Medicina Clinica最新文献

Background and objectives: Rhupus is a very rare syndrome of overlapping rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE), characterized by the presence of erosive polyarthritis associated with symptoms and signs of SLE and the presence of high specificity autoantibodies. The analysis of HLA-DR molecules would allow us to genetically characterize patients diagnosed with rhupus, being able to differentiate them from the HLA-DR profile of patients with RA and SLE.

Materials and methods: Cross-sectional observational study of 9 patients diagnosed with rhupus in whom the HLA-DR genotype was genetically characterized.

Results: Rhupus is usually more frequent in women with initial diagnosis of RA. The most frequent clinical manifestations are articular and, serologically, ANA, RF and anti-CCP positivity stand out. The most frequent HLA-DR were HLA-DR1, HLA-DR3, HLA-DR4, HLA-DR7 and HLA-DR13.

Conclusions: A higher proportion of HLA-DR1 and DR9 was observed in patients with rhupus compared to RA and SLE, as well as a lower proportion of HLA-DR2, DR6 and DR8, which would help the early characterization of these patients prior to the overlap diagnosis.

Objective: Evaluating the impact of solid organ neoplasms (SON) and hematological neoplasms (HN) on mortality among RA patients in a nationwide study.

Methods: A retrospective, observational comparison of SON and HN-related deaths in RA patients and the general Spanish population was conducted (Spanish Hospital Discharge Database). Binary logistic regression analyzed the impact of RA on mortality risk from each neoplasm.

Results: From 2016 to 2019, 139,531 neoplasm-related deaths were recorded, including 813 (0.6%) from RA patients. Patients with RA presented a lower mortality rate from SON (85.1% vs 91.2%, OR 0.99), mainly due to colorectal carcinoma (8% vs 10.6%, OR 0.67) and hepatocarcinoma (1% vs 2.7%, OR 0.44), but higher lung neoplasms risk (20.2% vs 18.6%, OR 1.31). HN-related deaths were also more prevalent in RA patients (14.9% vs 8.8%, OR 1.73), especially B and T/NK non-Hodgkin's lymphoma (6% vs 2.8%, OR 2.12) and myeloid leukemia (4.4% vs 2.3%, OR 1.92).

Conclusion: RA patients might have a higher mortality risk from lung and hematologic neoplasms. Reducing immunosuppressive burden and developing early-detection programs should be primary goals in this population.

Background and objective: The COVID-19 pandemic significantly increased the global burden of respiratory morbidity and mortality. In Spain, 2020 saw a 68.5% surge in deaths from respiratory diseases compared to 2019, largely due to COVID-19. This study aims to describe respiratory disease mortality in Spain from 2019 to 2022, focusing on the intersection of COVID-19, pre-existing respiratory conditions, and specific health determinants.

Materials and methods: We analyzed mortality data from the Spanish National Institute of Statistics (INE), covering 102 causes of death, including tuberculosis, COVID-19, and lung cancer as respiratory-related conditions. The analysis considered absolute death counts and proportions by sex, age, and region, along with percentage changes in proportional mortality. Logistic regression models were used to identify factors potentially associated with COVID-19 and respiratory-specific mortality.

Results: In 2022, Spain reported 98,128 deaths from respiratory diseases, accounting for 21.1% of all deaths and ranking as the second leading cause of death after cardiovascular diseases. Although deaths due to COVID-19 decreased in 2021 and 2022, there was a notable rise in other respiratory causes, indicating a lasting post-pandemic impact. Factors linked to higher mortality included male gender, older age, being divorced, and residing in urban areas, with significant regional variability.

Conclusions: Despite overall mortality returning to pre-pandemic levels, this study highlights a significant increase in respiratory disease deaths in Spain in 2022 compared to 2019.