Search

Necrotizing sarcoid granulomatosis (NSG) is a rare and under-recognized cause of granulomatous disease, described as a variant of typical nodular sarcoidosis. It can be asymptomatic when the patient has a single pulmonary nodule or may be accompanied by cough, fever, and dyspnea, or even symptoms due to the involvement of other organs such as the eyes, liver, and central nervous system. The histopathological analysis is essential for the differential diagnosis of other infectious and non-infectious causes of granuloma and to determine the appropriate treatment. NSG is characterized by the presence of a granuloma with extensive coagulative necrosis associated with the occurrence of vasculitis. We present the case of a patient diagnosed with NSG who had an unusual outcome with recurrent pulmonary thromboembolisms followed by hemodynamic instability and death.

Necrotizing sarcoid granulomatosis (NSG) is a rare and under-recognized cause of granulomatous disease, described as a variant of typical nodular sarcoidosis. It can be asymptomatic when the patient has a single pulmonary nodule or may be accompanied by cough, fever, and dyspnea, or even symptoms due to the involvement of other organs such as the eyes, liver, and central nervous system. The histopathological analysis is essential for the differential diagnosis of other infectious and non-infectious causes of granuloma and to determine the appropriate treatment. NSG is characterized by the presence of a granuloma with extensive coagulative necrosis associated with the occurrence of vasculitis. We present the case of a patient diagnosed with NSG who had an unusual outcome with recurrent pulmonary thromboembolisms followed by hemodynamic instability and death.

IgG4-related disease (IgG4-RD) is a recently recognized group of conditions, characterized by tumor-like swelling of involved organs, lymphoplasmacytic infiltrate rich in IgG4-positive plasma cells, variable degrees of fibrosis, and elevated serum IgG4 concentrations. Currently IgG4-RD is recognized as a systemic condition that can affect several organs and tissues. Herein we report the case of a 34-year-old male patient who was admitted to our hospital with diffuse abdominal pain, weight loss, and painful stiffness in his neck. He had a history of tumoral mass of the left maxillary region, right palpebral ptosis with protrusion of the eyeball, and chronic dry cough for about 6 years. Laboratory tests revealed polyclonal hypergammaglobulinemia and increased serum IgG4 levels. Immunohistochemical staining of the maxillary biopsy was compatible with IgG4-RD. He had an excellent response to corticosteroid therapy. This case highlights that IgG4-RD should be included in the differential diagnosis with multisystem diseases.

p. 1615-1617 Submitted by Santiago Fabio (fabio.ssantiago@hotmail.com) on 2013-11-06T18:23:45Z No. of bitstreams: 1 444444.pdf: 228578 bytes, checksum: a8e5c3cbaefb6b0bcc743ca9cfb92d39 (MD5) Approved for entry into archive by Rodrigo Meirelles (rodrigomei@ufba.br) on 2013-11-08T18:40:05Z (GMT) No. of bitstreams: 1 444444.pdf: 228578 bytes, checksum: a8e5c3cbaefb6b0bcc743ca9cfb92d39 (MD5) Made available in DSpace on 2013-11-08T18:40:05Z (GMT). No. of bitstreams: 1 444444.pdf: 228578 bytes, checksum: a8e5c3cbaefb6b0bcc743ca9cfb92d39 (MD5) Previous issue date: 2013 Jaccoud’s arthropathy (JA) is a deforming, non-erosive form of arthritis initially described in rheumatic fever but recently observed more frequently in patients with systemic lupus erythematosus. However, cases of JA have been described in association with other diffuse connective tissue diseases, neoplasias, and infection. We describe a rare case of sarcoidosis in a female subject who developed JA in her hands later in the course of the disease. Salvador

p. 685-687 Submitted by Santiago Fabio (fabio.ssantiago@hotmail.com) on 2013-11-19T18:12:03Z No. of bitstreams: 1 111111a.pdf: 93234 bytes, checksum: 3bc5103681fdb9d6bef0ac8b797d712a (MD5) Approved for entry into archive by Rodrigo Meirelles (rodrigomei@ufba.br) on 2013-11-19T20:13:38Z (GMT) No. of bitstreams: 1 111111a.pdf: 93234 bytes, checksum: 3bc5103681fdb9d6bef0ac8b797d712a (MD5) Made available in DSpace on 2013-11-19T20:13:38Z (GMT). No. of bitstreams: 1 111111a.pdf: 93234 bytes, checksum: 3bc5103681fdb9d6bef0ac8b797d712a (MD5) Previous issue date: 2013 Rheumatoid arthritis (RA) is an autoimmune disease characterized by symmetric polyarthritis, rheumatoid factor (RF) positivity, and bone erosions. Recently, research has been conducted on anti-citrullinated peptide antibodies (ACPAs) to which there are greater sensitivity and specificity than RF. However, these antibodies have also been described in infectious diseases, particularly tuberculosis (TB), placing the high specificity of the test in doubt. The aim of this research was to study the prevalence of ACPAs in TB, RA, and healthy controls. Patients with bacteriologically confirmed pulmonary tuberculosis, RA (ACR criteria), in addition to healthy controls were included. ACPAs were researched by: anti-cyclic citrullinated peptide (CCP), anti-modified citrullinated vimentin (MCV), and RF by ELISA. The study was conducted in 50 TB patients, 50 with RA, and 20 controls. Anti-CCP antibodies were found in 39 (78 %) of the RA patients (median titer, 128 U), whereas anti- MCV antibodies were found in 25 (50 %). Of the patients with TB, two (4 %) had positivity for anti- CCP and anti-MCV and no patient in the control group tested positive for these antibodies. Sensitivity of anti- CCP for RA was 78 % (confidence interval (CI), 63 to 88 %) and specificity was 97 % (CI, 89 to 99 %) while the sensitivity of anti-MCV was 50 % (CI, 35–64 %) and specificity was 97 % (CI, 89 to 99 %). RF was positive in 40 samples (80 %) of RA, in 30 (60 %) of TB, and in 1 (5 %) of the controls. Our findings showed high sensitivity of anti-CCP and high specificity of both anti-CCP and anti-MCV antibodies for RA, even in a population with high incidence of tuberculosis. The higher frequency of positivity of ACPA in TB observed in previous studies may be attributed to methodological factors. Salvador

Texto completo: acesso restrito. p. 332–334 Submitted by Edileide Reis (leyde-landy@hotmail.com) on 2014-08-19T12:22:42Z No. of bitstreams: 1 L. Costa Pinto.pdf: 155800 bytes, checksum: 04d765344000836358514038275c4c49 (MD5) Approved for entry into archive by Delba Rosa (delba@ufba.br) on 2014-09-29T16:04:59Z (GMT) No. of bitstreams: 1 L. Costa Pinto.pdf: 155800 bytes, checksum: 04d765344000836358514038275c4c49 (MD5) Made available in DSpace on 2014-09-29T16:04:59Z (GMT). No. of bitstreams: 1 L. Costa Pinto.pdf: 155800 bytes, checksum: 04d765344000836358514038275c4c49 (MD5) Previous issue date: 2012 Introduction: Females with systemic lupus erythematosus (SLE) have higher prevalence of human papillomavirus (HPV) infection, which can lead to the development of warts. Herein we report the first case of giant disseminated condylomatosis (GDC) in a SLE female on mycophenolate mofetil (MMF). Case report: The patient, a 33-year-old, Black female, was diagnosed with SLE during her first pregnancy in 2003 based on the features of arthritis, skin rash, seizures, nephritis and presence of antinuclear antibodies. Her pregnancy resulted in preterm delivery of a stillborn fetus at 28 weeks. Since that time she has been treated with steroids and different regimens of immunosuppressive drugs such as cyclophosphamide, azathioprine and lately MMF. In the last few years she presented GDC involving the genital area in addition to skin on the lower abdomen. Topical therapy with trichloroacetic acid, imiquimod and podophyllin was only partially effective. Different types of HPV were identified in the lesions, being HPV-11 in abdomen, HPV 6, 11, 42 in vulva, HPV-6, 11 in vagina and HPV-6, 11 in endocervix. Conclusions: GDC may be a complication of SLE, secondary to the disease itself, its treatment or other factors not yet identified.

