Chloroquine diphosphate: a risk factor for herpes zoster in patients with dermatomyositis/polymyositis

OBJECTIVES: Herpes zoster has been widely described in the context of different systemic autoimmune diseases but not dermatomyositis/polymyositis. Therefore, we analyzed the prevalence, risk factors and herpes zoster outcomes in this population. METHOD: A retrospective cohort study of herpes zoster infections in dermatomyositis/polymyositis patients was performed. The patients were followed at a tertiary center from 1991 to 2012. For the control group, each patient with herpes zoster was paired with two patients without herpes zoster. Patients were matched by gender and the type of myositis, age at myositis onset and disease duration. RESULTS: Of 230 patients, 24 (10.4%) had a histories of herpes zoster (19 with dermatomyositis and five with polymyositis, two-thirds female). The mean age of the patients with herpes zoster was 44.6±16.8 years. No difference between the groups was found regarding cumulative clinical manifestations. Disease activity, autoantibody, muscle and leukogram parameters were also comparable between the groups. No differences in immunosuppressive (alone or in association with other immunosuppressive therapies) or glucocorticoid (current use, medium dose and cumulative dose in the last two months) therapies were found between patients with and without herpes zoster. However, a higher proportion of patients in the herpes zoster group received chloroquine diphosphate compared to the control group. All of the patients received acyclovir; 58.3% of patients had postherpetic neuralgia and no cases of recurrence were reported. Furthermore, individuals who were taking high prednisone doses at the time of the herpes zoster diagnosis had reduced levels of postherpetic neuralgia. CONCLUSIONS: These data suggest that chloroquine diphosphate could predispose patients with dermatomyositis/polymyositis to developing herpes zoster, particularly women and dermatomyositis patients

Prevalência de manifestações clínico-laboratoriais e comorbidades na polimiosite segundo o gênero Prevalence of clinical and laboratory manifestations and comorbidities in polymyositis according to gender

OBJETIVO: Analisar a distribuição e a influência do gênero na polimiosite (PM), quanto às manifestações clínico-laboratoriais, evolução e comorbidades. MÉTODOS: Estudo de coorte retrospectivo, unicêntrico, em que foram avaliados 75 pacientes consecutivos com PM (Bohan e Peter, 1975) entre 1990 e 2010. Os exames complementares referem-se ao início do diagnóstico da PM. RESULTADOS: Este estudo avaliou 52 mulheres e 23 homens (razão 2,3:1), a maioria de cor branca (84,0%), com média de idade de 42,7 ± 13,7 anos (16 a 67 anos), e duração média de doença de 6,9 ± 5,5 anos (0 a 20 anos). Aproximadamente 50% apresentaram recidiva da doença durante o acompanhamento, com 4,0% de óbitos. Apesar disso, dois terços encontravam-se em remissão no desfecho do estudo. Não houve diferença entre os gêneros quanto à distribuição das características demográficas, clínico-laboratoriais, evolução clínica e terapia medicamentosa instituída. Com relação às comorbidades, houve alta prevalência de hipertensão arterial sistêmica (38,7%) e diabetes mellitus (17,3%), igualmente distribuídas entre os gêneros. Verificou-se alta prevalência de depressão e fibromialgia, porém apenas no gênero feminino. CONCLUSÕES: A prevalência de PM entre mulheres foi maior (razão 2,3:1). A prevalência de comorbidades foi alta na casuística estudada, cabendo-nos priorizar seus controles e, assim, oferecer melhor qualidade de vida aos pacientes.<br>OBJECTIVE: To assess gender distribution in polymyositis (PM) and its influence on disease, regarding clinical and laboratory manifestations, outcome and comorbidities. METHODS: Retrospective single-center cohort study assessing 75 consecutive patients with PM (Bohan and Peter, 1975) from 1990 to 2010. Complementary tests were related to early diagnosis of PM. RESULTS: The study assessed 52 women and 23 men (ratio 2.3:1), most of whom white (84.0%), with a mean age of 42.7 ± 13.7 years (16 to 67 years), and mean disease duration of 6.9 ± 5.5 years (0 to 20 years). Approximately 50% experienced disease relapse during follow-up. Nevertheless, two thirds were in remission at the end of this study, with 4.0% of deaths. There was no difference between genders regarding demographic, clinical and laboratory characteristics, clinical outcome and the drug therapy instituted. Regarding comorbidities, there was a high prevalence of hypertension (38.7%) and diabetes mellitus (17.3%), equally distributed between genders. There was also a high prevalence of depression and fibromyalgia, which were only observed among females. CONCLUSIONS: The prevalence of PM was higher among women than among men (2.3:1). Because the prevalence of comorbidities was high in the case series studied, it is worth emphasizing the need for their control to provide better quality of life for patients with PM

Antiphospholipid syndrome and dermatomyositis/polymyositis: a rare association

A associação entre a síndrome antifosfolípide e as miopatias inflamatórias idiopáticas tem sido raramente descrita na literatura. No presente trabalho relatamos dois pacientes com síndrome antifosfolípide diagnosticados com dermatomiosite ou polimiosite. Realizamos também uma revisão da literatura acerca dessa sobreposição de duas entidades autoimunes sistêmicas

Linfadenopatia e lúpus eritematoso sistêmico

A linfadenopatia no lúpus eritematoso sistêmico (LES) é um achado benigno encontrado comumente em jovens, com atividade cutânea e sintomas constitucionais, apresentando boa resposta à corticoterapia. O achado mais frequente à biópsia é a hiperplasia folicular reacional. Relatamos o caso de um paciente que, desde os 13 anos de idade, apresentava surtos recorrentes de linfadenopatia, acompanhados de hepatoesplenomegalia, febre e emagrecimento. Na evolução, apareceram artrite, hipertensão arterial, proteinúria, miocardiopatia e neuropatia periférica. Foi amplamente investigado sem esclarecimento diagnóstico e submetido a tratamento empírico de tuberculose. Somente após cinco anos de evolução firmou-se o diagnóstico de LES e recebeu tratamento específico. O diagnóstico precoce nestes casos é difícil, pois a investigação laboratorial pode ainda não demonstrar presença de autoanticorpos ou hipocomplementemia