F.A. Peres

University of Campinas, Conceição de Campinas, São Paulo, Brazil

Are you F.A. Peres?

Claim your profile

Publications (18)102.55 Total impact

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Tumor necrosis factor alpha (TNF-aα) is deeply related to pathogenesis of neurodevelopmental disorders, especially depression. The aim of this study was to explore potential relationships between sera TNF-aα levels and mood and anxiety disorders in systemic lupus erythematosus (SLE) patients. Methods: We included 153 consecutive SLE patients (women 148; median age 30; range 10-62) and 40 (women 37; mean age 28.5; range 12-59) age- and sex-matched healthy controls. Mood and anxiety disorders were determined through Beck Depression and Beck Anxiety Inventory. SLE patients were further assessed for clinical and laboratory SLE manifestations. TNF-aα levels were measured by enzyme-linked immunosorbent assay using commercial kits. Results: Depressive symptoms were identified in 70 (45.7 %) SLE patients and in 10 (25 %) healthy controls (p < 0.001). Anxiety symptoms were identified in 93 (60.7 %) SLE patients and in 16 controls (40 %) (p < 0.001). Sera TNF-aα levels were increased in SLE patients with depressive symptoms (p < 0.001) and with anxiety symptoms (p = 0.014). A direct correlation between the severity of depressive symptoms and sera TNF-aα levels (r = 0.22; p = 0.003) was observed. TNF-aα levels were significantly increased in patients with active disease (p = 0.012). In addition, we observed a correlation between sera TNF-aα levels and disease activity (r = 0.28; p = 0.008). In the multivariate analysis, sera TNF-aα levels were independently associated with depressive symptoms (t = 3.28; 95 % CI 1.08-2.2; p = 0.002). Conclusions: Sera TNF-aα levels are increased in SLE patients with mood and anxiety disorders. In SLE, sera TNF-aα levels are independently associated with mood disorders. The etiology of mood disorders is still debated in SLE, but our findings suggest the presence of immunological basis for depression in SLE.
    Preview · Article · Dec 2016 · Journal of Neuroinflammation
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background Mood and anxiety disorders are frequently observed in systemic lupus erythematosus (SLE) patients, and there are, probably due to physical disability and stress of living with chronic disease. However, these symptoms have not been evaluatedover time in childhood-onset SLE (cSLE) so far. Objectives To investigated mood and anxiety disorders pattern over time in cSLE. To explore potential relationships between mood and anxiety and clinical/laboratorial manifestations and treatment. Methods Consecutive cSLE patients recruited from the Pediatric Rheumatology Outpatient Clinic of State University of Campinas were included in this study. We followed up 51 cSLEpatients for two years (baseline (T0), 6 (T1), 12 (T2) and 18 months (T3). Three patients in use of antidepressants were excluded.Clinical visits were scheduled semiannuallywithinterval visits scheduled when necessary due to diseaseactivity or complications. Mood and anxiety disorderswere determined through Becks Depression and Becks Anxiety Inventory in all participants. For patients under sixteen years old, Children's Depression Inventory (CDI) was applied.These scales consist of 21 items, each describing a common symptom of depression/anxiety. The respondent is asked to rate how much he or she has been bothered by each symptom over the past month on a 4-point scale ranging from 0 to 3. The items are summed to obtain a total score that can range from 0 to 63. The cutoffs used for the BDI are: 0–13: no/minimal depression; 14–19: mild depression; 20–28: moderate depression; and 29–63: severe depression and for the BAI: 0-7: no/minimal level of anxiety; 8-15: mild anxiety; 16-25: moderate anxiety; 26-63: severe anxiety. The cutoff used for CDI is 17. SLE patients were further assessed for clinical and laboratory SLE manifestations, disease activity [SLE Disease Activity Index (SLEDAI)], damage [Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI)] and current drug exposures. We used Mann-Whitney Test to compare the scores of BAI and BDI between the groups and to longitudinal analyses, we used Friedman Test. Results We included 51cSLE patients (46 girls) with mean age of mean age of 16.15 [Standard deviation (SD) ±3.03 years; range 10-23]. Disease duration was 3.66 (SD ±3.0; range 1-12 years).We observed a significant variation in anxiety scores (p=0.04) and depression scores (p=0.02) over time. Cumulative damage was associated