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1.
JNMA J Nepal Med Assoc ; 59(233): 81-83, 2021 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-34508451

RESUMO

The systemic lupus erythematosus (SLE) is a connective tissue disorder with variable presentations in children. The usual presentation includes arthritis, malar rash, nephritis, hemolytic anemia, and fever. Isolated hematologic abnormality as the only presentation of SLE is rare. Here is a case report of a female child presented to us with superficial and mucosal bleeding with isolated low platelet count and anemia in proportion to blood loss. When platelet count did not go up despite appropriate treatment in lines of ITP, further investigations were done, diagnosis of SLE was established, and management was done accordingly.


Assuntos
Anemia , Artrite , Lúpus Eritematoso Sistêmico , Púrpura Trombocitopênica Idiopática , Criança , Feminino , Humanos , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/diagnóstico , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Contagem de Plaquetas , Púrpura Trombocitopênica Idiopática/complicações , Púrpura Trombocitopênica Idiopática/diagnóstico
2.
Am J Case Rep ; 22: e932751, 2021 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-34504052

RESUMO

BACKGROUND Manifestations of Coronavirus disease 2019 (COVID-19), caused by the SARS-CoV-2 virus, are highly variable among healthy populations. In connective tissue disease patients, the spectrum of clinical manifestations is even broader. In mild COVID-19 patients, diffuse lymphadenopathy (DL) has not been described as a late manifestation, and only severe COVID-19 has been associated with lupus flare-ups. Herein, we report 3 cases of connective tissue disease patients that presented with DL after diagnosis and complete resolution of mild COVID-19 disease. CASE REPORT Case 1. A 28-year-old man with inactive lupus, mixed connective tissue disease (MCTD), and a history of lung and cutaneous involvement. He presented with fever, polyarthralgia, and multiple lymphadenopathies 3 weeks after COVID-19 disease resolution. After evaluation, immunosuppressive treatment was initiated, with rapid response. Case 2. A 25-year-old woman with inactive lupus with a history of articular, hematologic, and cutaneous involvement. Four weeks after resolution of COVID-19 disease, she presented with malaise and cervical lymphadenopathies. After laboratory testing and imaging, she was treated for lupus flare-up, with rapid response. Case 3. A 68-year-old woman with inactive lupus with a history of articular and cutaneous involvement. Four weeks after COVID-19 resolution, she presented with malaise and cervical and axillary lymphadenopathies. After extensive evaluation, immunosuppressive treatment resulted in a rapid response. CONCLUSIONS After 3 to 4 weeks of mild, outpatient-treated COVID-19 and complete resolution of symptoms, 3 patients with connective tissue disease presented diffuse lymphadenopathy associated with inflammatory and constitutional symptoms. Infectious and neoplastic causes were thoroughly ruled out. All patients responded to reintroduction of or an increase in immunosuppressive therapy. We recommend considering the diffuse lymphadenopathy as a possible post-acute COVID-19 syndrome (PACS) manifestation in these patients, mainly when they are in the inactive phase.


Assuntos
Complexo Relacionado com a AIDS , COVID-19 , Lúpus Eritematoso Sistêmico , Doença Mista do Tecido Conjuntivo , Adulto , Idoso , Feminino , Humanos , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/diagnóstico , Masculino , Doença Mista do Tecido Conjuntivo/complicações , SARS-CoV-2 , Exacerbação dos Sintomas
3.
BMJ Case Rep ; 14(8)2021 Aug 25.
Artigo em Inglês | MEDLINE | ID: mdl-34433539

RESUMO

A 39-year-old woman with systemic lupus erythematosus treated with anti-CD20 monoclonal antibody rituximab was admitted to our hospital with COVID-19 pneumonia. Despite receiving dexamethasone, she developed hypoxaemia and persistent lung opacities. As bronchoalveolar lavage was suggestive of cryptogenic organising pneumonia, high-dose corticosteroid was administered, and she received antimicrobial therapy for opportunistic infections without improvement. Reverse transcription PCR was repeatedly positive for SARS-CoV-2, and virus replication was confirmed in cell cultures. As no anti-SARS-CoV-2 antibodies were detected more than 100 days after symptom onset, she was treated with convalescent plasma with fast clinical improvement, returning home days later. Our case shows that persistent SARS-CoV-2 infection in an immunocompromised patient may be overturned with the appropriate treatment.


