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Martínez Perez JM, Mollerach FB, Scaglioni V, Vergara F, Gandino IJ, Catoggio LJ, Rosa JE, Soriano ER, Scolnik M. Incidence and Prevalence of Polymyalgia Rheumatica and Giant Cell Arteritis in a Healthcare Management Organization in Buenos Aires, Argentina. J Rheumatol 2023; 50:93-97. [PMID: 36243415 DOI: 10.3899/jrheum.220084] [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] [Accepted: 08/11/2022] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To estimate incidence and prevalence of polymyalgia rheumatica (PMR) and giant cell arteritis (GCA) in a university hospital-based health management organization (Hospital Italiano Medical Care Program) in Argentina. METHODS Overall and sex-specific incidence rates (IRs) and prevalence were calculated (age ≥ 50 yrs). Incidence study followed members with continuous affiliation ≥ 1 year from January 2000 to December 2015. Diagnosis as per the 2012 European Alliance of Associations for Rheumatology/American College of Rheumatology (ACR) criteria for PMR or the ACR 1990 criteria for GCA. Prevalence was calculated on January 1, 2015. RESULTS There were 176,558 persons who contributed a total of 1,046,620 person-years (PY). Of these, 825 developed PMR, with an IR (per 100,000 PY) of 78.8 (95% CI 73.4-84.2) overall, 90.1 (95% CI 82.9-97.2) for women, and 58.9 (95% CI 51.1-66.6) for men. Ninety persons developed GCA; the IR was 8.6 (95% CI 6.8-10.4) overall, 11.1 (95% CI 8.5-10.6) for women, and 4.2 (2.2-6.3) for men. There were 205 prevalent PMR cases and 23 prevalent GCA cases identified from a population of 80,335. Prevalence of PMR was 255 per 100,000 (95% CI 220-290) overall, 280 (95% CI 234-325) for women, and 209 (95% CI 150-262) for men; and the prevalence of GCA was 28.6 per 100,000 (95% CI 16.9-40.3) overall, 36.4 (95% CI 20.1-52.8) for women, and 14.2 (95% CI 0.3-28.1) for men. CONCLUSION This is the first study of incidence and prevalence of PMR and GCA in Argentina. There were similarities and differences with cohorts from other parts of the world, but population-based epidemiologic studies in Latin America are needed.
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Affiliation(s)
- José Maximiliano Martínez Perez
- J.M. Martínez Perez, MD, F.B. Mollerach, MD, V. Scaglioni, MD, F. Vergara, MD, I.J. Gandino, MD, L.J. Catoggio, PhD, J. E. Rosa, MSc, E.R. Soriano, MSc, M. Scolnik, MD, Rheumatology Section, Hospital Italiano de Buenos Aires, Argentina
| | - Florencia Beatriz Mollerach
- J.M. Martínez Perez, MD, F.B. Mollerach, MD, V. Scaglioni, MD, F. Vergara, MD, I.J. Gandino, MD, L.J. Catoggio, PhD, J. E. Rosa, MSc, E.R. Soriano, MSc, M. Scolnik, MD, Rheumatology Section, Hospital Italiano de Buenos Aires, Argentina
| | - Valeria Scaglioni
- J.M. Martínez Perez, MD, F.B. Mollerach, MD, V. Scaglioni, MD, F. Vergara, MD, I.J. Gandino, MD, L.J. Catoggio, PhD, J. E. Rosa, MSc, E.R. Soriano, MSc, M. Scolnik, MD, Rheumatology Section, Hospital Italiano de Buenos Aires, Argentina
| | - Facundo Vergara
- J.M. Martínez Perez, MD, F.B. Mollerach, MD, V. Scaglioni, MD, F. Vergara, MD, I.J. Gandino, MD, L.J. Catoggio, PhD, J. E. Rosa, MSc, E.R. Soriano, MSc, M. Scolnik, MD, Rheumatology Section, Hospital Italiano de Buenos Aires, Argentina
| | - Ignacio Javier Gandino
- J.M. Martínez Perez, MD, F.B. Mollerach, MD, V. Scaglioni, MD, F. Vergara, MD, I.J. Gandino, MD, L.J. Catoggio, PhD, J. E. Rosa, MSc, E.R. Soriano, MSc, M. Scolnik, MD, Rheumatology Section, Hospital Italiano de Buenos Aires, Argentina
| | - Luis José Catoggio
- J.M. Martínez Perez, MD, F.B. Mollerach, MD, V. Scaglioni, MD, F. Vergara, MD, I.J. Gandino, MD, L.J. Catoggio, PhD, J. E. Rosa, MSc, E.R. Soriano, MSc, M. Scolnik, MD, Rheumatology Section, Hospital Italiano de Buenos Aires, Argentina
| | - Javier Eduardo Rosa
- J.M. Martínez Perez, MD, F.B. Mollerach, MD, V. Scaglioni, MD, F. Vergara, MD, I.J. Gandino, MD, L.J. Catoggio, PhD, J. E. Rosa, MSc, E.R. Soriano, MSc, M. Scolnik, MD, Rheumatology Section, Hospital Italiano de Buenos Aires, Argentina
| | - Enrique Roberto Soriano
- J.M. Martínez Perez, MD, F.B. Mollerach, MD, V. Scaglioni, MD, F. Vergara, MD, I.J. Gandino, MD, L.J. Catoggio, PhD, J. E. Rosa, MSc, E.R. Soriano, MSc, M. Scolnik, MD, Rheumatology Section, Hospital Italiano de Buenos Aires, Argentina
| | - Marina Scolnik
- J.M. Martínez Perez, MD, F.B. Mollerach, MD, V. Scaglioni, MD, F. Vergara, MD, I.J. Gandino, MD, L.J. Catoggio, PhD, J. E. Rosa, MSc, E.R. Soriano, MSc, M. Scolnik, MD, Rheumatology Section, Hospital Italiano de Buenos Aires, Argentina.
