Effectiveness of methotrexate and leflunomide as corticoid-sparing drugs in patients with polymyalgia rheumatica.

Objectives: The need for glucocorticoid-sparing drugs (GCSD) remains an important issue and is an unmet need in the treatment of polymyalgia rheumatica (PMR). We therefore aimed to assess the effectiveness and safety of methotrexate (MTX) and of leflunomide (LEF) in daily clinical practice in PMR patients from Argentina. Methods: A multicentre and observational study (medical records review) of PMR patients seen between 2007 and 2023, who had at least three months of follow-up after starting a GCSD, either MTX or LEF, was performed. Results are expressed as medians and interquartile ranges [25th-75th (IQR)] for continuous variables and percentages for categorical ones. The two treatment groups were compared using χ2 test for categorical variables, Mann-Whitney U test for continuous variables and the log-rank test for time-to-event data. Crude and adjusted odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using logistic regression. In all cases, a p-value <0.05 was considered statistically significant. Results: One-hundred and eighty-six patients (79% female) with a median age of 72 years (IQR, 65-77 years) were included. One-hundred and forty-three patients (77%) were prescribed MTX (15, IQR 10-15) and 43 (23%) LEF (20 mg, fixed dose). Flare-ups (relapses and recurrences) occurred in 13 patients (7%) and were comparable between both groups. Persistent GCSD intake was observed in 145 patients (78%). Glucocorticoid (GC) withdrawal was achieved in 67 of these 145 patients (46%) and this occurred more frequently in the LEF group (P = 0.001). Furthermore, time until prednisone discontinuation was shorter in the LEF-treated patients (4.7 months, IQR 3-20 on LEF versus 31.8 months, IQR 10-82 on MTX, P = 0.000). Remission was found more frequently in the LEF group (P = 0.003). In the multivariate analysis, the probability of remission was higher with LEF therapy (P = 0.010) and this finding persisted in the subgroup analysis who were followed up < 40 months (OR 3.12, 95% CI = 1.30-7.47, P = 0.011). Conclusions: This study demonstrated the clinical effectiveness of LEF and even its superiority in achieving remission when compared with MTX as GCSD in PMR patients. Further research is needed to support these findings.

[Clinical evolution and levels of anti-S SARS-CoV-2 IgG in rheumatic disease and COVID-19]. / Evolución clínica y niveles de anti-S SARS-CoV-2 en enfermedades reumáticas y COVID-19.

Controversies still exist regarding the humoral response to the virus SARS-CoV-2 in convalescent patients and seroconversion in patients with autoimmune diseases. There are few reports on the clinical and evolution of COVID-19 in the latter group. The objective was to examine the clinical and evolutionary characteristics associated with COVID-19 and the percentage of seroconversion in people with rheumatic diseases. Fifty-three patients were included, mainly with rheumatoid arthritis and lupus. The majority were female and average age 48 ± 14 years. Symptoms: fever (56%), anosmia (35.8%), dyspnea (34%), headache (30.2%) and cough (30.2%). Duration of infection 12 ± 7 days. Almost half of the patients were hospitalized (23, 43.4%), 5 in critical care units (9.4%) and 3 died (5.6%). The prevalence of steroid use was 56.6% (30), with an average dose of 8 mg/d, and 17 (32%) used immunosuppressive biopharmaceuticals. There was a correlation between age and the need for hospitalization with a risk of 9.4% per year. There were no differences with other variables. The presence in serum of IgG immunoglobulin against SARS-CoV-2 protein S was determined in 23/53 patients (43.4%), with detectable levels in 15 (62.2%), and in the 23 without autoimmune connective tissue diseases who suffered from COVID-19, 12 had detectable antibodies. Death in this group of rheumatic diseases was low, similar to the general population. More than half had specific antibodies against the virus regardless of the medication used.

