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1.
Radiat Res ; 193(3): 236-240, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31877253

RESUMO

Interventional fluoroscopy is a leading source of occupational ionizing radiation exposure for medical personnel. For example, orthopedic surgeons represent one occupation where the risk of exposure is large. This occupational hazard is the result of a cumulative dose of radiation over time. Adverse health effects induced by low-dose radiation exposure can arise from daily procedures performed over an entire career. Many of the radiation-induced effects that may develop are transient erythema, permanent epilation, dry desquamation, dermal necrosis and telangiectasia; these effects have occurred on the skin of fingers of interventionalists. Nailfold videocapillaroscopy (NVC) is a non-invasive technique useful for early detection of radiation-induced effects on microcirculation of fingernails. Here we report on a case of an orthopedic surgeon exposed to radiation for 30 years during his professional career. He performed NVC before and after the end of his professional career, and regression of the microcirculatory abnormalities were documented after cessation of radiation exposure. To our knowledge, this is the first published work in which the regression of chronic low-dose radiation-induced alterations of finger microvessels have been described and documented.


Assuntos
Capilares/efeitos da radiação , Angioscopia Microscópica/métodos , Unhas/efeitos da radiação , Exposição Ocupacional , Cirurgiões Ortopédicos , Exposição à Radiação , Idoso , Relação Dose-Resposta à Radiação , Humanos , Masculino , Unhas/irrigação sanguínea
2.
Biomed Res Int ; 2019: 7908793, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31687398

RESUMO

The earliest clinical manifestation of SSc is usually Raynaud's phenomenon, a small-arteries vasospasm driven by vascular tone dysregulation and microcirculatory abnormalities, resulting in digital ulcers (DU) in up to 50% of patients. Many cytokines as well as growth factors have been shown to play a role in promoting vascular smooth muscle cell proliferation and fibroblast activation, leading to ischemic damage as well as skin fibrosis. We aim to investigate a possible difference in venous and arterial blood levels of many cytokines (Th1- and Th17-related), GM-CSF, and endothelin-1 (ET1) in patients with and without DU. In the same patients, the correlations between capillary damage, evaluated by nailfold videocapillaroscopy (NVC), extension of skin fibrosis, calculated by modified Rodnan skin score (mRSS), and cytokines, ET-1, and GM-CSF levels were also measured. Patients with DU showed venous levels of IL-1ß (p=0.024), IL-6 (p=0.012), IL-22(p=0.006), and TGF-ß (p=0.046) significantly higher compared to arterial levels and arterial levels of GM-CSF and TNF-alpha significantly higher compared to venous levels (p < 0.001). NVC abnormalities were correlated with arterial TNFa and venous IL22, IL23, and IL17 levels and negatively correlated with venous ET-1 levels, whereas mRSS showed a negative correlation with IL-21(ρ = -0.427, p=0.050). The increased Th17-cytokine levels in venous compared to arterial blood of patients with DU suggest local cytokine production on ulcer site. The higher TNFa and GM-CSF levels in arterial blood of DU patients support the attempt to mitigate the hypoxic damage, and the correlation between Th17-cytokines, mRSS, NVC, and ET1 agrees with the potent profibrotic stimulus at the onset of the disease, which decreases as the SSc progresses.


Assuntos
Artérias/metabolismo , Citocinas/sangue , Doença de Raynaud/sangue , Úlcera Cutânea/sangue , Células Th1/metabolismo , Células Th17/metabolismo , Veias/metabolismo , Adulto , Idoso , Idoso de 80 Anos ou mais , Capilares/metabolismo , Citocinas/metabolismo , Endotelina-1/metabolismo , Feminino , Fibrose/metabolismo , Humanos , Masculino , Microcirculação/fisiologia , Angioscopia Microscópica/métodos , Pessoa de Meia-Idade , Doença de Raynaud/metabolismo , Pele/metabolismo , Úlcera Cutânea/metabolismo , Fator de Necrose Tumoral alfa/metabolismo
4.
Clin Exp Rheumatol ; 37 Suppl 119(4): 82-87, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31587694