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Di Sanzo L, Scrivo R, Soriano ER, Citera G, Mysler E, Wei JCC, Ríos MHC. Editorial: Drug Survival: Treatment of Rheumatic Diseases in the Biologic Era. Front Med (Lausanne) 2022; 9:858817. [PMID: 35252282 PMCID: PMC8895950 DOI: 10.3389/fmed.2022.858817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 01/31/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Lorenzo Di Sanzo
- Rheumatology Unit, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Rossana Scrivo
- Rheumatology Unit, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
- *Correspondence: Rossana Scrivo
| | | | - Gustavo Citera
- Instituto Nacional de Rehabilitación Psicofísica, Buenos Aires, Argentina
| | | | - James Cheng-Chung Wei
- Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
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Alves Pereira I, Maldonado Cocco J, Feijó Azevedo V, Guerra G, Bautista-Molano W, Casasola JC, Vega Morales D, Soriano ER, Gil DR, Zazzetti F, Aldunate L, Holdsworth EA, Massey O, Lobosco S, Lawson F. Levels of satisfaction with rheumatoid arthritis treatment and associated alignment between physicians and patients across Latin America. Clin Rheumatol 2020; 39:1813-1822. [PMID: 32030635 DOI: 10.1007/s10067-019-04858-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 07/12/2019] [Revised: 10/10/2019] [Accepted: 11/14/2019] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Discordance (misalignment) regarding treatment satisfaction may exist in real-life clinical practice between patients and their physicians. We aimed to assess physician and patient treatment satisfaction levels and associated degree of misalignment in rheumatoid arthritis (RA). METHOD A point-in-time, multinational survey of patients and physicians was conducted in Latin America from December 2014 to October 2015. Physician- and patient-reported satisfaction levels with current RA treatment, alignment levels in satisfaction perception, and factors associated with satisfaction misalignment were assessed through bivariate and logistic regression analyses. RESULTS Participating physicians (N = 114) completed 555 patient record forms (PRFs); 372 patients completed self-complete questionnaires (PSC). A total of 346 physician-patient pairs were analyzed. Physicians reported satisfaction with current disease control in 270/346 (78.0%) PRFs; patients reported such satisfaction in 286/346 (82.7%) PSCs. Physician-patient alignment was observed in 78.6% of pairs. Compared with aligned patients, misaligned patients were younger, more likely to have moderate or severe disease (physician subjectively defined), deteriorating or unstable disease (physician subjectively defined), been exposed to a greater number of advanced therapy lines (biologic or Janus kinase inhibitor), greater current pain, a current acute episode, poorer health, and greater disability and impairment. Misaligned patients were less likely to be in remission. Logistic regression analysis revealed that misaligned patients were more likely to experience greater activity impairment. CONCLUSIONS High treatment satisfaction and alignment were observed among RA patients and their physicians in Latin America. Misaligned patients were more likely to report more severe disease and were less likely to be in remission. Addressing misalignment may lead to improved RA disease control.Key Points• High treatment satisfaction was observed among RA patients and their treating physicians in Latin America.• One-fifth of physician-patient pairs were misaligned in treatment satisfaction.• Patients misaligned with their physicians reported higher disease activity, lower quality of life, and greater disability than those who were aligned with their physicians.• Understanding and addressing misalignment in treatment satisfaction may improve outcomes in this patient population.
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Affiliation(s)
- Ivanio Alves Pereira
- Divisão de Reumatologia, Hospital Universitário, Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
| | - José Maldonado Cocco
- School of Medicine, Buenos Aires University and Argentine Rheumatologic Foundation Dr. Osvaldo Carcia Morteo, Buenos Aires, Argentina
| | | | - Generoso Guerra
- Internal Medicine and Rheumatology, Centro Médico Royal Center Paitilla, Panama City, Panamá
| | - Wilson Bautista-Molano
- Rheumatology Section, University Hospital Fundación Santa Fe de Bogotá and Universidad Militar Nueva Granada, Bogotá, Colombia
- School of Medicine, Universidad Militar Nueva Granada, Bogotá, Colombia
| | | | - David Vega Morales
- Rheumatology Service, Internal Medicine Department, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Enrique Roberto Soriano
- Sección Reumatología, Servicio de Clínica Médica, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
- Instituto Universitario Escuela de Medicina Hospital Italiano de Buenos Aires, Fundación Pedro M Catoggio para el progreso de la Reumatologia, Buenos Aires, Argentina
| | - Diana Rocío Gil
- Internal Medicine and Rheumatology, ART Medica-Hospital Universitario Mayor MEDERI, Bogota, Colombia
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Soriano ER, Zazzetti F, Alves Pereira I, Maldonado Cocco J, Feijó Azevedo V, Guerra G, Bautista-Molano W, Casasola JC, Vega Morales D, Gil DR, Lobosco S, Lawson F. Physician-patient alignment in satisfaction with psoriatic arthritis treatment in Latin America. Clin Rheumatol 2020; 39:1859-1869. [DOI: 10.1007/s10067-019-04870-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 09/25/2019] [Accepted: 10/17/2019] [Indexed: 01/10/2023]
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Scolnik M, Scaglioni V, Pons-Estel GJ, Soriano ER. Management of non-renal non-neurologic persistent lupus activity in real world patients from Argentina. Lupus 2019; 28:1167-1173. [PMID: 31299882 DOI: 10.1177/0961203319861687] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Management of systemic lupus erythematosus patients is challenging because of disease heterogeneity. Although treatment of renal nephritis is more standardized, treating non-renal lupus activity remains controversial. Our objective was to identify non-renal, non-neurologic persistent active systemic lupus erythematosus patients in our cohort and described therapeutic behaviors in them. All systemic lupus erythematosus patients (American College of Rheumatology and/or Systemic Lupus Erythematosus International Collaborating Clinics criteria) seen at a university hospital between 2000 and 2017 were included and electronic medical records manually reviewed. Persistent lupus activity was defined as a patient with a Systemic Lupus Erythematosus Disease Activity Index score ≥ 6 (without renal and central nervous system manifestations) despite being on a stable treatment regimen for ≥ 30 days. Stable treatment could include prednisone alone (7.5-40 mg/d) or combined with antimalarial drugs and immunosuppressant therapies. A total of 257 lupus patients were included, 230 females (89.5%, 95% confidence interval 85.1-92.7), mean age at diagnosis 29.9 years (SD 16.4). After a median cohort follow-up of 5.7 years (interquartile range 2.4-10.2), 14 patients (5.4%, 95% confidence interval 3.2-9.0) showed persistent non-renal non neurologic lupus activity, with a median disease duration of 11.3 years (interquartile range 3.6-19.4). At that time, 12/14 (85.7 %, 95% confidence interval 52.6-97.0%) had low complement and 11/14 (78.6 %, 95% confidence interval 46.5-93.9%) had positive antiDNA antibodies. The main reasons for being refractory were mucocutaneous disease (50%, 95% confidence interval 23.5-76.5) and arthritis (42.9%, 95% confidence interval 18.5-71.2). Therapeutic choices after being refractory were: only increasing corticosteroid dose in one patient, starting rituximab in four, belimumab in eight, and in one mycophenolate and rituximab; with good response in all of them. In conclusion, 5.4% of systemic lupus erythematosus patients in our cohort were considered to have non-renal non neurologic persistent lupus activity, with mucocutaneous and arthritis the main manifestations. In total, 92.8% of these patients started a biologic treatment at this point (rituximab or belimumab).