with a worsening of anxiety (p=0.01). No association between mood and anxiety disorders and disease activity (p>0.05) and corticosteroid dose (p>0.05) was observed. In addition, no difference in mood disorders in patients with and without immunosuppressant medication was observed. Conclusions Mood and anxiety disorders have a significant variation over time in cSLEpatients. Cumulative damage is associated with worsening of anxiety incSLE patients. Acknowledgements Grants: Research Support Foundation of São Paulo –FAPESP (Simone 2008/02917-0, Mariana 2011/03788-2, Aline 2013/09480-5, Nailú 2010/13637-9) CNPQ (300447/2009-4 and 471343/2011-0; 302205/2012-8; 473328/2013-5) Disclosure of Interest None declared
    No preview · Article · Jun 2015 · Annals of the Rheumatic Diseases
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objectives To determine hippocampal and amigdala abnormalities in systemic sclerosis (SSc) and to determine the possible relationship with clinical, laboratory and treatment features of the disease. Methods A total of 41 SSc patients and sixty-six health age and sex matched volunteers. A complete clinical, laboratory and neurological evaluation was performed in all subjects. Cognitive evaluation was performed in all participants using the Montreal Cognitive Assessment (MoCA). Mood disorders were determined through Beck's Depression and Beck's Anxiety Inventories. SSc patients were further assessed for disease activity (Valentini Activity Index), severity activity (Medsger Severity Index) and current drug exposure. MRI scans were performed in a 3T Phillips® scanner. Coronal T1 weighted were used for manual volumetric measurements. Results We included 27 (65.9%) limited SSc (lSSc) and 14 (34.1%) diffuse SSc (dSSc) with mean disease duration of 10.4 (SD 6.9) years. Active disease was identified in 12 (29.3%) SSc patients. Abnormal neurological examination was observed in 27 (65.8%) and cognitive impairment in 36 (87.8%) SSc patients. Mood disorders were identified in 25 (60.9%) SSc patients. In dSSc, hippocampal (mean volume =2.95 cm3;; SD=0.13) and amigdala (mean volume =1.81 cm3;; SD=0.09) were significantly smaller when compared to hippocampal (mean volume =3.19 cm3;; SD=0.08; p=0.03) and amigdala (mean volume =2.12 cm3;; SD=0.09 p=0.02) volumes of lSSc and to hippocampal (mean volume =3.26 cm3;; SD=0.09; p=0.03) and amigdala (mean volume =2.15 cm3;; SD=0.10; p=0.02) volumes of healthy volunteers. No difference between hippocampal (p=0.08) and amigdala (p=0.12) volumes of lSSC and healthy controls were observed. Depression correlated with left hippocampal volume in dSSc (r=-0.51, p=0.003). No correlation between depression and amigdala volumes was observed. Anxiety correlated with hippocampal volume in dSSc (r=-0.38; p=0.03) and with amigdala volume in both dSSc (r=-0.29, p=0.04) and lSSc (r=-0.28, p=0.04).MoCA scores correlated with hippocampal volume in dSSc (r=0.44; p=0.03) and lSSc (r=0.32; p=0.04) and with amigdala volume in dSSc (r=0.36; p=0.04) and lSSc (r=0.35; p=0.03). No correlation was found between disease activity and hippocampal volume (r=-0.06; p=0.16) or amigdala volume (r=-0.09; p=0.19). No association was found between organic impairment and hippocampal volume (r=-0.05; p=0.11) or amigdala volume (r=-0.04; p=0.12). Conclusions This is the first study to analyze hippocampal and amigdala volume in SSc. We observed significant reduced hippocampal and amigdala volumes in dSSc when compared to lSSc and healthy volunteers. Hippocampal and amigdala volumes correlated with cognitive impairment and mood disorders in SSc. Disclosure of Interest None declared
    No preview · Article · Jun 2015 · Annals of the Rheumatic Diseases
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background There is an increased appreciation of the burden of cognitive impairment in people with autoimmune diseases. Autoantibodies, cytokines and cardiovascular disease (CVD) risk factors have been shown to contribute in different levels. Furthermore, recent studies have demonstrated diffuse white matter involvement and cerebral hypoperfusion in Systemic Sclerosis (SSc) patients. Objectives To evaluate the prevalence of cognitive impairment in SSc and to determine the role of disease related features and CVD risk factors in its occurrence. Methods Consecutive SSc patients [42 (68.85%) limited SSc (lSSc) and 19 (31.15%) with diffuse SSc (dSSc)] from the State University of Campinas were enrolled. Controls were age and sex matched and had the same educational level and sociodemographic background as SSc patients. Montreal