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1.
Pan Afr Med J ; 33: 237, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31692731

RESUMO

The wrist is a rare location of septic arthritis. It often involves patients with preexisting joint disease which symptoms could be confused with infection making the diagnosis more difficult and usually delayed. It is often responsible for residual functional impairment and for a high mortality rate among vulnerable patients. We report 6 cases of septic arthritis of the wrist in 3 males and 3 females. The mean age was 32 years in the male patients and 66 in the female patients. All the women were followed for rheumatoid arthritis. Biological results showed elevated rates of white blood cells and c-reactive protein in all the patients. Joint fluid analyses showed elevated white blood cell count. The treatment was medico-surgical consisting in synovectomy, joint debridement and immobilization of the wrist. At the average follow-up of 1 year and 4 months, 3 patients recovered a perfect mobility of the wrist without any limitation of the range of motion nor the strength. Three patients developed stiffness of the wrist.


Assuntos
Artrite Infecciosa/cirurgia , Desbridamento/métodos , Articulação do Punho/cirurgia , Adulto , Idoso , Artrite Infecciosa/diagnóstico , Artrite Infecciosa/patologia , Artrite Reumatoide/complicações , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Estudos Retrospectivos , Resultado do Tratamento , Articulação do Punho/patologia
2.
Medicine (Baltimore) ; 98(41): e17371, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593087

RESUMO

Rheumatoid arthritis (RA) is a chronic, systemic, inflammatory autoimmune disease associated with increased prevalence of type 2 diabetes mellitus (T2DM). Here, we investigated the effect of the combination of cyclooxygenase (COX)-2 inhibitors and metformin on the rate of admission in patients with RA and T2DM and compared it with that of only COX-2 inhibitors.In total, 1268 subjects with RA and T2DM under COX-2 inhibitor and metformin therapy were selected from the National Health Insurance Research Database of Taiwan, along with 2536 patients as 1:2 sex-, age-, and index year-matched controls without metformin therapy. Cox proportional hazard analysis was used to compare the rate of admission during the 10 years of follow-up.At the end of the follow-up, 72 enrolled subjects (1.89%) had admission, including 9 from the combination group (0.71%) and 63 from the COX-2 inhibitor group (2.48%). The combination group was associated with a lower rate of admission at the end of follow-up (P < .001). Cox proportional hazard regression analysis revealed the lower rate of admission for subjects under combination therapy (adjusted hazard ratio of 0.275; 95% confidence interval = 0.136-0.557, P < .001).Patients with RA and T2DM receiving the combination of COX-2 inhibitors and metformin were associated with lower admission rate than those on COX-2 inhibitors alone, and this effect may be attributed to the decrease in the levels of proinflammatory factors.


Assuntos
Artrite Reumatoide/tratamento farmacológico , Inibidores de Ciclo-Oxigenase 2/administração & dosagem , Diabetes Mellitus Tipo 2/tratamento farmacológico , Hospitalização/estatística & dados numéricos , Hipoglicemiantes/administração & dosagem , Metformina/administração & dosagem , Idoso , Artrite Reumatoide/complicações , Bases de Dados Factuais , Diabetes Mellitus Tipo 2/complicações , Quimioterapia Combinada , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Taiwan/epidemiologia
3.
Medicine (Baltimore) ; 98(39): e17280, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574843

RESUMO

BACKGROUND: This study will aim to evaluate the diagnostic accuracy of digital X-ray radiogrammetry (DXR) on hand bone loss (HBL) for rheumatoid arthritis (RA). METHODS: In this study, we will search the literature from PubMed, EMBASE, Cochrane Library, PsycINFO, Web of Science, Google Scholar, Cumulative Index to Nursing and Allied Health Literature, Allied and Complementary Medicine Database, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, and WANFANG from the inception to June 1, 2019 without language restrictions. All case-controlled studies on assessing diagnostic accuracy of DXR on HBL for diagnosis of RA will be included. Quality Assessment of Diagnostic Accuracy Studies tool will be used for eligible studies. We will apply RevMan V.5.3 software and Stata V.12.0 software for statistical analysis. RESULTS: We will evaluate diagnostic accuracy of DXR on HBL in patients with RA by assessing the sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio. CONCLUSION: This study will detect the diagnostic accuracy of DXR evaluation on HBL in patients with RA. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42019139489.


