RESUMO

OBJECTIVES: To identify the predictive factors of first hospitalization and associated variables to the main causes of hospitalizations in lupus patients from a Latin American cohort. METHODS: The first hospitalization after entry into the cohort during these patients' follow-up due to either lupus disease activity and/or infection was examined. Clinical and therapeutic variables were those occurring prior to the first hospitalization. Descriptive statistical tests, multivariable logistic, and Cox regression models were performed. RESULTS: 1341 individuals were included in this analysis; 1200 (89.5%) were women. Their median and interquartile range (IQR) age at diagnosis were 27 (20-37) years and their median and IQR follow up time were 27.5 (4.7-62.2) months. A total of 456 (34.0%) patients were hospitalized; 344 (75.4%), 85 (18.6%) and 27 (5.9%) for disease activity, infections, or both, respectively. The predictors of the first hospitalization regardless of its cause were: medium (HR 2.03(1.27-3.24); p = 0.0028) and low (HR 2.42(1.55-3.79); p < 0.0001) socioeconomic status, serosal (HR 1.32(1.07-1.62); p = 0.0074) and renal (HR 1.50(1.23-1.82); p < 0.0001) involvement. Antimalarial (AM) use (HR 0.61(0.50-0.74); p < 0.0001) and achieving remission (HR 0.80(0.65-0.97); p = 0.0300) were negative predictors. CONCLUSIONS: The first hospitalization was associated with worse socioeconomic status and serosal and renal involvement. Conversely, AM use and achieving remission were associated with a lower risk of hospitalizations.

RESUMO

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).

Assuntos

RESUMO

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.

Assuntos

RESUMO

Al igual que en las enfermedades autoinmunes y reumáticas, las infecciones por virus pueden ser disparadores de mecanismos inmunopatogénicos. El SARSCoV-2 puede causar la liberación de citocinas y provocar un daño tisular grave, sobre todo pulmonar, con peligro para la vida. Se suma a ello el riesgo del uso de medicamentos inmunosupresores, empleados en los protocolos de tratamiento de las afecciones autoinmunes y también contra la infección viral de COVID-19. Hoy no contamos con conocimientos y evidencias científicas suficientemente sólidas para el enfrentamiento a la COVID-19, y cómo puede impactar entre los pacientes inmunodeprimidos por afecciones reumáticas. El Grupo Nacional de Atención y Enfrentamiento a la COVID-19 de la Sociedad Cubana de Reumatología se propuso elaborar un documento científico actualizado con las bases teórico-prácticas que permita acceder al conocimiento acerca de la infección por SARSCoV-2 y la COVID-19, y su repercusión sobre los pacientes con enfermedades autoinmunes y reumáticas para esbozar una estrategia de trabajo y ofrecer recomendaciones para los reumatólogos y pacientes cubanos. Se realizó un estudio de revisión y actualización acerca de la asociación entre las enfermedades reumáticas y autoinmunes y la COVID-19. Se emplearon las palabras clave enfermedades reumáticas, lupus eritematoso sistémico, artritis reumatoide, virus SARSCoV-2 y COVID-19. Se realizó una amplia búsqueda en MEDLINE y LILACS, y se revisaron más de 150 artículos, boletines de actualización de los sitios Web, páginas de salud de Cuba, resúmenes seleccionados por su calidad metodológica, revisiones y metaanálisis sobre el tema. A partir de la información recogida, se estableció una discusión y análisis considerando las principales experiencias internacionales, criterios de expertos, experiencias previas con otros virus en el Sistema de Salud de Cuba, con la participación de su red de científicos liderados por la Sociedad Cubana de Reumatología y su Grupo Nacional y el apoyo de la comunidad de reumatólogos(AU)

The outbreak of the infection by the new coronavirus SARSCoV-2, COVID-19, in December in Wuhan Province of China, has become a pandemic and health emergency given the deficiency of antiviral therapy for the acute respiratory syndrome that generates danger to life. The debut of the epidemic was in China, then the epicenter developed in Europe, northern Italy that suffered a severe blow. Worldwide, more than 10 million people are infected with the virus that has impacted on health systems until it practically collapsed, resulting in thousands of deaths. Today the epicenter of the pandemic has shifted to the Americas. Alarming figures highlight the United States of North America with some 2,737,600 infected and more than 128,471 deaths, followed by the South American giant Brazil with 1.3 million infections and 57,659 deaths. The Caribbean has a better setting. In Cuba, by the end of June, 2,340 cases of patients infected with deaths from COVID-19 were reported. We conducted a review, analysis and evaluation study of more than 150 articles from international journals, update bulletins of the WEB sites, health pages of the MINSAP of Cuba, and summaries selected for their methodological quality, and reviews, on the subject COVID-19 and autoimmune-rheumatic diseases by MEDLINE: database prepared by the National Library of Medicine of The USA contains bibliographic references and abstracts from more than 4,000 biomedical journals published in the United States and in 70 other countries, We also use Latin American and Caribbean Center for Information on Health Sciences: System, in Latin America and the Caribbean, since 1982. Our objective and results achieved have been to develop the theoretical-practical bases in an updated scientific document that allow access in an essential and summarized way to current knowledge about the infection by SACOV-2, COVID-19, and its repercussion and impact on patients suffering from rheumatic autoimmune diseases, and thus outline a coping and action strategy with recommendations for the Cuban rheumatologists in their health care work, and for patients as a guideline, given their well-founded concerns and fears given their underlying condition and the immunosuppressive drugs prescribed in an unfavorable context of a pandemic. The information is based on international experiences with the most published scientific evidence and those treasured national experiences in the face of similar situations of epidemics, faced by the vast health system and achievements of Cuban science(AU)

