IEDA MARIA MAGALHAES LAURINDO
Projetos de Pesquisa
Unidades Organizacionais
LIM/17 - Laboratório de Investigação em Reumatologia, Hospital das Clínicas, Faculdade de Medicina
6 resultados
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- Wrist ultrasound analysis of patients with early rheumatoid arthritis(2011) MENDONCA, J. A.; YAZBEK, M. A.; LAURINDO, I. M. M.; BERTOLO, M. B.In the present study, we evaluated 42 wrists using the semi-quantitative scales power Doppler ultrasound (PDUS) and gray scale ultrasound (GSUS) with scores ranging from 0 to 3 and correlated the results with clinical, laboratory and radiographic data. Twenty-one patients (17 women and 4 men) with rheumatoid arthritis according to criteria of the American College of Rheumatology were enrolled in the study from September 2008 to July 2009 at Universidade Estadual de Campinas (UNICAMP). The average disease duration was 14 months. The patients were 66.6% Caucasians and 33.3% non-Caucasians, with a mean age of 42 and 41 years, respectively. A dorsal longitudinal scan was performed by ultrasound on the radiocarpal and midcarpal joints using GE LOGIQ XP-linear ultrasound and a high frequency (8-10 MHz) transducer. All patients were X-rayed, and the Larsen score was determined for the joints, with grades ranging from 0 to V. This study showed significant correlations between clinical, sonographic and laboratory data: GSUS and swollen right wrist (r = 0.546), GSUS of right wrist and swelling of left wrist (r = 0.511), PDUS of right wrist and pain in left wrist (r = 0.436), PDUS of right wrist and C-reactive protein (r = 0.466). Ultrasound can be considered a useful tool in the diagnosis of synovitis in early rheumatoid arthritis mainly when the anti-cyclic citrullinated peptide and rheumatoid factor are negative, and can lead to an early change in the therapeutic decision.
- 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, ValeriaTreatment 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.
- 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.
- Posicionamento sobre o uso de tofacitinibe no algoritmo do Consenso 2012 da Sociedade Brasileira de Reumatologia para o tratamento da artrite reumatoide(2015) MOTA, Licia Maria Henrique da; CRUZ, Bóris Afonso; ALBUQUERQUE, Cleandro Pires de; GONÇALVES, Deborah Pereira; LAURINDO, Ieda Maria Magalhães; PEREIRA, Ivanio Alves; CARVALHO, Jozélio Freire de; PINHEIRO, Geraldo da Rocha Castelar; BERTOLO, Manoel Barros; PINTO, Maria Raquel da Costa; LOUZADA-JUNIOR, Paulo; XAVIER, Ricardo Machado; GIORGI, Rina Dalva Neubarth; LIMA, Rodrigo Aires CorrêaAbstract In 2014, tofacitinib, a target-specific, synthetic disease modifying anti rheumatic drug (DMARD) and a selective inhibitor of Janus kinase (JAK) was approved for use in Brazil. This position paper aims to update the recommendations of the Brazilian Society of Rheumatology (SBR) on the treatment of rheumatoid arthritis (RA) in Brazil, specifically regarding the use of target-specific synthetic DMARDs. The method of this recommendation consisted of a literature review of scientific papers held on the Medline database. After this review, a text was produced, answering questions in Pico structure, considering efficacy and safety issues of tofacitinib use for RA treatment in different scenarios (such as first-line treatment after failure with methotrexate [MTX] or other conventional synthetic DMARDs after failure with biological therapy). Based on existing evidence, and considering the available data on efficacy, safety and cost of medications available to treat the disease in Brazil, the RA Commission of SBR, after a process of discussion and voting on proposals, established the following position on the use of tofacitinib for treatment of RA in Brazil: “Tofacitinib, alone or in combination with MTX, is an alternative for RA patients with moderate or high activity after failure of at least two different synthetic DMARDs and one biological DMARD.” The level of agreement with this recommendation was 7.5. This position may be reviewed in the coming years, in the face of a greater experience with the use of this medication.