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Affiliation(s)
- M Scolnik
- 1 Rheumatology Section, Hospital Italiano de Buenos Aires, Argentina.,2 Department of Medicine, Instituto Universitario Hospital Italiano de Buenos Aires, Argentina
| | - V Scaglioni
- 1 Rheumatology Section, Hospital Italiano de Buenos Aires, Argentina.,2 Department of Medicine, Instituto Universitario Hospital Italiano de Buenos Aires, Argentina
| | - G J Pons-Estel
- 3 Internal Medicine Department, Centro Regional de Enfermedades Autoinmunes y Reumáticas, Rosario, Argentina.,4 Rheumatology Service, Hospital Provincial de Rosario, Rosario, Argentina
| | - E R Soriano
- 1 Rheumatology Section, Hospital Italiano de Buenos Aires, Argentina.,2 Department of Medicine, Instituto Universitario Hospital Italiano de Buenos Aires, Argentina
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Gandino IJ, Scolnik M, Bertiller E, Scaglioni V, Catoggio LJ, Soriano ER. Complement levels and risk of organ involvement in patients with systemic lupus erythematosus. Lupus Sci Med 2017; 4:e000209. [PMID: 29259790 PMCID: PMC5729297 DOI: 10.1136/lupus-2017-000209] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 05/03/2017] [Accepted: 05/07/2017] [Indexed: 11/06/2022]
Abstract
Objective Complement plays a major role in SLE. Complement participation has been linked to disease activity and damage. Our objective was to estimate the association of complement behaviour with clinical manifestations, visceral injury and mortality in patients with SLE. Methods Complement determinations (C3 and C4 levels) were analysed in patients with SLE (fulfilling American College of Rheumatology (ACR) or Systemic Lupus International Collaborating Clinics (SLICC)criteria) seen at a university hospital between 2000 and 2013. Patients were grouped in those with permanent C3 and/or C4 low values (low complement group), those with C3 and C4 constant normal values (normal complement group) and those with fluctuant values (periods of normal and periods of low values: fluctuant group). Clinical characteristics and mortality were analysed and compared between groups. Results 270 patients with SLE were included (242 females, 89.6%), mean age at diagnosis was 34.2 years (SD 15.8). 75 patients had fluctuant levels of complement, 79 patients had persistent low complement levels and 116 had normal complement levels. Lupus glomerulonephritis was more frequent in patients with fluctuant levels (75%, 56% and 49%, respectively, p=0002). The normal complement group had less frequency of haematological involvement and anti-double stranded DNA (dsDNA) antibodies. At the end of the follow-up, 53% of the patients had damage (SLICC/ACR ≥1). In a Cox proportional hazard model age at diagnosis, neurological impairment, thrombocytopaenia and corticosteroids were associated with more damage, while hydroxychloroquine was a protective factor. There were no differences between complements groups on accumulated damage. Ten-year survival rate was 93%, 93.5% and 92% for the normal complement group, the persistently low group and the fluctuant group, respectively. Conclusions Patients with constant normal complement had lower prevalence of haematological involvement and anti-dsDNA, while patients with fluctuant complement had higher renal impairment. Neither the persistent low complement nor the fluctuant complement groups had increased mortality and/or visceral damage.
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Affiliation(s)
- Ignacio Javier Gandino
- Hospital Italiano de Buenos Aires, Rheumatology Section, Medical Services. Instituto Universitario Hospital Italiano de Buenos Aires, and Fundacion PM Catoggio., Buenos Aires, Argentina
| | - Marina Scolnik
- Hospital Italiano de Buenos Aires, Rheumatology Section, Medical Services. Instituto Universitario Hospital Italiano de Buenos Aires, and Fundacion PM Catoggio., Buenos Aires, Argentina
| | - Emmanuel Bertiller
- Hospital Italiano de Buenos Aires, Rheumatology Section, Medical Services. Instituto Universitario Hospital Italiano de Buenos Aires, and Fundacion PM Catoggio., Buenos Aires, Argentina
| | - Valeria Scaglioni
- Hospital Italiano de Buenos Aires, Rheumatology Section, Medical Services. Instituto Universitario Hospital Italiano de Buenos Aires, and Fundacion PM Catoggio., Buenos Aires, Argentina
| | - Luis Jose Catoggio
- Hospital Italiano de Buenos Aires, Rheumatology Section, Medical Services. Instituto Universitario Hospital Italiano de Buenos Aires, and Fundacion PM Catoggio., Buenos Aires, Argentina
| | - Enrique Roberto Soriano
- Hospital Italiano de Buenos Aires, Rheumatology Section, Medical Services. Instituto Universitario Hospital Italiano de Buenos Aires, and Fundacion PM Catoggio., Buenos Aires, Argentina
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Pons-Estel GJ, Aspey LD, Bao G, Pons-Estel BA, Wojdyla D, Saurit V, Alvarellos A, Caeiro F, Haye Salinas MJ, Sato EI, Soriano ER, Costallat LTL, Neira O, Iglesias-Gamarra A, Reyes-Llerena G, Cardiel MH, Acevedo-Vásquez EM, Chacón-Díaz R, Drenkard C. Early discoid lupus erythematosus protects against renal disease in patients with systemic lupus erythematosus: longitudinal data from a large Latin American cohort. Lupus 2016; 26:73-83. [DOI: 10.1177/0961203316651740] [Citation(s) in RCA: 7] [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] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 05/04/2016] [Indexed: 01/13/2023]
Abstract
Objectives The objective of this study was to examine whether early discoid lupus erythematosus (DLE) would be a protective factor for further lupus nephritis in patients with systemic lupus erythematosus (SLE). Methods We studied SLE patients from GLADEL, an inception longitudinal cohort from nine Latin American countries. The main predictor was DLE onset, which was defined as physician-documented DLE at SLE diagnosis. The outcome was time from the diagnosis of SLE to new lupus nephritis. Univariate and multivariate survival analyses were conducted to examine the association of DLE onset with time to lupus nephritis. Results Among 845 GLADEL patients, 204 (24.1%) developed lupus nephritis after SLE diagnosis. Of them, 10 (4.9%) had DLE onset, compared to 83 (12.9%) in the group of 641 patients that remained free of lupus nephritis (hazard ratio 0.39; P = 0.0033). The cumulative proportion of lupus nephritis at 1 and 5 years since SLE diagnosis was 6% and 14%, respectively, in the DLE onset group, compared to 14% and 29% in those without DLE ( P = 0.0023). DLE onset was independently associated with a lower risk of lupus nephritis, after controlling for sociodemographic factors and disease severity at diagnosis (hazard ratio 0.38; 95% confidence interval 0.20–0.71). Conclusions Our data indicate that DLE onset reduces the risk of further lupus nephritis in patients with SLE, independently of other factors such as age, ethnicity, disease activity, and organ damage. These findings have relevant prognosis implications for SLE patients and their clinicians. Further studies are warranted to unravel the biological and environmental pathways associated with the protective role of DLE against renal disease in patients with SLE.
