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1.
J Autoimmun ; 112: 102502, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32527675

RESUMO

BACKGROUND: Whether patients with autoimmune rheumatic diseases (ARD) have a higher risk for SARS-CoV-2 infection (COVID-19) and how SARS-CoV-2 pandemic impacts on adherence to therapy has not been fully elucidated. We assessed the rate and clinical presentation of COVID-19, and adherence to therapy in a large cohort of patients with ARD followed-up in a tertiary University-Hospital in Northeast Italy. METHODS: Between April 9th and April 25th, 2020, after SARS-CoV-2 infection peak, a telephone survey investigating the impact of COVID-19 on patients with systemic lupus erythematosus (SLE), systemic sclerosis (SSc), rheumatoid arthritis (RA), ANCA-associated vasculitis (AAV), and idiopathic inflammatory myopathies (IIM) was administered. Demographics, disease activity status, therapy, occupational exposure, and adherence to social distancing advise were also collected. RESULTS: 916 patients (397 SLE, 182 AAV, 176 SSc, 111 RA, 50 IIM) completed the survey. 148 patients developed at least one symptom compatible with COVID-19 (cough 96, sore throat 64, fever 64, arthromyalgias 59, diarrhea 26, conjunctivitis 18, ageusia/hyposmia, 18). Among the 916 patients, 65 (7.1%) underwent SARS-CoV-2 nasopharyngeal swab (18 symptomatic and 47 asymptomatic), 2 (0.21%) tested positive, a proportion similar to that observed in the general population of the Veneto region. No deaths occurred. 31 patients (3.4%) withdrew ≥1 medication, mainly immunosuppressants or biologics. Adoption of social distancing was observed by 860 patients (93.9%), including 335 (36.6%) who adopted it before official lockdown. CONCLUSIONS: COVID-19 incidence seems to be similar in our cohort compared to the general population. Adherence to therapy and to social distancing advise was high.


Assuntos
Doenças Autoimunes/tratamento farmacológico , Betacoronavirus , Infecções por Coronavirus/tratamento farmacológico , Imunossupressores/administração & dosagem , Pneumonia Viral/tratamento farmacológico , Doenças Reumáticas/tratamento farmacológico , Adulto , Idoso , Doenças Autoimunes/diagnóstico , Doenças Autoimunes/virologia , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/patologia , Feminino , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/patologia , Doenças Reumáticas/diagnóstico , Doenças Reumáticas/virologia
2.
Joint Bone Spine ; 87(5): 439-443, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32445935

RESUMO

OBJECTIVE: The aim of this study is to determine the prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease 2019 (COVID-19) among adult patients treated with biologic agents or small molecules for chronic inflammatory rheumatic diseases, in particular for chronic inflammatory arthritides. METHODS: To this end, a population-based study, in the province of Udine (466,700 inhabitants, with age>15 years old, Friuli Venezia Giulia region, Italy) was planned. The primary outcome was the prevalence of COVID-19 in the first two months of the outbreak. All the rheumatic patients treated with biologic agents or small molecules in the last 6 months in our province were included (N=1051). RESULTS: From February 29 to April 25, 2020, 4 adult patients (4/1051, i.e. 3.8/1000, 95% Confidence Interval 1.5-9.7/1000) were registered as swab test positive by PCR for COVID-19. Overall, a total of 47/1051 (4.5%) cases were tested for COVID-19 by PCR in the same period, and 15 of them due to symptoms compatible with COVID-19. In the general population, the prevalence was 937 cases/466700 (2/1000, 95% Confidence Interval 1.9-2.1/1000, P-value=0.33, chi square test), and 20,179/466,700 (4.3%) swab tests for COVID-19 were performed. CONCLUSION: The risk of COVID-19 in rheumatic patients under biologic agents or small molecules does not appear different from that observed in the general population. Patients should be informed to safely proceed with their treatment and follow the rules for self-protection to COVID-19.


