RENATA MIOSSI
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/17 - Laboratório de Investigação em Reumatologia, Hospital das Clínicas, Faculdade de Medicina
LIM/17 - Laboratório de Investigação em Reumatologia, Hospital das Clínicas, Faculdade de Medicina
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- Diagnosis and treatment of interstitial lung disease related to systemic autoimmune myopathies: a narrative review(2023) SOUZA, F. H. C. de; ARAUJO, D. B. de; HOFF, L. S.; BALDI, B. G.; FARIA, M. S. M. S.; ROCHA JUNIOR, L. F. da; SILVA, L. R. S. Da; PINTO, Behrens; BEZERRA, M. C.; MIOSSI, R.; CORDEIRO, R. A.; SHINJO, S. K.Systemic autoimmune myopathies (SAMs) are rare diseases that lead to muscle inflammation and may be associated with a variety of systemic manifestations. Although there is great heterogeneity in the spectrum of extra-muscular involvement in SAMs, interstitial lung disease (ILD) is the most frequent lung manifestation. SAM-related ILD (SAM-ILD) presents significant variations according to geographic location and temporal trends and is associated with increased morbidity and mortality. Several myositis autoantibodies have been discovered over the last decades, including antibodies targeting aminoacyl-tRNA synthetase enzymes, which are associated with a variable risk of developing ILD and a myriad of other clinical features. In this review, the most relevant topics regarding clinical manifestations, risk factors, diagnostic tests, autoantibodies, treatment, and prognosis of SAM-ILD are highlighted. We searched PubMed for relevant articles published in English, Portuguese, or Spanish from January 2002 to September 2022. The most common SAM-ILD patterns are nonspecific interstitial pneumonia and organizing pneumonia. The combination of clinical, functional, laboratory, and tomographic features is usually sufficient for diagnostic confirmation, without the need for additional invasive methods. Glucocorticoids remain the first-line treatment for SAM-ILD, although other traditional immunosuppressants, such as azathioprine, mycophenolate, and cyclophosphamide have demonstrated some efficacy and, therefore, have an important role as steroid-sparing agents.
conferenceObject Latent Tuberculosis Screening and Treatment In Ankylosing Spondylitis Patients Eligible For Anti-TNF Therapy In Endemic Area(2013) MIOSSI, Renata; BONFIGLIOLI, Karina Rossi; SAAD, Carla G. S.; RIBEIRO, Ana Cristina; MORAES, Julio C. B.; BONFA, Eloisa- Immunogenicity and safety of primary fractional-dose yellow fever vaccine in autoimmune rheumatic diseases(2021) TONACIO, Adriana Coracini; PEDROSA, Tatiana do Nascimento; BORBA, Eduardo Ferreira; AIKAWA, Nadia Emi; PASOTO, Sandra Gofinet; FERREIRA FILHO, Julio Cesar Rente; BARROS, Marilia Mantovani Sampaio; LEON, Elaine Pires; LOMBARDI, Suzete Cleusa Ferreira Spina; MENDRONE JUNIOR, Alfredo; AZEVEDO, Adriana de Souza; SCHWARCZ, Waleska Dias; FULLER, Ricardo; YUKI, Emily Figueiredo Neves; LOPES, Michelle Remiao Ugolini; PEREIRA, Rosa Maria Rodrigues; BARROS, Percival Degrava Sampaio; ANDRADE, Danieli Castro Oliveira de; MEDEIROS-RIBEIRO, Ana Cristina de; MORAES, Julio Cesar Bertacini de; SHINJO, Samuel Katsuyuki; MIOSSI, Renata; DUARTE, Alberto Jose da Silva; LOPES, Marta Heloisa; KALLAS, Esper Georges; SILVA, Clovis Artur Almeida da; BONFA, EloisaBackground Brazil faced a yellow fever(YF) outbreak in 2016-2018 and vaccination was considered for autoimmune rheumatic disease patients(ARD) with low immunosuppression due to YF high mortality. Objective This study aimed to evaluate, prospectively for the first time, the short-term immunogenicity of the fractional YF vaccine(YFV) immunization in ARD patients with low