Manuel Francisco Ugarte-Gil

Universidad Científica del Sur · Department of Medicine

In patients with systemic lupus erythematosus (SLE), remission and low disease activity (LDA) have been shown to be protective of damage accrual, mortality, and flares; they have also been shown to be associated with a better health-related quality of life. ¹ However, the large majority of published studies include patients with long-standing disea...

Background Systemic lupus erythematosus (SLE) is an autoimmune disease with a broad range of clinical manifestations and a high unmet need across patient populations. Real-world data on SLE are scattered across >50 registries worldwide with variable data collection. The Lupus Federated Data Network (LupusNet) is an interdisciplinary international i...

Background Lupus nephritis (LN) is one of the most common, serious manifestations of systemic lupus erythematosus (SLE) and is associated with significant morbidity and mortality. Data on treatment response among Latin American patients with LN remain limited. Objectives To describe the rate of treatment response at 12 months in a cohort of SLE pa...

Background Frailty, measured with the SLICC-FI, has been reported as a predictor of damage in several cohorts. Objectives To evaluate the SLICC-FI as a predictor of hospitalization in systemic lupus erythematosus (SLE) patients. Methods Patients from a single-center prevalent cohort were included. The SLICC-FI was measured at baseline. Hospitaliz...

Objectives This study aims to determine the independent impact of definitions of remission/low disease activity (LDA) on direct/indirect costs (DCs, ICs) in a multicentre inception cohort. Methods Patients from 31 centres in 10 countries were enrolled within 15 months of diagnosis and assessed annually. Five mutually exclusive disease activity sta...

Background Systemic Lupus Erythematosus (SLE) patients experience frequent hospitalizations; lupus flares and infections have been shown to be the two most common causes. Objectives The aim of this study is to describe the main causes and predictors of first hospitalizations due to disease activity and infections in SLE patients. Methods SLE pati...

Background Obstetric morbidity (OM) is higher in SLE women than in healthy ones. Few data on SLE pregnancy outcomes in Latin America (LA) have been reported. Objectives To study SLE pregnancy outcomes in LA. Methods GLADEL 2.0 is an observational prevalent/incident cohort started in 2019. To date, 43 centers from 10 LA countries have enrolled 103...

Objective This international task force aimed to provide healthcare professionals and persons living with systemic lupus erythematosus (SLE) with consensus-based recommendations for physical activity and exercise in SLE. Methods Based on evidence from a systematic literature review and expert opinion, 3 overarching principles and 15 recommendation...

Objective Poor medical adherence has been reported to be associated with several negative outcomes in systemic lupus erythematosus (SLE) patients, such as increased disease activity and damage accrual. However, the predictive factors of medical adherence have been only scarcely been evaluated overall, and particularly in Latin American populations....

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 Rheumatol...

Background/Objective The 2019 American College of Rheumatology/European League Against Rheumatism Classification Criteria (2019 AECC) for IgG4-related disease (IgG4-RD) is considered a significant advancement in the study of this condition. Most studies evaluating their performance have focused on White and Asian patients, leaving a knowledge gap...

Objective Cognitive dysfunction is a prevalent manifestation of systemic lupus erythematosus (SLE). There is evidence for the role of antiphospholipid (aPL) antibodies on its etiopathogenesis. Our objective was to identify the association between aPL antibodies and cognitive dysfunction in SLE patients. Methods This cross-sectional study included...

Background Fatigue is reported as the most prevalent symptom by patients with systemic lupus erythematosus (SLE). Fatigue management is complex due to its multifactorial nature. The aim of the study was to assess the usefulness of an innovative digital tool to manage fatigue in SLE, in a completely automated manner. Methods The «Lupus Expert Syste...

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...

Innate immune responses through the production of type I interferon-α (anti-IFN-α) play an essential role in the defense against viruses. The autoantibodies (auto-Abs) anti-IFN-α are implicated in COVID-19 pathogenesis with higher levels among patients with worse prognoses. The study aimed to assess the levels of anti-IFN-α auto-Abs in Peruvian pat...