Cognitive Assessment (MoCA) was used to assess cognitive dysfunction and scores ≤26 were considered abnormal. Mood disorders were determined through Becks Depression and Anxiety Inventory in all participants. CVD risk factors (hypertension, diabetes mellitus, insulin resistance, obesity, dyslipidemia) were screened in all individuals according to 2009 Joint Interim Statement on Metabolic Syndrome. SSc patients were further clinically and laboratory assessed to determine organ involvement, autoantibody profile (anti-topoisomerase I, anticentromere, and anti-RNA polymerase III), disease activity (Valentine Activity Index) and disease severity (Medsger Severity Index). Data were compared by non-parametric tests. Results A total of 61 SSc (55 female; mean age =50.9; SD ±11.6) and 40 health subjects (38 female; mean age=53.1; SD ±13.1) (p=0.7) were included in the study. Active disease was observed in 15 (24.59%) SSc patients. Cognitive impairment was identified in 53 (86.89%) SSc patients (38 lSSc and 15 dSSc) and in 5 (12.5%) health controls (p<0.001). Cognitive impaired SSc patients were significantly younger than controls (p=0.01). Cognitive impaired SSc patients were significantly older [mean age of 52.30 (SD=11.58); vs 41.95 (SD=9.17); p=0.016] and had higher insulin resistance evaluated by homeostatic model assessment (HOMA) (p=0.01) when compared to SSc without cognitive impairment. No association with other metabolic or disease related variables, disease's activity or severity was identified. Conclusions An increased prevalence of cognitive impairment was observed in SSc and associated with age and insulin resistance. Nonetheless, cognitive impairment seems to be an early age-related process in SSc when compared to healthy controls. Disclosure of Interest None declared
    No preview · Article · Jun 2015 · Annals of the Rheumatic Diseases
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background Neuropsychiatric manifestations areconsidered to be a serious complication in systemic lupus erythematosus (SLE).The pathogenesis of neuropsychiatric manifestations has been attributed to autoantibody-mediated neural dysfunction. Objectives To investigate the prevalence and associations of neuropsychiatric manifestations and serum biomarkers in SLE. Methods We included consecutive SLE followed at the rheumatology unit of the State University of Campinas. Neurological manifestations were analyzed according to the ACR classification criteria. Mood disorders were determined through Becks Depression and Anxiety Inventory in all participants. SLE patients were further assessed for clinical and laboratory SLE manifestations, disease activity [SLE Disease Activity Index (SLEDAI)], damage [Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI)] and current drug exposures. Total dose of corticosteroids and other immunosuppressant medications used since the onset of disease were calculated by data obtained by careful review of the medical charts.Serum biomarkers (S100β, NF-H and antiribossomal P (Anti-P) and anticardiolipin antibodies levels were measured by enzyme-linked immunosorbent assay using commercial kits from BioVendor, Inc (Czech Republic). Anti-double stranded DNA (dsDNA) antibodies were determined by indirect immunofluorescence using Crithidia as substrate and considered positive if ≥1:20.Precipitating antibodies to extractable nuclear antigens (ENAs),including Ro (SSA), La (SSB), and Sm were detected by a standardizedELISA method, and considered positive if higher than 1:40. Data were compared by non-parametric tests. Results We included 146 SLE patients (138 women; mean age of 26.60±13.42 years; range 9-67). The mean disease duration was 8.13±7.05 years (range 0-39 years). At time of study entry, 50 (34.24%) SLE patients had active disease (mean SLEDAI scores3.68±3.97; range 0-14). Forty (27.39%) cSLE had cumulative damage (mean SDI scores 0.68±1.04; range0-4). We observed neuropsychiatric manifestations in 59 (40.41%) SLE. The most frequent manifestations observed in our cohort were anxiety (43.83%), headache (39.04%), depression (34.24%) and seizure (11.64%). We observed an association between neuropsychiatric manifestations and antiribosomal P protein (p=0.001), aCL (p=0.012) and LA (p<0.001). In the analyses of each individual manifestation, anxiety was associated with antiribosomal P protein (p=0.003) and anti-Smith (p=0.010), headache with antiribosomal P protein (p<0.001) and LA (p=0.006) and depression was associated with antiribosomal P protein (p=0.031). Conclusions Autoantibodies such as antiribosomal P protein antibodies, aCL and LA, anti-Ro, anti-dsDNA and anti-Smith are associated with neuropsychiatric manifestations in SLE, suggesting the autoantibodies pathway in neural dysfunction in SLE. Acknowledgements Grants: Research Support Foundation of São Paulo –FAPESP (Simone 2008/02917-0, Mariana 2011/03788-2, Aline 2013/09480-5) CNPQ (300447/2009-4 and 471343/2011-0; 302205/2012-8; 473328/2013-5) Disclosure of Interest None declared
