Rastreamento da infecção latente por tuberculose em pacientes com artrite idiopática juvenil previamente à terapia anti‐TNF em um país de alto risco para tuberculose

ResumoObjetivoAvaliar, em um país endêmico, a eficácia em longo prazo do rastreamento à procura de infecção latente por tuberculose (ILTB) e profilaxia primária em pacientes com AIJ em uso de bloqueadores do TNF.MétodosTrata‐se de uma coorte retrospectiva que incluiu pacientes com AIJ elegíveis para a terapia anti‐TNF. Os pacientes foram rastreados à procura de ILTB previamente ao uso de anti‐TNF por meio do teste tuberculínico (TT), radiografia de tórax e história de exposição à TB. Os indivíduos foram acompanhados regularmente em intervalos de dois meses.ResultadosIncluíram‐se 69 pacientes com AIJ com idade atual de 17,4±5,8 anos, com média de duração da doença de 5±4,9 anos; 47 pacientes receberam um único anti‐TNF, enquanto 22 foram transferidos para outro anti‐TNF uma ou duas vezes: 57 foram tratados com etanercepte, 33 com adalimumabe e três com infliximabe. O rastreamento à procura de ILTB foi positivo em três pacientes: um era TT positivo e tinha história de exposição à TB e dois apenas eram TT positivo. Não foi diagnosticado caso de TB ativa durante o período de estudo (mediana de seguimento de 3,8 anos).ConclusãoA avaliação em longo prazo revelou que o rastreamento à procura de ILTB e a profilaxia primária antes do tratamento com anti‐TNF foram eficazes em um país de alto risco para TB e o TT foi o parâmetro mais sensível para identificar esses pacientes.AbstractObjectivesTo evaluate, in an endemic country, the long‐term efficacy of latent tuberculosis infection (LTBI) screening and primary prophylaxis in patients with JIA receiving TNF blockers.MethodsThis was a retrospective cohort that included JIA patients eligible to anti‐TNF therapy. Patients were screened for LTBI prior to anti‐TNF using tuberculin skin test (TST), chest X‐ray and history of exposure to TB. Subjects were regularly followed at 2‐month intervals.ResultsSixty‐nine JIA patients with current age of 17.4±5.8 years, mean disease duration of 5.0±4.9 years were included. Forty‐seven patients received a single anti‐TNF, while 22 patients switched to another anti‐TNF once or twice: 57 were treated with etanercepte, 33 patients with adalimumab and 3 infliximab. LTBI screening was positive in three patients: one had TST‐positive and history of TB exposure and two had solely TST‐positive. No active TB was diagnosed during the study period (median of follow‐up was 3.8 years).ConclusionLong‐term evaluation revealed that LTBI screening and primary prophylaxis before anti‐TNF treatment was effective in a high‐risk country and TST was the most sensitive parameter to identify these patients

