Carotid atherosclerosis in the first five years since rheumatoid arthritis diagnosis: a cross sectional study

Abstract Background Systemic inflammation, documented before rheumatoid arthritis (RA) diagnosis, is associated with accelerated atherosclerosis. We aimed to compare the prevalence of carotid plaque (CP) in RA patients in the first five years since diagnosis and healthy controls, and to determine disease characteristics associated with the presence of subclinical atherosclerosis in RA patients. Methods This was a cross-sectional study. We recruited 60 RA patients in the first five years since diagnosis and 60 matched healthy controls. Carotid ultrasound was performed to detect the presence of CP and measure carotidintima media thickness (cIMT). Subclinical atherosclerosis was considered as the presence of CP and/or increased cIMT. Distribution was evaluated with the Kolmogorov-Smirnov test. Comparisons were made with Chi-square or Fisher's exact test for qualitative variables and Student's t or Mann-Whitney's U test for quantitative variables. A p-value < 0.05 was considered significant. Results There were no differences in the demographic characteristics between RA patients and controls. The mean disease duration was 2.66 ± 1.39 years. A higher prevalence of CP (30.0% vs. 11.7%, p = 0.013), bilateral CP (18.3% vs. 3.3%, p = 0.008), increased cIMT (30.0% vs. 6.7%, p = 0.001), and subclinical atherosclerosis (53.3% vs. 18.3%, p = < 0.001) was found in RA patients. RA patients with subclinical atherosclerosis were older (56.70 years vs. 50.00 years, p = 0.002), presented a higher prevalence of dyslipidemia (53.1% vs. 14.3%, p = 0.002), and higher prevalence of classification in moderate-high disease activity category measured by DAS28-CRP (68.8% vs. 35.7%, p = 0.010). The latter variable persisted independently associated with subclinical atherosclerosis in the binary logistic regression (OR 6.11, 95% CI 1.51-24.70, p = 0.011). Conclusions In the first five years since diagnosis, higher prevalence of subclinical atherosclerosis, including CP was found in RA patients. Carotid ultrasound should be considered part of the systematic CVR evaluation of RA at the time of diagnosis.

Statin indication according to the 2019 World Health Organization cardiovascular disease risk charts and carotid ultrasound in Mexican mestizo rheumatoid arthritis patients

Abstract Background: We aimed to assess the concordance of recommendation for initiating statin therapy according to the 2019 World Health Organization (WHO) cardiovascular disease (CVD) risk charts and to the presence of carotid plaque (CP) identified with carotid ultrasound in Mexican mestizo rheumatoid arthritis (RA) patients, and to determine the proportion of patients reclassified to a high cardiovascular risk after the carotid ultrasound was performed. Methods: This was a cross-sectional study nested of a RA patients' cohort. A total of 157 Mexican mestizo RA patients were included. The cardiovascular evaluation was performed using the 2019 WHO CVD risk charts (laboratory-based model) for the Central Latin America region. A carotid ultrasound was performed in all patients. The indication to start statin therapy was considered if the patient was classified as high risk, moderate risk if > 40 years with total cholesterol (TC) > 200 mg/dl or LDL-C > 120 mg/dl, and low risk if > 40 years with TC > 300 mg/dl, according to the WHO CVD risk chart or if the patient had carotid plaque (CP). Cohen's kappa (k) coefficient was used to evaluate the concordance between statin therapy initiation. Results: Initiation of statin therapy was considered in 49 (31.2%) patients according to the 2019 WHO CVD risk charts and 49 (31.2%) patients by the presence of CP. Cardiovascular risk reclassification by the presence of CP was observed in 29 (18.9%) patients. A slight agreement (k = 0.140) was observed when comparing statin therapy recommendations between 2019 WHO CVD risk charts and the presence of CP. Conclusion: The WHO CVD risk charts failed to identify a large proportion of patients with subclinical atherosclerosis detected by the carotid ultrasound and the concordance between both methods was poor. Therefore, carotid ultra-sound should be considered in the cardiovascular evaluation of RA patients.

