Assessment and personalised advice for fatigue in systemic lupus erythematosus using an innovative digital tool: the Lupus Expert system for the Assessment of Fatigue (LEAF) study.

BACKGROUND: Fatigue is reported as the most prevalent symptom by patients with systemic lupus erythematosus (SLE). Fatigue management is complex due to its multifactorial nature. The aim of the study was to assess the usefulness of an innovative digital tool to manage fatigue in SLE, in a completely automated manner. METHODS: The «Lupus Expert System for Assessment of Fatigue¼ (LEAF) is free digital tool which measures the intensity and characteristics of fatigue and assesses disease activity, pain, insomnia, anxiety, depression, stress, fibromyalgia and physical activity using validated patient-reported instruments. Then, LEAF automatically provides personalised feedback and recommendations to cope with fatigue. RESULTS: Between May and November 2022, 1250 participants with SLE were included (95.2% women, median age 43yo (IQR: 34-51)). Significant fatigue (Functional Assessment of Chronic Illness Therapy-Fatigue <34) was reported by 78.9% of patients. In univariate analysis, SLE participants with fatigue were more likely to be women (p=0.01), perceived their disease as more active (p<0.0001), had higher levels of pain (p<0.0001), anxiety (p<0.0001), depression (p<0.0001), insomnia (p<0.0001), stress (p<0.0001) and were more likely to screen for fibromyalgia (p<0.0001), compared with patients without significant fatigue. In multivariable analysis, parameters independently associated with fatigue were insomnia (p=0.0003), pain (p=0.002), fibromyalgia (p=0.008), self-reported active SLE (p=0.02) and stress (p=0.045). 93.2% of the participants found LEAF helpful and 92.3% would recommend it to another patient with SLE. CONCLUSION: Fatigue is commonly severe in SLE, and associated with insomnia, pain, fibromyalgia and active disease according to patients' perspective. Our study shows the usefulness of an automated digital tool to manage fatigue in SLE.

Polyautoimmunity in Sjögren Syndrome.

Polyautoimmunity is defined as the presence of more than one well-defined autoimmune disease (AD) in a single patient. Polyautoimmunity is a frequent condition in Sjögren syndrome (SS) and follows a grouping pattern. The most frequent ADs observed in SS are autoimmune thyroid disease, rheumatoid arthritis, and systemic lupus erythematosus. Main factors associated with polyautoimmunity in SS are tobacco smoking and some genetic variants. The study of polyautoimmunity provides important clues for elucidating the common mechanisms of autoimmne diseases (ie, the autoimmune tautology).

Septic sacroiliitis in the late postpartum due to Escherichia cóli / Sacroiliitis séptica por Escherichia cóli en el puerperio tardío

Septic sacroiliitis is an unusual condition, and due to its non-specific symptoms, the diagnosis is often delayed. It should be suspected in cases in which inflammatory back pain and systemic inflammatory signs co-exist, especially in people with risk factors, such as postpartum. The case is presented of a woman, who in the late postpartum, presented with sacroiliitis and severe sepsis due to Escherichia coli. This is the second report of a case of septic sacroiliitis due to E. coli associated with pregnancy.

La sacroiliitis séptica es una condición inusual, a menudo el diagnóstico se hace de forma tardía debido a la poca especificidad de los síntomas. Debe ser sospechada en casos donde coexista dolor lumbar inflamatorio y signos de respuesta inflamatoria sistémica, especialmente en personas con factores de riesgo tales como el puerperio. En este artículo reportamos el caso de una mujer quien durante el puerperio tardío presentó sacroiliitis por Escherichia coli y sepsis grave secundaria, siendo este el segundo caso reportado de sacroiliitis séptica por Escherichia coli asociada al embarazo.

Cardiovascular disease in latin american patients with systemic lupus erythematosus: a cross-sectional study and a systematic review.