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Affiliation(s)
- G J Pons-Estel
- Department of Autoimmune Diseases, Institut Clínic de Medicina i Dermatologia, Barcelona, Spain
| | - L D Aspey
- Department of Dermatology, Emory School of Medicine, Atlanta, USA
| | - G Bao
- Division of Rheumatology, Emory School of Medicine, Atlanta, USA
| | - B A Pons-Estel
- Servicio de Reumatología, Hospital Provincial de Rosario, Rosario, Argentina
| | - D Wojdyla
- GLADEL Consultant, Universidad Nacional de Rosario, Rosario, Argentina
| | - V Saurit
- Servicio de Reumatología, Hospital Privado, Córdoba, Argentina
| | - A Alvarellos
- Servicio de Reumatología, Hospital Privado, Córdoba, Argentina
| | - F Caeiro
- Servicio de Reumatología, Hospital Privado, Córdoba, Argentina
| | | | - E I Sato
- Departamento de Medicina, Universidade Federal da São Paulo (UNIFESP), São Paulo, Brazil
| | - E R Soriano
- Sección de Reumatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
- Fundación Dr Pedro M Catoggio para el Progreso de la Reumatología, Buenos Aires, Argentina
| | - L T L Costallat
- Divisao de Reumatologia, Universidade Estadual de Campinas, Campinas, Brazil
| | - O Neira
- Sección de Reumatología, Hospital del Salvador, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - A Iglesias-Gamarra
- Facultad de Medicina, Universidad Nacional de Colombia, Bogota, Colombia
| | - G Reyes-Llerena
- Servicio Nacional de Reumatología, Centro de Investigaciones Médico Quirúrgicas (CIMEQ), La Habana, Cuba
| | - M H Cardiel
- Centro de Investigación Clínica de Morelia, Morelia, México
| | - E M Acevedo-Vásquez
- Servicio de Reumatología, Hospital Nacional ‘Guillermo Almenara Irigoyen’, School of Medicine, Universidad Nacional Mayor de San Marcos, Lima, Perú
| | - R Chacón-Díaz
- Servicio de Reumatología, Hospital Universitario, Caracas, Venezuela
| | - C Drenkard
- Division of Rheumatology, Emory School of Medicine, Atlanta, USA
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Vergara F, Rosa J, Orozco C, Bertiller E, Gallardo MA, Bravo M, Catay E, Collado V, Gómez G, Sabelli M, García MV, Rosemffet MG, Citera G, Schneeberger EE, Catoggio LJ, Soriano ER. Evaluation of learned helplessness, self-efficacy and disease activity, functional capacity and pain in Argentinian patients with rheumatoid arthritis. Scand J Rheumatol 2016; 46:17-21. [DOI: 10.3109/03009742.2016.1155643] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- F Vergara
- Rheumatology Unit, Internal Medicine Service, Hospital Italiano, Buenos Aires, Argentina
| | - J Rosa
- Rheumatology Unit, Internal Medicine Service, Hospital Italiano, Buenos Aires, Argentina
- University School of Medicine, Hospital Italiano, and Dr Pedro M Catoggio Foundation, Buenos Aires, Argentina
| | - C Orozco
- Institute of Psychophysical Rehabilitation, Buenos Aires, Argentina
| | - E Bertiller
- Rheumatology Unit, Internal Medicine Service, Hospital Italiano, Buenos Aires, Argentina
| | - MA Gallardo
- Rheumatology Unit, Internal Medicine Service, Hospital Italiano, Buenos Aires, Argentina
| | - M Bravo
- Rheumatology Unit, Internal Medicine Service, Hospital Italiano, Buenos Aires, Argentina
| | - E Catay
- Rheumatology Unit, Internal Medicine Service, Hospital Italiano, Buenos Aires, Argentina
| | - V Collado
- The Alfred Lanari Medical Research Institute, Buenos Aires, Argentina
| | - G Gómez
- The Alfred Lanari Medical Research Institute, Buenos Aires, Argentina
| | - M Sabelli
- Rheumatology Unit, Internal Medicine Service, Hospital Italiano, Buenos Aires, Argentina
| | - MV García
- Rheumatology Unit, Internal Medicine Service, Hospital Italiano, Buenos Aires, Argentina
| | - MG Rosemffet
- Institute of Psychophysical Rehabilitation, Buenos Aires, Argentina
| | - G Citera
- Institute of Psychophysical Rehabilitation, Buenos Aires, Argentina
| | - EE Schneeberger
- Institute of Psychophysical Rehabilitation, Buenos Aires, Argentina
| | - LJ Catoggio
- Rheumatology Unit, Internal Medicine Service, Hospital Italiano, Buenos Aires, Argentina
- University School of Medicine, Hospital Italiano, and Dr Pedro M Catoggio Foundation, Buenos Aires, Argentina
| | - ER Soriano
- Rheumatology Unit, Internal Medicine Service, Hospital Italiano, Buenos Aires, Argentina
- University School of Medicine, Hospital Italiano, and Dr Pedro M Catoggio Foundation, Buenos Aires, Argentina
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Catoggio LJ, Soriano ER, Imamura PM, Wojdyla D, Jacobelli S, Massardo L, Chacón Díaz R, Guibert-Toledano M, Alvarellos A, Saurit V, Manni JA, Pascual-Ramos V, Silva de Sauza AW, Bonfa E, Tavares Brenol JC, Ramirez LA, Barile-Fabris LA, De La Torre IG, Alarcón GS, Pons-Estel BA. Late-onset systemic lupus erythematosus in Latin Americans: a distinct subgroup? Lupus 2014; 24:788-95. [PMID: 25504653 DOI: 10.1177/0961203314563134] [Citation(s) in RCA: 27] [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] [Received: 07/29/2014] [Accepted: 11/15/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To examine the characteristics of patients who developed late onset systemic lupus erythematosus (SLE) in the GLADEL (Grupo Latino Americano de Estudio del Lupus) cohort of patients with SLE. METHODS Patients with SLE of less than two years of disease duration, seen at 34 centers of nine Latin American countries, were included. Late-onset was defined as >50 years of age at time of first SLE-related symptom. Clinical and laboratory manifestations, activity index (SLEDAI), and damage index (SLICC/ACR- DI) were ascertained at time of entry and