ABSTRACT
Objective: To characterize the incidence density of systematic lupus erythematosus (SLE) in Yinzhou District of Ningbo from 2016 to 2021, and compare the age and gender specific differences. Methods: A retrospective cohort study was conducted based on the related data from 2015 to 2021 collected from the Health Information Platform of Yinzhou. Suspected SLE cases in local residents were identified by fuzzy matching of International Classification of Diseases 10th edition code "M32" or Chinese text "lupus". The classification criteria from Systemic Lupus International Collaboration Clinics-2012 and The European League Against Rheumatism/American College of Rheumatology-2019 were used for case verification. SLE cases were identified with specific algorithm based on verification results, and new cases were identified with 1 year as the washout period. The incidence density and 95%CI were estimated by Poisson distribution. Results: From 2016 to 2021, a total of 1 551 921 permanent residents were registered in Yinzhou, in whom 51.52% were women. The M(Q1,Q3) age at enrollment was 40.38 (27.54, 53.54) years. The M(Q1,Q3) of follow-up person-years was 3.83 (0.41, 5.83) years. There were 451 new SLE cases, in which 352 were women (78.05%). The 6-year incidence density was 8.14/100 000 person-years (95%CI: 7.41/100 000 person-years-8.93/100 000 person-years) for the total population, 3.68/100 000 person-years (95%CI: 2.99/100 000 person-years-4.48/100 000 person-years) for men and 12.37/100 000 person-years (95%CI: 11.11/100 000 person-years- 13.73/100 000 person-years) for women. The incidence density in men appeared a small peak at 20-29 years old, and began to increase with age from 40 years old. The incidence density in women was highest in age group 20-29 years (16.57/100 000 person-years) and remained to be high until 30-79 years old. The incidence density of SLE in Yinzhou show no significant temporal trend from 2016 to 2021 (men: P=0.848; women: P=1.000). Conclusions: The incidence density of SLE in Yinzhou from 2016 to 2021 was similar to those of other areas in China. SLE has a high incidence in women, especially in the young and elderly, suggesting that more attention should be paid to the diagnosis and treatment of SLE in women.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Asian People , Incidence , Lupus Erythematosus, Systemic/diagnosis , Retrospective Studies , China/epidemiologyABSTRACT
O Lúpus Eritematoso Sistêmico (LES) é uma patologia crônica, de origem autoimune e inflamatória. As diversas manifestações clínicas existentes em pacientes acometidos pelo LES, sejam elas sistêmicas ou órgãos-alvo, possibilitam variados diagnósticos diferenciais. Dentre as manifestações clínicas que possibilitam estes diagnósticos está o acometimento cutâneo, com vasta variabilidade de apresentação. Da mesma forma, a sífilis também possui apresentação cutânea, tornando possível o diferencial de diagnóstico com outras patologias, inclusive o próprio LES. O presente estudo tem como objetivo relatar um caso de sífilis mimetizando lúpus eritematoso sistêmico, descrever o quadro clínico apresentado pelo paciente, bem como as ferramentas utilizadas para diagnóstico, e a posterior abordagem terapêutica. O caso relatado refere-se a um paciente de 29 anos, do sexo masculino, procedente de Campos Novos (SC), que apresentou um quadro clínico e laboratorial de lúpus-like induzido por uma infecção aguda de sífilis. A resolução completa de critérios inflamatórios de LES ocorreu após tratamento correto da doença infecciosa, com total melhora clínica e sorológica.
Systemic lupus erythematosus (SLE) is a chronic autoimmune inflammatory disease. The various clinical manifestations in SLE patients, both systemic and in target organs, allow for various differential diagnoses. Among the clinical manifestations that aid in diagnosis are the cutaneous injuries, which have a wide range of presentations. Syphilis also has cutaneous manifestations, which aid in the differential diagnosis from other pathologies, including SLE. The present study aims to report a case of syphilis mimicking SLE, describe the clinical condition presented by the patient, the tools used for diagnosis, and the therapeutic approach. The case reported refers to a 29- year-old male patient from Campos Novos (SC), who showed a clinical and laboratory lupus-like condition induced by an acute syphilis infection. The full resolution of SLE inflammatory criteria occurred following appropriate treatment for the infectious disease, with complete clinical and serological improvement.
El lupus eritematoso sistémico (LES) es una enfermedad inflamatoria autoinmune crónica. Las diversas manifestaciones clínicas de los pacientes con LES, tanto sistémicas como en órganos diana, permiten realizar varios diagnósticos diferenciales. Entre las manifestaciones clínicas que ayudan al diagnóstico se encuentran las lesiones cutáneas, que tienen una amplia gama de presentaciones. La sífilis también tiene manifestaciones cutáneas, que ayudan al diagnóstico diferencial con otras patologías, incluido el LES. El presente estudio tiene como objetivo comunicar un caso de sífilis que simula un LES, describir el cuadro clínico presentado por la paciente, las herramientas utilizadas para el diagnóstico y el abordaje terapéutico. El caso relatado se refiere a un paciente masculino de 29 años, natural de Campos Novos (SC), que presentó un cuadro clínico y de laboratorio semejante al lupus, inducido por una infección aguda por sífilis. La resolución completa de los criterios inflamatorios del LES ocurrió tras el tratamiento adecuado de la enfermedad infecciosa, con mejoría clínica y serológica completa.
