Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 12 de 12
Filtrar
Filtros adicionais











País/Região como assunto
Intervalo de ano
1.
Arthritis Rheumatol ; 2019 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-31237427

RESUMO

OBJECTIVE: To compare the efficacy of infliximab (IFX) versus adalimumab (ADA) as first biologic drug in a large series of patients with refractory uveitis due to Behçet's disease (BD) for 1-year period. METHODS: Open-label multicenter study of IFX or ADA-treated patients with BD-uveitis refractory to conventional non-biologic treatment. IFX or ADA were chosen as first biologic treatment based on physician and patient agreement. Dosing schedule was: IFX: 3-5 mg/kg i.v. at 0, 2 and 6 weeks and every 4-8 weeks thereafter, and ADA: 40 mg/s.c./every other week without loading dose. Comparison between patients treated with IFX and patients treated with ADA was performed. RESULTS: 177 patients (316 affected eyes) were included. IFX was used in 103 and ADA in 74 cases. No significant differences at baseline were observed between IFX vs ADA groups regarding main demographic features, previous therapy and ocular severity. After one year of therapy, we observed an improvement in all ocular parameters in both groups. However, ADA therapy yielded better outcome in some parameters that in some cases yielded statistically significant differences: anterior chamber inflammation (78.18% in IFX-treated vs 92.31%in ADA-treated; p=0.06), vitritis (78.95% vs 93.33%; p=0.04), retinal vasculitis (97% vs 95%; p=0.28), macular thickness (264.89±59.74 vs 250.62±36.85; p=0.15), best-corrected visual acuity (0.67±0.34 vs 0.81±0.26; p=0.001), and drug retention (84.95% vs 95.24%; p=0.042). CONCLUSION: Although IFX and ADA yields efficacy refractory BD uveitis, ADA appears to be associated with better outcome than IFX after one-year follow-up. This article is protected by copyright. All rights reserved.

2.
Am J Ophthalmol ; 200: 85-94, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30660771

RESUMO

PURPOSE: Cystoid macular edema (CME) is a leading cause of blindness. This study assessed the efficacy and safety of tocilizumab (TCZ) in refractory CME. DESIGN: Retrospective case series. METHODS: Patients with CME secondary to noninfectious uveitis who had inadequate response to corticosteroids and at least 1 conventional immunosuppressive drug, and in most cases to other biological agents, were studied. CME was defined as central retinal thickness greater than 300 µm. The primary outcome measure was macular thickness. Intraocular inflammation, best-corrected visual acuity (BCVA), and corticosteroid-sparing effect were also analyzed. RESULTS: A total of 25 patients (mean ± standard deviation age 33.6 ± 18.9 years; 17 women) with CME were assessed. Underlying diseases associated with uveitis-related CME are juvenile idiopathic arthritis (n = 9), Behçet disease (n = 7), birdshot retinochoroidopathy (n = 4), idiopathic (n = 4), and sarcoidosis (n = 1). The ocular patterns were panuveitis (n = 9), anterior uveitis (n = 7), posterior uveitis (n = 5), and intermediate uveitis (n = 4). Most patients had CME in both eyes (n = 24). TCZ was used in monotherapy (n = 11) or combined with conventional immunosuppressive drugs. Regardless of the underlying disease, compared to baseline, a statistically significant improvement in macular thickness (415.7 ± 177.2 vs 259.1 ± 499.5 µm; P = .00009) and BCVA (0.39 ± 0.31 vs 0.54 ± 0.33; P = .0002) was obtained, allowing us to reduce the daily dose of prednisone (15.9 ± 13.6 mg/day vs 3.1 ± 2.3 mg/day; P = .002) after 12 months of therapy. Remission was achieved in 14 patients. Only minor side effects were observed after a mean follow-up of 12.7 ± 8.34 months. CONCLUSION: Macular thickness is reduced following administration of TCZ in refractory uveitis-related CME.

