Asunto(s)

Enfermedades del Tejido Conjuntivo/mortalidad , Esperanza de Vida , Enfermedades Pulmonares Intersticiales/mortalidad , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Artritis Reumatoide/complicaciones , Artritis Reumatoide/epidemiología , Artritis Reumatoide/mortalidad , Enfermedades del Tejido Conjuntivo/complicaciones , Enfermedades del Tejido Conjuntivo/epidemiología , Dermatomiositis/complicaciones , Dermatomiositis/epidemiología , Dermatomiositis/mortalidad , Femenino , Humanos , Enfermedades Pulmonares Intersticiales/epidemiología , Enfermedades Pulmonares Intersticiales/etiología , Masculino , Persona de Mediana Edad , Polimiositis/complicaciones , Polimiositis/epidemiología , Polimiositis/mortalidad , Prevalencia , Esclerodermia Sistémica/complicaciones , Esclerodermia Sistémica/epidemiología , Esclerodermia Sistémica/mortalidad , Estados Unidos , Adulto Joven

RESUMEN

The aim was to analyze the distribution and trends of deaths reported for rheumatoid arthritis (RA) in Mexico in 1998-2017. We carried out a cross-sectional study. Data were obtained from Dynamic Cubes, General Direction of Health Information, on deaths related to RA in Mexico. Seropositive RA was diagnosed using the International Classification of Diseases version 10. Variables were categorized by diagnosis, age, and gender. Time trends of age-standardized mortality rates (ASMRs) were analyzed for RA, and the annual percent change (APC) was estimated using Joinpoint trend analysis. We found 714 deaths mentioned as RA and 9,749,956 non-RA deaths between 1998 and 2017. Overall RA mortality decreased from 0.14 in 2004 to 0.04 per 100 000 in 2017 (APC: - 10.3%; 95% CI - 16.5%, - 3.3%), while the non-RA ASMR remained stable. In females, there was an initial increase of 27.3% per year through 1998-2004 and a reduction of - 11.7% per year subsequently, while in males, the APC remained stable between 1998 and 2017. The trend for RA mortality resulted in a cumulative change in the ratio of RA ASMR to non-RA ASMR of - 20.6% in females and + 3.2% in males. Although mortality attributable to RA increased from 1998 to 2004 in Mexico, it began to improve after 2004, particularly in females. Prospective, population-based data could help to identify risk factors that could be altered to improve outcomes.

Asunto(s)

Artritis Reumatoide/mortalidad , Estudios Transversales , Femenino , Humanos , Masculino , México/epidemiología , Distribución por Sexo

RESUMEN

BACKGROUND & AIMS: Inhibitors of Janus kinases (JAKs) are being developed for treatment of inflammatory bowel diseases and other immune-mediated diseases. Tofacitinib is effective in treatment of ulcerative colitis, but there are safety concerns. We performed a systematic review and meta-analysis to investigate the safety profile of tofacitinib, upadacitinib, filgotinib, and baricitinib in patients with rheumatoid arthritis, inflammatory bowel diseases, psoriasis, or ankylosing spondylitis. METHODS: We searched the MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials from January 1, 1990, through July 1, 2019. We performed a manual review of conference databases from 2012 through 2018. The primary outcome was incidence rates of adverse events (AEs) and serious AEs. We also estimated incidence rates of serious infections, herpes zoster infection, non-melanoma skin cancer, other malignancies, major cardiovascular events, venous thromboembolism, and mortality. We performed a meta-analysis, which included controlled studies, to assess the relative risk of these events. RESULTS: We identified 973 studies; of these, 82 were included in the final analysis, comprising 66,159 patients with immune-mediated diseases who were exposed to a JAK inhibitor. Two-thirds of the included studies were randomized controlled trials. The incidence rate of AEs was 42.65 per 100 person-years and of serious AEs was 9.88 per 100 person-years. Incidence rates of serious infections, herpes zoster infection, malignancy, and major cardiovascular events were 2.81 per 100 person-years, 2.67 per 100 person-years, 0.89 per 100 person-years, and 0.48 per 100 person-years, respectively. Mortality was not increased in patients treated with JAK inhibitors compared with patients given placebo or active comparator (relative risk 0.72; 95% confidence interval 0.40-1.28). The meta-analysis showed a significant increase in risk of herpes zoster infection among patients who received JAK inhibitors (relative risk 1.57; 95% confidence interval 1.04-2.37). CONCLUSIONS: In a systematic review and meta-analysis, we found an increased risk of herpes zoster infection among patients with immune-mediated diseases treated with JAK inhibitors. All other AEs were not increased among patients treated with JAK inhibitors.

