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1.
Int J Oncol ; 2019 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-31746375

RESUMO

Current treatment against glioblastoma consists of surgical resection followed by temozolomide, with or without combined radiotherapy. Glioblastoma frequently acquires resistance to chemotherapy and/or radiotherapy. Novel therapeutic approaches are thus required. The inhibition of enhancer of zeste homolog 2 (EZH2; a histone methylase) and histone deacetylases (HDACs) are possible epigenetic treatments. Temozolomide, 3­deazaneplanocin A (DZ­Nep; an EZH2 inhibitor) and panobinostat (an HDAC inhibitor) were tested in regular and temozolomide­resistant glioblastoma cells to confirm whether the compounds could behave in a synergistic, additive or antagonistic manner. A total of six commercial cell lines, two temozolomide­induced resistant cell lines and two primary cultures derived from glioblastoma samples were used. Cell lines were exposed to single treatments of the drugs in addition to all possible two­ and three­drug combinations. Colony formation assays, synergistic assays and reverse transcription­quantitative PCR analysis of apoptosis­associated genes were performed. The highest synergistic combination was DZ­Nep + panobinostat. Triple treatment was also synergistic. Reduced clonogenicity and increased apoptosis were both induced. It was concluded that the therapeutic potential of the combination of these three drugs in glioblastoma was evident and should be further explored.

2.
J Clin Rheumatol ; 2019 Oct 11.
Artigo em Inglês | MEDLINE | ID: mdl-31609811

RESUMO

OBJECTIVES: The aims of this study were to establish delay times from articular symptoms onset to first rheumatologist consultation, rheumatoid arthritis (RA) diagnosis, and treatment initiation with disease-modifying antirheumatic drug (DMARD) therapy and to assess the impact of delayed diagnosis on structural damage. METHODS: This was an observational cohort study. Rheumatoid arthritis adult patients treated in a private health system between January 1, 1996, and December 31, 2016, were included. Electronic medical records were reviewed to obtain clinical and demographic data, dates of first disease symptom, diagnosis, and date of first treatment with DMARDs. Physical function (Health Assessment Questionnaire) and structural damage (Sharp score modified by van der Heijde) were also assessed. RESULTS: Two hundred forty-six patients (81% female), with a mean age of 67.25 (standard deviation [SD], 14.53) years, were included. At the end of follow-up period, median Health Assessment Questionnaire (n = 145) and radiological scores (n = 171) were 0.125 (interquartile range, 0-0.87) and 15 (interquartile range, 6-33), respectively. A mean of 9.2 (SD, 20) months (median, 3 months) elapsed from the first disease symptom to rheumatologist consultation, 14.2 (SD, 24) months (median, 4.8 months) to RA diagnosis, and 16.9 (SD, 25.4) months (median, 7 months) to treatment initiation with DMARDs. Significantly greater structural damage was found in patients with a diagnosis delay of more than 12 months (n = 70) (p = 0.0325). CONCLUSIONS: Despite good access to medical consultation in a private health system, there is still a delay to RA diagnosis and to start pharmacological therapy. A delay of more than 12 months was significantly associated with greater radiological damage after 5 years of follow-up.

3.
J Alzheimers Dis ; 2019 Oct 18.
Artigo em Inglês | MEDLINE | ID: mdl-31640103

RESUMO

BACKGROUND: Primary progressive aphasia (PPA) is a heterogeneous syndrome that is difficult to diagnose at early stages. Plasma neurofilament light chain (NFL) has been proposed as a potential biomarker for PPA. OBJECTIVE: To examine the diagnostic properties of plasma NFL in PPA and to evaluate its association with clinical stages of the disease and brain metabolism. METHODS: Our study included 80 participants (13 with non-fluent, 12 with semantic, and 16 with logopenic variant PPA; 13 with amnestic Alzheimer's disease [AD]; 13 with behavioral variant frontotemporal dementia; and 13 healthy controls). Plasma NFL concentration was measured using a high-sensitivity enzyme-linked immunosorbent assay (ELISA) kit. PET imaging was performed in a subgroup of patients. RESULTS: NFL discriminated patients from controls with an area under the curve of 0.914 (95% CI, 0.843-0.984; p <  0.001) (cut-off: 76.46 pg/mL; 94% sensitivity, 76.9% specificity). There were no significant differences between clinical syndromes (PPA subtypes), the main clinical forms of dementia (frontotemporal dementia and AD), or the expected pathological groups (frontotemporal lobar degeneration-tau [FTLD-tau], FTLD-TDP43, and AD). NFL levels showed weak to moderate correlations with age and functional scale score. We found no significant correlation with the extent of hypometabolism observed on FDG-PET images. CONCLUSION: Plasma NFL is a non-specific marker of neurodegeneration, and may be helpful in the diagnosis of PPA. However, NFL does not permit differential diagnosis between PPA subtypes and is not correlated with the extent of neurodegeneration.

