JULIANE ALINE PAUPITZ
Projetos de Pesquisa
Unidades Organizacionais
LIM/17 - Laboratório de Investigação em Reumatologia, Hospital das Clínicas, Faculdade de Medicina
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- Increased visceral adipose tissue and altered adiposity distribution in premenopausal lupus patients: correlation with cardiovascular risk factors(2018) SEGURO, L. P. C.; PAUPITZ, J. A.; CAPARBO, V. F.; BONFA, E.; PEREIRA, R. M. R.Objective: Visceral adipose tissue (VAT) correlates with cardiovascular risk factors and has never been assessed in systemic lupus erythematosus (SLE). Our aim was to evaluate VAT in premenopausal SLE patients. Methods: Sixty-three premenopausal SLE patients and 186 age-matched healthy women were included. Demographic, anthropometric, disease and treatment parameters were evaluated. VAT was measured by dual X-ray absorptiometry (DXA) with APEX 4.0 software. Results: SLE patients had a disease duration of 5.25 +/- 3.80 years, SLEDAI activity score of 4.35 +/- 5.13, SLICC/ACR-DI of 0.70 +/- 0.80, current prednisone dose of 11.60 +/- 12.10 mg/day and cumulative glucocorticoid dose of 22.34 +/- 12.94 g. Overweight/obese SLE patients and controls had similar VAT parameters (p>0.05). Among individuals with BMI <25 kg/m(2), SLE patients and controls had similar weight, fat mass and fat percentage (p>0.05) but patients had higher values of VAT parameters (VAT mass: 260.60 +/- 117.23 vs. 194.77 +/- 71.42 g, p=0.001; VAT area: 54.05 +/- 24.30 vs. 40.40 +/- 14.82 cm(2), p=0.001; VAT volume: 281.75 +/- 126.81 vs. 210.61 +/- 77.29 cm(3), p=0.001) and trunk/limb fat mass ratio (0.78 +/- 0.21 vs. 0.67 +/- 0.12, p=0.002) compared to controls. In SLE, VAT area correlated with weight (r=0.66, p<0.001), non-HDL cholesterol (r=0.53, p<0.001), LDL cholesterol (r=0.48, p<0.001) and triglycerides (r=0.33, p=0.008), but not with disease duration, SLEDAI, SLICC/ACR-DI or current glucocorticoid use (p>0.05). Conclusion: This study provides original evidence that SLE is associated with increased VAT and altered adiposity distribution. The correlation with traditional risk factors for cardiovascular disease, independent of current glucocorticoid dose and disease activity, suggests the role of visceral fat as an additional tool for risk assessment in these young patients.
- Risk factors for bone loss in juvenile-onset systemic lupus erythematosus: a prospective study(2019) SOUSA, L. F. A. de; PAUPITZ, J. A.; AIKAWA, N. E.; TAKAYAMA, L.; CAPARBO, V. F.; PEREIRA, R. M. R.Objective Juvenile-onset systemic lupus erythematosus (JoSLE) is associated with low bone mass for age and fractures; nevertheless, risk factors for bone impairment are poorly understood. The aim of this study was to evaluate risk factors for bone mass loss in JoSLE patients. Methods Forty-nine female JoSLE patients were evaluated at baseline and after a 3.5-year follow-up regarding clinical, laboratory (including bone turnover markers), areal bone mineral density (aBMD) and bone microarchitecture parameters using high-resolution peripheral quantitative computed tomography (HR-pQCT). Based on the difference between final and baseline aBMD value, the patients were divided into three groups: aBMD gain (BG), aBMD loss (BL) and aBMD no change (NC). Results The mean patient age was 18.7 +/- 3.3 years. Sixty-one percent of patients presented with aBMD gain, 18.4% aBMD loss, and 20.4% remained stable during this follow-up period. Comparing the BL with the BG group, there was a higher frequency of alcohol consumption (p = 0.009), a higher frequency of inadequate calcium intake (p = 0.047) and lower levels of baseline procollagen type 1 amino-terminal propeptide (P1NP) (p = 0.036) in the BL group. Moreover, worsening of HR-pQCT parameters trabecular volumetric density (p = 0.003) and cortical thickness (p = 0.009) was observed in the BL group. In addition, a higher frequency of renal activity was observed comparing the BL + NC with the BG group (p = 0.036). Conclusions This is the first longitudinal study that has analyzed the risk factors of bone loss in JoSLE patients. The authors emphasize the importance of evaluating lifestyle habits and renal disease activity in these young women. Furthermore, this study suggests that trabecular and cortical compartments deteriorated, and low levels of P1NP may be a predictor of bone impairment in JoSLE.