Assuntos
COVID-19 , Lúpus Eritematoso Sistêmico , Adulto , COVID-19/terapia , Feminino , Humanos , Imunização Passiva , Hospedeiro Imunocomprometido , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/tratamento farmacológico , SARS-CoV-2
4.
Zhong Nan Da Xue Xue Bao Yi Xue Ban ; 46(7): 704-710, 2021 Jul 28.
Artigo em Inglês, Chinês | MEDLINE | ID: mdl-34382586

RESUMO

OBJECTIVES: To investigate the risk factors for serious infections among hospitalized systemic lupus erythematosus (SLE) patients, and to provide the advice for preventing serious infections in SLE patients. METHODS: Information of SLE patients hospitalized from March 2017 to February 2019 at the Department of Rheumatology and Immunology, Xiangya Hospital, Central South University was obtained. The patients were assigned into a serious infection group and a non-serious infection group. The risk factors for serious infections among SLE inpatients were identified by comparison between the 2 groups and multivariate logistic regression analysis. RESULTS: There were 463 SLE inpatients in total, and 144 were in the serious infection group and 319 in the non-serious infection group. Multivariate logistic regression analysis showed that age ≥54.50 years old (OR=4.958, P<0.001), cardiovascular involvement (OR=6.287, P<0.001), hematologic involvement (OR=2.643, P=0.003), serum albumin <20 g/L (OR=2.340, P=0.036), C-reaction protein (CRP)/erythrocyte sedimentation rate (ESR)≥0.12 (OR=2.430, P=0.002), glucocorticoid dose ≥8.75 mg/d prednisone-equivalent (OR=2.465, P=0.002), and the combined use of immunosuppressive agents (OR=2.847, P=0.037) were the risk factors for serious infections in SLE inpatients. CONCLUSIONS: SLE patients with older age, cardiovascular involvement, hematologic involvement, low serum albumin are prone to suffering serious infections. Increased CRP/ESR ratio indicates serious infections in SLE inpatients. High-dose glucocorticoid and the combined use of immunosuppressive agents can increase the risk of serious infections in SLE inpatients.


Assuntos
Pacientes Internados , Lúpus Eritematoso Sistêmico , Idoso , Glucocorticoides/efeitos adversos , Humanos , Lúpus Eritematoso Sistêmico/complicações , Pessoa de Meia-Idade , Prednisona , Fatores de Risco
5.
Zhong Nan Da Xue Xue Bao Yi Xue Ban ; 46(7): 780-784, 2021 Jul 28.
Artigo em Inglês, Chinês | MEDLINE | ID: mdl-34382597

RESUMO

Addison disease is rare, and it is rarer to coexist with systemic lupus erythematosus and antiphospholipid antibody syndrome. We hereby reported a middle-aged female who presented with nausea, vomit, skin and mucosa hyperpigmentation, hypotension, hyponatremia, and pulmonary infection after diagnosis of deep venous thrombosis of the left lower extremity and systemic lupus erythematosus in 2012. The patient was finally diagnosed with antiphospholipid antibody syndrome secondary to systemic lupus erythematosus with Addison disease after the examination, such as blood cortisol, adrenocorticotropic hormone rhythm, and antiphospholipid antibody, who was improved clinically after hormone, anti-infective, and anticoagulant treatment. The patient's condition was stable in the follow-up. In clinic, we should pay attention to adrenal damage in patients with connective tissue diseases such as systemic lupus erythematosus and antiphospholipid antibody syndrome, and be alert to the occurrence of adrenal crisis.


