Tuberculosis en una cohorte de pacientes con lupus eritematoso sistémico / Tuberculosis in a cohort of patients with systemic lupus erythematosus

Objetivos. Analizar los casos de tuberculosis (TB) en una cohorte de pacientes con lupus eritematoso sistémico (LES) y comparar la frecuencia y características de la TB en nuestra serie con las de otras series publicadas; identificar características diferenciales entre los pacientes que presentaron TB y los que no la presentaron, y evaluar si las formas más graves se relacionaron con dosis más altas de glucocorticoides (GC) u otros inmunosupresores. Material y método. Análisis descriptivo de 13 pacientes con TB de una serie de 789 pacientes con LES. Revisión de las historias clínicas de los casos. Búsqueda bibliográfica en MEDLINE-PubMed de las series LES/TB publicadas, utilizando los términos «infection», «tuberculosis», «lupus erythematosus». Estudio comparativo de casos (LES/TB+) y controles (LES/TB–) en cuanto a las características clínicas, de laboratorio y el tratamiento realizado, mediante test X2 y test exacto de Fisher. Resultados. Trece pacientes estuvieron afectados por TB (10 mujeres, con edad media de 36 años; DE de 11,2, y prevalencia del 1,6%). Se diagnosticaron 9 primoinfecciones (69,2%) y 4 reactivaciones (30,8%). El diagnóstico se confirmó mediante aislamiento microbiológico (baciloscopia y/o cultivo) en 11 casos (84,6%). La afectación pulmonar fue la más frecuente (69,2%). Ocho pacientes (61,5%) presentaron formas extrapulmonares, de las que 6 (46%) fueron diseminadas. En el momento del diagnóstico, 9 pacientes (69,2%) recibían tratamiento con GC. Fallecieron 4 pacientes (30,8%). La afectación muscular fue más frecuente en el grupo casos (p < 0,05). Conclusiones. La TB en nuestra serie supuso una alta mortalidad (30,8%) en los enfermos con LES. Las formas extrapulmonares representaron el doble con respecto a la observada en la población general. Los pacientes que recibieron dosis mayores de GC fueron los que presentaron formas más graves de TB. Los datos son similares a los publicados en la mayoría de las series nacionales y extranjeras (AU)

Objectives. 1) To study tuberculosis (TB) infection in a cohort of patients with systemic lupus erythematosus (SLE) and to compare its frequency and characteristics with that of others series. 2) To look for differential characteristic among SLE patients with and without TB. 3) To investigate if there was any relationship between TB's most severe forms and higher doses of glucocorticoids (GC) or other immunosuppressants. Patients and Method Retrospective review of medical records of 789 SLE patients and description of the clinical characteristics of 13 cases of active TB infection among them. Bibliographical search in MEDLINE-PubMed of the SLE/TB series published, using the terms: infection, tuberculosis, systemic lupus erythematosus. Comparative study of clinical, biological and therapeutic differences between cases (SLE/TB+) and controls (SLE/TB) using X2 and Fisher exact test. Results. Thirteen patients with active tuberculosis were detected (10 women, average age 36 years/SD 11,2/prevalence 1,6%). Nine (69,2%) of them were primary infections and 4 (30,8%) reactivations. Microbiological diagnosis (smear examination for acid-fast bacilli and/or culture on Lowestein-Jensen medium) was established in 11 patients (84,6%). TB Pulmonary manifestations was present in 9 patients (69,2%) and extra-pulmonary manifestations were found in 8 [(61,5%); 6 of them (46%) were disseminated forms]. Nine (69,2%) patients were on GC therapy at the moment TB was diagnosed. Four of the TB patients died (30,8%). Myositis was more frequent in TB cases (p < 0,05). This data is similar to that reported in the literature. Conclusions. In our series, TB mortality was high (30,8%) in a patients with SLE. Frequency of extrapulmonary forms was double than that described in the Spanish population. Patients with higher GC dose had more severe forms of TB (AU)

Evaluación de la eficacia del tratamiento con rituximab asociado a ciclofosfamida en pacientes con miopatía inflamatoria idiopática refractaria / Evaluation of the effectiveness of treatment with rituximab associated to cyclophosphamide in patients with resistant idiopathic inflammatory myopathy

Fundamento y objetivo: Comunicamos nuestra experiencia con rituximab más ciclofosfamida en el tratamiento de pacientes con miopatía inflamatoria idiopática refractaria. Pacientes y método: Estudio prospectivo abierto no controlado sobre 17 pacientes.Resultados: Evaluación cumplimentada tras 1, 6 y 12 meses en el 95,2, el 85,7 y el 52,4% de los ciclos, respectivamente. Remisión total o parcial tras 1, 6 y 12 meses en el 65, el 100 y el 63,6% de los ciclos evaluados, respectivamente. Depleción absoluta de linfocitos B en sangre periférica en los 18 casos con datos disponibles, con tendencia a la normalización tras 6 a 12 meses. Hubo 5 recaídas; la mediana de tiempo hasta la recaída fue de 11 meses; hubo repetición del tratamiento en 4 casos. Cuatro pacientes tenían afectación respiratoria; uno (etiología multifactorial) no mejoró, pero sí los otros 3, con neumopatía intersticial aislada o asociada a debilidad muscular respiratoria. Hubo 5 pacientes con anticuerpos anti-Jo-1 positivos (6 ciclos), con respuesta al tratamiento superponible al resto. Se observaron escasos efectos adversos; solo cabe destacar un caso de meningitis por Corynebacterium, con buena evolución.Conclusiones: El rituximab parece una alternativa válida en el tratamiento de pacientes con polimiositis o dermatomiositis resistentes (AU)

