Pleuropulmonary involvement in patients with systemic lupus erythematosus from a Latin American inception cohort (GLADEL).

Objectives The objectives of this study were to examine the demographic and clinical features associated with the occurrence of pleuropulmonary manifestations, the predictive factors of their occurrence and their impact on mortality in systemic lupus erythematosus (SLE) patients. Materials and methods The association of pleuropulmonary manifestations with demographic and clinical features, the predictive factors of their occurrence and their impact on mortality were examined in GLADEL patients by appropriate univariable and multivariable analyses. Results At least one pleuropulmonary manifestation occurred in 421 of the 1480 SLE patients (28.4%), pleurisy being the most frequent (24.0%). Age at SLE onset ≥30 years (OR 1.42; 95% CI 1.10-1.83), the presence of lower respiratory tract infection (OR 3.19; 95% CI 2.05-4.96), non-ischemic heart disease (OR 3.17; 95% CI 2.41-4.18), ischemic heart disease (OR 3.39; 95% CI 2.08-5.54), systemic (OR 2.00; 95% CI 1.37-2.91), ocular (OR 1.58; 95% CI 1.16-2.14) and renal manifestations (OR 1.44; 95% CI 1.09-1.83) were associated with pleuropulmonary manifestations, whereas cutaneous manifestations were negatively associated (OR 0.47; 95% CI 0.29-0.76). Non-ischemic heart disease (HR 2.24; 95% CI 1.63-3.09), SDI scores ≥1 (OR 1.54; 95% CI 1.10-2.17) and anti-La antibody positivity (OR 2.51; 95% CI 1.39-4.57) independently predicted their subsequent occurrence. Cutaneous manifestations were protective of the subsequent occurrence of pleuropulmonary manifestations (HR 0.62; 95% CI 0.43-0.90). Pleuropulmonary manifestations independently contributed a decreased survival (HR: 2.79 95% CI 1.80-4.31). Conclusion Pleuropulmonary manifestations are frequent in SLE, particularly pleuritis. Older age, respiratory tract infection, cardiac, systemic and renal involvement were associated with them, whereas cutaneous manifestations were negatively associated. Cardiac compromise, SDI scores ≥1 and anti-La positivity at disease onset were predictive of their subsequent occurrence, whereas cutaneous manifestations were protective. They independently contributed to a decreased survival in these patients.

Características diferenciales entre espondilitis anquilosante pura y espondilitis psoriásica en pacientes argentinos / Differential features between pure ankylosing spondylitis and spondylitis associated to psoriasis in argentine patients

El compromiso axial, característico de la Espondilitis Anquilosante (EA), puede también presentarse en pacientes con diagnóstico de Artritis Psoriásica (APs). El objetivo del presente estudio fue describir las características diferenciales de pacientes con diagnóstico de EA pura comparados con los pacientes con APs y compromiso axial asociado, ingresados en el Registro Iberoamericano de Espondiloartropatías (SpA) (RESPONDIA-Argentina). Pacientes y métodos: Se seleccionaron aquellos pacientes que cumplían criterios de Nueva York modificados, pertenecientes a la cohorte prospectiva, observacional y multicéntrica de SpA en Argentina (RESPONDIA-Argentina), que acudieron a la consulta ambulatoria entre junio y diciembre del 2006. Los datos fueron extraídos online de la base REGISPONSER. Se recolectaron datos de actividad de la enfermedad, status funcional, características clínicas y radiológicas, tratamiento y calidad de vida, mediante herramientas validadas.Análisis estadístico: Para la comparación de datos categóricos se utilizó el Test de Chi Cuadrado o Test Exacto de Fisher y para las variables continuas el Test de Student y Test de Mann-Whitney. Se consideró significativa una p <0,05. Resultados: Se incluyeron 140 pacientes, 86 (61,4%) presentaban diagnóstico de EA y 54 (38,6%) Espondilitis Psoriásica (EPs). El tiempo de evolución de la enfermedad fue comparable en ambos grupos (mediana 3 vs. 5,5 años, respectivamente). En pacientes con diagnóstico de EA predominó en forma significativa el sexo masculino 88% vs. 48,1% (p <0,05), el antecedente de lumbalgia 81,4% vs. 51,9% (p <0,05), la presencia de síndrome sacroilíaco 52,3% vs. 33,3% (p <0,05), el antecedente de historia familiar de SpA 23,4% vs. 7,7% (p <0,05) y el compromiso moderado de caderas 20,9% vs. 2,1%(p<0,05)...

