Publications by authors named "Luis J Catoggio"

29 Publications

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Factors associated with neuropsychiatric involvement in Latin American patients with systemic lupus erythematosus.

Lupus 2021 Aug 4;30(9):1481-1491. Epub 2021 Jun 4.

Grupo Oroño - Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina.

Introduction: Factors related to presentation of neuropsychiatric (NP) SLE manifestations, early in the course of the disease, and during follow up have not been clearly established.

Purpose: To identify disease and non-disease related factors associated with NP manifestations in early SLE.

Methods: We included 1193 patients from the GLADEL inception cohort free of NP involvement at cohort entry. We evaluated the association of demographic, clinical and laboratory data with NP involvement during follow-up.

Statistical Methods: Independent factors associated with NP involvement were identified using a multivariable Cox regression model.

Results: Factors independently associated with NP manifestations were: mestizo ethnicity (HR 1.701, 95% CI 1.282-2.258, p = 0.0002), myalgias/myositis (HR 1.832, 95% CI 1.335-2.515, p = 0.0002), pneumonitis (HR 2.476, 95% CI 1.085-5.648, p = 0.0312), shrinking lung (HR 2.428, 95% CI 1.074-5.493, p = 0.0331) and hemolytic anemia (HR 1.629, 95% CI 1.130-2.347, p = 0.0089). Longer disease duration at cohort entry (13 to 24 months) was associated with a lower risk of developing NP manifestations (HR 0.642, 95% CI 0.441-0.934, p = 0.0206).

Conclusions: Patients with myalgias/myositis, pneumonitis, shrinking lung and hemolytic anemia are at higher risk of NP involvement, whereas longer disease duration at cohort entry is associated with a lower risk of developing NP involvement.
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http://dx.doi.org/10.1177/09612033211020364DOI Listing
August 2021

A longitudinal multiethnic study of biomarkers in systemic lupus erythematosus: Launching the GLADEL 2.0 Study Group.

Lupus 2021 Jan 28:961203320988586. Epub 2021 Jan 28.

Sección de Reumatología, Departamento de Medicina Interna/Grupo de Inmunología Celular e Inmunogenética, Facultad de Medicina, Universidad de Antioquía, Medellín, Colombia.

After more than 20 years of sustained work, the Latin American Group for the Study of Lupus (GLADEL) has made a significant number of contributions to the field of lupus, not only in the differential role that race/ethnicity plays in its course and outcome but also in several other studies including the beneficial effects of using antimalarials in lupus patients and the development of consensus guidelines for the treatment of lupus in our region. A new generation of "Lupus Investigators" in more than 40 centers throughout Latin America has been constituted in order to continue the legacy of the investigators of the original cohort and to launch a novel study of serum and urinary biomarkers in patients with systemic lupus erythematosus. So far, we have recruited 807 patients and 631 controls from 42 Latin-American centers including 339 patients with SLE without renal involvement, 202 patients with SLE with prevalent but inactive renal disease, 176 patients with prevalent and active renal disease and 90 patients with incident lupus nephritis. The different methodological aspects of the GLADEL 2.0 cohort are discussed in this manuscript, including the challenges and difficulties of conducting such an ambitious project.
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http://dx.doi.org/10.1177/0961203320988586DOI Listing
January 2021

Predictors of renal damage in systemic lupus erythematous patients: data from a multiethnic, multinational Latin American lupus cohort (GLADEL).

RMD Open 2020 12;6(3)

Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, Mexico.

Aim: A decrease in proteinuria has been considered protective from renal damage in lupus nephritis (LN), but a cut-off point has yet to be established. The aim of this study was to identify the predictors of renal damage in patients with LN and to determine the best cut-off point for a decrease in proteinuria.

Methods: We included patients with LN defined clinically or histologically. Possible predictors of renal damage at the time of LN diagnosis were examined: proteinuria, low complement, anti-double-stranded DNA antibodies, red cell casts, creatinine level, hypertension, renal activity (assessed by the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI)), prednisone dose, immunosuppressive drugs and antimalarial use. Sociodemographic variables were included at baseline. Proteinuria was assessed at baseline and at 12 months, to determine if early response (proteinuria <0.8 g/day within 12 months since LN diagnosis) is protective of renal damage occurrence. Renal damage was defined as an increase of one or more points in the renal domain of The Systemic Lupus International Collaborating Clinics (SLICC)/American College of Rheumatology (ACR) Damage Index (SDI). Cox regression models using a backward selection method were performed.

Results: Five hundred and two patients with systemic lupus erythematosus patients were included; 120 patients (23.9%) accrued renal damage during their follow-up. Early response to treatment (HR=0.58), antimalarial use (HR=0.54) and a high SES (HR=0.25) were protective of renal damage occurrence, whereas male gender (HR=1.83), hypertension (HR=1.86) and the renal component of the SLEDAI (HR=2.02) were risk factors for its occurrence.

Conclusions: Early response, antimalarial use and high SES were protective of renal damage, while male gender, hypertension and higher renal activity were risk factors for its occurrence in patients with LN.
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http://dx.doi.org/10.1136/rmdopen-2020-001299DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7859505PMC
December 2020

Clinical features, damage accrual, and survival in patients with familial systemic lupus erythematosus: data from a multi-ethnic, multinational Latin American lupus cohort.

Lupus 2020 Aug 30;29(9):1140-1145. Epub 2020 Jun 30.

Centro Médico ABC, Ciudad de México, Mexico.

Objectives: This study aimed to compare the clinical features, damage accrual, and survival of patients with familial and sporadic systemic lupus erythematosus (SLE).

Methods: A multi-ethnic, multinational Latin American SLE cohort was studied. Familial lupus was defined as patients with a first-degree SLE relative; these relatives were interviewed in person or by telephone. Clinical variables, disease activity, damage, and mortality were compared. Odds ratios (OR) and 95% confidence intervals (CI) were estimated. Hazard ratios (HR) were calculated using Cox proportional hazard adjusted for potential confounders for time to damage and mortality.

Results: A total of 66 (5.6%) patients had familial lupus, and 1110 (94.4%) had sporadic lupus. Both groups were predominantly female, of comparable age, and of similar ethnic distribution. Discoid lupus (OR = 1.97; 95% CI 1.08-3.60) and neurologic disorder (OR = 1.65; 95% CI 1.00-2.73) were significantly associated with familial SLE; pericarditis was negatively associated (OR = 0.35; 95% CI 0.14-0.87). The SLE Disease Activity Index and Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI) were similar in both groups, although the neuropsychiatric (45.4% vs. 33.5%;  = 0.04) and musculoskeletal (6.1% vs. 1.9%;  = 0.02) domains of the SDI were more frequent in familial lupus. They were not retained in the Cox models (by domains). Familial lupus was not significantly associated with damage accrual (HR = 0.69; 95% CI 0.30-1.55) or mortality (HR = 1.23; 95% CI 0.26-4.81).

