Impact of intimate partner violence on quality of life and disease activity in women with systemic lupus erythematosus.

OBJECTIVE: Stress and trauma are psychosocial factors with an impact on the course of systemic lupus erythematosus (SLE). The influence of violence on SLE has not been entirely explored, even though women (including patients with rheumatic diseases) are a vulnerable population to any form of violence. This study aims to assess the prevalence and impact of intimate partner violence (IPV) on health-related quality of life in women with SLE. METHODS: An observational, cross-sectional, and analytical study was conducted at a rheumatology clinic of a university hospital from September 2022 and September 2023. We evaluated the presence of IPV in 85 women with SLE with the Hurt, Insulted, Threatened with Harm and Screamed at (HITS) questionnaire and the Index of Spouse Abuse (ISA), and quality of life with LupusQoL. RESULTS: The prevalence by HITS score of past-year IPV was 24.4% and of lifetime IPV was 36.5%. Past-year non-physical violence was present in 17.1% of patients by ISA, and 27.1% were victims in their lifetime. While in physical violence, 7.3% were victims in the previous year and 21.2% in their lifetime. The total quality of life and the emotional domain by LupusQoL were diminished in victims of past-year IPV, compared to those who weren't exposed (p = .018 and p = .036, respectively). Past-year HITS score correlated with the Physician Global Assessment (PGA) (rho = 0.301, p = .006), while lifetime HITS score correlated with PGA (rho = 0.329, p = .002) and SLEDAI-2K (rho = 0.277, p = .010). CONCLUSION: We found that one in four women suffered IPV in the previous year, and those who were exposed had diminished quality of life. Also, the severity of the abuse correlated with disease activity. Our findings emphasize the importance of comprehensive care for patients with SLE.

Update of the guidelines for the pharmacological treatment of rheumatoid arthritis by the Mexican College of Rheumatology 2023.

OBJECTIVE: To develop updated guidelines for the pharmacological management of rheumatoid arthritis (RA). METHODS: A group of experts representative of different geographical regions and various medical services catering to the Mexican population with RA was formed. Questions based on Population, Intervention, Comparison, and Outcome (PICO) were developed, deemed clinically relevant. These questions were answered based on the results of a recent systematic literature review (SLR), and the evidence's validity was assessed using the GRADE system, considered a standard for these purposes. Subsequently, the expert group reached consensus on the direction and strength of recommendations through a multi-stage voting process. RESULTS: The updated guidelines for RA treatment stratify various therapeutic options, including different classes of DMARDs (conventional, biologicals, and JAK inhibitors), as well as NSAIDs, glucocorticoids, and analgesics. By consensus, it establishes the use of these in different subpopulations of interest among RA patients and addresses aspects related to vaccination, COVID-19, surgery, pregnancy and lactation, and others. CONCLUSIONS: This update of the Mexican guidelines for the pharmacological treatment of RA provides reference points for evidence-based decision-making, recommending patient participation in joint decision-making to achieve the greatest benefit for our patients. It also establishes recommendations for managing a variety of relevant conditions affecting our patients.

Quality indicators and satisfaction with care in patients with systemic lupus erythematosus.

Grading the quality of care in patients with systemic lupus erythematosus and determining its relationship with care satisfaction may recognize gaps that could lead to better clinical practice. Eighteen quality indicators (QIs) were recently developed and validated for patients with SLE based on the 2019 EULAR management recommendations. Few studies have analyzed the relationship between quality of care and care satisfaction in patients with lupus. This was a cross-sectional study. We included patients at least 18 years old who met the EULAR/ACR 2019 classification criteria for SLE. We interviewed patients and retrieved data from medical records to assess their compliance with a set of 18 EULAR-based QIs. We calculated each QI fulfillment as the proportion of fulfilled QI divided by the number of eligible patients for each indicator. Care satisfaction was evaluated with the satisfaction domain of LupusPRO version 1.7. Spearman correlation coefficient was used to determine the relationship between quality of care and care satisfaction. Seventy patients with a median age of 33 (IQR 23-48) were included, 90% were women. Overall adherence was 62.29%. The median care satisfaction was 100. Global adherence to the 18-QIs and the care satisfaction score revealed no correlation (r = 0.064, p = 0.599). Higher QI fulfillment was found in the group with remission versus the moderate-high activity group (p = 0.008). In our study, SLE patients in remission had higher fulfillment of quality indicators. We found no correlation between the quality of care and satisfaction with care.

