Examinando por Autor "Ugarte-Gil, M.F."
Mostrando 1 - 20 de 23
Resultados por página
Opciones de ordenación
Ítem Acceso Abierto Abatacept for the treatment of systemic lupus erythematosus(Taylor and Francis Ltd, 2016) Pimentel-Quiroz, V.R.; Ugarte-Gil, M.F.; Alarcón, G.S.Introduction: Due to improvements in our understanding of the pathogenesis of systemic lupus erythematosus (SLE), several target drugs have been and are being developed. One of the possible targets in SLE is co-stimulation between antigen-presenting cells and T cells. Abatacept is a co-stimulation moderator approved for the treatment of several autoimmune diseases. There is an unmet need for drugs with a better efficacy and safety profile when treating patients with SLE.Areas covered: In this review, the authors discuss the mechanism of action of abatacept including its role in the immune system and glomeruli, and relevant information about its clinical efficacy and safety. Possible explanations for the failure of previous randomized clinical trials are also discussed.Expert opinion: Abatacept has demonstrated efficacy in other autoimmune diseases, but in SLE, randomized clinical trials have failed to achieve their primary outcome. Despite these disappointing results and based on its mechanism of action, abatacept seems to have a role in lupus nephritis and arthritis. This should be corroborated with new trials which hopefully will overcome the design pitfalls of the ones conducted to date. © 2016 Informa UK Limited, trading as Taylor & Francis Group.Ítem Acceso Abierto Circulating CD4+CD28null and extra-thymic CD4+CD8+ double positive T cells are independently associated with disease damage in systemic lupus erythematosus patients(SAGE Publications Ltd, 2016) Ugarte-Gil, M.F.; Sánchez-Zúñiga, C.; Gamboa-Cárdenas, R.V.; Aliaga-Zamudio, M.; Zevallos, F.; Tineo-Pozo, G.; Cucho-Venegas, J.M.; Mosqueira-Riveros, A.; Medina, M.; Perich-Campos, R.A.; Alfaro-Lozano, J.L.; Rodriguez-Bellido, Z.; Alarcón, G.S.; Pastor-Asurza, C.A.Objective: To determine whether circulating CD4+CD28null and extra-thymic CD4+CD8+ double positive (DP) T cells are independently associated with damage accrual in systemic lupus erythematosus (SLE) patients. Methods: This cross-sectional study was conducted between September 2013 and April 2014 in consecutive SLE patients from our Rheumatology Department. CD4+CD28null and CD4+CD8+ DP T-cell frequencies were analyzed by flow-cytometry. The association of damage (SLICC/ACR Damage Index, SDI) and CD4+CD28null and CD4+CD8+ DP T cells was examined by univariable and multivariable Poisson regression models, adjusting for possible confounders. All analyses were performed using SPSS 21.0. Results: Patients' (n = 133) mean (SD) age at diagnosis was 35.5 (16.8) years, 124 (93.2%) were female; all were mestizo (mixed Caucasian and Amerindian ancestry). Disease duration was 7.4 (6.8) years. The SLE Disease Activity Index was 5.5 (4.2), and the SDI 0.9 (1.2). The percentages of CD4+CD28null and CD4+CD8+ DP T cells were 17.1 (14.4) and 0.4 (1.4), respectively. The percentage of CD4+CD28null and CD4+CD8+ DP T cells were positively associated with a higher SDI in both univariable (rate ratio (RR) 1.02, 95% confidence interval (CI): 1.01-1.03 and 1.17, 95% CI: 1.07-1.27, respectively; p < 0.001 for both) and multivariable analyses RR 1.02, 95% CI: 1.01-1.03, p = 0.001 for CD4+CD28null T cells and 1.28, 95% CI: 1.13-1.44, p < 0.001 for CD4+CD8+ DP T cells). Only the renal domain remained associated with CD4+CD28null in multivariable analyses (RR 1.023 (1.002-1.045); p = 0.034). Conclusions: In SLE patients, CD4+CD28null and CD4+CD8+ DP T cells are independently associated with disease damage. Longitudinal studies are warranted to determine the predictive value of these associations. © The Author(s) 2015.