Objective. This study was performed to determine the prevalence of and associated risk factors for cardiovascular disease (CVD) in Latin American (LA) patients with systemic lupus erythematosus (SLE). Methods. First, a cross-sectional analytical study was conducted in 310 Colombian patients with SLE in whom CVD was assessed. Associated factors were examined by multivariate regression analyses. Second, a systematic review of the literature on CVD in SLE in LA was performed. Results. There were 133 (36.5%) Colombian SLE patients with CVD. Dyslipidemia, smoking, coffee consumption, and pleural effusion were positively associated with CVD. An independent effect of coffee consumption and cigarette on CVD was found regardless of gender and duration of disease. In the systematic review, 60 articles fulfilling the eligibility criteria were included. A wide range of CVD prevalence was found (4%-79.5%). Several studies reported ancestry, genetic factors, and polyautoimmunity as novel risk factors for such a condition. Conclusions. A high rate of CVD is observed in LA patients with SLE. Awareness of the observed risk factors should encourage preventive population strategies for CVD in patients with SLE aimed at facilitating the suppression of cigarette smoking and coffee consumption as well as at the tight control of dyslipidemia and other modifiable risk factors.

Novel risk factors for cardiovascular disease in rheumatoid arthritis.

Since cardiovascular disease (CVD) is the most common cause of mortality in patients with rheumatoid arthritis (RA), we aimed to determine factors associated with such a complication in a large series of Colombian patients. This was a cross-sectional analytical study in which 800 consecutive Colombian patients with RA were assessed for variables associated with CVD. Furthermore, a systematic literature review was performed to address the state of the art about non-traditional risk factors for CVD in RA. The preferred reporting items for systematic reviews and meta-analyses guidelines were followed in data extraction, analysis, and reporting of articles selected. Hypercholesterolemia, type 2 diabetes mellitus, abnormal body mass index, abdominal obesity, and current smoking were all traditional risk factors significantly associated with CVD in Colombians. As non-traditional risk factors, familial autoimmunity, more than 10 years of duration of the disease, patients working on household duties, use of systemic steroids, and low education level were associated with CVD in the studied population. Out of a total of 9,812 articles identified in PubMed and Scopus databases, 140 fulfilled the eligibility criteria and were included. Through this systematic review, several factors and outcomes related to CVD were confirmed and identified. These were categorized into genetics, RA-related, and others. Traditional risk factors do not completely explain the high rates of CVD in patients with RA; thus, novel risk factors related to autoimmunity are now recognized predicting the presence of CVD as strong as traditional risk factors. Our results may assist health professionals and policymakers in making decisions about CVD in patients with RA.

Nefrotoxicidad inducida por medicamentos / Drug-induced nephrotoxicity

La presente revisión incluye la descripción de los diferentes tipos de nefrotoxicidad inducida por medicamentos de acuerdo a su clasificación histopatológica, mecanismo de generación, presentación clínica y medicamentos más frecuentemente implicados. Para esta revisión fue realizada una búsqueda sistemática en el Index Medicus de artículos relacionados publicados a partir de 1999, los cuales fueron seleccionados de acuerdo a su pertinencia. La nefrotoxicidad inducida por medicamentos es un hallazgo de gran importancia clínica, debido a su alta frecuencia y potencial severidad, así como al desconocimiento de medidas preventivas en muchos casos. Las principales alteraciones renales producidas por medicamentos se pueden clasificar histopatológicamente, según la función renal alterada. De este modo, se encuentra la necrosis tubular aguda, la nefritis intersticial, la lesión glomerular y las alteraciones vasculares, que a su vez incluyen la microangiopatía trombótica, la aterosclerosis y la vasculitis. Finalmente, se hace una revisión de algunos medicamentos de uso habitual con alto potencial de nefrotoxicidad, haciendo énfasis en las recomendaciones de uso clínico dirigidas a optimizar la seguridad renal de estos productos...

This review includes a description of the different types of drug-induced nephrotoxicity (DIN) according to histopathologic classification, generation mechanism, clinical presentation and drugs most frequently involved. For this review, a systematic search was conducted in the Index Medicus for articles published since 1999, which were selected according to their relevance. The DIN is a finding of major clinical importance due to their high frequency and potential severity, and the lack of preventive measures in many cases. The main renal impairments caused by drugs can be classifi ed histopathologically according to altered renal function. Thus, there is the acute tubular necrosis, interstitial nephritis, glomerular injury and vascular changes that in turn include thrombotic microangiopathy, atherosclerosis and vasculitis. Finally, some commonly used drugs with high potential for nephrotoxicity are reviewed, with emphasis on recommendations for clinical use to optimize the renal safety of these products...