Os marcadores HLA-DR do lúpus eritematoso sistêmico do brasileiro caucasóide, adulto, do Rio Grande do Sul

A determinação dos antígenos de histocompatibilidade do loco DR de pacientes com lúpus eritematoso sistêmico, brasileiros caucasóides, adultos, do Rio Grande do Sul (25 casos), comparada com a que foi registrada num grupo controle (25 indivíduos caucasóides brasileiros normais) mostrou forte associação entre o HLA-DR3 e a doença (DR3-positivoem 72% dos pacientes e em 12% dos controles, risco relativo 18,86, p corrigindo = 0,0002). A associação da positividade do DR3 e o LES se tornou mais nítida quando foram considerados apenas os 11 pacientes com anti-DNA positivo (DR3-positivo em 10 casos = 91% - risco relativo 73,33 - p corrigido = 0,0001). Os pacientes com LES e nefrite (14 casos) mostraram significativa associação com o DR3 (risco relativo 18,33 - p corrigido = 0,0029). Os 11 pacientes com LES e fenômeno de Raynaud mostraram uma associação menos significativa com o HLA-DR3 (risco relativo 12,83 - p corrigido = 0,03). Embora não se tenha obtido resultados estatísticos significativos (p corrigido = 0,21), notou-se uma tendência da associação de LES com comprometimento do sistema nervoso central (6 casos) e o HLA-DR2 (DR2-positivo em 5 casos - 83%). Não se observou diferenças estatísticas significativas entre os antígenos DR dos subgrupos de idade de início mais jovem e mais tardio, tendo como marco os 30 anos. Não se registou também associação entre antígenos DR e o subgrupo de LES com síndrome de Sjogren (4 casos)

Freqüência dos auto-anticorpos antinucleares e suas associações com manifestações clínico-laboratoriais, numa população de pacientes com lúpus eritematoso sistêmico do Rio Grande do Sul

Com o objetivo de determinar a freqüência dos auto-anticorpos antinucleares e suas associações com manifestações clínico-laboratoriais e entre si, no Lúpus Eritematoso Sistêmico (LES), foi elaborado o presente estudo numa população de 120 pacientes do Rio Grande do Sul.In arder to determine the frequency of antinuclear autoantibodies, their relationships between themselves and with different clinical and laboratory features, 120 patients with Systemic Lupus Rrytbematosus (SLE) from the state of Rio Grande do Sul were studied

First Latin American clinical practice guidelines for the treatment of systemic lupus erythematosus : Latin American Group for the Study of Lupus (GLADEL, Grupo Latino Americano de Estudio del Lupus)–Pan-American League of Associations of Rheumatology (PANLAR)

Systemic lupus erythematosus (SLE), a complex and heterogeneous autoimmune disease, represents a significant challenge for both diagnosis and treatment. Patients with SLE in Latin America face special problems that should be considered when therapeutic guidelines are developed. The objective of the study is to develop clinical practice guidelines for Latin American patients with lupus. Two independent teams (rheumatologists with experience in lupus management and methodologists) had an initial meeting in Panama City, Panama, in April 2016. They selected a list of questions for the clinical problems most commonly seen in Latin American patients with SLE. These were addressed with the best available evidence and summarised in a standardised format following the Grading of Recommendations Assessment, Development and Evaluation approach. All preliminary findings were discussed in a second face-to-face meeting in Washington, DC, in November 2016. As a result, nine organ/system sections are presented with the main findings; an ’overarching’ treatment approach was added. Special emphasis was made on regional implementation issues. Best pharmacologic options were examined for musculoskeletal, mucocutaneous, kidney, cardiac, pulmonary, neuropsychiatric, haematological manifestations and the antiphospholipid syndrome. The roles of main therapeutic options (ie, glucocorticoids, antimalarials, immunosuppressant agents, therapeutic plasma exchange, belimumab, rituximab, abatacept, low-dose aspirin and anticoagulants) were summarised in each section. In all cases, benefits and harms, certainty of the evidence, values and preferences, feasibility, acceptability and equity issues were considered to produce a recommendation with special focus on ethnic and socioeconomic aspects. Guidelines for Latin American patients with lupus have been developed and could be used in similar settings

Combined effects of CXCL8 and CXCR2 gene polymorphisms on susceptibility to systemic sclerosis

AbstractA previous study suggested that the CXCR2 (+1208) TT genotype was associated with increased risk of systemic sclerosis (SSc). In the present study, we investigated the influence of variation in the CXCL8 and CXCR2 genes on susceptibility to SSc and combined the variant alleles of these genes to analyze their effects on SSc.MethodsOne fifty one patients with SSc and 147 healthy bone marrow donors were enrolled in a case-control study. Blood was collected for DNA extraction; typing of CXCL8 (−251) T/A and CXCR2 (+1208) T/C genes was made by polymerase chain reaction with sequence specific primers (PCR-SSP), followed by agarose gel electrophoresis.ResultsThe CXCR2-TC genotype was significantly less frequent in patients (23.8% versus 55.1% in controls; P<0.001, OR=0.26, 95%CI=0.15–0.43), whereas the CXCR2-CC genotype was significantly more frequent (44.4% versus 22.4% in controls; P<0.001, OR=2.76, 95%CI, 1.62–4.72). When CXCR2 and CXCL8 combinations were analyzed, the presence of CXCR2 T in the absence of CXCL8 A (CXCR2 T+/CXCL8 A−) was more frequent in patients than in controls (34.5% versus 3.5%; P<0.001, OR=14.50, 95%CI=5.04–41.40). However, CXCR2 TT and CXCL8 A were significantly more common in controls (100%) than in patients (58.3%) (P<0.001). Likewise, the presence of CXCR2 TC and CXCL8 A was more frequent in controls (95.1%) than in patients (75%) (P=0.004). Furthermore, the CXCR2-CC genotype in CXCL8 A was more frequent in patients (59.7% versus 0% in controls; P<0.001, adjusted OR=98.67, 95%CI=6.04–1610.8). In patients, a high frequency was observed in combination with the CXCL8 TA and AA genotypes (P<0.001; OR=28.92), whereas in controls, there was a high frequency of combination with CXCL8 T (P<0.001; OR=0.03) and TT (P<0.001; OR=0.01). Conclusions: These findings suggest a protective role of CXCL8 (−251) A in the CXCR2 (+1208) TT and TC genotypes and an increased risk of CXCL8 (−251) A in association with the CXCR2 (+1208) CC genotype in SSc patients

Diminished Expression of Complement Regulatory Proteins on Peripheral Blood Cells from Systemic Lupus Erythematosus Patients

CD55, CD59, CD46, and CD35 are proteins with complement regulatory (Creg) properties that ensure cell and tissue integrity when this system is activated. The aim of this study was to evaluate the Creg expression on peripheral blood cells from SLE patients and its association with cytopenia and disease activity. Flow cytometric analyses were performed on blood cells from 100 SLE patients and 61 healthy controls. Compared with healthy controls, we observed in SLE patients with lymphopenia and neutropenia decreased expression of CD55, CD59, and CD46 (P < 0.05). In SLE patients with anemia, CD59 and CD35 were decreased on red blood cells. Furthermore, there was a negative correlation between CD55 and CD59 on neutrophils and the disease activity. The results suggest there is an altered pattern of Creg expression on the peripheral blood cells of SLE patients, and the expression is correlated with disease activity and/or with activation of the complement system