Ítem Acceso Abierto Circulating naive and memory CD4+ T cells and metabolic syndrome in patients with systemic lupus erythematosus: data from a primarily mestizo population(Oxford University Press, 2015) Ugarte-Gil, M.F.; Sánchez-Zúñiga, C.; Gamboa-Cárdenas, R.V.; Aliaga-Zamudio, M.; Zevallos, F.; Tineo-Pozo, G.; Cucho-Venegas, J.M.; Mosqueira-Riveros, A.; Perich-Campos, R.A.; Alfaro-Lozano, J.L.; Medina, M.; Rodríguez-Bellido Z.; Alarcón, G.S.; Pastor-Asurza, C.A.Objective. The aim of this study was to determine whether the proportions of naive and memory CD4+ T cell are independently associated with the metabolic syndrome (MetS) in patients with SLE. Methods. This cross-sectional study was conducted in SLE patients seen at our rheumatology department between September 2013 and April 2014. CD4+ T cell subpopulations were examined by flow cytometry. The association of MetS and CD4+ T cell subpopulations was examined by Mann-Whitney U-test and by multivariable analysis, adjusting for all possible confounding variables. Results. One hundred and seventeen patients were evaluated. Their mean age was 44.6 years (s.d. 12.6), 109 (93.2%) were female and all patients were Mestizo (mixed Caucasian and Amerindian ancestry). Fifty-two patients (44.4%) presented with MetS. Disease duration was 7.6 years (s.d. 6.8). The percentage of naive CD4+ T cells was 25.0 (s.d. 12.7) and memory CD4+ T cells was 66.7 (s.d. 13.2) and the memory:naive CD4+ T cell ratio was 4.3 (s.d. 5.6). In multivariable analysis, the percentage of naive CD4+ T cells was negatively associated with the presence of MetS [odds ratio (OR) 0.959 (95% CI 0.923, 0.997), P = 0.033], whereas the percentage of memory CD4+T cells and the memory:naive CD4+ T cell ratio were positively associated with its presence [OR 1.040 (95% CI 1.003, 1.078), P = 0.031 and OR 1.238 (95% CI 1.041, 1.472), P = 0.016, respectively]. Conclusion. In the SLE patients studied, a lower percentage of naive CD4+ T cells, a higher percentage of memory CD4+ T cells and the memory:naive CD4+ T cell ratio were independently associated with the presence of MetS. This association could reflect the impact of immunosenescence among SLE patients with cardiovascular morbidity. © The Author 2014. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved.Ítem Acceso Abierto Defining quality of rheumatologic care: Peru(Lippincott Williams and Wilkins, 2017) Reátegui-Sokolova, C.; Pimentel-Quiroz, V.R.; Elera-Fitzcarrald, C.; Ugarte-Gil, M.F.; Calvo, A.; Alarcón, G.S.[No abstract available]Ítem Acceso Abierto Disease features and outcomes in United States lupus patients of Hispanic origin and their Mestizo counterparts in Latin America: a commentary(Oxford University Press, 2016) Ugarte-Gil, M.F.; Pons-Estel, G.J.; Molineros, J.; Wojdyla, D.; McGwin, G. Jr.; Nath, S.K.; Pons-Estel, B.A.; Alarcón-Riquelme, M.; Alarcón, G.S.Objective. To evaluate disease features and outcomes in two populations with significant Amerindian ancestry. Methods. Hispanic patients (from Texas) from the Lupus in Minorities: Nature versus Nurture (LUMINA) cohort and Mestizo patients from the Grupo Latino Americano De Estudio del Lupus or Latin American Group for the Study of Lupus (GLADEL) cohort were included. Disease features and outcomes were evaluated at baseline and last visit. Admixture informative markers of Mestizo Genoma de Lupus Eritematoso Sistémico Network consortium (GENLES) patients and Hispanic LUMINA patients were compared. Univariable analyses were performed using Chi square or Student's t test as appropriate. Multivariable analyses adjusting for possible confounders were carried out using Poisson, logistic or Cox regression models as appropriate. Results. A total of 114 LUMINA and 619 GLADEL patients were included. GLADEL patients had accrued more damage at baseline, but the opposite was the case at last visit. Being from LUMINA was a risk factor for damage accrual, even after adjusting for possible confounders [relative risk (RR) 1.33, 95% CI 1.12, 1.58]. Also, LUMINA patients have a higher risk of mortality than GLADEL patients [hazard ratio (HR) 2.37, 95% CI 1.10, 5.15], having 5-year survival of 85.6% and 94.5%, respectively. In addition, 79 LUMINA patients and 744 Mestizo GENLES patients were evaluated in order to compare genetic ancestry between the two groups; GENLES patients had a higher proportion of European ancestry (48.5% vs 43.3%, P = 0.003) and a lower proportion of Asian ancestry (3.7% vs 4.9%, P = 0.048), but the proportions of Amerindian and African ancestry were comparable in both. Conclusion. USA Hispanic patients seemed to have a poorer prognosis than their counterparts from Latin America, despite having a comparable genetic background. Socioeconomic factors may account for these observations. © The Author 2014.