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1.
Reumatol Clin (Engl Ed) ; 15(1): 34-42, 2019.
Artículo en Inglés, Español | MEDLINE | ID: mdl-28528869

RESUMEN

OBJECTIVES: The course and long-term outcome of pure membranous lupus nephritis (MLN) are little understood. The aims of this study are to evaluate the clinical features, course, outcome and prognostic indicators in pure MLN and to determine the impact of ethnicity and the type of health insurance on the course and prognosis of pure MLN. METHODS: We conducted a retrospective review of medical records of 150 patients with pure MLN from Spain and the USA. RESULTS: Mean age was 34.2±12.5 and 80% were women. Sixty-eight percent of patients had nephrotic syndrome at diagnosis. The average serum creatinine was 0.98±0.78mg/dl. Six percent of patients died and 5.3% developed end-stage renal disease (ESRD). ESRD was predicted by male sex, hypertension, dyslipidemia, high basal 24h-proteinuria, high basal serum creatinine and a low basal creatinine clearance. Age, cardiac insufficiency, peripheral artheriopathy, hemodialysis and not having received mycophenolate mofetil or antimalarials for MLN predicted death. CONCLUSIONS: Pure MLN frequently presents with nephrotic syndrome, high proteinuria and normal serum creatinine. Its prognosis is favourable in maintaining renal function although proteinuria usually persists over time. Baseline cardiovascular disease and not having a health insurance are related with poor prognosis.


Asunto(s)
Glomerulonefritis Membranosa/diagnóstico , Nefritis Lúpica/diagnóstico , Adulto , Femenino , Estudios de Seguimiento , Glomerulonefritis Membranosa/mortalidad , Glomerulonefritis Membranosa/fisiopatología , Glomerulonefritis Membranosa/terapia , Humanos , Nefritis Lúpica/mortalidad , Nefritis Lúpica/fisiopatología , Nefritis Lúpica/terapia , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos
2.
Reumatol. clín. ; 15(1): 34-42, ene.-feb. 2019. tab
Artículo en Inglés | IBECS (España) | ID: ibc-176075

RESUMEN

Objectives: The course and long-term outcome of pure membranous lupus nephritis (MLN) are little understood. The aims of this study are to evaluate the clinical features, course, outcome and prognostic indicators in pure MLN and to determine the impact of ethnicity and the type of health insurance on the course and prognosis of pure MLN. Methods: We conducted a retrospective review of medical records of 150 patients with pure MLN from Spain and the USA. Results: Mean age was 34.2±12.5 and 80% were women. Sixty-eight percent of patients had nephrotic syndrome at diagnosis. The average serum creatinine was 0.98±0.78mg/dl. Six percent of patients died and 5.3% developed end-stage renal disease (ESRD). ESRD was predicted by male sex, hypertension, dyslipidemia, high basal 24h-proteinuria, high basal serum creatinine and a low basal creatinine clearance. Age, cardiac insufficiency, peripheral artheriopathy, hemodialysis and not having received mycophenolate mofetil or antimalarials for MLN predicted death. Conclusions: Pure MLN frequently presents with nephrotic syndrome, high proteinuria and normal serum creatinine. Its prognosis is favourable in maintaining renal function although proteinuria usually persists over time. Baseline cardiovascular disease and not having a health insurance are related with poor prognosis


Objetivos: Los conocimientos sobre el curso y el desenlace a largo plazo de la nefritis lúpica membranosa (NLM) pura son todavía escasos. El objetivo de este estudio es evaluar las características clínicas, curso, desenlace e indicadores pronósticos de la NLM y determinar el impacto de la etnicidad y tipo de cobertura sanitaria en el curso y pronóstico de la NLM. Métodos: Se realizó una revisión retrospectiva de las historias de 150 pacientes con NLM de España y Estados Unidos. Resultados: La edad media fue 34,2±12,5 y el 80% eran mujeres. El 68% de los pacientes tenían síndrome nefrótico al diagnóstico. La creatinina sérica media fue 0,98±0,78mg/dl. El 6% de los pacientes fallecieron y el 5,3% desarrollaron insuficiencia renal terminal (IRT). El sexo masculino, la hipertensión, la dislipemia, la alta proteinuria basal, la alta creatininemia y un aclaramiento de creatinina reducido predijeron el desarrollo de IRT. La edad, la insuficiencia cardíaca, la arteriopatía periférica, la hemodiálisis y el no haber recibido micofenolato de mofetilo o antimaláricos predijeron el fallecimiento. Conclusiones: La NLM pura suele debutar con síndrome nefrótico, alta proteinuria y creatininemia normal. Su pronóstico es favourable en términos de mantenimiento de la función renal aunque la proteinuria habitualmente persiste durante el seguimiento. La enfermedad cardiovascular basal y no tener cobertura sanitaria se relacionan con mal pronóstico


