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Rua-Figueroa I, García de Yébenes MJ, Martinez-Barrio J, Galindo Izquierdo M, Calvo Alén J, Fernandez-Nebro A, Menor-Almagro R, Carmona L, Tejera Segura B, Tomero E, Freire-González M, Sangüesa C, Horcada L, Blanco R, Uriarte Itzazelaia E, Narváez J, Rosas Gómez de Salazar JC, Gómez-Sabater S, Morales CM, Andreu JL, Segarra VT, Aurrecoechea E, Perez A, Nóvoa Medina J, Salgado E, Lozano-Rivas N, Montilla C, Ruiz-Lucea E, Arevalo M, Iñiguez C, García-Villanueva MJ, Exposito L, Ibáñez-Barceló M, Bonilla G, Carrión-Barberà I, Erausquin C, Fragio Gil JJ, Pecondón A, Toyos FJ, Cobo T, Muñoz-Jiménez A, Oller J, Nolla JM, Pego-Reigosa JM. SLESIS-R: an improved score for prediction of serious infection in patients with systemic lupus erythematosus based on the RELESSER prospective cohort. Lupus Sci Med 2024; 11:e001096. [PMID: 38589223 PMCID: PMC11015315 DOI: 10.1136/lupus-2023-001096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 03/22/2024] [Indexed: 04/10/2024]
Abstract
OBJECTIVE To develop an improved score for prediction of severe infection in patients with systemic lupus erythematosus (SLE), namely, the SLE Severe Infection Score-Revised (SLESIS-R) and to validate it in a large multicentre lupus cohort. METHODS We used data from the prospective phase of RELESSER (RELESSER-PROS), the SLE register of the Spanish Society of Rheumatology. A multivariable logistic model was constructed taking into account the variables already forming the SLESIS score, plus all other potential predictors identified in a literature review. Performance was analysed using the C-statistic and the area under the receiver operating characteristic curve (AUROC). Internal validation was carried out using a 100-sample bootstrapping procedure. ORs were transformed into score items, and the AUROC was used to determine performance. RESULTS A total of 1459 patients who had completed 1 year of follow-up were included in the development cohort (mean age, 49±13 years; 90% women). Twenty-five (1.7%) had experienced ≥1 severe infection. According to the adjusted multivariate model, severe infection could be predicted from four variables: age (years) ≥60, previous SLE-related hospitalisation, previous serious infection and glucocorticoid dose. A score was built from the best model, taking values from 0 to 17. The AUROC was 0.861 (0.777-0.946). The cut-off chosen was ≥6, which exhibited an accuracy of 85.9% and a positive likelihood ratio of 5.48. CONCLUSIONS SLESIS-R is an accurate and feasible instrument for predicting infections in patients with SLE. SLESIS-R could help to make informed decisions on the use of immunosuppressants and the implementation of preventive measures.
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Affiliation(s)
- Iñigo Rua-Figueroa
- Department of Rheumatology, Hospital Universitario Gran Canaria Doctor Negrin, Las Palmas de Gran Canaria, Spain
| | | | - Julia Martinez-Barrio
- Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Jaime Calvo Alén
- Department of Rheumatology, Hospital Sierrallana, Vitoria, Spain
| | - Antonio Fernandez-Nebro
- UGC de Reumatología, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Malaga, Spain
| | | | - Loreto Carmona
- Instituto de Salud Musculoesquelética (INMUSC), Madrid, Spain
| | - Beatriz Tejera Segura
- Department of Rheumatology, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Eva Tomero
- Department of Rheumatology, Hospital Universitario de la Princesa, Instituto de Investigación La Princesa, Madrid, Spain
| | | | - Clara Sangüesa
- Department of Rheumatology, Hospital Germán Trias i Pujol, Barcelona, Spain
| | - Loreto Horcada
- Department of Rheumatology, Hospital de Navarra, Pamplona, Spain
| | - Ricardo Blanco
- Department of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | | | - Javier Narváez
- Department of Rheumatology, Hospital Universitario de Bellvitge, Barcelona, Spain
| | | | - Silvia Gómez-Sabater
- Department of Rheumatology, Hospital General Universitario de Alicante, Alicante, Spain
| | | | - Jose L Andreu
- Department of Rheumatology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | | | - Elena Aurrecoechea
- Department of Rheumatology, Hospital Universitario Sierrallana, Torrelavega, Spain
| | - Ana Perez
- Immune System Diseases and Oncology Service, University Hospital "Príncipe de Asturias", Alcala de Henares, Spain
| | - Javier Nóvoa Medina
- Department of Rheumatology, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas GC, Spain
| | - Eva Salgado
- Department of Rheumatology, Complejo Hospitalario de Orense, Ourense, Spain
| | - Nuria Lozano-Rivas
- Department of Rheumatology, Hospital Virgen de la Arrixaca, Murcia, Spain
| | - Carlos Montilla
- Department of Rheumatology, Hospital Clinico Universitario Salamanca, Salamanca, Spain
| | | | - Marta Arevalo
- Consorci Corporació Sanitària Parc Taulí, Sabadell, Spain
| | | | | | | | | | - Gema Bonilla
- Department of Rheumatology, La Paz University Hospital, Madrid, Spain
| | | | - Celia Erausquin
- Department of Rheumatology, Hospital Universitario Gran Canaria Doctor Negrin, Las Palmas de Gran Canaria, Spain
| | | | | | - Francisco J Toyos
- Department of Rheumatology, Hospital Virgen Macarena, Sevilla, Spain
| | | | | | - Jose Oller
- Doctor Peset University Hospital, Valencia, Spain
| | - Joan M Nolla
- Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
| | - J M Pego-Reigosa
- Department of Rheumatology, University Hospital Complex of Vigo, Vigo, Spain
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Tandaipan J, Guillén-Del-Castillo A, Simeón-Aznar CP, Carreira PE, De la Puente C, Narváez J, Lluch J, Rubio-Rivas M, Alegre-Sancho JJ, Bonilla G, Moriano C, Casafont-Sole I, García-Vicuña R, Ortiz-Santamaría V, Riera E, Atienza-Mateo B, Blanco R, Galisteo C, Gonzalez-Martin JJ, Pego-Reigosa JM, Pros A, Heredia S, Castellví I. Immunoglobulins in systemic sclerosis management. A large multicenter experience. Autoimmun Rev 2023; 22:103441. [PMID: 37708984 DOI: 10.1016/j.autrev.2023.103441] [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: 08/08/2023] [Accepted: 09/03/2023] [Indexed: 09/16/2023]
Abstract
OBJECTIVE To analyze the effectiveness and safety of intravenous immunoglobulin (IVIG) given in routine care to patients with systemic sclerosis (SSc). METHODS A retrospective multicenter observational study was conducted in SSc patients treated with IVIG. We collected data on epidemiological parameters and clinical outcomes. Firstly, we assessed changes in organ manifestations during IVIG treatment. Secondly, we analyzed the frequency of adverse effects. The following parameters were collected from baseline to the last follow-up: the patient's weight, modified Rodnan Skin Score (mRSS), modified manual muscle strength scale (MRC), laboratory test(creatine kinase(CK), hemoglobin and protein levels), The University of California Los Angeles Scleroderma Clinical Trials Consortium gastrointestinal tract 2.0 (UCLA GIT 2.0) questionnaire, pulmonary function tests, and echocardiography. RESULTS Data were collected on 78 patients (82% females; 59% with diffuse SSc). Inflammatory idiopathic myopathy was the most frequent concomitant overlap disease (41%). The time since Raynaud's phenomenon and SSc onset were 8.8 ± 18 and 6.2 ± 6.7 years respectively. The most frequent IVIG indication was myositis (38/78), followed by gastrointestinal (27/78) and cutaneous (17/78) involvement. The median number of cycles given were 5. 54, 53 and 9 patients have been treated previously with glucocorticoids, synthetic disease-modifying antirheumatic drugs and biologic therapies respectively. After IVIG use we found significant improvements in muscular involvement (MRC ≥ 3/5 92% IVIG, p = 0.001 and CK levels from 1149 ± 2026 UI to 217 ± 224 UI, p = 0.02), mRSS (15 ± 12.4 to 13 ± 12.5, p = 0.015) and improvement in total score of UCLA GIT 2.0 (p = 0.05). None Anti-RNA polymerase III patients showed an adequate response in gastrointestinal involvement (0/7) in comparison with other antibodies (0 vs. 25, p = 0,039). Cardiorespiratory involvement remained stable. A total of 12 adverse events were reported with only one withdrawn due to serious adverse effect. CONCLUSIONS this study suggest that IVIG may improve myositis, gastrointestinal and skin involvement in SSc patients treated in routine care and seems to have a good safety profile.
