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Does [18F]F-FDG-PET/MRI add metabolic information to magnetic resonance image in childhood-onset Takayasu’s arteritis patients? A multicenter case series
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Clemente, Gleice

; Souza, Alexandre W. de

; Leão Filho, Hilton

; Coelho, Fernando M. A.

; Buchpiguel, Carlos

; Lima, Marcos

; Carneiro, Camila

; Pereira, Rosa M. R.

; Aikawa, Nadia

; Silva, Clovis A.

; Campos, Lucia M. A.

; Alves, Gabriel

; Astley, Camilla

; Gualano, Bruno

; Terreri, Maria Teresa

Advances in Rheumatology

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2022, Volume 62 elocation 28

Abstract: En | Text: En | PDF: En

Abstract Background: The observation that 2-deoxy-2[18F]fluoro-D-glucose-positron emission tomography/magnetic resonance imaging ([18F]F-FDG-PET/MRI) revealed high-grade arterial wall FDG uptake, without arterial wall thickening with contrast-enhancement, in a considerable number of c-TA patients in our previous study, encouraged us to compare patients with both PET and MR angiography (MRA) positives, with those with PET positive but MRA negative. Our aim was to evaluate the relevance of these two imaging modalities together. Methods: A three-center cross-sectional study with 17 patients who fulfilled the EULAR/PRINTO/PReS criteria for c-TA and who underwent [18F]F-FDG-PET/MRI was previously performed. Herein we compared patients/vessels with positive PET (arterial wall 18F-FDG uptake higher than liver) and positive MRA (arterial wall thickening with contrast-enhancement)—group 1, with those with positive PET but negative MRA—group 2. Results: Median disease duration of 17 c-TA patients was 10.4 years. Nine patients were classified as group 1 and six as group 2. Median of metabolic inflammatory volume (MIV) of all arterial segments was significantly higher in group 1 (2346 vs. 1177 cm3; p = 0.036). Fifty-four (19%) from 284 available arterial segments presented positive findings in vessel wall in one or both images. Positive findings were concordant between PET and MRA in only 13% arterial segments (group 1); most changes (28–59.6%) that were discordant between both images, were positive in PET and negative in MRA (group 2). Conclusions: Our study demonstrated that [18F]F-FDG-PET/MRI added information about inflammation in vessel wall of c-TA patients. Prospective multicenter studies are needed in order to get solid data to guide immunosuppressive tapering and withdrawal.

https://doi.org/10.1186/s42358-022-00260-5

Lower genital tract infections in young female juvenile idiopathic arthritis patients
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Ferreira, Gabriela R. V.

; Tomioka, Renato B.

; Queiroz, Ligia B.

; Kozu, Katia

; Aikawa, Nadia E.

; Sallum, Adriana M. E.

; Serafini, Paulo

; Tacla, Maricy

; Baracat, Edmund C.

; Pereira, Rosa M. R.

; Bonfá, Eloisa

; Silva, Clovis A.

Advances in Rheumatology

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2019, Volume 59 elocation 50

Abstract: En | Text: En | PDF: En

Abstract Background: To evaluate human papillomavirus (HPV), Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections in juvenile idiopathic arthritis (JIA) patients. Methods: After exclusion, 33 female adolescent and young JIA patients (ILAR criteria) and 28 healthy controls were selected for this study. Demographic data, gynecological, sexual function, cervical cytology and histological abnormalities were evaluated. JIA clinical/laboratorial parameters and treatment were also assessed. HPV-DNA, CT-DNA and NG-DNA testing in cervical specimens were performed by Hybrid Capture 2 assays. Results: The mean current age was similar in JIA patients and controls (23.3 ± 6.24 vs. 26.1 ± 6.03 years, p = 0.09). The frequencies of sexual intercourse (76% vs. 89%, p = 0.201) and abnormal cervical cytology (24% vs. 11%, p = 0.201) were similar in JIA compared to controls. The higher frequency of HPV infection in JIA patients than controls (30% vs. 11%, p = 0.155) did not reach statistical significance. CT (0% vs. 7%, p = 0.207) and NG infections (0% vs. 4%, p = 0.459) were also alike in both groups. Further evaluation of JIA patients with abnormal and normal cervical cytology showed that the former group had a higher frequency of HPV infection (87% vs. 12%, p = 0.0002) with a low frequency of HPV vaccination (0% vs. 8%, p = 1.0). No differences were evidenced between these two JIA groups regarding demographic data, sexual function and clinical/laboratorial parameters. The frequencies of methotrexate (p =0.206) and biological agent use (p =0.238) were similar in both JIA groups. Conclusions: To our knowledge, this was the first study to assess lower genital infections in JIA patients allowing the identification of HPV as main cause of cervical dysplasia. Methotrexate and biological agents do not seem to increase risk of lower genital tract infections in JIA patients.

https://doi.org/10.1186/s42358-019-0092-6 407 downloads

Autoimmune hepatitis in 847 childhoodonset systemic lupus erythematosus population: a multicentric cohort study
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Balbi, Verena A.

