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1.
Tuberk Toraks ; 69(2): 125-132, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34256502

RESUMO

Introduction: The objective of this study was to investigate the clinical and radiological features and pulmonary function tests (PFTs) in patients with the pulmonary involvement of systemic rheumatic diseases (SRDs). Materials and Methods: This study was conducted as a retrospective and single-center study. Patients diagnosed with an SRD and admitted/referred to the department of chest diseases of our hospital between January 2015 and June 2019 were enrolled. All patients were evaluated using High Resolution Computed Tomography (HRCT) and PFT. Result: This study included 68 patients (15 males, 53 females) with a mean age of 62.38 ± 12.4 years. Forty-one (60.2%) patients had diagnosis of rheumatoid arthritis (RA), 10 (14.7%) patients had sjögren's syndrome (SS), 8 (11.7%) patients had systemic lupus erythematosus (SLE), 6 (8.8%) patients had systemic sclerosis (SSc), and 3 (4.4%) patients had mixed connective tissue disease (MCTD). While RA, SLE, MCTD patients were more commonly symptomatic, most of the SS patients were asymptomatic. Overall, 30 (44.1%) patients had normal PFT. Although 30 (%44.1) patients were asymptomatic and 30 (%44.1) patients had normal PFTs, at least one imaging finding was found in all patients according to HRCT imaging. "Bronchiectasis" was the most common HRCT finding in RA, followed by "chronic fibrotic changes" and "peribronchial thickening". "Chronic fibrotic changes" and "peribronchial thickening" were the most common changes in SS. Similarly, "peribronchial thickening" was the most common radiologic finding in SLE. As for SSc, "chronic fibrotic changes", "interlobular septal thickening", and "pleural effusion" were the most common radiologic findings. Conclusions: Pulmonary involvement in systemic rheumatic diseases can occur with various radiological images even in asymptomatic patients. PFTs can be normal as well as an obstructive, restrictive or mixed pattern can be seen. Heterogeneous and combined HRCT findings can be seen in SRD patients.


Assuntos
Artrite Reumatoide/complicações , Bronquiectasia/diagnóstico , Pneumopatias/diagnóstico , Lúpus Eritematoso Sistêmico/complicações , Testes de Função Respiratória/métodos , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Bronquiectasia/complicações , Bronquiectasia/diagnóstico por imagem , Feminino , Humanos , Pneumopatias/complicações , Pneumopatias/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade
2.
Acta Reumatol Port ; 46(2): 126-133, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34226432

RESUMO

OBJECTIVE: The aim of this study was to evaluate the self-reported impact of mandatory confinement occurring in the first wave of the SARS-CoV-2 pandemic in Portuguese patients with rheumatoid arthritis (RA), as a means to improve care during this and in future pandemics. MATERIAL AND METHODS: The web-based survey COVIDRA was developed to assess 5 domains including RA symptoms, attitudes towards medication, employment status, physical exercise and mental health. The questionnaire was sent to RA patients through e-mail and social media of the Portuguese Society of Rheumatology and two patient associations; and it was filled locally at two rheumatology centers in Lisbon. Recruitment took place during June and July 2020. RESULTS: We obtained 441 valid questionnaires. Most respondents were female (88.4%), caucasian (93.6%) with a mean age of 58 years. The majority had disease lasting >10 years and were treated with csDMARDs (63.2%) and/or bDMARDs/tsDMARDS (23.7%). Over 40% experienced symptom worsening during confinement, almost half considered moderate or severe. Mobility restriction and increased stress, anxiety or depression were responsible for this worsening. Only 2.5% reduced or withheld their immunosuppressive medication due to fear of becoming infected with SARS-CoV-2. After confinement, 16.2% of those previously employed were in a lay-off regime and 3% lost their jobs. Most employed RA patients practiced telework during confinement. The majority of patients decreased or did not practice any physical exercise (80.5%). Symptoms of anxiety and depression developed or worsened in 67.3% and 51.9% respectively, approximately one third were considered moderate or severe. CONCLUSIONS: Portuguese RA patients experienced significant symptom worsening, anxiety and depression during the first wave confinement. Only a minority changed their immunosuppressive treatment for fear of SARS-CoV-2 infection. Published literature on these matters shows results very similar to ours.


