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de Abreu MM, Monticielo OA, Fernandes V, Rodrigues DLAS, da Silva CAL, Maiorano AC, Beserra FDS, Lamarão FRM, de Veras BMG, David N, Araújo M, Alves MCR, Stocco MA, Lima FM, Borret E, Gasparin AA, Chapacais GF, Bulbol GA, da Silva Lima D, da Silva NJM, Freitas MMC, Bica BERG, de Lima DSN, das Chagas Medeiros MM. Characterization of the patterns of care, access, and direct cost of systemic lupus erythematosus in Brazil: findings from the Macunaíma study. Adv Rheumatol 2024; 64:30. [PMID: 38641825 DOI: 10.1186/s42358-024-00369-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 03/30/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND A cost of illness (COI) study aims to evaluate the socioeconomic burden that an illness imposes on society as a whole. This study aimed to describe the resources used, patterns of care, direct cost, and loss of productivity due to systemic lupus erythematosus (SLE) in Brazil. METHODS This 12-month, cross-sectional, COI study of patients with SLE (ACR 1997 Classification Criteria) collected data using patient interviews (questionnaires) and medical records, covering: SLE profile, resources used, morbidities, quality of life (12-Item Short Form Survey, SF-12), and loss of productivity. Patients were excluded if they were retired or on sick leave for another illness. Direct resources included health-related (consultations, tests, medications, hospitalization) or non-health-related (transportation, home adaptation, expenditure on caregivers) hospital resources.Costs were calculated using the unit value of each resource and the quantity consumed. A gamma regression model explored cost predictors for patients with SLE. RESULTS Overall, 300 patients with SLE were included (92.3% female,mean [standard deviation (SD)] disease duration 11.8 [7.9] years), of which 100 patients (33.3%) were on SLE-related sick leave and 46 patients (15.3%) had stopped schooling. Mean (SD) travel time from home to a care facility was 4.4 (12.6) hours. Antimalarials were the most commonly used drugs (222 [74.0%]). A negative correlation was observed between SF-12 physical component and SLE Disease Activity Index (- 0.117, p = 0.042), Systemic Lupus International CollaboratingClinics/AmericanCollegeofRheumatology Damage Index (- 0.115, p = 0.046), medications/day for multiple co-morbidities (- 0.272, p < 0.001), SLE-specific drugs/day (- 0.113, p = 0.051), and lost productivity (- 0.570, p < 0.001). For the mental component, a negative correlation was observed with medications/day for multiple co-morbidities (- 0.272, p < 0.001), SLE-specific medications/day (- 0.113, p = 0.051), and missed appointments (- 0.232, p < 0.001). Mean total SLE cost was US$3,123.53/patient/year (median [interquartile range (IQR)] US$1,618.51 [$678.66, $4,601.29]). Main expenditure was medication, with a median (IQR) cost of US$910.62 ($460, $4,033.51). Mycophenolate increased costs by 3.664 times (p < 0.001), and inflammatory monitoring (erythrocyte sedimentation rate or C-reactive protein) reduced expenditure by 0.381 times (p < 0.001). CONCLUSION These results allowed access to care patterns, the median cost for patients with SLE in Brazil, and the differences across regions driven by biological, social, and behavioral factors. The cost of SLE provides an updated setting to support the decision-making process across the country.
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Affiliation(s)
- Mirhelen Mendes de Abreu
- Faculdade de Medicina, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, R. Prof. Rodolpho Paulo Rocco, 255- Cidade Universitária-, RJ 21941-617, Rio de Janeiro, Brazil.
