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Carrascosa JM, Echarri A, Gavín Sebastián O, García de la Peña P, Martínez Pérez O, Ramirez S, Valderrama M, Montoro Álvarez M. Contraceptive Recommendations for Women with Immune-Mediated Inflammatory Diseases: A Delphi Consensus. Adv Ther 2024; 41:1372-1384. [PMID: 38326688 DOI: 10.1007/s12325-023-02779-5] [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: 11/07/2023] [Accepted: 12/21/2023] [Indexed: 02/09/2024]
Abstract
INTRODUCTION Immune-mediated inflammatory diseases (IMID) are a group of disorders characterized by chronic inflammation caused by an altered immune regulation in targeted organs or systems. IMID itself could have an implied increased risk of venous thromboembolism (VTE) and this risk varies throughout the course of the disease as well as with some contraceptive methods and treatments. The aim of this study was to present some key considerations in relation to contraception in women with IMID. METHODS This was an exploratory study conducted in Spain following the online modified Delphi methodology with two rounds of participation. Four questionnaires were designed for each medical specialty: gastroenterology, rheumatology, dermatology, and gynecology. Each questionnaire was divided in three domains: general recommendations about IMID, specific recommendations, and contraceptive methods for patients with IMID. A 5-point Likert scale measured agreement with each statement, with an 80% agreement threshold. Following the first round, the percentage of each response was calculated for every item. Subsequently, a second round was conducted to reach a consensus on the items for which discrepancies were observed. RESULTS A total of 52 and 50 experts participated in the first and second round, respectively. Participants agreed on the existence of a higher risk of VTE in inflammatory bowel diseases, psoriasis, and rheumatoid arthritis diseases. Regarding recommendations for contraceptive methods in patients with IMID, experts considered the hormonal intrauterine device (IUD) as a first-line contraceptive (80.0%) and low doses of progesterone-only pills if the latter is not recommended (88.0%). Most of the interviewees concurred on the importance of the patients' contraceptive needs during the disease course (98.1%). CONCLUSION Raising awareness and promoting a multidisciplinary relationship among the physicians involved in the therapeutic decisions by considering all the risk factors when prescribing a contraceptive method is important to prevent VTE in women with IMID.
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Affiliation(s)
- José Manuel Carrascosa
- Servicio de Dermatología, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, IGTP, Badalona, Spain
| | - Ana Echarri
- Servicio de Digestivo, Complejo Hospitalario Universitario de Ferrol, La Coruña, Spain
| | - Olga Gavín Sebastián
- Servicio de Hematología y Hemoterapia, Hospital Clínico Universitario Lozano Blesa, Saragossa, Spain
| | | | - Oscar Martínez Pérez
- Servicio de Obstetricia y Ginecología, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Susan Ramirez
- Pfizer Medical SLU, Av. de Europa, 20, B, Alcobendas, 28108, Madrid, Spain
| | - Mónica Valderrama
- Pfizer Medical SLU, Av. de Europa, 20, B, Alcobendas, 28108, Madrid, Spain
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Novella-Navarro M, Cabrera-Alarcón JL, Rosales-Alexander JL, González-Martín JJ, Carrión O, de la Peña PG. Primary Sjögren’s syndrome as independent risk factor for subclinical atherosclerosis. Eur J Rheumatol 2022; 9:20-25. [PMID: 35110133 PMCID: PMC10089143 DOI: 10.5152/eurjrheum.2021.20093] [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] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To assess the prevalence of subclinical atherosclerosis in patients with primary Sjögren's syndrome (pSS) and its possible association with clinical and analytical parameters of the disease. METHODS In this cross-sectional study, 38 consecutive patients with pSS were compared with 38 age and sex healthy controls. Demographic variables and classic cardiovascular risk factors (CVRFs): Hypertension, dyslipidemia, diabetes mellitus, obesity, and smoking habit were assessed in both groups, and also disease-related features were collected in pSS group. The presence of subclinical atherosclerosis was assessed by carotid ultrasound, with carotid intima-media thickness (CIMT) measurement and determination of the presence of atheromatous plaques. RESULTS Subclinical atherosclerosis presence was remarkably greater in patients with pSS than in healthy controls (OR = 4.17, 95%CI [1.27-16.54]), as well as CIMT values (0.79 ± 0.43mm vs. 0.66 ± 0.27mm; P = .02). No differences for classic CVRFs were found between both groups. An association of subclinical atherosclerosis with erythrocyte sedimentation rate (ESR) and rheumatoid factor (RF) was observed in patients with pSS. CONCLUSION This cohort showed a greater prevalence of subclinical atherosclerosis in patients with pSS, indicating this disease as an independent risk factor for presence of early vascular damage.
