Gilda Aparecida Ferreira

Presentation and prognosis of shrinking lung syndrome in systemic lupus erythematosus: report of four cases.

Systemic lupus erythematosus is an autoimmune systemic disease that commonly affects the respiratory system. Shrinking lung syndrome is a rare respiratory complication associated with systemic lupus erythematosus. Patients present with dyspnea alone or associated with chest pain and orthopnea, lung volume reduction with no parenchymal abnormalities and a restrictive ventilatory defect on pulmonary function tests. The pathogenesis, treatment, and prognosis of shrinking lung syndrome remain controversial. This study describes the clinical features, investigations, and outcome of a series of four patients with systemic lupus erythematosus and shrinking lung syndrome regularly followed on Rheumatology Service of the Clinics Hospital of the Federal University of Minas Gerais, Brazil, with a brief review of literature. It emphasizes that, despite prognosis of shrinking lung syndrome has been reported as good, it may cause severe functional pulmonary abnormalities and must be treated promptly and aggressively in order to, at least, stabilize pulmonary function tests.

Subgingival microbiota dysbiosis in systemic lupus erythematosus: association with periodontal status

BackgroundPeriodontitis results from the interaction between a subgingival biofilm and host immune response. Changes in biofilm composition are thought to disrupt homeostasis between the host and subgingival bacteria resulting in periodontal damage. Chronic systemic inflammatory disorders have been shown to affect the subgingival microbiota and clinical periodontal status. However, this relationship has not been examined in subjects with systemic lupus erythematosus (SLE). The objective of our study was to investigate the influence of SLE on the subgingival microbiota and its connection with periodontal disease and SLE activity.MethodsWe evaluated 52 patients with SLE compared to 52 subjects without SLE (control group). Subjects were classified as without periodontitis and with periodontitis. Oral microbiota composition was assessed by amplifying the V4 region of 16S rRNA gene from subgingival dental plaque DNA extracts. These amplicons were examined by Illumina MiSeq sequencing.ResultsSLE patients exhibited higher prevalence of periodontitis which occurred at a younger age compared to subjects of the control group. More severe forms of periodontitis were found in SLE subjects that had higher bacterial loads and decreased microbial diversity. Bacterial species frequently detected in periodontal disease were observed in higher proportions in SLE patients, even in periodontal healthy sites such as Fretibacterium, Prevotella nigrescens, and Selenomonas. Changes in the oral microbiota were linked to increased local inflammation, as demonstrated by higher concentrations of IL-6, IL-17, and IL-33 in SLE patients with periodontitis.ConclusionsSLE is associated with differences in the composition of the microbiota, independently of periodontal status.

Tomography patterns of lung disease in systemic sclerosis.

Currently, lung impairment is the leading factor responsible for the morbidity and mortality associated with systemic sclerosis. Therefore, the recognition of the various tomography patterns becomes decisive in the clinical management of these patients. In high-resolution computed tomography studies, the most common pattern is that of nonspecific interstitial pneumonia. However, there are other forms of lung involvement that must also be recognized. The aim of this study was to review the literature on the main changes resulting from pulmonary involvement in systemic sclerosis and the corresponding radiological findings, considering the current classification of interstitial diseases. We searched the Medline (PubMed), Lilacs, and SciELO databases in order to select articles related to pulmonary changes in systemic sclerosis and published in English between 2000 and 2015. The pulmonary changes seen on computed tomography in systemic sclerosis are varied and are divided into three main categories: interstitial, alveolar, and vascular. Interstitial changes constitute the most common type of pulmonary involvement in systemic sclerosis. However, alveolar and vascular manifestations must also be recognized and considered in the presence of atypical clinical presentations and inadequate treatment responses.

Regular menstrual cycles do not rule out ovarian damage in adult women with systemic lupus erythematosus

