Margarita Muñoz-Guarneros

Lack of subclinical myocardial ischaemia in Mexican patients with systemic lupus erythematosus without traditional risk factors for coronary artery disease

The objective of this study was to analyse whether patients with systemic lupus erythematosus (SLE) without traditional risk factors for coronary artery disease (CAD) develop subclinical myocardial ischaemia in the first years after diagnosis. A cross-sectional analysis of a cohort of 200 female SLE patients was conducted. We selected those patients who fulfilled the American College of Rheumatology (ACR) SLE criteria and had no traditional risk factors for CAD, including diabetes mellitus, hypertension, obesity, hyperlipidemia, and smoking. After an initial clinical and laboratory examination, patients were evaluated using a baseline echocardiogram and a dobutamine and atropine stress echocardiogram to search for subclinical myocardial ischaemia. Forty-one patients were included in the study. The mean age at the time of the study was 34.5 ± 9.56 years (mean ± SD). The mean age at diagnosis was 30.3 ± 9.39 years. The mean time from diagnosis was 3.9 ± 3.3 years. Baseline disease activity index (MEX-SLEDAI score) showed that 92.6% of patients had disease activity, although most patients had mild activity. A dobutamine and atropine stress echocardiogram was performed in 40 patients. All 40 patients had negative tests for subclinical myocardial ischaemia. Patients without traditional risk factors for CAD do not have an increased risk for subclinical myocardial ischaemia in the first years after diagnosis. A longitudinal follow-up study of these patients is needed to confirm our findings and assess if additional non-traditional risk factors for CAD increase the risk for myocardial ischaemia. Lupus (2007) 16, 298—301.

Lack of association between serum 25-hydroxyvitamin D levels and cervical human papillomavirus infection in systemic lupus erythematosus.

Our objective was to evaluate whether vitamin D deficiency is associated with cervical human papilloma virus (HPV) infection in women with SLE. This is a cross-sectional study of 67 women with SLE. A structured questionnaire was administered to ascertain the possible risk factors associated with cervical HPV infection. A gynaecological evaluation and cervical cytology screening were made. HPV detection and genotyping was made by PCR and linear array assay. Serum 25 hydroxyvitamin D levels were quantified by chemiluminescence immunoassay. Mean age and disease duration were 44.8 ± 10.6 and 42.5 ± 11.8 years, respectively. Demographic characteristics were similar in patients with and without deficiency (<20 ng/ml and ≥20 ng/ml). There were 28.4% of women with cervical HPV infection and 68.4% had high-risk HPV infections. Patients with 25 hydroxyvitamin D levels <20 ng/ml had a higher prevalence of cervical HPV infection than those with levels ≥20 ng/ml (30.7% vs. 25.8%; p = 0.72). We found no significant difference when high-risk HPV infection was evaluated (36.8% vs. 31.5%; p = 0.73). In conclusion, women with SLE have a high prevalence of vitamin D deficiency and cervical HPV infection. However, we found no association between vitamin D deficiency and cervical HPV.

The impact of glucocorticoids and anti-cd20 therapy on cervical human papillomavirus infection risk in women with systemic lupus erythematosus

OBJECTIVE: To identify the prevalence and factors associated with cervical human papillomavirus infection in women with systemic lupus erythematosus METHODS: This cross-sectional study collected traditional and systemic lupus erythematosus-related disease risk factors, including conventional and biologic therapies. A gynecological evaluation and cervical cytology screen were performed. Human papillomavirus detection and genotyping were undertaken by PCR and linear array assay. RESULTS: A total of 148 patients were included, with a mean age and disease duration of 42.5±11.8 years and 9.7±5.3 years, respectively. The prevalence of squamous intraepithelial lesions was 6.8%. The prevalence of human papillomavirus infection was 29%, with human papillomavirus subtype 59 being the most frequent. Patients with human papillomavirus were younger than those without the infection (38.2±11.2 vs. 44.2±11.5 years, respectively; p = 0.05), and patients with the virus had higher daily prednisone doses (12.8±6.8 vs. 9.7±6.7 mg, respectively; p = 0.01) and cumulative glucocorticoid doses (14.2±9.8 vs. 9.7±7.3 g, respectively; p = 0.005) compared with patients without. Patients with human papillomavirus infection more frequently received rituximab than those without (20.9% vs. 8.5%, respectively; p = 0.03). In the multivariate analysis, only the cumulative glucocorticoid dose was associated with human papillomavirus infection. CONCLUSIONS: The cumulative glucocorticoid dose may increase the risk of human papillomavirus infection. Although rituximab administration was more frequent in patients with human papillomavirus infection, no association was found. Screening for human papillomavirus infection is recommended in women with systemic lupus erythematosus.

