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1.
N Z Med J ; 133(1516): 47-57, 2020 06 12.
Artigo em Inglês | MEDLINE | ID: mdl-32525861

RESUMO

AIM: To describe the epidemiology and clinical characteristics of recurrences of acute rheumatic fever (ARF) in New Zealand 2010-14. METHOD: Retrospective hospital chart review for ARF with repeat hospital admissions from 2010-14, to identify recurrences of ARF. Definitions of recurrence as per NZ Heart Foundation Guidelines. RESULTS: There were 65 episodes of recurrent ARF among 60 patients. Maori 51%, Pacific 49%. Arthritis and carditis were the most common major manifestations. Median age at recurrence 21.6 years, (8-42 years), with 83% patients over 15 years. There were 841 first episodes of ARF in New Zealand in 2010-4. Overall New Zealand ARF recurrence rate was 7.2% (CI 5.5-8.9%). The recurrence rate was 4% for those under 16 years, 16% for those aged 16-20 and 25% for those >20 years (p<0.05). Seventy-three percent of recurrences occurred in the Auckland region. Recurrences of ARF were strongly associated with RHD progression. CONCLUSION: The risk of recurrence of ARF in New Zealand is low for children. In contrast, recurrences of ARF in New Zealand occur predominantly after age 15, and disproportionately in the Auckland DHBs. Current medical systems and registers may not be meeting the needs of adolescents and adults requiring secondary prophylaxis.


Assuntos
Antibacterianos/uso terapêutico , Antibioticoprofilaxia , Readmissão do Paciente/estatística & dados numéricos , Penicilinas/uso terapêutico , Febre Reumática/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Criança , Pré-Escolar , Humanos , Auditoria Médica , Erros Médicos , Pessoa de Meia-Idade , Nova Zelândia/epidemiologia , Grupo com Ancestrais Oceânicos , Recidiva , Estudos Retrospectivos , Febre Reumática/complicações , Febre Reumática/prevenção & controle , Prevenção Secundária , Adulto Jovem
2.
Immunol Med ; 43(2): 92-97, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32089102

RESUMO

The aim of this study was to find the correlation between severity of dry eye and rheumatoid arthritis (RA) disease activity. Forty- two RA patients with dry eye were recruited from Rheumatology Outpatient Clinic in Minia University Hospital. Assessment of RA disease activity was performed using disease activity score (DAS-28). Ocular tests include Schirmer test I, tear film break up time (TBUT) and ocular staining score (OSS) was performed by ophthalmologist to find evidence of ocular dryness. Erythrocyte sedimentation rate (ESR), rheumatoid factor (RF), anti SSA/Ro and anti SSB/La was also tested. Patients with severe dry (OSS ≥ 3) underwent minor salivary gland biopsy (MSGB) as suspected to have secondary Sjögren's syndrome (SS). Of 42 RA patients, 30 had definite dry eye. DAS-28 did not show significant correlation with any of ocular tests for dryness while the duration of RA was significantly positively correlated with Schirmer test and OSS. The biopsy results of RA patients with severe dry eye show no evidence of SS. The severity of dry eye is not correlated with activity of RA but with its duration.


Assuntos
Síndromes do Olho Seco/etiologia , Febre Reumática/complicações , Adulto , Síndromes do Olho Seco/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Febre Reumática/diagnóstico , Índice de Gravidade de Doença , Fatores de Tempo
5.
Am J Emerg Med ; 37(11): 2118.e5-2118.e7, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31474378

RESUMO

Isolated motor disturbances in the paediatric population are uncommon presentations to the emergency department. Choreiform movements have a broad differential diagnosis and may present insidiously with progressive worsening of asymmetric clumsiness, hypotonia and dysarthria. The incidence of Sydenham's chorea (SC) caused by acute rheumatic fever (ARF) is very rare in developed countries. We report a previously healthy, vaccinated 9-year old male who presented to our ED with intermittent and progressive right sided clumsiness for four weeks. Physical examination findings showed dysdiadokinesis and dysmetric movements of the right side, which varied in intensity and were less pronounced on serial re-examination during the same ED visit. Basic bloodwork, MRI and MRA/V showed no abnormalities, and the patient was discharged home with urgent neurology follow-up. He re-presented to our ED four days later with worsening gait and inability to hold a pencil at school. He was subsequently diagnosed with chorea by the neurology team. The cause of chorea was later determined to be SC, and the patient's throat swab came back positive for group A-beta hemolytic strep (GAS) infection. We explore current literature regarding the various presentations of ARF, differential considerations in acute chorea, and diagnostic studies needed to determine the etiology of acute chorea. With the low incidence of chorea in developed nations, this diagnosis can be easily overlooked. We highlight the importance of this diagnosis, as well as primary and secondary treatment in ARF.


