RESUMO
BACKGROUND: Whether patients with autoimmune rheumatic diseases (ARD) have a higher risk for SARS-CoV-2 infection (COVID-19) and how SARS-CoV-2 pandemic impacts on adherence to therapy has not been fully elucidated. We assessed the rate and clinical presentation of COVID-19, and adherence to therapy in a large cohort of patients with ARD followed-up in a tertiary University-Hospital in Northeast Italy. METHODS: Between April 9th and April 25th, 2020, after SARS-CoV-2 infection peak, a telephone survey investigating the impact of COVID-19 on patients with systemic lupus erythematosus (SLE), systemic sclerosis (SSc), rheumatoid arthritis (RA), ANCA-associated vasculitis (AAV), and idiopathic inflammatory myopathies (IIM) was administered. Demographics, disease activity status, therapy, occupational exposure, and adherence to social distancing advise were also collected. RESULTS: 916 patients (397 SLE, 182 AAV, 176 SSc, 111 RA, 50 IIM) completed the survey. 148 patients developed at least one symptom compatible with COVID-19 (cough 96, sore throat 64, fever 64, arthromyalgias 59, diarrhea 26, conjunctivitis 18, ageusia/hyposmia, 18). Among the 916 patients, 65 (7.1%) underwent SARS-CoV-2 nasopharyngeal swab (18 symptomatic and 47 asymptomatic), 2 (0.21%) tested positive, a proportion similar to that observed in the general population of the Veneto region. No deaths occurred. 31 patients (3.4%) withdrew ≥1 medication, mainly immunosuppressants or biologics. Adoption of social distancing was observed by 860 patients (93.9%), including 335 (36.6%) who adopted it before official lockdown. CONCLUSIONS: COVID-19 incidence seems to be similar in our cohort compared to the general population. Adherence to therapy and to social distancing advise was high.
Assuntos
Doenças Autoimunes/tratamento farmacológico , Betacoronavirus , Infecções por Coronavirus/tratamento farmacológico , Imunossupressores/administração & dosagem , Pneumonia Viral/tratamento farmacológico , Doenças Reumáticas/tratamento farmacológico , Adulto , Idoso , Doenças Autoimunes/diagnóstico , Doenças Autoimunes/virologia , COVID-19 , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/patologia , Feminino , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/patologia , Doenças Reumáticas/diagnóstico , Doenças Reumáticas/virologia , SARS-CoV-2RESUMO
Septic arthritis (SA) is a clinical emergency with considerable morbidity and mortality that can lead to rapid joint destruction and irreversible functional loss. The reported incidence varies from 2-5 cases/100,000 person-years in the general population to 70 cases/100,000 person-years among patients with rheumatoid arthritis. In fact, individuals with rheumatoid arthritis are at particular risk for developing SA. This may be due to several reasons: joint disease predisposes to bacterial joint colonization and RA itself and its treatment with corticosteroids, disease-modifying antirheumatic drugs (DMARDs) and biological therapies may decrease the immune function required for protection from pathogens. Steroids and DMARDs seem to affect the leukocyte synovial count; indeed, RA patients with SA have a leukocyte count in synovial fluid (SF) lower than patients with SA without underlying rheumatic diseases. The diagnosis of SA in RA patients can be difficult because the development of a hot painful joint is often confused with a relapse of the underlying joint disease leading to delay in diagnosis. For this reason the microscopic analysis and culture of synovial fluid are crucial to exclude septic arthritis.
