The impact of disease activity on health-related quality of life in patients with systemic lupus erythematosus / Impacto de la actividad clínica en la calidad de vida relacionada con la salud de pacientes con lupus eritematoso sistémico

Background and objective The aim of this research was to investigate the relationship between disease activity and health-related quality of life (HRQoL) in patients with systemic lupus erythematosus (SLE) considering the increased interest in the management of this disease. Materials and methods HRQoL was measured at clinic visits during a 12-month follow-up period using questionnaires on fatigue (FACIT-FATIGUE); quality of life, EuroQol 5-dimension (EQ-5D-5L) health questionnaire with 5 levels; disability, Health Assessment Questionnaire (HAQ), and a Global Health Status (GHS) scale. Disease activity, organ damage and other clinical factors that could affect HRQoL were recorded. The association between disease activity and HRQoL was assessed using Bayesian linear regression models with monotonic effects. Results Data from 70 patients at the baseline visit and 42 patients with 1 year of follow-up were analyzed. At baseline, 28.57% of patients presented Systemic Lupus Erythematosus Disease Activity Index (SLEDAI)>6. In the 70 baseline patients, disease activity was associated with HRQoL in all four parameters. In the 42 patients with 12 months of follow-up, the positive association of disease activity with GHS, FACIT-FATIGUE and EQ-5D-5L and the negative association with HAQ was maintained.Patients who are smokers and those receiving immunosuppressant therapy presented low GHS and FACIT-FATIGUE scores. Moreover, older age at inclusion was significantly associated to low GHS, while low leucocyte and 25-OH-vitamin D levels were associated to fatigue perception in SLE patients. Conclusion Our results showed a statistically significant association between disease activity and HRQoL parameters. (AU)

Objetivo El objetivo del estudio fue analizar la relación entre la actividad clínica y la calidad de vida relacionada con la salud (CVRS) en pacientes con lupus eritematoso sistémico (LES).Material y métodos La CVRS se evaluó en la visita basal y durante 12 meses de seguimiento mediante un cuestionario de fatiga (FACIT-FATIGUE), calidad de vida (EQ-5D-5L), discapacidad (HAQ) y una escala analógica visual de estado general de salud (EVA). La actividad clínica, el daño acumulado y otros factores clínicos que pudieran afectar a la CVRS se analizaron mediante un modelo de regresión lineal bayesiano con efectos monotónicos. Resultados Se analizaron los datos de 70 pacientes incluidos en la visita basal y los 42 con 12 meses de seguimiento seleccionados aleatoriamente. En la visita basal el 28,57% de los pacientes presentaban un índice SLEDAI>6. La actividad clínica medida mediante el índice SLEDAI se asociaba de forma estadísticamente significativa a los 4 parámetros de CVRS. En los 42 pacientes con un año de seguimiento la relación directa entre la actividad clínica y el FACIT-FATIGUE, EVA y EQ-5D-5L, así como la relación indirecta con el HAQ, se mantuvieron. Los pacientes fumadores y aquellos bajo tratamiento inmunosupresor presentaban valores disminuidos de EVA y FACIT-FATIGUE. Además, los pacientes con edades más avanzadas presentaban valores disminuidos de EVA, y aquellos con niveles bajos de vitamina D o leucopenia presentaban mayor percepción de fatiga. Conclusión La actividad clínica se asocia a diferentes dominios de la CVRS, apoyando la evaluación de la CVRS como complemento en el manejo del LES. (AU)

The impact of disease activity on health-related quality of life in patients with systemic lupus erythematosus.

BACKGROUND AND OBJECTIVE: The aim of this research was to investigate the relationship between disease activity and health-related quality of life (HRQoL) in patients with systemic lupus erythematosus (SLE) considering the increased interest in the management of this disease. MATERIALS AND METHODS: HRQoL was measured at clinic visits during a 12-month follow-up period using questionnaires on fatigue (FACIT-FATIGUE); quality of life, EuroQol 5-dimension (EQ-5D-5L) health questionnaire with 5 levels; disability, Health Assessment Questionnaire (HAQ), and a Global Health Status (GHS) scale. Disease activity, organ damage and other clinical factors that could affect HRQoL were recorded. The association between disease activity and HRQoL was assessed using Bayesian linear regression models with monotonic effects. RESULTS: Data from 70 patients at the baseline visit and 42 patients with 1 year of follow-up were analyzed. At baseline, 28.57% of patients presented Systemic Lupus Erythematosus Disease Activity Index (SLEDAI)>6. In the 70 baseline patients, disease activity was associated with HRQoL in all four parameters. In the 42 patients with 12 months of follow-up, the positive association of disease activity with GHS, FACIT-FATIGUE and EQ-5D-5L and the negative association with HAQ was maintained. Patients who are smokers and those receiving immunosuppressant therapy presented low GHS and FACIT-FATIGUE scores. Moreover, older age at inclusion was significantly associated to low GHS, while low leucocyte and 25-OH-vitamin D levels were associated to fatigue perception in SLE patients. CONCLUSION: Our results showed a statistically significant association between disease activity and HRQoL parameters.

