Short-term atorvastatin therapy improves arterial stiffness of middle-aged systemic lupus erythematosus patients with pathological pulse wave velocity.

Objectives Statins have been proposed as a potential treatment for systemic lupus erythematosus (SLE) due to their immunomodulatory properties, their role restoring endothelial function and preventing atherosclerosis. We evaluate the effect of a short period treatment with a low dose of atorvastatin and its withdrawal on early stage subclinical atherosclerosis. Methods Thirty-seven SLE females received 20 mg/day atorvastatin during eight weeks. At baseline, at the end of treatment and six months after atorvastatin withdrawal, disease activity, subclinical atherosclerosis -assessed by measuring carotid-femoral pulse wave velocity (PWV) - and quantification of circulating endothelial progenitor cells (EPC) - as a surrogate biological marker of subclinical atherosclerosis - were carried out. Results The group of SLE patients with baseline pathological arterial stiffness showed a significant decrease of PWV after atorvastatin therapy (8.43 ± 1.45 m/s vs 7.42 ± 1.06 m/s; p = 0.002) that is maintained six months after treatment finished. Only patients of the middle-aged group showed a nearly significant decrease in the PWV measured along the study (7.16 ± 1.23 m/s vs 6.76 ± 0.82 m/s; p = 0.05). Atorvastatin induced a significant decrease in the circulating EPC percentage (0.65 ± 0.67 vs 0.40 ± 0.31; p = 0.023) as well as a downward trend of disease activity that it is observed by a decrease in SLE disease activity index simultaneously with an increase in C3 complement and significant decrease in serum concentration of vascular endothelial grow factor (VEGF) and sVCAM-1. Conclusions Short-term atorvastatin therapy reduces arterial stiffness of SLE patients with baseline pathological PWV, who are mainly in the group of middle-aged patients. Further studies are needed to determine whether these patients would benefit from statin therapy in preventing cardiovascular events.

Metabolic syndrome is associated with decreased circulating endothelial progenitor cells and increased arterial stiffness in systemic lupus erythematosus.

OBJECTIVES: Metabolic syndrome (MetS) is highly prevalent in patients with systemic lupus erythematosus (SLE) and it has been associated with increased cardiovascular risk. We examined the contribution of MetS to inflammatory markers, arterial stiffness and circulating endothelial progenitor cells (EPCs) as surrogates of subclinical atherosclerosis. METHODS: Cardiovascular risk factors, SLE-specific factors and peripheral blood EPCs were assessed in 50 female SLE patients. MetS was defined according to the National Cholesterol Education Program Adult Treatment Panel III. Simultaneously, atherosclerosis was assessed by measuring the carotid-femoral pulse wave velocity (PWV) by doppler velocimetry. RESULTS: Beyond the factors included in the definition, SLE patients with MetS have a significantly higher serum level of uric acid (6.88 ± 2.20 vs 4.45 ± 1.17, p < 0.001) and some inflammatory biomarkers such as homocysteine, IL-8, sICAM-1 or complement molecules. The presence of MetS in our patients was closely linked with a significantly increased patient organ damage score (3.20 ± 1.97 vs 1.60 ± 1.67, p = 0.008), a decreased percentage of circulating EPCs (0.53 ± 0.24 vs 0.85 ± 0.57, p = 0.007) and an increased arterial stiffness (9.89 ± 2.40 vs 7.13 ± 1.51, p < 0.001). CONCLUSIONS: MetS may contribute to the development of atherosclerosis by significantly increasing inflammation levels and arterial stiffness and decreasing circulating EPCs. This finding would justify close monitoring of these patients.

Increased arterial stiffness is independently associated with metabolic syndrome and damage index in systemic lupus erythematosus patients.

