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Unraveling the genetic collagen connection: clinical and therapeutic insights on genetic connective tissue disorders connection
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Rosa Neto, Nilton Salles

; Pereira, Ivânio Alves

; Sztajnbok, Flávio Roberto

; Azevedo, Valderílio Feijó

Advances in Rheumatology

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2024, Volume 64 elocation 32

Abstract: En | Text: En | PDF: En

Abstract Hereditary connective tissue disorders include more than 200 conditions affecting different organs and tissues, compromising the biological role of the extracellular matrix through interference in the synthesis, development, or secretion of collagen and/or its associated proteins. The clinical phenotype includes multiple signs and symptoms, usually nonspecific but of interest to rheumatologists because of musculoskeletal involvement. The patient's journey to diagnosis is long, and physicians should include these disorders in their differential diagnoses of diseases with systemic involvement. In this review, insights for the diagnosis and treatment of osteogenesis imperfecta, hypermobility spectrum disorder/Ehlers–Danlos syndrome, Marfan, Loeys–Dietz, and Stickler syndromes are presented. 20 tissues synthesis development andor proteins symptoms involvement patients patient s long review imperfecta disorderEhlersDanlos disorder Ehlers Danlos syndrome Marfan LoeysDietz Loeys Dietz Loeys–Dietz presented 2

https://doi.org/10.1186/s42358-024-00373-z

Epidemiological analysis of patients with psoriatic arthritis in follow-up at the brazilian Unified Health System followup follow up
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Rossetto, Chayanne Natielle

; Palominos, Penélope Esther

; Machado, Natalia Pereira

; Paiva, Eduardo dos Santos

; Azevedo, Valderílio Feijó

Advances in Rheumatology

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2023, Volume 63 elocation 47

Abstract: En | Text: En | PDF: En

Abstract Introduction/Objectives Psoriatic arthritis (PsA) is a chronic multisystem osteoarticular disease that requires specialized care. Most Brazilians depend on the public healthcare provided by the Unified Health System (Sistema Único de Saúde, SUS). This study aimed to describe the epidemiological characteristics of patients with PsA in follow-up in SUS, focusing on the incidence and prevalence of the disease, comorbidities, and hospitalizations. Methods We collected data from the Outpatient Data System of SUS (Sistema de Informações Ambulatoriais do SUS, SIA/SUS) regarding outpatient visits and hospitalizations in the Brazilian public healthcare system from January 2008 to March 2021 using the Techtrials Disease Explorer® platform and the medical code related to PsA were selected. Results We evaluated 40,009 patients and found a prevalence of 24.4 cases of visits due to PsA per 100,000 patients in follow-up in SUS. Female patients were predominant (54.38%). The incidence of visits due to PsA has been increasing in recent years and we observed an incidence of 8,982 new visits in 2020. The main comorbidities of these patients were osteoarthritis, lower back pain, shoulder injuries, oncological diseases, crystal arthropathies, and osteoporosis. Hospitalizations were mainly due to treating clinical or cardiovascular conditions and performing orthopedic procedures. Conclusion The number of visits due to PsA in SUS has increased in recent years, mainly on account of new diagnoses of the disease, although the prevalence found in this study's population was lower than that observed in the general population. IntroductionObjectives Introduction Objectives (PsA care Sistema Saúde . SUS) followup follow up SIA/SUS SIASUS SIA 200 202 Explorer selected 40009 40 009 40,00 244 24 4 24. 100000 100 000 100,00 54.38%. 5438 54.38% 54 38 (54.38%) 8982 8 982 8,98 2020 osteoarthritis pain injuries diseases arthropathies osteoporosis procedures studys s 20 4000 00 40,0 2 10000 10 100,0 543 54.38 5 3 (54.38% 898 98 8,9 400 0 40, 1000 1 100, 54.3 (54.38 89 9 8, 54. (54.3 (54. (54 (5 (

https://doi.org/10.1186/s42358-023-00327-x

Brazilian recommendations for the use of nonsteroidal anti-inflammatory drugs in patients with axial spondyloarthritis
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Lage, Ricardo da Cruz