during the course (cumulative incidence). Features were compared between the two patient groups (<50 and ≥50) using descriptive statistics and hypothesis tests. Logistic regression was performed to examine the association of late-onset lupus, adjusting for other variables. RESULTS Of the 1480 patients included, 102 patients (6.9 %) had late-onset SLE, 87% of which were female. Patients with late-onset SLE had a shorter follow-up (3.6 vs. 4.4 years, p < 0.002) and a longer time to diagnosis (10.1 vs. 5.8 months, p < 0.001) compared to the younger onset group. Malar rash, photosensitivity, and renal involvement were less prevalent while interstitial lung disease, pleural effusions, and sicca symptoms were more frequent in the older age group (p > 0.05). In multivariable analysis, late onset was independently associated with higher odds of ocular (OR = 3.66, 95% CI = 2.15-6.23), pulmonary (OR = 2.04, 95% CI = 1.01-4.11), and cardiovascular (OR = 1.76, 95% CI = 1.04-2.98) involvement and lower odds of cutaneous involvement (OR = 0.41, 95% CI = 0.21-0.80), number of cumulative SLE criteria (OR = 0.79, 95% CI = 0.64-0.97), use of cyclophosphamide (OR = 0.47, 95% CI = 0.24-0.95), and anti-RNP antibodies (OR = 0.43, 95% CI = 0.20-0.91). A Cox regression model revealed a higher risk of dying in older onset than the younger-onset SLE (OR = 2.61, 95% CI = 1.2-5.6). CONCLUSION Late-onset SLE in Latin Americans had a distinct disease expression compared to the younger-onset group. The disease seems to be mild with lower cumulative SLE criteria, reduced renal/mucocutaneous involvements, and less use of cyclophosphamide. Nevertheless, these patients have a higher risk of death and of ocular, pulmonary, and cardiovascular involvements.
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Affiliation(s)
- L J Catoggio
- Hospital Italiano de Buenos Aires and Fundación Dr. Pedro M. Catoggio para el Progreso de la Reumatología, Buenos Aires, Argentina
| | - E R Soriano
- Hospital Italiano de Buenos Aires and Fundación Dr. Pedro M. Catoggio para el Progreso de la Reumatología, Buenos Aires, Argentina
| | - P M Imamura
- Hospital Italiano de Buenos Aires and Fundación Dr. Pedro M. Catoggio para el Progreso de la Reumatología, Buenos Aires, Argentina
| | - D Wojdyla
- Universidad Nacional de Rosario, Rosario, Argentina
| | - S Jacobelli
- Departamento de Inmunología Clínica y Reumatología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - L Massardo
- Departamento de Inmunología Clínica y Reumatología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - R Chacón Díaz
- Hospital Universitario de Caracas, Caracas, Venezuela
| | | | - A Alvarellos
- Servicio de Reumatología, Hospital Privado, Centro Médico de Córdoba, Córdoba, Argentina
| | - V Saurit
- Servicio de Reumatología, Hospital Privado, Centro Médico de Córdoba, Córdoba, Argentina
| | - J A Manni
- Instituto de Investigaciones Médicas "Alfredo Lanari", Buenos Aires, Argentina
| | - V Pascual-Ramos
- Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", México Distrito Federal, Mexico
| | | | - E Bonfa
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - J C Tavares Brenol
- Hospital das Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - L A Ramirez
- Universidad de Antioquia, Hospital Universitario "Fundación San Vicente", Medellín, Colombia
| | - L A Barile-Fabris
- Hospital de Especialidades Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México Distrito Federal, Mexico
| | - I Garcia De La Torre
- Hospital General de Occidente de la Secretaría de Salud, Guadalajara, Jalisco, Mexico
| | - G S Alarcón
- Department of Medicine, Division of Clinical Immunology and Rheumatology, School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
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Scolnik M, Lancioni E, Saucedo C, Marin J, Sabelli M, Bedran Z, Soriano ER, Catoggio LJ. Systemic sclerosis in Argentina: evaluation of a large cohort from a single centre and comparison with other international series. Clin Exp Rheumatol 2014; 32:S-94-7. [PMID: 25198424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 06/03/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVES Prevalence of systemic sclerosis (SSc) and different clinical subsets varies across the world. Few data have been published on SSc patients in Latin America. Our objective was to describe a SSc cohort in Argentina and to compare clinical findings, disease subsets and antibodies with other international SSc populations. METHODS Patients with SSc (n=234) seen at the Rheumatology section of the Hospital Italiano de Buenos Aires between 2000-2011 were retrospectively analysed. Data on clinical manifestations, disease subsets and antibodies were obtained. Patients were classified into diffuse cutaneous (dc) and limited cutaneous (lc) subsets. Comparison with other cohorts (France, United States, Germany, Italy, Mexico, EUSTAR and Brazil) was made based on published information. RESULTS A higher female:male ratio (12:1) and a higher limited subset prevalence (76.1%) was found in this Argentine cohort comparing with others. We also found a lower prevalence of diffuse disease, anti Scl-70 (antitopoisomerase) and nucleolar pattern antinuclear antibodies. Within each subset, clinical findings were similar with other SSc populations except for a very low prevalence in renal crisis (0.02% of dc SS). CONCLUSIONS With slight variations perhaps due to genetic, environmental or referral factors, SSc in this cohort appears to be similar to that described in other parts of the world.
