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Abstract Background: There is a lack of information on the role of chronic use of hydroxychloroquine during the SARS-CoV-2 outbreak. Our aim was to compare the occurrence of COVID-19 between rheumatic disease patients on hydroxychloroquine with individuals from the same household not taking the drug during the first 8 weeks of community viral transmission in Brazil. Methods: This baseline cross-sectional analysis is part of a 24-week observational multi-center study involving 22 Brazilian academic outpatient centers. All information regarding COVID-19 symptoms, epidemiological, clinical, and demographic data were recorded on a specific web-based platform using telephone calls from physicians and medical students. COVID-19 was defined according to the Brazilian Ministry of Health (BMH) criteria. Mann-Whitney, Chi-square and Exact Fisher tests were used for statistical analysis and two binary Final Logistic Regression Model by Wald test were developed using a backward-stepwise method for the presence of COVID-19. Results: From March 29th to May 17st, 2020, a total of 10,443 participants were enrolled, including 5166 (53.9%) rheumatic disease patients, of whom 82.5% had systemic erythematosus lupus, 7.8% rheumatoid arthritis, 3.7% Sjögren’s syndrome and 0.8% systemic sclerosis. In total, 1822 (19.1%) participants reported flu symptoms within the 30 days prior to enrollment, of which 3.1% fulfilled the BMH criteria, but with no significant difference between rheumatic disease patients (4.03%) and controls (3.25%). After adjustments for multiple confounders, the main risk factor significantly associated with a COVID-19 diagnosis was lung disease (OR 1.63; 95% CI 1.03-2.58); and for rheumatic disease patients were diagnosis of systemic sclerosis (OR 2.8; 95% CI 1.19-6.63) and glucocorticoids above 10 mg/ day (OR 2.05; 95% CI 1.31-3.19). In addition, a recent influenza vaccination had a protective effect (OR 0.674; 95% CI 0.46-0.98). Conclusion: Patients with rheumatic disease on hydroxychloroquine presented a similar occurrence of COVID-19 to household cohabitants, suggesting a lack of any protective role against SARS-CoV-2 infection. Trial registration Brazilian Registry of Clinical Trials (ReBEC; RBR - 9KTWX6).

https://doi.org/10.1186/s42358-021-00217-0 22 downloads

Revisiting hydroxychloroquine and chloroquine for patients with chronic immunity-mediated inflammatory rheumatic diseases
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Reis Neto, Edgard Torres dos

; Kakehasi, Adriana Maria

; Pinheiro, Marcelo de Medeiros

; Ferreira, Gilda Aparecida

; Marques, Cláudia Diniz Lopes

; Mota, Licia Maria Henrique da

; Paiva, Eduardo dos Santos

; Pileggi, Gecilmara Cristina Salviato

; Sato, Emília Inoue

; Reis, Ana Paula Monteiro Gomides

; Xavier, Ricardo Machado

; Provenza, José Roberto

Advances in Rheumatology

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2020, Volume 60 elocation 32

Abstract: En | Text: En | PDF: En

Abstract Hydroxychloroquine and chloroquine, also known as antimalarial drugs, are widely used in the treatment of rheumatic diseases and have recently become the focus of attention because of the ongoing COVID-19 pandemic. Rheumatologists have been using antimalarials to manage patients with chronic immune-mediated inflammatory rheumatic diseases for decades. It is an appropriate time to review their immunomodulatory and anti-inflammatory mechanisms impact on disease activity and survival of systemic lupus erythematosus patient, including antiplatelet effect, metabolic and lipid benefits. We also discuss possible adverse effects, adding a practical and comprehensive approach to monitoring rheumatic patients during treatment with these drugs.

https://doi.org/10.1186/s42358-020-00134-8 2393 downloads

Psychoanalytic psychotherapy improves quality of life, depression, anxiety and coping in patients with systemic lupus erythematosus: a controlled randomized clinical trial
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Conceição, Céu Tristão Martins

; Meinão, Ivone Minhoto

; Bombana, José Atilio

; Sato, Emília Inoue

Advances in Rheumatology

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2019, Volume 59 elocation 4

Abstract: En | Text: En | PDF: En

Abstract Background: Systemic Lupus Erythematosus (SLE) is an autoimmune disease which impairs the quality of life. The objective of study was to evaluate the effectiveness of Brief Group Psychoanalytic Psychotherapy to improve quality of life, depression, anxiety and coping strategies in SLE patients. Methods: In a randomized clinical trial, 80 female SLE patients were allocated into two groups: therapy group (n = 37) and control group (n =43). Therapy group (TG) attended weekly psychotherapy sessions for 20 weeks; control group (CG) remained on a waiting list. Both groups received standard medical care. Questionnaires and scales were applied by blinded evaluators at baseline (T1) and after 20 weeks (T2): Socioeconomic Status, SLE International Collaborating Clinic/American College of Rheumatology-Damage Index, SLE International Disease Activity, SLE Specific Symptom Checklist, SLE Quality of life, Hospital Anxiety Depression Scale, Coping Strategies Inventory. Intent to treat intra- and inter-group analysis was performed for all variables in T1 and T2 using Qui-square, t-Student, Mann-Whitney and Wilcoxon tests. Analysis of Variance was used to compare categorical variables overtime. P < 0.05 was considered significant. Results: The mean age of patients was 42 years; 54% were white, with mean disease duration of years 12. At baseline, both groups were homogeneous in all variables, including medications. After 20 weeks of psychotherapy TG was significantly different from CG, with lower frequency of symptoms (p = 0.001), lower level of anxiety (p = 0.019) and depression (p = 0.022), better index in five of six domains of quality of life scale (p ≤ 0.005), including total SLEQOL (p < 0.001) and with higher positive planful problem solving strategy (p = 0.017). No change in disease activity score was observed in both groups. Conclusions: Psychoanalytic psychotherapy was effective to improve many domains of quality of life and one positive coping skill and to reduce SLE symptoms, anxiety and depression levels. Brief group psychotherapy can be a useful tool to complement medical care in SLE patients. Trial registration: Number NCT01840709.

