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OBJECTIVE: The aim is to analyze health care resource utilization (HCRU) of patients with lupus (SLE) from a health management organization (HMO) in Buenos Aires, Argentina, compared with matched controls and comparing periods of flare, low disease activity, and remission. METHODS: This is a retrospective observational study including all SLE incident cases (ACR 1997/SLICC 2012 criteria) between 2000 and 2020 and 5 matched controls. Clinical data and HCRU (medical and nonmedical consultations, lab and imaging tests performed, emergency room visits, hospitalizations, and drugs prescribed) were obtained from administrative databases and electronic medical records. For each patient with SLE, an activity state was determined in every month of follow-up: flare (BILAG A or 2 BILAG B); low disease activity (LLDAS); remission (DORIS definition); or intermediate activity (not fulfilling any of previous). Incidence rates for each HCRU item and incidence rate ratios between SLE and control patients were and between remission and flare periods were calculated. Multivariate negative binomial logistic regression analyses were performed for identification of variables associated with major resource use. RESULTS: A total of 62 SLE and 310 control patients were included, 88.7% were women, the median age at diagnosis was 46 years, and were followed for more than 8 years. Patients with SLE contributed with 537.2 patient-years (CI 95% 461.1-613.3) and controls with 2761.9 patient-years (CI 95% 2600.9-2922.8). HCRU in patients with SLE was significantly higher than in controls in all items, even in remission periods. Patients with SLE remained 74.4% of the time in remission, 12.1% in LLDAS, 12.2% in intermediate activity, and 1.3% in flare (there were 64 flares in 36 patients). HCRU was significantly higher during flare periods compared with remission periods. Number of flares was independently associated with emergency department consultations, lab tests and X-ray performed, number of drugs prescribed, and hospitalizations. CONCLUSION: Significantly more HCRU was observed in patients with SLE in flare compared to remission periods.
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Lúpus Eritematoso Sistêmico , Humanos , Feminino , Masculino , Argentina/epidemiologia , Lúpus Eritematoso Sistêmico/epidemiologia , Estudos Retrospectivos , Aceitação pelo Paciente de Cuidados de Saúde , Índice de Gravidade de DoençaRESUMO
OBJECTIVES: To evaluate IP-10 gene expression in patients with SLE, and its possible relationship with disease activity. PATIENTS AND METHODS: This study included 120 patients diagnosed with SLE and 30 healthy controls. The relative gene expression of IP-10 was investigated with the Fold Change method, which was correlated with the level of lupus activity evaluated with the SLEDAI 2-K instrument. RESULTS: Different levels of gene expression were found according to the SLE activity (P = <.001). IP-10 gene expression levels were higher in patients with severe activity than in those with no activity, low activity, and moderate activity. The increase in gene expression in the severe activity group was significant with a Fold Change of 3 CONCLUSION: The significant increase in relative gene expression IP-10 may be a marker of severe lupus activity.
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Lúpus Eritematoso Discoide , Lúpus Eritematoso Sistêmico , Biomarcadores , Quimiocina CXCL10/genética , Expressão Gênica , Humanos , Lúpus Eritematoso Sistêmico/genéticaRESUMO
OBJECTIVES: To validate the systemic lupus activity questionnaire (SLAQ) in Spanish language. METHODS: The SLAQ questionnaire was translated and adapted in Spanish. Consecutive SLE patients from 8 centers in Argentina were included. A rheumatologist completed a Systemic Lupus Activity Measure (SLAM), Systemic Lupus Erythematosus Disease Activity Index (SLEDAI)-2K, and a physician's assessment. Reliability was assessed by internal consistency (Cronbach's alpha), stability by test-retest reliability (intraclass correlation coefficient), and construct validity by evaluating the correlation with clinically relevant scores. Sensitivity and specificity for clinically significant disease activity (SLEDAI ≥6) of different S-SLAQ cut-off points were evaluated. RESULTS: We included 97 patients ((93% female, mean age: 40 years (SD14.7)). Internal consistency was excellent (Cronbach's alpha = 0.84, p < 0.001), and the intraclass correlation coefficient was 0.95 (p < 0.001). Mean score of S-SLAQ was 8.2 (SD 7.31). Correlation of S-SLAQ was moderate with Patient NRS (r= 0.63 p< 0.001), weak with SLAM-no lab (r = 0.42, p <0.001) and SLAM (r = 0.38, p < 0.0001), and very weak with SLEDAI-2K (r = 0.15, p =0.1394). Using the S-SLAQ cutoff of five points, the sensitivity was 72.2% and specificity was 37.9%, for clinically significant disease activity. CONCLUSIONS: The S-SLAQ showed good validity and reliability. A good correlation, similar to the original instrument, was observed with patient´s global disease activity. No correlation was found between S-SLAQ and gold standard disease activity measures like SLEDAI-2K and SLAM. The S-SLAQ cutoff point of 5 showed a good sensitivity to identify the active SLE population and therefore could be an appropriate screening instrument for disease activity in clinical and epidemiological studies.
