Transverse Myelitis in Systemic Lupus Erythematosus: Clinical Features and Prognostic Factors in a Large Cohort of Latin American Patients.

BACKGROUND: Acute transverse myelitis (ATM) is an infrequent but severe complication of systemic lupus erythematosus (SLE). The purpose of study was to describe clinical features and prognostic factors of patients with SLE-related ATM. METHODS: In this medical records review study, data were collected from 60 patients from 16 centers seen between 1996 and 2017 who met diagnostic criteria for SLE and myelitis as defined by the American College of Rheumatology/Systemic International Collaborating Clinics and the Working Group of the Transverse Myelitis Consortium, respectively. Objective neurological impairment was measured with American Spinal Injury Association Impairment Scale (AIS) and European Database for Multiple Sclerosis Grade Scale (EGS). RESULTS: Among patients included, 95% (n = 57) were female, and the average age was 31.6 ± 9.6 years. Myelitis developed after diagnosis of SLE in 60% (n = 36). Symmetrical paraparesis with hypoesthesia, flaccidity, sphincter dysfunction, AIS = A/B, and EGS ≥ 8 was the most common presentation. Intravenous methylprednisolone was used in 95% (n = 57), and 78.3% (n = 47) received intravenous cyclophosphamide. Sensory/motor recovery at 6 months was observed in 75% (42 of 56), but only in 16.1% (9 of 56) was complete. Hypoglycorrhachia and EGS ≥ 7 in the nadir were associated with an unfavorable neurological outcome at 6 months (p < 0.05). A relapse rate during follow-up was observed in 30.4% (17 of 56). Hypoglycorrhachia and hypocomplementemia seem to be protective factors for relapse. Intravenous cyclophosphamide was associated with time delay to relapse. CONCLUSIONS: Systemic lupus erythematosus-related ATM may occur at any time of SLE course, leading to significant disability despite treatment. Relapses are infrequent and intravenous cyclophosphamide seems to delay it. Hypoglycorrhachia, hypocomplementemia, and EGS at nadir are the most important prognostic factors.

Association between leptin and IL-6 concentrations with cardiovascular risk in patients with rheumatoid arthritis.

Pro-inflammatory cytokines such as leptin and IL-6 play an important role in the development of cardiovascular risk. Determine the relationship between leptin and IL-6 concentrations with cardiovascular risk in patients with rheumatoid arthritis. We determined IL-6 and leptin levels in 77 patients with the diagnosis of rheumatoid arthritis. The cardiovascular risk was calculated using the modified Framingham scale. Statistical analysis was performed using SPSS 22 considering a significant p < 0.05. Serum leptin concentrations and cardiovascular risk (CVR) factors were compared and found that there was a significant difference between higher leptin values and disease activity (p 0.047), obesity (p 0.038), positive rheumatoid factor (p 0.009), tobacco (p 0.009), and metabolic syndrome (p 0.001). Likewise, a significant relationship was found between lower leptin concentrations and hydroxychloroquine consumption (p = 0.023). We found significant difference between IL-6 concentrations and disease activity (p 0.028), hypertriglyceridemia (p 0.023), LDL-C (p 0.029), and smoking (0.005). Similarly, an association between hydroxychloroquine consumption and low concentrations of IL-6 was found (p 0.005). Framingham CVR was calculated and the result obtained was multiplied by 1.5. The 35.2% of the population studied had a low Framingham CVR, 38.9% moderate, and 25.9% presented a high risk. We compared the level of CVR and serum leptin and IL-6 concentrations, finding that the highest CVR was the leptin and IL-6 values. There is a positive association between CVR and serum leptin concentrations. It is also significantly associated with traditional and non-traditional risk factors.

Relationship between leptin concentrations and disease activity in patients with rheumatoid arthritis. / Relación entre las concentraciones de la leptina y la actividad de la enfermedad en pacientes con artritis reumatoide.