3.
Rheumatology (Oxford) ; 57(5): 856-864, 2018 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-29471416

RESUMO

Objective: To assess the efficacy of tocilizumab (TCZ) in refractory uveitis of Behçet's disease (BD). Methods: Multicentre study of patients with BD-associated uveitis. Patients were refractory to conventional and biologic immunosuppressive drugs. The main outcome measures were intraocular inflammation, macular thickness, visual acuity and corticosteroid-sparing effects. Results: We studied 11 patients (7 men) (20 affected eyes); median age 35 years. Uveitis was bilateral in nine patients. The patterns of ocular involvement were panuveitis (n = 8, with retinal vasculitis in 4), anterior uveitis (n = 2) and posterior uveitis (n = 1). Cystoid macular oedema was present in seven patients. The clinical course was recurrent (n = 7) or chronic (n = 4). Before TCZ, patients had received systemic corticosteroids, conventional immunosuppressants and the following biologic agents: adalimumab (n = 8), infliximab (n = 4), canakimumab (n = 1), golimumab (n = 3), etanercept (n = 1). TCZ was used as monotherapy or combined with conventional immunosuppressants at 8 mg/kg/i.v./4 weeks (n = 10) or 162 mg/s.c./week (n = 1). At TCZ onset the following extraocular manifestations were present: oral and/or genital ulcers (n = 7), arthritis (n = 4), folliculitis/pseudofolliculitis (n = 4), erythema nodosum (n = 2), livedo reticularis (n = 1) and neurological involvement (n = 2). TCZ yielded rapid and maintained improvement in all ocular parameters of the patients, with complete remission in eight of them. However, this was not the case for the extraocular manifestations, since TCZ was only effective in three of them. After a mean (s.d.) follow-up of 9.5 (8.05) months, TCZ was withdrawn in two cases, due to a severe infusion reaction and arthritis impairment, respectively. Conclusion: TCZ could be a therapeutic option in patients with BD and refractory uveitis.


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Síndrome de Behçet/complicações , Receptores de Interleucina-6/antagonistas & inibidores , Uveíte/tratamento farmacológico , Adolescente , Adulto , Idoso , Síndrome de Behçet/diagnóstico , Síndrome de Behçet/tratamento farmacológico , Criança , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Indução de Remissão , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Uveíte/diagnóstico , Uveíte/etiologia , Adulto Jovem
5.
Reumatol. clín. (Barc.) ; 12(5): 244-247, sept.-oct. 2016. tab
Artigo em Espanhol | IBECS | ID: ibc-155873

RESUMO

Introducción. La uveítis anterior es la forma más frecuente de inflamación intraocular. Las formas asociadas al antígeno HLA-B27 suponen entre un 18 y un 32% de los casos de uveítis anterior. Objetivos. Describir las características clínicas, la necesidad de tratamiento sistémico y la frecuencia y el tipo de complicaciones oculares de una cohorte de pacientes con uveítis anterior asociada a HLA-B27 y de una cohorte de pacientes con uveítis anterior no asociada a HLA-B27. Establecer si existen diferencias entre ambas cohortes. Material y métodos. Se realiza un estudio de cohortes retrospectivo descriptivo con componentes analíticos incluyendo a pacientes con uveítis anterior endógena no infecciosa asociada y no asociada a HLA-B27. Resultados. Se incluye un total de 162 pacientes, 58 con uveítis anterior asociada a HLAB27 (cohorte HLA-B27+) y 104 con uveítis anterior no asociada a HLA-B27 (cohorte HLA-B27–). No se aprecian diferencias estadísticamente significativas en las características clínicas de ambas cohortes a excepción de una mayor tendencia a la recurrencia en la cohorte HLA-B27+ y una mayor tendencia a la cronicidad en la cohorte HLA-B27–. Tampoco se aprecian diferencias en cuanto al uso de tratamiento sistémico ni al desarrollo de complicaciones oculares de forma global. Conclusiones. A diferencia de lo descrito con anterioridad, en este trabajo no encontramos un mayor predominio masculino en la cohorte de uveítis asociada a HLA-B27. Tampoco se aprecian diferencias en edad media, lateralidad, presencia de complicaciones ni frecuencia de uso de corticoides sistémicos (AU)