; Marques, Claudia Diniz Lopes

; Oliveira, Thauana Luiza

; Resende, Gustavo Gomes

; Kohem, Charles Lubianca

; Saad, Carla Gonçalves

; Ximenes, Antônio Carlos

; Gonçalves, Célio Roberto

; Bianchi, Washington Alves

; Meirelles, Eduardo de Souza

; Keiserman, Mauro Waldemar

; Chiereghin, Adriano

; Campanholo, Cristiano Barbosa

; Lyrio, André Marun

; Schainberg, Cláudia Goldenstein

; Pieruccetti, Lenise Brandao

; Yazbek, Michel Alexandre

; Palominos, Penelope Esther

; Goncalves, Rafaela Silva Guimarães

; Assad, Rodrigo Luppino

; Bonfiglioli, Rubens

; Lima, Sônia Maria Alvarenga Anti Loduca

; Carneiro, Sueli

; Azevedo, Valderílio Feijó

; Albuquerque, Cleandro Pires

; Bernardo, Wanderley Marques

; Sampaio-Barros, Percival Degrava

; Pinheiro, Marcelo de Medeiros

Advances in Rheumatology

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2021, Volume 61 elocation 4

Abstract: En | Text: En | PDF: En

Abstract Spondyloarthritis (SpA) is a group of chronic inflammatory systemic diseases characterized by axial and/or peripheral joints inflammation, as well as extra-articular manifestations. Over some decades, nonsteroidal anti-inflammatory drugs (NSAIDs) have been the basis for the pharmacological treatment of patients with axial spondyloarthritis (axSpA). However, the emergence of the immunobiologic agents brought up the discussion about the role of NSAIDs in the management of these patients. The objective of this guideline is to provide recommendations for the use of NSAIDs for the treatment of axSpA. A panel of experts from the Brazilian Society of Rheumatology conducted a systematic review and meta-analysis of randomized clinical trials for 15 predefined questions. The Grading of Recommendations, Assessment, Development and Evaluation methodology to assess the quality of evidence and formulate recommendations were used, and at least 70% agreement of the voting panel was needed. Fourteen recommendations for the use of NSAIDs in the treatment of patients with axSpA were elaborated. The purpose of these recommendations is to support clinicians’ decision making, without taking out his/her autonomy when prescribing for an individual patient.

https://doi.org/10.1186/s42358-020-00160-6 505 downloads

Brazilian Society of Rheumatology 2020 guidelines for psoriatic arthritis
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Carneiro, Sueli

; Palominos, Penelope Esther

; Anti, Sônia Maria Alvarenga

; Assad, Rodrigo Luppino

; Gonçalves, Rafaela Silva Guimarães

; Chiereghin, Adriano

; Lyrio, Andre Marun

; Ximenes, Antônio Carlos

; Saad, Carla Gonçalves

; Gonçalves, Célio Roberto

; Kohem, Charles Lubianca

; Marques, Cláudia Diniz Lopes

; Schainberg, Cláudia Goldenstein

; Meirelles, Eduardo de Souza

; Resende, Gustavo Gomes

; Pieruccetti, Lenise Brandao

; Keiserman, Mauro Waldemar

; Yazbek, Michel Alexandre

; Sampaio-Barros, Percival Degrava

; Lage, Ricardo da Cruz

; Bonfiglioli, Rubens

; Oliveira, Thauana Luíza

; Azevedo, Valderílio Feijó

; Bianchi, Washington Alves

; Bernardo, Wanderley Marques

; Simões, Ricardo dos Santos

; Pinheiro, Marcelo de Medeiros

; Campanholo, Cristiano Barbosa

Advances in Rheumatology

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2021, Volume 61 elocation 69

Abstract: En | Text: En | PDF: En

Abstract Psoriatic arthritis (PsA) is a chronic and systemic immune disease characterized by inflammation of peripheral and/ or axial joints and entheses in patients with psoriasis (PsO). Extra-articular and extracutaneous manifestations and numerous comorbidities can also be present. These recommendations replace the previous version published in May 2013. A systematic review of the literature retrieved 191 articles that were used to formulate 12 recommendations in response to 12 clinical questions, divided into 4 sections: diagnosis, non-pharmacological treatment, conventional drug therapy and biologic therapy. These guidelines provide evidence-based information on the clinical management for PsA patients. For each recommendation, the level of evidence (highest available), degree of strength (Oxford) and degree of expert agreement (interrater reliability) are reported.

https://doi.org/10.1186/s42358-021-00219-y

The Brazilian Society of Rheumatology guidelines for axial spondyloarthritis – 2019
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Resende, Gustavo Gomes

