Our study cohort found that digital pitting scar, xerophthalmia, hypo-hyperpigmentation, joint contracture, and hypertension are more prevalent in late-onset SSc than early-onset SSc. However, no significant differences regarding the IR of cardiopulmonary involvement between the two subgroups, the majority of which were dcSSc, in the early phase of the disease.
Introduction: An outbreak of coronavirus disease-19 (COVID-19) has occurred in different parts of the world. Although a large piece of information regarding the epidemiology, clinical features, and management of COVID-19 has been reported in the general population, there is very limited data regarding organ transplant recipients, particularly regarding the management of maintenance immunosuppressive agents during infection. Methodology: We described a case of kidney transplant recipient from Thailand who had COVID-19 pneumonia and severe acute kidney injury. Results: The patient’s serum creatinine peaked at 7.0 mg/dL on day 15 of illness and returned to baseline value of 2.0 mg/dL on day 26 of illness. We have shown how we modified tacrolimus, mycophenolate, and steroids in the patient who had received favipiravir and lopinavir/ritonavir for COVID-19 pneumonia. Conclusions: In this case, successful modification of this immunosuppressive regimen was accomplished to reduce drug interaction complications, aiming to avoid calcineurin inhibitor nephrotoxicity while maintaining appropriate levels of immunosuppression to prevent organ rejection and to promote the patient’s recovery from infection.
BackgroundCardiac complication is one of leading causes of death in patients with systemic sclerosis (SSc). The incidence and predictors of myocardial involvement in patients with early SSc have been inconclusive.ObjectivesThe aims of this study were to (1) examine the prevalence of myocardial involvement determined by electrocardiography (ECG) and echocardiography; (2) compare the differences of those cardiac complications between DcSSc and LcSSc; (3) compare the differences of incidence rate (IR) of myocardial disease determined by echocardiogram between the two subtypes; and (4) determine the factors associated with myocardial involvement of early SSc.MethodsWe used an inception cohort of SSc patients seen at the Rheumatology clinic, Chiang Mai University, between January 2010 and June 2014. All patients were assessed for demographic data, clinical manifestations, laboratory testing and had ECG and echo performed at the study entry and every 12 months thereafter. All ECG and echo results were interpreted by two experienced cardiologists.ResultsOne hundred and sixteen patients (69 females) with a mean (SD) age of 53.5 years (8.5) and mean (SD) disease duration (non-Raynaud's phenomenon: NRP) 12.1 months (9.2) at cohort entry were enrolled during a mean (SD) observation period of 2.3 years (1.4). Of 116 patients, there were 92 (79.3%) patients with DcSSc, 67 (57.8%) with NYHA class II, 81 (69.8%) with ILD determined by HRCT, 93 (80.2%) with positive anti Scl-70, 9 (7.7%) with positive anti-centromere antibodies, and 35 (30.2%) with telangiectasia. Mean (SD) values were: modified Rodnan's skin score 19.9 (11.2); hemoglobin 12.3 (1.8) g/dl; creatinine 0.8 (0.3) mg/dl; CK 431.9 (709.4) U/L; pro-BNP 958.9 (3,656.7) mg/dl; uric acid 5.6 (1.5) mg/dl; ESR 41.8 (30.2) mg/dl; estimated systolic pulmonary arterial pressure 32.8 (9.3) mmHg; %LVEF 67.7 (7.9). DcSSc had shorter duration from NRP to the study entry than LcSSc (11.1±8.6 vs 16.1±10.5 months, p=0.023). At enrollment, there were no significant differences in the prevalence of myocardial involvement determined by ECG between DcSSc and LcSSc consisting of conduction defect (21.7% vs 8.3%), abnormal ST-T change (5.4% vs 4.2%), abnormal T wave (4.3% vs 8.3%), and pathological Q wave (4.3% vs 4.2%). There was no significant difference in the prevalence of myocardial involvement determined by echocardiogram (presence of any wall hypokinesia without evidence of coronary artery disease) between the two groups (14.1% vs 8.3%). Of 62 patients diagnosed myocardial disease, 19 (30.6%) was found within the first two years from NRP. There was significant difference of the IR of myocardial disease determined by echo since NRP between DcSSc and LcSSc (22.1 vs 11.6 per 100 person-years, p=0.027). Cox-regression analysis revealed that only baseline pro-BNP>200 mg/dl [HR 2.35 (95%CI 1.13, 4.89)] was a predictor of myocardial involvement, whereas presence of telangiectasia [HR 0.47 (95%CI 0.24, 0.91)] showed negatively associated.ConclusionsEarly SSc patients with DcSSc subtype had h...
BackgroundData regarding the incidence rate (IR) of cardiopulmonary involvement in comparison between male and female patients with early systemic sclerosis (SSc) are limited.ObjectivesTo compare the prevalence of clinical manifestations and the IR of cardiopulmonary involvement comparing between male and female patients with early SSc.MethodsAn inception cohort of early SSc patients (disease duration ≤3 years from the first non-Raynaud’s phenomenon) seen at the Rheumatology clinic, Maharaj Nakorn Chiang Mai Hospital, Thailand, between January 2010 and June 2016, was used. All patients were assessed for clinical manifestations and underwent ECG, echocardiography, and HRCT at the study entry and every 12 months thereafter. In the last visit, the cumulative clinical manifestations were recorded. Patients who continue to follow up at least 12 months were included for analysis.ResultsOne hundred and fifteen patients (89 dcSSc) with a mean (SD) disease duration of 11.6 (8.8) months at cohort entry were enrolled during a mean (SD) observation period of 3.8 (1.6) years. There were 46 male patients (40%). Tests for anti-topoisomerase I and anti-centromere antibodies were positive in 91 (79.1%) and 7 (6.1%) patients, respectively. The male group had higher prevalence of dcSSc subtype (91.3% vs. 69.5%,p=0.006) and positive test for anti-topoisomerase I antibody (89.1% vs. 72.5%,p=0.031) compared with the female group. At enrollment, the male group had higher prevalence of hypo-hyperpigmentation (84.8% vs. 65.2%,p=0.021), suspected myositis (26.1% vs. 10.1%,p=0.024), and right ventricular dysfunction (8.7% vs. 0%,p=0.024) compared with the female group. In the last visit, the male group had higher cumulative prevalence of digital ulcer (47.8% vs. 27.5%,p=0.026), telangiectasia (93.5% vs. 69.6%,p=0.002), joint contracture (69.6% vs. 43.5%,p=0.006), tendon friction rub (39.1% vs. 20.3%,p=0.027), LVEF <50% (21.7% vs. 8.7%,p=0.048) and right ventricular dysfunction (34.8% vs. 7.2%,p<0.001) compared with the female group. The male group had significant higher IR of right ventricular dysfunction (8.21 vs. 1.99 per 100 person-years,p=0.006) and interstitial lung disease (ILD) determined by HRCT (63.66 vs. 39.19 per 100 person-years,p=0.022) compared to the female group. However, no significant IR of LVEF <50% (5.63 vs. 2.10 per 100 person-years,p=0.078), and elevated systolic pulmonary artery pressure ≥50 mmHg determined by echocardiography (2.81 vs. 1.55 per 100 person-years,p=0.339) were observed among the two groups.ConclusionsOur study cohort found that male gender had higher proportion of dcSSc subtype and had more severe clinical manifestations compared with female. In addition, during the follow-up period, the IR of right ventricular dysfunction and ILD were higher in male than that in female patients in the early stage of SSc.Disclosure of InterestNone declared
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