LUCAS YUGO SHIGUEHARA YAMAKAMI
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- Ovarian reserve in adult patients with childhood-onset lupus: a possible deleterious effect of methotrexate?(2014) ARAUJO, D. B. de; YAMAKAMI, L. Y. S.; AIKAWA, N. E.; BONFA, E.; VIANA, V. S. T.; PASOTO, S. G.; PEREIRA, R. M. R.; SERAFIN, P. C.; BORBA, E. F.; SILVA, C. A.Objectives: To assess ovarian reserve markers and anti-corpus luteum antibodies (anti-CoL) in adult patients with childhood-onset systemic lupus erythematosus (c-SLE). Method: Fifty-seven adult c-SLE female patients and 21 healthy controls were evaluated for anti-CoL. Ovarian reserve was assessed by: follicle stimulating hormone (FSH), luteinizing hormone (LH), oestradiol, anti-Mullerian hormone (AMH), and antral follicle count (AFC). Demographic data, menstrual abnormalities, disease activity, damage, and treatment were also analysed. Results: The median current age was similar in adult c-SLE patients and controls (27.7 vs. 27.7 years, p = 0.414). The medians of AMH (1.1 vs. 1.5 ng/mL, p = 0.037) and AFC (6 vs. 16, p < 0.001) were significantly reduced in SLE patients compared to controls without significant menstrual abnormalities. Anti-CoL were solely observed in c-SLE patients (16% vs. 0%, p = 0.103) and were not associated with demographic data, ovarian reserve parameters, disease activity/damage, and treatment. Further evaluation of c-SLE patients treated with cyclophosphamide revealed a higher median of FSH levels compared to c-SLE patients not treated with cyclophosphamide and controls (8.8 vs. 5.7 vs. 5.6 IU/L, p = 0.032) and lower median AMH (0.4 vs. 1.5 vs. 1.5 ng/mL, p = 0.004) and AFC (4.0 vs. 6.5 vs. 16 IU/L, p = 0.001) levels. Nineteen patients treated exclusively with methotrexate demonstrated a negative correlation between the cumulative dose and AMH levels (p = 0.027, r = -0.507). Conclusions: The present study demonstrated for the first time that a high cumulative methotrexate dose is a possible cause of subclinical ovarian dysfunction in adult c-SLE patients. Further studies are required to confirm this deleterious effect in other rheumatic diseases, particularly juvenile idiopathic arthritis and idiopathic inflammatory myopathy.
- Reduced ovarian reserve in patients with adult polymyositis(2015) SOUZA, Fernando Henrique Carlos de; SILVA, Clovis Artur da; YAMAKAMI, Lucas Yugo Shiguehara; VIANA, Vilma dos Santos Trindade; BONFA, Eloisa; SHINJO, Samuel KatsuyukiPolymyositis (PM) affects female gender during reproductive age; however, there is no study assessing ovarian reserve in these patients to evaluate ovarian reserve markers in PM. Eight female patients with PM (Bohan and Peter criteria, 1975) with aged 18-40 years, followed at our tertiary centre from March 2011 to May 2014, were invited to participate. They were age-matched with 16 healthy individuals (control group). All were evaluated at early follicular phase of menstrual cycle. Follicle stimulating hormone (FSH), estradiol, inhibin B, anti-Mullerian hormone (AMH) serum levels (ELISA) and sonographic antral follicle count (AFC) were determined. PM patients and controls had comparable mean age (31.4 +/- 6.5 vs. 30.7 +/- 6.2 years, P = 0.946), ethnicity and socioeconomic class (P > 0.05). PM mean age of onset was 27.3 +/- 6.5 years and disease duration of 6.5 +/- 4.1 years. Menstrual cycles were alike in both groups with a similar frequency of age at menarche, gynaecological age, duration and length of menstrual cycle (P > 0.05). The median serum level of AMH was significantly lower in PM compared to controls [0.7(0.3-3.4) vs. 3.1(1.4-4.0), P = 0.021]. AMH levels a parts per thousand currency sign1 ng/mL (50 vs. 6.3 %, P = 0.024) and very low AFC (37.5 vs. 6.3 %, P = 0.037) were significantly in PM patients versus controls. The other hormones (FSH, inhibin B and estradiol levels) were similar between both groups (P > 0.05). The present study was the first to identify subclinical ovarian dysfunction in PM patients during reproductive ages. Further study is necessary to assess the possible role of PM-related factors that may influence the ovarian function of these patients.
