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Montero-López E, Peralta-Ramírez MI, Ortego-Centeno N, Sabio JM, Callejas-Rubio JL, Navarrete-Navarrete N, García-Ríos MC, Santos-Ruiz A. Does stress response axis activation differ between patients with autoimmune disease and healthy people? Stress Health 2024:e3392. [PMID: 38454759 DOI: 10.1002/smi.3392] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 02/06/2024] [Accepted: 02/21/2024] [Indexed: 03/09/2024]
Abstract
Many studies have shown that patients with autoimmune disease present a hypoactive hypothalamic-pituitary-adrenal (HPA) axis, but the results are controversial. Our objective was to study differences in stress response axis activity between patients with autoimmune disease and healthy people. The study sample consisted of 97 women divided into four groups: 37 healthy women (HW), 21 with systemic lupus erythematosus (SLE), 21 with Sjögren's syndrome (SS), and 18 with systemic sclerosis (SSc). After being exposed to a stress task, participants' skin conductance and salivary cortisol levels were measured in order to assess their response to psychological stress. Diurnal cortisol concentrations were assessed by measuring salivary cortisol in samples collected five times over one day. In addition, self-administered questionnaires were used to assess psychological variables. A time × group interaction effect was found (p = 0.003) in salivary cortisol secretion in response to stressful challenge. The healthy group presented normal activation, the SS and SLE groups showed no activation, and the SSc group presented a similar activation pattern to the HW group, except at the time of recovery. Total cortisol production (AUCg) was higher in the SSc group than in the HW group (p = 0.001). Differences were also observed in the cortisol AUCg collected over one day between healthy women and patients with SLE (p = 0.004) as well as with SSc (p = 0.001): women with SLE and SSc presented higher total hormone production than healthy women. Patients with autoimmune disease present a different HPA axis response, which may contribute to the harmful effects of stress in these diseases.
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Affiliation(s)
- Eva Montero-López
- Department of Evolutionary Psychology, University of Granada, Granada, Spain
| | - María Isabel Peralta-Ramírez
- Department of Personality, Evaluation, and Psychological Treatment, University of Granada, Granada, Spain
- Mind, Brain and Behavior Research Center (CIMCYC), Granada, Spain
| | - Norberto Ortego-Centeno
- Department of Medicine, University of Granada, Granada, Spain
- Systemic Autoimmune Diseases Unit, San Cecilio Clinical Hospital, Granada, Spain
- Biohealth Research Institute (IBS), Granada, Spain
| | - José Mario Sabio
- Systemic Autoimmune Disease Unit, Internal Medicine Service, Virgen de las Nieves University Hospital, Granada, Spain
| | - José Luis Callejas-Rubio
- Systemic Autoimmune Diseases Unit, San Cecilio Clinical Hospital, Granada, Spain
- Biohealth Research Institute (IBS), Granada, Spain
| | - Nuria Navarrete-Navarrete
- Systemic Autoimmune Disease Unit, Internal Medicine Service, Virgen de las Nieves University Hospital, Granada, Spain
| | - M Carmen García-Ríos
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Ana Santos-Ruiz
- Department of Health Psychology, School of Health Sciences, University of Alicante, Alicante, Spain
- Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
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Carmona EG, Callejas-Rubio JL, Raya E, Ríos-Fernández R, Villanueva-Martín G, Cid MC, Hernández-Rodríguez J, Ballestar E, Timmermann B, Ortego-Centeno N, Martín J, Márquez A. Single-cell transcriptomic profiling reveals a pathogenic role of cytotoxic CD4 + T cells in giant cell arteritis. J Autoimmun 2024; 142:103124. [PMID: 37952293 DOI: 10.1016/j.jaut.2023.103124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 09/27/2023] [Accepted: 10/04/2023] [Indexed: 11/14/2023]
Abstract
Giant cell arteritis (GCA) is a systemic vasculitis mediated by an aberrant immunological response against the blood vessel wall. Although the pathogenic mechanisms that drive GCA have not yet been elucidated, there is strong evidence that CD4+ T cells are key drivers of the inflammatory process occurring in this vasculitis. The aim of this study was to further delineate the role of CD4+ T cells in GCA by applying single-cell RNA sequencing and T cell receptor (TCR) repertoire profiling to 114.799 circulating CD4+ T cells from eight GCA patients in two different clinical states, active and in remission, and eight healthy controls. Our results revealed an expansion of cytotoxic CD4+ T lymphocytes (CTLs) in active GCA patients, which expressed higher levels of cytotoxic and chemotactic genes when compared to patients in remission and controls. Accordingly, differentially expressed genes in CTLs of active patients were enriched in pathways related to granzyme-mediated apoptosis, inflammation, and the recruitment of different immune cells, suggesting a role of this cell type in the inflammatory and vascular remodelling processes occurring in GCA. CTLs also exhibited a higher clonal expansion in active patients with respect to those in remission. Drug repurposing analysis prioritized maraviroc, which targeted CTLs, as potentially repositionable for this vasculitis. In addition, effector regulatory T cells (Tregs) were decreased in GCA and showed lower expression of genes involved in their suppressive activity. These findings provide further insights into the pathogenic role of CD4+ T cells in GCA and suggest targeting CTLs as a potential therapeutic option.
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Affiliation(s)
- Elio G Carmona
- Institute of Parasitology and Biomedicine López-Neyra (IPBLN), Spanish National Research Council (CSIC), Granada, Spain; Systemic Autoimmune Diseases Unit, Hospital Universitario Clínico San Cecilio, Instituto de Investigación Biosanitaria de Granada ibs.GRANADA, Granada, Spain
| | - José Luis Callejas-Rubio
- Systemic Autoimmune Diseases Unit, Hospital Universitario Clínico San Cecilio, Instituto de Investigación Biosanitaria de Granada ibs.GRANADA, Granada, Spain
| | - Enrique Raya
- Rheumatology Department, Hospital Universitario Clínico San Cecilio, Instituto de Investigación Biosanitaria de Granada ibs.GRANADA, Granada, Spain
| | - Raquel Ríos-Fernández
- Systemic Autoimmune Diseases Unit, Hospital Universitario Clínico San Cecilio, Instituto de Investigación Biosanitaria de Granada ibs.GRANADA, Granada, Spain
| | - Gonzalo Villanueva-Martín
- Institute of Parasitology and Biomedicine López-Neyra (IPBLN), Spanish National Research Council (CSIC), Granada, Spain
| | - María C Cid
- Vasculitis Research Unit, Department of Autoimmune Diseases, Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - José Hernández-Rodríguez
- Vasculitis Research Unit, Department of Autoimmune Diseases, Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Esteban Ballestar
- Epigenetics and Immune Disease Group, Josep Carreras Research Institute (IJC), Badalona, Barcelona, Spain
| | | | - Norberto Ortego-Centeno
- Department of Medicine, University of Granada, Instituto de Investigación Biosanitaria de Granada ibs.GRANADA, Granada, Spain
| | - Javier Martín
- Institute of Parasitology and Biomedicine López-Neyra (IPBLN), Spanish National Research Council (CSIC), Granada, Spain
| | - Ana Márquez
- Institute of Parasitology and Biomedicine López-Neyra (IPBLN), Spanish National Research Council (CSIC), Granada, Spain.
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Díaz-Villamarín X, Fernández-Varón E, Rojas Romero MC, Callejas-Rubio JL, Cabeza-Barrera J, Rodríguez-Nogales A, Gálvez J, Morón R. Azathioprine dose tailoring based on pharmacogenetic information: Insights of clinical implementation. Biomed Pharmacother 2023; 168:115706. [PMID: 37857254 DOI: 10.1016/j.biopha.2023.115706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 10/05/2023] [Accepted: 10/11/2023] [Indexed: 10/21/2023] Open
Abstract
Azathioprine is commonly used as an immunosuppressive antimetabolite in the treatment of acute lymphoblastic leukemia, autoimmune disorders (such as Crohn's disease and rheumatoid arthritis), and in patients receiving organ transplants. Thiopurine-S-methyltransferase (TPMT) is a cytoplasmic trans-methylase catalyzing the S-methylation of thiopurines. The active metabolites obtained from thiopurines are hydrolyzed into inactive forms by the Nudix hydrolase 15 (NUDT15). The TPMT*2 (defined by rs1800462), *3A (defined by rs1800460 and rs1142345), *3B (defined by rs1800460), *3C (defined by rs1142345), *6 (defined by rs75543815), and NUDT15 rs116855232 genetic variant have been associated, with the highest level of evidence, with the response to azathioprine, and, the approved drug label for azathioprine and main pharmacogenetic dosing guidelines recommend starting with reduced initial doses in TPMT intermediate metabolizer (IM) patients and considering an alternative treatment in TPMT poor metabolizer (PM) patients. This study aims to assess the clinical impact of azathioprine dose tailoring based on TPMT genotyping studying the azathioprine toxicity and efficacy, treatment starts, and dose adjustments during follow-up, comparing TPMT IM/PM and normal metabolizer (NM) patients. It also studied the association of NUDT15 rs116855232 with response to azathioprine in patients receiving a tailored treatment based on TPMT and characterized the TMPT and NUDT15 studied variants in our population. Results show that azathioprine dose reduction in TPMT IM patients (TPMT*1/*2, *1/*3A, or *1/*3C genotypes) is related to lower toxicity events compared to TPMT NM (TPMT *1/*1 genotype), and lower azathioprine dose adjustments during follow-up without showing differences in the efficacy. The results support the hypothesis of existing other genetic variants affecting azathioprine toxicity.
