1
|
Balbi GGM, Ahmadzadeh Y, Tektonidou MG, Pengo V, Sciascia S, Ugarte A, Belmont HM, Lopez-Pedrera C, Fortin PR, Wahl D, Gerosa M, de Jesús GR, Ji L, Atsumi T, Efthymiou M, Branch DW, Nalli C, Rodriguez Almaraz E, Petri M, Cervera R, Knight JS, Artim-Esen B, Willis R, Bertolaccini ML, Cohen H, Roubey R, Erkan D, de Andrade DCO. Damage measured by Damage Index for Antiphospholipid Syndrome (DIAPS) in antiphospholipid antibody-positive patients included in the APS ACTION registry. Rheumatology (Oxford) 2024; 63:772-779. [PMID: 37307082 DOI: 10.1093/rheumatology/kead292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 04/27/2023] [Accepted: 05/15/2023] [Indexed: 06/13/2023] Open
Abstract
OBJECTIVES Our primary objective was to quantify damage burden measured by Damage Index for Antiphospholipid Syndrome (DIAPS) in aPL-positive patients with or without a history of thrombosis in an international cohort (the APS ACTION cohort). Secondly, we aimed to identify clinical and laboratory characteristics associated with damage in aPL-positive patients. METHODS In this cross-sectional study, we analysed the baseline damage in aPL-positive patients with or without APS classification. We excluded patients with other autoimmune diseases. We analysed the demographic, clinical and laboratory characteristics based on two subgroups: (i) thrombotic APS patients with high vs low damage; and (ii) non-thrombotic aPL-positive patients with vs without damage. RESULTS Of the 826 aPL-positive patients included in the registry as of April 2020, 586 with no other systemic autoimmune diseases were included in the analysis (412 thrombotic and 174 non-thrombotic). In the thrombotic group, hyperlipidaemia (odds ratio [OR] 1.82; 95% CI 1.05, 3.15; adjusted P = 0.032), obesity (OR 2.14; 95% CI 1.23, 3.71; adjusted P = 0.007), aβ2GPI high titres (OR 2.33; 95% CI 1.36, 4.02; adjusted P = 0.002) and corticosteroid use (ever) (OR 3.73; 95% CI 1.80, 7.75; adjusted P < 0.001) were independently associated with high damage at baseline. In the non-thrombotic group, hypertension (OR 4.55; 95% CI 1.82, 11.35; adjusted P = 0.001) and hyperlipidaemia (OR 4.32; 95% CI 1.37, 13.65; adjusted P = 0.013) were independent predictors of damage at baseline; conversely, single aPL positivity was inversely correlated with damage (OR 0.24; 95% CI 0.075, 0.77; adjusted P = 0.016). CONCLUSIONS DIAPS indicates substantial damage in aPL-positive patients in the APS ACTION cohort. Selected traditional cardiovascular risk factors, steroids use and specific aPL profiles may help to identify patients more prone to present with a higher damage burden.
Collapse
Affiliation(s)
- Gustavo G M Balbi
- Universidade de São Paulo, São Paulo, São Paulo, Brazil
- Universidade Federal de Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - Yasaman Ahmadzadeh
- Barbara Volcker Center for Women and Rheumatic Disease, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY, USA
| | | | | | - Savino Sciascia
- Center of Research of Immunopathology and Rare Diseases, University of Turin, Turin, Italy
| | - Amaia Ugarte
- Hospital Universitario Cruces, País Vasco, Barakaldo, Spain
| | | | - Chary Lopez-Pedrera
- Rheumatology Service, IMIBIC/Reina Sofia Hospital, University of Cordoba, Cordoba, Spain
| | - Paul R Fortin
- CHU de Québec-Université Laval, Québec, Québec, Canada
| | - Denis Wahl
- Université de Lorraine, INSERM, DCAC, Nancy, France
- Vascular Medicine Division and Regional Competence Center for Rare Vascular and Systemic Autoimmune Diseases, CHRU-Nancy, Nancy, France
| | - Maria Gerosa
- Clinical Immunology & Rheumatology Unit, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | | | - Lanlan Ji
- Rheumatology and Immunology Department, Peking University First Hospital, Beijing, China
| | | | - Maria Efthymiou
- Haemostasis Research Unit, Department of Haematology, University College London, London, UK
| | - D Ware Branch
- University of Utah and Intermountain Healthcare, Salt Lake City, UT, USA
| | - Cecilia Nalli
- Rheumatology and Immunology Unit, ASST Spedali Civili of Brescia, Brescia, Italy
| | | | - Michelle Petri
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ricard Cervera
- Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Catalonia, Spain
| | - Jason S Knight
- Division of Rheumatology, University of Michigan, Ann Arbor, MI, USA
| | | | - Rohan Willis
- Antiphospholipid Standardization Laboratory, University of Texas Medical Branch, Galveston, TX, USA
| | - Maria Laura Bertolaccini
- Academic Department of Vascular Surgery, King's College London British Heart Foundation Centre of Excellence, School of Cardiovascular Medicine & Sciences, London, UK
| | - Hannah Cohen
- Haemostasis Research Unit, Department of Haematology, University College London, London, UK
| | | | - Doruk Erkan
- Barbara Volcker Center for Women and Rheumatic Disease, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY, USA
| | | |
Collapse
|
2
|
Erton ZB, K Leaf R, de Andrade D, Clarke AE, Tektonidou MG, Pengo V, Sciascia S, Ugarte A, Belmont HM, Gerosa M, Fortin PR, Lopez-Pedrera C, Atsumi T, Zhang Z, Cohen H, Ramires de Jesús G, Branch DW, Wahl D, Andreoli L, Rodriguez-Almaraz E, Petri M, Barilaro G, Zuo Y, Artim-Esen B, Willis R, Quintana R, Vendramini MB, Barber MW, Bertolaccini ML, Roubey R, Erkan D. Immunosuppression use in primary antiphospholipid antibody-positive patients: Descriptive analysis of the AntiPhospholipid Syndrome Alliance for Clinical Trials and InternatiOnal Networking (APS ACTION) Clinical Database and Repository ("Registry"). Lupus 2022; 31:1770-1776. [PMID: 36206383 DOI: 10.1177/09612033221128742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND/PURPOSE APS ACTION Registry was created to study the outcomes of patients with persistently positive antiphospholipid antibodies (aPL) with or without other systemic autoimmune disease (SAIDx). Given that immunosuppression (IS) is used for certain aPL manifestations, for example, thrombocytopenia (TP), our primary objective was to describe the indications for IS in aPL-positive patients without other SAIDx. Secondly, we report the type of IS used in patients with selected microvascular or non-thrombotic aPL manifestations. METHODS An online database is used to collect clinical data. The inclusion criteria are positive aPL based on the laboratory section of the APS Classification Criteria, tested at least twice within one year prior to enrollment. Patients are followed every 12 ± 3 months. For this descriptive retrospective and prospective analysis, we included aPL-positive patients without other SAIDx and excluded those with new SAIDx classification during follow-up. For each patient, we retrieved clinical data at baseline and follow-up including selected aPL manifestations (diffuse alveolar hemorrhage [DAH], antiphospholipid-nephropathy [aPL-N], livedoid vasculopathy [LV]-related skin ulcers, TP, autoimmune hemolytic anemia [AIHA], cardiac valve disease [VD]), and IS medications. RESULTS Of 899 patients enrolled, 537 were included in this analysis (mean age 45 ± 13 years, female 377 [70%], APS Classification in 438 [82%], and at least one selected microvascular or non-thrombotic aPL manifestation in 141 (26%)). Of 537 patients, 76 (14%) were reported to use IS (ever), and 41/76 (54%) received IS primarily for selected aPL manifestation. In six of 8 (75%) DAH patients, 6/19 (32%) aPL-N, 4/28 (14%) LV, 25/88 (28%) TP, 6/11 (55%) AIHA, and 1/43 (2%) VD, the IS (excluding corticosteroids/hydroxychloroquine) indication was specific for selected aPL manifestation. CONCLUSION In our international cohort, 14% of aPL-positive patients without other SAIDx were reported to receive IS; the indication was at least one of the selected microvascular and/or non-thrombotic aPL-related manifestations in half. Thrombocytopenia was the most frequent among those selected aPL-related manifestations; however, approximately one-third received IS specifically for that indication. Diffuse alveolar hemorrhage was frequently treated with IS followed by AIHA and aPL-N. Systematic controlled studies are urgently needed to better define the role of IS in APS.
Collapse
Affiliation(s)
- Zeynep B Erton
- Rheumatology, 25062Hospital for Special Surgery, New York, NY, USA
| | - Rebecca K Leaf
- Hematology, 2348Massachusetts General Hospital, Boston, MA, USA
| | | | - Ann E Clarke
- Clinical Epidemiology, University of Calgary, Calgary, AB, Canada
| | - Maria G Tektonidou
- Pathophysiology, National and Kapodistrian University of Athens, Athens, Greece
| | - Vittorio Pengo
- Cardiothoracic and Vascular Sciences, Padova University Hospital, Padova, Italy
| | - Savino Sciascia
- Centro Multidisciplinare di Ricerche di Immunopatologia e Documentazione su Malattie Rare, Struttura Complessa a Direzione Universitaria di Immunologia Clinica, University of Turin, Turin, Italy
| | - Amaia Ugarte
- Rheumatology, BioCruces Bizkaia Health Research Institute, Barakaldo, Spain
| | - H Michael Belmont
- Rheumatology, New York University Langone Medical Center, New York, NY, USA
| | - Maria Gerosa
- Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Paul R Fortin
- Rheumatology, CHU de Québec- Université Laval, Quebec, QC, Canada
| | - Chary Lopez-Pedrera
- Rheumatology, Maimonides Institute for Biomedical Research of Córdoba, Córdoba, Spain
| | - Tatsuya Atsumi
- Medicine II, Hokkaido University Hospital, Sapporo, Japan
| | - Zhouli Zhang
- Rheumatology, Peking University First Hospital, Beijing, China
| | - Hannah Cohen
- Haematology, 4919University College London, London, UK
| | | | - David W Branch
- Obstetrics and Gynecology, 14434University of Utah and Intermountain Healthcare, Salt Lake City, UT, USA
| | - Denis Wahl
- Rheumatology, Université de Lorraine, Inserm DCAC, and CHRU-Nancy, Nancy, France
| | | | | | - Michelle Petri
- Rheumatology, 1466Johns Hopkins University, Baltimore, MD, USA
| | | | - Yu Zuo
- Rheumatology, University of Michigan, Ann Arbor, MI, USA
| | - Bahar Artim-Esen
- Internal Medicine, Rheumatology, Istanbul University School of Medicine, Istanbul, Turkey
| | - Rohan Willis
- Internal Medicine, 12334University of Texas Medical Branch, Galveston, TX, USA
| | - Rosana Quintana
- Internal Medicine, Centro Regional de Enfermedades Autoinmunes y Reumáticas GO-CREAR, Rosario Santa Fe Argentina
| | | | - Megan W Barber
- Clinical Epidemiology, University of Calgary, Calgary, AB, Canada
| | | | - Robert Roubey
- Rheumatology, Allergy & Immunolog, University of North Carolina, Chapel Hill, NC, USA
| | - Doruk Erkan
- Barbara Volcker Center for Women and Rheumatic Disease, 25062Hospital for Special Surgery Weill Cornell Medicine, New York, NY, USA
| |
Collapse
|
3
|
Erton ZB, Sevim E, de Jesús GR, Cervera R, Ji L, Pengo V, Ugarte A, Andrade D, Andreoli L, Atsumi T, Fortin PR, Gerosa M, Zuo Y, Petri M, Sciascia S, Tektonidou MG, Aguirre-Zamorano MA, Branch DW, Erkan D. Pregnancy outcomes in antiphospholipid antibody positive patients: prospective results from the AntiPhospholipid Syndrome Alliance for Clinical Trials and InternatiOnal Networking (APS ACTION) Clinical Database and Repository ('Registry'). Lupus Sci Med 2022; 9:e000633. [PMID: 35701043 PMCID: PMC9198709 DOI: 10.1136/lupus-2021-000633] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 05/14/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To describe the outcomes of pregnancies in antiphospholipid antibody (aPL)-positive patients since the inception of the AntiPhospholipid Syndrome Alliance for Clinical Trials and InternatiOnal Networking Registry. METHODS We identified persistently aPL-positive patients recorded as 'pregnant' during prospective follow-up, and defined 'aPL-related outcome' as a composite of: (1) Preterm live delivery (PTLD) at or before 37th week due to pre-eclampsia (PEC), eclampsia, small-for-gestational age (SGA) and/or placental insufficiency (PI); or (2) Otherwise unexplained fetal death after the 10th week of gestation. The primary objective was to describe the characteristics of patients with and without aPL-related composite outcomes based on their first observed pregnancies following registry recruitment. RESULTS Of the 55 first pregnancies observed after registry recruitment among nulliparous and multiparous participants, 15 (27%) resulted in early pregnancy loss <10 weeks gestation. Of the remaining 40 pregnancies: (1) 26 (65%) resulted in term live delivery (TLD), 4 (10%) in PTLD between 34.0 weeks and 36.6 weeks, 5 (12.5%) in PTLD before 34th week, and 5 (12.5%) in fetal death (two associated with genetic anomalies); and (2) The aPL-related composite outcome occurred in 9 (23%). One of 26 (4%) pregnancies with TLD, 3/4 (75%) with PTLD between 34.0 weeks and 36.6 weeks, and 3/5 (60%) with PTLD before 34th week were complicated with PEC, SGA and/or PI. Fifty of 55 (91%) pregnancies were in lupus anticoagulant positive subjects, as well as all pregnancies with aPL-related composite outcome. CONCLUSION In our multicentre, international, aPL-positive cohort, of 55 first pregnancies observed prospectively, 15 (27%) were complicated by early pregnancy loss. Of the remaining 40 pregnancies, composite pregnancy morbidity was observed in 9 (23%) pregnancies.
Collapse
Affiliation(s)
- Zeynep Belce Erton
- Divison of Rheumatology, Hospital for Special Surgery, New York, New York, USA
| | - Ecem Sevim
- Medicine, Yeshiva University Albert Einstein College of Medicine, Bronx, New York, USA
- Internal Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Guilherme Ramires de Jesús
- Department of Obstetrics, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
- Department of Obstetrics, Instituto Fernandes Figueira - FIOCRUZ, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ricard Cervera
- Autoimmune Diseases, Hospital Clínic de Barcelona Institut Clínic de Medicina i Dermatologia, Barcelona, Spain
| | - Lanlan Ji
- Department of Rheumatology and Clinical Immunology, Peking University First Hospital, Beijing, Beijing, China
| | - Vittorio Pengo
- Cardiac Thoracic and Vascular Sciences, University of Padova, padua, Italy
| | - Amaia Ugarte
- Internal Medicine, Hospital de Cruces, Barkaldo, Spain
| | - Danieli Andrade
- Rheumatology, University of Sao Paulo, Sao Paulo, Sao Paulo, Brazil
| | - Laura Andreoli
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Unit of Rheumatology and Clinical Immunology, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Tatsuya Atsumi
- Medicine II, Hokkaido University School of Medicine, Sapporo, Japan
| | - Paul R Fortin
- Medicine - Rheumatology, Centre Hospitalier de l'Université Laval, Quebec City, Quebec, Canada
| | - Maria Gerosa
- Dept. of Clinical & Community Science University of Milano, Division of Rheumatology, Milano, Italy
| | - Yu Zuo
- Internal Medicine/Division of Rheumatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Michelle Petri
- Rheumatology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Savino Sciascia
- Dipartimento di Malattie Rare, Immunologiche, Ematologiche ed Immunoematologiche. Centro di Ricerche di Immunopatologia e Documentazione su Malattie Rare (CMID). Struttura Complessa a Direzione Universitaria di Immunologia Clinica, Ospedale Torino Nord Emergenza San G. Bosco ed Università di Torino, Torino, Italy
| | - Maria G Tektonidou
- First Department of Propaedeutic Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | - D Ware Branch
- Maternal-Fetal Medicine, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
- Maternal- Fetal Medicine, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Doruk Erkan
- Rheumatology, Barbara Volcker Center for Women and Rheumatic Diseases, Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
| |
Collapse
|
4
|
Chighizola C, Pregnolato F, Andrade D, Tektonidou M, Sciascia S, Pengo V, Ugarte A, Belmont HM, Gerosa M, Fortin P, Lopez-Pedrera C, Zhang Z, Atsumi T, De Jesùs G, Kello N, Branch DW, Andreoli L, Wahl D, Petri MA, Rodríguez Almaraz E, Cervera R, Pons Estel G, Knight J, Willis R, Barber M, Artim Esen B, Efthymiou M, Erkan D, Bertolaccini ML. POS0462 HYDROXYCHLOROQUINE REDUCES THE TITERS OF ANTI-DOMAIN 1 ANTIBODIES OVER TIME IN PATIENTS WITH PERSISTENTLY POSITIVE ANTIPHOSPHOLIPID ANTIBODIES: RESULTS FROM THE APS ACTION CLINICAL DATABASE AND REPOSITORY (“REGISTRY”). Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundData on fluctuation of antibodies directed against domain 1 (anti-D1) of β2-glycoprotein I (β2GPI) are scarce. Patients with antiphospholipid syndrome (APS) and all three criteria tests for antiphospholipid antibodies (aPL) display higher titers of anti-D1, which correlate with anti-β2GPI levels.ObjectivesThis project aims at evaluating predictors of the variation of anti-D1 titers over time in a large international cohort of persistently aPL positive patients.MethodsAntiPhospholipid Syndrome Alliance For Clinical Trials and InternatiOnal Networking (APS ACTION) Registry was created to study the course of persistently aPL-positive patients with or without autoimmune disorders over at least 10 years. Inclusion criteria are positive aPL by Updated Sapporo Criteria tested within one year prior to enrolment. Patients are followed every 12±3 months with clinical data and blood collection. Patients with available blood samples from at least three time points were included in this analysis. Anti-β2GPI and anti-D1 IgG were tested by chemiluminescence (BioFlash, Werfen) at APS ACTION core laboratories. Positive results were defined as >20 CU, according to the manufacturer. Clinical data were retrieved from APS ACTION online database. Anti-D1 titers within the same subject were compared by Friedman’s test. A mixed linear model was built to identify predictors of the fluctuation of anti-D1 antibody titers over time.ResultsIn this longitudinal study, 230 patients with anti-D1 tested at 4 time points were included (Table 1). Patients with thrombotic APS had anti-D1 titers significantly higher than those without thrombosis (p=0.022). Among 135 patients with at least one anti-D1 positive result, anti-D1 titers varied significantly over time (Friedman statistics: 508.5, p<0.0001; anti-D1 geometric mean at baseline 189.0; T1 132.3 [-15%]; T2 113.8 [-17%]; T3 109.2 [-6% versus T2, -38% versus T1]). Anti-D1 titers were significantly higher at baseline compared to T3 (p=0.029). In the 4 years of follow-up, 18 new thrombotic events occurred. Patients with double/triple aPL positivity displayed 12.5 fold increase [95%CI 7.4-20.0] in baseline anti-D1 titers. After adjustment for age, gender and number of positive aPL tests, the fluctuation of anti-D1 titers was associated with treatment with hydroxychloroquine (HCQ) at each time-point. In particular, treatment with HCQ, but not those with conventional immunosuppressors, was associated with a 1.3-fold decrease in anti-D1 titers [95%CI 1.1-1.5]. In the same multivariable model, incident vascular events were associated with a 1.5 fold increase of anti-D1 titers. A concomitant diagnosis of systemic lupus erythematosus did not affect the fluctuation of anti-D1 titers.Table 1.Demographic and Clinical Characteristics of 230 APS ACTION Registry Patients with anti-D1 tested ≥3 time points during the follow-upAnti-D1 pos samplesAnti-D1 neg samplesp-valueOverall sample(n=135)(n=95)(n=230)Age [years] mean (SD)42.3 (11.8)48.8 (13.0)0.000145.0 (12.7)%Female (n)71.9 (97)65.3 (62)0.35869.1 (159)Associated systemic autoimmune disease39.3 (53)44.2 (42)0.53941.3 (95)aPL without APS19.3 (26)34.7 (33)0.01025.7 (59)Thrombotic APS54.1 (73)53.7 (51)53.9 (124)Obstetric APS11.9 (16)5.3 (5)9.1 (21)Thrombotic/+obstetric APS14.8 (20)6.3 (6)11.3 (26)aCL IgG89.5 (119/133)25.5 (24/94)<0.000163.0 (143/227)aCL, IgM36.1 (48/133)27.7 (26/94)0.23432.6 (74/227)Anti-2GPI, IgG93.2 (124/133)39.4 (37/94)<0.000170.9 (161/227)Anti-2GPI, IgM34.6 (46/133)21.3 (20/94)0.04329.1 (66/227)LA82.8 (82/99)59.5 (44/74)0.00172.8 (126/173)ConclusionTreatment with HCQ and vascular events during follow-up were identified as significant predictors of the fluctuation of anti-D1 antibody titers over time.Disclosure of InterestsNone declared.
