Factors associated with active tuberculosis in Colombian patients with systemic lupus erythematosus: a case-control study / Ruth María Eraso Garnica  

Público ISBD Título : Factors associated with active tuberculosis in Colombian patients with systemic lupus erythematosus: a case-control study Tipo de documento : documento electrónico Autores : Ruth María Eraso Garnica, Fecha de publicación : 2021 Títulos uniformes : Clinical Rheumatology Idioma : Inglés (eng) Palabras clave : Glucocorticoids  Immunosuppressants  Opportunistic infections  Systemic lupus erythematosus  Tuberculosis Resumen : Objective: To identify factors associated with active tuberculosis (TB) in patients with systemic lupus erythematosus (SLE). Methods: We performed a retrospective case-control study in two tertiary care teaching hospitals in Medellín, Colombia. From January 2007 to December 2017, a total of 268 patients with SLE were included. SLE patients with TB (cases) were matched 1:3 with SLE patients without TB (controls) by disease duration and the date of the hospitalization in which the diagnosis of TB was made (index date of cases) to the nearest available rheumatology hospitalization in the matched controls (± 2 years). Conditional univariable and multivariable logistic regression analyses were performed. Results: Sixty-seven cases and 201 controls were assessed. Only pulmonary TB occurred in 46.3%, only extrapulmonary TB in 16.4% and disseminated TB in 37.3% of cases. Multivariable logistic regression analysis showed that lymphopenia (OR, 2.91; 95% CI 1.41-6.03; P = 0.004), 12-month cumulative glucocorticoid dose ≥ 1830 mg (OR, 2.74; 95% CI 1.26-5.98; P = 0.011), and having been treated with ≥ 2 immunosuppressants during the last 12 months (OR, 2.81; 95% CI 1.16-6.82; P = 0.022) were associated with TB after adjusting for age, sex, ethnicity, disease duration, disease activity, and comorbidity index. A trend towards an association of kidney transplantation with TB was also found (OR, 3.77; 95% CI 0.99-14.30; P = 0.051). Conclusion: Among SLE patients, cumulative glucocorticoid dose, lymphopenia, and the use of ≥ 2 immunosuppressants during the last 12 months were associated with active TB infection. Key Points • Among SLE patients, a cumulative dose of glucocorticoids equivalent to 5 mg/day of prednisone during the last 12 months is independently associated with the development of TB. • The use of two or more immunosuppressants during the last 12 months is also a risk factor for TB infection development is SLE patients. • Lymphopenia is predominant in SLE patients with TB, being especially profound in those with disseminated TB. • Renal transplant recipients with SLE also have an elevated risk of TB. Mención de responsabilidad : Luis Alonso González-Naranjo, Jaime Alberto Coral-Enríquez, Mauricio Restrepo-Escobar, Carlos Horacio Muñoz-Vahos, Daniel Jaramillo-Arroyave, Adriana Lucía Vanegas-García, Ruth Eraso, Gloria Vásquez & Fabián Jaimes Referencia : Clin Rheumatol. 2021 Jan;40(1):181-191. DOI (Digital Object Identifier) : 10.1007/s10067-020-05225-x PMID : 32529420 En línea : https://link.springer.com/article/10.1007%2Fs10067-020-05225-x Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=5753 Factors associated with active tuberculosis in Colombian patients with systemic lupus erythematosus: a case-control study [documento electrónico] / Ruth María Eraso Garnica,  . - 2021. Obra : Clinical Rheumatology Idioma : Inglés (eng) Palabras clave : Glucocorticoids  Immunosuppressants  Opportunistic infections  Systemic lupus erythematosus  Tuberculosis Resumen : Objective: To identify factors associated with active tuberculosis (TB) in patients with systemic lupus erythematosus (SLE). Methods: We performed a retrospective case-control study in two tertiary care teaching hospitals in Medellín, Colombia. From January 2007 to December 2017, a total of 268 patients with SLE were included. SLE patients with TB (cases) were matched 1:3 with SLE patients without TB (controls) by disease duration and the date of the hospitalization in which the diagnosis of