Monoarthritis induced by the Oxford-AstraZenecaR SARS-CoV-2 vaccine

We describe the case of a 25-year-old woman who presented with monoarthritis of the proximal interphalangeal articulation of the fourth left finger 4 days after receiving the second dose of the Oxford-AstraZenecaR SARS-CoV-2 vaccine. She had no abnormalities in her X-ray or blood exams, but she had a cousin diagnosed with juvenile rheumatoid arthritis. The patient had an excellent response to anti-inflammatory medication, the arthritis was transient and left no sequelae. Studies have shown some vaccines may be associated with acute arthritis, in particular the measles-mumps-rubella vaccine. Young women such as our patient seem to be more susceptible to post-vaccination arthritis. Most of the cases reported were transient and left no articular sequelae, thus we did not contraindicate further doses of the Oxford-AstraZenecaR SARS-CoV-2 vaccine (should they be recommended in the future) in this case.

Describimos el caso de una mujer de 25 años que presentó monoartritis de la articulación interfalángica proximal del cuarto quirodáctil izquierdo 4 días después de recibir la segunda dosis de la vacuna Oxford-AstraZenecaR SARS-CoV-2. No presentaba anomalías en sus radiografías ni en los exámenes de sangre, pero tenía una prima diagnosticada con artritis reumatoide juvenil. La paciente tuvo una excelente respuesta a la medicación antiinflamatoria, la artritis fue transitoria y no dejó secuelas. Los estudios han demostrado que algunas vacunas pueden estar asociadas con la artritis aguda, en particular las vacunas contra el sarampión, las paperas y la rubéola. Las mujeres jóvenes como nuestra paciente parecen ser más susceptibles a la artritis posvacunación. La mayoría de los casos notificados fueron transitorios y no dejaron secuelas articulares, por lo que no contraindicamos nuevas dosis de la vacuna Oxford-AstraZenecaR SARS-CoV-2 (en caso de recomendarse en el futuro) en este caso.

Ambulatório conjunto de dermatologia e reumatologia para tratamento de psoríase e artrite psoriásica: experiência de um hospital terciário do sul do Brasil / Combined dermatology and rheumatology outpatient clinic for the management of psoriasis and psoriatic arthritis: a Southern Brazilian experience

Introdução: Diversas diretrizes enfatizam as vantagens do manejo multidisciplinar no cuidado ao paciente com psoríase (PSO) e artrite psoriásica (PSA). O diagnóstico precoce de PSA se relaciona com melhores desfechos em 5 anos. No entanto, o diagnóstico precoce de PSA ainda é um desafio. Métodos: Estudo transversal retrospectivo de pacientes com diagnóstico prévio ou suspeito de PSO e/ou PSA atendidos em ambulatório conjunto de dermatologia e reumatologia do sul do Brasil de janeiro de 2013 a janeiro de 2017. Resultados: Entre os 55 pacientes previamente diagnosticados com PSO, 30,9% (n = 17) foram diagnosticados com PSA. Alterações do tratamento foram feitas em 58,5% (n = 48) dos pacientes, principalmente devido ao mau controle da pele e das articulações. Os imunobiológicos foram a classe de medicamentos mais comumente iniciada, correspondendo a 35,4% (n = 17) das modificações terapêuticas. O metotrexato foi o segundo medicamento mais comumente iniciado (18,8%, n = 9) ou com modificação da dose ou via de administração (20,8%, n = 10), totalizando 39,6% (n = 19) de modificações terapêuticas. Houve um aumento na proporção de pacientes em uso de tratamento sistêmico (79,3%, n = 65). Conclusão: Este estudo reforça a importância da abordagem multidisciplinar no diagnóstico precoce da PSA e demonstra que a abordagem conjunta entre dermatologia e reumatologia é possível de ser realizada no Brasil, com resultados semelhantes aos reportados na literatura internacional. (AU)

Introduction: Several guidelines emphasize the advantages of multidisciplinary management of patients with psoriasis (PSO) or psoriatic arthritis (PSA). Early diagnosis of PSA is associated with better outcomes in 5 years. However, early diagnosis of PSA remains a challenge. Methods: We conducted a retrospective cross-sectional study of patients with previous or suspected diagnosis of PSO and/or PSA treated at a combined dermatology and rheumatology outpatient clinic in southern Brazil from January 2013 to January 2017. Results: Of 55 patients previously diagnosed with PSO, 30.9% (n = 17) were diagnosed with PSA. Changes in treatment were made in 58.5% (n = 48) of patients, mainly due to poor control of cutaneous and articular symptoms. Immunobiological agents were the most commonly prescribed class of drugs, corresponding to 35.4% (n = 17) of changes in medical therapy. Methotrexate was the second most commonly prescribed drug (18.8%; n = 9) and the second drug to undergo most changes in dose or route of administration (20.8%; n = 10), accounting for 39.6% (n = 19) of changes in medical therapy. There was an increase in the number of patients undergoing systemic therapies (79.3%; n = 65). Conclusions: This study reinforces the importance of a multidisciplinary approach in the early diagnosis of PSA and demonstrates that a collaborative approach between dermatology and rheumatology is feasible in Brazil, with outcomes similar to those reported in the international literature. (AU)