Assuntos
Doença de Addison , Síndrome Antifosfolipídica , Lúpus Eritematoso Sistêmico , Doença Aguda , Doença de Addison/complicações , Doença de Addison/diagnóstico , Síndrome Antifosfolipídica/complicações , Feminino , Humanos , Lúpus Eritematoso Sistêmico/complicações , Pessoa de Meia-Idade
6.
Pediatr Emerg Care ; 37(9): e565-e566, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34406996

RESUMO

ABSTRACT: Systemic lupus erythematosus (SLE) is a chronic, autoimmune, multisystem disorder that can sometimes be life-threatening. The presentation varies widely given the wide range of clinical and serological manifestations coupled with the disease's ability to affect any organ. Prognosis depends on the organ systems involved, as well as the severity of the involvement. This case involves a 17-year-old with initial presentation of supraventricular tachycardia subsequently found to have pancreatitis, myocarditis, and nephritis secondary to a new diagnosis of SLE. Systemic lupus erythematosus can involve virtually any organ system, which leads to the variable nature of presentation, as was the case for our patient and his presentation being supraventricular tachycardia from underlying myocarditis secondary to SLE. Lupus myocarditis is rare, but when present often indicates severe systemic illness. The echocardiogram will often show global hypokinesis without evidence of coronary artery disease. This was the case with our patient. His echocardiogram demonstrated new-onset systolic left-sided heart failure due to nonischemic cardiomyopathy with an ejection fraction of 25%. Unfortunately for our patient, he had several poor prognostic factors on his initial presentation prior to any treatment being started, including renal disease, male, age (17 years), low socioeconomic status, African American race, and high disease activity. Systemic lupus erythematosus is the great mimicker and can present in a variety of ways. Given its ability to involve virtually any organ system, it is important to consider it on the differential diagnoses, especially in patients with a strong family history.


Assuntos
Lúpus Eritematoso Sistêmico , Miocardite , Taquicardia Supraventricular , Adolescente , Ecocardiografia , Humanos , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/diagnóstico , Masculino , Miocardite/diagnóstico , Miocardite/etiologia , Prognóstico , Taquicardia Supraventricular/diagnóstico , Taquicardia Supraventricular/etiologia
7.
BMJ Case Rep ; 14(8)2021 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-34413046

RESUMO

We describe an unusual case of membranous nephropathy precipitated by syphilis infection in a patient without systemic lupus erythematosus (SLE). A previously healthy 20-year-old man presented with leg and facial swelling. Laboratory investigation revealed nephrotic range proteinuria, acute kidney injury, hypocomplementaemia and a highly positive rapid plasma reagin. Kidney biopsy showed membranous nephropathy with 'full-house' immunofluorescence (IgG, IgA, IgM, C1q and C3), mimicking lupus nephritis class Vb. However, the patient had no features of SLE and had negative antinuclear and anti-double-stranded DNA antibodies. He was treated with high-dose methylprednisolone and mycophenolate mofetil for lupus nephritis and with penicillin for syphilis. After 2 months of therapy, his proteinuria resolved, and his renal function and C4 level normalised. This case illustrates that syphilis infection can be a mimicker of lupus nephritis. A literature review suggests that ful-house nephropathy may occur independently of lupus nephritis and may or may not develop into SLE.


Assuntos
Glomerulonefrite Membranosa , Lúpus Eritematoso Sistêmico , Nefrite Lúpica , Sífilis , Adulto , Anticorpos Antinucleares , Glomerulonefrite Membranosa/diagnóstico , Glomerulonefrite Membranosa/tratamento farmacológico , Humanos , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/diagnóstico , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Nefrite Lúpica/complicações , Nefrite Lúpica/diagnóstico , Nefrite Lúpica/tratamento farmacológico , Masculino , Adulto Jovem
8.
BMJ Case Rep ; 14(8)2021 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-34340988

RESUMO

A 42 year-old Caribbean woman with, known type 2 diabetes, was admitted with worsening fatigue, arthritis and rashes. She was diagnosed with multisystem systemic lupus erythematosus and was initially treated with systemic steroids. During this admission, she had persistently elevated capillary glucose levels with insulin requirements over 8 U/kg/day that still did not control her blood glucose levels. Due to her profound hyperglycaemia, serum samples of fasting insulin, C-peptide, paired with blood glucose were analysed, which confirmed significant hyperinsulinaemia. Further analysis confirmed the presence of insulin receptor antibodies consistent with type B insulin resistance.She was started on intravenous cyclophosphamide (Euro-Lupus regimen) along with continuous glucose monitoring system. After completing her six cycles of cyclophosphamide, she no longer required insulin treatment. The goal of therapy for our patient with confirmed type B insulin resistance was to manage hyperglycaemia with high doses of insulin until autoantibodies were eliminated with immunosuppressive therapy.