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Lúpus Eritematoso Discoide , Lúpus Eritematoso Sistêmico , Adulto , Feminino , Humanos , Idioma , Lúpus Eritematoso Sistêmico/diagnóstico , Masculino , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Inquéritos e QuestionáriosRESUMO
Resumen: ANTECEDENTES: el lupus eritematoso sistémico es una enfermedad autoinmunitaria de origen multifactorial en la que se afectan múltiples órganos. OBJETIVO: establecer las principales características de los pacientes con lupus eritematoso sistémico tratados en el servicio de Medicina Interna, las causas de ingreso, el grado de actividad de la enfermedad y la evolución posterior a su ingreso al hospital. MATERIAL Y MÉTODO: estudio descriptivo y retrospectivo de pacientes con diagnóstico de lupus eritematoso sistémico, ingresados durante el periodo del 1 de enero de 2013 al 30 de junio de 2016 en el servicio de Medicina Interna del Hospital Escuela Universitario de Tegucigalpa, Honduras. RESULTADOS: se estudiaron 78 pacientes del sexo femenino y 5 masculinos, con relación aproximada de 16:1; el promedio de ingresos hospitalarios por paciente fue de 1.19. Se encontró un índice MEX-SLEDAI promedio de actividad al ingreso de 7.5 ± 4.6 puntos. El promedio de estancia hospitalaria fue de 12.4 ± 11.7 días, en 61% de los casos la duración de la hospitalización fue mayor de 7 días, en este grupo se encontró un valor promedio de actividad lúpica de 8.5 ± 4.4 puntos. La causa más frecuente de ingreso hospitalario fue la actividad de la enfermedad 58%, seguida de procesos infecciosos 24%. CONCLUSIONES: el lupus eritematoso sistémico se diagnostica comúnmente en pacientes jóvenes principalmente del sexo femenino; sin embargo, cuando afecta a pacientes masculinos, la actividad de la enfermedad suele ser más severa. La actividad lúpica fue la principal causa de ingreso.
Abstract: BACKGROUND: Systemic lupus erythematosus SLE is an autoimmune pathology of multifactorial etiology where multiple organ involvement occurs. OBJECTIVE: To establish the main characteristics of patients with systemic lupus erythematosus treated at Internal Medicine service, their causes of entering, degree of disease activity and evolution posterior to hospitalization. MATERIAL AND METHOD: A descriptive and retrospective study of patients diagnosed with systemic lupus erythematosus admitted during the period from January 1st 2013 to June 30 2016 at the Internal Medicine Service of the Hospital Universitario de Tegucigalpa, Honduras. RESULTS: We studied 78 female and 5 male patients, establishing a ratio of approximately 16:1, the average hospital admission per patient was 1.19. We found an average MEX-SLEDAI of activity at the entrance of 7.5 ± 4.6 points. The average hospital stay was 12.4 ± 11.7 days, in 61% of cases duration of more than 7 days was presented, in this group an average value of lupus activity of 8.5 ± 4.4 points was found. The most frequent cause of hospital admission was the activity of the disease 58%, followed by infectious processes 24%. CONCLUSIONS: Systemic lupus erythematosus is commonly diagnosed in young female patients, but when it occurs in male patients, the disease activity is usually more severe. Lupic activity was the main cause of hospitalization.
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The objective of this cross-sectional study was to determine relationships between socioeconomic status and organ damage in Mexican systemic lupus erythematosus (SLE) patients. Demographic and clinical variables were assessed. Socioeconomic status was evaluated using the Graffar method and monthly household income. Lupus activity and organ damage were measured using the SLE disease activity scale, validated for the Mexican population (Mex-SLEDAI), and the Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) scale. The 143 Mexican female SLE patients included (mean age 40.1 ± 8.9 years, mean disease duration 8.9 ± 6.3 years) had a mean monthly household income of $ 407.2 ± 326.5. According to the Graffar index, 18.9%, 52.5%, and 28.7% had high/medium-high, medium, and medium-low/low socioeconomic status, respectively. Organ damage was observed in 61 patients (42.7%). Patients with organ damage had lower monthly household incomes ($241.4 ± 152.4 vs. $354.8 ± 288.3) and were more frequently unemployed (57.3% vs. 35.3%; p = 0.01) than those without. Low monthly income was not associated with lupus activity or self-reported health status. In the adjusted multivariate analysis, low monthly income ( < $300) was associated with organ damage. In conclusion, low income may be associated with organ damage in Mexican SLE patients.
