Background Cardiovascular disease (CVD) is a major cause of morbidity and mortality in patients with systemic lupus erythematosus (SLE), a 50-fold than general population. Traditional risk factors, such as, cigarette smoking and dyslipidemia, are known but they cannot fully account for the increased risk. Instead, non-traditional risk factors, related to disease are also contributing. Varied results have been reported on the association between coffee drinking and CVD in the general population, with controversial results. Coffee consumption has not been evaluated systematically in SLE patients with CVD. Objectives We aimed to determine the prevalence and associated risk factors for CVD in a Latin American population with SLE. Methods This was a cross-sectional study in which consecutive patients with SLE (ACR 1997 update) seen on an outpatient basis were assessed for CVD including arterial hypertension, coronary artery disease, peripheral arterial disease, cerebrovascular disease and thrombosis. Factors associated with its occurrence were examined by bivariate and multivariate regression analyses. Results Out of a total of 310 patients, 113 (36.5%) presented with CVD. The most frequent condition was hypertension (69%). Dyslipidemia (28% vs. 12%), ever smoking (51% vs. 37%), coffee consumption (70.5% vs. 55.2%) and pleural effusion (32% vs. 19%) were positively associated with CVD (Table). Logistic regression analyses disclosed an independent effect of coffee consumption and cigarette smoking on CVD regardless of gender and duration of disease. Conclusions A high rate of CVD was observed in our patient population. Awareness of the observed risk factors should encourage preventive population strategies for CVD in patients with SLE aimed to facilitate the suppression of cigarette smoking and coffee consumption as well as to the tight control of dyslipidemia. References Magder LS, Petri M. Am J Epidemiol. 2012;176(8):708-19 Zhang Z, et al. Am J Clin Nutr. 2011;93(6):1212-9 Di Castelnuovo A, et al. Eur J Intern Med. 2012;23(1):15-25 Kahlenberg JM, Kaplan MJ.Arthritis Res Ther. 2011;13(1):203 Disclosure of Interest None Declared
La cefalea constituye uno de los principales síntomas de consulta en el servicio deurgencias y constituye un desafío para el médico. Objetivo: Determinar los factoresclínicos que están asociados con la presencia de masa cerebral en pacientes que debutancon cefalea. Metodología: Estudio retrospectivo de casos y controles. Se definió como caso cada paciente que consultó por cefalea con evidencia imagenológica por tomografía axial computarizada (TAC) o resonancia nuclear magnética (RMN)de masa cerebral. Los controles fueron pacientes con cefalea sin evidencia imagenológica de masa cerebral. El tamaño de muestra fue de 272 pacientes (62 casos y 210 controles).Para determinar los factores asociados al desenlace se realizó un análisis de regresión logística binaria, incluyendo variables plausibles con p < 0,2 en el análisis bivariado y aquellas biológicamente plausibles. Se calcularon los odds ratio ajustados (ORA) y sus respectivos intervalos de confianza. Se consideró significativo un valor de p < 0,5. Resultados: Las variables clínicas asociadas con la presencia de masa cerebral fueron: 1) antecedente de cáncer fuera del sistema nervioso central, 2) cefalea que empeora con las maniobras de Valsalva, 3) alteraciones en el examen motor y 4) cefalea que despierta al paciente en la noche. Conclusiones: Se encontró que las variables mencionadas constituyen signos de alarma predictivos de la presencia de cefalea secundaria a masa cerebral y son importantes en la evaluación de todo paciente que consultapor cefalea en el servicio de urgencias y pueden orientar para la toma de decisiones.
Background Lupus nephritis (LN) is one of the most serious complications of systemic lupus erythematous (SLE). Multiple clinical and serological risk and protective factors for LN have been identified in Caucasians. Objectives The aim of this study was to examine associated factors for LN in a new cohort of Latin American patients. Methods The study included 310 consecutive SLE patients (91% female, median age at onset: 38 years) followed at a single-center. The population means estimated autosomic Amerindian, European and African admixture are 26%, 63.5% and 10.6%, respectively and the means estimated X-chromosome admixture are 43.5%, 45.3% and 11.2%, respectively. LN was defined by the presence of active urinary sediment or proteinuria, nephritic or nephrotic syndrome, or a positive renal biopsy (ISN/RPS). Data were examined by bivariate and multiple correspondence analyses. Environmental exposure (i.e., ever smoke, coffee consumption, silicone implants, organic solvents, hair dye, and pesticides exposure) and cutaneous involvement (i.e., photosensitivity, oral ulcers, malar rash, urticary, discoid lupus, subacute lupus, and skin and oral ulcers) were examined by latent trait analysis using two-parameters logistic model through item response theory. Logistic regression analysis was done to assess the factors associated with LN. Interaction among biologically plausible variables was also evaluated. Results Nephritis was present in 46.5% of patients. Environmental factors (AOR: 1.64, 95%CI: 1.02-2.71, p=0.04), dyslipidemia (AOR: 18.1, 95%CI: 4.58-89.2, p<0.001), pleural effusion (AOR: 3.1, 95%IC: 1.45-6.99, p=0.004) and psychosis (AOR: 5.9, 95%CI: 1.40-31.4, p=0.02) were positively associated with LN. In contrast, the presence of Sjögren’s syndrome (SS, AECG 2002) disclosed a protective factor (AOR: 0.23, 95%CI: 0.06-0.73, p=0.01). In addition, dyslipidemic patients with short duration of disease and those with pleural effusion with cutaneous involvement exhibited a higher risk for LN. The coefficient of determination was 27%, indicating the multifactorial causation of LN. Conclusions Risk and protective factors for LN were confirmed in this admixed SLE population. These results may serve to define public health policies aimed to tight control the modifiable risk factors for LN. The search for additional factors for LN including genetics and epigenetics will improve our knowledge of this critical condition. Admixed populations can be a powerful resource for elucidating those factors. References Contreras G, et al. Am J Phys Anthropol. 2006; 69:1846–51. Rojas W, et al. Kidney Int. 2010; 143(1):13-20. Disclosure of Interest None Declared
Background Cutaneous involvement is one of the most frequent manifestations of systemic lupus erythematosus (SLE); however ethnicity may influence its prevalence and clinical expression. Objectives We aimed to evaluate its prevalence and associated factors in a non-Caucasian population. Methods Data from a cohort of 310 patients with SLE (ACR 1997 update) who were seen at a single clinical center were analyzed. The cutaneous involvement latent trait (CILT) was constructed using item response theory and two-parameter logistic model (1) which involved the following variables: photosensitivity, oral ulcers, malar rash, discoid lupus, subacute lupus and urticary. CILT was included as dependent variable in a lineal regression model, adjusted for gender and age at onset. Results Cutaneous involvement was observed in 88% (n=273) of patients, and was associated with familial autoimmunity (β=0.44, p=0.001), renal involvement (β=0.34, p=0.042), serositis (β=0.32, p=0.009) and immunological criteria (β=0.20, p=0.035). On the other hand, inverse relationship with age at onset (β=-0.01, p=0.027) and leukopenia (β=-0.23, p=0.03) was found. Some interactions were also observed. Among these, patients with polyautoimmunity tended to have a lower CILT than those with lupus arthropathy. Conclusions Cutaneous involvement is a common manifestation in our SLE population. Found associations and interactions can help distinguish patients at risk and guide early interventions. Latent trait analysis may be an instrumental tool for the study of subphenotypes in SLE and other autoimmune diseases. References Rizopoulos, D. (2006) ltm: An R package for latent variable modeling and item response theory analyses. Journal of Statistical Software, 17(5), 1–25. Disclosure of Interest None Declared
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