Subject(s)
Humans , Male , Adult , Syphilis/diagnosis , Syphilis/pathology , Syphilis/therapy , Lupus Erythematosus, Systemic/diagnosis , Lupus Erythematosus, Systemic/pathology , Lupus Erythematosus, Systemic/therapy , Skin Manifestations , Adaptation, Biological , Communicable Diseases/pathology , Communicable Diseases/therapy , Clinical Laboratory Techniques/methods , Case Reports as Topic , Infections/diagnosisABSTRACT
Introducción: El lupus eritematoso sistémico (LES), prototipo de enfermedad autoinmune, cursa con empujes y remisiones. Dada la diversidad de presentaciones posibles, su diagnóstico y tratamiento son un reto para el clínico, y se requiere tener un alto índice de sospecha. Objetivo: presentar el caso clínico de un adolescente que debuta con LES a forma de anemia hemolítica, probablemente gatillado por infección por virus de Epstein Barr. Caso clínico: Varón de 14 años, sin antecedentes a destacar. Consulta por fiebre de 7 días de evolución de hasta 39º C, odinofagia, astenia y adinamia. Al examen físico se constata palidez cutáneo mucosa, ictericia, adenopatías cervicales y hepatoesplenomegalia. El laboratorio muestra anemia severa regenerativa con aumento de las bilirrubinas a expensas de la indirecta sin hepatitis. Prueba de Coombs positiva. Anticuerpos específicos para Epstein Barr positivos, con lo que se diagnostica anemia hemolítica secundaria a mononucleosis y se inicia tratamiento corticoideo. En la evolución agrega eritema malar y limitación en flexión de codos y rodillas. Se reciben anticuerpos antinucleares y anti ADN nativo positivos con hipocomplementemia severa. Con diagnóstico de LES se inicia hidroxicloroquina y azatioprina, manteniéndose la prednisona. Conclusiones: Muchos virus (hepatitis C, Parvovirus B19, Epstein Barr y Citomegalovirus) se han descrito como posibles inductores o simuladores de LES. Es necesario mantener un alto índice de sospecha para realizar un diagnóstico oportuno y tratamiento precoz.
Introduction: Systemic lupus erythematosus (SLE), prototype of autoimmune disease, progresses with flares and remissions. Given the diversity of possible presentations, its diagnosis and treatment are a challenge for the clinician, and a high index of suspicion is required. Objective: To present the clinical case of an adolescent who debuted with SLE in the form of hemolytic anemia, probably triggered by Epstein Barr virus infection. Clinical case: 14 - year - old male, with no history to highlight. Consultation for fever of 7 days of evolution of up to 39º C, odynophagia, asthenia and adynamia. Physical examination revealed mucous skin pallor, jaundice, cervical lymphadenopathy, and hepatosplenomegaly. The laboratory shows severe regenerative anemia with increased bilirubin at the expense of indirect without hepatitis. Positive Coombs test. Specific antibodies for Epstein Barr were positive, with which hemolytic anemia secondary to mononucleosis was diagnosed and corticosteroid treatment was started. In the evolution, it adds malar erythema and limitation in flexion of the elbows and knees. Positive antinuclear and anti-native DNA antibodies are received with severe hypocomplementemia. With a diagnosis of SLE, hydroxychloroquine and azathioprine were started, maintaining prednisone. Conclusions: Many viruses (hepatitis C, Parvovirus B19, Epstein Barr and Cytomegalovirus) have been described as possible inducers or mimics of SLE. It is necessary to maintain a high index of suspicion for timely diagnosis and early treatment.
Introdução: O lúpus eritematoso sistêmico (LES), protótipo de doença autoimune, evolui com impulsos e remissões. Dada a diversidade de apresentações possíveis, seu diagnóstico e tratamento são um desafio para o clínico, sendo necessário um alto índice de suspeição. Objetivo: apresentar o caso clínico de uma adolescente que iniciou com LES na forma de anemia hemolítica, provavelmente desencadeada por infecção pelo vírus Epstein Barr. Caso clínico: Homem de 14 anos, sem antecedentes a destacar. Consulta por febre de 7 dias de evolução de até 39º C, odinofagia, astenia e adinamia. O exame físico revelou palidez cutânea mucosa, icterícia, linfadenopatia cervical e hepatoesplenomegalia. O laboratório mostra anemia regenerativa grave com aumento da bilirrubina em detrimento da indireta sem hepatite. Teste de Coombs positivo. Anticorpos específicos para Epstein Barr foram positivos, com o qual foi diagnosticada anemia hemolítica secundária à mononucleose e iniciado tratamento com corticosteróides. Na evolução, acrescenta eritema malar e limitação na flexão dos cotovelos e joelhos. Anticorpos antinucleares e anti-DNA nativos positivos são recebidos com hipocomplementemia grave. Com diagnóstico de LES, iniciou-se hidroxicloroquina e azatioprina, mantendo-se prednisona. Conclusões: Muitos vírus (hepatite C, Parvovírus B19, Epstein Barr e Citomegalovírus) têm sido descritos como possíveis indutores ou mimetizadores do LES. É necessário manter um alto índice de suspeição para diagnóstico oportuno e tratamento precoce.
Subject(s)
Humans , Male , Adolescent , Epstein-Barr Virus Infections/diagnosis , Infectious Mononucleosis/diagnosis , Anemia, Hemolytic, Autoimmune/diagnosis , Lupus Erythematosus, Systemic/diagnosis , Azathioprine/therapeutic use , Methylprednisolone/therapeutic use , Antirheumatic Agents/therapeutic use , Epstein-Barr Virus Infections/drug therapy , Diagnosis, Differential , Glucocorticoids/therapeutic use , Hydroxychloroquine/therapeutic use , Infectious Mononucleosis/drug therapy , Lupus Erythematosus, Systemic/drug therapyABSTRACT
ABSTRACT Amicrobial Pustulosis of the Folds is a relapsing, chronic and rare neutrophilic dermatosis, characterized by papulopustular, eczematous and aseptic lesions on skin folds. This disorder usually occurs predominantly in females (30 years of age average) with a history of an autoimmune disorder, especially systemic lupus erythematosus. There is no standard therapy, but systemic corticosteroids, alone or in combination with other immunosuppressive drugs, are usually the first-line therapy. We report two females aged 37 and 20 years with the disease but without associated autoimmune diseases. They were successfully treated with non-steroidal treatments.