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Affiliation(s)
| | - Emilio Fernández-Varón
- Instituto de Investigación Biosanitaria de Granada (Ibs.Granada), Granada, Spain; Department of Pharmacology, Center for Biomedical Research (CIBM), University of Granada, Granada, Spain
| | | | - José Luis Callejas-Rubio
- Instituto de Investigación Biosanitaria de Granada (Ibs.Granada), Granada, Spain; Internal Medicine Department, Hospital Universitario San Cecilio, Granada, Spain
| | - José Cabeza-Barrera
- Instituto de Investigación Biosanitaria de Granada (Ibs.Granada), Granada, Spain; Hospital Pharmacy Unit. Hospital Universitario San Cecilio, Granada, Spain
| | - Alba Rodríguez-Nogales
- Instituto de Investigación Biosanitaria de Granada (Ibs.Granada), Granada, Spain; Department of Pharmacology, Center for Biomedical Research (CIBM), University of Granada, Granada, Spain
| | - Julio Gálvez
- Instituto de Investigación Biosanitaria de Granada (Ibs.Granada), Granada, Spain; Department of Pharmacology, Center for Biomedical Research (CIBM), University of Granada, Granada, Spain; Centro de Investigaciones Biomédicas en Red - Enfermedades Hepáticas y Digestivas (CIBER-ehd)
| | - Rocío Morón
- Instituto de Investigación Biosanitaria de Granada (Ibs.Granada), Granada, Spain; Hospital Pharmacy Unit. Hospital Universitario San Cecilio, Granada, Spain
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Aomar-Millán IF, Salvatierra J, Callejas-Rubio JL, Raya-Álvarez E. [Anakinra as a potential alternative in the treatment of severe acute respiratory infection associated with SARS-CoV-2 refractory to tocilizumab: coment]. Reumatol Clin 2023; 19:120-121. [PMID: 35165530 PMCID: PMC8828423 DOI: 10.1016/j.reuma.2022.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Indexed: 02/01/2023]
Affiliation(s)
- Ismael Francisco Aomar-Millán
- Servicio de Medicina Interna, Hospital Clínico Universitario San Cecilio, Granada, España,Autor para correspondencia
| | - Juan Salvatierra
- Servicio de Reumatología, Hospital Clínico Universitario San Cecilio, Granada, España
| | | | - Enrique Raya-Álvarez
- Servicio de Reumatología, Hospital Clínico Universitario San Cecilio, Granada, España
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Aomar-Millán IF, Salvatierra J, Callejas-Rubio JL, Raya-Álvarez E. Anakinra as a potential alternative in the treatment of severe acute respiratory infection associated with SARS-CoV-2 refractory to tocilizumab: comment. Reumatol Clin (Engl Ed) 2023; 19:120-121. [PMID: 35752586 PMCID: PMC9219577 DOI: 10.1016/j.reumae.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 01/27/2022] [Indexed: 02/06/2023]
Affiliation(s)
| | - Juan Salvatierra
- Servicio de Reumatología, Hospital Clínico Universitario San Cecilio, Granada, Spain
| | | | - Enrique Raya-Álvarez
- Servicio de Reumatología, Hospital Clínico Universitario San Cecilio, Granada, Spain
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6
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Montero-López E, Peralta-Ramírez MI, Ortego-Centeno N, Callejas-Rubio JL, Ríos-Fernández R, Santos-Ruiz A. Psychological and quality of life effects of vaccination against COVID-19 in patients with systemic autoimmune diseases. Lupus 2022; 31:1808-1815. [PMID: 36355914 PMCID: PMC9659700 DOI: 10.1177/09612033221134203] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2024]
Abstract
To verify the psychological and quality of life benefits of vaccination against COVID-19 in patients with systemic autoimmune diseases. In this study, levels of psychological stress, psychopathological symptoms, quality of life, and satisfaction with life were compared in patients with systemic autoimmune diseases vaccinated against COVID-19 (n = 132) versus unvaccinated patients (n = 254). To this end, we used the Perceived Stress Scale (PSS), Symptom Checklist-90-Revised (SCL-90-R), EUROQoL-5Q health questionnaire, and Satisfaction with Life Scale (SWLS), respectively. Statistically significant differences were found with better scores in the vaccinated group in the following quality of life dimensions: mobility (p ≤ 0.010), domestic activities (p ≤ 0.004), pain/discomfort (p ≤ 0.001), and anxiety/depression (p≤ 0.005). The scores were also significantly higher in the vaccinated group for the total values of quality of life (p ≤ 0.001), health status self-assessment on the EUROQoL-5Q (p ≤ 0.043), and satisfaction with life (p ≤ 0.015). In addition, the unvaccinated group presented higher scores with clinically pathological levels in depression and psychoticism for somatizations (p ≤ 0.006), depression (p ≤ 0.015), anxiety (p ≤ 0.003), and phobic anxiety (p ≤ 0.001). Finally, participants vaccinated with the complete regimen showed better levels of psychological well-being than those who were not vaccinated or those that had not completed the vaccination regimen. Our results reflect and confirm the positive effects reported elsewhere of the COVID-19 vaccine in autoimmune patients with systemic diseases, both in terms of quality and satisfaction with life as well as psychopathological symptoms and perceived stress. These benefits increased as the patients completed their vaccination schedule.
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Affiliation(s)
- Eva Montero-López
- Department of Developmental and
Educational Psychology, University of Granada, Granada, Spain
| | - María Isabel Peralta-Ramírez
- Department of Clinical Psychology, University of Granada, Granada, Spain
- Mind, Brain, Behavior Research Center
(CIMCYC), Granada, Spain
| | - Norberto Ortego-Centeno
- Department of Medicine, University of Granada, Granada, Spain
- Systemic Autoimmune Diseases Unit, San Cecilio Clinical
Hospital, Granada, Spain
- Biohealth Research Institute
(IBS), Granada, Spain
| | - José Luis Callejas-Rubio
- Systemic Autoimmune Diseases Unit, San Cecilio Clinical
Hospital, Granada, Spain
- Biohealth Research Institute
(IBS), Granada, Spain
| | - Raquel Ríos-Fernández
- Systemic Autoimmune Diseases Unit, San Cecilio Clinical
Hospital, Granada, Spain
- Biohealth Research Institute
(IBS), Granada, Spain
| | - Ana Santos-Ruiz
- Department of of Health Psychology, University of Alicante, Alicante, Spain
- Institute for Health and Biomedical
Research (ISABIAL), Alicante, Spain
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Affiliation(s)
- Andrés González-García
- Unidad de Enfermedades Autoinmunes Sistémicas, Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain.
| | - José Luis Callejas-Rubio
- Unidad de Enfermedades Autoinmunes Sistémicas, Department of Internal Medicine, Hospital San Cecilio Granada, Spain
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Gámiz-Molina AB, Cabrero-Rodríguez C, Martín-Ripoll L, Callejas-Rubio JL, Valero-González MÁ. Diffuse alveolar hemorrhage induced by inhalation of chemicals: a case report and review of the literature. Emergencias 2021; 33:405-406. [PMID: 34581539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
| | | | - Laura Martín-Ripoll
- Servicio de Medicina Interna, Unidad de Enfermedades Sistémicas y Autoinmunes, Hospital Universitario Clínico San Cecilio, Granada, España
| | - José Luis Callejas-Rubio
- Servicio de Medicina Interna, Unidad de Enfermedades Sistémicas y Autoinmunes, Hospital Universitario Clínico San Cecilio, Granada, España
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9
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Aomar-Millán IF, Salvatierra J, Torres-Parejo Ú, Faro-Miguez N, Callejas-Rubio JL, Ceballos-Torres Á, Cruces-Moreno MT, Gómez-Jiménez FJ, Hernández-Quero J, Anguita-Santos F. Anakinra after treatment with corticosteroids alone or with tocilizumab in patients with severe COVID-19 pneumonia and moderate hyperinflammation. A retrospective cohort study. Intern Emerg Med 2021; 16:843-852. [PMID: 33400157 PMCID: PMC7782569 DOI: 10.1007/s11739-020-02600-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 12/02/2020] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Little evidence appears to exist for the use of anakinra, a recombinant interleukin-1 receptor antagonist, after non-response to treatment with corticosteroids alone or combined with tocilizumab in patients with severe COVID-19 pneumonia and moderate hyperinflammatory state. PATIENTS AND METHODS A retrospective observational cohort study was carried out involving 143 patients with severe COVID-19 pneumonia and moderate hyperinflammation. They received standard therapy along with pulses of methylprednisolone (group 1) or methylprednisolone plus tocilizumab (group 2), with the possibility of receiving anakinra (group 3) according to protocol. The aim of this study was to assess the role of anakinra in the clinical course (death, admission to the intensive care ward) during the first 60 days after the first corticosteroid pulse. Clinical, laboratory, and imaging characteristics as well as infectious complications were also analyzed. RESULTS 74 patients (51.7%) in group 1, 59 (41.3%) patients in group 2, and 10 patients (7%) in group 3 were included. 8 patients (10.8%) in group 1 died, 6 (10.2%) in group 2, and 0 (0%) in group 3. After adjustment for age and clinical severity indices, treatment with anakinra was associated with a reduced risk of mortality (adjusted hazard ratio 0.518, 95% CI 0.265-0.910; p = 0.0437). Patients in group 3 had a lower mean CD4 count after 3 days of treatment. No patients in this group presented infectious complications. CONCLUSIONS In patients with moderate hyperinflammatory state associated with severe COVID-19 pneumonia, treatment with anakinra after non-response to corticosteroids or corticosteroids plus tocilizumab therapy may be an option for the management of these patients and may improve their prognosis.
