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Departamento de Clínica Médica, Faculdade de Medicina - Docente
LIM/17 - Laboratório de Investigação em Reumatologia, Hospital das Clínicas, Faculdade de Medicina

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  • article 0 Citação(ões) na Scopus
    Time to diagnosis in systemic lupus erythematosus: Associated factors and its impact on damage accrual and mortality. Data from a multi-ethnic, multinational Latin American lupus cohort
    (2024) NIETO, Romina; QUINTANA, Rosana; ZAVALA-FLORES, Ernesto; SERRANO, Rosa; ROBERTS, Karen; CATOGGIO, Luis J.; GARCIA, Mercedes A.; BERBOTTO, Guillermo A.; SAURIT, Veronica; BONFA, Eloisa; BORBA, Eduardo F.; COSTALLAT, Lilian T. Lavras; SILVA, Nilzio A. Da; I, Emilia Sato; BRENOL, Joao C. Tavares; MASSARDO, Loreto; NEIRA, Oscar J.; VAZQUEZ, Gloria; TOLEDANO, Marlene Guibert; PASCUAL-RAMOS, Virginia; POZO, Maria J. Sauza del; BARILE-FABRIS, Leonor A.; AMIGO, Mary-Carmen; TORRE, Ignacio Garcia De La; ACEVEDO-VASQUEZ, Eduardo M.; I, Maria Segami; CHACON-DIAZ, Rosa; ESTEVA-SPINETTI, Maria H.; ALARCON, Graciela S.; PONS-ESTEL, Bernardo A.; PONS-ESTEL, Guillermo J.
    Background Systemic lupus erythematosus (SLE) often mimics symptoms of other diseases, and the interval between symptom onset and diagnosis may be long in some of these patients. Aims: To describe the characteristics associated with the time to SLE diagnosis and its impact on damage accrual and mortality in patients with SLE from a Latin American inception cohort.Methods Patients were from a multi-ethnic, multi-national Latin-American SLE inception cohort. All participating centers had specialized lupus clinics. Socio-demographic, clinical/laboratory, disease activity, damage, and mortality between those with a longer and a shorter time to diagnosis were compared using descriptive statistical tests. Multivariable Cox regression models with damage accrual and mortality as the end points were performed, adjusting for age at SLE diagnosis, gender, ethnicity, level of education, and highest dose of prednisone for damage accrual, plus highest dose of prednisone, baseline SLEDAI, and baseline SDI for mortality.Results Of the 1437 included in these analyses, the median time to diagnosis was 6.0 months (Q1-Q3 2.4-16.2); in 721 (50.2%) the time to diagnosis was longer than 6 months. Patients whose diagnosis took longer than 6 months were more frequently female, older at diagnosis, of Mestizo ethnicity, not having medical insurance, and having ""non-classic"" SLE symptoms. Longer time to diagnosis had no impact on either damage accrual (HR 1.09, 95% CI 0.93-1.28, p = 0.300) or mortality (HR 1.37, 95% CI 0.88-2.12, p = 0.200).Conclusions In this inception cohort, a maximum time of 24 months with a median of 6 months to SLE diagnosis had no apparent negative impact on disease outcomes (damage accrual and mortality).
  • article 0 Citação(ões) na Scopus
    Predictors of severe hemolytic anemia and its impact on major outcomes in systemic lupus erythematosus: Data from a multiethnic Latin American cohort
    (2023) GONZALEZ, Luis Alonso; ALARCON, Graciela S.; HARVEY, Guillermina B.; QUINTANA, Rosana; PONS-ESTEL, Guillermo J.; UGARTE-GIL, Manuel F.; VASQUEZ, Gloria; CATOGGIO, Luis J.; GARCIA, Mercedes A.; BORBA, Eduardo F.; SILVA, Nilzio A. Da; BRENOL, Joao C. Tavares; TOLEDANO, Marlene Guibert; MASSARDO, Loreto; NEIRA, Oscar; PASCUAL-RAMOS, Virginia; AMIGO, Mary-Carmen; BARILE-FABRIS, Leonor A.; TORRE, Ignacio Garcia De La; ALFARO-LOZANO, Jose; I, Maria Segami; CHACON-DIAZ, Rosa; ESTEVA-SPINETTI, Maria H.; IGLESIAS-GAMARRA, Antonio; PONS-ESTEL, Bernardo A.
    Objective To determine the predictors of the occurrence of severe autoimmune hemolytic anemia (AIHA) and its impact on damage accrual and mortality in SLE patients. Methods Factors associated with time to severe AIHA (hemoglobin level <= 7 g/dL) occurring from the onset of SLE symptoms were examined by Cox proportional hazards regressions. The association of severe AIHA with mortality was examined by logistic regression analyses while its impact on damage was by negative binomial regression. Results Of 1,349 patients, 49 (3.6%) developed severe AIHA over a mean (SD) follow-up time of 5.4 (3.8) years. The median time from the first clinical manifestation to severe AIHA was 111 days (IQR 43-450). By multivariable analysis, male sex (HR 2.26, 95% CI 1.02-4.75, p = 0.044), and higher disease activity at diagnosis (HR 1.04, 95% CI 1.01-1.08, p = 0.025) were associated with a shorter time to severe AIHA occurrence. Of the SLEDAI descriptors, only hematologic (leukopenia and/or thrombocytopenia) showed a certain trend toward significance in the multivariable analysis (HR 2.36, 95% CI 0.91-6.13, p = 0.0772). Severe AIHA contributed neither to damage nor to mortality. Conclusions Severe AIHA occurs during the early course of SLE. Male sex and higher disease activity at diagnosis emerged as independent predictors of a shorter time to severe AIHA occurrence. Although not statistically significant, hematological abnormalities at SLE diagnosis could predict the occurrence of severe AIHA in a shorter time. Damage and mortality did not seem to be impacted by the occurrence of severe AIHA.