Collapse
|
5
|
Sevim E, Zisa D, Andrade D, Sciascia S, Pengo V, Tektonidou MG, Ugarte A, Gerosa M, Michael Belmont H, Zamorano MAA, Fortin PR, Ji L, Efthymiou M, Cohen H, Ware Branch D, de Jesus GR, Andreoli L, Petri M, Rodriguez E, Cervera R, Knight JS, Atsumi T, Willis R, Roubey R, Bertolaccini ML, Erkan D, Barbhaiya M. Characteristics of Patients With Antiphospholipid Antibody Positivity in the APS ACTION International Clinical Database and Repository. Arthritis Care Res (Hoboken) 2022; 74:324-335. [PMID: 32986935 PMCID: PMC10725727 DOI: 10.1002/acr.24468] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 09/04/2020] [Accepted: 09/22/2020] [Indexed: 12/19/2023]
Abstract
OBJECTIVE To describe the baseline characteristics of patients with positivity for antiphospholipid antibodies (aPLs) who were enrolled in an international registry, the Antiphospholipid Syndrome (APS) Alliance for Clinical Trials and International Networking (APS ACTION) clinical database and repository, overall and by clinical and laboratory subtypes. METHODS The APS ACTION registry includes adults who persistently had positivity for aPLs. We evaluated baseline sociodemographic and aPL-related (APS classification criteria and "non-criteria") characteristics of patients overall and in subgroups (aPL-positive without APS, APS overall, thrombotic APS only, obstetric APS only, and both thrombotic APS/obstetric APS). We assessed baseline characteristics of patients tested for the presence of three aPLs (lupus anticoagulant [LAC] test, anticardiolipin antibody [aCL], and anti-β2 -glycoprotein I [anti-β2 GPI]) antibodies by aPL profiles (LAC only, single, double, and triple aPL positivity). RESULTS The 804 aPL-positive patients assessed in the present study had a mean age of 45 ± 13 years, were 74% female, and 68% White; additionally, 36% had other systemic autoimmune diseases. Of these 804 aPL-positive patients, 80% were classified as having APS (with 55% having thrombotic APS, 9% obstetric APS, and 15% thrombotic APS/obstetric APS). In the overall cohort, 71% had vascular thrombosis, 50% with a history of pregnancy had obstetric morbidity, and 56% had experienced at least one non-criteria manifestation. Among those with three aPLs tested (n = 660), 42% were triple aPL-positive. While single-, double-, and triple aPL-positive subgroups had similar frequencies of vascular, obstetric, and non-criteria events, these events were lowest in the single aPL subgroup, which consisted of aCLs or anti-β2 GPI only. CONCLUSION Our study demonstrates the heterogeneity of aPL-related clinical manifestations and laboratory profiles in a multicenter international cohort. Within single aPL positivity, LAC may be a major contributor to clinical events. Future prospective analyses, using standardized core laboratory aPL tests, will help clarify aPL risk profiles and improve risk stratification.
Collapse
Affiliation(s)
- Ecem Sevim
- Ecem Sevim, MD: Hospital for Special Surgery, New York, New York, and Montefiore Medical Center, Bronx, New York
| | - Diane Zisa
- Diane Zisa, MD, Doruk Erkan, MD, MPH, Medha Barbhaiya, MD, MPH: Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | - Danieli Andrade
- Danieli Andrade, MD, PhD: University of Sao Paulo, Sao Paulo, Brazil
| | | | - Vittorio Pengo
- Vittorio Pengo, MD: University Hospital Padova, Padova, Italy
| | - Maria G. Tektonidou
- Maria G. Tektonidou, MD: National and Kapodistrian University of Athens, Athens, Greece
| | - Amaia Ugarte
- Amaia Ugarte, MD: Hospital Universitario Cruces, Barakaldo, País Vasco, Spain
| | - Maria Gerosa
- Maria Gerosa, MD, PhD: University of Milan, Milan, Italy
| | - H. Michael Belmont
- H. Michael Belmont, MD: New York University Langone Medical Center, New York, New York
| | | | - Paul R. Fortin
- PaulR. Fortin, MD, PhD: CHU de Québec and Université Laval, Quebec City, Canada
| | - Lanlan Ji
- Lanlan Ji, MD: Peking University First Hospital, Beijing, China
| | - Maria Efthymiou
- MariaEfthymiou, PhD, Hannah Cohen, MD: University College London, London, UK
| | - Hannah Cohen
- MariaEfthymiou, PhD, Hannah Cohen, MD: University College London, London, UK
| | - D. Ware Branch
- D. Ware Branch, MD: University of Utah and Intermountain Healthcare, Salt Lake City, Utah
| | | | - Laura Andreoli
- Laura Andreoli, MD, PhD: University of Brescia, Brescia, Italy
| | - Michelle Petri
- Michelle Petri, MD, MPH: Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Esther Rodriguez
- Esther Rodriguez, MD: Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Ricard Cervera
- Ricard Cervera, MD, PhD, FRCP: Hospital Clínic Institut d’Investigacions Biomèdiques August Pi i Sunyer(IDIBAPS), Barcelona, Catalonia, Spain
| | | | - Tatsuya Atsumi
- Tatsuya Atsumi, MD, PhD: Hokkaido University Hospital, Sapporo, Japan
| | - Rohan Willis
- Rohan Willis, MD: University of Texas Medical Branch, Galveston
| | - Robert Roubey
- Robert Roubey, MD: University of North Carolina, Chapel Hill
| | | | - Doruk Erkan
- Diane Zisa, MD, Doruk Erkan, MD, MPH, Medha Barbhaiya, MD, MPH: Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| | - Medha Barbhaiya
- Diane Zisa, MD, Doruk Erkan, MD, MPH, Medha Barbhaiya, MD, MPH: Hospital for Special Surgery and Weill Cornell Medicine, New York, New York
| |
Collapse
|
6
|
de Azevedo Lopes E, Balbi GGM, Tektonidou MG, Pengo V, Sciascia S, Ugarte A, Belmont HM, Gerosa M, Fortin PR, Lopez-Pedrera C, Ji L, Cohen H, de Jesús GR, Branch DW, Nalli C, Petri M, Rodriguez E, Kello N, Ríos-Garcés R, Knight JS, Atsumi T, Willis R, Bertolaccini ML, Erkan D, Andrade D. Clinical and laboratory characteristics of Brazilian versus non-Brazilian primary antiphospholipid syndrome patients in AntiPhospholipid Syndrome Alliance for Clinical Trials and InternatiOnal Networking (APS ACTION) clinical database and repository. Adv Rheumatol 2021; 61:64. [PMID: 34711275 DOI: 10.1186/s42358-021-00222-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 10/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Antiphospholipid syndrome (APS) is characterized by episodes of thrombosis, obstetric morbidity or both, associated with persistently positive antiphospholipid antibodies (aPL). Studying the profile of a rare disease in an admixed population is important as it can provide new insights for understanding an autoimmune disease. In this sense of miscegenation, Brazil is characterized by one of the most heterogeneous populations in the world, which is the result of five centuries of interethnic crosses of people from three continents. The objective of this study was to compare the clinical and laboratory characteristics of Brazilian vs. non-Brazilian primary antiphospholipid syndrome (PAPS) patients. METHODS We classified PAPS patients into 2 groups: Brazilian PAPS patients (BPAPS) and PAPS patients from other countries (non-BPAPS). They were compared regarding demographic characteristics, criteria and non-criteria APS manifestations, antiphospholipid antibody (aPL) profile, and the adjusted Global Antiphospholipid Syndrome Score (aGAPSS). RESULTS We included 415 PAPS patients (88 [21%] BPAPS and 327 [79%] non-BPAPS). Brazilian patients were significantly younger, more frequently female, sedentary, obese, non-white, and had a higher frequency of livedo (25% vs. 10%, p < 0.001), cognitive dysfunction (21% vs. 8%, p = 0.001) and seizures (16% vs. 7%, p = 0.007), and a lower frequency of thrombocytopenia (9% vs. 18%, p = 0.037). Additionally, they were more frequently positive for lupus anticoagulant (87.5% vs. 74.6%, p = 0.01), and less frequently positive to anticardiolipin (46.6% vs. 73.7%, p < 0.001) and anti-ß2-glycoprotein-I (13.6% vs. 62.7%, p < 0.001) antibodies. Triple aPL positivity was also less frequent (8% vs. 41.6%, p < 0.001) in Brazilian patients. Median aGAPSS was lower in the Brazilian group (8 vs. 10, p < 0.0001). In the multivariate analysis, BPAPS patients still presented more frequently with livedo, cognitive dysfunction and sedentary lifestyle, and less frequently with thrombocytopenia and triple positivity to aPL. They were also less often white. CONCLUSIONS Our study suggests a specific profile of PAPS in Brazil with higher frequency of selected non-criteria manifestations and lupus anticoagulant positivity. Lupus anticoagulant (not triple positivity) was the major aPL predictor of a classification criteria event.
Collapse
Affiliation(s)
| | - Gustavo Guimarães Moreira Balbi
- University of São Paulo, Av. Dr. Arnaldo 455, Third Floor, Room 3109, São Paulo, 01246903, Brazil.,Federal University of Juiz de Fora, Minas Gerais, Brazil
| | | | | | - Savino Sciascia
- Center of Research of Immunopathology and Rare Diseases, University of Turin, Turin, Italy
| | - Amaia Ugarte
- Hospital Universitario Cruces, Barakaldo, País Vasco, Spain
| | | | - Maria Gerosa
- Clinical Immunology and Rheumatology Unit, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | | | - Chary Lopez-Pedrera
- Rheumatology Service, IMIBIC/Reina Sofia Hospital, University of Cordoba, Cordoba, Spain
| | - Lanlan Ji
- Rheumatology and Immunology Department, Peking University First Hospital, Beijing, China
| | - Hannah Cohen
- Haemostasis Research Unit, Department of Haematology, University College London, London, UK
| | | | - D Ware Branch
- University of Utah and Intermountain Healthcare, Salt Lake City, UT, USA
| | - Cecilia Nalli
- Rheumatology and Immunology Unit, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Michelle Petri
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | - Roberto Ríos-Garcés
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Barcelona, Catalonia, Spain
| | - Jason S Knight
- Division of Rheumatology, University of Michigan, Ann Arbor, MI, USA
| | | | - Rohan Willis
- Antiphospholipid Standardization Laboratory, University of Texas Medical Branch, Galveston, TX, USA
| | - Maria Laura Bertolaccini
- Academic Department of Vascular Surgery, King's College London British Heart Foundation Centre of Excellence, School of Cardiovascular Medicine and Sciences, London, UK
| | - Doruk Erkan
- Barbara Volcker Center for Women and Rheumatic Disease, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Danieli Andrade
- University of São Paulo, Av. Dr. Arnaldo 455, Third Floor, Room 3109, São Paulo, 01246903, Brazil.
| | | |
Collapse
|
7
|
Torres B, Guardo AC, Squarcia M, Diaz A, Fabra A, Caballero M, Ugarte A, Leal L, Gatell JM, Plana M, Garcia F. Impact of switching to raltegravir and/or adding losartan in lymphoid tissue fibrosis and inflammation in people living with HIV. A randomized clinical trial. HIV Med 2021; 22:674-681. [PMID: 34288357 DOI: 10.1111/hiv.13114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 03/23/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Persistent inflammation and immune activation are associated with lymph node fibrosis and end-organ diseases in treatment-suppressed people living with HIV (PLWH). We investigated the effect of switching to raltegravir and/or adding losartan on lymphoid tissue fibrosis and on the inflammatory/immune-activation mediators in treated HIV patients. METHODS Chronic HIV-infected patients treated with two nucleoside reverse transcriptase inhibitors (2NRTI) and one non-NRTI (NNRTI) or protease inhibitor (PI) during at least 48 weeks were randomized to four groups (n = 48): 2NRTI + efavirenz (EFV), 2NRTI + EFV + losartan, 2NRTI + raltegravir and 2NRTI + raltegravir + losartan for 48 weeks. Tonsillar biopsy and peripheral blood markers of CD4 and CD8 T-lymphocyte activation and senescence, monocyte activation and soluble markers of inflammation were determined at baseline and at week 48 and compared between groups. RESULTS No changes in lymphoid tissue architecture were observed. Adding losartan had no impact on lymphocyte subsets. Conversely, patients who switched to raltegravir showed a higher decrease in all activated [CD4+CD38+HLA-DR+, -0.3 vs. 0.48 (P = 0.033); CD8+CD38+ HLA-DR+, -1.6 vs. 1.3 (P = 0.02)] and senescent [CD4+CD28-CD57+, -0.3 vs. 0.26 (P = 0.04); CD8+CD28-CD57+, -6.1 vs. 3.8 (P = 0.002)] T lymphocytes. In addition, the median CD4/CD8 ratio increased by 0.35 in patients in the raltegravir group vs. 0.03 in the other arms (P = 0.002). Differences between groups in monocyte subpopulations or soluble inflammation markers were not observed. CONCLUSIONS Losartan had no effect on lymphoid fibrosis or immune activation/inflammation. Conversely, switching to a regimen with raltegravir significantly decreased activated and senescent T-lymphocyte subpopulations and increased CD4/CD8 ratio in successfully treated PLWH.
Collapse
Affiliation(s)
- B Torres
- Infectious Diseases Department, Hospital Clínic, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - A C Guardo
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - M Squarcia
- Radiology Department, Hospital Clínic, Barcelona, Spain
| | - A Diaz
- Pathology Department, Hospital Clínic, Barcelona, Spain
| | - A Fabra
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - M Caballero
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Otorhinolaryngology Department, Hospital Clínic, Barcelona, Spain
| | - A Ugarte
- Infectious Diseases Department, Hospital Clínic, Barcelona, Spain
| | - L Leal
- Infectious Diseases Department, Hospital Clínic, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - J M Gatell
- Infectious Diseases Department, Hospital Clínic, Barcelona, Spain
| | - M Plana
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - F Garcia
- Infectious Diseases Department, Hospital Clínic, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| |
Collapse
|
8
|
Gkrouzman E, Sevim E, Finik J, Andrade D, Pengo V, Sciascia S, Tektonidou MG, Ugarte A, Chighizola CB, Belmont HM, Lopez-Pedrera C, Ji L, Fortin P, Efthymiou M, de Jesus GR, Branch DW, Nalli C, Petri M, Rodriguez E, Cervera R, Knight JS, Atsumi T, Willis R, Bertolaccini ML, Cohen H, Rand J, Erkan D. Antiphospholipid Antibody Profile Stability Over Time: Prospective Results From the APS ACTION Clinical Database and Repository. J Rheumatol 2021; 48:541-547. [PMID: 33259328 PMCID: PMC10727093 DOI: 10.3899/jrheum.200513] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The APS ACTION Registry studies long-term outcomes in persistently antiphospholipid antibody (aPL)-positive patients. Our primary objective was to determine whether clinically meaningful aPL profiles at baseline remain stable over time. Our secondary objectives were to determine (1) whether baseline characteristics differ between patients with stable and unstable aPL profiles, and (2) predictors of unstable aPL profiles over time. METHODS A clinically meaningful aPL profile was defined as positive lupus anticoagulant (LAC) test and/or anticardiolipin (aCL)/anti-β2 glycoprotein-I (anti-β2-GPI) IgG/M ≥ 40 U. Stable aPL profile was defined as a clinically meaningful aPL profile in at least two-thirds of follow-up measurements. Generalized linear mixed models with logit link were used for primary objective analysis. RESULTS Of 472 patients with clinically meaningful aPL profile at baseline (median follow-up 5.1 yrs), 366/472 (78%) patients had stable aPL profiles over time, 54 (11%) unstable, and 52 (11%) inconclusive. Time did not significantly affect odds of maintaining a clinically meaningful aPL profile at follow-up in univariate (P = 0.906) and multivariable analysis (P = 0.790). Baseline triple aPL positivity decreased (OR 0.25, 95% CI 0.10-0.64, P = 0.004) and isolated LAC test positivity increased (OR 3.3, 95% CI 1.53-7.13, P = 0.002) the odds of an unstable aPL profile over time. CONCLUSION Approximately 80% of our international cohort patients with clinically meaningful aPL profiles at baseline remain stable at a median follow-up of 5 years; triple aPL-positivity increase the odds of a stable aPL profile. These results will guide future validation studies of stored blood samples through APS ACTION Core Laboratories.
