Clinical and Serological Features in Latin American IgG4-Related Disease Patients Differ According to Sex, Ethnicity, and Clinical Phenotype.

BACKGROUND/OBJECTIVE: Data on IgG4-related disease (IgG4-RD) come almost exclusively from cohorts from Asia, Europe, and North America. We conducted this study to describe the clinical presentation, phenotype distribution, and association with sex, ethnicity, and serological markers in a large cohort of Latin American patients with IgG4-RD. METHODS: We performed a multicenter medical records review study including 184 Latin American IgG4-RD patients. We assigned patients to clinical phenotypes: group 1 (pancreato-hepato-biliary), group 2 (retroperitoneal/aortic), group 3 (head and neck-limited), group 4 (Mikulicz/systemic), and group 5 (undefined). We focused the analysis on how sex, ethnicity, and clinical phenotype may influence the clinical and serological presentation. RESULTS: The mean age was 50.8 ± 15 years. Men and women were equally affected (52.2% vs 48.8%). Fifty-four patients (29.3%) were assigned to group 1, 21 (11.4%) to group 2, 57 (30.9%) to group 3, 32 (17.4%) to group 4, and 20 (10.8%) to group 5. Male sex was associated with biliary tract (odds ratio [OR], 3.4; 95% confidence interval [CI], 1.36-8.26), kidney (OR, 3.4; 95% CI, 1.28-9.25), and retroperitoneal involvement (OR, 5.3; 95% CI, 1.45-20). Amerindian patients presented more frequently with atopy history and gallbladder involvement. Group 3 had a female predominance. CONCLUSIONS: Latin American patients with IgG4-RD were younger, and men and women were equally affected compared with White and Asian cohorts. They belonged more commonly to group 1 and group 3. Retroperitoneal and aortic involvement was infrequent. Clinical and serological features differed according to sex, ethnicity, and clinical phenotype.

Reliability of OMERACT ultrasound elementary lesions in gout: results from a multicenter exercise.

The aim of this study was to evaluate the reliability of the outcome measures in rheumatology (OMERACT) definitions for ultrasound (US) elementary lesions in gout through an image reading exercise. Images from patients with gout (static images and videos) were collected. As an initial step, we carried out a image reading exercise within the experts of the Pan-American League of Associations for Rheumatology (PANLAR) US Study Group (n = 16). The following step consisted in a web-based exercise with the participation of larger number of sonographers (n = 63) from different centers. Images were rated evaluating the presence/absence of any US elementary lesion. Inter- and intra-reader reliabilities were analyzed using kappa coefficients. Participants were stratified according to their level of experience. In the first exercise, inter-reader kappa values were 0.45 for aggregates, 0.57 for tophus, 0.69 for erosions, and 0.90 for double contour (DC). Intra-reader kappa values were 0.86, 0.76, 0.80, and 0.90, respectively. The web-based exercise showed inter-reader kappa values for aggregates, tophus, erosions, and DC of 0.42, 0.49, 0.69, and 0.79, respectively. The intra-reader kappa values were 0.62, 0.69, 0.77, and 0.85, respectively. Reliability was not influenced by the sonographer's level of experience. The reliability of the new OMERACT US definitions for elementary lesions in gout ranged from moderate to excellent, depending on the type of lesion.

Prevalence and correlates of metabolic syndrome in patients with rheumatoid arthritis in Argentina.

BACKGROUND: The increased mortality reported among patient with rheumatoid arthritis (RA) has been attributed to cardiovascular disease. Metabolic syndrome (MS) is a cluster of major risk factors for cardiovascular disease such as dyslipidemia, obesity, hypertension, and diabetes. There is a lack of reporting on the prevalence of MS in RA patients in Argentina. OBJECTIVES: The objectives of this study were to determine and compare the frequency of MS in patients with RA and a control group and to assess the factors associated with MS. METHODS: This is a cross-sectional study involving 1033 (409 RA and 624 age- and sex-matched control subjects) patients, followed up at 9 different rheumatology units in Argentina. Metabolic syndrome was defined according to the Adult Treatment Panel III (ATP III) and the International Diabetes Federation (IDF). The relationship between demographic variables, clinical data (disease duration, disease activity by Disease Activity Score of 28 joints, presence of rheumatoid factor [RF] and/or anti-cyclic citrullinated peptide antibody, presence of extra-articular manifestations), pharmacological treatment, and MS was examined by descriptive statistics. Variables with P ≤ 0.10 in these analyses were then examined by logistic regression. RESULTS: The frequency of MS in RA patients and the control group was 30% versus 39% (P = 0.002) when defined as per the ATP III and 35% versus 40% (P = 0.10) as per the IDF. Variables independently associated with MS in RA patients were age (odds ratio [OR], 1.03; 95% confidence interval [CI], 1.01-1.06 [P = 0.01] for the ATP III and OR, 1.03; 95% CI, 1.01-1.05 [P < 0.001] for the IDF), the presence of RF and/or anti-cyclic citrullinated peptide antibody (OR, 2.91; 95% CI, 1.11-7.61 [P = 0.02] for the ATP III and OR, 2.37; 95% CI, 1.09-5.16 [P = 0.02] for the IDF), and the use of hydroxychloroquine (OR, 0.48; 95% CI, 0.23-0.97 [P = 0.04] only for the IDF). CONCLUSIONS: In this study, we were not able to demonstrate a higher frequency of MS in RA patients. However, older patients with positive RF or CCP have a higher risk of MS. A protective effect to develop MS was seen in the population treated with hydroxychloroquine.

[Relapse of lupus nephritis in temporal association with anti SARS-CoV-2 vaccination]. / Reactivación de glomerulonefritis lúpica en asociación temporal con vacunas anti SARS-CoV-2.