La pustulosis amicrobiana de los pliegues es una dermatosis neutrofílica crónica, recurrente y poco común. Se caracteriza por lesiones pápulo-pustulosas, eczematosas y asépticas de los pliegues cutáneos. Este cuadro se presenta predominantemente en mujeres de alrededor de 30 años con enfermedades autoinmunes, especialmente lupus eritematoso sistémico. No existe un tratamiento estándar pero los corticoides solos o con inmunosupresores se usan de primera línea. Informamos dos mujeres de 27 y 20 años sin patología autoinmune, con la enfermedad. Ellas fueron tratadas exitosamente sin usar esteroides.
Subject(s)
Humans , Female , Adult , Autoimmune Diseases/complications , Lupus Erythematosus, Systemic/complications , Lupus Erythematosus, Systemic/diagnosis , Lupus Erythematosus, Systemic/drug therapy , Adrenal Cortex Hormones , Drug Therapy, Combination , Immunosuppressive Agents/therapeutic useSubject(s)
Humans , Male , Adult , Young Adult , Endocarditis, Non-Infective/complications , Heart Valves/abnormalities , Lupus Erythematosus, Systemic/diagnosis , Methylprednisolone/therapeutic use , Echocardiography/methods , Immunoglobulins, Intravenous/therapeutic use , Pulse Therapy, Drug/methods , Cyclophosphamide/therapeutic useABSTRACT
Abstract Systemic lupus erythematosus (SLE) is a chronic multisystem autoimmune inflammatory disease. However, some patients may exhibit a histological pattern of kidney injury, with characteristics indistinguishable from lupus nephritis, but without presenting any extrarenal symptoms or serologies suggestive of SLE. Such involvement has recently been called non-lupus full-house nephropathy. The objective is to report a series of clinical cases referred to the Laboratory of the Federal University of Maranhão that received the diagnosis of "full-house" nephropathy unrelated to lupus, upon immunofluorescence and to discuss its evolution and outcomes. Non-lupus full-house nephropathy represents a diagnostic and therapeutic challenge, because it is a new entity, which still needs further studies and may be the initial manifestation of SLE, isolated manifestation of SLE or a new pathology unrelated to SLE.
Resumo O lúpus eritematoso sistêmico (LES) é uma doença inflamatória crônica autoimune multissistêmica. Alguns pacientes, contudo, podem exibir um padrão histológico de lesão renal, com características indistinguíveis da nefrite lúpica, porém sem apresentar quaisquer sintomas extrarrenais ou sorologias sugestivas de LES. Tal acometimento tem sido recentemente denominado nefropatia "full-house" não relacionada ao lúpus. O objetivo é relatar uma série de casos clínicos encaminhados ao Laboratório da Universidade Federal do Maranhão que receberam o diagnóstico de nefropatia "full-house" não relacionada ao lúpus à imunofluorescência e discutir sua evolução e desfechos. A nefropatia "full-house" não relacionada ao lúpus representa um desafio diagnóstico e terapêutico por ser uma entidade nova, que ainda necessita de maiores estudos e pode ser a manifestação inicial do LES, manifestação isolada do LES ou uma patologia nova não relacionada ao LES.
Subject(s)
Humans , Lupus Nephritis/diagnosis , Kidney Diseases , Lupus Erythematosus, Systemic/complications , Lupus Erythematosus, Systemic/diagnosis , Fluorescent Antibody Technique , KidneyABSTRACT
El lupus eritematoso sistémico es una enfermedad autoinmune, de curso crónico con afectación multisistémica. Las manifestaciones oculares del lupus eritematoso sistémico pueden afectar cualquier estructura del ojo. La formación de catarata y la aparición de la diabetes secundaria asociada con el tratamiento esteroideo prolongado es frecuente en estos pacientes. Se presenta el caso de una paciente femenina de 69 años, con antecedentes de lupus eritematoso sistémico de más de 20 años de evolución, tratada con 5 mg diarios de prednisona oral en dosis de mantenimiento. Refiere, además, diabetes mellitus tipo 2 controlada de más de 10 años de evolución. Asiste a la consulta de Oftalmología por disminución de la visión y se diagnostica catarata en el ojo derecho. Se realiza facoemulsificación con implante de lente intraocular plegable, previa profilaxis para la endoftalmitis. La catarata asociada a la diabetes secundaria en los pacientes con lupus eritematoso sistémico justifica el uso de profilaxis antinflamatoria con esteroides tópicos y sistémicos para asegurar una mínima inflamación posoperatoria y mejorar el pronóstico visual(AU)
Systemic lupus erythematosus is a chronic autoimmune disease of multisystemic involvement. Ocular manifestations of systemic lupus erythematosus may present in any structure of the eye. Cataract formation and the appearance of secondary diabetes associated to prolonged steroid therapy are common in these patients. A case is presented of a female 69-year-old patient with a history of systemic lupus erythematosus of more than 20 years' evolution, treated with 5 mg daily of oral prednisone at maintenance doses. The patient also reports controlled diabetes mellitus type 2 of more than ten years' evolution. Her main concern in attending Ophthalmology consultation is vision reduction. Cataract is diagnosed in her right eye. The treatment indicated is phacoemulsification with foldable intraocular lens implantation following prophylaxis for endophthalmitis. Cataract associated to secondary diabetes in patients with systemic lupus erythematosus justifies the use of anti-inflammatory prophylaxis with topical and systemic steroids to ensure minimum postoperative inflammation and improve visual prognosis(AU)
Subject(s)
Humans , Female , Aged , Cataract/diagnosis , Endophthalmitis/complications , Phacoemulsification/methods , Lens Implantation, Intraocular/methods , Diabetes Mellitus, Type 2/etiology , Lupus Erythematosus, Systemic/diagnosis , Lasers, Solid-State/therapeutic use , Research ReportABSTRACT
El debut del lupus eritematoso sistémico (LES) durante el embarazo, intrincado con preeclampsia grave, asociado a edema vulvar masivo gestacional, es raro y de difícil diagnóstico. Se reporta una paciente de 19 años, con 35 semanas de gestación, que debutó con LES durante el tercer trimestre del embarazo, y que consulta por manifestaciones cutáneas, dadas por eritemas en pulpejos de dedos de manos. Se constata preeclampsia severa. Se realiza cesárea de urgencia, e ingresa a la unidad de cuidados intensivos. Instala edema de vulva masivo que incapacita la deambulación.