; Meirelles, Eduardo de Souza

; Marques, Cláudia Diniz Lopes

; Chiereghin, Adriano

; Lyrio, Andre Marun

; Ximenes, Antônio Carlos

; Saad, Carla Gonçalves

; Gonçalves, Célio Roberto

; Kohem, Charles Lubianca

; Schainberg, Cláudia Goldenstein

; Campanholo, Cristiano Barbosa

; Bueno Filho, Júlio Silvio de Sousa

; Pieruccetti, Lenise Brandao

; Keiserman, Mauro Waldemar

; Yazbek, Michel Alexandre

; Palominos, Penelope Esther

; Goncalves, Rafaela Silva Guimarães

; Lage, Ricardo da Cruz

; Assad, Rodrigo Luppino

; Bonfiglioli, Rubens

; Anti, Sônia Maria Alvarenga

; Carneiro, Sueli

; Oliveira, Thauana Luíza

; Azevedo, Valderílio Feijó

; Bianchi, Washington Alves

; Bernardo, Wanderley Marques

; Pinheiro, Marcelo de Medeiros

; Sampaio-Barros, Percival Degrava

Advances in Rheumatology

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2020, Volume 60 elocation 19

Abstract: En | Text: En | PDF: En

Abstract Spondyloarthritis is a group of chronic inflammatory systemic diseases characterized by axial and/or peripheral joints inflammation, as well as extra-articular manifestations. The classification axial spondyloarthritis is adopted when the spine and/or the sacroiliac joints are predominantly involved. This version of recommendations replaces the previous guidelines published in May 2013. A systematic literature review was performed, and two hundred thirty-seven studies were selected and used to formulate 29 recommendations answering 15 clinical questions, which were divided into four sections: diagnosis, non-pharmacological therapy, conventional drug therapy and biological therapy. For each recommendation the level of evidence supporting (highest available), the strength grade according to Oxford, and the degree of expert agreement (inter-rater reliability) is informed. These guidelines bring evidence-based information on clinical management of axial SpA patients, including, diagnosis, treatment, and prognosis.

https://doi.org/10.1186/s42358-020-0116-2 1116 downloads

The musculoskeletal impairment negatively impacts the quality of life of children and adolescents with psoriasis
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Meneghetti, Thaís Cugler

; Padilha, Thaís Mayumi Honda

; Azevedo, Valderílio Feijó

; Cat, Mônica Nunes Lima

; Sarolli, Bruna Maria Stofela

; Carvalho, Vânia Oliveira de

Advances in Rheumatology

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2020, Volume 60 elocation 33

Abstract: En | Text: En | PDF: En

Abstract Background The severity of nail disease, the presence of arthralgia and fatigue are predictors of development of psoriatic arthritis (PsA) in patients with psoriasis (Pso). In children, little is known about the musculoskeletal (MSK) impairment in patients with Pso and its effect on health-related quality of life (HRQoL). Objectives To determine the frequencies of pain and MSK inflammation (i.e., arthritis, enthesitis, and sacroiliitis) among children and adolescents with Pso and its relationship to HRQoL and fatigue. Methods Pediatric patients with Pso underwent a rheumatologic physical examination to evaluate synovitis, enthesalgia, sacroiliac joint (SIJ) pain and tender points of fibromyalgia. The core set of domains recommended by the GRAPPA - OMERACT to be measured in PsA studies was assessed. Ultrasound (US) was performed in clinical cases of enthesitis, and magnetic resonance imaging (MRI) was performed in cases of SIJ pain. Results Forty-three participants (10 ± 2.9 years old) were evaluated. Pain on palpation of the entheses was observed in 10 (23.2%) patients and pain on SIJ palpation was observed in 3 (7%). No patient presented with synovitis; one presented with enthesitis on US, but MRI did not confirm sacroiliitis in any case. Patients with MSK pain had greater skin disease severity (PASI 5.4 vs. 2, p < 0.01), worse fatigue, and lower HRQoL scores on all instruments used. The estimated risk of HRQoL impairment was eight times higher in the presence of MSK pain, which was an independent predictive factor. With a NAPSI greater than 30, the probability of pain was greater than 80%. Conclusion MSK pain is frequent among children with Pso, related to the severity of skin and nail disease, and negatively affects HRQoL. The typically used complementary exams might not detect the inflammatory process caused by Pso.