Assuntos
Artrite Reumatoide/diagnóstico por imagem , Doenças Ósseas Metabólicas/diagnóstico por imagem , Densitometria/estatística & dados numéricos , Intensificação de Imagem Radiográfica/métodos , Radiografia/estatística & dados numéricos , Artrite Reumatoide/complicações , Doenças Ósseas Metabólicas/etiologia , Estudos de Casos e Controles , Densitometria/métodos , Progressão da Doença , Feminino , Ossos da Mão/diagnóstico por imagem , Humanos , Masculino , Radiografia/métodos , Projetos de Pesquisa , Índice de Gravidade de Doença , Revisão Sistemática como Assunto
5.
Rev Fac Cien Med Univ Nac Cordoba ; 76(3): 174-179, 2019 08 29.
Artigo em Espanhol | MEDLINE | ID: mdl-31465186

RESUMO

Background: Mortality from cardiovascular disease (CVD) is increased in rheumatoid arthritis, not explained by traditional cardiovascular risk factors (CVRF), suggesting a role of inflammation. This process would occur early. The common sonographic markers of subclinical atherosclerosis (SA), are increased carotid intima-media thickness (cIMT) or the presence of carotid atherosclerotic plaque and they are closely related to CVD. Aims: To evaluate sonographic markers and cardiovascular risk factors in early Arthritis (EA). Methods: A case control study of patients with EA, defined by 3 joints swollen with <1 year of evolution, served consecutively from January 2011 to may 2013, matched with healthy controls, by sex, age and cardiovascular risk factors (hypertension, diabetes mellitus, cardiovascular disease -IAM and ACV, dyslipidemia, family history of CVD) was conducted. We studied demographics data, cardiovascular risk factors, carotid ultrasound measuring increased cIMT or the presence of carotid atherosclerotic plaque in Common Carotid Artery (CCA) and Carotid Bulb (BC), laboratory test that included cholesterol, LDL, HDL, triglycerides in mg%, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR ), anti citrullinated peptide (ACCP), rheumatoid factor (RF), antinuclear antibodies (ANA). EA activity was measured by DAS 28, considering high disease activity (HDA) 5.1; moderate (MDA) from 5.1 to 3.2; and low (LDA) <3.2. Statistics: test Mann-Whitney and chi-square were used, p <0.05 was significant. Results: 25 women, 5 men, average age 43 years (DS 14.7) and 30 controls were included. The average DAS 28 was 4, 8 ± 1. 8; 47% had HDA, 33%MDA and 20%BDA. Both groups had similar values cIMT CCA (0, 57 ± 0.10 mm vs. 0.58 ± 0.15 mm, respectively, P = 0.82) and cIMT BC (0.18mm ± 0.67 vs 0.62 ± 0.15 mm respectively, P = 0.47). There were no carotid plaques. The median total cholesterol was 181,5 vs 183,5 (p = 0.35); triglycerides 99 vs 92,5 (p = 0.68); HDL 54,5 vs 52,5 (p = 0.921 and LDL 105 vs 110 (p = 0.27) in EA and controls respectively. The cIMT CCA and CB were not related to RF, ACCP, CRP, DAS 28 and smoking (NS). There was no difference in other cardiovascular risk factors Conclusions: Ultrasound evidence of atherosclerosis subclinical markers was not found in this study, suggesting that this process may occur after a year of diagnosis.


Assuntos
Artrite Reumatoide/diagnóstico por imagem , Aterosclerose/diagnóstico por imagem , Biomarcadores/sangue , Adulto , Artrite Reumatoide/sangue , Artrite Reumatoide/complicações , Aterosclerose/sangue , Aterosclerose/complicações , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/diagnóstico por imagem , Doenças Cardiovasculares/etiologia , Artéria Carótida Primitiva/diagnóstico por imagem , Artéria Carótida Primitiva/patologia , Estudos de Casos e Controles , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Ultrassonografia
6.
Medicine (Baltimore) ; 98(33): e16714, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31415364

RESUMO

To investigate the efficiency and clinical safety of intra-articular triamcinolone acetonide (TA) injection under the guide of ultrasonography combined with standard treatment for treating refractory small joints arthritis in rheumatoid arthritis (RA) patients.TA was injected upon confirmation of the needle inserting into the articular cavity. The dose was 40 mg for the wrist, 20 mg for the metacarpophalangeal (MCP) joint and 20 mg for the proximal interphalangeal (PIP) joint, respectively. Visual analogue scale (VAS) for joint pain, swelling, tenderness, synovial hyperplasia and power Doppler signal scores were evaluated at pretreatment, and post-treatment 24 hours, 1 week, 4 weeks as well as 12 weeks.The VAS for pain and tenderness scores showed gradual improvement at 24 hours, 1 week, 4 weeks and 12 weeks after treatment compared with the baseline levels (P' < .005). The swelling showed no changes at 24 hours after treatment compared with the baseline, and showed gradual improvement at 1 week, 4 weeks and 12 weeks after treatment (P' < .005). Significant decrease was noticed in the synovial hyperplasia score at 4 weeks and 12 weeks compared with the baseline level. Power Doppler signal score showed significant decrease at post-treatment 24 hours, which showed further decrease at 1 week and 4 weeks.Ultrasound-guided intra-articular TA injection is effective for treating RA patients with refractory small joints arthritis without changing the original treatment plan.