https://doi.org/10.1186/s42358-019-0047-y 721 downloads

Endothelial progenitor cells and vascular endothelial growth factor in patients with Takayasu's arteritis
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Machado, Luiz Samuel Gomes

; Oliveira, Ana Cecilia Diniz

; Semedo-Kuriki, Patricia

; Souza, Alexandre Wagner Silva de

; Sato, Emilia Inoue

Advances in Rheumatology

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2018, Volume 58 elocation 24

Abstract: En | Text: En | PDF: En

Abstract Background: Endothelial progenitor cells (EPCs) are responsible for endothelial damage repair. Takayasu's arteritis (TA) is a chronic inflammatory disease that affects large vessels. The aim of the study was to evaluate the number of EPCs and the levels of vascular endothelial growth factor (VEGF) and the relationship of these variables in patients with TA. Methods: Thirty women with TA and 30 healthy controls were included. EPCs were assessed by flow cytometry and cell culture and VEGF quantification was performed by commercial ELISA kits. Results: Ages of patients and controls were similar. The number of EPCs in patients and controls (median (interquartile range) were 0.0073% (0.0081%) vs. 0.0062% (0.0089%), p = 0.779 by flow cytometry and 27.0 (42.3) colony forming units (CFUs) vs. 27.0 (20.5) CFUs, p = 0.473 by cells culture, respectively. VEGF levels in patients and controls was 274.5 (395.5) pg/ml vs. 243.5 (255.3) pg/ml, p = 0.460. There was no difference in the number of EPCs and VEGF level between patients with active and inactive disease. There was a tendency of the number of angioblast-like EPCs in patients taking anti-TNFs to be higher; and in patients using methotrexate to be lower. Conclusion: No significant difference was found in the quantification of EPCs and VEGF levels in TA patients compared to controls, and no difference was observed between patients with active and inactive disease.

https://doi.org/10.1186/s42358-018-0025-9 288 downloads

Atualização da Diretriz Brasileira de Dislipidemias e Prevenção da Aterosclerose – 2017
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Faludi, André Arpad

; Izar, Maria Cristina de Oliveira

; Saraiva, José Francisco Kerr

; Chacra, Ana Paula Marte

; Bianco, Henrique Tria

; Afiune Neto, Abrahão

; Bertolami, Adriana

; Pereira, Alexandre C.

; Lottenberg, Ana Maria

; Sposito, Andrei C.

; Chagas, Antonio Carlos Palandri

; Casella Filho, Antonio

; Simão, Antônio Felipe

; Alencar Filho, Aristóteles Comte de

; Caramelli, Bruno

; Magalhães, Carlos Costa

; Negrão, Carlos Eduardo

; Ferreira, Carlos Eduardo dos Santos

; Scherr, Carlos

; Feio, Claudine Maria Alves

; Kovacs, Cristiane

; Araújo, Daniel Branco de

; Magnoni, Daniel

; Calderaro, Daniela

; Gualandro, Danielle Menosi

; Mello Junior, Edgard Pessoa de

; Alexandre, Elizabeth Regina Giunco

; Sato, Emília Inoue

; Moriguchi, Emilio Hideyuki

; Rached, Fabiana Hanna

; Santos, Fábio César dos

; Cesena, Fernando Henpin Yue

; Fonseca, Francisco Antonio Helfenstein

; Fonseca, Henrique Andrade Rodrigues da

; Xavier, Hermes Toros

; Mota, Isabela Cardoso Pimentel

; Giuliano, Isabela de Carlos Back

; Issa, Jaqueline Scholz

; Diament, Jayme

; Pesquero, João Bosco

; Santos, José Ernesto dos

; Faria Neto, José Rocha

; Melo Filho, José Xavier de

; Kato, Juliana Tieko

; Torres, Kerginaldo Paulo

; Bertolami, Marcelo Chiara

; Assad, Marcelo Heitor Vieira

; Miname, Márcio Hiroshi

; Scartezini, Marileia

; Forti, Neusa Assumpta

; Coelho, Otávio Rizzi

; Maranhão, Raul Cavalcante

; Santos Filho, Raul Dias dos

; Alves, Renato Jorge

; Cassani, Roberta Lara

; Betti, Roberto Tadeu Barcellos

; Carvalho, Tales de

; Martinez, Tânia Leme da Rocha

; Giraldez, Viviane Zorzanelli Rocha

; Salgado Filho, Wilson

Arquivos Brasileiros de Cardiologia

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aug 2017, Volume 109 N. 2 Pages 1 - 76

