[Hyperhomocystinemia as a thrombotic risk factor in patients suffering from systemic lupus erithematosus and antiphospholipid syndrome]. / Hiperhomocisteinemia como factor de riesgo trombótico en pacientes con lupus eritematoso sistémico y síndrome antifosfolípido.

OBJECTIVES: to detect the prevalence of hyperhcy in SLE patients with and without antiphospholipid syndrom; to compare the Hcy levels between those patients and healthy controls and to determine the correlation between hyperhcy and antiphospholipid antibodies. PATIENTS AND METHODS: we studied 44 SLE patients: 17 had antiphospholipid syndrom and 27 didn't have it, and we compared them to 24 healthy controls. All of them where checked clinically and with laboratory tests like anticardiolypin antibodies, lupus anticoagulant and Hcy. Hcy > 9 was considered abnormal. Patient who had hyperhcy were treated with folic acid+vitB6+vitB12 a month along. STATISTICAL ANALYSIS: cualytative variables: chi square or Fischer's; cuantitative variables: Student's T test or Mann-Whitney's test. RESULTS AND CONCLUSIONS: there were 35 trombotic manifestations in 44 patients. Hyperhcy was present in 27 SLE patients (61,4%), 12 of them had antiphospholipid syndrom. Hcy concentrations patients vs.controls was statisticaly different (p= 0,002). There was also stastisticaly different the hcy concentration from SLE patients with SAF vs controls (p=0,003) and without SAF vs controls (p= 0,015). From 33 SLE patients, 20 (33%) were aCL(+). 15(75%) of them had hiperhcy.

[Hyperhomocysteine like thrombocytic risk factor in patient with systemic lupus erythematous with antiphospholipid syndrome]. / Hiperhomocisteinemia como factor de riesgo trombótico en pacientes con lupus eritematoso sistémico y síndrome antifosfolípido.

OBJECTIVES: to detect the prevalence of hyperhcy in SLE patients with and without antiphospholipid syndrom; to compare the Hcy levels between those patients and healthy controls and to determine the correlation between hyperhcy and antiphospholipid antibodies. PATIENTS AND METHODS: we studied 44 SLE patients: 17 had antiphospholipid syndrom and 27 didn't have it, and we compared them to 24 healthy controls. All of them where checked clinically and with laboratory tests like anticardiolypin antibodies, lupus anticoagulant and Hcy. Hcy > 9 was considered abnormal. Patient who had hyperhcy were treated with folic acid+vitB6+vitB12 a month along. STATISTICAL ANALYSIS: cualytative variables: chi square or Fischer's; cuantitative variables: Student's T test or Mann-Whitney's test. RESULTS AND CONCLUSIONS: there were 35 trombotic manifestations in 44 patients. Hyperhcy was present in 27 SLE patients (61,4%), 12 of them had antiphospholipid syndrom. Hcy concentrations patients vs.controls was statisticaly different (p=0,002). There was also stastisticaly different the hcy concentration from SLE patients with SAF vs controls (p=0,003) and without SAF vs controls (p= 0,015). From 33 SLE patients, 20 (33%) were aCL(+). 15(75%) of them had hiperhcy.

[Semester direct cost by rheumatoid arthritis in patients in a university hospital]. / Costo directo semestral por artritis reumatoidea en pacientes que concurren a un hospital universitario.

INTRODUCTION: There are no medical publications with economic analysis of rheumatoid arthritis patients (RA) from Argentina are lacking. The objective of the present study is to determine the direct cost and its breakdown in patients with RA. MATERIAL AND METHODS: Fifty-two patients who met the American College of Rheumatology RA criteria were included. Direct cost was calculated over a follow-up period of 6 months during year 2001. Variables were analyzed with Student's T test, Mann-Whitney U Test, c' or ANOVA as corresponded. P values < 0.05 were considered significant. RESULTS: The mean monthly home income was $426.6 SD 272. The mean half-yearly direct costs was $677.5 SD 376.2. The components of the direct cost were identified and the mean for medication cost was $606.7 (89%), for lab tests was $45.5 (7%), for medical attention $12.5 (2%) and other costs $2.4. No differences in total cost or in medication cost were found when compared considering age, evolution time of RA or HAQ scores. CONCLUSION: Half-yearly direct cost in RA is excessively high considering the monthly mean income of the patients being analyzed. The cost of medication was the principal component of the direct cost.

