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Hoi A, Igel T, Mok CC, Arnaud L. Systemic lupus erythematosus. Lancet 2024; 403:2326-2338. [PMID: 38642569 DOI: 10.1016/s0140-6736(24)00398-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 09/28/2023] [Accepted: 02/25/2024] [Indexed: 04/22/2024]
Abstract
Systemic lupus erythematosus (SLE) is a multisystemic autoimmune disease characterised by the presence of autoantibodies towards nuclear antigens, immune complex deposition, and chronic inflammation at classic target organs such as skin, joints, and kidneys. Despite substantial advances in the diagnosis and management of SLE, the burden of disease remains high. It is important to appreciate the typical presentations and the diagnostic process to facilitate early referral and diagnosis for patients. In most patients, constitutional, mucocutaneous, and musculoskeletal symptoms represent the earliest complaints; these symptoms can include fatigue, lupus-specific rash, mouth ulcers, alopecia, joint pain, and myalgia. In this Seminar we will discuss a diagnostic approach to symptoms in light of the latest classification criteria, which include a systematic evaluation of clinical manifestations (weighted within each domain) and autoantibody profiles (such as anti-double-stranded DNA, anti-Sm, hypocomplementaemia, or antiphospholipid antibodies). Non-pharmacotherapy management is tailored to the individual, with specific lifestyle interventions and patient education to improve quality of life and medication (such as hydroxychloroquine or immunosuppressant) adherence. In the last decade, there have been a few major breakthroughs in approved treatments for SLE and lupus nephritis, such as belimumab, anifrolumab, and voclosporin. However the disease course remains variable and mortality unacceptably high. Access to these expensive medications has also been restricted across different regions of the world. Nonetheless, understanding of treatment goals and strategies has improved. We recognise that the main goal of treatment is the achievement of remission or low disease activity. Comorbidities due to both disease activity and treatment adverse effects, especially infections, osteoporosis, and cardiovascular disease, necessitate vigilant prevention and management strategies. Tailoring treatment options to achieve remission, while balancing treatment-related comorbidities, are priority areas of SLE management.
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Affiliation(s)
- Alberta Hoi
- Department of Rheumatology, Monash Health, School of Clinical Sciences, Monash University, Melbourne, VIC, Australia.
| | - Talia Igel
- Department of Rheumatology, Monash Health, School of Clinical Sciences, Monash University, Melbourne, VIC, Australia
| | - Chi Chiu Mok
- Department of Medicine, Tuen Mun Hospital, Hong Kong Special Administrative Region, China
| | - Laurent Arnaud
- Department of Rheumatology, National Reference Center for Autoimmune Diseases, INSERM UMR-S 1109, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
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2
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Shumilova A, Vital EM. Musculoskeletal manifestations of systemic lupus erythematosus. Best Pract Res Clin Rheumatol 2023; 37:101859. [PMID: 37620235 DOI: 10.1016/j.berh.2023.101859] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 07/20/2023] [Indexed: 08/26/2023]
Abstract
MSK is the most common and impactful symptom of lupus at a population level. It has a variety of different presentations, but joint swelling is often not present despite imaging-proven synovitis. Imaging with US and MRI has been shown to improve detection of inflammation and identify treatment-responsive patients. In contrast, the SLEDAI shows poor sensitivity, specificity, and responsiveness. While BILAG and SLE-DAS are superior, they are still less accurate than imaging. These issues may explain why the evidence for conventional and biologic therapies for MSK lupus is complex. In clinical practice, physicians must take care not to underestimate MSK inflammation and consider using imaging. Future research should investigate new therapeutic targets specifically for synovitis and more sensitive outcome measures and trials to evaluate them.
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Affiliation(s)
- Anastasiia Shumilova
- University of Leeds, Leeds, United Kingdom; V.A. Nasonova Research Institute of Rheumatology, Moscow, Russian Federation
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3
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Ng C, Qin Y, Xia Y, Hu X, Zhao B. Jagged1 Acts as an RBP-J Target and Feedback Suppresses TNF-Mediated Inflammatory Osteoclastogenesis. JOURNAL OF IMMUNOLOGY (BALTIMORE, MD. : 1950) 2023; 211:1340-1347. [PMID: 37756541 PMCID: PMC10693321 DOI: 10.4049/jimmunol.2300317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 08/17/2023] [Indexed: 09/29/2023]
Abstract
TNF plays a crucial role in inflammation and bone resorption in various inflammatory diseases, including rheumatoid arthritis (RA). However, its direct ability to drive macrophages to differentiate into osteoclasts is limited. Although RBP-J is recognized as a key inhibitor of TNF-mediated osteoclastogenesis, the precise mechanisms that restrain TNF-induced differentiation of macrophages into osteoclasts are not fully elucidated. In this study, we identified that the Notch ligand Jagged1 is a previously unrecognized RBP-J target. The expression of Jagged1 is significantly induced by TNF mainly through RBP-J. The TNF-induced Jagged1 in turn functions as a feedback inhibitory regulator of TNF-mediated osteoclastogenesis. This feedback inhibition of osteoclastogenesis by Jagged1 does not exist in RANKL-induced mouse osteoclast differentiation, as RANKL does not induce Jagged1 expression. The Jagged1 level in peripheral blood monocytes/osteoclast precursors is decreased in RA compared with the nonerosive inflammatory disease systemic lupus erythematosus, suggesting a mechanism that contributes to increased osteoclast formation in RA. Moreover, recombinant Jagged1 suppresses human inflammatory osteoclastogenesis. Our findings identify Jagged1 as an RBP-J direct target that links TNF and Notch signaling pathways and restrains TNF-mediated osteoclastogenesis. Given that Jagged1 has no effect on TNF-induced expression of inflammatory genes, its use may present a new complementary therapeutic approach to mitigate inflammatory bone loss with little impact on the immune response in disease conditions.
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Affiliation(s)
- Courtney Ng
- Correspondence: Baohong Zhao, Ph.D. Hospital for Special Surgery, Research Institute R804, 535 East 70 Street, New York, NY 10021, 212-774-2772 (Tel), 646-714-6333 (Fax),
| | - Yongli Qin
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Yuhan Xia
- Correspondence: Baohong Zhao, Ph.D. Hospital for Special Surgery, Research Institute R804, 535 East 70 Street, New York, NY 10021, 212-774-2772 (Tel), 646-714-6333 (Fax),
| | - Xiaoyu Hu
- Institute for Immunology and School of Medicine, Tsinghua University, Beijing, China
| | - Baohong Zhao
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
- Graduate Program in Cell and Development Biology, Weill Cornell Graduate School of Medical Sciences, New York, New York, USA
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Xia Y, Inoue K, Du Y, Baker SJ, Reddy EP, Greenblatt MB, Zhao B. TGFβ reprograms TNF stimulation of macrophages towards a non-canonical pathway driving inflammatory osteoclastogenesis. Nat Commun 2022; 13:3920. [PMID: 35798734 PMCID: PMC9263175 DOI: 10.1038/s41467-022-31475-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 06/20/2022] [Indexed: 01/12/2023] Open
Abstract
It is well-established that receptor activator of NF-κB ligand (RANKL) is the inducer of physiological osteoclast differentiation. However, the specific drivers and mechanisms driving inflammatory osteoclast differentiation under pathological conditions remain obscure. This is especially true given that inflammatory cytokines such as tumor necrosis factor (TNF) demonstrate little to no ability to directly drive osteoclast differentiation. Here, we found that transforming growth factor β (TGFβ) priming enables TNF to effectively induce osteoclastogenesis, independently of the canonical RANKL pathway. Lack of TGFβ signaling in macrophages suppresses inflammatory, but not basal, osteoclastogenesis and bone resorption in vivo. Mechanistically, TGFβ priming reprograms the macrophage response to TNF by remodeling chromatin accessibility and histone modifications, and enables TNF to induce a previously unrecognized non-canonical osteoclastogenic program, which includes suppression of the TNF-induced IRF1-IFNβ-IFN-stimulated-gene axis, IRF8 degradation and B-Myb induction. These mechanisms are active in rheumatoid arthritis, in which TGFβ level is elevated and correlates with osteoclast activity. Our findings identify a TGFβ/TNF-driven inflammatory osteoclastogenic program, and may lead to development of selective treatments for inflammatory osteolysis.
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Affiliation(s)
- Yuhan Xia
- Arthritis and Tissue Degeneration Program and David Z. Rosensweig Genomics Research Center, Hospital for Special Surgery, New York, New York, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
- Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Kazuki Inoue
- Arthritis and Tissue Degeneration Program and David Z. Rosensweig Genomics Research Center, Hospital for Special Surgery, New York, New York, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Yong Du
- Arthritis and Tissue Degeneration Program and David Z. Rosensweig Genomics Research Center, Hospital for Special Surgery, New York, New York, USA
| | - Stacey J Baker
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - E Premkumar Reddy
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Matthew B Greenblatt
- Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY, USA
- Research Institute, Hospital for Special Surgery, New York, NY, USA
| | - Baohong Zhao
- Arthritis and Tissue Degeneration Program and David Z. Rosensweig Genomics Research Center, Hospital for Special Surgery, New York, New York, USA.
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
- Graduate Program in Cell and Development Biology, Weill Cornell Graduate School of Medical Sciences, New York, NY, USA.
