RESUMO
We assessed whether quantitative analysis of Doppler flow velocity waveforms is able to identify subclinical microvascular abnormalities in SLE and whether eigenvector analysis can detect changes not detectable using the resistive index (RI). Fifty-four SLE patients with no conventional cardiovascular risk factors, major organ involvement or retinopathy were compared to 32 controls. Flow velocity waveforms were obtained from the ophthalmic artery (OA), central retinal artery (CRA) and common carotid artery (CA). The waveforms were analysed using eigenvector decomposition and compared between groups at each arterial site. The RI was also determined. The RI was comparable between groups. In the OA and CRA, there were significant differences in the lower frequency sinusoidal components (P < 0.05 for each component). No differences were apparent in the CA between groups. Eigenvector analysis of Doppler flow waveforms, recorded in proximity of the terminal vascular bed, identified altered ocular microvascular haemodynamics in SLE. Altered waveform structure could not be identified by changes in RI, the traditional measure of downstream vascular resistance. This analytical approach to waveform analysis is more sensitive in detecting preclinical microvascular abnormalities in SLE. It may hold potential as a useful tool for assessing disease activity, response to treatment, and predicting future vascular complications.
Assuntos
Olho , Hemodinâmica/fisiologia , Lúpus Eritematoso Sistêmico , Microcirculação/fisiologia , Fluxo Sanguíneo Regional/fisiologia , Adulto , Algoritmos , Olho/irrigação sanguínea , Olho/diagnóstico por imagem , Feminino , Humanos , Lúpus Eritematoso Sistêmico/sangue , Lúpus Eritematoso Sistêmico/diagnóstico por imagem , Lúpus Eritematoso Sistêmico/patologia , Pessoa de Meia-Idade , Artéria Oftálmica/diagnóstico por imagem , Artéria Oftálmica/fisiologia , Artéria Retiniana/diagnóstico por imagem , Artéria Retiniana/fisiologia , Ultrassonografia Doppler em CoresRESUMO
OBJECTIVE: To determine the clinical effect of dietary supplementation with low-dose omega-3-polyunsaturated fatty acids on disease activity and endothelial function in patients with systemic lupus erythematosus. METHODS: A 24-week randomised double-blind placebo-controlled parallel trial of the effect of 3 g of omega-3-polyunsaturated fatty acids on 60 patients with systemic lupus erythematosus was performed. Serial measurements of disease activity using the revised Systemic Lupus Activity Measure (SLAM-R) and British Isles Lupus Assessment Group index of disease activity for systemic lupus erythematosus (BILAG), endothelial function using flow-mediated dilation (FMD) of the brachial artery, oxidative stress using platelet 8-isoprostanes and analysis of platelet membrane fatty acids were taken at baseline, 12 and 24 weeks. RESULTS: In the fish oil group there was a significant improvement at 24 weeks in SLAM-R (from 9.4 (SD 3.0) to 6.3 (2.5), p<0.001); in BILAG (from 13.6 (6.0) to 6.7 (3.8), p<0.001); in FMD (from 3.0% (-0.5 to 8.2) to 8.9% (1.3 to 16.9), p<0.001) and in platelet 8-isoprostanes (from 177 pg/mg protein (23-387) to 90 pg/mg protein (32-182), p = 0.007). CONCLUSIONS: Low-dose dietary supplementation with omega-3 fish oils in systemic lupus erythematosus not only has a therapeutic effect on disease activity but also improves endothelial function and reduces oxidative stress and may therefore confer cardiovascular benefits.