Assuntos
Coreia/microbiologia , Febre Reumática/diagnóstico , Criança , Coreia/diagnóstico , Humanos , Masculino , Febre Reumática/complicações
6.
Am J Trop Med Hyg ; 101(5): 1054-1057, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31516109

RESUMO

We report a case of acute rheumatic fever with severe pancarditis occurring simultaneously with probable acute post-streptococcal glomerulonephritis in a previously well, Australian Aboriginal, 29-year-old male. These autoimmune streptococcal sequelae are usually considered pathogenetically distinct, and concurrence has not previously been reported from this high-burden setting. We hypothesize that a single type of infecting group A Streptococcus (Strep A) triggered both autoimmune sequelae. Salient features included mitral and aortic regurgitation that worsened during the acute illness, painful pericarditis, and high troponin; severe acute kidney injury with oliguria, hematuria, and macroalbuminuria; reduced complement (C3); and elevated streptococcal serology. The case highlights important diagnostic and management challenges. It also illustrates the serious morbidity impact of the complications of Strep A.


Assuntos
Glomerulonefrite/etiologia , Febre Reumática/complicações , Adulto , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Anti-Inflamatórios/administração & dosagem , Anti-Inflamatórios/uso terapêutico , Ceftriaxona/administração & dosagem , Ceftriaxona/uso terapêutico , Floxacilina/administração & dosagem , Floxacilina/uso terapêutico , Cardiopatias/microbiologia , Cardiopatias/patologia , Humanos , Masculino , Prednisolona/administração & dosagem , Prednisolona/uso terapêutico , Febre Reumática/diagnóstico , Febre Reumática/tratamento farmacológico
7.
Medicina (Kaunas) ; 55(6)2019 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-31174287

RESUMO

Introduction: Patients with inflammatory rheumatic diseases have an increased risk of developing cardiovascular manifestations. The high risk of cardiovascular pathology in these patients is not only due to traditional cardiovascular risk factors (age, gender, family history, smoking, sedentary lifestyle, cholesterol), but also to chronic inflammation and autoimmunity. Aim: In this review, we present the mechanisms of cardiovascular comorbidities associated with inflammatory rheumatic diseases, as they have recently been reported by different authors, grouped in electrical abnormalities, valvular, myocardial and pericardial modifications and vascular involvement. Methods: We conducted a systematic search of published literature on the following online databases: EBSCO, ScienceDirect, Scopus and PubMed. Searches were limited to full-text English-language journal articles published between 2010 and 2017 using the following key words: heart, systemic inflammation, autoimmunity, rheumatic diseases and disease activity. After the primary analysis we included 50 scientific articles in this review. Results: The results showed that cardiac manifestations of systemic inflammation can occur frequently with different prevalence in rheumatoid arthritis (RA), systemic lupus erythematosus(SLE), systemic sclerosis(SSc) and ankylosing spondylitis(AS). Rheumatologic diseases can affect the myocardium, cardiac valves, pericardium, conduction system and arterial vasculature. Conclusions: Early detection, adequate management and therapy of specific cardiac involvement are essential in rheumatic disease. Electrocardiographic and echocardiographic evaluation should be performed as routine investigations in patients with inflammatory rheumatic diseases.


Assuntos
Coração/fisiopatologia , Febre Reumática/complicações , Humanos , Inflamação/complicações , Inflamação/fisiopatologia , Febre Reumática/fisiopatologia
8.
Cardiol Young ; 29(6): 744-748, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31198127

