Differences in clinical manifestations and increased severity of systemic lupus erythematosus between two groups of Hispanics: European Caucasians versus Latin American mestizos (data from the RELESSER registry).

BACKGROUND: Systemic lupus erythematosus (SLE) is regarded as a prototype autoimmune disease because it can serve as a means for studying differences between ethnic minorities and sex. Traditionally, all Hispanics have been bracketed within the same ethnic group, but there are differences between Hispanics from Spain and those from Latin America, not to mention other Spanish-speaking populations. OBJECTIVES: This study aimed to determine the demographic and clinical characteristics, severity, activity, damage, mortality and co-morbidity of SLE in Hispanics belonging to the two ethnic groups resident in Spain, and to identify any differences. METHODS: This was an observational, multi-centre, retrospective study. The demographic and clinical variables of patients with SLE from 45 rheumatology units were collected. The study was conducted in accordance with Good Clinical Practice guidelines. Hispanic patients from the registry were divided into two groups: Spaniards or European Caucasians (EC) and Latin American mestizos (LAM). Comparative univariate and multivariate statistical analyses were carried out. RESULTS: A total of 3490 SLE patients were included, 90% of whom were female; 3305 (92%) EC and 185 (5%) LAM. LAM patients experienced their first lupus symptoms four years earlier than EC patients and were diagnosed and included in the registry younger, and their SLE was of a shorter duration. The time in months from the first SLE symptoms to diagnosis was longer in EC patients, as were the follow-up periods. LAM patients exhibited higher prevalence rates of myositis, haemolytic anaemia and nephritis, but there were no differences in histological type or serositis. Anti-Sm, anti-Ro and anti-RNP antibodies were more frequently found in LAM patients. LAM patients also had higher levels of disease activity, severity and hospital admissions. However, there were no differences in damage index, mortality or co-morbidity index. In the multivariate analysis, after adjusting for confounders, in several models the odds ratio (95% confidence interval) for a Katz severity index >3 in LAM patients was 1.45 (1.038-2.026; p = 0.02). This difference did not extend to activity levels (i.e. SLEDAI >3; 0.98 (0.30-1.66)). CONCLUSION: SLE in Hispanic EC patients showed clinical differences compared to Hispanic LAM patients. The latter more frequently suffered nephritis and higher severity indices. This study shows that where lupus is concerned, not all Hispanics are equal.

Relationship between damage and mortality in juvenile-onset systemic lupus erythematosus: Cluster analyses in a large cohort from the Spanish Society of Rheumatology Lupus Registry (RELESSER).

OBJECTIVES: To identify patterns (clusters) of damage manifestation within a large cohort of juvenile SLE (jSLE) patients and evaluate their possible association with mortality. METHODS: This is a multicentre, descriptive, cross-sectional study of a cohort of 345 jSLE patients from the Spanish Society of Rheumatology Lupus Registry. Organ damage was ascertained using the Systemic Lupus International Collaborating Clinics Damage Index. Using cluster analysis, groups of patients with similar patterns of damage manifestation were identified and compared. RESULTS: Mean age (years) ±â€¯S.D. at diagnosis was 14.2 ±â€¯2.89; 88.7% were female and 93.4% were Caucasian. Mean SLICC/ACR DI ±â€¯S.D. was 1.27 ±â€¯1.63. A total of 12 (3.5%) patients died. Three damage clusters were identified: Cluster 1 (72.7% of patients) presented a lower number of individuals with damage (22.3% vs. 100% in Clusters 2 and 3, P < 0.001); Cluster 2 (14.5% of patients) was characterized by renal damage in 60% of patients, significantly more than Clusters 1 and 3 (P < 0.001), in addition to increased more ocular, cardiovascular and gonadal damage; Cluster 3 (12.7%) was the only group with musculoskeletal damage (100%), significantly higher than in Clusters 1 and 2 (P < 0.001). The overall mortality rate in Cluster 2 was 2.2 times higher than that in Cluster 3 and 5 times higher than that in Cluster 1 (P < 0.017 for both comparisons). CONCLUSIONS: In a large cohort of jSLE patients, renal and musculoskeletal damage manifestations were the two dominant forms of damage by which patients were sorted into clinically meaningful clusters. We found two clusters of jSLE with important clinical damage that were associated with higher rates of mortality, especially for the cluster of patients with predominant renal damage. Physicians should be particularly vigilant to the early prevention of damage in this subset of jSLE patients with kidney involvement.

[Corticosteroids and osteoporosis]. / Corticoides y osteoporosis.

Corticosteroids are the principal cause of secondary osteoporosis due to drug treatment. Doses of more than 5 mg daily and periods of treatment lasting more than 3 months increase the risk of osteoporosis and fragility fractures. It is therefore essential to be aware of measures to reduce the risk of osteoporosis in our patients.

Undernutrition in rheumatoid arthritis patients with disability.

