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Isnardi CA, Landi M, Pons-Estel GJ, Schneeberger EE. Reply. Arthritis Care Res (Hoboken) 2024; 76:583-584. [PMID: 37823240 DOI: 10.1002/acr.25257] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 10/03/2023] [Indexed: 10/13/2023]
Affiliation(s)
- Carolina Ayelen Isnardi
- Research Unit, Argentine Society of Rheumatology and Instituto de Rehabilitación Psicofísica, Buenos Aires, Argentina
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Isnardi CA, Alpizar-Rodriguez D, Calderaro DC, Marques CDL, Pons-Estel GJ, Xavier RM, Saurit V, Pisoni CN, Tissera YS, D'Angelo Exeni ME, Alba P, Pereira D, Gobbi CA, Gamba MJ, Alfaro MA, Virasoro BM, Colunga-Pedraza IJ, Irazoque-Palazuelos F, Reyes-Cordero G, Rodriguez-Reyna TS, Veloz-Aranda JA, Skinner-Taylor CM, Juárez-Mora IM, Silveira LH, Pacheco Tena CF, Xibille-Friedmann DX, Ferreira GA, Kakehasi AM, Pinheiro MM, Gomides APM, Pileggi GCS, da Mota LMH, Dos Reis-Neto ET, Ribeiro SLE, de Azevedo Valadares LD, Martínez-Martínez MU. Factors Associated With Mortality in Patients With Immune-Mediated Rheumatic Diseases and COVID-19 From Latin America: Data From Argentina, Mexico, and Brazil. J Clin Rheumatol 2024; 30:e9-e17. [PMID: 37936271 DOI: 10.1097/rhu.0000000000002038] [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: 11/09/2023]
Abstract
OBJECTIVE To describe characteristics of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in patients with rheumatic immune-mediated inflammatory diseases (IMIDs) from Argentina, Mexico and Brazil, and to assess factors associated with mortality in this population. METHODS Data from 3 national registries, SAR-COVID (Argentina), CMR-COVID (Mexico), and ReumaCoV-Brasil (Brazil), were combined. Adult patients with IMIDs and SARS-CoV-2 infection were recruited. Sociodemographic data, comorbidities, IMID clinical characteristics and treatment, and SARS-CoV-2 infection presentation and outcomes were recorded. RESULTS A total of 4827 individuals were included: 2542 (52.7%) from SAR-COVID, 1167 (24.2%) from CMR-COVID, and 1118 (23.1%) from ReumaCoV-Brasil. Overall, 82.1% were female with a mean age of 49.7 (SD, 14.3) years; 22.7% of the patients were hospitalized, and 5.3% died because of COVID-19 (coronavirus disease 2019). Argentina and Brazil had both 4% of mortality and Mexico 9.4%. In the multivariable analysis, older age (≥60 years; odds ratio [OR], 7.4; 95% confidence interval [CI], 4.6-12.4), male sex (OR, 1.5; 95% CI, 1.1-2.1), living in Mexico (OR, 3.0; 95% CI, 2.0-4.4), comorbidity count (1 comorbidity: OR, 1.5; 95% CI, 1.0-2.1), diagnosis of connective tissue disease or vasculitis (OR, 1.8; 95% CI, 1.3-2.4), and other diseases (OR, 2.6; 95% CI, 1.6-4.1) compared with inflammatory joint disease, high disease activity (OR, 4.2; 95% CI, 2.5-7.0), and treatment with glucocorticoids (OR, 1.9; 95% CI, 1.4-2.5) or rituximab (OR, 4.2; 95% CI, 2.7-6.6) were associated with mortality. CONCLUSIONS Mortality in patients with IMIDs was particularly high in Mexicans. Ethnic, environmental, societal factors, and different COVID-19 mitigation measures adopted have probably influenced these results.