Assuntos

RESUMO

Introducción: La osteonecrosis es un trastorno asociado al déficit de riego sanguíneo con isquemia en los vasos nutricios de los huesos interesados, causa dolor crónico y discapacidad funcional. Con el desarrollo de la epidemia de VIH, se aprecia un marcado incremento de esta afección. Objetivo: Determinar la frecuencia y caracterizar clínica y epidemiológicamente a los pacientes cubanos con VIH/sida que desarrollaron osteonecrosis. Métodos: Estudio analítico prospectivo de pilotaje en una serie de 285 pacientes adultos, con infección por HIV/sida atendidos en el Instituto de Medicina Tropical Pedro Kourí en la era posterior a la terapia antirretroviral (TARVAE), años 2003-2018. Los pacientes ofrecieron su consentimiento informado. Se evaluaron variables epidemiológicas consideradas factores de riesgo (estatus procoagulante, alcoholismo, tabaquismo, hipercolesterolemia e hiperlipidemia, consumo de esteroides, conteo de células T, CD4+ y drogas antirretrovirales). Resultados: La edad promedio de la serie fue de 41 años, con una supervivencia de 12 años, marcado predominio del sexo masculino y piel blanca. El modo de adquisición del VIH prevaleciente fue la vía sexual y de hombres que tienen sexo con hombres (67,3 por ciento). Tres pacientes desarrollaron osteonecrosis (1,05 por ciento), necrosis avascular de caderas (2 casos en la derecha y uno bilateral), con cambios radiográficos por esta afección. Entre los factores asociados, un paciente tenía hiperlipidemia, dos eran fumadores, uno consumía alcohol, y los tres tenían conteo de células T CD4+ de más de 200. Todos tenían instaurada la TARVAE con inhibidores de proteasas y de la transcriptasa inversa, incluido tenofovir. Conclusiones: En esta serie de 285 pacientes con VIH, hubo una baja frecuencia de osteonecrosis. No se establecieron relaciones causales entre los factores de riesgo reconocidos en la literatura, la TARVAE y la aparición de osteonecrosis. Queda por definir el papel desempeñado por la infección VIH per se en el desarrollo de esta complicación, o develar si existen otras variables no exploradas en este estudio(AU)

Introduction: Avascular Necrosis or Osteonecrosis (ON) is a process associated with the blood supply deficit with ischemia in the nutritional vessels of the interested bones determining chronic pain, functional disability. In recent years with the growing development of the HIV epidemic, a marked increase in this condition has been observed. Objective: To determine an characterize in the clinical and epidemiological order the Cuban HIV + patients, who developed ON in the context of the HIV epidemic in a series of 285 HIV + cases with highly effective ARV therapy including tenofovir. Methods: Prospective analytical pilot study in a series of 285 patients, with HIV-AIDS infection adults treated in the IPK of Cuba in the later era (years 2003-17) to high-efficiency ARV therapy (TARVAE). Patients diagnosed with HIV / AIDS who offered their informed consent to participate in the study were included, and the research was approved by the IPK Ethics Committee. Results: Average age 41 (15-71) years (p <0.05). Survival 12 years by studies of Kaplan and Maier. Marked male predominance with 230 (81 percent), 55 (19.2 percent) women, white skin color, and 50-59 age group with 146 (51.2 percent) (p <0.05); data similar to the rest of the Cuban population according to other COPCORD Epidemiological studies. (18) Sexual and HIVH prevalent HIV acquisition mode with 192 (67.3 percent). 154 (54 percent) had an undetectable viral load. We found 3 (1.05 percent) patients who developed ON, with an average age of 52 (40-61a), 2 patients in right hip, and one bilateral avascular necrosis of the hips, all with radiological changes of this condition. As associated FR, one patient had hyperlipidemia, another 2 smoker, and 1 alcohol, all 3 with CD4 + T cell count <200 And high viral load. All cases had TARVAE with protease inhibitors, and reverse transcriptase, including Tenofovir. Conclusions: Our report is aimed at showing a low frequency of ON in our series of 285 patients studied in the Cuban HIV epidemic. The hips were the sites of ON, with 1 patients bilateral involvement. Hyperlipidemia, tabaquism and alcohol were the principal risk factors presented and low level of CD4 + T cels, and high viral load. We were unable to establish causal relationships between the recognized risk factors reported in the literature, HAART and the appearance of ON, all of which leave the role played by HIV infection per se in the development of this complication, or the effects of other variables that we have not explored in this preliminary study(AU)

Assuntos

RESUMO

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.