Collapse
Affiliation(s)
- Elena Gkrouzman
- E. Gkrouzman, MD, MS, Hospital for Special Surgery, New York, New York, USA;
| | - Ecem Sevim
- E. Sevim, MD, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, New York, USA
| | - Jackie Finik
- J. Finik, MPH, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Danieli Andrade
- D. Andrade, MD, PhD, University of São Paulo, São Paulo, Brazil
| | | | - Savino Sciascia
- S. Sciascia, MD, PhD, Center of Research of Immunopathology and Rare Diseases, University of Turin, Turin, Italy
| | - Maria G Tektonidou
- M.G. Tektonidou, MD, PhD, National and Kapodistrian University of Athens, Athens, Greece
| | - Amaia Ugarte
- A. Ugarte, MD, Hospital Universitario Cruces, Barakaldo, País Vasco, Spain
| | - Cecilia B Chighizola
- C.B. Chighizola, MD, PhD, Clinical Immunology & Rheumatology Unit, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - H Michael Belmont
- H.M. Belmont, MD, Hospital for Joint Diseases, New York University, New York, New York, USA
| | - Chary Lopez-Pedrera
- C. Lopez-Pedrera, PhD, Rheumatology Service, IMIBIC/Reina Sofia Hospital, University of Cordoba, Cordoba, Spain
| | - Lanlan Ji
- L. Ji, MD, Rheumatology and Immunology Department, Peking University First Hospital, Beijing, China
| | - Paul Fortin
- P. Fortin, MD, CHU de Québec-Université Laval, Québec City, Québec, Canada
| | - Maria Efthymiou
- M. Efthymiou, PhD, H. Cohen, MD, Haemostasis Research Unit, Department of Haematology, University College London, London, UK
| | | | - D Ware Branch
- D.W. Branch, MD, University of Utah and Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Cecilia Nalli
- C. Nalli, MD, Rheumatology and Immunology Unit, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Michelle Petri
- M. Petri, MD, MPH, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Esther Rodriguez
- E. Rodriguez, MD, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Ricard Cervera
- R. Cervera, MD, PhD, FRCP, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | - Jason S Knight
- J.S. Knight, MD, PhD, Division of Rheumatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Tatsuya Atsumi
- T. Atsumi, MD, PhD, Hokkaido University Hospital, Sapporo, Japan
| | - Rohan Willis
- R. Willis, MD, Antiphospholipid Standardization Laboratory, University of Texas Medical Branch, Galveston, Texas, USA
| | - Maria Laura Bertolaccini
- M.L. Bertolaccini, PhD, Academic Department of Vascular Surgery, King's College London British Heart Foundation Centre of Excellence, School of Cardiovascular Medicine & Sciences, London, UK
| | - Hannah Cohen
- M. Efthymiou, PhD, H. Cohen, MD, Haemostasis Research Unit, Department of Haematology, University College London, London, UK
| | - Jacob Rand
- J. Rand, MD, Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Doruk Erkan
- D. Erkan, MD, MPH, Barbara Volcker Center for Women and Rheumatic Diseases, Hospital for Special Surgery, Weill Cornell Medicine, New York, New York, USA
| |
Collapse
|
9
|
Ugarte A, Garcia de Bustos A, Ruiz-Arruza I, Soto-Peleteiro A, Martin-Iglesias D, Gonzalez-Echavarri C, Ruiz-Irastorza G. ANTIPHOSPHOLIPID ANTIBODIES DO NOT PREDICT DAMAGE IN SLE PATIENTS IN THE XXI CENTURY. AN OBSERVATIONAL STUDY FROM THE LUPUS-CRUCES COHORT. Rheumatology (Oxford) 2021; 61:249-257. [PMID: 33769455 DOI: 10.1093/rheumatology/keab307] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE To compare the influence of antiphospholipid antibodies (aPL) on global and cardiovascular damage in patients with systemic lupus erythematosus (SLE) diagnosed before and after year 2000. METHODS 286 patients from the Lupus-Cruces cohort with a minimum follow-up of 5 years, divided into two sub-cohorts according to the date of diagnosis, before 2000 (<2000) and from 2000 on (≥2000). We compared the mean SDI score and global and cardiovascular damage-free survival rates in the presence/absence of aPL in both sub-cohorts. Variables potentially modulating damage among aPL-positive patients were analysed. RESULTS The sub-cohorts were comparable for demographic and lupus-related variables except for treatment variables: the ≥2000 sub-cohort received lower doses of prednisone and more hydroxychloroquine, low-dose aspirin, statins, immunosuppressive agents and Vitamin D. aPL-positive patients in the <2000, but not in the ≥2000 sub-cohort, accrued more damage compared with aPL-negative. In the <2000 sub-cohort, the adjusted HRs for global and cardiovascular damage in aPL-positive vs. aPL-negative patients were 1.98 (95% CI 1.24-3.14) and 9.3 (95% CI 3.24-26.92), respectively. No differences in damage were seen between aPL-positive and aPL-negative patients in the ≥2000 sub-cohort. Hypertension (HR 4.64, 95%CI 1.33-16.19), lupus anticoagulant (HR 3.85, 95%CI 1.1-13.41) and the number of months on hydroxychloroquine (HR 0.97, 95%CI 0.95-0.99) were independent predictors of vascular damage in the combined analysis of all aPL-positive patients. CONCLUSION The effects of aPL on damage accrual in SLE patients have been reduced over the last years. The widespread use of hydroxychloroquine and a better thromboprophylaxis are likely causing this change.
Collapse
Affiliation(s)
- Amaia Ugarte
- Autoimmune Diseases Research Unit, Department of Internal Medicine, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, Bizkaia, The Basque Country, Spain
| | | | - Ioana Ruiz-Arruza
- Autoimmune Diseases Research Unit, Department of Internal Medicine, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, Bizkaia, The Basque Country, Spain.,University of The Basque Country, Bizkaia, The Basque Country, Spain
| | - Adriana Soto-Peleteiro
- Autoimmune Diseases Research Unit, Department of Internal Medicine, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, Bizkaia, The Basque Country, Spain
| | - Daniel Martin-Iglesias
- Autoimmune Diseases Research Unit, Department of Internal Medicine, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, Bizkaia, The Basque Country, Spain
| | - Cristina Gonzalez-Echavarri
- Autoimmune Diseases Research Unit, Department of Internal Medicine, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, Bizkaia, The Basque Country, Spain
| | - Guillermo Ruiz-Irastorza
- Autoimmune Diseases Research Unit, Department of Internal Medicine, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, Bizkaia, The Basque Country, Spain.,University of The Basque Country, Bizkaia, The Basque Country, Spain
| |
Collapse
|
10
|
Ruiz-Irastorza G, Pijoan JI, Bereciartua E, Dunder S, Dominguez J, Garcia-Escudero P, Rodrigo A, Gomez-Carballo C, Varona J, Guio L, Ibarrola M, Ugarte A, Martinez-Berriotxoa A. Second week methyl-prednisolone pulses improve prognosis in patients with severe coronavirus disease 2019 pneumonia: An observational comparative study using routine care data. PLoS One 2020; 15:e0239401. [PMID: 32960899 PMCID: PMC7508405 DOI: 10.1371/journal.pone.0239401] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 09/06/2020] [Indexed: 12/15/2022] Open
Abstract
Objective To analyze the effects of a short course of methyl-prednisolone pulses (MP) during the second week of disease (week-2) in patients with severe coronavirus disease 2019 (COVID-19) pneumonia. Methods Comparative observational study using data collected from routine care at Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain in patients with COVID-19 pneumonia. We compared patients who received week-2-MP (125–250 mg/d x3) with those who did not, with the end-points time to death and time to death or endotracheal intubation. Results We included 242 patients with COVID-19 pneumonia and elevated inflammatory markers at admission. Sixty-one patients (25%) received week-2-MP. Twenty-two patients (9%) died and 31 (12.8%) suffered death or intubation. The adjusted HRs for death and death or intubation for patients in the week-2-MP group were 0.35 (95%CI 0.11 to 1.06, p = 0.064) and 0.33 (95%CI 0.13 to 0.84, p = 0.020), respectively. These differences were specifically seen in the subcohort of patients with a SpO2/FiO2 at day 7 lower than 353 (adjusted HR 0.31, 95% CI 0.08 to 1.12, p = 0.073 and HR 0.34, 95%CI 0.12 to 0.94, p = 0.038, respectively) but not in patients with higher SpO2/FiO2. Patients receiving out-of-week-2-MP, non-pulse glucocorticoids or no glucocorticoids had an increased adjusted risk for both outcomes compared with week-2-MP group: HR 5.04 (95% CI 0.91–27.86), HR 10.09 (95% CI 2.14–47.50), HR 4.14 (95% CI 0.81–21.23), respectively, for death; HR 7.38 (95% CI 1.86–29.29), HR 13.71 (95% CI 3.76–50.07), HR 3.58 (95% CI 0.89–14.32), respectively, for death or intubation. These differences were significant only in the subgroup with low SpO2/FiO2. Conclusions Week-2-MP are effective in improving the prognosis of patients with COVID-19 pneumonia with features of inflammatory activity and respiratory deterioration entering the second week of disease. The recognition of this high-risk population should prompt early use of MP at this point.
Collapse
Affiliation(s)
- Guillermo Ruiz-Irastorza
- Autoimmune Diseases Research Unit, Service of Internal Medicine, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain
- Infectious Diseases Unit, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain
- Service of Internal Medicine, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain
- * E-mail:
| | - Jose-Ignacio Pijoan
- Biocruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain
- Infectious Diseases Unit, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain
- Service of Rheumatology, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain
| | - Elena Bereciartua
- University of the Basque Country (UPV/EHU), Leioa, BI, Spain
- Infectious Diseases Unit, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain
- Service of Internal Medicine, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain
| | - Susanna Dunder
- Clinical Epidemiology Unit, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain
- Infectious Diseases Unit, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain
| | - Jokin Dominguez
- Clinical Epidemiology Unit, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain
- Infectious Diseases Unit, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain
| | - Paula Garcia-Escudero
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Infectious Diseases Unit, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain
| | - Alejandro Rodrigo
- Clinical Epidemiology Unit, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain
- Infectious Diseases Unit, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain
| | - Carlota Gomez-Carballo
- Clinical Epidemiology Unit, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain
- Infectious Diseases Unit, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain
| | - Jimena Varona
- Clinical Epidemiology Unit, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain
- Infectious Diseases Unit, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain
| | - Laura Guio
- University of the Basque Country (UPV/EHU), Leioa, BI, Spain
- Infectious Diseases Unit, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain
- Service of Internal Medicine, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain
| | - Marta Ibarrola
- University of the Basque Country (UPV/EHU), Leioa, BI, Spain
- Infectious Diseases Unit, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain
| | - Amaia Ugarte
- Autoimmune Diseases Research Unit, Service of Internal Medicine, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain
- Infectious Diseases Unit, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain
| | - Agustin Martinez-Berriotxoa
- Clinical Epidemiology Unit, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain
- Infectious Diseases Unit, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain
- Service of Internal Medicine, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain
| | | |
Collapse
|
11
|
Zuily S, Clerc-Urmès I, Bauman C, Andrade D, Sciascia S, Pengo V, Tektonidou MG, Ugarte A, Gerosa M, Michael Belmont H, Zamorano MAA, Fortin P, Ji L, Efthymiou M, Cohen H, Branch DW, Jesus GRD, Nalli C, Petri M, Rodriguez E, Cervera R, Knight JS, Atsumi T, Willis R, Bertolaccini ML, Vega J, Wahl D, Erkan D. Cluster analysis for the identification of clinical phenotypes among antiphospholipid antibody-positive patients from the APS ACTION Registry. Lupus 2020:961203320940776. [PMID: 32703117 DOI: 10.1177/0961203320940776] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE This study aimed to use cluster analysis (CA) to identify different clinical phenotypes among antiphospholipid antibodies (aPL)-positive patients. METHODS The Alliance for Clinical Trials and International Networking (APS ACTION) Registry includes persistently positive aPL of any isotype based on the Sydney antiphospholipid syndrome (APS) classification criteria. We performed CA on the baseline characteristics collected retrospectively at the time of the registry entry of the first 500 patients included in the registry. A total of 30 clinical data points were included in the primary CA to cover the broad spectrum of aPL-positive patients. RESULTS A total of 497 patients from international centres were analysed, resulting in three main exclusive clusters: (a) female patients with no other autoimmune diseases but with venous thromboembolism (VTE) and triple-aPL positivity; (b) female patients with systemic lupus erythematosus, VTE, aPL nephropathy, thrombocytopaenia, haemolytic anaemia and a positive lupus anticoagulant test; and (c) older men with arterial thrombosis, heart valve disease, livedo, skin ulcers, neurological manifestations and cardiovascular disease (CVD) risk factors. CONCLUSIONS Based on our hierarchical cluster analysis, we identified different clinical phenotypes of aPL-positive patients discriminated by aPL profile, lupus or CVD risk factors. Our results, while supporting the heterogeneity of aPL-positive patients, also provide a foundation to understand disease mechanisms, create new approaches for APS classification and ultimately develop new management approaches.
Collapse
Affiliation(s)
- Stéphane Zuily
- Vascular Medicine Division and Regional Competence Centre for Systemic And Autoimmune Diseases, Nancy Academic Hospital, Nancy, France.,Inserm UMR_S 1116, Lorraine University, Nancy, France
| | - Isabelle Clerc-Urmès
- ESPRI-BioBase, Platform of Clinical Research Support PARC (MDS unity), Nancy Academic Hospital, Nancy, France
| | - Cédric Bauman
- ESPRI-BioBase, Platform of Clinical Research Support PARC (MDS unity), Nancy Academic Hospital, Nancy, France
| | - Danieli Andrade
- Department of Rheumatology, Faculty of Medicine, University of Sao Paulo (USP), Sao Paulo, Brazil
| | - Savino Sciascia
- Centre of Research of Immunopathology and Rare Diseases, University of Turin, Turin, Italy
| | - Vittorio Pengo
- Thrombosis Research Laboratory, Department of Cardiac Thoracic and Vascular Sciences, and Public Health, University of Padova; Arianna Foundation on Anticoagulation, Bologna, Italy
| | - Maria G Tektonidou
- First Department of Propaedeutic Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Amaia Ugarte
- Autoimmune Diseases Research Unit, Department of Internal Medicine, Hospital Universitario Cruces, Barakaldo, Spain
| | - Maria Gerosa
- Clinical Rheumatology Unit, Research Center for Adult and Pediatric Diseases, Department of Clinical Sciences and Community Health, ASST Pini-CTO, University of Milan, Milan, Italy
| | | | | | - Paul Fortin
- CHU de Quebec - Université Laval, Quebec, Canada
| | - Lanlan Ji
- Rheumatology and Immunology Department, Peking University First Hospital, Beijing, PR China
| | - Maria Efthymiou
- Haemostasis Research Unit, Department of Haematology, University College London, London, UK
| | - Hannah Cohen
- Haemostasis Research Unit, Department of Haematology, University College London, London, UK
| | - D Ware Branch
- University of Utah and Intermountain Healthcare, Salt Lake City, USA
| | - Guilherme Ramires de Jesus
- Departamento de Obstetrícia, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Cecilia Nalli
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Michelle Petri
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | | | - Ricard Cervera
- Department of Autoimmune Diseases, Hospital Clínic Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Jason S Knight
- Division of Rheumatology, University of Michigan, Ann Arbor, USA
| | | | - Rohan Willis
- Antiphospholipid Standardization Laboratory, University of Texas Medical Branch, Galveston, USA
| | | | - Joann Vega
- Barbara Volcker Centre for Women and Rheumatic Disease, Hospital for Special Surgery, Weill Cornell Medicine, New York, USA
| | - Denis Wahl
- Vascular Medicine Division and Regional Competence Centre for Systemic And Autoimmune Diseases, Nancy Academic Hospital, Nancy, France.,Inserm UMR_S 1116, Lorraine University, Nancy, France
| | - Doruk Erkan
- Barbara Volcker Centre for Women and Rheumatic Disease, Hospital for Special Surgery, Weill Cornell Medicine, New York, USA
| | | |
Collapse
|
12
|
Ruiz-Irastorza G, Ugarte A, Ruiz-Arruza I, Khamashta M. Seventy years after Hench’s Nobel prize: revisiting the use of glucocorticoids in systemic lupus erythematosus. Lupus 2020; 29:1155-1167. [DOI: 10.1177/0961203320930099] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
In 1950, Hench, Kendall and Reichstein were awarded with the Nobel Prize in Physiology and Medicine for the isolation and first therapeutic use of glucocorticoids. Since then, they have become one of the main agents in the treatment of systemic lupus erythematosus (SLE). The use of high-dose oral glucocorticoids (usually 1 mg/kg/day of prednisone equivalent) have become the rule for treating moderate to severe lupus activity. In addition, tapering schemes have not been well defined, all this leading to prolonged exposures to potentially damaging amounts of glucocorticoids. Several studies have shown that glucocorticoids are a major cause of toxicity in SLE in a dose-dependent manner, with prolonged doses greater than 7.5 mg/day being associated with damage accrual. Thus, there is an urgent need for different therapeutic schedules that can achieve a rapid and durable control of lupus activity while reducing the many unwanted effects of glucocorticoids. Recent data show that pulses of methyl-prednisolone are an effective first-line therapy to treat lupus flares (not only severe ones) without major short or long-term toxicity and allowing a reduction in oral prednisone doses. Universal use of hydroxychloroquine – always recommended, infrequently accomplished – and early therapy with immunosuppressive drugs also help control SLE and reduce prednisone load. Results from observational studies confirm the more rapid achievement of remission and the reduction of long-term damage using these combination schedules with reduced prednisone doses. Seventy years after their first therapeutic use, we are learning to use glucocorticoids in a more efficient and safe manner.
