EDUARDO FERREIRA BORBA NETO

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Departamento de Clínica Médica, Faculdade de Medicina - Docente
LIM/17 - Laboratório de Investigação em Reumatologia, Hospital das Clínicas, Faculdade de Medicina

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  • article
    Measurement properties of selected patient-reported outcome measures for use in randomised controlled trials in patients with systemic lupus erythematosus: a systematic review
    (2020) STRAND, Vibeke; SIMON, Lee S.; MEARA, Alexa Simon; TOUMA, Zahi; BORBA NETO, Eduardo Ferreira
    Objective The heterogeneous multisystem manifestations of SLE include fatigue, pain, depression, sleep disturbance and cognitive dysfunction, and underscore the importance of a multidimensional approach when assessing health-related quality of life. The US Food and Drug Administration has emphasised the importance of patient-reported outcomes (PROs) for approval of new medications and Outcome Measures in Rheumatology has mandated demonstration of appropriate measurement properties of selected PRO instruments. Methods Published information regarding psychometric properties of the Medical Outcomes Survey Short Form 36 (SF-36), Lupus Quality of Life Questionnaire (LupusQoL) and Functional Assessment of Chronic Illness Therapy-Fatigue Scale (FACIT-F), and their suitability as end points in randomised controlled trials (RCTs) and longitudinal observational studies (LOS) were assessed. A search of English-language literature using MEDLINE and EMBASE identified studies related to development and validation of these instruments. Evidence addressed content validity, reliability (internal consistency and test-retest reliability), construct validity (convergent and divergent) and longitudinal responsiveness, including thresholds of meaning and discrimination. Results All instruments demonstrated strong internal consistency, reliability and appropriate face/content validity, indicating items within each instrument that measure the intended concept. SF-36 and LupusQoL demonstrated test-retest reliability; although not published with FACIT-F in SLE supported by evidence from other rheumatic diseases. All instruments demonstrated convergent validity with other comparable PROs and responsivity to treatment. Conclusion The measurement properties of PRO instruments with published data from RCTs including: SF-36, LupusQoL and FACIT-F indicate their value as secondary end points to support labelling claims in RCTs and LOS evaluating the efficacy of SLE treatments.
  • article 14 Citação(ões) na Scopus
    Effects of acute aerobic exercise on leukocyte inflammatory gene expression in systemic lupus erythematosus
    (2016) PERANDINI, L. A.; SALES-DE-OLIVEIRA, D.; ALMEIDA, D. C.; AZEVEDO, H.; MOREIRA-FILHO, C. A.; CENEDEZE, M. A.; BENATTI, F. B.; LIMA, F. R.; BORBA, E.; BONFA, E.; SA-PINTO, A. L.; ROSCHEL, H.; CAMARA, N. O.; GUALANO, B.
    Systemic lupus erythematosus (SLE) is an autoimmune disease with a persistent systemic inflammation. Exercise-induced inflammatory response in SLE remains to be fully elucidated. The aim of this study was to assess the effects of acute exercise on leukocyte gene expression in active (SLEACTIVE) and inactive SLE (SLEINACTIVE) patients and healthy controls (HC). Methods: All subjects (n = 4 per group) performed a 30-min single bout of acute aerobic exercise (similar to 70% of VO2 peak) on a treadmill, and blood samples were collected for RNA extraction from circulating leukocyte at baseline, at the end of exercise, and after three hours of recovery. The expression of a panel of immune-related genes was evaluated by a quantitative PCR array assay. Moreover, network-based analyses were performed to interpret transcriptional changes occurring after the exercise challenge. Results: In all groups, a single bout of acute exercise led to the down-regulation of the gene expression of innate and adaptive immunity at the end of exercise (e.g., TLR3, IFNG, GATA3, FOXP3, STAT4) with a subsequent up-regulation occurring upon recovery. Exercise regulated the expression of inflammatory genes in the blood leukocytes of the SLE patients and HC, although the SLE groups exhibited fewer modulated genes and less densely connected networks (number of nodes: 29, 40 and 58; number of edges: 29, 60 and 195; network density: 0.07, 0.08 and 0.12, for SLEACTIVE, SLEINACTIVE and HC, respectively). Conclusion: The leukocytes from the SLE patients, irrespective of disease activity, showed a down-regulated inflammatory gene expression immediately after acute aerobic exercise, followed by an up-regulation at recovery. Furthermore, less organized gene networks were observed in the SLE patients, suggesting that they may be deficient in triggering a normal exercise-induced immune transcriptional response.
