RESUMEN

Objective In this paper, we aim to define factors associated with health-related quality of life (HRQoL) in Mestizo patients with systemic lupus erythematosus (SLE). Methods We evaluated patients with SLE from Peru's two largest hospitals between October 2012 and July 2015 to ascertain HRQoL. Using a standard protocol, we incorporated demographic characteristics, clinical manifestations and treatment in our analysis. HRQoL was measured with the LupusQoL, disease activity was ascertained with the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), and damage was appraised with the Systemic Lupus International Collaborating Clinics (SLICC)/American College of Rheumatology (ACR) damage index (SDI). The associations between the LupusQoL and these variables were examined using linear regression models. Model selection was based on backward elimination. Results A total of 277 patients fit the inclusion criterion. Of these, 254 (91.7%) were female, the median (interquartile range, IQR) age at diagnosis was 41.5 (33.8-51.8) years, disease duration was 6.5 (2.7-11.3) years. The HRQoL domains most affected were the following: burden to others, fatigue, and intimate relationships. Through multivariate analysis, we determined that older age at diagnosis, higher disease activity, damage, and immunosuppressive drug use were negatively associated with HRQoL. Further, we found that higher socioeconomic status, disease duration, and antimalarial use were positively associated with HRQoL. Conclusion Age at diagnosis, disease activity, damage, and use of immunosuppressive drugs were negatively associated with HRQoL; high socioeconomic status, disease duration, and use of antimalarials were positively associated with HRQoL.

Asunto(s)

RESUMEN

Infliximab es un medicamento efectivo en el tratamiento de pacientes con espondilitis anquilosante (EA) activa. Sin embargo, debido a su alto costo, su uso indiscriminado es prohibitivo. Objetivo: Evaluar si un régimen de inducción con infliximab es efectivo en pacientes con EA activa. Diseño: Sólo expuestos. Lugar: Servicio de Reumatología del Hospital Nacional Edgardo Rebagliati. Participantes: Pacientes con espondilitis anquilosante activa refractaria. Intervenciones: infliximab a las 0, 2 y 6 semanas. Un paciente recibió dosis de 3 mg/kg y los restantes 5 mg/kg de infliximab. Todos los pacientes continuaron recibiendo sulfasalazina. Principales medidas de resultados: Se determinó la proporción de pacientes que alcanzaron mejoría de acuerdo a los criterios ASAS 20, ASAS 40 y BASDAI 50, en la última evaluación (mediana de 55 semanas). Resultados: En la última evaluación, cinco pacientes (71,4 por ciento) presentaban respuesta ASAS 20 sostenida. Cuatro (57 por ciento) y tres (43 por ciento) de los pacientes alcanzaron BASDAI 50 y ASAS 40, respectivamente. Tres pacientes (43 por ciento) recayeron en un tiempo promedio de 26,6 semanas. No se observó efectos adversos serios. Conclusiones: La infusión de tres dosis de infliximab es efectiva para controlar la actividad de la enfermedad de los pacientes con EA refractaria a AINEs y en algunos pacientes controla la enfermedad por periodos prolongados de tiempo.

Infliximab is effective in treating patients with ankylosing spondylitis (AS). However, its cost makes its indiscrimate use prohibitive. Objective: To determine whether an induction regimen with infliximab remained effective over time in a group of patients with active AS. Design: Exposed only. Setting: Rheumatology Service, Hospital Nacional Edgardo Rebagliati. Participants: Patients with active and refractory ankylosing spondylitis. Interventions: Infliximab administered at weeks 0, 2 and 6. One patient received doses of 3 mg/kg and the remaining patients received 5 mg/kg of infliximab. All patients continued their treatment with sulfasalazine. Main outcome measures: We determined the proportion of patients achieving ASAS 20, ASAS 40 and Bath ankylosing spondylitis disease activity index - BASDAI 50 at last assessment (median of 55 weeks). Results: At last observation, five patients (71,4 per cent) had a sustained ASAS 20 response. Four (57 per cent) and three (43 per cent) patients remained responders according to the BASDAI 50 and ASAS 40 respectively. Three patients (43 per cent) relapsed, with mean time of 26,6 weeks. No serious adverse events were observed. Conclusions: The infusion of three doses of infliximab is effective to control disease activity in patients with refractory AS. In some patients, effectiveness remained for a prolonged period of time.