; Montenegro, Bárbara

; Pitta, Ana C.

; Schmidt, Ana R.

; Farhat, Sylvia C.

; Coelho, Laila P.

; Ferreira, Juliana C. O.

; Pereira, Rosa M. R.

; Terreri, Maria T.

; Saad-Magalhães, Claudia

; Aikawa, Nadia E.

; Sakamoto, Ana P.

; Kozu, Kátia

; Campos, Lucia M.

; Sallum, Adriana M.

; Ferriani, Virginia P.

; Piotto, Daniela P.

; Bonfá, Eloisa

; Silva, Clovis A.

Advances in Rheumatology

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2018, Volume 58 elocation 43

Abstract: En | Text: En | PDF: En

Abstract Objective: To evaluate autoimmune hepatitis (AIH) in a multicenter cohort of childhood-onset systemic lupus erythematosus (cSLE) patients. Methods: This retrospective multicenter study included 847 patients with cSLE, performed in 10 Pediatric Rheumatology services of São Paulo state, Brazil. AIH was defined according to the International Autoimmune Hepatitis Group criteria (IAHGC). The statistical analysis was performed using the Bonferroni's correction (p < 0.0033). Results: AIH in cSLE patients confirmed by biopsy was observed in 7/847 (0.8%) and all were diagnosed during adolescence. The majority occurred before or at cSLE diagnosis [5/7 (71%)]. Antinuclear antibodies were a universal finding, 43% had concomitantly anti-smooth muscle antibodies and all were seronegative for anti-liver kidney microsomal antibodies. All patients with follow-up ≥18 months (4/7) had complete response to therapy according to IAHGC. None had severe hepatic manifestations such as hepatic failure, portal hypertension and cirrhosis at presentation or follow-up. Further comparison of 7 cSLE patients with AIH and 28 without this complication with same disease duration [0 (0–8.5) vs. 0.12 (0–8.5) years, p = 0.06] revealed that the frequency of hepatomegaly was significantly higher in cSLE patients in the former group (71% vs. 11%, p = 0.003) with a similar median SLEDAI-2 K score [6 (0–26) vs. 7 (0–41), p = 0.755]. No differences were evidenced regarding constitutional involvement, splenomegaly, serositis, musculoskeletal, neuropsychiatric and renal involvements, and treatments in cSLE patients with and without AIH (p > 0.0033). Conclusions: Overlap of AIH and cSLE was rarely observed in this large multicenter study and hepatomegaly was the distinctive clinical feature of these patients. AIH occurred during adolescence, mainly at the first years of lupus and it was associated with mild liver manifestations.

https://doi.org/10.1186/s42358-018-0043-7 473 downloads

Diffuse alveolar hemorrhage in childhoodonset systemic lupus erythematosus: a severe disease flare with serious outcome
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Blay, Gabriela

; Rodrigues, Joaquim C.

; Ferreira, Juliana C. O.

; Leal, Gabriela N.

; Gormezano, Natali W.

; Novak, Glaucia V.

; Pereira, Rosa M. R.

; Terreri, Maria T.

; Magalhães, Claudia S.

; Molinari, Beatriz C.

; Sakamoto, Ana P.

; Aikawa, Nadia E.

; Campos, Lucia M. A.

; Fernandes, Taciana A. P.

; Clemente, Gleice

; Peracchi, Octavio A. B.

; Bugni, Vanessa

; Marini, Roberto

; Sacchetti, Silvana B.

; Carvalho, Luciana M.

; Fraga, Melissa M.

; Castro, Tânia C. M.

; Ramos, Valéria C.

; Bonfá, Eloisa

; Silva, Clovis A.

Advances in Rheumatology

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2018, Volume 58 elocation 39