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Affiliation(s)
- Ismael Francisco Aomar-Millán
- Department of Internal Medicine, San Cecilio University Hospital, Hospital Universitario San Cecilio, Avda. del Conocimiento s/n, 18016, Granada, Spain.
| | - Juan Salvatierra
- Department of Rheumatology, San Cecilio University Hospital, Granada, Spain
| | - Úrsula Torres-Parejo
- Department of Statistics and Operational Research, University of Granada, Granada, Spain
| | - Naya Faro-Miguez
- Department of Infectious Diseases, San Cecilio University Hospital, Granada, Spain
| | - José Luis Callejas-Rubio
- Department of Internal Medicine, San Cecilio University Hospital, Hospital Universitario San Cecilio, Avda. del Conocimiento s/n, 18016, Granada, Spain
| | - Ángel Ceballos-Torres
- Department of Internal Medicine, San Cecilio University Hospital, Hospital Universitario San Cecilio, Avda. del Conocimiento s/n, 18016, Granada, Spain
| | | | - Francisco Javier Gómez-Jiménez
- Department of Internal Medicine, San Cecilio University Hospital, Hospital Universitario San Cecilio, Avda. del Conocimiento s/n, 18016, Granada, Spain
| | - José Hernández-Quero
- Department of Infectious Diseases, San Cecilio University Hospital, Granada, Spain
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Álvarez-Cienfuegos A, Cantero-Nieto L, García-Gomez JA, Callejas-Rubio JL, González-Gay MA, Ortego-Centeno N. Association Between Homocysteine Serum Level and Bone Mineral Density in Patients With Rheumatoid Arthritis. J Clin Densitom 2020; 23:561-567. [PMID: 31005409 DOI: 10.1016/j.jocd.2019.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 03/24/2019] [Accepted: 03/25/2019] [Indexed: 11/25/2022]
Affiliation(s)
| | | | - J A García-Gomez
- Infectious Diseases Unit, Hospital General de Elche, Alicante, Spain
| | - J L Callejas-Rubio
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, Hospital Universitario San Cecilio, Granada, Spain
| | - M A González-Gay
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology Division, IDIVAL, Santander, Spain; School of Medicine, University of Cantabria, Santander, Spain; Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - N Ortego-Centeno
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, Hospital Universitario San Cecilio, Granada, Spain
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Gavilán-Carrera B, Vargas-Hitos JA, Morillas-de-Laguno P, Rosales-Castillo A, Sola-Rodríguez S, Callejas-Rubio JL, Sabio JM, Soriano-Maldonado A. Effects of 12-week aerobic exercise on patient-reported outcomes in women with systemic lupus erythematosus. Disabil Rehabil 2020; 44:1863-1871. [PMID: 32878503 DOI: 10.1080/09638288.2020.1808904] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE To evaluate the effects of aerobic exercise on patient-reported outcomes (PROs) in women with systemic lupus erythematosus (SLE), and whether changes in cardiorespiratory fitness (CRF) mediate the changes in PROs. METHODS A total of 58 women with SLE were assigned to either an exercise group (EG; n = 26) or a control group (CG; n = 32) in this non-randomized clinical trial. The EG comprised 12 weeks of aerobic exercise (2 sessions/week) between 40%-75% of the individual's heart rate reserve. At baseline, and at week 12, CRF (Bruce test) and PROs were assessed including psychological stress (Perceived Stress Scale), sleep quality (Pittsburg Sleep Quality Index), fatigue (Multidimensional Fatigue Inventory), depressive symptoms (Beck Depression Inventory), and quality of life (36-item Short-Form Health Survey). RESULTS In comparison to the CG, the EG showed a significant reduction in general fatigue (mean difference (MD) -2.86 units; 95%CI -5.70 to -0.01; p = 0.049), physical fatigue (MD -4.33 units; 95%CI -7.02 to -1.65; p = 0.002) and a non-significant reduction of reduced motivation (MD - 1.29 units; 95%CI -2.60 to 0.03; p = 0.055). There were no significant between-group differences in the changes in psychological stress, sleep quality, depressive symptoms, quality of life, or other fatigue dimensions (all p > 0.05). Changes in CRF mediated the effects of the exercise intervention on general fatigue by 53.8%. CONCLUSION The results suggest that 12 weeks of progressive aerobic exercise might improve relevant dimensions of fatigue in women with SLE, despite the absence of effects on other PROs. Improvements in CRF seem to mediate the effect of exercise on general fatigue.Implications for rehabilitationAerobic exercise could be safely introduced in rehabilitation programs for inactive patients with SLE with mild disease activity.Including physical activity recommendations as part of rehabilitation could improve relevant aspects of fatigue in women with SLE.When rehabilitation aims at reducing fatigue, cardiorespiratory fitness improvements derived from physical activity might enhance benefits.
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Affiliation(s)
- Blanca Gavilán-Carrera
- PA-HELP "Physical Activity for Health Promotion" Research Group, Sport and Health University Research Institute (iMUDS), Department of Physical and Sports Education, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - José Antonio Vargas-Hitos
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, "Virgen de las Nieves" University Hospital, Granada, Spain
| | - Pablo Morillas-de-Laguno
- Department of Physical and Sports Education, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Antonio Rosales-Castillo
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, "Virgen de las Nieves" University Hospital, Granada, Spain
| | - Sergio Sola-Rodríguez
- Department of Education, Faculty of Education Sciences, University of Almería, Almería, Spain
| | - José Luis Callejas-Rubio
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, "San Cecilio" University Hospital, Granada, Spain
| | - José Mario Sabio
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, "Virgen de las Nieves" University Hospital, Granada, Spain
| | - Alberto Soriano-Maldonado
- Department of Education, Faculty of Education Sciences, University of Almería, Almería, Spain.,SPORT Research Group (CTS-1024), CERNEP Research Center, University of Almería, Almería, Spain
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Herrero-Morant A, Álvarez-Reguera C, Martín-Varillas JL, Calvo-Río V, Casado A, Prieto-Peña D, Atienza-Mateo B, Maiz-Alonso O, Blanco A, Vicente E, Rúa-Figueroa Í, Cáceres-Martin L, García-Serrano JL, Callejas-Rubio JL, Ortego-Centeno N, Narváez J, Romero-Yuste S, Sánchez J, Estrada P, Demetrio-Pablo R, Martínez-López D, Castañeda S, Hernández JL, González-Gay MÁ, Blanco R. Biologic Therapy in Refractory Non-Multiple Sclerosis Optic Neuritis Isolated or Associated to Immune-Mediated Inflammatory Diseases. A Multicenter Study. J Clin Med 2020; 9:E2608. [PMID: 32796717 PMCID: PMC7464396 DOI: 10.3390/jcm9082608] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 07/31/2020] [Accepted: 08/07/2020] [Indexed: 01/24/2023] Open
Abstract
We aimed to assess the efficacy of biologic therapy in refractory non-Multiple Sclerosis (MS) Optic Neuritis (ON), a condition more infrequent, chronic and severe than MS ON. This was an open-label multicenter study of patients with non-MS ON refractory to systemic corticosteroids and at least one conventional immunosuppressive drug. The main outcomes were Best Corrected Visual Acuity (BCVA) and both Macular Thickness (MT) and Retinal Nerve Fiber Layer (RNFL) using Optical Coherence Tomography (OCT). These outcome variables were assessed at baseline, 1 week, and 1, 3, 6 and 12 months after biologic therapy initiation. Remission was defined as the absence of ON symptoms and signs that lasted longer than 24 h, with or without an associated new lesion on magnetic resonance imaging with gadolinium contrast agents for at least 3 months. We studied 19 patients (11 women/8 men; mean age, 34.8 ± 13.9 years). The underlying diseases were Bechet's disease (n = 5), neuromyelitis optica (n = 3), systemic lupus erythematosus (n = 2), sarcoidosis (n = 1), relapsing polychondritis (n = 1) and anti-neutrophil cytoplasmic antibody -associated vasculitis (n = 1). It was idiopathic in 6 patients. The first biologic agent used in each patient was: adalimumab (n = 6), rituximab (n = 6), infliximab (n = 5) and tocilizumab (n = 2). A second immunosuppressive drug was simultaneously used in 11 patients: methotrexate (n = 11), azathioprine (n = 2), mycophenolate mofetil (n = 1) and hydroxychloroquine (n = 1). Improvement of the main outcomes was observed after 1 year of therapy when compared with baseline data: mean ± SD BCVA (0.8 ± 0.3 LogMAR vs. 0.6 ± 0.3 LogMAR; p = 0.03), mean ± SD RNFL (190.5 ± 175.4 μm vs. 183.4 ± 139.5 μm; p = 0.02), mean ± SD MT (270.7 ± 23.2 μm vs. 369.6 ± 137.4 μm; p = 0.03). Besides, the median (IQR) prednisone-dose was also reduced from 40 (10-61.5) mg/day at baseline to. 2.5 (0-5) mg/day after one year of follow-up; p = 0.001. After a mean ± SD follow-up of 35 months, 15 patients (78.9%) achieved ocular remission, and 2 (10.5%) experienced severe adverse events. Biologic therapy is effective in patients with refractory non-MS ON.
