RESUMO
OBJECTIVES: To describe the response and relapse of severe thrombocytopenia in patients with systemic lupus erythematosus (SLE) with different treatments. METHOD: We performed a retrospective cohort study, which included SLE patients who were hospitalized for thrombocytopenia of less than 30,000/µL platelets, from January 2012 to December 2021. Demographic and clinical information was obtained from clinical records. Kaplan-Meier and logrank test were performed. RESULTS: Forty-seven patients, mostly women (83%) with a median age of 31 years, were included in the study. Eight patients (17%) relapsed within a median period of 35.7 weeks. Initial acute treatment with prednisone at 1 mg/kg/day was as effective as glucocorticoid pulses. However, induction treatment with cyclophosphamide (CYC) had the lowest remission rate (43%, p = 0.034). There was no significant difference in relapse-free survival (RFS) among the acute glucocorticoid treatments. CYC induction was associated with lower RFS compared to rituximab (RTX) (CYC 43.6 weeks vs. RTX 51.8 weeks, p = 0.040) or azathioprine (AZA) (CYC 43.6 weeks vs. AZA 51.2 weeks, p = 0.024). Administration of antimalarials was associated with longer RFS (51.6 weeks vs. 45.0 weeks, p = 0.021). Factors such as antiphospholipid syndrome, IgG anti-ß2 glycoprotein I positivity, renal and additional hematologic SLE activity during follow-up significantly reduced RFS. CONCLUSIONS: Despite similar response of acute glucocorticoid regimens, induction therapy with AZA or RTX resulted in a longer RFS compared to CYC. Adding an antimalarial also improved RFS. Our study provides evidence that may help develop better treatment strategies for severe thrombocytopenia in SLE patients. Key Points ⢠Induction therapy with azathioprine or rituximab provided longer relapse-free survival in SLE thrombocytopenia compared with cyclophosphamide. ⢠Antimalarial administration was associated with longer relapse-free survival in SLE thrombocytopenia. ⢠Antiphospholipid syndrome, IgG anti-ß2 glycoprotein I positivity, as well as renal and additional hematologic SLE activity during follow-up, decreased relapse-free survival.
Assuntos
Azatioprina , Ciclofosfamida , Glucocorticoides , Imunossupressores , Lúpus Eritematoso Sistêmico , Recidiva , Rituximab , Humanos , Feminino , Estudos Retrospectivos , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Adulto , Masculino , Ciclofosfamida/uso terapêutico , Rituximab/uso terapêutico , Glucocorticoides/uso terapêutico , Azatioprina/uso terapêutico , Imunossupressores/uso terapêutico , Antimaláricos/uso terapêutico , Pessoa de Meia-Idade , Prednisona/uso terapêutico , Adulto Jovem , Resultado do Tratamento , Púrpura Trombocitopênica Idiopática/tratamento farmacológico , Púrpura Trombocitopênica Idiopática/complicações , Trombocitopenia/tratamento farmacológico , Trombocitopenia/etiologiaRESUMO
OBJECTIVE: To address the relationship between systemic lupus erythematosus (SLE) disease activity and the functional parameters of the innate immunity. METHODS: We evaluated a cohort of 26 adult SLE patients and 10 sex and age-paired healthy donors. When the patients had a disease flare (baseline) and when they achieve clinical response (follow-up), we assessed the systemic lupus erythematosus disease activity index 2 K (SLEDAI 2 K) and the following parameters with flow cytometry and confocal microscopy: monocyte subsets, their expression of TLR2, phagocytic monocytes and neutrophils using the pHrodo Red E. coli BioParticles, the respiratory burst with 123-dihydrorhodamine