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Soares-Jr JM, Espósito Sorpreso IC, Nunes Curado JF, Ferreira Filho ES, Dos Santos Simões R, Bonfá E, Silva CA, Baracat EC. Hormone therapy effect on menopausal systemic lupus erythematosus patients: a systematic review. Climacteric 2022; 25:427-433. [PMID: 35438053 DOI: 10.1080/13697137.2022.2050205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Systemic lupus erythematosus (SLE) primarily affects women, who may need hormone therapy (HT) in menopause. There is, however, some concern as to its efficacy and safety. This systematic review aimed to determine the effect of HT on the activity of SLE and its safety. The study was a qualitative systematic review. Research was conducted with data retrieved from Embase, MEDLINE and Cochrane databases using MESH terms up to April 2021, with no bar on date or language. Sixteen studies were selected for analysis. Most of them showed HT to be effective in the treatment of menopausal symptoms with no impact in SLE activity, but one randomized clinical trial showed an increase in the number of thrombotic events. The present systematic review demonstrated the efficacy of HT for treating the menopausal symptoms of SLE patients. The risk of flare and thrombosis seems to be very low.
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Affiliation(s)
- J M Soares-Jr
- Discipline of Gynecology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - I C Espósito Sorpreso
- Discipline of Gynecology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - J F Nunes Curado
- Discipline of Gynecology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - E S Ferreira Filho
- Discipline of Gynecology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - R Dos Santos Simões
- Discipline of Gynecology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - E Bonfá
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - C A Silva
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.,Pediatric Rheumatology Unit, Children's Institute, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - E C Baracat
- Discipline of Gynecology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
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Balmant B, Fonseca D, Torrinhas R, Marques I, Callado L, Kadouaki D, Pinelli D, Santos W, Prudêncio A, Formiga F, Fernandes G, Bonfá E, Borba E, Waitzberg D. Reduction of beneficial gut bacteria can increase intestinal permeability in inactive systemic lupus erythematosus. Clin Nutr ESPEN 2021. [DOI: 10.1016/j.clnesp.2021.09.333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Torricelli AK, Ugolini-Lopes MR, Bonfá E, Andrade D. Antiphospholipid syndrome damage index (DIAPS): distinct long-term kinetic in primary antiphospholipid syndrome and antiphospholipid syndrome related to systemic lupus erythematosus. Lupus 2020; 29:256-262. [PMID: 31986962 DOI: 10.1177/0961203320901598] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Antiphospholipid syndrome (APS) is an acquired thrombophilia that affects young productive individuals, with permanent damage and negative impact on quality of life. Recently, a damage index specific for APS (DIAPS) was developed. There are, however, no data regarding the comparison of its performance and long-term damage in primary antiphospholipid syndrome (PAPS) and APS related to systemic lupus erythematosus (SLE; APS + SLE). The primary purpose of this study was therefore to compare the long-term damage in patients with these conditions. METHODS This is a retrospective analysis of a single tertiary center cohort followed for approximately 10 years using a standardized prospective electronic chart database. Fifty consecutive PAPS patients age matched with 50 APS+SLE patients were consecutively selected for the study, and DIAPS was calculated once a year during follow-up. Long-term damage and damage kinetics in both groups were compared. RESULTS PAPS and APS + SLE had comparable age (47.10 ± 12.4 vs. 44.04 ± 10.80 years; p = 0.19) and time of follow-up (9.40 ± 3.60 vs. 10.94 ± 4.50 years; p = 0.06). At diagnosis, PAPS had higher DIAPS than APS + SLE (1.72 ± 1.17 vs. 0.82 ± 0.96; p < 0.001). At the end of the 10-year follow-up, both groups presented comparable mean damage scores (2.04 ± 1.50 vs. 2.24 ± 1.61; p = 0.52). The damage increment throughout the observation period for PAPS was solely 35%, whereas for APS + SLE it was gradual, persistent and reached 139% at the end of follow-up, with a total damage increment for PAPS lower than APS + SLE (0.43 ± 0.30 vs. 1.22 ± 1.24; p < 0.001). Of note, the frequency of individuals who acquired damage was lower in PAPS than in APS + SLE (32% vs. 71%; p < 0.001). PAPS also had a longer delay in diagnosis than APS + SLE (4.00 ± 4.20 vs. 2.54 ± 3.05 years; p = 0.04). This delay was positively correlated with a higher damage score at diagnosis (r = 0.36, p < 0.001) in all groups. CONCLUSION We identified a distinct pattern of damage in PAPS and APS related to SLE. Damage in PAPS is an early event, while APS+SLE is associated with higher long-term damage, with a striking increment of damage along the follow-up. A diagnosis delay is correlated with higher damage scores. Damage surveillance therefore requires different approaches for these two conditions.
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Affiliation(s)
- A Kuhl Torricelli
- Rheumatology Division - Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo (FMUSP), Sao Paulo, Brazil
| | - M Remião Ugolini-Lopes
- Rheumatology Division - Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo (FMUSP), Sao Paulo, Brazil
| | - E Bonfá
- Rheumatology Division - Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo (FMUSP), Sao Paulo, Brazil
| | - D Andrade
- Rheumatology Division - Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo (FMUSP), Sao Paulo, Brazil
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Hoff LS, Pimentel CQ, Faillace BLR, Rochitte CE, Demarchi LMMF, Bonfá E, Seguro LPC. Left ventricular pseudoaneurysm associated with systemic lupus erythematosus. Lupus 2019; 28:681-684. [PMID: 30907295 DOI: 10.1177/0961203319837359] [Citation(s) in RCA: 1] [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] [Indexed: 11/17/2022]
Abstract
Systemic lupus erythematosus (SLE) is associated with several cardiac manifestations but, to our knowledge, there have been no previously published reports on left ventricular (LV) pseudoaneurysm in this disease. We describe a case of a 30-year-old woman with SLE who presented with a disease flare (acute and subacute cutaneous lupus, pericarditis, fever, leukopenia) associated with heart failure syndrome. The patient was diagnosed with a large LV pseudoaneurysm and a bovine pericardium patch closure was performed. Coronary arteries were angiographically normal, and cardiac magnetic resonance imaging did not exhibit detectable myocardial fibrosis or infarction. Trauma, previous cardiac surgery, Chagas disease, and antiphospholipid syndrome were excluded. Histopathology of the pericardium revealed lymphocytic arteriolitis raising the possibility of an autoimmune-mediated mechanism for this complication. The unequivocal concomitant diagnosis of lupus flare, the exclusion of other causes of pseudoaneurysm and the histopathological finding of arteriolitis in this patient reinforces the hypothesis of lupus-mediated lesion.
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Affiliation(s)
- L S Hoff
- 1 Division of Rheumatology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - C Q Pimentel
- 1 Division of Rheumatology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - B L R Faillace
- 2 Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - C E Rochitte
- 3 Cardiovascular Magnetic Resonance Imaging and Computed Tomography Department, Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - L M M F Demarchi
- 4 Laboratory of Anatomic Pathology, Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - E Bonfá
- 1 Division of Rheumatology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - L P C Seguro
- 1 Division of Rheumatology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Tiseo BC, Bonfá E, Borba EF, Munhoz GA, Wood GJA, Srougi M, Silva CA, Cocuzza M. Complete urological evaluation including sperm DNA fragmentation in male systemic lupus erythematosus patients. Lupus 2018; 28:59-65. [DOI: 10.1177/0961203318815764] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Objective To evaluate sperm DNA fragmentation analysis in non-azoospermic male systemic lupus erythematosus (SLE) patients. Methods Twenty-eight consecutive male SLE patients (American College of Rheumatology criteria) and 34 healthy controls were evaluated for demographic/exposures data, urological evaluation, hormone profile and sperm analysis (including sperm DNA fragmentation). Clinical features, disease activity/damage scores and treatment were also evaluated. Results The median age (33 (20–52) vs. 36.5 (25–54) years, P = 0.329) and frequency of varicocele (25% vs. 32%, P = 0.183) were similar in SLE patients and healthy controls. Sperm DNA fragmentation showed significantly higher levels of cells class III (44 (9–88) vs. 16.5 (0–80)%, P = 0.001) and cell class IV (10.5 (3–86) vs. 7 (0–36)%, P = 0.039) in SLE. The sperm DNA fragmentation index was also significantly higher in SLE patients (62 (31–97) vs. 25.5 (0–100)%, P < 0.001). Conventional sperm parameters (including sperm count, motility and morphology) were similar in both groups. In SLE patients no correlations were observed between sperm DNA fragmentation index and age, disease duration, Systemic Lupus Erythematosus Disease Activity Index 2000 and Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index scores, and cumulative dose of prednisone, hydroxychloroquine, intravenous cyclophosphamide, methotrexate, azathioprine and mycophenolate mofetil ( P > 0.05). Further analysis of SLE patients treated with and without intravenous cyclophosphamide showed that total sperm motility was significantly lower in the former group (64% (15–83) vs. 72% (57–86), P = 0.024). The sperm DNA fragmentation index was alike in both groups (52.5 (31–95) vs. 67.5 (34–97)%, P = 0.185). Conclusions To our knowledge, this is the first demonstration that male non-azoospermic SLE patients have increased sperm DNA fragmentation without evident gonadal dysfunction. Intravenous cyclophosphamide does not seem to be a major determinant for this abnormality. Future prospective study is necessary to determine the impact of this alteration in these patients' fertility.
