Reasons for hospitalisation in patients with systemic lupus erythematosus in a university hospital in Buenos Aires.

OBJECTIVE: To determine the reasons for hospitalisation in patients with systemic lupus erythematosus (SLE) admitted to the Hospital de Clínicas "José de San Martín" Buenos Aires, Argentina. METHODS: We retrospectively analysed the clinical histories of SLE patients (SLICC 2012) during or prior to hospitalisation, from 1-2014 to 12-2017. Demographic data, reasons for hospitalisation, treatments, SLEDAI-2 K and comorbid conditions. RESULTS: 121 hospitalisations corresponding to 72 patients, 25 patients (34.7%) were hospitalised more than once. Females (83.3%), the median length of disease until admission was 5 years. There was more than one reason for hospitalisation in 32, a total of 164 reasons. The main reason was relapse of disease (52.4%). The most frequent manifestations were renal involvement, serositis and pulmonary involvement. Infections were the second reason for hospitalisation (26.8%); urinary tract, pneumonia and soft tissue. Cardiovascular involvement 4.9%. Hospitalisation in a closed unit 14.05%, mortality 2.48%. CONCLUSION: Relapse of disease and infections were the main reasons for hospitalisation; admission secondary to infection was higher than that reported in other series.

Causas de internación en pacientes con lupus eritematoso sistémico en un hospital universitario de Buenos Aires / Reasons for Hospitalisation in Patients with Systemic Lupus Erythematosus in a University Hospital in Buenos Aires

Objetivo: Determinar causas de hospitalización en pacientes con lupus eritematoso sistémico (LES) internados en Hospital de Clínicas «José de San Martín», Buenos Aires, Argentina. Métodos: Se analizaron retrospectivamente historias clínicas de pacientes LES (SLICC 2012) durante o previo a la internación, desde 1-2014 hasta 12-2017. Datos demográficos, motivos de hospitalización, tratamientos, SLEDAI 2 K y condiciones comórbidas. Resultados: 121 hospitalizaciones correspondientes a 72 pacientes, 25 pacientes (34,7%) tuvieron más de una hospitalización. Mujeres (83,3%), mediana de duración de la enfermedad hasta la admisión 5 años. Más de una causa de internación en 32, total de 164 motivos. La principal causa fue recaída de la enfermedad (52,4%). La manifestación más frecuente fue compromiso renal, serositis y compromiso pulmonar. Las infecciones fueron la segunda causa de hospitalización (26,8%); tracto urinario, neumonía y partes blandas. Compromiso cardiovascular 4,9%. Hospitalización en unidad cerrada 14,05%, mortalidad 2,48%. Conclusión: Recaída de la enfermedad e infecciones, fueron las principales causas de hospitalización; la admisión secundaria a infección fue superior a la reportada en otras series.(AU)

Objective: To determine the reasons for hospitalisation in patients with systemic lupus erythematosus (SLE) admitted to the Hospital de Clínicas «José de San Martín» Buenos Aires, Argentina. Methods: We retrospectively analysed the clinical histories of SLE patients (SLICC 2012) during or prior to hospitalisation, from 1-2014 to 12-2017. Demographic data, reasons for hospitalisation, treatments, SLEDAI-2K and comorbid conditions. Results: 121 hospitalisations corresponding to 72 patients, 25 patients (34.7%) were hospitalised more than once. Females (83.3%), the median length of disease until admission was 5 years. There was more than one reason for hospitalisation in 32, a total of 164 reasons. The main reason was relapse of disease (52.4%). The most frequent manifestations were renal involvement, serositis and pulmonary involvement. Infections were the second reason for hospitalisation (26.8%); urinary tract, pneumonia and soft tissue. Cardiovascular involvement 4.9%. Hospitalisation in a closed unit 14.05%, mortality 2.48%. Conclusion: Relapse of disease and infections were the main reasons for hospitalisation; admission secondary to infection was higher than that reported in other series.(AU)

Reasons for Hospitalisation in Patients with Systemic Lupus Erythematosus in a University Hospital in Buenos Aires. / Causas de internación en pacientes con lupus eritematoso sistémico en un hospital universitario de Buenos Aires.