RESUMO

OBJECTIVES: To determine whether cumulative endogenous estrogen exposure (CEEE) is associated with severity of microvascular damage or with presence of clinical characteristics in women with systemic sclerosis (SSc). METHODS: The population was composed of female SSc patients from the Leiden CCISS (combined care in SSc) cohort. Reproductive life history was investigated through structured questionnaires and CEEE was calculated with a mathematical equation. Demographic, laboratory and clinical characteristics were available for all patients. The most recent nailfold videocapillaroscopy (NVC) was used to semiquantitatively score microangiopathy parameters. RESULTS: We included 97 patients, with a mean age of 59.6±14 years and a mean CEEE of 9±5.5 years. Ordinal logistic regression using CEEE as independent variable failed to demonstrate an association with loss (OR 1.05, 95% CI 0.97-1.14), dilated capillaries (OR 1.05, 95% CI 0.96-1.14), giants (OR 1.03, 95% CI 0.95-1.12) and ramifications (OR 0.99, 95% CI 0.92-1.07). Binary logistic regression did not show an effect of CEEE on presence of scleroderma pattern vs. non-scleroderma pattern, (OR 0.99, 95% CI 0.89-1.1) or of late scleroderma pattern vs. non-late patterns (OR 0.96, 95% CI 0.88-1.05) at NVC. Furthermore, no association was found between CEEE and presence of interstitial lung involvement (OR 0.98, 95% CI 0.88-1.08) but a trend for occurrence of digital ulcers (OR 1.09, 95% CI 0.99-1.19) was observed. CONCLUSIONS: In SSc patients, CEEE is not associated with the extent of microvascular derangement. No associations between CEEE and organ involvement were found.


Assuntos
Capilares , Estrogênios/farmacologia , Angioscopia Microscópica/métodos , Unhas/irrigação sanguínea , Escleroderma Sistêmico , Idoso , Capilares/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Escleroderma Sistêmico/patologia
5.
Clin Exp Rheumatol ; 37 Suppl 119(4): 102-107, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31587695

RESUMO

OBJECTIVES: To retrospectively study nailfold videocapillaroscopy (NVC) changes in mixed connective tissue disease (MCTD) patients and to compare the capillary morphological abnormalities between patients affected by MCTD and systemic sclerosis (SSc) over time. METHODS: Ten MCTD patients on whom NVC had been performed, with a follow-up of three years, were selected. In addition, ten patients affected by SSc with similar age and disease duration of MCTD patients were enrolled to compare NVC abnormalities at baseline (T0). RESULTS: Seven out of ten patients with MCTD showed a "scleroderma-like pattern" at first NVC. No statistically significant variation of the detected NVC parameters was observed during the 3-year follow-up, and no statistically significant correlation was observed between capillary parameters and MCTD clinical aspects at first visit and during the follow-up. The scores of enlarged capillaries, giant capillaries and microhaemorrhages were significantly lower (p<0.05) in MCTD versus SSc patients at T0, moreover, the absolute number of total capillaries and normal capillaries was found significantly higher (p<0.05) in MCTD versus SSc patients. CONCLUSIONS: This study suggests that nailfold microvascular damage does not seem to be significantly progressive in MCTD patients during a three-year follow-up. MCTD patients show significantly lower number of enlarged/giant capillaries, but higher number of total and normal capillaries than SSc patients at first nailfold capillaroscopy. The identification of a specific NVC pattern in MCTD patients is not yet possible.


Assuntos
Angioscopia Microscópica/métodos , Doença Mista do Tecido Conjuntivo , Unhas , Escleroderma Sistêmico , Capilares , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Doença Mista do Tecido Conjuntivo/diagnóstico por imagem , Unhas/irrigação sanguínea , Unhas/diagnóstico por imagem , Estudos Retrospectivos , Escleroderma Sistêmico/diagnóstico por imagem
8.
Autoimmun Rev ; 18(11): 102394, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31520797

