A.S. Braz

Recomendações da Sociedade Brasileira de Reumatologia sobre diagnóstico e tratamento das parasitoses intestinais em pacientes com doenças reumáticas autoimunes

Intestinal parasites - helminths and protozoa - are cosmopolitan diseases which are most prevalent in tropical regions. Patients with diagnoses of autoimmune rheumatic diseases have, due to the underlying disease or its treatment, an increased risk of occurrence of severe manifestations of intestinal parasites. Although the prevalence of these parasitic infections is very high in our environment, not always is the rheumatologist attentive to the need for investigation and treatment of helminthiasis and protozooses before the use of immunomodulatory, immunosuppressive therapies, and of biological drugs that are modifiers of the course of the disease. In this document, the Brazilian Society of Rheumatology establishes general recommendations on the diagnosis and treatment of intestinal parasitic infections in Brazil in patients with autoimmune rheumatic diseases, highlighting rheumatoid arthritis, systemic lupus erythematosus and spondyloarthritis.

Manifestações musculoesqueléticas nos pacientes em programa de hemodiálise

A large diversity of ostearticular complaints has been described in patients in long-term hemodialysis. OBJECTIVE: To verify the proportion and the type of musculoskeletal complaints in patients in maintenance hemodialysis, at three centers of metropolitan Recife, and to relate these complains to the following variables: sex, ethnic group, patients current age and when the dialysis began, and dialitic treatment time. METHODS: Firstly, questionnaires were applied to 197 patients, distributed at the three centers from March 2001 to January 2002. After excluding 35 patients with previous diagnosis of rheumatic disease, we investigatied the presence of musculoskeletal signs and/or symptoms in 162 patients. The average age was 47,3 years old, and 43,8 years old was the average age at the beginning of the treatment; 94 patients (58%) were men and 120 patients (74.1%) were not Caucasian. The average time of the dialitic treatment was 44,1 months, and polysulphone membrane was used in all of them. RESULTS: Musculoskeletal manifestations were observed in 55 (34%) of the patients on this research. One type of manifestation was presented by 38 of these patients, and 17 patients presented more than one type (16 presented two and 1 presented three types), making up a total of 73 manifestations, distributed among joints (44), bones (18), neuromuscular (6) and periarticular (5) structures. Arthralgia was responsible for 46.6% of all musculoskeletal complaints and the knee was the joint most injured (52.9% of all cases). Bone pain was the second common complaint (21.9%), periarticular changes were responsible for 6.8% of musculoskeletal manifestations, and carpal tunnel syndrome, bone deformities and joint tumours occurred in 4.1%, 2.7% and 2.7% of all manifestations, respectively. Among 55 patients, joint changes were found in 72.7% of them, bone changes in 32.7%, neuromuscular complaints in 10.8% and periarticular in 9.1% of the patients. The relation between the dialitic treatment time (59,8 months) and the development of the musculoskeletal manifestations (p < 0.001) was observed in this research. CONCLUSIONS: According to this information, we can conclude that the proportion of musculoskeletal complaints on our patients was 34%; the joint problems were the most frequently observed; and arthralgia was the most common complaint. Except for the dialitic treatment time, all the other variables were not associated with the musculoskeletal manifestations.

Artrite da gota tofácea crônica mimetizando artrite reumatoide

ABSTRACT Gout is a disorder of purine metabolism, usually associated with recurrent bouts of arthritis in the joints of the lower limbs, affecting men 40 to 50 years of age, which leads to the development of subcutaneous tophi in patients with long-lasting disease. Cases of patients with chronic gouty arthritis mimicking rheumatoid arthritis, and vice-versa, are rare. This report describes the case of a 56-year old male with symmetric, deforming, and polyarticular arthritis affecting, specially, the joints of the hands and wrists, with diffuse subcutaneous nodules throughout his body, atypical radiographic findings, and urolithiasis. Following clinical evaluation and additional tests, this patient received a diagnosis of chronic tophaceous gout mimicking mutilating rheumatoid arthritis. Keywords : gout, deforming polyarthritis, subcutaneous tophi, rheumatoid arthritis. INTRODUCTION Gout is a metabolic disease that affects, specially, middle aged and elderly men and postmenopausal women. It is six times more common in males than in females.Gout is a disorder of purine metabolism, usually associated with recurrent bouts of arthritis in the joints of the lower limbs, affecting men 40 to 50 years of age, which leads to the development of subcutaneous tophi in patients with long-lasting disease. Cases of patients with chronic gouty arthritis mimicking rheumatoid arthritis, and vice-versa, are rare. This report describes the case of a 56-year old male with symmetric, deforming, and polyarticular arthritis affecting, specially, the joints of the hands and wrists, with diffuse subcutaneous nodules throughout his body, atypical radiographic findings, and urolithiasis. Following clinical evaluation and additional tests, this patient received a diagnosis of chronic tophaceous gout mimicking mutilating rheumatoid arthritis.

IgA nephropathy in systemic lupus erythematosus patients: case report and literature review

Systemic erythematosus lupus (SLE) is a multisystemic autoimmune disease which has nephritis as one of the most striking manifestations. Although it can coexist with other autoimmune diseases, and determine the predisposition to various infectious complications, SLE is rarely described in association with non-lupus nephropathies etiologies. We report the rare association of SLE and primary IgA nephropathy (IgAN), the most frequent primary glomerulopathy in the world population. The patient was diagnosed with SLE due to the occurrence of malar rash, alopecia, pleural effusion, proteinuria, ANA 1: 1280, nuclear fine speckled pattern, and anticardiolipin IgM and 280U/mL. Renal biopsy revealed mesangial hypercellularity with isolated IgA deposits, consistent with primary IgAN. It was treated with antimalarial drug, prednisone and inhibitor of angiotensin converting enzyme, showing good progress. Since they are relatively common diseases, the coexistence of SLE and IgAN may in fact be an uncommon finding for unknown reasons or an underdiagnosed condition. This report focus on the importance of the distinction between the activity of renal disease in SLE and non-SLE nephropathy, especially IgAN, a definition that has important implications on renal prognosis and therapeutic regimens to be adopted in both the short and long terms.

Rituximab as an alternative for patients with severe systemic vasculitis refractory to conventional therapy: report of seven cases and literature review

The greater understanding of pathophysiology and behavior of systemic vasculitis, together with the development of therapeutic regimens with increasingly better safety and efficacy profiles, dramatically changed the prognosis of patients diagnosed with these clinical entities. Recently, the use of rituximab in the treatment of patients with ANCA-associated vasculitis in randomized clinical trials showed an important alternative in selected cases, especially patients refractory or intolerant to standard therapy with cyclophosphamide and corticosteroids. This article presents the report of seven cases of systemic vasculitis successfully treated with rituximab.