Abstract The aim of this study was to evaluate ovarian reserve markers in women with systemic lupus erythematosus (SLE) and regular menstrual cycles, and explore the relationship of such markers with clinical and treatment features. This was a case–control study including 27 women with SLE and 27 controls. All participants were aged 18–40 years, were eumenorrheic and had not used hormone therapy or hormone contraceptives in the past six months. Clinical manifestations of SLE, past and current use of immunosuppressive therapy and organ damage index were assessed at a regular follow-up visit, while antral follicle count (AFC), serum anti-Mullerian hormone (AMH) and follicle-stimulating hormone (FSH) were assessed at early follicular phase of menstrual cycle. AFC was significantly reduced in SLE women [median (interquartile interval) 7 (5–11) versus 11 (7–12), p = 0.029]. AMH levels were more heterogeneous in SLE patients compared to the control group [1.23 (0.24–4.63) ng/ml versus 1.52 (1.33–1.88) ng/ml]. The SLE and control groups had similar serum FSH levels [6.44 (4.19–7.69) versus 7.5 (6.03–8.09) IU/L, p = 0.135]. AFC was inversely correlated with organ damage index (p = 0.046) and cumulative dose of cyclophosphamide (p = 0.028), while AMH levels were negatively correlated with the maximal dose of corticosteroid ever used (p = 0.003). These findings suggest that ovarian reserve may be decreased in women with SLE despite regular menstrual cycles. Chinese abstract 本研究的目的为评估患有系统性红斑狼疮（SLE）女性卵巢储备标志物和探究这些标志物与临床及治疗特征之间的相互联系。 研究为包括27名患SLE女性和27名对照的病例对照研究。所有受试者均为18-40岁，月经正常，且在过去的六个月中未受过激素治疗或未使用过口服避孕药。 SLE临床表现，过去和目前所使用的免疫抑制疗法及器官损伤指数均会在规律的随访中评估，而窦卵泡数（AFC），血清抗苗勒氏管激素和卵泡刺激素水平在月经周期中的早期卵泡期进行评估。 SLE妇女AFC水平显著降低[中位 (四分位间隔)7 (5–11) 与 11 (7–12), p=0.029]。SLE患者AMH水平与对照组相比更为异常[1.23 (0.24–4.63) ng/ml 与 1.52 (1.33–1.88) ng/ml]。SLE组和对照组FSH水平相类似[6.44 (4.19–7.69) 与 7.5 (6.03–8.09) IU/L, p=0.135]。 AFC与器官损伤指数(p=0.046) 和环磷酰胺累积剂量呈反相关(p=0.028), 而AMH水平与曾用过最大剂量皮质类固醇呈负相关(p=0.003)。这些发现说明即使月经周期规律的SLE患者卵巢储备也有可能降低。

Is there an association between systemic lupus erythematosus and periodontal disease

Periodontal disease results from the interaction between pathogenic bacteria that colonize supragingival and subgingival biofilms and the host, triggering an inflammatory response, with systemic effects leading to immune-mediated destruction of the attachment apparatus and loss of supporting alveolar bone. Immunological pathways and predisposing genetic factors common to periodontal disease and rheumatic diseases, including systemic lupus erythematosus, have been described. Case reports have suggested greater severity of periodontal disease in patients with systemic lupus erythematosus. However, studies evaluating the influence of the treatment of one disease on the clinical and laboratory manifestations of the other have yielded conflicting results.

Avaliação clínica, laboratorial e radiográfica de brasileiros com espondiloartropatias

OBJECTIVE: to evaluate disease manifestations of Brazilian patients with spondyloarthropathies. METHODS: a group of 156 patients was studied in a descriptive evaluation the analysis of the association between clinical, laboratory and radiographic aspects and the presence of the HLA-B27 was done. RESULTS: the following diseases were identified: ankylosing spondylitis (48.10%), undifferentiated spondyloarthropathy (20.51%), reactive arthritis (15.39%), psoriatic arthritis (14.10%) and inflammatory bowel disease arthropathy (1.92%). The HLA-B27 was identified in 53.85%. HLA-B27 presence was associated with clinical and/or radiographic findings of sacroiliac joints involvement (p=0.007; OR=3.13; CI 95% 1.38 to 7.06), with the presence of radiographic bilateral sacroiliitis > grade II, bilateral (p=0.05; OR=2.85; IC 95% 1.02 to 8.04) and with male gender (p=<0.001; OR=3.00; CI 95% 1.83 to 4.92). On the other hand, negative HLA-B27 was significantly associated with the occurrence of balanitis during the course of the disease (p=0.03; OR=0.21; IC 95% 0.05 to 0.88). CONCLUSION: clinical, laboratory and radiographic manifestations were similar to those reported by other studies. The frequency of HLA-B27 was low when compared to other studies. A significant association was observed between the HLA-B27 and gender as well as compromised sacroiliac joints.

Diagnostic Evaluation of ELISA and Chemiluminescent Assays as Alternative Screening Tests to Indirect Immunofluorescence for the Detection of Antibodies to Cellular Antigens

OBJECTIVES Detection of antinuclear antibodies (ANAs) plays an important role in the diagnosis of systemic autoimmune rheumatic disease (SARD). Our goal was to evaluate the diagnostic accuracy of three commercially available enzyme-linked immunosorbent assay (ELISA) kits and one chemiluminescent assay for ANA detection, using the clinical diagnostic as the reference standard. METHODS We evaluated serum samples from 143 patients with an established diagnosis of SARD (group 1), 166 patients with infectious diseases and other rheumatic diseases for which the ANA test is not useful in diagnosis (group 2), and 89 outpatients with suspicion of SARD (group 3). RESULTS The sensitivity for ANA HEp-2, calculated in group 1, was 87.4% and varied between 62.9% and 90.0% for other tests. The specificity for ANA HEp-2, calculated in group 2, was 72.3% and varied between 45.2% and 90.4% for other tests. In group 3, the negative predictive value for ANA Hep-2 was 92.5% and varied between 89.3% and 100% for other tests. CONCLUSIONS Some ELISA kits have comparable or superior diagnostic sensitivity to ANA HEp-2 and could be used as an alternative method for ANA screening, therefore allowing the immediate report of the results with fewer false negatives than ANA HEp-2. Owing to the lower specificity, ELISA-positive samples should be submitted to ANA HEp-2 for confirmation of results.