- MAPEAR Laboratory, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Odirlei Andre Monticielo
- Serviço de Reumatologia do Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | | | | | | | | | | | | | | | | | - Marcelly Cristinny Ribeiro Alves
- Faculdade de Medicina, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, R. Prof. Rodolpho Paulo Rocco, 255- Cidade Universitária-, RJ 21941-617, Rio de Janeiro, Brazil
| | - Matheus Amaral Stocco
- Faculdade de Medicina, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, R. Prof. Rodolpho Paulo Rocco, 255- Cidade Universitária-, RJ 21941-617, Rio de Janeiro, Brazil
| | - Fernando Mello Lima
- Faculdade de Medicina, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, R. Prof. Rodolpho Paulo Rocco, 255- Cidade Universitária-, RJ 21941-617, Rio de Janeiro, Brazil
| | - Emilly Borret
- Faculdade de Medicina, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, R. Prof. Rodolpho Paulo Rocco, 255- Cidade Universitária-, RJ 21941-617, Rio de Janeiro, Brazil
| | - Andrese Aline Gasparin
- Serviço de Reumatologia do Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Gustavo Flores Chapacais
- Serviço de Reumatologia do Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | | | | | | | - Blanca Elena Rios Gomes Bica
- Faculdade de Medicina, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, R. Prof. Rodolpho Paulo Rocco, 255- Cidade Universitária-, RJ 21941-617, Rio de Janeiro, Brazil
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Brufatto MZ, Lanças SHS, de Albuquerque Pedrosa Fernandes T, Sallum AME, Campos LMA, Sakamoto AP, Terreri MT, Sztajnbok FR, Bica BERG, Ferriani VPL, de Carvalho LM, Silva CAA, Saad-Magalhaes C. Childhood-onset systemic lupus erythematosus (cSLE) and malignancy: a nationwide multicentre series review. Adv Rheumatol 2024; 64:13. [PMID: 38321580 DOI: 10.1186/s42358-024-00353-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 01/26/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND Increased malignancy frequency is well documented in adult-systemic lupus erythematosus (SLE), but with limited reports in childhood-onset SLE (cSLE) series. We explored the frequency of malignancy associated with cSLE, describing clinical and demographic characteristics, disease activity and cumulative damage, by the time of malignancy diagnosis. METHOD A retrospective case-notes review, in a nationwide cohort from 27 Pediatric Rheumatology centres, with descriptive biopsy-proven malignancy, disease activity/damage accrual, and immunosuppressive treatment were compiled in each participating centre, using a standard protocol. RESULTS Of the 1757 cSLE cases in the updated cohort, 12 (0.7%) developed malignancy with median time 10 years after cSLE diagnosis. There were 91% females, median age at cSLE diagnosis 12 years, median age at malignancy diagnosis 23 years. Of all diagnosed malignancies, 11 were single-site, and a single case with concomitant multiple sites; four had haematological (0.22%) and 8 solid malignancy (0.45%). Median (min-max) SLEDAI-2 K scores were 9 (0-38), median (min-max) SLICC/ACR-DI (SDI) score were 1 (1-5) Histopathology defined 1 Hodgkin's lymphoma, 2 non-Hodgkin's lymphoma, 1 acute lymphoblastic leukaemia; 4 gastrointestinal carcinoma, 1 squamous cell carcinoma of the tongue and 1 anal carcinoma; 1 had sigmoid adenocarcinoma and 1 stomach carcinoid; 3 had genital malignancy, being 1 vulvae, 1 cervix and 1 vulvae and cervix carcinomas; 1 had central nervous system oligodendroglioma; and 1 testicle germ cell teratoma. CONCLUSION Estimated malignancy frequency of 0.7% was reported during cSLE follow up in a multicentric series. Median disease activity and cumulative damage scores, by the time of malignancy diagnoses, were high; considering that reported in adult series.
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Affiliation(s)
- Matheus Zanata Brufatto
- Department of Internal Medicine, Discipline of Rheumatology, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil.