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Affiliation(s)
- Marta Novella-Navarro
- Department of Rheumatology, Hospital Universitario Sanchinarro, Madrid, Spain
- Address for correspondence: Marta Novella-Navarro; Department of Rheumatology, Hospital Universitario Sanchinarro, Madrid, Spain E-mail:
| | - José Luis Cabrera-Alarcón
- Bioinformatic Unit, GENOXPHOS-group Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | | | | | - Ofelia Carrión
- Department of Vascular Surgery, Hospital Universitario Sanchinarro, Madrid, Spain
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González-Martín JJ, Novella-Navarro M, Calvo-Aranda E, Cabrera-Alarcón JL, Carrión O, Abdelkader A, Aramburu F, Alcocer P, Sainz F, García de la Peña P. Endothelial dysfunction and subclinical atheromatosis in patients with systemic sclerosis. Clin Exp Rheumatol 2020; 38 Suppl 125:48-52. [PMID: 32083542] [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: 08/07/2019] [Accepted: 12/16/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To assess subclinical vascular features in patients with systemic sclerosis (SSc) via carotid ultrasound, and flow-mediated vasodilation (FMD), as measures of cardiovascular risk (CVR). METHODS This was a cross-sectional study of 70 patients diagnosed with SSc (diffuse or limited forms), on whom a vascular study protocol was performed to assess angiodynamic parameters measured by FMD in brachial artery and carotid ultrasound lesions: carotid intima-media thickness (CIMT) and carotid atheroma plaques (AP). Classical CVR factors were also assessed, as well as main features of SSc regarding skin and organic involvement, laboratory parameters, presence of autoantibodies and specific treatments. RESULTS 94% of patients were women with a mean age of 50.2±12.5 years. 84% had endothelial dysfunction (ED), being severe in 49%, statistically associated with glucocorticoid (GC) treatment (OR=8.78; CI=1.52-50.78; p=0.015). CIMT was pathological in 39%, 23% had AP (none had significative haemo-dymanic stenosis). Serum vitamin D concentration (25(OH)D3) showed a protective effect on CIMT (OR=0.94; CI=0.89-0.99; p=0.025). No differences between types of SSc were obtained; neither association between SSc features and classical CVR factors. CONCLUSIONS GC treatment has implications in CVR, despite in SSc GC doses administered are lower than in other autoimmune diseases (in our cohort even prednisone ≤10 mg daily was associated with ED). GC may be associated with an early vascular damage in these patients, which could lead to changes in FMD, ED and finally AP. On the other hand, optimum levels of 25(OH)D3 seemed to be beneficial against vascular damage.
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Affiliation(s)
| | | | | | | | - Ofelia Carrión
- Angiology & Vascular Surgery Department, University Hospital HM Sanchinarro, Madrid, Spain
| | - Afnan Abdelkader
- Angiology & Vascular Surgery Department, University Hospital HM Sanchinarro, Madrid, Spain
| | - Francisco Aramburu
- Rheumatology Department, University Hospital HM Sanchinarro, Madrid, Spain
| | - Patricia Alcocer
- Rheumatology Department, University Hospital HM Sanchinarro, Madrid, Spain
| | - Felipe Sainz
- Angiology & Vascular Surgery Department, University Hospital HM Sanchinarro, Madrid, Spain
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Álvarez B, Montero Á, Aramburu F, Calvo E, Ángel de la Casa M, Valero J, Hernando O, López M, Ciérvide R, García-Aranda M, Rodríguez S, Sánchez E, Chen X, Alonso R, García de la Peña P, Rubio C. Radiotherapy for ostheoarticular degenerative disorders: When nothing else works. Osteoarthritis and Cartilage Open 2020; 1:100016. [DOI: 10.1016/j.ocarto.2019.100016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 11/27/2019] [Indexed: 01/05/2023] Open
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Galindo-Izquierdo M, Rodriguez-Almaraz E, Pego-Reigosa JM, López-Longo FJ, Calvo-Alén J, Olivé A, Fernández-Nebro A, Martinez-Taboada V, Vela-Casasempere P, Freire M, Narváez FJ, Rosas J, Ibáñez-Barceló M, Uriarte E, Tomero E, Zea A, Horcada L, Torrente V, Castellvi I, Calvet J, Menor-Almagro R, Zamorano MAA, Raya E, Díez-Álvarez E, Vázquez-Rodríguez T, García de la Peña P, Movasat A, Andreu JL, Richi P, Marras C, Montilla-Morales C, Hernández-Cruz B, Marenco de la Fuente JL, Gantes M, Úcar E, Alegre-Sancho JJ, Manero J, Ibáñez-Ruán J, Rodríguez-Gómez M, Quevedo V, Hernández-Beriaín J, Silva-Fernández L, Alonso F, Pérez S, Rúa-Figueroa I. Characterization of Patients With Lupus Nephritis Included in a Large Cohort From the Spanish Society of Rheumatology Registry of Patients With Systemic Lupus Erythematosus (RELESSER). Medicine (Baltimore) 2016; 95:e2891. [PMID: 26945378 PMCID: PMC4782862 DOI: 10.1097/md.0000000000002891] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The aim of the study was to profile those patients included in the RELESSER registry with histologically proven renal involvement in order to better understand the current state of lupus nephritis (LN) in Spain. RELESSER-TRANS is a multicenter cross-sectional registry with an analytical component. Information was collected from the medical records of patients with systemic lupus erythematosus who were followed at participating rheumatology units. A total of 359 variables including demographic data, clinical manifestations, disease activity, severity, comorbidities, LN outcome, treatments, and mortality were recorded. Only patients with a histological confirmation of LN were included. We performed a descriptive analysis, chi-square or Student's t tests according to the type of variable and its relationship with LN. Odds ratio and confidence intervals were calculated by using simple logistic regression. LN was histologically confirmed in 1092/3575 patients (30.5%). Most patients were female (85.7%), Caucasian (90.2%), and the mean age at LN diagnosis was 28.4 ± 12.7 years. The risk for LN development was higher in men (M/F:47.85/30.91%, P < 0.001), in younger individuals (P < 0.001), and in Hispanics (P = 0.03). Complete response to treatment was achieved in 68.3% of patients; 10.35% developed ESRD, which required a kidney transplant in 45% of such cases. The older the patient, the greater was the likelihood of complete response (P < 0.001). Recurrences were associated with persistent lupus activity at the time of the last visit (P < 0.001) and with ESRD (P < 0.001). Thrombotic microangiopathy was a risk factor for ESRD (P = 0.04), as for the necessity of dialysis (P = 0.01) or renal transplantation (P = 0.03). LN itself was a poor prognostic risk factor of mortality (OR 2.4 [1.81-3.22], P < 0.001). Patients receiving antimalarials had a significantly lower risk of developing LN (P < 0.001) and ESRD (P < 0.001), and responded better to specific treatments for LN (P = 0.014). More than two-thirds of the patients with LN from a wide European cohort achieved a complete response to treatment. The presence of positive anti-Sm antibodies was associated with a higher frequency of LN and a decreased rate of complete response to treatment. The use of antimalarials reduced both the risk of developing renal disease and its severity, and contributed to attaining a complete renal response.