Asunto(s)

Artritis Reumatoide/tratamiento farmacológico , Herpes Zóster/epidemiología , Enfermedades Inflamatorias del Intestino/tratamiento farmacológico , Inhibidores de las Cinasas Janus/efectos adversos , Psoriasis/tratamiento farmacológico , Espondilitis Anquilosante/tratamiento farmacológico , Artritis Reumatoide/inmunología , Artritis Reumatoide/mortalidad , Azetidinas/efectos adversos , Herpes Zóster/inducido químicamente , Herpes Zóster/inmunología , Compuestos Heterocíclicos con 3 Anillos/efectos adversos , Humanos , Incidencia , Enfermedades Inflamatorias del Intestino/inmunología , Enfermedades Inflamatorias del Intestino/mortalidad , Inhibidores de las Cinasas Janus/administración & dosificación , Quinasas Janus/antagonistas & inhibidores , Quinasas Janus/inmunología , Quinasas Janus/metabolismo , Piperidinas/efectos adversos , Placebos/administración & dosificación , Placebos/efectos adversos , Psoriasis/inmunología , Psoriasis/mortalidad , Purinas , Pirazoles , Piridinas/efectos adversos , Pirimidinas/efectos adversos , Pirroles/efectos adversos , Ensayos Clínicos Controlados Aleatorios como Asunto , Espondilitis Anquilosante/inmunología , Espondilitis Anquilosante/mortalidad , Sulfonamidas/efectos adversos , Análisis de Supervivencia , Resultado del Tratamiento , Triazoles/efectos adversos

RESUMEN

OBJECTIVE: Analyze adverse events (AE) and survival associated with biologic therapies (BT) in the Biobadaguay, the Paraguayan Uruguayan registry of adverse events. METHODS: Prospective, observational study of undetermined duration. Patients on BT at initiation and controls were included. Clinical, biological and treatment variables were registered. RESULTS: A total of 826 registers were entered (650 BT and 176 controls); 70.9% were women and rheumatoid arthritis (RA) was the most frequent diagnosis (63.2%). The BT most often used was adalimumab and the main cause of discontinuation was loss of efficacy (42.1%). The incidence of AE of patients on BT was 143.9 (128.8-160.8) per 1000 patients/year. In the comparative study of AE related to diagnosis, juvenile idiopathic arthrosis (JIA) was associated with a higher overall number of AE (RTI = 2.3; 95%CI: 1.6-3.4; P = 4.27 ×10-6), whereas RA was associated with a higher number of serious AE (RTI = 2.2; 95% CI: 1.2-4.1; P =1.17 ×10-2). On the other hand, treatment with tocilizumab was associated with a higher rate of AE (RTI = 2.69; 95% CI: 1.9-3.82; P = 3.13 ×10-8). In JIA, treatment with corticosteroids and number of previous BT was associated with a decrease in BT survival. CONCLUSION: In this first report of the Biobadaguay registry, the main cause of BT discontinuation was loss of efficacy. In terms of the diagnosis involved, RA and JIA were associated with a higher risk of AE. In this registry, variables related to a shorter survival of BT were identified.

Asunto(s)

Adalimumab/uso terapéutico , Anticuerpos Monoclonales Humanizados/uso terapéutico , Antirreumáticos/uso terapéutico , Artritis Juvenil/tratamiento farmacológico , Artritis Reumatoide/tratamiento farmacológico , Productos Biológicos/uso terapéutico , Adalimumab/efectos adversos , Adulto , Anticuerpos Monoclonales Humanizados/efectos adversos , Antirreumáticos/efectos adversos , Artritis Juvenil/mortalidad , Artritis Reumatoide/mortalidad , Productos Biológicos/efectos adversos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Paraguay , Estudios Prospectivos , Sistema de Registros , Tasa de Supervivencia , Uruguay

RESUMEN

OBJECTIVE: To determine the incidence of positive CMV antigenemia (CMV-Ag) in patients with autoimmune rheumatic diseases (AIRD) and to describe the outcomes of these patients. METHODS: From January 2011 to December 2014, a total of 443 patients with AIRD were enrolled in this retrospective analysis. Demographic, clinical and laboratory data, current clinical manifestations, organs affected by CMV infection, therapeutic management and outcomes were evaluated. The CMV-Ag was considered positive when one cell was detected at least. RESULTS: CMV-Ag was requested in 70 (15.8%) patients with suspicious CMV infection and was positive in 24 (34.3%). The incidence rate of positive CMV-Ag was 4.97% (95% CI 3.1-7.4%). Systemic lupus erythematosus (SLE) (59%), followed by ANCA-related vasculitis (18.2%) and rheumatoid arthritis (9%) were the diseases more associated with positive CMV-Ag. At the time of CMV infection, SLE patients had moderate to severe disease activity, with high frequency of positive anti-dsDNA antibody (69.2%) and complement consumption (61.5%), as well as high doses of corticosteroids and use of immunosuppressants. The main CMV sites involved were lung (45.5%), bone marrow (40.9%) and gut (27.3%). Mortality rate was 45.5%, especially in those with higher doses of daily oral corticosteroids (107 ± 55.4 mg vs. 71.7 ± 46.3 mg; p = 0.07) and lower number of lymphocytes (309 ± 368.2/mm3 vs. 821 ± 692.9/mm3; p = 0.06). CONCLUSIONS: Our data showed high incidence of CMV-Ag in AIRD patients, particularly those with SLE and greater disease severity. In addition, it was observed high mortality in these patients, highlighting the CMV infection should be included in differential diagnosis.