immunossupression. Methods and Results A total of 318 participants(159 ARD and 159 age- and sex-matched healthy controls) were vaccinated with the fractional-dose(one fifth) of 17DD-YFV. All subjects were evaluated at entry(D0), D5, D10, and D30 post-vaccination for clinical/laboratory and disease activity parameters for ARD patients. Post-vaccination seroconversion rate(83.7%vs.96.6%, p = 0.0006) and geometric mean titers(GMT) of neutralizing antibodies[1143.7 (95%CI 1012.3-1292.2) vs.731 (95%CI 593.6-900.2), p< 0.001] were significantly lower in ARD compared to controls. A lower positivity rate of viremia was also identified for ARD patients compared to controls at D5 (53%vs.70%, p = 0.005) and the levels persisted in D10 for patients and reduced for controls(51%vs.19%, p = 0.0001). The viremia was the only variable associated with seroconvertion. No serious adverse events were reported. ARD disease activity parameters remained stable at D30(p>0.05). Conclusion Fractional-dose 17DD-YF vaccine in ARD patients resulted in a high rate of seroconversion rate(> 80%) but lower than controls, with a longer but less intense viremia. This vaccine was immunogenic, safe and did not induce flares in ARD under low immunosuppression and may be indicated in YF outbreak situations and for patients who live or travel to endemic areas.
- The effects of exercise on lipid profile in systemic lupus erythematosus and healthy individuals: a randomized trial(2015) BENATTI, Fabiana Braga; MIOSSI, Renata; PASSARELI, Marisa; NAKANDAKARE, Edna R.; PERANDINI, Luiz; LIMA, Fernanda Rodrigues; ROSCHEL, Hamilton; BORBA, Eduardo; BONFA, Eloisa; GUALANO, Bruno; PINTO, Ana Lucia de SaThe aim of the present study was to evaluate the effects of an exercise training program on lipid profile and composition of high-density lipoprotein (HDL) subfractions in systemic lupus erythematosus (SLE) patients and healthy controls. A 12-week, randomized trial was conducted. Thirty-three physically inactive SLE patients were randomly assigned into two groups: trained (SLE-TR, n = 17) and non-trained (SLE-NT, n = 16). A gender-, BMI-, and age-matched healthy control groups (C-TR, n = 11) also underwent the exercise program. Subjects were assessed at baseline (Pre) and 12 weeks after the 3-month exercise training program (Post) for lipid profile (HDL, low-density lipoprotein, very low-density lipoprotein, and total cholesterol and triglycerides levels) and composition of the HDL subfractions HDL2 and HDL3. SLE patients showed significantly lower contents of Apo A-I, phospholipid, and triglyceride in the HDL3 subfraction (p < 0.05, between-group comparisons) than healthy controls at baseline. The exercise training program did not affect any of the parameters in the SLE-TR group (p > 0.05, within-group comparisons), although there was a trend toward decreased circulating Apo B levels (p = 0.06, ES = -0.3, within-group comparison). In contrast, the same exercise training program was effective in increasing contents of cholesterol, triglyceride, and phospholipid in the HDL2 subfraction in the C-TR group (p = 0.036, ES = 2.06; p = 0.038, ES = 1.77; and p = 0.0021, ES = 2.37, respectively, within-group comparisons), whereas no changes were observed in the composition of the HDL3 subfraction. This study showed that SLE patients have a less effective response to a 12-week exercise training program than healthy individuals, with regard to lipid profile and chemical composition of HDL subfractions. These results reinforce the need for further studies to define the optimal training protocol to improve lipid profile and particularly the HDL composition in these patients (registered at clinicaltrials.gov as NCT01515163).