Relation between cumulative damage in systemic lupus erythematosus and recognised disability by the National Social Security Institute of Spain (INSS) / Relación entre el daño acumulado en el lupus eritematoso sistémico y la discapacidad reconocida por el Instituto Nacional de la Seguridad Social de España

Introduction: Systemic Lupus Erythematosus (SLE) is a multisystemic autoimmune disease that particularly affects young women during their second and third decades. Events attributed to SLE itself and others related to the disease may impact negatively on the quality of life, employment and disability. However, there are not many studies focused on the impact that the disease may have on patients regarding those aspects. In Spain, the evaluation of disability and the assignation of a pension is given by the National Social Security Institute of Spain, INSS (“Instituto Nacional de la Seguridad Social”). Objective: To assess the relationship between cumulative damage regarding the affected organ and the percentage of disability recognised by the National Social Security Institute of Spain (INSS) in SLE patients. Methods: Cross-sectional prospective study of SLE patients according to the SLICC-2012 criteria, from the Rheumatology Service of two Spanish hospitals. We collected clinical and demographic data through personal interview and the SLICC/ACR questionnaire, and classified patients regarding a recognised disability or not. Results: 142 patients were evaluated; 30% had some percentage of official disability. We found a positive correlation between percentage of recognised disability and the SLICC/ACR index score. Musculoskeletal system is the most affected system, without differences between both groups; but we found a higher proportion of damage in nervous system, renal and vasculitis in patients with a recognised disability. Conclusion: There is a positive correlation between percentage of recognised disability in Spain and the cumulative damage in SLE.(AU)

Introducción: El lupus eritematoso sistémico (LES) es una enfermedad multisistémica autoinmune que afecta especialmente a las mujeres jóvenes durante su segunda y tercera décadas. Los eventos atribuidos al propio LES y otros relacionados con la enfermedad pueden tener un impacto negativo en la calidad de vida, el empleo y la discapacidad. Sin embargo, existen pocos datos publicados al respecto. En España, la evaluación de la discapacidad y la asignación de una pensión corresponden al Instituto Nacional de Seguridad Social de España (INSS). Objetivo: Evaluar la relación entre el daño acumulado relacionado con el órgano afectado y el porcentaje de discapacidad reconocido por el INSS en pacientes con LES. Métodos: Estudio prospectivo transversal de pacientes con LES según los criterios SLICC-2012, del servicio de reumatología de 2 hospitales de España. Recopilamos datos clínicos y demográficos mediante entrevista personal y el cuestionario SLICC/ACR, y clasificamos a los pacientes con respecto a una discapacidad reconocida o no. Resultados: Se evaluaron 142 pacientes; el 30% tenía algún porcentaje de discapacidad oficial. Encontramos una correlación positiva entre el porcentaje de discapacidad reconocida y la puntuación del índice SLICC/ACR. El sistema musculoesquelético es el sistema más afectado, sin diferencias entre ambos grupos; pero encontramos una mayor proporción de daño en el sistema nervioso, renal y vasculitis en pacientes con una discapacidad reconocida.(AU)ConclusiónExiste una correlación positiva entre el porcentaje de discapacidad reconocida en España y el daño acumulado en el LES.(AU)

Relation between cumulative damage in systemic lupus erythematosus and recognised disability by the National Social Security Institute of Spain (INSS).

INTRODUCTION: Systemic Lupus Erythematosus (SLE) is a multisystemic autoimmune disease that particularly affects young women during their second and third decades. Events attributed to SLE itself and others related to the disease may impact negatively on the quality of life, employment and disability. However, there are not many studies focused on the impact that the disease may have on patients regarding those aspects. In Spain, the evaluation of disability and the assignation of a pension is given by the National Social Security Institute of Spain, INSS ("Instituto Nacional de la Seguridad Social"). OBJECTIVE: To assess the relationship between cumulative damage regarding the affected organ and the percentage of disability recognised by the National Social Security Institute of Spain (INSS) in SLE patients. METHODS: Cross-sectional prospective study of SLE patients according to the SLICC-2012 criteria, from the Rheumatology Service of two Spanish hospitals. We collected clinical and demographic data through personal interview and the SLICC/ACR questionnaire, and classified patients regarding a recognised disability or not. RESULTS: 142 patients were evaluated; 30% had some percentage of official disability. We found a positive correlation between percentage of recognised disability and the SLICC/ACR index score. Musculoskeletal system is the most affected system, without differences between both groups; but we found a higher proportion of damage in nervous system, renal and vasculitis in patients with a recognised disability. CONCLUSION: There is a positive correlation between percentage of recognised disability in Spain and the cumulative damage in SLE.