Problems related to sexuality are relevant but not addressed in rheumatology practice: results from a cross-sectional survey.

Sexual issues have a high prevalence in people with rheumatic diseases, but they are not commonly discussed in clinical practice, so we aim to determine the relevance and frequency of addressing problems related to sexuality in Rheumatology clinical practice in Mexico. We obtained data from an electronic survey applied to Mexican physicians involved in Rheumatology practice. The questionnaire was adapted from a previous study. The responses were analyzed and presented with descriptive statistics. We received 75 responses, 52% were from women, with an average age of 35.5 years. Sixty-two (82.6%) participants considered problems related to sexuality as quite relevant to Rheumatology practice, but a lower proportion (10, 13.3%) approach them to the same extent. The main barriers to the management of sexual issues that we recognized were the patient's embarrassment, patient´s age, and time. Most of our participants (62.7%) considered the rheumatologist as responsible for initiating the dialogue about sexual issues. Mexican rheumatologists consider sexual issues as relevant. Further training in sexuality is warranted for health care professionals attending people with rheumatic diseases.

Sexual function in women with systemic lupus erythematosus: a case-control study.

The effect of systemic lupus erythematosus (SLE) in sexual function is one of the least studied areas. There are few previous studies that investigate sexual function in SLE, and current evidence indicates a negative impact. The main objective of this study is to evaluate sexual function in Mexican women with SLE and compare if sexual dysfunction occurs in a greater proportion than in healthy women. A case-control study with 102 Mexican women between 18 and 60 years, with SLE diagnosis and a control group of healthy women (n = 156) matched by age. They were asked about their sexual life in the last month, and the Female Sexual Function Index (FSFI) self-questionnaire was applied. Variables between groups were compared with Chi-square and Mann-Whitney U test. SLE women had less sexual activity than controls (63.7% vs 77.5%, p = 0.01). Out of the total, the FSFI was applied only to those that had an active sexual life, 65 with SLE and 121 healthy women. Sexual dysfunction (< 26.5 points) was found in 28% women with SLE and in 22% of controls, with no significant differences (p = 0.4). In the SLE group, a worse performance was found in the desire and excitation domains compared to healthy women. SLE women had less active sexual life than healthy women, but no greater sexual dysfunction. However, they performed worse in the desire and excitation domains. This alteration did not show a relation with demographic nor disease-related variables.

Efficacy and safety of weekly vitamin D3 in patients with fibromyalgia: 12-week, double-blind, randomized, controlled placebo trial.

INTRODUCTION: FM is a chronic musculoskeletal disorder characterized by the presence of generalized pain. There are contradictory results regarding the prevalence and supplementation effect of vitamin D deficiency on FM patients. We aim to determine the safety and efficacy of a 12-week vitamin D supplementation on FM patients. METHODS: We conducted a randomized, placebo-controlled, double-blind clinical trial. We included female participants of 18 years old or older, who met 1990 or 2010 ACR criteria for fibromyalgia. The Spanish validated FIQ and the VAS of pain were applied at baseline. The participants were then randomized to receive placebo or 50,000 IU of Vitamin D3 PO, weekly for 12 weeks. RESULTS: We included 80 patients. There was no statistical difference in the initial and final FIQ between both groups. The FIQ delta also did not prove to be different at the end of the study. The increase in vitamin D levels in the intervention group was corroborated. Regarding serious adverse effects, none was reported in both groups. There was no statistical difference in minor adverse events. CONCLUSION: In this double-blind placebo-controlled randomized study conducted to measure the efficacy and safety of vitamin D exclusively in patients with FM, we found that there is no evidence of a trend in favor of vitamin D treatment, since we did not observe improvement in the VAS of pain or FIQ. TRIAL REGISTRY: Clinical Trials.gov number: NCT03369379 Key Points • There are conflicting results in vitamin D to treat fibromyalgia. • In this double-blind, randomized controlled trial, we did not find a difference in the VAS nor FIQ with vitamin D supplementation. • The increase in vitamin D levels in the intervention group was corroborated.