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Affiliation(s)
| | | | | | - Claudia Diniz Lopes Marques
- Área acadêmica de Medicina Clínica, Universidade Federal de Pernambuco; Hospital das Clínicas da UFPE/Ebserh, Pernambuco
| | | | - Ricardo Machado Xavier
- Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | | | - Cecilia Nora Pisoni
- Centro de Educación Médica e Investigaciones Clínicas, CEMIC, Ciudad Autónoma de Buenos Aires
| | | | | | - Paula Alba
- Rheumatology Unit, Cátedra de Semiología, Hospital Córdoba y Materno Neonatal, FMC Universidad Nacional de Córdoba
| | | | | | | | | | | | | | | | - Greta Reyes-Cordero
- Universidad Autónoma de Chihuahua, Facultad de Medicina y Ciencias Biomédicas, Chihuahua
| | - Tatiana S Rodriguez-Reyna
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City
| | | | | | | | | | | | | | | | - Adriana Maria Kakehasi
- Locomotor System Department, Medical School, Universidade Federal de Minas Gerais, Minas Gerais
| | - Marcelo Medeiros Pinheiro
- Rheumatology Division, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP/ EPM), São Paulo
| | | | | | - Licia Maria Henrique da Mota
- Hospital Universitário de Brasília, Programa de Pós-graduação em Ciências Médicas, Programa de Pós-graduação em Patologia Molecular, Faculdade de Medicina, Universidade de Brasília, Brasília
| | - Edgard Torres Dos Reis-Neto
- Rheumatology Division, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP/ EPM), São Paulo
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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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Pimentel-Quiroz VR, Ugarte-Gil MF, Harvey GB, Wojdyla D, Pons-Estel GJ, Quintana R, Esposto A, García MA, Catoggio LJ, Cardiel MH, Barile LA, Amigo MC, Sato EI, Bonfa E, Borba E, Lavras Costallat LT, Neira OJ, Massardo L, Guibert-Toledano M, Chacón-Díaz R, Alarcón GS, Pons-Estel BA. Factors predictive of serious infections over time in systemic lupus erythematosus patients: data from a multi-ethnic, multi-national, Latin American lupus cohort. Lupus 2019; 28:1101-1110. [DOI: 10.1177/0961203319860579] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Aim The aim of this study was to identify factors predictive of serious infections over time in patients with systemic lupus erythematosus (SLE). Methods A multi-ethnic, multi-national Latin American SLE cohort was studied. Serious infection was defined as one that required hospitalization, occurred during a hospitalization or led to death. Potential predictors included were sociodemographic factors, clinical manifestations (per organ involved, lymphopenia and leukopenia, independently) and previous infections at baseline. Disease activity (SLEDAI), damage (SLICC/ACR Damage Index), non-serious infections, glucocorticoids, antimalarials (users and non-users), and immunosuppressive drugs use; the last six variables were examined as time-dependent covariates. Cox regression models were used to evaluate the predictors of serious infections using a backward elimination procedure. Univariable and multivariable analyses were performed. Results Of the 1243 patients included, 1116 (89.8%) were female. The median (interquartile range) age at diagnosis and follow-up time were 27 (20–37) years and 47.8 (17.9–68.6) months, respectively. The incidence rate of serious infections was 3.8 cases per 100 person-years. Antimalarial use (hazard ratio: 0.69; 95% confidence interval (CI): 0.48–0.99; p = 0.0440) was protective, while doses of prednisone >15 and ≤60 mg/day (hazard ratio: 4.18; 95 %CI: 1.69–10.31; p = 0.0019) and >60 mg/day (hazard ratio: 4.71; 95% CI: 1.35–16.49; p = 0.0153), use of methylprednisolone pulses (hazard ratio: 1.53; 95% CI: 1.10–2.13; p = 0.0124), increase in disease activity (hazard ratio: 1.03; 95% CI: 1.01–1.04; p = 0.0016) and damage accrual (hazard ratio: 1.22; 95% CI: 1.11–1.34; p < 0.0001) were predictive factors of serious infections. Conclusions Over time, prednisone doses higher than 15 mg/day, use of methylprednisolone pulses, increase in disease activity and damage accrual were predictive of infections, whereas antimalarial use was protective against them in SLE patients.
