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1.
Rev Assoc Med Bras (1992) ; 65(6): 767-770, 2019 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-31340300

RESUMO

Leprosy is a chronic infectious disease caused by Mycobacterium leprae, which affects mainly the skin and peripherical nerves. Brasil has not yet achieved its goal of elimination of the number of cases of this disease, ranking second in terms of absolute numbers worldwide, with India occupying the first position. Primary Neural Leprosy is considered to be a challenge in diagnosis, since it affects the peripherical nerve system with the absence of skin lesions, thus mimicking rheumatological disorders, like in the case presented. A male, 31, with no previous comorbidities, five years ago, started feeling severe pain in the left ankle as well as morning hand pain and stiffness. After many years of being submitted to intense rheumatological disease investigation, they all proved to be negative. Upon physical examination, the patient presented no skin lesions, symmetric polyarthritis in metacarpophalangeal joints and thickness of the left sural nerve. Lab exams showed no alterations and bacilloscopy was negative. Ultrasonography was used to investigate the thickness of the left sural nerve. Biopsy showed a minimal amount of perineural lymphocytes and positive AFB testing. Based on the electroneuromyography, the conclusion was multiple mononeuropathy, and multibacillary polychemotherapy was started. Leprosy remains a public health problem in Brasil. Due to the high prevalence of the disease, our medical colleagues must be alert and trained to recognize this clinical presentation of leprosy. Correct referral to Reference Centers accelerates research, contributing to an accurate diagnosis, classification, and treatment, thus preventing irreversible sequelae with severe functional disability.


Assuntos
Hanseníase Tuberculoide/diagnóstico por imagem , Doenças Reumáticas/diagnóstico por imagem , Adulto , Biópsia , Eletromiografia , Humanos , Hanseníase Tuberculoide/patologia , Masculino , Doenças Reumáticas/patologia , Pele/patologia , Ultrassonografia
2.
Int J Mol Sci ; 20(7)2019 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-30978945

RESUMO

The unfolded protein response (UPR) is a highly conserved pathway that allows cells to respond to stress in the endoplasmic reticulum caused by an accumulation of misfolded and unfolded protein. This is of great importance to secretory cells because, in order for proteins to traffic from the endoplasmic reticulum (ER), they need to be folded appropriately. While a wealth of literature has implicated UPR in immune responses, less attention has been given to the role of UPR in T cell development and function. This review discusses the importance of UPR in T cell development, homeostasis, activation, and effector functions. We also speculate about how UPR may be manipulated in T cells to ameliorate pathologies.


Assuntos
Ativação Linfocitária , Linfócitos T/imunologia , Resposta a Proteínas não Dobradas , Animais , Asma/imunologia , Asma/patologia , Estresse do Retículo Endoplasmático , Humanos , Neoplasias/imunologia , Neoplasias/patologia , Doenças Reumáticas/imunologia , Doenças Reumáticas/patologia , Linfócitos T/citologia , Linfócitos T/patologia
3.
Radiol Med ; 124(11): 1167-1174, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30840189

RESUMO

Although the diagnosis of arthritis and spondyloarthritis is based on clinical criteria, today the imaging methods are an indispensable aid to the rheumatologist. Imaging has not only the task of helping early diagnosis, but it has also a fundamental role in disease grading and therapeutic monitoring. In this scenario where many publications emphasize the importance of identifying synovitis and erosions at an early stage, it is essential to know the possible pitfalls which can determine both false positives and false negatives. The high variability of the musculoskeletal system anatomy makes it necessary to have a correct knowledge of all anatomical complexes, in order not to confuse them with the pathology. Moreover, the correct and standardized method of the execution and interpretation of the exams, such as ultrasound, is crucial to identifying and correctly monitoring the pathological hallmarks of the arthritis. This paper aims to provide an instrument to radiologists, highlighting the main imaging pitfalls in ultrasound and magnetic resonance which may be encountered in daily practice.