RESUMO

OBJECTIVES: First-degree heart block is a minor manifestation of acute rheumatic fever. Second and third degree heart block and junctional rhythms occur less commonly. We report patients presenting with these latter three electrocardiographic abnormalities and investigate their diagnostic utility. DESIGN: Patients admitted to our centre meeting the 2014 New Zealand Rheumatic Fever Guideline Diagnostic Criteria for rheumatic fever over a 5-year period from January 2010 to December 2014 were identified. Clinical, haematologic, electrocardiographic, and echocardiographic records were reviewed. Electrocardiograms (ECG) were considered abnormal if there was second- or third-degree atrioventricular block or junctional rhythms. Comparative data from patients with advanced conduction abnormalities without a diagnosis of rheumatic fever during the same time period were reviewed. RESULTS: A total of 201 patients met inclusion criteria for rheumatic fever. Of these, 17 (8.5%) had transient abnormalities of atrioventricular conduction, 5 (2.5%) with second or third-degree atrioventricular block, and 12 (6%) junctional rhythms. The remaining 173 (86%) patients had evidence of rheumatic valvulitis at presentation. Only one patient without rheumatic fever was found to have advanced conduction abnormalities over the study period, from a total of 3702 ECG. CONCLUSIONS: This large contemporary cohort of acute rheumatic fever shows that 8.5% of cases had either advanced atrioventricular block or junctional rhythms both highly suggestive of the diagnosis in our population.


Assuntos
Bloqueio Atrioventricular/etiologia , Eletrocardiografia , Sistema de Condução Cardíaco/fisiopatologia , Febre Reumática/diagnóstico , Adolescente , Bloqueio Atrioventricular/diagnóstico , Bloqueio Atrioventricular/fisiopatologia , Criança , Pré-Escolar , Ecocardiografia , Feminino , Seguimentos , Humanos , Masculino , Estudos Retrospectivos , Febre Reumática/complicações
9.
J Healthc Eng ; 2019: 1351305, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30931088

RESUMO

Objectives: The increasing population of patients with chronic diseases generates great challenge of chronic disease management. The occurrence of mobile health monitoring service (MHMS) is beneficial to chronic disease prevention and health promotion. The objective of this study is to investigate how patients with chronic diseases make usage decisions on MHMS. Study Design: A survey. Methods: 213 respondents with chronic diseases were asked to rate their level of health severity, negative health emotions, and health uncertainty avoidance. SmartPLS was used to test the measurement model. Results: Of 213 research respondents, 159 of them have one chronic disease, while 54 have more than one such disease. Perceived health severity of patients with chronic diseases positively influences MHMS usage intentions, while negative health emotions do not. Health uncertainty avoidance strengthens the effect of health severity but weakens the effect of negative health emotions on MHMS usage intentions. Conclusion: Patients with chronic diseases have a unique decision-making process regarding MHMS usage in which their special health-related factors and tendencies play a critical role in determining behavioral intentions.


Assuntos
Doença Crônica/terapia , Tomada de Decisões , Telemedicina/métodos , Adulto , Idoso , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/psicologia , Transtornos Cerebrovasculares/complicações , Transtornos Cerebrovasculares/psicologia , China/epidemiologia , Doença Crônica/psicologia , Comorbidade , Coleta de Dados , Feminino , Promoção da Saúde , Humanos , Hipertensão/complicações , Hipertensão/psicologia , Internet , Masculino , Pessoa de Meia-Idade , Modelos Teóricos , Febre Reumática/complicações , Febre Reumática/psicologia , Autorrelato , Inquéritos e Questionários , Incerteza
11.
Cardiol Young ; 29(1): 78-81, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30160648

RESUMO

Acute rheumatic fever is the most commonly acquired heart disease in developing countries. The most common cardiac presentation is valvular disease. Although some rhythm disturbances may occur during the acute stages of the disease, ventricular tachycardia is extremely rare. Here, a case of acute rheumatic fever with severe endocarditis involving four valves and ventricular tachycardia is presented.


Assuntos
Endocardite/etiologia , Febre Reumática/complicações , Cardiopatia Reumática/etiologia , Taquicardia Ventricular/etiologia , Criança , Eletrocardiografia Ambulatorial , Endocardite/diagnóstico , Humanos , Masculino , Cardiopatia Reumática/diagnóstico , Taquicardia Ventricular/diagnóstico
12.
Turk J Pediatr ; 61(5): 810-814, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-32105019

RESUMO

Bagrul D. Syncope due to acute rheumatic fever with pacemakerlike syndrome. Turk J Pediatr 2019; 61: 810-814. The prolongation in the PR interval on the electrocardiogram is one of the minor criteria of Jones. Abnormal increases in the PR interval lead to hemodynamic impairments caused by atrioventricular asynchrony and is called pseudo-pacemaker or pacemaker-like syndrome in the literature. A 13-yearold boy who had polyarthralgia for six weeks was referred to the emergency room because of syncope while exerting effort. In the electrocardiography, the P wave was regularly seen at the onset of the T wave immediately after the QRS wave with extremely prolonged PR interval and mild tachycardia. Also, 24 hours rhythm Holter recording showed atrioventricular dissociation. The echocardiography revealed findings of severe carditis. Diagnosis of acute rheumatic fever accompanying pacemaker-like syndrome was made. Although the recommendation for marked first-degree atrioventricular block that causes hemodynamic impairment is pacemaker implantation, a significant improvement in the PR prolongation was observed in the short term with anti-inflammatory treatment because the impairment of conduction in the patient was due to inflammation. The pacemaker-like syndrome in a child is being reported for the first time in the literature.