Aumento de las concentraciones de interferón-1alpha, interleucina-10 y BLyS como biomarcadores de actividad clínica en el lupus eritematoso sistémico / Increased interferon-1alpha, interleukin-10 and BLyS concentrations as clinical activity biomarkers in systemic lupus erythematosus

Fundamento y objetivo: Analizar la asociación entre concentraciones de interferón-1alpha (INF1alpha), interleucina 10 (IL-10) y BLyS con la actividad clínica en el lupus eritematoso sistémico (LES). Pacientes y métodos: Estudio observacional transversal de 142 pacientes con LES y 34 controles sanos mediante analítica de sangre y orina y revisión de la historia clínica. La concentración sérica de citocinas se determinó mediante métodos colorimétricos. El análisis bioestadístico se realizó con R (3.3.2). Resultados: El 69% de pacientes mostraron al menos una citocina aumentada. Las tres citocinas están más elevadas en pacientes que en controles (p<0,001, p=0,005 y p=0,043), siendo INF1alpha el más frecuente. Los pacientes fueron categorizados según las concentraciones de las tres citocinas. Encontramos una asociación significativa entre concentraciones elevadas de IL-10/INF1alpha y una mayor actividad clínica según SELENA-SLEDAI (p<0,0001) y, en menor medida, con concentraciones aumentadas de INF1alpha/IL-10/BLyS. Concentraciones elevadas de IL-10/INF1alpha e INF1alpha/IL-10/BLyS se relacionaron con un mayor consumo de C3-C4 (p<0,001 y p=0,001) y títulos elevados de anti-dsDNA (p=0,001 y p=0,002). Concentraciones elevadas de INF1alpha/BLyS se relacionaron con títulos más altos de anti-dsDNA (p=0,004) y positividad ENA (p<0,001). Concentraciones altas de INF1alpha/IL-10/BLyS se relacionaron con la positividad de ANA (p<0,001) y anticuerpos antifosfolípidos (p=0,004). Conclusiones: INF1alpha, IL-10 y BLyS están más elevados en pacientes con LES que en controles sanos. El aumento de IL-10, asociado o no a aumento de BLyS y/o INF1alpha, es la citocina que mejor se ajusta a la actividad clínica del LES medida con métodos clásicos

Background and objective: to analyse the association between interferon-1alpha (INF1alpha), interleukin-10 (IL-10) and BLyS concentrations and clinical activity in systemic lupus erythematosus (SLE). Patients and methods: A cross-sectional, observational study of 142 SLE patients and 34 healthy controls was performed, through a complete blood and urine test and review of their medical history. Serum concentration of INF1alpha, IL-10 and BLyS was determined by colorimetric methods. A biostatistical analysis was performed with R (3.3.2.). Results: 69% of our SLE patients showed at least one cytokine increased. INF1alpha, IL-10 and BLyS are higher in SLE patients than in healthy controls (P<.001, P=.005 and P=.043, respectively), being INF1alpha the most frequent. Patients were categorised according to low or high concentrations of the three cytokines. We found a significant association between increased IL-10/INF1alpha concentrations and a higher clinical activity measured by SELENA-SLEDAI (P<.0001) and, to a lesser extent, an association with increased INF1alpha/IL-10/BLyS concentrations. Elevated levels of IL-10/INF1alpha and INF1alpha/IL-10/BLyS related to increased C3-C4 consumption (P<.001 and P=.001 respectively) and anti-dsDNA titres (P=.001 and P=.002 respectively). Elevated INF1alpha/BLyS related to higher anti-dsDNA titres (P=.004) and ENA positivity (P<.001). Increased levels of INF1alpha/IL-10/BLyS related to positivity of ANAs (P<.001) and APL (P=.004). Conclusions: INF1alpha, IL-10 and BLyS are higher in SLE patients than in healthy controls. Increased IL-10 levels, regardless of whether or not there were also increased levels of BLyS and/or INF1alpha, was the cytokine that best fit with clinical activity in SLE measured with classic methods

Increased interferon-1α, interleukin-10 and BLyS concentrations as clinical activity biomarkers in systemic lupus erythematosus. / Aumento de las concentraciones de interferón-1α, interleucina-10 y BLyS como biomarcadores de actividad clínica en el lupus eritematoso sistémico.

