Examinando por Autor "Wojdyla, D."
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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 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 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 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 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.