Assuntos
Anti-Inflamatórios/administração & dosagem , Artrite Reumatoide/complicações , Sinovite/tratamento farmacológico , Triancinolona Acetonida/administração & dosagem , Ultrassonografia de Intervenção/métodos , Adolescente , Adulto , Idoso , Feminino , Articulações dos Dedos/efeitos dos fármacos , Humanos , Injeções Intra-Articulares , Masculino , Articulação Metacarpofalângica/efeitos dos fármacos , Pessoa de Meia-Idade , Estudos Prospectivos , Sinovite/etiologia , Sinovite/patologia , Resultado do Tratamento , Articulação do Punho/efeitos dos fármacos , Adulto Jovem
7.
Egypt J Immunol ; 26(1): 141-150, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31333004

RESUMO

The most common types of anemia in rheumatoid arthritis (RA) are iron deficiency anemia (IDA) and anemia of chronic disease (ACD).The differentiation between both is important and challenging. Our objective is to select the most accurate method that differentiates IDA from ACD in RA patients. This case control study was carried out on 80 RA patients. 40 RA patients with anemia and 40 RA patients without anemia, complete blood count, assessment of disease activity using DAS 28 score, serum iron, transferrin level, transferrin saturation (TSAT), serum ferritin, log ferritin and transferrin /log ferritin were tested, anemic patients were divided into 2 subgroups according to TSAT: group Ia (with low TSAT) and group Ib (with normal TSAT). There was a statistically significant difference between anemic and non-anemic RA patients as regard serum iron level and transferrin saturation. Among the anemic group 67.5% had low TSAT (IDA) and 32.5% had normal TSAT (ACD). In these 2 subgroups there was no significant differences as regard DAS28 score, blood indices, serum ferritin and transferrin /log ferritin) and there was a positive correlation between TSAT and ferritin and log ferritin and a significant negative correlation between TSAT and transferrin/log ferritin. In conclusions, Iron deficiency anemia is prevalent in RA patients. A combination of serum ferritin and TSAT is simple and accurate parameter to differentiate both. Log ferritin and transferrin /log ferritin may be promising new parameters in diagnosis of IDA in general population but their use in inflammatory diseases like RA still has a limitation.


Assuntos
Anemia Ferropriva/diagnóstico , Artrite Reumatoide/complicações , Ferritinas/sangue , Transferrina/análise , Anemia/diagnóstico , Estudos de Casos e Controles , Doença Crônica , Diagnóstico Diferencial , Humanos , Ferro
8.
Medicine (Baltimore) ; 98(27): e16286, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31277159

RESUMO

Patients with rheumatoid arthritis (RA) have a high risk of cardiovascular diseases and fractures. This retrospective cohort study explored whether patients with RA face higher complication risks or longer hospital stays than other patients when they had a lower limb fracture that required the surgery. Patients aged >45 years who received lower limb fracture surgeries between 2005 and 2012 were selected from the National Health Insurance Research Database, and 10 related variables including sex and age were used in propensity score matching to pair RA patients with non-RA patients in a 1:4 ratio. The final study sample comprised 1109 patients with RA and 4436 non-RA patients. The results indicated that 5.57% of the study sample had postoperative complications, accounting for 5.05% of patients with RA and 5.70% of the control group. After conditional logistic regression analysis was performed, the risk of major complications has no significant differences between patients with RA and the control group (odds ratio [OR] = 0.87; 95% confidence interval [CI]: 0.61-1.24; P > .05). However, the comorbidity severity score exerted a significant effect on complications; patients with scores ≥3 were 2.78 times more likely to experience complications (OR = 2.78; 95% CI 1.52-5.07). When considering different types of complications, patients with RA were less likely to be exposed to the risk of stroke (OR = 0.48). After controlling all related factors, no significant differences were observed in the complication risks or deaths between the 2 groups (P > .05). Regarding hospitalization length, the average stay for all patients was 8.12 days; after controlling related factors, the hospitalization length for patients with RA was 0.97 times that of the control group, which was nonsignificant (P > .05). These results may provide some information to healthcare professionals when providing treatments.