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Affiliation(s)
- Alba Herrero-Morant
- Rheumatology, Ophtalmology and Internal Medicine, Hospital Universitario Marqués de Valdecilla, Av. de Valdecilla, 25, 39008 Santander, Spain; (A.H.-M.); (C.Á.-R.); (V.C.-R.); (A.C.); (D.P.-P.); (B.A.-M.); (R.D.-P.); (D.M.-L.)
| | - Carmen Álvarez-Reguera
- Rheumatology, Ophtalmology and Internal Medicine, Hospital Universitario Marqués de Valdecilla, Av. de Valdecilla, 25, 39008 Santander, Spain; (A.H.-M.); (C.Á.-R.); (V.C.-R.); (A.C.); (D.P.-P.); (B.A.-M.); (R.D.-P.); (D.M.-L.)
| | | | - Vanesa Calvo-Río
- Rheumatology, Ophtalmology and Internal Medicine, Hospital Universitario Marqués de Valdecilla, Av. de Valdecilla, 25, 39008 Santander, Spain; (A.H.-M.); (C.Á.-R.); (V.C.-R.); (A.C.); (D.P.-P.); (B.A.-M.); (R.D.-P.); (D.M.-L.)
| | - Alfonso Casado
- Rheumatology, Ophtalmology and Internal Medicine, Hospital Universitario Marqués de Valdecilla, Av. de Valdecilla, 25, 39008 Santander, Spain; (A.H.-M.); (C.Á.-R.); (V.C.-R.); (A.C.); (D.P.-P.); (B.A.-M.); (R.D.-P.); (D.M.-L.)
| | - Diana Prieto-Peña
- Rheumatology, Ophtalmology and Internal Medicine, Hospital Universitario Marqués de Valdecilla, Av. de Valdecilla, 25, 39008 Santander, Spain; (A.H.-M.); (C.Á.-R.); (V.C.-R.); (A.C.); (D.P.-P.); (B.A.-M.); (R.D.-P.); (D.M.-L.)
| | - Belén Atienza-Mateo
- Rheumatology, Ophtalmology and Internal Medicine, Hospital Universitario Marqués de Valdecilla, Av. de Valdecilla, 25, 39008 Santander, Spain; (A.H.-M.); (C.Á.-R.); (V.C.-R.); (A.C.); (D.P.-P.); (B.A.-M.); (R.D.-P.); (D.M.-L.)
| | - Olga Maiz-Alonso
- Rheumatology and Ophtalmology, Hospital de Donostia, Paseo Dr. Begiristain, 117, 20080 Donostia, Spain; (O.M.-A.); (A.B.)
| | - Ana Blanco
- Rheumatology and Ophtalmology, Hospital de Donostia, Paseo Dr. Begiristain, 117, 20080 Donostia, Spain; (O.M.-A.); (A.B.)
| | - Esther Vicente
- Rheumatology, Hospital Universitario de La Princesa, C/Diego de León, 62, 28006 Madrid, Spain; (E.V.); (S.C.)
| | - Íñigo Rúa-Figueroa
- Rheumatology, Hospital Universitario de Gran Canaria Doctor Negrín, C/Plaza Barranco de la Ballena, s/n, 35010 Las Palmas de Gran Canaria, Spain; (Í.R.-F.); (L.C.-M.)
| | - Laura Cáceres-Martin
- Rheumatology, Hospital Universitario de Gran Canaria Doctor Negrín, C/Plaza Barranco de la Ballena, s/n, 35010 Las Palmas de Gran Canaria, Spain; (Í.R.-F.); (L.C.-M.)
| | - José L. García-Serrano
- Internal Medicine and Ophtalmology, Hospital San Cecilio, Av. del Conocimiento, s/n, 18016 Granada, Spain; (J.L.G.-S.); (J.L.C.-R.); (N.O.-C.)
| | - José Luis Callejas-Rubio
- Internal Medicine and Ophtalmology, Hospital San Cecilio, Av. del Conocimiento, s/n, 18016 Granada, Spain; (J.L.G.-S.); (J.L.C.-R.); (N.O.-C.)
| | - Norberto Ortego-Centeno
- Internal Medicine and Ophtalmology, Hospital San Cecilio, Av. del Conocimiento, s/n, 18016 Granada, Spain; (J.L.G.-S.); (J.L.C.-R.); (N.O.-C.)
| | - Javier Narváez
- Rheumatology, Hospital de Bellvitge, Carrer de la Feixa Llarga, s/n, 08907 L’Hospitalet de Llobregat, Spain;
| | - Susana Romero-Yuste
- Rheumatology, Complejo Hospitalario Universitario de Pontevedra, Loureiro Crespo, 2, 36002 Pontevedra, Spain;
| | - Julio Sánchez
- Rheumatology, Hospital Universitario 12 de Octubre, Av. de Córdoba, s/n, 28041 Madrid, Spain;
| | - Paula Estrada
- Rheumatology, Hospital de Sant Joan Despí Moisès Broggi, Carrer de Jacint Verdaguer, 90, 08970 Sant Joan Despí, Spain;
| | - Rosalía Demetrio-Pablo
- Rheumatology, Ophtalmology and Internal Medicine, Hospital Universitario Marqués de Valdecilla, Av. de Valdecilla, 25, 39008 Santander, Spain; (A.H.-M.); (C.Á.-R.); (V.C.-R.); (A.C.); (D.P.-P.); (B.A.-M.); (R.D.-P.); (D.M.-L.)
| | - David Martínez-López
- Rheumatology, Ophtalmology and Internal Medicine, Hospital Universitario Marqués de Valdecilla, Av. de Valdecilla, 25, 39008 Santander, Spain; (A.H.-M.); (C.Á.-R.); (V.C.-R.); (A.C.); (D.P.-P.); (B.A.-M.); (R.D.-P.); (D.M.-L.)
| | - Santos Castañeda
- Rheumatology, Hospital Universitario de La Princesa, C/Diego de León, 62, 28006 Madrid, Spain; (E.V.); (S.C.)
| | - José L. Hernández
- Rheumatology, Ophtalmology and Internal Medicine, Hospital Universitario Marqués de Valdecilla, Av. de Valdecilla, 25, 39008 Santander, Spain; (A.H.-M.); (C.Á.-R.); (V.C.-R.); (A.C.); (D.P.-P.); (B.A.-M.); (R.D.-P.); (D.M.-L.)
| | - Miguel Á. González-Gay
- Rheumatology, Ophtalmology and Internal Medicine, Hospital Universitario Marqués de Valdecilla, Av. de Valdecilla, 25, 39008 Santander, Spain; (A.H.-M.); (C.Á.-R.); (V.C.-R.); (A.C.); (D.P.-P.); (B.A.-M.); (R.D.-P.); (D.M.-L.)
| | - Ricardo Blanco
- Rheumatology, Ophtalmology and Internal Medicine, Hospital Universitario Marqués de Valdecilla, Av. de Valdecilla, 25, 39008 Santander, Spain; (A.H.-M.); (C.Á.-R.); (V.C.-R.); (A.C.); (D.P.-P.); (B.A.-M.); (R.D.-P.); (D.M.-L.)
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Pocovi-Gerardino G, Correa-Rodríguez M, Callejas-Rubio JL, Ríos-Fernández R, Ortego-Centeno N, Rueda-Medina B. Dietary intake and nutritional status in patients with systemic lupus erythematosus. ACTA ACUST UNITED AC 2018; 65:533-539. [PMID: 29997049 DOI: 10.1016/j.endinu.2018.05.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 04/12/2018] [Accepted: 05/02/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Systemic lupus erythematosus (SLE) is a chronic inflammatory autoimmune disease. Despite the influence of diet on inflammation, dietary habits in patients with systemic lupus erythematosus (SLE) are not well established. The study objective was to assess dietary intake and nutritional status in SLE patients. PATIENTS AND METHODS A cross-sectional study was conducted in 92 patients with SLE. Nutritional status was determined by body mass index (BMI) and energy/nutrient distribution of diet was analyzed and compared to a control group. Dietary reference intakes (DRIs) issued by the Spanish Societies of Nutrition, Feeding and Dietetics (FESNAD) and the Spanish Society of Community Nutrition (SENC) were used as reference. RESULTS Body mass index was normal in 53.26% of patients, while 43.48% had excess weight. Energy, protein, and fat intake was significantly lower in the SLE group (p=0.003, p=0.000, and p=0.001 respectively). Protein and fat contribution to total energy was higher, while that of carbohydrate and fiber was lower than recommended. Most patients did not reach the recommended intake for iron (88%), calcium (65.2%), iodine (92.4%), potassium (73.9%), magnesium (65%), folate (72.8%), and vitamins E (87%) and D (82.6%), but exceeded the recommendations for sodium and phosphorus. CONCLUSIONS Spanish SLE patients have an unbalanced diet characterized by low carbohydrate/fiber and high protein/fat intakes. Significant deficiencies were seen in micronutrient intake. Dietary counseling to improve nutrition would therefore be advisable in management of SLE.
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Affiliation(s)
- Gabriela Pocovi-Gerardino
- Instituto de Investigación Biosanitaria, IBS, Granada, Spain; Universidad de Granada, UGR, Granada, Spain
| | - María Correa-Rodríguez
- Instituto de Investigación Biosanitaria, IBS, Granada, Spain; Faculty of Health Science, University of Granada, Spain.