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Affiliation(s)
- BC Tiseo
- Discipline of Urology, Hospital das Clinicas HCFMUSP, Sao Paulo, Brazil
- Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - E. Bonfá
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Sao Paulo, Brazil
| | - EF. Borba
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Sao Paulo, Brazil
| | - GA. Munhoz
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Sao Paulo, Brazil
| | - GJA. Wood
- Discipline of Urology, Hospital das Clinicas HCFMUSP, Sao Paulo, Brazil
| | - M. Srougi
- Discipline of Urology, Hospital das Clinicas HCFMUSP, Sao Paulo, Brazil
| | - CA. Silva
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Sao Paulo, Brazil
- Pediatric Rheumatology Unit, Hospital das Clinicas HCFMUSP, Sao Paulo, Brazil
| | - M. Cocuzza
- Discipline of Urology, Hospital das Clinicas HCFMUSP, Sao Paulo, Brazil
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Ugolini-Lopes MR, Santos LPS, Stagnaro C, Seguro LPC, Mosca M, Bonfá E. Late-onset biopsy-proven lupus nephritis without other associated autoimmune diseases: severity and long-term outcome. Lupus 2018; 28:123-128. [DOI: 10.1177/0961203318811603] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background/Purpose Lupus nephritis (LN) usually develops within the first years of systemic lupus erythematosus (SLE) onset and rarely after that. There are scarce studies comparing early- versus late-onset nephritis (before versus after five years of SLE diagnosis). The aim of this study was to compare the severity and long-term outcome (after 7 years) in these two, late-onset and early-onset, nephritis groups. Methods This study included 93 patients from rheumatology tertiary centers from Brazil and Italy, all of them with biopsy-proven LN with > 7 years follow-up. Patients were divided in two groups: early-onset nephritis ( n = 75) and late-onset nephritis ( n = 18). Clinical and laboratorial data were obtained using a standardized electronic chart database protocol carried out at 1–6 months interval and established in 2000. Patients >50 years or with concomitant autoimmune diseases were excluded. Variables evaluated at the LN presentation were Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), creatinine, albumin, anti-DNA positivity and nephritis class. Variables evaluated at the long-term outcome (after 7 years) were Systemic Lupus International Collaborating Clinics Damage Index (SDI), creatinine, dialysis and mortality. Results The average time of LN presentation was 10.94 ± 3.73 years for the late-onset and 1.20 ± 1.60 years for the early-onset group. Their similar nephritis duration (12.44 ± 3.2 versus 13.28 ± 4.03 years, p = 0.41) and comparable mean ages (49.17 ± 9.9 versus 44.11 ± 10.8 years old, p = 0.06) allow a more accurate comparison. Regarding severity, late-onset was similar to early-onset group: SLEDAI (8 (range: 6–22) versus 12 (range: 2–24), p = 0.47), creatinine (1.36 ± 0.94 versus 1.36 ± 1.13 mg/dl, p = 0.99); albumin (2.84 ± 0.65 versus 2.59 ± 0.84 mg/dl, p = 0.30); proteinuria (3.77 ± 2.18 versus 5.01 ± 4.51 g/vol, p = 0.26); proliferative nephritis (44% ( n = 8) versus 60% ( n = 45), p = 0.23). There was also no difference in the long-term outcomes between groups: SDI (1 (range: 0–5) versus 0.5 (range: 0–5), p = 0.27); creatinine (2.04 ± 2.38 versus 1.69 ± 2.26 mg/dl, p = 0.56); dialysis (22% ( n = 4) versus 13% ( n = 10), p = 0.46) and mortality (0% ( n = 0) versus 12% ( n = 9), p = 0.19). Conclusion This study provides novel evidence of comparable long-term outcomes between late-onset and early-onset nephritis, which is most likely explained by the observation that at presentation, the clinical, laboratorial and histological features of late-onset and early-onset nephritis are similar. This suggests that there should be no distinct treatment targets and therapeutic interventions for the late- and early-onset groups.
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Affiliation(s)
- M R Ugolini-Lopes
- Department of Rheumatology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - L P S Santos
- Department of Rheumatology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - C Stagnaro
- Rheumatology Unit, Department of Clinical and Experimental Medicine, Università di Pisa, Pisa, Italy
| | - L P C Seguro
- Department of Rheumatology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - M Mosca
- Rheumatology Unit, Department of Clinical and Experimental Medicine, Università di Pisa, Pisa, Italy
| | - E Bonfá
- Department of Rheumatology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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7
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Castro M, Ugolini-Lopes M, Borba EF, Bonfá E, Seguro LPC. Effectiveness of renoprotective approaches for persistent proteinuria in lupus nephritis: more than just immunosuppression. Lupus 2018; 27:2215-2219. [PMID: 30394834 DOI: 10.1177/0961203318809883] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The objective of this study is to evaluate the efficacy of a tightly controlled renoprotective protocol in systemic lupus erythematosus (SLE) patients with persistent proteinuria. METHODS Thirteen SLE patients with nephritis and persistent proteinuria (>1 g/24 hours) were included. The protocol consisted of regular clinical evaluations every two weeks to assess blood pressure (BP, target <130/80 mmHg), adherence to therapy, diet and smoking. No change in immunosuppressive drugs was allowed but reduction of glucocorticoid dose was permitted if indicated. Clinical, laboratory and treatment evaluations were performed at baseline and at the end of the study (after three months). RESULTS SLE patients had a mean age of 37.85 ± 7.68 years and disease duration of 9.85 ± 7.29 years. At baseline, patients had a mean duration of maintenance therapy of 10.38 ± 7.56 months, 12 with mycophenolate mofetil (92.3%) and one with azathioprine (7.7%). At least one dose optimization of antihypertensive regimen was required in all patients during the study. Seven patients (53.8%) had BP>130/80mmHg at baseline. At the end, 11 patients (84.6%) achieved stable BP target; 92.3% were using an angiotensin-converting enzyme inhibitor, 53.9% an angiotensin receptor blocker, and 46.2% were using combined therapy. All patients had a significant reduction in proteinuria levels (2.26 ± 1.09 vs 0.88 ± 0.54 g/24 hours, p < 0.001) and 61.5% achieved proteinuria <1 g/24 hours. A significant decrease in mean prednisone dose was observed (10.96 ± 6.73 vs 5.38 ± 3.36 mg/day, p = 0.013) as well as mean Systemic Lupus Erythematosus Disease Activity Index score (4.38 ± 0.72 vs 3.08 ± 1.86, p = 0.043). No significant changes were identified in serum creatinine, albumin, potassium, complement 3 and complement 4 levels ( p > 0.05). CONCLUSION This study provides evidence that a tightly controlled renoprotective protocol is effective in reducing persistent proteinuria in lupus nephritis. The concomitant reduction of prednisone without any change in immunosuppression reinforces the importance of strategies beyond the treatment of nephritis activity.
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Affiliation(s)
- M Castro
- Rheumatology Division, Hospital das Clinicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - M Ugolini-Lopes
- Rheumatology Division, Hospital das Clinicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - E F Borba
- Rheumatology Division, Hospital das Clinicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - E Bonfá
- Rheumatology Division, Hospital das Clinicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - L P C Seguro
- Rheumatology Division, Hospital das Clinicas da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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Novak GV, Molinari BC, Ferreira JC, Sakamoto AP, Terreri MT, Pereira RMR, Saad-Magalhães C, Aikawa NE, Campos LM, Len CA, Appenzeller S, Ferriani VP, Silva MF, Oliveira SK, Islabão AG, Sztajnbok FR, Paim LB, Barbosa CM, Santos MC, Bica BE, Sena EG, Moraes AJ, Rolim AM, Spelling PF, Scheibel IM, Cavalcanti AS, Matos EN, Robazzi TC, Guimarães LJ, Santos FP, Silva CT, Bonfá E, Silva CA. Characteristics of 1555 childhood-onset lupus in three groups based on distinct time intervals to disease diagnosis: a Brazilian multicenter study. Lupus 2018; 27:1712-1717. [PMID: 30020023 DOI: 10.1177/0961203318787037] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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] [Indexed: 12/12/2022]
Abstract
Objective The objective of this study was to compare demographic data, clinical/laboratorial features and disease activity at diagnosis in three different groups with distinct time intervals between onset of signs/symptoms and disease diagnosis. Methods A multicenter study was performed in 1555 childhood-onset systemic lupus erythematosus (American College of Rheumatology criteria) patients from 27 pediatric rheumatology services. Patients were divided into three childhood-onset systemic lupus erythematosus groups: A: short time interval to diagnosis (<1 month); B: intermediate time interval (≥1 and <3 months); and C: long time interval (≥3 months). An investigator meeting was held to define the protocol. Demographic data, SLICC classification criteria and SLEDAI-2 K were evaluated. Results The number of patients in each group was: A = 60 (4%); B = 522 (33.5%); and C = 973 (62.5%). The median age at diagnosis (11.1 (4.2-17) vs. 12 (1.9-17.7) vs. 12.5 (3-18) years, P = 0.025) was significantly lower in group A compared with groups B and C. The median number of diagnostic criteria according to SLICC (7 (4-12) vs. 6 (4-13) vs. 6 (4-12), P < 0.0001) and SLEDAI-2 K (18 (6-57) vs. 16 (2-63) vs. 13 (1-49), P < 0.0001) were significantly higher in group A than the other two groups. The frequency of oral ulcers in the palate (25% vs. 15% vs. 11%, P = 0.003), pleuritis (25% vs. 24% vs. 14%, P < 0.0001), nephritis (52% vs. 47% vs. 40%, P = 0.009), neuropsychiatric manifestations (22% vs. 13% vs. 10%, P = 0.008), thrombocytopenia (32% vs. 18% vs. 19%, P = 0.037), leucopenia/lymphopenia (65% vs. 46% vs. 40%, P < 0.0001) and anti-dsDNA antibodies (79% vs. 66% vs. 61%, P = 0.01) were significantly higher in group A compared with the other groups. In contrast, group C had a less severe disease characterized by higher frequencies of synovitis (61% vs. 66% vs. 71%, P = 0.032) and lower frequencies of serositis (37% vs. 33% vs. 25%, P = 0.002), proteinuria >500 mg/day (48% vs. 45% vs. 36%, P = 0.002) and low complement levels (81% vs. 81% vs. 71%, P < 0.0001) compared with groups A or B. Conclusions Our large Brazilian multicenter study demonstrated that for most childhood-onset systemic lupus erythematosus patients, diagnosis is delayed probably due to mild disease onset. Conversely, the minority has a very short time interval to diagnosis and a presentation with a more severe and active multisystemic condition.