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Affiliation(s)
- María Galindo-Izquierdo
- From the Rheumatology Department, Hospital 12 Octubre, Madrid (MG-I, ER-A); Rheumatology (JMP-R), University Hospital Complex, Instituto de Investigación Biomédica, Vigo, Spain; Rheumatology Department (FJL-L), Gregorio Marañón University Hospital, Madrid; Rheumatology Department (JC-A), Sierrallana Hospital, Torrelavega; Rheumatology Department (AO), Germans Trías i Pujol University Hospital, Badalona; Rheumatology Department (AF-N), Hospital Regional Universitario de Málaga, Málaga; Rheumatology Department (VM-T), Marques de Valdecilla Hospital, Santander; Rheumatology Department (PV-C), Hospital General de Alicante, Alicante; Rheumatology Department (MF), Hospital Universitario Juan Canalejo, Coruña; Rheumatology Department (FJN), Hospital Universitario de Bellvitge, Barcelona; Rheumatology Department (JR), Hospital Marina Baixa, Villajoyosa; Rheumatology Department (MI-B), Hospital Son Llatzer, Palma de Mallorca; Rheumatology Department (EU), Hospital de Donosti, San Sebastián; Rheumatology Department (ET), Hospital Universitario de La Princesa; Rheumatology Department (AZ), Hospital Universitario Ramón y Cajal, Madrid; Rheumatology Department (LH), Complejo Hospitalario de Navarra, Pamplona; Rheumatology Department (VT), Hospital Moisés Broggi; Rheumatology Department (IC), Hospital de la Santa Creu i Sant Pau, Barcelona; Rheumatology Department (JC), Hospital Parc Taulí. Sabadell; Rheumatology Department (RM-A), Hospital de Jerez, Jerez de la Frontera; Rheumatology Department (MAAZ), IMIBIC-Reina Sofia Hospital, Cordoba; Rheumatology Department (ER), University Hospital San Cecilio, Granada; Rheumatology Department (ED-Á), Leon Hospital, Leon; Rheumatology Department (TV-R), Hospital Lucus Augusti, Lugo; Rheumatology Department (PGDlP), Hospital Norte Sanchinarro, Madrid; Rheumatology Department (AM), Hospital Universitario Príncipe de Asturias, Alcalá de Henares; Rheumatology Department (JLA), Hospital Puerta de Hierro, Majadahonda, Madrid; Rheumatology Department (PR), Hospital Infanta Sofía, San Sebastián de los Reyes, Madrid; Rheumatology Department (CM), Hospital Virgen de la Arrixaca, Murcia, Spain; Rheumatology Department (CM-M), Hospital Clínico Universitario de Salamanca, Salamanca; Rheumatology Department (BH-C), University Hospital Virgen Macarena; Rheumatology Department (JLMDlF), Hospital de Valme, Sevilla; Rheumatology Department (MG), Hospital Universitario de Canarias, Tenerife; Rheumatology Department (EÚ), Hospital de Basurto, Bilbao; Rheumatology Department (JJA-S), Hospital Universitario Dr Peset, Valencia; Rheumatology Department (JM), Hospital Miguel Servet Zaragoza; Rheumatology Department (JI-R), Clínica POVISA, Vigo; Rheumatology Department (MR-G), Complejo Hospitalario Universitario de Ourense, Ourense; Rheumatology Department (VQ), Hospital de Monforte, Lugo; Rheumatology Department (JH-B), Hospital Insular de Gran Canaria, Las Palmas de Gran Canaria; Rheumatology Department (LSF), Hospital Universitario de Guadalajara, Guadalajara; Statistical Department (FA, SP), Research Unit, Spanish Society of Rheumatology (SER), Madrid; and Rheumatology Department (IR-F), Doctor Negrín University Hospital, Gran Canaria, Spain
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López-Isac E, Campillo-Davo D, Bossini-Castillo L, Guerra SG, Assassi S, Simeón CP, Carreira P, Ortego-Centeno N, García de la Peña P, Beretta L, Santaniello A, Bellocchi C, Lunardi C, Moroncini G, Gabrielli A, Riemekasten G, Witte T, Hunzelmann N, Kreuter A, Distler JH, Voskuyl AE, de Vries-Bouwstra J, Herrick A, Worthington J, Denton CP, Fonseca C, Radstake TR, Mayes MD, Martín J. Influence of TYK2 in systemic sclerosis susceptibility: a new locus in the IL-12 pathway. Ann Rheum Dis 2015; 75:1521-6. [PMID: 26338038 DOI: 10.1136/annrheumdis-2015-208154] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 08/13/2015] [Indexed: 12/14/2022]
Abstract