4.
Nat Commun ; 10(1): 3534, 2019 08 06.
Artigo em Inglês | MEDLINE | ID: mdl-31388000

RESUMO

We are constantly interacting with our environment whilst we encode memories. However, how actions influence memory formation remains poorly understood. Goal-directed movement engages the locus coeruleus (LC), the main source of noradrenaline in the brain. Noradrenaline is also known to enhance episodic encoding, suggesting that action could improve memory via LC engagement. Here we demonstrate, across seven experiments, that action (Go-response) enhances episodic encoding for stimuli unrelated to the action itself, compared to action inhibition (NoGo). Functional magnetic resonance imaging, and pupil diameter as a proxy measure for LC-noradrenaline transmission, indicate increased encoding-related LC activity during action. A final experiment, replicated in two independent samples, confirmed a novel prediction derived from these data that emotionally aversive stimuli, which recruit the noradrenergic system, modulate the mnemonic advantage conferred by Go-responses relative to neutral stimuli. We therefore provide converging evidence that action boosts episodic memory encoding via a noradrenergic mechanism.

5.
Clin Rheumatol ; 38(8): 2129-2139, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31016578

RESUMO

OBJECTIVE: Most reports on serious infections (SI) in rheumatoid arthritis (RA) patients treated with biological disease-modifying antirheumatic drugs (bDMARDs) are from the USA and Western Europe. Data from other regions are largely missing. We report data from South American countries with different backgrounds and health-care systems but similar registries. METHODS: We merged 2010-2016 data from two registries, BIOBADABRASIL (Brazil) and BIOBADASAR (Argentina), which share the same protocol, online platform and data monitoring process. Patients with active RA were included when they began the first bDMARD or a conventional synthetic DMARD (csDMARD, control group). The SI incidence rate (IR) per 1000 patient/years and adjusted IR ratio (aIRR) were estimated for bDMARDs and csDMARDs. RESULTS: Data were analysed for 3717 RA patients with an exposure of 13,380 patient/years. The 2591 patients treated with bDMARDs (64% tumour necrosis factor-α inhibitors (TNFi)) had a follow-up of 9300 years, and the 1126 treated with csDMARDs had an exposure of 4081 patient/years. The SI IR was 30.54 (CI 27.18-34.30) for all bDMARDs and 5.15 (CI 3.36-7.89) for csDMARDs. The aIRR between the two groups was 2.03 ([1.05, 3.9] p = 0.034) for the first 6 months of treatment but subsequently increased to 8.26 ([4.32, 15.76] p < 0.001). The SI IR for bDMARDs decreased over time in both registries, dropping from 36.59 (28.41-47.12) in 2012 to 7.27 (4.79-11.05) in 2016. CONCLUSION: While SI remains a major concern in South American patients with RA treated with bDMARDs, a favourable trend toward a reduction was observed in the last years.Key Points• New comprehensive data on biologic drugs safety from international collaboration in South America.• First proposal for national registries data merging in South America.• Serious infections remain a major concern in RA patients treated with biologics.• A significant reduction of serious infections in RA patients exposed to biologics was observed over a 7 years period.