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5
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Santiago MB. Jaccoud-type lupus arthropathy. Lupus 2022; 31:398-406. [DOI: 10.1177/09612033221082908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Jaccoud’s arthropathy (JA) is a condition characterized by joint deformities that have a “reducible” pattern, that is, they return to the normal appearance with a passive manoeuvre. JA was described in patients with rheumatic fever (RF) more than a century ago, and presently, the majority of the patients have systemic lupus erythematosus (SLE). Purpose: The aim of this review is to draw one attention to the epidemiology, pathogenesis, histopathology, clinical features, imaging, and management of JA in patients with SLE (Jaccoud-type lupus arthropathy). Data collection: The search strategy included articles retrieved from PubMed utilizing the terms “lupus arthropathy”, “lupus deforming arthropathy”, “lupus hand”, “lupus foot”, “chronic postrheumatic arthropathy”, “Jaccoud’s” and “Jaccoud” from 1950 until March 2021, with no language restriction. Results: The prevalence of Jaccoud-type arthropathy in SLE is approximately 5%. The aetiopathogenic mechanisms of JA are not yet known. The most common joint deformities of JA, are ulnar deviation, swan neck, and the “z” of the thumb. Unfortunately, none of the proposed classification criteria for JA have been validated so far. Characteristically, there is no bone erosion on plain radiographs of the joints, but more sensitive imaging methods, magnetic resonance imaging or high-performance ultrasound may reveal small bone erosions. There is no preventive measure against JA development, specific clinical treatment or convincing surgical approach for correcting the deformities. Conclusion: As daily activities and quality of life are compromised in patients with JA, other studies are urgently needed in this area.
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Ikumi A, Okuwaki S, Hara Y, Yoshii Y, Kawamura H. Spontaneous rupture of the extensor pollicis longus tendon in systemic lupus erythematosus: A case report and literature review. Mod Rheumatol Case Rep 2022; 6:29-32. [PMID: 34505159 DOI: 10.1093/mrcr/rxab004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/30/2021] [Accepted: 05/25/2021] [Indexed: 06/13/2023]
Abstract
Spontaneous tendon rupture is a rare entity. Herein, we report a case of spontaneous rupture of the extensor pollicis longus (EPL) tendon in a 61-year-old woman with systemic lupus erythematosus (SLE). The patient worked as an aesthetician and had a 42-year history of SLE that was well controlled using oral steroids. She presented with an inability to extend her left thumb, with no prior history of trauma or symptoms. On imaging, there was no evidence of degenerative changes or osteophyte formation in the gliding area of the EPL tendon. Intraoperatively, there was evidence of tendon rupture around Lister's tubercle. We performed a tendon transfer of the extensor indicis proprius for repair. The patient recovered active thumb extension and returned to work 4 months after surgery without any complications. We suspected that spontaneous EPL tendon rupture was caused by a combination of disease-related factors, including long-term steroid use, chronic inflammation, and continuous mechanical stress from her work and daily activity. This case report demonstrates the multifactorial aetiology of spontaneous tendon rupture in patients with SLE and the importance of monitoring for this complication during routine follow-up.
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Affiliation(s)
- Akira Ikumi
- Department of Orthopaedic Surgery, Kenpoku Medical Center Takahagi Kyodo Hospital, Ibaraki, Japan
| | - Shun Okuwaki
- Department of Orthopaedic Surgery, Kenpoku Medical Center Takahagi Kyodo Hospital, Ibaraki, Japan
| | - Yuki Hara
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Yuichi Yoshii
- Department of Orthopaedic Surgery, Tokyo Medical University Ibaraki Medical Center, Ibaraki, Japan
| | - Haruo Kawamura
- Department of Orthopaedic Surgery, Kenpoku Medical Center Takahagi Kyodo Hospital, Ibaraki, Japan
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Keramiotou K, Anagnostou C, Konstantonis G, Kataxaki E, Sfikakis PP, Tektonidou MG. Impaired hand function and performance in activities of daily living in systemic lupus erythematosus, even in patients achieving lupus low disease activity state (LLDAS). Rheumatol Adv Pract 2021; 5:rkab029. [PMID: 34557620 PMCID: PMC8450930 DOI: 10.1093/rap/rkab029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 04/21/2021] [Indexed: 12/20/2022] Open
Abstract
Objective The aim was to examine hand function and performance in activities of daily living (ADL) in patients with SLE vs healthy controls, and any associations with demographic and disease-related characteristics. Methods Hand function (grip strength, pinch strength and dexterity) and ADL performance were evaluated in 240 patients with SLE and 122 age- and biological sex-matched healthy controls. Grip strength, pinch strength and dexterity were measured by Jamar dynamometer, pinch gauge and Purdue pegboard test, respectively. Self-reported ADL performance was assessed by disabilities of the arm, shoulder and hand (DASH) and HAQ. Regression analysis was performed to assess the determinants of hand dysfunction. Results All hand function and ADL performance variables were significantly impaired in the entire SLE cohort and the subgroup of patients achieving lupus low disease activity state (LLDAS; n = 157) compared with healthy subjects (P < 0.05). Joint pain, often underestimated in SLE, was the major determinant of hand function and ADL performance in multiple regression models. In addition, age was correlated with grip strength and Purdue scores, gender with grip strength, arthritis with DASH and HAQ, and use of immunosuppressives with DASH, HAQ and grip strength. Likewise, in patients in LLDAS, painful joints were correlated with DASH and HAQ, age with grip strength and Purdue (P < 0.001), gender with grip strength, and immunosuppressives with HAQ and grip strength. Conclusion Hand function and performance of daily activities are significantly impaired in SLE, even in patients who achieve LLDAS, suggesting the need for their evaluation and management in clinical practice.
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Affiliation(s)
- Kyriaki Keramiotou
- First Department of Propaedeutic Internal Medicine, Joint Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Athens.,Rheumatology Unit, Thriasio General Hospital of Elefsina, Magoula, Greece
| | | | - George Konstantonis
- First Department of Propaedeutic Internal Medicine, Joint Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Athens
| | - Evangelia Kataxaki
- Rheumatology Unit, Thriasio General Hospital of Elefsina, Magoula, Greece
| | - Petros P Sfikakis
- First Department of Propaedeutic Internal Medicine, Joint Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Athens
| | - Maria G Tektonidou
- First Department of Propaedeutic Internal Medicine, Joint Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Athens
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Pimenta da Fonseca E, Lins CF, de Sá Ribeiro DL, Santos WGD, Rosa G, Machicado V, Pedreira AL, Souza APMD, Baleeiro C, Dos Santos Ferreira LG, de Oliveira IS, da Silva JPCG, Atta AM, Santiago MB. Videocapillaroscopic Findings in Patients With Systemic Lupus Erythematosus With or Without Jaccoud Arthropathy. J Clin Rheumatol 2021; 27:S198-S203. [PMID: 33337816 DOI: 10.1097/rhu.0000000000001617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND/OBJECTIVE Systemic lupus erythematosus (SLE) is an autoimmune disease that can present changes in blood vessels, which can be evaluated by periungual nailfold videocapillaroscopy (VCP). This technique is important for the diagnosis of systemic sclerosis and to identify individuals with Raynaud phenomenon at higher risk of developing systemic sclerosis. This study aims to describe the videocapillaroscopic profile of a series of SLE patients and to investigate if the VCP pattern is different among those with Jaccoud arthropathy (JA) compared with those without. METHODS Between September 2014 and March 2015, the patients in this study underwent VCP, clinical evaluation, and laboratory tests. The capillaroscopic patterns were defined as minor, major, and scleroderma (SD). The presence of capillaroscopic findings, such as elongated capillaries, tortuosity, ectasia, prominent venous plexus, neoangiogenesis, hemorrhage, and megacapillaries, were also observed. Associations were calculated using the χ2, Fisher exact, or Student t test. RESULTS In a population of 113 females with SLE (67 without JA and 46 with JA), at least 1 alteration was observed in VCP in 89.40% of them, among which "nonspecific changes" were the most prevalent. Minor changes were seen in 39 (58.2%) and 26 (56.5%), major changes in 21 (31.3%) and 11 (23.9%), and SD pattern in 2 (3.0%) and 3 (6.5%), in the patients without and with JA, respectively (p > 0.05). CONCLUSIONS The majority of patients with SLE demonstrated changes in the VCP examination, but this tool did not allow discrimination between those with or without JA.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Ajax Merces Atta
- Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Federal University of Bahia
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9
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Sousa APMD, de Souza Costa GC, de Oliveira Costa GN, Barbosa LM, Grassi MFR, Monteiro MEH, Dos Reis MG, Barreto ML, Pedreira AL, Ribeiro DS, Lins CF, Galvão V, Santos WGD, Machicado V, da Fonseca EP, Silva CBR, Santiago MB. Genetic Polymorphisms in Patients With Systemic Lupus Erythematosus and Jaccoud Arthropathy: A Pilot Study. J Clin Rheumatol 2021; 27:S193-S197. [PMID: 34525002 DOI: 10.1097/rhu.0000000000001653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Jaccoud arthropathy (JA) is a nonerosive and deforming arthropathy experienced frequently by patients with systemic lupus erythematosus (SLE). Although genetic polymorphisms are associated with SLE development, the association between genetic polymorphisms and JA has not been studied to date. The main objective of this study was to evaluate an association between HLA, STAT4, IRF5, and BLK polymorphisms and the presence of JA in Brazilian individuals with SLE. METHODS Patients were selected from a cohort of individuals with SLE followed at 2 rheumatology reference centers in Salvador, Bahia, Brazil. The JA diagnosis was based on clinical and radiological criteria. The participants were genotyped for rs9271100, rs7574865, rs10488631, and rs13277113 polymorphisms in the HLA, STAT4, IRF5, and BLK genes, respectively, using real-time polymerase chain reaction. The presence of JA was correlated with allele frequencies, and clinical and laboratory data. RESULTS One hundred forty-four individuals with SLE (38 with JA and 106 with SLE without JA) were studied. The mean age of the patients was 45 ± 12 years; the majority were women and had brown skin. Patients with JA had a longer disease duration than patients without JA. Serositis and neuropsychiatric manifestations were more frequent in the JA population. The A allele of rs13277113 in the BLK gene was associated with the presence of JA. CONCLUSIONS The rs13277113 polymorphism in the BLK gene was found to be a possible genetic risk for JA development. However, further studies in larger populations should be performed to confirm this finding.
