IEDA MARIA MAGALHAES LAURINDO
Projetos de Pesquisa
Unidades Organizacionais
LIM/17 - Laboratório de Investigação em Reumatologia, Hospital das Clínicas, Faculdade de Medicina
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conferenceObject Regular Measure of Disease Activity During the Routine Care of Rheumatoid Arthritis Patients Involves Some Extra Work but Positive Results(2012) GUEDES, Lissiane K. N.; RIBEIRO, Ana Cristina Medeiros; BONFIGLIOLI, Karina Rossi; DOMICIANO, Diogo; VIZIOLI, Carolina Reither; CUNHA, Gilmara Franco da; ABREU, Andressa Silva; MELLO, Filipi M.; FOELKEL, Ana Luiza de Aguiar; GONCALVES, Celio R.; LAURINDO, IedaBackground/Purpose: According to treat to target recommendations the use of validated composite measures of disease activity, which include joint assessments, is needed in routine clinical practice to guide treatment decisions with the final objective of reaching remission or low disease activity in patients with RA.Objective: to study the outcome of adding avalidated composite measure of disease activity (DAS28) to routine clinical visits. Methods: Since 2007 all RA patients (ACR-1987 criteria) in regular follow-up at the Rheumatology Service of a tertiary center change to electronic files with a DAS28-ESR calculator and this measure became mandatory in the routine care visits. Inclusion criteria: patients in regular follow-up for at least 2 years before 2007and no use of biologic agents during the study period (January 2007-December 2011). All patients could receive, free of charge, traditional DMARDs (chloroquine, methotrexate, sulfasalazine, leflunomide and azathioprine), corticosteroids (including intra-articular injections), analgesic and antiinflamatory medications as needed and according to a pre-established protocol. The first DAS28 recorded in the electronic files was compared to the last one recorded in 2011, after 4 years of regular measure of disease activity guiding therapeutic decisions (RA-study group). ERA patients (less than one year of symptoms at the beginning of treatment) submitted to a therapeutic strategy of tight control and DAS28 based clinical decisions were also evaluated. Results: a total of 304 patients was included, 217 consisting our study group(RA-SG) (86% female, mean age 63±11yrs, mean disease duration 22±10yrs) and 87 ERA patients (83% female, mean age 53±12yrs, mean disease duration 6.7±1.6yrs). ERA patients were significantly younger and with shorter disease duration. DAS28 values and different levels of disease activity are depicted below: RA-SG n217 ERA n87 2007 2011 2007 2011 DAS28 mean (SD) 3.9* (1.4) 3.3* (1.3) 3.7** (1.7) 2.9** (1.4)% DAS28 < 2.6 17* 34* 29** 45**% low disease activity 18 16 12** 24**% moderate disease activity 47 39 30** 9**% high disease activity 18 11 24 16*,** p0.05 Conclusion: regularly applying validate composite indexes such as DAS 28 leads to better control of disease activity, mainly an increased percentage of patients in DAS28 remission.- DIAGNOSIS OF EARLY RHEUMATOID ARTHRITIS: IS THERE A BEST CLASSIFICATION CRITERIA?(2014) PEREZ, M. O.; AQUILA, L.; MEDEIROS, A. C.; BONFIGLIOLI, K.; DOMICIANO, D.; GUEDES, L. N.; GONCALVES, C. R.; LAURINDO, I. M. M.
