RESUMO
Diabetic neuropathy (DN) encompasses a group of clinical or subclinical manifestations involving a dysfunction in the peripheral nervous system. The cause of the dysfunction is the development of microvascular complications related to diabetes, a disease that affects about 381 million people worldwide. Approximately 50% of patients currently diagnosed with diabetes are expected to manifest DN in the next 10 years. The diagnosis can be made clinically by establishing a good patient history and delving into the symptoms to rule out other etiologies. Treatment of DN focuses on glycemic control and the use of medications to reduce pain, including NSAIDs, antidepressants and antiepileptic drugs. The pathogenesis is of multifactorial origin, associated with various metabolic, vascular, inflammatory and neurodegenerative disorders. The three fundamental cellular alterations participating in the development of DN are chronic inflammation, endothelial dysfunction and oxidative stress. Since the combination of all three is capable of giving rise to nerve ischemia and direct axonal injury, these factors play a key role in the development of polyneuropathy. However, neuronal and microvascular changes do not occur in the same way in all patients with DN, some of whom have no detectable blood abnormalities.
Assuntos
Diabetes Mellitus , Neuropatias Diabéticas , Neuropatias Diabéticas/diagnóstico , Neuropatias Diabéticas/tratamento farmacológico , Humanos , Inflamação/complicações , Estresse OxidativoRESUMO
BACKGROUND: The 2S albumin Ber e 1 is the major allergen in Brazil nuts. Previous findings indicated that the protein alone does not cause an allergenic response in mice, but the addition of components from a Brazil nut lipid fraction were required. Structural details of Ber e 1 may contribute to the understanding of the allergenic properties of the protein and its potential interaction partners. METHODOLOGY/PRINCIPAL FINDINGS: The solution structure of recombinant Ber e 1 was solved using NMR spectroscopy and measurements of the protein back bone dynamics at a residue-specific level were extracted using (15)N-spin relaxation. A hydrophobic cavity was identified in the structure of Ber e 1. Using the paramagnetic relaxation enhancement property of Cu(2+) in conjunction with NMR, it was shown that Ber e 1 is able to specifically interact with the divalent copper ion and the binding site was modeled into the structure. The IgE binding region as well as the copper binding site show increased dynamics on both fast ps-ns timescale as well as slower µs-ms timescale. CONCLUSIONS/SIGNIFICANCE: The overall fold of Ber e 1 is similar to other 2S albumins, but the hydrophobic cavity resembles that of a homologous non-specific lipid transfer protein. Ber e 1 is the first 2S albumin shown to interact with Cu(2+) ions. This Cu(2+) binding has minimal effect on the electrostatic potential on the surface of the protein, but the charge distribution within the hydrophobic cavity is significantly altered. As the hydrophobic cavity is likely to be involved in a putative lipid interaction the Cu(2+) can in turn affect the interaction that is essential to provoke an allergenic response.
Assuntos
Albuminas 2S de Plantas/química , Antígenos de Plantas/química , Bertholletia/imunologia , Cobre/metabolismo , Albuminas 2S de Plantas/metabolismo , Antígenos de Plantas/metabolismo , Modelos Moleculares , Ressonância Magnética Nuclear Biomolecular , Ligação Proteica , Conformação Proteica , Proteínas Recombinantes/química , Proteínas Recombinantes/metabolismoRESUMO
