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Ramos-Casals M, Sisó-Almirall A. Immune-Related Adverse Events of Immune Checkpoint Inhibitors. Ann Intern Med 2024; 177:ITC17-ITC32. [PMID: 38346306 DOI: 10.7326/aitc202402200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/21/2024] Open
Abstract
Immune-related adverse events (irAEs) are toxicities that arise after the administration of monoclonal antibodies targeting immune checkpoints (immune checkpoint inhibitors [ICIs]) in patients with cancer. They can occur at any time after initiation of ICI treatment, with a broad clinical phenotype that can be organ-specific or systemic. Although most irAEs manifest as mild to moderate signs and symptoms, severe forms of irAEs can lead to irreversible organ failure and have acute life-threatening presentations. Treatment should be tailored to the specific organ involved and the severity. Glucocorticoids are the first-line treatment for most irAEs, with immunosuppressants and biologics mainly used as second-line treatments.
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Affiliation(s)
- Manuel Ramos-Casals
- Department of Autoimmune Diseases, ICMiD, Hospital Clínic, and Department of Medicine, University of Barcelona, Barcelona, Spain (M.R.)
| | - Antoni Sisó-Almirall
- Department of Medicine, University of Barcelona; Primary Healthcare Transversal Research Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); and Primary Care Centre Les Corts, Consorci d'Atenció Primària de Salut Barcelona Esquerra (CAPSBE), Barcelona, Spain (A.S.)
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Brito-Zerón P, Lower EE, Ramos-Casals M, Baughman RP. Hematological involvement in sarcoidosis: from cytopenias to lymphoma. Expert Rev Clin Immunol 2024; 20:59-70. [PMID: 37878359 DOI: 10.1080/1744666x.2023.2274363] [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: 06/23/2023] [Accepted: 10/19/2023] [Indexed: 10/26/2023]
Abstract
INTRODUCTION We present an updated overview of the hematological involvementassociated with sarcoidosis, including a management approach forcytopenias and revisiting the association with hematologicalmalignancies. AREAS COVERED Theetiology of cytopenias in sarcoidosis can be attributed to two majoretiopathogenic mechanisms: infiltration of hematopoietic organs suchas the spleen and bone marrow, and autoimmune-mediated cytopenias.With respect to the association with hematological malignancies, itrequires careful evaluation of patients from a chronologicalperspective. Patients must be classified into one of three pathogenicscenarios, including preexisting hematological malignancies,synchronous development of malignancy and sarcoidosis due to commonpredisposing factors, or sarcoidosis as a predisposing factor formalignancies. EXPERT OPINION The association between sarcoidosis and hematologic involvement isbest understood as a pathogenic continuum, with cytopenias andhematologic neoplasms intertwined due to various etiopathogenicmechanisms. These mechanisms include sarcoid infiltration ofhematopoietic organs, common predisposing immunogenetics for thedevelopment of autoimmune cytopenias and malignancies, and anincreased risk of neoplasm development in patients with autoimmunecytopenias. Collaboration among the main specialties involved in theclinical management of these patients is crucial for an earlymonitoring and management.
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Affiliation(s)
- Pilar Brito-Zerón
- Autoimmune Diseases Unit, Research and Innovation Group in Autoimmune Diseases, Sanitas Digital Hospital, Hospital-CIMA-Centre Mèdic Milenium Balmes Sanitas, Barcelona, Spain
- SarcoGEAS Study Group ("Grupo de Estudio de Enfermedades Autoinmunes -GEAS-, Sociedad Española de Medicina Interna -SEMI-), Spain
| | - Elyse E Lower
- Department of Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Manuel Ramos-Casals
- SarcoGEAS Study Group ("Grupo de Estudio de Enfermedades Autoinmunes -GEAS-, Sociedad Española de Medicina Interna -SEMI-), Spain
- Department of Autoimmune Diseases, ICMiD, Hospital Clínic, Barcelona, Spain
- Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Robert P Baughman
- Department of Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA
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Flores-Chávez A, Brito-Zerón P, Ng WF, Szántó A, Rasmussen A, Priori R, Baldini C, Armagan B, Özkiziltaş B, Praprotnik S, Suzuki Y, Quartuccio L, Hernández-Molina G, Inanc N, Bartoloni E, Rischmueller M, Reis-de Oliveira F, Fernandes Moça Trevisani V, Jurcut C, Nordmark G, Carubbi F, Hofauer B, Valim V, Pasoto SG, Retamozo S, Atzeni F, Fonseca-Aizpuru E, López-Dupla M, Giacomelli R, Nakamura H, Akasbi M, Thompson K, Fanny Horváth I, Farris AD, Simoncelli E, Bombardieri S, Kilic L, Tufan A, Perdan Pirkmajer K, Fujisawa Y, De Vita S, Abacar K, Ramos-Casals M. Influence of exposure to climate-related hazards in the phenotypic expression of primary Sjögren's syndrome. Clin Exp Rheumatol 2023; 41:2437-2447. [PMID: 38019164 DOI: 10.55563/clinexprheumatol/pmbay6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 10/24/2023] [Indexed: 11/30/2023]
Abstract
OBJECTIVES To analyse how the key components at the time of diagnosis of the Sjögren's phenotype (epidemiological profile, sicca symptoms, and systemic disease) can be influenced by the potential exposure to climate-related natural hazards. METHODS For the present study, the following variables were selected for harmonisation and refinement: age, sex, country, fulfilment of 2002/2016 criteria items, dry eyes, dry mouth, and overall ESSDAI score. Climate-related hazards per country were defined according to the OECD and included seven climate-related hazard types: extreme temperature, extreme precipitation, drought, wildfire, wind threats, river flooding, and coastal flooding. Climatic variables were defined as dichotomous variables according to whether each country is ranked among the ten countries with the most significant exposure. RESULTS After applying data-cleaning techniques and excluding people from countries not included in the OECD climate rankings, the database study analysed 16,042 patients from 23 countries. The disease was diagnosed between 1 and 3 years earlier in people living in countries included among the top 10 worst exposed to extreme precipitation, wildfire, wind threats, river flooding, and coastal flooding. A lower frequency of dry eyes was observed in people living in countries exposed to wind threats, river flooding, and coastal flooding, with a level of statistical association being classified as strong (p<0.0001 for the three variables). The frequency of dry mouth was significantly lower in people living in countries exposed to river flooding (p<0.0001) and coastal flooding (p<0.0001). People living in countries included in the worse climate scenarios for extreme temperature (p<0.0001) and river flooding (p<0.0001) showed a higher mean ESSDAI score in comparison with people living in no-risk countries. In contrast, those living in countries exposed to worse climate scenarios for wind threats (p<0.0001) and coastal flooding (p<0.0001) showed a lower mean ESSDAI score in comparison with people living in no-risk countries. CONCLUSIONS Local exposure to extreme climate-related hazards plays a role in modulating the presentation of Sjögren across countries concerning the age at which the disease is diagnosed, the frequency of dryness, and the degree of systemic activity.
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Affiliation(s)
| | - Pilar Brito-Zerón
- Autoimmune Diseases Unit, Research and Innovation Group in Autoimmune Diseases, Sanitas Digital Hospital, Hospital-CIMA-Centre Mèdic Milenium Balmes Sanitas, Barcelona, Spain
| | - Wan-Fai Ng
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, and NIHR Biomedical Research Centre & NIHR Newcastle Clinical Research Facility, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Antónia Szántó
- Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Hungary
| | - Astrid Rasmussen
- Genes and Human Disease Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - Roberta Priori
- Department of Internal Medicine and Medical Specialties, Rheumatology Clinic, Sapienza University of Rome, and Saint Camillus International University of Health Science, UniCamillus, Rome, Italy
| | | | - Berkan Armagan
- Division of Rheumatology, Department of Internal Medicine, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Burcugül Özkiziltaş
- Department of Internal Medicine, Division of Rheumatology, Gazi University School of Medicine, Ankara, Turkey
| | - Sonja Praprotnik
- Department of Rheumatology, University Medical Centre, Ljubljana, Slovenia
| | - Yasunori Suzuki
- Division of Rheumatology, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan
| | - Luca Quartuccio
- Division of Rheumatology, University of Udine, Department of Medicine, University Hospital Santa Maria della Misericordia, Udine, Italy
| | - Gabriela Hernández-Molina
- Immunology and Rheumatology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, Mexico
| | - Nevsun Inanc
- Marmara University, School of Medicine, Istanbul, Turkey
| | - Elena Bartoloni
- Rheumatology Unit, Department of Medicine, University of Perugia, Italy
| | - Maureen Rischmueller
- Department of Rheumatology, The Queen Elizabeth Hospital, Discipline of Medicine, University of Adelaide, South Australia, Australia
| | | | | | - Ciprian Jurcut
- Department of Internal Medicine, Carol Davila Central Military Emergency Hospital, Bucharest, Romania
| | - Gunnel Nordmark
- Rheumatology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Francesco Carubbi
- Internal Medicine and Nephrology Unit, Department of Medicine, ASL Avezzano-Sulmona-L'Aquila, San Salvatore Hospital, L'Aquila, Italy
| | - Benedikt Hofauer
- Otorhinolaryngology, Head and Neck Surgery, Technical University Munich, Germany
| | - Valeria Valim
- University Hospital Cassiano Antonio Moraes (Hucam-Ufes/Ebserh), Federal University of Espírito Santo, Brazil
| | - Sandra G Pasoto
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - Soledad Retamozo
- Department of Rheumatology, Hospital Quirón Salud, Barcelona, Spain
| | | | | | | | - Roberto Giacomelli
- Fondazione Policlinico Universitario Campus Bio-Medico, Roma, and Research Unit of Immuno-Rheumatology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Italy
| | - Hideki Nakamura
- Division of Haematology and Rheumatology, Department of Medicine, Nihon University School of Medicine, Oyaguchi Kami-cho, Itabashi-ku, Tokyo, Japan
| | - Miriam Akasbi
- Department of Internal Medicine, Hospital Infanta Leonor, Madrid, Spain
| | - Kyle Thompson
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, and NIHR Biomedical Research Centre & NIHR Newcastle Clinical Research Facility, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Ildiko Fanny Horváth
- Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Hungary
| | - A Darise Farris
- Genes and Human Disease Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - Edoardo Simoncelli
- Department of Internal Medicine and Medical Specialties, Rheumatology Clinic, Sapienza University of Rome, and Saint Camillus International University of Health Science, UniCamillus, Rome, Italy
| | | | - Levent Kilic
- Division of Rheumatology, Department of Internal Medicine, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Abdurrahman Tufan
- Department of Internal Medicine, Division of Rheumatology, Gazi University School of Medicine, Ankara, Turkey
| | - Katja Perdan Pirkmajer
- Department of Rheumatology, University Medical Centre, Ljubljana, and Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, Slovenia
| | - Yuhei Fujisawa
- Division of Rheumatology, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan
| | - Salvatore De Vita
- Division of Rheumatology, University of Udine, Department of Medicine, University Hospital Santa Maria della Misericordia, Udine, Italy
| | - Kerem Abacar
- Marmara University, School of Medicine, Istanbul, Turkey
| | - Manuel Ramos-Casals
- Department of Autoimmune Diseases, ICMiD, Hospital Clínic, Barcelona, and Department of Medicine, University of Barcelona, Spain.
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Brito-Zerón P, Flores-Chávez A, Ng WF, Fanny Horváth I, Rasmussen A, Priori R, Baldini C, Armagan B, Özkiziltaş B, Praprotnik S, Suzuki Y, Quartuccio L, Hernandez-Molina G, Abacar K, Bartoloni E, Rischmueller M, Reis-de Oliveira F, Fernandes Moça Trevisani V, Jurcut C, Fugmann C, Carubbi F, Hofauer B, Valim V, Pasoto SG, Retamozo S, Atzeni F, Fonseca-Aizpuru E, López-Dupla M, Giacomelli R, Nakamura H, Akasbi M, Thompson K, Szántó A, Farris AD, Villa M, Bombardieri S, Kilic L, Tufan A, Perdan Pirkmajer K, Fujisawa Y, de Vita S, Inanc N, Ramos-Casals M. Exposure to air pollution as an environmental determinant of how Sjögren's disease is expressed at diagnosis. Clin Exp Rheumatol 2023; 41:2448-2457. [PMID: 38019154 DOI: 10.55563/clinexprheumatol/p1r1j4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 11/03/2023] [Indexed: 11/30/2023]
Abstract
OBJECTIVES To analyse how the potential exposure to air pollutants can influence the key components at the time of diagnosis of Sjögren's phenotype (epidemiological profile, sicca symptoms, and systemic disease). METHODS For the present study, the following variables were selected for harmonization and refinement: age, sex, country, fulfilment of 2002/2016 criteria items, dry eyes, dry mouth, and overall ESSDAI score. Air pollution indexes per country were defined according to the OECD (1990-2021), including emission data of nitrogen and sulphur oxides (NO/SO), particulate matter (PM2.5 and 1.0), carbon monoxide (CO) and volatile organic compounds (VOC) calculated per unit of GDP, Kg per 1000 USD. RESULTS The results of the chi-square tests of independence for each air pollutant with the frequency of dry eyes at diagnosis showed that, except for one, all variables exhibited p-values <0.0001. The most pronounced disparities emerged in the dry eye prevalence among individuals inhabiting countries with the highest NO/SO exposure, a surge of 4.61 percentage points compared to other countries, followed by CO (3.59 points), non-methane (3.32 points), PM2.5 (3.30 points), and PM1.0 (1.60 points) exposures. Concerning dry mouth, individuals residing in countries with worse NO/SO exposures exhibited a heightened frequency of dry mouth by 2.05 percentage points (p<0.0001), followed by non-methane exposure (1.21 percentage points increase, p=0.007). Individuals inhabiting countries with the worst NO/SO, CO, and PM2.5 pollution levels had a higher mean global ESSDAI score than those in lower-risk nations (all p-values <0.0001). When systemic disease was stratified according to DAS into low, moderate, and high systemic activity levels, a heightened proportion of individuals manifesting moderate/severe systemic activity was observed in countries with worse exposures to NO/SO, CO, and PM2.5 pollutant levels. CONCLUSIONS For the first time, we suggest that pollution levels could influence how SjD appears at diagnosis in a large international cohort of patients. The most notable relationships were found between symptoms (dryness and general body symptoms) and NO/SO, CO, and PM2.5 levels.
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Affiliation(s)
- Pilar Brito-Zerón
- Autoimmune Diseases Unit, Research and Innovation Group in Autoimmune Diseases, Sanitas Digital Hospital, Hospital-CIMA-Centre Mèdic Milenium Balmes Sanitas, Barcelona, Spain
| | | | - Wan-Fai Ng
- Newcastle NIHR Biomedical Research Centre, The United Kingdom Primary Sjögren's Syndrome Registry, Newcastle upon Tyne, UK
| | - Ildiko Fanny Horváth
- Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Hungary
| | - Astrid Rasmussen
- Genes and Human Disease Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - Roberta Priori
- Department of Internal Medicine and Medical Specialties, Rheumatology Clinic, Sapienza University of Rome, and Saint Camillus International University of Health Science, UniCamillus, Rome, Italy
| | | | - Berkan Armagan
- Division of Rheumatology, Department of Internal Medicine, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Burcugül Özkiziltaş
- Department of Internal Medicine, Division of Rheumatology, Gazi University School of Medicine, Ankara, Turkey
| | - Sonja Praprotnik
- Department of Rheumatology, University Medical Centre, Ljubljana, Slovenia
| | - Yasuori Suzuki
- Division of Rheumatology, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan
| | - Luca Quartuccio
- Division of Rheumatology, Department of Medicine, University of Udine, University Hospital Santa Maria della Misericordia, Udine, Italy
| | - Gabriela Hernandez-Molina
- Immunology and Rheumatology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, Mexico
| | - Kerem Abacar
- Marmara University, School of Medicine, Istanbul, Turkey
| | - Elena Bartoloni
- Rheumatology Unit, Department of Medicine, University of Perugia, Italy
| | - Maureen Rischmueller
- Department of Rheumatology, The Queen Elizabeth Hospital, Discipline of Medicine, University of Adelaide, South Australia, Australia
| | | | | | - Ciprian Jurcut
- Department of Internal Medicine, Carol Davila Central Military Emergency Hospital, Bucharest, Romania
| | - Cecilia Fugmann
- Rheumatology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Francesco Carubbi
- Internal Medicine and Nephrology Unit, Department of Medicine, ASL Avezzano-Sulmona-L'Aquila, San Salvatore Hospital, L'Aquila, Italy
| | - Benedikt Hofauer
- Otorhinolaryngology, Head and Neck Surgery, Medical University Innsbruck, Austria
| | | | - Sandra G Pasoto
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - Soledad Retamozo
- Department of Rheumatology, Hospital Quirón Salud, Barcelona, Spain
| | - Fabiola Atzeni
- IRCCS Galeazzi Orthopedic Institute, Milan, and Rheumatology Unit, University of Messina, Italy
| | | | | | - Roberto Giacomelli
- Clinical Unit of Rheumatology and Clinical Immunology, University of Rome Campus Biomedico, Rome, Italy
| | - Hideki Nakamura
- Division of Haematology and Rheumatology, Department of Medicine, Nihon University School of Medicine, Oyaguchi Kami-cho, Itabashi-ku, Tokyo, Japan
| | - Miriam Akasbi
- Department of Internal Medicine, Hospital Infanta Leonor, Madrid, Spain
| | - Kyle Thompson
- Newcastle NIHR Biomedical Research Centre, The United Kingdom Primary Sjögren's Syndrome Registry, Newcastle upon Tyne, UK
| | - Antónia Szántó
- Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Hungary
| | - A Darise Farris
- Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - Martina Villa
- Department of Internal Medicine and Medical Specialties, Rheumatology Clinic, Sapienza University of Rome, and Saint Camillus International University of Health Science, UniCamillus, Rome, Italy
| | | | - Levent Kilic
- Division of Rheumatology, Department of Internal Medicine, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Abdurrahman Tufan
- Department of Internal Medicine, Division of Rheumatology, Gazi University School of Medicine, Ankara, Turkey
| | - Katja Perdan Pirkmajer
- Department of Rheumatology, University Medical Centre, Ljubljana, and Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, Slovenia
| | - Yuhei Fujisawa
- Division of Rheumatology, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan
| | - Salvatore de Vita
- Division of Rheumatology, Department of Medicine, University of Udine, University Hospital Santa Maria della Misericordia, Udine, Italy
| | - Nevsun Inanc
- Marmara University, School of Medicine, Istanbul, Turkey
| | - Manuel Ramos-Casals
- Department of Autoimmune Diseases, ICMiD, Hospital Clínic, Barcelona, and Department of Medicine, University of Barcelona, Spain.
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Brito-Zerón P, Flores-Chávez A, Horváth IF, Rasmussen A, Li X, Olsson P, Vissink A, Priori R, Armagan B, Hernandez-Molina G, Praprotnik S, Quartuccio L, Inanç N, Özkızıltaş B, Bartoloni E, Sebastian A, Romão VC, Solans R, Pasoto SG, Rischmueller M, Galisteo C, Suzuki Y, Trevisani VFM, Fugmann C, González-García A, Carubbi F, Jurcut C, Shimizu T, Retamozo S, Atzeni F, Hofauer B, Melchor-Díaz S, Gheita T, López-Dupla M, Fonseca-Aizpuru E, Giacomelli R, Vázquez M, Consani S, Akasbi M, Nakamura H, Szántó A, Farris AD, Wang L, Mandl T, Gattamelata A, Kilic L, Pirkmajer KP, Abacar K, Tufan A, de Vita S, Bootsma H, Ramos-Casals M. Mortality risk factors in primary Sjögren syndrome: a real-world, retrospective, cohort study. EClinicalMedicine 2023; 61:102062. [PMID: 37457113 PMCID: PMC10344811 DOI: 10.1016/j.eclinm.2023.102062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 06/07/2023] [Accepted: 06/09/2023] [Indexed: 07/18/2023] Open
Abstract
Background What baseline predictors would be involved in mortality in people with primary Sjögren syndrome (SjS) remains uncertain. This study aimed to investigate the baseline characteristics collected at the time of diagnosis of SjS associated with mortality and to identify mortality risk factors for all-cause death and deaths related to systemic SjS activity measured by the ESSDAI score. Methods In this international, real-world, retrospective, cohort study, we retrospectively collected data from 27 countries on mortality and causes of death from the Big Data Sjögren Registry. Inclusion criteria consisted of fulfilling 2002/2016 SjS classification criteria, and exclusion criteria included chronic HCV/HIV infections and associated systemic autoimmune diseases. A statistical approach based on a directed acyclic graph was used, with all-cause and Sjögren-related mortality as primary endpoints. The key determinants that defined the disease phenotype at diagnosis (glandular, systemic, and immunological) were analysed as independent variables. Findings Between January 1st, 2014 and December 31, 2023, data from 11,372 patients with primary SjS (93.5% women, 78.4% classified as White, mean age at diagnosis of 51.1 years) included in the Registry were analysed. 876 (7.7%) deaths were recorded after a mean follow-up of 8.6 years (SD 7.12). Univariate analysis of prognostic factors for all-cause death identified eight Sjögren-related variables (ocular and oral tests, salivary biopsy, ESSDAI, ANA, anti-Ro, anti-La, and cryoglobulins). The multivariate CPH model adjusted for these variables and the epidemiological features showed that DAS-ESSDAI (high vs no high: HR = 1.68; 95% CI, 1.27-2.22) and cryoglobulins (positive vs negative: HR = 1.72; 95% CI, 1.22-2.42) were independent predictors of all-cause death. Of the 640 deaths with available information detailing the specific cause of death, 14% were due to systemic SjS. Univariate analysis of prognostic factors for Sjögren-cause death identified five Sjögren-related variables (oral tests, clinESSDAI, DAS-ESSDAI, ANA, and cryoglobulins). The multivariate competing risks CPH model adjusted for these variables and the epidemiological features showed that oral tests (abnormal vs normal results: HR = 1.38; 95% CI, 1.01-1.87), DAS-ESSDAI (high vs no high: HR = 1.55; 95% CI, 1.22-1.96) and cryoglobulins (positive vs negative: HR = 1.52; 95% CI, 1.16-2) were independent predictors of SjS-related death. Interpretation The key mortality risk factors at the time of SjS diagnosis were positive cryoglobulins and a high systemic activity scored using the ESSDAI, conferring a 2-times increased risk of all-cause and SjS-related death. ESSDAI measurement and cryoglobulin testing should be considered mandatory when an individual is diagnosed with SjS. Funding Novartis.
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Affiliation(s)
- Pilar Brito-Zerón
- Autoimmune Diseases Unit, Research and Innovation Group in Autoimmune Diseases, Sanitas Digital Hospital, Hospital-CIMA-Centre Mèdic Milenium Balmes Sanitas, Barcelona, Spain
| | | | - Ildiko Fanny Horváth
- Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Astrid Rasmussen
- Genes and Human Disease Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - Xiaomei Li
- Department of Rheumatology and Immunology, The First Affiliated Hospital of USTC, University of Science and Technology of China(Anhui Provincial Hosipital), Hefei, China
| | - Peter Olsson
- Department of Rheumatology, Skane University Hospital Malmö, Lund University, Lund, Sweden
| | - Arjan Vissink
- Department of Oral and Maxillofacial Surger, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Roberta Priori
- Department of Internal Medicine and Medical Specialties, Rheumatology Clinic, Sapienza University of Rome, Rome, Italy
- Saint Camillus International University of Health Science, UniCamillus, Rome, Italy
| | - Berkan Armagan
- Division of Rheumatology, Department of Internal Medicine, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Gabriela Hernandez-Molina
- Immunology and Rheumatology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, Mexico
| | - Sonja Praprotnik
- Department of Rheumatology, University Medical Centre, Ljubljana, Slovenia
| | - Luca Quartuccio
- Clinic of Rheumatology, Department of Medical and Biological Sciences, University Hospital “Santa Maria della Misericordia”, Udine, Italy
| | - Nevsun Inanç
- Marmara University, School of Medicine, Istanbul, Turkey
| | - Burcugül Özkızıltaş
- Division of Rheumatology, Department of Internal Medicine, Gazi University School of Medicine, Ankara, Turkey
| | - Elena Bartoloni
- Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy
| | - Agata Sebastian
- Department of Rheumatology and Internal Medicine, Wroclaw Medical Hospital, Wroclaw, Poland
| | - Vasco C. Romão
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte and Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon Academic Medical Centre, Lisbon, Portugal
| | - Roser Solans
- Department of Internal Medicine, Hospital Vall d'Hebron, Barcelona, Spain
| | - Sandra G. Pasoto
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Maureen Rischmueller
- Department of Rheumatology, The Queen Elizabeth Hospital, Discipline of Medicine, University of Adelaide, South Australia, Australia
| | - Carlos Galisteo
- Department of Rheumatology, Hospital Parc Taulí, Barcelona, Spain
| | - Yasunori Suzuki
- Division of Rheumatology, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan
| | | | - Cecilia Fugmann
- Rheumatology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | | | - Francesco Carubbi
- Internal Medicine and Nephrology Unit, Department of Medicine, ASL Avezzano-Sulmona-L'Aquila, San Salvatore Hospital, L'Aquila, Italy
| | - Ciprian Jurcut
- Department of Internal Medicine, Carol Davila Central Military Emergency Hospital, Bucharest, Romania
| | - Toshimasa Shimizu
- Division of Advanced Preventive Medical Sciences, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Soledad Retamozo
- Department of Rheumatology, Hospital Quirón Salud, Barcelona, Spain
| | - Fabiola Atzeni
- IRCCS Galeazzi Orthopedic Institute, Milan and Rheumatology Unit, University of Messina, Messina, Italy
| | - Benedikt Hofauer
- Otorhinolaryngology, Head and Neck Surgery, Technical University Munich, Munich, Germany
| | | | - Tamer Gheita
- Rheumatology Department, Kasr Al Ainy School of Medicine, Cairo University, Cairo, Egypt
| | | | | | - Roberto Giacomelli
- Clinical Unit of Rheumatology, University of l'Aquila, School of Medicine, L'Aquila, Italy
| | - Marcos Vázquez
- Department of Rheumatology, Hospital de Clínicas, San Lorenzo, Paraguay
| | - Sandra Consani
- Internal Medicine, Hospital Maciel, and Universidad de la República (UdelaR), Montevideo, Uruguay
| | - Miriam Akasbi
- Department of Internal Medicine, Hospital Infanta Leonor, Madrid, Spain
| | - Hideki Nakamura
- Division of Hematology and Rheumatology, Department of Medicine, Nihon University School of Medicine, Oyaguchi Kami-cho, Itabashi-ku, Tokyo, Japan
| | - Antónia Szántó
- Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - A. Darise Farris
- Genes and Human Disease Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - Li Wang
- Department of Rheumatology and Immunology, The First Affiliated Hospital of USTC, University of Science and Technology of China(Anhui Provincial Hosipital), Hefei, China
| | - Thomas Mandl
- Department of Rheumatology, Skane University Hospital Malmö, Lund University, Lund, Sweden
| | - Angelica Gattamelata
- Department of Internal Medicine and Medical Specialties, Rheumatology Clinic, Sapienza University of Rome, Rome, Italy
| | - Levent Kilic
- Division of Rheumatology, Department of Internal Medicine, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | | | - Kerem Abacar
- Marmara University, School of Medicine, Istanbul, Turkey
| | - Abdurrahman Tufan
- Division of Rheumatology, Department of Internal Medicine, Gazi University School of Medicine, Ankara, Turkey
| | - Salvatore de Vita
- Clinic of Rheumatology, Department of Medical and Biological Sciences, University Hospital “Santa Maria della Misericordia”, Udine, Italy
| | - Hendrika Bootsma
- Department of Rheumatology & Clinical Immunology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Manuel Ramos-Casals
- Department of Autoimmune Diseases, ICMiD, Hospital Clínic, Barcelona, Spain
- Department of Medicine, University of Barcelona, Barcelona, Spain
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Brito-Zerón P, Pérez-Álvarez R, Ramos-Casals M. Reply. Med Clin (Barc) 2023; 160:278. [PMID: 36707372 DOI: 10.1016/j.medcli.2022.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 11/24/2022] [Accepted: 11/30/2022] [Indexed: 01/27/2023]
Affiliation(s)
- Pilar Brito-Zerón
- Research and Innovation Group in Autoimmune Diseases, Sanitas Digital Hospital, Hospital-CIMA-Centre Mèdic Millenium Balmes Sanitas, Barcelona, España; Línea de investigación de Sarcoidosis del Grupo de Enfermedades Autoinmunes Sistémicas (GEAS), Sociedad Española de Medicina Interna (SEMI), Madrid, España
| | - Roberto Pérez-Álvarez
- Línea de investigación de Sarcoidosis del Grupo de Enfermedades Autoinmunes Sistémicas (GEAS), Sociedad Española de Medicina Interna (SEMI), Madrid, España; Servicio de Medicina Interna, Hospital San Rafael, La Coruña, España
| | - Manuel Ramos-Casals
- Línea de investigación de Sarcoidosis del Grupo de Enfermedades Autoinmunes Sistémicas (GEAS), Sociedad Española de Medicina Interna (SEMI), Madrid, España; Servicio de Enfermedades Autoinmunes, Instituto Clínic de Medicina y Dermatología (ICMiD), Hospital Clínic, Barcelona, España; Departament de Medicina, Universitat de Barcelona, Barcelona, España.
