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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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2
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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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7
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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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8
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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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9
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Cénit MC, Simeón CP, Vonk MC, Callejas-Rubio JL, Espinosa G, Carreira P, Blanco FJ, Narvaez J, Tolosa C, Román-Ivorra JA, Gómez-García I, García-Hernández FJ, Gallego M, García-Portales R, Egurbide MV, Fonollosa V, García de la Peña P, López-Longo FJ, González-Gay MA, Hesselstrand R, Riemekasten G, Witte T, Voskuyl AE, Schuerwegh AJ, Madhok R, Fonseca C, Denton C, Nordin A, Palm Ø, van Laar JM, Hunzelmann N, Distler JHW, Kreuter A, Herrick A, Worthington J, Koeleman BP, Radstake TRDJ, Martín J. Influence of the IL6 gene in susceptibility to systemic sclerosis. J Rheumatol 2012; 39:2294-302. [PMID: 23027890 DOI: 10.3899/jrheum.120506] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Systemic sclerosis (SSc) is a genetically complex autoimmune disease; the genetic component has not been fully defined. Interleukin 6 (IL-6) plays a crucial role in immunity and fibrosis, both key aspects of SSc. We investigated the influence of IL6 gene in the susceptibility and phenotype expression of SSc. METHODS We performed a large metaanalysis including a total of 2749 cases and 3189 controls from 6 white populations (Germany, The Netherlands, Norway, Spain, Sweden, and United Kingdom). Three IL6 single-nucleotide polymorphisms (SNP; rs2069827, rs1800795, and rs2069840) were selected by SNP tagging and genotyped using TaqMan(®) allele discrimination technology. RESULTS Individual SNP metaanalysis showed no evidence of association of the 3 IL6 genetic variants with the global disease. Phenotype analyses revealed a significant association between the minor allele of rs2069840 and the limited cutaneous SSc clinical form (Bonferroni p = 0.036, OR 1.14, 95% CI 1.04-1.25). A trend of association between the minor allele of the rs1800795 and the diffuse cutaneous SSc clinical form was also evident (Bonferroni p = 0.072, OR 0.86, 95% CI 0.77-0.96). In the IL6 allelic combination analyses, the GGC allelic combination rs2069827-rs1800795-rs2069840 showed an association with overall SSc (Bonferroni p = 0.016, OR 1.13, 95% CI 1.04-1.23). CONCLUSION Our results suggest that the IL6 gene may influence the development of SSc and its progression.
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Affiliation(s)
- Maria Carmen Cénit
- Instituto de Parasitología y Biomedicina López-Neyra,IPBLN-CSIC, Granada, The Netherlands.
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10
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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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11
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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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12
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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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Palomino-Morales RJ, Vazquez-Rodriguez TR, Torres O, Morado IC, Castañeda S, Miranda-Filloy JA, Callejas-Rubio JL, Fernandez-Gutierrez B, Gonzalez-Gay MA, Martin J. Association between IL-18 gene polymorphisms and biopsy-proven giant cell arteritis. Arthritis Res Ther 2010; 12:R51. [PMID: 20331879 PMCID: PMC2888200 DOI: 10.1186/ar2962] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2009] [Revised: 03/02/2010] [Accepted: 03/23/2010] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION The objective was to investigate the potential implication of the IL18 gene promoter polymorphisms in the susceptibility to giant-cell arteritis (GCA). METHODS In