Periodontitis is associated with higher subclinical atherosclerosis in patients with systemic lupus erythematosus

We would like to thank the patients from the Unit of Autoimmune Diseases of the “Virgen de las Nieves” University Hospital. This investigation has not received funds from any private entity. All procedures in this were performed from the regular care, with resources of the Spanish National Health System. All authors declare no conflicts of interest, and all authors have approved the final article.Aim: To determine periodontitis prevalence in patients with systemic lupus erythematosus (SLE) and to assess whether periodontitis in SLE patients is associated with a greater subclinical atherosclerosis. Methods: An observational case–control study was conducted in SLE (cases) and patients without any rheumatic diseases (controls), matched for sex. Sociodemographic and cardiometabolic variables were gathered, and SLE activity was assessed through several indexes. Periodontal examination registered probing pocket depth, clinical attachment level, bleeding on probing, plaque index, and tooth loss. Subclinical atherosclerosis was assessed by measuring the carotid–femoral pulse wave velocity (PWV) by Doppler velocimetry, homocysteine levels, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR). Bivariate analyses and logistic regression were used to assess the association of any of the studied variables with SLE. Results: Seventy-one cases and 72 controls were included in the study. Thirty-nine SLE patients (54.9%) were diagnosed with periodontitis, compared with 16 controls (22.2%). High levels of PWV (≥7.7 m/s, 75th percentile) were shown by 44.3% of the cases vs. 22.4% of the controls (p = .011). Among SLE patients, those with periodontitis showed higher PWV values (8.1 ± 1.52 vs. 7.16 ± 1.11 m/s, p = .006) and higher homeostasis model assessment index (indicative of insulin resistance) (1.7 ± 0.73 vs. 2.92 ± 3.05, p = .028) compared to those with periodontal health. Logistic regression showed that waist circumference (OR 1.06, 95% CI 1.01–1.12, p = .015); ESR (OR 1.09, 95% CI 1.03–1.16, p = .003); and bleeding on probing (OR 1.1, 95% CI 1.01–1.19, p = .018) were associated with the risk of SLE. Conclusion: Systemic lupus erythematosus patients showed a higher periodontitis percentage than controls. Higher PWV values were found in SLE patients with periodontitis, indicating a higher prevalence of subclinical atherosclerosis. Patients with higher gingival bleeding showed a higher risk of SLE

39-year-old women with severe headache

Paciente de 39 años que acude a urgencias por presentar un cuadro de cefalea intensa, holocraneal, con foto y sonofobia intensas, acompañada de febrícula. En la exploración física únicamente destacaban leves roncus en base de hemitórax izquierdo. Las pruebas complementarias iniciales fueron normales. Tras un estudio exhaustivo y fundamentalmente una insistencia en la anamnesis por órganos y aparatos, finalmente se llegó al diagnóstico.A 39-year-old comes to the emergency department because of severe headache, holocraneal, with photo and sonophoby, associated with febricula. In the physical examination, we found only rhonchus in the left lung. Initial complementary tests were normal. After an exhaustive study, principally a correct anamnesis, we could finally get to the diagnosis

35-Year-old woman with generalized edema

Mujer de 35 años que consulta por edematización progresiva de ambos miembros inferiores y facial de una semana de evolución. Además, diez días antes del inicio de los edemas, la paciente había presentado una infección respiratoria de vías altas. En la exploración se objetivó una tensión arterial 156/95 mmHg y edemas en ambos miembros inferiores. Analíticamente destacaba la presencia de insuficiencia renal leve (creatinina de 1.42 mg/dL, urea 93 mg/dL), unos niveles de C3 disminuidos, un sedimento de orina patológico (con hematíes, cilindros hemáticos y proteínas) y una proteinuria en orina de 24h de 900 mg. El cultivo de frotis faríngeo fue negativo pero el ASLO se encontraba elevado (522 U/mL), lo que, añadido al curso clínico de la enfermedad, permitió establecer el diagnóstico de glomerulonefritis postestreptocócica. La paciente fue tratada con dieta pobre en sal, ARA-II y diuréticos, presentando una evolución favorable hasta alcanzarse una completa normalización de la función renal y la proteinuria.A 35-year-old woman presented with a one-week history of progressive oedema of both lower limbs and the face. Besides, the patient had suffered from an upper airways infection ten days before the onset of the oedemas. On examination, a blood pressure of 156/95 mmHg and oedema in both lower limbs were observed. Laboratory tests revealed the presence of mild renal impairment (creatinine 1.42 mg/dL, urea 93 mg/dL), decreased levels of C3, abnormal urine sediment (red cells, red cell casts and proteins) and a 24-hour urine protein of 900 mg. The throat swab culture was negative but the ASO was elevated (522 U/mL), which, added to the clinical course of the disease, established the diagnosis of poststreptococcal glomerulonephritis. The patient was treated with low-salt diet, diuretics and ARBs, showing a favourable evolution until reaching a complete normalization of the renal function and the proteinuria

Ambulatory follow-up of patients with lupus in a systemic autoimmune disease unit