Abstract: En | Text: En | PDF: En

Abstract Objective: To evaluate prevalence, clinical manifestations, laboratory abnormalities and treatment in a multicenter cohort study including 847 childhood-onset systemic lupus erythematosus (cSLE) patients with and without diffuse alveolar hemorrhage (DAH), as well as concomitant parameters of severity. Methods: DAH was defined as the presence of at least three respiratory symptoms/signs associated with diffuse interstitial/alveolar infiltrates on chest x-ray or high-resolution computer tomography and sudden drop in hemoglobin levels. Statistical analysis was performed using Bonferroni correction (p < 0.0022). Results: DAH was observed in 19/847 (2.2%) cSLE patients. Cough/dyspnea/tachycardia/hypoxemia occurred in all cSLE patients with DAH. Concomitant parameters of severity observed were: mechanical ventilation in 14/19 (74%), hemoptysis 12/19 (63%), macrophage activation syndrome 2/19 (10%) and death 9/19 (47%). Further analysis of cSLE patients at DAH diagnosis compared to 76 cSLE control patients without DAH with same disease duration [3 (1–151) vs. 4 (1–151) months, p = 0.335], showed higher frequencies of constitutional involvement (74% vs. 10%, p < 0.0001), serositis (63% vs. 6%, p < 0.0001) and sepsis (53% vs. 9%, p < 0.0001) in the DAH group. The median of disease activity score(SLEDAI-2 K) was significantly higher in cSLE patients with DAH [18 (5–40) vs. 6 (0–44), p < 0.0001]. The frequencies of thrombocytopenia (53% vs. 12%, p < 0.0001), intravenous methylprednisolone (95% vs. 16%, p < 0.0001) and intravenous cyclophosphamide (47% vs. 8%, p < 0.0001) were also significantly higher in DAH patients. Conclusions: This was the first study to demonstrate that DAH, although not a disease activity score descriptor, occurred in the context of significant moderate/severe cSLE flare. Importantly, we identified that this condition was associated with serious disease flare complicated by sepsis with high mortality rate.

https://doi.org/10.1186/s42358-018-0038-4 467 downloads

Juvenile dermatomyositis: is periodontal disease associated with dyslipidemia?
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Kozu, Kátia T.

; Silva, Clovis A.

; Aikawa, Nadia E.

; Pereira, Rosa M. R.

; Sallum, Adriana M.

; Savioli, Cynthia

; Borba, Eduardo

; Campos, Lucia M.

Advances in Rheumatology

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2018, Volume 58 elocation 28

Abstract: En | Text: En | PDF: En

Abstract Background: Association between periodontal disease and dyslipidemia was recently reported in healthy adults. However, a systematic evaluation of concomitant periodontal diseases and lipid profile was not carried out in juvenile dermatomyositis (JDM). A cross-section study was performed in 25 JDM patients and 25 healthy controls, assessing demographic data, periodontal evaluation, fasting lipoproteins and anti-lipoprotein lipase antibodies. Disease parameters, laboratorial tests and treatment were also evaluated in JDM patients. Results: The mean current age was similar in patients and controls (11.5 ± 3.75 vs. 11.2 ± 2.58 years, p = 0.703). Regarding lipid profile, the median triglycerides [80(31–340) vs. 61(19–182)mg/dL, p = 0.011] and VLDL[16(6–68) vs. 13(4–36)mg/dL,p = 0.020] were significantly higher in JDM patients versus controls. Gingival vasculopathy pattern was significantly higher in the former group (60% vs. 0%, p = 0.0001), as well as the median of gingival bleeding index (GBI) [24.1(4.2–69.4) vs. 11.1(0–66.6)%,p = 0.001] and probing pocket depth (PPD) [1.7(0.6–2.4) vs.1.4(0–2.12) mm,p = 0.006]. Comparison between JDM patients with and without dyslipidemia revealed that the median of dental plaque index (PI) [100(26.7–100) vs. 59(25–100)%,p = 0.022], PPD[1.9(0.6–2.4) vs. 1.4(1.2–1.8)mm,p = 0.024] and clinical attachment level (CAL) [1.31(0.7–1.7) vs. 0.8(0.6–1.7)mm,p = 0.005] were significantly higher in patients with dyslipidemia. Further analysis between JDM patients with and without gingivitis revealed that the median of current age [12.4 (8.3–18.4) vs. 9.2 (5.5–17.5) years, p = 0.034] and disease duration [7.09 ± 3.07 vs. 3.95 ± 2.1 years, p = 0.008] were significantly higher in the former group. Conclusion: Our study showed that gingival inflammation seems to be related to dyslipidemia in JDM patients, suggesting underlying mechanisms for both complications.

https://doi.org/10.1186/s42358-018-0024-x 289 downloads

Low bone mineral density among HIV-infected patients in Brazil
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Chaba, Daniela Cardeal da Silva

; Soares, Lisméia R.

; Pereira, Rosa M. R.

; Rutherford, George W.

; Assone, Tatiane

; Takayama, Liliam

; Fonseca, Luiz A. M.

; Duarte, Alberto J. S.