Assuntos
Artrite Reumatoide , COVID-19/epidemiologia , Quarentena , Idoso , Ansiedade/etiologia , Artrite Reumatoide/complicações , Artrite Reumatoide/psicologia , Depressão/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Portugal/epidemiologia , Autorrelato
3.
Adv Rheumatol ; 61(1): 45, 2021 07 08.
Artigo em Inglês | MEDLINE | ID: mdl-34238376

RESUMO

As the coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continues to spread rapidly, there are still many unresolved questions of how this virus would impact on autoimmune inflammatory joint diseases and autoinflammatory disorders. The main aim of this paper is to describe the main studies focusing their attention on COVID-19 incidence and outcomes of rheumatoid arthritis (RA), spondylarthritis (SpA), and autoinflammatory disease cohorts. We also revised possible pathogenic mechanisms associated with. Available data suggest that, in patients with RA and SpA, the immunosuppressive therapy, older age, male sex, and the presence of comorbidities (hypertension, lung disease, diabetes, CVD, and chronic renal insufficiency/end-stage renal disease) could be associated with an increased risk of infections and high rate of hospitalization. Other studies have shown that lower odds of hospitalization were associated with bDMARD or tsDMARDs monotherapy, driven largely by anti-TNF therapies. For autoinflammatory diseases, considering the possibility that COVID-19 could be associated with a cytokine storm syndrome, the question of the susceptibility and severity of SARS-CoV-2 infection in patients displaying innate immunity disorders has been raised. In this context, data are very scarce and studies available did not clarify if having an autoinflammatory disorder could be or not a risk factor to develop a more severe COVID-19. Taking together these observations, further studies are likely to be needed to fully characterize these specific patient groups and associated SARS-CoV-2 infection.


Assuntos
COVID-19/complicações , Doenças do Sistema Imunitário/complicações , Fatores Etários , Artrite Reumatoide/complicações , Comorbidade , Humanos , Incidência , Estudos Observacionais como Assunto , Fatores de Risco , Espondilartrite/complicações
5.
Int J Mol Sci ; 22(9)2021 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-34066338

RESUMO

In rheumatoid arthritis (RA), extracellular vesicles (EVs) are associated with both the propagation and attenuation of joint inflammation and destruction. However, the specific EV content responsible for these processes is largely unknown. Investigations into identifying EV content are confounded by the challenges in obtaining high-quality EV preparations from synovial fluid. Implementing a size exclusion chromatography-based method of EV isolation, coupled with small RNA sequencing, we accurately characterised EV miRNAs in synovial fluid obtained from RA patients and investigated the differences between joints with high- and low-grade inflammation. Synovial fluid was obtained from the joints of 12 RA patients and, based on leukocyte counts, classified as either high (n = 7)- or low (n = 5)-grade inflammation. Using size exclusion chromatography, EVs were purified and small RNA was extracted and sequenced on a NextSeq 500. Sequencing reads were aligned to miRBase v21, and differences in miRNA profiles between RA patients with high- and low-grade joint inflammation were analysed. In total, 1972 distinct miRNAs were identified from RA synovial fluid EVs. miRNAs with less than five reads in fewer than five patients were filtered out, leaving 318 miRNAs for analysis. Analysis of the most abundant miRNAs suggested that they negatively regulate multiple genes relevant to inflammation, including signal transducer and activator of transcription 3 (STAT3), which lies downstream of IL-6 and has a pro-inflammatory role in RA. Synovial fluid from joints with high-grade inflammation contained 3.5-fold more EV miRNA per mL of synovial fluid (p = 0.0017). Seventy-eight EV miRNAs were differentially expressed between RA joints with high- and low-grade inflammation, and pathway analysis revealed that their target genes were commonly involved a variety of processes, including cellular apoptosis, proliferation and migration. Of the 49 miRNAs that were elevated in joints with high-grade inflammation, pathway analysis revealed that genes involved in cytokine-mediated signalling pathways were significantly enriched targets. In contrast, genes associated with reactive oxygen species signalling were significantly enriched as targets of the 29 miRNAs elevated in joints with low-grade inflammation. Our study identified an abundance of EV miRNAs from the synovial fluid of RA patients with the potential to modulate inflammation. In doing so, we defined potential mechanisms by which synovial fluid EVs may contribute to RA pathophysiology.


