Suicide risk in systemic lupus erythematosus: a narrative review

Introduction: the restrictions imposed by the disease and the perception of personal and social losses related to its course, despite the medical and scientific advances, reinforce fear and generate intense suffering in lupus patients. Psychiatric comorbidities, especially major depressive episodes, are highly prevailing during the course of systemic lupus erythematosus. Among them, suicide is a behavior that is much more common then we believe. Objective: to perform a narrative review on suicidal behavior associated with systemic erythematosus lupus (SLE). Results: studies have shown an increased risk of suicide among patients with chronic diseases and psychiatric disorder, especially depression. However, suicide occurrence cannot be attributed only to a higher prevalence of depression and other mental illnesses. It is necessary to learn more about the suicide risk factors that can be present in patients with lupus to work on a secondary prevention, and avoid not only the premature loss of lives but also the additional suffering of families and surrounding communities. The coordination between the studies on suicidal behavior and its complex network of individual and sociocultural factors and the studies on this multisystem autoimmune disease with a wide manifestation spectrum, which is lupus, creates a new and important field of research. Conclusion: non-psychiatrist office-based physicians, health clinics, or wards dedicated to the treatment of SLE should be able to recognize and handle the suicide risk factors on their patients in order to reduce the suffering caused by this disease

SHOENFELD`S SYNDROME AFTER PANDEMIC INFLUENZA A/H1N1 VACCINATION

Recently, reports have suggested grouping different autoimmune conditions that are triggered by external stimuli as a single syndrome called autoimmune/inflammatory syndrome induced by adjuvants (ASIA). This syndrome is characterized by the appearance of myalgia, myositis, muscle weakness, arthralgia, arthritis, chronic fatigue, sleep disturbances, cognitive impairment and memory loss, and the possible emergence of a demyelinating autoimmune disease caused by systemic exposure after vaccines and adjuvants. In the current study, the authors reported the first Brazilian case of a woman who developed ASIA, which was characterized by arthralgia, changes in inflammatory markers, and chronic fatigue, after the pandemic anti-influenza A/H1N1 vaccine without causing any other rheumatic disease, and it had a positive outcome.Federico FoundationCNPq[300665/2009-1

Chorea in primary antiphospholipid syndrome is associated with rheumatic fever

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)The aim of the study is to evaluate the frequency of chorea in a cohort of primary antiphospholipid syndrome (PAPS) patients and their possible clinical and laboratory associations. The records of 88 PAPS patients, fulfilling Sapporo criteria, followed up at the rheumatology outpatient clinic, were analyzed in order to determine the frequency of chorea. Risk factors for chorea, clinical manifestations, associated comorbidities, serologic features and treatment strategies were analyzed. Eighty-eight PAPS patients were evaluated. Mean age was 40.6 +/- A 11.1 years, and 91% of them were Caucasian and 91% women. Four (4.5%) patients with chorea were identified: 2 of them (50%) had only one chorea episode and 2 (50%) had recurrent chorea. All patients had chorea onset before PAPS diagnosis. Mean age, gender and ethnical distribution were comparable in groups with or without seizures (P > 0.05). Interestingly, the comparison of the 4 PAPS patients with chorea with those without this abnormality (n = 84) demonstrated a lower BMI [21.1 (18-24.2) vs. 27.5 (17.5-40.9) kg/m(2), P = 0.049] and frequency of venous events (0 vs. 63.1%, P = 0.023) in the first group. A higher frequency of rheumatic fever (75% vs. 0, P 0.05). This study demonstrated that 4.5% of PAPS patients had chorea, predominately before PAPS diagnosis, and this neurological abnormality was associated with rheumatic fever and thrombocytopenia. These data reinforce the need for RF diagnosis in those PAPS patients with chorea.32928572861Federico FoundationConselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq

Chorea in primary antiphospholipid syndrome is associated with rheumatic fever

The aim of the study is to evaluate the frequency of chorea in a cohort of primary antiphospholipid syndrome (PAPS) patients and their possible clinical and laboratory associations. The records of 88 PAPS patients, fulfilling Sapporo criteria, followed up at the rheumatology outpatient clinic, were analyzed in order to determine the frequency of chorea. Risk factors for chorea, clinical manifestations, associated comorbidities, serologic features and treatment strategies were analyzed. Eighty-eight PAPS patients were evaluated. Mean age was 40.6 +/- A 11.1 years, and 91% of them were Caucasian and 91% women. Four (4.5%) patients with chorea were identified: 2 of them (50%) had only one chorea episode and 2 (50%) had recurrent chorea. All patients had chorea onset before PAPS diagnosis. Mean age, gender and ethnical distribution were comparable in groups with or without seizures (P > 0.05). Interestingly, the comparison of the 4 PAPS patients with chorea with those without this abnormality (n = 84) demonstrated a lower BMI [21.1 (18-24.2) vs. 27.5 (17.5-40.9) kg/m(2), P = 0.049] and frequency of venous events (0 vs. 63.1%, P = 0.023) in the first group. A higher frequency of rheumatic fever (75% vs. 0, P < 0.001) and thrombocytopenia (75 vs. 21.4%, P = 0.041) was observed in PAPS individuals with chorea. Both groups were alike regarding the other clinical APS manifestations, disease duration, risk factors for cerebrovascular diseases, use of drugs and antiphospholipid antibodies (P > 0.05). This study demonstrated that 4.5% of PAPS patients had chorea, predominately before PAPS diagnosis, and this neurological abnormality was associated with rheumatic fever and thrombocytopenia. These data reinforce the need for RF diagnosis in those PAPS patients with chorea.Federico FoundationFederico FoundationCNPq [300665/2009-1, 2009/06049-6]CNPqFAPESP [2008/02917-0]FAPES