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Affiliation(s)
- G V Novak
- 1 Pediatric Rheumatology Unit, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - B C Molinari
- 1 Pediatric Rheumatology Unit, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - J C Ferreira
- 1 Pediatric Rheumatology Unit, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - A P Sakamoto
- 2 Pediatric Rheumatology Unit, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - M T Terreri
- 2 Pediatric Rheumatology Unit, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - R M R Pereira
- 3 Division of Rheumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - C Saad-Magalhães
- 4 Pediatric Rheumatology Division, Sao Paulo State University (UNESP), Botucatu, Brazil
| | - N E Aikawa
- 1 Pediatric Rheumatology Unit, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
- 3 Division of Rheumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - L M Campos
- 1 Pediatric Rheumatology Unit, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - C A Len
- 2 Pediatric Rheumatology Unit, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - S Appenzeller
- 5 Pediatric Rheumatology Unit, University of Campinas (UNICAMP), Campinas, Brazil
| | - V P Ferriani
- 6 Pediatric Rheumatology Unit, University of Sao Paulo, Ribeirão Preto, Brazil
| | - M F Silva
- 7 Pediatric Rheumatology Unit, Hospital Geral de Fortaleza, Fortaleza, Brazil
| | - S K Oliveira
- 8 Pediatric Rheumatology Unit, Rio de Janeiro Federal University (IPPMG-UFRJ), Rio de Janeiro, Brazil
| | - A G Islabão
- 9 Pediatric Rheumatology Unit, Hospital Jose Alencar, Brasília, Brazil
| | - F R Sztajnbok
- 10 Pediatric Rheumatology Unit, Pedro Ernesto University Hospital, Rio de Janeiro, Brazil
| | - L B Paim
- 11 Pediatric Rheumatology Unit, Albert Sabin Children's Hospital, Fortaleza, Brazil
| | - C M Barbosa
- 12 Pediatric Rheumatology Unit, Hospital Darcy Vargas, Sao Paulo, Brazil
| | - M C Santos
- 13 Pediatric Rheumatology Unit, Irmandade da Santa Casa de Misericórdia de Sao Paulo, Sao Paulo, Brazil
| | - B E Bica
- 14 Rheumatology Division, Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, Brazil
| | - E G Sena
- 15 Pediatric Rheumatology Unit, Lauro Vanderley University Hospital, João Pessoa, Brazil
| | - A J Moraes
- 16 Pediatric Rheumatology Unit, Federal University of Pará, Belém, Brazil
| | - A M Rolim
- 17 Pediatric Rheumatology Unit, Obras Sociais Irmã Dulce, Salvador, Brazil
| | - P F Spelling
- 18 Pediatric Rheumatology Unit, Hospital Evangélico de Curitiba, Curitiba, Brazil
| | - I M Scheibel
- 19 Pediatric Rheumatology Unit, Hospital Criança Conceição, Porto Alegre, Brazil
| | - A S Cavalcanti
- 20 Pediatric Rheumatology Unit, Federal University of Pernambuco, Recife, Brazil
| | - E N Matos
- 21 Pediatric Rheumatology Unit, Federal University of Mato Grosso do Sul, Campo Grande, Brazil
| | - T C Robazzi
- 22 Pediatric Rheumatology Unit, Federal University of Bahia, Salvador, Brazil
| | - L J Guimarães
- 23 Pediatric Rheumatology Unit, University of Brasilia, Brasília, Brazil
| | - F P Santos
- 24 Pediatric Rheumatology Unit, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - C T Silva
- 25 Pediatric Rheumatology Unit, Hospital Municipal Piedade, Rio de Janeiro, Brazil
| | - E Bonfá
- 3 Division of Rheumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - C A Silva
- 1 Pediatric Rheumatology Unit, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
- 3 Division of Rheumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
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Valões CCM, Molinari BC, Pitta ACG, Gormezano NWS, Farhat SCL, Kozu K, Sallum AME, Appenzeller S, Sakamoto AP, Terreri MT, Pereira RMR, Magalhães CS, Ferreira JCOA, Barbosa CM, Gomes FH, Bonfá E, Silva CA. Anti-ribosomal P antibody: a multicenter study in childhood-onset systemic lupus erythematosus patients. Lupus 2017; 26:484-489. [PMID: 28394238 DOI: 10.1177/0961203316676386] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Objectives Anti-ribosomal P protein (anti-P) autoantibodies are highly specific for systemic lupus erythematosus (SLE). However, the evaluation of this autoantibody in childhood-onset SLE (cSLE) populations has been limited to a few small series, hampering the interpretation of the clinical and laboratorial associations. Therefore, the objective of this multicenter cohort study was to evaluate demographic, clinical/laboratorial features, and disease damage score in cSLE patients with and without the presence of anti-P antibody. Methods This was a retrospective multicenter study performed in 10 pediatric rheumatology services of São Paulo state, Brazil. Anti-P antibodies were measured by ELISA in 228 cSLE patients. Results Anti-P antibodies were observed in 61/228 (27%) cSLE patients. Frequencies of cumulative lymphadenopathy (29% vs. 15%, p = 0.014), acute confusional state (13% vs. 5%, p = 0.041), mood disorder (18% vs. 8%, p = 0.041), autoimmune hemolytic anemia (34% vs. 15%, p = 0.001), as well as presence of anti-Sm (67% vs. 40%, p = 0.001), anti-RNP (39% vs. 21%, p = 0.012) and anti-Ro/SSA antibodies (43% vs. 25%, p = 0.016) were significantly higher in cSLE patients with anti-P antibodies compared to those without these autoantibodies. A multiple regression model revealed that anti-P antibodies were associated with autoimmune hemolytic anemia (odds ratio (OR) = 2.758, 95% confidence interval (CI): 1.304-5.833, p = 0.008) and anti-Sm antibody (OR = 2.719, 95% CI: 1.365-5.418, p = 0.004). The SLICC/ACR damage index was comparable in patients with and without anti-P antibodies ( p = 0.780). Conclusions The novel association of anti-P antibodies and autoimmune hemolytic anemia was evidenced in cSLE patients and further studies are necessary to determine if anti-P titers may vary with this hematological manifestation.
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Affiliation(s)
- C C M Valões
- 1 Pediatric Rheumatology Unit, Children's Institute, Faculdade de Medicina da Universidade de São Paulo (FMUSP), Brazil
| | - B C Molinari
- 1 Pediatric Rheumatology Unit, Children's Institute, Faculdade de Medicina da Universidade de São Paulo (FMUSP), Brazil
| | - A C G Pitta
- 1 Pediatric Rheumatology Unit, Children's Institute, Faculdade de Medicina da Universidade de São Paulo (FMUSP), Brazil
| | - N W S Gormezano
- 1 Pediatric Rheumatology Unit, Children's Institute, Faculdade de Medicina da Universidade de São Paulo (FMUSP), Brazil.,2 Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), Brazil
| | - S C L Farhat
- 1 Pediatric Rheumatology Unit, Children's Institute, Faculdade de Medicina da Universidade de São Paulo (FMUSP), Brazil
| | - K Kozu
- 1 Pediatric Rheumatology Unit, Children's Institute, Faculdade de Medicina da Universidade de São Paulo (FMUSP), Brazil
| | - A M E Sallum
- 1 Pediatric Rheumatology Unit, Children's Institute, Faculdade de Medicina da Universidade de São Paulo (FMUSP), Brazil
| | - S Appenzeller
- 3 Pediatric Rheumatology Unit, State University of Campinas (UNICAMP), Brazil
| | - A P Sakamoto
- 4 Pediatric Rheumatology Unit, Universidade Federal de São Paulo (UNIFESP), Brazil
| | - M T Terreri
- 4 Pediatric Rheumatology Unit, Universidade Federal de São Paulo (UNIFESP), Brazil
| | - R M R Pereira
- 2 Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), Brazil
| | - C S Magalhães
- 5 Pediatric Rheumatology Division, São Paulo State University (UNESP) - Faculdade de Medicina de Botucatu, Brazil
| | - J C O A Ferreira
- 1 Pediatric Rheumatology Unit, Children's Institute, Faculdade de Medicina da Universidade de São Paulo (FMUSP), Brazil
| | - C M Barbosa
- 6 Pediatric Rheumatology Unit, Hospital Darcy Vargas, Brazil
| | - F H Gomes
- 7 Pediatric Rheumatology Unit, Ribeirão Preto Medical School - FMUSP, Brazil
| | - E Bonfá
- 2 Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), Brazil
| | - C A Silva
- 1 Pediatric Rheumatology Unit, Children's Institute, Faculdade de Medicina da Universidade de São Paulo (FMUSP), Brazil.,2 Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), Brazil
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10
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Gaburo N, de Carvalho JF, Timo-Iaria C, Bueno C, Reichlin M, Viana VST, Bonfá E. Electrophysiological dysfunction induced by anti-ribosomal P protein antibodies injection into the lateral ventricle of the rat brain. Lupus 2017; 26:463-469. [PMID: 28394228 DOI: 10.1177/0961203316666185] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective Anti-ribosomal P antibodies (anti-P) are strongly associated with neuropsychiatric lupus. This study was designed to determine whether these antibodies are capable of causing electro-oscillogram (EOSG) and behavior alterations in rats. Methods IgG fraction anti-P positive and affinity-purified anti-P antibodies were injected intraventricularly in rats. Sequential cortical and subcortical EOSGs were analyzed during 30 days. IgG anti-Ro/SS-A and normal IgG were used as controls. Results All 13 animals injected with IgG anti-P demonstrated a high prevalence of polyspikes, diffusely distributed in hippocampal fields and cerebral cortex. These abnormalities persisted approximately a month. Remarkably, an identical electrical disturbance was observed with the inoculation of affinity-purified anti-P antibodies. The EOSG alterations were associated with behavioral disorders with varying degrees of severity in every animal injected with anti-P. In contrast, no changes in EOSG or behavioral disturbances were observed in the control group. Conclusion Our study indicates that anti-P antibodies can directly induce electrophysiological dysfunction in central nervous system particularly in hippocampus and cortex associated with behavior disturbances.
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Affiliation(s)
- N Gaburo
- 1 Rheumatology Division from Faculdade de Medicina da Universidade de São Paulo e Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil
| | | | - C Timo-Iaria
- 3 (in memoriam) Laboratory of Functional Neurosurgery, Department of Neurology and Neurosurgery from Faculdade de Medicina da Universidade de São Paulo e Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - C Bueno
- 1 Rheumatology Division from Faculdade de Medicina da Universidade de São Paulo e Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - M Reichlin
- 4 Formerly of Oklahoma University Health Sciences Center, Department of Medicine, Oklahoma City, OK, USA
| | - V S T Viana
- 1 Rheumatology Division from Faculdade de Medicina da Universidade de São Paulo e Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - E Bonfá
- 1 Rheumatology Division from Faculdade de Medicina da Universidade de São Paulo e Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil
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11
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Ugarte-Gil MF, Wojdyla D, Pastor-Asurza CA, Gamboa-Cárdenas RV, Acevedo-Vásquez EM, Catoggio LJ, García MA, Bonfá E, Sato EI, Massardo L, Pascual-Ramos V, Barile LA, Reyes-Llerena G, Iglesias-Gamarra A, Molina-Restrepo JF, Chacón-Díaz R, Alarcón GS, Pons-Estel BA. Predictive factors of flares in systemic lupus erythematosus patients: data from a multiethnic Latin American cohort. Lupus 2017; 27:536-544. [PMID: 28857715 DOI: 10.1177/0961203317728810] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Purpose The purpose of this paper is to determine the factors predictive of flares in systemic lupus erythematosus (SLE) patients. Methods A case-control study nested within the Grupo Latino Americano De Estudio de Lupus (GLADEL) cohort was conducted. Flare was defined as an increase ≥4 points in the SLEDAI. Cases were defined as patients with at least one flare. Controls were selected by matching cases by length of follow-up. Demographic and clinical manifestations were systematically recorded by a common protocol. Glucocorticoid use was recorded as average daily dose of prednisone and antimalarial use as percentage of time on antimalarial and categorized as never (0%), rarely (>0-25%), occasionally (>25%-50%), commonly (˃50%-75%) and frequently (˃75%). Immunosuppressive drugs were recorded as used or not used. The association between demographic, clinical manifestations, therapy and flares was examined using univariable and multivariable conditional logistic regression models. Results A total of 465 cases and controls were included. Mean age at diagnosis among cases and controls was 27.5 vs 29.9 years, p = 0.003; gender and ethnic distributions were comparable among both groups and so was the baseline SLEDAI. Independent factors protective of flares identified by multivariable analysis were older age at diagnosis (OR = 0.929 per every five years, 95% CI 0.869-0.975; p = 0.004) and antimalarial use (frequently vs never, OR = 0.722, 95% CI 0.522-0.998; p = 0.049) whereas azathioprine use (OR = 1.820, 95% CI 1.309-2.531; p < 0.001) and SLEDAI post-baseline were predictive of them (OR = 1.034, 95% CI 1.005-1.064; p = 0.022). Conclusions In this large, longitudinal Latin American cohort, older age at diagnosis and more frequent antimalarial use were protective whereas azathioprine use and higher disease activity were predictive of flares.
