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1.
Acta Med Indones ; 52(3): 214-226, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33020333

RESUMO

BACKGROUND: autoimmune patients can be more susceptible to infection. Proper knowledge, perception, and practices towards COVID-19 are essential for these patients during pandemic. This study aimed to know their knowledge, perception, and practices regarding COVID-19. METHODS: cross sectional study using online survey was conducted from April to May 2020. Patients with autoimmune disease were asked about demographic characteristics, diagnosis, history of treatment, knowledge, perception, and practice regarding COVID-19. RESULTS: there were 685 respondents. Most of them were female and had systemic lupus erythematosus with median age of 37 years old. Almost all respondents had good knowledge regarding transmission of COVID-19 and did proper prevention practices. Adequacy of information and steroid or mycophenolate mofetil/mycophenolic acid (MMF/MPA) use were related to perception of the effect of pandemic to their own health. Visiting private clinic and receiving hydroxychloroquine/chloroquine sulfate or sulfasalazine were related to perception that autoimmune conditions would make them more prone to COVID-19. Work from home was related to perception that when contracting COVID-19, the symptoms would be more severe. Living in Sumatra region and getting hydroxychloroquine/chloroquine sulfate or MMF/MPA were related to perception that autoimmune medications could reduce risk of getting COVID-19. Adequate information, university education, private clinic visit, and hydroxychloroquine/chloroquine sulfate use were related to perception that COVID-19 pandemic would cause difficulties in getting medications. CONCLUSION: almost all respondents had good knowledge and practices regarding COVID-19. Adequacy of information, autoimmune treatment, work from home, educational background, area of living, and health care facilities contributed to perception regarding COVID-19 pandemic.


Assuntos
Doenças Autoimunes/epidemiologia , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde , Pandemias , Percepção , Pneumonia Viral/epidemiologia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Comorbidade , Estudos Transversais , Feminino , Seguimentos , Humanos , Incidência , Indonésia/epidemiologia , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Inquéritos e Questionários , Taxa de Sobrevida/tendências , Adulto Jovem
2.
Rheumatol Int ; 40(10): 1593-1598, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32794113

RESUMO

OBJECTIVE: To describe clinical characteristics of patients with rheumatic and musculoskeletal diseases (RMDs) and immunosuppressive therapies with Coronavirus disease 2019 (COVID-19) at an academic rheumatology center in Madrid and to identify baseline variables associated with a severe infection requiring hospitalization. METHODS: We identified SARS-CoV-2 positive cases by polymerase chain reaction performed at our center within an updated RMDs database in our clinic. Additional RMDs patients were identified when they contacted the clinic because of a positive infection. Data extraction included diagnosis, demographics, immunosuppressive treatment, comorbidities, and laboratory tests. Comparisons between patients with or without hospitalization were performed. Multivariate logistic regression was used to analyze associations between baseline variables and need for hospitalization. RESULTS: A total of 62 patients with COVID-19 and underlying RMDs were identified by April 24, 2020. Median age was 60.9 years, and 42% men. Forty-two patients required hospitalization; these were more frequently men, older and with comorbidities. There were no statistically significant between-group differences for rheumatologic diagnosis and for baseline use of immunosuppressive therapy except for glucocorticoids that were more frequent in hospitalized patients. Total deaths were 10 (16%) patients. In multivariate analysis, male sex (odds ratio [OR], 8.63; p = 0.018), previous lung disease (OR, 27.47; p = 0.042), and glucocorticoids use (> 5 mg/day) (OR, 9.95; p = 0.019) were significantly associated to hospitalization. CONCLUSION: Neither specific RMD diagnoses or exposures to DMARDs were associated with increased odds of hospitalization. Being male, previous lung disease and exposure to glucocorticoids were associated with higher odds of hospitalization in RMDs patients.


Assuntos
Artrite Psoriásica/tratamento farmacológico , Artrite Reumatoide/tratamento farmacológico , Infecções por Coronavirus/fisiopatologia , Glucocorticoides/uso terapêutico , Hospitalização/estatística & dados numéricos , Imunossupressores/uso terapêutico , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Pneumonia Viral/fisiopatologia , Idoso , Antibacterianos/uso terapêutico , Anticorpos Monoclonais Humanizados/uso terapêutico , Antirreumáticos/uso terapêutico , Antivirais/uso terapêutico , Artrite Psoriásica/complicações , Artrite Psoriásica/epidemiologia , Artrite Reumatoide/complicações , Artrite Reumatoide/epidemiologia , Doenças Autoimunes/complicações , Doenças Autoimunes/tratamento farmacológico , Doenças Autoimunes/epidemiologia , Azitromicina/uso terapêutico , Betacoronavirus , Comorbidade , Infecções por Coronavirus/complicações , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/terapia , Combinação de Medicamentos , Feminino , Humanos , Hidroxicloroquina/uso terapêutico , Modelos Logísticos , Lopinavir/uso terapêutico , Pneumopatias/epidemiologia , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/epidemiologia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/mortalidade , Pneumonia Viral/terapia , Estudos Retrospectivos , Ritonavir/uso terapêutico , Índice de Gravidade de Doença , Fatores Sexuais , Espanha/epidemiologia
3.
Therapie ; 75(4): 335-342, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32665090