Abstract: Pt | Text: Pt | PDF: Pt

https://doi.org/10.5935/abc.20170121 199102 downloads

Leflunomide in Takayasu arteritis – A long term observational study
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Souza, Alexandre Wagner Silva de

; Agustinelli, Renan de Almeida

; Almeida, Hemerli de Cinque

; Oliveira, Patrícia Bermudes

; Pinheiro, Frederico Augusto Gurgel

; Oliveira, Ana Cecilia Diniz

; Sato, Emilia Inoue

Revista Brasileira de Reumatologia

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aug 2016, Volume 56 N. 4 Pages 371 - 375

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

RESUMO Objetivo: Avaliar os dados de seguimento em longo prazo em relação à eficácia e toxicidade do tratamento com leflunomida em pacientes com arterite de Takayasu (AT) previamente recrutados no estudo aberto original dos efeitos de curto prazo da leflunomida na AT. Métodos: Fez-se um estudo longitudinal aberto de longo prazo com pacientes que preencheram os critérios para AT da American College of Rheumatology de 1990 e que participaram de um estudo anterior que avaliou a eficácia em curto prazo da leflunomida na AT. Obtiveram-se informações completas do seguimento de 12 dos 15 pacientes incluídos no estudo original. A atividade da doença foi avaliada pelos critérios de Kerr e pelo Indian Takayasu Activity Score 2010 (ITAS2010). Resultados: O tempo médio de seguimento foi de 43,0 ± 7,6 meses. Cinco (41,6%) pacientes com AT permaneceram em tratamento com leflunomida, enquanto sete (58,3%) tiveram de mudar para outro tratamento em razão da falha em prevenir recidivas em seis pacientes e toxicidade em um paciente. Não foram encontradas diferenças significativas entre os pacientes que continuaram o tratamento com leflunomida e aqueles que mudaram para outro agente em relação à idade no início do estudo, tempo desde o diagnóstico, dose diária de prednisona no início do estudo, ITAS2010 inicial, valor médio ou máximo de VHS e PCR, e dose de prednisona cumulativa no fim do estudo. Entre os dois pacientes com AT que mudaram de leflunomida para outro agente, dois tiveram uma recidiva clínica e precisaram mudar de tratamento. Conclusão: A leflunomida levou à remissão sustentada em aproximadamente metade dos pacientes por um período médio de 12 meses e foi bem tolerada pelos pacientes com AT.

ABSTRACT Objective: To evaluate the extended follow-up data on efficacy and toxicity of leflunomide therapy in Takayasu arteritis (TA) patients previously enrolled in the original open-label study of short-term effects of leflunomide in TA. Methods: An open-label long-term longitudinal study was performed in TA patients who fulfilled the 1990 American College of Rheumatology criteria for TA and had participated in a previous study that evaluated short-term efficacy of leflunomide in TA. Complete follow-up information could be retrieved from 12 out of 15 patients enrolled in the original study. Disease activity was evaluated by Kerr's criteria and by the Indian Takayasu Activity Score 2010 (ITAS2010). Results: The mean follow up time was 43.0 ± 7.6 months and 5 (41.6%) TA patients remained on leflunomide therapy while 7 (58.3%) TA patients had to change to another therapy due to failure to prevent relapses in 6 patients and toxicity in one patient. No significant differences were found between patients who remained on leflunomide therapy and those who changed to another agent regarding age at study entry, time since diagnosis, prednisone daily dose at study entry, baseline ITAS2010, mean or maximum ESR and CRP, and cumulative prednisone dose at study end. Among TA patients who had changed leflunomide to another agent, two had an additional clinical relapse and needed to change therapy. Conclusion: Leflunomide led to sustained remission in approximately half of patients at a mean time of 12 months and was well tolerated by TA patients.

https://doi.org/10.1016/j.rbre.2016.02.003 1412 downloads

Visual loss resulting from immunosuppressive therapy in patients with syphilitic uveitis
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Afonso, Vivian Cristina Costa

; Nascimento, Heloisa

; Belfort, Rubens M.

; Sato, Emilia Inoue

; Muccioli, Cristina

; Belfort Jr., Rubens

Arquivos Brasileiros de Oftalmologia

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jun 2015, Volume 78 N. 3 Pages 185 - 186

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

RESUMO Elucidar os efeitos adversos do uso de medicações imunossupressoras em pacientes com uveíte não diagnosticada por sífilis. Avaliação de quatro pacientes com uveíte por sífilis submetidos a tratamento com drogas imunossupressoras por suspeita de uveíte secundária a doenças reumáticas, que desenvolveram perda visual permanente. Sífilis deve ser sempre um diagnóstico diferencial nas doenças inflamatórias oculares, principalmente antes do início de terapia imunossupressora.