OBJECTIVES TYK2 is a common genetic risk factor for several autoimmune diseases. This gene encodes a protein kinase involved in interleukin 12 (IL-12) pathway, which is a well-known player in the pathogenesis of systemic sclerosis (SSc). Therefore, we aimed to assess the possible role of this locus in SSc. METHODS This study comprised a total of 7103 patients with SSc and 12 220 healthy controls of European ancestry from Spain, USA, Germany, the Netherlands, Italy and the UK. Four TYK2 single-nucleotide polymorphisms (V362F (rs2304256), P1104A (rs34536443), I684S (rs12720356) and A928V (rs35018800)) were selected for follow-up based on the results of an Immunochip screening phase of the locus. Association and dependence analyses were performed by the means of logistic regression and conditional logistic regression. Meta-analyses were performed using the inverse variance method. RESULTS Genome-wide significance level was reached for TYK2 V362F common variant in our pooled analysis (p=3.08×10(-13), OR=0.83), while the association of P1104A, A928V and I684S rare and low-frequency missense variants remained significant with nominal signals (p=2.28×10(-3), OR=0.80; p=1.27×10(-3), OR=0.59; p=2.63×10(-5), OR=0.83, respectively). Interestingly, dependence and allelic combination analyses showed that the strong association observed for V362F with SSc, corresponded to a synthetic association dependent on the effect of the three previously mentioned TYK2 missense variants. CONCLUSIONS We report for the first time the association of TYK2 with SSc and reinforce the relevance of the IL-12 pathway in SSc pathophysiology.
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Affiliation(s)
- Elena López-Isac
- Institute of Parasitology and Biomedicine López-Neyra, IPBLN-CSIC, PTS Granada, Granada, Spain
| | - Diana Campillo-Davo
- Institute of Parasitology and Biomedicine López-Neyra, IPBLN-CSIC, PTS Granada, Granada, Spain
| | - Lara Bossini-Castillo
- Institute of Parasitology and Biomedicine López-Neyra, IPBLN-CSIC, PTS Granada, Granada, Spain
| | - Sandra G Guerra
- Centre for Rheumatology, Royal Free and University College Medical School, London, UK
| | - Shervin Assassi
- Division of Rheumatology and Clinical Immunogenetics, The University of Texas Health Science Center-Houston, Houston, USA
| | | | - Patricia Carreira
- Department of Rheumatology, 12 de Octubre University Hospital, Madrid, Spain
| | | | | | | | - Lorenzo Beretta
- Referral Center for Systemic Autoimmune Diseases, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Alessandro Santaniello
- Referral Center for Systemic Autoimmune Diseases, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Chiara Bellocchi
- Referral Center for Systemic Autoimmune Diseases, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Claudio Lunardi
- Department of Medicine, Università degli Studi di Verona, Verona, Italy
| | - Gianluca Moroncini
- Clinica Medica, Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche and Ospedali Riuniti, Ancona, Italy
| | - Armando Gabrielli
- Clinica Medica, Dipartimento di Scienze Cliniche e Molecolari, Università Politecnica delle Marche and Ospedali Riuniti, Ancona, Italy
| | - Gabriela Riemekasten
- Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin, Germany German Rheumatism Research Center (DRFZ), a Leibniz Institute, Berlin, Germany
| | - Torsten Witte
- Department of Clinical Immunology, Hannover Medical School, Hannover, Germany
| | | | - Alexander Kreuter
- Department of Dermatology, Venereology, and Allergology, HELIOS St Elisabeth Hospital Oberhausen, Germany
| | - Jörg Hw Distler
- Department of Internal Medicine, Institute for Clinical Immunology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Alexandre E Voskuyl
- Department of Rheumatology, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Ariane Herrick
- Centre for Musculoskeletal Research and NIHR Manchester Musculoskeletal Biomedical Research Unit, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Jane Worthington
- Centre for Musculoskeletal Research and NIHR Manchester Musculoskeletal Biomedical Research Unit, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Christopher P Denton
- Centre for Rheumatology, Royal Free and University College Medical School, London, UK
| | - Carmen Fonseca
- Centre for Rheumatology, Royal Free and University College Medical School, London, UK
| | - Timothy Rdj Radstake
- Department of Rheumatology & Clinical Immunology, Laboratory of Translational Immunology, department of Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Maureen D Mayes
- Division of Rheumatology and Clinical Immunogenetics, The University of Texas Health Science Center-Houston, Houston, USA
| | - Javier Martín
- Institute of Parasitology and Biomedicine López-Neyra, IPBLN-CSIC, PTS Granada, Granada, Spain