in neutrophils, and the spontaneous and lipopolysaccharide (LPS)-induced production of neutrophil extracellular traps (NETs). We used the Wilcoxon test to compare the paired medians with interquartile range (IQR) and the Mann-Whitney U test for independent medians. To assess the effect of prednisone and SLEDAI 2 K on the mentioned parameters, we applied a generalized mixed linear model. RESULTS: Twenty-three patients (88.4%) were women. The SLEDAI 2 K was higher at baseline 8 (6-14) in comparison to that at follow-up (6 (4-8), P = 0.028). At baseline, SLE patients had a decreased percentage of intermediate monocytes, a higher expression of TLR2 in total monocytes, increased phagocytosis in monocytes and neutrophils, a decreased respiratory burst intensity, and an increased production of NETs. In the mix model, the SLEDAI 2 K was the main factor influencing these functional innate immune parameters. CONCLUSION: Disease activity regulates the innate immune function in SLE which may contribute to the clinical features and infection predisposition. Key points ⢠This is the first cohort study addressing the effect of disease activity and prednisone use on the innate immune function of lupus patients. ⢠Our results show that the disease activity is a key regulator of the respiratory burst, phagocytosis, and the production of neutrophil extracellular traps. ⢠Also, we observed a differential proportion of monocyte subsets according to SLE disease activity. ⢠We consider that our manuscript contributes to the evidence addressing the intrinsic immune abnormalities of patients with SLE regardless of the use of immunosuppressants and set the bases for new research work considering the disease activity as an element to decide the prescription and duration of antibiotic prophylaxis in SLE patients, which is of interest to all rheumatologists.
Assuntos
Lúpus Eritematoso Sistêmico , Receptor 2 Toll-Like , Adulto , Humanos , Feminino , Masculino , Prednisona/uso terapêutico , Estudos de Coortes , Escherichia coli , Lúpus Eritematoso Sistêmico/tratamento farmacológico , ImunidadeRESUMO
BACKGROUND: Currently, there is scant information regarding the features associated to the persistence of post-COVID-19 syndrome, which is the main aim of the present study. METHODS: A cohort study of 102 COVID-19 patients was conducted. The post-COVID-19 symptoms were assessed by a standardised questionnaire. Lymphocyte immunophenotyping was performed by flow cytometry and chemokines/cytokines, neutrophil extracellular traps, the tripartite motif 63, anti-cellular, and anti-SARS-CoV-2 IgG antibodies were addressed in serum. The primary outcome was the persistence of post-COVID-19 syndrome after six months follow-up. RESULTS: Thirteen patients (12.7%) developed the primary outcome and had a more frequent history of post-COVID-19 syndrome 3 months after infection onset (p = .044), increased levels of IL-1α (p = .011) and IP-10 (p = .037) and increased CD57 expression in CD8+ T cells (p = .003). There was a trend towards higher levels of IFN-γ (p = .051), IL-1ß (p = .062) and IL-6 (p = .087). The history of post COVID-19 in the previous 3 months, obesity, baseline serum MIP-1α and IP-10, and CD57 expression in CD8+ T cells were independently associated with the persistence of post-COVID-19 syndrome. CONCLUSION: Our data suggest an important relationship between a pro-inflammatory state mediated through metabolic pathways related to obesity and increased cellular senescence as a key element in the persistence of post-COVID-19 syndrome at six months of follow-up.
