RESUMO
AIM: To describe the clinical manifestations, evolution and treatment of patients with rheumatoid vasculitis. METHODS: Retrospective study (1975-2017) of all patients diagnosed with rheumatoid vasculitis in 2 Rheumatology Services. RESULTS: A total of 41 patients were included, 17 (41.5%) males and 24 (58.5%) females; mean age at diagnosis: 67 ± 9 years; duration of rheumatoid arthritis: 10 ± 8.3 years. Most patients had erosive disease, 33 (80%). Rheumatoid factor and anticitrullinated antibodies were positive in all patients. Constitutional symptoms were present in 30 (73%) patients and extra-articular manifestations in 17 (41%) patients. The clinical manifestations of rheumatoid vasculitis were mainly: cutaneous 28 (68%), and polyneuritis 26 (63%). All patients were treated with glucocorticoids. An immunosuppressant was associated in 24 (58.5%) patients. Five (12%) patients were treated with the association of glucocorticoids and a biologic treatment. The mortality after 2years of follow-up was 33%, the most common causes being infection and progression of the vasculitis. The frequency of rheumatoid vasculitis has decreased over the last decade. CONCLUSION: The clinical manifestations of rheumatoid vasculitis were similar to previous studies. The frequency of rheumatoid vasculitis seems to decrease. However, the clinical picture and severity remains invariable.
Assuntos
Artrite Reumatoide , Vasculite Reumatoide , Vasculite , Artrite Reumatoide/diagnóstico , Artrite Reumatoide/tratamento farmacológico , Artrite Reumatoide/epidemiologia , Feminino , Humanos , Imunossupressores/uso terapêutico , Masculino , Estudos Retrospectivos , Vasculite Reumatoide/diagnóstico , Vasculite Reumatoide/epidemiologia , Vasculite Reumatoide/etiologia , Vasculite/diagnóstico , Vasculite/epidemiologiaRESUMO
Adult-onset Still's disease (AOSD) is often refractory to standard therapy. Anakinra (ANK), an interleukin-1 receptor antagonist, has demonstrated efficacy in single cases and small series of AOSD. We assessed the efficacy of ANK in a series of AOSD patients. Multicenter retrospective open-label study. ANK was used due to lack of efficacy to standard synthetic immunosuppressive drugs and in some cases also to at least 1 biologic agent. Forty-one patients (26 women/15 men) were recruited. They had a mean age of 34.4 ± 14 years and a median [interquartile range (IQR)] AOSD duration of 3.5 [2-6] years before ANK onset. At that time the most common clinical features were joint manifestations 87.8%, fever 78%, and cutaneous rash 58.5%. ANK yielded rapid and maintained clinical and laboratory improvement. After 1 year of therapy, the frequency of joint and cutaneous manifestations had decreased to 41.5% and to 7.3% respectively, fever from 78% to 14.6%, anemia from 56.1% to 9.8%, and lymphadenopathy from 26.8% to 4.9%. A dramatic improvement of laboratory parameters was also achieved. The median [IQR] prednisone dose was also reduced from 20 [11.3-47.5] mg/day at ANK onset to 5 [0-10] at 12 months. After a median [IQR] follow-up of 16 [5-50] months, the most important side effects were cutaneous manifestations (n = 8), mild leukopenia (n = 3), myopathy (n = 1), and infections (n = 5). ANK is associated with rapid and maintained clinical and laboratory improvement, even in nonresponders to other biologic agents. However, joint manifestations are more refractory than the systemic manifestations.