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Affiliation(s)
- M Scolnik
- Rheumatology Section, Medical Services, Hospital Italiano de Buenos Aires, Instituto Universitario Escuela de Medicina Hospital Italiano de Buenos Aires and Fundación Dr. Pedro M Catoggio para el Progreso de la Reumatologia, Buenos Aires, Argentina
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11
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Scolnik M, Marin J, Valeiras SM, Marchese MF, Talani AS, Avellaneda NL, Etchepare A, Etchepare P, Plou MS, Soriano ER. Incidence and prevalence of lupus in Buenos Aires, Argentina: a 11-year health management organisation-based study. Lupus Sci Med 2014; 1:e000021. [PMID: 25379189 PMCID: PMC4213830 DOI: 10.1136/lupus-2014-000021] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [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: 01/29/2014] [Revised: 04/28/2014] [Accepted: 05/02/2014] [Indexed: 01/06/2023]
Abstract
Objectives Studies regarding the epidemiology of systemic lupus erythematosus (SLE) are lacking in Argentina. Our purpose was to estimate the incidence and prevalence of SLE in a university hospital-based health management organisation in Buenos Aires (HIMCP). Methods For incidence calculation, the population at risk included all adult members of the HIMCP, with continuous affiliation for at least 1 year from January 1998 to January 2009. Each person was followed until he/she voluntarily left the HIMCP, death or finalisation of the study. Multiple methods for case finding were used to ensure complete ascertainment: (a) patients with problem SLE, undifferentiated autoimmune disease or mixed connective tissue disease in the Computer-based Patient Record System, (b) patients with positive antinuclear antibody test, anti-Sm antibodies and/or anti-dsDNA antibodies in the laboratory database and (c) patients who consumed hydroxichloroquine, chloroquine, azathioprine, cyclophosphamide, mycophenolate, cyclosporine or rituximab, from the administrative HIMCP drugs database. Medical records of all patients found were reviewed, and only patients fulfilling ACR criteria for SLE were included. Global and gender incidence rate (IR) was calculated. Prevalence was estimated on 1 January 2009, and the denominator population was the number of active members >18 years at that date (n=127 959). Results In the study period, 68 patients developed SLE. The observed IR (per 100 000 person-years, (CI 95%)) was 6.3 (4.9 to 7.7) for total population; 8.9 (CI 6.6 to 11.2) for women and 2.6 (1.2 to 3.9) for men. On 1 January 2009, 75 prevalent cases were identified. Prevalence rates (cases per 100 000 habitants, (CI 95%)) were 58.6 (46.1 to 73.5) for total population; 83.2 (63.9 to 106.4) for women and 23 (CI 11.9 to 40.1) for men. Conclusions SLE incidence and prevalence rates in Argentina are in agreement with those of other studies from different parts of the world.
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Affiliation(s)
- M Scolnik
- Rheumatology Section, Medical Services , Hospital Italiano de Buenos Aires , and Fundacion Pedro M. Catoggio para el Progreso de la Reumatologia, Buenos Aires , Argentina ; Instituto Universitario Escuela de Medicina Hospital Italiano de Buenos Aires , Buenos Aires , Argentina
| | - J Marin
- Rheumatology Section, Medical Services , Hospital Italiano de Buenos Aires , and Fundacion Pedro M. Catoggio para el Progreso de la Reumatologia, Buenos Aires , Argentina ; Instituto Universitario Escuela de Medicina Hospital Italiano de Buenos Aires , Buenos Aires , Argentina
| | - S M Valeiras
- Instituto Universitario Escuela de Medicina Hospital Italiano de Buenos Aires , Buenos Aires , Argentina
| | - M F Marchese
- Instituto Universitario Escuela de Medicina Hospital Italiano de Buenos Aires , Buenos Aires , Argentina
| | - A S Talani
- Instituto Universitario Escuela de Medicina Hospital Italiano de Buenos Aires , Buenos Aires , Argentina
| | - N L Avellaneda
- Instituto Universitario Escuela de Medicina Hospital Italiano de Buenos Aires , Buenos Aires , Argentina
| | - A Etchepare
- Instituto Universitario Escuela de Medicina Hospital Italiano de Buenos Aires , Buenos Aires , Argentina
| | - P Etchepare
- Instituto Universitario Escuela de Medicina Hospital Italiano de Buenos Aires , Buenos Aires , Argentina
| | - M S Plou
- Instituto Universitario Escuela de Medicina Hospital Italiano de Buenos Aires , Buenos Aires , Argentina
| | - E R Soriano
- Rheumatology Section, Medical Services , Hospital Italiano de Buenos Aires , and Fundacion Pedro M. Catoggio para el Progreso de la Reumatologia, Buenos Aires , Argentina ; Instituto Universitario Escuela de Medicina Hospital Italiano de Buenos Aires , Buenos Aires , Argentina
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Greloni G, Scolnik M, Marin J, Lancioni E, Quiroz C, Zacariaz J, De la Iglesia Niveyro P, Christiansen S, Pierangelo MA, Varela CF, Rosa-Diez GJ, Catoggio LJ, Soriano ER. Value of repeat biopsy in lupus nephritis flares. Lupus Sci Med 2014; 1:e000004. [PMID: 25396056 PMCID: PMC4225737 DOI: 10.1136/lupus-2013-000004] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 12/26/2013] [Accepted: 12/30/2013] [Indexed: 01/13/2023]
Abstract
Objectives Renal flares are common in lupus nephritis (LN), and class switch is thought to be characteristic. There is no agreement on indications for performing a repeat renal biopsy. Our objective was to retrospectively review patients who had more than one renal biopsy performed on clinical indications, and analyse clinical, pathological and treatment changes after successive biopsies. Methods Forty-five patients with LN and one or more repeat renal biopsies were included, with a total of 116 biopsies. Results Of the 71 repeat biopsies, pathological transition occurred in 39 (54.9%). When having a previous biopsy with a proliferative lesion, class switch occurred in 55.6%, with 24.4% evolving into non-proliferative classes. When previous biopsy was class V, transition to other classes occurred in 58.3% and changes were all into proliferative classes. Conversion from one pure proliferative form to another (class III to class IV or vice versa) happened in 11.3% of the rebiopsies, with 62 rebiopsies (87.3%) leading to a change in the treatment regimen. Conclusions Histological transformations were common, and they occurred when the previous biopsy had non-proliferative lesions as well as when lesions were proliferative. Treatments were modified after repeat renal biopsy in the majority of patients. In this experience, kidney repeat biopsies were useful in guiding treatment of LN flares.