Collapse
Affiliation(s)
- Guillermo Ruiz-Irastorza
- Hospital Universitario Cruces, BioCruces Bizkaia Health Research Institute, University of the Basque Country, Spain
| | - Amaia Ugarte
- Hospital Universitario Cruces, BioCruces Bizkaia Health Research Institute, University of the Basque Country, Spain
| | - Ioana Ruiz-Arruza
- Hospital Universitario Cruces, BioCruces Bizkaia Health Research Institute, University of the Basque Country, Spain
| | - Munther Khamashta
- Department of Women and Children’s Health, St Thomas Hospital, London
| |
Collapse
|
13
|
Delgado P, Robles Á, Martínez López JA, Sáez-Comet L, Rodríguez Almaraz E, Martínez-Sánchez N, Ugarte A, Vela-Casasempere P, Marco B, Espinosa G, Galindo M, Casellas M, Ruiz-Irastorza G, Martínez-Taboada V, Bartha JL. Pregnancy control in Patients with Systemic Lupus Erythematosus/Antiphospholipid Syndrome. Part 3: Childbirth. Puerperium. Breastfeeding Contraception. Newborn. ACTA ACUST UNITED AC 2019; 17:183-186. [PMID: 31831386 DOI: 10.1016/j.reuma.2019.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 07/23/2019] [Accepted: 09/23/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE In order to agree on the fundamental aspects related to the management of pregnancy in patients with systemic lupus erythematosus and antiphospholipid syndrome, the Spanish Societies of Gynaecology and Obstetrics, Internal Medicine and Rheumatology have set up a working group for the preparation of three consensus documents. METHODS Each of the Scientific Societies involved proposed five representatives based on their experience in the field of pregnancy control in patients with autoimmune diseases. The recommendations were developed following the Delphi methodology. RESULTS This third document contains the recommendations regarding the management of delivery, puerperium and lactation, including medication use during these periods and the care of the newborn. In addition, a section on contraception is included. CONCLUSIONS These multidisciplinary recommendations are considered decision-making tools for clinicians involved in the care of patients with systemic lupus erythematosus/antiphospholipid syndrome during pregnancy.
Collapse
Affiliation(s)
- Paloma Delgado
- Servicio de Obstetricia y Ginecología, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, Barakaldo, Bizkaia, España
| | - Ángel Robles
- Servicio de Medicina Interna, Hospital Universitario La Paz, Madrid, España
| | | | - Luis Sáez-Comet
- Unidad de Enfermedades Autoinmunes Sistémicas (UEAS), Servicio de Medicina Interna, Hospital Universitario Miguel Servet, Zaragoza, España
| | | | | | - Amaia Ugarte
- Unidad de Enfermedades Autoinmunes, Servicio de Medicina Interna, BioCruces Bizkaia Health Research Institute, Hospital Universitario Cruces, UPV/EHU, Barakaldo, Bizkaia, España
| | - Paloma Vela-Casasempere
- Sección de Reumatología, Hospital Universitario de Alicante, Instituto de investigaci ón sanitaria y biomédica ISABIAL - FISABIO, Departamento de Medicina Clínica, Universidad Miguel Hernandez, Alicante, España
| | - Beatriz Marco
- Servicio de Ginecología y Obstetricia, HUP La Fe, Valencia, España
| | - Gerard Espinosa
- Department of Autoimmune Diseases, Hospital Clinic, Biological aggresion and response mechanisms, IDIBAPS, Barcelona, Universitat de Barcelona, España
| | - María Galindo
- Servicio de Reumatología, Hospital 12 de Octubre, Madrid, España
| | - Manel Casellas
- Unitat Alt Risc Obstetric, Vall d' Hebron Hospital Campus, Barcelona, España
| | - Guillermo Ruiz-Irastorza
- Unidad de Enfermedades Autoinmunes, Servicio de Medicina Interna, BioCruces Bizkaia Health Research Institute, Hospital Universitario Cruces, UPV/EHU, Barakaldo, Bizkaia, España.
| | - Victor Martínez-Taboada
- Servicio de Reumatología, Hospital Universitario Marqués de Valdecilla, IDIVAL, Facultad de Medicina, Universidad de Cantabria, Santander, España
| | - José Luis Bartha
- Servicio de Obstetricia y Ginecología, Hospital Universitario La Paz, Madrid, España
| |
Collapse
|
14
|
Radin M, Sciascia S, Erkan D, Pengo V, Tektonidou MG, Ugarte A, Meroni P, Ji L, Belmont HM, Cohen H, Ramires de Jesús G, Branch DW, Fortin PR, Andreoli L, Petri M, Rodriguez E, Rodriguez-Pinto I, Knight JS, Atsumi T, Willis R, Gonzalez E, Lopez-Pedrera R, Rossi Gandara AP, Borges Gualhardo Vendramini M, Banzato A, Sevim E, Barbhaiya M, Efthymiou M, Mackie I, Bertolaccini ML, Andrade D. The adjusted global antiphospholipid syndrome score (aGAPSS) and the risk of recurrent thrombosis: Results from the APS ACTION cohort. Semin Arthritis Rheum 2019; 49:464-468. [PMID: 31153708 PMCID: PMC7402528 DOI: 10.1016/j.semarthrit.2019.04.009] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 04/01/2019] [Accepted: 04/29/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVES To assess whether patients with antiphospholipid syndrome (APS) and history of recurrent thrombosis have higher levels of adjusted Global AntiphosPholipid Syndrome Score (aGAPSS) when compared to patients without recurrent thrombosis. METHODS In this cross-sectional study of antiphospholipid antibody (aPL)-positive patients, we identified APS patients with a history of documented thrombosis from the AntiPhospholipid Syndrome Alliance For Clinical Trials and InternatiOnal Networking (APS ACTION) Clinical Database and Repository ("Registry"). Data on aPL-related medical history and cardiovascular risk factors were retrospectively collected. The aGAPSS was calculated at Registry entry by adding the points corresponding to the risk factors: three for hyperlipidemia, one for arterial hypertension, five for positive anticardiolipin antibodies, four for positive anti-β2 glycoprotein-I antibodies and four for positive lupus anticoagulant test. RESULTS The analysis included 379 APS patients who presented with arterial and/or venous thrombosis. Overall, significantly higher aGAPSS were seen in patients with recurrent thrombosis (arterial or venous) compared to those without recurrence (7.8 ± 3.3 vs. 6 ± 3.9, p<0.05). When analyzed based on the site of the recurrence, patients with recurrent arterial, but not venous, thrombosis had higher aGAPSS (8.1 ± SD 2.9 vs. 6 ± 3.9; p<0.05). CONCLUSIONS Based on analysis of our international large-scale Registry of aPL-positive patients, the aGAPSS might help risk stratifying patients based on the likelihood of developing recurrent thrombosis in APS.
Collapse
Affiliation(s)
- Massimo Radin
- Center of Research of Immunopathology and Rare Diseases, Coordinating Center of Piemonte and Valle d'Aosta Network for Rare Diseases, Department of Clinical and Biological Sciences, and SCDU Nephrology and Dialysis, S. Giovanni Bosco Hospital, Piazza del Donatore di Sangue 3, Turin 10124, Italy
| | - Savino Sciascia
- Center of Research of Immunopathology and Rare Diseases, Coordinating Center of Piemonte and Valle d'Aosta Network for Rare Diseases, Department of Clinical and Biological Sciences, and SCDU Nephrology and Dialysis, S. Giovanni Bosco Hospital, Piazza del Donatore di Sangue 3, Turin 10124, Italy.
| | - Doruk Erkan
- Department of Medicine, Weill Cornell Medicine, New York, NY, United States
| | | | - Maria G Tektonidou
- First Department of Propaedeutic Internal Medicine, Joint Rheumatology Program, National and Kapodistrian University of Athens, Athens, Greece
| | - Amaia Ugarte
- Autoimmune Diseases Research Unit, Department of Internal Medicine, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, UPV/EHU, Bizkaia, The Basque Country, Spain
| | - Pierluigi Meroni
- Laboratory of Immuno-Rheumatology Research, Istituto Auxologico Italiano, Milan, Italy
| | - Lanlan Ji
- Peking University First Hospital, Beijing, China
| | - H Michael Belmont
- NYU School of Medicine Langone Medical Center, New York, NY, United States
| | - Hannah Cohen
- University College London, London, United Kingdom
| | | | - D Ware Branch
- University of Utah and Intermountain Healthcare, Salt Lake City, UT, United States
| | | | - Laura Andreoli
- Department of Clinical and Experimental Science, University of Brescia, Brescia, Italy
| | - Michelle Petri
- Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | | | - Ignasi Rodriguez-Pinto
- Department of Autoimmune Diseases, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi iSunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | | | | | - Rohan Willis
- Antiphospholipid Standardization Laboratory, University of Texas Medical Branch, Galveston, TX,United States
| | - Emilio Gonzalez
- Antiphospholipid Standardization Laboratory, University of Texas Medical Branch, Galveston, TX,United States
| | | | | | | | | | - Ecem Sevim
- Department of Medicine, Weill Cornell Medicine, New York, NY, United States
| | - Medha Barbhaiya
- Barbara Volcker Center for Women and Rheumatic Diseases, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY, United States
| | | | - Ian Mackie
- University College London, London, United Kingdom
| | - Maria Laura Bertolaccini
- Academic Department of Vascular Surgery, School of Cardiovascular Medicine & Sciences, King's College London, London, United Kingdom
| | | |
Collapse
|
15
|
Efthymiou M, Mackie IJ, Lane PJ, Andrade D, Willis R, Erkan D, Sciascia S, Krillis S, Bison E, Borges Galhardo Vendramini M, Romay-Penabad Z, Qi M, Tektonidou M, Ugarte A, Chighizola C, Belmont HM, Aguirre MA, Ji L, Branch DW, de Jesus G, Fortin PR, Andreoli L, Petri M, Cervera R, Rodriguez E, Knight JS, Atsumi T, Vega J, Sevim E, Bertolaccini ML, Pengo V, Cohen H. Comparison of real world and core laboratory lupus anticoagulant results from the Antiphospholipid Syndrome Alliance for Clinical Trials and International Networking (APS ACTION) clinical database and repository. J Thromb Haemost 2019; 17:2069-2080. [PMID: 31364274 DOI: 10.1111/jth.14596] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 07/25/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Variability remains a challenge in lupus anticoagulant (LA) testing. OBJECTIVE To validate LA test performance between Antiphospholipid Syndrome Alliance for Clinical Trials and International Networking (APS ACTION) Core laboratories and examine agreement in LA status between Core and local/hospital laboratories contributing patients to this prospective registry. METHODS Five Core laboratories used the same reagents, analyzer type, protocols, and characterized samples for LA validation. Non-anticoagulated registry samples were retested at the corresponding regional Core laboratories and anticoagulated samples at a single Core laboratory. Categorical agreement and discrepancies in LA status between Core and local/hospital laboratories were analyzed. RESULTS Clotting times for the reference/characterized plasmas used for normalized ratios were similar between Core laboratories (CV <4%); precision and agreement for LA positive/negative plasma were similar (all CV ≤5%) in the four laboratories that completed both parts of the validation exercise; 418 registry samples underwent LA testing. Agreement for LA positive/negative status between Core and local/hospital laboratories was observed in 87% (115/132) non-anticoagulated and 77% (183/237) anticoagulated samples. However, 28.7% (120/418) of samples showed discordance between the Core and local/hospital laboratories or equivocal LA results. Some of the results of the local/hospital laboratories might have been unreliable in 24.7% (41/166) and 23% (58/252) of the total non-anticoagulated and anticoagulated samples, respectively. Equivocal results by the Core laboratory might have also contributed to discordance. CONCLUSIONS Laboratories can achieve good agreement in LA performance by use of the same reagents, analyzer type, and protocols. The standardized Core laboratory results underpin accurate interpretation of APS ACTION clinical data.
Collapse
Affiliation(s)
- Maria Efthymiou
- Haemostasis Research Unit, Department of Haematology, University College London, London, UK
| | - Ian J Mackie
- Haemostasis Research Unit, Department of Haematology, University College London, London, UK
| | - Philip J Lane
- Haemostasis Research Unit, Department of Haematology, University College London, London, UK
| | | | - Rohan Willis
- Antiphospholipid Standardization Laboratory, University of Texas Medical Branch, Galveston, TX, USA
| | - Doruk Erkan
- Barbara Volcker Center for Women and Rheumatic Diseases, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Savino Sciascia
- Center of Research of Immunopathology and Rare Diseases, University of Turin, Turin, Italy
| | - Steven Krillis
- Department of Infectious Diseases, Immunology and Sexual Health, St George Hospital, Sydney, NSW, Australia
| | | | | | - Zurina Romay-Penabad
- Antiphospholipid Standardization Laboratory, University of Texas Medical Branch, Galveston, TX, USA
| | - Miao Qi
- Department of Infectious Diseases, Immunology and Sexual Health, St George Hospital, Sydney, NSW, Australia
| | | | - Amaia Ugarte
- Internal Medicine, Hospital Universitario Cruces, Barakaldo, País Vasco, Spain
| | | | | | | | - Lanlan Ji
- Rheumatology and Immunology Department, Peking University First Hospital, Beijing, China
| | - D Ware Branch
- University of Utah and Intermountain Healthcare, Salt Lake City, UT, USA
| | | | - Paul R Fortin
- CHU de Quebec - Université Laval, Quebec, QC, Canada
| | - Laura Andreoli
- Rheumatology and Clinical Immunology, Spedali Civili, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Michelle Petri
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ricard Cervera
- Department of Autoimmune Diseases, Hospital Clínic Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | | | - Jason S Knight
- Division of Rheumatology, University of Michigan, Ann Arbor, MI, USA
| | | | - Joann Vega
- University Hospital Padova, Padova, Italy
| | - Ecem Sevim
- University Hospital Padova, Padova, Italy
| | - Maria Laura Bertolaccini
- Academic Department of Vascular Surgery, School of Cardiovascular Medicine & Sciences, King's College London, London, UK
| | - Vittorio Pengo
- Department of Infectious Diseases, Immunology and Sexual Health, St George Hospital, Sydney, NSW, Australia
| | - Hannah Cohen
- Haemostasis Research Unit, Department of Haematology, University College London, London, UK
- Department of Haematology, University College London Hospitals NHS Foundation Trust, London, UK
| |
Collapse
|
16
|
Unlu O, Erkan D, Barbhaiya M, Andrade D, Nascimento I, Rosa R, Banzato A, Pengo V, Ugarte A, Gerosa M, Ji L, Efthymiou M, Branch DW, de Jesus GR, Tincani A, Belmont HM, Fortin PR, Petri M, Rodriguez E, Pons-Estel GJ, Knight JS, Atsumi T, Willis R, Zuily S, Tektonidou MG. The Impact of Systemic Lupus Erythematosus on the Clinical Phenotype of Antiphospholipid Antibody-Positive Patients: Results From the AntiPhospholipid Syndrome Alliance for Clinical Trials and InternatiOnal Clinical Database and Repository. Arthritis Care Res (Hoboken) 2019; 71:134-141. [PMID: 29669399 DOI: 10.1002/acr.23584] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 04/10/2018] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Although systemic lupus erythematosus (SLE) is the most common autoimmune disease associated with antiphospholipid antibodies (aPL), limited data exist regarding the impact of SLE on the clinical phenotype of aPL-positive patients. The primary objective of this study was to compare the clinical, laboratory, and treatment characteristics of aPL-positive patients with SLE with those of aPL-positive patients without SLE. METHODS A secure web-based data capture system was used to store patient demographic characteristics and aPL-related clinical and laboratory characteristics. Inclusion criteria included positive aPL according to the updated Sapporo classification criteria. Antiphospholipid antibody-positive patients fulfilling the American College of Rheumatology criteria for the classification of SLE ("aPL with SLE") and those with no other autoimmune diseases ("aPL only") were included in the analysis. RESULTS Six hundred seventy-two aPL-positive patients were recruited from 24 international centers; 426 of these patients did not have other autoimmune disease, and 197 had SLE. The frequency of thrombocytopenia, hemolytic anemia, low complement levels, and IgA anti-β2 -glycoprotein I (anti-β2 GPI) antibodies was higher in the aPL-positive patients with SLE, whereas the frequency of cognitive dysfunction and IgG anti-β2 GPI antibodies was higher in the aPL-only group. The frequency of arterial and venous thromboses (including recurrent) as well as pregnancy morbidity was similar in the 2 groups. The prevalence of cardiovascular disease risk factors at the time of entry into the registry entry did not differ between the 2 groups, with the exception of current smoking, which was more frequent in aPL-positive patients with SLE. CONCLUSION Although the frequencies of thrombosis and pregnancy morbidity are similar in aPL-positive patients with and those without SLE, the diagnosis of SLE in patients with persistently positive aPL is associated with an increased frequency of thrombocytopenia, hemolytic anemia, low complement levels, and positive IgA anti-β2 GPI antibodies.
