Mortality and cardiovascular risk in vasculitis ANCA. Importance of hypertension and renal function. Experience from southern Spain / Mortalidad y riesgo cardiovascular en vasculitis ANCA. Importancia de la hipertension y funcion renal. Experiencia del sur de España

Background: Cardiovascular disease (CVD) is one of the principal causes of death in antineutrophil cytoplasmic antibody-(ANCA)-associated vasculitis (AAV). Objectives: To evaluate the mortality and it's causes and CVD and its vascular risk factors (VRFs) in AAV patients in Andalusia. Methods: A multicenter cohort of 220 AAV patients followed-up from 1979 until June 2020 was studied in Andalussia, south of Spain. The information, including socio-demographic and clinical data was recorded retrospectively through chart review. Data was analysed using Chi2, ANOVA and Cox proportional hazards regresion as uni and multivariate test with a 95% confidence interval (CI). Results: During a mean ± standard deviation follow-up of 96.79 ± 75.83 months, 51 patients died and 30 presented at least one CVE. Independent prognostic factors of mortality were age (HR 1.083, p=0.001) and baseline creatinine (HR 4.41, p=0.01). Independent prognostic factors of CVE were age [hazard ratio (HR) 1.042, p=0.005] and the presence of hypertension (HTN) six months after diagnosis (HR 4.641, p=0.01). HTN, diabetes and renal failure, all of these important VRFs, are more prevalent in AAV patients than it is described in matched general population. Conclusions: Age and baseline renal function, but not CVEs, are predictors of mortality and age and early HTN are independent predictors for having a CVE. CVD screening in AAV patients is demanded.(AU)

Introducción: La enfermedad cardiovascular (ECV) es una de las principales causas de muerte en las vasculitis asociadas a anticuerpos anticitoplasma de neutrófilos (ANCA) (VAA). Objetivos: Evaluar la mortalidad y sus causas, entre ellas la ECV y sus factores de riesgo vascular (FRV) en pacientes con VAA en Andalucía. Métodos: Se estudió una cohorte multicéntrica de 220 pacientes con VAA seguidos desde 1979 hasta junio de 2020 en Andalucía. La información, incluidos los datos sociodemográficos y clínicos, se registró retrospectivamente a través de la revisión de historias clínicas. Los datos se analizaron mediante Chi2, ANOVA y regresión de riesgos proporcionales de Cox de forma uni y multivariante con un intervalo de confianza (IC) del 95%. Resultados: Durante un seguimiento medio y desviación estándar de 96,79 ± 75,83 meses, 51 pacientes fallecieron y 30 presentaron al menos un ECV. Los factores pronósticos independientes de mortalidad fueron la edad (HR 1,083, p=0,001) y la creatinina basal (HR 4,41, p=0,01). Los factores pronósticos independientes de ECV fueron la edad [hazard ratio (HR) 1,042, p=0,005] y la presencia de hipertensión arterial (HTA) seis meses después del diagnóstico (HR 4,641, p=0,01). La prevalencia de HTA, diabetes e insuficiencia renal fue elevada o muy elevada en comparación con la población general emparentada, todos FRCV determinantes para el pronóstico de estos pacientes. Conclusiones: La edad y la función renal basal son predictores de mortalidad y la edad y la HTA de aparición precoz son predictores independientes de tener ECV. Se recomienda el cribado de FRCV en pacientes con vasculitis ANCA.(AU)

Efficacy of cognitive behavioural therapy for the treatment of chronic stress in patients with lupus erythematosus: a randomized controlled trial.

BACKGROUND: Chronic stress worsens the quality of life (QOL) of lupus patients by affecting their physical and psychological status. The effectiveness of a cognitive-behavioural intervention in a group of patients with lupus and high levels of daily stress was investigated. METHODS: Forty-five patients with lupus and high levels of daily stress were randomly assigned to a control group (CG) or a therapy group (TG); they received cognitive behavioural therapy (CBT) which consisted of ten consecutive weekly sessions. The following variables were evaluated at baseline and at 3, 9 and 15 months: (1) stress, anxiety, depression, (2) Systemic Lupus Erythematosus Disease Activity Index, somatic symptoms, number of flares, (3) anti-nDNA antibodies, complement fractions C3 and C4 and (4) QOL. A multivariate analysis of repeated measures and various analyses of variance were carried out. RESULTS: We found a significant reduction in the level of depression, anxiety and daily stress in the TG compared to the CG and a significant improvement in QOL and somatic symptoms in the TG throughout the entire follow-up period. We did not find any significant changes in the immunological parameters. CONCLUSIONS: CBT is effective in dealing with patients suffering from lupus and high levels of daily stress as it significantly reduces the incidence of psychological disorders associated with lupus and improves and maintains patients' QOL, despite there being no significant reduction in the disease activity index.

