Sociodemographic and obstetric factors may affect breastfeeding attitudes, self-efficacy, and knowledge in women with rheumatic diseases: a retrospective analysis of self-reported surveys.

Women with autoimmune rheumatic disease (ARDs) experience difficulties with BF in addition to those concerning their own disease. The aim of this study is to identify the impact factors as infant feeding attitude, the level of BF knowledge, BF self-efficacy, and the sociodemographic have in the intention to BF in women with ARDs. We performed an observational, retrospective, and analytical study. Reproductive-age women (18-50 years old) with ARDs with prior pregnancy history and who filled out self-reported BF surveys as part of the Rheumatology Integral Care Program were included. Sociodemographic and clinical characteristics were retrieved from medical charts. We analyzed three validated BF questionnaires. Sixty-five participants with a mean age of 41.32 ± 7.48 were evaluated. Of these, 63 (97%) women agreed with BF in the first 6 months. The most prevalent infant feeding attitude was neutral with 42 (64.6%) women. The most common level of BF knowledge was poor with 45 (69.2%) patients. There were significant correlations of BF knowledge with education years (p = < 0.001, r = 0.464) and age (p = 0.049, r=-0.245). A significant correlation was found between BF self-efficacy and age (p = 0.039, r = 0.257). Attitude toward BF was significantly associated with education level > 9 years (OR = 3.400; 95% CI = 1.091-10.593) and a history of miscarriage (OR = 3.670; 95% CI = 1.051-12.813). Although most women with ARDs agreed with BF, we identified a poor level of BF knowledge and a neutral infant feeding attitude as the most predominant. By identifying this data in women with ARDs, BF practices may be improved.

Rheumatoid arthritis-associated antibodies in healthy first-degree relatives of RA patients.

Rheumatoid arthritis (RA) affects approximately 1.5% of the population worldwide and 0.5-3.3% of the Mexican population. The presence of rheumatoid factor (RF), anti-citrullinated protein antibodies (ACPA) and anti-carbamylated protein (anti-CarP) antibodies has been described in populations at risk of RA development, such as first-degree relatives (FDR). Anti-CarP antibodies are present in RA patients (44%), FDR of RA patients (18%) and healthy controls (4.7%). Anti-CarP antibodies have not been described in FDR of the Mexican population. The objective of this study was to determine the prevalence of Rheumatoid Factors (RF) isotypes, ACPA and anti-CarP antibodies isotypes in FDR of RA patients. An observational, cross-sectional study, in an FDR of RA cohort, was performed. We measured IgA, IgG and IgM isotypes of RF, ACPA and anti-CarP antibodies. A total of 144 FDRs from 99 RA patients were enrolled. The prevalence of anti-CarP antibodies was 2.8% for IgA, 4.2% for IgG, whereas IgM was not detected. The serologic association was for RF/ACPA 4.48%, RF/anti-CarP 2.7%, FR 64.5%, ACPA 1.3%, ACPA/anti-CarP 0.69%, anti-CarP 3.4%, and no RF/ACPA/anti-CarP was observed. We found a low prevalence of anti-CarP antibodies in our cohort of FDR of RA patients, but the prevalence of ACPA and RF were higher than other cohorts previously reported.

The COVID-19 epidemic curve and vaccine acceptance among patients with rheumatic diseases: an ecological study.

The attitudes toward emerging COVID-19 vaccines have been of great interest worldwide, especially among vulnerable populations such as patients with rheumatic and musculoskeletal diseases (RMDs). The aim of this study was to analyze the relationship between the nationwide number of COVID-19 cases and deaths, and vaccine acceptance or hesitancy of patients with RMDs from four patient care centers in Mexico. Furthermore, we explored differences in acceptance according to specific diagnoses: rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). This ecological study was a secondary analysis of a cross-sectional study using a validated questionnaire to measure vaccine acceptance. We generated a global Likert scale to evaluate overall attitudes toward the COVID-19 vaccine. We analyzed data from 1336 patients from March to September 2021: 85.13% (1169) were women, with a mean age of 47.87 (SD 14.14) years. The most frequent diagnoses were RA (42.85%, 559) and SLE (27.08%, 393). 635(47.52%) patients were unvaccinated, 253(18.93%) had one dose and 478(35.77%) had two doses. Of all participating patients, 94% were accepting toward the COVID-19 vaccine. Vaccine acceptance remained consistently high throughout the study. However, differences in vaccine acceptance are identified when comparing diagnoses. The peak of the national epidemic curve coincided with an increase in hesitancy among patients with RA. Contrastingly, patients with SLE became more accepting as the epidemic curve peaked. Mexican patients show high acceptance of the COVID-19 vaccine, influenced in part by a patient's specific diagnosis. Furthermore, vaccine acceptance increased mirroring the curve of COVID-19 cases and deaths in the country. This should be taken into consideration when updating recommendations for clinical practice.