Assuntos
Diabetes Mellitus Tipo 2 , Resistência à Insulina , Lúpus Eritematoso Sistêmico , Adulto , Glicemia , Automonitorização da Glicemia , Região do Caribe , Ciclofosfamida/uso terapêutico , Feminino , Humanos , Imunossupressores/uso terapêutico , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/diagnóstico , Lúpus Eritematoso Sistêmico/tratamento farmacológico
9.
J Card Surg ; 36(10): 3968-3970, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34351022

RESUMO

We report the case of a young woman who underwent cardiac transplantation from systemic lupus erythematosus affected donor and who developed a type A aortic dissection limited only to the graft aortic wall 9 years after.


Assuntos
Aneurisma Dissecante , Transplante de Coração , Lúpus Eritematoso Sistêmico , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/etiologia , Aneurisma Dissecante/cirurgia , Aorta , Feminino , Humanos , Lúpus Eritematoso Sistêmico/complicações
10.
Chirurgia (Bucur) ; 116(eCollection): 1-6, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34463244

RESUMO

Bartter's syndrome (BS) is an inherited renal tubular disorder characterized by hypochloremia, hypokalemia, metabolic alkalosis. Prognosis of Bartter's syndrome depends on the severity of the receptor dysfunction. In many cases the prognosis is good and patients are able to have fairly normal lives. Systemic lupus erythematosus (SLE) is a chronic autoimmune disease of unknown cause that can affect virtually any organ of the body. The prognosis of SLE is quite variable, depending on the severity of the disease, the clinical course and organs involved. The last decades, there is a marked improvement in patient survival due to earlier diagnosis and treatment. Despite these improvements, patients with SLE still have higher mortality rates ranging from two to five times higher than that of the general population. Leishmaniasis is a disease caused by an intracellular protozoan parasite transmitted by the bite of a female phlebotomine sandfly. We report herein the case of a 22-year-old man with Bartter's syndrome (BS) and Systemic lupus erythematosus (SLE), who was hospitalized in the clinic of internal medicine because of Leishmaniasis. In the third day of his hospitalization the patient underwent Hartmann's operation for perforation located on descending colon. Management of patients with many severe diseases is very difficult for medical professionals.


Assuntos
Síndrome de Bartter , Leishmaniose , Lúpus Eritematoso Sistêmico , Adulto , Colo , Feminino , Humanos , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/diagnóstico , Masculino , Resultado do Tratamento , Adulto Jovem
11.
BMJ Case Rep ; 14(8)2021 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-34417246

RESUMO

A 27-year-old woman presented with a history of excessive hair loss, loss of appetite, loss of weight, amenorrhoea and loss of axillary and pubic hair for 6 months followed by fever and vomiting for 5 months and abdominal pain for 1 month. During the course of her illness, the patient developed intravascular haemolysis as evidenced by a drop in haemoglobin, indirect hyperbilirubinaemia, raised lactate dehydrogenase (LDH) and haemoglobinuria. Examination revealed severe pallor, mild icterus, elevated jugular venous pressure, generalised lymphadenopathy and hyperpigmentation. Investigations revealed severe anaemia, indirect hyperbilirubinaemia, raised LDH and negative Coombs test. Antinuclear antibody and anti-dsDNA, anti-Sm and anti-SS-A/Ro antibodies were positive and complement C3 was low. The patient was diagnosed to have systemic lupus erythematosus and immune-mediated intravascular haemolysis and was treated with prednisolone and hydroxychloroquine. Haemolysis resolved following steroid therapy, and during follow-up, there were no further episodes of haemolysis.


