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1.
Artigo em Inglês | MEDLINE | ID: mdl-31529686

RESUMO

OBJECTIVE: To estimate the incidence and analyze any cancer-associated factors in patients with Systemic Lupus Erythematosus (SLE) differentiating between hormone-sensitive (HS) and non-HS cancers. METHODS: Retrospective multicentric study of a patient cohort from the SLE Registry of the Spanish Society of Rheumatology (RELESSER - Spanish acronym). Included are the following: the first cancer post-SLE diagnosis, clinical and sociodemographic information, cumulative damage, severity, comorbidities, treatments and refractoriness. Cancers were classified as HS (prostate, breast, endometrium and ovarian) and non-HS (the rest). Standardized Incidence Ratio (SIR) was calculated and logistic regression models were built. RESULTS: 3,539 patients (90.4% women) were included, 154 of whom presented cancer (91% women), 44 HS (100% women). Cancer SIR was 1.37 (CI 95%: 1.15-1.59), with higher values in women under 65s [2.38 (CI 95%: 1.84-2.91)]. SIR in women with HS vs. non-HS cancer was 1.02 (CI 95%: 0.13-1.91) and 1.93 (CI 95%: 0.98-2.89)], respectively. In HS vs. non-HS cancers, SLE diagnostic age [odds ratio (OR) 1.04 (p= 0.002) vs. 1.04 (p= 0.019), respectively] and period of disease evolution [OR 1.01 (p< 0.001) vs. 1.00 (p= 0.029), respectively] were associated with cancer. SLICC/ACR damage index [OR 1.27 (p= 0.022)] and ACE inhibitor prescriptions [OR 2.87 (p= 0.048)] were associated with non-HS cancers. CONCLUSION: Cancer incidence in SLE patients is higher than in the Spanish population, particularly among young women. This increase might be due to non-HS cancers, which would be associated with an SLE involving greater cumulative damage where more ACE inhibitors are prescribed.

2.
Semin Arthritis Rheum ; 47(1): 38-45, 2017 08.
Artigo em Inglês | MEDLINE | ID: mdl-28259425

RESUMO

OBJECTIVES: To estimate the incidence of severe infection and investigate the associated factors and clinical impact in a large systemic lupus erythematosus (SLE) retrospective cohort. METHODS: All patients in the Spanish Rheumatology Society Lupus Registry (RELESSER) who meet ≥4 ACR-97 SLE criteria were retrospectively investigated for severe infections. Patients with and without infections were compared in terms of SLE severity, damage, comorbidities, and demographic characteristics. A multivariable Cox regression model was built to calculate hazard ratios (HRs) for the first infection. RESULTS: A total of 3658 SLE patients were included: 90% female, median age 32.9 years (DQ 9.7), and mean follow-up (months) 120.2 (±87.6). A total of 705 (19.3%) patients suffered ≥1 severe infection. Total severe infections recorded in these patients numbered 1227. The incidence rate was 29.2 (95% CI: 27.6-30.9) infections per 1000 patient years. Time from first infection to second infection was significantly shorter than time from diagnosis to first infection (p < 0.000). Although respiratory infections were the most common (35.5%), bloodstream infections were the most frequent cause of mortality by infection (42.0%). In the Cox regression analysis, the following were all associated with infection: age at diagnosis (HR = 1.016, 95% CI: 1.009-1.023), Latin-American (Amerindian-Mestizo) ethnicity (HR = 2.151, 95% CI: 1.539-3.005), corticosteroids (≥10mg/day) (HR = 1.271, 95% CI: 1.034-1.561), immunosuppressors (HR = 1.348, 95% CI: 1.079-1.684), hospitalization by SLE (HR = 2.567, 95% CI: 1.905-3.459), Katz severity index (HR = 1.160, 95% CI: 1.105-1.217), SLICC/ACR damage index (HR = 1.069, 95% CI: 1.031-1.108), and smoking (HR = 1.332, 95% CI: 1.121-1.583). Duration of antimalarial use (months) proved protective (HR = 0.998, 95% CI: 0.997-0.999). CONCLUSIONS: Severe infection constitutes a predictor of poor prognosis in SLE patients, is more common in Latin-Americans and is associated with age, previous infection, and smoking. Antimalarials exerted a protective effect.


