[Electrocardiographic changes and QT interval modifications in patients with Early Arthritis]. / Comportamiento del QT corregido en artritis.

BACKGROUND: The QT interval modification has been described in patients witrthritis (RA) and it could be a useful marker of cardiovascular morbidity and mortality. AIMS: To evaluate the QT interval modifications in patients with early arthritis (EA) and its association with disease activity (DA). METHODS: We studied patients with diagnosis of EA attended to Rheumatology Unit at Córdoba Hospital from January 2010 to December 2013. Control group was population age, gender and cardiovascular risk factors matched. Exclusion criteria were: myocardial infarction, arrhythmia, K level >5, or anti-arrhythmia treatment. ECG was performed by standard technique and QT interval was measured from the beginning of QRS to the end of T wave. QTC value was calculated by Bazzet formula. The activity disease was measured by Disease Activity Score (DAS 28), and was considered low disease activity below 3.2, and moderate / high disease activity more than 3,2. RESULTS: 31 patients were included with 83.9 % of females and the mean age was 41.9 years old and DAS 28 was 5.09. 31 persons were included as a control group with a mean age of 42.2 years old. QT interval was 0.376 mm/s and l QTC 0.408 in EA and QT was 0.381 mm/s and QTC 0.415 mm/s in the control group ( p= NS, p= NS). QT interval and QTC were 0.39 and 0.38 in low DA patients; 0.37 and 0.411 in Moderate / High DA ( p=NS) Conclusions: The QT interval was not modified and it was not related with DA in EA.

Evolución y factores pronósticos en pacientes lúpicos con admisión en unidad de terapia intensiva / Evolution and prognostic factors in patients with lupus admitted to intensive care unit

El objetivo de este estudio fue evaluar las causas de ingreso y la mortalidad de pacientes con LES admitidos en Unidad de Terapia Intensiva (UTI), e identificar factores de riesgo asociados con mortalidad así comola utilidad de la escala de APACHE II como factor de pronóstico. Se estudiaron retrospectivamente pacientes con diagnóstico de LES acorde al ACR 1997, ingresados en UTI del Hospital Córdoba des de junio de 2008 a marzo del 2011. Se analizaron datos demográficos, características de la enfermedad, causas de admisión, escala de APACHEII en las primeras 24 hs de internación, tratamiento realizado, días de internación y mortalidad. Valores de p <0,05 fueron considerados estadísticamente significativos. Se incluyeron 23 pacientes con edad promedio de 31 años, 87,5% de sexo femenino. Las principales causas de ingreso fueron la actividad lúpica e infección en 52,1%. El promedio de días de internación fue de 12. Los tratamientos recibidos más frecuentes fueron: antibióticos 93,8%, pulsos de esteroides 62,5%, ARM e inmunosupresores 56,3%, respectivamente. Ninguno se correlacionó conmortalidad. La mortalidad fue de un 21,7% principalmente causada por la combinación de actividad lúpica con infección. El scoreAPACHE II no tuvo asociación estadísticamente significativa con lamortalidad. Conclusión: La tasa de mortalidad en los pacientes lúpicos admitidosen UTI fue elevada. Sería importante desarrollar instrumentos más certeros de pronóstico en pacientes lúpicos que ingresen a UTI.

Objective: To study the causes of admission and mortality in lupus patients admitted to Intensive Care Unit (ICU) and to identify risk factors associated with mortality.We retrospectivel y studied patients with SLE diagnosis with ACRCriteria who were admitted to ICU of Córdoba hospital from June2008 to March 2011. We analyzed demographic data (age, gender, socioeconomic status by Graffar scale), duration of disease, treatment, disease activity by ECLAM score, organic damage by SLICC, causes of ICU admission, APACHE II score in the first 24 hours of hospitalization, days in ICU and mortality. P value <0.05 was considered statistically significant.23 patients were included with a mean age of 31 years, 87.5% female and 81.3% with good socioeconomic status. The duration of SLE beforeICU admission was 53 months, 37.5% had no treatment at admission.The main reasons for admission were lupus activity and infection in 52.1% of the patients. The average days of ICU hospitalization was12. The most frequent treatments used were steroid pulses (62.5%), ARM, immunosuppressive treatment (56.3%), and antibiotics 93.8%. Treatments received were not correlated with mortality. Mortality was21.7% and the most frequent cause was the combination of lupus activity with infection. The APACHE II score was not statistically significant association with mortality. Conclusion: The mortality rate in lupus patients admitted to ICU remains high despite of treatment.

