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1.
Am J Med ; 133(10): 1168-1179.e4, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32278845

RESUMO

BACKGROUND: There is a paucity of data on the outcomes of acute myocardial infarction in patients with rheumatoid arthritis in the contemporary era. METHODS: We queried the National Inpatient Sample database (2002-2016) for hospitalizations with acute myocardial infarction. We described the trends and outcomes of acute myocardial infarction-rheumatoid arthritis compared with acute myocardial infarction-no rheumatoid arthritis. RESULTS: The analysis included 9,359,546 hospitalizations with acute myocardial infarction, of whom 123,783 (1.3%) had rheumatoid arthritis. There was an increase in the number of hospitalizations with acute myocardial infarction-rheumatoid arthritis (Ptrend < .001). There was an observed downtrend in mortality rates for acute myocardial infarction-rheumatoid arthritis (5.8% in 2002 vs 5.2% in 2016, Ptrend = .01) corresponding to an increase in the utilization of percutaneous coronary intervention (Ptrend < .001). In the overall cohort of acute myocardial infarction, rheumatoid arthritis was independently associated with lower rate of in-hospital mortality (adjusted odds ratio 0.90; 95% confidence interval, 0.81-0.99, P = .03). Compared with ST-elevation myocardial infarction (STEMI)-no rheumatoid arthritis, STEMI-rheumatoid arthritis was associated with lower in-hospital mortality and cardiac arrest, while it was associated with higher discharges to nursing facilities. No difference in mortality was observed among non-ST-elevation myocardial infarction (NSTEMI)-rheumatoid arthritis and NSTEMI-no rheumatoid arthritis, while NSTEMI-rheumatoid arthritis was associated with lower cardiac arrest, cardiogenic shock, and hemodialysis, at the expense of higher bleeding events and discharges to nursing facilities. CONCLUSION: In this nationwide analysis, we found an increase in hospitalizations for acute myocardial infarction-rheumatoid arthritis. Among patients with acute myocardial infarction, rheumatoid arthritis was independently associated with lower in-hospital mortality, particularly in cases of STEMI.


Assuntos
Artrite Reumatoide/epidemiologia , Mortalidade Hospitalar/tendências , Infarto do Miocárdio sem Supradesnível do Segmento ST/terapia , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Injúria Renal Aguda/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Circulação Assistida , Transtornos da Coagulação Sanguínea/epidemiologia , Transfusão de Sangue/estatística & dados numéricos , Doença Crônica , Comorbidade , Ponte de Artéria Coronária/estatística & dados numéricos , Ponte de Artéria Coronária/tendências , Feminino , Parada Cardíaca/epidemiologia , Parada Cardíaca/etiologia , Hemorragia/epidemiologia , Hemorragia/terapia , Hospitalização , Humanos , Pneumopatias , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Infarto do Miocárdio/mortalidade , Infarto do Miocárdio/terapia , Infarto do Miocárdio sem Supradesnível do Segmento ST/complicações , Infarto do Miocárdio sem Supradesnível do Segmento ST/mortalidade , Alta do Paciente , Intervenção Coronária Percutânea/estatística & dados numéricos , Intervenção Coronária Percutânea/tendências , Diálise Renal/estatística & dados numéricos , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/terapia , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Infarto do Miocárdio com Supradesnível do Segmento ST/mortalidade , Choque Cardiogênico/epidemiologia , Choque Cardiogênico/etiologia , Instituições de Cuidados Especializados de Enfermagem/estatística & dados numéricos , Estados Unidos/epidemiologia
2.
Patient Prefer Adherence ; 12: 2475-2479, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30538431

RESUMO

Belimumab is a novel add-on therapy that has been approved for patients with active and antibody-mediated systemic lupus erythematosus. It is a monoclonal antibody that decreases the activation of B-cells and consequently decreases antibodies' production. Recently, the US Food and Drug Administration approved subcutaneous belimumab for patients who have received training on using it. Subcutaneous belimumab can be administered using either a prefilled syringe or an auto-injector device. Weekly subcutaneous belimumab seems to be as effective as monthly intravenous belimumab with a similar safety margin. In this article, we reviewed the literature on subcutaneous belimumab focusing on safety and patients' experiences and satisfaction. Overall, subcutaneous belimumab appears to be preferred over intravenous belimumab for a number of reasons. However, more studies are still required to prove these findings.

3.
Hematol Rep ; 9(2): 6992, 2017 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-28626541

RESUMO

Epstein Barr virus (EBV) is well known to cause different types of malignancies. In immunocompromised patients, such as those infected with human immunodeficiency virus (HIV), there is a higher likelihood of EBV related malignant transformation. Diagnosis of EBV related malignancies may be difficult and sometimes requires clinical and pathological correlation. It is very rare to have more than one type of EBV related malignancy in a single patient. Until now, there are no specific guidelines for treatment of EBV related malignancies and lymphoproliferative disorders (LPD). We present a patient who developed three different types of EBV related LPD during a sixteen-year course of HIV infection.

4.
Case Rep Gastrointest Med ; 2016: 1763041, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27042365

RESUMO

Ulcerative colitis (UC) is a chronic inflammatory and recurrent disorder that is characterized by bowel inflammation. Among the extraintestinal manifestations (EIMs) that associate UC are the joints and renal manifestations. Joint affection in the form of arthritis can precede the intestinal manifestations of UC. However, renal affection with amyloidosis does not precede the UC diagnosis. Herein, we report a case of 26-year-old male diagnosed with UC after having peripheral arthritis for long time in addition to spondylitis and kidney amyloidosis.

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