Alteración pulmonar en el síndrome de Sjögren primario y asociado a artritis reumatoide

Hemos estudiado un total de 38 pacientes afectos con Síndrome de Sjögren, de ellos 13 corresponden a formas primarias (sin otra conectivopatía asociada) y 25 secundarios a Artritis Reumatoide. Hemos eliminado del estudio los pacientes con enfermedad pulmonar previa conocida, hábito tabáquico y otras conectivopatías a fin de unificar la patología. Se encontraron un total de 17 pacientes con algunas alteración en las pruebas funcionales respiratorias (44,7%), que clasificaron de la siguiente forma: 10 pacientes con patrones obstructivos (6 de ellos exclusivamente con obstrucción de vía aérea pequeña –menor de 2 mm-), 6 pacientes con restricción respiratoria y un paciente con insuficiencia respiratoria mixta de predominio restrictivo. Entre los afectados desde el punto de vista respiratorio predominan aquellos con A.R. asociada, con un claro predominio de las mujeres en todos los grupos. Se compararon todos los grupos afectados entre si y con el grupo sin afectación pulmonar, no encontrándose ningún dato clínico, analítico, radiológico o inmunológico distintivo de ninguno de ellos, salvo que el grupo restrictivo mostró una PO2 significativamente menor que el resto. Importa destacar la baja expresividad radiológica de todos los casos, lo que nos hace proponer el estudio funcional respiratorio como rutinario en estos pacientes. Hemos encontrado una alta incidencia de signos y síntomas del aparato locomotor entre nuestros pacientes con S.S.P., hecho tal vez condicionado por haber sido diagnosticados todos ellos en la Sección de Reumatología. CONCLUSIONES. 1. Hemos encontrado alteración de las pruebas funcionales respiratorias en 17 pacientes de los 38 estudiados (44,7%) con S.S. y sin afectación pulmonar previa conocida. 2. En los pacientes con S.S. asociado a Artritis Reumatoide se dio alteración de las pruebas funcionales respiratorias en el 56% de los casos, cifra superior a la que se encuentra en la literatura para pacientes con A.R. sin S.S. asociado. 3. Los pacientes que mostraron alguna alteración en las pruebas de función respiratoria se agruparon de la siguiente forma: 10 pacientes con obstrucción al flujo aéreo (4 con obstrucción puro y 6 con obstrucción de vías aéreas menores de 2 mm. exclusivamente); 6 pacientes con restricción respiratoria pura y 1 con insuficiencia respiratoria mixta de predominio restrictivo. 4. Los pacientes con Síndrome de Sjögren asociado a Artritis Reumatoide presentan con más frecuencia enfermedad pulmonar (56%) que los que tienen un Síndrome de Sjögren aislado (23%). 5. Se ha encontrado un claro predominio femenino en los pacientes con Síndrome de Sjögren, tanto en los que tienen afectación respiratoria como en los que no la tienen. 6. La comparación entre pacientes con alteraciones funcionales respiratorias y sin alteraciones, no arroja significación estadística en cuanto a la edad, tiempo de evolución de la A.R. o tiempo de evolución del S.S. Así mismo tampoco existen diferencias en cuanto al estadío radiológico o funcional de la A.R. o grado de afectación en la biopsia labial. 7. Los parámetros analíticos (VSG elevada, hiperproteinemia, anemia, ANA positivos), en general, está más alterados en el grupo con afectación pulmonar, aunque no alcanza significación estadística. 8. No encontramos correlación entre la clínica respiratoria, radiología pulmonar y pruebas funcionales respiratorias, siendo de destacar la escasa expresividad de la radiología pulmonar en todos nuestros casos. 9. Los pacientes con alteración funcional respiratoria de tipo Obstructivo fueron los más numerosos entre los afectados (10 de 17), no existiendo ningún dato clínico, analítico, radiológico o inmunológico distintivo del grupo. 10. Los pacientes con Restricción pulmonar, así mismo, no presentaron ningún dato clínico, analítico, radiológico o inmunológico peculiar, salvo el de predominar también entre los pacientes con A.R. y tener una PO2 significativamente menor que el resto de los grupos. 11. Estimamos oportuno el estudio de la función respiratoria en los pacientes con Síndrome de Sjögren aún en los casos con estudios radiológicos pulmonares negativos, dada la baja expresividad radiológica de la patología intersticial en fases iniciales. 12. En cuanto a la afectación del aparato Locomotor entre nuestros pacientes con Síndrome de Sjögren, se encontraba presente en el 50% de los casos, algunos de ellos con diagnóstico de Poliartritis sin filiar, lo que nos hace proponer la búsqueda sistemática de síntomas de sequedad entre los pacientes con síndromes articulares mal definidos

Tocilizumab in giant cell arteritis. Observational, open-label multicenter study of 134 patients in clinical practice.

