LEANDRO LARA DO PRADO
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
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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- Ankylosing spondylitis and psoriatic arthritis: revisiting screening of latent tuberculosis infection and its follow-up during anti-tumor necrosis factor therapy in an endemic area(2020) SHIMABUCO, Andrea Yukie; MEDEIROS-RIBEIRO, Ana Cristina de; MIOSSI, Renata; BONFIGLIOLI, Karina Rossi; MORAES, Julio Cesar Bertacini de; GONCALVES, Celio Roberto; SAMPAIO-BARROS, Percival Degrava; GOLDENSTEIN-SCHAINBERG, Claudia; SOUZA, Fernando Henrique Carlos de; PRADO, Leandro Lara do; UGOLINI-LOPES, Michele Remiao; YUKI, Emily Figueiredo Vieira Neves; BONFA, Eloisa; SAAD, Carla Goncalves SchahinOBJECTIVES: To retrospectively evaluate the performance and distinctive pattern of latent tuberculosis (TB) infection (LTBI) screening and treatment in patients with ankylosing spondylitis (AS) and psoriatic arthritis (PsA) under anti-tumor necrosis factor (TNF) therapy and determine the relevance of re-exposure and other risk factors for TB development. METHODS: A total of 135 and 83 patients with AS and PsA, respectively, were evaluated for LTBI treatment before receiving anti-TNF drugs via the tuberculin skin test (TST), chest radiography, and TB exposure history assessment. All subjects were evaluated for TB infection at 3-month intervals. RESULTS: The patients with AS were more often treated for LTBI than were those with PsA (42% versus 30%, p=0.043). The former also presented a higher frequency of TST positivity (93% versus 64%, p=0.002), although they had a lower frequency of exposure history (18% versus 52%, p=0.027) and previous TB (0.7% versus 6%, p=0.03). During follow-up [median, 5.8 years; interquartile range (1QR), 2.2-9.0 years], 11/218 (5%) patients developed active TB (AS, n=7; PsA, n=4). TB re-exposure was the main cause in seven patients (64%) after 12 months of therapy (median, 21.9 months; IQR, 14.2-42.8 months) and five LTBI-negative patients. TB was identified within the first year in four patients (36.3%) (median, 5.3 months; IQR, 1.2-8.8 months), two of whom were LTBI-positive. There was no difference in the TB-free survival according to the anti-TNF drug type/class; neither synthetic drug nor prednisone use was related to TB occurrence (p > 0.05). CONCLUSION: Known re-exposure is the most critical factor for incident TB cases in spondyloarthritis. There are also some distinct features in AS and PsA LTBI screening, considering the higher frequency of LTBI and TST positivities in patients with AS. Annual risk reassessment taking into consideration these peculiar features and including the TST should be recommended for patients in endemic countries.
- Frosted branch angiitis and cerebral venous sinus thrombosis as an initial onset of neuro-Behçet’s disease: a case report and review of the literature(2017) FERREIRA, B. F. D. A.; RODRIGUEZ, E. E. C.; PRADO, L. L. D.; GONCALVES, C. R.; HIRATA, C. E.; YAMAMOTO, J. H.Background: Frosted branch angiitis is a rare, severe condition. It can be either a primary or a secondary condition and is characterized by rapid deterioration of vision and fulminant retinal vasculitis that manifests as diffuse sheathing of retinal vessels, macular edema, papillitis, vitritis and anterior uveitis. We aimed to describe a case of frosted branch angiitis and cerebral venous sinus thrombosis as an initial neuro-Behçet’s disease onset. Diagnosis of Behçet’s disease was based on the current 2014 International Criteria for Behçet’s Disease and the International consensus recommendation criteria for neuro-Behçet’s disease. In addition, a literature review using search parameters of “frosted branch angiitis”, “Behçet” and “neuro-Behçet” in the PubMed database is presented. Case presentation: A 28-year-old Brazilian pardo woman presented to our hospital with abrupt bilateral vision loss associated with recurrent aphthous oral ulcers 6 months before visual symptom onset. A fundus examination showed bilateral widespread retinal vasculitis with venous and arterial white sheathing, optic disc swelling, macular edema, and retinal hemorrhages, leading to the diagnosis of frosted branch angiitis. An extensive systemic workup for retinal vasculitis was uneventful, except for brain magnetic resonance imaging demonstrating cerebral venous sinus thrombosis and lymphocytic aseptic meningitis. A diagnosis of neuro-Behçet’s disease was made, and treatment was started with methylprednisolone therapy 1 g/day for 5 consecutive days, followed by oral mycophenolate mofetil and infliximab 5 mg/kg infusion. The patient’s response was rapid, with improvement of visual acuity to hand movement and counting fingers by day 7 and final visual acuity of counting fingers and 20/130. Conclusions: Frosted branch angiitis may be associated with infectious, noninfectious, or idiopathic causes. An extensive workup should be done to exclude systemic vasculitis such as Behçet’s disease. Treatment with systemic steroids must be promptly initiated in association with specific treatment aimed at inflammation control and blindness risk reduction. © 2017 The Author(s).
