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Autoimmun Rev ; 17(9): 900-905, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30005858


BACKGROUND AND OBJECTIVES: Recently published population-based cohort studies have shown a high prevalence of cardiovascular disease in Systemic Sclerosis (SSc) patients. The aim of this study is to compare three different methods to measure cardiovascular risk in patients with scleroderma. METHODS: Forty-three SSc patients were included. A prospective study was performed for evaluation of cardiovascular risk and subclinical atheromatosis using 3 non-invasive methods: cardiovascular risk tables, carotid Doppler ultrasonography and quantification of coronary calcium by computerized tomography (CT). RESULTS: The cardiovascular risk charts for the Spanish population did not identify patients at high cardiovascular risk. Framingham-REGICOR identified 13 intermediate-risk patients. Twenty-two patients (51.2%) had plaques on carotid ultrasonography. We performed a ROC curve to identify the best cutoff point for the quantification of coronary artery calcium (CACscore), the value of CACscore > 28 AU (Agatston Units) had the highest sensitivity (73%) and specificity (81%) for the diagnosis of subclinical atheromatosis. In the multiple regression study, age and decreased HDL cholesterol levels were identified as independent factors for subclinical atherosclerotic disease. No disease-related factors were associated with increased subclinical arteriosclerosis. CONCLUSION: Carotid ultrasound and CACscore are useful for identifying subclinical atheromatosis in patients with SSc and are superior compared to risk charts used for general population. HDL cholesterol and age were independent factors for the presence of subclinical atherosclerotic disease. A carotid ultrasound or CT should be performed for early detection of subclinical atheromatosis if these factors are present.

Cálcio/metabolismo , Doenças Cardiovasculares/complicações , Vasos Coronários/patologia , Escleroderma Sistêmico/etiologia , Ultrassonografia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Cálcio/análise , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco
Clin Rheumatol ; 37(4): 999-1009, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29214548


The objective of the study is to determine the importance of the mode of onset as prognostic factor in systemic sclerosis (SSc). Data were collected from the Spanish Scleroderma Registry (RESCLE), a nationwide retrospective multicenter database created in 2006. As first symptom, we included Raynaud's phenomenon (RP), cutaneous sclerosis, arthralgia/arthritis, puffy hands, interstitial lung disease (ILD), pulmonary arterial hypertension (PAH), and digestive hypomotility. A total of 1625 patients were recruited. One thousand three hundred forty-two patients (83%) presented with RP as first symptom and 283 patients (17%) did not. Survival from first symptom in those patients with RP mode of onset was higher at any time than those with onset as non-Raynaud's phenomenon: 97 vs. 90% at 5 years, 93 vs. 82% at 10 years, 83 vs. 62% at 20 years, and 71 vs. 50% at 30 years (p < 0.001). In multivariate analysis, factors related to mortality were older age at onset, male gender, dcSSc subset, ILD, PAH, scleroderma renal crisis (SRC), heart involvement, and the mode of onset with non-Raynaud's phenomenon, especially in the form of puffy hands or pulmonary involvement. The mode of onset should be considered an independent prognostic factor in systemic sclerosis and, in particular, patients who initially present with non-Raynaud's phenomenon may be considered of poor prognosis.

Artralgia/etiologia , Hipertensão Pulmonar/etiologia , Doenças Pulmonares Intersticiais/etiologia , Doença de Raynaud/etiologia , Escleroderma Sistêmico/diagnóstico , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Sistema de Registros , Estudos Retrospectivos , Escleroderma Sistêmico/complicações , Escleroderma Sistêmico/fisiopatologia , Índice de Gravidade de Doença , Avaliação de Sintomas
Lupus ; 23(10): 1073-8, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25118052


Neuropsychiatric manifestations can be a serious complication of systemic lupus erythematosus, affecting nearly 56% of these patients. Frequently, acceptable clinical outcome is observed in neurolupus with immunosuppressive therapy. Different metabolites identified with MR spectroscopy may be associated with modifications in the natural history of this disease, specifically in the central nervous system. We report a case of neurolupus with progressive neurologic impairment despite aggressive immunosuppressive treatment. We describe clinical features, laboratory and MRI results, as well as characteristic findings on MR spectroscopy. Serial MRI identified atrophy of the left temporal lobe. MR spectroscopy showed an increase of myo-inositol/creatine ratio intensity, accompanied by a decrease of N-acetylaspartate/creatine ratio in both parietal white and gray matter. During follow-up, the patient developed progressive cognitive deficiency despite the intensification of therapy. Neurolupus manifestations are common and immunosuppressive treatment often avoids severe complications. Characteristic findings on MR spectroscopy may be useful for clinicians to determine poor prognosis and resistance to therapy.