RESUMO

Since December 2019, the COVID-19 pandemic has become a major public health problem. To date, there is no evidence of a higher incidence of COVID in patients with autoimmune rheumatic diseases and we support the approach of maintaining chronic rheumatological treatments. However, once infected there is a small but significant increased risk of mortality. Among the different treatments, NSAIDs are associated with higher rates of complications, but data for other drugs are conflicting or incomplete. The use of certain drugs for autoimmune inflammatory rheumatisms appears to be a potentially interesting options for the treatment. The rationale for their use is based on the immune system runaway and the secretion of pro-inflammatory cytokines (Il1, IL6, TNFα) in severe forms of the disease. Notably, patients on chloroquine or hydroxychloroquine as a treatment for their autoimmune rheumatic disease are not protected from COVID-19.


Assuntos
Doenças Autoimunes/epidemiologia , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Doenças Reumáticas/epidemiologia , Anti-Inflamatórios não Esteroides/administração & dosagem , Antirreumáticos/administração & dosagem , Doenças Autoimunes/tratamento farmacológico , Cloroquina/administração & dosagem , Infecções por Coronavirus/mortalidade , Humanos , Hidroxicloroquina/administração & dosagem , Incidência , Pandemias , Pneumonia Viral/mortalidade , Doenças Reumáticas/tratamento farmacológico
4.
Rheumatol Int ; 40(9): 1353-1360, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32654078

RESUMO

As of June 10th 2020 about 7.2 million individuals have tested positive for, and more than 410,000 have died due to COVID-19. In this review we outline the pathophysiology that underpins the potential use of anti-rheumatic therapies for severe COVID-19 infection and summarize the current evidence regarding the risk and outcome of COVID-19 in patients with systemic autoimmune diseases. Thus far there is no convincing evidence that any disease-modifying anti-rheumatic drug (conventional synthetic, biologic or targeted synthetic) including hydroxychloroquine, may protect against severe COVID-19 infection; answers about their possible usefulness in the management of the cytokine storm associated with severe COVID-9 infection will only arise from ongoing randomized controlled trials. Evidence on COVID-19 risk and outcome in patients with systemic autoimmune diseases is extremely limited; thus, any conclusions would be unsafe and should be seen with great caution. At present, the risk and severity (hospitalization, intensive care unit admission and death) of COVID-19 infection in people with autoimmune diseases do not appear particularly dissimilar to the general population, with the possible exception of hospitalization in patients exposed to high glucocorticoid doses. At this stage it is impossible to draw any conclusions for differences in COVID-19 risk and outcome between different autoimmune diseases and between the various immunomodulatory therapies used for them. More research in the field is obviously required, including as a minimum careful and systematic epidemiology and appropriately controlled clinical trials.


Assuntos
Antirreumáticos/uso terapêutico , Doenças Autoimunes/tratamento farmacológico , Infecções por Coronavirus/tratamento farmacológico , Síndrome da Liberação de Citocina/tratamento farmacológico , Pneumonia Viral/tratamento farmacológico , Anticorpos Monoclonais Humanizados/uso terapêutico , Doenças Autoimunes/epidemiologia , Doenças Autoimunes/imunologia , Betacoronavirus , Comorbidade , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/imunologia , Síndrome da Liberação de Citocina/imunologia , Humanos , Inibidores de Janus Quinases/uso terapêutico , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/imunologia , Fatores de Risco , Índice de Gravidade de Doença , Inibidores do Fator de Necrose Tumoral/uso terapêutico
5.
Am J Nurs ; 120(8): 32-37, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32665509

RESUMO

If undiagnosed and untreated, pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS) can suddenly and drastically disrupt the lives of previously healthy children and their families. The key to prompt diagnosis of PANDAS and its appropriate treatment is provider awareness that streptococcal infection may present with neuropsychiatric symptoms. The authors discuss the signs and symptoms that characterize PANDAS, as well as its presumed pathogenesis, and illustrate, through a composite case history, a symptom presentation, diagnostic journey, treatment course, and recovery that is representative of many PANDAS cases.


