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Reis-Neto ETD, Monticielo OA, Daher M, Lopes F, Angrimani D, Klumb EM. Life expectancy and death pattern associated with systemic lupus erythematosus diagnosis in Brazil between 2000 and 2019. Lupus 2024; 33:536-542. [PMID: 38414428 DOI: 10.1177/09612033241236383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
OBJECTIVES to evaluate the main factors associated with mortality and determine the life expectancy of SLE patients between 2000 and 2019 years in Brazil. METHODS death data related to SLE available in the Brazilian Unified Health System (SUS) (DATASUS) were evaluated in all Brazilian states. Three groups of death causes potentially associated from SLE were evaluated: cardiovascular and kidney diseases and infections. RESULTS The main causes of death associated with SLE were infection and kidney disease. Most SLE patients died between 19 and 50 years of age. Deaths associated with kidney disease were proportionally higher than in the general population with progressive decrease during the period. Instead, there have been an increase in the proportion of deaths due to infections both in SLE and in the general population. CONCLUSIONS SLE patients presented higher mortality compared to the general population matched for sex and age and the main causes associated with death were infection and kidney disease. Public health policies that promote early diagnosis, treatment and prevention of damage are necessary to reduce morbidity and mortality in SLE patients.
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Affiliation(s)
- Edgard Torres Dos Reis-Neto
- Division of Rheumatology, Department of Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM / Unifesp), São Paulo, Brazil
| | - Odirlei Andre Monticielo
- Division of Rheumatology, Department of Internal Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil
| | | | | | | | - Evandro Mendes Klumb
- Department of Rheumatology, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
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Radin M, Cecchi I, Crisafulli F, Klumb EM, de Jesús GR, Lacerda MI, Saavedra MÁ, Reyes-Navarro GV, Iaccarino L, Larosa M, Moroni G, Tamborini F, Roccatello D, Andreoli L, Sciascia S, Chighizola CB. Complement levels during the first trimester predict disease flare and adverse pregnancy outcomes in systemic lupus erythematosus: A network meta-analysis on 532 pregnancies. Autoimmun Rev 2023; 22:103467. [PMID: 37852515 DOI: 10.1016/j.autrev.2023.103467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 10/15/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Complement levels have been proposed as candidate biomarkers of disease activity and obstetric risk in systemic lupus erythematosus (SLE) pregnancies, but their reliability has been questioned due to the physiologic fluctuations of complement during gestation. Thus, this network meta-analysis aimed at assessing the clinical significance of complement fluctuations in lupus pregnant women. METHODS Corresponding authors of 19 studies meeting inclusion criteria were invited to contribute with additional data including C3 and C4 levels [before pregnancy, at conception, in every trimester (T) and 3 months after delivery]; data were pooled together in a network meta-analysis. RESULTS A total of 532 lupus women from four studies were included in the analysis. In SLE women, C3 and C4 increased progressively during gestation: levels remained stable during T1 and peaked in T2 to decrease in T3. Patients with previous lupus nephritis (LN) and those who experienced flares during pregnancy had significantly lower mean levels of C3 and C4 at all timepoints. The lowest levels of complement were observed, particularly during T1, in patients with LN and gestational flare. Both reduction and the lack of increase of C3 and C4 levels at T1 versus conception were associated with gestational flares, particularly in LN patients. Pregnancies with flare had a statistically significant higher rate of maternal and fetal complications(60% versus 50.3%; p = 0.03). CONCLUSIONS Low complement levels, particularly in T1, were associated with a higher frequency of gestational flare. Either reduction or smaller increase of C3 and/or C4 levels, even within normal range, might predict flares especially in early gestation.
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Affiliation(s)
- Massimo Radin
- University Center of Excellence on Nephrologic, Rheumatologic and Rare Diseases (ERK-Net, ERN-Reconnect and RITA-ERN Member) with Nephrology and Dialysis Unit and Center of Immuno-Rheumatology and Rare Diseases (CMID), Coordinating Center of the Interregional Network for Rare Diseases of Piedmont and Aosta Valley, San Giovanni Bosco Hub Hospital, Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Irene Cecchi
- University Center of Excellence on Nephrologic, Rheumatologic and Rare Diseases (ERK-Net, ERN-Reconnect and RITA-ERN Member) with Nephrology and Dialysis Unit and Center of Immuno-Rheumatology and Rare Diseases (CMID), Coordinating Center of the Interregional Network for Rare Diseases of Piedmont and Aosta Valley, San Giovanni Bosco Hub Hospital, Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Francesca Crisafulli
- Rheumatology and Clinical Immunology Unit, Department of Clinical and Experimental Sciences, ASST SpedaliCivili of Brescia, University of Brescia, Brescia, Italy
| | - Evandro Mendes Klumb
- Department of Rheumatology, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - Miguel Ángel Saavedra
- RheumatologyDepartment, Hospital de Especialidades Dr. Antonio Fraga Mouret, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | | | - Luca Iaccarino
- Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Maddalena Larosa
- Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy; Division of Rheumatology, Department of Locomotor System, ASL3, Genoa, Italy
| | - Gabriella Moroni
- Department of Biomedical Sciences, Humanitas University, 20089 Rozzano, Italy; IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | | | - Dario Roccatello
- University Center of Excellence on Nephrologic, Rheumatologic and Rare Diseases (ERK-Net, ERN-Reconnect and RITA-ERN Member) with Nephrology and Dialysis Unit and Center of Immuno-Rheumatology and Rare Diseases (CMID), Coordinating Center of the Interregional Network for Rare Diseases of Piedmont and Aosta Valley, San Giovanni Bosco Hub Hospital, Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Laura Andreoli
- Rheumatology and Clinical Immunology Unit, Department of Clinical and Experimental Sciences, ASST SpedaliCivili of Brescia, University of Brescia, Brescia, Italy
| | - Savino Sciascia
- University Center of Excellence on Nephrologic, Rheumatologic and Rare Diseases (ERK-Net, ERN-Reconnect and RITA-ERN Member) with Nephrology and Dialysis Unit and Center of Immuno-Rheumatology and Rare Diseases (CMID), Coordinating Center of the Interregional Network for Rare Diseases of Piedmont and Aosta Valley, San Giovanni Bosco Hub Hospital, Department of Clinical and Biological Sciences, University of Turin, Turin, Italy.
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Cintra FRE, Araújo LM, Dib MI, Brollo LCS, Klumb EM. Cervical Cancer Screening Is a Highly Neglected Procedure Among Women With Systemic Lupus Erythematosus. J Rheumatol 2023; 50:1199-1200. [PMID: 37003603 DOI: 10.3899/jrheum.230082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
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Macedo JMB, Silva AL, Pinto AC, Landeira LFL, Portari EA, Santos-Rebouças CB, Klumb EM. TP53 and p21 (CDKN1A) polymorphisms and the risk of systemic lupus erythematosus. Adv Rheumatol 2023; 63:43. [PMID: 37605254 DOI: 10.1186/s42358-023-00320-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 08/03/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND The p53 and p21 proteins are important regulators of cell cycle and apoptosis and may contribute to autoimmune diseases, such as systemic lupus erythematosus (SLE). As genetic polymorphisms may cause changes in protein levels and functions, we investigated associations of TP53 and p21 (CDKN1A) polymorphisms (p53 72 G > C-rs1042522; p53 PIN3-rs17878362; p21 31 C > A-rs1801270; p21 70 C > T-rs1059234) with the development of systemic lupus erythematosus (SLE) in a Southeastern Brazilian population. METHODS Genotyping of 353 female volunteers (cases, n = 145; controls, n = 208) was performed by polymerase chain reaction, restriction fragment length polymorphism and/or DNA sequencing. Associations between TP53 and p21 polymorphisms and SLE susceptibility and clinical manifestations of SLE patients were assessed by logistic regression analysis. RESULTS Protective effect was observed for the genotype combinations p53 PIN3 A1/A1-p21 31 C/A, in the total study population (OR 0.45), and p53 PIN3 A1/A2-p21 31 C/C, in non-white women (OR 0.28). In Whites, p53 72 C-containing (OR 3.06) and p53 PIN3 A2-containing (OR 6.93) genotypes were associated with SLE risk, and higher OR value was observed for the combined genotype p53 72 G/C-p53 PIN3 A1/A2 (OR 9.00). Further, p53 PIN3 A1/A2 genotype was associated with serositis (OR 2.82), while p53 PIN3 A2/A2 and p53 72 C/C genotypes were associated with neurological disorders (OR 4.69 and OR 3.34, respectively). CONCLUSIONS Our findings showed that the TP53 and p21 polymorphisms included in this study may have potential to emerge as SLE susceptibility markers for specific groups of patients. Significant interactions of the TP53 polymorphisms with serositis and neurological disorders were also observed in SLE patients.
