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Piga M, Tselios K, Viveiros L, Chessa E, Neves A, Urowitz MB, Isenberg D. Clinical patterns of disease: From early systemic lupus erythematosus to late-onset disease. Best Pract Res Clin Rheumatol 2024:101938. [PMID: 38388232 DOI: 10.1016/j.berh.2024.101938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 12/27/2023] [Accepted: 02/16/2024] [Indexed: 02/24/2024]
Abstract
Systemic lupus erythematosus (SLE) is a complex disease with an insidious clinical presentation. In up to half of the cases, SLE onset is characterized by clinical and serological manifestations that, although specific, are insufficient to fulfill the classification criteria. This condition, called incomplete SLE, could be as challenging as the definite and classifiable SLE and requires to be treated according to the severity of clinical manifestations. In addition, an early SLE diagnosis and therapeutic intervention can positively influence the disease outcome, including remission rate and damage accrual. After diagnosis, the disease course is relapsing-remitting for most patients. Time in remission and cumulative glucocorticoid exposure are the most important factors for prognosis. Therefore, timely identification of SLE clinical patterns may help tailor the therapeutic intervention to the disease course. Late-onset SLE is rare but more often associated with delayed diagnosis and a higher incidence of comorbidities, including Sjogren's syndrome. This review focuses on the SLE disease course, providing actionable strategies for early diagnosis, an overview of the possible clinical patterns of SLE, and the clinical variation associated with the different age-at-onset SLE groups.
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Affiliation(s)
- Matteo Piga
- Department of Medical Sciences and Public Health, University of Cagliari, Italy; Rheumatology Unit, University Clinic, AOU, Cagliari, Italy.
| | - Kostantinos Tselios
- McMaster Lupus Clinic, Department of Medicine, McMaster University, Toronto, Canada
| | - Luísa Viveiros
- Department of Internal Medicine, Centro Hospitalar Universitário de Santo, António, Portugal
| | | | - Ana Neves
- Department of Internal Medicine, Centro Hospitalar Universitário de São João, Portugal
| | | | - David Isenberg
- Centre for Rheumatology, Division of Medicine, University College of London, United Kingdom
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Neves A, Viveiros L, Venturelli V, Isenberg DA. Where are we now in biological drugs for myositis? Rheumatology (Oxford) 2024:keae096. [PMID: 38321569 DOI: 10.1093/rheumatology/keae096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 01/10/2024] [Accepted: 01/30/2024] [Indexed: 02/08/2024] Open
Abstract
Idiopathic inflammatory myopathies (IIM) are a rare and heterogeneous group of chronic autoimmune disorders. Up to 40% of IIM patients have long-term sequelae and significant functional disability. Its management can be challenging. New therapies are badly needed. The small number of cases with diverse presentations, and different diagnostic criteria interfere significantly with clinical trial results. Only intravenous immunoglobulin has been internationally approved for IIM patients. Most clinical trials of new biological therapies have failed to meet their primary endpoints in IIM, with only one biological drug recommended for refractory IIM treatment (rituximab), although not approved. We review several new emerging biological drugs including B cell depletion therapies, abatacept, janus-kinase inhibitors, and aldesleukin. Encouragingly, some phase II randomized controlled trials have evaluated the efficacy and safety of new biologics in IIM, demonstrating an improvement in clinical and laboratory measures.
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Affiliation(s)
- Ana Neves
- Internal Medicine Department, Centro Hospitalar Universitário de São João, Oporto, Portugal
| | - Luísa Viveiros
- Internal Medicine Department, Centro Hospitalar Universitário de Santo António, Oporto, Portugal
| | - Veronica Venturelli
- Rheumatology Unit, Department of Medical Sciences, Università degli Studi di Ferrara, Azienda Ospedaliero-Universitaria S. Anna, Cona, Italy
| | - David A Isenberg
- Centre for Rheumatology, Department of Medicine, University College London, London, United Kingdom
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Neves A, Viveiros L, Venturelli V, Isenberg DA. Promising Experimental Treatments for Lupus Nephritis: Key Talking Points and Potential Opportunities. Res Rep Urol 2023; 15:333-353. [PMID: 37456804 PMCID: PMC10348374 DOI: 10.2147/rru.s385836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 07/03/2023] [Indexed: 07/18/2023] Open
Abstract
Lupus nephritis (LN) is a frequent and serious complication of systemic lupus erythematosus (SLE), impairing patients' quality of life and significantly increasing mortality. Despite optimizing the use of conventional immunosuppressants and other biological drugs, its management remains unsatisfactory. This is mainly due to the heterogeneity of SLE, but also to insufficiently effective treatment regimens and clinical trial limitations (strict criteria, low number of patients included, and side effects). Most clinical trials of new biological therapies have failed to meet their primary endpoints in both general SLE and LN, with only two biological drugs (belimumab and anifrolumab) being approved by the Food and Drug Administration (FDA) for the treatment of SLE. Recently, several Phase II randomized controlled trials have evaluated the efficacy and safety of new biologics in LN, and some of them have demonstrated an improvement in clinical and laboratory measures. Multi-target therapies are also being successfully developed and encourage a belief that there will be an improvement in LN outcomes.