Assuntos
Antirreumáticos/uso terapêutico , Artrite Infecciosa/epidemiologia , Imunidade Ativa/efeitos dos fármacos , Líquido Sinovial/citologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Artrite Infecciosa/tratamento farmacológico , Artrite Reumatoide/imunologia , Causalidade , Feminino , Humanos , Terapia de Imunossupressão , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Líquido Sinovial/efeitos dos fármacosRESUMO
Septic arthritis (SA) is a clinical emergency with considerable morbidity and mortality that can lead to rapid joint destruction and irreversible loss of function. The reported incidence varies from 2-5 cases per 100.000 individuals per year in the general populations to 70 cases per 100.000 individuals annually among patients with rheumatoid arthritis (RA). Predisposing factors are immunosuppressive and corticosteroids therapy and RA "itself". The expected decrease in incidence of SA was not seen over the last 20 years period but we can, on the contrary, expect an increase in the frequency of its appearance because of the population ageing, the increasingly prosthetic joint replacement, the ability of the bacteria to evade clearance by the host immune response and the rapidly growing number of patients with RA, ankylosing spondylitis and psoriatic arthritis treated with tumour necrosis factor alpha (TNF alpha) antagonists. Up to now there have been conflicting reports regarding joint infections in patients under anti-TNF therapy but according to data from Deutsch as well as the British register there might be an increase in the incidence of joint infections in anti-TNF treated patients. Microscopic analysis and culture of synovial fluid are fundamental diagnostic tools in the evaluation of possible joint sepsis. Sonographic guidance of arthrocentesis led to successful aspiration of difficult-to-access joints as shoulder and hip. There is controversy over which mode of drainage of septic synovial fluid should be employed but needle aspiration appear to be preferable to surgical treatment as an initial mode of treatment of SA. Rheumatologists should have a central role in the diagnosis and management of SA.
Assuntos
Artrite Infecciosa/diagnóstico , Artrite Infecciosa/terapia , Diagnóstico Precoce , Humanos , Papel do Médico , ReumatologiaRESUMO
Wegener's granulomatosis (WG) is a multisystemic necrotising granulomatous vasculitis of small and medium sized vessels, that primarily involves the upper and lower respiratory tracts, lung tissues and kidneys. Serum antineutrophil cytoplasmic antibodies (ANCA) are a sensitive and specific marker of WG. Whereas the peripheral nervous system is often involved in WG, central nervous system manifestations are reported only in 2-8%, and are rarely present at onset. We report on a patient with atypical neurological presentation of ANCA negative WG in whom the diagnosis was made only after a meningeal biopsy.
Assuntos
Encéfalo/patologia , Doenças do Sistema Nervoso Central/diagnóstico , Doenças do Sistema Nervoso Central/etiologia , Granulomatose com Poliangiite/diagnóstico , Idoso , Anticorpos Anticitoplasma de Neutrófilos/sangue , Biópsia , Doenças do Sistema Nervoso Central/complicações , Transtornos de Deglutição/etiologia , Disfonia/etiologia , Feminino , Granulomatose com Poliangiite/complicações , Granulomatose com Poliangiite/tratamento farmacológico , HumanosRESUMO
BACKGROUND: Septic arthritis is a disabling and potentially life-threatening condition that requires prompt diagnosis and treatment. The most important risk factors are joint prosthesis, pre-existing joint disease and immunosuppressive drugs. The aim of our study therefore was to revaluate all septic arthritis cases discharged from our Rheumatologic Unit in the last 12 years, to assess the risk factors, the clinical and laboratory characteristics, the causative microorganisms and its possible increase in frequency. METHODS: The medical records of 42 consecutive patients with septic arthritis discharged from our Rheumatology Unit between January 1995 and December 2006 were reviewed. The patients ranged in age from 23 to 90 and there isn't gender predominance. Septic arthritis was diagnosed based on the finding of purulent material in the joint space and/or the isolation of a bacterial pathogen from joint fluid. Demographic data, risk factors, co-morbidity, clinical manifestations, time interval between symptoms onset and diagnosis, treatment and laboratory data including serum white blood cell count, erythrocyte sedimentation rate (ESR), C reactive protein (CRP), synovial white blood cells and culture results were analysed. We considered these parameters in the whole population and in two different age groups (< or =60, >60) and tried to determine if there was a change of microorganisms involved in septic arthritis during the years. RESULTS: Of 42 patients, 47% were aged 60 and younger. Only 10 patients were admitted to our unit before 2001. A predisposing factor was recorded in 90,5% of cases: 15 patients had rheumatoid arthritis, 8 were diabetic, 6 had seronegative arthritis, 4 had a connective tissue disease, 8 patients had a prosthetic infection and 3 were subjected recently to arthrocentesis. We found that patients aged 60 and younger were more frequently affected by joint disease and had a synovial white blood cell count lower than patients older than 60. Staphylococcus aureus caused septic arthritis in 70% of cases before 2001, and only in 35,8 % after 2001. Also, after 2001, some infections were caused by more unusual pathogens, prevalently in patients treated with TNFa inhibitors. Instead Streptococcus infections were found only in patients aged 70 and older. CONCLUSION: The incidence of bacterial arthritis has increased in the last six years and there was a modification of microorganisms involved, possibly related to a greater therapeutic aggressiveness. The increased frequency of joint disease and the use of immunosuppressive drugs in patients under the age of 60 could be responsible for a lower synovial white blood cell count in these patients.