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Affiliation(s)
| | - Amanda Lima Silva
- Department of Biochemistry, State University of Rio de Janeiro - UERJ, Rio de Janeiro, Brazil
| | - Amanda Chaves Pinto
- Department of Biochemistry, State University of Rio de Janeiro - UERJ, Rio de Janeiro, Brazil
| | | | - Elyzabeth Avvad Portari
- Department of Pathological Anatomy, State University of Rio de Janeiro - UERJ, Rio de Janeiro, Brazil
- Department of Pathology, Fernandes Figueira Institute - FIOCRUZ, Rio de Janeiro, Brazil
| | | | - Evandro Mendes Klumb
- Department of Rheumatology, Pedro Ernesto University Hospital, State University of Rio de Janeiro - UERJ, Boulevard 28 de Setembro, 87, Vila Isabel, Rio de Janeiro, RJ, CEP 20551-030, Brazil.
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Rezende RPVD, Oliveira-Santos M, Andrade LEC, Klumb EM. Combined 13-valent pneumococcal conjugate and 23-valent pneumococcal polysaccharide vaccine regimens for adults with systemic lupus erythematosus: Does the sequence of pneumococcal vaccination affect immunogenicity responses? A single-center cohort study in Brazil. Lupus 2023; 32:694-703. [PMID: 36705619 DOI: 10.1177/09612033231153535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE A combination of 13-valent pneumococcal conjugate vaccine (PCV13) and 23-valent pneumococcal polysaccharide vaccine (PPSV23) is currently recommended for adults with systemic lupus erythematosus (SLE). However, data on the immunogenicity elicited by sequential pneumococcal vaccination in this patient population are scarce. In this study, we compared short-term antibody responses to both PCV13/PPSV23 (≥8-week interval) and PPSV23/PCV13 (≥12-month interval) vaccination strategies in pneumococcal vaccine-naive adults with SLE. METHODS This longitudinal, open-label, quasi-randomized study was performed in a single-center cohort of adults (18 years or older) with SLE. In both vaccination groups, blood samples were collected immediately before administering the first dose of the pneumococcal vaccine (timepoint T0), 4-6 weeks after the priming dose (T1), and 4-6 weeks after the booster dose (T2). We focused on the 12 shared serotypes between PCV13 and PPSV23, and compared the following immunogenicity outcomes between the groups at T2: anti-pneumococcal antibody geometric mean concentration (ApAb GMC), fold increase in ApAb levels (FI-ApAb), overall seroprotection rate, and overall seroconversion rate. The protective level for each pneumococcal serotype was set at 1.3 μg/mL. We used the multi-analyte immunodetection method to determine serum levels of ApAbs. RESULTS Thirty-four patients with SLE were screened between April 2019 and January 2020, and 16 of them (mean age: 39.4 years, 87.5% female, and 100% on immunosuppressants) had evaluable immunogenicity results at T2. The median time elapsed between the pneumococcal vaccinations was 56 days in the PCV13/PPSV23 group (n = 11 patients) and 16 months in the PPSV23/PCV13 group (n = 5 patients). Priming with PCV13 (PCV13/PPSV23 group), as opposed to PPSV23 (PPSV23/PCV13 group), yielded significantly better results regarding FI-ApAb, overall seroconversion rate, and overall seroprotection rate 4-6 weeks after each pneumococcal vaccination. A trend toward augmented ApAb GMC in the patients who received the PCV13/PPSV23 sequence was also observed. No relevant safety issues were identified with sequential pneumococcal vaccination. CONCLUSION The PCV13-priming PPSV23-boost strategy in adults with SLE induced greater antibody responses for most immunogenicity outcomes than those elicited by the PPSV23/PCV13 strategy.
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Affiliation(s)
| | - Marise Oliveira-Santos
- Department of Rheumatology, Hospital Universitário Pedro Ernesto, 28130Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Luís Eduardo Coelho Andrade
- Immunology Division, 504998Fleury Medicine and Health Laboratories, São Paulo, Brazil.,Rheumatology Division, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Evandro Mendes Klumb
- Department of Rheumatology, Hospital Universitário Pedro Ernesto, 28130Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
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Calderaro DC, Teodoro MLM, Basualto S, Borges AR, Lopes JVZ, Araújo NC, Mariz HDA, Valadares LDDA, Ribeiro SLE, Kahlow BS, Gomes KWP, Munhoz GA, Ferreira GA, Kakehasi AM, Pileggi GS, Bica B, Brito DCSE, Gomides APM, Klumb EM, Paiva EDS, Provenza JR, Reis-Neto E, Souza VAD, Valim V, Pinheiro MDM. Participating as a research team during the COVID-19 pandemic benefits mental health of undergraduate medical students in Brazil. PSYCHOL HEALTH MED 2022:1-9. [DOI: 10.1080/13548506.2022.2141280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | | | - Samuel Basualto
- Medical School, Universidade Federal Do Amazonas, Manaus (AM), Brazil
| | | | | | - Nafice Costa Araújo
- Rheumatology Service, Hospital do Servidor Público Estadual de São Paulo, São Paulo (SP), Brazil
| | | | | | | | - Bárbara Stadler Kahlow
- Rheumatology Service, Hospital Universitário Evangélico Mackenzie, Curitiba (PR), Brazil
| | | | - Gabriela Araújo Munhoz
- Rheumatology Service, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo (SP), Brazil
| | - Gilda Aparecida Ferreira
- Locomotor Apparatus Department, Universidade Federal de Minas Gerais, Belo Horizonte (MG), Brazil
| | - Adriana Maria Kakehasi
- Locomotor Apparatus Department, Universidade Federal de Minas Gerais, Belo Horizonte (MG), Brazil
| | | | - Blanca Bica
- Rheumatology Service, Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ), Brazil
| | | | | | - Evandro Mendes Klumb
- Rheumatology Service, Universidade do Estado do Rio de Janeiro, Rio de Janeiro (RJ), Brazil
| | | | - José Roberto Provenza
- Rheumatology Service, Pontifícia Universidade Católica de Campinas, Campinas (SP), Brazil
| | - Edgard Reis-Neto
- Rheumatology Service, Universidade Federal de São Paulo, São Paulo (SP), Brazil
| | | | - Valeria Valim
- Rheumatology Service, Universidade Federal Do Espírito Santo, Vitória (ES), Brazil
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Valviesse DMDJ, Monteiro DLM, Jésus NRD, Jésus GRRD, Santos FC, Lacerda MI, Rodrigues NCP, Klumb EM. Risk factors associated with infections in pregnant women with systemic lupus erythematosus. Rev Assoc Med Bras (1992) 2022; 68:536-541. [DOI: 10.1590/1806-9282.20220074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 01/25/2022] [Indexed: 11/21/2022] Open
Affiliation(s)
| | | | - Nilson Ramires de Jésus
- Universidade do Estado do Rio de Janeiro, Brazil; Universidade Federal do Rio de Janeiro, Brazil
| | | | - Flavia Cunha Santos
- Universidade do Estado do Rio de Janeiro, Brazil; Universidade Federal do Rio de Janeiro, Brazil
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Dos Santos FC, Ignacchiti ML, Rodrigues B, Velarde LG, Levy RA, de Jesús GR, de Jesús NR, de Andrade CAF, Klumb EM. Premature rupture of membranes - A cause of foetal complications among lupus: A cohort study, systematic review and meta-analysis. Lupus 2021; 30:2042-2053. [PMID: 34806483 DOI: 10.1177/09612033211045056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The present study aimed to analyse the frequency of premature rupture of membranes (PROMs) among 190 women with systemic lupus erythematosus (SLE) followed up at the Hospital Universitário Pedro Ernesto from 2011 to 2018 and to review the literature on PROM in patients with SLE. METHODS A cohort study of SLE patients was conducted by analysing the following variables: sociodemographic characteristics, clinical manifestations of lupus, modified disease activity index for pregnancy, drugs used during pregnancy, intercurrent maternal infections and obstetric outcomes. Additionally, seven electronic databases (PubMed, Embase, Cochrane, Scielo, Scielo Brazil, Virtual Health Library Regional Portal and Google Scholar) were systematically searched. The search was updated on 3 February 2020. RESULTS Infections (relative risk (RR): 3.26, 95% confidence interval (CI): 1.5-6.7, p = .001), history of serositis (RR: 2.59, 95% CI: 1.31-5.11, p = .006) and anti-RNP positivity (RR: 3.08, 95% CI: 1.39-6.78, p = .005) were associated risk factors for PROM, while anti-RNP positivity (RR: 3.37, 95% CI: 1.35-8.40; p = .009) were associated with premature PROM (PPROM). The prevalence of PROM and PPROM was 28.7% and 12.9%, respectively. In the systematic review, the prevalence of PROM and PPROM was 2.7%-35% (I2 = 87.62%) and 2.8%-20% (I2 = 79.56%), respectively. CONCLUSIONS PROM, both at term and preterm, occurs more frequently in women with lupus than in the general population. A history of serositis, anti-RN, infections and immunosuppression during pregnancy may increase the susceptibility to PROM. The systematic review did not find any study with the main objective of evaluating PROM/PPROM in women with lupus.