Objectives: To assess the prevalence, characteristics and knowledge about photosensitivity and the use of photoprotective measures in an international cohort of cutaneous and systemic lupus erythematosus patients. Methods: We conducted an international, cross-sectional study based on a 46-question web-based survey including patients with medical...

Objective To develop the first evidence-based Pan American League of Associations for Rheumatology (PANLAR) guidelines for the treatment of Takayasu arteritis (TAK). Methods A panel of vasculitis experts developed a series of clinically meaningful questions addressing the treatment of TAK patients in the PICO (population/intervention/comparator/ou...

Background Systemic lupus erythematosus (SLE) is an important cause of secondary warm-antibody autoimmune hemolytic anemia (AIHA). The prevalence of AIHA has been estimated to range from 5% to 30%, but severe AIHA is comparatively less frequent in SLE patients. The severity of AIHA has rarely been studied in SLE patients;1–3 we thus have examined t...

Background Self-efficacy for managing chronic conditions assesses the confidence an individual has on her/his ability of successfully performing specific tasks related to a chronic condition in several different situations. It is considered a modifiable behavior in educational interventions in SLE patients. The aim of this study was to evaluate the...

Background Systemic Lupus Erythematosus (SLE) patients experience frequent hospitalizations; lupus flares and infections have been shown to be the two most common causes. The aim of this study is to describe the main causes and predictors of first hospitalizations due to disease activity and infections in SLE patients. Methods SLE patients from GL...

Background Systemic lupus erythematosus (SLE) is heterogeneous autoimmune disease. Identification of patient clusters may be useful for the management of the disease. The aim of this study is to describe different SLE clusters according to sociodemographic, clinical and serological characteristics. Methods GLADEL 2.0 is an ongoing Latin-American o...

Background Obstetric morbidity (OM) is higher in Systemic Lupus Erythematosus (SLE) women than in healthy ones. Few data on SLE pregnancy outcomes in Latin America (LA) have been reported. The aim of this study was to assess SLE pregnancy outcomes in LA. Methods GLADEL 2.0 is an observational prevalent/incident cohort started in 2019.¹ To date, 43...

Although the public health emergency associated with the COVID‐19 pandemic has ended, challenges remain, especially for individuals with rheumatic diseases. We aimed to assess the historical and ongoing effects of COVID‐19 on individuals with rheumatic diseases and rheumatology practices globally, with specific attention to vulnerable communities a...

Considerable variability exists in the way health-care providers treat patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis in Latin America. The most frequently used treatments for ANCA-associated vasculitis are cyclophosphamide and prolonged glucocorticoid tapers; however, randomised controlled trials conducted over the...

Background Fatigue is reported as the most prevalent and bothersome symptom by Systemic Lupus Erythematosus (SLE) patients as it may impair key aspects of the quality of life. Assessing and treating fatigue is therefore an important aspect of SLE care. However, fatigue management is complex due to its multifactorial nature, as well as the need for...

Background Systemic Lupus Erythematosus (SLE) patients experience frequent hospitalizations; lupus flares and infections have been shown to be the two most common causes. Objectives The aim of this study is to describe the main causes and predictors of first hospitalizations due to disease activity and infections in SLE patients. Methods SLE pati...

Background Health-related quality of life (HRQoL) is impaired in systemic lupus erythematosus (SLE) patients, but its association with physicians reported disease activity is modest to none. Objectives To determine the impact of patients reported disease activity on their HRQoL. Methods We evaluated patient-reported disease activity on SLE patien...

Background Systemic lupus erythematosus (SLE) is heterogeneous autoimmune disease. Identification of patient clusters may be useful for the management of the disease. Objectives To describe different SLE clusters according to sociodemographic, clinical and serological variables. Methods GLADEL 2.0 is an ongoing Latin-American observational cohort...

