Papers by Manuel Ugarte-Gil
Annals of the Rheumatic Diseases, 2012
ABSTRACT Background The management of the Rheumatoid Arthritis using standardized activity measur... more ABSTRACT Background The management of the Rheumatoid Arthritis using standardized activity measures have probed better outcomes than usual care. There are few studies that evaluated the concordance of the most used activity measures in Hispanic population. Objectives To evaluate concordance and agreement of the original DAS28/ESR-4 item composite disease activity status measure with 3 of its derivatives: DAS28/CRP-4 item, DAS28/ESR-3 item, DAS28/CRP 3-item, SDAI and CDAI when classifying patient disease activity by European League of Associations for Rheumatology (EULAR) criteria, using an established rheumatoid arthritis (RA) patient cohort. Methods A cross-sectional study was performed at the Rheumatology Departments of the two biggest hospitals of Lima, Peru (since 2005 to 2009). Disease activity was evaluated using DAS28/ESR-4 item, DAS28/CRP-4 item, DAS28/ESR-3 item, DAS28/CRP 3-item, SDAI and CDAI. We analyzed the degree of agreement using kappa (k) index for these cutoff points: DAS28-ESR 4 or 3 item (<2.6: remission, 2.6 to <3.2: mild activity, 3.2 to 5.1: moderate activity and>5.1: severe activity), DAS28-CRP 4 or 3 item (<1.8: remission, 1.8 to <2.5: mild activity, 2.5 to 4.1: moderate activity and>4.1: severe activity), SDAI (<3.3: remission, 3.3 to <11: mild activity, 11 to 26: moderate activity and>26: severe activity) and CDAI (<2.8: remission, 2.8 to <10: mild activity, 10 to 22: moderate activity and>22: severe activity). Results We included 615 patients, with an average age of 57.54 years (SD 13.34), and a disease duration of 15.29 years (SD: 11.23); 536 (87.2%) were female. The average DAS28/ESR-4 item was 4.87 (SD 1.44). According to DAS28/ESR-4 item 33 (5.4%) were in remission, 52 (8.5%) showed mild activity, 258 (42.0%) moderate and 272 (44.2%) severe activity. Agreement between the categories using DAS28/ESR-4 item and DAS28/CRP-4 item was 79.3% (k: 0.68); DAS28/ESR-4 item and DAS28/ESR-3 item was 84.4% (k: 0.75), DAS28/ESR-4 item and DAS28/CRP-3 item was 68.8% (k: 0.53), DAS28/ESR-4 item and SDAI was 65.1% (k: 0.47), DAS28/ESR-4 item and CDAI was 69.2% (k: 0.54). Conclusions The DAS28/ESR-4 item, and its variants, SDAI, and CDAI are valid tools for disease activity assessment in Peruvian population with RA, and present a moderate or good agreement between its categories. Disclosure of Interest None Declared
Arthritis Research & Therapy, 2014
The protracted diagnostic period and variable disease presentation not only complicate diagnosing... more The protracted diagnostic period and variable disease presentation not only complicate diagnosing SLE but also the epidemiologic study of it. Coupled with the remitting and relapsing nature of the disease and the challenges in managing it, clinical research in lupus requires careful attention to study design, control selection, temporality, and many often overlooked issues in the analysis phase. Between "big data" and the impressive advances in the basic sciences, it is tempting to either oversimplify methods to take advantage of "big data" or overcomplicate because the problem itself is complicated. As we revisit the building blocks of epidemiologic research, we will uncover opportunities to move epidemiology and clinical research forward in SLE. Why do we care about effect modification and what is it? Why can we not just adjust for everything that we want to? And perhaps, most importantly, going back to the very beginning and asking ourselves: does this matter? During this talk we will discuss issues relating to case identification methods, potential biases associated with control selection, and return to the basics of epidemiologic research. Although we shall discuss these issues in the context of environmental (nongenetic) factors, these concerns extend across the worlds of observational data analysis, can impact randomized trials, and are relevant for all types of exposures and outcomes.