ABSTRACT Permanent visual loss can be caused by improper use of immunosuppressive therapy in cases of uveitis without differential diagnosis of syphilitic uveitis. We present four cases of syphilitic uveitis that were incorrectly diagnosed as being secondary to rheumatic diseases and were subsequently treated with immunosuppressive therapy, leading to permanent visual loss. These cases highlight the importance of ruling out syphilis in the differential diagnosis of inflammatory ocular diseases before starting use of immunosuppressive therapy.

https://doi.org/10.5935/0004-2749.20150047 2408 downloads

Consenso da Sociedade Brasileira de Reumatologia para o diagnóstico, manejo e tratamento da nefrite lúpica
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Klumb, Evandro Mendes

; Silva, Clovis Artur Almeida

; Lanna, Cristina Costa Duarte

; Sato, Emilia Inoue

; Borba, Eduardo Ferreira

; Brenol, João Carlos Tavares

; Albuquerque, Elisa Martins das Neves de

; Monticielo, Odirlei Andre

; Costallat, Lilian Tereza Lavras

; Latorre, Luiz Carlos

; Sauma, Maria de Fátima Lobato da Cunha

; Bonfá, Eloisa Silva Dutra de Oliveira

; Ribeiro, Francinne Machado

Revista Brasileira de Reumatologia

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feb 2015, Volume 55 N. 1 Pages 1 - 21

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

Objetivo Elaborar recomendações para o diagnóstico, manejo e tratamento da nefrite lúpica no Brasil. Método Revisão extensa da literatura com seleção dos artigos com base na força de evidência científica e opinião dos membros da Comissão de Lúpus Eritematoso Sistêmico da Sociedade Brasileira de Reumatologia. Resultados e conclusões 1) A biópsia renal deve ser feita sempre que possível e houver indicação e quando não for possível, o tratamento deve ser orientado com base na inferência da clase histológica. 2) Devem ser implementados medidas e cuidados idealmente antes do início do tratamento, com ênfase na atenção ao risco de infecção. 3) Devem-se compartilhar riscos e benefícios do tratamento com pacientes e familiares. 4) O uso da hidroxicloroquina (preferencialmente) ou difosfato de cloroquina é recomendado para todos os pacientes (exceto contraindicação) durante as fases de indução e manutenção. 5) A avaliação da eficácia do tratamento deve ser feita com critérios objetivos de resposta (remissão completa/remissão parcial/refratariedade). 6) Os IECA e/ou BRA são recomendados como antiproteinúricos para todos os pacientes (exceto contraindicação). 7) A identificação de sinais clínicos e/ou laboratoriais sugestivos de GN laboratoriais sugestivos de glomerulonefrite proliferativa ou membranosa deve indicar início imediato de terapia específica incluindo corticosteroides e agente imunossupressor, mesmo que não seja possível comprovação histológica. 8) O tempo de uso dos imunossupressores deve ser no mínimo de 36 meses, mas eles podem ser mantidos por períodos mais longos. A sua suspensão só deve ser feita quando o paciente atingir e mantiver remissão completa sustentada. 9) Deve-se considerar nefrite lúpica refratária quando a remissão completa ou parcial não for alcançada após 12 meses de tratamento adequado, quando uma nova biópsia renal deve ser considerada para auxiliar na identificação da causa da refratariedade e decisão terapêutica.

Objective To develop recommendations for the diagnosis, management and treatment of lupus nephritis in Brazil. Method Extensive literature review with a selection of papers based on the strength of scientific evidence and opinion of the Commission on Systemic Lupus Erythematosus members, Brazilian Society of Rheumatology. Results and conclusions (1) Renal biopsy should be performed whenever possible and if this procedure is indicated; and, when the procedure is not possible, the treatment should be guided with the inference of histologic class. (2) Ideally, measures and precautions should be implemented before starting treatment, with emphasis on attention to the risk of infection. (3) Risks and benefits of treatment should be shared with the patient and his/her family. (4) The use of hydroxychloroquine (preferably) or chloroquine diphosphate is recommended for all patients (unless contraindicated) during induction and maintenance phases. (5) The evaluation of the effectiveness of treatment should be made with objective criteria of response (complete remission/partial remission/refractoriness). (6) Angiotensin-converting enzyme inhibitors and/or angiotensin receptor blockers are recommended as antiproteinuric agents for all patients (unless contraindicated). (7) The identification of clinical and/or laboratory signs suggestive of proliferative or membranous glomerulonephritis should indicate an immediate implementation of specific therapy, including corticosteroids and an immunosuppressive agent, even though histological confirmation is not possible. (8) Immunosuppressives must be used during at least 36 months, but these medications can be kept for longer periods. Its discontinuation should only be done when the patient could achieve and maintain a sustained and complete remission. (9) Lupus nephritis should be considered as refractory when a full or partial remission is not achieved after 12 months of an appropriate treatment, when a new renal biopsy should be considered to assist in identifying the cause of refractoriness and in the therapeutic decision.

https://doi.org/10.1016/j.rbr.2014.09.008 84295 downloads

Anticorpos antinucleossomo e síndrome antifosfolipídica: estudo observacional
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Souza, Alexandre Wagner Silva de

; Keusseyan, Silene Peres

; Silva, Neusa Pereira da

; Sato, Emilia Inoue

; Andrade, Luis Eduardo Coelho

Revista Brasileira de Reumatologia

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jun 2012, Volume 52 N. 3 Pages 361 - 365

