ROSA MARIA RODRIGUES PEREIRA
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Clínica Médica, Faculdade de Medicina - Docente
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/17 - Laboratório de Investigação em Reumatologia, Hospital das Clínicas, Faculdade de Medicina
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/17 - Laboratório de Investigação em Reumatologia, Hospital das Clínicas, Faculdade de Medicina
35 resultados
Resultados de Busca
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- Improvement of bone microarchitecture parameters after 12 months of treatment with asfotase alfa in adult patient with hypophosphatasia Case report(2018) FREITAS, Thiago Quadrante; FRANCO, Andre Silva; PEREIRA, Rosa Maria RodriguesRationale: Hypophosphatasia is an inborn error of metabolism that can appear any time in life, mainly with bone manifestations due to low alkaline phosphatase activity. Asfotase alfa is a specific enzyme reposition treatment that has shown promising results in children; however, there are few reports about the outcomes in adult patients. Patient concerns: A 36-year-old male presented with an early history of craniosynostosis, short stature, and multiple fractures since the age of 13 years-which needed numerous surgical corrections. He was admitted with a previous diagnosis of osteogenesis imperfecta, taking alendronate, calcium carbonate, cholecalciferol, and calcitriol. Bone mineral density was low (lumbar spine Z-score = -3.0 SD), with impairment of all parameters of high-resolution peripheral quantitative computed tomography (HR-pQCT). Kidney impairment was also observed with reduced creatinine clearance, nephrolithiasis, and nephrocalcinosis. Diagnosis: Alkaline phosphatase was unexpectedly low (6 U/L, reference value: 30-120U/L), with high serum vitamin B6 (260 mcg/L, reference value: 5.2-34.1). Genetic testing showed a homozygous missense mutation in ALPL gene c.443 C>T: p.Thr148Ile. Intervention: Asfotase alfa was requested due to important bone deterioration, ambulatory disability, and kidney impairment. It was given subcutaneously 2 mg/kg per dose, 3 times a week, for 12 months before reassessment. Outcomes: Bone mineral densities of the lumbar spine and whole body, besides almost all HR-pQCT microstructural parameters of the distal tibia, showed improvements and the patient was able to walk without assistant device. Kidney function did not further deteriorate. Lessons: Hypophosphatasia should be considered as a differential diagnosis in young patients with multiple fractures and kidney impairment, since the use of antiresorptive drugs, calcium and vitamin D, commonly used to treat fractures, worsen its symptoms and prognosis. A 12-month asfotase alfa treatment improved bone density and structural parameters even in an adult patient with late diagnosis.
- Mortality predictors in ANCA-associated vasculitis Experience of a Brazilian monocentric cohort of a rheumatology center(2021) DAGOSTIN, Marilia A.; NUNES, Sergio L. O.; SHINJO, Samuel K.; PEREIRA, Rosa M. R.The mortality rate of patients with anti-neutrophil cytoplasm antibody -associated vasculitis (AAV) is higher than the general population. To date, no studies have evaluated the factors associated with unfavorable outcomes in Brazilian patients, who represent a miscegenated population. Our objective was to identify clinical and laboratory features associated with mortality in Brazilian patients with AAV. One hundred twenty eight patients fulfilling the American College of Rheumatology and Chapel Hill Classification Criteria followed between 2000 and 2018 in our Rheumatology Outpatient Clinics were included. Data were obtained from an ongoing electronic database. Patients were divided into 2 groups (dead or alive in 2018), and disease activity (Birmingham vasculitis activity score [BVAS]), vasculitis-related damage (VDI), and laboratory parameters were compared at the most recent attendance and at the last attendance before death. Of the 128 patients followed, 78.9% had granulomatosis with polyangiitis, 16.4% had eosinophilic granulomatosis with polyangiitis, and 4.6% had microscopic polyangiitis. In 2018, 78 patients were alive, 25 had died, and 25 had lost contact. The main cause of death was infection. According to the univariate analysis, the Birmingham vasculitis activity score, VDI, and glucocorticoid dose were higher in the group of patients who died. Laboratorial features related to mortality were creatinine, hemoglobin, erythrocyte sedimentation ratio, and C-reactive protein (CRP). Logistic regression analysis showed that high VDI, creatinine levels, and CRP levels were independent factors associated with mortality. Survival was significantly decreased in patients with renal impairment. This is the first study to use this approach performed in a Brazilian population and it showed that damage index, renal impairment, and CRP levels were associated with mortality in a miscegenated population with AAV.
