RESUMO

The vertiginous advance for identifying the genomic sequence of SARS-CoV-2 allowed the development of a vaccine including mRNA-based vaccines, inactivated viruses, protein subunits, and adenoviral vaccines such as Sputnik. This study aims to report on autoimmune disease manifestations that occurred following COVID-19 Sputnik vaccination. Patients and Methods: A retrospective study was conducted on patients with new-onset autoimmune diseases induced by a post-COVID-19 vaccine between March 2021 and December 2022, in two referral hospitals in Mexico City and Argentina. The study evaluated patients who received the Sputnik vaccine and developed recent-onset autoimmune diseases. Results: Twenty-eight patients developed recent-onset autoimmune diseases after Sputnik vaccine. The median age was 56.9 ± 21.7 years, with 14 females and 14 males. The autoimmune diseases observed were neurological in 13 patients (46%), hematological autoimmune manifestations occurred in 12 patients (42%), with thrombotic disease observed in 10 patients (28%), and autoimmune hemolytic anemia in two patients (7.1%). Rheumatological disorders were present in two patients (7.1%), and endocrine disorders in one patient (3.5%). Principio del formulario Conclusion: Although the COVID-19 Sputnik vaccine is generally safe, it can lead to adverse effects. Thrombosis and Guillain-Barre were the most frequent manifestations observed in our group of patients.

RESUMO

OBJECTIVES: Dry eye disease (DED) is arguably the most frequent ocular disease encountered in ophthalmic clinical practice. DED is frequently an underestimated condition causing a significant impact on visual function and quality of life. Many systemic autoimmune diseases (SAIDs) are related to moderate to severe DED. The main objective of this review is to enhance the awareness among ophthalmologists of the potential association of an underlying SAID in a high-risk patient with DED. METHODS: An exhaustive literature search was performed in the National Library of Medicine's Pubmed, Scopus, Web of Science, and Google Scholar databases for all English language articles published until November 2021. The main keywords included "dry eye disease" associated with autoimmune, connective tissue, endocrine, gastrointestinal, hematopoietic, vascular, and pulmonary diseases. Case reports, series, letters to the editor, reviews, and original articles were included. RESULTS: Although DED is frequently associated with SAIDs, its diagnosis is commonly delayed or missed, producing significant complications, including corneal ulceration, melting, scleritis, uveitis, and optic neuritis resulting in severe complications detrimental to visual function and quality of life. SAID should be suspected in a woman, 30 to 60 years old with a family history of autoimmunity, presenting with DED symptoms and extraocular manifestations including arthralgias, dry mouth, unexplained weight and hair loss, chronic fatigue, heat or cold intolerance, insomnia, and mood disorders. CONCLUSIONS: Establishing the correct diagnosis and treatment of DED associated with SAIDs is crucial to avoid its significant burden and severe ocular complications.

Assuntos

RESUMO

Resumen: Introducción: Las enfermedades autoinmunes sistémicas son un grupo de enfermedades de baja prevalencia, cuya patogenia está basada en la pérdida de la auto-tolerancia. A pesar de su baja incidencia y prevalencia, la profundización en el estudio y conocimiento de estas enfermedades ha permitido importantes avances diagnósticos y terapéuticos en los últimos años, constituyendo un desafío en la práctica clínica. Objetivo: determinar la prevalencia y características clínico-humorales de estas patologías en la Policlínica de Enfermedades Autoinmunes del Hospital Pasteur, en el periodo 2016 -2019. Resultados: El total de población fue de 62 pacientes., 55/62 (88%) son mujeres. La más prevalente fue Lupus Eritematoso Sistémico, representando un 32% de esta población (20/62), la artritis reumatoide en un 21% (13/62), la esclerosis sistémica en un 8% (5/62), vasculitis sistémica 8% (5/62), Overlap 6% (4/62), Bechet 5% (3/62). Conclusiones: Se destaca un claro predominio del lupus y de la artritis reumatoide como enfermedades más prevalentes, así como un incremento mantenido de otras patologías menos habituales. Es de suma importancia fomentar el desarrollo de unidades especializadas en estas enfermedades para poder mejorar y protocolizar el manejo de estos pacientes.

Abstract: Introduction: Systemic Autoimmune Diseases are a group of low-prevalence diseases whose pathogeny is based on the loss of self-tolerance. Despite their low incidence and prevalence, deepening the study and knowledge of these diseases has enabled significant diagnostic and therapeutic advances in recent years, constituting a challenge in clinical practice. Objective: to determine the prevalence and clinical-humoral characteristics of these pathologies in the Polyclinic of Autoimmune Diseases of Pasteur Hospital, in the period 2016 -2019. Results: The total population was 62 patients., 55/62 (88%) were women. Most prevalent was Systemic Lupus Erythematosus (SLE), representing 32% of this population (20/62), Rheumatoid Arthritis by 21% (13/62), Systemic Sclerosis by 8% (5/62), Systemic vasculitis 8% (5/62), Overlap syndrome 6% (4/62), Bechet 5% (3/62). Conclusions: Lupus and rheumatoid arthritis as more prevalent diseases, as well as a maintained increase in other less common diseases. It is very important to promote the development of specialized units in these área, in order to improve and protocol the management of these patients.