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Affiliation(s)
- V R Pimentel-Quiroz
- Department of Rheumatology, Hospital Nacional ‘Guillermo Almenara Irigoyen’ Essalud, Lima, Peru
| | - M F Ugarte-Gil
- Department of Rheumatology, Hospital Nacional ‘Guillermo Almenara Irigoyen’ Essalud, Lima, Peru
- Universidad Científica del Sur, Lima, Peru
| | - GB Harvey
- Escuela de Estadística, Facultad de Ciencias Económicas y Estadística, Universidad Nacional de Rosario, Rosario, Argentina
| | - D Wojdyla
- GLADEL consultant, Rosario, Argentina
| | - G J Pons-Estel
- Grupo Oroño, Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
- Servicio de Reumatología, Hospital Provincial de Rosario, Rosario, Argentina
| | - R Quintana
- Grupo Oroño, Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
- Servicio de Reumatología, Hospital Provincial de Rosario, Rosario, Argentina
| | - A Esposto
- Servicio de Infectología, Hospital Interzonal General de Agudos ‘General San Martín’, La Plata, Argentina
| | - M A García
- Servicio de Infectología, Hospital Interzonal General de Agudos ‘General San Martín’, La Plata, Argentina
| | - L J Catoggio
- Servicio de Reumatolgía, Hospital Italiano and Fundación ‘Dr. Pedro M. Catoggio para el Progreso de la Reumatología’, Buenos Aires, Argentina
| | - M H Cardiel
- Centro de Investigación Clínica de Morelia, Morelia, Michoacán, Mexico
| | - L A Barile
- Servicio de Reumatología, Hospital Ángeles del Pedregal, Ciudad de México, Mexico
| | - M -C Amigo
- Centro Médico ABC, Ciudad de México, Mexico
| | - E I Sato
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - E Bonfa
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - E Borba
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - L T Lavras Costallat
- Departamento de Clínica Médica, Faculdade de Ciências Medicas da UNICAMP, Universidade Estadual de Campinas, Campinas, Brazil
| | - O J Neira
- Sección de Reumatología, Hospital del Salvador, Universidad de Chile. Unidad de Reumatología, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - L Massardo
- Centro de Biología Celular y Biomedicina, Facultad de Medicina y Ciencia, Universidad San Sebastián, Santiago, Chile
| | | | - R Chacón-Díaz
- Servicio de Reumatología, Policlínica Méndez Gimón, Caracas, Venezuela
| | - G S Alarcón
- Division of Clinical Immunology and Rheumatology, Department of Medicine, School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
- Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - B A Pons-Estel
- Grupo Oroño, Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
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Pons-Estel GJ, Quintana R, Alarcón GS, Sacnún M, Ugarte-Gil MF, Pons-Estel BA. A 12-year retrospective review of bullous systemic lupus erythematosus in cutaneous and systemic lupus erythematosus patients. Lupus 2018; 27:1753-1754. [DOI: 10.1177/0961203318776104] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- G J Pons-Estel
- Hospital Provincial de Rosario, Rosario, Santa Fe, Argentina
- Centro Regional de Enfermedades Autoinmunes y Reumáticas (CREAR), Grupo Oroño. Rosario, Santa Fe, Argentina
| | - R Quintana
- Hospital Provincial de Rosario, Rosario, Santa Fe, Argentina
- Centro Regional de Enfermedades Autoinmunes y Reumáticas (CREAR), Grupo Oroño. Rosario, Santa Fe, Argentina
| | - G S Alarcón
- Department of Medicine, Division of Clinical Immunology and Rheumatology, School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - M Sacnún
- Hospital Provincial de Rosario, Rosario, Santa Fe, Argentina
| | - M F Ugarte-Gil
- Department of Rheumatology, Hospital Guillermo Almenara Irigoyen. EsSalud, Lima, Perú
- Universidad Científica del Sur, Lima, Perú
| | - B A Pons-Estel
- Hospital Provincial de Rosario, Rosario, Santa Fe, Argentina
- Centro Regional de Enfermedades Autoinmunes y Reumáticas (CREAR), Grupo Oroño. Rosario, Santa Fe, 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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Pons-Estel GJ, Catoggio LJ, Cardiel MH, Bonfa E, Caeiro F, Sato E, Massardo L, Molina-Restrepo JF, Toledano MG, Barile-Fabris LA, Amigo MC, Acevedo-Vásquez EM, Abadi I, Wojdyla D, Alarcón-Riquelme ME, Alarcón GS, Pons-Estel BA. Lupus in Latin-American patients: lessons from the GLADEL cohort. Lupus 2015; 24:536-45. [PMID: 25697768 DOI: 10.1177/0961203314567753] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [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: 10/30/2014] [Accepted: 12/18/2014] [Indexed: 01/04/2023]
Abstract
The need for comprehensive published epidemiologic and clinical data from Latin American systemic lupus erythematosus (SLE) patients motivated the late Dr Alarcón-Segovia and other Latin American professionals taking care of these patients to spearhead the creation of the G: rupo L: atino A: mericano D: e E: studio del L: upus (GLADEL) cohort in 1997. This inception cohort recruited a total of 1480 multiethnic (Mestizo, African-Latin American (ALA), Caucasian and other) SLE patients diagnosed within two years from the time of enrollment from 34 Latin American centers with expertise in the diagnosis and management of this disease. In addition to the initial 2004 description of the cohort, GLADEL has contributed to improving our knowledge about the course and outcome of lupus in patients from this part of the Americas. The major findings from this cohort are highlighted in this review. They have had important clinical implications for the adequate care of SLE patients both in Latin America and worldwide where these patients may have emigrated.