Background Obstetric morbidity (OM) is higher in SLE women than in healthy ones. Few data on SLE pregnancy outcomes in Latin America (LA) have been reported. Objectives To study SLE pregnancy outcomes in LA. Methods GLADEL 2.0 is an observational prevalent/incident cohort started in 2019. To date, 43 centers from 10 LA countries have enrolled 103...

Despite how difficult the early diagnosis of systemic lupus erythematosus (SLE) is, which is mainly due to the heterogeneity and non-specificity of its clinical manifestations, SLE is currently being diagnosed more frequently than in past decades. In fact, there has been an increase in the incidence and prevalence of SLE over the last four decades;...

SLE increases disease burden in those affected with it, and that is particularly the case in low- and middle-income countries. The 2019 Addressing Lupus Pillar of Health Advancement project is a multiphase initiative whose objective is to recognize, hierarchize and establish approaches for diligent SLE research, care and access to healthcare. Lack...

Objective: To determine the predictors of the occurrence of severe autoimmune hemolytic anemia (AIHA) and its impact on damage accrual and mortality in SLE patients. Methods: Factors associated with time to severe AIHA (hemoglobin level ≤7 g/dL) occurring from the onset of SLE symptoms were examined by Cox proportional hazards regressions. The a...

Objective To determine the possible predictive value of self-efficacy on health-related quality of life (HRQoL) in patients with SLE. Methods Patients with SLE from the Almenara Lupus Cohort were included. Self-efficacy was ascertained with the six domains from the Patient-Reported Outcomes Measurement Information System (PROMIS) self-efficacy for...

Objective COVID-19 vaccines have a favorable safety profile in patients with autoimmune rheumatic diseases (AIRDs) such as idiopathic inflammatory myopathies (IIMs), however hesitancy continues to persist among these patients. Therefore, we studied the prevalence, predictors, and reasons for hesitancy in patients with IIMs, other AIRDs, non-rheumat...

Objective The long‐term impact of childhood‐onset systemic lupus erythematosus (SLE) on health‐related quality of life (HRQoL) in adult SLE patients in comparison to those with adult‐onset SLE is unknown. We aim to examine and compare HRQoL trajectories in adults with adolescent‐ and adult‐onset SLE. Methods Patients enrolled in the LUpus in MInor...

Systemic lupus erythematosus (SLE) affects more severely non-White populations, due to their genetic background and sociodemographic characteristics. Several studies have evaluated Latin American SLE patients to determine their genetic and clinical characteristics as well as prognostic factors; these studies have not only allowed the development of...

[This corrects the article DOI: 10.3389/fcimb.2022.1000291.].

Background/Purpose Remission and low disease activity (LDA) are associated with decreased flares, damage, and mortality. However, little is known about the impact of disease activity states (DAS) on health care costs. We determined the independent impact of different definitions of remission and LDA on direct and indirect costs (DC, IC) in a multic...

Objective To determine the association between race/ethnicity and COVID‐19 outcomes in individuals with systemic lupus erythematosus (SLE). Methods Individuals 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, a...

Dear Editor, Patients with idiopathic inflammatory myopathies (IIMs) represent a high-risk group for adverse pregnancy outcomes (APOs), and post COVID-19 vaccination disease flares have been speculated. However, data on vaccine-associated adverse events (ADEs) in the antenatal period and APOs in this vulnerable group are virtually non-existent, lim...

Objective To evaluate the association between the Systemic Lupus International Collaborating Clinics frailty index (SLICC‐FI) and damage accrual in systemic lupus erythematosus (SLE) patients. Methods Patients from the multiethnic, multicenter LUpus in MInorities, NAture versus nurture (LUMINA) cohort were included. Damage was ascertained with the...

El Lupus Eritematoso Sistémico (LES) es una enfermedad autoinmune inflamatoria crónica que tiene como uno de sus síntomas más frecuentes la fatiga. La etiología de ésta es multifactorial, existen factores relacionados a la propia enfermedad, estilos de vida, comorbilidades y tratamiento que están asociados. Asimismo, se cuenta con diversos factores...