Assuntos
Arritmias Cardíacas/etiologia , Febre Reumática/complicações , Febre Reumática/diagnóstico , Síncope/etiologia , Adolescente , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/terapia , Ecocardiografia , Eletrocardiografia , Frequência Cardíaca , Humanos , Masculino , Marca-Passo Artificial , Febre Reumática/terapia , Síncope/diagnóstico , Síncope/terapia , Síndrome
13.
BMJ Case Rep ; 11(1)2018 Dec 19.
Artigo em Inglês | MEDLINE | ID: mdl-30573535

RESUMO

A 20-year-old primigravid experienced sudden stiffening of the neck, upper and lower extremities and trunk associated with joint pains. She was generally well before hospital admission with no history of attacks, except for her inflammatory bowel disease that was treated more than a year ago. During physical examination, the patient manifested neck flexion deviated to the right, deviation of the eyes downward and to the right, spooning of the upper extremities, exhibition of milkmaid's grip, extension of both lower extremities and jerky speech. She also showed uncontrollable tremors of the neck and occasional flailing of upper extremities. Her preliminary laboratory tests were within normal range. It was worth noting here that her family's medical history was unremarkable. In this article, the process of arriving at the final diagnosis and treatment would be discussed.


Assuntos
Coreia Gravídica/diagnóstico , Coreia Gravídica/etiologia , Feminino , Humanos , Paridade , Gravidez , Febre Reumática/complicações , Índice de Gravidade de Doença , Adulto Jovem
14.
Sci Rep ; 8(1): 17287, 2018 11 23.
Artigo em Inglês | MEDLINE | ID: mdl-30470801

RESUMO

Mixed cryobulinemia (MC) is the most common chronic hepatitis C virus (HCV)-associated extrahepatic manifestation. C-type lectin 18 (CLEC18) is a novel secretory lectin that is abundantly expressed in hepatocytes and peripheral blood cells (PBCs). We investigated the associations between CLEC18 expression during HCV infection and the presence of extrahepatic manifestations. A total of 41 rheumatic patients with HCV infection (including 28 patients with MC syndrome), 45 rheumatic patients without infection, and 14 healthy subjects were enrolled. The CLEC18 levels in PBCs and serum were determined by using flow cytometry and enzyme-linked immunosorbent assay, respectively. Significantly higher CLEC18 levels were observed in patients with HCV infection (P < 0.001) and were positively correlated with HCV viral loads (γ = 0.56, P < 0.05). Among patients with HCV infection, significantly increased CLEC18 levels were observed in patients with MC syndrome, particularly in those with type II MC (P < 0.05). CLEC18 levels were associated with cryoglobulin and C4 levels (P < 0.05). CLEC18 was significantly associated with HCV infection, particularly in those with HCV-associated MC. CLEC18 levels were also positively correlated with MC disease activity, suggesting its involvement in MC pathogenesis. CLEC18 may be a novel indicator of HCV infection and a potential therapeutic target in rheumatic patients.


Assuntos
Vírus da Hepatite B/isolamento & purificação , Hepatite C Crônica/diagnóstico , Hepatócitos/virologia , Lectinas Tipo C/sangue , Febre Reumática/virologia , Idoso , Estudos de Casos e Controles , Feminino , Hepatite C Crônica/sangue , Hepatite C Crônica/epidemiologia , Hepatite C Crônica/virologia , Hepatócitos/metabolismo , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Febre Reumática/complicações , Febre Reumática/patologia
15.
Med J Malaysia ; 73(5): 323-325, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30350813

RESUMO

Acute Rheumatic fever (ARF) is commonly associated with ECG abnormalities particularly atrioventricular block. However, third degree atrioventricular block or complete heart block is a rare manifestation. Most cases occurred in children. We reported a 25 year old man who developed complete heart block during an acute episode of ARF. He presented to hospital with five days history of fever, malaise and migrating arthralgia, followed by pleuritic chest pain. One day after admission his electrocardiogram (ECG) revealed complete heart block. Transthoracic echocardiography showed good left ventricular function with thickened, mild mitral regurgitation with minimal pericardial effusion. ASOT titer was positive with elevated white blood count and acute phase reactant. A temporary pacemaker was inserted in view of symptomatic bradycardia. The complete heart block resolved after medical therapy. He was successfully treated with penicillin, steroid and aspirin. He was discharged well with oral penicillin. The rarity of this presentation is highlighted.