O lúpus eritematoso sistêmico é uma doença autoimune que envolve múltiplos sistemas orgânicos. O acometimento musculoesquelético é uma das manifestações mais comuns da doença, com envolvimento ósseo, articular, muscular, tendíneo e ligamentar, tanto primário como relacionado ao tratamento instituído. Neste artigo revisamos e ilustramos as alterações articulares e complicações musculoesqueléticas mais comuns relacionadas a esta doença. Systemic lupus erythematosus is an autoimmune disease involving multiple organ systems. Musculoskeletal involvement is one of the most frequent presentations of the disease, affecting bones, joints, muscles, tendons and ligaments, either as a primary manifestation or secondary to the treatment of the disease. In the present article, the authors review and illustrate the joint disorders and the most common musculoskeletal abnormalities seen in this disorder.

P. 52–58. Jan/Fev. Submitted by JURANDI DE SOUZA SILVA (jssufba@hotmail.com) on 2011-11-04T13:59:02Z No. of bitstreams: 1 13.pdf: 378618 bytes, checksum: e86251b8b2fb2b0f984ab0d5c55538dc (MD5) Made available in DSpace on 2011-11-04T13:59:02Z (GMT). No. of bitstreams: 1 13.pdf: 378618 bytes, checksum: e86251b8b2fb2b0f984ab0d5c55538dc (MD5) Previous issue date: 2011 O lúpus eritematoso sistêmico é uma doença autoimune que envolve múltiplos sistemas orgânicos. O acometimento musculoesquelético é uma das manifestações mais comuns da doença, com envolvimento ósseo, articular, muscular, tendíneo e ligamentar, tanto primário como relacionado ao tratamento instituído. Neste artigo revisamos e ilustramos as alterações articulares e complicações musculoesqueléticas mais comuns relacionadas a esta doença. São Paulo

Texto completo: acesso restrito. p.401-406 Submitted by Suelen Reis (suziy.ellen@gmail.com) on 2013-08-27T11:02:01Z No. of bitstreams: 1 Ajax Atta.pdf: 287323 bytes, checksum: d1762ff00dc0f19c8861a059121227a3 (MD5) Approved for entry into archive by Patricia Barroso(pbarroso@ufba.br) on 2013-08-27T17:36:44Z (GMT) No. of bitstreams: 1 Ajax Atta.pdf: 287323 bytes, checksum: d1762ff00dc0f19c8861a059121227a3 (MD5) Made available in DSpace on 2013-08-27T17:36:44Z (GMT). No. of bitstreams: 1 Ajax Atta.pdf: 287323 bytes, checksum: d1762ff00dc0f19c8861a059121227a3 (MD5) Previous issue date: 2010 Background: Systemic lupus erythematosus (SLE) patients may exhibit high total IgE and antinuclear IgE antibodies (ANA-IgE). Here, we investigated the specificity of ANA-IgE in SLE patients and the involvement of cytokines in this immune response. Methods: Sera from 92 SLE patients and 68 healthy controls were evaluated for the presence of antinuclear IgE antibodies by immunoperoxidase with HEp-2,000® cells and immunoblotting with IgG-depleted sera. Total IgE, IgE specific to allergens, and serum cytokine levels were determined by ELISA. Results: Antinuclear IgE antibodies were detected only in SLE patients (29/92, 31.5%). High total IgE was associated with ANA-IgE (p < 0.0001), but was not associated with IgE antibodies to allergens. In the immunoblotting, ANA-IgE reacted with nucleosomes (23/29, 79.3%), dsDNA (14/29, 48.3%), SS-A/Ro (14/29, 48.3%), SS-B/La (2/29, 18.7%), Sm (14/29, 48.3%) and RNP (18/29, 62.1%). Patients with ANA-IgE had very low serum IL-4, less IL-5 than controls (p < 0.05), more IL-10 than seronegative patients (p < 0.05), and unaltered IFN-γ levels. The IL-5/IL-10 ratio was lower in ANA-IgE seropositive patients in comparison with either seronegative patients (p < 0.05) or healthy controls (p = 0.001). Controls displayed higher IL-5/IFN-γ ratios than either SLE patients with ANA-IgE (p < 0.05) or patients without these immunoglobulins (p < 0.01). Conclusions: We conclude that IgE antibodies against cell autoantigens involved in protein expression, cellular proliferation, and cell death are present in patients with SLE. Interleukin-10 seems to down-regulate this IgE autoimmune response in SLE.

Texto completo: acesso restrito. p.401-406 Submitted by Suelen Reis (suziy.ellen@gmail.com) on 2013-08-27T11:02:01Z No. of bitstreams: 1 Ajax Atta.pdf: 287323 bytes, checksum: d1762ff00dc0f19c8861a059121227a3 (MD5) Approved for entry into archive by Patricia Barroso(pbarroso@ufba.br) on 2013-08-27T17:36:44Z (GMT) No. of bitstreams: 1 Ajax Atta.pdf: 287323 bytes, checksum: d1762ff00dc0f19c8861a059121227a3 (MD5) Made available in DSpace on 2013-08-27T17:36:44Z (GMT). No. of bitstreams: 1 Ajax Atta.pdf: 287323 bytes, checksum: d1762ff00dc0f19c8861a059121227a3 (MD5) Previous issue date: 2010 Background: Systemic lupus erythematosus (SLE) patients may exhibit high total IgE and antinuclear IgE antibodies (ANA-IgE). Here, we investigated the specificity of ANA-IgE in SLE patients and the involvement of cytokines in this immune response. Methods: Sera from 92 SLE patients and 68 healthy controls were evaluated for the presence of antinuclear IgE antibodies by immunoperoxidase with HEp-2,000® cells and immunoblotting with IgG-depleted sera. Total IgE, IgE specific to allergens, and serum cytokine levels were determined by ELISA. Results: Antinuclear IgE antibodies were detected only in SLE patients (29/92, 31.5%). High total IgE was associated with ANA-IgE (p < 0.0001), but was not associated with IgE antibodies to allergens. In the immunoblotting, ANA-IgE reacted with nucleosomes (23/29, 79.3%), dsDNA (14/29, 48.3%), SS-A/Ro (14/29, 48.3%), SS-B/La (2/29, 18.7%), Sm (14/29, 48.3%) and RNP (18/29, 62.1%). Patients with ANA-IgE had very low serum IL-4, less IL-5 than controls (p < 0.05), more IL-10 than seronegative patients (p < 0.05), and unaltered IFN-γ levels. The IL-5/IL-10 ratio was lower in ANA-IgE seropositive patients in comparison with either seronegative patients (p < 0.05) or healthy controls (p = 0.001). Controls displayed higher IL-5/IFN-γ ratios than either SLE patients with ANA-IgE (p < 0.05) or patients without these immunoglobulins (p < 0.01). Conclusions: We conclude that IgE antibodies against cell autoantigens involved in protein expression, cellular proliferation, and cell death are present in patients with SLE. Interleukin-10 seems to down-regulate this IgE autoimmune response in SLE.