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Rúa-Figueroa Í, Richi P, López-Longo FJ, Galindo M, Calvo-Alén J, Olivé-Marqués A, Loza-Santamaría E, Vicente SP, Erausquin C, Tomero E, Horcada L, Uriarte E, Sánchez-Atrio A, Rosas J, Montilla C, Fernández-Nebro A, Rodríguez-Gómez M, Vela P, Blanco R, Freire M, Silva L, Díez-Álvarez E, Ibáñez-Barceló M, Zea A, Narváez J, Martínez-Taboada V, Marenco JL, de Castro MF, Fernández-Berrizbeitia O, Hernández-Beriain JÁ, Gantes M, Hernández-Cruz B, Pérez-Venegas JJ, Pecondón Á, Marras C, Carreira P, Bonilla G, Torrente V, Castellví I, Alegre J, Moreno M, Raya E, de la Peña PG, Vázquez T, Aguirre Á, Quevedo V, Pego-Reigosa JM. Comprehensive description of clinical characteristics of a large systemic lupus erythematosus cohort from the Spanish Rheumatology Society Lupus Registry (RELESSER) with emphasis on complete versus incomplete lupus differences. Medicine (Baltimore) 2015; 94:e267. [PMID: 25569641 PMCID: PMC4602842 DOI: 10.1097/md.0000000000000267] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 10/22/2014] [Accepted: 10/23/2014] [Indexed: 10/26/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by multiple organ involvement and pronounced racial and ethnic heterogeneity. The aims of the present work were (1) to describe the cumulative clinical characteristics of those patients included in the Spanish Rheumatology Society SLE Registry (RELESSER), focusing on the differences between patients who fulfilled the 1997 ACR-SLE criteria versus those with less than 4 criteria (hereafter designated as incomplete SLE (iSLE)) and (2) to compare SLE patient characteristics with those documented in other multicentric SLE registries.RELESSER is a multicenter hospital-based registry, with a collection of data from a large, representative sample of adult patients with SLE (1997 ACR criteria) seen at Spanish rheumatology departments. The registry includes demographic data, comprehensive descriptions of clinical manifestations, as well as information about disease activity and severity, cumulative damage, comorbidities, treatments and mortality, using variables with highly standardized definitions.A total of 4.024 SLE patients (91% with ≥4 ACR criteria) were included. Ninety percent were women with a mean age at diagnosis of 35.4 years and a median duration of disease of 11.0 years. As expected, most SLE manifestations were more frequent in SLE patients than in iSLE ones and every one of the ACR criteria was also associated with SLE condition; this was particularly true of malar rash, oral ulcers and renal disorder. The analysis-adjusted by gender, age at diagnosis, and disease duration-revealed that higher disease activity, damage and SLE severity index are associated with SLE [OR: 1.14; 95% CI: 1.08-1.20 (P < 0.001); 1.29; 95% CI: 1.15-1.44 (P < 0.001); and 2.10; 95% CI: 1.83-2.42 (P < 0.001), respectively]. These results support the hypothesis that iSLE behaves as a relative stable and mild disease. SLE patients from the RELESSER register do not appear to differ substantially from other Caucasian populations and although activity [median SELENA-SLEDA: 2 (IQ: 0-4)], damage [median SLICC/ACR/DI: 1 (IQ: 0-2)], and severity [median KATZ index: 2 (IQ: 1-3)] scores were low, 1 of every 4 deaths was due to SLE activity.RELESSER represents the largest European SLE registry established to date, providing comprehensive, reliable and updated information on SLE in the southern European population.
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Affiliation(s)
- Íñigo Rúa-Figueroa
- From the Doctor Negrín University Hospital of Gran Canaria, Las Palmas GC, Las Plamas, Spain (ÍRF); Rheumatology Department Hospital Infanta Sofía, Madrid Spain (PR); Rheumatology Department Gregorio Marañón University Hospital, Madrid Spain (FJLL); Rheumatology Department Doce de Octubre University Hospital, Madrid Spain (MG); Rheumatology Department Sierrallana Hospital, Torrelavega Spain (JCA); Rheumatology Department Germans Trías i Pujol University Hospital, Badalona Spain (AOM); Research Unit Spanish Society of Rheumatology, Madrid Spain (ELS); Statistical Department Research Unit. Spanish Society of Rheumatology (SER); Madrid Spain (SPV); Rheumatology Department Dr Negrin General Hospital, Las Palmas de Gran Canaria, Spain (CE); Rheumatology Department La Princesa University Hospital, Madrid Spain (ET); Rheumatology Department Navarra Hospital Spain (LH); Rheumatology Department Donosti Hospital, Guipuzcoa Spain (EU); Rheumatology Department Príncipe de Asturias University Hospital, Madrid, Spain (ASA); Rheumatology Department H Marina Baixa, Alicante Spain (JR); Rheumatology Department Salamanca Clinic University Hospital Spain (CM); Rheumatology Department Carlos Haya University Hospital, Málaga, Spain (AFN); Rheumatology Department Hospital Complex of Ourense, Ourense Spain (MRG); Rheumatology Department Alicante General Hospital, Alicante, Spain (PV); Rheumatology Department Marqués de Valdecilla University Hospital, Santander Spain (RB); Rheumatology Department Juan Canalejo University Hospital, La Coruña Spain (MF); Rheumatology Department Guadalajara Hospital, Guadalajara Spain (LS); Rheumatology Department León Hospital, León Spain (EDÁ); Rheumatology