Claudio Arnaldo Len

Universidade Federal de São Paulo, San Paulo, São Paulo, Brazil

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Publications (113)211.33 Total impact

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    IBRO - 9th World Congress International Brain Research Organization, Rio de Janeiro; 07/2015
  • Annals of the Rheumatic Diseases 06/2015; 74(Suppl 2):594.1-594. DOI:10.1136/annrheumdis-2015-eular.2969 · 10.38 Impact Factor
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    ABSTRACT: Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in childhood. Without an effective therapy, patients may progress quickly to functional disability. Recently, depletion of B cells emerged as a new approach for the treatment of autoimmune diseases, including JIA.
    Revista Brasileira de Reumatologia 05/2015; 30. DOI:10.1016/j.rbr.2014.12.015 · 0.99 Impact Factor
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    ABSTRACT: Avaliar a qualidade de vida relacionada à saúde (QVRS) em pacientes pediátricos com hanseníase.
    Revista Brasileira de Reumatologia 05/2015; 16. DOI:10.1016/j.rbr.2014.12.013 · 0.99 Impact Factor
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    ABSTRACT: Devic's disease, also known as neuromyelitis optica, is an autoimmune inflammatory demyelinating disorder of the central nervous system that mainly affects the optic nerve and spinal cord. Recently, Devic's disease was demonstrated to be a channelopathy due to the presence of antibodies against the water channel aquaporin-4 in the blood-brain barrier. There have been reports of Devic's disease in infancy, but there are few reported associations of Devic's disease with other diseases. The association of Devic's disease with dermatomyositis has not yet been described in the literature. The aim of this paper is to describe the first case of Devic's disease in an adolescent with juvenile dermatomyositis. Copyright © 2015 Elsevier Editora Ltda. All rights reserved.
    Revista Brasileira de Reumatologia 03/2015; 187. DOI:10.1016/j.rbre.2014.12.004 · 0.99 Impact Factor
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    ABSTRACT: Devic's disease, also known as neuromyelitis optica, is an autoimmune inflammatory demyelinating disorder of the central nervous system that mainly affects the optic nerve and spinal cord. Recently, Devic's disease was demonstrated to be a channelopathy due to the presence of antibodies against the water channel aquaporin‐4 in the blood‐brain barrier. There have been reports of Devic's disease in infancy, but there are few reported associations of Devic's disease with other diseases. The association of Devic's disease with dermatomyositis has not yet been described in the literature. The aim of this paper is to describe the first case of Devic's disease in an adolescent with juvenile dermatomyositis.
    Revista Brasileira de Reumatologia 01/2015; 187. DOI:10.1016/j.rbr.2014.12.004 · 0.99 Impact Factor
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    ABSTRACT: The case of a girl with recurring chorea and a Takayasu's arteritis diagnosis is reported. This clinical manifestation has been reported in only one patient with this vasculitis in the pediatric group.
    11/2014; 41. DOI:10.1016/j.rbre.2013.09.003
  • Pediatric Rheumatology 09/2014; 12(Suppl 1):P104-P104. DOI:10.1186/1546-0096-12-S1-P104 · 1.62 Impact Factor
  • Pediatric Rheumatology 09/2014; 12(Suppl 1):P156-P156. DOI:10.1186/1546-0096-12-S1-P156 · 1.62 Impact Factor
  • Pediatric Rheumatology 09/2014; 12(Suppl 1):P38-P38. DOI:10.1186/1546-0096-12-S1-P38 · 1.62 Impact Factor
  • Pediatric Rheumatology 09/2014; 12(Suppl 1):P320-P320. DOI:10.1186/1546-0096-12-S1-P320 · 1.62 Impact Factor
  • Pediatric Rheumatology 09/2014; 12(Suppl 1):P295-P295. DOI:10.1186/1546-0096-12-S1-P295 · 1.62 Impact Factor
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    ABSTRACT: The case of a girl with recurring chorea and a Takayasu's arteritis diagnosis is reported. This clinical manifestation has been reported in only one patient with this vasculitis in the pediatric group.
    Revista Brasileira de Reumatologia 08/2014; 41. DOI:10.1016/j.rbr.2013.09.003 · 0.99 Impact Factor
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    ABSTRACT: We evaluated the concentrations of 25-hydroxyvitamin D [25(OH)D] in children and adolescents with juvenile systemic lupus erythematosus (JSLE) and associated them with disease duration and activity, use of medication (chloroquine and glucocorticoids), vitamin D intake, calcium and alkaline phosphatase levels, and bone mineral density. Thirty patients with JSLE were evaluated and compared to 30 healthy individuals, who were age and gender matched. Assessment was performed of clinical status, disease activity, anthropometry, laboratory markers, and bone mineral density. The 30 patients included 25 (83.3%) females and 16 (53.3%) Caucasians, with a mean age of 13.7 years. The mean age at diagnosis was 10.5 years and mean disease duration was 3.4 years. Mean levels of calcium, albumin, and alkaline phosphatase were significantly lower in patients with JSLE compared with controls (P<0.001, P=0.006, and