RESUMO
Blastocystis hominis is a common human parasite with infection rates up to 50% in developing countries, and giardiasis is the commonest intestinal one in Mexico. No doubt, various parasites as Giardia lamblia and Entamoeba histolytica can cause rheumatic diseases. This study coproparasitoscopic analysis evaluated the cysts by B. hominis, G. lamblia, E. hartmani, E. coli and E. histolytica in Mexican rheumatic disease patients. Also, ELISA was used to detect E. histolytica, Ascaris lumbricoides, Toxocara canis, and Trichinella spiralis in Mexican patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS). Thirty-six patients (24 with AS and 12 with RA) and 77 healthy control individuals were enrolled in this study. The frequencies of protozoan cysts were comparable in rheumatic disease patients (AS and RA) and healthy control donors (33 and 25 vs. 26%, respectively; p > 0.05). The frequency of antibodies to T. canis was significantly higher in AS patients than in healthy control donors (16 vs. 2.6%, respectively; p = 0.027), whereas no differences were observed for the prevalence of antibodies for the other parasites (E. histolytica, A. lumbricoides and T. spiralis) (p > 0.05). This information indicates the need to intensify educational efforts for the prevention of parasite infections associated with AS disease that cannot be controlled only by drugs.
Assuntos
Enteropatias Parasitárias/complicações , Doenças Reumáticas/complicações , Espondilite Anquilosante/complicações , Adolescente , Adulto , Anticorpos Anti-Helmínticos/sangue , Anticorpos Antiprotozoários/sangue , Estudos de Casos e Controles , Ensaio de Imunoadsorção Enzimática , Fezes/parasitologia , Feminino , Helmintíase/complicações , Helmintíase/epidemiologia , Humanos , Enteropatias Parasitárias/epidemiologia , Masculino , México , Pessoa de Meia-Idade , Prevalência , Infecções por Protozoários/complicações , Infecções por Protozoários/epidemiologia , Adulto JovemRESUMO
Systemic lupus erythematosus (SLE) is a clinical syndrome of varying severity. Although the survival and prognosis of SLE have steadily improved, there is a group of patients who present an acute fatal outcome despite aggressive therapy. We designed this study to evaluate the factors associated with mortality in patients with acute severe SLE. During 2004-06, 41 Mexican SLE patients that could not be managed in the out-patient clinic and with acute severe major organ system involvement [nephritis, severe thrombocytopenia (platelet count below 20 000 per microL) acute neuropsychiatric pulmonary, gastrointestinal or cardiac disease and generalized vasculitis] were studied. During the first admission, disease activity (SLE Disease Activity Index (SLEDAI), SLE Activity Measured), damage [SLE International Collaborating Clinics (SLICC)], and therapy were assessed. Survival using Kaplan-Meier curves, odd ratios with 95% confidence interval and logistic regression analysis were used to determine risk factors for mortality. Ninety percent were female with a mean age of 29 +/- 19 years and mean disease duration of 21 +/- 9 months. The principal causes of first admission were renal (27%), SNC (22%) and cardiopulmonary (15%). After a mean follow-up of 9.7 +/- 6 months, 16 (39%) patients died. Deceased patients had significantly higher SLEDAI (P = 0.004), and SLICC (P = 0.03) scores. The manifestations associated with mortality were renal disease activity (odds ratio, OR 4.6, confidence interval, CI 95% 1.0-20.6), infections (OR 3.2 CI 95% 2.0-5.3) and thrombocytopenia (OR 4.0, CI 95% 1.0-15.9). The survival at 9.7 months was 72, 62 and 50% in patients with an SLEDAI score of 3-10, 11-20 and > or =21, respectively. The SLEDAI score, the presence of damage and infection were associated with death in patients with acute severe SLE.
Assuntos
Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/mortalidade , Índice de Gravidade de Doença , Doença Aguda , Adolescente , Adulto , Estudos de Coortes , Hospitalização , Humanos , Infecções/complicações , Infecções/mortalidade , Estimativa de Kaplan-Meier , Nefrite Lúpica/mortalidade , Masculino , México/epidemiologia , Razão de Chances , Trombocitopenia/complicações , Trombocitopenia/mortalidadeRESUMO
The objective of this study was to assess the incidence and risk factors of infections in 200 SLE outpatients. All outpatients with active or inactive SLE without infections in the previous month were included. They were assessed every 3 months. Major infections were those requiring hospitalization and parental antibiotic therapy; minor infections required oral or topical therapy. Sociodemographic, disease activity using the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), therapy and laboratory variables were evaluated. After a follow-up of 22+/-7 months, 65 (32%) patients had infections; 35% of those were major. The most common sites for infection were urinary (26%), skin (23%), systemic (12%), and vaginal (9%). At infection onset, 50 of 65 patients (77%) had disease activity, with a mean SLEDAI score of 6.1. The variables significantly associated with infection in the univariate analyses were the presence of disease activity, SLEDAI score, renal activity, prednisone dose, and IV cyclophosphamide. The only variable associated with infection in the multivariate analyses was a SLEDAI score of 4 or higher. Most infections in SLE outpatients were single, minor, non-life threatening, and associated with disease activity independently of sociodemographic and therapeutic factors.