OBJECTIVE: To determine the reasons for hospitalisation in patients with systemic lupus erythematosus (SLE) admitted to the Hospital de Clínicas «José de San Martín¼ Buenos Aires, Argentina. METHODS: We retrospectively analysed the clinical histories of SLE patients (SLICC 2012) during or prior to hospitalisation, from 1-2014 to 12-2017. Demographic data, reasons for hospitalisation, treatments, SLEDAI-2K and comorbid conditions. RESULTS: 121 hospitalisations corresponding to 72 patients, 25 patients (34.7%) were hospitalised more than once. Females (83.3%), the median length of disease until admission was 5 years. There was more than one reason for hospitalisation in 32, a total of 164 reasons. The main reason was relapse of disease (52.4%). The most frequent manifestations were renal involvement, serositis and pulmonary involvement. Infections were the second reason for hospitalisation (26.8%); urinary tract, pneumonia and soft tissue. Cardiovascular involvement 4.9%. Hospitalisation in a closed unit 14.05%, mortality 2.48%. CONCLUSION: Relapse of disease and infections were the main reasons for hospitalisation; admission secondary to infection was higher than that reported in other series.

Associations between disease activity, markers of HDL functionality and arterial stiffness in patients with rheumatoid arthritis.

BACKGROUND AND AIMS: Rheumatoid arthritis (RA) is a chronic, inflammatory disease associated with increased risk of cardiovascular disease (CVD). Measures of HDL metabolism/function were shown to be altered in RA patients with high disease activity. We aimed at evaluating the effect of HDL characteristics on arterial stiffness in RA patients classified according to the inflammatory disease activity. METHODS: RA patients were classified according to disease activity (DAS-28) into active RA (n = 27; DAS-28 > 3.2) and inactive RA patients (n = 17; DAS-28 < 3.2). A control group of healthy individuals was also studied (n = 33). Clinical and biochemical characteristics, cholesteryl ester transfer protein (CETP) and paraoxonase 1 (phenylacetate and paraoxonase) activities and carotid-femoral pulse wave velocity (cf-PWV) were determined. RESULTS: Anthropometric characteristics were similar in all groups. In accordance with the inflammatory status, active RA patients presented elevated hsCRP levels (p < 0.001). There were no differences in the lipid profile between groups. Similarly, features of insulin resistance were absent in RA patients (p = non-significant). Active RA patients presented higher CETP activity than the other two groups (p = 0.026). Phenylacetate and paraoxonase activities were altered in active RA patients in comparison with the other groups (p = 0.034 and p = 0.041, respectively). Cf-PWV was significantly higher in active RA patients in comparison with controls, following adjustment by age (p = 0.030). Age (ßst = 0.468, p = 0.013) and apo A-I levels (ßst = -0.405, p = 0.029) were independent predictors of cf-PWV in a model including hsCRP, HOMA-IR, and phenylacetate activity (r(2) = 0.42). CONCLUSIONS: High DAS-28 identifies patients with alterations in HDL characteristics. Plasma levels of apo A-I can be used as a marker of arterial stiffness in RA.

Work instability in rheumatoid arthritis patients from Argentina: prevalence and associated factors.

To determine the prevalence of and associated factors to work instability (WI) in rheumatoid arthritis (RA) Argentinean patients. Observational cross-sectional study that assessing employment status in currently working RA patients. They answered the validated version of RA work instability scale (RA-WIS). High-risk WI was considered when RA-WIS was ≥17. Factors associated with high-risk WI were examined by univariable and multivariable analysis. Four-hundred and fifty RA patients were enrolled; of these, 205 patients were currently employed, but only 172 have completed questionnaires required [RA-WIS and health assessment questionnaire (HAQ-A)]. Their mean age was 49.3 ± 10.8 years; 81.3 % were female; and their mean disease duration was 8.1 ± 7.2 years. Fifty-two percent of patients were doing manual work. The mean RA-WIS score was 11.4 ± 6.8, and 41 % of patients had a high-risk WI. High-risk WI was associated with radiographic erosions (p < 0.001) and HAQ-A >0.87 (p < 0.001) in the univariable analysis, whereas in the multivariable logistic regression analysis the variables associated with a high-risk WI were as follows: HAQ-A >0.87 [odds ratio (OR) 12.31; 95 % CI 5.38-28.18] and the presence of radiographic erosions (OR 4.848; 95 % CI 2.22-10.5). In this model, having a higher monthly income (OR 0.301; 95 % CI 0.096-0.943) and a better functional class (OR 0.151; 95 % CI 0.036-0.632) were protective. Forty-one percent of RA working patients had high-risk WI. The predictors of high RA-WIS were HAQ-A ≥0.87 and radiographic erosions, whereas having a better functional class and have higher incomes were protective.

