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Figueroa-Parra G, Castañeda-Martinez MM, Herrera-Sandate P, Castañeda-Martinez DD, Esquivel-Valerio JA, Vega-Morales D. Clinical features of patients with hands arthralgia referred from primary care physicians to rheumatologists: A cohort study. Reumatol Clin (Engl Ed) 2024; 20:67-72. [PMID: 38395497 DOI: 10.1016/j.reumae.2023.09.003] [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] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 06/28/2023] [Indexed: 02/25/2024]
Abstract
PURPOSE Early referral of patients with suspicious of rheumatoid arthritis (RA) has an impact on prognosis. Our study aimed to evaluate the clinical characteristics of patients with hands arthralgia who were referred from primary care physicians (PCP) to the rheumatologist. METHODS A descriptive, observational, prospective cohort study was performed. We included patients who visited a PCP for the first time for hands arthralgia. Demographics and the European Alliance of Associations for Rheumatology criteria for arthralgia suspicious for progression to RA plus seven complementary questions, the time to referral, the pressure needed to provoke pain with an automatic squeeze test machine in the metacarpophalangeal joints of both hands, and the diagnoses established at the last review of medical charts from patients on follow-up were documented. The primary outcome was the referral to a rheumatologist. RESULTS A total of 109 patients were included. The mean age was 49.9 years, 81.6% were women. 30.3% were referred to the rheumatologist. The time to referral was a median of 38 days. The main clinical characteristics associated with referral to the rheumatologist were the "most severe symptoms are present after midnight" (OR=6.29) and the "difficulty with making a fist" (OR=3.67). An isolated "positive squeeze test of metacarpophalangeal joints" was not associated with a referral to the rheumatologist. CONCLUSIONS Among patients with hands arthralgia who attended PCP, those with most severe symptoms after midnight and difficulty making a fist were more likely to be referred to the rheumatology clinic. Isolated positive squeeze tests are not a parameter for referral, it should only be performed if arthralgia is clinically suspected.
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Affiliation(s)
- Gabriel Figueroa-Parra
- Rheumatology Service, University Hospital "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | | | - Pablo Herrera-Sandate
- Rheumatology Service, University Hospital "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | | | - Jorge Antonio Esquivel-Valerio
- Rheumatology Service, University Hospital "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - David Vega-Morales
- Rheumatology Service, University Hospital "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Mexico.
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Gastelum-Strozzi A, Flores-Alvarado DE, Pascual-Ramos V, Álvarez-Hernández E, Pacheco-Tena CF, Guaracha-Basáñez GA, García CG, González-Chávez SA, Moctezuma-Ríos JF, Manrique de Lara A, Esquivel-Valerio JA, Contreras-Yáñez I, Galarza-Delgado DÁ, Vázquez-Mellado J, Peláez-Ballestas I, Reyes-Cordero GC. The COVID-19 epidemic curve and vaccine acceptance among patients with rheumatic diseases: an ecological study. Rheumatol Int 2023; 43:1253-1264. [PMID: 37129609 PMCID: PMC10153056 DOI: 10.1007/s00296-023-05334-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 02/16/2023] [Accepted: 04/19/2023] [Indexed: 05/03/2023]
Abstract
The attitudes toward emerging COVID-19 vaccines have been of great interest worldwide, especially among vulnerable populations such as patients with rheumatic and musculoskeletal diseases (RMDs). The aim of this study was to analyze the relationship between the nationwide number of COVID-19 cases and deaths, and vaccine acceptance or hesitancy of patients with RMDs from four patient care centers in Mexico. Furthermore, we explored differences in acceptance according to specific diagnoses: rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). This ecological study was a secondary analysis of a cross-sectional study using a validated questionnaire to measure vaccine acceptance. We generated a global Likert scale to evaluate overall attitudes toward the COVID-19 vaccine. We analyzed data from 1336 patients from March to September 2021: 85.13% (1169) were women, with a mean age of 47.87 (SD 14.14) years. The most frequent diagnoses were RA (42.85%, 559) and SLE (27.08%, 393). 635(47.52%) patients were unvaccinated, 253(18.93%) had one dose and 478(35.77%) had two doses. Of all participating patients, 94% were accepting toward the COVID-19 vaccine. Vaccine acceptance remained consistently high throughout the study. However, differences in vaccine acceptance are identified when comparing diagnoses. The peak of the national epidemic curve coincided with an increase in hesitancy among patients with RA. Contrastingly, patients with SLE became more accepting as the epidemic curve peaked. Mexican patients show high acceptance of the COVID-19 vaccine, influenced in part by a patient's specific diagnosis. Furthermore, vaccine acceptance increased mirroring the curve of COVID-19 cases and deaths in the country. This should be taken into consideration when updating recommendations for clinical practice.
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Affiliation(s)
| | | | - Virginia Pascual-Ramos
- Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | | | - César Francisco Pacheco-Tena
- Facultad de Medicina y Ciencias Biomédicas, Universidad Autónoma de Chihuahua, Circuito Universitario 31109, Campus Uach II, 31125, Chihuahua, Chih, Mexico
| | | | | | - Susana Aideé González-Chávez
- Facultad de Medicina y Ciencias Biomédicas, Universidad Autónoma de Chihuahua, Circuito Universitario 31109, Campus Uach II, 31125, Chihuahua, Chih, Mexico
| | | | | | | | - Irazú Contreras-Yáñez
- Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | | | | | | | - Greta Cristina Reyes-Cordero
- Facultad de Medicina y Ciencias Biomédicas, Universidad Autónoma de Chihuahua, Circuito Universitario 31109, Campus Uach II, 31125, Chihuahua, Chih, Mexico.
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Vega-Morales D, Pérez-Barbosa L, Vega-Sevilla LF, Esquivel-Valerio JA, Ramírez-Monterrubio LE, Gonzalez-Torres KI, Leal-Bramasco AS, Elizondo-Solis CV, Mendiola-Jimenez A, Garza-Elizondo MA, Galarza-Delgado DÁ. Rheumatoid arthritis-associated antibodies in healthy first-degree relatives of RA patients. Int J Immunogenet 2023; 50:19-23. [PMID: 36428093 DOI: 10.1111/iji.12608] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 10/19/2022] [Accepted: 11/05/2022] [Indexed: 11/27/2022]
Abstract
Rheumatoid arthritis (RA) affects approximately 1.5% of the population worldwide and 0.5-3.3% of the Mexican population. The presence of rheumatoid factor (RF), anti-citrullinated protein antibodies (ACPA) and anti-carbamylated protein (anti-CarP) antibodies has been described in populations at risk of RA development, such as first-degree relatives (FDR). Anti-CarP antibodies are present in RA patients (44%), FDR of RA patients (18%) and healthy controls (4.7%). Anti-CarP antibodies have not been described in FDR of the Mexican population. The objective of this study was to determine the prevalence of Rheumatoid Factors (RF) isotypes, ACPA and anti-CarP antibodies isotypes in FDR of RA patients. An observational, cross-sectional study, in an FDR of RA cohort, was performed. We measured IgA, IgG and IgM isotypes of RF, ACPA and anti-CarP antibodies. A total of 144 FDRs from 99 RA patients were enrolled. The prevalence of anti-CarP antibodies was 2.8% for IgA, 4.2% for IgG, whereas IgM was not detected. The serologic association was for RF/ACPA 4.48%, RF/anti-CarP 2.7%, FR 64.5%, ACPA 1.3%, ACPA/anti-CarP 0.69%, anti-CarP 3.4%, and no RF/ACPA/anti-CarP was observed. We found a low prevalence of anti-CarP antibodies in our cohort of FDR of RA patients, but the prevalence of ACPA and RF were higher than other cohorts previously reported.