Considerable variability exists in the way that health-care providers treat patients with giant cell arteritis in Latin America, with patients commonly exposed to excessive amounts of glucocorticoids. In addition, large health disparities prevail in this region due to socioeconomic factors, which influence access to care, including biological treat...

Objective To evaluate the Systemic Lupus International Collaborating Clinics Frailty Index (SLICC-FI) as a predictor of damage accrual in a primarily Mestizo SLE patient cohort. Methods Patients from a single-center prevalent cohort were included. Damage accrual was defined as the increase in the SLICC/American College of Rheumatology (ACR) damage...

Objective We investigated prolonged COVID-19 symptom duration, defined as lasting 28 days or longer, among people with systemic autoimmune rheumatic diseases (SARDs). Methods We analysed data from the COVID-19 Global Rheumatology Alliance Vaccine Survey (2 April 2021–15 October 2021) to identify people with SARDs reporting test-confirmed COVID-19....

Zonulin has previously been related to intestinal permeability in various inflammatory diseases, and more recently to the physiopathology of severe COVID-19 infections. We analysed serum samples from a previous study of a Peruvian cohort of hospitalised COVID-19 patients, for the quantification of zonulin by sandwich ELISA. Comparisons with clinica...

Systemic lupus erythematosus (SLE) is an autoimmune disorder with significant health disparities, as it disproportionately and more severely affects vulnerable and disadvantaged population groups in the United States and around the world, that is, women, ethnic minorities, individuals living in poverty, less educated, and lacking medical insurance....

Vaccine hesitancy is considered a major barrier to achieving herd immunity against COVID-19. While multiple alternative and synergistic approaches including heterologous vaccination, booster doses, and antiviral drugs have been developed, equitable vaccine uptake remains the foremost strategy to manage pandemic. Although none of the currently appro...

Objective To determine the independent impact of different definitions of remission and low disease activity (LDA) on damage accrual. Methods Patients with ≥2 annual assessments from a longitudinal multinational inception lupus cohort were studied. Five mutually exclusive disease activity states were defined: remission off-treatment: clinical Syst...

Objective: Some patients with rheumatic diseases might be at higher risk for coronavirus disease 2019 (COVID-19) acute respiratory distress syndrome (ARDS). We aimed to develop a prediction model for COVID-19 ARDS in this population and to create a simple risk score calculator for use in clinical settings. Methods: Data were derived from the COV...

Background Differences in the distribution of individual-level clinical risk factors across regions do not fully explain the observed global disparities in COVID-19 outcomes. We aimed to investigate the associations between environmental and societal factors and country-level variations in mortality attributed to COVID-19 among people with rheumati...

Background: Clinical remission is the goal in rheumatoid arthritis (RA) management; however, this can be difficult to achieve in several parts of the world. Our objective was to determine predictors of remission and remission/low disease activity (LDA) in RA. Methods: A longitudinal real-setting RA cohort was followed up (January 2016-2020). Pre...

Background Systemic lupus erythematosus (SLE) patients have a worse health-related quality of life (HRQoL) than the general population. This seems to be related to patients characteristics like age, poverty, behavioral issues rather than to disease activity or damage. Self-efficacy is defined as individual’s confidence on performing a task and coul...

Background Mental disorders constitute a serious and underestimated problem in Latin America and they could have worse features in comparison with Europe or North America ⁽¹⁾; that was the case even before the COVID-19 epidemic ensued in 2020. Objectives The objective of this study was to determine the factors associated with the occurrence of men...

The Physician Global Assessment International Standardisation COnsensus in Systemic Lupus Erythematosus (PISCOS) study aimed to obtain an evidence-based and expert-based consensus standardisation of the Physician Global Assessment (PGA) scoring of disease activity in systemic lupus erythematosus (SLE). An international panel of 79 SLE experts parti...

Objective To examine the frequency of, and risk factors for, disease flare following COVID-19 vaccination in patients with systemic rheumatic disease (SRD). Methods An international study was conducted from April 2 to August 16, 2021, using an online survey of 5619 adults with SRD for adverse events following COVID-19 vaccination, including flares...