Assuntos
Imagem por Ressonância Magnética/métodos , Doenças Reumáticas/diagnóstico por imagem , Ultrassonografia/métodos , Diagnóstico Diferencial , Diagnóstico Precoce , Humanos , Doenças Reumáticas/patologia
4.
Autoimmun Rev ; 18(4): 369-381, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30772494

RESUMO

Overt polyautoimmunity (PolyA) corresponds to the presence of more than one well-defined autoimmune disease (AD) manifested clinically in a single patient. The current study aimed to describe the main characteristics of juvenile PolyA in a pediatric rheumatology setting and analyze the chronological aspects, index cases, familial autoimmunity, and clustering pattern. This was a cross-sectional and multicenter study in which 313 children with overt PolyA were included. Patients were systematically interviewed and their medical records reviewed using a questionnaire that sought information about demographic, clinical, immunological, and familial characteristics. A hierarchical cluster analysis was done to determine similarities between autoimmune diseases based on PolyA. PolyA occurred simultaneously in 138 (44%) patients. Multiple autoimmune syndrome was observed in 62 (19.8%) patients. There were 25 index diseases of which, systemic lupus erythematosus (SLE, n = 134, 42.8%), juvenile idiopathic arthritis (JIA, n = 40, 12.7%), Hashimoto's thyroiditis (HT, n = 24, 7.66%), immune thrombocytopenic purpura (ITP n = 20, 6.39%), antiphospholipid syndrome (APS, n = 15, 4.79%), and vitiligo (VIT, n = 15, 4.79%) were the most frequent and represented 79.23% of the total number of patients. Familial autoimmunity influenced PolyA. A high aggregation of autoimmunity was observed (λr = 3.5). Three main clusters were identified, of which SLE and APS were the most similar pair of diseases (based on the Jaccard index) followed by HT and JIA, which were related to ITP and Sjögren's syndrome. The third cluster was composed of localized scleroderma and VIT. Our findings may assist physicians to make an early diagnosis of this frequent condition. Pediatric patients with ADs should be systematically assessed for PolyA.


Assuntos
Doenças Autoimunes , Doenças Reumáticas , Adolescente , Idade de Início , Doenças Autoimunes/classificação , Doenças Autoimunes/epidemiologia , Doenças Autoimunes/patologia , Doenças Autoimunes/terapia , Autoimunidade/imunologia , Criança , Análise por Conglomerados , Estudos Transversais , Feminino , Humanos , Masculino , Estudos Retrospectivos , Doenças Reumáticas/classificação , Doenças Reumáticas/epidemiologia , Doenças Reumáticas/patologia , Doenças Reumáticas/terapia , Reumatologia/métodos , Inquéritos e Questionários
5.
Ann Lab Med ; 39(4): 345-357, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30809980

RESUMO

The platelet-to-lymphocyte ratio (PLR) has emerged as an informative marker revealing shifts in platelet and lymphocyte counts due to acute inflammatory and prothrombotic states. PLR has been extensively examined in neoplastic diseases accompanied by immune suppression and thrombosis, which can be predicted by combined blood cell counts and their ratios. Several large observational studies have demonstrated the value of shifts in PLR in evaluating the severity of systemic inflammation and predicting infections and other comorbidities, in inflammatory rheumatic diseases. The value of PLR as an inflammatory marker increases when its fluctuations are interpreted along with other complementary hematologic indices, particularly the neutrophil-to-lymphocyte ratio (NLR), which provides additional information about the disease activity, presence of neutrophilic inflammation, infectious complications, and severe organ damage in systemic lupus erythematosus. PLR and NLR have high predictive value in rheumatic diseases with predominantly neutrophilic inflammation (e.g., Behçet disease and familial Mediterranean fever). High PLR, along with elevated platelet count, is potentially useful in diagnosing some systemic vasculitides, particularly giant-cell arteritis. A few longitudinal studies on rheumatic diseases have demonstrated a decrease in PLR in response to anti-inflammatory therapies. The main limitations of PLR studies are preanalytical faults, inadequate standardization of laboratory measurements, and inappropriate subject selection. Nonetheless, accumulating evidence suggests that PLR can provide valuable information to clinicians who encounter multisystem manifestations of rheumatic diseases, which are reflected in shifts in platelet, lymphocyte, neutrophil, or monocyte counts. Interpretation of PLR combined with complementary hematologic indices is advisable to more accurately diagnose inflammatory rheumatic diseases and predict related comorbidities.