Magic syndrome and true aortic aneurysm.

Magic syndrome is a very uncommon disease, and vascular involvement is exceptional; only one case has been reported in the literature associated to a true aortic aneurysm. The treatment of aneurysms recommended in these patients is based on isolated cases and includes corticosteroids, other immunosuppressant drugs, and surgery. We report a case of a patient with Magic syndrome who developed aneurysm at the end of the aorta during treatment with infliximab, corticosteroids, and cyclosporine and who needed endovascular prosthesis implantation. After 12 months, she suffered an aneurysm of the ascending aorta, dilatation of the sinotubular junction, and severe aortic insufficiency, which forced surgery. During this time, the patient finally died.

Patrón no reductor de presión arterial y enfermedad renal crónica en pacientes hipertensos / Non-reducing pattern of blood pressure and chronic kidney disease in hypertensive patients

Introducción. La monitorización ambulatoria de la presión arterial (MAPA) se correlaciona mejor con el daño orgánico que la presión arterial (PA) casual. La MAPA también ha permitido dividir a los pacientes en dipper y non-dipper. Los pacientes non-dipper parecen tener un peor pronóstico en morbimortalidad cardiovascular. Nosotros presentamos los datos del patrón circadiano de PA y la afectación renal en pacientes hipertensos. Pacientes y método. Se incluyeron en el estudio 702 pacientes con criterio para realizar MAPA. A todos ellos se les midió el filtrado glomerular (FG) según la ecuación MDRD (Modification of Diet in Renal Disease) corregida para el sexo. Todos los resultados se registraron en base de datos ACCESS y se realizó estudio estadístico mediante el programa SPSS versión 12.0. Resultados. Los pacientes con FG menor de 60 ml/ min/m2 eran varones, de mayor edad, diabéticos y con niveles más elevados de colesterol, triglicéridos y ácido úrico. Las PA clínicas y de la MAPA fueron significativamente más elevadas en los pacientes con FG menor de 60 ml/min/m2. Un FG menor de 60 ml supone un riesgo estimado de 2,86 (IC al 95 %: 1,29-6,36) para presentar un patrón non-dipper. Conclusiones. En nuestro estudio el 15,8 % de los pacientes presenta un FG menor de 60 ml/min/m2. Los pacientes con FG reducido tienen más edad, son varones, diabéticos y con cifras de PA más elevadas. Un FG reducido se asocia a patrón non-dipper

Introduction. Ambulatory blood pressure monitoring (ABPM) correlates better with body damage than with casual blood pressure (BP). The ABPM has also made it possible to divide the patients into dipper and non-dipper. Non-dipper patients seem to have a worse prognosis in cardiovascular morbidity-mortality. We present the data of the circadian pattern of BP and kidney involvement in hypertensive patients. Patients and methods. A total of 702 patients with criterion to perform ABPM were included in the study. Glomerular filtration (GF) rate was measured in all of them according to the MDRD (Modification of Diet in Renal Disease) equation corrected for gender. All the results were recorded in the ACCESS database and statistical study was done with the SPSS version 12.0 program. Results. Patients with GF < 60 ml/min/m2 were male, of greater age, diabetics and with higher levels of cholesterol, triglycerides and uric acid. Clinical BP and those of ABPM were significantly higher in patients with GF < 60 ml/min/m2. A GF under 60 ml meant an estimated risk of 2.86 (95 % CI: 1.29-6.6) to have a NRP. Conclusions. In our study, 15.8 % of the patients showed a glomerular filtration less than 60 ml/m2. Patients with reduced GF are older, males, diabetics and with higher blood pressure values. A reduced GF is associated to a non-dipper pattern

Características clínicas y grado de presión arterialde los pacientes atendidos por primera vez en una unidadhospitalaria específica de hipertensión arterial / Clinical manifestations and level of blood pressure in patients evaluated for the first time in a Hypertension Clinic