Background and objective: We report our experience with rituximab plus cyclophosphamide in the treatment of patients with resistant idiopathic inflammatory myopathies. Patients and method: Open-label uncontrolled prospective sudy on 17 patients.Results: Evaluation was completed after 1, 6 and 12 months in 95’2, 85’7 y 52’4% of cycles, respectively. Total or partial remission was achieved after 1, 6 and 12 months in 65, 100 y 63’6% of evaluated cycles, respectively. Absolute depletion of B lymphocites from peripheral blood was found in the 18 cases with available data. There were 5 relapses; median of time to relapse: 11 months; treatment was repeated in 4. Four patients (6 cycles) had impaired pulmonary function; one (with a multifactorial etiology) did not improve but the other 3, with interstitial pneumonia associated or not with respiratory muscle weakness, did. Five patients with positive anti-Jo-1 antibodies (6 cycles) displayed similar results. The only adverse event observed was a case of meningitis caused by Corynebacterium, with good results. Conclusion: Rituximab seems a valid alternative for the treatment of patients with resistant polymyositis or dermatomyosytis (AU)

[Evaluation of the effectiveness of treatment with rituximab associated to cyclophosphamide in patients with resistant idiopathic inflammatory myopathy]. / Evaluación de la eficacia del tratamiento con rituximab asociado a ciclofosfamida en pacientes con miopatía inflamatoria idiopática refractaria.

BACKGROUND AND OBJECTIVE: We report our experience with rituximab plus cyclophosphamide in the treatment of patients with resistant idiopathic inflammatory myopathies. PATIENTS AND METHOD: Open-label uncontrolled prospective study on 17 patients. RESULTS: Evaluation was completed after 1, 6 and 12 months in 95'2, 85'7 y 52'4% of cycles, respectively. Total or partial remission was achieved after 1, 6 and 12 months in 65, 100 y 63'6% of evaluated cycles, respectively. Absolute depletion of B lymphocites from peripheral blood was found in the 18 cases with available data. There were 5 relapses; median of time to relapse: 11 months; treatment was repeated in 4. Four patients (6 cycles) had impaired pulmonary function; one (with a multifactorial etiology) did not improve but the other 3, with interstitial pneumonia associated or not with respiratory muscle weakness, did. Five patients with positive anti-Jo-1 antibodies (6 cycles) displayed similar results. The only adverse event observed was a case of meningitis caused by Corynebacterium, with good results. CONCLUSION: Rituximab seems a valid alternative for the treatment of patients with resistant polymyositis or dermatomyosytis.

[Tuberculosis in a cohort of patients with systemic lupus erythematosus]. / Tuberculosis en una cohorte de pacientes con lupus eritematoso sistémico.

OBJECTIVES: 1) To study tuberculosis (TB) infection in a cohort of patients with systemic lupus erythematosus (SLE) and to compare its frequency and characteristics with that of others series. 2) To look for differential characteristic among SLE patients with and without TB. 3) To investigate if there was any relationship between TB's most severe forms and higher doses of glucocorticoids (GC) or other immunosuppressants. PATIENTS AND METHOD: Retrospective review of medical records of 789 SLE patients and description of the clinical characteristics of 13 cases of active TB infection among them. Bibliographical search in MEDLINE-PubMed of the SLE/TB series published, using the terms: infection, tuberculosis, systemic lupus erythematosus. Comparative study of clinical, biological and therapeutic differences between cases (SLE/TB+) and controls (SLE/TB) using χ(2) and Fisher exact test. RESULTS: Thirteen patients with active tuberculosis were detected (10 women, average age 36 years/SD 11,2/prevalence 1,6%). Nine (69,2%) of them were primary infections and 4 (30,8%) reactivations. Microbiological diagnosis (smear examination for acid-fast bacilli and/or culture on Lowestein-Jensen medium) was established in 11 patients (84,6%). TB Pulmonary manifestations was present in 9 patients (69,2%) and extra-pulmonary manifestations were found in 8 [(61,5%); 6 of them (46%) were disseminated forms]. Nine (69,2%) patients were on GC therapy at the moment TB was diagnosed. Four of the TB patients died (30,8%). Myositis was more frequent in TB cases (p < 0,05). This data is similar to that reported in the literature. CONCLUSIONS: In our series, TB mortality was high (30,8%) in a patients with SLE. Frequency of extrapulmonary forms was double than that described in the Spanish population. Patients with higher GC dose had more severe forms of TB.