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 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.- 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.bookPart Osteoporose Induzida por Glicocorticoide(2018) DOMICIANO, Diogo Souza; SEGURO, Luciana Parente Costa; PEREIRA, Rosa Maria Rodrigues- Effectiveness of renoprotective approaches for persistent proteinuria in lupus nephritis: more than just immunosuppression(2018) CASTRO, M.; UGOLINI-LOPES, M.; BORBA, E. F.; BONFA, E.; SEGURO, L. P. C.Objective The objective of this study is to evaluate the efficacy of a tightly controlled renoprotective protocol in systemic lupus erythematosus (SLE) patients with persistent proteinuria. Methods Thirteen SLE patients with nephritis and persistent proteinuria (>1 g/24 hours) were included. The protocol consisted of regular clinical evaluations every two weeks to assess blood pressure (BP, target <130/80 mmHg), adherence to therapy, diet and smoking. No change in immunosuppressive drugs was allowed but reduction of glucocorticoid dose was permitted if indicated. Clinical, laboratory and treatment evaluations were performed at baseline and at the end of the study (after three months). Results SLE patients had a mean age of 37.85 +/- 7.68 years and disease duration of 9.85 +/- 7.29 years. At baseline, patients had a mean duration of maintenance therapy of 10.38 +/- 7.56 months, 12 with mycophenolate mofetil (92.3%) and one with azathioprine (7.7%). At least one dose optimization of antihypertensive regimen was required in all patients during the study. Seven patients (53.8%) had BP>130/80mmHg at baseline. At the end, 11 patients (84.6%) achieved stable BP target; 92.3% were using an angiotensin-converting enzyme inhibitor, 53.9% an angiotensin receptor blocker, and 46.2% were using combined therapy. All patients had a significant reduction in proteinuria levels (2.26 +/- 1.09 vs 0.88 +/- 0.54 g/24 hours, p < 0.001) and 61.5% achieved proteinuria <1 g/24 hours. A significant decrease in mean prednisone dose was observed (10.96 +/- 6.73 vs 5.38 +/- 3.36 mg/day, p = 0.013) as well as mean Systemic Lupus Erythematosus Disease Activity Index score (4.38 +/- 0.72 vs 3.08 +/- 1.86, p = 0.043). No significant changes were identified in serum creatinine, albumin, potassium, complement 3 and complement 4 levels (p > 0.05). Conclusion This study provides evidence that a tightly controlled renoprotective protocol is effective in reducing persistent proteinuria in lupus nephritis. The concomitant reduction of prednisone without any change in immunosuppression reinforces the importance of strategies beyond the treatment of nephritis activity.
conferenceObject Vertebral fractures and bone metabolism impairment after heart transplant: results from a prospective cohort study(2018) SEGURO, L. F. B. C.; SEGURO, L. P. C.; MARCONDES-BRAGA, F. G.; CAPARBO, V. P.; TAKAYAMA, L.; MANGINI, S.; AVILA, M. S.; WOZNIAK, I.; GAIOTTO, F. A.; PEREIRA, R. M. R.; BACAL, F.- First Latin American clinical practice guidelines for the treatment of systemic lupus erythematosus: Latin American Group for the Study of Lupus (GLADEL, Grupo Latino Americano de Estudio del Lupus)-Pan-American League of Associations of Rheumatology (PANLAR)(2018) PONS-ESTEL, Bernardo A.; BONFA, Eloisa; SORIANO, Enrique R.; CARDIEL, Mario H.; IZCOVICH, Ariel; POPOFF, Federico; CRINITI, Juan M.; VASQUEZ, Gloria; MASSARDO, Loreto; DUARTE, Margarita; BARILE-FABRIS, Leonor A.; GARCIA, Mercedes A.; AMIGO, Mary-Carmen; ESPADA, Graciela; CATOGGIO, Luis J.; SATO, Emilia Inoue; LEVY, Roger A.; VASQUEZ, Eduardo M. Acevedo; CHACON-DIAZ, Rosa; GALARZA-MALDONADO, Claudio M.; GAMARRA, Antonio J. Iglesias; MOLINA, Jose Fernando; NEIRA, Oscar; SILVA, Clovis A.; PENA, Andrea Vargas; GOMEZ-PUERTA, Jose A.; SCOLNIK, Marina; PONS-ESTEL, Guillermo J.; UGOLINI-LOPES, Michelle