European Journal of Rheumatology (Eur J Rheumatol) is an international, open access peer reviewed journal committed to promoting the highest standards of scientific exchange and education. The journal is published quarterly on January, April, July and October. The aim of the European Journal of Rheumatology is to cover various aspects of rheumatology for its readers, encompassing the spectrum of diseases with arthritis, musculoskeletal conditions, autoinflammatory diseases, connective tissue disorders, osteoporosis, translational research, the latest therapies and treatment programs. European Journal of Rheumatology publishes original articles, invited reviews, case based reviews, letters to the editor and images in rheumatology. The publication language of the journal is English. Accepted manuscripts are copy-edited for grammar, punctuation, and format. Once the publication process of a manuscript is completed, it is published online on the journal's webpage as an aheadof-print publication before it is included in its scheduled issue. A PDF proof of the accepted manuscript is sent to the corresponding author and their publication approval is requested within 2 days of their receipt of the proof.
BackgroundIn patients with SLE, subjective parameters are very important as they have a great impact on the quality of life. Among them, fatigue is the most prevalent symptom in SLE, as it occurs in more than 90% of patients (1). Likewise, approximately 50% of patients consider fatigue the most disabling symptom of the disease (2). Despite its high prevalence and impact on quality of life, fatigue has not been extensively studied in patients with SLE.ObjectivesTo determine the prevalence of fatigue in our cohort as well as the factors with which it is associated, its relationship with demographic variables, vitamin D levels, treatments, SLE symptoms and disease activity.MethodsA cross-sectional study was carried out including female patients with SLE (ACR 1997 criteria) who regularly attended the Parc de Salut Mar-IMAS in Barcelona between January 2012 and May 2014. We collected sociodemographic data, vitamin D supplementation, the VAS fatigue, pharmacological treatment, main serological markers of SLE, and plasma levels of 25-hydroxy vitamin D. The association between fatigue and the different variables was evaluated by the Spearman's rho correlation coefficient for the continuous and the Mann-Whitney U test for the categorical variables.ResultsOne hundred and two consecutive female patients were included. The fatigue variable was evaluated through a fatigue VAS with a mean score of 52.84 (range 0–100), a median of 59.00 and a standard deviation of 29.86. A statistically significant relationship was found between fatigue and age, MHAQ, SLICC and photosensitivity in the entirety of the 102 patients. As for the relationship between fatigue and vitamin D insufficiency (25-OH vit. D≤30 levels), the sample was divided into patients receiving vitamin D supplementation (N=60) and without supplementation (N=40), finding a significant relationship between fatigue and vitamin D insufficiency in the group without supplementation.Table 1.Correlation between fatigue and the different SLE variables studiedAge**Correlation coefficient0.289p-value0.003N102MHAQ**Correlation coefficient0.484p-value0.000N102SLICC**Correlation coefficient0.256p-value0.009N10225-0H-VitD**Correlation coefficient )-0.356p-value0.024N (not supplemented)40Photosensitivity*55.32 [30–80]p-value = 0.043N102Significant value p<0.05. Med [P25–P75]. *Mann-Whitney U test; **Spearman's rho test.ConclusionsFatigue is highly prevalent among female patients with SLE. A statistically significant association was found between the presence of fatigue, on the one hand, and age, MHAQ, SLICC, photosensitivity, and vitamin D insufficiency in the group of patients without supplementation on the other. It is necessary to carry out further studies with a larger sample and with validated fatigue measurement scales to confirm our findings.References Zonana-Nacach, A., Roseman, J. M., McGwin, G., Friedman, A. W., Baethge, B. A., Reveille, J. D., et al., and the LUMINA Study Group. Systemic lupus erythematosus in three ethnic groups. VI. Factors associated with fatigue within 5 ...