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Abstract
PURPOSE OF REVIEW To highlight the potential uses and applications of imaging in the assessment of the most common and relevant musculoskeletal (MSK) manifestations in systemic lupus erythematosus (SLE). RECENT FINDINGS Ultrasound (US) and magnetic resonance imaging (MRI) are accurate and sensitive in the assessment of inflammation and structural damage at the joint and soft tissue structures in patients with SLE. The US is particularly helpful for the detection of joint and/or tendon inflammation in patients with arthralgia but without clinical synovitis, and for the early identification of bone erosions. MRI plays a key role in the early diagnosis of osteonecrosis and in the assessment of muscle involvement (i.e., myositis and myopathy). Conventional radiography (CR) remains the traditional gold standard for the evaluation of structural damage in patients with joint involvement, and for the study of bone pathology. The diagnostic value of CR is affected by the poor sensitivity in demonstrating early structural changes at joint and soft tissue level. Computed tomography allows a detailed evaluation of bone damage. However, the inability to distinguish different soft tissues and the need for ionizing radiation limit its use to selected clinical circumstances. Nuclear imaging techniques are valuable resources in patients with suspected bone infection (i.e., osteomyelitis), especially when MRI is contraindicated. Finally, dual energy X-ray absorptiometry represents the imaging mainstay for the assessment and monitoring of bone status in patients with or at-risk of osteoporosis. Imaging provides relevant and valuable information in the assessment of MSK involvement in SLE.
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The Influence of Hand Dominance on the Degree of Deformities in Patients With Systemic Lupus Erythematosus and Jaccoud Arthropathy. J Clin Rheumatol 2020; 26:S205-S207. [PMID: 32332272 DOI: 10.1097/rhu.0000000000001392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND/OBJECTIVE Joint deformities in Jaccoud arthropathy (JA), associated with systemic lupus erythematosus (SLE), can lead to a reduction in articular function and an impaired quality of life. There is controversy in the literature as to whether hand dominance contributes to deformities observed in rheumatoid arthritis and other forms of rheumatism. The purpose of this study was to assess whether hand dominance has any influence on the degree of deformity or joint range of motion in patients with JA associated with SLE. METHODS This was a pilot cross-sectional study of 22 female patients (mean age, 46.18 ± 12.61 years) with both SLE and JA. Each patient's hand grip and hand and wrist joint range of motion were assessed by the same examiner. The Wilcoxon test was used to compare the median values of the angles and muscular strength found between the sides. RESULTS All the study participants were right-side dominant. The median muscle strength of the right and left hands was 13.25 kilogram-force (KgF) (range, 7.00-18.00 KgF) and 10.50 KgF (range, 7.50-17.25 KgF), respectively. Both the fingers of the right and left hands had a median ulnar drift of 10.00°; however, their ranges differed (right, 4.50° to 20.00°; left: 0.00° to 15.50°). No statistically significant differences were found in the extension angulation of the proximal interphalangeal joints or the flexion of the distal interphalangeal joints of the second to fifth fingers, between the dominant and nondominant hands. CONCLUSIONS Hand dominance does not seem to influence the degree of JA deformities in patients with SLE.
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Quintana R, Pons-Estel G, Roberts K, Sacnún M, Berbotto G, Garcia MA, Saurit V, Barile-Fabris L, Acevedo-Vazquez EM, Tavares Brenol JC, Sato EI, Iglesias A, Uribe O, Alarcon G, Pons-Estel BA. Jaccoud’s arthropathy in SLE: findings from a Latin American multiethnic population. Lupus Sci Med 2019; 6:e000343. [PMID: 31478011 PMCID: PMC6703282 DOI: 10.1136/lupus-2019-000343] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 07/22/2019] [Accepted: 07/26/2019] [Indexed: 11/17/2022]
Abstract
Objective To compare the clinical, laboratory and outcome features of SLE patients with and without Jaccoud’s arthropathy (JA) from the Grupo Latino Americano De Estudio del Lupus (GLADEL) cohort. Methods 1480 patients with SLE [(34 centres, 9 Latin American countries with a recent diagnosis (≤2 years)] constitute the GLADEL cohort. JA was defined as reducible deformity of the metacarpophalangeal axis, without radiographic erosions at any time. Within this cohort, a nested case–control study was carried out. Control was matched for age, gender and centre in a 1:3 proportion. The variables included were: sociodemographic, clinical and immunological features, disease activity, damage and mortality. Comparisons were performed with Wilcoxon and χ2 tests for continuous and categorical variables, respectively. ORs and 95% CIs and Kaplan-Meier survival curve were estimated. Results Of 1480 patients, 17 (1.1%) JA patients were identified; 16 (94.1%) of them were women, mean age: 31.0 years (SD 12.0). Five (29.4%) patients presented JA at SLE diagnosis and 12 (70.6%) after. The median follow-up time and all disease features were comparable in both groups except for a higher frequency of pneumonitis in the patients with JA [4 (23.5) vs 1 (2.0); p=0.012; (OR: 15.4; 95% CI 1.6 to 149.6)]. The SLE disease activity index, Systemic Lupus International Collaborating Clinics/American College of Rheumatology damage Index and the Kaplan-Meier survival curve were similar in both groups. Conclusion JA may tend to appear early in the course of SLE; it seems not to have an impact on disease activity, damage accrual or in survival.
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Affiliation(s)
- Rosana Quintana
- Department of Internal Medicine, Centro Regional de Enfermedades Autoinmunes y Reumáticas (CREAR), Rosario, Argentina
| | - Guillermo Pons-Estel
- Department of Internal Medicine, Centro Regional de Enfermedades Autoinmunes y Reumáticas (CREAR), Rosario, Argentina
| | - Karen Roberts
- Department of Rheumatology, Hospital Provincial de Rosario, Rosario, Argentina
| | - Monica Sacnún
- Department of Rheumatology, Hospital Provincial de Rosario, Rosario, Argentina
| | - Guillermo Berbotto
- Department of Rheumatology, Hospital Escuela Eva Perón, Granadero Baigorria, Argentina
| | - Mercedes A Garcia
- Department of Rheumatology, Hospital Interzonal General de Agudos General San Martín, La Plata, Argentina
| | - Veronica Saurit
- Department of Rheumatology, Hospital Privado, Cordoba, Cordoba, Argentina
| | - Leonor Barile-Fabris
- Department of Rheumatology, Hospital Angeles del Pedregal, Ciudad de México, Ciudad de Mexico, Mexico
| | | | - João C Tavares Brenol
- Department of Rheumatology, Hospital das Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Emilia I Sato
- Department of Rheumatology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Antonio Iglesias
- Department of Medicine, Universidad Nacional de Colombia, Bogota, Colombia
| | - Oscar Uribe
- Department of Rheumatology, Universidad de Antioquia, Hospital Universitario “Fundación San Vicente”, Medellin, Colombia
| | - Graciela Alarcon
- Department of Medicine, Division of Clinical Immunology and Rheumatology, School of Medicine, The University of Alabama at Birmingham, Birmingham, England, USA
- Department of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Bernardo A Pons-Estel
- Department of Internal Medicine, Centro Regional de Enfermedades Autoinmunes y Reumáticas (CREAR), Rosario, Argentina
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Wijemanne S, Jankovic J. Hand, foot, and spine deformities in parkinsonian disorders. J Neural Transm (Vienna) 2019; 126:253-264. [PMID: 30809710 DOI: 10.1007/s00702-019-01986-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 02/09/2019] [Indexed: 12/31/2022]
Abstract
Hand and foot deformities, known as "striatal deformities", and other musculoskeletal abnormalities such as dropped head, bent spine, camptocormia, scoliosis and Pisa syndrome, are poorly understood and often misdiagnosed features of Parkinson's disease and other parkinsonian syndromes. These deformities share some similarities with known rheumatologic conditions and can be wrongly diagnosed as rheumatoid arthritis, osteoarthritis, psoriatic arthritis, Dupuytren's contracture, trigger finger, or other rheumatologic or orthopedic conditions. Neurologists, rheumatologists, and other physicians must be familiar with these deformities to prevent misdiagnosis and unnecessary diagnostic tests, and to recommend appropriate treatment options.
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Affiliation(s)
| | - Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, 7200 Cambridge St, Suite #9A, Houston, TX, 77030, USA.
