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Nieto R, Quintana R, Zavala-Flores E, Serrano R, Roberts K, Catoggio LJ, García MA, Berbotto GA, Saurit V, Bonfa E, Borba EF, Lavras Costallat LT, Da Silva NA, Sato EI, Tavares Brenol JC, Massardo L, Neira OJ, Vázquez G, Guibert Toledano M, Pascual-Ramos V, Sauza Del Pozo MJ, Barile-Fabris LA, Amigo MC, García De La Torre I, Acevedo-Vásquez EM, Segami MI, Chacón-Díaz R, Esteva-Spinetti MH, Alarcón GS, Pons-Estel BA, Pons-Estel GJ. Time to diagnosis in systemic lupus erythematosus: Associated factors and its impact on damage accrual and mortality. Data from a multi-ethnic, multinational Latin American lupus cohort. Lupus 2024; 33:340-346. [PMID: 38334100 DOI: 10.1177/09612033241232821] [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: 02/10/2024]
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) often mimics symptoms of other diseases, and the interval between symptom onset and diagnosis may be long in some of these patients. Aims: To describe the characteristics associated with the time to SLE diagnosis and its impact on damage accrual and mortality in patients with SLE from a Latin American inception cohort. METHODS Patients were from a multi-ethnic, multi-national Latin-American SLE inception cohort. All participating centers had specialized lupus clinics. Socio-demographic, clinical/laboratory, disease activity, damage, and mortality between those with a longer and a shorter time to diagnosis were compared using descriptive statistical tests. Multivariable Cox regression models with damage accrual and mortality as the end points were performed, adjusting for age at SLE diagnosis, gender, ethnicity, level of education, and highest dose of prednisone for damage accrual, plus highest dose of prednisone, baseline SLEDAI, and baseline SDI for mortality. RESULTS Of the 1437 included in these analyses, the median time to diagnosis was 6.0 months (Q1-Q3 2.4-16.2); in 721 (50.2%) the time to diagnosis was longer than 6 months. Patients whose diagnosis took longer than 6 months were more frequently female, older at diagnosis, of Mestizo ethnicity, not having medical insurance, and having "non-classic" SLE symptoms. Longer time to diagnosis had no impact on either damage accrual (HR 1.09, 95% CI 0.93-1.28, p = 0.300) or mortality (HR 1.37, 95% CI 0.88-2.12, p = 0.200). CONCLUSIONS In this inception cohort, a maximum time of 24 months with a median of 6 months to SLE diagnosis had no apparent negative impact on disease outcomes (damage accrual and mortality).
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Affiliation(s)
- Romina Nieto
- Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
| | - Rosana Quintana
- Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
| | | | - Rosa Serrano
- Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
| | - Karen Roberts
- Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
| | - Luis J Catoggio
- Rheumatology Section, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Mercedes A García
- Servicio de Reumatología, HIGA San Martin de La Plata, Buenos Aires, Argentina
| | - Guillermo A Berbotto
- Servicio de Reumatología, Hospital Escuela "Eva Perón", Granadero Baigorria, Argentina
| | - Verónica Saurit
- Servicio de Reumatología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - Eloisa Bonfa
- Rheumatology Division, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Eduardo F Borba
- Rheumatology Division, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | - Nilzio A Da Silva
- Servico de Reumatologia, Departamento de Clinica Medica, Faculdade de Medicina, Hospital das Clínicas,Universidade Federal de Goiás, Goiania, Brazil
| | - Emilia I Sato
- Escola Paulista de Medicina, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Joao 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
| | - Loreto Massardo
- Centro de Biología Celular y Biomedicina (CEBICEM), Facultad de Medicina y Ciencia, Universidad San Sebastián, Santiago de Chile, Chile
| | - Oscar J 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
| | - Gloria Vázquez
- Grupo de Inmunología Celular e Inmunogenética, Universidad de Antioquia, Hospital Universitario, Fundación San Vicente, Medellín, Colombia
| | - Marlene Guibert Toledano
- Servicio Nacional de Reumatología, Centro de Investigaciones Médico Quirúrgicas (CIMEQ), La Habana, Cuba
| | - Virginia Pascual-Ramos
- Virginia Pascual-Ramos, Departamento de Inmunología y Reumatología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México DF, México
| | - María J Sauza Del Pozo
- Maria Josefina Sauza del Pozo, Laura E. Aranda Baca, and Adelfia Urenda Quezada, Servicio de Reumatología, Insti- tuto Mexicano de Seguro Social, Hospital de Especialidades No 25, Monterrey, México
| | | | | | - Ignacio García De La Torre
- Departamento de Inmunología y Reumatología, Hospital General de Occidente de la S.S. y Universidad de Guadalajara, Zapopan, Jalisco, México
| | | | - María I Segami
- Servicio de Reumatología, Hospital General Guillermo Almenara Irigoyen, EsSalud, Lima, Peru
| | - Rosa Chacón-Díaz
- Servicio de Reumatología, Policlínica Méndez Gimón, Caracas, Venezuela
| | - María H Esteva-Spinetti
- Servicio de Reumatología, Departamento de Medicina, Hospital Central de San Cristóbal, San Cristóbal, Venezuela
| | - Graciela S Alarcón
- Universidad Peruana Cayetano Heredia, Lima, Perú
- The University of Alabama at Birmingham Marnix E. Heersink School of Medicine, Birmingham, AL, USA
| | - Bernardo A Pons-Estel
- Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
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Alarcón GS, Pons-Estel BA, Pons-Estel GJ, Zavala E, Nieto R, Quintana R. Comment on the paper by Kapsala et al. Clin Exp Rheumatol 2023; 41:2341. [PMID: 37382459 DOI: 10.55563/clinexprheumatol/tz7trd] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 05/25/2023] [Indexed: 06/30/2023]
Affiliation(s)
- Graciela S Alarcón
- Division of Clinical Immunology and Rheumatology, Department of Medicine, Marnix E. Heersink School of Medicine, The University of Alabama at Birmingham, AL, USA
| | - Bernardo A Pons-Estel
- Grupo Oroño, Centro Regional de Enfermedades Autoinmunes y Reumaticas (GO-CREAR), Rosario, Argentina
| | - Guillermo J Pons-Estel
- Grupo Oroño, Centro Regional de Enfermedades Autoinmunes y Reumaticas (GO-CREAR), Rosario, Argentina
| | | | - Romina Nieto
- Grupo Oroño, Centro Regional de Enfermedades Autoinmunes y Reumaticas (GO-CREAR), Rosario, Argentina
| | - Rosana Quintana
- Grupo Oroño, Centro Regional de Enfermedades Autoinmunes y Reumaticas (GO-CREAR), Rosario, Argentina.
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Quintana R, Ramirez-Flores MF, Fuentes-Silva Y, Peláez-Ballestas I. Diagnostic Delay in Autoimmune Rheumatic Diseases: A Global Health Problem. J Rheumatol 2023:jrheum.2023-0847. [PMID: 37778764 DOI: 10.3899/jrheum.2023-0847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
In this issue of The Journal of Rheumatology, Xiang et al1 describe the experience and influencing factors of symptom appraisal and help-seeking among patients with various autoimmune rheumatic diseases (ARDs) in a multiethnic urban Asian population.The authors guided the interpretation of this qualitative study based on the social cognitive theory framework to enhance the appraisal of symptoms and help-seeking.
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Affiliation(s)
- Rosana Quintana
- R. Quintana, MD, PhD, Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
| | - María Fernanda Ramirez-Flores
- M.F. Ramírez-Flores, MD,PhD student, Programa de Estudios Combinados en Medicina (PECEM),Faculty of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Yurilis Fuentes-Silva
- Y. Fuentes-Silva, MD, Department of Medicine, Universidad de Oriente, Bolívar, Venezuela
| | - Ingris Peláez-Ballestas
- I. Peláez-Ballestas, MD, PhD, Rheumatology Unit, Hospital General de México "Dr Eduardo Liceaga", Mexico City, Mexico
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Granados Y, Gastelum Strozzi A, Alvarez-Nemegyei J, Quintana R, Julian-Santiago F, Santos AM, Guevara-Pacheco S, Loyola-Sanchez A, Goycochea-Robles MV, Juarez V, Garza-Elizondo MA, Rueda JC, Burgos-Vargas R, Londoño J, Pons-Estel BA, Pelaez-Ballestas I. Inequity and vulnerability in Latin American Indigenous and non-Indigenous populations with rheumatic diseases: a syndemic approach. BMJ Open 2023; 13:e069246. [PMID: 36958782 PMCID: PMC10040077 DOI: 10.1136/bmjopen-2022-069246] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/25/2023] Open
Abstract
UNLABELLED Syndemics are a framework that documents health inequities and vulnerabilities in populations with rheumatic diseases. Compared with other approaches, syndemics are able to conjunctly consider epidemiological, biological, sociodemographic and economic factors, and their interactions. OBJECTIVE To estimate health inequity and vulnerability among Indigenous and non-Indigenous populations with rheumatic and musculoskeletal diseases (RMD) in Latin America using the syndemic approach. DESIGN This is a secondary analysis of a previously published large-scale study on the prevalence of RMD. SETTING Studies carried out in five Latin American countries (Argentina, Colombia, Ecuador, Mexico and Venezuela). Health inequity and vulnerability in RMD were identified through a syndemic approach using network and cluster analysis. PARTICIPANTS A total of 44 560 individuals were studied: 29.78% self-identified as Indigenous, 60.92% were female, the mean age was 43.25 years. Twenty clusters were identified in the Indigenous population and 17 in the non-Indigenous population. RESULTS The variables associated with RMD among Indigenous populations were rurality, public health system, high joint biomechanical stress, greater pain, disability and alcoholism; and among non-Indigenous people they were being a woman, urban origin, older age, private health system, joint biomechanical stress, greater pain and disability. We identified different health inequities among patients with RMD (ie, lower educational attainment, more comorbidities), associated with factors such as Indigenous self-identification and rural residence. CONCLUSIONS A syndemic approach enables us to identify health inequities in RMD, as shown by higher prevalence of comorbidities, disability and socioeconomic factors like lower educational attainment. These inequities exist for the overall population of patients with RMD, although it is more evident in Indigenous groups with added layers of vulnerability.
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Affiliation(s)
- Ysabel Granados
- Rheumatology Department, Hospital “Dr. Manuel Núñez Tovar”, Maturin, Venezuela
| | | | | | - Rosana Quintana
- Reumatology, Hospital Provincial de Rosario, Rosario, Santa Fe, Argentina
| | - Flor Julian-Santiago
- Faculty of Medicine, Universidad Nacional Autonoma de Mexico, Ciudad de Mexico, Ciudad de México, Mexico
| | - Ana M Santos
- Rheumatology, Universidad de La Sabana, Chia, Cundinamarca, Colombia
| | | | | | | | - Vicente Juarez
- Rheumatology Department, Hospital Señor del Milagro, Salta, Argentina
| | - Mario Alberto Garza-Elizondo
- Internal Medicine, Rheumatology Service, Hospital Universitario "Dr. José Eleuterio González" de la Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - Juan Camilo Rueda
- Rheumatology, Universidad de La Sabana, Chia, Cundinamarca, Colombia
| | - Ruben Burgos-Vargas
- Rheumatology, Hospital General de Mexico Dr Eduardo Liceaga, Ciudad de Mexico, Ciudad de Mexico, Mexico
| | - John Londoño
- Rheumatology, Universidad de La Sabana, Chia, Cundinamarca, Colombia
- Rheumatology, Hospital Militar Central, Chia, Cundinamarca, Colombia
| | | | - Ingris Pelaez-Ballestas
- Rheumatology Department, Hospital General de México Dr Eduardo Liceaga, Ciudad de Mexico, Ciudad de Mexico, Mexico
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González LA, Alarcón GS, Harvey GB, Quintana R, Pons-Estel GJ, Ugarte-Gil MF, Vásquez G, Catoggio LJ, García MA, Borba EF, Da Silva NA, Tavares Brenol JC, Toledano MG, Massardo L, Neira O, Pascual-Ramos V, Amigo MC, Barile-Fabris LA, De La Torre IG, Alfaro-Lozano J, Segami MI, Chacón-Díaz R, Esteva-Spinetti MH, Iglesias-Gamarra A, Pons-Estel BA. Predictors of severe hemolytic anemia and its impact on major outcomes in systemic lupus erythematosus: Data from a multiethnic Latin American cohort. Lupus 2023; 32:658-667. [PMID: 36916674 DOI: 10.1177/09612033231163745] [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: 03/15/2023]
Abstract
OBJECTIVE To determine the predictors of the occurrence of severe autoimmune hemolytic anemia (AIHA) and its impact on damage accrual and mortality in SLE patients. METHODS Factors associated with time to severe AIHA (hemoglobin level ≤7 g/dL) occurring from the onset of SLE symptoms were examined by Cox proportional hazards regressions. The association of severe AIHA with mortality was examined by logistic regression analyses while its impact on damage was by negative binomial regression. RESULTS Of 1,349 patients, 49 (3.6%) developed severe AIHA over a mean (SD) follow-up time of 5.4 (3.8) years. The median time from the first clinical manifestation to severe AIHA was 111 days (IQR 43-450). By multivariable analysis, male sex (HR 2.26, 95% CI 1.02-4.75, p = 0.044), and higher disease activity at diagnosis (HR 1.04, 95% CI 1.01-1.08, p = 0.025) were associated with a shorter time to severe AIHA occurrence. Of the SLEDAI descriptors, only hematologic (leukopenia and/or thrombocytopenia) showed a certain trend toward significance in the multivariable analysis (HR 2.36, 95% CI 0.91-6.13, p = 0.0772). Severe AIHA contributed neither to damage nor to mortality. CONCLUSIONS Severe AIHA occurs during the early course of SLE. Male sex and higher disease activity at diagnosis emerged as independent predictors of a shorter time to severe AIHA occurrence. Although not statistically significant, hematological abnormalities at SLE diagnosis could predict the occurrence of severe AIHA in a shorter time. Damage and mortality did not seem to be impacted by the occurrence of severe AIHA.
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Affiliation(s)
- Luis Alonso González
- División de Reumatología, Departamento de Medicina Interna, Facultad de Medicina, 27983Universidad de Antioquia, Medellin, Colombia
| | - 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.,Department of Medicine, School of Medicine, Universidad Peruana Cayetano, Heredia, Lima, Perú
| | - Guillermina B Harvey
- Escuela de Estadística, Facultad de Ciencias Económicas y Estadística, 488296Universidad Nacional de Rosario, Rosario, Argentina
| | - Rosana Quintana
- Grupo Oroño, Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
| | - Guillermo J Pons-Estel
- Grupo Oroño, Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
| | - Manuel F Ugarte-Gil
- Rheumatology Department, Hospital Nacional Guillermo Almenara Irigoyen, Lima, Perú.,Grupo Peruano de Estudio de Enfermedades Autoinmunes Sistémicas, Universidad Científica del Sur, Lima, Perú
| | - Gloria Vásquez
- División de Reumatología, Departamento de Medicina Interna, Facultad de Medicina, 27983Universidad de Antioquia, Medellin, Colombia
| | - Luis J Catoggio
- Rheumatology Section, 37533Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Mercedes A García
- Servicio de Reumatología, 37533HIGA San Martin de La Plata, Buenos Aires, Argentina
| | - Eduardo F Borba
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Nilzio A Da Silva
- Rheumatology Unit, Faculdade de Medicina da Universidad e Federal de Goias, Goiania, Brazil
| | - João C Tavares Brenol
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,28124Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Marlene Guibert Toledano
- Servicio Nacional de Reumatología, Centro de Investigaciones Médico Quirúrgicas (CIMEQ), La Habana, Cuba
| | - Loreto Massardo
- Centro de Biología Celular y Biomedicina (CEBICEM), Facultad de Medicina y Ciencia, 373328Universidad San Sebastián, Santiago de Chile, Chile
| | - Oscar Neira
- Sección de Reumatología, 476601Hospital del Salvador, Universidad de Chile, Santiago, Chile
| | - Virginia Pascual-Ramos
- Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Ciudad de México, México
| | | | | | - Ignacio García De La Torre
- Departamento de Inmunología y Reumatología, 37758Hospital General de Occidentede la S.S. y Universidad de Guadalajara, Zapopan, Jalisco, México
| | - José Alfaro-Lozano
- Rheumatology Department, Hospital Nacional Guillermo Almenara Irigoyen, Lima, Perú
| | - María I Segami
- Hospital Nacional "Edgardo Rebagliati Martins", Essalud, Lima, Perú
| | - Rosa Chacón-Díaz
- Centro Nacional de Enfermedades Reumáticas, 198370Hospital Universitario de Caracas, Caracas, Venezuela
| | - María H Esteva-Spinetti
- Servicio de Reumatología, Departamento de Medicina, Hospital Central de San Cristóbal, San Cristóbal, Venezuela
| | - Antonio Iglesias-Gamarra
- Unidad de Reumatología, Departamento de Medicina Interna, 28021Universidad Nacional de Colombia, Bogotá, Colombia
| | - Bernardo A Pons-Estel
- Grupo Oroño, Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
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Isnardi CA, Soriano ER, Graf C, de la Vega MC, Pons-Estel BA, Roberts K, Quintana R, Gomez G, Yazdany J, Saurit V, Báez RM, Coello VVC, Pisoni CN, Berbotto G, Vivero F, Zelaya MD, Haye Salinas MJ, Reyes Torres ÁA, Ornella S, Nieto RE, Maldonado FN, Gamba MJ, Severina MDLÁ, Tissera Y, Alba P, Cogo AK, Alle G, Gobbi C, Baños A, Velozo E, Pera M, Tanten R, Albiero JA, Maldonado Ficco H, Martire MV, Elkin MSG, Cosatti M, Cusa MA, Pereira D, Savio VG, Pons-Estel GJ. Does the Use of Immunosuppressive Drugs Impact on SARS-CoV-2 Infection Outcome? Data From A National Cohort of Patients With Immune-Mediated Inflammatory Diseases (SAR-COVID Registry). J Clin Rheumatol 2023; 29:68-77. [PMID: 36454054 PMCID: PMC9940788 DOI: 10.1097/rhu.0000000000001903] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
BACKGROUND/OBJECTIVE This study describes the impact of immunomodulatory and/or immunosuppressive (IM/IS) drugs in the outcomes of COVID-19 infection in a cohort of patients with immune-mediated inflammatory diseases (IMIDs). METHODS Adult patients with IMIDs with a confirmed SARS-CoV-2 infection were included. Data were reported by the treating physician between August 13, 2020 and July 31, 2021. Sociodemographic data, comorbidities, and DMARDs, as well as clinical characteristics, complications, and treatment of the SARS-CoV-2 infection, were recorded. Descriptive analysis and multivariable logistic regression models were carried out. RESULTS A total of 1672 patients with IMIDs were included, of whom 1402 were treated with IM/IS drugs. The most frequent diseases were rheumatoid arthritis (47.7%) and systemic lupus erythematosus (18.4%). COVID-19 symptoms were present in 95.2% of the patients. A total of 461 (27.6%) patients were hospitalized, 8.2% were admitted to the intensive care unit, and 4.4% died due to COVID-19.Patients without IM/IS treatment used glucocorticoids less frequently but at higher doses, had higher levels of disease activity, were significantly older, were more frequently hospitalized, admitted to the intensive care unit, and died due to COVID-19. After adjusting for these factors, treatment with IM/IS drugs was not associated with a worse COVID-19 outcome (World Health Organization-Ordinal Scale ≥5) (odds ratio, 1.24; 95% confidence interval, 0.73-2.06). CONCLUSIONS SAR-COVID is the first multicenter Argentine registry collecting data from patients with rheumatic diseases and SARS-CoV-2 infection. After adjusting for relevant covariates, treatment with IM/IS drugs was not associated with severe COVID-19 in patients with IMIDs. STUDY REGISTRATION This study has been registered in ClinicalTrials.gov under the number NCT04568421.
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Affiliation(s)
| | | | - Cesar Graf
- Argentine Society of Rheumatology, Argentina
| | | | | | | | | | | | - Jinoos Yazdany
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, CA
| | | | | | | | - Cecilia Nora Pisoni
- Centro de Educación Médica e Investigaciones Clínicas, Ciudad Autónoma de Buenos Aires
| | - Guillermo Berbotto
- Hospital Escuela Eva Perón, Granadero Baigorria
- Sanatorio Británico, Chief of the Rheumatology Service, Rosario, Santa Fe
| | | | | | | | | | | | - Romina Estefanía Nieto
- Centro Regional de Enfermedades Autoinmunes y Reumáticas, Rosario, Argentina
- Hospital Escuela Eva Perón, Granadero Baigorria
- Hospital Intendente Carrasco, Rosario, Santa Fe
| | | | | | | | | | - Paula Alba
- Hospital Córdoba, Córdoba
- Hospital Materno-Neonatal
- Hospital Italiano de Córdoba, Córdoba, Córdoba
| | - Adriana Karina Cogo
- Hospital Interzonal Luis Guemes, Haedo
- Hospital San Juan de Dios, Castelar, Buenos Aires
| | - Gelsomina Alle
- Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires
| | - Carla Gobbi
- Cátedra de Clínica Médica I, Hospital Córdoba, FCM, UNC, Córdoba, Córdoba
| | - Andrea Baños
- Fundación CIDEA, Ciudad Autónoma de Buenos Aires
- Sanatorio Adventista del Plata, Libertador San Martín, Entre Ríos
| | - Edson Velozo
- Sanatorio Adventista del Plata, Libertador San Martín, Entre Ríos
| | - Mariana Pera
- Hospital Ángel C Padilla, San Miguel de Tucumán, Tucumán
| | - Romina Tanten
- Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires
| | | | | | | | | | - Micaela Cosatti
- Centro de Educación Médica e Investigaciones Clínicas, Ciudad Autónoma de Buenos Aires
| | | | | | - Verónica G. Savio
- Hospital Córdoba, Córdoba
- Consultora Integral de Salud CMP, Córdoba, Córdoba
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Ugarte-Gil MF, Fuentes-Silva Y, Pimentel-Quiroz VR, Pons-Estel GJ, Quintana R, Pons-Estel BA, Alarcón GS. Global excellence in rheumatology in Latin America: The case of systemic lupus erythematosus. Front Med (Lausanne) 2023; 9:988191. [PMID: 36714141 PMCID: PMC9874001 DOI: 10.3389/fmed.2022.988191] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 12/23/2022] [Indexed: 01/12/2023] Open
Abstract
Systemic lupus erythematosus (SLE) affects more severely non-White populations, due to their genetic background and sociodemographic characteristics. Several studies have evaluated Latin American SLE patients to determine their genetic and clinical characteristics as well as prognostic factors; these studies have not only allowed the development of treatment guidelines aimed at the region but also to support regional and global projects. Additionally, educational activities in Spanish and Portuguese have been started to reduce our patients' health illiteracy. Despite the relatively low research output from Latin American countries, we consider that studies from our region coupled with the networks developed to increase our capabilities, could be a model for other rare autoimmune diseases.
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Affiliation(s)
- Manuel F. Ugarte-Gil
- Grupo Peruano de Estudio de Enfermedades Autoinmunes Sistémicas, School of Medicine, Universidad Científica del Sur, Lima, Peru,Department Rheumatology, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Peru,*Correspondence: Manuel F. Ugarte-Gil,
| | | | - Victor R. Pimentel-Quiroz
- Grupo Peruano de Estudio de Enfermedades Autoinmunes Sistémicas, School of Medicine, Universidad Científica del Sur, Lima, Peru,Department Rheumatology, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Peru
| | - Guillermo J. Pons-Estel
- Grupo Oroño, Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
| | - Rosana Quintana
- Grupo Oroño, Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
| | - Bernardo A. Pons-Estel
- Grupo Oroño, Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
| | - Graciela S. Alarcón
- Marnix E. Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, United States,Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru
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Isnardi CA, Roberts K, Saurit V, Petkovic I, Báez RM, Quintana R, Tissera Y, Ornella S, D.Angelo Exeni ME, Pisoni CN, Castro Coello VV, Berbotto G, Haye Salinas MJ, Velozo E, Reyes Torres ÁA, Tanten R, Zelaya MD, Gobbi C, Alonso CG, de los Ángeles Severina M, Vivero F, Paula A, Cogo AK, Alle G, Pera M, Nieto RE, Cosatti M, Asnal C, Pereira D, Albiero JA, Savio VG, Maldonado FN, Gamba MJ, Germán NF, Baños A, Gallino Yanzi J, Gálvez Elkin MS, Morbiducci JS, Martire MV, Maldonado Ficco H, Schmid MM, Villafañe Torres JA, de los Ángeles Correa M, Medina MA, Cusa MA, Scafati J, Agüero SE, Lloves Schenone NM, Soriano ER, Graf C, Pons-Estel BA, Gomez G, Landi M, De la Vega MC, Pons-Estel GJ. Sociodemographic and clinical factors associated with poor COVID-19 outcomes in patients with rheumatic diseases: data from the SAR-COVID Registry. Clin Rheumatol 2023; 42:563-578. [PMID: 36201124 PMCID: PMC9535223 DOI: 10.1007/s10067-022-06393-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 09/22/2022] [Accepted: 09/23/2022] [Indexed: 01/29/2023]
Abstract
BACKGROUND/OBJECTIVE This study aims to describe the course and to identify poor prognostic factors of SARS-CoV-2 infection in patients with rheumatic diseases. METHODS Patients ≥ 18 years of age, with a rheumatic disease, who had confirmed SARS-CoV-2 infection were consecutively included by major rheumatology centers from Argentina, in the national, observational SAR-COVID registry between August 13, 2020 and July 31, 2021. Hospitalization, oxygen requirement, and death were considered poor COVID-19 outcomes. RESULTS A total of 1915 patients were included. The most frequent rheumatic diseases were rheumatoid arthritis (42%) and systemic lupus erythematosus (16%). Comorbidities were reported in half of them (48%). Symptoms were reported by 95% of the patients, 28% were hospitalized, 8% were admitted to the intensive care unit (ICU), and 4% died due to COVID-19. During hospitalization, 9% required non-invasive mechanical ventilation (NIMV) or high flow oxygen devices and 17% invasive mechanical ventilation (IMV). In multivariate analysis models, using poor COVID-19 outcomes as dependent variables, older age, male gender, higher disease activity, treatment with glucocorticoids or rituximab, and the presence of at least one comorbidity and a greater number of them were associated with worse prognosis. In addition, patients with public health insurance and Mestizos were more likely to require hospitalization. CONCLUSIONS In addition to the known poor prognostic factors, in this cohort of patients with rheumatic diseases, high disease activity, and treatment with glucocorticoids and rituximab were associated with worse COVID-19 outcomes. Furthermore, patients with public health insurance and Mestizos were 44% and 39% more likely to be hospitalized, respectively. STUDY REGISTRATION This study has been registered in ClinicalTrials.gov under the number NCT04568421. Key Points • High disease activity, and treatment with glucocorticoids and rituximab were associated with poor COVID-19 outcome in patients with rheumatic diseases. • Some socioeconomic factors related to social inequality, including non-Caucasian ethnicity and public health insurance, were associated with hospitalization due to COVID-19.
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Affiliation(s)
- Carolina A. Isnardi
- Present Address: Unidad de Investigación de la Sociedad Argentina de Reumatología, Buenos Aires, Argentina
| | - Karen Roberts
- Present Address: Unidad de Investigación de la Sociedad Argentina de Reumatología, Buenos Aires, Argentina
| | - Verónica Saurit
- grid.413199.70000 0001 0368 1276Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | | | - Roberto M. Báez
- Hospital Francisco López Lima, General Roca, Río Negro, Argentina
| | - Rosana Quintana
- Present Address: Centro Regional de Enfermedades Autoinmunes Y Reumáticas, Rosario, Argentina
| | - Yohana Tissera
- grid.497623.dPresent Address: Hospital Córdoba, Córdoba, Argentina
| | - Sofía Ornella
- HIGA San Martín de La Plata, La Plata, Buenos Aires, Argentina
| | | | - Cecilia N. Pisoni
- grid.418248.30000 0004 0637 5938CEMIC—Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires, Argentina
| | | | - Guillermo Berbotto
- Hospital Escuela Eva Perón, Sanatorio Británico, Granadero Baigorria; Rosario, Santa Fe, Argentina
| | - María J. Haye Salinas
- grid.441659.b0000 0001 2201 7776CEMMA, Universidad Nacional de La Rioja, La Rioja, Argentina
| | - Edson Velozo
- grid.441666.70000 0001 2284 8908Sanatorio y Universidad Adventista del Plata, Libertador San Martín, Entre Ríos, Argentina
| | - Álvaro A. Reyes Torres
- grid.414775.40000 0001 2319 4408Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Romina Tanten
- grid.414775.40000 0001 2319 4408Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Carla Gobbi
- grid.10692.3c0000 0001 0115 2557Cátedra de Clínica Médica I, Hospital Córdoba, FCM, UNC, Córdoba, Argentina
| | | | | | | | - Alba Paula
- Hospital Materno-Neonatal, Córdoba, Argentina
| | - Adriana K. Cogo
- Hospital Interzonal Luis Guemes, Haedo; Hospital San Juan de Dios, Castelar, Buenos Aires, Argentina
| | - Gelsomina Alle
- grid.414775.40000 0001 2319 4408Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Mariana Pera
- Hospital Ángel C Padilla, San Miguel de Tucumán, Tucumán, Argentina
| | | | - Micaela Cosatti
- grid.418248.30000 0004 0637 5938CEMIC—Centro de Educación Médica e Investigaciones Clínicas, Buenos Aires, Argentina
| | | | | | | | | | | | | | | | - Andrea Baños
- Fundación CIDEA, Ciudad Autónoma de Buenos Aires, Sindicato Empleados de Junín, Junín, Buenos Aires, Argentina
| | | | | | | | | | | | | | | | - Maria de los Ángeles Correa
- grid.419103.eInstituto de Rehabilitación Psicofísica, Instituto de Diagnóstico E Investigaciones Metabólicas, Buenos Aires, Argentina
| | | | | | - Julia Scafati
- HIGA San Martín de La Plata, La Plata, Buenos Aires, Argentina
| | - Santiago E. Agüero
- Centro de Rehabilitación Dr Mauricio Figueroa, Artrosport Catamarca, San Fernando del Valle de Catamarca, Catamarca, Argentina
| | | | - Enrique R. Soriano
- grid.414775.40000 0001 2319 4408Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Cesar Graf
- Sociedad Argentina de Reumatología, Buenos Aires, Argentina
| | - Bernardo A. Pons-Estel
- Present Address: Centro Regional de Enfermedades Autoinmunes Y Reumáticas, Rosario, Argentina
| | - Gimena Gomez
- Present Address: Unidad de Investigación de la Sociedad Argentina de Reumatología, Buenos Aires, Argentina
| | - Margarita Landi
- Present Address: Unidad de Investigación de la Sociedad Argentina de Reumatología, Buenos Aires, Argentina
| | | | - Guillermo J. Pons-Estel
- Present Address: Unidad de Investigación de la Sociedad Argentina de Reumatología, Buenos Aires, Argentina
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Isnardi CA, Cerda OL, Landi M, Cruces L, Schneeberger EE, Montoro CC, Alfaro MA, Roldán BM, Gómez Vara AB, Giorgis P, Ezquer RA, Crespo Rocha MG, Reyes Gómez CR, de Los Ángeles Correa M, Rosemffet MG, Abarza VC, Pellet SC, Perandones M, Reimundes C, Longueira Y, Turk G, Quiroga MF, Laufer N, Quintana R, de la Vega MC, Kreplak N, Pifano M, Maid P, Pons-Estel GJ, Citera G. Immune Response to SARS-CoV-2 Third Vaccine in Patients With Rheumatoid Arthritis Who Had No Seroconversion After Primary 2-Dose Regimen With Inactivated or Vector-Based Vaccines. J Rheumatol 2022; 49:1385-1389. [PMID: 36182107 DOI: 10.3899/jrheum.220469] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The aim of this study was to assess the immune response after a third dose of SARS-CoV-2 vaccine in patients with rheumatoid arthritis (RA) with undetectable antibody titers after the primary regimen of 2 doses. METHODS Patients with RA with no seroconversion after 2 doses of SARS-CoV-2 vaccine and who received a third dose of either an mRNA or vector-based vaccine were included. Anti-SARS-CoV-2 IgG antibodies, neutralizing activity, and T cell responses were assessed after the third dose. RESULTS A total of 21 nonresponder patients were included. At the time of vaccination, 29% were receiving glucocorticoids and 85% biologic disease-modifying antirheumatic drugs (including 6 taking abatacept [ABA] and 4 taking rituximab [RTX]). The majority (95%) received the BNT162b2 vaccine and only one of them received the ChAdOx1 nCoV-19 vaccine. After the third dose, 91% of the patients presented detectable anti-SARS-CoV-2 IgG and 76% showed neutralizing activity. Compared to other treatments, ABA and RTX were associated with the absence of neutralizing activity in 4 out of 5 (80%) patients and lower titers of neutralizing antibodies (median 3, IQR 0-20 vs 8, IQR 4-128; P = 0.20). Specific T cell response was detected in 41% of all patients after the second dose, increasing to 71% after the third dose. The use of ABA was associated with a lower frequency of T cell response (33% vs 87%, P = 0.03). CONCLUSION In this RA cohort, 91% of patients who failed to seroconvert after 2 doses of SARS-CoV-2 vaccine presented detectable anti-SARS-CoV-2 IgG after a third dose. The use of ABA was associated with a lower frequency of specific T cell response.