Ítem Acceso Abierto Epidemiology(Elsevier Inc., 2016) Ugarte-Gil, M.F.; Pons-Estel, G.J.; Alarcón, G.S.Systemic lupus erythematosus (SLE) is a disease distributed worldwide that occurs in both genders and across racial/ethnic and age groups; however, higher rates are observed in adults, women, and non-Caucasians. Genetic, environmental, sociodemographic, and methodological issues are responsible for these differences and for the variable course and outcome of the disease. Non-Caucasians may have more severe disease with a higher risk for early mortality and damage accrual. Males also may have a more severe disease; however, a negative impact of male gender on lupus outcomes has not been firmly established. Childhood onset is associated with a more severe disease; however, it is not associated with higher damage or diminished survival. Finally, late-onset lupus is associated with a mild disease but with higher damage accrual and a diminished survival. © 2016 Elsevier Inc. All rights reserved.Ítem Acceso Abierto Epidemiology of systemic lupus erythematosus(2017) Pons-Estel G.J.; Ugarte-Gil, M.F.; Alarcón, G.S.Introduction: Systemic lupus erythematosus (SLE) is a disease distributed worldwide, which occurs in both genders, and across racial/ethnic and age groups; however, higher rates are observed in adults, in women and in non-Caucasians. Genetic, environmental, sociodemographic and methodological issues are responsible not only for these differences but for the variable course and outcome of the disease. Non-Caucasians have a more severe disease with a higher risk for early mortality and damage accrual. Males also have a more severe disease; however, a negative impact of male gender on lupus outcomes has not been firmly established. Childhood-onset is associated with a more severe disease; moreover, it is also associated with higher damage and diminished survival; finally, late-onset lupus is mild but it is associated with higher damage accrual and a diminished survival. Areas covered: In this review, we discuss the incidence and prevalence of SLE, the impact of age, gender and race/ethnicity in SLE and in the survival of those affected. Expert commentary: Age, gender and race/ethnicity impact disease expression in SLE patients; despite improvements in survival, mortality in SLE remains almost three times higher than in the general population. © 2017 Informa UK Limited, trading as Taylor & Francis Group.Ítem Acceso Abierto Factors associated with disease expression patterns in systemic lupus erythematosus patients: results from LUMINA (LXXVII), a multiethnic US cohort(SAGE Publications Ltd, 2017) Ugarte-Gil, M.F.; Pimentel-Quiroz, V.R.; Vilá, L.M.; Reveille, J.D.; McGwin, G.; Alarcón, G.S.Objective The objective of this study was to determine the association of disease expression patterns with demographic and clinical characteristics in SLE. Methods Patients from a multi-ethnic SLE cohort were included. Disease expression patterns were defined as acute SLE and insidious SLE; this group was divided into those who accrued three ACR criteria and then accrued the fourth (insidious pattern A) and those who have one or two and then accrued four criteria (insidious pattern B). Disease activity was ascertained with the SLAM-R and disease damage with SLICC/ACR damage index. Variables were compared using analysis of variance for numeric variables and X2 for categorical variables. Multivariable analyses adjusting for possible confounders were performed. Results Six hundred and forty patients were included; the most frequent pattern was the insidious pattern B, with 415 (64.8%) patients, followed by the acute SLE group with 115 (18.0%) and the insidious pattern A with 110 (17.2%) patients. Patients from the insidious pattern A were older at diagnosis (pattern A: 39.8 vs pattern B: 36.7 vs acute: 32.4 years; p < 0.0001), more educated (13.6 vs 13.1 vs 12.1; p = 0.0008) and with a less active disease at baseline (8.8 vs 9.2 vs 10.7; p = 0.0227). Caucasian and Hispanic (Puerto Rico) ethnicities were overrepresented in this group (40.0% vs 27.7% vs 19.1% and 18.2% vs 17.1% vs 9.6%; p = 0.0003). Conclusions More insidious onset is associated with older age, Caucasian ethnicity, higher level of education, and lower disease activity than those with acute onset. However, after multivariable analyses, disease activity was not associated with any disease expression pattern. © SAGE Publications.