Problems related to sexuality are relevant but not addressed in rheumatology practice: results from a cross-sectional survey.

Sexual issues have a high prevalence in people with rheumatic diseases, but they are not commonly discussed in clinical practice, so we aim to determine the relevance and frequency of addressing problems related to sexuality in Rheumatology clinical practice in Mexico. We obtained data from an electronic survey applied to Mexican physicians involved in Rheumatology practice. The questionnaire was adapted from a previous study. The responses were analyzed and presented with descriptive statistics. We received 75 responses, 52% were from women, with an average age of 35.5 years. Sixty-two (82.6%) participants considered problems related to sexuality as quite relevant to Rheumatology practice, but a lower proportion (10, 13.3%) approach them to the same extent. The main barriers to the management of sexual issues that we recognized were the patient's embarrassment, patient´s age, and time. Most of our participants (62.7%) considered the rheumatologist as responsible for initiating the dialogue about sexual issues. Mexican rheumatologists consider sexual issues as relevant. Further training in sexuality is warranted for health care professionals attending people with rheumatic diseases.

Sexual function in women with systemic lupus erythematosus: a case-control study.

The effect of systemic lupus erythematosus (SLE) in sexual function is one of the least studied areas. There are few previous studies that investigate sexual function in SLE, and current evidence indicates a negative impact. The main objective of this study is to evaluate sexual function in Mexican women with SLE and compare if sexual dysfunction occurs in a greater proportion than in healthy women. A case-control study with 102 Mexican women between 18 and 60 years, with SLE diagnosis and a control group of healthy women (n = 156) matched by age. They were asked about their sexual life in the last month, and the Female Sexual Function Index (FSFI) self-questionnaire was applied. Variables between groups were compared with Chi-square and Mann-Whitney U test. SLE women had less sexual activity than controls (63.7% vs 77.5%, p = 0.01). Out of the total, the FSFI was applied only to those that had an active sexual life, 65 with SLE and 121 healthy women. Sexual dysfunction (< 26.5 points) was found in 28% women with SLE and in 22% of controls, with no significant differences (p = 0.4). In the SLE group, a worse performance was found in the desire and excitation domains compared to healthy women. SLE women had less active sexual life than healthy women, but no greater sexual dysfunction. However, they performed worse in the desire and excitation domains. This alteration did not show a relation with demographic nor disease-related variables.

Reproductive health counseling and contraceptive use in Mexican women with rheumatic diseases: a cross-sectional study.

BACKGROUND: There is an overall increased risk of adverse pregnancy outcomes and maternal morbidity in patients with most autoimmune rheumatic diseases (ARD); outcomes are generally improved when the pregnancy is planned and the disease is in control. OBJECTIVE: The objective of the present study was to describe the sexual and reproductive health characteristics and contraceptive use of Mexican women in childbearing age with ARD. METHODS: We conducted an observational, cross-sectional, and descriptive study. All non-pregnant childbearing age women with an ARD were invited to participate. A self-administered questionnaire of ten items that included questions about sexuality, use of contraceptive methods, pregnancy desire, and contraceptional counseling was applied. RESULTS: A total of 135 women were evaluated. The median age was 33 (25-39) years. Contraceptive use was referred by 49 (71%) of the patients that had sexual activity the last month, while 20 (28.9%) patients denied use. From the patients who had initiated sexual activity (N = 112), 41 (36.6%) did not use any contraceptive method, and 16 (14%) used a method classified as ineffective. The question about contraceptive counseling was answered by 112 patients. Eighty (70.4%) said they had received counseling from health-professional and 64 (57.1%) from their rheumatologist. A total of 57% of the women with teratogenic drugs did not employ a contraception method. CONCLUSION: Contraceptive use and reproductive health counseling are suboptimal in Mexican women with ARD. A high proportion of women taking teratogenic drugs did not employ a highly effective contraceptive method. Strategies to improve reproductive and sexual health are necessary.

Vaccination in rheumatic disease patients: results of a pilot quality improvement program.