6.
J Rheumatol ; 46(7): 694-700, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30554153

RESUMO

OBJECTIVE: To evaluate the diagnostic value of color Doppler ultrasound (CDUS) for the detection of sacroiliitis, in patients with inflammatory back pain (IBP). METHODS: Consecutive patients with IBP and suspected axial spondyloarthritis (SpA), but without a definitive diagnosis, were included. Consecutive patients with defined SpA and axial involvement were included as a control group. All patients underwent clinical evaluation, magnetic resonance imaging (MRI), and CDUS of sacroiliac joints (SIJ) within the same week. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for the diagnosis of sacroiliitis by CDUS were calculated, using MRI as the gold standard. RESULTS: There were 198 SIJ evaluated in 99 patients (36 with previous SpA). There were 61 men (61.6%), with a mean age of 39.8 years (SD 11.3) and median disease duration of 24 months (IQR 12-84). At the patient level, CDUS had a sensitivity of 63% (95% CI 48.7-75.7%) and a specificity of 89% (95% CI 76-96%). The PPV was 87.2% (95% CI 72.6-95.7%) and the NPV was 66.7% (95% CI 53.3-78.3%). At joint level, CDUS had a sensitivity of 60% (95% CI 49-70%) and a specificity of 93% (95% CI 88-98%). The PPV was 83% (95% CI 78-95%) and the NPV was 43% (95% CI 33-56%). The sensitivity of CDUS for the diagnosis of axial SpA was 54% (95% CI 36.6-71.2%), specificity was 82% (95% CI 63.1-93.9%), PPV was 79% (95% CI 57.8-92.9%), and NPV was 59% (95% CI 42.1-74.4%). CONCLUSION: CDUS showed adequate diagnostic properties for detection of sacroiliitis and is a useful tool in patients with IBP.

7.
Rheumatol Int ; 39(4): 707-713, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30539275

RESUMO

The aim of this study was to evaluate the reliability of the outcome measures in rheumatology (OMERACT) definitions for ultrasound (US) elementary lesions in gout through an image reading exercise. Images from patients with gout (static images and videos) were collected. As an initial step, we carried out a image reading exercise within the experts of the Pan-American League of Associations for Rheumatology (PANLAR) US Study Group (n = 16). The following step consisted in a web-based exercise with the participation of larger number of sonographers (n = 63) from different centers. Images were rated evaluating the presence/absence of any US elementary lesion. Inter- and intra-reader reliabilities were analyzed using kappa coefficients. Participants were stratified according to their level of experience. In the first exercise, inter-reader kappa values were 0.45 for aggregates, 0.57 for tophus, 0.69 for erosions, and 0.90 for double contour (DC). Intra-reader kappa values were 0.86, 0.76, 0.80, and 0.90, respectively. The web-based exercise showed inter-reader kappa values for aggregates, tophus, erosions, and DC of 0.42, 0.49, 0.69, and 0.79, respectively. The intra-reader kappa values were 0.62, 0.69, 0.77, and 0.85, respectively. Reliability was not influenced by the sonographer's level of experience. The reliability of the new OMERACT US definitions for elementary lesions in gout ranged from moderate to excellent, depending on the type of lesion.

8.
Reumatol Clin ; 2018 Oct 29.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30385296

RESUMO

BACKGROUND: The SpENAT, a Spanish version of the Educational Needs Assessment Tool, is a self-completed questionnaire that assesses educational needs (ENs) with the purpose of providing tailored and patient-centered information. It consists of 39 questions grouped into the 7 following domains: Pain management, Movement, Feelings, Arthritic process, Treatments, Self-help measures and Support system. OBJECTIVES: The objective of the study was to describe the ENs of rheumatoid arthritis (RA) patients using the SpENAT and to determine the main sources of information consulted by these patients. MATERIAL AND METHODS: Multicenter, observational, cross-sectional study. We included consecutive patients≥18 years with diagnosis of RA (ACR 87/ACR-EULAR 2010). Sociodemographic data, disease characteristics and clinimetric properties were recorded. All patients completed the SpENAT and were asked about the sources employed to obtain information about their disease. STATISTICAL ANALYSIS: Population characteristics were described. ENs were determined as percentages of the highest possible score for each domain. Needs for each domain according to sex, years of education, disease duration, use of biologicals and functional capacity were analyzed by means of ANOVA, and bivariate comparisons were made with Student's t-test and the Bonferroni correction. Correlation between domains was determined with the Spearman correlation coefficient. We compared patients' age by source of information with Student's t-test. RESULTS: We included 496 patients from 20 centers in Spain. More ENs were observed in the domains of Movement, Feelings and the Arthritic process. Patients with higher educational level (>7 years) reported more ENs in the Arthritic process and Self-help measure domains. A higher functional impairment (HAQ-A≥0.87) was associated with more ENs in every domain. Patients with high activity showed more ENs than those in remission in the domains of Pain management, Movement, Feelings, Treatments and Support system, as well as those with low activity in Self-help measures and Support system domains. All SpENAT domains showed positive correlations among each other (P<.0001), the most important being Pain management/Movement and Treatments/Arthritic process (r≥0.7). The source of information most frequently consulted was the rheumatologist (93.95%); those who made use of Internet were on average younger (P=.0004). CONCLUSION: RA patients were very interested about knowing more about their disease. High functional impairment was associated with more ENs. Patients with high disease activity had higher EN levels in almost every domain. The rheumatologist was the main source of information for the patient with RA.