Introduction. Anterior uveitis is the most common type of intraocular inflammation. Those associated to HLA-B27 represent 18 to 32% of all anterior uveitis cases. Objectives. To describe clinical characteristics, systemic treatment need, and frequency and type of ocular complications in a cohort of patients diagnosed with HLAB27-related anterior uveitis and in a cohort of patients diagnosed with HLA-B27 non-related anterior uveitis. To establish if statistically significant differences between both cohorts exist. Material and methods. We performed a retrospective cohort study including patients with non infectious anterior uveitis related and not related to the antigen HLA-B27. Results. 162 patients were included, 58 diagnosed with HLA-B27-related anterior uveitis (cohort HLA-B27+1) and 104 diagnosed with HLA-B27- non related anterior uveitis (cohort HLA-B27-). No statistically significant differences were found regarding clinical characteristics between both cohorts with the exception of a higher frequency of recurrences in cohort HLA-B27+ and a higher frequency of chronic uveitis in cohort HLA-B27-. No differences were found regarding systemic treatment use nor development of ocular complications. Discussion. In contrast to previous studies, we neither found higher male gender predominance in the cohort of patients with HLA-B27-related anterior uveitis, Nor did we find differences regarding average age, laterality, development of complications nor use of systemic corticosteroids (AU)


Assuntos
Humanos , Masculino , Feminino , Uveíte Anterior/complicações , Uveíte Anterior/diagnóstico , Uveíte Anterior/tratamento farmacológico , Antígeno HLA-B27/análise , Inflamação/complicações , Inflamação/tratamento farmacológico , Oftalmopatias/complicações , Corticosteroides/uso terapêutico , Estudos de Coortes , Estudos Retrospectivos , Imunossupressores/uso terapêutico
6.
Clin Exp Rheumatol ; 34(6 Suppl 102): S34-S40, 2016 Sep-Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27054359

RESUMO

OBJECTIVES: To assess the efficacy of other biologic therapies, different from infliximab (IFX) and adalimumab (ADA), in patients with Behçet's disease uveitis (BU). METHODS: Multicenter study of 124 patients with BU refractory to at least one standard immunosuppressive agent that required IFX or ADA therapy. Patients who had to be switched to another biologic agent due to inefficacy or intolerance to IFX or ADA or patient's decision were assessed. The main outcome measures were the degree of anterior and posterior chamber inflammation and macular thickness. RESULTS: Seven (5.6%) of 124 cases (4 women/3 men; mean age, 43 (range 28- 67) years; 12 affected eyes) were studied. Five of them had been initially treated with ADA and 2 with IFX. The other biologic agents used were golimumab (n=4), tocilizumab (n=2) and rituximab (n=1). The ocular pattern was panuveitis (n=4) or posterior uveitis (n=3). Uveitis was bilateral in 5 patients (71.4%). At baseline, anterior chamber and vitreous inflammation were present in 6 (50%) and 7 (58.3%) of the eyes. All the patients (12 eyes) had macular thickening (OCT>250µm) and 4 of them (7 eyes), cystoid macular edema (OCT>300 µm). Besides reduction anterior chamber and vitreous inflammation, we observed a reduction of OCT values, from 330.4±58.5 µm at the onset of the biological agent to 273±50 µm at month 12 (p=0.06). Six patients achieved a complete remission of uveitis. CONCLUSIONS: The vast majority of patients with BU refractory to standard immunosuppressive drugs are successfully controlled with ADA and/or IFX. Other biologic agents appear to be also useful.


