ABSTRACT
A cross-sectional and multicenter study was undertaken to analyze the clinical and immunological characteristics at diagnosis associated with nephritis in northwestern Colombian patients with systemic lupus erythematosus (SLE). Thirty nine patients with lupus nephritis were included and were compared to 100 SLE patients without nephritis. A multivariate analysis was performed. The patients who developed nephritis had a higher frequency of oral ulcers (41 percent vs. 21 percent, OR3.1, 95 percent CI: 1.3-7.5 p 0.01) and malar erythema (77 percent vs. 45 percent, OR4.4, 95 percent CI: 1.8-10.8 p0.001). Lupus nephritis was observed in 77 percent of cases during the first year of the disease. The frequency of anti-DNA antibodies was higher in patients with nephritis, however, differences were not statistically significant (83 percent vs 64 percent, OR2.6, 95 percent CI: 1.03-6.41, p0.06). The presence of other autoantibodies (anti-Ro, anti-La, anti-RNP, anti-Sm and anticardiolipin) at diagnosis was similar in both groups. This autoantibody profile remained unchanged throughout the evolution of the disease. Patients with lupus nephritis had a higher prevalence of arterial hypertension (60 percent vs 10 percent, OR13.7, 95 percent IC: 5-37, 0.00001) and hyperlipidemia (30 percent vs 7 percent, OR8.1, 95 percent IC: 2.5-27, p0.0006) at onset. Finally, patients with lupus nephritis required more hospitalizations (1) over the course of disease (89 percent vs 60 percent, OR7.8, 95 percent IC: 2.1-29, p0.002). In conclusion, lupus nephritis appears early during the course of SLE. Malar erythema, oral ulcers, hypertension and hyperlipidemia at onset of disease are associated factors. Lupus nephritis is a major risk factor leading to repeated hospitalizations. This study may help to assist in public health policies in our population in order to improve patient outcomes while simultaneously reducing disease costs.
Subject(s)
Humans , Lupus Erythematosus, Systemic/immunology , Lupus Nephritis/immunology , Antibodies , Colombia , Hyperlipidemias , Hypertension , Risk FactorsABSTRACT
Objetivo; evaluar la aplicabilidad del modelo diagnóstico propuesto por el Grupo Internacional de Hepatitis Autoinmune (G1HA). Metodología: estudio retrospectivo, observacional, no analítico de 28 pacientes con diagnóstico de Hepatitis Autoinmune (HA1) de la ciudad de Medellín- Colombia. Resultados; se analizaron 28 pacientes con diagnóstico de HAI. Según el modelo de criterios diagnósticos de 1992 aplicado a los pacientes antes del inicio del tratamiento, 25 por ciento tuvieron diagnostico definitivo y 53 por ciento diagnóstico probable. Al aplicar los nuevos criterios, 14 por ciento tenían diagnostico definitivo y 64 por ciento probable. En ambos modelos 22 por ciento de los pacientes no alcanzaron el puntaje para clasificarlos como HA1. La concordancia entre el diagnóstico clínico y los criterios del GIHA fue de 78. 5 por ciento con ambos puntajes. Conclusiones: ambos modelos son útiles para el diagnóstico de hepatitis autoinmune. El modelo de 1998 es más especifico en nuestro estudio
Subject(s)
Hepatitis, AutoimmuneABSTRACT
El síndrome antifosfolípido (SAF) se caracteriza por trombosis vascular y/o pérdida fetal asociada a la presencia de anticuerpos antifosfolípidos (anticardiolipina y/o anticoagulante tópico). Este síndrome puede presentarse aislado (primario - SAFP-) o secundario al lupus eritematoso sistémico (SAFS). Tanto la presentación primaria como secundaria pueden ser responsables de manifestaciones sistémicas distintas a las vasculares, entre ellas pulmonares. Aquí se presenta una paciente con disnea por hipertensión pulmonar (HTP) y enfermedad pulmonar insterstícial (EPI), en quien se diagnosticó SAFS. Las manifestaciones pulmonares del SAF son revisadas e incluyen tromboembolismo pulmonar, HTP, EPI, hemorragia pulmonar, y síndrome de dificultad respiratoria del adulto con falla multisistémica