SAMUEL KATSUYUKI SHINJO
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Clínica Médica, Faculdade de Medicina - Docente
LIM/17 - Laboratório de Investigação em Reumatologia, Hospital das Clínicas, Faculdade de Medicina
LIM/17 - Laboratório de Investigação em Reumatologia, Hospital das Clínicas, Faculdade de Medicina
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- Work situation, work ability and expectation of returning to work in patients with systemic autoimmune myopathies(2023) CORDEIRO, Rafael A.; FISCHER, Frida M.; SHINJO, Samuel K.Objectives To document the work situation, the work ability and the expectation of returning to work among adult patients with systemic autoimmune myopathies (SAMs), and to identify the factors associated with each of these outcomes. Methods Cross-sectional study. The work situation (performing paid work vs out of work) was ascertained via a structured questionnaire. For those who were working, we applied the Work Ability Index (WAI; scale 7-49); and for those who were out of work, we applied the Return-to-Work Self-Efficacy questionnaire (RTW-SE; scale 11-66). Results Of the 75 patients with SAMs included, 33 (44%) were doing paid work and 42 (56%) were out of work. The work situation was independently associated with physical function, assessed by the Health Assessment Questionnaire-Disability Index (HAQ-DI). A 1-point increase in the HAQ-DI (scale 0-3) decreased the chance of doing paid work by 66% (95% CI: 0.16, 0.74; P = 0.007). Patients performing paid work had a mean WAI of 33.5 (6.9). The following variables were associated with a decrease in the WAI score in the regression model: female sex (-5.04), diabetes (-5.94), fibromyalgia (-6.40), fatigue (-4.51) and severe anxiety (-4.59). Among those out of work, the mean RTW-SE was 42.8 (12.4). Cutaneous manifestations and >12 years of education were associated with an average increase of 10.57 and 10.9 points, respectively, in the RTW-SE. A 1-point increase in the HAQ-DI decreased the RTW-SE by 4.69 points. Conclusion Our findings highlight the poor work participation in a well-characterized sample of working-age patients with SAMs. Strategies to improve work-related outcomes in these patients are urgently needed.
- Exercise as an Adjuvant Treatment in Persistent Active Polymyositis(2014) MATTAR, Melina Andrade; GUALANO, Bruno; ROSCHEL, Hamilton; PERANDINI, Luiz Augusto; DASSOUKI, Thalita; LIMA, Fernanda Rodrigues; SHINJO, Samuel Katsuyuki; PINTO, Ana Lucia de SaObjectives: A growing number of studies have suggested that exercise may promote therapeutic effects in patients with idiopathic inflammatory myopathy. This prospective case series study aimed to report on the effects of exercise in patients with persistent active myositis. Methods: Three patients with persistent active polymyositis were submitted to a 12-week supervised exercise program comprising both aerobic and strength exercises. Results: After the intervention, the patients presented improvements in selected parameters of muscle function and aerobic conditioning. In addition, an overall improvement was detected in the quality of life, as measured by both the 36-item Short-Form Health Survey and the Health Assessment Questionnaire questionnaires. Importantly, exercise did not increase serum levels of creatine kinase and aldolase. Conclusions: The findings herein suggest that a combined aerobic and strength training program may be tolerable and potentially effective in improving muscle function, aerobic conditioning, and quality of life in patients with persistent active polymyositis.