; Casseb, Jorge

Revista do Instituto de Medicina Tropical de São Paulo

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2017, Volume 59 elocation e89

Abstract: En | Text: En | PDF: En

ABSTRACT Decrease in bone mineral density (BMD) has been a complication among people living with HIV/AIDS. To investigate the prevalence of osteopenia/osteoporosis among HIV-infected people living in São Paulo city, we studied 108 HIV-infected patients (79 men and 29 women). We extracted data from patients’ medical records and BMD was measured by dual-energy X-ray absorptiometry (DXA). Median age of participants was 42 years (interquartile range [IQR] 36-48 years), and the median time since HIV diagnosis was 4.01 years (IQR 2-11 years). Patients had acquired HIV primarily by the sexual route (men who have sex with men 44%, heterosexual 49%). Median age, duration of HIV infection, duration of ART and CD4 nadir were similar for men and women. Plasma viral load was undetectable for 53 patients (49%). Median CD4 T cell count was 399 cells/µL (IQR 247 - 568). Twenty five patients (23%) had LBMD, and there was no statistically significant difference between men and women (<-1). The associated risk factors for LBMD were older age (≥ 50 years old) and smoking with a RR of 3.87 and 2.80, respectively. Thus, despite the lack of statistically significant relationship between the use of ART and LBMD or between duration of ART and LBMD, these factors should be addressed in larger studies.

https://doi.org/10.1590/s1678-9946201759089 772 downloads

Quality of life measurements in patients with osteoporosis and fractures
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Madureira, Melisa M.

; Ciconelli, Rozana M.

; Pereira, Rosa M. R.

Clinics

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nov 2012, Volume 67 N. 11 Pages 1315 - 1320

Abstract: En | Text: En | PDF: En

To review all specific questionnaires regarding quality of life in osteoporosis and to describe their distinctive indications, we searched Medline, the Scientific Electronic Library Online database, and the Latin-American and Caribbean Health Sciences Literature database. Nine specific questionnaires related to osteoporosis quality of life were found: 1) the Women's Health Questionnaire, 2) Osteoporosis Quality of Life Questionnaire, 3) Osteoporosis Assessment Questionnaire, 4) Osteoporosis Functional Disability Questionnaire, 5) Quality of Life Questionnaire of the European Foundation for Osteoporosis, 6) Osteoporosis-Targeted Quality of Life Questionnaire, 7) Japanese Osteoporosis Quality of Life Questionnaire, 8) the 16-item Assessment of Health-Related Quality of Life in Osteoporosis, and 9) the Quality of Life Questionnaire in Osteoporosis (QUALIOST TM). The Quality of Life Questionnaire of the European Foundation for Osteoporosis is the osteoporosis-specific questionnaire most commonly used in the literature. The Quality of Life Questionnaire of the European Foundation for Osteoporosis and the Osteoporosis Quality of Life Questionnaire are targeted more toward fracture assessment, and the Osteoporosis Functional Disability Questionnaire can be used for longitudinal studies involving exercise. In the present study, the authors summarize all of the specific questionnaires for osteoporosis and demonstrate that these questionnaires should be selected based on the objectives to be evaluated. Osteoporosis-specific quality of life questionnaires should be validated in the language of the country of origin before being used.

https://doi.org/10.6061/clinics/2012(11)16 5225 downloads

Hypoparathyroidism mimicking ankylosing spondylitis and myopathy: a case report
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Kajitani, Thayana Ribeiro

; Silva, Renata Viana da

; Bonfá, Eloisa

; Pereira, Rosa M. R.

Clinics

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2011, Volume 66 N. 7 Pages 1287 - 1290

Abstract: En | Text: En | PDF: En

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Osteoporose na infância e na adolescência
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Campos, Lúcia M. A.

; Liphaus, Bernadete L.

; Silva, Clóvis A. A.

; Pereira, Rosa M. R.

Jornal de Pediatria

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nov 2003, Volume 79 N. 6 Pages 481 - 488

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

OBJETIVO: Revisar a literatura acerca da osteoporose na infância e adolescência, abordando diagnóstico, prevenção e tratamento de osteopenia e osteoporose. FONTE DOS DADOS: Foram utilizadas informações através de revisão bibliográfica, realizada por busca direta de artigos científicos e por pesquisa nas bases de dados Medline e Lilacs, no período de 1992 a 2002. SÍNTESE DOS DADOS: O artigo é estruturado em tópicos, nos quais procura-se definir e classificar a osteoporose na infância, enfatizar os métodos diagnósticos de imagem e laboratoriais e abordar sua terapêutica preventiva e medicamentosa. CONCLUSÃO: É de responsabilidade dos pediatras a identificação de fatores de risco para osteoporose e a orientação de seus pacientes quanto a prevenção e tratamento.

OBJECTIVE: To review recent data concerning osteoporosis and osteopenia in childhood and adolescence, focusing on diagnosis, prevention and treatment. SOURCES OF DATA: Literature review of Medline and Lilacs databases (1992 to 2002). SUMMARY OF THE FINDINGS: Childhood osteoporosis is defined and classified. Imaging and laboratory diagnostic techniques are emphasized, as well as prevention and drug treatment. CONCLUSIONS: Pediatricians should identify the risk factors for osteoporosis and guide patients in terms of its prevention and treatment.

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