https://doi.org/10.1186/s42358-020-00136-6 335 downloads

Translation and validation of the Indian Takayasu clinical activity score (ITAS2010) for the Brazilian Portuguese language
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Fritsch, Scheila

; Copes, Rafaela Martinez

; Savioli, Bruna

; Aguiar, Mariana Freitas de

; Ciconelli, Rozana Mesquita

; Azevedo, Valderílio Feijó

; Souza, Alexandre W. S. de

Advances in Rheumatology

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2019, Volume 59 elocation 43

Abstract: En | Text: En | PDF: En

Abstract Background: The Indian Takayasu Clinical Activity Score (ITAS2010) was developed in 2010 as an assessment tool for disease activity in patients with Takayasu arteritis (TA). It has since been widely used in different studies and in clinical practice for the management of patients with TA. The present study aims to translate the ITAS2010 into Brazilian Portuguese language and to validate it for use in clinical practice in Brazil. Methods: For this cross-sectional study, the ITAS2010 was translated in accordance with the guidelines described by Beaton et al. and then applied with 27 patients with TA on three assessments by two rheumatologists working independently. To measure interrater agreement, the assessments were performed on the same day within approximately 1 hour. One of the rheumatologists performed a second evaluation of patients with TA within 7 to 14 days to measure intrarater agreement. Results: The correlation coefficient for the ITAS2010 score between the two raters was high (r =0.916; p < 0.0001), as well as the intraclass correlation coefficient (ICC) [0.918 with a 95% confidence interval (95CI): 0.828-0.962]. The correlation coefficient and the ICC for intrarater agreement were moderate for ITAS2010 (r =0.633; p < 0.0001 and ICC = 0.594; 95CI: 0.292-0.790). The ITAS2010 at baseline was compared with the physician's global assessment (PGA) and with Kerr's criteria for detecting disease activity in TA. Higher ITAS2010 scores were observed in patients with active and grumbling/persistent disease than in those presenting inactive disease according to the PGA [1.5 (0.0-3.0) vs. 0.0 (0.0-0.0); p = 0.0025]. Patients with active disease according to the Kerr's criteria had also higher ITAS2010 scores than those considered in remission [3.0 (3.0-7.0) vs. 0.0 (0.0-0.0); p = 0.0068]. Conclusions: The Brazilian Portuguese version of the ITAS2010 is a valid and reproducible tool for the assessment of disease activity in TA and it is an additional tool for the routine evaluation of Brazilian patients with TA.

https://doi.org/10.1186/s42358-019-0087-3 565 downloads

ProCura - a arte da vida: um projeto pela humanização na saúde
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Rosevics, Leticia

; Aguiar, Débora Assunção

; Borges, Conrado Regis

; Hasegawa Filho, Roberto

; Yamashita, Thomas Szabó

; Manchak, Ana Cristina

; Azevedo, Valderílio Feijó

Revista Brasileira de Educação Médica

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dec 2014, Volume 38 N. 4 Pages 486 - 492

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

As modificações da medicina tornaram o conhecimento biomédico soberano, gerando a perda da relação médico-paciente, o que fomentou o movimento pela humanização. Na Universidade Federal do Paraná (UFPR), formou-se o projeto de extensão "ProCura - a arte da vida", a fim de implementar a humanização entre os alunos e em suas relações profissionais. Seus objetivos se baseiam nos pilares: relação estudante-paciente, relação estudante-estudante e formação teórico-reflexiva, e se subdividem nos grupos Cineclube, Clown e Contação de Histórias. De 2010 a 2012, 79 alunos participaram e atenderam 905 pacientes, 505 acompanhantes e 107 funcionários. Apesar de limitações de alcance no que concerne a atingir todos os alunos do Setor de Ciências da Saúde, o projeto pretende fomentar a discussão entre grupos e que seus ideais e atividades se espalhem e permeiem o meio acadêmico.

Changes in medicine have promoted biomedical knowledge to a position of sovereignty. Coupled with the decline of the physician-patient relationship, this has brought about the the humanization movement. At the Federal University of Paraná (UFPR), a community outreach project entitled "ProCura - the art of living" has been created to implement humanization among students and in their professional relationships. Its objectives are based on three pillars: student-patient relationship, student-student relationship and theoretical-reflexive training, subdivided into groups named Cineclube, Clown and Contação de Histórias. Between 2010 and 2012, 79 students participated in the project, attending to 905 to patients, 505 companions and 107 employees. Despite its limited scope as regards reaching all Department of Health Sciences students, the Project aims to promote discussion between groups and disseminate their ideals and activities throughout academic circles.