Assuntos
Antirreumáticos/uso terapêutico , Fatores Biológicos/uso terapêutico , Infecções por Coronavirus/epidemiologia , Surtos de Doenças/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Doenças Reumáticas/tratamento farmacológico , Doenças Reumáticas/epidemiologia , Adulto , Estudos de Coortes , Comorbidade , Intervalos de Confiança , Infecções por Coronavirus/diagnóstico , Feminino , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico , Prevalência , Prognóstico , Estudos Retrospectivos , Doenças Reumáticas/diagnóstico , Medição de Risco , Resultado do Tratamento
3.
Joint Bone Spine ; 87(5): 431-437, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32473418

RESUMO

BACKGROUND: Rheumatologists must contend with COVID-19 pandemic in the management of their patients and many questions have been raised on the use of both anti-inflammatory drugs and disease-modifying anti-rheumatic drugs (DMARD). The French Society of Rheumatology (SFR) selected the most critical ones to the daily practice of a rheumatologist and a group of 10 experts from SFR and Club Rheumatism and Inflammation (CRI) boards proposed responses based on the current knowledge of May 2020. METHODS: Following the availability of the first 18 questions and statements, 1400 individuals consulted the frequently asked questions between the March 31, 2020 and April 12, 2020. As a result, 16 additional questions were forwarded to the SFR, and answered by the board. An additional round of review by email and video conference was organized, which included updates of the previous statements. The scientific relevance of 5 of the questions led to their inclusion in this document. Each response received a final assessment on a scale of 0-10 with 0 meaning no agreement whatsoever and 10 being in complete agreement. The mean values of these votes for each question are presented as the levels of agreement (LoA) at the end of each response. This document was last updated on April 17, 2020. RESULTS: Based on current scientific literature already published, in most circumstances, there is no contraindication to the initiation or continuation of anti-inflammatory drugs as well as DMARDs. If signs suggestive of infection (coronavirus or other) occur, treatments should be discontinued and resumed, if necessary, after 2 weeks without any symptoms. Only, some signals suggest that people taking an immunosuppressive dose of corticosteroid therapy are at greater risk of developing severe COVID-19. Intra-articular injections of glucocorticoids are allowed when there is no reasonable therapeutic alternative, and providing that precautions to protect the patient and the practitioner from viral contamination are adopted, included appropriate information to the patient. CONCLUSIONS: Currently available data on managing patients with rheumatic diseases during the COVID-19 pandemic are reassuring and support continuing or initiating symptomatic as well as specific treatments of these diseases, the main target of their management remaining their appropriate control, even during this pandemic.


Assuntos
Antirreumáticos/uso terapêutico , Infecções por Coronavirus/epidemiologia , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Doenças Reumáticas/tratamento farmacológico , Doenças Reumáticas/epidemiologia , Inquéritos e Questionários , Infecções por Coronavirus/prevenção & controle , Técnica Delfos , Gerenciamento Clínico , Feminino , França/epidemiologia , Humanos , Controle de Infecções/métodos , Masculino , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Prognóstico , Estudos Retrospectivos , Doenças Reumáticas/diagnóstico , Reumatologia , Sociedades Médicas , Resultado do Tratamento
5.
Z Rheumatol ; 79(5): 447-458, 2020 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-32458159

RESUMO

Testing for antinuclear antibodies (ANA) on human epithelial cell lines (HEp-2) using indirect immunofluorescence (IIF) is central for ruling out or for diagnosing connective tissue diseases and other diseases, such as primary biliary cholangitis and autoimmune hepatitis as well as drug-induced ANA. The comprehensive description of 29 different ANA-IIF patterns by the international consensus of ANA patterns (ICAP) facilitates the harmonization of ANA-IIF diagnostics. Positive ANA tests are frequently observed in healthy individuals and a reason for referral to rheumatologists. In these cases, the detection of anti-DFS70 antibodies can be helpful to exclude systemic autoimmune rheumatic diseases.


Assuntos
Anticorpos Antinucleares/sangue , Doenças Reumáticas , Proteínas Adaptadoras de Transdução de Sinal , Doenças Autoimunes , Técnica Indireta de Fluorescência para Anticorpo , Humanos , Doenças Reumáticas/sangue , Doenças Reumáticas/diagnóstico , Fatores de Transcrição
8.
Prog Cardiovasc Dis ; 63(3): 327-340, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32201285

