RESUMO
Lymphocytic hypophysitis (LH) has been described previously in systemic lupus erythematosus (1.3%), Sjögren's syndrome (0.8%). Lymphocytic hypophysitis (LH) is rarely associated with rheumatic diseases, although three cases of pituitary disease associated with antiphospholipid syndrome (APS) have been described. Here, we report a possible association between APS and LH for the first time. A 34-yr-old woman with primary APS presented with polyuria, polydipsia, hypernatremia and impaired vision. Her hormone profile was compatible with panhypopituitarism, and sellar magnetic resonance imaging (MRI) depicted a normal pituitary gland with a thickened and displaced stalk and infundibulum portion. Hormone replacement was started, and the patient experienced a good clinical evolution.
Assuntos
Síndrome Antifosfolipídica/complicações , Hipopituitarismo/complicações , Adulto , Feminino , HumanosRESUMO
The objective of this study was to evaluate the influence of anti-tumor necrosis factor (anti-TNF) in juvenile idiopathic arthritis (JIA), ankylosing spondylitis (AS) or psoriatic arthritis (PsA). Sixty-two patients were investigated: 7 JIA; 37 AS; and 18 PsA. Caucasian race accounted for 79% and 29% were female. Mean age was 40.4 +/- 12.6 years. None of the patients had a history of diabetes, and none had used oral hypoglycemic agents or insulin. Treatment was with adalimumab, infliximab and etanercept. Glucose, inflammatory markers and prednisone dose were assessed at baseline, as well as after three and six months of treatment. The mean erythrocyte sedimentation rate was significantly lower at three months and six months than at baseline (13.7 +/- 18.0 and 18 +/- 22.5 vs. 27.9 +/- 23.4 mm; p = 0.001). At baseline, three months and six months, we found the following: mean C-reactive protein levels were comparable (22.1 +/- 22.7, 14.5 +/- 30.7 and 16.0 +/- 23.8 mg/L, respectively; p = 0.26); mean glucose levels remained unchanged (90.8 +/- 22.2 mg/dl, 89.5 +/- 14.6 mg/dl and 89.8 +/- 13.6 mg/dl, respectively; p = 0.91); and mean prednisone doses were low and stable (3.9 +/- 4.9 mg/day, 3.7 +/- 4.8 mg/day and 2.6 +/- 4.0 mg/day, respectively; p = 0.23). During the first six months of treatment, anti-TNF therapy does not seem to influence glucose metabolism in JIA, AS or PsA.
Assuntos
Antirreumáticos/farmacologia , Artrite Juvenil/metabolismo , Artrite Psoriásica/metabolismo , Glicemia/efeitos dos fármacos , Espondilite Anquilosante/metabolismo , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Adalimumab , Adulto , Anticorpos Monoclonais/farmacologia , Anticorpos Monoclonais/uso terapêutico , Anticorpos Monoclonais Humanizados , Antirreumáticos/uso terapêutico , Artrite Juvenil/sangue , Artrite Juvenil/tratamento farmacológico , Artrite Psoriásica/sangue , Artrite Psoriásica/tratamento farmacológico , Glicemia/metabolismo , Etanercepte , Feminino , Seguimentos , Humanos , Imunoglobulina G/farmacologia , Imunoglobulina G/uso terapêutico , Infliximab , Masculino , Pessoa de Meia-Idade , Receptores do Fator de Necrose Tumoral/uso terapêutico , Espondilite Anquilosante/sangue , Espondilite Anquilosante/tratamento farmacológico , Fator de Necrose Tumoral alfa/imunologiaRESUMO
Dermatomyositis is an unknown cause's disease that in general is characterized by muscular inflammation with weakness and typical skin rash (heliotrope and Gottron's papules). In this article we describe a 13-year-old girl with juvenile dermatomyositis associated with toxoplasmosis. Myositis was treated with corticosteroids and immunosuppressive drugs, but she had good response only after anti-parasitary drug was started.