Objetivos: Describir los síntomas referidos por los pacientes con lupus eritematoso sistémico (LES) durante su seguimiento ambulatorio en una Unidad de Enfermedades Autoinmunes Sistémicas (UEAS), la relación de éstos con el propio LES o con otras patologías y la necesidad de derivación a otros especialistas. Material y Métodos: Se realizó un análisis descriptivo prospectivo durante 5 meses que incluyó a 112 pacientes con LES en seguimiento ambulatorio por una UEAS. Se valoró la sintomatología padecida desde la última revisión, tuviera o no relación con el LES y la prevalencia de pacientes derivados a otros especialistas. Resultados: Ochenta (71.4%) pacientes presentaron sintomatología no explicable por el LES, destacando la artralgias por artrosis y el síndrome ansioso-depresivo. Presentaron síntomas asociados al LES 32 (23.5%) pacientes, siendo el brote articular en 10 (8.3%) pacientes, el brote renal en 8 (7.1%) y el brote cutáneo en 5 (4.4%) los más frecuentes. Por último, fueron derivados a otros especialistas 10 (8.3%) pacientes. Conclusiones: Durante el seguimiento ambulatorio en una UEAS de los pacientes con LES, la prevalencia de consultas por síntomas y enfermedades no relacionadas con el LES podría ser superior a aquellas atribuibles al propio LES, subrayando la necesidad de una visión global y multidisciplinar en el manejo de estos pacientes.Objectives: To describe the symptoms referred by the patients with systemic lupus erythematosus (SLE) during their ambulatory follow-up by an Autoinmune Disease Unit (ADU), the relationship between them and SLE itself or with other clinic entities and the need to refer lupus patients to other specialists. Methods: We performed a descriptive analysis during 5 months that included 112 patients with SLE with ambulatory follow-up by an ADU. We assessed the symptomatology suffered by the patients since the last visit, related or not to SLE, and the prevalence of patients referred to other specialists. Results: Eighty (71.4%) patients had symptoms no explainable by SLE, mainly due to arthralgias secondary to osteoarthrosis and anxiety-depressive syndrome. Thirty-two (23.5%) patients had symptoms related to SLE, the most frequent of which were articular flare in 10 (8.3%) patients, lupus nephritis in 8 (7.1%) and skin flare in 5 (4.4%). Finally, ten (8.3%) patients were referred to other specialists. Conclusions: During the ambulatory follow-up of patients with SLE in an ADU, the frequency of consultations for symptoms and illnesses no related to SLE may be higher than those secondary to SLE, highlighting the need of a global and multidisciplinary management of these patients

A 62-year-old male with Raynaud’s phenomenon

Varón de 62 años que consulta por fenómeno de Raynaud en ambas manos de un mes de evolución acompañado de lesiones digitales necróticas e intenso dolor. La anamnesis y la exploración física no aportaron información adicional y la capilaroscopia solo evidenció pobreza vascular. Fueron normales o negativas tanto pruebas de laboratorio (hemograma, bioquímica, hormonas tiroideas, marcadores tumorales, serologías frente a hepatitis B y C, proteinograma, inmunoglobulinas, complemento, crioglobulinas y estudio de autoinmunidad), como de imagen (ecocardiografía, TAC toraco-abdominal y PET-TAC) e incluso una biopsia de las lesiones isquémicas. Sin embargo, el estudio de trombofilia mostró una mutación heterocigota para los genes de la metilen-tetrahidrofolato reductasa y del factor XII, así como positividad de los anticuerpos antifosfolipídicos (anti ß2-glicoproteína). Alcanzado el diagnóstico de síndrome antifosfolipídico y trombofilia genética, se inició tratamiento con vasodilatadores (prostaciclinas y bosentán) y anticoagulantes orales, los cuales permitieron una favorable evolución de las lesiones isquémicas.A 62-year-old male presented with a one month history of Raynaud’s phenomenon in both hands along with digital necrotic lesions and severe pain. The medical history and physical examination did not provide any additional information and nailfold capillaroscopy only showed escarce vasculature. Both laboratory (blood count, blood chemistry, thyroid hormones, tumor markers, serologies for hepatitis B and C, proteinogram, immunoglobulins, complement, cryoglobulins, autoimmunity tests) and imaging tests (echocardiography, thoracic and abdominal CT scan and a PET-CT) and even a biopsy of the ischemic lesions were normal or negative. However, the thrombophilia workup showed a heterozygous mutation in the genes of the methylenetetrahydrofolate reductase and the factor XII, and positivity for antiphospholipid antibodies (anti-beta2-glycoprotein). Once the diagnosis of antiphospholipid syndrome and genetic thrombophilia were made, treatment with oral vasodilators (prostacyclin and bosentan) and oral anticoagulants were started, which produced a satisfactory evolution of the ischemic lesions

Differential diagnosis of systemic lupus erythematosus: Key aspects of day-to-day

Este artículo aborda el diagnóstico diferencial del Lupus eritematoso sistémic

Síndrome metabólico en pacientes con lupus eritematoso sistémico

Tesis Univ. Granada. Departamento de Medicina Interna. Leída el 24 de septiembre de 201