Priscila Schmidt Lora

Diminished expression of complement regulatory proteins on peripheral blood cells from systemic lupus erythematosus patients.

CD55, CD59, CD46, and CD35 are proteins with complement regulatory (Creg) properties that ensure cell and tissue integrity when this system is activated. The aim of this study was to evaluate the Creg expression on peripheral blood cells from SLE patients and its association with cytopenia and disease activity. Flow cytometric analyses were performed on blood cells from 100 SLE patients and 61 healthy controls. Compared with healthy controls, we observed in SLE patients with lymphopenia and neutropenia decreased expression of CD55, CD59, and CD46 (P < 0.05). In SLE patients with anemia, CD59 and CD35 were decreased on red blood cells. Furthermore, there was a negative correlation between CD55 and CD59 on neutrophils and the disease activity. The results suggest there is an altered pattern of Creg expression on the peripheral blood cells of SLE patients, and the expression is correlated with disease activity and/or with activation of the complement system.

Expressão de proteínas reguladoras do complemento CD55, CD59, CD35 e CD46 na artrite reumatoide

Rheumatoid arthritis (RA) is an autoimmune disease associated with polyarticular inflammatory synovitis affecting mainly peripheral joints. It affects approximately 1% of the world population, being two to three times more prevalent in women. Rheumatoid arthritis has a complex and multifactorial pathogenesis. The synovium of the affected joints is infiltrated by T and B lymphocytes, macrophages, and granulocytes. The rheumatoid synovium has proliferative characteristics, forming the pannus, which invades cartilage and bone, leading to normal architecture destruction and function loss. The decreased expression of complement regulatory proteins (CRP) seems to play an important role in RA activity, and is associated with worsening of the clinical symptoms. In several models of autoimmune diseases, the overactivation of the complement system (CS) is the cause of disease exacerbation. This article aimed at reviewing the main aspects related to CS regulation in RA in order to provide a better understanding of the potential role of this system in the pathophysiology and activity of the disease.

Effect of Aqueous Extract of Giant Horsetail (Equisetum giganteum L.) in Antigen-Induced Arthritis

Equisetum giganteum is a plant used in traditional medicine as diuretic. From our knowledge this is the first time this plant is tested in an in vivo model of acute inflammation. To evaluate the effect of aqueous extract of giant horsetail (AEGH) as immunomodulatory therapy, antigen-induced arthritis (AIA) was generated in mice with methylated bovine serum albumin (mBSA). Inflammation was evaluated by articular nociception, leukocytes migration and lymphocyte proliferation. AEGH reduced nociception at 3, 6 and 24 h (P < 0.01), decreased leukocyte migration (P < 0.015), and inhibited lymphocyte proliferation stimulated with Concanavalin A and Lipopolysaccharide (P < 0.05). In conclusion, AEGH has an anti-inflammatory potential in acute model of inflammation, as well as immunomodulatory effect on both B and T lymphocytes, with an action independent of cytotoxicity.

Padrões de imunofluorescência do fator antinuclear (FAN) em células HEp-2 de soros reagentes para anti-SSA/Ro

OBJECTIVE: to evaluate the pattern at immunofluorescence of the antinuclear antibodies (ANA) detected by the indirect immunofluorescence (IIF) technique in positive samples for anti-SSA/Ro autoantibody and the clinical associations. METHODS: a retrospective transversal study was performed in a period of two years where the all the solicitations of testing for the presence of anti-extractable nuclear antigen (anti-ENA) antibodies delivered to the SPC/HCPA were analyzed. We selected the positive samples and identified which autoantibodies were involved (anti-SSA/RO, anti-SSB/La, anti-RNP, anti-Sm and anti-Scl70) as well as the immunofluorescence patterns by ANA testing and the clinical associations found in the patients presenting anti-SSA/Ro positive serum. IIF was used for ANA using HEp-2 cells and hemagglutination for anti-ENA antibodies detection. RESULTS: 90 out of the 392 solicitations analyzed were anti-ENA positive, with a predominance of women (86/91 - 94%) and the mean age was 42 years old. The most frequent autoantibody was anti-SSA/Ro (61/90 - 67.8%) and all samples that were anti-SSA/Ro positive were also ANA positive. Speckled nuclear immunofluorescence was the most frequent ANA pattern (42/61 - 68.9%) among the anti-SSA/Ro positive samples and systemic lupus erythematosus was the most common clinical diagnosis (31/61 - 50.8%). CONCLUSION: ANA testing by IIF using HEp-2 cells proved to be a good screening test for the detection of anti-SSA/Ro antibodies, that showed a strong positive association to the speckled nuclear IIF pattern. As opposed to what has been described in the literature, there was no ANA negative among the anti-SSA/Ro positive samples. At least in our experience, these data question the cost-effectiveness of performing routine screening for anti-SSA/Ro antibodies in ANA negative samples by IIF testing.