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Lúpus Eritematoso Discoide/economia , Lúpus Eritematoso Discoide/patologia , Lúpus Eritematoso Sistêmico/economia , Lúpus Eritematoso Sistêmico/patologia , Insuficiência de Múltiplos Órgãos/economia , Insuficiência de Múltiplos Órgãos/patologia , Adulto , Estudos Transversais , Feminino , Nível de Saúde , Humanos , México , Pessoa de Meia-Idade , Análise Multivariada , Índice de Gravidade de Doença , Classe Social , Saúde da MulherRESUMO
Los auto anticuerpos contra la proteína P ribosomal (anti-P ribosomales) se presentan en aproximadamente el 15% de los pacientes con lupus eritematoso sistémico (LES). Estos anticuerpos fueron inicialmente asociados con psicosis lúpica y enfermedad neuropsiquiátrica. Posteriormente se reconoció su asociación con alto riesgo de compromiso renal y hepático. Objetivos: evaluar la coexistencia serológica y clínica de anticuerpos anti-P ribosomal y anti-DNA en pacientes con LES con compromiso renal y neuropsiquiátrico. Materiales y métodos: casos: 12 pacientes con lupus neuropsiquiátrico (cambios conductuales 6, depresión 4, alucinaciones 3, alteración cognitiva 2, convulsiones 2 y psicosis 2). Controles: 13 pacientes con actividad por LES sin evidencia de manifestaciones neuropsiquiátricas. Todos los pacientes estuvieron activos para el tiempo de la evaluación. Los anticuerpos anti-P ribosomal fueron determinados por ELISA y los anti-dcDNA por el método de Crithidia luciliae. La función renal fue valorada por medición de creatinina y el compromiso renal con uroanálisis. Resultados: la edad media fue de 39 años, 2 hombres / 23 mujeres. Ocho casos (66,6%) y seis (46,1%) controles tenían compromiso renal. El 20% de los pacientes fueron positivos para anti-P ribosomal (5/25 pacientes: 2 controles y 3 casos). El 36% de los pacientes tenían anticuerpos anti-dsDNA (30,7% controles y 41,6% casos). La presencia de anticuerpo P ribosomal estuvo asociada con anti-dcDNA (p = 0,002) y con nefritis lúpica (p = 0,046), pero no hubo asociación entre el anti-P ribosomal y las manifestaciones neuropsiquiátricas (p = 0,645). Conclusiones: la presencia de anticuerpos anti-P ribosomal está asociada con anti-dcDNA y nefritis lúpica. Este estudio no encontró asociación estadísticamente significante entre anti-P ribosomal y manifestaciones neuropsiquiátricas del LES.
Summary The ribosomal P protein autoantibodies are present in approximately 15% of patients with Systemic Lupus Erythematosus (SLE). These antibodies were initially associated with lupus psychosis and neuropsychiatric diseases. Posteriorly, they were associated to a higher risk of renal and liver involvement in patients with SLE. Objective: to evaluate the serologic and clinic coexistence of ribosomal P protein autoantibodies and anti-dsDNA in patients with SLE with renal and neuropsychiatric manifestations. Materials and Methods: cases: 12 patients with neuropsychiatric and renal involvement (behavior changes 6, depression 4, hallucinations 3, cognitive impairment 2, seizures 2 and psychosis 2). Controls: 13 patients with active SLE, without evidence of neuropsychiatric manifestations. SLE was active in all patients during the process of evaluations. The anti-ribosomal P protein antibodies were determined by ELISA and the dsDNA antibodies by Crithidia luciliae´s immunofluorescence test. The renal function was evaluated by serum creatinin and urinalyses. Results: the median age was 39 years, 2 men/23 women. 8 cases (66.6%) and 7 controls (53.8 %) have renal involvement. 20% of patients were positive for anti P-ribosomal antibodies (5/25 patients: 2 controls and 3 cases). 36% of patients have anti dsDNA antibodies (30.7% controls and 41.6% cases). The presence of anti-ribosomal P protein antibodies was associated with anti dsDNA antibodies (p = 0.002) and with lupus nephritis (p = 0.046), but no association between ribosomal P protein autoantibodies and neuropsychiatric manifestations was found (p = 0.645). Conclusions: the P-ribosomal antibodies are associated with anti-dsDNA and lupus nephritis. This study did not show statistically significant associations between ribosomal P protein autoantibodies and neuropsychiatric manifestations in patients with SLE.