¿Es la nefritis lúpica un factor pronóstico en el embarazo? Resultados maternos y fetales / Is Lupus Nephritis a Prognosis Factor for Pregnancy? Maternal and Foetal Outcomes

Introducción: La preexistencia de nefritis lúpica (NL) es un factor de riesgo importante al planificar un embarazo debido al riesgo de complicaciones. Objetivo: Evaluar complicaciones maternas y fetales en la gestación de mujeres con lupus eritematoso sistémico (LES) con y sin NL previa a la concepción. Métodos: Se estudiaron retrospectivamente todas las pacientes lúpicas embarazadas con y sin NL previa, asistidas desde enero de 2015 hasta abril de 2017. Se analizaron datos demográficos, clínicos y de laboratorio, presencia de anticuerpos antifosfolípidos (AAF) y síndrome antifosfolípido (SAF) según criterios de Sydney, resultados maternos y fetales.Resultados: Se incluyeron 79 pacientes, 40 con NL previa y 39 sin NL, sumando 121 embarazos (52 sin NL y 69 con NL). El grupo NL registró mayor porcentaje de presencia de AAF, SAF y mayor SLEDAI basal, además recibieron más terapia inmunosupresora y corticoidea. En NL fue más frecuente la claseIV (47,5%): 25,8% en el grupo NL vs 10,9% (p=0,041) tuvieron reactivaciones, especialmente renales, sin desarrollo de enfermedad renal terminal. La preeclampsia fue mayor en el grupo con NL: 18,8% vs 6,3% sin NL (p=0,047). Registramos una muerte materna en el grupo NL. La vía de finalización fue cesárea (68,5% en el grupo NL y 31,5% en grupo sin NL), siendo más frecuente de urgencia en el grupo con NL. En resultados fetales, no hubo diferencia en porcentaje de nacidos vivos, peso del neonato ni edad gestacional. Se registraron 3 muertes fetales: 2 en el grupo con NL y 1 en el otro. Conclusión: Las pacientes con NL sufrieron más complicaciones maternas como brote lúpico y preeclampsia. Sin embargo, la NL no conduciría a peores resultados obstétricos ni fetales.

Background: Pregnancy in women with systemic lupus erythematosus (SLE) and nephritis (LN) is at risk of foetal and maternal complications. Objective: to evaluate the effect of LN on pregnancy with respect to foetal and maternal outcome.Methods: We retrospectively studied all pregnant SLE patients with and without diagnosis of LN, who attended the Materno Neonatal Hospital in Cordoba city, Argentina, from January 2015 to April 2017. Demographic, clinical, and laboratory data were collected. The presence of antiphospholipid syndrome (APS) and antiphospholipid antibodies (AAF), and maternal and foetal outcome were evaluated. Results: 121 pregnancies in 79 patients were included. Pregnancies were divided into those with LN (69) and those without LN (52). The presence of APS and AAF was more frequent in the LN group as well as higher basal SLEDAI. The LN group received more immunosuppressive therapy and increased steroid dose treatment. Of the patients, 47.5% had ClassIV LN. Lupus flares occurred more frequently in the LN group 25.8% vs 10.9% in the group without LN (P=.041), mainly renal flares in the LN group. No patients developed end-stage renal failure. Preeclampsia was more frequent in the LN group, 18.8% vs 6.3% in the group without LN (P=.047). There was only one maternal death. A caesarean section was required in 68.5% of the LN group vs 31.5 in the group without LN, and urgent caesarean section was also performed in the LN group. There were no differences in foetal outcomes in either group: live birth, gestational age, weight birth, perinatal death, foetal distress.Conclusions: Patients with LN experienced more maternal complications such as lupus flares and preeclampsia. However, LN does not lead to a worse pregnancy and foetal outcome. Patients should be strictly monitored before and after conception.(AU)

Is lupus nephritis a prognosis factor for pregnancy? Maternal and foetal outcomes.