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Affiliation(s)
- J Tandaipan
- Department of Rheumatology and Systemic Autoinmune Diseases, Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain
| | - A Guillén-Del-Castillo
- Unit of Systemic Autoimmune Diseases, Department of Internal Medicine, Hospital Universitari Vall d'Hebrón, Barcelona, Spain
| | - C P Simeón-Aznar
- Unit of Systemic Autoimmune Diseases, Department of Internal Medicine, Hospital Universitari Vall d'Hebrón, Barcelona, Spain
| | - P E Carreira
- Department of Rheumatology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - C De la Puente
- Department of Rheumatology, Hospital Universitario Ramon y Cajal, Madrid, Spain
| | - J Narváez
- Department of Rheumatology, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Spain
| | - J Lluch
- Department of Rheumatology, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Spain
| | - M Rubio-Rivas
- Department of Internal Medicine, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Spain
| | - J J Alegre-Sancho
- Department of Rheumatology, Hospital Universitario Doctor Peset, Valencia, Spain
| | - G Bonilla
- Department of Rheumatology, Hospital Universitario La Paz, Madrid, Spain
| | - C Moriano
- Department of Rheumatology, Complejo Asistencial Universitario de León, León, Spain
| | - I Casafont-Sole
- Department of Rheumatology, Hospital Germans Trias i Pujol, Badalona, Spain
| | - R García-Vicuña
- Department of Rheumatology, Hospital Universitario de La Princesa, Madrid, Spain
| | - V Ortiz-Santamaría
- Department of Rheumatology, Hospital General de Granollers, Granollers, Spain
| | - E Riera
- Department of Rheumatology, Hospital Universitari Mútua de Terrassa, Terrassa, Spain
| | - B Atienza-Mateo
- Department of Rheumatology, Hospital Universitario Marques de Valdecilla, Santander, Spain
| | - R Blanco
- Department of Rheumatology, Hospital Universitario Marques de Valdecilla, Santander, Spain
| | - C Galisteo
- Department of Rheumatology, Hospital Universitari Parc Taulí, Sabadell, Spain
| | - J J Gonzalez-Martin
- Department of Rheumatology, Hospital Universitario HM San Chinarro, Madrid, Spain
| | - J M Pego-Reigosa
- Department of Rheumatology, Complejo Hospitalario Universitario de Vigo, IRIDIS (Investigation in Rheumatology and Immune-Mediated Diseases)-VIGO Group, Galicia Sur Health Research Institute (IISGS), Vigo, Spain
| | - A Pros
- Department of Rheumatology, Hospital del Mar, Barcelona, Spain
| | - S Heredia
- Department of Rheumatology, Hospital Sant Joan Despí Moisès Broggi, Sant Joan Despí, Spain
| | - I Castellví
- Department of Rheumatology and Systemic Autoinmune Diseases, Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain; Department of Medicine, Universitat Autonoma de Barcelona, Spain.
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Álvaro Gracia JM, Sanchez-Piedra C, Manero J, Ruiz-Lucea ME, López-Vives L, Bohorquez C, Martinez-Barrio J, Bonilla G, Vela P, García-Villanueva MJ, Navío-Marco MT, Pavía M, Galindo M, Erausquin C, Gonzalez-Gay MA, Rua-Figueroa I, Pego-Reigosa JM, Castrejon I, Sanchez-Costa JT, González-Dávila E, Diaz-Gonzalez F. Role of targeted therapies in rheumatic patients on COVID-19 outcomes: results from the COVIDSER study. RMD Open 2021; 7:rmdopen-2021-001925. [PMID: 34887346 PMCID: PMC8662584 DOI: 10.1136/rmdopen-2021-001925] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 11/09/2021] [Indexed: 12/14/2022] Open
Abstract
Objectives To analyse the effect of targeted therapies, either biological (b) disease-modifying antirheumatic drugs (DMARDs), targeted synthetic (ts) DMARDs and other factors (demographics, comorbidities or COVID-19 symptoms) on the risk of COVID-19 related hospitalisation in patients with inflammatory rheumatic diseases. Methods The COVIDSER study is an observational cohort including 7782 patients with inflammatory rheumatic diseases. Multivariable logistic regression was used to estimate ORs and 95% CIs of hospitalisation. Antirheumatic medication taken immediately prior to infection, demographic characteristics, rheumatic disease diagnosis, comorbidities and COVID-19 symptoms were analysed. Results A total of 426 cases of symptomatic COVID-19 from 1 March 2020 to 13 April 2021 were included in the analyses: 106 (24.9%) were hospitalised and 19 (4.4%) died. In multivariate-adjusted models, bDMARDs and tsDMARDs in combination were not associated with hospitalisation compared with conventional synthetic DMARDs (OR 0.55, 95% CI 0.24 to 1.25 of b/tsDMARDs, p=0.15). Tumour necrosis factor inhibitors (TNF-i) were associated with a reduced likelihood of hospitalisation (OR 0.32, 95% CI 0.12 to 0.82, p=0.018), whereas rituximab showed a tendency to an increased risk of hospitalisation (OR 4.85, 95% CI 0.86 to 27.2). Glucocorticoid use was not associated with hospitalisation (OR 1.69, 95% CI 0.81 to 3.55). A mix of sociodemographic factors, comorbidities and COVID-19 symptoms contribute to patients’ hospitalisation. Conclusions The use of targeted therapies as a group is not associated with COVID-19 severity, except for rituximab, which shows a trend towards an increased risk of hospitalisation, while TNF-i was associated with decreased odds of hospitalisation in patients with rheumatic disease. Other factors like age, male gender, comorbidities and COVID-19 symptoms do play a role.