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 Genetics of ANCA-associated vasculitides(Current Science Inc., 2014) Ugarte-Gil, M.F.; Espinoza, L.R.The distribution of the anti-neutrophil cytoplasmic antibodies (ANCA)-associated vasculitides (AAV) is not uniform across geographical regions and ethnic and racial groups, suggesting that genetic and environmental factors affect the pathogenesis of these diseases. In addition, genetic factors affect not only the clinical syndrome phenotypes and their prognosis, but also ANCA specificity; these data suggest that AAV may need reclassification. Several genes have been evaluated, including ANCA targets and those of the immune system, for example co-stimulatory molecules, signaling regulators, cytokines, Fc and other receptors, and other proteins. This article provides a review of genetic factors affecting the pathogenesis and prognosis of AAV. Further studies to determine the effect of genetic factors on the clinical syndrome phenotypes and ANCA specificity need to be performed across different ethnic groups. © Springer Science+Business Media 2014.Ítem Acceso Abierto High prolactin levels are independently associated with damage accrual in systemic lupus erythematosus patients(SAGE Publications Ltd, 2014) Ugarte-Gil, M.F.; Gamboa-Cárdenas, R.V.; Zevallos, F.; Medina, M.; Cucho-Venegas, J.M.; Perich-Campos, R.A.; Alfaro-Lozano, J.L.; Rodriguez-Bellido, Z.; Alarcón, G.S.; Pastor-Asurza, C.A.Objective: to determine whether prolactin levels are independently associated with disease damage in systemic lupus erythematosus (SLE) patients. Methods: these cross-sectional analyses were conducted in SLE patient members of the Almenara Lupus Cohort who were seen between January 2012 and June 2013. Disease damage was ascertained with the System Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) damage index (SDI). Prolactin was measured in ng/ml. The association between prolactin levels and the SDI (total and its domains) was evaluated using Spearman's correlation. Subsequently, adjusted Poisson regression models were performed to evaluate these associations. Results: 160 patients were included. 147 (91.9%) were female; their median age at diagnosis was 33.4 (interquartile range (IQR): 26.0-44.3) years; their disease duration was 5.5 (IQR: 2.6-9.7) years. The median prolactin value was 16.8 (IQR: 11.8-24.5) ng/ml. After adjusting for confounders in the Poisson regression model the estimated rate ratios (RR) and 95% confidence interval (CI) for each 10 ng/ml increment of prolactin were 1.13 (95% CI 1.60-1.20, p<0.001) for the total SDI score, 1.15 (1.03-1.28, p=0.003) for the renal domain and 1.41 (1.11-1.79, p=0.003) for the cardiac/peripheral vascular domains. Conclusions: there was a positive association between prolactin levels and the SDI (overall and its renal and cardiac/peripheral vascular domains), independently of other well-known risk factors. © The Author(s), 2014.Ítem Acceso Abierto Incomplete systemic Lupus Erythematosus: early diagnosis or overdiagnosis?(John Wiley and Sons Inc., 2016) Ugarte-Gil, M.F.; Alarcón, G.S.[No abstract available]Ítem Acceso Abierto Is there an effective treatment for late-onset systemic lupus erythematosus?(2013) Ugarte-Gil, M.F.; Alarcón, G.S.Over the past 60 years, overall mortality in systemic lupus erythematosus patients has dramatically decreased, but late mortality, which relates to the damage caused by the disease, its treatments and/or evolving comorbidities, is still high. This is particularly true in patients with late-onset lupus, a special subgroup of patients who, despite not having very active disease, experience a larger number of comorbidities, and higher damage accrual and mortality rates than early-onset patients. Treating these late-onset patients can be more difficult due to the risk of drug-drug interactions and aging-related processes. Antimalarials should be used whenever possible, and glucocorticoids and immunosuppressive drugs must used be carefully, especially in this population. NSAIDs should be avoided if possible. Adequate treatment of comorbidities should improve these patients' prognoses. © 2013 Future Medicine Ltd.