LUCIANA PARENTE COSTA SEGURO
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
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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conferenceObject Induction of Lupus Nephritisin in Real Situation: Cyclophosphamide or Mycophenolate Mofetil?(2017) MUNHOZ, Gabriela; LACERDA, Maira; LOPES, Michelle; BORBA, Eduardo Ferreira; SEGURO, Luciana; BONFA, Eloisa- Early proteinuria response: a valid real-life situation predictor of long-term lupus renal outcome in an ethnically diverse group with severe biopsy-proven nephritis?(2017) UGOLINI-LOPES, Michelle R.; SEGURO, Luciana Parente C.; CASTRO, Maite Xavier F.; DAFFRE, Danielle; LOPES, Alex C.; BORBA, Eduardo F.; BONFA, EloisaObjective Two recent important lupus nephritis trials reported that proteinuria was a good predictor of renal outcome in Caucasians, but data on real-life situation, other races and severe nephritis are lacking to substantiate this finding as a simple test to guide clinical practice. The aim of this study was to validate proteinuria as a predictor of long-term renal outcome in real-life situation in a racially diverse group of patients with severe nephritis. Methods Proteinuria, serum creatinine (SCr) and urine red blood cells were assessed at baseline and after 3, 6 and 12 months, as early predictors of long-term renal outcome (SCr <1.5 mg/dL at 7 years), in 94 patients with biopsy-proven lupus nephritis. The parameter performance and cut-off values were computed by receiver operating characteristic curves. Kaplan-Meier curves were used to validate the parameter. Results A proteinuria <0.8 g/24 hours at 12 months was the best single predictor of long-term renal outcome (sensitivity 90%, specificity 78%, positive predictive value 67%, negative predictive value (NPV) 94% and area under the curve 0.86; p<0.001). Addition of other variables to proteinuria such as SCr and haematuria at 12 months did not improve its performance. The proteinuria cut-aft value of <0.8 g/24 hours at 12 months was a good predictor of 7-year renal survival (years free of dialysis) for patients with pure membranous (p=0.005) and proliferative nephritis (p=0.043), as well as black (p=0.002) and white race (p=0.001), anti-dsDNA positive (p=0.001) and anti-dsDNA negative (p=0.04) and male (p=0.028) and female (p=0.003) patients. Conclusion We provided novel evidence that, in a real-life situation, proteinuria at 12 months of follow-up was the single best predictor of renal outcome at 7 years for an ethnically diverse group of patients with severe nephritis and a valid parameter for distinct histological classes, races, genders and anti-dsDNA profiles. The remarkably high NPV obtained reinforces its recommendation as the ideal predictor for clinical practice, since it is of low cost, easy to interpret, non-invasive and widely available.
conferenceObject EARLY AND LATE ONSET BIOPSY-PROVEN LUPUS NEPHRITIS WITHOUT OTHER ASSOCIATED AUTOIMMUNE DISEASES: SEVERITY AND LONG-TERM OUTCOME(2018) LOPES, M.; SANTOS, L.; SEGURO, L.; BONFA, E.conferenceObject CLINICAL AND SEROLOGICAL COMPARATIVE ANALYSIS OF SYSTEMIC SCLEROSIS WITH OR WITHOUT OVERLAP SYNDROMES IN A LARGE BRAZILIAN COHORT(2014) SILVA, C. M.; PASOTO, S. G.; VIANA, V. S.; SEGURO, L. P. C.; ANDRADE, D. C. O.; BONFA, E.; SAMPAIO-BARROS, P. D.