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Affiliation(s)
- G J Pons-Estel
- Department of Autoimmune Diseases, Institut Clínic de Medicina i Dermatologia, Hospital Clínic, Spain
| | - L J Catoggio
- Sección de Reumatología, Servicio de Clínica Médica; Hospital Italiano and Fundación Dr Pedro M. Catoggio para el Progreso de la Reumatología, Buenos Aires, Argentina
| | - M H Cardiel
- Centro de Investigación Clínica de Morelia SC, Morelia, Michoacán, México
| | - E Bonfa
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - F Caeiro
- Hospital Privado, Centro Médico de Córdoba, Córdoba, Argentina
| | - E Sato
- Disciplina de Reumatología, Escola Paulista de Medicina, Universidade Federal da São Paulo (UNIFESP), São Paulo, Brazil
| | - L Massardo
- Department of Clinical Immunology and Rheumatology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - M Guibert Toledano
- Servicio Nacional de Reumatología, Centro de Investigaciones Médico Quirúrgicas (CIMEQ), La Habana, Cuba
| | - L A Barile-Fabris
- Hospital de Especialidades Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México Distrito Federal, México
| | - M C Amigo
- Reumatología, Centro Médico ABC, Ciudad de México, México
| | - E M Acevedo-Vásquez
- Servicio de Reumatología, Hospital Nacional 'Guillermo Almenara Irigoyen', Essalud, Lima, Perú
| | - I Abadi
- Unidad de Reumatología del Hospital de Clínicas Caracas, Venezuela
| | - D Wojdyla
- Escuela de Estadística, Universidad Nacional de Rosario, Rosario, Argentina
| | - M E Alarcón-Riquelme
- Centro Pfizer-Universidad de Granada-Junta de Andalucía de Gemómica e Investigaciones Oncológicas, Granada, Spain, and Oklahoma Medical Research Foundation, Oklahoma City, USA
| | - G S Alarcón
- Department of Medicine, Division of Clinical Immunology and Rheumatology, School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
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Chighizola CB, Andreoli L, de Jesus GR, Banzato A, Pons-Estel GJ, Erkan D. The association between antiphospholipid antibodies and pregnancy morbidity, stroke, myocardial infarction, and deep vein thrombosis: a critical review of the literature. Lupus 2015; 24:980-4. [PMID: 25697769 DOI: 10.1177/0961203315572714] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [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: 05/09/2014] [Accepted: 01/21/2015] [Indexed: 12/25/2022]
Abstract
In a previous systematic literature search, we demonstrated that the frequencies of antiphospholipid antibodies (aPL) in general-population patients with pregnancy morbidity (PM), deep vein thrombosis (DVT), myocardial infarction (MI), and stroke (ST) are 6%, 10%, 11%, and 14%. To determine the association between aPL and clinical outcomes, we conducted a follow-up analysis of the 120 studies included in the original paper. Based on the analysis of 81 studies, a significant difference in the frequency of aPL criteria tests between patients and controls emerged considering all the outcomes together (10% versus 3%). In particular, a significant difference was reported for overall PM, pregnancy loss (PrL), late PrL, severe preeclampsia (PEC), ST, MI, and DVT. No difference emerged for early PrL, intrauterine growth restriction (IUGR), PEC, eclampsia (EC), and HELLP. A positive association was found in more than half of the studies for overall PrL, severe PEC, HELLP, ST, MI, and DVT and in less than half for early and late PrL, PEC, EC, and IUGR. The positive association between aPL and clinical outcomes included in the antiphospholipid syndrome classification criteria is not supported by every study, being particularly inconsistent for early PL, IUGR, PEC, EC, and HELLP.