Altered lipidome and antioxidative activity of small, dense HDL in normolipidemic rheumatoid arthritis: relevance of inflammation.

OBJECTIVE: High-density lipoprotein (HDL) particles exert potent antiatherogenic activities, including antioxidative actions, which are relevant to attenuation of atherosclerosis progression. Such activities are enriched in small, dense HDL and can be compromised under conditions of chronic inflammation like rheumatoid arthritis (RA). However, structure-function relationships of HDL largely remain indeterminate. METHODS: The relationships between HDL structure and function were evaluated in normolipidemic patients with active RA (DAS28 > 3.2; n = 12) and in normolipidemic age-matched controls (n = 10). Small, dense HDL3b and 3c particles were isolated from plasma or serum by density gradient ultracentrifugation and their physicochemical characteristics, lipidome (by LC/MS/MS) and antioxidative function (as protection of normolipidemic LDL from free radical-induced oxidation) were evaluated. RESULTS: As expected, active RA patients featured significantly elevated plasma levels of high-sensitivity C-reactive protein (hsCRP; p < 0.001) and serum amyloid A (SAA; p < 0.01) relative to controls. Antioxidative activity and weight % chemical composition of small, dense HDL did not differ between RA patients and controls (p > 0.05), whereas HDL phosphosphingolipidome was significantly altered in RA. Subgroup analyses revealed that RA patients featuring high levels of inflammation (hsCRP>10 mg/l) possessed small, dense HDL with reduced antioxidative activities (p < 0.01). Furthermore, antioxidative activity of HDL was inversely correlated with plasma hsCRP (p < 0.01). CONCLUSIONS: These data revealed that (i) despite normolipidemic state, the lipidome of small, dense HDL was altered in RA and (ii) high levels of inflammation can be responsible for the functional deficiency of small, dense HDL in RA.

[Pachydermoperiostosis (primary hypertrophic osteoarthropathy)]. / Paquidermoperiostosis (osteoartropatia hipertrofica primaria).

Pachydermoperiostosis or primary hypertrophic osteoarthropathy is a rare disease characterized by cutaneous and osteoarthicular involvement. We describe two patients with finger clubbing, watch crystal nails, bones thickenings, arthritis and different grades of skin affection, without other clinical manifestations. Both did not know of having relatives with the same alterations. Radiological studies of the affected areas showed periostosis. Because of normal laboratory results and chest radiography plus the absence of other underlying causes, diagnosis of primary hypertrophic osteoarthropathy was made.

Paquidermoperiostosis (osteoartropatia hipertrofica primaria) / Pachydermoperiostosis (primary hypertrophic osteoarthropathy)

La paquidermoperiostosis u osteoartropatía hipertrófica primaria es una rara enfermedadcaracterizada por compromiso cutáneo y osteoarticular. Comunicamos dos casos que presentabanhipocratismo digital, uñas en vidrio de reloj, agrandamiento óseo, tumefacción articular y diferentes grados deafectación cutánea, sin otros hallazgos clínicos relevantes. Ambos desconocían antecedentes familiares similares.El estudio radiográfico de las zonas comprometidas mostró periostosis. Con resultados de laboratorio yradiografía de tórax normales, y ausencia de evidencia clínica de otra enfermedad subyacente, se realizó diagnósticode osteoartropatía hipertrófica primaria.

Pachydermoperiostosis orprimary hypertrophic osteoarthropathy is a rare disease characterized by cutaneous and osteoarthicularinvolvement. We describe two patients with finger clubbing, watch crystal nails, bones thickenings,arthritis and different grades of skin affection, without other clinical manifestations. Both did not know of havingrelatives with the same alterations. Radiological studies of the affected areas showed periostosis. Because ofnormal laboratory results and chest radiography plus the absence of other underlying causes, diagnosis of primaryhypertrophic osteoarthropathy was made.