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Affiliation(s)
- David Vega-Morales
- Rheumatology Service at Hospital Universitario 'Dr, José Eleuterio González', Universidad Autónoma de Nuevo León, Monterrey, Nuevo, León, México
| | - Lorena Pérez-Barbosa
- Rheumatology Service at Hospital Universitario 'Dr, José Eleuterio González', Universidad Autónoma de Nuevo León, Monterrey, Nuevo, León, México
| | - Luis Francisco Vega-Sevilla
- Rheumatology Service at Hospital Universitario 'Dr, José Eleuterio González', Universidad Autónoma de Nuevo León, Monterrey, Nuevo, León, México
| | - Jorge Antonio Esquivel-Valerio
- Rheumatology Service at Hospital Universitario 'Dr, José Eleuterio González', Universidad Autónoma de Nuevo León, Monterrey, Nuevo, León, México
| | - Luis Eduardo Ramírez-Monterrubio
- Rheumatology Service at Hospital Universitario 'Dr, José Eleuterio González', Universidad Autónoma de Nuevo León, Monterrey, Nuevo, León, México
| | - Karina I Gonzalez-Torres
- Rheumatology Service at Hospital Universitario 'Dr, José Eleuterio González', Universidad Autónoma de Nuevo León, Monterrey, Nuevo, León, México
| | - Ana Sofía Leal-Bramasco
- Rheumatology Service at Hospital Universitario 'Dr, José Eleuterio González', Universidad Autónoma de Nuevo León, Monterrey, Nuevo, León, México
| | - Cesar V Elizondo-Solis
- Rheumatology Service at Hospital Universitario 'Dr, José Eleuterio González', Universidad Autónoma de Nuevo León, Monterrey, Nuevo, León, México
| | - Andres Mendiola-Jimenez
- Rheumatology Service at Hospital Universitario 'Dr, José Eleuterio González', Universidad Autónoma de Nuevo León, Monterrey, Nuevo, León, México
| | - Mario Alberto Garza-Elizondo
- Rheumatology Service at Hospital Universitario 'Dr, José Eleuterio González', Universidad Autónoma de Nuevo León, Monterrey, Nuevo, León, México
| | - Dionicio Ángel Galarza-Delgado
- Rheumatology Service at Hospital Universitario 'Dr, José Eleuterio González', Universidad Autónoma de Nuevo León, Monterrey, Nuevo, León, México
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Vega-Morales D, Del Carmen Larios-Forte M, Pérez-Barbosa L, Esquivel-Valerio JA, Garza-Elizondo MA, Skinner-Taylor CM, Vázquez-Fuentes BR, Flores-Alvarado DE, Villarreal-Alarcón MÁ, de Jesús Hernández-Galarza I, Lozano-Plata LI, Castañeda-Martínez MM, Castañeda-Martínez DD, Herrera-Sandate P, Cardenas-de la Garza JA, Galarza-Delgado DÁ. Bone erosions by MRI in first-degree relatives of patients with RA: an exploratory study. Clin Rheumatol 2022; 41:1343-1348. [PMID: 35088207 DOI: 10.1007/s10067-021-06028-4] [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: 10/21/2021] [Revised: 12/15/2021] [Accepted: 12/17/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION/OBJECTIVES First-degree relatives (FDR) of patients with rheumatoid arthritis (RA) are at increased risk of RA diagnosis. Magnetic resonance imaging (MRI) has been proposed as a useful tool to detect subclinical synovitis and bone abnormalities as predictors of progression to RA. The presence of grade ≥ 2 bone erosions in RA MRI scoring system (RAMRIS) was reported to be RA-specific. We aim to describe the prevalence and characteristics of MRI findings in RA patients and FDR. METHODS A cross-sectional and exploratory study of 60 individuals was performed in 38 RA patients and 22 FDR with hand arthralgia without clinical arthritis and positive rheumatoid factor or anticitrullinated protein antibodies. All patients underwent an MRI and were evaluated for synovitis, bone erosion, and bone marrow edema. We evaluated second to fifth metacarpophalangeal joints of the dominant hand according to RAMRIS. RESULTS Among the total population, eighteen (30%) subjects had grade ≥ 2 bone erosions, and 42 (70%) had at least one erosion of any grade. In patients with grade ≥ 2 bone erosions, 12 (31.6%) were from RA patients and 6 (27.2%) from FDR (p = 0.72). In patients with erosions of any grade, 26 (68.4%) were from RA patients and 15 (68.2%) were from FDR (p = 0.98). CONCLUSION A high prevalence of bone erosions was found in RA patients' FDR who had symptoms without clinical arthritis and positive serology. MRI might be helpful in this population for an early detection of RA-specific erosions. The prognosis and the treatment decisions in these subjects should be elucidated. KEY POINTS • First-degree relatives (FDR) of rheumatoid arthritis (RA) patients with positive serology and joint symptoms constitute a select subpopulation of individuals with an increased risk of developing RA. • Magnetic resonance imaging (MRI) of FDR shows a high prevalence of bone erosions of any grade, grade ≥ 2 erosions, and synovitis. • MRI might be helpful in FDR of RA patients to screen for the presence of RA-specific erosions or clinically undetectable synovitis.
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Affiliation(s)
- David Vega-Morales
- Universidad Autónoma de Nuevo León, Rheumatology Service at Hospital Universitario "Dr, José Eleuterio González", Gonzalitos 235 N. 64020 Monterrey, Nuevo León, Mexico.
| | - María Del Carmen Larios-Forte
- Radiology Department, Hospital Regional Monterrey, Instituto de Seguridad Y Servicios Sociales de los Trabajadores del Estado, Monterrey, Nuevo León, Mexico
| | - Lorena Pérez-Barbosa
- Universidad Autónoma de Nuevo León, Rheumatology Service at Hospital Universitario "Dr, José Eleuterio González", Gonzalitos 235 N. 64020 Monterrey, Nuevo León, Mexico
| | - Jorge Antonio Esquivel-Valerio
- Universidad Autónoma de Nuevo León, Rheumatology Service at Hospital Universitario "Dr, José Eleuterio González", Gonzalitos 235 N. 64020 Monterrey, Nuevo León, Mexico
| | - Mario Alberto Garza-Elizondo
- Universidad Autónoma de Nuevo León, Rheumatology Service at Hospital Universitario "Dr, José Eleuterio González", Gonzalitos 235 N. 64020 Monterrey, Nuevo León, Mexico
| | - Cassandra Michelle Skinner-Taylor
- Universidad Autónoma de Nuevo León, Rheumatology Service at Hospital Universitario "Dr, José Eleuterio González", Gonzalitos 235 N. 64020 Monterrey, Nuevo León, Mexico
| | - Brenda Roxana Vázquez-Fuentes
- Universidad Autónoma de Nuevo León, Rheumatology Service at Hospital Universitario "Dr, José Eleuterio González", Gonzalitos 235 N. 64020 Monterrey, Nuevo León, Mexico
| | - Diana Elsa Flores-Alvarado
- Universidad Autónoma de Nuevo León, Rheumatology Service at Hospital Universitario "Dr, José Eleuterio González", Gonzalitos 235 N. 64020 Monterrey, Nuevo León, Mexico
| | - Miguel Ángel Villarreal-Alarcón
- Universidad Autónoma de Nuevo León, Rheumatology Service at Hospital Universitario "Dr, José Eleuterio González", Gonzalitos 235 N. 64020 Monterrey, Nuevo León, Mexico
| | - Iván de Jesús Hernández-Galarza
- Universidad Autónoma de Nuevo León, Rheumatology Service at Hospital Universitario "Dr, José Eleuterio González", Gonzalitos 235 N. 64020 Monterrey, Nuevo León, Mexico
| | - Luis Iván Lozano-Plata
- Universidad Autónoma de Nuevo León, Rheumatology Service at Hospital Universitario "Dr, José Eleuterio González", Gonzalitos 235 N. 64020 Monterrey, Nuevo León, Mexico
| | - Martha Mariana Castañeda-Martínez