Department Son Llatzer Hospital, Mallorca Spain (MIB); Rheumatology Department Ramon y Cajal, University Hospital, Madrid Spain (AZ); Rheumatology Department Bellvitge Hospital, Barcelona, Spain (JN); Rheumatology Department Marqués de Valdecilla University Hospital, Santander Spain (VMT); Rheumatology Department Valme Hospital, Sevilla Spain, (JLM); Rheumatology Department Puerta del Hierro-Majadahonda Hospital, Madrid Spain (MFC); Rheumatology Department Basurto Hospital, Basurto Spain (OFB); Rheumatology Department Hospital Insular of Gran Canaria, Gran Canaria Spain (JÁH); Rheumatology Department Tenerife Clinic Hospital, Tenerife Spain (MG); Rheumatology Department Virgen Macarena Hospital, Sevilla Spain (BHC); Rheumatology Department Jerez de la Frontera University Hospital, Cádiz Spain (JJPV); Rheumatology Department Miguel Servet University Hospital, Zaragoza Spain (ÁP); Rheumatology Department Virgen de la Arrixaca University Hospital, Murcia Spain (CM); Rheumatology Department Doce de Octubre University Hospital, Madrid Spain (PC); Rheumatology Department La Paz University Hospital, Madrid Spain (GB); MD, Rheumatology Department Hospitalet General Hospital, Hospitalet, Barcelona Spain (VT); Rheumatology Unit L'Alt Penedés District Hospital Spain (IC); Rheumatology Department Dr. Peset Hospital, Valencia Spain (JA); Rheumatology Department Parc Taulí Hospital, Barcelona Spain (MM); Rheumatology Department San Cecilio Hospital, Granada Spain (ER); Rheumatology Department Hospital Universitario Sanchinarro, Madrid Spain (PGP); Rheumatology Department Lucus Augusti, Kugo Spain (TV); Rheumatology Department Reina Sofía University Hospital, Cordoba Spain (ÁA); Rheumatology Unit Monforte Hospital, Lugo Spain (VQ); University Hospital Complex, Instituto de Investigación Biomédica de Vigo(IBIV) (Spain) Alto do Meixoeiro s/n, 36200 Vigo Spain (JMPR)
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Teruel M, Simeon CP, Broen J, Carreira P, García de la Peña P, Aguirre MÁ, Beretta L, Witte T, Kreuter A, Vonk MC, Voskuyl AE, Schuerwegh AJ, Radstake TRDJ, Martin J. The role of the NLRP1 gene in systemic sclerosis: a replication study. Clin Exp Rheumatol 2013; 31:187-188. [PMID: 23380025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Accepted: 09/05/2012] [Indexed: 06/01/2023]
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Cénit MC, Simeón CP, Vonk MC, Callejas-Rubio JL, Espinosa G, Carreira P, Blanco FJ, Narvaez J, Tolosa C, Román-Ivorra JA, Gómez-García I, García-Hernández FJ, Gallego M, García-Portales R, Egurbide MV, Fonollosa V, García de la Peña P, López-Longo FJ, González-Gay MA, Hesselstrand R, Riemekasten G, Witte T, Voskuyl AE, Schuerwegh AJ, Madhok R, Fonseca C, Denton C, Nordin A, Palm Ø, van Laar JM, Hunzelmann N, Distler JHW, Kreuter A, Herrick A, Worthington J, Koeleman BP, Radstake TRDJ, Martín J. Influence of the IL6 gene in susceptibility to systemic sclerosis. J Rheumatol 2012; 39:2294-302. [PMID: 23027890 DOI: 10.3899/jrheum.120506] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Systemic sclerosis (SSc) is a genetically complex autoimmune disease; the genetic component has not been fully defined. Interleukin 6 (IL-6) plays a crucial role in immunity and fibrosis, both key aspects of SSc. We investigated the influence of IL6 gene in the susceptibility and phenotype expression of SSc. METHODS We performed a large metaanalysis including a total of 2749 cases and 3189 controls from 6 white populations (Germany, The Netherlands, Norway, Spain, Sweden, and United Kingdom). Three IL6 single-nucleotide polymorphisms (SNP; rs2069827, rs1800795, and rs2069840) were selected by SNP tagging and genotyped using TaqMan(®) allele discrimination technology. RESULTS Individual SNP metaanalysis showed no evidence of association of the 3 IL6 genetic variants with the global disease. Phenotype analyses revealed a significant association between the minor allele of rs2069840 and the limited cutaneous SSc clinical form (Bonferroni p = 0.036, OR 1.14, 95% CI 1.04-1.25). A trend of association between the minor allele of the rs1800795 and the diffuse cutaneous SSc clinical form was also evident (Bonferroni p = 0.072, OR 0.86, 95% CI 0.77-0.96). In the IL6 allelic combination analyses, the GGC allelic combination rs2069827-rs1800795-rs2069840 showed an association with overall SSc (Bonferroni p = 0.016, OR 1.13, 95% CI 1.04-1.23). CONCLUSION Our results suggest that the IL6 gene may influence the development of SSc and its progression.
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Affiliation(s)
- Maria Carmen Cénit
- Instituto de Parasitología y Biomedicina López-Neyra,IPBLN-CSIC, Granada, The Netherlands.