Existen controversias sobre la respuesta humoral al virus SARS-CoV-2 y la seroconversión en pacientes con enfermedades autoinmunes. Hay pocas publicaciones sobre la clínica y la evolución de COVID-19 en este último grupo. El objetivo fue examinar las características clínicas y evolutivas asociadas a COVID-19 y el porcentaje de seroconversión en personas con enfermedades reumáticas. Se incluyeron 53 pacientes principalmente con artritis reumatoide y lupus. La mayoría de sexo femenino y edad promedio 48 ± 14 años. La sintomatología fue fiebre (56%), anosmia (35.8%), disnea (34%), cefalea (30.2%) y tos (30.2%). Duración de infección 12 ± 7 días. Casi la mitad de los pacientes fueron hospitalizados (23, 43.4%), 5 en unidad de cuidados críticos (9.4%) y 3 murieron (5.6%). La prevalencia de uso de esteroides fue de 56.6% (30), con una dosis media 8 mg/d, y 17 (32%) usaban biofármacos inmunosupresores. Hubo correlación entre edad y la necesidad de internación con un riesgo de 9.4% por año. No hubo diferencias con otras variables. Se determinó la presencia en suero de inmunoglobulina IgG contra la proteína S del SARS-CoV-2 en 23/53 pacientes (43.4%), con niveles detectables en 15 (62.2%). Se evaluaron 23 sin enfermedades autoinmunes del tejido conectivo que padecieron COVID-19, 12 tuvieron anticuerpos detectables. La muerte en este grupo de enfermedades reumatológicas fue baja, similar a la comunicada en la población general. Más de la mitad presentó anticuerpos específicos contra el virus independientemente de la medicación utilizada.

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)

Evolución clínica y niveles de anti-S SARS-CoV-2 en enfermedades reumáticas y COVID-19 / Clinical evolution and levels of anti S SARS-CoV-2 IgG in rheumatic disease and COVID-19

Resumen Existen controversias sobre la respuesta humoral al virus SARS-CoV-2 y la seroconversión en pacientes con enfermedades autoinmunes. Hay pocas publicaciones sobre la clínica y la evolución de COVID-19 en este último grupo. El objetivo fue examinar las características clínicas y evolutivas asociadas a COVID-19 y el porcentaje de seroconversión en personas con enfermedades reumáticas. Se incluyeron 53 pacientes principalmente con artritis reumatoide y lupus. La mayoría de sexo femenino y edad promedio 48 ± 14 años. La sintomatología fue fiebre (56%), anosmia (35.8%), disnea (34%), cefalea (30.2%) y tos (30.2%). Duración de infección 12 ± 7 días. Casi la mitad de los pacientes fueron hospitalizados (23, 43.4%), 5 en unidad de cuida dos críticos (9.4%) y 3 murieron (5.6%). La prevalencia de uso de esteroides fue de 56.6% (30), con una dosis media 8 mg/d, y 17 (32%) usaban biofármacos inmunosupresores. Hubo correlación entre edad y la necesidad de internación con un riesgo de 9.4% por año. No hubo diferencias con otras variables. Se determinó la presencia en suero de inmunoglobulina IgG contra la proteína S del SARS-CoV-2 en 23/53 pacientes (43.4%), con niveles detectables en 15 (62.2%). Se evaluaron 23 sin enfermedades autoinmunes del tejido conectivo que padecieron COVID-19, 12 tuvieron anticuerpos detectables. La muerte en este grupo de enfermedades reumatológicas fue baja, similar a la comunicada en la población general. Más de la mitad presentó anticuerpos específicos contra el virus independientemente de la medicación utilizada.

Abstract Controversies still exist regarding the humoral response to the virus SARS-CoV-2 in convalescent patients and seroconversion in patients with autoimmune diseases. There are few reports on the clinical and evo lution of COVID-19 in the latter group. The objective was to examine the clinical and evolutionary characteristics associated with COVID-19 and the percentage of seroconversion in people with rheumatic diseases. Fifty-three patients were included, mainly with rheumatoid arthritis and lupus. The majority were female and average age 48 ± 14 years. Symptoms: fever (56%), anosmia (35.8%), dyspnea (34%), headache (30.2%) and cough (30.2%). Duration of infection 12 ± 7 days. Almost half of the patients were hospitalized (23, 43.4%), 5 in critical care units (9.4%) and 3 died (5.6%). The prevalence of steroid use was 56.6% (30), with an average dose of 8 mg/d, and 17 (32%) used immunosuppressive biopharmaceuticals. There was a correlation between age and the need for hospitalization with a risk of 9.4% per year. There were no differences with other variables. The presence in serum of IgG immunoglobulin against SARS-CoV-2 protein S was determined in 23/53 patients (43.4%), with detectable levels in 15 (62.2%), and in the 23 without autoimmune connective tissue diseases who suffered from COVID-19, 12 had detectable antibodies. Death in this group of rheumatic diseases was low, similar to the general population. More than half had specific antibodies against the virus regardless of the medication used.

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.