Collapse
Affiliation(s)
- Ozan Unlu
- Weill Cornell Medicine, New York, New York
| | | | | | | | | | | | | | | | | | | | - Lanlan Ji
- Peking University First Hospital, Beijing, China
| | | | - D Ware Branch
- University of Utah and Intermountain Healthcare, Salt Lake City
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Ruiz-Irastorza G, Ruiz-Estevez B, Lazaro E, Ruiz-Arruza I, Duffau P, Martin-Cascon M, Richez C, Ugarte A, Blanco P. Prolonged remission in SLE is possible by using reduced doses of prednisone: An observational study from the Lupus-Cruces and Lupus-Bordeaux inception cohorts. Autoimmun Rev 2019; 18:102359. [DOI: 10.1016/j.autrev.2019.102359] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 02/20/2019] [Indexed: 10/26/2022]
|
18
|
Martín-Iglesias D, Artaraz J, Fonollosa A, Ugarte A, Arteagabeitia A, Ruiz-Irastorza G. Evolution of retinal changes measured by optical coherence tomography in the assessment of hydroxychloroquine ocular safety in patients with systemic lupus erythematosus. Lupus 2019; 28:555-559. [PMID: 30755141 DOI: 10.1177/0961203319829826] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The objective of this report is to analyse retinal changes over a five-year period, assessed by spectral domain-optical coherence tomography (SD-OCT), in patients from the Lupus-Cruces cohort treated with hydroxychloroquine (HCQ). METHODS SD-OCT screening was performed annually between 2012 and 2017. Average macular thickness (AMT), ganglion cell layer thickness (GCLT) and qualitative data of retinal pigment epithelium (RPE) and external retina (ExtR) were collected prospectively. We compared data from 2012 (first) and 2017 (second) SD-OCT. RESULTS We studied 110 patients and 195 eyes. No cases of HCQ toxicity were detected. At the time of the second SD-OCT, 99% patients had taken a daily dose of HCQ ≤5 mg/kg/day. The median time on HCQ was 133 months. The mean AMT and GCLT were significantly lower in both eyes at the second SD-OCT; however, all the differences were clinically insignificant at less than 1%. Qualitative analysis of RPE and ExtR showed no significant changes. Similar results were found among patients with risk factors for retinopathy. The comparison of patients with and without risk factors showed no differences. CONCLUSIONS This study shows clinically irrelevant retinal changes in an SLE cohort on HCQ treatment over a five-year follow-up. Our findings support the safety of long-term HCQ at doses ≤5 mg/kg/day.
Collapse
Affiliation(s)
- D Martín-Iglesias
- 1 Autoimmune Diseases Research Unit, Department of Internal Medicine, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, University of The Basque Country, Bizkaia, Basque Country, Spain
| | - J Artaraz
- 2 Ophthalmology Department, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, University of The Basque Country, Bizkaia, Basque Country, Spain
| | - A Fonollosa
- 2 Ophthalmology Department, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, University of The Basque Country, Bizkaia, Basque Country, Spain
| | - A Ugarte
- 1 Autoimmune Diseases Research Unit, Department of Internal Medicine, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, University of The Basque Country, Bizkaia, Basque Country, Spain
| | - A Arteagabeitia
- 2 Ophthalmology Department, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, University of The Basque Country, Bizkaia, Basque Country, Spain
| | - G Ruiz-Irastorza
- 1 Autoimmune Diseases Research Unit, Department of Internal Medicine, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, University of The Basque Country, Bizkaia, Basque Country, Spain
| |
Collapse
|
19
|
Sciascia S, Willis R, Pengo V, Krilis S, Andrade D, Tektonidou MG, Ugarte A, Chighizola C, Branch DW, Levy RA, Nalli C, Fortin PR, Petri M, Rodriguez E, Rodriguez-Pinto I, Atsumi T, Nascimento I, Rosa R, Banzato A, Erkan D, Cohen H, Efthymiou M, Mackie I, Bertolaccini ML. The comparison of real world and core laboratory antiphospholipid antibody ELISA results from antiphospholipid syndrome alliance for clinical trials & international networking (APS ACTION) clinical database and repository analysis. Thromb Res 2019; 175:32-36. [PMID: 30685523 DOI: 10.1016/j.thromres.2019.01.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 01/08/2019] [Accepted: 01/16/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND The APS ACTION International Clinical Database and Repository includes a secure web-based data capture system storing patient information including demographics, antiphospholipid antibodies (aPL)-related medical history, and aPL tests. Despite efforts at harmonization, inter-assay variability remains a problem in aPL testing. As a clinical repository open to researchers, ensuring comparability between assays and consistency in results between APS ACTION laboratories is essential to the validity of studies emerging from this network. OBJECTIVE To assess the level of agreement between an aPL-registry inclusion and core laboratory (core lab) anticardiolipin antibody (aCL) and anti-β2-glycoprotein-I antibody (aβ2GPI) ELISA testing results. METHODS Patients are recruited from 25 international centers based on positive aPL tests at inclusion. All samples are retested at the corresponding national APS ACTION core lab to confirm aPL positivity based on standard validated protocols. We analysed the categorical agreement, degree of linear association, and correlation between inclusion (local laboratory) and core lab aPL tests. Samples were included in this study only if results of aPL testing with ELISA at baseline were available. RESULTS 497 registry samples underwent confirmatory aPL tests. Categorical agreement between the inclusion and core lab values, as expressed by Cohen's kappa coefficients, ranged between 0.61 and 0.80 (as substantial agreement). The correlation between quantitative results in the aCL and aβ2GPI was better for IgM and IgA compared to IgG (Spearman rho 0.789 and 0.666 vs. 0.600 for aCL and rho 0.892 and 0.744 vs. 0.432 for aβ2GPI). CONCLUSIONS The results of inclusion for aCL and aβ2GPI tests used for recruitment into the registry were in agreement to the results obtained by the APS ACTION core laboratories; aCL and aβ2GPI results showed very good categorical agreement. This agreement increased when considering high titer (>40 units) samples. APS ACTION is a reliable and useful research resource for APS.
Collapse
Affiliation(s)
- Savino Sciascia
- Center of Research of Immunopathology and Rare Diseases, University of Turin, Italy.
| | - Rohan Willis
- Antiphospholipid Standardization Laboratory, Department of Internal Medicine, Rheumatology Division, University of Texas Medical Branch, Galveston, TX, USA
| | - Vittorio Pengo
- Clinical Cardiology, Thrombosis Center, Department of Cardiac Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Steve Krilis
- Department of Infectious Diseases, Immunology and Sexual Health, St George Hospital, Sydney, Australia
| | - Danieli Andrade
- Division of Rheumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | | | | | - D Ware Branch
- University of Utah and Intermountain Healthcare, Salt Lake City, UT, USA
| | - Roger A Levy
- State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Cecilia Nalli
- Department of Clinical and Experimental Science, University of Brescia, Brescia, Italy
| | | | | | | | - Ignasi Rodriguez-Pinto
- Department of Autoimmune Diseases, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia, Spain
| | | | - Iana Nascimento
- Division of Rheumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Renata Rosa
- Division of Rheumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Alessandra Banzato
- Clinical Cardiology, Thrombosis Center, Department of Cardiac Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Doruk Erkan
- Barbara Volcker Center for Women and Rheumatic Diseases, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Hannah Cohen
- Haemostasis Research Unit, Department of Haematology, University College London, London, UK; Department of Haematology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Maria Efthymiou
- Haemostasis Research Unit, Department of Haematology, University College London, London, UK
| | - Ian Mackie
- Haemostasis Research Unit, Department of Haematology, University College London, London, UK
| | - Maria Laura Bertolaccini
- Academic Department of Vascular Surgery, Cardiovascular School of Medicine & Sciences, King's College London, UK
| | | |
Collapse
|
20
|
de Jesús GR, Sciascia S, Andrade D, Barbhaiya M, Tektonidou M, Banzato A, Pengo V, Ji L, Meroni PL, Ugarte A, Cohen H, Branch DW, Andreoli L, Belmont HM, Fortin PR, Petri M, Rodriguez E, Cervera R, Knight JS, Atsumi T, Willis R, Nascimento IS, Rosa R, Erkan D, Levy RA. Factors associated with first thrombosis in patients presenting with obstetric antiphospholipid syndrome (APS) in the APS Alliance for Clinical Trials and International Networking Clinical Database and Repository: a retrospective study. BJOG 2018; 126:656-661. [PMID: 30222236 DOI: 10.1111/1471-0528.15469] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the subsequent rate of thrombosis among women with obstetric antiphospholipid syndrome (Ob-APS) in a multicentre database of antiphospholipid antibody (aPL)-positive patients, and the clinical utility of the adjusted Global Antiphospholipid Syndrome Score (aGAPSS), a validated tool to assess the likelihood of developing new thrombosis, in this group of patients. DESIGN Retrospective study. SETTING The Antiphospholipid Syndrome Alliance for Clinical Trials and International Networking Clinical Database and Repository. POPULATION Women with Ob-APS. METHODS Comparison of clinical and laboratory characteristics and measurement of aGAPSS in women with Ob-APS, with or without thrombosis, after initial pregnancy morbidity (PM). MAIN OUTCOME MEASURES Risk factors for thrombosis and aGAPSS. RESULTS Of 550 patients, 126 had Ob-APS; 74/126 (59%) presented with thrombosis, and 47 (63%) of these women developed thrombosis after initial PM, in a mean time of 7.6 ± 8.2 years (4.9/100 patient years). Younger age at diagnosis of Ob-APS, additional cardiovascular risk factors, superficial vein thrombosis, heart valve disease, and multiple aPL positivity increased the risk of first thrombosis after PM. Women with thrombosis after PM had a higher aGAPSS compared with women with Ob-APS alone [median 11.5 (4-16) versus 9 (4-13); P = 0.0089]. CONCLUSION Based on a retrospective analysis of our multicentre aPL database, 63% of women with Ob-APS developed thrombosis after initial obstetric morbidity; additional thrombosis risk factors, selected clinical manifestations, and high-risk aPL profile increased the risk. Women with subsequent thrombosis after Ob-APS had a higher aGAPSS at entry to the registry. We believe that aGAPSS is a valid tool to improve risk stratification in aPL-positive women. TWEETABLE ABSTRACT More than 60% of women with obstetric antiphospholipid syndrome had thrombosis after initial pregnancy morbidity.
Collapse
Affiliation(s)
- G R de Jesús
- Department of Obstetrics, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - S Sciascia
- Department of Clinical and Biological Sciences, Centre of Research of Immunopathology and Rare Diseases, University of Turin, Turin, Italy
| | - D Andrade
- Departament of Rheumatology, Universidade de São Paulo, São Paulo, Brazil
| | - M Barbhaiya
- Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, New York, NY, USA
| | - M Tektonidou
- Rheumatology Unit, First Department of Propaedeutic Internal Medicine, University of Athens, Athens, Greece
| | - A Banzato
- Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, Padova, Italy
| | - V Pengo
- Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, Padova, Italy
| | - L Ji
- Rheumatology and Immunology Department, Peking University, First Hospital, Beijing, China
| | - P L Meroni
- Department of Rheumatology, University of Milan, Milan, Italy
| | - A Ugarte
- Autoimmune Diseases Research Unit, Department of Internal Medicine, Hospital Universitario Cruces, Barakaldo, Spain
| | - H Cohen
- Department of Haematology, University College London, London, UK
| | - D W Branch
- Department of Obstetrics and Gynecology, University of Utah Health Sciences and Intermountain Healthcare, Salt Lake City, UT, USA
| | - L Andreoli
- Rheumatology and Clinical Immunology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - H M Belmont
- Division of Rheumatology, NYU School of Medicine, New York, NY, USA
| | - P R Fortin
- Division of Rheumatology, Centre Hospitalier de l'Université Laval, Québec, QC, Canada
| | - M Petri
- Division of Rheumatology, John Hopkins University, Baltimore, MD, USA
| | - E Rodriguez
- Rheumatology Department, Hospital 12 de Octubre, Madrid, Spain
| | - R Cervera
- Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain
| | - J S Knight
- Division of Rheumatology, University of Michigan, Ann Arbor, MI, USA
| | - T Atsumi
- Department of Rheumatology, Endocrinology, and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - R Willis
- Antiphospholipid Standardization Laboratory, Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - I S Nascimento
- Departament of Rheumatology, Universidade de São Paulo, São Paulo, Brazil
| | - R Rosa
- Departament of Rheumatology, Universidade de São Paulo, São Paulo, Brazil
| | - D Erkan
- Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, New York, NY, USA
| | - R A Levy
- Department of Rheumatology, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil.,GlaxoSmithKline Immunology and Inflammation, Upper Providence, PA, USA
| | | |
Collapse
|
21
|
Sanada K, de Azúa SR, Nakajima S, Alberich S, Ugarte A, Zugasti J, Vega P, Martínez-Cengotitabengoa M, González-Pinto A. Correlates of neurocognitive functions in individuals at ultra-high risk for psychosis - A 6-month follow-up study. Psychiatry Res 2018; 268:1-7. [PMID: 29986171 DOI: 10.1016/j.psychres.2018.06.053] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 06/12/2018] [Accepted: 06/21/2018] [Indexed: 01/30/2023]
Abstract
Cognitive deficits are evident at the prodromal phase of psychosis. It has been noted that brain-derived neurotrophic factor (BDNF) is correlated with cognition in both preclinical and clinical studies. However, to our knowledge, no study has evaluated blood BDNF levels and their association with cognitive impairment in individuals at ultra-high risk for psychosis (UHR). We included 13 individuals at UHR and 30 healthy controls (HC) matched by sex, age, and educational level. Plasma BDNF levels were measured at baseline and 6 months. Neurocognitive functions (executive functions, speed of processing, verbal learning and memory, working memory) were examined at 6 months. Regression analyses were conducted to examine the relationship between BDNF levels and cognitive performance. BDNF levels were lower in UHR group than in HC group both at baseline and at 6 months (P = 0.001, and P = 0.007, respectively). There were no associations between plasma BDNF levels and all of the cognitive domains in both groups. Our findings showed that peripheral BDNF levels were not related to cognitive deficits in UHR and HC groups while the lower BDNF level in the former persisted up to 6 months. Further research is needed in a large sample.
Collapse
Affiliation(s)
- Kenji Sanada
- Department of Psychiatry, Showa University School of Medicine, Tokyo, Japan
| | - Sonia Ruiz de Azúa
- Department of Psychiatry, Araba University Hospital, BioAraba Research Institute, OSI Araba Vitoria, Spain; Biomedical Research Networking Centre in Mental Health (CIBERSAM), Madrid, Spain; University of the Basque Country
| | - Shinichiro Nakajima
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Susana Alberich
- Department of Psychiatry, Araba University Hospital, BioAraba Research Institute, OSI Araba Vitoria, Spain; Biomedical Research Networking Centre in Mental Health (CIBERSAM), Madrid, Spain
| | - Amaia Ugarte
- Department of Psychiatry, Araba University Hospital, BioAraba Research Institute, OSI Araba Vitoria, Spain; Biomedical Research Networking Centre in Mental Health (CIBERSAM), Madrid, Spain
| | - Jone Zugasti
- Department of Psychiatry, Araba University Hospital, BioAraba Research Institute, OSI Araba Vitoria, Spain; Biomedical Research Networking Centre in Mental Health (CIBERSAM), Madrid, Spain
| | - Patricia Vega
- Department of Psychiatry, Araba University Hospital, BioAraba Research Institute, OSI Araba Vitoria, Spain; Biomedical Research Networking Centre in Mental Health (CIBERSAM), Madrid, Spain
| | - Mónica Martínez-Cengotitabengoa
- Department of Psychiatry, Araba University Hospital, BioAraba Research Institute, OSI Araba Vitoria, Spain; Biomedical Research Networking Centre in Mental Health (CIBERSAM), Madrid, Spain; University of the Basque Country; National Distance Education University (UNED), Spain
| | - Ana González-Pinto
- Department of Psychiatry, Araba University Hospital, BioAraba Research Institute, OSI Araba Vitoria, Spain; Biomedical Research Networking Centre in Mental Health (CIBERSAM), Madrid, Spain; University of the Basque Country.
| |
Collapse
|
22
|
Ruiz-Irastorza G, Ugarte A, Ruiz-Arruza I, Erdozain JG, Gonzalez-Echavarri C, Soto A. Comment on: The British Society for Rheumatology guideline for the management of systemic lupus erythematosus in adults. Rheumatology (Oxford) 2018; 57:1501-1502. [DOI: 10.1093/rheumatology/key168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 05/09/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Guillermo Ruiz-Irastorza
- Autoimmune Diseases Research Unit, Department of Internal Medicine, Biocruces Health Research Institute, Hospital Universitario Cruces, UPV/EHU, Bizkaia, The Basque Country, Spain
| | - Amaia Ugarte
- Autoimmune Diseases Research Unit, Department of Internal Medicine, Biocruces Health Research Institute, Hospital Universitario Cruces, UPV/EHU, Bizkaia, The Basque Country, Spain
| | - Ioana Ruiz-Arruza
- Autoimmune Diseases Research Unit, Department of Internal Medicine, Biocruces Health Research Institute, Hospital Universitario Cruces, UPV/EHU, Bizkaia, The Basque Country, Spain
| | - Jose-Gabriel Erdozain
- Autoimmune Diseases Research Unit, Department of Internal Medicine, Biocruces Health Research Institute, Hospital Universitario Cruces, UPV/EHU, Bizkaia, The Basque Country, Spain
| | - Cristina Gonzalez-Echavarri
- Autoimmune Diseases Research Unit, Department of Internal Medicine, Biocruces Health Research Institute, Hospital Universitario Cruces, UPV/EHU, Bizkaia, The Basque Country, Spain
| | - Adriana Soto
- Autoimmune Diseases Research Unit, Department of Internal Medicine, Biocruces Health Research Institute, Hospital Universitario Cruces, UPV/EHU, Bizkaia, The Basque Country, Spain
| |
Collapse
|
23
|
Ugarte A, Porta S, Ríos R, Martinez-Zapico A, Ortego-Centeno N, Agesta N, Ruiz-Irastorza G. Combined mepacrine-hydroxychloroquine treatment in patients with systemic lupus erythematosus and refractory cutaneous and articular activity. Lupus 2018; 27:1718-1722. [PMID: 29635998 DOI: 10.1177/0961203318768877] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aim The aim of this study was to evaluate the clinical response to combined therapy with hydroxychloroquine and mepacrine in patients with systemic lupus erythematosus and refractory joint and/or skin disease. Methods Mepacrine was added to 46 systemic lupus erythematosus patients unresponsive to treatment with the following drug combinations: hydroxychloroquine + prednisone + immunosuppressive drugs ( n = 24), hydroxychloroquine + prednisone ( n = 16), hydroxychloroquine + prednisone + retinoids ( n = 2), hydroxychloroquine alone ( n = 1), hydroxychloroquine + one immunosuppressive drug ( n = 1), hydroxychloroquine + prednisone + one immunosuppressive drug + belimumab ( n = 1) or hydroxychloroquine + prednisone + belimumab ( n = 1). The outcome variable was the clinical response, either complete or partial, based on clinical judgement. The Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI) and the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) score were additionally used. Results A total of 91% patients showed complete/partial response, with similar rates among those with joint or skin disease. In patients with cutaneous activity, a statistically significant decrease in the CLASI was seen. There also was a statistically significant decrease in the SLEDAI. The mean daily dose of prednisone decreased from 5.8 to 3.4 mg/d ( p = 0.001). Prednisone could be discontinued in 20% of patients. No serious adverse events were seen. Smoking was the only predictor of complete response. Conclusion In the setting of refractory skin and/or joint disease, the addition of mepacrine to previous therapy including hydroxychloroquine was safe and effective in reducing disease activity and decreasing prednisone doses. The fact that smokers responded better opens the door to further studying the combination of mepacrine-hydroxychloroquine as a first-line therapy in such patients.