    No preview · Article · Jun 2015 · Annals of the Rheumatic Diseases
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background Childhood-onset systemic lupus erythematosus (cSLE) is a chronic autoimune disease with fluctuating disease activity. Neurospichiatric manifestations are common and vary from common manifestations such as headache and anxiety to life threatening manifestations such as acute confusional syndrome. Ataxia has not been studied frequently in cSLE. Objectives To determine the prevalence of ataxia in cSLE and clinical, laboratory and treatment features associated with its occurrence. To determine neuroimaging features associated with ataxia, especially medullary area and cerebellar volume. Methods We included 62 cSLE patients followed at the State university of Campinas and 28 healthy controls with similar age and gender distribution. All patients and controls were evaluated for ataxia using Scale for the assessment and rating of ataxia (SARA), validated in portugues. All subjects realized magnetic resonance imaging using a 3 tesla scanner (Phillips). Sagittal T1 1mm thick slices were used for analysis. Medullary area and excentricity and cerebellar volume were analyzed using semiautomatic computer segemntation software (SpineSeg and Neuroline). Results We observed ataxia in 22 out of 62 (35.5%) patients and in none of the controls (p=0.002). Ataxia was associated with the presence of neuropsychiatric manifestations (p=0.003) and antifosfolipid antibodies (p=0.005). None of the other clinical, laboratory or treatment features were associated with ataxia. Medullary area was significant smaller in cSLE when compared to controls (p=0.002). Reduction of medullar area was associated with cumulative corticosteroid dose (r=-0.43; p=0.008) and the presence of ataxia (p=0.003). Cerebellar volume was significantly reduced in cSLE patients when compared to controls (p<0.001). Cerebellar atrophy was associated with medullary area (r=0.46; p=0.001). None of the other clinical, laboratory and treatment features were associated with cerebellar volume. Conclusions Ataxia is frequently observed in cSLE and associated with neuropsychiatric manifestations and antiphospholipid antibodies. Neuroimaging features, especially medullary volume is associated with ataxia and cerebellar atrophy may be secondary. Disclosure of Interest None declared
    No preview · Article · Jun 2015 · Annals of the Rheumatic Diseases
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To determine the serum interleukin-17 (IL-17) levels in childhood-onset systemic lupus erythematosus patients and to evaluate the association between IL-17 and clinical manifestations, disease activity, laboratory findings and treatment. We included 67 consecutive childhood-onset systemic lupus erythematosus patients [61 women; median age 18 years (range 11-31)], 55 first-degree relatives [50 women; median age 40 years (range 29-52)] and 47 age- and sex-matched healthy controls [42 women; median age 19 years (range 6-30)]. The childhood-onset systemic lupus erythematosus patients were assessed for clinical and laboratory systemic lupus erythematosus manifestations, disease activity [Systemic Lupus Erythematosus Disease Activity Index (SLEDAI)], cumulative damage [Systemic Lupus International Collaborating Clinics/American College of Rheumatology (ACR) Damage Index] and current drug use. Serum IL-17 levels were measured by an enzyme-linked immunosorbent assay using commercial kits. The median serum IL-17 level was 36.3 (range 17.36-105.92) pg/mL in childhood-onset systemic lupus erythematosus patients and 29.47 (15.16-62.17) pg/mL in healthy controls (p=0.009). We observed an association between serum IL-17 levels and active nephritis (p=0.01) and migraines (p=0.03). Serum IL-17 levels were not associated with disease activity (p=0.32), cumulative damage (p=0.34), or medication use (p=0.63). IL-17 is increased in childhood-onset systemic lupus erythematosus and may play a role in the pathogenesis of neuropsychiatric and renal manifestations. Longitudinal studies are necessary to determine the role of IL-17 in childhood-onset systemic lupus erythematosus.