| | - Sean Hideo Shirata Lanças
- Department of Internal Medicine, Discipline of Rheumatology, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | | | - Adriana Maluf Elias Sallum
- Pediatric Rheumatology Unit, Child and Adolescent Institute, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Lucia Maria Arruda Campos
- Pediatric Rheumatology Unit, Child and Adolescent Institute, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Ana Paula Sakamoto
- Pediatric Rheumatology Unit, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Maria Teresa Terreri
- Pediatric Rheumatology Unit, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Blanca Elena Rios Gomes Bica
- Pediatric Rheumatology Unit, Universidade Federal do Rio de Janeiro, Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, Brazil
| | - Virginia Paes Leme Ferriani
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Luciana Martins de Carvalho
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Clovis Artur Almeida Silva
- Adolescent and Pediatric Rheumatology Units, Child and Adolescent Institute HC-FMUSP, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
| | - Claudia Saad-Magalhaes
- Pediatric Rheumatology Unit, Department of Pathology, Botucatu Medical School, Sao Paulo State University (UNESP), Botucatu, São Paulo, Brazil
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Azevedo LGBD, Biancardi AL, Silva RA, Tavares NDC, Abreu MMD, Bica BERG, Moraes HVD. Lupus retinopathy: epidemiology and risk factors. Arq Bras Oftalmol 2021; 84:395-401. [PMID: 34287516 DOI: 10.5935/0004-2749.20210076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 07/02/2020] [Indexed: 11/20/2022] Open
Abstract
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.
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Affiliation(s)
| | - Ana Luiza Biancardi
- Ophthalmology Department, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Renata Alves Silva
- Ophthalmology Department, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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Lopes FPPL, Souza SALD, Bica BERG, da Fonseca LMB, de Azevedo MNL, Gutfilen B. Reduced activation and CD3 lymphocyte recruitment after TNF-inhibitor use: evaluation of clinical and 99mTc-OKT3 scintigraphic response in a patient with juvenile idiopathic arthritis. Rev Bras Reumatol Engl Ed 2017; 57:616-619. [PMID: 29173698 DOI: 10.1016/j.rbre.2015.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 03/01/2015] [Indexed: 06/07/2023] Open
Affiliation(s)
- Flavia Paiva Proença Lobo Lopes
- Universidade Federal do Rio de Janeiro (UFRJ), Faculdade de Medicina, Departamento de Radiologia, Laboratório de Marcação de Células e Moléculas (LMCM), Rio de Janeiro, RJ, Brazil
| | - Sergio Augusto Lopes de Souza
- Universidade Federal do Rio de Janeiro (UFRJ), Faculdade de Medicina, Departamento de Radiologia, Laboratório de Marcação de Células e Moléculas (LMCM), Rio de Janeiro, RJ, Brazil.
| | - Blanca Elena Rios Gomes Bica
- Universidade Federal do Rio de Janeiro (UFRJ), Hospital Universitário Clementino Fraga Filho, Serviço de Reumatologia, Rio de Janeiro, RJ, Brazil
| | - Lea Mirian Barbosa da Fonseca
- Universidade Federal do Rio de Janeiro (UFRJ), Faculdade de Medicina, Departamento de Radiologia, Laboratório de Marcação de Células e Moléculas (LMCM), Rio de Janeiro, RJ, Brazil
| | - Mario Newton Leitão de Azevedo
- Universidade Federal do Rio de Janeiro (UFRJ), Hospital Universitário Clementino Fraga Filho, Serviço de Reumatologia, Rio de Janeiro, RJ, Brazil
| | - Bianca Gutfilen
- Universidade Federal do Rio de Janeiro (UFRJ), Faculdade de Medicina, Departamento de Radiologia, Laboratório de Marcação de Células e Moléculas (LMCM), Rio de Janeiro, RJ, Brazil