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Affiliation(s)
| | | | - Javier Manero
- Rheumatology Department, Hospital Universitario Miguel Servet, Zaragoza, Aragón, Spain
| | | | - Laura López-Vives
- Rheumatology Department, Hospital San Rafael, Barcelona, Catalunya, Spain
| | - Cristina Bohorquez
- Department of Rheumatology, Hospital Universitario Príncipe de Asturias, Alcala de Henares, Madrid, Spain
| | - Julia Martinez-Barrio
- Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Gema Bonilla
- Department of Rheumatology, La Paz University Hospital, Madrid, Spain
| | - Paloma Vela
- Department of Rheumatology, Hospital General Universitario de Alicante, Alicante, Spain
| | | | | | - Marina Pavía
- Department of Rheumatology, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Comunidad de Madrid, Spain
| | - María Galindo
- Department of Rheumatology, Hospital Universitario 12 de Octubre, Madrid, Comunidad de Madrid, Spain
| | - Celia Erausquin
- Department of Rheumatology, Hospital Doctor Negrin, Las Palmas GC, Spain
| | - Miguel A Gonzalez-Gay
- Department of Rheumatology, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - Inigo Rua-Figueroa
- Department of Rheumatology, Hospital Doctor Negrin, Las Palmas GC, Spain
| | - Jose M Pego-Reigosa
- Department of Rheumatology, University Hospital Complex of Vigo, Vigo, Spain
| | - Isabel Castrejon
- Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Enrique González-Dávila
- Departamento de Estadística e Investigación Operativa, Universidad de La Laguna, La Laguna, Islas Canarias, Spain
| | - Federico Diaz-Gonzalez
- Department of Rheumatology, Hospital Universitario de Canarias, La Laguna, Spain .,Department of Internal Medicine and Psychiatry, Universidad de La Laguna, La Laguna, Spain
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Carvalheiro T, Rafael-Vidal C, Malvar-Fernandez B, Lopes AP, Pego-Reigosa JM, Radstake TRDJ, Garcia S. Semaphorin4A-Plexin D1 Axis Induces Th2 and Th17 While Represses Th1 Skewing in an Autocrine Manner. Int J Mol Sci 2020; 21:ijms21186965. [PMID: 32971928 PMCID: PMC7555002 DOI: 10.3390/ijms21186965] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 09/17/2020] [Accepted: 09/19/2020] [Indexed: 12/13/2022] Open
Abstract
Semaphorin (Sema)4A is a transmembrane glycoprotein that is elevated in several autoimmune diseases such as systemic sclerosis, rheumatoid arthritis and multiple sclerosis. Sema4A has a key role in the regulation of Thelper Th1 and Th2 differentiation and we recently demonstrated that CD4+ T cell activation induces the expression of Sema4A. However, the autocrine role of Sema4A on Th cell differentiation remains unknown. Naïve Th cells from healthy controls were cell sorted and differentiated into Th1, Th2 and Th17 in the presence or absence of a neutralizing antibody against the Sema4A receptor PlexinD1. Gene expression was determined by quantitative PCR and protein expression by ELISA and flow cytometry. We found that the expression of Sema4A is induced during Th1, Th2 and Th17 differentiation. PlexinD1 neutralization induced the differentiation of Th1 cells, while reduced the Th2 and Th17 skewing. These effects were associated with an upregulation of the transcription factor T-bet by Th1 cells, and to downregulation of GATA3 and RORγt in Th2 cells and Th17 cells, respectively. Finally, PlexinD1 neutralization regulates the systemic sclerosis patients serum-induced cytokine production by CD4+ T cells. Therefore, the autocrine Sema4A-PlexinD1 signaling acts as a negative regulator of Th1 skewing but is a key mediator on Th2 and Th17 differentiation, suggesting that dysregulation of this axis might be implicated in the pathogenesis of CD4+ T cell-mediated diseases.
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Affiliation(s)
- Tiago Carvalheiro
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, University of Utrecht, 3508 GA Utrecht, The Netherlands; (T.C.); (B.M.-F.); (A.P.L.); (T.R.D.J.R.)
- Center for Translational Immunology, University Medical Center Utrecht, University of Utrecht, 3508 GA Utrecht, The Netherlands
| | - Carlos Rafael-Vidal
- Rheumatology & Immuno-mediated Diseases Research Group (IRIDIS), Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, 36312 Vigo, Spain; (C.R.-V.); (J.M.P.-R.)
- Rheumatology Department, University Hospital Complex of Vigo, 36312 Vigo, Spain
| | - Beatriz Malvar-Fernandez
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, University of Utrecht, 3508 GA Utrecht, The Netherlands; (T.C.); (B.M.-F.); (A.P.L.); (T.R.D.J.R.)
- Center for Translational Immunology, University Medical Center Utrecht, University of Utrecht, 3508 GA Utrecht, The Netherlands
| | - Ana P. Lopes
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, University of Utrecht, 3508 GA Utrecht, The Netherlands; (T.C.); (B.M.-F.); (A.P.L.); (T.R.D.J.R.)
- Center for Translational Immunology, University Medical Center Utrecht, University of Utrecht, 3508 GA Utrecht, The Netherlands
| | - Jose M. Pego-Reigosa
- Rheumatology & Immuno-mediated Diseases Research Group (IRIDIS), Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, 36312 Vigo, Spain; (C.R.-V.); (J.M.P.-R.)
- Rheumatology Department, University Hospital Complex of Vigo, 36312 Vigo, Spain
| | - Timothy R. D. J. Radstake
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, University of Utrecht, 3508 GA Utrecht, The Netherlands; (T.C.); (B.M.-F.); (A.P.L.); (T.R.D.J.R.)
- Center for Translational Immunology, University Medical Center Utrecht, University of Utrecht, 3508 GA Utrecht, The Netherlands
| | - Samuel Garcia
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, University of Utrecht, 3508 GA Utrecht, The Netherlands; (T.C.); (B.M.-F.); (A.P.L.); (T.R.D.J.R.)
- Center for Translational Immunology, University Medical Center Utrecht, University of Utrecht, 3508 GA Utrecht, The Netherlands
- Rheumatology & Immuno-mediated Diseases Research Group (IRIDIS), Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, 36312 Vigo, Spain; (C.R.-V.); (J.M.P.-R.)
- Rheumatology Department, University Hospital Complex of Vigo, 36312 Vigo, Spain
- Correspondence: ; Tel.: +34-986-515-463
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Riancho-Zarrabeitia L, Martínez-Taboada V, Rúa-Figueroa I, Alonso F, Galindo-Izquierdo M, Ovalles J, Olivé-Marqués A, Fernández-Nebro A, Calvo-Alén J, Menor-Almagro R, Tomero-Muriel E, Uriarte-Isacelaya E, Botenau A, Andres M, Freire-González M, Santos Soler G, Ruiz-Lucea E, Ibáñez-Barceló M, Castellví I, Galisteo C, Quevedo Vila V, Raya E, Narváez-García J, Expósito L, Hernández-Beriaín JA, Horcada L, Aurrecoechea E, Pego-Reigosa JM. Antiphospholipid syndrome (APS) in patients with systemic lupus erythematosus (SLE) implies a more severe disease with more damage accrual and higher mortality. Lupus 2020; 29:1556-1565. [PMID: 32807021 DOI: 10.1177/0961203320950477] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Antiphospholipid antibodies (aPL) have been associated with organ damage and certain features in systemic lupus erythematosus(SLE) patients. Our aim was to investigate the differences between SLE patients according to the presence of aPL and/or clinical antiphospholipid syndrome (APS). MATERIALS AND METHODS Patients from the RELESSER-T registry were included. RELESSER-T is a Spanish multicenter, hospital-based, retrospective, SLE registry. RESULTS We included 2398 SLE patients, 1372 of whom were positive for aPL. Overall 1026 patients were classified as SLE, 555 as SLE-APS and817 as SLE-aPL. Regarding cardiovascular risk factors, SLE-APS patients had higher rates of hypertension, dyslipidemia and diabetes than those with SLE-aPL and SLE (p < 0.001). SLE-APS patients showed higher rates of neuropsychiatric, cardiac, pulmonary, renal and ophthalmological manifestations than the other groups (p < 0.001). SLE-APS patients presented greater damage accrual with higher SLICC values (1.9 ± 2.2 in SLE-APS, 0.9 ± 1.4 in SLE-aPL and 1.1 ± 1.6 in SLE, p < 0.001) and more severe disease as defined by the Katz index (3 ± 1.8 in SLE-APS, 2.7 ± 1.7 in SLE-aPL and 2.6 ± 1.6 in SLE, p < 0.001). SLE-APS patients showed higher mortality rates (p < 0.001). CONCLUSIONS SLE-APS patients exhibited more severe clinical profiles with higher frequencies of major organ involvement, greater damage accrual and higher mortality than SLE-aPL and SLE patients.
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Affiliation(s)
| | - Victor Martínez-Taboada
- Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Santander, Spain
| | | | - Fernando Alonso
- Unidad de Investigación. Sociedad Española de Reumatología, Madrid, Spain
| | | | - Juan Ovalles
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | | | | | | | | | | | | | - Mariano Andres
- Hospital General Universitario de Alicante, Valenciana, Spain
| | | | | | | | | | | | | | | | - Enrique Raya
- Hospital Universitario Clínico San Cecilio, Andalucía, Spain
| | | | | | | | - Loreto Horcada
- Complejo Hospitalario Universitario de Navarra, Pamplona, Spain
| | - Elena Aurrecoechea
- Rheumatology Department, Hospital Sierrallana, IDIVAL, Torrelavega, Spain
| | - Jose M Pego-Reigosa
- Complejo Hospitalario Universitario de Vigo IRIDIS Group, Instituto de Investigación Sanitaria Galicia Sur (IISGS), Vigo, Spain
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Hernández Cruz B, Alonso F, Calvo Alén J, Pego-Reigosa JM, López-Longo FJ, Galindo-Izquierdo M, Olivé A, Tomero E, Horcada L, Uriarte E, Erausquin C, Sánchez-Atrio A, Montilla C, Santos Soler G, Fernández-Nebro A, Blanco R, Rodríguez-Gómez M, Vela P, Freire M, Díez-Álvarez E, Boteanu AL, Narváez J, Martínez Taboada V, Ruiz-Lucea E, Andreu JL, Fernández-Berrizbeitia O, Hernández-Beriain JÁ, Gantes M, Pérez-Venegas JJ, Ibáñez-Barceló M, Pecondón-Español Á, Marras C, Bonilla G, Castellví I, Moreno M, Raya E, Quevedo Vila VE, Vázquez T, Ruán JI, Muñoz S, Rúa-Figueroa Í. Differences in clinical manifestations and increased severity of systemic lupus erythematosus between two groups of Hispanics: European Caucasians versus Latin American mestizos (data from the RELESSER registry). Lupus 2019; 29:27-36. [DOI: 10.1177/0961203319889667] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background Systemic lupus erythematosus (SLE) is regarded as a prototype autoimmune disease because it can serve as a means for studying differences between ethnic minorities and sex. Traditionally, all Hispanics have been bracketed within the same ethnic group, but there are differences between Hispanics from Spain and those from Latin America, not to mention other Spanish-speaking populations. Objectives This study aimed to determine the demographic and clinical characteristics, severity, activity, damage, mortality and co-morbidity of SLE in Hispanics belonging to the two ethnic groups resident in Spain, and to identify any differences. Methods This was an observational, multi-centre, retrospective study. The demographic and clinical variables of patients with SLE from 45 rheumatology units were collected. The study was conducted in accordance with Good Clinical Practice guidelines. Hispanic patients from the registry were divided into two groups: Spaniards or European Caucasians (EC) and Latin American mestizos (LAM). Comparative univariate and multivariate statistical analyses were carried out. Results A total of 3490 SLE patients were included, 90% of whom were female; 3305 (92%) EC and 185 (5%) LAM. LAM patients experienced their first lupus symptoms four years earlier than EC patients and were diagnosed and included in the registry younger, and their SLE was of a shorter duration. The time in months from the first SLE symptoms to diagnosis was longer in EC patients, as were the follow-up periods. LAM patients exhibited higher prevalence rates of myositis, haemolytic anaemia and nephritis, but there were no differences in histological type or serositis. Anti-Sm, anti-Ro and anti-RNP antibodies were more frequently found in LAM patients. LAM patients also had higher levels of disease activity, severity and hospital admissions. However, there were no differences in damage index, mortality or co-morbidity index. In the multivariate analysis, after adjusting for confounders, in several models the odds ratio (95% confidence interval) for a Katz severity index >3 in LAM patients was 1.45 (1.038–2.026; p = 0.02). This difference did not extend to activity levels (i.e. SLEDAI >3; 0.98 (0.30–1.66)). Conclusion SLE in Hispanic EC patients showed clinical differences compared to Hispanic LAM patients. The latter more frequently suffered nephritis and higher severity indices. This study shows that where lupus is concerned, not all Hispanics are equal.
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Affiliation(s)
- B Hernández Cruz
- Rheumatology Department, Virgen Macarena University Hospital, Seville, Spain
| | - F Alonso
- Research Unit, Spanish Society of Rheumatology, Madrid, Spain
| | - J Calvo Alén
- Rheumatology Department, Araba University Hospital, Vitoria, Spain
| | - J M Pego-Reigosa
- Rheumatology Department, University Hospital Complex, Instituto de Investigación Biomédica de Vigo, Vigo, Spain
| | - F J López-Longo
- Rheumatology Department, Gregorio Marañón University Hospital, Madrid, Spain
| | | | - A Olivé
- Rheumatology Department, Germans Trías i Pujol University Hospital, Badalona, Spain
| | - E Tomero
- Rheumatology Department, La Princesa University Hospital, Madrid, Spain
| | - L Horcada
- Rheumatology Department, Navarra Hospital, Navarra, Spain
| | - E Uriarte
- Rheumatology Department, Donosti Hospital, Guipuzcoa, Spain
| | - C Erausquin
- Rheumatology Department, Dr Negrín University Hospital, Las Palmas de Gran Canaria, Spain
| | - A Sánchez-Atrio
- Rheumatology Department, Príncipe de Asturias University Hospital, Madrid, Spain
| | - C Montilla
- Rheumatology Department, Salamanca Clinic University Hospital, Salamanca, Spain
| | - G Santos Soler
- Rheumatology Department, Marina Baixa Hospital, Alicante, Spain
| | - A Fernández-Nebro
- Rheumatology Department, Carlos Haya University Hospital, Malaga, Spain
| | - R Blanco
- Rheumatology Department, Marqués de Valdecilla University Hospital, Santander, Spain
| | - M Rodríguez-Gómez
- Rheumatology Department, Hospital Complex of Ourense, Ourense, Spain
| | - P Vela
- Rheumatology Department, Alicante General Hospital, Alicante, Spain
| | - M Freire
- Rheumatology Department, Juan Canalejo University Hospital, La Coruña, Spain
| | | | - A L Boteanu
- Rheumatology Department, Ramon y Cajal University Hospital, Madrid, Spain
| | - J Narváez
- Rheumatology Department, Bellvitge Hospital, Barcelona, Spain
| | - V Martínez Taboada
- Rheumatology Department, Marqués de Valdecilla University Hospital, Santander, Spain
| | - E Ruiz-Lucea
- Rheumatology Department, Basurto Hospital, Bilbao, Spain
| | - JL Andreu
- Rheumatology Department, Puerta del Hierro-Majadahonda Hospital, Madrid, Spain
| | | | | | - M Gantes
- Rheumatology Department, Tenerife Clinic Hospital, Tenerife, Spain
| | - J J Pérez-Venegas
- Rheumatology Department, Jerez de la Frontera University Hospital, Cadiz, Spain
| | | | - Á Pecondón-Español
- Rheumatology Department, Miguel Servet University Hospital, Zaragoza, Spain
| | - C Marras
- Rheumatology Department, Virgen de la Arrixaca University Hospital, Murcia, Spain
| | - G Bonilla
- Rheumatology Department, La Paz University Hospital, Madrid, Spain
| | - I Castellví
- Rheumatology Unit, L’Alt Penedés District Hospital, Barcelona, Spain
| | - M Moreno
- Rheumatology Department, Parc Taulí Hospital, Barcelona, Spain
| | - E Raya
- Rheumatology Department, San Cecilio Hospital, Granada, Spain
| | | | - T Vázquez
- Rheumatology Department, Lucus Augusti Hospital, Lugo, Spain
| | - J Ibáñez Ruán
- Rheumatology Unit, POVISA Medical Centre, Vigo, Spain
| | - S Muñoz
- Rheumatology Service, Infanta Sofía University Hospital, San Sebastián de los Reyes, Madrid, Spain
| | - Í Rúa-Figueroa
- Rheumatology Department, Doctor Negrín University Hospital of Gran Canaria, Las Palmas de Gran Canaria, Spain
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Torrente-Segarra V, Salman Monte TC, Rúa-Figueroa I, De Uña-Álvarez J, Balboa-Barreiro V, López-Longo FJ, Galindo-Izquierdo M, Calvo-Alén J, Olivé-Marqués A, Mouriño-Rodríguez C, Horcada L, Sánchez-Atrio A, Montilla C, Salgado E, Díez-Álvarez E, Blanco R, Andreu JL, Fernández-Berrizbeitia O, Hernández-Beriain JA, Gantes M, Hernández-Cruz B, Pecondón-Español A, Marras C, Bonilla G, Pego-Reigosa JM. Relationship between damage and mortality in juvenile-onset systemic lupus erythematosus: Cluster analyses in a large cohort from the Spanish Society of Rheumatology Lupus Registry (RELESSER). Semin Arthritis Rheum 2018; 48:1025-1029. [PMID: 30344081 DOI: 10.1016/j.semarthrit.2018.09.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 08/21/2018] [Accepted: 09/24/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To identify patterns (clusters) of damage manifestation within a large cohort of juvenile SLE (jSLE) patients and evaluate their possible association with mortality. METHODS This is a multicentre, descriptive, cross-sectional study of a cohort of 345 jSLE patients from the Spanish Society of Rheumatology Lupus Registry. Organ damage was ascertained using the Systemic Lupus International Collaborating Clinics Damage Index. Using cluster analysis, groups of patients with similar patterns of damage manifestation were identified and compared. RESULTS Mean age (years) ± S.D. at diagnosis was 14.2 ± 2.89; 88.7% were female and 93.4% were Caucasian. Mean SLICC/ACR DI ± S.D. was 1.27 ± 1.63. A total of 12 (3.5%) patients died. Three damage clusters were identified: Cluster 1 (72.7% of patients) presented a lower number of individuals with damage (22.3% vs. 100% in Clusters 2 and 3, P < 0.001); Cluster 2 (14.5% of patients) was characterized by renal damage in 60% of patients, significantly more than Clusters 1 and 3 (P < 0.001), in addition to increased more ocular, cardiovascular and gonadal damage; Cluster 3 (12.7%) was the only group with musculoskeletal damage (100%), significantly higher than in Clusters 1 and 2 (P < 0.001). The overall mortality rate in Cluster 2 was 2.2 times higher than that in Cluster 3 and 5 times higher than that in Cluster 1 (P < 0.017 for both comparisons). CONCLUSIONS In a large cohort of jSLE patients, renal and musculoskeletal damage manifestations were the two dominant forms of damage by which patients were sorted into clinically meaningful clusters. We found two clusters of jSLE with important clinical damage that were associated with higher rates of mortality, especially for the cluster of patients with predominant renal damage. Physicians should be particularly vigilant to the early prevention of damage in this subset of jSLE patients with kidney involvement.
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Affiliation(s)
- V Torrente-Segarra
- Rheumatology Department, Hospital General Hospitalet-Sant Joan DespíMoisèsBroggi, C/ Josep Molins 29-41, 08906 Hospitalet, Llobregat 08906, Spain.
| | - T C Salman Monte
- Rheumatology Department, Parc de Salut Mar-IMIM, Barcelona, Spain
| | - I Rúa-Figueroa
- Rheumatology Department, Doctor Negrín University Hospital of Gran Canaria, Las Palmas de Gran Canaria, Spain.
| | | | | | - F J López-Longo
- Rheumatology Department, Gregorio Marañón University Hospital, Madrid, Spain
| | - M Galindo-Izquierdo
- Rheumatology Department, Doce de Octubre University Hospital, Madrid, Spain.
| | - J Calvo-Alén
- Rheumatology Department, Sierrallana Hospital, Torrelavega, Spain.
| | - A Olivé-Marqués
- Rheumatology Department, Germans TríasiPujol University Hospital, Badalona, Spain.
| | - C Mouriño-Rodríguez
- Rheumatology Department, Complexo Hospitalario Universitario de Vigo, Spain.
| | - L Horcada
- Rheumatology Department, Navarra Hospital, Navarra, Pamplona, Spain
| | - A Sánchez-Atrio
- Rheumatology Department, Príncipe de Asturias University Hospital, Madrid, Spain
| | - C Montilla
- Rheumatology Department, Salamanca Clinic University Hospital, Salamanca, Spain
| | - E Salgado
- Rheumatology Department, Complexo Hospitalario Universitario de Ourense, Ourense, Spain.
| | | | - R Blanco
- Rheumatology Department, Marqués de Valdecilla University Hospital, Santander, Spain.
| | - J L Andreu
- Rheumatology Department, Puertadel Hierro-Majadahonda Hospital, Madrid, Spain.
| | | | - J A Hernández-Beriain
- José Ángel, Rheumatology Department, Hospital Insular of Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - M Gantes
- RheumatologyDepartment, Tenerife Clinic Hospital, Tenerife, Spain
| | - B Hernández-Cruz
- Rheumatology Department, Virgen Macarena Hospital, Sevilla, Spain
| | - A Pecondón-Español
- RheumatologyDepartment, Miguel Servet University Hospital, Zaragoza, Spain.
| | - C Marras
- RheumatologyDepartment, Virgen de laArrixaca University Hospital, Murcia, Spain
| | - G Bonilla
- RheumatologyDepartment, La Paz University Hospital, Madrid, Spain.
| | - J M Pego-Reigosa
- Rheumatology Department, Complexo Hospitalario Universitario de Vigo, IRIDIS (Investigation in Rheumatology and Immune-Mediated Diseases) Group Instituto de Investigación Sanitaria Galicia Sur (IISGS), Vigo, Spain.
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8
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Riveros Frutos A, Casas I, Rúa-Figueroa I, López-Longo FJ, Calvo-Alén J, Galindo M, Fernández-Nebro A, Pego-Reigosa JM, Olivé Marqués A. Systemic lupus erythematosus in Spanish males: a study of the Spanish Rheumatology Society Lupus Registry (RELESSER) cohort. Lupus 2016; 26:698-706. [PMID: 27799439 DOI: 10.1177/0961203316673728] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Objective The objective of this study was to describe the demographic, clinical, and immunological manifestations of systemic lupus erythematosus (SLE) in male patients. Methods A cross-sectional, multicenter study was carried out of 3651 patients (353 men, 9.7%, and 3298 women, 90.2%) diagnosed with SLE, included in the Spanish Rheumatology Society SLE Registry (RELESSER). Results Mean ages (18-92 years) of symptom onset were 37 (SD 17) years (men) and 32 (SD 14) years (women). Male/female ratio was 1/9. Age of onset of symptoms and age at diagnosis were higher in men than in women ( p < 0.001). Males were diagnosed earlier than females (p = 0.04) and had more cardiovascular comorbidities ( p < 0.001). Two hundred and thirty-six males (68%) with SLE required hospitalization in comparison with 1713 females (53%) ( p < 0.001). During follow-up, 208 patients died: 30 men (9.3%) and 178 women (5.9%) ( p = 0.02). As regards clinical manifestations, loss of weight ( p = 0.01), lymphadenopathies ( p = 0.02), and splenomegaly ( p = 0.02) were more common in male patients. Female patients were more likely to have inflammatory rash, alopecia, and arthritis ( p < 0.05). As for lung involvement, men with SLE had more pleural fibrosis ( p < 0.001) and pulmonary embolism ( p = 0.01). However, Raynaud's phenomenon was more common in women (35%) than in men (23.7%) ( p < 0.001); lupus nephritis was more common in men, being present in 155 (44.8%) of males versus 933 (29%) of females ( p < 0.001). Multivariate analysis showed that SLE patients with a high Charlson index (more than 3 points) and age > 50 years had a higher mortality (odds ratios 3.6 and 2.1, respectively). Furthermore, SLE patients who developed pulmonary hemorrhage, pulmonary hypertension, psychiatric involvement, complement deficiency, and hemophagocytic syndrome also had higher mortality, regardless of gender. Conclusion Patients with SLE over the age of 50 years have an increased risk of mortality. In Caucasians, age at diagnosis and symptom onset is higher in men than in women. The diagnostic delay is shorter in men. Male SLE patients present more cardiovascular comorbidities, and also more serositis, adenopathies, splenomegaly, renal involvement, convulsion, thrombosis, and lupus anticoagulant positivity than women.
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Affiliation(s)
- A Riveros Frutos
- 1 Rheumatology Department, Germans Trias i Pujol University Hospital, Badalona, Spain.,2 Medicine Department, UAB, Spain
| | - I Casas
- 3 Preventive Department, Germans Trias i Pujol University Hospital, Badalona, Spain
| | - I Rúa-Figueroa
- 4 Rheumatology Department, Doctor Negrín University Hospital of Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - F J López-Longo
- 5 Rheumatology Department, Gregorio Marañón University Hospital, Madrid, Spain
| | - J Calvo-Alén
- 6 Rheumatology Department, Sierrallana Hospital, Torrelavega, Spain
| | - M Galindo
- 7 Rheumatology Department, Doce de Octubre University Hospital, Madrid, Spain
| | - A Fernández-Nebro
- 8 Rheumatology Department, Carlos Haya University Hospital, Málaga, Spain
| | - J M Pego-Reigosa
- 9 Rheumatology Department, University Hospital Complex Instituto de Investigación Biomédica de Vigo (IBIV), Spain
| | - A Olivé Marqués
- 1 Rheumatology Department, Germans Trias i Pujol University Hospital, Badalona, Spain
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9
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Schneider M, Mosca M, Pego-Reigosa JM, Hachulla E, Teh LS, Perna A, Koscielny V, Pike J, Lobosco S, Apolone G. Understanding remission in real-world lupus patients across five European countries. Lupus 2015; 25:505-12. [PMID: 26635245 DOI: 10.1177/0961203315619030] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [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: 12/12/2014] [Accepted: 11/02/2015] [Indexed: 02/01/2023]
Abstract
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease associated with increased mortality and significant personal, psychological and socioeconomic consequences. An agreed definition of remission is needed and lacking. We sought to visualize 'remission in SLE' in European patients considered by their physicians to be 'in remission' by comparing the reported symptom burden as reported by treating physicians for patients considered to be 'in remission' and those not considered to be 'in remission'. Data for 1227 patients drawn from a multinational, real-world survey of patients with SLE consulting practising rheumatologists and nephrologists in France, Germany, Italy, Spain, and the UK show that physicians classed their patients as 'in remission' despite a considerable ongoing symptom burden and intensive immunosuppressive medication. Patients considered to be 'in remission' still had a mean of 2.68 current symptoms vs 5.48 for those considered to be not 'in remission' (p < 0.0001). The most common symptoms among those seen to be 'in remission' were joint symptoms, fatigue, pain, mucocutaneous involvement, haematological manifestations and kidney abnormalities. The current analysis highlights important ongoing disease activity, symptom burden and immunosuppressive medication in European patients with SLE considered by their treating physician to be 'in remission'. For a further improvement of outcome, there is an urgent need for an international consensus on the definitions for remission among patients with SLE.
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Affiliation(s)
- M Schneider
- Policlinic of Rheumatology, Heinrich-Heine University, Dusseldorf, Germany
| | - M Mosca
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - J M Pego-Reigosa
- Rheumatology Section, Hospital do Meixoeiro (Complexo Hospitalario Universitario de Vigo), Instituto de Investigación Biomédica de Vigo (IBIV), Vigo, Spain
| | - E Hachulla
- National Centre for Auto-immune and Systemic Diseases, Internal Medicine Department, Hôpital Claude Huriez, University of Lille Nord de France, Lille, France
| | - L-S Teh
- Department of Rheumatology, Royal Blackburn Hospital, Blackburn, UK
| | - A Perna
- Immune Inflammation & Infectious Diseases Global Franchise GlaxoSmithKline, Brentford, UK
| | - V Koscielny
- Immune Inflammation & Infectious Diseases Global Franchise GlaxoSmithKline, Brentford, UK
| | - J Pike
- Adelphi Real World, Adelphi Mill, Bollington, UK
| | - S Lobosco
- Adelphi Real World, Adelphi Mill, Bollington, UK
| | - G Apolone
- Scientific Directorate, IRCCS Arcispedale S. Maria Nuova, Reggio-Emilia, Italy
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10
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Pego-Reigosa JM, Rúa-Figueroa Í, López-Longo FJ, Galindo-Izquierdo M, Calvo-Alén J, Olivé-Marqués A, del Campo V, García-Yébenes MJ, Loza-Santamaría E, Blanco R, Melero-González R, Vela-Casasempere P, Otón-Sánchez T, Tomero-Muriel E, Uriarte-Isacelaya E, Fito-Manteca MC, Freire-González M, Narváez J, Fernández-Nebro A, Zea-Mendoza A, Carlos Rosas J. Analysis of disease activity and response to treatment in a large Spanish cohort of patients with systemic lupus erythematosus. Lupus 2014; 24:720-9. [DOI: 10.1177/0961203314563818] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 11/15/2014] [Indexed: 11/16/2022]
Abstract
Objectives The objectives of this paper are to study the impact of disease activity in a large cohort of patients with systemic lupus erythematosus (SLE) and estimate the rate of response to therapies. Methods We conducted a nationwide, retrospective, multicenter, cross-sectional cohort study of 3658 SLE patients. Data on demographics, disease characteristics: activity (SELENA-SLEDAI), damage, severity, hospitalizations and therapies were collected. Factors associated with refractory disease were identified by logistic regression. Results A total of 3658 patients (90% female; median SLE duration (interquartile range): 10.4 years (5.3–17.1)) were included. At the time of their last evaluation, 14.7% of the patients had moderate-severe SLE (SELENA-SLEDAI score ≥6). There were 1954 (53.4%) patients who were hospitalized for activity at least once over the course of the disease. At some stage, 84.6% and 78.8% of the patients received glucocorticoids and antimalarials, respectively, and 51.3% of the patients received at least one immunosuppressant. Owing to either toxicity or ineffectiveness, cyclophosphamide was withdrawn in 21.5% of the cases, mycophenolate mofetil in 24.9%, azathioprine in 40.2% and methotrexate in 46.8%. At some stage, 7.3% of the patients received at least one biologic. A total of 898 (24.5%) patients had refractory SLE at some stage. Renal, neuropsychiatric, vasculitic, hematological and musculoskeletal involvement, a younger age at diagnosis and male gender were associated with refractory disease. Conclusions A significant percentage of patients have moderately-to-severely active SLE at some stage. Disease activity has a big impact in terms of need for treatment and cause of hospitalization. The effectiveness of the standard therapies for reducing disease activity is clearly insufficient. Some clinical features are associated with refractory SLE.