Assuntos

RESUMO

The original version of this article, unfortunately, contained an error. The first and family name of Loreto Massardo was interchanged and is now presented correctly in this article.

RESUMO

OBJECTIVES: To identify baseline predictors of remission and low disease activity (LDA) in early rheumatoid arthritis (RA) from the GLADAR (Grupo Latino Americano De estudio de la Artritis Reumatoide) cohort. METHODS: Patients with 1- and 2-year follow-up visits were included. Remission and LDA were defined by DAS28-ESR (< 2.6 and ≤ 3.2, respectively). Baseline predictors examined were gender, ethnicity, age at diagnosis, socioeconomic status, symptoms' duration, DMARDs, RF, thrombocytosis, anemia, morning stiffness, DAS28-ESR (and its components), HAQ-DI, DMARDs and corticosteroid use, and Sharp-VDH score. Multivariable binary logistic regression models (excluding DAS28-ESR components to avoid over adjustment) were derived using a backward selection method (α-level set at 0.05). RESULTS: Four hundred ninety-eight patients were included. Remission and LDA/remission were met by 19.3% and 32.5% at the 1-year visit, respectively. For the 280 patients followed for 2 years, these outcomes were met by 24.3% and 38.9%, respectively. Predictors of remission at 1 year were a lower DAS28-ESR (OR 1.17; CI 1.07-1.27; p = 0.001) and HAQ-DI (OR 1.48; CI 1.04-2.10; p = 0.028). At 2 years, only DAS28-ESR (OR 1.40; CI 1.17-1.6; p < 0.001) was a predictor. Predictors of LDA/remission at 1 year were DAS28-ESR (OR 1.42; CI 1.26-1.61; p < 0.001), non-use of corticosteroid (OR 1.74; CI 1.11-2.44; p = 0.008), and male gender (OR 1.77; CI 1.2-2.63; p = 0.036). A lower baseline DAS28-ESR (OR 1.45; CI 1.23-1.70; p < 0.001) was the only predictor of LDA/remission at 2 years. CONCLUSIONS: A lower disease activity consistently predicted remission and LDA/remission at 1 and 2 years of follow-up in early RA patients from the GLADAR cohort. Key Points • In patients with early RA, a lower disease activity at first visit is a strong clinical predictor of achieving remission and LDA subsequently. • Other clinical predictors of remission and LDA to keep in mind in these patients are male gender, non-use of corticosteroids and low disability at baseline. • Not using corticosteroids at first visit is associated with a lower disease activity and predicts LDA/remission at 1 year in these patients.

Assuntos

RESUMO

Introducción: La infección por VIH/SIDA constituye uno de los principales problemas de salud en el mundo con elevadas tasas de morbilidad y mortalidad demostradas. En diferentes estudios epidemiológicos ha quedado confirmado que 36,3 millones de personas vivían con el VIH hasta el año 2015 en todo el mundo. Hasta este momento 78 millones han sido infectados desde 1981, año en que comenzó la epidemia, y el 25 por ciento de los pacientes desconocen que están infectados, lo cual propicia el contagio. Objetivo: Realizar una revisión bibliográfica relacionada con la infección por el VIH/SIDA, sus complicaciones en las enfermedades reumáticas y metabólicas y su respuesta al tratamiento antirretroviral de alta eficiencia. Método: Se realizó una búsqueda bibliográfica en bases de datos nacionales e internacionales y en diferentes fuentes de información para recuperar los artículos relacionados con el tema sobre el VIH-SIDA, las complicaciones reumáticas y metabólicas y su respuesta al tratamiento antirretroviral de alta eficiencia, tema escogido para este trabajo. Resultados: Se recuperaron 78 artículos y nueve textos que trataban temas relacionados con la infección por VIH-SIDA; de ellos fueron útiles para nuestros objetivos 55 documentos que forman parte de nuestras referencias bibliográficas, los cuales agrupamos de acuerdo con los diferentes temas planteados para este estudio y se llegó a conclusiones útiles para nuestra comunidad científica. Conclusiones: Las enfermedades reumáticas y autoinmunes han sido diagnosticadas con mucha frecuencia en los pacientes infectados con el VIH-SIDA en Cuba y en el mundo antes del tratamiento antirretroviral de alta eficiencia, mediante el cual ha aumentado la expectativa de supervivencia de estos enfermos y disminuido la aparición de síntomas clínicos y afecciones, así como infecciones oportunistas, después de su inclusión en el enfoque terapéutico(AU)