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Affiliation(s)
- C B Chighizola
- Experimental Laboratory of Immunological and Rheumatologic Researches, Istituto Auxologico Italiano, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - L Andreoli
- Rheumatology and Clinical Immunology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - G Ramires de Jesus
- Department of Obstetrics, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - A Banzato
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - G J Pons-Estel
- Department of Autoimmune Diseases, Institut Clínic de Medicina i Dermatologia, Hospital Clínic, Barcelona, Catalonia, Spain
| | - D Erkan
- Barbara Volcker Center for Women and Rheumatic Diseases, Hospital for Special Surgery, New York, NY, USA Weill Medical College of Cornell University, New York, NY, USA
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Cervera R, Serrano R, Pons-Estel GJ, Ceberio-Hualde L, Shoenfeld Y, de Ramón E, Buonaiuto V, Jacobsen S, Zeher MM, Tarr T, Tincani A, Taglietti M, Theodossiades G, Nomikou E, Galeazzi M, Bellisai F, Meroni PL, Derksen RHWM, de Groot PGD, Baleva M, Mosca M, Bombardieri S, Houssiau F, Gris JC, Quéré I, Hachulla E, Vasconcelos C, Fernández-Nebro A, Haro M, Amoura Z, Miyara M, Tektonidou M, Espinosa G, Bertolaccini ML, Khamashta MA. Morbidity and mortality in the antiphospholipid syndrome during a 10-year period: a multicentre prospective study of 1000 patients. Ann Rheum Dis 2014; 74:1011-8. [DOI: 10.1136/annrheumdis-2013-204838] [Citation(s) in RCA: 392] [Impact Index Per Article: 39.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 01/05/2014] [Indexed: 12/20/2022]
Abstract
ObjectivesTo assess the prevalence of the main causes of morbi-mortality in the antiphospholipid syndrome (APS) during a 10-year-follow-up period and to compare the frequency of early manifestations with those that appeared later.MethodsIn 1999, we started an observational study of 1000 APS patients from 13 European countries. All had medical histories documented when entered into the study and were followed prospectively during the ensuing 10 years.Results53.1% of the patients had primary APS, 36.2% had APS associated with systemic lupus erythematosus and 10.7% APS associated with other diseases. Thrombotic events appeared in 166 (16.6%) patients during the first 5-year period and in 115 (14.4%) during the second 5-year period. The most common events were strokes, transient ischaemic attacks, deep vein thromboses and pulmonary embolism. 127 (15.5%) women became pregnant (188 pregnancies) and 72.9% of pregnancies succeeded in having one or more live births. The most common obstetric complication was early pregnancy loss (16.5% of the pregnancies). Intrauterine growth restriction (26.3% of the total live births) and prematurity (48.2%) were the most frequent fetal morbidities. 93 (9.3%) patients died and the most frequent causes of death were severe thrombosis (36.5%) and infections (26.9%). Nine (0.9%) cases of catastrophic APS occurred and 5 (55.6%) of them died. The survival probability at 10 years was 90.7%.ConclusionsPatients with APS still develop significant morbidity and mortality despite current treatment. It is imperative to increase the efforts in determining optimal prognostic markers and therapeutic measures to prevent these complications.
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Pons-Estel GJ, Wojdyla D, McGwin G, Magder LS, Petri MA, Pons-Estel BA, Alarcón GS. The American College of Rheumatology and the Systemic Lupus International Collaborating Clinics Classification criteria for systemic lupus erythematosus in two multiethnic cohorts: a commentary. Lupus 2014; 23:3-9. [DOI: 10.1177/0961203313512883] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
The authors offer some comments on the advantages and possible drawbacks of using the SLICC criteria in longitudinal observational studies and clinical trials after applying and comparing them to the ACR criteria in two multinational, multiethnic lupus cohorts.