- Development and implementation of the AIDA International Registry for patients with Behcet's disease(2022) VITALE, Antonio; CASA, Francesca Della; RAGAB, Gaafar; ALMAGHLOUTH, Ibrahim A.; LOPALCO, Giuseppe; PEREIRA, Rosa Maria; GUERRIERO, Silvana; GOVONI, Marcello; SFIKAKIS, Petros P.; GIACOMELLI, Roberto; CICCIA, Francesco; MONTI, Sara; RUSCITTI, Piero; PIGA, Matteo; LOMATER, Claudia; TUFAN, Abdurrahman; OPRIS-BELINSKI, Daniela; EMMI, Giacomo; HERNANDEZ-RODRIGUEZ, Jose; KARKAS, Burak; SEBASTIANI, Gian Domenico; BARTOLONI, Elena; AKKOC, Nurullah; CATTALINI, Marco; CONTI, Giovanni; HATEMI, Gulen; MAIER, Armin; PARRONCHI, Paola; GIUDICE, Emanuela Del; ERTEN, Sukran; INSALACO, Antonella; GOBBI, Francesca Li; MAGGIO, Maria Cristina; SHAHRAM, Farhad; CAGGIANO, Valeria; HEGAZY, Mohamed Tharwat; ASFINA, Kazi Nur; MORRONE, Maria; PRADO, Leandro L.; DAMMACCO, Rosanna; RUFFILLI, Francesca; ARIDA, Aikaterini; NAVARINI, Luca; PANTANO, Ilenia; CAVAGNA, Lorenzo; CONFORTI, Alessandro; CAULI, Alberto; MARUCCO, Elena Maria; KUCUK, Hamit; IONESCU, Ruxandra; MATTIOLI, Irene; ESPINOSA, Gerard; ARAUJO, Olga; CANOFARI, Claudia; SOTA, Jurgen; LAYMOUNA, Ahmed Hatem; BEDAIWI, Asma A.; COLELLA, Sergio; GIARDINI, Henrique Ayres M.; ALBANO, Valeria; MONACO, Andrea Lo; FRAGOULIS, George E.; KARDAS, Riza Can; BERLENGIERO, Virginia; HUSSEIN, Mohamed A.; RICCI, Francesca; TORRE, Francesco La; RIGANTE, Donato; WIESIK-SZEWCZYK, Ewa; FRASSI, Micol; GENTILESCHI, Stefano; TOSI, Gian Marco; DAGOSTIN, Marilia Ambiel; MAHMOUD, Ayman Abdel-Monem Ahmed; TARSIA, Maria; ALESSIO, Giovanni; CIMAZ, Rolando; GIANI, Teresa; GAGGIANO, Carla; IANNONE, Florenzo; CIPRIANI, Paola; MOURABI, Mariam; SPEDICATO, Veronica; BARNESCHI, Sara; ARAGONA, Emma; BALISTRERI, Alberto; FREDIANI, Bruno; FABIANI, Claudia; CANTARINI, LucaPurpose of the present paper is to point out the design, development and deployment of the AutoInflammatory Disease Alliance (AIDA) International Registry dedicated to pediatric and adult patients with Behcet's disease (BD). The Registry is a clinical physician-driven non-population- and electronic-based instrument implemented for the retrospective and prospective collection of real-life data about demographics, clinical, therapeutic, laboratory, instrumental and socioeconomic information from BD patients; the Registry is based on the Research Electronic Data Capture (REDCap) tool, which is thought to collect standardised information for clinical real-life research, and has been realised to change over time according to future scientific acquisitions and potentially communicate with other existing and future Registries dedicated to BD. Starting from January 31st, 2021, to February 7th, 2022, 110 centres from 23 countries in 4 continents have been involved. Fifty-four of these have already obtained the approval from their local Ethics Committees. Currently, the platform counts 290 users (111 Principal Investigators, 175 Site Investigators, 2 Lead Investigators, and 2 data managers). The Registry collects baseline and follow-up data using 5993 fields organised into 16 instruments, including patient's demographics, history, clinical manifestations and symptoms, trigger/risk factors, therapies and healthcare access. The development of the AIDA International Registry for BD patients will facilitate the collection of standardised data leading to real-world evidence, enabling international multicentre collaborative research through data sharing, international consultation, dissemination of knowledge, inclusion of patients and families, and ultimately optimisation of scientific efforts and implementation of standardised care. Trial registration NCT05200715 in 21/01/2022.