Assuntos
Artrite Reumatoide/genética , Vesículas Extracelulares/genética , Inflamação/genética , MicroRNAs/genética , Líquido Sinovial/metabolismo , Idoso , Artrite Reumatoide/complicações , Estudos de Coortes , Vesículas Extracelulares/ultraestrutura , Feminino , Perfilação da Expressão Gênica , Regulação da Expressão Gênica , Humanos , Fatores Imunológicos/metabolismo , Inflamação/complicações , Inflamação/patologia , Masculino , MicroRNAs/metabolismo , Pessoa de Meia-Idade
7.
BMJ Open ; 11(6): e046283, 2021 06 08.
Artigo em Inglês | MEDLINE | ID: mdl-34103319

RESUMO

OBJECTIVE: To investigate the bidirectional association between migraine and rheumatoid arthritis (RA). DESIGN: Two longitudinal follow-up studies. SETTING: Data collected from a national cohort between 2002 and 2013 by the Korean National Health Insurance Service-Health Screening Cohort. PARTICIPANTS: In cohort 1, matching resulted in the inclusion of 31 589 migraine patients and 126 356 control I participants. In cohort 2, matching resulted in the inclusion of 9287 RA patients and 37 148 control II participants. PRIMARY AND SECONDARY OUTCOME MEASURES: The HRs for RA in patients with migraine (cohort 1) and migraine in patients with RA (cohort 2) were analysed using stratified Cox proportional hazard models after adjusting for autoimmune disease, Charlson Comorbidity Index scores without rheumatoid diseases, obesity (body mass index), smoking and history of alcohol intake. Subgroup analyses stratified by age, sex, income and region of residence were also performed. RESULTS: The incidence of RA in the migraine group (2.0% (640/31 589)) was higher than that in the control I group (1.4% (1709/126 356), p<0.001). The adjusted HR for RA in the migraine without aura group was 1.48 (95% CIs=1.34 to 1.63, p<0.001).The incidence of migraine in the RA group (6.4% (590/9287)) was higher than that in the control II group (4.6% (1721/37 148), p<0.001). The adjusted HR for migraine without aura in the RA group was 1.35 (95% CI=1.23 to 1.49, p<0.001). CONCLUSION: Migraine increases the risk of RA, and RA is also associated with an increased risk of migraine.


Assuntos
Artrite Reumatoide , Transtornos de Enxaqueca , Artrite Reumatoide/complicações , Artrite Reumatoide/epidemiologia , Seguimentos , Humanos , Incidência , Estudos Longitudinais , Transtornos de Enxaqueca/complicações , Transtornos de Enxaqueca/epidemiologia , Modelos de Riscos Proporcionais , Fatores de Risco
9.
Aging (Albany NY) ; 13(11): 15061-15077, 2021 06 03.
Artigo em Inglês | MEDLINE | ID: mdl-34081620

RESUMO

We developed and validated a nomogram to predict the risk of stroke in patients with rheumatoid arthritis (RA) in northern China. Out of six machine learning algorithms studied to improve diagnostic and prognostic accuracy of the prediction model, the logistic regression algorithm showed high performance in terms of calibration and decision curve analysis. The nomogram included stratifications of sex, age, systolic blood pressure, C-reactive protein, erythrocyte sedimentation rate, total cholesterol, and low-density lipoprotein cholesterol along with the history of traditional risk factors such as hypertensive, diabetes, atrial fibrillation, and coronary heart disease. The nomogram exhibited a high Hosmer-Lemeshow goodness-for-fit and good calibration (P > 0.05). The analysis, including the area under the receiver operating characteristic curve, the net reclassification index, the integrated discrimination improvement, and clinical use, showed that our prediction model was more accurate than the Framingham risk model in predicting stroke risk in RA patients. In conclusion, the nomogram can be used for individualized preoperative prediction of stroke risk in RA patients.