Low-dose rituximab therapy in steroid-refractory thrombocytopenia due to systemic lupus erythematosus.

Systemic lupus erythematosus (SLE) is an autoimmune disease, characterized by multi-organ symptomatology. 16% of the patients with autoimmune thrombocytopenia have SLE and are associated with high mortality. Intravenous methylprednisolone or high-dose steroids are the first-line treatments in those patients who experienced life-threatening bleeding or have a severely low platelet count, whereas a second line includes splenectomy, as well as other immunosuppressive agents as monotherapy or combined therapy, including azathioprine, cyclophosphamide, cyclosporine, and mycophenolate mofetil. However, response rates of these therapies vary considerably. Rituximab (RTX) became a useful tool in the treatment of autoimmune diseases, due to the decrease of autoantibodies production. In addition, there is evidence that low doses of RTX (100 mg IV per week for 4 weeks) can have a similar effect compared to the standard dose. The objective of this study was to describe the response to low doses of RTX in patients with lupus-induced thrombocytopenia. We present a report of four female patients with newly diagnosed SLE, accompanied by purpuric syndrome and severe thrombocytopenia (< 30 × 109/L) as the clinical debut that was refractory to glucocorticoids (GC) therapy and treated with low doses of RTX. By week 5, complete response (> 100 × 109/L) was achieved in two patients, partial response (> 50 × 109/L) in 1 patient, and no response in one patient. There is little information on the treatment of SLE-associated autoimmune thrombocytopenia. The most extensive study found at the time of our search was the study of 10 Asian patients. They found that 80% of the patients responded by week four and maintained until week 24 of follow-up. At week 36, a follow-up for two patients showed relapse; this occurred on patients with the most disease duration (> 5 years) and was associated with a lower response rate. In contrast, our study with four patients found that half of them presented a complete response: one patient added concomitant therapy with azathioprine (AZA) and another patient without the concomitant therapy. A third patient with a partial improvement, this was seen by week five of treatment. Moreover, a fourth patient who did not have a response by week five of treatment presented a clinical response in subsequent appointments with a count of > 100 at week 24. Those patients who required concomitant use of AZA were patients who had positive antiphospholipid serology. The use of low-dose RTX for the management of severe thrombocytopenia refractory to GC in patients with SLE has a good response. It could be a safe, economical, and effective therapy.

Assessment of six cardiovascular risk calculators in Mexican mestizo patients with rheumatoid arthritis according to the EULAR 2015/2016 recommendations for cardiovascular risk management.

Variability of the 10-year cardiovascular (CV) risk predicted by the Framingham Risk Score (FRS) using lipids, FRS using body mass index (BMI), Reynolds Risk Score (RRS), QRISK2, Extended Risk Score-Rheumatoid Arthritis (ERS-RA), and algorithm developed by the American College of Cardiology and the American Heart Association in 2013 (ACC/AHA 2013) according to the European League Against Rheumatism (EULAR) 2015/2016 update of its evidence-based recommendations for cardiovascular risk management in patients with rheumatoid arthritis (RA) has not been evaluated in Mexican mestizo patients. CV risk was predicted using six different risk calculators in 116 patients, aged 40-75, who fulfilled the ACR/EULAR 2010 classification criteria. Results were multiplied by 1.5 according to the EULAR 2015/2016 update. Global comparison of the risk predicted by all scales was done using the Friedman test, considering a P value of ≤0.05 as statistically significant. Individual comparison between the algorithms was made using the Wilcoxon signed-rank test, and a P value of ≤0.003 was considered statistically significant. All calculators showed to be different in the Friedman test (p ≤ 0.001). Median values of predicted 10-year CV risk were 11.02% (6.18-17.55) for FRS BMI; 8.47% (4.6-13.16) for FRS lipids; 5.55% (2.5-11.85) for QRISK2; 5% (3.1-8.65) for ERS-RA; 3.6% (1.5-9.3) for ACC/AHA 2013; and 1.5% (1.5-4.5) for RRS. ERS-RA showed no difference when compared against QRISK2 (p = 0.269). CV risk calculators showed variability among them and cannot be used indistinctly in RA-patients.