Assuntos
Plaquetas/citologia , Linfócitos/citologia , Doenças Reumáticas/patologia , Anti-Inflamatórios/uso terapêutico , Biomarcadores/metabolismo , Arterite de Células Gigantes/imunologia , Arterite de Células Gigantes/patologia , Humanos , Linfócitos/imunologia , Neoplasias/imunologia , Neoplasias/patologia , Doenças Reumáticas/tratamento farmacológico , Doenças Reumáticas/imunologia
6.
Autoimmun Rev ; 18(2): 203-208, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30572130

RESUMO

INTRODUCTION: The upcoming of biosimilars in rheumatic diseases have generated considerable interest throughout the past five years among pharmaceutical industries and regulatory agencies, their development is associated with considerable variation and heterogeneity on the variable requirements for license and marketing throughout the various continents. AIM: In this article we reviewed the contents of the conference presented on the last XI International Conference in Autoimmunity in Lisbon. EVIDENCE: Truly biosimilars that followed requirements from stringent agencies are now available and licensed for infliximab, etanercept, adalimumab and rituximab but several compounds from the same mechanism of action are also being developed and are reviewed and the strengths of their evidence analized and discussed. The use of intended copies (biomimics) and its presence in less regulated markets are also reviewed and the risks of their use without proper monitoring is also evaluated. PLACE IN THERAPY: Biosimilars for rheumatic diseases is expected to change the access of patients to high costs biologics and gradually more and more patients are being switched to biosimilars either by the rheumatologist prescription or mandatory national indications. The economic impact is expected to be huge in the coming years. Second generation biosimilars are also being developed and clinical trials are underway for license in the near future.


Assuntos
Medicamentos Biossimilares/uso terapêutico , Doenças Reumáticas/tratamento farmacológico , Reumatologia/métodos , Medicamentos Biossimilares/farmacologia , Humanos , Doenças Reumáticas/patologia
7.
Autoimmun Rev ; 18(2): 164-176, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30572134

RESUMO

Pregnancy requires a special management in women with inflammatory rheumatic diseases (RDs), with the aim of controlling maternal disease activity and avoiding fetal complications. Despite the heterogeneous course of RDs during pregnancy, their impact on pregnancy largely relates to the extent of active inflammation at the time of conception. Therefore, accurate evaluation of disease activity is crucial for the best management of pregnant patients. Nevertheless, there are limitations in using conventional measures of disease activity in pregnancy, as some items included in these instruments can be biased by symptoms or by physiological changes related to pregnancy and the pregnancy itself may influence laboratory parameters used to assess disease activity. This article aims to summarize the current literature about the available instruments to measure disease activity during pregnancy in RDs. Systemic lupus erythematosus is the only disease with instruments that have been modified to account for several adaptations which might interfere with the attribution of signs or symptoms to disease activity during pregnancy. No modified-pregnancy indices exist for women affected by other RDs, but standard indices have been applied to pregnant patients. The current body of knowledge shows that the physiologic changes that occur during pregnancy need to be either adapted from existing instruments or developed to improve the management of pregnant women with RDs. Standardized instruments to assess disease activity during pregnancy would be helpful not only for clinical practice but also for research purposes.


Assuntos
Complicações na Gravidez/fisiopatologia , Doenças Reumáticas/fisiopatologia , Feminino , Humanos , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/patologia , Doenças Reumáticas/patologia
8.
Mol Immunol ; 106: 12-21, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30576947

RESUMO

Chemerin receptor (CMKLR1) is a G protein-coupled receptor (GPCR) implicated in macrophage-mediated inflammation and in several forms of human arthritis. Analogous to other GPCR, CMKLR1 is likely regulated by G protein-coupled receptor kinase (GRK) phosphorylation of intracellular domains in an activation-dependent manner, which leads to recruitment and termination of intracellular signaling via desensitization and internalization of the receptor. The ubiquitously expressed GRK family members include GRK2, GRK3, GRK5, and GRK6, but it is unknown which GRK regulates CMKLR1 cellular and signaling functions. Our data show that activation of CMKLR1 by chemerin in primary macrophages leads to signaling and functional outcomes that are regulated by GRK6 and ß-arrestin 2. We show that arrestin recruitment to CMKLR1 following chemerin stimulation is enhanced with co-expression of GRK6. Further, internalization of endogenous CMKLR1, following the addition of chemerin, is decreased in inflammatory macrophages from GRK6- and ß-arrestin 2-deficient mice. These GRK6- and ß-arrestin 2-deficient macrophages display increased migration toward chemerin and altered AKT and Extracellular-signal Related Kinase (ERK) signaling. Our findings show that chemerin-activated CMKLR1 regulation in inflammatory macrophages is largely GRK6 and ß-arrestin mediated, which may impact innate immunity and have therapeutic implications in rheumatic disease.


Assuntos
Quimiocinas/imunologia , Quinases de Receptores Acoplados a Proteína G/imunologia , Imunidade Inata , Peptídeos e Proteínas de Sinalização Intercelular/imunologia , Macrófagos/imunologia , Receptores Acoplados a Proteínas-G/imunologia , beta-Arrestina 2/imunologia , Animais , Linhagem Celular , Quimiocinas/genética , Quinases de Receptores Acoplados a Proteína G/genética , Humanos , Inflamação/genética , Inflamação/imunologia , Inflamação/patologia , Peptídeos e Proteínas de Sinalização Intercelular/genética , Macrófagos/patologia , Camundongos , Camundongos Knockout , Receptores Acoplados a Proteínas-G/genética , Doenças Reumáticas/genética , Doenças Reumáticas/imunologia , Doenças Reumáticas/patologia , beta-Arrestina 2/genética
9.
Biomed Res Int ; 2018: 6930297, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29854780

RESUMO

Lung illness encountered in patients with rheumatic diseases bears clinical significance in terms of increased morbidity and mortality as well as potential challenges placed on patient care. Although our understanding of natural history of this important illness is still limited, epidemiologic knowledge has been accumulated during the past decade to provide useful information on the risk factors and prognosis of lung involvements in rheumatic diseases. Moreover, the pathogenesis particularly in the context of genetics has been greatly updated for both the underlying rheumatic disease and associated lung involvement. This review will focus on the current update on the epidemiologic and genetics features and treatment options of the lung involvements associated with four major rheumatic diseases (rheumatoid arthritis, systemic sclerosis, myositis, and systemic lupus erythematosus), with more attention to a specific form of involvement or interstitial lung disease.


Assuntos
Pneumopatias/epidemiologia , Pneumopatias/patologia , Pulmão/patologia , Doenças Reumáticas/epidemiologia , Doenças Reumáticas/patologia , Humanos , Pneumopatias/genética , Prognóstico , Doenças Reumáticas/genética , Fatores de Risco
10.
Vascul Pharmacol ; 108: 8-14, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29842927

RESUMO

Rheumatic diseases are associated with accelerated atherosclerosis and with increased risk of cardiovascular morbidity and mortality. The mechanisms underlying the higher prevalence of cardiovascular disease are not completely clarified, but it is likely that a pivotal role is played by vascular inflammation and consequently to altered vascular endothelium homeostasis. Also, high prevalence of traditional risk factors, proatherogenic activation and endothelial dysfunction further contribute to vascular damage. Circulating endothelial progenitor cells (EPCs) can restore dysfunctional endothelium and protect against atherosclerotic vascular disease. However, abnormalities in number and function of these cells in patients with rheumatic condition have been extensively reported. During the last years, growing interest in the mechanisms of endothelial renewal and its potential as a therapy for CVD has been shown; in addition, pioneering studies show that EPC dysfunction might be improved with pharmacological strategies. However, how to restore EPC function, and whether achieving this aim may be effective in preventing cardiovascular complications in rheumatic disease, remain to be established. In this review we report an overview on the current stand of knowledge on the effect of pharmaceutical and lifestyle intervention in improving EPCs number and function in rheumatic disease.


Assuntos
Antirreumáticos/uso terapêutico , Doenças Cardiovasculares/prevenção & controle , Células Progenitoras Endoteliais/efeitos dos fármacos , Doenças Reumáticas/tratamento farmacológico , Animais , Antirreumáticos/efeitos adversos , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/metabolismo , Doenças Cardiovasculares/patologia , Proliferação de Células/efeitos dos fármacos , Células Progenitoras Endoteliais/metabolismo , Células Progenitoras Endoteliais/patologia , Humanos , Mediadores da Inflamação/metabolismo , Fenótipo , Doenças Reumáticas/complicações , Doenças Reumáticas/metabolismo , Doenças Reumáticas/patologia , Fatores de Risco , Transdução de Sinais/efeitos dos fármacos , Resultado do Tratamento
11.
Autoimmun Rev ; 17(3): 201-214, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29353099

RESUMO

Systemic autoimmune diseases can affect various kinds of organs including the kidney, the skin, soft tissue and the bone. Among others, cardiovascular involvement in rheumatic diseases has been shown to affect myocardium, pericardium, cardiac vessels, conduction system and valves, eventually leading to increased mortality. In general, underlying chronic inflammation leads to premature atherosclerosis, but also other manifestations such as arrhythmia and heart failure may have a 'silent' progress. Traditional cardiovascular risk factors play a secondary role, while disease-specific factors (i.e. disease duration, severity, antibody positivity, persistent disease activity) can directly influence the cardiovascular system. Therefore, early diagnosis is critical to optimize management and to control inflammatory activity and recent data suggest that risk factors (i.e. hypercholesterolemia and hypertension) need intensive treatment as well. With the advent of immunosuppressive agents, most rheumatic diseases are well controlled on treatment, but information related to their cardioprotective efficacy is not well-defined. In this review, we focus on cardiovascular involvement in rheumatic diseases and highlight current evidence which should be of help for the treating physicians. Moreover, cardiotoxicity of immunosuppressive drugs is a rare issue and such potential adverse events will be briefly discussed.


Assuntos
Doenças Cardiovasculares/etiologia , Médicos/normas , Doenças Reumáticas/complicações , Doenças Cardiovasculares/patologia , Humanos , Doenças Reumáticas/patologia , Fatores de Risco
12.
Qual Life Res ; 27(3): 755-764, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-28983738

RESUMO

PURPOSE: Different patient-reported outcome (PRO) measures are used for rheumatic diseases (RD). The aims of this study are-(1) Identify PROMIS® domains most relevant to care of patients with RD, (2) Collect T-Score metrics in patients with RD, and (3) Identify clinically meaningful cut-points for these domains. METHODS: A convenience sample of RD patients was recruited consecutively during clinic visits, and asked to complete computer-adaptive tests on thirteen Patient-Reported Outcomes Measurement Information System (PROMIS®) instruments. Based on discussion with clinical providers, four measures were chosen to be relevant and actionable (from rheumatologists' perspective) in RD patients. Data from RD patients were used to develop clinical vignettes across a range of symptom severity. Vignettes were created based on most likely item responses at different levels on the T-score metric (mean = 50; SD = 10) and anchored at 5-point intervals (0.5 SDs). Patients with RD (N = 9) and clinical providers (N = 10) participated as expert panelists in separate one-day meetings using a modified educational standard setting method. RESULTS: Four domains (physical function, pain interferences, sleep disturbance, depression) that are actionable at the point-of-care were selected. For all domains, patients endorsed cut-points at lower levels of impairment than providers by 0.5 to 1 SD (e.g., severe impairment in physical function was defined as a T-score of 35 by patients and 25 by providers). CONCLUSIONS: We used a modified educational method to estimate clinically relevant cut-points to classify severity for PROMIS measures This allows for meaningful interpretation of PROMIS® measures in a clinical setting of RD population.