Assuntos
Artrite Reumatoide/complicações , Fixação Interna de Fraturas/efeitos adversos , Fraturas Ósseas/cirurgia , Tempo de Internação/tendências , Extremidade Inferior/lesões , Complicações Pós-Operatórias/diagnóstico , Pontuação de Propensão , Idoso , Idoso de 80 Anos ou mais , Bases de Dados Factuais , Feminino , Fraturas Ósseas/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Taiwan/epidemiologia
9.
Paraguay Oral Research ; 8(1): 35-40, julio 2019.
Artigo em Espanhol | BDNPAR | ID: biblio-1021606

RESUMO

La xerostomía, síndrome de boca seca o síndrome de Sjögren se define como la disminución del flujo salival en condiciones de reposo. El origen de esta endad clínica es mulcausal, pudiendo ser el resultado de una alteración localizada sobre las glándulas productoras de la saliva, o bien el resultado de un desequilibrio o alteración de índole sistémica. La evaluación del grado de disfunción de las glándulas salivares ha constuido un objevo básico por ello el propósito de este estudio fue determinar frecuencia del síndrome de Sjögren en pacientes con lupus eritematoso del hospital central del Instuto de Previsión Social en el año 2017 que acuden a tratamiento odontológico. Se realizó un descripción observacional retrospecvo para lo cual se recurrió a la historial clínico previo permiso del jefe de reumatología para acceder a los datos . Como conclusión general se obtuvo que existe una predominancia de pacientes de entre 46 a 50 años de edad representada por el 39% y de sexo femenino en el 83% de los casos. Se demuestra la frecuencia mencionando que acudieron 74 pacientes y de los cuales 18 (24%) personas presentan lupus eritematoso y síndrome de Sjögren, y entre estos el 78% acude a tratamiento odontológico.


Xerostomia, dry mouth syndrome or Sjögren's syndrome is defined as decreased salivary flow under resng condions. The origin of this clinical enty is mulcausal, and may be the result of an alteraon located on the glands producing saliva, or the result of an imbalance or alteraon of a systemic nature. The evaluaon of the degree of dysfuncon of the salivary glands has been a basic objecve and therefore the purpose of this study was to determine the frequency of Sjögren syndrome in paents with lupus erythematosus from the central hospital of the Social Welfare Instute in 2017 who seek dental treatment. A retrospecve observaonal descripon was made, for which the clinical history was used with the prior permission of the head of rheumatology to access the data. The general conclusion was that there is a predominance of paents between 46 and 50 years of age represented by 39% and female in 83% of cases. The frequency is demonstrated by menoning that 74 paents aended and of which 18 (24%) people present with lupus erythematosus and Sjögren's syndrome, of which 78% aend dental treatment


Assuntos
Pessoa de Meia-Idade , Idoso , Artrite Reumatoide/complicações , Doenças Autoimunes , Lúpus Eritematoso Sistêmico/complicações , Xerostomia , Síndrome de Sjogren
10.
Zh Nevrol Psikhiatr Im S S Korsakova ; 119(3. Vyp. 2): 68-75, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31184627

RESUMO

To study the relationship between cerebral perfusion with arterial hypertension (AH) and the state of endothelium in patients with rheumatoid arthritis (RA). MATERIAL AND METHODS: Seventy-eight patients with RA were divided into two groups: with- and without AH.The functional methods included ultrasonic duplex angioscanning and dopplerografy of the extracranial and intracranial arteries of the head and neck and daily 24 hour monitoring of arterial blood pressure (BP). C-reactive protein (CRP), vascular endothelial adhesion molecule type 1 (sVCAM-1), von Willebrand Factor antigen (vWF AG), interleukin-8 (Il-8), rheumatoid factor (RF) IgG, endothelin-1 (ET-1) were determined by immunoenzyme analysis and velocity of sedimentation (VS). The dysfunction of endothelium was evaluated by calculation of the number of desquamated endotheliocytes cells (DE). RESULTS: AH occurred in 46 (59%) patients. Cerebral hypoperfusion was observed in patients with RA in whom the reduction in the high-speed indices of blood flow were correlated with BP increase. There were negative correlations between the linear speed of blood flow on the common carotid arteries and average day and night systolic BP, average day and night diastolic BP, indices of time systolic BP and diastolic BP and avariability of BP. The same results were established for the intracranial arteries: inverse correlations between the linear speed on the anterior cerebral arteries and average day systolic BP. The signs of endothelial dysfunction represented by significant differences among the indices of activation of endothelium in RA patients in comparison with the control group were shown. Content of ET-1, sVCAM-1, vWF AG, Il-8, CRP was higher in RA. The number of DE was significantly higher as well. These indices showed significant differences depending on RA activity. Correlation analysis revealed that the markers of endothelium activation sVCAM-1, vWF AG were positively correlated with the indices of immune inflammation. CONCLUSION: An increase in the activity of inflammatory process in RA leads to endothelial dysfunction, which contributes to the increase in the peripheral vascular resistance of cerebral arteries, reduction in the high-speed indices of blood flow, growth of BP variability and the increase in load by pressure.