RESUMO

Chronic inflammation represents the cornerstone of the raised cardiovascular (CV) risk in patients with inflammatory rheumatic diseases (IRD). Standardized mortality ratios are increased in these patients compared to the general population, which can be explained by premature mortality associated with early atherosclerotic events. Thus, IRD patients need appropriate CV risk management in view of this CV disease (CVD) burden. Currently, optimal CV risk management is still lacking in usual care, and early diagnosis of silent and subclinical CVD involvement is mandatory to improve the long-term prognosis of those patients. Although CV involvement in such patients is highly heterogeneous and may affect various structures of the heart, it can now be diagnosed earlier and promptly treated. CV imaging provides valuable information as a reliable diagnostic tool. Currently, different techniques are employed to evaluate CV risk, including transthoracic or trans-esophageal echocardiography, magnetic resonance imaging, or computed tomography, to investigate valve abnormalities, pericardial disease, and ventricular wall motion defects. All the above methods are reliable in investigating CV involvement, but more recently, Speckle Tracking Echocardiography (STE) has been suggested to be diagnostically more accurate. In recent years, the role of left ventricular ejection fraction (LVEF) as the gold standard parameter for the evaluation of systolic function has been debated, and many efforts have been focused on the clinical validation of new non-invasive tools for the study of myocardial contractility as well as to characterize the subclinical alterations of the myocardial function. Improvement in the accuracy of STE has resulted in a large amount of research showing the ability of STE to overcome LVEF limitations in the majority of primary and secondary heart diseases. This review summarizes the additional value that STE measurement can provide in the setting of IRD, with a focus in the different clinical stages.


Assuntos
Doenças Cardiovasculares/diagnóstico por imagem , Ecocardiografia , Doenças Reumáticas/complicações , Doenças Cardiovasculares/imunologia , Doenças Cardiovasculares/terapia , Diagnóstico Precoce , Humanos , Valor Preditivo dos Testes , Prognóstico , Doenças Reumáticas/diagnóstico , Doenças Reumáticas/imunologia , Doenças Reumáticas/terapia , Fatores de Risco
9.
Ann Rheum Dis ; 79(7): 908-913, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32213497

RESUMO

OBJECTIVE: To assess Doppler ultrasound (US) and tenosynovial fluid (TSF) characteristics in tenosynovitis within common rheumatic conditions, as well as their diagnostic utility. METHODS: Subjects with tenosynovitis underwent Doppler US and US-guided TSF aspiration for white cell count (WCC) and crystal analysis. Tenosynovial Doppler scores (DS) were semiquantitatively graded. TSF WCC and DS were compared using Kruskal-Wallis tests and logistic regression between non-inflammatory conditions (NIC), inflammatory conditions (IC) and crystal-related conditions (CRC). Receiver operating curves, sensitivity and specificity assessed the ability of WCC and DS to discriminate IC from NIC. RESULTS: We analysed 100 subjects from 14 sites. The mean age was 62 years, 65% were female, and the mean TSF volume was 1.2 mL. Doppler signal was present in 93.7% of the IC group and was more frequent in IC than in NIC group (OR 6.82, 95% CI 1.41 to 32.97). The TSF median WCC per 109/L was significantly higher in the IC (2.58, p<0.001) and CRC (1.07, p<0.01) groups versus the NIC group (0.38). A TSF cut-off of ≥0.67 WCC per 109/L optimally discriminated IC versus NIC with a sensitivity and specificity each of 81.3%. In the IC group, 20 of 48 (41.7%) subjects had a TSF WCC <2.00 per 109/L. CONCLUSIONS: A negative DS helps rule out IC in tenosynovitis, but a positive DS is non-specific and merits TSF testing. Unlike synovial fluid, a lower TSF WCC better discriminates IC from NIC. US guidance facilitates aspiration of minute TSF volume, which is critical for diagnosing tenosynovial CRC.


Assuntos
Doenças Reumáticas/diagnóstico , Líquido Sinovial/química , Tenossinovite/diagnóstico por imagem , Tenossinovite/metabolismo , Ultrassonografia Doppler/estatística & dados numéricos , Idoso , Diagnóstico Diferencial , Feminino , Humanos , Contagem de Leucócitos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Curva ROC , Doenças Reumáticas/etiologia , Sensibilidade e Especificidade , Tenossinovite/complicações
10.
Nat Rev Rheumatol ; 16(2): 87-99, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31892734

RESUMO

The cellular complexity and functional diversity of the human immune system necessitate the use of high-dimensional single-cell tools to uncover its role in multifaceted diseases such as rheumatic diseases, as well as other autoimmune and inflammatory disorders. Proteomic technologies that use elemental (heavy metal) reporter ions, such as mass cytometry (also known as CyTOF) and analogous high-dimensional imaging approaches (including multiplexed ion beam imaging (MIBI) and imaging mass cytometry (IMC)), have been developed from their low-dimensional counterparts, flow cytometry and immunohistochemistry, to meet this need. A growing number of studies have been published that use these technologies to identify functional biomarkers and therapeutic targets in rheumatic diseases, but the full potential of their application to rheumatic disease research has yet to be fulfilled. This Review introduces the underlying technologies for high-dimensional immune monitoring and discusses aspects necessary for their successful implementation, including study design principles, analytical tools and future developments for the field of rheumatology.