| | - José Luis Callejas-Rubio
- Instituto de Investigación Biosanitaria, IBS, Granada, Spain; Hospital Campus de la Salud, Granada, Spain
| | - Raquel Ríos-Fernández
- Instituto de Investigación Biosanitaria, IBS, Granada, Spain; Hospital Campus de la Salud, Granada, Spain
| | - Norberto Ortego-Centeno
- Instituto de Investigación Biosanitaria, IBS, Granada, Spain; Hospital Campus de la Salud, Granada, Spain
| | - Blanca Rueda-Medina
- Instituto de Investigación Biosanitaria, IBS, Granada, Spain; Faculty of Health Science, University of Granada, Spain
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Moreno-Higueras M, Callejas-Rubio JL, Gallo-Padilla L. Síndrome de Dress y panuveítis bilateral por ranelato de estroncio. Med Clin (Barc) 2017; 149:317-318. [DOI: 10.1016/j.medcli.2017.05.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 05/17/2017] [Accepted: 05/18/2017] [Indexed: 11/16/2022]
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Bossini-Castillo L, Campillo-Davó D, López-Isac E, Carmona FD, Simeon CP, Carreira P, Callejas-Rubio JL, Castellví I, Fernández-Nebro A, Rodríguez-Rodríguez L, Rubio-Rivas M, García-Hernández FJ, Madroñero AB, Beretta L, Santaniello A, Lunardi C, Airó P, Hoffmann-Vold AM, Kreuter A, Riemekasten G, Witte T, Hunzelmann N, Vonk MC, Voskuyl AE, de Vries-Bouwstra J, Shiels P, Herrick A, Worthington J, Radstake TR, Martin J. An MIF Promoter Polymorphism Is Associated with Susceptibility to Pulmonary Arterial Hypertension in Diffuse Cutaneous Systemic Sclerosis. J Rheumatol 2017; 44:1453-1457. [DOI: 10.3899/jrheum.161369] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2017] [Indexed: 11/22/2022]
Abstract
Objective.Systemic sclerosis (SSc) is a fibrotic immune-mediated disease of unknown etiology. Among its clinical manifestations, pulmonary involvement is the leading cause of mortality in patients with SSc. However, the genetic factors involved in lung complication are not well defined. We aimed to review the association of the MIF gene, which encodes a cytokine implicated in idiopathic pulmonary hypertension among other diseases, with the susceptibility and clinical expression of SSc, in addition to testing the association of this polymorphism with SSc-related pulmonary involvement.Methods.A total of 4392 patients with SSc and 16,591 unaffected controls from 6 cohorts of European origin were genotyped for the MIF promoter variant rs755622. An inverse variance method was used to metaanalyze the data.Results.A statistically significant increase of the MIF rs755622*C allele frequency compared with controls was observed in the subgroups of patients with diffuse cutaneous SSc (dcSSc) and with pulmonary arterial hypertension (PAH) independently (dcSSc: p = 3.20E–2, OR 1.13; PAH: p = 2.19E–02, OR 1.32). However, our data revealed a stronger effect size with the subset of patients with SSc showing both clinical manifestations (dcSSc with PAH: p = 6.91E–3, OR 2.05).Conclusion.We reviewed the association of the MIF rs755622*C allele with SSc and described a phenotype-specific association of this variant with the susceptibility to develop PAH in patients with dcSSc.
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Sánchez-Cano D, Callejas-Rubio JL, Vilanova-Mateu A, Gómez-Morales M, Ortego-Centeno N. Intravascular lymphoma in a patient with systemic lupus erythematosus: a case report. Lupus 2016; 16:525-8. [PMID: 17670853 DOI: 10.1177/0961203307079461] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Intravascular lymphoma IVL is a rare and aggressive disorder characterized by proliferation of large lymphoid cells (most commonly B-cells) within the lumen of small vessels of nearly every organ. Obliteration of vessels leads to the different clinical signs, being cutaneous lesions and neurological signs the most frequent presentations, whereas lymph node and reticuloendothelial system involvement is typically absent.1—4 No association with SLE has been described up to the present. We report a case of IVL in a patient with systemic lupus erythematosus (SLE) involving skin, central nervous system (CNS) and bone marrow. Lupus (2007) 16, 525—528.
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Affiliation(s)
- D Sánchez-Cano
- Unidad de Enfermedades Autoinmunes Sistémicas, Hospital Clínico San Cecilio, Granada, Spain.
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Peralta-Ramírez MI, Coín-Mejías MA, Jiménez-Alonso J, Ortego-Centeno N, Callejas-Rubio JL, Caracuel-Romero A, Pérez-García M. Stress as a predictor of cognitive functioning in lupus. Lupus 2016; 15:858-64. [PMID: 17211991 DOI: 10.1177/0961203306071404] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The objective of this study was to investigate the possible effects of the daily stress experienced during a six-month period on the cognitive functioning of patients with systemic lupus erythematosus (SLE). For this purpose, we evaluated the daily stress of 21 patients with lupus every day for six months. Later, we carried out a neuropsychological exam that included an evaluation of attention and memory. At the same time, scores on depression and anxiety were recorded with the objective of controlling other emotional variables that might be influencing these cognitive processes. The results show that daily stress was able to predict the scores on the neuropsychological variables studied. Specifically, the daily stress experienced in the previous six months is the variable with the greatest explanatory-predictive power on the scores for delayed recall visual memory, visual fluency and attention speed. This relationship proved to be negative in all three cases ( R2 corr = 0.290; t = −2.712, P < 0.014); ( R2 corr = 0.318; t = −2.818, P < 0.012); ( R2 corr = 0.319; t −2.906, P < 0.009), which means that the greater the daily stress, the lower the score on visual memory, fluency and total attention speed. We can state that daily stress is related to impairments in visual memory, fluency and attention in patients with SLE. This effect was not found with other emotional variables, such as depression and anxiety.
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Simeón-Aznar CP, Fonollosa-Plá V, Tolosa-Vilella C, Espinosa-Garriga G, Campillo-Grau M, Ramos-Casals M, García-Hernández FJ, Castillo-Palma MJ, Sánchez-Román J, Callejas-Rubio JL, Ortego-Centeno N, Egurbide-Arberas MV, Trapiellla-Martínez L, Caminal-Montero L, Sáez-Comet L, Velilla-Marco J, Camps-García MT, de Ramón-Garrido E, Esteban-Marcos EM, Pallarés-Ferreres L, Navarrete-Navarrete N, Vargas-Hitos JA, Torre RGDL, Salvador-Cervello G, Rios-Blanco JJ, Vilardell-Tarrés M. Registry of the Spanish Network for Systemic Sclerosis: Survival, Prognostic Factors, and Causes of Death. Medicine (Baltimore) 2015; 94:e1728. [PMID: 26512564 PMCID: PMC4985378 DOI: 10.1097/md.0000000000001728] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Systemic sclerosis (SSc) is a rare, multisystem disease showing a large individual variability in disease progression and prognosis. In the present study, we assess survival, causes of death, and risk factors of mortality in a large series of Spanish SSc patients. Consecutive SSc patients fulfilling criteria of the classification by LeRoy were recruited in the survey. Kaplan-Meier and Cox proportional-hazards models were used to analyze survival and to identify predictors of mortality. Among 879 consecutive patients, 138 (15.7%) deaths were registered. Seventy-six out of 138 (55%) deceased patients were due to causes attributed to SSc, and pulmonary hypertension (PH) was the leading cause in 23 (16.6%) patients. Survival rates were 96%, 93%, 83%, and 73% at 5, 10, 20, and 30 years after the first symptom, respectively. Survival rates for diffuse cutaneous SSc (dcSSc) and limited cutaneous SSc were 91%, 86%, 64%, and 39%; and 97%, 95%, 85%, and 81% at 5, 10, 20, and 30 years, respectively (log-rank: 67.63, P < 0.0001). The dcSSc subset, male sex, age at disease onset older than 65 years, digital ulcers, interstitial lung disease (ILD), PH, heart involvement, scleroderma renal crisis (SRC), presence of antitopoisomerase I and absence of anticentromere antibodies, and active capillaroscopic pattern showed reduced survival rate. In a multivariate analysis, older age at disease onset, dcSSc, ILD, PH, and SRC were independent risk factors for mortality. In the present study involving a large cohort of SSc patients, a high prevalence of disease-related causes of death was demonstrated. Older age at disease onset, dcSSc, ILD, PH, and SRC were identified as independent prognostic factors.
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Affiliation(s)
- C P Simeón-Aznar
- From the Department of Internal Medicine, Hospital Valld'Hebron (CPS-A, VF-P, MV-T); Department of Internal Medicine, Hospital Parc Taulí, Sabadell (CT-V); Department of Autoimmune Diseases, Hospital Clinic (GE-G, MR-C); Laboratori of Computacional Medicine, Bioestatistics Unit, Universitat Autònoma de Barcelona, Bellaterra, Barcelona (MC-G); Unit of Connective Tissue Diseases, Department of Internal Medicine, Hospital Virgen del Rocio, Sevilla (FJG-H, MJC-P, JS-R); Unit of Autoimmune Systemic Diseases, Department of Internal Medicine, Hospital Clínico San Cecilio, Granada (JLC-R, NO-C); Department of Internal Medicine, Hospital de Cruces, Galdakano, Bilbao (MVE-A); Department of Internal Medicine, Hospital de Cabueñes, Gijón (LT-M); Department of Internal Medicine, Hospital Universitario Central de Asturias, Oviedo (LC-M); Department of Internal Medicine, Hospital Miguel Servet, Zaragoza (LS-C, JV-M); Department of Internal Medicine, Hospital Carlos Haya, Málaga (MTC-G, ER-G); Department of Internal Medicine, Hospital Son Espases, Palma de Mallorca (EME-M, LP-F); Department of Internal Medicine, Hospital Virgen de las Nieves, Granada (NN-N, JAV-H); Department of Internal Medicine, Hospital San Agustín, Avilés (RGT); Department of Internal Medicine, Hospital La Fe, Valencia (GS-C); and Department of Internal Medicine, Hospital La Paz, Madrid (JJR-B), Systemic Autoimmune Diseases Group (GEAS), Spanish Scleroderma Study Group (SSSG), Spanish Society of Internal Medicine, Spain
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López-Robles C, Ríos-Fernández R, Callejas-Rubio JL, Moreno-Escobar E, Ortego-Centeno N. Low bone mass and carotid atherosclerosis in lupus erythematosus patients from Granada, a city in the south of Spain. Lupus 2015; 25:223-4. [DOI: 10.1177/0961203315608255] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 08/25/2015] [Indexed: 11/15/2022]
Affiliation(s)
- C López-Robles
- Clinical Internal Medicine Unit, Hospital General de Antequera, Antequera, Málaga, Spain
| | - R Ríos-Fernández
- Autoimmune Diseases Unit, Hospital Universitario San Cecilio, Granada, Spain
| | - J L Callejas-Rubio
- Autoimmune Diseases Unit, Hospital Universitario San Cecilio, Granada, Spain
| | - E Moreno-Escobar
- Clinical Cardiology Unit, Hospital Universitario San Cecilio, Granada, Spain
| | - N Ortego-Centeno
- Autoimmune Diseases Unit, Hospital Universitario San Cecilio, Granada, Spain
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González-Moreno J, Callejas-Rubio JL, Ríos-Fernández R, Ortego-Centeno N. Antiphospholipid syndrome, antiphospholipid antibodies and solid organ transplantation. Lupus 2015; 24:1356-63. [DOI: 10.1177/0961203315595129] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 06/17/2015] [Indexed: 11/16/2022]
Abstract
Antiphospholipid syndrome is considered a high risk factor for any kind of surgery. Considering that all solid organ transplants are critically dependent on the patency of vascular anastomosis, there is much concern about the consequences this pro-thrombotic condition may have on transplantation. Relatively little information is available in the literature assessing the real risk that antiphospholipid syndrome or the presence of antiphospholipid antibodies represent in solid organ transplantation. The aim of this article is to review the literature related to transplantation of solid organs in patients diagnosed with antiphospholipid syndrome or patients with positive antiphospholipid antibodies.