Assuntos
Artrite Reumatoide , Circulação Cerebrovascular , Hipertensão , Artrite Reumatoide/complicações , Artrite Reumatoide/fisiopatologia , Biomarcadores , Endotélio Vascular/fisiopatologia , Humanos , Hipertensão/complicações , Molécula 1 de Adesão de Célula Vascular
11.
Medicine (Baltimore) ; 98(22): e15887, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31145347

RESUMO

RATIONALE: For hip or knee arthroplasty, it is essential to develop a satisfied peripheral nerve block method that will benefit elderly patients or patients who are contraindicated to neuraxial anesthesia. PATIENTS CONCERNS: Patient in Case 1 suffered from the right intertrochanteric fracture, combined with chronic obstructive pulmonary disease; Patient in Case 2 suffered from hip osteoarthritis; combined with ankylosing spondylitis; Patient in Case 3 suffered from rheumatoid arthritis, combined with ischemic encephalopathy. DIAGNOSIS: Case 1: Right intertrochanteric fracture, chronic obstructive pulmonary disease. Case 2: hip osteoarthritis. Case 3: rheumatoid arthritis. INTERVENTIONS: Ultrasound-guided lumbar selective nerve root block (SNRB) plus T12 paravertebral and sacral plexus block were performed in 2 patients who received hip arthroplasty and 1 patient who received knee arthroplasty. OUTCOMES: All patients successfully received surgeries with this peripheral nerve block method and no postoperative complication was reported. LESSONS: Ultrasound-guided lumbar SNRB plus T12 paravertebral and sacral plexus block not only satisfied the analgesia requirement of surgery, but also reduced the consumption of local anesthetic.


Assuntos
Analgesia/métodos , Artroplastia de Quadril/métodos , Artroplastia do Joelho/métodos , Bloqueio Nervoso/métodos , Ultrassonografia de Intervenção/métodos , Idoso , Idoso de 80 Anos ou mais , Artrite Reumatoide/complicações , Artrite Reumatoide/cirurgia , Isquemia Encefálica/complicações , Isquemia Encefálica/cirurgia , Feminino , Fraturas do Quadril/complicações , Fraturas do Quadril/cirurgia , Humanos , Vértebras Lombares , Plexo Lombossacral , Pneumopatias Obstrutivas/complicações , Pneumopatias Obstrutivas/cirurgia , Masculino , Pessoa de Meia-Idade , Osteoartrite do Quadril/complicações , Osteoartrite do Quadril/cirurgia , Raízes Nervosas Espinhais , Espondilite Anquilosante/complicações , Espondilite Anquilosante/cirurgia , Vértebras Torácicas
12.
BMC Musculoskelet Disord ; 20(1): 194, 2019 May 04.
Artigo em Inglês | MEDLINE | ID: mdl-31054567

RESUMO

BACKGROUND: Fatigue is a major symptom of rheumatoid arthritis (RA). There is some evidence that physical activity (PA) may be effective in reducing RA fatigue. However, few PA interventions have been designed to manage fatigue and there is limited evidence of end-user input into intervention development. The aim of this research was to co-design an intervention to support self-management of RA fatigue through modifying PA. METHODS: A series of studies used mixed methodological approaches to co-design a fatigue management intervention focused on modifying PA based on UK Medical Research Council guidance, and informed by the Behaviour Change Wheel theoretical framework. Development was based on existing evidence, preferences of RA patients and rheumatology healthcare professionals, and practical issues regarding intervention format, content and implementation. RESULTS: The resulting group-based intervention consists of seven sessions delivered by a physiotherapist over 12 weeks. Each session includes an education and discussion session followed by supervised PA chosen by the participant. The intervention is designed to support modification and maintenance of PA as a means of managing fatigue. This is underpinned by evidence-based behaviour change techniques that might support changes in PA behaviour. Intervention delivery is interactive and aims to enhance capability, opportunity and motivation for PA. CONCLUSION: This study outlines stages in the systematic development of a theory-based intervention designed through consultation with RA patients and healthcare professionals to reduce the impact of RA fatigue. The feasibility of future evaluation of the intervention should now be determined.