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Elabras J, Mello FCDQ, Lupi O, Bica BERG, Papi JADS, França AT. Staphylococcal superantigen-specific IgE antibodies: degree of sensitization and association with severity of asthma. J Bras Pneumol 2017; 42:356-361. [PMID: 27812635 PMCID: PMC5094872 DOI: 10.1590/s1806-37562016000000010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 07/07/2016] [Indexed: 11/21/2022] Open
Abstract
Objective: To determine the presence of staphylococcal superantigen-specific IgE antibodies and degree of IgE-mediated sensitization, as well as whether or not those are associated with the severity of asthma in adult patients. Methods: This was a cross-sectional study involving outpatients with asthma under treatment at a tertiary care university hospital in the city of Rio de Janeiro, Brazil. Consecutive patients were divided into two groups according to the severity of asthma based on the Global Initiative for Asthma criteria: mild asthma (MA), comprising patients with mild intermittent or persistent asthma; and moderate or severe asthma (MSA). We determined the serum levels of staphylococcal toxin-specific IgE antibodies, comparing the results and performing a statistical analysis. Results: The study included 142 patients: 72 in the MA group (median age = 46 years; 59 females) and 70 in the MSA group (median age = 56 years; 60 females). In the sample as a whole, 62 patients (43.7%) presented positive results for staphylococcal toxin-specific IgE antibodies: staphylococcal enterotoxin A (SEA), in 29 (20.4%); SEB, in 35 (24.6%); SEC, in 33 (23.2%); and toxic shock syndrome toxin (TSST), in 45 (31.7%). The mean serum levels of IgE antibodies to SEA, SEB, SEC, and TSST were 0.96 U/L, 1.09 U/L, 1.21 U/L, and 1.18 U/L, respectively. There were no statistically significant differences between the two groups in terms of the qualitative or quantitative results. Conclusions: Serum IgE antibodies to SEA, SEB, SEC, and TSST were detected in 43.7% of the patients in our sample. However, neither the qualitative nor quantitative results showed a statistically significant association with the clinical severity of asthma. Objetivo: Determinar a presença de anticorpos IgE específicos para superantígenos estafilocócicos e o grau de sensibilização mediada por esses, assim como se esses estão associados à gravidade da asma em pacientes adultos. Métodos: Estudo transversal incluindo asmáticos adultos em acompanhamento ambulatorial em um hospital universitário terciário no Rio de Janeiro (RJ). Os pacientes foram alocados consecutivamente em dois grupos de gravidade da asma segundo critérios da Global Initiative for Asthma: asma leve (AL), com asmáticos leves intermitentes ou persistentes, e asma moderada ou grave (AMG). Foram determinados os níveis séricos de anticorpos IgE antitoxinas estafilocócicas, e os resultados foram comparados por análise estatística. Resultados: Foram incluídos 142 pacientes no estudo: 72 no grupo AL (mediana de idade = 46 anos; 59 do sexo feminino) e 70 do grupo AMG (mediana de idade = 56 anos; 60 do sexo feminino). Na amostra geral, 62 pacientes (43,7%) apresentaram resultados positivos para dosagens de anticorpos IgE antitoxinas estafilocócicas: enterotoxina (TX) A, em 29 (20,4%); TXB, em 35 (24,6%); TXC, em 33 (23,2%); e toxic shock syndrome toxin (TSST), em 45 (31,7%). As médias das dosagens séricas de anticorpos IgE específicos anti-TXA, TXB, TXC e TSST foram, respectivamente, de 0,96 U/l, 1,09 U/l, 1,21 U/l, e 1,18 U/l. Não houve diferença estatisticamente significativa dos resultados qualitativos ou quantitativos entre os grupos. Conclusões: A presença de anticorpos IgE séricos anti-TXA, TXB, TXC e TSST, foi detectada em 43,7% nessa amostra de pacientes, mas não houve associação estatisticamente significativa entre seus resultados qualitativos ou quantitativos e gravidade clínica da asma.