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Abstract
In 1933, the Swedish ophthalmologist Hendrik Sjögren was the first to suggest that behind the dryness that several of his patients presented, there could be a systemic disease related to an abnormal immune response. Since then, the term Sjögren's syndrome (SjS) has been used and it has been considered a minor and infrequent disorder compared to other systemic autoimmune diseases (SAD) and, consequently, with little progress both in clinical and therapeutic research. The emergence of new technologies at the end of the 20th century rapidly promoted the development of international projects of great impact and diffusion, which have completely changed this scenario, and in the last 20 years significant progress has been made in understanding the main epidemiological determinants and pathogenic mechanisms to increase the diagnostic accuracy and to design specific and individualized therapeutic strategies. Currently, SjS should be considered one of the most frequent SADs with an undoubtedly systemic phenotype beyond dryness, in which the identification of prognostic factors can allow personalized follow-up and, therefore, early therapeutic interventions that avoid severe, irreversible outcomes.
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Affiliation(s)
- Pilar Brito-Zerón
- Research and Innovation Group in Autoimmune Diseases, Sanitas Digital Hospital, Hospital-CIMA-Centre Mèdic Milenium Balmes Sanitas, Barcelona, España; Línea de investigación de Sjögren del Grupo de Enfermedades Autoinmunes Sistémicas (GEAS), Sociedad Española de Medicina Interna (SEMI), España
| | - Soledad Retamozo
- Línea de investigación de Sjögren del Grupo de Enfermedades Autoinmunes Sistémicas (GEAS), Sociedad Española de Medicina Interna (SEMI), España; Servicio de Reumatología, Hospital Universitari Parc Taulí, Sabadell, Barcelona, España; Servicio de Reumatología, Hospital Quirón Salud, Barcelona, España
| | - Manuel Ramos-Casals
- Línea de investigación de Sjögren del Grupo de Enfermedades Autoinmunes Sistémicas (GEAS), Sociedad Española de Medicina Interna (SEMI), España; Departament de Medicina, Universitat de Barcelona, Barcelona, España; Servicio de Enfermedades Autoinmunes, Institut Clínic de Medicina i Dermatologia (ICMiD), Hospital Clínic, Barcelona, España.
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8
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Flores-Chávez A, Brito-Zerón P, Retamozo S, Bitoun S, Fisher BA, Liew D, Suijkerbuijk K, Chatzidionysiou K, Suárez-Almazor M, Lambotte O, Mariette X, Ramos-Casals M. Using autoantibodies to diagnose systemic autoimmune diseases triggered by immune checkpoint inhibitors: a clinical perspective. Crit Rev Immunol 2023; 42:21-36. [PMID: 37022357 DOI: 10.1615/critrevimmunol.2023047272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Immunotherapies, such as immune checkpoint inhibitors (ICIs), have significantly advanced the treatment of cancer and other conditions. However, these therapies can also cause immune-related adverse events (irAEs), which are unintended side effects due to their effects on the immune system of the treated patient. These effects can be classified as organ-specific or systemic, with the latter being of particular interest due to their potential overlap with systemic autoimmune diseases (SADs). Autoantibodies, which are proteins produced by the immune system that react with self components, are often used to diagnose and classify SAD. However, the diagnostic value of autoantibodies in the context of systemic irAEs (sirAEs) triggered by ICIs is not well understood. This review aims to evaluate the diagnostic value of conventional autoantibodies in the identification and classification of sirAEs. A comprehensive search of the literature was conducted using the PubMed database, with a focus on articles published in the past 10 years. The results of the review suggest that, although autoantibodies can be useful in the diagnosis and classification of some SAD triggered by ICIs, there is a clear predominance of seronegative irAEs. The lack of traditional autoantibodies may suggest a unique mechanism for sirAEs and increases the already complex diagnostic approach of these manifestations, requiring evaluation by multidisciplinary teams with extensive experience in immunomediated diseases. Further research is needed to fully understand the diagnostic value of autoantibodies in this context and to determine the optimal approach for their detection and interpretation.
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Affiliation(s)
| | - Pilar Brito-Zerón
- Research and Innovation Group in Autoimmune Diseases, Sanitas Digital Hospital, Hospital-CIMA-Centre Mèdic Milenium Balmes Sanitas, Barcelona, Spain
| | - Soledad Retamozo
- Department of Rheumatology, Hospital Quirón Salud, Barcelona, Spain
| | - Samuel Bitoun
- Université Paris-Saclay, INSERM, UMR 1184, Department of Rheumatology, Assistance Publique - Hôpitaux de Paris, Hôpital Bicêtre, FHU CARE, Le Kremlin Bicêtre, France
| | - Benjamin A Fisher
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, United Kingdom; National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre and Department of Rheumatology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - David Liew
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia; Division of Rheumatology and Department of Clinical Pharmacology and Therapeutics, Austin Health, Heidelberg, Victoria, Australia
| | - Karijn Suijkerbuijk
- Department of Medical Oncology, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | | | - María Suárez-Almazor
- Department of Health Services Research and Section of Rheumatology and Clinical Immunology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Olivier Lambotte
- Université Paris-Saclay, INSERM, CEA, UMR 1184, Le Kremlin Bicêtre, France; Assistance Publique - Hôpitaux de Paris, Department of Internal Medicine and Clinical Immunology, Hôpital Bicêtre, Le Kremlin Bicêtre, France
| | - Xavier Mariette
- Université Paris-Saclay, INSERM, UMR 1184, Department of Rheumatology, Assistance Publique - Hôpitaux de Paris, Hôpital Bicêtre, FHU CARE, Le Kremlin Bicêtre, France
| | - Manuel Ramos-Casals
- Department of Autoimmune Diseases, ICMiD, Hospital Clínic, Barcelona, Spain; School of Medicine, Universitat de Barcelona, Spain
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9
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Hernández-Molina G, Kostov B, Brito-Zerón P, Vissink A, Mandl T, Hinrichs AC, Quartuccio L, Baldini C, Seror R, Szántó A, Isenberg D, Gerli R, Nordmark G, Rasmussen A, Solans-Laque R, Hofauer B, Sène D, Pasoto SG, Rischmueller M, Praprotnik S, Gheita TA, Danda D, Armağan B, Suzuki Y, Valim V, Devauchelle-Pensec V, Retamozo S, Kvarnstrom M, Sebastian A, Atzeni F, Giacomelli R, Carsons SE, Kwok SK, Nakamura H, Fernandes Moça Trevisani V, Flores-Chávez A, Mariette X, Ramos-Casals M. Characterization and outcomes of 414 patients with primary SS who developed haematological malignancies. Rheumatology (Oxford) 2022; 62:243-255. [PMID: 35385104 DOI: 10.1093/rheumatology/keac205] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/28/2022] [Accepted: 03/24/2022] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To characterize 414 patients with primary SS who developed haematological malignancies and to analyse how the main SS- and lymphoma-related features can modify the presentation patterns and outcomes. METHODS By January 2021, the Big Data Sjögren Project Consortium database included 11 966 patients fulfilling the 2002/2016 classification criteria. Haematological malignancies diagnosed according to the World Health Organization (WHO) classification were retrospectively identified. RESULTS There were 414 patients (355 women, mean age 57 years) with haematological malignancies (in 43, malignancy preceded at least one year the SS diagnosis). A total of 376 (91%) patients had mature B-cell malignancy, nearly half had extranodal marginal zone lymphoma (MZL) of mucosa-associated lymphoid tissue (MALT lymphoma) (n = 197), followed by diffuse large B-cell lymphoma (DLBCL) (n = 67), nodal MZL lymphoma (n = 29), chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) (n = 19) and follicular lymphoma (FL) (n = 17). Rates of complete response, relapses and death were 80%, 34% and 13%, respectively, with a 5-year survival rate of 86.5% after a mean follow-up of 8 years. There were significant differences in age at diagnosis (younger in MALT, older in CLL/SLL), predominant clinical presentation (glandular enlargement in MALT lymphoma, peripheral lymphadenopathy in nodal MZL and FL, constitutional symptoms in DLBCL, incidental diagnosis in CLL/SLL), therapeutic response (higher in MALT lymphoma, lower in DLBCL) and survival (better in MALT, nodal MZL and FL, worse in DLBCL). CONCLUSION In the largest reported study of haematological malignancies complicating primary SS, we confirm the overwhelming predominance of B-cell lymphomas, especially MALT, with the salivary glands being the primary site of involvement. This highly-specific histopathological scenario is linked with the overall good prognosis with a 5-year survival rate of nearly 90%.
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Affiliation(s)
- Gabriela Hernández-Molina
- Immunology and Rheumatology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Belchin Kostov
- Primary Healthcare Transversal Research Group, IDIBAPS.,Department of Statistics and Operations Research, Universitat Politècnica de Catalunya (UPC)
| | - Pilar Brito-Zerón
- Department of Medicine, Autoimmune Diseases Unit, Hospital CIMA- Sanitas, Barcelona, Spain
| | - Arjan Vissink
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Thomas Mandl
- Department of Clinical Sciences Malmö, Division of Rheumatology, Lund University, Malmö, Sweden
| | - Anneline C Hinrichs
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Luca Quartuccio
- Clinic of Rheumatology, Department of Medicine (DAME), University of Udine, ASU FC, Udine
| | | | - Raphaele Seror
- Rheumatology Department, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Paris-Sud - Hôpital Bicêtre, Paris-Saclay University, INSERM UMR1184: Centre for Immunology of Viral Infections and Autoimmune Diseases, Le Kremlin-Bicêtre, France
| | - Antonia Szántó
- Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - David Isenberg
- Centre for Rheumatology, Division of Medicine, University College London, London, UK
| | - Roberto Gerli
- Rheumatology Unit, Department of Medicine & Surgery, University of Perugia, Perugia, Italy
| | - Gunnel Nordmark
- Rheumatology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Astrid Rasmussen
- Genes and Human Disease Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - Roser Solans-Laque
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, Hospital Vall d'Hebron, Barcelona, Spain
| | - Benedikt Hofauer
- Otorhinolaryngology/Head and Neck Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich,Germany
| | - Damien Sène
- Université de Paris, Departement of Internal Medicine, Hôpital Lariboisière, Assistance Publique- Hôpitaux de Paris, Paris, France
| | - Sandra G Pasoto
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Maureen Rischmueller
- Department of Rheumatology, The Queen Elizabeth Hospital, Discipline of Medicine, University of Adelaide, Adelaide, Australia
| | - Sonja Praprotnik
- Department of Rheumatology, University Medical Centre, Ljubljana, Slovenia
| | - Tamer A Gheita
- Rheumatology Department, Kasr Al Ainy School of Medicine, Cairo University, Cairo, Egypt
| | - Debashish Danda
- Department of Clinical Immunology & Rheumatology, Christian Medical College & Hospital, Vellore, India
| | - Berkan Armağan
- Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Yasunori Suzuki
- Division of Rheumatology, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan
| | - Valeria Valim
- Department of Medicine, Federal University of Espírito Santo, Vitória, Brazil
| | | | - Soledad Retamozo
- Rheumatology Department, Hospital Universitari Parc Taulí, Sabadell, Barcelona, Spain.,Instituto Modelo de Cardiología Privado SRL, Córdoba, Argentina.,Instituto Universitario de Ciencias Biomédicas de Córdoba (IUCBC), Córdoba, Argentina
| | - Marika Kvarnstrom
- Division of Rheumatology, Department of Medicine, Karolinska Institutet, Karolinska University Hospital.,Academic Specialist Center, Center for Rheumatology, Stockholm Health Services, Stockholm, Sweden
| | - Agata Sebastian
- Department of Rheumatology and Internal Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Fabiola Atzeni
- IRCCS Galeazzi Orthopaedic Institute, Milan and Rheumatology Unit, University of Messina, Messina
| | - Roberto Giacomelli
- Department of Clinical Immunology and Rheumatology, School of Medicine, University of Rome 'Campus Biomedico', Rome, Italy
| | - Steven E Carsons
- Division of Rheumatology, Allergy and Immunology, NYU Long Island School of Medicine, Mineola, NY, USA
| | - Seung-Ki Kwok
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Hideki Nakamura
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | | | | | - Xavier Mariette
- Rheumatology Department, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Paris-Sud - Hôpital Bicêtre, Paris-Saclay University, INSERM UMR1184: Centre for Immunology of Viral Infections and Autoimmune Diseases, Le Kremlin-Bicêtre, France
| | - Manuel Ramos-Casals
- Department of Diseases, ICMiD.,Department of Medicine, University of Barcelona, Hospital Clinic, Barcelona, Spain
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Flores-Chavez A, Ng WF, Alunno A, Inanc N, Feijoo-Massó C, Seror R, Hernandez-Molina G, Devauchelle-Pensec V, Hofauer B, Pasoto SG, Robles A, Akasbi M, López-Dupla M, Retamozo S, Bandeira M, Romão VC, Carubbi F, Loaiza-Cabello D, García-Morillo JS, Benegas M, Sánchez M, Muxí Á, Fuster D, Sellarés J, Mariette X, Ramos-Casals M, Brito-Zéron P. Characterisation of the coexistence between sarcoidosis and Sjögren's syndrome. Analysis of 43 patients. Clin Exp Rheumatol 2022; 40:2329-2337. [DOI: 10.55563/clinexprheumatol/pg964c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 08/26/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Alejandra Flores-Chavez
- Sjögren Syndrome Research Group, GRESS-AGAUR, Barcelona; Department of Autoimmune Diseases, ICMiD, Hospital Clínic, Barcelona, and University of Barcelona, Spain.
| | - Wan-Fai Ng
- The United Kingdom Primary Sjögren's Syndrome Registry, UK
| | - Alessia Alunno
- Department of Life, Health & Environmental Sciences, University of L'Aquila and Internal Medicine and Nephrology Unit, Department of Medicine, ASL Avezzano-Sulmona-L'Aquila, San Salvatore Hospital, L'Aquila, Italy
| | - Nevsun Inanc
- Marmara University, School of Medicine, Istanbul, Turkey
| | | | | | - Gabriela Hernandez-Molina
- Immunology and Rheumatology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de Mexico, Mexico
| | | | | | - Sandra G. Pasoto
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Facultades de Medicina da Universidade de São Paulo, Brazil
| | - Angel Robles
- Internal Medicine, Hospital La Paz, Madrid, Spain
| | - Miriam Akasbi
- Department of Internal Medicine, Hospital Infanta Leonor, Madrid, Spain
| | - Miguel López-Dupla
- Department of Internal Medicine, Hospital Universitari Joan XXIII, Tarragona, Spain
| | | | - Matilde Bandeira
- Rheumatology Department, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa (CAML), Lisboa, and Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, CAML, Lisboa, Portugal
| | - Vasco C. Romão
- Rheumatology Department, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa (CAML), Lisboa, and Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, CAML, Lisboa, Portugal
| | - Francesco Carubbi
- Department of Life, Health & Environmental Sciences, University of L'Aquila and Internal Medicine and Nephrology Unit, Department of Medicine, ASL Avezzano-Sulmona-L'Aquila, San Salvatore Hospital, L'Aquila, Italy
| | - Daniel Loaiza-Cabello
- Systemic Autoimmune and Rare Diseases Unit, Internal Medicine Department, Hospital Virgen del Rocio, Seville, Spain
| | - Jóse-Salvador García-Morillo
- Systemic Autoimmune and Rare Diseases Unit, Internal Medicine Department, Hospital Virgen del Rocio, Seville, Spain
| | - Mariana Benegas
- Radiology Department, Centre de Diagnòstic per la Imatge Clínic, Hospital Clínic of Barcelona, Spain
| | - Marcelo Sánchez
- Radiology Department, Centre de Diagnòstic per la Imatge Clínic, Hospital Clínic of Barcelona, Spain
| | - África Muxí
- Department of Nuclear Medicine, University of Barcelona, Hospital Clínic, Barcelona, Spain
| | - David Fuster
- Department of Nuclear Medicine, University of Barcelona, Hospital Clínic, Barcelona, Spain
| | - Jacobo Sellarés
- Respiratory Institute, Hospital Clínic, University of Barcelona, Spain
| | | | - Manuel Ramos-Casals
- Sjögren Syndrome Research Group, GRESS-AGAUR, Barcelona; Department of Autoimmune Diseases, ICMiD, Hospital Clínic, Barcelona, and University of Barcelona, Spain
| | - Pilar Brito-Zéron
- Research and Innovation Group in Autoimmune Diseases, Milenium Balmes-Hospital CIMA Sanitas, Barcelona, Spain
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11
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Goules AV, Pringle S, Ramos-Casals M, Tzioufas AG. Pathophysiology of Sjögren's-like syndrome induced by cancer immunotherapies: similarities and differences with classical Sjögren's syndrome. Clin Exp Rheumatol 2022; 40:2237-2239. [PMID: 36226611 DOI: 10.55563/clinexprheumatol/v9zras] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 09/19/2022] [Indexed: 01/26/2023]
Affiliation(s)
- Andreas V Goules
- Department of Pathophysiology,School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Sarah Pringle
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Manuel Ramos-Casals
- Department of Autoimmune Diseases, ICMiD, University of Barcelona, Hospital Clínic, Barcelona, Spain
| | - Athanasios G Tzioufas
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Greece.
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12
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Inanc N, Kostov B, Priori R, Flores-Chavez A, Carubbi F, Szántó A, Valim V, Bootsma H, Praprotnik S, Fernandes Moça Trevisani V, Hernández-Molina G, Hofauer B, Pasoto SG, López-Dupla M, Bartoloni E, Rischmueller M, Devauchelle-Pensec V, Abacar K, Giardina F, Alunno A, Fanny Horváth I, de Wolff L, Caldas L, Retamozo S, Ramos-Casals M, Brito-Zerón P. Safety and efficacy of SARS-CoV-2 vaccination in 1237 patients with primary Sjögren syndrome. Clin Exp Rheumatol 2022; 40:2290-2297. [PMID: 36441656 DOI: 10.55563/clinexprheumatol/dt6klo] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 08/02/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To investigate the safety and efficacy of SARS-Cov-2 vaccination in patients with primary Sjögren syndrome (pSS) due to scarcity of data in this population. METHODS By the first week of May 2021, all Big Data SS Consortium centres patients who had received at least one dose of any SARS-CoV-2 vaccine were included in the study. The in-charge physician asked patients about local and systemic reactogenicity to collect SARS-CoV-2 vaccination data. RESULTS The vaccination data of 1237 patients were received. A total of 835 patients (67%) reported any adverse events (AEs), including local (53%) and systemic (50%) AEs. Subjective symptoms (63%) were the most common local AEs, followed by objective signs at the injection site (16%), and general symptoms were the most commonly reported systemic AEs (46%), followed by musculoskeletal (25%), gastrointestinal (9%), cardiopulmonary (3%), and neurological (2%). In addition, 141 (11%) patients reported a significant worsening/exacerbation of their pre-vaccination sicca symptoms and fifteen (1.2%) patients reported active involvement in the glandular (n=7), articular (n=7), cutaneous (n=6), pulmonary (n=2), and peripheral nervous system (n=1) domains due to post-vaccination SS flares. In terms of vaccination efficacy, breakthrough SARS-CoV-2 infection was confirmed after vaccination in three (0.24 %) patients, and positive anti-SARS-Cov-2 antibodies were detected in approximately 95% of vaccinated SS patients, according to data available. CONCLUSIONS Our data suggest that patients with pSS develop adequate humoral response and no severe AEs after SARS-CoV-2 vaccination and therefore raise no concerns about the vaccine's efficacy or safety profile in this population.
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Affiliation(s)
- Nevsun Inanc
- Marmara University, School of Medicine, Istanbul, Turkey
| | - Belchin Kostov
- Primary Care Centre Les Corts, Consorci d'Atenció Primària de Salut Barcelona Esquerra (CAPSBE), Barcelona, Spain
| | - Roberta Priori
- Department of Internal Medicine and Medical Specialties, Rheumatology Clinic, Sapienza University of Rome, and Saint Camillus International University of Health Science, UniCamillus, Rome, Italy
| | - Alejandra Flores-Chavez
- Department of Autoimmune Diseases, ICMiD, Hospital Clínic, Barcelona, Spain, and Consejo Nacional de Ciencia y Tecnología (CONACYT), Mexico
| | - Francesco Carubbi
- Department of Life, Health & Environmental Sciences, University of L'Aquila and Internal Medicine and Nephrology Unit, Department of Medicine, ASL Avezzano-Sulmona-L'Aquila, San Salvatore Hospital, L'Aquila, Italy
| | - Antónia Szántó
- Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Hungary
| | - Valeria Valim
- Department of Medicine, Federal University of Espírito Santo, Vitória, Brazil
| | - Hendrika Bootsma
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Centre Groningen, the Netherlands
| | - Sonja Praprotnik
- Department of Rheumatology, University Medical Centre, Ljubljana, Slovenia
| | | | - Gabriela Hernández-Molina
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Benedikt Hofauer
- Otorhinolaryngology, Head and Neck Surgery, Klinikum rechts der Isar, Technical University of Munich, Germany
| | - Sandra G Pasoto
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - Miguel López-Dupla
- Department of Internal Medicine, Hospital Universitari Joan XXIII, Tarragona, Spain
| | - Elena Bartoloni
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Italy
| | - Maureen Rischmueller
- Department of Rheumatology, The Queen Elizabeth Hospital, Discipline of Medicine, University of Adelaide, SA, Australia
| | | | - Kerem Abacar
- Marmara University, School of Medicine, Istanbul, Turkey
| | - Federico Giardina
- Department of Internal Medicine and Medical Specialties, Rheumatology Clinic, Sapienza University of Rome, and Saint Camillus International University of Health Science, UniCamillus, Rome, Italy
| | - Alessia Alunno
- Department of Life, Health & Environmental Sciences, University of L'Aquila and Internal Medicine and Nephrology Unit, Department of Medicine, ASL Avezzano-Sulmona-L'Aquila, San Salvatore Hospital, L'Aquila, Italy
| | - Ildikó Fanny Horváth
- Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Hungary
| | - Liseth de Wolff
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Centre Groningen, the Netherlands
| | | | - Soledad Retamozo
- Grup de Recerca Consolidat en la Síndrome de Sjögren (GRESS), Agència de Gestió d'Ajuts Universitaris i de Recerca (AGAUR), Generalitat de Catalunya, Spain
| | - Manuel Ramos-Casals
- Department of Autoimmune Diseases, ICMiD, Hospital Clínic, Barcelona; Grup de Recerca Consolidat en la Síndrome de Sjögren (GRESS), Agència de Gestió d'Ajuts Universitaris i de Recerca (AGAUR), Generalitat de Catalunya, Spain; and Department of Medicine, University of Barcelona, Spain.
| | - Pilar Brito-Zerón
- Grup de Recerca Consolidat en la Síndrome de Sjögren (GRESS), Agència de Gestió d'Ajuts Universitaris i deRecerca (AGAUR), Generalitat de Catalunya, and Research and Innovation Group in Autoimmune Diseases, Sanitas Digital Hospital, Hospital-CIMA-Centre Mèdic Milenium Balmes Sanitas, Barcelona, Spain
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Almeida-Brasil CC, Hanly JG, Urowitz M, Clarke AE, Ruiz-Irastorza G, Gordon C, Ramsey-Goldman R, Petri MA, Ginzler EM, Wallace DJ, Bae SC, Romero-Diaz J, Dooley MA, Peschken C, Isenberg D, Rahman A, Manzi S, Jacobsen S, Lim SS, van Vollenhoven R, Nived O, Jönsen A, Kamen DL, Aranow C, Sánchez-Guerrero J, Gladman DD, Fortin PR, Alarcon GS, Merrill JT, Kalunian K, Ramos-Casals M, Steinsson K, Zoma A, Askanase AD, Khamashta M, Bruce IN, Inanc M, Lukusa L, Bernatsky S. Retinal toxicity in a multinational inception cohort of patients with systemic lupus on hydroxychloroquine. Lupus Sci Med 2022; 9:9/1/e000789. [PMID: 36396267 PMCID: PMC9677013 DOI: 10.1136/lupus-2022-000789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 10/17/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate hydroxychloroquine (HCQ)-related retinal toxicity in the Systemic Lupus International Collaborating Clinics (SLICC) inception cohort. METHODS Data were collected at annual study visits between 1999 and 2019. We followed patients with incident SLE from first visit on HCQ (time zero) up to time of retinal toxicity (outcome), death, loss-to-follow-up or end of study. Potential retinal toxicity was identified from SLICC Damage Index scores; cases were confirmed with chart review. Using cumulative HCQ duration as the time axis, we constructed univariate Cox regression models to assess if covariates (ie, HCQ daily dose/kg, sex, race/ethnicity, age at SLE onset, education, body mass index, renal damage, chloroquine use) were associated with HCQ-related retinal toxicity. RESULTS We studied 1460 patients (89% female, 52% white). Retinal toxicity was confirmed in 11 patients (incidence 1.0 per 1000 person-years, 0.8% overall). Average cumulative time on HCQ in those with retinal toxicity was 7.4 (SD 3.2) years; the first case was detected 4 years after HCQ initiation. Risk of retinal toxicity was numerically higher in older patients at SLE diagnosis (univariate HR 1.05, 95% CI 1.01 to 1.09). CONCLUSIONS This is the first assessment of HCQ and retinal disease in incident SLE. We did not see any cases of retinopathy within the first 4 years of HCQ. Cumulative HCQ may be associated with increased risk. Ophthalmology monitoring (and formal assessment of cases of potential toxicity, by a retinal specialist) remains important, especially in patients on HCQ for 10+ years, those needing higher doses and those of older age at SLE diagnosis.
