THIAGO BITAR MORAES BARROS
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Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
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conferenceObject Metabolic Syndrome: The Genesis of Nephrolithiasis in Gout Patients?(2012) MELLO, Filipi M.; TOMITA, Rafael B.; FULLER, Ricardo; FILHO, Marco Antonio G. P.; BARROS, Thiago B. M.; PRADO, Leandro L. do; AUGUSTO, Kristopherson L.; GOLDENSTEIN-SCHAINBERG, ClaudiaBackground/Purpose: Gout patients have a high frequency of metabolic syndrome (MS), a disorder known to be associated with hyperinsulinemia. The latter condition augments proximal tubular sodium reabsorption and leads to reduced renal urate excretion and hyperuricemia. There are no data, however, evaluating whether MS can influence gout-associated clinical characteristics. Thus, we aimed to determine the prevalence of MS in our population and to investigate if the presence of MS would characterize a particular clinical and laboratorial gout profile. Methods: This was a cross-sectional study of 158 gout patients (ACR criteria). MS was defined in accordance to the National Cholesterol Education Program ATP III (NCEP-ATP III) and the International Diabetes Federation (IDF) criteria. Demographic, anthropometric (body mass index - BMI) and clinical data were evaluated. Fasting serum levels of UA, glucose, triglycerides and cholesterol fractions were analyzed by routine laboratory tests. Nephrolithiasis was demonstrated by usual ultrasonography and urate under-excretion defined as UA clearance lower than 7.5 ml/min. Statistical comparisons were performed using Fisher’s exact, chi-square, students T and Spearman’s tests and P<0.05 was considered significant. Results: The frequency of MS in gout patients was 73% and 71% according to NCEP ATPIII and IDF criteria respectively. Further comparison of 125 patients with MS and those 33 without this condition revealed similar mean ages (63.0 ± 11.5 vs 62.5 ± 12.9; p>0,05) and male predominance (94% and 75%). As expected, those with MS had higher BMI (30.2 ± 5.5kg/m2 vs 27.0 5.8kg/m2; p=0.005) and higher prevalences of systemic arterial hypertension (93.3% vs 75% p=0.012) and diabetes (25.8% vs 0, p=0.001), though comparable frequency of coronary artery disease (22.5% vs 16.7%; p=0.469). With regard to gout clinical/laboratorial characteristic, patients with MS had more nephrolitiasis (37.1% vs 16.7%, p=0.026), but they did not differ from patients without MS concerning the presence of tophi (52.8% vs. 55.6%; p = 0.780) or uric acid underexcretion (83.1% vs 94.4%; p=0.148). Current alcohol consumption, mean estimated creatinine clearance and mean serum levels of uric acid, were alike in both groups (p>0.05). Conclusion: The novel demonstration that MS in gout is associated to nephrolithiasis suggests that this condition may underlie the genesis of uric acid stones. Whether insulin resistance may account for a renal alteration that may ultimately impair buffering and amplification of acidic urine remains to be determined. Moreover, the elevated prevalence of MS in gout patients from our country (almost 3⁄4) is higher than overall rates of 63% MS in gout worldwide, indicating possible influence of dietary, geographical and/or genetic background.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.conferenceObject INCREASED PREVALENCE OF METABOLIC SYNDROME IS ASSOCIATED TO NEPHROLITHIASIS BUT NOT TO THE PRESENCE OF TOPHUS IN GOUT PATIENTS(2012) MELLO, F. M.; TOMITA, F. R. B.; FULLER, R.; PONTES FILHO, M. A. G.; BARROS, T. B. M.; PRADO, L. L.; AUGUSTO, K. L.; GOLDENSTEIN-SCHAINBERG, C.- Adult dermatomyositis: experience of a Brazilian tertiary care center(2012) SOUZA, Fernando Henrique Carlos de; BARROS, Thiago Bitar Moraes; LEVY-NETO, Mauricio; SHINJO, Samuel KatsuyukiObjective: To report the results of a retrospective cohort involving 139 patients with dermatomyositis, conducted from 1991 to 2011. Methods: All patients met at least four of the five Bohan and Peter criteria (1975). Results: The patients' mean age at disease onset was 41.7 +/- 14.1 years, and mean disease duration was 7.2 +/- 5.2 years. The sample comprised 90.2% white patients and 79.9% female patients. Constitutional symptoms occurred in less than half of the patients. Cutaneous and joint involvements occurred in 95.7% and 41.7% of the patients, respectively. Incipient pneumopathy, ground glass opacities and/or pulmonary fibrosis were present in 48.2% of the patients. All patients received prednisone (1 mg/kg/day) and 51.1% also received intravenous methylprednisolone (1 g/day for three days). Several immunosuppressants were used as corticosteroid sparing agents according to tolerance, side effects and/or refractoriness. Although disease relapse (clinical and/or laboratory) occurred in 53.2% of the patients, 76.3% were in disease remission at the end of the study. The rate of severe infection was 35.3%, and herpes zoster predominated. There were 15(10.8%) cases of cancer, 12 within one year after the diagnosis. There were 16 deaths (11.5%), and their major causes were sepsis/septic shock (27.5%), pneumopathy attributed to the disease (31.3%), neoplasms (31.3%), and cardiovascular events (12.5%). Conclusions: In this study, the clinical and laboratory data were similar to those of other population groups described in the literature, with minimal differences regarding the frequency and characteristics of the extramuscular manifestations.
