ABSTRACT
OBJETIVO: Describir las manifestaciones clínicas, antecedentes, comorbilidades y tratamientos asociados, hallazgos imagenológicos y seguimiento evolutivo de los pacientes con síndrome de leucoencefalopatía posterior reversible. MÉTODOS: Se realizó un análisis retrospectivo y descriptivo de pacientes ingresados desde junio de 2009 hasta mayo de 2014, en un centro de tercer nivel de atención. Se evaluó edad, sexo, comorbilidades, sintomatología, valores de presión arterial al ingreso, función renal, medicación, tiempo transcurrido hasta la desaparición de síntomas. RESULTADOS: Se incluyeron 13 pacientes. El 77% estaba hipertenso al inicio del cuadro y el 85% presentó deterioro de la función renal. En 5 pacientes se objetivó el antecedente de trasplante renal. La manifestación clínica más común fueron convulsiones. Todos presentaron lesiones subcorticales y el compromiso más frecuente fue parietooccipital bilateral. CONCLUSIONES: Este síndrome debe tenerse en cuenta entre los diagnósticos diferenciales de pacientes que se presenten con cuadros neurológicos agudos y los factores de riesgo mencionados
OBJECTIVE: To describe clinical manifestations, antecedents, comorbidities and associated treatments, imaging findings, and follow-up in patients with posterior reversible encephalopathy syndrome. METHODS: A retrospective, descriptive analysis of admitted patients was performed between June 2009 and May 2014 in a third-level care hospital. We evaluated age, sex, comorbidities, symptoms, values of blood pressure at admission, renal function, medication and time elapsed until the disappearance of symptoms. RESULTS: Thirteen patients were included. In all, 77% of them had a history of hypertension at baseline and 85% had impaired renal function. The most prevalent comorbidity was renal transplantation, and 85% had deterioration of renal function. Five of the patients had undergone renal transplantation. The most common clinical manifestation was seizures. All had subcortical lesions and bilateral parietooccipital involvement was the finding most frequently observed. CONCLUSION: This syndrome should be taken into account in the differential diagnoses of patients presenting with acute neurological syndromes and the abovementioned risk factors
Subject(s)
Humans , Male , Female , Young Adult , Adult , Middle Aged , Posterior Leukoencephalopathy Syndrome/diagnostic imaging , Posterior Leukoencephalopathy Syndrome/therapy , Retrospective Studies , Epidemiology, Descriptive , Arterial Pressure , Kidney Transplantation , Magnetic Resonance Spectroscopy , Immunosuppressive Agents , Diagnosis, DifferentialABSTRACT
OBJECTIVE: To describe clinical manifestations, antecedents, comorbidities and associated treatments, imaging findings, and follow-up in patients with posterior reversible encephalopathy syndrome. METHODS: A retrospective, descriptive analysis of admitted patients was performed between June 2009 and May 2014 in a third-level care hospital. We evaluated age, sex, comorbidities, symptoms, values of blood pressure at admission, renal function, medication and time elapsed until the disappearance of symptoms. RESULTS: Thirteen patients were included. In all, 77% of them had a history of hypertension at baseline and 85% had impaired renal function. The most prevalent comorbidity was renal transplantation, and 85% had deterioration of renal function. Five of the patients had undergone renal transplantation. The most common clinical manifestation was seizures. All had subcortical lesions and bilateral parietooccipital involvement was the finding most frequently observed. CONCLUSION: This syndrome should be taken into account in the differential diagnoses of patients presenting with acute neurological syndromes and the abovementioned risk factors.