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Affiliation(s)
- Celline C Almeida-Brasil
- Centre for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
| | - John G Hanly
- Rheumatology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Murray Urowitz
- Schroeder Arthritis Institute, Krembil Research Institute, Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Ann Elaine Clarke
- Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Guillermo Ruiz-Irastorza
- Autoimmune Diseases Research Unit, Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
| | - Caroline Gordon
- Rheumatology Research Group, University of Birmingham, Birmingham, UK
| | | | - Michelle A Petri
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ellen M Ginzler
- Medicine/Rheumatology, SUNY Downstate Medical Center, New York, New York, USA
| | - Daniel J Wallace
- Cedars-Sinai/David Geffen School of Medicine at UCLA, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Sang-Cheol Bae
- Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Hanyang University Institute for Rheumatology and Hanyang University Institute of Bioscience and Biotechnology, Seoul, Korea
| | - Juanita Romero-Diaz
- Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Mary-Anne Dooley
- Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - David Isenberg
- Medicine (Rheumatology), University College London, London, UK
| | - Anisur Rahman
- Medicine (Rheumatology), University College London, London, UK
| | - Susan Manzi
- Allegheny Singer Research Institute, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Søren Jacobsen
- Copenhagen Lupus and Vasculitis Clinic, Copenhagen University Hospital Center for Rheumatology and Spine Diseases, Copenhagen, Denmark
| | - S Sam Lim
- School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Ronald van Vollenhoven
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands
| | - Ola Nived
- Department of Clinical Science, Rheumatology, Lund University Faculty of Medicine, Lund, Sweden
| | - Andreas Jönsen
- Department of Clinical Science, Rheumatology, Lund University Faculty of Medicine, Lund, Sweden
| | - Diane L Kamen
- Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Cynthia Aranow
- Autoimmune and Musculoskeletal Disease, Feinstein Institute for Medical Research Fertility Research Laboratory, Manhasset, New York, USA
| | - Jorge Sánchez-Guerrero
- Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Dafna D Gladman
- Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Paul R Fortin
- Medicine-Rheumatology, Universite Laval, Quebec, Quebec, Canada
| | - Graciela S Alarcon
- Medicine, Division of Clinical Immunology and Rheumatology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Joan T Merrill
- Arthritis & Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
| | - Kenneth Kalunian
- Division of Rheumatology, Allergy and Immunology, University of California San Diego, La Jolla, California, USA
| | - Manuel Ramos-Casals
- Department of Autoimmune Diseases, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Kristjan Steinsson
- Rheumatology, Department of Obstetrics and Gynecology, Landspitali University Hospital, Reyjavik, Iceland
| | - A Zoma
- Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, UK
| | - Anca D Askanase
- Rheumatology, Columbia University Medical Center, New York, New York, USA
| | | | - Ian N Bruce
- Arc Epidemiology Unit, The University of Manchester, Manchester, UK
| | - Murat Inanc
- Internal Medicine Rheumatology, Istanbul University, Fatih, Istanbul, Turkey
| | - Luck Lukusa
- Centre for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
| | - Sasha Bernatsky
- Centre for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre, Montreal, Québec, Canada .,Division of Rheumatology, McGill University Health Centre, Montreal, Quebec, Canada
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14
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Ramos-Casals M, Flores-Chávez A, Brito-Zerón P, Lambotte O, Mariette X. Immune-related adverse events of cancer immunotherapies targeting kinases. Pharmacol Ther 2022; 237:108250. [DOI: 10.1016/j.pharmthera.2022.108250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 07/07/2022] [Accepted: 07/11/2022] [Indexed: 11/25/2022]
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Abstract
Sarcoidosis is a systemic autoimmune disease that is associated with the development of non-caseating granulomas. The disease especially affects the lymph nodes, lungs, skin and eyes. It is an infrequent but not rare disease, especially in northern Europe, the United States and India. Sarcoidosis affects more women and is diagnosed between the ages of 30 and 50. Etiopathogenically, it is closely linked to environmental factors, especially occupational exposures. Clinically, it stands out for a wide variety of presentation phenotypes (casual diagnosis, involvement of a single organ or systemic presentation). The diagnosis of sarcoidosis is complex and requires the integration of clinical, analytical, radiological, and histolopathogical data carried out by multidisciplinary clinical units. The evolution of the disease is variable, as is the indication for systemic treatment, based on the use of corticosteroids as first-line option, the use of immunosuppressants as second-line therapy, and anti-TNF agents in severe and/or refractory cases.
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Affiliation(s)
- Pilar Brito-Zerón
- Research and Innovation Group in Autoimmune Diseases, Sanitas Digital Hospital, Hospital-CIMA-Centre Mèdic Millenium Balmes Sanitas, Barcelona, España; Línea de Investigación en Sarcoidosis del GEAS, Sociedad Española de Medicina Interna (SEMI), Madrid, España
| | - Roberto Pérez-Álvarez
- Línea de Investigación en Sarcoidosis del GEAS, Sociedad Española de Medicina Interna (SEMI), Madrid, España; Servicio de Medicina Interna, Hospital San Rafael, La Coruña, España
| | - Manuel Ramos-Casals
- Línea de Investigación en Sarcoidosis del GEAS, Sociedad Española de Medicina Interna (SEMI), Madrid, España; Servicio de Enfermedades Autoinmunes, ICMiD, Hospital Clínic, Barcelona, España; Departament de Medicina, Universtat de Barcelona, Barcelona, España.
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16
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Brito-Zerón P, Retamozo S, Flores-Chávez A, Akasbi M, Sisó-Almirall A, Ramos-Casals M. Practical diagnostic tips for the Sjögren Clinic: pearls, myths and mistakes. Clin Exp Rheumatol 2022; 40:2413-2427. [DOI: 10.55563/clinexprheumatol/3bvq48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 08/02/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Pilar Brito-Zerón
- Research and Innovation Group in Autoimmune Diseases, Sanitas Digital Hospital, Hospital-CIMA-Centre Mèdic Millenium Balmes Sanitas, Barcelona, and Grup de Recerca Consolidat en la Síndrome de Sjögren (GRESS), Agència de Gestió d’Ajuts Universitaris i de Recerca (AGAUR), Generalitat de Catalunya, Spain
| | - Soledad Retamozo
- Grup de recerca consolidat en la síndrome de Sjögren (GRESS), Agència de Gestió d’Ajuts Universitaris i de Recerca (AGAUR), Generalitat de Catalunya, Spain
| | - Alejandra Flores-Chávez
- Department of Autoimmune Diseases, ICMiD, Hospital Clínic, Barcelona, Spain, and Consejo Nacional de Ciencia y Tecnología (CONACYT), México DF, México
| | - Miriam Akasbi
- Department of Internal Medicine, Hospital Infanta Leonor, Madrid, Spain
| | - Antoni Sisó-Almirall
- Primary Care Centre Les Corts, Consorci d’Atenció Primària de Salut Barcelona Esquerra (CAPSBE), Barcelona; Primary Healthcare Transversal Research Group, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, and Department of Medicine, University of Barcelona, Spain
| | - Manuel Ramos-Casals
- Grup de Recerca Consolidat en la Síndrome de Sjögren (GRESS), Agència de Gestió d’Ajuts Universitaris i de Recerca (AGAUR), Generalitat de Catalunya; Department of Autoimmune Diseases, ICMiD, Hospital Clínic, Barcelona, and Department of Medicine, University of Barcelona, Spain.
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17
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Casadó-Llombart S, Gheitasi H, Ariño S, Consuegra-Fernández M, Armiger-Borràs N, Kostov B, Ramos-Casals M, Brito-Zerón P, Lozano F. Gene Variation at Immunomodulatory and Cell Adhesion Molecules Loci Impacts Primary Sjögren's Syndrome. Front Med (Lausanne) 2022; 9:822290. [PMID: 35372412 PMCID: PMC8971656 DOI: 10.3389/fmed.2022.822290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 02/16/2022] [Indexed: 11/24/2022] Open
Abstract
Primary Sjögren's syndrome (pSS) is an autoimmune disease triggered by a combination of environmental and host genetic factors, which results in the focal lymphocytic infiltration of exocrine glands causing eye and mouth dryness. Glandular infiltrates include T and B cell subsets positive for CD5 and/or CD6, two surface scavenger receptors involved in the fine-tuning of intracellular signals mediated by the antigen-specific receptor complex of T (TCR) and B (BCR) cells. Moreover, the epithelial cells of inflamed glands overexpress CD166/ALCAM, a CD6 ligand involved in homo and heterotypic cell adhesion interactions. All this, together with the reported association of functionally relevant single nucleotide polymorphisms (SNPs) of CD5, CD6, and CD166/ALCAM with the risk or prognosis of some immune-mediated inflammatory disorders, led us to investigate similar associations in a local cohort of patients with pSS. The logistic regression analyses of individual SNPs showed the association of CD5 rs2241002T with anti-Ro/La positivity, CD6 rs17824933C with neutropenia, and CD6 rs11230563T with increased leukopenia and neutropenia but decreased peripheral nervous system EULAR Sjögren's syndrome disease activity index (ESSDAI). Further analyses showed the association of haplotypes from CD5 (rs2241002T-rs2229177C) with anemia and thrombocytopenia, CD6 (rs17824933G-rs11230563C-rs12360861G) with cutaneous ESSDAI, and CD166/ALCAM (rs6437585C-rs579565A-rs1044243C and rs6437585C-rs579565G-rs1044243T) with disease susceptibility and several analytical parameters (anti-nuclear antibodies, neurological ESSDAI, and hematologic cytopenias). These results support the relevance of gene variation at loci coding for cell surface receptors involved in the modulation of T and B lymphocyte activation (CD5, CD6) and epithelial-immune cell adhesion (CD166/ALCAM) in modulating the clinical and analytical outcomes in patients with pSS.
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Affiliation(s)
- Sergi Casadó-Llombart
- Immunoreceptors del Sistema Innat i Adaptatiu, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Hoda Gheitasi
- Department of Autoimmune Diseases, ICMiD, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Silvia Ariño
- Immunoreceptors del Sistema Innat i Adaptatiu, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Marta Consuegra-Fernández
- Immunoreceptors del Sistema Innat i Adaptatiu, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Noelia Armiger-Borràs
- Immunoreceptors del Sistema Innat i Adaptatiu, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Belchin Kostov
- Primary Care Centre Les Corts, Consorci d'Atenció Primària de Salut Barcelona Esquerra (CAPSBE), Barcelona, Spain
- Primary Healthcare Transversal Research Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Department of Statistics and Operations Research, Universitat Politècnica de Catalunya (UPC), Barcelona, Spain
| | - Manuel Ramos-Casals
- Department of Autoimmune Diseases, ICMiD, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Pilar Brito-Zerón
- Research and Innovation Group in Autoimmune Diseases, RGAD-Sanitas Digital Hospital, Barcelona, Spain
- Systemic Autoimmune Diseases Unit, Internal Medicine, Millenium Clinic, Sanitas, Barcelona, Spain
- *Correspondence: Pilar Brito-Zerón
| | - Francisco Lozano
- Immunoreceptors del Sistema Innat i Adaptatiu, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Servei d'Immunologia, Centre de Diagnòstic Biomèdic, Hospital Clínic de Barcelona, Barcelona, Spain
- Departament de Biomedicina, Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain
- Francisco Lozano
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18
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Almeida-Brasil CC, Hanly JG, Urowitz M, Clarke AE, Ruiz-Irastorza G, Gordon C, Ramsey-Goldman R, Petri M, Ginzler EM, Wallace DJ, Bae SC, Romero-Diaz J, Dooley MA, Peschken C, Isenberg D, Rahman A, Manzi S, Jacobsen S, Lim S, van Vollenhoven RF, Nived O, Jönsen A, Kamen DL, Aranow C, Sanchez-Guerrero J, Gladman DD, Fortin PR, Alarcón GS, Merrill JT, Kalunian K, Ramos-Casals M, Steinsson K, Zoma A, Askanase A, Khamashta MA, Bruce IN, Inanc M, Abrahamowicz M, Bernatsky S. Flares after hydroxychloroquine reduction or discontinuation: results from the Systemic Lupus International Collaborating Clinics (SLICC) inception cohort. Ann Rheum Dis 2022; 81:370-378. [PMID: 34911705 PMCID: PMC8862090 DOI: 10.1136/annrheumdis-2021-221295] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 11/10/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To evaluate systemic lupus erythematosus (SLE) flares following hydroxychloroquine (HCQ) reduction or discontinuation versus HCQ maintenance. METHODS We analysed prospective data from the Systemic Lupus International Collaborating Clinics (SLICC) cohort, enrolled from 33 sites within 15 months of SLE diagnosis and followed annually (1999-2019). We evaluated person-time contributed while on the initial HCQ dose ('maintenance'), comparing this with person-time contributed after a first dose reduction, and after a first HCQ discontinuation. We estimated time to first flare, defined as either subsequent need for therapy augmentation, increase of ≥4 points in the SLE Disease Activity Index-2000, or hospitalisation for SLE. We estimated adjusted HRs (aHRs) with 95% CIs associated with reducing/discontinuing HCQ (vs maintenance). We also conducted separate multivariable hazard regressions in each HCQ subcohort to identify factors associated with flare. RESULTS We studied 1460 (90% female) patients initiating HCQ. aHRs for first SLE flare were 1.20 (95% CI 1.04 to 1.38) and 1.56 (95% CI 1.31 to 1.86) for the HCQ reduction and discontinuation groups, respectively, versus HCQ maintenance. Patients with low educational level were at particular risk of flaring after HCQ discontinuation (aHR 1.43, 95% CI 1.09 to 1.87). Prednisone use at time-zero was associated with over 1.5-fold increase in flare risk in all HCQ subcohorts. CONCLUSIONS SLE flare risk was higher after HCQ taper/discontinuation versus HCQ maintenance. Decisions to maintain, reduce or stop HCQ may affect specific subgroups differently, including those on prednisone and/or with low education. Further study of special groups (eg, seniors) may be helpful.
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Affiliation(s)
- Celline C Almeida-Brasil
- Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - John G Hanly
- Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Murray Urowitz
- Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Ann Elaine Clarke
- Divisions of Clinical Immunology/Allergy and Clinical Epidemiology, University of Calgary, Calgary, Alberta, Canada
| | | | - Caroline Gordon
- Rheumatology Research Group, University of Birmingham, Birmingham, UK
| | | | - Michelle Petri
- Rheumatology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ellen M Ginzler
- Medicine/Rheumatology, SUNY Downstate Medical Center, New York City, New York, USA
| | - D J Wallace
- Cedars-Sinai/David Geffen School of Medicine at UCLA, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Sang-Cheol Bae
- Rheumatology, Hanyang University, Seongdong-gu, Seoul, The Republic of Korea
| | - Juanita Romero-Diaz
- Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Ciudad de Mexico, Mexico
| | - Mary Anne Dooley
- Medicine, Unversity of North Carolina, Chapel Hill, North Carolina, USA
| | - Christine Peschken
- Division of Rheumatology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - David Isenberg
- Division of Medicine, University College London, London, UK
| | | | - Susan Manzi
- Allegheny Singer Research Institute, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Søren Jacobsen
- Copenhagen Lupus and Vasculitis Clinic, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Sam Lim
- School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Ronald F van Vollenhoven
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands
| | - Ola Nived
- Rheumatology, Lund University, Lund, Sweden
| | - Andreas Jönsen
- Faculty of Medicine, Department of Clinical Sciences Lund, Section of Rheumatology, Lund University, Lund, Sweden
| | - Diane L Kamen
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - Cynthia Aranow
- Northwell Health Feinstein Institutes for Medical Research Institute of Health Innovations and Outcomes Research, Manhasset, New York, USA
| | - Jorge Sanchez-Guerrero
- Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, Toronto, Ontario, Canada
| | | | - Paul R Fortin
- Medicine-Rheumatology, Université Laval, Quebec, Quebec, Canada
| | - Graciela S Alarcón
- Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham Center for Health Promotion, Birmingham, Alabama, USA
| | - Joan T Merrill
- Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
| | - Kenneth Kalunian
- Division of Rheumatology, Allergy and Immunology, University of California San Diego School of Medicine, La Jolla, California, USA
| | - Manuel Ramos-Casals
- Department of Autoimmune Diseases, Universitat de Barcelona, Barcelona, Catalunya, Spain
| | - Kristján Steinsson
- Rheumatology, Department of Obstetrics and Gynecology, Landspitali University Hospital, Reyjavik, Iceland
| | - Asad Zoma
- Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, South Lanarkshire, UK
| | - Anca Askanase
- Rheumatology, Columbia University Medical Center, New York, New York, USA
| | | | - Ian N Bruce
- Arc Epidemiology Unit, The University of Manchester, Manchester, UK
| | - Murat Inanc
- Department of Internal Medicine, Division of Rheumatology, Istanbul University, Fatih, Istanbul, Turkey
| | - Michal Abrahamowicz
- Department of Epidemiology Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Sasha Bernatsky
- Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Division of Rheumatology, McGill University Health Centre, Montreal, Quebec, Canada
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Abstract
Cryoglobulins are immunoglobulins that precipitate in vitro at temperatures below 37 ̊C. Cryoglobulin-associated disease is heterogeneous, as not all patients present with it, includes various syndromic presentations (vasculitis is the most common, hyperviscosity syndrome is more exceptional), and can be associated with acute clinical pictures with high mortality. Until the appearance of specific antiviral treatments, the main aetiology has been chronic HCV infection, and currently it is mainly associated with systemic autoimmune diseases, malignant neoplasms and cases with no identified aetiology (essential cryoglobulinemia). Treatment should be modulated according to the predominant etiopathogenesis (vasculitis or hyperviscosity), the severity of internal organ involvement and, especially, the associated underlying disease. Due to the complex aetiological, clinical and pathological scenario of cryoglobulinaemia, early recognition of the most common clinical presentations, a comprehensive clinical assessment of the different organs that may be affected, and multidisciplinary work led by a unit specialised in systemic autoimmune diseases is essential.
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Affiliation(s)
- Soledad Retamozo
- Servicio de Reumatología, Hospital Universitari Parc Taulí, Sabadell, Barcelona, España; Servicio de Reumatología, Hospital Quirón Salud, Barcelona, España
| | - Luca Quartuccio
- Departamento de Medicina, Reumatología, Universidad de Udine, Udine, Italia
| | - Manuel Ramos-Casals
- Servicio de Enfermedades Autoinmunes, ICMiD, Hospital Clínic, Barcelona, España; Departamento de Medicina, Universitad de Barcelona, Barcelona, España.
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20
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Drosos GC, Vedder D, Houben E, Boekel L, Atzeni F, Badreh S, Boumpas DT, Brodin N, Bruce IN, González-Gay MÁ, Jacobsen S, Kerekes G, Marchiori F, Mukhtyar C, Ramos-Casals M, Sattar N, Schreiber K, Sciascia S, Svenungsson E, Szekanecz Z, Tausche AK, Tyndall A, van Halm V, Voskuyl A, Macfarlane GJ, Ward MM, Nurmohamed MT, Tektonidou MG. EULAR recommendations for cardiovascular risk management in rheumatic and musculoskeletal diseases, including systemic lupus erythematosus and antiphospholipid syndrome. Ann Rheum Dis 2022; 81:768-779. [PMID: 35110331 DOI: 10.1136/annrheumdis-2021-221733] [Citation(s) in RCA: 96] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 01/05/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To develop recommendations for cardiovascular risk (CVR) management in gout, vasculitis, systemic sclerosis (SSc), myositis, mixed connective tissue disease (MCTD), Sjögren's syndrome (SS), systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS). METHODS Following European League against Rheumatism (EULAR) standardised procedures, a multidisciplinary task force formulated recommendations for CVR prediction and management based on systematic literature reviews and expert opinion. RESULTS Four overarching principles emphasising the need of regular screening and management of modifiable CVR factors and patient education were endorsed. Nineteen recommendations (eleven for gout, vasculitis, SSc, MCTD, myositis, SS; eight for SLE, APS) were developed covering three topics: (1) CVR prediction tools; (2) interventions on traditional CVR factors and (3) interventions on disease-related CVR factors. Several statements relied on expert opinion because high-quality evidence was lacking. Use of generic CVR prediction tools is recommended due to lack of validated rheumatic diseases-specific tools. Diuretics should be avoided in gout and beta-blockers in SSc, and a blood pressure target <130/80 mm Hg should be considered in SLE. Lipid management should follow general population guidelines, and antiplatelet use in SLE, APS and large-vessel vasculitis should follow prior EULAR recommendations. A serum uric acid level <0.36 mmol/L (<6 mg/dL) in gout, and disease activity control and glucocorticoid dose minimisation in SLE and vasculitis, are recommended. Hydroxychloroquine is recommended in SLE because it may also reduce CVR, while no particular immunosuppressive treatment in SLE or urate-lowering therapy in gout has been associated with CVR lowering. CONCLUSION These recommendations can guide clinical practice and future research for improving CVR management in rheumatic and musculoskeletal diseases.
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Affiliation(s)
- George C Drosos
- First Department of Propaedeutic Internal Medicine, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Daisy Vedder
- Reade, Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands
| | - Eline Houben
- Department of Internal Medicine, Northwest Clinics, Alkmaar, The Netherlands
| | - Laura Boekel
- Reade, Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands
| | - Fabiola Atzeni
- Rheumatology Unit, Department of Internal Medicine, University of Messina, Messina, Italy
| | - Sara Badreh
- EULAR Patient Research Partner, Brussels, Belgium
| | - Dimitrios T Boumpas
- 4th Department of Internal Medicine, "Attikon" University Hospital, Athens, Greece.,Joint Academic Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nina Brodin
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Huddinge, Sweden.,Department of Orthopaedics, Danderyd Hospital Corp, Stockholm, Sweden
| | - Ian N Bruce
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, University of Manchester, Manchester, UK.,NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Miguel Ángel González-Gay
- Rheumatology Division, Hospital Universitario Marqués de Valdecilla and University of Cantabria, Santander, Spain
| | - Søren Jacobsen
- Copenhagen Lupus and Vasculitis Clinic, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - György Kerekes
- Intensive Care Unit, Department of Medicine, University of Debrecen, Debrecen, Hungary
| | | | - Chetan Mukhtyar
- Rheumatology Department, Norfolk and Norwich University Hospital, Colney Lane, UK
| | - Manuel Ramos-Casals
- Department of Autoimmune Diseases, ICMiD, University of Barcelona, Hospital Clínic, Barcelona, Spain
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Karen Schreiber
- EMEUNET member, Danish Hospital for Rheumatic Diseases, Sonderburg, Denmark
| | - Savino Sciascia
- EMEUNET member, CMID-Nephrology, San Giovanni Bosco Hospital, University of Torino, Torino, Italy
| | - Elisabet Svenungsson
- Department of Medicine, Rheumatology Unit, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Zoltan Szekanecz
- Department of Rheumatology, University of Debrecen Faculty of Medicine, Debrecen, Hungary
| | - Anne-Kathrin Tausche
- Department of Rheumatology, University Clinic Carl Gustav Carus at the TU Dresden, Dresden, Germany
| | - Alan Tyndall
- Department of Rheumatology, University of Basel, Basel, Switzerland
| | - Vokko van Halm
- Department of Cardiology, Amsterdam University Medical Center, location VU University medical center, Amsterdam, The Netherlands
| | - Alexandre Voskuyl
- Department of Rheumatology and Clinical Immunology, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | | | - Michael M Ward
- Intramural Research Program, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Michael T Nurmohamed
- Reade, Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands.,Amsterdam University Medical Center, location VU University Medical Centre, Amsterdam, The Netherlands
| | - Maria G Tektonidou
- First Department of Propaedeutic Internal Medicine, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece .,Joint Academic Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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21
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Alunno A, Najm A, Machado PM, Bertheussen H, Burmester GRR, Carubbi F, De Marco G, Giacomelli R, Hermine O, Isaacs JD, Koné-Paut I, Magro-Checa C, McInnes IB, Meroni PL, Quartuccio L, Ramanan AV, Ramos-Casals M, Rodríguez Carrio J, Schulze-Koops H, Stamm TA, Tas SW, Terrier B, McGonagle DG, Mariette X. 2021 update of the EULAR points to consider on the use of immunomodulatory therapies in COVID-19. Ann Rheum Dis 2022; 81:34-40. [PMID: 34620584 PMCID: PMC8507408 DOI: 10.1136/annrheumdis-2021-221366] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 09/29/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To update the EULAR points to consider (PtCs) on the use of immunomodulatory therapies in COVID-19. METHODS According to the EULAR standardised operating procedures, a systematic literature review up to 14 July 2021 was conducted and followed by a consensus meeting of an international multidisciplinary task force. The new statements were consolidated by formal voting. RESULTS We updated 2 overarching principles and 12 PtC. Evidence was only available in moderate to severe and critical patients. Glucocorticoids alone or in combination with tocilizumab are beneficial in COVID-19 cases requiring oxygen therapy and in critical COVID-19. Use of Janus kinase inhibitors (baricitinib and tofacitinib) is promising in the same populations of severe and critical COVID-19. Anti-SARS-CoV-2 monoclonal antibodies and convalescent plasma may find application in early phases of the disease and in selected subgroups of immunosuppressed patients. There was insufficient robust evidence for the efficacy of other immunomodulators with further work being needed in relation to biomarker-based stratification for IL-1 therapy CONCLUSIONS: Growing evidence supports incremental efficacy of glucocorticoids alone or combined with tocilizumab/Janus kinase inhibitors in moderate to severe and critical COVID-19. Ongoing studies may unmask the potential application of other therapeutic approaches. Involvement of rheumatologists, as systemic inflammatory diseases experts, should be encouraged in clinical trials of immunomodulatory therapy in COVID-19.