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Affiliation(s)
- Carolina A Isnardi
- C.A. Isnardi, MD, Research Unit - Argentine Society of Rheumatology, and Instituto de Rehabilitación Psicofísica, Rheumatology Section
| | - Osvaldo L Cerda
- O.L. Cerda, MD, E.E. Schneeberger, MD, M.A. Alfaro, MD, B.M. Roldán, MD, A.B. Gómez Vara, MD, P. Giorgis, MD, R.A. Ezquer, MD, M.G. Crespo Rocha, MD, C.R. Reyes Gómez, MD, M.Á. Correa, MD, M.G. Rosemffet, MD, V.C. Abarza, MD, M. Perandones, MD, G. Citera, MD, Instituto de Rehabilitación Psicofísica, Rheumatology Section
| | - Margarita Landi
- M. Landi, MD, C. Calle Montoro, MD, S. Catalan Pellet, MD, C. Reimundes, MD, P. Maid, MD, Austral University Hospital, Rheumatology Department
| | - Leonel Cruces
- L. Cruces, BCh, Y. Longueira, MSc, G. Turk, PhD, M.F. Quiroga, PhD, N. Laufer, MD, PhD, Universidad de Buenos Aires, Consejo Nacional de Investigaciones Científicas y Técnicas, Instituto de Investigaciones Biomédicas en Retrovirus y Sida (INBIRS), Facultad de Medicina, Ciudad Autónoma de Buenos Aires
| | - Emilce E Schneeberger
- O.L. Cerda, MD, E.E. Schneeberger, MD, M.A. Alfaro, MD, B.M. Roldán, MD, A.B. Gómez Vara, MD, P. Giorgis, MD, R.A. Ezquer, MD, M.G. Crespo Rocha, MD, C.R. Reyes Gómez, MD, M.Á. Correa, MD, M.G. Rosemffet, MD, V.C. Abarza, MD, M. Perandones, MD, G. Citera, MD, Instituto de Rehabilitación Psicofísica, Rheumatology Section
| | - Claudia Calle Montoro
- M. Landi, MD, C. Calle Montoro, MD, S. Catalan Pellet, MD, C. Reimundes, MD, P. Maid, MD, Austral University Hospital, Rheumatology Department
| | - María Agustina Alfaro
- O.L. Cerda, MD, E.E. Schneeberger, MD, M.A. Alfaro, MD, B.M. Roldán, MD, A.B. Gómez Vara, MD, P. Giorgis, MD, R.A. Ezquer, MD, M.G. Crespo Rocha, MD, C.R. Reyes Gómez, MD, M.Á. Correa, MD, M.G. Rosemffet, MD, V.C. Abarza, MD, M. Perandones, MD, G. Citera, MD, Instituto de Rehabilitación Psicofísica, Rheumatology Section
| | - Brian M Roldán
- O.L. Cerda, MD, E.E. Schneeberger, MD, M.A. Alfaro, MD, B.M. Roldán, MD, A.B. Gómez Vara, MD, P. Giorgis, MD, R.A. Ezquer, MD, M.G. Crespo Rocha, MD, C.R. Reyes Gómez, MD, M.Á. Correa, MD, M.G. Rosemffet, MD, V.C. Abarza, MD, M. Perandones, MD, G. Citera, MD, Instituto de Rehabilitación Psicofísica, Rheumatology Section
| | - Andrea B Gómez Vara
- O.L. Cerda, MD, E.E. Schneeberger, MD, M.A. Alfaro, MD, B.M. Roldán, MD, A.B. Gómez Vara, MD, P. Giorgis, MD, R.A. Ezquer, MD, M.G. Crespo Rocha, MD, C.R. Reyes Gómez, MD, M.Á. Correa, MD, M.G. Rosemffet, MD, V.C. Abarza, MD, M. Perandones, MD, G. Citera, MD, Instituto de Rehabilitación Psicofísica, Rheumatology Section
| | - Pamela Giorgis
- O.L. Cerda, MD, E.E. Schneeberger, MD, M.A. Alfaro, MD, B.M. Roldán, MD, A.B. Gómez Vara, MD, P. Giorgis, MD, R.A. Ezquer, MD, M.G. Crespo Rocha, MD, C.R. Reyes Gómez, MD, M.Á. Correa, MD, M.G. Rosemffet, MD, V.C. Abarza, MD, M. Perandones, MD, G. Citera, MD, Instituto de Rehabilitación Psicofísica, Rheumatology Section
| | - Roberto Alejandro Ezquer
- O.L. Cerda, MD, E.E. Schneeberger, MD, M.A. Alfaro, MD, B.M. Roldán, MD, A.B. Gómez Vara, MD, P. Giorgis, MD, R.A. Ezquer, MD, M.G. Crespo Rocha, MD, C.R. Reyes Gómez, MD, M.Á. Correa, MD, M.G. Rosemffet, MD, V.C. Abarza, MD, M. Perandones, MD, G. Citera, MD, Instituto de Rehabilitación Psicofísica, Rheumatology Section
| | - María G Crespo Rocha
- O.L. Cerda, MD, E.E. Schneeberger, MD, M.A. Alfaro, MD, B.M. Roldán, MD, A.B. Gómez Vara, MD, P. Giorgis, MD, R.A. Ezquer, MD, M.G. Crespo Rocha, MD, C.R. Reyes Gómez, MD, M.Á. Correa, MD, M.G. Rosemffet, MD, V.C. Abarza, MD, M. Perandones, MD, G. Citera, MD, Instituto de Rehabilitación Psicofísica, Rheumatology Section
| | - Camila R Reyes Gómez
- O.L. Cerda, MD, E.E. Schneeberger, MD, M.A. Alfaro, MD, B.M. Roldán, MD, A.B. Gómez Vara, MD, P. Giorgis, MD, R.A. Ezquer, MD, M.G. Crespo Rocha, MD, C.R. Reyes Gómez, MD, M.Á. Correa, MD, M.G. Rosemffet, MD, V.C. Abarza, MD, M. Perandones, MD, G. Citera, MD, Instituto de Rehabilitación Psicofísica, Rheumatology Section
| | - Mária de Los Ángeles Correa
- O.L. Cerda, MD, E.E. Schneeberger, MD, M.A. Alfaro, MD, B.M. Roldán, MD, A.B. Gómez Vara, MD, P. Giorgis, MD, R.A. Ezquer, MD, M.G. Crespo Rocha, MD, C.R. Reyes Gómez, MD, M.Á. Correa, MD, M.G. Rosemffet, MD, V.C. Abarza, MD, M. Perandones, MD, G. Citera, MD, Instituto de Rehabilitación Psicofísica, Rheumatology Section
| | - Marcos G Rosemffet
- O.L. Cerda, MD, E.E. Schneeberger, MD, M.A. Alfaro, MD, B.M. Roldán, MD, A.B. Gómez Vara, MD, P. Giorgis, MD, R.A. Ezquer, MD, M.G. Crespo Rocha, MD, C.R. Reyes Gómez, MD, M.Á. Correa, MD, M.G. Rosemffet, MD, V.C. Abarza, MD, M. Perandones, MD, G. Citera, MD, Instituto de Rehabilitación Psicofísica, Rheumatology Section
| | - Virginia Carrizo Abarza
- O.L. Cerda, MD, E.E. Schneeberger, MD, M.A. Alfaro, MD, B.M. Roldán, MD, A.B. Gómez Vara, MD, P. Giorgis, MD, R.A. Ezquer, MD, M.G. Crespo Rocha, MD, C.R. Reyes Gómez, MD, M.Á. Correa, MD, M.G. Rosemffet, MD, V.C. Abarza, MD, M. Perandones, MD, G. Citera, MD, Instituto de Rehabilitación Psicofísica, Rheumatology Section
| | - Santiago Catalan Pellet
- M. Landi, MD, C. Calle Montoro, MD, S. Catalan Pellet, MD, C. Reimundes, MD, P. Maid, MD, Austral University Hospital, Rheumatology Department
| | - Miguel Perandones
- O.L. Cerda, MD, E.E. Schneeberger, MD, M.A. Alfaro, MD, B.M. Roldán, MD, A.B. Gómez Vara, MD, P. Giorgis, MD, R.A. Ezquer, MD, M.G. Crespo Rocha, MD, C.R. Reyes Gómez, MD, M.Á. Correa, MD, M.G. Rosemffet, MD, V.C. Abarza, MD, M. Perandones, MD, G. Citera, MD, Instituto de Rehabilitación Psicofísica, Rheumatology Section
| | - Cecilia Reimundes
- M. Landi, MD, C. Calle Montoro, MD, S. Catalan Pellet, MD, C. Reimundes, MD, P. Maid, MD, Austral University Hospital, Rheumatology Department
| | - Yesica Longueira
- L. Cruces, BCh, Y. Longueira, MSc, G. Turk, PhD, M.F. Quiroga, PhD, N. Laufer, MD, PhD, Universidad de Buenos Aires, Consejo Nacional de Investigaciones Científicas y Técnicas, Instituto de Investigaciones Biomédicas en Retrovirus y Sida (INBIRS), Facultad de Medicina, Ciudad Autónoma de Buenos Aires
| | - Gabriela Turk
- L. Cruces, BCh, Y. Longueira, MSc, G. Turk, PhD, M.F. Quiroga, PhD, N. Laufer, MD, PhD, Universidad de Buenos Aires, Consejo Nacional de Investigaciones Científicas y Técnicas, Instituto de Investigaciones Biomédicas en Retrovirus y Sida (INBIRS), Facultad de Medicina, Ciudad Autónoma de Buenos Aires
| | - María Florencia Quiroga
- L. Cruces, BCh, Y. Longueira, MSc, G. Turk, PhD, M.F. Quiroga, PhD, N. Laufer, MD, PhD, Universidad de Buenos Aires, Consejo Nacional de Investigaciones Científicas y Técnicas, Instituto de Investigaciones Biomédicas en Retrovirus y Sida (INBIRS), Facultad de Medicina, Ciudad Autónoma de Buenos Aires
| | - Natalia Laufer
- L. Cruces, BCh, Y. Longueira, MSc, G. Turk, PhD, M.F. Quiroga, PhD, N. Laufer, MD, PhD, Universidad de Buenos Aires, Consejo Nacional de Investigaciones Científicas y Técnicas, Instituto de Investigaciones Biomédicas en Retrovirus y Sida (INBIRS), Facultad de Medicina, Ciudad Autónoma de Buenos Aires
| | - Rosana Quintana
- R. Quintana, MD, G.J. Pons-Estel, MD, PhD, Research Unit - Argentine Society of Rheumatology
| | | | - Nicolás Kreplak
- N. Kreplak, MD, MPH, M. Pifano, MSc, Ministry of Health of the Province of Buenos Aires, Buenos Aires, Argentina
| | - Marina Pifano
- N. Kreplak, MD, MPH, M. Pifano, MSc, Ministry of Health of the Province of Buenos Aires, Buenos Aires, Argentina
| | - Pablo Maid
- M. Landi, MD, C. Calle Montoro, MD, S. Catalan Pellet, MD, C. Reimundes, MD, P. Maid, MD, Austral University Hospital, Rheumatology Department
| | - Guillermo J Pons-Estel
- R. Quintana, MD, G.J. Pons-Estel, MD, PhD, Research Unit - Argentine Society of Rheumatology
| | - Gustavo Citera
- O.L. Cerda, MD, E.E. Schneeberger, MD, M.A. Alfaro, MD, B.M. Roldán, MD, A.B. Gómez Vara, MD, P. Giorgis, MD, R.A. Ezquer, MD, M.G. Crespo Rocha, MD, C.R. Reyes Gómez, MD, M.Á. Correa, MD, M.G. Rosemffet, MD, V.C. Abarza, MD, M. Perandones, MD, G. Citera, MD, Instituto de Rehabilitación Psicofísica, Rheumatology Section
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Erton ZB, K Leaf R, de Andrade D, Clarke AE, Tektonidou MG, Pengo V, Sciascia S, Ugarte A, Belmont HM, Gerosa M, Fortin PR, Lopez-Pedrera C, Atsumi T, Zhang Z, Cohen H, Ramires de Jesús G, Branch DW, Wahl D, Andreoli L, Rodriguez-Almaraz E, Petri M, Barilaro G, Zuo Y, Artim-Esen B, Willis R, Quintana R, Vendramini MB, Barber MW, Bertolaccini ML, Roubey R, Erkan D. Immunosuppression use in primary antiphospholipid antibody-positive patients: Descriptive analysis of the AntiPhospholipid Syndrome Alliance for Clinical Trials and InternatiOnal Networking (APS ACTION) Clinical Database and Repository ("Registry"). Lupus 2022; 31:1770-1776. [PMID: 36206383 DOI: 10.1177/09612033221128742] [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
BACKGROUND/PURPOSE APS ACTION Registry was created to study the outcomes of patients with persistently positive antiphospholipid antibodies (aPL) with or without other systemic autoimmune disease (SAIDx). Given that immunosuppression (IS) is used for certain aPL manifestations, for example, thrombocytopenia (TP), our primary objective was to describe the indications for IS in aPL-positive patients without other SAIDx. Secondly, we report the type of IS used in patients with selected microvascular or non-thrombotic aPL manifestations. METHODS An online database is used to collect clinical data. The inclusion criteria are positive aPL based on the laboratory section of the APS Classification Criteria, tested at least twice within one year prior to enrollment. Patients are followed every 12 ± 3 months. For this descriptive retrospective and prospective analysis, we included aPL-positive patients without other SAIDx and excluded those with new SAIDx classification during follow-up. For each patient, we retrieved clinical data at baseline and follow-up including selected aPL manifestations (diffuse alveolar hemorrhage [DAH], antiphospholipid-nephropathy [aPL-N], livedoid vasculopathy [LV]-related skin ulcers, TP, autoimmune hemolytic anemia [AIHA], cardiac valve disease [VD]), and IS medications. RESULTS Of 899 patients enrolled, 537 were included in this analysis (mean age 45 ± 13 years, female 377 [70%], APS Classification in 438 [82%], and at least one selected microvascular or non-thrombotic aPL manifestation in 141 (26%)). Of 537 patients, 76 (14%) were reported to use IS (ever), and 41/76 (54%) received IS primarily for selected aPL manifestation. In six of 8 (75%) DAH patients, 6/19 (32%) aPL-N, 4/28 (14%) LV, 25/88 (28%) TP, 6/11 (55%) AIHA, and 1/43 (2%) VD, the IS (excluding corticosteroids/hydroxychloroquine) indication was specific for selected aPL manifestation. CONCLUSION In our international cohort, 14% of aPL-positive patients without other SAIDx were reported to receive IS; the indication was at least one of the selected microvascular and/or non-thrombotic aPL-related manifestations in half. Thrombocytopenia was the most frequent among those selected aPL-related manifestations; however, approximately one-third received IS specifically for that indication. Diffuse alveolar hemorrhage was frequently treated with IS followed by AIHA and aPL-N. Systematic controlled studies are urgently needed to better define the role of IS in APS.
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Affiliation(s)
- Zeynep B Erton
- Rheumatology, 25062Hospital for Special Surgery, New York, NY, USA
| | - Rebecca K Leaf
- Hematology, 2348Massachusetts General Hospital, Boston, MA, USA
| | | | - Ann E Clarke
- Clinical Epidemiology, University of Calgary, Calgary, AB, Canada
| | - Maria G Tektonidou
- Pathophysiology, National and Kapodistrian University of Athens, Athens, Greece
| | - Vittorio Pengo
- Cardiothoracic and Vascular Sciences, Padova University Hospital, Padova, Italy
| | - Savino Sciascia
- Centro Multidisciplinare di Ricerche di Immunopatologia e Documentazione su Malattie Rare, Struttura Complessa a Direzione Universitaria di Immunologia Clinica, University of Turin, Turin, Italy
| | - Amaia Ugarte
- Rheumatology, BioCruces Bizkaia Health Research Institute, Barakaldo, Spain
| | - H Michael Belmont
- Rheumatology, New York University Langone Medical Center, New York, NY, USA
| | - Maria Gerosa
- Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Paul R Fortin
- Rheumatology, CHU de Québec- Université Laval, Quebec, QC, Canada
| | - Chary Lopez-Pedrera
- Rheumatology, Maimonides Institute for Biomedical Research of Córdoba, Córdoba, Spain
| | - Tatsuya Atsumi
- Medicine II, Hokkaido University Hospital, Sapporo, Japan
| | - Zhouli Zhang
- Rheumatology, Peking University First Hospital, Beijing, China
| | - Hannah Cohen
- Haematology, 4919University College London, London, UK
| | | | - David W Branch
- Obstetrics and Gynecology, 14434University of Utah and Intermountain Healthcare, Salt Lake City, UT, USA
| | - Denis Wahl
- Rheumatology, Université de Lorraine, Inserm DCAC, and CHRU-Nancy, Nancy, France
| | | | | | - Michelle Petri
- Rheumatology, 1466Johns Hopkins University, Baltimore, MD, USA
| | | | - Yu Zuo
- Rheumatology, University of Michigan, Ann Arbor, MI, USA
| | - Bahar Artim-Esen
- Internal Medicine, Rheumatology, Istanbul University School of Medicine, Istanbul, Turkey
| | - Rohan Willis
- Internal Medicine, 12334University of Texas Medical Branch, Galveston, TX, USA
| | - Rosana Quintana
- Internal Medicine, Centro Regional de Enfermedades Autoinmunes y Reumáticas GO-CREAR, Rosario Santa Fe Argentina
| | | | - Megan W Barber
- Clinical Epidemiology, University of Calgary, Calgary, AB, Canada
| | | | - Robert Roubey
- Rheumatology, Allergy & Immunolog, University of North Carolina, Chapel Hill, NC, USA
| | - Doruk Erkan
- Barbara Volcker Center for Women and Rheumatic Disease, 25062Hospital for Special Surgery Weill Cornell Medicine, New York, NY, USA
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Maguire S, Al-Emadi S, Alba P, Aguiar MC, Lawati TA, Alle G, Bermas B, Bhana S, Branimir A, Bulina I, Clowse M, Cogo K, Colunga I, Cook C, Cortez KJ, Dao K, Gianfrancesco M, Gore-Massey M, Gossec L, Grainger R, Hausman J, Hsu TYT, Hyrich K, Isnardi C, Kawano Y, Kilding R, Kusevich DA, Lawson-Tovey S, Liew J, McCarthy E, Montgumery A, Moyano S, Nasir N, Padjen I, Papagoras C, Patel NJ, Pera M, Pisoni C, Pons-Estel G, Quiambao AL, Quintana R, Ruderman E, Sattui S, Savio V, Sciascia S, Sencarova M, Morales RS, Siddique F, Sirotich E, Sparks J, Strangfeld A, Sufka P, Tanner H, Tissera Y, Wallace Z, Werner ML, Wise L, Worthing AB, Zell J, Zepa J, Machado PM, Yazdany J, Robinson P, Conway R. Obstetric Outcomes in Women with Rheumatic Disease and COVID-19 in the Context of Vaccination Status. Rheumatology (Oxford) 2022; 62:1621-1626. [PMID: 36124987 DOI: 10.1093/rheumatology/keac534] [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: 06/11/2022] [Revised: 08/30/2022] [Accepted: 09/04/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To describe obstetric outcomes based on COVID-19 vaccination status, in women with rheumatic and musculoskeletal diseases (RMDs) who developed COVID-19 during pregnancy. METHODS Data regarding pregnant women entered into the COVID-19 Global Rheumatology Alliance registry from 24 March 2020-25 February 2022 were analysed. Obstetric outcomes were stratified by number of COVID-19 vaccine doses received prior to COVID-19 infection in pregnancy. Descriptive differences between groups were tested using the chi -square or Fisher's exact test. RESULTS There were 73 pregnancies in 73 women with RMD and COVID-19. Overall, 24.7% (18) of pregnancies were ongoing, while of the 55 completed pregnancies 90.9% (50) of pregnancies resulted in livebirths. At the time of COVID-19 diagnosis, 60.3% (n = 44) of women were unvaccinated, 4.1% (n = 3) had received one vaccine dose while 35.6% (n = 26) had two or more doses. Although 83.6% (n = 61) of women required no treatment for COVID-19, 20.5% (n = 15) required hospital admission. COVID-19 resulted in delivery in 6.8% (n = 3) of unvaccinated women and 3.8% (n = 1) of fully vaccinated women. There was a greater number of preterm births (PTB) in unvaccinated women compared with fully vaccinated 29.5% (n = 13) vs 18.2%(n = 2). CONCLUSION In this descriptive study, unvaccinated pregnant women with RMD and COVID-19 had a greater number of PTB compared with those fully vaccinated against COVID-19. Additionally, the need for COVID-19 pharmacological treatment was uncommon in pregnant women with RMD regardless of vaccination status. These results support active promotion of COVID-19 vaccination in women with RMD who are pregnant or planning a pregnancy.
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Affiliation(s)
- Sinead Maguire
- Department of Rheumatology, St James's Hospital, Dublin, Ireland.,School of Medicine, Trinity College Dublin, Ireland
| | - Samar Al-Emadi
- Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Paula Alba
- Hospital Cordoba, Rheumatology Unit, Cordoba, Argentina.,Universidad Nacional de Cordoba, School of Medicine, Cordoba, Argentina
| | | | - Talal Al Lawati
- Department of Rheumatology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Gelsomina Alle
- Department of Rheumatology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Suleman Bhana
- Department of Rheumatology, Crystal Run Healthcare, Middleton, New York, USA
| | - Anic Branimir
- School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia.,University of Zagreb, Division of Immunology and Rheumatology, Department of Internal Medicine, Zagreb, Croatia
| | - Inita Bulina
- Department of Rheumatology, Paul Stradins Clinical University Hospital, Riga, Latvia.,Department of Internal Diseases, Riga Stradins University, Riga, Latvia
| | - Megan Clowse
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Karina Cogo
- Department of Rheumatology, Hospital Interzonal Luis Guemes, Buenos Aires, Argentina.,Hospital San Juan De Dios, Department of Rheumatology, Buenos Aires, Argentina
| | - Iris Colunga
- Hospital Universitario Dr Jose Eleuterio Gonzalez, Department of Rheumatology, Monterrey, Mexico
| | - Claire Cook
- Division of Rheumatology, Massachusetts General Hospital, Allergy & Immunology, Boston, Massachusetts, USA
| | - Karen J Cortez
- Baguio General Hospital and Medical Center, Department of Rheumatology, Baguio City, Philippines
| | - Kathryn Dao
- UT Southwestern Medical Center, Dallas, Texas, USA
| | - Milena Gianfrancesco
- Division of Rheumatology, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | | | - Laure Gossec
- Sorbonne Universite, Paris, France.,Pitie-Salpetriere Hospital, Paris, France
| | - Rebecca Grainger
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Jonathon Hausman
- Department of Pediatric Rheumatology, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Rheumatology and Clinical Immunology, Beth Isreal Deaconess Medical Center, Boston, Massachusetts, USA
| | - Tiffany Y T Hsu
- Brigham and Women's Hospital, Division of Rheumatology, Inflammation and Immunity, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Kimme Hyrich
- The University of Manchester, Centre for Epidemiology Versus Arthritis, Manchester, UK.,Department of MSK Research, Manchester Academic Health Science Centre, Manchester, UK.,Department of Biomedical Research, UK and National Institute of Health Research Manchester, Manchester, UK
| | - Carolina Isnardi
- Argenitine Society of Rheumatology, Research Unit, Buenos Aires, Argentina
| | - Yumeko Kawano
- Brigham and Women's Hospital, Division of Rheumatology, Inflammation and Immunity, Boston, Massachusetts, USA
| | - Rachael Kilding
- Department of Rheumatology, Sheffield Teaching Hospitals, NHS Foundation Trust, Sheffield, UK
| | - Daria A Kusevich
- Nasonova Research Institute of Rheumatology, Department of Rheumatology, Vidnoe, Russia
| | - Saskia Lawson-Tovey
- Department of MSK Research, Manchester Academic Health Science Centre, Manchester, UK.,UK and National Institute of Health Research Manchester, Department of Biomedical Research, Manchester, UK.,University of Manchester, Centre for Musculoskeletal Research, Centre for Genetics and Genomics Versus Arthritis, Manchester, UK.,Department of Biomedical Research, Manchester University NHS Foundation Trust, Manchester, UK
| | - Jean Liew
- Boston University School of Medicine, Boston, Massachusetts, USA
| | - Eoghan McCarthy
- Department of Rheumatology, Beaumont Hospital, Dublin, Ireland
| | - Anna Montgumery
- University of California San Francisco, Division of Rheumatology, Department of Medicine, San Francisco, California, USA.,VA Medical Center, Department of Health Research, San Francisco, California, USA
| | - Sebastian Moyano
- Department of Rheumatology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Noreen Nasir
- The Aga Khan University Hospital, Section of Internal Medicine, Department of Medicine, Karachi, Pakistan
| | - Ivan Padjen
- School of Medicine, University Hospital Centre Zagreb, Zagreb, Croatia.,University of Zagreb, Division of Immunology and Rheumatology, Department of Internal Medicine, Zagreb, Croatia
| | - Charalampos Papagoras
- Democritus University of Thrace, First Department of Internal Medicine, Alexandroupolis, Greece
| | - Naomi J Patel
- Massachusetts General Hospital, Division of Rheumatology, Allergy & Immunology, Boston, Massachusetts, USA
| | - Mariana Pera
- Hospital Angel C Padilla, Department of Rheumatology, Tucuman, Argentina
| | - Cecilia Pisoni
- CEMIC, Rheumatology and Immunology Section, Department of Internal Medicine, Buenos Aires, Argentina
| | - Guillermo Pons-Estel
- Sheffield Teaching Hospitals, NHS Foundation Trust, Department of Rheumatology, Sheffield, UK
| | - Antonio L Quiambao
- East Avenue Medical Center, Department of Rheumatology, Quezon City, Philippines
| | - Rosana Quintana
- Argenitine Society of Rheumatology, Research Unit, Buenos Aires, Argentina
| | - Eric Ruderman
- Northwestern University Feinberg School of Medicine, Department of Medicine/Rheumatology, Chicago, Illinois, USA
| | - Sebastian Sattui
- University of Pittsburgh, Department of Rheumatology, Pittsburgh, Pennsylvania, USA
| | | | - Savino Sciascia
- Osedale San Giovanni Bosco, Centro Multidisciplinare de Recerche di Immunopatologia e Documentazione su Malattie Rare (C.M.I.D.), Turin, Italy
| | - Marieta Sencarova
- Univerzitna Nemocnica L Pasteura, Department of Rheumatology, Slovakia
| | - Rosa Serrano Morales
- Centro Regional de Enfermedades Autoinmunes y Reumaticas (GO-CREAR), Rosario, Argentina
| | - Faizah Siddique
- Department of Rheumatology, Loyola University Medical Center, Maywood, Illinois, USA
| | - Emily Sirotich
- McMaster University, Department of Health Research, Evidence and Impact, Hamilton, Ontario, Canada
| | - Jeffrey Sparks
- Brigham and Women's Hospital, Division of Rheumatology, Inflammation and Immunity, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Anja Strangfeld
- German Rheumatism Research Centre, Epidemiology Unit, Berlin, Germany
| | - Paul Sufka
- Healthcare Partners, St Paul, Minnesota, USA
| | - Helen Tanner
- Royal Brisbane and Women's Hospital, Department of Rheumatology, Queensland, Australia.,University of Queensland, Royal Brisbane Clinical Unit, Queensland, Australia
| | | | - Zachary Wallace
- Massachusetts General Hospital, Division of Rheumatology, Allergy & Immunology, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Marina L Werner
- Hospital Nacional de Clinicas, Department of Rheumatology, Cordoba, Argentina
| | - Leanna Wise
- University of Southern California, Keck School of Medicine, Los Angelos, California, USA
| | - Angus B Worthing
- Department of Rheumatology, Arthritis and Rheumatism Associates PC, Washington, DC, USA.,Georgetown University Medical Center, Washington, DC, USA
| | - JoAnn Zell
- Division of Rheumatology, University of Colorado Health, Aurora, Colorado, USA
| | - Julija Zepa
- Department of Rheumatology, Paul Stradins Clinical University Hospital, Latvia, Riga.,Riga Stradins University, School of Medicine, Latvia, Riga
| | - Pedro M Machado
- Centre for Rheumatology & Department of Neuromuscular Diseases, University College London, London, UK.,National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC), London, UK.,Department of Rheumatology, Northwick Park Hospital, London, UK
| | - Jinoos Yazdany
- University of California San Francisco, Division of Rheumatology, Department of Medicine, San Francisco, California, USA
| | - Philip Robinson
- Royal Brisbane and Women's Hospital, Department of Rheumatology, Queensland, Australia.,University of Queensland, Royal Brisbane Clinical Unit, Queensland, Australia.,Metro North Hospital & Health Service, Herston, Queensland, Australia
| | - Richard Conway
- Department of Rheumatology, St James's Hospital, Dublin, Ireland.,School of Medicine, Trinity College Dublin, Ireland
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Monteverde E, Diehl M, Saieg M, Beauchamp M, Castellini JLA, Neira JA, Klappenbach RF, Rey P, Mirofsky M, Quintana R, Boietti BR, Zanchetta MB, Giacoia E, Lartigue B, Abbate AS, Medina A, Matassa VS, Olivetto R, Dodero R, Maglio I, Bordes M, Nemerovsky J, Bosque L. Alliance for the development of the Argentinian Hip Fracture Registry. Arch Osteoporos 2022; 17:122. [PMID: 36098882 PMCID: PMC9469067 DOI: 10.1007/s11657-022-01163-0] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 09/02/2022] [Indexed: 02/03/2023]
Abstract
Age expectancy has significantly increased over the last 50 years, as well as some age-related health conditions such as hip fractures. The development of hip fracture registries has shown enhanced patient outcomes through quality improvement strategies. The development of the Argentinian Hip Fracture Registry is going in the same direction. INTRODUCTION Age expectancy has increased worldwide in the last 50 years, with the population over 64 growing from 4.9 to 9.1%. As fractures are an important problem in this age group, specific approaches such as hip fracture registries (HFR) are needed. Our aim is to communicate the Argentinian HFR (AHFR) development resulting from an alliance between Fundación Trauma, Fundación Navarro Viola, and the Argentinian Network of Hip Fracture in the elderly. METHODS Between October 2020 and May 2021, an iterative consensus process involving 5 specialty-focused meetings and 8 general meetings with more than 20 specialists was conducted. This process comprised inclusion criteria definitions, dataset proposals, website deployment with data protection and user validation, the definition of hospital-adjusted registry levels, implementation planning, and sustainability strategies. RESULTS By June 2021, we were able to (1) outline data fields, including epidemiological, clinical, and functional dimensions for the pre-admission, hospitalization, discharge, and follow-up stages; (2) define three levels: basic (53 fields), intermediate (85), and advanced (99); (3) identify 21 benchmarking indicators; and (4) make a correlation scheme among fracture classifications. Simultaneously, we launched a fundraising campaign to implement the AHFR in 30 centers, having completed 18. CONCLUSION AHFR development was based on four pillars: (1) representativeness and support, (2) solid definitions from onset, (3) committed teams, and (4) stable funding. This tool may contribute to the design of evidence-based health policies to improve patient outcomes, and we hope this experience will help other LMICs to develop their own tailored-to-their-needs registries.