Assuntos
Artrite Reumatoide/complicações , Terapia Cognitivo-Comportamental/métodos , Exercício/psicologia , Fadiga/reabilitação , Motivação , Adulto , Idoso , Artrite Reumatoide/fisiopatologia , Artrite Reumatoide/psicologia , Exercício/fisiologia , Fadiga/etiologia , Fadiga/fisiopatologia , Fadiga/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Encaminhamento e Consulta , Projetos de Pesquisa , Reumatologistas , Resultado do Tratamento
13.
Autoimmun Rev ; 18(7): 679-690, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31059840

RESUMO

Patients with rheumatoid arthritis (RA) suffer cardiovascular events 1.5-2 fold than the general population, and cardiovascular (CV) events are leading cause of death in patients with RA. It is known that patients with RA have endothelial dysfunction, related with impaired function of endothelial progenitor cells (EPCs). The mechanistic pathways leading to endothelial function are complicated, but understanding these mechanisms may open new frontiers of management and therapies to patients suffering from atherosclerosis. Inflammation is a key factor in atherosclerosis, including endothelial function, plaque stabilization and post infarct remodeling; thus, inhibition of TNF-α may affect the inflammatory burden and plaque vulnerability leading to less cardiovascular events and myocardial infarctions. An aggressive management of inflammation may lead to a significant improvement in the clinical cardiovascular outcome of patients with RA. The clinical evidence that showed a reduced risk of CV events following treatment with anti-inflammatory agents may suggest a new approach to treat atherosclerosis, i.e., inhibition of inflammation using biological medications that were primarily aimed to treat the high scale inflammation of RA and other autoimmune-inflammatory diseases, but may be useful also to prevent progression of atherosclerosis.


Assuntos
Anti-Inflamatórios/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Doenças Cardiovasculares/tratamento farmacológico , Animais , Artrite Reumatoide/complicações , Artrite Reumatoide/epidemiologia , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Humanos
14.
Medicine (Baltimore) ; 98(18): e15237, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31045763

RESUMO

RATIONALE: Idiopathic multicentric Castleman disease (iMCD) is a systemic disease with multiple regions of lymphadenopathy and systemic symptoms and associated with rheumatoid arthritis (RA) and collagen diseases. However, few reported have described the coexistence of iMCD and RA and the mechanisms by which iMCD induces arthritis remain elusive. We experienced a rare case of iMCD, wherein the patient exhibited symptoms of polyarthritis with high-grade fever. PATIENT CONCERNS: A 34-year-old woman was admitted to our hospital for further evaluation of a high fever with polyarthritis. The levels of both rheumatoid factor and anticitrullinated protein antibody were negative. F-fluorodeoxyglucose/positron emission tomography-computed tomography showed lymphadenopathy with increased fluoro-2-deoxy-D-glucose uptake. Magnetic resonance imaging and musculoskeletal ultrasonography revealed active synovitis in the hands which was consistent with RA. DIAGNOSES: We diagnosed iMCD based on human herpesvirus 8 negativity, HIV negativity, systemic lymphadenopathy, and pathologic findings of the lymph nodes. The patient did not satisfy the 2010 American College of Rheumatology and European League Against Rheumatism classification criteria for RA. Cytokine assay showed elevated serum levels of interleukin-17 and CXCL10, comparable to those in patients with RA. INTERVENTIONS: We administered 15 mg/d of predonisolone. OUTCOMES: After this treatment, the patient's symptoms showed improvement. As of this writing, we tapered the prednisolone to 7.5 mg/d, and the patient's remission has been maintained for >4 months. LESSONS: The present case suggests that RA-like active synovitis may coexist in iMCD, resulting from aberrant T-cell activation and histologic examination using lymph node biopsy may help enable early diagnosis of iMCD.


Assuntos
Artrite Reumatoide/complicações , Hiperplasia do Linfonodo Gigante/complicações , Linfadenopatia/diagnóstico por imagem , Sinovite/diagnóstico por imagem , Adulto , Artrite/diagnóstico , Artrite/etiologia , Artrite Reumatoide/diagnóstico por imagem , Artrite Reumatoide/patologia , Hiperplasia do Linfonodo Gigante/sangue , Hiperplasia do Linfonodo Gigante/tratamento farmacológico , Hiperplasia do Linfonodo Gigante/patologia , Quimiocina CXCL10/sangue , Diagnóstico Diferencial , Feminino , Febre/diagnóstico , Febre/etiologia , Glucocorticoides/administração & dosagem , Glucocorticoides/uso terapêutico , Herpesvirus Humano 8 , Humanos , Interleucina-17/sangue , Linfadenopatia/patologia , Imagem por Ressonância Magnética/métodos , Prednisolona/administração & dosagem , Prednisolona/uso terapêutico , Sinovite/patologia , Linfócitos T/patologia , Resultado do Tratamento
15.
Life Sci ; 229: 67-79, 2019 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-31085245