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Affiliation(s)
- J González-Moreno
- Internal Medicine Department, Hospital Son Llàtzer, Palma de Mallorca, Illes Balears, Spain
| | - J L Callejas-Rubio
- Autoimmune Diseases Unit, Internal Medicine Department, Hospital Clínico San Cecilio, Granada, Spain
| | - R Ríos-Fernández
- Autoimmune Diseases Unit, Internal Medicine Department, Hospital Clínico San Cecilio, Granada, Spain
| | - N Ortego-Centeno
- Autoimmune Diseases Unit, Internal Medicine Department, Hospital Clínico San Cecilio, Granada, Spain
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Coín MA, Vilar-López R, Peralta-Ramírez I, Hidalgo-Ruzzante N, Callejas-Rubio JL, Ortego-Centeno N, Pérez-García M. The role of antiphospholipid autoantibodies in the cognitive deficits of patients with systemic lupus erythematosus. Lupus 2015; 24:875-9. [DOI: 10.1177/0961203315572717] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 01/21/2015] [Indexed: 11/17/2022]
Abstract
Objective: To analyze the role of the antiphospholipid autoantibodies (aPL) on the neuropsychological deficits in systemic lupus erythematosus (SLE) patients, comparing groups of patients with antiphospholipid syndrome (APS; n = 15), SLE with aPL ( n = 12), and SLE without aPL ( n = 27), and a healthy control group ( n = 31). Methods: Patients fulfilled the American College of Rheumatology SLE classification criteria or the Sydney criteria for APS. All participants were woman, and groups were matched on age and education. A standardized cognitive examination classified patients as cognitively declined or impaired according to the American College of Rheumatology. Results: Differences between the groups were found in all of the studied variables, comprising attention and executive functions (sustained and selective attention, fluency, and inhibition), and memory (verbal and visual). Post-hoc analyses showed cognitive performance was equivalent between APS and SLE with aPL. Differences between SLE without aPL and control groups were found only in four of the 10 studied variables, while differences in all but two memory variables were found between SLE without aPL and control groups. Furthermore, cognitive deficit was three times more frequent in APS and SLE with aPL patients than for the control group (80%, 75%, and 16%, respectively), and two times more frequent compared to SLE patients without aPL (48%). Conclusions: Our results support the relationship between aPL and cognitive symptoms in SLE. Also, almost half of the patients with SLE and no aPL showed cognitive problems, pointing to the multifactorial causes of cognitive problems in SLE. Future research with larger sample size is guaranteed to replicate our results.
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Affiliation(s)
- M A Coín
- Facultad de Psicología, Universidad de Jaén, Spain
| | - R Vilar-López
- Facultad de Psicología, Universidad de Granada, Spain
- Centro de Investigación Mente, Cerebro y Comportamiento (CIMCYC), Universidad de Granada, Spain
| | - I Peralta-Ramírez
- Facultad de Psicología, Universidad de Granada, Spain
- Centro de Investigación Mente, Cerebro y Comportamiento (CIMCYC), Universidad de Granada, Spain
| | - N Hidalgo-Ruzzante
- Facultad de Psicología, Universidad de Granada, Spain
- Centro de Investigación Mente, Cerebro y Comportamiento (CIMCYC), Universidad de Granada, Spain
| | - J L Callejas-Rubio
- Internal Medicine Unit, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - N Ortego-Centeno
- Internal Medicine Unit, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - M Pérez-García
- Facultad de Psicología, Universidad de Granada, Spain
- Centro de Investigación Mente, Cerebro y Comportamiento (CIMCYC), Universidad de Granada, Spain
- Centro de Investigaciones Biomédica en Red de Salud Mental (CIBERSAM), University of Granada, Spain
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22
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Ortego-Jurado M, Ríos-Fernández R, Callejas-Rubio JL, Gonzalez-Gay MA, Ortego-Centeno N. Vitamin D levels and response to biphosphonates in postmenopausal women receiving glucocorticoid therapy. Osteoporos Int 2014; 25:2157-8. [PMID: 24803328 DOI: 10.1007/s00198-014-2713-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 04/08/2014] [Indexed: 11/30/2022]
Affiliation(s)
- M Ortego-Jurado
- Unidad de Enfermedades Autoinmunes Sistémicas, Hospital Universitario San Cecilio, Granada, Spain
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23
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Sánchez-Cano D, Callejas-Rubio JL, Ruiz-Villaverde R, Ríos-Fernández R, Ortego-Centeno N. Off-label uses of anti-TNF therapy in three frequent disorders: Behçet's disease, sarcoidosis, and noninfectious uveitis. Mediators Inflamm 2013; 2013:286857. [PMID: 23983404 PMCID: PMC3747407 DOI: 10.1155/2013/286857] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Revised: 07/09/2013] [Accepted: 07/15/2013] [Indexed: 12/11/2022] Open
Abstract
Tumoral necrosis factor α plays a central role in both the inflammatory response and that of the immune system. Thus, its blockade with the so-called anti-TNF agents (infliximab, etanercept, adalimumab, certolizumab pegol, and golimumab) has turned into the most important tool in the management of a variety of disorders, such as rheumatoid arthritis, spondyloarthropatties, inflammatory bowel disease, and psoriasis. Nonetheless, theoretically, some other autoimmune disorders may benefit from these agents. Our aim is to review these off-label uses of anti-TNF blockers in three common conditions: Behçet's disease, sarcoidosis, and noninfectious uveitis. Due to the insufficient number of adequate clinical trials and consequently to their lower prevalence compared to other immune disorders, this review is mainly based on case reports and case series.
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Parra-García GD, Callejas-Rubio JL, Ríos-Fernández R, Sainz-Quevedo M, Ortego-Centeno N. Otolaryngologic manifestations of systemic vasculitis. Acta Otorrinolaringol Esp 2011; 63:303-10. [PMID: 22177421 DOI: 10.1016/j.otorri.2011.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Revised: 09/29/2011] [Accepted: 09/30/2011] [Indexed: 11/25/2022]
Abstract
Systemic vasculitis is a heterogeneous group of diseases of various aetiologies and manifestations. In general, the clinical results derive from ischemia caused by vascular inflammation, which depends on the organ affected. Such vasculitis cases are classified according to the classification of the Chapel Hill conference. They can present with relative frequency as ENT manifestations in both their debut and throughout their evolution. Consequently, the ENT specialist should include them in the differential diagnosis in patients with ENT manifestations that are difficult to control or of atypical presentation. Our objective was to review the most common ENT clinical signs and symptoms in each of these diseases.
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Simeón-Aznar CP, Fonollosa-Plá V, Tolosa-Vilella C, Espinosa-Garriga G, Ramos-Casals M, Campillo-Grau M, García-Hernández FJ, Castillo-Palma MJ, Sánchez-Román J, Callejas-Rubio JL, Ortego-Centeno N, Egurbide-Arberas MV, Trapiellla-Martínez L, Gallego-Villalobos M, Sáez-Comet L, Velilla-Marco J, Camps-García MT, de Ramón-Garrido E, Esteban Marcos EM, Pallarés-Ferreres L, Hidalgo-Tenorio C, Sabio-Sánchez JM, Gómez-de la Torre R, Salvador-Cervello G, Rios-Blanco JJ, Gil-Aguado A, Vilardell-Tarrés M. Registry of the Spanish network for systemic sclerosis: clinical pattern according to cutaneous subsets and immunological status. Semin Arthritis Rheum 2011; 41:789-800. [PMID: 22169458 DOI: 10.1016/j.semarthrit.2011.10.004] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2011] [Revised: 10/02/2011] [Accepted: 10/13/2011] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To investigate the incidence of clinical and immunological characteristics of a large cohort of Spanish patients with scleroderma (SSc) and identifying factors associated with particular organ manifestations assessed by a nationwide cross-sectional analysis. METHODS We classified SSc patients in 4 subsets using a modification of LeRoy and Medsger classification that included: "prescleroderma" (pre-SSc), limited cutaneous SSc (lcSSc), diffuse cutaneous SSc (dcSSc), and SSc sine scleroderma (ssSSc). Fourteen Spanish centers participated in patient recruitment. On January 2008, the database included 916 consecutive Spanish SSc patients, 801 women (87.4%) and 115 men (12.6%), all of whom fulfilled the classification criteria proposed by LeRoy and Medsger. Epidemiological, clinical, and laboratory data were collected according to a standard protocol. Mean age at diagnosis was 51.2 ± 15.1 years and mean age at disease onset was 44.9.0 ± 15.8 years. lcSSc was the most frequent subset (61.8%) followed by dcSSc (26.5%), ssSSc (7.5%), and preSSc (4%) subsets. Gender ratios were as follows: dcSSc subset, 200 women and 43 men (4.7:1); lcSSc subset, 503 women and 63 men (ratio 7.9:1), and ssSSc subset, 62 women and 7 men (ratio 8.9:1). Digital ulcers, interstitial lung disease (ILD), musculoeskeletal and esophageal involvement, and scleroderma renal crisis were more frequent in dcSSc than lcSSc and ssSSc subsets. The incidence of pulmonary arterial hypertension assessed by echocardiography was similar in all subsets but mean estimated systolic pulmonary arterial pressure was higher in ssSSc than in lcSSc subset (47.3 ± 23.9 mm Hg vs 39.6 ± 19.2 mm Hg; P < 0.03). Cardiac involvement was identified more frequently in ssSSc than in dcSSc and lcSSc subsets (49.3% vs 32.5% and 31.1%, respectively; P = 0.015 and P = 0.004 for both comparisons). Acro-osteolysis (8.2% vs 2.4%, P = 0.049), calcinosis (19.8% vs 7.2%, P < 0.05), and sicca syndrome (37.5% vs 14.5%, P < 0.0001) were more frequent in lcSSc than in ssSSc subsets. The frequency of clinical manifestations related to the presence of anticentromere antibodies or antitopoisomerase I antibodies was very similar to that identified in patients categorized to lcSSc and dcSSc, respectively. However, in multivariate studies, the ranking of the variables according to their overall explanatory effect on the model showed that the contributory effect of the antibody status was not greater than that of the clinical categorization into lcSSc and dcSSc for the majority of disease manifestations, but, in important manifestations, as ILD, absence of anticentromere antibodies was an independent predictor factor. CONCLUSIONS The classification of SSc into dcSSc, lcSSc, and ssSSc subsets is the one that most closely reflects the natural history of the disease, as they presented clear clinical differences. The immunological profile helps to define important visceral alteration as ILD. Finally, to improve early diagnosis of SSc, patients with preSSc should be considered both to trace the true evolution of the disease and to define which patients could benefit from therapeutic measures able to prevent the appearance of visceral involvements.