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Affiliation(s)
- José Elabras
- . Serviços de Imunologia Clínica e Reumatologia, Hospital Universitário Clementino Fraga Filho - HUCFF - Faculdade de Medicina, Universidade Federal do Rio de Janeiro - UFRJ - Rio de Janeiro (RJ) Brasil.,. Instituto de Doenças do Tórax, Faculdade de Medicina, Universidade Federal do Rio de Janeiro - UFRJ - Rio de Janeiro (RJ) Brasil
| | | | - Omar Lupi
- . Serviços de Imunologia Clínica e Reumatologia, Hospital Universitário Clementino Fraga Filho - HUCFF - Faculdade de Medicina, Universidade Federal do Rio de Janeiro - UFRJ - Rio de Janeiro (RJ) Brasil.,. Serviço de Dermatologia, Hospital Universitário Gaffrée e Guinle, Faculdade de Medicina, Universidade Federal do Estado do Rio de Janeiro - UNIRIO - Rio de Janeiro (RJ) Brasil
| | - Blanca Elena Rios Gomes Bica
- . Serviços de Imunologia Clínica e Reumatologia, Hospital Universitário Clementino Fraga Filho - HUCFF - Faculdade de Medicina, Universidade Federal do Rio de Janeiro - UFRJ - Rio de Janeiro (RJ) Brasil
| | - José Angelo de Souza Papi
- . Serviços de Imunologia Clínica e Reumatologia, Hospital Universitário Clementino Fraga Filho - HUCFF - Faculdade de Medicina, Universidade Federal do Rio de Janeiro - UFRJ - Rio de Janeiro (RJ) Brasil
| | - Alfeu Tavares França
- . Serviços de Imunologia Clínica e Reumatologia, Hospital Universitário Clementino Fraga Filho - HUCFF - Faculdade de Medicina, Universidade Federal do Rio de Janeiro - UFRJ - Rio de Janeiro (RJ) Brasil
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Lima Pinto APF, Silva NA, Osorio CT, Rivera LM, Carneiro S, Ramos-E-Silva M, Gomes Bica BER. Martorell's Ulcer: Diagnostic and Therapeutic Challenge. Case Rep Dermatol 2015; 7:199-206. [PMID: 26351431 PMCID: PMC4560305 DOI: 10.1159/000430884] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Martorell's ulcer is an uncommon ischemic and extremely painful lesion located in the distal portion of the lower limb, resulting from severe systemic and poorly controlled hypertension. It is common in women between 50 and 70 years of age. The diagnosis is clinical and mostly belated, following exclusion of other causes. The response to treatment takes time and is unsatisfactory. A combination of several drugs associated with surgery may be required for wound healing. The authors present a case of Martorell's hypertensive ulcer, with emphasis on the diagnostic and therapeutic difficulties.
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Affiliation(s)
- Ana Paula Frade Lima Pinto
- Sector of Dermatology and Post-Graduation Course, University Hospital and School of Medicine, Federal University of Rio de Janeiro, Brazil
| | - Nelson Araújo Silva
- Sector of Rheumatology and Post-Graduation Course, University Hospital and School of Medicine, Federal University of Rio de Janeiro, Brazil
| | | | - Lina Maria Rivera
- Sector of Rheumatology and Post-Graduation Course, University Hospital and School of Medicine, Federal University of Rio de Janeiro, Brazil
| | - Sueli Carneiro
- Sector of Dermatology and Post-Graduation Course, University Hospital and School of Medicine, Federal University of Rio de Janeiro, Brazil ; Sector of Dermatology, University Hospital and School of Medicine, University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marcia Ramos-E-Silva
- Sector of Dermatology and Post-Graduation Course, University Hospital and School of Medicine, Federal University of Rio de Janeiro, Brazil
| | - Blanca Elena Rios Gomes Bica
- Sector of Rheumatology and Post-Graduation Course, University Hospital and School of Medicine, Federal University of Rio de Janeiro, Brazil
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Lopes FPPL, Souza SALD, Bica BERG, Fonseca LMBD, Azevedo MNLD, Gutfilen B. Reduced activation and CD3 lymphocyte recruitment after TNF-inhibitor use: evaluation of clinical and 99mTc-OKT3 scintigraphic response in a patient with juvenile idiopathic arthritis. Rev Bras Reumatol 2015; 57:S0482-5004(15)00077-7. [PMID: 26255077 DOI: 10.1016/j.rbr.2015.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 11/13/2014] [Accepted: 03/01/2015] [Indexed: 10/23/2022] Open
Affiliation(s)
- Flavia Paiva Proença Lobo Lopes
- Laboratório de Marcação de Células e Moléculas (LMCM), Departamento de Radiologia, Faculdade de Medicina, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brasil
| | - Sergio Augusto Lopes de Souza
- Laboratório de Marcação de Células e Moléculas (LMCM), Departamento de Radiologia, Faculdade de Medicina, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brasil.