Subject(s)
Posterior Leukoencephalopathy Syndrome , Adolescent , Adult , Female , Humans , Male , Middle Aged , Posterior Leukoencephalopathy Syndrome/complications , Posterior Leukoencephalopathy Syndrome/diagnosis , Posterior Leukoencephalopathy Syndrome/drug therapy , Retrospective Studies , Young AdultABSTRACT
Systemic lupus erythematosus (SLE), a complex and heterogeneous autoimmune disease, represents a significant challenge for both diagnosis and treatment. Patients with SLE in Latin America face special problems that should be considered when therapeutic guidelines are developed. The objective of the study is to develop clinical practice guidelines for Latin American patients with lupus. Two independent teams (rheumatologists with experience in lupus management and methodologists) had an initial meeting in Panama City, Panama, in April 2016. They selected a list of questions for the clinical problems most commonly seen in Latin American patients with SLE. These were addressed with the best available evidence and summarised in a standardised format following the Grading of Recommendations Assessment, Development and Evaluation approach. All preliminary findings were discussed in a second face-to-face meeting in Washington, DC, in November 2016. As a result, nine organ/system sections are presented with the main findings; an 'overarching' treatment approach was added. Special emphasis was made on regional implementation issues. Best pharmacologic options were examined for musculoskeletal, mucocutaneous, kidney, cardiac, pulmonary, neuropsychiatric, haematological manifestations and the antiphospholipid syndrome. The roles of main therapeutic options (ie, glucocorticoids, antimalarials, immunosuppressant agents, therapeutic plasma exchange, belimumab, rituximab, abatacept, low-dose aspirin and anticoagulants) were summarised in each section. In all cases, benefits and harms, certainty of the evidence, values and preferences, feasibility, acceptability and equity issues were considered to produce a recommendation with special focus on ethnic and socioeconomic aspects. Guidelines for Latin American patients with lupus have been developed and could be used in similar settings.
Subject(s)
Antiphospholipid Syndrome/drug therapy , Hematologic Diseases/drug therapy , Kidney Diseases/drug therapy , Lupus Erythematosus, Systemic/drug therapy , Antiphospholipid Syndrome/etiology , Heart Diseases/drug therapy , Heart Diseases/etiology , Hematologic Diseases/etiology , Humans , Kidney Diseases/etiology , Latin America , Lung Diseases/drug therapy , Lung Diseases/etiology , Lupus Erythematosus, Systemic/complications , Lupus Nephritis/drug therapy , Lupus Nephritis/etiology , Mental Disorders/drug therapy , Mental Disorders/etiology , Musculoskeletal Diseases/drug therapy , Musculoskeletal Diseases/etiology , Skin Diseases/drug therapy , Skin Diseases/etiology , Standard of CareABSTRACT
Our objective was to analyze the effects of cigarette smoking on disease activity, functional capacity, radiographic damage, serology and presence of extraarticular manifestations in patients with rheumatoid arthritis and undifferentiated arthritis. This is a cross-sectional study of 1,305 patients (729 with rheumatoid arthritis and 576 with undifferentiated arthritis) from CONAART, the Argentine Consortium for Early Arthritis that includes patients older than 16 years with <2 years of disease. Sociodemographic data, clinical characteristics of the disease and smoking history were collected. In patients with rheumatoid arthritis the disease activity score of 28 joints was 5.4 ± 1.3 in current smokers, 5.2 ± 1.4 in former smokers and 5.1 ± 1.4 in never smokers (p = 0.011). The simple erosion narrowing score was higher in current smokers and former smokers than in never smokers (M 14.0, R Q 6.0-21.0; M 15.0, R Q 7.0-24.0; M 10.0, R Q 5.0-17.0; p = 0.006). Current smokers had higher rheumatoid factor titer (M 160.0, R Q 80.0-341.0) than former smokers (M 146.8, R Q 6.03-255.5) and never smokers (M 15.0, R Q 9.0-80.0) (p = 0.004). The variable independently associated with tobacco exposure was simple erosion narrowing score (OR = 1.03, 95 % CI 1.00-1.05; p = 0.012). In patients with undifferentiated arthritis, an association between smoking status and parameters of activity or radiographic damage was not observed. Neither was tobacco exposure related to the presence of extraarticular manifestations or to the degree of disability in any of the two groups of patients. No relation was found between disease activity and severity, and number of packs smoked per year. Tobacco.