Assuntos
Doenças Autoimunes/diagnóstico , Transtorno Obsessivo-Compulsivo/diagnóstico , Infecções Estreptocócicas/diagnóstico , Antibacterianos/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Antipsicóticos/uso terapêutico , Doenças Autoimunes/tratamento farmacológico , Doenças Autoimunes/epidemiologia , Doenças Autoimunes/fisiopatologia , Criança , Feminino , Humanos , Masculino , Transtorno Obsessivo-Compulsivo/tratamento farmacológico , Transtorno Obsessivo-Compulsivo/epidemiologia , Transtorno Obsessivo-Compulsivo/fisiopatologia , Pais/educação , Educação de Pacientes como Assunto , Prevalência , Prognóstico , Infecções Estreptocócicas/tratamento farmacológico , Infecções Estreptocócicas/epidemiologia , Infecções Estreptocócicas/fisiopatologia
7.
Autoimmun Rev ; 19(8): 102590, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32561463

RESUMO

OBJECTIVE: To evaluate prevalence and clinical features of immune-related adverse events (irAEs) to immune checkpoint inhibitors (ICIs) in accordance with the gender of treated cancer patients. METHODS: A systematic review of the medical literature was conducted by searching all available clinical data up to December 2019 in several databases using a combination of MESH terms related to immune checkpoint inhibitors, autoimmunity, and gender. Analyzed data were related to all FDA approved ICIs and respective indications in cancer. RESULTS: According to data from the literature, male display a slightly lower frequencies of ICIs-related endocrinopathies compared with females, specifically thyroid dysfunction. On the contrary, ICIs-hypophysitis has been reported at higher rates among males compared with females. ICI-induced Sicca/Sjogren's syndrome showed a more frequent occurrence in men than the idiopathic primary form. No differences in gender distribution seem to arise in hematologic and gastrointestinal-irAEs. Interestingly, the gender distribution of neurologic and vascular ICIs-irAEs appears male-dominant. CONCLUSIONS: The present systematic review highlights for the first time that the distribution of patients experiencing irAEs associated with ICIs changes among the genders according to the specific drug used, the frequency of the cancer and of the autoimmune conditions in the general population.


Assuntos
Antineoplásicos , Doenças Autoimunes , Neoplasias , Antineoplásicos/efeitos adversos , Antineoplásicos/uso terapêutico , Doenças Autoimunes/induzido quimicamente , Doenças Autoimunes/epidemiologia , Doenças Autoimunes/fisiopatologia , Autoimunidade , Feminino , Humanos , Masculino , Neoplasias/tratamento farmacológico , Fatores Sexuais
8.
Medicine (Baltimore) ; 99(22): e20437, 2020 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-32481446

RESUMO

To study the changes of pancreas, thyroid, adrenal, parathyroid and gonadal organ-specific antibodies in patients with type 1 diabetic patients and to explore the risk of development to other endocrine gland autoimmune diseases.Fifty one patients with type 1 diabetes mellitus were selected. ELISA was used to detect islet, adrenal gland, Parathyroid, gonadal organ-specific antibody levels, the level of thyroid-related antibodies by lectrochemiluminescence.Compared with the healthy control group, the levels of the 17-α-OHAb, 21-OHAb, NALP5Ab, P450sccAb, and CaSRAb in the T1DM group were significantly higher. GADAb-positive patients were more likely to have TPOAb-positive patients than GADAb-negative patients, and the positive rate of 2 thyroid antibodies in GADAb-positive patients was significantly higher than that in GADAb-negative patients. The presence of these antibodies is related to the age of onset of type 1 diabetes or Patient age. In combination with 1 or 2 islet antibody-positive patients, the combined non-islet antibody positive rate was higher than that of islet antibody-negative patients.Patients with type 1 diabetes with other autoimmune diseases at risk significantly increased compared with normal, of which the most common thyroid autoimmune disease, thyroid antibodies and hormone levels should be routinely detected at the first visit and long-term follow-up.


Assuntos
Doenças Autoimunes/epidemiologia , Doenças Autoimunes/imunologia , Diabetes Mellitus Tipo 1/epidemiologia , Diabetes Mellitus Tipo 1/imunologia , Adolescente , Adulto , Anticorpos/sangue , Doenças Autoimunes/sangue , Criança , Pré-Escolar , Diabetes Mellitus Tipo 1/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Adulto Jovem
9.
Clin Nephrol ; 94(2): 78-85, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32567543

RESUMO

OBJECTIVE: To determine the prognostic values of clinical and laboratory features at the time of presentation on renal function and survival of patients with myeloperoxidase anti-neutrophil cytoplasmic antibody-associated glomerulonephritis. (MPO-ANCA GN). MATERIALS AND METHODS: A total of 119 patients (52 males and 67 females) with MPO-ANCA GN and hospitalized at the First Affiliated Hospital of Nanjing Medical University from January 2010 to April 2018 were enrolled. The baseline clinical characteristics, renal biopsy pathological data, and risk factors predictive of renal and patient survival were retrospectively analyzed. RESULTS: Among these 119 patients, the median serum creatinine at diagnosis was 354.30 (range, 216.10 - 637.30) mmol/L and the median estimated glomerular filtration rate (eGFR) was 14.78 (range, 7.23 - 29.21) mL/min. In total, 58 (48.7%) patients received initial renal replacement therapy (RRT). During a median follow-up duration of 32 (range, 3 - 113) months, 57 (47.9%) patients progressed to end-stage renal disease (ESRD). Initial renal function status (i.e., initial RRT, serum creatinine, and eGFR) (p < 0.001) and hemoglobin level (p = 0.027) were significant risk factors for renal survival. During the follow-up, 69 (57.6%) of 119 patients survived. Age (p = 0.009) and urine red blood cell count (p = 0.012) were predictive of patient survival. CONCLUSION: Among patients with MPO-ANCA GN, poor renal function and lower hemoglobin level were predictive of ESRD, while older age and higher urinary red blood cell count were associated with a higher risk for all-cause mortality.