Assuntos
Qualidade de Vida/psicologia , Doenças Reumáticas/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Reumáticas/patologia
13.
Curr Med Chem ; 25(24): 2797-2810, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-28901270

RESUMO

The story of antimalarials as antinflammatory drugs dates back several centuries. Chinin, the extract of the Cinchona bark, has been exploited since the 18th century for its antimalarial and antifebrile properties. Later, during the Second World War, the broad use of antimalarials allowed arguing their antirheumatic effect on soldiers. Since then, these drugs have been broadly used to treat Systemic Lupus Erythematosus, but, only recently, have the molecular mechanisms of action been partly clarified. Inhibitory action on vacuole function and trafficking has been considered for decades the main mechanism of the action of antimalarials, affecting the activation of phagocytes and dendritic cells. In addition, chloroquine is also known as a potent inhibitor of autophagy, providing another possible explanation of its antinflammatory action. However, much attention has been recently devoted to the action of antimalarials on the so-called cGASSTING pathway leading from the sensing of cytoplasmic nucleic acids to the production of type I interferons. This pathway is a fundamental mechanism of host defence, since it is able to detect microbial DNA and induce the type I interferon-mediated immune response. Of note, genetic defects in the degradation of nucleic acids lead to inappropriate cGAS-STING activation and inflammation. These disorders, called type I interferonopathies, represent a valuable model to study the antinflammatory potential of antimalarials. We will discuss possible development of antimalarials to improve the treatment of type I interferonopathies and likely multifactorial disorders characterised by interferon inflammation, such as Systemic Lupus Erythematosus.


Assuntos
Antimaláricos/uso terapêutico , Doenças Autoimunes/tratamento farmacológico , Interferon Tipo I/metabolismo , Antimaláricos/química , Doenças Autoimunes/patologia , Humanos , Hidroxicloroquina/química , Hidroxicloroquina/uso terapêutico , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Lúpus Eritematoso Sistêmico/patologia , Nucleotidiltransferases/antagonistas & inibidores , Nucleotidiltransferases/metabolismo , Proteínas Serina-Treonina Quinases/antagonistas & inibidores , Proteínas Serina-Treonina Quinases/metabolismo , Doenças Reumáticas/tratamento farmacológico , Doenças Reumáticas/patologia , Receptor Toll-Like 9/antagonistas & inibidores , Receptor Toll-Like 9/metabolismo
15.
Best Pract Res Clin Rheumatol ; 32(6): 735-749, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-31427052

RESUMO

As a result of advances in surgery, anesthesiology, and perioperative care, patients of more advanced age and medical complexity are now considered suitable candidates for surgical intervention. Rheumatologists, though frequently called upon to advise their patient in the surgical domain, may not be fully cognizant of the principles underlying medical consultation and therapy in perioperative setting. This paper provides an approach for guiding such medical care with a particular focus on the concerns pertinent to patient suffering from a chronic rheumatic disease.