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Affiliation(s)
- GJ Pons-Estel
- Department of Autoimmune Diseases, Institut Clínic de Medicina i Dermatologia, Hospital Clínic, Spain
- Departments of Medicine, (Division of Clinical Immunology and Rheumatology) and Epidemiology, Schools of Medicine and Public Health, The University of Alabama at Birmingham, USA
| | - D Wojdyla
- Escuela de Estadística, Universidad Nacional de Rosario, Argentina
| | - G McGwin
- Departments of Medicine, (Division of Clinical Immunology and Rheumatology) and Epidemiology, Schools of Medicine and Public Health, The University of Alabama at Birmingham, USA
| | - LS Magder
- University of Maryland Dental School, USA
| | - MA Petri
- Johns Hopkins University School of Medicine, USA
| | | | - GS Alarcón
- Departments of Medicine, (Division of Clinical Immunology and Rheumatology) and Epidemiology, Schools of Medicine and Public Health, The University of Alabama at Birmingham, USA
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Pons-Estel GJ, Alarcón GS, Burgos PI, Hachuel L, Boggio G, Wojdyla D, Nieto R, Alvarellos A, Catoggio LJ, Guibert-Toledano M, Sarano J, Massardo L, Vásquez GM, Iglesias-Gamarra A, Lavras Costallat LT, Da Silva NA, Alfaro JL, Abadi I, Segami MI, Huerta G, Cardiel MH, Pons-Estel BA. Mestizos with systemic lupus erythematosus develop renal disease early while antimalarials retard its appearance: data from a Latin American cohort. Lupus 2013; 22:899-907. [PMID: 23857989 DOI: 10.1177/0961203313496339] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [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: 11/15/2022]
Abstract
OBJECTIVES The objective of this paper is to assess the predictors of time-to-lupus renal disease in Latin American patients. METHODS Systemic lupus erythematosus (SLE) patients (n = 1480) from Grupo Latino Americano De Estudio de Lupus (GLADEL's) longitudinal inception cohort were studied. Endpoint was ACR renal criterion development after SLE diagnosis (prevalent cases excluded). Renal disease predictors were examined by univariable and multivariable Cox proportional hazards regression analyses. Antimalarials were considered time dependent in alternative analyses. RESULTS Of the entire cohort, 265 patients (17.9%) developed renal disease after entering the cohort. Of them, 88 (33.2%) developed persistent proteinuria, 44 (16.6%) cellular casts and 133 (50.2%) both; 233 patients (87.9%) were women; mean (± SD) age at diagnosis was 28.0 (11.9) years; 12.2% were African-Latin Americans, 42.5% Mestizos, and 45.3% Caucasians (p = 0.0016). Mestizo ethnicity (HR 1.61, 95% CI 1.19-2.17), hypertension (HR 3.99, 95% CI 3.02-5.26) and SLEDAI at diagnosis (HR 1.04, 95% CI 1.01-1.06) were associated with a shorter time-to-renal disease occurrence; antimalarial use (HR 0.57, 95% CI 0.43-0.77), older age at onset (HR 0.90, 95% CI 0.85-0.95, for every five years) and photosensitivity (HR 0.74, 95% CI 0.56-0.98) were associated with a longer time. Alternative model results were consistent with the antimalarial protective effect (HR 0.70, 95% CI 0.50-0.99). CONCLUSIONS Our data strongly support the fact that Mestizo patients are at increased risk of developing renal disease early while antimalarials seem to delay the appearance of this SLE manifestation. These data have important implications for the treatment of these patients regardless of their geographic location.
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Affiliation(s)
- G J Pons-Estel
- Department of Autoimmune Diseases, Institut Clínic de Medicina i Dermatologia, Hospital Clínic, Villarroel 170, Barcelona, Catalonia, Spain.
