Publications by authors named "Guillermo Pons Estel"

Objective: To examine the predictors of the occurrence of severe thrombocytopenia and its impact on damage accrual and mortality in SLE patients.

Methods: Factors associated with time to severe thrombocytopenia (platelet count ≤20,000/mm) occurring from the onset of SLE symptoms were assessed by Cox proportional hazards regressions. The association of severe thrombocytopenia with mortality was evaluated by logistic regression analyses while its impact on damage was by negative binomial regression.

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Background: SARS-CoV-2 infection has become a major international issue, not only from a medical point of view, but also social, economic and political. Most of the available information comes from the United States, Europe, and China, where the population and the socioeconomic status are very different from Latin American countries. This study evaluates the effect of regional socioeconomic characteristics on mortality due SARS-CoV-2 infection in patients with immune-mediated rheumatic diseases (IMRD) from Argentina, Mexico and Brazil.

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Objectives: To identify the predictive factors of first hospitalization and associated variables to the main causes of hospitalizations in lupus patients from a Latin American cohort.

Methods: The first hospitalization after entry into the cohort during these patients' follow-up due to either lupus disease activity and/or infection was examined. Clinical and therapeutic variables were those occurring prior to the first hospitalization.

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Article Synopsis
  • - The study aimed to update the 1998 Systemic Lupus Erythematosus (SLE) Core Outcome Set by evaluating existing domains and generating new ones, involving both patients and collaborators in the process.
  • - A survey collected responses from 100 patients and 145 collaborators, revealing that patients focused on life-impact domains while collaborators emphasized clinical aspects, highlighting a need for balanced input from both groups.
  • - Findings showed agreement on some domains for inclusion in the updated SLE Core Outcome Set, while also identifying areas that need more explanation and suggesting new domains for consideration.
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Objective: Primary antiphospholipid syndrome (PAPS) is a rare autoimmune disease characterized by the presence of antiphospholipid antibodies and the occurrence of thrombotic events and pregnancy complications. Our study aimed to identify novel genetic susceptibility loci associated with PAPS.

Methods: We performed a genome-wide association study comprising 5,485 individuals (482 affected individuals) of European ancestry.

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Article Synopsis
  • Systemic lupus erythematosus (SLE) significantly increases the risk of cardiovascular disease, prompting a study to evaluate traditional cardiovascular risk factors in SLE patients worldwide between 2015 and 2020.
  • The study included 3,401 SLE patients from 24 countries, predominantly women, revealing high rates of hypertension (35.6%), obesity (23.7%), and hyperlipidaemia (19.8%), with poor control of these risk factors across the board.
  • Notably, patients with antiphospholipid syndrome had higher prevalence of cardiovascular risks but showed better control of blood pressure and lipid levels compared to those without, highlighting international discrepancies in risk factor management.
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Objectives: Primary antiphospholipid syndrome (PAPS) is a rare autoimmune disease characterized by the presence of antiphospholipid antibodies and the occurrence of thrombotic events and pregnancy complications. Our study aimed to identify novel genetic susceptibility loci associated with PAPS.

Methods: We performed a genome-wide association study comprising 5,485 individuals (482 affected individuals) of European ancestry.

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Background: Clinical experience has shown that a single measure is not sufficient to assess disease activity in rheumatoid arthritis (RA). Various clinimetric tools are necessary to address the many clinical situations that can arise.

Methods: In order to develop a comprehensive measurement tool, the Pan American League of Associations for Rheumatology searched for the most frequent measures of disease activity applied in RA by means of a semi-systematic review of the available literature.

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Article Synopsis
  • - The study investigates the characteristics and effects of the time taken to diagnose systemic lupus erythematosus (SLE) in a Latin American cohort, noting that diagnosis can often be delayed and that SLE may resemble other diseases.
  • - Patients with longer diagnosis times (over 6 months) were often older, female, of Mestizo descent, uninsured, and displayed atypical symptoms, but this delayed diagnosis did not seem to affect their disease progression or mortality rates significantly.
  • - Overall, the research concludes that within this cohort, waiting up to 24 months for an SLE diagnosis, with a median of 6 months, did not lead to worse health outcomes.
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Objectives: To evaluate the trajectory of students enrolled in the specialty training in rheumatology.

Methods: Retrospective analysis (2009-2016). Promotion, repetition, and dropout rates were determined.

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Background: The Outcome Measures in Rheumatology (OMERACT) Systemic Lupus Erythematosus (SLE) Working Group held a Special Interest Group (SIG) at the OMERACT 2023 conference in Colorado Springs where SLE collaborators reviewed domain sub-themes generated through qualitative research and literature review.

Objective: The objective of the SIG and the subsequent meetings of the SLE Working Group was to begin the winnowing and binning of candidate domain sub-themes into a preliminary list of candidate domains that will proceed to the consensus Delphi exercise for the SLE COS.

Methods: Four breakout groups at the SLE SIG in Colorado Springs winnowed and binned 132 domain sub-themes into candidate domains, which was continued with a series of virtual meetings by an advisory group of SLE patient research partners (PRPs), members of the OMERACT SLE Working Group Steering Committee, and other collaborators.