Trabalho completo: acesso restrito, p.775–778 Submitted by Bruna Lessa (lessbruna@gmail.com) on 2012-05-14T18:57:50Z No. of bitstreams: 1 (16)fulltext.pdf: 196911 bytes, checksum: 9d7dda9c62f92eff5e3267270d500874 (MD5) Made available in DSpace on 2012-05-14T18:57:50Z (GMT). No. of bitstreams: 1 (16)fulltext.pdf: 196911 bytes, checksum: 9d7dda9c62f92eff5e3267270d500874 (MD5) Previous issue date: 2010 Human T cell lymphotropic virus type 1 (HTLV-1) is endemic in many regions of the world, including Brazil, and has been associated to several immunological manifestations such as arthritis, uveitis, dermatitis and Sjögren’s syndrome. This study was intended to evaluate the frequency of autoantibodies in patients infected with HTLV-1 and manifesting keratoconjunctivitis sicca (KCS). HTLV-1 patients with KCS, enrolled in a reference ambulatory of the city of Salvador, were tested for autoantibodies such as antinuclear antibodies, rheumatoid factor, anti-SSA/Ro and anti-SSB/La. Two comparison groups were also included: (a) HTLV-1 patients without KCS and (b) seronegative patients with KCS. Correlation of proviral load (PVL) in HTLV-1 patients with presence or absence of KCS was also assessed. No autoantibodies were detected in HTLV-1 patients with KCS. The PVL of HTLV-1 patients was higher in patients with KCS without other clinical manifestations customarily associated to HTLV-1. In conclusion, in this study, no changes were observed in humoral immunity concerning production of certain autoantibodies in HTLV-1-infected patients with KCS, which suggests that other mechanisms may be involved in the pathogenesis of this manifestation. Additionally, PVL may be a marker of KCS development in these patients.

Trabalho completo: acesso restrito, p.356–360 Submitted by Bruna Lessa (lessbruna@gmail.com) on 2012-07-13T19:35:20Z No. of bitstreams: 1 (121)1-s2.0-S1297319X09000049-main.pdf: 151518 bytes, checksum: 52ae2b02fda2a4c3027328c1e176f21c (MD5) Made available in DSpace on 2012-07-13T19:35:21Z (GMT). No. of bitstreams: 1 (121)1-s2.0-S1297319X09000049-main.pdf: 151518 bytes, checksum: 52ae2b02fda2a4c3027328c1e176f21c (MD5) Previous issue date: 2009-06 To compare the frequency of different autoantibodies in a group of patients with Jaccoud's arthropathy (JA) secondary to systemic lupus erythematosus (SLE) with those without JA. A group of SLE patients with JA was compared with another group of SLE patients without this complication, matched by age and gender, regarding the presence of autoantibodies. Antibodies to cyclical citrullinated peptides (anti-CCP) and to mutated citrullinated vimentin (anti-MCV) as well as anti-SSA/Ro, anti-SSB/La, anti-Sm and anti-RNP and anticardiolipin (aCL) antibodies were searched by ELISA, using commercial kits. Rheumatoid factor was determined by nephelometry and antinuclear and anti-dsDNA antibodies by IIF. Forty-eight individuals were included in the study, being 24 patients with JA and 24 without JA, matched by gender and age. The frequency of anti-CCP antibodies in the whole population was 12.5% (6 cases), with no difference between the 2 groups. Anti-MCV antibodies were detected in 10.4% (5 cases), being found only in those with JA (p = 0.05). There was no association between the presence of JA and aCL, anti-Sm, anti-RNP and anti-SSB/La antibodies. On the other hand, a statistically significant association between the presence of anti-dsDNA antibodies and JA was observed (p = 0.04) as well as a marginal association with a decrease in serum levels of C3 (p = 0.06). In the present study, there was an association between the presence of JA and anti-dsDNA antibodies, and anti-MCV antibodies were found only in those SLE patients with JA. Whether these antibodies have an etiopathogenic role in JA is entirely unknown.

OBJETIVO:O 3º Consenso Brasileiro para pesquisa de autoanticorpos em Células HEp-2 (FAN) teve como propósito avaliar as dificuldades de implantação do 2º Consenso ocorrido no ano de 2002, discutir estratégias para controlar a qualidade do ensaio e promover a atualização das associações clínicas dos diversos padrões. MÉTODOS:Participaram do encontro em Goiânia nos dias 13 e 14 de abril de 2008 pesquisadores e especialistas de diversos centros universitários e laboratórios clínicos de diferentes regiões do Brasil, com o propósito de discutir e aprovar as recomendações que visam à melhor padronização, interpretação e utilização do ensaio pelos clínicos. Representantes comerciais de diferentes empresas produtoras de insumos para realização do teste de FAN foram convidados como ouvintes. RESULTADOS E CONCLUSÕES: O 3º Consenso enfatizou a necessidade do controle de qualidade em imunofluorescência dada a heterogeneidade de microscópios e reagentes disponíveis no mercado, promoveu adequações na terminologia utilizada para classificar os diferentes padrões e, finalmente, atualizou as associações clínicas com finalidade de facilitar cada vez mais o melhor uso do ensaio pelos clínicos. OBJECTIVE: The Third Brazilian Consensus for autoantibodies Screening in HEp-2 cells had as purpose the evaluation of difficulties in the accomplishment of the 2nd Consensus recommendations that took place in the year of 2002, the discussion of strategies for quality control of the assay and the promotion of an update of the clinical associations of the several immunofluorescent patterns. METHODS:Several ANA experts from university centers and private laboratories in different areas in Brazil joined the workshop in Goiânia on 2008 April 13 and 14 with the purpose of discussing and approving the recommendations for standardization, interpretation and use of the test by physicians. Commercial representatives of different ANA slide brands were also invited as listeners to the workshop. RESULTS AND CONCLUSIONS: The 3rd Consensus emphasized the need for quality control in indirect immunofluorescent since there is a considerable heterogeneity of available microscopes and reagents. It also promoted adaptations in the previously approved terminology used to classify the different patterns and finally updated the clinical associations of the several patterns with the purpose of providing guidance for interpretation of the assay by clinical pathologists and assistant physicians.

Objetivo: O 3º Consenso Brasileiro para pesquisa de autoanticorpos em Células HEp-2 (FAN) teve como propósito avaliar as dificuldades de implantação do 2º Consenso ocorrido no ano de 2002, discutir estratégias para controlar a qualidade do ensaio e promover a atualização das associações clínicas dos diversos padrões. Métodos: Participaram do encontro em Goiânia nos dias 13 e 14 de abril de 2008 pesquisadores e especialistas de diversos centros universitários e laboratórios clínicos de diferentes regiões do Brasil, com o propósito de discutir e aprovar as recomendações que visam à melhor padronização, interpretação e utilização do ensaio pelos clínicos. Representantes comerciais de diferentes empresas produtoras de insumos para realização do teste de FAN foram convidados como ouvintes. Resultados e Conclusões: O 3º Consenso enfatizou a necessidade do controle de qualidade em imunofluorescência dada a heterogeneidade de microscópios e reagentes disponíveis no mercado, promoveu adequações na terminologia utilizada para classificar os diferentes padrões e, finalmente, atualizou as associações clínicas com finalidade de facilitar cada vez mais o melhor uso do ensaio pelos clínicos. ________________________________________________________________________________ ABSTRACT Objective: The Third Brazilian Consensus for autoantibodies Screening in HEp-2 cells had as purpose the evaluation of difficulties in the accomplishment of the 2nd Consensus recommendations that took place in the year of 2002, the discussion of strategies for quality control of the assay and the promotion of an update of the clinical associations of the several immunofluorescent patterns. Methods: Several ANA experts from university centers and private laboratories in different areas in Brazil joined the workshop in Goiânia on 2008 April 13 and 14 with the purpose of discussing and approving the recommendations for standardization, interpretation and use of the test by physicians. Commercial representatives of different ANA slide brands were also invited as listeners to the workshop. Results and Conclusions: The 3rd Consensus emphasized the need for quality control in indirect immunofluorescent since there is a considerable heterogeneity of available microscopes and reagents. It also promoted adaptations in the previously approved terminology used to classify the different patterns and finally updated the clinical associations of the several patterns with the purpose of providing guidance for interpretation of the assay by clinical pathologists and assistant physicians.

