IEDA MARIA MAGALHAES LAURINDO

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LIM/17 - Laboratório de Investigação em Reumatologia, Hospital das Clínicas, Faculdade de Medicina

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  • article 7 Citação(ões) na Scopus
    Residual oil fly ash worsens pulmonary hyperreactivity in chronic allergic mice
    (2011) AVILA, Mariana Barcellos; MAZZOLI-ROCHA, Flavia; MAGALHAES, Clarissa Bichara; SALDIVA, Paulo Hilario Nascimento; CARVALHO, Alysson Roncally; FAFFE, Debora Souza; ZIN, Walter Araujo
    BALB/c mice received saline (SAL groups) or ovalbumin (OVA groups) intraperitoneally (days 1, 3, 5, 7, 9, 11 and 13). After 27 days, a burst of intratracheal OVA or SAL (days 40, 43 and 46) was performed. Animals were then divided into four groups (N = 8, each) and intranasally instilled with saline (SAL-SAL and OVA-SAL) or residual oil fly ash (SAL-ROFA and OVA-ROFA). 24h later, total, initial and difference resistances (Rtot, Rinit, Rdiff) and static elastance (Est) were measured. Lung responsiveness to methacholine was assessed as slope and sensitivity of Est, Rtot, Rinit, and Rdiff. Lung morphometry (collapsed and normal areas and bronchoconstriction index) and cellularity (polymorphonuclear, mononuclear and mast cells) were determined. OVA or ROFA similarly impaired lung mechanics and increased the amount of polymorphonuclear cells and collapsed areas. OVA-ROFA showed even higher hyperresponsiveness, bronchoconstriction and mast cell infiltration. Thus, we concluded that ROFA exposure may add an extra burden to hyperresponsive lungs.
  • article 217 Citação(ões) na Scopus
    Low dose of fine particulate matter (PM2.5) can induce acute oxidative stress, inflammation and pulmonary impairment in healthy mice
    (2011) RIVA, D. R.; MAGALHAES, C. B.; LOPES, A. A.; LANCAS, T.; MAUAD, T.; MALM, O.; VALENCA, S. S.; SALDIVA, P. H.; FAFFE, D. S.; ZIN, W. A.
    Air pollution is associated with morbidity and mortality induced by respiratory diseases. However, the mechanisms therein involved are not yet fully clarified. Thus, we tested the hypothesis that a single acute exposure to low doses of fine particulate matter (PM2.5) may induce functional and histological lung changes and unchain inflammatory and oxidative stress processes. PM2.5 was collected from the urban area of Sao Paulo city during 24 h and underwent analysis for elements and polycyclic aromatic hydrocarbon contents. Forty-six male BALB/c mice received intranasal instillation of 30 mu L of saline (CTRL) or PM2.5 at 5 or 15 mu g in 30 mu L of saline (P5 and P15, respectively). Twenty-four hours later, lung mechanics were determined. Lungs were then prepared for histological and biochemical analysis. P15 group showed significantly increased lung impedance and alveolar collapse, as well as lung tissue inflammation, oxidative stress and damage. P5 presented values between CTRL and P15: higher mechanical impedance and inflammation than CTRL, but lower inflammation and oxidative stress than P15. In conclusion, acute exposure to low doses of fine PM induced lung inflammation, oxidative stress and worsened lung impedance and histology in a dose-dependent pattern in mice.
  • 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, Ieda
    Background/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.
  • conferenceObject
    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.