3341 downloads

Avaliação da aterosclerose subclínica e de níveis plasmáticos de LDL minimamente modificada em pacientes com espondilite anquilosante e sua correlação com a atividade da doença
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Ceccon, Fernanda Teles

; Azevedo, Valderílio Feijó

; Engelhorn, Carlos A.

; Abdalla, Dulcinéia S. P.

; Faulin, Tanize E. S.

; Guarita-Souza, Luis Cesar

; Pecoits-Filho, Roberto

; Faria-Neto, José Rocha

Revista Brasileira de Reumatologia

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dec 2013, Volume 53 N. 6 Pages 470 - 475

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

INTRODUÇÃO: A aterosclerose acelerada foi demonstrada em algumas doenças autoimunes, principalmente lúpus eritematoso sistêmico e artrite reumatóide. Embora a alta prevalência do uso de corticosteróides possa ser um fator complicador, por causa de seus efeitos prejudiciais em diversos fatores de risco, acredita-se que, nesses pacientes, a inflamação sistêmica per se desempenhe papel importante na aterogênese. MÉTODOS: Avaliamos a aterosclerose subclínica e os níveis plasmáticos de LDL eletronegativa circulante em pacientes com espondilite anquilosante (EA). Catorze pacientes que atendiam aos critérios de Nova York modificados para EA foram comparados com 13 controles equiparados. Avaliamos a espessura da íntima-média (EIM) na carótida por ultrassonografia bilateral da artéria carótida comum, artéria carótida interna e na bifurcação. Os grupos foram homogêneos, no que tange a fatores de risco cardiovasculares. Apenas um paciente no grupo de EA estava sendo medicado com corticosteróide. RESULTADOS: A presença de inflamação ativa foi demonstrada por BASDAI elevado e níveis mais elevados de PCR em pacientes versus controles (12,36 vs. 3,45 mg/dl, P=0,002). Não observamos diferença na EIM da carótida entre os dois grupos, em qualquer local da artéria. A média de EIM (6 mensurações em 3 locais pré-especificados, bilateralmente) foi 0,72 ± 0,28 no grupo de EA e 0,70 ± 0,45 mm nos controles (P=0,91). Também não observamos diferença significativa na LDL minimamente modificada entre pacientes e controles (14,03 ± 17,40 vs. 13,21 ± 10,21; P=0,88). CONCLUSÕES: Pacientes com EA não demonstraram aumento na EIM da carótida, em comparação com controles. Do mesmo modo, os níveis plasmáticos circulantes de LDL(-) não diferiram significativamente nos dois grupos.

INTRODUCTION: Accelerated atherosclerosis has been shown in some autoimmune diseases, mainly in Systemic Lupus Erythematosus and Rheumatoid Arthritis. Although high prevalence of corticosteroids use may be a confounding factor due to their detrimental effects on several risk factors, systemic inflammation per se is supposed to play an important role in atherogenesis in these patients. METHODS: We have evaluated sub-clinical atherosclerosis and plasma levels of circulating electronegative LDL, which represents the fraction of LDL that is minimally modified, in patients with ankylosing spondylitis (AS). Fourteen patients who fulfilled the modified New York criteria for AS were compared with 13 paired controls. Carotid intimal-media thickness (IMT) was assessed by ultrasonography bilaterally in common carotid artery, internal carotid artery and in the bifurcation. Groups were homogeneous regarding cardiovascular risk factors. Only a single patient in AS group was in use of corticosteroid. RESULTS: The presence of active inflammation was demonstrated by elevated BASDAI and higher CRP levels and in patients versus controls (12.36 vs. 3.45 mg/dl, P = 0.002). No difference was found in carotid IMT between both groups, in any site of artery. Averaged IMT (6 measurements, at 3 pre-specified sites bilaterally) was 0.72 ± 0.28 in AS group and 0.70 ± 0.45 mm in controls (P = 0.91). Minimally modified LDL did not differ significantly either between patients and controls (14.03 ± 17.40 vs. 13.21 ± 10.21; P = 0.88). CONCLUSIONS: Patients with AS did not show increased carotid IMT in comparison to controls. In the same way, circulating plasma levels of LDL (-), did not differ significantly in both groups.

https://doi.org/10.1016/j.rbr.2013.06.002 2658 downloads

10.

