RESUMO
Objetivos: Estimar el efecto de los antimaláricos (AM) sobre los diferentes dominios del índice de daño SLICC (SDI). Métodos: Se estudiaron pacientes con diagnóstico clínico reciente (≤2 años) de lupus eritematoso sistémico (LES) de la cohorte GLADEL. Variable de estudio: aumento en los dominios del SDI desde el ingreso a la cohorte. Variables independientes: características sociodemográficas, clínicas, laboratorio y tratamientos. El efecto de los AM, como variable dependiente del tiempo, sobre los dominios más frecuentes del SDI (ajustado por factores de confusión) fue examinado con un modelo de regresión de Cox multivariado. Resultados: De 1466 pacientes estudiados, 1049 (72%) recibieron AM con un tiempo medio de exposición de 30 meses (Q1-Q3: 11-57) y 665 pacientes (45%) presentaron daño durante un seguimiento medio de 24 meses (Q1-Q3: 8-55); 301 eventos fueron cutáneos, 208 renales, 149 neuropsiquiátricos, 98 musculoesqueléticos, 88 cardiovasculares y 230 otros. Después de ajustar por factores de confusión, el uso de AM se asoció a un menor riesgo de daño renal (HR 0,652; IC 95%: 0,472-0,901) y en el límite de la significancia estadística (HR 0,701, IC 95%: 0,481-1,024) para el dominio neuropsiquiátrico. Conclusión: En GLADEL, el uso de AM se asoció independientemente a un menor riesgo de daño acumulado renal.
Objective: To assess the effects of antimalarials (AM) over the items of the SLICC Damage Index (SDI). Methods: Patients with recent (≤2 years) diagnosis of systemic lupus erythematosus (SLE) from the GLADEL cohort were studied. End-point: increase in items SDI since cohort entry. Independent variables (socio-demographic, clinical, laboratory and treatment) were included. The effect of AM as a time dependent variable on most frequent SDI items (adjusting for potential confounders) was examined with a multivariable Cox regression model. Results: Of the 1466 patients included in this analysis, 1049 (72%) received AM with a median exposure time of 30 months (Q1-Q3: 11-57). Damage occurred in 665 (45%) patients during a median follow-up time of 24 months (Q1-Q3: 8-55). There were 301 integument, 208 renal, 149 neuropsychiatric, 98 musculoskeletal, 88 cardiovascular and 230 others less frequently represented damages. After adjusting for potential confounders at any time during follow-up, a lower risk of renal damage (HR 0.652; 95% CI: 0.472-0.901) and borderline for neuropsychiatric damage (HR 0.701, 95% CI: 0.481-1.024) was found. Conclusion: In the GLADEL cohort, after adjustment for possible confounding factors, AM were independently associated with a reduced risk of renal damage accrual.
Assuntos
Lúpus Eritematoso Sistêmico , AntimaláricosRESUMO
BACKGROUND AND OBJECTIVE: The purpose of this study was to describe the clinical and epidemiological features of anaphylactic reactions to hymenoptera stings, with a case-history analysis according to severity. PATIENTS AND METHOD: We conducted an observational descriptive study of patients aged between 10 and 80 years who suffered a systemic reaction after hymenoptera sting. All of them showed specific serum IgE to venoms from Apis, Vespula and/or Polistes. A questionnaire including history of atopy, past reactions and characteristics of the reaction, was performed by individual interview. Anaphylactic reactions were classified into two levels of severity according to Müller's classification. An analysis of independence was carried out in order to relate each level with several factors: age, gender, atopy, type of previous reactions, area of sting and time sequence. RESULTS: 113 patients were included (63 male; mean age [standard deviation]: 40.1 [15.9] years). Reactions were accounted for bee venom in 10.6% of patients, and wasp in 89.4%. Specific IgE was positive to Vespula in 91.9% of subjects, Polistes in 71.4%, and Apis in 28.7%. Furthermore, 50.4% were sensitive to both Vespula and Polistes. Personal history of atopy was found in 20.3%. Among the 106 patients who reminded previous stings, local large reactions were referred by 35.9% and systemic reactions by 16.5%. Upper limb was the most frequent area of sting (38.9%). Most common symptoms were: pruritus (77.8%), hives (57.5%), edema (54.8%), erythema (52.2%), dizziness (51.3%) and dyspnea (49.5%). Severe reactions occurred in 65.5% of patients. Age, gender, atopy, type of previous reactions, area of sting and restoration time were not significantly associated with severity. Time elapsed to first symptom was proportionally shorter in severe cases (p < 0.05). CONCLUSIONS: There is a high frequency of hypersensitivity to wasp venom (Vespula) in the studied population. Except for immediacy, severity-associated data could not be established.