P<0.001, respectively). Twenty-nine patients (97%) and 23 controls (77%) had 25(OH)D concentrations lower than 32 ng/mL, with significant differences between them (P<0.001). Fifteen patients (50%) had vitamin D levels <20 ng/mL and 14 had vitamin D levels between 20 and 32 ng/mL. However, these values were not associated with greater disease activity, higher levels of parathormone, medication intake, or bone mineral density. Vitamin D concentrations were similar with regard to ethnic group, body mass index, height for age, and pubertal stage. Significantly more frequently than in controls, we observed insufficient serum concentrations of 25(OH)D in patients with JSLE; however, we did not observe any association with disease activity, higher levels of parathormone, lower levels of alkaline phosphatase, use of medications, or bone mineral density alterations.
    Brazilian journal of medical and biological research = Revista brasileira de pesquisas medicas e biologicas / Sociedade Brasileira de Biofisica ... [et al.] 07/2014; DOI:10.1590/1414-431X20143948 · 1.08 Impact Factor
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    ABSTRACT: The aim of the study was (1) to translate the "Pediatric Quality of Life Inventory-Multidimensional Fatigue Scale" (PedsQL-Fatigue) into Brazilian Portuguese language and culture and evaluate its reliability and (2) to measure fatigue among patients with juvenile idiopathic arthritis (JIA): (1) Translation of the PedsQL-Fatigue by two bilingual researchers; (2) Backtranslation into English assessed by the authors of the original version; (3) Pilot study with five patients followed in the Pediatric Rheumatology Outpatient Clinic and their parents; and (4) Field study and assessment of measurement properties (internal consistency, reproducibility, and construct validity). In this stage, the scale was administered to 67 patients with JIA and 63 healthy individuals, aged from 2 to 18 years old, matched by age (from 2 to 4, 5 to 7, 8 to 12, and from 13 to 18 years old). Cronbach's alpha coefficient ranged from 0.6 to 0.8 for children and parents, indicating the instrument's good internal consistency. The scale's construct validity was confirmed by a satisfactory Spearman's coefficient between the PedsQL-Fatigue and the generic PedsQL 4.0 (0.840 for the children and 0.742 for the parents). Reproducibility was also adequate (0.764 for the children and 0.938 for the parents). No differences were found between the scores obtained by the JIA group and control group, though lower scores were observed among patients with clinically active JIA when compared to those without clinical activity. The PedsQL-Fatigue is a valid and reliable tool, and that can be used to measure fatigue among patients with JIA.
    Rheumatology International 06/2014; 35(1). DOI:10.1007/s00296-014-3064-5 · 1.63 Impact Factor
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    ABSTRACT: Background The intra-articular steroids injections (IASI) for treatment of juvenile idiopathic arthritis (JIA) patients are being increasingly used in pediatric rheumatology. Objectives To describe and to assess the factors associated with good response to IASI in JIA patients. Methods A study of JIA patients who were administered IASI with a minimum follow-up of six months was performed between January 2008 and December 2012. The response to IASI regarding the patients was classified as a good response (complete - all joints remained inactive for at least six months or partial - part of the joints remained inactive for at least six months) or poor response (all joints remained active or reactivated in less than six months). The response to IASI regarding the joints was classified as a good response (the joints remained inactive for at least six months) or poor response (the joints remained active or reactivated in less than six months). Results A total of 165 IASI were administered to 88 patients. Of the 88 JIA patients, 66 were female, 35.2% were persistent oligoarticular, 19.3% extended oligoarticular, 38.6% polyarticular, 4.5% systemic and 2.2% others. Patients were grouped according to disease course in oligoarticular (37.5%), polyarticular (58%) and systemic (4.5%). The mean age at diagnosis was 6.8±4 years and the mean follow-up time was 7.0±4 years. Sixty-two patients (70.4%) showed good response to IASI, 44.3% complete and 26.1% partial. There were no associations between the responses to the IASI and gender (p=0.42), JIA subtype (p=0.07), disease course (p=0.08), antinuclear antibodies (p=0.12), rheumatoid factor (p=0.27), time to diagnosis (p=0.73) and mean follow-up time (p=0.08). There was an association between good response to IASI and presence of uveitis (p=0.01) and earlier age of diagnosis (p=0.03). From the 165 joints injected, there were 100 knees, 30 ankles, 15 wrists, 9 elbows and 11 others. A hundred and four joints (63%) showed good response to IASI, with mean duration of 18.1±13 months. There were no associations between the responses to the IASI and the severity of joint effusion (p=0.49), use of DMARDs (p=0.31) or oral steroids (p=0.55), time of follow-up until the IASI (p=0.25), age at IASI (p=0.53), CHAQ (p=0.53), C reactive protein (p=0.22), erythrocyte sedimentation rate (p=0.41) and number of active (p=0.09) and limited (p=0.77) joints at the time of IASI. There was an association between good response to IASI and the injected joint (p=0.001) - knees, wrists and elbows, the use of ultrasonography to guide the IASI (p=0.02) and the parents and physician visual analogue scale (p=0.01). Local adverse events occurred in nine (0.05%) IASI (five atrophy and four hypochromia). Conclusions More than half joints showed good response to IASI, with sustained response. The JIA patients with uveitis and earlier age of diagnosis had a good response to IASI. The knees, wrists and elbows were the joints that had the better response with the injections. References Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.2279
    Annals of the Rheumatic Diseases 06/2014; 73(Suppl 2):589-589. DOI:10.1136/annrheumdis-2014-eular.2279 · 10.38 Impact Factor
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    ABSTRACT: Medical treatment of juvenile idiopathic arthritis (JIA) has advanced in the last decade, and improved prognosis is a reality in daily clinical practice. Despite this improvement in the quality of treatment, the outcome can still be compromised by modifiable factors, including delayed referral to a specialist, delayed drug treatment, poor adherence to treatment, and early interruption of drug treatment. In this review we discuss the most relevant aspects related to adherence to treatment in JIA, with emphasis on: factors that affect adherence to treatment; effect of poor adherence to treatment on JIA prognosis; when to suspect and how to assess poor adherence to treatment; and strategies to promote adherence to treatment, with an emphasis on information-reinforcement education. Besides presenting the findings of other authors, we also try to report our experience of this subject, which is still a challenge for health professionals.
    Current Rheumatology Reports 04/2014; 16(4):410. DOI:10.1007/s11926-014-0410-2 · 2.45 Impact Factor
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    ABSTRACT: Background/Purpose:The intra-articular steroids injections (IASI) for treatment of juvenile idiopathic arthritis (JIA) patients are being increasingly used in pediatric rheumatology. Most on knowledge about IASI comes from studies on adults and animal models and there are few reports on children. The aims of this study were to describe and to assess the factors associated with good response to IASI in JIA patients.Methods:A retrospective study of JIA patients who were administered IASI with a minimum follow-up of six months was performed between January 2008 and December 2012. The response to IASI regarding the patients was classified as a good response (complete—all joints remained inactive for at least six months or partial—part of the joints remained inactive for at least six months) or poor response (all joints remained active or reactivated in less than six months). The response to IASI regarding the joints was classified as a good response (the joints remained inactive for at least six months) or poor response (the joints remained active or reactivated in less than six months).Results:A total of 165 IASI were administered to 88 patients. Of the 88 JIA patients, 66 were female, 35.2% were persistent oligoarticular, 19.3% extended oligoarticular, 38.6% polyarticular, 4.5% systemic, 1.1% enthesitis related arthritis and 1.1% psoriatic. Patients were grouped according to disease course in oligoarticular—37.5%, polyarticular—58% and systemic—4.5%. The mean time to diagnosis was 10.5 ± 16 months, the mean age at diagnosis was 6.8 ± 4 years and the mean follow-up time was 7.0 ± 4 years. Sixty-two patients (70.4%) showed good response to IASI, 44.3 % complete and 26.1% partial. There were no associations between the responses to the IASI and gender (p = 0.42), JIA subtype (p = 0.07), disease course (p = 0.08), antinuclear antibodies (p = 0.12), rheumatoid factor (p = 0.27), time to diagnosis (p = 0.73) and mean follow-up time (p = 0.08). There was an association between good response to IASI and presence of uveitis (p = 0.01) and earlier age of diagnosis (p = 0.03). From the 165 joints injected, there were 100 knees, 30 ankles, 15 wrists, 9 elbows, 6 hips, 3 shoulders and 2 hand's proximal interphalangeal. A hundred and four joints (63%) showed good response to IASI, with mean duration of 18.1 ± 13 months. There were no associations between the responses to the IASI and the severity of joint effusion (p = 0.49), use of DMARDs (p = 0.31) or oral steroids (p = 0.55), time of follow-up until the IASI (p = 0.25), age at IASI (p = 0.53), CHAQ (p = 0.53), C reactive protein (p = 0.22), erythrocyte sedimentation rate (p = 0.41) and number of active (p = 0.09) and limited (p = 0.77) joints at the time of IASI. There was an association between good response to IASI and the injected joint (p = 0.001)—knees, wrists and elbows, the use of ultrasonography to guide the IASI (p = 0.02) and the parents (p = 0.01) and physician (p = 0.01) visual analogue scale. Local adverse events occurred in nine (0.05%) IASI (five atrophy and four hypochromia).Conclusion:This study showed that IASI are effective, safe and have a good sustained response. More prospective studies are needed to better define the profile of JIA patients who may benefit from IASI.