La Vasculitis Reumatoidea (VR) es una complicación severa de laArtritis Reumatoidea (AR). Varios estudios demuestran que las moléculasde adhesión soluble serían indicadores de activación endotelial y se asociarían a daño vascular. Objetivo: Medir los niveles séricos de moléculas de adhesión solubles en pacientes con VR y evaluar la utilidad de las mismas para elmonitoreo de la respuesta terapéutica.Material y métodos: Se incluyeron en forma consecutiva pacientes con AR según criterios ACR87 y diagnóstico VR. Por cada paciente con VR, se evaluaron 2 pacientes con AR sin vasculitis apareados por edad, sexo y tiempo de evolución de la enfermedad. Se consignaron datos demográficos, hábitos tóxicos, enfermedades comórbidas, parámetros de laboratorio, datos relacionados a la AR, en el momento previo al proceso vasculítico, en el período activo y 6 meses posterior al inicio del tratamiento específico para vasculitis. Las moléculas de adhesión VCAM-1 y E-selectina fueron medidaspor método de ELISA, en ambos grupos basalmente y luego de 6 meses de iniciado el tratamiento. Resultados: Los pacientes con VR (n = 10) tenían una edad mediana de 51 años (RIC 42,2-55,2) y un tiempo mediano de evolución de la enfermedad de 84 meses (RIC 69-180). El 80% era de sexo femenino. Los pacientes con AR sin VR (n = 20) tenían característicasdemográficas y tiempo de evolución de la enfermedad comparables. El 80% de los pacientes con VR presentaban compromiso cutáneo. El 100% tenía compromiso neurológico. Todos los pacientes recibieron tratamiento con esteroides, 9 pulsos de ciclofosfamida y1 azatioprina. Los niveles de VCAM-1 fueron significativamente mayores en pacientes con VR vs. controles (765 μg/ml vs. 595 μg/ml,p = 0,033). Los valores de E-selectina fueron mayores en vasculitis vs. controles (49,25 μg/ml vs. 40,3 μg/ml), pero esta diferencia noalcanzó significancia estadística. Los niveles VCAM-1 también disminuyeronen forma significativa...
Rheumatoid vasculitis (RV) is a severe complication in patients with RA. Some studies demonstrated that the soluble adhesion molecules are associated with endothelial activation and vascular damage. Objective:To measure serum levels of soluble adhesion moleculesin RA patients with RV and to evaluate their utility for monitoring thetherapeutic response. Material and methods:Consecutive patients with RA (ACR87) and RV were included. For each patient with RV, 2 patients with RA and without RV matched by age, sex and disease duration were used as controls. Demographical data, toxic habits, comorbidities, laboratory, RA characteristics were registered previously vasculitis, in the active period and 6 months after the beginning of the specific vasculitis treatment. The adhesion molecules VCAM-1 and E-selectin were measured by ELISA, in both groups, basally and 6 months afterof the therapy beginning. Results: RV patients (n = 10) median age 51 years (IQR 42.2-55.2) and median disease duration 84 months (IQR 69-180) and80% female sex. RA patients without RV (n = 20) had comparabledemographical and disease duration. 80% RV patients had skin involvement. 100% had neurological involvement. All the patients received steroids treatment, 9 IV cyclophosphamide and 1 azathioprine. VCAM-1 levels were significantly greater in RV patients vs.controls (765 μg/ml vs. 595 μg/ml, p = 0.033). E-selectin levels were also greater in vasculitis vs. controls (49.25 μg/ml vs. 40.3 μg/ml), but this difference did not reach statistical significance. VCAM-1 levels significantly decreased after 6 months of treatment, 765 μg/ml (592.5-975) vs. 555 μg/ml (455-685), p = 0.01. We did not observe difference in E-selectin levels.Conclusion: VCAM-1 levels are increased in RV patients versus RA patients without RV and these soluble adhesion molecules decreased after treatment. The VCAM-1 measurement could be a useful vascular inflammation indicator in RV and would allow to monitoring treatment.