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Affiliation(s)
- Flávia Cunha Dos Santos
- Department of Obstetrics, 28130Universidade do Estado do Rio de Janeiro. Rio de Janeiro, RJ, Brazil
| | | | - Bruna Rodrigues
- Department of Rheumatology, 28130Universidade do Estado Rio de Janeiro. Rio de Janeiro, RJ, Brazil
| | - Luis Guillermo Velarde
- Postgraduate Program in Medical Sciences, 28110Universidade Federal Fluminense, Niterói, RJ, Brazil
| | - Roger Abramino Levy
- Department of Rheumatology, 28130Universidade do Estado Rio de Janeiro. Rio de Janeiro, RJ, Brazil
| | | | - Nilson Ramires de Jesús
- Department of Obstetrics, 28130Universidade do Estado do Rio de Janeiro. Rio de Janeiro, RJ, Brazil
| | - Carlos Augusto Ferreira de Andrade
- Department of Epidemiology, Quantitative Methods in Health, 42499Escola Nacional de Saúde Pública Sérgio Arouca, Fiocruz, Rio de Janeiro, RJ, Brazil
| | - Evandro Mendes Klumb
- Department of Rheumatology, 28130Universidade do Estado Rio de Janeiro. Rio de Janeiro, RJ, Brazil
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Lacerda MI, de Jesús GRR, Dos Santos FC, de Jesús NR, Levy RA, Klumb EM. The SLICC/ACR Damage Index (SDI) may predict adverse obstetric events in patients with systemic lupus erythematosus. Lupus 2021; 30:1966-1972. [PMID: 34530654 DOI: 10.1177/09612033211045061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the potential impact of irreversible damage accrual in women with systemic lupus erythematosus (SLE) and adverse maternal and/or fetal/neonatal outcomes. METHODS Retrospective cohort study with SLE pregnant patients was carried out from January 2011 to January 2020 at the Hospital University Pedro Ernesto (HUPE) of the State University of Rio de Janeiro, Brazil. Irreversible damage was defined according to SLICC/ACR damage index (SDI). The association of SDI on pregnancy outcomes was established by univariate and multivariate regression models and included demographic and clinical variables. RESULTS This study included data from 260 patients in their first pregnancies after SLE diagnosis, with a quarter of them (67/260) scoring one or more points on SDI at the beginning of prenatal care. These patients presented more frequently adverse maternal events, namely, disease activity during pregnancy (p = 0.004) and puerperium (p = 0.001), active lupus nephritis (p = 0.04), and hospitalizations (p = 0.004), than those with no SDI score. Similarly, the risks of adverse fetal and neonatal outcomes were also higher among the patients with SDI ≥ 1 (59.7% vs 38.3% p = 0.001) even after controlling data for disease activity (SLEPDAI > 4). Patients with SDI ≥ 1 presented more frequently preterm deliveries (46.3% vs 31.6%; p = 0.01), small for gestational age infants (28.3% vs 18.1%; p = 0.04), and neonatal intensive care unit admission (26.9% vs 1.5%; p < 0.001). The multivariate analyses showed that SDI ≥ 1 is an independent risk factor for hospitalization due to obstetric complications (p = 0.0008) and preterm delivery (p = 0.009). CONCLUSION Pregnant SLE patients who present irreversible damage accrual may have higher risk of maternal and fetal adverse outcomes, independently of disease activity. These results should be validated in further prospective studies.
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Affiliation(s)
| | - Guilherme Ribeiro Ramires de Jesús
- 28130Departments of Obstetrics and Rheumatology of the State University of Rio de Janeiro, Rio de Janeiro, Brazil.,Department of Obstetrics, Instituto Fernandes Figueira - FIOCRUZ, Rio de Janeiro, Brazil
| | - Flávia Cunha Dos Santos
- 28130Departments of Obstetrics and Rheumatology of the State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Nilson Ramires de Jesús
- 28130Departments of Obstetrics and Rheumatology of the State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Evandro Mendes Klumb
- Rheumatology, 199987Hospital Universitario Pedro Ernesto, Rio de Janeiro, Brazil
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10
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Klumb EM, Scheinberg M, de Souza VA, Xavier RM, Azevedo VF, McElwee E, Restrepo MR, Monticielo OA. The landscape of systemic lupus erythematosus in Brazil: An expert panel review and recommendations. Lupus 2021; 30:1684-1695. [PMID: 34255586 PMCID: PMC8489682 DOI: 10.1177/09612033211030008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 06/09/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE The objective of this review is to address the barriers limiting access to diagnosis and treatment of systemic lupus erythematosus (SLE) and lupus nephritis (LN) in Brazil, specifically for patients in the public healthcare system, arguably those with the least access to innovation. DESIGN A selected panel of Brazilian experts in SLE/LN were provided with a series of relevant questions to address in a multi-day conference. During the conference, responses were discussed and edited by the entire group through numerous drafts and rounds of discussion until a consensus was achieved. RESULTS The authors propose specific and realistic recommendations for implementing access to innovative diagnostic tools and treatment alternatives for SLE/LN in Brazil. Moreover, in creating these recommendations, the authors strived to address barriers and impediments for technology adoption. The multidisciplinary care required for SLE/LN necessitates the collective participation of all involved stakeholders. CONCLUSION A great need exists to expand the adoption of innovative diagnostic tools and treatments for SLE/LN not only in Brazil but also in most countries, as access issues remain an urgent demand. The recommendations presented in this article can serve as a strategy for new technology adoption in other countries in a similar situation.
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Affiliation(s)
- Evandro Mendes Klumb
- Rheumatology Department, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
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Ignacchiti Lacerda M, Costa Rodrigues B, Ramires de Jesús G, Cunha Dos Santos F, Ramires de Jesús N, Levy RA, Mendes Klumb E. The association between active proliferative lupus nephritis during pregnancy and small for gestational age newborns. Clin Exp Rheumatol 2021; 39:1043-1048. [DOI: 10.55563/clinexprheumatol/xspect] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 09/07/2020] [Indexed: 11/13/2022]
Affiliation(s)
| | | | | | | | | | - Roger A. Levy
- GlaxoSmithKline Immunology and Inflammation Upper Providence, PA, USA
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12
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Rezende RPVD, Cardoso-Marques NT, Rodrigues LAS, Almeida JPCLD, Pillegi GS, Teixeira LM, Klumb EM, Neves FPG. Carriage prevalence, serotype distribution, and antimicrobial susceptibility among pneumococcal isolates recovered from adults with systemic lupus erythematosus. Lupus 2021; 30:1863-1865. [PMID: 34225521 DOI: 10.1177/09612033211030549] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Nayara Torres Cardoso-Marques
- Departamento de Microbiologia e Parasitologia, Instituto Biomédico, Universidade Federal Fluminense, Niterói, Brazil
| | | | | | | | - Lúcia Martins Teixeira
- Departamento de Microbiologia Médica, Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Evandro Mendes Klumb
- Departamento de Reumatologia, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
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Lopes-Souza P, Dionello CF, Bernardes-Oliveira CL, Moreira-Marconi E, Marchon RM, Teixeira-Silva Y, Paineiras-Domingos LL, da Cunha Sá-Caputo D, Xavier VL, Bergmann A, Klumb EM, Bernardo-Filho M. Effects of 12-week whole-body vibration exercise on fatigue, functional ability and quality of life in women with systemic lupus erythematosus: A randomized controlled trial. J Bodyw Mov Ther 2021; 27:191-199. [PMID: 34391233 DOI: 10.1016/j.jbmt.2021.01.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 12/28/2020] [Accepted: 01/23/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) is a complex rheumatic autoimmune disease characterized by periods of exacerbations that can present damage in organs with important clinical manifestations. OBJECTIVE The aim of this study was to evaluate the effect of 12-week whole-body vibration exercise (WBVE) on the fatigue, functional ability and quality of life of women with systemic lupus erythematosus (SLE) in chronic glucocorticoids use (CGU). METHODS Twenty-one women were allocated randomly in the WBVE group or isometry group. The participants of WBVE group were positioned on the vibrating platform with 130° knee flexion and received the intervention twice a week for 12 weeks. The isometry group performed the same position and time, but without the stimulus of mechanical vibration. Fatigue, functional ability and the quality of life were evaluated at weeks 0, 6, and 12. RESULTS From a sample of seventy-seven individuals, seventeen participants completed the study, 8 in WBVE group and 9 in isometry group. Fatigue reduced in the WBVE group at 6 and 12 weeks of intervention (p = 0.04) and (p = 0.03) respectively. There was a significant improvement in the functional ability evaluated by the Health Assessment Questionnaire in the WBVE group compared to the isometry group (p = 0.03). CONCLUSION WBVE would be a useful intervention for control of fatigue and improvement of the functional ability of women with SLE in CGU.