Ítem Acceso Abierto Predictive factors of flares in systemic lupus erythematosus patients: data from a multiethnic Latin American cohort(SAGE Publications Ltd, 2018) Ugarte-Gil, M.F.; Wojdyla, D.; Pastor-Asurza, C.A.; Alarcón, G.S.; Pons-Estel, B.A.Purpose: The purpose of this paper is to determine the factors predictive of flares in systemic lupus erythematosus (SLE) patients. Methods: A case-control study nested within the Grupo Latino Americano De Estudio de Lupus (GLADEL) cohort was conducted. Flare was defined as an increase ≥4 points in the SLEDAI. Cases were defined as patients with at least one flare. Controls were selected by matching cases by length of follow-up. Demographic and clinical manifestations were systematically recorded by a common protocol. Glucocorticoid use was recorded as average daily dose of prednisone and antimalarial use as percentage of time on antimalarial and categorized as never (0%), rarely (>0–25%), occasionally (>25%–50%), commonly (˃50%–75%) and frequently (˃75%). Immunosuppressive drugs were recorded as used or not used. The association between demographic, clinical manifestations, therapy and flares was examined using univariable and multivariable conditional logistic regression models. Results: A total of 465 cases and controls were included. Mean age at diagnosis among cases and controls was 27.5 vs 29.9 years, p = 0.003; gender and ethnic distributions were comparable among both groups and so was the baseline SLEDAI. Independent factors protective of flares identified by multivariable analysis were older age at diagnosis (OR = 0.929 per every five years, 95% CI 0.869–0.975; p = 0.004) and antimalarial use (frequently vs never, OR = 0.722, 95% CI 0.522–0.998; p = 0.049) whereas azathioprine use (OR = 1.820, 95% CI 1.309–2.531; p < 0.001) and SLEDAI post-baseline were predictive of them (OR = 1.034, 95% CI 1.005–1.064; p = 0.022). Conclusions: In this large, longitudinal Latin American cohort, older age at diagnosis and more frequent antimalarial use were protective whereas azathioprine use and higher disease activity were predictive of flares. © 2017, © The Author(s) 2017.Ítem Acceso Abierto Prolactin levels are associated with a pro-inflammatory body mass distribution among women with systemic lupus erythematosus(SAGE Publications Ltd, 2017) Elera-Fitzcarrald C.; Ugarte-Gil, M.F.; Gamboa-Cárdenas, R.V.; Zevallos, F.; Medina, M.; Cucho-Venegas, J.M.; Perich-Campos, R.A.; Alfaro-Lozano, J.L.; Rodriguez-Bellido, Z.; Alarcón, G.S.; Pastor-Asurza, C.A.Objectives The objective of this study was to determine whether prolactin levels are associated with a pro-inflammatory body mass distribution in women with systemic lupus erythematosus (SLE). Methods This cross-sectional study was conducted in consecutive female SLE patients seen in our rheumatology department from January 2012 to July 2015. Prolactin was measured in ng/ml. Body mass distribution was measured by dual energy x-ray absorptiometry and it was divided into subtotal (whole body excluding the head), subtotal bone mineral content, lean mass index (appendicular lean mass/height2), subtotal trunk and leg fat percentages and trunk-to-leg fat ratio. The association between prolactin levels and body mass distribution components was evaluated by univariable and multivariable linear regression models adjusting for possible confounders. Results One hundred and eighty-five patients were evaluated; their mean (SD) age at diagnosis was 34.8 (13.8) years; nearly all patients were Mestizo. Patients included in this study were comparable to the rest of the cohort in terms of age, disease duration, SLEDAI, SDI and body mass index. Disease duration was 7.3 (6.6) years. The SLEDAI was 5.2 (4.3) and the SDI 0.9 (1.3). Prolactin levels were 18.9 (16.7) ng/ml. In univariable analyses, prolactin was negatively associated with bone mineral density, bone mineral content, leg fat percentage and lean mass index, and positively associated with trunk-to-leg fat ratio. In the multivariable analyses, prolactin was negatively associated with bone mineral content and positively associated with trunk-to-leg fat ratio. Conclusions Higher prolactin levels are associated with a pro-inflammatory body mass distribution in SLE patients. © 2017 SAGE Publications.