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Abstract
Sarcoidosis is a chronic multisystem disease of unknown etiology, characterized by noncaseating granulomatous infiltration of virtually any organ system. Treatment is often undertaken in an attempt to resolve symptoms or prevent progression to organ failure. Previous studies have suggested a prominent role for tumor necrosis factor-alpha (TNF-α) in the inflammatory process seen in sarcoidosis. TNF-α and interleukin-1 are released by alveolar macrophages in patients with active lung disease. Corticosteroids have proved to be efficacious in the treatment of sarcoidosis, possibly by suppressing the production of TNF-α and other cytokines. Three agents are currently available as specific TNF antagonists: etanercept, infliximab, and adalimumab. Although data from noncomparative trials suggest that all three have comparable therapeutic effects in rheumatoid arthritis, their effects in a granulomatous disease such as sarcoidosis are less consistent. In this review, current data on the effectiveness are summarized.
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27
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Arias-Santiago S, Callejas-Rubio JL, Orgaz-Molina J, Ríos-Fernández R, Gutiérrez-Salmerón MT, Ortego-Centeno N. Palmar and plantar keratoderma, visual loss, and alopecia. J Am Acad Dermatol 2011. [DOI: 10.1016/j.jaad.2010.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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28
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Bossini-Castillo L, Simeon CP, Beretta L, Vonk MC, Callejas-Rubio JL, Espinosa G, Carreira P, Camps MT, Rodríguez-Rodríguez L, Rodríguez-Carballeira M, García-Hernández FJ, López-Longo FJ, Hernández-Hernández V, Sáez-Comet L, Egurbide MV, Hesselstrand R, Nordin A, Hoffmann-Vold AM, Vanthuyne M, Smith V, De Langhe E, Kreuter A, Riemekasten G, Witte T, Hunzelmann N, Voskuyl AE, Schuerwegh AJ, Lunardi C, Airó P, Scorza R, Shiels P, van Laar JM, Fonseca C, Denton C, Herrick A, Worthington J, Koeleman BP, Rueda B, Radstake TRDJ, Martin J. Confirmation of association of the macrophage migration inhibitory factor gene with systemic sclerosis in a large European population. Rheumatology (Oxford) 2011; 50:1976-81. [DOI: 10.1093/rheumatology/ker259] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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29
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Sánchez-Cano D, Ruiz-Villaverde R, Callejas-Rubio JL, Pérez CC, García MG, Centeno NO. Déficit de vitamina D y densidad mineral ósea en la enfermedad de Crohn. Med Clin (Barc) 2011; 137:62-5. [DOI: 10.1016/j.medcli.2010.09.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2010] [Revised: 09/07/2010] [Accepted: 09/09/2010] [Indexed: 11/29/2022]
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30
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López-Robles C, Rios-Fernández R, Callejas-Rubio JL, Ortego-Centeno N. Vitamin D deficiency in a cohort of patients with systemic lupus erythematous from the South of Spain. Lupus 2010; 20:330-1. [DOI: 10.1177/0961203310378670] [Citation(s) in RCA: 18] [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: 11/17/2022]
Affiliation(s)
- C López-Robles
- Autoimmune Diseases Unit, Hospital Universitario San Cecilio, Avd Dr. Oloriz s/n, Granada, Spain
| | - R Rios-Fernández
- Autoimmune Diseases Unit, Hospital Universitario San Cecilio, Avd Dr. Oloriz s/n, Granada, Spain
| | - JL Callejas-Rubio
- Autoimmune Diseases Unit, Hospital Universitario San Cecilio, Avd Dr. Oloriz s/n, Granada, Spain
| | - N Ortego-Centeno
- Autoimmune Diseases Unit, Hospital Universitario San Cecilio, Avd Dr. Oloriz s/n, Granada, Spain
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31
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Husein-Elahmed H, Callejas-Rubio JL, Ortega Del Olmo R, Ríos-Fernandez R, Ortego-Centeno N. Severe Raynaud syndrome induced by adjuvant interferon alfa in metastatic melanoma. Curr Oncol 2010; 17:122-3. [PMID: 20697523 DOI: 10.3747/co.v17i4.519] [Citation(s) in RCA: 3] [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: 11/15/2022] Open
Abstract
Melanoma is the most lethal form of skin malignancy because of its aggressive behaviour. In advanced disease, interferon alfa can be used as adjuvant therapy. However, this therapy is not free of side effects. We present a case of severe Raynaud syndrome and digital necrosis induced by interferon alfa in a patient with melanoma. Pathogenic mechanisms are discussed.
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Affiliation(s)
- H Husein-Elahmed
- Department of Dermatology, San Cecilio University Hospital, Granada, Spain.
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32
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Navarrete-Navarrete N, Peralta-Ramírez MI, Sabio-Sánchez JM, Coín MA, Robles-Ortega H, Hidalgo-Tenorio C, Ortego-Centeno N, Callejas-Rubio JL, Jiménez-Alonso J. Efficacy of cognitive behavioural therapy for the treatment of chronic stress in patients with lupus erythematosus: a randomized controlled trial. Psychother Psychosom 2010; 79:107-15. [PMID: 20090397 DOI: 10.1159/000276370] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2008] [Accepted: 04/03/2009] [Indexed: 11/19/2022]
Abstract
BACKGROUND Chronic stress worsens the quality of life (QOL) of lupus patients by affecting their physical and psychological status. The effectiveness of a cognitive-behavioural intervention in a group of patients with lupus and high levels of daily stress was investigated. METHODS Forty-five patients with lupus and high levels of daily stress were randomly assigned to a control group (CG) or a therapy group (TG); they received cognitive behavioural therapy (CBT) which consisted of ten consecutive weekly sessions. The following variables were evaluated at baseline and at 3, 9 and 15 months: (1) stress, anxiety, depression, (2) Systemic Lupus Erythematosus Disease Activity Index, somatic symptoms, number of flares, (3) anti-nDNA antibodies, complement fractions C3 and C4 and (4) QOL. A multivariate analysis of repeated measures and various analyses of variance were carried out. RESULTS We found a significant reduction in the level of depression, anxiety and daily stress in the TG compared to the CG and a significant improvement in QOL and somatic symptoms in the TG throughout the entire follow-up period. We did not find any significant changes in the immunological parameters. CONCLUSIONS CBT is effective in dealing with patients suffering from lupus and high levels of daily stress as it significantly reduces the incidence of psychological disorders associated with lupus and improves and maintains patients' QOL, despite there being no significant reduction in the disease activity index.
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Affiliation(s)
- N Navarrete-Navarrete
- Autoimmune Diseases Unit, Internal Medicine Service, University Hospital Virgen de Las Nieves, Granada, Spain.
