José Fernando Molina

Systemic lupus erythematosus in males. A study of 107 Latin American patients.

Clinical and laboratory features were analyzed in 107 Latin American male patients with systemic lupus erythematosus (SLE) who were compared with a group of 1,209 Latin American female patients with SLE to determine the presence of gender-associated differences. Males had an increased prevalence of renal disease, vascular thrombosis, and the presence of anti-dsDNA antibodies, as well as the use of moderate to high doses of corticosteroids, compared with female SLE patients. Although there was no difference in mortality from all causes, SLE-related mortality was higher in the male group. All these findings are consistent with a more severe disease in Latin American males than in female patients from the same region.

Ethnic differences in the clinical expression of systemic lupus erythematosus: A comparative study between African-Americans and Latin Americans

Since ethnic differences in the disease expression of systemic lupus erythematosus (SLE) have been recognized, we compared the clinical and serological features in two different ethnic groups of patients with SLE. The study population consisted of 222 African-American and 300 Latin American (Colombian) SLE patients. Clinical, demographic, and laboratory data were obtained by chart review using a standard data collection form. African-American patients more commonly manifested discoid skin lesions, pulmonary fibrosis, and pleuritis, and less commonly manifested photosensitivity, livedo reticularis, and vascular thrombosis than did Latin Americans. In addition, there was a higher frequency of anti-Sm, anti-RNP, and anti-Ro positivity among African-American patients compared with Latin Americans. These results are additional evidence for the presence of ethnic differences in the clinical expression of SLE.

Anticardiolipin antibodies in childhood rheumatic disorders.

Anticardiolipin antibodies (aCL) have been reported to occur in a wide variety of autoimmune and non-autoimmune disorders in adults. Our objective was to investigate the prevalence and isotype distribution of aCL and its relationship with the features of antiphospholipid syndrome (APS) in childhood rheumatic disorders. Between November 1995 and May 1996, all patients who visited our paediatric rheumatology clinic whose guardians signed a consent form participated in the study. The study population included 106 patients (36 systemic lupus erythematosus (SLE), 28 juvenile rheumatoid arthritis (JRA), 11 fibromyalgia, 7 sarcoidosis, 5 dermatomyositis, 3 rheumatic fever (RF), 3 vasculitis, 2 scleroderma, and 11 miscellaneous). aCL measurements were performed by enzyme linked immunoabsorbent assay (ELISA). All patients were carefully evaluated for symptoms and signs of APS. Eighteen of the 106 patients (17%) were tested positive for one or more of the three aCL isotypes. In SLE, aCL were found positive in 13 of 36 (37%); in JRA 2 of 28 (7%); in sarcoidosis 2 of 7; and in RF 1 of 3. aCL of IgG isotype were found positive in 16 patients (11 SLE, 2 sarcoidosis, 2 JRA, and 1 RF). This isotype was usually detected at low titers (16–24 GPL). aCL of IgM isotype were found positive in five patients (2 sarcoidosis, 2 SLE, 1 JRA), and aCL of IgA isotype were found positive in only three patients (2 SLE, 1 sarcoidosis). Clinical features of APS were rarely seen in our SLE population and were not associated with the presence of aCL. None of the patients in the other groups exhibited any clinical manifestations of APS. In conclusion, aCL were found in 37% of our childhood SLE patients as compared with only 7% in JRA. These were mostly aCL of IgG isotype of low titers and therefore were not associated with the main features of APS. Prospective studies with a larger sample size may be needed to ascertain the exact prevalence and clinical significance of aCL in childhood-onset SLE.

Anticardiolipin and anti-β2glycoprotein-I antibodies in patients with systemic lupus erythematosus: Comparison between Colombians and Spaniards

We studied the prevalence, isotype distribution, and clinical significance of anticardiolipin (aCL) and anti-β2glycoprotein I (anti-β2) antibodies in two populations of patients with systemic lupus erythematosus (SLE), 160 Colombians and 160 Spaniards. All sera were tested in our laboratory by enzyme-linked immunosorbent assay (ELISA) for IgG, IgM, and IgA aCL, as well as IgG and IgM anti-β2GPI. Positive results for at least 1 of the 3 aCL isotypes were found in 40 Colombians (25%) and 55 Spaniards (34%). IgG aCL was the predominant isotype in both populations. Positive results for at least 1 of the anti-β2GPI isotypes were found in 34 Colombians (21%) and 29 Spaniards (18%). IgG anti-β2GPI was the dominant isotype in Colombians, while IgM was predominant in Spaniards. Positivity for anti-β2GPI in aCL-positive patients was present in 77% in the Colombian group and 50% in the Spaniard group. Among Colombians, IgG aCL and anti-β2GPI correlated with thrombosis, fetal loss, and thrombocytopenia. Among Spaniards, IgG aCL and IgG anti-β2GPI correlated with thrombosis, fetal loss, and livedo reticularis. For detecting thrombosis and fetal loss, aCL ELISA was more sensitive than anti-β2GPI in Spaniards, and anti-β2GPI ELISA was more specific than aCL in both populations.