Insuficiencia y deficiencia de vitamina D en pacientes mexicanas con lupus eritematoso sistémico: prevalencia y relación con actividad de la enfermedad

OBJECTIVES To determine and compare the prevalence of vitamin D insufficiency and deficiency in patients with systemic lupus erythematosus (SLE) with and without disease activity. PATIENTS AND METHODS We made a comparative, observational, cross-sectional, prospective study of 137 women with SLE according to American College of Rheumatology criteria. Patients with chronic kidney disease, cancer, hyperparathyroidism, pregnancy, and lactation were excluded. Disease activity was assessed using the MEX-SLEDAI score: a score of ≥3 was considered as disease activity. Data were collected on diabetes mellitus, the use of corticosteroids, chloroquine, and immunosuppressants, photoprotection and vitamin D supplementation. Vitamin D levels were measured by chemiluminescent immunoassay: insufficiency was defined as serum 25-hydroxyvitamin D <30ng/ml and deficiency as <10ng/ml. RESULTS 137 women with SLE (mean age 45.9±11.6 years, disease duration 7.7±3.4 years) were evaluated. Mean disease activity was 2 (0-8): 106 patients had no disease activity and 31 had active disease (77.4% versus 22.6%). Vitamin D insufficiency and deficiency was found in 122(89.0%) and 4 (2.9%) patients, respectively. There was no significant difference in vitamin D levels between patients with and without active disease (19.3±4.5 versus 19.7±6.8; P=.75). No correlation between the MEX-SLEDAI score (P=.21), photosensitivity, photoprotection, prednisone or chloroquine use and vitamin D supplementation was found. CONCLUSIONS Women with SLE had a high prevalence of vitamin D insufficient. No association between vitamin D levels and disease activity was found.

Incidence of cervical human papillomavirus infection in systemic lupus erythematosus women.

Objectives Our objective was to study the incidence, persistence and clearance of human papillomavirus infection in systemic lupus erythematosus women and assess risk factors for persistence of human papillomavirus infection. Methods We carried out a prospective, observational cohort study of 127 systemic lupus erythematosus women. Patients were evaluated at baseline and at three years. Traditional and systemic lupus erythematosus women-related disease risk factors were collected. Gynaecological evaluations and cervical cytology screening were made. Human papillomavirus detection and genotyping were made by polymerase chain reaction and linear array. Results The cumulative prevalence of human papillomavirus infection increased from 22.8% at baseline to 33.8% at three years; p = < 0.001: 20.1% of patients experienced 43 incident infections. The risk of any human papillomavirus infection was 10.1 per 1000 patient-months. At three years, 47 (88.6%) prevalent infections were cleared. Independent risk factors associated with incident human papillomavirus infection included more lifetime sexual partners (odds ratio = 1.8, 95% confidence interval = 1.11–3.0) and cumulative cyclophosphamide dose (odds ratio = 3.9, 95% confidence interval = 1.2–12.8). Conclusions In systemic lupus erythematosus women, the cumulative prevalence of human papillomavirus infection, including high risk-human papillomavirus and multiple human papillomavirus infections, may increase over time. Most persistent infections were low risk-human papillomavirus. The number of lifetime sexual partners and the cumulative cyclophosphamide dose were independently associated with incident human papillomavirus infection.

Genital Mycoplasma infection among Mexican women with systemic lupus erythematosus

To assess the prevalence of genital Mycoplasma spp. among women with systemic lupus erythematosus (SLE) and to identify factors associated with such infection.

AB0411 The impact of irritable bowel syndrome on health related quality of life in systemic lupus erythematosus

Background Health-related quality of life (HRQOL) is impaired in patients with systemic lupus erythematosus (SLE). Irritable bowel syndrome (IBS) is highly prevalent and also reduces HRQOL. However, the relationship between IBS in SLE and its impact on HRLQOL has not been explored. Objectives To evaluate the prevalence and risk factors for IBS in patients with SLE and its impact on HRQOL. Methods Patients with confirmed SLE according to American College of Rheumatology (ACR) criteria were included in this cross-sectional study. Sociodemographic and clinical variables were recorded. HRQOL was assessed using the Short Form 36 (SF-36) instrument; fibromyalgia (FM) and depression symptoms were also evaluated. The diagnosis of IBS was based on the Rome III criteria. Results 105 women with SLE were included. The mean age and disease duration were 43.6±11.3 and 10.4±7.3 years, respectively. FM was present in 23.8% of patients. Fifty-one (48.6%) patients were diagnosed with IBS. The prevalence of IBS-C, IBS-D and IBS-M subtypes was 23.5%, 37.3% and 39.2%, respectively. IBS-C patients had higher depression scores than those of the other subtypes. Compared with non-IBS patients, those with IBS were more likely to have FM (33.0% vs. 14.8%; p= 0.02) and had higher SLE activity scores (2.5±8.6 vs. 1.7±2.0; p=0.03). Logistic multivariate analysis showed that IBS was significantly associated with depression and FM in SLE patients (OR= 1.07 95% CI: 1.02-1.13 and OR= 2.85 95% CI: 1.1-7.4, respectively). SF-36 scores were significantly lower in IBS patients compared with non-IBS patients (49.6 ± 18.5 vs. 62.6 ± 18.1; p = 0.025). There was a trend to a lower SF-36 lower global score in patients with IBS+FM compared to those without FM (p = 0.76). Conclusions IBS is highly prevalent among women with SLE. Risk factors for this association were depression and fibromyalgia. SLE patients with IBS have worse HRQOL, independently of the presence of FM. We suggest that treating IBS may improve HRQOL in patients with SLE. References Morgan DR, Squella FE, Pena E, Mearni F, Rey E, Enriquez-Blanco HE, et al. Multinational validation of the Spanish ROME III adult diagnostic questionnaire: comparable sensitivity and specificity to English instrument. Gastroenterology 2012;138:S386. Lopez-Colombo A, Morgan D, Bravo-González D, Montiel-Jarquín A, Méndez-Martínez S, Schmulson M. The epidemiology of functional gastrointestinal disorders in Mexico: A population-based study. Gastroenterol Res Pract 2012;2012:606174 Acknowledgements We would like to thank to David Buss for the valuable guidance and advice in this project. Disclosure of Interest None Declared