Assuntos
Imunossupressores/uso terapêutico , Proteína Antagonista do Receptor de Interleucina 1/uso terapêutico , Doença de Still de Início Tardio/tratamento farmacológico , Adulto , Quimioterapia Combinada , Feminino , Humanos , Imunossupressores/administração & dosagem , Proteína Antagonista do Receptor de Interleucina 1/administração & dosagem , Masculino , Pessoa de Meia-Idade , Prednisona/administração & dosagem , Estudos RetrospectivosRESUMO
OBJETIVO: Analizar las características clínicas, tratamiento y evolución de la vasculitis reumatoide. MÉTODOS: Estudio retrospectivo (1975-2017). Pacientes con vasculitis reumatoide diagnosticados en 2 servicios de reumatología. RESULTADOS: Se incluyó a 41 pacientes: 17 (41,5%) varones y 24 (58,5%) mujeres; con una edad media al diagnóstico de 67 ± 9 años y una duración de la artritis reumatoide de 10 ± 8,3 años. La artritis fue erosiva en 33 (80%) pacientes. Tanto el factor reumatoide como los anticuerpos antipéptido citrulinados fueron positivos en todos los casos. Los síntomas constitucionales se presentaron en 30 pacientes (73%) y las manifestaciones extrarticulares en 17 (41%). Las manifestaciones clínicas más frecuentes fueron: cutáneas 28 (68%) y neuropatía periférica 26 (63%). Todos los pacientes fueron tratados con glucocorticoides. En 24 pacientes (58%) se asoció a un inmunosupresor y 5 (12%) pacientes fueron tratados con fármacos biológicos. La mortalidad a los 2 años de seguimiento fue del 33%. Las principales causas de muerte fueron: la infección y la progresión de la vasculitis reumatoide. La frecuencia de la vasculitis reumatoide disminuyó en la última década. CONCLUSIONES: Las manifestaciones clínicas de la vasculitis reumatoide en España son similares a las descritas. La frecuencia disminuye; sin embargo, el cuadro clínico y la gravedad se mantienen invariables
AIM: To describe the clinical manifestations, evolution and treatment of patients with rheumatoid vasculitis. METHODS: Retrospective study (1975-2017) of all patients diagnosed with rheumatoid vasculitis in 2 Rheumatology Services. RESULTS: A total of 41 patients were included, 17 (41.5%) males and 24 (58.5%) females; mean age at diagnosis: 67 ± 9 years; duration of rheumatoid arthritis: 10 ± 8.3 years. Most patients had erosive disease, 33 (80%). Rheumatoid factor and anticitrullinated antibodies were positive in all patients. Constitutional symptoms were present in 30 (73%) patients and extra-articular manifestations in 17 (41%) patients. The clinical manifestations of rheumatoid vasculitis were mainly: cutaneous 28 (68%), and polyneuritis 26 (63%). All patients were treated with glucocorticoids. An immunosuppressant was associated in 24 (58.5%) patients. Five (12%) patients were treated with the association of glucocorticoids and a biologic treatment. The mortality after 2years of follow-up was 33%, the most common causes being infection and progression of the vasculitis. The frequency of rheumatoid vasculitis has decreased over the last decade. CONCLUSION: The clinical manifestations of rheumatoid vasculitis were similar to previous studies. The frequency of rheumatoid vasculitis seems to decrease. However, the clinical picture and severity remains invariable
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Vasculite Reumatoide/diagnóstico , Vasculite Reumatoide/terapia , Progressão da Doença , Estudos Retrospectivos , Fator Reumatoide/análise , Fator Reumatoide/efeitos dos fármacos , Anticorpos Antiproteína Citrulinada/análise , Glucocorticoides/uso terapêutico , Terapia Biológica , Anticorpos Anticitoplasma de Neutrófilos/análise , ImunossupressoresAssuntos
Artrite Infecciosa/diagnóstico , Condrocalcinose/complicações , Infecções por Enterobacteriaceae/diagnóstico , Escherichia/isolamento & purificação , Gota/complicações , Articulação do Joelho/microbiologia , Articulação do Ombro/microbiologia , Idoso de 80 Anos ou mais , Artrite Infecciosa/etiologia , Infecções por Enterobacteriaceae/etiologia , Infecções por Escherichia coli/diagnóstico , Infecções por Escherichia coli/etiologia , Feminino , HumanosRESUMO
No disponible
Assuntos
Humanos , Feminino , Idoso de 80 Anos ou mais , Artrite Infecciosa/tratamento farmacológico , Artrite Infecciosa , Gota/complicações , Gota/diagnóstico , Gota/tratamento farmacológico , Vancomicina/uso terapêutico , Fatores de Risco , Artrite Infecciosa/complicações , Artrite Infecciosa/fisiopatologia , Staphylococcus aureus/isolamento & purificação , Comorbidade , Imageamento por Ressonância Magnética , Irrigação Terapêutica/métodos , Condrocalcinose/complicações , Condrocalcinose/fisiopatologia , Condrocalcinose , Enterococcus faecium/isolamento & purificaçãoAssuntos
Infecções por Parvoviridae/virologia , Parvovirus B19 Humano/isolamento & purificação , Derrame Pleural/virologia , Adulto , Anemia/virologia , Artralgia/virologia , Colestase/virologia , Humanos , Masculino , Infecções por Parvoviridae/diagnóstico , Derrame Pleural/diagnóstico por imagem , RadiografiaRESUMO
No disponible
Assuntos
Humanos , Doença de Still de Início Tardio/tratamento farmacológico , Terapia Biológica/métodos , Anticorpos Monoclonais/uso terapêuticoRESUMO
No disponible
Assuntos
Humanos , Masculino , Adulto , Derrame Pleural/complicações , Infecções por Parvoviridae/complicações , Parvovirus/patogenicidadeRESUMO
No disponible