RESUMO

OBJECTIVES: This study was designed to propose a simple "Fast Track algorithm" for capillaroscopists of any level of experience to differentiate "scleroderma patterns" from "non-scleroderma patterns" on capillaroscopy and to assess its inter-rater reliability. METHODS: Based on existing definitions to categorise capillaroscopic images as "scleroderma patterns" and taking into account the real life variability of capillaroscopic images described standardly according to the European League Against Rheumatism (EULAR) Study Group on Microcirculation in Rheumatic Diseases, a fast track decision tree, the "Fast Track algorithm" was created by the principal expert (VS) to facilitate swift categorisation of an image as "non-scleroderma pattern (category 1)" or "scleroderma pattern (category 2)". Mean inter-rater reliability between all raters (experts/attendees) of the 8th EULAR course on capillaroscopy in Rheumatic Diseases (Genoa, 2018) and, as external validation, of the 8th European Scleroderma Trials and Research group (EUSTAR) course on systemic sclerosis (SSc) (Nijmegen, 2019) versus the principal expert, as well as reliability between the rater pairs themselves was assessed by mean Cohen's and Light's kappa coefficients. RESULTS: Mean Cohen's kappa was 1/0.96 (95% CI 0.95-0.98) for the 6 experts/135 attendees of the 8th EULAR capillaroscopy course and 1/0.94 (95% CI 0.92-0.96) for the 3 experts/85 attendees of the 8th EUSTAR SSc course. Light's kappa was 1/0.92 at the 8th EULAR capillaroscopy course, and 1/0.87 at the 8th EUSTAR SSc course. CONCLUSION: For the first time, a clinical expert based fast track decision algorithm has been developed to differentiate a "non-scleroderma" from a "scleroderma pattern" on capillaroscopic images, demonstrating excellent reliability when applied by capillaroscopists with varying levels of expertise versus the principal expert and corroborated with external validation.


Assuntos
Algoritmos , Esclerodermia Localizada/diagnóstico , Escleroderma Sistêmico/diagnóstico , Humanos , Angioscopia Microscópica/métodos , Reprodutibilidade dos Testes
10.
PLoS One ; 14(7): e0219505, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31287835

RESUMO

PURPOSE: The purpose of the present study was to evaluate the nailfold capillary morphological features in patients with exfoliative glaucoma (XFG) and compare them with those pertaining to primary open-angle glaucoma (POAG), normal controls and subjects with exfoliation syndrome (XFS). The second purpose was to investigate all parameters related to platelet function on the hemogram, including the platelet count (PLT), the mean platelet volume (MPV), platelet distribution width (PDW), and plateletcrit (PCT) in patients with XFG. These parameters were subsequently compared with those belonging to normal controls, POAG and XFS subjects. METHODS: This case control study involved 152 consecutive patients that were examined at the Glaucoma Department of Clinic for Eye Diseases, Clinical Centre of Serbia, as the referral center for glaucoma in Serbia, between June 2016 and December 2017. RESULTS: Regarding capillaroscopic characteristics, statistically significant difference was found in capillary diameter and tortuosity between the XFG and POAG group (p = 0.050 and p = 0.035) and the XFG and NC group (p = 0.003 and p = 0.044), as well as in the distribution of capillary loops and avascular zones between the XFG and NC group (p = 0.014 and p = 0.004). The subjects with XFG had lower PLT values compared to POAG patients (p = 0.022). CONCLUSIONS: In conclusion, to the best of our knowledge, this study marks the first attempt to evaluate capillary morphology as well as to investigate all parameters related to platelet function on the hemogram, in patients with newly diagnosed XFG. Our findings revealed nailfold capillary morphological vascular changes in XFG patients. The subjects with XFG had lower PLT values and a higher MPV serum parameter compared to normal controls and patients with POAG. Further research in this field should therefore aim to evaluate the consequences of the aforementioned microvascular abnormalities in patients with XFG.


Assuntos
Síndrome de Exfoliação/diagnóstico , Angioscopia Microscópica , Testes de Função Plaquetária , Análise de Variância , Biomarcadores , Diagnóstico Diferencial , Feminino , Glaucoma de Ângulo Aberto/diagnóstico , Humanos , Pressão Intraocular , Masculino , Angioscopia Microscópica/métodos , Índice de Gravidade de Doença
11.
Clin Rheumatol ; 38(9): 2343-2354, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31278512

RESUMO

Nailfold capillaroscopy (NC) is a highly sensitive, safe, and non-invasive technique to assess involvement rate of microvascularity in dermatomyositis and systemic sclerosis. A large number of studies have focused on NC pattern description, classification, and scoring system validation, but minimal information has been published on the accuracy and precision of the measurement. The objective of this review article is to identify different factors affecting the reliability and validity of the assessment in NC. Several factors can affect the reliability of the examination, e.g., physiological artifacts, the nailfold imaging instrument, human factors, and the assessment rules and standards. It is impossible to avoid all artifacts, e.g., skin transparency, physically injured fingers, and skin pigmentation. However, minimization of the impact of some of these artifacts by considering some protocols before the examination and by using specialized tools, training, guidelines, and software can help to reduce errors in the measurement and assessment of NC images. Establishing guidelines and instructions for automatic characterization and measurement based on machine learning techniques also may reduce ambiguities and the assessment time.