- Daily practice feasibility and effectiveness of treating long-standing rheumatoid arthritis to target with synthetic disease-modifying antirheumatic drugs: a prospective cohort study(2015) BRENOL, Claiton Viegas; CHAKR, Rafael Mendonca Silva da; ANDRADE, Nicole Pamplona Bueno; TONI, Mariana; LAURINDO, Ieda Maria Magalhaes; BRENOL, Joao Carlos Tavares; XAVIER, Ricardo MachadoTo prospectively study the daily practice feasibility and effectiveness of treat-to-target (T2T) strategy with synthetic drugs aiming to maintain and achieve disease remission or low activity based on DAS28 and CDAI in long-standing rheumatoid (RA) patients. Two hundred and forty-one consecutive RA patients from Hospital de Clinicas de Porto Alegre were followed for 14 (+/- 5.3) months. At follow-up, patients were evaluated by a rheumatologist at least once every 3 to 4 months. Treatment was adjusted following a step-up strategy, based on the disease activity scores (DAS28 and CDAI), aiming at remission (< 2.6 or < 2.8, respectively) or at least low disease activity (< 3.2 or < 10). Patients were predominantly women (84.7 %), mean age 54.9 (+/- 11.9) years with 11.1 (+/- 7.4) years of disease duration. At visit 4, T2T intervention significantly reduced DAS28 (4.6 +/- 1.6 vs. 4.0 +/- 1.5; p < 0.005), CDAI [17.8 (8.2-28.7) vs. 12.6 (5.1-22.5); p < 0.001], and HAQ (1.5 +/- 0.9 vs. 1.3 +/- 0.8; p = 0.002). At the end of the study, compared to the baseline scores, more patients achieved remission by DAS28 (11.6 vs. 18.6 %; p < 0.001) and CDAI (8.1 vs. 13.6 %; p < 0.001) and also low disease activity by DAS28 (9.8 vs. 13.0 %; p < 0.001) and CDAI (23.9 vs. 28.4 %; p < 0.001). Both average doses of sulfasalazine and methotrexate at visit 4 were higher (1375 vs. 1621 mg, p = 0.024; and 14.5 vs. 16.5 mg, p < 0.001, respectively). More patients were on combination therapy at the end of the follow-up (48.2 vs. 52.3 %; p < 0.001). The implementation of T2T strategy in the treatment of RA was feasible and effective in this outpatient population. The optimization of synthetic DMARDs use with dose adjustments and combinations of drugs seemed to improve disease outcome regarding disease activity and functional status.
- Safe use of biological therapies for the treatment of rheumatoid arthritis and spondyloarthritides(2015) MOTA, Licia Maria Henrique da; CRUZ, Boris Afonso; BRENOL, Claiton Viegas; POLLAK, Daniel Feldman; PINHEIRO, Geraldo da Rocha Castelar; LAURINDO, Ieda Maria Magalhaes; PEREIRA, Ivanio Alves; CARVALHO, Jozelio Freire de; BERTOLO, Manoel Barros; PINHEIRO, Marcelo de Medeiros; FREITAS, Max Victor Carioca; SILVA, Nilzio Antonio da; LOUZADA-JUNIOR, Paulo; SAMPAIO-BARROS, Percival Degrava; GIORGI, Rina Dalva Neubarth; LIMA, Rodrigo Aires Correa; ANDRADE, Luis Eduardo CoelhoThe treatment of autoimmune rheumatic diseases has gradually improved over the last half century, which has been expanded with the contribution of biological therapies or immunobiopharmaceuticals. However, we must be alert to the possibilities of undesirable effects from the use of this class of medications. The Brazilian Society of Rheumatology (Sociedade Brasileira de Reumatologia) produced a document based on a comprehensive literature review on the safety aspects of this class of drugs, specifically with regard to the treatment of rheumatoid arthritis and spondyloarthritides. The themes selected by the participating experts, on which considerations have been established as the safe use of biological drugs, were: occurrence of infections (bacterial, viral, tuberculosis), infusion reactions, hematological, neurological, gastrointestinal and cardiovascular reactions, neoplastic events (solid tumors and hematologic neoplasms), immunogenicity, other occurrences and vaccine response. For didactic reasons, we opted by elaborating a summary of safety assessment in accordance with the previous themes, by drug class/mechanism of action (tumor necrosis factor antagonists, T-cell co-stimulation blockers, B-cell depletors and interleukin-6 receptor blockers). Separately, general considerations on safety in the use of biologicals in pregnancy and lactation were proposed. This review seeks to provide a broad and balanced update of that clinical and experimental experience pooled over the last two decades of use of immunobiological drugs for RA and spondyloarthritides treatment.