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Affiliation(s)
- M F Ugarte-Gil
- 1 Hospital Guillermo Almenara Irigoyen, EsSalud, Lima, Perú.,2 Universidad Científica del Sur, Lima, Perú
| | - D Wojdyla
- 3 Universidad Nacional de Rosario, Rosario, Argentina
| | - C A Pastor-Asurza
- 1 Hospital Guillermo Almenara Irigoyen, EsSalud, Lima, Perú.,4 Universidad Nacional Mayor de San Marcos, Lima, Perú
| | | | - E M Acevedo-Vásquez
- 1 Hospital Guillermo Almenara Irigoyen, EsSalud, Lima, Perú.,4 Universidad Nacional Mayor de San Marcos, Lima, Perú
| | - L J Catoggio
- 5 Sección de Reumatología, Servicio de Clínica Médica, Hospital Italiano, Instituto Universitario Escuela de Medicina Hospital Italiano and Fundación Dr. Pedro M. Catoggio para el Progreso de la Reumatología, Buenos Aires, Argentina
| | - M A García
- 6 Hospital Interzonal General de Agudos "General San Martín," La Plata, Argentina
| | - E Bonfá
- 7 Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - E I Sato
- 8 Disciplina de Reumatología, Escola Paulista de Medicina, Universidade Federal da São Paulo-UNIFESP, São Paulo, Brazil
| | - L Massardo
- 9 Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - V Pascual-Ramos
- 10 Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán," Ciudad de Mexico, Mexico
| | - L A Barile
- 11 Hospital de Especialidades Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de Mexico, Mexico
| | - G Reyes-Llerena
- 12 Centro de Investigaciones Médico Quirúrgicas-CIMEQ, Habana, Cuba
| | | | | | - R Chacón-Díaz
- 15 Servicio de Reumatología, Centro Nacional de Enfermedades Reumáticas, Hospital Universitario de Caracas, Caracas, Venezuela
| | - G S Alarcón
- 16 Department of Medicine, Division of Clinical Immunology and Rheumatology, School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
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12
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Lopes SRM, Gormezano NWS, Gomes RC, Aikawa NE, Pereira RMR, Terreri MT, Magalhães CS, Ferreira JC, Okuda EM, Sakamoto AP, Sallum AME, Appenzeller S, Ferriani VPL, Barbosa CM, Lotufo S, Jesus AA, Andrade LEC, Campos LMA, Bonfá E, Silva CA. Outcomes of 847 childhood-onset systemic lupus erythematosus patients in three age groups. Lupus 2017; 26:996-1001. [PMID: 28134038 DOI: 10.1177/0961203317690616] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective The objective of this study was to assess outcomes of childhood systemic lupus erythematosus (cSLE) in three different age groups evaluated at last visit: group A early-onset disease (<6 years), group B school age (≥6 and <12 years) and group C adolescent (≥12 and <18 years). Methods An observational cohort study was performed in ten pediatric rheumatology centers, including 847 cSLE patients. Results Group A had 39 (4%), B 395 (47%) and C 413 (49%). Median disease duration was significantly higher in group A compared to groups B and C (8.3 (0.1-23.4) vs 6.2 (0-17) vs 3.3 (0-14.6) years, p < 0.0001). The median Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SLICC/ACR-DI) (0 (0-9) vs 0 (0-6) vs 0 (0-7), p = 0.065) was comparable in the three groups. Further analysis of organ/system damage revealed that frequencies of neuropsychiatric (21% vs 10% vs 7%, p = 0.007), skin (10% vs 1% vs 3%, p = 0.002) and peripheral vascular involvements (5% vs 3% vs 0.3%, p = 0.008) were more often observed in group A compared to groups B and C. Frequencies of severe cumulative lupus manifestations such as nephritis, thrombocytopenia, and autoimmune hemolytic anemia were similar in all groups ( p > 0.05). Mortality rate was significantly higher in group A compared to groups B and C (15% vs 10% vs 6%, p = 0.028). Out of 69 deaths, 33/69 (48%) occurred within the first two years after diagnosis. Infections accounted for 54/69 (78%) of the deaths and 38/54 (70%) had concomitant disease activity. Conclusions This large multicenter study provided evidence that early-onset cSLE group had distinct outcomes. This group was characterized by higher mortality rate and neuropsychiatric/vascular/skin organ damage in spite of comparable frequencies of severe cumulative lupus manifestations. We also identified that overall death in cSLE patients was an early event mainly attributed to infection associated with disease activity.
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Affiliation(s)
- S R M Lopes
- 1 Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - N W S Gormezano
- 1 Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - R C Gomes
- 2 Pediatric Rheumatology Unit, Children's Institute, Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - N E Aikawa
- 1 Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo, Brazil.,2 Pediatric Rheumatology Unit, Children's Institute, Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - R M R Pereira
- 1 Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - M T Terreri
- 3 Pediatric Rheumatology Unit, Universidade Federal de São Paulo, Brazil
| | - C S Magalhães
- 4 Pediatric Rheumatology Division, São Paulo State University (UNESP) - Faculdade de Medicina de Botucatu, Brazil
| | - J C Ferreira
- 2 Pediatric Rheumatology Unit, Children's Institute, Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - E M Okuda
- 5 Pediatric Rheumatology Unit, Irmandade da Santa Casa de Misericórdia de São Paulo, Brazil
| | - A P Sakamoto
- 3 Pediatric Rheumatology Unit, Universidade Federal de São Paulo, Brazil
| | - A M E Sallum
- 2 Pediatric Rheumatology Unit, Children's Institute, Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - S Appenzeller
- 6 Pediatric Rheumatology Unit, State University of Campinas (UNICAMP), Brazil
| | - V P L Ferriani
- 7 Pediatric Rheumatology Unit, Ribeirão Preto Medical School - University of São Paulo, Brazil
| | - C M Barbosa
- 8 Pediatric Rheumatology Unit, Hospital Infantil Darcy Vargas, Brazil
| | - S Lotufo
- 9 Pediatric Rheumatology Unit, Hospital Menino Jesus, Brazil
| | - A A Jesus
- 2 Pediatric Rheumatology Unit, Children's Institute, Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - L E C Andrade
- 3 Pediatric Rheumatology Unit, Universidade Federal de São Paulo, Brazil
| | - L M A Campos
- 2 Pediatric Rheumatology Unit, Children's Institute, Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - E Bonfá
- 1 Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - C A Silva
- 1 Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo, Brazil.,2 Pediatric Rheumatology Unit, Children's Institute, Faculdade de Medicina da Universidade de São Paulo, Brazil
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13
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Balbi V, Montenegro B, Schimidt A, Pitta A, Coelho L, Sakamoto A, Terreri M, Pereira R, Magalhães C, Kozu K, Campos L, Petry D, Appenzeller S, Ferriani V, Bonfá E, Silva C. HEPATITE AUTOIMUNE EM UMA POPULAÇÃO DE 847 PACIENTES COM LÚPUS ERITEMATOSO SISTÊMICO JUVENIL. Revista Brasileira de Reumatologia 2017. [DOI: 10.1016/j.rbr.2017.07.436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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14
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Ferreira G, Tomioka R, Kozu K, Aikawa N, Serafini P, Pereira R, Bonfá E, Silva C. INFECÇÕES DO TRATO GENITAL INFERIOR EM ADOLESCENTES E ADULTAS JOVENS COM ARTRITE IDIOPÁTICA JUVENIL. Revista Brasileira de Reumatologia 2017. [DOI: 10.1016/j.rbr.2017.07.439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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15
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Torricelli A, Lopes M, Bonfá E, Andrade D. AVALIAÇÃO LONGITUDINAL DOS ÍNDICES DE DANO PERMANENTE SLICC E DIAPS EM PACIENTES COM SÍNDROME ANTIFOSFOLÍPIDE. Revista Brasileira de Reumatologia 2017. [DOI: 10.1016/j.rbr.2017.07.487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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16
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Rosário D, Bulhões C, Aikawa N, Toledo R, Ribeiro A, Moraes J, Bonfiglioli K, Saad C, Silva C, Bonfá E. PREDITORES DE MORTALIDADE EM PACIENTES COM ARTRITE REUMATOIDE EM USO DE BIOLÓGICOS. Revista Brasileira de Reumatologia 2017. [DOI: 10.1016/j.rbr.2017.07.539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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17
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Torricelli A, Lopes M, Bonfá E, Andrade D. A IMPORTÂNCIA DO DIAGNÓSTICO PRECOCE NA SÍNDROME ANTIFOSFOLÍPIDE: MINIMIZANDO DANOS. Revista Brasileira de Reumatologia 2017. [DOI: 10.1016/j.rbr.2017.07.474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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18
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Gormezano NWS, Kern D, Pereira OL, Esteves GCX, Sallum AME, Aikawa NE, Pereira RMR, Silva CA, Bonfá E. Autoimmune hemolytic anemia in systemic lupus erythematosus at diagnosis: differences between pediatric and adult patients. Lupus 2016; 26:426-430. [PMID: 27821514 DOI: 10.1177/0961203316676379] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Objective To determine the overall prevalence of autoimmune hemolytic anemia (AIHA), and to compare clinical and laboratory features in a large population of children and adult lupus patients at diagnosis. Methods This retrospective study evaluated the medical charts of 336 childhood-onset systemic lupus erythematosus (cSLE) and 1830 adult SLE (aSLE) patients followed in the same tertiary hospital. Demographic data, clinical features and disease activity were recorded. AIHA was defined according to the presence of anemia (hemoglobin <10 g/dL) and evidence of hemolysis (reticulocytosis and positive direct antiglobulin test (DAT)/Coombs test) at SLE diagnosis. Evans syndrome (ES) was defined by the combination of immune thrombocytopenia (platelet count <100,000/mm3) and AIHA. Results The frequency of AIHA at diagnosis was significantly higher in cSLE patients compared to aSLE (49/336 (14%) vs 49/1830 (3%), p = 0.0001), with similar frequency of ES (3/336 (0.9%) vs 10/1830 (0.5%), p = 0.438). The median of hemoglobin levels was reduced in cSLE vs aSLE patients (8.3 (2.2-10) vs 9.5 (6.6-10) g/dL, p = 0.002) with a higher frequency of multiple hemorrhagic manifestations (41% vs 7%, p = 0.041) and erythrocyte transfusion due to bleeding (24% vs 5%, p = 0.025). cSLE patients also had more often constitutional involvement (84% vs 31%, p < 0.001), fever (65% vs 26%, p < 0.001), weight loss > 2 kg (39% vs 6%, p < 0.001), reticuloendothelial manifestations (48% vs 8%, p < 0.001), hepatomegaly (25% vs 2%, p < 0.001) and splenomegaly (21% vs 2%, p = 0.004). Other major organ involvements were common but with similar frequencies in cSLE and aSLE ( p > 0.05). Median systemic lupus erythematosus disease activity index 2000 (SLEDAI-2 K) was comparable in cSLE and aSLE (p = 0.161). Conclusions We identified that AIHA was not a common condition in cSLE and aSLE, with distinct features characterized by a higher prevalence/severity in children and concomitant constitutional symptoms in the majority of them.