Assuntos
Corticosteroides/uso terapêutico , Antimaláricos/uso terapêutico , Antirreumáticos/uso terapêutico , Imunossupressores/uso terapêutico , Infecção/epidemiologia , Lúpus Eritematoso Sistêmico/epidemiologia , Adulto , Feminino , Humanos , Incidência , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Masculino , Ácido Micofenólico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença
3.
Medicine (Baltimore) ; 95(9): e2891, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26945378

RESUMO

The aim of the study was to profile those patients included in the RELESSER registry with histologically proven renal involvement in order to better understand the current state of lupus nephritis (LN) in Spain. RELESSER-TRANS is a multicenter cross-sectional registry with an analytical component. Information was collected from the medical records of patients with systemic lupus erythematosus who were followed at participating rheumatology units. A total of 359 variables including demographic data, clinical manifestations, disease activity, severity, comorbidities, LN outcome, treatments, and mortality were recorded. Only patients with a histological confirmation of LN were included. We performed a descriptive analysis, chi-square or Student's t tests according to the type of variable and its relationship with LN. Odds ratio and confidence intervals were calculated by using simple logistic regression. LN was histologically confirmed in 1092/3575 patients (30.5%). Most patients were female (85.7%), Caucasian (90.2%), and the mean age at LN diagnosis was 28.4 ±â€Š12.7 years. The risk for LN development was higher in men (M/F:47.85/30.91%, P < 0.001), in younger individuals (P < 0.001), and in Hispanics (P = 0.03). Complete response to treatment was achieved in 68.3% of patients; 10.35% developed ESRD, which required a kidney transplant in 45% of such cases. The older the patient, the greater was the likelihood of complete response (P < 0.001). Recurrences were associated with persistent lupus activity at the time of the last visit (P < 0.001) and with ESRD (P < 0.001). Thrombotic microangiopathy was a risk factor for ESRD (P = 0.04), as for the necessity of dialysis (P = 0.01) or renal transplantation (P = 0.03). LN itself was a poor prognostic risk factor of mortality (OR 2.4 [1.81-3.22], P < 0.001). Patients receiving antimalarials had a significantly lower risk of developing LN (P < 0.001) and ESRD (P < 0.001), and responded better to specific treatments for LN (P = 0.014). More than two-thirds of the patients with LN from a wide European cohort achieved a complete response to treatment. The presence of positive anti-Sm antibodies was associated with a higher frequency of LN and a decreased rate of complete response to treatment. The use of antimalarials reduced both the risk of developing renal disease and its severity, and contributed to attaining a complete renal response.


Assuntos
Nefrite Lúpica/epidemiologia , Sistema de Registros , Adolescente , Adulto , Feminino , Humanos , Nefrite Lúpica/terapia , Masculino , Recidiva , Estudos Retrospectivos , Reumatologia , Espanha/epidemiologia , Adulto Jovem
4.
Rheumatology (Oxford) ; 55(7): 1243-50, 2016 07.
Artigo em Inglês | MEDLINE | ID: mdl-27018057

RESUMO

OBJECTIVES: To identify patterns (clusters) of damage manifestations within a large cohort of SLE patients and evaluate the potential association of these clusters with a higher risk of mortality. METHODS: This is a multicentre, descriptive, cross-sectional study of a cohort of 3656 SLE 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 manifestations were identified. Then, overall clusters were compared as well as the subgroup of patients within every cluster with disease duration shorter than 5 years. RESULTS: Three damage clusters were identified. Cluster 1 (80.6% of patients) presented a lower amount of individuals with damage (23.2 vs 100% in clusters 2 and 3, P < 0.001). Cluster 2 (11.4% of patients) was characterized by musculoskeletal damage in all patients. Cluster 3 (8.0% of patients) was the only group with cardiovascular damage, and this was present in all patients. The overall mortality rate of patients in clusters 2 and 3 was higher than that in cluster 1 (P < 0.001 for both comparisons) and in patients with disease duration shorter than 5 years as well. CONCLUSION: In a large cohort of SLE patients, cardiovascular and musculoskeletal damage manifestations were the two dominant forms of damage to sort patients into clinically meaningful clusters. Both in early and late stages of the disease, there was a significant association of these clusters with an increased risk of mortality. Physicians should pay special attention to the early prevention of damage in these two systems.


Assuntos
Doenças Cardiovasculares/mortalidade , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/mortalidade , Doenças Musculoesqueléticas/mortalidade , Índice de Gravidade de Doença , Adulto , Doenças Cardiovasculares/etiologia , Análise por Conglomerados , Estudos Transversais , Feminino , Humanos , Lúpus Eritematoso Sistêmico/patologia , Masculino , Pessoa de Meia-Idade , Doenças Musculoesqueléticas/etiologia , Sistema de Registros , Espanha , Fatores de Tempo
5.
Medicine (Baltimore) ; 94(1): e267, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25569641