Assuntos
Artrite Infecciosa , Adulto , Idoso , Idoso de 80 Anos ou mais , Artrite Infecciosa/tratamento farmacológico , Artrite Infecciosa/epidemiologia , Artrite Infecciosa/microbiologia , Feminino , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Reumatologia , Fatores de Tempo , Adulto JovemRESUMO
Joint fluid aspiration, or arthrocentesis, is one of the most useful and commonly performed procedures for the diagnosis and treatment of rheumatic diseases, but to date no definite guidelines have been published. For this reason, a group of experts of the Italian Society of Rheumatology (SIR) produced evidence based recommendations for performing arthrocentesis. Among them, the most relevant are: a) arthrocentesis is necessary when synovial effusion of unknown origin is present, especially if septic or crystal arthritis is suspected; b) the patient should be clearly informed of the benefits and risks of the procedure in order to give an informed consent; c) ultrasonography should be used to facilitate arthrocentesis in difficult joints; d) fluid evacuation often has a therapeutic effect and facilitates the success of the following intraarticular injection; e) careful skin disinfection and the use of sterile, disposable material is mandatory for avoiding septic complications. Disposable, non sterile gloves should always be used by the operator, mainly for his own protection; f) contraindications are the presence of skin lesions or infections in the area of the puncture; g) the patient's anticoagulant treatment is not a contraindication, providing the therapeutic range is not exceeded; h) joint rest after arthrocentesis is not indicated. Several of these recommendations were based on experts' opinion rather than on published evidence which is scanty.
Assuntos
Paracentese , Líquido Sinovial , Administração Tópica , Anestésicos Locais/administração & dosagem , Anestésicos Locais/uso terapêutico , Anticoagulantes/administração & dosagem , Anticoagulantes/uso terapêutico , Artrite/complicações , Artrite/diagnóstico , Contraindicações , Desinfecção , Medicina Baseada em Evidências , Prova Pericial , Humanos , Paracentese/instrumentação , Paracentese/métodos , Paracentese/normas , Pele/microbiologia , Dermatopatias Infecciosas/complicações , Úlcera Cutânea/complicações , Ultrassonografia de IntervençãoRESUMO
The present paper is a review of the data available in the literature concerning the prenatal exposure to radiation evaluating the reported teratogenic effect. We have particularly focused on the fetal effects of maternal ionising radiation exposure, both diagnostic and occupational, particularly in terms of congenital anomalies and birth weight. Ionising radiation represents a possible teratogen for the fetus, but this risk has been found to be dependent on the dosage and the effects correlatable to the gestational age at exposure. Recently, of particularly note is the fact that maternal thyroid exposure to diagnostic radiation has been associated with a slight reduction in the birth weight. Inadvertent exposure from diagnostic procedures in pregnancy doesn't usually increase the natural risk of congenital anomalies but creates a considerable state of maternal anxiety. Diagnostic radiological procedures should be avoided in pregnant women unless the information cannot be obtained by other techniques.