  • article 42 Citação(ões) na Scopus
    Diet and nutritional aspects in systemic lupus erythematosus
    (2012) KLACK, Karin; BONFA, Eloisa; BORBA NETO, Eduardo Ferreira
    The authors reviewed the influence of nutritional factors on systemic lupus erythematosus (SLE) and discussed an alternative treatment option. The autoimmunity and inflammatory process of SLE are related to the presence of dyslipidemia, obesity, systemic arterial hypertension, and metabolic syndrome, which should be properly considered to decrease cardiovascular risk. A diet with moderate protein and energy content, but rich in vitamins, minerals (especially antioxidants), and mono/polyunsaturated fatty acids can promote a beneficial protective effect against tissue damage and suppression of inflammatory activity, in addition to helping the treatment of those comorbidities. Diet therapy is a promising approach and some recommendations may offer a better quality of life to patients with SLE.
  • article 24 Citação(ões) na Scopus
    Antibodies to ribosomal P proteins in lupus nephritis: A surrogate marker for a better renal survival?
    (2011) MACEDO, Patricia Andrade de; BORBA, Eduardo Ferreira; VIANA, Vilma dos Santos Trindade; LEON, Elaine Pires; TESTAGROSSA, Leonardo de Abreu; BARROS, Rui Toledo; NASCIMENTO, Ana Patricia; BONFA, Eloisa
    Objective: To define if antibodies to ribosomal P proteins disclose a better lupus nephritis long-term survival. Methods: Sixty consecutive SLE patients with biopsy-proven nephritis (2004 ISN/RPS) were evaluated for renal survival parameters. Inclusion criteria were at least one serum sample at: renal flares, biopsy, and last follow-up until 2008. Anti-P was detected by ELISA/immunoblot and anti-dsDNA by indirect immunofluorescence/ELISA. Results: Eleven patients (18%) with anti-P+ (without anti-dsDNA) during renal flare were compared to 49 (82%) persistently negative for anti-P throughout the study. At the final follow-up post-biopsy (6.3 +/- 2.5 vs. 6.8 +/- 2.4 years, p = 0.36), the comparison of anti-P+/anti-dsDNA with anti-P group revealed a trend to lower mean creatinine levels (0.9 +/- 0.3 vs. 2.3 +/- 2.1 mg/dl, p = 0.07), lower frequency of dialysis (0% vs. 35%, p = 0.025), and higher frequency of normal renal function (91% vs. 53%, p = 0.037). The overall renal survival was significantly higher in anti-P+/anti-dsDNA compared to anti-P (11.0 +/- 4.5 vs. 9.2 +/- 4.5 years, p = 0.033), anti-dsDNA+/anti-P (vs. 8.7 +/- 4.7 years, p = 0.017), and anti-P /anti-dsDNA (vs. 9.8 +/- 4.3 years, p = 0.09) groups. Conclusion: Our data supports the notion that anti-P antibody in the absence of anti-dsDNA during nephritis flares is a valuable marker to predict a better long-term renal outcome in lupus patients.
  • article 28 Citação(ões) na Scopus
    Cutting-Edge Issues in Autoimmune Orchitis
    (2012) SILVA, Clovis A.; COCUZZA, Marcello; BORBA, Eduardo F.; BONFA, Eloisa
    Autoimmune orchitis is a relevant cause of decreased fecundity in males, and it is defined as a direct aggression to the testis with the concomitant presence of anti-sperm antibodies (ASA). The presence of these specific antibodies has been observed in approximately 5-12% of infertile male partners. Primary autoimmune orchitis is defined by isolated infertility with ASA but without evidence of a systemic disease. Secondary causes of orchitis and/or testicular vasculitis are uniformly associated with autoimmune diseases, mainly in primary vasculitis such as polyarteritis nodosa, Beh double dagger et's disease, and Henoch-Schonlein purpura. The overall frequencies of acute orchitis and ASA in rheumatic diseases are 2-31% and 0-50%, respectively. The pathogenesis of primary/secondary autoimmune orchitis is not completely understood but probably involves the access of immune cells to the testicular microenvironment due to inflammation, infection or trauma, leading to apoptosis of spermatocytes and spermatids. Glucocorticoids and immunosuppressive drugs are indicated in autoimmune orchitis-associated active systemic autoimmune diseases. However, there are no standardized treatment options, and the real significance of ASA in infertile men is still controversial. Assisted reproductive technologies such as intrauterine insemination, in vitro fertilization, and intracytoplasmic sperm injection (ICSI) are therapeutic options for male infertility associated with these autoantibodies. ICSI is considered to be the best choice for patients with severe sperm autoimmunity, particularly in males with low semen counts or motility.