Lúpus eritematoso sistêmico e pancreatite aguda: relato de dois casos

A pancreatite aguda e uma manifestacao incomum do lupus eritematoso sistemico (LES) e a frequencia desta associacao nao e conhecida. Contudo, a pancreatite aguda e um diagnostico diferencial importante na avaliacao da dor abdominal em pacientes com LES. Os pacientes, normalmente, apresentam dor de intensidade variavel, algumas vezes simulando abdome agudo. Varios fatores tem sido implicados na patogenese desta condicao, tais como fenomenos autoimunes, vasculite, anticorpos antifosfolipides e drogas. O papel dos corticosteroides como um fator etiologico e ainda controverso. Alem disso, em alguns relatos a manutencao do corticosteroide foi fundamental na recuperacao dos pacientes. Relatamos duas pacientes com lupus eritematoso sistemico que apresentaram pancreatite aguda. Em nenhum dos casos havia evidencias de quaisquer fatores predisponentes conhecidos para a pancreatite aguda, portanto esta condicao foi considerada uma manifestacao de atividade lupica. Uma das pacientes faleceu por sindrome da resposta inflamatoria sistemica secundaria a pancreatite. No outro caso, utilizouse corticoide em doses de estresse durante o tratamento, com boa evolucao.

Executive dysfunction, obsessive–compulsive symptoms, and attention deficit and hyperactivity disorder in Systemic Lupus Erythematosus: Evidence for basal ganglia dysfunction?☆

INTRODUCTION Chorea is well described in a group of patients with Systemic Lupus Erythematosus (SLE). There is less information, however, on other movement disorders as well as non-motor neuropsychiatric features such as obsessive-compulsive symptoms (OCS), executive dysfunction and attention deficit and hyperactivity disorder (ADHD) in subjects with SLE. METHODS Fifty-four subjects with SLE underwent a battery of neuropsychiatric tests that included the Mini Mental State Examination, the Montreal Cognitive Assessment, the Frontal Assessment Battery (FAB), the FAS verbal and the categorical (animals) semantic fluency tests, the Obsessive and Compulsive Inventory - Revised, the Yale-Brown Obsessive and Compulsive Scale and Becks Anxiety and Depression Scales. ADHD was diagnosed according to DSM-IV criteria. SLE disease activity and cumulative damage were evaluated according to the modified SLE Disease Activity Index 2000 (mSLEDAI-2K) and the SLICC/ACR, respectively. RESULTS Six (11.1%) and 33 (61.1%) patients had cognitive impairment according to the MMSE and MoCA, respectively. Eleven (20.4%) had abnormal FAB scores, and 5 (9.3%) had lower semantic fluency scores than expected. The overall frequency of cognitive dysfunction was 72.2% (39 patients) and of neuropsychiatric SLE was 77.8% (42 patients). Two patients (3.7%) had movement disorders. Fifteen (27.8%) had OCS and 17 (31.5%) met diagnostic criteria for ADHD. ADHD and OCS correlated with higher disease activity, p=0.003 and 0.006, respectively. Higher cumulative damage correlated with lower FAB scores (p 0.026). CONCLUSIONS Executive dysfunction, ADHD, OCS, and movement disorders are common in SLE. Our finding suggests that there is frequent basal ganglia dysfunction in SLE.

Recommendations of the Brazilian Society of Rheumatology for the induction therapy of ANCA-associated vasculitis

The purpose of these recommendations is to guide the appropriate induction treatment of antineutrophil cytoplasmic antibody-associated vasculitis (AAV) patients with active disease. The recommendations proposed by the Vasculopathies Committee of the Brazilian Society Rheumatology for induction therapy of AAV, including granulomatosis with polyangiitis, microscopic polyangiitis and renal-limited vasculitis, were based on systematic literature review and expert opinion. Literature review was performed using Medline (PubMed), EMBASE and Cochrane database to retrieve articles until October 2016. PRISMA guidelines were used for the systematic review and articles were assessed according to the Oxford levels of evidence. Sixteen recommendations were made regarding different aspects of induction therapy for AAV. The purpose of these recommendations is to serve as a guide for therapeutic decisions by health care professionals in the management of AAV patients presenting active disease.