Assuntos
Doenças Autoimunes , Glomerulonefrite , Anticorpos Anticitoplasma de Neutrófilos , Doenças Autoimunes/epidemiologia , Doenças Autoimunes/mortalidade , Doenças Autoimunes/fisiopatologia , Feminino , Taxa de Filtração Glomerular , Glomerulonefrite/epidemiologia , Glomerulonefrite/mortalidade , Glomerulonefrite/fisiopatologia , Humanos , Rim/fisiopatologia , Masculino , Peroxidase , Estudos Retrospectivos , Fatores de Risco
10.
Ann Rheum Dis ; 79(9): 1170-1173, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32532753

RESUMO

BACKGROUND: The susceptibility of patients with rheumatic diseases and the risks or benefits of immunosuppressive therapies for COVID-19 are unknown. METHODS: We performed a retrospective study with patients under follow-up in rheumatology departments from seven hospitals in Spain. We matched updated databases of rheumatology patients with severe acute respiratory syndrome coronavirus 2-positive PCR tests performed in the hospital to the same reference populations. Rates of PCR+ confirmed COVID-19 were compared among groups. RESULTS: Patients with chronic inflammatory diseases had 1.32-fold higher prevalence of hospital PCR+ COVID-19 than the reference population (0.76% vs 0.58%). Patients with systemic autoimmune or immune-mediated disease (AI/IMID) showed a significant increase, whereas patients with inflammatory arthritis (IA) or systemic lupus erythematosus did not. COVID-19 cases in some but not all diagnostic groups had older ages than cases in the reference population. Patients with IA on targeted-synthetic or biological disease-modifying antirheumatic drugs (DMARDs), but not those on conventional-synthetic DMARDs, had a greater prevalence despite a similar age distribution. CONCLUSION: Patients with AI/IMID show a variable risk of hospital-diagnosed COVID-19. Interplay of ageing, therapies and disease-specific factors seem to contribute. These data provide a basis to improve preventive recommendations to rheumatic patients and to analyse the specific factors involved in COVID-19 susceptibility.


Assuntos
Doenças Autoimunes/epidemiologia , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Hospitalização/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Doenças Reumáticas/epidemiologia , Adulto , Distribuição por Idade , Idoso , Antirreumáticos/efeitos adversos , Artrite Reumatoide/tratamento farmacológico , Artrite Reumatoide/epidemiologia , Artrite Reumatoide/virologia , Doenças Autoimunes/tratamento farmacológico , Doenças Autoimunes/virologia , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/virologia , Feminino , Humanos , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Lúpus Eritematoso Sistêmico/epidemiologia , Lúpus Eritematoso Sistêmico/virologia , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/virologia , Reação em Cadeia da Polimerase , Prevalência , Estudos Retrospectivos , Doenças Reumáticas/tratamento farmacológico , Doenças Reumáticas/virologia , Espanha/epidemiologia
11.
Ann Rheum Dis ; 79(9): 1163-1169, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32546598

RESUMO

OBJECTIVES: Increasing data about COVID-19 have been acquired from the general population. We aim to further evaluate the clinical characteristics of COVID-19 in patients with systemic autoimmune diseases (AIDs). METHODS: We included all confirmed inpatients with COVID-19 and systemic AIDs in Wuhan Tongji Hospital from 29 January to 8 March 2020. We retrospectively collected and analysed information on epidemiology of 1255 inpatients and additional clinical characteristics of patients with systemic AIDs. Outcomes were followed up until 16 April 2020. RESULTS: Of the 1255 patients with COVID-19, the median age was 64.0 years and 53.1% were male. More than half (63.0%) had chronic comorbidities. The proportions of elderly, male and patients with comorbidities were significantly higher in intensive care unit (ICU) than in the general ward (p<0.001). 17 (0.61%) patients with systemic AIDs were further screened and analysed from 2804 inpatients. The median age was 64.0 years and 82.4% were female. All patients were living in Wuhan and two family clusters were found. 1 (5.9%) patient was admitted to ICU and one died. 10 (62.5%) of 16 patients changed or stopped their anti-AIDs treatments during hospitalisation, and 5 of them felt that the disease had worsened after the quarantine. CONCLUSIONS: Older males with chronic comorbidities are more vulnerable to severe COVID-19. The lower proportion of COVID-19 in patients with systemic AIDs needs more high-quality human clinical trials and in-depth mechanism researches. Of note, the withdrawal of anti-AIDs treatments during hospitalisation can lead to flares of diseases.