Conclusion: Familial SLE is not characterized by a more severe form of disease than sporadic lupus. We also observed that familial SLE has a higher frequency of discoid lupus and neurologic manifestations and a lower frequency of pericarditis.
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http://dx.doi.org/10.1177/0961203320935184DOI Listing
August 2020

Predictors of Remission and Low Disease Activity State in Systemic Lupus Erythematosus: Data from a Multiethnic, Multinational Latin American Cohort.

J Rheumatol 2019 10 1;46(10):1299-1308. Epub 2019 Mar 1.

From the Department of Rheumatology, Hospital Guillermo Almenara Irigoyen, EsSalud; Universidad Científica del Sur, Lima, Peru; Grupo Latino Americano De Estudio de Lupus (GLADEL), Rosario, Argentina; Department of Autoimmune Diseases, Hospital Clinic, Barcelona, Spain; Centro Regional de Enfermedades Autoinmunes y Reumáticas (CREAR), Grupo Oroño, Sanatorio Parque, Rosario, Santa Fe, Argentina; Servicio de Reumatología, Hospital Clinic, Barcelona, Spain; Sección de Reumatología, Servicio de Clínica Médica, Hospital Italiano de Buenos Aires, Instituto Universitario, Escuela de Medicina Hospital Italiano and Fundación Dr. Pedro M. Catoggio para el Progreso de la Reumatología, Buenos Aires; Servicio de Reumatología, Hospital Privado, Centro Medico de Córdoba, Córdoba, Argentina; Rheumatology Division, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo; Disciplina de Reumatologia, Escola Paulista de Medicina/UNIFESP, Hospital São Paulo, Universidade Federal de São Paulo, São Paulo; Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas; Faculdade de Medicina, Universidade Federal de Goiás, Goiânia, Brazil; Clínica Saludcoop 104 Jorge Piñeros Corpas and Hospital San Juan de Dios, Universidad Nacional de Colombia, Bogotá, Colombia; Hospital del Salvador, Facultad de Medicina, Universidad de Chile, Santiago, Chile; Servicio de Reumatología, Centro de Investigaciones Médico Quirúrgicas-CIMEQ, Havana, Cuba; Centro de Investigación Clínica de Morelia SC, Morelia, Michoacán; Reumatología, Centro Médico ABC, Ciudad de México, México; Universidad Nacional Mayor de San Marcos, Lima, Peru; Hospital Central de San Cristóbal, San Cristóbal, Venezuela; Department of Medicine, Division of Clinical Immunology and Rheumatology, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.

Objective: To determine the predictors of remission and low disease activity state (LDAS) in patients with systemic lupus erythematosus (SLE).

Methods: Three disease activity states were defined: Remission = SLE Disease Activity Index (SLEDAI) = 0 and prednisone ≤ 5 mg/day and/or immunosuppressants (maintenance dose); LDAS = SLEDAI ≤ 4, prednisone ≤ 7.5 mg/day and/or immunosuppressants (maintenance dose); and non-optimally controlled state = SLEDAI > 4 and/or prednisone > 7.5 mg/day and/or immunosuppressants (induction dose). Antimalarials were allowed in all groups. Patients with at least 2 SLEDAI reported and not optimally controlled at entry were included in these analyses. Outcomes were remission and LDAS. Multivariable Cox regression models (stepwise selection procedure) were performed for remission and for LDAS.

Results: Of 1480 patients, 902 were non-optimally controlled at entry; among them, 196 patients achieved remission (21.7%) and 314 achieved LDAS (34.8%). Variables predictive of a higher probability of remission were the absence of mucocutaneous manifestations (HR 1.571, 95% CI 1.064-2.320), absence of renal involvement (HR 1.487, 95% CI 1.067-2.073), and absence of hematologic involvement (HR 1.354, 95% CI 1.005-1.825); the use of immunosuppressive drugs before the baseline visit (HR 1.468, 95% CI 1.025-2.105); and a lower SLEDAI score at entry (HR 1.028, 95% CI 1.006-1.051 per 1-unit decrease). These variables were predictive of LDAS: older age at entry, per 5-year increase (HR 1.050, 95% CI 1.004-1.098); absence of mucocutaneous manifestations (HR 1.401, 95% CI 1.016-1.930) and renal involvement (HR 1.344, 95% CI 1.049-1.721); and lower SLEDAI score at entry (HR 1.025, 95% CI 1.009-1.042).

Conclusion: Absence of mucocutaneous, renal, and hematologic involvement, use of immunosuppressive drugs, and lower disease activity early in the course of the disease were predictive of remission in patients with SLE; older age was predictive of LDAS.
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http://dx.doi.org/10.3899/jrheum.180433DOI Listing
October 2019

First Latin American clinical practice guidelines for the treatment of systemic lupus erythematosus: Latin American Group for the Study of Lupus (GLADEL, )-Pan-American League of Associations of Rheumatology (PANLAR).

Ann Rheum Dis 2018 11 25;77(11):1549-1557. Epub 2018 Jul 25.

Servicio de Reumatología, Hospital Italiano de Córdoba, Córdoba, Argentina.

Systemic lupus erythematosus (SLE), a complex and heterogeneous autoimmune disease, represents a significant challenge for both diagnosis and treatment. Patients with SLE in Latin America face special problems that should be considered when therapeutic guidelines are developed. The objective of the study is to develop clinical practice guidelines for Latin American patients with lupus. Two independent teams (rheumatologists with experience in lupus management and methodologists) had an initial meeting in Panama City, Panama, in April 2016. They selected a list of questions for the clinical problems most commonly seen in Latin American patients with SLE. These were addressed with the best available evidence and summarised in a standardised format following the Grading of Recommendations Assessment, Development and Evaluation approach. All preliminary findings were discussed in a second face-to-face meeting in Washington, DC, in November 2016. As a result, nine organ/system sections are presented with the main findings; an 'overarching' treatment approach was added. Special emphasis was made on regional implementation issues. Best pharmacologic options were examined for musculoskeletal, mucocutaneous, kidney, cardiac, pulmonary, neuropsychiatric, haematological manifestations and the antiphospholipid syndrome. The roles of main therapeutic options (ie, glucocorticoids, antimalarials, immunosuppressant agents, therapeutic plasma exchange, belimumab, rituximab, abatacept, low-dose aspirin and anticoagulants) were summarised in each section. In all cases, benefits and harms, certainty of the evidence, values and preferences, feasibility, acceptability and equity issues were considered to produce a recommendation with special focus on ethnic and socioeconomic aspects. Guidelines for Latin American patients with lupus have been developed and could be used in similar settings.
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http://dx.doi.org/10.1136/annrheumdis-2018-213512DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6225798PMC
November 2018

Effects of Amerindian Genetic Ancestry on Clinical Variables and Therapy in Patients with Rheumatoid Arthritis.