Assuntos
Infecções/etiologia , Lúpus Eritematoso Sistêmico/complicações , Adulto , Feminino , Seguimentos , Humanos , Infecções/epidemiologia , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais , Estudos Prospectivos , Fatores de RiscoRESUMO
The authors' objective was to determine by 2-dimensional echo Doppler (2DECHO) the cardiac abnormalities in juvenile onset ankylosing spondylitis (JOAS) and adult onset ankylosing spondylitis (AOAS) in male patients with long-term disease. Twenty patients with JOAS, 31 with AOAS, and 20 healthy controls of the same age and gender without cardiopulmonary symptoms were studied. Using 2DECHO, the heart dimensions were determined according to American Society of Echocardiography guidelines. The left ventricle ejection fraction (LVEF) was calculated by Teichholz's formula. Cardiomyopathy was established when 2DECHO had diminished LVEF. Statistics used were the Student t and Fisher test, chi2, and ANOVA. Ninety percent of JOAS and 51% of AOAS patients were B27+ (p=0.005). The disease duration was 19.3 +/- 8.8 years in JOAS and 14.8 +/- 12.8 years in AOAS (p=NS). Age at the time of the study was 30.7 +/- 9.9 years in JOAS vs 40.3 +/- 12.7 in AOAS (p=0.003), and vs 40.2 +/- 17 years in controls (p=NS). There was a higher frequency of cardiomyopathy in AOAS (32.2%) than in JOAS (25%) and the controls (0%) (p=0.01). Patients with JOAS had a higher mitral valve gradient (25%) than AOAS patients (19%, p=NS) and controls (0%, p=0.04). Abnormal aortic ring reflectance was shown in 19% of AOAS vs 0% abnormalities in JOAS and controls (p=0.01). The aortic root diameter was increased in 58% of AOAS, 30% of JOAS, and 0% of controls (p=0.001). The frequency of 2DECHO abnormalities was increased in cardiopulmonary asymptomatic spondylitis patients. Despite the high frequency of B27+, JOAS had a lower frequency of aortic abnormalities than AOAS. Mitral valve gradient was found in JOAS and in AOAS that could contribute to a decreased ejection fraction and to left ventricular dysfunction.
Assuntos
Ecocardiografia Doppler/métodos , Doenças das Valvas Cardíacas/diagnóstico por imagem , Espondilite Anquilosante/complicações , Disfunção Ventricular Esquerda/diagnóstico por imagem , Adolescente , Adulto , Distribuição por Idade , Idade de Início , Análise de Variância , Valva Aórtica/diagnóstico por imagem , Criança , Pré-Escolar , Intervalos de Confiança , Doenças das Valvas Cardíacas/epidemiologia , Doenças das Valvas Cardíacas/etiologia , Humanos , Incidência , Masculino , Valva Mitral/diagnóstico por imagem , Valores de Referência , Medição de Risco , Sensibilidade e Especificidade , Espondilite Anquilosante/epidemiologia , Disfunção Ventricular Esquerda/epidemiologia , Disfunção Ventricular Esquerda/etiologiaRESUMO
We describe a clinical case of juvenile ankylosing spondylitis (AS) that developed "pseudo-chronic tendinitis" of the foot. A 20-year-old male patient had HLA-B27 positive juvenile AS since he was 13 years old. At the age of 19 he presented chronic pain in the dorsum of the left foot. Examination disclosed an increased volume of the tarsal dorsum, with rubbery consistency, with no evidence of venous or lymphatic insufficiency, godette, or inflammation in laboratory tests, giving the foot the appearance of a tamale. Synovectomy of the foot extensor tendon sheath was followed by relief of pain and swelling. Histopathological study showed a deposit of acid mucopolysaccharides (MPS) with no inflammatory cell infiltrate. Tamale foot in juvenile AS may develop as a consequence of acid MPS deposit with no evidence of synovial inflammation. The good response to synovectomy suggests this is the preferred treatment for tamale foot.
Assuntos
Doenças do Pé/etiologia , Doenças do Pé/patologia , Glicosaminoglicanos/metabolismo , Espondilite Anquilosante/complicações , Membrana Sinovial/patologia , Tendinopatia/etiologia , Tendinopatia/patologia , Adolescente , Doenças do Pé/classificação , Humanos , Masculino , México , Membrana Sinovial/metabolismo , Membrana Sinovial/fisiopatologia , Tendinopatia/classificaçãoRESUMO
The Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) Damage Index is a validated instrument specifically designed to ascertain damage in SLE; this instrument has been applied mainly to Caucasians and African-American SLE patients. The objective of this study was to assess damage using the SLICC/ACR Damage Index in Mexican SLE patients. The SLICC/ACR Damage Index was applied to 210 consecutive SLE patients with disease of variable duration. The SLICC/ACR Damage Index was assessed by review of hospital clinical records, interview and physical examination. One hundred and seventeen (55.5%) patients had some damage. The proportion of patients with damage increased significantly with disease duration (33% at 1-60 months, 66% at 61-120 months and 70% at > or = 121 months, P < 0.001). The main organ systems involved were musculoskeletal (osteonecrosis), neuropsychiatric (neuropathy, seizures), gonadal (amenorrhea prior to age 40 years), ocular (cataracts), renal (glomerular filtration < 50%) and peripheral vascular (permanent damage by venous thrombosis). Damage was frequent, increased over time, particularly for ocular, renal, musculoskeletal and gonadal. Patients who experienced damage were older, had a longer disease duration, a greater number of ACR criteria at diagnosis, and were more likely to have renal involvement and antibodies to dsDNA. The damage occurred in many different domains and started to develop early after disease onset. Mexican patients had more peripheral vascular and gonadal involvement compared with published data from non-Hispanic SLE populations.
