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Projetos de Pesquisa
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LIM/17 - Laboratório de Investigação em Reumatologia, Hospital das Clínicas, Faculdade de Medicina

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Agora exibindo 1 - 10 de 68
  • article 4 Citação(ões) na Scopus
    Antiphospholipid syndrome plus rheumatic fever: a higher risk factor for stroke?
    (2012) CAMARGO, Elisa Watanabe; FREIRE, Paula Vieira; SILVA, Clovis Artur; SANTOS, Nelita Rocha dos; MOTA, Licia Maria Henrique da; PEREIRA, Rosa Maria Rodrigues; CARVALHO, Jozelio Freire de
    To compare clinical and laboratory findings between patients with primary antiphospholipid syndrome (PAPS) versus secondary APS due to rheumatic fever (APS-RF) (according to Jones criteria). Seventy-three APS patients (Sapporo criteria) were enrolled, and demographic, clinical, and laboratory data were collected. Exclusion criteria were heart congenital abnormalities and previous infectious endocarditis. Patients were divided into two groups: PAPS (n = 68) and APS-RF (n = 5). The mean current age, disease duration, frequencies of female gender, and Caucasian race were similar in APS-RF and PAPS patients (P > 0.05). Remarkably, the frequency of stroke was significantly higher in APS-RF compared to PAPS patients (80% vs. 25%, P = 0.02). Of note, echocardiogram of these patients did not show intracardiac thrombus. No significant differences were found in peripheral thromboembolic events (P = 1.0), pulmonary thromboembolism (P = 1.0), miscarriage (P = 0.16), thrombocytopenia (P = 0.36), arterial events (P = 0.58), and thrombosis of small vessels (P = 1.0). There were no differences in the frequencies of comorbidities such as diabetes mellitus, hypertension, smoking, and hyperlipidemia in both groups (P > 0.05). The frequencies of lupus anticoagulant, IgG, and IgM anticardiolipin were similar in two groups. APS patients associated with rheumatic fever without infective endocarditis may imply a high stroke risk as compared with PAPS, and future studies are needed to confirm this finding.
  • article 67 Citação(ões) na Scopus
    Livedoid vasculopathy as a coagulation disorder
    (2011) CRIADO, Paulo Ricardo; RIVITTI, Evandro Ararigboia; SOTTO, Mirian Nacagami; CARVALHO, Jozelio Freire de
    Livedoid vasculopathy is an occlusive cutaneous disease of the dermal vessels with pauci-inflammatory or non-inflammatory histopathology findings. It is characterized by the presence of macules or papules, erythemato-purpuric lesions located on the legs, especially on the ankles and feet, which produce ulcerations that are intensely painful and originate ivory atrophic scars called ""atrophie blanche"". In this review article, studies on LV from the literature are analyzed, and their etiopathogenic associations, particularly those related to the thrombophilic states, as well as the pathologic findings and therapeutic approaches applied in the difficult clinical management of these cases, are evaluated.
  • article 5 Citação(ões) na Scopus
    Pulmonary capillaritis leading to alveolar hemorrhage in a juvenile idiopathic arthritis patient: first description
    (2012) WATANABE, Elisa; DINIZ, Leonardo Rios; MOTA, Licia Maria Henrique da; BARROS, Solange Murta; CARVALHO, Jozelio Freire de
    Juvenile idiopathic arthritis (JIA) is characterized by the typical joint involvement and some patients have extra-articular lesions, such as uveitis and pleuritis. However, until this date, no case of alveolar hemorrhage in JIA has been described. Herein, the authors describe a case of a male patient, 33 years old diagnosed as polyarticular JIA who had a dramatic evolution with alveolar hemorrhage secondary to pulmonary capillaritis. He received intravenous immunoglobulin and pulse therapies with glucocorticoid and cyclophosphamide with a satisfactory outcome. In addition, the authors review this important pulmonary complication in rheumatic diseases.
  • article 14 Citação(ões) na Scopus
    Distinct antibody profile: a clue to primary antiphospholipid syndrome evolving into systemic lupus erythematosus?