BACKGROUND: Pregnancy in women with systemic lupus erythematosus (SLE) and nephritis (LN) is at risk of foetal and maternal complications. OBJECTIVE: To evaluate the effect of LN on pregnancy with respect to foetal and maternal outcome. METHODS: We retrospectively studied all pregnant SLE patients with and without diagnosis of LN, who attended the Materno Neonatal Hospital in Cordoba city, Argentina, from January 2015 to April 2017. Demographic, clinical, and laboratory data were collected. The presence of antiphospholipid syndrome (APS) and antiphospholipid antibodies (AAF), and maternal and foetal outcome were evaluated. RESULTS: 121 pregnancies in 79 patients were included. Pregnancies were divided into those with LN (69) and those without LN (52). The presence of APS and AAF was more frequent in the LN group as well as higher basal SLEDAI. The LN group received more immunosuppressive therapy and increased steroid dose treatment. Of the patients, 47.5% had Class IV LN. Lupus flares occurred more frequently in the LN group 25.8% vs 10.9% in the group without LN (P = .041), mainly renal flares in the LN group. No patients developed end-stage renal failure. Preeclampsia was more frequent in the LN group, 18.8% vs 6.3% in the group without LN (P = .047). There was only one maternal death. A caesarean section was required in 68.5% of the LN group vs 31.5 in the group without LN, and urgent caesarean section was also performed in the LN group. There were no differences in foetal outcomes in either group: live birth, gestational age, weight birth, perinatal death, foetal distress. CONCLUSIONS: Patients with LN experienced more maternal complications such as lupus flares and preeclampsia. However, LN does not lead to a worse pregnancy and foetal outcome. Patients should be strictly monitored before and after conception.

Work productivity and activity impairment in patients with primary Sjögren's syndrome.

OBJECTIVES: In this observational, analytical, cross-sectional study we aimed to describe the impact of primary Sjögren's syndrome (pSS) on work productivity and activities of daily living (ADL) to assess the association between ADL impairment and clinical manifestations and to compare ADL impairment according to patients' socioeconomic condition. METHODS: Patients diagnosed with pSS attending 11 centres from Argentina were included. To evaluate work productivity and ADL impairment, a work productivity and activity impairment questionnaire (WPAI) was used. A multiple linear regression model was performed, considering deterioration on ADL due to health as a dependent variable, adjusted for potential confounders. RESULTS: 252 patients were included, 98.4% were women, with a mean age of 52.6 years (±14.8). The average percentage of time lost due to health was 15.7 hours (±30.1 95% CI: 9.6-21.9); the decrease in work productivity was 27.2 (±30.2 95% CI: 21.3-33.1), the total disability was 33.7 (±35.8 95% CI: 26.4-4) and ADL deterioration was 34.2 (±30.9. 95% CI: 30.4-38). In the multivariate analysis, xerostomia, arthritis and depression showed significant and independent association. The mean of ADL impairment was 38.2 (±30.7) in patients attending public centres versus 28 (± 30.6) in private centres, which was a statistically significant difference. CONCLUSIONS: We found a compromise in all WPAI domains. Arthritis, xerostomia and depression were associated significantly and independently with ADL impairment. Deterioration in ADL was greater in patients treated in public centres. Considering these aspects will allow a better understanding of patients who suffer from this disease.

Sobrevida, eficacia y seguridad de Golimumab en pacientes con Artritis Reumatoidea y Espondiloartritis: Datos de una cohorte argentina / Survival, efficacy and safety of Golimumab in patients with Rheumatoid Arthritis and Spondyloarthritis: Data from an Argentine cohort

