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During the past two years we have witness a tremendous worldwide health crisis imposed by the coronavirus disease (COVID-19). This situation led to the urgent development and implementation of vaccines in an attempt to decrease not only the SARS-CoV-2 transmissibility but also the severe forms of COVID-19. Although these vaccines were approved based on an adequate benefit-risk ratio, at the moment of their implementation in 2021 we did not have sub-studies in special populations; patients with systemic lupus erythematosus (SLE) among them. We describe two cases of lupus nephritis flare following the immunization against SARS-CoV-2 with the first component of Sputnik V and Sinopharm. Both patients were in complete remission on maintenance therapy with mycophenolate and without glucocorticoids. The flare presented with an increased protein/creatinine ratio in urine and positive anti-DNA antibodies without other relevant accompanying findings. After treatment with prednisone (20 y 10 mg/day in case 1 and 2, respectively) and an increased dose of mycophenolate (from 1.5 g/day to 2.0 g/dayand 1.08 to 1.44 g/día of sodic mycophenolate in case 1 y 2, respectively) both patients regained renal remission. These cases are of relevance as they introduce a possible association between the different anti-SARS-CoV-2 vaccine platforms and SLE flares; at the same time to suggest the need for close control in the post vaccination period in this population of patients.

The objectives of this study were to compare the frequency of dyslipidemia (DLP) and the elevated cardiovascular risk between rheumatoid arthritis (RA) patients and a control group, to identify disease-related factors associated with the presence of DLP and to estimate the frequency of RA patients receiving treatment for DLP. This is a cross sectional study that included 409 RA patients and 624 controls. Cardiovascular (CV) risk was determined using the Framingham score, National Cholesterol Education Program (NCEP) and the Systematic Coronary Risk Evaluation (SCORE) adapted versions according to the European League Against Rheumatism (EULAR) guidelines. DLP was defined according to the Adult Treatment Panel III (ATPIII). The frequency of CV risk was similar in RA patients and controls, except when NCEP-EULAR adapted version for RA was applied (7% vs. 2%; p = 0.00002). A 43% of patients and 47% of controls had DLP (p = 0.15). RA patients with DLP tended to have extra-articular manifestations more frequently (36% vs. 24%; p = 0.01) and higher erythrocyte sedimentation rate (ESR) (21 [13-35] vs. 18 [10-30] mm; p = 0.003). RA patients treated for DLP varied between 11% and 32% according to the definition used. Patients with RA showed an elevated CV risk only when the NCEP-EULAR definition was used. Among RA patients, those with higher ESR and the presence of extra-articular manifestations were more likely to show DLP. The vast majority of patients were not receiving treatment for DLP.

The objective of this study was to obtain post-marketing information about the use of infliximab in an ambulatory setting. We studied--retrospectively and prospectively--the case records of patients with rheumatoid arthritis (n=37), psoriatic arthritis (n=5), mixed connective tissue disease (n=1), and ankylosing spondylitis (n=2) who received infliximab (3 mg/kg) from August 2000 to January 2003. Descriptive values were given as percentage, mean or median, and standard deviation or interquartile range. Wilcoxon test was used for paired analysis of pre/post doses of corticosteroids, non-steroidal anti-inflammatory drugs, and methotrexate therapy. A p value < or = 0.05 was considered significant. Forty-five patients were included. A total of 207 infusions were administered. In 4 patients the treatment was permanently discontinued due to severe back pain during the infusion (2 cases) and serious anaphylactic reactions (2 cases). Other adverse reactions occurring during infusions were mild and successfully managed with standard treatment. A case of staphylococcal septic arthritis resolved with standard antibiotic treatment. No patient had evidence of active tuberculosis. One patient with rheumatoid arthritis and chronic renal insufficiency, received treatment with infliximab 1.9 mg/kg, every 30 days, with no changes in renal function. Due to improvement of symptoms, 14/39 (35.9%) patients could decrease the doses of corticosteroids, 15/43 (34.8%) decreased the doses of antiinflammatory drugs and 12/34 (35.3%) decreased methotrexate dosage. Although some questions remain to be elucidated, this case series shows the drug safety profile, the possibility to reduce concomitant drug doses, as well as individual approaches for situations where there are not yet guidelines available, so that rheumatologists have to make decisions based on clinical needs.

The objective was to analyze the prevalence of mucocutaneous lesions in patients with systemic lupus erythematosus (SLE). During a 3-year period, we analyzed 77 patients with a diagnosis of SLE. The mucocutaneous lesions were classified into specific and non-specific. We defined skin type, sunlight exposure and photoprotection and correlated these lesions with serology and disease activity. Acute specific lesions were found in 67.5% of the patients, subacute lupus in 6.5% and chronic lesions in 26.0%. The most prevalent non-specific lesions were alopecia (59.7%), photosensitivity (57.1%), Raynaud's syndrome (46.7%), oral ulcerations (15.6%) and livedo reticularis (11.7%). Skin type 3 (35%) and exposure to mild ultraviolet radiation (74%) were seen in the majority of the patients. Appropriate sunlight protection was only used by 47% of the patients. When dermatological lesions and serology were compared, we found a significant association between malar rash, photosensitivity, livedo reticularis and alopecia with the presence of anti-Ro and Raynaud's phenomenon in patients with positive anti-Sm. The presence of malar rash, photosensitivity, Raynaud's phenomenon, diffuse alopecia and livedo reticularis was more frequent among patients with active disease. The prevalence of mucocutaneous manifestation in our population was slightly higher than data reported in other series. The presence of malar rash, diffuse alopecia, photosensitivity and livedo reticularis significantly related with the presence of anti-Ro and Raynaud's phenomenon with anti-Sm. All these lesions were more frequently seen in patients with active disease.

Cases of arthritis caused by Streptococcus agalactiae are infrequent and in our knowledge there are no case reports of tenosynovitis caused by S. agalactiae. A 46-year-old woman presented with fever, polyarthralgia, myalgia, diarrhea and vomiting. She had a history of papillary thyroid carcinoma and functional hyposplenia. She was febrile, with arthritis in hands, wrists, elbows, right shoulder and left ankle joints, and presented tenosynovitis in both feet and left hand. Blood and right olecranon bursa sample cultures were positive for S. agalactiae. An ultrasound scan made at the musculus tibialis anterior of left foot revealed signs of tenosynovitis. She was treated with intravenous cefazolin for 20 days and oral cefuroxime for 12 days. The joint involvement completely subsided in 60 days. Streptococcus agalactiae can cause, infrequently, a polyarthritis and tenosynovitis syndrome similar to disseminated gonococcal infection.