- Abatacept and Reduced Immune Response to Pandemic 2009 Influenza A/H1N1 Vaccination in Patients With Rheumatoid Arthritis(2013) RIBEIRO, Ana C.; LAURINDO, Ieda M.; GUEDES, Lissiane K.; SAAD, Carla G.; MORAES, Julio C.; SILVA, Clovis A.; BONFA, EloisaObjective. To evaluate the influence of abatacept (ABA) and associated contributing factors on pandemic 2009 influenza A/H1N1 vaccine immunogenicity in rheumatoid arthritis (RA) patients. Methods. The response to a nonadjuvanted monovalent pandemic 2009 influenza A/H1N1 killed virus vaccine was analyzed in 11 RA patients using ABA (RA-ABA), most with concomitant nonbiologic disease-modifying antirheumatic drugs (DMARDS), and compared to 33 age-matched RA patients on methotrexate (MTX) and 55 healthy controls, all without previous seroprotection. Clinical and laboratory evaluations were performed before and 21 days after vaccination. Anti-influenza antibody titers were measured by hemagglutination inhibition assay. Seroprotection (antibody titers >= 1:40) and the factor increase (FI) in the geometric mean titers (GMTs) were calculated. Prevaccination lymphocyte counts and gammaglobulin levels were determined. Results. Sex distribution, disease duration, and the Disease Activity Score in 28 joints were similar in the RA groups (P > 0.05). After vaccination, seroprotection was significantly reduced in RA-ABA patients compared to RA-MTX patients (9% versus 58%; P = 0.006) and controls (69%; P <= 0.001). FI-GMT was severely reduced in RA-ABA patients compared to RA-MTX patients (1.8 [1.4-2.3] versus 8.7 [5.2-17.4]; P < 0.001) and controls (11.5 [8.0-16.7]; P <= 0.001). Lymphocyte counts were comparable in RA groups (P > 0.05), but RA-ABA patients had slightly lower gammaglobulin levels than RA-MTX patients (0.9 gm/dl [0.6-1.8] versus 1.2 gm/dl [0.8-1.7]; P = 0.03), although almost all were within the normal range values. Conclusion. The current study established that ABA, in association with traditional DMARDs, significantly reduces the humoral response to pandemic 2009 influenza A/H1N1 vaccine in RA patients. The results suggest an influence of costimulatory modulation in humoral response to this vaccine.
- LTBI screening in rheumatoid arthritis patients prior to anti-TNF treatment in an endemic area(2014) BONFIGLIOLI, K. R.; RIBEIRO, A. C. M.; MORAES, J. C. B.; SAAD, C. G. S.; SOUZA, F. H. C.; CALICH, A. L.; BONFA, E.; LAURINDO, I. M. M.SETTING: Recommendations for screening for latent tuberculous infection (LTBI) in patients eligible for antitumour necrosis factor (TNF) agents remain unclear in endemic regions. OBJECTIVE: To evaluate the long-term efficacy of LTBI screening and treatment in patients with rheumatoid arthritis (RA) receiving TNF blockers. DESIGN: A total of 202 RA patients were screened for LTBI before receiving anti-TNF treatment Using the tuberculin skin test (TST), chest X-ray (CXR) and history of exposure to tuberculosis (TB). All subjects were regularly followed at 1- to 3-month intervals. RESULTS: Eighty-five patients (42%) were treated with a single anti-TNF agent, while 117 patients (58%) changed anti-TNF agents once or twice. LTBI screening was positive in 66 patients, 44 were TST-positive, 23 had a history of TB exposure and 14 had an abnormal CXR. Exposure alone accounted for LTBI diagnosis in 14 patients with a negative TST. LTBI patients were treated with isoniazid (300 mg/day) for 6 months, and none developed TB. During follow-up, TST was repeated in 51 patients. Conversion was observed in 5; 3 were diagnosed with LTBI and 2 with active TB respectively 14 and 36 months after receiving anti-TNF treatment, suggesting new TB exposure. CONCLUSION: LTBI screening and treatment before anti-TNF treatment is effective in endemic areas and reinforces the importance of establishing contact history for diagnosing LTBI in RA patients.