total, 212 patients diagnosed with biopsy-proven GCA were included in this study. DNA from patients and matched controls was obtained from peripheral blood. Samples were genotyped for the IL18-137 G>C (rs187238), the IL18-607 C>A (rs1946518), and the IL18-1297 T>C (rs360719) gene polymorphisms with polymerase chain reaction, by using a predesigned TaqMan allele discrimination assay. RESULTS No significant association between the IL18-137 G>C polymorphism and GCA was found. However, the IL18 -607 allele A was significantly increased in GCA patients compared with controls (47.8% versus 40.9% in patients and controls respectively; P = 0.02; OR, 1.32; 95% CI, 1.04 to 1.69). It was due to an increased frequency of homozygosity for the IL18 -607 A/A genotype in patients with GCA (20.4%) compared with controls (13.4%) (IL18 -607 A/A versus IL18 -607 A/C plus IL18 -607 C/C genotypes: P = 0.04; OR, 1.59; 95% CI, 1.02 to 2.46). Also, the IL18-1297 allele C was significantly increased in GCA patients (30.7%) compared with controls (23.0%) (P = 0.003; OR, 1.48; 95% CI, 1.13 to 1.95). In this regard, an increased susceptibility to GCA was observed in individuals carrying the IL18-1297 C/C or the IL18-1297 C/T genotypes compared with those carrying the IL18-1297 T/T genotype (IL18-1297 C/C plus IL18-1297 T/C versus IL18-1297 T/T genotype in GCA patients compared with controls: P = 0.005; OR, 1.61; 95% CI, 1.15 to 2.25). We also found an additive effect of the IL18 -1297 and -607 polymorphisms with TLR4 Asp299Gly polymorphism. The OR for GCA was 1.95 for combinations of genotypes with one or two risk alleles, whereas carriers of three or more risk alleles have an OR of 3.7. CONCLUSIONS Our results show for the first time an implication of IL18 gene-promoter polymorphisms in the susceptibility to biopsy-proven GCA. In addition, an additive effect between the associated IL18 and TLR4 genetic variants was observed.
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Affiliation(s)
- Rogelio J Palomino-Morales
- Instituto de Parasitología y Biomedicina Lopez-Neyra, CSIC, Parque Tecnológico de Ciencias de la Salud, Avenida del Conocimiento s/n Armilla, Granada-18100, Spain
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14
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Palomino-Morales R, Torres O, Vazquez-Rodriguez TR, Castañeda S, Morado IC, Miranda-Filloy JA, Amigo-Diaz E, Callejas-Rubio JL, Fernandez-Gutierrez B, Martin J, Gonzalez-Gay MA. Lack of association between the rs6920220 (G/A) polymorphism of the 6q23 region and biopsy-proven giant cell arteritis. J Rheumatol 2010; 37:1020-3. [PMID: 20231195 DOI: 10.3899/jrheum.091142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Recently, 2 independent studies have identified an association between several single-nucleotide polymorphisms (SNP) located in the 6q23 chromosomal region and rheumatoid arthritis (RA). Like RA, giant cell arteritis (GCA) is also a complex polygenic disease in which more than 1 genetic locus is likely to contribute to disease susceptibility and clinical expression. We analyzed the involvement of the rs6920220 (G/A) polymorphism from the 6q23/TNFAIP3 gene region in susceptibility to GCA. METHODS Two hundred twenty patients with biopsy-proven GCA and 490 matched controls were assessed. DNA from patients and controls was obtained from peripheral blood. Samples were geno-typed for the 6q23 region rs6920220 using a TaqMan allele discrimination assay and by polymerase chain reaction (PCR) amplification. After PCR, the genotype of each sample was attributed automatically by allelic-specific fluorescence using the ABI Prism 7900 sequence detection system. RESULTS No significant differences in the genotype distribution between patients with GCA and controls for the rs6920220 (G/A) polymorphism were found. No significant differences were observed when patients with GCA were stratified according to the presence of specific clinical features of the disease such as polymyalgia rheumatica or severe ischemic manifestations or specific visual ischemic complications. CONCLUSION Our results show no involvement of this 6q23/TNFAIP3 gene region SNP in the susceptibility to or clinical expression of GCA.