P. 89-109,Mar./Apr. Submitted by JURANDI DE SOUZA SILVA (jssufba@hotmail.com) on 2011-10-10T13:14:57Z No. of bitstreams: 1 02.pdf: 1783667 bytes, checksum: 2b636e63a7f4153b552cdfa46437c532 (MD5) Made available in DSpace on 2011-10-10T13:14:58Z (GMT). No. of bitstreams: 1 02.pdf: 1783667 bytes, checksum: 2b636e63a7f4153b552cdfa46437c532 (MD5) Previous issue date: 2009 OBJETIVO:O 3º Consenso Brasileiro para pesquisa de autoanticorpos em Células HEp-2 (FAN) teve como propósito avaliar as dificuldades de implantação do 2º Consenso ocorrido no ano de 2002, discutir estratégias para controlar a qualidade do ensaio e promover a atualização das associações clínicas dos diversos padrões. MÉTODOS:Participaram do encontro em Goiânia nos dias 13 e 14 de abril de 2008 pesquisadores e especialistas de diversos centros universitários e laboratórios clínicos de diferentes regiões do Brasil, com o propósito de discutir e aprovar as recomendações que visam à melhor padronização, interpretação e utilização do ensaio pelos clínicos. Representantes comerciais de diferentes empresas produtoras de insumos para realização do teste de FAN foram convidados como ouvintes. RESULTADOS E CONCLUSÕES: O 3º Consenso enfatizou a necessidade do controle de qualidade em imunofluorescência dada a heterogeneidade de microscópios e reagentes disponíveis no mercado, promoveu adequações na terminologia utilizada para classificar os diferentes padrões e, finalmente, atualizou as associações clínicas com finalidade de facilitar cada vez mais o melhor uso do ensaio pelos clínicos. São Paulo

Acesso restrito: Texto completo. p. 469-475 Submitted by JURANDI DE SOUZA SILVA (jssufba@hotmail.com) on 2012-05-16T18:10:04Z No. of bitstreams: 1 __www.springerlink.com_c...k2464146086630h7_fulltext.pdf: 174093 bytes, checksum: f7383fe55843dc019ca73a11241bc925 (MD5) Made available in DSpace on 2012-05-16T18:10:04Z (GMT). No. of bitstreams: 1 __www.springerlink.com_c...k2464146086630h7_fulltext.pdf: 174093 bytes, checksum: f7383fe55843dc019ca73a11241bc925 (MD5) Previous issue date: 2009 Biomarkers of clinical response to rituximab (RTX) therapy and early predictors of outcome are still under investigation. We report a Xow cytometric immunophenotyping analysis from peripheral blood leukocyte subpopulations of two patients with systemic lupus erythematosus (SLE) associated thrombocytopenia and one patient with rheumatoid arthritis (RA), before and after 6 weeks of treatment with RTX. Our results show a reduced population of CD19+ expressing cells (B cells) after RTX treatment in all three patients. Increased frequency of peripheral regulatory CD4+CD25high T cell subset and the CD3¡CD16¡CD56bright NK cell subset after RTX therapy were also observed in all patients, the latter being more pronounced in the SLE patient with sustained clinical response. In addition, an increased population of NKT cell subsets was observed in the patients with clinical response. This is the Wrst evaluation of NK and NKT cells as biomarkers of clinical response after rituximab therapy in rheumatic diseases.

p.693–697 Submitted by Ana Valéria de Jesus Moura (anavaleria_131@hotmail.com) on 2011-12-13T15:11:37Z No. of bitstreams: 1 fulltext.pdf: 120762 bytes, checksum: 143190d57bf2f4bb591809495d978eda (MD5) Made available in DSpace on 2011-12-13T15:11:37Z (GMT). No. of bitstreams: 1 fulltext.pdf: 120762 bytes, checksum: 143190d57bf2f4bb591809495d978eda (MD5) Previous issue date: 2009 Renal disease is associated with morbidity and mortality in systemic lupus erythematosus (SLE) and antidsDNA antibodies with SLE immunopathogenesis. We investigated the dsDNA antibody profile of 84 Brazilian SLE patients, 27 with lupus nephritis. Thirty-six (39.1%) patients had dsDNA IgG antibodies shown in enzymelinked immunosorbent assay (454.7±281.1 WHO units/ mL), nine presenting renal disease. The following profile of dsDNA antibodies was demonstrated in Crithidia luciliae test: IgA (seven out of 36; 19.4%), IgG (22 out of 36, 66.1%); IgM (nine out of 36, 25.0%), and IgE (four out of 36, 11.1%). Two or three isotypes of dsDNA antibodies were observed in nine (25.0%) patients, while 11 (30.5%) were seronegative in the C. luciliae test. Patients with dsDNA antibodies had lower serum C3 and C4 when compared with SLE individuals without these immunoglobulins (P

Trabalho completo: acesso restrito, p.123–125 Submitted by Bruna Lessa (lessbruna@gmail.com) on 2012-06-25T19:18:22Z No. of bitstreams: 1 (85)fulltext.pdf: 203671 bytes, checksum: 88e513f17d135bb760e160fd94698e5a (MD5) Made available in DSpace on 2012-06-25T19:18:22Z (GMT). No. of bitstreams: 1 (85)fulltext.pdf: 203671 bytes, checksum: 88e513f17d135bb760e160fd94698e5a (MD5) Previous issue date: 2009 Catastrophic antiphospholipid syndrome (CAPS) is characterized by life-threatening diVuse thrombotic manifestations involving particularly small vessels of kidney, lungs, brain and skin. We report a 20-year-old female with systemic lupus erythematosus and secondary antiphospholipid syndrome who presented typical organ and histological involvement as seen in CAPS but with protracted course suggesting a “smoldering” form of the disease.

Texto completo: acesso restrito. p. 1825-1830 Submitted by Suelen Reis (suziy.ellen@gmail.com) on 2014-01-13T13:18:11Z No. of bitstreams: 1 art%3A10.1007%2Fs10067-007-0581-6.pdf: 147869 bytes, checksum: a7d5aa6c0ec4e0b53f0fd3ecb3c178cc (MD5) Approved for entry into archive by Rodrigo Meirelles (rodrigomei@ufba.br) on 2014-09-09T15:08:25Z (GMT) No. of bitstreams: 1 art%3A10.1007%2Fs10067-007-0581-6.pdf: 147869 bytes, checksum: a7d5aa6c0ec4e0b53f0fd3ecb3c178cc (MD5) Made available in DSpace on 2014-09-09T15:08:25Z (GMT). No. of bitstreams: 1 art%3A10.1007%2Fs10067-007-0581-6.pdf: 147869 bytes, checksum: a7d5aa6c0ec4e0b53f0fd3ecb3c178cc (MD5) Previous issue date: 2007 Antiphospholipid (aPL) antibodies classically have been associated with thrombotic phenomena and abortion in patients with autoimmune diseases. The objective of the present work was to evaluate the frequency of such antibodies in patients infected with HIV and study its association with the presence of clinical manifestations of antiphospholipid syndrome (APS). Using a transversal study, a population of patients diagnosed with HIV, identified through an enzyme-linked immunosorbent assay (ELISA) test and confirmed by Western blotting, aged above 17 years old, was investigated. Through a standard questionnaire, the presence of APS manifestations was investigated, as well as the frequency of rheumatic manifestations. Antibodies against β2 glycoprotein I (anti-β2 GPI) and anticardiolipin (aCL) IgA, IgG, and IgM were investigated by the ELISA method using commercial kits (QUANTA Lite, INOVA Diagnostics). Ninety patients were studied, 47 (52.2%) male and 43 (47.8%) female. Clinical manifestations of APS were detected in 12 patients (13.3%) of the studied population, whereas arthralgia was the most common rheumatic manifestation (38.9%). Of the 90 patients, 40 (44.4%) were reactive for at least one type of aPL antibody (aCL and/or anti-β2 GPI). The frequency of aCL was 17.8%, from which 15 (16.7%) had aCL IgG, 3 (3.3%) IgM, and 1 (1.1%) IgA. The frequency of the anti-β2 GPI antibody was 33.3%, from which 29 (32.2%) were positive for isotype IgA, 4 (4.4%) isotype IgM, and 1 (1.1%) isotype IgG. No association was observed between immunoreactivity for aPL antibodies in general or each isotype in particular and the presence of APS manifestation. In the present study, it was possible to observe a relatively high frequency of aPL antibodies, particularly for isotype IgA anti-β2 GPI in HIV. However, there was no association to APS manifestations, suggesting that such antibodies had no etiopathogenic role in these complications in patients with such retroviral infection.