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Affiliation(s)
- N W S Gormezano
- 1 Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo, Brazil.,2 Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - D Kern
- 1 Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - O L Pereira
- 1 Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - G C X Esteves
- 1 Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - A M E Sallum
- 2 Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - N E Aikawa
- 1 Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo, Brazil.,2 Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - R M R Pereira
- 1 Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - C A Silva
- 1 Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo, Brazil.,2 Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - E Bonfá
- 1 Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo, Brazil
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Hayata ALS, Borba EF, Bonfá E, Kochen JAL, Goldenstein-Schainberg C. The frequency of high/moderate lipoprotein risk factor for coronary artery disease is significant in juvenile-onset systemic lupus erythematosus. Lupus 2016; 14:613-7. [PMID: 16175933 DOI: 10.1191/0961203305lu2177oa] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
To determine the prevalence of dyslipoproteinemia on a large juvenile systemic lupus erythematosus (jSLE) cohort, we selected 40 patients after rigorous exclusion criteria. Lipoprotein levels were determinated after 12 hours fast and risk levels for CAD were defined by standards of the Brazilian Guidelines for dyslipoproteinemia according to US-NCEP. All individuals were under steroid therapy and chloroquine and 43% had active disease. Thirty patients (75%) had high-risk levels for CAD (23 isolated low HDL, while in seven subjects low HDL was associated to high TG in four, high LDL in one, high TG/LDL in one and high TC/LDL in one). Remarkably, overall analysis revealed that 85% patients were included in high/medium risk levels group (29% for TC, 29% for LDL, 88% for HDL, and 18% for TG) and these disturbances occured mainly in the first four years of disease. Unexpectedly, one-third of the patients presented two or more high/medium lipoprotein risk factors. Independently, active jSLE was associated to TG (OR = 3.2; P < 0.001) and had a tendency towards reduction on HDL (OR = 8.5; P = 0.056). Considering improvements on jSLE outcome, the increased frequency of high/medium lipoprotein risk levels for CAD reinforces the need of prevention measures in order to minimize deleterious effects of this disturbance.
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Affiliation(s)
- A L S Hayata
- Division of Rheumatology, University of São Paulo, Brazil.
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20
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Fialho SCMS, Bonfá E, Vitule LF, D'Amico E, Caparbo V, Gualandro S, Pereira RMR. Disease activity as a major risk factor for osteonecrosis in early systemic lupus erythematosus. Lupus 2016; 16:239-44. [PMID: 17439929 DOI: 10.1177/0961203307076771] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study Identifies the possible risk factors for osteonecrosis (ON) in a homogenous group of early system lupus erythematosus (SLE). Forty-six consecutive SLE patients (<5 years duration) followed at the Lupus Clinic, were enrolled between 2004 and 2005. An extensive clinical and laboratory evaluation using a standard electronic protocol established since 1999, including osteonecrosis symptoms and appropriate magnetic resonance imaging (MRI), were carried out at 1—6 months intervals. All other asymptomatic for osteonecrosis patients at study entry underwent MRI. ON confirmed by MRI was found in 10 of 46 patients (22%). Age, disease duration, clinical vascular features, frequency of thrombophilia and hypofibrinolysis factors and the lipoprotein profile were comparable in patients with and without osteonecrosis ( P > 0.05). Remarkably, the frequency of patients with system lupus erythematosus disease activity index (SLEDAI) ≥8 in the previous year of osteonecrosis clinical diagnosis was significantly higher when compared to patients without this manifestation (60.0% versus 19.4%, P = 0.011), supported by the higher glucocorticoid cumulative dose in the same period ( P = 0.045). In contrast, these two parameters evaluated in 13th—24th months preceding osteonecrosis diagnosis were similar in patients with and without osteonecrosis ( P > 0.05). In the logistic regression analysis only SLEDAI remained as an independent risk factor for ON (OR = 6.78, CI = 1.05—43.55, P = 0.04). Disease activity in the previous year of ON clinical diagnosis is the main predictor factor for the development of this complication in early SLE. Lupus (2007) 16, 239—244.
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Affiliation(s)
- S C M S Fialho
- Division of Rheumatology, University of São Paulo, São Paulo, Brazil
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Borba EF, Turrini-Filho JR, Kuruma KAM, Bertola C, Pedalini MEB, Lorenzi MC, Bonfá E. Chloroquine gestational use in systemic lupus erythematosus: assessing the risk of child ototoxicity by pure tone audiometry. Lupus 2016; 13:223-7. [PMID: 15176656 DOI: 10.1191/0961203304lu528oa] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The objective of this study was to assess child chloroquine ototoxicity after its use during the gestational period in systemic lupus erythematosus (SLE). Nineteen children over four years old were evaluated: nine were exposed to chloroquine diphosphate (CDP) during gestation and 10 were born from mothers that did not take this drug before conception or anytime during pregnancy (CONTROL). Pure tone audiometry was performed in all children and high and low frequency threshold means were compared to evaluate the hearing status. All nine mothers taking CDP were exposed to this drug at least during the first trimester of pregnancy (56% during the whole gestational period) and the mean time of CDP use was 6.1 + 2.9 months. No significant difference was found in children of CDP and CONTROL groups regarding age (7.6 + 4.4 versus 12.3 + 7.2 years; P 0.10, respectively) and gender (P 0.65). Pure tone high frequency thresholds, which are the first to be affected by ototoxic drugs, presented within normal limits in children exposed or not to CDP (8.5 + 5.0 versus 7.4 + 3.6 dBHL; P 0.55, respectively). Likewise, the mean hearing thresholds at low frequencies were also similar in both groups (11.4 + 4.5 versus 11.9 + 3.0 dBHL; P 0.66). In conclusion, child in utero exposure to chloroquine diphosphate does not seem to induce hearing impairment as measured by pure tone audiometry, reinforcing its safe use during pregnancy of lupus patients.
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Affiliation(s)
- E F Borba
- Rheumatology Division, University of São Paulo, São Paulo, SP, Brazil.
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22
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Abstract
To determine the clinical relevance of `scleroderma-pattern' (SD-pattern) in mixed connective tissue disease (MCTD), 63 (MCTD) patients (Kasukawa's criteria) were consecutively selected. The main inclusion criterion was availability of previous nailfold capillaroscopy (NC) five years before inclusion. At entry, organ involvement and autoantibody evaluation were performed. The mean age and disease duration were 45.3 ± 10 and 8.45 ± 5.42 years, respectively. SD-pattern was observed in 41 patients at entry (65%) and in 45 at previous NC (71.5%), P = 0.20. Ten patients (16%) changed NC, seven normalized, and three developed SD-pattern. Disease duration, number and frequency of organ involvement were similar in patients with and without SD-pattern. In contrast, analysis of each SD-pattern parameter revealed a significantly lower frequency of moderate/severe avascular areas (AA) at entry compared to previous examination (26.5 versus 53%, P = 0.013). Moreover, 76% of patients with interstitial lung disease (HRCT) had AA at entry, whereas only 24% of patients with this alteration did not have this NC finding ( P = 0.017). Furthermore, reduced capillary density was more frequently observed in patients taking immunosuppressive therapy than in those without this medication (66.7 versus 33.3%, P = 0.001). NC in MCTD is a dynamic process and analysis of each SD-pattern parameter seems to be a good indicator of lung involvement and disease severity. Lupus (2007) 16, 254—258.
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Silva CAA, Hilário MO, Febrônio MV, Oliveira SK, Terreri MT, Sacchetti SB, Sztajnbok FR, Marini R, Quintero MV, Bica BE, Pereira RM, Bonfá E, Ferriani VP, Robazzi TC, Magalhães CS. Risk factors for amenorrhea in juvenile systemic lupus erythematosus (JSLE): a Brazilian multicentre cohort study. Lupus 2016; 16:531-6. [PMID: 17670855 DOI: 10.1177/0961203307079300] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
We evaluated the prevalence and clinical associations of amenorrhea in 298 female juvenile systemic lupus erythematosus (JSLE) patients (ACR criteria) followed in 12 Brazilian Paediatric Rheumatology centres. Amenorrhea was observed in 35 patients (11.7%) with a mean duration of 7.2 ± 3.6 months. The hormones were performed in 32/35 patients and none of them had FSH and LH levels above and estradiol below the normal range according to pubertal changes. JSLE patients with amenorrhea were younger (15.04 ± 2.5 versus 17.8 ± 3.1 years; P = 0.001), and had a shorter period of time between menarche and current age (3.4 ± 2.9 versus 6.7 ± 5.4 years; P = 0.001). Interestingly, the frequency, cumulative dose, number of pulses and duration of intravenous cyclophosphamide treatment were alike in patients with and without amenorrhea ( P > 0.05). In contrast, patients with amenorrhea had significantly higher SLEDAI ( P = 0.01) and SLICC/ACR-DI ( P = 0.024) scores compared to those without this condition. Independent risk factors identified by multivariate analysis were higher SLEDAI (OR = 1.059; CI = 1.004—1.116; P = 0.034) and SLICC/ACR-DI (OR = 2.125; IC = 1.373—3.291; P = 0.001) scores. Our data suggest that in spite of immunosuppressive therapy, JSLE patients have an adequate ovarian follicular reserve and amenorrhea is particularly associated with disease activity and damage. Lupus (2007) 16, 531—536.
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Affiliation(s)
- C A A Silva
- Pediatric Rheumatology Unit, University of São Paulo, Brazil.
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Lube G, Ferriani M, Campos L, Terreri M, Bonfá E, Magalhães C, Aikawa N, Piotto D, Peracchi O, Santos M, Appenzeller S, Ferriani V, Pereira R, Silva C. SAT0253 Evans Syndrome at Childhood-Onset Systemic Lupus Erythematosus Diagnosis: A Large Multicenter Study. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Ferreira JCOA, Marques HH, Ferriani MPL, Gormezano NWS, Terreri MT, Pereira RM, Magalhães CS, Campos LM, Bugni V, Okuda EM, Marini R, Pileggi GS, Barbosa CM, Bonfá E, Silva CA. Herpes zoster infection in childhood-onset systemic lupus erythematosus patients: a large multicenter study. Lupus 2016; 25:754-9. [PMID: 26821966 DOI: 10.1177/0961203315627203] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [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: 09/09/2015] [Accepted: 12/21/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The aim of this multicenter study in a large childhood-onset systemic lupus erythematosus (cSLE) population was to assess the herpes zoster infection (HZI) prevalence, demographic data, clinical manifestations, laboratory findings, treatment, and outcome. METHODS A retrospective multicenter cohort study (Brazilian cSLE group) was performed in ten Pediatric Rheumatology services in São Paulo State, Brazil, and included 852 cSLE patients. HZI was defined according to the presence of acute vesicular-bullous lesions on erythematous/edematous base, in a dermatomal distribution. Post-herpetic neuralgia was defined as persistent pain after one month of resolution of lesions in the same dermatome. Patients were divided in two groups for the assessment of current lupus manifestations, laboratory findings, and treatment: patients with HZI (evaluated at the first HZI) and patients without HZI (evaluated at the last visit). RESULTS The frequency of HZI in cSLE patients was 120/852 (14%). Hospitalization occurred in 73 (61%) and overlap bacterial infection in 16 (13%). Intravenous or oral aciclovir was administered in 113/120 (94%) cSLE patients at HZI diagnosis. None of them had ophthalmic complication or death. Post-herpetic neuralgia occurred in 6/120 (5%). After Holm-Bonferroni correction for multiple comparisons, disease duration (1.58 vs 4.41 years, p < 0.0001) was significantly lower in HZI cSLE patients compared to those without HZI. Nephritis (37% vs 18%, p < 0.0001), lymphopenia (32% vs 17%, p < 0.0001) prednisone (97% vs 77%, p < 0.0001), cyclophosphamide (20% vs 5%, p < 0.0001) and SLE Disease Activity Index 2000 (6.0 (0-35) vs 2 (0-45), p < 0.0001) were significantly higher in the former group. The logistic regression model showed that four independent variables were associated with HZI: disease duration < 1 year (OR 2.893 (CI 1.821-4.597), p < 0.0001), lymphopenia <1500/mm(3) (OR 1.931 (CI 1.183-3.153), p = 0.009), prednisone (OR 6.723 (CI 2.072-21.815), p = 0.002), and cyclophosphamide use (OR 4.060 (CI 2.174-7.583), p < 0.0001). CONCLUSION HZI is an early viral infection in cSLE with a typical dermatomal distribution. Lymphopenia and immunosuppressive treatment seem to be major factors underlying this complication in spite of a benign course.