Assuntos
Diagnóstico por Imagem/métodos , Citometria de Fluxo/métodos , Monitorização Imunológica/métodos , Proteômica/métodos , Doenças Reumáticas/imunologia , Reumatologia/métodos , Biomarcadores/metabolismo , Humanos , Doenças Reumáticas/diagnóstico , Doenças Reumáticas/metabolismo
11.
Arthritis Care Res (Hoboken) ; 72(2): 243-255, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31421021

RESUMO

OBJECTIVE: To conduct a systematic review to describe how administrative health databases have been used to study depression and anxiety in patients with rheumatic diseases and to synthesize the case definitions that have been applied. METHODS: Search strategies to identify articles evaluating depression and anxiety among individuals with rheumatic diseases were employed in Medline, Embase, CINAHL, Cochrane Database of Systematic Reviews, and PsycINFO. Studies included were those using administrative health data and reporting case definitions for depression and anxiety using International Classification of Diseases (ICD) codes. We extracted information on study design and objectives, administrative health database, specific data sources (e.g., inpatient, pharmacy records), ICD codes, operational definitions, and validity of case definitions. RESULTS: Of the 36 studies included in this review, all studies assessed depression, and 13 studies (36.1%) evaluated anxiety. A number of specific ICD-9/10 codes were consistently applied to identify depression and anxiety, but the overall combination of ICD codes and operational definitions varied across studies. Twenty-four studies reported operational definitions, and 19 of these studies (79.2%) combined claims from more than 1 type of administrative data source (e.g., inpatient, outpatient). Validated case definitions were used by 6 studies (16.7%), with sensitivity estimates for depression and anxiety case definitions ranging from 33% to 74% and 42% to 76%, respectively. CONCLUSION: We identified numerous case definitions used to evaluate depression and anxiety among individuals with rheumatic diseases within administrative health databases. Recommendations include using case definitions with demonstrated validity as well as operationalizing case definitions within multiple data sources.


Assuntos
Ansiedade/diagnóstico , Bases de Dados Factuais , Depressão/diagnóstico , Doenças Reumáticas/diagnóstico , Ansiedade/epidemiologia , Ansiedade/psicologia , Estudos de Coortes , Bases de Dados Factuais/tendências , Depressão/epidemiologia , Depressão/psicologia , Humanos , Classificação Internacional de Doenças/tendências , Doenças Reumáticas/epidemiologia , Doenças Reumáticas/psicologia
13.
Z Rheumatol ; 79(1): 55-73, 2020 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-31828424

RESUMO

Inflammatory rheumatic diseases preferentially affect women of childbearing age. Immunological alterations can have positive or negative effects on the maternal disease. Most of these women can have a successful pregnancy with careful medical and obstetric care. Nevertheless, complications are more frequent than in healthy women. Pregnancies should therefore be planned during inactive phases of the disease and patients should be educated in advance about possible maternal and child risks and about treatment options compatible with pregnancy. In pregnancy, individualized and interdisciplinary care can promote a stable course of the disease and reduce the risks for mother and child. Especially with respect to a compatible treatment, detailed information for the patients is necessary for a shared decision making.


Assuntos
Complicações na Gravidez , Doenças Reumáticas , Criança , Feminino , Humanos , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/tratamento farmacológico , Doenças Reumáticas/complicações , Doenças Reumáticas/diagnóstico , Doenças Reumáticas/tratamento farmacológico
14.
Yonsei Med J ; 61(1): 73-78, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31887802

RESUMO

PURPOSE: Testing for autoantibodies to extractable nuclear antigens (ENAs) plays an important role in the diagnosis and management of systemic rheumatic disease. Currently, no gold standard tests are available for detecting anti-ENAs. To address this gap, we aimed to identify an assay that exhibits satisfactory diagnostic performance in the detection of five common anti-ENAs by comparing two commonly used assays, an automated fluorescent enzyme immunoassay (FEIA) and a microplate ELISA assay. MATERIALS AND METHODS: Sera from 100 patients with systemic rheumatic disease were collected and assayed with FEIA and microplate ELISA to detect anti-ENAs. Statistical analyses were performed to check the agreement rate between the two platforms using kappa coefficients. Analytical sensitivity and specificity for each assay were calculated. RESULTS: The concordance rates between ELISA and FEIA ranged from 89% for anti-RNP to 97% for anti-Scl-70, and the kappa coefficients of the two assays were in the range of 0.44 to 0.82. Between the two assays, a significant difference in sensitivity and specificity was seen only for anti-Sm and anti-RNP, respectively. CONCLUSION: In this study, FEIA and ELISA showed comparable efficiency for detecting anti-ENAs.


