ORCID Profile
0000-0001-5190-9175
Does something not look right? The information on this page has been harvested from data sources that may not be up to date. We continue to work with information providers to improve coverage and quality. To report an issue, use the Feedback Form.
Publisher: BMJ
Date: 16-02-2022
DOI: 10.1136/ANNRHEUMDIS-2021-221636
Abstract: To determine characteristics associated with more severe outcomes in a global registry of people with systemic lupus erythematosus (SLE) and COVID-19. People with SLE and COVID-19 reported in the COVID-19 Global Rheumatology Alliance registry from March 2020 to June 2021 were included. The ordinal outcome was defined as: (1) not hospitalised, (2) hospitalised with no oxygenation, (3) hospitalised with any ventilation or oxygenation and (4) death. A multivariable ordinal logistic regression model was constructed to assess the relationship between COVID-19 severity and demographic characteristics, comorbidities, medications and disease activity. A total of 1606 people with SLE were included. In the multivariable model, older age (OR 1.03, 95% CI 1.02 to 1.04), male sex (1.50, 1.01 to 2.23), prednisone dose (1–5 mg/day 1.86, 1.20 to 2.66, 6–9 mg/day 2.47, 1.24 to 4.86 and ≥10 mg/day 1.95, 1.27 to 2.99), no current treatment (1.80, 1.17 to 2.75), comorbidities (eg, kidney disease 3.51, 2.42 to 5.09, cardiovascular disease/hypertension 1.69, 1.25 to 2.29) and moderate or high SLE disease activity (vs remission 1.61, 1.02 to 2.54 and 3.94, 2.11 to 7.34, respectively) were associated with more severe outcomes. In age-adjusted and sex-adjusted models, mycophenolate, rituximab and cyclophosphamide were associated with worse outcomes compared with hydroxychloroquine outcomes were more favourable with methotrexate and belimumab. More severe COVID-19 outcomes in in iduals with SLE are largely driven by demographic factors, comorbidities and untreated or active SLE. Patients using glucocorticoids also experienced more severe outcomes.
Publisher: Wiley
Date: 20-12-2021
DOI: 10.1002/ACR.24849
Abstract: The Systemic Lupus International Collaborating Clinics, American College of Rheumatology and Lupus Foundation of America are developing a revised SLE Damage Index (SDI). Shifts in the concept of damage in SLE have occurred with new insights into disease manifestations, diagnostics, and therapy. We evaluated contemporary constructs in SLE damage to inform development of the revised SDI. We conducted a 3-part qualitative study of international SLE experts. Facilitated small groups evaluated the construct underlying the concept of damage in SLE. A consensus meeting using nominal group technique was conducted to achieve agreement on aspects of the conceptual framework and scope of the revised damage index. The framework was finally reviewed and agreed upon by the entire group. Fifty participants from 13 countries were included. Eight thematic clusters underlying the construct of SLE damage were purpose, items, weighting, reversibility, impact, timeframe, attribution, and perspective. The revised SDI will be a discriminative index to measure morbidity in SLE, independent of activity or impact on the patient, and should be related to mortality. The SDI is primarily intended for research purposes and should take a life course approach. Damage can occur before a diagnosis of SLE but should be attributable to SLE. Damage to an organ is irreversible but the functional consequences on that organ may improve over time through physiological adaptation or treatment. We identified shifts in the paradigm of SLE damage and developed a unifying conceptual framework. These data form the groundwork for the next phases of SDI development.
Publisher: Wiley
Date: 02-12-2022
DOI: 10.1002/ACR.25039
Abstract: To determine the association between race/ethnicity and COVID-19 outcomes in in iduals with systemic lupus erythematosus (SLE). In iduals with SLE from the US with data entered into the COVID-19 Global Rheumatology Alliance registry between March 24, 2020 and August 27, 2021 were included. Variables included age, sex, race, and ethnicity (White, Black, Hispanic, other), comorbidities, disease activity, pandemic time period, glucocorticoid dose, antimalarials, and immunosuppressive drug use. The ordinal outcome categories were: not hospitalized, hospitalized with no oxygenation, hospitalized with any ventilation or oxygenation, and death. We constructed ordinal logistic regression models evaluating the relationship between race/ethnicity and COVID-19 severity, adjusting for possible confounders. We included 523 patients 473 (90.4%) were female and the mean ± SD age was 46.6 ± 14.0 years. A total of 358 patients (74.6%) were not hospitalized 40 patients (8.3%) were hospitalized without oxygen, 64 patients (13.3%) were hospitalized with any oxygenation, and 18 (3.8%) died. In a multivariable model, Black (odds ratio [OR] 2.73 [95% confidence interval (95% CI) 1.36-5.53]) and Hispanic (OR 2.76 [95% CI 1.34-5.69]) in iduals had higher odds of more severe outcomes than White in iduals. Black and Hispanic in iduals with SLE experienced more severe COVID-19 outcomes, which is consistent with findings in the US general population. These results likely reflect socioeconomic and health disparities and suggest that more aggressive efforts are needed to prevent and treat infection in this population.
Publisher: Pan American League of Associations of Rheumatology (PANLAR)
Date: 15-09-2020
DOI: 10.46856/GRP.10.E003
Abstract: Objective: To compare the characteristics of patients with rheumatic diseases and COVID-19 reported from Latin American countries with those from the rest of the world. Methods: Patients from the COVID-19 Global Rheumatology Alliance Physician-Reported Registry were included. Details regarding demographics, rheumatic disease features, comorbidities, COVID-19 diagnosis and treatment, and outcomes were examined. Chi-squared and t-tests were used to compare associations between groups (Latin America vs. rest of the world). Multivariable logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) of hospitalization (yes/no) and ventilatory support (not hospitalized or supplementary oxygen only vs. non-invasive, invasive ventilation, or ECMO) Poisson models were used to estimate ORs and 95% CIs of mortality. Results: Seventy-four patients from Latin America and 583 patients from the rest of the world were included. The most frequent rheumatic diseases in both groups were rheumatoid arthritis (35% and 39%, respectively) and systemic lupus erythematosus (22% and 14% respectively). Mortality was similar between groups (12% Latin America vs 11% rest of the world, p=0.88. However, Latin American patients in the registry had a higher odds of requiring non-invasive or invasive ventilation, after adjustment [OR= 2.29, 95%CI (1.29, 4.07), p less than 0.01].. Conclusion: Latin American patients with rheumatic disease and COVID-19 reported to this global registry presented a higher need for ventilatory support, however experienced a similar mortality than patients from the rest of the world.
Location: United States of America
No related grants have been discovered for Graciela Alarcon.