DANIELA MENCARONI RODRIGUES LOURENCO
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- Sexual function in female juvenile idiopathic arthritis patients(2019) PITTA, Ana Claudia; FERREIRA, Gabriela Ribeiro Viola; TOMIOKA, Renato Bussadori; LOURENCO, Daniela Mencaroni Rodrigues; KOZU, Katia; AIKAWA, Nadia Emi; SALLUM, Adriana Maluf Elias; CAMPOS, Lucia Maria Arruda; ABDO, Carmita Helena Najjar; PEREIRA, Rosa Maria Rodrigues; BARACAT, Edmund Chada; BONFA, Eloisa; SILVA, Clovis ArturObjective: To evaluate sexual function female adolescents and young adults with juvenile idiopathic arthritis (JIA) and healthy controls. Methods: After exclusion, 21 female adolescent and young JIA patients and 25 healthy controls were selected for this study. Sexual function was assessed by the Sexual Quotient Questionnaire for Females (SQQ-F) score, which is a validated tool and adapted for Brazilian Portuguese language. Demographic data, JIA clinical/laboratory parameters and treatment were also assessed. Results: The median current age [26.5 (17-38.1) vs. 29.3 (19.7-35.8) years, p = 0.700)] as well as age at the first sexual activity [18 (14-30) vs. 17 (10-24) years, p = 0.158] were similar in JIA patients and healthy controls. The median of SQQF score was alike in both groups [75.9 (50-92) vs. 78.2 (58-94), p = 0.529], as well as frequencies of sexual dysfunction (14% vs. 12%, p = 1.000). The frequencies of all sexual domains (desire/sexual fantasies, desire/interest, arousal/foreplay, arousal/lubrication, arousal/in tune with partner, penetration/relaxation, pain/penetration, desire/involvement, orgasm and general satisfaction scores) were similar in JIA patients and healthy controls (p > 0.05). Conclusions: To our knowledge, this was the first study using a validated sexual score in a chronic arthritis population suggesting a low frequency of overall sexual dysfunction in young JIA patients. Future multicenter studies with a large sample will be necessary to confirm this finding.
- Idiopathic musculoskeletal pain, musculoskeletal pain syndromes, and use of electronic devices in adolescents with asthma(2022) NASTRI, Mariana Machado Forti; LOURENCO, Benito; QUEIROZ, Ligia Bruni; SILVA, Luiz Eduardo Vargas da; LOURENCO, Daniela Mencaroni Rodrigues; CASTRO, Ana Paula Beltran Moschione; SILVA, Clovis Artur; PASTORINO, Antonio CarlosObjective: To evaluate idiopathic musculoskeletal pain, musculoskeletal pain syndromes, and use of electronic devices in adolescents with asthma and healthy controls. Methods: Cross-sectional study was conducted on 150 asthmatic adolescents and 300 controls. Adolescents completed a self-administered questionnaire regarding painful symptoms, use of electronic devices, and physical activity. Seven musculoskeletal pain syndromes were evaluated, and Asthma Control Test (ACT) was assessed. Results: Musculoskeletal pain (42% vs. 61%, p = 0.0002) and musculoskeletal pain syndromes (2.7% vs. 15.7%, p = 0.0006) were significantly lower in asthmatic adolescents than in controls. The frequency of pain in the hands and wrists was reduced in asthmatic than in controls (12.6% vs. 31.1%, p = 0.004), in addition to cell phone use (80% vs. 93%, p < 0.0001), simultaneous use of at least two electronic media (47% vs. 91%, p < 0.0001), myofascial syndrome (0% vs. 7.1%, p = 0.043), and tendinitis (0% vs. 9.2%, p = 0.008). Logistic regression analysis, including asthma with musculoskeletal pain as the dependent variable, and female sex, ACT > 20, simultaneous use of at least two electronic devices, cell phone use, and weekends and weekdays of cell phone use, as independent variables, showed that female sex (odds ratio [OR], 2.06; 95% confidence interval [CI], 1.929-6.316; p = 0.0009) and ACT >= 20 (OR, 0.194; 95% CI, 0.039-0.967; p = 0.045) were associated with asthma and musculoskeletal pain (Nagelkerke R-2 = 0.206). Conclusions: Musculoskeletal pain and musculoskeletal pain syndromes were lower in adolescents with asthma. Female sex was associated with musculoskeletal pain in asthmatic, whereas patients with asthma symptoms and well-controlled disease reported a lower prevalence of musculoskeletal pain. (C) 2021 Sociedade Brasileira de Pediatria.