Mean platelet volume is decreased in adults with active lupus disease / O volume plaquetário médio está reduzido em adultos com lúpus ativo

ABSTRACT Background: Only a few biomarkers are available for assessing disease activity in systemic lupus erythematosus (SLE). Mean platelet volume (MPV) has been recently studied as an inflammatory biomarker. It is currently unclear whether MPV may also play a role as a biomarker of disease activity in adult patients with SLE. Objective: We investigated the association between MPV and disease activity in adult patients with SLE. Methods: In this retrospective study, we compared two groups of adult patients divided according to disease activity (36 per group). Subjects were age- and gender-matched. Results: MPV was significantly decreased with respect to those of inactive patients (7.16 ± 1.39 vs. 8.16 ± 1.50, p = 0.005). At a cutoff level of 8.32 fL, MPV has a sensitivity of 86% and a specificity of 41% for the detection of disease activity. A modest positive correlation was found between MPV and albumin (r = 0.407, p = 0.001), which in turn is inversely associated with disease activity. Conclusions: In summary, MPV is decreased in adult patients with active lupus disease, and positively correlated with albumin, another biomarker of disease activity. Prospective studies are needed to evaluate the prognostic value of this biomarker.

RESUMO Antecedentes: Existem poucos biomarcadores disponíveis para avaliar a atividade da doença no lúpus eritematoso sistêmico (LES). O volume plaquetário médio (VPM) foi recentemente estudado como um biomarcador inflamatório. Atualmente não está claro se o VPM também pode desempenhar um papel como um biomarcador da atividade da doença em pacientes adultos com LES. Objetivo: Investigou-se a associação entre o VPM e a atividade da doença em pacientes adultos com LES. Métodos: Neste estudo retrospectivo, compararam-se dois grupos de pacientes adultos divididos de acordo com a atividade da doença (36 por grupo). Os indivíduos foram pareados por idade e gênero. Resultados: O VPM esteve significativamente diminuído nos pacientes com doença ativa em comparação com os níveis em pacientes com doença inativa (7,16 ± 1,39 versus 8,16 ± 1,50, p = 0,005). Em um nível de corte de 8,32 fL, o VPM tem uma sensibilidade de 86% e uma especificidade de 41% para a detecção da atividade da doença. Encontrou-se uma correlação positiva modesta entre o VPM e a albumina (r = 0,407, p = 0,001), que por sua vez está inversamente associada à atividade da doença. Conclusões: Em resumo, o VPM está diminuído em pacientes adultos com lúpus ativo e positivamente correlacionado com a albumina, outro biomarcador da atividade da doença. São necessários estudos prospectivos para avaliar o valor prognóstico desse biomarcador.

Manifestaciones reumatológicas en pacientes con infección por virus de la inmunodeficiencia humana / Rheumatic manifestations in AIDS

En el presente la infección por virus de la inmunodeficiencia humana (VIH) es considerada como una de las grandes mimetizadoras de otras enfermedades. Un número variable de hallazgos clínicos asociados con esta infección pueden ser descritos como afección autoinmune y/o reumática. Estos incluyen enfermedades del tejido conectivo (linfocitosis infiltrativa difusa, síndrome de Sjögren),síndromes articulares (sépticos, psoriásicos, Reiter), miopatías (por zidovudina, síndrome de desgaste, asociada a VIH, infecciones oportunistas), síndromes vasculíticos (necrotizante sistémica, hipersensibilidad, lesiones angiocéntricas inmuno-proliferativas) y alteración en estudios de laboratorio (anticuerpos anticardiolipina, anticuerpos anticelulares, anticuerpos antinucleares, complejos inmunes circulantes, hipergammaglobulinemia, factor reumatoide). El tratamiento de esta afección incluye terapia antiretroviral, esteroides, antinflamatorios no esteroideos y terapia inmunosupresora. La coexistencia de infección por VIH y enfermedad reumática ofrece nuevos conocimientos acerca de la patogénesis de ambas condiciones.

Vasculitis: Diagnóstico y manejo actual / Vasculitis: Diagnosis and current management

El término vasculitis se refiere a una inflamación de la pared de los vasos sanguíneos que clínicamente se manifiesta por las consecuencias de esta reacción inflamatoria o las complicaciones de ésta (isquemia o sangrado) en los diversos órganos (piel, riñón, pulmón, corazón, etc) y pueden ocurrrir en forma primaria, o bien, relacionarse con diversos padecimientos infecciosos, neoplásicos o autoinmunológicos con lupus o artritis reumatoide. El espectro clínico es muy amplio y depende del número de vasos afectados, de su calibre y de la localización del daño vascular