Assuntos
Doenças Autoimunes/epidemiologia , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/imunologia , Hospitalização/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Pneumonia Viral/imunologia , Adolescente , Adulto , Idoso , Doenças Autoimunes/virologia , China/epidemiologia , Comorbidade , Infecções por Coronavirus/virologia , Feminino , Humanos , Pacientes Internados/estatística & dados numéricos , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/virologia , Estudos Retrospectivos , Adulto Jovem
12.
Clin Immunol ; 217: 108480, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32461193

Assuntos
Autoanticorpos/imunologia , Autoantígenos/imunologia , Doenças Autoimunes/epidemiologia , Betacoronavirus/imunologia , Infecções por Coronavirus/epidemiologia , Proteínas do Nucleocapsídeo/imunologia , Pandemias , Pneumonia Viral/epidemiologia , Glicoproteína da Espícula de Coronavírus/imunologia , Anticorpos Antivirais/química , Anticorpos Antivirais/genética , Autoanticorpos/química , Autoanticorpos/genética , Autoantígenos/química , Autoantígenos/genética , Doenças Autoimunes/etiologia , Doenças Autoimunes/imunologia , Doenças Autoimunes/virologia , Autoimunidade , Betacoronavirus/patogenicidade , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/virologia , Reações Cruzadas , Expressão Gênica , Interações Hospedeiro-Patógeno/genética , Interações Hospedeiro-Patógeno/imunologia , Humanos , Imunidade Inata , Proteínas do Nucleocapsídeo/química , Proteínas do Nucleocapsídeo/genética , Pandemias/prevenção & controle , Pneumonia Viral/imunologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/virologia , Proteínas Associadas a Surfactantes Pulmonares/antagonistas & inibidores , Proteínas Associadas a Surfactantes Pulmonares/genética , Proteínas Associadas a Surfactantes Pulmonares/imunologia , Glicoproteína da Espícula de Coronavírus/química , Glicoproteína da Espícula de Coronavírus/genética , Vacinas Virais/efeitos adversos , Vacinas Virais/biossíntese
13.
PLoS One ; 15(5): e0232842, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32384131

RESUMO

OBJECTIVE: The risk of complications of nonsurgical hypoparathyroidism in Asia is unclear. We estimated the prevalence and risk of complications in patients with nonsurgical hypoparathyroidism. METHODS: We performed a retrospective cohort study using a nationwide claims database from 2005 to 2016. Among the entire Korean population, we identified 897 patients diagnosed with nonsurgical hypoparathyroidism during 2005-2015. We selected 210 patients with nonsurgical hypoparathyroidism during 2005-2008 who had no complications at baseline and followed them to 2016. Control subjects (n = 2075) were matched using propensity scores based on age, sex, and comorbid disease with a 1:10 ratio and monitored until 2016. RESULTS: The age-standardized prevalence of nonsurgical hypoparathyroidism was 0.2 cases per 100,000 persons in 2005. During a mean follow-up period of 9.5 years, patients with nonsurgical hypoparathyroidism had a higher risk of cardiovascular disease, especially arrhythmia (hazard ratio [HR], 2.03; 95% confidence interval [CI], 1.11-3.70) and heart failure (HR, 2.43; 95% CI, 1.22-4.83). The risk of vertebral fracture was higher in patients than in controls (HR, 2.27; 95% CI, 1.09-4.72). Patients had a significantly increased risk of renal disease (HR, 2.57; 95% CI, 1.56-4.21), seizure (HR, 5.74; 95% CI, 3.34-9.86), depression and bipolar disease (HR, 1.82; 95% CI, 1.30-2.56), and cataract (HR, 1.90; 95% CI, 1.30-2.79) compared with controls. CONCLUSIONS: The prevalence of nonsurgical hypoparathyroidism was very low in Korea but was associated with a higher risk of incident cardiovascular disease and vertebral fracture as well as known complications including renal disease, seizure, and cataract.


Assuntos
Hipoparatireoidismo/epidemiologia , Adulto , Doenças Autoimunes/epidemiologia , Transtorno Bipolar/epidemiologia , Transtorno Bipolar/etiologia , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Estudos de Casos e Controles , Catarata/epidemiologia , Catarata/etiologia , Comorbidade , Transtorno Depressivo/epidemiologia , Transtorno Depressivo/etiologia , Feminino , Fraturas Espontâneas/epidemiologia , Fraturas Espontâneas/etiologia , Humanos , Hipoparatireoidismo/complicações , Masculino , Síndrome Metabólica/epidemiologia , Pessoa de Meia-Idade , Prevalência , Pontuação de Propensão , República da Coreia/epidemiologia , Convulsões/epidemiologia , Convulsões/etiologia , Fraturas da Coluna Vertebral/epidemiologia , Fraturas da Coluna Vertebral/etiologia , Cálculos Urinários/epidemiologia , Cálculos Urinários/etiologia , Adulto Jovem
14.
Med. clín (Ed. impr.) ; 154(9): 344-347, mayo 2020. tab
Artigo em Inglês | IBECS | ID: ibc-193214