J Rheumatol 2017 Dec 1;44(12):1804-1812. Epub 2017 Nov 1.

From the Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Departamento de Inmunología y Reumatología, Hospital General de Occidente y Universidad de Guadalajara, Zapopan; Unidad de Investigación "Dr. Mario Alvizouri Muñoz" Hospital General "Dr. Miguel Silva," Secretaría de Salud de Michoacán, Morelia; Servicio de Reumatología del Departamento de Medicina Interna, Facultad de Medicina y Hospital Universitario "Dr. José Eleuterio González," Universidad Autonoma de Nuevo León, Monterrey; Departamento de Reumatología, Hospital General de Culiacán, Culiacán; Unidad de Reumatología, Hospital General de México "Dr. Eduardo Liceaga"; Unidad de Biología Molecular y Medicina Genómica from Instituto de Investigaciones Biomédicas de la Universidad Nacional Autónoma de México, and Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Hospital Provincial de Rosario; Instituto Lucha Antipoliomielítica de Rosario (ILAR); Hospital Escuela Eva Perón, Granadero Baigorria; Hospital José Maria Cullen; Hospital J.B. Iturraspe, Santa Fe; Hospital San Martín, Paraná; Hospital Privado de Córdoba; Hospital Italiano de Córdoba; Instituto Reumatológico Strusberg, Córdoba; Hospital Cosme Argerich; Hospital Italiano de Buenos Aires; Organización Médica Integral; Centro de Educación Médica e Investigaciones Clínicas (CEMIC); Instituto de Rehabilitación Psicofísica (IREP); Hospital Bernardino Rivadavia; Hospital de Clínicas de Buenos Aires, Buenos Aires; H.I.G.A. San Martín, La Plata; H.I.G.A. Oscar E. Alende, Mar del Plata; Centro Medico Privado de Reumatología; FUNIPSE, San Miguel de Tucumán, Tucumán; Hospital Interzonal San Juan Bautista, Catamarca; Hospital G. Rawson, San Juan; Sanatorio Parque, Rosario, Argentina; Facultad Medicina Occidente, and Facultad de Medicina Campus Centro, Universidad de Chile, Santiago de Chile, Chile; Servicio de Reumatología, Hospital Nacional Guillermo Almenara I, EsSalud y Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Perú; GENYO, Centro Pfizer-Universidad de Granada-Junta de Andalucía de Genómica e Investigación Oncológica, Granada, Spain; Unit of Chronic Inflammatory Diseases, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.

Objective: To define whether Amerindian genetic ancestry correlates with clinical and therapeutic variables in admixed individuals with rheumatoid arthritis (RA) from Latin America.

Methods: Patients with RA (n = 1347) and healthy controls (n = 1012) from Argentina, Mexico, Chile, and Peru were included. Samples were genotyped for the Immunochip v1 using the Illumina platform. Clinical data were obtained through interviews or the clinical history.

Results: Percentage of Amerindian ancestry was comparable between cases and controls. Morning stiffness (p < 0.0001, OR 0.05), rheumatoid factor (RF; p < 0.0001, OR 0.22), radiographic changes (p < 0.0001, OR 0.05), and higher number of criteria were associated with lower Amerindian ancestry after Bonferroni correction. Higher Amerindian ancestry correlated only with weight loss (p < 0.0001, OR 2.85). Increased Amerindian ancestry correlated with higher doses of azathioprine (p < 0.0001, OR 163.6) and sulfasalazine (p < 0.0001, OR 48.6), and inversely with methotrexate (p = 0.001, OR 0.35), leflunomide (p = 0.001, OR 0.16), and nonsteroidal antiinflammatory drugs (p = 0.001, OR 0.37). Only the presence of RF and weight loss were modified after confounders adjustment.

Conclusion: Amerindian ancestry protects against most major clinical criteria of RA, but regarding the association of RF with increased European ancestry, age, sex, and smoking are modifiers. Ancestry also correlates with the therapeutic profiles.
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http://dx.doi.org/10.3899/jrheum.160485DOI Listing
December 2017

Remission and Low Disease Activity Status (LDAS) protect lupus patients from damage occurrence: data from a multiethnic, multinational Latin American Lupus Cohort (GLADEL).

Ann Rheum Dis 2017 Dec 22;76(12):2071-2074. Epub 2017 Sep 22.

Centro Regional de Enfermedades Autoinmunes y Reumáticas (CREAR), Rosario, Argentina.

Objective: To evaluate disease activity statuses' (DAS') impact on systemic lupus erythematosus (SLE) outcomes.

Materials And Methods: Four DAS were defined: remission off-therapy: SLE Disease Activity Index (SLEDAI)=0, no prednisone or immunosuppressive drugs (IS); remission on-therapy: SLEDAI=0, prednisone ≤5 mg/day and/or IS (maintenance); low (L) DAS: SLEDAI ≤4, prednisone ≤7.5 mg/day and/or IS (maintenance); non-optimally controlled: SLEDAI >4 and/or prednisone >7.5 mg/day and/or IS (induction). Antimalarials were allowed in all. Predefined outcomes were mortality, new damage (increase of at least one Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) damage index (SDI) point) and severe new damage (increase of at least 3 SDI points). Univariable and multivariable Cox regression models were performed to define the impact of DAS, as time-dependent variable, on these outcomes.

Results: 1350 patients were included, 79 died during follow-up, 606 presented new and 177 severe new damage. In multivariable analyses, remission (on/off-therapy) was associated with a lower risk of new (HR 0.60; 95% CI 0.43 to 0.85), and of severe new damage (HR 0.32; 95% CI 0.15 to 0.68); low disease activity status (LDAS) was associated with a lower risk of new damage (HR 0.66; 95% CI 0.48 to 0.93) compared with non-optimally controlled. No significant effect on mortality was observed.

Conclusions: Remission was associated with a lower risk of new and severe new damage; LDAS with a lower risk of new damage after adjusting for other damage confounders.
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http://dx.doi.org/10.1136/annrheumdis-2017-211814DOI Listing
December 2017

ANCA-associated pauci-immune glomerulonephritis: always pauci-immune?

Clin Exp Rheumatol 2017 Mar-Apr;35 Suppl 103(1):55-58. Epub 2017 Jan 31.

Rheumatology Section, Medical Services, Hospital Italiano de Buenos Aires, Argentina.