Lupus eritematoso sistémico: datos sociodemográficos y su correlación clínico-analítica en un hospital universitario / Systemic Lupus Erythemathosus: sociodemographic data and clinical correlation at an university hospital

Objetivos: Analizar las características sociodemográficas y clínicas de los pacientes con Lupus Eritematoso Sistémico (LES) del Servicio de Reumatología de un Hospital Universitario de Córdoba. Pacientes y métodos: Estudio retrospectivo, descriptivo y analítico de 303 pacientes adultos con LES asistidos entre 1987-2017, que cumplían con los criterios ACR1982. Se registraron datos sociodemográficos, clínicos, de laboratorio, internaciones, óbitos y los tratamientos. Los datos fueron analizados con Excel, Infostat y SPSS 11.5 para Windows. Resultados: El 92% eran mujeres, 44% de ellas y 61% de los hombres eran mestizos. La edad promedio al diagnóstico fue de 32 años y el tiempo medio de evolución de la enfermedad de 11 años. Un tercio terminó la escuela primaria y la mayoría pertenecía al nivel socieconómico medio. Las manifestaciones del aparato locomotor y dermatológicas fueron las más frecuentes como presentación y evolución de la enfermedad. El 60% mostró compromiso renal, siendo la glomerulonefritis tipo 4 el hallazgo histopatológico prevalente. Las causas de óbito fueron septicemia y hemorragia alveolar principalmente, asociados a SLICC más alto, anti-DNA (+), leucopenia, nivel socioeconómico medio y bajo y raza mestiza como marcadores de mal pronóstico. Conclusiones: En esta serie predominaron sexo femenino, raza mestiza, nivel socioeconómico medio y nivel de instrucción primario. Los síntomas de presentación fueron osteoarticulares y dérmicos. Las causas de muerte fueron infecciones o hemorragia alveolar. Fueron factores de mal pronóstico: anti-DNA, leucopenia, etnia mestiza y bajo nivel socioeconómico

Objective: to analyze demographic and clinical characteristics in SLE patients from a university hospital in Córdoba. Patients and Methods: We analyzed retrospectively 303 adult SLE patients assisted between 1987 and 2017 who met ACR1982 SLE criteria. Demographic, clinical and laboratory data and causes of death, hospitalization and treatments were analyzed with excel, infostat and SPSS for Windows. Results: 92% were women (race: women 44% mestizo; men 61% mestizo; mean age at diagnosis: 32 years, mean time of evolution 11 years). 1/3 of them finished primary school and most of them had medium socioeconomic status. Musculoskeletal and skin involvement was most frequent as presentation symptom and during the evolution of disease. 60% had renal involvement being type 4 glomerulonephritis the most prevalent histopathological finding. Causes of death were septicemia and alveolar hemorrhage, associated with higher SLICC, anti-DNA (+), leucopenia, low socioeconomic status and mestizo race as markers of poor prognosis. Conclusion: Female gender, mestizo race, medium socioeconomic status and primary level of education predominated in this series. Presentation symptoms were musculoskeletal and skin involvement. Causes of death were infections or alveolar hemorrhage. Anti-DNA (+), leucopenia, low socioeconomic status and mestizo race were markers of poor prognosis

[Function of flow cytometry on the dosage of antibodies against double stranded DNA in systemic lupus erythematosus]. / Función de la citometría de flujo en el dosaje de anticuerpos anti-DNA de doble cadena en el lupus eritematoso sistémico.