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Pons-Estel GJ, Saurit V, Alarcón GS, Hachuel L, Boggio G, Wojdyla D, Alfaro-Lozano JL, de la Torre IG, Massardo L, Esteva-Spinetti MH, Guibert-Toledano M, Gómez LAR, Costallat LTL, Del Pozo MJS, Silveira LH, Cavalcanti F, Pons-Estel BA. The impact of rural residency on the expression and outcome of systemic lupus erythematosus: data from a multiethnic Latin American cohort. Lupus 2012; 21:1397-404. [PMID: 22941567 DOI: 10.1177/0961203312458465] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The objective of this paper is to examine the role of place of residency in the expression and outcomes of systemic lupus erythematosus (SLE) in a multi-ethnic Latin American cohort. PATIENTS AND METHODS SLE patients (< two years of diagnosis) from 34 centers constitute this cohort. Residency was dichotomized into rural and urban, cut-off: 10,000 inhabitants. Socio-demographic, clinical/laboratory and mortality rates were compared between them using descriptive tests. The influence of place of residency on disease activity at diagnosis and renal disease was examined by multivariable regression analyses. RESULTS Of 1426 patients, 122 (8.6%) were rural residents. Their median ages (onset, diagnosis) were 23.5 and 25.5 years; 85 (69.7%) patients were Mestizos, 28 (22.9%) Caucasians and 9 (7.4%) were African-Latin Americans. Rural residents were more frequently younger at diagnosis, Mestizo and uninsured; they also had fewer years of education and lower socioeconomic status, exhibited hypertension and renal disease more frequently, and had higher levels of disease activity at diagnosis; they used methotrexate, cyclophosphamide pulses and hemodialysis more frequently than urban patients. Disease activity over time, renal damage, overall damage and the proportion of deceased patients were comparable in rural and urban patients. In multivariable analyses, rural residency was associated with high levels of disease activity at diagnosis (OR 1.65, 95% CI 1.06-2.57) and renal disease occurrence (OR 1.77, 95% CI 1.00-3.11). CONCLUSIONS Rural residency associates with Mestizo ethnicity, lower socioeconomic status and renal disease occurrence. It also plays a role in disease activity at diagnosis and kidney involvement but not on the other end-points examined.
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Affiliation(s)
- G J Pons-Estel
- Department of Autoimmune Diseases, Institut Clínic de Medicina i Dermatologia, Hospital Clínic, Spain.
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González LA, Pons-Estel GJ, Zhang J, Vilá LM, Reveille JD, Alarcón GS. Time to neuropsychiatric damage occurrence in LUMINA (LXVI): a multi-ethnic lupus cohort. Lupus 2009; 18:822-30. [PMID: 19578107 DOI: 10.1177/0961203309104392] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aims of this study were to examine the predictors of time to neuropsychiatric (NP) damage and its impact on mortality in 632 systemic lupus erythematosus African-American, Hispanic and Caucasian LUpus in MInorities: NAture versus Nurture (LUMINA) patients, age >or= 16 years and disease duration <or=5 years at baseline (T0). Time-to-NP damage and its impact on mortality were examined by Cox proportional hazards regressions. A total of 185 (29.3%) patients developed NP damage over a mean (SD) disease duration of 5.6 (3.7) years. After adjusting for NP manifestations present, older age [Hazard ratio (HR) = 1.02; 95% Confidence interval (CI) 1.00-1.04], Caucasian ethnicity (HR = 1.87; 95% CI, 1.22-2.87), disease activity over the disease course (HR = 1.16; 95% CI, 1.12-1.21), diabetes (HR = 3.47; 95% CI, 1.44-8.38) and abnormal illness-related behaviours (HR = 1.05; 95% CI, 1.02-1.08) were associated with a shorter time-to-NP damage. Photosensitivity (HR = 0.65; 95% CI, 0.44-0.95), anaemia (HR = 0.56; 95% CI, 0.31-0.98), Raynaud's phenomenon (HR = 0.49; 95% CI, 0.34-0.72), a medium dose of prednisone (HR = 0.56; 95% CI, 0.35-0.92) and hydroxychloroquine use (HR = 0.58; 95% CI, 0.36-0.93) were associated with a longer time. NP damage did not contribute to mortality. Older age, Caucasian ethnicity, disease activity and abnormal illness-related behaviours are associated with a shorter time-to-NP damage; hydroxychloroquine and a medium dose of prednisone with a longer time.
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Affiliation(s)
- L A González
- Department of Medicine (Division of Clinical Immunology and Rheumatology), School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
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González LA, Pons-Estel GJ, Zhang JS, McGwin G, Roseman J, Reveille JD, Vilá LM, Alarcón GS. Effect of age, menopause and cyclophosphamide use on damage accrual in systemic lupus erythematosus patients from LUMINA, a multiethnic US cohort (LUMINA LXIII). Lupus 2009; 18:184-6. [PMID: 19151125 DOI: 10.1177/0961203308098988] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Gonzalez LA, McGwin G, Duran S, Pons-Estel GJ, Apte M, Vila LM, Reveille JD, Alarcon GS. Predictors of premature gonadal failure in patients with systemic lupus erythematosus. Results from LUMINA, a multiethnic US cohort (LUMINA LVIII). Ann Rheum Dis 2008; 67:1170-3. [DOI: 10.1136/ard.2007.083436] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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