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Affiliation(s)
- G Greloni
- Nephrology Service , Hospital Italiano de Buenos Aires , Buenos Aires , Argentina
| | - M Scolnik
- Rheumatology Section, Medical Services , Hospital Italiano de Buenos Aires , Buenos Aires , Argentina ; Instituto Universitario Escuela de Medicina Hospital Italiano de Buenos Aires, Fundacion Dr. Pedro M Catoggio para el Progreso de la Reumatologia , Buenos Aires , Argentina
| | - J Marin
- Rheumatology Section, Medical Services , Hospital Italiano de Buenos Aires , Buenos Aires , Argentina ; Instituto Universitario Escuela de Medicina Hospital Italiano de Buenos Aires, Fundacion Dr. Pedro M Catoggio para el Progreso de la Reumatologia , Buenos Aires , Argentina
| | - E Lancioni
- Rheumatology Section, Medical Services , Hospital Italiano de Buenos Aires , Buenos Aires , Argentina ; Instituto Universitario Escuela de Medicina Hospital Italiano de Buenos Aires, Fundacion Dr. Pedro M Catoggio para el Progreso de la Reumatologia , Buenos Aires , Argentina
| | - C Quiroz
- Rheumatology Section, Medical Services , Hospital Italiano de Buenos Aires , Buenos Aires , Argentina ; Instituto Universitario Escuela de Medicina Hospital Italiano de Buenos Aires, Fundacion Dr. Pedro M Catoggio para el Progreso de la Reumatologia , Buenos Aires , Argentina
| | - J Zacariaz
- Rheumatology Section, Medical Services , Hospital Italiano de Buenos Aires , Buenos Aires , Argentina ; Instituto Universitario Escuela de Medicina Hospital Italiano de Buenos Aires, Fundacion Dr. Pedro M Catoggio para el Progreso de la Reumatologia , Buenos Aires , Argentina
| | | | - S Christiansen
- Pathology Department , Hospital Italiano de Buenos Aires , Buenos Aires , Argentina
| | - M A Pierangelo
- Nephrology Service , Hospital Italiano de Buenos Aires , Buenos Aires , Argentina
| | - C F Varela
- Nephrology Service , Hospital Italiano de Buenos Aires , Buenos Aires , Argentina
| | - G J Rosa-Diez
- Nephrology Service , Hospital Italiano de Buenos Aires , Buenos Aires , Argentina
| | - L J Catoggio
- Rheumatology Section, Medical Services , Hospital Italiano de Buenos Aires , Buenos Aires , Argentina ; Instituto Universitario Escuela de Medicina Hospital Italiano de Buenos Aires, Fundacion Dr. Pedro M Catoggio para el Progreso de la Reumatologia , Buenos Aires , Argentina
| | - E R Soriano
- Rheumatology Section, Medical Services , Hospital Italiano de Buenos Aires , Buenos Aires , Argentina ; Instituto Universitario Escuela de Medicina Hospital Italiano de Buenos Aires, Fundacion Dr. Pedro M Catoggio para el Progreso de la Reumatologia , Buenos Aires , Argentina
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Ritchlin CT, Kavanaugh A, Gladman DD, Mease PJ, Helliwell P, Boehncke WH, de Vlam K, Fiorentino D, Fitzgerald O, Gottlieb AB, McHugh NJ, Nash P, Qureshi AA, Soriano ER, Taylor WJ. Treatment recommendations for psoriatic arthritis. Ann Rheum Dis 2008; 68:1387-94. [PMID: 18952643 PMCID: PMC2719080 DOI: 10.1136/ard.2008.094946] [Citation(s) in RCA: 340] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Objective: To develop comprehensive recommendations for the treatment of the various clinical manifestations of psoriatic arthritis (PsA) based on evidence obtained from a systematic review of the literature and from consensus opinion. Methods: Formal literature reviews of treatment for the most significant discrete clinical manifestations of PsA (skin and nails, peripheral arthritis, axial disease, dactylitis and enthesitis) were performed and published by members of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA). Treatment recommendations were drafted for each of the clinical manifestations by rheumatologists, dermatologists and PsA patients based on the literature reviews and consensus opinion. The level of agreement for the individual treatment recommendations among GRAPPA members was assessed with an online questionnaire. Results: Treatment recommendations were developed for peripheral arthritis, axial disease, psoriasis, nail disease, dactylitis and enthesitis in the setting of PsA. In rotal, 19 recommendations were drafted, and over 80% agreement was obtained on 16 of them. In addition, a grid that factors disease severity into each of the different disease manifestations was developed to help the clinician with treatment decisions for the individual patient from an evidenced-based perspective. Conclusions: Treatment recommendations for the cardinal physical manifestations of PsA were developed based on a literature review and consensus between rheumatologists and dermatologists. In addition, a grid was established to assist in therapeutic reasoning and decision making for individual patients. It is anticipated that periodic updates will take place using this framework as new data become available.
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Affiliation(s)
- C T Ritchlin
- Clinical Immunology Research Center, University of Rochester Medical Center, 601 Elmwood Avenue, Box 695, Rochester, New York 14642, USA.
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McHugh NJ, Soriano ER. Conventional therapy of psoriatic arthritis: evidence-based review. Reumatismo 2007; 59 Suppl 1:81-4. [PMID: 17828352 DOI: 10.4081/reumatismo.2007.1s.81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Psoriatic arthritis is a heterogeneous condition, the pattern of which is determined by any combination of pathology affecting peripheral joints, the enthesis and the spine. There is a paucity of evidence for most of the conventional agents used to treat psoriatic arthritis, with many of them being used on the basis of experience in rheumatoid arthritis. Herein, we summarise the evidence compiled relating to effectiveness of treatment for various manifestation of PsA. For those patients with progressive forms of arthritis who may benefit from intervention of newer biological therapies, the continued use of conventional therapy needs ever increasing scrutiny.
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Affiliation(s)
- N J McHugh
- Royal National Hospital for Rheumatic Diseases, Upper Borough Walls, Bath, UK.
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Figar S, Galarza C, Petrlik E, Hornstein L, Rodríguez Loria G, Waisman G, Rada M, Soriano ER, de Quirós FGB. Effect of education on blood pressure control in elderly persons: a randomized controlled trial. Am J Hypertens 2006; 19:737-43. [PMID: 16814130 DOI: 10.1016/j.amjhyper.2005.10.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2005] [Revised: 10/14/2005] [Accepted: 10/18/2005] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND It is not clear which educational strategy is most effective in helping patients to change their lifestyles. This study compared the efficacy of two different educational models on reducing blood pressure (BP). METHODS This was a randomized controlled trial in ambulatory hypertensive patients >65 years of age. Workshops that aimed to develop self-management and patient empowerment (PEM) were compared to workshops that used a compliance-based model (CEM). The primary outcome was change in systolic BP at 3 months compared with basal values between groups (net reduction), measured by 24-h ambulatory BP monitoring. RESULTS A total of 30 patients were educated with PEM and 30 others with CM. Both groups were statistically similar with regard to age (67 v 70 years), systolic BP (157 v 156 mm Hg) and diastolic BP (88 v 88 mm Hg), diabetes (23% v 31%), and basal natriuresis 116 v 121 mEq/day). There were more women in the PEM group (57% v 30%). The PEM group showed a significant reduction of 8 mm Hg (95% confidence interval [CI] 2 to 15), whereas the CM group showed a reduction of 3 mm Hg (95% CI -3 to 8), with a net reduction of 6 (95% CI -3 to 14). Mean net night-time systolic BP reduction was 12 mm Hg (95% CI 2 to 22). BP control was 70% in PEM group vs 45% in CM group (P = 0.045). The relative odds ratio for BP control for the PEM group after adjustment for age, sex, diabetes, basal blood pressure and changes in pharmacological treatment was 3.7 (95% CI 1.05 to 13.1). CONCLUSION Based on these study results, the self-management education model was significantly more effective than the compliance-based model in BP control.