conferenceObject Reduction of Ovarian Reserve in Adult Patients with Dermatomyositis.(2014) SOUZA, Fernando Henrique Carlos de; SHINJO, Samuel Katsuyuki; YAMAKAMI, Lucas Yugo Shiguehara; VIANA, Vilma dos Santos Trindade; BARACAT, Edmund Chada; BONFA, Eloisa; SILVA, Clovis Artur Almeidaarticle 17 Citação(ões) na Scopus Reduction of ovarian reserve in adult patients with dermatomyositis(2015) SOUZA, F. H. C. de; SHINJO, S. K.; YAMAKAMI, L. Y. S.; VIANA, V. S. T.; BARACAT, E. C.; BONFA, E.; SILVA, C. A.Objective To assess ovarian reserve markers and anti-corpus luteum (anti-CoL) antibodies in dermatomyositis (DM) patients. Methods Forty female DM patients were invited to participate. Exclusion criteria included hormonal contraceptive use within the last six months, neoplasia associations, overlapped systemic autoimmune diseases, current pregnancy, gynaecological surgery and individual choice not to participate. The final experimental group for this cross-sectional study included 16 DM patients and 23 healthy controls, each of whom was evaluated during the early follicular phase of the menstrual cycle. Values for IgG anti-CoL (via immunoblotting), follicle stimulating hormone (FSH), estradiol, inhibin B, anti-Mullerian hormone (AMH) serum levels (via ELISA) and sonographic antral follicle count (AFC) were determined. Results DM patients and controls were of comparable mean age (p>0.05). The mean age of DM onset was 29.1 +/- 4.7 years, with disease duration of 5.6 +/- 3.2 years. Menstrual cycle characteristics, comorbidity and lifestyle were similar amongst patients in both groups (p>0.05). AMH values of <= lng/mL (p=0.027) and AFC values (p=0.017) were significantly reduced in DM patients relative to the control group, whereas serum estradiol levels (p<0.001) were higher in DM patients compared to controls. In contrast, serum FSH and inhibin B levels, ovarian volumes, and anti-CoL antibody frequency were similar in both groups. Differences in AFC and estradiol were determined to be significant following Bonferroni correction for multiple testing. Conclusion We identified a diminished ovarian reserve in DM patients of reproductive age. Further studies are necessary to assess the idiopathic inflammatory myopathy-related factors involved in the ovarian impairment of this patient population.- Clark CA, Laskin CA. Ovarian reserve in antiphospholipid syndrome: the jury is still out. Lupus 2015; 24: 773(2015) YAMAKAMI, L. Y. S.; SERAFINI, P. C.; ARAUJO, D. B. de; BONFA, E.; LEON, E. P.; BARACAT, E. C.; SILVA, C. A.
bookPart Tratamentos de baixa complexidade em reprodução humana(2015) BIANCHI, Paulo Homem de Mello; YAMAKAMI, Lucas Yugo Shiguehara; SERAFINI, Paulo CesarconferenceObject Subclinical Reduced Ovarian Reserve in Adult Polymiositis Patients(2015) SOUZA, Fernando Henrique Carlos de; SILVA, Clovis A.; YAMAKAMI, Lucas Yugo Shiguehara; VIANA, Vilma S. T.; BONFA, Eloisa; SHINJO, Samuel KatsuyukiconferenceObject DO WOMEN WITH PRIMARY ANTIPHOSPHOLIPID SYNDROME HAVE LOW OVARIAN RESERVE?(2013) YAMAKAMI, L. Y. S.; SERAFINI, P. C.; ARAUJO, D. B.; BONFA, E.; BARACAT, E. C.; SILVA, C. A.conferenceObject Ovarian Reserve In Women With Primary Antiphospholipid Syndrome(2013) YAMAKAMI, Lucas; SERAFINI, Paulo; ARAUJO, Daniel B.; BONFA, Eloisa; LEON, Elaine P.; BARACAT, Edmund C.; SILVA, Clovis A.- Autoimmune primary ovarian insufficiency(2014) SILVA, C. A.; YAMAKAMI, L. Y. S.; AIKAWA, N. E.; ARAUJO, D. B.; CARVALHO, J. F.; BONFA, E.Primary ovarian insufficiency (POI) is defined as sustained amenorrhea, increased follicle-stimulating hormone and low estrogen levels, whereas diminished ovarian reserve (DOR) is characterized as regular menses and alterations of ovarian reserve tests. POI of autoimmune origin may be associated with adrenal autoimmunity, non-adrenal autoimmunity or isolated. This autoimmune disease is characterized by serum ovarian, adrenocortical or steroidogenic cell autoantibodies. POI of adrenal autoimmune origin is the most frequent type observed in 60-80% of patients. Clinically, amenorrhea is the hallmark of POI, however before menstruation stops completely, irregular cycles occur. Infertility, hot flushes, vaginal atrophy, and dyspareunia are also common. Autoimmune oophoritis is characterized by mononuclear inflammatory cell infiltrate in the theca cells of growing follicles, with early stage follicles without lymphocytic infiltration. This infiltrate includes plasma, B and T-cells. A novel classification criterion for autoimmune POI/DOR is proposed subdividing in three distinct categories (possible, probable and confirmed) according to autoantibodies, autoimmune disease and ovarian histology. Unfortunately, up to date guidelines for the treatment of autoimmune oophoritis are not available. Strategies to POI treatment include hormone replacement and infertility therapy. Assisted conception with donated oocytes has been proven to achieve pregnancy by intra cytoplasmic sperm injection in POI women.