The onset of systemic lupus erythematosus during pregnancy, complicated with severe preeclampsia, associated with massive gestational vulvar edema, is rare and difficult to diagnose. A 19-year-old patient is reported, with 35 weeks of gestation, who started with systemic lupus erythematosus during her third trimester of pregnancy, and consulted due to cutaneous manifestations caused by erythema on the pads of the fingers. Severe preeclampsia was observed. An emergency cesarean section was performed, and the patient was admitted to the Intensive Care Unit. She developed a massive vulvar edema that disabled ambulation.
O aparecimento de lúpus eritematoso sistêmico durante a gravidez, intrincado com pré-eclâmpsia grave é raro e de difícil diagnóstico. É relatada uma paciente de 19 anos, com 35 semanas de gestação, que estreou com lúpus eritematoso sistêmico no terceiro trimestre de gestação, e que se consultou por manifestações cutâneas causadas por eritema nas pontas dos dedos das mãos. Também existe uma pré-eclâmpsia grave. E realizada cesárea de emergência e ela é internada na Unidade de Terapia Intensiva. Instala um edema vulvar maciço que impede a deambulação.
Subject(s)
Humans , Female , Pregnancy , Adult , Pre-Eclampsia , Vulva/pathology , Edema/surgery , Lupus Erythematosus, Systemic/diagnosis , Lupus Erythematosus, Systemic/drug therapy , Catastrophic Illness , Diagnosis, DifferentialABSTRACT
OBJECTIVE@#To investigate the clinical relevance of serum interleukin-2 receptor α (IL-2Rα) in patients with systemic lupus erythematosus (SLE).@*METHODS@#One hundred and seven SLE patients and 39 healthy controls with comparable age and gender were recruited at Peking University People's Hospital from January 2019 to December 2020. Complete clinical data in 107 SLE patients at baseline and follow-up were collected. SLE disease activity index 2000 (SLEDAI-2K) was used to assess the disease activity of the SLE patients. The serum level of IL-2Rα in the SLE patients and healthy controls was measured using enzyme-linked immunosorbent assay (ELISA). The association between serum IL-2Rα and clinical and laboratory parameters was investigated. Mann-Whitney U test or t test, Chi-square test and Spearman correlation were used for statistical analysis.@*RESULTS@#The serum IL-2Rα levels were significantly higher in the SLE patients [830.82 (104.2-8 940.48) ng/L], compared with those in the healthy controls [505.1 (78.65-1 711.52) ng/L] (P < 0.001). Association analysis showed that the increased serum IL-2Rα was positively associated with SLEDAI-2K scores and anti-nucleosome antibody (r=0.357, P < 0.001; r=0.25, P=0.027, respectively). Thirty-six of 107 (33.6%) SLE patients had lupus nephritis. Serum IL-2Rα levels were significantly higher in the patients accompanied with lupus nephritis [1 102.14 (126.52-8 940.48) ng/L] than in the patients without lupus nephritis [743.89 (104.19-4 872.06) ng/L] (P=0.032). The patients in the high IL-2Rα group had more lupus nephritis compared with those in the low IL-2Rα group (40.8% vs. 19.4%, P=0.031). Meanwhile, SLEDAI-2K scores were found significantly higher in the high IL-2Rα group than in the low IL-2Rα group [10 (3-21) vs. 7 (3-16), P=0.001]. With the improvement of disease activity in the SLE patients after conventional treatments, serum levels of IL-2Rα [1 119.1 (372.25-2 608.86) ng/L] in the week 12 decreased significantly compared with the baseline [1 556.73 (373.08-8 940.48) ng/L] (P=0.042).@*CONCLUSION@#Serum IL-2Rα may be used as a biomarker of disease activity in patients with SLE. There is certain correlation between serum IL-2Rα and renal involvement in SLE.
Subject(s)
Humans , Biomarkers/blood , Case-Control Studies , Interleukin-2 Receptor alpha Subunit/blood , Lupus Erythematosus, Systemic/diagnosisABSTRACT
Resumo Objetivo: Identificar associação entre qualidade de vida e manifestações clínicas e sintomas de depressão em indivíduos com Lúpus Eritematoso Sistêmico. Métodos: Estudo quantitativo, realizado com 141 indivíduos com lúpus em acompanhamento no ambulatório de reumatologia de um hospital universitário. Os dados foram coletados mediante entrevistas, utilizando o WHOQOL- bref , a Escala Cognitiva de Depressão e o questionário de caracterização sociodemográfica. Para análise, os dados foram digitados em planilha no Microsoft Excel® e analisados no Statistical Analysis Software, utilizando o Odds Ratio para medida de estimativa do risco e ajustes de modelos de regressão logística binária para cada uma das covariáveis de interesse. A significância estatística foi estabelecida quando p<0,05. Resultados: Dos 141 participantes, 135 (95,7%) era do sexo feminino, 81 (57,9%) tinha mais de 40 anos e 89 (63,1%) tinha diagnóstico de lúpus há mais de cinco anos. A presença de algumas manifestações clínicas relacionadas à exacerbação da doença aumenta as chances de uma percepção insatisfatória da qualidade de vida em todos os domínios do WHOQOL- bref , sendo que o maior número de manifestações associadas à percepção insatisfatória da qualidade de vida foi observado no domínio saúde física, seguida pelo domínio saúde psicológica. A presença de sintomas de depressão também apresentou associação com percepção insatisfatória em todos os domínios do WHOQOL- bref Conclusão: As manifestações clínicas que caracterizam a atividade da doença, bem como a presença de complicações aumentam as chances de uma percepção insatisfatória da qualidade de vida e esta, por sua vez, aumenta as chances de o indivíduo apresentar sintomas depressivos.