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Affiliation(s)
| | - María Diehl
- Red Argentina de Fractura de Cadera en El Adulto Mayor, Asociación Argentina de Osteología Y Metabolismo Mineral, Buenos Aires, Argentina
| | | | | | | | | | | | - Paula Rey
- Asociación Argentina de Osteología Y Metabolismo Mineral, Buenos Aires, Argentina
| | | | | | | | | | | | | | | | - Arnaldo Medina
- Asociación Argentina de Salud Pública, Buenos Aires, Argentina
| | | | - Roberto Olivetto
- Asociación Argentina de Ortopedia Y Traumatología, Buenos Aires, Argentina
| | - Romina Dodero
- Sociedad Argentina de Medicina, Buenos Aires, Argentina
| | - Ignacio Maglio
- Asociación Argentina de Salud Pública, Buenos Aires, Argentina
| | | | - Julio Nemerovsky
- Sociedad Argentina de Geriatría Y Gerontología, Buenos Aires, Argentina
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Isnardi CA, Roberts K, Quintana R, Kreimer J, Echeverria C, Luna PC, Virasoro BM, Exeni IE, Kogan N, Correa MDLA, Pereira DA, Zelaya D, Tissera Y, Pisoni C, Gálvez Elkin MS, Alonso CG, Cogo AK, Cosatti M, Garcia L, Retamozo C, Severina M, Nieto R, Rosemffet M, Mussano ED, Bertoli A, Delavega M, Savio V, Cosentino V, Roldan B, Maldonado Ficco H, Maid P, Calle Montoro C, Fernandez L, Leguizamón ML, Gómez Vara AB, Alfaro MA, Landi M, Herscovich N, Maldini C, De la Vega Fernandez SS, Velozo E, Giorgis P, Sattler ME, Reyes Gómez C, Perrotat L, Reimundes C, Ezquer RA, Saurit V, Flores Trejo J, Cerda OL, Crespo Rocha MG, Carrizo Abarza V, Strusberg I, Rojas Tessel R, Verna G, Bande JM, Farfan P, Berbotto G, Pons-Estel G, Schneeberger EE. AB1094 SAFETY AND EFFICACY OF VACCINES FOR SARS-CoV-2 IN PATIENTS WITH RHEUMATIC AND IMMUNE-MEDIATED INFLAMMATORY DISEASES: DATA FROM THE ARGENTINEAN REGISTRY SAR-CoVAC. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.876] [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
BackgroundCurrently there is little information on the efficacy and safety of SARS-CoV-2 vaccination in patients with immune-mediated diseases and/or under immunosuppressive treatment in our country, where different types of vaccines and mix regimens are used. For this reason, the Argentine Society of Rheumatology (SAR) with the Argentine Society of Psoriasis (SOARPSO) set out to develop a national register of patients with rheumatic and immune-mediated inflammatory diseases (IMIDs) who have received a SARS-CoV-2 vaccine in order to assess their efficacy and safety in this population.ObjectivesTo assess SARS-CoV-2 vaccine efficacy and safety in patients with rheumatic and IMIDs.MethodsSAR-CoVAC is a national, multicenter and observational registry. Adult patients with a diagnosis of rheumatic or IMIDs who have been vaccinated for SARS-CoV-2 were consecutively included between June 1st and September 17th, 2021. Sociodemographic data, comorbidities, underlying rheumatic or IMIDs, treatments received and their modification prior to vaccination and history of SARS-CoV-2 infection were recorded. In addition, the date and place of vaccination, type of vaccine applied, scheme and indication will be registered. Finally, adverse events (AE), as well as SARS-CoV-2 infection after the application of the vaccine were documentedResultsA total of 1234 patients were included, 79% were female, with a mean age of 57.8 (SD 14.1) years. The most frequent diseases were rheumatoid arthritis (41.2%), osteoarthritis (14.5%), psoriasis (12.7%) and spondyloarthritis (12.3%). Most of them were in remission (28.5%) and low disease activity (41.4%). At the time of vaccination, 21% were receiving glucocorticoid treatment, 35.7% methotrexate, 29.7% biological (b) Disease Modifying Anti-Rheumatic Drugs (DMARDs) and 5.4% JAK inhibitors. Before vaccine application 16.9% had had a SARS-CoV-2 infection.Regarding the first dose of the vaccine, the most of the patients (51.1%) received Gam-COVID-Vac, followed by ChAdOx1 nCoV-19 (32.8%) and BBIBP-CorV (14.5%). In a lesser proportion, BNT162b2 (0.6%), Ad26.COV2.S (0.2%) and CoronaVac (0.2%) vaccines were used. Almost half of them (48.8%) completed the scheme, 12.5% were mix regimenes, the most frequent being Gam-COVID-Vac / mRNA-1273. The median time between doses was 51days (IQR 53).More than a quarter (25.9%) of the patients reported at least one AE after the first dose and 15.9% after the second. The flu-like syndrome and local hypersensitivity were the most frequent manifestations. There was one case of mild anaphylaxis. No patient was hospitalized. Altogether, the incidence of AE was 246.5 events/1000 doses. BBIBP-CorV presented significantly lower incidence of AE in comparison with the other types of vaccines. (118.5 events/1000 doses, p<0.002 in all cases)Regarding efficacy, 63 events of SARS-CoV-2 infection were reported after vaccination, 19% occurred before 14 days post-vaccination, 57.1% after the first dose (>14 days) and 23.8% after the second. In most cases (85.9%) the infection was asymptomatic or had an outpatient course and 2 died due to COVID-19.ConclusionIn this national cohort of patients with rheumatic and IMIDs vaccinated for SARS-CoV-2, the most widely used vaccines were Gam-COVID-Vac and ChAdOx1 nCoV-19, approximately half completed the schedule and in most cases homologously. A quarter of the patients presented some AE, while 5.1% presented SARS-CoV-2 infection after vaccination, in most cases mild.Disclosure of InterestsNone declared
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Savio V, Maldini C, Alba P, Saurit V, Berbotto G, Pisoni C, Tissera Y, Nieto R, Maldonado F, Ornella S, Gobbi C, Baños AR, Vivero F, Exeni IE, Cusa A, Bellomio VI, Perez Alamino R, Gomez G, Zelaya D, Risueño F, Quaglia MI, Correa MDLA, Rojas Tessel R, Delavega M, Lazaro MA, Mercé AL, Finucci P, Matellan CE, Romeo C, Martire V, Moyano S, Martin ML, Picco E, Goizueta C, Tralice ER, Tamborenea MN, Subils GC, Gallo R, Pineda Vidal SI, Velasco Zamora JL, Lloves Schenone N, Cosentino V, Rodriguez F, Diaz MP, Viola M, Mamani Ortega ML, Buschiazzo E, Gómez G, Roberts K, Quintana R, Isnardi CA, Pons-Estel G. POS1199 IS PSORIATIC ARTHRITIS A RISK FACTOR FOR SEVERE COVID -19 INFECTION? DATA FROM THE ARGENTINIAN REGISTRY SAR-COVID. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.715] [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
BackgroundComorbidities, particularly cardio-metabolic disorders, are highly prevalent in patients with psoriatic arthritis (PsA) and they were associated with an increased risk of atherosclerotic cardiovascular disease, which have been associated with higher morbidity and mortality. Whether PsA enhances the risk of SARS-CoV-2 infection or affects the disease outcome remains to be ascertained.ObjectivesTo describe the sociodemographic, clinical and treatment characteristics of patients with PsA with confirmed SARS-CoV-2 infection from the SAR-COVID registry and to identify the variables associated with poor COVID-19 outcomes, comparing them with those with rheumatoid arthritis (RA).MethodsCross-sectional observational study including patients ≥18 years old, with diagnosis of PsA (CASPAR criteria) and RA (ACR / EULAR 2010 criteria), who had confirmed SARS-CoV-2 infection (RT-PCR or serology) from the SAR-COVID registry. Recruitment period was between August 13, 2020 and July 31, 2021. Sociodemographic variables, comorbidities, and treatments were analyzed. To assess the severity of the infection, the ordinal scale of the National Institute of Allergy and Infectious Diseases (NIAID)1 was used, and it was considered that a patient met the primary outcome, if they presented criteria of categories 5 or higher on the severity scale. For this analysis, Chi2 test, Fisher’s test, Student’s test or Wilcoxon test, and binomial logistic regression using NIAID>=5 as dependent variable were performed.ResultsA total of 129 PsA patients and 808 with RA were included. Clinical characteristics are shown in Table 1. Regarding PsA treatment, 12.4% of PsA were receiving IL-17 inhibitors, 5.4% IL12-23 inhibitors, one patient apremilast and one abatacept. The frequency of NIAID≥5 was comparable between groups (PsA 19.5% vs RA 20.1%; p=0.976). (Figure 1).Table 1.Characteristics of patients with PsA and RA who presented COVID-19 in the SAR-COVID registry.Psoriatic arthritis (n=129)Rheumatoid arthritis (n=808)P valueTotal (n=937)Age (years), mean (SD)51.7 (12.7)53.1 (12.9)0.23952.9 (12.9)Female72 (55.8)684 (84.7)<0.001756 (80.7)Comorbidities65 (50.4)355 (43.9)0.203420 (44.8) Obesity (BMI ≥30)19 (15.2)102 (13.4)0.692121 (13.7) Morbid obesity (BMI ≥40)1 (0.8)10 (1.3)111 (1.25) Hypertension35 (28.5)205 (26.8)0.783240 (27.0) Diabetes16 (13.0)67 (8.8)0.18883 (9.39) Dyslipidemia24 (19.5)102 (13.5)0.106126 (14.4) Cardiovascular or cerebrovascular disease5 (11.4)32 (3.9)0.03337 (4.2)Two or more comorbidities55 (42.6)219 (27.1)<0.001274 (29.2)Current smoking4 (3.6)60 (8.4)0.7964 (7.7)High disease activity0 (0)29 (3.8)0.02729 (3.23)Glucocorticoids treatment5 (20.0)95 (60.1)<0.001100 (54.6)Conventional DMARDs47 (36.4)443 (54.8)<0.001490 (52.3)Biologic DMARDs60 (46.5)193 (23.9)<0.001253 (27.0)JAK inhibitors4 (3.10)72 (8.9)0.03876 (8.1)Full recovery of COVID-19105 (84.0)644 (81.7)0.127749 (82.0)COVID-19 complications16 (12.5)68 (8.7)0.22784 (9.2)Death due to COVID-191 (0.8)34 (4.3)0.07435 (3.8)Notes=values n (%) unless otherwise indicated; BMI: Body Mass Index; DMARDs: disease-modifying antirheumatic drugs; JAK inhibitors: Janus kinase inhibitors.PsA patients with NIAID≥5 in comparison with NIAID<5 were older (58.6±11.4 vs 50±12.5; p=0.002), had more frequently hypertension (52.2% vs 23%; p=0.011) and dyslipidemia (39.1% vs 15%; p=0.017). In the multivariate analysis, age (OR 1.06; 95% CI 1.02–1.11) was associated with a worse outcome of the COVID-19 (NIAID≥5) in patients with PsA, while those who received methotrexate (OR 0.34; 95% CI 0.11–0.92) and biological DMARDs (OR 0.28; 95% CI 0.09–0.78) had a better outcome.ConclusionAlthough PsA patients have a higher frequency of cardiovascular and metabolic comorbidities than those with RA, the COVID-19 severity was similar. Most of the patients had mild SARS-CoV-2 infection and a low death rate.References[1]Beigel JH, et al. Remdesivir for the Treatment of Covid-19 - Final Report. N Engl J Med. 2020 Nov 5;383(19):1813-1826.Disclosure of InterestsNone declared
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Bertoli A, Muñoz L, López Pérez MJ, Sanchez Freytes L, Castaño MS, Saurit V, Berbotto G, Alle G, Severina M, Nieto R, Maldonado F, Pera M, Cogo AK, Baños AR, Vivero F, Pereira DA, Cosatti M, Savio V, Perez Alamino R, Medina MA, Schmid M, Risueño F, Quaglia MI, Pendon GP, Casalla L, Delavega M, Lazaro MA, Finucci P, Morbiducci J, Romeo C, Cucchiaro N, Moyano S, Barbich T, Conti SM, Goizueta C, Tralice ER, Maldini C, Rebak J, Gallo R, Maid P, Velasco Zamora JL, Lloves Schenone N, Porta S, Morales NS, Diaz MP, Viola M, Buschiazzo E, Gómez G, Roberts K, Quintana R, Isnardi CA, Pons-Estel G, Matellan CE. POS1200 DIFFERENCES BETWEEN THE FIRST AND THE SECOND WAVE OF SARS-COV-2 INFECTION IN PATIENTS WITH IMMUNE-MEDIATED INFLAMMATORY DISEASES IN ARGENTINA: DATA FROM THE SAR-COVID REGISTRY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.776] [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
BackgroundIn Argentina we have witnessed two COVID 19 waves between 2020 and 2021. The first wave occurred during the spring of 2020 and it was related to the wild type of the virus, the second occurred during the fall/winter of 2021 when the gamma variant showed a clear predominance. During the first wave, patient with rheumatic diseases showed a higher frequency of hospitalization and mortality (4% vs 0.26%) when compared to the general population1; at that time, however, vaccination was not yet available.ObjectivesTo compare sociodemographic and disease characteristics, course and outcomes of SARS-CoV-2 infection in patients with immune-mediated/autoinflammatory diseases (IMADs) during the first and second waves in Argentina.MethodsSAR-COVID is a national, multicenter, longitudinal and observational registry, in which patients ≥18 years of age, with a diagnosis of a rheumatic disease who had confirmed SARS-CoV-2 infection (RT-PCR or positive serology) were consecutively included since August 2020. For the purpose of this report, only patients with IMADs who had SARS-CoV-2 infection during the first wave (defined as cases occurred between March 2020 and March 2021) and the second wave (cases occurred between April and August 2021) were examined. Sociodemographic characteristics, disease diagnosis and activity, comorbidities, immunosuppressive treatment and COVID 19 clinical characteristics, complications and outcomes: hospitalization, intensive care unit (ICU) admission, use of mechanical ventilation and death were compared among groups. Descriptive statistical analysis was performed. Variables were compared with Chi squared test and Student T test or Mann Whitney test. Multivariable logistic regression models with forward and backward selection method, using hospitalization, ICU admission and death as dependent variables were carried out.ResultsA total of 1777 patients were included, 1342 from the first wave and 435 of the second one. Patients had a mean (SD) age of 50.7 (14.2) years and 81% were female. Both groups of patients were similar in terms of socio-demographic features, disease diagnosis, disease activity, the use of glucocorticoids ≥ 10 mg/day and the immunosuppressive drugs (Table 1 below). Patients infected during the first wave have higher frequency of comorbidities (49% vs 41%; p= 0.004). Hospitalizations due to COVID 19 (31% vs 20%; p <0.001) and ICU admissions (9% vs 5%; p= 0.009) were higher during the first wave. No differences in the use of mechanical ventilation (16% vs 16%; p= 0.97) nor in the mortality rate (5% vs 4%; p= 0.41) were observed. In the multivariable analysis, after adjusting for demographics, clinical features and immunosuppressive treatment, patients infected during the second wave were 40% less likely to be hospitalized (OR= 0.6, IC95% 0.4-0.8) and to be admitted to the ICU (OR= 0.6, IC95% 0.3-0.9).Table 1.Variable (% or Mean – SD)First wave(n=1342)Second wave(n=435)p ValueFemale gender81800.7Age (years)51.0 (14.5)50.0 (13.3)0.2Disease diagnosis Rheumatoid arthritis46461 Ankylosing spondylitis10110.8 Systemic lupus erythematosus171850.9 Systemic Scleroderma551 Sjögren´s syndrome650.7 Inflammatory myopathies330.5 Vasculitis430.4Disease activity High430.5Use of immune modulatorsDMARDcs53560.2DMARDts460.1DMARDb82821Use of glucocorticoids ≥10 mg12120.9Comorbidities49410.004ConclusionThe impact of COVID 19 in Argentina, in terms of mortality in patients with IMADs was still higher compared to the general population during the second wave. However, the frequency of hospitalizations and ICU admissions was lower. These findings could be explained by the introduction of the SARS COV 2 vaccination and, probably, by the cumulative knowledge and management improvement of this infection among physicians.References[1]Isnardi CA et al. Epidemiology and outcomes of patients with rheumatic diseases and SARS-COV-2 infection: data from the argentinean SAR-COVID Registry. Ann Rheum Dis, 2021, suppl 1, 887.Disclosure of InterestsNone declared
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Quintana R, Garcia L, Alba P, Roverano S, Alvarez A, Graf C, Pisoni C, Spindler A, Gomez C, Figueredo HM, Papasidero S, Paniego RH, Delavega M, Civit De Garignani EE, Gonzalez Lucero L, Martire V, Águila Maldonado R, Gordon S, Gobbi C, Nieto R, Rausch G, Góngora V, D’amico MA, Dubinsky D, Orden AO, Zacariaz J, Romero J, Pera MA, Rillo O, Baez R, Arturi V, Gonzalez A, Vivero F, Schmid M, Caputo V, Larroude MS, Gomez G, Rodriguez G, Marin J, Collado MV, Jorfen M, Bedran Z, Sarano J, Zelaya D, Sacnun M, Finucci P, Rojas Tessel R, Sattler ME, Machado Escobar M, Astesana P, Paris UV, Allievi A, Vandale JM, Pons-Estel B, Pons-Estel G, García M. POS0707 POTENTIAL USE OF BELIMUMAB IN LUPUS PATIENTS FROM ARGENTINE COHORT ACCORDING DISEASE ACTIVITY STATE. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.789] [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
BackgroundThe goal of targeted treatment in patients with Systemic Lupus Erythematosus (SLE) is to achieve clinical remission or low disease activity, with the best quality of life, low damage rates and better survival 1-4. RELESSAR is a multicenter, cross-sectional study registry of ≥18 years SLE (ACR 97) patients 5.ObjectivesTo describe demographic, clinical characteristics and treatments in SLE patients according to disease activity state. To evaluate the proportion of SLE and refractory SLE patients that are potentially candidates for Belimumab treatment (Active SLE despite standard treatment including increased acDNA autoantibodies and low complement).MethodsWe evaluated demographic and clinical data, treatments, score of damage (SLICC), activity (SLEDAI) and comorbidity (Charlson), hospital admissions and severe infections. The patients were compared according to disease activity: remission (SLEDAI = 0 and without corticosteroids), low disease activity (LDA, SLEDAI> 0 and ≤4 and without corticosteroids) and non-optimal control (SLEDAI> 4 and any dose of corticosteroids). Refractory SLE was defined according to Rituximab (RTX) use, non-response to cyclophosphamide or two or more immunosuppressant or splenectomized patients. Potential use of Belimumab according approved prescription in Argentina was analyzed.ResultsOverall, 1277 patients were analyzed: 299 (23.4%) were in remission, 162 (12.7%) in LDA and 816 (63.9%) with non-optimal control of the disease.Patients in non-optimal control group were younger, less frequently female and they showed less time of disease and lower socioeconomic status (p < 0.001). They were also more prevalent mestizos (p= 0.004), had higher SLEDAI and SLICC indexes (p <0.001) and higher use of immunosuppressant therapy (p <0.001). There was no difference regarding biologic treatment (RTX p= 0.547 and Belimumab p= 0.08). This group had higher proportion of hospital admissions and severe infections (p<0.001, respectively).Two hundred and one SLE patients fulfilled the use of Belimumab prescription criteria but only 45/201 patients (22,3%) received it in the last visit. Malar rash was the only clinical variable associated with the use of Belimumab (72.7% vs 29.8% p= 0.005).Seventy-six patients classified as refractory SLE (15.7%) and 56/76 (75.7%) never received Belimumab. Patients on Belimumab therapy were associated to treatment with lower doses of corticoids (p= 0.018) and lower rate of hospital admission caused by SLE flare (p= 0.027).ConclusionA high percentage of patients had uncontrolled disease upon entry into the registry and were potential candidates for treatment with Belimumab. The patients who received biologic treatment showed the benefit of requiring fewer doses of corticosteroids and having a lower rate of hospitalizations.References[1]Mok CC. Treat-to-target in systemic lupus erythematosus: Are we there yet? Expert Rev Clin Pharmacol. 2016;9(5).[2]Morand EF, Mosca M. Treat to target, remission and low disease activity in SLE. Vol. 31, Best Practice and Research: Clinical Rheumatology. 2017.[3]Golder V, Tsang-A-Sjoe MWP. Treatment targets in SLE: Remission and low disease activity state. Rheumatol (United Kingdom). 2020;59.[4]Ruiz-Irastorza G, Bertsias G. Treating systemic lupus erythematosus in the 21st century: new drugs and new perspectives on old drugs. Vol. 59, Rheumatology (United Kingdom). 2021.[5]Hochberg MC. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum [Internet]. 1997;40(9):1725. Available from: http://www.ncbi.nlm.nih.gov/pubmed/9324032Disclosure of InterestsRosana Quintana: None declared, Lucila Garcia: None declared, Paula Alba: None declared, Susana Roverano: None declared, Analia Alvarez: None declared, Cesar Graf: None declared, Cecilia Pisoni: None declared, Alberto Spindler: None declared, Catalina Gomez: None declared, Heber Matias Figueredo: None declared, Silvia Papasidero: None declared, Raul Horacio Paniego: None declared, Maria DeLaVega: None declared, Emma Estela Civit De Garignani: None declared, Luciana Gonzalez Lucero: None declared, Victoria Martire: None declared, Rodrigo Águila Maldonado: None declared, Sergio Gordon: None declared, Carla Gobbi: None declared, Romina Nieto: None declared, Gretel Rausch: None declared, Vanina Góngora: None declared, Maria Agustina D´Amico: None declared, Diana Dubinsky: None declared, Alberto Omar Orden: None declared, Johana Zacariaz: None declared, Julia Romero: None declared, Mariana Alejandra Pera: None declared, Oscar Rillo: None declared, Roberto Baez: None declared, Valeria Arturi: None declared, Andrea Gonzalez: None declared, Florencia Vivero: None declared, Marcela Schmid: None declared, Victor Caputo: None declared, Maria Silvia Larroude: None declared, Graciela Gomez: None declared, Graciela Rodriguez: None declared, Josefina Marin: None declared, Maria Victoria Collado: None declared, Marisa Jorfen: None declared, Zaida Bedran: None declared, Judith Sarano: None declared, David Zelaya: None declared, MONICA SACNUN: None declared, Pablo Finucci: None declared, Romina Rojas Tessel: None declared, Maria Emilia Sattler: None declared, MAXIMILIANO MACHADO ESCOBAR: None declared, Pablo Astesana: None declared, Ursula Vanesa Paris: None declared, Alberto Allievi: None declared, Juan Manuel Vandale: None declared, Bernardo Pons-Estel: None declared, Guillermo Pons-Estel: None declared, Mercedes García Grant/research support from: GSK grant
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Gonzalez Gomez CA, Cosatti M, Castro Coello VV, Haye M, Tissera Y, Reyes AA, Albiero JA, Ornella S, Alba P, Gobbi C, Gamba MJ, Exeni IE, Cusa A, Gallino Yanzi J, Bellomio VI, Gomez G, Zelaya D, Takashima L, Carlevaris L, Correa MDLA, Rojas Tessel R, García M, German N, Mercé AL, Bertoli A, Aguero SE, Calvo ME, Martire V, Mauri M, Martin ML, Picco E, Castrillon Bustamante D, Ibañez Zurlo L, Tamborenea MN, Subils GC, Vasquez DL, Soares de Souza S, Herscovich N, Raiti L, Cosentino V, Rodriguez F, Ledesma C, Diaz MP, Mamani Ortega ML, Castaño MS, Gómez G, Roberts K, Quintana R, Isnardi CA, Pons-Estel G, Pisoni C. AB1101 PREVALENCE OF LONG COVID IN RHEUMATIC DISEASE PATIENTS: ANALYSIS OF SAR COVID REGISTRY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundPersistent symptoms after acute COVID have been described previously. Main symptoms reported are fatigue, arthralgias, myalgias and mental sickness. Definition and methods vary widely.1ObjectivesTo asses prevalence and related factors to long COVID in a retrospective cohort of patients with rheumatic diseases from Argentina.MethodsA total of 1915 patients were registered from August 18th, 2020 to July 29th, 2021. Patients > 18 years old, with rheumatic disease and confirmed infection by SARS-CoV-2 (antigen or RT-PCR) were included. Those dead, with unknown outcome, wrong date or missing data were excluded. Demographic data, comorbidities, rheumatic disease, and characteristics of SARS-CoV-2 infection were recorded.Long COVID was defined according to NICE guidelines (persistent symptoms for more than 4 weeks, without alternative diagnosis). Long COVID symptoms were defined by rheumatologist. Severity of infection was classified according to WHO ordinal scale.We used descriptive statistics, univariate model (Student’s test, chi square test, ANOVA) and multivariate logistic regression analysis.Results230 (12%) had long COVID. Median age was 51 (IQR 40-61]) years, 82% were females, 51% were not caucasian. Median of education was 13.3 years (IQR 12 – 16), 79 % had private health insurance and 55 % were employed. Nearly half (n=762, 46%) had comorbidities, the most prevalent was hypertension (n=396, 24%).The most frequent rheumatic diseases were rheumatoid arthritis (n=719, 42%) and systemic lupus erythematosus (n=280, 16 %). Most were in low activity/remission (79%), used Conventional DMARD (n=773 patients, 45%) and steroids (n=588, 34%) at low dose (n=415, 71%).Main laboratory findings were abnormal D-dimer (n=94, 28%) and leukopenia (n=93, 26%). Most patients had a WHO ordinal scale < 5 (n=1472, 86%). Median of hospitalization at intensive care unit (ICU) was 8 days [IQR 5, 13]. Treatment for SARS-CoV-2 infection (steroids, anticoagulation, azithromycin, convalescent plasma) was used in 461 (27%) patients.Most of long COVID (n= 152, 69%) reported 1 symptom, the most frequent was fatigue (n= 55, 22%). Figure 1.Univariate analysis is presented in Table 1. In multivariate logistic regression analysis non-caucasian ethnicity OR 1.44 (1.07-1.95), years of education OR 1.05 (1-1.09), treatment with cyclophosphamide OR 11.35 (1.56-112.97), symptoms of COVID – 19 OR 13.26 (2.75-242.08), severity scale WHO ≥ 5 OR 2.46 (1.68-3.57), and ICU hospitalization days OR 1.09 (1.05-1.14) were factors associated to long COVID.Table 1.Univariate analysis of long COVID syndrome in SAR – COVID registryVariableAcute COVID n=1486Long COVID n=221P valueAge, years, median [IQR]51 [40, 60]54 [42, 62]0.032Caucasian, n (%)744 (48)132 (53)0.227Female sex, n (%)1242 (80)215 (86)0.066Education, years, median [IQR]12 [10, 17]13 [12, 16]-Private health insurance, n (%)1161 (79)181 (82)0.325Smoking, n (%)381 (25)71 (29)0.224Comorbidities, n (%)650 (45)108 (52)0.066Dyslipidemia, n (%)173 (12)39 (19)0.008Hypertension, n (%)332 (23)60 (29)0.053Low activity/remission disease, n (%)1140 (80)179 (77)1Rheumatoid arthritis, n (%)623 (42)96 (42)1Systemic lupus erythematosus, n (%)243 (16)37 (16)0.996DMARD, n (%)664 (45)109 (47)0.486Cyclophosphamide, n (%)3 (0.2)3 (1)0.035Rituximab, n (%)19 (1)9 (34)0.008Lymphocyte66 (23)19 (30)0.011<1.500 / mm3, n (%)Ferritin > 2000 ng/ml, n (%)32 (11)16 (25)0.011ICU hospitalization, days,7 [4, 10]10 [8, 24]<0.001median [IQR]Treatment for COVID-19, n (%)394 (27)91 (41)<0.001ConclusionPrevalence of long COVID was 12%. Non-caucasian ethnicity, higher education, treatment with cyclophosphamide, symptoms of COVID – 19, severe disease and ICU hospitalization days were related to long COVID.References[1]Cabrera Martimbianco AL, Pacheco RL, Bagattini ÂM, Riera R. Frequency, signs and symptoms, and criteria adopted for long COVID-19: A systematic review. Int J Clin Pract.Disclosure of InterestsNone declared