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Affiliation(s)
- Alessia Alunno
- Internal Medicine and Nephrology Unit, Department of Life, Health & Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Aurélie Najm
- Institute of Infection, Immunity and Inflammation, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Pedro M Machado
- Centre for Rheumatology and Department of Neuromuscular Diseases, University College London, London, UK
- National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre (BRC), University College London Hospitals NHS Foundation Trust, London, UK
- Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
| | | | - Gerd-Rüdiger R Burmester
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Freie Universität und Humboldt-Universität Berlin, Berlin, Germany
| | - Francesco Carubbi
- Internal Medicine and Nephrology Unit, Department of Life, Health & Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Gabriele De Marco
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds & The NIHR Leeds Biomedical Research Centre, Chapel Allerton Hospital, Leeds, UK
| | - Roberto Giacomelli
- Rheumatology and Clinical Immunology Unit, University of Rome "Campus Biomedico" School of Medicine, Rome, Italy
| | - Olivier Hermine
- Department of Hematology, Hôpital Necker, Assistance Publique - Hôpitaux de Paris, Paris, France
- Institut Imagine, Université de Paris, INSERM UMR1183, Paris, France
| | - John D Isaacs
- Translational and Clinical Research Institute, Newcastle University and Musculoskeletal Unit, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Isabelle Koné-Paut
- Department of Paediatric Rheumatology, Reference Centre for Autoinflammatory Diseases and Amyloidosis (CEREMAIA), Bicêtre University Hospital, AP-HP, Le Kremlin-Bicetre, France
- University of Paris Sud Saclay, Paris, France
| | - César Magro-Checa
- Department of Rheumatology, Zuyderland Medical Centre Heerlen, Heerlen, Netherlands
| | - Iain B McInnes
- Institute of Infection, Immunity and Inflammation, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Pier Luigi Meroni
- Experimental Laboratory of Immunological and Rheumatologic Researches, Istituto Auxologico Italiano IRCCS, Milano, Italy
| | - Luca Quartuccio
- Department of Medicine, Rheumatology Clinic, University of Udine, ASUFC Udine, Udine, Italy
| | - A V Ramanan
- University Hospitals Bristol NHS Foundations Trust, Bristol, UK
- Translational Health Sciences, University of Bristol, Bristol, UK
| | - Manuel Ramos-Casals
- Department of Autoimmune Diseases, ICMiD, Laboratory of Autoimmune Diseases Josep Font, IDIBAPS-CELLEX, Department of Autoimmune Diseases, ICMiD, University of Barcelona, Hospital Clínic, Barcelona, Spain
| | - Javier Rodríguez Carrio
- Department of Functional Biology, Immunology Area, Faculty of Medicine, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), University of Oviedo, Oviedo, Spain
| | - Hendrik Schulze-Koops
- Division of Rheumatology and Clinical Immunology, Department of Internal Medicine IV, Ludwig-Maximilians University Munich, Munich, Germany
| | - Tanja A Stamm
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna and Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Wien, Austria
| | - Sander W Tas
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and immunology Center, Amsterdam University Medical Centres, AMC/University of Amsterdam, Amsterdam, Netherlands
| | - Benjamin Terrier
- Department of Internal Medicine, Cochin University Hospital, Paris, France; National Referral Centre for Systemic and Autoimmune Diseases, University Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Dennis G McGonagle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds & The NIHR Leeds Biomedical Research Centre, Chapel Allerton Hospital, Leeds, UK
| | - Xavier Mariette
- Department of Rheumatology, INSERM UMR1184, Le Kremlin Bicêtre, France
- Department of Rheumatology, Université Paris-Saclay, Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, INSERM UMR1184, Le Kremlin Bicêtre, France
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22
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Sisó-Almirall A, Meijer JM, Brito-Zerón P, Conangla L, Flores-Chavez A, González de Paz L, Bootsma H, Ramos-Casals M. Practical guidelines for the early diagnosis of Sjögren's syndrome in primary healthcare. Clin Exp Rheumatol 2021; 39 Suppl 133:197-205. [DOI: 10.55563/clinexprheumatol/pal3z7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 08/08/2021] [Indexed: 11/13/2022]
Affiliation(s)
- Antoni Sisó-Almirall
- Permanent Board of the Catalan Society of Family and Community Medicine (CAMFiC), Barcelona; Primary Care Centre Les Corts, Consorci d’Atenció Primària de Salut Barcelona Esquerra (CAPSBE), Barcelona; and Primary Healthcare Transversal Research Group, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
| | - Jiska M. Meijer
- General Practitioners Research Institute, Groningen, The Netherlands
| | - Pilar Brito-Zerón
- Autoimmune Diseases Unit, Department of Medicine, Hospital CIMA-Sanitas, Barcelona, and Department of Autoimmune Diseases, ICMiD, Hospital Clínic, Barcelona, Spain
| | - Laura Conangla
- Permanent Board of the Catalan Society of Family and Community Medicine (CAMFiC), Barcelona, Spain
| | - Alejandra Flores-Chavez
- Department of Autoimmune Diseases, ICMiD, Hospital Clínic, Barcelona, Spain, and Consejo Nacional de Ciencia y Tecnología (CONACYT), México DF, México
| | - Luís González de Paz
- Primary Care Centre Les Corts, Consorci d’Atenció Primària de Salut Barcelona Esquerra (CAPSBE), Barcelona, Spain
| | - Hendrika Bootsma
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Centre Groningen, the Netherlands
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23
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Ramos-Casals M, Sainz-de-la-Maza M, Muxí A. COVID-19 vaccination unveiling subclinical Sjögren's syndrome. Clin Exp Rheumatol 2021; 39 Suppl 133:228-229. [DOI: 10.55563/clinexprheumatol/u1v6z1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 07/26/2021] [Indexed: 11/13/2022]
Affiliation(s)
- Manuel Ramos-Casals
- Department of Autoimmune Diseases, ICMiD, Hospital Clinic, Barcelona, Spain.
| | | | - Africa Muxí
- Department of Nuclear Medicine, University of Barcelona, Hospital Clínic, Barcelona, Spain
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24
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Retamozo S, Acar-Denizli N, Horváth IF, Ng WF, Rasmussen A, Dong X, Li X, Baldini C, Olsson P, Priori R, Seror R, Gottenberg JE, Kruize AA, Hernandez-Molina G, Vissink A, Sandhya P, Armagan B, Quartuccio L, Sebastian A, Praprotnik S, Bartoloni E, Kwok SK, Kvarnstrom M, Rischmueller M, Soláns-Laqué R, Sene D, Pasoto SG, Suzuki Y, Isenberg DA, Valim V, Nordmark G, Nakamura H, Fernandes Moça Trevisani V, Hofauer B, Sisó-Almirall A, Giacomelli R, Devauchelle-Pensec V, Bombardieri M, Atzeni F, Hammenfors D, Maure B, Carsons SE, Gheita T, Sánchez-Berná I, López-Dupla M, Morel J, Inanç N, Fonseca-Aizpuru E, Morcillo C, Vollenweider C, Melchor S, Vázquez M, Díaz-Cuiza E, Consani-Fernández S, de-Miguel-Campo B, Szántó A, Bombardieri S, Gattamelata A, Hinrichs A, Sánchez-Guerrero J, Danda D, Kilic L, De Vita S, Wiland P, Gerli R, Park SH, Wahren-Herlenius M, Bootsma H, Mariette X, Ramos-Casals M, Brito-Zerón P. Influence of the age at diagnosis in the disease expression of primary Sjögren syndrome. Analysis of 12,753 patients from the Sjögren Big Data Consortium. Clin Exp Rheumatol 2021; 39 Suppl 133:166-174. [DOI: 10.55563/clinexprheumatol/egnd1i] [Citation(s) in RCA: 1] [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: 06/28/2021] [Accepted: 09/06/2021] [Indexed: 11/13/2022]
Affiliation(s)
- Soledad Retamozo
- Instituto Modelo de Cardiología Privado SRL, Córdoba, and Instituto Universitario de Ciencias Biomédicas de Córdoba (IUCBC), Argentina; and Rheumatology Department, Hospital Universitari Parc Taulí, Sabadell, Barcelona, Spain
| | - Nihan Acar-Denizli
- Department of Statistics and Operations Research, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Ildiko Fanny Horváth
- Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Hungary
| | - Wan-Fai Ng
- Institute of Cellular Medicine, Newcastle University, and NIHR Biomedical Research Centre, Newcastle Upon Tyne, UK
| | - Astrid Rasmussen
- Genes and Human Disease Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - Xu Dong
- Department of Rheumatology, Peking Union Medical College Hospital, Beijing, China
| | - Xiaomei Li
- Department of Rheumatology and Immunology, Anhui Provincial Hospital, Hefei, China
| | | | - Peter Olsson
- Department of Rheumatology, Skane University Hospital Malmö, Lund University, Sweden
| | - Roberta Priori
- Department of Internal Medicine and Medical Specialties, Rheumatology Clinic, Sapienza University of Rome, and Saint Camillus International University of Health Science, UniCamillus, Rome, Italy
| | - Raphaèle Seror
- Centre for Immunology of Viral Infections and Autoimmune Diseases, Assistance Publique – Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud, Le Kremlin-Bicêtre, Université Paris Sud, INSERM, Paris, France
| | - Jacques-Eric Gottenberg
- Department of Rheumatology, Strasbourg University Hospital, Université de Strasbourg, CNRS, Strasbourg, France
| | - Aike A. Kruize
- Department of Rheumatology and Clinical Immunology, University Medical Centre Utrecht, The Netherlands
| | - Gabriela Hernandez-Molina
- Immunology and Rheumatology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, Mexico
| | - Arjan Vissink
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Centre Groningen, the Netherlands
| | - Pulukool Sandhya
- Department of Clinical Immunology and Rheumatology, Christian Medical College and Hospital, Vellore, India
| | - Berkan Armagan
- Department of Internal Medicine, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Luca Quartuccio
- Clinic of Rheumatology, Department of Medical and Biological Sciences, University Hospital "Santa Maria della Misericordia", Udine, Italy
| | - Agata Sebastian
- Department of Rheumatology and Internal Medicine, Wroclaw Medical Hospital, Wroclaw, Poland
| | - Sonja Praprotnik
- Department of Rheumatology, University Medical Centre, Ljubljana, Slovenia
| | - Elena Bartoloni
- Rheumatology Unit, Department of Medicine, University of Perugia, Italy
| | - Seung-Ki Kwok
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Marika Kvarnstrom
- Department of Medicine, Solna, Division of Experimental Rheumatology, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden
| | - Maureen Rischmueller
- Department of Rheumatology, The Queen Elizabeth Hospital, Discipline of Medicine, University of Adelaide, South Australia, Australia
| | - Roser Soláns-Laqué
- Department of Internal Medicine, Hospital Vall d'Hebron, Barcelona, Spain
| | - Damien Sene
- Service de Médecine Interne 2, Hôpital Lariboisière, Université Paris VII, Assistance Publique-Hôpitaux de Paris 2, Paris, France
| | - Sandra G. Pasoto
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo, Brazil
| | - Yasunori Suzuki
- Division of Rheumatology, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan
| | - David A. Isenberg
- Centre for Rheumatology, Division of Medicine, University College London, UK
| | - Valéria Valim
- Department of Medicine, Federal University of Espírito Santo, Vitória, Brazil
| | - Gunnel Nordmark
- Rheumatology, Department of Medical Sciences, University of Uppsala, Sweden
| | - Hideki Nakamura
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | | | - Benedikt Hofauer
- Otorhinolaryngology, Head and Neck Surgery, Technical University Munich, Germany
| | - Antoni Sisó-Almirall
- Primary Care Centre Les Corts, Consorci d’Atenció Primària de Salut Barcelona Esquerra (CAPSBE), Barcelona, Spain
| | - Roberto Giacomelli
- Clinical Unit of Rheumatology, School of Medicine, University of l'Aquila, Italy
| | | | - Michele Bombardieri
- Centre for Experimental Medicine and Rheumatology, Queen Mary University of London, UK
| | - Fabiola Atzeni
- IRCCS Galeazzi Orthopaedic Institute, Milan and Rheumatology Unit, University of Messina, Italy
| | - Daniel Hammenfors
- Department of Clinical Science, University of Bergen, and Department of Rheumatology, Haukeland University Hospital, Bergen, Norway
| | - Brenda Maure
- Department of Internal Medicine, Complexo Hospitalario Universitario de Vigo, Spain
| | - Steven E. Carsons
- Division of Rheumatology, Allergy and Immunology, New York University Winthrop Hospital and NYU Langone Health, New York, NY, USA
| | - Tamer Gheita
- Rheumatology Department, Kasr Al Ainy School of Medicine, Cairo University, Cairo, Egypt
| | - Isabel Sánchez-Berná
- Department of Internal Medicine, Hospital Rey Juan Carlos de Móstoles, Madrid, Spain
| | | | - Jacques Morel
- Department of Rheumatology, Teaching Hospital and University of Montpellier, France
| | - Nevsun Inanç
- Marmara University, School of Medicine, Istanbul, Turkey
| | | | - César Morcillo
- Autoimmune Diseases Unit, Department of Medicine, Hospital CIMA- Sanitas, Barcelona, Spain
| | | | - Sheila Melchor
- Department of Rheumatology, Hospital 12 de Octubre, Madrid, Spain
| | - Marcos Vázquez
- Department of Rheumatology, Hospital de Clínicas, San Lorenzo, Paraguay
| | - Ericka Díaz-Cuiza
- Departamento de Reumatología del Seguro Social Universitario y consultorio privado de Reumatología, Sucre, Bolivia
| | - Sandra Consani-Fernández
- Internal Medicine, Hospital Maciel, and Universidad de la República (UdelaR), Montevideo, Uruguay
| | | | - Antónia Szántó
- Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Hungary
| | | | - Angelica Gattamelata
- Department of Internal Medicine and Medical Specialties, Rheumatology Clinic, Sapienza University of Rome, Italy
| | - Anneline Hinrichs
- Department of Rheumatology and Clinical Immunology, University Medical Centre Utrecht, The Netherlands
| | - Jorge Sánchez-Guerrero
- Immunology and Rheumatology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, Mexico
| | - Debashish Danda
- Department of Clinical Immunology and Rheumatology, Christian Medical College and Hospital, Vellore, India
| | - Levent Kilic
- Department of Internal Medicine, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Salvatore De Vita
- Clinic of Rheumatology, Department of Medical and Biological Sciences, University Hospital "Santa Maria della Misericordia", Udine, Italy
| | - Piotr Wiland
- Department of Rheumatology and Internal Medicine, Wroclaw Medical Hospital, Wroclaw, Poland
| | - Roberto Gerli
- Rheumatology Unit, Department of Medicine, University of Perugia, Italy
| | - Sung-Hwan Park
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Marie Wahren-Herlenius
- Department of Medicine, Solna, Division of Experimental Rheumatology, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden
| | - Hendrika Bootsma
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Centre Groningen, the Netherlands
| | - Xavier Mariette
- Centre for Immunology of Viral Infections and Autoimmune Diseases, Assistance Publique – Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud, Le Kremlin-Bicêtre, Université Paris Sud, INSERM, Paris, France
| | - Manuel Ramos-Casals
- Department of Autoimmune Diseases, ICMiD, University of Barcelona, Hospital Clínic, Barcelona, Spain.
| | - Pilar Brito-Zerón
- Autoimmune Diseases Unit, Department of Medicine, Hospital CIMA- Sanitas, Barcelona, Spain
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25
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Najm A, Alunno A, Machado P, Bertheussen H, Burmester G, Carubbi F, De Marco G, Giacomelli R, Hermine O, Isaacs J, Koné-Paut I, Magro-Checa C, McInnes I, Meroni P, Quartuccio L, Athimalaipet V, Ramos-Casals M, Rodríguez-Carrio J, Schultze-Koops H, Stamm T, Tas S, Terrier B, McGonagle D, Mariette X. Mise à jour des recommandations EULAR sur l’utilisation des thérapies immunomodulatrices dans la prise en charge de la Covid-19. Revue du Rhumatisme 2021. [PMCID: PMC8626108 DOI: 10.1016/j.rhum.2021.10.349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/29/2022]
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26
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Brito-Zerón P, Acar-Denizli N, Romão VC, Armagan B, Seror R, Carubbi F, Melchor S, Priori R, Valim V, Retamozo S, Pasoto SG, Trevisani VFM, Hofauer B, Szántó A, Inanc N, Hernández-Molina G, Sebastian A, Bartoloni E, Devauchelle-Pensec V, Akasbi M, Giardina F, Bandeira M, Sisó-Almirall A, Ramos-Casals M. Post-COVID-19 syndrome in patients with primary Sjögren's syndrome after acute SARS-CoV-2 infection. Clin Exp Rheumatol 2021; 39 Suppl 133:57-65. [PMID: 34874821 DOI: 10.55563/clinexprheumatol/0anatx] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 08/30/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To analyse the frequency and characteristics of post-COVID-19 syndrome in patients with primary Sjögren's syndrome (pSS) affected by acute SARS-CoV-2 infection. METHODS By the first week of April 2021, all centres included in the Big Data Sjögren Consortium were contacted asking for patients included in the Registry diagnosed with SARSCoV-2 infection according to the ECDC guidelines. According to the NICE definitions, symptoms related to COVID-19 were classified as acute COVID-19 (signs and symptoms for up to 4 weeks), ongoing symptomatic COVID-19 (presence of signs and symptoms from 4 to 12 weeks) and post-COVID-19 syndrome (signs and symptoms that continue for > 12 weeks not explained by an alternative diagnosis after a protocolized study). RESULTS We identified 132 patients who were followed a mean follow-up of 137.8 days (ranging from 5 days to 388 days) after being diagnosed with COVID-19. In the last visit, 75 (57%) patients remained symptomatic: 68 (52%) remained symptomatic for more than 4 weeks fulfilling the NICE definition for ongoing symptomatic post-COVID-19, and 38 (29%) remained symptomatic for more than 12 weeks fulfilling the definition of post-COVID-19 syndrome. More than 40% of pSS patients reported the persistence of four symptoms or more, including anxiety/depression (59%), arthralgias (56%), sleep disorder (44%), fatigue (40%), anosmia (34%) and myalgias (32%). Age-sex adjusted multivariate analysis identified raised LDH levels (OR 10.36), raised CRP levels (OR 7.33), use of hydroxychloroquine (OR 3.51) and antiviral agents (OR 3.38), hospital admission (OR 8.29), mean length of hospital admission (OR 1.1) and requirement of supplemental oxygen (OR 6.94) as factors associated with a higher risk of developing post-COVID-19 syndrome. A sensitivity analysis including hospital admission in the adjusted model confirmed raised CRP levels (OR 8.6, 95% CI 1.33-104.44) and use of hydroxychloroquine (OR 2.52, 95% CI 1.00-6.47) as the key independent factors associated with an enhanced risk of developing post-COVID-19 syndrome. CONCLUSIONS This is the first study that analyses the frequency and characteristics of post-COVID-19 syndrome in patients affected by a systemic autoimmune disease. We found that 57% of patients with pSS affected by COVID-19 remain symptomatic after a mean follow-up of 5 months. The risk of developing post-COVID-19 syndrome in patients who required hospitalisation was 8-times higher than in non-hospitalised patients, with baseline raised CRP levels and the use of hydroxychloroquine being independent risk factors for post-COVID-19.
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Affiliation(s)
- Pilar Brito-Zerón
- Autoimmune Diseases Unit, Department of Medicine, Hospital CIMA- Sanitas, Barcelona, Spain
| | - Nihan Acar-Denizli
- Department of Statistics and Operations Research, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Vasco C Romão
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte and Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon Academic Medical Centre, Lisbon, Portugal
| | - Berkan Armagan
- Department of Internal Medicine, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Raphaèle Seror
- Department of Rheumatology, National Reference Centre for Sjögren's Syndrome and Rare Autoimmune Diseases, Université Paris-Saclay; Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud, AP-HP, Le Kremlin Bicêtre, France
| | - Francesco Carubbi
- COVID-19 Medical Unit, San Salvatore Hospital, Department of Medicine, ASL1 Avezzano-Sulmona-L'Aquila, Italy
| | - Sheila Melchor
- Servicio de Reumatologia, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Roberta Priori
- Department of Internal Medicine and Medical Specialties, Rheumatology Clinic, Sapienza University of Rome, and Saint Camillus International University of Health Science, UniCamillus, Rome, Italy
| | - Valeria Valim
- Department of Medicine, Federal University of Espírito Santo, Vitória, Brazil
| | - Soledad Retamozo
- Instituto Modelo de Cardiología Privado SRL, Córdoba, and Instituto Universitario de Ciencias Biomédicas de Córdoba (IUCBC), Argentina, and Rheumatology Department, Hospital Universitari Parc Taulí, Sabadell, Barcelona, Spain
| | - Sandra G Pasoto
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Brazil
| | | | - Benedikt Hofauer
- Otorhinolaryngology, Head and Neck Surgery, Technical University Munich, Germany
| | - Antonia Szántó
- Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Hungary
| | - Nevsun Inanc
- Division of Rheumatology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Gabriela Hernández-Molina
- Immunology and Rheumatology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, Mexico
| | - Agata Sebastian
- Department of Rheumatology and Internal Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Elena Bartoloni
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Italy
| | | | - Miriam Akasbi
- Department of Internal Medicine, Hospital Infanta Leonor, Madrid, Spain
| | - Federico Giardina
- Department of Internal Medicine and Medical Specialties, Rheumatology Clinic, Sapienza University of Rome, Italy
| | - Matilde Bandeira
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte and Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon Academic Medical Centre, Lisbon, Portugal
| | - Antoni Sisó-Almirall
- Primary Care Centre Les Corts, Consorci d'Atenció Primària de Salut Barcelona Esquerra (CAPSBE), Barcelona; Primary Healthcare Transversal Research Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, and Department of Medicine, Universitat de Barcelona, Spain
| | - Manuel Ramos-Casals
- Department of Medicine, Universitat de Barcelona, and Department of Autoimmune Diseases, ICMiD, Hospital Clínic, Barcelona, Spain.
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Ramos-Casals M, Flores-Chavez A, Brito-Zerón P. Emerging role of eosinophils in immune-related adverse events related to therapy with immune checkpoint inhibitors. Pol Arch Intern Med 2021; 131. [PMID: 34704705 DOI: 10.20452/pamw.16092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Manuel Ramos-Casals
- Department of Autoimmune Diseases, ICMiD, Hospital Clinic, Barcelona, Spain.
| | - Alejandra Flores-Chavez
- Department of Autoimmune Diseases, ICMiD, Hospital Clinic, Barcelona, Spain
- Consejo Nacional de Ciencia y Tecnología (CONACYT), México DF, México
| | - Pilar Brito-Zerón
- Autoimmune Diseases Unit, Department of Medicine, Hospital CIMA-Sanitas, Barcelona, Spain
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Chanson N, Ramos-Casals M, Pundole X, Suijkerbuik K, José de Barros E Silva M, Lidar M, Benesova K, Leipe J, Acar-Denizli N, Pradère P, Michot JM, Voisin AL, Suárez-Almazor ME, Radstake TRD, Fernandes Moça Trevisani V, Schulze-Koops H, Melin A, Robert C, Mariette X, Baughman RP, Lambotte O. Immune checkpoint inhibitor-associated sarcoidosis: A usually benign disease that does not require immunotherapy discontinuation. Eur J Cancer 2021; 158:208-216. [PMID: 34452793 DOI: 10.1016/j.ejca.2021.05.041] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 04/27/2021] [Accepted: 05/24/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To analyse the clinical patterns of sarcoidosis triggered by immune checkpoint inhibitors (ICIs) in patients with cancer. PATIENTS AND METHODS The ImmunoCancer International Registry is a big data-sharing multidisciplinary network from 18 countries dedicated to evaluating the clinical research of immune-related adverse events related to cancer immunotherapies. RESULTS We identified 32 patients with biopsy-proven sarcoidosis. Underlying cancer included mainly melanoma (n = 24). Cancer immunotherapy consisted of monotherapy in 19 cases (anti-PD-1 in 18 and ipilimumab in 1) or combined ipilimumab + nivolumab in 13. The time median interval between initiation of ICI and sarcoidosis diagnosis was 3 months (range, 2-29 months). The use of combined ICI was associated with a shorter delay in developing sarcoidosis symptoms. The disease was symptomatic in 19 (59%) cases with mostly cutaneous, respiratory and general symptoms. The organs involved included mainly the mediastinal lymph nodes (n = 32), the lungs (n = 11), the skin (n = 10) and the eyes (n = 5). Pulmonary computed tomography studies showed bilateral hilar lymphadenopathy in all cases. There was no severe manifestation. Specific systemic therapy was required in only 12 patients (37%): oral glucocorticoids in 9, and hydroxychloroquine in 3. ICIs were held in 25 patients (78%) and definitively discontinued in 18 (56%) patients. Seven patients continued ICI treatment with a second flare in one case. In six additional patients, an ICI was reintroduced with no harm, and sarcoidosis relapsed in one of them. CONCLUSION Our study shows that ICI-related sarcoidosis seems to have a specific profile, possibly more benign than that of idiopathic sarcoidosis, and does not necessarily imply ICI discontinuation.
