médica del Hospital Alemán de Buenos Aires, Hospital Alemán de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - Gloria Vásquez
- Grupo de Inmunología Celular e Inmunogenética, Universidad de Antioquia, Hospital Universitario, Fundación San Vicente, Medellín, Colombia
| | - Loreto Massardo
- Centro de Biología Celular y Biomedicina, Facultad de Medicina y Ciencia. Universidad San Sebastián, Santiago, Chile
| | - Margarita Duarte
- Departamento de Reumatología, Hospital de Clínicas, Facultad de Ciencias Médicas, Universidad Nacional de Asunción, Asunción, Paraguay
| | | | - Mercedes A García
- Servicio de Reumatología, HIGA General San Martín, La Plata, Argentina
| | - Mary-Carmen Amigo
- Servicio de Reumatología, Centro Médico ABC, Ciudad de México, México
| | - Graciela Espada
- Servicio de Reumatología Infantil, Hospital de Niños Dr Ricardo Gutiérrez, Buenos Aires, Argentina
| | - Luis J Catoggio
- Sección de Reumatología, Servicio de Clínica Médica, Instituto Universitario, Escuela de Medicina, and Fundación Dr Pedro M Catoggio para el Progreso de la Reumatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Emilia Inoue Sato
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paul, Brazil
| | - Roger A Levy
- Discipline of Rheumatology, University of the State of Rio de Janeiro, Rio de Janeiro, Brasil
| | - Eduardo M Acevedo Vásquez
- Facultad de Medicina., Universidad Nacional Mayor de San Marcos. Servicio de Reumatología. Clínica San Felipe, J. María., Lima, Perú
| | - Rosa Chacón-Díaz
- Servicio de Reumatología, Policlínica Méndez Gimón, Caracas, Venezuela
| | | | | | | | - Oscar Neira
- Sección de Reumatología, Hospital del Salvador. Universidad de Chile. Unidad de Reumatología. Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo., Santiago, Chile
| | - Clóvis A Silva
- Pediatric Department, Faculdade de Medicina, Children's Institute, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Andrea Vargas Peña
- Clínica Reumatológica, Universidad de la República, and Unidad Docente Asistencial, Hospital Pasteur, Instituto Nacional de Reumatología., Montevideo, Uruguay
| | | | - Marina Scolnik
- Sección de Reumatología, Servicio de Clínica Médica, Instituto Universitario, Escuela de Medicina, and Fundación Dr Pedro M Catoggio para el Progreso de la Reumatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Guillermo J Pons-Estel
- Departamento de Medicina Interna, Grupo Oroño-Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
- Servicio de Reumatología, Hospital Provincial de Rosario, Rosario, Argentina
| | - Michelle R Ugolini-Lopes
- Rheumatology Division, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Verónica Savio
- Servicio de Reumatología, Hospital Italiano de Córdoba, Córdoba, Argentina
| | - Cristina Drenkard
- Division of Rheumatology, Department of Medicine, Emory School of Medicine, Atlanta, Georgia, USA
| | | | - Manuel F Ugarte-Gil
- Servicio de Reumatología, Hospital General Guillermo Almenara Irigoyen, EsSalud., Lima, Perú
- Universidad Científica del Sur, Lima, Perú
| | - Alejandra Babini
- Servicio de Reumatología, Hospital Italiano de Córdoba, Córdoba, Argentina
| | - André Cavalcanti
- Serviço de Reumatologia do Hospital das Clínicas da Universidade Federal de Pernambuco (HC-UFPE), Recife, Brazil
| | - Fernanda Athayde Cardoso Linhares
- Clínica Reumatológica, Universidad de la República, and Unidad Docente Asistencial, Hospital Pasteur, Instituto Nacional de Reumatología., Montevideo, Uruguay
| | | | - Yurilis J Fuentes-Silva
- Unidad de Reumatología, Departamento de Medicina, Universidad de Oriente, Complejo Hospitalario Universitario Ruiz y Páez, Ciudad Bolívar, Venezuela
| | | | - Ruth M Eraso Garnica