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Isnardi CA, Cerda OL, Schneeberger EE, Landi M, Calle Montoro C, Alfaro MA, Roldan B, Gómez Vara AB, Giorgis P, Ezquer RA, Crespo Rocha MG, Reyes Gómez C, Correa MDLA, Rosemffet M, Carrizo Abarza V, Catalan Pellet S, Perandones M, Reimundes C, Cruces L, Yesica L, Turk G, Quiroga F, Laufer N, Quintana R, Delavega M, Maid P, Pons-Estel G, Citera G. AB1123 EFFICACY AND SAFETY OF SARS-CoV-2 THIRD VACCINE IN PATIENTS WITH RHEUMATOID ARTHRITIS WHO DID NOT RESPOND AFTER PRIMARY TWO-DOSE REGIMEN. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundVaccination for COVID-19 is an essential tool to fight the pandemic. Evidence suggests that patients with immune mediated inflammatory diseases (IMIDs) have less response. The application of a booster shot is a strategy that has been implemented in this population, however there is scarce information about its efficacy.ObjectivesTo assess the humoral and cellular immune response after a third dose of SARS-CoV-2 vaccine in patients with rheumatoid arthritis (RA) with undetectable antibodies titles after primary regimen of two doses.MethodsObservational study. Patients with RA (ACR/EULAR 2010 criteria) from two rheumatology centers, ≥18 years old, with no seroconversion after two doses of SARS-CoV-2 vaccine, who received a third dose of either mRNA or vector-based vaccines (BNT162b2 or ChAdOx1 nCoV-19) were included. Anti-SARS-CoV-2 IgG antibodies, neutralising activity and T cell responses were assessed between 21 and 40 days after the third dose. Sociodemographic data, comorbidities, treatment, vaccine applied and the presence of adverse events (AE) were recorded. Statistical analysis: descriptive analysis. Chi2 or Fischer test and T test.ResultsA total of 21 non-responder patients were included, all of them females with a mean age of 63.7 years (SD 11,6) and mean disease duration of 15.8 years (SD 8). Most of them (81%) reported comorbidities, being the most frequent arterial hypertension, obesity and dyslipidemia. At vaccination time, 6 (28.6%) were receiving glucocorticoids, 3 of them ≥10 mg/day, 17 c-DMARDs (methotrexate 57.1%) and 18 (85.1%) b-DMARDs, 6 abatacept (ABT) and 4 rituximab (RTX).Regarding the primary vaccination regimen, 13 (61.9%) received two doses of BBIBP-CorV, 3 (14.3%) Gam-COVID-Vac, 3 (14.3%) ChAdOx1 nCoV-19 and 2 (9.5%) a mix regimen of Gam-COVID-Vac/mRNA-1273. The majority (95.2%) received BNT162b2 vaccine and only one of them ChAdOx1 nCoV-19, with a mean time between the second and third dose of 151,4 days (SD 46,4). After the third dose, 90.5% of the patients presented detectable anti-SARS-CoV-2 IgG and 76.2% presented neutralizing activity. The median of neutralizing antibodies titers was 1/12 (IQR 1/7-1/48). Both patients who did not present detectable antibodies were obese, recieved BBIBP-CorV during the primary regimen and BNT162b2 as the third dose, one of them was taking methotrexate and ABT and the other one RTX. Compared to other treatments, ABT and RTX was associated with no neutralizing activity in 4 (80%) patients and lower titers of neutralizing antibodies [median 1/3 (IQR 0-1/20) vs median 1/8 (IQR 1/4-1/128), p=0.197].A T-cell response was present in 41.2% of all patients after the second dose, increasing to 75% after the third dose. The use of ABT was associated with a lower frequency of T-cell response (80% vs 20%, p=0.014).Sixteen (76.1%) patients reported at least one AE, 66.7% injection site reaction and 25% flu-like syndrome.ConclusionIn this RA cohort who failed to seroconvert after two doses of SARS-CoV-2 vaccine, 90.5% presented detectable anti-SARS-CoV-2 IgG and 75% T-cell responce after a third dose. The use of ABT was associated with a lower frequency of T-cell response. This data highlights the importance of a third vaccine in this group of patients.Disclosure of InterestsNone declared
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Gómez Vara AB, Barbich T, Isnardi CA, Schneeberger EE, Citera G, Castro Coello VV, Baez R, Haye M, Reyes AA, Albiero JA, Tanten R, Velozo E, Alba P, Gamba MJ, Alonso CG, Maldonado Ficco H, Gallino Yanzi J, Savio V, Asnal C, Matellan C, Takashima L, Carlevaris L, Gálvez Elkin MS, Scafati J, García M, German N, Werner ML, Aeschlimann C, Aguero SE, Calvo ME, Gonzalez Lucero L, Rodriguez Gil GF, Mauri M, Petruzzelli S, Castrillon Bustamante D, Ibañez Zurlo L, Alonso D, Tomas JL, Vasquez DL, Soares de Souza S, Herscovich N, Raiti L, Mareco JM, Guaglianone D, Ledesma C, Diaz MP, Bedoya ME, Kisluk B, Gómez G, Roberts K, Quintana R, Pons-Estel G. POS1238 GLUCOCORTICOIDS, RITUXIMAB AND THE PRESENCE OF INTERSTITIAL LUNG DISEASE ARE ASSOCIATED WITH POOR OUTCOMES OF THE SARS-COV-2 INFECTION IN PATIENTS WITH RHEUMATOID ARTHRITIS: DATA FROM THE NATIONAL REGISTRY SAR-COVID. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3000] [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
BackgroundHigh disease activity, treatment with glucocorticoids (GC) and rituximab (RTX), have been related to worse outcomes of COVID-19.ObjectivesTo assess the clinical characteristics and severity of the SARS-CoV-2 infection in patients with rheumatoid arthritis (RA) included in the SAR-COVID registry and to identify factors associated with poor outcomes.MethodsSAR-COVID is a national, longitudinal and observational registry. Patients of ≥18 years old, with diagnosis of RA (ACR-EULAR criteria 2010) who had confirmed SARS-CoV-2 infection (RT-PCR or positive serology) were included between 13-8-20 and 31-7-21. Sociodemographic and clinical data, comorbidities, disease activity and treatment at the moment of the SARS-CoV-2 infection were collected. Additionally, infection symptoms, complications, medical interventions and treatments for COVID-19 were registered. Infection severity was assessed using the WHO-ordinal scale (WHO-OS)1. A cut-off value of ≥5 identified patients with severe COVID-19 and those who died.Statistical analysis: Descriptive statistics. Chi2 or Fischer test, Student T test or Mann-Whitney and Kruskal Wallis or ANOVA, as appropriate. Multiple logistic regression model.ResultsA total of 801 patients were included, with a mean age of 53.1 ± 12.9 years, most of them were female (84.5%) and the median (m) disease duration was 8 years (IQR 4-14). One third were in remission and 46.4% had comorbidities, being the most frequent, hypertension (26.9 %), dyslipidemia (13.5 %), obesity (13.4 %) and diabetes (8.9%). Moreover, 3.2% had interstitial lung disease (ILD) associated with RA. At SARS-CoV-2 diagnosis, 42.5% were receiving glucocorticoids (GC), 73.9% conventional (c) disease modifying antirheumatic drugs (DMARD), 24% biologic (b) DMARD and 9.1% targeted synthetic (ts) DMARD. Among bDMARD, the most frequently used were TNF inhibitors (17%), followed by abatacept (2.8%), IL-6 inhibitors (2.4%) and rituximab (RTX) (2.1%). During the SARS-CoV-2 infection, 95.8% had symptoms, 27% required hospitalization, 7.9% presented complications and 4.4% died due to COVID-19. Severe disease and death (WHO-OS≥5) was present in 7.5% of the patients. They were older (62.9±12.5 vs 52.2±12.7, p<0.001), and they had more frequently ILD (18.5% vs 2%, p<0.001), comorbidities (82.5% vs 43.7%, p<0.001), ≥2 comorbidities (60.3% vs 25.8%, p<0.001), treatment with GC (61% vs 40.7%, p=0.04) and RTX (8.3% vs 1.6%, p=0.007). Conversely, the use of cDMARD and TNF inhibitors was more frequent in patients with WHO-OS<5, nevertheless this difference was not significant. Disease activity was comparable between groups. In multivariable analysis, older age, the presence of diabetes, ILD, the use of GC and RTX were significantly associated with WHO-OS≥5 (Figure 1). Furthermore, older age (65.7±10.8 vs 52.4±12.8, p<0.001), the presence of comorbidities (87.9% vs 44.7%, p<0.001), chronic obstructive pulmonary disease (21.9% vs 5.2%, p=0.002), diabetes (30.3% vs 7.9%, p<0.001), hypertension (57.6% vs 25.6%, p<0.001), cardiovascular disease (15.6% vs 3.2%, p=0.005), cancer (9.1% vs 1.3%, p=0.001), ILD (23.3% vs 2.4%, p<0.001) and the use of GC (61.8% vs 41.4%, p=0.02) were associated with mortality. Older age [OR 1.1 IC95% 1.06-1.13] and the use of GC 5-10 mg/day [OR 4.6 IC95% 1.8-11.6] remained significantly associated with death due to COVID-19.Figure 1.Factors associated with severe disease and death due to COVID-19 (WHO-OS≥5) in patients with rheumatoid arthritis. Multivariable analysis. (ref.: reference; PDN: prednisone; OR: odds ratio; CI: confidence interval)ConclusionTreatment with RTX and GC, as well as older age, the presence of diabetes and ILD were associated with poor COVID-19 outcomes in this national cohort of patients with RA. Older patients and those taking GC had a higher mortality rate.References[1]World Health Organization coronavirus disease (COVID-19) Therapeutic Trial Synopsis Draft 2020.Disclosure of InterestsNone declared
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Brigante A, Isnardi CA, Gómez G, Quintana R, Haye M, Roberts K, García M, Gomez G, Gobbi C, Casado G, Rebak J, Dapeña JM, Berbotto G, Viola M, Saurit V, Petkovic IE, Bertoli A, Giorgis P, Diaz MP, Catay E, Exeni IE, Pons-Estel B, Paira S, Bovea Castelblanco G, De La Sota ME, Larroude MS, Pereira DA, Granel AB, Medina G, Pisoni C, Alvarez A, Aguero SE, Fernandez L, Sacnun M, Soares de Souza S, Velozo E, Aste N, Castro C, Lazaro A, Kerzberg E, Gallardo MDLÁ, Savio V, Gamba J, Secco A, Citera G, Soriano E, Graf C, Pons-Estel G, Delavega M. POS0655 SURVIVAL AND SAFETY OF BIOLOGICAL AND TARGETED SYNTHETIC THERAPIES AS REGARDS TO AGE GROUPS. BIOBADASAR 3.0 REGISTRY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundAdvances in rheumatology and new therapeutic options have certainly impacted patient survival, changing the age range, from youth to seniors. The differences between the age groups could influence the evolution of the disease and the adverse events (AEs) related to the treatments. There are few real-world data on the safety and efficacy of treatments in different age groups.ObjectivesTo evaluate the frequency of AEs and the survival of treatments according to the age in patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA) or ankylosing spondylitis (AS).MethodsRetrospective, observational, multicenter study of real-life data of patients included in the BIOBADASAR 3.0 registry; exposed and not exposed to original biological treatments (b-DMARDs), biosimilars, targeted synthetic drugs (ts-DMARDs). The unexposed group received treatment with conventional disease-modifying drugs (cDMARDs). A Kaplan-Meier and Log Rank Test analysis was performed to study AEs-free survival and treatment in different age groups (young people <25; young adults 25-34; mature adults 34-65; old adults >65). Factors related to treatment survival were evaluated using Cox regression models.Results5,297 patients were included, 80.3% female, mean age 43.7 years (SD 15.6) and median disease progression 14.3 [IQR 11.5]. RA 4658 (87.9%); APs 490 (9.25%) and EA 149 (2.8%). The main reason for treatment discontinuation was ineffectiveness, in 624 patients in the exposed group and in 53 (2.5%) patients in control group, followed by the presence of AEs in 352 (11.2%) and 83 (3.9%), respectively (p=0.001).A mean Charlson Score of 0.268 (SD 0.6) in the exposed group and 0.306 (SD 0.7) in the control group (p=0.095). Median EAs-free survival in the exposed group was 12.5 years [IQR 16.6] while in controls was 28 years [IQR 11], p<0.0001. Median AEs-free survival was 12 years (IQR 11) in young people, 11.5 years [IQR: 4.9] in young adults, 10 years [IQR: 3.25] in mature adults and 7.6 years [IQR: 6] in old adults with a difference statistically significant (p>0.017). The exposed group presented a median treatment survival in years of 11.25 years [IQR: 10] in young people; 12.5 years [IQR: 4.7] in young adults, 7.5 years [IQR: 12.1] in mature adults and 4.5 years [IQR: 1.14] in old adults (p>0.0001). Considering only the first line of treatment, a median survival of 11.5 years [IQR: 10] was evidenced in the age group <25; 12 years [IQR: 2.6] between 25-34 years old, 10 years [IQR: 12] in the group between 34-65 years old and 5.5 years [IQR: 1.14] in the group > 65 years old (p>0.004). (Figure 1). Considering the second line of treatment, the differences between the groups were not statistically significant (p=0.57). In the multivariate regression model for patients with RA, the factors with the greatest impact on treatment survival were female sex (HR 1.3, 95% CI 1.2-1.4), old age (HR 1.01, 95% CI 1.008-1.01), treatment with steroids (HR 1.19, 95% CI1.1-1.2) and longer disease duration (HR 1.01, 95% CI1.01 – 1.02).ConclusionIn the present study we were able to demonstrate a greater occurrence of AEs in old adults and mature adults compared to young people and young adults. Conversely, survival for b-DMARDs and ts-DMARDs were greater in youth and young adults. In patients with RA, female sex, corticosteroid therapy, old aged and longer disease duration were associated with treatment discontinuation.References[1]Souto A, et al. Rate of discontinuation and drug survival of biologic therapies in rheumatoid arthritis: a systematic review and meta-analysis of drug registries and health care databases. Rheumatology (Oxford). 2016;55(3):523–34.[2]Ray D, et al. Immune senescence, epigenetics and autoimmunity. Clin Immunol. 2018 Nov;196:59-63. doi: 10.1016/j.clim.2018.04.002. Epub 2018 Apr 11.[3]Vela P, et al. Influence of age on the occurrence of adverse events in rheumatic patients at the onset of biological treatment: data from the BIOBADASER III register. Arthritis Res Ther. 2020 Jun 15;22(1):143. doi: 10.1186/s13075-020-02231-x.Disclosure of InterestsNone declared
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Machado PM, Schaefer M, Mahil S, Dand N, Gianfrancesco M, Lawson-Tovey S, Yiu Z, Yates M, Hyrich K, Gossec L, Carmona L, Mateus E, Wiek D, Bhana S, Gore-Massy M, Grainger R, Hausmann J, Sufka P, Sirotich E, Wallace Z, Olofsson T, Lomater C, Romeo N, Wendling D, Pham T, Miceli Richard C, Fautrel B, Silva L, Santos H, Martins FR, Hasseli R, Pfeil A, Regierer A, Isnardi C, Soriano E, Quintana R, Omura F, Machado Ribeiro F, Pinheiro M, Bautista-Molano W, Alpizar-Rodriguez D, Saad C, Dubreuil M, Haroon N, Gensler LS, Dau J, Jacobsohn L, Liew J, Strangfeld A, Barker J, Griffiths CEM, Robinson P, Yazdany J, Smith C. OP0249 CHARACTERISTICS ASSOCIATED WITH POOR COVID-19 OUTCOMES IN PEOPLE WITH PSORIASIS AND SPONDYLOARTHRITIS: DATA FROM THE COVID-19 PsoProtect AND GLOBAL RHEUMATOLOGY ALLIANCE PHYSICIAN-REPORTED REGISTRIES. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1753] [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
BackgroundSome factors associated with severe COVID-19 outcomes have been identified in patients with psoriasis (PsO) and inflammatory/autoimmune rheumatic diseases, namely older age, male sex, comorbidity burden, higher disease activity, and certain medications such as rituximab. However, information about specificities of patients with PsO, psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA), including disease modifying anti-rheumatic drugs (DMARDs) specifically licensed for these conditions, such as IL-17 inhibitors (IL-17i), IL-23/IL-12 + 23 inhibitors (IL-23/IL-12 + 23i), and apremilast, is lacking.ObjectivesTo determine characteristics associated with severe COVID-19 outcomes in people with PsO, PsA and axSpA.MethodsThis study was a pooled analysis of data from two physician-reported registries: the Psoriasis Patient Registry for Outcomes, Therapy and Epidemiology of COVID-19 Infection (PsoProtect), comprising patients with PsO/PsA, and the COVID-19 Global Rheumatology Alliance (GRA) registry, comprising patients with PsA/axSpA. Data from the beginning of the pandemic up to 25 October, 2021 were included. An ordinal severity outcome was defined as: 1) not hospitalised, 2) hospitalised without death, and 3) death. A multivariable ordinal logistic regression model was constructed to assess the relationship between COVID-19 severity and demographic characteristics (age, sex, time period of infection), comorbidities (hypertension, other cardiovascular disease [CVD], chronic obstructive lung disease [COPD], asthma, other chronic lung disease, chronic kidney disease, cancer, smoking, obesity, diabetes mellitus [DM]), rheumatic/skin disease (PsO, PsA, axSpA), physician-reported disease activity, and medication exposure (methotrexate, leflunomide, sulfasalazine, TNFi, IL17i, IL-23/IL-12 + 23i, Janus kinase inhibitors (JAKi), apremilast, glucocorticoids [GC] and NSAIDs). Age-adjustment was performed employing four-knot restricted cubic splines. Country-adjustment was performed using random effects.ResultsA total of 5008 individuals with PsO (n=921), PsA (n=2263) and axSpA (n=1824) were included. Mean age was 50 years (SD 13.5) and 51.8% were male. Hospitalisation (without death) was observed in 14.6% of cases and 1.8% died. In the multivariable model, the following variables were associated with severe COVID-19 outcomes: older age (Figure 1), male sex (OR 1.53, 95%CI 1.29-1.82), CVD (hypertension alone: 1.26, 1.02-1.56; other CVD alone: 1.89, 1.22-2.94; vs no hypertension and no other CVD), COPD or asthma (1.75, 1.32-2.32), other lung disease (2.56, 1.66-3.97), chronic kidney disease (2.32, 1.50-3.59), obesity and DM (obesity alone: 1.36, 1.07-1.71; DM alone: 1.85, 1.39-2.47; obesity and DM: 1.89, 1.34-2.67; vs no obesity and no DM), higher disease activity and GC intake (remission/low disease activity and GC intake: 1.96, 1.36-2.82; moderate/severe disease activity and no GC intake: 1.35, 1.05-1.72; moderate/severe disease activity and GC intake 2.30, 1.41-3.74; vs remission/low disease activity and no GC intake). Conversely, the following variables were associated with less severe COVID-19 outcomes: time period after 15 June 2020 (16 June 2020-31 December 2020: 0.42, 0.34-0.51; 1 January 2021 onwards: 0.52, 0.41-0.67; vs time period until 15 June 2020), a diagnosis of PsO (without arthritis) (0.49, 0.37-0.65; vs PsA), and exposure to TNFi (0.58, 0.45-0.75; vs no DMARDs), IL17i (0.63, 0.45-0.88; vs no DMARDs), IL-23/IL-12 + 23i (0.68, 0.46-0.997; vs no DMARDs) and NSAIDs (0.77, 0.60-0.98; vs no NSAIDs).ConclusionMore severe COVID-19 outcomes in PsO, PsA and axSpA are largely driven by demographic factors (age, sex), comorbidities, and active disease. None of the DMARDs typically used in PsO, PsA and axSpA, were associated with severe COVID-19 outcomes, including IL-17i, IL-23/IL-12 + 23i, JAKi and apremilast.AcknowledgementsWe thank all the contributors to the COVID-19 PsoProtect, GRA and EULAR Registries.Disclosure of InterestsNone declared
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Quintana R, Fernández S, Orzuza SM, Silvestre AMR, Bensi A, Goñi M, Iglesias P, Mathern N, García-Bianco V, Honeri A, Pons-Estel BA, Valdata M, Peláez-Ballestas I. «Living with rheumatoid arthritis» in an indigenous qom population in Argentina. A qualitative study. ACTA ACUST UNITED AC 2021; 17:543-548. [PMID: 34756317 DOI: 10.1016/j.reumae.2020.04.006] [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] [Received: 01/31/2020] [Accepted: 04/22/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Rheumatoid arthritis (RA) is a chronic disease which impacts patients' quality of life. The prevalence of RA in the qom population was 2.4% and represented an aggressive and disabling disease. The study goal was to describe the experience of the indigenous qom community individual suffering from RA, along with their experience with the local health care system in the city of Rosario, Santa Fe, Argentina. METHODS Qualitative Study using techniques of participant observation and semi-structured interviews; following a guideline developed by a multidisciplinary research group comprising anthropologists, rheumatologists, nurses, and psychologists. A triangulation strategy was implemented for the analysis. RESULTS A total of 33 interviews were conducted in 29 individuals with RA. The results showed a "normalization" of their symptoms and of their limitations in performing daily tasks. The individuals' relationship with the local health care system was complex and limited in several aspects (e.g. access to health care, continuity of treatment, complexity of medical care pathway and lack of cultural competence). CONCLUSIONS RA is a disease that has a negative impact on the daily lives of the qom people living in Rosario. Improving the relationship between this population and the local health care system as well as the implementation of multidisciplinary work should be priorities.
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Affiliation(s)
- Rosana Quintana
- Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina.
| | - Sofía Fernández
- Centro de Estudios Aplicados a Problemáticas Socio-culturales (CEAPROS), Facultad de Humanidades y Artes, Universidad Nacional de Rosario, Argentina
| | - Stella M Orzuza
- Centro de Estudios Aplicados a Problemáticas Socio-culturales (CEAPROS), Facultad de Humanidades y Artes, Universidad Nacional de Rosario, Argentina
| | - Adriana M R Silvestre
- Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
| | - Ana Bensi
- Centro de Estudios Aplicados a Problemáticas Socio-culturales (CEAPROS), Facultad de Humanidades y Artes, Universidad Nacional de Rosario, Argentina
| | - Mario Goñi
- Centro de Especialidades Médicas Ambulatorias de Rosario, Secretaría de Salud Pública, Municipalidad de Rosario, Argentina
| | - Paola Iglesias
- Centro de Estudios Aplicados a Problemáticas Socio-culturales (CEAPROS), Facultad de Humanidades y Artes, Universidad Nacional de Rosario, Argentina
| | - Nora Mathern
- Instituto de Reumatología, Ortopedia y Fisiatría, Rosario, Argentina
| | - Vanina García-Bianco
- Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
| | - Andrés Honeri
- Centro de Estudios Aplicados a Problemáticas Socio-culturales (CEAPROS), Facultad de Humanidades y Artes, Universidad Nacional de Rosario, Argentina
| | - Bernardo A Pons-Estel
- Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
| | - Marcela Valdata
- Centro de Estudios Aplicados a Problemáticas Socio-culturales (CEAPROS), Facultad de Humanidades y Artes, Universidad Nacional de Rosario, Argentina
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Izadi Z, Brenner EJ, Mahil SK, Dand N, Yiu ZZN, Yates M, Ungaro RC, Zhang X, Agrawal M, Colombel JF, Gianfrancesco MA, Hyrich KL, Strangfeld A, Carmona L, Mateus EF, Lawson-Tovey S, Klingberg E, Cuomo G, Caprioli M, Cruz-Machado AR, Mazeda Pereira AC, Hasseli R, Pfeil A, Lorenz HM, Hoyer BF, Trupin L, Rush S, Katz P, Schmajuk G, Jacobsohn L, Seet AM, Al Emadi S, Wise L, Gilbert EL, Duarte-García A, Valenzuela-Almada MO, Isnardi CA, Quintana R, Soriano ER, Hsu TYT, D’Silva KM, Sparks JA, Patel NJ, Xavier RM, Marques CDL, Kakehasi AM, Flipo RM, Claudepierre P, Cantagrel A, Goupille P, Wallace ZS, Bhana S, Costello W, Grainger R, Hausmann JS, Liew JW, Sirotich E, Sufka P, Robinson PC, Machado PM, Griffiths CEM, Barker JN, Smith CH, Yazdany J, Kappelman MD. Association Between Tumor Necrosis Factor Inhibitors and the Risk of Hospitalization or Death Among Patients With Immune-Mediated Inflammatory Disease and COVID-19. JAMA Netw Open 2021; 4:e2129639. [PMID: 34661663 PMCID: PMC8524310 DOI: 10.1001/jamanetworkopen.2021.29639] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
IMPORTANCE Although tumor necrosis factor (TNF) inhibitors are widely prescribed globally because of their ability to ameliorate shared immune pathways across immune-mediated inflammatory diseases (IMIDs), the impact of COVID-19 among individuals with IMIDs who are receiving TNF inhibitors remains insufficiently understood. OBJECTIVE To examine the association between the receipt of TNF inhibitor monotherapy and the risk of COVID-19-associated hospitalization or death compared with other commonly prescribed immunomodulatory treatment regimens among adult patients with IMIDs. DESIGN, SETTING, AND PARTICIPANTS This cohort study was a pooled analysis of data from 3 international COVID-19 registries comprising individuals with rheumatic diseases, inflammatory bowel disease, and psoriasis from March 12, 2020, to February 1, 2021. Clinicians directly reported COVID-19 outcomes as well as demographic and clinical characteristics of individuals with IMIDs and confirmed or suspected COVID-19 using online data entry portals. Adults (age ≥18 years) with a diagnosis of inflammatory arthritis, inflammatory bowel disease, or psoriasis were included. EXPOSURES Treatment exposure categories included TNF inhibitor monotherapy (reference treatment), TNF inhibitors in combination with methotrexate therapy, TNF inhibitors in combination with azathioprine/6-mercaptopurine therapy, methotrexate monotherapy, azathioprine/6-mercaptopurine monotherapy, and Janus kinase (Jak) inhibitor monotherapy. MAIN OUTCOMES AND MEASURES The main outcome was COVID-19-associated hospitalization or death. Registry-level analyses and a pooled analysis of data across the 3 registries were conducted using multilevel multivariable logistic regression models, adjusting for demographic and clinical characteristics and accounting for country, calendar month, and registry-level correlations. RESULTS A total of 6077 patients from 74 countries were included in the analyses; of those, 3215 individuals (52.9%) were from Europe, 3563 individuals (58.6%) were female, and the mean (SD) age was 48.8 (16.5) years. The most common IMID diagnoses were rheumatoid arthritis (2146 patients [35.3%]) and Crohn disease (1537 patients [25.3%]). A total of 1297 patients (21.3%) were hospitalized, and 189 patients (3.1%) died. In the pooled analysis, compared with patients who received TNF inhibitor monotherapy, higher odds of hospitalization or death were observed among those who received a TNF inhibitor in combination with azathioprine/6-mercaptopurine therapy (odds ratio [OR], 1.74; 95% CI, 1.17-2.58; P = .006), azathioprine/6-mercaptopurine monotherapy (OR, 1.84; 95% CI, 1.30-2.61; P = .001), methotrexate monotherapy (OR, 2.00; 95% CI, 1.57-2.56; P < .001), and Jak inhibitor monotherapy (OR, 1.82; 95% CI, 1.21-2.73; P = .004) but not among those who received a TNF inhibitor in combination with methotrexate therapy (OR, 1.18; 95% CI, 0.85-1.63; P = .33). Similar findings were obtained in analyses that accounted for potential reporting bias and sensitivity analyses that excluded patients with a COVID-19 diagnosis based on symptoms alone. CONCLUSIONS AND RELEVANCE In this cohort study, TNF inhibitor monotherapy was associated with a lower risk of adverse COVID-19 outcomes compared with other commonly prescribed immunomodulatory treatment regimens among individuals with IMIDs.