- Universidad Autónoma de Nuevo León, Rheumatology Service at Hospital Universitario "Dr, José Eleuterio González", Gonzalitos 235 N. 64020 Monterrey, Nuevo León, Mexico
| | - Diana Daniela Castañeda-Martínez
- Universidad Autónoma de Nuevo León, Rheumatology Service at Hospital Universitario "Dr, José Eleuterio González", Gonzalitos 235 N. 64020 Monterrey, Nuevo León, Mexico
| | - Pablo Herrera-Sandate
- Universidad Autónoma de Nuevo León, Rheumatology Service at Hospital Universitario "Dr, José Eleuterio González", Gonzalitos 235 N. 64020 Monterrey, Nuevo León, Mexico
| | - Jesus Alberto Cardenas-de la Garza
- Universidad Autónoma de Nuevo León, Rheumatology Service at Hospital Universitario "Dr, José Eleuterio González", Gonzalitos 235 N. 64020 Monterrey, Nuevo León, Mexico
| | - Dionicio Ángel Galarza-Delgado
- Universidad Autónoma de Nuevo León, Rheumatology Service at Hospital Universitario "Dr, José Eleuterio González", Gonzalitos 235 N. 64020 Monterrey, Nuevo León, Mexico
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Vega-Morales D, Esquivel-Valerio JA, Vázquez-Fuentes BR, Díaz-Borjón A, Arce-Salinas CA, Álvarez-Hernández E, Torres-Roldán JF, Aguilera-Zepeda JM, Toledo-Infanson V, Alcántar-Luna E, Aldrete-Velasco JA, Martínez Hernández JL, Gutiérrez-Gómez JJ, Espinosa-Morales R. Comorbidity burden in terms of disability in patients with osteoarthritis in Mexico. The IMPACTAR registry. ACTA ACUST UNITED AC 2021; 17:440-446. [PMID: 34625146 DOI: 10.1016/j.reumae.2020.03.004] [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] [Received: 02/05/2020] [Accepted: 03/30/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To determine the comorbidities associated with disability in patients with OA in Mexico (2013-2015). MATERIAL AND METHODS A cross-sectional, retrospective and multicentre IMPACTAR study (n=7703) in Mexican patients (2013-2015). Comorbidities associated with disability were identified in 4971 patients diagnosed with OA from the IMPACTAR registry (n=7073). An adjusted logistic regression analysis was carried out by demographic, economic, clinical and medical variables. RESULTS Mean age was 63 years; and 75% of the patients were women. Subjects with OA and presence of comorbidities are 42% more likely to develop disabilities than patients without associated comorbidity, considering age, sex, family income, OA diagnosis duration, and education level. The highest rate of people with disability (28.9%) was concentrated in Region 7, which corresponds to Mexico City. There are also significant differences between median family incomes, when the income of persons with disability is under $13 000 (IQR: 9000-16 000) Mexican pesos, compared to patients without disability. Almost half of the subjects (49.6%) reported having at least one comorbidity. Arterial hypertension was the risk factor with a statistically significant difference (32.8%) among those with disability (34.7%). CONCLUSIONS Programs and interventions for OA patients should take into consideration comorbidity factors, being female, family income, and the region of residence as variables that may increase the possibility of developing an OA-associated disability.
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Affiliation(s)
- David Vega-Morales
- Universidad Autónoma de Nuevo León, Rheumatology Service and Internal Medicine Department at Hospital Universitario "Dr. José Eleuterio González", Ave. Gonzalitos 235 Norte, Colonia Mitras Centro, Monterrey, C.P. 64020 Nuevo León, Mexico; Instituto Mexicano del Seguro Social, IMSS Hospital General de Zona Número 17, Fortunato Lozano 2627, Benito Juárez, Monterrey, C.P. 64420 Nuevo León, Mexico
| | - Jorge Antonio Esquivel-Valerio
- Universidad Autónoma de Nuevo León, Rheumatology Service and Internal Medicine Department at Hospital Universitario "Dr. José Eleuterio González", Ave. Gonzalitos 235 Norte, Colonia Mitras Centro, Monterrey, C.P. 64020 Nuevo León, Mexico
| | - Brenda Roxana Vázquez-Fuentes
- Universidad Autónoma de Nuevo León, Rheumatology Service and Internal Medicine Department at Hospital Universitario "Dr. José Eleuterio González", Ave. Gonzalitos 235 Norte, Colonia Mitras Centro, Monterrey, C.P. 64020 Nuevo León, Mexico
| | - Alejandro Díaz-Borjón
- Hospital Angeles Lomas, Av. Vialidad de la Barranca S/N. Col. Valle de las Palmas, C.P. 52763 Mexico City, Mexico
| | - César Alejandro Arce-Salinas
- Hospital Central Sur PEMEX, Division of Internal Medicine, Fuentes del Pedregal, Tlalpan, C.P. 14140 Mexico City, Mexico
| | - Everardo Álvarez-Hernández
- Hospital General de Mexico, Doctor Balmis 148, Doctores, Delegación Cuahutemoc, C.P. 06726 Mexico City, Mexico
| | | | | | - Víctor Toledo-Infanson
- Hospital General Agua Prieta, Servicios de Salud Sonora, Calle 12 y 13 Av 22S/NInt. 3, Agua Prieta, C.P. 84200 Sonora, Mexico
| | - Ernesto Alcántar-Luna
- Hospital Angeles del Carmen, Fracc. Monraz, Monraz, Guadalajara, C.P. 44670 Jalisco, Mexico
| | | | | | | | - Rolando Espinosa-Morales
- Instituto Nacional de Rehabilitación, Departamento de Reumatología, Calz México-Xochimilco 289, Arenal Tepepan, C.P. 14389 Mexico City, Mexico.
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Esquivel-Valerio JA, Skinner-Taylor CM, Moreno-Arquieta IA, Cardenas-de la Garza JA, Garcia-Arellano G, Gonzalez-Garcia PL, Almaraz-Juarez FDR, Galarza-Delgado DA. Adverse events of six COVID-19 vaccines in patients with autoimmune rheumatic diseases: a cross-sectional study. Rheumatol Int 2021; 41:2105-2108. [PMID: 34622311 PMCID: PMC8496432 DOI: 10.1007/s00296-021-05017-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 09/28/2021] [Indexed: 11/25/2022]
Abstract
Data regarding COVID-19 vaccine efficacy and adverse events (AE) in patients with autoimmune and inflammatory rheumatic diseases (AIIRD) have been published recently although these mostly include the mRNA vaccines (Pfizer-BioNTech and Moderna) and the ChAdOx1 nCoV-19/AZD1222 (Oxford-AstraZeneca). This research aimed to study the prevalence of AE presented with six different SARS-CoV-2 vaccines {ChadOX1 nCoV-19 (AZD1222), Ad5-nCoV2, Ad26.COV2.S, mRNA-1273, BNT162b2, and CoronaVac} in Mexican patients with AIIRD. We performed a cross-sectional study about vaccine history. Two hundred and twenty five consecutive patients were recruited, mean age was 50.7 years and the majority (n = 213; 94.6%) were females. One hundred and seven (47.5%) received BNT162b2 mRNA, 34 (15.1%) Ad5-nCoV, 29 (12.8%) mRNA-1273, 28 (12.4%) ChAdOX1 nCoV-19 (AZD1222), 22 (9.7%) CoronaVac and 5 (2.2%) Ad26.COV2.S. The vaccines that had the most AE proportionally to the number of patients vaccinated were Janssen (5; 100%) followed by Pfizer-BioNTEch (86; 80%) and CanSinoBIO (27; 79.4%). Localized pain was the most frequent (158; 70.2%) AE. Fatigue (78; 34.7%), headache (69; 30.6%) and muscle ache (66; 29.3%) were the most common systemic symptoms. No serious AE that required medical attention or hospitalization were reported. The current results support the safety of different COVID-19 vaccines in patients with AIIRD. This information can help fight vaccine hesitancy in this population.