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Affiliation(s)
- Patrícia Lopes-Souza
- Laboratório de Vibrações Mecânicas e Práticas Integrativas, Departamento de Biofísica e Biometria, Instituto de Biologia Roberto Alcântara Gomes, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil; Programa de Pós-Graduação em Ciências Médicas, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ Brazil.
| | - Carla Fontoura Dionello
- Laboratório de Vibrações Mecânicas e Práticas Integrativas, Departamento de Biofísica e Biometria, Instituto de Biologia Roberto Alcântara Gomes, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil; Programa de Pós-Graduação em Ciências Médicas, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ Brazil.
| | - Camila Leite Bernardes-Oliveira
- Laboratório de Vibrações Mecânicas e Práticas Integrativas, Departamento de Biofísica e Biometria, Instituto de Biologia Roberto Alcântara Gomes, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil; Programa de Pós-Graduação em Ciências Médicas, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ Brazil.
| | - Eloá Moreira-Marconi
- Laboratório de Vibrações Mecânicas e Práticas Integrativas, Departamento de Biofísica e Biometria, Instituto de Biologia Roberto Alcântara Gomes, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil; Programa de Pós-Graduação em Fisiopatologia Clínica e Experimental, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
| | - Renata Marques Marchon
- Laboratório de Vibrações Mecânicas e Práticas Integrativas, Departamento de Biofísica e Biometria, Instituto de Biologia Roberto Alcântara Gomes, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil; Mestrado Profissional em Saúde, Medicina Laboratorial e Tecnologia Forense, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
| | - Ygor Teixeira-Silva
- Laboratório de Vibrações Mecânicas e Práticas Integrativas, Departamento de Biofísica e Biometria, Instituto de Biologia Roberto Alcântara Gomes, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil; Programa de Pós-Graduação em Ciências Médicas, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ Brazil.
| | - Laisa Liane Paineiras-Domingos
- Laboratório de Vibrações Mecânicas e Práticas Integrativas, Departamento de Biofísica e Biometria, Instituto de Biologia Roberto Alcântara Gomes, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil; Programa de Pós-Graduação em Ciências Médicas, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ Brazil; Faculdade Bezerra de Araújo, Rio de Janeiro, RJ, Brazil.
| | - Danúbia da Cunha Sá-Caputo
- Laboratório de Vibrações Mecânicas e Práticas Integrativas, Departamento de Biofísica e Biometria, Instituto de Biologia Roberto Alcântara Gomes, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil; Programa de Pós-Graduação em Ciências Médicas, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ Brazil; Faculdade Bezerra de Araújo, Rio de Janeiro, RJ, Brazil.
| | - Vinicius Layter Xavier
- Departamento de Estatística, Instituto de Matemática e Estatística, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Anke Bergmann
- Programa de Epidemiologia Clínica, Instituto Nacional de Câncer (INCA), Brazil.
| | - Evandro Mendes Klumb
- Programa de Pós-Graduação em Ciências Médicas, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ Brazil; Departamento de Reumatologia do Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
| | - Mario Bernardo-Filho
- Laboratório de Vibrações Mecânicas e Práticas Integrativas, Departamento de Biofísica e Biometria, Instituto de Biologia Roberto Alcântara Gomes, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
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de Rezende RPV, Klumb EM, Pileggi GS. Correction to: Mortality burden associated with all-cause pneumonia among adults with autoimmune inflammatory rheumatic diseases, human immunodeficiency virus infection, and malignancies: a population-based comparative study for informed decision-making in public health policies. Clin Rheumatol 2020; 39:2843-2844. [DOI: 10.1007/s10067-020-05298-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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15
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Oliveira-Santos M, Verani JFS, Camacho LAB, de Andrade CAF, Klumb EM. Effectiveness of pharmaceutical care for drug treatment adherence in women with lupus nephritis in Rio de Janeiro, Brazil: a randomized controlled trial. Lupus 2019; 28:1368-1377. [DOI: 10.1177/0961203319877237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective Studies have been conducted to determine the causal factors and clinical consequences of non-adherence to treatment in systemic lupus erythematosus (SLE). However, no interventions have been performed to increase drug adherence. Our objective was to assess the effectiveness of pharmaceutical care (PC) for drug treatment adherence in lupus nephritis (LN). Methods This was a randomized clinical trial (pragmatic trial) in patients with LN in Rio de Janeiro, Brazil, allocated in two groups: an intervention group (Dader Method for PC) and a control group (institution's usual care). Drug treatment adherence was measured by the combination of five questions normally used in clinical practice. Results A total of 131 patients were randomized, and 122 completed the study, with a mean follow-up of 12.7 months and use of six drugs per day and 10–12 doses per day. Low adherence was observed at baseline (intervention group: 30%; control group: 29%). PC showed 27% effectiveness (95% confidence interval (CI) –6% to 50%) in the intention to treat analysis and 31% (95% CI 0–52%) in per protocol analysis, considering all drugs. As for adherence to specific drugs for SLE, effectiveness of PC was 64% (95% CI 34–80%) with intention-to-treat analysis and 62% (95% CI 32–79%) in per protocol analysis. Conclusions PC was effective for increasing drug treatment adherence in SLE. The detailed account provided by the Dader Method of the difficulties with patients' drug therapy proved invaluable to approach non-adherence.
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Affiliation(s)
- M Oliveira-Santos
- Department of Epidemiology, Quantitative Methods in Health, Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- Department of Rheumatology, Pedro Ernesto University Hospital, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - J F S Verani
- Department of Epidemiology, Quantitative Methods in Health, Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - L A B Camacho
- Department of Epidemiology, Quantitative Methods in Health, Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - C A F de Andrade
- Department of Epidemiology, Quantitative Methods in Health, Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- Vassouras University, Rio de Janeiro, Brazil
| | - E M Klumb
- Department of Rheumatology, Pedro Ernesto University Hospital, State University of Rio de Janeiro, Rio de Janeiro, Brazil
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Pileggi GS, Da Mota LMH, Kakehasi AM, De Souza AW, Rocha A, de Melo AKG, da Fonte CAM, Bortoletto C, Brenol CV, Marques CDL, Zaltman C, Borba EF, Reis ER, Freire EAM, Klumb EM, Christopoulos GB, Laurindo IMM, Ballalai I, Da Costa IP, Michelin L, de Azevêdo Valadares LD, Chebli LA, Lacerda M, Toscano MAF, Yazbek MA, De Abreu Vieira RMR, Magalhães R, Kfouri R, Richtmann R, Merenlender SDCS, Valim V, De Assis MR, Kowalski SC, Trevisani VFM. Brazilian recommendations on the safety and effectiveness of the yellow fever vaccination in patients with chronic immune-mediated inflammatory diseases. Adv Rheumatol 2019; 59:17. [PMID: 31036077 DOI: 10.1186/s42358-019-0056-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 03/06/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Brazil, we are facing an alarming epidemic scenario of Yellow fever (YF), which is reaching the most populous areas of the country in unvaccinated people. Vaccination is the only effective tool to prevent YF. In special situations, such as patients with chronic immune-mediated inflammatory diseases (CIMID), undergoing immunosuppressive therapy, as a higher risk of severe adverse events may occur, assessment of the risk-benefit ratio of the yellow fever vaccine (YFV) should be performed on an individual level. Faced with the scarcity of specific orientation on YFV for this special group of patients, the Brazilian Rheumatology Society (BRS) endorsed a project aiming the development of individualized YFV recommendations for patients with CIMID, guided by questions addressed by both medical professionals and patients, followed an internationally validated methodology (GIN-McMaster Guideline Development). Firstly, a systematic review was carried out and an expert panel formed to take part of the decision process, comprising BRS clinical practitioners, as well as individuals from the Brazilian Dermatology Society (BDS), Brazilian Inflammatory Bowel Diseases Study Group (GEDIIB), and specialists on infectious diseases and vaccination (from Tropical Medicine, Infectious Diseases and Immunizations National Societies); in addition, two representatives of patient groups were included as members of the panel. When the quality of the evidence was low or there was a lack of evidence to determine the recommendations, the decisions were based on the expert opinion panel and a Delphi approach was performed. A recommendation was accepted upon achieving ≥80% agreement among the panel, including the patient representatives. As a result, eight recommendations were developed regarding the safety of YFV in patients with CIMID, considering the immunosuppression degree conferred by the treatment used. It was not possible to establish recommendations on the effectiveness of YFV in these patients as there is no consistent evidence to support these recommendations. CONCLUSION This paper approaches a real need, assessed by clinicians and patient care groups, to address specific questions on the management of YFV in patients with CIMID living or traveling to YF endemic areas, involving specialists from many areas together with patients, and might have global applicability, contributing to and supporting vaccination practices. We recommended a shared decision-making approach on taking or not the YFV.