Ítem Acceso Abierto Remission and Low Disease Activity Status (LDAS) protect lupus patients from damage occurrence: data from a multiethnic, multinational Latin American Lupus Cohort (GLADEL)(2017) Ugarte-Gil, M.F.; Wojdyla, D.; Pons-Estel, G.J.; Catoggio L.J.; Drenkard, C.; Sarano, J.; Berbotto, G.A.; Borba, E.F.; Sato, E.I.; Tavares Brenol, J.C.; Uribe, O.; Ramirez Gómez, L.A.; Guibert-Toledano, M.; Massardo, L.; Cardiel, M.H.; Silveira, L.H.; Chacón-Diaz, R.; Alarcón, G.S.; Pons-Estel, B.A.; GLADELOBJECTIVE: 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. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.Ítem Acceso Abierto Serum uric acid levels contribute to new renal damage in systemic lupus erythematosus patients(Springer London, 2017) Reátegui-Sokolova, C.; Ugarte-Gil, M.F.; Gamboa-Cárdenas, R.V.; Zevallos, F.; Cucho-Venegas, J.M.; Alfaro-Lozano, J.L.; Medina, M.; Rodriguez-Bellido, Z.; Pastor-Asurza, C.A.; Alarcón, G.S.; Perich-Campos, R.A.This study aims to determine whether uric acid levels contribute to new renal damage in systemic lupus erythematosus (SLE) patients. This prospective study was conducted in consecutive patients seen since 2012. Patients had a baseline visit and follow-up visits every 6 months. Patients with ≥2 visits were included; those with end-stage renal disease (regardless of dialysis or transplantation) were excluded. Renal damage was ascertained using the SLICC/ACR damage index (SDI). Univariable and multivariable Cox-regression models were performed to determine the risk of new renal damage. Uric acid was included as a continuous and dichotomous (per receiving operating characteristic curve) variable. Multivariable models were adjusted for age at diagnosis, disease duration, socioeconomic status, SLEDAI, SDI, serum creatinine, baseline use of prednisone, antimalarials, and immunosuppressive drugs. One hundred and eighty-six patients were evaluated; their mean (SD) age at diagnosis was 36.8 (13.7) years; nearly all patients were mestizo. Disease duration was 7.7 (6.8) years. Follow-up time was 2.3 (1.1) years. The SLEDAI was 5.2 (4.3) and the SDI 0.8 (1.1). Uric acid levels were 4.5 (1.3) mg/dl. During follow-up, 16 (8.6%) patients developed at least one new point in the renal domain of the SDI. In multivariable analyses, uric acid levels (continuous and dichotomous) at baseline predicted the development of new renal damage (HR 3.21 (1.39–7.42), p 0.006; HR 18.28 (2.80–119.48), p 0.002; respectively). Higher uric acid levels contribute to the development of new renal damage in SLE patients independent of other well-known risk factors for such occurrence. © 2017, International League of Associations for Rheumatology (ILAR).Ítem Acceso Abierto Socioeconomic aspects of Systemic Lupus Erythematosus(Elsevier Inc., 2016) González-Naranjo, L.A.; Ugarte-Gil, M.F.; Alarcón, G.S.Lower socioeconomic status (SES) can affect systemic lupus erythematosus (SLE) outcomes by several possible mechanisms, such as inadequate access to quality care services, communication barriers, and malnutrition. SES should be systematically measured at the individual level (education, income, and occupation), as well as at the household and neighborhood levels. Lower SES has been associated with higher disease activity, mainly over the disease course, higher damage accrual, mortality, and disability. Furthermore, outcome differences between Caucasians and non-Caucasians are partially explained by socioeconomic factors. The association between non-Caucasian ethnicities and lower SES makes genetic and environmental risks difficult to disentangle. © 2016 Elsevier Inc. All rights reserved.