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Affiliation(s)
- Jorge Antonio Esquivel-Valerio
- Rheumatology Service, University Hospital “Dr. Jose Eleuterio Gonzalez”, Universidad Autónoma de Nuevo León, Av. Gonzalitos y Av. Madero s/n, Colonia Mitras Centro, C.P. 64460 Monterrey, NL Mexico
| | - Cassandra Michele Skinner-Taylor
- Rheumatology Service, University Hospital “Dr. Jose Eleuterio Gonzalez”, Universidad Autónoma de Nuevo León, Av. Gonzalitos y Av. Madero s/n, Colonia Mitras Centro, C.P. 64460 Monterrey, NL Mexico
| | - Ilse Andrea Moreno-Arquieta
- Rheumatology Service, University Hospital “Dr. Jose Eleuterio Gonzalez”, Universidad Autónoma de Nuevo León, Av. Gonzalitos y Av. Madero s/n, Colonia Mitras Centro, C.P. 64460 Monterrey, NL Mexico
| | - Jesus Alberto Cardenas-de la Garza
- Rheumatology Service, University Hospital “Dr. Jose Eleuterio Gonzalez”, Universidad Autónoma de Nuevo León, Av. Gonzalitos y Av. Madero s/n, Colonia Mitras Centro, C.P. 64460 Monterrey, NL Mexico
| | - Gisela Garcia-Arellano
- Rheumatology Service, University Hospital “Dr. Jose Eleuterio Gonzalez”, Universidad Autónoma de Nuevo León, Av. Gonzalitos y Av. Madero s/n, Colonia Mitras Centro, C.P. 64460 Monterrey, NL Mexico
| | - Patricia Ludivina Gonzalez-Garcia
- Rheumatology Service, University Hospital “Dr. Jose Eleuterio Gonzalez”, Universidad Autónoma de Nuevo León, Av. Gonzalitos y Av. Madero s/n, Colonia Mitras Centro, C.P. 64460 Monterrey, NL Mexico
| | - Fatima del Rocio Almaraz-Juarez
- Rheumatology Service, University Hospital “Dr. Jose Eleuterio Gonzalez”, Universidad Autónoma de Nuevo León, Av. Gonzalitos y Av. Madero s/n, Colonia Mitras Centro, C.P. 64460 Monterrey, NL Mexico
| | - Dioncio Angel Galarza-Delgado
- Rheumatology Service, University Hospital “Dr. Jose Eleuterio Gonzalez”, Universidad Autónoma de Nuevo León, Av. Gonzalitos y Av. Madero s/n, Colonia Mitras Centro, C.P. 64460 Monterrey, NL Mexico
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Figueroa-Parra G, Esquivel-Valerio JA, Santoyo-Fexas L, Moreno-Salinas A, Gamboa-Alonso CM, De Leon-Ibarra AL, Galarza-Delgado DA. Knowledge and attitudes about influenza vaccination in rheumatic diseases patients. Hum Vaccin Immunother 2021; 17:1420-1425. [PMID: 32991221 PMCID: PMC8078649 DOI: 10.1080/21645515.2020.1816108] [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] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 08/10/2020] [Accepted: 08/24/2020] [Indexed: 11/29/2022] Open
Abstract
Patients with rheumatic diseases (RD) have a higher risk of morbidity and mortality from vaccine-preventable infections attributed to disease activity, comorbidities, immunosuppressive therapy, and other factors. Vaccines are one of the safest and most effective public health interventions. The aim of this study was to investigate knowledge and attitudes about influenza vaccination as factors influencing vaccine uptake and hesitancy in a population with RD. A descriptive cross-sectional study was designed. A self-administered questionnaire surveyed age, RD diagnosis, ten questions about the uptake, safety and efficacy of influenza vaccine, knowledge of cost-free availability, and the relationship between influenza vaccination and RD. A total of 223 questionnaires were filled; 79.8% of patients were vaccinated for influenza at least once. Uptake by diagnosis was 80.3% in rheumatoid arthritis, 76.2% in osteoarthritis, 86.7% in lupus, 73.9% in other auto-immune diseases (AID), and 60% in other non-AID; 83.9% of patients considered influenza vaccine as safe and effective. From those who had never been vaccinated, 26.7% of patients did not consider influenza vaccine safe and effective vs. 13.5% among patients who had been vaccinated (P = .032). Only 7.6% considered that RD patients could not be vaccinated; 11.7% thought that influenza vaccine would worsen their RD symptoms. This study showed that concerns about safety, efficacy, side effects, fear of the vaccine, and knowledge of cost diminished vaccine uptake. These are factors related to confidence, complacency, and convenience as components of vaccine hesitancy that affect influenza vaccination in RD patients.
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Affiliation(s)
- Gabriel Figueroa-Parra
- Rheumatology Service, University Hospital “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Jorge Antonio Esquivel-Valerio
- Rheumatology Service, University Hospital “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Leticia Santoyo-Fexas
- Rheumatology Service, University Hospital “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Andrea Moreno-Salinas
- Rheumatology Service, University Hospital “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Carmen Magdalena Gamboa-Alonso
- Rheumatology Service, University Hospital “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Ana Laura De Leon-Ibarra
- Rheumatology Service, University Hospital “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Dionicio Angel Galarza-Delgado
- Rheumatology Service, University Hospital “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey, México
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Figueroa-Parra G, Esquivel-Valerio JA, Santoyo-Fexas L, Moreno-Salinas A, Gamboa-Alonso CM, De Leon-Ibarra AL, Galarza-Delgado DA. Knowledge and attitudes about influenza vaccination in rheumatic diseases patients. Hum Vaccin Immunother 2021; 17:1420-1425. [PMID: 32991221 DOI: 10.1080/21645515.2020.1816] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
Patients with rheumatic diseases (RD) have a higher risk of morbidity and mortality from vaccine-preventable infections attributed to disease activity, comorbidities, immunosuppressive therapy, and other factors. Vaccines are one of the safest and most effective public health interventions. The aim of this study was to investigate knowledge and attitudes about influenza vaccination as factors influencing vaccine uptake and hesitancy in a population with RD. A descriptive cross-sectional study was designed. A self-administered questionnaire surveyed age, RD diagnosis, ten questions about the uptake, safety and efficacy of influenza vaccine, knowledge of cost-free availability, and the relationship between influenza vaccination and RD. A total of 223 questionnaires were filled; 79.8% of patients were vaccinated for influenza at least once. Uptake by diagnosis was 80.3% in rheumatoid arthritis, 76.2% in osteoarthritis, 86.7% in lupus, 73.9% in other auto-immune diseases (AID), and 60% in other non-AID; 83.9% of patients considered influenza vaccine as safe and effective. From those who had never been vaccinated, 26.7% of patients did not consider influenza vaccine safe and effective vs. 13.5% among patients who had been vaccinated (P = .032). Only 7.6% considered that RD patients could not be vaccinated; 11.7% thought that influenza vaccine would worsen their RD symptoms. This study showed that concerns about safety, efficacy, side effects, fear of the vaccine, and knowledge of cost diminished vaccine uptake. These are factors related to confidence, complacency, and convenience as components of vaccine hesitancy that affect influenza vaccination in RD patients.