Objetivos: Golimumab ha sido aprobado para el tratamiento de pacientes con artritis reumatoidea (AR), artritis psoriásica (APs) y espondiloartritis axial. Sin embargo, los datos provenientes de nuestra región son escasos. El objetivo de este estudio fue evaluar la eficacia, seguridad y sobrevida acumulada de golimumab en pacientes de la vida real con AR, APs y espondilitis anquilosante (EA) de diferentes centros de Argentina. Material y métodos: Se llevó a cabo un estudio longitudinal, en el que se incluyeron pacientes consecutivos mayores de 18 años con diagnóstico de AR (criterios ACR/EULAR 2010), APs (criterios CASPAR) y Espax (criterios ASAS 2009), que hayan iniciado tratamiento con golimumab de acuerdo a la indicación médica. Se obtuvieron los datos por revisión de historias clínicas. Se consignaron características sociodemográficas, clínicas, comorbilidades y tratamientos previos. Con respecto al golimumab, se registraron fecha de inicio, vía de administración y tratamientos concomitantes. Se determinó la actividad de la enfermedad mediante DAS28 en el caso de la AR, por DAPSA y MDA para APs y por BASDAI en el caso de Espax. Se consignó la presencia de eventos adversos (EA). En el caso de suspensión del tratamiento, se identificaron la fecha y motivo del mismo. Los pacientes fueron seguidos hasta la suspensión del golimumab, pérdida de seguimiento, muerte, o finalización del estudio (30 de noviembre de 2020). Resultados: Se incluyeron 182 pacientes, 116 con diagnóstico de AR, 30 con APs y 36 con Espax. La mayoría de ellos (70.9%) eran mujeres con una edad mediana (m) de 55 años (RIC 43.8-64) y una duración de la enfermedad m de 7 años (RIC 4-12.7) al inicio del tratamiento. El 34.6% de los mismos habían recibido al menos una droga modificadora de la enfermedad (DME) biológica (-b) o sintética dirigida (-sd) previamente. El seguimiento total fue de 318.1 pacientes/año. El tratamiento con golimumab mostró mejoría clínica en los tres grupos de pacientes. La incidencia de eventos adversos fue de 6.6 por 100 pacientes/año, siendo las infecciones las más frecuentes. Durante el seguimiento, 50 pacientes (27.5%) suspendieron golimumab, la causa más frecuente fue el fracaso del tratamiento (68%), seguida de la falta de cobertura (16%) y el desarrollo de eventos adversos (10%). La persistencia de golimumab fue del 76% y 68% a los 12 y 24 meses, respectivamente. Se registró una sobrevida de 50.2 meses (IC 95% 44.4-55.9). Los pacientes que habían recibido tratamiento previo con DME-b y/o -sd mostraron una menor sobrevida (HR 2.4, IC 95% 1.3-4.4). Conclusiones: El tratamiento con golimumab en pacientes de la vida real en Argentina ha demostrado una buena eficacia y seguridad. La sobrevida del fármaco fue de más de 4 años y casi el 80% seguía usando golimumab después de un año. El tratamiento previo con otros DME-b o -sd se asoció con una menor sobrevida al tratamiento.

Objectives: Golimumab is approved for patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA) and axial spondyloarthritis. However, data from our region are scarce. The aim of this study was to evaluate the efficacy, safety, and cumulative survival of golimumab in real-life patients with RA, PsA and axial spondyloarthritis (axSpa) from different rheumatology centers in Argentina. Material and methods: We performed a longitudinal study of consecutive adults with RA (ACR/EULAR 2010 criteria), PsA (CASPAR criteria) and axSpa (ASAS 2009 criteria), who have started treatment with golimumab according to medical indication. Data was obtained by review of medical records. Sociodemographic and clinical data, musculoskeletal manifestations, comorbidities and previous treatments were recorded. In reference to golimumab treatment, start date, route of administration and concomitant treatments were identified. Disease activity was assessed using DAS28 for RA patients, DAPSA and MDA for PsA and BASDAI for axSpa. The presence of adverse events was recorded. If golimumab was stopped, date and cause was documented. Patients were followed up until golimumab discontinuation, loss of follow-up, death, or study completion (November 30, 2020). Results: In total 182 patients were included, 116 with a diagnosis of RA, 30 with PsA and 36 with axSpa. Most of them (70.9%) were female with a median (m) age of 55 years (IQR 43.8-64) and m disease duration of 7 years (IQR 4-12.7) at treatment initiation. Al least one prior biological (-b) and/or targeted synthetic (-ts) disease modifying antirheumatic drug (DMARD) was received by 63 patients (34.6%). Total follow-up was 318.1 patients/year. Golimumab treatment showed clinical improvement in all three groups of patients. The incidence of AE was 6.6 per 100 patients/year, being infections the most frequents ones. During follow-up, 50 patients (27.5%) discontinued golimumab, the most frequent cause was treatment failure (68%), followed by lack of health insurance (16%) and adverse events (10%). Golimumab persistence was 76% and 68% at 12 and 24 months, respectively. Treatment survival was 50.2 months (95% CI 44.4-55.9). Patients who had received prior treatment with b- or ts-DMARDs showed lower survival (HR 2.41, 95% CI 1.3-4.4). Conclusions: Golimumab treatment in real life patients in Argentina has shown good efficacy and safety. Drug survival was over 4 years and almost 80% were still using golimumab after one year. Prior treatment with other b- or ts-DMARDs was associated with lower treatment survival.

Is Lupus Nephritis a Prognosis Factor for Pregnancy? Maternal and Foetal Outcomes. / ¿Es la nefritis lúpica un factor pronóstico en el embarazo? Resultados maternos y fetales.