- Departamento de Pediatría, Facultad de Medicina, Universidad de Antioquia, Hospital Pablo Tobón Uribe, Medellín, Colombia
| | - Sebastián Herrera Uribe
- Servicio de Reumatología, Hospital General de Medellín 'Luz Castro de Gutierrez' ESE, ARTMEDICA, Medellín, Colombia
| | - Diana Gómez-Martín
- Departamento de Inmunología y Reumatología, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Ciudad de México, Mexico
| | - Ricardo Robaina Sevrini
- Unidad de Enfermedades Autoinmunes Sistémicas, Facultad de Medicina, Clínica Médica 'C', Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
| | - Rosana M Quintana
- Departamento de Medicina Interna, Grupo Oroño-Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
- Servicio de Reumatología, Hospital Provincial de Rosario, Rosario, Argentina
| | - Sergio Gordon
- Unidad de Reumatología y Enfermedades Autoinmunes Sistémicas, HIGA Dr Oscar Alende, Mar del Plata, Argentina
| | - Hilda Fragoso-Loyo
- Departamento de Inmunología y Reumatología, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Ciudad de México, Mexico
| | - Violeta Rosario
- Servicio de Reumatología, Enfermedades Reumatológicas e Investigación Clínica (ERIC), Hospital Docente Padre Billini, Santo Domingo, Dominican Republic
| | - Verónica Saurit
- Servicio de Reumatología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - Simone Appenzeller
- Departamento de Clínica Médica, Disciplina de Reumatologia, Faculdade de Ciências Medicas da UNICAMP, Universidade Estadual de Campinas, Campinas, Brazil
| | | | - Jorge Cieza
- Servicio de Reumatología, Departamento de Especialidades Médicas, Hospital Nacional Edgardo Rebagliati Martins, EsSalud., Lima, Perú
| | - Luis A González Naranjo
- Grupo de Inmunología Celular e Inmunogenética, Universidad de Antioquia, Hospital Universitario, Fundación San Vicente, Medellín, Colombia
| | | | - María Victoria Collado
- Servicio de Inmunología, Instituto de Investigaciones Médicas "Alfredo "Lanari", Ciudad Autónoma de Buenos Aires, Argentina
| | - Judith Sarano
- Servicio de Inmunología, Instituto de Investigaciones Médicas "Alfredo "Lanari", Ciudad Autónoma de Buenos Aires, Argentina
| | - Soledad Retamozo
- Servicio de Reumatología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - María E Sattler
- Servicio de Reumatología, Hospital Escuela "Eva Perón", Granadero Baigorria, Argentina
| | - Rocio V Gamboa-Cárdenas
- Servicio de Reumatología, Hospital General Guillermo Almenara Irigoyen, EsSalud., Lima, Perú
| | - Ernesto Cairoli
- Unidad de Enfermedades Autoinmunes Sistémicas, Facultad de Medicina, Clínica Médica 'C', Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
| | - Silvana M Conti
- Servicio de Reumatología, Hospital Provincial de Rosario, Rosario, Argentina
| | - Luis M Amezcua-Guerra
- Departamento de Inmunología, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, Mexico
| | - Luis H Silveira
- Departamento de Reumatología, Instituto Nacional de Cardiología "Ignacio Chávez", Ciudad de México, México
| | - Eduardo F Borba
- Rheumatology Division, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Mariana A Pera
- Servicio de Reumatología, HIGA General San Martín, La Plata, Argentina
| | - Paula B Alba Moreyra
- Unidad de Reumatología, Cátedra de Clínica Médica I, Hospital Córdoba. Cátedra de Semiología, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba., Córdoba, Argentina
| | - Valeria Arturi
- Servicio de Reumatología, HIGA General San Martín, La Plata, Argentina
| | - Guillermo A Berbotto
- Servicio de Reumatología, Hospital Escuela "Eva Perón", Granadero Baigorria, Argentina
| | - Cristian Gerling
- Unidad de Reumatología y Enfermedades Autoinmunes Sistémicas, HIGA Dr Oscar Alende, Mar del Plata, Argentina