Assuntos
Hemólise , Lúpus Eritematoso Sistêmico , Adulto , Teste de Coombs , Feminino , Humanos , Hidroxicloroquina/uso terapêutico , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Prednisolona/uso terapêutico
12.
BMJ Case Rep ; 14(8)2021 Aug 24.
Artigo em Inglês | MEDLINE | ID: mdl-34429285

RESUMO

A 28-year-old Southeast Asian non-pregnant woman with asthma and prior cholecystectomy presented to the emergency department with acute watery diarrhoea, intermittent abdominal pain and vomiting. Apart from abdominal tenderness, the rest of the physical examination was unremarkable. She had leucocytosis, alkaline phosphatase elevation and exudative ascites. Radiological imaging ruled out biliary leak and was only significant for circumferential small and large bowel thickening. Upper endoscopy and colonoscopy showed normal duodenal and colonic mucosae. Both infectious and malignancy workup were also unremarkable. Bereft of other systemic symptoms, autoimmune pathology was initially deemed unlikely; however, autoimmune workup revealed positive antinuclear antibody, double-stranded DNA, anti-Smith antibody, antinuclear ribonucleoprotein and hypocomplementaemia. With multidisciplinary collaboration, the patient was initiated on high-dose steroids, which dramatically improved her symptoms. She was discharged home with a steroid taper, and at 3 months of follow-up with her rheumatologist, she was continued on steroids and hydroxychloroquine.


Assuntos
Enterite , Lúpus Eritematoso Sistêmico , Dor Abdominal , Adulto , Ascite , Diarreia , Enterite/diagnóstico , Enterite/tratamento farmacológico , Feminino , Humanos , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/diagnóstico , Lúpus Eritematoso Sistêmico/tratamento farmacológico
13.
J Trop Pediatr ; 67(3)2021 07 02.
Artigo em Inglês | MEDLINE | ID: mdl-34345902

RESUMO

OBJECTIVES: The purpose of the study was to determine the clinical features of NLE and to compare the neonatal outcomes between newborns born to pregnant women with SLE and healthy pregnant women. METHODS: We conducted a retrospective cohort analysis between 2007 and 2019 in a tertiary referral hospital in Thailand. A total of 118 pregnant women with SLE with 132 neonates compared with 264 randomly selected healthy pregnant women. RESULTS: The median (interquartile range) gestational age and birth weight of 132 neonates born to women with SLE were 37 (35-38) weeks and 2687 g (2045-3160 g), respectively. The clinical features of NLE infants were hemolytic anemia (8%), thrombocytopenia (2.7%) and hyperbilirubinemia (5.3%). There was no neonate with a congenital complete heart block or skin lesion. Moreover, logistic regression analysis found that neonates born to women with SLE increased the risk of preterm birth [odd ratio (OR) 8.87, 95% confidence interval (95% CI) 4.32-18.21, p < 0.001], low birth weight (OR 10.35, 95% CI 5.08-21.08, p < 0.001), birth asphyxia (OR 2.91, 95% CI 1.26-6.73, p = 0.011) and NICU admission (OR 4.26, 95% CI 2.44-7.42, p < 0.001). SLE disease activity and corticosteroid and azathioprine usage were associated with preterm delivery in pregnant women with SLE. CONCLUSION: The major clinical features of NLE patients were hematologic and hepatobiliary abnormalities in our study. Pregnancies with SLE dramatically increased the risk of preterm delivery and neonatal complications. LAY SUMMARY: Neonatal lupus erythematosus (NLE) is the consequence of the transplacental passage of autoantibodies to newborns during pregnancy. The clinical features of NLE infants in our study were hemolytic anemia (8%), thrombocytopenia (2.7%) and hyperbilirubinemia (5.3%). There was no neonate with a congenital complete heart block or skin lesion. We also compared the neonatal outcomes between 118 pregnant women with SLE and 264 randomly selected healthy pregnant women. Our study found that the neonates born to women with SLE increased the risk of preterm birth, low birth weight, birth asphyxia and NICU admission. Moreover, SLE disease activity and corticosteroid and azathioprine usage were associated with preterm delivery in pregnant women with SLE.