Assuntos
Adalimumab/uso terapêutico , Síndrome de Behçet/tratamento farmacológico , Produtos Biológicos/uso terapêutico , Substituição de Medicamentos , Imunossupressores/uso terapêutico , Infliximab/uso terapêutico , Uveíte/tratamento farmacológico , Adalimumab/efeitos adversos , Adulto , Idoso , Síndrome de Behçet/diagnóstico , Síndrome de Behçet/imunologia , Produtos Biológicos/efeitos adversos , Resistência a Medicamentos , Feminino , Humanos , Imunossupressores/efeitos adversos , Infliximab/efeitos adversos , Masculino , Pessoa de Meia-Idade , Indução de Remissão , Espanha , Fatores de Tempo , Resultado do Tratamento , Uveíte/diagnóstico , Uveíte/imunologia
7.
Reumatol Clin ; 12(5): 244-7, 2016 Sep-Oct.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-26708737

RESUMO

INTRODUCTION: Anterior uveitis is the most common type of intraocular inflammation. Those associated to HLA-B27 represent 18 to 32% of all anterior uveitis cases. OBJECTIVES: To describe clinical characteristics, systemic treatment need, and frequency and type of ocular complications in a cohort of patients diagnosed with HLAB27-related anterior uveitis and in a cohort of patients diagnosed with HLA-B27 non-related anterior uveitis. To establish if statistically significant differences between both cohorts exist. MATERIAL AND METHODS: We performed a retrospective cohort study including patients with non infectious anterior uveitis related and not related to the antigen HLA-B27. RESULTS: 162 patients were included, 58 diagnosed with HLA-B27-related anterior uveitis (cohort HLA-B27+1) and 104 diagnosed with HLA-B27- non related anterior uveitis (cohort HLA-B27-). No statistically significant differences were found regarding clinical characteristics between both cohorts with the exception of a higher frequency of recurrences in cohort HLA-B27+ and a higher frequency of chronic uveitis in cohort HLA-B27-. No differences were found regarding systemic treatment use nor development of ocular complications. DISCUSSION: In contrast to previous studies, we neither found higher male gender predominance in the cohort of patients with HLA-B27-related anterior uveitis, Nor did we find differences regarding average age, laterality, development of complications nor use of systemic corticosteroids.


Assuntos
Antígeno HLA-B27/metabolismo , Uveíte Anterior/imunologia , Doença Aguda , Adulto , Idoso , Biomarcadores/metabolismo , Estudos de Casos e Controles , Doença Crônica , Feminino , Seguimentos , Humanos , Imunossupressores/uso terapêutico , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Uveíte Anterior/complicações , Uveíte Anterior/diagnóstico , Uveíte Anterior/tratamento farmacológico
8.
BMC Musculoskelet Disord ; 16: 378, 2015 Dec 05.
Artigo em Inglês | MEDLINE | ID: mdl-26638151

RESUMO

BACKGROUND: Central serous chorioretinopathy is a disorder often related to systemic corticosteroids, drugs commonly used in rheumatologists' clinical practice. Central serous chorioretinopathy prognosis is generally good but in some cases, it may lead to substantial loss of vision resulting in an important functional limitation for patients. It is very important to distinguish this pathology from other diseases involving retinal detachment. When central serous chorioretinopathy and uveitis coexist, it is mandatory to distinguish serous retinal detachment from a uveitis worsening, as the respective treatments can be radically different. CASE PRESENTATION: We describe three cases of central serous chorioretinopathy in patients taking systemic corticosteroids due to rheumatological diseases (ankylosing spondylitis, systemic lupus erythematosus and Behçet's disease). They were diagnosed and managed at our Multidisciplinary (Rheumatology-Ophthalmology) Uveitis Clinic. All three cases improved after corticosteroids dose tapering. CONCLUSION: Central serous chorioretinopathy must be kept in mind by rheumatologists as it is related to systemic corticosteroids.