Assuntos
COVID-19 , Humanos , COVID-19/complicações , Projetos Piloto , Síndrome de COVID-19 Pós-Aguda , Linfócitos T CD8-Positivos , Estudos de Coortes , Quimiocina CXCL10 , ObesidadeRESUMO
Background: Until now, most of the research addressing long-term humoral responses in coronavirus disease 2019 (COVID-19) had only evaluated the serum titers of anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) IgGs, without the assessment of the baseline antiviral clinical and immune profile, which is the aim of this study and may be the key factor leading to a broad and sustained antibody response. Methods: We included 103 patients with COVID-19. When the patients sought medical attention (baseline), a blood sample was drawn to perform immunophenotype of lymphocytes by flow cytometry. The patients were assessed 15 days after baseline and then every month until the third month, followed by a last visit 6 months after recruitment. We evaluated the anti-SARS-COV-2 IgG at all time points, and the serum levels of cytokines, chemokines, anti-cellular (AC) antibodies and neutrophil extracellular traps were also assessed during the follow-up. The primary outcome of the study was the presence of a sustained immune humoral response, defined as an anti-SARS-CoV-2 IgG titer >4.99 arbitrary units/mL in at least two consecutive measures. We used generalized lineal models to assess the features associated with this outcome and to assess the effect of the changes in the cytokines and chemokines throughout time on the development of a sustained humoral immune response. Results: At baseline the features associated to a sustained immune humoral response were the diagnosis of critical disease, absolute number of lymphocytes, serum IP-10, IL-4, IL-2, regulatory T cells, CD8+ T cells, and positive AC antibodies. Critical illness and the positivity of AC antibodies were associated with a sustained humoral immune response after 3 months, whilst critical illness and serum IL-13 were the explanatory variables after 6 months. Conclusion: A sustained immune humoral response is strongly related to critical COVID-19, which is characterized by the presence of AC antibodies, quantitative abnormalities in the T cell compartment, and the serum cytokines and chemokines during acute infection and throughout time.
Assuntos
COVID-19 , Anticorpos Antivirais , Linfócitos T CD8-Positivos , Quimiocinas , Estudos de Coortes , Estado Terminal , Citocinas , Humanos , Imunoglobulina G , SARS-CoV-2RESUMO
BACKGROUND: Colchicine is an available, safe, and effective anti-inflammatory drug and has been suggested as a COVID-19 treatment, but its usefulness in hospitalized severe COVID-19 patients has not been thoroughly demonstrated. OBJECTIVE: To address the safety and efficacy of colchicine in hospitalized patients with severe COVID-19. DESIGN: We conducted a triple-blind parallel non-stratified placebo-controlled clinical trial. PARTICIPANTS: We recruited 116 hospitalized patients with severe COVID-19 in Mexico. INTERVENTIONS: Patients were randomized to receive 1.5 mg of colchicine or placebo at the time of the recruitment in the study (baseline) and 0.5 mg BID PO to complete 10 days of treatment. MAIN MEASURES: The primary composite outcome was the progression to critical disease or death. Besides, we evaluated immunological features at baseline and after recovery or disease progression in 20 patients. KEY RESULTS: Fifty-six patients were allocated to colchicine and 60 patients received placebo. The study was suspended after the second interim analysis demonstrated colchicine had no effect on the primary outcome (OR 0.83, 95%CI 0.35-1.93, P = 0.67), nor in the days of ICU and hospital stays. Adverse events were similar between groups (OR 1.63, 95% CI 0.66-3.88, P = 0.37). After colchicine treatment, patients had higher BUN and lower serum levels of IL-8, IL-12p70, and IL-17A. CONCLUSIONS: Colchicine is safe but not effective in the treatment of severe COVID-19. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04367168.
Assuntos
Tratamento Farmacológico da COVID-19 , Colchicina/efeitos adversos , Hospitalização , Humanos , SARS-CoV-2 , Resultado do TratamentoAssuntos