Assuntos
Artrite Reumatoide , VasculiteRESUMO
La Vasculitis Reumatoidea (VR) es una complicación severa de laArtritis Reumatoidea (AR). Varios estudios demuestran que las moléculasde adhesión soluble serían indicadores de activación endotelial y se asociarían a daño vascular. Objetivo: Medir los niveles séricos de moléculas de adhesión solubles en pacientes con VR y evaluar la utilidad de las mismas para elmonitoreo de la respuesta terapéutica.Material y métodos: Se incluyeron en forma consecutiva pacientes con AR según criterios ACR87 y diagnóstico VR. Por cada paciente con VR, se evaluaron 2 pacientes con AR sin vasculitis apareados por edad, sexo y tiempo de evolución de la enfermedad. Se consignaron datos demográficos, hábitos tóxicos, enfermedades comórbidas, parámetros de laboratorio, datos relacionados a la AR, en el momento previo al proceso vasculítico, en el período activo y 6 meses posterior al inicio del tratamiento específico para vasculitis. Las moléculas de adhesión VCAM-1 y E-selectina fueron medidaspor método de ELISA, en ambos grupos basalmente y luego de 6 meses de iniciado el tratamiento. Resultados: Los pacientes con VR (n = 10) tenían una edad mediana de 51 años (RIC 42,2-55,2) y un tiempo mediano de evolución de la enfermedad de 84 meses (RIC 69-180). El 80% era de sexo femenino. Los pacientes con AR sin VR (n = 20) tenían característicasdemográficas y tiempo de evolución de la enfermedad comparables. El 80% de los pacientes con VR presentaban compromiso cutáneo. El 100% tenía compromiso neurológico. Todos los pacientes recibieron tratamiento con esteroides, 9 pulsos de ciclofosfamida y1 azatioprina. Los niveles de VCAM-1 fueron significativamente mayores en pacientes con VR vs. controles (765 μg/ml vs. 595 μg/ml,p = 0,033). Los valores de E-selectina fueron mayores en vasculitis vs. controles (49,25 μg/ml vs. 40,3 μg/ml), pero esta diferencia noalcanzó significancia estadística. Los niveles VCAM-1 también disminuyeronen forma significativa...(AU)
Rheumatoid vasculitis (RV) is a severe complication in patients with RA. Some studies demonstrated that the soluble adhesion molecules are associated with endothelial activation and vascular damage. Objective:To measure serum levels of soluble adhesion moleculesin RA patients with RV and to evaluate their utility for monitoring thetherapeutic response. Material and methods:Consecutive patients with RA (ACR87) and RV were included. For each patient with RV, 2 patients with RA and without RV matched by age, sex and disease duration were used as controls. Demographical data, toxic habits, comorbidities, laboratory, RA characteristics were registered previously vasculitis, in the active period and 6 months after the beginning of the specific vasculitis treatment. The adhesion molecules VCAM-1 and E-selectin were measured by ELISA, in both groups, basally and 6 months afterof the therapy beginning. Results: RV patients (n = 10) median age 51 years (IQR 42.2-55.2) and median disease duration 84 months (IQR 69-180) and80% female sex. RA patients without RV (n = 20) had comparabledemographical and disease duration. 80% RV patients had skin involvement. 100% had neurological involvement. All the patients received steroids treatment, 9 IV cyclophosphamide and 1 azathioprine. VCAM-1 levels were significantly greater in RV patients vs.controls (765 μg/ml vs. 595 μg/ml, p = 0.033). E-selectin levels were also greater in vasculitis vs. controls (49.25 μg/ml vs. 40.3 μg/ml), but this difference did not reach statistical significance. VCAM-1 levels significantly decreased after 6 months of treatment, 765 μg/ml (592.5-975) vs. 555 μg/ml (455-685), p = 0.01. We did not observe difference in E-selectin levels.Conclusion: VCAM-1 levels are increased in RV patients versus RA patients without RV and these soluble adhesion molecules decreased after treatment. The VCAM-1 measurement could be a useful vascular inflammation indicator in RV and would allow to monitoring treatment.(AU)
Assuntos
Artrite Reumatoide , VasculiteRESUMO
We have previously developed and validated a self-administered questionnaire, modelled after the Systemic Lupus International Collaborating Clinics Damage Index (SDI), the Lupus Damage Index Questionnaire (LDIQ), which may allow the ascertainment of this construct in systemic lupus erythematosus (SLE) patients followed in the community and thus expand observations made about damage. We have now translated, back-translated and adapted the LDIQ to Spanish, Portuguese and French and applied it to patients followed at academic and non-academic centres in North and South America, Portugal and Spain while their physicians scored the SDI. A total of 887 patients (659 Spanish-speaking, 140 Portuguese-speaking and 80 French-speaking patients) and 40 physicians participated. Overall, patients scored all LDIQ versions higher than their physicians (total score and all domains). Infrequent manifestations had less optimal clinimetric properties but overall agreement was more than 95% for the majority of items. Higher correlations were observed among the Spanish-speaking patients than the Portuguese-speaking and French-speaking patients; further adjustments may be needed before the Portuguese and French versions of the LDIQ are applied in community-based studies. The relationship between the LDIQ and other outcome parameters is currently being investigated in a different patient sample.