Asunto(s)

RESUMEN

Objetivo: Evaluar la terapia con pamidronato, en pacientes con espondilitis anquilosante (EA) activa, con respuesta subóptima o falla a los antiinflamatorios no-esteroideos (AINES) y sulfasalazina. Diseño: Estudio clínico comparativo. Lugar: Hospital Nacional Edgardo Rebagliati Martins, EsSalud, Lima, Perú. Participantes: Pacientes con espondilitis anquilosante. Intervenciones. Se incluyó 9 pacientes con EA (6 varones), con enfermedad activa (BASDAI mayor igual que 4), actividad axial y falta de respuesta a los Aines y sulfasalazina a dosis de 3g/d. Todos los pacientes recibieron 60 mg de pamidronato mensual, en infusión endovenosa, durante 6 meses, y continuaron tomando AINES y sulfasalazina. La mejoría clínica fue evaluada usando el Asas 20. En forma secundaria se evaluó el ASAS 40, BASDAI 50, BASDAI, BASFI Y BASMI, a las 24 y 48 semanas (32 a 86 semanas). La diferencia entre el índice de pre y postratamiento fue evaluada usando la prueba de Wilcoxon. Principales medidas de resultados: Evaluación del ASAS 20. Resultados. El 67 por ciento alcanzó un Asas 20 a las 24 semanas y 78 por ciento a las 48 semanas; 33,3 por ciento y 55,6 por ciento tuvieron ASAS 40 y 33,3 por ciento; y 44,4 por ciento alcanzó BASDAI 50 a las 24 y 48 semanas, respectivamente. Un paciente recayó a la semana 20. Tres pacientes (33,3 por ciento) permanecieron sin cambios. A las 24 y 48 semanas, la media de BASDAI disminuyó en 45,1 por ciento (p=0,007) y en 52,1 por ciento (p=0,01), la media de BASFI en 38,2 por ciento (p=0,007) y en 52,3 por ciento (p=0,007), y la media de BASMI en 39,2 por ciento (p=0,01) y 39,2 por ciento (p=0,01), respectivamente. Los eventos adversos no fueron importantes con esta terapia. Conclusiones. El tratamiento con pamidronato demostró ser efectivo en este grupo de pacientes con EA, refractaria a AINES y a sulfasalazina.

Objective: To determine the response of an aminobisphosphonate (pamidronate) in patients with ankylosing spondylitis (AS) who had suboptimal or no response to nonsteroidal anti inflammatory drugs (NSAIDs) and sulfasalazine. Design: Comparative clinical study. Setting: Hospital Nacional Edgardo Rebagliati Martins, EsSalud, Lima, Peru. Participants: Patients with ankylosing spondylitis. Intervenciones: Nine patients with AS (6 males), with active disease [BASDAI major 4] and no response to NSAIDs and sulfasalazine up to 3g/day entered the study. All patients received monthly infusions of 60 mg of pamidronate for 6 months and remained taking NSAID and sulfasalazine. Clinical improvement was evaluated using the Assessments in Ankylosing Spondylitis 20 (ASAS 20). Secondary evaluations included ASAS 40, BASDAI 50, BASDAI, BASFI, and BASMI at 24 weeks and at last observation [48 weeks (32 to 86 weeks)]. Differences between pre and post treatment distributions of all continuous indices were evaluated using the Wilcoxon signed rank test. Main outcome measures: Evaluated of ASAS 20. Results: Sixty-seven percent achieved ASAS 20 at 24 weeks and 78 per cent at 48 weeks; 33,3 per cent and 55,6 per cent achieved ASAS 40 at 24 and 48 weeks, respectively, and 33,3 per cent and 44,4 per cent achieved BASDAI 50 at weeks 24 and 48, respectively. One patient relapsed at week 20. In three patients (33,3 per cent) the scores remained unchanged. At weeks 24 and 48 mean BASDAI decreased by 45,1 per cent (p=0,007) and by 52,1 per cent (p=0,01), mean BASFI decreased by 38,2 per cent (p=0,007) and by 52,3 per cent (p=0.007), and mean BASMI decreased by 39,2 per cent (p=0,01) and 39,2 per cent (p=0,01), respectively. There were no significant adverse events with this therapy. Conclusions: Our data provide further evidence of pamidronate therapy effectiveness in patients with AS who are refractory to NSAIDs and sulfasalazine.

Asunto(s)

Asunto(s)