    (2014) FREIRE, Paula Vieira; WATANABE, Elisa; SANTOS, Nelita Rocha dos; BUENO, Cleonice; BONFA, Eloisa; CARVALHO, Jozelio Freire de
    We have performed a retrospective study to determine if patients with antiphospholipid syndrome that developed systemic lupus erythematosus (APS/SLE) had distinct clinical and/or serological features. All 80 primary APS (PAPS) patients followed up at our APS unit were included in the study and divided into two groups: 14 APS/SLE and 66 PAPS. Prior or at onset of lupus manifestations, six patients were uniformly negative for lupus and Sjogren autoantibodies, and the other eight patients had persistent positive. In the first year after diagnosis of SLE, three patients remained with negative antibodies, the other seven patients maintained the same antibodies, and four patients developed other antibodies. APS/SLE group had a significant lower mean age at PAPS diagnosis (26.0 +/- 8.0 vs. 34.2 +/- 11.9 years, p = 0.03) and a longer disease duration (14.0 +/- 7.0 vs. 6.0 +/- 5.0 years, p < 0.0001). The mean time for PAPS to develop SLE was 5.2 +/- 4.3 years. The typical clinical and laboratorial findings of APS did not discriminate both groups of patients. At lupus onset, antinuclear antibodies were more frequently observed in those who evolved to SLE (100 vs. 51.5 %, p = 0.0005). Anti-double-stranded DNA (dsDNA), anti-ribosomal P, anti-Ro/SS-A, anti-La/SS-B, and anti-U1RNP antibodies were exclusively found in the APS/SLE patients, whereas anti-Smith (Sm) antibodies were not detected in both groups. The detection of a distinct subgroup of lupus-associated autoantibody in PAPS patients seems to be a hint to overt SLE disease, particularly in those patients with young age at diagnosis.
  • conferenceObject
    Pandemic Influenza Immunization in Primary Antiphospholipid Syndrome (PAPS): A Trigger to Autoantibody Production?
    (2012) MEDEIROS, Danielle M.; BUENO, Cleonice; RIBEIRO, Ana Cristina M.; CALICH, Ana L. G.; BONFIGLIOLI, Karina Rossi; VIANA, Vilma S.; CARVALHO, Jozelio F.; SILVA, Clovis Artur; BONFA, Eloisa
    Background/Purpose: There are scarce data suggesting that pan-demic influenza vaccination may induce antiphospholipid (APL) autoan- tibodies in inflammatory rheumatic diseases, particularly in systemic lupus erythematosus patients. However, there is no study evaluating the APL autoantibodies induction in primary antiphospholipid syndrome (PAPS) patients. The objective was to perform short and long-term evaluations of a large panel of APL autoantibodies following pandemic influenza A/H1N1 non-adjuvant vaccine in PAPS patients and healthy controls. Lupus specific antibodies were also investigated in these patients. Methods: Forty-five PAPS patients (Sapporo criteria) and 33 healthy controls were vaccinated with monovalent, inactivated H1N1 vaccine (Butantan Institute/Sanofi Pasteur, São Paulo, Brazil). They were prospec-tively assessed at pre-vaccination, 3 weeks and 6 months after vaccination. APL autoantibodies were determined by an enzyme-linked immunosor-bent assay (ELISA) and included: anti-cardiolipin (aCL) IgG/IgM and anti-β2GPI IgG/IgM antibodies (Inova Diagnostics, USA); anti-annexin V IgG/IgM, anti-phosphatidyl serine IgG/IgM and anti-prothrombin IgG/IgM (Orgentec Diagnostica, Germany). Anti-Sm was determined by ELISA (Inova Diagnostics, USA) and anti-dsDNA by indirect immun-fluorescence. Arterial and venous thromboses were also clinically assessed. The statistical analyses were carried out with qui square test, McNemar s test and one-way repeated measures analysis of variance (ANOVA). Results: Pre-vaccination frequency of at least one APL antibody was significantly higher in PAPS patients compared to controls (58% vs. 21%, p=0.003). The overall frequencies of APL antibody at pre-vaccination, 3 weeks and 6 months after immunization remained unchanged in patients (p=0.89) and controls (p=0.83). Further analysis of each evaluated antibody in PAPS revealed that their percentages at pre-vaccination and after 3 weeks and 6 months were also comparable (p>0.05): aCL IgG (42%, 38% and 42%), aCL IgM (22%, 20% and 24%), anti-β2GPI IgG (22%, 22% and 20%), anti-β2GPI IgM (15%, 15% and 18%), anti- annexin V IgG (4.5%, 4.5% and 2.5%), anti-annexin V IgM (uniformly negative), anti-phosphatidyl serine IgG (38%, 35% and 38%), anti- phosphatidyl serine IgM (15%, 13% and 13%), anti-prothrombin IgG (20%, 15% and 18%) and anti-prothrombin IgM (2.5%, 2.5% and 2.5%). The same pattern was observed for the control group (p>0.05). At 3 weeks, 2 PAPS patients developed a new but transient APL anti-body (moderate titer aCL IgG and IgM) whereas at 6 months, new APL antibodies were observed in 6 PAPS patients: 3 moderate titer aCL IgM, 1 moderate anti-β2GPI IgM, 1 low anti-phosphatidyl serine IgG and 1 low anti-prothrombin IgG. Fluctuations of antibody levels were not detected for any evaluated antibody (p>0.05). Of note, anti-Sm and anti-dsDNA autoantibodies were consistently negative during all evaluations. No new arterial or venous thrombosis events occurred during the study period. Conclusion: This was the first study to demonstrate that pandemic non-adjuvant influenza A/H1N1 in PAPS patients does not trigger a change in APL antibody profile or induce lupus specific autoantibodies.
  • article 81 Citação(ões) na Scopus
    Immunogenicity and safety of the 2009 non-adjuvanted influenza A/H1N1 vaccine in a large cohort of autoimmune rheumatic diseases
    (2011) SAAD, Carla G. S.; BORBA, Eduardo F.; AIKAWA, Nadia E.; SILVA, Clovis A.; PEREIRA, Rosa M. R.; CALICH, Ana Luisa; MORAES, Julio C. B.; RIBEIRO, Ana C. M.; VIANA, Vilma S. T.; PASOTO, Sandra G.; CARVALHO, Jozelio F.; FRANCA, Ivan L. A.; GUEDES, Lissiane K. N.; SHINJO, Samuel K.; SAMPAIO-BARROS, Percival D.; CALEIRO, Maria T.; GONCALVES, Celio R.; FULLER, Ricardo; LEVY-NETO, Mauricio; TIMENETSKY, Maria do Carmo S.; PRECIOSO, Alexander R.; BONFA, Eloisa
    Background Despite the WHO recommendation that the 2010-2011 trivalent seasonal flu vaccine must contain A/California/7/2009/H1N1-like virus there is no consistent data regarding its immunogenicity and safety in a large autoimmune rheumatic disease (ARD) population. Methods 1668 ARD patients (systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), ankylosing spondylitis (AS), systemic sclerosis, psoriatic arthritis (PsA), Behcet's disease (BD), mixed connective tissue disease, primary antiphospholipid syndrome (PAPS), dermatomyositis (DM), primary Sjogren's syndrome, Takayasu's arteritis, polymyositis and Granulomatosis with polyangiitis (Wegener's) (GPA)) and 234 healthy controls were vaccinated with a non-adjuvanted influenza A/California/7/2009(H1N1) virus-like strain flu. Subjects were evaluated before vaccination and 21 days post-vaccination. The percentage of seroprotection, seroconversion and the factor increase in geometric mean titre (GMT) were calculated. Results After immunisation, seroprotection rates (68.5% vs 82.9% p < 0.0001), seroconversion rates (63.4% vs 76.9%, p < 0.001) and the factor increase in GMT (8.9 vs 13.2 p < 0.0001) were significantly lower in ARD than controls. Analysis of specific diseases revealed that seroprotection significantly reduced in SLE (p < 0.0001), RA (p < 0.0001), PsA (p=0.0006), AS (p=0.04), BD (p=0.04) and DM (p=0.04) patients than controls. The seroconversion rates in SLE (p < 0.0001), RA (p < 0.0001) and PsA (p=0.0006) patients and the increase in GMTs in SLE (p < 0.0001), RA (p < 0.0001) and PsA (p < 0.0001) patients were also reduced compared with controls. Moderate and severe side effects were not reported. Conclusions The novel recognition of a diverse vaccine immunogenicity profile in distinct ARDs supports the notion that a booster dose may be recommended for diseases with suboptimal immune responses. This large study also settles the issue of vaccine safety. ( #NCT01151644)