9.
Carbohydr Polym ; 200: 289-296, 2018 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-30177169

RESUMO

In this paper, the synthesis of magnetic nanofibrous materials with a soft ferromagnetic response based on magnetite nanoparticles (SMON) loaded to aqueous carboxymethyl-cellulose (CMC)/polyvinyl-alcohol (PVA) polymeric blends is reported. The nanofibrous materials were obtained from the electrospinning of SMON-CMC/PVA blends with different SMON content, applying a constant tension of 15 kV. The synthesized samples were analyzed by transmission electron microscopy, scanning electron microscopy, attenuated total reflectance Fourier transform infrared, Raman and X-Ray photoelectron spectroscopy, as well as static magnetic measuring. Our experimental findings indicate that nanofibers' diameter decreases as SMON content in the electrospun polymeric blends is increased, since these magnetic nanoparticles diminish the interactions between PVA and CMC molecules, which improves their spinnability. Moreover, the spatial distribution of SMON in the fibers provides to the synthesized nanofibrous materials a novel soft ferromagnetic response at room temperature. This phenomenon is attributed to the formation of nanoparticles' aggregates that are discretely distributed in the nanofibers.

10.
Free Radic Biol Med ; 126: 249-258, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30130568

RESUMO

Colorectal cancer (CRC) is a leading cause of malignant cancer-related morbidity and mortality, with a higher incidence in developed countries and a high mortality rate mainly attributable to metastases. The aim of the present study was to determine the metabolic adaptations related to oxidative stress in tumor tissue from advanced stages (III and IV) of CRC and whether they could be used as potential biomarkers for clinical applications. To tackle this aim, we have analyzed the protein expression levels related to oxidative stress and the enzymatic activities of MnSOD and catalase, comparing samples of non-tumor adjacent tissue and tumor tissue of CRC patients in stages III and IV. The results showed no differences between stage III and IV in tumor tissues for any of the proteins studied. However, some differences were found between samples of non-tumor adjacent tissue and tumor tissue for some of the antioxidant enzymes. Overwhelmingly, the greatest differences were detected when comparing samples of non-tumor adjacent tissue from stage III and stage IV. To the best of our knowledge, this is the first study where differences between the non-tumor adjacent tissues of CRC patients from different cancer stages were determined. This study suggests that the parameters analyzed should be evaluated as biomarkers for the evolution of CRC. Furthermore, tumor tissue status should not be of sole importance for the prognosis of CRC, as the non-tumor adjacent tissues could also merit consideration.

11.
Reumatol. clín. (Barc.) ; 14(4): 202-206, jul.-ago. 2018. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-175922

RESUMO

Objetivos: Describir los hallazgos ecográficos en pacientes con artritis reumatoide (AR) en remisión clínica y evaluar la capacidad de la ecografía con Doppler de poder (DP) para reclasificar la actividad de la enfermedad en este grupo de pacientes. Material y métodos: Se incluyeron pacientes consecutivos con diagnóstico de AR (criterios ACR/EULAR 2010) en remisión clínica por DAS28 (<2,6). Se evaluaron mediante ecografía 20 articulaciones de ambas manos. La señal DP fue evaluada mediante una escala semicuantitativa de 0 a 3. Se construyeron 3 índices clínico-ecográficos que denominamos ECO-DAS28 1, 2 y 3, donde el recuento de articulaciones tumefactas evaluadas clínicamente fue reemplazado por el recuento de articulaciones con señal DP positiva grado ≥1, ≥2 o 3, respectivamente. Resultados: Se incluyeron 86 pacientes, de los cuales 23 (26,7%) tuvieron al menos una articulación con señal DP positiva. Un 13% de los pacientes fueron reclasificados hacia baja actividad de la enfermedad aplicando el ECO-DAS28 cuando se consideraron activas las articulaciones con señal DP grado ≥1, el 12% cuando se consideró actividad una señal DP≥2 y el 2% de los pacientes cuando se consideró la señal DP igual a 3. Ningún paciente se reclasificó a un nivel de moderada o alta actividad. Conclusiones: A pesar de encontrar actividad inflamatoria residual por ecografía en aproximadamente un cuarto de los pacientes con AR en remisión clínica, solo un bajo porcentaje fue reclasificado a un estado de baja actividad de la enfermedad y ninguno a un nivel de moderada o alta, aplicando los ECO-DAS28 propuestos