BACKGROUND: Pregnancy in women with systemic lupus erythematosus (SLE) and nephritis (LN) is at risk of foetal and maternal complications. OBJECTIVE: To evaluate the effect of LN on pregnancy with respect to foetal and maternal outcome. METHODS: We retrospectively studied all pregnant SLE patients with and without diagnosis of LN, who attended the Materno Neonatal Hospital in Cordoba city, Argentina, from January 2015 to April 2017. Demographic, clinical, and laboratory data were collected. The presence of antiphospholipid syndrome (APS) and antiphospholipid antibodies (AAF), and maternal and foetal outcome were evaluated. RESULTS: 121 pregnancies in 79 patients were included. Pregnancies were divided into those with LN (69) and those without LN (52). The presence of APS and AAF was more frequent in the LN group as well as higher basal SLEDAI. The LN group received more immunosuppressive therapy and increased steroid dose treatment. Of the patients, 47.5% had ClassIV LN. Lupus flares occurred more frequently in the LN group 25.8% vs 10.9% in the group without LN (P=.041), mainly renal flares in the LN group. No patients developed end-stage renal failure. Preeclampsia was more frequent in the LN group, 18.8% vs 6.3% in the group without LN (P=.047). There was only one maternal death. A caesarean section was required in 68.5% of the LN group vs 31.5 in the group without LN, and urgent caesarean section was also performed in the LN group. There were no differences in foetal outcomes in either group: live birth, gestational age, weight birth, perinatal death, foetal distress. CONCLUSIONS: Patients with LN experienced more maternal complications such as lupus flares and preeclampsia. However, LN does not lead to a worse pregnancy and foetal outcome. Patients should be strictly monitored before and after conception.

Subclinical markers of atherosclerosis and cardiovascular risk factors in early arthritis. / [Marcadores subclínicos de aterosclerosis y factores de riesgo cardiovascular en artritis temprana.]

Background: Mortality from cardiovascular disease (CVD) is increased in rheumatoid arthritis, not explained by traditional cardiovascular risk factors (CVRF), suggesting a role of inflammation. This process would occur early. The common sonographic markers of subclinical atherosclerosis (SA), are increased carotid intima-media thickness (cIMT) or the presence of carotid atherosclerotic plaque and they are closely related to CVD. Aims: To evaluate sonographic markers and cardiovascular risk factors in early Arthritis (EA). Methods: A case control study of patients with EA, defined by 3 joints swollen with <1 year of evolution, served consecutively from January 2011 to may 2013, matched with healthy controls, by sex, age and cardiovascular risk factors (hypertension, diabetes mellitus, cardiovascular disease -IAM and ACV, dyslipidemia, family history of CVD) was conducted. We studied demographics data, cardiovascular risk factors, carotid ultrasound measuring increased cIMT or the presence of carotid atherosclerotic plaque in Common Carotid Artery (CCA) and Carotid Bulb (BC), laboratory test that included cholesterol, LDL, HDL, triglycerides in mg%, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR ), anti citrullinated peptide (ACCP), rheumatoid factor (RF), antinuclear antibodies (ANA). EA activity was measured by DAS 28, considering high disease activity (HDA) 5.1; moderate (MDA) from 5.1 to 3.2; and low (LDA) <3.2. Statistics: test Mann-Whitney and chi-square were used, p <0.05 was significant. Results: 25 women, 5 men, average age 43 years (DS 14.7) and 30 controls were included. The average DAS 28 was 4, 8 ± 1. 8; 47% had HDA, 33%MDA and 20%BDA. Both groups had similar values cIMT CCA (0, 57 ± 0.10 mm vs. 0.58 ± 0.15 mm, respectively, P = 0.82) and cIMT BC (0.18mm ± 0.67 vs 0.62 ± 0.15 mm respectively, P = 0.47). There were no carotid plaques. The median total cholesterol was 181,5 vs 183,5 (p = 0.35); triglycerides 99 vs 92,5 (p = 0.68); HDL 54,5 vs 52,5 (p = 0.921 and LDL 105 vs 110 (p = 0.27) in EA and controls respectively. The cIMT CCA and CB were not related to RF, ACCP, CRP, DAS 28 and smoking (NS). There was no difference in other cardiovascular risk factors Conclusions: Ultrasound evidence of atherosclerosis subclinical markers was not found in this study, suggesting that this process may occur after a year of diagnosis.