Texto completo: acesso restrito. p. 622-626 Submitted by Suelen Reis (suziy.ellen@gmail.com) on 2014-01-21T11:18:29Z No. of bitstreams: 1 00043426-200709000-00009.pdf: 131072 bytes, checksum: e72f51ce46def6b00e814444cabe8870 (MD5) Made available in DSpace on 2014-01-21T11:18:29Z (GMT). No. of bitstreams: 1 00043426-200709000-00009.pdf: 131072 bytes, checksum: e72f51ce46def6b00e814444cabe8870 (MD5) Previous issue date: 2007 Objective: This study was to determine the prevalence and characteristics of the osteoarticular manifestations on initial clinical presentation of acute leukemias (ALs) on childhood in the state of Bahia, Brazil. Materials and Methods: This retrospective study assessed the medical records of 406 patients with AL from January 1995 to December 2004. Results: Acute lymphocytic leukemia (ALL) was diagnosed in 313 (77.1%) patients and acute myeloid leukemia (AML), in 93 (22.9%) patients, including 241 males (59.4%) and 165 females (40.6%). Age ranged from 9 months to 15 years (average: 6.18 y). The most common presenting features were fever (18.5%), musculoskeletal diffuse tenderness (15.0%), pallor (11.4%), and leg tenderness (5.7%). Prior referral to our center, the most frequent initial diagnosis was anemia (15.8%), leukemia (15.0%), amygdalitis (3.7%), and rheumatic fever (2.7%). Osteoarticular manifestations were found on 54.7% of the patients with AL, with a higher frequency among patients between 1 and 9 years of age (58.7%, P=0.0007). The presence of joint tenderness (16.2% in ALL×5.4% in AML), arthritis (26.6% in ALL×9.7 in AML), bone tenderness (26.1% in ALL×16.1% in AML), limb tenderness (49.5% in ALL×25.8% in AML), and antalgic gait (32.8% in ALL×9.7% in AML) had higher prevalence on ALL. The large joints, chiefly the knees (10.6%), ankles (9.4%), elbows (4.4%), and shoulders (3.6%) were more often affected. Conclusions: AL should be considered on the differential diagnosis of osteoarticular symptoms of unknown etiology in children.

P. 330-333, set/out. Submitted by JURANDI DE SOUZA SILVA (jssufba@hotmail.com) on 2011-10-10T13:27:57Z No. of bitstreams: 1 a07v47n5.pdf: 170951 bytes, checksum: 61a8930aa8784d0507a80c668947b180 (MD5) Made available in DSpace on 2011-10-10T13:27:57Z (GMT). No. of bitstreams: 1 a07v47n5.pdf: 170951 bytes, checksum: 61a8930aa8784d0507a80c668947b180 (MD5) Previous issue date: 2007 OBJETIVO: avaliar a freqüência das doenças hepáticas em pacientes com esclerodermia e, secundariamente, estudar a freqüência de infecção pelos vírus B e C da hepatite nesses pacientes, assim como a freqüência de auto-anticorpos séricos. MATERIAL E MÉTODOS: estudaram-se pacientes com diagnóstico de esclerodermia, localizada ou sistêmica, acompanhados no Ambulatório de Reumatologia do Hospital Santa Izabel. Como grupo de comparação, foram estudados pacientes com diagnóstico de acne vulgar. RESULTADOS: dos 65 pacientes com diagnóstico de esclerodermia incluídos nesse trabalho, 35% apresentaram a gama-glutamiltransferase (gama-GT) alterada, 30% tiveram a fosfatase alcalina aumentada e 17,1%, a alaninoaminotransferase (ALT) acima dos valores de referência. A ALT apresentou-se mais alterada nos pacientes do que nos controles. Apenas um indivíduo dos 41 testados apresentou positividade para o anticorpo antimitocôndria enquanto 19% tinham anticorpo antimúsculo liso, não se observando diferença estatística na positividade desses anticorpos entre os dois grupos. Um paciente apresentou o HBsAg positivo e outro foi positivo para o anticorpo anti-HCV. Nenhum paciente apresentou manifestações clínicas de doença hepática. CONCLUSÕES: no presente estudo, embora as alterações de enzimas hepáticas em pacientes com esclerodermia não tenham sido incomuns, não se observou nenhum caso com manifestações clínicas de doença hepática. São Paulo

Texto completo: acesso restrito. p. 85-86 Submitted by Suelen Reis (suziy.ellen@gmail.com) on 2014-01-31T13:16:05Z No. of bitstreams: 1 00124743-200704000-00009.pdf: 97666 bytes, checksum: 36f1f3216456785daaf6fb596657b1e3 (MD5) Approved for entry into archive by Rodrigo Meirelles (rodrigomei@ufba.br) on 2014-09-09T15:57:47Z (GMT) No. of bitstreams: 1 00124743-200704000-00009.pdf: 97666 bytes, checksum: 36f1f3216456785daaf6fb596657b1e3 (MD5) Made available in DSpace on 2014-09-09T15:57:47Z (GMT). No. of bitstreams: 1 00124743-200704000-00009.pdf: 97666 bytes, checksum: 36f1f3216456785daaf6fb596657b1e3 (MD5) Previous issue date: 2007 A multiple sclerosis-like syndrome, also called lupoid sclerosis for having some lupus characteristics, has been described in a few reports. Recently, antiphospholipid antibodies have been demonstrated in patients with this syndrome, suggesting that they can participate in the etiopathogenic process, which can have therapeutic implications. We report the case of a patient previously diagnosed with multiple sclerosis who later presented with ANA positivity and antiphospholipid antibodies, livedo reticularis, and deep venous thrombosis, leading her to be characterized as having lupoid sclerosis. The patient was anticoagulated. Antiphospholipid antibodies may be involved in the pathogenesis of lupoid sclerosis.

Texto completo: acesso restrito. p. 821-822 Submitted by Suelen Reis (suziy.ellen@gmail.com) on 2014-01-24T15:26:04Z No. of bitstreams: 1 art%3A10.1007%2Fs10067-006-0277-3.pdf: 67878 bytes, checksum: 07a66cd100d0194802881947f228ad33 (MD5) Approved for entry into archive by Rodrigo Meirelles (rodrigomei@ufba.br) on 2014-09-09T16:13:49Z (GMT) No. of bitstreams: 1 art%3A10.1007%2Fs10067-006-0277-3.pdf: 67878 bytes, checksum: 07a66cd100d0194802881947f228ad33 (MD5) Made available in DSpace on 2014-09-09T16:13:49Z (GMT). No. of bitstreams: 1 art%3A10.1007%2Fs10067-006-0277-3.pdf: 67878 bytes, checksum: 07a66cd100d0194802881947f228ad33 (MD5) Previous issue date: 2007 The antiphospholipid syndrome (APS) is characterized by obstetric and thrombotic complications in the presence of antiphospholipid antibodies. It can happen in an isolated way or in association with diffuse connective tissue diseases, mainly systemic lupus erythematosus. The association of APS with Takayasu arteritis (TA) is rarely described in the literature. We described a case of primary APS in a female patient who developed obstruction in large-size arteries, in spite of the use of oral anticoagulant, and increase of erythrocyte sedimentation rate, suggesting TA. The favorable response to prednisone treatment and later to infliximab reinforced the diagnosis of TA. The present report illustrates the existence of APS associated to TA, whose recognition is very important once the therapeutic strategy is radically different.