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Bossini-Castillo L, Martin JE, Broen J, Simeon CP, Beretta L, Gorlova OY, Vonk MC, Ortego-Centeno N, Espinosa G, Carreira P, García de la Peña P, Oreiro N, Román-Ivorra JA, Castillo MJ, González-Gay MA, Sáez-Comet L, Castellví I, Schuerwegh AJ, Voskuyl AE, Hoffmann-Vold AM, Hesselstrand R, Nordin A, Lunardi C, Scorza R, van Laar JM, Shiels PG, Herrick A, Worthington J, Fonseca C, Denton C, Tan FK, Arnett FC, Assassi S, Koeleman BP, Mayes MD, Radstake TRDJ, Martin J. Confirmation of TNIP1 but not RHOB and PSORS1C1 as systemic sclerosis risk factors in a large independent replication study. Ann Rheum Dis 2012; 72:602-7. [PMID: 22896740 DOI: 10.1136/annrheumdis-2012-201888] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
INTRODUCTION A recent genome-wide association study in European systemic sclerosis (SSc) patients identified three loci (PSORS1C1, TNIP1 and RHOB) as novel genetic risk factors for the disease. The aim of this study was to replicate the previously mentioned findings in a large multicentre independent SSc cohort of Caucasian ancestry. METHODS 4389 SSc patients and 7611 healthy controls from different European countries and the USA were included in the study. Six single nucleotide polymorphisms (SNP): rs342070, rs13021401 (RHOB), rs2233287, rs4958881, rs3792783 (TNIP1) and rs3130573 (PSORS1C1) were analysed. Overall significance was calculated by pooled analysis of all the cohorts. Haplotype analyses and conditional logistic regression analyses were carried out to explore further the genetic structure of the tested loci. RESULTS Pooled analyses of all the analysed SNPs in TNIP1 revealed significant association with the whole disease (rs2233287 p(MH)=1.94×10(-4), OR 1.19; rs4958881 p(MH)=3.26×10(-5), OR 1.19; rs3792783 p(MH)=2.16×10(-4), OR 1.19). These associations were maintained in all the subgroups considered. PSORS1C1 comparison showed association with the complete set of patients and all the subsets except for the anti-centromere-positive patients. However, the association was dependent on different HLA class II alleles. The variants in the RHOB gene were not associated with SSc or any of its subsets. CONCLUSIONS These data confirmed the influence of TNIP1 on an increased susceptibility to SSc and reinforced this locus as a common autoimmunity risk factor.
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Affiliation(s)
- Lara Bossini-Castillo
- Department of Immunology, Instituto de Parasitología y Biomedicina López-Neyra, IPBLN-CSIC, Consejo Superior de Investigaciones Científicas, Parque Tecnológico Ciencias de la Salud, Avenida del Conocimiento s/n 18100-Armilla, Granada, Spain.
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Martin JE, Broen JC, Carmona FD, Teruel M, Simeon CP, Vonk MC, van 't Slot R, Rodriguez-Rodriguez L, Vicente E, Fonollosa V, Ortego-Centeno N, González-Gay MA, García-Hernández FJ, de la Peña PG, Carreira P, Voskuyl AE, Schuerwegh AJ, van Riel PLCM, Kreuter A, Witte T, Riemekasten G, Airo P, Scorza R, Lunardi C, Hunzelmann N, Distler JHW, Beretta L, van Laar J, Chee MM, Worthington J, Herrick A, Denton C, Tan FK, Arnett FC, Assassi S, Fonseca C, Mayes MD, Radstake TRDJ, Koeleman BPC, Martin J. Identification of CSK as a systemic sclerosis genetic risk factor through Genome Wide Association Study follow-up. Hum Mol Genet 2012; 21:2825-35. [PMID: 22407130 DOI: 10.1093/hmg/dds099] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Systemic sclerosis (SSc) is complex autoimmune disease affecting the connective tissue; influenced by genetic and environmental components. Recently, we performed the first successful genome-wide association study (GWAS) of SSc. Here, we perform a large replication study to better dissect the genetic component of SSc. We selected 768 polymorphisms from the previous GWAS and genotyped them in seven replication cohorts from Europe. Overall significance was calculated for replicated significant SNPs by meta-analysis of the replication cohorts and replication-GWAS cohorts (3237 cases and 6097 controls). Six SNPs in regions not previously associated with SSc were selected for validation in another five independent cohorts, up to a total of 5270 SSc patients and 8326 controls. We found evidence for replication and overall genome-wide significance for one novel SSc genetic risk locus: CSK [P-value = 5.04 × 10(-12), odds ratio (OR) = 1.20]. Additionally, we found suggestive association in the loci PSD3 (P-value = 3.18 × 10(-7), OR = 1.36) and NFKB1 (P-value = 1.03 × 10(-6), OR = 1.14). Additionally, we strengthened the evidence for previously confirmed associations. This study significantly increases the number of known putative genetic risk factors for SSc, including the genes CSK, PSD3 and NFKB1, and further confirms six previously described ones.
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Carmona FD, Gutala R, Simeón CP, Carreira P, Ortego-Centeno N, Vicente-Rabaneda E, García-Hernández FJ, García de la Peña P, Fernández-Castro M, Martínez-Estupiñán L, Egurbide MV, Tsao BP, Gourh P, Agarwal SK, Assassi S, Mayes MD, Arnett FC, Tan FK, Martín J. Novel identification of the IRF7 region as an anticentromere autoantibody propensity locus in systemic sclerosis. Ann Rheum Dis 2011; 71:114-9. [PMID: 21926187 DOI: 10.1136/annrheumdis-2011-200275] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Systemic sclerosis (SSc) and systemic lupus erythematosus (SLE) are related chronic autoimmune diseases of complex aetiology in which the interferon (IFN) pathway plays a key role. Recent studies have reported an association between IRF7 and SLE which confers a risk to autoantibody production. A study was undertaken to investigate whether the IRF7 genomic region is also involved in susceptibility to SSc and the main clinical features. METHODS Two case-control sets of Caucasian origin from the USA and Spain, comprising a total of 2316 cases of SSc and 2347 healthy controls, were included in the study. Five single nucleotide polymorphisms (SNPs) in the PHRF1-IRF7-CDHR5 locus were genotyped using TaqMan allelic discrimination technology. A meta-analysis was performed to test the overall effect of these genetic variants on SSc. RESULTS Four out of five analysed SNPs were significantly associated with the presence of anticentromere autoantibodies (ACA) in the patients with SSc in the combined analysis (rs1131665: p(FDR)=6.14 × 10(-4), OR=0.78; rs4963128: p(FDR)=6.14 × 10(-4), OR=0.79; rs702966: p(FDR)=3.83 × 10(-3), OR=0.82; and rs2246614: p(FDR)=3.83 × 10(-3), OR=0.83). Significant p values were also obtained when the disease was tested globally; however, the statistical significance was lost when the ACA-positive patients were excluded from the study, suggesting that these associations rely on ACA positivity. Conditional logistic regression and allelic combination analyses suggested that the functional IRF7 SNP rs1131665 is the most likely causal variant. CONCLUSIONS The results show that variation in the IRF7 genomic region is associated with the presence of ACA in patients with SSc, supporting other evidence that this locus represents a common risk factor for autoantibody production in autoimmune diseases.