R.; SAVIO, Veronica; DRENKARD, Cristina; ALVARELLOS, Alejandro J.; UGARTE-GIL, Manuel F.; BABINI, Alejandra; CAVALCANTI, Andre; LINHARES, Fernanda Athayde Cardoso; SALINAS, Maria Jezabel Haye; FUENTES-SILVA, Yurilis J.; SILVA, Ana Carolina Montandon de Oliveira e; GARNICA, Ruth M. Eraso; URIBE, Sebastian Herrera; GOMEZ-MARTIN, Diana; SEVRINI, Ricardo Robaina; QUINTANA, Rosana M.; GORDON, Sergio; FRAGOSO-LOYO, Hilda; ROSARIO, Violeta; SAURIT, Veronica; APPENZELLER, Simone; REIS NETO, Edgard Torres dos; CIEZA, Jorge; NARANJO, Luis A. Gonzalez; BELLO, Yelitza C. Gonzalez; COLLADO, Maria Victoria; SARANO, Judith; RETAMOZO, Soledad; SATTLER, Maria E.; GAMBOA-CARDENAS, Rocio V.; CAIROLI, Ernesto; CONTI, Silvana M.; AMEZCUA-GUERRA, Luis M.; SILVEIRA, Luis H.; BORBA, Eduardo F.; PERA, Mariana A.; MOREYRA, Paula B. Alba; ARTURI, Valeria; BERBOTTO, Guillermo A.; GERLING, Cristian; GOBBI, Carla A.; GERVASONI, Viviana L.; SCHERBARTH, Hugo R.; BRENOL, Joao C. Tavares; CAVALCANTI, Fernando; COSTALLAT, Lilian T. Lavras; SILVA, Nilzio A. Da; MONTICIELO, Odirlei A.; SEGURO, Luciana Parente Costa; XAVIER, Ricardo M.; LLANOS, Carolina; GUARDADO, Ruben A. Montufar; TORRE, Ignacio Garcia de la; PINEDA, Carlos; HERNANDEZ, Margarita Portela; DANZA, Alvaro; GUIBERT-TOLEDANO, Marlene; REYES, Gil Llerena; COLMAN, Maria Isabel Acosta; AQUINO, Alicia M.; MORA-TRUJILLO, Claudia S.; MUNOZ-LOUIS, Roberto; VALLADARES, Ignacio Garcia; OROZCO, Maria Celeste; BURGOS, Paula I.; BETANCUR, Graciela V.; ALARCON, Graciela S.Systemic lupus erythematosus (SLE), a complex and heterogeneous autoimmune disease, represents a significant challenge for both diagnosis and treatment. Patients with SLE in Latin America face special problems that should be considered when therapeutic guidelines are developed. The objective of the study is to develop clinical practice guidelines for Latin American patients with lupus. Two independent teams (rheumatologists with experience in lupus management and methodologists) had an initial meeting in Panama City, Panama, in April 2016. They selected a list of questions for the clinical problems most commonly seen in Latin American patients with SLE. These were addressed with the best available evidence and summarised in a standardised format following the Grading of Recommendations Assessment, Development and Evaluation approach. All preliminary findings were discussed in a second face-to-face meeting in Washington, DC, in November 2016. As a result, nine organ/system sections are presented with the main findings; an 'overarching' treatment approach was added. Special emphasis was made on regional implementation issues. Best pharmacologic options were examined for musculoskeletal, mucocutaneous, kidney, cardiac, pulmonary, neuropsychiatric, haematological manifestations and the antiphospholipid syndrome. The roles of main therapeutic options (ie, glucocorticoids, antimalarials, immunosuppressant agents, therapeutic plasma exchange, belimumab, rituximab, abatacept, low-dose aspirin and anticoagulants) were summarised in each section. In all cases, benefits and harms, certainty of the evidence, values and preferences, feasibility, acceptability and equity issues were considered to produce a recommendation with special focus on ethnic and socioeconomic aspects. Guidelines for Latin American patients with lupus have been developed and could be used in similar settings.
conferenceObject INDUCTION TREATMENT IN LUPUS NEPHRITIS IN A REAL-LIFE SITUATION: CYCLOPHOSPHAMIDE OR MYCOPHENOLATE MOFETIL?(2018) MUNHOZ, G. A.; LACERDA, M. L. M.; SEGURO, L. P. C.; UGOLINI-LOPES, M. R.; BORBA, E. F. B.; BONFA, E.bookPart Lúpus Eritematoso Sistêmico(2018) BORBA NETO, Eduardo Ferreira; SEGURO, Luciana Parente Costa; LOPES, Michelle Remião Ugolini; GONçALVES, Célio Roberto; BONFá, Eloisa Silva Dutra de Oliveira