Asunto(s)
Humanos , Masculino , Femenino , Adulto Joven , Adulto , Persona de Mediana Edad , Nefritis Lúpica/epidemiología , Glomerulonefritis Membranosa/epidemiología , Lupus Eritematoso Sistémico/complicaciones , Estudios Retrospectivos , Proteinuria/epidemiología , Evaluación del Resultado de la Atención al Paciente , Lupus Eritematoso Sistémico/etnología , Creatinina/sangre
3.
Reumatol Clin ; 9(1): 18-23, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-22938792

RESUMEN

AIM: To determine whether rheumatoid arthritis (RA) patients who have been prescribed biological agents exhibit a different comorbidity burden than RA patients who take disease-modifying antirheumatic drugs (DMARDs) alone, and to understand the association between comorbidity and other variables, as well as the association between comorbidity and multimorbidity. METHODS: This observational case-control study included 114 RA patients treated with biological agents and a control group comprising 163 sex- and age-matched RA patients treated with DMARDs only. Current and previous data regarding the patients' disease activity, comorbidities, and treatments were collected. The data were analysed using bivariate and multivariate regression models. RESULTS: The patients who were prescribed biological agents exhibited poorer disease control, received more DMARDs and steroids, and underwent more total joint arthroplasties compared with the patients in the control group. However, the risk factors for cardiovascular disease and the comorbidity frequency were similar between cases and controls. The most prevalent comorbidities were hypertension, obesity, and respiratory, thyroid, and upper gastrointestinal disorders. The incidence of cardiovascular disease was low, and only 29% of the patients exhibited multimorbidities. A bivariate association of age, late diagnosis, joint replacements and a high score on the health assessment questionnaire score (HAQ) with comorbidity was observed. There were also correlations between the Charlson index and age, joint reconstructive surgery, disease activity (DAS28), and HAQ score. However, when binary logarithmic regression models were applied, only patient age remained significantly associated with comorbidity and multimorbidity [hazard ratio, 1.08; 95% confidence interval, 1.05-1.12; p<0.0005]. CONCLUSION: RA patients taking biological drugs have a comorbidity burden equivalent to those treated with DMARDs alone. Age is the main predictive factor of comorbidity in these patients.


Asunto(s)
Anticuerpos Monoclonales/uso terapéutico , Antirreumáticos/uso terapéutico , Artritis Reumatoide/epidemiología , Adalimumab , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Anticuerpos Monoclonales Humanizados/uso terapéutico , Anticuerpos Monoclonales de Origen Murino/uso terapéutico , Artritis Reumatoide/tratamiento farmacológico , Comorbilidad , Etanercept , Femenino , Humanos , Inmunoglobulina G/uso terapéutico , Infliximab , Modelos Logísticos , Masculino , Análisis por Apareamiento , Persona de Mediana Edad , Análisis Multivariante , Receptores del Factor de Necrosis Tumoral/uso terapéutico , Estudios Retrospectivos , Rituximab , España , Resultado del Tratamiento , Adulto Joven
4.
Reumatol. clín. ; 9(1): 18-23, ene.-feb. 2013. tab
Artículo en Inglés | IBECS (España) | ID: ibc-109048