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

OBJETIVO: Avaliar a associação entre a presença de anticorpos antinucleossomo (anti-NCS) e a síndrome antifosfolipídica primária (SAFP) e o posterior desenvolvimento de lúpus eritematoso sistêmico (LES). MATERIAIS E MÉTODOS: Trinta e seis mulheres com o diagnóstico de SAFP foram avaliadas prospectivamente para manifestações de doenças reumáticas autoimunes e para a presença de anticorpos antifosfolípides, anticorpos antinucleares e anti-NCS/cromatina. RESULTADOS: Após um período médio de seguimento de 45,7 meses, anticorpos anti-NCS/cromatina foram detectados em apenas uma paciente (2,8%), que desenvolveu manifestações de LES tais como poliartrite, linfopenia, neurite óptica, lesões compatíveis com esclerose múltipla em substância branca cerebral e perfil de autoanticorpos altamente sugestivo de LES. CONCLUSÃO: A frequência de anticorpos anti-NCS/cromatina é baixa em pacientes com SAFP, e sua presença pode associar-se ao desenvolvimento de manifestações de LES.

OBJECTIVE: To study the association of anti-nucleosome (anti-NCS) antibodies in primary antiphospholipid syndrome (APS) and the development of systemic lupus erythematosus (SLE) during follow-up. MATERIALS AND METHODS: Thirty-six women with primary APS were evaluated prospectively for clinical features of systemic autoimmune diseases and for the presence of antiphospholipid antibodies, antinuclear antibodies and anti-NCS/chromatin antibodies. RESULTS: After a mean follow-up period of 45.7 months, anti-NCS/chromatin antibodies were detected in only one patient (2.8%), who developed features of SLE including polyarthritis, lymphopenia, optic neuritis, multiple sclerosis-like lesions, and an autoantibody profile suggestive of SLE. CONCLUSION: The frequency of anti-NCS/chromatin antibodies in primary APS patients is very low, and they may be associated with the development of SLE manifestations.

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10.

Consenso de lúpus eritematoso sistêmico
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Borba, Eduardo Ferreira

; Latorre, Luiz Carlos

; Brenol, João Carlos Tavares

; Kayser, Cristiane

; Silva, Nilzio Antonio da

; Zimmermann, Adriana Fontes

; Pádua, Paulo Madureira de

; Costallat, Lilian Tereza Lavras

; Bonfá, Eloísa

; Sato, Emília Inoue

Revista Brasileira de Reumatologia

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aug 2008, Volume 48 N. 4 Pages 196 - 207

Abstract: Pt | Text: Pt | PDF: Pt

190478 downloads Cited 10 times in SciELO

11.

Factores de riesgo para aterosclerosis en enfermedades autoinmunitarias
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Silvariño, Ricardo

; Sato, Emilia Inoue

Revista Médica del Uruguay

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jun 2008, Volume 24 N. 2 Pages 118 - 132

Los pacientes con enfermedades autoinmunitarias sistémicas (EAIS) presentan un riesgo incrementado de desarrollar aterosclerosis (AE). Esto responde a la presencia de factores de riesgo cardiovascular (FRCV) tradicionales -dislipemia, hipertensión arterial, diabetes, tabaquismo, obesidad, sedentarismo- y no tradicionales -actividad de la enfermedad, hiperhomocisteinemia, corticoterapia- que por diferentes caminos están incrementados. Los scores de riesgo cardiovascular absoluto no se mostraron útiles para predecir enfermedad cardiovascular en esta población, ya que al considerar solo los FRCV tradicionales subestiman el riesgo de futuros eventos. Las manifestaciones clínicas tienen características diferenciales que deben ser consideradas para no desestimarlas en la práctica clínica. El screening sistemático de los FRCV y la búsqueda de aterosclerosis subclínica deben estar dentro de la rutina de seguimiento de esta población. En ausencia de guías específicas y bajo el postulado que las EAIS imprimen un riesgo cardiovascular (CV) similar a la diabetes mellitus, los objetivos terapéuticos se asimilan a los propuestos para esta enfermedad. El control agresivo de los FRCV con medidas farmacológicas y no farmacológicas es el único camino capaz de reducir una de las principales causas de muerte en portadores de EAIS.

Résumé Les patients ayant des maladies auto-immunes systémiques (MAIS) risquent de subir athérosclérose (AS).Cela est dû aux facteurs de risque cardiovasculaire (FRCV) traditionnels -dislipémie, hypertension artérielle, diabète, tabagisme, obésité, sédentarisme- et pas tradi-tionnels -activité de la maladie, hyperhomocystéinémie, corticothérapie- qui y sont exacerbés pour de différentes voies. Les scores de risque cardiovasculaire absolu se sont avérés inutiles pour prédire des troubles cardiovasculaires chez ces patients, puisque ne tenant compte que des FRCV traditionnels, le risque de futurs événements est sous-estimé. Les données cliniques ont des caractéristiques différentielles qui doivent être consi-dérées dans la pratique clinique. Le screening systéma-tique des FRCV ainsi que la recherche d’athérosclérose subclinique doivent faire partie du suivi de routine de cette population. N’ayant pas de guides spécifiques et sachant que les MAIS comportent un risque cardiovasculaire (CV) comparable à celui du diabète mellitus, les objectifs thérapeutiques se rapprochent de ceux proposés pour cette maladie-là. Le contrôle agressif des FRCV avec des mesures pharmacologiques et pas pharmacologiques devient la seule voie pouvant réduire une des principales causes de mort chez les porteurs de MAIS.