Linfócitos B/imunologia , Linfócitos T CD4-Positivos/imunologia , Linfócitos T CD8-Positivos/imunologia , COVID-19/complicações , Área Sob a Curva , Linfócitos B/metabolismo , Biomarcadores/metabolismo , Linfócitos T CD4-Positivos/metabolismo , Linfócitos T CD8-Positivos/metabolismo , COVID-19/diagnóstico , COVID-19/imunologia , Estudos de Coortes , Feminino , Humanos , Masculino , Razão de Chances , Valor Preditivo dos Testes , Curva ROC , Fatores Sexuais , Fator A de Crescimento do Endotélio Vascular/sangue , Síndrome de COVID-19 Pós-AgudaRESUMO
OBJECTIVE: The objective of this study was to identify clinical and laboratory risk factors for ischemic stroke (IS) in primary antiphospholipid syndrome (APS) patients. MATERIALS AND METHODS: We performed a case-control study with consecutive primary APS patients divided into two groups, those who presented with IS, vs. those with no history of stroke. Demographics, vascular risk factors, therapeutic approaches, laboratory, imaging and functional outcomes were recorded. RESULTS: Fifty-three confirmed primary APS patients with IS and sixty-six non-stroke primary APS controls were recruited. Most patients were female (65.5 %), with a median age of 33 years. The main vascular risk factors for primary APS-associated stroke were hypertension (11.3 %), diabetes (11.3 %) and hypercholesterolemia (9.4 %). Among patients with stroke, median NIHSS score was 6; 15.1 % of these patients presented a recurrent stroke, and 88.8 % had a good functional outcome at the final follow-up. Positive lupus anticoagulant (OR = 6.1, 95 %CI 2.7-13.5), anti-ß2 glycoprotein IgG (OR = 3.6, 95 %CI 1.7-7.9), and anticardiolipin IgG (OR = 2.8, 95 %CI 1.3-5.9) were more prevalent in non-stroke primary APS, with a triple-positive antibody presence in 46.4 % of controls vs. 22.2 % of patients with stroke (OR = 3.0, 95 %CI 1.3-6.7). At the time of the index event (arterial or venous), 14 known primary APS patients were using vitamin K antagonists, but only 35.7 % of them had achieved therapeutic INR. CONCLUSION: Patients with primary APS and IS have similar vascular risk factors and lower antibody positivity than those with extracranial thrombosis.
Assuntos
Síndrome Antifosfolipídica/epidemiologia , AVC Isquêmico/epidemiologia , Adulto , Anticorpos Anticardiolipina/imunologia , Anticoagulantes/uso terapêutico , Síndrome Antifosfolipídica/tratamento farmacológico , Síndrome Antifosfolipídica/imunologia , Estudos de Casos e Controles , Diabetes Mellitus/epidemiologia , Feminino , Estado Funcional , Humanos , Hipercolesterolemia/epidemiologia , Hipertensão/epidemiologia , Coeficiente Internacional Normatizado , AVC Isquêmico/etiologia , AVC Isquêmico/imunologia , AVC Isquêmico/fisiopatologia , Inibidor de Coagulação do Lúpus/imunologia , Masculino , Isquemia Mesentérica/epidemiologia , Isquemia Mesentérica/etiologia , Oclusão Vascular Mesentérica/epidemiologia , Oclusão Vascular Mesentérica/etiologia , Pessoa de Meia-Idade , Veia Porta , Embolia Pulmonar/epidemiologia , Embolia Pulmonar/etiologia , Fatores de Risco , Trombose Venosa/epidemiologia , Trombose Venosa/etiologiaRESUMO
It is often unclear to the clinical investigator whether observational studies should be submitted to a research ethics committee (REC), mostly because, in general, no active or additional interventions are performed. Moreover, obtaining an informed consent under these circumstances may be challenging, either because these are very large epidemiological registries, or the subject may no longer be alive, is too ill to consent, or is impossible to contact after being discharged. Although observational studies do not involve interventions, they entail ethical concerns, including threats such as breaches in confidentiality and autonomy, and respect for basic rights of the research subjects according to the good clinical practices. In this context, in addition to their main function as evaluators from an ethical, methodological, and regulatory point of view, the RECs serve as mediators between the research subjects, looking after their basic rights, and the investigator or institution, safeguarding them from both legal and unethical perils that the investigation could engage, by ensuring that all procedures are performed following the international standards of care for research. The aim of this manuscript is to provide information on each type of study and its risks, along with actions to prevent such risks, and the function of RECs in each type of study.