BACKGROUND AND OBJECTIVE: to analyse the association between interferon-1α (INF1α), interleukin-10 (IL-10) and BLyS concentrations and clinical activity in systemic lupus erythematosus (SLE). PATIENTS AND METHODS: A cross-sectional, observational study of 142 SLE patients and 34 healthy controls was performed, through a complete blood and urine test and review of their medical history. Serum concentration of INF1α, IL-10 and BLyS was determined by colorimetric methods. A biostatistical analysis was performed with R (3.3.2.). RESULTS: 69% of our SLE patients showed at least one cytokine increased. INF1α, IL-10 and BLyS are higher in SLE patients than in healthy controls (P<.001, P=.005 and P=.043, respectively), being INF1α the most frequent. Patients were categorised according to low or high concentrations of the three cytokines. We found a significant association between increased IL-10/INF1α concentrations and a higher clinical activity measured by SELENA-SLEDAI (P<.0001) and, to a lesser extent, an association with increased INF1α/IL-10/BLyS concentrations. Elevated levels of IL-10/INF1α and INF1α/IL-10/BLyS related to increased C3-C4 consumption (P<.001 and P=.001 respectively) and anti-dsDNA titres (P=.001 and P=.002 respectively). Elevated INF1α/BLyS related to higher anti-dsDNA titres (P=.004) and ENA positivity (P<.001). Increased levels of INF1α/IL-10/BLyS related to positivity of ANAs (P<.001) and APL (P=.004). CONCLUSIONS: INF1α, IL-10 and BLyS are higher in SLE patients than in healthy controls. Increased IL-10 levels, regardless of whether or not there were also increased levels of BLyS and/or INF1α, was the cytokine that best fit with clinical activity in SLE measured with classic methods.

Monitorización de los valores séricos de vitamina D en mujeres con osteoporosis posmenopáusica tratadas con dosis habituales de vitamina D / Vitamin D status in osteoporotic postmenopausal women taking oral recommended vitamin D supplementation

Fundamento y objetivo: El objetivo del trabajo es evaluar la efectividad de las dosis habituales de suplementos de vitamina D (25[OH]D) para alcanzar valores séricos óptimos (30ng/ml). Pacientes y método: Estudio transversal en 165 mujeres con osteoporosis posmenopáusica, tratadas con suplementos de vitamina D oral con dosis superiores a 800UI/día durante al menos 3 meses. Se dividió a las pacientes en 3 grupos: grupo 1, 800-1.000UI/día; grupo 2, 1.001-1.600UI/día; grupo 3, >1.600UI/día. Se comparó la proporción de pacientes con valores séricos superiores a 20, 30 y 40ng/ml. Resultados: La edad media (DE) fue de 69 (10) años. El porcentaje de pacientes con valores superiores a 20ng/ml fue del 79,5% (intervalo de confianza del 95% [IC 95%] 63,5-88,5), 92,7% (IC 95% 78,7-96) y 97,6% (IC 95% 90,6-100) en los grupos 1, 2 y 3, respectivamente (p=0,009), el de pacientes con valores superiores a 30ng/ml del 27,7% (IC 95% 14,7-44,7), 53,6% (IC 95% 37,6-70) y 90,2% (IC 95% 81,2-96,6), respectivamente (p<0,001) y el de pacientes con valores superiores a 40ng/ml del 7,2% (IC 95% 1-20), 24,4% (IC 95% 12-40) y 61% (IC 95% 49-72), respectivamente (p<0,001). Conclusiones: Las dosis diarias recomendadas de suplementos de vitamina D (800-1.000UI) pueden ser insuficientes para conseguir valores séricos óptimos en mujeres osteoporóticas posmenopáusicas (AU)