Introducción: La mortalidad por Enfermedad cardiovascular (ECV) temprana está incrementada en enfermedades inflamatorias. Los marcadores ecográficos de aterosclerosis subclínica (AS) están estrechamente relacionados con ECV. Objetivo: Evaluar marcadores de AS ecográficos y Factores de Riesgo Cardiovascular (FRCV) en Artritis temprana (AT) y correlacionarlo con la actividad de la enfermedad. Material y Métodos: Estudio transversal de casos y controles en pacientes con AT, definida por 3 articulaciones inflamadas con menos de 1 año de evolución, realizado desde 2011 a 2013, apareados con controles sanos, por sexo, edad y FRCV. Se registraron datos demográficos, FRCV, rigidez de pared (cIMT) en Arteria Carótida Común (ACC) y en Bulbo Carotídeo (BC) y presencia de placas ateroscleróticas por ecografía, perfil lipídico, Proteína C Reactiva, eritrosedimentación, anticuerpos anti péptido citrulinado, Factor reumatoide, anticuerpos antinucleares. La actividad de AT se midió por Disease Activity Score (DAS) 28. Estadística: Se usaron test U de Mann-Whitney, Kruskal Wallis y chi-cuadrado, p <0,05 fue significativo. Resultados: Se incluyeron 25 mujeres, 5 hombres con edad promedio 40 años (18-61) y 30 controles. El DAS 28 promedio fue 4,8 ±1.8. Pacientes y controles tuvieron similares valores cIMT ACC (0, 57 ±0.10 mm vs 0,58 ± 0,15 mm, respectivamente) y cIMT CB (0,67 ±0,18mm vs 0,62 ±0,15 mm), no hubo placas carotídeas y el perfil lipídico fue similar en ambos grupos, PNS. El cIMT CCA y CB no tuvieron relación con DAS 28, serología, ni FRCV, P: NS. Conclusiones: La aterosclerosis subclínica se produciría después del primer año de enfermedad en artritis temprana.

Valoración de técnicas de citología en mucosa bucal en pacientes con síndrome de Sjögren / Assessment of cytology techniques in oral mucosa of Sjögren's syndrome patients

Resumen El objetivo del presente trabajo es comparar dos técnicas de estudio de citología bucal, la citología exfoliativa y de impresión, para evaluar cambios en la mucosa oral que permitan el diagnóstico no invasivo de síndrome de Sjögren (SS). Pacientes: Se seleccionaron 50 pacientes apareados por sexo y edad, diagnosticados con síndrome de Sjögren según criterios del Consenso Americano-Europeo. Los pacientes fueron distribuidos en tres grupos experimentales: controles sanos (C), n = 14, boca y ojo secos sin SS (BO), n = 13, y con SS n = 23. Material y métodos: Para la citología exfoliativa se utilizó cepillo recolector de células (Citobrush) deslizándolo a lo largo de la lámina de vidrio, fijándose posteriormente en etanol al 95%. En citologías por impresión se utilizó papel de acetato de celulosa (Milipore Hawp 304®), en tiras de un cm de longitud colocadas sobre la superficie de la mucosa bucal sobre el surco vestibular superior inmovilizando el papel y presionando por tres segundos. Se tiñeron con técnica de Papanicolau (PAP). Se valoró la morfología e histomorfometría, estudiando: área citoplasmática (AC), área nuclear (AN), relación núcleo-citoplasma (N:C) y cantidad de células por milímetro cuadrado (mm2). Resultados: Ambas técnicas nos permitieron observar en C: células epiteliales pavimentosas aisladas, basófilos, núcleos centrales normales, 20 a 30 por mm2, relación N/C 1:8. En el grupo BO: células aisladas, agrupadas y plegadas, con citoplasma a predominio eosinófilo, aumento de la cantidad de células 40 por mm2, relación núcleo-citoplasma relación N/C 1:4. En los pacientes SS se observó el área nuclear con cromatina más densa, 400 células por mm2, y relación N/C 1:2 en relación a BO y C. Hubo diferencias estadísticamente significativas entre los grupos en todas las características estudiadas. Conclusión: Podríamos inferir que la citología por impresión puede ser utilizada en el diagnóstico de lesiones orales y sistémicas en pacientes con hiposalivación.