    Full-text · Article · May 2015 · Clinics (São Paulo, Brazil)
  • Source

    Preview · Article · Sep 2014 · Pediatric Rheumatology
  • Source

    Preview · Article · Sep 2014 · Pediatric Rheumatology
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: In systemic lupus erythematosus (SLE), atherosclerosis is attributed to traditional and lupus related risk factors, including metabolic syndrome (MetS), obesity, and inflammation. Objective. To evaluate the association between obesity, measures of body fat content, serum tumor necrosis factor alpha (TNF-α), and interleukin (IL)-6 and -10 levels in childhood-onset SLE (cSLE). Methods: We screened consecutive cSLE patients followed up in the Pediatric Rheumatology Outpatient Clinic of the State University of Campinas. cSLE patients were assessed for disease and damage. Obesity was definite as body mass index (BMI) ≥30 kg/m(2). Serum TNF-α, IL-6, and IL-10 levels were measured by ELISA. Dual-energy X-ray absorptiometry was used to determine total fat mass, lean mass, and percent of body fat. Results: We included 52 cSLE patients and 52 controls. cSLE patients had higher serum TNF-α (P = 0.004), IL-6 (P = 0.002), and IL-10 (P < 0.001) levels compared to controls. We observed higher serum TNF-α (P = 0.036) levels in cSLE patients with obesity. An association between serum TNF-α levels and body fat percent (P = 0.046) and total fat mass on trunk region (P = 0.035) was observed. Conclusion: Serum TNF-α levels were associated with obesity and body fat content in cSLE. Our finding suggests that obesity may contribute to the increase of serum TNF-α levels in cSLE.
    Full-text · Article · Mar 2014 · Journal of Immunology Research
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background Systemic lupus erythematosus (SLE) is an autoimmune disorder that affects 0.1% of the world population and central nervous system involvement in the disease neuropsychiatric SLE has been observed in 12–95% of SLE patients. Numerous autoantibodies, including anti–ribosomal P (anti-P) antibodies, have been linked to central nervous system involvement manifestations. Moreover, these antibodies are capable of binding and penetrating neuronal cells of the limbic areas that are associated with olfaction. Involvement of the limbic system (e.g., atrophy of the hippocampus and amygdala) in SLE patients was recently documented utilizing magnetic resonance imaging Recently, links between the olfactory system, the immune system, and various diseases have been identified. Decreased olfaction was observed in patients with several CNS diseases in which immune-mediated mechanisms have been implicated (e.g., Parkinson’s disease, schizophrenia, Alzheimer’s disease, and multiple sclerosis). Objectives To analyze the prevalence of olfactory disorders in patients with SLE, to correlate the presence of mood disorders (depression and anxiety), disease activity and the presence of cognitive disorders abnormalities of the olfactory, and correlate levels of anti-P with smell disorders. Methods Olfactory functions were evaluated in 150 SLE patients and 50 age- and sex-matched controls using the Sniffin’ Sticks test. We excluded patients with histories of head injuries, nasofacial operations, or active nasal-sinus or allergic diseases. The test consists of 3 stages: threshold, discrimination, and identification (TDI) of different odors. Neuropsychiatric manifestations were assessed according ACR criteria. Depression was assessed by Beck Depression Scale (BDI), anxiety by the BeckAnxiety Inventory (BAI) and psychiatric manifestations by the Brief Psychiatric RatingScale (BPRS). Disease activity was assessed by the Disease Activity Index (SLEDAI) and the disease is considered active if the sum of points in the SLEDAI exceeds three. The cumulative damage was assessed according to Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI). We use Kruskall-Wallis test, Fischer exact test and Spearman correlation. p<0.05 was considered significant. Results Mean age of SLE patients was 38.49±10.96 years and 35.02±14.15 years in controls (p=0.45). A decrease in the sense of smell was observed in SLE patients (52.48%) and controls (25.64%) (p<0.01), while loss of smell (anosmia) was documented in SLE patients (3.54%) and controls (1.28%) (p<0.01). Patients had an average of 28.80±5.75 total points at the 3 stages of Sniffin’ Sticks test while the controls had mean of 31.27±5.35 points (p=0.02). 