Prevalencia e impacto de la violencia íntima de pareja en mujres con lupus eritematoso sistémico

Objective: Stress and trauma are psychosocial factors with an impact on the course of systemic lupus erythematosus (SLE). The influence of violence on SLE has not been entirely explored, even though women (including patients with rheumatic diseases) are a vulnerable population to any form of violence. This study aims to assess the prevalence and impact of intimate partner violence (IPV) on healthrelated quality of life in women with SLE. Methods: An observational, cross-sectional, and analytical study was conducted at a rheumatology clinic of a university hospital from September 2022 and September 2023. We evaluated the presence of IPV in 85 women with SLE with the Hurt, Insulted, Threatened with Harm and Screamed at (HITS) questionnaire and the Index of Spouse Abuse (ISA), and quality of life with LupusQoL. Results: The prevalence by HITS score of past-year IPV was 24.4% and of lifetime IPV was 36.5%. Past-year non-physical violence was present in 17.1% of patients by ISA, and 27.1% were victims in their lifetime. While in physical violence, 7.3% were victims in the previous year and 21.2% in their lifetime. The total quality of life and the emotional domain by LupusQoL were diminished in victims of past-year IPV, compared to those who weren’t exposed (p = 0.018 and p = 0.036, respectively). Past-year HITS score correlated with the physician global assessment (PGA) (rho = 0.301, p = 0.006), while lifetime HITS score correlated with PGA (rho = 0.329, p = 0.002) and SLEDAI-2K (rho = 0.277, p = 0.010). Conclusion: We found that 1 in 4 women suffered IPV in the previous year, and those who were exposed had diminished quality of life. Also, the severity of the abuse correlated with disease activity. The findings of this study highlight the relevance of assessing psychosocial factors in these patients to achieve better comprehensive care

Transancestral mapping and genetic load in systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is an autoimmune disease with marked gender and ethnic disparities. We report a large transancestral association study of SLE using Immunochip genotype data from 27,574 individuals of European (EA), African (AA) and Hispanic Amerindian (HA) ancestry. We identify 58 distinct non-HLA regions in EA, 9 in AA and 16 in HA (∼50% of these regions have multiple independent associations); these include 24 novel SLE regions (P<5 × 10-8), refined association signals in established regions, extended associations to additional ancestries, and a disentangled complex HLA multigenic effect. The risk allele count (genetic load) exhibits an accelerating pattern of SLE risk, leading us to posit a cumulative hit hypothesis for autoimmune disease. Comparing results across the three ancestries identifies both ancestry-dependent and ancestry-independent contributions to SLE risk. Our results are consistent with the unique and complex histories of the populations sampled, and collectively help clarify the genetic architecture and ethnic disparities in SLE.info:eu-repo/semantics/publishedVersio

Transancestral mapping and genetic load in systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is an autoimmune disease with marked gender and ethnic disparities. We report a large transancestral association study of SLE using Immunochip genotype data from 27,574 individuals of European (EA), African (AA) and Hispanic Amerindian (HA) ancestry. We identify 58 distinct non-HLA regions in EA, 9 in AA and 16 in HA (B50% of these regions have multiple independent associations); these include 24 novel SLE regions (Po5 10 8), refined association signals in established regions, extended associations to additional ancestries, and a disentangled complex HLA multigenic effect. The risk allele count (genetic load) exhibits an accelerating pattern of SLE risk, leading us to posit a cumulative hit hypothesis for autoimmune disease. Comparing results across the three ancestries identifies both ancestry-dependent and ancestry-independent contributions to SLE risk. Our results are consistent with the unique and complex histories of the populations sampled, and collectively help clarify the genetic architecture and ethnic disparities in SL

Hypokalemic Paralysis due to Primary Sjögren Syndrome: Case Report and Review of the Literature