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Affiliation(s)
- J C O A Ferreira
- Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo, Brazil
| | | | - M P L Ferriani
- Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - N W S Gormezano
- Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo, Brazil Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - M T Terreri
- Pediatric Rheumatology Unit, Universidade Federal de São Paulo, Brazil
| | - R M Pereira
- Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - C S Magalhães
- Pediatric Rheumatology Unit, São Paulo State University (UNESP), Faculdade de Medicina de Botucatu, Brazil
| | - L M Campos
- Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - V Bugni
- Pediatric Rheumatology Unit, Universidade Federal de São Paulo, Brazil
| | - E M Okuda
- Pediatric Rheumatology Unit, Irmandade da Santa Casa de Misericórdia de São Paulo, Brazil
| | - R Marini
- Pediatric Rheumatology Unit, State University of Campinas, Brazil
| | - G S Pileggi
- Pediatric Rheumatology Unit, Ribeirão Preto Medical School, University of São Paulo, Brazil
| | - C M Barbosa
- Pediatric Rheumatology Unit, Hospital Infantil Darcy Vargas, Brazil
| | - E Bonfá
- Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - C A Silva
- Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo, Brazil
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Andrade D, Bortolotto L, Bonfá E, Borba E. Primary antiphospholipid syndrome: absence of premature atherosclerosis in patients without traditional coronary artery disease risk factors. Lupus 2015; 25:472-8. [PMID: 26585072 DOI: 10.1177/0961203315617841] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [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: 06/26/2014] [Accepted: 10/23/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To investigate if patients with Primary Antiphospholipid Syndrome (PAPS) with venous and/or arterial thrombosis without traditional coronary artery disease (CAD) risk factors develop early atherosclerotic vascular damage. METHODS 27 female patients with PAPS (Sidney criteria) and 27 age, body mass index (BMI), and sex matched controls were consecutively selected. Exclusion criteria were: black race, age ≥55 years, traditional cardiovascular risk factors, other thrombophilias or connective tissue diseases, corticosteroids use and pregnancy. All subjects underwent Pulse Wave Velocity (PWV) and Echo-Tracking (ET), both in carotidal bed, to analyse vascular functional properties. RESULTS Age (p = 0.92) and BMI (p = 0.91) were comparable in both groups. PAPS patients and controls had similar PWV (9.07 ± 1.08 m/s vs 9.42 ± 1.47 m/s, p = 0.34) as well as echo tracking parameters such as intima-media thickness (683 ± 171 µm vs 636 ± 140 µm, p = 0.52), carotideal diameter (p = 0.26), distensibility (p = 0.92), compliance coefficients (p = 0.36) and elastic modulus (p = 0.78). Patients with exclusively venous thrombosis showed lower PWV than patients with arterial thrombosis (8.55 ± 0.70 m/s vs 9.56 ± 0.94 m/s, p = 0.01), but no difference regarding intima-media thickness (683 ± 171 µm vs 636 ± 140 µm, p = 0.52) was observed. CONCLUSION Patients with PAPS do not seem to be at higher risk of developing premature atherosclerosis. Patients who suffered exclusively venous thrombosis seem to be at lower risk than those with exclusively arterial events. Other studies need to confirm our findings.
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Affiliation(s)
- D Andrade
- Rheumatology Division, São Paulo University, São Paulo, Brazil
| | - L Bortolotto
- Heart Institute of São Paulo University, São Paulo, Brazil
| | - E Bonfá
- Rheumatology Division, São Paulo University, São Paulo, Brazil
| | - E Borba
- Rheumatology Division, São Paulo University, São Paulo, Brazil
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Leal GN, Silva KF, Lianza AC, Giacomin MF, Andrade JL, Kozu K, Bonfá E, Silva CA. Subclinical left ventricular dysfunction in childhood-onset systemic lupus erythematosus: a two-dimensional speckle-tracking echocardiographic study. Scand J Rheumatol 2015; 45:202-9. [DOI: 10.3109/03009742.2015.1063686] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- GN Leal
- Department of Radiology, Children’s Institute, Hospital das Clínicas, São Paulo University Medical School
| | - KF Silva
- Department of Radiology, Children’s Institute, Hospital das Clínicas, São Paulo University Medical School
| | - AC Lianza
- Department of Radiology, Children’s Institute, Hospital das Clínicas, São Paulo University Medical School
| | - MF Giacomin
- Rheumatology Unit, Children’s Institute, Hospital das Clínicas, Faculty of Medicine, University of São Paulo
| | - JL Andrade
- Institute of Radiology, Hospital das Clínicas, São Paulo University Medical School
| | - K Kozu
- Rheumatology Unit, Children’s Institute, Hospital das Clínicas, Faculty of Medicine, University of São Paulo
| | - E Bonfá
- Department of Rheumatology, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - CA Silva
- Rheumatology Unit, Children’s Institute, Hospital das Clínicas, Faculty of Medicine, University of São Paulo
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Yamakami LYS, Serafini PC, de Araujo DB, Bonfá E, Leon EP, Baracat EC, Silva CA. Clark CA, Laskin CA. Ovarian reserve in antiphospholipid syndrome: the jury is still out. Lupus 2015; 24: 773. Lupus 2015; 24:1007. [PMID: 26082466 DOI: 10.1177/0961203315591029] [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: 03/16/2015] [Accepted: 05/07/2015] [Indexed: 11/17/2022]
Affiliation(s)
- L Y S Yamakami
- Department of Gynecology, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - P C Serafini
- Department of Gynecology, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - D B de Araujo
- Division of Rheumatology, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - E Bonfá
- Division of Rheumatology, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - E P Leon
- Division of Rheumatology, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - E C Baracat
- Department of Gynecology, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - C A Silva
- Division of Rheumatology, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
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van Vollenhoven R, Aranow C, Bertsias G, Bonfá E, Cervera R, Costedoat-Chalumeau N, Dörner T, Houssiau F, Lerstrom K, Morand E, Mosca M, Navarra S, Petri M, Urowitz M, Voskuijl A, Voss A, Ward M, Werth V, Schneider M. OP0092 Remission in Sle: Consensus Findings from a Large International Panel on Definitions of Remission in SLE (DORIS). Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.4666] [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: 11/04/2022]
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Gormezano N, Silva C, Otsuzi C, Barros D, da Silva M, Sallum A, Pasoto S, Pereira R, Bonfá E. THU0497 Herpes Zoster Infection in Childhood and Adult Systemic Lupus Erythematosus: Higher Prevalence and Distinct Features. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.3620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Bonfá AC, Seguro LPC, Caparbo V, Bonfá E, Pereira RMR. RANKL and OPG gene polymorphisms: associations with vertebral fractures and bone mineral density in premenopausal systemic lupus erythematosus. Osteoporos Int 2015; 26:1563-71. [PMID: 25609157 DOI: 10.1007/s00198-015-3029-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 01/04/2015] [Indexed: 12/31/2022]
Abstract
UNLABELLED Premenopausal women with systemic lupus erythematosus (SLE) have a higher prevalence of low bone mineral density and vertebral fractures. Multiple genetic loci for osteoporotic fracture were identified in recent genome-wide association studies. This study provides a novel data demonstrating that receptor activator of NF-κB ligand (RANKL)/osteoprotegerin (OPG) polymorphisms likely plays an important role in the bone remodeling process in SLE premenopausal women. INTRODUCTION The purpose of this study was to evaluate single-nucleotide polymorphisms (SNPs) of the RANKL, RANK, and OPG genes in premenopausal SLE patients and their association with sRANKL and OPG serum levels, vertebral fractures, and bone mineral density (BMD). METHODS A total of 211 premenopausal SLE patients (American College of Rheumatology (ACR) criteria) and 154 healthy controls were enrolled. SNPs of RANKL 290A>G (rs2277438), OPG 1181G>C (rs2073618), 245T>G (rs3134069), 163A>G (rs3102735), and RANK A>G (rs3018362) were obtained by real-time PCR. sRANKL/OPG serum levels were determined by ELISA. BMD and vertebral fractures were evaluated by dual-energy X-ray absorptiometry (DXA). RESULTS SLE patients and controls had similar frequencies of the RANKL 290 G allele (p = 0.94), OPG 1181 C allele (p = 0.85), OPG 245 G allele (p = 0.85), OPG 163 G allele (p = 0.78), and RANK G allele (p = 0.87). Further analysis of the SLE patients revealed that the frequency of the RANKL 290 G allele was lower in patients with fractures than that in patients without fractures (28.1 vs 46.9%, p = 0.01). In addition, the frequency of the OPG 245 G allele was higher in patients with low BMD than that in patients with normal BMD (31.4 vs 18.1%, p = 0.04). No association of OPG 1181 G>C, OPG 163 A>G, and RANK A>G SNPs with BMD/fractures was found. Additionally, no association was observed between RANKL/OPG/RANK SNPs and sRANKL/OPG serum levels. CONCLUSIONS Our study provides novel data demonstrating that RANKL/OPG genetic variations appear to play a role in bone remodeling, particularly in its major complication, fracture, in premenopausal patients with SLE.
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Affiliation(s)
- A C Bonfá
- Rheumatology Division, Faculdade Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455, 3 andar, Sala, 3105, São Paulo, Brazil
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Leal GN, Silva KF, França CMP, Lianza AC, Andrade JL, Campos LMA, Bonfá E, Silva CA. Subclinical right ventricle systolic dysfunction in childhood-onset systemic lupus erythematosus: insights from two-dimensional speckle-tracking echocardiography. Lupus 2014; 24:613-20. [DOI: 10.1177/0961203314563135] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 11/15/2014] [Indexed: 01/07/2023]
Abstract
Objective The objective of this article is to evaluate right ventricle strain imaging by two-dimensional speckle-tracking (2DST) in childhood-onset systemic lupus erythematosus (c-SLE). Methods Thirty-five c-SLE patients with no signs or symptoms of heart failure and 33 healthy volunteers were evaluated by standard echocardiogram and 2DST. Conventional parameters included tricuspid annular plane systolic excursion (TAPSE), RV tissue-Doppler-derived Tei index and systolic pulmonary artery pressure. Global peak longitudinal systolic strain (PLSS) and strain rate (PLSSR) of RV were obtained by 2DST. Demographic/clinical features, SLEDAI-2K/SLICC/ACR-DI and treatment were also assessed. Results The median current age was similar in patients and controls (14.75 vs. 14.88 years, p = 0.62). RV PLSS was significantly reduced in c-SLE (−24.5 ± 5.09 vs. −27.62 ± 3.02%, p = 0.003). Similar findings were observed after excluding patients with pulmonary hypertension (−24.62 ± 4.87% vs. −27.62 ± 3.02%, p = 0.0041). RV PLSS was positively correlated with TAPSE ( r = +0.49, p = 0.0027) and negatively correlated with Tei index ( r = −0.34, p = 0.04) in c-SLE. RV PLSSR was not different comparing patients and controls (−0.65 s−1 ± 0.47 vs. −1.87 ± 0.49 s−1, p = 0.07). Further analysis of c-SLE patients revealed higher frequencies of neuropsychiatric manifestations (39% vs. 0%, p = 0.007) and antiphospholipid antibodies (55% vs. 18%, p = 0.035) in those with RV PLSS ≤ −23.7% vs >−23.7%. No differences were evidenced in demographic data, disease activity/damage or treatments ( p > 0.05). Conclusions The present study, using a new and more sensitive technique, revealed subclinical RV systolic dysfunction in c-SLE patients that may have future prognostic implications. The novel association of asymptomatic RV dysfunction with neuropsychiatric manifestations and antiphospholipid antibodies may suggest common physiopathological pathways.