O rash do lúpus eritematoso sistêmico (LES) é usualmente tratado com corticosteróides tópicos, porém seu uso prolongado causa efeitos adversos cutâneos. Pimecrolimus é um protótipo da classe de agentes imunosupressores tópicos com grande potencial para o tratamento de doenças inflamatórias cutâneas. Terapia tópica com pimecrolimus foi aplicada em lesões cutâneas de face em um caso de LES refratária a esteróides sistêmico e tópico. Houve uma marcante regressão das lesões de pele, após terapia com pimecrolimus. Este tratamento foi bem tolerado, sem efeitos colaterais nesta paciente. Pimecrolimus tópico parece ser uma nova ferramenta para o manejo de lesões cutâneas refratárias em LES. The rash of systemic lupus erythematosus (SLE) is usually treated with topical corticosteroids, but prolonged use causes adverse cutaneous side-effects. Pimecrolimus is a prototype of a class of topical immunosuppressive agents with great potential for the treatment of inflammatory skin diseases. Topical pimecrolimus therapy was applied to facial skin lesions in one case of SLE refractory to topical and systemic steroids. There was a marked regression of the skin lesions after pimecrolimus therapy. This treatment was well tolerated without side effects in this patient. Topical pimecrolimus seems to be a new tool for the management of refractory skin lesions in lupus erythematosus.

OBJETIVO: avaliar condutas tomadas pelos reumatologistas de todo Brasil frente a situações clínicas comuns na prática do dia-a-dia. MÉTODO: cenários clínicos fictícios sobre várias doenças reumáticas foram montados, com perguntas objetivas acerca do tratamento. Os questionários foram enviados aos 831 sócios com títulos de especialistas pela Sociedade Brasileira de Reumatologia (SBR), com envelope selado para envio das respostas. RESULTADOS: a taxa média de devolução dos questionários foi de apenas 21,4%. A média de idade (DP) dos reumatologistas respondedores foi de 42,7 anos (DP=11,7), com tempo médio de formados de 19,8 anos (DP=10,1). No cenário clínico sobre artrite reumatóide (AR) de início recente em atividade, a maioria dos colegas (84,7%) tratava inicialmente o paciente com prednisona ou prednisolona. As drogas modificadoras da doença mais escolhidas foram metotrexato (84,2%) e cloroquina (63,8%). Quatro médicos (2,8%) escolheram os agentes biológicos (infliximabe e etanercepte) como droga de primeira escolha no tratamento inicial da doença. A profilaxia para osteoporose induzida pelo corticóide com suplementação de cálcio e vitamina D só foi orientada por 61,2% e 46,5% dos reumatologistas, respectivamente. No cenário clínico de um paciente com lúpus eritematoso sistêmico (LES), a grande maioria dos colegas optou pelo tratamento com corticóide oral (93,7%), cloroquina (92,5%) e fotoproteção (93,7%). Na presença de nefrite lúpica caracterizada com preservação da função renal e níveis pressóricos normais, a conduta mais escolhida foi pulsoterapia de corticóide (47,7%) ou prednisona oral em altas doses. Pulsoterapia de ciclofosfamida foi escolhida por 34,6% dos reumatologistas. No cenário sobre lombalgia aguda mecânico-postural, sem sinais de alarme, 55,4% dos colegas não solicitavam nenhum exame na abordagem inicial e as drogas mais escolhidas para o tratamento foram: antiinflamatórios não-hormonais (AINHs) (89,3%), relaxante muscular (72,9%), fisioterapia (33,3%). O repouso no leito foi orientado por 31,6% dos especialistas. Num caso de lombalgia crônica com raio X recente mostrando espondilolistese grau 1 e discoartrose, 39,6% dos reumatologistas não solicitavam nenhum exame adicional, enquanto 26,2% e 24,4% solicitavam tomografia computadorizada (TC) e ressonância nuclear magnética (RNM), respectivamente. As condutas mais indicadas nesse caso foram: fisioterapia (75,1%), relaxante muscular (48,5%), RPG (45,6%), exercícios físicos (41%), AINH seletivo da Cox-2 (40,5%), amitriptilina (35,3%), analgésicos opióides (34,7%). Outros cenários de artrose de joelho e ombro doloroso foram apresentados. CONCLUSÕES: a baixa taxa de devolução dos questionários pode refletir uma prática ainda não-incorporada na nossa cultura. O perfil dos reumatologistas respondedores é muito semelhante entre as regiões. A maioria das condutas escolhidas está de acordo com as melhores evidências disponíveis, refletindo uma homogeneidade de abordagem terapêutica entre os reumatologistas. Embora este estudo traga importantes dados sobre a prática reumatológica, pode não ser representativo da população de reumatologistas brasileiros, tendo em vista o baixo percentual de respondedores. OBJECTIVE: Evaluate routine clinical practices of Brazilian rheumatologists. METHOD: Virtual clinical scenarios representing a range of rheumatological practical situations were sent by mail to 831 specialists certified by the Brazilian Society of Rheumatology (SBR) with postage-paid envelopes for reply. RESULTS: Only 21.4% of the questionnaires were returned. The average age of responding rheumatologists was 42.7 years (SD=11.7), with an average time since graduation from medical school of 19.8 years (SD=10.1). In a clinical scenario describing early active rheumatoid arthritis most respondents (84.7%) chose to initiate treatment with prednisone or prednisolone. The most chosen disease modifying antirheumatic drugs were methotrexate (84,2%) and chloroquine (63.8%). Four rheumatologists (2.8%) indicated biological agents (infliximab and etanercept) as their initial choice of treatment. Prophylaxis for corticoid-induced osteoporosis and calcium and vitamin D supplementation were recommended by only 61.2% and 46.5% of the respondents, respectively. In a clinical scenario describing systemic lupus erythematosus, almost all doctors prescribed oral corticoids (93.7%), chloroquine (92.5%) and photoprotection (93.7%). In the presence of lupus nephritis with unimpaired renal function and normal blood pressure levels, the most frequently adopted management was pulse therapy with corticoids (47.7%) or high doses of oral prednisone. Pulsetherapy with cyclophosphamide was indicated by 34.6% of the respondents. In a clinical scenario describing acute mechanical back pain without alarming signs, 55.4% stated that they would request no laboratory examinations on the first encounter and the main treatments of choice were non-hormonal antiinflammatory drugs (89.3%), muscle relaxant drugs (72.9%) and physical therapy (33.3%). Bed rest was recommended by 31.6% of the respondents. In a clinical scenario describing chronic back pain with recent X-ray showing first degree spondylolisthesis and disc arthrosis, 39.6% of the rheumatologists stated that they would not request additional examinations, while 26.2% and 24.4% would request computer tomography scans and magnetic resonance scans, respectively. The most frequently prescribed treatments were physical therapy (75.1%), muscle relaxant drugs (48.5%), RPG (45.6%), physical exercise (41%), Cox-2-selective non-hormonal antiinflammatory drugs (40.5%), amitriptyline (35.3%) and opioid analgesics (34.7%). The questionnaire also included scenarios describing knee arthrosis and shoulder pain. CONCLUSION: The low rate of response from rheumatologists may be associated with aspects of Brazilian culture. In fact, respondents displayed a very similar profile throughout the country. Most of the prescribed treatments agree with available evidence and reflect a homogeneous approach to rheumatological disease among professionals. However, although the present study has provided interesting information regarding clinical practices, the small number of respondents may not be particularly representative of the population of Brazilian rheumatologists.