During the past two years we have witness a tremendous worldwide health crisis imposed by the coronavirus disease (COVID-19). This situation led to the urgent development and implementation of vaccines in an attempt to decrease not only the SARS-CoV-2 transmissibility but also the severe forms of COVID-19. Although these vaccines were approved based on an adequate benefit-risk ratio, at the moment of their implementation in 2021 we did not have sub-studies in special populations; patients with systemic lupus erythematosus (SLE) among them. We describe two cases of lupus nephritis flare following the immunization against SARS-CoV-2 with the first component of Sputnik V and Sinopharm. Both patients were in complete remission on maintenance therapy with mycophenolate and without glucocorticoids. The flare presented with an increased protein/creatinine ratio in urine and positive anti-DNA antibodies without other relevant accompanying findings. After treatment with prednisone (20 y 10 mg/day in case 1 and 2, respectively) and an increased dose of mycophenolate (from 1.5 g/day to 2.0 g/dayand 1.08 to 1.44 g/día of sodic mycophenolate in case 1 y 2, respectively) both patients regained renal remission. These cases are of relevance as they introduce a possible association between the different anti-SARS-CoV-2 vaccine platforms and SLE flares; at the same time to suggest the need for close control in the post vaccination period in this population of patients.

Debido el alto impacto sanitario que causó el nuevo coronavirus SARS-CoV-2, se procedió al rápido desarrollo e implementación de vacunas en un intento de disminuir su transmisibilidad y las formas graves de la COVID 19. La aprobación de estas vacunas se basó en una adecuada relación riesgo/beneficio, sin embargo, en el año 2021 no disponíamos de sub-estudios en poblaciones especiales; entre ellas, pacientes con lupus eritematoso sistémico (LES). Presentamos dos casos de brote de glomerulonefritis lúpica luego de la inmunización contra SARS-CoV-2 dado por el primer componente de Sputnik V y Sinopharm. Ambas pacientes se encontraban en remisión completa con tratamiento de mantenimiento en dosis estables de micofenolato y libre de glucocorticoides. El brote de glomerulonefritis se presentó con aumento de relación proteinuria/creatininuria y anticuerpos anti ADN positivos sin otros hallazgos acompañantes de relevancia. En ambas pacientes se reinició prednisona (20 y 10 mg/día en caso 1 y 2, respectivamente) y se aumentó la dosis de micofenolato (de 1.5 g/día a 2.0 g/día y de 1.08 a 1.44 g/día de micofenolato sódico en caso 1 y 2, respectivamente) con remisión completa del cuadro. Estos casos son de relevancia ya que introducen una posible asociación entre las diferentes plataformas vacunales anti SARS-CoV-2 y reactivación del LES, a la vez de sugerir la necesidad de un control estrecho en el período post-vacunal en esta población de pacientes.

Reactivación de glomerulonefritis lúpica en asociación temporal con vacunas anti SARS-CoV-2 / Relapse of lupus nephritis in temporal association with anti SARS-CoV-2 vaccination

Resumen Debido el alto impacto sanitario que causó el nuevo coronavirus SARS-CoV-2, se procedió al rápido desarrollo e implementación de vacunas en un intento de disminuir su transmisibilidad y las formas graves de la COVID 19. La aprobación de estas vacunas se basó en una adecuada relación riesgo/beneficio, sin embargo, en el año 2021 no disponíamos de sub-estudios en poblaciones especiales; entre ellas, pacientes con lupus eritematoso sistémico (LES). Presentamos dos casos de brote de glomerulonefritis lúpica luego de la inmunización contra SARS-CoV-2 dado por el primer componente de Sputnik V y Sinopharm. Ambas pacientes se encontraban en remisión completa con tratamiento de mantenimiento en dosis estables de micofenolato y libre de glucocorticoides. El brote de glomerulonefritis se presentó con aumento de relación proteinuria/creati ninuria y anticuerpos anti ADN positivos sin otros hallazgos acompañantes de relevancia. En ambas pacientes se reinició prednisona (20 y 10 mg/día en caso 1 y 2, respectivamente) y se aumentó la dosis de micofenolato (de 1.5 g/día a 2.0 g/día y de 1.08 a 1.44 g/día de micofenolato sódico en caso 1 y 2, respectivamente) con remisión completa del cuadro. Estos casos son de relevancia ya que introducen una posible asociación entre las diferentes plataformas vacunales anti SARS-CoV-2 y reactivación del LES, a la vez de sugerir la necesidad de un control estrecho en el período post-vacunal en esta población de pacientes.

Abstract During the past two years we have witness a tremendous worldwide health crisis imposed by the coronavirus disease (COVID-19). This situation led to the urgent development and implementation of vac cines in an attempt to decrease not only the SARS-CoV-2 transmissibility but also the severe forms of CO VID-19. Although these vaccines were approved based on an adequate benefit-risk ratio, at the moment of their implementation in 2021 we did not have sub-studies in special populations; patients with systemic lupus erythematosus (SLE) among them. We describe two cases of lupus nephritis flare following the immunization against SARS-CoV-2 with the first component of Sputnik V and Sinopharm. Both patients were in complete remission on maintenance therapy with mycophenolate and without glucocorticoids. The flare presented with an increased protein/creatinine ratio in urine and positive anti-DNA antibodies without other relevant ac companying findings. After treatment with prednisone (20 y 10 mg/day in case 1 and 2, respectively) and an increased dose of mycophenolate (from 1.5 g/day to 2.0 g/dayand 1.08 to 1.44 g/día of sodic mycophenolate in case 1 y 2, respectively) both patients regained renal remission. These cases are of relevance as they intro duce a possible association between the different anti-SARS-CoV-2 vaccine platforms and SLE flares; at the same time to suggest the need for close control in the post vaccination period in this population of patients.