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Arias-Santiago S, Sanchez-Cano D, Callejas-Rubio JL, Fernández-Pugnaire MA, Ortego-Centeno N. Adalimumab treatment for SAPHO syndrome. Acta Derm Venereol 2010; 90:301-2. [PMID: 20526553 DOI: 10.2340/00015555-0822] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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34
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Arias-Santiago S, Fernández-Pugnaire MA, Aneiros-Fernández J, Falcón CS, Callejas-Rubio JL, Ortego-Centeno N, Serrano-Ortega S. Recurrent telangiectasias on the cheek: angiolupoid sarcoidosis. Am J Med 2010; 123:e7-8. [PMID: 20102979 DOI: 10.1016/j.amjmed.2009.08.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2009] [Revised: 08/01/2009] [Accepted: 08/05/2009] [Indexed: 01/19/2023]
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Sánchez-Cano D, Callejas-Rubio JL, Ríos-Fernández R, Gutiérrez-Salmerón MT, Fernández Pugnaire MA, Ortego-Centeno N. Efalizumab for subacute cutaneous lupus: report of two different outcomes. Lupus 2009; 18:1334-6. [DOI: 10.1177/0961203309106761] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- D. Sánchez-Cano
- Unidad de Enfermedades Autoinmunes Sistémicas, Hospital Universitario San Cecilio, Granada, Spain,
| | - JL Callejas-Rubio
- Unidad de Enfermedades Autoinmunes Sistémicas, Hospital Universitario San Cecilio, Granada, Spain
| | - R. Ríos-Fernández
- Unidad de Enfermedades Autoinmunes Sistémicas, Hospital Universitario San Cecilio, Granada, Spain
| | | | | | - N. Ortego-Centeno
- Unidad de Enfermedades Autoinmunes Sistémicas, Hospital Universitario San Cecilio, Granada, Spain
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Sánchez E, González-Gay MA, Callejas-Rubio JL, Ortego-Centeno N, Sabio JM, Jiménez-Alonso J, Micó L, Suarez A, Gutierrez C, de Ramón E, Camps M, Garcia-Portales R, Tolosa C, López-Nevot MA, Sánchez-Román J, Hernández FJ, González-Escribano MF, Martín J. No evidence for genetic association of interferon regulatory factor 3 in systemic lupus erythematosus. Lupus 2009; 18:230-4. [PMID: 19213861 DOI: 10.1177/0961203308096256] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The aim of this study was to determine the potential role of three IRF3 gene polymorphisms (rs2304204, rs7251 and rs2304207) with systemic lupus erythematosus (SLE). Our study population consisted of 610 patients with SLE and 730 healthy controls. All individual were of Spanish Caucasian origin. The IRF3 polymorphisms were genotyped using a PCR system with pre-developed TaqMan allelic discrimination assay. No statistically significant differences were found when allele and genotype distribution of rs2304204, rs7251 and rs2304207 polymorphisms were compared between patients with SLE and controls [overall P values: rs7251, P = 0.06; rs2304204, P = 0.26 and rs2304207, P = 0.36, by chi-squared test on a 3 x 2 contingency table. Overall allelic P values: rs7251, P = 0.8, OR (95%CI) = 1.03 (0.87-1.22); rs2304204, P = 0.2, OR (95%CI) = 1.12 (0.93-1.34) and rs2304207, P = 0.8, OR (95%CI) = 1.02 (0.82-1.26)]. In addition, no evidence of association with haplotypes and clinical features of SLE was found. Our data suggest that the IRF3 polymorphisms do not appear to play a major role in the susceptibility or severity of SLE in a Spanish population.
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Affiliation(s)
- E Sánchez
- Instituto de Parasitología y Biomedicina López-Neyra, CSIC, Granada, Spain.
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Sánchez E, Callejas-Rubio JL, Sabio JM, Gónzalez-Gay MA, Jimenez-Alonso J, Micó L, de Ramón E, Camps M, Suarez A, Gutierrez C, Garcia-Portales R, Tolosa C, Ortego-Centeno N, Sánchez-Román J, Garcia-Hernández FJ, Gónzalez-Escribano MF, Martin J. Investigation of TLR5 and TLR7 as candidate genes for susceptibility to systemic lupus erythematosus. Clin Exp Rheumatol 2009; 27:267-271. [PMID: 19473567] [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: 05/27/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the relevance of genetic variants of TLR5 (rs5744168) and TLR7 (rs179008) gene in systemic lupus erythematosus (SLE) in a Spanish population. MATERIAL AND METHODS Our study population consisted of 752 SLE patients and 1107 healthy controls. All individual were of Spanish Caucasian origin. The TLR5 and TLR7 polymorphisms were genotyped using a PCR system with pre-developed TaqMan allelic discrimination assay. RESULTS No statistically significant differences were observed when the allele and genotype distribution of TLR5 rs5744168 and TLR7 rs179008 polymorphisms was compared between SLE patients and healthy controls. A significant increase frequency in the CC genotype of the TLR5 rs5744168 polymorphism among SLE patients without nephritis was found (93% vs. 87% in SLE patients with nephritis, p=0.03, OR=2.11 95%CI 0.93-3.51). However, this difference did not reach statistical significance in the allele frequencies (p=0.08). CONCLUSION These results suggest that the tested variations of TLR5 and TLR7 genes do not confer a relevant role in the susceptibility or severity to SLE in the Spanish population.
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Affiliation(s)
- E Sánchez
- Instituto de Parasitología y Biomedicina López-Neyra, CSIC, Granada, Spain.
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Sánchez-Cano D, Callejas-Rubio JL, Ruiz-Villaverde R, Ortego-Centeno N. Recalcitrant, recurrent aphthous stomatitis successfully treated with adalimumab. J Eur Acad Dermatol Venereol 2009; 23:206. [DOI: 10.1111/j.1468-3083.2008.02790.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Callejas-Rubio JL, Sánchez-Cano D, Lara MA, Ortego-Centeno N. Omalizumab as a therapeutic alternative for chronic urticaria. Ann Allergy Asthma Immunol 2008; 101:556. [PMID: 19055216 DOI: 10.1016/s1081-1206(10)60302-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Callejas-Rubio JL, Sánchez-Cano D, Serrano JLG, Ortego-Centeno N. Adalimumab Therapy for Refractory Uveitis: A Pilot Study. J Ocul Pharmacol Ther 2008; 24:613-4; author reply 614. [DOI: 10.1089/jop.2008.0073] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Montes-Romero JA, Callejas-Rubio JL, Sánchez-Cano D, González-Martínez FJ, Navas-Parejo A, Ortego-Centeno N. Amyloidosis secondary to hidradenitis suppurativa. Exceptional response to infliximab. Eur J Intern Med 2008; 19:e32-3. [PMID: 18848164 DOI: 10.1016/j.ejim.2007.11.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2007] [Accepted: 11/09/2007] [Indexed: 11/17/2022]
Affiliation(s)
- J A Montes-Romero
- Unidad de Enfermedades Autoinmunes Sistémicas, Servicio de Medicina Interna, Hospital Universitario San Cecilio, Granada, Spain
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Luis Callejas-Rubio J, Sánchez-Cano D, Ríos-Férnandez R, Ortego-Centeno N. Adalimumab en el tratamiento de la enfermedad de Behçet. Med Clin (Barc) 2008; 131:438-9. [DOI: 10.1157/13126223] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Ríos-Fernández R, Callejas-Rubio JL, Sánchez-Cano D, Martín-Ruiz JL, Ortego-Centeno N. [Paniculitis, polyarthritis and pancreatitis]. Rev Clin Esp 2008; 208:156-7. [PMID: 18275770 DOI: 10.1157/13115824] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- R Ríos-Fernández
- Unidad de Enfermedades Sistémicas, Hospital Clínico San Cecilio, Granada, España
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Ríos Fernández R, Callejas-Rubio JL, Guerrero Fernández M, Serrano Falcón MM, Ortego-Centeno N. [Necrotizing systemic sarcoidosis with pulmonary and central nervous system involvement]. ACTA ACUST UNITED AC 2008; 25:23-6. [PMID: 18377191 DOI: 10.4321/s0212-71992008000100006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Sarcoidosis is a multisystemic disease which diagnosis depends on the presence of nonnecrotizing granulomas in the biopsy. However there are variants such as necrotizing sarcoidal granulomas or nodular sarcoidosis which have atypical findings and make difficult the differential diagnosis with other infectious processes. We describe a case of a man who develops granulomas with extensive necrosis in a systemic sarcoidosis that affected the lung and the central nervous system. This finding made us to make the diagnosis of tuberculosis and delay the specific treatment.
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Affiliation(s)
- R Ríos Fernández
- Unidad de Enfermedades Sistémicas, Nuerología, Anatomía Patológica, Hospital Clínico San Cecilio, Granada.
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Sánchez-Cano D, Callejas-Rubio JL, Lara-Jiménez MA, López-Trascasa M, Circadi M, Ortego-Centeno N. Successful use of rituximab in acquired C1 inhibitor deficiency secondary to Sjögren’s syndrome. Lupus 2008; 17:228-9. [DOI: 10.1177/0961203307087405] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [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)
- D Sánchez-Cano
- Hospital Universitario San Cecilio, Unidad de Enfermedades Autoinmunes Sistémicas, Granada, Spain
| | - JL Callejas-Rubio
- Hospital Universitario San Cecilio, Unidad de Enfermedades Autoinmunes Sistémicas, Granada, Spain
| | - MA Lara-Jiménez
- Hospital Universitario San Cecilio, Unidad de Alergología, Granada, Spain
| | | | - M Circadi
- Dipartimento di Medicina Interna, Università degli Studi di Milano, Milano, Italy
| | - N Ortego-Centeno
- Hospital Universitario San Cecilio, Unidad de Enfermedades Autoinmunes Sistémicas, Granada, Spain
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Tomás C, Luis Callejas-Rubio J, Ríos-Fernández R, Ortego-Centeno N. Bosentán e hipertensión pulmonar tromboembólica crónica. Med Clin (Barc) 2007; 129:639. [DOI: 10.1157/13111817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Ortego-Centeno N, Callejas-Rubio JL, Sanchez-Cano D, Caballero-Morales T. Refractory chronic erythema nodosum successfully treated with adalimumab. J Eur Acad Dermatol Venereol 2007; 21:408-10. [PMID: 17309478 DOI: 10.1111/j.1468-3083.2006.01893.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Affiliation(s)
- Daniel Sánchez-Cano
- Unidad de Enfermedades Autoinmunes Sistémicas, Hospital Clínico San Cecilio, Granada, Spain.
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Sánchez-Cano D, Callejas-Rubio JL, Ríos-Fernández R, Ortego-Centeno N. Imagen de la semana. Med Clin (Barc) 2007; 129:200. [PMID: 17669343 DOI: 10.1016/s0025-7753(07)72800-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Daniel Sánchez-Cano
- Unidad de Enfermedades Autoinmunes Sistémicas, Hospital Clínico San Cecilio, Granada, España
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