Clinical evaluation of nutritional status (NS) was performed in 75 rheumatoid arthritis patients. They were distributed according to functional class, radiological stage and other prognostic factors (rheumatoid factor, extraarticular disease, disease duration). Evaluation of the different anthropometrical measurements in this group of long-standing RA patients (average disease duration: 10 years) revealed a significant impairment of lean body mass (LBM), especially among those with greater disability (Functional Class III and IV). Patients in more severe radiological stages (Radiological Stage III and IV) or patients with extraarticular disease also presented a significant loss of LBM compared with a matched cohort of the general population and patients with a more benign-course disease. There was less impairment of the fat mass, according to our clinical evaluation. Serological parameters of undernutrition (albumin and transferrin) did not show significant differences among the groups of patients. Clinical evaluation of NS in RA patients is a useful procedure for recognising patients at high risk of related complications by means of their poor nutritional status.

[The evolution of the clinical activity of systemic lupus erythematosus after a kidney transplant]. / Evolución de la actividad clínica del lupus eritematoso sistémico postrasplante renal.

BACKGROUND: To study the clinical activity of systemic lupus erythematosus (SLE) in recipients of renal transplants (rT) performed by terminal renal failure (TRF) secondary to lupus nephritis. METHODS: The clinical evolution of 11 patients with SLE (ARA criteria) and TRF were evaluated with a descriptive character by the modified index of activity SLE-DAI during dialysis periods and post rT as well as in the course prior to disease. A comparative analysis was carried out in a control group of 25 patients with SLE without renal failure. RESULTS: The indexes of activity of the group investigated were higher than those of the control group during the predialysis period, similar in the dialysis period and significantly decreased (p < 0.01) in the post rT. In the group with rT a significant decrease was reported in the indexes of activity in the periods of dialysis (p < 0.05) and post rT (p < 0.01) with respect to the previous period. A significant reduction was observed in the post rT therapeutic options. CONCLUSIONS: The clinical activity of systemic lupus erythematosus is reduced in the terminal renal failure in dialysis. The most significant reduction of clinical activity is found after renal transplantation.

Community health advocacy: primary health care nurse-advocate teams in urban communities.

In summary, our health advocacy program uses PHC teams in urban, underserved communities to deal with the interaction of social and health factors in solving problems related to access to appropriate (as perceived by residents) and affordable health care. This approach encourages grass-roots participation in problem identification and solution, a fundamental ingredient of community empowerment. Further, this program facilitates community identification of nurses as resource persons who encourage collaboration to improve the community's health status and as health providers who enhance the authority and autonomy of community participation in the resolution of health issues.

The use of daily fetal movement records in a clinical setting.

A variety of biochemical and biophysical techniques are used for the assessment of fetal well-being in high-risk pregnancy. Based on clinical experience, the daily fetal movement record has been found to be an inexpensive, non-invasive, simple tool that may be used for the continuous assessment of the fetus by the mother. The daily fetal movement record may predict fetal distress occurring in the interim between other assessments. Patients are instructed to count the number of fetal movements perceived in a 30-minute period, three times per day. The daily fetal movement record is a screening tool that may signal the need for further fetal well-being assessment. The tool promotes the mother's active participation in assessment of her high-risk fetus and may encourage maternal-fetal attachment.

Breast massage to obtain contraction stress test.

A standard contraction stress test (CST) is usually obtained by the intravenous infusion of exogenous oxytocin for 1 to 3 hours. To assess whether breast massage could elicit a CST, 30 high-risk pregnant women between 37 and 44 weeks gestation massaged their breasts with mineral oil for a maximum of 40 to 60 minutes. Of the 21 patients (70%) who met the CST criterion, 15 had at least one spontaneous uterine contraction in the 20 minutes preceding breast massage, p = .05. Thirty-three percent of those who met the CST criterion did so within 10 minutes of the start of breast massage, and 95% met the criterion within 40 minutes. Other factors, including weeks gestation, parity, overstimulation, and fetal heart rate deceleration that could reasonably influence the effectiveness of the procedure are discussed. Breast massage appears to be an effective method for meeting the CST criterion.

[HLA haplotypes in congenital adrenal hyperplasia (21-hydroxylase deficiency]. / Haplotipos HLA en la hiperplasia suprarrenal congénita (deficiencia de 21-hidroxilasa).

In order to study HLA haplotypes in congenital adrenal hyperplasia secondary to 21 hydroxylase (21-OH) deficiency, HLA typing was performed in Three families with six affected members. HLA genotypes revealed that in family number 1, two of the three affected members with CAH 21-OH presented salt-losing syndrome and were genotypically identical for HLA A1, B15/A32, Bw35. Family number 2 had two affected members with CAH 21-OH and salt-losing and they were genotypically identical for HLA A11, Bw51/A29, B12. In family number 3, only one of three members presented CAH 21-OH without salt-losing and was HLA homozygous A29, B12/A29, B12; the other two family members were heterozygous with genotype HLA A2, B37/A29, B12. The study suggests that haplotype HLA A29, B12 is related to CAH 21-OH with or without salt-losing syndrome.