Assuntos
Idioma , Lúpus Eritematoso Sistêmico , Inquéritos e Questionários , Adulto , Feminino , Inquéritos Epidemiológicos , Humanos , Lúpus Eritematoso Sistêmico/patologia , Lúpus Eritematoso Sistêmico/fisiopatologia , América do Norte , Portugal , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , América do Sul , Espanha , Inquéritos e Questionários/normasRESUMO
La Artritis Reumatoidea suele comprometer, en su curso a la Articulación Temporomandibular. El presente trabajo muestra los hallazgos encontrados al explorar 118 articulaciones temporomandibulares, obteniendo signosintomatología de cada paciente, imágenes radiográficas de manos y de la articulación mencionada, interrelacionando estos datos con la eritrosedimentación (ERS), HAQ y el DAS 28.
Assuntos
Artrite Reumatoide , Côndilo Mandibular , Síndrome da Disfunção da Articulação TemporomandibularAssuntos
Albuminas/química , Precursores de Proteínas/química , Albuminas 2S de Plantas , Antígenos de Plantas , Isótopos de Carbono , Deutério , Isótopos de Nitrogênio , Ressonância Magnética Nuclear Biomolecular , Estrutura Secundária de Proteína , Estrutura Terciária de Proteína , Homologia de Sequência de AminoácidosRESUMO
The objective of the study was to evaluate the influence of the male gender in the clinical presentation and outcome of systemic lupus erythematosus in a prospective inception cohort of Latin-American patients. Of the 1214 SLE patients included in the GLADEL cohort, 123 were male. Demographic characteristics as well as clinical manifestations, laboratory profile, activity and damage scores were evaluated at onset and during the course of the disease and compared with female patients. The median age at onset of the male patients was 27 and that at diagnosis 29.2 years. Delay to diagnosis was shorter in males (134 versus 185 days, P = 0.01). At onset, men more frequently showed fever (42.3 versus 27.0%, P = 0.001) and weight loss (23.6 versus 11.8%, P = 0.001). During disease course the incident of symptoms was: fever, 67.8 versus 55.6%, P = 0.012; weight loss, 47.2 versus 24.3%, P = 0.001; arterial hypertension, 37.4 versus 25.8%, P = 0.007; renal disease (persistent proteinuria and/or cellular casts), 58.5 versus 44.6%, P = 0.004); and hemolytic anemia, 19.5 versus 10.9%, P = 0.008. The laboratory results showed that: men more frequently had IgG anticardiolipin antibodies (68.2 versus 49%, P = 0.02) and low C3 (61.3 versus 48.1%, P = 0.03); 5/123 men died (4%) compared with 29/1091 women (2.7%). In conclusion, 10% of GLADEL's cohort patients were male. They showed a distinctive profile with shorter delay to diagnosis, higher incidence of fever, weight loss, arterial hypertension, renal disease, hemolytic anemia, IgG anticardiolipin antibodies and low C3. Although not statistically significant, mortality was higher in men.
Assuntos
Lúpus Eritematoso Sistêmico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , América Latina/epidemiologia , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/diagnóstico , Lúpus Eritematoso Sistêmico/epidemiologia , Lúpus Eritematoso Sistêmico/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores SexuaisRESUMO
A protein microarray system containing different dilutions of 77 related and non-related proteins was used to show that IgE from subjects allergic to Brazil nut specifically recognise the seed 2S albumin protein (Ber e 1). Further, correctly folded chimaeric 2S albumin proteins containing structural epitope replacement were constructed and directed to the secretion pathway of the methylotropic yeast Pichia pastoris. Through the use of a chimaeric protein microarray system together with sera from a panel of 18 well-characterised Brazil nut allergic subjects, a structural IgE epitope of Ber e 1 was mapped to a helix-loop-helix region. The same structural region has been previously reported as the immunodominant region in related food allergens by different techniques. In conclusion, the combination of chimaeric proteins and protein microarrays will greatly facilitate the screening of a large number of individuals for a particular structural epitope and help to further our understanding of how proteins are recognised by the adaptive immune system.