  • article 9 Citação(ões) na Scopus
    Factors predictive of high disease activity early in the course of SLE in patients from a Latin-American cohort
    (2017) PIMENTEL-QUIROZ, Victor R.; UGARTE-GIL, Manuel E.; PONS-ESTEL, Guillermo J.; SORIANO, Enrique R.; SAURIT, Veronica; SATO, Emilia I.; COSTALLAT, Lilian T. Lavras; MOLINA, Jose Fernando; IGLESIAS-GAMARRA, Antonio; REYES-LLERENA, Gil; NEIRA, Oscar J.; BARILE, Leonor A.; SILVEIRA, Luis H.; SEGAMI, Maria Ines; CHACON-DIAZ, Rosa; WOJDYLA, Daniel; ALARCON, Graciela S.; PONS-ESTEL, Bernardo A.; BONFA, Eloisa; BORBA, Eduardo Ferreira
    Aims: To determine the factors predictive of disease activity early in the course of SLE (baseline visit). Methods: Patients from GLADEL, a multi-national, multi-ethnic, Latin-American lupus cohort were included. Disease activity was evaluated at baseline with the SLEDAI score. Demographic characteristics (age at diagnosis, gender, ethnicity, marital status, educational level, medical coverage and socioeconomic status) were assessed. Disease duration was defined as the time between the fourth ACR criterion and baseline. Time to criteria accrual was defined as the interval between the first and fourth ACR criterion. Use of glucocorticoids was recorded as the highest dose received before the baseline visit. Antimalarials and immunosuppressive drugs were recorded as use or not use. Univariable and multivariable analysis were performed. Model selection was based on backward elimination. Results: One thousand two hundred sixty-eight patients were included; 1136 (89.6%) of them were female. Mean age at diagnosis was 29.2 (SD: 12.3) years. Five hundred sixty-five (44.6%) were Mestizo, 539 (42.5%) were Caucasians and 164 (12.9%) were African-Latin-Americans. The mean SLEDAI at baseline was 10.9 (SD: 8.4). Longer time between first and fourth ACR criterion, medical coverage, a dose of prednisone between 15 and 60 mg/d, and the use of antimalarials were factors protective of disease activity, while Mestizo and African-Latin-American ethnicities were predictive factors. Conclusions: Mestizo and African-Latin-American ethnicities were predictive whereas antimalarial use, medical coverage, and longer time to criteria accrual were protective of higher disease activity early in the disease course.
  • article 30 Citação(ões) na Scopus
    Macrophage activation syndrome: A severe and frequent manifestation of acute pancreatitis in 362 childhood-onset compared to 1830 adult-onset systemic lupus erythematosus patients
    (2016) GORMEZANO, Natali W. S.; OTSUZI, Carini I.; BARROS, Diego L.; SILVA, Mariana A. da; PEREIRA, Rosa M. R.; CAMPOS, Lucia M. A.; BORBA, Eduardo F.; BONFA, Eloisa; SILVA, Clovis A.