Correlación de hallazgos serológicos y compuestos orgánicos en saliva en el Síndrome de Sjõgren / Correlation of serological findings and saliva’s organic compounds in Sjõgren’s Syndrome

Introducción: El objetivo del presente trabajo es evaluar los cambios en flujo y composición orgánica en saliva, así como la presencia de anticuerpos anti Ro/SSA y La/SSB séricos y salivales y su implicancia en el diagnóstico no invasivo del SS. Diseño del estudio: Estudio de corte transversal, de 73 pacientes distribuidos en los siguientes grupos experimentales: Síndrome de Sjõgren primario (SSp) (n = 15), SS secundario (SSs) (n = 17), boca seca y ojo seco sin Síndrome de Sjõgren (BO) (n = 20), y controles sanos (C) (n = 21). Se realizó una determinación del flujosalivalbasal y una toma de muestras de saliva para la medición de proteínas totales, IgA, urea y anticuerpos. Se determinaron anticuerpos anti Ro/SSA y La/SSB en muestras de suero y saliva. Resultados: El flujo salival en SSp, SSs, BO fue significativamente menor (p < 0,001) comparado con C. La composición salival de SS mostró modificaciones de componentes estudiados. Los anticuerpos anti Ro/SSA y anti La/SSB aparecieron con mayor frecuencia en suero y saliva en pacientes con SS en comparación con BO y C, siendo la frecuencia de positividad superior en suero en comparación con saliva. Conclusión: La determinación de anticuerpos Ro/SSA en saliva podrían ayudar a diagnosticar a pacientes con xerostomía como el Síndrome de Sjõgren.

Introduction: The aim of this study was to evaluate changes in flow andorganic composition in saliva, the presence of anti Ro/SSA and La/SSBantibodies in serum and saliva and its implication in the noninvasivediagnosis of SS.Study Design: Cross sectional study, 73 patients divided into four experimentalgroups: Primary Sjögren's syndrome (pSS) (n = 15), secondarySS (sSS) (n = 17), dry eye and dry mouth syndrome without Sjögren's(DEMS) (n = 20) and healthy controls (C) (n = 21). We performed a determinationof basal salivary flow and saliva sampling for measurement oftotal protein, IgA, urea and antibodies. We determined anti Ro/SSA andLa/SSB in serum and saliva.Results: The salivary flow in pSS, sSS, DEMS patients was significantlylower (p <0.001) compared with C. The composition of SS salivary componentsstudied showed changes. The anti Ro/SSA and anti La/SSB occurredmore frequently in serum and saliva in SS patients comparedwith DEMS and C, the frecuency of positivity was higher in serum thanin saliva.Conclusion: The determination in saliva of antibodies Ro/SSA may helpdiagnose patients with xerostomy as Sjögren's Syndrome.

Correlación de hallazgos serológicos y compuestos orgánicos en saliva en el Síndrome de Sj§gren / Correlation of serological findings and salivaÆs organic compounds in Sj§grenÆs Syndrome

Introducción: El objetivo del presente trabajo es evaluar los cambios en flujo y composición orgánica en saliva, así como la presencia de anticuerpos anti Ro/SSA y La/SSB séricos y salivales y su implicancia en el diagnóstico no invasivo del SS. Diseño del estudio: Estudio de corte transversal, de 73 pacientes distribuidos en los siguientes grupos experimentales: Síndrome de Sj§gren primario (SSp) (n = 15), SS secundario (SSs) (n = 17), boca seca y ojo seco sin Síndrome de Sj§gren (BO) (n = 20), y controles sanos (C) (n = 21). Se realizó una determinación del flujosalivalbasal y una toma de muestras de saliva para la medición de proteínas totales, IgA, urea y anticuerpos. Se determinaron anticuerpos anti Ro/SSA y La/SSB en muestras de suero y saliva. Resultados: El flujo salival en SSp, SSs, BO fue significativamente menor (p < 0,001) comparado con C. La composición salival de SS mostró modificaciones de componentes estudiados. Los anticuerpos anti Ro/SSA y anti La/SSB aparecieron con mayor frecuencia en suero y saliva en pacientes con SS en comparación con BO y C, siendo la frecuencia de positividad superior en suero en comparación con saliva. Conclusión: La determinación de anticuerpos Ro/SSA en saliva podrían ayudar a diagnosticar a pacientes con xerostomía como el Síndrome de Sj§gren.(AU)