Assuntos
Artrite Reumatoide/complicações , Nomogramas , Acidente Vascular Cerebral/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Calibragem , Estudos de Coortes , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Modelos Biológicos , Reprodutibilidade dos Testes , Fatores de Risco , Adulto Jovem
10.
Vnitr Lek ; 67(E-2): 18-24, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34074100

RESUMO

Rheumatoid arthritis is a chronic autoimmune inflammatory disease associated with multiple metabolic alterations and increased cardiovascular risk. It is supposed that visceral obesity seems to be a connection between rheumatoid arthritis and cardiovascular diseases. Obesity is not only associated with increased disease activity and worsened quality of life in this group of patients, but also determines the effectiveness of treatment. Biological therapy interferes with metabolic changes, too. Therefore, there is a tendency to select the right anticytokine preparation in the first line of treatment to reduce not only disease activity but also affect aspects of metabolic syndrome and comorbidites, thereby reducing cardiovascular risk and patients mortality. This work offers a basic overview of the associations between rheumatoid arthritis and metabolic disorders, describes the impact of biological therapy on individual components of the metabolic syndrome.


Assuntos
Artrite Reumatoide , Doenças Cardiovasculares , Doenças Metabólicas , Síndrome Metabólica , Artrite Reumatoide/complicações , Doenças Cardiovasculares/etiologia , Humanos , Doenças Metabólicas/complicações , Síndrome Metabólica/complicações , Qualidade de Vida
11.
Artigo em Inglês | MEDLINE | ID: mdl-34068737

RESUMO

Foot problems are highly prevalent in people with rheumatoid arthritis. This study aims to explore the foot morphology, pain and function in rheumatoid arthritis patients and the relation with the time of disease debut. A cross-sectional study was designed. Footprint, the Foot Posture Index, the hallux valgus prevalence, foot pain and function in 66 rheumatoid arthritis patients and the association with time since diagnosis, were recorded. The Foot Function Index, the Manchester Foot Pain and Disability Index, the Visual Analogic Scale, and the Manchester Scale for hallux valgus were administered and analyzed in two groups, with less and more than 10 years of diagnosis of the disease. A high prevalence of pronated (right 36.8% and left 38.6%) and highly pronated (right 15.8% and left 15.8%) feet was observed, as well as an elevated percentage of low arched footprints (right 68.4 and left 66.7%) and hallux valgus (right 59.6% and left 54.4%). Hallux valgus prevalence, toe deformities and Foot Function Index (Functional limitation) factors were significantly associated with the time since RA diagnosed adjusted for the other factors. The adjusted odds ratio of Hallux valgus prevalence was 4.9 (1.2-19.7). In addition, the foot function was diminished, and foot pain was present in most participants. In conclusion, rheumatoid arthritis patients' feet showed altered morphology and function, and with longer rheumatoid arthritis history, metatarsophalangical stability and foot function, but not pain and global foot posture, were likely to deteriorate.


Assuntos
Artrite Reumatoide , Hallux Valgus , Artrite Reumatoide/complicações , Artrite Reumatoide/epidemiologia , Estudos Transversais , , Hallux Valgus/epidemiologia , Humanos , Dor/epidemiologia , Dor/etiologia
12.
J Med Case Rep ; 15(1): 273, 2021 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-34039422