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Affiliation(s)
- Noémie Chanson
- AP-HP.Université Paris-Saclay, Hôpital Bicêtre, Department of Internal Medicine and Clinical Immunology, Le Kremlin Bicêtre, France; Université Paris-Saclay; INSERM; CEA, Centre Immunology of Viral Infections and Autoimmune Diseases, IDMIT Department, IBFJ, Le Kremlin-Bicêtre, France
| | - Manuel Ramos-Casals
- Department of Autoimmune Diseases, ICMiD, Hospital Clínic, Barcelona, Spain; Laboratory of Autoimmune Diseases Josep Font, IDIBAPS-CELLEX, Barcelona, Spain; Department of Medicine, University of Barcelona, Barcelona, Spain.
| | - Xerxes Pundole
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Karijn Suijkerbuik
- Department of Medical Oncology, UMC Utrecht Cancer Center, Utrecht, the Netherlands
| | | | - Merav Lidar
- Rheumatology Unit, Sheba Medical Center, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Karolina Benesova
- Department of Internal Medicin and Rheumatology, Universitätsklinikum Heidelberg, Germany
| | - Jan Leipe
- Division of Rheumatology, Department of Medicine V, University Hospital Mannheim, Medical Faculty Mannheim of the University Heidelberg, German
| | - Nihan Acar-Denizli
- Department of Statistics, Faculty of Science and Letters, Mimar Sinan Fine Arts University, Istanbul, Turkey
| | - Pauline Pradère
- Department of Thoracic Surgery, Hôpital Marie-Lannelongue, Le Plessis-Robinson, France
| | - Jean-Marie Michot
- Département D'Innovation Thérapeutique et D'Essais Précoces, Institut Gustave Roussy, Université Paris-Saclay, Villejuif, F-94805, France
| | - Anne-Laure Voisin
- Unité Fonctionnelle de Pharmacovigilance, Institut Gustave Roussy, Université Paris-Saclay, Villejuif, F-94805, France
| | - Maria E Suárez-Almazor
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Timothy R D Radstake
- Department of Medical Oncology, UMC Utrecht Cancer Center, Utrecht, the Netherlands
| | | | - Hendrik Schulze-Koops
- Department of Internal Medicin and Rheumatology, Universitätsklinikum Heidelberg, Germany
| | - Audrey Melin
- Department of Dermatology, Institut Gustave Roussy, Université Paris-Saclay, Villejuif, F-94805, France
| | - Caroline Robert
- Department of Dermatology, Institut Gustave Roussy, Université Paris-Saclay, Villejuif, F-94805, France
| | - Xavier Mariette
- Université Paris-Saclay; INSERM; CEA, Centre Immunology of Viral Infections and Autoimmune Diseases, IDMIT Department, IBFJ, Le Kremlin-Bicêtre, France; AP-HP.Université Paris-Saclay, Department of Rheumatology, Hôpital Bicêtre, Le Kremlin Bicêtre, France
| | - Robert P Baughman
- Department of Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Olivier Lambotte
- AP-HP.Université Paris-Saclay, Hôpital Bicêtre, Department of Internal Medicine and Clinical Immunology, Le Kremlin Bicêtre, France; Université Paris-Saclay; INSERM; CEA, Centre Immunology of Viral Infections and Autoimmune Diseases, IDMIT Department, IBFJ, Le Kremlin-Bicêtre, France.
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Retamozo S, Sisó-Almirall A, Flores-Chávez A, Ramos-Casals M, Brito-Zerón P. An update of targeted therapeutic options for primary Sjögren syndrome: current status and future development. Expert Opin Pharmacother 2021; 22:2359-2371. [PMID: 34323636 DOI: 10.1080/14656566.2021.1951224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Introduction: Primary Sjögren syndrome (pSS) is a systemic autoimmune disease that may affect 3 in 1,000 people within the general population. The therapeutic scenario is complex, and no therapy has proved to be able to modify the natural course of the disease, nor to prevent the most severe systemic complications.Areas covered: Recently, the EULAR 2020 Recommendations for pSS have underlined the low level of evidence supporting efficacious therapeutic approaches, lacking a definition of specific treatment targets and being far from the 'disease modification' concept that is frequently used in other diseases. Herein, the authors review the status of current targeted therapies and provide the reader with their expert opinion.Expert opinion: The progress in discovering novel treatments for pSS seem to be focused on searching new biological therapies as highly-selective drugs that can be effective without the adverse effects related to the wide, nonspecific immunosuppression induced by the drugs currently used. Most likely, the more disruptive therapeutic approach in pSS that could be seen in a few years is the use of combination strategies targeting different etiopathogenic pathways.
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Affiliation(s)
- Soledad Retamozo
- Sjogren Syndrome Research Group (AGAUR), Department of Autoinmune Diseases, ICMiD, Hospital Clinic, Barcelona, Spain.,Rheumatology Department, Hospital Universitari Parc Taulí, Sabadell, Barcelona, Spain
| | - Antoni Sisó-Almirall
- Primary Care Centre Les Corts, Consorci d'Atenció Primària De Salut Barcelona Esquerra (CAPSBE), Barcelona, Spain.,Primary Healthcare Transversal Research Group, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | | | - Manuel Ramos-Casals
- Sjogren Syndrome Research Group (AGAUR), Department of Autoinmune Diseases, ICMiD, Hospital Clinic, Barcelona, Spain.,Laboratory of Autoimmune Diseases Josep Font, IDIBAPS-CELLEX, Barcelona, Spain
| | - Pilar Brito-Zerón
- Laboratory of Autoimmune Diseases Josep Font, IDIBAPS-CELLEX, Barcelona, Spain.,Autoimmune Diseases Unit, Department of Medicine, Hospital CIMA-Sanitas, Barcelona, Spain
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Ramos-Casals M, Pérez-Alvarez R, Kostov B, Gómez-de-la-Torre R, Feijoo-Massó C, Chara-Cervantes J, Pinilla B, González-García A, Garcia-Morillo JS, López-Dupla M, De-Escalante B, Rascón J, Perez-Guerrero P, Bonet M, Cruz-Caparrós G, Alguacil A, Callejas JL, Calvo E, Soler C, Robles A, de Miguel-Campo B, Oliva-Nacarino P, Estela-Herrero J, Pallarés L, Brito-Zerón P, Blanco Y. Clinical characterization and outcomes of 85 patients with neurosarcoidosis. Sci Rep 2021; 11:13735. [PMID: 34215779 PMCID: PMC8253777 DOI: 10.1038/s41598-021-92967-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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: 09/04/2020] [Accepted: 04/26/2021] [Indexed: 11/09/2022] Open
Abstract
To analyze the frequency and clinical phenotype of neurosarcoidosis (NS) in one of the largest nationwide cohorts of patients with sarcoidosis reported from southern Europe. NS was evaluated according to the Diagnostic Criteria for Central Nervous System and Peripheral Nervous System Sarcoidosis recently proposed by Stern et al. Pathologic confirmation of granulomatous disease was used to subclassify NS into definite (confirmation in neurological tissue), probable (confirmation in extraneurological tissue) and possible (no histopathological confirmation of the disease). Of the 1532 patients included in the cohort, 85 (5.5%) fulfilled the Stern criteria for NS (49 women, mean age at diagnosis of NS of 47.6 years, 91% White). These patients developed 103 neurological conditions involving the brain (38%), cranial nerves (36%), the meninges (3%), the spinal cord (10%) and the peripheral nerves (14%); no patient had concomitant central and peripheral nerve involvements. In 59 (69%) patients, neurological involvement preceded or was present at the time of diagnosis of the disease. According to the classification proposed by Stern et al., 11 (13%) were classified as a definite NS, 61 (72%) as a probable NS and the remaining 13 (15%) as a possible NS. In comparison with the systemic phenotype of patients without NS, patients with CNS involvement presented a lower frequency of thoracic involvement (82% vs 93%, q = 0.018), a higher frequency of ocular (27% vs 10%, q < 0.001) and salivary gland (15% vs 4%, q = 0.002) WASOG involvements. In contrast, patients with PNS involvement showed a higher frequency of liver involvement (36% vs 12%, p = 0.02) in comparison with patients without NS. Neurosarcoidosis was identified in 5.5% of patients. CNS involvement prevails significantly over PNS involvement, and both conditions do not overlap in any patient. The systemic phenotype associated to each involvement was clearly differentiated, and can be helpful not only in the early identification of neurological involvement, but also in the systemic evaluation of patients diagnosed with neurosarcoidosis.
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Affiliation(s)
- Manuel Ramos-Casals
- Department of Autoimmune Diseases, ICMiD, Hospital Clínic, Barcelona, Spain.,Department of Medicine, University of Barcelona, Barcelona, Spain
| | | | - Belchin Kostov
- Primary Healthcare Transversal Research Group, IDIBAPS, Primary Care Center Les Corts, CAPSBE, Barcelona, Spain.,Department of Statistics and Operational Research, Universitat Politècnica de Catalunya, Barcelona, Spain
| | | | | | | | - Blanca Pinilla
- Department of Internal Medicine, Hospital Gregorio Marañón, Madrid, Spain
| | | | | | | | | | - Javier Rascón
- Department of Internal Medicine, Hospital Son Espases, Palma de Mallorca, Spain
| | | | - Mariona Bonet
- Department of Internal Medicine, Althaia, Xarxa Assistencial de Manresa, Manresa, Spain
| | - Gracia Cruz-Caparrós
- Department of Internal Medicine, Hospital de Poniente de El Ejido, Almería, Spain
| | - Ana Alguacil
- Department of Internal Medicine, Hospital Virgen de la Salud, Toledo, Spain
| | | | - Eva Calvo
- Department of Internal Medicine, Hospital San Jorge, Huesca, Spain
| | - Cristina Soler
- Department of Internal Medicine, Hospital Santa Caterina, Girona, Spain
| | - Angel Robles
- Department of Internal Medicine, Hospital La Paz, Madrid, Spain
| | | | - Pedro Oliva-Nacarino
- Department of Neurology. Hospital, Universitario Central de Asturias (HUCA), Oviedo, Spain
| | | | - Lucio Pallarés
- Department of Internal Medicine, Hospital Son Espases, Palma de Mallorca, Spain
| | - Pilar Brito-Zerón
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, Hospital CIMA-Sanitas, Barcelona, Spain.
| | - Yolanda Blanco
- Department of Neurology, Hospital Clínic, Barcelona, Spain
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Brito-Zerón P, Melchor S, Seror R, Priori R, Solans R, Kostov B, Baldini C, Carubbi F, Callejas JL, Guisado-Vasco P, Hernández-Molina G, Pasoto SG, Valim V, Sisó-Almirall A, Mariette X, Carreira P, Ramos-Casals M. SARS-CoV-2 infection in patients with primary Sjögren syndrome: characterization and outcomes of 51 patients. Rheumatology (Oxford) 2021; 60:2946-2957. [PMID: 33316070 PMCID: PMC7798705 DOI: 10.1093/rheumatology/keaa748] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 08/11/2020] [Revised: 10/12/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To analyse the prognosis and outcomes of SARS-CoV-2 infection in patients with primary SS. METHODS We searched for patients with primary SS presenting with SARS-CoV-2 infection (defined following and according to the European Centre for Disease Prevention and Control guidelines) among those included in the Big Data Sjögren Registry, an international, multicentre registry of patients diagnosed according to the 2002/2016 classification criteria. RESULTS A total of 51 patients were included in the study (46 women, mean age at diagnosis of infection of 60 years). According to the number of patients with primary SS evaluated in the Registry (n = 8211), the estimated frequency of SARS-CoV-2 infection was 0.62% (95% CI 0.44, 0.80). All but two presented with symptoms suggestive of COVID-19, including fever (82%), cough (57%), dyspnoea (39%), fatigue/myalgias (27%) and diarrhoea (24%), and the most frequent abnormalities included raised lactate dehydrogenase (LDH) (88%), CRP (81%) and D-dimer (82%) values, and lymphopenia (70%). Infection was managed at home in 26 (51%) cases and 25 (49%) required hospitalization (five required admission to ICU, four died). Compared with patients managed at home, those requiring hospitalization had higher odds of having lymphopenia as laboratory abnormality (adjusted OR 21.22, 95% CI 2.39, 524.09). Patients with comorbidities had an older age (adjusted OR 1.05, 95% CI 1.00, 1.11) and showed a risk for hospital admission six times higher than those without (adjusted OR 6.01, 95% CI 1.72, 23.51) in the multivariate analysis. CONCLUSION Baseline comorbidities were a key risk factor for a more complicated COVID-19 in patients with primary SS, with higher rates of hospitalization and poor outcomes in comparison with patients without comorbidities.
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Affiliation(s)
- Pilar Brito-Zerón
- Laboratory of Autoimmune Diseases Josep Font, IDIBAPS-CELLEX, Barcelona, Spain
- Autoimmune Diseases Unit, Department of Medicine, Hospital CIMA- Sanitas, Barcelona, Spain
| | - Sheila Melchor
- Servicio de Reumatologia, Hospital Universitario, 12 de Octubre, Madrid, Spain
| | - Raphaèle Seror
- Department of Rheumatology, National Reference Center for Sjögren Syndrome and Rare Autoimmune Diseases, Université Paris-Saclay, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud, AP-HP, Le Kremlin Bicêtre, France
| | - Roberta Priori
- Department of Internal Medicine and Medical Specialties, Rheumatology Clinic, Sapienza University of Rome, Rome, Italy
| | - Roser Solans
- Department of Internal Medicine, Hospital Vall d'Hebron, Barcelona, Spain
| | - Belchin Kostov
- Primary Care Centre Les Corts, Consorci d’Atenció Primària de Salut Barcelona Esquerra (CAPSBE), Barcelona, Spain
- Primary healthcare transversal research group, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Department of Statistics and Operations Research, Universitat Politècnica de Catalunya (UPC), Barcelona, Spain
| | | | - Francesco Carubbi
- COVID-19 Medical Unit, San Salvatore Hospital, Department of Medicine, ASL1 Avezzano-Sulmona-L’Aquila, L’Aquila, Italy
| | | | - Pablo Guisado-Vasco
- Department of Internal Medicine, Hospital Universitario Quironsalud, Madrid, Spain
| | - Gabriela Hernández-Molina
- Immunology and Rheumatology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, Mexico
| | - Sandra G Pasoto
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Valeria Valim
- Department of Medicine, Federal University of Espírito Santo, Vitória, Brazil
| | - Antoni Sisó-Almirall
- Primary Care Centre Les Corts, Consorci d’Atenció Primària de Salut Barcelona Esquerra (CAPSBE), Barcelona, Spain
- Primary healthcare transversal research group, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Department of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Xavier Mariette
- Centre for Immunology of Viral Infections and Autoimmune Diseases, Assistance Publique – Hôpitaux de Paris, Hôpitaux Universitaires Paris-Saclay, Le Kremlin-Bicêtre, Université Paris-Saclay, INSERM, Paris, France
| | - Patricia Carreira
- Servicio de Reumatologia, Hospital Universitario, 12 de Octubre, Madrid, Spain
| | - Manuel Ramos-Casals
- Laboratory of Autoimmune Diseases Josep Font, IDIBAPS-CELLEX, Barcelona, Spain
- Department of Medicine, Universitat de Barcelona, Barcelona, Spain
- Department of Autoimmune Diseases, ICMiD, Hospital Clínic, Barcelona, Spain
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Brito-Zerón P, Pérez-Alvarez R, Feijoo-Massó C, Gracia-Tello B, González-García A, Gómez-de-la-Torre R, Alguacil A, López-Dupla M, Robles A, Garcia-Morillo S, Bonet M, Cruz-Caparrós G, Fonseca-Aizpuru E, Akasbi M, Callejas JL, de Miguel-Campo B, Pérez-de-Lis M, Ramos-Casals M. Coexistence of immune-mediated diseases in sarcoidosis. Frequency and clinical significance in 1737 patients. Joint Bone Spine 2021; 88:105236. [PMID: 34116201 DOI: 10.1016/j.jbspin.2021.105236] [Citation(s) in RCA: 12] [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] [Received: 03/23/2021] [Accepted: 05/31/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To analyze whether immune-mediated diseases (IMDs) occurs in sarcoidosis more commonly than expected in the general population, and how concomitant IMDs influence the clinical presentation of the disease. METHODS We searched for coexisting IMDs in patients included in the SARCOGEAS-cohort, a multicenter nationwide database of consecutive patients diagnosed according to the ATS/ESC/WASOG criteria. Comparisons were made considering the presence or absence of IMD clustering, and odds ratios (OR) and their 95% confidence intervals (CI) were calculated as the ratio of observed cases of every IMD in the sarcoidosis cohort to the observed cases in the general population. RESULTS Among 1737 patients with sarcoidosis, 283 (16%) patients presented at least one associated IMD. These patients were more commonly female (OR: 1.98, 95% CI: 1.49-2.62) and were diagnosed with sarcoidosis at an older age (49.6 vs. 47.5years, P<0.05). The frequency of IMDs in patients with sarcoidosis was nearly 2-fold higher than the frequency observed in the general population (OR: 1.64, 95% CI: 1.44-1.86). Significant associations were identified in 17 individual IMDs. In comparison with the general population, the IMDs with the strongest strength of association with sarcoidosis (OR>5) were common variable immunodeficiency (CVID) (OR: 431.8), familial Mediterranean fever (OR 33.9), primary biliary cholangitis (OR: 16.57), haemolytic anemia (OR: 12.17), autoimmune hepatitis (OR: 9.01), antiphospholipid syndrome (OR: 8.70), immune thrombocytopenia (OR: 8.43), Sjögren syndrome (OR: 6.98), systemic sclerosis (OR: 5.71), ankylosing spondylitis (OR: 5.49), IgA deficiency (OR: 5.07) and psoriatic arthritis (OR: 5.06). Sex-adjusted ORs were considerably higher than crude ORs for eosinophilic digestive disease in women, and for immune thrombocytopenia, systemic sclerosis and autoimmune hepatitis in men. CONCLUSION We found coexisting IMDs in 1 out of 6 patients with sarcoidosis. The strongest associations were found for immunodeficiencies and some systemic, rheumatic, hepatic and hematological autoimmune diseases.
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Affiliation(s)
- Pilar Brito-Zerón
- Systemic Autoimmune Diseases Unit, Hospital CIMA-Sanitas, Barcelona, Spain
| | | | | | | | | | | | - Ana Alguacil
- Department of Internal Medicine, Hospital Virgen de la Salud, Toledo, Spain
| | | | - Angel Robles
- Department of Internal Medicine, Hospital La Paz, Madrid, Spain
| | | | - Mariona Bonet
- Department of Internal Medicine, Althaia, Xarxa Assistencial de Manresa, Manresa, Spain
| | | | | | - Miriam Akasbi
- Department of Internal Medicine, Hospital Infanta Leonor, Madrid, Spain
| | | | | | - Marta Pérez-de-Lis
- Department of Anesthesiology, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Manuel Ramos-Casals
- Department of Medicine, Universitat de Barcelona, Barcelona, Spain; Department of Autoimmune Diseases, ICMiD, Hospital Clinic, Barcelona, Spain.
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Alunno A, Najm A, Machado PM, Bertheussen H, Burmester GR, Carubbi F, De Marco G, Giacomelli R, Hermine O, Isaacs JD, Koné-Paut I, Magro-Checa C, McInnes I, Meroni PL, Quartuccio L, Ramanan AV, Ramos-Casals M, Rodríguez Carrio J, Schulze-Koops H, Stamm TA, Tas SW, Terrier B, McGonagle DG, Mariette X. EULAR points to consider on pathophysiology and use of immunomodulatory therapies in COVID-19. Ann Rheum Dis 2021; 80:698-706. [PMID: 33547062 PMCID: PMC7871226 DOI: 10.1136/annrheumdis-2020-219724] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/11/2021] [Accepted: 01/27/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Severe systemic inflammation associated with some stages of COVID-19 and in fatal cases led therapeutic agents developed or used frequently in Rheumatology being at the vanguard of experimental therapeutics strategies. The aim of this project was to elaborate EULAR Points to consider (PtCs) on COVID-19 pathophysiology and immunomodulatory therapies. METHODS PtCs were developed in accordance with EULAR standard operating procedures for endorsed recommendations, led by an international multidisciplinary Task Force, including rheumatologists, translational immunologists, haematologists, paediatricians, patients and health professionals, based on a systemic literature review up to 15 December 2020. Overarching principles (OPs) and PtCs were formulated and consolidated by formal voting. RESULTS Two OPs and fourteen PtCs were developed. OPs highlight the heterogeneous clinical spectrum of SARS-CoV-2 infection and the need of a multifaceted approach to target the different pathophysiological mechanisms. PtCs 1-6 encompass the pathophysiology of SARS-CoV-2 including immune response, endothelial dysfunction and biomarkers. PtCs 7-14 focus on the management of SARS-CoV-2 infection with immunomodulators. There was evidence supporting the use of glucocorticoids, especially dexamethasone, in COVID-19 cases requiring oxygen therapy. No other immunomodulator demonstrated efficacy on mortality to date, with however inconsistent results for tocilizumab. Immunomodulatory therapy was not associated with higher infection rates. CONCLUSIONS Multifactorial pathophysiological mechanisms, including immune abnormalities, play a key role in COVID-19. The efficacy of glucocorticoids in cases requiring oxygen therapy suggests that immunomodulatory treatment might be effective in COVID-19 subsets. Involvement of rheumatologists, as systemic inflammatory diseases experts, should continue in ongoing clinical trials delineating optimal immunomodulatory therapy utilisation in COVID-19.
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Affiliation(s)
- Alessia Alunno
- Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy
| | - Aurélie Najm
- Institute of Infection, Immunity and Inflammation, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Pedro M Machado
- Centre for Rheumatology & Department of Neuromuscular Diseases, University College London, London, UK
- National Institute for Health Research (NIHR) Biomedical Research Centre (BRC), University College London Hospitals NHS Foundation Trust, London, UK
- Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
| | | | - Gerd R Burmester
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Freie Universität und Humboldt-Universität Berlin, Berlin, Germany
| | - Francesco Carubbi
- Department of Medicine, ASL 1 Avezzano-Sulmona-L'Aquila, Internal Medicine and Nephrology Unit, Department of Life, Health & Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Gabriele De Marco
- The Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Roberto Giacomelli
- Rheumatology and Clinical Immunology Unit, University of Rome "Campus Biomedico" School of Medicine Rome, Rome, Italy
| | - Olivier Hermine
- Department of Haematology, Hôpital Necker, Assistance Publique - Hôpitaux de Paris, Paris, France
- INSERM UMR1183, Institut Imagine, Université de Paris, Paris, France
| | - John D Isaacs
- Translational and Clinical Research Institute, Newcastle University and Musculoskeletal Unit, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Isabelle Koné-Paut
- Service de Rhumatologie Pédiatrique, Centre de Référence des Maladies Auto-Inflammatoires de l'enfant, Hôpital Bicêtre, AP HP, Université Paris Sud, Bicètre, France
| | - César Magro-Checa
- Department of Rheumatology, Zuyderland Medical Centre Heerlen, Heerlen, The Netherlands
| | - Iain McInnes
- Institute of Infection, Immunity and Inflammation, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Pier Luigi Meroni
- Experimental Laboratory of Immunological and Rheumatologic Researches, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Luca Quartuccio
- Department of Medicine, Rheumatology Clinic, University of Udine, ASUFC Udine, Udine, Italy
| | - Athimalaipet V Ramanan
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- University of Bristol Translational Health Sciences, Bristol, UK
| | - Manuel Ramos-Casals
- Department of Autoimmune Diseases, ICMiD, Laboratory of Autoimmune Diseases Josep Font, IDIBAPS-CELLEX, Department of Autoimmune Diseases, ICMiD, University of Barcelona, Hospital Clínic, Barcelona, Spain
| | - Javier Rodríguez Carrio
- Department of Functional Biology, Immunology Area, Faculty of Medicine, University of Oviedo, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Hendrik Schulze-Koops
- Division of Rheumatology and Clinical Immunology, Department of Internal Medicine IV, Ludwig-Maximilians University of Munich, Munchen, Germany
| | - Tanja A Stamm
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna and Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Wien, Austria
| | - Sander W Tas
- Department of Rheumatology and Clinical Immunology, Amsterdam Rheumatology and Immunology Center, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Benjamin Terrier
- Department of Internal Medicine, Cochin University Hospital, Paris, France; National Referral Centre for Systemic and Autoimmune Diseases, University Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Dennis G McGonagle
- The Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Xavier Mariette
- Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, INSERM UMR1184, Department of Rheumatology, Université Paris-Saclay, Le Kremlin Bicêtre, France
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Brito-Zerón P, Sisó-Almirall A, Flores-Chavez A, Retamozo S, Ramos-Casals M. SARS-CoV-2 infection in patients with systemic autoimmune diseases. Clin Exp Rheumatol 2021. [DOI: 10.55563/clinexprheumatol/lekp1y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Pilar Brito-Zerón
- Laboratory of Autoimmune Diseases Josep Font, IDIBAPS-CELLEX, Barcelona, and Autoimmune Diseases Unit, Department of Internal Medicine, Hospital CIMA- Sanitas, Barcelona, Spain
| | - Antoni Sisó-Almirall
- Centre d’Atenció Primària Les Corts, Consorci d’Atenció Primària de Salut Barcelona Esquerre (CAPSBE), Barcelona; Grup Tranversal de Recerca en Atenció Primària, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona; and Department of Medicine, Universitat de Barcelona, Barcelona, Spain.
| | | | - Soledad Retamozo
- Rheumatology Department, Hospital Universitari Parc Taulí, Sabadell, Barcelona; Instituto Modelo de Cardiología Privado SRL, Córdoba, and Instituto Universitario de Ciencias Biomédicas de Córdoba (IUCBC), Argentina
| | - Manuel Ramos-Casals
- Laboratory of Autoimmune Diseases Josep Font, IDIBAPS-CELLEX, Barcelona; Department of Medicine, Universitat de Barcelona, and Department of Autoimmune Diseases, ICMiD, Hospital Clínic, Barcelona, Spain
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Sisó-Almirall A, Brito-Zerón P, Conangla Ferrín L, Kostov B, Moragas Moreno A, Mestres J, Sellarès J, Galindo G, Morera R, Basora J, Trilla A, Ramos-Casals M. Long Covid-19: Proposed Primary Care Clinical Guidelines for Diagnosis and Disease Management. Int J Environ Res Public Health 2021; 18:4350. [PMID: 33923972 PMCID: PMC8073248 DOI: 10.3390/ijerph18084350] [Citation(s) in RCA: 93] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/02/2021] [Accepted: 04/16/2021] [Indexed: 01/08/2023]
Abstract
Long COVID-19 may be defined as patients who, four weeks after the diagnosis of SARS-Cov-2 infection, continue to have signs and symptoms not explainable by other causes. The estimated frequency is around 10% and signs and symptoms may last for months. The main long-term manifestations observed in other coronaviruses (Severe Acute Respiratory Syndrome (SARS), Middle East respiratory syndrome (MERS)) are very similar to and have clear clinical parallels with SARS-CoV-2: mainly respiratory, musculoskeletal, and neuropsychiatric. The growing number of patients worldwide will have an impact on health systems. Therefore, the main objective of these clinical practice guidelines is to identify patients with signs and symptoms of long COVID-19 in primary care through a protocolized diagnostic process that studies possible etiologies and establishes an accurate differential diagnosis. The guidelines have been developed pragmatically by compiling the few studies published so far on long COVID-19, editorials and expert opinions, press releases, and the authors' clinical experience. Patients with long COVID-19 should be managed using structured primary care visits based on the time from diagnosis of SARS-CoV-2 infection. Based on the current limited evidence, disease management of long COVID-19 signs and symptoms will require a holistic, longitudinal follow up in primary care, multidisciplinary rehabilitation services, and the empowerment of affected patient groups.