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Affiliation(s)
- Gecilmara Salviato Pileggi
- SBR. Faculdade de Ciências da Saúde de Barretos - FACISB, Barretos, São Paulo, Brazil. .,School of Medical Science Barretos- FACISB, Avenue Masonic Lodge Renovadora 68, No. 100 - Airport Neighborhood, Barretos/SP, 14785-002, Brazil.
| | | | - Adriana Maria Kakehasi
- SBR. Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Aline Rocha
- Pós graduanda do programa de Medicina Baseada em Evidências, Universidade Federal do Estado de São Paulo (UNIFESP), São Paulo, Brazil
| | - Ana Karla Guedes de Melo
- SBR. Hospital Universitário Lauro Wanderley, Universidade Federal da Paraíba (UFPB), João Pessoa, Brazil
| | | | | | - Claiton Viegas Brenol
- SBR. Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Cyrla Zaltman
- GEDIIB. Presidente do GEDIIB 2017-2019, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Eduardo Ferreira Borba
- SBR. Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Enio Ribeiro Reis
- SBR. Diretor médico do Centro de infusão do Hospital Humanitas, Varginha, Brazil
| | | | - Evandro Mendes Klumb
- SBR. Unidade Docente Assistencial de Reumatologia, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - Isabella Ballalai
- SBIm. Vice-Presidente da Sociedade Brasileira de Imunizações (SBIm), SBiM, Rio de Janeiro, Brazil
| | - Izaias Pereira Da Costa
- SBR. Professor da Faculdade de Medicina da Universidade Federal do Mato Grosso do Sul, Cuiabá, Brazil
| | - Lessandra Michelin
- SBI. Professora na faculdade de Medicina, Universidade de Caxias do Sul, Caxias do Sul, Brazil
| | | | - Liliana Andrade Chebli
- GEDIIB, Faculdade de Medicina da Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil
| | - Marcus Lacerda
- SMBT. Instituto Leônidas e Maria Deane (Fiocruz - Amazônia), Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), Maceio-AL, Brazil
| | | | | | | | - Renata Magalhães
- SBD. Faculdade de Medicina da Universidade Estadual de Campinas, Campinas, Brazil
| | - Renato Kfouri
- SBIm. Presidente do Departamento de Imunizações da Sociedade Brasileira de Pediatria (SBP), Maceio-AL, Brazil
| | | | | | - Valeria Valim
- SBR. Faculdade de Medicina, Universidade Federal do Espírito Santo, Vitória, Brazil
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Cabral RTDS, Klumb EM, Carneiro S. Patients opinion and adherence to antimalarials in lupus erythematosus and rheumatoid arthritis treatment. J DERMATOL TREAT 2019; 31:264-269. [DOI: 10.1080/09546634.2019.1595504] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Renata Tavares de Souza Cabral
- Ophthalmology Service, Retina and Vitreo Departamento, Pedro Ernesto University Hospital (HUPE), State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - Evandro Mendes Klumb
- Rheumatology, FCM/UERJ, Rio de Janeiro, Brazil
- Rheumatology Sector, Pedro Ernesto University Hospital (HUPE – UERJ), State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Sueli Carneiro
- Dermatology, School of Medical Sciences, State University of Rio de Janeiro (FCM/UERJ), Rio de Janeiro, Brazil
- Clementino Fraga Filho University Hospital/Federal University of Rio de Janeiro (HUCFF/UFRJ), Rio de Janeiro, Brazil
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18
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Rezende RP, Andrade LEC, Klumb EM. Revisiting the issue of how to assess pneumococcal vaccine immunogenicity: a post hoc analysis of antipneumococcal antibody responses among adult patients with systemic lupus erythematosus previously immunised with 23-valent pneumococcal polysaccharide vaccine. Ann Rheum Dis 2019; 78:853-855. [PMID: 30709813 DOI: 10.1136/annrheumdis-2018-214888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 12/31/2018] [Accepted: 01/02/2019] [Indexed: 11/03/2022]
Affiliation(s)
- Rodrigo Poubel Rezende
- Rheumatology, Departamento de Medicina Clínica, Universidade Federal Fluminense, Rio de Janeiro, Brazil
| | - Luís Eduardo Coelho Andrade
- Fleury Medicine and Health Laboratories, Disciplina de Reumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Evandro Mendes Klumb
- Rheumatology, Disciplina de Reumatologia, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
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Cabral RTDS, Klumb EM, Couto MINN, Carneiro S. Evaluation of toxic retinopathy caused by antimalarial medications with spectral domain optical coherence tomography. Arq Bras Oftalmol 2018; 82:12-17. [PMID: 30403262 DOI: 10.5935/0004-2749.20190002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 05/27/2018] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To investigate the frequency of toxic retinopathy in patients with lupus erythematosus and rheumatoid arthritis with long-term use of chloroquine diphosphate or hydroxychloroquine through spectral domain optical coherence tomography and the outcomes of ophthalmological exams (visual acuity - Snellen's table, color vision test - Ishihara's table, fundoscopy, and retinography - red-free). METHODS A cross-sectional study was carried out involving the ophthalmologic evaluation of patients using regular chloroquine diphosphate or hydroxychloroquine for a period of 1 year or longer. The patients completed a questionnaire on their opinions and treatment regularity. The same patients underwent ophthalmologic examination and spectral domain optical coherence tomography. RESULTS The prevalence of toxic retinopathy caused by antimalarials was 4.15% (9 of 217 patients), 7.4% (4 of 54 patients) following chloroquine diphosphate usage, and 0.82% (1 of 121 patients) following hydroxychloroquine usage. Only patients with advanced stage maculopathy presented abnormalities during the ophthalmologic exam: the color vision test was altered in 11.1%, and visual acuity and fundoscopy were altered in 33.3%. Identification of early toxic retinopathy, detected in six patients, was possible using spectral domain optical coherence tomography. The mean duration of antimalarial drug usage among patients with toxic retinopathy was 10.4 years. Only 31% of the patients reported some symptoms during treatment, and although 24% were afraid to use the medication, they did so as prescribed. CONCLUSION Use of spectral domain optical coherence tomography was essential for the diagnosis of early-stage antimalarial toxic retinopathy in patients with the following characteristics: asymptomatic, antimalarial use 7 days a week for a period of more than 5 years, and normal clinical ophthalmologic examination.
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Affiliation(s)
- Renata Tavares de Souza Cabral
- Sector of Ophtalmology, Retina and Vitreo Departament, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Evandro Mendes Klumb
- Department of Medical Clinic, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, RJ, Brazil
| | | | - Sueli Carneiro
- Department of Medical Specialties, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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Lino K, Trizzotti N, Carvalho FR, Cosendey RI, Souza CF, Klumb EM, Silva AA, Almeida JR. Pp65 antigenemia and cytomegalovirus diagnosis in patients with lupus nephritis: report of a series. ACTA ACUST UNITED AC 2018; 40:44-52. [PMID: 29796586 PMCID: PMC6533970 DOI: 10.1590/2175-8239-jbn-3838] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 08/22/2017] [Indexed: 02/07/2023]
Abstract
Introduction: In contrast to organ transplantation, few studies correlate the monitoring of
pp65 antigenemia with a diagnosis of cytomegalovirus (CMV) in patients with
systemic lupus erythematosus (SLE). Objective: To highlight the importance of CMV outside transplantation, we monitored pp65
antigenemia in a series of SLE patients. Methods: From March 2015 to March 2016, SLE patients presenting kidney involvement,
fever, and an unclear infection at hospital admission were monitored through
pp65 antigenemia. The pp65 antigenemia assay, revealed by
immunofluorescence, was correlated with clinical and laboratory
findings. Results: We included 19 patients with a suspected unclear infection. A positivity for
pp65 antigenemia was found in seven patients (36.8%). The mean age was 33.5
± 11.2 years, 16 (84%) were females, and 16 (84%) were black. Lymphopenia,
anemia, and higher scores of SLEDAI were significantly more common in
pp65-positive patients. Five patients received antiviral therapy with
ganciclovir. Although receiving specific CMV treatment, one patient died
because of suspected CMV disease. Conclusions: Pp65 antigenemia might be relevant in SLE patients, and studies with a
greater number of patients are needed in order to establish sensitivity and
specificity of pp65 antigenemia in different clinical contexts of SLE
patients.
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Affiliation(s)
- Katia Lino
- Universidade Federal Fluminense, Niterói, RJ, Brasil
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de Jesus GR, Rodrigues BC, Lacerda MI, dos Santos FC, de Jesus NR, Klumb EM, Levy RA. Gestational outcomes in patients with neuropsychiatric systemic lupus erythematosus. Lupus 2017; 26:537-542. [DOI: 10.1177/0961203317693929] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
This study analyzed maternal and fetal outcomes of pregnancies of neuropsychiatric systemic lupus erythematosus patients followed in a reference unit. This retrospective cohort study included 26 pregnancies of patients seen between 2011 and 2015 included with history and/or active neuropsychiatric systemic lupus erythematosus among 135 pregnancies. Three patients had active neuropsychiatric systemic lupus erythematosus at conception, but only one remained with neurological activity during gestation, characteristically related to the inadvertent suspension of medications. Twenty six percent of the newborns were small for gestational age and 40% of live births were premature, with no neonatal death or early complications of prematurity. Preeclampsia was diagnosed in nine pregnancies, with two cases of early severe form that resulted in intrauterine fetal death. Patients with neuropsychiatric systemic lupus erythematosus had more prematurity and preeclampsia compared to patients without neuropsychiatric disease. However, when concomitant lupus nephritis was excluded, the gestational results of neuropsychiatric systemic lupus erythematosus patients were more favorable.
