Asymptomatic coronary artery disease assessed by coronary computed tomography in patients with systemic lupus erythematosus: A systematic review and meta-analysis.

BACKGROUND: Coronary artery disease (CAD) assessed by coronary computed tomography (CT) in patients with systemic lupus erythematosus (SLE) has been investigated in several studies, but with conflicting results. The aim of this systematic review and meta-analysis of the literature was synthesize the evidence on this topic. METHODS: The relevant literature was identified and evaluated from inception until January 2021 in PubMed, Embase, Web of Science and Cochrane library. Studies reporting coronary artery calcification (CAC), and its prevalence and extent using the coronary calcium score (CCS) were included. Data extracted from eligible studies were used to calculate effect estimates (ESs) and 95% confidence intervals (95%CI) and weighted mean differences (WMD) with 95%CI. RESULTS: Twenty-four studies were eligible for inclusion. For the CAC prevalence, 11 studies were included (918 SLE patients and 3952 controls) and the pooled prevalence for the random effect was 29.8% (95%CI 25.7-32.9%) for SLE patients and 11.8% (95%CI 16.2-20.4%) in controls (RR 2.22, 95%CI 1.42 to 3.48; p= 0.0005) and no significant increase in the WMD for CCS (MD= 0.32, 95%CI -5.55 to 6.20, p= 0.91) compared with controls in seven studies. Greater organ damage and glucocorticoid use has been associated with a higher CCS. According to two studies, the coronary CT angiography calcified and non-calcified plaque burden were increased in SLE patients compared with controls. CONCLUSIONS: In SLE, asymptomatic CAD by CAC is more prevalent and there is more multivessel disease compared with controls without lupus. However, the extent of CAC was not increased in SLE patients. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42021228710.

Changing trends in rheumatoid arthritis mortality in Mexico, from 1998 to 2017.

The aim was to analyze the distribution and trends of deaths reported for rheumatoid arthritis (RA) in Mexico in 1998-2017. We carried out a cross-sectional study. Data were obtained from Dynamic Cubes, General Direction of Health Information, on deaths related to RA in Mexico. Seropositive RA was diagnosed using the International Classification of Diseases version 10. Variables were categorized by diagnosis, age, and gender. Time trends of age-standardized mortality rates (ASMRs) were analyzed for RA, and the annual percent change (APC) was estimated using Joinpoint trend analysis. We found 714 deaths mentioned as RA and 9,749,956 non-RA deaths between 1998 and 2017. Overall RA mortality decreased from 0.14 in 2004 to 0.04 per 100 000 in 2017 (APC: - 10.3%; 95% CI - 16.5%, - 3.3%), while the non-RA ASMR remained stable. In females, there was an initial increase of 27.3% per year through 1998-2004 and a reduction of - 11.7% per year subsequently, while in males, the APC remained stable between 1998 and 2017. The trend for RA mortality resulted in a cumulative change in the ratio of RA ASMR to non-RA ASMR of - 20.6% in females and + 3.2% in males. Although mortality attributable to RA increased from 1998 to 2004 in Mexico, it began to improve after 2004, particularly in females. Prospective, population-based data could help to identify risk factors that could be altered to improve outcomes.