Background:Although the pathophysiology of osteonecrosis (ON) is not completely well-understood, it is likely the result of multiple combined effects such as environment, metabolic or genetic factors.Clinical presentation of ON may be silent or may appear in a variable range of gradual-onset pain. The prevalence of ON in patients with SLE varies according to whether the lesions are symptomatic or asymptomatic.Corticosteroid therapy (CT) has been recognized as a main risk factor to develop ON. Nevertheless, it looks like ON is more frequent in patients with SLE than in any other disease requiring systemic CT, which suggests that the use of corticosteroids may not be the only risk factor in those patients.Objectives:To evaluate the prevalence of ON and to determine the association between ON and other variables such as sociodemographic factors, cardiovascular risk factors, SLE symptoms, autoimmunity, treatment received and disease activity in patients with SLE from Hospital del Mar.Methods:177 medical records were reviewed. Inclusion criteria included patients with SLE that met at least 4 of 11 ACR-LUPUS criteria revised in 1982 and updated in 1997. We identified six ON cases. The ON variable was evaluated by nuclear magnetic resonance in symptomatic patients. Afterwards, we matched ON patients with controls according to age and gender in a 1:2 proportion.A bivariate descriptive analysis between cases and controls was made including demographic and clinical variables, cardiovascular risk factors and treatment received. The association between ON and the previously mentioned variables was evaluated by Fishers Exact test and Chi-square test.Results:The prevalence of ON was 3.4% (CI 95%: 0.01% - 0.07%), lower than that described in other series. We found statistical significance association between ON and arterial hypertension (patients with ON and hypertension: 62.5% vs patients with ON without hypertension: 10%; p-value 0.043), as well as between ON and CT evaluated by its presence in the last hospital follow-up (patients with ON under CT: 100% vs patients with ON without CT: 20%; p-value 0.025). The association between ON and the use of corticosteroid pulse therapy (CPT) was also statistical significance (patients with ON who received CPT: 80% vs patients with ON who did not receive CPT: 15.3%; p-value 0.022). Finally, we found a marginal association, although relevant, between ON and the SLICC damage index (p-value 0.057) (Table/Fig-1).Conclusion:We found a statistical significance association between ON and hypertension (classical known cardiovascular risk factor) as well as between ON and CT (in the last visit) and the use of CPT (risk factor known as an etiological agent in ON). We did not find a statistical significance association between ON and lupus disease activity (SLEDAI), but a trend to statistical significance was noticeable with respect to the accumulated irreversible damage on lupus disease (SLICC). In order to confirm the results obtained, it is necessary to carry out other studies, with a larger sam...
BackgroundThe effectiveness of the switch when the first anti-TNF failure in patients with rheumatoid arthritis has been demonstrated in multiple studies. But what is more effective, if you make the switch to another anti-TNF or another molecule, is not clearly defined.ObjectivesA retrospective study was performed in clinical practice to determine if there is a response to DAS 28 at 6 months of change and whether there is a difference in response if the switch is performed on another anti-TNF or another biological.MethodsFrom a total of 254 that met ACR 2010 criteria for RA, which have been biologically treated at Rheumatology of the Parc Salut Mar from 2000 to 2016, 61 (24%) were the first switch and the DAS 28 response at 3 and 6 months of follow-up. The following variables were analyzed: age, sex, years of evolution RA, erosions, FR, ACPA, type of biological treatment, DAS 28 at the start of the switch, 3 months and 6 months,% of patients presenting DAS 28 <2, 6 at 6 months.The statistical study was performed with SPSS 20 for paired and independent quantitative variables with Student's T and chi2 for qualitative variablesResultsOf the total of 61 first treatment changes, 27 (44.3%) were to another anti-TNF alpha, 23 (37.7) to tocilizumab (TCZ), 7 to abatacept (11.5%) and 4 to RTX (6,6). The demographic and response data DAS 28 are shown in Table 1. There are no differences in the years of evolution,% of women, FR or ACPA positive, erosions and disease activity, as measured by DAS 28, before the switch, between The two groups (anti-TNF vs non-anti-TNF). Patients in the anti-TNF group were slightly younger than non-anti-TNF.When the DAS 28 response is evaluated at 3 and 6 months, modifying the treatment is effective (DAS 28 beginning 4,40 vs DAS 28 6 months 2.8 p<0.001). When assessing the response to change, there is no difference in the DAS 28 response at 3 months or 6 months, if you switched to anti-TNF or non-anti-TNF (3.18 vs 2.52 p=0.122).When comparing the patients with anti TNF alpha vs TCZ, 62.5% of the patients with TCZ are in remission compared to 38, 5% (p=0.047).Table 1TotalSwich anti-TNF alphaSwich No anti-TNF alphap n=61n=26n=35 Age (years)60.08±11,556.19±8,462.97±12,80.023Sex (% M)80.384.677.10.532Years evolution (years)17.44±9,418.92±11,616.34±7,40.298Erosion (%)90.292.388.61.000FR+ (%)77.076.977.11.000ACPA+ (%)91.888.594.30.642Table 2TotalSwich anti-TNF alphaSwich No anti-TNF alphap n=61n=26n=35 DAS 28 Swich4.40±1,384.61±1,54.21±1,30.216DAS 28 3 months3.18±1,523.52±1,092.96±1,70.167DAS 28 6 months2.8±1,543.18±1,742.52±1,30.122DAS 28 <2.6 6 m (%)52.538.562.50.047ConclusionsIn this retrospective study in daily clinical practice, it is evident that the change in treatment after failure of the first biological one, without differences if the change is to an anti TNF or another treatment. The percentage of patients who are remission at 6 months is higher if the change is at TCZ. Given the small number of patients, larger studies would be needed to confirm the results.References Johnston SS et col...
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