Collapse
Affiliation(s)
- A Ugarte
- 1 Autoimmune Diseases Research Unit, Department of Internal Medicine, Biocruces, Hospital Universitario Cruces, UPV/EHU Bizkaia, The Basque Country, Spain
| | - S Porta
- 1 Autoimmune Diseases Research Unit, Department of Internal Medicine, Biocruces, Hospital Universitario Cruces, UPV/EHU Bizkaia, The Basque Country, Spain.,2 Rheumatology Department, Hospital J.M. Ramos Mejía, Buenos Aires, Argentina
| | - R Ríos
- 3 Systemic Autoimmune Diseases Unit, Department of Internal Medicine, Hospital Clínico San Cecilio, Granada, Spain
| | - A Martinez-Zapico
- 1 Autoimmune Diseases Research Unit, Department of Internal Medicine, Biocruces, Hospital Universitario Cruces, UPV/EHU Bizkaia, The Basque Country, Spain.,4 Department of Internal Medicine, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - N Ortego-Centeno
- 3 Systemic Autoimmune Diseases Unit, Department of Internal Medicine, Hospital Clínico San Cecilio, Granada, Spain
| | - N Agesta
- 5 Department of Dermatology, Hospital Universitario Cruces, Bizkaia, Spain
| | - G Ruiz-Irastorza
- 1 Autoimmune Diseases Research Unit, Department of Internal Medicine, Biocruces, Hospital Universitario Cruces, UPV/EHU Bizkaia, The Basque Country, Spain
| |
Collapse
|
24
|
Ruiz-Arruza I, Lozano J, Cabezas-Rodriguez I, Medina JA, Ugarte A, Erdozain JG, Ruiz-Irastorza G. Restrictive Use of Oral Glucocorticoids in Systemic Lupus Erythematosus and Prevention of Damage Without Worsening Long-Term Disease Control: An Observational Study. Arthritis Care Res (Hoboken) 2018; 70:582-591. [DOI: 10.1002/acr.23322] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 07/11/2017] [Indexed: 12/22/2022]
Affiliation(s)
- Ioana Ruiz-Arruza
- Biocruces Health Research Institute; Hospital Universitario Cruces; University of The Basque Country; Bizkaia The Basque Country Spain
| | - Jesús Lozano
- Biocruces Health Research Institute; Hospital Universitario Cruces; University of The Basque Country, Bizkaia, The Basque Country; and Hospital Universitario J. M. Morales Meseguer; Murcia Spain
| | - Ivan Cabezas-Rodriguez
- Biocruces Health Research Institute; Hospital Universitario Cruces; University of The Basque Country, Bizkaia, The Basque Country; and Hospital Universitario Central de Asturias; Oviedo Asturias Spain
| | - Jose-Alejandro Medina
- Biocruces Health Research Institute; Hospital Universitario Cruces; University of The Basque Country, Bizkaia, The Basque Country; and Complejo Hospitalario Universitario Nuestra Sra. de Candelaria; S/C de Tenerife Spain
| | - Amaia Ugarte
- Biocruces Health Research Institute; Hospital Universitario Cruces; University of The Basque Country; Bizkaia The Basque Country Spain
| | - José-Gabriel Erdozain
- Biocruces Health Research Institute; Hospital Universitario Cruces; University of The Basque Country; Bizkaia The Basque Country Spain
| | - Guillermo Ruiz-Irastorza
- Biocruces Health Research Institute; Hospital Universitario Cruces; University of The Basque Country; Bizkaia The Basque Country Spain
| |
Collapse
|
25
|
Muñoz-de-la-Torre LP, Eguibar JR, Cortés C, Ugarte A, Trujillo A. Follicular Development and Secretion of Ovarian Hormones during the Juvenile and Adult Reproductive Lives of the Myelin Mutant taiep Rat: An Animal Model of Demyelinating Diseases. Int J Endocrinol 2018; 2018:5718782. [PMID: 30363667 PMCID: PMC6180977 DOI: 10.1155/2018/5718782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 06/26/2018] [Accepted: 08/05/2018] [Indexed: 11/18/2022] Open
Abstract
Infertility and reproductive problems have been reported in women with several neurological disorders, for example, demyelination. However, the physiology of such problems has remained unknown so far. The taiep rats are an animal neurological model that initially shows a hypomyelination followed by a progressive demyelination of the central nervous system. This animal has reproductive problems, and the aim of this work is to characterize the follicular development, secretion of ovarian hormones, and presence of noradrenaline in the ovaries of the female taiep rats in the juvenile and adult stages. The taiep rats have low body weight (approximately 19% less than that of SD rats), a delay of 4 days in the age of vaginal opening, and an irregularity in the estrous cycle by the absence or prolongation of some estral cycle stage. In the juvenile stage, we observed a decrease of approximately 44% in the total number of follicles with a 15% increase of atresia and an 80% decrease in the fluorescence intensity of catecholamines in the ovaries, with a 21% increment in plasma concentrations of testosterone. In the adult stage, we observed follicular cysts and a 50% decrease in fluorescence intensity of catecholamines in the ovaries, with changes in the secretion of ovarian hormones, an increase of 20 times in progesterone, and a decrement of a half in estradiol. The demyelination in taiep rats affects follicular development and steroidogenesis in the early stages of the animal's life, and this is maintained until adulthood.
Collapse
Affiliation(s)
| | - J. R. Eguibar
- Instituto de Fisiología, Benemérita Universidad Autónoma de Puebla, 72570 Puebla, Mexico
- Vicerrectoría de Investigación y Estudios de Posgrado, Benemérita Universidad Autónoma de Puebla, 72000 Puebla, Mexico
| | - C. Cortés
- Instituto de Fisiología, Benemérita Universidad Autónoma de Puebla, 72570 Puebla, Mexico
| | - A. Ugarte
- Instituto de Fisiología, Benemérita Universidad Autónoma de Puebla, 72570 Puebla, Mexico
| | - A. Trujillo
- Facultad de Ciencias Biológicas, Benemérita Universidad Autónoma de Puebla, 72570 Puebla, Mexico
| |
Collapse
|
26
|
Flores A, González G, Lahera G, Bayón C, Bravo M, Rodríguez Vega B, Avedillo C, Villanueva R, Barbeito S, Saenz M, García Alocén A, Ugarte A, González Pinto A, Vaughan M, Carballeira L, Pérez P, Barga P, García N, De Dios C. Mindfulness effects on cognition: Preliminary results. Eur Psychiatry 2017. [DOI: 10.1016/j.eurpsy.2017.01.382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
BackgroundMindfulness-based cognitive therapy (MBCT) is a psychotherapeutic intervention that has been shown effective in several clinical conditions. Nevertheless, research is still needed on its effectiveness on cognition.ObjectiveTo analyze possible effects on cognition of the addition of MBCT intervention versus a brief structured group psycho-education to the standard treatment of subsyndromal bipolar depression. Our hypothesis was that MBCT could improve some aspects of cognitive function to a higher degree than psycho-education and treatment as usual (TAU).Methods/designA randomized, multicenter, prospective, versus active comparator, evaluator-blinded clinical trial was conducted. Forty patients with BD and subclinical or mild depressive symptoms were randomly allocated to:– MBCT added to psychopharmacological treatment (n = 16);– a brief structured group psycho-educational intervention added to psychopharmacological treatment (n = 17);– standard clinical management, including psychopharmacological treatment (n = 7).Assessments were conducted at screening, baseline, post-intervention (8 weeks) and 4-month follow-up.ResultsCognition results point to significant improvement in Stroop Color test as well as processing speed in TMT A test (P < 0.05) in the two psychological intervention groups versus TAU.ConclusionThese preliminary findings suggest that the addition of MBCT or psycho-education to usual treatment could improve some cognitive dimensions in subsyndromal bipolar depressive patients.Disclosure of interestThe authors have not supplied their declaration of competing interest.
Collapse
|
27
|
González-Ortega I, Ugarte A, Ruiz de Azúa S, Núñez N, Zubia M, Ponce S, Casla P, Llano JX, Faria Á, González-Pinto A. Online psycho-education to the treatment of bipolar disorder: protocol of a randomized controlled trial. BMC Psychiatry 2016; 16:452. [PMID: 28007034 PMCID: PMC5178094 DOI: 10.1186/s12888-016-1159-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 12/07/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Bipolar disorder patients frequently present recurrent episodes and often experience subsyndromal symptoms, cognitive impairment and difficulties in functioning, with a low quality of life, illness relapses and recurrent hospitalization. Early diagnosis and appropriate intervention may play a role in preventing neuroprogression in this disorder. New technologies represent an opportunity to develop standardized psychological treatments using internet-based tools that overcome some of the limitations of face-to-face treatments, in that they are readily accessible and the timing of therapy can be tailored to user needs and availability. However, although many psychological programs are offered through the web and mobile devices for bipolar disorder, there is a lack of high quality evidence concerning their efficacy and effectiveness due to the great variability in measures and methodology used. METHODS This clinical trial is a simple-blind randomized trial within a European project to compare an internet-based intervention with treatment as usual. Bipolar disorder patients are to be included and randomly assigned to one of two groups: 1) the experimental group (tele-care support) and 2) the control group. Participants in both groups will be evaluated at baseline (pre-treatment) and post-treatment. DISCUSSION This study describes the design of a clinical trial based on psychoeducation intervention that may have a significant impact on both prognosis and treatment in bipolar disorder. Specifically, bringing different services together (service aggregation), it is hoped that the approach proposed will significantly increase the impact of information and communication technologies on access and adherence to treatment, quality of the service, patient safety, patient and professional satisfaction, and quality of life of patients. TRIAL REGISTRATION NCT02924415 . Retrospectively registered 27 September 2016.
Collapse
Affiliation(s)
- Itxaso González-Ortega
- Center for Biomedical Research in the Mental Health Network (CIBERSAM), Department of Psychiatry, Araba University Hospital, University of the Basque Country, Olaguibel Street 29, 01004, Vitoria, Spain.
| | - Amaia Ugarte
- Center for Biomedical Research in the Mental Health Network (CIBERSAM), Department of Psychiatry, Araba University Hospital, University of the Basque Country, Olaguibel Street 29, 01004 Vitoria, Spain
| | - Sonia Ruiz de Azúa
- Center for Biomedical Research in the Mental Health Network (CIBERSAM), Department of Psychiatry, Araba University Hospital, University of the Basque Country, Olaguibel Street 29, 01004 Vitoria, Spain
| | - Nuria Núñez
- Center for Biomedical Research in the Mental Health Network (CIBERSAM), Department of Psychiatry, Araba University Hospital, University of the Basque Country, Olaguibel Street 29, 01004 Vitoria, Spain
| | - Marta Zubia
- Center for Biomedical Research in the Mental Health Network (CIBERSAM), Department of Psychiatry, Araba University Hospital, University of the Basque Country, Olaguibel Street 29, 01004 Vitoria, Spain
| | - Sara Ponce
- Centro de Investigación en Cronicidad-Kronikgune, Barakaldo, Spain
| | | | | | - Ángel Faria
- Subdirección de Informática, Sistemas de Información-Osakidetza, Vitoria, Spain
| | - Ana González-Pinto
- Center for Biomedical Research in the Mental Health Network (CIBERSAM), Department of Psychiatry, Araba University Hospital, University of the Basque Country, Olaguibel Street 29, 01004 Vitoria, Spain
| |
Collapse
|
28
|
Alberich S, Barbeito S, González-Ortega I, Ugarte A, Vega P, de Azúa SR, López P, Zorrilla I, González-Pinto A. Psychometric properties and validation of a four-item version of the Strauss-Carpenter scale in bipolar disorder. Int J Bipolar Disord 2016; 4:22. [PMID: 27757849 PMCID: PMC5069208 DOI: 10.1186/s40345-016-0063-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Accepted: 10/05/2016] [Indexed: 01/04/2023] Open
Abstract
Background Bipolar disorder is a chronic illness that impairs functioning and affects the quality of life of patients. The onset of this illness usually occurs at an early age, and the risk of relapse remains high for decades. Thus, due to the great clinical relevance of identifying long-term predictors of functioning in bipolar disorder, Strauss and Carpenter developed a scale composed of items known to have prognostic value. Methods To determine the clinical usefulness of the four-item Strauss–Carpenter scale in bipolar disorder, a 1-year prospective follow-up study was carried out. The internal consistency, convergent and discriminant validity, and test–retest reliability of the scale were assessed. We also compared the Strauss–Carpenter scale with the reference scales Global Assessment Functioning (GAF), Clinical Global Impression for Bipolar Disorder, the Modified Version (CGI-BIP-M) and the Sheehan Disability Scale (Sheehan). Additionally, a cut-off point for remission was established. Results The total sample was composed of 98 patients with a diagnosis of bipolar disorder. The four-item version of the Strauss–Carpenter scale showed to have appropriate psychometric properties, comparable to those of reference scales. The best cut-off point for remission was 14. Conclusions The four-item version of the Strauss–Carpenter scale has suitable validity and reliability for the assessment of functioning in patients with bipolar disorder.
Collapse
Affiliation(s)
- Susana Alberich
- Department of Psychiatry, Bioaraba Research Institute, Araba University Hospital, Olaguibel Street 29, 01004, Vitoria, Spain.,Biomedical Research Networking Centre in Mental Health (CIBERSAM), OSI Araba-University Hospital, Vitoria, Spain
| | - Sara Barbeito
- Department of Psychiatry, Bioaraba Research Institute, Araba University Hospital, Olaguibel Street 29, 01004, Vitoria, Spain.,Biomedical Research Networking Centre in Mental Health (CIBERSAM), OSI Araba-University Hospital, Vitoria, Spain.,Grupo de Investigación en Psicología clínica de la Unir, Madrid, Spain
| | - Itxaso González-Ortega
- Department of Psychiatry, Bioaraba Research Institute, Araba University Hospital, Olaguibel Street 29, 01004, Vitoria, Spain.,Biomedical Research Networking Centre in Mental Health (CIBERSAM), OSI Araba-University Hospital, Vitoria, Spain.,University of the Basque Country, Vitoria, Spain
| | - Amaia Ugarte
- Department of Psychiatry, Bioaraba Research Institute, Araba University Hospital, Olaguibel Street 29, 01004, Vitoria, Spain.,Biomedical Research Networking Centre in Mental Health (CIBERSAM), OSI Araba-University Hospital, Vitoria, Spain
| | - Patricia Vega
- Department of Psychiatry, Bioaraba Research Institute, Araba University Hospital, Olaguibel Street 29, 01004, Vitoria, Spain.,Biomedical Research Networking Centre in Mental Health (CIBERSAM), OSI Araba-University Hospital, Vitoria, Spain
| | - Sonia Ruiz de Azúa
- Department of Psychiatry, Bioaraba Research Institute, Araba University Hospital, Olaguibel Street 29, 01004, Vitoria, Spain.,Biomedical Research Networking Centre in Mental Health (CIBERSAM), OSI Araba-University Hospital, Vitoria, Spain.,University of the Basque Country, Vitoria, Spain
| | - Purificación López
- Department of Psychiatry, Bioaraba Research Institute, Araba University Hospital, Olaguibel Street 29, 01004, Vitoria, Spain.,Biomedical Research Networking Centre in Mental Health (CIBERSAM), OSI Araba-University Hospital, Vitoria, Spain.,University of the Basque Country, Vitoria, Spain
| | - Iñaki Zorrilla
- Department of Psychiatry, Bioaraba Research Institute, Araba University Hospital, Olaguibel Street 29, 01004, Vitoria, Spain.,Biomedical Research Networking Centre in Mental Health (CIBERSAM), OSI Araba-University Hospital, Vitoria, Spain.,University of the Basque Country, Vitoria, Spain
| | - Ana González-Pinto
- Department of Psychiatry, Bioaraba Research Institute, Araba University Hospital, Olaguibel Street 29, 01004, Vitoria, Spain. .,Biomedical Research Networking Centre in Mental Health (CIBERSAM), OSI Araba-University Hospital, Vitoria, Spain. .,University of the Basque Country, Vitoria, Spain.
| |
Collapse
|
29
|
Abstract
Throughout the 20th century, a remarkable improvement in the prognosis of systemic lupus erythematosus (SLE) has been seen, mostly due to a better understanding of the disease and the advent of new therapies. However, a plateau seems to have been reached. Whilst outcomes related to active disease have greatly improved, damage accrual tends to be slowly increasing especially damage secondary to high-dose glucocorticoids, which could lead not only to increased morbidity but also to a worse long-term prognosis. Cardiovascular disease and infections still account for the majority of deaths yet both could potentially be improved, again, by the use of high-dose glucocorticoids. In addition, antimalarials have also demonstrated many beneficial effects on patients with lupus. Thus, the universal use of hydroxychloroquine, a more rational prescription of glucocorticoids and preventive strategies for cardiovascular disease can be used as measures with major impacts on the future prognosis of patients with SLE.