    Objective: We previously reported a case series of acute pancreatitis (AP) and macrophage activation syndrome (MAS) in childhood (cSLE) patients; however, there are no data regarding the comparison of AP and MAS in large populations of cSLE and adult SLE (aSLE). Methods: A study included 362 cSLE and 1830 aSLE patients. MAS was diagnosed according to preliminary diagnostic guidelines and AP according to the presence of abdominal pain or vomiting associated to an increase of pancreatic enzymes and/or pancreatic radiological abnormalities. Demographic data, clinical features, SLEDAI-2K, SLICC/ACR-DI, and treatment were assessed. Results: Age in MAS patients was significantly lower compared with those without this complication [15 (8.8-55) vs. 33.5 (10.2-45.7) years, p = 0.0071. The frequencies of fever (94% vs. 37%, p = 0.001), leucopenia (82% vs. 19%, p = 0.0001), thrombocytopenia (65% vs. 19%, p = 0.013), hypertriglyceridemia (87% vs. 42%, p = 0.037), and hyperferritinemia (93% vs. 37%, p = 0.011) were also more frequently observed in AP patients with MAS compared in AP patients without MAS. Fever and hyperferritinemia concomitantly were more frequent in the former group (86% vs. 12%, p = 0.0015). Higher and significant frequency of AP in cSLE compared to aSLE patients [12/362 (3.3%) vs. 20/1830 (1.1%), p = 0.003], with similar AP duration [22 (6-60) vs. 15 (4-90) days, p = 0.534]. MAS (85% vs. 30%, p = 0.003) and death by MAS complication (31% vs. 0%, p = 0.017) were significantly higher in children compared with aSLE. Conclusions: This study provides novel data demonstrating that MAS occur in the majority of cSLE with AP with a higher mortality compared to aSLE. In addition, we identified in AP patients, a cluster of MAS clinical and laboratorial parameters more associated with this complication.
  • article 88 Citação(ões) na Scopus
    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)
    (2018) PONS-ESTEL, Bernardo A.; BONFA, Eloisa; SORIANO, Enrique R.; CARDIEL, Mario H.; IZCOVICH, Ariel; POPOFF, Federico; CRINITI, Juan M.; VASQUEZ, Gloria; MASSARDO, Loreto; DUARTE, Margarita; BARILE-FABRIS, Leonor A.; GARCIA, Mercedes A.; AMIGO, Mary-Carmen; ESPADA, Graciela; CATOGGIO, Luis J.; SATO, Emilia Inoue; LEVY, Roger A.; VASQUEZ, Eduardo M. Acevedo; CHACON-DIAZ, Rosa; GALARZA-MALDONADO, Claudio M.; GAMARRA, Antonio J. Iglesias; MOLINA, Jose Fernando; NEIRA, Oscar; SILVA, Clovis A.; PENA, Andrea Vargas; GOMEZ-PUERTA, Jose A.; SCOLNIK, Marina; PONS-ESTEL, Guillermo J.; UGOLINI-LOPES, Michelle R.; SAVIO, Veronica; DRENKARD, Cristina; ALVARELLOS, Alejandro J.; UGARTE-GIL, Manuel F.; BABINI, Alejandra; CAVALCANTI, Andre; LINHARES, Fernanda Athayde Cardoso; SALINAS, Maria Jezabel Haye; FUENTES-SILVA, Yurilis J.; SILVA, Ana Carolina Montandon de Oliveira e; GARNICA, Ruth M. Eraso; URIBE, Sebastian Herrera; GOMEZ-MARTIN, Diana; SEVRINI, Ricardo Robaina; QUINTANA, Rosana M.; GORDON, Sergio; FRAGOSO-LOYO, Hilda; ROSARIO, Violeta; SAURIT, Veronica; APPENZELLER, Simone; REIS NETO, Edgard Torres dos; CIEZA, Jorge; NARANJO, Luis A. Gonzalez; BELLO, Yelitza C. Gonzalez; COLLADO, Maria Victoria; SARANO, Judith; RETAMOZO, Soledad; SATTLER, Maria E.; GAMBOA-CARDENAS, Rocio V.; CAIROLI, Ernesto; CONTI, Silvana M.; AMEZCUA-GUERRA, Luis M.; SILVEIRA, Luis H.; BORBA, Eduardo F.; PERA, Mariana A.; MOREYRA, Paula B. Alba; ARTURI, Valeria; BERBOTTO, Guillermo A.; GERLING, Cristian; GOBBI, Carla A.; GERVASONI, Viviana L.; SCHERBARTH, Hugo R.; BRENOL, Joao C. Tavares; CAVALCANTI, Fernando; COSTALLAT, Lilian T. Lavras; SILVA, Nilzio A. Da; MONTICIELO, Odirlei A.; SEGURO, Luciana Parente Costa; XAVIER, Ricardo M.; LLANOS, Carolina; GUARDADO, Ruben A. Montufar; TORRE, Ignacio Garcia de la; PINEDA, Carlos; HERNANDEZ, Margarita Portela; DANZA, Alvaro; GUIBERT-TOLEDANO, Marlene; REYES, Gil Llerena; COLMAN, Maria Isabel Acosta; AQUINO, Alicia M.; MORA-TRUJILLO, Claudia S.; MUNOZ-LOUIS, Roberto; VALLADARES, Ignacio Garcia; OROZCO, Maria Celeste; BURGOS, Paula I.; BETANCUR, Graciela V.; ALARCON, Graciela S.
