Rosa Weiss Telles

Metabolic syndrome in patients with systemic lupus erythematosus: association with traditional risk factors for coronary heart disease and lupus characteristics

The objective of this study was to determine the frequency of Metabolic Syndrome (MetS) in patients with SLE and to analyze the association of MetS with traditional risk factors for CHD and lupus characteristics. In this cross-sectional study the frequency of MetS was determined according to the National Cholesterol Education Program Adult Treatment Panel III in patients with SLE. The association of MetS with the traditional risk factors for CHD not included in the syndrome definition, and with lupus characteristics was examined. The mean age (sd) of the 162 females patients was 38.8(11.2) years. The frequency of MetS was 32.1%. Abdominal obesity and hypertension were the two most common components of the syndrome (86.5% each) followed by low levels of HDL-cholesterol (84.6%), hypertriglyceridemia (69.2%) and hyperglycemia (15.4%). MetS was significantly associated with older age, family history of CHD, obesity, postmenopausal status, LDL-c ≥100mg/dl, and higher Framingham risk score. Lupus characteristics associated with MetS were history of nephrotic proteinuria during follow-up and current cyclophosphamide use, higher modified SLEDAI-2k, higher damage index score (SLICC/ACR), and older age at lupus diagnosis. In the logistic regression analysis, obesity, LDL-c ≥100mg/dl, older age at lupus diagnosis, higher damage index and nephrotic proteinuria were independently associated with MetS. We conclude that MetS diagnosis was frequent in patients with lupus. The syndrome was associated not only with traditional risk factors for CHD, confirming the clustering of those risk factors, but also with lupus characteristics. Some of those factors, especially LDL-c ≥100mg/dl and age at lupus diagnosis, have been associated with atherosclerosis in lupus patients. Lupus (2010) 19, 803—809.

Carotid atherosclerotic alterations in systemic lupus erythematosus patients treated at a Brazilian university setting.

To determine the frequency of carotid plaque and intima-media thickness (IMT) in patients with systemic lupus erythematosus (SLE) and their association with risk factors in a Brazilian university setting. Carotid plaque and IMT were identified and measured by ultrasonography. Traditional risk factors and lupus-related factors were analysed. One hundred and seventy-two patients (women = 96%, age = 38 ± 11 years) were evaluated. The frequency of carotid plaque was 9.3%. The median (IR) IMT was 0.60 mm (0.54—0.71 mm). Age, family history (FH) of premature coronary disease, low-density cholesterol (LDL-c) >100 mg/dL, hypertriglyceridemia, diabetes, hypertension, smoking, postmenopause, number of risk factors, Framingham risk score, age at diagnosis, duration of lupus, mucocutaneous manifestations and duration of prednisone use were associated with plaque (P < 0.05), univariate analysis. Nephritis, immunosuppressive therapy, intravenous methylprednisolone and a higher average daily dose of prednisone were associated with the absence of plaque. Independent predictors of plaque were smoking (P = 0.004), LDL-c >100 mg/dL (P = 0.044), Framingham score (P = 0.006) and absence of immunosuppressive therapy (P = 0.032). There was an independent correlation between IMT and age (P < 0.001) and duration of prednisone use (P = 0.020). Subclinical atherosclerosis was associated with traditional risk and SLE-related factors, especially the absence of immunosuppressive therapy. The present study suggests that the levels of LDL-c should be kept under 100mg/dL in lupus. Lupus (2008) 17, 105—113.

Nutritional status and food intake in patients with systemic lupus erythematosus

OBJECTIVE Systemic inflammation, therapy with corticosteroids, and reduced physical activity may increase the predisposition to accumulate body fat in patients with systemic lupus erythematosus (SLE). The aim of this study was to assess the nutritional status and food intake of patients with SLE. METHODS One hundred seventy women with SLE were evaluated consecutively in a cross-sectional study. Nutritional status was assessed by subjective global assessment and body mass index. Food intake was assessed by a 24-h recall and a semiquantitative food frequency questionnaire. Statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS), considering P < 0.05 as significant. RESULTS The mean ± SD age of the patients was 39.14 ± 9.98 y, and the duration of the disease was 9.94 ± 6.18 y. Approximately 91.8% patients were classified as being well nourished; 6.5% were classified as suspected or moderately malnourished, and 1.8% were classified as severely malnourished. In terms of body mass index, malnutrition was found in 1.2% of the patients, normal weight in 35.9%, overweight in 35.3%, and obesity in 27.7%. Most patients reported food consumption below the estimated needs for energy. Calcium was the nutrient with the most inadequate intake. Low consumption of fruits, vegetables, and dairy products and a high consumption of oils and fats were reported. CONCLUSION The results showed that patients with SLE have inadequate nutritional status and food intake.