    03/2014; 66(S11). DOI:10.1002/art.38462
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    ABSTRACT: Background Juvenile systemic sclerosis (jSSc) is a rare autoimmune disease. Currently just retrospective data exist without a standardized assessment of the organ involvement. Our project is the first projects, where prospectively and with a standardized assessment data of early jSSc patients are collected. Objectives To learn about the evolvement of juvenile systemic sclerosis Methods Using the proposed standardized patient assessment protocol patients with early jSSc, entry into the cohort within the first 24 months of disease, are prospectively assessed. All participating centres approved the protocol over the own IRB. Results 50 centers from 20 countries applied to participate on the project. The assent and consent forms were translated into the local native languages. Up till now 16 patients were enrolled, who fulfilled the inclusion criteria. The mean follow up of the patients in the cohort are 1.9 years. 12 of the 16 patients were female. The age of onset of Raynaud symptomatic were 13.1 years The mean age at the onset of the non-Raynaud symptomatic were 13.2 years. Age at diagnosis at diagnosis was 13.5 years. 11 of the 16 have diffuse subtype, 5 of them have an overlap symptomatic. alle were ANA positive, and 6 of them were anti-Scl 70 positive. None of them was anticentromere positive. 15 of them have Raynaud’s. None had renal crisis. Conclusions We present the data on the first 16 prospectively assessed patients with jSSc. The current recruitment data confirms that pediatric patients are different from the adult patients. A large number of patients show overlap feutures. We are only at the first phase of this project and hope to recruit up to 50 patients and follow them prospectively over the next 2 to 4 years at least. Disclosure of Interest None Declared
    Annals of the Rheumatic Diseases 01/2014; 71(Suppl 3):262-263. DOI:10.1136/annrheumdis-2012-eular.2281 · 10.38 Impact Factor
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    ABSTRACT: Background Takayasu’s arteritis (TA) is a chronic granulomatous vasculitis affecting the large and medium arteries and can result in end organ damage. The disease is rare and there are few reports about the clinical features in the pediatric population. Objectives To evaluate and to compare the clinical features of TA in Brazilian children and adolescents. Methods In this Brazilian multicenter retrospective study including 10 pediatric rheumatology centers we identified 71 children and adolescents with TA diagnosed before the age of 18 years according to the validated classification criteria for pediatric age1. Patients’ demographic, clinical, laboratory and angiographic data were collected. The angiographic type was classified according to the 1994 International Conference of Takayasu arteritis in Tokyo2. Patients were divided in 2 groups: children, younger than 10 years – group 1, and adolescents, older than or equal to 10 years – group 2 and their disease characteristics at initial presentation were compared. Results Thirty-six (50.7%) patients were in group 1 and 35 (49.3%) were in group 2. Twenty-one (58.3%) patients in group 1 and 30 (85.7%) patients in group 2 were girls (p=0.010). The mean onset age was 5.7 and 12.7 in groups 1 and 2 (p<0.001); the mean time to diagnosis was 1.8 and 0.7 in groups 1 and 2 (p= 0.001) and the mean follow-up time was 7.2 and 3.6 in groups 1 and 2 (p <0.001). The predominant clinical symptoms at onset were decreased pulses (85.9%), followed by arterial hypertension (84.5%), constitutional (77.5%) and neurological symptoms (70.4%), however without statistical differences between the two groups. The main laboratory finding was an increased erythrocyte sedimentation rate followed by leukocytosis. Anemia and thrombocytosis were significantly more frequent in group 1 (p = 0.031; p= 0.001). Angiographic data were similar in both groups. Conclusions Children under the age of 10 had more laboratory abnormalities, but similar clinical and angiographic features when compared to adolescents with TA. A delay in diagnosis is more common in younger patients and clinicians must be aware about this disease in this age group. References Disclosure of Interest: None Declared
    Annals of the Rheumatic Diseases 01/2014; 72(Suppl 3):A496-A496. DOI:10.1136/annrheumdis-2013-eular.1490 · 10.38 Impact Factor

Publication Stats

573 Citations
211.33 Total Impact Points

Institutions

  • 2001–2015
    • Universidade Federal de São Paulo
      • Departamento de Pediatria
      San Paulo, São Paulo, Brazil
  • 2013
    • IRCCS Istituto G. Gaslini
      Genova, Liguria, Italy
  • 2008–2012
    • Senac São Paulo
      San Paulo, São Paulo, Brazil
    • University of Iowa Children's Hospital
      Iowa City, Iowa, United States
  • 2009
    • University of São Paulo
      San Paulo, São Paulo, Brazil
  • 2002
    • EPM
      Medellín, Antioquia, Colombia