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Jung YK, Kang YM, Han S. Osteoclasts in the Inflammatory Arthritis: Implications for Pathologic Osteolysis. Immune Netw 2019; 19:e2. [PMID: 30838157 PMCID: PMC6399096 DOI: 10.4110/in.2019.19.e2] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 01/31/2019] [Accepted: 02/17/2019] [Indexed: 02/07/2023] Open
Abstract
The enhanced differentiation and activation of osteoclasts (OCs) in the inflammatory arthritis such as rheumatoid arthritis (RA) and gout causes not only local bone erosion, but also systemic osteoporosis, leading to functional disabilities and morbidity. The induction and amplification of NFATc1, a master regulator of OC differentiation, is mainly regulated by receptor activator of NF-κB (RANK) ligand-RANK and calcium signaling which are amplified in the inflammatory milieu, as well as by inflammatory cytokines such as TNFα, IL-1β and IL-6. Moreover, the predominance of CD4+ T cell subsets, which varies depending on the condition of inflammatory diseases, can determine the fate of OC differentiation. Anti-citrullinated peptide antibodies which are critical in the pathogenesis of RA can bind to the citrullinated vimentin on the surface of OC precursors, and in turn promote OC differentiation and function via IL-8. In addition to adaptive immunity, the activation of innate immune system including the nucleotide oligomerization domain leucine rich repeat with a pyrin domain 3 inflammasome and TLRs can regulate OC maturation. The emerging perspectives about the diverse and close interactions between the immune cells and OCs in inflammatory milieu can have a significant impact on the future direction of drug development.
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Affiliation(s)
- Youn-Kwan Jung
- Biomedical Research Institute, Gyeongsang National University Hospital, Jinju, Korea
| | - Young-Mo Kang
- Division of Rheumatology, Department of Internal medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Seungwoo Han
- Division of Rheumatology, Department of Internal medicine, Kyungpook National University Hospital, Daegu, Korea
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Abstract
Systemic lupus erythematosus is a chronic autoimmune condition with variable organ system involvement; manifestations can range from mild to potentially life threatening. Early diagnosis is important, as progression of disease can be halted. Diagnosis is made by review of signs and symptoms, imaging, and serology.
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Affiliation(s)
- Ruba Kado
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, Suite 7C27 North Ingalls Building, 300 North Ingalls SPC 5422, Ann Arbor, MI 48109-5422, USA.
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Wu Q, Yang Q, Sun H. Collagen triple helix repeat containing-1: a novel biomarker associated with disease activity in Systemic lupus erythematosus. Lupus 2018; 27:2076-2085. [PMID: 30336754 DOI: 10.1177/0961203318804877] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The objective of this article is to investigate whether the aberrant expression of collagen triple helix repeat containing-1 (CTHRC1) from patients with systemic lupus erythematosus (SLE) could contribute to the pathogenesis of lupus. METHODS We divided SLE patients into active groups (Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) score ≥ 6) and inactive groups (SLEDAI score < 6). Serum concentrations of CTHRC1, interferon alpha, interleukin (IL)-28A and IL-28B were determined using an enzyme-linked immunosorbent assay in a group of 40 patients with SLE. Results were compared with those from 23 healthy controls. RESULTS Serum CTHRC1 protein levels were higher in patients with SLE compared with healthy controls. Patients with active disease displayed higher CTHRC1 levels compared with those with inactive disease as well. There was a positive association between serum CTHRC1 levels and SLEDAI and erythrocyte sedimentation rate, and a negative correlation with complement 3 and 4. Moreover, serum CTHRC1 levels were higher in SLE patients with arthritis and anemia compared with patients without the above-mentioned manifestations. CONCLUSIONS These findings indicate CTHRC1 probably plays an important part in the pathogenesis of SLE, and is positively associated with disease activity, while it also likely refers to the development of arthritis and anemia in SLE. Therefore, CTHRC1 may provide a novel research target and shed new light on the pathogenesis and therapy of SLE.
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Affiliation(s)
- Q Wu
- Department of Rheumatology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, P.R. China
| | - Q Yang
- Department of Rheumatology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, P.R. China
| | - H Sun
- Department of Rheumatology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, P.R. China
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Krishnan Y, Grodzinsky AJ. Cartilage diseases. Matrix Biol 2018; 71-72:51-69. [PMID: 29803938 PMCID: PMC6146013 DOI: 10.1016/j.matbio.2018.05.005] [Citation(s) in RCA: 225] [Impact Index Per Article: 37.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 05/14/2018] [Accepted: 05/15/2018] [Indexed: 01/13/2023]
Abstract
Hyaline cartilages, fibrocartilages and elastic cartilages play multiple roles in the human body including bearing loads in articular joints and intervertebral discs, providing joint lubrication, forming the external ears and nose, supporting the trachea, and forming the long bones during development and growth. The structure and organization of cartilage's extracellular matrix (ECM) are the primary determinants of normal function. Most diseases involving cartilage lead to dramatic changes in the ECM which can govern disease progression (e.g., in osteoarthritis), cause the main symptoms of the disease (e.g., dwarfism caused by genetically inherited mutations) or occur as collateral damage in pathological processes occurring in other nearby tissues (e.g., osteochondritis dissecans and inflammatory arthropathies). Challenges associated with cartilage diseases include poor understanding of the etiology and pathogenesis, delayed diagnoses due to the aneural nature of the tissue and drug delivery challenges due to the avascular nature of adult cartilages. This narrative review provides an overview of the clinical and pathological features as well as current treatment options available for various cartilage diseases. Late breaking advances are also described in the quest for development and delivery of effective disease modifying drugs for cartilage diseases including osteoarthritis, the most common form of arthritis that affects hundreds of millions of people worldwide.
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Affiliation(s)
- Yamini Krishnan
- Department of Chemical Engineering, MIT, Cambridge, MA 02139, USA
| | - Alan J Grodzinsky
- Department of Biological Engineering, MIT, Cambridge, MA 02139, USA; Department of Mechanical Engineering, MIT, Cambridge, MA 02139, USA; Department of Electrical Engineering and Computer Science, MIT, Cambridge, MA 02139, USA.
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Torrente-Segarra V, Monte TCS, Corominas H. Musculoskeletal involvement and ultrasonography update in systemic lupus erythematosus: New insights and review. Eur J Rheumatol 2018; 5:127-130. [PMID: 30183613 DOI: 10.5152/eurjrheum.2017.17198] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 01/13/2018] [Indexed: 12/25/2022] Open
Abstract
Ultrasonography has been rarely used to measure musculoskeletal and joint activity in systemic lupus erythematosus (SLE). The aim of this review is to discuss the utility and reliability of this non-invasive diagnostic tool for the assessment of joint disease in SLE patients. In the last decade, several reports have highlighted the role of ultrasonography for a better evaluation of SLE-related musculoskeletal symptoms. The symptoms have also been associated with worse outcomes in SLE; therefore, it is essential to seek useful and accessible techniques for better understanding of such patients who are insufficiently assessed by standard physical examination.
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Affiliation(s)
- Vicenç Torrente-Segarra
- Department of Rheumatology, Hospital Sant Joan Despí Moisès Broggi/Hospital General de l' Hospitalet, Barcelona, Spain
| | | | - Hèctor Corominas
- Rheumatology Unit, Hospital Universitari de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
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Sonographic Findings of Hands and Wrists in Systemic Lupus Erythematosus Patients With Jaccoud Arthropathy. J Clin Rheumatol 2018; 24:70-74. [DOI: 10.1097/rhu.0000000000000622] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Background Patients with systemic lupus erythematosus (SLE) may form clusters with clinical manifestations and autoantibodies. Objective The objective of this report is to study whether SLE patients with positive rheumatoid factor (RF) have a special clinical and/or serological profile. Methods A retrospective study of 467 SLE patients seen at a single rheumatology unit was conducted. Epidemiological data (age, gender, age at disease onset, ethnic background and tobacco use), clinical data (malar rash, photosensitivity, oral ulcers, discoid lesions, serositis, glomerulonephritis, convulsions, psychosis, hemolytic anemia, leukopenia, lymphocytopenia, arthritis and hypothyroidism) and serological profile (anti-dsDNA, anti-Ro/SS-A, anti-La/SS-B, anti-RNP, anti-Sm, IgG aCL, IgM aCL, lupus anticoagulant, direct Coombs and RF) were collected. Patients with positive and negative RF were compared. Results RF was found in 24.9% of the sample. In univariate analysis, RF was positively associated with butterfly rash ( p = 0.04), anti-Ro ( p = 0.03), anti-Sm antibodies ( p = 0.01) and hypothyroidism ( p = 0.01) and negatively associated with glomerulonephritis ( p = 0.003). Logistic regression showed that only glomerulonephritis ( p = 0.03; OR = 0.45; 95% CI = 0.21-0.93) and anti-Ro ( p = 0.009; OR = 2.3; 95% CI = 1.24-4.57) were independent associations. Conclusion In our sample RF was associated with protection from glomerulonephritis and with higher prevalence of anti-Ro antibodies.
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Affiliation(s)
- A Fedrigo
- 1 Rheumatology Service, Evangelical University Hospital of Curitiba, Curitiba, Brazil
| | - T A F G Dos Santos
- 1 Rheumatology Service, Evangelical University Hospital of Curitiba, Curitiba, Brazil
| | - R Nisihara
- 1 Rheumatology Service, Evangelical University Hospital of Curitiba, Curitiba, Brazil
- 2 Department of Medicine, Positivo University, Curitiba, Brazil
| | - T Skare
- 1 Rheumatology Service, Evangelical University Hospital of Curitiba, Curitiba, Brazil
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Ribeiro DS, Lins CF, Galvão V, Santos WGD, Rosa G, Machicado V, Pedreira AL, da Fonseca EP, Souza APMD, Baleeiro C, Ferreira LG, Oliveira ISD, Gama da Silva JPC, Atta AM, Santiago MB. Association of CXCL13 serum level and ultrasonographic findings of joints in patients with systemic lupus erythematosus and Jaccoud’s arthropathy. Lupus 2018; 27:939-946. [DOI: 10.1177/0961203317753557] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- D Sá Ribeiro
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia, Brazil
| | - C F Lins
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia, Brazil
| | - V Galvão
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia, Brazil
| | | | - G Rosa
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia, Brazil
| | - V Machicado
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia, Brazil
| | - A L Pedreira
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia, Brazil
| | - E P da Fonseca
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia, Brazil
| | | | - C Baleeiro
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia, Brazil
| | - L G Ferreira
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia, Brazil
| | - I Silva de Oliveira
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - J P Cotrim Gama da Silva
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - A M Atta
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - M B Santiago
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia, Brazil
- Serviços Especializados em Reumatologia da Bahia, Salvador, Bahia, Brazil
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Ceccarelli F, Perricone C, Cipriano E, Massaro L, Natalucci F, Capalbo G, Leccese I, Bogdanos D, Spinelli FR, Alessandri C, Valesini G, Conti F. Joint involvement in systemic lupus erythematosus: From pathogenesis to clinical assessment. Semin Arthritis Rheum 2017; 47:53-64. [DOI: 10.1016/j.semarthrit.2017.03.022] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 03/22/2017] [Accepted: 03/31/2017] [Indexed: 12/13/2022]
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Current Perspectives on Imaging for Systemic Lupus Erythematosus, Systemic Sclerosis, and Dermatomyositis/Polymyositis. Rheum Dis Clin North Am 2016; 42:711-732. [DOI: 10.1016/j.rdc.2016.07.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Ultrasonographic assessment of bone erosions in the different subtypes of systemic lupus erythematosus arthritis: comparison with computed tomography. Arthritis Res Ther 2016; 18:222. [PMID: 27716316 PMCID: PMC5050586 DOI: 10.1186/s13075-016-1125-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 09/19/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The aim was to determine the accuracy of high-resolution ultrasonography (US) for detecting erosion in the metacarpophalangeal (MCP) and wrist joints of patients with different subtypes of systemic lupus erythematosus (SLE) arthritis, using computed tomography (CT) as the gold-standard reference method. METHOD The ulnar head, radiocarpal and second to fifth MCP joints in 26 patients with SLE - 9 classified as having rhupus syndrome, 10 as having Jaccoud's arthropathy (JA) and 7 as having non-deforming non-erosive (NDNE) arthritis - were subdivided into areas and bilaterally evaluated for the presence of bone erosion by CT and US. On CT, erosion volume was scored according to the outcome measures in rheumatology-rheumatoid arthritis magnetic resonance imaging (OMERACT-RAMRIS) score. On US, erosions were semi-quantitatively scored 0-3 according to scoring by ultrasound structural erosion (ScUSSe) systems. RESULTS Erosions were detected by CT in 92/728 areas (12.6 %) and by US in 43/728 areas (5.9 %). Sensitivity, specificity and accuracy of US overall was 36 %, 98 % and 90 % compared with 57 %, 98 % and 93 % in the dorsal and lateral aspects of the second and fifth MCP, which were identified as areas with the best US reliability. Adding wrist joints would capture a larger number of erosions without affecting the accuracy. US detected 90.0 % of CT erosions with bone volume loss >20 % and 51.2 % of erosions with bone volume loss >10 %. Patients with rhupus had a greater number of larger erosions than those with JA or NDNE arthritis, with prevalent involvement of the MCP joints. Overall reliability of US in detecting bone erosions was moderate for rhupus syndrome (0.55) and JA (0.58), but poor for NDNE arthritis (0.10). CONCLUSION US had moderate sensitivity and excellent specificity for detection and semi-quantitative assessment of bone erosions in SLE.
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Piga M, Gabba A, Congia M, Figus F, Cauli A, Mathieu A. Predictors of musculoskeletal flares and Jaccoud׳s arthropathy in patients with systemic lupus erythematosus: A 5-year prospective study. Semin Arthritis Rheum 2016; 46:217-224. [DOI: 10.1016/j.semarthrit.2016.04.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Revised: 03/14/2016] [Accepted: 04/25/2016] [Indexed: 01/15/2023]
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Hosokawa T, Oda R, Toyama S, Taniguchi D, Tokunaga D, Fujiwara H, Kubo T. Spontaneous flexor tendon rupture due to an insufficiency fracture of the hamate hook in a patient with systemic lupus erythematosus: A case report. Int J Surg Case Rep 2016; 27:63-65. [PMID: 27552031 PMCID: PMC4995535 DOI: 10.1016/j.ijscr.2016.06.052] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 06/30/2016] [Accepted: 06/30/2016] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Spontaneous flexor tendon rupture is usually caused by trauma, systemic diseases, or carpal bone and joint disorders. Here we report a case of spontaneous flexor tendon rupture occurring in a systemic lupus erythematosus (SLE) patient following nonunion of the hamate hook after an insufficiency fracture, and which was also associated with tendon degeneration caused by SLE. CASE PRESENTATION A 57-year-old woman was diagnosed with SLE 22 years ago and being treated with oral prednisolone. She became unable to flex her left little finger without any history of trauma or sporting activity. CT showed nonunion of the hamate hook. MRI showed rupture of the flexor digitorum profundus tendon of the little finger. We performed tendon transfer and excision of the hamate hook. She recovered active flexion of the little finger at 4 months postoperatively with full satisfaction. DISCUSSION There was no history of trauma that could have caused nonunion of the hamate hook. We considered that the insufficiency fracture of the hamate hook occurred as a result of osteoporosis caused by SLE and long-term steroid use. Nonunion of the hamate hook caused mechanical attrition of the tendons, and in combination with the tendon degeneration caused by SLE, further resulted in rupture of the flexor tendon. CONCLUSION When we encounter a case of spontaneous flexor tendon rupture in a patient with systemic disease such as SLE or long-term steroid use, attention should be paid to the state of the carpal bones and joints as they sometimes accompany unexpected causes.
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Affiliation(s)
- Toshihiro Hosokawa
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan.
| | - Ryo Oda
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan.
| | - Shogo Toyama
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan.
| | - Daigo Taniguchi
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan.
| | - Daisaku Tokunaga
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan.
| | - Hiroyoshi Fujiwara
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan.
| | - Toshikazu Kubo
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan.
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Najm A, Le Goff B, Achille A, Espitia O, Durant C, Perrin F, Agard C. [Three cases of Jaccoud's arthropathy during systemic sclerosis]. Rev Med Interne 2016; 37:708-713. [PMID: 26869295 DOI: 10.1016/j.revmed.2016.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 01/06/2016] [Accepted: 01/11/2016] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Jaccoud's arthropathy (JA) is a chronic and non-erosive deforming arthropathy, usually affecting the hands. JA pathophysiology is poorly known but involves periarticular structures such as tendons and the joint capsule. JA is associated with various conditions including the connective tissue disease, especially systemic lupus erythematosis. JA has been rarely described and studied in systemic sclerosis. CASE REPORTS We report the clinical histories of 3 patients with systemic sclerosis (ScS) who developed JA. One patient had a systemic limited disease and the 2 others a cutaneous limited disease ; mean age of the patients was 79.3 years. Systemic sclerosis was diagnosed respectively 19, 1 and 21 years prior to the development of JA. One of the 3 patients had a past clinical history of discoid lupus. For 1 out of the 3 patients, JA appeared whereas the ScS was completely stable. The disease was still active in the 2 remaining patients, with concurrent pulmonary hypertension diagnosis. Deformities increased during years (Z thumbs, ulnar deviation), leading to mild to severe disability. No benefit from either prednisone (n=2) or a combination of prednisone and methotrexate (n=1) was obtained. CONCLUSION We described 3 cases of Jaccoud's arthropathy among our scleroderma cohort of 296 patients (1%). This arthropathy worsens hand functional disability. Its pathophysiology is unknown and optimal therapeutic approach remains to establish.
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Affiliation(s)
- A Najm
- Service de rhumatologie, pôle hospitalo-universitaire 4, hôpital Hôtel-Dieu, place Alexis-Ricordeau, 44093 Nantes cedex 1, France
| | - B Le Goff
- Service de rhumatologie, pôle hospitalo-universitaire 4, hôpital Hôtel-Dieu, place Alexis-Ricordeau, 44093 Nantes cedex 1, France
| | - A Achille
- Service de médecine interne, pôle hospitalo-universitaire 3, centre de compétences maladies systémiques et auto-immunes rares, hôpital Hôtel-Dieu, place Alexis-Ricordeau, 44093 Nantes cedex 1, France
| | - O Espitia
- Service de médecine interne, pôle hospitalo-universitaire 3, centre de compétences maladies systémiques et auto-immunes rares, hôpital Hôtel-Dieu, place Alexis-Ricordeau, 44093 Nantes cedex 1, France
| | - C Durant
- Service de médecine interne, pôle hospitalo-universitaire 3, centre de compétences maladies systémiques et auto-immunes rares, hôpital Hôtel-Dieu, place Alexis-Ricordeau, 44093 Nantes cedex 1, France
| | - F Perrin
- Service de médecine interne, pôle hospitalo-universitaire 3, centre de compétences maladies systémiques et auto-immunes rares, hôpital Hôtel-Dieu, place Alexis-Ricordeau, 44093 Nantes cedex 1, France
| | - C Agard
- Service de médecine interne, pôle hospitalo-universitaire 3, centre de compétences maladies systémiques et auto-immunes rares, hôpital Hôtel-Dieu, place Alexis-Ricordeau, 44093 Nantes cedex 1, France; Inserm UMR1087, CNRS UMR6291, unité de recherche de l'Institut du thorax, équipe 2 « Signalisation et hypertension artérielle », IRS université de Nantes, 8, quai Moncousu, BP 70721, 44007 Nantes cedex 1, France.