Asunto(s)

Vasculitis Asociada a Anticuerpos Citoplasmáticos Antineutrófilos/inmunología , Antígenos Virales/sangre , Artritis Reumatoide/inmunología , Infecciones por Citomegalovirus/inmunología , Citomegalovirus/inmunología , Lupus Eritematoso Sistémico/inmunología , Adolescente , Corticoesteroides/uso terapéutico , Adulto , Anciano , Vasculitis Asociada a Anticuerpos Citoplasmáticos Antineutrófilos/tratamiento farmacológico , Vasculitis Asociada a Anticuerpos Citoplasmáticos Antineutrófilos/mortalidad , Vasculitis Asociada a Anticuerpos Citoplasmáticos Antineutrófilos/virología , Artritis Reumatoide/tratamiento farmacológico , Artritis Reumatoide/mortalidad , Artritis Reumatoide/virología , Médula Ósea/inmunología , Médula Ósea/virología , Brasil/epidemiología , Femenino , Granulomatosis con Poliangitis/inmunología , Granulomatosis con Poliangitis/virología , Humanos , Inmunosupresores/uso terapéutico , Intestinos/inmunología , Intestinos/virología , Pulmón/inmunología , Pulmón/virología , Lupus Eritematoso Sistémico/tratamiento farmacológico , Lupus Eritematoso Sistémico/mortalidad , Lupus Eritematoso Sistémico/virología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Fiebre Reumática/inmunología , Fiebre Reumática/virología , Factores de Tiempo , Adulto Joven

Asunto(s)

Fibrilación Atrial/epidemiología , Salud Global , Animales , Artritis Reumatoide/mortalidad , Artritis Reumatoide/fisiopatología , Fibrilación Atrial/diagnóstico , Fibrilación Atrial/mortalidad , Fibrilación Atrial/terapia , Modelos Animales de Enfermedad , Electrocardiografía , Hospitalización/tendencias , Humanos , Valor Predictivo de las Pruebas , Factores de Riesgo

RESUMEN

OBJECTIVE: We described the clinical profile and outcomes of patients with SLE and RA diseases reported to the Brazilian Health Information System with primary dengue infection. METHODS: Databases from the Brazilian Public Health Informatics System (SUS) were linked as the source of information. Three databases comprising different longitudinal information of lupus or rheumatoid arthritis (RA) patients under treatment and care through the Brazilian Health System were linked. Patients who had lupus ICD-9 code or RA ICD-9 code and their treatment approved by SUS were included in the study. In Study 1, we described the clinical characteristics of RA/lupus patients who had dengue infection. In Study 2, we compared RA/lupus patients with or without dengue for hospitalization rates after index dengue diagnosis for dengue-exposed or matching date for dengue-unexposed. RESULTS: We included 69 SLE and 301 RA patients with dengue. In the RA/lupus with dengue case series, hospitalization was found in 24.6% of lupus subjects and of 11.2% of RA subjects. It differed by geographic region (p = 0.03), gender (p = 0.05) and the use of azathioprine (p = 0.02). Dengue was the most frequent reason for hospitalization reported (43.0%). Hospitalization due to dengue was noted in 12 (42.9%) dengue-exposed patients (p = 0.02), while rheumatoid arthritis was reported as the cause of hospitalization in 22.2% of dengue-unexposed (p = 0.005). Five deaths were reported among the dengue-exposed and none among dengue-unexposed. Bacterial infection was the most frequent cause of death. We found that the dengue exposure was associated with an increased risk of hospitalization outcome in RA and lupus patients (RR = 6.2; 95% CI: 2.99-12.94). SUMMARY: We found that when comparing RA/lupus patients with or without dengue, dengue-exposed patients had an increased rates of hospitalization and death.