RESUMO

BACKGROUND: Felty syndrome is a rare manifestation of chronic rheumatoid arthritis in which patients develop extraarticular features of hepatosplenomegaly and neutropenia. The typical presentation of Felty syndrome is in Caucasians, females, and patients with long-standing rheumatoid arthritis of 10 or more years. This case report presents a patient with an early-onset and atypical demographic for Felty syndrome. CASE PRESENTATION: Our patient is a 28-year-old African American woman with past medical history of rheumatoid arthritis diagnosed in 2017, asthma, pneumonia, anemia, and mild intellectual disability who was admitted to inpatient care with fever, chills, and right ear pain for 7 days. The patient's mother, also her caregiver, brought the patient to the hospital after symptoms of fever and ear pain failed to improve. Our patient was diagnosed with sepsis secondary to pneumonia and urinary tract infection. She had been admitted twice in the past year, both times with a diagnosis of pneumonia. During this visit in September 2019, it was discovered that the patient had leukopenia and neutropenia. Bone marrow biopsy revealed increased immature mononuclear cells with left shift and rare mature neutrophils. During the hospital course, the patient was provisionally diagnosed with Felty syndrome and treated with adalimumab and hydroxychloroquine for her rheumatoid arthritis. Her sepsis secondary to pneumonia and urinary tract infection was treated with ceftriaxone and doxycycline, which was later switched to cefepime because of positive blood and urine cultures for Pseudomonas aeruginosa. She was discharged with stable vital signs and is continuing to control her rheumatoid arthritis with adalimumab. CONCLUSION: This case report details the clinical course of sepsis secondary to pneumonia and urinary tract infection in the setting of Felty syndrome. Our patient does not fit the conventional profile for presentation given her race, age, and the length of time following diagnosis of rheumatoid arthritis.


Assuntos
Artrite Reumatoide , Síndrome de Felty , Neutropenia , Adulto , Artrite Reumatoide/complicações , Artrite Reumatoide/diagnóstico , Artrite Reumatoide/tratamento farmacológico , Síndrome de Felty/complicações , Síndrome de Felty/diagnóstico , Síndrome de Felty/tratamento farmacológico , Feminino , Humanos , Baço , Esplenomegalia
15.
Georgian Med News ; (312): 46-52, 2021 Mar.
Artigo em Russo | MEDLINE | ID: mdl-33964825

RESUMO

Objective - to determine the features of the daily profile of blood pressure (BP), blood lipid spectrum, features of left ventricular remodeling in patients with hypertension in combination with RA and to evaluate the effectiveness of using medium doses of rosuvastatin to correct dyslipidemia in this group of patients. 70 patients aged 40-65 years were examined (average - M±m - 54.88±0.96 years). Hypertensive disease in combination with rheumatoid arthritis was found in 50 patients, which made up the main group. The patients were divided into 2 subgroups: the first group included 25 patients with essential hypertension in combination with rheumatoid arthritis, who took valsartan at a dose of 80 mg at home, indapamide 1.5 mg, rosuvastatin 20 mg. The second subgroup included 25 patients who took valsartan at a dose of 80 mg / day, amlodipine at a dose of 5 mg, rosuvastatin at a dose of 20 mg. The control group (comparison) consisted of 20 patients with arterial hypertension without RA, matched by sex and age with the main groups. (3 people, 17 women, average age 55.65±1.19 years). 1. Valsartan therapy and its combination with indapamide in hypertensive patients in combination with rheumatoid arthritis led to regression of LVH in all patients, normalization of LV geometry in 33% of patients, improvement of LV diastolic function in 88.2%. 2. The addition of indapamide to therapy led to a further decrease in the average values of blood pressure at night, increased the number of patients who achieved normalization of blood pressure from 50 to 75%, while therapy with amlodipine with indapamide did not change the severity of the circadian rhythm of blood pressure and the degree of nighttime decrease in SBP and in general the group remained inadequate. 3. Changes in the diurnal blood pressure profile, found in the majority of patients with arterial hypertension in combination with rheumatoid arthritis, were characterized by increased mean daily, mean systolic blood pressure levels, increased daytime variability, and a lower degree of nocturnal decrease in comparison with patients without RA. 4. The use of 20 mg rosuvastatin as part of complex therapy in patients with hypertension in combination with RA contributed to the achievement of target levels of lipid spectrum in the blood in most patients.ent of target levels of lipid spectrum in the blood in most patients.