Doença de Still do Adulto associada à neoplasia de ovário: relato de caso
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Schade, Lilian

; Fritsch, Scheila

; Gentili, Arthur Conelian

; Noronha, Lucia de

; Azevedo, Valderílio Feijó

; Paiva, Eduardo dos Santos

Revista Brasileira de Reumatologia

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dec 2013, Volume 53 N. 6 Pages 532 - 534

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Relatamos um caso de diagnóstico de Doença de Still do Adulto (DSA) em paciente feminina com febre, mialgia, rash cutâneo fugaz e linfonodomegalia inguinal bilateral, após extensa investigação para exclusão de outras doenças reumatológicas, infecciosas e neoplásicas. A paciente inicialmente apresentou resposta ao tratamento com prednisona, porém evoluiu com aumento de volume de linfonodos inguinais, cuja biópsia revelou adenocarcinoma seroso de ovário. De acordo com nosso conhecimento, esse é o primeiro relato de neoplasia ovariana associada ao diagnóstico de DSA.

We report a case of adult-onset Still's disease in a female patient with fever, myalgia, vanishing rash and bilateral inguinal lymphadenopathy, diagnosed after extensive workup to exclude other rheumatic, infectious and neoplastic diseases. The patient initially responded to corticosteroid therapy, but progressed to increased lymph nodes size that when biopsied, revealed serous ovarian adenocarcinoma. To our knowledge, this is the first report of ovarian neoplasm associated with adult-onset Still's disease.

https://doi.org/10.1016/j.rbr.2013.05.001 2742 downloads

11.

Recomendações sobre diagnóstico e tratamento da artrite psoriásica
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Carneiro, Sueli

; Azevedo, Valderílio Feijó

; Bonfiglioli, Rubens

; Ranza, Roberto

; Gonçalves, Célio Roberto

; Keiserman, Mauro

; Meirelles, Eduardo de Souza

; Pinheiro, Marcelo de Medeiros

; Ximenes, Antonio Carlos

; Bernardo, Wanderley

; Sampaio-Barros, Percival Degrava

Revista Brasileira de Reumatologia

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jun 2013, Volume 53 N. 3 Pages 227 - 241

Abstract: Pt | Text: Pt | PDF: Pt

21703 downloads Cited 1 time in SciELO

12.

Recomendações sobre diagnóstico e tratamento da espondilite anquilosante
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Sampaio-Barros, Percival Degrava

; Keiserman, Mauro

; Meirelles, Eduardo de Souza

; Pinheiro, Marcelo de Medeiros

; Ximenes, Antonio Carlos

; Azevedo, Valderílio Feijó

; Bonfiglioli, Rubens

; Carneiro, Sueli

; Ranza, Roberto

; Bernardo, Wanderley Marques

; Gonçalves, Célio Roberto

Revista Brasileira de Reumatologia

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jun 2013, Volume 53 N. 3 Pages 242 - 257

Abstract: Pt | Text: Pt | PDF: Pt

31251 downloads Cited 2 times in SciELO

13.

Biossimilares necessitam de dados clínicos comparativos cientificamente confiáveis
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Azevedo, Valderílio Feijó

Revista Brasileira de Reumatologia

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feb 2013, Volume 53 N. 1 Pages 129 - 131

Abstract: Pt | Text: Pt | PDF: Pt

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14.

Leucopenia e trombocitopenia induzidas por etanercepte: relato de dois casos e revisão da literatura
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Azevedo, Valderílio Feijó

; Silva, Marília Barreto Gameiro

; Marinello, Débora Karine

; Santos, Felipe Dunin dos

; Silva, Guilherme Barreto Gameiro

Revista Brasileira de Reumatologia

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feb 2012, Volume 52 N. 1 Pages 110 - 112

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

O fator de necrose tumoral alfa (TNF-alfa) é uma citocina pró-inflamatória, e seu excesso pode levar a sérias consequências. Esses efeitos são conhecidos por serem antagonizados por inibidores da atividade do TNF-alfa. O etanercepte é uma proteína de fusão que inibe a ação do TNF-alfa. Como a regulação do TNF-alfa está relacionada à diferenciação celular de várias células envolvidas na resposta imunológica por meio da expressão de várias outras citocinas, é possível que o uso de inibidores dessa citocina possa causar citopenia. Relatamos dois casos de bicitopenia induzidos por etanercepte. Em ambos os casos houve melhora clínica do quadro após a retirada da medicação. Discutimos a necessidade da introdução de testes laboratoriais de rotina em pacientes que usam terapia anti-TNF, para identificar possíveis alterações hematológicas