conferenceObject Latent Tuberculosis Screening and Treatment in Rheumatoid Arthritis Patients Eligible for Anti-TNF Therapy in Endemic Areas: Does It Work?(2012) LAURINDO, Ieda; RIBEIRO, Ana C. M.; MORAES, Julio C. B.; SAAD, Carla G. S.; BONFIGLIOLI, Karina Rossi; SOUZA, Fernando H. C.; CALICH, Ana L. G.; WAISBERG, Mariana G.; GUEDES, Lissiane K. N.; BONFA, EloisaBackground/Purpose: Background: Current recommendations for latent tuberculosis infection (LTB) screening and treatment in patients eligible for anti-TNF agents are not well established in endemic regions. Thus, the aim of this study is to evaluate the long-term efficacy of LTB screening and treatment in RA patients under TNF blockers tight control therapeutic strategy Methods: Two hundred and two RA patients (1987 criteria) eligible for anti-TNF agents were initially screened for LTB by PPD test, chest X-ray and history of contact. Two hundred and nine patients receiving traditional DMARDs comprised the control group. Patients and controls were regularly followed at 1–3 months interval, from January 2007 to December 2011. During the study period, PPD was repeated in patients with TB clinical suspicion or due to extended ( 12 months) interruption/re-start of biologic treatment. Results: 202 patients were treated with anti-TNF blockers, 85(42%) with one agent and 117(58%) with two or more: 181 received infliximab, 93 adalimumab and 75 etanercept. LTB screening (PPD and/or history of contact and/or X-ray) was positive in 69(34%) patients. In 65%(45 patients) PPD was positive, 36%(n 25) had history of contact and 21%(n 15) with X-ray alterations. Of note, in the 24 LTB patients with negative PPD, contact history accounted for 75% and X-ray for 37% of the positive screened cases. LTB treatment with isoniazid during 6 months was administered to all positive screened patients and none developed TB during follow-up. Regarding the 133 remaining screening negative patients none had TB during the first twelve months of anti-TNF therapy. PPD test was repeated in only 53 patients (26%) due to interruption/re-start of biologic treatment (51cases) or clinical TB suspicion (2 cases). PPD turned out to be positive in five patients: three that received LTB treatment and the two patients with clinical TB suspicion, both diagnosed as active TB (after 14 and 36 months of anti-TNF treatment) and properly treated with standard TB treatment. In those RA patients under traditional DMARDs, three cases (1.5%) of active TB were observed. Thus, the frequency of TB in RA patients during five years of observation was similar in patients under biological and traditional DMARDs (1% vs. 1.5%, p 0.68), although higher than the expected for the area (60/100,000/ per year). Conclusion: The present study provided evidence that the recommended screening and treatment protocol for LTB in patients under anti-TNF treatment was also efficient in endemic areas, with a special attention to contact history in those with negative PPD. Active TB diagnosis during anti-TNF treatment seems not to be related to screening failure, reinforcing the importance of constant clinical surveillance.conferenceObject CUTANEOUS RHEUMATOID VASCULITIS: STILL A CHALLENGE(2013) PAMPLONA, T.; BONFIGLIOLI, K.; QUEDES, L.; DOMICINIANO, D.; MEDEIROS, A. C.; GONCALVES, C. R.; LAURINDO, I. M. M.bookPart Artrite Reumatoide(2016) MEDEIROS, Ana Cristina de; DOMICIANO, Diogo; LAURINDO, Iêda Maria Magalhães; BONFIGLIOLI, Karina Rossi- Reduced seroprotection after pandemic H1N1 influenza adjuvant-free vaccination in patients with rheumatoid arthritis: implications for clinical practice(2011) RIBEIRO, Ana C. M.; GUEDES, Lissiane K. N.; MORAES, Julio C. B.; SAAD, Carla G. S.; AIKAWA, Nadia E.; CALICH, Ana Luisa; FRANCA, Ivan L. A.; CARVALHO, Jozelio F.; SAMPAIO-BARROS, Percival D.; GONCALVES, Celio R.; BORBA, Eduardo F.; TIMENETSKY, Maria do Carmo S.; PRECIOSO, Alexander R.; DUARTE, Alberto; BONFA, Eloisa; LAURINDO, Ieda M. M.Background Reduced response to pandemic (2009) H1N1 (pH1N1) vaccine in patients with rheumatoid arthritis (RA) was recently reported. Objectives To evaluate the contribution of age, disease activity, medication and previous antibody levels to this reduced response. Methods 340 adult RA patients and 234 healthy controls were assessed before and 21 days after adjuvant-free influenza A/California/7/2009 (pH1N1) vaccine. Disease activity (DAS28), current treatment and pH1N1 antibody titres were collected. Seroprotection, seroconversion and factor increase in geometric mean titre (GMT) were calculated and adverse events registered. Results RA and controls showed similar (p> 0.05) prevaccination GMT (8.0 vs 9.3) and seroprotection (10.8% vs 11.5%). After vaccination a significant reduction (p< 0.001) was observed in all endpoints: GMT and factor increase in GMT, seroprotection and seroconversion rates. Disease activity did not preclude seroconversion or seroprotection and remained unchanged in 97.4% of patients. Methotrexate was the only disease-modifying antirheumatic drug associated with reduced responses (p= 0.001). Vaccination was well tolerated. Conclusions The data confirmed both short-term anti-pH1N1 vaccine safety and, different from most studies with seasonal influenza, reduced seroprotection in RA patients, unrelated to disease activity and to most medications (except methotrexate). Extrapolation of immune responses from one vaccine to another may therefore not be possible and specific immunisation strategies (possibly booster) may be needed.