Objectives: Anti-neutrophil cytoplasmic antibody (ANCA)-associated glomerulonephritis (GN) is considered "pauci-immune" with absent or mild glomerular tuft staining for immunoglobulin (Ig) and/or complement. However, it is not unusual to see some immune deposits (ID) within glomeruli on immunofluorescence (IF). We determined to evaluate the prevalence and clinical significance of immune deposits in ANCA-associated GN.

Methods: We included all patients with ANCA associated vasculitis with renal biopsies between January 2002 and May 2014: granulomatosis with polyangiitis, eosinophilic granulomatosis with polyangiitis, microscopic polyangiitis and renal limited vasculitis. Patients were divided into Group A: biopsy without ID (≤2+ intensity of immunostaining) and Group B: biopsy with ID (>2+ intensity of immunostaining). Serum creatinine, estimated glomerular filtration rate (eGFR) at time of the biopsy, amount of proteinuria and hematuria, requirement of dialysis and extra renal involvement were recorded.

Results: Fifty-three patients (75.4% females) were included. Mean age at biopsy was 66.3 years. Typical pauci-immune GN was found in 39 patients (73.5%, group A). In 14 patients (26.4%, group B) examination revealed substantial deposition of Ig or complement in the mesangium and/or along the glomerular capillary wall. The only difference comparing both groups was significantly higher proteinuria in group B (mean 1.6/24 h (SD: 10.7) vs. 0.8/24 h (SD: 7.6), p=0.0036).

Conclusions: In ANCA GN at least a quarter of patients were not "pauci-immune" (26.4%). In this subgroup, immune deposits were only associated with a significantly higher proteinuria. Further basic and clinical research is needed to elucidate the significance of immune deposition in ANCA GN.
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July 2017

Does a Simplified 6-Joint Ultrasound Index Correlate Well Enough With the 28-Joint Disease Activity Score to Be Used in Clinical Practice?

J Clin Rheumatol 2016 Jun;22(4):179-83

From the *Sección Reumatología, Servicio de Clínica Médica and Instituto Universitario Escuela de Medicina, Hospital Italiano de Buenos Aires; †Fundación Dr Pedro M. Catoggio para el Progreso de la Reumatología; and ‡Servicio de Diagnóstico por Imágenes, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.

Objective: Ultrasound (US) has become an important tool in the management of rheumatoid arthritis (RA) but it is time consuming in clinical practice. We compared 3 US indices (with different numbers of joints) with disease activity measured by the 28-Joint Disease Activity Score (DAS28) in order to find the most parsimonious index still useful in clinical practice.

Methods: Sixty consecutive RA patients were included. The DAS28 score was calculated by the attending rheumatologist, and later in the day, they underwent US examination by another rheumatologist trained in US (bilateral gray-scale and power Doppler examination of the wrist and metacarpophalangeal and proximal interphalangeal joints). Three different US indices were constructed: index A (22 joints), index B (10 joints), and index C (6 joints).

Results: All 3 US indices were significantly higher in patients with active disease versus inactive disease (P < 0.05 for all 3). Ultrasound index C showed the best correlation with DAS28 (rho = 0.5020, P < 0.0001) and a very good discriminative value for moderate to high disease activity (DAS28 >3.2) and for absence of remission (DAS28 >2.6) (areas under receiver operating characteristic curve = 0.75 and 0.80, respectively). A cutoff value of 3 in US index C showed sensitivity of 88.89% and specificity of 66.67% for absence of remission. Correlation between the 3 US indices was excellent.

Conclusions: A US index of 6 joints (both wrists and second and third metacarpophalangeal joints bilaterally) correlated well with disease activity measured by DAS28 and may be used to evaluate RA patients in daily practice.
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http://dx.doi.org/10.1097/RHU.0000000000000415DOI Listing
June 2016

Genome-Wide Association Study in an Amerindian Ancestry Population Reveals Novel Systemic Lupus Erythematosus Risk Loci and the Role of European Admixture.

Arthritis Rheumatol 2016 Apr;68(4):932-43

Hospital Universitario Dr. José Eleuterio González Universidad Autonoma de Nuevo León, Monterrey, Mexico.

Objective: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with a strong genetic component. We undertook the present work to perform the first genome-wide association study on individuals from the Americas who are enriched for Native American heritage.

Methods: We analyzed 3,710 individuals from the US and 4 countries of Latin America who were diagnosed as having SLE, and healthy controls. Samples were genotyped with HumanOmni1 BeadChip. Data on out-of-study controls genotyped with HumanOmni2.5 were also included. Statistical analyses were performed using SNPtest and SNPGWA. Data were adjusted for genomic control and false discovery rate. Imputation was performed using Impute2 and, for classic HLA alleles, HiBag. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated.

Results: The IRF5-TNPO3 region showed the strongest association and largest OR for SLE (rs10488631: genomic control-adjusted P [Pgcadj ] = 2.61 × 10(-29), OR 2.12 [95% CI 1.88-2.39]), followed by HLA class II on the DQA2-DQB1 loci (rs9275572: Pgcadj  = 1.11 × 10(-16), OR 1.62 [95% CI 1.46-1.80] and rs9271366: Pgcadj  = 6.46 × 10(-12), OR 2.06 [95% CI 1.71-2.50]). Other known SLE loci found to be associated in this population were ITGAM, STAT4, TNIP1, NCF2, and IRAK1. We identified a novel locus on 10q24.33 (rs4917385: Pgcadj  = 1.39 × 10(-8)) with an expression quantitative trait locus (eQTL) effect (Peqtl  = 8.0 × 10(-37) at USMG5/miR1307), and several new suggestive loci. SLE risk loci previously identified in Europeans and Asians were corroborated. Local ancestry estimation showed that the HLA allele risk contribution is of European ancestral origin. Imputation of HLA alleles suggested that autochthonous Native American haplotypes provide protection against development of SLE.

Conclusion: Our results demonstrate that studying admixed populations provides new insights in the delineation of the genetic architecture that underlies autoimmune and complex diseases.
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http://dx.doi.org/10.1002/art.39504DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4829354PMC
April 2016

Are There Clinical Differences in Limited Systemic Sclerosis according to Extension of Skin Involvement?

Int J Rheumatol 2014 11;2014:716358. Epub 2014 Nov 11.

Rheumatology Section, Medical Services, Hospital Italiano de Buenos Aires, 1181 Buenos Aires, Argentina ; Fundación Dr. Pedro M. Catoggio para el Progreso de la Reumatologia, 1181 Buenos Aires, Argentina ; Instituto Universitario Escuela de Medicina, Hospital Italiano de Buenos Aires, 1181 Buenos Aires, Argentina.