Objectives: The aim of the present study was to describe the ultrasound (US) findings in patients with rheumatoid arthritis (RA) in clinical remission, and to evaluate the ability of power Doppler (PD) US to reclassify disease activity in these patients. Material and methods: We included consecutive patients with RA according to 2010 American College of Rheumatology/European League Against Rheumatism criteria, who were in clinical remission by the Disease Activity Score (DAS28<2.6). Twenty joints of both hands were assessed by US. PD signal was evaluated on a semi-quantitative scale from 0 to 3. Three different US-modified DAS28 (US-DAS28) were constructed, replacing the clinical swollen joint count by the PD US joint count using PD score ≥1, ≥2 or ≥3, respectively. Results: Eighty-six patients were included. Twenty-three (26.7%) patients had at least one joint with abnormal US-positive PD signal. Thirteen percent of patients were reclassified to low disease activity by applying the US-DAS28 when joints were considered active with a PD signal ≥1; 12%, when a PD signal ≥2 was considered, and 2% of the patients were reclassified when a PD score of 3 was considered. No patients were reclassified to a level of moderate or high activity applying US-DAS28. Conclusions: Although around a quarter of patients with RA in clinical remission showed PD US features indicating residual activity, only a small percentage were reclassified to a state of low activity and none to a level of moderate or high activity, applying the proposed US-DAS28


Assuntos
Humanos , Masculino , Feminino , Ultrassonografia Doppler/métodos , Artrite Reumatoide/diagnóstico por imagem , Indução de Remissão , Progressão da Doença , Artrite Reumatoide/classificação
12.
Rev. argent. reumatol ; 29(2): 28-33, jun. 2018. ilus, tab
Artigo em Espanhol | LILACS | ID: biblio-977285

RESUMO

El objetivo fue evaluar la prevalencia de tenosinovitis detectada por ecografía-doppler en pacientes con Artritis Reumatoidea (AR) en remisión clínica sostenida, determinar su asociación con las características de la enfermedad y determinar si la presencia de tenosinovitis ecográfica podría agregar información a la sinovitis para definir remisión ecográfica. Se incluyeron 60 pacientes con AR en remisión clínica (DAS28 <2,6, CDAI <2,8 y/o SDAI <3,3) sostenida a quienes se les realizó una ecografía con señal doppler de poder (DP). Un reumatólogo entrenado evaluó en forma bilateral: 1°-6° compartimentos extensores a nivel del carpo, 2°-5° tendones flexores de los dedos de las manos, tibial posterior, peroneo lateral corto y largo. A nivel articular se evaluaron en forma bilateral: carpo, 2°-5° metacarpofalángicas y 2°-5° interfalángicas proximales. Se definió remisión ecográfica a la ausencia de sinovitis en escala de grises (EG) grado ≥2 y la ausencia de señal DP a nivel articular o tendinoso. Se detectó tenosinovitis por EG grado ≥2 y señal DP ≥1 en 14 (23%; IC 95%: 12-34) y 13 (21,7%; IC 95%: 10-32) pacientes, respectivamente. Los tendones más frecuentemente afectados fueron: 6° compartimento extensor del carpo, tibial posterior y 3° tendón flexor tibial posterior. En el análisis multivariado, la única variable que se asoció con la presencia de tenosinovitis por ecografía-doppler fue la ERS (OR: 1,11; IC 95%: 1,02-1,22). Veintinueve pacientes (48,3%; IC 95%: 35-60) presentaron sinovitis subclínica y no fueron clasificados como AR en remisión ecográfica. La adición de la información brindada por la presencia de tenosinovitis subclínica, permitió clasificar 6 pacientes más sin remisión ecográfica, arrojando un total de 35 pacientes (58,3%; IC 95%: 45-70) (p=0,272).