Abstract The aim of the present research project was to compare two techniques for oral cytology study (exfoliative cytology and impression cytology) in order to assess changes in oral mucosa which might allow non -invasive diagnosis of Sjögren's syndrome cases (SS). Patients: 50 patients were selected, patients were paired by age and gender, and had been diagnosed with Sjögren's syndrome according to criteria of the American-European Consensus. Patients were distributed into the following three experimental groups: healthy control group (C), n = 14, Dry mouth and eyes group without SS, (ME) n = 13, and SS group n = 23. Material and methods: A cell harvesting brush (Cytobrush) was used for the exfoliative cytology procedure, sliding it along a glass plate and later fixating harvested cells in 95% ethanol. Cellulose acetate paper (Millipore Hawp 304®) was used for the impression cytology procedure. The paper was in 1 cm long stripes which were placed on the oral mucosa surface above upper vestibular groove; stripes were immobilized and pressure was applied for three seconds. Papanicolau (PAP) technique was used for dyeing. Morphology and histomorphology were assessed studying the following: cytoplasmic area (CA), nuclear areas (NA) nucleus-cytoplasm relationship (N:C) and amount of cells per square millimeter (mm2). Results: Both techniques revealed the following in C: isolated single-layered epithelial cells, basophils, normal central nuclei, 20 to 30 per mm2, N:C ratio 1:8. In the eye and mouth group (EM): grouped and folded isolated cells, cytoplasm with eosinophilic predominance increase of cell amount to 40 per mm2, nucleus-cytoplasm relationship N/C 1:4. SS patients showed the following: nuclear area with denser chromatin, 400 cells per mm2, and 1:2 N/C relationship with respect to mouth and ears and control. Statistically significant differences wereobserved among groups in all studied characteristics. Conclusion: We can infer that impression cytology can be used in systemic and oral lesion's diagnosis in patients afflicted with hyposalivation.

[Lipid profile in early arthritis and its relation with inflammatory activity] / Prevalencia de dislipidemia en artritis temprana y su relación con actividad inflamatoria.

Cardiovascular risk is increased in Rheumatoid Arthritis and it is associated with higher morbility and mortality. Few studies have evaluated the lipid profile in early arthritis (EA). Aims: To study the lipid profile in patients with EA and its association with disease activity (DA). Methods: We studied 31 patients with diagnosis of EA and a control group, with age, gender and cardiovascular risk factors matched, who were attended to Rheumatology Unit at Córdoba Hospital from January 2011 to May 2013. We evaluated demographic data, lipid profile and DA by DAS28. Results: 31 patients were included with mean age of 42.3 years old, 87% female , the cholesterol level was 191.9 mg/dl, HDL 54, LDL 115.8, Triglycerides 117,6; and 31 patients were included in the control group with average age of 42.7 years old, and cholesterol level of 198.7 mg / dl, HDL 56.9 LDL 122.6, Triglycerides 99.6 (p NS). Regards disease activity, in the low DA group the Cholesterol level was 196.3 , LDL 115.8, HDL 62 y triglycerides 95.17, and in the Moderate and High DA the Cholesterol level was 190 mg/ dl, LDL 115, HDL 52 y triglycerides 122,9 (p NS) Conclusions: The lipid profile was normal and it was not associated with DA in EA patients.

El riesgo cardiovascular está aumentado en pacientes con Artritis Reumatoidea establecida, con aumento de la morbimortalidad cardiovascular, inclusive tempranamente y puede ser expresión subclínica de la enfermedad. Pocos estudios han evaluado el perfil lipídico en artritis temprana (AT). Objetivos: Determinar la prevalencia y el tipo de alteración del perfil lipídico en pacientes con AT y su asociación con la actividad de la enfermedad (AE). Material y métodos: Se estudiaron pacientes con diagnóstico de AT comparados con un grupo control, apareados por sexo, edad y factores de riesgo cardiovascular, asistidos de forma consecutiva desde enero de 2011 a mayo de 2013 en el Hospital Córdoba. Se recolectaron datos demográficos, perfil lipídico y actividad de la enfermedad (AE) por Disease Activity Score (DAS 28). Se comparó el nivel de lípidos en ambos grupos y entre pacientes con artritis según el nivel de AE, clasificándolos en Baja AE y Mediana / Alta AE. P menor a 0.05 fue considerada significativa. Resultados: El número de pacientes con Artritis temprana fue de 31, con una media de edad de 42.3 años, 87% sexo femenino y el nivel de Colesterol Total promedio fue de 191.9 mg/dl, HDL 54, LDL 115.8, Triglicéridos 117,6, mientras que el grupo control fue de 31 pacientes con una media de edad de 42.7 años, con nivel promedio de Colesterol 198.7 mg/dl, HDL 56.9, LDL 122.6, Triglicéridos 99.6 (p=NS, para todas las determinaciones). En cuanto a la actividad de la enfermedad, en el grupo de Baja AE los niveles de Colesterol fueron 196.3, LDL 115.8, HDL 62 y triglicéridos 95.17 y en el grupo moderada y alta AE, Colesterol 190,1 LDL 115, 8, HDL 52 y triglicéridos 122,9 (p NS para todas las comparaciones) Conclusion: El perfil lipídico fue normal y no se encontró asociado a la AE en pacientes con AT.