Objective The relative risk of SARS–CoV‐2 infection and COVID‐19 disease severity among people with rheumatic and musculoskeletal diseases (RMDs) compared to those without RMDs is unclear. This study was undertaken to quantify the risk of SARS–CoV‐2 infection in those with RMDs and describe clinical outcomes of COVID‐19 in these patients. Methods...

Introducción. En pacientes con lupus eritematoso sistémico (LES) existe incremento de infecciones debido a la propia enfermedad, al uso de inmunosupresores y corticoides. Objetivo. Identificar los factores asociados a infecciones serias en pacientes lúpicos en un hospital de referencia nacional. Estudio retrospectivo, analítico, de casos y control...

Background Flares in patients with SLE, regardless of their severity, have been associated with damage accrual. However, their impact on health-related quality of life (HRQoL) has not been fully evaluated. In fact, disease activity is only minimally associated with HRQoL. Objective To determine the association between flares and HRQoL. Methods Pa...

Objective To evaluate the impact of the COVID-19 pandemic on rheumatology trainees’ clinical experiences, research opportunities, and well-being. Methods A voluntary, anonymous, web-based survey was administered in English, Spanish, or French from 19 August 2020 to 5 October 2020. Adult and paediatric rheumatology trainees were invited to particip...

Aim To determine characteristics associated with more severe outcomes in a global registry of people with systemic lupus erythematosus (SLE) and COVID-19. Methods 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 hospit...

Objective To determine if achieving lupus low disease activity state (LLDAS) or remission prevents damage accrual in a primarily Mestizo population. Methods Patients with SLE from a single-centre cohort with at least two visits occurring every 6 months were included. The definitions used were the following: for remission, the 2021 Definition Of Re...

Little is known about the epidemiology of systemic vasculitis in South American countries. The aim of this study is to compare the prevalence of systemic vasculitides in two vasculitis referral centers from Brazil and Peru. A cross-sectional study was performed and all patients above 18 years of age, with at least 6 months of follow-up and who met...

Introduction Serological markers such as anti-double stranded (ds)DNA antibodies and complement fractions C3/C4, are integral components of disease activity assessment in patients with systemic lupus erythematosus (SLE). However, it remains uncertain whether treatment should aim at restoration of serological abnormalities. Objectives To analyze an...

Objectives This study aims to determine whether the MetS predicts damage accrual in SLE patients. Methods This longitudinal study was conducted in a cohort of consecutive SLE patients seen since 2012 at one single Peruvian institution. Patients had a baseline visit and then follow-up visits every 6 months. Patients with ≥ 2 visits were included. E...

The objective of our study was to describe knowledge, attitudes and practices of Latin-American rheumatology patients regarding management and follow-up of their disease during COVID-19 pandemic. A cross-sectional observational study was conducted using a digital anonymous survey. Rheumatic patients ≥ 18 years from non-English-speaking PANLAR count...

Introducción: El presente artículo resume la guía de práctica clínica (GPC) para el tratamiento farmacológico inicial nefritis lúpica en el Seguro Social del Perú (EsSalud). Objetivo: Proveer recomendaciones clínicas basadas en evidencia para tratamiento farmacológico inicial de adultos con nefritis lúpica clase I a V no refractarios en EsSalud....

Objective To assess whether the care model (comprehensive vs regular) has any impact on the clinical outcomes of systemic lupus erythematosus patients. Methods Between August 2019 and January 2020, we evaluated SLE patients being cared for at two Peruvian hospitals to define the impact of care model on disease activity state and health-related qua...

Most of the existing literature, including epidemiological studies and clinical trials, on antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV) include North American (mainly United States and Canada), European, and Asian populations. Few studies have focused on multiethnic populations such as the one from Latin America. Racial...

BACKGROUND: Patients with primary systemic vasculitis or polymyalgia rheumatica might be at a high risk for poor COVID-19 outcomes due to the treatments used, the potential organ damage cause by primary systemic vasculitis, and the demographic factors associated with these conditions. We therefore aimed to investigate factors associated with COVID-...