Resumen Objetivo: Identificar la relación entre calidad de vida y manifestaciones clínicas y síntomas de depresión en individuos con lupus eritematoso sistémico. Métodos: Estudio cuantitativo, llevado a cabo con 141 individuos con lupus que realizan seguimiento en consultorios externos de reumatología de un hospital universitario. Los datos fueron recopilados mediante entrevistas, utilizando el WHOQOL- bref , la Escala Cognitiva de Depresión y el cuestionario de caracterización sociodemográfica. Para el análisis, los datos fueron digitalizados en planilla de Microsoft Excel® y analizados en Statistical Analysis Software , utilizando el Odds Ratio para la medida estimativa del riesgo y ajustes de modelos de regresión logística binaria para cada una de las covariables de interés. La significación estadística fue establecida cuando p<0,05. Resultados: De los 141 estudiantes, 135 (95,7 %) eran de sexo femenino, 81 (57,9 %) tenían más de 40 años y 89 (63,1 %) tenían diagnóstico de lupus hace más de cinco años La presencia de algunas manifestaciones clínicas relacionadas con la exacerbación de la enfermedad aumenta las chances de una percepción insatisfactoria de la calidad de vida en todos los dominios del WHOQOL- bref , donde el mayor número de manifestaciones relacionadas con la percepción insatisfactoria de la calidad de vida fue observado en el dominio salud física, seguido del dominio salud psicológica. La presencia de síntomas de depresión también presentó relación con la percepción insatisfactoria en todos los dominios del WHOQOL- bref. Conclusión: Las manifestaciones clínicas que caracterizan la actividad de la enfermedad, así como la presencia de complicaciones, aumentan las chances de una percepción insatisfactoria de la calidad de vida, que por su parte aumenta las chances de que el individuo presente síntomas depresivos.
Abstract Objective: To identify an association between quality of life and clinical manifestations and symptoms of depression in individuals with systemic lupus erythematosus. Methods: This is a quantitative study conducted with 141 individuals with lupus under follow-up at the rheumatology outpatient clinic of a university hospital. Data were collected through interviews using the WHOQOL-bref, the Cognitive Depression Scale and a sociodemographic characterization questionnaire. For analysis, data were entered in a spreadsheet in Microsoft Excel®and analyzed in Statistical Analysis Software, using Odds Ratio to measure risk estimation and adjustments of binary logistic regression models for each of the covariates of interest. Statistical significance was set at p < 0.05. Positive and negative predictive values were calculated for the diagnostic variables that presented statistical significance. Results: Of the 141 participants, 135 (95.7%) were female, 81 (57.9%) were over 40 years old and in 89 (63.1%) lupus had been diagnosed for more than five years. The presence of some clinical manifestations related to exacerbation of the disease increases the chances of an unsatisfactory perceived quality of life in all WHOQOL-bref domains, and the highest number of manifestations associated with unsatisfactory perceived quality of life was observed in the physical health domain, followed by the psychological health domain. The presence of symptoms of depression was also associated with unsatisfactory perception in all WHOQOL-bref domains. Conclusion: The clinical manifestations that characterize the activity of the disease, as well as the presence of complications, increase the chances of an unsatisfactory perceived quality of life and this, in turn, increases the chances of individuals presenting depressive symptoms.
Subject(s)
Humans , Male , Female , Adult , Quality of Life , Depression/diagnosis , Lupus Erythematosus, Systemic/diagnosis , Cross-Sectional Studies , Interviews as Topic/methods , Evaluation Studies as TopicABSTRACT
Antecedentes: El Lupus Eritematoso Sistémico es una enfermedad autoinmune, sistémica, que involucra diferentes órganos incluyendo el corazón. Una de las manifestaciones cardíacas más comunes es la pericarditis; sin embargo, también se pueden presentar otras formas de afectación cardiaca entre las que se incluye la enfermedad arterial coronaria, arteritis y enfermedad valvular. Una de las presentaciones raras del lupus eritematoso sistémico incluye la miocarditis y una vez sospechada, debe ser diagnosticada y tratada con prontitud para evitar consecuencias fatales para el paciente. Descripción del caso: Presentamos un caso de una paciente femenina de 31 años con historia de dolor torácico, fiebre, fatiga, alteraciones ecocardiográficas y niveles elevados de troponina, a quien se le diagnóstico miocarditis y confirmación de Lupus Eritematoso Sistémico. El manejo fue terapia anti-isquémica e inmunoreguladores, con respuesta terapéutica y evolución satisfactoria. Conclusión: La miocardiopatía clínicamente evidente rara vez es la manifestación inicial de Lupus Eritematoso Sistémico, aunque también puede presentarse en el curso de la enfermedad con disfunción ventricular izquierda, insuficiencia cardiaca aguda y edema pulmonar, es de progresión rápida y requiere de diagnóstico y atención temprana, manejo multidisciplinario para evitar complicaciones fatales...(AU)
Subject(s)
Humans , Female , Adult , Hypertension, Pulmonary , Lupus Erythematosus, Systemic/diagnosis , Heart Failure/complications , MyocarditisABSTRACT