- LTBI screening in rheumatoid arthritis patients prior to anti-TNF treatment in an endemic area (vol 18, pg 905, 2014)(2014) BONFIGLIOLI, K. R.; RIBEIRO, A. C. M.; MORAES, J. C. B.; SAAD, C. G. S.; SOUZA, F. H. C.; CALICH, A. L.; BONFA, E.; LAURINDO, I. M. M.
conferenceObject IS H1N1 INFLUENZA VACCINE SAFE AND EFFECTIVE IN PATIENTS WITH SSc?(2012) ANDRADE, D.; SEGURO, L.; RIBEIRO, A.; MORAES, J.; SAAD, C.; AIKAWA, N.; CALICH, A.; VIANA, V.; PASOTO, S.; LEVY-NETO, M.; LAURINDO, I.; TIMENESTSKY, M.; PRECIOSO, A.; BONFA, E.; SAMPAIO-BARROS, P.Introduction. Immunosuppressed patients are potentially at risk to suffer from life-threatening pulmonary infections caused by H1N1. Although pulmonary disease is an important cause of morbidity in patients with SSc, low rates of influenza vaccination are still observed in this population due to lack of information and fear of adverse events. The recent WHO recommendation that the 2010–2011 trivalent seasonal flu vaccine must contain A/California/7/2009/H1N1-like virus reinforces the need to access the safety and efficacy of H1N1 vaccination in SSc patients. Patients and methods. One hundred twenty-seven patients and 234 controls were vaccinated with adjuvant-free influenza A/California/7/2009 (pH1N1) vaccine. All participants were evaluated pre- and 21 days post-vaccination and serology for anti-H1N1 was performed by haemagglutination inhibition (HI) assay (HIA). Efficacy was assessed by seroprotection and seroconversion rates and the factor increase in geometric mean antibody titre (GMT). Participants received a 21-day symptom diary card and were instructed to report local and systemic adverse events. Severe side effects were considered if hospitalization was required. Results. SSc patients had mean age of 52 (5.3) years, mean disease duration of 11.96 (7.9) years and a female predominance (93%). Of SSc patients, 69.3% had limited cutaneous disease, whereas 30.7% had diffuse cutaneous disease. Half of the patients were on immunosuppressant therapy (mostly AZA, MTX and CYC). Thirteen (10%) patients were taking CSs, but only two patients received a daily dose > 10 mg of prednisone. SSc patients and controls presented similar pre-vaccination GMT (11.2 vs 9.3; P = 0.094) and seroprotection rates (18.1 vs. 11.5%; P = 0.110). After vaccination seroprotection rates (81.1 vs 82.9%; P = 0.668) and GMT (134.4 vs. 122.9; P = 0.654) rose in both groups. Seroconversion rates (72.4 vs 76.9%; P = 0.372) and factor increase in GMT (12.0 vs 13.2; P = 0.553) were comparable in both groups. Disease-modifying antirheumatic drugs were not associated with reduced vaccination responses (P > 0.05). Immunization was well tolerated with mild local (7.1 vs 14.1%; P = 0.058) and minor systemic reactions (23.6 vs 25.6%; P = 0.704) in patients and controls, respectively. No severe side effect was reported.Conclusion. Vaccination against H1N1 was safe and induced a satisfactory response in patients with SSc, including in those under immunosuppressive therapy. Due to the inherent risks of lower respiratory infections in this group of patients, physicians should consider annually influenza vaccination recommendation.