- Chronic arthritis in systemic lupus erythematosus: distinct features in 336 paediatric and 1830 adult patients(2016) GORMEZANO, Natali W. S.; SILVA, Clovis A.; AIKAWA, Nadia E.; BARROS, Diego L.; SILVA, Mariana A. da; OTSUZI, Carini I.; KOZU, Katia; SEGURO, Luciana Parente; PEREIRA, Rosa M. R.; BONFA, EloisaThe objectives of this study are to assess the frequency of chronic arthritis and compare the clinical and laboratory features in a large population of childhood-onset systemic lupus erythematosus (cSLE) and adult-onset (aSLE) patients. This historical study evaluated 336 cSLE and 1830 aSLE patients. Chronic arthritis was defined as synovitis of at least 6 weeks of duration. Rhupus was characterised as the association of SLE and chronic inflammatory arthritis with erosion and positive rheumatoid factor. Jaccoud's arthropathy is a non-erosive subluxation leading to severe deformity of the hands and feet. Data were compared using Student's t test or the Mann-Whitney test for continuous variables. For categorical variables, differences were assessed by Fisher's exact test and Pearson chi-square. Frequencies of chronic arthritis were similar in cSLE and aSLE (2.4 vs. 3.8 %, p=0.261). The median time from disease onset to appearance of chronic arthritis was shorter in cSLE (0 vs. 10 years, p<0.001), and the median of age at chronic arthritis diagnosis was [10.8 (4.2-14.6) vs. 40 (21-67), p<0.001]. The children presented with more chronic polyarthritis than the adults (75 vs. 32 %, p=0.024), a higher median number of joints with arthritis [8.5 (118) vs. 3 (1-9), p=0.017] and a higher number of joints with limitation [1.5(0-24) vs. 0(0-4), p=0.004]. The chronic arthritis diagnosis frequencies of hepatomegaly (25 vs. 0 %, p=0.009), splenomegaly (25 vs. 0 %, p=0.009), pericarditis (25 vs. 0 %, p=0.009), nephritis (37 vs. 3 %, p=0.006), haematuria (37 vs. 1.4 %, p=0.002), lupus anticoagulant (40 vs. 1.6 %, p=0.012), anticardiolipin IgM (40 vs. 1.5 %, p=0.012) and median Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) [10.5(1-20) vs. 6(4-16), p=0.029] were higher in cSLE. Frequency of rhupus, (12 vs. 17 %, p=1.0), Jaccoud's arthropathy (0 vs. 17 %, p=0.343) and treatments were similar in cSLE and aSLE. We determined that chronic arthritis in SLE has distinct features in children, with very early onset, polyarticular involvement and association with active disease. We further demonstrated in this series that a proportion of chronic arthritis involvement in SLE is manifested as rhupus and Jaccoud's arthropathy.
- 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.
conferenceObject PERIPHERAL NERVOUS SYSTEM DISEASE IN SYSTEMIC LUPUS ERYTHEMATOSUS: THE ROLE OF PREDISPOSING CONDITIONS(2018) FARGETTI, S.; BONFA, E.; SHINJO, S. K.; PASOTO, S. G.; SEGURO, L. P. C.; LOPES, M. R. U.; GONCALVES, C. R.; BORBA, E. F.conferenceObject SHORT AND LONG-TERM FOLLOW-UP OF PERIPHERAL NEUROPATHY DUE TO SYSTEMIC LUPUS ERYTHEMATOSUS: EVIDENCE OF A FAVORABLE OUTCOME(2018) FARGETTI, S.; BONFA, E.; SHINJO, S. K.; PASOTO, S. G.; SEGURO, L. P. C.; LOPES, M. R. U.; GONCALVES, C. R.; BORBA, E. F.- Left ventricular pseudoaneurysm associated with systemic lupus erythematosus(2019) HOFF, L. S.; PIMENTEL, C. Q.; FAILLACE, B. L. R.; ROCHITTE, C. E.; DEMARCHI, L. M. M. F.; BONFA, E.; SEGURO, L. P. C.Systemic lupus erythematosus (SLE) is associated with several cardiac manifestations but, to our knowledge, there have been no previously published reports on left ventricular (LV) pseudoaneurysm in this disease. We describe a case of a 30-year-old woman with SLE who presented with a disease flare (acute and subacute cutaneous lupus, pericarditis, fever, leukopenia) associated with heart failure syndrome. The patient was diagnosed with a large LV pseudoaneurysm and a bovine pericardium patch closure was performed. Coronary arteries were angiographically normal, and cardiac magnetic resonance imaging did not exhibit detectable myocardial fibrosis or infarction. Trauma, previous cardiac surgery, Chagas disease, and antiphospholipid syndrome were excluded. Histopathology of the pericardium revealed lymphocytic arteriolitis raising the possibility of an autoimmune-mediated mechanism for this complication. The unequivocal concomitant diagnosis of lupus flare, the exclusion of other causes of pseudoaneurysm and the histopathological finding of arteriolitis in this patient reinforces the hypothesis of lupus-mediated lesion.
