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Title: Clinical and immunogenetic factors associated with pneumonia in patients with systemic lupus erythematosus: A case-control study
Authors: Rúa-Figueroa, Iñigo
Nóvoa, Javier
García-Laorden, María Isabel
Erausquin, Celia
García-Bello, Miguel
De Castro, Felipe Rodríguez 
Herrera-Ramos, Estefanía
Ojeda, Soledad
Quevedo, Juan Carlos
Francisco, Félix
Naranjo, Antonio 
Rodríguez-Lozano, Carlos
Rodríguez-Gallego, Carlos 
UNESCO Clasification: 32 Ciencias médicas
320508 Enfermedades pulmonares
Keywords: Lupus
Issue Date: 2014
Journal: Journal of Rheumatology 
Abstract: Objective. To determine the incidence of pneumonia and associated factors in a single-center systemic lupus erythematosus (SLE) cohort. Methods. We included all our SLE patients [1997 American College of Rheumatology (ACR) criteria] with ≥ 1 pneumonia event, and 196 age and sex-matched SLE controls with no pneumonia events. Cumulative clinical data, weighted Systemic Lupus International Collaborating Clinics/ACR damage index (wSLICC/ACR-DI), comorbidities, and risk factors for pneumonia were retrospectively collected. The standardized incidence ratio (SIR) of pneumonia was estimated. Polymorphisms at genes coding for mannose binding lectin (MBL), MBL-associated serine protease 2, Fc-gamma receptors, and surfactant proteins A1, A2, and D were determined, and their potential association with pneumonia was analyzed. Patients with and without pneumonia were compared using a multivariate logistic regression model for adjustment of pneumonia-associated factors. Results. Thirty-six of 232 patients with SLE had experienced ≥ 1 pneumonia event. SIR for pneumonia was 5.1 (95% CI 3.5–7.4; p < 0.0001). Excluding patients receiving immunosuppressive therapy at the time of pneumonia (13%), associations were found for Katz Severity Index (KSI) (p = 0.016), wSLICC/ACR-DI (p = 0.044), number of SLE criteria (p = 0.005), hospital admissions (p < 0.001), FCGR2A HH genotype (p = 0.03), previous use of immunosuppressive therapy (p = 0.049), cutaneous ulcers (p < 0.001), and vasculitis (p = 0.008) in bivariate analyses. In the multivariate analysis adjusted to previous immunosuppressive treatment, only KSI and FCGR2A HH genotype remained statistically significant (p = 0.05 and p = 0.03, respectively). Conclusion. The incidence of pneumonia in patients with SLE is higher than that in the general population, and particularly high in severe SLE, regardless of immunosuppressive therapy. The HH genetic variant of FCGR2A appears to predispose patients with SLE to pneumonia.
ISSN: 0315-162X
DOI: 10.3899/jrheum.131470
Source: Journal of Rheumatology [ISSN 0315-162X],v. 41, p. 1801-1807
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