BackgroundSystemic autoimmune diseases (SAD) have traditionally been treated with steroids and immunosuppressants, but not all patients respond to this strategy. Rituximab (RTX) has been used in several SAD with favorable efficacy and safety results; there are only reports of isolated clinical experiences of small series of patients. The description of this drug safety data in daily clinical practice may be relevant.ObjectivesTo describe the adverse events and the hospital admissions during the treatment of a series of patients with SAD with RTX.MethodsDemographic data, related to disease and treatment, response and safety variables were included. We use the EULAR definitions of partial response (improvement of at least 50% of the main manifestations) and complete response (disappearance of the manifestations), because of the heterogeneity of the SAD.ResultsWe included 53 patients, 90.6% were women; the mean age at diagnosis was 31.42±14.33 years; and the median duration of disease at the onset of RTX 1.99 (0–7.5) years. Patients received a median of 2 cycles (1–3; min -1, max 12); and the median interval between cycles was 14.81 months (6–15.75;min 6, max 120).The SAD were SLE with 23 cases (43.4%), systemic sclerosis with 7 cases (13.2%), Sjögren's syndrome with 6 cases (11.3%), vasculitis with 5 cases (9.4%), Still disease with 3 cases (5.7%), autoinmune cytopenias with 3 cases (5.7%), dermatomyositis with 2 cases (3.8%), Behçet's disease with 2 cases (3.8%), IgG4 disease with 1 case (1.9%) and sarcoidosis with 1 case (1.9%).A partial response was observed in 27 patients (50.9%) and complete in 20 patients (37.7%). There was no response in 6 of the 53 patients (11.3%).Adverse events were detected in 15 of the 53 patients (28.3%) and 20 were hospitalized (37.7%) during the treatment with RTX (Table 1).Infecctions (9)Disease activity (8)Others (3) Respiratory: 7LES: 8Acute coronary syndrome: 1Pyelonephritis: 1Vertebral fracture: 1Stomach flu: 1Metrorrhagia: 1Three patients developed hypogammaglobulinemia, only one of them was associated with recurrent respiratory infections and even hospitalized in one occasion. Febrile neutropenia was detected in 2 patients, and one of them required admission. Three patients were diagnosed with pneumonia and admitted for supportive and antibiotic treatment. Three other patients suffered gastroenteritis requiring admission in one of them. In two cases, low respiratory infections were repeated requiring admission on 7 occasions. There was also recurrent otitis and a severe hypersensitivity reaction.ConclusionsThe most frequent adverse event were the infectious, mainly respiratory tract infections followed by an infusion reaction. No patient developed opportunistic diseases. This findings are similar than observed in other studies on patients with SAD treated with RTX. Infusion reactions are becoming less frequent, due in part to premedication.We are dealing with a large number of patients with refractory EAS treated with RTX, so the data obtained from this study show an acceptabl...
