COVID-19 was not associated or trigger disease activity in spondylarthritis patients: ReumaCoV-Brasil cross-sectional data.

OBJECTIVES: To evaluate the disease activity before and after COVID-19 and risk factors associated with outcomes, including hospitalization, intensive care unit (ICU) admission, mechanical ventilation (MV) and death in patients with spondylarthritis (SpA). METHODS: ReumaCoV Brazil is a multicenter prospective cohort of immune-mediated rheumatic diseases (IMRD) patients with COVID-19 (case group), compared to a control group of IMRD patients without COVID-19. SpA patients enrolled were grouped as axial SpA (axSpA), psoriatic arthritis (PsA) and enteropathic arthritis, according to usual classification criteria. RESULTS: 353 SpA patients were included, of whom 229 (64.9%) were axSpA, 118 (33.4%) PsA and 6 enteropathic arthritis (1.7%). No significant difference was observed in disease activity before the study inclusion comparing cases and controls, as well no worsening of disease activity after COVID-19. The risk factors associated with hospitalization were age over 60 years (OR = 3.71; 95% CI 1.62-8.47, p = 0.001); one or more comorbidities (OR = 2.28; 95% CI 1.02-5.08, p = 0.001) and leflunomide treatment (OR = 4.46; 95% CI 1.33-24.9, p = 0.008). Not having comorbidities (OR = 0.11; 95% CI 0.02-0.50, p = 0.001) played a protective role for hospitalization. In multivariate analysis, leflunomide treatment (OR = 8.69; CI = 95% 1.41-53.64; p = 0.023) was associated with hospitalization; teleconsultation (OR = 0.14; CI = 95% 0.03-0.71; p = 0.01) and no comorbidities (OR = 0.14; CI = 95% 0.02-0.76; p = 0.02) remained at final model as protective factor. CONCLUSIONS: Our results showed no association between pre-COVID disease activity or that SARS-CoV-2 infection could trigger disease activity in patients with SpA. Teleconsultation and no comorbidities were associated with a lower hospitalization risk. Leflunomide remained significantly associated with higher risk of hospitalization after multiple adjustments.

Plasmaférese como tratamento de glomeruloesclerose segmentar focal (GESF) recorrente após transplante renal. Relato de caso e revisão da literatura / Plasmapheresis as a therapy for relapsed focal segmental glomerulosclerosis (FSGS) after kidney transplantation: case report and a review of the literature

A glomerulosclerose segmentar focal (GESF) é uma doença renal caracterizada por síndrome nefrótica, com freqüente progressão para insuficiência renal terminal. Nesta fase, o transplante renal, tanto com doador cadáver como intervivos, aparece como a única opção terapêutica para esses pacientes. Contudo, após o transplante renal, a taxa de recorrência de GESF é alta, chegando até 50 por cento dos casos. Nesta situação, a causa parece estar relacionada a um "fator humoral" circulante, responsável pelo aumento da permeabilidade glomerular. A remoção desse "fator humoral", por meio da plasmaférese terapêutica, aparece como uma boa opção de tratamento para esses pacientes. Neste artigo descreveremos o caso de um paciente masculino de 12 anos de idade, com diagnóstico de glomeruloesclerose segmentar focal recorrente após transplante renal, submetido a tratamento com plasmaférese. Após cinco sessões o paciente evoluiu com melhora sustentada da função renal. O uso de plasmaférese para tratamento da glomeruloesclerose segmentar focal pré e pós-transplante renal ainda é limitado, a maioria dos estudos apresentando resultados de curto prazo ou com pequeno número de pacientes. Alguns fatores preditivos de boa resposta ao tratamento têm sido identificados por diversos autores, dentre eles o início precoce do tratamento após a recorrência e a baixa idade. O número de sessões necessárias para atingir a remissão varia bastante e deve ser determinado individualmente. Outra possibilidade apresentada pelos autores é a plasmaférese profilática, não sendo possível até agora determinar sua eficácia. O caso apresentado é um exemplo de glomeruloesclerose recorrente com ótima resposta a plasmaférese terapêutica, evidenciando o potencial dessa modalidade de tratamento nesta situação e reforçando a necessidade de mais estudos.

Focal segmental glomerulosclerosis (FSGS) is a renal disease characterized by a nephrotic syndrome frequently evolving to end-stage renal failure. At this stage, renal transplantation, using either cadaver or live donors, is the only therapeutic option. However, after renal transplantation relapse is high, at a rate of 50 percent on average. The cause seems to be related to a peripheral humoral factor responsible for increasing glomerular permeability. The clearance of this factor by apheresis is today considered a good therapeutic option. We describe the case of a 12-year-old male patient, with relapsed FSGS after renal transplantation, who was treated by plasmapheresis. After five procedures a sustained improvement in the renal function was obtained. Reports published on plasmapheresis for the treatment of FSGS before and after renal transplantation are still limited to short-term results involving a small number of patients. Some predictive factors for good responses were identified by several investigators including the early start of treatment after relapse and lower ages. The number of plasmapheretic procedures to reach remission varies widely, and should be determined on a case to case basis. Another possibility presented by some investigators is prophylactic plasmapheresis, but this still lacks evidence on efficacy. This case report is an example of FSGS with a good response to plasmapheretic procedures, showing a potential benefit of this treatment. However, further controlled studies involving a higher number of patients are necessary.