Asunto(s)

Artritis Reumatoide/complicaciones , Dengue/complicaciones , Lupus Eritematoso Sistémico/complicaciones , Adulto , Anciano , Artritis Reumatoide/mortalidad , Brasil , Bases de Datos Factuales , Dengue/mortalidad , Femenino , Hospitalización , Humanos , Lupus Eritematoso Sistémico/mortalidad , Masculino , Persona de Mediana Edad , Índice de Severidad de la Enfermedad , Tasa de Supervivencia

RESUMEN

INTRODUCCIÓN: Los pacientes con artritis reumatoidea (AR) presentan una mobimortalidad cardiovascular (CV) 50-60% más alta comparada con la población general. En este grupo poblacional, la carga inflamatoria acumulada, medida por los niveles de VSG y PCR durante un período prolongado, se ha asociado con aterosclerosis subclínica, riesgo cardiovascular y mortalidad. En contrapartida, la presencia de un estado pro-inflamatorio conduciría a una disminución del colesterol total (CT), colesterol HDL y colesterol LDL, por lo que la contribución de los lípidos como factor de riesgo CV es, ciertamente, contradictorio. OBJETIVO Correlacionar los reactantes de fase aguda (VSG-PCR) y los valores de lípidos (CT, HDL, LDL) en una muestra de pacientes con AR. PACIENTES Y METODO: Estudio observacional, retrospectivo, analítico, en el que se incluyeron pacientes con diagnóstico de AR según criterios ACR/EULAR 2010. La relación entre los valores de CT, HDL, LDL con la PCR y VSG se analizó con correlación de Pearson. Dada la distribución no simétrica de los valores de PCR, se obtuvo una transformación logarítmica (logaritmo normal) de la misma. En un segundo modelo, los valores de CT, HDL y LDL se correlacionaron con el logaritmo normal de la PCR realizando distintos cortes de la misma (concentración de PCR ≤5 mg/l, > 5 a 10 mg/l). Finalmente, las correlaciones significativas, se incluyeron en un modelo de regresión lineal multivariado ajustado por edad, género, tiempo de evolución de la enfermedad, uso de hipolipemiantes, medicamentos biológicos y dosis de glucocorticoides. RESULTADOS El análisis de este estudio incluyó 449 mediciones del perfil de lípidos y reactantes de fase aguda (PCR y VSG) correspondientes a 318 pacientes. Los pacientes fueron predominantemente mujeres (79.5%), con una edad media (desviación estándar) de 57.7 (12.3) años. La mediana (rango intercuartilo) del tiempo de evolución de la enfermedad fue de 74.0 (108.0) meses. La mayoría de los pacientes eran seropositivos (67%). La correlación entre PCR y CT (r= 0.16; p= 0.60), así como sus fracciones HDL (0.09; p= 0.30) y LDL (r= 0.09; p= 0.36), fueron débiles. En el sub-análisis de la PCR dividida en tres valores de corte, tanto el CT (r= -0.18 a 0.09) y la fracción LDL (r= -0.34 a 0.11) mostraron correlaciones débiles, independientemente del valor de corte analizado de PCR. Por el contrario, se observó una correlación positiva moderada entre los valores positivos intermedios de PCR y HDL (r= 0.53; p= 0.01). Las correlación entre VSG y CT (r=- 0.03; p= 0.58), así como su fracción LDL (r= 0.10; p= 0.88), fueron débiles. Se observó una correlación negativa débil, pero estadísticamente significativa entre VSG y la fracción HDL (r=-0.14; p= 0.02). En el análisis multivariado de regresión lineal la VSG mantuvo una asociación negativa y significativa con los valores de colesterol HDL (coeficiente ß= -0.179, IC95% -0.28 -0.07; p= 0.001). CONCLUSION: En este estudio pudimos corroborar una relación inversa, aunque débil, entre la VSG y la fracción HDLcolesterol, por el contrario, no pudimos reproducir los hallazgos previamente publicados sobre la relación inversa entre la PCR y los niveles séricos de colesterol y sus fracciones. (AU)