TB was made (index date of cases) to the nearest available rheumatology hospitalization in the matched controls (± 2 years). Conditional univariable and multivariable logistic regression analyses were performed. Results: Sixty-seven cases and 201 controls were assessed. Only pulmonary TB occurred in 46.3%, only extrapulmonary TB in 16.4% and disseminated TB in 37.3% of cases. Multivariable logistic regression analysis showed that lymphopenia (OR, 2.91; 95% CI 1.41-6.03; P = 0.004), 12-month cumulative glucocorticoid dose ≥ 1830 mg (OR, 2.74; 95% CI 1.26-5.98; P = 0.011), and having been treated with ≥ 2 immunosuppressants during the last 12 months (OR, 2.81; 95% CI 1.16-6.82; P = 0.022) were associated with TB after adjusting for age, sex, ethnicity, disease duration, disease activity, and comorbidity index. A trend towards an association of kidney transplantation with TB was also found (OR, 3.77; 95% CI 0.99-14.30; P = 0.051). Conclusion: Among SLE patients, cumulative glucocorticoid dose, lymphopenia, and the use of ≥ 2 immunosuppressants during the last 12 months were associated with active TB infection. Key Points • Among SLE patients, a cumulative dose of glucocorticoids equivalent to 5 mg/day of prednisone during the last 12 months is independently associated with the development of TB. • The use of two or more immunosuppressants during the last 12 months is also a risk factor for TB infection development is SLE patients. • Lymphopenia is predominant in SLE patients with TB, being especially profound in those with disseminated TB. • Renal transplant recipients with SLE also have an elevated risk of TB. Mención de responsabilidad : Luis Alonso González-Naranjo, Jaime Alberto Coral-Enríquez, Mauricio Restrepo-Escobar, Carlos Horacio Muñoz-Vahos, Daniel Jaramillo-Arroyave, Adriana Lucía Vanegas-García, Ruth Eraso, Gloria Vásquez & Fabián Jaimes Referencia : Clin Rheumatol. 2021 Jan;40(1):181-191. DOI (Digital Object Identifier) : 10.1007/s10067-020-05225-x PMID : 32529420 En línea : https://link.springer.com/article/10.1007%2Fs10067-020-05225-x Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=5753

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Antiphospholipid antibodies, steroid dose, arterial hypertension, relapses, and late-onset predict organ damage in a population of Colombian patients with systemic lupus erythematosus / Luis Fernando Pinto Peñaranda ; Carolina Muñoz Grajales ; Mónica Zuluaga Quintero ; Andrés Felipe Echeverri García ; Javier Darío Márquez Hernández  

Público ISBD Título : Antiphospholipid antibodies, steroid dose, arterial hypertension, relapses, and late-onset predict organ damage in a population of Colombian patients with systemic lupus erythematosus Tipo de documento : documento electrónico Autores : Luis Fernando Pinto Peñaranda, ; Carolina Muñoz Grajales, ; Mónica Zuluaga Quintero, ; Andrés Felipe Echeverri García, ; Javier Darío Márquez Hernández, Fecha de publicación : 2018 Títulos uniformes : Clinical Rheumatology Idioma : Inglés (eng) Palabras clave : Organ damage  SLICC/ACR SDI  systemic lupus erythematosus Resumen : Organ damage predicts mortality, increased accrual of detriment, and poor quality of life in systemic lupus erythematosus patients. The objective of this study is to determine the damage-free survival and its predictive factors in a population of Colombian subjects. The method used in this study is the retrospective follow-up of a cohort; damage was measured with SLICC/ACR index. Predictors of impairment were assessed by logistic regression and survival analysis. One hundred sixty-one individuals were included; 28.9% suffered damage, primarily neuropsychiatric, renal, and vascular. Arterial hypertension, antiphospholipid antibodies, prednisone dose, and number of relapses were all predictors of detriment. Onset after age 50 and daily prednisone dose higher than 7.5 mg determined earlier occurrence of damage. Mención de responsabilidad : Luis F Pinto-Peñaranda, C Muñoz-Grajales, A F Echeverri Garcia, C J Velásquez-Franco, M A Mesa-Navas, M Zuluaga Quintero, S Herrera-Uribe, J D Márquez-Hernández Referencia : Clin Rheumatol. 