Assuntos
Albuminas/química , Albuminas/imunologia , Bertholletia/imunologia , Epitopos , Imunoglobulina E/imunologia , Proteínas de Plantas/química , Proteínas de Plantas/imunologia , Precursores de Proteínas/química , Precursores de Proteínas/imunologia , Proteínas Recombinantes de Fusão/química , Albuminas 2S de Plantas , Sequência de Aminoácidos , Antígenos de Plantas , Dicroísmo Circular , Hipersensibilidade Alimentar , Humanos , Modelos Moleculares , Dados de Sequência Molecular , Peptídeos/química , Peptídeos/genética , Peptídeos/imunologia , Pichia/genética , Pichia/metabolismo , Análise Serial de Proteínas , Dobramento de Proteína , Proteínas Recombinantes de Fusão/imunologia , Proteínas Recombinantes de Fusão/metabolismo , Alinhamento de SequênciaRESUMO
Cyclosporine for microemulsion has been widely used in the treatment of rheumatoid arthritis (RA) with remarkably good results over progression of joint damage, as reported by the GRISAR Study. A local group in Argentina, performed a prospective, open label study (Neo-Ra-02), consisting of 12 centres which recruited 50 RA patients, who were followed during 6 months in order to assess efficacy, tolerability and safety of cyclosporine microemulsion in the treatment of RA. Efficacy parameters were: morning stiffness, functional evaluation (HAQ, Lee and Ritchie index) and laboratory and radiological (Larsen score) assessments. Safety parameters were: blood pressure and renal, liver and hematological laboratory data. Patients criteria for participation were: presence of active RA (as defined by the ACR), Steinbrocker anatomic and functional grade I to III, disease evolution no longer than 5 years, no previous history of hypertension, renal or liver disease and absence of DMARDs use during the previous 2 months. There was a statistically significant decrease in morning stiffness and in pain evolution. Improvement became evident after 4 weeks of treatment. Reduction of Ritchie index was significant also at 4 weeks and the same observation was made with tenderness and swollen joint scores. Regarding evolution of CRP and RF, a statistically significant reduction was observed only in positive RF. Safety parameters showed no significant increase in serum creatinine or uric acid: 6/50 patients developed mild hypertension with only a significant increase in systolic blood pressure in comparison with baseline. Cyclosporine microemulsion demonstrated efficacy with minimal adverse events (12% mild hypertension) when appropriately monitored and administered in low doses (3 mg/kg/day).
Assuntos
Antirreumáticos/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Ciclosporina/uso terapêutico , Adolescente , Adulto , Idoso , Antirreumáticos/efeitos adversos , Artrite Reumatoide/complicações , Artrite Reumatoide/diagnóstico , Creatinina/análise , Ciclosporina/efeitos adversos , Emulsões , Feminino , Seguimentos , Humanos , Hipertensão/induzido quimicamente , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento , Ácido Úrico/análiseRESUMO
Cyclosporine for microemulsion has been widely used in the treatment of rheumatoid arthritis (RA) with remarkably good results over progression of joint damage, as reported by the GRISAR Study. A local group in Argentina, performed a prospective, open label study (Neo-Ra-02), consisting of 12 centres which recruited 50 RA patients, who were followed during 6 months in order to assess efficacy, tolerability and safety of cyclosporine microemulsion in the treatment of RA. Efficacy parameters were: morning stiffness, functional evaluation (HAQ, Lee and Ritchie index) and laboratory and radiological (Larsen score) assessments. Safety parameters were: blood pressure and renal, liver and hematological laboratory data. Patients criteria for participation were: presence of active RA (as defined by the ACR), Steinbrocker anatomic and functional grade I to III, disease evolution no longer than 5 years, no previous history of hypertension, renal or liver disease and absence of DMARDs use during the previous 2 months. There was a statistically significant decrease in morning stiffness and in pain evolution. Improvement became evident after 4 weeks of treatment. Reduction of Ritchie index was significant also at 4 weeks and the same observation was made with tenderness and swollen joint scores. Regarding evolution of CRP and RF, a statistically significant reduction was observed only in positive RF. Safety parameters showed no significant increase in serum creatinine or uric acid: 6/50 patients developed mild hypertension with only a significant increase in systolic blood pressure in comparison with baseline. Cyclosporine microemulsion demonstrated efficacy with minimal adverse events (12
mild hypertension) when appropriately monitored and administered in low doses (3 mg/kg/day).