Assessment of nutritional status and physical activity in systemic lupus erythematosus patients

INTRODUCTION Patients with systemic lupus erythematosus (SLE) may present nutritional changes triggered by disease or treatment, and these conditions may interfere with prognosis. OBJECTIVE Assess the nutritional status, physical activity and associated factors in patients with SLE under treatment at the Service of Rheumatology of Hospital das Clínicas/Universidade Federal de Minas Gerais. METHODS A cross-sectional study evaluating the nutritional status, clinical laboratory findings, sociodemographic, and treatment characteristics of 170 SLE female patients. RESULTS Patients aged between 18 and 60 years were included. The mean (SD) age of patients and duration of SLE was 39.1 (10.0) and 9.9 (6.2) years, respectively. Two (1.2%) patients were classified as grade I underweight, 59 (34.7%) eutrophic, 61 (35.9%) as overweight, 37 (21.8%) as grade I obesity, seven (4,1%) as grade II obesity, and four (2,4%) as grade III obesity. Overweight and obesity were significantly associated with older age, lower education, higher SLE damage index, higher serum concentration of complement, higher incidence of hypertension and diabetes mellitus, presence of ovarian failure, and less frequent use of antimalarials Regarding physical activity, 39 patients (22.9%) were classified as inactive, 100 (58.8%) insufficiently active, and 31 (18.2%) active. Of the latter, 13 (43.3%) were in the eutrophic group. CONCLUSION Excess weight was high in this population and associated with some traditional risk factors for cardiovascular disease and SLE poor prognosis. Therefore, encouraging weight control must be part of the main goals in treating SLE patients.

Freqüência de doença cardiovascular aterosclerótica e de seus fatores de risco em pacientes com lúpus eritematoso sistêmico

INTRODUCTION: the pathogenesis of coronary disease in systemic lupus erythematosus patients is not completely understood. Risk factors associated with lupus or its treatment may be associated with traditional risk factors for coronary disease. Such risk factors are more common in patients with lupus. OBJECTIVE: to determine the frequency of cardiovascular disease and traditional risk factors in patients with systemic lupus erythematosus at Rheumatology Division of Hospital das Clinicas of Minas Gerais Federal University. METHODS: 172 patients with systemic lupus erythematosus were evaluated. Cardiovascular events, traditional risk factors and clinical-laboratorial findings were investigated in this cross-sectional research. RESULTS: the mean age (SD) of the patients was 38.5 years (11.2 years). 95.9% were female and 64.5% were non white. Cardiovascular disease was identified in 8 patients (4.7%), with 11 different diagnoses. Three patients had coronary insufficiency, three had stroke and five had peripheral arterial disease. Systemic arterial hypertension was the most frequent risk factor (48.8%), followed by dyslipidemia in 70 patients (40.7%) and hypertriglyceridemia in 51 patients (29.7%). LDL-c > 100 mg/dl was found in 77 patients (44.8%). Among 165 female patients, 67 (40.6%) had menopause, 43.3% of them with early menopause. CONCLUSION: the present study describes the frequency of risk factors for coronary artery disease in a Brazilian sample of lupus patients. The impact of recognition and management of those risk factors in prevention of cardiovascular events should be object of others studies.

Ácidos graxos poli-insaturados ômega-3 e lúpus eritematoso sistêmico: o que sabemos?

Various studies have demonstrated the impact of omega-3 fatty acids on the concentration of C reactive protein (CRP), pro-inflammatory eicosanoids, cytokines, chemokines and other inflammatory mediators. Therefore, the supplementation of these types of lipids may represent additional option treatment for chronic systemic diseases, such as Systemic Lupus Erythematous and other rheumatic diseases. The role of these lipids has not been well established, yet. However, it seems there is a direct relationship between its intake and the decrease of the disease clinical manifestations as well as of the inflammatory status of the patients. Thus, the aim of this manuscript is to present a thorough review on the effects of omega-3 fatty acids in patients with SLE. Bibliographic data set as the Medical Literature Analysis and Retrieval System Online (MEDLINE) and Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) were searched using as key words: systemic lupus erythematous (SLE), polyunsaturated fatty acids omega-3, eicosapentanoic acid (EPA), docosahexanoic acid (DHA), antioxidants and diet. Manuscripts published up to September 2013 were included. There were 43 articles related to the topic, however only 15 pertained human studies, with three review articles and 12 clinical studies.

Multiple symmetric lipomatosis.

Background: Multiple symmetric lipomatosis (MSL) is a relatively uncommon entity of unknown etiology characterized by symmetrically subcutaneous accumulation of nonencapsulated adipose tissue. Approximately 200 to 300 cases have been published. Objectives: The aims of this article are to report the case of a 58-year-old Brazilian patient with MSL and provide a comprehensive overview of the current concepts concerning this disease. Methods: Our search yielded 28 articles on MSL, including case reports and reviews of the literature. Results: MSL predominantly affects Mediterranean males with a history of chronic alcohol abuse. It is usually asymptomatic and may be associated with diabetes mellitus, hyperlipidemia, hyperuricemia, macrocytic anemia, and oral cancer. Surgical resection is the best treatment option. Conclusion: The case reported is a classic presentation of MSL; however, it is particularly uncommon owing to the association with immune thrombocytopenic purpura. This association has been described only once in the medical literature.