Assuntos
Comitês de Ética em Pesquisa/organização & administração , Estudos Observacionais como Assunto/ética , Projetos de Pesquisa , Humanos , Consentimento Livre e Esclarecido/ética , Entrevistas como Assunto/métodos , Sistema de Registros/ética , Pesquisadores/organização & administração , Estudos RetrospectivosRESUMO
Abstract It is often unclear to the clinical investigator whether observational studies should be submitted to a research ethics committee (REC), mostly because, in general, no active or additional interventions are performed. Moreover, obtaining an informed consent under these circumstances may be challenging, either because these are very large epidemiological registries, or the subject may no longer be alive, is too ill to consent, or is impossible to contact after being discharged. Although observational studies do not involve interventions, they entail ethical concerns, including threats such as breaches in confidentiality and autonomy, and respect for basic rights of the research subjects according to the good clinical practices. In this context, in addition to their main function as evaluators from an ethical, methodological, and regulatory point of view, the RECs serve as mediators between the research subjects, looking after their basic rights, and the investigator or institution, safeguarding them from both legal and unethical perils that the investigation could engage, by ensuring that all procedures are performed following the international standards of care for research. The aim of this manuscript is to provide information on each type of study and its risks, along with actions to prevent such risks, and the function of RECs in each type of study.
Assuntos
Humanos , Projetos de Pesquisa , Comitês de Ética em Pesquisa/organização & administração , Estudos Observacionais como Assunto/ética , Pesquisadores/organização & administração , Sistema de Registros/ética , Entrevistas como Assunto/métodos , Estudos Retrospectivos , Consentimento Livre e Esclarecido/éticaRESUMO
OMERACT proposed a set of mandatory and discretionary domains to evaluate the effect of treatment in patients with gout. To determine the percentage of improvement and the effect size 6 and 12 months after starting a proper treatment in patients with gout from our cohort (GRESGO) based on the OMERACT proposal for chronic gout. GRESGO is a cohort of consecutive, new patients with gout attending either of two dedicated clinics. This report includes 141 patients evaluated at baseline and 6 months plus 101 of them completing a 12-month follow-up in 2012. Clinical data including the OMERACT domains for chronic gout were collected at baseline and every 6 months. Treatment was prescribed by their attending physician with the purpose of getting < 6 mg/dL of seric uric acid (sUA). Most patients were males (96%) with inappropriate treatment (95%); 66% had tophi, 30% metabolic syndrome, and 32% low renal function. Mean dose of allopurinol at baseline and throughout the study went from 344 ± 168 mg/day to 453 ± 198 at 12 months. Most OMERACT domains and renal function improved significantly; 73% improved > 20% from 6 to 12 months. Greater improvement was observed in the domains: flares, index tophus size, pain, general health assessment, and HAQ score, all of them associated to lower sUA values. Chronic gout patients improve significantly in most OMERACT domains when conventional and regular treatment is indicated. sUA < 6 mg/dL is associated with greater improvement.
Assuntos
Gota/tratamento farmacológico , Rim/efeitos dos fármacos , Adulto , Alopurinol/administração & dosagem , Feminino , Seguimentos , Gota/sangue , Gota/fisiopatologia , Supressores da Gota/administração & dosagem , Humanos , Rim/fisiopatologia , Masculino , México , Pessoa de Meia-Idade , Fatores de Tempo , Resultado do Tratamento , Ácido Úrico/sangueRESUMO
BACKGROUND: An increasing role of dual-energy computed tomography (DECT) scan in tophaceous gout assessment is recognized, whereas its role in asymptomatic hyperuricemia is unknown. OBJECTIVE: The objective of this study was to assess the prevalence of joint and renal monosodium urate deposits by DECT in asymptomatic hyperuricemia. METHODS: Among a renal transplant population with at least 1 year of follow-up, we included 27 patients with sustained hyperuricemia and 11 with normal serum uric acid (SUA) levels. We excluded patients with gout or history of monoarthritis or oligoarthritis. We registered demographic data, drugs, hyperuricemia onset, comorbidities, renal function, and SUA. We used a 128-slice dual-source CT system, and the acquisition protocol included the pelvis and imaging of elbows, wrists, hands, knees, ankles, and feet. The reading process was performed by 2 radiologists. RESULTS: The mean age was 43.7 ± 12 years, 57.8% were males, and median follow-up was 7 years. Hyperuricemia presented after a median time of 0.61 years after transplantation and had persisted for a median of 3.2 years (0.5-16.8 years). For the hyperuricemic group, the median SUA at the DECT scan and the maximum SUA levels were 7.9 and 8.9 mg/dL, respectively. Groups were similar in most of the clinical variables. We did not find any articular or renal deposit; conversely, we demonstrated a quadriceps tendon deposition in 1 patient with hyperuricemia (prevalence of 0.03%; 95% confidence interval, 0.006%-0.17%). CONCLUSIONS: In these patients with asymptomatic hyperuricemia, the prevalence of monosodium urate deposition assessed by DECT was low; however, larger studies need to be performed for further validation.