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Affiliation(s)
- Rogelio Palomino-Morales
- Instituto de Parasitología y Biomedicina López Neyra, Consejo Superior de Investigaciones Cientificas (CSIC), and the Hospital Clínico San Cecílio, Granada, Spain
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Torres O, Palomino-Morales R, Vazquez-Rodriguez T, Castañeda S, Morado IC, Miranda-Filloy JA, Amigo-Diaz E, Callejas-Rubio JL, Fernandez-Gutierrez B, Martin J, Gonzalez-Gay MA. Lack of association between IFNGR1 gene polymorphisms and biopsy-proven giant cell arteritis. Clin Exp Rheumatol 2010; 28:31-4. [PMID: 20412699] [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: 05/29/2023]
Abstract
OBJECTIVES Since IFN-gamma plays a pivotal role in the pathogenesis of giant cell arteritis (GCA), a polygenic primary systemic vasculitis involving elderly people from Western countries, in the present study we analysed for first time the implication of three IFN-gamma receptor (IFNGR) 1 gene variants in the susceptibility to and clinical expression of GCA. METHODS Two hundred and sixteen biopsy-proven GCA patients and 460 matched controls were assessed. DNA from patients and controls was obtained from peripheral blood. Samples were genotyped for three single nucleotide polymorphisms (SNPs) rs1327474 (-611A/G), rs11914 (+189G7C) and rs7749390 (+95C/T) of the IFNGR1 gene using a pre-designed TaqMan allele discrimination assay. Post PCR, the genotype of each sample was attributed automatically by measuring the allelic specific fluorescence on the ABI PRISM 7900 sequence. RESULTS No significant differences in the genotype or allele distribution between GCA patients and controls for the three IFNGR1 gene variants were found. Furthermore, no significant differences in the genotype distribution were observed when GCA patients were stratified according to the presence of specific clinical features of the disease such as polymyalgia rheumatica or severe ischemic complications including visual ischemic manifestations. CONCLUSIONS Our results do not show an implication of IFNGR1gene polymorphisms in the susceptibility to and clinical expression of GCA.
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Affiliation(s)
- Orlando Torres
- Instituto de Parasitología y Biomedicina López Neyra, Consejo Superior de Investigaciones Cientificas (CSIC), Granada, Spain
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Torres O, Palomino-Morales R, Vazquez-Rodriguez TR, Gamallo C, Morado IC, Miranda-Filloy JA, Amigo-Diaz E, Callejas-Rubio JL, Fernadez-Gutierrez B, Castañeda S, Morado IC, Martin J, Gonzalez-Gay MA. Lack of association between hypoxia inducible factor-1 alpha gene polymorphisms and biopsy-proven giant cell arteritis. Clin Exp Rheumatol 2010; 28:40-45. [PMID: 20412701] [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: 05/29/2023]
Abstract
OBJECTIVES Since the transcription factor hypoxia-inducible factor 1 (HIF-1) is a key early mediator of the response to ischemia and giant cell arteritis (GCA) is a polygenic disease leading to severe ischemic complications, in the present study we analysed for first time the implication of two HIF-1alpha gene polymorphisms in the susceptibility to and clinical expression of GCA. METHODS Two hundred and fifteen biopsy-proven GCA patients and 470 matched controls were assessed. DNA from patients and controls was obtained from peripheral blood. Samples were genotyped for two single nucleotide polymorphisms, rs11549465 (C/T) and rs11549467 (G/A), using a pre-designed TaqMan allele discrimination assay. Post PCR, the genotype of each sample was attributed automatically by measuring the allelic specific fluorescence on the ABI PRIM 7900 sequence. RESULTS The HIF-1alpha, rs11549465 TT genotype was extremely uncommon in both GCA patients (2.3%) and controls (2.1%). Although the frequency of individuals carrying the CT or TT genotypes was increased in GCA patients (25.1%) compared to controls (20.4%) the difference was not statistically significant (OR 1.30 [95% CI: 0.89- 1.91]; p=0.17). Also, all GCA patients and most controls (98.9%) were homozygous for the rs11549467 GG genotype. GCA patients carrying the rs11549465 CT or TT genotypes had a slight increased risk of developing visual ischemic complications (33.1%) compared to the remaining GCA patients (22.8%); OR 1.60 (95% CI: 0.81- 3.16); p=0.18. CONCLUSIONS Our results do not confirm an implication of HIF-1alpha gene polymorphisms in the susceptibility to and clinical expression of GCA.