BACKGROUND AND OBJECTIVE: Multiple studies have found a direct relationship between leptin concentrations and disease activity in rheumatoid arthritis. PATIENTS AND METHODS: We studied 77 patients with the diagnosis of rheumatoid arthritis; the leptin determination was through an enzyme immunoassay. Disease activity was assessed by the DAS-28 CRP. A multivariate logistic regression model was used to determine the association between significant variables and leptin concentrations. RESULTS: 40.3% of the patients were in remission, 41.6% were mildly active, 11.7% were moderately active and 6.5% were severely active. The results show an independent association between higher concentrations of leptin and disease activity (OR 1.7; 95% CI 1.4-3.2; p .03), the number of swollen joints (OR 4.6; 95% CI 1.7-8.3; p .000), the number of painful joints (OR 3.4; 95% CI 1.6-4.6; p .000), and the presence of metabolic syndrome (OR 1.3; 95% IC 1.2-1,9; p .045). CONCLUSION: The data suggest that serum leptin is elevated in patients with active RA.

[Dyslipidemia and atherogenic risk in patients with rheumatoid arthritis]. / Dislipidemia y riesgo aterogénico en pacientes con artritis reumatoide.

INTRODUCTION: Dyslipidaemia is one of the main risk factors for atherosclerotic cardiovascular disease. Patients with rheumatoid arthritis have 2-3 times more cardiovascular risk, which is partly due to the pattern of lipids which increase the atherogenic index. METHODS: A descriptive, cross-sectional, observational and prospective study was conducted on 82 patients, selected for their lipid profile. Variables associated with the disease and the drugs used were recorded. Atherogenic risk was calculated, with Chi square being used for categorical variables, and the Mann-Whitney test for the continuous ones. RESULTS: The dyslipidaemia frequency was 54.9%. The most frequent age range of dyslipidaemia was between 51 and 60 years. Patients with type i obesity had a higher frequency of dyslipidaemia. Less dyslipidaemia was found with a lower rate of disease activity. Patients with cyclic citrullinated anti-peptide antibodies and positive rheumatoid factor, erythrocyte sedimentation rate>13mm or CRP>2mg/L had a higher frequency of dyslipidaemia. The mean Castelli atherogenic index was 4.36, the index of Kannel was 2.59, and triglycerides/HDL-c ratio was 3.83.Patients with dyslipidaemia showed a higher frequency of positive rheumatoid factor (P=.0008), and those patients who were taking hydroxychloroquine had a lower frequency of dyslipidaemia P=.03. CONCLUSIONS: Patients with rheumatoid arthritis have a pro-atherogenic lipid profile. It is important to know this and treat it to reduce cardiovascular risk.

[Dyslipidaemia and atherogenic risk in patients with systemic lupus erythematosus]. / Dislipidemia y riesgo aterogénico en pacientes con lupus eritematoso sistémico.

INTRODUCTION: Dyslipidaemia is a common comorbidity in patients with systemic lupus erythematosus. PATIENTS AND METHODS: Fifty-one patients were included. Variables associated with the disease and the drugs used were recorded. Atherogenic risk was calculated. Chi square was used for categorical variables. ANOVA was performed and a logistic regression model to determine the association of the variables with the presence of dyslipidaemia. RESULTS: A percentage of 68.6 had dyslipidaemia. A significant difference between the presence of dyslipidaemia and activity index measured by SLEDAI was found, the presence of lupus nephritis, use of prednisone≥20mg/day, evolution of the disease<3 years. Significance between the absence of dyslipidaemia and use of hydroxychloroquine was found. SLEDAI≥4 and the use of prednisone≥20mg/day were independently associated with the presence of dyslipidaemia. The average of Castelli rate was 5.02, the Kannel index was 2.97 and triglyceride/HDL-C ratio was 5.24. CONCLUSIONS: Patients with systemic lupus erythematosus have a high prevalence of dyslipidaemia and a high atherogenic rate, which increases cardiovascular risk significantly.

Riesgo cardiovascular en lupus eritematoso sistémico / Cardiovascular risk in systemic lupus erythematosus