Assuntos
Corticosteroides/efeitos adversos , Coriorretinopatia Serosa Central/induzido quimicamente , Coriorretinopatia Serosa Central/diagnóstico por imagem , Doenças Reumáticas/diagnóstico por imagem , Corticosteroides/sangue , Adulto , Coriorretinopatia Serosa Central/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Doenças Reumáticas/sangue , Doenças Reumáticas/tratamento farmacológico
9.
Rheumatology (Oxford) ; 53(12): 2223-31, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24996907

RESUMO

OBJECTIVE: The aim of this study was to assess the efficacy of anti-TNF-α therapy in refractory uveitis due to Behçet's disease (BD). METHODS: We performed a multicentre study of 124 patients with BD uveitis refractory to conventional treatment including high-dose corticosteroids and at least one standard immunosuppressive agent. Patients were treated for at least 12 months with infliximab (IFX) (3-5 mg/kg at 0, 2 and 6 weeks and then every 4-8 weeks) or adalimumab (ADA) (usually 40 mg every 2 weeks). The main outcome measures were degree of anterior and posterior chamber inflammation, visual acuity, macular thickness and immunosuppression load. RESULTS: Sixty-eight men and 56 women (221 affected eyes) were studied. The mean age was 38.6 years (s.d. 10.4). HLA-B51 was positive in 66.1% of patients and uveitis was bilateral in 78.2%. IFX was the first biologic agent in 77 cases (62%) and ADA was first in 47 (38%). In most cases anti-TNF-α drugs were used in combination with conventional immunosuppressive drugs. At the onset of anti-TNF-α therapy, anterior chamber and vitreous inflammation was observed in 57% and 64.4% of patients, respectively. In both conditions the damage decreased significantly after 1 year. At baseline, 50 patients (80 eyes) had macular thickening [optical coherence tomography (OCT) >250 µm] and 35 (49 eyes) had cystoid macular oedema (OCT>300 µm) that improved from 420 µm (s.d. 119.5) at baseline to 271 µm (s.d. 45.6) at month 12 (P < 0.01). The best-corrected visual acuity and the suppression load also showed significant improvement. After 1 year of follow-up, 67.7% of patients were inactive. Biologic therapy was well tolerated in most cases. CONCLUSION: Anti-TNF-α therapy is effective and relatively safe in refractory BD uveitis.


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Anticorpos Monoclonais/uso terapêutico , Síndrome de Behçet/tratamento farmacológico , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Uveíte/tratamento farmacológico , Adalimumab , Adolescente , Adulto , Idoso , Anticorpos Monoclonais/administração & dosagem , Anticorpos Monoclonais/efeitos adversos , Anticorpos Monoclonais Humanizados/administração & dosagem , Anticorpos Monoclonais Humanizados/efeitos adversos , Síndrome de Behçet/complicações , Produtos Biológicos/efeitos adversos , Produtos Biológicos/uso terapêutico , Criança , Esquema de Medicação , Resistência a Medicamentos , Quimioterapia Combinada , Feminino , Seguimentos , Glucocorticoides/administração & dosagem , Glucocorticoides/uso terapêutico , Humanos , Imunossupressores/uso terapêutico , Infliximab , Masculino , Pessoa de Meia-Idade , Prednisona/administração & dosagem , Prednisona/uso terapêutico , Resultado do Tratamento , Uveíte/etiologia , Adulto Jovem
10.
J Rheumatol ; 40(8): 1268-74, 2013 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-23729803