RESUMO
La Histiocitois X es una rara entidad proliferativa benigna que incluye al :1)granuloma eosinófilo.2) Sindrome de Hand Schuller Christian y 3) Enfermedad de Lettere Siwe.El propósito de esta comunicación es presentar dos pacientes portadores de esta entidad.Caso 1: Mujer de 28 años que consultó por coxalgia y diabetes insípida de dos años de evolución.Presentó imágenes líticas en cabeza femoral y ramas isquiopubianas.La bipsia ósea reveló el diagnóstico de granuloma eosinófilo.Las lesiones respondieron a la terapia radiante.Dos años después desarrolló nuevas lesiones osteolíticas en cráneo,arcos cortales y columna.Catorce años después desarrolló aplastamiento vertebral con compresión radicular que requirió cirugía estabilizadora con evolución favorable.Caso 2: Mujer de 57 años de edad que consultó por cefalea,náuseas,vómitos y tumuración occipital.al año desarrolló una lesión tumoral expansiva en zona epitroclear izquierda.Presentaba imágenes líticas múltiples.Se diagnosticó granuloma por biopsia ósea.Ambas pacientes recibieron tratamiento con vinblastina presentando mejoría de la enfermedad sin progresión radiológica de la misma.
Assuntos
Granuloma Eosinófilo/terapia , Histiocitose de Células de Langerhans , Vimblastina/administração & dosagemRESUMO
La Histiocitois X es una rara entidad proliferativa benigna que incluye al :1)granuloma eosinófilo.2) Sindrome de Hand Schuller Christian y 3) Enfermedad de Lettere Siwe.El propósito de esta comunicación es presentar dos pacientes portadores de esta entidad.Caso 1: Mujer de 28 años que consultó por coxalgia y diabetes insípida de dos años de evolución.Presentó imágenes líticas en cabeza femoral y ramas isquiopubianas.La bipsia ósea reveló el diagnóstico de granuloma eosinófilo.Las lesiones respondieron a la terapia radiante.Dos años después desarrolló nuevas lesiones osteolíticas en cráneo,arcos cortales y columna.Catorce años después desarrolló aplastamiento vertebral con compresión radicular que requirió cirugía estabilizadora con evolución favorable.Caso 2: Mujer de 57 años de edad que consultó por cefalea,náuseas,vómitos y tumuración occipital.al año desarrolló una lesión tumoral expansiva en zona epitroclear izquierda.Presentaba imágenes líticas múltiples.Se diagnosticó granuloma por biopsia ósea.Ambas pacientes recibieron tratamiento con vinblastina presentando mejoría de la enfermedad sin progresión radiológica de la misma.
Assuntos
Granuloma Eosinófilo/terapia , Histiocitose de Células de Langerhans , Vimblastina/administração & dosagemRESUMO
We prospectively determined the frequency of atlantoaxial subluxation in a group of patients with systemic lupus erythematosus (SLE) and analyzed its relationship with tendinous laxity, Jaccoud's syndrome and other features of the disease. Five of 59 patients (8.5%) had atlantoaxial subluxation. No patient presented atlantoaxial subluxation in neutral lateral cervical radiographs but all 5 had anterior atlantoaxial subluxation in full flexion films; one patient also had lateral subluxation. The 5 patients with atlantoaxial subluxation were compared with the remaining 54. Mean SLE disease duration was longer in patients with atlantoaxial subluxation (12 years) than in those without (6.6 years) (p less than 0.01). Jaccoud's syndrome, patellar tendon elongation and articular hypermobility were significantly more frequent in patients with atlantoaxial subluxation. The presence or history of arthritis failed to distinguish patients with and without atlantoaxial subluxation, while chronic renal failure and increased serum parathyroid hormone levels were significantly associated to the presence of atlantoaxial subluxation. We suggest that atlantoaxial subluxation is further evidence of tendinous alterations seen in patients with SLE.