Assuntos
Capilares/diagnóstico por imagem , Angioscopia Microscópica/métodos , Unhas/irrigação sanguínea , Escleroderma Sistêmico/diagnóstico por imagem , Humanos , Unhas/diagnóstico por imagem , Reprodutibilidade dos Testes
12.
Rheumatology (Oxford) ; 58(12): 2273-2283, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-31230071

RESUMO

OBJECTIVE: The pathological changes in SSc include immune system dysregulation and microvascular damage. However, the association of immune cell phenotype heterogeneity and microvascular abnormalities is unclear. The aim of this study is to elucidate this association in SSc. METHODS: Peripheral blood mononuclear cells obtained from 150 SSc patients were used for comprehensive flow cytometric analysis based on the Human Immunology Project. Hierarchical cluster analysis was used to classify SSc patients into subgroups and their association with microvascular abnormalities, as assessed by nailfold videocapillaroscopy (i.e. 'early', 'active' and 'late' patterns), was analysed. RESULTS: The proportions of activated CD4+ T cells, T cells re-expressing CD45RA, activated Th1 and Th17 cells and IgD-CD27- B cells were higher in SSc patients than in healthy individuals. Hierarchical cluster analysis stratified SSc patients into three groups: patients with few immune abnormalities (fewer abnormalities group), patients with high proportions of activated T and Treg cells (Treg-dominant group) and patients with high proportions of Tfh and plasmablasts (Tfh-dominant group). Age and disease duration were comparable among the groups. On the other hand, microvascular abnormalities, especially the 'late' nailfold videocapillaroscopy pattern, correlated with internal organ involvement. Among the groups stratified according to immune cell phenotype, the progression to the 'late' nailfold videocapillaroscopy pattern was more frequent in the Tfh-dominant group. CONCLUSION: Our study confirmed the presence of immunophenotypic abnormalities in SSc. Immunological abnormalities were not uniform but rather limited to subpopulations, particularly the Tfh-dominant group, where they were highly associated with microvascular abnormalities and organ involvement.


Assuntos
Linfócitos B/imunologia , Capilares/patologia , Imunidade Celular , Leucócitos Mononucleares/imunologia , Angioscopia Microscópica/métodos , Unhas/irrigação sanguínea , Escleroderma Sistêmico/imunologia , Linfócitos B/patologia , Feminino , Citometria de Fluxo , Humanos , Leucócitos Mononucleares/patologia , Ativação Linfocitária , Masculino , Pessoa de Meia-Idade , Fenótipo , Escleroderma Sistêmico/patologia
13.
Clin Rheumatol ; 38(9): 2327-2337, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31177397

RESUMO

OBJECTIVE: The aim of this work was to produce a consensus-based report for capillaroscopy in rheumatology to be used in daily clinical practice. METHODS: A written Delphi questionnaire regarding capillaroscopy report was developed from a literature review and expert consensus. The Delphi questionnaire was sent to an international panel including 25 rheumatologists experts in capillaroscopy, asking them to rate their level of agreement or disagreement with each statement. The exercise consisted of three online rounds and a face-to-face (live meeting) that took place in the PANLAR 2018 congress held in Buenos Aires, Argentina. RESULTS: The participants to the first, second, third, and face-to-face round were 22, 21, 21, and 16 rheumatologists, respectively. Fifty-five items were discussed in the first round, 58 in the second, 22 in the third, and 9 in the face-to-face meeting. At the end of the exercise, 46 recommendations for the capillaroscopy report in rheumatology reached a consensus. CONCLUSION: This is the first consensus-based report in capillaroscopy. It will be useful in daily clinical practice and to address the effort of the standardization in the technique. KEY POINTS: • The current lack of consensus for the capillaroscopy report makes difficult the interpretation of findings as well as follow-up of rheumatic diseases. • This study produced the first international consensus for the format and content of the naifold capillaroscopy report in rheumatology. • The report is an integral part of the capillaroscopy examination and its use in a homogeneous form can help in the correct interpretation of findings in daily practice.