Paquidermoperiostosis (osteoartropatia hipertrofica primaria) / Pachydermoperiostosis (primary hypertrophic osteoarthropathy)

La paquidermoperiostosis u osteoartropatía hipertrófica primaria es una rara enfermedadcaracterizada por compromiso cutáneo y osteoarticular. Comunicamos dos casos que presentabanhipocratismo digital, uñas en vidrio de reloj, agrandamiento óseo, tumefacción articular y diferentes grados deafectación cutánea, sin otros hallazgos clínicos relevantes. Ambos desconocían antecedentes familiares similares.El estudio radiográfico de las zonas comprometidas mostró periostosis. Con resultados de laboratorio yradiografía de tórax normales, y ausencia de evidencia clínica de otra enfermedad subyacente, se realizó diagnósticode osteoartropatía hipertrófica primaria. (AU)

Pachydermoperiostosis orprimary hypertrophic osteoarthropathy is a rare disease characterized by cutaneous and osteoarthicularinvolvement. We describe two patients with finger clubbing, watch crystal nails, bones thickenings,arthritis and different grades of skin affection, without other clinical manifestations. Both did not know of havingrelatives with the same alterations. Radiological studies of the affected areas showed periostosis. Because ofnormal laboratory results and chest radiography plus the absence of other underlying causes, diagnosis of primaryhypertrophic osteoarthropathy was made. (AU)

Paquidermoperiostosis (osteoartropatia hipertrofica primaria) / Pachydermoperiostosis (primary hypertrophic osteoarthropathy)

La paquidermoperiostosis u osteoartropatía hipertrófica primaria es una rara enfermedadcaracterizada por compromiso cutáneo y osteoarticular. Comunicamos dos casos que presentabanhipocratismo digital, uñas en vidrio de reloj, agrandamiento óseo, tumefacción articular y diferentes grados deafectación cutánea, sin otros hallazgos clínicos relevantes. Ambos desconocían antecedentes familiares similares.El estudio radiográfico de las zonas comprometidas mostró periostosis. Con resultados de laboratorio yradiografía de tórax normales, y ausencia de evidencia clínica de otra enfermedad subyacente, se realizó diagnósticode osteoartropatía hipertrófica primaria. (AU)

Pachydermoperiostosis orprimary hypertrophic osteoarthropathy is a rare disease characterized by cutaneous and osteoarthicularinvolvement. We describe two patients with finger clubbing, watch crystal nails, bones thickenings,arthritis and different grades of skin affection, without other clinical manifestations. Both did not know of havingrelatives with the same alterations. Radiological studies of the affected areas showed periostosis. Because ofnormal laboratory results and chest radiography plus the absence of other underlying causes, diagnosis of primaryhypertrophic osteoarthropathy was made. (AU)

Milia en placa en varias y sucesivas áreas / Milia en plaque at multiple and successive sites

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Papilomatosis reticulada y confluente (Gougerot-Carteaud): respuesta terapéutica a sulfuro de selenio y revisión / Reticulated and confluent papillomatosis (Gougerot-Carteaud): response to selenium sulfide

La papilomatosis reticulada y confluente (Gougerot-Carteaud) es una entidad poco frecuente que se carateriza por la presencia de papulas pardas queratósicas que coalescen formando placas de aspecto reticulado en la periferia, cuyas localizaciones mas frecuentes son nuca, axilas, tronco anterior y zona intermamaria. Presentamos un caso que respondió favorablemente al tratamiento con sulfuro de selenio. Se realiza una revisión del tema

Papilomatosis reticulada y confluente (Gougerot-Carteaud): respuesta terapéutica a sulfuro de selenio y revisión / Reticulated and confluent papillomatosis (Gougerot-Carteaud): response to selenium sulfide

La papilomatosis reticulada y confluente (Gougerot-Carteaud) es una entidad poco frecuente que se carateriza por la presencia de papulas pardas queratósicas que coalescen formando placas de aspecto reticulado en la periferia, cuyas localizaciones mas frecuentes son nuca, axilas, tronco anterior y zona intermamaria. Presentamos un caso que respondió favorablemente al tratamiento con sulfuro de selenio. Se realiza una revisión del tema (AU)

Metástasis cutánea sobre cicatriz por carcinoma de esófago en acondroplásica: comunicación de un caso diagnosticado por punción aspiración con aguja fina / Cutaneous metastasis on a scar secondary to esophageal carcinoma in an achondroplasic patient: diagnosis by needle aspiration biopsy

Las metástasis cutáneas son infrecuentes y excepcionalmente provienen de esófago. Muy rara vez asientan sobre una cicatriz o son signo de presentación de un cáncer oculto. Describimos una metástasis cutánea como signo de presentación de cáncer epidermoide de esófago en una anciana acondroplásica. El diagnóstico fue realizado por punción aspiración por aguja fina (PAAF) de la lesión cutánea. Se discute el valor de la PAAF como un método rápido y válido para el diagnóstico de metástasis cutáneas. Asimismo se remarca que la ocurrencia de carcinoma de esófago y acondroplasia en una misma paciente probablemente sea una coincidencia más que una asociación