Assuntos
Lúpus Eritematoso Sistêmico , Complicações na Gravidez , Nascimento Prematuro , Feminino , Humanos , Lactente , Recém-Nascido , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/diagnóstico , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Gravidez , Complicações na Gravidez/epidemiologia , Resultado da Gravidez/epidemiologia , Gestantes , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/etiologia , Estudos Retrospectivos , Tailândia/epidemiologia
14.
J Int Med Res ; 49(7): 3000605211029766, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34334006

RESUMO

A 28-year-old female patient was hospitalized primarily because of "intermittent fever for 28 days aggravated by systemic rashes, oral ulcer, and edema in both eyelids for 5 days." During treatment, convulsions and loss of consciousness occurred. Magnetic resonance imaging (MRI) of the head revealed an abnormal signal with shadows in the bilateral frontal, parietal, temporal, and occipital lobes; cerebellar hemispheres; and basal nodes, with high signal intensity on T2 weighted imaging (T2WI), on fluid-attenuated inversion-recovery, and of the apparent diffusion coefficient and low signal intensity on T1WI and diffusion weighted imaging. Therefore, the patient was diagnosed with systemic lupus erythematosus (SLE) with reversible posterior encephalopathy syndrome (RPES). Intravenous high-dose methylprednisolone and cyclophosphamide were administered for blood pressure control, which effectively controlled the disease. Therefore, when patients with SLE and hypertension or renal insufficiency or those receiving high-dose methylprednisolone or immunosuppressants suddenly present with neurologic abnormalities, a diagnosis of RPES must be considered, and head MRI is the first choice for diagnosis of this disease. In terms of treatment, the blood pressure should be quickly controlled, and the primary disease should be aggressively treated.


Assuntos
Encefalopatias , Lúpus Eritematoso Sistêmico , Síndrome da Leucoencefalopatia Posterior , Adulto , Imagem de Difusão por Ressonância Magnética , Feminino , Humanos , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/diagnóstico por imagem , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Imageamento por Ressonância Magnética , Síndrome da Leucoencefalopatia Posterior/complicações , Síndrome da Leucoencefalopatia Posterior/diagnóstico por imagem , Síndrome da Leucoencefalopatia Posterior/tratamento farmacológico
15.
Tuberk Toraks ; 69(2): 125-132, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34256502

RESUMO

Introduction: The objective of this study was to investigate the clinical and radiological features and pulmonary function tests (PFTs) in patients with the pulmonary involvement of systemic rheumatic diseases (SRDs). Materials and Methods: This study was conducted as a retrospective and single-center study. Patients diagnosed with an SRD and admitted/referred to the department of chest diseases of our hospital between January 2015 and June 2019 were enrolled. All patients were evaluated using High Resolution Computed Tomography (HRCT) and PFT. Result: This study included 68 patients (15 males, 53 females) with a mean age of 62.38 ± 12.4 years. Forty-one (60.2%) patients had diagnosis of rheumatoid arthritis (RA), 10 (14.7%) patients had sjögren's syndrome (SS), 8 (11.7%) patients had systemic lupus erythematosus (SLE), 6 (8.8%) patients had systemic sclerosis (SSc), and 3 (4.4%) patients had mixed connective tissue disease (MCTD). While RA, SLE, MCTD patients were more commonly symptomatic, most of the SS patients were asymptomatic. Overall, 30 (44.1%) patients had normal PFT. Although 30 (%44.1) patients were asymptomatic and 30 (%44.1) patients had normal PFTs, at least one imaging finding was found in all patients according to HRCT imaging. "Bronchiectasis" was the most common HRCT finding in RA, followed by "chronic fibrotic changes" and "peribronchial thickening". "Chronic fibrotic changes" and "peribronchial thickening" were the most common changes in SS. Similarly, "peribronchial thickening" was the most common radiologic finding in SLE. As for SSc, "chronic fibrotic changes", "interlobular septal thickening", and "pleural effusion" were the most common radiologic findings. Conclusions: Pulmonary involvement in systemic rheumatic diseases can occur with various radiological images even in asymptomatic patients. PFTs can be normal as well as an obstructive, restrictive or mixed pattern can be seen. Heterogeneous and combined HRCT findings can be seen in SRD patients.