Assuntos
Anormalidades Induzidas por Radiação , Exposição Materna/efeitos adversos , Efeitos Tardios da Exposição Pré-Natal , Adulto , Animais , Peso ao Nascer/efeitos da radiação , Relação Dose-Resposta à Radiação , Feminino , Humanos , Exposição Ocupacional/efeitos adversos , Gravidez , Doses de Radiação , Liberação Nociva de Radioativos , Radiografia/efeitos adversosRESUMO
Diabetes mellitus is a chronic metabolic condition characterized by persistent hyperglycaemia with resultant morbidity and mortality related to its microvascular and macrovascular complications. In addition diabetes is also associated with several musculoskeletal disorders of the hand, that can be debilitating. There is increased incidence of these abnormalities in patients with type 1 and type 2 diabetes compared with the general population, related to disease duration but not to the age or sex. Typical diabetes associated hand condition include the palmar flexor tenosynovitis, Dupuytren's contracture, syndrome of limited joint mobility, carpal tunnel syndrome, Charcot arthropathy and reflex sympathetic dystrophy. Maintaining good glycaemic control by exercise, diet and drugs improves or prevents the development of these hand rheumatic condition. In this brief report we review the rational therapeutic approach to these disorders.
Assuntos
Complicações do Diabetes , Mãos , Doenças Musculoesqueléticas/etiologia , Artropatia Neurogênica/etiologia , Síndrome do Túnel Carpal/etiologia , Diabetes Mellitus/terapia , Neuropatias Diabéticas/etiologia , Contratura de Dupuytren/etiologia , Mãos/inervação , Mãos/fisiopatologia , Humanos , Doenças Musculoesqueléticas/fisiopatologia , Distrofia Simpática Reflexa/etiologia , Tenossinovite/etiologiaRESUMO
OBJECTIVE: To evaluate the potential bleeding risks of arthrocentesis in patients with different arthropathies and taking oral anticoagulants. MATERIALS AND METHODS: Fifteen consecutive patients, 8 males and 7 females, treated with anticoagulant therapy for atrial fibrillation (9 pts), deep venous thrombosis (4 pts) and replacement of cardiac valves (3 pts) were submitted to arthrocentesis for synovial fluid effusion due to different arthropathies. In all patients INR was = 5. Nine of them were assuming AINS for the joint pain. RESULTS: Two of fifteen patients have hemarthrosis, the first only lightly, the second more frankly. Both the patients were in therapy with AINS and INR was 3.8 and 5, respectively. CONCLUSIONS: The hemarthrosis or bleeding frequency associated with intraarticular injections in patients taking anticoagulant therapy seems not very high. Therefore the therapy with oral anticoagulants would not be an absolute contraindication to the arthrocentesis execution.
Assuntos
Anticoagulantes/efeitos adversos , Artrite/complicações , Hemartrose/induzido quimicamente , Articulação do Joelho , Paracentese , Varfarina/efeitos adversos , Adulto , Idoso , Anti-Inflamatórios não Esteroides/efeitos adversos , Artrite/diagnóstico , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/tratamento farmacológico , Feminino , Hemartrose/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Medição de RiscoRESUMO
We describe the emergence of arthritis following a physical trauma, in a young man with clinical and histopathologic features of primary anetoderma (Jadassohn type) of 13 years' duration. Diagnosis of post-traumatic arthritis in a young patient with genetic predisposition was assumed. Indeed septic arthritis and other possible cause of arthritis were ruled out.