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Abstract
OBJECTIVE The aim of this study was to determine the prevalence, spectrum, and clinical, radiological, and serologic findings as well as hand functions among Thai systemic lupus erythematosus (SLE) patients with deforming arthropathy. METHODS All SLE patients attending the rheumatology clinic between January and December 2012 were interviewed, with their complete history and a physical examination being taken. Those with hand deformities were invited to join the study. RESULTS Forty (8.7%) of 458 SLE patients had deforming arthropathy, with 13 (2.8%) of them having erosive arthritis (EA group) and 27 nonerosive arthropathy (NEA group) (8 [1.8%] with Jaccoud arthropathy [JA subgroup] and 19 [4.1%] with mild deforming arthropathy [MDA subgroup]). Three of 13 EA patients (0.7% of all SLE patients) had high titer of rheumatoid factor (RF) and anti-cyclic citrullinated peptide (CCP) antibodies that might represent true overlapping between rheumatoid arthritis and SLE. There were no statistically significant differences in autoantibodies, RF, or anti-CCP between the EA and NEA groups or the JA and MDA subgroups, except for discoid rash that was seen more commonly in the MDA subgroup. Rheumatoid factor and anti-CCP were not present in the JA subgroup. Hand joint destruction and deformities were seen more commonly in the EA group and JA subgroup. The hand grip and palmar pinch strength decreased moderately, with hand functions quite well preserved in all groups. CONCLUSIONS Deforming arthropathy was not uncommon in Thai SLE patients, but true overlapping between rheumatoid arthritis and SLE was rare. Despite significant hand joint deformities and moderately decreased hand grip and palmar pinch strength, preservation of hand functions was generally apparent.
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Gormezano NWS, Silva CA, Aikawa NE, Barros DL, da Silva MA, Otsuzi CI, Kozu K, Seguro LP, Pereira RMR, Bonfá E. Chronic arthritis in systemic lupus erythematosus: distinct features in 336 paediatric and 1830 adult patients. Clin Rheumatol 2015; 35:227-31. [PMID: 26615611 DOI: 10.1007/s10067-015-3127-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 11/20/2015] [Accepted: 11/21/2015] [Indexed: 11/27/2022]
Abstract
The objectives of this study are to assess the frequency of chronic arthritis and compare the clinical and laboratory features in a large population of childhood-onset systemic lupus erythematosus (cSLE) and adult-onset (aSLE) patients. This historical study evaluated 336 cSLE and 1830 aSLE patients. Chronic arthritis was defined as synovitis of at least 6 weeks of duration. Rhupus was characterised as the association of SLE and chronic inflammatory arthritis with erosion and positive rheumatoid factor. Jaccoud's arthropathy is a non-erosive subluxation leading to severe deformity of the hands and feet. Data were compared using Student's t test or the Mann-Whitney test for continuous variables. For categorical variables, differences were assessed by Fisher's exact test and Pearson chi-square. Frequencies of chronic arthritis were similar in cSLE and aSLE (2.4 vs. 3.8%, p = 0.261). The median time from disease onset to appearance of chronic arthritis was shorter in cSLE (0 vs. 10 years, p < 0.001), and the median of age at chronic arthritis diagnosis was [10.8 (4.2-14.6) vs. 40 (21-67), p < 0.001]. The children presented with more chronic polyarthritis than the adults (75 vs. 32%, p = 0.024), a higher median number of joints with arthritis [8.5 (1-18) vs. 3 (1-9), p = 0.017] and a higher number of joints with limitation [1.5(0-24) vs. 0(0-4), p = 0.004]. The chronic arthritis diagnosis frequencies of hepatomegaly (25 vs. 0%, p = 0.009), splenomegaly (25 vs. 0%, p = 0.009), pericarditis (25 vs. 0%, p = 0.009), nephritis (37 vs. 3% , p = 0.006), haematuria (37 vs. 1.4%, p = 0.002), lupus anticoagulant (40 vs. 1.6%, p = 0.012), anticardiolipin IgM (40 vs. 1.5%, p = 0.012) and median Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) [10.5(1-20) vs. 6(4-16), p = 0.029] were higher in cSLE. Frequency of rhupus, (12 vs. 17%, p = 1.0), Jaccoud's arthropathy (0 vs. 17%, p = 0.343) and treatments were similar in cSLE and aSLE. We determined that chronic arthritis in SLE has distinct features in children, with very early onset, polyarticular involvement and association with active disease. We further demonstrated in this series that a proportion of chronic arthritis involvement in SLE is manifested as rhupus and Jaccoud's arthropathy.
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Affiliation(s)
- Natali W S Gormezano
- Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo (USP), Av. Dr. Arnaldo, n° 455, 3° andar, sala 3190 - Cerqueira César, São Paulo, SP, 05403-010, Brazil
- Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, Brazil
| | - Clovis A Silva
- Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, Brazil.
| | - Nadia E Aikawa
- Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo (USP), Av. Dr. Arnaldo, n° 455, 3° andar, sala 3190 - Cerqueira César, São Paulo, SP, 05403-010, Brazil
- Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, Brazil
| | - Diego L Barros
- Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo (USP), Av. Dr. Arnaldo, n° 455, 3° andar, sala 3190 - Cerqueira César, São Paulo, SP, 05403-010, Brazil
| | - Mariana A da Silva
- Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo (USP), Av. Dr. Arnaldo, n° 455, 3° andar, sala 3190 - Cerqueira César, São Paulo, SP, 05403-010, Brazil
| | - Carini I Otsuzi
- Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo (USP), Av. Dr. Arnaldo, n° 455, 3° andar, sala 3190 - Cerqueira César, São Paulo, SP, 05403-010, Brazil
| | - Katia Kozu
- Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, Brazil
| | - Luciana Parente Seguro
- Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo (USP), Av. Dr. Arnaldo, n° 455, 3° andar, sala 3190 - Cerqueira César, São Paulo, SP, 05403-010, Brazil
| | - Rosa M R Pereira
- Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo (USP), Av. Dr. Arnaldo, n° 455, 3° andar, sala 3190 - Cerqueira César, São Paulo, SP, 05403-010, Brazil
| | - Eloisa Bonfá
- Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo (USP), Av. Dr. Arnaldo, n° 455, 3° andar, sala 3190 - Cerqueira César, São Paulo, SP, 05403-010, Brazil
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Santiago MB, Galvão V, Ribeiro DS, Santos WD, da Hora PR, Mota AP, Pimenta E, Oliveira I, Atta AM, Reis MG, Reis EAG, Lins C. Severe Jaccoud's arthropathy in systemic lupus erythematosus. Rheumatol Int 2015; 35:1773-7. [PMID: 26310503 DOI: 10.1007/s00296-015-3351-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 08/18/2015] [Indexed: 11/30/2022]
Abstract
Jaccoud's arthropathy (JA) is a clinical situation nowadays present mostly in systemic lupus erythematosus (SLE). It is characterized by the presence of joint deformities such as "swan neck," ulnar deviation and "Z-thumb" resembling rheumatoid arthritis (RA) but that are passively correctable and without bone erosion on plain radiographs. From our cohort of SLE patients with JA, we selected a subgroup with a more severe form of this arthropathy and looked at their clinical and laboratory profile as well as studied the magnetic resonance imaging (MRI) findings or ultrasound (US) obtained from the hand with most evident deformities. Seven SLE patients with a severe form of JA were identified. All seven patients have "swan neck," ulnar deviation and "Z-thumb" deformities. Two out of seven had "mutilans-type JA" and four had fixed deformities in the metacarpophalangeal (MCP) joints. The MRI of the hand with more evident deformity clinically performed in six cases and US performed in one case showed mild synovitis in five and moderate synovitis in two patients, mild flexor tenosynovitis in six and severe tenosynovitis in one. Only two small bone erosions were observed in the second and third MCP joints of one patient with moderate synovitis. Severe JA compromises the functional capacity of the joints and imposes the risk of misdiagnosis of RA. With the improvement of the survival rate of SLE and the lack of specific prophylactic or therapeutical measures for JA, it is reasonable to assume that more and more cases of severe JA are going to be identified.
