Association between leptin and IL-6 concentrations with cardiovascular risk in patients with rheumatoid arthritis.

Pro-inflammatory cytokines such as leptin and IL-6 play an important role in the development of cardiovascular risk. Determine the relationship between leptin and IL-6 concentrations with cardiovascular risk in patients with rheumatoid arthritis. We determined IL-6 and leptin levels in 77 patients with the diagnosis of rheumatoid arthritis. The cardiovascular risk was calculated using the modified Framingham scale. Statistical analysis was performed using SPSS 22 considering a significant p < 0.05. Serum leptin concentrations and cardiovascular risk (CVR) factors were compared and found that there was a significant difference between higher leptin values and disease activity (p 0.047), obesity (p 0.038), positive rheumatoid factor (p 0.009), tobacco (p 0.009), and metabolic syndrome (p 0.001). Likewise, a significant relationship was found between lower leptin concentrations and hydroxychloroquine consumption (p = 0.023). We found significant difference between IL-6 concentrations and disease activity (p 0.028), hypertriglyceridemia (p 0.023), LDL-C (p 0.029), and smoking (0.005). Similarly, an association between hydroxychloroquine consumption and low concentrations of IL-6 was found (p 0.005). Framingham CVR was calculated and the result obtained was multiplied by 1.5. The 35.2% of the population studied had a low Framingham CVR, 38.9% moderate, and 25.9% presented a high risk. We compared the level of CVR and serum leptin and IL-6 concentrations, finding that the highest CVR was the leptin and IL-6 values. There is a positive association between CVR and serum leptin concentrations. It is also significantly associated with traditional and non-traditional risk factors.

Riesgo cardiovascular en lupus eritematoso sistémico / Cardiovascular risk in systemic lupus erythematosus

Antecedentes: Los pacientes con lupus eritematoso sistémico (LES) tienen mayor frecuencia de factores de riesgo cardiovascular (RCV) tradicionales, esto sumado a la presencia de factores de RCV no tradicionales, aumenta la probabilidad de eventos cardiacos hasta 5 veces. Objetivo: Determinar la frecuencia de los factores de RCV en una población de pacientes con LES. Materiales y métodos: Se realizó un estudio descriptivo, transversal, observacional, en 51 pacientes con diagnóstico de LES. Resultados: Se reportó el patrón lúpico de dislipoproteinemia ya que el 52,9% presentó hipoal-falipoproteinemia, 49% hipercolesterolemia, 35,3% hipertrigliceridemia y 19,6% elevación de c-LDL. Con respecto a las comorbilidades el 31,4% presentó obesidad, 27,5% hipertensión arterial y 6% diabetes mellitus. Los factores de RCV no tradicionales que predominaron fueron los asociados con la actividad de la enfermedad, el 90,1% tomaba glucocorticoides, 70,6% presentó niveles bajos de C3, 66,7% tuvo PCR > 2 mg/l, 56,9% tenía más de 4 puntos de SLEDAI-2 K, 41,2% presentó niveles bajos de C4, 29,4% tenía más de 10 arios de duración de la enfermedad, 25,5% tenía nefritis lúpica. Con lo que respecta a la presencia de anticuerpos asociados a RCV el 58,8, 9,8, 74,8 y el 3,9% presentaron anti-Smith, anticoagulante lúpico, anti-beta 2 glicoproteína I, anticardiolipinas positivas, respectivamente. Conclusiones: Los pacientes con LES presentan un estado proinflamatorio y aterogénico, aumentando el riesgo de desarrollar enfermedades cardiovasculares tanto por mayor incidencia de los factores de riesgo tradicionales, como por la presencia de factores que promueven una inflamación crónica.

Background: Patients with systemic lupus erythematosus (SLE) have a higher frequency of traditional cardiovascular risk factors (CVR). This, combined with the presence of nontraditional cardiovascular risk factors, increases the probability of cardiac events by five times. Objective: To determine the prevalence of CVR factors in a population of patients with SLE. Material and methods: A descriptive, cross-sectional, observational study in 51 patients with the diagnosis of SLE. Results: A lupus dyslipoproteinaemia pattern was reported, of which 52.9% had hypo-alphalipoproteinaemia, 49% hypercholesterolaemia, 35.3% hypertriglyceridaemia, and 19.6% with an elevated c-LDL. The comorbidities found were, 31.4% with obesity, 27.5% with high blood pressure, and 6% suffered from diabetes mellitus. Predominant non-traditional CVR factors were associated with disease activity, with 90.1% taking glucocorticoids, 70.6% had low levels of complement C3, 41.2% had low levels of complement C4, 66.7% had a CRP > 2 mg/l, 56.9% had a SLEDAI-2 K score greater than 4 points, 29.4% had more than 10 years of disease duration, and 25.5% had lupus nephritis. As regards the presence of antibodies associated with CVR, 58.8, 9.8, 74.8 and 3.9% had anti-Smith antibodies, lupus anticoagulant, antibeta2glycoprotein I, and positive anticardiolipin, respectively. Conclusions: Patients with SLE have a pro-inflammatory and atherogenic state, increasing the risk of developing cardiovascular diseases, and therefore a higher incidence of traditional risk factors, such as the presence of factors that promote chronic inflammation.

Neurolupus and pregnancy: An ethical and therapeutic dilemma in a second level hospital / Neurolupus y embarazo: un dilema ético y terapéutico en un hospital de segundo nivel

Optic neuritis secondary to systemic lupus erythematosus is a rare manifestation with a prevalence of 1%. The case described concerns a patient who presented with optic neuritis associated with SLE. She was 19 weeks pregnant, and required pulses with methyl-prednisolone and cyclophosphamide, which are within the category D drugs used during pregnancy. Three weeks later, she presented with uterine activity, and went into labor, with a fetus of 22 weeks gestation and weighing 430 g being obtained, which died 48 h later. In medical practice there are ethical guidelines and economic obstacles to carrying out diagnostic and therapeutic protocols established by limiting clinical practice

La neuritis óptica secundaria a lupus eritematoso sistémico es una rara manifestación con una prevalencia del 1%. Presentamos el caso de una paciente que mostró neuritis óptica asociada a lupus eritematoso sistémico, con 19 semanas de gestación, requiriendo de pulsos de metilprednisolona y ciclofosfamida, que se encuentran dentro de los medicamentos categoría D utilizados durante el embarazo. Tres semanas después presentó actividad uterina y posteriormente trabajo de parto obteniéndose un producto de 22 semanas de gestación y 430 g, falleciendo a las 48 h. En la práctica médica existen lineamientos éticos y obstáculos económicos que limitan la realización de protocolos diagnósticos y terapéuticos establecidos, limitando la práctica clínica