Assuntos
Articulação do Tornozelo , Artrite/etiologia , Tecido Elástico , Dermatopatias/complicações , Adulto , Traumatismos dos Dedos/complicações , Seguimentos , Humanos , Masculino , Síndrome , Fatores de Tempo , Ferimentos Perfurantes/complicaçõesAssuntos
Carcinoma Broncogênico/diagnóstico por imagem , Carcinoma Broncogênico/prevenção & controle , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/prevenção & controle , Programas de Rastreamento , Radiografia Torácica , Tomografia Computadorizada por Raios X , Análise Custo-Benefício , Diagnóstico Diferencial , Humanos , Programas de Rastreamento/economia , Radiografia Torácica/economia , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X/economiaAssuntos
Doenças da Aorta/diagnóstico , Diagnóstico por Imagem , Idoso , Aneurisma da Aorta Abdominal/diagnóstico , Doenças da Aorta/diagnóstico por imagem , Diagnóstico Diferencial , Fibrose , Humanos , Inflamação , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , UltrassonografiaRESUMO
BACKGROUND: Scleromyxoedema is a variant of papular mucinosis affecting the skin and internal organs. The different therapeutic approaches proposed for scleromyxoedema are still unsatisfactory. Intravenous immunoglobulin (IVIg) has been successfully employed in the treatment of connective tissue diseases and vasculitides. PATIENTS: The successful treatment of three cases of scleromyxoedema with IVIg is reported here. CONCLUSIONS: The relatively low risk of the drug and the high effectiveness seen in three patients suggest that IVIg is a new treatment potentially useful in scleromyxoedema.
Assuntos
Imunoglobulinas Intravenosas/uso terapêutico , Mixedema/terapia , Adulto , Idoso , Feminino , Humanos , Masculino , Mixedema/diagnóstico , Terapia de Salvação/métodos , Resultado do TratamentoRESUMO
The aim of this study was to assess in vivo patency of seven commonly used non-ferromagnetic plain stents as regards demonstration of the contained lumen at 3D gadolinium-enhanced MRA in a 0.5-T MR environment. Twenty-one patients with 22 stents (1 aortic, 18 iliac, 3 popliteal) were imaged with MRA. Stent-related artefacts were evaluated. Images were assessed for the presence and size of stent artefacts, luminal patency, and were correlated with stent metal mass, composition, configuration and angulation with respect to the magnetic field. Four different types of stent (Symphony, Wallstent, Memotherm, SMART) showed major artefacts preventing assessment of intradevice luminal patency or restenosis, in two stents (ZAV stent, Intracoil) minor artefacts allowed assessment of high-degree stenosis, and only one type of stent (Strecker) was perfectly imaged. Based on our limited experience, Gd-MRA appears well suited for the evaluation of only a minority of MR-compatible stents.
Assuntos
Imageamento Tridimensional , Angiografia por Ressonância Magnética , Stents , Grau de Desobstrução Vascular/fisiologia , Artefatos , Análise de Falha de Equipamento , Humanos , Variações Dependentes do ObservadorRESUMO
A procedure for enzyme entrapment into matrices suitable for biocatalytic applications is reported. The method, which takes advantage of the stable formation of polyvinyl alcohol (PVA) hydrogels by freezing and thawing PVA aqueous solutions, was assayed using lipase as model enzyme. The leakage of lipase was minimised by using high molecular weight PVA and by previous conjugation of the enzyme to PEG. The immobilised PEG enzyme maintained its catalytic activity in organic solvents also, thus allowing enzymatic activity towards water insoluble substrates. The activity was largely increased reducing the diffusional constrain by cutting the matrices into slices of micron size. Matrix-entrapped lipase-PEG, when used in the hydrolysis of acetoxycoumarins, showed a conversion rate of about 10 times lower than the enzyme-PEG in the free form, and maintained regioselectivity when a diacetylated product was used as substrate.