Introduction: HIV/AIDS infection is one of the main health problems worldwide, with high morbidity and mortality. Different epidemiological studies have confirmed that 36.3 million people worldwide were living with HIV until 2015. So far, 78 million have been infected since 1981, the year in which the epidemic began, and 25 percent of patients do not know they are infected, which spreads infection. Objective: To carry out a literature review about HIV/AIDS infection, its complications in rheumatic metabolic manifestations, and its response to highly efficient antiretroviral treatment. Method: A literature search was carried out in the databases PudMed/MEDLINE, Cumed and Lilac, as well as in the regional information sources SciELO and ScienceDirect, using the key phrases manifestaciones reumáticas y VIH-SIDA [rheumatic manifestations and HIV-AIDS], complicaciones metabólicas y VIH-SIDA [metabolic complications and HIV-AIDS], tratamiento antirretroviral de alta eficiencia y VIH-SIDA [high-efficiency antiretroviral treatment and HIV-AIDS], in order to recover the articles about HIV-AIDS and rheumatic and metabolic complications and their response to highly efficient antiretroviral treatment. Results: 78 articles and nine texts dealing about the aforementioned topics were recovered; of them, 55 documents that are part of our bibliographical references were useful for our purposes, which were grouped according to the different topics proposed for this study. We reached useful conclusions for our scientific community. Conclusions: Rheumatic and autoimmune diseases have been diagnosed very frequently in patients infected with HIV/AIDS in Cuba and worldwide during the era prior to highly efficient antiretroviral treatment. Its incorporation into the therapeutic approach has increased the survival expectations of these patients, in addition to the substantial decrease in the appearance of clinical symptoms and conditions, especially the inflammatory arthritic conditions, seronegative spondyloarthropathies, psoriasis and opportunistic infections(AU)

Assuntos

RESUMO

Objetivos: Estimar el efecto de los antimaláricos (AM) sobre los diferentes dominios del índice de daño SLICC (SDI). Métodos: Se estudiaron pacientes con diagnóstico clínico reciente (≤2 años) de lupus eritematoso sistémico (LES) de la cohorte GLADEL. Variable de estudio: aumento en los dominios del SDI desde el ingreso a la cohorte. Variables independientes: características sociodemográficas, clínicas, laboratorio y tratamientos. El efecto de los AM, como variable dependiente del tiempo, sobre los dominios más frecuentes del SDI (ajustado por factores de confusión) fue examinado con un modelo de regresión de Cox multivariado. Resultados: De 1466 pacientes estudiados, 1049 (72%) recibieron AM con un tiempo medio de exposición de 30 meses (Q1-Q3: 11-57) y 665 pacientes (45%) presentaron daño durante un seguimiento medio de 24 meses (Q1-Q3: 8-55); 301 eventos fueron cutáneos, 208 renales, 149 neuropsiquiátricos, 98 musculoesqueléticos, 88 cardiovasculares y 230 otros. Después de ajustar por factores de confusión, el uso de AM se asoció a un menor riesgo de daño renal (HR 0,652; IC 95%: 0,472-0,901) y en el límite de la significancia estadística (HR 0,701, IC 95%: 0,481-1,024) para el dominio neuropsiquiátrico. Conclusión: En GLADEL, el uso de AM se asoció independientemente a un menor riesgo de daño acumulado renal.

Objective: To assess the effects of antimalarials (AM) over the items of the SLICC Damage Index (SDI). Methods: Patients with recent (≤2 years) diagnosis of systemic lupus erythematosus (SLE) from the GLADEL cohort were studied. End-point: increase in items SDI since cohort entry. Independent variables (socio-demographic, clinical, laboratory and treatment) were included. The effect of AM as a time dependent variable on most frequent SDI items (adjusting for potential confounders) was examined with a multivariable Cox regression model. Results: Of the 1466 patients included in this analysis, 1049 (72%) received AM with a median exposure time of 30 months (Q1-Q3: 11-57). Damage occurred in 665 (45%) patients during a median follow-up time of 24 months (Q1-Q3: 8-55). There were 301 integument, 208 renal, 149 neuropsychiatric, 98 musculoskeletal, 88 cardiovascular and 230 others less frequently represented damages. After adjusting for potential confounders at any time during follow-up, a lower risk of renal damage (HR 0.652; 95% CI: 0.472-0.901) and borderline for neuropsychiatric damage (HR 0.701, 95% CI: 0.481-1.024) was found. Conclusion: In the GLADEL cohort, after adjustment for possible confounding factors, AM were independently associated with a reduced risk of renal damage accrual.

Assuntos

RESUMO

OBJECTIVE: To evaluate disease activity statuses' (DAS') impact on systemic lupus erythematosus (SLE) outcomes. MATERIALS AND METHODS: Four DAS were defined: remission off-therapy: SLE Disease Activity Index (SLEDAI)=0, no prednisone or immunosuppressive drugs (IS); remission on-therapy: SLEDAI=0, prednisone ≤5 mg/day and/or IS (maintenance); low (L) DAS: SLEDAI ≤4, prednisone ≤7.5 mg/day and/or IS (maintenance); non-optimally controlled: SLEDAI >4 and/or prednisone >7.5 mg/day and/or IS (induction). Antimalarials were allowed in all. Predefined outcomes were mortality, new damage (increase of at least one Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) damage index (SDI) point) and severe new damage (increase of at least 3 SDI points). Univariable and multivariable Cox regression models were performed to define the impact of DAS, as time-dependent variable, on these outcomes. RESULTS: 1350 patients were included, 79 died during follow-up, 606 presented new and 177 severe new damage. In multivariable analyses, remission (on/off-therapy) was associated with a lower risk of new (HR 0.60; 95% CI 0.43 to 0.85), and of severe new damage (HR 0.32; 95% CI 0.15 to 0.68); low disease activity status (LDAS) was associated with a lower risk of new damage (HR 0.66; 95% CI 0.48 to 0.93) compared with non-optimally controlled. No significant effect on mortality was observed. CONCLUSIONS: Remission was associated with a lower risk of new and severe new damage; LDAS with a lower risk of new damage after adjusting for other damage confounders.