Assuntos
Angioscopia Microscópica/métodos , Unhas/irrigação sanguínea , Doenças Reumáticas/diagnóstico por imagem , Reumatologia , Consenso , Humanos , Unhas/diagnóstico por imagem
14.
Clin Exp Rheumatol ; 37 Suppl 119(4): 63-68, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31172926

RESUMO

OBJECTIVES: We assessed the correlation between severity of systemic sclerosis (SSc) and current staging systems based on nailfold capillaroscopy. METHODS: SCLEROCAP is a multicenter prospective study including consecutive scleroderma patients who have a yearly routine follow-up with capillaroscopy and digital blood pressure measurement. Capillaroscopy images were read by two observers blinded from each other, then by a third one in the case of discordance. A follow-up of 3 years is planned. The present study assessed the correlation between severity of systemic sclerosis (SSc) and current staging systems based on nail fold capillaroscopy at enrollment in the SCLEROCAP study. Univariate and multivariate logistic regression analysis was performed for both the Maricq and Cutolo classifications. RESULTS: SCLEROCAP included 387 patients in one year. Maricq's active and Cutolo's late classifications were very similar. In multivariate analysis, the number of digital ulcers (OR for 2 ulcers or more, respectively 2.023 [1.074-3.81] and 2.596 [1.434-4.699]) and Rodnan's skin score >15 (OR respectively 32.007 [6.457-158.658] and 18.390 [5.380-62.865]) correlated with Maricq's active and Cutolo's late stages. Haemoglobin rate correlated with Cutolo's late stage (hemoglobin<100 vs. >120 g/dl: OR 0.223 [0.051-0.980]), and total lung capacity with Maricq's active one: increase in 10%: OR0.833 [0.717-0.969]. CONCLUSIONS: The correlations found between capillaroscopy and severity of SSc are promising before the ongoing prospective study definitively assesses whether capillaroscopy staging predicts complications of SSc. Only two capillaroscopic patterns seem useful: one involving many giant capillaries and haemorrhages and the other with severe capillary loss.


Assuntos
Angioscopia Microscópica/métodos , Escleroderma Sistêmico , Úlcera Cutânea , Capilares , Feminino , Humanos , Masculino , Unhas , Estudos Prospectivos , Escleroderma Sistêmico/classificação , Escleroderma Sistêmico/patologia , Índice de Gravidade de Doença , Úlcera Cutânea/classificação , Úlcera Cutânea/patologia
15.
Actas dermo-sifiliogr. (Ed. impr.) ; 110(5): 347-352, jun. 2019. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-180922

RESUMO

La capilaroscopia es una técnica de estudio que permite obtener imágenes directas in vivo de la microcirculación cutánea. Constituye un método accesible y no invasivo para analizar las anormalidades microvasculares, por lo que puede utilizarse en niños y adultos. En la actualidad se ha demostrado su utilidad en múltiples dolencias, principalmente en el fenómeno de Raynaud y otras enfermedades autoinmunes. La capilaroscopia se realiza en el lecho ungueal del segundo al quinto dedo de ambas manos con la finalidad de encontrar un patrón capilaroscópico específico. El patrón de normalidad se caracteriza por la presencia de 7-11 capilares por milímetro dispuestos en forma de «U» invertida. Los patrones patológicos muestran alteraciones morfológicas y estructurales como: ectasias, capilares gigantes, hemorragias patológicas, áreas avasculares y neoangiogénesis. En este artículo se presentan las bases de la capilaroscopia, incluyendo la técnica, las indicaciones, así como la utilidad diagnóstica y como factor pronóstico en enfermedades reumatológicas


Capillaroscopy produces in vivo images of skin microcirculation. It is a simple, noninvasive tool for analyzing microvascular abnormalities and, as such, can be used in both adults and children. Capillaroscopy has proven useful in many diseases, but it is of particular value in Raynaud phenomenon and other autoimmune diseases. The test is used to analyze capillaroscopic patterns in the nailfold bed of the second to fifth fingers of each hand. A normal capillaroscopic pattern is characterized by the presence of 7 to 11 capillaries in a hairpin shape. Pathologic patterns are characterized by morphologic and structural alterations, such as ectasias, giant capillaries, pathologic hemorrhages, avascular areas, and neoangiogenesis. In this article, we review the fundamentals of capillaroscopy, with an emphasis on the technique and its indications, diagnostic value, and use as a prognostic tool for rheumatologic disorders


Assuntos
Humanos , Angioscopia Microscópica , Doenças Reumáticas/diagnóstico por imagem , Angioscopia Microscópica/métodos , Microscopia Intravital , Microcirculação , Doenças Autoimunes/diagnóstico por imagem , Escleroderma Sistêmico , Unhas/irrigação sanguínea , Doença de Raynaud/diagnóstico por imagem
16.
Arthritis Res Ther ; 21(1): 96, 2019 04 15.
Artigo em Inglês | MEDLINE | ID: mdl-30987674