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Affiliation(s)
- J M Pego-Reigosa
- Rheumatology Department, University Hospital Complex, Instituto de Investigación Biomédica de Vigo, Spain
| | - Í Rúa-Figueroa
- Rheumatology Department, Doctor Negrín University Hospital of Gran Canaria, Spain
| | - F J López-Longo
- Rheumatology Department, Gregorio Marañón University Hospital, Madrid, Spain
| | | | - J Calvo-Alén
- Rheumatology Department, Sierrallana Hospital, Torrelavega, Spain
| | - A Olivé-Marqués
- Rheumatology Department, Germans Trías I Pujol University Hospital, Badalona, Spain
| | - V del Campo
- Preventive Medicine and Epidemiology Department, University Hospital Complex, Instituto de Investigación Biomédica de Vigo, Spain
| | | | | | - R Blanco
- Rheumatology Department, Marqués de Valdecilla University Hospital, Santander, Spain
| | - R Melero-González
- Rheumatology Department, University Hospital Complex, Instituto de Investigación Biomédica de Vigo, Spain
| | - P Vela-Casasempere
- Rheumatology Department, University Hospital of Alicante, Alicante, Spain
| | - T Otón-Sánchez
- Rheumatology Department, Hospital of Torrejón, Madrid, Spain
| | - E Tomero-Muriel
- Rheumatology Department, La Princesa University Hospital, Madrid, Spain
| | | | | | - M Freire-González
- Rheumatology Department, University Hospital Complex of A Coruña, A Coruña, Spain
| | - J Narváez
- Rheumatology Department, Bellvitge University Hospital, Barcelona, Spain
| | - A Fernández-Nebro
- Rheumatology Department, University Hospital Carlos Haya, Málaga, Spain
| | - A Zea-Mendoza
- Rheumatology Department, Ramón y Cajal University Hospital, Madrid, Spain
| | - J Carlos Rosas
- Rheumatology Department, Marinabaixa Hospital, Villajoyosa, and the Spanish Society of Rheumatology Systemic Autoimmune Diseases Study Group (EASSER), Spain
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11
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Fernández-Nebro A, Marenco JL, López-Longo F, Galindo M, Hernández-Cruz BE, Narváez J, Rúa-Figueroa ÍI, Raya-Alvarez E, Zea A, Freire M, Sánchez-Atrio AI, García-Vicuña R, Pego-Reigosa JM, Manrique-Arija S, Nieves-Martín L, Carreño L. The effects of rituximab on the lipid profile of patients with active systemic lupus erythematosus: results from a nationwide cohort in Spain (LESIMAB). Lupus 2014; 23:1014-22. [DOI: 10.1177/0961203314534909] [Citation(s) in RCA: 8] [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] [Indexed: 11/17/2022]
Abstract
Introduction Patients with systemic lupus erythematosus (SLE) have increased cardiovascular risk related to lipid changes induced by inflammatory activity, proteinuria and treatments. Our objective was to analyse lipid changes in a cohort of patients with SLE resistant to standard treatments who were treated with rituximab. Methods The study population comprised a retrospective multicentre, national cohort of patients with SLE resistant to standard treatments who were treated with rituximab. The basic lipid profile, concomitant treatment and disease activity were analysed at the start of the treatment, 24 weeks later, and at the end of the follow-up period. The effects of the main lupus variables and therapy on the lipid changes were analysed. Results Seventy-nine patients with active lupus treated with rituximab were assessed during 149.3 patient-years. Prior to the treatment, 69% had dyslipidaemia. The most frequent abnormalities were a low-density lipoprotein (LDL) level of ≥100 mg/dl (34%) and a high-density lipoprotein (HDL) level of <50 mg/dl (27%). Baseline total cholesterol (TC) and LDL levels correlated with the degree of proteinuria, while the concentration of triglycerides (TGs) correlated with the SLE Disease Activity Index (SLEDAI). TGs were reduced at short- and long-term follow-up after rituximab treatment. A multiple linear regression analysis identified that the reduction of the lupus inflammatory activity, particularly changes in proteinuria, was the only independent variable that was positively associated with the reduction in TGs after 24 weeks ( p = 0.001) and with TC ( p = 0.005) and TGs ( p < 0.001) at the end of the follow-up period. Conclusion Our results suggest that rituximab may improve the long-term lipid profile of patients with SLE refractory to standard treatment, mainly by reducing inflammatory activity.
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Affiliation(s)
- A Fernández-Nebro
- UGC Reumatología, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga/Universidad de Málaga, Málaga, Spain
| | - JL Marenco
- Hospital Virgen de Valme, Rheumatology Department, Sevilla, Spain
| | - F López-Longo
- Hospital General Universitario Gregorio Marañón, Rheumatology Department, Madrid, Spain
| | - M Galindo
- Hospital Universitario 12 de Octubre, Rheumatology Department, Madrid, Spain
| | | | - J Narváez
- Hospital Universitario de Bellvitge, Rheumatology Department, Hospitalet de Llobregat, Barcelona, Spain
| | - Í I Rúa-Figueroa
- Hospital Universitario de Gran Canaria Dr Negrín, Rheumatology Department, Las Palmas de Gran Canaria, Spain
| | - E Raya-Alvarez
- Hospital Clínico Universitario San Cecilio, Rheumatology Department, Granada, Spain
| | - A Zea
- Hospital Universitario Ramón y Cajal, Rheumatology Department, Madrid, Spain
| | - M Freire
- Complejo Hospitalario Universitario A Coruña, Rheumatology Department, A Coruña, Spain
| | - AI Sánchez-Atrio
- Hospital Universitario Príncipe de Asturias, Rheumatology Department, Alcalá de Henares, Madrid, Spain
| | - R García-Vicuña
- Hospital Universitario de la Princesa, Rheumatology Department, Madrid, Spain
| | - JM Pego-Reigosa
- Complejo Hospitalario Universitario de Vigo, Rheumatology Department, Hospital del Mexoeiro, Instituto de Investigación Biomédica de Vigo (IBIV), Vigo, Spain
| | - S Manrique-Arija
- UGC Reumatología, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga/Universidad de Málaga, Málaga, Spain
| | - L Nieves-Martín
- UGC Reumatología, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga/Universidad de Málaga, Málaga, Spain
| | - L Carreño
- Hospital General Universitario Gregorio Marañón, Rheumatology Department, Madrid, Spain
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Fernández-Nebro A, de la Fuente JLM, Carreño L, Izquierdo MG, Tomero E, Rúa-Figueroa I, Hernández-Cruz BE, Narváez J, Ucar E, Olivé A, Zea A, Fernández-Castro M, Raya-Álvarez E, Pego-Reigosa JM, Freire M, Martínez-Taboada VM, Pérez-Venegas J, Sánchez-Atrio AI, Villa-Blanco I, Manrique-Arija S, López-Longo FJ, Carreira PE, Martínez-Pérez R, García-Vicuña R. Multicenter longitudinal study of B-lymphocyte depletion in refractory systemic lupus erythematosus: the LESIMAB study. Lupus 2012; 21:1063-76. [PMID: 22786985 DOI: 10.1177/0961203312446627] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This study aimed to investigate the effectiveness and safety of single and repeated courses of rituximab in patients with refractory lupus. METHODS LESIMAB is a multicenter, retrospective, longitudinal study of lupus patients who have not responded to standard therapy and have been treated with rituximab. Response rates at six months and at follow-up were defined as efficacy outcomes. Complete response was defined as a SELENA-SLEDAI score ≤ two and a SELENA-SLEDAI Flare Index of zero. Partial response was defined as a reduction in the SELENA-SLEDAI score of ≥four points with no new or worsening of symptoms. Adverse events were collected. RESULTS Seventy-three (62.9%) of 116 patients achieved a response at six months (complete in 22 and partial in 51). Ninety-seven (77.6%) of 128 patients achieved a response after a mean follow-up of 20.0 ± 15.2 months (complete in 50 and partial in 47). High baseline SLEDAI score, previous treatment with ≥100 mg/day prednisone, and no history of severe hematologic flare were associated with response after the first treatment course. The median time to response was 6.5 months (95% CI, 5.0-8.0). Thirty-seven patients (38.1%) relapsed after the first infusion. The flare was severe in seven cases and mild to moderate in 29 cases. Serious infection rate was 12.6/100 patient-years. A schedule of four weekly doses was associated with more serious infections. Six patients died: two of infection and four of lupus complications. CONCLUSION Rituximab can be an effective treatment option for patients who have refractory lupus with severe or life-threatening disease with an acceptable tolerance profile.