Assuntos

RESUMO

Introducción: el síndrome de anticuerpos antifosfolípidos es un estado protrombótico adquirido determinado por la presencia de anticuerpos antifosfolípidos en pacientes con trombosis venosa o arterial y una morbilidad incrementada durante el embarazo.Objetivos: describir los principales aspectos epidemiológico-clínicos del síndrome durante el embarazo y los resultados perinatales.Métodos: se realizó un estudio descriptivo y analítico de una serie de pacientes con síndrome de anticuerpos antifosfolípidos y embarazo en el Centro de Investigaciones Médico Quirúrgicas y el Centro Nacional de Reumatología, en La Habana, Cuba. La serie estudiada se constituyó con 188 mujeres. Se revisaron los expedientes clínicos de las gestantes internadas y de consultas externas de ambas instituciones, diagnosticadas como patología primaria o secundaria y se conformó una base de datos con variables epidemiológicas como: características del embarazo y desenlace materno fetal.Resultados: del total de pacientes estudiadas de la serie, 32 sufrieron trombosis con morbilidad obstétrica. Se diagnosticó síndrome de anticuerpos antifosfolípidos primario en seis pacientes y secundario en 26 (17,5 por ciento). La edad promedio fue de 27 años. Según el color de la piel; seis de cada 10 eran blancas y el resto, mestizas y negras. Entre estas pacientes hubo 81 embarazos; con una razón de 2,53 embarazos/paciente; 76 por ciento nacieron vivos, 18 por ciento tuvo un aborto espontáneo y hubo 5 por ciento de muertes fetales. De ellas, 16 por ciento tuvo parto pretérmino y 10 por ciento desarrolló preeclampsia. No hubo muertes maternas.Conclusiones: el embarazo en pacientes con síndrome de anticuerpos antifosfolípidos es de elevado riesgo, y se constató una elevada morbimortalidad materno fetal(AU)

Introduction: antiphospholipid antibody syndrome (APS) is an acquired prothrombotic state characterized by the presence of antiphospholipid antibodies in patients with venous or arterial thrombosis and increased morbidity during pregnancy.Objectives: describe the main clinical and epidemiological features of the syndrome during pregnancy as well as its perinatal outcomes.Methods: a descriptive analytical study was conducted of a series of patients with antiphospholipid antibody syndrome and pregnancy at the Center for Medical Surgical Research and the National Rheumatology Center in Havana, Cuba. The study series was composed of 188 women. Examination was performed of the medical records of pregnant women either hospitalized or attending outpatient consultation at the two institutions who had been diagnosed with the syndrome as a primary or a secondary condition. A database was developed with epidemiological variables such as characteristics of the pregnancy and maternal fetal outcome.Results: of the total patients studied in the series, 32 had thrombosis with obstetric morbidity. Primary antiphospholipid antibody syndrome was diagnosed in six patients, whereas secondary APS was diagnosed in 26 (17.5 percent). Mean age was 27 years. With respect to skin color, six out of every ten patients were white, and the rest were either brown or black. There were 81 pregnancies in the series, i.e. 2.53 patients / pregnancy, with 76 percent live births, 18 percent spontaneous abortions and 5 percent fetal deaths. 16 percent had a preterm delivery and 10 percent developed preeclampsia. There were no maternal deaths.Conclusions: pregnancy in patients with antiphospholipid antibody syndrome is highly risky, with increased maternal and fetal morbidity and mortality(AU)

Assuntos

RESUMO

Introducción: el síndrome de anticuerpos antifosfolípidos es un estado protrombótico adquirido determinado por la presencia de anticuerpos antifosfolípidos en pacientes con trombosis venosa o arterial y una morbilidad incrementada durante el embarazo. Objetivos: describir los principales aspectos epidemiológico-clínicos del síndrome durante el embarazo y los resultados perinatales. Métodos: se realizó un estudio descriptivo y analítico de una serie de pacientes con síndrome de anticuerpos antifosfolípidos y embarazo en el Centro de Investigaciones Médico Quirúrgicas y el Centro Nacional de Reumatología, en La Habana, Cuba. La serie estudiada se constituyó con 188 mujeres. Se revisaron los expedientes clínicos de las gestantes internadas y de consultas externas de ambas instituciones, diagnosticadas como patología primaria o secundaria y se conformó una base de datos con variables epidemiológicas como: características del embarazo y desenlace materno fetal. Resultados: del total de pacientes estudiadas de la serie, 32 sufrieron trombosis con morbilidad obstétrica. Se diagnosticó síndrome de anticuerpos antifosfolípidos primario en seis pacientes y secundario en 26 (17,5 por ciento). La edad promedio fue de 27 años. Según el color de la piel; seis de cada 10 eran blancas y el resto, mestizas y negras. Entre estas pacientes hubo 81 embarazos; con una razón de 2,53 embarazos/paciente; 76 por ciento nacieron vivos, 18 por ciento tuvo un aborto espontáneo y hubo 5 por ciento de muertes fetales. De ellas, 16 por ciento tuvo parto pretérmino y 10 por ciento desarrolló preeclampsia. No hubo muertes maternas. Conclusiones: el embarazo en pacientes con síndrome de anticuerpos antifosfolípidos es de elevado riesgo, y se constató una elevada morbimortalidad materno fetal(AU)