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INTRODUCTION: Cardiovascular disease (CVD) is the main cause of premature mortality in patients with rheumatoid arthritis (RA). The risk of CVD mortality is increased by approximately 50% compared to the general population. In patients with RA, the cumulative inflammatory burden, as measured by the levels of the globular sedimentation rate (GSR) and the Creactive protein (CRP), has been associated with sub-clinical atherosclerosis, CV risk and mortality. On the contrary, the presence of a proinflammatory state, as observed in patients with RA, may lead to a decline of the total cholesterol (TC) and HDL fraction. This observation suggests that inflammation may play a confounding role in the association of lipids with CVD. OBJETIVO: To correlate acute phase reactants (GSR and CRP) with the lipid measurements (TC, HDL and LDL) in a sample of patients with RA. PATIENTS Y METHOD: In this observational, retrospective and analytic study, we included 318 patients fulfilling the CR/EULAR 2010 criteria for RA. The relationship between the TC, HDL, LDL and the CRP (normal logarithm) and GSR was analyzed with the Pearson´s correlation. In a second model, the relationship of the TC, HDL and LDL with the normal logarithm of CRP was analyzed using different cutoff values (CRP ≤5 mg/l, > 5 a <10 mg/l y >10 mg/l). Finally, all the significant correlations were included in a multivariate linear regression model adjusting for age, gender, disease duration, use of lipid lowering drugs, biologic disease modifying antirheumatic drugs and glucocorticoid doses. RESULTS: The study included 449 measurements of the lipid profile and acute phase reactants. Patients were predominantly women (79.5%) with mean (SD) age of 57.7 (12.3) years. Median (IQR) disease duration was 74.0 (108.0) months. Most of the patients (67%) were either positive for the rheumatoid factor and/or anti-citrullinated antibodies. The correlation of the CRP and TC (r= 0.16; p= 0.6) and their fractions HDL (0.09; p= 0.30) and LDL (r= 0.09; p= 0.36) were positive and weak. In the sub-analyses using the three cut-off values of the CRP, the correlations of both, TC (r= -0.18 to 0.09) and LDL (r= -0.34 to 0.11) were also weak. On the contrary, the correlation between the intermediate values of CRP and HDL was positive and moderate (r= 0.53; p= 0.01). The correlation of the GSR and TC (r=-0.03; p= 0.58) and LDL (r= 0.10; p= 0.88) were weak. There was, however, a negative and significant, although weak correlation between the GSR and HDL (r=-0.14; p= 0.02). In the multivariate analyses, the GSR had a negative and significant association with the levels of HDL (ß coefficient = -0.179, 95%CI - 0.28 -0.07; p= 0.001). CONCLUSION: In this study we confirmed an inverse, although weak, relationship between the GSR and HDL-cholesterol. On the contrary, we were not able to reproduce previous published data regarding the inverse relationship between the CRP values and the levels of the TC or their fractions. (AU)

Asunto(s)

Humanos , Masculino , Femenino , Persona de Mediana Edad , Artritis Reumatoide/mortalidad , Enfermedades Cardiovasculares/mortalidad , Lípidos

Asunto(s)

Artritis Reumatoide/mortalidad , Artritis Reumatoide/fisiopatología , Obesidad/fisiopatología , Pérdida de Peso/fisiología , Femenino , Humanos , Masculino

RESUMEN

OBJECTIVE: To evaluate rheumatoid arthritis (RA)-related mortality in the state of São Paulo (Brazil). METHODS: Data from all death certificates (DC) from 1996 to 2010 were analyzed using a multiple cause-of-death method. We compared the results from 2 subperiods (1996-2000 and 2006-2010). RESULTS: We found 3955 DC related to RA - 27.6% with RA as the underlying cause of death (UCD) and 72.4% with RA as the nonunderlying cause of death (NUCD). Ninety percent of RA-related deaths occurred at age ≥ 50 years. The mean ages at death were 67.1 ± 13.3 and 67.9 ± 13 years for RA as the UCD and NUCD, respectively. The most frequent NUCD associated with RA were pneumonia, sepsis, renal failure, interstitial lung disease, and heart failure. In the last subperiod, there was an increase in infectious causes. When RA was an NUCD, we observed a decrease in the mean age at death for the last subperiod (p = 0.021). The most common UCD were circulatory and respiratory system diseases. Comparing the mean age at death between RA-related deaths and the general population when deaths occurred at ages beyond 50 years, the linear regression analysis showed a downward curve for RA-related death (p < 0.001 and r = -0.795), while for the general population, as expected, the curve had an upward pattern (p < 0.001 and r = 0.993). CONCLUSION: Unexpectedly, RA-related deaths occurred at earlier ages in the more recent subperiod. Cardiovascular disease remained the most important cause, and infectious diseases are an increasing cause of death associated with RA, raising the question of whether infections were related to the more vigorous immunosuppressive treatment recommended by recent guidelines.

Asunto(s)

Artritis Reumatoide/mortalidad , Artritis Reumatoide/terapia , Causas de Muerte , Certificado de Defunción , Factores de Edad , Anciano , Anciano de 80 o más Años , Artritis Reumatoide/fisiopatología , Brasil , Enfermedades Cardiovasculares/mortalidad , Enfermedades Cardiovasculares/fisiopatología , Distribución de Chi-Cuadrado , Estudios de Cohortes , Bases de Datos Factuales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neumonía/mortalidad , Neumonía/fisiopatología , Pronóstico , Estudios Retrospectivos , Sepsis , Índice de Severidad de la Enfermedad , Factores Sexuales , Estadísticas no Paramétricas , Análisis de Supervivencia , Estadísticas Vitales