Current Rheumatology Reports, 2014
The distribution of the anti-neutrophil cytoplasmic antibodies (ANCA)-associated vasculitides (AA... more The distribution of the anti-neutrophil cytoplasmic antibodies (ANCA)-associated vasculitides (AAV) is not uniform across geographical regions and ethnic and racial groups, suggesting that genetic and environmental factors affect the pathogenesis of these diseases. In addition, genetic factors affect not only the clinical syndrome phenotypes and their prognosis, but also ANCA specificity; these data suggest that AAV may need reclassification. Several genes have been evaluated, including ANCA targets and those of the immune system, for example co-stimulatory molecules, signaling regulators, cytokines, Fc and other receptors, and other proteins. This article provides a review of genetic factors affecting the pathogenesis and prognosis of AAV. Further studies to determine the effect of genetic factors on the clinical syndrome phenotypes and ANCA specificity need to be performed across different ethnic groups.
Lupus, 2014
to determine whether prolactin levels are independently associated with disease damage in systemi... more to determine whether prolactin levels are independently associated with disease damage in systemic lupus erythematosus (SLE) patients. these cross-sectional analyses were conducted in SLE patient members of the Almenara Lupus Cohort who were seen between January 2012 and June 2013. Disease damage was ascertained with the System Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) damage index (SDI). Prolactin was measured in ng/ml. The association between prolactin levels and the SDI (total and its domains) was evaluated using Spearman's correlation. Subsequently, adjusted Poisson regression models were performed to evaluate these associations. 160 patients were included. 147 (91.9%) were female; their median age at diagnosis was 33.4 (interquartile range (IQR): 26.0-44.3) years; their disease duration was 5.5 (IQR: 2.6-9.7) years. The median prolactin value was 16.8 (IQR: 11.8-24.5) ng/ml. After adjusting for confounders in the Poisson regression model the estimated rate ratios (RR) and 95% confidence interval (CI) for each 10 ng/ml increment of prolactin were 1.13 (95% CI 1.60-1.20, p<0.001) for the total SDI score, 1.15 (1.03-1.28, p=0.003) for the renal domain and 1.41 (1.11-1.79, p=0.003) for the cardiac/peripheral vascular domains. there was a positive association between prolactin levels and the SDI (overall and its renal and cardiac/peripheral vascular domains), independently of other well-known risk factors.
Clinical Rheumatology, 2014
Despite significant advances in our understanding of the pathogenesis of systemic lupus erythemat... more Despite significant advances in our understanding of the pathogenesis of systemic lupus erythematosus (SLE), there are only a few drugs approved by the regulatory agencies across the world for the treatment of these patients; in fact, many of the compounds subjected to clinical trials have failed in achieving their primary endpoints. Current therapeutic options include antimalarials which should be used in all SLE patients unless they are strongly contraindicated, glucocorticoids which should be used at the lowest possible dose and for the shortest possible time, and immunosuppressive drugs which should be used judiciously, mainly in patients with severe organ involvements or receiving high doses of steroids to control their disease. Despite improvement on the survival of SLE patients, damage accrual has not varied over the last few decades, reflecting a gap between these therapeutic options and the expectations of these patients and their treating physicians. Biologic compounds can be used in some refractory cases. However, their cost is of great concern for both the patients and the health system. Cost is of special importance in low-income countries, because low-income SLE patients tend to experience a more severe disease having an overall worse prognosis which is compounded by their limited access to the health system. Although a treatment to target based on defined molecular pathways for specific disease subsets is appealing, this is not yet a reality. This review addressed current therapeutic options for SLE patients and the state of the art of investigational drugs targeting pathogenic pathways identified in these patients.
Aging Health, 2013
and higher doses of glucocoticoids (GCs) [36], whereas the use of antimalarials seems be a protec... more and higher doses of glucocoticoids (GCs) [36], whereas the use of antimalarials seems be a protective factor [28,[37][38][39]. It should be noted, however, that when socioeconomic factors are taken into account, the race/ethnicity variable is no longer a significant contributing factor to early mortality [18,31]. Known risk factors for increased damage are age at diagnosis [21,[40][41][42][43], non-Caucasian race/ethnicity [43][44][45][46], poverty [45,46], lower educational level [47], disease duration [40,42,45,48], higher levels of disease activity [20,21,40,41,43,44,49], previous damage [41,45,50], higher doses of GC [36,41] and the use of immunosuppressive drugs [21 45,48]. Again, the use of antimalarials exerts a protective role on damage accrual [51].
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Papers by Manuel Ugarte-Gil