Tocilizumab (TCZ) has shown efficacy in clinical trials on giant cell arteritis (GCA). Real-world data are scarce. Our objective was to assess efficacy and safety of TCZ in unselected patients with GCA in clinical practice Methods: Observational, open-label multicenter study from 40 national referral centers of GCA patients treated with TCZ due to inefficacy or adverse events of previous therapy. Outcomes variables were improvement of clinical features, acute phase reactants, glucocorticoid-sparing effect, prolonged remission and relapses. A comparative study was performed: (a) TCZ route (SC vs. IV); (b) GCA duration (≤6 vs. >6 months); (c) serious infections (with or without); (d) ≤15 vs. >15 mg/day at TCZ onset. 134 patients; mean age, 73.0 ± 8.8 years. TCZ was started after a median [IQR] time from GCA diagnosis of 13.5 [5.0-33.5] months. Ninety-eight (73.1%) patients had received immunosuppressive agents. After 1 month of TCZ 93.9% experienced clinical improvement. Reduction of CRP from 1.7 [0.4-3.2] to 0.11 [0.05-0.5] mg/dL (p  In clinical practice, TCZ yields a rapid and maintained improvement of refractory GCA. Serious infections appear to be higher than in clinical trials

Switching TNF antagonists in patients with chronic arthritis: An observational study of 488 patients over a four-year period

The objective of this work is to analyze the survival of infliximab, etanercept and adalimumab in patients who have switched among tumor necrosis factor (TNF) antagonists for the treatment of chronic arthritis. BIOBADASER is a national registry of patients with different forms of chronic arthritis who are treated with biologics. Using this registry, we have analyzed patient switching of TNF antagonists. The cumulative discontinuation rate was calculated using the actuarial method. The log-rank test was used to compare survival curves, and Cox regression models were used to assess independent factors associated with discontinuing medication. Between February 2000 and September 2004, 4,706 patients were registered in BIOBADASER, of whom 68% had rheumatoid arthritis, 11% ankylosing spondylitis, 10% psoriatic arthritis, and 11% other forms of chronic arthritis. One- and two-year drug survival rates of the TNF antagonist were 0.83 and 0.75, respectively. There were 488 patients treated with more than one TNF antagonist. In this situation, survival of the second TNF antagonist decreased to 0.68 and 0.60 at 1 and 2 years, respectively. Survival was better in patients replacing the first TNF antagonist because of adverse events (hazard ratio (HR) for discontinuation 0.55 (95% confidence interval (CI), 0.34-0.84)), and worse in patients older than 60 years (HR 1.10 (95% CI 0.97-2.49)) or who were treated with infliximab (HR 3.22 (95% CI 2.13-4.87)). In summary, in patients who require continuous therapy and have failed to respond to a TNF antagonist, replacement with a different TNF antagonist may be of use under certain situations. This issue will deserve continuous reassessment with the arrival of new medications. © 2006 Gomez-Reino and Loreto Carmona; licensee BioMed Central Ltd

Environmental and societal factors associated with COVID-19-related death in people with rheumatic disease: an observational study

Published by Elsevier Ltd.Background: Differences in the distribution of individual-level clinical risk factors across regions do not fully explain the observed global disparities in COVID-19 outcomes. We aimed to investigate the associations between environmental and societal factors and country-level variations in mortality attributed to COVID-19 among people with rheumatic disease globally. Methods: In this observational study, we derived individual-level data on adults (aged 18-99 years) with rheumatic disease and a confirmed status of their highest COVID-19 severity level from the COVID-19 Global Rheumatology Alliance (GRA) registry, collected between March 12, 2020, and Aug 27, 2021. Environmental and societal factors were obtained from publicly available sources. The primary endpoint was mortality attributed to COVID-19. We used a multivariable logistic regression to evaluate independent associations between environmental and societal factors and death, after controlling for individual-level risk factors. We used a series of nested mixed-effects models to establish whether environmental and societal factors sufficiently explained country-level variations in death. Findings: 14 044 patients from 23 countries were included in the analyses. 10 178 (72·5%) individuals were female and 3866 (27·5%) were male, with a mean age of 54·4 years (SD 15·6). Air pollution (odds ratio 1·10 per 10 μg/m3 [95% CI 1·01-1·17]; p=0·0105), proportion of the population aged 65 years or older (1·19 per 1% increase [1·10-1·30]; p<0·0001), and population mobility (1·03 per 1% increase in number of visits to grocery and pharmacy stores [1·02-1·05]; p<0·0001 and 1·02 per 1% increase in number of visits to workplaces [1·00-1·03]; p=0·032) were independently associated with higher odds of mortality. Number of hospital beds (0·94 per 1-unit increase per 1000 people [0·88-1·00]; p=0·046), human development index (0·65 per 0·1-unit increase [0·44-0·96]; p=0·032), government response stringency (0·83 per 10-unit increase in containment index [0·74-0·93]; p=0·0018), as well as follow-up time (0·78 per month [0·69-0·88]; p<0·0001) were independently associated with lower odds of mortality. These factors sufficiently explained country-level variations in death attributable to COVID-19 (intraclass correlation coefficient 1·2% [0·1-9·5]; p=0·14). Interpretation: Our findings highlight the importance of environmental and societal factors as potential explanations of the observed regional disparities in COVID-19 outcomes among people with rheumatic disease and lay foundation for a new research agenda to address these disparities.MAG is supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (grant numbers K01 AR070585 and K24 AR074534 [JY]). KDW is supported by the Department of Veterans Affairs and the Rheumatology Research Foundation Scientist Development award. JAS is supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (grant numbers K23 AR069688, R03 AR075886, L30 AR066953, P30 AR070253, and P30 AR072577), the Rheumatology Research Foundation (K Supplement Award and R Bridge Award), the Brigham Research Institute, and the R. Bruce and Joan M. Mickey Research Scholar Fund. NJP is supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (T32-AR-007258). AD-G is supported by grants from the Centers for Disease Control and Prevention and the Rheumatology Research Foundation. RH was supported by the Justus-Liebig University Giessen Clinician Scientist Program in Biomedical Research to work on this registry. JY is supported by grants from the National Institutes of Health (K24 AR074534 and P30 AR070155).info:eu-repo/semantics/publishedVersio