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Affiliation(s)
- G N Leal
- Radiology Unit, Instituto da Criança, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - K F Silva
- Radiology Unit, Instituto da Criança, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - C M P França
- Pediatric Rheumatology Unit, Instituto da Criança, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - A C Lianza
- Radiology Unit, Instituto da Criança, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - J L Andrade
- Department of Radiology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - L M A Campos
- Pediatric Rheumatology Unit, Instituto da Criança, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - E Bonfá
- Department of Rheumatology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - C A Silva
- Pediatric Rheumatology Unit, Instituto da Criança, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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de Araujo DB, Yamakami LYS, Aikawa NE, Bonfá E, Viana VST, Pasoto SG, Pereira RMR, Serafin PC, Borba EF, Silva CA. Ovarian reserve in adult patients with childhood-onset lupus: a possible deleterious effect of methotrexate? Scand J Rheumatol 2014; 43:503-11. [DOI: 10.3109/03009742.2014.908237] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Silva C, Viana V, Pasoto S, Seguro L, Andrade D, Bonfá E, Sampaio-Barros P. FRI0493 Clinical and Serological Comparative Analysis of Systemic Sclerosis with or without Overlap Syndromes in A Large Brazilian Cohort. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.5863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Perandini L, Gualano B, Pinto A, Lima F, Bonfá E, Borba E, Roschel H, Mello S. THU0056 Acute Aerobic Exercise Induces Increases on Plasma Levels of α-Melanocyte Stimulating Hormone in Patients with Active Systemic Lupus Erythematosus. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.5206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Silva C, Bortoluzzo A, Viana V, Pasoto S, Leon E, Bonfá E, Sampaio-Barros P. AB0637 Systemic Sclerosis-Related Auto-Antibodies Are Markers of New Clinical Associations in A Cohort of 328 Brazilian Patients. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.5641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Schmitz M, Botte D, Bonfá E, Borba E, Mello S. AB0185 Increased Corticotropin-Releasing Hormone (CRH) Expression in Cutaneous Lupus Lesions. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.1492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Yamakami LYS, Serafini PC, de Araujo DB, Bonfá E, Leon EP, Baracat EC, Silva CA. Ovarian reserve in women with primary antiphospholipid syndrome. Lupus 2014; 23:862-7. [DOI: 10.1177/0961203314529468] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2013] [Accepted: 03/06/2014] [Indexed: 11/16/2022]
Abstract
Objective The objective of this paper is to evaluate ovarian reserve in primary antiphospholipid syndrome (PAPS) women and the association between ovarian reserve tests and clinical and laboratorial parameters, and anti-corpus luteum antibody (anti-CoL). Methods We screened 85 female patients between 18 to 40 years old with APS. Of these, 67 patients were excluded because of association with other autoimmune diseases ( n = 42), contraindication or unwillingness to stop hormonal contraceptive ( n = 21), current pregnancy or breastfeeding ( n = 3) and previous ovarian surgery ( n = 1). Therefore, a cross-sectional study was conducted in 18 PAPS patients and 24 healthy women. They were evaluated at early follicular phase with measurement of follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol, and anti-Müllerian hormone (AMH) and sonographic antral follicle count (AFC). Serum measurement of anti-CoL was determined by immunoblot analysis. All analyses were performed after at least six months from the last intake of hormonal contraceptive and resumption of menstruation. Results The mean age was comparable in PAPS and controls (33.0 ± 5.0 vs. 30.4 ± 7.0 years; p = 0.19). Regarding ovarian reserve tests, the frequencies of low AFC (≤10) (56% vs. 22%, p = 0.04) and very low AFC (≤5) (37% vs. 9%, p = 0.04) were significantly higher in PAPS patients than controls. Trends of higher frequencies of reduced (<1.0 ng/ml), low (<0.5 ng/ml) and negligible (<0.2 ng/ml) AMH levels were found in PAPS patients ( p = 0.08, p = 0.07 and p = 0.07, respectively). FSH, LH and estradiol were similar in patients and controls. There was no association between low ovarian reserve and specific types of antiphospholipid antibodies. Anti-CoL was solely observed in PAPS patients (11% vs. 0%; p = 0.177) and was not related to ovarian reserve tests. Conclusion Women suffering from PAPS possessed reduced ovarian reserve, with prevalence greater than 50%.
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Affiliation(s)
| | | | - DB de Araujo
- Division of Rheumatology
- Department of Rheumatology, Hospital do Servidor Público Estadual de São Paulo, São Paulo, Brazil
| | | | | | | | - CA Silva
- Division of Rheumatology
- Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Figueiredo CP, Domiciano DS, Lopes JB, Caparbo VF, Scazufca M, Bonfá E, Pereira RMR. Prevalence of sarcopenia and associated risk factors by two diagnostic criteria in community-dwelling older men: the São Paulo Ageing & Health Study (SPAH). Osteoporos Int 2014; 25:589-96. [PMID: 23892584 DOI: 10.1007/s00198-013-2455-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2013] [Accepted: 06/24/2013] [Indexed: 01/13/2023]
Abstract
UNLABELLED Sarcopenia is an aging syndrome that can be characterized by many criteria adjusted or not by fat mass. This study suggested that the optimal criteria should be selected according to body mass index (BMI) in older men and identified age, BMI, race, smoking, physical activity, hip bone mineral density (BMD) as risk factors for this syndrome. INTRODUCTION This study aims to analyze the prevalence of sarcopenia and associated risk factors using appendicular skeletal mass (ASM)/height(2) and ASM adjusted for total fat mass criteria in older men from community. METHODS Three hundred ninety-nine men were included and answered a questionnaire about lifestyle and medical history. Individuals were classified by their BMI using the classification adjusted by age. Body composition and bone mineral density were measured by dual X-ray absorptiometry. Sarcopenia was classified according to both criteria. Logistic regression models were used to analyze risk factors associated with sarcopenia. RESULTS The mean BMI was 26.46 kg/m(2): 12.5 % underweight, 43.6 % normal, and 43.9 % overweight/obese. Fifty-four (13.5 %) were considered sarcopenic by ASM/height(2) and 79 (19.8 %) by ASM adjusted for fat (p = 0.001). Fifty-one (12.8 %) individuals had discordant sarcopenia classification: 13 were classified only by ASM/height(2) and 38 only by ASM adjusted for fat. Of the 13 subjects classified as sarcopenic only by ASM/height(2), 84.6 % (11/13) were underweight and solely one (7.7 %) was considered overweight/obese. In contrast, of those 38 older men classified as sarcopenic only by ASM adjusted for fat, none were underweight and 53 % (20/38) were overweight/obese. Subjects classified as sarcopenic according to both criteria had the same risk factors in the final model analyses (age, BMI, race, smoking, physical activity, hip BMD; p < 0.05). CONCLUSION This study suggested that the optimal criteria for sarcopenia should be selected according to BMI in community-dwelling older men.
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Affiliation(s)
- C P Figueiredo
- Bone Metabolism Laboratory, Rheumatology Division, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Arnaldo, 455, 3º andar, sala 3105, São Paulo, SP, 01246-903, Brazil
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Abstract
Primary ovarian insufficiency (POI) is defined as sustained amenorrhea, increased follicle-stimulating hormone and low estrogen levels, whereas diminished ovarian reserve (DOR) is characterized as regular menses and alterations of ovarian reserve tests. POI of autoimmune origin may be associated with adrenal autoimmunity, non-adrenal autoimmunity or isolated. This autoimmune disease is characterized by serum ovarian, adrenocortical or steroidogenic cell autoantibodies. POI of adrenal autoimmune origin is the most frequent type observed in 60-80% of patients. Clinically, amenorrhea is the hallmark of POI, however before menstruation stops completely, irregular cycles occur. Infertility, hot flushes, vaginal atrophy, and dyspareunia are also common. Autoimmune oophoritis is characterized by mononuclear inflammatory cell infiltrate in the theca cells of growing follicles, with early stage follicles without lymphocytic infiltration. This infiltrate includes plasma, B and T-cells. A novel classification criterion for autoimmune POI/DOR is proposed subdividing in three distinct categories (possible, probable and confirmed) according to autoantibodies, autoimmune disease and ovarian histology. Unfortunately, up to date guidelines for the treatment of autoimmune oophoritis are not available. Strategies to POI treatment include hormone replacement and infertility therapy. Assisted conception with donated oocytes has been proven to achieve pregnancy by intra cytoplasmic sperm injection in POI women.
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Affiliation(s)
- C A Silva
- Pediatric Rheumatology Unit, Department of Pediatric, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
| | - L Y S Yamakami
- Division of Gynecology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - N E Aikawa
- Pediatric Rheumatology Unit, Department of Pediatric, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - D B Araujo
- Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Division of Rheumatology, Faculdade de Medicina da Universidade Federal de Pelotas, Rio Grande do Sul, Brazil
| | - J F Carvalho
- Division of Rheumatology, Faculdade de Medicina da Universidade da Bahia, Bahia, Brazil
| | - E Bonfá
- Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Araujo DB, Yamakami LY, Bonfá E, Viana VS, Pasoto SG, Pereira RM, Serafin PC, Borba EF, Silva CA. PReS-FINAL-2289: Ovarian dysfunction in adult childhood-onset lupus patients: a possible role of methotrexate? Pediatr Rheumatol Online J 2013. [PMCID: PMC4043757 DOI: 10.1186/1546-0096-11-s2-p279] [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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Yamakami L, Serafini P, Araujo D, Bonfá E, Baracat E, Silva C. Do women with primary antiphospholipid syndrome have low ovarian reserve? Fertil Steril 2013. [DOI: 10.1016/j.fertnstert.2013.07.1527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Borba EF, Araujo DB, Bonfá E, Shinjo SK. Clinical and immunological features of 888 Brazilian systemic lupus patients from a monocentric cohort: comparison with other populations. Lupus 2013; 22:744-9. [DOI: 10.1177/0961203313490432] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Epidemiological studies with systemic lupus erythematosus (SLE) patients have been reported worldwide but, until now, a large evaluation had not been performed in Brazil. Therefore, we determined the clinical and immunological features of 888 SLE patients followed at our service from 2008 to 2012. The mean age at SLE onset and the mean disease duration were 29.9 ± 9.5 years old and 14.5 ± 8.4 years, respectively. A predominance of female gender (91.9%) and Caucasian ethnicity (69.9%) were observed. Cumulative mucocutaneous manifestations (90.7%) were most commonly identified (malar rash (83.2%), photosensitivity (76.9%)) followed by articular (87.4%), hematological (44.0%) and renal (36.9%) involvements. Antinuclear antibody was detected in all patients, followed by anti-dsDNA (35.1%), anti-Sm (21.8%) and anti-ribosomal P protein antibodies (19.8%). Additional comparison of clinical and laboratory features between genders revealed that malar rash was observed more in female SLE patients (84.5% vs. 69.4%, p = 0.001). Male lupus patients presented a higher frequency of anti-dsDNA (45.8% vs. 34.2%, p = 0.047) and a trend of more nephritis (47.2% vs. 36.0%, p = 0.059). In conclusion, we identified a high prevalence of mucocutaneous manifestations in this Brazilian SLE cohort compared to other countries, mainly malar rash that was most commonly observed in female patients. Anti-dsDNA and other specific SLE autoantibodies were also identified in a higher frequency, predominantly in the male gender.
