Osteoporotic fractures in rheumatoid arthritis patients in Argentina: a matched retrospective cohort study

Abstract Background: To compare the incidence of osteoporotic fractures in patients with rheumatoid arthritis (RA) with matched controls from a university hospital. Methods: Consecutive RA patients (n = 100) were matched (age and sex) with controls (1:2). The follow-up period began at the index date, defined as the date of diagnosis for RA patients and the date of the first medical claim at the Health Management Organization (HMO) for non-RA patients. Fracture incidence rates per 1000 persons-years (PY) for distinct types of fractures were calculated. Multivariate cox regression analysis was performed to identify factors associated with fractures. Results: One hundred RA patients were followed for a total of 975.1 patients-years and 200 controls for 1485.7 patients-years. No difference was found in the overall fracture incidence rate per 1000 PY between RA and controls (19.5, 95% CI 12.7-28.6 vs 12.1, 95% CI 7.7-18.7, p =0.07). In the Cox regression analysis, only age (HR 1.06, 95% CI 1.02-1.11, p = 0.006) and history of a prior fracture (HR 9.85, 95% CI 2.97-32.64, p < 0.001) were associated with fractures after the index date. The stratified analysis of the fractures by location showed that only the vertebral fractures were more frequent in RA patients compared with controls (12.9 per 1000 PY, 95% CI 8.9-25.8, vs. 3.4, 95% CI 1.4-8.1, respectively, p =0.01). Conclusion: Patients with RA didn't show an overall increased risk of osteoporotic fractures compared with matched controls, but vertebral fractures were more frequently observed in patients with RA.

Daño coronario secundario a enfermedad de Kawasaki / Coronary Lesions in Kawasaki Disease

Introducción: La enfermedad de Kawasaki, una vasculitis aguda de origen desconocido, es actualmente la principal causa de cardiopatía adquirida durante la infancia y sus principales secuelas están relacionadas con las arterias coronarias, por lo que el reconocimiento temprano de la probabilidad de daño coronario posibilita el tratamiento oportuno para disminuir su ocurrencia. Objetivos: Determinar la probabilidad de sufrir daño coronario en pacientes con enfermedad de Kawasaki, reconocer los factores de riesgo para el desarrollo de lesión coronaria y la evolución a largo plazo de estos pacientes. Material y métodos: Se diagnosticó enfermedad de Kawasaki en 245 niños (octubre 1988 - diciembre 2013) con edad media de 3,48 años. Las variables analizadas fueron: edad, sexo, criterios clínicos y de laboratorio de enfermedad de Kawasaki, hallazgos ecocardiográficos y evolución a largo plazo. Se calculó el odds ratio para evaluar las diferentes variables analizadas como probables factores de riesgo de enfermedad coronaria. Resultados: Presentaron daño coronario 39 pacientes: 25 varones y 14 mujeres; edad media: 2,05 años. Se identificaron como factores de riesgo la edad < 3 años, la fiebre prolongada = 6 días, la eritrosedimentación > 50 mm/h, la proteína C reactiva > 100 mg/L y el hematocrito < 30%. Trece pacientes mostraron dilatación transitoria de las arterias coronarias, 12 pacientes aneurismas solitarios de tamaño pequeño o mediano, 7 pacientes aneurismas coronarios múltiples, 6 pacientes aneurismas coronarios gigantes y uno infarto agudo de miocardio por lesión obstructiva grave. La mortalidad hospitalaria fue del 4‰. Conclusiones: La probabilidad de presentar daño coronario en pacientes con enfermedad de Kawasaki fue del 15,91%. Los factores de riesgo para lesión coronaria detectados fueron: edad menor de 3 años, 6 o más días de fiebre, eritrosedimentación > 50 mm/h, proteína C reactiva > 100 mg/L y hematocrito < 30%. En los pacientes con daño coronario residual persistente tratados en forma convencional no hubo eventos adversos durante el seguimiento a mediano y a largo plazos.

Background: Kawasaki disease, a vasculitis of unknown origin, is currently the main cause of acquired heart disease during childhood and its main sequelae are associated with coronary arteries. Therefore, early identification of possible coronary lesions enables adequate treatment to decrease their occurrence. Objectives: The aims of this study were to determine the probability of coronary injury in patients with Kawasaki disease, to identify the risk factors for developing coronary lesions and the long-term outcome of these patients. Methods: A total of 245 children with mean age of 3.48 years were diagnosed with Kawasaki disease between October 1988 and December 2013. Age, sex, clinical and laboratory criteria of Kawasaki disease, echocardiographic findings and long-term outcome were analyzed, and the odds ratio was used to assess their participation as probable risk factors for coronary lesions. Results: Thirty-nine patients presented coronary lesions: 25 male and 14 female patients with mean age of 2.05 years. Risk factors were: age < 3 years; prolonged fever = 6 days, erythrocyte sedimentation rate > 50 mm/hr; C-reactive protein > 100 mg/l and hematocrit < 30%. Thirteen patients showed transient coronary artery dilation, 12 solitary small or medium-sized aneurysms, 7 multiple coronary aneurysms, 6 giant coronary aneurysms and one myocardial infarction by severe obstructive lesion. In-hospital mortality was 4‰. Conclusions: Risk of coronary artery lesions in patients with Kawasaki disease was 15.91%. Risk factors were age under 3 years, fever lasting more than 6 days, erythrocyte sedimentation rate > 50 mm/hr; C-reactive protein > 100 mg/L and hematocrit < 30%. In patients with persistent residual coronary lesions treated conventionally there were no adverse events in the mid- and long-term follow-up.