article 18 Citação(ões) na Scopus High prevalence of metabolic syndrome in antisynthetase syndrome(2018) ARAUJO, P. A. O.; SILVA, M. G.; BORBA, E. F.; SHINJO, S. K.Objective A high frequency of metabolic syndrome (MetS) has been recently described in different idiopathic inflammatory myopathies, but not in antisynthetase syndrome (ASS). Therefore, the aim of the present study was to determine the prevalence of MetS in ASS and also its possible association with cardiovascular the risk factors and ASS-related disease characteristics. Methods A cross-sectional single centre study of 42 consecutive ASS patients was conducted from 2012 to 2015 and compared to 84 healthy individuals matched for gender, age, ethnicity and body mass index-matched (control group). MetS was defined according to the 2009 Join Interim Statement. Clinical and laboratory data were assessed according to a standardised protocol. Results ASS patients had a median age of 41.1 years with a predominance of female gender and white race. ASS patients had a higher frequency of MetS (42.9% vs. 13.1%; p<0.001) as well as of insulin resistance than controls. Moreover, ASS patients had higher resistin, lower leptin and similar adiponectin levels in serum than controls. Further analysis of ASS patients with (n=18) and without (n=24) MetS revealed that older age at disease onset (48.7 vs. 35.4 years; p<0.001) was identified in those with the syndrome but were similar regarding disease duration, disease status, treatment, insulin resistance and serum adipocytokine levels. Conclusion The prevalence of MetS was high in ASS patients that also had serum resistin and low leptin levels. As also identified in other idiopathic inflammatory myopathies, MetS in ASS is more prevalent in older patients.article 6 Citação(ões) na Scopus Serum hyaluronic acid in polymyositis: high serum levels tend to correlate with disease activity(2014) SILVA, M. B.; SILVA, M. G.; SHINJO, S. K.Objective: Polymyositis (PM) is a rare systemic idiopathic inflammatory myopathy. Hyaluronic acid (HA) is closely linked to inflammatory cellular reactions and disease activity. Increased serum levels of HA have been reported in several inflammatory diseases, but currently, there are no studies analysing the HA in PM. Thus, clinical association of HA with PM in patients was determined in the present study. Methods: The present cross-sectional study was performed at one centre from 2012 to 2013 and included 35 consecutive adult patients with PM (Bohan and Peter criteria, 1975) and 38 adult healthy volunteers. The serum HA was assessed with anti-HA antibody, using the specific ELISA/EIA kits according to the manufacturer's protocol. Results: The average age, distribution of females and ethnicity were comparable in patients with PM and the control group. Regarding disease status, patients with PM had a median patient visual analogue score (VAS) of 2 [0-6], physician VAS of 1 [0-3], MMT-8 of 74 [68-80] and HAQ of 0.48 [0.00-1.14]. The serum levels of HA were also significantly increased in patients with PM (390 +/- 412ng/mL) compared to healthy subjects (129 +/- 119ng/mL), p=0.001. In an additional analysis, the serum levels of HA did not correlate with PM demographic data (gender and ethnicity), current organ involvement or autoantibodies and were not been influenced by the use of prednisolone and/or immunosuppressives by the PM patients. However, there was a positive correlation between serum levels of HA and VAS (patient and physician), and a negative correlation between serum levels of HA and MMT-8. Conclusion: High serum levels of HA were observed in patients with PM and tended to correlate with PM disease activity. Additional studies are needed to assess this correlation, as well as to understand the mechanism involved in the pathogenesis of PM by HA.- Serum Myostatin and Follistatin Levels in Patients With Dermatomyositis and Polymyositis(2022) SORDI, Cintia M. de; REIS-NETO, Edgard T. dos; KEPPEKE, Gerson D.; SHINJO, Samuel K.; SATO, Emilia InoueBackground Myostatin is a protein in the TGF-beta family that negatively regulates muscle mass, and follistatin is a myostatin antagonist. Objective The aim of this study was to measure serum levels of myostatin and follistatin in idiopathic inflammatory myopathy patients and correlate these levels with muscle strength, fatigue, functional capacity, damage, and serum levels of muscle enzymes. Methods This was a multicenter cross-sectional study including 50 patients (34 dermatomyositis and 16 polymyositis [PM]) and 52 healthy individuals (control group [CG]). The disease status was evaluated according to the International Myositis Assessment & Clinical Studies. Fatigue was rated according to the Fatigue Severity Scale, and body composition was measured using dual-energy x-ray emission densitometry. Myostatin and follistatin were measured using enzyme-linked immunosorbent assays. Results Mean age was 50.9 +/- 14.0 years, and mean disease duration was 89.2 +/- 80.9 months. There were no differences in levels of myostatin (14.15 +/- 9.65 vs. 10.97 +/- 6.77 ng/mL; p = 0.131) or follistatin (0.53 +/- 0.71 vs. 0.49 +/- 0.60 ng/mL; p = 0.968) between patients and the CG. However, myostatin levels were higher in PM than CG (16.9 +/- 12.1 vs. 11.0 +/- 6.8 ng/mL; p = 0.036). There was no difference in serum myostatin among patients with and without low lean mass. Patients not treated with corticosteroids had higher serum levels of myostatin than the CG. There was a weak negative correlation between follistatin and Manual Muscle Testing and a Subset of Eight Muscles and a weak positive correlation between follistatin and Healthy Assessment Questionnaire. Conclusions Serum levels of myostatin and follistatin did not differ between dermatomyositis and PM patients and control subjects. The assessment of serum levels of myostatin and follistatin in idiopathic inflammatory myopathy patients seems not to be helpful in clinical practice.