Assuntos
Artrite Reumatoide/complicações , Articulação Atlantoaxial , Luxações Articulares/epidemiologia , Instabilidade Articular/complicações , Lúpus Eritematoso Sistêmico/complicações , Tendões/fisiopatologia , Adulto , Articulação Atlantoaxial/diagnóstico por imagem , Articulação Atlantoaxial/fisiopatologia , Creatinina/farmacocinética , Feminino , Humanos , Luxações Articulares/sangue , Luxações Articulares/diagnóstico por imagem , Falência Renal Crônica/complicações , Articulação do Joelho/fisiopatologia , Lúpus Eritematoso Sistêmico/sangue , Masculino , Hormônio Paratireóideo/sangue , Estudos Prospectivos , Radiografia , Síndrome , Fatores de TempoRESUMO
Fourteen of 52 unselected patients with systemic lupus erythematosus (SLE) (27%) had ligamentous derangement demonstrated by either Jaccoud's syndrome and/or patellar tendon elongation. Three cases had only Jaccoud's syndrome, 4 isolated patellar tendinous laxity, while the remaining 7 presented both findings. Jaccoud's syndrome and/or tendinous laxity were not associated to an increased frequency of arthritis, corticosteroid therapy or a longer disease duration, but significantly associated with increased serum PTH levels secondary to chronic renal failure. Hyperparathyroidism secondary to chronic renal failure should, therefore, be considered a potential factor contributing to the development of Jaccoud's syndrome and/or tendinous laxity in patients with SLE.
Assuntos
Artrite/fisiopatologia , Hiperparatireoidismo Secundário/fisiopatologia , Instabilidade Articular/fisiopatologia , Lúpus Eritematoso Sistêmico/fisiopatologia , Tendões/fisiopatologia , Adolescente , Adulto , Cálcio/sangue , Criança , Creatinina/urina , Feminino , Deformidades Congênitas do Pé , Deformidades Congênitas da Mão , Humanos , Articulação do Joelho/fisiopatologia , Masculino , Pessoa de Meia-Idade , Hormônio Paratireóideo/sangue , Fósforo/sangue , Ácido Úrico/sangueRESUMO
We describe a patient with systemic lupus erythematosus, chronic renal failure and secondary hyperparathyroidism who developed laxity and elongation of the patellar tendon, followed by its rupture one year later. Hydroxyapatite and urate crystals were identified from the chalky material surrounding the patellar tendon observed at surgery. These findings suggest that tendon laxity and elongation could possibly be detected before its rupture and that secondary hyperparathyroidism could be considered as another causative factor of tendon damage in patients with systemic lupus erythematosus.
Assuntos
Hiperparatireoidismo Secundário/complicações , Joelho , Lúpus Eritematoso Sistêmico/complicações , Traumatismos dos Tendões/etiologia , Adulto , Doença Crônica , Feminino , Humanos , Hiperparatireoidismo Secundário/etiologia , Nefropatias/complicações , Joelho/diagnóstico por imagem , Radiografia , Ruptura Espontânea , Traumatismos dos Tendões/diagnóstico por imagem , Traumatismos dos Tendões/patologia , Tendões/diagnóstico por imagem , Tendões/patologiaRESUMO
Manifestaciones neurologicas no secundarias a traumatismos, en particular sindrome de la cola de caballo, han sido ocasionalmente descriptos en pacientes con espondilitis anquilosante (EA).Estos cuadros neurologicos han sido recientemente considerados como otra manifestacion extraarticular de esta enfermedad. En este trabajo se presentan 6 enfermos de una serie de 120 pacientes con EA estudiados en nuestro Servicio, que desarrollaron sindromes neurologicos definidos y no traumaticos. Tres de ellos tuvieron un sindrome de cauda equina; el cuarto presento una cuadriplejia secundaria a una aracnoiditis quistica.Los dos pacientes restantes tenian asociada una esclerosis multiple. Nuestros hallazgos confirman estudios previos, demostrando que la ocurrencia de manifestaciones neurologicas espontaneas no traumaticas,en especial el sindrome de la cola de caballo puede en ocasiones ser observada en pacientes con EA, constituyendo asi otra manifestacion extraarticular de la enfermedad. Futuros estudios aportando nuevas evidencias de esclerosis multiple en pacientes con EA son necesarios para confirmar o no esta asociacion