[The repeated biopsy in patients with lupus nephritis]. / El rol de la biopsia repetida en pacientes con nefritis lúpica.

We retrospectively studied patients with SLE according to ACR criteria, with NL who underwent a repeat renal biopsy from 2005 to 2012. We analyzed the main indications of renal biopsies, the histopathological Class and activity and chronicity changes. RESULTS The total number of patients with NL was 120, of which 18 (15%) patients underwent repeat renal biopsy, 18 had 2 renal biopsies and 6 had 3 biopsies. 3 (16.7%) patients were smokers; 1 (5.6%) had a history of previous DBT, 2 (11.1%) had a history of hypertension; and 3 (16.7%) patients had previous obesity. The duration of SLE was 15 ± 96 months; the time between the 1st and the 2nd biopsy was 45 ± 11 months and the time between the 2nd and 3rd biopsy was 56 ± 12 months. Indications for repeat biopsy were proteinuria in 10 biopsies (41.6%); proteinuria with impaired renal function in 2 biopsies (8.3%); proteinuria with pathological urine sediment in 8 (33.3%); . and pathological proteinuria with pathological urine sediment and impaired renal function in 4 biopsies (16.6%) The most frequent histological changes found between first and repeat biopsies were class IV to class III: 2 (8.2%) ; Class IV to Class IV: 8 (33.3%), class IV to class III + V: 2 (8.2%); class IV to class IV + V 3 (12.5%); class IV to class V: 2 (8.2%). Changes in NL biopsies with proliferative activity and chronicity indices (A / C) were: A to A / C: 7 (29.1%), A / C to A / C: 7 (29.1%). The immunosuppressive therapy was increased in 79.1% and 16.6% remained without changes. 20% patients received cyclophosphamide 1 g every 30 days, 26% Cyclophosphamide 500 mg every 15 days, 23% induction therapy with mycophenolate mofetil; 23% with Rituximab; 8% Cyclosporin A. Maintenance therapy with mycophenolate mofetil was performed in 87.5%; azathioprine in 1 case. Hydroxychloroquine was used in all cases.

Se estudiaron retrospectivamente pacientes con diagnóstico de lupus eritematoso sistémico (LES) de acuerdo a criterios ACR 1982, con nefritis lúpica (NL) durante el período comprendido desde 2005 al 2012 y que fueran sometidos a una biopsia renal repetida. El número total de pacientes con NL atendidos fue de 120, de los cuales 18 (15%) pacientes fueron sometidos a biopsia renal repetida, 18 con 2 biopsias renales y 6 con 3 biopsias. 3 (16,7%) de los pacientes fueron fumadores; 1 (5,6%) poseía antecedentes de DBT previa, 2 (11,1%) poseían antecedentes de HTA; y 3 (16,7%) pacientes tenían obesidad previa. El tiempo de diagnóstico de LES al momento del estudio fue de 96 meses ± 15; el tiempo transcurrido entre la 1° y la 2° biopsia fue de 45 ± 11 meses y el tiempo entre la 2° y 3° biopsia fue de 56 ± 12 meses. Las indicaciones de la biopsia repetida fueron proteinuria en 10 biopsias (41,6%); proteinuria con alteración de la función renal en 2 biopsias (8,3%); proteinuria con sedimento patológico en 8 biopsias (33,3%); y proteinuria con sedimento patológico y alteración de la función renal en 4 biopsias (16,6%). Los cambios histológicos más frecuentes encontrados entre las primeras y las biopsias repetidas fueron: de clase IV a clase III: 2 (8,2%); clase IV a clase IV: 8 (33,3%), clase IV a clase III+V: 2 (8,2%); clase IV a clase IV+V: 3 (12,5%); clase IV a clase V: 2 (8,2%). Los cambios en las biopsias de NL proliferativas con índices de actividad y cronicidad (A/C) fueron: de A a A/C: 7 (29,1%), A/C a A/C: 7 (29,1%). La intensidad de la terapia inmunosupresora aumentó en 79,1%, se mantuvo el tratamiento inmunosupresor en 16.6%. Con respecto al cambio de medicación 7 (20%) pacientes recibieron Ciclofosfamida 1 gr cada 30 días, 9 (26%) Ciclofosfamida 500 mg cada 15 días, 8 (23%) tratamiento de reinducción con Micofenolato mofetil; Rituximab 8 (23%); y 3 (8%) Ciclosporina A. El tratamiento de mantenimiento se realizó con micofenolato mofetil en 23 casos (55%); con azatioprina en 11 (26%) casos; ciclosporina en 3 (7%) oportunidades y rituximab en 5 (12%). En todos los casos se utilizó hidroxicloroquina.