Resumen: Introducción: Al menos 50% de los pacientes pediátricos portadores de artritis idiopática juvenil (AIJ) continuará control en reumatología adulto. La clasificación de la Liga Internacional de Asociaciones de Reumatología (ILAR) vigente, actualmente en revisión, difiere de la clasificación de las artritis inflamatorias del adulto. Se ha reportado cambios de categoría en 10,8% de los pacientes durante el seguimiento. Objetivo: Analizar los pacientes con AIJ seguidos al menos 7 años para objetivar cambios de diagnós tico en la transición, e identificar factores de mal pronóstico funcional. Pacientes y Método: Estudio retrospectivo en base a registros clínicos. Se incluyó a la totalidad de los pacientes con AIJ controla dos en policlínico pediátrico del Hospital de Puerto Montt entre el año 2005 y 2017, que cumplieron siete o más años de seguimiento. Se realizó análisis descriptivo en base a variables clínicas: categoría diagnóstica, tiempo de evolución al diagnóstico, actividad clínica y serológica, y tiempo de evolución al inicio de la terapia farmacológica. Resultados: Se evaluaron 18 pacientes, 3 Oligo-articular (OA) persistente, 1 OA extendida, 4 Poli-articular (PA) factor reumatoide (FR) negativo, 4 PA FR positivo, 5 Sistémicas, 1 Psoriática, todos con seguimiento mayor a 7 años. Once de 18 niños fueron transfe ridos a adultos. Tres de 11 cambiaron de diagnóstico a Artritis Reumatoide (AR) más otra enferme dad autoinmune: Síndrome de Sjögren + Lupus eritematoso sistémico, Púrpura trombocitopénico inmune, Enfermedad autoinmune no clasificada y cinco de 11 niños de categoría ILAR: OA a Artritis reumatoide juvenil, OA extendida a PA FR negativo, 3 Sistémicas a PA FR negativo. Edad de inicio, formas poli-articulares, retrasos en diagnóstico y comienzo de terapia se asociaron a secuelas e infla mación persistente. Conclusiones: Ocho de once pacientes transferidos cambiaron denominación diagnóstica y/o presentaron otras enfermedades autoinmunes. Algunos factores de mal pronóstico deben mejorar.
Abstract: Introduction: At least 50% of pediatric patients with Juvenile Idiopathic Arthritis (JIA) will require continued fo llow-up in adult rheumatology. The present International League of Associations for Rheumatology (ILAR) classification, currently under revision, differs from its classification of inflammatory arthritis in adults. Category changes have been reported in 10.8% of patients during follow-up. Objective: To analyze JIA patients in follow-up for at least 7 years to detect diagnosis changes during transition to adult care, identifying factors of poor functional prognosis. Patients and Method: Retrospective study based on medical records of JIA patients seen at the pediatric polyclinic of the Puerto Montt Hospital between 2005 and 2017, who were monitored for at least 7 years. Descriptive analysis was performed according to clinical variables: diagnostic category, evolution before diagnosis, clinical and serological activity, and evolution before starting drug therapy. Results: We evaluated 18 pa tients, corresponding to 3 patients with persistent oligoarticular arthritis (OA), 1 with extended OA, 4 with polyarticular arthritis (PA) rheumatoid factor (RF) negative, 4 with PA RF positive, 5 with syste mic JIA, and 1 with psoriatic arthritis, all have had follow-up more than 7 years. 11 out of 18 patients transitioned to adult care. Three out of 11 patients changed diagnosis to Rheumatoid Arthritis (RA) plus another autoimmune disease such as Sjögren's Syndrome + Systemic Lupus Erythematosus, Immune thrombocytopenia, or unclassified autoimmune disease, and 5 out of 11 children changed ILAR category from OA to Juvenile Rheumatoid Arthritis, extended OA to PA RF negative, and 3 from Systemic arthritis to PA RF negative. Age of onset, polyarticular forms, delay in diagnosis, and the start of therapy were associated with sequelae and persistent inflammation. Conclusions: Eight of the eleven JIA patients who transitioned to adult care changed their diagnosis or presented other autoimmune diseases. Some factors of poor prognosis must improve.
Subject(s)
Humans , Male , Female , Young Adult , Arthritis, Juvenile/diagnosis , Transition to Adult Care , Arthritis, Juvenile/classification , Arthritis, Juvenile/complications , Arthritis, Juvenile/therapy , Arthritis, Rheumatoid/classification , Arthritis, Rheumatoid/complications , Arthritis, Rheumatoid/diagnosis , Arthritis, Rheumatoid/therapy , Prognosis , Arthritis, Psoriatic/complications , Arthritis, Psoriatic/diagnosis , Arthritis, Psoriatic/therapy , Retrospective Studies , Follow-Up Studies , Purpura, Thrombocytopenic, Idiopathic/complications , Purpura, Thrombocytopenic, Idiopathic/diagnosis , Purpura, Thrombocytopenic, Idiopathic/therapy , Aftercare , Disease Progression , Lupus Erythematosus, Systemic/complications , Lupus Erythematosus, Systemic/diagnosis , Lupus Erythematosus, Systemic/therapyABSTRACT
Introducción: Los biomarcadores son claves en el diagnóstico y pronóstico del lupus eritematoso sistémico en el cual las manifestaciones clínicas son extremadamente complejas y heterogéneas. Objetivo: Determinar el valor clínico de los inmunocomplejos circulantes en pacientes con lupus eritematosos sistémico. Métodos: Se determinaron los niveles séricos de inmunocomplejos fijadores del C1q y de los anticuerpos anti-ácido desoxirribonucleico de doble cadena (anti-ADNdc), anti-nucleosoma (anti-Nuc) y anti-proteínas ribosomales (anti-RibP) por el ensayo inmuno-adsorbente ligado a enzima (ELISA) en 93 pacientes con diagnóstico de lupus eritematosos sistémico. Se utilizaron exámenes no paramétricos para probar la asociación entre los inmunocomplejos y los auto-anticuerpos. La frecuencia de nefritis lupica en los grupos de pacientes positivos y negativos de inmunocomplejos circulantes se comparó mediante Chi cuadrado. Resultados: Los inmunocomplejos se encontraron en 24 (25,8 por ciento) pacientes con lupus eritematosos sistémico. Los pacientes que presentaron los títulos más altos de inmunocomplejos fueron los positivos a los tres auto-anticuerpos usados (p=0,044). Se encontró correlación directa entre los niveles de anti-RibP y los inmunocomplejos (Rho=0,303, p=0,003) y entre los anti-ADNdc y anti-Nuc (Rho=0,449, p=0,001). La nefritis lúpica se presentó en 58,3 por ciento de pacientes con inmunocomplejos, y 31,9 por ciento pacientes negativos de inmunocomplejos (p=0,213). Conclusiones: Los inmunocomplejos circulantes caracterizaron una fracción menor de pacientes con lupus eritematosos sistémico. La presencia de estos no se asoció a los anticuerpos anti-ADNdc ni a la nefritis lupica(AU)