RESUMO

OBJECTIVE: Clinical remission currently is the treatment target for all patients with rheumatoid arthritis (RA). At the same level of inflammation, the prognosis regarding joint damage is believed to be different for anticitrullinated protein antibody (ACPA)-negative and ACPA-positive patients. Our objective was to show the difference in prognosis at similar disease activity levels, and to illustrate how this could be translated to differentiation of treatment targets. METHODS: Data were used from the Nijmegen Early RA Cohort. The relation between the time-averaged disease activity level (by Disease Activity Score; DAS) and joint damage progression over 3 years was analyzed, separately for ACPA-negative and ACPA-positive patients. Joint damage was assessed as change in Ratingen score, and dichotomized as occurrence of erosions in joints that were unaffected at baseline. Linear and logistic multivariable regression models were used. RESULTS: The regression coefficient of DAS on change in Ratingen score was 3.9 (p < 0.001) for ACPA-negative and 4.7 (p < 0.001) for ACPA-positive patients, showing less joint damage progression at the same disease activity level in ACPA-negative patients. This difference became greater with increasing disease activity. The probability for erosions in joints unaffected at baseline was 0.35 in ACPA-negative patients when time-averaged DAS was < 2.4 versus 0.80 in ACPA-positive patients. CONCLUSION: At the same level of inflammation, ACPA-negative patients have less joint damage and lower probability for damage in newly affected joints than ACPA-positive patients. Low disease activity might be a sufficiently strict treatment target for ACPA-negative patients to prevent progression of joint damage.


Assuntos
Anticorpos Anti-Idiotípicos/sangue , Antirreumáticos/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Artrite Reumatoide/imunologia , Avaliação de Resultados (Cuidados de Saúde)/normas , Peptídeos Cíclicos/imunologia , Índice de Gravidade de Doença , Adulto , Idoso , Artrite Reumatoide/diagnóstico , Artrografia , Sedimentação Sanguínea , Estudos de Coortes , Feminino , Seguimentos , Humanos , Modelos Lineares , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fator Reumatoide/sangue , Resultado do Tratamento
11.
Reumatol. clín. (Barc.) ; 4(4): 155-158, jul.-ago. 2008.
Artigo em Espanhol | IBECS | ID: ibc-78047

RESUMO

Streptococcus agalactiae (S. agalactiae) es un germen habitualmente asociado a infecciones en neonatos y en mujeres durante el embarazo y el puerperio inmediato. S. agalactiae también se ha relacionado con bacteriemias, endocarditis e infecciones osteoarticulares, de piel y tejidos blandos en adultos con enfermedades concomitantes e, incluso, en pacientes inmunocompetentes. En los últimos años se han comunicado más de 70 casos de artritis séptica por este germen en adultos. Se presentan dos casos de infección articular, axial y periférica, por S. agalactiae, comparando los hallazgos, el tratamiento y la evolución con los casos publicados hasta abril de 2008 (AU)


Streptococcus agalactiae (S agalactiae) is a germ habitually associated with infections in neonates and women during the pregnancy and the immediate puerperiumum. S. agalactiae has also been related with bacteriemias, endocarditis and bone, joint, skin and soft tissues infections in adults with concomitant diseases and even in immunocompetent patients. In the last years more than 70 cases of septic arthritis in adults due to this germ have been communicated. We present two cases of axial and peripheral joint infection due to S. agalactiae, comparing finds, treatment and evolution with the cases published until April, 2008 (AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Streptococcus agalactiae/patogenicidade , Artrite Infecciosa/microbiologia , Infecções Estreptocócicas/complicações , Diagnóstico Diferencial , Antibacterianos/uso terapêutico
12.
Reumatol Clin ; 4(4): 155-8, 2008 Jul.
Artigo em Espanhol | MEDLINE | ID: mdl-21794522

RESUMO

Streptococcus agalactiae (S agalactiae) is a germ habitually associated with infections in neonates and women during the pregnancy and the immediate puerperiumum. S. agalactiae has also been related with bacteriemias, endocarditis and bone, joint, skin and soft tissues infections in adults with concomitant diseases and even in immunocompetent patients. In the last years more than 70 cases of septic arthritis in adults due to this germ have been communicated. We present two cases of axial and peripheral joint infection due to S. agalactiae, comparing finds, treatment and evolution with the cases published until April, 2008.

SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA