Examinando por Autor "Segami, M.I."
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Ítem Acceso Abierto Factors associated with health-related quality of life in Peruvian patients with systemic lupus erythematosus(SAGE Publications Ltd, 2018) Elera-Fitzcarrald, C.; Alva, M.; Gamboa-Cardenas, R.; Segami, M.I.; Ugarte-Gil, M.F.Objective: In this paper, we aim to define factors associated with health-related quality of life (HRQoL) in Mestizo patients with systemic lupus erythematosus (SLE). Methods: We evaluated patients with SLE from Peru’s two largest hospitals between October 2012 and July 2015 to ascertain HRQoL. Using a standard protocol, we incorporated demographic characteristics, clinical manifestations and treatment in our analysis. HRQoL was measured with the LupusQoL, disease activity was ascertained with the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), and damage was appraised with the Systemic Lupus International Collaborating Clinics (SLICC)/American College of Rheumatology (ACR) damage index (SDI). The associations between the LupusQoL and these variables were examined using linear regression models. Model selection was based on backward elimination. Results: A total of 277 patients fit the inclusion criterion. Of these, 254 (91.7%) were female, the median (interquartile range, IQR) age at diagnosis was 41.5 (33.8–51.8) years, disease duration was 6.5 (2.7–11.3) years. The HRQoL domains most affected were the following: burden to others, fatigue, and intimate relationships. Through multivariate analysis, we determined that older age at diagnosis, higher disease activity, damage, and immunosuppressive drug use were negatively associated with HRQoL. Further, we found that higher socioeconomic status, disease duration, and antimalarial use were positively associated with HRQoL. Conclusion: Age at diagnosis, disease activity, damage, and use of immunosuppressive drugs were negatively associated with HRQoL; high socioeconomic status, disease duration, and use of antimalarials were positively associated with HRQoL. © 2018, © The Author(s) 2018.Ítem Acceso Abierto Factors predictive of high disease activity early in the course of SLE in patients from a Latin-American cohort(W.B. Saunders, 2017) Pimentel-Quiroz, V.R.; Ugarte-Gil, M.F.; Pons-Estel, G.J.; Soriano, E.R.; Saurit V.; Sato, E.I.; Lavras Costallat, L.T.; Molina J.F.; Iglesias-Gamarra, A.; Reyes-Llerena, G.; Neira O.J.; Barile L.A.; Silveira, L.H.; Segami, M.I.; Chacón-Díaz, R.; Wojdyla, D.; Alarcón, G.S.; Pons-Estel, B.A.Aims: To determine the factors predictive of disease activity early in the course of SLE (baseline visit). Methods: Patients from GLADEL, a multi-national, multi-ethnic, Latin-American lupus cohort were included. Disease activity was evaluated at baseline with the SLEDAI score. Demographic characteristics (age at diagnosis, gender, ethnicity, marital status, educational level, medical coverage and socioeconomic status) were assessed. Disease duration was defined as the time between the fourth ACR criterion and baseline. Time to criteria accrual was defined as the interval between the first and fourth ACR criterion. Use of glucocorticoids was recorded as the highest dose received before the baseline visit. Antimalarials and immunosuppressive drugs were recorded as use or not use. Univariable and multivariable analysis were performed. Model selection was based on backward elimination. Results: One thousand two hundred sixty-eight patients were included; 1136 (89.6%) of them were female. Mean age at diagnosis was 29.2 (SD: 12.3) years. Five hundred sixty-five (44.6%) were Mestizo, 539 (42.5%) were Caucasians and 164 (12.9%) were African-Latin-Americans. The mean SLEDAI at baseline was 10.9 (SD: 8.4). Longer time between first and fourth ACR criterion, medical coverage, a dose of prednisone between 15 and 60. mg/d, and the use of antimalarials were factors protective of disease activity, while Mestizo and African-Latin-American ethnicities were predictive factors. Conclusions: Mestizo and African-Latin-American ethnicities were predictive whereas antimalarial use, medical coverage, and longer time to criteria accrual were protective of higher disease activity early in the disease course. © 2017 Elsevier Inc.Ítem Acceso Abierto Features associated with hematologic abnormalities and their impact in patients with systemic lupus erythematosus: data from a multiethnic Latin American cohort(W.B. Saunders, 2016) González-Naranjo, L.A.; Betancur, O.M.; Alarcón, G.S.; Ugarte-Gil, M.F.; Jaramillo-Arroyave, D.; Wojdyla, D.; Pons-Estel, G.J.; Rondón-Herrera, F.; Vásquez-Duque, G.M.; Quintana-López, G.; Da Silva, N.A.; Tavares Brenol, J.C.; Reyes-Llerena, G.; Pascual-Ramos, V.; Amigo, M.C.; Massardo, L.; Alfaro-Lozano, J.; Segami, M.I.; Esteva-Spinetti, M.H.; Iglesias-Gamarra, A.; Pons-Estel, B.A.Objective: To examine hematological manifestations' correlates and their impact on damage accrual and mortality in SLE patients from the multiethnic, Latin American, GLADEL cohort. Methods: In patients with recent SLE diagnosis (≤2 years), the association between follow-up hematological manifestations (per ACR criteria) and socio-demographic and clinical variables was examined by univariable and multivariable logistic regressions; their impact on damage accrual and mortality was examined by Poisson and Cox proportional-hazards regression analyses, respectively. Results: Of 1437 patients, 948 (66.0%) developed ≥1 hematological manifestation [5.5% hemolytic anemia (AHA), 16.3% thrombocytopenia, and 56.4% lymphopenia] over 4.3 (3.3) follow-up years. Younger age, Mestizo ethnicity, hematologic disorder (at/or before SLE diagnosis), and first damage recorded were associated with hematological manifestations while antimalarials were negatively associated. AHA (at/or before SLE diagnosis), anti-Sm, and anti-RNP antibodies were associated with subsequent AHA occurrence while musculoskeletal involvement was negatively associated. Thrombocytopenia (at/or before SLE diagnosis), AHA, anti-phospholipid antibodies (aPLs), anti-SSA/Ro, anti-SSB/La antibodies, and first damage recorded were associated with later thrombocytopenia occurrence. Lymphopenia (at/or before SLE diagnosis), younger age at diagnosis, Mestizo ethnicity, having medical insurance, and first damage recorded were associated with subsequent lymphopenia occurrence while antimalarials and azathioprine treatment were negatively associated. AHA was associated with damage accrual and mortality after adjusting for variables known to affect these outcomes. Conclusions: Mestizo ethnicity and early hematological manifestations are risk factors for their subsequent occurrence while antimalarials have a protective effect. The associations between AHA and aPLs and thrombocytopenia were corroborated. AHA contributes independently to damage accrual and diminished survival. © 2016 Elsevier Inc..Ítem Acceso Abierto The number of flares patients experience impacts on damage accrual in systemic lupus erythematosus: Data from a multiethnic Latin American cohort(BMJ Publishing Group, 2015) Ugarte-Gil, M.F.; Acevedo-Vásquez, E.; Alarcón, G.S.; Pastor-Asurza, C.A.; Alfaro-Lozano, J.L.; Cucho-Venegas, J.M.; Segami, M.I.; Wojdyla, D.; Soriano, E.R.; Drenkard, C.; Brenol, J.C.; De Oliveira E Silva Montandon, A.C.; Lavras Costallat, L.T.; Massardo, L.; Molina-Restrepo, J.F.; Guibert-Toledano, M.; Silveira, L.H.; Amigo, M.C.; Barile-Fabris, L.A.; Chacón-Díaz, R.; Esteva-Spinetti, M.H.; Pons-Estel, G.J.; McGwin, G. Jr.; Pons-Estel, B.A.Purpose: To determine the association between the number of flares systemic lupus erythematosus (SLE) patients experience and damage accrual, independently of other known risk factors. Methods: SLE patients (34 centres, nine Latin American countries) with a recent diagnosis (≤2 years) and ≥3 evaluations were studied. Disease activity was ascertained with the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and damage with the SLICC/ACR Damage Index (SDI). Flare was defined as an increase ≥4 points in the SLEDAI between two study visits. An ambidirectional case- crossover design was used to determine the association between the number of flares and damage accrual. Results: 901 patients were eligible for the study; 500 of them (55.5%) experienced at least one flare, being the mean number of flares 0.9 (SD: 1.0). 574 intervals from 251 patients were included in the case-crossover design since they have case and control intervals, whereas, the remaining patients did not. Their mean age at diagnosis was 27.9 years (SD: 11.1), 213 (84.9%) were women. The mean baseline SDI and SLEDAI were 1.3 (1.3) and 13.6 (8.1), respectively. Other features were comparable to those of the entire sample. After adjusting for possible confounding variables, the number of flares, regardless of their severity, was associated with damage accrual (SDI) OR 2.05, 95% CI 1.43 to 2.94, p<0.001 (OR 2.62, 95% CI 1.31 to 5.24, p=0.006 for severe and OR 1.91, 95% CI 1.28 to 2.83, p=0.001 for mild-moderate). Conclusions: The number of flares patients experience, regardless of their severity, increases the risk of damage accrual, independently of other known risk factors. © 2015, BMJ Publishing Group. All rights reserved.