RESUMO
The natural history of primary Sjögren's syndrome has been little studied. Some studies agree that, although it is not a benign disease, it is characterized by a steady evolution of the predominant symptoms (sicca and general manifestations). However, there are 2 main exceptions to this chronic course: the development of vasculitic manifestations, and the high incidence of lymphomas, both processes being related to the excess of mortality in patients with primary Sjögren's syndrome. Recent studies have prospectively analyzed the outcome of this disease in a large series of patients and identified those factors present at diagnosis prospectively associated with an adverse outcome. The main prognostic factors identified are severe involvement of the exocrine glands, vasculitis, hypocomplementemia and cryoglobulins at diagnosis. These features identify a specific subset of patients diagnosed with primary Sjögren's syndrome in whom a closer follow-up, and probably an earlier and more robust therapeutic management, should be mandatory.
Assuntos
Síndrome de Sjogren , Adulto , Fatores Etários , Terapia Biológica , Feminino , Glucocorticoides/uso terapêutico , Humanos , Imunossupressores/uso terapêutico , Linfoma de Células B/epidemiologia , Transtornos Linfoproliferativos/epidemiologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Fatores de Risco , Fatores Sexuais , Síndrome de Sjogren/classificação , Síndrome de Sjogren/complicações , Síndrome de Sjogren/diagnóstico , Síndrome de Sjogren/tratamento farmacológico , Síndrome de Sjogren/epidemiologia , Síndrome de Sjogren/imunologia , Síndrome de Sjogren/mortalidadeRESUMO
A fatal case of Lactobacillus rhamnosus septicaemia after prolonged oral vancomycin for recalcitrant Clostridium difficile infection is reported. The patient was immunosuppressed with cyclophosphamide and steroids for Sjögren's syndrome. The administration of Lactobacillus spp as "biotherapy" may be hazardous in such circumstances.
Assuntos
Terapia Biológica , Hospedeiro Imunocomprometido , Lactobacillus , Infecções Oportunistas/microbiologia , Sepse/microbiologia , Iogurte/efeitos adversos , Adulto , Antibacterianos/uso terapêutico , Contraindicações , Ciclofosfamida/uso terapêutico , Evolução Fatal , Feminino , Fludrocortisona/uso terapêutico , Humanos , Imunossupressores/uso terapêutico , Infecções Oportunistas/mortalidade , Sepse/mortalidade , Síndrome de Sjogren/tratamento farmacológico , Síndrome de Sjogren/microbiologia , Síndrome de Sjogren/mortalidade , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/microbiologia , Infecções Estafilocócicas/mortalidade , Vancomicina/uso terapêuticoRESUMO
Hybrids of New Zealand black and New Zealand white mice were used in an animal model for Sjögren's syndrome. The animals were treated with bromhexine (Bisolvon), ambroxol (Mucosolvan), or placebo from their 20th week of life for 10-17 weeks. The parotic glands were examined in a masked fashion by light and transmission electron microscopy after treatment. Significant inhibition of pathological changes in the parotic glands was observed by both methods in hybrids receiving 60 mg/kg bromhexine. Other types of treatment had no effect. In addition, the animals receiving the high dosage of bromhexine had a significantly higher survival rate than other hybrids.