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Affiliation(s)
- Gabriel Figueroa-Parra
- Rheumatology Service, University Hospital "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, México
| | - Jorge Antonio Esquivel-Valerio
- Rheumatology Service, University Hospital "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, México
| | - Leticia Santoyo-Fexas
- Rheumatology Service, University Hospital "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, México
| | - Andrea Moreno-Salinas
- Rheumatology Service, University Hospital "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, México
| | - Carmen Magdalena Gamboa-Alonso
- Rheumatology Service, University Hospital "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, México
| | - Ana Laura De Leon-Ibarra
- Rheumatology Service, University Hospital "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, México
| | - Dionicio Angel Galarza-Delgado
- Rheumatology Service, University Hospital "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, México
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Moreno-Arquieta IA, Cardenas-de la Garza JA, Esquivel-Valerio JA, Riega-Torres J, Cuellar-Barboza A, Herz-Ruelas ME, Ocampo-Candiani J, Galarza-Delgado DA. Mycophenolate mofetil and mycophenolic acid for the treatment of eosinophilic fasciitis: report of two cases and literature review. J DERMATOL TREAT 2021; 33:1765-1768. [PMID: 33615948 DOI: 10.1080/09546634.2021.1890682] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Eosinophilic fasciitis (EF) is an uncommon autoimmune connective tissue disorder characterized by edema, erythema, and subsequent induration of the extremities. It is commonly treated with corticosteroids but there is no treatment ladder for immunosuppressants or steroid-sparing agents. We report two EF cases treated effectively with mycophenolate mofetil (MMF) or mycophenolic acid (MPA) and present a literature review. We performed a MEDLINE search using the keywords 'eosinophilic fasciitis', 'Shulman syndrome', 'mycophenolic acid', or 'mofetil mycophenolate', and found 8 articles with 27 cases in which MMF or MPA was used. Twenty-nine cases were reviewed (2 reported herein and 27 from the literature search); all patients received a combination of systemic corticosteroids and MMF. MMF/MPA were given as a steroid-sparing agent in 27 (93.1%), in 1 (3.4%) as adjunctive therapy with other immunosuppressants, and in one, as monotherapy 1 (3.4%). Nineteen had a complete response, 6, a partial response, and 2 were unresponsive to diverse immunomodulators; in 2 cases, the outcome was not reported. MMF and MPA show promising therapeutic results and could be a treatment option to reduce corticosteroid related side effects.
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Affiliation(s)
- Ilse Andrea Moreno-Arquieta
- Rheumatology Department, Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Monterrey, Mexico
| | - Jesus Alberto Cardenas-de la Garza
- Rheumatology Department, Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Monterrey, Mexico
| | - Jorge Antonio Esquivel-Valerio
- Rheumatology Department, Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Monterrey, Mexico
| | - Janett Riega-Torres
- Rheumatology Department, Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Monterrey, Mexico
| | - Adrian Cuellar-Barboza
- Dermatology Department, Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Monterrey, Mexico
| | - Maira Elizabeth Herz-Ruelas
- Dermatology Department, Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Monterrey, Mexico
| | - Jorge Ocampo-Candiani
- Dermatology Department, Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Monterrey, Mexico
| | - Dionicio Angel Galarza-Delgado
- Rheumatology Department, Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González", Monterrey, Mexico
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Vega-Morales D, Esquivel-Valerio JA, Vázquez-Fuentes BR, Díaz-Borjón A, Arce-Salinas CA, Álvarez-Hernández E, Torres-Roldán JF, Aguilera-Zepeda JM, Toledo-Infanson V, Alcántar-Luna E, Aldrete-Velasco JA, Martínez Hernández JL, Gutiérrez-Gómez JJ, Espinosa-Morales R. Comorbidity burden in terms of disability in patients with osteoarthritis in Mexico. The IMPACTAR registry. Reumatol Clin (Engl Ed) 2020; 17:S1699-258X(20)30080-2. [PMID: 32563732 DOI: 10.1016/j.reuma.2020.03.005] [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] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 03/30/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine the comorbidities associated with disability in patients with OA in Mexico (2013-2015). MATERIAL AND METHODS A cross-sectional, retrospective and multicentre IMPACTAR study (n=7703) in Mexican patients (2013-2015). Comorbidities associated with disability were identified in 4971 patients diagnosed with OA from the IMPACTAR registry (n=7073). An adjusted logistic regression analysis was carried out by demographic, economic, clinical and medical variables. RESULTS Mean age was 63 years; and 75% of the patients were women. Subjects with OA and presence of comorbidities are 42% more likely to develop disabilities than patients without associated comorbidity, considering age, sex, family income, OA diagnosis duration, and education level. The highest rate of people with disability (28.9%) was concentrated in Region 7, which corresponds to Mexico City. There are also significant differences between median family incomes, when the income of persons with disability is under $13 000 (IQR: 9000-16 000) Mexican pesos, compared to patients without disability. Almost half of the subjects (49.6%) reported having at least one comorbidity. Arterial hypertension was the risk factor with a statistically significant difference (32.8%) among those with disability (34.7%). CONCLUSIONS Programs and interventions for OA patients should take into consideration comorbidity factors, being female, family income, and the region of residence as variables that may increase the possibility of developing an OA-associated disability.
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Affiliation(s)
- David Vega-Morales
- Universidad Autónoma de Nuevo León, Rheumatology Service and Internal Medicine Department at Hospital Universitario "Dr. José Eleuterio González", Ave. Gonzalitos 235 Norte, Colonia Mitras Centro, Monterrey, C.P. 64020 Nuevo León, Mexico; Instituto Mexicano del Seguro Social, IMSS Hospital General de Zona Número 17, Fortunato Lozano 2627, Benito Juárez, Monterrey, C.P. 64420 Nuevo León, Mexico
| | - Jorge Antonio Esquivel-Valerio
- Universidad Autónoma de Nuevo León, Rheumatology Service and Internal Medicine Department at Hospital Universitario "Dr. José Eleuterio González", Ave. Gonzalitos 235 Norte, Colonia Mitras Centro, Monterrey, C.P. 64020 Nuevo León, Mexico
| | - Brenda Roxana Vázquez-Fuentes
- Universidad Autónoma de Nuevo León, Rheumatology Service and Internal Medicine Department at Hospital Universitario "Dr. José Eleuterio González", Ave. Gonzalitos 235 Norte, Colonia Mitras Centro, Monterrey, C.P. 64020 Nuevo León, Mexico
| | - Alejandro Díaz-Borjón
- Hospital Angeles Lomas, Av. Vialidad de la Barranca S/N. Col. Valle de las Palmas, C.P. 52763 Mexico City, Mexico
| | - César Alejandro Arce-Salinas
- Hospital Central Sur PEMEX, Division of Internal Medicine, Fuentes del Pedregal, Tlalpan, C.P. 14140 Mexico City, Mexico
| | - Everardo Álvarez-Hernández
- Hospital General de Mexico, Doctor Balmis 148, Doctores, Delegación Cuahutemoc, C.P. 06726 Mexico City, Mexico
| | | | | | - Víctor Toledo-Infanson
- Hospital General Agua Prieta, Servicios de Salud Sonora, Calle 12 y 13 Av 22S/NInt. 3, Agua Prieta, C.P. 84200 Sonora, Mexico
| | - Ernesto Alcántar-Luna
- Hospital Angeles del Carmen, Fracc. Monraz, Monraz, Guadalajara, C.P. 44670 Jalisco, Mexico
| | | | | | | | - Rolando Espinosa-Morales
- Instituto Nacional de Rehabilitación, Departamento de Reumatología, Calz México-Xochimilco 289, Arenal Tepepan, C.P. 14389 Mexico City, Mexico.