    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.
  • article 26 Citação(ões) na Scopus
    Inflammatory cytokine kinetics to single bouts of acute moderate and intense aerobic exercise in women with active and inactive systemic lupus erythematosus
    (2015) PERANDINI, L. A.; SALES-DE-OLIVEIRA, D.; V, S. B. Mello; CAMARA, N. O.; BENATTI, F. B.; LIMA, F. R.; BORBA, E.; BONFA, E.; ROSCHEL, H.; SA-PINTO, A. L.; GUALANO, B.
    Objectives: The aim of this study was to evaluate changes in the cytokines INF-gamma, IL-10, IL-6, TNF-alpha and soluble TNF receptors (sTNFR1 and sTNFR2) in response to single bouts of acute moderate and intense exercise in systemic lupus erythematosus women with active (SLEACTIVE) and inactive (SLEINACTIVE) disease. Methods: Twelve SLEINACTIVE women (age: 35.3 +/- 5.7 yrs: 25.6 +/- 3.4 kg/m(2)), eleven SLEINACTIVE women (age: 30.4 +/- 4.5 yrs; 26.1 +/- 4.8 kg/m(2)), and 10 age- and BMI-matched healthy control women (HC) performed 30 minutes of acute moderate (similar to 50% of VO(2)peak) and intense (similar to 70% of VO(2)peak) exercise bout. Cytokines and,soluble TNF receptors were assessed at baseline, immediately after; every 30 minutes up to three howls, and 24 hours after both acute exercise bouts. Results: In response to acute moderate exercise, cytokines and soluble TNF receptors levels remained unchanged in all groups (P>0.05), except for a reduction in IL-6 levels in the SLEACTIVE group at the 60th and 180th minutes of recovery (P<0.05), and a reduction in sTNFR1 levels in the He group at the 90th, 120th, 150th, 180th minutes of recovery (P<0.05). The SLEINACTIVE group showed higher levels of TNF-alpha, sTNFR1, and sTNFR2 at all time points when compared with the HC group (P<0.05). Also, the SLEACTIVE group showed higher levels of IL-6 at the 60th minute of recovery (P<0.05) when compared with the HC group. After intense exercise, sTNFR1 levels were reduced at the 150th (P=0.041) and 180th (P=0.034) minutes of recovery in the group. whereas the other cytokines and sTNFR2 levels remained unchanged (P>0.05). hi the He group, IL-10, TNF-alpha, sTNFR1, and sTNFR2 levels did not change, whilst INF-gamma levels decreased (P=0.05) and IL-6 levels increased immediately after the exercise (P=0.028), returning to baseline levels 24 hours later (P > 0.05). When compared with the HC group, the SLEINACTIVE, group showed higher levels of TNF-alpha and sTNFR2 in all time points, and higher levels of sTNFR1 at the end of exercise and at the 30th minute of recovery (P<0.05). The SLEACTIVE group also showed higher levels of TNF-alpha at all time points when compared with the HC group (P<0.05), (except after 90 min, 120 min and 24 hours of recovery) (P>0.05). Importantly, the levels of all cytokine and soluble TNF receptors returned to baseline 24 hours after the end of acute exercise, irrespective of its intensity in all three groups (P>0.05). Conclusion: This study demonstrated that both the single bouts of acute moderate and intense exercise induced mild and transient changes in cytokine levels in both SLEINACTIVE and SLEACTIVE women, providing novel evidence that acute aerobic execise does not trigger inflammation in patients with this disease.