- Quality of life measurements in patients with osteoporosis and fractures(2012) MADUREIRA, Melisa M.; CICONELLI, Rozana M.; PEREIRA, Rosa M. R.To review all specific questionnaires regarding quality of life in osteoporosis and to describe their distinctive indications, we searched Medline, the Scientific Electronic Library Online database, and the Latin-American and Caribbean Health Sciences Literature database. Nine specific questionnaires related to osteoporosis quality of life were found: 1) the Women's Health Questionnaire, 2) Osteoporosis Quality of Life Questionnaire, 3) Osteoporosis Assessment Questionnaire, 4) Osteoporosis Functional Disability Questionnaire, 5) Quality of Life Questionnaire of the European Foundation for Osteoporosis, 6) Osteoporosis-Targeted Quality of Life Questionnaire, 7) Japanese Osteoporosis Quality of Life Questionnaire, 8) the 16-item Assessment of Health-Related Quality of Life in Osteoporosis, and 9) the Quality of Life Questionnaire in Osteoporosis (QUALIOST (TM)). The Quality of Life Questionnaire of the European Foundation for Osteoporosis is the osteoporosis-specific questionnaire most commonly used in the literature. The Quality of Life Questionnaire of the European Foundation for Osteoporosis and the Osteoporosis Quality of Life Questionnaire are targeted more toward fracture assessment, and the Osteoporosis Functional Disability Questionnaire can be used for longitudinal studies involving exercise. In the present study, the authors summarize all of the specific questionnaires for osteoporosis and demonstrate that these questionnaires should be selected based on the objectives to be evaluated. Osteoporosis-specific quality of life questionnaires should be validated in the language of the country of origin before being used.
- Serum cytokines in childhood-Takayasu arteritis: Are they biomarkers for indolent disease activity?(2023) CLEMENTE, Gleice; TERRERI, Maria Teresa; PEREIRA, Rosa M. R.; GUALANO, Bruno; SILVA, Clovis Artur; SOUZA, Alexandre Wagner de
- Serum 25-hydroxyvitamin D levels in patients with Granulomatosis with Polyangiitis: association with respiratory infection(2017) PEREZ, Mariana O.; OLIVEIRA, Ricardo M.; LEVY-NETO, Mauricio; CAPARBO, Valeria F.; PEREIRA, Rosa M. R.OBJECTIVES: To determine the possible association of serum 25-hydroxyvitamin D (25OHD) levels with disease activity and respiratory infection in granulomatosis with polyangiitis patients during two different periods: winter/spring and summer/autumn. METHODS: Thirty-two granulomatosis with polyangiitis patients were evaluated in the winter/spring, and the same patients (except 5) were evaluated in summer/autumn (n = 27). The 25OHD levels were measured by radioimmunoassay. Disease activity was assessed by the Birmingham Vasculitis Activity Score Modified for Wegener's Granulomatosis (BVAS/WG) and antineutrophil cytoplasmic antibody (ANCA) positivity. Respiratory infection was defined according the Centers for Disease Control and Prevention criteria. RESULTS: 25OHD levels were lower among patients in winter/spring than in summer/autumn (32.31 +/- 13.10 vs. 38.98 +/- 10.97 ng/mL, p= 0.04). Seven patients met the criteria for respiratory infection: 5 in winter/spring and 2 in summer/autumn. Patients with respiratory infection presented lower 25OHD levels than those without infection (25.15 +/- 11.70 vs. 36.73 +/- 12.08 ng/mL, p= 0.02). A higher frequency of low vitamin D levels (25OHD <20 ng/mL) was observed in patients with respiratory infection (37.5% vs. 7.8, p= 0.04). Serum 25OHD levels were comparable between patients with (BVAS/WGX1 plus positive ANCA) and without disease activity (BVAS/WG= 0 plus negative ANCA) (35.40 +/- 11.48 vs. 35.34 +/- 13.13 ng/mL, p = 0.98). CONCLUSIONS: Lower 25OHD levels were associated with respiratory infection but not disease activity in granulomatosis with polyangiitis patients. Our data suggest that hypovitaminosis D could be an important risk factor for respiratory infection in granulomatosis with polyangiitis patients.