Subject(s)
Arthritis, Rheumatoid/epidemiology , Foot Joints/diagnostic imaging , Hand Joints/diagnostic imaging , Smoking/epidemiology , Adult , Age Factors , Aged , Argentina/epidemiology , Arthritis/diagnostic imaging , Arthritis/epidemiology , Arthritis/immunology , Arthritis, Rheumatoid/diagnostic imaging , Arthritis, Rheumatoid/immunology , Blood Sedimentation , C-Reactive Protein/immunology , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Radiography , Rheumatoid Factor/immunology , Risk Factors , Severity of Illness Index , Sex Factors , Smoking/immunologyABSTRACT
Los pacientes con artritis reumatidea (AR) pueden desarrollar manifestaciones extra articulares (MExA), relacionadas a su morbi-mortalidad. Los anticuerpos anti-péptidos citrulinados cíclicos (ACCP) son específicos para la AR y estan relacionados con el daño articular; y podrían tener rol patogénico en las MExA. Nuestro objetivo fue determinar la relación entre los anticuerpos ACCP y MExA en pacientes con AR. Se incluyeron 74 pacientes con diagnóstico de AR (ACR 1987) mayores de 18 años, de más de 6 meses de evolución, con MExA, y un control apareado por sexo y edad sin MExA por cada paciente. Las variables demográficas, clínicas y de laboratorio se compararon con test t, chi cuadrado o Mann-Whitney. Se realizó análisis multivariado; p ≤ 0.05. Los pacientes con MExA presentaron mayor título de anticuerpo ACCP (116 vs. 34, p < 0.01) y de factor reumatoideo (FR) (108 vs. 34.5, p < 0.01). En el análisis multivariado hubo asociación entre la presencia de MExA y tabaquismo activo (p = 0.02, OR: 3.78, IC 95%: 1.17-12.2), FR positivo (p = 0.04, OR: 3.23, IC95%: 1.04-11.8) y anticuerpo ACCP positivo (p = 0.04, OR: 3.23, IC 95%: 1.04-10). Presentaron mayor título de anticuerpo ACCP que los controles los pacientes con xerostomía (109 vs. 34, p = 0.04), xeroftalmia (150 vs. 34, p < 0.01), nódulos sub-cutáneos (NSC) (141 vs. 34, p < 0.01) y fibrosis pulmonar (158 vs. 34, p = 0.04). En conclusión, el anticuerpo ACCP positivo, el FR positivo y el tabaquismo activo fueron factores de riesgo independientes para el desarrollo de MExA.
A large proportion of rheumatoid arthritis (RA) patients develop extra-articular manifestations (EAM), which are associated with morbidity and early mortality. Anti cyclic citrullinated peptide (ACCP) antibody has proven to be highly specific for the diagnosis of RA, associated with severe joint damage and may have some role in the pathogenesis of EAM. The aim of this study was to determine the relationship between ACCP antibody and the presence of EAM in RA patients. Seventy four RA patients (ACR 1987) with EAM, > 18 years, more than 6 months duration were included, and an EAM free control, matched by sex and age, for each patient. Demographic, clinical and laboratory variables were compared using t-test, chi-square or Mann-Whitney test. Multivariate analysis was performed: p ≤ 0.05. Patients with EAM presented a greater value of ACCP antibody (116 vs. 34, p < 0.01) and rheumatoid factor (108 vs. 34.5, p < 0.01). Independent association with current smoking habit (p = 0.02, OR = 3.78, 95%: 1.17-12.2), RF positive (p = 0.04, OR 3.23, CI 95%: 1.04 to 11.8) and ACCP antibody positive (p = 0.04, OR 3.23, 95% CI: 1.04-10) was found. The patients with xerostomia (109 vs. 34, p = 0.04), xerophthalmia (150 vs. 34, p < 0.01), subcutaneous nodules (141 vs. 34, p < 0.01) and pulmonary fibrosis (158 vs. 34, p = 0.04) had a higher degree of the ACCP antibody, than controls. In conclusion, ACCP antibody positive, RF positive and smoking were independent risk factors for the development of MEXA.