RESUMO

BACKGROUND: Patients with pernicious anemia (PA) have a higher prevalence of other autoimmune diseases. We assessed the correlation between PA and autoimmune thyroid diseases (AITD), and evaluated the risk factors for this association. METHODS: A longitudinal study was conducted involving patients with PA between 2010 and 2017. RESULTS: A total of 86 patients with PA were evaluated, 74 (86%) female, with a median age of 51.5 years. Thyroid abnormalities were detected in 45 (52.3%) patients, including 28 (32.3%) hypothyroidism, 3 (3.5%) hyperthyroidism and 20 (23.3%) thyroperoxidase antibody positivity. Logistic regression analysis identified risk factors for having AITD in PA patients: weight loss (OR 12.03; 95% CI 1.06-137.02, P=0.045), diabetes mellitus (OR 4.68, 95% CI 1.15-26.58, P=0.047) and gastric antibodies positivity (OR 5.05, 95% CI 1.45-18.24, P=0.013). CONCLUSION: PA and AITD are frequently associated, suggesting all patients with PA should be investigated for occult thyroid disease, especially those with weight loss, diabetes mellitus and gastric autoantibodies


ANTECEDENTES: Los pacientes con anemia perniciosa (AP) tienen una mayor prevalencia de otras enfermedades autoinmunes. Evaluamos la correlación entre AP y enfermedades tiroideas autoinmunes (AITD), así como los factores de riesgo para esta asociación. MÉTODOS: Realizamos un estudio longitudinal que incluyó a pacientes con AP entre 2010 y 2017. RESULTADOS: Evaluamos a un total de 86 pacientes con AP, 74 (86%) mujeres, con una edad media de 51,5 años. Detectamos alteraciones tiroideas en 45 (52,3%) pacientes, incluyendo 28 (32,3%) casos de hipotiroidismo, 3 (3,5%) de hipertiroidismo y 20 (23,3%) de positividad para anticuerpos anti-tiroperoxidasa. El análisis de regresión logística identificó los factores de riesgo de padecer AITD en pacientes de AP: pérdida de peso (OR: 12,03; IC 95%: 1,06-137,02; p = 0,045), diabetes mellitus (OR: 4,68; IC 95%: 1,15-26,58; p = 0,047) y positividad frente a anticuerpos gástricos (OR: 5,05; IC 95%: 1,45-18,24; p = 0,013). CONCLUSIÓN: AP y AITD están frecuentemente asociados, lo cual sugiere que deberían investigarse las enfermedades tiroideas ocultas en todos los pacientes con AP, especialmente aquellos con pérdida de peso, diabetes mellitus y auto-anticuerpos gástricos


Assuntos
Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Doenças da Glândula Tireoide/epidemiologia , Anemia Perniciosa/complicações , Valor Preditivo dos Testes , Doenças Autoimunes/epidemiologia , Fatores de Risco , Estudos Longitudinais , Complicações do Diabetes , Análise Multivariada , Deficiência de Vitamina B 12
15.
Arthritis Rheumatol ; 72(6): 1026-1035, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32266792

RESUMO

OBJECTIVE: Growing evidence suggests increasing frequencies of autoimmunity and certain autoimmune diseases, but findings are limited by the lack of systematic data and evolving approaches and definitions. This study was undertaken to investigate whether the prevalence of antinuclear antibodies (ANA), the most common biomarker of autoimmunity, changed over a recent 25-year span in the US. METHODS: Serum ANA were measured by standard indirect immunofluorescence assays on HEp-2 cells in 14,211 participants age ≥12 years from the National Health and Nutrition Examination Survey, with approximately one-third from each of 3 time periods: 1988-1991, 1999-2004, and 2011-2012. We used logistic regression adjusted for sex, age, race/ethnicity, and survey design variables to estimate changes in ANA prevalence across the time periods. RESULTS: The prevalence of ANA was 11.0% (95% confidence interval [95% CI] 9.7-12.6%) in 1988-1991, 11.5% (95% CI 10.3-12.8%) in 1999-2004, and 15.9% (95% CI 14.3-17.6%) in 2011-2012 (P for trend < 0.0001), which corresponds to ~22 million, ~27 million, and ~41 million affected individuals, respectively. Among adolescents age 12-19 years, ANA prevalence increased substantially, with odds ratios (ORs) of 2.02 (95% CI 1.16-3.53) and 2.88 (95% CI 1.64-5.04) in the second and third time periods relative to the first (P for trend < 0.0001). ANA prevalence increased in both sexes (especially in men), older adults (age ≥50 years), and non-Hispanic whites. These increases in ANA prevalence were not explained by concurrent trends in weight (obesity/overweight), smoking exposure, or alcohol consumption. CONCLUSION: The prevalence of ANA in the US has increased considerably in recent years. Additional studies to determine factors underlying these increases in ANA prevalence could elucidate causes of autoimmunity and enable the development of preventative measures.