Collapse
Affiliation(s)
- A Ugarte
- Autoimmune Diseases Research Unit, Department of Internal Medicine, Biocruces Health Research Institute, Hospital Universitario Cruces, University of The Basque Country, Bizkaia, Spain
| | - G Ruiz-Irastorza
- Autoimmune Diseases Research Unit, Department of Internal Medicine, Biocruces Health Research Institute, Hospital Universitario Cruces, University of The Basque Country, Bizkaia, Spain
| |
Collapse
|
30
|
Gonzalez-Echavarri C, Ugarte A, Ruiz-Irastorza G. Rituximab-refractory lupus nephritis successfully treated with belimumab. Clin Exp Rheumatol 2016; 34:355-356. [PMID: 26886714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 10/26/2015] [Indexed: 06/05/2023]
Affiliation(s)
- Cristina Gonzalez-Echavarri
- Autoimmune Diseases Research Unit, Department of Internal Medicine, Biocruces Health Research Institute, Hospital Universitario Cruces, University of The Basque Country, Spain.
| | - Amaia Ugarte
- Autoimmune Diseases Research Unit, Department of Internal Medicine, Biocruces Health Research Institute, Hospital Universitario Cruces, University of The Basque Country, Spain
| | - Guillermo Ruiz-Irastorza
- Autoimmune Diseases Research Unit, Department of Internal Medicine, Biocruces Health Research Institute, Hospital Universitario Cruces, University of The Basque Country, Spain
| |
Collapse
|
31
|
Cuadrado-Tejedor M, Garcia-Barroso C, Sanzhez-Arias J, Mederos S, Rabal O, Ugarte A, Franco R, Pascual-Lucas M, Segura V, Perea G, Oyarzabal J, Garcia-Osta A. Concomitant histone deacetylase and phosphodiesterase 5 inhibition synergistically prevents the disruption in synaptic plasticity and it reverses cognitive impairment in a mouse model of Alzheimer's disease. Clin Epigenetics 2015; 7:108. [PMID: 26457123 PMCID: PMC4599811 DOI: 10.1186/s13148-015-0142-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 09/28/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Given the implication of histone acetylation in memory processes, histone deacetylase inhibitors (HDACIs) have been postulated as potential modulators of cognitive impairment in Alzheimer's disease (AD). However, dose-dependent side effects have been described in patients with the currently available broad-spectrum HDACIs, explaining why their therapeutic potential has not been realized for chronic diseases. Here, by simultaneously targeting two independent enzyme activities, histone deacetylase (HDAC) and phosphodiesterase-5 (PDE5), we propose a novel mode of inhibitory action that might increase the therapeutic specificity of HDACIs. RESULTS The combination of vorinostat, a pan-HDACI, and tadalafil, a PDE5 inhibitor, rescued the long-term potentiation impaired in slices from APP/PS1 mice. When administered in vivo, the combination of these drugs alleviated the cognitive deficits in AD mice, as well as the amyloid and tau pathology, and it reversed the reduced dendritic spine density on hippocampal neurons. Significantly, the combination of vorinostat and tadalafil was more effective than each drug alone, both against the symptoms and in terms of disease modification, and importantly, these effects persisted after a 4-week washout period. CONCLUSIONS The results highlight the pharmacological potential of a combination of molecules that inhibit HDAC and PDE5 as a therapeutic approach for AD treatment.
Collapse
Affiliation(s)
- M Cuadrado-Tejedor
- Neurobiology of Alzheimer's Disease, Neurosciences Division, Center for Applied Medical Research (CIMA), University of Navarra, Pio XII, 31008 Pamplona, Spain.,Anatomy Department, School of Medicine, University of Navarra, Pamplona, Spain
| | - C Garcia-Barroso
- Neurobiology of Alzheimer's Disease, Neurosciences Division, Center for Applied Medical Research (CIMA), University of Navarra, Pio XII, 31008 Pamplona, Spain
| | - J Sanzhez-Arias
- Small Molecule Discovery Platform, Molecular Therapeutics Program, Center for Applied Medical Research (CIMA), University of Navarra, Pio XII, 55, 31008 Pamplona, Spain
| | - S Mederos
- Cajal Institute, CSIC, Madrid, Spain
| | - O Rabal
- Small Molecule Discovery Platform, Molecular Therapeutics Program, Center for Applied Medical Research (CIMA), University of Navarra, Pio XII, 55, 31008 Pamplona, Spain
| | - A Ugarte
- Small Molecule Discovery Platform, Molecular Therapeutics Program, Center for Applied Medical Research (CIMA), University of Navarra, Pio XII, 55, 31008 Pamplona, Spain
| | - R Franco
- Neurobiology of Alzheimer's Disease, Neurosciences Division, Center for Applied Medical Research (CIMA), University of Navarra, Pio XII, 31008 Pamplona, Spain.,Department of Biochemistry and Molecular Biology, Faculty of Biology, University of Barcelona, Barcelona, Spain
| | - M Pascual-Lucas
- Neurobiology of Alzheimer's Disease, Neurosciences Division, Center for Applied Medical Research (CIMA), University of Navarra, Pio XII, 31008 Pamplona, Spain
| | - V Segura
- Bioinformatics Unit, Center for Applied Medical Research (CIMA), University of Navarra, Pamplona, Spain
| | - G Perea
- Cajal Institute, CSIC, Madrid, Spain
| | - J Oyarzabal
- Small Molecule Discovery Platform, Molecular Therapeutics Program, Center for Applied Medical Research (CIMA), University of Navarra, Pio XII, 55, 31008 Pamplona, Spain
| | - A Garcia-Osta
- Neurobiology of Alzheimer's Disease, Neurosciences Division, Center for Applied Medical Research (CIMA), University of Navarra, Pio XII, 31008 Pamplona, Spain
| |
Collapse
|
32
|
Eguibar JR, Cortes C, Isidro O, Ugarte A. Central administration of oxytocin differentially increases yawning, penile erections and scratching in high- (HY) and low-yawning (LY) sublines of Sprague–Dawley rats. Pharmacol Biochem Behav 2015; 134:6-11. [DOI: 10.1016/j.pbb.2015.04.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 03/30/2015] [Accepted: 04/09/2015] [Indexed: 11/25/2022]
|
33
|
Ruiz-Arruza I, Barbosa C, Ugarte A, Ruiz-Irastorza G. Comparison of high versus low-medium prednisone doses for the treatment of systemic lupus erythematosus patients with high activity at diagnosis. Autoimmun Rev 2015; 14:875-9. [PMID: 26044819 DOI: 10.1016/j.autrev.2015.05.011] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 05/23/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare the efficacy and safety of high vs. low-moderate oral doses of prednisone to treat patients with highly active lupus at diagnosis. PATIENTS AND METHODS Patients from the Lupus-Cruces cohort with an SLEDAI score ≥6 at diagnosis and treated with regimes containing low-medium prednisone doses (≤30 mg/day) were identified (group M). They were matched by sex and SLEDAI score with historical patients treated with high doses (>30 mg/day) at diagnosis (group H). Patients with proliferative nephritis were excluded. The difference in SLEDAI scores between baseline (SLEDAI-0) and year one (SLEDAI-1) was the efficacy variable. Damage at 5 years was calculated using the SLICC damage index (SDI) and regarded as the safety variable. Glucocorticoid related damage was considered in the presence of cataracts, osteonecrosis, osteoporotic fractures and/or diabetes mellitus. RESULTS 30 patients were included in each group. Patients in group H received 5-fold higher doses of prednisone, less hydroxychloroquine and less methyl-prednisolone pulses. SLEDAI improvement was similar in both groups. Patients in group H were more likely to accrue new damage (adjusted HR 3.85 (95% CI 1.03-14.2)). No patients in group M suffered glucocorticoid-related damage, vs. 5 patients in group H (p=0.02). The average daily prednisone dose during the first year predicted accrual of new damage (adjusted HR 1.03, 95% CI 1.0-1.07, p=0.056) and accrual of glucocorticoid-related damage (adjusted HR 1.06, 95% CI 1.01-1.13, p=0.03). Likewise, average doses of prednisone >7.5mg/day were an independent predictor of new damage (adjusted HR 4.8, 95% CI 1.2-19.1). CONCLUSION Prednisone doses ≤30 mg/day are similarly effective and safer than higher doses for treating active lupus.
Collapse
Affiliation(s)
- Ioana Ruiz-Arruza
- Autoimmune Diseases Research Unit, Department Of Internal Medicine, Biocruces Health Research Institute, Hospital Universitario Cruces, University Of The Basque Country, Bizkaia, The Basque Country, Spain
| | - Cristiana Barbosa
- Autoimmune Diseases Research Unit, Department Of Internal Medicine, Biocruces Health Research Institute, Hospital Universitario Cruces, University Of The Basque Country, Bizkaia, The Basque Country, Spain; Internal Medicine Department, Hospital De Viseu, Portugal
| | - Amaia Ugarte
- Autoimmune Diseases Research Unit, Department Of Internal Medicine, Biocruces Health Research Institute, Hospital Universitario Cruces, University Of The Basque Country, Bizkaia, The Basque Country, Spain
| | - Guillermo Ruiz-Irastorza
- Autoimmune Diseases Research Unit, Department Of Internal Medicine, Biocruces Health Research Institute, Hospital Universitario Cruces, University Of The Basque Country, Bizkaia, The Basque Country, Spain.
| |
Collapse
|
34
|
Ugarte A, Ruiz Irastorza G. [Rituximab in antiphospholipid syndrome: always, never, sometimes?]. Med Clin (Barc) 2015; 144:115-7. [PMID: 25148947 DOI: 10.1016/j.medcli.2014.04.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 04/10/2014] [Indexed: 11/26/2022]
Affiliation(s)
- Amaia Ugarte
- Unidad de Investigación de Enfermedades Autoinmunes, Servicio de Medicina Interna, BioCruces Health Research Institute, Hospital Universitario Cruces, Universidad del País Vasco/Euskal Herriko Unibertsitatea, Barakaldo, Bizkaia, España
| | - Guillermo Ruiz Irastorza
- Unidad de Investigación de Enfermedades Autoinmunes, Servicio de Medicina Interna, BioCruces Health Research Institute, Hospital Universitario Cruces, Universidad del País Vasco/Euskal Herriko Unibertsitatea, Barakaldo, Bizkaia, España.
| |
Collapse
|
35
|
Gonzalez-Echavarri C, Villar I, Ugarte A, Larrieta R, Ruiz-Irastorza G. Prevalence and significance of persistently positive antiphospholipid antibodies in women with preeclampsia. J Rheumatol 2014; 42:210-3. [PMID: 25512484 DOI: 10.3899/jrheum.140737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine the prevalence of antiphospholipid antibodies (aPL) and their association with obstetric outcomes in women with preeclampsia. METHODS The study included 150 patients. Clinical variables, risk factors, and severity criteria for preeclampsia and aPL were analyzed. RESULTS We found aPL in 4% of patients without risk factors for preeclampsia and in no women with risk factors (p = 0.03). Fifty percent of aPL-positive patients had a fetus with intrauterine growth restriction versus 13.9% (p = 0.04). No relation between aPL and severe preeclampsia was found. CONCLUSION The prevalence of aPL among women with preeclampsia is low. aPL can predispose women without risk factors to preeclampsia.
Collapse
Affiliation(s)
- Cristina Gonzalez-Echavarri
- From the Autoimmune Diseases Research Unit, Department of Internal Medicine, and the Department of Obstetrics, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Universidad del País Vasco (UPV)/ Euskal Herriko Unibertsitatea (EHU), Bizkaia, Spain.C. Gonzalez-Echavarri, MD, Senior Registrar; I. Villar, MD, Consultant Physician; A. Ugarte, MD, Consultant Physician; G. Ruiz-Irastorza, MD, PhD, Professor of Medicine, Head of the Autoimmune Diseases Research Unit, Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, UPV/EHU; R. Larrieta, MD, Consultant Physician, Department of Obstetrics, BioCruces Health Research Institute, Hospital Universitario Cruces.
| | - Irama Villar
- From the Autoimmune Diseases Research Unit, Department of Internal Medicine, and the Department of Obstetrics, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Universidad del País Vasco (UPV)/ Euskal Herriko Unibertsitatea (EHU), Bizkaia, Spain.C. Gonzalez-Echavarri, MD, Senior Registrar; I. Villar, MD, Consultant Physician; A. Ugarte, MD, Consultant Physician; G. Ruiz-Irastorza, MD, PhD, Professor of Medicine, Head of the Autoimmune Diseases Research Unit, Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, UPV/EHU; R. Larrieta, MD, Consultant Physician, Department of Obstetrics, BioCruces Health Research Institute, Hospital Universitario Cruces
| | - Amaia Ugarte
- From the Autoimmune Diseases Research Unit, Department of Internal Medicine, and the Department of Obstetrics, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Universidad del País Vasco (UPV)/ Euskal Herriko Unibertsitatea (EHU), Bizkaia, Spain.C. Gonzalez-Echavarri, MD, Senior Registrar; I. Villar, MD, Consultant Physician; A. Ugarte, MD, Consultant Physician; G. Ruiz-Irastorza, MD, PhD, Professor of Medicine, Head of the Autoimmune Diseases Research Unit, Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, UPV/EHU; R. Larrieta, MD, Consultant Physician, Department of Obstetrics, BioCruces Health Research Institute, Hospital Universitario Cruces
| | - Rosa Larrieta
- From the Autoimmune Diseases Research Unit, Department of Internal Medicine, and the Department of Obstetrics, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Universidad del País Vasco (UPV)/ Euskal Herriko Unibertsitatea (EHU), Bizkaia, Spain.C. Gonzalez-Echavarri, MD, Senior Registrar; I. Villar, MD, Consultant Physician; A. Ugarte, MD, Consultant Physician; G. Ruiz-Irastorza, MD, PhD, Professor of Medicine, Head of the Autoimmune Diseases Research Unit, Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, UPV/EHU; R. Larrieta, MD, Consultant Physician, Department of Obstetrics, BioCruces Health Research Institute, Hospital Universitario Cruces
| | - Guillermo Ruiz-Irastorza
- From the Autoimmune Diseases Research Unit, Department of Internal Medicine, and the Department of Obstetrics, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Universidad del País Vasco (UPV)/ Euskal Herriko Unibertsitatea (EHU), Bizkaia, Spain.C. Gonzalez-Echavarri, MD, Senior Registrar; I. Villar, MD, Consultant Physician; A. Ugarte, MD, Consultant Physician; G. Ruiz-Irastorza, MD, PhD, Professor of Medicine, Head of the Autoimmune Diseases Research Unit, Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, UPV/EHU; R. Larrieta, MD, Consultant Physician, Department of Obstetrics, BioCruces Health Research Institute, Hospital Universitario Cruces
| |
Collapse
|
36
|
Gutiérrez-Fernández A, Palomino A, González-Pinto A, Ugarte A, Hernanz M, Mendíbil B, Etxebeste M, Pacheco L, Gónzalez-García G, Matute C. Novel association of Neuregulin 1 gene with bipolar disorder but not with schizophrenia. Schizophr Res 2014; 159:552-3. [PMID: 25244971 DOI: 10.1016/j.schres.2014.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 08/29/2014] [Accepted: 09/01/2014] [Indexed: 12/22/2022]
Affiliation(s)
- Arantza Gutiérrez-Fernández
- Neurotek UPV-EHU, Departamento de Neurociencias, CIBERNED and Achucarro Basque Center for Neuroscience, Parque Tecnológico de Bizkaia, E-48170 Zamudio, Vizcaya, Spain
| | - Aitor Palomino
- Neurotek UPV-EHU, Departamento de Neurociencias, CIBERNED and Achucarro Basque Center for Neuroscience, Parque Tecnológico de Bizkaia, E-48170 Zamudio, Vizcaya, Spain
| | - Ana González-Pinto
- Stanley Research Center, 03-RC-003, Vitoria, Spain; CIBERSAM, Vitoria, Spain
| | - Amaia Ugarte
- Stanley Research Center, 03-RC-003, Vitoria, Spain; CIBERSAM, Vitoria, Spain
| | - Margarita Hernanz
- Stanley Research Center, 03-RC-003, Vitoria, Spain; CIBERSAM, Vitoria, Spain
| | | | | | | | | | - Carlos Matute
- Neurotek UPV-EHU, Departamento de Neurociencias, CIBERNED and Achucarro Basque Center for Neuroscience, Parque Tecnológico de Bizkaia, E-48170 Zamudio, Vizcaya, Spain.
| |
Collapse
|
37
|
Gonzalez-Echavarri C, Pernas B, Ugarte A, Ruiz-Irastorza G. Severe multiorganic flare of systemic lupus erythematosus successfully treated with rituximab and cyclophosphamide avoiding high doses of prednisone. Lupus 2014; 23:323-6. [PMID: 24531426 DOI: 10.1177/0961203314520842] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Both acute pancreatitis and diffuse alveolar haemorrhage are rare conditions associated with systemic lupus erythematosus (SLE). In this case report, a 23-year-old female with SLE was diagnosed with lupus-associated pancreatitis and, within a few days and despite initial therapy with pulse methyl-prednisolone, subsequently suffered an acute respiratory failure due to a diffuse alveolar haemorrhage. The patient was admitted to the intensive care unit and treatment was intensified with cyclophosphamide and rituximab, which shortly induced the complete remission of SLE with resolution of both clinical conditions. She completed treatment with six pulses of cyclophosphamide followed by azathioprine, hydroxychloroquine and prednisone at initial doses of 20 mg/d with rapid tapering to 5 mg/d, without relapse of the disease during the following year. This case can illustrate that, even in severe, life-threatening SLE flares, it is possible to avoid high-dose prednisone, which has been associated with severe side effects, including infections. Acute pancreatitis and diffuse alveolar haemorrhage are rare conditions caused by SLE. DAH can be a life-threatening complication, with an early mortality of at least 50%. When facing such severe SLE activity, there is a general tendency to use high doses of prednisone as the initial therapy, maintaining such high doses for long periods of time, even after the clinical situation has subsided. We report a case of a young woman with SLE, suffering from acute pancreatitis and diffuse alveolar haemorrhage, who was successfully treated with pulse methyl-prednisolone, hydroxychloroquine, cyclophosphamide and rituximab, combined with medium doses of prednisone.