Assuntos
Endotélio Vascular/fisiopatologia , Ácidos Graxos Ômega-3/administração & dosagem , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Adulto , Biomarcadores/sangue , Artéria Braquial/diagnóstico por imagem , Artéria Braquial/efeitos dos fármacos , Artéria Braquial/fisiopatologia , Membrana Celular/química , Suplementos Nutricionais , Dinoprosta/análogos & derivados , Dinoprosta/sangue , Ácidos Docosa-Hexaenoicos/análise , Método Duplo-Cego , Ácido Eicosapentaenoico , Endotélio Vascular/efeitos dos fármacos , Endotélio Vascular/metabolismo , Ácidos Graxos Insaturados/análise , Feminino , Humanos , Lúpus Eritematoso Sistêmico/metabolismo , Masculino , Pessoa de Meia-Idade , Nitroglicerina , Fluxo Sanguíneo Regional , Estatísticas não Paramétricas , Resultado do Tratamento , Ultrassonografia Doppler de Pulso , Vasodilatação , VasodilatadoresRESUMO
Tender point count (TPC) is central to fibromyalgia syndrome (FMS), and with total myalgic score (TMS) is often used to monitor the patient's condition. This study aimed to determine the stability of TPC and TMS over time, and to examine how well these measures reflected patients' perceptions of their condition. Twenty-four patients with FMS completed the Fibromyalgia Impact Questionnaire (FIQ) and a visual analogue scale (VAS) measuring well-being, at entrance into the study, and 7 and 28 days later. There was no significant change in TPC (P = 0.074), FIQ score (P = 0.291) or VAS (P = 0.079) of well-being with time. However, mean TMS score did change over time (P = 0.021). There was no correlation between total FIQ score and the other measures (all P-values > 0.05). The significant change in TMS over time may reflect the natural fluctuation in the clinical presentation of FMS.
Assuntos
Fibromialgia/complicações , Medição da Dor , Índice de Gravidade de Doença , Atividades Cotidianas , Adulto , Progressão da Doença , Feminino , Fibromialgia/classificação , Fibromialgia/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Limiar da Dor , Prognóstico , Estudos Prospectivos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Perfil de Impacto da DoençaAssuntos
Anti-Inflamatórios não Esteroides/administração & dosagem , Artrite Reumatoide/tratamento farmacológico , Seleção de Pacientes , Padrões de Prática Médica , Idoso , Artrite Reumatoide/complicações , Doenças Cardiovasculares/complicações , Inibidores de Ciclo-Oxigenase 2/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de RiscoRESUMO
Fibromyalgia is a complex problem in which symptoms of anxiety and depression feature prominently. Low levels of vitamin D have been frequently reported in fibromyalgia, but no relationship was demonstrated with anxiety and depression. Seventy-five Caucasian patients who fulfilled the ACR criteria for fibromyalgia had serum vitamin D levels measured and completed the Fibromyalgia Impact Questionnaire (FIQ) and Hospital Anxiety and Depression Score (HADS). Deficient levels of vitamin D was found in 13.3% of the patients, while 56.0% had insufficient levels and 30.7% had normal levels. Patients with vitamin D deficiency (<25 nmol/l) had higher HADS [median, IQR, 31.0 (23.8-36.8] than patients with insufficient levels [25-50 nmol/l; HADS 22.5 (17.0-26.0)] or than patients with normal levels [50 nmol/l or greater; HADS 23.5 (19.0-27.5); Kruskal-Wallis ANOVA on ranks p<0.05]. There was no relationship with global measures of disease impact or musculoskeletal symptoms. Vitamin D deficiency is common in fibromyalgia and occurs more frequently in patients with anxiety and depression. The nature and direction of the causal relationship remains unclear, but there are definite implications for long-term bone health.