Assuntos
Artrite Reumatoide/complicações , Bronquiectasia/diagnóstico , Pneumopatias/diagnóstico , Lúpus Eritematoso Sistêmico/complicações , Testes de Função Respiratória/métodos , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Bronquiectasia/complicações , Bronquiectasia/diagnóstico por imagem , Feminino , Humanos , Pneumopatias/complicações , Pneumopatias/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade
16.
Zhonghua Nei Ke Za Zhi ; 60(8): 744-750, 2021 Aug 01.
Artigo em Chinês | MEDLINE | ID: mdl-34304451

RESUMO

Objective: To investigate the clinical characteristics and risk factors for osteonecrosis (ON) in patients with systemic lupus erythematosus (SLE). Methods: This is a case-control study. A total of 118 patients diagnosed with SLE complicated with ON (study group) were retrospectively analyzed between 2014 and 2019. Gender, age, and course matched 118 SLE patients without ON were selected as controls. Clinical manifestations, laboratory findings, medical history, and treatments were recorded and analyzed. Results: Among 118 patients, the male to female ratio was 20 to 98 with a median age of 27 years and course of disease 1-168 months. Compared with the control group, the study group presented a longer cumulative duration of glucocorticoid therapy [36.5 (0-168) months vs. 19.0(0-168) months on average, P<0.05], a higher incidence of osteoporosis (29.7% vs. 4.2%, P<0.001), a higher frequency of immune-suppressive therapy (83.9% vs. 64.4%, P=0.035), more organs involveed [median 2 (0-5) vs. 1 (0-4)], and a higher SLE disease activity index (SLEDAI) (14.22±7.40 vs. 11.63±6.11, P<0.05) in univariate logistic regression. The control group had a higher rate of positive Coombs test (39.8% vs. 7.6%, P<0.05). No statistical difference on methylprednisolone (MP) pulse therapy (P>0.05) was observed. Multivariate logistic regression suggested that SLEDAI (OR= 1.070, 95%CI 1.026-1.116, P<0.005), osteoporosis (OR=10.668, 95%CI 3.911-29.103, P<0.001) and a positive Coombs test(OR=0.492, 95%CI 0.266-0.910, P<0.05) were related to the development of ON in SLE patients. Conclusion: A higher disease activity and the presence of osteoporosis are associated with an increased risk of ON in patients with SLE, and positive Coombs test seems a protective factor of ON.


Assuntos
Lúpus Eritematoso Sistêmico , Osteonecrose , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Lúpus Eritematoso Sistêmico/epidemiologia , Masculino , Osteonecrose/epidemiologia , Osteonecrose/etiologia , Estudos Retrospectivos , Fatores de Risco
17.
Autoimmun Rev ; 20(9): 102887, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34237422

RESUMO

OBJECTIVE: Cardiovascular (CV) morbidity is a well-established problem in systemic lupus erythematosus (SLE). Antimalarial (AM) therapy has been seen as a potential atheroprotective agent. The aim was to assess the impact of AM therapy on traditional and novel atherosclerosis (AT) biomarkers in patients with SLE. METHODS: A search of MEDLINE, EMbase, and Cochrane library for studies evaluating the impact of AM on AT biomarkers in SLE was conducted. Data extraction included serum, functional and structural traditional and novel biomarkers. A narrative synthesis of the findings and a meta-analysis with random effects was conducted estimating mean differences (MD), OR, HR and 95% CIs. RESULTS: The search strategy produced 148 articles, of which 64 were extracted for analysis. The MD in VLDL-cholesterol (-10.29, 95% CI -15.35, 5.24), triglycerides (-15.68, 95% CI -27.51, -3.86), and diastolic BP (-3.42, 95% CI -5.62, -1.23) differed significantly in patients on AM therapy compared with those without AM therapy. Patients on AM had a lower prevalence and incidence of diabetes mellitus than patients not on AM (HR: 0.39, 95% CI 0.17, 0.88). HCQ use was associated with lower blood pressure (BP) variability. Structural markers like carotid intima-media thickness (IMT), carotid plaque (CP) and coronary artery calcification (CAC) were not influenced by AM. For functional markers like endothelial and arterial stiffness the benefit was unclear. The GRADE approach showed a very low-to-low quality of evidence (QoE) per outcome. CONCLUSIONS: There is some evidence on the associations between AM therapy and some AT markers. However, the data on which this conclusion was based was of low to very low evidence.