  • article 6 Citação(ões) na Scopus
    Characterization of Cumulative Joint Damage Patterns in Patients with Rheumatoid Arthritis: A Clinical, Serological, and Gene Polymorphism Perspective
    (2015) ALARCON, Renata Trigueirinho; FERNANDES, Artur da Rocha Correa; LAURINDO, Ieda Maria; BERTOLO, Manoel Barros; PINHEIRO, Geraldo Castelar; ANDRADE, Luis Eduardo
    Objective. To characterize cumulative joint damage (CJD) patterns in rheumatoid arthritis (RA) and determine their associations with demographic/clinical features and HLA-DRB1 gene polymorphism. Methods. Hand and foot radiographs were obtained from 404 patients with RA. CJD patterns were determined by 3 derivations from Sharp/van der Heijde scores, obtained by the mathematical division of scores for hands/feet (Sharp-h/f score), fingers/wrists (Sharp-f/w score), and erosion/space narrowing (Sharp-e/sn score), respectively. DNA and serum were obtained for determination of HLA-DRB1 polymorphism, rheumatoid factor (RF), and anticitrullinated protein antibodies (ACPA). Results. Patients with wrist-dominant CJD pattern were more likely to have severe RA than those with finger-dominant pattern (68.4% vs 46.0%; p = 0.036) as were those with foot-dominant vs hand-dominant CJD pattern (76.5% vs 56.4%; p = 0.044). HLA-DRB1 shared epitope (SE) alleles were associated with erosion-dominant CJD pattern (p = 0.021). Patients with erosion-dominant CJD pattern had higher levels of RF and ACPA than those with space-narrowing-dominant CJD pattern (median RF 71.35 U/ml vs 22.05 U/ml, respectively; p = 0.003; median ACPA 187.9 U/ml vs 143.2 U/ml, respectively; p < 0.001). The majority of triple-positive patients (SE+, RF+, ACPA+) had erosion-dominant CJD pattern (62.3%) while the majority of triple-negative patients (SE-, FR-, ACPA-) had space narrowing-dominant CJD pattern (75%; p = 0.017). ACPA was associated with HLA-DRB1 SE alleles (p < 0.05). Patients with foot-dominant CJD pattern were taller than those with hand-dominant CJD pattern (p = 0.002); those with erosion-dominant CJD pattern had higher weight and body mass index than those with space narrowing-dominant CJD pattern (p = 0.014, p = 0.001). Conclusion. CJD patterns were associated with disease severity, HLA-DRB1 SE status, presence and titer of ACPA and RF, and morphometric features.
  • conferenceObject
    PATIENTS CENTERED BARRIERS TO TREAT TO TARGET (T2T) IMPLEMENTATION
    (2015) LAURINDO, I.; TORIGOE, D.; BERTOLO, M.; REZENDE, L.; BRENOL, C.; VASCONCELOS, J.; PEREIRA, I.; FREITAS, M.; RANZA, R.; ROMAIRO, L.; MOTA, L.
  • article 35 Citação(ões) na Scopus
    Drug survival and causes of discontinuation of the first anti-TNF in ankylosing spondylitis compared with rheumatoid arthritis: analysis from BIOBADABRASIL
    (2015) FAFA, Barbara P.; LOUZADA-JUNIOR, Paulo; TITTON, David C.; ZANDONADE, Eliana; RANZA, Roberto; LAURINDO, Ieda; PECANHA, Paula; RANZOLIN, Aline; HAYATA, Andre L.; DUARTE, Angela; SILVEIRA, Ines G.; COSTA, Izaias; MACIEIRA, Jose C.; GUEDES-BARBOSA, Luiz S.; BERTOLO, Manoel B.; SAUMA, Maria Fatima Lobato da C.; SILVA, Marilia B. G.; FREIRE, Marlene; SCHEINBERG, Morton A.; FERNANDES, Vander; BIANCHI, Washington; MIRANDA, Jose R. S.; PINHEIRO, Geraldo R. C.; CARVALHO, Hellen M. S.; BRENOL, Claiton Viegas; PEREIRA, Ivanio A.; CASTRO, Glaucio Ricardo Werner de; MORAIS, Julio C. Bertacini de; OLIVEIRA, Sheila K. F.; ABREU, Mirhelen Mendes de; TOLEDO, Roberto A.; PINHEIRO, Marcelo M.; VIEIRA, Walber Pinto; VALIM, Valeria
    Treatment survival with biological therapy may be influenced by many factors, and it seems to be different among various rheumatic diseases and biological agents. The goal of the study was to compare the drug survival and the causes of discontinuation of anti-tumoral necrosis factor (anti-TNF) therapy in ankylosing spondylitis (AS) with rheumatoid arthritis (RA). Study participants were a cohort from the Brazilian Registry of Biological Therapies in Rheumatic Diseases (BIOBADABRASIL) between 2008 and 2012. The observation time was up to 4 years following the introduction of the first treatment. Gender, age, disease duration, disease activity, comorbidities, and concomitant therapies were assessed. A total of 1303 patients were included: 372 had AS and 931 had RA in which 38.7%(n=504) used infliximab (IFX), 34.9 % (n=455) used adalimumab (ADA), and 26.4 % (n=344) used etanercept (ETA). The anti-TNF drug survival of patients with AS was 63.08 months (confidence interval (CI) 60.24, 65.92) and patients with RA was 47.5 months (CI 45.65, 49.36). It was significant higher in AS (log-rank; p=0.001). Patients with RA discontinued anti-TNF more than patients with AS when adjusted to gender and corticosteroid. The adjHR (95 % CI) was 1.6 (1.14, 2.31). Female patients who were also corticosteroid users, but not of advanced age, have shown lower survival for both diseases (log-rank, p=0.001). The discontinuation rate of IFX, but not of ADA or ETA, was significantly higher in RA than in SA; HR (95 % CI) was 2.49 (1.46, 4.24). The main causes of discontinuation were ineffectiveness and adverse event in both diseases. AS patients have better drug survival adjusted to gender, age, and corticosteroid. This results appear to be related to the disease mechanism.