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Arthritis, Rheumatoid/immunology , Citrulline/immunology , Peptide Fragments/immunology , Xerophthalmia/immunology , Xerostomia/immunology , Cross-Sectional Studies , Peptide Fragments , Pulmonary Fibrosis/immunology , Risk Factors , Rheumatoid Factor/blood , Smoking/adverse effectsABSTRACT
Los objetivos del estudio fueron comparar la frecuencia de riesgo cardiovascular (CV) elevado y dislipemia (DLP) en pacientes con artritis reumatoide (AR) y en controles, identificar variables de la enfermedad asociadas a DLP y estimar el porcentaje de pacientes con AR medicados para DLP. Estudio de corte transversal que incluyó 409 pacientes con AR y 624 controles. El riesgo CV se determinó con las clasificaciones NCEP y SCORE modificados por European League Against Rheumatism (EULAR). Para DLP se utilizó la definición de Adult Treatment Panel III (ATP III). La frecuencia de riesgo CV elevado fue similar en pacientes con AR y controles excepto cuando fue definida por NCEP-EULAR (7% vs. 2%; p = 0.00002). La DLP fue encontrada en el 43% de los pacientes con AR y en el 47% de los controles (p = 0.15). Los pacientes con AR y DLP tuvieron más manifestaciones extra-articulares (36% vs. 24%; p = 0.01) y mayor velocidad de sedimentación globular (VSG) (21 (13-35) vs. 18 (10-30) mm; p = 0.003). El tratamiento recibido para DLP varió según la definición utilizada (11% a 32%). Se encontró mayor riesgo CV en los pacientes con AR solo cuando se definió por NCEP- EULAR. Los pacientes con AR y DLP tuvieron mayor VSG y manifestaciones extra-articulares. La mayoría de los pacientes con AR y DLP no estaban recibiendo tratamiento hipolipemiante.
The objectives of this study were to compare the frequency of dyslipidemia (DLP) and the elevated cardiovascular risk between rheumatoid arthritis (RA) patients and a control group, to identify disease-related factors associated with the presence of DLP and to estimate the frequency of RA patients receiving treatment for DLP. This is a cross sectional study that included 409 RA patients and 624 controls. Cardiovascular (CV) risk was determined using the Framingham score, National Cholesterol Education Program (NCEP) and the Systematic Coronary Risk Evaluation (SCORE) adapted versions according to the European League Against Rheumatism (EULAR) guidelines. DLP was defined according to the Adult Treatment Panel III (ATPIII). The frequency of CV risk was similar in RA patients and controls, except when NCEP-EULAR adapted version for RA was applied (7% vs. 2%; p = 0.00002). A 43% of patients and 47% of controls had DLP (p = 0.15). RA patients with DLP tended to have extra-articular manifestations more frequently (36% vs. 24%; p = 0.01) and higher erythrocyte sedimentation rate (ESR) (21 [13-35] vs. 18 [10-30] mm; p = 0.003). RA patients treated for DLP varied between 11% and 32% according to the definition used. Patients with RA showed an elevated CV risk only when the NCEP-EULAR definition was used. Among RA patients, those with higher ESR and the presence of extra-articular manifestations were more likely to show DLP. The vast majority of patients were not receiving treatment for DLP.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Arthritis, Rheumatoid/complications , Cardiovascular Diseases/etiology , Dyslipidemias/epidemiology , Argentina/epidemiology , Case-Control Studies , Cross-Sectional Studies , Dyslipidemias/drug therapy , Hypolipidemic Agents/therapeutic use , Prevalence , Risk Assessment , Risk FactorsABSTRACT
Los pacientes con artritis reumatidea (AR) pueden desarrollar manifestaciones extra articulares (MExA), relacionadas a su morbi-mortalidad. Los anticuerpos anti-péptidos citrulinados cíclicos (ACCP) son específicos para la AR y estan relacionados con el daño articular; y podrían tener rol patogénico en las MExA. Nuestro objetivo fue determinar la relación entre los anticuerpos ACCP y MExA en pacientes con AR. Se incluyeron 74 pacientes con diagnóstico de AR (ACR 1987) mayores de 18 años, de más de 6 meses de evolución, con MExA, y un control apareado por sexo y edad sin MExA por cada paciente. Las variables demográficas, clínicas y de laboratorio se compararon con test t, chi cuadrado o Mann-Whitney. Se realizó análisis multivariado; p ≤ 0.05. Los pacientes con MExA presentaron mayor título de anticuerpo ACCP (116 vs. 34, p < 0.01) y de factor reumatoideo (FR) (108 vs. 34.5, p < 0.01). En el análisis multivariado hubo asociación entre la presencia de MExA y tabaquismo activo (p = 0.02, OR: 3.78, IC 95%: 1.17-12.2), FR positivo (p = 0.04, OR: 3.23, IC95%: 1.04-11.8) y anticuerpo ACCP positivo (p = 0.04, OR: 3.23, IC 95%: 1.04-10). Presentaron mayor título de anticuerpo ACCP que los controles los pacientes con xerostomía (109 vs. 34, p = 0.04), xeroftalmia (150 vs. 34, p < 0.01), nódulos sub-cutáneos (NSC) (141 vs. 34, p < 0.01) y fibrosis pulmonar (158 vs. 34, p = 0.04). En conclusión, el anticuerpo ACCP positivo, el FR positivo y el tabaquismo activo fueron factores de riesgo independientes para el desarrollo de MExA.(AU)