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Background: Long-term anticoagulant therapy is generally recommended for thrombotic antiphospholipid syndrome (TAPS) patients, however it may be withdrawn or not introduced in routine practice.

Objectives: To prospectively evaluate the risk of thrombosis recurrence and major bleeding in non-anticoagulated TAPS patients, compared to anticoagulated TAPS, and secondly, to identify different features between those two groups.

Patients/methods: Using an international registry, we identified non-anticoagulated TAPS patients at baseline, and matched them with anticoagulated TAPS patients based on gender, age, type of previous thrombosis, and associated autoimmune disease.

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Objective: To evaluate the association between patients' characteristics and disease activity in an Argentine lupus registry.

Methods: Cross-sectional study. Disease activity was stratified into: Remission off-treatment: SLEDAI = 0, without prednisone and immunosuppressive drugs.

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Objective: To describe characteristics of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in patients with rheumatic immune-mediated inflammatory diseases (IMIDs) from Argentina, Mexico and Brazil, and to assess factors associated with mortality in this population.

Methods: Data from 3 national registries, SAR-COVID (Argentina), CMR-COVID (Mexico), and ReumaCoV-Brasil (Brazil), were combined. Adult patients with IMIDs and SARS-CoV-2 infection were recruited.

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Objective: Approximately one third of individuals worldwide have not received a COVID-19 vaccine. Although studies have investigated risk factors linked to severe COVID-19 among unvaccinated people with rheumatic diseases (RDs), we know less about whether these factors changed as the pandemic progressed. We aimed to identify risk factors associated with severe COVID-19 in unvaccinated individuals in different pandemic epochs corresponding to major variants of concern.

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Objective: To develop new antiphospholipid syndrome (APS) classification criteria with high specificity for use in observational studies and trials, jointly supported by the American College of Rheumatology (ACR) and EULAR.

Methods: This international multidisciplinary initiative included four phases: (1) Phase I, criteria generation by surveys and literature review; (2) Phase II, criteria reduction by modified Delphi and nominal group technique exercises; (3) Phase III, criteria definition, further reduction with the guidance of real-world patient scenarios, and weighting via consensus-based multicriteria decision analysis, and threshold identification; and (4) Phase IV, validation using independent adjudicators' consensus as the gold standard.

Results: The 2023 ACR/EULAR APS classification criteria include an entry criterion of at least one positive antiphospholipid antibody (aPL) test within 3 years of identification of an aPL-associated clinical criterion, followed by additive weighted criteria (score range 1-7 points each) clustered into six clinical domains (macrovascular venous thromboembolism, macrovascular arterial thrombosis, microvascular, obstetric, cardiac valve, and hematologic) and two laboratory domains (lupus anticoagulant functional coagulation assays, and solid-phase enzyme-linked immunosorbent assays for IgG/IgM anticardiolipin and/or IgG/IgM anti-β-glycoprotein I antibodies).

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Article Synopsis
  • - The study aimed to create new and more specific classification criteria for antiphospholipid syndrome (APS) in collaboration with the American College of Rheumatology (ACR) and EULAR, using a detailed four-phase methodology.
  • - The new criteria require at least one positive antiphospholipid antibody test and assign points across six clinical and two laboratory domains, classifying patients with a minimum of 3 points in both areas as having APS.
  • - Compared to the older Sapporo criteria, the 2023 ACR/EULAR criteria showed a significant increase in specificity (99% vs. 86%) but slightly lower sensitivity (84% vs. 99%), demonstrating a more refined approach to diagnosing APS.
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Objective: The objective of this study was to assess the SARS-CoV-2-specific humoral and T cell response after a two-dose regimen of SARS-CoV-2 vaccine in patients with rheumatoid arthritis (RA).

Methods: In this observational study, patients with RA who are ≥18 years of age and vaccinated for SARS-CoV-2 according to the Argentine National Health Ministry's vaccination strategy were included. Anti-SARS-CoV-2 immunoglobulin G (IgG) antibodies (ELISA-COVIDAR test), neutralizing activity (cytotoxicity in VERO cells), and specific T cell response (IFN-γ ELISpot Assay) were assessed after the first and second dose.

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Strategies to prevent thrombosis in antiphospholipid antibody (aPL)-positive patients are of the utmost importance. The risk of thrombosis in patients with aPLs varies, depending on additional venous thrombosis and cardiovascular risk factors, as well as associated comorbidities. Recurrent thrombosis despite treatment with vitamin K antagonists is relatively common in daily practice.

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Systemic lupus erythematosus (SLE) is a disease of high unmet therapeutic need. The challenge of accurately measuring clinically meaningful responses to treatment has hindered progress towards positive outcomes in SLE trials, impeding the approval of potential new therapies. Current primary end points used in SLE trials are based on legacy disease activity measures that were neither specifically designed for the clinical trial context, nor developed according to contemporary recommendations for clinical outcome assessments (COAs), such as that substantial patient input should be incorporated into their design.

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