Assuntos
Bloqueio Cardíaco/etiologia , Febre Reumática/complicações , Adulto , Ecocardiografia , Eletrocardiografia , Bloqueio Cardíaco/diagnóstico por imagem , Bloqueio Cardíaco/terapia , Humanos , Masculino , Marca-Passo Artificial
16.
S Afr Med J ; 108(9): 702-704, 2018 08 28.
Artigo em Inglês | MEDLINE | ID: mdl-30182888

RESUMO

Twelve years after cardiologists and cardiac surgeons from all over the world issued the 'Drakensberg Declaration on the Control of Rheumatic Fever and Rheumatic Heart Disease in Africa', calling on the world community to address the prevention and treatment of rheumatic heart disease (RHD) through improving living conditions, to develop pilot programmes at selected sites for control of rheumatic fever and RHD, and to periodically review progress made and challenges that remain, RHD still accounts for a major proportion of cardiovascular diseases in children and young adults in low- and middle-income countries, where more than 80% of the world population live. Globally equal in prevalence to human immunodeficiency virus infection, RHD affects 33 million people worldwide. Prevention efforts have been important but have failed to eradicate the disease. At the present time, the only effective treatment for symptomatic RHD is open heart surgery, yet that life-saving cardiac surgery is woefully absent in many endemic regions. In this declaration, we propose a framework structure to create a co-ordinated and transparent international alliance to address this inequality.


Assuntos
Procedimentos Cirúrgicos Cardíacos/estatística & dados numéricos , Acesso aos Serviços de Saúde , Febre Reumática/complicações , Cardiopatia Reumática/cirurgia , Criança , Saúde Global , Humanos , Prevalência , Febre Reumática/epidemiologia , Cardiopatia Reumática/epidemiologia , África do Sul/epidemiologia , Resultado do Tratamento , Adulto Jovem
17.
PLoS One ; 13(9): e0203756, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30261069

RESUMO

AIMS: Left atrial (LA) structural remodelling develops in rheumatic heart disease (RHD) according to the disease severity of the mitral valve and the presence of atrial fibrillation. Sustained active inflammation has been previously reported in the LA of patients with RHD, suggesting a direct role of cell-mediated immunity in the pathogenesis of LA remodelling. Dendritic cells (DCs) have a major antigen-presenting role, and are known as crucial modulators of innate and adaptive immunity. We investigated whether DCs are involved in the pathogenesis of LA remodelling in RHD. METHODS AND RESULTS: Immunohistochemical analyses were performed using antibodies to CD11c, CD209 and CD80 as markers of myeloid DCs, migratory-active DCs, mature DCs and infiltrated inflammatory cells including T lymphocytes (CD3) and M1 (CD68; pro-inflammatory profile) and M2 (CD163; pro-resolution profile) macrophages. Furthermore, tenascin-C, an extracellular matrix (ECM) protein that appears during ECM remodelling and inflammatory response, was examined. Infiltrated myeloid DCs, migratory-active DCs, mature DCs and other inflammatory infiltrates including T lymphocytes and M1 and M2 macrophages, were significantly higher in the RHD group than the non-RHD group. The positive area fraction for tenascin-C was significantly higher in the RHD group than in the non-RHD group. CONCLUSION: Our histological findings suggest that inflammation may persist long after a bout of rheumatic fever, ultimately leading to ECM remodelling. We identified and quantitatively assessed several subsets of DCs and other immunocompetent cells, and our results indicated that activation of DCs has some role in persistence of LA inflammation in patients with chronic RHD.