A large proportion of rheumatoid arthritis (RA) patients develop extra-articular manifestations (EAM), which are associated with morbidity and early mortality. Anti cyclic citrullinated peptide (ACCP) antibody has proven to be highly specific for the diagnosis of RA, associated with severe joint damage and may have some role in the pathogenesis of EAM. The aim of this study was to determine the relationship between ACCP antibody and the presence of EAM in RA patients. Seventy four RA patients (ACR 1987) with EAM, > 18 years, more than 6 months duration were included, and an EAM free control, matched by sex and age, for each patient. Demographic, clinical and laboratory variables were compared using t-test, chi-square or Mann-Whitney test. Multivariate analysis was performed: p ≤ 0.05. Patients with EAM presented a greater value of ACCP antibody (116 vs. 34, p < 0.01) and rheumatoid factor (108 vs. 34.5, p < 0.01). Independent association with current smoking habit (p = 0.02, OR = 3.78, 95%: 1.17-12.2), RF positive (p = 0.04, OR 3.23, CI 95%: 1.04 to 11.8) and ACCP antibody positive (p = 0.04, OR 3.23, 95% CI: 1.04-10) was found. The patients with xerostomia (109 vs. 34, p = 0.04), xerophthalmia (150 vs. 34, p < 0.01), subcutaneous nodules (141 vs. 34, p < 0.01) and pulmonary fibrosis (158 vs. 34, p = 0.04) had a higher degree of the ACCP antibody, than controls. In conclusion, ACCP antibody positive, RF positive and smoking were independent risk factors for the development of MEXA.(AU)
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Arthritis, Rheumatoid/immunology , Citrulline/immunology , Peptide Fragments/immunology , Xerophthalmia/immunology , Xerostomia/immunology , Cross-Sectional Studies , Peptide Fragments/diagnosis , Pulmonary Fibrosis/immunology , Rheumatoid Factor/blood , Risk Factors , Smoking/adverse effectsABSTRACT
Los objetivos del estudio fueron comparar la frecuencia de riesgo cardiovascular (CV) elevado y dislipemia (DLP) en pacientes con artritis reumatoide (AR) y en controles, identificar variables de la enfermedad asociadas a DLP y estimar el porcentaje de pacientes con AR medicados para DLP. Estudio de corte transversal que incluyó 409 pacientes con AR y 624 controles. El riesgo CV se determinó con las clasificaciones NCEP y SCORE modificados por European League Against Rheumatism (EULAR). Para DLP se utilizó la definición de Adult Treatment Panel III (ATP III). La frecuencia de riesgo CV elevado fue similar en pacientes con AR y controles excepto cuando fue definida por NCEP-EULAR (7% vs. 2%; p = 0.00002). La DLP fue encontrada en el 43% de los pacientes con AR y en el 47% de los controles (p = 0.15). Los pacientes con AR y DLP tuvieron más manifestaciones extra-articulares (36% vs. 24%; p = 0.01) y mayor velocidad de sedimentación globular (VSG) (21 (13-35) vs. 18 (10-30) mm; p = 0.003). El tratamiento recibido para DLP varió según la definición utilizada (11% a 32%). Se encontró mayor riesgo CV en los pacientes con AR solo cuando se definió por NCEP- EULAR. Los pacientes con AR y DLP tuvieron mayor VSG y manifestaciones extra-articulares. La mayoría de los pacientes con AR y DLP no estaban recibiendo tratamiento hipolipemiante.(AU)
The objectives of this study were to compare the frequency of dyslipidemia (DLP) and the elevated cardiovascular risk between rheumatoid arthritis (RA) patients and a control group, to identify disease-related factors associated with the presence of DLP and to estimate the frequency of RA patients receiving treatment for DLP. This is a cross sectional study that included 409 RA patients and 624 controls. Cardiovascular (CV) risk was determined using the Framingham score, National Cholesterol Education Program (NCEP) and the Systematic Coronary Risk Evaluation (SCORE) adapted versions according to the European League Against Rheumatism (EULAR) guidelines. DLP was defined according