Assuntos
Ansiedade/metabolismo , Depressão/metabolismo , Fibromialgia/metabolismo , Fibromialgia/psicologia , Índice de Gravidade de Doença , Deficiência de Vitamina D/complicações , Adulto , Idoso , Estudos Transversais , Feminino , Fibromialgia/complicações , Humanos , Masculino , Pessoa de Meia-IdadeAssuntos
Fraturas Espontâneas/etiologia , Fraturas Espontâneas/enfermagem , Osteoporose/complicações , Ambulatório Hospitalar , Especialidades de Enfermagem/organização & administração , Idoso , Idoso de 80 Anos ou mais , Assistência Ambulatorial , Densidade Óssea , Feminino , Fraturas Espontâneas/epidemiologia , Humanos , Irlanda/epidemiologia , Masculino , Pessoa de Meia-Idade , Osteoporose/epidemiologia , Osteoporose/metabolismo , Educação de Pacientes como Assunto , Desenvolvimento de Programas , Fatores de RiscoAssuntos
Anticorpos Monoclonais/administração & dosagem , Antineoplásicos/administração & dosagem , Antirreumáticos/administração & dosagem , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Esteroides/administração & dosagem , Adulto , Anticorpos Monoclonais Murinos , Quimioterapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , RituximabAssuntos
Anticorpos Antinucleares/sangue , Dermatomiosite/imunologia , Doenças Pulmonares Intersticiais/etiologia , Adulto , Dermatomiosite/complicações , Dermatomiosite/diagnóstico , Dermatomiosite/tratamento farmacológico , Feminino , Glucocorticoides/uso terapêutico , Humanos , Doenças Pulmonares Intersticiais/diagnóstico por imagem , Masculino , Prednisolona/uso terapêutico , Tomografia Computadorizada por Raios XRESUMO
In this cross-sectional study of 706 European patients with rheumatoid arthritis (RA) of < or = 4 yr duration, we examined possible correlates of functional disability assessed by the Health Assessment Questionnaire. First, we examined a subsample of 237 Norwegian patients. The Ritchie index, sex, age, erythrocyte sedimentation rate (ESR) and disease duration correlated significantly with disability, whereas serum rheumatoid factor, hand X-ray changes and educational level did not. Subsequently, we cross-validated these findings in a similar sample of 469 French, Dutch and Northern Irish patients. The results supported the Ritchie index, sex, ESR and disease duration as significant correlates of disability, whereas rheumatoid factor, age and education were not significantly correlated with disability. The correlation between X-ray changes and disability could not be cross-validated. The main findings of this study are that female sex correlates significantly with disability even early in the course of RA, whereas the rheumatoid factor does not.
Assuntos
Artrite Reumatoide/complicações , Avaliação da Deficiência , Fator Reumatoide/sangue , Índice de Gravidade de Doença , Adulto , Idoso , Antirreumáticos/uso terapêutico , Artrite Reumatoide/sangue , Artrite Reumatoide/tratamento farmacológico , Sedimentação Sanguínea , Estudos Transversais , Feminino , França , Humanos , Irlanda , Masculino , Pessoa de Meia-Idade , Países Baixos , Noruega , Prognóstico , Análise de Regressão , Fatores Sexuais , Fatores de TempoRESUMO
A patient with Felty's syndrome and rheumatoid arthritis was treated with recombinant granulocyte stimulating factor rhG-CSF (Neupogen) in view of severe neutropenia. He had a prompt rise in his neutrophil count and associated with this a severe flare of his arthritis and a skin rash. rhG-CSF was stopped, his neutrophil count fell rapidly and his symptoms resolved. rhG-CSF and the resulting rise in neutrophil count may be associated with flare of autoimmune disease in susceptible individuals.