conferenceObject BONE IMPAIRMENT ASSESSED BY HR-PQCT IN JUVENILE - ON SET SYSTEMIC LUPUS ERYTHEMATOSUS(2017) PEREIRA, R. M. R.; PAUPITZ, J. A.; LIMA, G. L.; ALVARENGA, J. C.; OLIVEIRA, R. M.; BONFA, E.conferenceObject A RANDOMIZED DOUBLE-BLIND PLACEBO-CONTROLLED TRIAL OF VITAMIN D SUPPLEMENTATION IN JUVENILE-ONSET SYSTEMIC LUPUS ERYTHEMATOSUS: EFFECTS ON MICROARCHITECTURE USING HR-PQCT(2016) PAUPITZ, J. A.; LIMA, G. L.; AIKAWA, N. E.; ALVARENGA, J. C.; BONFA, E.; PEREIRA, R. M. R.- Bone impairment assessed by HR-pQCT in juvenile-onset systemic lupus erythematosus(2016) PAUPITZ, J. A.; LIMA, G. L.; ALVARENGA, J. C.; OLIVEIRA, R. M.; BONFA, E.; PEREIRA, R. M. R.High-resolution peripheral quantitative computed tomography (HR-pQCT) analysis of female juvenile-onset systemic lupus erythematosus (JoSLE) patients revealed trabecular/cortical bone damage and reduced bone strength primarily at the distal radius compared to healthy controls. We demonstrated for the first time that JoSLE patients with vertebral fracture (VF) present trabecular impairment at the distal radius. This study investigated the volumetric bone mineral density (vBMD), microarchitecture, and biomechanical features at the distal radius and tibia using HR-pQCT and laboratory bone markers in JoSLE patients compared to controls to determine whether this method discriminates JoSLE patients with or without VF. We compared 56 female JoSLE patients to age- and Tanner-matched healthy controls. HR-pQCT was performed at the distal radius and tibia. Serum levels of the amino-terminal pro-peptide of type I collagen, the C-terminal telopeptide of type I collagen, intact parathormone, sclerostin, and 25-hydroxyvitamin D (25OHD) were evaluated. VFs were analyzed using VFA-dual-energy X-ray absorptiometry (DXA) (Genant's method). Reduced density and strength parameters and microarchitecture alterations of cortical and trabecular bones were observed in JoSLE patients compared to controls, primarily at the distal radius (p < 0.05). Patients with VF exhibited a significant decrease in trabecular bone parameters solely at the distal radius (Total.BMD, p = 0.034; Trabecular.BMD [Tb.BMD], p = 0.034; bone volume (BV)/trabecular volume (TV), p = 0.034; apparent modulus, p = 0.039) and higher scores for disease damage (Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SLICC/ACR-DI), p = 0.002). Bone metabolism markers were similar in all groups. Logistic regression analysis of parameters that were significant in univariate analysis revealed that Tb.BMD (OR 0.98, 95 % CI 0.95-0.99, p = 0.039) and SLICC/ACR-DI (OR 7.37, 95 % CI 1.75-30.97, p = 0.006) were independent risk factors for VF. In conclusion, this study is the first demonstration of bone microstructure and strength deficits in JoSLE patients, particularly at the distal radius. Our results demonstrated that VF was associated with trabecular radius alteration and emphasized the potential detrimental effect of disease damage on this condition.
- A randomized double-blind placebo-controlled trial of vitamin D supplementation in juvenile-onset systemic lupus erythematosus: positive effect on trabecular microarchitecture using HR-pQCT(2018) LIMA, G. L.; PAUPITZ, J. A.; AIKAWA, N. E.; ALVARENGA, J. C.; PEREIRA, R. M. RodriguesIn this randomized double-blind placebo-controlled 24-week trial, cholecalciferol supplementation at 50,000 IU/week effectively improved bone microarchitecture parameters in juvenile-onset systemic lupus erythematosus (JoSLE) patients, as assessed by high-resolution peripheral quantitative computed tomography (HR-pQCT) at tibia site. An increase in the trabecular number and a decrease in the trabecular separation were observed, suggesting that vitamin D supplementation may be recommended for JoSLE patients with its deficiency. Introduction Vitamin D has an important effect on bone but there are no trials that directly address the boosting of serumlevels of 25-hydroxyvitamin D (25OHD) in bone microarchitecture in JoSLE patients. The aim of this study was to evaluate the effect of vitamin D supplementation on bone microarchitecture parameters using HR-pQCT in JoSLE patients. Methods This study was a randomized double-blind placebo-controlled 24-week trial. Forty female JoSLE patients were randomized (1: 1) to receive oral cholecalciferol at 50,000 IU/week (JoSLE-VitD) or placebo (JoSLE-PL). The medications remained stable throughout the study. Serum levels of 25OHD were measured using a radioimmunoassay. The bone microarchitecture and volumetric bone density were analyzed using HR-pQCT at tibia site. Results At baseline, the groups were similar with respect to their age, body mass index, organ involvement, glucocorticoid dose, immunosuppressant use, serum 25OHD levels, and HR-pQCT parameters. After 24 weeks, higher 25OHD levels were observed in the JoSLE-VitD group compared to the JoSLE-PL group [31.3 (8.6) vs. 16.5 (5.8) ng/mL, p < 0.001]. An increase in the trabecular number [Delta Tb. N 0.16 (0.24) vs. 0.03 (0.19) 1/mm, p = 0.024] and a decrease in the trabecular separation [Delta ThSp -0.045 (0.067) vs. 0.001 (0.009) mm, p = 0.017] were found in the JoSLE-VitD group compared to the JoSLE-PL group at tibia site. No differences were observed in other structural parameters [trabecular (Tb.Th) or cortical thickness (Ct.Th)], volumetric bone mineral densities, cortical porosity, and biomechanical parameters (p > 0.05). Conclusion This study suggests that cholecalciferol supplementation for 24 weeks effectively improved the bone microarchitecture parameters, mainly the trabecular number, in JoSLE patients.
conferenceObject VISCERAL FAT MEASURED BY DXA IN JUVENILE-ONSET SYSTEMIC LUPUS ERYTHEMATOSUS PATIENTS: A CORRELATION WITH DISEASE DURATION AND DAMAGE INDEX SCORE(2016) PAUPITZ, J. A.; LIMA, G. L.; SEGURO, L. P. C.; AIKAWA, N. E.; PEREIRA, R. M. R.