to the Adult Treatment Panel III (ATPIII). The frequency of CV risk was similar in RA patients and controls, except when NCEP-EULAR adapted version for RA was applied (7% vs. 2%; p = 0.00002). A 43% of patients and 47% of controls had DLP (p = 0.15). RA patients with DLP tended to have extra-articular manifestations more frequently (36% vs. 24%; p = 0.01) and higher erythrocyte sedimentation rate (ESR) (21 [13-35] vs. 18 [10-30] mm; p = 0.003). RA patients treated for DLP varied between 11% and 32% according to the definition used. Patients with RA showed an elevated CV risk only when the NCEP-EULAR definition was used. Among RA patients, those with higher ESR and the presence of extra-articular manifestations were more likely to show DLP. The vast majority of patients were not receiving treatment for DLP.(AU)
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Arthritis, Rheumatoid/complications , Cardiovascular Diseases/etiology , Dyslipidemias/epidemiology , Argentina/epidemiology , Case-Control Studies , Cross-Sectional Studies , Dyslipidemias/drug therapy , Hypolipidemic Agents/therapeutic use , Prevalence , Risk Assessment , Risk FactorsABSTRACT
A large proportion of rheumatoid arthritis (RA) patients develop extra-articular manifestations (EAM), which are associated with morbidity and early mortality. Anti cyclic citrullinated peptide (ACCP) antibody has proven to be highly specific for the diagnosis of RA, associated with severe joint damage and may have some role in the pathogenesis of EAM. The aim of this study was to determine the relationship between ACCP antibody and the presence of EAM in RA patients. Seventy four RA patients (ACR 1987) with EAM, > 18 years, more than 6 months duration were included, and an EAM free control, matched by sex and age, for each patient. Demographic, clinical and laboratory variables were compared using t-test, chi-square or Mann-Whitney test. Multivariate analysis was performed: p = 0.05. Patients with EAM presented a greater value of ACCP antibody (116 vs. 34, p < 0.01) and rheumatoid factor (108 vs. 34.5, p < 0.01). Independent association with current smoking habit (p = 0.02, OR = 3.78, 95%: 1.17-12.2), RF positive (p = 0.04, OR 3.23, CI 95%: 1.04 to 11.8) and ACCP antibody positive (p = 0.04, OR 3.23, 95% CI: 1.04-10) was found. The patients with xerostomia (109 vs. 34, p = 0.04), xerophthalmia (150 vs. 34, p < 0.01), subcutaneous nodules (141 vs. 34, p < 0.01) and pulmonary fibrosis (158 vs. 34, p = 0.04) had a higher degree of the ACCP antibody, than controls. In conclusion, ACCP antibody positive, RF positive and smoking were independent risk factors for the development of MEXA.
Subject(s)
Arthritis, Rheumatoid/immunology , Citrulline/immunology , Peptide Fragments/immunology , Xerophthalmia/immunology , Xerostomia/immunology , Aged , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Pulmonary Fibrosis/immunology , Rheumatoid Factor/blood , Risk Factors , Smoking/adverse effectsABSTRACT
The objectives of this study were to compare the frequency of dyslipidemia (DLP) and the elevated cardiovascular risk between rheumatoid arthritis (RA) patients and a control group, to identify disease-related factors associated with the presence of DLP and to estimate the frequency of RA patients receiving treatment for DLP. This is a cross sectional study that included 409 RA patients and 624 controls. Cardiovascular (CV) risk was determined using the Framingham score, National Cholesterol Education Program (NCEP) and the Systematic Coronary Risk Evaluation (SCORE) adapted versions according to the European League Against Rheumatism (EULAR) guidelines. DLP was defined according to the Adult Treatment Panel III (ATPIII). The frequency of CV risk was similar in RA patients and controls, except when NCEP-EULAR adapted version for RA was applied (7% vs. 2%; p = 0.00002). A 43% of patients and 47% of controls had DLP (p = 0.15). RA patients with DLP tended to have extra-articular manifestations more frequently (36% vs. 24%; p = 0.01) and higher erythrocyte sedimentation rate (ESR) (21 [13-35] vs. 18 [10-30] mm; p = 0.003). RA patients treated for DLP varied between 11% and 32% according to the definition used. Patients with RA showed an elevated CV risk only when the NCEP-EULAR definition was used. Among RA patients, those with higher ESR and the presence of extra-articular manifestations were more likely to show DLP. The vast majority of patients were not receiving treatment for DLP.