Antecedentes: Los pacientes con lupus eritematoso sistémico (LES) tienen mayor frecuencia de factores de riesgo cardiovascular (RCV) tradicionales, esto sumado a la presencia de factores de RCV no tradicionales, aumenta la probabilidad de eventos cardiacos hasta 5 veces. Objetivo: Determinar la frecuencia de los factores de RCV en una población de pacientes con LES. Materiales y métodos: Se realizó un estudio descriptivo, transversal, observacional, en 51 pacientes con diagnóstico de LES. Resultados: Se reportó el patrón lúpico de dislipoproteinemia ya que el 52,9% presentó hipoal-falipoproteinemia, 49% hipercolesterolemia, 35,3% hipertrigliceridemia y 19,6% elevación de c-LDL. Con respecto a las comorbilidades el 31,4% presentó obesidad, 27,5% hipertensión arterial y 6% diabetes mellitus. Los factores de RCV no tradicionales que predominaron fueron los asociados con la actividad de la enfermedad, el 90,1% tomaba glucocorticoides, 70,6% presentó niveles bajos de C3, 66,7% tuvo PCR > 2 mg/l, 56,9% tenía más de 4 puntos de SLEDAI-2 K, 41,2% presentó niveles bajos de C4, 29,4% tenía más de 10 arios de duración de la enfermedad, 25,5% tenía nefritis lúpica. Con lo que respecta a la presencia de anticuerpos asociados a RCV el 58,8, 9,8, 74,8 y el 3,9% presentaron anti-Smith, anticoagulante lúpico, anti-beta 2 glicoproteína I, anticardiolipinas positivas, respectivamente. Conclusiones: Los pacientes con LES presentan un estado proinflamatorio y aterogénico, aumentando el riesgo de desarrollar enfermedades cardiovasculares tanto por mayor incidencia de los factores de riesgo tradicionales, como por la presencia de factores que promueven una inflamación crónica.

Background: Patients with systemic lupus erythematosus (SLE) have a higher frequency of traditional cardiovascular risk factors (CVR). This, combined with the presence of nontraditional cardiovascular risk factors, increases the probability of cardiac events by five times. Objective: To determine the prevalence of CVR factors in a population of patients with SLE. Material and methods: A descriptive, cross-sectional, observational study in 51 patients with the diagnosis of SLE. Results: A lupus dyslipoproteinaemia pattern was reported, of which 52.9% had hypo-alphalipoproteinaemia, 49% hypercholesterolaemia, 35.3% hypertriglyceridaemia, and 19.6% with an elevated c-LDL. The comorbidities found were, 31.4% with obesity, 27.5% with high blood pressure, and 6% suffered from diabetes mellitus. Predominant non-traditional CVR factors were associated with disease activity, with 90.1% taking glucocorticoids, 70.6% had low levels of complement C3, 41.2% had low levels of complement C4, 66.7% had a CRP > 2 mg/l, 56.9% had a SLEDAI-2 K score greater than 4 points, 29.4% had more than 10 years of disease duration, and 25.5% had lupus nephritis. As regards the presence of antibodies associated with CVR, 58.8, 9.8, 74.8 and 3.9% had anti-Smith antibodies, lupus anticoagulant, antibeta2glycoprotein I, and positive anticardiolipin, respectively. Conclusions: Patients with SLE have a pro-inflammatory and atherogenic state, increasing the risk of developing cardiovascular diseases, and therefore a higher incidence of traditional risk factors, such as the presence of factors that promote chronic inflammation.

Neurolupus and pregnancy: An ethical and therapeutic dilemma in a second level hospital / Neurolupus y embarazo: un dilema ético y terapéutico en un hospital de segundo nivel

Optic neuritis secondary to systemic lupus erythematosus is a rare manifestation with a prevalence of 1%. The case described concerns a patient who presented with optic neuritis associated with SLE. She was 19 weeks pregnant, and required pulses with methyl-prednisolone and cyclophosphamide, which are within the category D drugs used during pregnancy. Three weeks later, she presented with uterine activity, and went into labor, with a fetus of 22 weeks gestation and weighing 430 g being obtained, which died 48 h later. In medical practice there are ethical guidelines and economic obstacles to carrying out diagnostic and therapeutic protocols established by limiting clinical practice

La neuritis óptica secundaria a lupus eritematoso sistémico es una rara manifestación con una prevalencia del 1%. Presentamos el caso de una paciente que mostró neuritis óptica asociada a lupus eritematoso sistémico, con 19 semanas de gestación, requiriendo de pulsos de metilprednisolona y ciclofosfamida, que se encuentran dentro de los medicamentos categoría D utilizados durante el embarazo. Tres semanas después presentó actividad uterina y posteriormente trabajo de parto obteniéndose un producto de 22 semanas de gestación y 430 g, falleciendo a las 48 h. En la práctica médica existen lineamientos éticos y obstáculos económicos que limitan la realización de protocolos diagnósticos y terapéuticos establecidos, limitando la práctica clínica