RESUMO
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Assuntos
Idoso , Feminino , Humanos , Granulomatose Linfomatoide/diagnóstico , Transtornos Linfoproliferativos/diagnóstico , Diagnóstico Diferencial , Nódulos Pulmonares Múltiplos/diagnóstico , Radiografia TorácicaAssuntos
Neoplasias Pulmonares/diagnóstico por imagem , Granulomatose Linfomatoide/diagnóstico por imagem , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Doenças Assintomáticas , Diagnóstico Diferencial , Infecções por Vírus Epstein-Barr/diagnóstico , Infecções por Vírus Epstein-Barr/tratamento farmacológico , Evolução Fatal , Feminino , Humanos , Achados Incidentais , Interferon alfa-2 , Interferon-alfa/administração & dosagem , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/tratamento farmacológico , Granulomatose Linfomatoide/diagnóstico , Granulomatose Linfomatoide/tratamento farmacológico , Prednisona/administração & dosagem , Radiografia , Proteínas Recombinantes/administração & dosagemRESUMO
OBJECTIVE: Cardiovascular disease is the major cause of excessive mortality in rheumatoid arthritis (RA) and endothelial dysfunction plays a key role in atherosclerosis. The aim of the present study was to assess whether rituximab therapy was able to improve endothelial function in RA patients refractory to tumor necrosis factor alpha (TNFalpha) blockers. METHODS: Six consecutive RA patients (5 women; age range 55-79 years) with active disease refractory to TNFalpha inhibitor therapy were studied. Patients received intravenous rituximab (1 course, consisting of 2 infusions of 1,000 mg each separated by 2 weeks). Flow-mediated endothelium-dependent vasodilatation (FMD%) and endothelium-independent vasodilatation (postnitroglycerin) were measured at day 0 prior to the first rituximab infusion, at week 2 (before the second infusion), and at month 6. RESULTS: At week 2, a dramatic increase in FMD% values was observed in all patients (mean +/- SD 7.02 +/- 2.31%, median 7.29%, range 3.2-9.75%) compared with those observed before the first infusion (mean +/- SD 3.35 +/- 1.58%, median 3.04%, range 1.69-5.89%). In addition, at month 6, FMD% values in all patients (mean +/- SD 7.66 +/- 1.73%, median 7.64%, range 5.61-9.98%) were greater than those found before the first infusion (P = 0.03). The dramatic improvement of FMD% was associated with a significant decrease in C-reactive protein level and Disease Activity Score in 28 joints. CONCLUSION: Our study demonstrates an active effect of rituximab on endothelial function in RA patients refractory to TNFalpha blockers.