article 6 Citação(ões) na Scopus Anti-alpha-enolase antibodies in Behcet's disease: a marker of mucocutaneous and articular disease activity?(2018) PRADO, L. L.; GONCALVES, C. R.; VIANA, V. T.; SAAD, C. G. S.; BONFA, E.Objective. To assess IgM anti-alphaenolase antibodies (AAEA) in systemic Behget's disease (BD) and its possible association with clinical manifestations and disease activity. Methods. Ninety-seven consecutively selected BD patients were compared to 36 enteropathic spondyloarthritis (ESpA) [24 Crohn's disease (CD) and 12 ulcerative colitis (UC)] patients and 87 healthy controls. 1gM AAEA was detected by immunoblotting. Disease activity was assessed by standardised indexes, Brazilian BD Current Activity Form (BR-BDCAF) for BD and HarveyBradshaw Index (HBI) for CD and UC patients. A second evaluation was performed in BD patients (n=56), regarding IgM AAEA presence, disease activity scores and C-reactive protein (CRP). Results. Higher IgM AAEA prevalence was found in 97 BD (17.7%) compared to ESpA (2.8%) and healthy controls (2.3%), p< O. O01. IgM AAEA frequency was higher in active BD compared to inactive BD (30.2% vs. 7.4%, p=O. O06), a finding confirmed in the second cross-sectional evaluation of 56 of these BD patients (45.5% vs. 13.3%, p=O. 02). Mean BR-BDCAF scores were higher in IgM AAEA positive group on both evaluations (9.1 + 5.4 vs. 4.9 + 4.9, p=O. O02; 5.0 + 4.9 vs. 2.2 + 2.9, p=O. 01, respectively). BD patients with mucocutaneous and articular symptoms presented higher IgM AAEA positivity in the first and second evaluations (64.7% vs. 27.5%, p=O. O05; 36.4% vs. 7.1%, p=0.039 respectively). Conclusions. Our data support the notion that alpha-enolase is a target antigen in BD, particularly associated with disease activity, mucocutaneous and articular involvement. In addition, IgM AAEA may distinguish BD from ESpA, especially in patients with high disease activity.- OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY BIOMARKERS AND MICROPERIMETRY FEATURES IN BEHÇET'S UVEITIS(2023) FERREIRA, Bruno F. A.; HIGASHI, Alex H.; PRADO, Leandro L.; GONCALVES, Celio R.; HADDAD, Maria A. O.; ZACHARIAS, Leandro C.; HIRATA, Carlos E.; YAMAMOTO, Joyce H.Purpose: To evaluate the parafoveal macular microvasculature and the macular function in patients with retinal vasculitis associated with Beh & ccedil;et's uveitis.Methods: In 14 patients with inactive Beh & ccedil;et's uveitis and 26 control individuals (13 with nonocular Beh & ccedil;et's syndrome and 13 healthy subjects), we analyzed the retinal nerve fiber layer, ganglion cell layer, full retinal thickness, foveal avascular zone area and sectorial parafoveal vascular density in the superficial vascular plexus, intermediate capillary plexus, and deep capillary plexus using SPECTRALIS optical coherence tomography (OCT) 2 and OCT angiography. Macular sensitivity was analyzed using an MP-3 microperimeter.Results: Eighteen eyes (78%) had a best-corrected visual acuity >= 20/25. Significant differences were found in Beh & ccedil;et's uveitis in comparison with the controls on the OCT and OCT angiography: 14.8%, 22.4%, and 14.9% ganglion cell layer thinning in the global, nasal, and inferior sectors, respectively; 6%, 13.2%, and 7.5% full retinal thickness thinning in the superior, nasal, and inferior sectors; and 16.8%, 14.9%, 23.6%, 15.8%, and 12.6% mean deep capillary plexus density reduction in the global, superior, nasal, inferior, and temporal sectors. Microperimetry data demonstrated significant mean reductions of 21% and 23.6% in central and average macular sensitivities and 28.8%, 40.4%, 27.7%, and 24.2% in the superior, nasal, inferior, and temporal sectors, respectively. Outer plexiform layer elevations were observed in Beh & ccedil;et's uveitis (69.6%).Conclusion: Beh & ccedil;et's uveitis presented structural and functional macular damage despite good best-corrected visual acuity, mainly affecting the nasal sector and the deep capillary plexus. On OCT and OCT angiography, quantitative and qualitative changes can be valuable biomarkers of ocular involvement in Beh & ccedil;et's syndrome.