RESUMO
BACKGROUND: Acute transverse myelitis (ATM) is an infrequent but severe complication of systemic lupus erythematosus (SLE). The purpose of study was to describe clinical features and prognostic factors of patients with SLE-related ATM. METHODS: In this medical records review study, data were collected from 60 patients from 16 centers seen between 1996 and 2017 who met diagnostic criteria for SLE and myelitis as defined by the American College of Rheumatology/Systemic International Collaborating Clinics and the Working Group of the Transverse Myelitis Consortium, respectively. Objective neurological impairment was measured with American Spinal Injury Association Impairment Scale (AIS) and European Database for Multiple Sclerosis Grade Scale (EGS). RESULTS: Among patients included, 95% (n = 57) were female, and the average age was 31.6 ± 9.6 years. Myelitis developed after diagnosis of SLE in 60% (n = 36). Symmetrical paraparesis with hypoesthesia, flaccidity, sphincter dysfunction, AIS = A/B, and EGS ≥ 8 was the most common presentation. Intravenous methylprednisolone was used in 95% (n = 57), and 78.3% (n = 47) received intravenous cyclophosphamide. Sensory/motor recovery at 6 months was observed in 75% (42 of 56), but only in 16.1% (9 of 56) was complete. Hypoglycorrhachia and EGS ≥ 7 in the nadir were associated with an unfavorable neurological outcome at 6 months (p < 0.05). A relapse rate during follow-up was observed in 30.4% (17 of 56). Hypoglycorrhachia and hypocomplementemia seem to be protective factors for relapse. Intravenous cyclophosphamide was associated with time delay to relapse. CONCLUSIONS: Systemic lupus erythematosus-related ATM may occur at any time of SLE course, leading to significant disability despite treatment. Relapses are infrequent and intravenous cyclophosphamide seems to delay it. Hypoglycorrhachia, hypocomplementemia, and EGS at nadir are the most important prognostic factors.
Assuntos
Lúpus Eritematoso Sistêmico , Mielite Transversa , Adulto , Feminino , Humanos , América Latina , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/diagnóstico , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Mielite Transversa/diagnóstico , Mielite Transversa/tratamento farmacológico , Mielite Transversa/epidemiologia , Recidiva Local de Neoplasia , Prognóstico , Adulto JovemRESUMO
La artritis reumatoide es una enfermedad caracterizada por una respuesta inmune patológica en diferentes tejidos, principalmente de naturaleza colágena. El presente artículo revisa los últimos avances en la fisiopatología de la artritis en el que juegan un papel importante los mecanismos inmunológicos así como algunos procesos aún no bien comprendidos como la apoptosis.
Assuntos
Artrite Reumatoide/fisiopatologiaRESUMO
La importancia de la investigación en osteoartritis radica en su alta incidencia, especialmente en personas mayores de cincuenta años. Para entender su desarrollo es necesario revisar la fisiopatología del cartílago normal y conocer las principales corrientes de explicación de esta enfermedad, entre estas las alteraciones funcionales, en las que se ven afectadas la protección activa y pasiva del cartílago contra el estrés, los cambios bioquímicos y metabólicos, así como los cambios celulares y morfológicos. El conocimiento de esta patogenia es imprescindible para llegar a resultados más prometedores en el tratamiento efectivo de la osteoartritis.