Subject(s)
Arthritis, Rheumatoid/complications , Cardiovascular Diseases/etiology , Dyslipidemias/epidemiology , Adult , Aged , Argentina/epidemiology , Case-Control Studies , Cross-Sectional Studies , Dyslipidemias/drug therapy , Female , Humans , Hypolipidemic Agents/therapeutic use , Male , Middle Aged , Prevalence , Risk Assessment , Risk FactorsABSTRACT
A large proportion of rheumatoid arthritis (RA) patients develop extra-articular manifestations (EAM), which are associated with morbidity and early mortality. Anti cyclic citrullinated peptide (ACCP) antibody has proven to be highly specific for the diagnosis of RA, associated with severe joint damage and may have some role in the pathogenesis of EAM. The aim of this study was to determine the relationship between ACCP antibody and the presence of EAM in RA patients. Seventy four RA patients (ACR 1987) with EAM, > 18 years, more than 6 months duration were included, and an EAM free control, matched by sex and age, for each patient. Demographic, clinical and laboratory variables were compared using t-test, chi-square or Mann-Whitney test. Multivariate analysis was performed: p = 0.05. Patients with EAM presented a greater value of ACCP antibody (116 vs. 34, p < 0.01) and rheumatoid factor (108 vs. 34.5, p < 0.01). Independent association with current smoking habit (p = 0.02, OR = 3.78, 95
: 1.17-12.2), RF positive (p = 0.04, OR 3.23, CI 95
: 1.04 to 11.8) and ACCP antibody positive (p = 0.04, OR 3.23, 95
CI: 1.04-10) was found. The patients with xerostomia (109 vs. 34, p = 0.04), xerophthalmia (150 vs. 34, p < 0.01), subcutaneous nodules (141 vs. 34, p < 0.01) and pulmonary fibrosis (158 vs. 34, p = 0.04) had a higher degree of the ACCP antibody, than controls. In conclusion, ACCP antibody positive, RF positive and smoking were independent risk factors for the development of MEXA.
Subject(s)
Arthritis, Rheumatoid/immunology , Citrulline/immunology , Peptide Fragments/immunology , Xerophthalmia/immunology , Xerostomia/immunology , Aged , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Peptide Fragments/diagnosis , Pulmonary Fibrosis/immunology , Rheumatoid Factor/blood , Risk Factors , Smoking/adverse effectsABSTRACT
The objectives of this study were to compare the frequency of dyslipidemia (DLP) and the elevated cardiovascular risk between rheumatoid arthritis (RA) patients and a control group, to identify disease-related factors associated with the presence of DLP and to estimate the frequency of RA patients receiving treatment for DLP. This is a cross sectional study that included 409 RA patients and 624 controls. Cardiovascular (CV) risk was determined using the Framingham score, National Cholesterol Education Program (NCEP) and the Systematic Coronary Risk Evaluation (SCORE) adapted versions according to the European League Against Rheumatism (EULAR) guidelines. DLP was defined according to the Adult Treatment Panel III (ATPIII). The frequency of CV risk was similar in RA patients and controls, except when NCEP-EULAR adapted version for RA was applied (7
vs. 2
; p = 0.00002). A 43
of patients and 47
of controls had DLP (p = 0.15). RA patients with DLP tended to have extra-articular manifestations more frequently (36
vs. 24
; p = 0.01) and higher erythrocyte sedimentation rate (ESR) (21 [13-35] vs. 18 [10-30] mm; p = 0.003). RA patients treated for DLP varied between 11
and 32
according to the definition used. Patients with RA showed an elevated CV risk only when the NCEP-EULAR definition was used. Among RA patients, those with higher ESR and the presence of extra-articular manifestations were more likely to show DLP. The vast majority of patients were not receiving treatment for DLP.