Assessing the determination of salivary electrolytes and anti-Roand anti-La antibodies for the diagnosis of Sjögren’s Syndrome (SS)

The aim of this study was to assess changes in salivary electrolyte flow and composition and the presence ofanti-Ro/SSA and anti-La/SSB serum and saliva antibodies and their implications for the non-invasive diagnosisof SS.Study design: 73 patients were studied, divided into the following experimental groups: primary Sjögren syndrome(SSp) (n=15), secondary SS (SSs) (n=17), dry mouth, dry eye without Sjögren’s syndrome (BO) (n=20)and healthy controls (C) (n=21). We conducted a baseline assessment of salivary flow and saliva sampling for themeasurement of sodium, chlorine, potassium, calcium and phosphate electrolytes, and the determination of anti-Ro/SSA and La/SSB antibodies; a serum sampling was made to assess antibody positivity.Results: Salivary flow in SSp, SSs and BO was significantly lower (p<0.001) relative to C. The salivary compositionof SS showed an increase of inorganic components. Anti-Ro/SSA and anti-La/SSB antibodies occurred morefrequently in serum and saliva in SS patients compared with BO and C, with higher frequency of positivity inserum compared with saliva.Conclusion: Our results suggest new tools that could aid the non-traumatic diagnosis of the origin of hyposalivation (AU)

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Assessing the determination of salivary electrolytes and anti-Ro and anti-La antibodies for the diagnosis of Sjögren's syndrome (SS).

UNLABELLED: The aim of this study was to assess changes in salivary electrolyte flow and composition and the presence of anti-Ro/SSA and anti-La/SSB serum and saliva antibodies and their implications for the non-invasive diagnosis of SS. STUDY DESIGN: 73 patients were studied, divided into the following experimental groups: primary Sjögren syndrome (SSp) (n=15), secondary SS (SSs) (n=17), dry mouth, dry eye without Sjögren's syndrome (BO) (n=20) and healthy controls (C) (n=21). We conducted a baseline assessment of salivary flow and saliva sampling for the measurement of sodium, chlorine, potassium, calcium and phosphate electrolytes, and the determination of anti-Ro/SSA and La/SSB antibodies; a serum sampling was made to assess antibody positivity. RESULTS: Salivary flow in SSp, SSs and BO was significantly lower (p<0.001) relative to C. The salivary composition of SS showed an increase of inorganic components. Anti-Ro/SSA and anti-La/SSB antibodies occurred more frequently in serum and saliva in SS patients compared with BO and C, with higher frequency of positivity in serum compared with saliva. CONCLUSION: Our results suggest new tools that could aid the non-traumatic diagnosis of the origin of hyposalivation.

Vasculopatía liveloide como presentación de síndrome antifosfolípido en el embarazo / Livedoid vasculopathy as an introduction to antiphospholipid syndrome during

Livedoid vasculopathy (LV) is an occlusive thrombotic disease that affects primarily the small blood vessels of the coger extremities and often is associated with recurrent painful ulcerations. The pathogenesis of Lvis unclear, but it is attributed to hypercoagulable state. We describe a 27-year old pregnant woman who developed a LV in the third trimester of her pregnancy. The skin biopsy revealed endothelial proliferation and fibrin thrombi in small vessels of the dermis. She had aCl Ig G and Ig M positive and lupus anticoagulant negative. Treatment with heparin, aspirin and steroids was required with dramatically improvement of the lesions