RESUMO

OBJECTIVE: Systemic sclerosis (SSc) can lead to ischemic complications such as digital ulcers (DUs). The aim of the study was to find predictors of DUs by clinical and new imaging methods. PATIENTS AND METHODS: All 79 SSc patients included in the study received a clinical, colour Doppler ultrasound (CDUS), fluorescence optical imaging (FOI) and capillaroscopy examination at baseline, and their capacity to predict new DU development was analysed in 76 patients at 12 months follow-up. RESULTS: Twenty-two of 76 patients (28.9%) developed new ulcers during follow-up (diffuse SSc 48.1%; limited SSc 18.4%). Receiver operating characteristic (ROC) curve analysis revealed an area under the curve of 0.7576 for DU development, with a specificity of 87% and a sensitivity of 54.6% (p = 0.0003, OR = 8.1 [95%CI 2.5-25.6]) at a cut-off of ≥ 21 points (ACR/EULAR classification criteria for SSc). Capillaroscopy and CDUS had high sensitivity (100% and 95.5%) but low specificity (28.9% and 22.2%) for ulcer occurrence when used alone, but better specificity (46.3%) when combined (OR = 18.1 [95%CI 2.3-144.4]; p = 0.0004). Using FOI, fingers with pathologic staining had a higher risk for new ulcer development in the same finger (p = 0.0153). General future DU (i.e. DU also in other fingers) was associated with a missing FOI signal in the right digit III at baseline (p = 0.048). CONCLUSION: New imaging modalities can predict digital ulcer development in SSc patients with high sensitivity for capillaroscopy and CDUS and enhanced specificity when combined. A missing signal of FOI in the right digit III at baseline was associated with general future DU.


Assuntos
Dedos/diagnóstico por imagem , Angioscopia Microscópica/métodos , Imagem Óptica/métodos , Escleroderma Sistêmico/diagnóstico por imagem , Úlcera Cutânea/diagnóstico por imagem , Ultrassonografia Doppler em Cores/métodos , Adulto , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Escleroderma Sistêmico/epidemiologia , Úlcera Cutânea/epidemiologia
18.
Respir Med ; 150: 154-160, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30961944

RESUMO

BACKGROUND: The term Interstitial Pneumonia with Autoimmune Features (IPAF) describes patients with Interstitial Lung Diseases (ILDs) and clinical or serological features of autoimmune diseases insufficient to reach a specific classification of a Connective Tissue Disease (CTD). Currently, retrospective studies on IPAF patients have proven to be heterogeneous in general characteristics, outcomes and High-Resolution Computed Tomography (HRCT) pattern. This study aims to describe for the first time the clinical, serological and radiological features of a prospective cohort of IPAF patients. This cohort is then compared to a group of patients with Idiopathic Pulmonary Fibrosis (IPF). MATERIAL AND METHODS: From 626 consecutive ILD patients evaluated, 45 IPAF and a comparison cohort of 143 IPF patients were enrolled. All patients underwent clinical assessment with rheumatologic and respiratory evaluation, HRCT, Pulmonary Function Tests and Nailfold Videocapillaroscopy. RESULTS: The IPAF patients had a predominance of female gender (62.12%) with a median age of 66 years. The most common findings were: Nonspecific Interstitial Pneumonia (NSIP, 68.89%), Antinuclear Antibody positivity (17.77%) and Raynaud Phenomenon (31.11%). In comparison with IPF, IPAF patients showed younger age, better performances in Pulmonary Function Tests, less necessity of O2 support and predominance of female sex and NSIP pattern. DISCUSSION: This is the first report of a prospective cohort of IPAF patients. IPAF patients seem to have a less severe lung disease than IPF. IPAF criteria probably need to be revisited and validated, but their capacity to recruit patients with incomplete forms or early onset of CTD could be useful for further research.