Assuntos
Hiperuricemia/metabolismo , Articulações/metabolismo , Transplante de Rim , Rim/metabolismo , Ácido Úrico/metabolismo , Adulto , Artrografia , Feminino , Seguimentos , Gota/diagnóstico por imagem , Gota/epidemiologia , Gota/metabolismo , Humanos , Hiperuricemia/diagnóstico por imagem , Hiperuricemia/epidemiologia , Rim/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Prevalência , Tomografia Computadorizada EspiralRESUMO
OBJECTIVES: To determine rates of incident erosive disease in early rheumatoid arthritis patients, to identify baseline predictors and to evaluate erosion's impact on patient-reported outcomes. METHODS: 82 patients with ≤ 12 months of disease duration, ≥ 3 years of follow-up and conventional treatment were included. Consecutive evaluations assessed swollen and tender joint counts, treatment and comorbidity, acute reactant-phase determinations and patient-reported outcomes. Digitized radiographs of the hands and feet were obtained at baseline and yearly thereafter. RA was defined as erosive when at least one unequivocal cortical bone defect was detected. Descriptive statistics and Cox regression analysis were performed. RESULTS: At baseline, 71 of the patients were â, population median (range) age was of 38.7 (16-78.2) years, 58 patients had antibodies and all the patients had active disease and substantial disability. Follow-up cohort was of 299.3 person-years. At last follow-up (49 ± 13.8 months), 28 patients developed erosions. Erosion's location was the feet, in 12 patients. Incident rates of erosive disease at one, two, three and four years were of 8.1, 12.8, 13.8 and 5.6 per 100 person-years, respectively. Higher C-reactive protein (HR: 1.20, 95%CI: 1.04-1.4, p=0.01) and positive antibodies (HR: 5.09, 95%CI: 1.08-23.86, p=0.04) were baseline predictors of incident erosive disease. Erosions had minor impact on patient-reported outcomes. CONCLUSION: Rheumatoid arthritis patients with antibodies and higher C reactive protein at baseline are at risk for incident erosions which appear most frequently at the feet. Up to 1/3 patients conventionally treated develop incident erosions, which minimally impact function.
Assuntos
Antirreumáticos/uso terapêutico , Artrite Reumatoide/diagnóstico por imagem , Artrite Reumatoide/tratamento farmacológico , Artrite Reumatoide/etnologia , Adolescente , Adulto , Idoso , Distribuição de Qui-Quadrado , Feminino , Seguimentos , Humanos , Masculino , México , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Modelos de Riscos Proporcionais , Radiografia , Resultado do TratamentoRESUMO
UNLABELLED: To investigate if serial clinical and ultrasound evaluations differ between early rheumatoid arthritis patients who do or do not develop erosive disease and to identify predictors of erosions. METHODS: Patients with at least 7 consecutive 2-monthly clinical and 3 consecutive 6-monthly ultrasound evaluations were included. Ultrasound (gray scale and power Doppler) assessed synovitis, power Doppler-positive synovitis (PD+) and power Doppler-negative synovitis (PD-) in each of 14 joints of the dominant hand. After 1 and 2 years, erosive disease was defined according to digitized radiography. Areas under the curve (AUCs) for serial assessments were calculated. Multivariate logistic regression analysis was performed. RESULTS: Seventy-one and 38 patients completed 1- and 2-year consecutive assessments. After 2 years (21.5 +/- 6.2 months), 13 patients developed erosions. At baseline, nonerosive patients had shorter duration of symptoms to RA diagnosis, lower number of the American College of Rheumatology (ACR) classification criteria, lesser synovitis and PD+ synovitis than erosive patients. At follow-up, erosive and nonerosive patients showed similar AUC for clinical, serological, and treatment parameters; erosive patients had higher AUCs for synovitis and PD+ synovitis than nonerosive patients. In the multivariate model, the amount of PD+ synovitis (odds ratio, 1.3; 95% confidence interval, 1.11-1.51; P = 0.001) and more ACR classification criteria (odds ratio, 2.3; 95% confidence interval, 1.05-5.02; P = 0.04), both at baseline, predicted erosive disease. CONCLUSIONS: Serial Power Doppler ultrasonography-assessed synovitis was greater in patients who developed erosions than in those who did not. More power Doppler positive (hypervascular) synovitis and more ACR classification criteria, both at baseline, were the only predictors of erosions.