The aims were to evaluate prevalence of ultrasound (US) tenosynovitis in Rheumatoid Arthritis (RA) patients in sustained clinical remission, its association with disease features and to assess whether the presence of tenosynovitis could add information to synovitis to define ultrasound (US) remission. Sixty consecutive RA patients in sustained (≥12 months) clinical remission (DAS28 <2.6, CDAI <2.8 and/or SDAI <3.3) were included. All patients underwent US examination by the same experienced rheumatologist. The following were bilaterally assessed: 1st-6th extensor tendon compartments at wrist level, 2nd-5th finger flexor tendons, posterior tibial, peroneal tendons, wrists, 2nd-5th metacarpophalangeal and 2nd-5th proximal interphalangeal. US remission was defined as the absence of synovitis on gray scale (GS ≥2) and the absence of power doppler (PD) signal at both joint and tendon level. Grey scale ≥2 and PD tenosynovitis were detected in 14 (23%; 95% CI: 12-34) and 13 (21.7%; 95% CI: 10-32) RA patients in clinical remission, respectively. The most frequent involved tendons were: 6th extensor wrist compartment, 3rd finger flexor and posterior tibials. In multivariate analysis, the only feature associated with the presence of subclinical tenosynovitis was erythrosedimentation rate (ESR)(OR: 1.11; 1.02-1.22). Twenty-nine (48.3%; 95% CI: 35-60) patients had subclinical synovitis and were not classified as in US remission. Adding the information of subclinical tenosynovitis, 6 more patients would have been classified as not in US remission, yielding a total of 35 patients (58.3%; 95% CI: 45-70) (p=0.272).


Assuntos
Artrite Reumatoide , Tenossinovite , Ultrassonografia Doppler
13.
J Clin Rheumatol ; 2018 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-29620593

RESUMO

OBJECTIVES: The aims of this study were to compare learned helplessness (LH) and perceived self-efficacy (SE) in patients with fibromyalgia (FM) and rheumatoid arthritis (RA) and to assess their correlation with functional disability, level of perceived pain, and fatigue. METHODS: This multicenter, cross-sectional study included consecutive patients (aged ≥18 years) with RA, according to the 2010 American College of Rheumatology/European League Against Rheumatism criteria, and FM, according to 2010 American College of Rheumatology criteria. Learned helplessness was measured by the Rheumatology Attitude Index, Spanish version; SE with the Arthritis Self-efficacy Scale, Spanish version; functional capacity with the Health Assessment Questionnaire (HAQ), Argentine version; depression with Center for Epidemiological Studies-Depression Scale 7-item version and perceived pain and fatigue by the visual analog scale. Disease activity was measured by the Clinical Disease Activity Index (CDAI) and disease impact with the Fibromyalgia Impact Questionnaire (FIQ). RESULTS: A total of 215 patients, 100 with FM and 115 with RA, were included. Mean age was 59 (SD, 14) years and 58 (SD, 13) years for FM and RA, patients respectively. Whereas LH and depression were significantly higher, SE was significantly lower in FM patients. We found a positive correlation between LH and HAQ, pain, depression, fatigue, FIQ, and CDAI in FM and RA patients. We observed a negative correlation between SE and HAQ, pain, depression, fatigue, FIQ (FM), and CDAI (RA) in both groups. CONCLUSIONS: Both LH and SE correlate significantly with functional capacity, perceived pain, disease activity, and disease impact in RA and FM patients. Learned helplessness was higher in patients with active disease or high disease impact, as opposed to those in remission or with low disease impact, and the reverse was true for SE. Patients with FM had significantly more LH, pain, fatigue, and depression and less SE compared with those with RA.

14.
Reumatol Clin ; 14(4): 202-206, 2018 Jul - Aug.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-28330716

RESUMO

OBJECTIVES: The aim of the present study was to describe the ultrasound (US) findings in patients with rheumatoid arthritis (RA) in clinical remission, and to evaluate the ability of power Doppler (PD) US to reclassify disease activity in these patients. MATERIAL AND METHODS: We included consecutive patients with RA according to 2010 American College of Rheumatology/European League Against Rheumatism criteria, who were in clinical remission by the Disease Activity Score (DAS28<2.6). Twenty joints of both hands were assessed by US. PD signal was evaluated on a semi-quantitative scale from 0 to 3. Three different US-modified DAS28 (US-DAS28) were constructed, replacing the clinical swollen joint count by the PD US joint count using PD score ≥1, ≥2 or ≥3, respectively. RESULTS: Eighty-six patients were included. Twenty-three (26.7%) patients had at least one joint with abnormal US-positive PD signal. Thirteen percent of patients were reclassified to low disease activity by applying the US-DAS28 when joints were considered active with a PD signal ≥1; 12%, when a PD signal ≥2 was considered, and 2% of the patients were reclassified when a PD score of 3 was considered. No patients were reclassified to a level of moderate or high activity applying US-DAS28. CONCLUSIONS: Although around a quarter of patients with RA in clinical remission showed PD US features indicating residual activity, only a small percentage were reclassified to a state of low activity and none to a level of moderate or high activity, applying the proposed US-DAS28.