article 3 Citação(ões) na Scopus Hepatite autoimune e dermatomiosite: uma rara associação(2012) SOUZA, Fernando Henrique Carlos de; BARROS, Thiago Bitar Moraes; MORAES, Mariana Teichner de; MISSUMI, Larissa Sayuri; LIMA, Fabiana Roberto; LEVY-NETO, Mauricio; SHINJO, Samuel KatsuyukiThe association between autoimmune hepatitis and idiopathic inflammatory myopathies has been rarely described in literature. To our knowledge, there are only five reports of autoimmune hepatitis, all coursing with polymyositis. In the present work, we describe a female patient at the age of 58 with cutaneous lesions (heliotrope), progressive proximal muscle weakness of four limbs and constitutional symptoms for 12 months, and worsened two months ago. She had also been episodes of jaundice for five months. During hospitalization, after intense clinical investigation, the diagnosis of dermatomyositis and autoimmune hepatitis were defined, and the patient had a good clinical and laboratory response to corticosteroids and immunosuppressive.conferenceObject An Analysis of Metabolic Syndrome in Adult Dermatomyositis with a Focus On Cardiovascular Disease(2012) MORAES, Mariana T.; SOUZA, Fernando H. C.; BARROS, Thiago B. M.; SHINJO, Samuel K.Background/Purpose: Metabolic syndrome (MetS) is a cluster of metabolic abnormalities associated with increased cardiovascular risk. MetS has been systematically evaluated in all systemic autoimmune rheumatic diseases except for dermatomyositis (DM). Hence, we evaluated the frequency of MetS in DM patients and analyzed the possible association of MetS with traditional cardiovascular disease (CVD) risk factors and DM-related clinical and laboratorial features. Methods: The present cross-sectional single center study included 84 consecutive DM patients (Bohan & Peter, 1975) and 105 healthy control individuals. MetS was diagnosed according to the National Cholesterol Education Program Adult Treatment Panel III. Results: The median age was similar in both the DM and control groups (aged 41.5 vs. aged 42.0, respectively; p=0.378) with a comparable predominance of the female gender (p=0.904) and white race (p=0.654) in both groups. The median disease duration was 4 years (range: 1–7). The DM patients had a higher prevalence of MetS (41.7 vs. 7.0%, p<0.001), diabetes mellitus (17.9 vs. 1.0%, p<0.001), ischemic stroke (4.8 vs. 0%, p=0.024), and a family history of premature CVD (32.8 vs. 8.6%, p=0.004). However, the frequency of sedentarism, hypothyroidism, smoking habit and alcohol intake were similar in both groups (p>0.05). Further analysis of the DM patients with (n=35) and without MetS (n=49) revealed that the patients with this complication were older (50.0±14.5 vs. 40.9±14.6, p=0.006) and had a similar disease duration (p=0.925) and a higher incidence of systemic arterial hypertension prior to the disease (54.3 vs. 10.2%, p=0.001). The frequency of other comorbidities, previously mentioned lifestyle contributing factors, clinical and laboratory disease features, and therapy schemes were similar in both groups (p>0.05). In a multivariate analysis, only hypertension diagnosed prior to the disease was associated with MetS (odds ratio 10.47, 95% confidence interval 2.62–44.81). Conclusion: MetS is highly prevalent in DM and prior hypertension seems to be a major determinant of its development while disease and therapy related factors do not appear to play a relevant role.