Assuntos
Assistência Perioperatória/métodos , Doenças Reumáticas/cirurgia , Doenças Reumáticas/terapia , Humanos , Doenças Reumáticas/patologia , Medição de Risco
16.
Best Pract Res Clin Rheumatol ; 32(6): 848-868, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-31427059

RESUMO

Hepatitis B and C viruses present dual considerations in rheumatic disease as both etiologic factors and important comorbidities that must be assessed and addressed. This review summarizes the link between hepatitis B and arthritis and polyarteritis nodosa as well as hepatitis C and arthritis, Sicca syndrome and cryoglobulinemic vasculitis. Recent data pertaining to the antiviral management in these conditions, especially regarding the use of the direct-acting antivirals in hepatitis C, are also presented. Additionally, guidance on testing and treatment of hepatitis B and C as comorbidities in the context of systemic inflammatory rheumatic conditions and the use of disease-modifying antirheumatic therapy are discussed.


Assuntos
Hepatite B/terapia , Hepatite C/terapia , Doenças Reumáticas/complicações , Hepatite B/patologia , Hepatite C/patologia , Humanos , Doenças Reumáticas/patologia
17.
BMJ Case Rep ; 11(1)2018 Dec 31.
Artigo em Inglês | MEDLINE | ID: mdl-30598469

RESUMO

A 53-year-old male with rheumatoid arthritis presented with recurrent headaches, seizures and right-sided lower extremity paralysis while on antiepileptic medications. Work up revealed pachymeningeal and leptomeningeal enhancement on brain MRI. Differential diagnosis included a variety of infections, neoplasm and vasculitis. Histopathology showed findings consistent with rheumatoid meningitis (RM). Ultimately based on symptoms, MRI findings and tissue pathology, he was diagnosed with RM. Intravenous pulse dose steroids were initiated followed by rituximab every 6 months, resulting in significant improvement of the brain MRI findings. Patient has remained seizure free.


Assuntos
Antirreumáticos/uso terapêutico , Meningite/tratamento farmacológico , Doenças Reumáticas/tratamento farmacológico , Rituximab/uso terapêutico , Anticonvulsivantes/uso terapêutico , Encéfalo/diagnóstico por imagem , Cefaleia/etiologia , Hemiplegia/etiologia , Humanos , Imagem por Ressonância Magnética , Masculino , Meninges/patologia , Meningite/complicações , Meningite/diagnóstico por imagem , Meningite/patologia , Pessoa de Meia-Idade , Doenças Reumáticas/complicações , Doenças Reumáticas/diagnóstico por imagem , Doenças Reumáticas/patologia , Convulsões/tratamento farmacológico , Convulsões/etiologia
18.
PLoS One ; 12(12): e0189840, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29261752

RESUMO

OBJECTIVES: To compare physical and mental health-related quality of life (HRQoL) across four systemic autoimmune rheumatic diseases (SARD). METHODS: Incident subjects enrolled in four SARD cohorts, namely systemic lupus erythematosus (SLE), systemic sclerosis (SSc), rheumatoid arthritis (RA) and idiopathic inflammatory myopathies (IIM) were studied. The outcomes of interest were baseline Short Form Health Survey physical (PCS) and mental (MCS) component summary scores. Multivariate analysis was conducted to determine whether PCS and MCS scores differed across SARD type. RESULTS: The study included 118 SLE (93% women, mean age 36 years), 108 SSc (79% women, mean age 55), 64 RA (63% women, mean age 58) and 25 IIM (68% women, mean age 49) subjects. Mean PCS scores were 38.9 ± 12.2 in SLE, 37.1 ± 13.3 in RA, 35.0 ± 13.6 in SSc and 28.0 ± 15.4 in IIM. Mean MCS scores were 45.0 ± 13.3 in RA, 44.4 ± 14.7 in SSc, 40.1 ± 14.3 in SLE and 33.6 ± 18.7 in IIM. SARD type was an independent predictor of HRQoL with, in some cases, the magnitude of the differences reaching one standard deviation (IIM worse PCS scores compared to SLE (ß -12.23 [95% CI -18.11, -6.36; p<0.001]); IIM worse MCS scores compared to SSc (ß -11.05 [95% CI -17.53, -4.58; p = 0.001]) and RA (ß -11.72 [95% CI -18.62, -4.81; p = 0.001]). CONCLUSIONS: Cross-SARD research provides a novel approach to gain greater understanding of commonalities and differences across rheumatic diseases. The differences observed warrant further research into correlates and trajectories over time.


