BACKGROUNDBehçet's disease (BD) is an inflammatory multisystem disease.Neuro-Behçet's disease (NBD) has variable prevalence depending on the series but can represent around 5-10% of the affected patients in a large series.The diagnostic criteria for NBD are the current diagnosis of BD plus the presence of neurological symptoms not otherwise explained by known systemic or neurological diseases.In this report, we would like to present a case of NBD with an unusual initial presentation of papilledema and intracranial hypertension and emphasize on NBD as rare but important cause of bilateral papilledema due to intracranial hypertension. CASE REPORTFB, 42 years old, male, with a history of oral, nasal ulcers and recurrent genital ulcers for > 2 years associated with inflammatory joint manifestations and pseudofolliculitis.He was diagnosed with BD only in 2020.Prednisone 20 mg/day, colchicine 0.5 mg/day and azathioprine 100 mg/day for 6 months (irregular treatment) with partial response.In 2020, 1 month after a viral infection (COVID-19 with exclusively respiratory manifestations) evolved with mucocutaneous worsening.Followed by severe headache, decreased bilateral progressive visual acuity, visual blurring, nausea and vomiting.Magnetic resonance showed hypersignal on T2 and flair in the supratentorial white matter and trunk.Hydrocephalus with signs of incipient cerebrospinal fluid (CSF) transudation.In the cranial venous and arterial phase computed tomography angiography thrombosis was not evidenced.Cerebrospinal fluid puncture showed high opening pressure, without signs of infection.With other infectious serologies (HIV, syphilis, hepatitis B, C, cytomegalovirus and Epstein-Barr virus) negative.Autoantibodies (anti-dsDNA, ANA, anti-SM, C3 and C4) was also negative.The diagnosis of NBD with intracranial hypertension was made, with pulse therapy with methylprednisolone 1 g/day for 5 days, with induction with cyclophosphamide 0.75 mg and measures for intracranial hypertension.The patient evolved with improved light perception of vision and resolution of cranial hypertension, with normalization of CSF opening pressure.He was discharged with prednisone 1 mg/kg/day and scheduled for another 6 pulses of cyclophosphamide.Currently, the patient maintains visual sequelae, but controlled and stabilized. CONCLUSIONNeurological involvement occurs in 9% of cases, vascular complications occur in 14%.Intracranial hypertension secondary to inflammatory disease of the brain without thrombotic manifestations is most uncommon.In conclusion, we emphasize the importance of considering NBD in the differential diagnosis when patients present with bilateral papilledema, complaining of visual changes and intracranial hypertension.
A Brucelose e uma antropozoonose de importância tanto para saude publica quanto para a economia das regioes onde ocorre, devido a alta taxa de aborto e infertilidade em rebanhos infectados. O animal infectado e a mais importante fonte de transmissao ao homem, que pode ocorrer de forma ocupacional ou pela ingestao de produtos contaminados. A brucelose caprina e a que desenvolve maior virulencia para o homem. No atual projeto foi possivel investigou-se a soroprevalencia para brucelose em diferentes rebanhos da Bahia, onde, assim como em todo o nordeste do Brasil, a caprinocultura representa uma das principais fontes de renda e de alimento para a populacao. Amostras de soro de 400 caprinos provenientes de rebanhos das regioes de Amelia Rodrigues, Feira de Santana e Jaguarari, na Bahia, foram testadas pelo metodo de soro aglutinacao direta com antigeno brucelico rosa-bengala em prova rapida para triagem, Todas as amostras positivas por este metodo foram submetidas a prova lenta em tubo, confirmando-se 03 casos positivos numa regiao que possui poucos relatos bibliograficos de endemia para brucelose.
Abstract Background Psoriatic arthritis (PsA) is a chronic inflammatory disease of widely varying presentation, which determines functional and psychological impairment, with a high negative impact on patients’ quality of life. Therefore, knowing the patient’s perception of their health status is of fundamental importance for understanding the real impact of PsA. Given this context, the European League Against Rheumatism (EULAR) recently developed the Psoriatic Arthritis Impact of Disease (PsAID) - instrument to specifically assess the impact of PsA for the patient. Objective Validate the brazilian portuguese version of PsAID-12 (Psoriatic Arthritis Impact of Disease) and to verify its interpretability in clinical practice, through its relation with measures of psoriatic arthritis activity. Methods A multicenter cross-sectional study, which recruited 160 patients, who met the Classification criteria for Psoriatic Arthritis (CASPAR), in six Brazilian centers of rheumatology. Reliability was assessed by Cronbach’s alpha coefficient and by the intraclass correlation coefficient (ICC). The construct validity was evaluated by exploratory factorial analysis and also by Spearman correlation with other PROMs and measures of disease activity evaluation. Results Of the total number of participants, 50% were female, with a mean age (SD) of 54.0 ± 11.2 years; 68% had only peripheral arthritis and 32% had pure or mixed axial involvement. The majority (67.7%) of the patients were using biological treatment. The reliability of internal consistency (alpha-Cronbach = 0.93) and test-retest (ICC = 0.996) were good. Factor analysis revealed two factors, named physical and psychosocial, which included the skin evaluation item. PsAID-12 correlated significantly with other PROMs, demonstrating good construct validity. PsAID-12 was also significantly associated with the disease activity assessment instruments (DAS28-ESR, ASDAS, and BASDAI) and the MDA status: “Minimum Disease Activity”. Fibromyalgia did not significantly affect the final PsAID-12 score. Conclusion The brazilian version of PsAID-12 has been shown to be a reliable and valid measure of the impact of the disease in patients with psoriatic arthritis. Moreover, it associated significantly with the scores of disease activity assessment.
Psoriatic arthritis is an inflammatory arthritis associated with psoriasis. Its prevalence in patients with psoriasis varies from 7 to 42% but its exact prevalence is unknown.Considering the lack of national data related to its diagnosis in patients with psoriasis, this study aims to describe the clinical, laboratorial and radiological manifestations of psoriatic arthritis in these patients.We evaluated 133 patients with psoriasis, treated as outpatients. These patients were asked to fill in the forms with data about the disease and were submitted to a clinical evaluation by a dermatologist and a rheumatologist. Suspected cases of arthritis were referred for further investigation and were classified according to presence or absence of psoriatic arthritis according to CASPAR criteria.The number of patients with psoriatic arthritis was 47 (35%), 17 of them were new cases. There was no difference between the groups regarding the type of psoriasis, nail involvement, presence of scalp lesions and psoriatic arthritis. Patients with psoriatic arthritis had more enthesitis and dactylitis (46.7%) than those without arthritis.Despite the high prevalence of arthritis found, we know that results from epidemiological studies are variable, which limits their use and interpretation. We conclude that more studies are needed to draw a profile of rheumatic manifestations in our population of psoriasis patients.