Resumo Os pacientes com enfermidades auto-imunes sistêmicas (EAIS) têm um risco maior de apresentar aterosclerose (AE). Isto se deve a presença de fatores de risco cardiovascular (FRCV) tradicionais -dislipemia, hipertensão arterial, diabete, tabagismo, obesidade, sedentarismo- e não tradicionais -atividade da doença, hiperhomocisteinemia, corticoterapia- que por diferentes causas estão aumentados. Os indicadores de risco cardiovascular absoluto não foram úteis para fazer a predição de doença cardiovascular nesta população, pois considerando somente os FRCV tradicionais subestimam o risco de futuros eventos. As manifestações clínicas têm características diferenciadas que devem ser consideradas para não serem subestimadas na prática clínica. A triagem sistemática dos FRCV e a busca de ateroscleroses sub-clínica devem ser parte da rotina de seguimento desta população. Considerando a falta de pautas específicas e considerando que as EAIS apresentam um risco cardiovascular (CV) similar à diabetes mellitus, os objetivos terapêuticos são semelhantes aos propostos para esta patologia. O controle agressivo dos FRCV com medidas farmacológicas y não farmacológicas é o único caminho capaz de reduzir uma das principais causas de morte em portadores de EAIS.

Summary Patients with systemic autoimmune diseases have an increased risk to develop atherosclerosis. This is due to the presence of traditional cardiovascular risk factors - dysli-pidemia, high blood pressure, diabetes, smoking, obesity, sedentary lifestyle- and non-traditional ones -the disease itself, hyperhomocisteinemia, corticotherapy- , which rise in a number of ways. Absolute cardiovascular risk scores were not useful to predict cardiovascular disease in this population since by considering just the traditional cardiovascular risk factors futures events are being underestimated. Systematic screening of cardiovascular risk factors and looking for subclinical atherosclerosis must be a part of the follow-up routine for this population. Upon absence of specific guidelines and understanding systematic autoimmuune diseases is a cardiovascular risk factor similar to diabetes mellitus, therapeutic objectives adopted are similar to those used for the latter. Aggressive pharmacological and non-pharmacological control of cardiovascular risk factors is the only way to reduce and is one of the leading causes of death in carriers of systemic autoimmune diseases.

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12.

Tratamento da arterite de Takayasu
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Souza, Alexandre Wagner Silva de

; Neves, Raissa Maria Sampaio

; Oliveira, Kathia Regina

; Sato, Emília Inoue

Revista Brasileira de Reumatologia

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jun 2006, Volume 46 Suppl. 1 Pages 2 - 7

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

A arterite de Takayasu (AT) é uma vasculite granulomatosa crônica que envolve a aorta e seus principais ramos. A monitoração da atividade da doença e o melhor esquema terapêutico ainda têm sido um desafio para todos os que tratam estes pacientes. Corticosteróides e imunossupressores vêm sendo utilizados na prática clínica diária com resultados nem sempre animadores. Apesar de não haver estudos controlados que abordem o tratamento da AT, diferentes estudos observacionais descrevem a resposta de pacientes com AT ao uso de corticosteróides, metotrexato (MTX), azatio-prina e ciclofosfamida. Após a introdução da terapia biológica, novas perspectivas têm surgido para os pacientes com AT refratários aos esquemas terapêuticos tradicionais.

Takayasus’s arteritis is a chronic granulomatous vasculitis involving the aorta and its main branches. Monitoring disease activity and the choice for the best therapy has been major challenger faced by all physicians who treat these patients. Corticosteroids and immunosuppressive therapy have been used in daily medical practice, but results have not always been encouraging. Although there are no controlled studies evaluating the treatment of Takayasu’s arteritis, observational studies have described the response to the use of corticosteroids, methotrexate, azathioprine and cyclophosphamide. The emerging of biological therapy has brought new perspective for Takayasu’s patients who are refractory to conventional therapy.

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13.

Lúpus eritematoso sistêmico (LES): perfil clínico-laboratorial dos pacientes do Hospital Universitário Onofre Lopes (UFRN-Natal/Brasil) e índice de dano nos pacientes com diagnóstico recente
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Bezerra, Elaine Lira Medeiros

; Vilar, Maria José Pereira

; Barbosa, Olívia de Fátima Costa

; Santos, Sílvia Queiroz

; Castro, Milena de Araújo

; Trindade, Marília Cavalcanti da

; Sato, Emilia Inoue

Revista Brasileira de Reumatologia

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dec 2005, Volume 45 N. 6 Pages 339 - 342