Introduction: antiphospholipid antibody syndrome (APS) is an acquired prothrombotic state characterized by the presence of antiphospholipid antibodies in patients with venous or arterial thrombosis and increased morbidity during pregnancy. Objectives: describe the main clinical and epidemiological features of the syndrome during pregnancy as well as its perinatal outcomes. Methods: a descriptive analytical study was conducted of a series of patients with antiphospholipid antibody syndrome and pregnancy at the Center for Medical Surgical Research and the National Rheumatology Center in Havana, Cuba. The study series was composed of 188 women. Examination was performed of the medical records of pregnant women either hospitalized or attending outpatient consultation at the two institutions who had been diagnosed with the syndrome as a primary or a secondary condition. A database was developed with epidemiological variables such as characteristics of the pregnancy and maternal fetal outcome. Results: of the total patients studied in the series, 32 had thrombosis with obstetric morbidity. Primary antiphospholipid antibody syndrome was diagnosed in six patients, whereas secondary APS was diagnosed in 26 (17.5 percent). Mean age was 27 years. With respect to skin color, six out of every ten patients were white, and the rest were either brown or black. There were 81 pregnancies in the series, i.e. 2.53 patients / pregnancy, with 76 percent live births, 18 percent spontaneous abortions and 5 percent fetal deaths. 16 percent had a preterm delivery and 10 percent developed preeclampsia. There were no maternal deaths. Conclusions: pregnancy in patients with antiphospholipid antibody syndrome is highly risky, with increased maternal and fetal morbidity and mortality(AU)

Assuntos

RESUMO

OBJECTIVE: To examine the role of ethnicity and the use of anti-malarials (protective) on lupus renal disease. METHODS: A nested case-control study (1:2 proportion, n = 265 and 530) within GLADEL's (Grupo Latino Americano De Estudio de Lupus) longitudinal inception cohort was carried out. The end-point was ACR renal criterion development after diagnosis. Cases and controls were matched for follow-up time (end-point or a comparable time, respectively). Renal disease predictors were examined by univariable and multivariable analyses. Additional analyses were done to determine if the protective effect of anti-malarials persisted after adjusting for intake-associated confounders. RESULTS: Of the cases, 233 (87.9%) were women; their mean (s.d.) age at diagnosis was 28.0 (11.9) years and their median (Q3-Q1 interquartile range) follow-up time for cases and controls was 8.3 months (Q3-Q1: 23.5); 56.6% of the cases and 74.3% of the controls were anti-malarial users. Mestizo ethnicity [odds ratio (OR) 1.72, 95% CI 1.19, 2.48] and hypertension (OR 2.26, 95% CI 1.38, 3.70) were independently associated with a higher risk of renal disease, whereas anti-malarial use (OR 0.39, 95% CI 0.26, 0.58), older age at disease onset (OR 0.98, 95% CI 0.96, 0.99) and female gender (OR 0.56, 95% CI 0.32, 0.99) were negatively associated with such occurrence. After adjusting for variables associated with their intake, the protective effect of anti-malarials on renal disease occurrence persisted (OR 0.38, 95% CI 0.25, 0.58). CONCLUSION: Mestizo patients are at increased risk of developing renal disease, whereas anti-malarial use protects patients from such an occurrence.

Assuntos

Assuntos

RESUMO

OBEJTIVOS: conocer el comportamiento epidemiológico clínico de pacientes con Lupus Eritematoso Sistémico (LES) que resultaron embarazadas, el desenlace materno fetal y el enfoque terapéutico actualmente propuesto. Analizar la frecuencia de factores como anticoagulante lúpico y otras manifestaciones clínicas asociadas al desarrollo de síndrome antifosfolípido secundario que complican el curso del lupus y al feto. MÉTODOS: se realizó un estudio de tipo observacional, analítico y ambispectivo de 160 pacientes con el diagnóstico de lupus eritematoso sistémico (LES), atendidos o ingresados en el Servicio Nacional de Reumatología (SNR) y CIMEQ, entre enero 1985 y febrero de 2009. El análisis estadístico se realizó utilizando las frecuencias relativas y porcentajes a partir de una base de datos en Excel. El nivel de significación se estableció en p<0,05. RESULTADOS: se produjeron 385 embarazos con una razón de 2,40 embarazos / paciente l, nacieron vivos y sanos 313 (81,29 por ciento); 72 (18,71 por ciento) pérdidas de la gestación, considerando entre ellas 64 abortos (16,6 por ciento). Desarrollaron partos preterimos 22 pacientes (13,7 por ciento), hipertensión asociada a la gestación 18 (11,25 por ciento) y pre-eclampsia 12 (7,53 por ciento) de las embarazadas. Se constataron manifestaciones clínicas de síndrome antifosfolípido asociado a lupus en el 10 por ciento de las embarazadas. CONCLUSIONES: la fertilidad no parece estar comprometida, el embarazo es de alto riesgo, y resultan frecuentes la ocurrencia de brotes de la enfermedad en la madre, abortos espontáneos, partos pretérmino y posibilidad de fetos muertos. Consideramos que esta constituye una valiosa información para el equipo multidisciplinario que enfrente el reto de llevar a feliz término el cuidado y atención de mujeres embarazadas con lupus eritematoso sistémico (AU)