RESUMO

Endothelial dysfunction and vascular reactivity defects secondary to metabolic and immunological disorders carry risk of serious cardiovascular complications. Here, the effects of the phosphodiesterase (PDE) inhibitors vardenafil and cilostazol were examined against rheumatoid arthritis (RA)/diabetes mellitus (DM)-co-morbidity-induced endothelial dysfunction and vascular reactivity defects. After setting of RA/DM-co-morbidity model, rats were divided into a normal control group, an RA/DM-co-morbidity group, and two treatment groups receiving oral vardenafil (10 mg/kg/day) and cilostazol (30 mg/kg/day) for 21 days after RA/DM-co-morbidity induction. Aorta was isolated for biochemical estimations of the pro-inflammatory vasoconstrictor molecules angiotensin-II (Ang-II) and endothelin-1 (ET-1), the adhesion molecules P-selectin and vascular cell adhesion molecule-1 (VCAM-1), the energy sensor adenosine-5'-monophosphate-activated protein kinase (AMPK), and the vasodilator anti-inflammatory molecule vasoactive intestinal peptide (VIP) using enzyme-linked immunosorbent assay (ELISA) and western blot analysis. Immunohistochemical estimations of endothelial nitric oxide synthase (eNOS) and matrix metalloproteinase (MMP)-2 were performed coupled with histopathological examination using routine hematoxylin and eosin (H&E) and special Masson trichrome staining. The in vitro study was conducted using aortic strips where cumulative concentration response curves were done for the endothelium-dependent relaxing factor acetylcholine and the endothelium-independent relaxing factor sodium nitroprusside after submaximal contraction with phenylephrine. Vardenafil and cilostazol significantly improved endothelial integrity biomarkers in vivo supported with histopathological findings in addition to improved vasorelaxation in vitro. Apart from their known PDE inhibition, up-regulation of vascular AMPK and eNOS coupled with down-regulation of Ang-II, ET-1, P-selectin, VCAM-1 and MMP-2 may explain vardenafil and cilostazol protective effect against RA/DM-co-morbidity-induced endothelial dysfunction and vascular reactivity defects.


Assuntos
Artrite Experimental/complicações , Artrite Reumatoide/complicações , Doenças Cardiovasculares/tratamento farmacológico , Cilostazol/farmacologia , Diabetes Mellitus Experimental/complicações , Endotélio Vascular/efeitos dos fármacos , Dicloridrato de Vardenafila/farmacologia , Vasodilatadores/farmacologia , Animais , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/metabolismo , Comorbidade , Endotélio Vascular/metabolismo , Endotélio Vascular/patologia , Feminino , Ratos
16.
Am J Otolaryngol ; 40(3): 459-461, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30948137

RESUMO

Cricoarytenoid joint arthritis is an uncommon manifestation of rheumatoid arthritis. We encountered a 68-year-old woman with rheumatoid arthritis who presented with odynophagia, dysphagia, and progressive shortness of breath. Examination findings showed diminished mobility of the left vocal cord and right arytenoid swelling associated with an immobile right vocal cord. Computed tomography (CT) imaging identified a ring-enhancing lesion of the right lateral cricoarytenoid joint. Microdirect laryngoscopy with drainage of the cricoarytenoid abscess and tracheotomy were performed. Development of a laterally based cricoarytenoid joint abscess is identified as a complication of chronic rheumatoid arthritis with successful management described.


Assuntos
Abscesso/etiologia , Abscesso/cirurgia , Artrite Reumatoide/complicações , Cartilagem Aritenoide/cirurgia , Cartilagem Cricoide/cirurgia , Drenagem/métodos , Artropatias/etiologia , Artropatias/cirurgia , Abscesso/diagnóstico por imagem , Idoso , Cartilagem Aritenoide/diagnóstico por imagem , Doença Crônica , Cartilagem Cricoide/diagnóstico por imagem , Feminino , Humanos , Artropatias/diagnóstico por imagem , Laringoscopia , Traqueotomia , Resultado do Tratamento
17.
Biomed Res Int ; 2019: 3265847, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31032342

RESUMO

Objective: Patients with rheumatoid arthritis (RA) have an excess risk of cardiovascular (CV) disease (CVD). The objective of the study was to compare CV risk profile in female and male RA patients with low disease activity. Materials and Methods: The study group consisted of 70 RA patients with continuous low disease activity and no CVD (54 women, 16 men) and 33 healthy controls of comparable age. The groups were assessed for blood pressure, serum amino-terminal pro-brain natriuretic peptide (NT-proBNP), carotid intima media thickness (cIMT), electrocardiography, ejection fraction (EF), and diastolic dysfunction (DD). Results: Significantly higher burden of atherosclerosis, as revealed by higher cIMT, was found in males [0.93 (0.2) mm] vs females [0.80 (0.2) mm]. The risk of 10-year CVD was significantly higher in men than in women with RA. High/very high risk of fatal CVD was found in 62.5% of male patients. Males were significantly more often current/ex-smokers and had lower HDL-cholesterol and higher atherogenic index. There were no significant differences in NT-proBNP, QTc duration, and parameters of EF and DD. Conclusions: In RA patients with continued low disease activity, a higher burden of atherosclerosis was found in males than in females. The data suggest a significant impact of traditional CV risk factors.