Objectives. To examine the characteristics of our patients with limited systemic sclerosis (lSSc) for differences between Barnett Type 1 (sclerodactyly only) and Type 2 or intermediate (acrosclerosis-distal but may reach up to elbows and/or knees plus face) subsets. Methods. Records of patients between January 1, 2000, and December 31, 2011, with SSc or those with anti-Scl-70, anticentromere, or antinucleolar antibodies were reviewed. Only cases fulfilling ACR 1980 criteria were included and classified as diffuse or limited according to LeRoy's criteria. Limited SSc was separated into sclerodactyly and acrosclerosis (Barnett's Types 1 and 2). Results. 234 SSc patients (216 females) fulfilled criteria. Female/male ratio was 12 : 1; 24% had dSSc and 76% lSSC (64% Type 1 and 12% Type 2). Total follow-up was 688 patient-years. Within lSSC, the Type 2 group had significantly shorter duration of Raynaud's and more anti-Scl-70 and less anticentromere antibodies. In particular, interstitial lung disease (ILD) was significantly more prevalent in Type 2 group and similar to Type 3. Conclusions. These results appear to confirm that extension of skin involvement within limited SSc may identify two different subsets with clinical and serologic characteristics.
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http://dx.doi.org/10.1155/2014/716358DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4243126PMC
December 2014

Validation of a prediction rule for the diagnosis of rheumatoid arthritis in patients with recent onset undifferentiated arthritis.

Int J Rheumatol 2013 28;2013:548502. Epub 2013 Feb 28.

Servicio de Clínica Médica, Hospital Italiano de Buenos Aires, Instituto Universitario Escuela de Medicina Hospital Italiano de Buenos Aires, and Fundacion Dr. Pedro M. Catoggio Para el Progreso de la Reumatología, Peron 4190, C1199ABB Buenos Aires, Argentina.

Objectives. To validate van der Helm-van Mil score (vHvM) and new ACR/EULAR criteria for the diagnosis of rheumatoid arthritis (RA) in patients with undifferentiated arthritis (UA). Patients and Methods. Adult patients with UA (swelling ≥2 joints of less than 6 months duration, without diagnosis, and never treated with disease modifying drugs). Results. Ninety-one patients were included. Mean age: 55.6 years (SD: 17.4), 74% females. Median symptoms duration was 2 months (IR: 1-4 months). Mean van der Helm-van Mil score was 6.9 (SD: 2). After a mean followup of 6.2 months (SD: 6), 40.7% patients fulfilled ACR 1987 RA classification criteria, 28.6% fulfilled other diagnostic criteria, and 31% remained as UA. Receiver operator characteristic curve's (ROC's) area under the curve (AUC) for the vHvM score for diagnosis of RA was 0.83. A cutoff value of 6.94 showed sensitivity of 81% and 79.7% specificity. For the new ACR/EULAR criteria, the ROC AUC was 0.93, and a value equal to or greater than 6 showed 86.5% sensitivity and 87% specificity. Conclusion. van der Helm-van Mil prediction score and the new ACR/EULAR criteria proved to be valuable for the diagnosis of RA in patients with early UA.
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http://dx.doi.org/10.1155/2013/548502DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3603504PMC
March 2013

Rheumatoid arthritis in Latin Americans enriched for Amerindian ancestry is associated with loci in chromosomes 1, 12, and 13, and the HLA class II region.

Arthritis Rheum 2013 Jun;65(6):1457-67

Centro Pfizer-Universidad de Granada-Junta de Andalucía de Genómica e Investigaciones Oncológicas, Granada, Spain.

Objective: To identify susceptibility loci for rheumatoid arthritis (RA) in Latin American individuals with admixed European and Amerindian genetic ancestry.

Methods: Genotyping was performed in 1,475 patients with RA and 1,213 control subjects, using a customized BeadArray containing 196,524 markers covering loci previously associated with various autoimmune diseases. Principal components analysis (EigenSoft package) and Structure software were used to identify outliers and define the population substructure. REAP software was used to define cryptic relatedness and duplicates, and genetic association analyses were conducted using Plink statistical software.

Results: A strong genetic association between RA and the major histocompatibility complex region was observed, localized within BTNL2/DRA-DQB1- DQA2 (P = 7.6 × 10(-10) ), with 3 independent effects. We identified an association in the PLCH2-HES5-TNFRSF14-MMEL1 region of chromosome 1 (P = 9.77 × 10(-6) ), which was previously reported in Europeans, Asians, and Native Canadians. We identified one novel putative association in ENOX1 on chromosome 13 (P = 3.24 × 10(-7) ). Previously reported associations were observed in the current study, including PTPN22, SPRED2, STAT4, IRF5, CCL21, and IL2RA, although the significance was relatively moderate. Adjustment for Amerindian ancestry improved the association of a novel locus in chromosome 12 at C12orf30 (NAA25) (P = 3.9 × 10(-6) ). Associations with the HLA region, SPRED2, and PTPN22 improved in individuals positive for anti-cyclic citrullinated peptide antibodies.

Conclusion: Our data define, for the first time, the contribution of Amerindian ancestry to the genetic architecture of RA in an admixed Latin American population by confirming the role of the HLA region and supporting the association with a locus in chromosome 1. In addition, we provide data for novel putative loci in chromosomes 12 and 13.
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http://dx.doi.org/10.1002/art.37923DOI Listing
June 2013

Validation in Spanish of a screening questionnaire for the detection of psoriatic arthritis in patients with psoriasis.

Rheumatology (Oxford) 2013 Mar 21;52(3):510-4. Epub 2012 Nov 21.

Sección Reumatología, Servicio de Clínica Médica, Hospital Italiano de Buenos Aires, Instituto Universitario, Escuela de Medicina, Hospital Italiano de Buenos Aires, Fundación Dr Pedro M. Catoggio para Progreso de Reumatología, Ciudad Autonoma de Buenos Aires, Argentina.

Objective: A patient self-administered questionnaire [PsA Screening and Evaluation (PASE)] has been developed and validated in English, but has not been tried in Spanish speaking populations. This study aimed to adapt and validate PASE in Spanish to screen Spanish speaking psoriasis patients for signs and symptoms of inflammatory arthritis.

Methods: Initial translation from English to Spanish (forward translation) was performed by two independent translators and the resulting versions were synthesized during a consensus meeting. The questionnaire was tried in a pilot study and resulted in a change in the agreement scale for a frequency scale with wording adaptation [Spanish PASE (PASE-S)].

Results: One hundred and eleven patients were screened with PASE-S; 25 with PsA (without previous treatments), 23 with psoriasis, 22 with psoriasis and OA and 41 with OA without psoriasis. The diagnosis of psoriasis was performed by a dermatologist, and a rheumatologist determined the diagnosis of PsA or OA. Patients with PsA had statistically significant higher symptoms, function and total PASE-S scores compared with those without PsA. Receiver operator curves showed an area under the curve of 0.79 (95% CI 0.69, 0.89) for the total score. A cut-off value ≥34 showed sensitivity of 76%, and specificity of 74.4% for the diagnosis of PsA.