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Affiliation(s)
- A Fernández-Nebro
- Rheumatology Service, Hospital Regional Universitario Carlos Haya, Spain.
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Rubinstein T, Pitashny M, Levine B, Schwartz N, Schwartzman J, Weinstein E, Pego-Reigosa JM, Lu TYT, Isenberg D, Rahman A, Putterman C. Urinary neutrophil gelatinase-associated lipocalin as a novel biomarker for disease activity in lupus nephritis. Rheumatology (Oxford) 2010; 49:960-71. [PMID: 20144927 DOI: 10.1093/rheumatology/kep468] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES Clinical and laboratory markers in current use have limited specificity and sensitivity for predicting the development of renal disease in lupus patients. In this longitudinal study, we investigated whether urinary neutrophil gelatinase-associated lipocalin (uNGAL) predicts active nephritis and renal flares in lupus patients with and without a history of biopsy-proven lupus nephritis. METHODS Renal disease activity and flare status was determined by SLEDAI and BILAG scores. Random effects models were used to determine whether uNGAL was a significant predictor for renal disease activity in SLE patients, and for renal flares in patients with established nephritis. To assess the predictive performance of uNGAL, receiver operating characteristic (ROC) curves were constructed using the previous visit's uNGAL level. These curves were then compared with curves constructed with currently used biomarkers. Cut-offs determined by ROC curves were tested in an independent validation cohort. RESULTS uNGAL was found to be a significant predictor of renal disease activity in all SLE patients, and a significant predictor for flare in patients with a history of biopsy-proven nephritis, in multivariate models adjusting for age, race, sex and anti-double-stranded (ds)DNA antibody titres. As a predictor of renal flare in patients with biopsy-proven nephritis, uNGAL outperformed anti-dsDNA antibody titres. These results were confirmed in an independent validation cohort. CONCLUSIONS uNGAL predicts renal flare in patients with a history of biopsy-proven nephritis with high sensitivity and specificity. Furthermore, uNGAL is a more sensitive and specific forecaster of renal flare in patients with a history of lupus nephritis than anti-dsDNA antibody titres.
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Affiliation(s)
- Tamar Rubinstein
- Department of Medicine, Division of Rheumatology, Albert Einstein College of Medicine, Bronx, NY 10461, USA
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O'Neill SG, Pego-Reigosa JM, Hingorani AD, Bessant R, Isenberg DA, Rahman A. Use of a strategy based on calculated risk scores in managing cardiovascular risk factors in a large British cohort of patients with systemic lupus erythematosus. Rheumatology (Oxford) 2009; 48:573-5. [PMID: 19273540 DOI: 10.1093/rheumatology/kep037] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To develop a strategy for stratifying risk of cardiovascular disease (CVD) in a cohort of patients with SLE and to test the usefulness of this strategy in rationalizing management of cardiovascular risk factors. METHODS For each patient, data were collected once each year to allow calculation of risk of developing CVD in the next 10 years. Those with risk values >7.5% were considered for intervention to reduce risk. The risk figures and effect of this strategy on management of the cohort as a whole were assessed after 3 years. Patients who had been identified as smokers in 2005 were contacted in 2008 to assess changes in their smoking behaviour. RESULTS Over 3 years, 308 patients (>90%) of the cohort had CVD risk assessed at least once. Although 10-year CVD risk exceeded 7.5% in 35 patients, the majority (24) of these had either diabetes mellitus or previous CVD for which established cardiovascular risk reduction protocols already exist. Calculation of risk scores did not alter management in 96.5% of the patients. Ninety percent of the smokers remembered being counselled about smoking in the lupus clinic, 70% had received help to reduce smoking and 47% had either reduced or stopped. CONCLUSION A protocol mandating regular assessment of cardiovascular risk factors in our lupus clinic resulted in this issue being discussed with >90% of the patients and there was some evidence of an impact on smoking. However, use of these factors to calculate 10-year risk scores did not alter management in over 96% of the cases.
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Affiliation(s)
- Sean G O'Neill
- Centre for Rheumatology Research, Division of Medicine, University College London, London, UK
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Pego-Reigosa JM, Rodriguez-Rodriguez M, Hurtado-Hernandez Z, Gromaz-Martin J, Taboas-Rodriguez D, Millan-Cachinero C, Hernandez-Rodriguez I, Gonzalez-Gay MA. Calcium pyrophosphate deposition disease mimicking polymyalgia rheumatica: A prospective followup study of predictive factors for this condition in patients presenting with polymyalgia symptoms. ACTA ACUST UNITED AC 2005; 53:931-8. [PMID: 16342107 DOI: 10.1002/art.21585] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To assess the characteristics of calcium pyrophosphate deposition disease (CPDD) with proximal involvement mimicking polymyalgia rheumatica (PMR), and to identify the best predictive factors for the presence of a clinical pattern of CPDD in patients presenting with polymyalgia symptoms. METHODS Patients diagnosed with either PMR or CPDD at the Rheumatology Division of Hospital Meixoeiro (Vigo, Spain) over a 7-year period (1997-2003) were prospectively followed for at least 12 months. RESULTS The study group comprised 118 patients with PMR features and 112 patients with CPDD. Eighty-two of the 118 patients with PMR manifestations were diagnosed as having pure PMR, and 36 met the diagnostic criteria for both PMR and CPDD. Patients with CPDD mimicking PMR were older (P = 0.02) and had peripheral arthritis more frequently (P = 0.004) than those with pure PMR. Radiologic osteoarthritic changes in the hands and knees, including more advanced radiologic grade of knee osteoarthritis, and tendinous calcifications were more frequent in patients with PMR/CPDD (P < 0.001). The best predictive factors for the occurrence of this atypical pattern of CPDD in a patient presenting with PMR features were the age at diagnosis and the presence of tibiofemoral osteoarthritis, tendinous calcifications, and ankle arthritis. CONCLUSION Involvement of proximal joints may be the clinical presentation of CPDD. CPDD should be included in the spectrum of diseases mimicking PMR. The presence of tibiofemoral osteoarthritis, tendinous calcifications, and ankle arthritis are clues that may alert the clinician to the presence of CPDD in an elderly patient presenting with PMR manifestations.
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