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Pérez-Barbosa L, Garza-Elizondo MA, Vega-Morales D, Esquivel-Valerio JA, Peláez-Ballestas I, Vázquez-Fuentes BR, Galarza-Delgado DÁ. High frequency of rheumatic regional pain syndromes in first-degree relatives of patients with rheumatoid arthritis. Clin Rheumatol 2020; 39:3303-3307. [PMID: 32388744 DOI: 10.1007/s10067-020-05029-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 02/20/2020] [Accepted: 03/05/2020] [Indexed: 01/08/2023]
Abstract
First-degree relatives (FDR) of patients with rheumatoid arthritis (RA) have a higher risk for the development of RA. In the stages prior to the development of arthritis, nonspecific musculoskeletal (MSK) manifestations may occur. The aim of the study is to describe the frequency of rheumatic regional pain syndromes (RRPS) in FDR of RA patients. A cross-sectional study was carried out from July 2016 to September 2018. Parents, offspring, and siblings of RA patients completed the Community Oriented Program in the Rheumatic Diseases (COPCORD) questionnaire. Rheumatoid factor (RF) IgG, IgM, and IgA; anticitrullinated peptide antibodies (ACPAs); C-reactive protein (CRP); and erythrocyte sedimentation rate (ESR) were determined. All subjects with a positive COPCORD (defined by the presence of musculoskeletal pain) were evaluated and classified. Three hundred thirty-five FDRs participated, 75.8% were female, mean age of 44.15 years; 138 (41.2%) were diagnosed with at least one RRPS; 72 (21.5%) had rotator cuff tendinitis, 51 (15.2%) pes anserine bursitis, and 39 (11.6) lateral epicondylitis; RA was diagnosed in 24 (7.16%) subjects, undifferentiated arthritis (UA) in 30 (8.9%) and inflammatory arthralgia (AI) in 104 (31%). We found anti-CCP positivity in 6.8%, RF IgA in 22.3%, RF IgM in 48.6%, and RF IgG in 8.9%. The presence of RRPS was higher in this RA-FDR group compared to general population. Clinical evaluation of this risk group should include screening for RRPS.
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Affiliation(s)
- Lorena Pérez-Barbosa
- Rheumatology Service and Internal Medicine Department at Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Ave. Gonzalitos 235 Norte, Colonia Mitras Centro, 64020, Monterrey, Nuevo León, Mexico
| | - Mario Alberto Garza-Elizondo
- Rheumatology Service and Internal Medicine Department at Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Ave. Gonzalitos 235 Norte, Colonia Mitras Centro, 64020, Monterrey, Nuevo León, Mexico.
| | - David Vega-Morales
- Rheumatology Service and Internal Medicine Department at Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Ave. Gonzalitos 235 Norte, Colonia Mitras Centro, 64020, Monterrey, Nuevo León, Mexico
| | - Jorge Antonio Esquivel-Valerio
- Rheumatology Service and Internal Medicine Department at Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Ave. Gonzalitos 235 Norte, Colonia Mitras Centro, 64020, Monterrey, Nuevo León, Mexico
| | - Ingris Peláez-Ballestas
- Rheumatology Unit, Hospital General de México "Dr. Eduardo Liceaga", Dr. Balmis 148, Doctores, 06720, México City, Mexico
| | - Brenda Roxana Vázquez-Fuentes
- Rheumatology Service and Internal Medicine Department at Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Ave. Gonzalitos 235 Norte, Colonia Mitras Centro, 64020, Monterrey, Nuevo León, Mexico
| | - Dionicio Ángel Galarza-Delgado
- Rheumatology Service and Internal Medicine Department at Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Ave. Gonzalitos 235 Norte, Colonia Mitras Centro, 64020, Monterrey, Nuevo León, Mexico
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12
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Larios-Forte MDC, García-Coronado JM, Skinner-Taylor CM, Esquivel-Valerio JA, Vega-Morales D, Vilchez-Cavazos F, Quiroga-Garza A, Elizondo-Omaña RE. The very early inflammatory triquetral lesion by MRI - is this the first sign in Rheumatoid Arthritis? Acta Reumatol Port 2019; 44:218-224. [PMID: 31300634] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION/AIM Rheumatoid Arthritis (RA) an autoimmune, chronic, and disabling disease if untreated, affects wrist joints, with a diagnostic delay of up to 2 years. Triquetral bone allows rotational movement that pivots over the rest wrist bones, and maintains physiological loads during mobility. Magnetic Resonance Imaging (MRI) is the most sensitive (96%) method for diagnosis, evidencing lesions as early as in the initial RA stages. Our aim was to determine the most frequently affected structures in the hand-wrist joint by MRI using the OMERACT-RAMRIS Score (2003) in three different RA stages, including clinically suspicious arthralgia (CSA) that haven't reported before. METHODS We performed an exploratory, transverse, observational, descriptive study in 60 patients enrolled and classified by rheumatologists as: CSA, early rheumatoid arthritis (ERA), and established RA, prior to performing a dominant hand-wrist MRI for evaluation and descriptive analysis by an expert radiologist. RESULTS Female predominance 83% (50), with a mean age 42+13.5 years; A total of 1,731 hand-wrist bone and joint sites were evaluated using EULAR-OMERACT Atlas (2005), identifying 56% (964 sites) with typical RA lesions: synovitis, erosions, and bone marrow edema (BME or osteitis); synovitis was the most frequent with 46% (445 site-lesion), and triquetral synovitis the most frequent each clinical group: CSA 87% (20/23), ERA 91% (20/22), and RA 93% (14/15). CONCLUSION Synovitis and triquetral synovitis were the most prevalent lesion in three-studied phases. This could suggest the triquetrum as the first morphological site to be affected by RA; so it's assessment should be considered in the RA evaluation when it´s clinically suspected.
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Affiliation(s)
| | | | | | | | - David Vega-Morales
- Universidad Autonoma de Nuevo Leon, Hospital Universitario "Dr. José Eleuterio González"
| | - Felix Vilchez-Cavazos
- Universidad Autonoma de Nuevo Leon, Hospital Universitario "Dr. José Eleuterio González"
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Arana-Guajardo AC, Barrera-Torres G, Villarreal-Alarcón MÁ, Vega-Morales D, Esquivel-Valerio JA. Esophageal symptoms and their lack of association with high-resolution manometry in systemic sclerosis patients. ACTA ACUST UNITED AC 2017; 15:165-169. [PMID: 29258795 DOI: 10.1016/j.reuma.2017.09.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 06/25/2017] [Revised: 09/11/2017] [Accepted: 09/15/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND The esophageal involvement in systemic sclerosis (SSc) causes impact in the morbidity and mortality. High resolution manometry assesses esophageal involvement. Our aim was to categorize esophageal motor disorder in patients with SSc by HRM. METHODS We carried out an observational, descriptive and cross-sectional study. All patients underwent HRM as well as semi-structured interviews to assess frequency and severity of upper GI symptoms. Patients also completed the gastroesophageal reflux questionnaire (Carlsson-Dent). RESULTS We included 19 patients with SSc, 1 with morphea, and 1 with scleroderma sine scleroderma. Dysphagia and heartburn were the most frequent symptoms (61% each). We found an abnormal HRM in 15 (71.4%) patients. We found no statistically significant association between clinical or demographic variables and an abnormal HRM, or between any upper GI symptom and HRM findings. CONCLUSION We observed a high prevalence of esophageal symptoms and of HRM abnormalities. However, there was no clear association between symptomatology and HRM findings. HRM does not seem to accurately predict upper GI symptomatology.