Substância Cinzenta/metabolismo , Inositol/metabolismo , Vasculite Associada ao Lúpus do Sistema Nervoso Central/metabolismo , Lobo Parietal/metabolismo , Substância Branca/metabolismo , Atrofia , Biomarcadores/metabolismo , Cognição , Progressão da Doença , Feminino , Humanos , Imunossupressores/uso terapêutico , Vasculite Associada ao Lúpus do Sistema Nervoso Central/diagnóstico , Vasculite Associada ao Lúpus do Sistema Nervoso Central/tratamento farmacológico , Vasculite Associada ao Lúpus do Sistema Nervoso Central/psicologia , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Espectroscopia de Prótons por Ressonância Magnética , Lobo Temporal/patologia , Fatores de Tempo , Regulação para Cima
Clin Exp Rheumatol ; 32(6 Suppl 86): S-33-40, 2014 Nov-Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24776173


OBJECTIVES: To compare a cohort of patients with systemic sclerosis sine scleroderma (ssSSc) vs. patients with limited cutaneous systemic sclerosis (lcSSc). METHODS: Forty-five patients with ssSSc and 186 patients with lcSSc were investigated. Demographic, clinical and immunologic features and survival were compared. RESULTS: There were no significant differences between ssSSc and lcSSc in gender, age at onset and interval between onset and diagnosis. ssSSc patients fulfilled the ACR criteria for SSc less than lcSSc patients (13%/77%, p<0.0001). There were no significant differences in articular involvement, myopathy, tendon friction rubs and gastrointestinal, pulmonary, cardiac and renal involvements. There was a trend to higher prevalence of pulmonary arterial hypertension (PAH) in ssSSc patients (29%/19%) but not reach significant difference. The prevalence of antinuclear and anticentromere antibodies and slow capilaroscopic pattern was similar. Sicca syndrome (13%/30%; p=0.024), digital ulcers (16%/50%; p<0.0001), calcinosis (11%/26%; p=0.047) and acroosteolysis (0% /10%; p=0.028) were more frequently in lcSSc. Survival at 5, 10, and 15 yr was not different in ssSSc and lcSSc patients (100%/98%, 100%/98%, and 92%/89%, respectively). CONCLUSIONS: ssSSc and lcSSc patients share demographic, clinical and immunologic features. Survival is also similar in both groups. Differences are mainly due to peripheral vascular manifestations. However, despite great similarities, we believe that ssSSc patients should be considered as a different subset in order to avoid misdiagnosis. ssSSc patients should be truly differentiated from early SSc using sensitive and specific studies looking for any asymptomatic organ involvement.

Calcinose/etiologia , Dermatoses da Mão/etiologia , Hipertensão Pulmonar/etiologia , Escleroderma Sistêmico/complicações , Síndrome de Sjogren/etiologia , Úlcera Cutânea/etiologia , Acro-Osteólise/etiologia , Adulto , Idoso , Transtornos da Motilidade Esofágica/etiologia , Feminino , Humanos , Doenças Pulmonares Intersticiais/etiologia , Masculino , Pessoa de Meia-Idade , Esclerodermia Difusa/classificação , Esclerodermia Difusa/complicações , Esclerodermia Difusa/fisiopatologia , Esclerodermia Limitada/classificação , Esclerodermia Limitada/complicações , Esclerodermia Limitada/fisiopatologia , Escleroderma Sistêmico/classificação , Escleroderma Sistêmico/fisiopatologia
ENFURO: Rev. Asoc. Esp. A.T.S. Urol ; (106): 9-12, abr.-jun. 2008. ilus
Artigo em Espanhol | IBECS | ID: ibc-85535


La incontinencia urinaria es un problema universal, que tiene una repercusión importante en la percepción de salud de las mujeres quela padecen. Realizamos un estudio de calidad de vida en mujeres con incontinencia urinaria en un periodo de 9 meses con dos encuestas: ICIQ-SFy EQ-5D. Los resultados obtenidos mostraron una media de 15 en el ICIQ-SF y 0.67 en el EQ-5D, con una menor afectación en la calidad de vida de la incontinencia de esfuerzo respecto a la mixta y a la de urgencia. Como conclusión creemos que la enfermería juega un papel decisivo en la implantación de las encuestas auto administradas, como una herramienta más en la evaluación de estas pacientes (AU)

Urinary incontinence is a universal problem, which has an important repercussion on the perception of health of the women who suffer it. We carry out a study about quality of life in women with urinary incontinence in a period of 9 months with two surveys: ICIQ-SF and EQ-5D. The obtained results showed an average of 15 in the ICIQ-SF and 0.67 in the EQ-5D, with a smaller affectation in the quality of life of the incontinence of effort with regard to the mixed one and to that of urgency. As a conclusion, we think that nursing stakes a decisive role in the introduction of the self administered surveys, as one common tool in the evaluation of these patients (AU)

Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Incontinência Urinária/epidemiologia , Psicometria/instrumentação , Incontinência Urinária/psicologia , Qualidade de Vida , Distribuição por Idade