Background and objective: To assess the effectiveness of currently recommended daily intakes of vitamin D (25[OH]D) to bring optimal serum concentrations (30ng/ml) in postmenopausal osteoporotic women. Patients and methods: We reviewed 25(OH)D serum concentrations in 165 consecutive osteoporotic postmenopausal women who were taking oral vitamin D daily supplements above 800IU during at least 3 months. The proportion of patients who achieved 25(OH)D levels of 20, 30 and 40ng/ml were compared according to daily vitamin D intakes (group 1: 800-1,000IU, group 2: 1,001-1,600IU, group 3:>1,600IU). Results: Mean patient age was 69 (10) years. Percentage of patients with serum 25(OH)D levels above 20ng/ml was 79.5% (63.5-88.5%), 92.7%(78.7-96%) and 97.6% (90.6-100%) in group 1, 2, and 3 patients, respectively (P=.009). Serum levels above 30ng/ml were achieved in 27.7% (14.7-44.7%), 53.6% (37.6-70%) and 90.2% (81.2-96.6%), respectively (P<.001). Serum levels above 40ng/ml were reached in 7.2% (1-20%), 24.4% (12-40%) and 61% (49-72%), respectively (P<.001). Conclusion: Daily reference intakes of vitamin D supplements (800-1,000IU) may be insufficient to achieve optimal serum levels of vitamin D in postmenopausal osteoporotic women (AU)

[Vitamin D status in osteoporotic postmenopausal women taking oral recommended vitamin D supplementation]. / Monitorización de los valores séricos de vitamina D en mujeres con osteoporosis posmenopáusica tratadas con dosis habituales de vitamina D.

BACKGROUND AND OBJECTIVE: To assess the effectiveness of currently recommended daily intakes of vitamin D (25[OH]D) to bring optimal serum concentrations (30ng/ml) in postmenopausal osteoporotic women. PATIENTS AND METHODS: We reviewed 25(OH)D serum concentrations in 165 consecutive osteoporotic postmenopausal women who were taking oral vitamin D daily supplements above 800IU during at least 3 months. The proportion of patients who achieved 25(OH)D levels of 20, 30 and 40ng/ml were compared according to daily vitamin D intakes (group 1: 800-1,000IU, group 2: 1,001-1,600IU, group 3:>1,600IU). RESULTS: Mean patient age was 69 (10) years. Percentage of patients with serum 25(OH)D levels above 20ng/ml was 79.5% (63.5-88.5%), 92.7%(78.7-96%) and 97.6% (90.6-100%) in group 1, 2, and 3 patients, respectively (P=.009). Serum levels above 30ng/ml were achieved in 27.7% (14.7-44.7%), 53.6% (37.6-70%) and 90.2% (81.2-96.6%), respectively (P<.001). Serum levels above 40ng/ml were reached in 7.2% (1-20%), 24.4% (12-40%) and 61% (49-72%), respectively (P<.001). CONCLUSION: Daily reference intakes of vitamin D supplements (800-1,000IU) may be insufficient to achieve optimal serum levels of vitamin D in postmenopausal osteoporotic women.

Infección articular por Streptococcus agalactiae en adultos inmunocompetentes: presentación de dos casos / Joint infections due to treptococcus agalactiae in non immunocompromised adults: presentation of two cases

Streptococcus agalactiae (S. agalactiae) es un germen habitualmente asociado a infecciones en neonatos y en mujeres durante el embarazo y el puerperio inmediato. S. agalactiae también se ha relacionado con bacteriemias, endocarditis e infecciones osteoarticulares, de piel y tejidos blandos en adultos con enfermedades concomitantes e, incluso, en pacientes inmunocompetentes. En los últimos años se han comunicado más de 70 casos de artritis séptica por este germen en adultos. Se presentan dos casos de infección articular, axial y periférica, por S. agalactiae, comparando los hallazgos, el tratamiento y la evolución con los casos publicados hasta abril de 2008 (AU)

Streptococcus agalactiae (S agalactiae) is a germ habitually associated with infections in neonates and women during the pregnancy and the immediate puerperiumum. S. agalactiae has also been related with bacteriemias, endocarditis and bone, joint, skin and soft tissues infections in adults with concomitant diseases and even in immunocompetent patients. In the last years more than 70 cases of septic arthritis in adults due to this germ have been communicated. We present two cases of axial and peripheral joint infection due to S. agalactiae, comparing finds, treatment and evolution with the cases published until April, 2008 (AU)

[Joint Infections Due to Streptococcus agalactiae in Non Immunocompromised Adults: Presentation of Two Cases]. / Infección articular por Streptococcus agalactiae en adultos inmunocompetentes: presentación de dos casos.

Streptococcus agalactiae (S agalactiae) is a germ habitually associated with infections in neonates and women during the pregnancy and the immediate puerperiumum. S. agalactiae has also been related with bacteriemias, endocarditis and bone, joint, skin and soft tissues infections in adults with concomitant diseases and even in immunocompetent patients. In the last years more than 70 cases of septic arthritis in adults due to this germ have been communicated. We present two cases of axial and peripheral joint infection due to S. agalactiae, comparing finds, treatment and evolution with the cases published until April, 2008.