Assuntos
Indicadores Básicos de Saúde , Lúpus Eritematoso Sistêmico/epidemiologia , Atividades Cotidianas , Adulto , Fatores Etários , Idade de Início , Oftalmopatias/complicações , Feminino , Doenças Urogenitais Femininas/complicações , Inquéritos Epidemiológicos , Humanos , Nefropatias/complicações , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/psicologia , Masculino , Doenças Urogenitais Masculinas , México/epidemiologia , Pessoa de Meia-Idade , Doenças Musculoesqueléticas/complicações , Doenças do Sistema Nervoso/complicações , Doenças Vasculares Periféricas/complicações , Índice de Gravidade de Doença , Fatores de TempoRESUMO
OBJECTIVE: To compare the clinical course; laboratory and radiological features of women and men with ankylosing spondylitis (AS). METHODS: Retrospective review of charts of 41 women and 41 men with AS (25 B27+ and 16 B27- in each group) individually matched for age at onset and disease duration. RESULTS: No differences were observed in the clinical picture in either sex, but the disease was less severe in women than in men with lesser duration of uveitis attacks, lower leukocyte counts (p < 0.05), lower levels of gamma-globulins (p < 0.05), and longer asymptomatic periods. At the end of the study, women had less restriction of spinal extension (p = NS), less sequelae of uveitis without significant visual loss (p = NS), required fewer hip replacements, had less frequency of bamboo spine (p < 0.02), and better functional class (p < 0.0027) than men. CONCLUSION: There are no significant clinical or radiographic differences between women and men with AS. However, the disease was more severe in men and these features may be due to sexual dimorphism.
Assuntos
Espondilite Anquilosante/fisiopatologia , Adolescente , Adulto , Feminino , Humanos , Contagem de Leucócitos , Masculino , Prevalência , Radiografia , Estudos Retrospectivos , Caracteres Sexuais , Espondilite Anquilosante/diagnóstico por imagem , Espondilite Anquilosante/epidemiologia , gama-Globulinas/análiseRESUMO
Testicular function was studied in 22 patients with ankylosing spondylitis (AS) with serum measurements of hormone levels, seminal fluid analysis and testicular reserve test. Results were correlated with disease activity. The abnormal findings were elevated luteinizing hormone (LH), inversion of estradiol/testosterone ratio (E2:T) and diminished testicular reserve for testosterone (T) and slightly increased for estradiol (E2). Nine patients with severe active AS received biweekly 2,500 IU of human chorionic gonadotrophin injections with a resulting increase in E2 serum levels. When the values of E2 reached 40 pg/ml or higher, there was a decrease of the sedimentation rate (p less than 0.05) and a reversal to normal of the E2:T ratio. This was accompanied by an improvement in AS at the 10th week that lasted up to 9 weeks after discontinuation of treatment. Our findings suggest a possible role of sex hormones in the physiopathogenesis of AS and offers a possible therapeutic alternative.
Assuntos
Gonadotropina Coriônica/uso terapêutico , Espondilite Anquilosante/fisiopatologia , Testículo/fisiologia , 20-alfa-Di-Hidroprogesterona/sangue , Adulto , Androgênios/sangue , Estradiol/sangue , Hormônio Foliculoestimulante/sangue , Humanos , Hormônio Luteinizante/sangue , Masculino , Prolactina/sangue , Espondilite Anquilosante/sangue , Espondilite Anquilosante/tratamento farmacológico , Testículo/efeitos dos fármacos , Testosterona/sangueRESUMO
Serum glucose, serum immunoreactive insulin and sedimentation rate (ESR) were measured in eighteen male patients with ankylosing spondylitis (AS) and seven male healthy controls. The findings were correlated with the presence or absence of inflammatory activity of the disease. Fourteen patients had active AS with ESR of 47.0 +/- 27.7 mm; they had increased insulin levels measured as area under curve (AUC) of a glucose tolerance test 107.4 +/- 44.1 cm2 vs controls 40.8 +/- 12.6 cm2 (p less than 0.03). In 4 patients with clinically inactive AS and with ESR of 17.0 +/- 4.0 mm the insulin levels as the AUC were 83.2 +/- 38.0 cm2 vs controls (p = ns). In the whole group there was a direct correlation between ESR and serum immunoreactive insulin levels (r = 0.47 p less than 0.05). Our study suggests that AS may be associated with hyperinsulinism, whose role in the physiopathogenesis of the disease remains unknown.