Resumo: Introdução: As doenças autoimunes sistêmicas são um grupo de doenças de baixa prevalência, cuja patogênese se baseia na perda de autotolerância. Apesar de sua baixa incidência e prevalência, o aprofundamento no estudo e conhecimento dessas doenças permitiu importantes avanços diagnósticos e terapêuticos nos últimos anos, constituindo um desafio na prática clínica. Objetivo: determinar a prevalência e as características clínico-humorais dessas patologias no Hospital Pasteur Polyclinic of Autoimmune Diseases, no período 2016-2019. Resultados: a população total foi de 62 pacientes, 55/62 (88%) são mulheres. O mais prevalente foi o lúpus eritematoso sistêmico (LES), representando 32% dessa população (20/62), artrite reumatoide em 21% (13/62), esclerose sistêmica em 8% (5 / 62), vasculite sistêmica 8% (5/62), sobreposição de 6% (4/62), Bechet 5% (3/62). Conclusões: Uma clara predominância de lúpus e artrite reumatoide destaca-se como as doenças mais prevalentes, bem como um aumento sustentado de outras patologias menos comuns. É de extrema importância promover o desenvolvimento de unidades especializadas nessas doenças, a fim de melhorar e protocolar o manejo desses pacientes.

RESUMO

Patients with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) demonstrate increased circulating microparticles (MP). These vesicles, primarily those that form immune complexes (MP-IC), may activate monocytes. We evaluated the effect of MP and MP-IC in the differentiation of monocytes to macrophages (monocyte-derived macrophages; MDM) and for consequences in autologous lymphocyte activation. Monocytes from healthy controls (HC) and patients with RA and SLE that differentiated into MDM in the presence of MP-IC showed a proinflammatory (M1-like) profile, which was more evident using MP-IC from patients with RA than those from patients with SLE. Notably, MDM from HC and patients with RA that differentiated with MP-IC were more prone to M1-like profile than those from patients with SLE. In HC and patients with RA, monocyte differentiation using MP-IC decreased the frequency of MDM that bound/internalized latex beads. The M1-like profile did not completely revert following IL-4 treatment. The effect of M1-like MDM on T lymphocytes stimulated with phytohemagglutinin was further evaluated. MDM differentiated with MP enhanced the proliferation of T cells obtained from patients with RA compared with those differentiated with MP-IC or without vesicles. Neither MP nor MP-IC induced interferon (IFN)-γ+ and tumor necrosis factor (TNF)-α+ T cells in patients with RA. Conversely, unlike MDM differentiated with or without MP, MP-IC enhanced the proliferation and increased the frequencies of IFN-γ+CD4+ T, TNF-α+CD4+ T, and IFN-γ+CD8+ T cells in patients with SLE. The co-culture of B cells with MDM obtained from patients with RA and SLE and differentiated with MP-IC increased the expression of B-cell activation markers and prevented B lymphocyte death. Strikingly, only for patients with SLE, these responses seemed to be associated with a significant increase in B-cell activating factor levels, high plasmablast frequency and immunoglobulin production. These results showed that MP-IC from patients with systemic autoimmune diseases favored the polarization of MDM into a proinflammatory profile that promotes T-cell activation, and additionally induced B-cell activation and survival. Therefore, the effect of MP-IC in mononuclear phagocytes may be an important factor for modulating adaptive responses in systemic autoimmune diseases.

Assuntos

RESUMO

BACKGROUND Chronic cardiomyopathy occurs in 20-40% of the patients with Chagas disease. Autoimmune mechanisms may contribute to its pathogenesis. We diagnosed several cases of systemic autoimmune diseases among Bolivian migrants in Geneva with a high prevalence of Chagas disease. OBJECTIVES We tested the hypothesis of a clinical association between systemic autoimmune diseases and Chagas disease, particularly with the development of cardiomyopathy. METHODS We retrospectively searched the medical records of all Bolivian patients visiting Geneva University Hospitals between 2012 and 2015 for diagnosis of Chagas disease or systemic autoimmune diseases. FINDINGS Of the 2,189 eligible patients, 28 [1.3%; 95% confidence interval (CI) = 0.9-1.9%] presented with systemic autoimmune disease. The Chagas status was known in 903 (41.3%) patient, of whom 244 (27.0%; 95% CI = 24.2-30.0%) were positive. Eight (28.6%; 95% CI = 15.3-47.1%) of the 28 cases of systemic autoimmune disease had Chagas disease. We found no association between both entities (p = 1.000) or with Chagasic cardiomyopathy (p = 0.729). Moreover, there was no evidence of a temporal relationship between antiparasitic chemotherapy and the development of systemic autoimmune diseases. CONCLUSIONS Our results do not support a clinical association between chronic Chagas disease and systemic autoimmune diseases. However, prospective studies in areas endemic for Chagas disease should better assess the prevalence of systemic autoimmune diseases and thus a possible relationship with this infection.

Assuntos

RESUMO

Antiphospholipid syndrome (APS) affects young patients in the most productive years of their life, and the consequences of organic or tissue damage involve a decrease in health-related quality of life (HRQoL). While acute disease manifestations of APS are well known, information on the long-term prognosis and damage in affected patients is still very limited. Systemic lupus erythematosus (SLE) patients would be expected to experience long-term complications and even die as a consequence of APS. Organ damage in APS has been evaluated using different methods and definitions, including the SLICC/ACR Damage Index (SDI), which tend to underestimate aPL-related damage. A new damage index in APS has been proposed (DIAPS), and it seems to be more accurate than SDI. Given the implications for morbidity and mortality, it is imperative to assess accurately aPL-related damage and HRQoL in patients with APS.

Assuntos