| | - Carla A Gobbi
- Unidad de Reumatología, Cátedra de Clínica Médica I, Hospital Córdoba. Cátedra de Semiología, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba., Córdoba, Argentina
| | - Viviana L Gervasoni
- Servicio de Reumatología, Hospital Provincial de Rosario, Rosario, Argentina
| | - Hugo R Scherbarth
- Unidad de Reumatología y Enfermedades Autoinmunes Sistémicas, HIGA Dr Oscar Alende, Mar del Plata, Argentina
| | - João C Tavares Brenol
- Rheumatology Division, Department of Internal Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Fernando Cavalcanti
- Serviço de Reumatologia do Hospital das Clínicas da Universidade Federal de Pernambuco (HC-UFPE), Recife, Brazil
| | - Lilian T Lavras Costallat
- Departamento de Clínica Médica, Disciplina de Reumatologia, Faculdade de Ciências Medicas da UNICAMP, Universidade Estadual de Campinas, Campinas, Brazil
| | - Nilzio A Da Silva
- Serviço de Reumatologia, Departamento de Clinica Medica, Faculdade de Medicina, Hospital das Clínicas, Universidade Federal de Goiás, Goiânia, Brazil
| | - Odirlei A Monticielo
- Rheumatology Division, Department of Internal Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Luciana Parente Costa Seguro
- Rheumatology Division, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Ricardo M Xavier
- Rheumatology Division, Department of Internal Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Carolina Llanos
- Departamento de Inmunología Clínica y Reumatología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rubén A Montúfar Guardado
- Departamento de Reumatología, Consultorio de Especialidades del Instituto Salvadoreño de la Seguridad Social, San Salvador, El Salvador
| | | | - Carlos Pineda
- Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Ciudad de México, Mexico
| | | | - Alvaro Danza
- Grupo de Trabajo en Enfermedades Autoinmunes Sistémicas, Servicio de Clínica Médica, Facultad de Medicina, Universidad de la Republica, Hospital Pasteur, Administración de Servicios de Salud del Estado, Montevideo, Uruguay
| | - Marlene Guibert-Toledano
- Servicio Nacional de Reumatología, Centro de Investigaciones Médico Quirúrgicas (CIMEQ)., La Habana, Cuba
| | - Gil Llerena Reyes
- Servicio Nacional de Reumatología, Centro de Investigaciones Médico Quirúrgicas (CIMEQ)., La Habana, Cuba
| | - Maria Isabel Acosta Colman
- Departamento de Reumatología, Hospital de Clínicas, Facultad de Ciencias Médicas, Universidad Nacional de Asunción, Asunción, Paraguay
| | - Alicia M Aquino
- Departamento de Reumatología, Hospital de Clínicas, Facultad de Ciencias Médicas, Universidad Nacional de Asunción, Asunción, Paraguay
| | - Claudia S Mora-Trujillo
- Servicio de Reumatología, Departamento de Especialidades Médicas, Hospital Nacional Edgardo Rebagliati Martins, EsSalud., Lima, Perú
| | - Roberto Muñoz-Louis
- Servicio de Reumatología, Enfermedades Reumatológicas e Investigación Clínica (ERIC), Hospital Docente Padre Billini, Santo Domingo, Dominican Republic
| | | | - María Celeste Orozco
- Servicio de Reumatología, Instituto de Rehabilitación Psicofísica (IREP), Ciudad Autónoma de Buenos Aires, Argentina
| | - Paula I Burgos
- Departamento de Inmunología Clínica y Reumatología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Graciela V Betancur
- Servicio de Reumatología, Instituto de Rehabilitación Psicofísica (IREP), Ciudad Autónoma de Buenos Aires, Argentina
| | - Graciela S Alarcón
- Division of Clinical Immunology and Rheumatology, Department of Medicine, School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
- Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
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