Epidemiología de la osteoporosis

Resumen La osteoporosis se define como una entidad esqueletica caracterizada por baja masa osea y deterioro de la microarquitectura osea, lo cual lleva a una mayor fragilidad osea y riesgo de fractura. Todas las fracturas osteoporoticas aumentan la morbilidad de los pacientes; sin embargo, las fracturas de cadera y vertebrales tambien estan asociadas con una mayor mortalidad. Estas fracturas por fragilidad tambien son una carga considerable para el sistema de salud y tienen un gran impacto economico. Por lo tanto, el conocimiento de la epidemiologia de la enfermedad es fundamental para tratar de desarrollar estrategias que esten orientadas a disminuir esta carga.

Central nervous system compromise in primary Sjögren's syndrome.

Central nervous system (CNS) involvement in primary Sjögren’s syndrome (SS) is poorly understood, and its frequency as well as its manifestations are subjects of controversy. The current study was undertaken to determine the prevalence and the clinical and immunogenetic characteristics of CNS compromise in a well defined group of patients with primary SS. In this retrospective study, patients fulfilled the European classification criteria. Among 120 patients with primary SS, 3 (2.5%) had CNS compromise (multiple sclerosis–like illness, complicated migraine, and optic neuritis with epilepsy). The CNS involvement coincided with the onset of sicca symptoms in 1 case. All 3 patients carried the human leukocyte antigen (HLA) DQB1*0303 allele and tested positive for anti-Ro antibodies, but not for anti-cardiolipin antibodies. Although rare, CNS compromise in primary SS can be the presenting manifestation of the disease in a few cases, and may be severe and varied.

Ischemic optic neuropathy and high-level anticardiolipin antibodies in primary Sjögren's syndrome

A 39-year-old woman with recurrent severe anterior ischemic optic neuropathy in the setting of Sjögrens syndrome was found to have high-titer IgM anticardiolipin antibodies (aCL) that were enhanced by the phospholipid-binding glycoprotein β2GP1. The recognition of IgM aCL-associated vasculopathy as a possible etiologic factor in the optic neuropathy in Sjögrens syndrome may be relevant in deciding appropriate therapy.

PANLAR Consensus Recommendations for the Management in Osteoarthritis of Hand, Hip, and Knee.

ObjectiveThe objective of this consensus is to update the recommendations for the treatment of hand, hip, and knee osteoarthritis (OA) by agreeing on key propositions relating to the management of hand, hip, and knee OA, by identifying and critically appraising research evidence for the effectiveness of the treatments and by generating recommendations based on a combination of the available evidence and expert opinion of 18 countries of America. MethodsRecommendations were developed by a group of 48 specialists of rheumatologists, members of other medical disciplines (orthopedics and physiatrists), and three patients, one for each location of OA. A systematic review of existing articles, meta-analyses, and guidelines for the management of hand, hip, and knee OA published between 2008 and January 2014 was undertaken. The scores for Level of Evidence and Grade of Recommendation were proposed and fully consented within the committee based on The American Heart Association Evidence-Based Scoring System. The level of agreement was established through a variation of Delphi technique. ResultsBoth “strong” and “conditional” recommendations are given for management of hand, hip, and knee OA and nonpharmacological, pharmacological, and surgical modalities of treatment are presented according to the different levels of agreement. ConclusionsThese recommendations are based on the consensus of clinical experts from a wide range of disciplines taking available evidence into account while balancing the benefits and risks of nonpharmacological, pharmacological, and surgical treatment modalities, and incorporating their preferences and values. Different backgrounds in terms of patient education or drug availability in different countries were not evaluated but will be important.

Factors predictive of high disease activity early in the course of SLE in patients from a Latin-American cohort

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 60mg/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.

Melorreostosis con compromiso de múltiples estructuras óseas y distribución inusual

Resumen La melorreostosis, tambien denominada enfermedad de Leri, es una displasia osea esclerosante no familiar, de baja prevalencia, de etiologia poco clara, descrita en 1922 por Leri y Jhonny; afecta igualmente a hombres y mujeres, suele manifestarse alrededor de los 20 anos de edad, hasta en la mitad de los casos. Esta osteopatia es usualmente asimetrica y compromete, principalmente, las extremidades inferiores, siendo raro el compromiso del craneo, huesos de la cara y de la columna. Se presenta un caso de una paciente, de 49 anos de edad, con compromiso de multiples estructuras oseas y distribucion inusual.