Tumor necrosis factor-alpha (TNF-alpha) is a proinflammatory cytokine, and its excess can lead to severe consequences. Those effects are known to be antagonized by TNF-alpha inhibitors. Etanercept is a fusion protein that inhibits TNF-alpha action. As TNF-alpha regulation is related to cellular differentiation of various cellular types involved in immune response through expression of several other cytokines, it is possible that the use of its inhibitors may cause cytopenia. We report two cases of bicytopenia induced by etanercept. Both cases recovered after drug withdrawal. We discuss the need of introduction of routine laboratorial tests in patients using anti-TNF therapy, in order to identify possible hematological changes

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15.

Perfil de autoanticorpos e correlação clínica em um grupo de pacientes com esclerose sistêmica na região sul do Brasil
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Müller, Carolina de Souza

; Paiva, Eduardo dos Santos

; Azevedo, Valderílio Feijó

; Radominski, Sebastião Cezar

; Lima Filho, José Hermênio Cavalcante

Revista Brasileira de Reumatologia

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aug 2011, Volume 51 N. 4 Pages 319 - 324

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

OBJETIVOS: Este estudo visou à análise das manifestações da esclerose sistêmica (ES), com ênfase na pesquisa dos autoanticorpos e de suas correlações clínicas, na população de pacientes em acompanhamento no ambulatório de ES do Hospital de Clínicas da Universidade Federal do Paraná. METODOLOGIA: Realizou-se um estudo transversal com 96 pacientes em acompanhamento no ambulatório de ES do hospital, entre setembro de 2007 e setembro de 2009. RESULTADOS: A maioria dos pacientes era do sexo feminino, com idade entre a quarta e quinta décadas e tempo de doença com mediana de 10 anos. A forma cutânea limitada de ES foi a mais prevalente. Na análise dos autoanticorpos, o anticorpo anticentromérico (ACA) associou-se a ES forma limitada, idade mais avançada ao diagnóstico, maior tempo de doença, intervalo maior entre o surgimento do fenômeno de Raynaud (FRy) e o primeiro sintoma não FRy, maior prevalência de hipertensão arterial sistêmica (HAS) e de bloqueios de condução cardíaca. O anticorpo antitopoisomerase-1 (antitopo-1, previamente denominado anti-Scl-70) foi mais comum na forma difusa da ES, na presença de doença ativa e de úlceras digitais. O anticorpo anti-RNA polimerase III (antipol III) correlacionou-se com a forma difusa de ES, presença de doença ativa e sinovite. CONCLUSÕES: Este estudo vem ressaltar e ratificar o papel relevante dos autoanticorpos na avaliação dos pacientes com ES, sendo possível correlacionar o perfil autoimune dessa população com manifestações específicas da doença

OBJECTIVES: To assess the manifestations of systemic sclerosis (SSc), with an emphasis on the analysis of autoantibodies and their clinical correlations, in a population of patients followed up at the SSc Outpatient Clinics of the Hospital de Clínicas of the Universidade Federal do Paraná. METHODOLOGY: Cross-sectional study with 96 patients followed up at the SSc Outpatient Clinics of the hospital between September 2007 and September 2009. RESULTS: Most patients were of the female sex, in their forties or fifties, and the median time of disease was ten years. The limited cutaneous form of SSc was more prevalent. The analysis of the autoantibodies showed the association of anticentromere antibody (ACA) with the following: the limited form of SSc; more advanced age at the time of diagnosis; longer disease time; longer interval between the appearance of the Raynaud's phenomenon (RyP) and the first non-RyP symptom; systemic arterial hypertension (SAH); and cardiac conduction blocks. The antitopoisomerase-1 antibody (ATA-1, previously called anti-Scl-70) was more common in the presence of the diffuse form of SSc, active disease, and digital ulcers. The anti-RNA polymerase III antibody (anti-Pol III) correlated with the diffuse form of SSc, disease activity, and synovitis. CONCLUSIONS: This study emphasizes and confirms the important role of autoantibodies in assessing patients with SSc, allowing the correlation between the autoimmune profile of patients with SSc and specific manifestations of the disease

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