Tubulointerstitial nephritis (TIN) is the main renal involvement associated with primary Sjögren syndrome (pSS). TIN can manifest as distal renal tubular acidosis (RTA), nephrogenic diabetes insipidus, proximal tubular dysfunction, and others. We present a 31-year-old female with hypokalemic paralysis due to distal RTA (dRTA). She received symptomatic treatment and hydroxychloroquine with a good response. There is insufficient information on whether to perform a kidney biopsy in these patients or not. The evidence suggests that there is an inflammatory background and therefore a potential serious affection to these patients, such as hypokalemic paralysis. We found 52 cases of hypokalemic paralysis due to dRTA in pSS patients. The majority of those patients were treated only with symptomatic medication. Patients who received corticosteroids had stable evolution even though they did not have another symptomatology. With such heterogeneous information, prospective studies are needed to assess the value of adding corticosteroids as a standardized treatment of this manifestation

Treatment of Early Rheumatoid Arthritis in a Multinational Inception Cohort of Latin American Patients the GLADAR Experience

Background: Treatment of rheumatoid arthritis (RA) has evolved dramatically in the last decade. However, little is known about the way rheumatologists in Latin America treat their patients in clinical practice, outside the scope of clinical trials.Objective: the objective of this study was to describe treatment patterns at disease onset in early RA with data from a large, multicenter, multinational inception cohort of Latin American patients.Methods: Consecutive patients with early RA (<1 year of disease duration as diagnosed by a rheumatologist) from 46 centers in 14 Latin American countries were enrolled in the study. Clinical data, laboratory assessments, and a detailed registry on type of prescriptions were collected at baseline and at 3, 6, 12, 18, and 24 months of follow-up. Hands and feet x-rays were obtained at baseline and at 12 and 24 months. All data were captured in Arthros 6.1 database. Continuous variables were expressed as means and SDs, and categorical variables were expressed as percentages and 95% confidence intervals (95% CIs). Only therapeutic data at baseline are presented, corresponding to the period between disease onset and second visit (3 months).Results: A total of 1093 patients were included. Eighty-five percent were female, and 76% had a positive rheumatoid factor. Mean age at diagnosis was 46.5 (SD, 14.2) years, and mean disease duration at the first visit was 5.8 (SD, 3.8) months. Between baseline and second visit (3 months), 75% of patients (95% CI, 72%-78%) received disease-modifying antirheumatic drugs. Methotrexate (MTX) alone or in combination was the most frequently used (60.5%), followed by antimalarials (chloroquine or hydroxychloroquine, 32.1%), sulfasalazine (7.1%), and leflunomide (LEF, 4%). in 474 patients (43%), initiation of disease-modifying antirheumatic drugs was within the first month after the first visit. in addition, 290 patients (26%; 95% CI, 23%-29%) received combination therapy as initial treatment. the most frequently used combinations were MTX + chloroquine (45%), MTX + hydroxychloroquine (25%), and MTX + sulfasalazine (16%). Eleven patients (1%; 95% CI, 0.5%-1.8%) received biologics. Sixty-four percent (95% CI, 60%-66%) received corticosteroids. of those, 80% (95% CI, 77%-84%) received 10 mg of oral prednisone or less.Conclusions: in this cohort of Latin American patients with early RA, most patients received MTX very early in their disease course. Combination therapy was used approximately in 1 of every 4 patients as initial therapy. Biologics were rarely used at this early stage, and low-dose prednisone was commonly used.Abbott LaboratoriesAbbottHosp Italiano Buenos Aires, Serv Clin Med, Secc Reumatol, Buenos Aires, DF, ArgentinaFdn Dr Pedro M Catoggio Progreso Reumatol, Buenos Aires, DF, ArgentinaHosp Gen Dr Miguel Silva, Unidad Invest Dr Mario Alvizouri Munoz, Morelia, Michoacan, MexicoHosp Prov Rosario, Serv Reumatol, Rosario, Santa Fe, ArgentinaUniv Nacl Rosario, RA-2000 Rosario, ArgentinaHosp Privado, Ctr Med Cordoba, Dept Reumatol, Cordoba, ArgentinaHosp San Martin La Plata, Dept Reumatol, La Plata, Buenos Aires, ArgentinaUniv Fed Minas Gerais, Hosp Clin, Dept Aparelho Locomotor, Serv Reumatol, Belo Horizonte, MG, BrazilUniversidade Federal de São Paulo UNIFESP, Dept Med Interna, Serv Reumatol, São Paulo, BrazilPontificia Univ Catolica Rio Grande do Sul, Dept Reumatol, Porto Alegre, RS, BrazilUniv Fed Parana, Hosp Clin, Dept Clin Med, Disciplina Reumatol, BR-80060000 Curitiba, Parana, BrazilHosp Geral Goiania Dr Alberto Rassi, Secao Reumatol, Goiania, Go, BrazilPontificia Univ Catolica Chile, Fac Med, Dept Clin Immunol & Rheumatol, Santiago, ChileHosp Clin San Borja Arriaran, Dept Reumatol & Inmunol, Santiago, ChileClin Univ Bolivariana, Corp Invest Biol, Dept Inmunol Clin & Reumatol, Medellin, Antioquia, ColombiaHosp Mil, Dept Reumatol & Inmunol, Bogota, ColombiaHosp Especialidades Ctr Med La Raza, Ctr Med Nacl Siglo 21, Dept Reumatol, Mexico City, DF, MexicoUniv Autonoma Nuevo Leon, Hosp Univ Dr Jose Eleuterio Gonzalez, Dept Med Interna, Serv Reumatol, Monterrey, Nuevo Leon, MexicoHosp Gen Occidente Secretaria Salud, Dept Inmunol & Reumatol, Zapopan, Jalisco, MexicoHosp Presidente Estrella Urena, Clin Corominas, Clin Union Med, Dept Reumatol, Santiago, Dominican RepHosp Univ Caracas, Minist Salud, Ctr Nacl Enfermedades Reumat, Serv Reumatol, Caracas, VenezuelaUniversidade Federal de São Paulo UNIFESP, Dept Med Interna, Serv Reumatol, São Paulo, BrazilWeb of Scienc