Periodontal disease and dyslipidemia in juvenile dermatomyositis

Objetivo: A associação entre doença periodontal e dislipidemia foi recentemente reportada em adultos saudáveis. No entanto, a avaliação sistemática e concomitante de doença periodontal e a dislipidemia não foi realizada até o momento em pacientes com dermatomiosite juvenil (DMJ). Métodos: Foi realizado estudo transversal com 25 pacientes com DMJ e 25 controles saudáveis, nos quais foram avaliados os dados demográficos, dados periodontais, perfil lipídico e anticorpo anti-lipoproteínolipase (anti- LPL). Parâmetros de atividade de doença, dados laboratoriais e tratamento foram estudados nos pacientes com DMJ. Resultados: A média de idade foi semelhante quando comparados pacientes com DMJ e controles (11,5±3,75 vs. 11,2±2,58 anos, p=0,703). Em relação ao perfil lipídico, a mediana de triglicérides [80(31-340) vs. 61(19-182)mg/dL, p=0,011] e VLDL [16(6-68) vs. 13(4-36)mg/dL, p=0,020] foi significativamente mais elevada em pacientes com DMJ comparados aos controles. A frequência de vasculopatia gengival também foi significantemente mais elevada no grupo com DMJ (60% vs. 0%, p=0,0001), assim como a mediana de índice de sangramento (IS) [24,1(4,2-69,4) vs. 11,1(0-66,6)%, p=0,001] e a profundidade clínica de sondagem (PCS) [1,7(0,6-2,4) vs.1,4(0-2,12)mm, p=0,006]. A comparação entre pacientes com DMJ com e sem dislipidemia revelou que o índice de placa (IP) [100(26,7-100) vs. 59(25-100)%, p=0,022], PCS [1,9(0,6-2,4) vs. 1,4(1,2- 1,8)mm, p=0,024] e a profundidade clínica de inserção (PCI) [1,31(0,7-1,7) vs. 0,8(0,6-1,7)mm, p=0,005] eram significantemente mais elevados nos pacientes com DMJ e dislipidemia. Foram identificadas correlações positivas (Spearman) entre colesterol total e IP (rs=+0,498, p=0,0114) e entre LDL e IP (rs=+0,421, p=0,0357). Foi observado que pacientes com DMJ e gengivite apresentavam maior tempo de doença (7,09 ± 3,07 vs. 3,95 ± 2,1 anos, p=0,008) quando comparados aos pacientes sem gengivite. Conclusão: o estudo demonstrou que a inflamação gengival parece estar relacionada a dislipidemia em pacientes com DMJ, sugerindo mecanismos semelhantes para ambas as complicações. As alterações dentárias foram mais evidentes quanto maior o tempo de evolução da doençaObjective: Association between periodontal disease and dyslipidemia was recently reported in healthy adults. However, a systematic evaluation of concomitant periodontal diseases and lipid profile was not carried out in juvenile dermatomyositis (JDM). Methods: A cross-section study was performed in 25 JDM patients and 25 healthy controls, assessing demographic data, periodontal evaluation, fasting lipoproteins and anti-lipoprotein lipase antibodies. Disease parameters, laboratorial tests and treatment were evaluated in JDM patients. Results: The mean current age was similar in patients and controls (11.5±3.75 vs. 11.2±2.58 years, p=0.703). Regarding lipid profile, the median triglycerides [80(31-340) vs. 61(19-182)mg/dL, p=0.011] and VLDL [16(6-68) vs. 13(4-36)mg/dL, p=0.020] and were significantly higher in JDM patients versus controls. Gingival vasculopathy pattern was significantly higher in the former group (60% vs. 0%, p=0.0001), as well as the median of gingival bleeding index (GBI) [24.1(4.2-69.4) vs. 11.1(0-66.6)%, p=0.001] and probing pocket depth (PPD) [1.7(0.6-2.4) vs.1.4(0-2.12)mm, p=0.006]. Comparison between JDM patients with and without dyslipidemia revealed that the median of dental plaque index (PI) [100(26.7-100) vs. 59(25-100)%, p=0.022], PPD [1.9(0.6-2.4) vs. 1.4(1.2-1.8)mm, p=0.024] and clinical attachment level (CAL) [1.31(0.7-1.7) vs. 0.8(0.6-1.7)mm, p=0.005] were significantly higher in patients with dyslipidemia. Positive Spearman\'s correlations were found between total cholesterol and PI (rs=+0.498, p=0.0114) and LDL and PI (rs=+0.421, p=0.0357). It was observed that patients with JDM and gingivitis presented longer disease duration (7.09 ± 3.07 vs. 3.95 ± 2.1 years, p=0.008) compared to those without this condition. Conclusion: Our study showed that gingival inflammation seems to be related to dyslipidemia in JDM patients, suggesting underlying mechanisms for both complications. The periodontal abnormalities found were associated with a longer disease duratio