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Affiliation(s)
- G R de Jesus
- Department of Obstetrics, State University of Rio de Janeiro, Brazil
| | - B C Rodrigues
- Department of Rheumatology, State University of Rio de Janeiro, Brazil
| | - M I Lacerda
- Department of Rheumatology, State University of Rio de Janeiro, Brazil
| | - F C dos Santos
- Department of Obstetrics, State University of Rio de Janeiro, Brazil
| | - NR de Jesus
- Department of Obstetrics, State University of Rio de Janeiro, Brazil
| | - E M Klumb
- Department of Rheumatology, State University of Rio de Janeiro, Brazil
| | - R A Levy
- Department of Rheumatology, State University of Rio de Janeiro, Brazil
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Santos ECLD, Pinto AC, Klumb EM, Macedo JMB. Polimorfismos no gene NAT2 (N‐acetiltransferase 2) em pacientes com lúpus eritematoso sistêmico. Revista Brasileira de Reumatologia 2016. [DOI: 10.1016/j.rbr.2016.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
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Balbi GGM, Montes RA, Vilela VS, Andrade MAB, Nóbrega MM, Azulay-Abulafia L, da Silva RS, Klumb EM, Levy RA. Rapidly progressive diffuse systemic sclerosis after local vitamins A, D and E complex injections: literature review and report of two cases. Immunol Res 2016; 65:285-292. [PMID: 27515982 DOI: 10.1007/s12026-016-8851-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
The term autoimmune/autoinflammatory syndrome induced by adjuvants (ASIA) or Shoenfeld's syndrome refers to a wide group of immune-mediated diseases triggered by external agents. Several substances, such as vaccine adjuvants, squalene and silicone implants, are implied in the pathogenesis of ASIA syndrome. Treatment and prognosis of this complex condition are not completely known due to lack of good quality evidence. After a brief introductory literature review on ASIA, we report here two cases of patients that developed rapidly progressive systemic sclerosis clinical features after multiple intramuscular local injections of a substance recommended by a non-medical professional called ADE. ADE is an oily vitamin complex for veterinary use, and it was used in these cases for cosmetic muscular definition and enhancement purpose. To our knowledge, this is the first paper to describe the relation between injections of ADE and the development of ASIA with severe systemic sclerosis phenotype. Further investigation is needed to better understand the pathophysiology and to provide the basis for the treatment of this condition.
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Affiliation(s)
- Gustavo Guimarães Moreira Balbi
- Department of Rheumatology, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Boulevard 28 de Setembro, 77 - Vila Isabel, Rio de Janeiro, RJ, 20551-030, Brazil.
| | - Ricardo Azêdo Montes
- Department of Rheumatology, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Boulevard 28 de Setembro, 77 - Vila Isabel, Rio de Janeiro, RJ, 20551-030, Brazil
| | - Verônica Silva Vilela
- Department of Rheumatology, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Boulevard 28 de Setembro, 77 - Vila Isabel, Rio de Janeiro, RJ, 20551-030, Brazil
| | - Marcella Azevedo Borges Andrade
- Department of Rheumatology, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Boulevard 28 de Setembro, 77 - Vila Isabel, Rio de Janeiro, RJ, 20551-030, Brazil
| | - Monisa Martins Nóbrega
- Department of Dermatology, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Luna Azulay-Abulafia
- Department of Dermatology, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Roberto Souto da Silva
- Department of Dermatology, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Evandro Mendes Klumb
- Department of Rheumatology, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Boulevard 28 de Setembro, 77 - Vila Isabel, Rio de Janeiro, RJ, 20551-030, Brazil
| | - Roger Abramino Levy
- Department of Rheumatology, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Boulevard 28 de Setembro, 77 - Vila Isabel, Rio de Janeiro, RJ, 20551-030, Brazil
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Oliveira-Santos M, Verani JFDS, Camacho LAB, de Andrade CAF, Ferrante-Silva R, Klumb EM. Effectiveness of pharmaceutical care for drug treatment adherence in patients with systemic lupus erythematosus in Rio de Janeiro, Brazil: study protocol for a randomized controlled trial. Trials 2016; 17:181. [PMID: 27038611 PMCID: PMC4818901 DOI: 10.1186/s13063-016-1317-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 03/30/2016] [Indexed: 12/02/2022] Open
Abstract
Background Treatment adherence is a primary determinant of the success and effectiveness of healthcare. Lack of adherence can lead to treatment failure and death. Although studies have shown that pharmaceutical intervention can improve drug treatment for patients with chronic diseases, studies on pharmaceutical care are not only inconsistent, they are scarce and limited to developed countries, include few patients, and are not studied in randomized clinical trials. Systemic lupus erythematosus is an autoimmune disease with high hospitalization and case-fatality rates. The adherence rate is low (31.7 %) in this group of patients in Brazil, and drug treatment for the disease is complex. Our objective is to evaluate the effectiveness of pharmaceutical care in drug treatment adherence in patients with systemic lupus erythematosus treated at a rheumatology outpatient clinic in Rio de Janeiro, Brazil. Methods A randomized clinical trial (pragmatic trial) will be conducted. Adult participants (women) from a public hospital in Rio de Janeiro with a diagnosis of systemic lupus erythematosus will be followed for 12 months. A total of 120 patients will be randomized to two groups: intervention (Dader method for pharmaceutical care) and control (health/dietary counseling and risk reduction). The primary outcome will be drug treatment adherence evaluated by the eight-item Morisky Medication Adherence Scale. Secondary outcomes will be clinical improvement and quality of life. Discussion Patients with systemic lupus erythematosus present with low treatment adherence, thus justifying the mobilization of human resources to optimize their clinical management. Despite the proven effectiveness of pharmaceutical care for various diseases, there are still no studies evaluating its effectiveness in systemic lupus erythematosus. Our hypothesis is that the intervention will also be effective in this patient group. Trial registration ClinicalTrials.gov identifier: NCT02330250. Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1317-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marise Oliveira-Santos
- Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rua Leopoldo Bulhões, 1480, Manguinhos, Rio de Janeiro, Brazil. .,Pedro Ernesto University Hospital, State University of Rio de Janeiro, Boulevard 28 de Setembro n° 77, Vila Isabel, Rio de Janeiro, Brazil.
| | - José Fernando de Souza Verani
- Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rua Leopoldo Bulhões, 1480, Manguinhos, Rio de Janeiro, Brazil
| | - Luiz Antônio Bastos Camacho
- Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rua Leopoldo Bulhões, 1480, Manguinhos, Rio de Janeiro, Brazil
| | - Carlos Augusto Ferreira de Andrade
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Avenida Brasil n° 4.036, Manguinhos, Rio de Janeiro, Brazil.,Severino Sombra University, Av. Expedicionário Oswaldo de Almeida Ramos, n° 280, Centro, Vassouras, Rio de Janeiro, Brazil
| | - Rosele Ferrante-Silva
- Lagoa Federal Hospital, Ministry of Health, Rua Jardim Botânico n° 501, Jardim Botânico, Rio de Janeiro, Brazil
| | - Evandro Mendes Klumb
- Pedro Ernesto University Hospital, State University of Rio de Janeiro, Boulevard 28 de Setembro n° 77, Vila Isabel, Rio de Janeiro, Brazil
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Rezende RPV, Ribeiro FM, Albuquerque EMN, Gayer CR, Andrade LEC, Klumb EM. Immunogenicity of pneumococcal polysaccharide vaccine in adult systemic lupus erythematosus patients undergoing immunosuppressive treatment. Lupus 2016; 25:1254-9. [PMID: 26923283 DOI: 10.1177/0961203316636472] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 01/25/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the immunogenicity of the 23-valent pneumococcal polysaccharide vaccine (PPSV23) in adult systemic lupus erythematosus patients undergoing (IS group) and not undergoing (non-IS group) immunosuppressive treatment. METHODS In this prospective open-label study from February 2013 to April 2014, 54 patients had blood samples collected immediately before PPSV23 immunization and 4-6 weeks thereafter for the ELISA measurement of IgG antibody levels against seven pneumococcal serotypes. Positive vaccine response for each serotype was defined as a four-fold or greater antibody response over baseline levels or as a post-vaccine anti-pneumococcal IgG level ≥1.3 µg/ml when baseline values were <1.3 µg/ml. Patients should have responded appropriately to ≥70% of the tested serotypes. We also calculated the mean ratio of post- to pre-vaccination anti-pneumococcal IgG levels. RESULTS Twenty-eight patients were classified into the IS group and 26 into non-IS group. The median dose of prednisone at baseline was ≤5 mg/day in both groups. Serotype-specific vaccine response rates were not significantly different between the groups. Less than 40% of patients responded adequately by both vaccine response criteria, being numerically lower among IS patients. The mean ratio of increase in anti-pneumococcal levels was 6.4 versus 4.7 (p = 0.001) in non-IS and IS groups, respectively. CONCLUSION The vaccine was poorly immunogenic, especially among adult systemic lupus erythematosus patients under immunosuppressive therapy.