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Affiliation(s)
- Ana Cecilia Arana-Guajardo
- Universidad Autónoma de Nuevo León, Servicio de Reumatología, Departamento de Medicina Interna, Hospital Universitario "Dr. José Eleuterio González", Monterrey, Mexico
| | - Gustavo Barrera-Torres
- Universidad Autónoma de Nuevo León, Servicio de Gastroenterología, Departamento de Medicina Interna, Hospital Universitario "Dr. José Eleuterio González", Monterrey, Mexico
| | - Miguel Ángel Villarreal-Alarcón
- Universidad Autónoma de Nuevo León, Servicio de Reumatología, Departamento de Medicina Interna, Hospital Universitario "Dr. José Eleuterio González", Monterrey, Mexico
| | - David Vega-Morales
- Universidad Autónoma de Nuevo León, Servicio de Reumatología, Departamento de Medicina Interna, Hospital Universitario "Dr. José Eleuterio González", Monterrey, Mexico.
| | - Jorge Antonio Esquivel-Valerio
- Universidad Autónoma de Nuevo León, Servicio de Reumatología, Departamento de Medicina Interna, Hospital Universitario "Dr. José Eleuterio González", Monterrey, Mexico
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14
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Skinner-Taylor CM, Erhard-Ramírez A, Garza-Elizondo MA, Esquivel-Valerio JA, Abud-Mendoza C, Martínez-Martínez MU, Vega-Morales D, Arana-Guajardo A. Are RA patients from a non-endemic HCV population screened for HCV? A cross-sectional analysis of three different settings. ACTA ACUST UNITED AC 2016; 13:156-159. [PMID: 27132481 DOI: 10.1016/j.reuma.2016.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 02/08/2016] [Accepted: 03/03/2016] [Indexed: 11/19/2022]
Abstract
INTRODUCTION In Mexico, other risk factors are associated with hepatitis C virus (HCV): prior heroin users, living alone, widower, and northern region residence. Rheumatoid arthritis (RA) patients are considered immunosuppressed and HCV testing is recommended before treatment. The aim of the study was to describe the characteristics of HCV testing in RA patients in three different medical care settings in a non-endemic area. METHODS A retrospective observational study was performed using medical records from 960 RA patients describing the indications for HCV testing. RESULTS The test was performed in 28.6% and the HCV overall frequency was 0.36%. Population characteristics were not associated with an increased risk of HCV infection; therefore, anti-HCV positivity was low. The main reason for testing was before starting biological agents. CONCLUSION Due to the low pre-test probability, testing for HCV infection should be personalized; i.e., according to disease prevalence in a particular geographical location and the individual risk factors.
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Affiliation(s)
- Cassandra Michelle Skinner-Taylor
- Servicio de Reumatología, Departamento de Medicina Interna, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Mexico
| | - Alejandro Erhard-Ramírez
- Servicio de Reumatología, Departamento de Medicina Interna, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Mexico
| | - Mario Alberto Garza-Elizondo
- Servicio de Reumatología, Departamento de Medicina Interna, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Mexico
| | - Jorge Antonio Esquivel-Valerio
- Servicio de Reumatología, Departamento de Medicina Interna, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Mexico.
| | - Carlos Abud-Mendoza
- Hospital Central "Dr. Ignacio Morones Prieto", y Facultad de Medicina Universidad Autónoma de San Luis, Potosí, Mexico
| | | | - David Vega-Morales
- Servicio de Reumatología, Departamento de Medicina Interna, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Mexico; Hospital General de Zona No. 17, Instituto Mexicano del Seguro Social, Mexico
| | - Ana Arana-Guajardo
- Servicio de Reumatología, Departamento de Medicina Interna, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Mexico
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15
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Vega-Morales D, Esquivel-Valerio JA, Garza-Elizondo MA. Do rheumatologists know how to squeeze? Evaluations of Gaenslen´s maneuver. Rheumatol Int 2015; 35:2037-40. [PMID: 26318137 DOI: 10.1007/s00296-015-3354-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 06/22/2015] [Accepted: 08/21/2015] [Indexed: 11/28/2022]
Abstract
The Gaenslen´s compression maneuver is the application of pressure on the metacarpophalangeal joints in order to evoke pain on a patient who has active synovitis. The results from the use of the maneuver are seen as controversial due to the lack of information describing the technique required for this procedure. The present study will aim to clarify uncertainty in regard to the form, pressure, and time required to apply the maneuver by rheumatologist. Rheumatologist were observed and monitored while performing the Gaenslen compression maneuver on a prosthetic, biomedical device. The device was shaped to mimic a human hand and equipped with a sensor to monitor the force and time of which the pressure was applied. One hundred and eight (62 %) participants gave a valid recording. From these, 121 (87.7 %) were made by certified rheumatologists. The most predominant method (104 physicians/75.4 %) of applying the maneuver was by using the right hand with superior approach. The median strength calculated in grams resulted in 299 gr (IQR 145) (range 150-741 gr). The median time expressed in milliseconds was of 956.6 ms (IQR 824.6) . This is the first study to assess a clinical maneuver in a qualitative and quantitative manner. The results from this study, more specifically the low number of usable recordings, and the wide range of force exerted in the squeeze test may explain the differences in sensitivity and specificity in clinical studies.
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Affiliation(s)
- David Vega-Morales
- Rheumatology Service, Internal Medicine Department, Hospital Universitario "Dr. José Eleuterio González" Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico.
| | - Jorge Antonio Esquivel-Valerio
- Rheumatology Service, Internal Medicine Department, Hospital Universitario "Dr. José Eleuterio González" Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - Mario Alberto Garza-Elizondo
- Rheumatology Service, Internal Medicine Department, Hospital Universitario "Dr. José Eleuterio González" Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
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Velarde-Ochoa MDC, Esquivel-Valerio JA, Vega-Morales D, Skinner-Taylor CM, Galarza-Delgado DÁ, Garza-Elizondo MA. Anti-Müllerian hormone in reproductive age women with systemic lupus erythematosus. ACTA ACUST UNITED AC 2014; 11:78-82. [PMID: 24815955 DOI: 10.1016/j.reuma.2014.03.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [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: 11/08/2013] [Revised: 03/02/2014] [Accepted: 03/14/2014] [Indexed: 01/11/2023]
Abstract
UNLABELLED Systemic lupus erythematosus (SLE) is an inflammatory autoimmune systemic and chronic disease. Fertility in SLE patients is considered normal; factors that have been associated in these patients with ovarian failure are: disease activity, autoantibodies, and the use of cytotoxic agents. The anti-Müllerian hormone (AMH) is a marker that helps to determine the follicular reserve. OBJECTIVE Determinate the objective was to determine AMH levels in women of reproductive age with SLE. MATERIAL AND METHODS We included 65 women with SLE classified according to the 1997 ACR criteria, 18- to 40-years old. We obtained demographic, clinical, obstetric, and gynecological characteristics as well as serum levels of AMH. We performed a bivariate analysis among patients with low ovarian reserve and those with normal ovarian reserve. We also performed a correlation analysis between activity and damage index and between the cumulative cyclophosphamide dose and AMH levels. RESULTS We found a median of serum AMH in SLE patients of .61 ng/mL. The prevalence of low ovarian reserve in our study was 3.07%. We found a median MEX-SLEDAI score of 1 point and the median SLICC score was 2 points. Twenty-five patients (38.4%) had used cyclophosphamide and their cumulative average dose was 7.5 grams. CONCLUSIONS We found a median of AMH of .61 ng/mL in our population. The prevalence of low ovarian reserve in SLE patients was 3.07%. We did not find a correlation between AMH levels, the use of cyclophosphamide, and disease activity.