8.51% of the patients smoked while of the patients smoked, while in controls this percentage was 5.13% (p=0.427). No significant difference was observed in the smell sense of smokers and nonsmokers (p=0.797). Total TDI scores and individual stages of smell correlated with depression(r=0.278; p<0.01), anxiety (r=0.264; p=0.001) and SDI scores (r=0.302; p=0.010). Conclusions Reduced olfactory function has been observed in SLE patients and is associated with neurospychiatric manifestations, especilly mood disorders. Disclosure of Interest F. Peres Grant/Research support from: FAPESP: 2011/15422-2, N. Sinicato Grant/Research support from: 2010/13637-9, M. Postal Grant/Research support from: 2009/11076-2, K. Peliçari Grant/Research support from: 2010/13636-2, A. Ferrari: None Declared, C. Gomes: None Declared, L. Costallat: None Declared, S. Appenzeller Grant/Research support from: FAPESP 2008/02917-0; Conselho Nacional Pesquisa Desenvolvimento-Brasil CNPq (300447/2009-4; 471343/2011-0)
    No preview · Article · Jan 2014 · Annals of the Rheumatic Diseases
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background Systemic lupus erythematosus (SLE) is a multisystem inflammatory disease characterized by varied clinical manifestations. It mainly affects women of childbearing age and varies in intensity from a mild disease with skin lesions and arthritis to a devastating disease with renal, cardiac and profound disturbances of the central nervous system. In recent decades, due to the increased survival of patients with SLE, new complicationsand comorbidities have been recognized. Among these is cardiovascular disease atherosclerosis (CAD). Metabolic syndrome (MetS) is defined by the World Health Organization (WHO) as a set of metabolic alterations that commonly manifest together and are risk factors for coronary artery disease (CAD). Each component by it self, increases the risk of CAD, however, when combined, become more intense. These factors include hypertension, disturbed glucose metabolism, central obesity, and dyslipidemia. SM contributes to an 1.5-2.5 fold increase in mortality in CAD. Objectives To analyze the prevalence of MetS in SLE according to the consensus applicable to different populations. To correlate the clinical, laboratory and treatment features with the occurrence of MetS. Tif TNF-α levels are independently associated with presence of MetS in SLE. Methods We screened consecutive SLE patients followed in a longitudinal cohort at the rheumatology unit at the State University of Campinas. Controls were matched for age, sex and demographic background. SLE patients were assessed for disease activity [SLE Disease Activity Index (SLEDAI)], damage [Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI)] both at study entry and over time. Total dose of prednisone was calculated in prednisone equivalent during the entire follow-up period. MetS was assessed using the definitions recommended by the Brazilian Society of Cardiology. We determined height, weight, waist circumference (WC) and hip circumference (HC), measurements and fractions of cholesterol and fasting glucose levels for each individual. The reference values were adjusted according to age, as recommended by The National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (NCEPIII) definition.TNF-α levels were measured by ELISA. Results We included 120 (95% female) patients with a mean age of 41.20±11.87 years and 106 controls with mean age of 36.32±14.26 years (p=0.006). We identified 45 (37.5%) SLE patients and 11 (10.38%) controls with MetS (p<0.001). We found no association between the presence of MetS variables and TNF-α (p=0.902), SDI (p=0.187) and SLEDAI (p=0.562). Conclusions SLE patients have a higher prevalence of MetS than the general population. The higher risk of coronary disease and atherosclerosis makes the evaluation of MetS imperative in SLE patients. TNF-α was not associated with MetS in this cohort. Disclosure of Interest F. Peres Grant/Research support from: FAPESP: 2010/10523-2, N. Sinicato Grant/Research support from: 2010/13637-9, M. Postal Grant/Research support from: 2009/11076-2, K. Peliçari Grant/Research support from: 2010/13636-2, A. Ferrari: None Declared, L. Costallat: None Declared, S. Appenzeller Grant/Research support from: 2008/02917-0
    No preview · Article · Jan 2014 · Annals of the Rheumatic Diseases
  • [Show abstract] [Hide abstract]