conferenceObject Creatine In Osteoarthritis, A Randomized, Double-blinded, Placebo-controlled Trial(2012) ROSCHEL, Hamilton; NEVES- JR., Manoel; FULLER, Ricardo; BENATTI, Fabiana; PINTO, Ana Lucia Sa; LIMA, Fernanda R.; PEREIRA, Rosa M.; LANCHA- JR., Antonio H.; BONFA, Eloisa; GUALANO, Bruno- Vitamin D supplementation and disease activity in patients with immune-mediated rheumatic diseases: A systematic review and meta-analysis(2017) FRANCO, Andre Silva; FREITAS, Thiago Quadrante; BERNARDO, Wanderley M.; PEREIRA, Rosa Maria R.Background:Vitamin D serum levels and the presence and activity of rheumatic conditions have been associated. However, many studies are merely observational, and the existent randomized clinical trials were never systematically analyzed. Therefore, this study aims to provide a systematic review and meta-analysis of such a topic.Methods:MEDLINE, EMBASE, LILACS, COCHRANE, and CINAHL were explored to identify randomized trials that investigated clinical repercussions of vitamin D (or analogs) supplementation for at least 3 months in rheumatic diseases. Standardized clinical and/or laboratorial outcomes related to disease activity were analyzed according to each disease before and after supplementation.Results:Database searches rendered 668 results; 9 were included5 on rheumatoid arthritis, 3 on systemic lupus erythematosus, and 1 on systemic sclerosis. Seven of the studies were meta-analyzed. After vitamin D supplementation, rheumatoid arthritis recurrence decreased; however, not significantly (risk difference=-0.10, 95% CI=-0.21, 0.00, P=.05). No statistical significance was observed regarding visual analog scale (mean difference=2.79, 95% CI=-1.87, 7.44, P=.24) and disease activity score28 (mean difference=-0.31, 95% CI=-0.86, 0.25, P=.28). Regarding systemic lupus erythematosus, anti-dsDNA positivity was significantly reduced (risk difference=-0.10, 95% CI=-0.18, -0.03; P=.005).Conclusion:Vitamin D supplementation reduced anti-dsDNA positivity on systemic lupus erythematosus and could possibly reduce rheumatoid arthritis recurrence, although novel randomized clinical trials are needed to confirm and extend the benefits of this hormone in immune-mediated rheumatic diseases.
- No deleterious effect of low dose methotrexate on titanium implant osseointegration in a rabbit model(2011) CARVAS, Janaina Badin; PEREIRA, Rosa Maria Rodrigues; BONFA, Eloisa; SILVEIRA, Celey Aparecida; LIMA, Luiz Lapa; CAPARBO, Valeria de Falco; MELLO, Suzana Beatriz Verissimo deOBJECTIVE: To evaluate the effect of low dose methotrexate alone or in combination with glucocorticoid treatment on titanium implant osseointegration. METHODS: Groups of 6-8 adult New Zealand White rabbits were treated for 18 weeks with saline (control), methotrexate, glucocorticoid, or methotrexate plus glucocorticoid. The animals received a titanium implant in the tibia at week 6. Lumbar spine and tibia bone mineral densities were analyzed before and after treatment. Histomorphometric analysis of bone cortical thickness, total bone area around the implant, and % of bone to implant contact was performed. RESULTS: After 18 weeks, the change in the bone mineral density in the lumbar spines and tibias in the methotrexate group was comparable to the control group (0.035 vs. 0.055 g/cm(2) and 0.021 vs. 0.041 g/cm(2), respectively). In contrast, both the glucocorticoid group and glucocorticoid plus methotrexate group had significant reductions at both sites. Histomorphometric analysis of the tibia in the control and methotrexate groups revealed no significant changes in cortical thickness (133 vs. 126 mu m), total bone area around the implant (33 vs. 30%), or bone to implant contact (40 vs. 38%). In contrast, glucocorticoid group had significant reductions compared to controls in tibia cortical thickness (99 vs. 133 mu m), total bone area around the implant (24 vs. 33%), and bone to implant contact (27 vs. 40%). Similar reductions were observed in the glucocorticoid plus methotrexate group. CONCLUSIONS: Our results demonstrate that low dose methotrexate treatment does not affect titanium implant osseointegration, suggesting that this therapy is safe for surgical procedures requiring a titanium implant.