OBJECTIVES: Patients with rheumatic diseases (RD) are at increased risk of infections. Vaccination is recognized as a successful public health measure and is recommended for RD patients. The aim of this study was to describe the strategies implemented in an academic rheumatology outpatient clinic as part of a fellow-in-training-led vaccination quality improvement (QI) program and to explore the vaccination uptake before and one year after the implementation. MATERIAL AND METHODS: The program's objective is the promotion of vaccination among patients and rheumatology fellows (by educational interventions, development of vaccination charts and orders, and modifications to electronic medical records to register vaccination dates and generate reminders). As part of the continuous evaluation of the QI program, a descriptive cross-sectional study was performed to evaluate vaccine uptake pre- and post-interventions and vaccination barriers one year after implementation. Consecutive patients with RD answered a self-administered questionnaire. Results are shown as descriptive statistics. RESULTS: Before the program started 73 patients were surveyed and 102 patients one year after. The vaccination uptake rates for influenza pre- and post-interventions were 43% and 55%; for pneumococcal vaccination they were 26% and 30%; for herpes zoster they were 0% and 4%; for human papillomavirus they were 4% and 10%; for hepatitis B (HBV) they were 19% and 25% respectively. Eighty percent of patients reported some barriers to receiving any of the previous vaccines. The three main reasons for not receiving a vaccine were the lack of recommendation, the lack of availability, and the belief that vaccines do not work. CONCLUSIONS: The implementation of a pilot vaccination QI program led by rheumatology fellows-in-training showed promising preliminary benefits in the vaccination uptake among RD patients and helps to evaluate the barriers to surpass.

Anxiety and depression in reproductive age women with rheumatic diseases.

Women in reproductive age with rheumatic diseases (RD) are especially vulnerable for depression and anxiety which negatively impacts the pregnancy, birth, and RD. The purpose of this study is to describe the frequency of anxiety and depression symptoms employing the Hospital Anxiety and Depression Scale (HADS) in women in reproductive age. We conducted an observational, single-center, cross-sectional, and descriptive study in reproductive-age, non-pregnant women without a prior psychiatric diagnosis. Differences between disease groups, subscale results, and disease activity were analyzed with the Chi square, Mann-Whitney U test, or Kruskal-Wallis test. A total of 100 women were included. Mean age was 35.3 years (SD = 10.07). The most frequent diagnosis was rheumatoid arthritis (RA) with 48, followed by systemic lupus erythematosus (SLE) with 30. A total of 66 (66%) patients had an abnormal HADS score (probable or possible cases) in either subscale. More than 50% of RA patients had an abnormal HADS score. We found an association between RA disease activity groups and total HADS score (p = 0.003). Furthermore, we found a statically significant association between RA activity groups and HADS anxiety subscales group classification (p = 0.01). No differences between disease activity groups of SLE or other diseases and HADS classification or total score was found (p = 0.277). A high frequency of probable or possible cases of depression and anxiety were recognized in reproductive-age women with RD. A high RA disease activity was associated with a high total HADS score and an increased presence of anxiety symptoms.

Low-dose rituximab therapy in steroid-refractory thrombocytopenia due to systemic lupus erythematosus.

Systemic lupus erythematosus (SLE) is an autoimmune disease, characterized by multi-organ symptomatology. 16% of the patients with autoimmune thrombocytopenia have SLE and are associated with high mortality. Intravenous methylprednisolone or high-dose steroids are the first-line treatments in those patients who experienced life-threatening bleeding or have a severely low platelet count, whereas a second line includes splenectomy, as well as other immunosuppressive agents as monotherapy or combined therapy, including azathioprine, cyclophosphamide, cyclosporine, and mycophenolate mofetil. However, response rates of these therapies vary considerably. Rituximab (RTX) became a useful tool in the treatment of autoimmune diseases, due to the decrease of autoantibodies production. In addition, there is evidence that low doses of RTX (100 mg IV per week for 4 weeks) can have a similar effect compared to the standard dose. The objective of this study was to describe the response to low doses of RTX in patients with lupus-induced thrombocytopenia. We present a report of four female patients with newly diagnosed SLE, accompanied by purpuric syndrome and severe thrombocytopenia (< 30 × 109/L) as the clinical debut that was refractory to glucocorticoids (GC) therapy and treated with low doses of RTX. By week 5, complete response (> 100 × 109/L) was achieved in two patients, partial response (> 50 × 109/L) in 1 patient, and no response in one patient. There is little information on the treatment of SLE-associated autoimmune thrombocytopenia. The most extensive study found at the time of our search was the study of 10 Asian patients. They found that 80% of the patients responded by week four and maintained until week 24 of follow-up. At week 36, a follow-up for two patients showed relapse; this occurred on patients with the most disease duration (> 5 years) and was associated with a lower response rate. In contrast, our study with four patients found that half of them presented a complete response: one patient added concomitant therapy with azathioprine (AZA) and another patient without the concomitant therapy. A third patient with a partial improvement, this was seen by week five of treatment. Moreover, a fourth patient who did not have a response by week five of treatment presented a clinical response in subsequent appointments with a count of > 100 at week 24. Those patients who required concomitant use of AZA were patients who had positive antiphospholipid serology. The use of low-dose RTX for the management of severe thrombocytopenia refractory to GC in patients with SLE has a good response. It could be a safe, economical, and effective therapy.