RESUMEN
BACKGROUND: Systemic lupus erythematosus (SLE) is regarded as a prototype autoimmune disease because it can serve as a means for studying differences between ethnic minorities and sex. Traditionally, all Hispanics have been bracketed within the same ethnic group, but there are differences between Hispanics from Spain and those from Latin America, not to mention other Spanish-speaking populations. OBJECTIVES: This study aimed to determine the demographic and clinical characteristics, severity, activity, damage, mortality and co-morbidity of SLE in Hispanics belonging to the two ethnic groups resident in Spain, and to identify any differences. METHODS: This was an observational, multi-centre, retrospective study. The demographic and clinical variables of patients with SLE from 45 rheumatology units were collected. The study was conducted in accordance with Good Clinical Practice guidelines. Hispanic patients from the registry were divided into two groups: Spaniards or European Caucasians (EC) and Latin American mestizos (LAM). Comparative univariate and multivariate statistical analyses were carried out. RESULTS: A total of 3490 SLE patients were included, 90% of whom were female; 3305 (92%) EC and 185 (5%) LAM. LAM patients experienced their first lupus symptoms four years earlier than EC patients and were diagnosed and included in the registry younger, and their SLE was of a shorter duration. The time in months from the first SLE symptoms to diagnosis was longer in EC patients, as were the follow-up periods. LAM patients exhibited higher prevalence rates of myositis, haemolytic anaemia and nephritis, but there were no differences in histological type or serositis. Anti-Sm, anti-Ro and anti-RNP antibodies were more frequently found in LAM patients. LAM patients also had higher levels of disease activity, severity and hospital admissions. However, there were no differences in damage index, mortality or co-morbidity index. In the multivariate analysis, after adjusting for confounders, in several models the odds ratio (95% confidence interval) for a Katz severity index >3 in LAM patients was 1.45 (1.038-2.026; p = 0.02). This difference did not extend to activity levels (i.e. SLEDAI >3; 0.98 (0.30-1.66)). CONCLUSION: SLE in Hispanic EC patients showed clinical differences compared to Hispanic LAM patients. The latter more frequently suffered nephritis and higher severity indices. This study shows that where lupus is concerned, not all Hispanics are equal.
Asunto(s)
Progresión de la Enfermedad , Lupus Eritematoso Sistémico/etnología , Femenino , Humanos , América Latina/etnología , Lupus Eritematoso Sistémico/fisiopatología , Masculino , Sistema de Registros , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , España/epidemiología , Población Blanca/estadística & datos numéricosRESUMEN
OBJECTIVE: To compare the proportion of synovitis detected by ultrasonographic study (USS) of the hands, in subjects with no rheumatologic known disease according to self-reported level of overexertion performed the day before. METHODS: 407 consecutive volunteers were enrolled in a twelve-month period and underwent an ultrasound assessment of the hand. All studies were performed on Monday or Friday. Subjects were grouped according to their self-reported overexertion carried out the day before. Presence or absence of ultrasonographic findings compatible with synovitis was compared between groups. RESULTS: 95.8% of those tested on Friday had made no overexertion the day before the study, while 30.2% of those assessed on Monday declared to have carried out an overexertion. Presence of carpal synovial hypertrophy, synovial fluid/effusion, and power-Doppler signal was statistically higher in subjects who carried out an overexertion the day before the study than the rest of subjects when the dominant hand was assessed. Globally, presence of any synovitis ultrasonographic finding was statistically higher in subjects who were studied on Monday than Friday (34.9% versus 12.1%) and in subjects who self-reported an overexertion the day before compared to the rest of subjects (47.7 versus 11.5%). CONCLUSIONS: In general, we recommend performing the USS as many days as possible after the most recent overexertion.
Asunto(s)
Fatiga Muscular , Esfuerzo Físico , Sinovitis/diagnóstico por imagen , Sinovitis/diagnóstico , Adolescente , Adulto , Anciano , Femenino , Mano/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Examen Físico , Estudios Prospectivos , Autoinforme , Índice de Severidad de la Enfermedad , Sinovitis/fisiopatología , Factores de Tiempo , Ultrasonografía , Articulación de la Muñeca/diagnóstico por imagenRESUMEN
The authors present the case of a 35-years-old female with severe bronchial asthma non-responding to treatment, mobile infiltrative pulmonary images on chest X-ray considered and treated first as pulmonary tuberculosis smear-negative, maculo-papular skin lesions on the limbs and a high percentage of eosinophils in peripheral blood. The diagnosis was settled by histologic examination of the skin lesions. The evolution was very good with high doses of oral corticosteroids.