- Musculoskeletal pain and musculoskeletal syndromes in adolescents are related to electronic devices(2018) QUEIROZ, Ligia Bruni; LOURENCO, Benito; SILVA, Luiz Eduardo Vargas; LOURENCO, Daniela Mencaroni Rodrigues; SILVA, Clovis ArturObjective: To evaluate television and simultaneous electronic devices use in adolescents with musculoskeletal pain and musculoskeletal pain syndromes. Methods: A cross-sectional study was performed in 299 healthy adolescents of a private school. All students completed a self-administered questionnaire, including: demographic data, physical activities, musculoskeletal pain symptoms, and use of simultaneous television/electronic devices (computer, Internet, electronic games, and cell phones). Seven musculoskeletal pain syndromes were also evaluated: juvenile fibromyalgia, benign joint hypermobility syndrome, myofascial syndrome, tendinitis, bursitis, epicondylitis, and complex regional pain syndrome. Results: Inter-rater agreement between pretest and retest was 0.83. Musculoskeletal pain and musculoskeletal pain syndrome were found in 183/299 (61%) and 60/183 (33%), respectively. The median age (15 [10-18] vs. 14 [10-18] years, p = 0.032) and years of education (10 [5-12] vs. 9 [5-12] years, p = 0.011) were significantly higher in adolescents with musculoskeletal pain when compared with those without this condition. The frequencies of female gender (59% vs. 47%, p= 0.019), cell phone use (93% vs. 81%, p= 0.003), and simultaneous use of at least two electronic devices (80% vs. 67%, p= 0.011) were significantly higher in the former group. Further comparisons between adolescents with and without musculoskeletal pain syndromes revealed that the frequency of female gender was significantly higher in the former group (75% vs. 25%, p= 0.002), and with a significantly reduced median of weekends/holidays electronic games use (1.5 [0-10] vs. 3 [0-17] h/day, p=0.006). Conclusions: A high prevalence of musculoskeletal pain/syndromes was observed in female adolescents. Musculoskeletal pain was mostly reported at a median age of 15 years, and students used at least two electronic devices. Reduced use of electronic games was associated with musculoskeletal pain syndromes. (C) 2017 Sociedade Brasileira de Pediatria.
bookPart Artrite(2022) PUGLIESE, Camila; LOURENçO, Daniela Mencaroni Rodrigues; FERREIRA, Gabriela Ribeiro Viola; KOZU, Katia Tomie; SILVA, Clovis Artur Almeida da- Health-related quality of life evaluated by Pediatric Quality of Life Inventory 4.0 in pediatric leprosy patients with musculoskeletal manifestations(2015) NEDER, Luciana; WEELDEN, Marlon van; VIOLA, Gabriela Ribeiro; LOURENCO, Daniela Mencaroni; LEN, Claudio A.; SILVA, Clovis A.Objective: To evaluate the health-related quality of life (HRQL) in pediatric leprosy patients. Methods: A cross-sectional study included 47 leprosy patients and 45 healthy subjects. The HRQL was measured by Pediatric Quality of Life Inventory 4.0 (PedsQL 4.0), and evaluated physical, emotional, social and school domains. The leprosy patients were classified by Ridley and Jopling classification criteria and assessed according to clinical musculoskeletal manifestations, laboratory and radiographic examinations. Results: The median of current age was similar in leprosy patients and controls [12(6-18) vs. 15(5-18) years, p = 0.384], likewise the frequencies of female gender (p = 0.835) and middle/lower Brazilian socio-economic classes (p = 1.0). The domain school activities according the child-self report was significantly lower in leprosy patients compared to controls in the age group of 13-18 years [75(45-100) vs. 90(45-100), p = 0.021]. The other domains were alike in both groups (p > 0.05). At least one musculoskeletal manifestation (arthralgia, arthritis and/or myalgia) was observed in 15% of leprosy patients and none in controls (p = 0.012). Further comparison between all leprosy patients showed that the median of the physical capacity domain [81.25(50-100) vs. 98.44(50-100), p = 0.036] and school activities domain by child-self report [60(50-85) vs. 80(45-100), p = 0.042] were significantly lower in patients with musculoskeletal manifestations compared to patients without these manifestations. No differences were evidenced between the other HRQL parameters in both groups, reported by patients and parents (p > 0.05). Conclusions: Reduced physical capacity and school activities domains were observed in pediatric leprosy patients with musculoskeletal manifestations.