Introduction: Biomarkers are essential in the diagnosis and prognosis of systemic erythematous lupus in which clinical manifestations are extremely complex and heterogeneous. Objective: To determine the clinical value of circulating immunocomplexes in patients with systemic erythematous lupus. Methods: Serum levels of C1q-binding immunocomplexes and anti-double-stranded deoxyribonucleic acid (anti-dsDNA), anti-nucleosome (anti-Nuc) and anti-ribosomal proteins (anti-RibP) were determined by enzyme-linked immunosorbent assay (ELISA) in 93 patients diagnosed with systemic lupus erythematosus. Nonparametric tests were used to test the association between immunocomplexes and auto-antibodies. The frequency of lupus nephritis in the circulating immunocomplex positive and negative patient groups was compared using Chi square. Results: Immunocomplexes were found in 24 (25.8 percent) patients with systemic lupus erythematosus. The patients with the highest immunocomplex titers were positive for the three autoantibodies used (p = 0.044). A direct correlation was found between the levels of anti-RibP and immunocomplexes (Rho = 0.303, p = 0.003) and between anti-dsDNA and anti-Nuc (Rho = 0.449, p = 0.001). Lupus nephritis occurred in 58.3 percent of immunocomplex patients, and 31.9 percent immunocomplex negative patients (p = 0.213). Conclusions: Circulating immunocomplexes characterized a smaller fraction of patients with systemic lupus erythematosus. Their presence was not associated with anti-dsDNA antibodies or lupus nephritis(AU)
Subject(s)
Humans , Male , Female , Enzyme-Linked Immunosorbent Assay/methods , Biomarkers, Tumor/analysis , Lupus Erythematosus, Systemic/diagnosis , Cross-Sectional Studies , ISCOMs/analysisABSTRACT
Introducción: El lupus eritematoso sistémico es el modelo clásico de enfermedad autoinmune. En el desarrollo de la enfermedad intervienen varios tipos de inmunoglobulinas, con predominio de la IgG, IgM e IgA. Objetivo: Describir la utilidad del cociente albúmina/globulina como un indicador de actividad en el lupus eritematoso sistémico. Desarrollo: Se estima que el 50 por ciento de los pacientes con lupus eritematoso sistémico muestran una hipoalbuminemia con una hipergammaglobulinemia. La hipoalbuminemia en mayor medida está relacionada con la presencia de nefritis lúpica. La mitad de los pacientes con nefritis lúpica presentan proteinuria en el orden del síndrome nefrótico. Esta proteinuria iguala o invierte parcialmente el valor del cociente albúmina/globulina. El cociente albúmina/globulina invertido por sí solo es insuficiente para afirmar la presencia de actividad en el lupus eritematoso sistémico. Se deben excluir otras entidades clínicas causantes de hipergammaglobulinemia policlonal. Los criterios de actividad del lupus eritematoso sistémico incrementan la sensibilidad del cociente albúmina/globulina invertido. Conclusiones: La interpretación del cociente albúmina/globulina debe ir aparejada a la estimación de actividad por los criterios clínicos de mayor uso (SLICC, SLEDAI, BILAG). No en todos los pacientes con lupus eritematoso sistémico puede interpretarse como criterio de actividad, por lo que es necesario excluir otras entidades clínicas(AU)
Introduction: Systemic lupus erythematosus is the model of autoimmune disease. Several types of immunoglobulins are involved in the development of the disease, mainly IgG, IgM and IgA. Objective: To describe the potential use of the albumin/globulin ratio as an indicator of activity in systemic lupus erythematosus. Development: fifty percent of patients with systemic lupus erythematosus exhibit hypoalbuminemia with hypergammaglobulinemia. Hypoalbuminemia is mainly related to the presence of lupus nephritis. The half of patients with lupus nephritis develops proteinuria with values of nephrotic syndrome. The proteinuria equals or partially reverses the albumin/globulin ratio. The inverted albumin/globulin ratio is insufficient to establish the presence of lupus activity. Other clinical entities producing polyclonal hypergammaglobulinaemia should be excluded. The systemic lupus erythematosus activity criteria increase the sensitivity of the inverted albumin/globulin ratio. Conclusions: The interpretation of the albumin/globulin ratio requires the activity estimation by different clinical criteria (SLICC, SLEDAI, BILAG). The inverted albumin/globulin ratio cannot be interpreted as a stand-alone indicator of disease activity in every systemic lupus erythematosus patients(AU)
Subject(s)
Humans , Proteinuria , Autoimmune Diseases , Immunoglobulin A/analysis , Immunoglobulin G/analysis , Immunoglobulin M/analysis , Hypoalbuminemia , Hypergammaglobulinemia/diagnosis , Lupus Erythematosus, Systemic/diagnosis , Nephrotic Syndrome , Odds Ratio , Albumins/analysisABSTRACT
Systemic lupus erythematosus (SLE) is a chronic systematic autoimmune disease. Current methods of diagnosing SLE or evaluating its activity are complex and expensive. Numerous studies have suggested that neutrophil-to-lymphocyte ratio (NLR) is closely correlated with the presence of SLE and its activity, suggesting that it may serve as a diagnostic and monitoring indicator for SLE. Therefore, we performed a meta-analysis to systematically assess the association between NLR and SLE. We performed a literature search until 12 April 2019 in the PubMed, Web of Science, and China National Knowledge Infrastructure databases. Cross-sectional studies comparing the NLR of SLE patients versus those of healthy controls, of active versus inactive SLE patients, and of SLE patients with versus without lupus nephritis were considered for inclusion. Mean intergroup NLR differences were estimated using standardized mean differences and their 95% confidence intervals. Study quality was assessed using the Agency for Healthcare Research and Quality instrument for cross-sectional studies. Fourteen studies with 1,781 SLE patients and 1,330 healthy controls were included in this meta-analysis. The pooled results showed that the NLR was significantly higher in SLE patients than in healthy controls, in active SLE patients than in inactive SLE patients, and in SLE patients with lupus nephritis than in those without lupus nephritis. NLR may be an indicator for monitoring disease activity and reflecting renal involvement in SLE patients. Nevertheless, more high-quality studies are warranted to further validate our findings.