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Affiliation(s)
- Ana Neves
- Internal Medicine Department, Centro Hospitalar Universitário de São João, Oporto, Portugal
| | - Luísa Viveiros
- Internal Medicine Department, Centro Hospitalar Universitário de Santo António, Oporto, Portugal
| | - Veronica Venturelli
- Rheumatology Unit, Department of Medical Sciences, Università degli Studi di Ferrara, Azienda Ospedaliero-Universitaria S. Anna, Cona, Italy
| | - David A Isenberg
- Centre for Rheumatology, Department of Medicine, University College London, London, UK
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Viveiros L, Martins SR, Pires SX, Neves J. Paraneoplastic Lambert-Eaton myasthenic syndrome: a diagnostic challenge. BMJ Case Rep 2023; 16:16/1/e250947. [PMID: 36707096 PMCID: PMC9884852 DOI: 10.1136/bcr-2022-250947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Lambert-Eaton myasthenic syndrome (LEMS) is a rare neuromuscular junction disorder. Underlying small cell lung cancer is found in more than half of patients. Proximal muscle weakness, autonomic features and areflexia are typical manifestations. However, LEMS is often misdiagnosed. We report a rare case of paraneoplastic LEMS, identified amid admission due to a different diagnosis. Our patient was initially admitted due to aspiration pneumonia. Further investigation revealed clinical and electrophysiological manifestations of LEMS. High clinical suspicion and early diagnostic workup were paramount in the patient outcome. Nevertheless, paraneoplastic aetiology was difficult to confirm and revealed itself a difficult challenge. Clinical awareness is crucial to diagnose LEMS and urge cancer screening and early treatment.
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Affiliation(s)
- Luísa Viveiros
- Department of Internal Medicine, Centro Hospitalar Universitário do Porto, EPE, Porto, Portugal
| | - Sara Raquel Martins
- Department of Internal Medicine, Centro Hospitalar Universitário do Porto, EPE, Porto, Portugal
| | - Sara Xavier Pires
- Department of Internal Medicine, Centro Hospitalar Universitário do Porto, EPE, Porto, Portugal
| | - João Neves
- Department of Internal Medicine, Centro Hospitalar Universitário do Porto, EPE, Porto, Portugal
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Abstract
The aim of the present study was to investigate changes in muscle soreness, blood muscle damage markers, muscle strength and agility following an official basketball match. Eleven elite female professional basketball players (27.4 ± 4.8 years, 179.5 ± 5.5 cm, 72.0 ± 7.8 kg) of a team participated in this study. The official match was the seventh match of the season in the first phase of the Brazilian National Female Basketball Championship. Muscle soreness, plasma creatine kinase activity (CK), and myoglobin concentration (Mb) were determined before and after the match (post-match, 24 and 48 hours after the match). The 1RM strength for bench press and leg press, and the agility T test were assessed before and at 24 and 48 hours after the match. Significant increases in muscle soreness, CK and Mb were observed at 24 and 48 hours post-match (p<0.05). No significant changes in the 1RM strength and T test were detected during recovery (24 and 48 hours after the match). These results suggest that a basketball match induced limited muscle damage with minimal effect on performance during recovery. The small increase in muscle damage markers following a basketball match did not affect strength and agility performance.
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Affiliation(s)
- A Moreira
- School of Physical Education and Sport, University of Sao Paulo, Brazil
| | - K Nosaka
- School of Exercise and Health Sciences, Centre for Exercise and Sports Science Research, Edith Cowan University, Australia
| | - J A Nunes
- School of Arts, Sciences and Humanities, University of Sao Paulo, Brazil
| | - L Viveiros
- Brazilian Olympic Committee, Rio de Janeiro, Brazil
| | - A Z Jamurtas
- Department of Physical Education and Sport Science, University of Thessaly, Greece
| | - M S Aoki
- School of Arts, Sciences and Humanities, University of Sao Paulo, Brazil
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Nunes JA, Crewther BT, Viveiros L, De Rose D, Aoki MS. Effects of resistance training periodization on performance and salivary immune-endocrine responses of elite female basketball players. J Sports Med Phys Fitness 2011; 51:676-682. [PMID: 22212272] [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] [Indexed: 05/31/2023]
Abstract
AIM The aim of this paper was to examine the effects of resistance training periodization on the performance and salivary hormone-immune responses of elite female basketball players. METHODS Twelve female athletes were monitored across a 50 day period of resistance training that emphasized strength, endurance and power. One repetition maximum (1RM) strength, maximal repetitions at 50% 1RM and vertical jump performance was assessed pre- and post-training. Saliva samples were also collected at 0700, 0930, 1100 and 1730 hours and analyzed for testosterone (T), cortisol (C) and immunoglobulin A (IgA). RESULTS Improvements in 1RM strength, maximal repetitions and vertical jump performance were identified post-training (P<0.05). Training had no effect on salivary T and C concentrations, but the T:C ratio increased at 0730 hours (P<0.05) and IgA concentrations were lowered at 0930 and 1100 hours (P<0.05). The changes (∆ Pre-Post training) in strength and T concentrations were positively correlated at 0730 hours (P<0.05). CONCLUSION A periodized approach to resistance training increased muscle performance in elite female basketball players, but only minor changes in the salivary T:C ratio and IgA were noted. Correlational analysis identified a possible role for early morning changes in T as a regulator of individual strength changes.
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Affiliation(s)
- J A Nunes
- School of Arts, Sciences and Humanities, University of Sao Paulo, Sao Paulo, Brazil
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Viveiros L, Nunes J, Crewther B, De Rose D, Aoki M. Salivary hormone and immune responses to different resistance exercise schemes in elite female basketball players. J Sci Med Sport 2010. [DOI: 10.1016/j.jsams.2009.10.254] [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: 11/28/2022]
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Viveiros L, Duarte A, Soares P, Farinatti PV. Acute stretching effects on heart rate variability of healthy young men. J Sci Med Sport 2010. [DOI: 10.1016/j.jsams.2009.10.268] [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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