    ABSTRACT: To perform a systematic review of neurologic involvement in Systemic sclerosis (SSc) and Localized Scleroderma (LS), describing clinical features, neuroimaging, and treatment. We performed a literature search in PubMed using the following MeSH terms, scleroderma, systemic sclerosis, localized scleroderma, localized scleroderma "en coup de sabre", Parry-Romberg syndrome, cognitive impairment, memory, seizures, epilepsy, headache, depression, anxiety, mood disorders, Center for Epidemiologic Studies Depression (CES-D), SF-36, Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Patient Health Questionnaire-9 (PHQ-9), neuropsychiatric, psychosis, neurologic involvement, neuropathy, peripheral nerves, cranial nerves, carpal tunnel syndrome, ulnar entrapment, tarsal tunnel syndrome, mononeuropathy, polyneuropathy, radiculopathy, myelopathy, autonomic nervous system, nervous system, electroencephalography (EEG), electromyography (EMG), magnetic resonance imaging (MRI), and magnetic resonance angiography (MRA). Patients with other connective tissue disease knowingly responsible for nervous system involvement were excluded from the analyses. A total of 182 case reports/studies addressing SSc and 50 referring to LS were identified. SSc patients totalized 9506, while data on 224 LS patients were available. In LS, seizures (41.58%) and headache (18.81%) predominated. Nonetheless, descriptions of varied cranial nerve involvement and hemiparesis were made. Central nervous system involvement in SSc was characterized by headache (23.73%), seizures (13.56%) and cognitive impairment (8.47%). Depression and anxiety were frequently observed (73.15% and 23.95%, respectively). Myopathy (51.8%), trigeminal neuropathy (16.52%), peripheral sensorimotor polyneuropathy (14.25%), and carpal tunnel syndrome (6.56%) were the most frequent peripheral nervous system involvement in SSc. Autonomic neuropathy involving cardiovascular and gastrointestinal systems was regularly described. Treatment of nervous system involvement, on the other hand, varied in a case-to-case basis. However, corticosteroids and cyclophosphamide were usually prescribed in severe cases. Previously considered a rare event, nervous system involvement in scleroderma has been increasingly recognized. Seizures and headache are the most reported features in LS en coup de sabre, while peripheral and autonomic nervous systems involvement predominate in SSc. Moreover, recently, reports have frequently documented white matter lesions in asymptomatic SSc patients, suggesting smaller branches and perforating arteries involvement.
    No preview · Article · Jul 2013 · Seminars in arthritis and rheumatism
  • [Show abstract] [Hide abstract]
    ABSTRACT: Systemic lupus erythematosus (SLE) is an autoimmune disorder that affects 0.1% of the world population. The disorder is characterized by systemic inflammation, auto-antibody production, and immune dysregulation, and it may lead to significant neurologicaland psychiatric morbidities. Both adults and children are diagnosed according to a set of clinical and laboratory criteria with a high sensitivity and specificity. A diagnosis of SLE in any age-group depends on excluding systemic infections or malignancies and the presence of at least 4 of 11 American College of Rheumatology (ACR) diagnostic criteria. Nephritis (leading to hypertension and renal dysfunction) and nervous system involvement are two of the more ominous manifestations in all age-groups. There are 19 case-based peripheral and central nervous syndromes that are postulated to be associated with SLE. Syndromes requiring prompt neurological evaluation include seizures, cerebrovascular accidents, demyelination, movement disorders, and peripheral neuropathies. Manifestations that may prompt psychiatric consultation include acute confusional state (delirium), affective disorders (anxiety and depression), cognitive impairment, and psychosis. Neuropsychiatric presentations may be caused by hypercoagulability in cerebral vessels (vasculopathy), proinflammatory cytokines, auto-antibody effects on neuronalstructures or receptors, and blood-brain barrier disruption. Alteration in the regulation of neurotransmitters such as dopamine and serotonin appear to play a role in behavioral changes seen in lupus-prone mice. Psychiatric manifestations in all age-groups may also be influenced by significant disease-related psychosocial stressors and by medication. Psychotic manifestations in adult patients are associated with early and severe clinical presentations and are described in up to 11% of patients in retrospective reviews of adult cohorts. We will review the prevalence, etiology and clinical presentation of psychosis in SLE. In addition we will discuss treatment protocol for this serious manifestation in SLE.