  • article 71 Citação(ões) na Scopus
    Early Rheumatoid Arthritis in Latin America: Low Socioeconomic Status Related to High Disease Activity at Baseline
    (2012) Massardo, Loreto; Pons-Estel, Bernardo A.; Wojdyla, Daniel; Cardiel, Mario H.; Galarza-Maldonado, Claudio M.; Sacnun, Monica P.; Soriano, Enrique R.; Laurindo, Ieda M.; Acevedo-Vasquez, Eduardo M.; Caballero-Uribe, Carlo V.; Padilla, Oslando; Guibert-Toledano, Zoila M.; da Mota, Licia M.; Montufar, Ruben A.; Lino-Perez, Leticia; Diaz-Coto, Josef.; Achurra-Castillo, Angel F.; Hernandez, Jaime A.; Esteva-Spinetti, Maria H.; Ramirez, Luis A.; Pineda, Carlos; Furst, Daniel E.
    Objective. To determine the influence of socioeconomic factors on disease activity in a Latin American (LA) early rheumatoid arthritis (RA) multinational inception cohort at baseline. Methods. Clinical evaluation, ethnicity, socioeconomic status (SES), 4-variable Disease Activity Score in 28 joints using the erythrocyte sedimentation rate (DAS28-ESR), Health Assessment Questionnaire (HAQ) disability index (DI), and erosions were recorded in 1,093 patients with early RA (<1 year from onset). Multivariate analyses evaluated influences of sex, age, marital status, education, medical coverage, SES, and ethnicity on HAQ DI, DAS28-ESR, and presence of erosions. Results. Ethnicities included 43% Mestizo, 31% Caucasian, 19% African LA, 4% Amerindian, and 3% other. Fifty-eight percent were of low/low-middle SES, 42% had <8 years of education, 21% had no medical coverage, median disease duration was 6 months (25th, 75th percentiles 4, 9 months), median HAQ DI score was 1.25 (25th, 75th percentiles 0.63, 2.00), median DAS28-ESR score was 6.2 (25th, 75th percentiles 4.9, 7.2), and 25% had erosions. Women and Mestizos, African LA, and Amerindians had earlier onset than men or Caucasians (P < 0.01). When adjusted by country, the analysis of covariance model showed that low/low-middle SES, female sex, partial coverage, and older age were associated with worse HAQ DI scores; only low/low-middle SES was associated with higher DAS28 scores. Statistically significant differences were found in HAQ DI and DAS28 scores between countries. When excluding country, low/low-middle SES, female sex, and no coverage were associated with worse HAQ DI and DAS28 scores, whereas separated/divorced/widowed status was associated with worse HAQ DI scores and age was associated with worse DAS28 scores. Logistic regression showed that older age, no coverage, and the Amerindian and other ethnic groups were associated with erosions. Conclusion. We compared early RA patients from the main LA ethnic groups. Our findings suggest that low/low-middle SES is important in determining disease activity. A more genetic-related background for erosions is possible.