Assuntos
Artrite Reumatoide/diagnóstico por imagem , Artrite Reumatoide/epidemiologia , Modelos de Riscos Proporcionais , Medição de Risco/métodos , Sinovite/diagnóstico por imagem , Sinovite/epidemiologia , Comorbidade , Humanos , Incidência , México , Reprodutibilidade dos Testes , Fatores de Risco , Sensibilidade e Especificidade , UltrassonografiaRESUMO
BACKGROUND: Studies to date regarding hyperuricemia and gout in the postrenal transplant (RT) setting do not distinguish neither if patients with gout after the allograft had or did not have hyperuricemia before been transplanted nor if data concerning to hyperuricemia correspond to prevalent or incident cases. Among RT patients, we assessed (1) the incidence of gout in recipients with and without hyperuricemia pre-RT and (2) the incidence of hyperuricemia during the follow-up. METHODS: We selected from our RT registry (1989-2003) 236 subjects who were transplanted in our institution, with at least 1 year follow-up, without gout pre-RT, with at least one measurement of serum uric acid pre-RT and two post-RT. Immunosuppressants, demographic, and clinical features were registered. Survival curves for hyperuricemia and gout were derived using the Kaplan-Meier method and were statistically tested by log rank test. RESULTS: The median follow-up was 4.8 years (1.0-14.9), 43% were women, with a mean body mass index of 22.7+/-3.7 kg/m2 and a mean age at the moment of transplant of 32.4+/-11 years. The incidence of hyperuricemia was 315.2 x 1000 patient-years. Hyperuricemia was diagnosed in half of the subjects during the first year of follow-up. The incidence of gout was 19.7 x 1000 and 2.67 x 1000 patient-years in the groups with and without hyperuricemia pretransplant, respectively (Log rank 9.44, P<0.002). The group with hyperuricemia pre-RT also had earlier and more aggressive gout. CONCLUSIONS: Hyperuricemia was a common complication among RT recipients. However, gout incidence varied according to the pretransplant hyperuricemic status.
Assuntos
Gota/complicações , Hiperuricemia/complicações , Nefropatias/terapia , Transplante de Rim/métodos , Adulto , Índice de Massa Corporal , Feminino , Seguimentos , Gota/etiologia , Humanos , Hiperuricemia/epidemiologia , Imunossupressores/uso terapêutico , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estudos Retrospectivos , Resultado do TratamentoRESUMO
We describe the case of a young woman with systemic lupus erythematosus (SLE) who presented with painful acute swelling and limited motion of the elbow. Analysis of synovial fluid exhibited a noninflammatory cell count, negative cultures, amorphous nonbirefringent particles, and a positive Alizarin red S staining. X-rays showed calcifications, spurring, sclerosis, and despite the short duration of symptoms, loss of radial-humeral and cubital-humeral joint spaces. The diagnosis of an acute attack within a chronic degenerative arthropathy of the elbow associated with hydroxyapatite crystals was established. Such crystal-induced arthropathy can be an occasional explanation for acute arthritis in SLE.