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Affiliation(s)
- Zara Izadi
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, San Francisco
| | - Erica J. Brenner
- Division of Pediatric Gastroenterology, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill
| | - Satveer K. Mahil
- Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
- St John’s Institute of Dermatology, King’s College London, London, United Kingdom
| | - Nick Dand
- Department of Medical and Molecular Genetics, School of Basic and Medical Biosciences, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
- Health Data Research UK, London, United Kingdom
| | - Zenas Z. N. Yiu
- Dermatology Centre, The University of Manchester, Manchester Academic Health Science Centre, NIHR Manchester Biomedical Research Centre, Manchester, United Kingdom
- Salford Royal NHS Foundation Trust, Pendleton, Salford, England
| | - Mark Yates
- Centre for Rheumatic Diseases, King’s College London, London, United Kingdom
| | - Ryan C. Ungaro
- Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Xian Zhang
- Division of Gastroenterology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill
| | - Manasi Agrawal
- Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jean-Frederic Colombel
- Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Milena A. Gianfrancesco
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, San Francisco
| | - Kimme L. Hyrich
- Centre for Epidemiology Versus Arthritis, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
- NIHR Manchester Biomedical Research Centre, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Anja Strangfeld
- Epidemiology and Health Care Research, German Rheumatism Research Center, Berlin, Germany
| | | | - Elsa F. Mateus
- Portuguese League Against Rheumatic Diseases, Lisbon, Portugal
- European League Against Rheumatism Standing Committee of People With Arthritis/Rheumatism in Europe, Kilchberg, Switzerland
| | - Saskia Lawson-Tovey
- NIHR Manchester Biomedical Research Centre, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
- Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, The University of Manchester, Manchester, United Kingdom
| | - Eva Klingberg
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at the University of Gothenburg, Sweden
| | - Giovanna Cuomo
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Napoli, Italy
| | - Marta Caprioli
- Istituto di Ricovero e Cura a Carattere Scientifico, Humanitas Research Hospital, Milan, Italy
| | - Ana Rita Cruz-Machado
- Rheumatology Department, Hospital de Santa Maria, CHULN, Lisbon Academic Medical Centre, Lisbon, Portugal
- Rheumatology Research Unit, Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | | | - Rebecca Hasseli
- Department of Rheumatology and Clinical Immunology, Campus Kerckhoff, Justus-Liebig-University, Giessen, Germany
| | - Alexander Pfeil
- Department of Internal Medicine, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
| | - Hanns-Martin Lorenz
- Division of Rheumatology, Department of Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Bimba Franziska Hoyer
- German Society for Rheumatology, Berlin, Germany
- University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Laura Trupin
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, San Francisco
| | - Stephanie Rush
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, San Francisco
| | - Patricia Katz
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, San Francisco
| | - Gabriela Schmajuk
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, San Francisco
- San Francisco VA Healthcare System, San Francisco, California
| | - Lindsay Jacobsohn
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, San Francisco
| | - Andrea M. Seet
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, San Francisco
| | - Samar Al Emadi
- Rheumatology Department, Hamad Medical Corporation, Doha, Qatar
| | - Leanna Wise
- Division of Rheumatology, Department of Internal Medicine, University of Southern California, Los Angeles
| | | | - Alí Duarte-García
- Division of Rheumatology, Mayo Clinic, Rochester, Minnesota
- Robert D. and Patricia E. Kern Center for the Science of Health Care, Mayo Clinic, Rochester, Minnesota
| | | | | | | | - Enrique R. Soriano
- Rheumatology Unit, Internal Medicine Service, Hospital Italiano de Buenos Aires and Instituto Universitario Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Tiffany Y-T. Hsu
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Kristin M. D’Silva
- Harvard Medical School, Boston, Massachusetts
- Division of Rheumatology, Allergy, and Immunology, Clinical Epidemiology Program, Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Jeffrey A. Sparks
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Naomi J. Patel
- Harvard Medical School, Boston, Massachusetts
- Rheumatology Unit, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, Massachusetts
| | | | | | | | - René-Marc Flipo
- Department of Rheumatology, University of Lille, Lille, France
| | - Pascal Claudepierre
- EpiDermE, Université Paris Est Créteil, Créteil, France
- Rheumatology Department, Henri-Mondor University Hospital, Créteil, France
| | | | - Philippe Goupille
- Rheumatology Department, Chru Hospitals of Tours, Tours, France
- Groupe Innovation and Ciblage Cellulaire, University of Tours, Tours, France
| | - Zachary S. Wallace
- Harvard Medical School, Boston, Massachusetts
- Division of Rheumatology, Allergy, and Immunology, Clinical Epidemiology Program, Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Wendy Costello
- Irish Children’s Arthritis Network, Bansha, Tipperary, Ireland
| | - Rebecca Grainger
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Jonathan S. Hausmann
- Rheumatology Program, Boston Children’s Hospital, Boston, Massachusetts
- Division of Rheumatology and Clinical Immunology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Jean W. Liew
- Section of Rheumatology, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Emily Sirotich
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Canadian Arthritis Patient Alliance, Toronto, Ontario, Canada
| | - Paul Sufka
- HealthPartners Specialty Center–Rheumatology, St. Paul, Minnesota
| | - Philip C. Robinson
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- Royal Brisbane and Women’s Hospital, Metro North Hospital and Health Service, Queensland, Australia
| | - Pedro M. Machado
- Centre for Rheumatology and Department of Neuromuscular Diseases, University College London, London, United Kingdom
- NIHR University College London Hospitals Biomedical Research Centre, University College London Hospitals, NHS Foundation Trust, London, United Kingdom
- Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, United Kingdom
| | - Christopher E. M. Griffiths
- Dermatology Centre, The University of Manchester, Manchester Academic Health Science Centre, NIHR Manchester Biomedical Research Centre, Manchester, United Kingdom
- Salford Royal NHS Foundation Trust, Pendleton, Salford, England
| | - Jonathan N. Barker
- St John’s Institute of Dermatology, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
| | - Catherine H. Smith
- Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
- St John’s Institute of Dermatology, King’s College London, London, United Kingdom
| | - Jinoos Yazdany
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, San Francisco
| | - Michael D. Kappelman
- Division of Pediatric Gastroenterology, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill
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Reátegui-Sokolova C, Ugarte-Gil MF, Harvey GB, Wojdyla D, Pons-Estel GJ, Quintana R, Serrano-Morales RM, Sacnun MP, Catoggio LJ, Soriano ER, García MA, Saurit V, Alvarellos A, Caeiro F, Berbotto GA, Sato EI, Borba Neto EF, Bonfa E, de Oliveira E Silva Montandon AC, Da Silva NA, Cavalcanti F, Vásquez G, Guibert-Toledano M, Reyes-Llerena GA, Massardo L, Neira OJ, Cardiel MH, Barile-Fabris LA, Amigo MC, Silveira LH, Portela-Hernández M, Garcia de la Torre I, Segami MI, Chacón-Diaz R, Esteva-Spinetti MH, Alarcón GS, Pons-Estel BA. Predictors of renal damage in systemic lupus erythematous patients: data from a multiethnic, multinational Latin American lupus cohort (GLADEL). RMD Open 2021; 6:rmdopen-2020-001299. [PMID: 33310863 PMCID: PMC7859505 DOI: 10.1136/rmdopen-2020-001299] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/16/2020] [Accepted: 10/21/2020] [Indexed: 11/24/2022] Open
Abstract
Aim A decrease in proteinuria has been considered protective from renal damage in lupus nephritis (LN), but a cut-off point has yet to be established. The aim of this study was to identify the predictors of renal damage in patients with LN and to determine the best cut-off point for a decrease in proteinuria. Methods We included patients with LN defined clinically or histologically. Possible predictors of renal damage at the time of LN diagnosis were examined: proteinuria, low complement, anti-double-stranded DNA antibodies, red cell casts, creatinine level, hypertension, renal activity (assessed by the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI)), prednisone dose, immunosuppressive drugs and antimalarial use. Sociodemographic variables were included at baseline. Proteinuria was assessed at baseline and at 12 months, to determine if early response (proteinuria <0.8 g/day within 12 months since LN diagnosis) is protective of renal damage occurrence. Renal damage was defined as an increase of one or more points in the renal domain of The Systemic Lupus International Collaborating Clinics (SLICC)/American College of Rheumatology (ACR) Damage Index (SDI). Cox regression models using a backward selection method were performed. Results Five hundred and two patients with systemic lupus erythematosus patients were included; 120 patients (23.9%) accrued renal damage during their follow-up. Early response to treatment (HR=0.58), antimalarial use (HR=0.54) and a high SES (HR=0.25) were protective of renal damage occurrence, whereas male gender (HR=1.83), hypertension (HR=1.86) and the renal component of the SLEDAI (HR=2.02) were risk factors for its occurrence. Conclusions Early response, antimalarial use and high SES were protective of renal damage, while male gender, hypertension and higher renal activity were risk factors for its occurrence in patients with LN.
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Affiliation(s)
- Cristina Reátegui-Sokolova
- Rheumatology, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Perú .,Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Perú
| | - Manuel F Ugarte-Gil
- Rheumatology, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Perú.,Universidad Científica del Sur, Lima, Perú
| | - Guillermina B Harvey
- Escuela de Estadística, Facultad de Ciencias Económicas y Estadística, Universidad Nacional de Rosario, Rosario, Argentina
| | | | | | - Rosana Quintana
- Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
| | | | | | | | | | - Mercedes A García
- Hospital Interzonal General de Agudos General San Martín, La Plata, Argentina
| | - Verónica Saurit
- Hospital Privado, Centro Médico de Córdoba, Córdoba, Argentina
| | | | | | | | - Emilia I Sato
- Universidade Federal da Sao Paulo (UNIFESP), Sao Paulo, Brasil
| | | | - Eloisa Bonfa
- Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brasil
| | | | - Nilzio A Da Silva
- Faculdade de Medicina, Universidade Federal de Goias, Goiânia, Brasil
| | - Fernando Cavalcanti
- Servico de Reumatologia, Hospital das Clínicas da Universidade Federal de Pernambuco (HC-UFPE), Recife, Brasil
| | - Gloria Vásquez
- Grupo de Inmunología Celular e Inmunogenética, Universidad de Antioquia, Medellín, Colombia
| | | | | | - Loreto Massardo
- Facultad de Medicina, Universidad San Sebastián, Santiago, Chile
| | - Oscar J Neira
- Hospital del Salvador, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Mario H Cardiel
- Centro de Investigación Clínica de Morelia SC, Morelia, Mexico
| | | | | | - Luis H Silveira
- Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, Mexico
| | - Margarita Portela-Hernández
- Departamento de Reumatología, Hospital de Especialidades CMN SXXI, Instituto Mexicano de Seguridad Social, Ciudad de México, Mexico
| | | | | | - Rosa Chacón-Diaz
- Centro Nacional de Enfermedades Reumáticas, Hospital Universitario de Caracas, Caracas, Venezuela
| | | | - Graciela S Alarcón
- The University of Alabama at Birmingham, Birmingham, Alabama, Alabama, USA.,Universidad Peruana Cayetano Heredia, Lima, Perú
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Barile-Fabris LA, Fragoso-Loyo H, Wojdyla D, Quintana R, Pons-Estel GJ, Catoggio LJ, García MA, Saurit V, Drenkard C, Bonfa E, Borba EF, Sato E, Tavares Brenol JC, Cavalcanti F, Da Silva NA, Lavras Costallat LT, Guibert Toledano M, Massardo L, Neira O, Cardiel MH, Amigo MC, García De La Torre I, Silveira LH, Acevedo Vásquez EM, Chacón-Diaz R, Esteva-Spinetti MH, Alarcón GS, Pons-Estel BA. Factors associated with neuropsychiatric involvement in Latin American patients with systemic lupus erythematosus. Lupus 2021; 30:1481-1491. [PMID: 34082589 DOI: 10.1177/09612033211020364] [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: 11/15/2022]
Abstract
INTRODUCTION Factors related to presentation of neuropsychiatric (NP) SLE manifestations, early in the course of the disease, and during follow up have not been clearly established. PURPOSE To identify disease and non-disease related factors associated with NP manifestations in early SLE. METHODS We included 1193 patients from the GLADEL inception cohort free of NP involvement at cohort entry. We evaluated the association of demographic, clinical and laboratory data with NP involvement during follow-up. STATISTICAL METHODS Independent factors associated with NP involvement were identified using a multivariable Cox regression model. RESULTS Factors independently associated with NP manifestations were: mestizo ethnicity (HR 1.701, 95% CI 1.282-2.258, p = 0.0002), myalgias/myositis (HR 1.832, 95% CI 1.335-2.515, p = 0.0002), pneumonitis (HR 2.476, 95% CI 1.085-5.648, p = 0.0312), shrinking lung (HR 2.428, 95% CI 1.074-5.493, p = 0.0331) and hemolytic anemia (HR 1.629, 95% CI 1.130-2.347, p = 0.0089). Longer disease duration at cohort entry (13 to 24 months) was associated with a lower risk of developing NP manifestations (HR 0.642, 95% CI 0.441-0.934, p = 0.0206). CONCLUSIONS Patients with myalgias/myositis, pneumonitis, shrinking lung and hemolytic anemia are at higher risk of NP involvement, whereas longer disease duration at cohort entry is associated with a lower risk of developing NP involvement.
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Affiliation(s)
| | - Hilda Fragoso-Loyo
- Departamento de Inmunología y Reumatología, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Ciudad de México, México
| | | | - Rosana Quintana
- Grupo Oroño - Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
| | - Guillermo J Pons-Estel
- Grupo Oroño - Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
| | - Luis J Catoggio
- Sección de Reumatología, Servicio de Clínica Médica, Hospital Italiano de Buenos Aires, Instituto Universitario Escuela de Medicina y Fundación Dr. Pedro M. Catoggio para el Progreso de la Reumatología, Buenos Aires, Argentina
| | - Mercedes A García
- Servicio de Reumatología, HIGA General San Martín, La Plata, Argentina
| | - Verónica Saurit
- Servicio de Reumatología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - Cristina Drenkard
- Division of Rheumatology, Department of Medicine, Emory School of Medicine, Atlanta, GA, USA
| | - Eloisa Bonfa
- Rheumatology Division, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, São Paulo SP, Brasil
| | - Eduardo F Borba
- Rheumatology Division, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, São Paulo SP, Brasil
| | - Emilia Sato
- Escola Paulista de Medicina, Universidade Federal de Sao Paulo, Sao Paul, Brasil
| | - Joao C Tavares Brenol
- Rheumatology Division, Department of Internal Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil
| | - Fernando Cavalcanti
- Serviço de Reumatologia do Hospital das Clínicas da Universidade Federal de Pernambuco (HC-UFPE), Recife, Brasil
| | - Nilzio A Da Silva
- Serviço de Reumatologia, Departamento de Clinica Medica, Facultad de Medicina, Hospital das Clínicas, Universidade Federal de Goiás, Goiânia, Brasil
| | - Lilian T Lavras Costallat
- Departamento de Clínica Médica, Faculdade de Ciências Medicas da UNICAMP, Universidade Estadual de Campinas, Campinas, Brasil
| | - Marlene Guibert Toledano
- Servicio Nacional de Reumatología, Centro de Investigaciones Médico-Quirúrgicas (CIMEQ), La Habana, Cuba
| | - Loreto Massardo
- Facultad de Medicina y Ciencia, Centro de Biología Celular y Biomedicina, Universidad San Sebastián, Santiago, Chile
| | - 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
| | - Mario H Cardiel
- Centro de Investigación Clínica de Morelia, SC, Morelia, México
| | - Mary Carmen Amigo
- Servicio de Reumatología, Centro Médico ABC, Ciudad de México, México
| | | | - Luis H Silveira
- Departamento de Reumatología, Instituto Nacional de Cardiología "Ignacio Chávez", Ciudad de México, México
| | - Eduardo M Acevedo Vásquez
- Facultad de Medicina, Universidad Nacional Mayor de San Marcos. Servicio de Reumatología. Clínica San Felipe, Jesús María, Lima, Perú
| | - Rosa Chacón-Diaz
- Servicio de Reumatología, Policlínica Méndez Gimón, Caracas, Venezuela
| | | | - Graciela S Alarcón
- Division of Clinical Immunology and Rheumatology, Department of Medicine, School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Medicine, School of Medicine, Universidad Peruana Cayetano, Heredia, Lima, Perú
| | - Bernardo A Pons-Estel
- Grupo Oroño - Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
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Reyes AA, Alle G, Tanten R, Scolnik M, Soriano E, Berbotto G, Haye M, Gamba MJ, Nieto R, García M, Savio V, Gonzalez Lucero L, Alba P, Takashima L, Risueño F, Casalla L, Cucchiaro N, Bertoli A, Porta S, Maldini C, Gallo R, Goizueta C, Picco E, Quintana R, Roberts K, Isnardi CA, Pons-Estel G. POS1188 COVID-19 IN PATIENTS WITH RHEUMATIC DISEASES: COMPARISON OF DATA FROM THE ARGENTINE REGISTRY (SAR-COVID), WITH THE LATIN AMERICAN AND GLOBAL REGISTRY (GLOBAL RHEUMATOLOGY ALLIANCE). Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:SARS CoV-2 infection has recently burst onto the global scene, and the knowledge of the course of this infection in patients with rheumatic diseases receiving immunomodulatory treatment is still insufficient. The Argentine Society of Rheumatology (SAR) designed a national registry called SAR-COVID in order to get to assess our reality.Objectives:To identify the particular characteristics of patients with rheumatic diseases and COVID-19 in Argentina (SAR-COVID Registry), and to compare them with the data reported at the Latin American and Global level (Global International Alliance Rheum-COVID Registry).Methods:A national, multicenter, prospective and observational registry was carried out. Patients older than 18 years, with a diagnosis of rheumatic disease and SARS-CoV-2 infection by PCR or serology, were included between August 13, 2020 and January 17, 2021. Demographic data, underlying rheumatic disease (activity of the disease, current treatment), comorbidities, clinical-laboratory characteristics of the SARS-CoV-2 infection, as well as received treatments (pharmacological, oxygen therapy / ventilatory support) and outcomes (hospitalization, mortality) were recorded. The characteristics of the included patients were compared with the data reported at the Latin American and global level. Descriptive statistics were performed. Comparisons between groups were made using ANOVA, chi2 or Fisher’s test, according to the type of variable.Results:Four hundred sixty-five patients from Argentina, 74 patients from Latin America and 583 from the rest of the world were included, mostly women (79.6%, 73% and 71% respectively), with a mean age of 50.2 (SD 15.3), 53.5 (DE 15.6) and 55.8 (15.5), years respectively. The most frequent rheumatic diseases in the three groups were rheumatoid arthritis (43.9%, 35%, and 39%) and systemic lupus erythematosus (16.1%, 22%, and 14%) (Table 1).In Argentina, fewer patients received specific pharmacological treatment for COVID-19 (40.9%, 68% and 43% respectively, p <0.0001), and there was a lower requirement of NIMV / IMV (Non-Invasive Mechanical Ventilation/Invasive Mechanical Ventilation) than in the rest of Latin America and the world (10.5% vs 31% vs 13%, p <0.0001).Hospitalization was lower in Argentina than in the rest of Latin America (37.4% vs 61% p 0.0002) and of the world (37.4% vs 45% p 0.0123), and mortality was numerically lower in Argentina, but without statistically significant differences between the three groups (6.9%, 12% and 11%; p 0.6311). Most of the patients, (86.9%) did not present any complications in Argentina, with a statistically significant difference with the rest of the groups (62% and 77%, p <0.0001) (Graph 1).Conclusion:The patients with rheumatic diseases and SARS-CoV-2 infection reported in this argentinian registry received less specific pharmacological treatment for COVID-19, presented fewer complications and required less ventilatory support, than those reported in the Latinoamerican and Global registry. However, no statistically significant differences were observed in terms of mortality.Graph 1.Main outcomes and evolution of patients with rheumatic disease and COVID-19.References:[1]Stokes, Erin K, Zambrano, Laura D, Anderson, Kayla N, et al. Coronavirus Disease 2019 Case Surveillance - United States, January 22-May 30, 2020. MMWR Morb Mortal Wkly Rep; 69(24): 759-765, 2020 Jun 19.[2]Mehta P, McAuley DF, Brown M, et al. COVID-19: consider cytokine storm síndromes and immunosuppression. Lancet 2020;395:1033–4.[3]Gianfrancesco M, et al. Characteristics associated with hospitalisation for COVID-19 in people with rheumatic disease: data from the COVID-19 Global Rheumatology Alliance physician-reported registry. Ann Rheum Dis 2020;79:859–866.[4]Manuel F. Ugarte-Gil, et al. Characteristics associated with Covid-19 in patients with Rheumatic Disease in Latin America. Global Rheumatology. Septiembre 2020.Disclosure of Interests:Alvaro Andres Reyes Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Gelsomina Alle Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Romina Tanten Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Marina Scolnik Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Enrique Soriano Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Guillermo Berbotto Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Maria Haye Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, María Julieta Gamba Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Romina Nieto Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Mercedes García Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Veronica Savio Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Luciana Gonzalez Lucero Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Paula Alba Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Lorena Takashima Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, FABIAN RISUEÑO Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Luciana CASALLA Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Natalia Cucchiaro Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Ana Bertoli Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Sabrina POrta Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Carla Maldini Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Rosana Gallo Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Cecilia Goizueta Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Eugenia Picco Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Rosana Quintana Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Karen Roberts Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Carolina Ayelen Isnardi Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”, Guillermo Pons-Estel Grant/research support from: “Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.”
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Sorrentino L, Rebak J, Maldonado F, Castro Coello VV, Brigante A, Hamaui A, Dubinsky D, Baez R, Pisoni C, Gobbi C, Carlevaris L, Tanten R, Cogo AK, Delavega M, Perez Alamino R, Lazaro MA, Pera M, Pineda Vidal SI, Calvo ME, Guaglianone D, Alonso CG, Guinsburg M, Retamozo C, Aeschlimann C, Quintana R, Roberts K, Isnardi CA, Pons Estel G. POS1186 EFFECT OF SOCIO-ECONOMIC STATUS AND EDUCATIONAL LEVEL ON COVID-19 OUTCOMES IN PATIENTS WITH RHEUMATIC DISEASES FROM ARGENTINA: DATA FROM THE SAR-COVID REGISTRY. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:SARS-CoV-2 infection can present with a broad clinical spectrum, from asymptomatic to lethal. Different risk factors have been recognized. Socio-economic status and educational level may affect access to the healthcare system and therefore COVID-19 infection outcome.Objectives:The aim of this study was to assess the association between socio-demographic status and educational level and SARS-CoV-2 outcomes, such as hospitalization, ICU admission, need for mechanical ventilation and death, in Argentinean patients with rheumatic diseases from the SAR-COVID Registry.Methods:We performed a cross-sectional study of consecutive adult patients with rheumatic diseases and SARS-CoV-2 infection included in the multicentric Argentinean SAR-COVID Registry. The following variables were included: gender, ethnicity, age, health insurance, educational level (under or over 12 years of education), socio-economic level according to Graffar Scale in high, medium-high, medium, medium-low, low; underlying rheumatic disease, its duration and treatment at the time of infection.SARS-CoV-2 infection outcomes were: hospitalization, admission to ICU, mechanical ventilation requirement and death.Statistical analysis was performed using Chi2, Fisher, T-test, ANOVA.Results:Five hundred and twenty-five patients were included, 422 (80.4%) were female, with a mean age of 51.3 years (SD 15.2). Most of them were caucasians (48%) or mestizos (43%) and 96.8% lived in an urban environment. Almost half of the patients (47%) were categorized as middle-class, 24% middle-high or high class, 21% middle-low or low. 48.4% of the patients were employed. Regarding educational level, 54% had more than 12 years of education.The most prevalent rheumatic disease was Rheumatoid Arthritis (40.4%), followed by Systemic Lupus Erythematosus (14.9%), Sjögren (5.5%) and Psoriatic Arthritis (5.5%). Treatments used at the time of SARS-CoV-2 infection were corticosteroids (19%), cs-DMARDs (49%), and b- and ts-DMARDs (16%).Overall hospitalization frequency was 35%, median hospital stay was 10 days (IQR 10 days), 11.6% were admitted to the ICU, 10% required mechanical ventilation and the global mortality was 8%.Notably, patients with less than 12 years of education required mechanical ventilation more frequently than the more educated ones (11.9% vs. 5.6%, p=0.026) and showed a higher mortality due to COVID-19 (9% vs. 2.8%, p=0.0004).Patients categorized as upper social classes (middle-high and high) were admitted to the hospital on a more frequent basis (74.4% of cases), when compared with middle class (64.4%) and middle-low and low class (58%) (p=0.77). Median duration of hospitalization for the aforementioned groups was 12.5 (IQR 17.3), 10 (IQR 9) and 10.5 (IQR 9.3) days respectively (p=0.60).Patients with health insurance were found to be hospitalized more frequently in comparison to those without insurance (42.4% vs. 33.7%, p=0.14), but showed similar admission rates to the ICU (11.8% vs. 12.8%; p=0.78), need for mechanical ventilation (10.7% vs. 8.7%; p=0.70) and mortality (7.1% vs. 6.5%; p=0.99).Caucasian patients had fewer hospital admissions when compared against other ethnicities (mestizos mostly) (26.1% vs. 43.4%; p<0.0001), but showed no statistically significant difference in need for mechanical ventilation 10.3% vs. 9.9% (p=0.99) or mortality 8.7% vs. 5.1% (p=0.15).Conclusion:Patients with lower educational level needed twice the frequency of mechanical ventilation, and showed thrice the mortality than those with more than 12 years of education.Albeit patients in upper social stratus and those with health insurance were admitted to the hospital in a more frequent manner, no statistically significant differences were found regarding the need for ICU, mechanical ventilation or mortality.Caucasians were hospitalized less frequently than mestizos, but had no significant differences in the other measured outcomes.Disclosure of Interests:Laura Sorrentino Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Jonathan Rebak Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Federico Maldonado Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Vanessa Viviana Castro Coello Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Alejandro Brigante Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Adriana Hamaui Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Diana Dubinsky Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Roberto Baez Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Cecilia Pisoni Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Carla Gobbi Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Leandro Carlevaris Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Romina Tanten Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Adriana Karina Cogo Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Maria DeLaVega Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Rodolfo Perez Alamino Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Maria Alicia Lazaro Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Mariana Pera Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Susana Isabel Pineda Vidal Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Maria Elena Calvo Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Debora Guaglianone Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Carla G Alonso Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Mara Guinsburg Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Cinthya Retamozo Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Carolina Aeschlimann Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Rosana Quintana Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Karen Roberts Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Carolina Ayelen Isnardi Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Guillermo Pons Estel Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.
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Isnardi CA, Quintana R, Roberts K, Castro Coello VV, Reyes AA, Tissera Y, Cosatti M, Rojas Tessel R, Scafati J, Barbich T, Gálvez Elkin MS, Rodriguez Gil GF, Moyano S, Werner ML, Rebak J, Morbiducci J, Martire V, Castaño MS, Dieguez C, Subils GC, Pons-Estel G. POS1208 EPIDEMIOLOGY AND OUTCOMES OF PATIENTS WITH RHEUMATIC DISEASES AND SARS-CoV-2 INFECTION: DATA FROM THE ARGENTINEAN SAR-COVID REGISTRY. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:In the last time, many papers about SARS-CoV-2 have been published in the world. However, data from latinamerican patients is still scarce. In order to assess the impact of SARS-CoV-2 infection in patients with rheumatic diseases in our country and contribute to the global knowledge about the effect of immunosuppressive therapies in this group, the Argentine Society of Rheumatology has developed the National Registry of Patients with Rheumatic Diseases and COVID-19 (SAR-COVID).Objectives:The aim of this study was to evaluate clinical characteristics and outcomes of SARS-CoV-2 infection in patients with rheumatic diseases, treated or not with immunomodulators and/or immunosuppressants.Methods:SAR-COVID is a national, multicenter, prospective and observational registry, in which patients, ≥18 years of age, with a diagnosis of a rheumatic disease who had SARS-CoV-2 infection (PCR or positive serology) are consecutively included between August 13, 2020 and January 17, 2021. Sociodemographic data, comorbidities, underlying rheumatic disease and treatment, clinical characteristics, complications, laboratory and treatment of the SARS-CoV-2 infection were recorded. Hospitalization, mechanical ventilation requirements and death were assessed to evaluate COVID-19 outcome. Statistical analysis: Descriptive analysis. Chi2 or Fischer test and T test or Mann-Whitney U test or ANOVA, as appropriate. Multiple logistic regression.Results:A total of 525 patients were included, 80.4% were female, with a median age of 52 years (IQR 40-62). Comorbidities were reported in half of them (53.3%). The most frequent rheumatological diseases were rheumatoid arthritis (40.4%) and systemic lupus erythematosus (14.9%). At the time of the infection, most of them were in remission or in minimal/low disease activity (68.2%) and 72.9% were receiving immunosuppressive or immunomodulatory treatment.Symptoms were present in 96% of the patients, the most frequent being fever (56.2%), cough (46.7%) and headache (39.2%). During infection, 35.1% received some pharmacological treatment, dexamethasone (20%) the most frequently used. One third (35.1%) of the patients were hospitalized, 11.6% were admitted to the ICU, 10.1% needed mechanical ventilation and 6.9% died due to COVID-19. Complications were reported in 12.4%, being acute respiratory distress syndrome the most prevalent (8.8%).Patients over 65 years of age were more frequently hospitalized, admitted to the ICU, needed mechanical ventilation and died due to COVID-19 (50% vs 31.4%, 22% vs 9%, 16.3% vs 5.2%, 14% vs 5%, respectively; p<0.001 in all cases). Similar results were seen in patients with vasculitis (57.7% vs 33.9%, 46.2 vs 9.8%, 34.6% vs 6 %; 30.8% vs 5.6%, respectively; p< 0.001 in all cases) and those with moderate/high disease activity (55.7% vs 26.5%, 21.3 vs 7.8%, 17.2% vs 4.2 %; 17.2% vs 4.2 %, respectively; p< 0.001 in all cases). Patients with APS were more frequently admitted to the ICU (29.4% vs 11%, p= 0.037). The presence of comorbidities was associated with higher hospitalization (46% vs 22.6%, p<0.001), admission to the ICU (17.2% vs 5.9%, p<0.001) and mechanical ventilation (10.2% vs 4.6%, p= 0.028). Immunosuppressive treatment was not associated with worse outcomes.Conclusion:In this cohort of patients with a wide distribution of rheumatic diseases, we have found clinical characteristics similar to those reported by other international cohorts. Compared with national data, the mortality reported in these patients is higher. However, it should be noted that these are early data collected during isolation and that there may be an underreporting of asymptomatic patients or with mild symptoms who do not attend the rheumatologist.Older patients, those with comorbidities, with vasculitis and with higher disease activity showed poor COVID-19 outcomes.Disclosure of Interests:Carolina Ayelen Isnardi Speakers bureau: Janssen, BMS, Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Rosana Quintana Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Karen Roberts Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Vanessa Viviana Castro Coello Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Alvaro Andres Reyes Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Yohana Tissera Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Micaela Cosatti Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Romina Rojas Tessel Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Julia Scafati Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Tatiana Barbich Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., María Soledad Gálvez Elkin Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Gustavo Fabian Rodriguez Gil Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Sebastian Moyano Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Marina Laura Werner Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Jonathan Rebak Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Julieta Morbiducci Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Victoria Martire Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., María Sol Castaño Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Carolina Dieguez Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Gisela Constanza Subils Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data., Guillermo Pons-Estel Grant/research support from: Unrestricted grants: Pfizer, Abbvie, Elea Phoenix. None of them have access to patient data.