15.
Sci Rep ; 7(1): 11077, 2017 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-28894116

RESUMO

The comprehension of unconventional immune functions of tonsillar B cells, their role in tolerance induction and protective immune responses, is crucial to unveil the dynamic interactions of the upper aero digestive tract with polymicrobial commensal flora and pathogens, in health and disease. Here, we describe the kinetics of IL10 intracellular expression and compare it with that of cytokines known to be produced by tonsillar B cells. Additionally, we detected a relevant proportion of IL17-expressing tonsillar B cells, which has not previously been reported. We immunophenotyped tonsillar IL10-expressing B cells (B10) and observed IL10 production in activated B cells at every developmental stage. Finally, we identified a relationship between decreased B10 percentages, increased proportion of the germinal centre (GC) population and hypertrophied tonsils (HT). Our findings provide greater insight into the role of B10 in GC reactions and characterized their involvement in the pathogenesis of tonsillar dysfunction.

16.
Semin Arthritis Rheum ; 47(3): 338-342, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-28648658

RESUMO

OBJECTIVE: It has been shown that nail involvement in psoriasis is associated with systemic enthesopathy. Our objective was to evaluate the association of nail involvement and enthesopathy at distal interphalangeal joint (DIP) level in psoriasis (PsO) and psoriatic arthritis (PsA) patients. METHODS: Consecutive patients (54 PsO and 56 PsA) seen at the outpatients clinic in this cross-sectional study were included. All patients underwent both clinical and ultrasound (US) assessment on the same day. RESULTS: US revealed enthesopathy in at least 1 DIP joint in 9 patients with PsO (17%, 95% CI: 8-29%) and in 18 patients with PsA (32%, 95% CI: 20-46%). US extensor tendon enthesopathy was detected in a higher proportion of fingers with clinical nail involvement compared with fingers without clinical nail involvement, both in PsO and PsA patients (61.2% vs 16.8%, p < 0.0001 and 60.1% vs 22%, p < 0.0001, respectively). Among patients with PsO, 20% (95% CI: 7-41%) and 14% (95% CI: 4-32%) of those with and without clinical nail involvement showed enthesopathy on US examination, respectively (p = 0.54). Among PsA patients, the prevalence of enthesopathy was 30% (95% CI: 15-49%) for patients with clinical nail involvement and 35% (95% CI: 17-56%) for those without nail involvement (p = 0.71). CONCLUSION: Nail disease was associated with DIP US enthesopathy. There was a significant increased prevalence of extensor tendon enthesopathy in fingers with involved nails both in PsO and PsA, although no association was found between nail involvement and extensor tendon enthesopathy at patients' level. These features might support the nail-entheseal pathogenesis theory at DIP level.


Assuntos
Artrite Psoriásica/complicações , Entesopatia/complicações , Articulações dos Dedos/patologia , Doenças da Unha/complicações , Unhas/patologia , Adulto , Idoso , Estudos Transversais , Entesopatia/diagnóstico por imagem , Feminino , Articulações dos Dedos/diagnóstico por imagem , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Doenças da Unha/diagnóstico , Exame Físico , Psoríase/complicações , Sensibilidade e Especificidade , Ultrassonografia
17.
J Rheumatol ; 44(7): 1018-1023, 2017 07.
Artigo em Inglês | MEDLINE | ID: mdl-28461647

RESUMO

OBJECTIVE: Power Doppler ultrasound (PDUS) has been shown to detect subclinical synovitis in psoriatic arthritis (PsA), but its value is not yet fully understood. The aim of this study was to evaluate PDUS features at joint level in patients with PsA in clinical remission and to investigate its value for predicting short-term flares. METHODS: Consecutive patients with PsA in clinical remission according to the attending rheumatologist and who fulfill minimal disease activity criteria and/or 28-joint Disease Activity Score in remission criteria underwent PDUS examination of 18 joints. All patients were followed up for 6 months. Disease flare was defined as any increase of disease activity generating the need of any of the following changes in therapy with disease-modifying antirheumatic drugs (DMARD) by the attending rheumatologist: dose increase, switch or addition of a different DMARD, and/or switch or addition of biological therapies. RESULTS: Among 54 patients with PsA in clinical remission, 15 (27.8%) experienced a flare within the next 6 months. Twenty patients had at least 1 joint with PDUS synovitis at baseline, and 13 (65%) of these had a disease flare during the followup period compared with only 2 of the 34 patients (5.9%) without baseline PDUS synovitis (relative risk = 11, 95% CI 2.8-44, p < 0.001). On logistic regression analysis, the only variables associated with short-term flares were baseline PDUS synovitis and the use of nonbiologic DMARD. CONCLUSION: Among patients with PsA in clinical remission, PDUS-detected synovitis was a strong predictor of short-term flare of the disease.