Assuntos
Anticorpos Antinucleares/análise , Doenças Autoimunes/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Doenças Autoimunes/sangue , Biomarcadores/análise , Criança , Feminino , Técnica Indireta de Fluorescência para Anticorpo , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais , Razão de Chances , Prevalência , Estados Unidos/epidemiologia , Adulto Jovem
16.
J Womens Health (Larchmt) ; 29(4): 511-519, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32320330

RESUMO

Background: Autoimmune diseases are usually more prevalent in women. The risks of cardiovascular and renal disease in those with multiple autoimmune diseases have not been fully described. Materials and Methods: Using a national database from a large health insurer in the United States (years 2001-2017) containing ∼75 million members, we calculated age- and sex-specific co-prevalence of 12 autoimmune disorders for individuals with type 1 diabetes. We then evaluated whether concomitant autoimmune diseases were associated with renal failure, ischemic stroke, and myocardial infarction. Results: Of the 179,248 people diagnosed with type 1 diabetes, 1 in 4 had a concomitant autoimmune disease (27.03%; 95% confidence interval [CI] = 26.83%-27.24%), with hypothyroidism, rheumatoid arthritis, and celiac disease being the most common. The prevalence of autoimmune disease was 1.9 times greater in female than male patients (p < 0.001). In female patients with type 1 diabetes, one in three had another autoimmune disease (35.62%; 95% CI = 35.30%-35.94%) compared with one in five male patients (19.17%; 95% CI = 18.92%-19.42%). The risk of renal failure, ischemic stroke, and myocardial infarction increased with a greater number of concomitant autoimmune diseases (p < 0.001, test for trend for both female and male patients). Patients with type 1 diabetes who had multiple sclerosis or myasthenia gravis experienced an approximate threefold increase in risk of ischemic stroke (odds ratio [OR] = 3.57, OR = 3.22, respectively). Patients with type 1 diabetes and Addison's disease had a threefold increased risk of renal failure. Conclusions: Patients with type 1 diabetes, particularly women, frequently have coexisting autoimmune diseases that are associated with higher rates of renal failure, ischemic stroke, and myocardial infarction. Additional study is warranted, as are preventive efforts in this high-risk population.


Assuntos
Doenças Autoimunes/epidemiologia , Diabetes Mellitus Tipo 1/epidemiologia , Infarto do Miocárdio/epidemiologia , Insuficiência Renal/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Multimorbidade , Prevalência , Fatores de Risco , Caracteres Sexuais , Estados Unidos , Adulto Jovem
17.
Rev Assoc Med Bras (1992) ; 66(1): 55-60, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32130382

RESUMO

OBJECTIVE: It has been observed that celiac disease (CD) is not restricted to a single type characterized by diarrhea but also has atypical, asymptomatic (silent), and latent forms. The prevalence of this autoimmune disease, which affects approximately 1% of the world, is estimated to be around 3%, including atypical and asymptomatic cases. In our study, we aimed to evaluate adult celiac patients. METHODS: Between December 2008-2015, patients diagnosed with CD over the age of 18 years old were included in the study. Patients' symptoms at admission, frequency and type of anemia, transaminase levels, and celiac antibody positivity, and autoimmune diseases diagnosed at follow up were evaluated retrospectively. RESULTS: Of 195 patients, 151 (77.4%) were female. The mean age of the patients was 35.73 ± 12.19 years (range, 18-71 years). A hundred patients (51.3%) had gastrointestinal symptoms. At the time of admission, 118 patients (60.5%) had anemia, and 52 (26.7%) had hypertransaminasemia. During the mean follow-up period of 58 months (36-120 months), 84 (43.1%) of the patients presented at least one autoimmune disease, and this rate was 96.6% in individuals diagnosed above the age of 50 years. CONCLUSION: In adult CD, resistant anemia, dyspepsia, and hypertransaminasemia are very common findings at the time of diagnosis, and the association with other autoimmune diseases, especially Hashimoto's thyroiditis, is high.


Assuntos
Anemia/epidemiologia , Doenças Autoimunes/epidemiologia , Doença Celíaca/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Anemia/complicações , Doenças Autoimunes/complicações , Doença Celíaca/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Estatísticas não Paramétricas , Centros de Atenção Terciária/estatística & dados numéricos , Doenças da Glândula Tireoide/complicações , Doenças da Glândula Tireoide/epidemiologia , Transaminases/sangue , Turquia/epidemiologia , Adulto Jovem
18.
Niger J Clin Pract ; 23(2): 159-164, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32031089