Assuntos
Antígenos Nucleares/metabolismo , Imunoensaio/métodos , Doenças Reumáticas/imunologia , Adulto , Anticorpos Antinucleares/sangue , Anticorpos Antinucleares/metabolismo , Antígenos Nucleares/sangue , Ensaio de Imunoadsorção Enzimática , Feminino , Fluorescência , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Reumáticas/sangue , Doenças Reumáticas/diagnóstico , Sensibilidade e Especificidade
15.
Best Pract Res Clin Rheumatol ; 33(4): 101429, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31810541

RESUMO

Digital health or eHealth technologies, notably pervasive computing, robotics, big-data, wearable devices, machine learning, and artificial intelligence (AI), have opened unprecedented opportunities as to how the diseases are diagnosed and managed with active patient engagement. Patient-related data have provided insights (real world data) into understanding the disease processes. Advanced analytics have refined these insights further to draw dynamic algorithms aiding clinicians in making more accurate diagnosis with the help of machine learning. AI is another tool, which, although is still in the evolution stage, has the potential to help identify early signs even before the clinical features are apparent. The evolving digital developments pose challenges on allowing access to health-related data for further research but, at the same time, protecting each patient's privacy. This review focuses on the recent technological advances and their applications and highlights the immense potential to enable early diagnosis of rheumatological diseases.


Assuntos
Inteligência Artificial , Aprendizado de Máquina , Doenças Reumáticas , Telemedicina , Assistência à Saúde , Diagnóstico Precoce , Humanos , Doenças Reumáticas/diagnóstico , Doenças Reumáticas/terapia
16.
Best Pract Res Clin Rheumatol ; 33(4): 101426, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31810543

RESUMO

A significant proportion of patients with pyrexia of unknown origin (PUO) are found to have a rheumatological cause. The mainstay of treatment for rheumatic disease is immunosuppression, and therefore, accurate diagnosis is crucial given the risks associated with these drugs. In this review, we analyse the rheumatological conditions that most commonly present with fever and illustrate clinical cases demonstrating some of the challenges in the workup of these patients. With this in mind, we propose an evidence-based algorithm for investigating PUO from a rheumatological perspective, with the aim that it will aid clinicians when approaching these clinical scenarios.


Assuntos
Febre de Causa Desconhecida , Doenças Reumáticas , Adulto , Febre de Causa Desconhecida/etiologia , Humanos , Doenças Reumáticas/complicações , Doenças Reumáticas/diagnóstico
17.
Best Pract Res Clin Rheumatol ; 33(4): 101425, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31810545

RESUMO

Cytopenias may herald or concur with the onset of various systemic rheumatic diseases. Accordingly, patients with reduced blood cell counts are often referred for possible underlying autoimmune disease. Initial evaluation aims to exclude nonrheumatic causes such as drug toxicity, infections, or hematological/myelopoiesis disorders. Patient interview and physical examination are critical to unravel features related to or suggestive of rheumatic disease. Based on the clinical scenario, targeted immunological testing may provide additional diagnostic insights. Yet, not all patients may present with full-fledged, criteria-classified disease at early stages. Accordingly, physicians should have a high index of suspicion for individuals who present with a combination of immune/inflammatory cytopenia(s) and relevant clinical (e.g., synovitis) and/or serological manifestations, even if these are few in number or nonspecific (e.g., ANA). Ongoing studies in preclinical or early autoimmunity cohorts could lead to the discovery of diagnostic biomarkers applicable also to patients with cytopenias and suspected rheumatic disease.