2018 Apr;37(4):949-954. DOI (Digital Object Identifier) : 10.1007/s10067-017-3927-8 PMID : 29204758 En línea : https://link.springer.com/article/10.1007%2Fs10067-017-3927-8 Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=4200 Antiphospholipid antibodies, steroid dose, arterial hypertension, relapses, and late-onset predict organ damage in a population of Colombian patients with systemic lupus erythematosus [documento electrónico] / Luis Fernando Pinto Peñaranda, ; Carolina Muñoz Grajales, ; Mónica Zuluaga Quintero, ; Andrés Felipe Echeverri García, ; Javier Darío Márquez Hernández,  . - 2018. Obra : Clinical Rheumatology Idioma : Inglés (eng) Palabras clave : Organ damage  SLICC/ACR SDI  systemic lupus erythematosus Resumen : Organ damage predicts mortality, increased accrual of detriment, and poor quality of life in systemic lupus erythematosus patients. The objective of this study is to determine the damage-free survival and its predictive factors in a population of Colombian subjects. The method used in this study is the retrospective follow-up of a cohort; damage was measured with SLICC/ACR index. Predictors of impairment were assessed by logistic regression and survival analysis. One hundred sixty-one individuals were included; 28.9% suffered damage, primarily neuropsychiatric, renal, and vascular. Arterial hypertension, antiphospholipid antibodies, prednisone dose, and number of relapses were all predictors of detriment. Onset after age 50 and daily prednisone dose higher than 7.5 mg determined earlier occurrence of damage. Mención de responsabilidad : Luis F Pinto-Peñaranda, C Muñoz-Grajales, A F Echeverri Garcia, C J Velásquez-Franco, M A Mesa-Navas, M Zuluaga Quintero, S Herrera-Uribe, J D Márquez-Hernández Referencia : Clin Rheumatol. 2018 Apr;37(4):949-954. DOI (Digital Object Identifier) : 10.1007/s10067-017-3927-8 PMID : 29204758 En línea : https://link.springer.com/article/10.1007%2Fs10067-017-3927-8 Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=4200

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Predictive factors for low rate of remission in a population of Colombian patients with severe proliferative lupus nephritis / Luis Fernando Pinto Peñaranda ; Javier Darío Márquez Hernández ; Carolina Muñoz Grajales ; Carlos Jaime Velásquez Franco  

Público ISBD Título : Predictive factors for low rate of remission in a population of Colombian patients with severe proliferative lupus nephritis Tipo de documento : documento electrónico Autores : Luis Fernando Pinto Peñaranda, ; Javier Darío Márquez Hernández, ; Carolina Muñoz Grajales, ; Carlos Jaime Velásquez Franco, Fecha de publicación : 2015 Títulos uniformes : Clinical Rheumatology Idioma : Inglés (eng) Palabras clave : Latin American mestizo  lupus nephritis  nephrotic syndrome  proteinuria  remission induction Resumen : The objective of this study is to determine the predictive risk factors of failure to achieve remission within 12 months in a group of patients with proliferative lupus nephritis from Northwestern Colombia. Pragmatic clinical study with retrospective analysis was conducted. We included subjects with systemic lupus erythematosus as defined by the American College of Rheumatology with biopsy-proven nephritis. We assessed 149 patients, with 84 % female. Age at diagnosis of systemic lupus erythematosus is 24.7 years (16–31). The time between diagnosis of lupus erythematosus and proliferative nephritis is 2 months (0–35.5). ISN/RPS 2003 histologic classification types are the following: IV (63.8 %), III (13.4 %), V + III (3.3 %), and V + IV (3.3 %). Activity index is 6.18 ± 4.55 and chronicity index is 1 (0–3). The result of 24-h proteinuria is 2000 mg (667–4770) and baseline creatinine is 0.9 mg/dL (0.7–1.3). Induction therapy includes corticosteroids (100 %), cyclophosphamide (74.1 %), and mycophenolate mofetil (25.9 %). At 12 months, 40.7 % of individuals failed to attain partial or complete remission. Elevated creatinine (p = 0.0001) and 24-h proteinuria greater than 1500 