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Affiliation(s)
- F David Carmona
- Instituto de Parasitología y Biomedicina López-Neyra, Consejo Superior de Investigaciones Científicas, Parque Tecnológico Ciencias de Salud, Avenida del Conocimiento s/n 18100-Armilla, Granada, Spain.
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Carmona FD, Serrano-Lopera A, López-Isac E, Simeón CP, Carreira P, Rios-Fernandez R, Espinosa G, Camps MT, Navarrete N, González-Escribano MF, Vicente-Rabaneda E, Rodríguez-Rodríguez L, Tolosa C, Beltrán E, Gómez-Garcia I, Fernández-Castro M, López-Longo FJ, García-Hernández FJ, Castellví I, Trapiella L, Fernández-Nebro A, García-Portales R, Egurbide MV, Fonollosa V, García de la Peña P, Pros A, Rodríguez-Carballeira M, Díaz-Gónzalez F, Sáez-Comet L, González-Gay MA, Martín J. No evidence for association between the CCR5/Delta32CCR5 polymorphism and systemic sclerosis. Clin Exp Rheumatol 2011; 29:895-896. [PMID: 22011385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Accepted: 05/23/2011] [Indexed: 05/31/2023]
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Bossini-Castillo L, Broen JCA, Simeon CP, Beretta L, Vonk MC, Ortego-Centeno N, Espinosa G, Carreira P, Camps MT, Navarrete N, González-Escribano MF, Vicente-Rabaneda E, Rodríguez L, Tolosa C, Román-Ivorra JA, Gómez-Gracia I, García-Hernández FJ, Castellví I, Gallego M, Fernández-Nebro A, García-Portales R, Egurbide MV, Fonollosa V, de la Peña PG, Pros A, González-Gay MA, Hesselstrand R, Riemekasten G, Witte T, Coenen MJH, Koeleman BP, Houssiau F, Smith V, de Keyser F, Westhovens R, De Langhe E, Voskuyl AE, Schuerwegh AJ, Chee MM, Madhok R, Shiels P, Fonseca C, Denton C, Claes K, Padykov L, Nordin A, Palm Ø, Lie BA, Airó P, Scorza R, van Laar JM, Hunzelmann N, Kreuter A, Herrick A, Worthington J, Radstake TRDJ, Martín J, Rueda B. A replication study confirms the association of TNFSF4 (OX40L) polymorphisms with systemic sclerosis in a large European cohort. Ann Rheum Dis 2010; 70:638-41. [DOI: 10.1136/ard.2010.141838] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
ObjectivesThe aim of this study was to confirm the influence of TNFSF4 polymorphisms on systemic sclerosis (SSc) susceptibility and phenotypic features.MethodsA total of 8 European populations of Caucasian ancestry were included, comprising 3014 patients with SSc and 3125 healthy controls. Four genetic variants of TNFSF4 gene promoter (rs1234314, rs844644, rs844648 and rs12039904) were selected as genetic markers.ResultsA pooled analysis revealed the association of rs1234314 and rs12039904 polymorphisms with SSc (OR 1.15, 95% CI 1.02 to 1.31; OR 1.18, 95% CI 1.08 to 1.29, respectively). Significant association of the four tested variants with patients with limited cutaneous SSc (lcSSc) was revealed (rs1234314 OR 1.22, 95% CI 1.07 to 1.38; rs844644 OR 0.91, 95% CI 0.83 to 0.99; rs844648 OR 1.10, 95% CI 1.01 to 1.20 and rs12039904 OR 1.20, 95% CI 1.09 to 1.33). Association of rs1234314, rs844648 and rs12039904 minor alleles with patients positive for anti-centromere antibodies (ACA) remained significant (OR 1.23, 95% CI 1.10 to 1.37; OR 1.12, 95% CI 1.01 to 1.25; OR 1.22, 95% CI 1.07 to 1.38, respectively). Haplotype analysis confirmed a protective haplotype associated with SSc, lcSSc and ACA positive subgroups (OR 0.88, 95% CI 0.82 to 0.96; OR 0.88, 95% CI 0.80 to 0.96; OR 0.86, 95% CI 0.77 to 0.97, respectively) and revealed a new risk haplotype associated with the same groups of patients (OR 1.14, 95% CI 1.03 to 1.26; OR 1.20, 95% CI 1.08 to 1.35; OR 1.23, 95% CI 1.07 to 1.42, respectively).ConclusionsThe data confirm the influence of TNFSF4 polymorphisms in SSc genetic susceptibility, especially in subsets of patients positive for lcSSc and ACA.
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