Conclusion: The validated PASE questionnaire is a self-administered tool that can be used to screen for PsA among patients with psoriasis in a Spanish speaking population. PASE was able to distinguish between symptoms of PsA and OA.
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http://dx.doi.org/10.1093/rheumatology/kes306DOI Listing
March 2013

Cost of rheumatoid arthritis in a selected population from Argentina in the prebiologic therapy era.

Clinicoecon Outcomes Res 2012 23;4:219-25. Epub 2012 Aug 23.

Rheumatology Unit, Internal Medicine Service, Hospital Italiano de Buenos Aires, PM Catoggio Foundation, Buenos Aires, Argentina.

Background: The present study aimed to estimate the cost of rheumatoid arthritis and its components in a university hospital-based health management organization in Argentina, during the prebiologic era.

Methods: A one-year (2002) observational prevalence, cost-of illness study of patients with rheumatoid arthritis from the societal perspective was performed in a hospital-based health management organization population. Direct medical costs were obtained using administrative databases. Direct nonmedical and indirect costs were obtained from a semistructured questionnaire. Indirect costs included work absenteeism, permanent work disability, and housework lost for housewives, using the human capital approach. Costs are expressed in 2002 US dollars per patient per year.

Results: A total of 165 patients (84% females), of mean age 61 ± 15 years and with a mean disease duration of 8.5 ± 8.3 years were included. Mean total direct medical costs were US$1862 (95% confidence interval [CI] 828-2899). Mean direct nonmedical costs were US$222 (95% CI 149-294). Mean indirect costs were US$1008 (95% CI 606-1412). The annual mean total cost was US$3093 without biologics. Hospitalizations represented 73% of total direct medical costs while drugs and outpatient procedures represented 16% and 8% of total direct medical costs, respectively. Sixty percent of the total costs were related to direct medical costs, while indirect costs represented 33% of total costs.

Conclusion: In our population, annual mean total costs in the prebiologic therapy era were mainly driven by direct medical costs. Even without the use of biologic agents, rheumatoid arthritis represents an important burden for society in developing countries.
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http://dx.doi.org/10.2147/CEOR.S28845DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3430441PMC
October 2012

Ultrasound assessment of new onset bilateral painful shoulder in patients with polymyalgia rheumatica and rheumatoid arthritis.

Clin Rheumatol 2012 Sep 9;31(9):1383-7. Epub 2012 Jun 9.

Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.

The aim of our study was to investigate by ultrasound (US) the anatomical structures affected during a new episode of bilateral painful shoulder in patients with polymyalgia rheumatica (PMR) and rheumatoid arthritis (RA) and to compare the findings between these two conditions. PMR and RA patients complaining of new onset bilateral painful shoulder were included. Subjects without any known rheumatic condition with a new onset unilateral painful shoulder were assessed as a control group. US evaluation includes the depiction subacromial-subdeltoid (SAD) bursitis, long head biceps (LHB) tenosynovitis and/or gleno-humeral (GH) synovitis. Thirty patients with PMR, 30 with RA, and 60 controls were included for a total of 60 shoulders per group. Unilateral SAD bursitis and LHB tenosynovitis were significantly more frequent in patients with PMR when compared to those with RA (p < 0.0001 and p < 0.01, respectively) and controls (p < 0.001 and p < 0.01, respectively). Unilateral GH synovitis was more common in RA than in PMR and controls (p < 0.05 and p < 0.01, respectively). Bilateral SAD bursitis was significantly more frequent in patients with PMR than in those with RA (p < 0.01) as was bilateral LHB tenosynovitis (p < 0.01). No significant differences were found in bilateral GH synovitis. US-detected periarticular inflammatory involvement more frequently in PMR both unilaterally and bilaterally and intra-articular inflammatory involvement was commonly in RA but only unilaterally.
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http://dx.doi.org/10.1007/s10067-012-2016-2DOI Listing
September 2012

Incidence and prevalence of systemic sclerosis in a healthcare plan in Buenos Aires.

J Clin Rheumatol 2011 Mar;17(2):59-63

Sección Reumatología, Servicio de Clínica Médica, Hospital Italiano de Buenos Aires, Fundación Dr Pedro M. Catoggio para el Progreso de la Reumatología, Instituto Universitario, Escuela de Medicina, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.

Background: Systemic sclerosis (scleroderma) is an infrequent disease. Data on incidence and prevalence are scarce and conflictive. There are no such data in Latin America or in Argentina in particular.

Objectives: We undertook to examine the incidence and prevalence of systemic sclerosis in the prepaid health maintenance organization of our hospital, in the city of Buenos Aires.

Methods: Members of the plan between 1999 and 2004 were followed up for incident cases, and prevalence was calculated at the end of the period.

Results: A total of 98,642 persons were followed up for a total of 32,9534 person-years. Density of incidence overall was 21.2 per million person-years (95% confidence interval [CI], 5.4-37). Density of incidence for diffuse disease was 6.1 per million person-years (95% CI, 2.3-14.5), and for limited disease, it was 15.2 per million person-years (95% CI, 2-28). Prevalence was 296 per million people (95% CI, 193-434); females, 477 per million people (95% CI, 309-704); and males, 28 per million people (95% CI, 7-157). Prevalence for diffuse disease was 57 per million people (95% CI, 18-133), and for limited disease, it was 240 per million people (95% CI, 148-365).

Conclusions: Despite potential biases, these data are in agreement with others from different parts of the world and the first obtained in Argentina and, to our knowledge, in Latin America.
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http://dx.doi.org/10.1097/RHU.0b013e31820e7e8dDOI Listing
March 2011

Incidence and prevalence of psoriatic arthritis in Buenos Aires, Argentina: a 6-year health management organization-based study.

Rheumatology (Oxford) 2011 Apr 6;50(4):729-34. Epub 2010 Dec 6.

Servicio de Clinica Meédica, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires 1181, Argentina.

Objectives: Studies regarding epidemiology of PsA are lacking in Latin America. We estimated the incidence and prevalence of PsA in a University Hospital-based Health Management Organization in Buenos Aires [Hospital Italiano Medical Care Program (HIMCP)].

Methods:

Population: for incidence calculation, the population at risk was all adult members of the HIMCP, with continuous affiliation for at least 1 year from January 2000 to January 2006. Each person was followed until he/she voluntarily left the HIMCP, death or finalization of the study (final dates) contributing time at risk since January 2000 or enrolment date (whichever occurred later) to that final date. Case ascertainment: medical records of all patients with the problem psoriasis and/or PsA in the HIMCP problem-oriented computer-based patient record system, or registered in rheumatologists and/or dermatologists databases, were revised. Patients fulfilling CASPAR criteria were included.