RESUMEN

To evaluate impact of working days lost and factors for developing sick leave episodes in Mexicans workers with rheumatoid arthritis (RA). A prospective cohort of 123 patients with RA was followed for 1 year. Factors evaluated for sick leave episodes included: demographics, job characteristics, comorbidity, depressive symptoms, and clinical/therapeutic variables. Rates of sick leave episodes, working days lost, and permanent work disability (PWD) were identified. Statistical analysis included Cox regression models estimating hazard risks (HR) and their 95 % confidence intervals (95% CI). Cumulative time of follow-up for the cohort was 43,380 days, 24 % of workers had at least one episode of sick leave, with a mean of working days lost per patient-year of 18.36; 4.1 % developed PWD. Development of sick leave in the Kaplan-Meier analysis was associated with: age ≥40 years (p = 0.04), having a couple (p = 0.04), performing manual work (p = 0.03), suffering depressive symptoms (p = 0.04), limitations in functioning (p = 0.01), and poor global functional status ≥ III (p = 0.01). Cox regression models identified HAQ-Di ≥ 0.6 as the stronger predictor for sick leave (HR = 4.04, 95 % CI 1.41-11.58, p = 0.009) followed by age (HR = 1.05, 95 % CI 1.01-1.11, p = 0.04), ≥4 risk factors had a HR to 9.4 (95 % CI: 2.1-42.7) for sick leave. In this prospective cohort of Mexican workers with RA, we identified several factors associated with sick leave episodes and working days lost that should be potentially addressed by a multidisciplinary approach, being required to revaluate these strategies with the aim of increasing the work permanence of these patients.

Asunto(s)

Artritis Reumatoide , Ausencia por Enfermedad , Adulto , Artritis Reumatoide/mortalidad , Estudios de Cohortes , Femenino , Humanos , Estimación de Kaplan-Meier , Masculino , México , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Factores de Riesgo , Trabajo

RESUMEN

La esperanza de vida en la artritis reumatoide (AR) es inferior a la de poblaciones control y existe estrecha relación con la comorbilidad. Identificar la frecuencia de la comorbilidad, mortalidad y variables relacionadas con su incremento. La muestra fue de 172 enfermos que cumplieron criterios del Colegio Americano de Reumatología, vistos en la Sección de Reumatología del Hospital Universitario Cmdte Manuel Fajardo en un período de 6 años. Se midieron 13 variables a 136 pacientes y se compararon con las de los fallecidos en dicho período, se realizaron medidas de tendencia central, dispersión, porcentajes, comorbilidad y relación con la mortalidad. El 65,1 por ciento de los casos tuvo comorbilidades (media de 1,58 por paciente), las más frecuentes fueron: hipertensión arterial (26,7 por ciento), diabetes mellitus (9,3 por ciento) y enfermedad tiroidea (8,7 por ciento). Hubo 9 fallecidos y una tasa de mortalidad de 5,2 por ciento; las causas de muerte mßs frecuentes fueron la enfermedad cardiovascular y el sangrado digestivo. En los fallecidos, las cifras más altas se hallaron en las variables: edad media (65,2 vs. 55,9), bajo nivel cultural (88,8 vs. 36,7 por ciento), velocidad de sedimentación globular (77 ± 29,9 vs. 49,8 ± 30,7) cuestionario autoaplicado para medir incapacidad (1,7 ± 0,74 vs. 0,9 ± 0,65) y comorbilidad (2,67 vs. 1,57). Más de la mitad de los pacientes tuvo comorbilidades, la mortalidad fue baja. El bajo nivel cultural, la velocidad de sedimentación globular, el cuestionario autoaplicado para medir incapacidad y el número de comorbilidades se relacionaron estrechamente con la mortalidad(AU)

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Life expectancy in rheumatoid arthritis (RA) is lower than that of control-populations, and there is a close relationship with morbidity. Objectives: to identify frequency of morbidity, mortality, and variables related to its increase. Sample included 172 sick persons fulfilled criteria of American College of Rheumatology, seen in Rheumatology Service of Comandante Manuel Fajardo University Hospital during 6 years. In 136 patients 13 variables were measured and were compared with that of deceased in such period and we applied measures of central trend, dispersion, percentages, morbidity, and relationship with mortality. The 65.1 percent of cases had morbidities (mean of 1.58 by patient), where the more frequent included: high blood pressure/26.7 percent, diabetes mellitus/9.3 percent, and thyroid disease/8.7 percent. There were 9 deceased and a mortality rate of 5.2 percent; the more frequent causes were: cardiovascular disease, and digestive bleeding. In deceased ones, higher figures were present in following variables: mean age (65.2 percent versus 55.9 percent), low cultural level (88.8 versus 36.7 percent), globular sedimentation speed (77 ± 29,9 versus 49.8 ± 40.7), self-applied questionnaire to measure inability, and the number or morbidities was closely related to mortality(AU)