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

OBJETIVO: Determinar a freqüência das manifestações clínicas e laboratoriais de pacientes com lúpus eritematoso sistêmico (LES) e identificar os danos precoces nos pacientes com diagnóstico recente. MÉTODOS: Avaliação retrospectiva de 164 pacientes com LES do ambulatório de Reumatologia do Hospital Universitário Onofre Lopes - UFRN, de abril de 2003 a dezembro de 2004. As manifestações clínicas e laboratoriais avaliadas referem-se aos critérios de classificação do Colégio Americano de Reumatologia. A avaliação do índice de dano, através do SLICC/ACR DI (Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index) foi realizada em 32 pacientes que tinham entre dois e três anos de diagnóstico. RESULTADOS: As manifestações clínicas mais freqüentes foram as cutâneas (90,2%), em especial a fotossensibilidade. As demais manifestações clínicas e laboratoriais foram semelhantes às descritas na literatura. Dano orgânico precoce foi identificado em nove pacientes com doença recente (28,1%) e, novamente, o acometimento cutâneo foi o mais freqüente (12,5%). CONCLUSÃO: Tanto as manifestações clínicas quanto os danos orgânicos precoces mais comuns foram relacionados à pele. Portanto, faz-se necessário o incentivo à fotoproteção em nossa região, que tem alta influência dos raios ultravioleta.

OBJECTIVE: to analyse clinical and laboratory features of patients with systemic lupus erythematosus (SLE), and to describe the early damage outcome of SLE patients in recent onset disease. METHODS: a retrospective study of 164 SLE patients followed at The Onofre Lopes University Hospital - Universidade Federal do Rio Grande do Norte (ufrn), from April, 2003 to December, 2004. The clinical and laboratory data were analyzed according to American College of Rheumatology criteria for sle. Thirty two patients between two and three years of disease were evaluated concerning the irreversible damage using slicc/acr di (Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index). RESULTS: the most frequent clinical manifestations were cutaneous (90.2%), specially photosensitivity. The other clinical and laboratory features were similar to the literature. Early organ damage was present in nine patients (28.1%) with recent onset disease and the cutaneous involvement (12.5%) was the most frequent too. CONCLUSION: This study suggests that high exposure to ultraviolet light rays could influence clinical manifestations and early damage in sle patients.

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14.

Atherosclerotic plaque in carotid arteries in systemic lupus erythematosus: frequency and associated risk factors
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Souza, Alexandre Wagner Silva de

; Hatta, Francisca Satomi

; Miranda Jr., Fausto

; Sato, Emília Inoue

Sao Paulo Medical Journal

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may 2005, Volume 123 N. 3 Pages 137 - 142

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

CONTEXTO E OBJETIVO: Doença aterosclerótica é importante causa de morbidade e mortalidade em pacientes com lúpus eritematoso sistêmico. Não há estudos que verifiquem a prevalência de aterosclerose em carótidas nesses pacientes no Brasil. O objetivo deste trabalho foi estimar a prevalência de aterosclerose em carótidas em pacientes com lúpus e em controles, e avaliar associação entre fatores de risco e aterosclerose em carótidas. TIPO DE ESTUDO E LOCAL: Estudo transversal na: Universidade Federal de São Paulo - Escola Paulista de Medicina, São Paulo, Brasil. MÉTODOS: Foi utilizado o ultra-som modo B de carótidas em 82 mulheres com lúpus eritematoso sistêmico e em 62 controles. A idade média das pacientes foi de 34,0 anos (variação 16-65) e dos controles foi de 35,7 anos (variação 18-64). Placa aterosclerótica foi definida como área distinta de hiperecogenicidade ou como área focal de protrusão da parede para o lúmen do vaso. Foram pesquisados fatores de risco para doença coronária e variáveis relacionadas ao lúpus. RESULTADOS: 50% dos pacientes e 29% dos controles apresentaram placas em carótidas (p = 0,011). Idade mais avançada, maior tempo de lúpus, maior pontuação do escore Systemic Lupus International Collaborating Clinics, maiores níveis de lipoproteína de baixa densidade, maior freqüência de diabetes, falência ovariana precoce, obesidade e história familiar de doença coronariana foram encontrados em pacientes com placas de carótidas. Pacientes com placas em carótidas tiveram menor média de idade em relação às controles com placas. Fatores de risco associados a placas em carótidas foram diagnóstico de lúpus (razão de chances: 4,74; intervalo de confiança de 95%: 1,83 a 12,27), obesidade (razão de chances: 6,16; intervalo de confiança de 95%: 1,84 a 20,64), idade avançada (razão de chances: 1,12; intervalo de confiança de 95%: 1,07 a 1,17), maior escore Systemic Lupus International Collaborating Clinics (razão de chances: 1,69; intervalo de confiança de 95%: 1,31 a 2,52) e maior tempo de lúpus (razão de chances: 1,65; intervalo de confiança de 95%: 1,06 a 2,56). CONCLUSÃO: Pacientes jovens com lúpus apresentam maior prevalência de aterosclerose de carótidas. O diagnóstico de lúpus eritematoso sistêmico foi fator de risco para aterosclerose de carótidas.