Assuntos
Hidrogéis/síntese química , Lipase/química , Álcool de Polivinil/química , Hidrogéis/química , HidróliseRESUMO
Adding sludge to agricultural soil results in added organic matter, nutrients and metallic and/or organic pollutants. These components may modify the behaviour of pesticides in the soil. We monitored possible changes in the degradation of the herbicide isoproturon (production of CO2 and degradation products) in soil amended with sludge, heavy metals or nitrogen and phosphorus. The treated and control soils were incubated under controlled conditions for 60 days. The nitrogen and phosphorus had the greatest effect on isoproturon degradation, independent of the presence of pollutants. Mineralisation of the herbicide to CO2 was slow and seemed to be linked to a fast degradation and to the accumulation of a complex degradation product that was neither catabolized nor adsorbed, 4,4'-diisopropylazobenzene. This degradation pathway also produced smaller amounts of non-extractable residues. Sewage sludge had no significant effect on isoproturon degradation, despite a large increase of organic matter mineralisation (factor 2).
Assuntos
Herbicidas/metabolismo , Compostos de Metilureia/metabolismo , Compostos de Fenilureia , Esgotos/química , Poluentes do Solo/metabolismo , Agricultura , Biodegradação Ambiental , Dióxido de Carbono/análise , Monitoramento Ambiental , Metais Pesados/análise , Nitrogênio/análise , Fósforo/análise , Esgotos/microbiologia , Microbiologia do SoloRESUMO
Charcot-Marie-Tooth neuropathy type 1 (CMT1), the most common hereditary neurological disorder in humans, is characterized by clinical and genetic heterogeneity. It is caused mainly by a 1.5 Mb duplication in 17p11.2, but also by mutations in the myelin genes PMP22 (peripheral myelin protein 22), MPZ (myelin protein zero), Cx32 (connexin 32; also called GJB1), and EGR2 (early growth response 2). In this study, we have screened 172 index cases of Italian families in which there was at least one subject with a CMT1 diagnosis for the duplication on 17p11.2 and mutations in these genes. Among 170 informative unrelated patients, the overall duplication frequency was 57.6%. A difference could be observed between the duplication frequency in familial cases (71.6%) and that observed in non-familial cases (36.8%). Among the non-duplicated patients, 12 were mutated in Cx32, four in MPZ, two in PMP22, and none in the EGR2. In the non-duplicated cases, the overall point mutation frequency for these genes was 25.0%. We describe the mutations identified, and consider possible genotype-phenotype correlation.
Assuntos
Doença de Charcot-Marie-Tooth/genética , Cromossomos Humanos Par 17/genética , Genes Duplicados/genética , Neuropatia Hereditária Motora e Sensorial/genética , Mutação/genética , Doença de Charcot-Marie-Tooth/classificação , Estudos de Coortes , Conexinas/genética , Análise Mutacional de DNA , Duplicação Gênica , Frequência do Gene/genética , Testes Genéticos , Genótipo , Humanos , Itália , Proteína P0 da Mielina/genética , Proteínas da Mielina/genética , Fenótipo , Mutação Puntual/genética , Proteína beta-1 de Junções ComunicantesAssuntos
Pâncreas/diagnóstico por imagem , Pâncreas/lesões , Esqui/lesões , Adulto , Colangiopancreatografia Retrógrada Endoscópica , Emergências , Humanos , Laparotomia , Masculino , Ductos Pancreáticos/diagnóstico por imagem , Ductos Pancreáticos/lesões , Ruptura , Tomografia Computadorizada por Raios X , UltrassonografiaRESUMO
Hereditary motor and sensory neuropathy type V is a very rare disease in which hereditary spastic paraplegia is associated with peripheral motor and sensory neuropathy. The symptomatic onset of the disorder is usually in the second decade of life or later and the course is progressive over many years. Hereditary motor and sensory neuropathy type V is inherited as an autosomal dominant trait usually showing incomplete penetrance. So far, no molecular data are available in the literature about this disease. In our study we present clinical and molecular data from a large Italian family displaying hereditary motor and sensory neuropathy type V. Taking into account the clinical features in this family, we have performed a linkage analysis for markers strictly associated with all the known loci for autosomal dominant and autosomal recessive forms of hereditary spastic paraplegia and hereditary motor and sensory neuropathy type II, and have found no linkage to these loci. Our study suggests that hereditary motor and sensory neuropathy type V is not only a distinct clinical entity but also a distinct genetic entity.