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Pons-Estel GJ, Ugarte-Gil MF, Harvey GB, Wojdyla D, Quintana R, Saurit V, Soriano ER, Bonfa E, Massardo L, Cardiel M, Vila LM, Griffin R, Pons-Estel BA, Alarcón GS. Applying the 2019 EULAR/ACR lupus criteria to patients from an established cohort: a Latin American perspective. RMD Open 2021; 6:rmdopen-2019-001097. [PMID: 31958284 PMCID: PMC6999682 DOI: 10.1136/rmdopen-2019-001097] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 11/20/2019] [Accepted: 12/15/2019] [Indexed: 12/01/2022] Open
Abstract
Objective To evaluate the performance of the 2019 European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) systemic lupus erythematosus (SLE) criteria in terms of earlier patients’ classification in comparison to the 1982/1997 ACR or the 2012 Systemic Lupus International Collaborating Clinics (SLICC) criteria. Materials and methods Patients from a Latin America, multiethnic, multicentre cohort, where SLE was defined using the physicians’ diagnosis, were included. To calculate the sensitivity of the 2019 EULAR/ACR criteria, the 1982/1997 ACR criteria were considered the gold standard. Additionally, comparison of the 1982/1997 ACR criteria and the 2012 SLICC criteria with the 2019 EULAR/ACR criteria was performed. Results The sensitivity of the 2019 EULAR/ACR criteria when compared with the 1982/1997 ACR criteria as the gold standard was 91.3%. This new set of criteria allowed an earlier SLE patient classification in 7.4% (mean 0.67 years) and 0.6% (mean 1.47 years) than the 1982/1997 ACR and the 2012 SLICC criteria, respectively. Patients accruing the 2019 EULAR/ACR earlier than the 1982/1997 ACR criteria were more likely to have high anti-dsDNA titres; those accruing them later were less likely to have mucocutaneous and joint manifestations; this was not observed when comparing them with the 2012 SLICC criteria. Conclusions The 2019 EULAR/ACR criteria classified earlier only a small proportion of Latin America patients than with the two other criteria sets in real-life clinical practice scenarios. Further studies in different patient populations are needed before these new criteria are adopted worldwide.
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Affiliation(s)
- Guillermo J Pons-Estel
- Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Santa Fe, Argentina .,Servicio de Reumatología, Hospital Provincial de Rosario, Rosario, Santa Fe, Argentina
| | - Manuel Francisco Ugarte-Gil
- School of Medicine, Universidad Cientifica del Sur, Lima, Peru.,Servicio de Reumatología, Hospital Nacional Guillermo Almenara Irigoyen. EsSalud, Lima, Peru
| | - Guillermina B Harvey
- Escuela de Estadística, Facultad de Ciencias Económicas y Estadística, Universidad Nacional de Rosario, Rosario, Argentina
| | - Daniel Wojdyla
- Escuela de Estadística, Facultad de Ciencias Económicas y Estadística, Universidad Nacional de Rosario, Rosario, Argentina
| | - Rosana Quintana
- Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Santa Fe, Argentina.,Servicio de Reumatología, Hospital Provincial de Rosario, Rosario, Santa Fe, Argentina
| | - Verónica Saurit
- Servicio de Reumatología, Hospital Privado Universitario de Córdoba, Córdoba, Córdoba, Argentina
| | - Enrique R Soriano
- Rheumatology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Eloisa Bonfa
- Rheumatology, Faculdade de Medicina da Universidade de São Paulo-USP, São Paulo, SP, Brazil
| | - Loreto Massardo
- Centro de Biología Celular y Biomedicina, Universidad San Sebastián, Santiago, Chile
| | - Mario Cardiel
- Centro de Investigacion Clinica de Morelia, Morelia, Michoacán, Mexico
| | - Luis M Vila
- Division of Rheumatology, University of Puerto Rico, San Juan, San Juan, Puerto Rico
| | - Russell Griffin
- Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Bernardo A Pons-Estel
- Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Santa Fe, Argentina
| | - Graciela S Alarcón
- Department of Medicine, Division of Clinical Immunology and Rheumatology, School of Medicine, The University of Alabama, Birmingham, Alabama, USA
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Gómez-Puerta JA, Pons-Estel GJ, Quintana R, Nieto R, Serrano Morales RM, Harvey GB, Wojdyla D, Scolnik M, Funes Soaje C, Alba Moreyra P, Novatti E, Arizpe F, Berbotto GA, González Lucero L, Porta S, Pérez N, Rodriguez AM, Appenzeller S, de Oliveira E Silva Montadon AC, Monticielo OA, Cavalcanti FS, Machado Ribeiro F, Borba EF, Torres Dos Reis-Neto E, Neira O, Chahuán JM, Mimica M, Aroca Martínez G, Tobón GJ, Vásquez G, Quintana-Lopez G, Moreno Alvarez MJ, Saavedra MÁ, Cristobal MP, Fragoso-Loyo H, Amezcua-Guerra LM, González-Bello YC, Abud-Mendoza C, Esquivel-Valerio JA, Duarte M, Acosta Colman I, Mora-Trujillo C, Reátegui-Sokolova C, Calvo Quiroz AA, Muñoz-Louis R, Cairoli E, Rosas I, Rebella M, Cardiel MH, García de la Torre I, Catoggio LJ, Alarcón GS, Pons-Estel BA. A longitudinal multiethnic study of biomarkers in systemic lupus erythematosus: Launching the GLADEL 2.0 Study Group. Lupus 2021; 30:961203320988586. [PMID: 33509067 DOI: 10.1177/0961203320988586] [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: 11/15/2022]
Abstract
Introduction: After more than 20 years of sustained work, the Latin American Group for the Study of Lupus (GLADEL) has made a significant number of contributions to the field of lupus, not only in the differential role that race/ethnicity plays in its course and outcome but also in several other studies including the beneficial effects of using antimalarials in lupus patients and the development of consensus guidelines for the treatment of lupus in our region. Methods: A new generation of "Lupus Investigators" in more than 40 centers throughout Latin America has been constituted in order to continue the legacy of the investigators of the original cohort and to launch a novel study of serum and urinary biomarkers in patients with systemic lupus erythematosus. Results: So far, we have recruited 807 patients and 631 controls from 42 Latin-American centers including 339 patients with SLE without renal involvement, 202 patients with SLE with prevalent but inactive renal disease, 176 patients with prevalent and active renal disease and 90 patients with incident lupus nephritis. Conclusions: The different methodological aspects of the GLADEL 2.0 cohort are discussed in this manuscript, including the challenges and difficulties of conducting such an ambitious project.
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Affiliation(s)
| | | | - Rosana Quintana
- Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
| | - Romina Nieto
- Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
| | | | - Guillermina B Harvey
- Escuela de Estadística, Facultad de Ciencias Económicas y Estadística, Universidad Nacional de Rosario, Rosario, Argentina
| | | | - Marina Scolnik
- Rheumatology Section, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Carmen Funes Soaje
- Servicio de Reumatología, Hospital Italiano de Córdoba, Córdoba, Argentina
| | - Paula Alba Moreyra
- Hospital Córdoba, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Elisa Novatti
- Servicio de Reumatología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - Fernando Arizpe
- Servicio de Reumatología, HIGA San Martin de La Plata, Argentina
| | - Guillermo A Berbotto
- Servicio de Reumatología, Hospital Escuela "Eva Perón", Granadero Baigorria, Argentina
| | | | - Sabrina Porta
- Rheumatology Department, Hospital "José María Ramos Mejía", Buenos Aires, Argentina
| | - Nicolás Pérez
- Departamento de Inmunología, Instituto de Investigaciones Médicas "Alfredo Lanari", Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Anabella M Rodriguez
- Sección de Reumatología e Inmunología, Centro De Educación Médica e Investigaciones Clínicas, "Norberto Quirno" (CEMIC), Buenos Aires, Argentina
| | | | | | - Odirlei Andre Monticielo
- Rheumatology Division, Department of Internal Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Fernando S Cavalcanti
- Serviço de Reumatologia, Departamento de Medicina Clínica, Centro de Ciências Médicas, Hospital das Clínicas, Universidade Federal de Pernambuco, Pernambuco, Brazil
| | - Francinne Machado Ribeiro
- Rheumatology Division, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Eduardo F Borba
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Oscar Neira
- Sección de Reumatología, Hospital del Salvador, Universidad de Chile, Santiago, Chile
| | - José Miguel Chahuán
- Departamento de Inmunología Clínica y Reumatología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Milena Mimica
- Centro de Biología Celular y Biomedicina (CEBICEM), Facultad de Medicina y Ciencia, Universidad San Sebastián, Chile
| | - Gustavo Aroca Martínez
- Universidad Simón Bolívar, Barranquilla, Colombia
- Clínica de la Costa, Barranquilla, Colombia
| | - Gabriel J Tobón
- Unidad de Reumatología, Fundación Valle del Lili, Facultad de Medicina, Universidad ICESI, Cali, Colombia
| | - Gloria Vásquez
- Sección de Reumatología, Departamento de Medicina Interna/Grupo de Inmunología Celular e Inmunogenética, Facultad de Medicina, Universidad de Antioquía, Medellín, Colombia
| | - Gerardo Quintana-Lopez
- REUMAVANCE Group, Rheumatology Section, Department of Internal Medicine, Fundación Santa Fe de Bogotá, University Hospital, Bogotá, Colombia
- Department of Internal Medicine, School of Medicine, Universidad de Los Andes, Bogotá, Colombia
- Department of Internal Medicine, School of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Mario J Moreno Alvarez
- Servicio Reumatología, Hospital "Luis Vernaza", Universidad de Especialidades Espíritu Santo, Guayaquil, Ecuador
| | - Miguel Ángel Saavedra
- Hospital de Especialidades "Dr. Antonio Fraga Mouret", Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Mario Pérez Cristobal
- Departamento de Reumatología, Hospital de Especialidades del Centro Médico Nacional Siglo XXI, del Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Hilda Fragoso-Loyo
- Departamento de Inmunología y Reumatología, Instituto Nacional Ciencias Medicas y Nutrición "Salvador Zubirán", Ciudad de México, México
| | - Luis M Amezcua-Guerra
- Departamento de Inmunología/Departamento de Reumatología, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | - Yelitza C González-Bello
- Centro de Estudios de Investigación Básica y Clínica, S.C., Departamento de Inmunología, Guadalajara, México
| | - Carlos Abud-Mendoza
- Unidad Regional de Reumatología, Hospital Central "Dr. Ignacio Morones Prieto", y Facultad de Medicina, Universidad Autónoma de San Luis Potosí, San Luis Potosí, México
| | - Jorge A Esquivel-Valerio
- Servicio de Reumatología, Hospital Universitario "Dr, José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, México
| | - Margarita Duarte
- Primera Cátedra de Clínica Médica, Facultad de Ciencias Medicas, Universidad Nacional de Asunción, Asunción, Paraguay
| | - Isabel Acosta Colman
- Departamento de Reumatología, Facultad de Ciencias Medicas, Universidad Nacional de Asunción, Asunción, Paraguay
| | - Claudia Mora-Trujillo
- Servicio de Reumatología, Departamento de Especialidades Médicas, Hospital Nacional "Edgardo Rebagliati Martins", Lima, Perú
| | | | | | | | - Ernesto Cairoli
- Unidad de Enfermedades Autoinmunes Sistémicas, Hospital Evangélico, Montevideo, Uruguay
- Unidad de Enfermedades Autoinmunes Sistémicas, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Iliana Rosas
- Instituto Nacional de Reumatología/Hospital Pasteur, Montevideo, Uruguay
| | - Martín Rebella
- Unidad de Enfermedades Autoinmunes de Médica Uruguaya Corporación de Asistencia Médica (MUCAM). Clínica Médica, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Mario H Cardiel
- Centro de Investigación Clínica de Morelia, SC, Morelia, México
| | - Ignacio García de la Torre
- Departamento de Inmunología y Reumatología, Hospital General de Occidente de la S.S. y Universidad de Guadalajara, Zapopan, Jalisco, México
| | - Luis J Catoggio
- Rheumatology Section, Hospital Italiano de Buenos Aires, 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, USA
- Department of Medicine, School of Medicine, Universidad Peruana Cayetano, Heredia, Lima, Perú
| | - Bernardo A Pons-Estel
- Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
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Devenutto L, Quintana R, Quintana T. In vitro activation of ovarian cortex and autologous transplantation: A novel approach to primary ovarian insufficiency and diminished ovarian reserve. Hum Reprod Open 2020; 2020:hoaa046. [PMID: 33225075 PMCID: PMC7668396 DOI: 10.1093/hropen/hoaa046] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/26/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Primary ovarian insufficiency (POI) and diminished ovarian reserve are two conditions that affect women’s fertility. Oocyte donation remains an option for these patients; however, the development of certain novel technologies, such as in vitro activation of ovarian cortex (IVA), enables the possibility of activating the pool of resting primordial follicles, increasing the chance of pregnancy. OBJECTIVE AND RATIONALE Here, we review the main pathways (PI3K and Hippo signaling) that govern the activation of primordial follicles and its application through the development of culture systems that support ovarian cortex for autologous transplantation. We also review the available data from case reports regarding outcomes of pregnancy and live birth rates with IVA. SEARCH METHODS A PubMed search was conducted using the PubMed-NCBI database to identify literature pertinent to the pathways involved in the activation of primordial follicles and the outcomes of IVA techniques from 2013 to the present. OUTCOMES Women with POI have around a 5% chance of spontaneous pregnancy. Recently, novel techniques involving the activation of primordial follicles through molecular pathways have been developed, thus increasing the odds of these patients. More recently, the introduction of a drug-free IVA technique has shown to increase the number of antral follicles with successful oocyte maturation after gonadotropin treatment, reaching pregnancy rates over 30%, either through spontaneous conception or by the implementation of assisted reproductive technology. LIMITATIONS The evidence of this review is based on a few small series, so data should be interpreted with caution, and only randomized controlled trials could estimate the real magnitude and success of the procedure. REASONS FOR CAUTION IVA technique remains an experimental strategy, with limited available data and the requirement of invasive procedures. Moreover, possible carcinogenic effects not yet determined after transplantation require special caution. WIDER IMPLICATIONS In view of the results achieved, IVA could provide a promising option for the preservation of fertility in some cancer patients and prepuberal girls where the only alternative is tissue cryopreservation. STUDY FUNDING/COMPETING INTERESTS The authors received no specific funding for this work and declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
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Affiliation(s)
- L Devenutto
- Reproductive Medicine Service, "Procrearte", Institution Affiliated with the University of Buenos Aires (UBA), Buenos Aires, Argentina
| | - R Quintana
- Reproductive Medicine Service, "Procrearte", Institution Affiliated with the University of Buenos Aires (UBA), Buenos Aires, Argentina
| | - T Quintana
- Reproductive Medicine Service, "Procrearte", Institution Affiliated with the University of Buenos Aires (UBA), Buenos Aires, Argentina
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Quintana R, Pons-Estel GJ, Roberts K, Sacnún M, Serrano R, Nieto R, Conti S, Gervasoni V, Catoggio LJ, Soriano ER, Scolnik M, García MA, Alvarellos A, Saurit V, Berbotto GA, Sato EI, Costallat LTL, Neto EFB, Bonfa E, Xavier RM, de Oliveira e Silva Montandon AC, Molina-Restrepo JF, Iglesias-Gamarra A, Guibert-Toledano M, Reyes-Llerena GA, Massardo L, Neira OJ, Cardiel MH, Barile-Fabris LA, Amigo MC, Silveira LH, Torre IGDL, Acevedo-Vásquez EM, Ugarte-Gil MF, Alfaro-Lozano JL, Segami MI, Chacón-Díaz R, Esteva-Spinetti MH, Gomez-Puerta JA, Alarcón GS, Pons-Estel BA. Clinical features, damage accrual, and survival in patients with familial systemic lupus erythematosus: data from a multi-ethnic, multinational Latin American lupus cohort. Lupus 2020; 29:1140-1145. [DOI: 10.1177/0961203320935184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives This study aimed to compare the clinical features, damage accrual, and survival of patients with familial and sporadic systemic lupus erythematosus (SLE). Methods A multi-ethnic, multinational Latin American SLE cohort was studied. Familial lupus was defined as patients with a first-degree SLE relative; these relatives were interviewed in person or by telephone. Clinical variables, disease activity, damage, and mortality were compared. Odds ratios (OR) and 95% confidence intervals (CI) were estimated. Hazard ratios (HR) were calculated using Cox proportional hazard adjusted for potential confounders for time to damage and mortality. Results A total of 66 (5.6%) patients had familial lupus, and 1110 (94.4%) had sporadic lupus. Both groups were predominantly female, of comparable age, and of similar ethnic distribution. Discoid lupus (OR = 1.97; 95% CI 1.08–3.60) and neurologic disorder (OR = 1.65; 95% CI 1.00–2.73) were significantly associated with familial SLE; pericarditis was negatively associated (OR = 0.35; 95% CI 0.14–0.87). The SLE Disease Activity Index and Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI) were similar in both groups, although the neuropsychiatric (45.4% vs. 33.5%; p = 0.04) and musculoskeletal (6.1% vs. 1.9%; p = 0.02) domains of the SDI were more frequent in familial lupus. They were not retained in the Cox models (by domains). Familial lupus was not significantly associated with damage accrual (HR = 0.69; 95% CI 0.30–1.55) or mortality (HR = 1.23; 95% CI 0.26–4.81). Conclusion Familial SLE is not characterized by a more severe form of disease than sporadic lupus. We also observed that familial SLE has a higher frequency of discoid lupus and neurologic manifestations and a lower frequency of pericarditis.
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Affiliation(s)
- Rosana Quintana
- Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
- Hospital Provincial de Rosario, Rosario, Argentina
| | - Guillermo J Pons-Estel
- Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
- Hospital Provincial de Rosario, Rosario, Argentina
| | | | | | - Rosa Serrano
- Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
| | - Romina Nieto
- Hospital Provincial de Rosario, Rosario, Argentina
| | | | | | | | | | - Marina Scolnik
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Mercedes A García
- Hospital Interzonal General de Agudos General San Martín, La Plata, Argentina
| | | | | | | | - Emilia I Sato
- Universidade Federal da Sao Paulo (UNIFESP), Sao Paulo, Brazil
| | | | | | | | - Ricardo M Xavier
- Hospital da Clinicas da Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil
| | | | | | | | | | | | - Loreto Massardo
- Facultad de Medicina, Universidad San Sebastián, Santiago, Chile
| | - Oscar J Neira
- Hospital del Salvador, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Mario H Cardiel
- Centro de Investigación Clínica de Morelia SC, Morelia, Mexico
| | | | | | - Luis H Silveira
- Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, Mexico
| | | | | | - Manuel F Ugarte-Gil
- Servicio de Reumatología, Hospital General Guillermo Almenara Irigoyen, EsSalud, Lima, Peru
- Universidad Científica del Sur, Lima, Peru
| | | | | | - Rosa Chacón-Díaz
- Centro Nacional de Enfermedades Reumáticas, Hospital Universitario de Caracas, Caracas, Venezuela
| | | | | | - Graciela S Alarcón
- The University of Alabama at Birmingham, Birmingham, USA
- Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Bernardo A Pons-Estel
- Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
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Salama M, Ataman-Millhouse L, Braham M, Berjeb K, Khrouf M, Rodrigues JK, Reis FM, Silva TC, Sánchez F, Romero S, Smitz J, Vásquez L, Vega M, Sobral F, Terrado G, Lombardi MG, Scarella A, Bourlon MT, Verduzco-Aguirre H, Sánchez AM, Adiga SK, Tholeti P, Udupa KS, Mahajan N, Patil M, Dalvi R, Venter C, Demetriou G, Geel J, Quintana R, Rodriguez G, Quintana T, Viale L, Fraguglia M, Coirini M, Remolina-Bonilla YA, Noguera JAR, Velásquez JC, Suarez A, Arango GD, Pineda JID, Aldecoa MDC, Javed M, Al Sufyan H, Daniels N, Oranye BC, Ogunmokun AA, Onwuzurigbo KI, Okereke CJ, Whesu TC, Woodruff TK. Installing oncofertility programs for common cancers in limited resource settings (Repro-Can-OPEN Study): An extrapolation during the global crisis of Coronavirus (COVID-19) pandemic. J Assist Reprod Genet 2020; 37:1567-1577. [PMID: 32594284 PMCID: PMC7320246 DOI: 10.1007/s10815-020-01821-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 05/10/2020] [Indexed: 02/06/2023] Open
Abstract
PURPOSE The state of limited resource settings that Coronavirus (COVID-19) pandemic has created globally should be taken seriously into account especially in healthcare sector. In oncofertility, patients should receive their fertility preservation treatments urgently even in limited resource settings before initiation of anticancer therapy. Therefore, it is very crucial to learn more about oncofertility practice in limited resource settings such as in developing countries that suffer often from shortage of healthcare services provided to young patients with cancer. METHODS As an extrapolation during the global crisis of COVID-19 pandemic, we surveyed oncofertility centers from 14 developing countries (Egypt, Tunisia, Brazil, Peru, Panama, Mexico, Colombia, Guatemala, Argentina, Chile, Nigeria, South Africa, Saudi Arabia, and India). Survey questionnaire included questions on the availability and degree of utilization of fertility preservation options in case of childhood cancer, breast cancer, and blood cancer. RESULTS All surveyed centers responded to all questions. Responses and their calculated oncofertility scores showed different domestic standards for oncofertility practice in case of childhood cancer, breast cancer, and blood cancer in the developing countries under limited resource settings. CONCLUSIONS Medical practice in limited resource settings has become a critical topic especially after the global crisis of COVID-19 pandemic. Understanding the resources necessary to provide oncofertility treatments is important until the current COVID-19 pandemic resolves. Lessons learned will be valuable to future potential worldwide disruptions due to infectious diseases or other global crises.
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Affiliation(s)
- M. Salama
- Oncofertility Consortium, Feinberg School of Medicine, Northwestern University, Chicago, Illinois USA
| | - L. Ataman-Millhouse
- Oncofertility Consortium, Feinberg School of Medicine, Northwestern University, Chicago, Illinois USA
| | - M. Braham
- Aziza Othmana Hospital of Tunis, Tunis, Tunisia
| | - K. Berjeb
- Aziza Othmana Hospital of Tunis, Tunis, Tunisia
| | - M. Khrouf
- FERTILLA, Clinique la Rose, Tunis, Tunisia
| | - J. K. Rodrigues
- Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais Brazil
| | - F. M. Reis
- Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais Brazil
| | - T. Cury- Silva
- Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais Brazil
| | - F. Sánchez
- Laboratorio de Biología Reproductiva y Preservación de la Fertilidad, Laboratorios de Investigación y Desarrollo, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - S. Romero
- Laboratorio de Biología Reproductiva y Preservación de la Fertilidad, Laboratorios de Investigación y Desarrollo, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - J. Smitz
- Laboratorio de Biología Reproductiva y Preservación de la Fertilidad, Laboratorios de Investigación y Desarrollo, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - L. Vásquez
- Unidad de Oncología Pediátrica, Hospital Edgardo Rebagliati Martins, Lima, Peru
| | - M. Vega
- Panama Fertility, Sistema Nacional de Investigadores, Panama City, Panama
| | - F. Sobral
- Pregna Medicina Reproductiva, Buenos Aires, Argentina
| | - G. Terrado
- Pregna Medicina Reproductiva, Buenos Aires, Argentina
| | | | - A. Scarella
- Centro de Reproduccion Humana, Facultad de Medicina, Universidad de Valparaiso, Valparaiso, Chile
| | - M. T. Bourlon
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - H. Verduzco-Aguirre
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - A. M. Sánchez
- Instituto Nacional de Perinatología Isidro Espinoza de los Reyes, Mexico City, Mexico
| | - S. K. Adiga
- Fertility Preservation Centre, Department of Clinical Embryology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - P. Tholeti
- Fertility Preservation Centre, Department of Clinical Embryology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - K. S. Udupa
- Department of Medical Oncology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - N. Mahajan
- Mother and Child Hospital, New Delhi, India
| | - M. Patil
- Dr. Patil’s Fertility and Endoscopy Clinic, Bangalore, India
| | - R. Dalvi
- Hospital Institute of Medical Sciences & SRCC children’s Hospital, Mumbai, India
| | - C. Venter
- Vitalab Fertility Centre, Johannesburg, South Africa
| | - G. Demetriou
- Department Medical Oncology, University of Witwatersrand, Johannesburg, South Africa
| | - J. Geel
- Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | | | | | | | - L. Viale
- Procrearte, Buenos Aires, Argentina
| | | | - M. Coirini
- Hospital de Niños Victor J. Vilela. Rosario, Santa Fe, Argentina
| | | | | | | | - A. Suarez
- Instituto Nacional de Cancerología, Bogota, Colombia
| | | | - J. I. D. Pineda
- Instituto Guatemalteco de Seguridad Social (IGSS), Guatemala City, Guatemala
| | - M. D. C. Aldecoa
- Instituto Guatemalteco de Seguridad Social (IGSS), Guatemala City, Guatemala
| | - M. Javed
- Thuriah Medical Center, Riyadh, Kingdom of Saudi Arabia
| | - H. Al Sufyan
- Thuriah Medical Center, Riyadh, Kingdom of Saudi Arabia
| | - N. Daniels
- The Oncology and Fertility Centres of Ekocorp Plc, Eko Hospitals, Lagos, Nigeria
| | - B. C. Oranye
- The Oncology and Fertility Centres of Ekocorp Plc, Eko Hospitals, Lagos, Nigeria
| | - A. A. Ogunmokun
- The Oncology and Fertility Centres of Ekocorp Plc, Eko Hospitals, Lagos, Nigeria
| | | | | | - T. C. Whesu
- Kingswill Specialist Hospital, Lagos, Nigeria
| | - T. K. Woodruff
- Oncofertility Consortium, Feinberg School of Medicine, Northwestern University, Chicago, Illinois USA
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Quintana R, Fernández S, Orzuza SM, Silvestre AMR, Bensi A, Goñi M, Iglesias P, Mathern N, García-Bianco V, Honeri A, Pons-Estel BA, Valdata M, Peláez-Ballestas I. «Living with Rheumatoid Arthritis» in an Indigenous Qom Population in Argentina. A Qualitative Study. Reumatol Clin (Engl Ed) 2020; 17:S1699-258X(20)30112-1. [PMID: 32600980 DOI: 10.1016/j.reuma.2020.04.016] [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] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 04/13/2020] [Accepted: 04/22/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Rheumatoid arthritis (RA) is a chronic disease which impacts patients' quality of life. The prevalence of RA in the qom population was 2.4% and represented an aggressive and disabling disease. The study goal was to describe the experience of the indigenous qom community individual suffering from RA, along with their experience with the local health care system in the city of Rosario, Santa Fe, Argentina. METHODS Qualitative Study using techniques of participant observation and semi-structured interviews; following a guideline developed by a multidisciplinary research group comprising anthropologists, rheumatologists, nurses, and psychologists. A triangulation strategy was implemented for the analysis. RESULTS A total of 33 interviews were conducted in 29 individuals with RA. The results showed a «normalization» of their symptoms and of their limitations in performing daily tasks. The individual relationships with the local health care system was complex and limited in several aspects (e.g. access to health care, continuity of treatment, complexity of medical care pathway and lack of cultural competence). CONCLUSIONS RA is a disease that has a negative impact on the daily lives of the qom people living in Rosario. Improving the relationship between this population and the local health care system as well as the implementation of multidisciplinary work should be priorities.
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Affiliation(s)
- Rosana Quintana
- Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina.
| | - Sofía Fernández
- Centro de Estudios Aplicados a Problemáticas Socio-culturales (CEAPROS), Facultad de Humanidades y Artes, Universidad Nacional de Rosario, Argentina
| | - Stella M Orzuza
- Centro de Estudios Aplicados a Problemáticas Socio-culturales (CEAPROS), Facultad de Humanidades y Artes, Universidad Nacional de Rosario, Argentina
| | - Adriana M R Silvestre
- Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
| | - Ana Bensi
- Centro de Estudios Aplicados a Problemáticas Socio-culturales (CEAPROS), Facultad de Humanidades y Artes, Universidad Nacional de Rosario, Argentina
| | - Mario Goñi
- Centro de Especialidades Médicas Ambulatorias de Rosario, Secretaría de Salud Pública, Municipalidad de Rosario, Argentina
| | - Paola Iglesias
- Centro de Estudios Aplicados a Problemáticas Socio-culturales (CEAPROS), Facultad de Humanidades y Artes, Universidad Nacional de Rosario, Argentina
| | - Nora Mathern
- Instituto de Reumatología, Ortopedia y Fisiatría, Rosario, Argentina
| | - Vanina García-Bianco
- Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
| | - Andrés Honeri
- Centro de Estudios Aplicados a Problemáticas Socio-culturales (CEAPROS), Facultad de Humanidades y Artes, Universidad Nacional de Rosario, Argentina
| | - Bernardo A Pons-Estel
- Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
| | - Marcela Valdata
- Centro de Estudios Aplicados a Problemáticas Socio-culturales (CEAPROS), Facultad de Humanidades y Artes, Universidad Nacional de Rosario, Argentina
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Juárez V, Quintana R, Crespo ME, Aciar M, Buschiazzo E, Cucchiaro NL, Picco E, Ruiz M, Sánchez JA, Franco R, Estrella N, Jorge S, Retamozo C, Silvestre AMR, García V, Pelaez-Ballestas I, Pons Estel BA. Prevalence of musculoskeletal disorders and rheumatic diseases in an Argentinean indigenous Wichi community. Clin Rheumatol 2020; 40:75-83. [PMID: 32504194 DOI: 10.1007/s10067-020-05130-3] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 03/26/2020] [Accepted: 04/23/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To estimate the prevalence of musculoskeletal disorders (MSK) and rheumatic diseases in an indigenous Wichi population in Argentina. METHODS This is a cross-sectional, community-based study using the Community-Oriented Program for the Control of Rheumatic Diseases (COPCORD) methodology in ≥ 18-year-old subjects. Validated surveys were conducted by trained interviewers. Subjects with MSK pain (positive cases) were evaluated by internists and rheumatologists for diagnosis and treatment. RESULTS A total of 648 interviews were performed (90.4% of the census population). Mean age was 37.5 years (SD 14.8), and 379 (58.5%) were female. The mean years of education was 7.0 (SD 3.7); 552 subjects (85.2%) were covered by the public health care system. A total of 216 (33.3%) subjects had MSK pain in the last 7 days. Rheumatic disease prevalence was as follows: mechanical back pain (19.0%), rheumatic regional pain syndrome (5.2%), osteoarthritis (3.2%), rheumatoid arthritis (RA) (3.2%), inflammatory back pain (1.2%), undifferentiated arthritis (0.3%), Sjögren syndrome (0.15%), and fibromyalgia (0.15%). RA patients included 19 (90.5%) women and 9 (42.9%) with RA family history. One hundred percent were seropositive and 66.7% showed radiologic erosions. The mean of Disease Activity Score [DAS-28 (ESR)] at the time of diagnosis was 5.1 (SD 1.5) and the Health Assessment Questionnaire Disability Index (HAQ-DI) was 0.8 (SD 0.4). CONCLUSION RA prevalence was 3.2%, one of the highest reported using the COPCORD methodology in indigenous and non-indigenous peoples in Latin America, with a high percentage of family cases. Pain and functional capacity were the variables allowing patients' early referral to a specialist. Key Points • The RA prevalence was 3.2%, one of the highest reported using COPCORD methodology in indigenous and non-indigenous peoples in Latin America. • The patients with RA had high percentage of familiar history of RA. • The pain and functional capacity were the variables associated with a diagnosis of any rheumatic disease and should be considered for early referral. • The mean of the delay in the diagnosis was 5.8 years. In this community, the lack of the "migration health" phenomenon may be a social determinant that negatively impacts their health.