OBJETIVO: avaliar condutas tomadas pelos reumatologistas de todo Brasil frente a situações clínicas comuns na prática do dia-a-dia. MÉTODO: cenários clínicos fictícios sobre várias doenças reumáticas foram montados, com perguntas objetivas acerca do tratamento. Os questionários foram enviados aos 831 sócios com títulos de especialistas pela Sociedade Brasileira de Reumatologia (SBR), com envelope selado para envio das respostas. RESULTADOS: a taxa média de devolução dos questionários foi de apenas 21,4%. A média de idade (DP) dos reumatologistas respondedores foi de 42,7 anos (DP=11,7), com tempo médio de formados de 19,8 anos (DP=10,1). No cenário clínico sobre artrite reumatóide (AR) de início recente em atividade, a maioria dos colegas (84,7%) tratava inicialmente o paciente com prednisona ou prednisolona. As drogas modificadoras da doença mais escolhidas foram metotrexato (84,2%) e cloroquina (63,8%). Quatro médicos (2,8%) escolheram os agentes biológicos (infliximabe e etanercepte) como droga de primeira escolha no tratamento inicial da doença. A profilaxia para osteoporose induzida pelo corticóide com suplementação de cálcio e vitamina D só foi orientada por 61,2% e 46,5% dos reumatologistas, respectivamente. No cenário clínico de um paciente com lúpus eritematoso sistêmico (LES), a grande maioria dos colegas optou pelo tratamento com corticóide oral (93,7%), cloroquina (92,5%) e fotoproteção (93,7%). Na presença de nefrite lúpica caracterizada com preservação da função renal e níveis pressóricos normais, a conduta mais escolhida foi pulsoterapia de corticóide (47,7%) ou prednisona oral em altas doses. Pulsoterapia de ciclofosfamida foi escolhida por 34,6% dos reumatologistas. No cenário sobre lombalgia aguda mecânico-postural, sem sinais de alarme, 55,4% dos colegas não solicitavam nenhum exame na abordagem inicial e as drogas mais escolhidas para o tratamento foram: antiinflamatórios não-hormonais (AINHs) (89,3%), relaxante muscular (72,9%), fisioterapia (33,3%). O repouso no leito foi orientado por 31,6% dos especialistas. Num caso de lombalgia crônica com raio X recente mostrando espondilolistese grau 1 e discoartrose, 39,6% dos reumatologistas não solicitavam nenhum exame adicional, enquanto 26,2% e 24,4% solicitavam tomografia computadorizada (TC) e ressonância nuclear magnética (RNM), respectivamente. As condutas mais indicadas nesse caso foram: fisioterapia (75,1%), relaxante muscular (48,5%), RPG (45,6%), exercícios físicos (41%), AINH seletivo da Cox-2 (40,5%), amitriptilina (35,3%), analgésicos opióides (34,7%). Outros cenários de artrose de joelho e ombro doloroso foram apresentados. CONCLUSÕES: a baixa taxa de devolução dos questionários pode refletir uma prática ainda não-incorporada na nossa cultura. O perfil dos reumatologistas respondedores é muito semelhante entre as regiões. A maioria das condutas escolhidas está de acordo com as melhores evidências disponíveis, refletindo uma homogeneidade de abordagem terapêutica entre os reumatologistas. Embora este estudo traga importantes dados sobre a prática reumatológica, pode não ser representativo da população de reumatologistas brasileiros, tendo em vista o baixo percentual de respondedores.

P. 163,Mar/Abr. Submitted by JURANDI DE SOUZA SILVA (jssufba@hotmail.com) on 2011-10-10T14:33:55Z No. of bitstreams: 1 31344.pdf: 70417 bytes, checksum: 24835ee46be69e91bd1261e0c62b7640 (MD5) Made available in DSpace on 2011-10-10T14:33:55Z (GMT). No. of bitstreams: 1 31344.pdf: 70417 bytes, checksum: 24835ee46be69e91bd1261e0c62b7640 (MD5) Previous issue date: 2006 São Paulo

Texto completo: acesso restrito. p.301–303 Submitted by Edileide Reis (leyde-landy@hotmail.com) on 2013-08-22T12:32:01Z No. of bitstreams: 1 301.full.pdf: 129500 bytes, checksum: df7c42b8aeb6d9351f796519e43274bb (MD5) Approved for entry into archive by Flávia Ferreira(flaviaccf@yahoo.com.br) on 2013-09-16T17:18:30Z (GMT) No. of bitstreams: 1 301.full.pdf: 129500 bytes, checksum: df7c42b8aeb6d9351f796519e43274bb (MD5) Made available in DSpace on 2013-09-16T17:18:30Z (GMT). No. of bitstreams: 1 301.full.pdf: 129500 bytes, checksum: df7c42b8aeb6d9351f796519e43274bb (MD5) Previous issue date: 2006 Antiphospholipid syndrome (APS) is a clinical entity characterized by arterial and venous thrombosis, adverse obstetric outcome and the presence of antibodies against phospholipids in serum or plasma. The objective of the present study is to describe a rare case of APS that occurred in a neonate born from a patient previously diagnosed as primary APS. A male, preterm born twin infant, whose mother had been diagnosed as primary APS, developed thrombocytopenia, livedo reticularis, pericardial effusion and thrombosis of the left subclavian and external jugular veins concomitantly with severe respiratory tract infection soon after his delivery, that culminated with his death two months after the birth, in spite of the large spectrum antibiotic therapy and all supportive measures. Laboratory findings included high titers of IgM anticardiolipin antibodies and moderate titers of IgG isotype and negative antinuclear antibody, configuring a case of neonatal APS. Neonatal APS is a rare clinical condition, with only a few cases described in the literature. Its occurrence may depend on the passage of antibodies through the placenta or, as it seems to have occurred in the present case, by the production of de novo antibodies by the fetus. The present case illustrates the necessity of a higher surveillance of the neonates born from mothers with primary APS or systemic lupus erythematosus (SLE) for the eventual development of such complication.

p.13-17 Submitted by Edileide Reis (leyde-landy@hotmail.com) on 2013-08-05T14:53:37Z No. of bitstreams: 1 29911.pdf: 142292 bytes, checksum: a18fa704aa21a9ecc3b406a6dc063ac3 (MD5) Approved for entry into archive by Rodrigo Meirelles (rodrigomei@ufba.br) on 2013-11-22T12:01:42Z (GMT) No. of bitstreams: 1 29911.pdf: 142292 bytes, checksum: a18fa704aa21a9ecc3b406a6dc063ac3 (MD5) Made available in DSpace on 2013-11-22T12:01:42Z (GMT). No. of bitstreams: 1 29911.pdf: 142292 bytes, checksum: a18fa704aa21a9ecc3b406a6dc063ac3 (MD5) Previous issue date: 2006 OBJECTIVE: The standard enzyme-linked immunosorbent assay (ELISA) for anticardiolipin (aCL) antibodies is the most important test for the diagnosis of antiphospholipid syndrome (APS). However, the test is also positive in some infectious diseases and other non-related syndromes. It has been suggested that the detection of antibodies to a mixture of phospholipids or to b2-glycoprotein I (b2-GP I) has higher specificity for APS than the standard aCL ELISA. The aim of the present work is to compare the diagnostic specificity of three different antiphospholipid (aPL) assays in patients with infectious diseases. METHODS: Antiphospholipid antibodies were searched by three ELISA techniques, namely standard aCL, APhL® ELISA kit and anti-b2-GP I, in sera of patients with infectious diseases, including syphilis (69), leptospirosis (33) and visceral leishmaniasis (30). RESULTS: The frequency of positivity of IgG aPL in patients with syphilis, leptospirosis and Kala-azar was 13/69 (19%), 9/33 (27%) and 2/30 (6%), respectively, using standard ELISA, versus only 1/69 (1.4%), 0/33 (0%) and 0/30 (0%) positivity by the APhL® ELISA kit. The positivity of the isotype IgM aPL was 10/69 (14%), 4/33 (12%) and 1/30 (3%), respectively, by the standard ELISA, and 1/69 (1.4%), 0/33 (0%) and 0/30 (0%) by the APhL® ELISA kit. The presence of significant levels of IgG anti-b2GPI was observed in 14/69 cases of syphilis (20%), 6/33 cases of leptospirosis (18%) and 16/30 cases of Kala-azar (53%). The APhL® ELISA kit had superior performance showing the highest specificity: 97% (95% CI: 92%-99%) for IgG compared to 81% (95% CI: 74%-87%) for standard ELISA and 72% (95% CI: 64%-79%) for anti-b2 GPI assay. CONCLUSIONS: The APhL® ELISA kit proved to be significantly more specific than the aCL standard ELISA and the anti-b2GPI ELISA, and it should be used to help in the diagnosis and confirmation of APS.