BackgroundWe performed a descriptive study of our patients with psoriatic arthritis (PsA) over 40 years old, attending to the presence of coronary disease and cardiovascular risk factors in each group of treatment (DMARDS vs biologic therapy).MethodsPatients older than 40 years, diagnosed with psoriatic arthritis attending clinics at the Department of Rheumatology were analysed to determine how many of them presented coronary disease. The following information was recorded: age, sex, disease duration and age at the coronary event, HLA-B27 positivity, hypertension, type II diabetes and hyperlipidemia, on medical records and discharge reports for each patient.ResultsAll 137 patients were identified from an electronic database. We found a male predominance: 57% versus 43% of women. Mean age 57.05±10.6 years. Of the 137 patients, 82% had only peripheral arthritis, while 18% also showed axial involvement. With regard to the latter subgroup, 16% patients had a positive HLA-B27 test, 56% were HLA-B27 negative and 28% showed lack of HLA-B27 test. Almost all patients (87%) were in DMARDs therapy, while 31% received biologic therapy: etanercept 42%, secukinumab 16%, adalimumab 12%, ustekinumab 12%, infliximab 9,5%, golimumab 4,7% and certolizumab 2%. About 7% of patients didn’t receive DMARDS neither biologic therapy, because of intolerance.Results regarding to cardiovascular risk factors, and coronary disease are as follows:DMARD therapyBiologic therapy (±DMARDS) Arterial Hypertension43%26%Diabetes19,5%7%Hyperlipidemia47,5%38%Coronary disease10,9%2,4%In DMARD subgroup, we found 6 myocardial infarction (all of them revascularized) and 3 angina, versus 1 myocardial infarction in biologic subgroup.ConclusionsThere is solid epidemiologic evidence linking PsA to cardiovascular risk factors and an increased risk of developing cardiovascular disease1. Furthermore, over the past two decades it has become increasingly clear that chronic inflammation is an independent risk factor for cardiovascular events. In our study the ratio of ischaemic heart disease for patients with PsA in DMARD therapy is four times higher than that of biologic treatment group. This may be due to the greater percentage of cardiovascular risk factors in the first group, although, the cardioprotective effect of biologic therapies, must be taken into account, as there are some studies that show association between antiTNF and significant reduction in carotid IMT2. Proper management of cardiovascular risk requires aggressive control of disease activity.References[1] Int. J. Mol. Sci2018;19(1):58. doi:10.3390/ijms19010058[2] Int J Rheumatol2012;2012:714321.Disclosure of InterestNone declared
BackgroundAntiphospholipid syndrome (APS) is characterized by spontaneous and recurrent vascular thromboses, abortion and thrombocytopenia. Cardiac manifestations are rare, but may occur as cardiac masses, such as thrombus (Libman-Sacks endocarditis). On the other hand, it is known that the most common type of primary cardiac tumors, myxoma, can produce clinical pictures similar to APS and SLE, and that tumor exeresis resolves symptoms.MethodsWe examined 2 patients diagnosed with SLE and APS that presented cardiac mass. They were assessed with careful history taking, physical examination, laboratory tests, echocardiography and histological examination.ResultsCase 1. A 13-years-old girl, with history of autoimmune hemolytic anemia treated with corticosteroids, folic acid and splenectomy a year before, presented a right ischemic stroke with hemiparesis sequel. Laboratory tests revealed ANA, antiDNAds, aCL and lupus anticoagulant positive and echocardiography showed a cardiac mass. She was underwent surgery to exeresis the mass, which was compatible with myxoma. She was diagnosed with immune syndrome secondary to myxoma and did not take treatment. Seven months after the complete exeresis of the myxoma, she was admitted to our hospital because of two months fever, polyarthralgia, oral ulcers and malar rash. Echocardiography showed pericardial effusion and blood tests showed lymphopenia, anemia, ANA and antiDNA positive and elevation of acute phase reactants; urinalysis was normal. She was diagnosed with SLE flare and was successfully treated with corticoids and started hydroxychloroquine, azathioprine and acetylsalicylic acid.The second case is a 48-years-old woman diagnosed with SLE and associated APS (oral ulcers, thrombosis, arthritis, malar rash, ANA, Coombs and aCL positive), with a history of bilateral iliac arterial ischemia caused by myxoma emboli (confimated by histological examination) and a cardiac mass on echocardiogram. Fourteen months after the vascular surgery, the patient still needs treatment with rituximab, azathioprine and corticoids to control SLE activity and is on anticoagulant treatment to prevent thrombotic episodes.ConclusionsIn patients with myxoma and symptoms of APS and/or SLE, there is doubt whether these are secondary to myxoma or if these diseases coexist, so it is recommended to closely monitor clinical activity after exeresis of myxoma and consider not suspending immunosuppressants and/or anticoagulants or the progressive withdrawal of drugs according to symptoms, in order to avoid possible serious complications of autoimmune disease.Funding Source(s):None
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