Axial involvement, characteristic feature of Ankylosing Spondylitis(AS), can also be present in patients with Psoriatic Arthritis (PsA).Purpose: To describe differential characteristics of the axial involvementin AS as compared with that seen in PsA patients. Patients and methods: Consecutive Spondyloarthritis (SpA) patients attending ambulatory care in 11 rheumatology services locatedin 6 different Argentine provinces between June and December2006 were enrolled. Patients were diagnosed in accordance to the classification criteria of the European Spondyloarhtropathy Study Group (ESSG), and were included in a prospective, observational and multi-centre cohort of SpA in Argentina (RESPONDIAArgentina). Data were collected, transmitted on-line and stored in the Spanish SpA Registry (REGISPONSER) website. Demographic,disease activity and functional status, clinical forms, treatment and quality of life data were collected by means of validated tools. For this analysis, patients were selected only if they met modified New York criteria for AS.Statistical analysis: Categorical...

Validation of the Spanish, Portuguese and French versions of the Lupus Damage Index questionnaire: data from North and South America, Spain and Portugal.

We have previously developed and validated a self-administered questionnaire, modelled after the Systemic Lupus International Collaborating Clinics Damage Index (SDI), the Lupus Damage Index Questionnaire (LDIQ), which may allow the ascertainment of this construct in systemic lupus erythematosus (SLE) patients followed in the community and thus expand observations made about damage. We have now translated, back-translated and adapted the LDIQ to Spanish, Portuguese and French and applied it to patients followed at academic and non-academic centres in North and South America, Portugal and Spain while their physicians scored the SDI. A total of 887 patients (659 Spanish-speaking, 140 Portuguese-speaking and 80 French-speaking patients) and 40 physicians participated. Overall, patients scored all LDIQ versions higher than their physicians (total score and all domains). Infrequent manifestations had less optimal clinimetric properties but overall agreement was more than 95% for the majority of items. Higher correlations were observed among the Spanish-speaking patients than the Portuguese-speaking and French-speaking patients; further adjustments may be needed before the Portuguese and French versions of the LDIQ are applied in community-based studies. The relationship between the LDIQ and other outcome parameters is currently being investigated in a different patient sample.

Amerindian ancestry in Argentina is associated with increased risk for systemic lupus erythematosus.

Previous studies have demonstrated that in admixed populations, West African ancestry is associated with an increased prevalence of systemic lupus erythematosus (SLE). In the current study, the effect of Amerindian ancestry in SLE was examined in an admixed population in Argentina. The Argentine population is predominantly European with approximately 20% Amerindian admixture, and a very small (<2%) contribution from West Africa. The results indicate that Amerindian admixture in this population is associated with a substantial increase in SLE susceptibility risk (Odds Ratio=7.94, P=0.00006). This difference was not due to known demographic factors, including site of collection, age and gender. In addition, there were trends towards significance for Amerindian ancestry influencing renal disease, age of onset and anti-SSA antibodies. These studies suggest that populations with Amerindian admixture, like those with West African admixture, should be considered in future studies to identify additional allelic variants that predispose to SLE.

No evidence of association between genetic variants of the PDCD1 ligands and SLE.

PDCD1, an immunoreceptor involved in peripheral tolerance has previously been shown to be genetically associated with systemic lupus erythematosus (SLE). PDCD1 has two ligands whose genes are located in close proximity on chromosome 9p24. Our attention was drawn to these ligands after finding suggestive linkage to a marker (gata62f03, Z=2.27) located close to their genes in a genome scan of Icelandic families multiplex for SLE. Here, we analyse Swedish trios (N=149) for 23 single nucleotide polymorphisms (SNPs) within the genes of the PDCD1 ligands. Initially, indication of association to eight SNPs was observed, and these SNPs were therefore also analysed in Mexican trios (N=90), as well as independent sets of patients and controls from Sweden (152 patients, 448 controls) and Argentina (288 patients, 288 controls). We do not find support for genetic association to SLE. This is the first genetic study of SLE and the PDCD1 ligands and the lack of association in several cohorts implies that these genes are not major risk factors for SLE.