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Affiliation(s)
| | - Rosana Quintana
- Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Santa Fe, Argentina.
| | | | | | | | | | | | - Mario Ruiz
- Hospital Arturo Oñativia, Salta, Argentina
| | | | - Rodolfo Franco
- Centro de Salud Misión Chaqueña el Algarrobal, Embarcación, Salta, Argentina
| | | | - Silvia Jorge
- Hospital San Bernardo de Salta, Salta, Argentina
| | | | - Adriana M R Silvestre
- Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Santa Fe, Argentina
| | - Vanina García
- Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Santa Fe, Argentina
| | | | - Bernardo A Pons Estel
- Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Santa Fe, Argentina
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Strozzi AG, Peláez-Ballestas I, Granados Y, Burgos-Vargas R, Quintana R, Londoño J, Guevara S, Vega-Hinojosa O, Alvarez-Nemegyei J, Juarez V, Pacheco-Tena C, Cedeño L, Garza-Elizondo M, Santos AM, Goycochea-Robles MV, Feicán A, García H, Julian-Santiago F, Crespo ME, Rodriguez-Amado J, Rueda JC, Silvestre A, Esquivel-Valerio J, Rosillo C, Gonzalez-Chavez S, Alvarez-Hernández E, Loyola-Sanchez A, Navarro-Zarza E, Maradiaga M, Casasola-Vargas J, Sanatana N, Garcia-Olivera I, Goñi M, Sanin LH, Gamboa R, Cardiel MH, Pons-Estel BA. Syndemic and syndemogenesis of low back pain in Latin-American population: a network and cluster analysis. Clin Rheumatol 2020; 39:2715-2726. [PMID: 32232735 DOI: 10.1007/s10067-020-05047-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 10/15/2019] [Revised: 02/14/2020] [Accepted: 03/11/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Although low back pain (LBP) is a high-impact health condition, its burden has not been examined from the syndemic perspective. OBJECTIVE To compare and assess clinical, socioeconomic, and geographic factors associated with LBP prevalence in low-income and upper-middle-income countries using syndemic and syndemogenesis frameworks based on network and cluster analyses. METHODS Analyses were performed by adopting network and cluster design, whereby interrelations among the individual and social variables and their combinations were established. The required data was sourced from the databases pertaining to the six Latin-American countries. RESULTS Database searches yielded a sample of 55,724 individuals (mean age 43.38 years, SD = 17.93), 24.12% of whom were indigenous, and 60.61% were women. The diagnosed with LBP comprised 6.59% of the total population. Network analysis showed higher relationship individuals' variables such as comorbidities, unhealthy habits, low educational level, living in rural areas, and indigenous status were found to be significantly associated with LBP. Cluster analysis showed significant association between LBP prevalence and social variables (e.g. Gender inequality Index, Human Development Index, Income Inequality). CONCLUSIONS LBP is a highly prevalent condition in Latin-American populations with a high impact on the quality of life of young adults. It is particularly debilitating for women, indigenous individuals, and those with low educational level, and is further exacerbated by the presence of comorbidities, especially those in the mental health domain. Thus, the study findings demonstrate that syndemic and syndemogenesis have the potential to widen the health inequities stemming from LBP in vulnerable populations. Key points • Syndemic and syndemogenesis evidence health disparities in Latin-American populations, documenting the complexity of suffering from a disease such as low back pain that is associated with comorbidities, unhealthy habits, and the social and regional context where they live. • The use of network and cluster analyses are useful tools for documenting the complexity and the multifaceted impact in health in large populations as well as the differences between countries. • The variability and impact of socioeconomic indicators (e.g., Gini index) related to low back pain and comorbidities could be felt through the use of cluster analysis, which generates evidence of regional inequality in Latin America. • Populations can be studied from different models (network and cluster analysis) and grouping, presenting new interpretations beyond geographical groupings, such as syndemic and inequity in health.
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Affiliation(s)
- Alfonso Gastelum Strozzi
- Instituto de Ciencias Aplicadas y Tecnología, Universidad Nacional Autónoma de México (ICAT-UNAM), 04510, Ciudad de México, Mexico
| | | | | | - Rubén Burgos-Vargas
- Rheumatology Unit. Hospital General de México "Dr. Eduardo Liceaga", Mexico City, Mexico
| | - Rosana Quintana
- Hospital Provincial de Rosario, Rosario, Santa Fe, Argentina
| | | | | | | | | | | | - César Pacheco-Tena
- Facultad de Medicina y Ciencias Biomédicas, Universidad Autónoma de Chihuahua, Chihuahua, Mexico
| | - Ligia Cedeño
- Red Ambulatoria. Ministerio del Poder Popular para la Salud, Maturín, Venezuela
| | | | | | | | | | - Hazel García
- Hospital Amerimed, Av. Tulum Sur 260, 7, 77500, Cancún, Q.R., Mexico
| | | | | | | | | | - Adriana Silvestre
- Ministerio de Salud, Gobierno de la Provincia de Santa Fe, Santa Fe, Argentina
| | | | - Celenia Rosillo
- Red Ambulatoria. Ministerio del Poder Popular para la Salud, Maturín, Venezuela
| | - Susana Gonzalez-Chavez
- Facultad de Medicina y Ciencias Biomédicas, Universidad Autónoma de Chihuahua, Chihuahua, Mexico
| | | | | | - Eduardo Navarro-Zarza
- Hospital General de Chilpancingo "Dr. Raymundo Abarca Alarcón", Chilpancingo de los Bravo, Mexico
| | | | - Julio Casasola-Vargas
- Rheumatology Unit. Hospital General de México "Dr. Eduardo Liceaga", Mexico City, Mexico
| | | | | | - Mario Goñi
- Centro de Especialidades Médicas Ambulatorias de Rosario, Secretaría de Salud Pública, Municipalidad de Rosario, Santa Fe, Argentina
| | - Luz Helena Sanin
- Facultad de Medicina y Ciencias Biomédicas, Universidad Autónoma de Chihuahua, Chihuahua, Mexico
| | - Rocío Gamboa
- Hospital Nacional Guillermo Almenara Irigoyen, Lima, Peru
| | | | - Bernardo A Pons-Estel
- Centro Regional de Enfermedades Autoinmunes y Reumáticas (CREAR), Grupo Oroño, Rosario, Santa Fe, Argentina
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Luque P, Peirano I, Levi S, Vo P, Carboni V, Quintana R. PND15 CHARACTERIZATION OF THE ARGENTINE POPULATION WITH AT LEAST 4 MONTHLY MIGRAINE DAYS: RESULTS FROM MIGRAINE VOICE SURVEY. Value Health Reg Issues 2019. [DOI: 10.1016/j.vhri.2019.08.345] [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: 11/29/2022]
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Paredes D, Lenz Alcayaga R, Hitschfeld M, Vo P, Carboni V, Quintana R. PND14 OUT-OF-POCKET EXPENDITURE IN MIGRAINE PATIENTS WITH AND WITHOUT COMORBIDITIES IN CHILE: A HEALTHCARE SYSTEM PERSPECTIVE. Value Health Reg Issues 2019. [DOI: 10.1016/j.vhri.2019.08.344] [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: 11/29/2022]
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Lenz Alcayaga R, Paredes D, Hitschfeld M, Vo P, Quintana R, Carboni V. PND12 WORK PRODUCTIVITY AND DAILY ACTIVITIES IMPAIRMENT (WPAI) IN CHILEAN PATIENTS WITH MIGRAINE: PERSPECTIVES ON INDIRECT-COSTS DRIVERS. Value Health Reg Issues 2019. [DOI: 10.1016/j.vhri.2019.08.342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Quintana R, Pons-Estel G, Roberts K, Sacnún M, Berbotto G, Garcia MA, Saurit V, Barile-Fabris L, Acevedo-Vazquez EM, Tavares Brenol JC, Sato EI, Iglesias A, Uribe O, Alarcon G, Pons-Estel BA. Jaccoud’s arthropathy in SLE: findings from a Latin American multiethnic population. Lupus Sci Med 2019; 6:e000343. [PMID: 31478011 PMCID: PMC6703282 DOI: 10.1136/lupus-2019-000343] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 07/22/2019] [Accepted: 07/26/2019] [Indexed: 11/17/2022]
Abstract
Objective To compare the clinical, laboratory and outcome features of SLE patients with and without Jaccoud’s arthropathy (JA) from the Grupo Latino Americano De Estudio del Lupus (GLADEL) cohort. Methods 1480 patients with SLE [(34 centres, 9 Latin American countries with a recent diagnosis (≤2 years)] constitute the GLADEL cohort. JA was defined as reducible deformity of the metacarpophalangeal axis, without radiographic erosions at any time. Within this cohort, a nested case–control study was carried out. Control was matched for age, gender and centre in a 1:3 proportion. The variables included were: sociodemographic, clinical and immunological features, disease activity, damage and mortality. Comparisons were performed with Wilcoxon and χ2 tests for continuous and categorical variables, respectively. ORs and 95% CIs and Kaplan-Meier survival curve were estimated. Results Of 1480 patients, 17 (1.1%) JA patients were identified; 16 (94.1%) of them were women, mean age: 31.0 years (SD 12.0). Five (29.4%) patients presented JA at SLE diagnosis and 12 (70.6%) after. The median follow-up time and all disease features were comparable in both groups except for a higher frequency of pneumonitis in the patients with JA [4 (23.5) vs 1 (2.0); p=0.012; (OR: 15.4; 95% CI 1.6 to 149.6)]. The SLE disease activity index, Systemic Lupus International Collaborating Clinics/American College of Rheumatology damage Index and the Kaplan-Meier survival curve were similar in both groups. Conclusion JA may tend to appear early in the course of SLE; it seems not to have an impact on disease activity, damage accrual or in survival.
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Affiliation(s)
- Rosana Quintana
- Department of Internal Medicine, Centro Regional de Enfermedades Autoinmunes y Reumáticas (CREAR), Rosario, Argentina
| | - Guillermo Pons-Estel
- Department of Internal Medicine, Centro Regional de Enfermedades Autoinmunes y Reumáticas (CREAR), Rosario, Argentina
| | - Karen Roberts
- Department of Rheumatology, Hospital Provincial de Rosario, Rosario, Argentina
| | - Monica Sacnún
- Department of Rheumatology, Hospital Provincial de Rosario, Rosario, Argentina
| | - Guillermo Berbotto
- Department of Rheumatology, Hospital Escuela Eva Perón, Granadero Baigorria, Argentina
| | - Mercedes A Garcia
- Department of Rheumatology, Hospital Interzonal General de Agudos General San Martín, La Plata, Argentina
| | - Veronica Saurit
- Department of Rheumatology, Hospital Privado, Cordoba, Cordoba, Argentina
| | - Leonor Barile-Fabris
- Department of Rheumatology, Hospital Angeles del Pedregal, Ciudad de México, Ciudad de Mexico, Mexico
| | | | - João C Tavares Brenol
- Department of Rheumatology, Hospital das Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Emilia I Sato
- Department of Rheumatology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Antonio Iglesias
- Department of Medicine, Universidad Nacional de Colombia, Bogota, Colombia
| | - Oscar Uribe
- Department of Rheumatology, Universidad de Antioquia, Hospital Universitario “Fundación San Vicente”, Medellin, Colombia
| | - Graciela Alarcon
- Department of Medicine, Division of Clinical Immunology and Rheumatology, School of Medicine, The University of Alabama at Birmingham, Birmingham, England, USA
- Department of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Bernardo A Pons-Estel
- Department of Internal Medicine, Centro Regional de Enfermedades Autoinmunes y Reumáticas (CREAR), Rosario, Argentina
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Zhang H, Magooda A, Litman D, Correnti R, Wang E, Matsmura L, Howe E, Quintana R. eRevise: Using Natural Language Processing to Provide Formative Feedback on Text Evidence Usage in Student Writing. ACTA ACUST UNITED AC 2019. [DOI: 10.1609/aaai.v33i01.33019619] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Writing a good essay typically involves students revising an initial paper draft after receiving feedback. We present eRevise, a web-based writing and revising environment that uses natural language processing features generated for rubricbased essay scoring to trigger formative feedback messages regarding students’ use of evidence in response-to-text writing. By helping students understand the criteria for using text evidence during writing, eRevise empowers students to better revise their paper drafts. In a pilot deployment of eRevise in 7 classrooms spanning grades 5 and 6, the quality of text evidence usage in writing improved after students received formative feedback then engaged in paper revision.
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Pimentel-Quiroz VR, Ugarte-Gil MF, Harvey GB, Wojdyla D, Pons-Estel GJ, Quintana R, Esposto A, García MA, Catoggio LJ, Cardiel MH, Barile LA, Amigo MC, Sato EI, Bonfa E, Borba E, Lavras Costallat LT, Neira OJ, Massardo L, Guibert-Toledano M, Chacón-Díaz R, Alarcón GS, Pons-Estel BA. Factors predictive of serious infections over time in systemic lupus erythematosus patients: data from a multi-ethnic, multi-national, Latin American lupus cohort. Lupus 2019; 28:1101-1110. [DOI: 10.1177/0961203319860579] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Aim The aim of this study was to identify factors predictive of serious infections over time in patients with systemic lupus erythematosus (SLE). Methods A multi-ethnic, multi-national Latin American SLE cohort was studied. Serious infection was defined as one that required hospitalization, occurred during a hospitalization or led to death. Potential predictors included were sociodemographic factors, clinical manifestations (per organ involved, lymphopenia and leukopenia, independently) and previous infections at baseline. Disease activity (SLEDAI), damage (SLICC/ACR Damage Index), non-serious infections, glucocorticoids, antimalarials (users and non-users), and immunosuppressive drugs use; the last six variables were examined as time-dependent covariates. Cox regression models were used to evaluate the predictors of serious infections using a backward elimination procedure. Univariable and multivariable analyses were performed. Results Of the 1243 patients included, 1116 (89.8%) were female. The median (interquartile range) age at diagnosis and follow-up time were 27 (20–37) years and 47.8 (17.9–68.6) months, respectively. The incidence rate of serious infections was 3.8 cases per 100 person-years. Antimalarial use (hazard ratio: 0.69; 95% confidence interval (CI): 0.48–0.99; p = 0.0440) was protective, while doses of prednisone >15 and ≤60 mg/day (hazard ratio: 4.18; 95 %CI: 1.69–10.31; p = 0.0019) and >60 mg/day (hazard ratio: 4.71; 95% CI: 1.35–16.49; p = 0.0153), use of methylprednisolone pulses (hazard ratio: 1.53; 95% CI: 1.10–2.13; p = 0.0124), increase in disease activity (hazard ratio: 1.03; 95% CI: 1.01–1.04; p = 0.0016) and damage accrual (hazard ratio: 1.22; 95% CI: 1.11–1.34; p < 0.0001) were predictive factors of serious infections. Conclusions Over time, prednisone doses higher than 15 mg/day, use of methylprednisolone pulses, increase in disease activity and damage accrual were predictive of infections, whereas antimalarial use was protective against them in SLE patients.
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Affiliation(s)
- V R Pimentel-Quiroz
- Department of Rheumatology, Hospital Nacional ‘Guillermo Almenara Irigoyen’ Essalud, Lima, Peru
| | - M F Ugarte-Gil
- Department of Rheumatology, Hospital Nacional ‘Guillermo Almenara Irigoyen’ Essalud, Lima, Peru
- Universidad Científica del Sur, Lima, Peru
| | - GB Harvey
- Escuela de Estadística, Facultad de Ciencias Económicas y Estadística, Universidad Nacional de Rosario, Rosario, Argentina
| | - D Wojdyla
- GLADEL consultant, Rosario, Argentina
| | - G J Pons-Estel
- Grupo Oroño, Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
- Servicio de Reumatología, Hospital Provincial de Rosario, Rosario, Argentina
| | - R Quintana
- Grupo Oroño, Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
- Servicio de Reumatología, Hospital Provincial de Rosario, Rosario, Argentina
| | - A Esposto
- Servicio de Infectología, Hospital Interzonal General de Agudos ‘General San Martín’, La Plata, Argentina
| | - M A García
- Servicio de Infectología, Hospital Interzonal General de Agudos ‘General San Martín’, La Plata, Argentina
| | - L J Catoggio
- Servicio de Reumatolgía, Hospital Italiano and Fundación ‘Dr. Pedro M. Catoggio para el Progreso de la Reumatología’, Buenos Aires, Argentina
| | - M H Cardiel
- Centro de Investigación Clínica de Morelia, Morelia, Michoacán, Mexico
| | - L A Barile
- Servicio de Reumatología, Hospital Ángeles del Pedregal, Ciudad de México, Mexico
| | - M -C Amigo
- Centro Médico ABC, Ciudad de México, Mexico
| | - E I Sato
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - E Bonfa
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - E Borba
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - L T Lavras Costallat
- Departamento de Clínica Médica, Faculdade de Ciências Medicas da UNICAMP, Universidade Estadual de Campinas, Campinas, Brazil
| | - O J 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
| | - L Massardo
- Centro de Biología Celular y Biomedicina, Facultad de Medicina y Ciencia, Universidad San Sebastián, Santiago, Chile
| | | | - R Chacón-Díaz
- Servicio de Reumatología, Policlínica Méndez Gimón, Caracas, Venezuela
| | - G 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
| | - B A Pons-Estel
- Grupo Oroño, Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
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Ugarte-Gil MF, Wojdyla D, Pons-Estel GJ, Quintana R, Gómez-Puerta JA, Catoggio LJ, Alvarellos A, Saurit V, Borba E, Sato E, Costallat L, Da Silva NA, Iglesias-Gamarra A, Neira O, Reyes-Llerena G, Cardiel MH, Amigo MC, Acevedo-Vásquez E, Esteva-Spinetti MH, Alarcón GS, Pons-Estel BA. Predictors of Remission and Low Disease Activity State in Systemic Lupus Erythematosus: Data from a Multiethnic, Multinational Latin American Cohort. J Rheumatol 2019; 46:1299-1308. [DOI: 10.3899/jrheum.180433] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2018] [Indexed: 12/29/2022]
Abstract
Objective.To determine the predictors of remission and low disease activity state (LDAS) in patients with systemic lupus erythematosus (SLE).Methods.Three disease activity states were defined: Remission = SLE Disease Activity Index (SLEDAI) = 0 and prednisone ≤ 5 mg/day and/or immunosuppressants (maintenance dose); LDAS = SLEDAI ≤ 4, prednisone ≤ 7.5 mg/day and/or immunosuppressants (maintenance dose); and non-optimally controlled state = SLEDAI > 4 and/or prednisone > 7.5 mg/day and/or immunosuppressants (induction dose). Antimalarials were allowed in all groups. Patients with at least 2 SLEDAI reported and not optimally controlled at entry were included in these analyses. Outcomes were remission and LDAS. Multivariable Cox regression models (stepwise selection procedure) were performed for remission and for LDAS.Results.Of 1480 patients, 902 were non-optimally controlled at entry; among them, 196 patients achieved remission (21.7%) and 314 achieved LDAS (34.8%). Variables predictive of a higher probability of remission were the absence of mucocutaneous manifestations (HR 1.571, 95% CI 1.064–2.320), absence of renal involvement (HR 1.487, 95% CI 1.067–2.073), and absence of hematologic involvement (HR 1.354, 95% CI 1.005–1.825); the use of immunosuppressive drugs before the baseline visit (HR 1.468, 95% CI 1.025–2.105); and a lower SLEDAI score at entry (HR 1.028, 95% CI 1.006–1.051 per 1-unit decrease). These variables were predictive of LDAS: older age at entry, per 5-year increase (HR 1.050, 95% CI 1.004–1.098); absence of mucocutaneous manifestations (HR 1.401, 95% CI 1.016–1.930) and renal involvement (HR 1.344, 95% CI 1.049–1.721); and lower SLEDAI score at entry (HR 1.025, 95% CI 1.009–1.042).Conclusion.Absence of mucocutaneous, renal, and hematologic involvement, use of immunosuppressive drugs, and lower disease activity early in the course of the disease were predictive of remission in patients with SLE; older age was predictive of LDAS.
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Pérez S, Santa Cruz M, Sosa J, Kohan P, Medina M, Klajn D, Papasidero S, Caracciolo J, Pendón G, Giordano F, Pereira D, Alvarez D, Astudillo V, Kerzberg E, Perez Dávila A, Bohr A, Melo F, Lloves N, Mamani M, Hartvig C, Sanchez G, Sacnum M, Chichotky Y, Velazco Zamora J, Benegas M, Rosa J, García M, Raiti L, Cruzat V, Quintana R, Pons-Estel B, Kirmayr K, D'Orazio A, Retamozo C, Romano O, Perez Alamino R, Correa M, Citera G, Rillo O, Zalazar M, Costi A, García M, Gomez G, Maldonado Ficco H. Evaluation of the Educational Needs in Argentine Patients with Rheumatoid Arthritis Using the SpENAT Questionnaire. ACTA ACUST UNITED AC 2018; 16:386-390. [PMID: 30385296 DOI: 10.1016/j.reuma.2018.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 06/25/2018] [Accepted: 09/10/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND The SpENAT, a Spanish version of the Educational Needs Assessment Tool, is a self-completed questionnaire that assesses educational needs (ENs) with the purpose of providing tailored and patient-centered information. It consists of 39 questions grouped into the 7 following domains: Pain management, Movement, Feelings, Arthritic process, Treatments, Self-help measures and Support system. OBJECTIVES The objective of the study was to describe the ENs of rheumatoid arthritis (RA) patients using the SpENAT and to determine the main sources of information consulted by these patients. MATERIAL AND METHODS Multicenter, observational, cross-sectional study. We included consecutive patients≥18 years with diagnosis of RA (ACR 87/ACR-EULAR 2010). Sociodemographic data, disease characteristics and clinimetric properties were recorded. All patients completed the SpENAT and were asked about the sources employed to obtain information about their disease. STATISTICAL ANALYSIS Population characteristics were described. ENs were determined as percentages of the highest possible score for each domain. Needs for each domain according to sex, years of education, disease duration, use of biologicals and functional capacity were analyzed by means of ANOVA, and bivariate comparisons were made with Student's t-test and the Bonferroni correction. Correlation between domains was determined with the Spearman correlation coefficient. We compared patients' age by source of information with Student's t-test. RESULTS We included 496 patients from 20 centers across the country. More ENs were observed in the domains of Movement, Feelings and the Arthritic process. Patients with higher educational level (>7 years) reported more ENs in the Arthritic process and Self-help measure domains. A higher functional impairment (HAQ-A≥0.87) was associated with more ENs in every domain. Patients with high activity showed more ENs than those in remission in the domains of Pain management, Movement, Feelings, Treatments and Support system, as well as those with low activity in Self-help measures and Support system domains. All SpENAT domains showed positive correlations among each other (P<.0001), the most important being Pain management/Movement and Treatments/Arthritic process (r≥0.7). The source of information most frequently consulted was the rheumatologist (93.95%); those who made use of Internet were on average younger (P=.0004). CONCLUSION RA patients were very interested about knowing more about their disease. High functional impairment was associated with more ENs. Patients with high disease activity had higher EN levels in almost every domain. The rheumatologist was the main source of information for the patient with RA.
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Affiliation(s)
- Silvana Pérez
- Hospital General de Agudos Dr. E. Tornú, Ciudad Autónoma de Buenos Aires, Argentina.
