Remission and Low Disease Activity Status (LDAS) protect lupus patients from damage occurrence: data from a multiethnic, multinational Latin American Lupus Cohort (GLADEL).

OBJECTIVE: To evaluate disease activity statuses' (DAS') impact on systemic lupus erythematosus (SLE) outcomes. MATERIALS AND METHODS: Four DAS were defined: remission off-therapy: SLE Disease Activity Index (SLEDAI)=0, no prednisone or immunosuppressive drugs (IS); remission on-therapy: SLEDAI=0, prednisone ≤5 mg/day and/or IS (maintenance); low (L) DAS: SLEDAI ≤4, prednisone ≤7.5 mg/day and/or IS (maintenance); non-optimally controlled: SLEDAI >4 and/or prednisone >7.5 mg/day and/or IS (induction). Antimalarials were allowed in all. Predefined outcomes were mortality, new damage (increase of at least one Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) damage index (SDI) point) and severe new damage (increase of at least 3 SDI points). Univariable and multivariable Cox regression models were performed to define the impact of DAS, as time-dependent variable, on these outcomes. RESULTS: 1350 patients were included, 79 died during follow-up, 606 presented new and 177 severe new damage. In multivariable analyses, remission (on/off-therapy) was associated with a lower risk of new (HR 0.60; 95% CI 0.43 to 0.85), and of severe new damage (HR 0.32; 95% CI 0.15 to 0.68); low disease activity status (LDAS) was associated with a lower risk of new damage (HR 0.66; 95% CI 0.48 to 0.93) compared with non-optimally controlled. No significant effect on mortality was observed. CONCLUSIONS: Remission was associated with a lower risk of new and severe new damage; LDAS with a lower risk of new damage after adjusting for other damage confounders.

Síndrome de artritis dermatitis en niños / Arthritis dermatitis in child

La reumatología pediátrica es un área en la cual falta mucho por explorar. Compromete una gran serie de entidades cuya prevalencia, fisiopatología y forma de presentación puede ser diferente a la de los adultos. Hay enfermedades cuyos signos articulares se asocian a hallazgos dermatológicos que nos pueden servir de ayuda para una aproximación diagnóstica. Tanto enfermedades infecciosas, autoinmunes, neoplásicas como endocrinológicas se pueden presentar como síndrome artritis dermatitis, sin embargo, en el grupo pediátrico, las infecciosas e inmunológicas ocupan el mayor porcentaje. Los virus-parvovirus, rubéola, VIH, las bacterias -gonococo, meningococo-, son las causas infecciosas más frecuentes. Dentro del grupo de enfermedades autoinmunes, las vasculitís, específicamente púrpura de Henoch-Schonlein, y la enfermedad de Kawasaki, son las más prevalentes en esta edad como causa de artritis dermatitis. Se hace una revisión de manera general de las causas de síndrome artritis dermatitis de mayor importancia en el grupo pediátrico