BACKGROUND: Among the diverse number of antibodies observed in systemic lupus erythematosus, antibodies against double stranded DNA (anti-dsDNA) represent important serologic markers for the disease diagnosis and the follow-up of the disease activity. OBJECTIVE: To evaluate the role of a new quantitative methodology to detect antibodies against double stranded DNA in systemic lupus erythematosus and its association with the disease activity. MATERIAL AND METHODS: The performance of the indirect immunofluorescence flow cytometry with Crithidia luciliae as substrate was compared with the Crithidia luciliae indirect immunofluorescence assay and the ELISA technique in order to detect antibodies against double stranded DNA in 54 sera from 47 patient with systemic lupus erythematosus and 100 sera from normal controls. RESULTS: The new method showed a sensitivity of 78% and a specificity of 81% when the Crithidia luciliae indirect immunofluorescence assay was the gold standard. Compared with the ELISA technique, the flow cytometry showed a sensitivity of 78% and a specificity of 86%. No correlation was found among antibodies against double stranded DNA values detected with flow cytometry and the MEX-SLEDAI activity scores. However, the flow cytometry showed a sensitivity of 70% and a specificity of 42% to distinguish patients with systemic lupus erythematosus with and without activity (MEX-SLEDAI score > or = 5). The Rho intra-observer coefficient was 0.61 (p < 0.0001). CONCLUSIONS: In spite of the fact that this new method might represent an interesting advance for antibodies against double stranded DNA quantitative testing, a clear superiority does not emerge when it was compared with more traditional assays. Difficulties related with its reproducibility might represent a limitation in the routine use of this new method.

Occurrence of antineutrophil cytoplasmic and perinuclear antibodies (cANCA and pANCA in patients with diffuse connective tissue disease (DCTD) / Ocorrência de anticorpos antineutrófilos citoplasmáticos (cANCA) e perinucleares (pANCA) em pacientes com doença difusa do tecido conjuntivo (DDTC)

Com o objetivo de avaliar a ocorrência de anticorpos antineutrófilos citoplasmáticos (cANCA) e anticorpos antineutrófilos perinucleares (pANCA), foram estudadas amostras de soro de 100 pacientes com doenças do tecido conjuntivo (DDTC) sendo 38 com lúpus eritematoso sistêmico (LES), 23 com artrite reumatóide (AR), 13 com doença mista do tecido conjuntivo (DMTC), 12 com esclerose sistêmica (PSS), 1 com arterite de takayasu (AT), 2 com poliarterite nodosa (PAN), 2 com granulomatose de Wegener (GN), 2 com CREST, 2 com síndrome de Sjögren (SS), 3 com vasculite leucocitoclástica (VL), 1 com eritema nodoso (EN), 1 com polimiosite (PM) e 25 voluntários normais. O cANCA e pANCA foram identificados por imunofluorescência indireta (IFI), de acordo com as normas do International First Workshop of ANCA (1983) com amostras diluídas em 1:20 no soro e neutrófilos fixados com etanol absoluto. Foi detectado o cANCA em 6 pacientes. Obtiveram-se títulos elevados de cANCA (>1/320) em GW (n=2) e títulos baixos (de 1/40 a 1/320) em AR (n=1), PAN (n=1), ESP (n=1) e LV (N=1). Observou-se pANCA em 29 pacientes: TA (n=1), SLE (n=19), RA (n=2), PSS (n=1) e MCTD (n=6). Os dados mostram frequência elevada de cANCA em GW, apesar de o pequeno número de casos impossibilitar determinar a sensibilidade e especificidade diagnóstica

Costo directo semestral por artritis reumatoidea en pacientes que concurren a un hospital universitario / Semester direct cost by rheumatoid arthritis in patients in a university hospital

INTRODUCTION: There are no medical publications with economic analysis of rheumatoid arthritis patients (RA) from Argentina are lacking. The objective of the present study is to determine the direct cost and its breakdown in patients with RA. MATERIAL AND METHODS: Fifty-two patients who met the American College of Rheumatology RA criteria were included. Direct cost was calculated over a follow-up period of 6 months during year 2001. Variables were analyzed with Student's T test, Mann-Whitney U Test, c' or ANOVA as corresponded. P values < 0.05 were considered significant. RESULTS: The mean monthly home income was $426.6 SD 272. The mean half-yearly direct costs was $677.5 SD 376.2. The components of the direct cost were identified and the mean for medication cost was $606.7 (89 per cent), for lab tests was $45.5 (7 per cent), for medical attention $12.5 (2 per cent) and other costs $2.4. No differences in total cost or in medication cost were found when compared considering age, evolution time of RA or HAQ scores. CONCLUSION: Half-yearly direct cost in RA is excessively high considering the monthly mean income of the patients being analyzed. The cost of medication was the principal component of the direct cost.