| | - María Santa Cruz
- Hospital General de Agudos Dr. E. Tornú, Ciudad Autónoma de Buenos Aires, Argentina
| | - Julia Sosa
- Hospital General de Agudos Dr. E. Tornú, Ciudad Autónoma de Buenos Aires, Argentina
| | - Paula Kohan
- Hospital General de Agudos Dr. E. Tornú, Ciudad Autónoma de Buenos Aires, Argentina
| | - María Medina
- Hospital General de Agudos Dr. E. Tornú, Ciudad Autónoma de Buenos Aires, Argentina
| | - Diana Klajn
- Hospital General de Agudos Dr. E. Tornú, Ciudad Autónoma de Buenos Aires, Argentina
| | - Silvia Papasidero
- Hospital General de Agudos Dr. E. Tornú, Ciudad Autónoma de Buenos Aires, Argentina
| | - José Caracciolo
- Hospital General de Agudos Dr. E. Tornú, Ciudad Autónoma de Buenos Aires, Argentina
| | - Gisela Pendón
- Hospital Ricardo Gutiérrez, La Plata, Buenos Aires, Argentina
| | | | - Dora Pereira
- Hospital Ricardo Gutiérrez, La Plata, Buenos Aires, Argentina
| | - Damaris Alvarez
- Hospital Ramos Mejía, Ciudad Autónoma de Buenos Aires, Argentina
| | | | - Eduardo Kerzberg
- Hospital Ramos Mejía, Ciudad Autónoma de Buenos Aires, Argentina
| | - Adriana Perez Dávila
- Hospital de Rehabilitación Manuel Rocca, Ciudad Autónoma de Buenos Aires, Argentina
| | - Analía Bohr
- Hospital de Rehabilitación Manuel Rocca, Ciudad Autónoma de Buenos Aires, Argentina
| | - Fernando Melo
- Hospital Bernardino Rivadavia, Ciudad Autónoma de Buenos Aires, Argentina
| | - Nicolás Lloves
- Hospital Bernardino Rivadavia, Ciudad Autónoma de Buenos Aires, Argentina
| | - Marta Mamani
- Hospital Bernardino Rivadavia, Ciudad Autónoma de Buenos Aires, Argentina
| | - Claudia Hartvig
- Hospital Provincial de Rosario, Rosario, Santa Fe, Argentina
| | | | - Mónica Sacnum
- Hospital Provincial de Rosario, Rosario, Santa Fe, Argentina
| | | | | | - Mariana Benegas
- Sanatorio de la Providencia, Ciudad Autónoma de Buenos Aires, Argentina
| | - Javier Rosa
- Hospital Italiano, Ciudad Autónoma de Buenos Aires, Argentina
| | - María García
- Hospital Italiano, Ciudad Autónoma de Buenos Aires, Argentina
| | - Laura Raiti
- Clínica Bessone, San Miguel, Buenos Aires, Argentina
| | - Vanesa Cruzat
- Clínica Bessone, San Miguel, Buenos Aires, Argentina
| | | | | | - Karin Kirmayr
- Sanatorio San Carlos, Bariloche, Río Negro, Argentina
| | - Andrea D'Orazio
- Hospital Interzonal General De Agudos Dr. José Penna, Bahía Blanca, Buenos Aires, Argentina
| | - Cinthya Retamozo
- Centro de Estudios sobre Derecho y Religión, San Ramón de la Nueva Orán, Salta, Argentina
| | - Olga Romano
- Hospital de Clínicas Pte. Dr. Nicolás Avellaneda, San Miguel de Tucumán, Tucumán, Argentina
| | - Rodolfo Perez Alamino
- Hospital de Clínicas Pte. Dr. Nicolás Avellaneda, San Miguel de Tucumán, Tucumán, Argentina
| | - María Correa
- Instituto de Rehabilitación Psicofísica, Ciudad Autónoma de Buenos Aires, Argentina
| | - Gustavo Citera
- Instituto de Rehabilitación Psicofísica, Ciudad Autónoma de Buenos Aires, Argentina
| | - Oscar Rillo
- Hospital Pirovano, Ciudad Autónoma de Buenos Aires, Argentina
| | - María Zalazar
- Hospital Pirovano, Ciudad Autónoma de Buenos Aires, Argentina
| | - Ana Costi
- Hospital San Martín, La Plata, Buenos Aires, Argentina
| | | | - Graciela Gomez
- Instituto Lanari, Ciudad Autónoma de Buenos Aires, Argentina
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Redondo MJ, Geyer S, Steck AK, Sharp S, Wentworth JM, Weedon MN, Antinozzi P, Sosenko J, Atkinson M, Pugliese A, Oram RA, Antinozzi P, Atkinson M, Battaglia M, Becker D, Bingley P, Bosi E, Buckner J, Colman P, Gottlieb P, Herold K, Insel R, Kay T, Knip M, Marks J, Moran A, Palmer J, Peakman M, Philipson L, Pugliese A, Raskin P, Rodriguez H, Roep B, Russell W, Schatz D, Wherrett D, Wilson D, Winter W, Ziegler A, Benoist C, Blum J, Chase P, Clare-Salzler M, Clynes R, Eisenbarth G, Fathman C, Grave G, Hering B, Kaufman F, Leschek E, Mahon J, Nanto-Salonen K, Nepom G, Orban T, Parkman R, Pescovitz M, Peyman J, Roncarolo M, Simell O, Sherwin R, Siegelman M, Steck A, Thomas J, Trucco M, Wagner J, Greenbaum ,CJ, Bourcier K, Insel R, Krischer JP, Leschek E, Rafkin L, Spain L, Cowie C, Foulkes M, Krause-Steinrauf H, Lachin JM, Malozowski S, Peyman J, Ridge J, Savage P, Skyler JS, Zafonte SJ, Kenyon NS, Santiago I, Sosenko JM, Bundy B, Abbondondolo M, Adams T, Amado D, Asif I, Boonstra M, Bundy B, Burroughs C, Cuthbertson D, Deemer M, Eberhard C, Fiske S, Ford J, Garmeson J, Guillette H, Browning G, Coughenour T, Sulk M, Tsalikan E, Tansey M, Cabbage J, Dixit N, Pasha S, King M, Adcock K, Geyer S, Atterberry H, Fox L, Englert K, Mauras N, Permuy J, Sikes K, Berhe T, Guendling B, McLennan L, Paganessi L, Hays B, Murphy C, Draznin M, Kamboj M, Sheppard S, Lewis V, Coates L, Moore W, Babar G, Bedard J, Brenson-Hughes D, Henderson C, Cernich J, Clements M, Duprau R, Goodman S, Hester L, Huerta-Saenz L, Karmazin A, Letjen T, Raman S, Morin D, Henry M, Bestermann W, Morawski E, White J, Brockmyer A, Bays R, Campbell S, Stapleton A, Stone N, Donoho A, Everett H, Heyman K, Hensley H, Johnson M, Marshall C, Skirvin N, Taylor P, Williams R, Ray L, Wolverton C, Nickels D, Dothard C, Hsiao B, Speiser P, Pellizzari M, Bokor L, Izuora K, Abdelnour S, Cummings P, Paynor S, Leahy M, Riedl M, Shockley S, Karges C, Saad R, Briones T, Casella S, Herz C, Walsh K, Greening J, Hay F, Hunt S, Sikotra N, Simons L, Keaton N, Karounos D, Oremus R, Dye L, Myers L, Ballard D, Miers W, Sparks R, Thraikill K, Edwards K, Fowlkes J, Kinderman A, Kemp S, Morales A, Holland L, Johnson L, Paul P, Ghatak A, Phelen K, Leyland H, Henderson T, Brenner D, Law P, Oppenheimer E, Mamkin I, Moniz C, Clarson C, Lovell M, Peters A, Ruelas V, Borut D, Burt D, Jordan M, Leinbach A, Castilla S, Flores P, Ruiz M, Hanson L, Green-Blair J, Sheridan R, Wintergerst K, Pierce G, Omoruyi A, Foster M, Linton C, Kingery S, Lunsford A, Cervantes I, Parker T, Price P, Urben J, Doughty I, Haydock H, Parker V, Bergman P, Liu S, Duncum S, Rodda C, Thomas A, Ferry R, McCommon D, Cockroft J, Perelman A, Calendo R, Barrera C, Arce-Nunez E, Lloyd J, Martinez Y, De la Portilla M, Cardenas I, Garrido L, Villar M, Lorini R, Calandra E, D’Annuzio G, Perri K, Minuto N, Malloy J, Rebora C, Callegari R, Ali O, Kramer J, Auble B, Cabrera S, Donohoue P, Fiallo-Scharer R, Hessner M, Wolfgram P, Maddox K, Kansra A, Bettin N, McCuller R, Miller A, Accacha S, Corrigan J, Fiore E, Levine R, Mahoney T, Polychronakos C, Martin J, Gagne V, Starkman H, Fox M, Chin D, Melchionne F, Silverman L, Marshall I, Cerracchio L, Cruz J, Viswanathan A, Miller J, Wilson J, Chalew S, Valley S, Layburn S, Lala A, Clesi P, Genet M, Uwaifo G, Charron A, Allerton T, Milliot E, Cefalu W, Melendez-Ramirez L, Richards R, Alleyn C, Gustafson E, Lizanna M, Wahlen J, Aleiwe S, Hansen M, Wahlen H, Moore M, Levy C, Bonaccorso A, Rapaport R, Tomer Y, Chia D, Goldis M, Iazzetti L, Klein M, Levister C, Waldman L, Muller S, Wallach E, Regelmann M, Antal Z, Aranda M, Reynholds C, Leech N, Wake D, Owens C, Burns M, Wotherspoon J, Nguyen T, Murray A, Short K, Curry G, Kelsey S, Lawson J, Porter J, Stevens S, Thomson E, Winship S, Wynn L, O’Donnell R, Wiltshire E, Krebs J, Cresswell P, Faherty H, Ross C, Vinik A, Barlow P, Bourcier M, Nevoret M, Couper J, Oduah V, Beresford S, Thalagne N, Roper H, Gibbons J, Hill J, Balleaut S, Brennan C, Ellis-Gage J, Fear L, Gray T, Pilger J, Jones L, McNerney C, Pointer L, Price N, Few K, Tomlinson D, Denvir L, Drew J, Randell T, Mansell P, Roberts A, Bell S, Butler S, Hooton Y, Navarra H, Roper A, Babington G, Crate L, Cripps H, Ledlie A, Moulds C, Sadler K, Norton R, Petrova B, Silkstone O, Smith C, Ghai K, Murray M, Viswanathan V, Henegan M, Kawadry O, Olson J, Stavros T, Patterson L, Ahmad T, Flores B, Domek D, Domek S, Copeland K, George M, Less J, Davis T, Short M, Tamura R, Dwarakanathan A, O’Donnell P, Boerner B, Larson L, Phillips M, Rendell M, Larson K, Smith C, Zebrowski K, Kuechenmeister L, Wood K, Thevarayapillai M, Daniels M, Speer H, Forghani N, Quintana R, Reh C, Bhangoo A, Desrosiers P, Ireland L, Misla T, Xu P, Torres C, Wells S, Villar J, Yu M, Berry D, Cook D, Soder J, Powell A, Ng M, Morrison M, Young K, Haslam Z, Lawson M, Bradley B, Courtney J, Richardson C, Watson C, Keely E, DeCurtis D, Vaccarcello-Cruz M, Torres Z, Alies P, Sandberg K, Hsiang H, Joy B, McCormick D, Powell A, Jones H, Bell J, Hargadon S, Hudson S, Kummer M, Badias F, Sauder S, Sutton E, Gensel K, Aguirre-Castaneda R, Benavides Lopez V, Hemp D, Allen S, Stear J, Davis E, Jones T, Baker A, Roberts A, Dart J, Paramalingam N, Levitt Katz L, Chaudhary N, Murphy K, Willi S, Schwartzman B, Kapadia C, Larson D, Bassi M, McClellan D, Shaibai G, Kelley L, Villa G, Kelley C, Diamond R, Kabbani M, Dajani T, Hoekstra F, Magorno M, Beam C, Holst J, Chauhan V, Wilson N, Bononi P, Sperl M, Millward A, Eaton M, Dean L, Olshan J, Renna H, Boulware D, Milliard C, Snyder D, Beaman S, Burch K, Chester J, Ahmann A, Wollam B, DeFrang D, Fitch R, Jahnke K, Bounmananh L, Hanavan K, Klopfenstein B, Nicol L, Bergstrom R, Noland T, Brodksy J, Bacon L, Quintos J, Topor L, Bialo S, Bream S, Bancroft B, Soto A, Lagarde W, Lockemer H, Vanderploeg T, Ibrahim M, Huie M, Sanchez V, Edelen R, Marchiando R, Freeman D, Palmer J, Repas T, Wasson M, Auker P, Culbertson J, Kieffer T, Voorhees D, Borgwardt T, DeRaad L, Eckert K, Gough J, Isaacson E, Kuhn H, Carroll A, Schubert M, Francis G, Hagan S, Le T, Penn M, Wickham E, Leyva C, Ginem J, Rivera K, Padilla J, Rodriguez I, Jospe N, Czyzyk J, Johnson B, Nadgir U, Marlen N, Prakasam G, Rieger C, Granger M, Glaser N, Heiser E, Harris B, Foster C, Slater H, Wheeler K, Donaldson D, Murray M, Hale D, Tragus R, Holloway M, Word D, Lynch J, Pankratz L, Rogers W, Newfield R, Holland S, Hashiguchi M, Gottschalk M, Philis-Tsimikas A, Rosal R, Kieffer M, Franklin S, Guardado S, Bohannon N, Garcia M, Aguinaldo T, Phan J, Barraza V, Cohen D, Pinsker J, Khan U, Lane P, Wiley J, Jovanovic L, Misra P, Wright M, Cohen D, Huang K, Skiles M, Maxcy S, Pihoker C, Cochrane K, Nallamshetty L, Fosse J, Kearns S, Klingsheim M, Wright N, Viles L, Smith H, Heller S, Cunningham M, Daniels A, Zeiden L, Parrimon Y, Field J, Walker R, Griffin K, Bartholow L, Erickson C, Howard J, Krabbenhoft B, Sandman C, Vanveldhuizen A, Wurlger J, Paulus K, Zimmerman A, Hanisch K, Davis-Keppen L, Cotterill A, Kirby J, Harris M, Schmidt A, Kishiyama C, Flores C, Milton J, Ramiro J, Martin W, Whysham C, Yerka A, Freels T, Hassing J, Webster J, Green R, Carter P, Galloway J, Hoelzer D, Ritzie AQL, Roberts S, Said S, Sullivan P, Allen H, Reiter E, Feinberg E, Johnson C, Newhook L, Hagerty D, White N, Sharma A, Levandoski L, Kyllo J, Johnson M, Benoit C, Iyer P, Diamond F, Hosono H, Jackman S, Barette L, Jones P, Shor A, Sills I, Bzdick S, Bulger J, Weinstock R, Douek I, Andrews R, Modgill G, Gyorffy G, Robin L, Vaidya N, Song X, Crouch S, O’Brien K, Thompson C, Thorne N, Blumer J, Kalic J, Klepek L, Paulett J, Rosolowski B, Horner J, Terry A, Watkins M, Casey J, Carpenter K, Burns C, Horton J, Pritchard C, Soetaert D, Wynne A, Kaiserman K, Halvorson M, Weinberger J, Chin C, Molina O, Patel C, Senguttuvan R, Wheeler M, Furet O, Steuhm C, Jelley D, Goudeau S, Chalmers L, Wootten M, Greer D, Panagiotopoulos C, Metzger D, Nguyen D, Horowitz M, Christiansen M, Glades E, Morimoto C, Macarewich M, Norman R, Harding P, Patin K, Vargas C, Barbanica A, Yu A, Vaidyanathan P, Osborne W, Mehra R, Kaster S, Neace S, Horner J, McDonough S, Reeves G, Cordrey C, Marrs L, Miller T, Dowshen S, Doyle D, Walker S, Catte D, Dean H, Drury-Brown M, McGee PF, Hackman B, Lee M, Malkani S, Cullen K, Johnson K, Hampton P, McCarrell M, Curtis C, Paul E, Zambrano Y, Hess KO, Phoebus D, Quinlan S, Raiden E, Batts E, Buddy C, Kirpatrick K, Ramey M, Shultz A, Webb C, Romesco M, Fradkin J, Blumberg E, Beck G, Brillon D, Gubitosi-Klug R, Laffel L, Veatch R, Wallace D, Braun J, Lernmark A, Lo B, Mitchell H, Naji A, Nerup J, Orchard T, Steffes M, Tsiatis A, Zinman B, Loechelt B, Baden L, Green M, Weinberg A, Marcovina S, Palmer JP, Weinberg A, Yu L, Babu S, Winter W, Eisenbarth GS, Bingley P, Clynes R, DiMeglio L, Eisenbarth G, Hays B, Marks J, Matheson D, Rodriguez H, Wilson D, Redondo MJ, Gomez D, Zheng X, Pena S, Pietropaolo M, Batts E, Brown T, Buckner J, Dove A, Hammond M, Hefty D, Klein J, Kuhns K, Letlau M, Lord S, McCulloch-Olson M, Miller L, Nepom G, Odegard J, Ramey M, Sachter E, St. Marie M, Stickney K, VanBuecken D, Vellek B, Webber C, Allen L, Bollyk J, Hilderman N, Ismail H, Lamola S, Sanda S, Vendettuoli H, Tridgell D, Monzavi R, Bock M, Fisher L, Halvorson M, Jeandron D, Kim M, Wood J, Geffner M, Kaufman F, Parkman R, Salazar C, Goland R, Clynes R, Cook S, Freeby M, Gallagher MP, Gandica R, Greenberg E, Kurland A, Pollak S, Wolk A, Chan M, Koplimae L, Levine E, Smith K, Trast J, DiMeglio L, Blum J, Evans-Molina C, Hufferd R, Jagielo B, Kruse C, Patrick V, Rigby M, Spall M, Swinney K, Terrell J, Christner L, Ford L, Lynch S, Menendez M, Merrill P, Pescovitz M, Rodriguez H, Alleyn C, Baidal D, Fay S, Gaglia J, Resnick B, Szubowicz S, Weir G, Benjamin R, Conboy D, deManbey A, Jackson R, Jalahej H, Orban T, Ricker A, Wolfsdorf J, Zhang HH, Wilson D, Aye T, Baker B, Barahona K, Buckingham B, Esrey K, Esrey T, Fathman G, Snyder R, Aneja B, Chatav M, Espinoza O, Frank E, Liu J, Perry J, Pyle R, Rigby A, Riley K, Soto A, Gitelman S, Adi S, Anderson M, Berhel A, Breen K, Fraser K, Gerard-Gonzalez A, Jossan P, Lustig R, Moassesfar S, Mugg A, Ng D, Prahalod P, Rangel-Lugo M, Sanda S, Tarkoff J, Torok C, Wesch R, Aslan I, Buchanan J, Cordier J, Hamilton C, Hawkins L, Ho T, Jain A, Ko K, Lee T, Phelps S, Rosenthal S, Sahakitrungruang T, Stehl L, Taylor L, Wertz M, Wong J, Philipson L, Briars R, Devine N, Littlejohn E, Grant T, Gottlieb P, Klingensmith G, Steck A, Alkanani A, Bautista K, Bedoy R, Blau A, Burke B, Cory L, Dang M, Fitzgerald-Miller L, Fouts A, Gage V, Garg S, Gesauldo P, Gutin R, Hayes C, Hoffman M, Ketchum K, Logsden-Sackett N, Maahs D, Messer L, Meyers L, Michels A, Peacock S, Rewers M, Rodriguez P, Sepulbeda F, Sippl R, Steck A, Taki I, Tran BK, Tran T, Wadwa RP, Zeitler P, Barker J, Barry S, Birks L, Bomsburger L, Bookert T, Briggs L, Burdick P, Cabrera R, Chase P, Cobry E, Conley A, Cook G, Daniels J, DiDomenico D, Eckert J, Ehler A, Eisenbarth G, Fain P, Fiallo-Scharer R, Frank N, Goettle H, Haarhues M, Harris S, Horton L, Hutton J, Jeffrrey J, Jenison R, Jones K, Kastelic W, King MA, Lehr D, Lungaro J, Mason K, Maurer H, Nguyen L, Proto A, Realsen J, Schmitt K, Schwartz M, Skovgaard S, Smith J, Vanderwel B, Voelmle M, Wagner R, Wallace A, Walravens P, Weiner L, Westerhoff B, Westfall E, Widmer K, Wright H, Schatz D, Abraham A, Atkinson M, Cintron M, Clare-Salzler M, Ferguson J, Haller M, Hosford J, Mancini D, Rohrs H, Silverstein J, Thomas J, Winter W, Cole G, Cook R, Coy R, Hicks E, Lewis N, Marks J, Pugliese A, Blaschke C, Matheson D, Sanders-Branca N, Sosenko J, Arazo L, Arce R, Cisneros M, Sabbag S, Moran A, Gibson C, Fife B, Hering B, Kwong C, Leschyshyn J, Nathan B, Pappenfus B, Street A, Boes MA, Eck SP, Finney L, Fischer TA, Martin A, Muzamhindo CJ, Rhodes M, Smith J, Wagner J, Wood B, Becker D, Delallo K, Diaz A, Elnyczky B, Libman I, Pasek B, Riley K, Trucco M, Copemen B, Gwynn D, Toledo F, Rodriguez H, Bollepalli S, Diamond F, Eyth E, Henson D, Lenz A, Shulman D, Raskin P, Adhikari S, Dickson B, Dunnigan E, Lingvay I, Pruneda L, Ramos-Roman M, Raskin P, Rhee C, Richard J, Siegelman M, Sturges D, Sumpter K, White P, Alford M, Arthur J, Aviles-Santa ML, Cordova E, Davis R, Fernandez S, Fordan S, Hardin T, Jacobs A, Kaloyanova P, Lukacova-Zib I, Mirfakhraee S, Mohan A, Noto H, Smith O, Torres N, Wherrett D, Balmer D, Eisel L, Kovalakovska R, Mehan M, Sultan F, Ahenkorah B, Cevallos J, Razack N, Ricci MJ, Rhode A, Srikandarajah M, Steger R, Russell WE, Black M, Brendle F, Brown A, Moore D, Pittel E, Robertson A, Shannon A, Thomas JW, Herold K, Feldman L, Sherwin R, Tamborlane W, Weinzimer S, Toppari J, Kallio T, Kärkkäinen M, Mäntymäki E, Niininen T, Nurmi B, Rajala P, Romo M, Suomenrinne S, Näntö-Salonen K, Simell O, Simell T, Bosi E, Battaglia M, Bianconi E, Bonfanti R, Grogan P, Laurenzi A, Martinenghi S, Meschi F, Pastore M, Falqui L, Muscato MT, Viscardi M, Castleden H, Farthing N, Loud S, Matthews C, McGhee J, Morgan A, Pollitt J, Elliot-Jones R, Wheaton C, Knip M, Siljander H, Suomalainen H, Colman P, Healy F, Mesfin S, Redl L, Wentworth J, Willis J, Farley M, Harrison L, Perry C, Williams F, Mayo A, Paxton J, Thompson V, Volin L, Fenton C, Carr L, Lemon E, Swank M, Luidens M, Salgam M, Sharma V, Schade D, King C, Carano R, Heiden J, Means N, Holman L, Thomas I, Madrigal D, Muth T, Martin C, Plunkett C, Ramm C, Auchus R, Lane W, Avots E, Buford M, Hale C, Hoyle J, Lane B, Muir A, Shuler S, Raviele N, Ivie E, Jenkins M, Lindsley K, Hansen I, Fadoju D, Felner E, Bode B, Hosey R, Sax J, Jefferies C, Mannering S, Prentis R, She J, Stachura M, Hopkins D, Williams J, Steed L, Asatapova E, Nunez S, Knight S, Dixon P, Ching J, Donner T, Longnecker S, Abel K, Arcara K, Blackman S, Clark L, Cooke D, Plotnick L, Levin P, Bromberger L, Klein K, Sadurska K, Allen C, Michaud D, Snodgrass H, Burghen G, Chatha S, Clark C, Silverberg J, Wittmer C, Gardner J, LeBoeuf C, Bell P, McGlore O, Tennet H, Alba N, Carroll M, Baert L, Beaton H, Cordell E, Haynes A, Reed C, Lichter K, McCarthy P, McCarthy S, Monchamp T, Roach J, Manies S, Gunville F, Marosok L, Nelson T, Ackerman K, Rudolph J, Stewart M, McCormick K, May S, Falls T, Barrett T, Dale K, Makusha L, McTernana C, Penny-Thomas K, Sullivan K, Narendran P, Robbie J, Smith D, Christensen R, Koehler B, Royal C, Arthur T, Houser H, Renaldi J, Watsen S, Wu P, Lyons L, House B, Yu J, Holt H, Nation M, Vickers C, Watling R, Heptulla R, Trast J, Agarwal C, Newell D, Katikaneni R, Gardner C, Del Rio A, Logan A, Collier H, Rishton C, Whalley G, Ali A, Ramtoola S, Quattrin T, Mastrandea L, House A, Ecker M, Huang C, Gougeon C, Ho J, Pacuad D, Dunger D, May J, O’Brien C, Acerini C, Salgin B, Thankamony A, Williams R, Buse J, Fuller G, Duclos M, Tricome J, Brown H, Pittard D, Bowlby D, Blue A, Headley T, Bendre S, Lewis K, Sutphin K, Soloranzo C, Puskaric J, Madison H, Rincon M, Carlucci M, Shridharani R, Rusk B, Tessman E, Huffman D, Abrams H, Biederman B, Jones M, Leathers V, Brickman W, Petrie P, Zimmerman D, Howard J, Miller L, Alemzadeh R, Mihailescu D, Melgozza-Walker R, Abdulla N, Boucher-Berry C, Ize-Ludlow D, Levy R, Swenson Brousell C, Scott R, Heenan H, Lunt H, Kendall D, Willis J, Darlow B, Crimmins N, Edler D, Weis T, Schultz C, Rogers D, Latham D, Mawhorter C, Switzer C, Spencer W, Konstantnopoulus P, Broder S, Klein J, Bachrach B, Gardner M, Eichelberger D, Knight L, Szadek L, Welnick G, Thompson B, Hoffman R, Revell A, Cherko J, Carter K, Gilson E, Haines J, Arthur G, Bowen B, Zipf W, Graves P, Lozano R, Seiple D, Spicer K, Chang A, Fregosi J, Harbinson J, Paulson C, Stalters S, Wright P, Zlock D, Freeth A, Victory J, Maheshwari H, Maheshwari A, Holmstrom T, Bueno J, Arguello R, Ahern J, Noreika L, Watson V, Hourse S, Breyer P, Kissel C, Nicholson Y, Pfeifer M, Almazan S, Bajaj J, Quinn M, Funk K, McCance J, Moreno E, Veintimilla R, Wells A, Cook J, Trunnel S, Transue D, Surhigh J, Bezzaire D, Moltz K, Zacharski E, Henske J, Desai S, Frizelis K, Khan F, Sjoberg R, Allen K, Manning P, Hendry G, Taylor B, Jones S, Couch R, Danchak R, Lieberman D, Strader W, Bencomo M, Bailey T, Bedolla L, Roldan C, Moudiotis C, Vaidya B, Anning C, Bunce S, Estcourt S, Folland E, Gordon E, Harrill C, Ireland J, Piper J, Scaife L, Sutton K, Wilkins S, Costelloe M, Palmer J, Casas L, Miller C, Burgard M, Erickson C, Hallanger-Johnson J, Clark P, Taylor W, Galgani J, Banerjee S, Banda C, McEowen D, Kinman R, Lafferty A, Gillett S, Nolan C, Pathak M, Sondrol L, Hjelle T, Hafner S, Kotrba J, Hendrickson R, Cemeroglu A, Symington T, Daniel M, Appiagyei-Dankah Y, Postellon D, Racine M, Kleis L, Barnes K, Godwin S, McCullough H, Shaheen K, Buck G, Noel L, Warren M, Weber S, Parker S, Gillespie I, Nelson B, Frost C, Amrhein J, Moreland E, Hayes A, Peggram J, Aisenberg J, Riordan M, Zasa J, Cummings E, Scott K, Pinto T, Mokashi A, McAssey K, Helden E, Hammond P, Dinning L, Rahman S, Ray S, Dimicri C, Guppy S, Nielsen H, Vogel C, Ariza C, Morales L, Chang Y, Gabbay R, Ambrocio L, Manley L, Nemery R, Charlton W, Smith P, Kerr L, Steindel-Kopp B, Alamaguer M, Tabisola-Nuesca E, Pendersen A, Larson N, Cooper-Olviver H, Chan D, Fitz-Patrick D, Carreira T, Park Y, Ruhaak R, Liljenquist D. A Type 1 Diabetes Genetic Risk Score Predicts Progression of Islet Autoimmunity and Development of Type 1 Diabetes in Individuals at Risk. Diabetes Care 2018; 41:1887-1894. [PMID: 30002199 PMCID: PMC6105323 DOI: 10.2337/dc18-0087] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 06/06/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We tested the ability of a type 1 diabetes (T1D) genetic risk score (GRS) to predict progression of islet autoimmunity and T1D in at-risk individuals. RESEARCH DESIGN AND METHODS We studied the 1,244 TrialNet Pathway to Prevention study participants (T1D patients' relatives without diabetes and with one or more positive autoantibodies) who were genotyped with Illumina ImmunoChip (median [range] age at initial autoantibody determination 11.1 years [1.2-51.8], 48% male, 80.5% non-Hispanic white, median follow-up 5.4 years). Of 291 participants with a single positive autoantibody at screening, 157 converted to multiple autoantibody positivity and 55 developed diabetes. Of 953 participants with multiple positive autoantibodies at screening, 419 developed diabetes. We calculated the T1D GRS from 30 T1D-associated single nucleotide polymorphisms. We used multivariable Cox regression models, time-dependent receiver operating characteristic curves, and area under the curve (AUC) measures to evaluate prognostic utility of T1D GRS, age, sex, Diabetes Prevention Trial-Type 1 (DPT-1) Risk Score, positive autoantibody number or type, HLA DR3/DR4-DQ8 status, and race/ethnicity. We used recursive partitioning analyses to identify cut points in continuous variables. RESULTS Higher T1D GRS significantly increased the rate of progression to T1D adjusting for DPT-1 Risk Score, age, number of positive autoantibodies, sex, and ethnicity (hazard ratio [HR] 1.29 for a 0.05 increase, 95% CI 1.06-1.6; P = 0.011). Progression to T1D was best predicted by a combined model with GRS, number of positive autoantibodies, DPT-1 Risk Score, and age (7-year time-integrated AUC = 0.79, 5-year AUC = 0.73). Higher GRS was significantly associated with increased progression rate from single to multiple positive autoantibodies after adjusting for age, autoantibody type, ethnicity, and sex (HR 2.27 for GRS >0.295, 95% CI 1.47-3.51; P = 0.0002). CONCLUSIONS The T1D GRS independently predicts progression to T1D and improves prediction along T1D stages in autoantibody-positive relatives.
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Affiliation(s)
- Maria J. Redondo
- Texas Children’s Hospital, Baylor College of Medicine, Houston, TX
| | | | - Andrea K. Steck
- Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine, Aurora, CO
| | - Seth Sharp
- Institute of Biomedical and Clinical Science, University of Exeter, Exeter, U.K
| | - John M. Wentworth
- Walter and Eliza Hall Institute of Medical Research and Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Michael N. Weedon
- Institute of Biomedical and Clinical Science, University of Exeter, Exeter, U.K
| | | | | | | | | | - Richard A. Oram
- Institute of Biomedical and Clinical Science, University of Exeter, Exeter, U.K
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Peláez-Ballestas I, Granados Y, Quintana R, Loyola-Sánchez A, Julián-Santiago F, Rosillo C, Gastelum-Strozzi A, Alvarez-Nemegyei J, Santana N, Silvestre A, Pacheco-Tena C, Goñi M, García-García C, Cedeño L, Pons-Éstel BA. Epidemiology and socioeconomic impact of the rheumatic diseases on indigenous people: an invisible syndemic public health problem. Ann Rheum Dis 2018; 77:1397-1404. [DOI: 10.1136/annrheumdis-2018-213625] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 06/04/2018] [Accepted: 06/22/2018] [Indexed: 11/03/2022]
Abstract
Epidemiological studies in Latin America suggest indigenous people lack proper healthcare for musculoskeletal (MSK) and rheumatic diseases.ObjectivesThis study aimed to estimate the prevalence of MSK disorders and rheumatic diseases in eight Latin American indigenous communities, and to identify which factors influence such prevalence using network analysis and syndemic approach.MethodsThis is a cross-sectional, community-based census study according to Community-Oriented Program for the Control of Rheumatic Diseases methodology. Individuals with MSK pain, stiffness or swelling in the past and/or during the last 7 days were evaluated by participating physicians. A descriptive, univariable and multivariable analysis was performed, followed by a network analysis.ResultsWe surveyed 6155 indigenous individuals with a mean age of 41.2 years (SD 17.6; range 18–105); 3757 (61.0%) were women. Point prevalence in rank order was: low back pain in 821 (13.3%); osteoarthritis in 598 (9.7%); rheumatic regional pain syndromes in 368 (5.9%); rheumatoid arthritis in 85 (1.3%); undifferentiated arthritis in 13 (0.2%); and spondyloarthritis in 12 (0.1%). There were marked variations in the prevalence of each rheumatic disease among the communities. Multivariate models and network analysis revealed a complex relationship between rheumatic diseases, comorbidities and socioeconomic conditions.ConclusionsThe overall prevalence of MSK disorders in Latin American indigenous communities was 34.5%. Although low back pain and osteoarthritis were the most prevalent rheumatic diseases, wide variations according to population groups occurred. The relationship between rheumatic diseases, comorbidities and socioeconomic conditions allows taking a syndemic approach to the study.
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Pons-Estel GJ, Quintana R, Alarcón GS, Sacnún M, Ugarte-Gil MF, Pons-Estel BA. A 12-year retrospective review of bullous systemic lupus erythematosus in cutaneous and systemic lupus erythematosus patients. Lupus 2018; 27:1753-1754. [DOI: 10.1177/0961203318776104] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- G J Pons-Estel
- Hospital Provincial de Rosario, Rosario, Santa Fe, Argentina
- Centro Regional de Enfermedades Autoinmunes y Reumáticas (CREAR), Grupo Oroño. Rosario, Santa Fe, Argentina
| | - R Quintana
- Hospital Provincial de Rosario, Rosario, Santa Fe, Argentina
- Centro Regional de Enfermedades Autoinmunes y Reumáticas (CREAR), Grupo Oroño. Rosario, Santa Fe, Argentina
| | - G S Alarcón
- Department of Medicine, Division of Clinical Immunology and Rheumatology, School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - M Sacnún
- Hospital Provincial de Rosario, Rosario, Santa Fe, Argentina
| | - M F Ugarte-Gil
- Department of Rheumatology, Hospital Guillermo Almenara Irigoyen. EsSalud, Lima, Perú
- Universidad Científica del Sur, Lima, Perú
| | - B A Pons-Estel
- Hospital Provincial de Rosario, Rosario, Santa Fe, Argentina
- Centro Regional de Enfermedades Autoinmunes y Reumáticas (CREAR), Grupo Oroño. Rosario, Santa Fe, Argentina
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Quintana R, Goñi M, Mathern N, Jorfen M, Conti S, Nieto R, Sanabria A, Prigione C, Silvestre AMR, García V, Pons-Estel G, Cervera R, García C, Peláez-Ballestas I, Alarcón GS, Pons-Estel BA. Rheumatoid arthritis in the indigenous qom population of Rosario, Argentina: aggressive and disabling disease with inadequate adherence to treatment in a community-based cohort study. Clin Rheumatol 2018; 37:2323-2330. [DOI: 10.1007/s10067-018-4103-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 04/06/2018] [Accepted: 04/10/2018] [Indexed: 11/29/2022]
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Massone F, Martínez ME, Pascual-Ramos V, Quintana R, Stange L, Caballero-Uribe CV, Ferreyra-Garrot L, Kourilovitch M, Duarte M, Baumert C, Vergara C, Gareca N, Rodríguez C, Khoury V, Medina M, Cardiel MH, Massardo L. Educational website incorporating rheumatoid arthritis patient needs for Latin American and Caribbean countries. Clin Rheumatol 2017; 36:2789-2797. [DOI: 10.1007/s10067-017-3866-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 09/25/2017] [Accepted: 10/01/2017] [Indexed: 12/29/2022]
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Pelaez-Ballestas I, Granados Y, Silvestre A, Julian-Santiago F, Santana N, Rosillo C, Alvarez-Nemegyei J, Loyola-Sanchez A, Quintana R, Goycochea-Robles M, Pacheco-Tena C, Goñi M, Garcia-Garcia C, Cedeño L, Pons-Estel B. OP0167 Prevalence of Rheumatic Disease in Latin American Indigenous Population: A Community Based Study. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.1123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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