  • article 204 Citação(ões) na Scopus
    Glucocorticoid-induced myopathy
    (2011) PEREIRA, Rosa Maria Rodrigues; CARVALHO, Jozelio Freire de
    Glucocorticoid-induced myopathy, characterized by muscle weakness without pain, fatigue and atrophy, is an adverse effect of glucocorticoid use and is the most common type of drug-induced myopathy. This muscle disturbance has a frequency of 60%, and it has been most often associated with fluorinated glucocorticoid preparations. Glucocorticoids have a direct catabolic effect on muscle, decreasing protein synthesis and increasing the rate of protein catabolism leading to muscle atrophy. In clinical practice, it is important to differentiate myopathy due to glucocorticoid from muscle inflammatory diseases. The treatment is based on reduction or, if possible, on discontinuation of the steroid. Fluorinated glucocorticoids such as dexamethasone should be replaced with nonfluorinated glucocorticoids such as prednisone. Other experimental treatments may be tried such as IGF-I, branched-chain amino acids, creatine, androgens such as testosterone, nandrolone and dehydroepiandrosterone (DHEA), and glutamine.
  • article 5 Citação(ões) na Scopus
    Pierre-Auguste Renoir (1841-1919) and rheumatoid arthritis
    (2012) MOTA, Licia Maria Henrique da; NEUHARTH, Fernando; DINIZ, Leonardo Rios; CARVALHO, Jozelio Freire de; SANTOS NETO, Leopoldo Luiz dos
    Pierre-Auguste Renoir (1841-1919), one of the world's most celebrated impressionist painters, suffered from rheumatoid arthritis for most of his life. His symptoms developed when he was in his 50s and they became aggressive at about the age of 60 years that led to almost complete disability when he was 70 years old. Although the deformities he suffered because of the rheumatoid arthritis were disabling, Renoir never stopped painting nor decreased the quality of his work. The transition between styles adopted by the painter (Impressionist, Dry and Pearly periods) bear no relationship to the stages of flare-ups or the establishment of joint deformities due to rheumatoid arthritis. His work shows aspects of the body's ability to overcome pain and physical limitation.
  • article 24 Citação(ões) na Scopus
    Highlights of the Brazilian Thoracic Association Guidelines for Interstitial Lung Diseases
    (2012) BALDI, Bruno Guedes; PEREIRA, Carlos Alberto de Castro; RUBIN, Adalberto Sperb; SANTANA, Alfredo Nicodemos da Cruz; COSTA, Andre Nathan; CARVALHO, Carlos Roberto Ribeiro; ALGRANTI, Eduardo; CAPITANI, Eduardo Mello de; BETHLEM, Eduardo Pamplona; COLETTA, Ester Nei Aparecida Martins; ARAKAKI, Jaquelina Sonoe Ota; MARTINEZ, Jose Antonio Baddini; CARVALHO, Jozelio Freire de; STEIDLE, Leila John Marques; ROCHA, Marcelo Jorge Jaco; LIMA, Mariana Silva; SOARES, Maria Raquel; CARAMORI, Marlova Luzzi; AIDE, Miguel Abidon; FERREIRA, Rimarcs Gomes; KAIRALLA, Ronaldo Adib; OLIVEIRA, Rudolf Krawczenko Feitoza de; JEZLER, Sergio; RODRIGUES, Silvia Carla Sousa; PIMENTA, Suzana Pinheiro
    Interstitial lung diseases (ILDs) are heterogeneous disorders, involving a large number of conditions, the approach to which continues to pose an enormous challenge for pulmonologists. The 2012 Brazilian Thoracic Association ILD Guidelines were established in order to provide Brazilian pulmonologists with an instrument that can facilitate the management of patients with ILDs, standardizing the criteria used for the diagnosis of different conditions and offering guidance on the best treatment in various situations. The objective of this article was to briefly describe the highlights of those guidelines.
  • article 16 Citação(ões) na Scopus
    (2011) CARVALHO, Jozelio Freire; BARROS, Solange Murta; BRANCO, Jaime C.; FONSECA, Joao Eurico