Assuntos
Antirreumáticos/uso terapêutico , Artrite Psoriásica/diagnóstico por imagem , Psoríase/diagnóstico por imagem , Adulto , Idoso , Artrite Psoriásica/tratamento farmacológico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Psoríase/tratamento farmacológico , Índice de Gravidade de Doença , Ultrassonografia Doppler
18.
J Obstet Gynaecol ; 37(1): 131-135, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27866418

RESUMO

Carcinoma of the vagina is a rare disease, and it is even more rare when it appears in a neovagina, having its incidence and optimum treatment constantly discussed. The aim of this article was to review the cases described in the currently available literature and describe the second documented case of carcinoma in a neovagina created with peritoneal flaps, and also list the possible pathways and risk factors for its development. The case we present is a 49-year-old female who after undergoing a laparoscopic colpectomy of the upper two-thirds of the vagina, with an immediate reconstruction with peritoneal flaps by laparoscopy, at a 4 months follow up presented a focal microinvasive squamous carcinoma in the vault of the neovagina. After reviewing the literature, we conclude that excisional treatment is the preferable option to avoid the progression to an invasive carcinoma. However, this case demonstrates the importance of the necessity to do regular cito-vulvovaginoscopic examinations after the complete surgical treatment because of the chance of persistent or recurrent lesions on the transplanted tissue.


Assuntos
Carcinoma de Células Escamosas/etiologia , Colposcopia/efeitos adversos , Peritônio/transplante , Retalhos Cirúrgicos/efeitos adversos , Vagina , Neoplasias Vaginais/etiologia , Carcinoma de Células Escamosas/patologia , Colposcopia/métodos , Feminino , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Pessoa de Meia-Idade , Invasividade Neoplásica , Vagina/patologia , Vagina/cirurgia , Neoplasias Vaginais/patologia
19.
Rev. argent. reumatol ; 28(4): 5-5, 2017.
Artigo em Espanhol | LILACS | ID: biblio-912732

RESUMO

Estimado Editor: uno de los paradigmas en el tratamiento de la Artritis Reumatoidea(AR) ha sido la introducción de los agentes biológicos. Los primeros disponibles fueron los inhibidores del TNF (iTNF); sin embargo, un 20 a un 40% de los pacientes tienen una respuesta parcial con el uso de estas drogas. Desde el año 2010, tocilizumab(TCZ), un anticuerpo monoclonal humanizado contra el receptor de interleuquina (IL), está disponible para su uso en AR endiferentes países del mundo. La efectividad clínica de TCZ fue demostrada como monoterapia y como terapia combinada con metotrexato (MTX); en pacientes no respondedores a drogas modificadoras de la enfermedad (DMARs) convencionales ya Itnf


Assuntos
Anticorpos Monoclonais , Artrite Reumatoide
20.
Rev. argent. reumatol ; 28(4): 5-5, 2017.
Artigo em Espanhol | LILACS | ID: biblio-958085

RESUMO

Estimado Editor: uno de los paradigmas en el tratamiento de la Artritis Reumatoidea(AR) ha sido la introducción de los agentes biológicos. Los primeros disponibles fueron los inhibidores del TNF (iTNF); sin embargo, un 20 a un 40% de los pacientes tienen una respuesta parcial con el uso de estas drogas. Desde el año 2010, tocilizumab(TCZ), un anticuerpo monoclonal humanizado contra el receptor de interleuquina (IL), está disponible para su uso en AR endiferentes países del mundo. La efectividad clínica de TCZ fue demostrada como monoterapia y como terapia combinada con metotrexato (MTX); en pacientes no respondedores a drogas modificadoras de la enfermedad (DMARs) convencionales ya iTNF


Assuntos
Artrite Reumatoide , Fatores Biológicos
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