Assuntos
Doenças Autoimunes , Leucopenia , Doenças Reumáticas , Doenças Autoimunes/complicações , Doenças Autoimunes/diagnóstico , Autoimunidade , Diagnóstico Diferencial , Humanos , Leucopenia/complicações , Doenças Reumáticas/complicações , Doenças Reumáticas/diagnóstico
18.
Best Pract Res Clin Rheumatol ; 33(4): 101437, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31810549

RESUMO

Muscular symptoms, which may be due to multiple causes, are one of the most common early complaints in a rheumatology practice. Musculoskeletal symptoms in rheumatic conditions are very varied, ranging from mechanical problems to muscular symptoms derived from inflammatory and systemic autoimmune diseases. Several drugs commonly used by different specialists and certain drugs used in rheumatology can also cause a wide variety of muscle symptoms. A description of different systemic autoimmune diseases follows to describe the different forms of involvement of the musculoskeletal system that they cause, as well as the main causes with which a differential diagnosis should be made. In this chapter, we will try to give some clues to reach an early diagnosis using clinical criteria, particularly based on a directed anamnesis and physical examination, discussing possible guidelines for the complimentary tests that may be required in patients with muscle complaints.


Assuntos
Doenças Musculares , Doenças Reumáticas , Diagnóstico Diferencial , Humanos , Doenças Musculares/etiologia , Doenças Reumáticas/complicações , Doenças Reumáticas/diagnóstico
19.
Rheumatology (Oxford) ; 58(Suppl 7): vii29-vii39, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-31816079

RESUMO

Immune checkpoint inhibitors (CPIs) are an effective treatment for many cancers but cause diverse immune-related adverse events (IrAEs). Rheumatological IrAEs include arthralgia, arthritis, tenosynovitis, myositis, polymyalgia rheumatica and sicca syndrome. CPI use can unmask RA as well as causing flares of prior autoimmune or connective tissue disease. Oncologists categorize and grade IrAEs using the Common Terminology Criteria for Adverse Events and manage them according to international guidelines. However, rheumatological events are unfamiliar territory: oncologists need to work with rheumatologists to elicit and assess symptoms, signs, results of imaging and autoantibody testing and to determine the use of steroids and DMARDs. Myositis may overlap with myasthenic crisis and myocarditis and can be life-threatening. Treatment should be offered on balance of risk and benefit, including whether to continue CPI treatment and recognizing the uncertainty over whether glucocorticoids and DMARDs might compromise cancer control.


Assuntos
Antineoplásicos Imunológicos/efeitos adversos , Fatores Imunológicos/efeitos adversos , Imunoterapia/efeitos adversos , Neoplasias/tratamento farmacológico , Doenças Reumáticas/induzido quimicamente , Antirreumáticos/uso terapêutico , Doenças Autoimunes/induzido quimicamente , Glucocorticoides/uso terapêutico , Humanos , Imunossupressores/efeitos adversos , Imunoterapia/métodos , Doenças Reumáticas/diagnóstico , Doenças Reumáticas/tratamento farmacológico
20.
Rheumatology (Oxford) ; 58(Suppl 7): vii68-vii74, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-31816082

RESUMO

Compared with conventional cancer therapies, the spectrum of toxicities observed with checkpoint inhibitors is unique and can affect any organ system. Arthralgia and myalgia were by far the most commonly reported rheumatic immune-related adverse events in clinical trials, and there is now a growing number of case series and reports describing clinical features of de novo rheumatic immune-related adverse events, which will be the focus of this review. Some patients develop genuine classic rheumatic and musculoskeletal diseases, but a number of rheumatic immune-related adverse events mimic rheumatic and musculoskeletal diseases with atypical features, mainly polymyalgia rheumatica, rheumatoid arthritis and myositis, as well as several systemic conditions, including sicca syndrome, vasculitis, sarcoidosis, systemic sclerosis and lupus.


Assuntos
Antineoplásicos Imunológicos/efeitos adversos , Imunoterapia/efeitos adversos , Neoplasias/tratamento farmacológico , Doenças Reumáticas/induzido quimicamente , Antineoplásicos Imunológicos/uso terapêutico , Artrite Reumatoide/induzido quimicamente , Artrite Reumatoide/diagnóstico , Diagnóstico Diferencial , Humanos , Fatores Imunológicos/efeitos adversos , Fatores Imunológicos/uso terapêutico , Imunoterapia/métodos , Miosite/induzido quimicamente , Miosite/diagnóstico , Metástase Neoplásica , Polimialgia Reumática/induzido quimicamente , Polimialgia Reumática/diagnóstico , Doenças Reumáticas/diagnóstico , Síndrome de Sjogren/induzido quimicamente , Síndrome de Sjogren/diagnóstico , Vasculite/induzido quimicamente , Vasculite/diagnóstico
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