Statistical Analysis: incidence rate (IR) was calculated with 95% CIs. Cumulative prevalence was estimated on 1 January 2006 (denominator population ==88,112).

Results: In the study period, 138,288 persons contributed a total of 558,878 person-years, of whom 35 developed PsA (IR 6.26; 95% CI 4.2, 8.3 cases per 100,000 person-years). There were 12 females: IR 3.64 (95% CI 1.6, 5.7) cases per 100,000 person-years; and 23 males: IR 10.02 (95% CI 5.9, 14.1) cases per 100,000 person-years. On 1 January 2006, 65 prevalent cases were identified: prevalence 74 (95% CI 57, 94) cases per 100,000 members.

Conclusions: The incidence and prevalence of PsA in this Latin American country was similar to that reported in other studies from Europe and the USA.
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http://dx.doi.org/10.1093/rheumatology/keq369DOI Listing
April 2011

[Treatment and prognosis].

Reumatol Clin 2009 Nov 25;5 Suppl 3:35-9. Epub 2009 Sep 25.

Sección de Reumatología, Servicio de Clínica Médica, Hospital Italiano de Buenos Aires, Fundacion Dr. Pedro M. Catoggio para el Progreso de la Reumatología, Buenos Aires, Argentina; Instituto Universitario Escuela de Medicina Hospital Italiano de Buenos Aires, Fundacion Dr. Pedro M. Catoggio para el Progreso de la Reumatología, Buenos Aires, Argentina.

Diagnosis should include mandatory muscle biopsy to identify inclusion body myositis. Most forms of inflammatory myopathies are still treated similarly, although treatment strategies remain empirical and controlled trials are few. Muscle strength and CPK levels remain the most frequently used measures to monitor disease activity and response to therapy. Corticosteroids are the main pillar of drug therapy but simultaneous use of corticosteroid-sparing drugs may be considered from the start. The most frequently used drugs for combined therapy are methotrexate, azathioprine and antimalarials in cases of dermatomyositis. In refractory cases, especially if life threatening, rituximab has appeared to be effective although there are no controlled trials, and there is some consensus that this should be used prior to Immunoglobulin. Anti TNF antibodies have not been useful in these diseases. Cyclosporin (especially with lung involvement) and Mofetil mycophenolate may also have a role in non responding cases. Treatment of inclusion body myositis remains unsatisfactory.
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http://dx.doi.org/10.1016/j.reuma.2009.07.004DOI Listing
November 2009

[Insipid diabetes as initial presentation of Wegener's granulomatosis].

Rev Fac Cien Med Univ Nac Cordoba 2009 ;66(1):31-5

Servicio de Clínica Médica, Hospital Italiano de Buenos Aires.

Wegener's granulomatosis is a granulomatous necrotizing vasculitis which predominantly affects the respiratory tract, kidney, and less frequently other organs such as the nervous system. The latter may occur in up to 54% of cases and when it does it is more frequently of the peripheral nerves. We present a 19 year old woman who commenced her disease with involvement of respiratory sinuses, lungs and kidney and who developed central insipid diabetes (CID) at onset. The CID persisted in spite of adequate response of the other organs and systems with immunosuppresor treatment. The development of CID in the context of vasculitis should suggest this as a possible mechanism.
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January 2012

Childhood systemic lupus erythematosus in Latin America. The GLADEL experience in 230 children.

Lupus 2008 Jun;17(6):596-604

Sección de Reumatología, Universidad de Antioquia, Hospital Universitario San Vicente de Paúl. Medellín, Colombia.

To evaluate disease characteristics of childhood onset SLE in Latin America and to compare this information with an adult population in the same cohort of GLADEL. A protocol was designed as a multicenter, multinational, inception cohort of lupus patients to evaluate demographic, clinical, laboratory and serological variables, as well as classification criteria, disease activity, organ damage and mortality. Descriptive statistics, chi square, Fisher's exact test, Student's t test and multiple logistic regression were used to compare childhood and adult onset SLE. 230 patients were <18 years and 884 were adult SLE patients. Malar rash, fever, oral ulcers, thrombocytopenia and hemolytic anemia and some neurologic manifestations were more prevalent in children (p<0.05). On the other hand, myalgias, Sjögren's syndrome and cranial nerve involvement were more frequently seen in adults (p<0.05). Afro-Latin-American children had a higher prevalence of fever, thrombocytopenia and hemolytic anemia. White and mestizo children had a higher prevalence of malar rash. Mestizo children had a higher prevalence of cerebrovascular disease and cranial nerve involvement. Children met SLE ACR criteria earlier with higher mean values than adults (p: 0.001). They also had higher disease activity scores (p: 0.01), whereas adults had greater disease damage (p: 0.02). In Latin America, childhood onset SLE seems to be a more severe disease than adults. Some differences can be detected among ethnic groups.
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http://dx.doi.org/10.1177/0961203307088006DOI Listing
June 2008

Argentine population genetic structure: large variance in Amerindian contribution.

Am J Phys Anthropol 2007 Mar;132(3):455-62

Rowe Program in Human Genetics, Department of Biological Chemistry, University of California Davis, Davis, CA 95616, USA.

Argentine population genetic structure was examined using a set of 78 ancestry informative markers (AIMs) to assess the contributions of European, Amerindian, and African ancestry in 94 individuals members of this population. Using the Bayesian clustering algorithm STRUCTURE, the mean European contribution was 78%, the Amerindian contribution was 19.4%, and the African contribution was 2.5%. Similar results were found using weighted least mean square method: European, 80.2%; Amerindian, 18.1%; and African, 1.7%. Consistent with previous studies the current results showed very few individuals (four of 94) with greater than 10% African admixture. Notably, when individual admixture was examined, the Amerindian and European admixture showed a very large variance and individual Amerindian contribution ranged from 1.5 to 84.5% in the 94 individual Argentine subjects. These results indicate that admixture must be considered when clinical epidemiology or case control genetic analyses are studied in this population. Moreover, the current study provides a set of informative SNPs that can be used to ascertain or control for this potentially hidden stratification. In addition, the large variance in admixture proportions in individual Argentine subjects shown by this study suggests that this population is appropriate for future admixture mapping studies.
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http://dx.doi.org/10.1002/ajpa.20534DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3142769PMC
March 2007

Chromosome 17p12-q11 harbors susceptibility loci for systemic lupus erythematosus.

Hum Genet 2004 Aug 1;115(3):230-8. Epub 2004 Jul 1.

Department of Genetics and Pathology, Unit for Medical Genetics, Rudbeck Laboratory, University of Uppsala, Dag Hammarskjölds Väg 20, Uppsala, Sweden.

Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by the presence of autoantibodies against intracellular components, the formation of immune complexes, and inflammation in various organs, typically the skin and kidney glomeruli. The etiology of the disease is not well understood but is most likely the result of the interaction between genetic and environmental factors. In order to identify susceptibility loci for SLE, we have performed genome scans with microsatellite markers covering the whole genome in families from Argentina, Italy, and Europe. The results reveal a heterogeneous disease with different susceptibility loci in different family sets. We have found significant linkage to chromosome 17p12-q11 in the Argentine set of families. The maximum LOD score was given by marker D17S1294 in combination with D17S1293, when assuming a dominant inheritance model (Z = 3.88). We also analyzed a repeat in the promoter region of the NOS2A gene, a strong candidate gene in the region, but no association was found. The locus on chromosome 17 has previously been identified in genetic studies of multiple sclerosis families. Several other interesting regions were found at 1p35, 1q31, 3q26, 5p15, 11q23 and 19q13, confirming previously identified loci for SLE or other autoimmune diseases.
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http://dx.doi.org/10.1007/s00439-004-1145-3DOI Listing
August 2004

The GLADEL multinational Latin American prospective inception cohort of 1,214 patients with systemic lupus erythematosus: ethnic and disease heterogeneity among "Hispanics".

Medicine (Baltimore) 2004 Jan;83(1):1-17

From Servicio de Reumatología (BAP-E), Hospital Escuela Eva Perón, Granadero Baigorria, Rosario, Argentina; Sección Reumatología (LJC, ERS), Servicio de Clínica Médica Hospital Italiano, Buenos Aires, Argentina; Departamento de Inmunología y Reumatología (MHC, DA-S) and Unidad de Epidemiología Clínica (ARV), Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México DF, México; Servicio de Reumatología (SG), Hospital Provincial de Rosario, Rosario, Argentina; Servicio de Reumatología (IA), Centro Nacional de Enfermedades Reumáticas, Hospital Universitario de Caracas, Caracas, Venezuela; and Servicio de Reumatología (FC, AA), Hospital Privado, Centro Medico de Córdoba, Córdoba, Argentina.

Clinical and laboratory manifestations and outcome of systemic lupus erythematosus (SLE) may vary in different populations. A prospective multinational inception cohort should prove useful in identifying the influence of ethnicity on the clinical characteristics of SLE. We therefore analyzed clinical, laboratory, and prognostic variables in Latin American SLE patients with disease of recent onset who were entered into a prospective cohort, and compared these variables in the cohort's 3 major ethnic groups. Thirty-four centers from 9 Latin American countries participated by randomly incorporating SLE patients within 2 years of diagnosis into a standardized database. Participating centers were selected for their expertise in diagnosing and managing SLE. We were then able to evaluate prospectively socioeconomic variables, ethnicity, type of medical care, clinical and laboratory features, disease activity, damage, and mortality at each site. A coordinating center controlled the quality of the information submitted. Of the 1,214 SLE patients included in the cohort, 537 were mestizos, 507 were white, and 152 were African-Latin American (ALA). (There were also small numbers of pure Amerindian and oriental individuals.) Significant differences were found between them in socioeconomic characteristics, type of care, and level of education favoring whites. Mestizos and ALA were younger at onset. Delay to diagnosis and disease duration was shorter in ALA. Fever was more frequent in whites; discoid lesions in ALA; renal disease and lymphopenia in mestizos and ALA. Although we found differences in background variables between ethnic groups from different countries, mestizos from 2 distant countries (Argentina and Mexico) were clinically akin and showed similar differences to whites. Mortality was associated with lower education, poor medical coverage, and shorter follow-up. In an exploratory model nonwhite ethnicity was associated with renal disease and lymphopenia, damage, and cumulative American College of Rheumatology criteria. These differences in clinical, prognostic, socioeconomic, educational, and access to medical care features in Latin American lupus patients of 3 major ethnic groups from 9 different countries may have an impact on the patients' disease. "Hispanics," as they have come to be generically termed on the basis of language, actually constitute a markedly heterogeneous group of subjects.
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http://dx.doi.org/10.1097/01.md.0000104742.42401.e2DOI Listing
January 2004

[Polymyalgia rheumatica revisited].

Medicina (B Aires) 2002 ;62(4):358-64

Servicio de Clínica Médica, Hospital Italiano de Buenos Aires, Gascón 450, 1181 Buenos Aires, Argentina.

Polymyalgia rheumatica is an inflammatory disorder that usually affects persons over the age of 50 causing proximal muscle pain and stiffness, and an elevated erythrocyte sedimentation rate. Although increasingly recognized in this age group, it remains a diagnosis of exclusion and although several diagnostic criteria have been proposed, none has been clearly accepted. While polymyalgia rheumatica is associated with giant cell arteritis, obtaining a temporal artery biopsy is not recommended in patients with polymyalgia rheumatica without symptoms of giant cell arteritis. Early diagnosis and low dose corticosteroid therapy improve patients' clinical features and functional status. Treatment usually lasts between 12 and 24 months and the majority of patients manage to discontinue treatment completely.
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November 2002

Consultations for work related low back pain in Argentina.

J Rheumatol 2002 May;29(5):1029-33

Rheumatology Section, Medical Services, Hospital Italiano de Buenos Aires, Capital Federal, Argentina.

Objective: Low back pain (LBP) is a common cause of disability among people of working age. We investigated the incidence of consultation for work related LBP and of work absence, and determined the prevalence of continued work disability due to LBP in Argentina.

Methods: Our study population comprised 139,740 fulltime workers (mean age 34.4 yrs, range 17-79). An episode of work related LBP was defined as patient consulting because of acute LBP while at work or while traveling to/from work.

Results: In a 6 month period 360 episodes of acute LBP were reported in 69,329 worker-years of exposure to risk; thus the episode incidence rate was 5.2/1000 worker-years. This was the third most frequent work related injury. Twenty-one patients (5.8% of episodes) were lost to followup. Those with LBP were significantly older than the population at risk (p < 0.001) and were predominantly men (p < 0.001). In 244 episodes (72%) pain onset was related to heavy physical work and in 46 (13.6%) it followed trauma to the back. Surgery was performed in 9 (2.7%) cases. In total, 322 (98%) patients were absent beyond the day of the injury (median number of days of work absence, 7 days; range 0-422 days). Surgical patients lost significantly more days of work (p < 0.01). Seven patients (2%) remained off work more than 180 days: 2 were declared disabled, 3 moved to lighter jobs, and only 2 (28.5%) returned to their previous job.

Conclusion: The incidence of consultation for work related LBP was 5.2/1000 worker-years. This was the third most frequent work related injury. Most patients had some work absenteeism. Surgery did not shorten recovery times. Only a minority of patients off work for 6 months or more were able to return to their previous job.
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May 2002
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