P. 119-23, Mai./Jun. Submitted by JURANDI DE SOUZA SILVA (jssufba@hotmail.com) on 2011-10-10T14:47:14Z No. of bitstreams: 1 31344.pdf: 332993 bytes, checksum: f3503f908164a7b63bd87fd4473c9cb9 (MD5) Made available in DSpace on 2011-10-10T14:47:14Z (GMT). No. of bitstreams: 1 31344.pdf: 332993 bytes, checksum: f3503f908164a7b63bd87fd4473c9cb9 (MD5) Previous issue date: 2005 OBJETIVO: determinar a prevalência de anticorpos antifosfolípides em mulheres com antecedentes de perdas gestacionais na população obstétrica em geral e verificar se os anticorpos antifosfolípides representam fator de risco para perdas gestacionais na população estudada. MÉTODOS: foi realizado um estudo caso-controle prospectivo com mulheres grávidas e não grávidas, atendidas numa maternidade pública entre março de 2003 e junho de 2004. As mulheres foram divididas em dois grupos de acordo com o passado obstétrico; 100 mulheres com antecedentes de perdas gestacionais de acordo com a definição estabelecida para o diagnóstico da síndrome antifosfolipídica e que não apresentassem outros fatores relacionados ao insucesso gestacional; 150 mulheres saudáveis com antecedentes de duas ou mais gestações bem sucedidas. A determinação do anticoagulante lúpico (AL) foi feita mediante os testes de TTPA, dRVVT de triagem e dRVVT confirmatório. Para a pesquisa dos anticorpos anticardiolipina (aCL) classes IgG e IgM foi utilizado o teste de ELISA. e os resultados semiquantitativos expressos em unidades GPL e MPL. RESULTADOS: o anticoagulante lúpico estava presente em 5% das pacientes-caso e 2% dos controles (p=0,27). Os anticorpos aCL IgG estavam presentes em 18% das pacientes-caso e 8,7% das pacientes-controle (p=0,028; OR=2,3; IC 95%=1-53). Na classe IgM, 5% de positividade para os casos e 1% para os controles (p=0,21). CONCLUSÕES: os anticorpos antifosfolípides (AL e/ou aCL IgG e/ou IgM) foram mais prevalentes nas mulheres com perdas gestacionais (28%) que na população obstétrica em geral (17%). As mulheres com aCL IgG têm duas vezes mais chance de ter perdas gestacionais que a população obstétrica em geral. São Paulo

Condrocalcinose articular familiar é uma condição clínica caracterizada pela deposição de cristais de pirofosfato de cálcio no líquido sinovial e cartilagens articulares levando à artrite. Descrevemos três membros de uma família com condrocalcinose cujo quadro clínico era caracterizado por artrite intermitente em dois e artrite crônica lembrando artrite reumatóide em um. A avaliação radiológica mostrou calcificações em cartilagens de diversas articulações, particularmente de joelhos. A utilização de colchicina foi suficiente para prevenir as crises de artrite em dois pacientes e o paciente com a forma crônica necessitou uso contínuo de antiinflamatórios não-hormonais. Embora aparentemente rara no Brasil, não afastamos a possibilidade desse dado estar subestimado e sugerimos que seja realizada uma avaliação radiológica articular dos familiares de todo paciente com diagnóstico de condrocalcinose esporádica.

Condrocalcinose articular familiar é uma condição clínica caracterizada pela deposição de cristais de pirofosfato de cálcio no líquido sinovial e cartilagens articulares levando à artrite. Descrevemos três membros de uma família com condrocalcinose cujo quadro clínico era caracterizado por artrite intermitente em dois e artrite crônica lembrando artrite reumatóide em um. A avaliação radiológica mostrou calcificações em cartilagens de diversas articulações, particularmente de joelhos. A utilização de colchicina foi suficiente para prevenir as crises de artrite em dois pacientes e o paciente com a forma crônica necessitou uso contínuo de antiinflamatórios não-hormonais. Embora aparentemente rara no Brasil, não afastamos a possibilidade desse dado estar subestimado e sugerimos que seja realizada uma avaliação radiológica articular dos familiares de todo paciente com diagnóstico de condrocalcinose esporádica. Familial articular chondrocalcinosis is a disorder characterized by deposition of calcium pyrophosphate dihydrate crystal in synovial fluid and articular cartilage that can cause joint pain and arthritis. We have identified three members of the same family with chondrocalcinosis. The clinical features of the disease were intermittent episodes of arthritis in two patients and polyarthritis resembling rheumatoid arthritis in one member. The radiological evaluation showed calcification in several joints, particularly in cartilages of the knees. Therapy with colchicine was enough to prevent arthritic crisis in two patients and continous NSAID use was necessary to control symptoms in the last one. Familial chondrocalcinosis seems to be rare in Brazil, but we do not exclude the possibility that this figure is underestimated and suggest that in cases of sporadic chondrocalcinosis other members of the family should be fully investigated.

Texto completo:acesso restrito. p. 50-51 Submitted by JURANDI DE SOUZA SILVA (jssufba@hotmail.com) on 2013-01-25T12:06:55Z No. of bitstreams: 1 art%3A10.1007%2Fs10067-003-0823-1.pdf: 164389 bytes, checksum: 10ea308e7d9b19b37e3c1a5bdb5575bd (MD5) Made available in DSpace on 2013-01-25T12:06:55Z (GMT). No. of bitstreams: 1 art%3A10.1007%2Fs10067-003-0823-1.pdf: 164389 bytes, checksum: 10ea308e7d9b19b37e3c1a5bdb5575bd (MD5) Previous issue date: 2004 Progressive systemic sclerosis (PSS) can involve the skin diffusely or in a limited way. Rarely cutaneous involvement can assume a hypertrophic form, described in the literature as keloidal scleroderma. The authors describe a PSS patient who presented cutaneous manifestations compatible with the diagnosis of this clinical situation. The clinical features, pathogenic mechanism and therapeutic approach are discussed and a broad review of the literature is given.

Texto completo: acesso restrito. p. 199–205 Submitted by Suelen Reis (suelen_suzane@hotmail.com) on 2013-01-04T15:12:34Z No. of bitstreams: 1 Soares.pdf: 191788 bytes, checksum: b78c44651d8f3a884fc8fc69cbb05f66 (MD5) Made available in DSpace on 2013-01-04T15:12:34Z (GMT). No. of bitstreams: 1 Soares.pdf: 191788 bytes, checksum: b78c44651d8f3a884fc8fc69cbb05f66 (MD5) Previous issue date: 2001 A semi-quantitative ELISA for complement-fixing, IgG-containing immune complexes (IC) is described. The assay is based on the insolubilization of IC by polyethyleneglycol, their capture by solid-phase anti-C3 antibodies, reaction with peroxidase-labeled anti-IgG antibodies and incubation with a chromogenic peroxidase substrate. It was markedly improved by the use of a single-step procedure which simultaneously washed and precipitated the insolubilized immune complexes. Intra-assay and inter-assay coefficients of variation were lower than 8.6 and 14.7%, respectively. As expected, higher levels of circulating immune complexes, in relation to healthy individuals, were found in patients with American visceral leishmaniasis (AVL), systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA), with prevalences comparable to those described in the literature. The ELISA can be quickly assembled from reagents and plasticware widely available commercially, detects immune complexes fulfilling three different criteria and is more sensitive than a previously published method based on the same principles (detection limit for complement-sensitized aggregated IgG of 2 μg ml−1 as compared with a detection limit above 16 μg ml−1).