- The impact of asymptomatic vertebral fractures on quality of life in older community-dwelling women: the Sao Paulo Ageing & Health Study(2012) LOPES, Jaqueline B.; FUNG, Leandro K.; CHA, Caroline C.; GABRIEL, Gustavo M.; TAKAYAMA, Liliam; FIGUEIREDO, Camille P.; PEREIRA, Rosa Maria R.OBJECTIVES: The aim of this study was to investigate the impact of asymptomatic vertebral fractures on the quality of life in older women as part of the Sao Paulo Ageing & Health Study. METHODS: This study was a cross-sectional study with a random sample of 180 women 65 years of age or older with or without vertebral fractures. The Quality of Life Questionnaire of the European Foundation for Osteoporosis was administered to all subjects. Anthropometric data were obtained by physical examination, and the body mass index was calculated. Lateral thoracic and lumbar spine X-ray scans were obtained to identify asymptomatic vertebral fractures using a semi-quantitative method. RESULTS: Women with asymptomatic vertebral fractures had lower total scores [61.4(15.3) vs. 67.1(14.2), p = 0.03] and worse physical function domain scores [69.5(20.1) vs. 77.3(17.1), p = 0.02] for the Quality of Life Questionnaire of the European Foundation for Osteoporosis compared with women without fractures. The total score of this questionnaire was also worse in women classified as obese than in women classified as overweight or normal. High physical activity was related to a better total score for this questionnaire (p = 0.01). Likewise, lower physical function scores were observed in women with higher body mass index values (p < 0.05) and lower physical activity levels (p < 0.05). Generalized linear models with gamma distributions and logarithmic link functions, adjusted for age, showed that lower total scores and physical function domain scores for the Quality of Life Questionnaire of the European Foundation for Osteoporosis were related to a high body mass index, lower physical activity, and the presence of vertebral fractures (p < 0.05). CONCLUSION: Vertebral fractures are associated with decreased quality of life mainly physical functioning in older community-dwelling women regardless of age, body mass index, and physical activity. Therefore, the results highlight the importance of preventing and controlling asymptomatic vertebral fractures to reduce their impact on quality of life among older women.
- Development and implementation of the AIDA international registry for patients with Schnitzler's syndrome(2022) SOTA, Jurgen; VITALE, Antonio; WIESIK-SZEWCZYK, Ewa; FRASSI, Micol; LOPALCO, Giuseppe; EMMI, Giacomo; GOVONI, Marcello; PAULIS, Amato de; MARINO, Achille; GIDARO, Antonio; MONTI, Sara; OPRIS-BELINSKI, Daniela; PEREIRA, Rosa Maria R.; JAHNZ-ROZYK, Karina; GAGGIANO, Carla; CRISAFULLI, Francesca; IANNONE, Florenzo; MATTIOLI, Irene; RUFFILLI, Francesca; MORMILE, Ilaria; RYBAK, Katarzyna; CAGGIANO, Valeria; AIRO, Paolo; TUFAN, Abdurrahman; GENTILESCHI, Stefano; RAGAB, Gaafar; ALMAGHLOUTH, Ibrahim A.; KHALIL, Adham Aboul-Fotouh; CATTALINI, Marco; TORRE, Francesco La; TARSIA, Maria; GIARDINI, Henrique A. Mayrink; SAAD, Moustafa Ali; BOCCHIA, Monica; CARONI, Federico; GIANI, Teresa; CINOTTI, Elisa; RUSCITTI, Piero; RUBEGNI, Pietro; DAGOSTIN, Marilia A.; FREDIANI, Bruno; GULER, Aslihan Avanoglu; CASA, Francesca Della; MAGGIO, Maria Cristina; RECKE, Andreas; BUBNOFF, Dagmar von; KRAUSE, Karoline; BALISTRERI, Alberto; FABIANI, Claudia; RIGANTE, Donato; CANTARINI, LucaObjective: The present paper describes the design, development, and implementation of the AutoInflammatory Disease Alliance (AIDA) International Registry specifically dedicated to patients with Schnitzler's syndrome. Methods: This is a clinical physician-driven, population- and electronic-based registry implemented for the retrospective and prospective collection of real-life data from patients with Schnitzler's syndrome; the registry is based on the Research Electronic Data Capture (REDCap) tool, which is designed to collect standardized information for clinical research, and has been realized to change over time according to future scientific acquisitions and potentially communicate with other existing or future similar registries. Results: Since its launch, 113 centers from 23 countries in 4 continents have been involved. Fifty-seven have already obtained the approval from their local Ethics Committees. The platform counts 324 users (114 Principal Investigators, 205 Site Investigators, 2 Lead Investigators, and 3 data managers) at current (April 28th, 2022). The registry collects baseline and follow-up data using 3,924 fields organized into 25 instruments, including patient's demographics, history, clinical manifestations and symptoms, trigger/risk factors, laboratory, instrumental exams, therapies, socioeconomic information, and healthcare access. Conclusions: This International Registry for patients with Schnitzler's syndrome facilitates standardized data collection, enabling international collaborative projects through data sharing and dissemination of knowledge; in turn, it will shed light into many blind spots characterizing this complex autoinflammatory disorder.