Objective In systemic lupus erythematosus (SLE), disease activity and glucocorticoid (GC) exposure are known to contribute to irreversible organ damage. We aimed to examine the association between GC exposure and organ damage occurrence. Methods We conducted a literature search (PubMed (Medline), Embase and Cochrane January 1966–October 2021). We...

Systemic lupus erythematosus (SLE) is characterized by great clinical heterogeneity. The objectives of its management are to make a timely diagnosis and to initiate treatment as promptly as possible so organ damage can be avoided while at the same time exposure to potentially toxic drugs is minimized so that its overall course and outcome improve....

Objectives: This study aims to determine the factors associated with absenteeism, presenteeism, and overall work impairment in patients with systemic lupus erythematosus (SLE). Methods: A total of 133 consecutive working patients with SLE were assessed between October 2017 and December 2018, using a standardized data collection form. Sociodemograph...

Objective To evaluate the impact of telemedicine use during the coronavirus disease 2019 (COVID-19) pandemic on rheumatology trainees. Methods A voluntary, anonymous, web-based survey was administered in English, Spanish, or French from August 19 to October 5, 2020. Adult and pediatric rheumatology trainees were invited to participate via social m...

https://acrabstracts.org/abstract/sars-cov-2-infection-and-covid-19-outcomes-in-rheumatic-disease-a-systematic-literature-review/

Background Remission and LLDAS have been proposed as the treatment goal for SLE patients. Different investigators have reported that achieving these states prevent damage accrual; however, their independent impact on the occurrence of flares has been only scarcely evaluated. The aim of this study was to evaluate the independent impact of remission...

Background Patients with primary systemic vasculitis or polymyalgia rheumatica might be at a high risk for poor COVID-19 outcomes due to the treatments used, the potential organ damage cause by primary systemic vasculitis, and the demographic factors associated with these conditions. We therefore aimed to investigate factors associated with COVID-1...

Objective To achieve consensus on a definition of remission in SLE (DORIS). Background Remission is the stated goal for both patient and caregiver, but consensus on a definition of remission has been lacking. Previously, an international task force consisting of patient representatives and medical specialists published a framework for such a defin...

Background We describe the early experiences of adults with systemic rheumatic disease who received the COVID-19 vaccine. Methods From 2 April to 30 April 2021, we conducted an online, international survey of adults with systemic rheumatic disease who received COVID-19 vaccination. We collected patient-reported data on clinician communication, bel...

Objective To evaluate the performance of the 2019 European Alliance of Associations for Rheumatology (EULAR)/American College of Rheumatology (ACR) criteria for systemic lupus erythematosus (SLE) in terms of earlier SLE classification in comparison to the ACR or the Systemic Lupus International Collaborating Clinics (SLICC) criteria. Methods Patie...

Cytokines, chemokines and growth factors present different expression profiles related to the prognosis of COVID-19. We analyzed clinical parameters and assessed the expression of these biomarkers in patients with different disease severity in a hospitalized Peruvian cohort to determine those associated with worse prognosis. We measured anti-spike...

Background We describe the early experiences of adults with systemic rheumatic disease who received the COVID-19 vaccine. Methods From 2 April to 30 April 2021, we conducted an online, international survey of adults with systemic rheumatic disease who received COVID-19 vaccination. We collected patient-reported data on clinician communication, bel...

Background Remission and low disease activity (LDA) have been proposed as the treatment goals for patients with systemic lupus erythematosus (SLE). Several definitions for each have been proposed in the literature. Objective To assess the impact of remission/LDA according to various definitions on relevant outcomes in patients with SLE. Methods T...

Background/objective: Demand for rheumatology care has steadily increased in recent years. The number of specialists in this field, however, seems insufficient. No recent studies have diagnosed the attributes of rheumatology training in Latin America. Methods: This is a descriptive cross-sectional study. We obtained data on each country through...