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.

Relationship between rheumatoid arthritis and Mycoplasma pneumoniae: a case-control study.

OBJECTIVE: Rheumatoid arthritis (RA) has a complex and multifactorial aetiology. Infectious agents could start this disease. The majority of the characteristics of this infirmity can be observed in chronic arthritis produced by mycoplasmas in animals. In this study the association between Mycoplasma pneumoniae and RA has been evaluated. METHODS: A case-control study was performed. Sera taken from 78 RA patients and from 156 controls were analysed to ascertain the levels of immunoglobulin G (IgG) against M. pneumoniae. Other variables, like age, gender, work status, history of pneumonia, etc., were recorded in a questionnaire. RESULTS: The presence of antibodies against M. pneumoniae was associated with RA (odds ratio=2.34, P<0.001). CONCLUSIONS: The results suggest that M. pneumoniae could be a cofactor in the pathogenesis of RA; however, more studies need to be done.

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.