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Affiliation(s)
- R P V Rezende
- Department of Rheumatology, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - F M Ribeiro
- Department of Rheumatology, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - E M N Albuquerque
- Department of Rheumatology, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - C R Gayer
- Department of Biochemistry, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | | | - E M Klumb
- Department of Rheumatology, Rio de Janeiro State University, Rio de Janeiro, Brazil
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Vargas-Torres SL, Portari EA, Silva AL, Klumb EM, da Rocha Guillobel HC, de Camargo MJ, Santos-Rebouças CB, Russomano FB, Macedo JMB. Roles of CDKN1A gene polymorphisms (rs1801270 and rs1059234) in the development of cervical neoplasia. Tumour Biol 2016; 37:10469-78. [PMID: 26846214 DOI: 10.1007/s13277-016-4850-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 01/13/2016] [Indexed: 12/16/2022] Open
Abstract
The CDKN1A gene product is a p53 downstream effector, which participates in cell differentiation, development process, repair, apoptosis, senescence, migration, and tumorigenesis. The objective of our study was investigated the importance of two polymorphisms in the CDKN1A gene, rs1801270 (31C>A) and rs1059234 (70C>T), for the development of cervical lesions in a Southeastern Brazilian population (283 cases, stratified by lesion severity, and 189 controls). CDKN1A genotyping was performed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and/or DNA sequencing. CDKN1A 31A allele presents a genetic pattern of protection for the development of high-grade cervical lesions (CC vs CA genotype: OR = 0.60; 95 % CI = 0.38-0.95; p = 0.029; CA+AA vs CC genotype: OR = 0.60; 95 % CI = 0.39-0.93; p = 0.021). Allele distributions of the CDKN1A 70C>T polymorphism were also different between the two study groups, with the CDKN1A 70T allele being less prevalent among cases. Moreover, the double heterozygote genotype combination 31CA-70CT decreases the chance of developing high-grade squamous intraepithelial lesion (HSIL) and cancer (OR = 0.55; 95 % CI = 0.32-0.93; p = 0.034) by 50 %, representing a protective factor against the development of more severe cervical lesions.
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Affiliation(s)
- Sandra Liliana Vargas-Torres
- Department of Biochemistry, Biology Institute, State University of Rio de Janeiro - UERJ, Av. 28 de Setembro, 87 fundos 4°. andar, Vila Isabel, Rio de Janeiro, RJ, Brazil, CEP 20551-030
| | - Elyzabeth Avvad Portari
- Department of Pathology, State University of Rio de Janeiro - UERJ, Rio de Janeiro, Brazil.,Department of Pathology, Fernandes Figueira Institute - FIOCRUZ, Rio de Janeiro, Brazil
| | - Amanda Lima Silva
- Department of Biochemistry, Biology Institute, State University of Rio de Janeiro - UERJ, Av. 28 de Setembro, 87 fundos 4°. andar, Vila Isabel, Rio de Janeiro, RJ, Brazil, CEP 20551-030
| | - Evandro Mendes Klumb
- Department of Rheumatology, State University of Rio de Janeiro - UERJ, Rio de Janeiro, RJ, Brazil
| | | | - Maria José de Camargo
- Department of Gynecology, Fernandes Figueira Institute - FIOCRUZ, Rio de Janeiro, Brazil
| | | | - Fábio Bastos Russomano
- Department of Gynecology, Fernandes Figueira Institute - FIOCRUZ, Rio de Janeiro, Brazil
| | - Jacyara Maria Brito Macedo
- Department of Biochemistry, Biology Institute, State University of Rio de Janeiro - UERJ, Av. 28 de Setembro, 87 fundos 4°. andar, Vila Isabel, Rio de Janeiro, RJ, Brazil, CEP 20551-030.
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Abstract
Systemic lupus erythematous (SLE) is an autoimmune disease that presents an increased susceptibility to infections which may trigger reactivation. Disease flares have been mostly associated with parvovirus B19, cytomegalovirus, EBV and Mycobacterium tuberculosis infections, but it is probable that many other agents may also induce innate and adaptive immune system stimulation including the production of autoantibodies as ANA, anti nDNA and anti-ß2-GPI mainly in lepromatous leprosy. Mycobacterium leprae not only may determine symptoms that mimic lupus flares, including autoantibodies production, but could also act as a trigger for lupus reactivation; however, its association is still not fully explored. As demonstrated for tuberculosis, it is quite possible that molecular mimicry may also be involved in the interface of these two diseases. Some studies reported shared epitopes among idiotypes derived from 8E7 and TH9 lepromatous antibodies and those obtained from SLE patients, and it could partially explain the triggering phenomenon of SLE caused by M. leprae. We report and discuss three Brazilian patients whose disease was inactive and presented disease flares concurrently with the diagnosis of leprosy.
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Affiliation(s)
- F M Ribeiro
- Disciplina de Reumatologia, Universidade do Estado do Rio de Janeiro, Rua Dois de Dezembro, 131/702 - Flamengo, Rio de Janeiro, RJ, 22220-040, Brazil,
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Klumb EM, Silva CAA, Lanna CCD, Sato EI, Borba EF, Brenol JCT, Albuquerque EMDND, Monticielo OA, Costallat LTL, Latorre LC, Sauma MDFLDC, Bonfá ESDDO, Ribeiro FM. Consenso da Sociedade Brasileira de Reumatologia para o diagnóstico, manejo e tratamento da nefrite lúpica. Revista Brasileira de Reumatologia 2015; 55:1-21. [DOI: 10.1016/j.rbr.2014.09.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 09/14/2014] [Indexed: 12/29/2022] Open
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Vargas-Torres SL, Portari EA, Klumb EM, Guillobel HCDR, Camargo MJD, Russomano FB, Macedo JMB. Effects of MDM2 promoter polymorphisms on the development of cervical neoplasia in a Southeastern Brazilian population. Biomarkers 2014; 19:637-45. [PMID: 25271042 DOI: 10.3109/1354750x.2014.962614] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
We investigated the importance of two adjacent functional polymorphisms in the Murine Double Minute 2 (MDM2) gene, SNP285 G > C and SNP309 T > G, for the development of cervical lesions in a Southeastern Brazilian population (293 cases and 184 controls). MDM2 genotyping was performed by PCR-RFLP (Polymerase Chain Reaction-Restriction Fragment Length Polymorphism) and/or DNA sequencing. MDM2 SNP309 has potential as a biomarker of cervical neoplasia in non-smokers, patients with family history of cancer, or those who had late sexual debut (>16 years). Besides, this polymorphism may help identify women at risk of developing severe cervical lesion at a young age (<30 years).
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de Jesus GR, de Jesus NR, Levy RA, Klumb EM. The use of angiogenic and antiangiogenic factors in the differential diagnosis of pre-eclampsia, antiphospholipid syndrome nephropathy and lupus nephritis. Lupus 2014; 23:1299-301. [DOI: 10.1177/0961203314529172] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Pre-eclampsia (PE) is a major cause of maternal mortality and morbidity, perinatal deaths, preterm birth and intrauterine growth restriction. Differential diagnosis with antiphospholipid syndrome (APS) nephropathy and systemic lupus erythematosus (SLE) nephritis during pregnancy is difficult, if not sometimes impossible, as all three diseases may present hypertension and proteinuria. Improvement in diagnosis of PE has also offered new paths for differential diagnosis with other conditions and the analysis of angiogenic (vascular endothelial growth factor, placental growth factor) and antiangiogenic factors (serum soluble fms-like tyrosine kinase 1, soluble endoglin) is promising for differentiation between PE, APS nephropathy and SLE nephritis. This article reviews published studies about those factors in non-pregnant and pregnant patients with APS and SLE, comparing with patterns described in PE.
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Affiliation(s)
- GR de Jesus
- Department of Obstetrics, Universidade do Estado do Rio de Janeiro, Brazil
| | - NR de Jesus
- Department of Obstetrics, Universidade do Estado do Rio de Janeiro, Brazil
| | - RA Levy
- Department of Rheumatology, Universidade do Estado do Rio de Janeiro, Brazil
| | - EM Klumb
- Department of Rheumatology, Universidade do Estado do Rio de Janeiro, Brazil
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31
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Vargas-Torres SL, Portari EA, Klumb EM, Guillobel HCDR, Camargo MJD, Russomano FB, Macedo JMB. Association ofCDKN2Apolymorphisms with the severity of cervical neoplasia in a Brazilian population. Biomarkers 2014; 19:121-7. [DOI: 10.3109/1354750x.2014.881419] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Macedo PRWC, Mota ANCDM, Gripp AC, Alves MDFGS, Klumb EM. Diffuse systemic sclerosis with bullous lesions without systemic manifestations. An Bras Dermatol 2013; 88:78-81. [PMID: 24346886 PMCID: PMC3875988 DOI: 10.1590/abd1806-4841.20132160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Accepted: 01/17/2013] [Indexed: 11/21/2022] Open
Abstract
Here, we describe an atypical case of systemic sclerosis in its diffuse cutaneous
form with acute and rapid progression of the cutaneous condition, without any
systemic manifestations and the infrequent formation of bullae, showing the
importance of diagnosis and early treatment in such cases. This case also shows that
special measures should be taken for bullous cutaneous lesions and ulcerations
resulting from serious sclerosis, which are entry points and increase morbidity and
risk of death. Other prognostic factors include age, ESR and renal and pulmonary
involvement. Capillaroscopies can be useful predictors of greater severity of
systemic scleroderma, revealing a greater link with systemic, rather than cutaneous,
involvement.