- Late-onset biopsy-proven lupus nephritis without other associated autoimmune diseases: severity and long-term outcome(2019) UGOLINI-LOPES, M. R.; SANTOS, L. P. S.; STAGNARO, C.; SEGURO, L. P. C.; MOSCA, M.; BONFA, E.Background/Purpose Lupus nephritis (LN) usually develops within the first years of systemic lupus erythematosus (SLE) onset and rarely after that. There are scarce studies comparing early- versus late-onset nephritis (before versus after five years of SLE diagnosis). The aim of this study was to compare the severity and long-term outcome (after 7 years) in these two, late-onset and early-onset, nephritis groups. Methods This study included 93 patients from rheumatology tertiary centers from Brazil and Italy, all of them with biopsy-proven LN with > 7 years follow-up. Patients were divided in two groups: early-onset nephritis (n = 75) and late-onset nephritis (n = 18). Clinical and laboratorial data were obtained using a standardized electronic chart database protocol carried out at 1-6 months interval and established in 2000. Patients >50 years or with concomitant autoimmune diseases were excluded. Variables evaluated at the LN presentation were Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), creatinine, albumin, anti-DNA positivity and nephritis class. Variables evaluated at the long-term outcome (after 7 years) were Systemic Lupus International Collaborating Clinics Damage Index (SDI), creatinine, dialysis and mortality. Results The average time of LN presentation was 10.94 +/- 3.73 years for the late-onset and 1.20 +/- 1.60 years for the early-onset group. Their similar nephritis duration (12.44 +/- 3.2 versus 13.28 +/- 4.03 years, p = 0.41) and comparable mean ages (49.17 +/- 9.9 versus 44.11 +/- 10.8 years old, p = 0.06) allow a more accurate comparison. Regarding severity, late-onset was similar to early-onset group: SLEDAI (8 (range: 6-22) versus 12 (range: 2-24), p = 0.47), creatinine (1.36 +/- 0.94 versus 1.36 +/- 1.13 mg/dl, p = 0.99); albumin (2.84 +/- 0.65 versus 2.59 +/- 0.84 mg/dl, p = 0.30); proteinuria (3.77 +/- 2.18 versus 5.01 +/- 4.51 g/vol, p = 0.26); proliferative nephritis (44% (n = 8) versus 60% (n = 45), p = 0.23). There was also no difference in the long-term outcomes between groups: SDI (1 (range: 0-5) versus 0.5 (range: 0-5), p = 0.27); creatinine (2.04 +/- 2.38 versus 1.69 +/- 2.26 mg/dl, p = 0.56); dialysis (22% (n = 4) versus 13% (n = 10), p = 0.46) and mortality (0% (n = 0) versus 12% (n = 9), p = 0.19). Conclusion This study provides novel evidence of comparable long-term outcomes between late-onset and early-onset nephritis, which is most likely explained by the observation that at presentation, the clinical, laboratorial and histological features of late-onset and early-onset nephritis are similar. This suggests that there should be no distinct treatment targets and therapeutic interventions for the late- and early-onset groups.