A longitudinal multiethnic study of biomarkers in systemic lupus erythematosus: Launching the GLADEL 2.0 Study Group.

Introduction: After more than 20 years of sustained work, the Latin American Group for the Study of Lupus (GLADEL) has made a significant number of contributions to the field of lupus, not only in the differential role that race/ethnicity plays in its course and outcome but also in several other studies including the beneficial effects of using antimalarials in lupus patients and the development of consensus guidelines for the treatment of lupus in our region. Methods: A new generation of "Lupus Investigators" in more than 40 centers throughout Latin America has been constituted in order to continue the legacy of the investigators of the original cohort and to launch a novel study of serum and urinary biomarkers in patients with systemic lupus erythematosus. Results: So far, we have recruited 807 patients and 631 controls from 42 Latin-American centers including 339 patients with SLE without renal involvement, 202 patients with SLE with prevalent but inactive renal disease, 176 patients with prevalent and active renal disease and 90 patients with incident lupus nephritis. Conclusions: The different methodological aspects of the GLADEL 2.0 cohort are discussed in this manuscript, including the challenges and difficulties of conducting such an ambitious project.

Reliability of OMERACT ultrasound elementary lesions in gout: results from a multicenter exercise.

The aim of this study was to evaluate the reliability of the outcome measures in rheumatology (OMERACT) definitions for ultrasound (US) elementary lesions in gout through an image reading exercise. Images from patients with gout (static images and videos) were collected. As an initial step, we carried out a image reading exercise within the experts of the Pan-American League of Associations for Rheumatology (PANLAR) US Study Group (n = 16). The following step consisted in a web-based exercise with the participation of larger number of sonographers (n = 63) from different centers. Images were rated evaluating the presence/absence of any US elementary lesion. Inter- and intra-reader reliabilities were analyzed using kappa coefficients. Participants were stratified according to their level of experience. In the first exercise, inter-reader kappa values were 0.45 for aggregates, 0.57 for tophus, 0.69 for erosions, and 0.90 for double contour (DC). Intra-reader kappa values were 0.86, 0.76, 0.80, and 0.90, respectively. The web-based exercise showed inter-reader kappa values for aggregates, tophus, erosions, and DC of 0.42, 0.49, 0.69, and 0.79, respectively. The intra-reader kappa values were 0.62, 0.69, 0.77, and 0.85, respectively. Reliability was not influenced by the sonographer's level of experience. The reliability of the new OMERACT US definitions for elementary lesions in gout ranged from moderate to excellent, depending on the type of lesion.

Factors associated with health-related quality of life in Peruvian patients with systemic lupus erythematosus.

Objective In this paper, we aim to define factors associated with health-related quality of life (HRQoL) in Mestizo patients with systemic lupus erythematosus (SLE). Methods We evaluated patients with SLE from Peru's two largest hospitals between October 2012 and July 2015 to ascertain HRQoL. Using a standard protocol, we incorporated demographic characteristics, clinical manifestations and treatment in our analysis. HRQoL was measured with the LupusQoL, disease activity was ascertained with the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), and damage was appraised with the Systemic Lupus International Collaborating Clinics (SLICC)/American College of Rheumatology (ACR) damage index (SDI). The associations between the LupusQoL and these variables were examined using linear regression models. Model selection was based on backward elimination. Results A total of 277 patients fit the inclusion criterion. Of these, 254 (91.7%) were female, the median (interquartile range, IQR) age at diagnosis was 41.5 (33.8-51.8) years, disease duration was 6.5 (2.7-11.3) years. The HRQoL domains most affected were the following: burden to others, fatigue, and intimate relationships. Through multivariate analysis, we determined that older age at diagnosis, higher disease activity, damage, and immunosuppressive drug use were negatively associated with HRQoL. Further, we found that higher socioeconomic status, disease duration, and antimalarial use were positively associated with HRQoL. Conclusion Age at diagnosis, disease activity, damage, and use of immunosuppressive drugs were negatively associated with HRQoL; high socioeconomic status, disease duration, and use of antimalarials were positively associated with HRQoL.

Intervencionismo guiado por ecografía en reumatología / Ultrasound-guided intervention in rheumatology

Las aspiraciones e infiltraciones son procedimientos muy comunes en reumatología. La eficacia de ambos procedimientos depende de la posición correcta de la aguja dentro o alrededor del blanco elegido. Las intervenciones a ciegas con alta frecuencia son fallidas. La ultrasonografía (US) ha demostrado ser más eficaz y más segura como guía de procedimientos porque evita la lesión de estructuras nerviosas, tendinosas, óseas, etc., al facilitar observar la aguja hasta llegar al blanco. Dirigir una aguja por US hace que el procedimiento sea inocuo, de menor costo que la fluoroscopia o tomografía, con la posibilidad de acudir hasta la cama del paciente con los equipos portátiles. La terapia para infiltraciones no se reduce a los esteroides: actualmente se administra proloterapia, plasma rico en plaquetas, entre otros, para lesiones tendinosas con resultados alentadores. Otra de las ventajas del intervencionismo guiado por US es la realización de biopsias para el diagnóstico certero. En este artículo se hace una revisión de la técnica de infiltración de las diferentes regiones articulares y las ventajas que ofrece la US.

The aspirations and injections are common procedures in rheumatology. The efficacy of both procedures depends on the position of the needle within or around the chosen target. Blind interventions with high frequency are unsuccessful. Ultrasonography (U.S.) has proved more effective and safer procedures as a guide because in prevents injury to neural structures, tendon, bone, etc., to facilitate observing the needle to reach the target. U.S. direct needle makes the procedure is safe, lower cost than fluoroscopy or CT, with the possibility of going to the bedside with portable equipment. Therapy for infiltration is not limited to steroids, is currently given prolotherapy, platelet rich plasma for tendon injuries and others with encouraging results. Another advantage of U.S. interventionism is guided biopsies for diagnosis. In this article we review the technique of infiltration from the different regions and joint benefits of the U.S.