Assuntos
Antimaláricos , Aterosclerose , Lúpus Eritematoso Sistêmico , Antimaláricos/uso terapêutico , Aterosclerose/diagnóstico , Aterosclerose/epidemiologia , Biomarcadores , Espessura Intima-Media Carotídea , Humanos , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/diagnóstico , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Fatores de Risco
18.
Sultan Qaboos Univ Med J ; 21(2): e244-e252, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34221472

RESUMO

Objectives: This study was conducted to assess pregnancy outcomes in women with systemic lupus erythematosus (SLE) in Oman. Methods: A retrospective cohort study of 149 pregnancies in 98 women with SLE was conducted over 10 years to evaluate the impact of clinical and laboratory parameters in predicting adverse pregnancy outcomes. Results: Mean maternal age was 30.6 ± 5 years ranging from 20-44 years, and the mean disease duration was 10 ± 5 years, ranging from 2-27 years. The most common maternal manifestations were joint pain in 36 (24.2%), lupus nephritis (LN) in 18 (12.08%), preeclampsia in 11 (7.4%), eclampsia in three (2%) and lupus flare in one pregnancy. The live birth rate was 139 (93.3%) with a mean gestational age of 36 ± 2 weeks ranging from 26-40 weeks. In total, 55 (39.6%) were preterm deliveries, six (4%) pregnancies ended in miscarriage, and four (2.7%) resulted in intrauterine fetal death. Intrauterine growth restriction was observed in 49 babies (35%). A significant association was found between hypertension (HTN) and miscarriage (P = 0.024) and preterm birth (P = 0.019). In addition, HTN was positively associated with preeclampsia (P = 0.004) and LN (P = 0.048). Antiphospholipid syndrome impacted preterm birth (P = 0.013) and postpartem haemorrhage (PPH) (P = 0.027) and was found to be a significant predictor for women developing deep vein thrombosis and pulmonary embolism (P <0.001 for both). Conclusion: Despite potential complications, most pregnancies complicated by SLE in Oman result in good outcomes. Adverse pregnancy outcomes, however, may still occur in women with SLE. In women with SLE, pregnancy planning, careful antenatal monitoring and efficient SLE treatment need to be undertaken for successful pregnancy outcomes.


Assuntos
Lúpus Eritematoso Sistêmico/complicações , Complicações na Gravidez/etiologia , Resultado da Gravidez/epidemiologia , Nascimento Prematuro/etiologia , Adulto , Anticorpos Antifosfolipídeos/uso terapêutico , Cesárea , Parto Obstétrico/métodos , Feminino , Humanos , Lactente , Recém-Nascido , Lúpus Eritematoso Sistêmico/congênito , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Lúpus Eritematoso Sistêmico/epidemiologia , Nefrite Lúpica/complicações , Omã/epidemiologia , Gravidez , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/prevenção & controle , Nascimento Prematuro/epidemiologia , Cuidado Pré-Natal/métodos , Estudos Retrospectivos , Exacerbação dos Sintomas
20.
Arq Bras Oftalmol ; 84(4): 395-401, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34287516

RESUMO

Lupus retinopathy is a clinical manifestation of systemic lupus erythematosus in the visual system. It is generally asymptomatic; however, it can become a threatening condition. It is closely associated with the inflammatory activity and higher mortality of systemic lupus erythematosus. Lupus retinopathy has several different clinical presentations, such as lupus microangiopathy, vascular occlusion, vasculitis, hypertensive retinopathy associated with lupus nephritis, and autoimmune retinopathy. Although the prevalence and associated factors of lupus retinopathy have been well defined in some parts of the world, there are no data from Latin America, including Brazil. As lupus retinopathy is generally asymptomatic, without a routine fundoscopy, it has been probably underestimated. This review is intended to discuss the epidemiology and risk factors of lupus retinopathy.


Assuntos
Lúpus Eritematoso Sistêmico , Nefrite Lúpica , Doenças Retinianas , Humanos , América Latina , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/epidemiologia , Nefrite Lúpica/complicações , Nefrite Lúpica/epidemiologia , Fatores de Risco
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