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Affiliation(s)
- Silvana Figar
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
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Montero-Odasso M, Schapira M, Varela C, Pitteri C, Soriano ER, Kaplan R, Camera LA, Mayorga LM. Gait velocity in senior people. An easy test for detecting mobility impairment in community elderly. J Nutr Health Aging 2004; 8:340-3. [PMID: 15359349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
BACKGROUND Functional assessment is an important part of the evaluation of elderly patients. Mobility problems detected by functional tests predict the development of more severe disability and injurious events such as falls and hip fractures. Several tests to evaluate mobility have been described, but most of them are difficult to perform by a primary care physicians or take much time in the ambulatory setting. PURPOSE To evaluate different mobility test to detect mobility impairment in community senior people. Select an easier test to perform on the ambulatory ward by a GP with the hypothesis that gait velocity could be an easier test to detect early mobility impairment. METHODS A cohort of 100 elderly subjects of 75 year and older were selected from our database and contacted by phone. The subjects were appointed and assessed by three geriatricians from January to May 2000. The measures including MMSE, Yesavage Test, ADL (Barhtel) and IADL (Lawton), the Get Up and Go test, the POMA, one leg balance test and the Gait Velocity (GV). A gait velocity of 0.8 m/s or lower was defined as a pathological gait velocity (PGV). RESULTS 95 subjects, mean age 79.63 (+/- 4) ranged form 75 to 95. Women in 71.3%. The ADLs were normal on 85% of the patients and the MMSE was normal on 78%. There was a significant association between pathological gait velocity (<0.8m/sec) and impairment on Get up and Go (OR 2.20; 95% CI 1.44-3.34), incapacity to perform the one leg balance test (OR 2.20; 95%CI: 1.43 - 4.71) and abnormal POMA test (OR 4.60; 95 %CI 1.5-14.7). Only 15% of the subjects with normal gait velocity reported recurrent falls in the previous 6 months while 35% of subjects with pathological gait velocity did. (OR 0.32 CI95% 010-099 p < 0.044). CONCLUSION The pathological gait velocity (<0.8m/sec) correlates with a pathologic performance of Get Up and Go test and POMA and with the incapacity to perform the One Leg Balance test. Also correlate with previous repeated falls in the last 6 (p <0.04). The gait velocity could be a test easy to perform, no time consuming, and an operative tool to apply in the ambulatory care to detect elderly patients with mobility impairment.
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Affiliation(s)
- M Montero-Odasso
- Geriatric Medicine Program and Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires 1181(ACH), Argentina.
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Abstract
The present treatment of the inflammatory myopathies remains unsatisfactory in several areas, perhaps due in part to our incomplete knowledge of their aetiology. These conditions have been grouped together for practical purposes and because of a similar approach to treatment. However, recent data regarding pathological findings, serological patterns and different outcomes, suggest that some of these myopathies may be distinct, and perhaps approaches to treatment should be tailored according to these findings. This chapter will attempt to update our current management, offer an analysis of recent data regarding newer treatment modalities and highlight areas lacking solid data that need to be further addressed. Although corticosteroids are still considered to be the mainstay of treatment, the earlier use of immunosuppressive therapy will be discussed, as will the use of autoantibody profiles for tailoring treatment. Newer modalities for the monitoring of therapeutic response and their current place in clinical practice will be analysed. The management of refractory cases will be addressed as will the current management of calcinosis, a problem more frequently encountered in children.
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Affiliation(s)
- L J Catoggio
- Rheumatology Section, Medical Services, Hospital Italiano de Buenos Aires, Argentina.
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Soriano ER, Dixey J, Hall ND, Davies J, Maddison PJ. Synovial tissue responses following treatment of rheumatoid arthritis with the humanized monoclonal antibody CAMPATH-1H. Arthritis Rheum 1996; 39:181-2. [PMID: 8546734 DOI: 10.1002/art.1780390132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Soriano ER, Barcan L, Clara L, Imamura P, Catoggio LJ. Streptococcus pyomyositis occurring in a patient with dermatomyositis in a country with temperate climate. J Rheumatol 1992; 19:1305-7. [PMID: 1404172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
We describe a man in whom pyomyositis developed in a temperate climate. Three facts make this case unique. First the pyomyositis developed in someone with underlying dermatomyositis, this being the second reported case to our knowledge. Second, the organism involved was a Streptococcus and not a Staphylococcus as in most cases described, and the course of the disease was acute and not subacute as is usually reported. Finally, contrary to most described cases, surgical drainage was not necessary, probably because of the early diagnosis. Pyomyositis should be considered a possible cause of localized pain in patients with underlying inflammatory muscle disease.
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Affiliation(s)
- E R Soriano
- Rheumatology Section, Hospital Italiano de Buenos Aires, Argentina
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Soriano ER, Catoggio LJ. Baker's cysts, pseudothrombophlebitis, pseudo-pseudothrombophlebitis: where do we stand? Clin Exp Rheumatol 1990; 8:107-12. [PMID: 2186884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The diagnostic approach and therapeutic attitudes to be assumed when facing the dilemma of deep vein thrombosis versus a complicated Baker's cyst remain unclear. We examined our own approach with 16 Baker's cysts [11 presenting with a "thrombophlebitis picture" (TP)] recently diagnosed in our services, and reviewed the literature. All of our patients had an underlying joint disorder and previous knee effusions. The diagnostic approach (i.e., the request or not for venography) was related to the specialty of the physician who saw the patient first. The results of the venography led to anticoagulation treatment in 5 of the 6 patients on whom it was performed, although these patients did not otherwise differ from those with a similar clinical picture in whom no venogram was obtained. Arthrograms performed early after onset of the TP were more likely to reveal cyst rupture. The recent literature does not mention serious venous complications (in particular, pulmonary embolism) in patients in whom only the cyst was treated, without knowledge of possible coexisting venous occlusions. The need to perform venography, the importance of the localisation of the occlusions and the therapeutic consequences are discussed and a proposal is made to study these patients in a systematic way in order to better understand the inter-relationship between complicated popliteal cysts and venous alterations, and to decide the best approach to assume in the future.
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Affiliation(s)
- E R Soriano
- Medical Services, Hospital Italiano de Buenos Aires, Argentina
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