Experiência da adoção do I e II Consensos Brasileiros de Fator Antinuclear por Imunofluorescência Indireta em Células HEp-2 em um hospital universitário

OBJECTIVE: To evaluate the prevalence of patterns and titers of antinuclear antibodies (ANA) detected by indirect immunofluorescence (IIF) technique on HEp-2 cells in a university hospital following the introduction of I and II Brazilian Consensuses for Standardization of ANA in HEp-2 Cells. METHODS:A transversal study was performed between 2002 and 2005 during which all ANA orders to Servico de Hospital de Clinicas de Porto Alegre (SPC/HCPA) and cognate results were reviewed. RESULTS:12.095 tests of ANA were revised. The number of positive results during this period was 2.577 (21.30%), annual mean 644 (SD: 233). A marked increase in the number of positive results was observed following the introduction of the Consensuses (p < 0.001). Rheumatology was the medical specialty which requested the highest number of ANA testing per patient although a significant decrease of these numbers was observed after the introduction of the Consensus in 2004 (p < 0,001). Nuclear fine speckled immunofluorescence labeling was the most frequently ANA pattern observed, 52.3% (453/866), and low ANA titers (1/80 and 1/160) more commonly detected (27.8% and 29.4%, respectively). CONCLUSION: Following the introduction of the Brazilian Consensus for standardization of ANA in HEp-2 cells an increased number of positive results was observed, mostly in low titers and with nuclear fine speckled immunofluorescence pattern. Moreover, there were decreasing numbers of ANA orders by rheumatologists in the same period. Potential causes for these observations are discussed but the real impact in the clinical condition of the patient and therapy deserves to be better studied.

Height and sexual maturation in girls with juvenile idiopathic arthritis

OBJECTIVE To evaluate height, sexual maturation, and the difference between final and expected height in girls with juvenile idiopathic arthritis and no glucocorticoid treatment for at least six months, as compared to a group of healthy girls. METHODS This cross-sectional study involved 44 girls with juvenile idiopathic arthritis, diagnosed according to the International League of Associations for Rheumatology criteria, and 59 healthy controls aged between 8 and 18 (incomplete) years with no comorbid chronic diseases. Demographic data were collected from all participants, and disease and treatment variables were compiled for the patient group. Anthropometric measurements were converted into Z-scores based on World Health Organization standards. Sexual maturation was classified according to Tanner stages. RESULTS Body mass index and height Z-scores were lower in girls with juvenile idiopathic arthritis as compared to control participants. These values differed significantly in Tanner stage II. Three (6.8%) girls with juvenile idiopathic arthritis had height-for-age Z-scores <-2 (short stature). Girls with polyarticular juvenile idiopathic arthritis and higher cumulative glucocorticoid doses were significantly more likely to present with short stature. The percentage of prepubertal girls in the juvenile idiopathic arthritis group was significantly higher than that observed in the control group, (p=0.012). Age of menarche, adult height, and the difference between actual and expected height did not differ between groups. CONCLUSION These findings suggest that even six months after the suspension of glucocorticoid treatment, children with polyarticular/systemic juvenile idiopathic arthritis subtypes are still susceptible to low height and delayed puberty.