Asunto(s)

Humanos , Encuestas y Cuestionarios/normas , Artritis Reumatoide/epidemiología , Artritis Reumatoide/mortalidad , Estudios Prospectivos

RESUMEN

La esperanza de vida en la artritis reumatoide (AR) es inferior a la de poblaciones control y existe estrecha relación con la comorbilidad. Identificar la frecuencia de la comorbilidad, mortalidad y variables relacionadas con su incremento. La muestra fue de 172 enfermos que cumplieron criterios del Colegio Americano de Reumatología, vistos en la Sección de Reumatología del Hospital Universitario Cmdte Manuel Fajardo en un período de 6 años. Se midieron 13 variables a 136 pacientes y se compararon con las de los fallecidos en dicho período, se realizaron medidas de tendencia central, dispersión, porcentajes, comorbilidad y relación con la mortalidad. El 65,1 por ciento de los casos tuvo comorbilidades (media de 1,58 por paciente), las más frecuentes fueron: hipertensión arterial (26,7 por ciento), diabetes mellitus (9,3 por ciento) y enfermedad tiroidea (8,7 por ciento). Hubo 9 fallecidos y una tasa de mortalidad de 5,2 por ciento; las causas de muerte mßs frecuentes fueron la enfermedad cardiovascular y el sangrado digestivo. En los fallecidos, las cifras más altas se hallaron en las variables: edad media (65,2 vs. 55,9), bajo nivel cultural (88,8 vs. 36,7 por ciento), velocidad de sedimentación globular (77 ± 29,9 vs. 49,8 ± 30,7) cuestionario autoaplicado para medir incapacidad (1,7 ± 0,74 vs. 0,9 ± 0,65) y comorbilidad (2,67 vs. 1,57). Más de la mitad de los pacientes tuvo comorbilidades, la mortalidad fue baja. El bajo nivel cultural, la velocidad de sedimentación globular, el cuestionario autoaplicado para medir incapacidad y el número de comorbilidades se relacionaron estrechamente con la mortalidad.

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Life expectancy in rheumatoid arthritis (RA) is lower than that of control-populations, and there is a close relationship with morbidity. Objectives: to identify frequency of morbidity, mortality, and variables related to its increase. Sample included 172 sick persons fulfilled criteria of American College of Rheumatology, seen in Rheumatology Service of Comandante Manuel Fajardo University Hospital during 6 years. In 136 patients 13 variables were measured and were compared with that of deceased in such period and we applied measures of central trend, dispersion, percentages, morbidity, and relationship with mortality. The 65.1 percent of cases had morbidities (mean of 1.58 by patient), where the more frequent included: high blood pressure/26.7 percent, diabetes mellitus/9.3 percent, and thyroid disease/8.7 percent. There were 9 deceased and a mortality rate of 5.2 percent; the more frequent causes were: cardiovascular disease, and digestive bleeding. In deceased ones, higher figures were present in following variables: mean age (65.2 percent versus 55.9 percent), low cultural level (88.8 versus 36.7 percent), globular sedimentation speed (77 ± 29,9 versus 49.8 ± 40.7), self-applied questionnaire to measure inability, and the number or morbidities was closely related to mortality.

Asunto(s)

Humanos , Artritis Reumatoide/epidemiología , Artritis Reumatoide/mortalidad , Encuestas y Cuestionarios/normas , Estudios Prospectivos

Asunto(s)

Aterosclerosis/etiología , Enfermedades Autoinmunes/complicaciones , Artritis Reumatoide/complicaciones , Artritis Reumatoide/mortalidad , Aterosclerosis/mortalidad , Enfermedades Autoinmunes/mortalidad , Causas de Muerte , Humanos , Lupus Eritematoso Sistémico/complicaciones , Lupus Eritematoso Sistémico/mortalidad

RESUMEN

Autoimmune rheumatic diseases (AIRD) are not uncommon in the general population and up to one third of hospitalized patients with AIRD may need admission to intensive care unit (ICU). This paper describes the causes of admission, the clinical features and outcome of 24 AIRD patients admitted to a medical ICU from a third level hospital. Thirteen patients had systemic lupus erythematosus (54.2%), three rheumatoid arthritis (12.5%), three pulmonary renal syndrome (12.5%), two dermatopolymyositis (8.3%), two scleroderma (8.3%) and one antiphospholipid syndrome (4.2%). The main causes for ICU admission were rheumatic disease flare-up (37.5%), infection (37.5%) and complications derived from rheumatic disease (29.1%). Mortality during ICU stay was 16.7% (four patients). Excluding shock requiring vasopressor support, no statistical difference was found between survivors and nonsurvivors; although there was a trend to higher test severity scores (APACHE II, ODIN) in nonsurvivors. Our results reveal a lower mortality rate in AIRD patients admitted to the ICU than reported previously. Severity scores such as APACHE II are predictors of mortality in patients with AIRD in the ICU.