Adipokines, tumor necrosis factor and its receptors in female patients with systemic lupus erythematosus

Objectives To analyze the association of adipokines and tumor necrosis factor α (TNFα) and its receptors with characteristics of systemic lupus erythematosus (SLE) and to investigate the correlation between adipokines and the TNF system. Methods One hundred and thirty-six SLE women, aged ≥18 years old, were assessed. TNFα, soluble TNFα receptors 1 (sTNFR1) and 2 (sTNFR2) and adipokines were analyzed by ELISA kits. Results The median (IQR) of age was 41.5 (33.0–49.7) years old and of disease duration 11.3 (7.8–15.8) years. The median (IQR) of disease activity was 0 (0–4) and of damage index was 2 (1–3). Higher levels of sTNFR1 and sTNFR2 were associated with nephritis (p < 0.001 for both), and sTNFR1 (p = 0.025) and TNFα (p = 0.014) were positively associated with arthritis. Higher sTNFR1 levels were found in participants that were not using antimalarial drugs (p = 0.04). Independent correlation was found between sTNFR1 (β = 0.253; p = 0.003) and sTNFR2 (β = 0.297; p < 0.001) levels and disease activity and damage index (sTNFR1: β = 0.367; p < 0.001; sTNFR2: β = 0.335; p < 0.001). Higher adiponectin levels were independently associated with nephritis (p = 0.009) and antimalarial drugs use (p = 0.015). There was a positive correlation between leptin and sTNFR2 levels (p = 0.002) and between resistin levels and sTNFR1 (p < 0.001) and sTNFR2 (p < 0.001). Conclusion The correlation between adipokines and TNF system allows a better understanding of the role of adipokines in the inflammatory response in SLE patients.

Omega-3 fatty acids, inflammatory status and biochemical markers of patients with systemic lupus erythematosus: a pilot study ☆

BACKGROUND Studies have shown that omega-3 fatty acids reduce the concentrations of eicosanoids, cytokines, chemokines, C-reactive protein (CRP) and other inflammatory mediators. OBJECTIVE To investigate the effects of omega-3 fatty acids on circulating levels of inflammatory mediators and biochemical markers in women with systemic lupus erythematosus (SLE). METHODS Experimental clinical study (clinical trial: NCT02524795); 49 women with SLE (ACR1982/1997) were randomized: 22 to the omega-3 group (daily intake of 1080mg EPA+200mg DHA, for 12 weeks) and 27 to the control group. The inflammatory mediators and biochemical markers at T0 and T1 in omega-3 group were compared using Wilcoxon test. U-Mann-Whitney test was used to compare variations of measured variables [ΔV=pre-treatment (T0)-post-treatment (T1) concentrations] between groups. p<0.05 was considered significant. RESULTS The median (interquartile range - IQR) of age was 37 (29-48) years old, of disease duration was 7 (4-13) years, and of SLEDAI-2K was 1 (0-2). The median (IQR) of variation in CRP levels between the two groups showed a decrease in omega-3 group while there was an increase in control group (p=0.008). The serum concentrations of IL-6 and IL-10, leptin and adiponectin did not change after a 12 week treatment. CONCLUSIONS Supplementation with omega-3 had no impact on serum concentrations of IL-6, IL-10, leptin and adiponectin in women with SLE and low disease activity. There was a significant decrease of CRP levels as well as evidence that omega-3 may impact total and LDL-cholesterol.

Psychometric properties of Multidimensional Health Locus of Control - A and General Self-Efficacy Scale in civil servants: ELSA-Brasil Musculoskeletal Study (ELSA-Brasil MSK)

Abstract Background Health-related control and self-efficacy beliefs can be assessed in the general population using Multidimensional Health Locus of Control-A subscales (MHLC-A) and the General Self-Efficacy Scale (GSES), respectively. Objective To test construct validity, internal consistency, reliability (test-retest) and ceiling and floor effects of Portuguese-Brazil versions of MHLC-A and GSES. Method Civil servants (N=2901) enrolled in a large Brazilian cohort were included. A new version of the GSES was produced (GSES-Brazil). Procedures for cross-cultural adaptation and testing of psychometric properties followed well-accepted international guidelines. Results Confirmatory factor analyses yielded the following indices: MHLC-A (tridimensional model): χ2[df]=223.45[132], p-value <0.01; CFI=0.87; TLI=0.85; RMSEA=0.07 (0.07-0.08); WRMR=3.00. GSES-Brazil (unidimensional model): χ2[df]=788.60[35], p-value <0.01; CFI=0.95; TLI=0.94; RMSEA=0.09 (0.08-0.09); WRMR=2.50. Cronbach’s alpha coefficients and Intraclass Correlation Coefficients (ICC2,1) ranged from 0.57 (0.54-0.59) and 0.57 (0.47-0.65) for MHLC-A internality to 0.80 (0.79-0.81) and 0.71 (0.66-0.77) for GSES-Brazil, respectively. There was no evidence of ceiling and floor effects. Convergent validity analyses provided further support for construct validity of both scales. Conclusion These findings support the use of the newly developed version of GSES-Brazil for the assessment of general self-efficacy of adult Brazilians. Internal consistency was lower than ideal for MHLC-A, indicating these subscales may need further refinements to provide a more psychometrically sound measure of control beliefs.