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Affiliation(s)
- Antoni Sisó-Almirall
- Permanent Board of the Catalan Society of Family and Community Medicine (CAMFiC), 08009 Barcelona, Spain; (L.C.F.); (J.M.)
- Primary Care Centre Les Corts, Consorci d’Atenció Primària de Salut Barcelona Esquerra (CAPSBE), 08028 Barcelona, Spain;
- Primary Healthcare Transversal Research Group, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Pilar Brito-Zerón
- Laboratory of Autoimmune Diseases Josep Font, IDIBAPS-CELLEX, 08036 Barcelona, Spain; (P.B.-Z.); (M.R.-C.)
- Autoimmune Diseases Unit, Department of Medicine, Hospital CIMA-Sanitas, 08034 Barcelona, Spain
- Department of Autoimmune Diseases, ICMiD, Hospital Clínic, 08036 Barcelona, Spain
| | - Laura Conangla Ferrín
- Permanent Board of the Catalan Society of Family and Community Medicine (CAMFiC), 08009 Barcelona, Spain; (L.C.F.); (J.M.)
| | - Belchin Kostov
- Primary Care Centre Les Corts, Consorci d’Atenció Primària de Salut Barcelona Esquerra (CAPSBE), 08028 Barcelona, Spain;
- Primary Healthcare Transversal Research Group, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
- Department of Statistics and Operations Research, Universitat Politècnica de Catalunya (UPC), 08034 Barcelona, Spain
| | - Anna Moragas Moreno
- Jaume I Health Centre, Institut Català de la Salut, Universitat Rovira i Virgili, 43005 Tarragona, Spain;
| | - Jordi Mestres
- Permanent Board of the Catalan Society of Family and Community Medicine (CAMFiC), 08009 Barcelona, Spain; (L.C.F.); (J.M.)
| | | | - Gisela Galindo
- Permanent Board of the Spanish Society of Family and Community Medicine (semFYC), 08009 Barcelona, Spain;
| | - Ramon Morera
- Board of Spanish Society of Managers of Primary Care (SEDAP), 28026 Madrid, Spain;
| | | | - Antoni Trilla
- Faculty of Medicine and Health Sciences, University of Barcelona, 08036 Barcelona, Spain;
| | - Manuel Ramos-Casals
- Laboratory of Autoimmune Diseases Josep Font, IDIBAPS-CELLEX, 08036 Barcelona, Spain; (P.B.-Z.); (M.R.-C.)
- Department of Autoimmune Diseases, ICMiD, Hospital Clínic, 08036 Barcelona, Spain
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36
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Kim ST, Pundole X, Dadu R, Lambotte O, Ramos-Casals M, Suarez-Almazor ME. Use of immune checkpoint inhibitors in cancer patients with pre-existing sarcoidosis. Immunotherapy 2021; 13:465-475. [PMID: 33641345 DOI: 10.2217/imt-2020-0272] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Aim: To evaluate adverse events in cancer patients with pre-existing sarcoidosis receiving immune checkpoint inhibitors (ICIs). Patients & methods: We retrospectively reviewed cancer patients with sarcoidosis who underwent treatment with ICI to determine frequency of sarcoidosis flares. Results: 32 patients with sarcoidosis received ICIs The median time to ICI initiation was 7 years (range: 1 month to 51 years). One patient (3%) with a 20-year remote history of sarcoidosis developed a clinically symptomatic exacerbation after three doses of atezolizumab, with hilar lymphadenopathy, subcutaneous nodules, arthritis and uveitis. Atezolizumab was discontinued and prednisone initiated. She had a fluctuating course with two additional flares. Conclusion: Frequency of flares in patients with a remote history of sarcoidosis who receive ICIs is low.
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Affiliation(s)
- Sang T Kim
- Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Xerxes Pundole
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Ramona Dadu
- Department of Endocrine Neoplasia & Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Olivier Lambotte
- AP-HP. Université Paris-Saclay, Hôpital Bicêtre Department of Internal Medicine & Clinical Immunology, Le Kremlin Bicêtre, France.,Université Paris-Saclay; INSERM; CEA, Centre Immunology of Viral Infections & Autoimmune Diseases, IDMIT Department, IBFJ, Le Kremlin-Bicêtre, France
| | - Manuel Ramos-Casals
- Department of Autoimmune Diseases, ICMiD, Hospital Clínic, Barcelona, Spain.,Laboratory of Autoimmune Diseases Josep Font, IDIBAPS-CELLEX, Barcelona, Spain.,Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Maria E Suarez-Almazor
- Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.,Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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Ramos-Casals M, Acar-Denizli N, Vissink A, Brito-Zerón P, Li X, Carubbi F, Priori R, Toplak N, Baldini C, Faugier-Fuentes E, Kruize AA, Mandl T, Tomiita M, Gandolfo S, Hashimoto K, Hernandez-Molina G, Hofauer B, Mendieta-Zerón S, Rasmussen A, Sandhya P, Sene D, Trevisani VFM, Isenberg D, Sundberg E, Pasoto SG, Sebastian A, Suzuki Y, Retamozo S, Xu B, Giacomelli R, Gattamelata A, Bizjak M, Bombardieri S, Loor-Chavez RE, Hinrichs A, Olsson P, Bootsma H, Lieberman SM. Childhood-onset of primary Sjögren's syndrome: phenotypic characterization at diagnosis of 158 children. Rheumatology (Oxford) 2021; 60:4558-4567. [PMID: 33493333 DOI: 10.1093/rheumatology/keab032] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 11/12/2020] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES To characterize the phenotypic presentation at diagnosis of childhood-onset primary Sjögren syndrome (SjS). METHODS The Big Data Sjögren Project Consortium is an international, multicentre registry using worldwide data-sharing cooperative merging of pre-existing clinical SjS databases from the five continents. For this study, we selected those patients in whom the disease was diagnosed below the age of 19 according to the fulfilment of the 2002/2016 classification criteria. RESULTS Among the 12 083 patients included in the Sjögren Big Data Registry, 158 (1.3%) patients had a childhood-onset diagnosis (136 girls, mean age of 14.2 years): 126 (80%) reported dry mouth, 111 (70%) dry eyes, 52 (33%) parotid enlargement, 118/122 (97%) positive minor salivary gland biopsy and 60/64 (94%) abnormal salivary ultrasound study, 140/155 (90%) positive antinuclear antibody, 138/156 (89%) anti-Ro/La antibodies and 86/142 (68%) positive rheumatoid factor. The systemic ESSDAI domains containing the highest frequencies of active patients included the glandular (47%), articular (26%) and lymphadenopathy (25%) domains. Patients with childhood-onset primary SjS showed the highest mean ESSDAI score and the highest frequencies of systemic disease in 5 (constitutional, lymphadenopathy, glandular, cutaneous and haematological) of the 12 ESSDAI domains, and the lowest frequencies in 4 (articular, pulmonary, peripheral nerve and central nervous system) in comparison with patients with adult-onset disease. CONCLUSIONS Childhood-onset primary SjS involves around 1% of patients with primary SjS, with a clinical phenotype dominated by sicca features, parotid enlargement and systemic disease. Age at diagnosis plays a key role on modulating the phenotypic expression of the disease.
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Affiliation(s)
- Manuel Ramos-Casals
- Department of Autoimmune Diseases, ICMiD, Hospital Clínic, Barcelona, Spain.,Sjögren Syndrome Research Group (AGAUR), Laboratory of Autoimmune Diseases Josep Font, IDIBAPS-CELLEX, Barcelona, Spain.,Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Nihan Acar-Denizli
- Department of Statistics and Operations Research, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Arjan Vissink
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Pilar Brito-Zerón
- Sjögren Syndrome Research Group (AGAUR), Laboratory of Autoimmune Diseases Josep Font, IDIBAPS-CELLEX, Barcelona, Spain.,Autoimmune Diseases Unit, Department of Medicine, Hospital CIMA- Sanitas, Barcelona, Spain
| | - Xiaomei Li
- Department of Rheumatology and Immunology, Anhui Provincial Hospital, Hefei, China
| | - Francesco Carubbi
- Clinical Unit of Rheumatology, University of l'Aquila, School of Medicine, L'Aquila, Italy
| | - Roberta Priori
- Department of Internal Medicine and Medical Specialties, Rheumatology Clinic, Sapienza University of Rome, Rome, Italy
| | - Nataša Toplak
- University Children's Hospital Ljubljana, University Medical center Ljubljana, Medical faculty of Ljubljana, Slovenia
| | | | | | - Aike A Kruize
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Thomas Mandl
- Department of Rheumatology, Skane University Hospital Malmö, Lund University, Lund, Sweden
| | - Minako Tomiita
- Department of Pediatrics, National Hospital Organization, Shimoshizu National Hospital, Yotsukaido, Japan
| | - Saviana Gandolfo
- Clinic of Rheumatology, Department of Medical and Biological Sciences, University Hospital "Santa Maria della Misericordia", Udine, Italy
| | - Kunio Hashimoto
- Department of Pediatrics (Pediatric Allergy and Rheumatology), Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Gabriela Hernandez-Molina
- Immunology and Rheumatology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, Mexico
| | - Benedikt Hofauer
- Otorhinolaryngology, Head and Neck Surgery, Technical University Munich, Munich, Germany
| | | | - Astrid Rasmussen
- Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - Pulukool Sandhya
- Department of Clinical Immunology & Rheumatology, Christian Medical College & Hospital, Vellore, India
| | - Damien Sene
- Service de Médecine Interne 2, Hôpital Lariboisière, Université Paris VII, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - David Isenberg
- Centre for Rheumatology, Division of Medicine, University College London, London, UK
| | - Erik Sundberg
- Pediatric Rheumatology, Astrid Lindgreńs Children Hospital, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden
| | - Sandra G Pasoto
- Rheumatology Division, Hospital das Clinicas, Faculdade de Medicina da Universidade de Sao Paulo (HCFMUSP), Sao Paulo, Brazil
| | - Agata Sebastian
- Department of Rheumatology and Internal Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Yasunori Suzuki
- Division of Rheumatology, Kanazawa University Hospital, Kanazawa, Japan
| | - Soledad Retamozo
- Sjögren Syndrome Research Group (AGAUR), Laboratory of Autoimmune Diseases Josep Font, IDIBAPS-CELLEX, Barcelona, Spain.,Instituto De Investigaciones En Ciencias De La Salud (INICSA), Universidad Nacional de Córdoba (UNC), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Córdoba, Argentina.,Instituto Universitario de Ciencias Biomédicas de Córdoba (IUCBC), Córdoba, Argentina
| | - Bei Xu
- Department of Rheumatology and Immunology, Anhui Provincial Hospital, Hefei, China
| | - Roberto Giacomelli
- Clinical Unit of Rheumatology, University of l'Aquila, School of Medicine, L'Aquila, Italy
| | - Angelica Gattamelata
- Department of Internal Medicine and Medical Specialties, Rheumatology Clinic, Sapienza University of Rome, Rome, Italy
| | - Masa Bizjak
- University Children's Hospital Ljubljana, University Medical center Ljubljana, Medical faculty of Ljubljana, Slovenia
| | | | | | - Anneline Hinrichs
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Peter Olsson
- Department of Rheumatology, Skane University Hospital Malmö, Lund University, Lund, Sweden
| | - Hendrika Bootsma
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Scott M Lieberman
- Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
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Retamozo S, Brito-Zerón P, Sisó-Almirall A, Flores-Chávez A, Soto-Cárdenas MJ, Ramos-Casals M. Haemophagocytic syndrome and COVID-19. Clin Rheumatol 2021; 40:1233-1244. [PMID: 33389315 PMCID: PMC7778844 DOI: 10.1007/s10067-020-05569-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [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: 11/18/2020] [Revised: 12/19/2020] [Accepted: 12/22/2020] [Indexed: 12/15/2022]
Abstract
Primary and secondary haemophagocytic lymphohistiocytosis (HLH) are hyperferritinaemic hyperinflammatory syndromes with a common terminal pathway triggered by different etiopathogenetic factors. HLH is characterised by a decreased capacity of interferon gamma production with an activated NK phenotype profile similar to other hyperinflammatory syndromes. Viruses are closely linked to the development of HLH as infectious triggers, and the break of tolerance to self-antigens is considered a critical mechanism involved in the development of immune-mediated conditions triggered by viral infections. Emerging studies in patients with COVID-19 are suggesting a key role of monocytes/macrophages in the pathogenesis of this viral infection, and there is a significant overlap between several features reported in severe COVID-19 and the features included in the HLH-2004 diagnostic criteria. Therefore, SARS-Cov-2, as other respiratory viruses, may also be considered a potential etiological trigger of HLH. The frequency of HLH in adult patients with severe COVID-19 is lower than 5%, although this figure could be underestimated considering that most reported cases lacked information about some specific criteria (mainly the histopathological criteria and the measurement of NK cell function and sCD25 levels). Because HLH is a multi-organ syndrome, the diagnostic approach in a patient with severe COVID-19 in whom HLH is suspected must be carried out in a syndromic and holistic way, and not in the light of isolated clinical or laboratory features. In COVID-19 patients presenting with persistent high fever, progressive pancytopenia, and hepatosplenic involvement, together with the characteristic triad of laboratory abnormalities (hyperferritinaemia, hypertriglyceridaemia, and hypofibrinogenaemia), the suspicion of HLH is high, and the diagnostic workup must be completed with specific immunological and histopathological studies.
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Affiliation(s)
- Soledad Retamozo
- Instituto Modelo de Cardiología Privado S.R.L- Córdoba - Argentina, Instituto Universitario de Ciencias Biomédicas de Córdoba (IUCBC), Córdoba, Argentina
| | - Pilar Brito-Zerón
- Autoimmune Diseases Unit, Department of Medicine, Hospital CIMA- Sanitas, Barcelona, Spain
- Laboratory of Autoimmune Diseases Josep Font, IDIBAPS-CELLEX, Barcelona, Spain
| | - Antoni Sisó-Almirall
- Grup Tranversal de Recerca en Atenció Primària, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centre d'Atenció Primària Les Corts, Consorci d'Atenció Primària de Salut Barcelona Esquerre (CAPSBE), Barcelona, Spain
| | | | - María-José Soto-Cárdenas
- Department of Internal Medicine, Hospital Universitario Puerta del Mar, Cádiz, University of Cadiz, Cadiz, Spain
| | - Manuel Ramos-Casals
- Laboratory of Autoimmune Diseases Josep Font, IDIBAPS-CELLEX, Barcelona, Spain.
- Department of Medicine, University of Barcelona, Barcelona, Spain.
- Department of Autoimmune Diseases, ICMiD, Hospital Clínic, Barcelona, Spain.
- Servei de Malalties Autoimmunes Sistèmiques, Hospital Clínic, C/Villarroel, 170, 08036, Barcelona, Spain.
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Barber MRW, Hanly JG, Su L, Urowitz MB, St Pierre Y, Romero-Diaz J, Gordon C, Bae SC, Bernatsky S, Wallace DJ, Merrill JT, Isenberg DA, Rahman A, Ginzler EM, Petri M, Bruce IN, Dooley MA, Fortin PR, Gladman DD, Sanchez-Guerrero J, Steinsson K, Ramsey-Goldman R, Khamashta MA, Aranow C, Mackay M, Alarcón GS, Manzi S, Nived O, Jönsen A, Zoma AA, van Vollenhoven RF, Ramos-Casals M, Ruiz-Irastorza G, Lim SS, Kalunian KC, Inanc M, Kamen DL, Peschken CA, Jacobsen S, Askanase A, Farewell V, Stoll T, Buyon J, Clarke AE. Economic Evaluation of Damage Accrual in an International Systemic Lupus Erythematosus Inception Cohort Using a Multistate Model Approach. Arthritis Care Res (Hoboken) 2020; 72:1800-1808. [PMID: 31609532 DOI: 10.1002/acr.24092] [Citation(s) in RCA: 12] [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: 01/08/2019] [Accepted: 10/08/2019] [Indexed: 01/10/2023]
Abstract
OBJECTIVE There is a paucity of data regarding health care costs associated with damage accrual in systemic lupus erythematosus. The present study was undertaken to describe costs associated with damage states across the disease course using multistate modeling. METHODS Patients from 33 centers in 11 countries were enrolled in the Systemic Lupus International Collaborating Clinics (SLICC) inception cohort within 15 months of diagnosis. Annual data on demographics, disease activity, damage (SLICC/American College of Rheumatology Damage Index [SDI]), hospitalizations, medications, dialysis, and selected procedures were collected. Ten-year cumulative costs (Canadian dollars) were estimated by multiplying annual costs associated with each SDI state by the expected state duration using a multistate model. RESULTS A total of 1,687 patients participated; 88.7% were female, 49.0% were white, mean ± SD age at diagnosis was 34.6 ± 13.3 years, and mean time to follow-up was 8.9 years (range 0.6-18.5 years). Mean annual costs were higher for those with higher SDI scores as follows: $22,006 (Canadian) (95% confidence interval [95% CI] $16,662, $27,350) for SDI scores ≥5 versus $1,833 (95% CI $1,134, $2,532) for SDI scores of 0. Similarly, 10-year cumulative costs were higher for those with higher SDI scores at the beginning of the 10-year interval as follows: $189,073 (Canadian) (95% CI $142,318, $235,827) for SDI scores ≥5 versus $21,713 (95% CI $13,639, $29,788) for SDI scores of 0. CONCLUSION Patients with the highest SDI scores incur 10-year cumulative costs that are ~9-fold higher than those with the lowest SDI scores. By estimating the damage trajectory and incorporating annual costs, data on damage can be used to estimate future costs, which is critical knowledge for evaluating the cost-effectiveness of novel therapies.
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Affiliation(s)
| | - John G Hanly
- Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Li Su
- University of Cambridge, Cambridge, UK
| | - Murray B Urowitz
- Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Yvan St Pierre
- Research Institute of the McGill University Health Center, Montreal, Quebec, Canada
| | | | | | - Sang-Cheol Bae
- Hanyang University Hospital for Rheumatic Diseases, Seoul, Republic of Korea
| | | | - Daniel J Wallace
- Cedars-Sinai Medical Center and University of California, Los Angeles
| | | | | | | | - Ellen M Ginzler
- State University of New York Downstate Medical Center, Brooklyn
| | - Michelle Petri
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ian N Bruce
- Manchester Academic Health Sciences Centre, University of Manchester and Central Manchester University Hospitals National Health Service Foundation Trust, Manchester, UK
| | | | - Paul R Fortin
- CHU de Québec, Université Laval, Quebec City, Quebec, Canada
| | - Dafna D Gladman
- Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada
| | | | | | | | | | - Cynthia Aranow
- Feinstein Institutes for Medical Research, Manhasset, New York
| | - Meggan Mackay
- Feinstein Institutes for Medical Research, Manhasset, New York
| | | | - Susan Manzi
- University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | - Asad A Zoma
- Hairmyres Hospital, East Kilbride, Scotland, UK
| | | | | | | | | | | | | | | | | | - Søren Jacobsen
- Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anca Askanase
- Hospital for Joint Diseases, New York University Seligman Center for Advanced Therapeutics, New York, New York
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40
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Legge A, Kirkland S, Rockwood K, Andreou P, Bae SC, Gordon C, Romero-Diaz J, Sanchez-Guerrero J, Wallace DJ, Bernatsky S, Clarke AE, Merrill JT, Ginzler EM, Fortin PR, Gladman DD, Urowitz MB, Bruce IN, Isenberg DA, Rahman A, Alarcón GS, Petri M, Khamashta MA, Dooley MA, Ramsey-Goldman R, Manzi S, Zoma AA, Aranow C, Mackay M, Ruiz-Irastorza G, Lim SS, Inanc M, van Vollenhoven RF, Jonsen A, Nived O, Ramos-Casals M, Kamen DL, Kalunian KC, Jacobsen S, Peschken CA, Askanase A, Hanly JG. Prediction of hospitalizations in systemic lupus erythematosus using the Systemic Lupus International Collaborating Clinics Frailty Index (SLICC-FI). Arthritis Care Res (Hoboken) 2020; 74:638-647. [PMID: 33152181 DOI: 10.1002/acr.24504] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 10/22/2020] [Accepted: 11/03/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The Systemic Lupus International Collaborating Clinics (SLICC) frailty index (FI) predicts mortality and damage accrual in SLE, but its association with hospitalizations has not been described. We estimated the association of baseline SLICC-FI values with future hospitalizations in the SLICC inception cohort. METHODS Baseline SLICC-FI scores were calculated. The number and duration of inpatient hospitalizations during follow-up were recorded. Negative binomial regression was used to estimate the association between baseline SLICC-FI values and the rate of hospitalizations per patient-year of follow-up. Linear regression was used to estimate the association of baseline SLICC-FI scores with the proportion of follow-up time spent in hospital. Multivariable models were adjusted for relevant baseline characteristics. RESULTS The 1549 SLE patients eligible for this analysis were mostly female (88.7%) with mean (SD) age 35.7 (13.3) years and median (IQR) disease duration 1.2 (0.9-1.5) years at baseline. Mean (SD) baseline SLICC-FI was 0.17 (0.08). During mean (SD) follow-up of 7.2 (3.7) years, 614 patients (39.6%) experienced 1570 hospitalizations. Higher baseline SLICC-FI values (per 0.05 increment) were associated with more frequent hospitalizations during follow-up (Incidence Rate Ratio 1.21; 95%CI 1.13-1.30), adjusting for baseline age, sex, corticosteroid use, immunosuppressive use, ethnicity/location, SLE disease activity index 2000 (SLEDAI-2K), SLICC/ACR damage index (SDI), and disease duration. Among patients with ≥1 hospitalization, higher baseline SLICC-FI values predicted a greater proportion of follow-up time spent hospitalized (Relative Rate 1.09; 95%CI 1.02-1.16). CONCLUSION The SLICC-FI predicts future hospitalizations among incident SLE patients, further supporting the SLICC-FI as a valid health measure in SLE.
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Affiliation(s)
- Alexandra Legge
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Susan Kirkland
- Department of Community Health & Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kenneth Rockwood
- Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Pantelis Andreou
- Department of Community Health & Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sang-Cheol Bae
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Caroline Gordon
- Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | | | | | - Daniel J Wallace
- Cedars-Sinai/David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Sasha Bernatsky
- Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Ann E Clarke
- Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Joan T Merrill
- Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - Ellen M Ginzler
- Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Paul R Fortin
- Division of Rheumatology, CHU de Québec - Université Laval, Quebec City, Canada
| | - Dafna D Gladman
- Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, ON, Canada, Oakland
| | - Murray B Urowitz
- Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, ON, Canada, Oakland
| | - Ian N Bruce
- Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Center, The University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Center Manchester, UK
| | - David A Isenberg
- Center for Rheumatology, Department of Medicine, University College London, UK, London
| | - Anisur Rahman
- Center for Rheumatology, Department of Medicine, University College London, UK, London
| | - Graciela S Alarcón
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Michelle Petri
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Munther A Khamashta
- Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine, London, UK
| | - M A Dooley
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA, Chapel Hill
| | | | - Susan Manzi
- Lupus Center of Excellence, Allegheny Health Network, Pittsburgh, PA, USA
| | - Asad A Zoma
- Lanarkshire Center for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland, UK
| | - Cynthia Aranow
- Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Meggan Mackay
- Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Guillermo Ruiz-Irastorza
- Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Bizkaia Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo, Spain
| | - S Sam Lim
- Emory University School of Medicine, Division of Rheumatology, Atlanta, Georgia, USA
| | - Murat Inanc
- Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | | | - Andreas Jonsen
- Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden
| | - Ola Nived
- Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden
| | - Manuel Ramos-Casals
- Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain
| | - Diane L Kamen
- Medical University of South Carolina, Charleston, South Carolina, USA
| | | | - Soren Jacobsen
- Copenhagen Lupus and Vasculitis Clinic, 4242, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Anca Askanase
- Hospital for Joint Diseases, NYU, Seligman Center for Advanced Therapeutics, New York, NY, USA
| | - John G Hanly
- Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Nova Scotia, Canada
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41
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Urowitz MB, Gladman DD, Farewell V, Su J, Romero-Diaz J, Bae SC, Fortin PR, Sanchez-Guerrero J, Clarke AE, Bernatsky S, Gordon C, Hanly JG, Wallace DJ, Isenberg DA, Rahman A, Merrill JT, Ginzler E, Alarcón GS, Chatham WW, Petri MA, Bruce IN, Khamashta MA, Aranow C, Dooley MA, Manzi S, Ramsey-Goldman R, Nived O, Jönsen A, Steinsson K, Zoma AA, Ruiz-Irastorza G, Lim SS, Kalunian KC, Ỉnanç M, van Vollenhoven R, Ramos-Casals M, Kamen DL, Jacobsen S, Peschken CA, Askanase A, Stoll T. Accrual of Atherosclerotic Vascular Events in a Multicenter Inception Systemic Lupus Erythematosus Cohort. Arthritis Rheumatol 2020; 72:1734-1740. [PMID: 32515554 DOI: 10.1002/art.41392] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 05/13/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVE In previous studies, atherosclerotic vascular events (AVEs) were shown to occur in ~10% of patients with systemic lupus erythematosus (SLE). We undertook this study to investigate the annual occurrence and potential risk factors for AVEs in a multinational, multiethnic inception cohort of patients with SLE. METHODS A large 33-center cohort of SLE patients was followed up yearly between 1999 and 2017. AVEs were attributed to atherosclerosis based on SLE being inactive at the time of the AVE as well as typical atherosclerotic changes observed on imaging or pathology reports and/or evidence of atherosclerosis elsewhere. Analyses included descriptive statistics, rate of AVEs per 1,000 patient-years, and univariable and multivariable relative risk regression models. RESULTS Of the 1,848 patients enrolled in the cohort, 1,710 had ≥1 follow-up visit after enrollment, for a total of 13,666 patient-years. Of these 1,710 patients, 3.6% had ≥1 AVEs attributed to atherosclerosis, for an event rate of 4.6 per 1,000 patient-years. In multivariable analyses, lower AVE rates were associated with antimalarial treatment (hazard ratio [HR] 0.54 [95% confidence interval (95% CI) 0.32-0.91]), while higher AVE rates were associated with any prior vascular event (HR 4.00 [95% CI 1.55-10.30]) and a body mass index of >40 kg/m2 (HR 2.74 [95% CI 1.04-7.18]). A prior AVE increased the risk of subsequent AVEs (HR 5.42 [95% CI 3.17-9.27], P < 0.001). CONCLUSION The prevalence of AVEs and the rate of AVE accrual demonstrated in the present study is much lower than that seen in previously published data. This may be related to better control of both the disease activity and classic risk factors.