| | - Blanca Elena Rios Gomes Bica
- Serviço de Reumatologia, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brasil
| | - Lea Mirian Barbosa da Fonseca
- Laboratório de Marcação de Células e Moléculas (LMCM), Departamento de Radiologia, Faculdade de Medicina, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brasil
| | - Mario Newton Leitão de Azevedo
- Serviço de Reumatologia, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brasil
| | - Bianca Gutfilen
- Laboratório de Marcação de Células e Moléculas (LMCM), Departamento de Radiologia, Faculdade de Medicina, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brasil
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Bica BERG, Moro ALD, Hax V, Nicol NA, Campos GS, Rivera LMS, da Costa AFC, Xavier RM, Monticielo OA. Electroconvulsive therapy as a treatment for refractory neuropsychiatric lupus with catatonia: three case studies and literature review. Lupus 2015; 24:1327-31. [DOI: 10.1177/0961203315585816] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 04/16/2015] [Indexed: 11/15/2022]
Abstract
Neuropsychiatric disorders associated with systemic lupus erythematosus are very common. Treatment generally consists of glucocorticoids and immunosuppressive therapy; however, some cases are unresponsive. Electroconvulsive therapy (ECT) is a recognized treatment modality in psychiatry and is an option for refractory cases of neuropsychiatric lupus. This report describes three cases of neuropsychiatric lupus that improved with ECT after failure of antipsychotics and immunosuppressive therapy. All cases met DSM-5 criteria for catatonia (case 1: agitation, stereotypies, and grimacing; case 2: stupor, mutism, and grimacing; case 3: agitation, mutism, and stereotypies); therefore, ECT was indicated. This case series shows that ECT can be a therapeutic option in patients with neuropsychiatric lupus, especially when associated with catatonia and unresponsive to conventional treatment.
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Affiliation(s)
- B E R G Bica
- Division of Rheumatology, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Brazil
| | - A L D Moro
- Division of Rheumatology, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil
| | - V Hax
- Division of Rheumatology, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil
| | - N A Nicol
- Division of Rheumatology, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Brazil
| | - G S Campos
- Division of Rheumatology, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Brazil
| | - L M S Rivera
- Division of Rheumatology, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Brazil
| | - A F C da Costa
- Division of Rheumatology, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Brazil
| | - R M Xavier
- Division of Rheumatology, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil
| | - O A Monticielo
- Division of Rheumatology, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil
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de Melo EF, Rivera LMS, Quiroz LAD, Bica BERG. [Lipoma arborescens of the knee in a patient with ankylosing spondylitis: case report and literature review]. Rev Bras Reumatol 2015; 55:381-3. [PMID: 25805185 DOI: 10.1016/j.rbr.2013.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 06/05/2013] [Indexed: 10/24/2022] Open
Abstract
Lipoma arborescens (LA) is defined as a villous lipomatous proliferation of the synovial membrane with diffuse substitution of the synovial tissue by mature fat cells. The injury is very rare, involving the knee joint (suprapatellar region) and is associated with degenerative joint disease. We describe the case of a male patient, suffering from ankylosing spondylitis with monoarthritis of the right knee and swelling in suprapatellar region important. The diagnosis of lipoma arborescens was confirmed from the MRI of the right knee.
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Affiliation(s)
- Elisa Fernandes de Melo
- Serviço de Reumatologia, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil.
| | - Lina Maria Saldarriaga Rivera
- Serviço de Reumatologia, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Luis Alberto Delgado Quiroz
- Serviço de Reumatologia, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Blanca Elena Rios Gomes Bica
- Serviço de Reumatologia, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil; Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil.
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Saldarriaga Rivera LM, Fernandes de Melo E, Damião Araujo P, Araujo Silva Filho N, Delgado Quiroz LA, Rios Gomes Bica BE. Peripheral spondyloarthritis in a patient with Noonan's syndrome. Reumatol Clin 2015; 11:112-115. [PMID: 24447602 DOI: 10.1016/j.reuma.2013.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Revised: 09/09/2013] [Accepted: 10/02/2013] [Indexed: 06/03/2023]
Abstract
Noonan's syndrome is an autosomal dominant genetic disorder with high phenotypic variability, characterized mainly by facial dysmorphism, congenital heart disease and short stature. We describe the case of a male patient diagnosed with Noonan's syndrome and peripheral spondyloarthritis, a previously undescribed association in the literature.