    No preview · Article · Oct 2012
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background Patients with systemic lupus erythematosus (SLE) have a higher incidence of metabolic syndrome (MetS). Among the possible causes we may mention the inflammation associated with increased levels of triglycerides and cytokines such as tumor necrosis factor alpha (TNF-α), in addition to other factors that may cause the increase of cholesterol and its LDL fraction. These factors contribute to the development of premature coronary artery disease. Objectives To analyze the association of MetS and TNF-α serum levels in childhood-onset (c)SLE patients according to age-adjusted criteria Methods We screened consecutive cSLE patients followed in a cohort at the pediatric rheumatology unit at the State University of Campinas. All patients had disease-onset before the age of 16. Controls were matched for age, sex and demographic background. cSLE patients were assessed for disease activity [SLE Disease Activity Index (SLEDAI)], damage [Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI)] both at study entry and over time. Total dose of prednisone was calculated in prednisone equivalent during the entire follow-up period. MetS was assessed using the definitions recommended by The National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (NCEPIII) definition adjusted according to age. Obesity was defined as Body Mass Index (BMI) >30kg/m2. We determined height, weight, waist circumference (WC) and hip circumference (HC), measurements and fractions of cholesterol and fasting glucose levels for each individual. TNF-α levels were measured by ELISA. Results We included 51 cSLE patients (47 women, mean age 17.6 years (SD±3.7; range) and 51 controls (47 females, mean age 18.2 years (SD±6.4; range). Disease duration was 12.47 years (SD±2.86; range 6-16 years). Thirty-seven (18.8%) patients were above the recommended average WC/HC, compared to 14 (7.14%) controls (p=0.03). MetS was identified in 9 cSLE and 1 control (p=0.01). The mean serum TNF-α level was 4.47±8.95pg/ml in cSLE, compared to 1.83±1.82pg/ml in healthy controls (p=0.004). We observed higher TNF-α levels in patients with obesity (p=0.036). No association between MetS criteria and serum TNF-α levels was observed. We observed a significant correlation between adjusted SLEDAI scores over time and the prevalence of MetS (r=0.68; p=0.01). In addition, TNF-α (p=0.001) levels were significantly increased in patients with active disease (SLEDAI≥3) and TNF-α levels correlated directly with SLEDAI scores (r=0.4; p=0.002). No correlation between cumulative corticosteroid dose, SDI scores and other clinical manifestations and prevalence of MetS was observed. Conclusions cSLE patients have a higher prevalence of MetS than the general population. TNF-α levels were increased in cSLE patients with obesity. Disease activity over time was the only disease characteristics associated with MetS. The higher risk of coronary disease and atherosclerosis makes the evaluation of MetS imperative in cSLE patients. Disclosure of Interest N. Sinicato Grant/Research support from: FAPESP 2010/13637-9, M. Postal Grant/Research support from: FAPESP 2009/10744-1, F. Peres Grant/Research support from: FAPESP 2010/10523-2, K. Peliçari Grant/Research support from: FAPESP 2010/13636-2, R. Marini: None Declared, S. Appenzeller Grant/Research support from: FAPESP 2008/02917-0; Conselho Nacional Pesquisa Desenvolvimento-Brasil CNPq (300447/2009-4)
    No preview · Article · Jun 2012 · Annals of the Rheumatic Diseases
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Localized scleroderma is a rare disease, characterized by sclerotic lesions. A variety of presentations have been described, with different clinical characteristics and specific prognosis. In scleroderma en coup de sabre (LScs) the atrophic lesion in frontoparietal area is the disease hallmark. Skin and subcutaneous are the mainly affected tissues, but case reports of muscle, cartilage, and bone involvement are frequent. These cases pose a difficult differential diagnosis with Parry-Romberg syndrome. Once considered an exclusive cutaneous disorder, the neurologic involvement present in LScs has been described in several case reports. Seizures are most frequently observed, but focal neurologic deficits, movement disorders, trigeminal neuralgia, and mimics of hemiplegic migraines have been reported. Computed tomography and magnetic resonance imaging have aided the characterization of central nervous system lesions, and cerebral angiograms have pointed to vasculitis as a part of disease pathogenesis. In this paper we describe the clinical and radiologic aspects of neurologic involvement in LScs.
    Full-text · Article · Jan 2012
  • [Show abstract] [Hide abstract]
    ABSTRACT: Antiphospholipid syndrome (APS) is a multisystem prothrombotic condition, however, in recent years, its inflammatory nature has been studied extensively. Cerebral involvement is commonly observed in APS and results in different clinical manifestations. However, most of the studies include secondary APS. In this article, we review the prevalence, clinical characteristics, and physiopathology of cognitive impairment in patients with primary APS.
    No preview · Article · Dec 2011 · Current Rheumatology Reports

  • No preview · Article ·