- Insulin resistance is increased in adult patients with dermatomyositis(2018) OLIVEIRA, Diego Sales de; GUIMARÃES, Marilda Silva; SHINJO, Samuel KatsuyukiOBJECTIVE: To evaluate insulinemia in glucocorticoid naïve patients with dermatomyositis and to evaluate insulin resistance using the homeostatic model assessment of insulin resistance (HOMA2-IR). METHODS: This cross-sectional study included 25 dermatomyositis, non-diabetic glucocorticoid naïve patients. The control group consisted of 50 volunteers matched for age, gender, ethnicity, weight and height. The HOMA2-IR index was calculated from baseline insulin and glucose data. The International Myositis Assessment & Clinical Studies Group (IMACS) parameters were used to evaluate disease status. RESULTS: Mean age of the patients was 43.5 years and these were predominantly females. Patients had low disease activity according to IMACS parameters. Higher body mass index and waist circumference were observed in the dermatomyositis group compared to the control group. Insulin level and HOMA2-IR were also higher in patients with dermatomyositis. Moreover, analyzing dermatomyositis alone, the HOMA2-IR index correlated positively with weight, body mass index and waist circumference and was independent on disease status parameters. CONCLUSIONS: Patients with dermatomyositis had higher values for basal insulinemia, insulin resistance, body mass index and waist circumference. Moreover, HOMA2-IR moderately correlated with these anthropometric parameters. These metabolic abnormalities are related to the development of metabolic syndrome, one of the main comorbidities observed in dermatomyositis.
article 4 Citação(ões) na Scopus Miopatia inflamatória induzida por adalimumab na artrite reumatóide(2012) SOUZA, Fernando Henrique Carlos de; BARROS, Thiago Bitar Morais; LEVY-NETO, Mauricio; SHINJO, Samuel KatsuyukiThe application of immunobiologics for the rheumatoid arthritis treatment may present as a rare complication the development of inflammatory myopathy. Until this moment, there have been described in literature only seven cases of inhibitors of tumor necrosis factor induced-myositis. In this paper, we report the case of the patient with 39 years-old with eight years of arthritis rheumatoid and that due to refractory to various immunosuppressive drugs, the adalimumab was introduced, and evolved to dermatomyositis status.article 18 Citação(ões) na Scopus Feasibility, safety and efficacy of exercise training in immune-mediated necrotising myopathies: a quasi-experimental prospective study(2019) SOUZA, J. M. de; OLIVEIRA, D. S. de; PERIN, L. A.; MISSE, R. G.; SANTOS, A. M. dos; GUALANO, B.; PINTO, A. L. de Sa; ROSCHEL, H.; LIMA, F. R.; SHINJO, S. K.Objective To evaluate the feasibility, safety and efficacy of exercise training in patients with immune-mediated necrotising myopathies (IMNM). Methods Eight consecutive sedentary patients with IMNM (5 anti-signal recognition particle and 3 anti-hydroxy-methyl-glutaryl coenzyme A reductase) were engaged in this study. Disease status was based on International Myositis Assessment and Clinical Studies Group (IMACS) core set measures. Physical performance was evaluated by cardiopulmonary exercise test, repetition maximum (RM) protocol, handgrip dynamometry, sit-to-stand (STS) and timed up-and-go (TUG) tests. All these parameters were measured at baseline and after a 12-week, twice-a-week, supervised exercise training comprising aerobic and strength exercises. Results Patients (aged 61 years on average) were very disabled at the beginning of the disease (mean duration of 17.7 months), but after being aggressively treated with a treat-to-target approach, they presented only mild symptoms that were well-controlled with oral immunosuppression and low disease status scores by the time of the exercise intervention. No disease relapsing, worsening of the IMACS set scores or adverse events were observed throughout the training period. Patients also increased aerobic capacity (e.g. time to achieve anaerobic threshold and time to achieve exhaustion), muscle strength (e.g. 1RM bench press) and function (e.g. STS test). Conclusion Supervised exercise training did not impair disease status and seemed to be feasible, safe and effective in patients with IMNM. Moreover, exercise training increased aerobic capacity, muscle strength and function, suggesting that this could be a novel potential coadjuvant therapy in IMNM.article 17 Citação(ões) na Scopus Reduction of ovarian reserve in adult patients with dermatomyositis(2015) SOUZA, F. H. C. de; SHINJO, S. K.; YAMAKAMI, L. Y. S.; VIANA, V. S. T.; BARACAT, E. C.; BONFA, E.; SILVA, C. A.Objective To assess ovarian reserve markers and anti-corpus luteum (anti-CoL) antibodies in dermatomyositis (DM) patients. Methods Forty female DM patients were invited to participate. Exclusion criteria included hormonal contraceptive use within the last six months, neoplasia associations, overlapped systemic autoimmune diseases, current pregnancy, gynaecological surgery and individual choice not to participate. The final experimental group for this cross-sectional study included 16 DM patients and 23 healthy controls, each of whom was evaluated during the early follicular phase of the menstrual cycle. Values for IgG anti-CoL (via immunoblotting), follicle stimulating hormone (FSH), estradiol, inhibin B, anti-Mullerian hormone (AMH) serum levels (via ELISA) and sonographic antral follicle count (AFC) were determined. Results DM patients and controls were of comparable mean age (p>0.05). The mean age of DM onset was 29.1 +/- 4.7 years, with disease duration of 5.6 +/- 3.2 years. Menstrual cycle characteristics, comorbidity and lifestyle were similar amongst patients in both groups (p>0.05). AMH values of <= lng/mL (p=0.027) and AFC values (p=0.017) were significantly reduced in DM patients relative to the control group, whereas serum estradiol levels (p<0.001) were higher in DM patients compared to controls. In contrast, serum FSH and inhibin B levels, ovarian volumes, and anti-CoL antibody frequency were similar in both groups. Differences in AFC and estradiol were determined to be significant following Bonferroni correction for multiple testing. Conclusion We identified a diminished ovarian reserve in DM patients of reproductive age. Further studies are necessary to assess the idiopathic inflammatory myopathy-related factors involved in the ovarian impairment of this patient population.article 3 Citação(ões) na Scopus The effect of prior corticosteroid use in muscle biopsies from patients with dermatomyositis(2015) SHINJO, S. K.; NASCIMENTO, J. J.; MARIE, S. K. N.Objective The aim of this study was to evaluate the effect of prior corticosteroid (CS) use on the presence of inflammatory infiltrates (In!) in muscle biopsies from dermatomyositis (DM). Methods Sixty-five muscle biopsy samples were obtained at the time of DM diagnosis. The patients were divided into the following three groups according to the degree of the InI present in the muscle biopsies: (I) minimal InI present only in an interstitial area (endomysium, perimysium) or in a perivascular area; (II) moderate InI in one or two areas of the interstitium or of the perivascular area; and (III) moderate InI throughout the interstitium or intense inflammation in at least one area of the interstitium or of the perivascular area. Results All groups (I=17,II=16 and III=32) were comparable regarding the patient age at the time of the muscle biopsy, gender, ethnicity distribution, time interval between the muscle biopsy and the symptom onset, clinical manifestations, degree of muscle weakness, autoantibodies and serum muscle enzyme measurements (p<0.05). The median (interquartile) duration of CS use [7(0-60), 6(0-105) and 14 (0-30) days in groups I, II and III, respectively] and the median cumulative CS dose used [560 (0-2100), 1005 (0-2850) and 875 (0-2850) mg] were similar between the groups (p>0.05). Conclusion Previous CS use did not influence the presence or the degree of inflammatory infiltrates found in muscle biopsies in DM with clinical and laboratory disease activity. Therefore, muscle biopsies should be performed in this population, including patients currently undergoing CS therapy.