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Oliveira CS, d Oliveira I, Bacchiega ABS, Klumb EM, Albuquerque EMM, Souza E, Suassuna JHS, Ribeiro FM. Renal transplantation in lupus nephritis: a Brazilian cohort. Lupus 2011; 21:570-4. [PMID: 22129601 DOI: 10.1177/0961203311430220] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine the epidemiological profile and outcome of patients with lupus nephritis (LN) undergoing renal transplantation. METHODS The archival records of 50 patients with LN and end-stage renal disease (ESRD) treated by kidney transplantation from March 1992 to December 2010 were reviewed. All patients met the American College of Rheumatology criteria for systemic lupus erythematosus (SLE). RESULTS Fourteen patients were included in the study. The majority were women (85.7%) and non-Caucasian (85.7%); the mean age at diagnosis of SLE and LN was 24 ± 8 and 25 ± 8 years, respectively. Renal biopsy was performed in 12 patients, with 75% of them showing proliferative lesions (class III and IV according to the World Health Organization and International Society of Nephrology/Renal Pathology Society classification). Thirteen patients (93%) underwent intermittent hemodialysis or peritoneal dialysis before transplantation. The median time between the start of dialysis and transplantation was 30 months (range 3-103 months); 67% of the procedures involved deceased donors and 33% involved living-related donors. The graft survival rates were 93.3%, 90.9%, and 85.7% at 1, 5 and 10 years, respectively. Post-transplant immunosuppressive agents were mycophenolate mofetil (84%), azathioprine (17%), tacrolimus (25%), sirolimus (58%) and cyclosporine (8%). Eight episodes of acute rejection were noted in six patients. There was a graft loss due to renal vein thrombosis in the one patient with secondary antiphospholipid syndrome. The mean SLICC by the time of kidney transplantation was 5 ± 2. In total, 13 patients (92.8%) developed at least one infectious event during the follow-up, with one dying in the immediate post-transplant period because of sepsis. Two patients (14%) had a lupus flare. There was no clinical or histological evidence of LN recurrence. CONCLUSION LN is the major cause of morbidity in SLE, with progression to ESRD in 10-22% of cases. Despite concerns about LN recurrence after renal transplantation, the data obtained in our sample indicate this procedure as a safe alternative therapy for ESRD in this population.
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Affiliation(s)
- C S Oliveira
- Disciplina de Reumatologia, Hospital Universitário Pedro Ernesto - Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
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Oliveira-Santos M, Verani JFS, Klumb EM, Albuquerque EMN. Evaluation of adherence to drug treatment in patients with systemic lupus erythematosus in Brazil. Lupus 2010; 20:320-9. [DOI: 10.1177/0961203310383736] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The objectives of this study were to measure the prevalence of adherence to drug treatment and analyze associations with characteristics pertaining to the treatment, disease, health professionals and services, and socio-demographic issues in patients with systemic lupus erythematosus (SLE) in the city of Rio de Janeiro, Brazil. A sample of 246 women with SLE was analyzed. The data were collected through individual interviews and a review of patient charts. Adherence was estimated according to the Morisk criteria, and the associated factors were analyzed by hierarchical modeling. The percentage of patients classified as adherent to treatment was 31.7%. The reasons cited for non-adherence were: carelessness with drug administration times (52.43%), forgetfulness (38.21%), adverse drug reaction (13.8%), and interruption of treatment due to improvement in symptoms (7.72%). Factors associated with adherence were: behavior towards the presence of adverse drug reaction, hematological alterations, presence of mucocutaneous manifestations, legibility of the medical prescription, schooling, and family support. The study concludes that adherence to drug treatment in SLE is a complex and multifactorial phenomenon, and the results corroborate findings from studies conducted in developed countries. The hierarchical modeling proved to be a good alternative for evaluating adherence, since it allowed visualizing the various stages in the analysis.
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Affiliation(s)
- M Oliveira-Santos
- Escola Nacional de Saúde Pública Sérgio Arouca, Fundação Oswaldo Cruz, Departamento de Epidemiologia e Métodos Quantitativos em Saúde, Rio de Janeiro, Brazil
- Universidade do Estado do Rio de Janeiro, Hospital Universitário Pedro Ernesto, Rio de Janeiro, Brazil
| | - JFS Verani
- Escola Nacional de Saúde Pública Sérgio Arouca, Fundação Oswaldo Cruz, Departamento de Epidemiologia e Métodos Quantitativos em Saúde, Rio de Janeiro, Brazil
| | - EM Klumb
- Universidade do Estado do Rio de Janeiro, Hospital Universitário Pedro Ernesto, Rio de Janeiro, Brazil
| | - EMN Albuquerque
- Universidade do Estado do Rio de Janeiro, Hospital Universitário Pedro Ernesto, Rio de Janeiro, Brazil
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Umbelino Júnior AA, Cantisano MH, Klumb EM, Dias EP, Silva AAD. Achados bucais e laboratoriais em pacientes com lúpus eritematoso sistêmico. J Bras Patol Med Lab 2010. [DOI: 10.1590/s1676-24442010000600008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Klumb EM, Pinto AC, Jesus GR, Araujo M, Jascone L, Gayer CR, Ribeiro FM, Albuquerque EMN, Macedo JMB. Are women with lupus at higher risk of HPV infection? Lupus 2010; 19:1485-91. [DOI: 10.1177/0961203310372952] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Human papillomavirus (HPV) is the etiological agent of cervical cancer, the second most prevalent neoplasia among women. Although it has been proven that systemic lupus erythematosus (SLE) patients have higher frequency of cervical dysplasia, few studies have focused on HPV prevalence among them. This study aimed to investigate HPV prevalence among SLE patients and to evaluate associated risk factors, including the use of immunosuppressors (IM). Total DNA extracted from cervical samples of 173 SLE patients and 217 women (control group) submitted to routine cervical cytopathology was used as template in polymerase chain reaction (PCR)-based assays for detection of HPV DNA. HPV genotyping was performed by type-specific PCR, PCR-RFLP and/or DNA sequencing. Statistical methods included univariate analysis and logistic regression. Despite presenting significantly fewer HPV risk factors, SLE patients were found to have a threefold increase in HPV infection, mostly genotypes 53, 58, 45, 66, 6, 84, 83, 61, as compared with controls, who presented types 6, 18 and 61 more frequently. The higher rate of HPV infection was associated with immunosuppressive therapy. This study provides evidence that SLE patients have a high prevalence of HPV infection, which is even higher with the use of IM, a condition that might necessitate a more frequent cervical cancer screening program for these women.
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Affiliation(s)
- EM Klumb
- Department of Rheumatology, State University of Rio de Janeiro - UERJ, Rio de Janeiro, Brazil,
| | - AC Pinto
- Department of Biochemistry, State University of Rio de Janeiro - UERJ, Rio de Janeiro, Brazil
| | - GR Jesus
- Department of Gynecology, State University of Rio de Janeiro - UERJ, Rio de Janeiro, Brazil
| | - M. Araujo
- Department of Pathology, State University of Rio de Janeiro - UERJ, Rio de Janeiro, Brazil
| | - L. Jascone
- Department of Biochemistry, State University of Rio de Janeiro - UERJ, Rio de Janeiro, Brazil
| | - CR Gayer
- Department of Biochemistry, State University of Rio de Janeiro - UERJ, Rio de Janeiro, Brazil
| | - FM Ribeiro
- Department of Rheumatology, State University of Rio de Janeiro - UERJ, Rio de Janeiro, Brazil
| | - EMN Albuquerque
- Department of Rheumatology, State University of Rio de Janeiro - UERJ, Rio de Janeiro, Brazil
| | - JMB Macedo
- Department of Biochemistry, State University of Rio de Janeiro - UERJ, Rio de Janeiro, Brazil
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Cunha BMD, Klumb EM, Moura JQ, Santos A, Pinheiro GDRC, Albuquerque EMN, Levy RA. Freqüência de síndrome metabólica em pacientes com nefrite lúpica. Rev Bras Reumatol 2008. [DOI: 10.1590/s0482-50042008000500003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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de Oliveira PP, Klumb EM, Marinheiro LPF. Prevalência do risco para fraturas estimado pela ultra-sonometria óssea de calcâneo em uma população de mulheres brasileiras na pós-menopausa. CAD SAUDE PUBLICA 2007; 23:381-90. [PMID: 17221087 DOI: 10.1590/s0102-311x2007000200014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2005] [Accepted: 07/03/2006] [Indexed: 11/22/2022] Open
Abstract
Observa-se uma forte tendência de envelhecimento da população mundial levando a um aumento da prevalência de doenças como a osteoporose e fraturas. O objetivo deste estudo foi determinar a prevalência de risco para fraturas estimado pela ultra-sonometria óssea de calcâneo em uma população de mulheres na pós-menopausa, residentes na Ilha de Paquetá, Rio de Janeiro, Brasil. Realizamos medidas antropométricas e ultra-sonometria óssea de calcâneo com aparelho Sonost 2000 em 385 mulheres pós-menopausadas. Observamos que 59,22% da amostra apresentava T-score < -1, sendo que 16,88% tinham T-score < -2,5. Houve variação em todos os parâmetros do exame conforme o aumento da idade, e diferença estatisticamente significativa (p < 0,05) entre os grupos de risco para fratura por idade, tempo de menopausa, peso, IMC e percentual de gordura corpórea. Houve correlação entre velocidade do som e IMC (r = 0,155; p = 0,002). Concluímos que cerca de 60% da população feminina estudada apresenta algum grau de risco para fraturas. As mulheres do grupo de maior risco (T-score < -2,5) eram mais velhas, com maior tempo de menopausa, maior peso e IMC do que as dos outros grupos.
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