Assuntos
Artrite Reumatoide , Aterosclerose , Hipertensão , Adulto , Idoso , Anlodipino/uso terapêutico , Anti-Hipertensivos/uso terapêutico , Artrite Reumatoide/complicações , Artrite Reumatoide/tratamento farmacológico , Pressão Sanguínea , Monitorização Ambulatorial da Pressão Arterial , Feminino , Ventrículos do Coração , Humanos , Hipertensão/complicações , Hipertensão/tratamento farmacológico , Masculino , Pessoa de Meia-Idade
16.
Aging (Albany NY) ; 13(10): 14109-14130, 2021 05 18.
Artigo em Inglês | MEDLINE | ID: mdl-34015765

RESUMO

Many observation studies have demonstrated a close relationship between rheumatoid arthritis (RA) and osteoporosis (OP). However, the causal genetic correlation between RA and OP remains unclear. In this study, we performed bi-directional Mendelian randomization (MR) analyses to explore causal inference between these two traits. The instrumental variables for RA were selected from a large-scale genome-wide association study (GWAS) (1,523 cases and 461,487 controls). Bone mineral density (BMD) at five different sites (heel (n=265,627), forearm (FA) (n=8,143), femoral neck (FN) (n=32,735), lumbar spine (LS) (n=28,498), and total body (n=28,498)) were used as phenotypes for OP. The inverse variance weighted (IVW) method did not detect any causal effect of BMDs on RA except heel BMD (beta = -7.57 × 10-4, p = 0.02). However, other methods (MR-Egger, weighted median, weighted mode, MR-PRESSO, and MR-RAPS) showed no causal association between heel BMD and RA. Likewise, we did not find a causal effect of RA on BMD at any sites. In conclusion, we found no evidence that RA is causally associated with OP/BMD, or vice versa. We suggested that the associations found in previous observational studies between RA and OP/BMD are possibly related to secondary effects such as antirheumatic treatment and reduced physical activity.


Assuntos
Artrite Reumatoide/complicações , Artrite Reumatoide/genética , Análise da Randomização Mendeliana , Osteoporose/complicações , Osteoporose/genética , Densidade Óssea/genética , Humanos
17.
An. sist. sanit. Navar ; 44(1): 97-105, ene.-abr. 2021. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-201851

RESUMO

La presencia de artropatía en los pacientes con acromegalia puede ser debida a la recurrencia de la acromegalia o a la existencia de una enfermedad articular inflamatoria como la artritis reumatoide (AR). Existen pocas publicaciones que evalúen la coexistencia de AR y acromegalia. La presentación de dos casos con la coexistencia de AR y artropatía acromegálica permite evaluar las claves para su diagnóstico diferencial y sus implicaciones en el tratamiento. El diagnóstico de AR en los pacientes con acromegalia requiere de una alta sospecha clínica, por lo que debería ser considerado en aquellos casos en los que no se consiga un adecuado control de los síntomas. El retraso en el diagnóstico y tratamiento de la AR puede incrementar el daño articular y posiblemente empeora el pronóstico funcional de los pacientes


The presence of arthropathy in patients with acromegaly may suggest recurrence of acromegaly or the existence of an inflammatory joint disease such as rheumatoid arthritis (RA). Few publications have evaluated the coexistence of RA and acromegaly. Two cases were presented with a coexistence of RA and acromegalic arthopathy, which enabled us to evaluate the key factors in differential diagnoses and the implications for treatment. Diagnosis of RA in patients with acromegaly requires a high level of clinical suspicion, and should therefore be considered in cases where adequate symptom control is not achieved. Delay in the diagnosis and treatment of RA can increase joint damage and possibly worsen a patient's functional prognosis


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Acromegalia/diagnóstico por imagem , Artropatias/complicações , Artrite Reumatoide/complicações , Neoplasias Hipofisárias/diagnóstico , Artrocentese/métodos , Artrite Reumatoide/diagnóstico por imagem , Diagnóstico Diferencial , Adenoma/complicações , Neoplasias Hipofisárias/cirurgia , Articulações dos Dedos/diagnóstico por imagem , Articulações dos Dedos/patologia , Anti-Inflamatórios não Esteroides/administração & dosagem , Osteoartrite do Joelho/tratamento farmacológico , Injeções Intra-Articulares , Metilprednisolona/administração & dosagem
18.
Rev. cuba. reumatol ; 23(1): e870, tab
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1280402