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Affiliation(s)
- Lina Maria Saldarriaga Rivera
- Servicio de Reumatología. Hospital Universitario Clementino Fraga Filho, Universidad Federal de Río de Janeiro (HUCFF-UFRJ), Río de Janeiro, Brasil.
| | - Elisa Fernandes de Melo
- Servicio de Reumatología. Hospital Universitario Clementino Fraga Filho, Universidad Federal de Río de Janeiro (HUCFF-UFRJ), Río de Janeiro, Brasil
| | - Priscilla Damião Araujo
- Servicio de Reumatología. Hospital Universitario Clementino Fraga Filho, Universidad Federal de Río de Janeiro (HUCFF-UFRJ), Río de Janeiro, Brasil
| | - Nelson Araujo Silva Filho
- Servicio de Reumatología. Hospital Universitario Clementino Fraga Filho, Universidad Federal de Río de Janeiro (HUCFF-UFRJ), Río de Janeiro, Brasil
| | - Luis Alberto Delgado Quiroz
- Servicio de Reumatología. Hospital Universitario Clementino Fraga Filho, Universidad Federal de Río de Janeiro (HUCFF-UFRJ), Río de Janeiro, Brasil
| | - Blanca Elena Rios Gomes Bica
- Servicio de Reumatología. Hospital Universitario Clementino Fraga Filho, Universidad Federal de Río de Janeiro (HUCFF-UFRJ), Río de Janeiro, Brasil
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Maleh HC, Bica BERG, Papi JÂDS, de Azevedo MNL, Carneiro AJDV. [Colonoscopic evaluation in patients with ankylosing spondylitis]. Rev Bras Reumatol 2015; 54:342-8. [PMID: 25627296 DOI: 10.1016/j.rbr.2014.03.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Revised: 02/11/2014] [Accepted: 03/12/2014] [Indexed: 10/25/2022] Open
Abstract
INTRODUCTION Patients with ankylosing spondylitis can have intestinal inflammatory lesions, thus the use of colonoscopy for such patients should be defined. OBJECTIVES To assess the gross intestinal colonoscopic changes and microscopic histopathologic findings of patients with ankylosing spondylitis; to correlate the colonoscopic and histopathologic findings; and to study the relationship of the histopathologic findings with extra-articular manifestations of the disease, HLA-B27, BASFI and BASDAI. METHODS This is a cross-sectional study of 22 patients with ankylosing spondylitis. The patients underwent clinical assessment, BASDAI and BASFI application, blood collection for HLA-B27 measurement, and colonoscopy with biopsy of four intestinal segments (terminal ileum, right and sigmoid colons, and rectum). RESULTS Abnormal colonoscopic results were obtained in 13 (59.1%) patients, the major abnormality being intestinal polyps. The groups of normal and abnormal colonoscopic results (n=9 and n=13, respectively) were homogeneous regarding age, BASFI, BASDAI, and categorical variables, and the P-value showed no significant difference between groups. The histopathological findings revealed abnormal biopsies in 81%, 90.9%, 90.9% and 86.4% for terminal ileum, right colon, sigmoid colon, and rectum, respectively. The histopathologic results showed no statistically significant association with the extra-articular manifestations, BASFI, BASDAI and HLA-B27 positivity. CONCLUSIONS The histological analysis of the four intestinal segments evidenced inflammatory lesions in patients with normal and abnormal colonoscopic results, independently of bowel symptomatology and therapy used in the treatment of the basal disease.
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Affiliation(s)
- Haim Cesar Maleh
- Programa de Pós-Graduação em Clínica Médica, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil.
| | - Blanca Elena Rios Gomes Bica
- Serviço de Reumatologia, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - José Ângelo de Souza Papi
- Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Mário Newton Leitão de Azevedo
- Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
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Filho JE, França AT, De Souza Papi JA, Bica BERG, Lupi O. Staphylococcal superantigen-specific IgE antibodies and its correlation with asthma severity. World Allergy Organ J 2015. [PMCID: PMC4406596 DOI: 10.1186/1939-4551-8-s1-a44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
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Gomes Bica BER, Reis Monteiro de Barros MDGC, Junior CS. Doença de Mucha-Habermann. Revista Brasileira de Reumatologia 2013; 53:314-7. [DOI: 10.1590/s0482-50042013000300011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2011] [Accepted: 02/18/2013] [Indexed: 11/22/2022] Open
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Arnez MAC, de Azevedo MNL, Bica BERG. Reactive haemophagocytic syndrome in a systemic lupus erythematosus patient: case report. Rev Bras Reumatol 2012; 52:790-795. [PMID: 23090378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Accepted: 06/27/2012] [Indexed: 06/01/2023] Open
Abstract
The macrophagic syndrome or reactive haemophagocytic syndrome (RHS) is a complication resulting from systemic inflammatory diseases and may also be related to malign neoplasias, immunodeficiencies and to a variety of infections caused by virus, bacteria, and fungus. It is characterized by an excessive activation of macrophages and histiocytes along with intense hemophagocytosis in bone marrow and reticulum-endothelial system, causing the phagocytosis of erythrocytes, leukocytes, platelets, and their precursors. The clinical manifestations are fever, hepatosplenomegaly, lymphadenomegalies, neurological involvement, variable degrees of cytopenias, hyperferritinemia, liver disorders, intravascular coagulation, and multiple organs failure. We report a rare case of recurrent RHS complication in a systemic lupus erythematosus male patient after two years. Although extremely rare it has evolved with an improvement after a pulse methilprednisolone and cyclophosphamide therapy.
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Bica BERG, Ruiz DG, Paranhos FF, de Abreu AV, de Azevedo MNL. Bilateral osteochondrosis of lateral femoral condyles: case report and literature review. Rev Bras Reumatol 2012; 52:783-789. [PMID: 23090377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Accepted: 06/27/2012] [Indexed: 06/01/2023] Open
Abstract
Osteochondrosis is an injury on subchondral ossification with predominance of immature skeleton and whose etiology remains unknown. It may affect the femoral condyles (usually the medial condyle) and the involvement is mostly unilateral. The authors draw the attention to this usually late diagnosis due to its infrequent occurrence and report a child's rare case of bilateral osteochondrosis on lateral femoral condyles, stressing that just one similar case has been described in the orthopaedic literature up to the present time.
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Arnez MAC, Azevedo MNLD, Bica BERG. Síndrome de ativação macrofágica em paciente com lúpus eritematoso sistêmico: relato de caso. Rev Bras Reumatol 2012. [DOI: 10.1590/s0482-50042012000500013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Bica BERG, Ruiz DG, Paranhos FF, Abreu AVD, Azevedo MNLD. Osteocondrose bilateral de côndilos femorais laterais: relato de caso e revisão da literatura. Rev Bras Reumatol 2012. [DOI: 10.1590/s0482-50042012000500012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Guenka APR, Bica BERG, Carvalho de Mendonça LM, Fleiuss de Farias ML, Aversa de Escobar Velloso LP, Leitão de Azevedo MN. Bone mineral density in patients with juvenile systemic lupus erythematosus. Pediatr Rheumatol Online J 2012. [PMCID: PMC3403128 DOI: 10.1186/1546-0096-10-s1-a27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Barbosa CMPL, Terreri MTRA, Oliveira SKF, Rodrigues MCF, Bica BERG, Sacchetti S, Romanelli PRS, Len CA, Hilário MOE. Efeitos adversos durante a infusão de infliximabe em crianças e adolescentes: estudo multicêntrico. Rev Bras Reumatol 2008. [DOI: 10.1590/s0482-50042008000500005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Marins KS, Baptista R, Nentzinsky V, Azevedo MNLD, Bica BERG. Poliarterite nodosa cutânea na infância com gangrena digital e possível associação com o estreptococo beta-hemolítico do grupo a: relato de caso e revisão de literatura. Rev Bras Reumatol 2008. [DOI: 10.1590/s0482-50042008000200010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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