AB1015 Sexual Maturation in Brazilian Girls with Juvenile Idiopathic

Background Juvenile Idiopathic Arthritis (JIA) is among the most prevalent rheumatic disease in children. Abnormal puberty is often reported in chronic inflammatory diseases such as JIA.Such condition may be secondary to inflammation, undernutrition or medications (pex: glucocorticoids) Objectives The aim of this study was to compare sexual maturation of girls with JIA and age-gender paired healthy control group from Southern Brazil. Methods A case-control study was conducted with all consecutive JIA female patients followed at Rheumatology outpatient clinics from Clinics Hospital of Porto Alegre and health control (HC) subjects aged six to 18 year.JIA diagnosis was made according to the criteria of the International League of Association for Rheumatology. Demographic and disease related data were obtained as well as: Tanner breast stage (Bre), menarche age and ultrasound measurements of uterine volume (UV), pulsatility index by Color Doppler (PI) and Endometrial thickness (ET). Parametric tests (chi-square and t-test) were used to compare patients and healthy controls. A lower than 0.05 p value was considered statistically significant. Results Forty-two JIA girls and 42 HC were included in a cross-sectional study. The JIA girls mean of age was 12.0 (3.08) and HC was 12.0 (3.16) years. Ten percent had JIA systemic type, 31% oligopersistent, 59,6% oligoextended and polyarticular course. The mean age of JIA patients in stage tanner II was significantly higher than HC (11,2 [1,1) vs 9,6 [0,9]). All HC (10) girls above 15 years-old were in a stage tanner V in contrast to JIA patients that only fifty percent (5) was at this stage at this age. There was no difference in menarch age, weight and height between HC and JIA in all stages of tanner. In relation to ultrasound findings, there was only a difference in the PI on stage tanner II. Conclusions These results showed that JIA patients began and finished puberty maturation latter than HC individuals. However, these are preliminary data and more subjects have been enrolled in the study. Further investigation about the relation between delayed puberty and inflammation are still needed to better clarify this topic and to challenge new therapeutic strategies. References Asăvoaie C, Fufezan O, Coşarcă M. Ovarian and uterine ultrasonography in pediatric patients. Pictorial essay. Med Ultrason. 2014 Jun;16(2):160-7. Brämswig J1, Dübbers A. Disorders of pubertal development. Dtsch Arztebl Int. 2009 Apr;106(17):295-303; El Badri D, Rostom S, Bouaddi I, et al. Sexual maturation in Moroccan patients with juvenile idiopathic arthritis. Rheumatol Int. 2014 May;34(5):665-8 Maher SE, Ali FI. Sexual maturation in Egyptian boys and girls with juvenile rheumatoid arthritis. Rheumatol Int. 2013 Aug;33(8):2123-6. Disclosure of Interest None declared

AB0086 Food preferences in rats with collagen induced arthritis

Background Rheumatoid arthritis (RA) is an inflammatory disease with autoimmune manifestations characterized by chronic inflammation of the joints associated with systemic complications [1]. Systemic inflammation of RA causes metabolic changes and deregulation of leptin, adiponectin and insulin, leading to anorexia, changes in normal food intake and weight loss [2]. However, observational with human subjects have many potential bias and animal models can be a good alternative for studies on the effect of chronic arthritis in metabolic changes and feeding preferences. Objectives To evaluate the feeding preferences of rats with type II collagen induced arthritis (CIA). Methods Female Wistar rats were separated in two groups: control (CO) and collagen-induced arthritis (CIA) performed accordingly to Rosloniec et al. [3] with modifications (without booster). Arthritis clinical score (0-16) of animals was registered three times a week for analysis of the development of the disease [3]. All animals were offered four different diets at the same time: control diet (standard ration - CD), high calorie diet (addition of 5% of saccharose – HCD), high protein diet (addition of 5% of albumin – HPD) and high fat diet (addition of 5% of soybean oil – HFD). The animals and ration leftovers were weighted every three days for 14 days before and 25 days after the induction of arthritis. Comparison between groups was performed by two-way ANOVA followed by Tukey post-hoc test. Results The first signs of arthritis appeared by 14 days after induction (score 2.7±3.1) and the inflammatory peak appeared to be around day 17 to day 22 (score 9.8±4.1). Food consumption of control and CIA rats before the onset of arthritis was: 45% of HCD (51.9±6.4 g), 36% of HFD (41.6±9.7 g), 13% of HPD (15.3±5.1 g) and 7% of CD (7.5±5.8 g). During the peak of arthritis, CIA rats had a significant weight loss (-14.7±8.5 g) while CO group maintained their weight (-0.2±4.6 g, p<.01). At the same time, CIA had reduced total food intake (72.3 ± 8.6 g) compared to CO (107.3±5.7 g, p<.01). Besides that, CIA changed the food preference, increasing the intake of HPD to 20% (16.3±5.3 g, p<.05) and reducing the ingestion of the HCD to 27% (22.6±7.8 g, p<.05) compared to CO (10.0±1.5 g and 58.3±21.3 g, respectively). Conclusions CIA animals demonstrated changes in their food intake, especially during the inflammatory peak of arthritis, with concomitant reduction in weight. These changes include decreased total food consumption and different food preferences, like increased intake of high-protein diet and reduced intake of high-calorie diet, results never reported before. There is still needed more studies about the feeding preferences and intake, but CIA model could be a good model to study altered food consumption caused by arthritis and hereafter correlate these findings with alterations in RA patients. References Mc Innes IB, et al. Engl J Med, 2011. 365(23):2205-19. Argilés JM, et al. J. Biocel, 2005. 37(10):2036-46. Rosloniec EF, et al. Curr Protoc Immunol, 2010. Chapter 15: Unit 15.5 1-25. Acknowledgements FIPE-HCPA, CAPES, CNPq Disclosure of Interest None Declared