Introduction: The aim of this study was to evaluate changes in flow andorganic composition in saliva, the presence of anti Ro/SSA and La/SSBantibodies in serum and saliva and its implication in the noninvasivediagnosis of SS.Study Design: Cross sectional study, 73 patients divided into four experimentalgroups: Primary Sj÷grens syndrome (pSS) (n = 15), secondarySS (sSS) (n = 17), dry eye and dry mouth syndrome without Sj÷grens(DEMS) (n = 20) and healthy controls (C) (n = 21). We performed a determinationof basal salivary flow and saliva sampling for measurement oftotal protein, IgA, urea and antibodies. We determined anti Ro/SSA andLa/SSB in serum and saliva.Results: The salivary flow in pSS, sSS, DEMS patients was significantlylower (p <0.001) compared with C. The composition of SS salivary componentsstudied showed changes. The anti Ro/SSA and anti La/SSB occurredmore frequently in serum and saliva in SS patients comparedwith DEMS and C, the frecuency of positivity was higher in serum thanin saliva.Conclusion: The determination in saliva of antibodies Ro/SSA may helpdiagnose patients with xerostomy as Sj÷grens Syndrome.(AU)

[Bacterial endocarditis caused by salmonella in systemic lupus erythematosus]. / Endocarditis por salmonella en lupus eritematoso sistemico.

INTRODUCTION: Patients with SLE (Systemic Lupus Erythematosus) are prompt to develop infections with significant morbidity and mortality. The intravascular infection due to salmonella is a rare complication of difficult diagnosis and poor prognostic. OBJECTIVE: We report two cases of bacterial endocarditis due to salmonella in SLE patients. CLINICAL CASES: We report two cases of bacterial endocarditis caused by Salmonella in a patient with SLE, one with recent onset of mellitus diabetes and other with chronic renal failure. Despite of antibiotic treatment with fluoroquinolone and a third-generation cephalosporin, the patient required surgical intervention. CONCLUSION: Salmonella infection should be suspected in SLE patients in order to make earlier diagnosis and treatment.

[Ventricular diastolic dysfunction in rheumatoid arthritis]. / Disfunciondiastólica ventricular izquierda en la artritis reumatoidea.

UNLABELLED: Rheumatoid arthritis ( RA) is a chronic and systemic articular inflammatory disease, often associated with cardiac manifestations. However, cardiac involvement in RA is not always symptomatic. Previous studies reported high mortality rates for RA and that it was dependent on concurrent heart dis-ease. Myocardial infarction and inflammation have been reported in about 2% of the patients in autopsy studies. The earliest deterioration in cardiac disease is in diastolic function. OBJECTIVE: the aim of this study is to evaluate the ventricular diastolic dysfunction in patients with RA and its relation with the duration of the disease. PATIENTS AND METHODS: Thirty-two RA patients who attended the rheumatology unit at Hospital Cordoba during 2004 participated in this study. A control group was formed by thirty two healthy adults of matched sex and age. RA was diagnosed according to 1987 ACR criteria. None of them had diabetes mellitus, systemic hypertension, chronic lung disease, congenital cardiac malformation, coronary artery disease, arrhytmia or valvular heart disease. Two-dimensional, M-mode, pulsed and color Doppler echocardiography were performed on all these subjects by the same examiner. Diastolic dysfunction was defined when the E/A ratio was <1 (E wave velocity decreased, A wave velocity increased) , and desaceleration time (DT) and isovolumic relaxation time (IRT) were prolonged. Ap-value < 0.05 was considered as significant. RESULTS: The mean ages were 48,38 11,08 for patients and 46,81 9,96 for the control group.There were no significant differences between age, sex, heart rate, and systolic and diastolic blood pressure between RA patients and controls. Higher proportion of RA patients had E/A ratio < 1compared with the controls ( p<00001). The mean IRT value was significantly longer than in controls ( 83,59 1 13,82 vs 74,41 i 15,14 p<0.01). There was no correlation between the duration of illness and E/A ratio and IRT ( p=0.70, p=0.13). CONCLUSION: Diastolic function was impaired in patients with RA. There was no relation between some of the parameters of ventricular diastolic function and disease duration. These findings suggest a subclinical myocardial involvement in RA patients.

[Security of the combined treatment of methotrexate and leflunomide in patients with rheumatoid arthritis]. / Seguridad del tratamiento combinado de metotrexato y leflunomida en pacientes con artritis reumatoidea.