mg (p = 0.0011) were basal predictors of failure to attain partial or complete remission by bivariate analysis. Similar results were obtained in multivariate analysis: Baseline creatinine elevation (OR 3.62, 95 % CI, 1.59–8.23; p = 0.002) and 24-h proteinuria greater than 1500 mg (OR 3.62, 95 % CI, 1.29–10.13; p = 0.014) were independent predictors of failure to achieve partial or complete remission. At 12 months, 40.7 % of patients did not attain partial or complete remission. Baseline elevated creatinine and 24-h proteinuria over 1500 mg were predictors for poor response. Mención de responsabilidad : Luis Fernando Pinto-Peñaranda, Vladimir Duque-Caballero, Javier Darío Márquez-Hernández, Carolina Muñoz-Grajales, Carlos Jaime Velásquez-Franco Referencia : Clin Rheumatol. 2015 May;34(5):897-903. DOI (Digital Object Identifier) : 10.1007/s10067-015-2864-7 PMID : 25592376 En línea : https://link.springer.com/article/10.1007%2Fs10067-015-2864-7 Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=3887 Predictive factors for low rate of remission in a population of Colombian patients with severe proliferative lupus nephritis [documento electrónico] / Luis Fernando Pinto Peñaranda, ; Javier Darío Márquez Hernández, ; Carolina Muñoz Grajales, ; Carlos Jaime Velásquez Franco,  . - 2015. Obra : Clinical Rheumatology Idioma : Inglés (eng) Palabras clave : Latin American mestizo  lupus nephritis  nephrotic syndrome  proteinuria  remission induction Resumen : The objective of this study is to determine the predictive risk factors of failure to achieve remission within 12 months in a group of patients with proliferative lupus nephritis from Northwestern Colombia. Pragmatic clinical study with retrospective analysis was conducted. We included subjects with systemic lupus erythematosus as defined by the American College of Rheumatology with biopsy-proven nephritis. We assessed 149 patients, with 84 % female. Age at diagnosis of systemic lupus erythematosus is 24.7 years (16–31). The time between diagnosis of lupus erythematosus and proliferative nephritis is 2 months (0–35.5). ISN/RPS 2003 histologic classification types are the following: IV (63.8 %), III (13.4 %), V + III (3.3 %), and V + IV (3.3 %). Activity index is 6.18 ± 4.55 and chronicity index is 1 (0–3). The result of 24-h proteinuria is 2000 mg (667–4770) and baseline creatinine is 0.9 mg/dL (0.7–1.3). Induction therapy includes corticosteroids (100 %), cyclophosphamide (74.1 %), and mycophenolate mofetil (25.9 %). At 12 months, 40.7 % of individuals failed to attain partial or complete remission. Elevated creatinine (p = 0.0001) and 24-h proteinuria greater than 1500 mg (p = 0.0011) were basal predictors of failure to attain partial or complete remission by bivariate analysis. Similar results were obtained in multivariate analysis: Baseline creatinine elevation (OR 3.62, 95 % CI, 1.59–8.23; p = 0.002) and 24-h proteinuria greater than 1500 mg (OR 3.62, 95 % CI, 1.29–10.13; p = 0.014) were independent predictors of failure to achieve partial or complete remission. At 12 months, 40.7 % of patients did not attain partial or complete remission. Baseline elevated creatinine and 24-h proteinuria over 1500 mg were predictors for poor response. Mención de responsabilidad : Luis Fernando Pinto-Peñaranda, Vladimir Duque-Caballero, Javier Darío Márquez-Hernández, Carolina Muñoz-Grajales, Carlos Jaime Velásquez-Franco Referencia : Clin Rheumatol. 2015 May;34(5):897-903. DOI (Digital Object Identifier) : 10.1007/s10067-015-2864-7 PMID : 25592376 En línea : https://link.springer.com/article/10.1007%2Fs10067-015-2864-7 Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=3887

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Serious liver disease induced by infliximab / Alejandra María Restrepo Hamid  