  • article 13 Citação(ões) na Scopus
    The presence of anti-citrullinated protein antibodies (ACPA) and rheumatoid factor on patients with rheumatoid arthritis (RA) does not interfere with the chance of clinical remission in a follow-up of 3 years
    (2012) MOTA, Licia Maria Henrique da; SANTOS NETO, Leopoldo Luiz dos; CARVALHO, Jozelio Freire de; PEREIRA, Ivanio Alves; BURLINGAME, Rufus; MENARD, Henri A.; LAURINDO, Ieda Maria Magalhaes
    Autoantibodies in early rheumatoid arthritis (RA) have important diagnostic value. The association between the presence of autoantibodies against cyclic citrullinated peptide and the response to treatment is controversial. To prospectively evaluate a cohort of patients with early rheumatoid arthritis (< 12 months of symptoms) in order to determine the association between serological markers (rheumatoid factor (RF), anti-citrullinated protein antibodies) such as anti-cyclic citrullinated peptide antibodies (anti-CCP) and citrullinated anti-vimentin (anti-Sa) with the occurrence of clinical remission, forty patients diagnosed with early RA at the time of diagnosis were evaluated and followed for 3 years, in use of standardized therapeutic treatment. Demographic and clinical data were recorded, disease activity score 28 (DAS 28), as well as serology tests (ELISA) for RF (IgM, IgG, and IgA), anti-CCP (CCP2, CCP3, and CCP3.1) and anti-Sa in the initial evaluation and at 3, 6, 12, 18, 24, and 36 months of follow-up. The outcome evaluated was the percentage of patients with clinical remission, which was defined by DAS 28 lower than 2.6. Comparisons were made through the Student t test, mixed-effects regression analysis, and analysis of variance (significance level of 5%). The mean age was 45 years, and a female predominance was observed (90%). At the time of diagnosis, RF was observed in 50% of cases (RF IgA-42%, RF IgG-30%, and RF IgM-50%), anti-CCP in 50% (no difference between CCP2, CCP3, and CCP3.1) and anti-Sa in 10%. After 3 years, no change in the RF prevalence and anti-CCP was observed, but the anti-Sa increased to 17.5% (P = 0.001). The percentage of patients in remission, low, moderate, and intense disease activity, according to the DAS 28, was of 0, 0, 7.5, and 92.5% (initial evaluation) and 22.5, 7.5, 32.5, and 37.5% (after 3 years). There were no associations of the presence of autoantibodies in baseline evaluation and in serial analysis with the percentage of clinical remission during follow-up of 3 years The presence of autoantibodies in early RA has no predictive value for clinical remission in early RA.
  • article 6 Citação(ões) na Scopus
    Plasma kinetics of an LDL-Like non-protein nanoemulsion and transfer of lipids to high-density Lipoprotein (HDL) in patients with rheumatoid arthritis
    (2015) POZZI, Fernanda S.; MARANHAO, Raul C.; GUEDES, Lissiane K.; BORBA, Eduardo F.; LAURINDO, Ieda M. M.; BONFA, Eloisa; VINAGRE, Carmen G.
    BACKGROUND: Rheumatoid arthritis (RA) is a systemic inflammatory disease associated with cardiovascular risk, but with normal plasma lipids. OBJECTIVE: The aim was to investigate low-density lipoprotein (LDL) and high-density lipoprotein (HDL) metabolism in RA patients using radioactive nanoemulsions resembling an LDL lipid structure (LDE) as metabolic probes. METHODS: Thirty patients with RA, 16 in remission and 14 in high activity, and 30 healthy controls were studied. LDE labeled with C-14-cholesteryl ester (C-14-CE) and H-3-unesterified cholesterol (H-3-UC) was intravenously injected followed by 24 hour plasma sampling. Fractional clearance rates (FCR, h(-1)) were calculated by compartmental analysis. Lipid transfers to HDL were assayed by incubating plasma samples with a donor nanoemulsion labeled with radioactive lipids; % lipids transferred to HDL were quantified after chemical precipitation. RESULTS: LDL cholesterol, triglycerides, unesterified cholesterol, and oxidized LDL were equal in RA and controls, and HDL cholesterol was even higher in RA. Compared with controls, apolipoprotein B was lower, apolipoprotein A1 was equal, and apolipoprotein E was higher in RA. Decay curves of LDE labels were faster in RA patients than in controls (C-14-CE: 0.072 +/- 0.066 and 0.038 +/- 0.027, P = .0115; H-3-UC: 0.066 +/- 0.042 and 0.035 +/- 0.039; P < .0044). FCRs were equal in 2 RA subgroups. Transfer of UC, triglycerides, and phospholipids to HDL was equal between RA and controls, but CE transfer was lower in RA. HDL size was smaller in RA patients than in controls (8.5 +/- 0.5 nm; 9.2 +/- 0.8 nm, P < .0001). CONCLUSION: RA patients were more efficient in removing atherogenic LDL from plasma, as indicated by higher CE and UC FCR, with in lower apolipoprotein B. This was unexpected because of the higher cardiovascular risk in RA.