UNLABELLED: Rheumatoid Arthritis (RA) is a chronic disease leading to functional impairment and early mortality. Treatment with disease-modifying antirheumatic drugs have shown to achieve disease remission and improves its evolution. The use of combined therapy should have a biological efficacy, no increased toxicity and have an acceptable dose interval. Also, it should begin its action quickly and be cost-effective. AIMS: to assess the security of the combined treatment with Methotrexate (MTX) and Leflunomide (LF) in patients with Rheumatoid Arthritis (RA) and to evaluate whether the dose and route of MTX administration influence on the toxicity. PATIENTS AND METHODS: Patients with RA who fulfilled ACR criteria and they attended to the Rheumatology Unit at Córdoba Hospital in the last 2 years were assessed. All the patients that received combined treatment with MTX in doses from 7.5 mg to 25 mg weekly orally (PO) or intramuscularly (i.m.) that started LF treatment in doses of 20 mg/day due to disease activity persistence were retrospectively assessed. Patients having at least 6 months of combined treatment were included. Data on treatment and adverse events were collected. They were evaluated at the beginning, at 6 and 12 months of treatment. The presence of adverse events as well as the stop of combined treatment was evaluated at 6 and 12 months of treatment. Adverse events in patients with oral and i.m. MTX treatment and in different doses were compared for the analyses. P<0.05 was considered significant. RESULTS: 62 patients with a mean age of 54 were included. 89% were female and had positive rheumatoid factor and 83% had radiological erosions. Eighty eight percent were in doses of 15 mg MTX, 4.9% with 10 mg and 25 mg at the beginning of LF treatment. Twenty four percent suffered from adverse events and 33% left the medication by 6 months. Among adverse events, 6 patients had diarrhea, 5 increased hepatic enzymes, 3 alopecia, 3 weight loss, and 2 had anemia and leucopenia. Eight patients stopped the medication in 6 months, but only 5 did because of adverse events. There was not significant statistical difference in adverse events between patients with different dose or routes of administration of MTX. CONCLUSIONS: The presence of adverse events in MTX and LF combined treatment was low and it developed during the first 6 months of treatment in our patients. The MTX route of administration and doses did not influence on the toxicity of the combined treatment with LF. The combined therapy seems to be a safe treatment option in RA patients.

Anticuerpos antifosfolípidos en pacientes con nefritis lúpica: Estudio clínico-patológico / Antiphospholipid antibodies in lupic nephritis patients: Clinical-pathologic study

Introduction: Antiphospholipid Antibodies (APA) are detected in 30 and 40% of patients with Systemic lupus erythematosus (SLE). Antiphospholipid Syndrome nephropathy (APSN) is one of renal manifestations of APS. Histological lesions of APSN have been described in SLE. Objective: To evaluate the prevalence of APA in patients with lupus nephritis (LN), its clinical and laboratory association and the presence of APSN in renal biopsies from LN patients. Patients and Methods: We retrospectively studied 28 patients with SLE diagnosis according to ACR criteria, who underwent renal biopsies with diagnosis of LN. These patients attended to our rheumatology unit for the last 2 years. Demographic, clinical and serological data were collected at the time of the first biopsy. APA (Anticardiolipin Ig G, Ig M and lupus anticoagulant) were considered positivewhen they were positive in two opportunities during the follow up. Renal biopsies were classified according to NL classification 2004. Histological features of APSN were analyzed by 2 different pathologists who were blind to clinical data. P value <0.05 was considered statistically significant. Results: Mean age was 31 years old (17-53), 86% were female and mean SLE duration was 47 months (1-180). 54% of patients were positive for APA. There was not association between APA and first creatinine level, hypertension, amount of proteinuria and active sediment. Class II LN was most frequently associated with APA. Glomerular collapse and focal cortical atrophy (FCA) were associatedwith APA (p<0.008, p<0.005). Conclusions: APA were present in 54% of patients with LN. There was not association between APA and clinical features or histological type of LN. The main histological features of APSN were glomerular collapse and FCA

Mutations and polymorphisms of the CLCN2 gene in idiopathic epilepsy.

The authors analyzed the CLCN2 chloride channel gene in 112 probands with familial epilepsy, detecting 18 common polymorphisms. Two brothers with generalized epilepsy and their asymptomatic father, and a father and son with focal epilepsy carried variants of possible functional significance that were not found in 192 controls. The authors conclude that CLCN2 mutations may be a rare cause of familial epilepsy. Further studies are needed to test if polymorphisms in this gene are associated with epilepsy.