Público ISBD Título : Serious liver disease induced by infliximab Tipo de documento : documento electrónico Autores : Alejandra María Restrepo Hamid, Fecha de publicación : 2007 Títulos uniformes : Clinical Rheumatology Idioma : Inglés (eng) Palabras clave : Adverse reactions  autoimmune hepatitis  cholestatic liver disease  infliximab  rheumatoid arthritis Resumen : Infliximab, a chimeric monoclonal antibody that binds the tumor necrosis factor α (TNFα), is used in the treatment of rheumatoid arthritis (RA) and Crohn’s disease (CD). Previous cases of significant secondary liver disease associated with infliximab treatment have been reported in patients with RA, CD, and psoriatic arthritis. Two additional patients with RA who developed a serious liver disease associated with infliximab treatment are reported here. A 39-year old RA patient was admitted with cholestatic liver disease after 8 months of treatment with infliximab. She had no history of hepatic diseases, exposure to hepatotoxic or illicit drugs, or alcohol abuse. A liver biopsy showed severe ductal proliferation with collapse and enucleation of the hepatocytes. Despite aggressive treatment with oral prednisolone, she developed hepatic failure. On the 45th day, a liver transplant was performed. The second patient, a 54-year old RA patient, was diagnosed with autoimmune hepatitis after 12 infliximab infusions. She fulfilled autoimmune hepatitis type 1 criteria. A liver biopsy disclosed an altered lobulillar structure with chronic inflammation and the formation of collagen bands. She was treated with prednisolone and azatioprine and a complete recovery was noted 1 month later. These cases should alert rheumatologists to the possibility of new adverse reactions (liver injury) associated with the use of TNFα blockers in an autoimmune setting. Mención de responsabilidad : Gabriel J. Tobon, Carlos Cañas, Juan-Jose Jaller, Juan-Carlos Restrepo & Juan-Manuel Anaya Referencia : Clin Rheumatol. 2007 Apr;26(4):578-81. DOI (Digital Object Identifier) : 10.1007/s10067-005-0169-y PMID : 16547695 En línea : https://link.springer.com/article/10.1007%2Fs10067-005-0169-y Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=3450 Serious liver disease induced by infliximab [documento electrónico] / Alejandra María Restrepo Hamid,  . - 2007. Obra : Clinical Rheumatology Idioma : Inglés (eng) Palabras clave : Adverse reactions  autoimmune hepatitis  cholestatic liver disease  infliximab  rheumatoid arthritis Resumen : Infliximab, a chimeric monoclonal antibody that binds the tumor necrosis factor α (TNFα), is used in the treatment of rheumatoid arthritis (RA) and Crohn’s disease (CD). Previous cases of significant secondary liver disease associated with infliximab treatment have been reported in patients with RA, CD, and psoriatic arthritis. Two additional patients with RA who developed a serious liver disease associated with infliximab treatment are reported here. A 39-year old RA patient was admitted with cholestatic liver disease after 8 months of treatment with infliximab. She had no history of hepatic diseases, exposure to hepatotoxic or illicit drugs, or alcohol abuse. A liver biopsy showed severe ductal proliferation with collapse and enucleation of the hepatocytes. Despite aggressive treatment with oral prednisolone, she developed hepatic failure. On the 45th day, a liver transplant was performed. The second patient, a 54-year old RA patient, was diagnosed with autoimmune hepatitis after 12 infliximab infusions. She fulfilled autoimmune hepatitis type 1 criteria. A liver biopsy disclosed an altered lobulillar structure with chronic inflammation and the formation of collagen bands. She was treated with prednisolone and azatioprine and a complete recovery was noted 1 month later. These cases should alert rheumatologists to the possibility of new adverse reactions (liver injury) associated with the use of TNFα blockers in an autoimmune setting. Mención de responsabilidad : Gabriel J. Tobon, Carlos Cañas, Juan-Jose Jaller, Juan-Carlos Restrepo & Juan-Manuel Anaya Referencia : Clin Rheumatol. 2007 Apr;26(4):578-81. DOI (Digital Object Identifier) : 10.1007/s10067-005-0169-y PMID : 16547695 En línea : https://link.springer.com/article/10.1007%2Fs10067-005-0169-y Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=3450

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