OBJECTIVES: to know the clinical and epidemiological behavior of the pregnant patients presenting with systemic lupus erythematosus (SLE), the maternal-fetal outcome, and the therapeutical approach presently proposed. To analyze the factor frequency e.g. lupus anticoagulant and other clinical manifestations associated with secondary antiphospholipid syndrome complicating the lupus course and the fetus. METHODS: a analytical, observational and ambispective study of 160 patients diagnosed with SLE, seen or admitted in National Service of Rheumatology (NSR) and in CIMEQ from January, 1985 and February, 2009. Statistical analysis was made using the relative frequencies and percentages from a Excel database. Significance level was established in p<0,05. RESULTS: there were 385 pregnancies with a ratio of 2,40 pregnancies/ patient I, life birth and healthy 313 (81,29 percent); 72 (18,71 percent) losses of pregnancy including 14 abortions (16,6 percent). There were preterm labors in 22 patients (13,7 percent), high blood pressure associated to pregnancy in 18 (11,25 percent), and preeclampsia in 12 (7,53 percent). We confirmed clinical manifestations of lupus-associated antiphospholipid syndrome in 10 percent of pregnants.] CONCLUSIONS: fertility was not compromised; it is a high risk pregnancy and is frequent the occurrence of mother disease outbreaks, spontaneous abortions, preterm labors and possibility of dead fetus. We considered that it is valuable information for the multidisciplinary staff facing the challenge to achieve the care of pregnants presenting SLE (AU)

Assuntos

RESUMO

En este trabajo se evaluó la aplicación de la solución CM-95 tratada magnéticamente como adyuvante inmunológico, en comparación con el adyuvante de Freund, para la obtención del suero de Coombs en conejos, de gran demanda en bancos de sangre y hospitales, para el diagnóstico clínico de conflictos Rh y la enfermedad hemolítica del recién nacido, entre otras. Conejos Nueva Zelanda Blancos se inocularon por la vía subcutànea con suero humano obtenido de 30 donantes O+, unido con la solución CM-95 tratada magnéticamente como adyuvante inmunológico. Se empleó un esquema de inmunización de 40 días, donde se evaluó la dinàmica en el título de anticuerpos anti IgG humano por la técnica de hemoaglutinación en tubos. Al antisuero se le determinó la calidad inmunológica por el título de heteroaglutininas de los grupos sanguíneos A, B y O, de anticuerpos anticomplemento C3b, C3d y C4b y anti IgG, antes y después de su purificación. El suero de Coombs con la solución adyuvante CM-95 tratada magnéticamente mostró valores similares a los obtenidos con el adyuvante de Freund. En el mismo se cumplió con los requisitos establecidos por el Centro Estatal para el Control de la Calidad de los Medicamentos, según las normativas de la FDA para este diagnosticador. Estos resultados abren nuevas perspectivas para el uso de la solución adyuvante en la obtención del suero de Coombs(AU)

This paper assessed the application of the magnetically treated CM-95 solution as immunological adjuvant compared to Freund adjuvant for the obtainment of Coombs serum in rabbits. Among others, Coombs serum is very demanded in blood banks and hospitals for the clinical diagnosis of Rh conflicts and haemolytic disease of the newborn. New Zealand white rabbits were subcutaneously inoculated with human serum, obtained from 30 donors of O+ blood, together with the magnetically treated CM-95 adjuvant. The immunization schedule was of 40 days and dynamics in the titers of human anti IgG antibodies was assessed by the hemagglutination technique in tubes. The immunological quality of the antiserum was determined by the titers of heteroagglutins from A,B,O blood groups, of anti C3b¸ C3d and C4d and anti IgG, before and after purification. The Coombs serum with the magnetically treated CM-95 adjuvant solution showed values similar to those of Freund adjuvant. In addition, it meets the requirements of CECMED and FDA established for this diagnostic. These results open new perspectives to the use of the adjuvant Solution in the Coombs serum obtainment(AU)

