Clinical manifestations and vascular events in patients with lupus erythematosus anticardiolipin antibodies and raynaud's phenomenon.

BACKGROUND: Raynaud's phenomenon (RP) and anticardiolipin antibodies (ACL) are two common clinical manifestations in patients with systemic lupus erythematosus (SLE). RP may lead to digital or limb loss. ACL are associated to thrombotic episodes. It is not yet clear if there is an association between RP and the presence of ACL in patients with SLE. OBJECTIVES: To study if the presence of both RP and ACL in patients with SLE may be associated with certain clinical manifestations or thrombotic events compared to SLE patients without RP or ACL. METHODS: SLE patients from two lupus clinics were recruited. The patients were divided into 4 groups. Patients with RP and positive ACL (RP+ ACL+), patients with RP but negative ACL (RP+ ACL-), patients with negative RP and positive ACL (RP- ACL+), and patients that were negative for RP and ACL (RP- ACL-) used as the control group. Demographic data, diagnostic criteria, clinical manifestations, history of arterial thrombosis, venous thrombosis and abortions were recorded. A physical examination was done. Anticardiolipin antibodies IgG and IgM were done in the rheumatology laboratory at the University of Puerto Rico School of Medicine. Descriptive statistics as well as analysis of variances (ANOVA), and polytomous logistic regression were used. RESULTS: 236 patients with SLE were studied. There was a tendency toward an increase in arterial thrombosis (p-value = 0.094) and venous thrombosis (p-value = 0.067) in the group that were positive for RP and ACL (RP+ ACL+). Although it was not statistical significant, when polytomous logistic regression was used, both arterial and venous thrombosis had an increase in relative risk 3.21 for arterial and 3.11 for venous thrombosis. Abortions were not increased in any of the four groups. Clinical manifestations from SLE did not differ among the four groups. CONCLUSIONS: Patients with both RP and ACL seem to be at an increase risk for both arterial and venous thrombotic events; these patients may benefit from an antiplatelet medication to prevent these events to occur.

La prevalencia del síndrome de antifosfolípidos en pacientes con lupus eritematoso sistémico en el Hospital Universitario de Puerto Rico / Prevalence of antiphospholipid syndrome in patients with systemic lupus erythematosus at the University Hospital of Puerto Rico

This is a retrospective study based on a population of 80 patients with connective tissue diseases from the University Hospital of Puerto Rico. Among the population, 62 (77.5) of the patients had Systemic Lupus Erythematosus (SLE), whom we were most interested to monitor. The investigation revealed an incidence of 13.8 of anthiophospholipid syndrone within the general population. Among the patients with SLE it was 12.9, and only 5.5 among the population with other diagnoses. The antibody found with the highest frequency within the systemic lupus erythematosus population was the anticardiolipin IgG (30.6) and lupus anticoagulant (17.7). The antibody frequency among patients with other diagnoses was only 5.5 for lupus anticoagulant and 5.5 for anticardiolipin IgM (the only one found). Among SLE's clinical manifestations, the most frequently found were thrombocitopenia and pregnancy complications.

Mortality study in Puerto Ricans with systemic lupus erythematosus

OBJECTIVE: To determine the most common causes of death among Puerto Ricans with systemic lupus erythematosus. METHODS: Chart and record review of all deaths related to SLE complications from 1960 to 1994 at the University of Puerto Rico Hospital. RESULTS: Out of 662 patients diagnosed with SLE 161 (24) died. There were 151 (94) females and 10 (6) males. Mean duration of disease was 11.5 years. Mean age at death was 37 years. The primary causes of death were infection in 44 (27), uremia in 42 (26), cardiovascular complications in 33 (20), central nervous system complications in 18 (11), and pulmonary complications (other than infectious pneumonia) in 12 (7). CONCLUSIONS: The most common causes of death in SLE were infections and renal disease.

Takayasus arteritis in Puerto Rico: a clinical study

Dieciseis pacientes con evidencia angiográfica de arteritis de Takayasu fueron estudiados retrospectivamente. Los hallazgos más comunes al momento del diagnóstico fueron disminución en los pulsos, periféricos e hipertensión arterial. Los resultados de laboratório no fueron específicos. La mayoria de los pacientes respondieron favorablemente a los esteroides y/o inmunosupresores, con un buen pronóstico a largo plazo. Nuestra población de pacientes con arteritis de Takayasu es similar a otras series

Prevalence of upper gastrointestinal mucosal-abnormalities at a rheumatology clinic

El propósito de este estudio fue determinar la prevalencia y el grado de severidad de daño a la mucosa gastrointestinal superior en pacientes con artritis reumatoide y osteoartritis recibiendo agentes antinflamatorios no esteroidales con o sin prednisona; y la correlación entre los medicamentos y las anormalidades encontradas. Pacientes de la Clínica de Reumatología fueron escogidos al azar para participar en el estudio. Ochenta y cinco de 123 fueron incluidos. La apariencia endoscópica de la mucosa se clasificó del 0 al 9. Dieciseis pacientes tenían mucosa normal, 69 (81.1%) tenían anormalidades la mayoría mínimas (51.8%). Cincuenta y ocho de 85 pacientes tenían síntomas, 22 (38%) de estos tenían cambios moderados o severos; mientras que solo 3 (11.1%) de 27 asintomáticos tenían cambios moderados o severos. Seis pacientes (6%) tenían úlceras activas. La mayoría de los pacientes recibiendo drogas antireumáticas tenían cambios mínimos en endoscopía, y no se encontró un riesgo mayor para enfermedad severa al añadir prednisona a la terapia de no esteroidales. La prevalencia de úlceras en esta población no fue más alta que en la población general