Aterosclerosis carotídea en pacientes con artritis reumatoide y nódulos reumatoides / Carotid atherosclerosis in patients with rheumatoid arthritis and rheumatoid nodules

Objetivo. Determinar si existe una asociación entre la presencia de nódulos reumatoides y el engrosamiento de la íntima-media y de placa de las arterias carótidas. Materiales y métodos. Estudio observacional, transversal de 124 pacientes con artritis reumatoide del Servicio de Reumatología de un Hospital Universitario desde 2005 a 2006. Se dividieron los pacientes en 2 grupos, 62 con nódulos reumatoide y 62 sin nódulos reumatoides, pareados por edad y sexo. Se realizó una historia clínica completa, velocidad de sedimentación globular, medición de anticuerpos antipéptidos cíclicos citrulinados, factor reumatoide y una ecografía doppler de alta resolución de las arterias carótidas. Resultados. Las mujeres comprendieron el 89,5% de los pacientes. La prevalencia de al menos una placa en las carótidas fue del 57% en nuestra población. La presencia de placa carotídea estuvo asociada a la edad, hipertensión arterial y circunferencia abdominal. El grosor promedio de la íntima-media en pacientes con placa carotídea fue 0,085cm (±0,02). No hubo ninguna correlación entre los parámetros de laboratorio y el engrosamiento de íntima-media de la arteria carótida. Los nódulos subcutáneos estuvieron presentes en 33 (47%) de los 70 pacientes con placas de carótida y 29 (54%) de los pacientes sin una placa carótida (p=0,471). Conclusiones. No hemos encontrado una asociación entre nódulos reumatoides y la presencia de placa y/o el engrosamiento de la íntima-media de carótidas en pacientes con artritis reumatoide(AU)

Objective: To determine whether an association exists between the presence of rheumatoid nodules and thickening of the intima-media and plaque of the carotid artery, which is evidence of atherosclerosis. Materials and methods: Observational, cross-sectional study of 124 patients with rheumatoid arthritis from a University Hospital clinic from 2005 to 2006. We divided the patients into 2 groups, 62 with rheumatoid nodules and 62 without rheumatoid nodules, matched for age and sex. Medical history, erythrocyte sedimentation rate, anti-cyclic citrullinated peptide, rheumatoid factor, and a high resolution doppler ultrasound of the carotid arteries were performed. Results: Women comprised 89.5% of the patients. The prevalence of a carotid plaque was 57% in our population. The presence of a plaque was associated with age, arterial hypertension and abdominal circumference. Average intima-media thickness (IMT) in patients with a plaque was 0.085 cm (±0.02). There was no correlation between laboratory parameters and thickening of the intima-media of the carotid artery. Subcutaneous nodules were present in 33 (47%) of the 70 patients with a carotid plaque and in 29 (54%) of patients without a carotid plaque (p = .471). Conclusions: We did not find an association between rheumatoid nodules and the presence of a carotid plaque and thickening of the intima-media of the carotid in patients with rheumatoid arthritis(AU)

Carotid atherosclerosis in patients with rheumatoid arthritis and rheumatoid nodules.

OBJECTIVE: To determine whether an association exists between the presence of rheumatoid nodules and thickening of the intima-media and plaque of the carotid artery, which is evidence of atherosclerosis. MATERIALS AND METHODS: Observational, cross-sectional study of 124 patients with rheumatoid arthritis from a University Hospital clinic from 2005 to 2006. We divided the patients into 2 groups, 62 with rheumatoid nodules and 62 without rheumatoid nodules, matched for age and sex. Medical history, erythrocyte sedimentation rate, anti-cyclic citrullinated peptide, rheumatoid factor, and a high resolution doppler ultrasound of the carotid arteries were performed. RESULTS: Women comprised 89.5% of the patients. The prevalence of a carotid plaque was 57% in our population. The presence of a plaque was associated with age, arterial hypertension and abdominal circumference. Average intima-media thickness (IMT) in patients with a plaque was 0.085 cm (± 0.02). There was no correlation between laboratory parameters and thickening of the intima-media of the carotid artery. Subcutaneous nodules were present in 33 (47%) of the 70 patients with a carotid plaque and in 29 (54%) of patients without a carotid plaque (p=.471). CONCLUSIONS: We did not find an association between rheumatoid nodules and the presence of a carotid plaque and thickening of the intima-media of the carotid in patients with rheumatoid arthritis.