Assuntos
Átrios do Coração/patologia , Cardiopatia Reumática/patologia , Idoso , Idoso de 80 Anos ou mais , Remodelamento Atrial , Células Dendríticas/patologia , Feminino , Átrios do Coração/metabolismo , Humanos , Imunidade Celular , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Febre Reumática/complicações , Febre Reumática/imunologia , Febre Reumática/patologia , Cardiopatia Reumática/imunologia , Cardiopatia Reumática/metabolismo , Linfócitos T/patologia , Tenascina/metabolismo
18.
Cardiol Young ; 28(11): 1375-1377, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30070198

RESUMO

Steroids are used in the treatment of acute rheumatic fever with moderate-to-severe carditis. Corticosteroids have several cardiovascular side affects that are more common in adults than in children. Corticosteroid-related bradycardia is a rarely seen side effect. Children with bradycardia following oral corticosteroid use are rarely reported previously. We present a child who developed bradycardia after oral corticosteroid treatment and concurrent Wolff-Parkinson-White pattern.


Assuntos
Bradicardia/induzido quimicamente , Prednisolona/efeitos adversos , Febre Reumática/tratamento farmacológico , Síndrome de Wolff-Parkinson-White/etiologia , Administração Oral , Bradicardia/complicações , Criança , Ecocardiografia , Eletrocardiografia Ambulatorial , Feminino , Seguimentos , Glucocorticoides/administração & dosagem , Glucocorticoides/efeitos adversos , Humanos , Prednisolona/administração & dosagem , Febre Reumática/complicações , Fatores de Tempo , Síndrome de Wolff-Parkinson-White/diagnóstico , Síndrome de Wolff-Parkinson-White/fisiopatologia
19.
Pediatr Clin North Am ; 65(4): 623-638, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-30031490

RESUMO

This article focuses on creating an orderly approach to history taking, examination, and ordering appropriate investigations when caring for a child with joint complaints. It classifies complaints as those with and without pain, swelling, or fever and of short or long duration. It recommends an approach to the physical examination and both suggests and discourages various laboratory and imaging studies.


Assuntos
Artralgia/etiologia , Artrite/diagnóstico , Adolescente , Artralgia/diagnóstico , Artralgia/diagnóstico por imagem , Artralgia/terapia , Artrite/complicações , Criança , Pré-Escolar , Diagnóstico Diferencial , Humanos , Anamnese , Medição da Dor , Febre Reumática/complicações , Febre Reumática/diagnóstico , Índice de Gravidade de Doença
20.
Acta méd. costarric ; 60(2): 34-37, abr.-jun. 2018. tab
Artigo em Espanhol | LILACS | ID: biblio-886411

RESUMO

Resumen La vasculitis reumatoide constituye una complicación inusual, pero severa, de la artritis reumatoide, caracterizada por un proceso inflamatorio que compromete vasos sanguíneos de pequeño y mediano calibre, asociada o no a manifestaciones extraarticulares. Algunos factores predisponentes descritos incluyen ciertos haplotipos de antígenos leucocitarios humanos, fumado y enfermedad de larga data. Una disminución en la incidencia ha sido notada desde los años 90 y confirmada en estudios recientes, asociada en particular a un diagnóstico precoz de artritis reumatoide y estrategias terapéuticas que incluyen un aumento en la prescripción de metotrexate. La vasculitis reumatoide se asocia a tasas de mortalidad hasta del 40% a los 5 años y morbilidad importante. Se presentan dos pacientes con diagnóstico previo de artritis reumatoide, con un cuadro crónico de úlceras y disestesias en miembros inferiores, asociado a síndrome anémico. Los estudios histológicos revelaron vasculitis de mediano vaso compatible con vasculitis reumatoide. Se inició manejo con inmunosupresores más esteroides, con resolución del cuadro clínico inicial.


Abstract Rheumatoid vasculitis remains a rare but serious complication of rheumatoid arthritis characterized by an inflammatory process that primarily affects small to medium-sized blood vessels, it can be associated with other extra-articular manifestations. A number of predictor or predisposing factors including certain human leukocyte antigen haplotypes, smoking and long-standing disease. A declining trend in the incidence of rheumatoid vasculitis has been noted since the 1990s and reconfirmed in recent studies, related to early diagnosis of rheumatoid arthritis, and widespread use of methotrexate. Rheumatoid vasculitis is associated with high rates of premature mortality with up to 40% of patients dying by 5 years, as well as a significant morbidity. We present two patients with diagnosis of rheumatoid arthritis with a chronic condition of ulcers and dysesthesias on legs associated with anemic syndrome; the histological study revealed medium size vasculitis. Treatment with inmunosuppresants and steroids was given with resolution of symptoms.


Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Febre Reumática/complicações , Costa Rica , Vasculite Reumatoide/diagnóstico
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