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Affiliation(s)
- María Del Carmen Velarde-Ochoa
- Servicio de Reumatología, Departamento de Medicina Interna, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, México
| | - Jorge Antonio Esquivel-Valerio
- Servicio de Reumatología, Departamento de Medicina Interna, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, México
| | - David Vega-Morales
- Servicio de Reumatología, Departamento de Medicina Interna, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, México.
| | - Cassandra Michele Skinner-Taylor
- Servicio de Reumatología, Departamento de Medicina Interna, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, México
| | - Dionicio Ángel Galarza-Delgado
- Servicio de Reumatología, Departamento de Medicina Interna, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, México
| | - Mario Alberto Garza-Elizondo
- Servicio de Reumatología, Departamento de Medicina Interna, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, México
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Galarza-Delgado DA, Esquivel-Valerio JA, Garza-Elizondo MA, Góngora-Rivera F, Muñoz-De Hoyos JL, Serna-Peña G. Carotid atherosclerosis in patients with rheumatoid arthritis and rheumatoid nodules. ACTA ACUST UNITED AC 2012; 9:136-41. [PMID: 23273674 DOI: 10.1016/j.reuma.2012.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Revised: 07/05/2012] [Accepted: 07/18/2012] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine whether an association exists between the presence of rheumatoid nodules and thickening of the intima-media and plaque of the carotid artery, which is evidence of atherosclerosis. MATERIALS AND METHODS Observational, cross-sectional study of 124 patients with rheumatoid arthritis from a University Hospital clinic from 2005 to 2006. We divided the patients into 2 groups, 62 with rheumatoid nodules and 62 without rheumatoid nodules, matched for age and sex. Medical history, erythrocyte sedimentation rate, anti-cyclic citrullinated peptide, rheumatoid factor, and a high resolution doppler ultrasound of the carotid arteries were performed. RESULTS Women comprised 89.5% of the patients. The prevalence of a carotid plaque was 57% in our population. The presence of a plaque was associated with age, arterial hypertension and abdominal circumference. Average intima-media thickness (IMT) in patients with a plaque was 0.085 cm (± 0.02). There was no correlation between laboratory parameters and thickening of the intima-media of the carotid artery. Subcutaneous nodules were present in 33 (47%) of the 70 patients with a carotid plaque and in 29 (54%) of patients without a carotid plaque (p=.471). CONCLUSIONS We did not find an association between rheumatoid nodules and the presence of a carotid plaque and thickening of the intima-media of the carotid in patients with rheumatoid arthritis.
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Affiliation(s)
- Dionicio Angel Galarza-Delgado
- Rheumatology Service, Hospital Universitario Dr José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico.
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Vega-Morales D, Esquivel-Valerio JA, Negrete-López R, Galarza-Delgado DÁ, Garza-Elizondo MA. Safety and efficacy of methylprednisolone infiltration in anserine syndrome treatment. ACTA ACUST UNITED AC 2012; 8:63-7. [PMID: 22317851 DOI: 10.1016/j.reuma.2011.10.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Revised: 10/11/2011] [Accepted: 10/29/2011] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The anserine syndrome is a common cause of knee pain. Infiltration with glucocorticoids has been evaluated in studies with low level of evidence and there are no published clinical trials to determine its usefulness. The objective of this study was to determine the efficacy and safety of the infiltration of methylprednisolone in the treatment of Anserin Syndrome. METHODS We conducted a clinical trial in 58 adult patients with anserin syndrome, which presented intra-articular pathology ruled that reflected pain in the medial aspect of the knee. The WOMAC scale was assessed at baseline and patients were randomized to receive an infiltration of lidocaine plus 40 mg methylprednisolone acetate (group 1) versus xylocaine plus distilled water (group 2). Both groups received 100mg of diclofenac sodium for 10 days. The WOMAC scale was applied at 4 weeks and adverse events were recorded. RESULTS Equivalence was demonstrated in both groups for demographic variables and initial clinical evaluation. There was no statistical difference in the three domains of assessment of the baseline WOMAC score. The median baseline WOMAC in group 1 was 32 and in group 2 was 25.5 points. At 4 weeks it was 8 and 6.5 points, which corresponded to an improvement of 61.6 and 62.8% respectively. CONCLUSION The infiltration with methylprednisolone in anserin syndrome is not superior to placebo in patients taking diclofenac measured by the WOMAC scale at 4 weeks. The incidence of adverse events did not show any differences either.
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Affiliation(s)
- David Vega-Morales
- Departamento de Medicina Interna, Servicio de Reumatología, Hospital Universitario Dr. José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México.
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Rodriguez-Amado J, Peláez-Ballestas I, Sanin LH, Esquivel-Valerio JA, Burgos-Vargas R, Pérez-Barbosa L, Riega-Torres J, Garza-Elizondo MA. Epidemiology of rheumatic diseases. A community-based study in urban and rural populations in the state of Nuevo Leon, Mexico. J Rheumatol Suppl 2011; 86:9-14. [PMID: 21196593 DOI: 10.3899/jrheum.100952] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [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: 05/30/2023]
Abstract
OBJECTIVE To estimate the prevalence of rheumatic diseases in rural and urban populations using the WHO-ILAR COPCORD questionnaire. METHODS We conducted a cross-sectional home survey in subjects > 18 years of age in the Mexican state of Nuevo Leon. Results were validated locally against physical examination in positive cases according to an operational definition by 2 rheumatologists. We used a random, balanced, and stratified sample by region of representative subjects. RESULTS We surveyed 4713 individuals with a mean age of 43.6 years (SD 17.3); 55.9% were women and 87.1% were from urban areas. Excluding trauma, 1278 individuals (27.1%, 95% CI 25.8%-28.4%) reported musculoskeletal pain in the last 7 days; the prevalence of this variable was almost twice as frequent in women (33% vs 17% in men); 529 (11.2%) had pain associated with trauma. The global prevalence of pain was 38.3%. Mean pain score was 2.4 (SD 3.4) on a pain scale of 0-10. Most subjects classified as positive according to case definition (99%) were evaluated by a rheumatologist. Main diagnoses were osteoarthritis in 17.3% (95% CI 16.2-18.4), back pain in 9.8% (95% CI 9.0-10.7), undifferentiated arthritis in 2.4% (95% CI 2.0-2.9), rheumatoid arthritis in 0.4% (95% CI 0.2-0.6), fibromyalgia in 0.8% (95% CI 0.6-1.1), and gout in 0.3% (95% CI 0.1-0.5). CONCLUSION This is the first regional COPCORD study in Mexico performed with a systematic sampling, showing a high prevalence of pain. COPCORD is a useful tool for the early detection of rheumatic diseases as well as for accurately referring patients to different medical care centers and to reduce underreporting of rheumatic diseases.
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Affiliation(s)
- Jacqueline Rodriguez-Amado
- Department of Internal Medicine, Rheumatology Service, Hospital Universitario Dr. José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
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Esquivel-Valerio JA, Flores-Suárez LF, Rodríguez-Amado J, Garza-Elizondo MA, Rendón A, Salinas-Carmona MC. Antineutrophil cytoplasm autoantibodies in patients with tuberculosis are directed against bactericidal/permeability increasing protein and are detected after treatment initiation. Clin Exp Rheumatol 2010; 28:35-39. [PMID: 20412700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVES To determine the prevalence of antineutrophil cytoplasm autoantibodies (ANCA) and its antigenic specificities in sera of patients with pulmonary tuberculosis (Tb) before and after treatment. PATIENTS AND METHODS Sixty-eight patients with culture-proven Tb were studied for the presence of ANCA, both by indirect immunofluorescence (IIF) and ELISA against proteinase-3 (PR3), myeloperoxidase (MPO) and bactericidal/permeability increasing protein (BPI). They were sought before treatment and in 52 of them also after therapy for the infection. High sensitivity C-reactive protein (CRP) was also measured at both times. RESULTS ANCA by IIF were found in 3/68 (4.4%) sera prior to treatment, one C-ANCA and two P-ANCA, all recognizing BPI. After treatment, this increased to 15/52 (28.8%), 3 C-ANCA and 12 P-ANCA, the majority directed against BPI (11/15, 73%). BPI-ANCA were positive in 6/68 (8.8%) and 15/52 (28.8%) before and after Tb after treatment initiation (p=0.003). PR3-ANCA and MPO-ANCA were negative in all Tb sera. A positive ANCA test correlated with CRP as inflammatory marker (p=0.001). CONCLUSIONS The prevalence of ANCA in culture positive Tb patients is modified by Tb chemotherapy. BPI is the main target antigen for ANCA in tuberculosis and BPI-ANCA increase after treatment.
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Affiliation(s)
- Jorge Antonio Esquivel-Valerio
- Services of Rheumatology, Hospital Universitario 'Dr. Jose Eleuterio González' of the Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico.
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