Objetivo. Analizar las características clínicas, grado de presión arterial y factores condicionantes del grado de control en los pacientes remitidos por los médicos de Atención Primaria vistos por primera vez en una Unidad especializada en Hipertensión Arterial (HTA).Método. Se incluyeron de forma consecutiva 1.317 pacientes enviados por primera vez a la consulta de HTA por su médico de Atención Primaria entre enero de 1997 y noviembre de 2000. Se aplicó el siguiente protocolo inicial de estudio: anamnesis y exploración física, analítica de sangre y orina, radiografías de tórax y abdomen, fondo de ojo y electrocardiograma. En función de la orientación clínica inicial y de los resultados de las pruebas complementarias descritas, el estudio se completó o no con otros estudios complementarios. Los datos obtenidos se registraron en una base de datos informática y posteriormente se analizaron en el programa estadístico SPSS 9.0.Resultados. De los 1.317 pacientes, 741 (56,3 por ciento) fueron mujeres. La edad media fue de 54,58ñ14,4 años (rango: 14-91 años). La presión arterial sistólica (PAS) y la presión arterial diastólica (PAD) medias fueron de 152,6 ñ 22,7 mmHg y 94,2ñ11,6 mmHg, respectivamente. El 71,6 por ciento (943 pacientes) presentaron al menos dos factores de riesgo cardiovascular (FRCV), tres FRCV el 50,5 por ciento (665 pacientes) y cuatro FRCV el 10,4 por ciento (137 pacientes). El 43,6 por ciento (575 pacientes) presentaba un grado I de HTA, el 33,2 por ciento (438 pacientes) un grado II y el 23,1 por ciento (304 pacientes) un grado III de HTA. El grado de HTA se asoció con la edad, el tiempo transcurrido desde el inicio de la HTA, el índice de masa corporal (IMC) y los niveles en sangre de glucosa, colesterol total y colesterol LDL. Un modelo de regresión logística para clasificar a los pacientes como grados I o II-III identificó como variables independientes la edad, el tiempo transcurrido desde el inicio de HTA, el IMC, el padecimiento de diabetes mellitus (DM) y un nivel plasmático de colesterol LDL mayor de 160 mg/dl. Conclusiones. La mitad de los pacientes enviados por primera vez por su médico de Atención Primaria a nuestra Unidad de HTA presentaba al menos tres FRCV. Asimismo, el 56,4 por ciento presentaba una HTA moderada severa (grados II-III). Por último, el grado de HTA de los pacientes dependía de la edad, del tiempo transcurrido desde el inicio de la HTA, del índice de Quetelet y de la existencia de DM e hipercolesterolemia (AU)

[Clinical manifestations and level of blood pressure in patients evaluated for the first time in a Hypertension Clinic]. / Características clínicas y grado de presión arterial de los pacientes atendidos por primera vez en una unidad hospitalaria específica de hipertensión arterial.

OBJECTIVE: To analyze the clinical manifestations, blood pressure level, and determinants of the degree of hypertension (HT) control in the patients referred by the Primary Care physicians and evaluated for the first time in a Hypertension Clinic. METHOD: The participants were 1,317 consecutively referred patients for the first time to the Hypertension Clinic by their Primary Care physician, between January 1997 and November 2000. The following initial study protocol was applied: case history and physical exploration, blood and urine biochemistry, chest and abdomen x-rays, fundus oculi and electrocardiogram. According to the initial clinical orientation and the results of the complementary tests described, the study was supplemented or not with other complementary studies. Results were registered in a computer dabatase and subsequently were analyzed with the statistical program SPSS 9.0. RESULTS. 741 (56.3%) of the 1,317 patients were women. The average age was 54.58 14.4 years (range: 14-91 years). Average systolic blood pressure (SBP) and diastolic blood pressure (DBP) were 152.6 22.7 mmHg and 94.2 11.6 mmHg, respectively. 71.6% (943 patients) presented at least two cardiovascular risk factors (CVRF), 50.5% (665 patients) three CVRF and 10.4% (137 patients) four CVRF. 43.6% (575 patients) presented a degree I, 33.2% (438 patients) a degree II and 23.1% (304 patients) a degree III HT. The degree of HT was associated with the age, the time elapsed from the beginning of the HT, the body mass index (BMI) and the levels of blood glucose, total cholesterol and LDL cholesterol. A model of logistic regression to classify the patients as HT degrees I or II-III identified as independent variables the age, the time elapsed from the beginning of HTA, the BMI, the presence of diabetes mellitus (DM) and the plasma LDL cholesterol level greater of 160 mg/dl. CONCLUSIONS: Half of the patients sent for the first time by its Primary Care physician to our Hypertension Clinic presented at least three CVRF. Furthermore, 56.4% presented a moderate-severe HTA (degrees II-III). Finally, the degree of HTA of the patients was related to the age, the time elapsed from the beginning of the HTA, the Quetelet's index, and the existence of DM and hypercholesterolemia (HC).

Pemphigus vulgaris and systemic lupus erythematosus in a 46-y-old man.

Systemic lupus erythematosus (SLE) is an autoimmune disease that may affect many organs in the body. Skin manifestations are frequent and sometimes vesiculobullous lesions may apper such as in bullous lupus erythematosus. SLE may also be exceptionally associated with other blistering diseases such as pemphigus vulgaris (PV). We describe the case of a male diagnosed as having SLE, who one year later developed PV. Only three cases (all in women) of SLE associated with PV have been reported in the literature. Our case is noteworthy in that this exceptional association developed in a middle-aged male.