OBJECTIVES: We evaluated whether traditional or non-traditional cardiovascular (CV) risk factors and systemic lupus erythematosus (SLE)-related risk factors were associated with pathological arterial stiffness measured by pulse wave velocity (PWV) adjusted for patients' age and blood pressure. METHOD: CV risk factors were measured in the 46 SLE female patients studied. Activity and organ damage were assessed by the SLE Disease Activity Index (SLEDAI) and the Systemic Lupus International Collaborative Clinics/American College of Rheumatology (SLICC/ACR) Damage Index, respectively. Other lupus-related parameters and information concerning treatment were recorded. Subclinical atherosclerosis was assessed by PWV calculated from pulse wave recording by Doppler, a non-invasive method to measure arterial stiffness. Multivariate logistic regression analysis was used to identify independent determinants of increased PWV. RESULTS: PWV was categorized as normal or pathological arterial stiffness following the reference values adjusted by age and blood pressure recently published by the European Society of Cardiology. Pathological PWV was associated with CV risk factors including homocysteine (p = 0.01), high-sensitivity C-reactive protein (hs-CRP; p = 0.03), uric acid (p = 0.01), and metabolic syndrome (p = 0.007). With regard to SLE-specific risk factors, a significant association was found between PWV and SLICC/ACR score (p = 0.006). Multivariate analysis showed that increased PWV was independently associated with metabolic syndrome [odds ratio (OR) 6.6, 95% confidence interval (CI) 1.2-38, p = 0.03] and SLICC/ACR score (OR 1.5, 95% CI 1-2.32, p = 0.05). CONCLUSIONS: We have found a close link between metabolic syndrome and SLICC/ACR score with increased aortic stiffness. These variables might be an indicator of subclinical atherosclerosis in SLE women without clinical evidence of atherosclerotic cardiovascular disease (CVD).

Infección diseminada por histoplasma en España como primera manifestación de la infección por el VIH: a propósito de un paciente / Disseminated infection due to histoplasma in Spain as first manifestation of HIV infection

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Varón de 25 años con fiebre, adenopatías y lesiones cutáneas / 25 year old male with fever, abnormal lymph nodes and skin lesions

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[Antimalarials in systemic diseases]. / Los antimaláricos en las enfermedades sistémicas.

Antimalarials are drugs known for more than 300 years. Most widely used antimalarials are chloroquine, hydroxychloroquine, and less commonly quinacrine. The mechanisms of action are various and incompletely defined in the present moment. Antimalarials are used in numerous autoimmune diseases, the most frequent of which are rheumatoid arthritis and lupus erythematous. These drugs benefit especially cutaneous and articular disease, and moreover they are helpful for improvement blood glucose, lipids, and platelet aggregation. We discuss the dose and the most common adverse effects, especially those related to retina. Attention is especially directed to the treatment of pregnant women. Antimalarials favorable effectiveness-toxicity proportion advises consider them in the management of autoimmune diseases.

Los antimaláricos en las enfermedades sistémicas / Antimalarials in systemic diseases

Los antimaláricos son fármacos conocidos desde hace más de 300 años. Los más usados son la cloroquina, la hidroxicloroquina y más raramente la quinacrina. Los mecanismos de acción son diversos y aún no completamente comprendidos. Se emplean en numerosas enfermedades autoinmunes, siendo las más frecuentes la artritis reumatoide y el lupus eritematoso. Ejercen sus efectos, sobre todo, en la afectación cutánea y articular. Tienen también interés sus acciones sobre la glucemia, los lípidos y la agregación plaquetaria. Discutimos la dosis y efectos secundarios más frecuentes, con atención especial a los que interesan a la retina. Mención especial dedicamos al tratamiento durante el embarazo. Su favorable relación efectividad-toxicidad hace recomendable su consideración en el manejo terapéutico de este grupo de enfermedades (AU)

Antimalarials are drugs known for more than 300 years. Most widely used antimalarials are chloroquine, hydroxychloroquine, and less commonly quinacrine. The mechanisms of action are various and incompletely defined in the present moment. Antimalarials are used in numerous autoimmune diseases, the most frequent of which are rheumatoid arthritis and lupus erythematous. These drugs benefit especially cutaneous and articular disease, and moreover they are helpful for improvement blood glucose, lipids, and platelet aggregation. We discuss the dose and the most common adverse effects, especially those related to retina. Attention is especially directed to the treatment of pregnant women. Antimalarials favorable effectiveness-toxicity proportion advises consider them in the management of autoimmune diseases (AU)

Varón de 25 años con debilidad muscular y alteraciones electrocardiográficas tras ejercicio físico / 25-year-old male with muscular weakness and electrocardiographic changes after exercise

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El tratamiento del lupus eritematoso sistémico. Utilización de antipalúdicos en enfermedades inflamatorias / Systemic lupus erythematous therapy. Antimalarials is inflammatory diseases

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