- Critical digital ischaemia in systemic sclerosis exacerbated by multiple myeloma: A case report(2023) FRANCO, Andre Silva; POLHO, Gabriel Berlingieri; ASSAD, Ana Paula Luppino; MIOSSI, Renata; SAMPAIO-BARROS, Percival DegravaIntroduction: The overlapping of systemic sclerosis with hematologic malignancy has been described previously in the literature. This case report presents a patient with systemic sclerosis and multiple myeloma who had severe digital ischaemia that culminated in the amputation of several fingers. Case report: A 65-year-old White female patient was diagnosed with limited systemic sclerosis in 2002, smouldering multiple myeloma IgG/kappa in 2017 and liver cirrhosis in 2018 due to autoimmune hepatitis. In 2021, she was admitted to the emergency room with dry ischaemia of all fingers and toes despite optimized therapy, associated with visual blurring. The diagnostic hypothesis was hyperviscosity syndrome associated with multiple myeloma reactivation. The patient underwent chemotherapy and despite initial laboratory improvement, 19 digits required amputation. Conclusion: Although the association between systemic sclerosis and multiple myeloma is rare, it should be remembered in cases of significant worsening of Raynaud's phenomenon. Causes unrelated to systemic sclerosis should also be considered in the presence of severe exacerbations in patients with other comorbidities.
conferenceObject Nailfold Capillary Changes in the Adult Newly Onset-Dermatomyositis: A Prospective Cohort Study(2018) MIOSSI, Renata; SOUZA, Fernando Henrique Carlos de; SHINJO, Samuel K.bookPart Miopatias autoimunes sistêmicas(2021) SOUZA, Fernando Henrique Carlos de; MIOSSI, Renata; SHINJO, Samuel KatsuyukibookPart Doença Mista do Tecido Conectivo(2016) CALEIRO, Maria Teresa Correia; MIOSSI, Renata- Gathering patients and rheumatologists' perceptions to improve outcomes in idiopathic inflammatory myopathies(2022) BERTOGLIO, Isabela M.; ABRAHAO, Glaucia F.; SOUZA, Fernando H. C. de; MIOSSI, Renata; MORAES, Paloma C. de; SHINJO, Samuel K.; BONFA, Eloisa; LOPES, Michelle R. UgoliniObjective: Therapeutic targets in Idiopathic Inflammatory Myopathies (IIM) are based on the opinions of physicians/specialists, which may not reflect the main concerns of patients. The authors, therefore, assessed the outcome concerns of patients with IIM and compared them with the concerns of rheumatologists in order to develop an IIM outcome standard set. Methods: Ninety-three IIM patients, 51 rheumatologists, and one physiotherapist were invited to participate. An open questionnaire was initially applied. The top 10 answers were selected and applied in a multiple-choice questionnaire, inquiring about the top 3 major concerns. Answers were compared, and the agreement rate was calculated. Concerns were gathered in an IIM outcome standard set with validated measures. Results: The top three outcome concerns raised by patients were medication side effects/muscle weakness/prevention functionality loss. The top three concerns among rheumatologists were to prevent loss of functionality/to ensure the quality of life/to achieve disease remission. Other's outcomes concerns only pointed out by patients were muscle pain/diffuse pain/skin lesions/fatigue. The agreement rate between both groups was 41%. Assessment of these parameters guided the development of an IIM standard set which included Myositis Disease Activity Assessment Visual Analogue Scale/Manual Muscle Testing/fatigue and pain Global Visual Analogue Scale/Health Assessment Questionnaire/level of physical activity. Conclusion: The authors propose a novel standard set to be pursued in IIM routine follow-up, which includes not only the main patients/rheumatologist outcome concerns but also additional important outcomes only indicated by patients. Future studies are necessary to confirm if this comprehensive approach will result in improved adherence and ultimately in better assistance.
conferenceObject Nailfold Capillaroscopy in Patients with Early Onset-Dermatomyositis(2015) MIOSSI, Renata; SOUZA, Fernando Henrique Carlos de; SHINJO, Samuel Katsuyuki