Systemic Arterial Hypertension in Childhood: A Challenge Related to the Increasing Survival of Very Low Birth Weight Preterm Infants.

OBJECTIVE: To verify the prevalence of systemic arterial hypertension (SAH) and to identify possible early predictors of SAH at ages 2 and 4 years in very low birth weight (VLBW) infants. STUDY DESIGN: This is a prospective cohort study including inborn children with birth weight (BW) <1,500 g. Arterial blood pressure measurements were performed at 2 and 4 years. Model 1 compared children with and those without SAH at age 4. Model 2 compared children who had SAH at ages 2 and 4 with the others. SAH was diagnosed if the systolic or/and diastolic pressures were above the 95th percentile. RESULTS: A total of 198 patients were included during the 5-year study period, of whom 56% had SAH at age 4. In model 1, white matter injury (WMI) and catch-up growth at age 2 were predictors of SAH at age 4. In model 2, bronchopulmonary dysplasia, WMI, catch-up growth at age 2, and BW were predictors of SAH at 2 and 4 years. SAH at age 2 was an independent risk factor for SAH at age 4. After a multivariate analysis of model 2, BW and catch-up growth were associated with SAH. CONCLUSION: Prevalence of SAH was high in VLBW infants; it was associated with low BW and catch-up growth at age 2.

Classic homocystinuria and keratoconus: a case report / Homocistinúria clássica e ceratocone: um relato de caso

ABSTRACT Homocystinuria is one of a group of genetic disorders called inborn errors of metabolism. It is characterized by a deficiency of the enzyme that converts homocysteine to cystathionine. Keratoconus is an ophthalmologic condition characterized by thinning of the corneal stroma, which causes the cornea to assume a conical shape. There is little information in the scientific literature about the association between keratoconus and homocystinuria. We believe that a collagen cross-linking defect may be the key to understand the connection between these two conditions. This case report describes a 38-year-old male patient with a diagnosis of classical homocystinuria since age 13. At the age of 16, he received a diagnosis of asymmetrical keratoconus when referred for lensectomy with vitrectomy of his left eye. To the best of our knowledge, this is the first report of a patient with simultaneous homocystinuria and keratoconus.

RESUMO Homocistinúria é parte de um grupo de doenças genéticas chamado erros inatos do metabolismo. É caracterizada por uma deficiência da enzima que converte a homocisteína em cistationina. O ceratocone é uma patologia oftalmológica caracterizada pelo afinamento do estroma corneano, o que faz com que a córnea assuma um formato cônico. Há pouca informação na literatura científica sobre a associação entre ceratocone e homocistinúria. Acreditamos que um defeito no cross-linking do colágeno possa ser a chave para entender a conexão entre estas duas condições. Este relato de caso descreve um paciente masculino de 38 anos com diagnóstico de homocistinúria clássica desde os 13 anos. Aos 16 anos, recebeu o diagnóstico de ceratocone assimétrico quando foi encaminhado para lensectomia com vitrectomia do olho esquerdo. Até onde sabemos, este é o primeiro relato de um paciente com homocistinúria e ceratocone simultâneos.

Classic homocystinuria and keratoconus: a case report.

Homocystinuria is one of a group of genetic disorders called inborn errors of metabolism. It is characterized by a deficiency of the enzyme that converts homocysteine to cystathionine. Keratoconus is an ophthalmologic condition characterized by thinning of the corneal stroma, which causes the cornea to assume a conical shape. There is little information in the scientific literature about the association between keratoconus and homocystinuria. We believe that a collagen cross-linking defect may be the key to understand the connection between these two conditions. This case report describes a 38-year-old male patient with a diagnosis of classical homocystinuria since age 13. At the age of 16, he received a diagnosis of asymmetrical keratoconus when referred for lensectomy with vitrectomy of his left eye. To the best of our knowledge, this is the first report of a patient with simultaneous homocystinuria and keratoconus.