RESUMO

Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by multiple organ involvement and pronounced racial and ethnic heterogeneity. The aims of the present work were (1) to describe the cumulative clinical characteristics of those patients included in the Spanish Rheumatology Society SLE Registry (RELESSER), focusing on the differences between patients who fulfilled the 1997 ACR-SLE criteria versus those with less than 4 criteria (hereafter designated as incomplete SLE (iSLE)) and (2) to compare SLE patient characteristics with those documented in other multicentric SLE registries.RELESSER is a multicenter hospital-based registry, with a collection of data from a large, representative sample of adult patients with SLE (1997 ACR criteria) seen at Spanish rheumatology departments. The registry includes demographic data, comprehensive descriptions of clinical manifestations, as well as information about disease activity and severity, cumulative damage, comorbidities, treatments and mortality, using variables with highly standardized definitions.A total of 4.024 SLE patients (91% with ≥4 ACR criteria) were included. Ninety percent were women with a mean age at diagnosis of 35.4 years and a median duration of disease of 11.0 years. As expected, most SLE manifestations were more frequent in SLE patients than in iSLE ones and every one of the ACR criteria was also associated with SLE condition; this was particularly true of malar rash, oral ulcers and renal disorder. The analysis-adjusted by gender, age at diagnosis, and disease duration-revealed that higher disease activity, damage and SLE severity index are associated with SLE [OR: 1.14; 95% CI: 1.08-1.20 (P < 0.001); 1.29; 95% CI: 1.15-1.44 (P < 0.001); and 2.10; 95% CI: 1.83-2.42 (P < 0.001), respectively]. These results support the hypothesis that iSLE behaves as a relative stable and mild disease. SLE patients from the RELESSER register do not appear to differ substantially from other Caucasian populations and although activity [median SELENA-SLEDA: 2 (IQ: 0-4)], damage [median SLICC/ACR/DI: 1 (IQ: 0-2)], and severity [median KATZ index: 2 (IQ: 1-3)] scores were low, 1 of every 4 deaths was due to SLE activity.RELESSER represents the largest European SLE registry established to date, providing comprehensive, reliable and updated information on SLE in the southern European population.


Assuntos
Lúpus Eritematoso Sistêmico/epidemiologia , Sistema de Registros , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Espanha/epidemiologia
6.
Med. clín (Ed. impr.) ; 133(4): 139-146, jun. 2009. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-108045

RESUMO

Las infecciones de partes blandas son un importante problema de salud, con una incidencia creciente y una mortalidad elevada. El aumento de su incidencia se debe al incremento de la población de riesgo (especialmente sujetos inmunodeprimidos), al incremento de las resistencias bacterianas debido al uso inapropiado de antibióticos de amplio espectro y a la capacidad de los patógenos para adaptarse a ambientes nuevos. El tratamiento adecuado incluye un abordaje integral con una vigilancia epidemiológica estricta, el cumplimiento de las recomendaciones terapéuticas empíricas iniciales y un desbridamiento quirúrgico precoz cuando se estime necesario. El principal microorganismo causante de estas infecciones es Staphylococcus aureus. En los últimos años se han descrito múltiples casos por cepas de S. aureus resistentes a meticilina (SARM). En España, la incidencia global del SARM es del 29%, aunque hay series en las que llega hasta el 46,4%. Por este motivo, en la presente revisión se pone especial interés en este microorganismo (AU)


Soft tissue infections represent an emerging health problem with a growing incidence and mortality. The augmented incidence of skin and soft tissue infections is the result of a number of factors, such as the increase of immunocompromised patients, emergence of multidrug-resistant pathogens due to the irrational use of antibiotics and the ability of pathogens to adapt to the environment. Successful management requires a global performance that involves a surveillance program, appropriate empirical antibiotic therapy and prompt surgical exploration with extensive debridement of devitalized tissue. Staphylococcus aureus is the most common pathogen and, in the last few years, methicillin-resistant S. aureus (MRSA) has become commonplace. In Spain, the global incidence of MRSA is 29%; however, there are series in which rises to 46.4%. For this reason, MRSA will be highlighted in this revision (AU)


Assuntos
Humanos , Infecções dos Tecidos Moles/epidemiologia , Celulite/epidemiologia , Erisipela/epidemiologia , Infecções Estreptocócicas/epidemiologia , Fasciite Necrosante/epidemiologia , Miosite/epidemiologia , Piomiosite/epidemiologia , Staphylococcus aureus Resistente à Meticilina/patogenicidade , Fatores de Risco
7.
Med Clin (Barc) ; 133(4): 139-46, 2009 Jun 27.
Artigo em Espanhol | MEDLINE | ID: mdl-19368942

RESUMO

Soft tissue infections represent an emerging health problem with a growing incidence and mortality. The augmented incidence of skin and soft tissue infections is the result of a number of factors, such as the increase of immunocompromised patients, emergence of multidrug-resistant pathogens due to the irrational use of antibiotics and the ability of pathogens to adapt to the environment. Successful management requires a global performance that involves a surveillance program, appropriate empirical antibiotic therapy and prompt surgical exploration with extensive debridement of devitalized tissue. Staphylococcus aureus is the most common pathogen and, in the last few years, methicillin-resistant S. aureus (MRSA) has become commonplace. In Spain, the global incidence of MRSA is 29%; however, there are series in which rises to 46.4%. For this reason, MRSA will be highlighted in this revision.


Assuntos
Infecções dos Tecidos Moles , Humanos , Staphylococcus aureus Resistente à Meticilina , Infecções dos Tecidos Moles/diagnóstico , Infecções dos Tecidos Moles/terapia , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/terapia
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