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Affiliation(s)
- Murray B Urowitz
- Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, and University of Toronto, Toronto, Ontario, Canada
| | - Dafna D Gladman
- Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, and University of Toronto, Toronto, Ontario, Canada
| | - Vernon Farewell
- Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Jiandong Su
- Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, and University of Toronto, Toronto, Ontario, Canada
| | | | - Sang-Cheol Bae
- Hanyang University Hospital for Rheumatic Diseases, Seoul, Republic of Korea
| | - Paul R Fortin
- Centre Hospitalier Universitaire de Québec et Université Laval, Quebec City, Quebec, Canada
| | - Jorge Sanchez-Guerrero
- Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, and University of Toronto, Toronto, Ontario, Canada
| | - Ann Elaine Clarke
- University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Sasha Bernatsky
- Montreal General Hospital and McGill University Health Centre, Montreal, Quebec, Canada
| | - Caroline Gordon
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - John G Hanly
- Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Daniel J Wallace
- Cedars-Sinai Medical Center, David Geffen School of Medicine, University of California, Los Angeles
| | | | | | | | | | | | | | - Michelle A Petri
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ian N Bruce
- Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Sciences Centre, The University of Manchester, NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Munther A Khamashta
- St Thomas' Hospital and King's College London School of Medicine, London, UK
| | - Cynthia Aranow
- Feinstein Institute for Medical Research, Manhasset, New York
| | | | - Susan Manzi
- Lupus Center of Excellence, Allegheny Health Network, Pittsburgh, Pennsylvania
| | | | - Ola Nived
- Lund University and Skåne University Hospital, Lund, Sweden
| | - Andreas Jönsen
- Lund University and Skåne University Hospital, Lund, Sweden
| | - Kristján Steinsson
- Fossvogur Landspitali University Hospital Center for Rheumatology Research, Reykjavik, Iceland
| | - Asad A Zoma
- Hairmyres Hospital, East Kilbride, Scotland, UK
| | | | - S Sam Lim
- Emory University School of Medicine, Atlanta, Georgia
| | | | - Murat Ỉnanç
- Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | | | - Manuel Ramos-Casals
- Institut d'Investigacions Biomèdiques August Pi i Sunyer and Hospital Clínic, Barcelona, Spain
| | | | - Soren Jacobsen
- Copenhagen Lupus and Vasculitis Clinic and Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Anca Askanase
- Hospital for Joint Diseases, New York University, New York, New York
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Bernatsky S, Ramsey-Goldman R, Urowitz MB, Hanly JG, Gordon C, Petri MA, Ginzler EM, Wallace DJ, Bae SC, Romero-Diaz J, Dooley MA, Peschken CA, Isenberg DA, Rahman A, Manzi S, Jacobsen S, Lim SS, van Vollenhoven R, Nived O, Kamen DL, Aranow C, Ruiz-Irastorza G, Sanchez-Guerrero J, Gladman DD, Fortin PR, Alarcón GS, Merrill JT, Kalunian KC, Ramos-Casals M, Steinsson K, Zoma A, Askanase A, Khamashta MA, Bruce I, Inanc M, Clarke AE. Cancer risk in a large inception SLE cohort: Effects of demographics, smoking, and medications. Arthritis Care Res (Hoboken) 2020; 73:1789-1795. [PMID: 32813314 DOI: 10.1002/acr.24425] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 08/11/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To assess cancer risk factors in incident SLE. METHODS Clinical variables and cancer outcomes were assessed annually among incident SLE patients. Multivariate hazard regression models (over-all risk, and most common cancers) included demographics and time-dependent medications (corticosteroids, antimalarial drugs, immunosuppressants), smoking, and adjusted mean SLE Disease Activity Index-2K. RESULTS Among 1668 patients (average 9 years follow-up), 65 cancers occurred: 15 breast, 10 non-melanoma skin, seven lung, six hematological, six prostate, five melanoma, three cervical, three renal, two each gastric, head and neck, and thyroid, and one each rectal, sarcoma, thymoma, and uterine cancers. Half of cancers (including all lung cancers) occurred in past/current smokers, versus one-third of patients without cancer. Multivariate analyses indicated over-all cancer risk was related primarily to male sex and older age at SLE diagnosis. In addition, smoking was associated with lung cancer. For breast cancer risk, age was positively and anti-malarial drugs were negatively associated. Anti-malarial drugs and higher disease activity were also negatively associated with non-melanoma skin cancer (NMSC) risk, whereas age and cyclophosphamide were positively associated. Disease activity was associated positively with hematologic and negatively with NMSC risk. CONCLUSIONS Smoking is a key modifiable risk factor, especially for lung cancer, in SLE. Immunosuppressive medications were not clearly associated with higher risk except for cyclophosphamide and NMSC. Antimalarials were negatively associated with breast cancer and NMSC risk. SLE activity was associated positively with hematologic cancer and negatively with NMSC. Since the absolute number of cancers was small, additional follow-up will help consolidate these findings.
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Affiliation(s)
- Sasha Bernatsky
- Divisions of Rheumatology and Clinical Epidemiology, Department of Medicine, University McGill, Montreal, Quebec, Canada
| | | | - Murray B Urowitz
- Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, ON, Canada
| | - John G Hanly
- Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Caroline Gordon
- Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Michelle A Petri
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ellen M Ginzler
- Department of Medicine, SUNY Downstate Medical Centre, Brooklyn, NY, USA
| | - Daniel J Wallace
- Cedars-Sinai/David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Sang-Cheol Bae
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | | | - Mary Anne Dooley
- Thurston Arthritis Research Centre, University of North Carolina, Chapel Hill, NC, USA
| | | | - David A Isenberg
- Centre for Rheumatology, Department of Medicine, University College London, London, UK
| | - Anisur Rahman
- Centre for Rheumatology, Department of Medicine, University College London, London, UK
| | - Susan Manzi
- Lupus Centre of Excellence, Allegheny Health Network, Pittsburgh, PA, USA
| | - Soren Jacobsen
- Copenhagen Lupus and Vasculitis Clinic, 4242, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - S Sam Lim
- Emory University, Department of Medicine, Division of Rheumatology, Atlanta, Georgia, USA
| | - Ronald van Vollenhoven
- Department of Rheumatology and Clinical Immunology, Amsterdam University Medical Centres, Amsterdam, Holland, Netherlands
| | - Ola Nived
- Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden
| | - Diane L Kamen
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - Cynthia Aranow
- Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Guillermo Ruiz-Irastorza
- Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo, Spain
| | - Jorge Sanchez-Guerrero
- Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, ON, Canada
| | - Dafna D Gladman
- Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, ON, Canada
| | - Paul R Fortin
- Division of Rheumatology, Department of Medicine, CHU de Québec, Université Laval, Quebec City, Canada
| | - Graciela S Alarcón
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Joan T Merrill
- Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | | | - Manuel Ramos-Casals
- Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain
| | - Kristjan Steinsson
- Department of Rheumatology, Center for Rheumatology Research Fossvogur, Landspitali University Hospital, Reykjavik, Iceland
| | - Asad Zoma
- Lanarkshire Center for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland, UK
| | - Anca Askanase
- Department of Rheumatology, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Munther A Khamashta
- Lupus Research Unit, The Rayne Institute, St. Thomas' Hospital, King's College London School of Medicine, London, UK
| | - Ian Bruce
- Arthritis Research UK Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Centre, The University of Manchester, NIHR Manchester Musculoskeletal Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre Manchester, Manchester, UK
| | - Murat Inanc
- Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Ann E Clarke
- Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Brito-Zerón P, Pasoto SG, Robles-Marhuenda A, Mandl T, Vissink A, Armagan B, Praprotnik S, Nocturne G, Sebastian A, Fernandes Moça Trevisani V, Retamozo S, Acar-Denizli N, Wiland P, Sisó-Almirall A, Bootsma H, Mariette X, Ramos-Casals M, Kostov B. Autoimmune congenital heart block and primary Sjögren's syndrome: characterisation and outcomes of 49 cases. Clin Exp Rheumatol 2020; 38 Suppl 126:95-102. [PMID: 33025893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 09/10/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To characterise autoimmune congenital heart block (CHB) associated with a maternal diagnosis of primary Sjögren's syndrome (pSS) confirmed either before, concomitant or after the first pregnancy complicated with CHB. METHODS The following inclusion criteria were applied: (i) Mothers with positive Ro/La autoantibodies detected previously or at the time of diagnosis of the first case of CHB; (ii) diagnosis of CHB confirmed by fetal echocardiography; (iii) AV block diagnosed in uterus, at birth or within the neonatal period (0-27 days after birth) (8); (iv) absence of anatomical cardiac abnormalities which might be causal of AV block; and (v) maternal fulfillment of the 2002 SS criteria before, during or after having a pregnancy complicated with CHB. RESULTS We identified 49 cases of autoimmune CHB in children born from 44 mothers who had a mean age at the time of pregnancy of 30.3 years (range 18 to 41). At the time of diagnosis of autoimmune CHB, all mothers had positive anti-Ro antibodies and 28/44 (64%) were positive for anti-La antibodies. Only 10 (22%) mothers with affected pregnancies had a diagnosis of primary SS at the time of diagnosis of the first pregnancy complicated by CHB (a mean of 4 years before, ranging from 1 to 10 years). In 6 (14%) mothers, primary SS was diagnosed during pregnancy or less than 12 months after the delivery/termination. In the remaining 28 (64%) mothers, pSS was confirmed 1-5 years after CHB diagnosis (n=19, 68%), 6-10 years after (n=2, 7%), or more than 10 years after the first case of CHB was diagnosed (n=7, 25%). CHB was diagnosed in uterus in all cases but two. AV block was initially incomplete in 11 fetuses and complete in 36 (no available data in 2 cases). Among the 35 (71%) surviving children with CHB, 5 (14%) developed other features of neonatal lupus. After the index pregnancy, 12 women had 20 subsequent pregnancies: five were complicated by a CHB (recurrence rate of CHB of 25%). The 4 women who had recurrent CHB were double-positive for anti-Ro and anti-La antibodies, and all had a confirmed pSS before having the first index case of CHB. CONCLUSIONS In pSS, autoimmune CHB could be one of the first "indirect" signs of the disease in women of childbearing-age, in whom the diagnosis is confirmed several years later. Some maternal characteristics could be related with recurrent CHB, such as having an already-confirmed diagnosis of pSS and carrying the two Ro/La autoantibodies.
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Affiliation(s)
- Pilar Brito-Zerón
- Autoimmune Diseases Unit, Department of Medicine, Hospital CIMA-Sanitas, Barcelona, and Laboratory of Autoimmune Diseases Josep Font, IDIBAPS-CELLEX, Barcelona, Spain
| | - Sandra G Pasoto
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | - Thomas Mandl
- Department of Rheumatology, Skane University Hospital Malmö, Lund University, Lund, Sweden
| | - Arjan Vissink
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Centre Groningen, The Netherlands
| | - Berkan Armagan
- Department of Internal Medicine, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Sonja Praprotnik
- Department of Rheumatology, University Medical Centre, Ljubljana, Slovenia
| | - Gaetane Nocturne
- Centre for Immunology of Viral Infections and Autoimmune Diseases, Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud, Le Kremlin-Bicêtre, Université Paris Sud, INSERM, Paris, France
| | - Agata Sebastian
- Department of Rheumatology and Internal Medicine, Wroclaw Medical University, Wroclaw, Poland
| | | | - Soledad Retamozo
- Instituto Modelo de Cardiología Privado SRL, Córdoba, and Instituto Universitario de Ciencias Biomédicas de Córdoba, Córdoba, Argentina
| | - Nihan Acar-Denizli
- Department of Statistics and Operations Research, Universitat Politècnica de Catalunya (UPC), Barcelona, Spain
| | - Piotr Wiland
- Department of Rheumatology and Internal Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Antoni Sisó-Almirall
- Primary Healthcare Transversal Research Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, and Primary Care Centre Les Corts, Consorci d'Atenció Primària de Salut Barcelona Esquerra (CAPSBE), Barcelona, Spain
| | - Hendrika Bootsma
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Centre Groningen, The Netherlands
| | - Xavier Mariette
- Centre for Immunology of Viral Infections and Autoimmune Diseases, Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud, Le Kremlin-Bicêtre, Université Paris Sud, INSERM, Paris, France
| | - Manuel Ramos-Casals
- Laboratory of Autoimmune Diseases Josep Font, IDIBAPS-CELLEX, Barcelona; Department of Medicine, University of Barcelona; and Department of Autoimmune Diseases, ICMiD, Hospital Clínic, Barcelona, Spain.
| | - Belchin Kostov
- Department of Statistics and Operations Research, Universitat Politècnica de Catalunya (UPC), Barcelona; Primary Healthcare Transversal Research Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona; and Primary Care Centre Les Corts, Consorci d'Atenció Primària de Salut Barcelona Esquerra (CAPSBE), Barcelona, Spain
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Acar-Denizli N, Horváth IF, Mandl T, Priori R, Vissink A, Hernandez-Molina G, Armagan B, Praprotnik S, Sebastian A, Bartoloni E, Rischmueller M, Pasoto SG, Nordmark G, Nakamura H, Fernandes Moça Trevisani V, Retamozo S, Carsons SE, Maure-Noia B, Sánchez-Berná I, López-Dupla M, Fonseca-Aizpuru E, Melchor Díaz S, Vázquez M, Díaz Cuiza PE, de Miguel Campo B, Ng WF, Rasmussen A, Dong X, Li X, Baldini C, Seror R, Gottenberg JE, Kruize AA, Sandhya P, Gandolfo S, Kwok SK, Kvarnstrom M, Solans R, Sene D, Suzuki Y, Isenberg DA, Valim V, Hofauer B, Giacomelli R, Devauchelle-Pensec V, Atzeni F, Gheita TA, Morel J, Izzo R, Kalyoncu U, Szántó A, Olsson P, Bootsma H, Ramos-Casals M, Kostov B, Brito-Zerón P. Systemic phenotype related to primary Sjögren's syndrome in 279 patients carrying isolated anti-La/SSB antibodies. Clin Exp Rheumatol 2020; 38 Suppl 126:85-94. [PMID: 33095152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 09/03/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To evaluate the systemic phenotype associated with the presence of isolated anti-La/SSB antibodies in a large international registry of patients with primary Sjögren's syndrome (pSS) fulfilling the 2002 classification criteria. METHODS The Big Data Sjögren Project Consortium is an international, multicentre registry created in 2014. Baseline clinical information from leading centres on clinical research in SS of the 5 continents was collected. Combination patterns of anti-Ro/SSA-La/SSB antibodies at the time of diagnosis defined the following four immunological phenotypes: double positive (combined Ro/SSA and La/SSB,) isolated anti-Ro/SSA, isolated anti-La/SSB, and immunonegative. RESULTS The cohort included 12,084 patients (11,293 females, mean 52.4 years) with recorded ESSDAI scores available. Among them, 279 (2.3%) had isolated anti-La/SSB antibodies. The mean total ESSDAI score at diagnosis of patients with pSS carrying isolated anti-La/SSB was 6.0, and 80.4% of patients had systemic activity (global ESSDAI score ≥1) at diagnosis. The domains with the highest frequency of active patients were the biological (42.8%), glandular (36.8%) and articular (31.2%) domains. Patients with isolated anti-La/SSB showed a higher frequency of active patients in all ESSDAI domains but two (articular and peripheral nerve) in comparison with immune-negative patients, and even a higher absolute frequency in six clinical ESSDAI domains in comparison with patients with isolated anti-Ro/SSA. In addition, patients with isolated anti-La/SSB showed a higher frequency of active patients in two ESSDAI domains (pulmonary and glandular) with respect to the most active immunological subset (double-positive antibodies). Meanwhile, systemic activity detected in patients with isolated anti-La/SSB was overwhelmingly low. Even in ESSDAI domains where patients with isolated anti-La/SSB had the highest frequencies of systemic activity (lymphadenopathy and muscular), the percentage of patients with moderate or high activity was lower in comparison with the combined Ro/SSA and La/SSB group. CONCLUSIONS Patients carrying isolated La/SSB antibodies represent a very small subset of patients with a systemic SS phenotype characterised by a significant frequency of active patients in most clinical ESSDAI domains but with a relative low frequency of the highest severe organ-specific involvements. Primary SS still remains the best clinical diagnosis for this subset of patients.
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Affiliation(s)
- Nihan Acar-Denizli
- Department of Statistics and Operations Research, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Ildiko-Fanny Horváth
- Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Hungary
| | - Thomas Mandl
- Department of Rheumatology, Skane University Hospital Malmö, Lund University, Sweden
| | - Roberta Priori
- Department of Internal Medicine and Medical Specialties, Rheumatology Clinic, Sapienza University of Rome, Italy
| | - Arjan Vissink
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Gabriela Hernandez-Molina
- Immunology and Rheumatology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, Mexico
| | - Berkan Armagan
- Department of Internal Medicine, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Sonja Praprotnik
- Department of Rheumatology, University Medical Centre, Ljubljana, Slovenia
| | - Agata Sebastian
- Department of Rheumatology and Internal Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Elena Bartoloni
- Rheumatology Unit, Department of Medicine, University of Perugia, Italy
| | - Maureen Rischmueller
- Department of Rheumatology, The Queen Elizabeth Hospital, Discipline of Medicine, University of Adelaide, SA, Australia
| | - Sandra G Pasoto
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Brazil
| | - Gunnel Nordmark
- Rheumatology, Department of Medical Sciences, Uppsala University, Sweden
| | - Hideki Nakamura
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | | | - Soledad Retamozo
- Instituto Modelo de Cardiología Privado SRL, Córdoba, and Instituto Universitario de Ciencias Biomédicas de Córdoba (IUCBC), Córdoba, Argentina
| | - Steven E Carsons
- Division of Rheumatology, Allergy and Immunology, NYU Long Island School of Medicine, Mineola, NY, USA
| | - Brenda Maure-Noia
- Department of Autoimmune Diseases, Complexo Hospitalario Universitario de Vigo, Spain
| | - Isabel Sánchez-Berná
- Department of Internal Medicine, Hospital Rey Juan Carlos de Móstoles, Madrid, Spain
| | | | | | | | - Marcos Vázquez
- Department of Rheumatology, Hospital de Clínicas, San Lorenzo, Paraguay
| | - P Ericka Díaz Cuiza
- Departamento de Reumatología del Seguro Social Universitario y consultorio privado de Reumatología, Sucre, Bolivia
| | | | - Wan-Fai Ng
- Institute of Cellular Medicine, Newcastle University, and NIHR Biomedical Research Centre, Newcastle Upon Tyne, UK
| | - Astrid Rasmussen
- Genes and Human Disease Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - Xu Dong
- Department of Rheumatology, Peking Union Medical College Hospital, Beijing, China
| | - Xiaomei Li
- Department of Rheumatology and Immunology, Anhui Provincial Hospital, Hefei, China
| | | | - Raphaele Seror
- Centre for Immunology of Viral Infections and Autoimmune Diseases, Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud, Le Kremlin-Bicêtre, Université Paris Sud, INSERM, Paris, France
| | - Jacques-Eric Gottenberg
- Department of Rheumatology, Strasbourg University Hospital, Université de Strasbourg, CNRS, Strasbourg, France
| | - Aike A Kruize
- Department of Rheumatology and Clinical Immunology, University Medical Centre Utrecht, The Netherlands
| | - Pulukool Sandhya
- Department of Clinical Immunology & Rheumatology, Christian Medical College & Hospital, Vellore, India
| | - Saviana Gandolfo
- Clinic of Rheumatology, Department of Medical and Biological Sciences, University Hospital 'Santa Maria della Misericordia', Udine, Italy
| | - Seung-Ki Kwok
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Marika Kvarnstrom
- Department of Medicine, Solna, Division of Experimental Rheumatology, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden
| | - Roser Solans
- Department of Internal Medicine, Hospital Vall d'Hebron, Barcelona, Spain
| | - Damien Sene
- Service de Médecine Interne 2, Hôpital Lariboisière, Université Paris VII, Assistance Publique-Hôpitaux de Paris, France
| | - Yasunori Suzuki
- Division of Rheumatology , Kanazawa University Hospital, Kanazawa, Ishikawa, Japan
| | - David A Isenberg
- Centre for Rheumatology, Division of Medicine, University College London, UK
| | - Valeria Valim
- Department of Medicine, Federal University of Espírito Santo, Vitória, Brazil
| | - Benedikt Hofauer
- Otorhinolaryngology, Head and Neck Surgery, Technical University Munich, Germany
| | - Roberto Giacomelli
- Clinical Unit of Rheumatology, School of Medicine, University of L'Aquila, Italy
| | | | - Fabiola Atzeni
- IRCCS Galeazzi Orthopaedic Institute, Milan and Rheumatology Unit, University of Messina, Italy
| | - Tamer A Gheita
- Rheumatology Department, Kasr Al Ainy School of Medicine, Cairo University, Cairo, Egypt
| | - Jacques Morel
- Department of Rheumatology, Teaching Hospital and University of Montpellier, France
| | - Raffaella Izzo
- Department of Internal Medicine and Medical Specialties, Rheumatology Clinic, Sapienza University of Rome, Italy
| | - Umut Kalyoncu
- Department of Internal Medicine, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Antónia Szántó
- Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Hungary
| | - Peter Olsson
- Department of Rheumatology, Skane University Hospital Malmö, Lund University, Sweden
| | - Hendrika Bootsma
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Centre Groningen, The Netherlands
| | - Manuel Ramos-Casals
- Sjögren Syndrome Research Group (AGAUR), Laboratory of Autoimmune Diseases Josep Font, IDIBAPS-CELLEX, Department of Autoimmune Diseases, ICMiD, University of Barcelona, Hospital Clínic, Barcelona, Spain.
| | - Belchin Kostov
- Department of Statistics and Operations Research, Universitat Politècnica de Catalunya, Barcelona, and Primary Healthcare Transversal Research Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Primary Care Centre Les Corts, Consorci d'Atenció Primària de Salut Barcelona Esquerra (CAPSBE), Barcelona, Spain
| | - Pilar Brito-Zerón
- Sjögren Syndrome Research Group (AGAUR), Laboratory of Autoimmune Diseases Josep Font, IDIBAPS-CELLEX, Department of Autoimmune Diseases, ICMiD, University of Barcelona, Hospital Clínic, Barcelona, and Autoimmune Diseases Unit, Department of Medicine, Hospital CIMA-Sanitas, Barcelona, Spain
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Abstract
Background:Immune checkpoint inhibitors (ICI) have changed the treatment landscape of many cancer types, but are also associated with development of immune-related adverse events, includingde novosarcoid like reactions. However, little is known about the use of ICI therapy in patients with preexisting sarcoidosis as patients with preexisting autoimmune diseases have been systematically excluded from clinical trials of ICI therapy due to concerns of heightened toxicities. Emerging research suggests that ICI therapy can be considered in some patients with autoimmune diseases.1Objectives:To determine the risk of sarcoidosis exacerbation or flare in patients with preexisting sarcoidosis receiving ICI therapy.Methods:We conducted a retrospective cohort study of patients seen at The University of Texas MD Anderson Cancer Center between 2016-2019. Patients were included in the cohort if they received one of 7 ICI therapies (ipilimumab, nivolumab, pembrolizumab, durvalumab, avelumab, atezolizumab, or cemiplimab) and had an International Classification of Disease version 10 code of sarcoidosis (D86.*), prior to the ICI initiation, with diagnosis confirmed in medical record by treating physicians. A sarcoidosis diagnosis was considered “possible” if the medical record documented a history of sarcoidosis, “probable” if a history of biopsy proven sarcoidosis was mentioned, and “definitive” if histological evidence was available. Frequency of flares and outcomes of patients after receiving ICI were collected.Results:During the study timeframe a total of 32 patients with preexisting sarcoidosis received ICI therapy. Nine patients (28%) had a definitive diagnosis of sarcoidosis, 12 (37%) had a probable diagnosis and 11 (35%) had a possible diagnosis of sarcoidosis. The mean time between diagnosis of sarcoidosis and initiation of ICI therapy was 13 years (range: <1 to 51 years). Twenty-seven patients (84%) received monotherapy and five patients (16%) received combination or sequential ICI therapy. Of the 32 patients, one patient with a 20-year remote history of sarcoidosis, never treated, developed a clinically symptomatic exacerbation of sarcoidosis one month after the initial dose of atezolizumab, with increased hilar nodules on imaging, skin nodules, arthritis and uveitis. Biopsy of a lymph node showed non-necrotizing granulomas, and biopsy of the skin panniculitis. The patient also developed colitis thought to be an immune-related adverse event. Atezolizumab was discontinued after 3 doses. Patient was treated with prednisone and azathioprine.Conclusion:Patients with a remote history of stable sarcoidosis at the time of ICI therapy infrequently develop a flare of their sarcoidosis. The risk of flares in patients with active sarcoidosis requiring immunosuppression at the time of ICI initiation is unknown.References:[1]Kennedy LC, Bhatia S, Thompson JA, Grivas P. Preexisting autoimmune disease: implications for immune checkpoint inhibitor therapy in solid tumors. Journal of the National Comprehensive Cancer Network. 2019 Jun 1;17(6):750-7.Acknowledgments:NoneDisclosure of Interests:Xerxes Pundole: None declared, Olivier Lambotte Consultant of: BMS France, MSD, Astra Zeneca, Incyte, Manuel Ramos-Casals: None declared, Maria Suarez-Almazor: None declared
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Ramos-Casals M, Brahmer JR, Callahan MK, Flores-Chávez A, Keegan N, Khamashta MA, Lambotte O, Mariette X, Prat A, Suárez-Almazor ME. Immune-related adverse events of checkpoint inhibitors. Nat Rev Dis Primers 2020; 6:38. [PMID: 32382051 PMCID: PMC9728094 DOI: 10.1038/s41572-020-0160-6] [Citation(s) in RCA: 601] [Impact Index Per Article: 150.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/02/2020] [Indexed: 02/06/2023]
Abstract
Cancer immunotherapies have changed the landscape of cancer treatment during the past few decades. Among them, immune checkpoint inhibitors, which target PD-1, PD-L1 and CTLA-4, are increasingly used for certain cancers; however, this increased use has resulted in increased reports of immune-related adverse events (irAEs). These irAEs are unique and are different to those of traditional cancer therapies, and typically have a delayed onset and prolonged duration. IrAEs can involve any organ or system. These effects are frequently low grade and are treatable and reversible; however, some adverse effects can be severe and lead to permanent disorders. Management is primarily based on corticosteroids and other immunomodulatory agents, which should be prescribed carefully to reduce the potential of short-term and long-term complications. Thoughtful management of irAEs is important in optimizing quality of life and long-term outcomes.