Assuntos
Doenças Autoimunes/patologia , Saúde , Qualidade de Vida , Doenças Reumáticas/patologia , Feminino , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade
19.
Trans Am Clin Climatol Assoc ; 128: 24-43, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28790485

RESUMO

The hallmark of rheumatoid arthritis is synovitis, or inflammation of synovial tissues lining joints. Synovitis in rheumatoid arthritis promotes destruction of articular bone by inducing the differentiation and function of osteoclasts, leading to significant patient morbidity. The cell types and pathways mediating articular bone destruction have now been elucidated and the critical role of receptor activator of nuclear factor-kappa B ligand has been recognized, leading to the identification of new targets for the protection of articular bone. Synovitis not only promotes bone destruction, but also inhibits the ability of bone-forming osteoblasts to repair bone. In stark contrast, inflammation in spondyloarthritis, including ankylosing spondylitis, promotes bone formation at periosteal sites, resulting in pain and decreased motion of the spine and joints. Local anatomic factors contribute to these distinct outcomes for bone and anabolic pathways regulating bone formation are now being investigated to identify novel targets for prevention of abnormal bone formation.


Assuntos
Desenvolvimento Ósseo/fisiologia , Doenças Reumáticas/patologia , Desenvolvimento Ósseo/imunologia , Osso e Ossos/imunologia , Humanos , Doenças Reumáticas/imunologia , Doenças Reumáticas/metabolismo
20.
APMIS ; 125(10): 863-871, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28766758

RESUMO

This study was aimed to evaluate levels of neutrophil- (NLR), monocyte- (MLR), eosinophil- (ELR), and basophil-lymphocyte ratio (BLR) and their association with inflammatory markers in systemic autoimmune rheumatic diseases (SARDs). A total of 1139 SARD patients and 170 healthy individuals were enrolled. Clinical and laboratory data were extracted. NLR and MLR were significantly increased, but BLR decreased in most SARD patients (p < 0.05). ELR were significantly decreased in systemic lupus erythematosus (SLE) patients, but increased in those with other SARDs (p < 0.001). In SLE patients, C-reactive protein (CRP) showed positive correlation with NLR, MLR, and BLR. IgG negatively correlated with NLR, and did positively with ELR. IgM negatively correlated with NLR and MLR. In those with rheumatoid arthritis (RA), ankylosing spondylitis (AS), and osteoarthritis (OA), NLR and MLR positively correlated with erythrocyte sedimentation rate (ESR) and CRP. In primary Sjögren's syndrome (pSS) patients, ESR showed positive correlation with NLR and MLR. IgA had positive correlation with BLR. In polymyositis/dermatomyositis (PM/DM) patients, ESR and CRP positively correlated with NLR. Additionally, significant correlations were also found between CRP and BLR, IgG and ELR, IgM and ELR. In systemic sclerosis (SSc) patients, clear correlations were only observed between CRP and NLR or MLR. In mixed connective tissue disease (MCTD) patients, NLR positively correlated with ESR and CRP, while NLR and MLR did negatively with IgM. In polymyalgia rheumatic (PMR) patients, MLR positively correlated with CRP, while ELR did negatively with IgG. This study demonstrated increased NLR and MLR and deceased BLR in most SARDs, decreased ELR in SLE and increased ELR in other SARDs. Furthermore, NLR and MLR may be useful tools to reflect inflammatory status of SARDs.


Assuntos
Doenças Autoimunes/patologia , Biomarcadores/análise , Contagem de Leucócitos , Doenças Reumáticas/patologia , Adulto , Idoso , Feminino , Humanos , Inflamação/patologia , Masculino , Pessoa de Meia-Idade , Adulto Jovem
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