RESUMO

Introducción: La COVID-19 causa una variada gama de manifestaciones clínicas. En pacientes con enfermedades reumáticas destacan, además de las manifestaciones respiratorias, las manifestaciones articulares, dermatológicas, generales y cardiovasculares. Objetivo: Identificar las manifestaciones cardiovasculares que con mayor frecuencia se presentan en pacientes con enfermedades reumáticas afectados por la COVID-19. Métodos: Se realizó una investigación básica, no experimental, con alcance exploratorio, descriptivo y explicativo de un universo constituido por 37 pacientes con diagnóstico previo de enfermedad reumática y diagnóstico confirmado de COVID-19. Se empleó la observación dirigida y la revisión documental como técnicas de investigación para identificar la presencia de manifestaciones cardiovasculares en este tipo de pacientes. Resultados: Predominaron las pacientes femeninas (59,56 por ciento), con diagnóstico de osteoartritis (72,97 por ciento) y artritis reumatoide (72,97 por ciento) y con comorbilidades asociadas (83,78 por ciento). La hipertensión arterial (61,29 por ciento) y el hipotiroidismo (38,71 por ciento) fueron las comorbilidades más frecuentes. El 70,27 por ciento de los pacientes presentaron manifestaciones cardiovasculares: hipertensión arterial (65,38 por ciento), trastornos del ritmo cardiaco (57,69 por ciento) y el síndrome de Raynaud (53,85 por ciento). El 80,0 por ciento de los pacientes masculinos presentaron manifestaciones cardiovasculares, al igual que el 80,64 por ciento de los casos con enfermedad reumática, COVID-19 y comorbilidades asociadas. Conclusiones: Las manifestaciones cardiovasculares se presentaron con elevada frecuencia en los pacientes reumáticos con diagnóstico de COVID-19, sobre todo pacientes masculinos con comorbilidades asociadas. Las manifestaciones cardiovasculares más frecuentes fueron la hipertensión arterial, los trastornos del ritmo y el síndrome de Raynaud(AU)


Introduction: COVID-19 generates a wide range of clinical manifestations in general. In patients with rheumatic diseases, in addition to respiratory manifestations, joint, dermatological, general and cardiovascular manifestations, among others, stand out. Objective: To identify the cardiovascular manifestations that most frequently occur in patients with rheumatic diseases and COVID-19. Methods: A basic, non-experimental research was carried out, with an exploratory, descriptive and explanatory scope. Universe made up of 37 patients with a previous diagnosis of rheumatic disease and a confirmed diagnosis of COVID-19. Directed observation and documentary review were used as research techniques to identify the presence of cardiovascular manifestations in this type of patient. Results: Predominance of female patients (59.56 percent), diagnosed with osteoarthritis (72.97 percent) and rheumatoid arthritis (72.97 percent) and with associated comorbidities (83.78 percent). Hypertension (61.29 percent) and hypothyroidism (38.71 percent) were the most frequent comorbidities. 70.27 percent of the patients presented cardiovascular manifestations, predominantly arterial hypertension (65.38 percent), rhythm disorders (57.69 percent) and Raynaud´s syndrome (53.85 percent). 80.0 percent of the male patients presented cardiovascular manifestations, as did 80.64 percent of the cases with rheumatic disease, COVID-19 and associated comorbidities. Conclusions: Cardiovascular manifestations occurred with high frequency in rheumatic patients diagnosed with COVID-19; being more frequent in male patients and with associated comorbidities. High blood pressure, rhythm disorders and Raynaud's syndrome were the most frequent(AU)


Assuntos
Humanos , Artrite Reumatoide/complicações , Sinais e Sintomas , Doenças Cardiovasculares/complicações , Infecções por Coronavirus/complicações , Diagnóstico Precoce , Projetos de Pesquisa
19.
BMJ Case Rep ; 14(4)2021 Apr 12.
Artigo em Inglês | MEDLINE | ID: mdl-33846189

RESUMO

We describe a case of a 48-year-old woman who presented with acute respiratory failure due to diffuse alveolar haemorrhage and acute renal failure due to pauci-immune glomerulonephritis consistent with a new diagnosis of microscopic polyangiitis (MPA). The patient had a recent SARS-CoV-2 infection 6 weeks before MPA diagnosis and had stopped immunosuppression for her rheumatoid arthritis (RA) at that time. The patient was treated with pulse intravenous steroids, plasma exchange therapy and rituximab, which induced remission of her illness. This case highlights a timely dilemma of holding immunosuppression in a RA patient with low disease activity on combination therapy with SARS-CoV-2 infection, and the potential risk of developing an additional autoimmune disease, such as vasculitis, given their existing autoimmunity due to RA.


