RESUMO
Objectives The objectives of this study were to examine the demographic and clinical features associated with the occurrence of pleuropulmonary manifestations, the predictive factors of their occurrence and their impact on mortality in systemic lupus erythematosus (SLE) patients. Materials and methods The association of pleuropulmonary manifestations with demographic and clinical features, the predictive factors of their occurrence and their impact on mortality were examined in GLADEL patients by appropriate univariable and multivariable analyses. Results At least one pleuropulmonary manifestation occurred in 421 of the 1480 SLE patients (28.4%), pleurisy being the most frequent (24.0%). Age at SLE onset ≥30 years (OR 1.42; 95% CI 1.10-1.83), the presence of lower respiratory tract infection (OR 3.19; 95% CI 2.05-4.96), non-ischemic heart disease (OR 3.17; 95% CI 2.41-4.18), ischemic heart disease (OR 3.39; 95% CI 2.08-5.54), systemic (OR 2.00; 95% CI 1.37-2.91), ocular (OR 1.58; 95% CI 1.16-2.14) and renal manifestations (OR 1.44; 95% CI 1.09-1.83) were associated with pleuropulmonary manifestations, whereas cutaneous manifestations were negatively associated (OR 0.47; 95% CI 0.29-0.76). Non-ischemic heart disease (HR 2.24; 95% CI 1.63-3.09), SDI scores ≥1 (OR 1.54; 95% CI 1.10-2.17) and anti-La antibody positivity (OR 2.51; 95% CI 1.39-4.57) independently predicted their subsequent occurrence. Cutaneous manifestations were protective of the subsequent occurrence of pleuropulmonary manifestations (HR 0.62; 95% CI 0.43-0.90). Pleuropulmonary manifestations independently contributed a decreased survival (HR: 2.79 95% CI 1.80-4.31). Conclusion Pleuropulmonary manifestations are frequent in SLE, particularly pleuritis. Older age, respiratory tract infection, cardiac, systemic and renal involvement were associated with them, whereas cutaneous manifestations were negatively associated. Cardiac compromise, SDI scores ≥1 and anti-La positivity at disease onset were predictive of their subsequent occurrence, whereas cutaneous manifestations were protective. They independently contributed to a decreased survival in these patients.
Assuntos
Pneumopatias/etiologia , Lúpus Eritematoso Sistêmico/complicações , Pleurisia/etiologia , Adulto , Estudos de Coortes , Feminino , Humanos , Lúpus Eritematoso Sistêmico/mortalidade , Masculino , Infecções Respiratórias/etiologia , Índice de Gravidade de DoençaRESUMO
BACKGROUND: The purified protein derivative (PPD) skin test is the only widely used method which detects latent tuberculosis infection (LTBI) and is dependent on a normal T cell function. In rheumatoid arthritis (RA) the T cell function is altered, which may result in an inability to develop an adequate PPD reaction. OBJECTIVES: To evaluate the response to PPD in patients with RA and to compare it with that of control subjects. METHODS: 112 patients with RA and 96 healthy controls were studied. PPD 5 U was applied using the Mantoux method, and skin reaction was measured at 72 hours. The reaction was considered negative for PPD <5 mm. RESULTS: There were no significant differences in age, sex, history of bacille Calmette-Guerin vaccination, or tuberculosis contact between the two groups. The median size of the PPD induration in the patients with RA was significantly less than that in the control group (4.5 v 11.5 mm, p<0.01). 79 (70.6%) patients with RA compared with 25 (26%) of the control group had a negative reaction to PPD (p<0.01), a response not influenced by disease activity or duration of disease in the patients with RA. CONCLUSION: A PPD skin test is not an appropriate test for recognising LTBI in patients with RA in our population.
Assuntos
Artrite Reumatoide/imunologia , Teste Tuberculínico , Tuberculose/diagnóstico , Adulto , Idoso , Artrite Reumatoide/complicações , Contraindicações , Reações Falso-Negativas , Feminino , Humanos , Tolerância Imunológica , Masculino , Pessoa de Meia-Idade , Tuberculose/complicaçõesRESUMO
Objetivos: Evaluar la epidemiología de las Vasculitis Sistémicas Primarias (VSP), Poliangeítis Microscópica (MPA). Granulomatosis de Wegener (GW), Poliarteritis Nodosa (PAN) y Síndrome de Churg-Strauss (SCS) en una población latinoamericana bien definida. Métodos: Entre enero de 1990 y diciembre de 2004 se registraron todos los casos de estas VSP identificados en una población de 930.306 personas mayores de 15 años asignadas a la Red Asistencial del Hospital Almenara (nueve hospitales en 20 distritos de la ciudad de Lima). Los pacientes fueron clasificados de acuerdo a las definiciones de la Conferencia de Consenso de Chapel Hill. Resultados: Se identificaron 72 pacientes con VSP (56 MPA, 7 GW, 7 PAN y 2 SCS), 49 mujeres y 23 varones, con promedio de edad 56,42 ± 13,77 años. La incidencia anual de VSP entre 1990-2004 fue 5,16/millón (95 por ciento IC 5,12-5,20). Fue mayor en mujeres 6,98/millón (95 por ciento IC 6,91-7,05) que en varones 3,32/millón (95 por ciento IC 5,12-5,20) y en pacientes ≥ 50 años que < 50 años (13,96/millón vs 1,96/millón). La incidencia de MPA fue 4,01/millon (95 por ciento IC 3,97-4,05), de GW 0,50/millón (95 por ciento IC 0,49-0,51), de PAN 0,5/millón (95 por ciento IC 0,49-0,51) y de SCS 0,14/millón (95 por ciento IC 0,13-0,15). Por quinquenios la incidencia de VSP fue 3,44/millón (95 por ciento IC 3,40-3,48) entre 1990-1994; 4,73/millón (95 por ciento IC 4,69-4,77) entre 1995-1999 y 7,31/millón (95 por ciento IC 7,26-7,36) entre 2000-2004.