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Affiliation(s)
- Mittermayer B Santiago
- Escola Bahiana de Medicina e Saúde Pública, Av. Dom João VI, 275, Brotas, Salvador, BA, 40290-000, Brazil. .,Serviços Especializados em Reumatologia da Bahia, Rua Conde Filho, 117, Graça, Salvador, BA, 40150-150, Brazil.
| | - Verena Galvão
- Escola Bahiana de Medicina e Saúde Pública, Av. Dom João VI, 275, Brotas, Salvador, BA, 40290-000, Brazil
| | - Daniel Sá Ribeiro
- Escola Bahiana de Medicina e Saúde Pública, Av. Dom João VI, 275, Brotas, Salvador, BA, 40290-000, Brazil
| | - Willer D Santos
- Escola Bahiana de Medicina e Saúde Pública, Av. Dom João VI, 275, Brotas, Salvador, BA, 40290-000, Brazil
| | - Priscila R da Hora
- Escola Bahiana de Medicina e Saúde Pública, Av. Dom João VI, 275, Brotas, Salvador, BA, 40290-000, Brazil
| | - Anna Paula Mota
- Escola Bahiana de Medicina e Saúde Pública, Av. Dom João VI, 275, Brotas, Salvador, BA, 40290-000, Brazil
| | - Emanuela Pimenta
- Escola Bahiana de Medicina e Saúde Pública, Av. Dom João VI, 275, Brotas, Salvador, BA, 40290-000, Brazil
| | - Isabela Oliveira
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal da Bahia, Salvador, BA, 40000-000, Brazil
| | - Ajax M Atta
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal da Bahia, Salvador, BA, 40000-000, Brazil
| | - Mitermayer G Reis
- Laboratório de Biologia Molecular-Fundação Gonçalo Muniz (Fiocruz), Salvador, BA, 40000-000, Brazil
| | - Eliana A G Reis
- Laboratório de Biologia Molecular-Fundação Gonçalo Muniz (Fiocruz), Salvador, BA, 40000-000, Brazil
| | - Carolina Lins
- Escola Bahiana de Medicina e Saúde Pública, Av. Dom João VI, 275, Brotas, Salvador, BA, 40290-000, Brazil
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Lins CF, Santiago MB. Ultrasound evaluation of joints in systemic lupus erythematosus: a systematic review. Eur Radiol 2015; 25:2688-92. [PMID: 25716942 DOI: 10.1007/s00330-015-3670-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 01/30/2015] [Accepted: 02/13/2015] [Indexed: 12/18/2022]
Abstract
OBJECTIVES The aim of this systematic review is to describe the scientific evidence regarding sonographic findings of joints in SLE patients. METHODS Seven databases were searched (PubMed, ScienceDirect, Scopus, Cochrane, EMBASE, LILACS, and SciELO) for articles from 1950 to January 2015. The keywords used for selecting articles include "lupus", "ultrasound imaging", "ultrasonography", "synovitis", "tenosynovitis", and "arthritis". RESULTS A total of 12 articles were included in the final analysis. In total, 610 SLE patients and 1,091 joints were studied. Most patients underwent bilateral joint examination by US. A total of 888 hands and wrists, 154 ankles/feet, and 56 knees were examined. Effusion was identified in 602 joints, synovitis in 213, tenosynovitis in 210, synovial hypertrophy in 150, and bone erosions in 73 cases. The majority of the studies demonstrated higher frequency of musculoskeletal abnormalities on US than those observed on physical examination. CONCLUSION US seems to be a valuable tool to identify subclinical joint manifestations in SLE. Prospective studies are necessary to determine if those patients with subclinical joint abnormalities have a higher risk for the development of chronic deformities as those seen in Jaccoud's Arthropathy. KEY POINTS • Musculoskeletal involvement occurs in more than 90% of SLE cases. • Arthralgia or tender/swollen joints found on physical examination showed more US findings. • Patients without joint symptoms or physical examinations changes showed musculoskeletal sonographic findings. • US became a useful tool for rheumatologists. • A substantial number of asymptomatic patients show abnormalities at musculoskeletal US.
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Affiliation(s)
- Carolina F Lins
- Escola Bahiana de Medicina e Saúde Pública, Av. Dom João VI, 275, 40290-000, Salvador, Bahia, Brazil
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Cortés-Hernández J, Egri N, Vilardell-Tarrés M, Ordi-Ros J. Etanercept in refractory lupus arthritis: An observational study. Semin Arthritis Rheum 2015; 44:672-9. [PMID: 25712812 DOI: 10.1016/j.semarthrit.2015.01.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 12/22/2014] [Accepted: 01/16/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate the long-term safety and preliminary efficacy of etanercept in patients with refractory lupus arthritis. METHODS We evaluated 43 patients in this observational cohort study. All received etanercept (50mg/week) in addition to concomitant immunosuppressive agents. Patient and disease characteristics were collected. Incidence of adverse events and the effect on autoantibody levels were evaluated. Clinical efficacy was measured by the 28-joint count and the SLEDAI-2K scores. Remission of lupus arthritis was defined by a 28-joint score = 0. Clinically inactive systemic disease was defined by a SLEDAI-2K score <4. RESULTS The total follow-up time was 93 patient-years (median: 2.3 years per patient; range: 0.4-6.8 years). Most side effects were minor and related to local reactions. Only 2 significant adverse events occurred (8%), both were of infectious nature. The rate of autoantibody production was low (18%). A mild increase in titres of ANA (2), IgG anti-dsDNA (3) and IgM anticardiolipin (aCL) (2) antibodies was observed. All anti-dsDNA antibody increments were transient and coincided with systemic flares. No vascular events occurred. In general, disease activity declined during therapy. Most patients (83%) with lupus arthritis achieved clinical remission by week 12. All patients with simultaneous serositis experienced clinical and radiological resolution of this condition. Relapses were frequent (23%), mostly mild and related to etanercept reduction. A total of 24 patients discontinued treatment, 12 of them due to clinical remission. CONCLUSIONS Long-term therapy with etanercept was relatively safe and had remarkable long-term efficacy for refractory lupus arthritis. In view of these results, further controlled trials are warranted.
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Affiliation(s)
- Josefina Cortés-Hernández
- Systemic Autoimmune Diseases Unit, Internal Medicine Department, Universitari Vall d´Hebron Hospital, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Passeig Vall- d´Hebron 119-129, Barcelona 08035, Spain
| | - Natalia Egri
- Systemic Autoimmune Diseases Unit, Internal Medicine Department, Universitari Vall d´Hebron Hospital, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Passeig Vall- d´Hebron 119-129, Barcelona 08035, Spain
| | - Miquel Vilardell-Tarrés
- Systemic Autoimmune Diseases Unit, Internal Medicine Department, Universitari Vall d´Hebron Hospital, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Passeig Vall- d´Hebron 119-129, Barcelona 08035, Spain
| | - Josep Ordi-Ros
- Systemic Autoimmune Diseases Unit, Internal Medicine Department, Universitari Vall d´Hebron Hospital, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Passeig Vall- d´Hebron 119-129, Barcelona 08035, Spain.
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Malcus Johnsson P, Sandqvist G, Nilsson JÅ, Bengtsson AA, Sturfelt G, Nived O. Hand function and performance of daily activities in systemic lupus erythematosus: a clinical study. Lupus 2014; 24:827-34. [PMID: 25542902 DOI: 10.1177/0961203314565690] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 12/03/2014] [Indexed: 11/17/2022]
Abstract
This clinical study was performed to investigate hand problems in individuals with systemic lupus erythematosus (SLE) in comparison with healthy controls, and to explore problems in the performance of daily activities related to these hand problems, in order to objectify findings from a previous mail survey. We also investigated whether a simple hand test could detect hand problems in SLE. All individuals, 71 with SLE and 71 healthy controls, were examined for manifestations in body structures and body functions of the hands with a study-specific protocol. The simple hand test was performed by all the individuals and the arthritis impact measurement scale (AIMS 2) questionnaire was completed by the SLE individuals. In the SLE group, 58% had some kind of difficulty in the simple hand test, compared with 8% in the control group. Fifty percent of the SLE individuals experienced problems in performing daily activities due to hand deficits. Pain in the hands, reduced strength and dexterity, Raynaud's phenomenon and trigger finger were the most prominent body functions affecting the performance of daily activities. Deficits in hand function are common in SLE and affect the performance of daily activities. The simple hand test may be a useful tool in detecting hand problems.
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Affiliation(s)
- P Malcus Johnsson
- Lund University, Department of Clinical Sciences, Rheumatology, Lund, Sweden
| | - G Sandqvist
- Lund University, Department of Clinical Sciences, Rheumatology, Lund, Sweden
| | - J-Å Nilsson
- Lund University, Department of Clinical Sciences, Rheumatology, Lund, Sweden
| | - A A Bengtsson
- Lund University, Department of Clinical Sciences, Rheumatology, Lund, Sweden
| | - G Sturfelt
- Lund University, Department of Clinical Sciences, Rheumatology, Lund, Sweden
| | - O Nived
- Lund University, Department of Clinical Sciences, Rheumatology, Lund, Sweden
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Budhram A, Chu R, Rusta-Sallehy S, Ioannidis G, Denburg JA, Adachi JD, Haaland DA. Anti-cyclic citrullinated peptide antibody as a marker of erosive arthritis in patients with systemic lupus erythematosus: a systematic review and meta-analysis. Lupus 2014; 23:1156-63. [PMID: 24990382 DOI: 10.1177/0961203314540967] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Anti-cyclic citrullinated peptide (CCP) antibody is an established marker in the diagnosis and prognostication of rheumatoid arthritis (RA). Infrequently, systemic lupus erythematosus (SLE) patients also develop a deforming erosive arthritis, similar to that of RA. Our objective was to determine whether anti-CCP antibody is a useful marker of erosive disease in SLE patients presenting with arthritis. METHODS Electronic databases EMBASE, MEDLINE and non-indexed MEDLINE citations were searched through April 11, 2014, using the outlined key terms. Studies meeting predefined inclusion and exclusion criteria were reviewed. Two reviewers independently assessed the quality of included articles using previously described criteria. The DerSimonian-Laird random effects model was used to calculate pooled sensitivity and specificity of anti-CCP antibody for erosive arthritis in SLE. RESULTS Seven articles met inclusion and exclusion criteria. A total of 609 SLE patients with arthritis were identified, 70 of whom had erosive disease. Pooled sensitivity and specificity of anti-CCP antibody for erosive arthritis was 47.8% (95% CI, 26.2%-70.2%) and 91.8% (95% CI, 78.4%-97.2%), respectively. CONCLUSION Our findings suggest that anti-CCP antibody is a highly specific marker for erosive arthritis in SLE. Longitudinal prospective studies are needed to determine if anti-CCP antibody can be used as a predictor of erosive disease.