Assuntos
Fibrose Pulmonar Idiopática/diagnóstico por imagem , Fibrose Pulmonar Idiopática/imunologia , Doenças Pulmonares Intersticiais/diagnóstico por imagem , Doenças Pulmonares Intersticiais/imunologia , Idoso , Anticorpos Antinucleares/imunologia , Doenças Autoimunes/imunologia , Doenças do Tecido Conjuntivo/classificação , Doenças do Tecido Conjuntivo/epidemiologia , Feminino , Humanos , Fibrose Pulmonar Idiopática/sangue , Fibrose Pulmonar Idiopática/fisiopatologia , Doenças Pulmonares Intersticiais/sangue , Doenças Pulmonares Intersticiais/fisiopatologia , Masculino , Angioscopia Microscópica/métodos , Pessoa de Meia-Idade , Estudos Prospectivos , Radiografia/métodos , Doença de Raynaud/epidemiologia , Testes de Função Respiratória/métodos , Tomografia Computadorizada por Raios X/métodos
19.
Adv Rheumatol ; 59(1): 14, 2019 03 28.
Artigo em Inglês | MEDLINE | ID: mdl-30922404

RESUMO

BACKGROUND/OBJECTIVE: Digital ulcers (DUs) represent a frequent complication of systemic sclerosis (SSc). The aim of this study was to evaluate clinical, serological and capillaroscopy features that are associated with DUs in patients with SSc. METHODS: In this bicentric cross-sectional study, 70 patients with SSc were consecutively selected from March 2016 to April 2017. Demographic and clinical features, including the presence of active DUs, were collected. Videocapillaroscopy was performed in all patients. RESULTS: Among the 70 patients included (mean age of 46.8 years, mean disease duration of 9.41 years), 14 (20%) had active DUs. Based on multivariate analysis, the presence of anti-Scl-70 antibodies, the HAQ-DI score, and the capillary loss score were independently associated with DUs with odds ratios of 7.96 (95% CI 1.32-47.99), 55.77 (95% CI 1.76-1764.28), and 16.66 (95% CI 2.07-133.81), respectively. CONCLUSIONS: The presence of avascular areas in capillaroscopy, elevation of HAQ-DI score and anti-Scl-70 antibodies were independent factors associated with DUs in patients with SSc.


Assuntos
Dedos , Escleroderma Sistêmico/complicações , Úlcera Cutânea/etiologia , Adulto , Estudos Transversais , Feminino , Dedos/irrigação sanguínea , Dedos/diagnóstico por imagem , Humanos , Masculino , Angioscopia Microscópica/métodos , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Fatores de Risco , Escleroderma Sistêmico/imunologia , Úlcera Cutânea/epidemiologia , Úlcera Cutânea/imunologia
20.
Adv Rheumatol ; 59(1): 5, 2019 01 22.
Artigo em Inglês | MEDLINE | ID: mdl-30670098

RESUMO

Nailfold capillaroscopy (NFC) is a reproducible, simple, low-cost, and safe imaging technique used for morphological analysis of nail bed capillaries. It is considered to be extremely useful for the investigation of Raynaud's phenomenon and for the early diagnosis of systemic sclerosis (SSc). The capillaroscopic pattern typically associated with SSc, scleroderma ("SD") pattern, is characterized by dilated capillaries, microhemorrhages, avascular areas and/or capillary loss, and distortion of the capillary architecture. The aim of these recommendations is to provide orientation regarding the relevance of NFC, and to establish a consensus on the indications, nomenclature, the interpretation of NFC findings and the technical equipments that should be used. These recommendations were formulated based on a systematic literature review of studies included in the database MEDLINE (PubMed) without any time restriction.


Assuntos
Angioscopia Microscópica/métodos , Doenças Reumáticas/diagnóstico por imagem , Artrite Reumatoide/diagnóstico por imagem , Brasil , Capilares/diagnóstico por imagem , Capilares/patologia , Dermatomiosite/diagnóstico por imagem , Dermatomiosite/patologia , Diagnóstico Precoce , Humanos , Lúpus Eritematoso Sistêmico/diagnóstico por imagem , Lúpus Eritematoso Sistêmico/patologia , Angioscopia Microscópica/instrumentação , Angioscopia Microscópica/normas , Doença Mista do Tecido Conjuntivo/diagnóstico por imagem , Doença Mista do Tecido Conjuntivo/patologia , Doença de Raynaud/diagnóstico por imagem , Doença de Raynaud/patologia , Doenças Reumáticas/patologia , Reumatologia , Escleroderma Sistêmico/diagnóstico por imagem , Escleroderma Sistêmico/patologia , Sociedades Médicas , Vasculite Sistêmica/diagnóstico por imagem , Terminologia como Assunto
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