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Affiliation(s)
- EF Borba
- Division of Rheumatology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - DB Araujo
- Division of Rheumatology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil
- Department of Rheumatology, Hospital do Servidor Público Estadual de São Paulo, Brazil
| | - E Bonfá
- Division of Rheumatology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - SK Shinjo
- Division of Rheumatology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil
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Aikawa NE, Campos LMA, Goldenstein-Schainberg C, Saad CGS, Ribeiro AC, Bueno C, Precioso AR, Timenetsky M, Silva CAA, Bonfá E. Effective seroconversion and safety following the pandemic influenza vaccination (anti-H1N1) in patients with juvenile idiopathic arthritis. Scand J Rheumatol 2012; 42:34-40. [DOI: 10.3109/03009742.2012.709272] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Nukumizu LA, Saad CG, Ostensen M, Almeida BP, Cocuzza M, Gonçalves C, Saito O, Bonfá E, Silva CA. Gonadal function in male patients with ankylosing spondylitis. Scand J Rheumatol 2012; 41:476-81. [DOI: 10.3109/03009742.2012.688218] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Aikawa NE, Sallum AME, Pereira RMR, Suzuki L, Viana VST, Bonfá E, Silva CA. Subclinical impairment of ovarian reserve in juvenile systemic lupus erythematosus after cyclophosphamide therapy. Clin Exp Rheumatol 2012; 30:445-449. [PMID: 22703605] [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: 08/14/2011] [Accepted: 01/10/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVES To perform systematic assessment of ovarian reserve markers using a combination of tests in juvenile systemic lupus erythematosus (JSLE) patients without amenorrhoea. METHODS Twenty-seven consecutive JSLE female patients and 13 healthy controls without amenorrhoea were evaluated for 6 months. Ovarian reserve was assessed during early follicular phase by serum levels of follicle stimulating hormone (FSH), luteinising hormone (LH), estradiol, inhibin A, inhibin B and anti-Mullerian hormone (AMH). Ovarian size was measured by abdominal ultrasonography. Demographic data, disease activity, damage and treatment were also analysed. RESULTS The median of current age was similar in JSLE patients and controls (16.5 vs. 15years, p=0.31) with a significantly higher age at menarche (13 vs. 12years, p=0.03). A trend of lower median total antral follicle count was observed in JSLE compared to controls (9 vs. 14.5, p=0.062) with similar median of other ovarian reserve parameters (p>0.05). Further evaluation of patients treated with cyclophosphamide and those without this treatment revealed a higher median FSH levels (6.4 vs. 4.6 IU/L, p=0.023). Inhibin B, AMH levels and ovarian volume were also lower but did not reach statistical significance (10.8 vs. 27.6 pg/mL, p=0.175; 0.6 vs. 1.5 ng/mL, p=0.276; 3.4 vs. 5 cm3, p=0.133; respectively). LH (2.7 vs. 2.9 IU/L, p=0.43), estradiol (50 vs. 38 pg/mL, p=0.337) and inhibin A (1.1 vs. 0 pg/mL, p=0.489) levels were comparable in both groups. CONCLUSIONS Our study suggests that ovarian reserve after cyclophosphamide treatment may be hampered in spite of the presence of menstrual cycles emphasising the relevance of gonadal protection during the use of this alkylating agent.
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Affiliation(s)
- N E Aikawa
- Pediatric Rheumatology Unit and Rheumatology Division, Faculdade de Medicina da Universidade de Sao Paulo, Brazil.
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do Prado DML, Gualano B, Miossi R, Lima FR, Roschel H, Borba E, Bonfá E, de Sá Pinto AL. Erratic control of breathing during exercise in patients with systemic lupus erythematosus: a pilot-study. Lupus 2011; 20:1535-40. [DOI: 10.1177/0961203311425525] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: The aim of this study was to provide a comprehensive evaluation of the pattern and timing of breathing during incremental exercise in a sample of women living with systemic lupus erythematosus (SLE). Methods: In this cross-sectional study, 20 women with SLE without pulmonary involvement were compared with 20 gender-, body mass index- (BMI), and age-matched healthy individuals. By using a cardiopulmonary incremental exercise test, the following parameters were assessed: tidal volume (VT); breathing frequency (BF); total respiratory time (TOT); inspiratory time (TI); expiratory time (TE); inspiratory time to total time (TI/TOT); mean inspiratory flow (VT/TI); ventilatory equivalent for carbon dioxide (VE/VCO2) and end-tidal carbon dioxide pressure (PETCO2). Results: BF and BF/VT were significantly higher in patients with SLE versus controls, whereas VT, TE, TI and TOT were significantly lower in the former group ( p < 0.05). Additionally, patients with SLE presented higher VE/VCO2 and lower PETCO2 than controls ( p < 0.05), suggesting a ventilatory inefficiency. Conclusion: We reported compelling evidence of abnormal pattern and timing of breathing during incremental exercise in SLE. Considering that an erratic control of breathing may play an important role in exercise intolerance and fatigue, respiratory exercises emerge as a potential treatment for these symptoms in patients with SLE.
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Affiliation(s)
- DML do Prado
- Division of Rheumatology, School of Medicine, University of São Paulo, Brazil
| | - B Gualano
- Division of Rheumatology, School of Medicine, University of São Paulo, Brazil
- School of Physical Education and Sport, University of São Paulo, Brazil
| | - R Miossi
- Division of Rheumatology, School of Medicine, University of São Paulo, Brazil
| | - FR Lima
- Division of Rheumatology, School of Medicine, University of São Paulo, Brazil
| | - H Roschel
- Division of Rheumatology, School of Medicine, University of São Paulo, Brazil
- School of Physical Education and Sport, University of São Paulo, Brazil
| | - E Borba
- Division of Rheumatology, School of Medicine, University of São Paulo, Brazil
| | - E Bonfá
- Division of Rheumatology, School of Medicine, University of São Paulo, Brazil
| | - AL de Sá Pinto
- Division of Rheumatology, School of Medicine, University of São Paulo, Brazil
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Rabelo-Júnior CN, Freire de Carvalho J, Lopes Gallinaro A, Bonfá E, Cocuzza M, Saito O, Silva CA. Primary antiphospholipid syndrome: morphofunctional penile abnormalities with normal sperm analysis. Lupus 2011; 21:251-6. [PMID: 22004973 DOI: 10.1177/0961203311422715] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To perform a global gonadal and sexual functions assessment in primary antiphospholipid syndrome (PAPS) patients. METHODS A cross-sectional study was conducted in 12 male PAPS patients and 20 healthy controls. They were assessed by demographic data, clinical features, systematic urological examination, sexual function, testicular ultrasound, seminal parameters according to the World Health Organization (WHO), seminal sperm antibodies, and hormone profile, including follicle stimulating hormone (FSH), luteinizing hormone (LH), morning total testosterone, and thyroid hormones. RESULTS The median of current age and age of spermarche were similar in PAPS patients and controls (37.5 vs. 32.4 years, p = 0.270, and 13.1 vs. 12.85 years, p = 0.224, respectively), with a higher frequency of erectile dysfunction in the former group (25% vs. 0%, p = 0.044). Further analysis of PAPS patients with and without previous arterial thrombosis demonstrated that the median penis circumference was significantly lower in PAPS with arterial thrombosis than in PAPS without this complication (8.1 [6-10] vs. 10.2 [10-11] cm, p = 0.007). In addition, the median penis circumference was significantly lower in PAPS patients with erectile dysfunction than in patients without this complication (7.5 [6-9.5] vs. 9.5 [7.5-11] cm, p = 0.039). Regarding seminal analysis, the median sperm concentration, sperm motility, and normal sperm forms by WHO guidelines were comparable in PAPS patients and controls (141.5 [33-575] vs. 120.06 [34.5-329] × 10(6)/ml, p = 0.65; 61.29 [25-80] vs. 65.42 [43-82]%, p = 0.4; 21.12 [10-42.5] vs. 23.95 [10-45]%, p = 0.45, respectively), and none of them had oligo/azoospermia. No differences were observed between PAPS patients and controls regarding the frequency of antisperm antibodies, testicular volume by ultrasound, or hormone profile (FSH, LH, morning total testosterone, and thyroid hormone) (p > 0.05). CONCLUSIONS Normal testicular function has been identified in PAPS patients, in spite of morphofunctional penile abnormalities. Previous arterial thrombosis may underlie penile anthropometry alteration.
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Affiliation(s)
- C N Rabelo-Júnior
- Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo, Brazil
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Abstract
OBJECTIVES Patients with diffuse cutaneous systemic sclerosis (dcSSc) have distinct clinical manifestations, usually with more aggressive organ involvement and highermortality than limited cutaneous systemic sclerosis (lcSSC). Hearing loss had not yet been evaluated in this subtype, so our aim was to assess the auditory system of dcSSc patients in a controlled study. METHODS Twenty-six patients with dcSSc, according to American College of Rheumatology (ACR) criteria, were evaluated. For each dcSSc patient included in the study, two healthy controls were matched for sex and age (± 2 years). All patients responded to a structured questionnaire regarding otological symptoms and risk factors with regard to hearing loss. A complete ear/nose/throat physical examination was performed followed by speech/pure tone audiometry and impedance measurements. RESULTS The mean age of the dcSSc patients was 47.0 ± 11.9 years; the mean disease duration was 9.4 ± 9.1 years, and there was a clear female predominance (83%). The questionnaire revealed auditory complaints in 54% of the dcSSc patients (25% hearing loss, 21% aural fullness, 21% tinnitus, and 21% dizziness) and normal otoscopy. Nearly half (46%) of the dcSSc patients were diagnosed as having hearing loss on audiogram compared to only 19% in the control group (p = 0.01). All dcSSc with hearing loss had a sensorineural component, eight (73%) with excellent discrimination on the Percentage Index of Speech Recognition (PISR). Descending configuration and Metz recruitment were observed in 54% of these patients, suggesting cochlear involvement. CONCLUSION Patients with dcSSc have a high prevalence of sensorineural audiometric hearing impairment and otological complaints, suggesting that the cochlea is an additional target organ in this disease.
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Affiliation(s)
- T A Monteiro
- Departments of Otorhinolaryngology, University of Sao Paulo Medical School, Sao Paulo, Brazil.
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