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Affiliation(s)
- A Budhram
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - R Chu
- Mississauga Academy of Medicine, University of Toronto, Mississauga, Ontario, Canada
| | - S Rusta-Sallehy
- Peters-Boyd Academy, University of Toronto, Toronto, Ontario, Canada
| | - G Ioannidis
- Division of Rheumatology, McMaster University, Hamilton, Ontario, Canada
| | - J A Denburg
- Division of Clinical Immunology & Allergy, McMaster University, Hamilton, Ontario, Canada
| | - J D Adachi
- Division of Rheumatology, McMaster University, Hamilton, Ontario, Canada
| | - D A Haaland
- Division of Rheumatology, McMaster University, Hamilton, Ontario, Canada Division of Clinical Immunology & Allergy, McMaster University, Hamilton, Ontario, Canada
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Atta AM, Oliveira RC, Oliveira IS, Menezes MP, Santos TPS, Sousa Atta MLB, Santiago MB. Higher level of IL-6 in Jaccoud's arthropathy secondary to systemic lupus erythematosus: a perspective for its treatment? Rheumatol Int 2014; 35:167-70. [PMID: 24939558 DOI: 10.1007/s00296-014-3069-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 06/05/2014] [Indexed: 11/24/2022]
Abstract
Jaccoud's arthropathy (JA) is a condition characterized clinically by 'reversible' joint deformities along with an absence of articular erosions on a plain radiograph. The main clinical entity associated with JA is systemic lupus erythematosus (SLE) with a prevalence of around 5 %. The aim of the present study was to compare the inflammatory markers including cytokine levels in blood of SLE patients with and without JA. Patients with diagnosis of SLE as defined by ACR criteria were screened and divided in two groups, one with JA and one control group without JA. Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), complement C3 and C4 levels antinuclear antibodies (ANA), anti-dsDNA antibodies and serum levels of IL-2, IL-6, IL-10, IL-21, IL-22 and TNF-α were determined in all patients. Eighty female patients with SLE, 18 (22.5 %) with JA and 62 (77.5 %) without JA, were included in this study. JA patients had higher disease duration (p = 0.008), ESR (p < 0.001), CRP level (p = 0.002), ANA titer (p < 0.001) and dsDNA antibody level (p = 0.009). The serum levels of IL-2, IL-10, IL-21, IL-22 and TNF-α were not significantly different between the two groups (p > 0.05), but the level of IL-6 was higher in JA group (p < 0.001). The serum level of IL-6 might have a correlation with JA secondary to SLE.
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Affiliation(s)
- Ajax Mercês Atta
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal da Bahia, Salvador, Bahia, Brazil
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Abstract
Systemic lupus erythematosus is a prototypic but heterogeneous autoimmune disease. The major clinical symptoms and signs are reviewed, as well as the main immunological abnormalities. Emphasis is put on the role of long-lived autoimmune plasma cells, not affected by current immunosuppressants and biologics, which are responsible for refractoriness and relapses.
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Affiliation(s)
- Falk Hiepe
- Charité-Universitätsmedizin Berlin, Department of Rheumatology and Clinical Immunology; German Rheumatism Research Center - a Leibniz Institute, Charitéplatz 1, 10117 Berlin, Germany.
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Oishi H, Oda R, Morisaki S, Fujiwara H, Tokunaga D, Kubo T. Spontaneous tendon rupture of the extensor digitrum communis in systemic lupus erythematosus. Mod Rheumatol 2014. [DOI: 10.3109/s10165-012-0701-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kitaori T, Ito H, Yoshitomi H, Aoyama T, Fujii T, Mimori T, Nakamura T. Severe erosive arthropathy requiring surgical treatments in systemic lupus erythematosus. Mod Rheumatol 2014. [DOI: 10.3109/s10165-009-0171-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Jaccoud's arthropathy: proper classification criteria and treatment are still needed. Rheumatol Int 2012; 33:2953-4. [PMID: 22948542 DOI: 10.1007/s00296-012-2526-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Accepted: 08/23/2012] [Indexed: 10/27/2022]
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Spontaneous tendon rupture of the extensor digitrum communis in systemic lupus erythematosus. Mod Rheumatol 2012; 23:608-10. [PMID: 22782531 DOI: 10.1007/s10165-012-0701-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Accepted: 06/01/2012] [Indexed: 10/28/2022]
Abstract
We present a rare case of spontaneous tendon rupture of the extensor digitorum communis (EDC) in a patient with systemic lupus erythematosus (SLE). Inflammation in SLE presents as periarthritis, which may develop into Jaccoud's arthropathy. We bridged the ruptured tendon of the EDC (III) at the metacarpophalangeal (MP) joint of this patient with a tendon graft. This case demonstrates that this portion of the MP joint can be a site of tendon rupture of fingers in SLE patients.
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L. Skare T, Lima Godoi AD, O. Ferreira V. Jaccoud arthropathy in systemic lupus erythematosus: clinical and serological findings. Rev Assoc Med Bras (1992) 2012. [DOI: 10.1590/s0104-42302012000400022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Skare TL, Lima Godoi AD, Ferreira VO. Jaccoud arthropathy in systemic lupus erythematosus: clinical and serological findings. Rev Assoc Med Bras (1992) 2012. [DOI: 10.1016/s0104-4230(12)70234-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Lima I, Ribeiro DS, Cesare A, Machado WG, Santiago MB. Typical Jaccoud's arthropathy in a patient with sarcoidosis. Rheumatol Int 2011; 33:1615-7. [PMID: 22198663 DOI: 10.1007/s00296-011-2318-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Accepted: 12/10/2011] [Indexed: 10/14/2022]
Abstract
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.
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Affiliation(s)
- Isabella Lima
- Escola Bahiana de Medicina e Saúde Pública, Rua Frei Henrique, 08, Nazaré, Salvador, Bahia 40000-000, Brazil
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Ball EMA, Bell AL. Lupus arthritis--do we have a clinically useful classification? Rheumatology (Oxford) 2011; 51:771-9. [PMID: 22179731 DOI: 10.1093/rheumatology/ker381] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Joint disease in SLE is common and has a significant impact on patients in terms of their burden of disease and quality of life. Despite this it remains largely understudied in comparison with the other inflammatory arthropathies. Newer imaging techniques are challenging the traditional concepts of a non-erosive arthropathy that is outlined in the ACR diagnostic criteria for SLE. MRI and musculoskeletal US techniques have been applied extensively in RA to detail the underlying joint pathology, to monitor response to treatment and to guide prognosis. The advent of biological therapies has revolutionized the treatment of RA and has again been borne out of an abundance of research that exists surrounding the underlying pathobiological inflammatory pathways. Unfortunately, no such unified body of evidence exists for lupus arthritis, which has made the development of an appropriate classification system somewhat difficult as our understanding remains incomplete.
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Affiliation(s)
- Elisabeth M A Ball
- Rheumatology Department, Musgrave Park Hospital, Stockman's Lane, Belfast BT9 7JB, Northern Ireland.
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Jaccoud’s arthropathy. Best Pract Res Clin Rheumatol 2011; 25:715-25. [DOI: 10.1016/j.berh.2011.10.018] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Accepted: 10/13/2011] [Indexed: 11/20/2022]
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Eilertsen GØ, Nikolaisen C, Becker-Merok A, Nossent JC. Interleukin-6 promotes arthritis and joint deformation in patients with systemic lupus erythematosus. Lupus 2011; 20:607-13. [DOI: 10.1177/0961203310392432] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The underlying mechanisms for the subsets of self-limiting, intermittent or chronic and deforming arthritis in systemic lupus erythematosus (SLE) are not well understood. We performed a cross-sectional analysis of pro-inflammatory cytokines (IL-1β, IL-2, IL-6, IL-8 and TNF-α) and joint status in 47 SLE patients (79% females, age 42 years, disease duration 8.6 years). All cytokines levels were significantly elevated in SLE patients compared with controls, but only IL-2 and IL-8 levels were higher than in patients with rheumatoid arthritis. SLE patients with ongoing synovitis (19%) and joint deformities (11%) had increased erythrocyte sedimentation rate (ESR), IL-6 and anti-dsDNA Ab levels. IL-6 levels correlated with ESR, anti-dsDNA Ab and haemoglobin, but not with C-reactive protein levels. Arthritis constitutes a considerable burden of disease in SLE over time, and joint deformations are associated with longstanding disease and arthritis flare rates. IL-6 is a potential biomarker and therapeutic target in the prevention of joint damage in SLE arthritis.
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Affiliation(s)
- GØ Eilertsen
- Department of Rheumatology, Institute of Clinical Medicine, University of Tromsø, Norway
| | - C Nikolaisen
- Department of Rheumatology, Institute of Clinical Medicine, University of Tromsø, Norway
| | - A Becker-Merok
- Department of Rheumatology, Institute of Clinical Medicine, University of Tromsø, Norway
| | - JC Nossent
- Department of Rheumatology, Institute of Clinical Medicine, University of Tromsø, Norway
- Department of Rheumatology, University Hospital Northern Norway, Tromsø, Norway
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Ribeiro DS, Araújo Neto CD, D'Almeida F, Galvão VL, Santiago MB. Achados de imagem das alterações musculoesqueléticas associadas ao lúpus eritematoso sistêmico. Radiol Bras 2011. [DOI: 10.1590/s0100-39842011000100013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
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.
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Affiliation(s)
- Daniel Sá Ribeiro
- Hospital Santa Izabel; Escola Bahiana de Medicina e Saúde Pública, Brasil
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