Assuntos
Artrite Reumatoide/complicações , Toxidermias/etiologia , Síndrome de Felty/complicações , Síndrome de Felty/tratamento farmacológico , Fator Estimulador de Colônias de Granulócitos/efeitos adversos , Neutropenia/tratamento farmacológico , Artrite Reumatoide/fisiopatologia , Síndrome de Felty/fisiopatologia , Filgrastim , Fator Estimulador de Colônias de Granulócitos/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Neutropenia/etiologia , Proteínas Recombinantes/efeitos adversos , Proteínas Recombinantes/uso terapêuticoRESUMO
Assessment of blood gas status is important in the management of patients with chronic pulmonary disease. Arterial puncture is often painful and may damage the arterial wall. Measurement of oxygen saturation by transcutaneous oximetry offers a non-invasive alternative to arterial methods but does not allow assessment of partial pressure of carbon dioxide. We have examined the value of oximetry and dorsal hand venous carbon dioxide as an alternative to arterial puncture. Transcutaneous oxygen saturation correlated with arterial oxygen saturation (r = 0.76, p less than 0.001) with an error of 2.1% and dorsal hand venous carbon dioxide tension correlated with the arterial tension (r = 0.84, p less than 0.001) with an error of 8%. Changes in oximetric oxygen saturation and venous carbon dioxide tension following oxygen therapy reflected arterial values. Assessment of blood gas status using oximetry and dorsal hand venous carbon dioxide tension is a useful alternative to arterial puncture.
Assuntos
Monitorização Transcutânea dos Gases Sanguíneos/normas , Pneumopatias Obstrutivas/sangue , Idoso , Gasometria/normas , Monitorização Transcutânea dos Gases Sanguíneos/métodos , Estudos de Avaliação como Assunto , Humanos , Pneumopatias Obstrutivas/epidemiologia , Pessoa de Meia-Idade , Reprodutibilidade dos TestesRESUMO
The immunoglobulin (Ig) heavy chain isotype composition of intra-articular and circulating immune complexes (ICs) were determined by a Raji cell flow cytometric assay in paired serum and synovial fluid samples from 15 patients with rheumatoid arthritis (RA) and 15 patients with other articular diseases (osteoarthritis, ankylosing spondylitis, gout, psoriatic arthritis, Reiter's disease). ICs were most prevalent in synovial fluid samples of patients with RA but were infrequently detected in serum and synovial fluid samples from the non-RA patients. ICs in patients with RA were heterogeneous both in the prevalence of Ig subclasses identified and in the distribution of the respective Ig isotypes within the complexes. Furthermore, differences were observed in the Ig isotype composition of ICs in paired serum and synovial fluid samples indicating that circulating ICs may not always arise simply by spill-over from articular sites. The possible mechanisms for IC formation in RA are discussed with reference to four patients who displayed features of extra-articular disease.
Assuntos
Complexo Antígeno-Anticorpo/imunologia , Artrite/imunologia , Cadeias Pesadas de Imunoglobulinas/imunologia , Isotipos de Imunoglobulinas/imunologia , Adulto , Idoso , Complexo Antígeno-Anticorpo/análise , Artrite Psoriásica/sangue , Artrite Psoriásica/imunologia , Feminino , Citometria de Fluxo , Gota/sangue , Gota/imunologia , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite/sangue , Osteoartrite/imunologia , Fator Reumatoide/química , Fator Reumatoide/imunologia , Espondilite/sangue , Espondilite/imunologia , Líquido Sinovial/química , Líquido Sinovial/imunologiaRESUMO
Many immunological abnormalities, including circulating immune complexes (CICs), have been described in patients with sarcoidosis. The relationship of these abnormalities to clinical states is uncertain. In 31 proven cases of sarcoidosis we used the Raji assay in the investigation of the relationship between disease activity and the presence of CICs. Circulating immune complexes (greater than 49 micrograms.ml-1) were found in 11 of 14 patients with evidence of recent significant disease deterioration, whereas only one of 17 patients with chronic stable sarcoidosis demonstrated CICs (p less than 0.001). At follow-up, it was found that eight of the 11 cases with active disease and detectable CICs had resolved clinically. Resolution was accompanied by normalization of CICs in seven and persistence in one. The remaining three patients did not improve clinically and continued to demonstrate CICs. Measurements of complement levels did not demonstrate any significant difference between the two groups of patients. It is concluded that elevated levels of CICs, as detected by the Raji assay, are commonly found in association with significantly deteriorating sarcoidosis, often normalize following disease improvement and, consequently, may have a useful clinical role as a marker of activity.