Assuntos
Artrite Reumatoide/fisiopatologia , Doenças Cardiovasculares/fisiopatologia , Sistema Cardiovascular/fisiopatologia , Medição de Risco , Artrite Reumatoide/sangue , Artrite Reumatoide/complicações , Artrite Reumatoide/epidemiologia , Pressão Sanguínea/fisiologia , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Espessura Intima-Media Carotídea , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Fatores de Risco , Caracteres Sexuais , Volume Sistólico/fisiologia
18.
BMJ Case Rep ; 12(4)2019 Apr 03.
Artigo em Inglês | MEDLINE | ID: mdl-30948395

RESUMO

An 87-year-old woman with quiescent rheumatoid arthritis, not on immunosuppressive therapy, presented with unilateral arm weakness, confusion and visual hallucinations. There were no infective symptoms or history of malignancy. Cerebrospinal fluid (CSF) analysis demonstrated lymphocytosis and raised protein, without flow cytometric or cytological abnormalities. Viral, bacterial, mycobacterial and fungal testing of CSF and serum were negative. MRI brain indicated unilateral leptomeningeal enhancement. There was no evidence of occult malignancy on CT imaging of the chest, abdomen and pelvis. Rheumatoid factor and anticyclic citrullinated peptide were strongly positive. The patient declined meningeal biopsy but responded to treatment with corticosteroid therapy.


Assuntos
Artrite Reumatoide/complicações , Meningite/etiologia , Idoso de 80 Anos ou mais , Feminino , Humanos
19.
Cient. dent. (Ed. impr.) ; 16(1): 73-76, ene.-abr. 2019. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-183386

RESUMO

Objetivo: Mostrar las manifestaciones orales cuya etiología está relacionada con la artritis reumatoide (AR), revisando la literatura más reciente, a propósito de un caso. Caso clínico: El tratamiento de la AR está basado principalmente en la terapia farmacológica, siendo esta responsable de manifestaciones a nivel de la cavidad oral. Se presenta el caso de una mujer de 65 años con AR en tratamiento bajo metotrexato y tocilizumab, que acude a consulta por presentar desde hace 40 días una úlcera en el borde lateral de la lengua. Conclusión: Las manifestaciones orales de la AR derivan principalmente de la terapia farmacológica, que se debe conocer para el correcto diagnóstico y tratamiento de la patología oral de estos pacientes


Objective: The aim of the present article was to describe the oral manifestations whose etiology is related to rheumatoid arthritis (RA), reviewing the most recent literature, in relation to a case. Clinical case: The treatment of RA is based mainly on pharmacological therapy, being responsible for the manifestations at the level of the oral cavity. We present the case of a 65-year-old woman with RA on treatment with methotrexate and tocilizumab, which occurs through 40 days on the lateral border of the tongue. Conclusion: The oral manifestations of RA are derived mainly from pharmacological therapy, which should know the correct diagnosis and treatment of the oral pathology of these patients


Assuntos
Humanos , Feminino , Idoso , Artrite Reumatoide/complicações , Doenças da Língua/etiologia , Úlceras Orais/etiologia , Artrite Reumatoide/tratamento farmacológico , Metotrexato/administração & dosagem
20.
Intern Med ; 58(7): 979-984, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30930349

RESUMO

Chronic pulmonary aspergillosis, which features nodular lesions known as Aspergillus nodules, is a relatively uncommon disorder. We herein report a case of slowly progressing chronic multiple nodular pulmonary aspergillosis in a 59-year-old man with rheumatoid arthritis, dyspnea, and fatigue. One nodule was surgically resected. The surgical specimen featured central necrosis and was located adjacent to a respiratory bronchiole and pulmonary artery, without parenchymal invasion. Branching septate hyphae, compatible with Aspergillus, were seen inside this necrotic nodule. Chronic pulmonary aspergillosis should therefore be considered in the differential diagnosis of patients who present with slowly progressing pulmonary multiple nodules.


Assuntos
Artrite Reumatoide/complicações , Artrite Reumatoide/diagnóstico , Aspergilose Pulmonar/complicações , Aspergilose Pulmonar/diagnóstico , Antifúngicos/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Aspergillus , Aspergillus fumigatus , Doença Crônica , Humanos , Masculino , Pessoa de Meia-Idade , Necrose , Aspergilose Pulmonar/tratamento farmacológico , Tomografia Computadorizada por Raios X
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