Collapse
Affiliation(s)
- C Gonzalez-Echavarri
- Autoimmune Diseases Research Unit, Department of Internal Medicine, Biocruces Health Research Institute, Hospital Universitario Cruces, University of The Basque Country, Spain
| | | | | | | |
Collapse
|
38
|
Lahera G, Bayón C, Bravo-Ortiz MF, Rodríguez-Vega B, Barbeito S, Sáenz M, Avedillo C, Villanueva R, Ugarte A, González-Pinto A, de Dios C. Mindfulness-based cognitive therapy versus psychoeducational intervention in bipolar outpatients with sub-threshold depressive symptoms: a randomized controlled trial. BMC Psychiatry 2014; 14:215. [PMID: 25124510 PMCID: PMC4154516 DOI: 10.1186/s12888-014-0215-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Accepted: 07/18/2014] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The presence of depressive subsyndromal symptoms (SS) in bipolar disorder (BD) increases the risk of affective relapse and worsens social, cognitive functioning, and quality of life. Nonetheless, there are limited data on how to optimize the treatment of subthreshold depressive symptoms in BD. Mindfulness-Based Cognitive Therapy (MBCT) is a psychotherapeutic intervention that has been shown effective in unipolar depression. The assessment of its clinical effectiveness and its impact on biomarkers in bipolar disorder patients with subsyndromal depressive symptoms and psychopharmacological treatment is needed. METHODS/DESIGN A randomized, multicenter, prospective, versus active comparator, evaluator-blinded clinical trial is proposed. Patients with BD and subclinical or mild depressive symptoms will be randomly allocated to: 1) MBCT added to psychopharmacological treatment; 2) a brief structured group psychoeducational intervention added to psychopharmacological treatment; 3) standard clinical management, including psychopharmacological treatment. Assessments will be conducted at screening, baseline, post-intervention (8 weeks) and 4 month follow-up post-intervention. The aim is to compare MBCT intervention versus a brief structured group psychoeducation. Our hypothesis is that MBCT will be more effective in reducing the subsyndromal depressive symptoms and will improve cognitive performance to a higher degree than the psychoeducational treatment. It is also hypothesized that a significant increase of BDNF levels will be found after the MBCT intervention. DISCUSSION This is the first randomized controlled trial to evaluate the effects of MBCT compared to an active control group on depressive subthreshold depressive symptoms in patients with bipolar disorder. TRIAL REGISTRATION ClinicalTrials.gov: NCT02133170. Registered 04/30/2014.
Collapse
Affiliation(s)
- Guillermo Lahera
- Department of Medicine and Medical Specialties, University of Alcalá, Madrid, Spain
| | - Carmen Bayón
- University Hospital La Paz, IDIPAZ, Madrid, Spain
| | | | | | - Sara Barbeito
- CIBERSAM Biomedical Research Centre in Mental Health Net (CIBERSAM), University Hospital of Álava, Vitoria-Gasteiz, Spain
| | - Margarita Sáenz
- CIBERSAM Biomedical Research Centre in Mental Health Net (CIBERSAM), University Hospital of Álava, Vitoria-Gasteiz, Spain
| | | | | | - Amaia Ugarte
- CIBERSAM Biomedical Research Centre in Mental Health Net (CIBERSAM), University Hospital of Álava, Vitoria-Gasteiz, Spain
| | - Ana González-Pinto
- CIBERSAM Biomedical Research Centre in Mental Health Net (CIBERSAM), University Hospital of Álava, Vitoria-Gasteiz, Spain
| | | |
Collapse
|
39
|
Orbe J, Rodriguez JA, Sanchez JA, Salicio A, Belzunce M, Ugarte A, Chang HCY, Rabal O, Oyarzabal J, Paramo JA. P230Metalloproteinases inhibition: a new approach to reduce hemorrhage and blood transfusions. Cardiovasc Res 2014. [DOI: 10.1093/cvr/cvu082.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
40
|
Ruiz-Arruza I, Ugarte A, Cabezas-Rodriguez I, Medina JA, Moran MA, Ruiz-Irastorza G. Glucocorticoids and irreversible damage in patients with systemic lupus erythematosus. Rheumatology (Oxford) 2014; 53:1470-6. [DOI: 10.1093/rheumatology/keu148] [Citation(s) in RCA: 132] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
41
|
Torrent C, Bonnin CDM, Martínez-Arán A, Valle J, Amann BL, González-Pinto A, Crespo JM, Ibáñez Á, Garcia-Portilla MP, Tabarés-Seisdedos R, Arango C, Colom F, Solé B, Pacchiarotti I, Rosa AR, Ayuso-Mateos JL, Anaya C, Fernández P, Landín-Romero R, Alonso-Lana S, Ortiz-Gil J, Segura B, Barbeito S, Vega P, Fernández M, Ugarte A, Subirà M, Cerrillo E, Custal N, Menchón JM, Saiz-Ruiz J, Rodao JM, Isella S, Alegría A, Al-Halabi S, Bobes J, Galván G, Saiz PA, Balanzá-Martínez V, Selva G, Fuentes-Durá I, Correa P, Mayoral M, Chiclana G, Merchan-Naranjo J, Rapado-Castro M, Salamero M, Vieta E. Efficacy of functional remediation in bipolar disorder: a multicenter randomized controlled study. Am J Psychiatry 2013; 170:852-9. [PMID: 23511717 DOI: 10.1176/appi.ajp.2012.12070971] [Citation(s) in RCA: 199] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors sought to assess the efficacy of functional remediation, a novel intervention program, on functional improvement in a sample of euthymic patients with bipolar disorder. METHOD In a multicenter, randomized, rater-blind clinical trial involving 239 outpatients with DSM-IV bipolar disorder, functional remediation (N=77) was compared with psychoeducation (N=82) and treatment as usual (N=80) over 21 weeks. Pharmacological treatment was kept stable in all three groups. The primary outcome measure was improvement in global psychosocial functioning, measured blindly as the mean change in score on the Functioning Assessment Short Test from baseline to endpoint. RESULTS At the end of the study, 183 patients completed the treatment phase. Repeated-measures analysis revealed significant functional improvement from baseline to endpoint over the 21 weeks of treatment (last observation carried forward), suggesting an interaction between treatment assignment and time. Tukey's post hoc tests revealed that functional remediation differed significantly from treatment as usual, but not from psychoeducation. CONCLUSIONS Functional remediation, a novel group intervention, showed efficacy in improving the functional outcome of a sample of euthymic bipolar patients as compared with treatment as usual.
Collapse
Affiliation(s)
- Carla Torrent
- Centers for Biomedical Research Network on Mental Health(CIBERSAM), Barcelona, Madrid, Vitoria, Oviedo, and Valencia, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Ruiz-Arruza I, Ugarte A, Cabezas I, Medina JA, Moran MA. THU0279 Prednisone Therapy is an Independent Cause of Damage Attributable to Steroids in Systemic Lupus Erythematosus. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
43
|
Rosa AR, González-Ortega I, González-Pinto A, Echeburúa E, Comes M, Martínez-Àran A, Ugarte A, Fernández M, Vieta E. One-year psychosocial functioning in patients in the early vs. late stage of bipolar disorder. Acta Psychiatr Scand 2012; 125:335-41. [PMID: 22283440 DOI: 10.1111/j.1600-0447.2011.01830.x] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of this 1-year follow-up study was to compare functional outcome as well as clinical differences between patients with first- and multiple-episode bipolar disorder. METHOD Bipolar disorder patients with first (n = 60) and multiple episodes (n = 59) were recruited from two hospitals in Spain. The Functioning Assessment Short Test (FAST) was used to assess functioning. The Hamilton Depression Rating Scale (HAMD) and the Young Mania Rating Scale (YMRS) were administered to assess mood symptoms. RESULTS As expected, patients with first episode experienced a greater functioning compared to patients with multiple episodes (11.26 ± 10.94 vs. 26.91 ± 13.96; t = 6.436, P < 0.001). There were significant demographic and clinical differences between both groups. Baseline depressive symptoms (F = 9.553, df = 4, 102; P < 0.001) and age (F = 14.145, df = 4, 103; P < 0.001) were significantly associated with poor functional recovery at 6-month and 12-month assessment, respectively, in a group of patients with multiple episodes. CONCLUSION Our data give support to the model of staging in bipolar disorder, showing that the enduring neurotoxicity of repeated episodes may contribute to sustained impairment in multiple areas of psychosocial functioning.
Collapse
Affiliation(s)
- A R Rosa
- Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Catalonia, Spain
| | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Ugarte A, Villar I, Ruiz-Irastorza G. [Management of pregnancy in patients with systemic lupus erythematosus]. Rev Clin Esp 2012; 212:491-8. [PMID: 22245369 DOI: 10.1016/j.rce.2011.11.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2011] [Revised: 10/02/2011] [Accepted: 11/07/2011] [Indexed: 11/15/2022]
Abstract
Patients with systemic lupus erythematosus are exposed to a remarkably high number of maternal-fetal complications during pregnancy. Knowledge regarding the reciprocal influence between lupus and pregnancy is the starting point to assure that these patients are correctly monitored. It is also important to carry out comprehensive preconception evaluation to individually evaluate the risk of each patient. The immunological profile, history of nephritis, presence of chronic damage and disease activity are the basic data that will determine the specific individual risk profile. Finally, correct drug management must be assured during this period, based on the safety profile of the different treatments during pregnancy and lactation.
Collapse
Affiliation(s)
- A Ugarte
- Unidad de Investigación de Enfermedades Autoinmunes, Servicio de Medicina Interna, Hospital de Cruces, Barakaldo, Bizkaia, Spain
| | | | | |
Collapse
|
45
|
González-Pinto A, Ruiz de Azúa S, Ibáñez B, Otero-Cuesta S, Castro-Fornieles J, Graell-Berna M, Ugarte A, Parellada M, Moreno D, Soutullo C, Baeza I, Arango C. Can positive family factors be protective against the development of psychosis? Psychiatry Res 2011; 186:28-33. [PMID: 20627207 DOI: 10.1016/j.psychres.2010.05.015] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2009] [Revised: 04/26/2010] [Accepted: 05/20/2010] [Indexed: 10/19/2022]
Abstract
Genetic and environmental factors are both involved in the aetiology of psychotic disorders. The aim of this study was to assess if positive and negative environmental factors, together with psychotic family antecedents, are associated with the recent development of psychosis. We also investigated the interactions between family history of psychosis and positive and negative family environment. The sample comprised 110 children and adolescents, who had suffered a first psychotic episode and 98 healthy controls. All subjects were interviewed about their socioeconomic status, family history of psychosis and family environment (Family Environment Scale, FES). Early onset psychosis was significantly associated with a family history of psychosis. Family environment was perceived as more negative and less positive among patients than among controls. A negative family environment increased the risk of psychosis independently of the family history of psychosis. However, there was a significant protective effect of a positive family environment for persons with a family history of psychosis. This effect was not seen in subjects without a family history of psychosis. Therefore, our results support the importance of considering both family history of psychosis and family environment in the early stages of psychosis.
Collapse
Affiliation(s)
- Ana González-Pinto
- Biomedical Research Center in Mental Health Net (CIBERSAM), Hospital Santiago Apóstol, Vitoria, Spain, University of the Basque Country.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Ugarte A, Fernández M, González I, Peciña J, Villamor A, Zuhaitz E, García B, García J, González-Pinto A. Misdiagnosis and psychotic symptoms in bipolar disorder. Eur Psychiatry 2011. [DOI: 10.1016/s0924-9338(11)71965-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
IntroductionEarly onset forms of bipolar disorder may be difficult to distinguish from schizophrenia. Although operational criteria have become more precise, and there are more diagnostic systems to catalogue a psychotic adolescent, the clinicians continue having difficulties.ObjectiveTo know the stability of the diagnosis of definitively bipolar patients with psychotic symptoms during the episodes, and factors that can influence other psychotic diagnoses in the first episode of the illness.Method140 bipolar patients of Araba, (Basque country) were included during 2 years. Patients were divided into two groups: unstable diagnoses (UD)(bipolar patients with an initial diagnosis of other psychosis) and stable diagnoses (SD) of bipolar disorder. Clinical and sociodemographic data were obtained.ResultsThe mean age at onset was significantly lower in the UD group (p = 0.004). It was rare to have an unstable diagnosis when the first psychotic episode occurred after age 38 (p = 0.008). There were more singles in the UD group (p = 0.010).The presence of mood incongruent psychotic symptoms was more frequent in the UD group (p < 0.001).Mood incongruent psychotic symptoms variable was the only independent factor significantly associated with an unstable diagnosis in the multivariate analysis (p = 0.036).DiscussionOne third of the patients have been previously diagnosed with other psychotic illness.This study suggests that the most important factor is the clinical picture, especially the presence of mood-incongruent psychotic symptoms. A correct diagnosis is important because patients who are prescribed mood stabilizers have lower rates of rehospitalisation than those who are not treated with mood stabilizers.
Collapse
|
47
|
Fernandez M, Ugarte A, Ruiz de Azua S, Saenz M, Karim Haidar M, Ron S, Besga A, Gonzalez-Pinto A. P01-206-Validation of two scales of depression in mixed mania. Eur Psychiatry 2011. [DOI: 10.1016/s0924-9338(11)71917-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
IntroductionThere are manic disorders with depressive symptoms in mixed mania that do not reach the threshold for the diagnosis of mixed episode.Mania and hypomania are evaluated with scales that do not detect the depressive symptoms of patients in manic episode.ObjectivesTo determine the usefulness of HAMD-5 and MES depression scales in patients with bipolar disorder type I and II who have a manic or hypomanic episode with depressive symptoms. These scales were compared with the HAMD-21 and the MADRS scales respectively.Methods100 subjects between 18 and 65 years old were included. All patients met the DSM-IV-TR criteria for bipolar disorder with manic or hypomanic symptoms and major depression.All patients were evaluated at baseline and at 3 and 4 weeks during the follow-up.ResultsAt baseline the HAMD-5 and the MES had high reliability (α = 0.88 and α = 0,74 respectively)The test-retest reliability between the 3rd and the 4th week was great for both scales (HAMD-5: r = 0,89; p < 0,001; MES: r = 0,77; p < 0,001).The convergent validity had an acceptable level for the HAMD-5 (HAMD-21/HAMD-5 = 0,73; 95% CI 0,599–0,873) and for the MES (MADRS/MES = 0,79; 95% CI 0,766–0,894)Regarding the discriminant validity, the values for the HAMD-5 and MES were higher than for the HAMD-21 and MADRS respectively (HAM-5: AUC = 0,92, 95% CI: 0,892–0,980; MES: AUC = 0,86, 95% CI: 0,786–0,934).ConclusionsBoth scales showed an adequate correlation with the HAMD-21 and MADRS and a high capacity of detection of mixed, pure and other symptoms as their remission.
Collapse
|
48
|
Aspiazu S, Mosquera F, Ibañez B, Vega P, Barbeito S, López P, Ruiz de Azúa S, Ugarte A, Vieta E, González-Pinto A. Manic and depressive symptoms and insight in first episode psychosis. Psychiatry Res 2010; 178:480-6. [PMID: 20471100 DOI: 10.1016/j.psychres.2010.03.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2009] [Revised: 10/27/2009] [Accepted: 03/15/2010] [Indexed: 10/19/2022]
Abstract
Insight impairment is common early in the course of psychosis. Most studies have focused on the relationship between insight and depression, although manic symptoms are also frequent in psychoses. The main aim of this study was to examine the relationship between insight dimensions and manic and depressive symptoms in first-episode psychosis. A group of inpatients in their first psychotic episodes (n=124) were evaluated using the Scale to Assess Unawareness of Mental Disorder, Young Mania Rating Scale and Hamilton Depression Rating Scale. To study the effect of clinical, manic and depressive symptoms on insight, awareness of mental disorder, awareness of the achieved effects of medication, and awareness of the social consequences of having a mental disorder were modelled using ordinal logistic regression techniques. Results showed that greater awareness of mental disorder was significantly related to higher age at first episode together with higher scores for negative and depressive symptoms. The opposite was found to be true in presentations with a higher severity of disease and manic symptoms. The model fitting unawareness of the achieved effects of medication identified the same significant variables, except in the case of negative symptoms. Finally, the model assessing the social consequences of having a mental disorder showed unawareness to be greater when manic symptoms and disease severity were high.
Collapse
Affiliation(s)
- Saioa Aspiazu
- Santiago Apóstol Hospital, Stanley Institute International Mood-Disorders Research Center, 03-RC-003, Centro de Investigación Biomédica en Red de Salud Mental (CIBER-sam), EHU/UPV, Vitoria, Spain
| | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Ugarte A, García J, Ruiz de Azúa S, González I, Sáenz M, Gutierrez M, Valcarcel C, Zuhaitz E, de la Rosa I, Alonso R, González-Pinto A. PW01-35 - A prospective study of mixed bipolar patients: ten years of follow up. Eur Psychiatry 2010. [DOI: 10.1016/s0924-9338(10)71437-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
|
50
|
González Pinto A, Barbeito S, José Díaz F, Vega P, Mosquera F, López P, Alberich S, Ruiz de Azua S, Ugarte A, Martín M, de León J. Age at onset in bipolar I disorder: two may be better than three subgroups. Rev Psiquiatr Salud Ment 2009; 2:29-34. [PMID: 23034195 DOI: 10.1016/s1888-9891(09)70711-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2008] [Accepted: 09/29/2008] [Indexed: 10/20/2022]
Abstract
INTRODUCTION AND OBJECTIVE Age at onset in bipolar disorder is related to prognosis and to treatment response. However, it is not clear if there are three or two subgroups in relation to age at onset. The objective of this study is to analyze the number of subgroups in relation to age at the beginning of the disease in a representative sample of bipolar I patients and to compare the subgroups in relation to clinical variables. METHOD We included 169 patients diagnosed with bipolar I disorder. Normal mixture analysis was performed. The subgroups of patients formed above were compared regarding clinical characteristics. Patients were followed-up during six years. RESULTS We found three ages at onset subgroups. The early onset group (18.2±2 years) included 34% of the patients. The second group (26.1±5.5 years) included 44% of the patients. The third group (50.9±9.1 years) included 22% of the patients. Early and intermediate onset groups were not significantly different, and had more family history of affective disorders, more psychotic symptoms, more history of suicide attempts and more history of drug abuse history than the late onset group. CONCLUSIONS Our results suggest that there are three groups of age at onset but early and intermediate groups are similar in relation to clinical variables. The late onset group includes almost a quartile of patients and has different clinical profile.
Collapse
Affiliation(s)
- Ana González Pinto
- Departamento de Psiquiatría. Hospital Santiago Apóstol, Sistema Vasco de Salud Mental, Vitoria, España.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|