RESUMEN

Objetivo. Determinar si los pacientes con artritis reumatoide (AR) a los que se les prescribe terapia biológica tienen comorbilidad diferente a los pacientes con AR a los que se les prescribe solo fármacos antirreumáticos modificadores de la enfermedad (FAME). Entender la asociación de comorbilidad con otras variables y con multimorbilidad. Métodos. Estudio observacional de casos y controles, incluyó 114 pacientes con AR a los que se les prescribió terapia biológica, y un grupo control de 163 pacientes emparejados por sexo y edad a los que solo se les había prescrito FAME. Se recogieron datos previos y actuales sobre actividad de enfermedad, comorbilidad y tratamientos. Se realizó análisis de regresión bivariante y multivariante. Resultados. Los pacientes a los que se les prescribió terapia biológica tenían: peor control de la enfermedad, recibieron más FAME y glucocorticoides y se habían sometido a más artroplastias en comparación con el grupo control. Sin embargo, los factores de riesgo cardiovascular y la frecuencia de comorbilidad fueron similares entre casos y controles. Las comorbilidades más frecuentes fueron: hipercolesterolemia (33%), hipertensión (27%), obesidad (26%), y trastornos respiratorios (16%), tiroideos(13%) y gastrointestinales (10%). La incidencia de enfermedad cardiovascular es baja (2%). Solo el 29% de los pacientes tenían multimorbilidad. Se observó asociación bivariante entre edad, diagnóstico tardío, reemplazos articulares y HAQ, con comorbilidad. También se observaron correlaciones entre índice de Charlson y edad, la cirugía reconstructiva, actividad de la enfermedad y HAQ. Cuando se aplican los modelos de regresión Log binario, solo la edad se mantuvo asociada significativamente con comorbilidad y multimorbilidad (hazard ratio 1,8; intervalo de confianza al 95% 1,05-1,12; p<0,0005). Conclusión. Los pacientes con AR con terapia biológica tienen comorbilidad equivalente a los tratados solo con FAME. La edad es el principal factor predictivo de comorbilidad en estos pacientes (AU)


Aim: To determine whether rheumatoid arthritis (RA) patients who have been prescribed biological agents exhibit a different comorbidity burden than RA patients who take disease-modifying antirheumatic drugs (DMARDs) alone, and to understand the association between comorbidity and other variables, as well as the association between comorbidity and multimorbidity. Methods: This observational case–control study included 114 RA patients treated with biological agents and a control group comprising 163 sex- and age-matched RA patients treated with DMARDs only. Current and previous data regarding the patients’ disease activity, comorbidities, and treatments were collected. The data were analysed using bivariate and multivariate regression models. Results: The patients who were prescribed biological agents exhibited poorer disease control, received more DMARDs and steroids, and underwent more total joint arthroplasties compared with the patients in the control group. However, the risk factors for cardiovascular disease and the comorbidity frequency were similar between cases and controls. The most prevalent comorbidities were hypertension, obesity, and respiratory, thyroid, and upper gastrointestinal disorders. The incidence of cardiovascular disease was low, and only 29% of the patients exhibited multimorbidities. A bivariate association of age, late diagnosis, joint replacements and a high score on the health assessment questionnaire score (HAQ) with comorbidity was observed. There were also correlations between the Charlson index and age, joint reconstructive surgery, disease activity (DAS28), and HAQ score. However, when binary logarithmic regression models were applied, only patient age remained significantly associated with comorbidity and multimorbidity [hazard ratio, 1.08; 95% confidence interval, 1.05–1.12; p < 0.0005]. Conclusion: RA patients taking biological drugs have a comorbidity burden equivalent to those treated with DMARDs alone. Age is the main predictive factor of comorbidity in these patients (AU)


Asunto(s)
Humanos , Masculino , Femenino , Artritis Reumatoide/epidemiología , Artritis Reumatoide/prevención & control , Terapia Biológica/instrumentación , Terapia Biológica/métodos , Terapia Biológica/normas , Grupos Control , Antirreumáticos/metabolismo , Antirreumáticos/uso terapéutico , Artroplastia/métodos , Artroplastia/tendencias , Comorbilidad , Terapia Biológica/tendencias , Terapia Biológica , Modelos Logísticos , Antirreumáticos/farmacología , Análisis Multivariante , Protocolos Clínicos/normas
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