Metástasis cutánea sobre cicatriz por carcinoma de esófago en acondroplásica: comunicación de un caso diagnosticado por punción aspiración con aguja fina / Cutaneous metastasis on a scar secondary to esophageal carcinoma in an achondroplasic patient: diagnosis by needle aspiration biopsy

Las metástasis cutáneas son infrecuentes y excepcionalmente provienen de esófago. Muy rara vez asientan sobre una cicatriz o son signo de presentación de un cáncer oculto. Describimos una metástasis cutánea como signo de presentación de cáncer epidermoide de esófago en una anciana acondroplásica. El diagnóstico fue realizado por punción aspiración por aguja fina (PAAF) de la lesión cutánea. Se discute el valor de la PAAF como un método rápido y válido para el diagnóstico de metástasis cutáneas. Asimismo se remarca que la ocurrencia de carcinoma de esófago y acondroplasia en una misma paciente probablemente sea una coincidencia más que una asociación (AU)

Ulceras linfomatosas: estudio casuístico y análisis de la literatura / Lymphomas and cutaneous ulcers: casuistical study and analyses of literature

Las úlceras cutáneas son una complicación tardía de los linfomas. Indican mal pronóstico, pudiendo ser fuente de sepsis. Fueron analizados en forma retrospectiva, entre enero de 1999 a agosto de 2000, 13 pacientes con linfomas cutáneos con ulceración por infiltración linfomatosa. Las úlceras se caracterizaron en su mayoría por asentar sobre tumores y ser múltiples, necróticas e infectadas. La sepsis fue la causa principal de mortalidad en 10 pacientes y generalmente fueron secundarias a Staphylococcus aureus y Psedomona aeruginosa. Los factores asociados de mal pronóstico fueron la progresión del linfoma y la neutropenia febril posterior a la administración de quimioterapia (especialmente en los linfomas no-Hodgkin ganglionares). La sobrevida media de los pacientes fallecidos después del inicio de las úlceras fue 6.27 meses. Destacamos la importancia del tratamiento precoz, previo adecuado estudio bacteriológico

Ulceras linfomatosas: estudio casuístico y análisis de la literatura / Lymphomas and cutaneous ulcers: casuistical study and analyses of literature

Las úlceras cutáneas son una complicación tardía de los linfomas. Indican mal pronóstico, pudiendo ser fuente de sepsis. Fueron analizados en forma retrospectiva, entre enero de 1999 a agosto de 2000, 13 pacientes con linfomas cutáneos con ulceración por infiltración linfomatosa. Las úlceras se caracterizaron en su mayoría por asentar sobre tumores y ser múltiples, necróticas e infectadas. La sepsis fue la causa principal de mortalidad en 10 pacientes y generalmente fueron secundarias a Staphylococcus aureus y Psedomona aeruginosa. Los factores asociados de mal pronóstico fueron la progresión del linfoma y la neutropenia febril posterior a la administración de quimioterapia (especialmente en los linfomas no-Hodgkin ganglionares). La sobrevida media de los pacientes fallecidos después del inicio de las úlceras fue 6.27 meses. Destacamos la importancia del tratamiento precoz, previo adecuado estudio bacteriológico (AU)

Neurofibromatosis elefantiásica: presentación de dos casos / Neurofibromatosis elephantiasica: report of 2 cases

La neurofibromatosis elefantiásica (NFE) es una entidad escasamente descrita. Se caracteriza por la presencia de neurofibromas plexiformes gigantes cuyas localizaciones más frecuentes son las extremidades, cuero cabelludo, cuello y hombros. Presentamos dos casos de NFE con importante compromiso de cadera y abdomen que les ocasionaba principalmente trastornos psicosociales, incluyendo dificultades en el uso de vestimenta. Se realiza una actualización del tema

Neurofibromatosis elefantiásica: presentación de dos casos / Neurofibromatosis elephantiasica: report of 2 cases

La neurofibromatosis elefantiásica (NFE) es una entidad escasamente descrita. Se caracteriza por la presencia de neurofibromas plexiformes gigantes cuyas localizaciones más frecuentes son las extremidades, cuero cabelludo, cuello y hombros. Presentamos dos casos de NFE con importante compromiso de cadera y abdomen que les ocasionaba principalmente trastornos psicosociales, incluyendo dificultades en el uso de vestimenta. Se realiza una actualización del tema (AU)