- Borderline tuberculoid leprosy in childhood onset systemic lupus erythematosus patient(2015) LOPES, V. A. P.; LOURENCO, D. M. R.; GUARIENTO, A.; TRINDADE, M. A.; AVANCINI, J.; SILVA, C. A.Leprosy is a contagious and chronic systemic granulomatous disease caused by the bacillus Mycobacterium leprae. To our knowledge, no case of leprosy in a childhood-onset systemic lupus erythematosus (c-SLE) patient has been reported. For a period of 31 years, 312 c-SLE patients were followed at the Pediatric Rheumatology Unit of our University Hospital. One of them (0.3%) had tuberculoid leprosy skin lesions during the disease course and is here reported. A 10-year-old boy from Northwest of Brazil was diagnosed with c-SLE based on malar rash, photosensitivity, oral ulcers, lymphopenia, proteinuria, positive antinuclear antibodies, anti-double-stranded DNA, anti-Sm and anti-Ro/SSA autoantibodies. He was treated with prednisone, hydroxychloroquine and intravenous cyclophosphamide, followed by mycophenolate mofetil. At 12-years-old, he presented asymmetric skin lesions characterized by erythematous plaques with elevated external borders and hypochromic center with sensory loss. Peripheral nerve involvement was not evidenced. No history of familial cases of leprosy was reported, although the region where the patient resides is considered to be endemic for leprosy. Skin biopsy revealed a well-defined tuberculoid form. A marked thickening of nerves was observed, often destroyed by granulomas, without evidence of Mycobacterium leprae bacilli. At that time, the SLEDAI-2K score was 4 and he had been receiving prednisone 15mg/day, hydroxychloroquine 200mg/day and mycophenolate mofetil 3g/day. Paucibacillary treatment for leprosy with dapsone and rifampicine was also introduced. In conclusion, we have reported a rare case of leprosy in the course of c-SLE. Leprosy should always be considered in children and adolescents with lupus who present skin abnormalities, particularly with hypoesthesic or anesthesic cutaneous lesions.
- Adrenal steroidogenesis and ovarian reserve in adult childhood-onset systemic lupus erytematosus patients(2021) LOURENCO, Daniela M. R.; ARAUJO, Daniel B.; AIKAWA, Nadia E.; YAMAKAMI, Lucas Y. S.; BORBA, Eduardo F.; MACIEL, Gustavo A. R.; SOARES-JUNIOR, Jose M.; BARACAT, Edmund C.; PEREIRA, Rosa M. R.; BONFA, Eloisa; SILVA, Clovis A.Objective To assess overall adrenal mineralocorticoid/glucocorticoid/androgen steroidogenesis in childhood-onset systemic lupus erythematosus (cSLE) patients and the possible effect of prednisone on adrenal hormones and ovarian reserve. Methods Fifty-one adult cSLE (ACR criteria) patients and 23 healthy controls were evaluated for adrenal steroidogenesis including mineralocorticoid (progesterone, deoxycorticosterone, aldosterone), glucocorticoid (17-OHprogesterone, 11-desoxycortisol, cortisol), and androgen (dehydroepiandrosterone-sulfate, androstenedione, total testosterone, and dihydrotestosterone) hormones. Ovarian reserve assessment included follicle-stimulating hormone (FSH), estradiol, anti-Mullerian hormone, ovarian volumes, and antral follicle count. Results The median of current age [29.11 (19-39.8) vs. 30.8 (19.6-42.1) years, p = 0.502] was similar in adult cSLE and controls. Regarding mineralocorticoid/glucocorticoid, the median of progesterone (p = 0.003), 17-OH progesterone (p < 0.001), and 11-desoxycortisol (p = 0.036) were significantly lower in patients compared to controls. All androgen steroidogenesis hormones were reduced in the former group [dehydroepiandrosterone-sulfate (p < 0.001), androstenedione (p = 0.001), total testosterone (p = 0.005), and dihydrotestosterone (p < 0.001)]. Further comparison of patients with and without current use of prednisone and controls revealed a predominant impact on adrenal glucocorticoid and androgen steroidogenesis with reduced levels of 17-OH progesterone [0.17 (0-0.5) vs. 0.27 (0.1-2.9) vs. 0.33 (0.1-0.8) ng/mL, p < 0.001], dehydroepiandrosterone-sulfate [0.155 (0-0.6) vs. 0.49 (0.1-1.6) vs. 1.11 (0.1-2.6) mu g/mL, p < 0.001], androstenedione [0.56 (0.2-4.4) vs. 1.7 (0.5-4.5) vs. 2.33 (0.3-3.8) ng/mL, p < 0.001], total testosterone [12 (12-167) vs. 16 (12-28) vs. (16.5 (0-50) ng/d, p = 0.002], and dihydrotestosterone [92.68 (11.8-198.5) vs. 160.62 (37.9-842.1) vs. 188.3 (71.3-543.9) pg/ml, p < 0.001] in patients under this drug. In addition, patients with this therapy had reduced median ovarian volumes [4.14 (2-12) vs. 7.13 (2-25.7) vs. 5.18 (2.4-17.3) cm(3), p = 0.028) that was not associated with cyclophosphamide cumulative dose (p > 0.05). The median prednisone dose was 15/mg/day (2.5-40). Conclusions We provided novel evidence that cSLE patients have an overall androgen/glucocorticoid/mineralocorticoid adrenal suppression. Furthermore, low/moderate prednisone use seems to underlie these abnormalities and may also adversely affect ovarian reserve, independently of immunosuppressants.