Consenso mexicano sobre el síndrome de intestino irritable

Antecedentes: Desde la publicación de las guías de diagnóstico y tratamiento del síndrome del intestino irritable (SII) de la Asociación Mexicana de Gastroenterología en el 2009 (Guías 2009) se han producido avances significativos en el conocimiento de la epidemiología, fisiopatogenia, diagnóstico y tratamiento de esta enfermedad. Objetivos: Presentar una revisión consensuada del estado actual de los conocimientos sobre el SII que actualicen las Guías 2009, integrando las nuevas evidencias científicas publicadas a nivel mundial con énfasis en estudios realizados en México. Métodos: Se realizó una revisión de la bibliografía en PubMed de enero del 2009 a marzo del 2015, que se complementó en forma manual. Se incluyeron todas las publicaciones en inglés y español, con preferencia por los consensos, guías, revisiones sistemáticas y metaanálisis. Se generaron enunciados en los diferentes aspectos de la enfermedad que fueron votados por 24 gastroenterólogos con el método Delphi. Una vez consensuado cada enunciado, se calificó el nivel de la evidencia y se otorgó la fuerza de la recomendación utilizando el sistema GRADE. Resultados: Se generaron 48 enunciados que actualizaron la información sobre el SII y complementaron la información que no había sido incluida en las Guías 2009 con referencia al papel del ejercicio y la dieta, las estrategias diagnósticas, así como alternativas de tratamiento existentes que fueron evaluadas con mayor rigor o que surgieron en los 5 últimos años. Conclusiones: Presentamos una revisión consensuada de los progresos más relevantes en el SII, que actualizan y complementan las Guías 2009. Se incluyen diversos estudios realizados en México