Subject(s)
Humans , Lymphocytes/pathology , Lupus Erythematosus, Systemic/blood , Neutrophils/pathology , China , Cross-Sectional Studies , Lupus Erythematosus, Systemic/diagnosisABSTRACT
Abstract Background Anti-ribosomal P (anti-Rib-P) antibody is a specific serological marker for systemic lupus erythematosus (SLE) and routinely tested by targeting the common epitope of three ribosomal proteins of P0, P1 and P2. This study aimed to investigate if testing antibodies against individual ribosomal protein, but not the common epitope, is required to achieve the best diagnostic benefit in SLE. Methods The study included 82 patients with SLE and 22 healthy donors. Serum antibodies were determined by ELISA and immunoblot. Results The prevalence of each antibody determined by ELISA was 35.4% (anti-Rib-P), 45.1% (anti-Rib-P0), 32.9% (anti-Rib-P1) and 40.2% (anti-Rib-P2) at 99% specificity, respectively. Of 53 patients with negative anti-Rib-P antibody, 21 (39.6%) were positive for anti-Rib-P0, 9 (17.0%) for anti-Rib-P1 and 12 (22.6%) for anti-Rib-P2 antibody. The positive rate of anti-Rib-P antibody detected by ELISA was close to the results by immunoblot (33.4%). Patients with any of these antibodies were featured by higher disease activity and prevalence of skin rashes than those with negative antibodies. Moreover, each antibody was particularly related to some clinical and laboratory disorders. The distribution of subclasses of IgG1-4 was varied with each antibody. Anti-Rib-P0 IgG1 and IgG3 were strongly correlated with disease activity and lower serum complement components 3 and 4. Conclusions Anti-Rib-P antibody is not adequate to predict the existence of antibodies against ribosomal P0, P1 and P2 protein. The examination of antibodies against each ribosomal protein is required to achieve additional diagnostic benefit and to evaluate the association with clinical and serological disorders as well.(AU)
Subject(s)
Humans , Ribosomal Protein L10/blood , Lupus Erythematosus, Systemic/diagnosis , Antibodies/blood , Enzyme-Linked Immunosorbent Assay/instrumentation , Immunoblotting/instrumentationABSTRACT
OBJECTIVES: Many studies indicate that microRNAs (miRNAs) could be potential biomarkers for various diseases. The purpose of this study was to investigate the clinical value of serum exosomal miRNAs in systemic lupus erythematosus (SLE). METHODS: Serum exosomes were isolated from 38 patients with SLE and 18 healthy controls (HCs). The expression of miR-21, miR-146a and miR-155 within exosomes was examined by reverse transcription-quantitative polymerase chain reaction (RT-qPCR). Using receiver operating characteristic (ROC) curves, we evaluated the diagnostic value of exosomal miRNAs. RESULTS: Exosomal miR-21 and miR-155 were upregulated (p<0.01), whereas miR-146a expression (p<0.05) was downregulated in patients with SLE, compared to that in HCs. The expression of miR-21 (p<0.01) and miR-155 (p<0.05) was higher in SLE patients with lupus nephritis (LN) than in those without LN (non-LN). The analysis of ROC curves revealed that the expression of miR-21 and miR-155 showed a potential diagnostic value for LN. Furthermore, miR-21 (R=0.44, p<0.05) and miR-155 (R=0.33, p<0.05) were positively correlated with proteinuria. The expression of miR-21 was negatively associated with anti-SSA/Ro antibodies (R=−0.38, p<0.05), and that of miR-146a was negatively associated with anti-dsDNA antibodies (R=−0.39, p<0.05). CONCLUSIONS: These findings suggested that exosomal miR-21 and miR-155 expression levels may serve as potential biomarkers for the diagnosis of SLE and LN.
Subject(s)
Humans , Lupus Nephritis/diagnosis , Lupus Nephritis/genetics , MicroRNAs , Circulating MicroRNA , Lupus Erythematosus, Systemic/diagnosis , Lupus Erythematosus, Systemic/genetics , BiomarkersABSTRACT
In lupus enteritis, circulating pathological immune complexes and thrombosis of intestinal vessels may occur, resulting in acute abdominal pain. We report a 24-year-old woman without a history of systemic lupus erythematosus (SLE), admitted for abdominal pain. An exploratory laparotomy found an appendicitis along with ascites. An appendectomy was performed, and the patient was discharged from the hospital two days later. Three days after discharge, the patient was admitted to another hospital due to the persistence of abdominal pain. An abdominal computed tomography scan showed diffuse mesenteric congestion, concentric bowel loops (double halo or target sign) and the presence of free fluid in the peritoneal cavity. Suspecting a rheumatic disorder, the diagnosis of SLE was confirmed by immunological studies. The patient was treated with pulses of methylprednisolone with good results.