CONTEXT AND OBJECTIVE: Atherosclerotic disease is an important cause of morbidity and mortality in systemic lupus erythematosus (SLE) patients. No previous study has estimated carotid disease prevalence in such patients in Brazil. The aim was to evaluate the prevalence of atherosclerotic plaque in carotid arteries, in SLE patients and controls, and to verify possible associations between risk factors and carotid plaque. DESIGN AND SETTING: Cross-sectional study, at Universidade Federal de São Paulo - Escola Paulista de Medicina. METHODS: Carotid plaque prevalence was assessed by B-mode ultrasound in 82 female SLE patients of mean age 34.0 years and 62 controls of mean age 35.7 years. Plaque was defined as a distinct area of hyperechogenicity and/or focal protrusion of the vessel wall into the lumen. Risk factors for coronary disease and SLE-related variables were determined. RESULTS: 50% of patients and 29% of controls presented carotid plaque. Older age, longer disease duration, higher Systemic Lupus International Collaborating Clinics (SLICC) score, higher levels of low-density lipoprotein and greater diabetes, obesity, premature ovarian failure and family history of coronary artery disease were found in patients with carotid plaque than in those without plaque. Patients with plaque were younger than controls with plaque. SLE diagnosis, obesity, older age, higher SLICC score and longer disease duration were independent risk factors for carotid plaque. CONCLUSION: Young patients with SLE present higher prevalence of carotid plaque than controls. SLE diagnosis was a significant risk factor for carotid atherosclerosis.

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15.

Osteonecrose em pacientes com lúpus eritematoso sistêmico
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Sella, Elaine Marcelina Claudio

; Carvalho, Maria Rosenilda Petronila de

; Sato, Emilia Inoue

Revista Brasileira de Reumatologia

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feb 2005, Volume 45 N. 1 Pages 1 - 8

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

Osteonecrose é uma complicação relativamente comum em pacientes com lúpus eritematoso sistêmico (LES). OBJETIVO: avaliação dos possíveis fatores de risco associados à presença de osteonecrose em pacientes com LES. MÉTODOS: Foram incluídos neste estudo pacientes com LES [critérios para a classificação do American College of Rheumatology (ACR)] que apresentaram osteonecrose durante a evolução da doença. O grupo controle foi constituído por pacientes com LES sem indícios de osteonecrose. O diagnóstico de osteonecrose foi confirmado por radiografia simples, cintilografia óssea e/ou ressonância nuclear magnética. RESULTADOS: quatorze pacientes com LES desenvolveram osteonecrose (10 mulheres e 4 homens, 64% de cor branca, 33 ± 13 anos e 120 ± 67 meses de LES). O grupo controle, pareado por sexo e tempo de diagnóstico de LES, foi constituído por pacientes com LES e sem osteonecrose (n = 14, 57% de cor branca, 33 ± 7 anos e 111 ± 54 meses de LES). O escore do systemic lupus international collaborating clinics/ACR damage index for systemic lupus erythematosus (SLICC/ACR-DI) foi maior nos pacientes com osteonecrose (4 ± 1) em comparação com o grupo controle (1 ± 1) [p < 0,001]. Pacientes com osteonecrose apresentaram maior número de outros danos musculoesqueléticos permanentes quando comparados com os pacientes controles (29% versus zero, respectivamente; p = 0,034). A vasculite digital foi a variável associada à osteonecrose (p = 0,021). Não houve associação significante entre tempo de uso ou dose cumulativa de prednisona e osteonecrose nos pacientes regularmente acompanhados com o diagnóstico de LES (p = 0,624 e p = 0,806, respectivamente). CONCLUSÕES: História prévia de vasculite digital foi fator de risco para o desenvolvimento de osteonecrose. O risco de pacientes com vasculite digital pregressa apresentar osteonecrose foi nove vezes maior que o de pacientes com LES sem vasculite prévia.

Osteonecrosis is a relatively common complication in systemic lupus erythematosus (SLE) patients. OBJECTIVE: To evaluate the possible risk factors associated with osteonecrosis in SLE patients. METHODS: SLE patients [according to American College of Rheumatology (ACR) criteria] who presented osteonecrosis were included in this study. SLE patients with no symptomatic osteonecrosis constituted the control group. Osteonecrosis was confirmed by radiographic evaluation, bone scintigraphy and/or magnetic resonance imaging. RESULTS: The study group was constituted by 14 SLE patients with osteonecrosis (10 women and 4 men, 64% of them white, 33 ± 13 years old and 120 ± 67 months of disease duration). Sex and time of SLE diagnosis matched patients without osteonecrosis constituted the control group (n = 14, 57% of them white, 33 ± 7 years old and 111 ± 54 months of SLE). Systemic lupus international collaborating clinics/ACR damage index for SLE (SLICC/ACR-DI) score was higher in patients with osteonecrosis (4 ± 1) compared with control group (1 ± 1) [p < 0.001]. Patients with osteonecrosis had higher number of other musculoskeletal irreversible damage when compared with the control group (29% versus 0, respectively; p = 0.034). Digital vasculitis was the variable associated with osteonecrosis (p = 0.021). There was no significant association between duration of prednisone use or prednisone cumulative dose and osteonecrosis in patients with regular follow-up at the Institution (p = 0.624 and p = 0.806, respectively). CONCLUSIONS: Previous history of digital vasculitis was a risk factor for the development of osteonecrosis. Patients with digital vasculitis history had 9 times more risk to present osteonecrosis than patients without previous vasculitis.

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