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Affiliation(s)
- Orlando Torres
- Instituto de Parasitología y Biomedicina López Neyra, Consejo Superior de Investigaciones Cientificas (CSIC), Granada, Spain
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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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18
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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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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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23
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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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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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Sànchez-Cano D, Callejas-Rubio JL, Ortego-Centeno N, Ruiz-Villaverde R. Urticaria and angioedema in a patient with Behçet's disease treated with adalimumab. Clin Exp Rheumatol 2006; 24:S128. [PMID: 17067448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
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Jiménez-Alonso J, Sabio JM, Carrillo-Alascio PL, Jiménez-Jáimez J, Ortego-Centeno N, Jiménez-Jáimez E, Hidalgo-Tenorio C, Guzmán-Ubeda M, Jáimez L, Cáliz R, García-Sánchez A, Gallego M, Caminal L, Callejas-Rubio JL, Cervera R, Font J. [Intolerance to hydroxychloroquine marketed in Spain (Dolquine) in patients with autoimmune conditions]. Rev Clin Esp 2005; 204:588-91. [PMID: 15511405 DOI: 10.1157/13067369] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BASIS A significant proportion of our patients has described to have problems from tolerance to Dolquine, a new presentation of hydroxychloroquine recently marketed in Spain, compared to Plaquenil. The objective was to know the tolerability and the adverse effects of this new presentation. PATIENTS AND METHOD A cross-sectional multicenter study on 133 patients treated with Dolquine was conducted. RESULTS Of the 133 patients (87% women; average age [AA]: 32.9 [15.4] years) who received Dolquine during an average period of 6.7 (1.4) months, 32 patients (24%) described to have more problems with this drug in comparison with other antimalarial. The adverse effects experienced were: bitter taste (62.4%), difficulty in swallowing the tablet (13.5%), dyspepsia (9.8%), nausea (7.5%), vomiting (1.5%), pruritus (1.5%), diarrhea (0.7%), and instability feeling (0.7%). The presence of gastrointestinal adverse effects was not related to the consumption of gastroerosive drugs, gastric protectors, or a high number of drugs. The attrition rate was 9.8%. Conclusions. Dolquine induces lower tolerance and more gastrointestinal adverse effects than Plaquenil, pointing out its bitter taste and the difficulty in swallowing it. Despite this higher intolerance there was not an increase in the attition rate from the antimalarial treatment in comparison to other series.
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Affiliation(s)
- J Jiménez-Alonso
- Unidad de Enfermedades Autoinmunes Sistémicas, Hospital Universitario Virgen de las Nieves, Facultad de Medicina, Granada.
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Muñoz-Medina L, Callejas-Rubio JL, Troncoso-García E, Ortego-Centeno N. Utility of HLA typing in the differential diagnosis of severe aphthosis and Behçet's disease. Dermatology 2001; 201:280-1. [PMID: 11096210 DOI: 10.1159/000018481] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Ortego-Centeno N, Callejas-Rubio JL, López-Mañas JG, Troncoso-García E, de la Higuera Torres-Puchol J. Ileitis terminalis in a patient with Henoch-Schönlein purpura. Dig Dis Sci 1999; 44:1590-3. [PMID: 10492137 DOI: 10.1023/a:1026662926918] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [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] [Indexed: 01/22/2023]
Affiliation(s)
- N Ortego-Centeno
- Service of Internal Medicine B, San Cecilio University Hospital, Granada, Spain
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Callejas-Rubio JL, Ortego N, Díez A, Castro M, De La Higuera J. Recurrent epididymo-orchitis secondary to Behçets disease. J Urol 1998; 160:496. [PMID: 9679909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- J L Callejas-Rubio
- Department of Internal Medicine, San Cecilio University Hospital, Granada, Spain
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