Assuntos
Artrite Reumatoide/tratamento farmacológico , COVID-19/complicações , Imunossupressores/administração & dosagem , Vasculite/etiologia , Suspensão de Tratamento , Injúria Renal Aguda , Artrite Reumatoide/complicações , Diagnóstico Diferencial , Feminino , Glomerulonefrite , Hemorragia , Humanos , Pneumopatias , Poliangiite Microscópica , Pessoa de Meia-Idade , Troca Plasmática , Indução de Remissão , Síndrome do Desconforto Respiratório , Rituximab/uso terapêutico
20.
Nutrients ; 13(4)2021 Apr 12.
Artigo em Inglês | MEDLINE | ID: mdl-33921207

RESUMO

Rheumatoid arthritis (RA) is a progressive articular disease. In addition to damaging the joints, it may cause multiple organ complications, and considerably impair the patient's functioning. Elderly patients with RA report pain, fatigue, mood disorders, sleep disorders and insomnia, accompanied by weakness, poor appetite, and weight loss. All these factors combined have an adverse effect on the patient's perceived quality of life (QoL). Due to the chronic nature of RA and the high risk of malnutrition in this patient group, the present study investigated QoL, activities of daily living, and frailty syndrome severity in relation to MNA (Mini Nutritional Assessment) questionnaire scores among elderly RA patients. The study included 98 patients (aged over 60) diagnosed with RA per the ARA (American Rheumatism Association) criteria. The following standardized instruments were used: WHOQoL-BREF for QoL, the Edmonton Frail Scale for frailty syndrome severity, MNA for nutritional status assessment, and MMSE (Mini-Mental State Examination) to assess any cognitive impairment. Medical data were obtained from hospital records. Patients with a different nutritional status differed significantly in terms of limitations in activities of daily living (ADL) and instrumental activities of daily living (IADL). Higher levels of malnutrition were associated with greater limitations in activity. An adverse impact of lower body weight on cognitive function was also observed (dementia was identified in 33.33% of malnourished patients vs. 1.79% in patients with a normal body weight). Likewise, frailty was more common in malnourished patients (mild frailty syndrome in 33.3%, moderate in 16.67%, and severe in 16.67%). Malnourished patients had significantly lower QoL scores in all WHOQoL-BREF questionnaire domains than those with a normal body weight, and multiple-factor analysis for the impact of selected variables on QoL in each domain demonstrated that frailty was a significant independent determinant of poorer QoL in all domains: perceived quality of life (ß = -0.069), perceived health (ß = -0.172), physical domain (ß = -0.425), psychological domain (ß = -0.432), social domain (ß = -0.415), environmental domain (ß = -0.317). Malnutrition was a significant independent determinant of QoL in the "perceived health" domain (ß = -0.08). In addition, regression analysis demonstrated the positive impact of male sex on QoL scores in the psychological (ß = 1.414) and environmental domains (ß = 1.123). Malnourished patients have a lower QoL than those with a normal body weight. Malnutrition adversely affects daily functioning, cognitive function, and the severity of frailty syndrome. Frailty syndrome is a significant independent determinant of poorer QoL in all WHOQoL BREF domains.


Assuntos
Artrite Reumatoide/complicações , Fragilidade/diagnóstico , Desnutrição/diagnóstico , Qualidade de Vida , Atividades Cotidianas/psicologia , Idoso , Idoso de 80 Anos ou mais , Artrite Reumatoide/psicologia , Cognição , Feminino , Idoso Fragilizado/psicologia , Fragilidade/etiologia , Fragilidade/psicologia , Hospitalização , Humanos , Masculino , Desnutrição/etiologia , Desnutrição/psicologia , Testes de Estado Mental e Demência , Pessoa de Meia-Idade , Avaliação Nutricional , Estado Nutricional , Índice de Gravidade de Doença
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