RESUMO

Background: There is an increased risk of long-term dental and periodontal disease in autoimmune bullous diseases (AIBD). Aims: In this cross-sectional study, we aimed to determine whether the oral health-related quality of life status (OHRQoL) was associated with disease severity and activity in patients with AIBD. Subjects and Methods: 67 patients with AIBD were enrolled in this study. Autoimmune Bullous Skin Disorder Intensity Score (ABSIS) was used to evaluate the disease severity. The score was categorized as a significant course (≥17) and moderate course (<17). Oral health impact profile-14 (OHIP-14) questionnaire was filled to assess the OHRQoL. Self-reported oral health status and oral lesion related pain score were also evaluated in the study group. Results: OHIP-14 score was significantly higher in active patients (42.28 ± 13.66) than inactive patients (29.08 ± 12.25) (P = 0.004) and it was correlated with the pain score (6.33 ± 2.78; r = 0.409, P = 0.013). Furthermore, OHIP-14 score was higher in patients with a significant disease course (45.18 ± 15.08) (P = 0.010) than in patients with a moderate course (36.09 ± 9.73). Conclusions: OHRQoL may be useful in the disease management and treatment. Since it can be affected by both presence of oral erosions and disease severity, a collaboration between dermatologists and dentists could be crucial to the disease management in AIBD.


Assuntos
Doenças Autoimunes/psicologia , Saúde Bucal , Higiene Bucal , Qualidade de Vida , Dermatopatias Vesiculobolhosas/psicologia , Adulto , Doenças Autoimunes/epidemiologia , Doenças Autoimunes/imunologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Periodontais/epidemiologia , Autorrelato , Índice de Gravidade de Doença , Dermatopatias Vesiculobolhosas/epidemiologia , Dermatopatias Vesiculobolhosas/imunologia , Inquéritos e Questionários , Turquia/epidemiologia
19.
Medicina (B Aires) ; 80(1): 10-16, 2020.
Artigo em Espanhol | MEDLINE | ID: mdl-32044736

RESUMO

Myasthenia gravis (MG) is an antibody-mediated autoimmune disease of the neuromuscular junction. The aim of this study was to evaluate clinical, epidemiological and serological features of patients with MG in a Public Hospital of Buenos Aires City. A retrospective analysis of 190 patients diagnosed with MG was performed. The mean age of MG onset was 38 years, 30% had late-onset MG (onset age > 50 years). The female/male ratio was 1.7 / 1. Disease started earlier in women than in men, mean 32 vs. 48 years (p < 0.0001). Familial autoimmune MG represented 3.2% of the cases. Most of the patients initiated their disease with a pure ocular form (52%). 12.1% (23/190) were considered ocular MG at follow-up. Thymoma-associated MG represented 11.6% of cases. 27.1% had other associated autoimmune disease, thyroid disorders were the most frequent. 81.4% were anti-acetylcholine receptor antibody (AChR-ab) positive MG; 22.7% of AChR-ab negatives were positive for anti-muscle specific kinase (MusK) antibodies. Clinical outcome was relatively good; more than half of cases were in remission or minimal manifestations at the last visit. The majority of patients required immunosuppression to control the symptoms, 78% received corticosteroids and 48%, a non-steroidal immunosuppressant.


Assuntos
Miastenia Gravis/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idade de Início , Idoso , Idoso de 80 Anos ou mais , Argentina/epidemiologia , Doenças Autoimunes/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Miastenia Gravis/imunologia , Prevalência , Receptores Proteína Tirosina Quinases/imunologia , Receptores Colinérgicos/imunologia , Estudos Retrospectivos , Distribuição por Sexo , Fatores Sexuais , Adulto Jovem
20.
Epidemiol Infect ; 148: e20, 2020 02 05.
Artigo em Inglês | MEDLINE | ID: mdl-32019616

RESUMO

Infectious diseases, such as Helicobacter pylori, which produce systemic inflammation may be one key factor in the onset of autoimmunity. The association between H. pylori and antinuclear antibodies (ANA), a marker of autoimmunity, has been understudied. Data from the 1999-2000 National Health and Nutrition Examination Survey were used to evaluate the cross-sectional association between H. pylori seroprevalence and ANA positivity in US adults aged ≥20 years. ANA was measured in a 1:80 dilution of sera by indirect immunofluorescence using HEp-2 cells (positive ⩾3). H. pylori immunoglobulin G enzyme-linked immunosorbent assays were used to categorise individuals as seropositive or seronegative. H. pylori seropositivity and ANA positivity were common in the adult US population, with estimated prevalences of 33.3% and 9.9%, respectively. Both were associated with increasing age. H. pylori seropositivity was associated with higher odds of ANA (prevalence odds ratio = 1.89, 95% confidence interval = 1.08-3.33), adjusted for age, sex, race/ethnicity, educational attainment and body mass index. H. pylori infection may be one key factor in the loss of self-tolerance, contributing to immune dysfunction.


Assuntos
Anticorpos Antinucleares/sangue , Anticorpos Antibacterianos/sangue , Doenças Autoimunes/epidemiologia , Infecções por Helicobacter/complicações , Infecções por Helicobacter/epidemiologia , Helicobacter pylori/imunologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Imunoglobulina G/sangue , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais , Estudos Soroepidemiológicos , Estados Unidos/epidemiologia , Adulto Jovem
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