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Affiliation(s)
- Manuel Ramos-Casals
- Department of Autoimmune Diseases, ICMiD, Barcelona, Spain. .,Laboratory of Autoimmune Diseases Josep Font, IDIBAPS-CELLEX, Barcelona, Spain. .,Department of Medicine, University of Barcelona, Hospital Clínic, Barcelona, Spain.
| | - Julie R. Brahmer
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
| | - Margaret K. Callahan
- Melanoma and Immunotherapeutics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA,Weill Cornell Medical College, New York, NY, USA,Parker Institute for Cancer Immunotherapy, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Niamh Keegan
- Melanoma and Immunotherapeutics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA,Weill Cornell Medical College, New York, NY, USA
| | - Munther A. Khamashta
- Lupus Clinic, Rheumatology Department, Dubai Hospital, Dubai, United Arab Emirates
| | - Olivier Lambotte
- APHP Médecine Interne/Immunologie Clinique, Hôpital Bicêtre, Paris, France,Université Paris-Saclay – INSERM U1184 - CEA, Immunology of Viral Infections and Autoimmune Diseases, IDMIT Department, IBFJ, Fontenay-aux-Roses and Le Kremlin-Bicêtre, France
| | - Xavier Mariette
- Université Paris-Saclay, INSERM, CEA, Centre de recherche en Immunologie des infections virales et des maladies auto-immunes ; AP-HP.Université Paris-Saclay, Hôpital Bicêtre, Rheumatology Department, Le Kremlin Bicêtre, France
| | - Aleix Prat
- Translational Genomic and Targeted Therapeutics in Solid Tumors, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain,Department of Medical Oncology, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Maria E. Suárez-Almazor
- Section of Rheumatology/Clinical Immunology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Legge A, Kirkland S, Rockwood K, Andreou P, Bae SC, Gordon C, Romero-Diaz J, Sanchez-Guerrero J, Wallace DJ, Bernatsky S, Clarke AE, Merrill JT, Ginzler EM, Fortin PR, Gladman DD, Urowitz MB, Bruce IN, Isenberg DA, Rahman A, Alarcón GS, Petri M, Khamashta MA, Dooley MA, Ramsey-Goldman R, Manzi S, Zoma AA, Aranow C, Mackay M, Ruiz-Irastorza G, Lim SS, Inanc M, van Vollenhoven RF, Jonsen A, Nived O, Ramos-Casals M, Kamen DL, Kalunian KC, Jacobsen S, Peschken CA, Askanase A, Hanly JG. Prediction of Damage Accrual in Systemic Lupus Erythematosus Using the Systemic Lupus International Collaborating Clinics Frailty Index. Arthritis Rheumatol 2020; 72:658-666. [PMID: 31631584 DOI: 10.1002/art.41144] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 10/15/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The Systemic Lupus International Collaborating Clinics (SLICC) frailty index (FI) has been shown to predict mortality, but its association with other important outcomes is unknown. We examined the association of baseline SLICC FI values with damage accrual in the SLICC inception cohort. METHODS The baseline visit was defined as the first visit at which both organ damage (SLICC/American College of Rheumatology Damage Index [SDI]) and health-related quality of life (Short Form 36) were assessed. Baseline SLICC FI scores were calculated. Damage accrual was measured by the increase in SDI between the baseline assessment and the last study visit. Multivariable negative binomial regression was used to estimate the association between baseline SLICC FI values and the rate of increase in the SDI during follow-up, adjusting for relevant demographic and clinical characteristics. RESULTS The 1,549 systemic lupus erythematosus (SLE) patients eligible for this analysis were mostly female (88.7%) with a mean ± SD age of 35.7 ± 13.3 years and a median disease duration of 1.2 years (interquartile range 0.9-1.5 years) at baseline. The mean ± SD baseline SLICC FI was 0.17 ± 0.08. Over a mean ± SD follow-up of 7.2 ± 3.7 years, 653 patients (42.2%) had an increase in SDI. Higher baseline SLICC FI values (per 0.05 increase) were associated with higher rates of increase in the SDI during follow-up (incidence rate ratio [IRR] 1.19 [95% confidence interval 1.13-1.25]), after adjusting for age, sex, ethnicity/region, education, baseline SLE Disease Activity Index 2000, baseline SDI, and baseline use of glucocorticoids, antimalarials, and immunosuppressive agents. CONCLUSION Our findings indicate that the SLICC FI predicts damage accrual in incident SLE, which further supports the SLICC FI as a valid health measure in SLE.
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Affiliation(s)
| | | | | | | | - Sang-Cheol Bae
- Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Caroline Gordon
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Juanita Romero-Diaz
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Mexico City, Mexico
| | - Jorge Sanchez-Guerrero
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Mexico City, Mexico
| | - Daniel J Wallace
- Cedars-Sinai Medical Center and David Geffen School of Medicine at University of California, Los Angeles
| | | | - Ann E Clarke
- University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | | | | | - Paul R Fortin
- CHU de Quebec-Université Laval, Quebec City, Quebec, Canada
| | - Dafna D Gladman
- Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Murray B Urowitz
- Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Ian N Bruce
- Arthritis Research UK Epidemiology Unit, University of Manchester, NIHR Manchester Musculoskeletal Biomedical Research Centre, and Manchester University NHS Foundation Trust, Manchester, UK
| | | | | | | | - Michelle Petri
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Munther A Khamashta
- St. Thomas Hospital and King's College London GKT School of Medical Education, London, UK
| | - M A Dooley
- University of North Carolina at Chapel Hill
| | | | - Susan Manzi
- Lupus Center of Excellence, Allegheny Health Network, Pittsburgh, Pennsylvania
| | | | - Cynthia Aranow
- Feinstein Institute for Medical Research, Manhasset, New York
| | - Meggan Mackay
- Feinstein Institute for Medical Research, Manhasset, New York
| | | | - S Sam Lim
- Emory University School of Medicine, Atlanta, Georgia
| | | | | | | | | | - Manuel Ramos-Casals
- Institut d'Investigacions Biomèdiques August Pi i Sunyer and Hospital Clínic, Barcelona, Barcelona, Spain
| | | | | | - Soren Jacobsen
- Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Anca Askanase
- Hospital for Joint Diseases, New York University New York, New York
| | - John G Hanly
- Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Nova Scotia, Canada
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Jousse-Joulin S, Gatineau F, Baldini C, Baer A, Barone F, Bootsma H, Bowman S, Brito-Zerón P, Cornec D, Dorner T, de Vita S, Fisher B, Hammenfors D, Jonsson M, Mariette X, Milic V, Nakamura H, Ng WF, Nowak E, Ramos-Casals M, Rasmussen A, Seror R, Shiboski CH, Nakamura T, Vissink A, Saraux A, Devauchelle-Pensec V. Weight of salivary gland ultrasonography compared to other items of the 2016 ACR/EULAR classification criteria for Primary Sjögren's syndrome. J Intern Med 2020; 287:180-188. [PMID: 31618794 DOI: 10.1111/joim.12992] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Major salivary gland ultrasonography (SGUS) is widely used for the diagnosis of primary Sjögren's syndrome (pSS). Our objective was to assess the contribution of SGUS compared to other items of the 2016 ACR/EULAR pSS classification criteria, based on expert opinion. METHODS A secure web-based relational database was used by 24 experts from 14 countries to assess 512 realistic vignettes developed from data of patients with suspected pSS. Each vignette provided classification criteria items and information on history, clinical symptoms and SGUS findings. Each expert assessed 64 vignettes, and each vignette was assessed by 3 experts. A diagnosis of pSS was defined according to at least 2 of 3 experts. Validation was performed in the independent French DiapSS cohort of patients with suspected pSS. RESULTS A criteria-based pSS diagnosis and SGUS findings were independently associated with an expert diagnosis of pSS (P < 0.001). The derived diagnostic weights of individual items in the 2016 ACR/EULAR criteria including SGUS were as follows: anti-SSA, 3; focus score ≥ 1, 3; SGUS score ≥ 2, 1; positive Schirmer's test, 1; dry mouth, 1; and salivary flow rate < 0.1 mL/min, 1. The corrected C statistic area under the curve for the new weighted score was 0.96. Adding SGUS improves the sensitivity from 90.2 % to 95.6% with a quite similar specificity 84.1% versus 82.6%. Results were similar in the DiapSS cohort: adding SGUS improves the sensitivity from 87% to 93%. CONCLUSION SGUS had similar weight compared to minor items, and its addition improves the performance of the 2016 ACR/EULAR classification criteria.
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Affiliation(s)
- S Jousse-Joulin
- From the, Rheumatology Department, INSERM UMR 1227, Cavale Blanche Hospital and Brest Occidentale University, Brest, France
| | - F Gatineau
- INSERM CIC 1412, Brest Medical University Hospital, Brest, France
| | - C Baldini
- Rheumatology Unit, University of Pisa, Pisa, Italy
| | - A Baer
- Department of Medicine (Rheumatology), Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - F Barone
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - H Bootsma
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - S Bowman
- Department of Rheumatology, University Hospitals, Birmingham NHS Trust, Birmingham, UK
| | - P Brito-Zerón
- Autoimmune Diseases Unit, Department of Medicine, Hospital CIMA- Sanitas, Barcelona, Spain
| | - D Cornec
- From the, Rheumatology Department, INSERM UMR 1227, Cavale Blanche Hospital and Brest Occidentale University, Brest, France
| | - T Dorner
- Department of Medicine, Rheumatology and Clinical Immunology, Charite Universitätsmedizin Berlin and DRFZ Berlin, Berlin, Germany
| | - S de Vita
- Clinic of Rheumatology, Department of Medical and Biological Sciences, University Hospital "Santa Maria della Misericordia", Udine, Italy
| | - B Fisher
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - D Hammenfors
- Department of Rheumatology, Haukeland University Hospital, Bergen, Norway.,Section for Rheumatology, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - M Jonsson
- Section for Oral and Maxillofacial Radiology, Department of Clinical Dentistry, University of Bergen, Bergen, Norway
| | - X Mariette
- Center for Immunology of Viral Infections and Autoimmune Diseases, Assistance Publique, Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud, Le Kremlin-Bicêtre, France.,INSERM, Université Paris Sud, Paris, France
| | - V Milic
- Institute of Rheumatology, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - H Nakamura
- Department of Immunology and Rheumatology, Unit of Advanced Medical Sciences, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - W-F Ng
- Institute of Cellular Medicine, Newcastle University & NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne, UK
| | - E Nowak
- INSERM CIC 1412, Brest Medical University Hospital, Brest, France
| | - M Ramos-Casals
- Autoimmune Diseases Unit, Department of Medicine, Hospital CIMA- Sanitas, Barcelona, Spain
| | - A Rasmussen
- Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - R Seror
- Center for Immunology of Viral Infections and Autoimmune Diseases, Assistance Publique, Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud, Le Kremlin-Bicêtre, France.,INSERM, Université Paris Sud, Paris, France
| | - C H Shiboski
- Department of Orofacial Sciences, School of Dentistry, University of California, San Francisco, CA, USA
| | - T Nakamura
- Department of Radiology and Cancer Biology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - A Vissink
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - A Saraux
- From the, Rheumatology Department, INSERM UMR 1227, Cavale Blanche Hospital and Brest Occidentale University, Brest, France
| | - V Devauchelle-Pensec
- From the, Rheumatology Department, INSERM UMR 1227, Cavale Blanche Hospital and Brest Occidentale University, Brest, France
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Hanly JG, Li Q, Su L, Urowitz MB, Gordon C, Bae SC, Romero-Diaz J, Sanchez-Guerrero J, Bernatsky S, Clarke AE, Wallace DJ, Isenberg DA, Rahman A, Merrill JT, Fortin PR, Gladman DD, Bruce IN, Petri M, Ginzler EM, Dooley MA, Steinsson K, Ramsey-Goldman R, Zoma AA, Manzi S, Nived O, Jonsen A, Khamashta MA, Alarcón GS, Svenungsson E, van Vollenhoven RF, Aranow C, Mackay M, Ruiz-Irastorza G, Ramos-Casals M, Lim SS, Inanc M, Kalunian KC, Jacobsen S, Peschken CA, Kamen DL, Askanase A, Theriault C, Farewell V. Peripheral Nervous System Disease in Systemic Lupus Erythematosus: Results From an International Inception Cohort Study. Arthritis Rheumatol 2020; 72:67-77. [PMID: 31390162 PMCID: PMC6935421 DOI: 10.1002/art.41070] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [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: 02/01/2019] [Accepted: 08/01/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To determine the frequency, clinical characteristics, associations, and outcomes of different types of peripheral nervous system (PNS) disease in a multiethnic/multiracial, prospective inception cohort of systemic lupus erythematosus (SLE) patients. METHODS Patients were evaluated annually for 19 neuropsychiatric (NP) events including 7 types of PNS disease. SLE disease activity, organ damage, autoantibodies, and patient and physician assessment of outcome were measured. Time to event and linear regressions were used as appropriate. RESULTS Of 1,827 SLE patients, 88.8% were female, and 48.8% were white. The mean ± SD age was 35.1 ± 13.3 years, disease duration at enrollment was 5.6 ± 4.2 months, and follow-up was 7.6 ± 4.6 years. There were 161 PNS events in 139 (7.6%) of 1,827 patients. The predominant events were peripheral neuropathy (66 of 161 [41.0%]), mononeuropathy (44 of 161 [27.3%]), and cranial neuropathy (39 of 161 [24.2%]), and the majority were attributed to SLE. Multivariate Cox regressions suggested longer time to resolution in patients with a history of neuropathy, older age at SLE diagnosis, higher SLE Disease Activity Index 2000 scores, and for peripheral neuropathy versus other neuropathies. Neuropathy was associated with significantly lower Short Form 36 (SF-36) physical and mental component summary scores versus no NP events. According to physician assessment, the majority of neuropathies resolved or improved over time, which was associated with improvements in SF-36 summary scores for peripheral neuropathy and mononeuropathy. CONCLUSION PNS disease is an important component of total NPSLE and has a significant negative impact on health-related quality of life. The outcome is favorable for most patients, but our findings indicate that several factors are associated with longer time to resolution.
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Affiliation(s)
- John G Hanly
- Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Qiuju Li
- University of Cambridge, Cambridge, UK
| | - Li Su
- University of Cambridge, Cambridge, UK
| | - Murray B Urowitz
- Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Caroline Gordon
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Sang-Cheol Bae
- Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | | | | | | | - Ann E Clarke
- University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Daniel J Wallace
- Cedars-Sinai and University of California, Los Angeles School of Medicine
| | | | | | | | - Paul R Fortin
- CHU de Québec and Université Laval, Québec City, Québec, Canada
| | - Dafna D Gladman
- Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Ian N Bruce
- Arthritis Research UK Epidemiology Unit, University of Manchester, NIHR Manchester Musculoskeletal Biomedical Research Centre, and Manchester University NHS Foundation Trust, Manchester, UK
| | - Michelle Petri
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - M A Dooley
- University of North Carolina, Chapel Hill, North Carolina
| | | | | | | | - Susan Manzi
- Allegheny Health Network, Pittsburgh, Pennsylvania
| | | | | | - Munther A Khamashta
- St. Thomas' Hospital and King's College London School of Medicine, London, UK
| | | | | | | | - Cynthia Aranow
- Feinstein Institute for Medical Research, Manhasset, New York
| | - Meggan Mackay
- Feinstein Institute for Medical Research, Manhasset, New York
| | | | - Manuel Ramos-Casals
- Institut d'Investigacions Biomèdiques August Pi i Sunyer and Hospital Clínic de Barcelona, Barcelona, Spain
| | - S Sam Lim
- Emory University School of Medicine, Atlanta, Georgia
| | | | | | - Soren Jacobsen
- Rigshospitalet and Copenhagen University Hospital, Copenhagen, Denmark
| | | | | | | | - Chris Theriault
- Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Nova Scotia, Canada
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50
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Brito-Zerón P, Acar-Denizli N, Ng WF, Horváth IF, Rasmussen A, Seror R, Li X, Baldini C, Gottenberg JE, Danda D, Quartuccio L, Priori R, Hernandez-Molina G, Armagan B, Kruize AA, Kwok SK, Kvarnstrom M, Praprotnik S, Sene D, Gerli R, Solans R, Rischmueller M, Mandl T, Suzuki Y, Isenberg D, Valim V, Wiland P, Nordmark G, Fraile G, Bootsma H, Nakamura H, Giacomelli R, Devauchelle-Pensec V, Hofauer B, Bombardieri M, Trevisani VFM, Hammenfors D, Pasoto SG, Retamozo S, Gheita TA, Atzeni F, Morel J, Vollenweider C, Zeher M, Sivils K, Xu B, Bombardieri S, Sandhya P, De Vita S, Minniti A, Sánchez-Guerrero J, Kilic L, van der Heijden E, Park SH, Wahren-Herlenius M, Mariette X, Ramos-Casals M. Epidemiological profile and north–south gradient driving baseline systemic involvement of primary Sjögren’s syndrome. Rheumatology (Oxford) 2019; 59:2350-2359. [DOI: 10.1093/rheumatology/kez578] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 10/27/2019] [Indexed: 12/21/2022] Open
Abstract
Abstract
Objective
To characterize the systemic phenotype of primary Sjögren’s syndrome at diagnosis by analysing the EULAR-SS disease activity index (ESSDAI) scores.
Methods
The Sjögren Big Data Consortium is an international, multicentre registry based on worldwide data-sharing cooperative merging of pre-existing databases from leading centres in clinical research in Sjögren’s syndrome from the five continents.
Results
The cohort included 10 007 patients (9352 female, mean 53 years) with recorded ESSDAI scores available. At diagnosis, the mean total ESSDAI score was 6.1; 81.8% of patients had systemic activity (ESSDAI score ≥1). Males had a higher mean ESSDAI (8.1 vs 6.0, P < 0.001) compared with females, as did patients diagnosed at <35 years (6.7 vs 5.6 in patients diagnosed at >65 years, P < 0.001). The highest global ESSDAI score was reported in Black/African Americans, followed by White, Asian and Hispanic patients (6.7, 6.5, 5.4 and 4.8, respectively; P < 0.001). The frequency of involvement of each systemic organ also differed between ethnic groups, with Black/African American patients showing the highest frequencies in the lymphadenopathy, articular, peripheral nervous system, CNS and biological domains, White patients in the glandular, cutaneous and muscular domains, Asian patients in the pulmonary, renal and haematological domains and Hispanic patients in the constitutional domain. Systemic activity measured by the ESSDAI, clinical ESSDAI (clinESSDAI) and disease activity states was higher in patients from southern countries (P < 0.001).
Conclusion
The systemic phenotype of primary Sjögren’s syndrome is strongly influenced by personal determinants such as age, gender, ethnicity and place of residence, which are key geoepidemiological players in driving the expression of systemic disease at diagnosis.
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Affiliation(s)
- Pilar Brito-Zerón
- Department of Medicine, Autoimmune Diseases Unit, Hospital CIMA – Sanitas, Barcelona, Spain
- Sjögren Syndrome Research Group (AGAUR), Laboratory of Autoimmune Diseases Josep Font, IDIBAPS-CELLEX, Department of Autoimmune Diseases, ICMiD, University of Barcelona, Hospital Clínic, Barcelona, Spain
| | - Nihan Acar-Denizli
- Department of Statistics, Faculty of Science and Letters, Mimar Sinan Fine Arts University, Istanbul, Turkey
| | - Wan-Fai Ng
- Institute of Cellular Medicine, Newcastle University, NIHR Biomedical Research Centre, Newcastle Upon Tyne, UK
| | - Ildiko Fanny Horváth
- Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Astrid Rasmussen
- Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - Raphaele Seror
- Center for Immunology of Viral Infections and Autoimmune Diseases, Assistance Publique – Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud, Le Kremlin-Bicêtre, Université Paris Sud, INSERM, Paris, France
| | - Xiaomei Li
- Department of Rheumatology and Immunology, Anhui Provincial Hospital, Hefei, China
| | | | - Jacques-Eric Gottenberg
- Department of Rheumatology, Strasbourg University Hospital, Université de Strasbourg, CNRS, Strasbourg, France
| | - Debashish Danda
- Department of Clinical Immunology & Rheumatology, Christian Medical College & Hospital, Vellore, India
| | - Luca Quartuccio
- Clinic of Rheumatology, Department of Medical Area, University Hospital ‘Santa Maria della Misericordia’, Udine, Italy
| | - Roberta Priori
- Department of Internal Medicine and Medical Specialties, Rheumatology Clinic, Sapienza University of Rome, Rome, Italy
| | - Gabriela Hernandez-Molina
- Immunology and Rheumatology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, Mexico
| | - Berkan Armagan
- Department of Internal Medicine, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Aike A Kruize
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Seung-Ki Kwok
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Marika Kvarnstrom
- Division of Rheumatology, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Sonja Praprotnik
- Department of Rheumatology, University Medical Centre, Ljubljana, Slovenia
| | - Damien Sene
- Département de Médecine Interne, Hôpital Lariboisière, Université Paris VII, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Roberto Gerli
- Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy
| | - Roser Solans
- Department of Internal Medicine, Hospital Vall d'Hebron, Barcelona, Spain
| | - Maureen Rischmueller
- Department of Rheumatology, The Queen Elizabeth Hospital, Discipline of Medicine, University of Adelaide, South Australia, Australia
| | - Thomas Mandl
- Department of Rheumatology, Skane University Hospital Malmö, Lund University, Malmö, Sweden
| | - Yasunori Suzuki
- Division of Rheumatology, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan
| | - David Isenberg
- Centre for Rheumatology, Division of Medicine, University College London, London, UK
| | - Valeria Valim
- Department of Medicine, Federal University of Espírito Santo, Vitória, Brazil
| | - Piotr Wiland
- Department of Rheumatology and Internal Medicine, Wroclaw Medical Hospital, Wroclaw, Poland
| | - Gunnel Nordmark
- Rheumatology, Department of Medical Sciences, University of Uppsala, Uppsala, Sweden
| | - Guadalupe Fraile
- Department of Internal Medicine, Hospital Ramón y Cajal, Madrid, Spain
| | - Hendrika Bootsma
- Department of Rheumatology & Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Hideki Nakamura
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Roberto Giacomelli
- Clinical Unit of Rheumatology, School of Medicine, University of L'Aquila, L'Aquila, Italy
| | | | - Benedikt Hofauer
- Otorhinolaryngology / Head and Neck Surgery, University Medical Center Freiburg, Freiburg, Germany
| | - Michele Bombardieri
- Centre for Experimental Medicine and Rheumatology, Queen Mary University of London, London, UK
| | | | - Daniel Hammenfors
- Section for Rheumatology, Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Rheumatology, Haukeland University Hospital, Bergen, Norway
| | - Sandra G Pasoto
- Rheumatology Division, Hospital das Clinicas, Faculdade de Medicina da Universidade de Sao Paulo (HCFMUSP), Sao Paulo, Brazil
| | - Soledad Retamozo
- Instituto De Investigaciones En Ciencias De La Salud (INICSA), Universidad Nacional de Córdoba (UNC), Cordoba, Argentina
- Department of Rheumatology, Instituto Modelo de Cariología Privado S.R.L, Instituto Universitario de Ciencias Biomídicas de Córdoba, Cordoba, Argentina
| | - Tamer A Gheita
- Rheumatology Department, Kasr Al Ainy School of Medicine, Cairo University, Cairo, Egypt
| | - Fabiola Atzeni
- IRCCS Galeazzi Orthopedic Institute, Milan, Italy
- Rheumatology Unit, University of Messina, Messina, Italy
| | - Jacques Morel
- Department of Rheumatology, CHU Montpellier, University of Montpellier, Montpellier, France
| | | | - Margit Zeher
- Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Kathy Sivils
- Arthritis and Clinical Immunology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
| | - Bei Xu
- Department of Rheumatology and Immunology, Anhui Provincial Hospital, Hefei, China
| | | | - Pulukool Sandhya
- Department of Clinical Immunology & Rheumatology, Christian Medical College & Hospital, Vellore, India
| | - Salvatore De Vita
- Clinic of Rheumatology, Department of Medical Area, University Hospital ‘Santa Maria della Misericordia’, Udine, Italy
| | - Antonina Minniti
- Department of Internal Medicine and Medical Specialties, Rheumatology Clinic, Sapienza University of Rome, Rome, Italy
| | - Jorge Sánchez-Guerrero
- Immunology and Rheumatology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, Mexico
| | - Levent Kilic
- Department of Internal Medicine, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Eefje van der Heijden
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sung-Hwan Park
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Marie Wahren-Herlenius
- Division of Rheumatology, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Xavier Mariette
- Center for Immunology of Viral Infections and Autoimmune Diseases, Assistance Publique – Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud, Le Kremlin-Bicêtre, Université Paris Sud, INSERM, Paris, France
| | - Manuel Ramos-Casals
- Sjögren Syndrome Research Group (AGAUR), Laboratory of Autoimmune Diseases Josep Font, IDIBAPS-CELLEX, Department of Autoimmune Diseases, ICMiD, University of Barcelona, Hospital Clínic, Barcelona, Spain
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