Assuntos

RESUMO

OBEJTIVOS: conocer el comportamiento epidemiológico clínico de pacientes con Lupus Eritematoso Sistémico (LES) que resultaron embarazadas, el desenlace materno fetal y el enfoque terapéutico actualmente propuesto. Analizar la frecuencia de factores como anticoagulante lúpico y otras manifestaciones clínicas asociadas al desarrollo de síndrome antifosfolípido secundario que complican el curso del lupus y al feto. MÉTODOS: se realizó un estudio de tipo observacional, analítico y ambispectivo de 160 pacientes con el diagnóstico de lupus eritematoso sistémico (LES), atendidos o ingresados en el Servicio Nacional de Reumatología (SNR) y CIMEQ, entre enero 1985 y febrero de 2009. El análisis estadístico se realizó utilizando las frecuencias relativas y porcentajes a partir de una base de datos en Excel. El nivel de significación se estableció en p<0,05. RESULTADOS: se produjeron 385 embarazos con una razón de 2,40 embarazos / paciente l, nacieron vivos y sanos 313 (81,29 por ciento); 72 (18,71 por ciento) pérdidas de la gestación, considerando entre ellas 64 abortos (16,6 por ciento). Desarrollaron partos preterimos 22 pacientes (13,7 por ciento), hipertensión asociada a la gestación 18 (11,25 por ciento) y pre-eclampsia 12 (7,53 por ciento) de las embarazadas. Se constataron manifestaciones clínicas de síndrome antifosfolípido asociado a lupus en el 10 por ciento de las embarazadas. CONCLUSIONES: la fertilidad no parece estar comprometida, el embarazo es de alto riesgo, y resultan frecuentes la ocurrencia de brotes de la enfermedad en la madre, abortos espontáneos, partos pretérmino y posibilidad de fetos muertos. Consideramos que esta constituye una valiosa información para el equipo multidisciplinario que enfrente el reto de llevar a feliz término el cuidado y atención de mujeres embarazadas con lupus eritematoso sistémico

OBJECTIVES: to know the clinical and epidemiological behavior of the pregnant patients presenting with systemic lupus erythematosus (SLE), the maternal-fetal outcome, and the therapeutical approach presently proposed. To analyze the factor frequency e.g. lupus anticoagulant and other clinical manifestations associated with secondary antiphospholipid syndrome complicating the lupus course and the fetus. METHODS: a analytical, observational and ambispective study of 160 patients diagnosed with SLE, seen or admitted in National Service of Rheumatology (NSR) and in CIMEQ from January, 1985 and February, 2009. Statistical analysis was made using the relative frequencies and percentages from a Excel database. Significance level was established in p<0,05. RESULTS: there were 385 pregnancies with a ratio of 2,40 pregnancies/ patient I, life birth and healthy 313 (81,29 percent); 72 (18,71 percent) losses of pregnancy including 14 abortions (16,6 percent). There were preterm labors in 22 patients (13,7 percent), high blood pressure associated to pregnancy in 18 (11,25 percent), and preeclampsia in 12 (7,53 percent). We confirmed clinical manifestations of lupus-associated antiphospholipid syndrome in 10 percent of pregnants.] CONCLUSIONS: fertility was not compromised; it is a high risk pregnancy and is frequent the occurrence of mother disease outbreaks, spontaneous abortions, preterm labors and possibility of dead fetus. We considered that it is valuable information for the multidisciplinary staff facing the challenge to achieve the care of pregnants presenting SLE

Assuntos

RESUMO

OBJECTIVE: To estimate the prevalence, burden of illness, and help-seeking behavior of patients with musculoskeletal complaints and provide point prevalence estimates of osteoarthritis, low back pain, fibromyalgia, rheumatoid arthritis, gout, and bone fractures not related to trauma among the adult population in a urban community in Havana City. METHODS: Home survey of adults validated against physical examination. Forty-eight trained family doctors and 3 rheumatologists supervised the interviews and confirmed diagnoses. Family doctors applied a validated Community Oriented Program for the Control of Rheumatic Diseases core questionnaire. A diagnosis using American College of Rheumatology criteria was established. Analysis was based on descriptive statistics and point prevalence estimates with 95% confidence intervals (CIs) of most common diseases and associated disability rate. RESULTS: One thousand two hundred thirty-eight men and 1917 women were included. Prevalence of musculoskeletal pain was estimated in 43.9% (95% CI: 42.2-45.7). The knees were the most affected area (11.7%; 95% CI: 10.6-12) followed by low back pain (11.6%; 95% CI: 10.5-12.8). Point prevalence and 95% CI were as follows: osteoarthritis, 20.4% (95% CI: 19-21.8); gout, 0.38% (95% CI: 0.2-0.6); fibromyalgia, 0.22% (95% CI: 0.09-0.4); systemic lupus erythematosus, 0.06% (95% CI: 0.01-0.25); spondyloarthropathies, 0.19% (95% CI: 0.07-0.4); and rheumatoid arthritis,1.24% (95% CI: 0.8-1.7). Bone fractures not related to trauma were found in 1.14%, hip fracture being the most common (30.5%). Most patients were seen by the general practitioner (65.4%) and 6.2% described some disability. CONCLUSIONS: Musculoskeletal pain is highly prevalent in Cuba. Prevalence estimates are similar to those described in other surveys except for rheumatoid arthritis that seems more prevalent in Cuba and fibromyalgia less prevalent.

Assuntos