Asunto(s)

Enfermedades Autoinmunes/terapia , Unidades de Cuidados Intensivos , Enfermedades Reumáticas/terapia , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Artritis Reumatoide/mortalidad , Artritis Reumatoide/terapia , Enfermedades Autoinmunes/mortalidad , Colombia/epidemiología , Femenino , Hospitales Universitarios , Humanos , Lupus Eritematoso Sistémico/mortalidad , Lupus Eritematoso Sistémico/terapia , Masculino , Persona de Mediana Edad , Admisión del Paciente , Estudios Retrospectivos , Enfermedades Reumáticas/mortalidad

RESUMEN

Estudiamos las manifestaciones extra-articulares y las causas de mortalidad en artritis reumatoidea en dos períodos de tiempo: el primero con 2000 pacientes de manera retrospectiva entre 1996 y 1995 y el segundo, de modo prospectivo, con 92 pacientes en 1996. Encontramos manifestaciones extra-articulares en la mayoría de sistemas orgánicos siendo la incidencia de estas mas frecuentes y severas en el primer periodo, y esto probablemente tenga relación con un mejor tratamiento recibido, una mayor educación y una atención más temprana en los pacientes del segundo periodo. La mortalidad la observamos únicamente en el primer período y las causas fueron similares a las informadas en otras series, siendo estas, en la mayoría de los casos, no relacionada con la artritis reumatoidea directamente, sino con enfermedades intercurrentes

Asunto(s)

Humanos , Artritis Reumatoide/mortalidad , Artritis Reumatoide/complicaciones

Asunto(s)

Humanos , Artritis Reumatoide/mortalidad , Artritis Reumatoide/complicaciones , Artritis Reumatoide/tratamiento farmacológico , Causas de Muerte

RESUMEN

El compromiso pulmonar es una de las manifestaciones extra-articulares de las artritis reumatoidea (AR) y uno de los factores agravantes de morbilidad y de riesgo de mortalida. Incluye la presencia de pleuritis, nódulos, fibrosis y Bronquiolitis obliterante. El mismo tratamiento para la enfermedad puede ser causa de neumopatía. A pesar de que la AR es más frecuente en mujeres, el compromiso pulmonar es más frecuente en hombres, quienes muestran larga evolución de la enfermedad articular, factor reumatoideo positivo y nódulos subcutáneos. El presente artículo resume las manifestaciones pulmonares de la AR haciendo énfasis en el compromiso intersticial y en la distinción entre bronquiolitis obliterante y bronquiolitis oblioterante con neumonia organizada, dos distintas manifestaciones asociadas al compromiso pulmonar.

Asunto(s)

Humanos , Artritis Reumatoide , Artritis Reumatoide/clasificación , Artritis Reumatoide/complicaciones , Artritis Reumatoide/diagnóstico , Artritis Reumatoide/tratamiento farmacológico , Artritis Reumatoide/epidemiología , Artritis Reumatoide/etiología , Artritis Reumatoide/mortalidad , Artritis Reumatoide/fisiopatología , Artritis Reumatoide/terapia , Enfermedades Pulmonares Intersticiales/etiología

RESUMEN

Se investigaron las causas de muerte en 38 pacientes con diagnóstico de artritis reumatoide del adulto (AR), 26 del sexo femenino y 12 del masculino con una edad promedio de inicio de la enfermedad de 54 años y una duración media de la misma de 10.6 años. En el grupo del sexo femenino, la edad promedio de muerte fue a los 63.2 años y en el masculino a los 58. En los pacientes que iniciaron la AR antes de los 30 años de edad, mostraron una reducción considerable del periodo de vida pues sólo llegaron en promedio a los 51.7 años y la duración de la enfermedad fue mayor. Las causas de muerte no fueron diferentes a las de la población general para la edad grupo, refiriéndose a las siguientes: cardiovascular en 17 casos (44.7 por ciento), infecciones en 9 casos (23.6 por ciento), problemas digestivos en 6 (15.7 por ciento) y neoplasias malignas en otros 6 (15.7 por ciento). Se concluye que si bien la AR no constituye la causa directa de la muerte, parece acortar el periodo de vida en algunos pacientes sobre todo aquello que inician la enfermedad a edad más temprana

Asunto(s)

Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Artritis Reumatoide/mortalidad , Artritis Reumatoide/epidemiología , Enfermedades Cardiovasculares/mortalidad , Encuestas de Morbilidad , Causalidad

Asunto(s)

Artritis Reumatoide/epidemiología , Absentismo , Artritis Reumatoide/mortalidad , Chile , Femenino , Humanos , Masculino