Dyslipidemia in patients with juvenile dermatomyositis

OBJETIVO: Avaliar a presença de dislipidemia em pacientes com dermatomiosite juvenil (DMJ) e seus possíveis fatores de risco. MÉTODO: 25 pacientes com DMJ foram comparados a 25 controles de acordo com dados demográficos, composição corporal, perfil lipídico, glicêmico, autoanticorpos e enzimas musculares. Foram avaliados os instrumentos de atividade da DMJ: Disease Activity Score (DAS), Childhood Myositis Assessment Scale (CMAS), Manual Muscle Testing (MMT), Myositis Disease Activity Assessment Analogue Scale (MYOACT) e Myositis Intention to Treat Activity Index (MYTAX). RESULTADOS: Perfil lipídico alterado foi encontrado em nove pacientes e quatro controles (36% vs. 16%, p=0,196). Os pacientes com DMJ demonstraram níveis significativamente mais elevados de triglicérides (TG) [80 (31-340) vs. 61 (19-182) mg/dl, p=0,011] e maior freqüência de baixos níveis de lipoproteínas de alta densidade (HDL) (28% vs. 4%, p=0,04) quando comparados aos controles. A mediana dos níveis de HDL foi significativamente menor nos pacientes com DMJ com dislipidemia comparados aos DMJ com perfil lipídico normal [29 (0-49) vs. 50 (39-72) mg/dL, p=0,0005], enquanto os níveis TG [128 (31-340) vs. 69 (46- 138) mg/dL, p=0,011] foram significativamente mais elevados no primeiro grupo. Foi observada uma maior freqüência de baixos níveis de HDL (77% vs. 0%, p=0,001) e de níveis elevados de TG (44% vs. 0%, p=0,01) e de colesterol total (CT) (33 vs. 0%, p=0,03) no grupo de pacientes com DMJ com dislipidemia. O anticorpo anti-LPL foi positivo em apenas um paciente com perfil lipídico alterado. Pacientes com DMJ com dislipidemia apresentaram níveis significativamente mais elevados de velocidade de hemossedimentação (VHS) (26 vs. 14,5 mm/1a hora, p=0,006), proteína C reativa (PCR) (2,1 vs. 0,4 mg/dL, p=0,01), DAS (6 vs. 2, p=0,008), MYOACT (0,13 vs. 0,01, p=0,012) e MYTAX 0,06 vs. 0, p=0,018) e escores mais baixos de CMAS (47 vs. 52, p=0,024) e MMT (78 vs. 80, p=0,001) comparados aos pacientes com DMJ sem dislipidemia. Os níveis de TG apresentaram correlações positivas com PCR (r=0,697, p=0,001), DAS (r=0,610, p=0,001), MYOACT (r=0,661, p=0,001) e MYTAX (r=0,511, p=0,008) e correlações negativas com CMAS (r= - 0,506, p=0,009) e MMT (r= - 0,535, p=0,005). Nenhuma diferença entre estes grupos foi encontrada em relação ao IMC, composição corporal, presença de lipodistrofia, anticorpos anti-LPL e terapêutica (doses atuais e cumulativas de prednisona, metotrexato e cloroquina) (p>0,05), exceto pela frequência significativamente mais elevada do uso de ciclosporina nos pacientes com DMJ dislipidêmicos (33% vs. 0%, p=0,03). CONCLUSÃO: A dislipidemia em pacientes com DMJ se caracterizou por elevação de níveis séricos de TG e diminuição de HDL, sendo a atividade da doença e o uso da ciclosporina os principais fatores associados a esta alteração metabólicaOBJECTIVE: To evaluate the presence of dyslipidemia in JDM and its possible risk factors. METHODS: 25 JDM patients were compared to 25 healthy controls according to demographic data, body composition, fasting lipoproteins, glycemia, insulin, antibodies and muscle enzymes. The following JDM scores were assessed: Disease Activity Score (DAS), Childhood Myositis Assessment Scale (CMAS), Manual Muscle Testing (MMT), Myositis Disease Activity Assessment Analogue Scale (MYOACT) and Myositis Intention to Treat Activity Index (MYTAX). RESULTS: Abnormal lipid profile was found in nine patients (36%) and four controls (16%) (p=0.196). JDM patients demonstrated significant higher levels of triglycerides (TG) [80 (31- 340) vs. 61 (19-182) mg/dL, p=0.011] and higher frequency of abnormal levels of high density lipoproteins (HDL) (28 vs. 4%, p=0.04) when compared to controls. JDM patients with dyslipidemia demonstrated significant lower median HDL levels compared to those without this condition [29 (0-49) vs. 50 (39-72) mg/dL, p=0.0005] and also had significant higher TG levels [128 (31- 340) vs. 69 (46-138) mg/dL, p=0.011]. Higher frequency of low HDL levels (77% vs. 0%, p=0.0001), and also a higher frequency of increased levels of TG (44% vs. 0%, p=0.01), and TC (33% vs. 0%, p=0.03) were observed in JDM patients with dyslipidemia. Positive anti-LPL antibody was detected in just one JDM patient with abnormal lipid profile. JDM with dyslipidemia had higher ESR (26 vs 14.5mm/1sthour, p=0.006), CRP (2.1 vs 0.4mg/dL, p=0.006), DAS (6 vs. 2, p=0.008), MYOACT (0.13 vs. 0.01, p=0.012), MYTAX (0.06 vs. 0, p=0.018), and lower scores of CMAS (47 vs. 52, p=0.024) and MMT (78 vs. 80, p=0.001) compared to JDM without dyslipidemia. Positive correlations were detected between TG levels and CRP (r=0.697, p=0.001), DAS (r=0.610, p=0.001), MYOACT (r=0.661, p=0.001), MYTAX (r=0.511, p=0.008), and negative correlations with CMAS (r=-0.506, p=0.009) and MMT (r=-0.535, p=0.005). No differences were found between these groups regarding body mass index, body composition, lipodystrophy, anti-LPL antibodies, and treatment (current and cumulative doses of prednisone, methotrexate and hydroxichloroquine) (p>0.05), except by higher frequency of cyclosporine use in patients with dyslipidemia (33 vs. 0%, p=0.03). CONCLUSIONS: Dyslipidemia in JDM patients was characterized by increased levels of TG and low levels of HDL, and disease activity and cyclosporine use were the mainly factors associated to these metabolic abnormalitie

Latent tuberculosis infection screening in juvenile idiopathic arthritis patients preceding anti-TNF therapy in a tuberculosis high-risk country

Abstract Objectives: To evaluate, in an endemic country, the long-term efficacy of latent tuberculosis infection (LTBI) screening and primary prophylaxis in patients with JIA receiving TNF blockers. Methods: This was a retrospective cohort that included JIA patients eligible to anti-TNF therapy. Patients were screened for LTBI prior to anti-TNF using tuberculin skin test (TST), chest X-ray and history of exposure to TB. Subjects were regularly followed at 2-month intervals. Results: Sixty-nine JIA patients with current age of 17.4 ± 5.8 years, mean disease duration of 5.0 ± 4.9 years were included. Forty-seven patients received a single anti-TNF, while 22 patients switched to another anti-TNF once or twice: 57 were treated with etanercepte, 33 patients with adalimumab and 3 infliximab. LTBI screening was positive in three patients: one had TST-positive and history of TB exposure and two had solely TST-positive. No active TB was diagnosed during the study period (median of follow-up was 3.8 years). Conclusion: Long-term evaluation revealed that LTBI screening and primary prophylaxis before anti-TNF treatment was effective in a high-risk country and TST was the most sensitive parameter to identify these patients