Clinical predictors of remission and low disease activity in Latin American early rheumatoid arthritis: data from the GLADAR cohort.

OBJECTIVES: To identify baseline predictors of remission and low disease activity (LDA) in early rheumatoid arthritis (RA) from the GLADAR (Grupo Latino Americano De estudio de la Artritis Reumatoide) cohort. METHODS: Patients with 1- and 2-year follow-up visits were included. Remission and LDA were defined by DAS28-ESR (< 2.6 and ≤ 3.2, respectively). Baseline predictors examined were gender, ethnicity, age at diagnosis, socioeconomic status, symptoms' duration, DMARDs, RF, thrombocytosis, anemia, morning stiffness, DAS28-ESR (and its components), HAQ-DI, DMARDs and corticosteroid use, and Sharp-VDH score. Multivariable binary logistic regression models (excluding DAS28-ESR components to avoid over adjustment) were derived using a backward selection method (α-level set at 0.05). RESULTS: Four hundred ninety-eight patients were included. Remission and LDA/remission were met by 19.3% and 32.5% at the 1-year visit, respectively. For the 280 patients followed for 2 years, these outcomes were met by 24.3% and 38.9%, respectively. Predictors of remission at 1 year were a lower DAS28-ESR (OR 1.17; CI 1.07-1.27; p = 0.001) and HAQ-DI (OR 1.48; CI 1.04-2.10; p = 0.028). At 2 years, only DAS28-ESR (OR 1.40; CI 1.17-1.6; p < 0.001) was a predictor. Predictors of LDA/remission at 1 year were DAS28-ESR (OR 1.42; CI 1.26-1.61; p < 0.001), non-use of corticosteroid (OR 1.74; CI 1.11-2.44; p = 0.008), and male gender (OR 1.77; CI 1.2-2.63; p = 0.036). A lower baseline DAS28-ESR (OR 1.45; CI 1.23-1.70; p < 0.001) was the only predictor of LDA/remission at 2 years. CONCLUSIONS: A lower disease activity consistently predicted remission and LDA/remission at 1 and 2 years of follow-up in early RA patients from the GLADAR cohort. Key Points • In patients with early RA, a lower disease activity at first visit is a strong clinical predictor of achieving remission and LDA subsequently. • Other clinical predictors of remission and LDA to keep in mind in these patients are male gender, non-use of corticosteroids and low disability at baseline. • Not using corticosteroids at first visit is associated with a lower disease activity and predicts LDA/remission at 1 year in these patients.

Correction to: Clinical predictors of remission and low disease activity in Latin American early rheumatoid arthritis: data from the GLADAR cohort.

The original version of this article, unfortunately, contained an error. The first and family name of Loreto Massardo was interchanged and is now presented correctly in this article.

Early rheumatoid arthritis in Latin America: low socioeconomic status related to high disease activity at baseline.

OBJECTIVE: To determine the influence of socioeconomic factors on disease activity in a Latin American (LA) early rheumatoid arthritis (RA) multinational inception cohort at baseline. METHODS: Clinical evaluation, ethnicity, socioeconomic status (SES), 4-variable Disease Activity Score in 28 joints using the erythrocyte sedimentation rate (DAS28-ESR), Health Assessment Questionnaire (HAQ) disability index (DI), and erosions were recorded in 1,093 patients with early RA (<1 year from onset). Multivariate analyses evaluated influences of sex, age, marital status, education, medical coverage, SES, and ethnicity on HAQ DI, DAS28-ESR, and presence of erosions. RESULTS: Ethnicities included 43% Mestizo, 31% Caucasian, 19% African LA, 4% Amerindian, and 3% other. Fifty-eight percent were of low/low-middle SES, 42% had <8 years of education, 21% had no medical coverage, median disease duration was 6 months (25th, 75th percentiles 4, 9 months), median HAQ DI score was 1.25 (25th, 75th percentiles 0.63, 2.00), median DAS28-ESR score was 6.2 (25th, 75th percentiles 4.9, 7.2), and 25% had erosions. Women and Mestizos, African LA, and Amerindians had earlier onset than men or Caucasians (P < 0.01). When adjusted by country, the analysis of covariance model showed that low/low-middle SES, female sex, partial coverage, and older age were associated with worse HAQ DI scores; only low/low-middle SES was associated with higher DAS28 scores. Statistically significant differences were found in HAQ DI and DAS28 scores between countries. When excluding country, low/low-middle SES, female sex, and no coverage were associated with worse HAQ DI and DAS28 scores, whereas separated/divorced/widowed status was associated with worse HAQ DI scores and age was associated with worse DAS28 scores. Logistic regression showed that older age, no coverage, and the Amerindian and other ethnic groups were associated with erosions. CONCLUSION: We compared early RA patients from the main LA ethnic groups. Our findings suggest that low/low-middle SES is important in determining disease activity. A more genetic-related background for erosions is possible.

Lupus eritematoso sistémico y embarazo / Systemic lupus erythematosus and pregnancy

Se estudiaron los 14 expedientes de veinte embarazadas, que sufrían de Lupus Eritematoso Sistémico (LES) y que fueron atendidas en el Servicio de Reumatología del Complejo Hospitalario Metropolitano de Seguro Social (CHMSS), entre enero de 1975 y marzo de 1985. En cada embarazada se estudió la actividad lúpica antes, en cada trimestre de gestación y después del embarazo; y se observó que la enfermedad afecta al producto de la gestación y es la causa de abortos (30 a 35%) y de nacimientos prematuros (25%). Se observó que el prognóstico es mejor en pacientes controlados y en remisión al momento de la gestación; que la exacerbación es frecuente en el primer trimestre (57%) y después del embarazo (23%); y que el prognóstico es peor en las pacientes que sufren de nefropatía grave o que no son tratadas con suficiente cantidad de cortisona. Se aconseja que el embarazo comience solamente en el período de inactividad lúpica; y un estricto control del paciente, por el médico obstetra y por el internista, durante toda la gestación

Polimiositis y dermatomiositis en el Complejo Hospitalario Metropolitano de la Caja de Seguro Social de Panamá 1973-1983: revisión clínica y efectos del tratamiento / Polymyositis and dermatomyositis in the Complejo Hospitalario Metropolitano de la Caja de Seguro Social of Panama 1973-1983: clinical review and effects of the treatment

De 1973 a 1983 fueron internados en el Complejo Hospitalario Metropolitano de la Caja de Seguro Social de Panamá ventidós pacientes que egresaron con diagnóstico de Polimiositis (PM) o de Dermatomiositis (DM) y que fueron observados de seis meses a diez años. La mayoría de los casos fueron del sexo femenino y tenían cuarenta o más años de edad. Los clasificamos según los criterios de Bohan y Peter, porque facilitan conocer la evolución y el efecto del tratamiento. La enfermedad evolucionó sin ser reconocida inicialmente; por esa razón es necesario que los médicos sospechemos la enfermedad en todo paciente que presenta pérdida progresiva de peso, debilidad muscular y lesiones cutáneas. La mayoría de los casos respondieron satisfactoriamente al tratamiento con Corticoides. Los que eran refractarios o presentaron recaídas mejoraron al ser tratados con un inmunosupresor, como el Methotrexate, por vía intravenosa, o con Azathioprina, por vía oral. El tratamiento puede ser delicado y prolongado; por esa razón recomendamos que el control y el seguimiento de los pacientes debe ser vigilado por un médico que tenga experiencia en la evolución de la enfermedad y en el uso de la droga prescita