Introducao: O lupus eritematoso sistemico (LES) e uma doenca autoimune cronica de origem ainda desconhecida, podendo causar lesoes inflamatorias em diversos orgaos. Nos ultimos anos, tem sido atribuido as plaquetas funcoes relacionadas na fisiopatogenia da autoimunidade, inflamacao, aterosclerose e imunologia do câncer. O papel das plaquetas como marcador de inflamacao no LES constitui area de interesse na atualidade. O volume plaquetario medio (VPM) tem sido o indice mais estudado nas doencas autoimunes recentemente, mas o uso do indice de plaquetas imaturas (IPI) pode trazer novas luzes no conhecimento da atividade plaquetaria no LES e ainda nao temos descricao do seu comportamento no LES.
Objetivo: Quantificar os indices plaquetarios (plaquetometria, VPM e IPI) em pacientes com LES ativo e inativo comparativamente a controles sadios de banco de sangue. Em paralelo, correlacionar os indices entre si e com alteracoes laboratoriais da doenca.
Metodos: Estudo transversal, controlado. Adultos com LES de acordo com os criterios do ACR 1997 e controles sadios de banco de sangue compuseram os grupos. A plaquetometria e o VPM foram obtidos em contador automatizado XE-5000. O IPI foi expresso de forma percentual por citometria de fluxo, sendo positivas as celulas com fluorescencia para RNA citoplasmico.
Resultados: Quarenta e cinco pacientes com LES (30 inativos) e 257 controles foram avaliados. A mediana do IPI foi significativamente maior no LES ativo do que em controles sadios (p=0,032). Houve correlacao significativa do IPI com o VPM na populacao lupica (p<0,001; rs=0,519) e nos controles (p<0,001, rs=0,845). Uma correlacao inversa entre IPI e plaquetometria foi observada nos lupicos ativos (p=0,025; rs=0,575). Nao houve associacao entre IPI e presenca de anti-DNA.
Conclusao: Os resultados do nosso estudo apontam para IPI elevado em pacientes com LES ativo comparativamente a controles sadios. A correlacao inversa do IPI com plaquetometria no LES ativo e um achado instigante e podeestimular novas pesquisas. O papel do IPI como marcador inflamatorio no LES demanda confirmacao futura.
To the Editors: Kawasaki Disease (KD) is nowadays the main cause of acquired heart disease among children in North America and Japan.1 The role of vaccination as a trigger for KD is enigmatic. We herein describe an unusual case of KD following yellow fever vaccination. The patient, a 12-year-old white boy living in a risk area for yellow fever, developed fever, fatigue, myalgia, and a diffuse rash, 20 days after yellow fever vaccination. After 2 weeks, the patient remained feverish. Conjuntivitis and cervical lymph node enlargement developed. Leukocytosis (17,000 cells/mm3), eosinophilia (1500 cells/mm3), and moderate anemia were present. The erythrocyte sedimentation rate was 112 mm in the first hour. Antinuclear antibodies and rheumatoid factors were absent. Tests for viral infections (cytomegalovirus, Epstein-Barr) and toxoplasmosis were negative. The echocardiogram revealed right (5 mm) and left (3.5 mm) dilated coronary lesions. KD was diagnosed, and the patient was treated with a 2 g/kg single dose of intravenous immunoglobulin plus acetyl-salicylic acid. After a week, he complained of intense arthralgia of the right knee and hip. Conjuntivitis reappeared. Low-dose prednisone (10mg daily) was started, with prompt clearing of the articular and ocular symptoms. One month later, a new echocardiogram showed partial improvement of coronary lesions (right coronary lumen 3.5 mm, left coronary lumen 2.8 mm). The current echocardiogram is normal. The patient has been asymptomatic on low-dose acetyl-salicylic acid. KD is an autoimmune systemic disorder, and the immune response to previous vaccination is a matter of interest in patients with established KD. Reactions at a Bacillus Calmette-Guerin vaccination scar site during the course of KD have been reported by 3 groups of authors.2–4 Of note, KD was reported in a 35-day-old infant following immunization with hepatitis B vaccine.5 Eleven cases of KD following rotavirus vaccine (Rota Teq) were recently identified.6 To our knowledge, no cases of KD following yellow fever vaccination have been reported so far. The attenuated live virus vaccine for yellow fever has been available since 1937.7 Adverse viscerotropic and neurotropic events are very rare following immunization with yellow fever vaccine.8 Our patient was 12 years old, an unusual age for KD9; thus, an exogenous trigger such as vaccine might have contributed to KD occurrence by an immunocomplex mechanism. Although no cause-and-effect association between receiving a vaccine and the occurrence of KD is assumed, the issue is polemic. In our patient, KD appearance after yellow fever vaccination could have been only coincidental. Nevertheless, the possibility of triggering of KD by vaccines should not be neglected. Deonilson Schmöeller, MD Mauro W. Keiserman, MD Henrique Luiz Staub, MSc, PhD Rheumatology Department Flávio Petersen Velho, MD Cardiology Department Marily de Fátima Grohe, MD Pediatrics Department São Lucas Hospital Pontifical Catholic University of Rio Grande do Sul (PUCRS) Porto Alegre, Brazil
Enquanto os critérios de neurolúpus estão bem-estabelecidos, manifestações psiquiatricas globais são de frêquencia variavel em pacientes com lúpus eritematoso sistemico (LES); suas relações com atividade da doenca e prognóstico são desconhecidas. Objetivo Avaliar a frequência de sintomas psiquiatricos no LES utilizando o Questionario de Morbidade Psiquiatrica em Adultos (QMPA); correlacionar alteracoes no QMPA com atividade da doença e variáveis socioeconômicas. Este estudo transversal avaliou pacientes com LES ativo ou inativo quanto a prevalencia de sintomas psiquiátricos utilizando, pela primeira vez, o QMPA. Oito ou mais respostas afirmativas entre 45 perguntas definiram um QMPA como anormal. Os pacientes foram classificados de acordo com os criterios do American College of Rheumatology de 1997, e o grau de atividade da doença foi mensurado pelo SLEDAI. Participaram do estudo 72 pacientes com LES, dos quais 68 eram do sexo feminino (94,4%). A media de idade foi de 46,1 anos ( ± 12 DP). A frêquencia de QMPA anormal foi de 89%. Entre os 64 pacientes lupicos com QMPA alterado, 60 (93,7%) apresentavam disturbios mentais comuns, a maioria ansiedade e somatização. Não houve correlacao de sintomas psiquiatricos com atividade da doenca (P = 0,46; rs = 0,09) ou com historia de psicose e/ou convulsoes atribuiveis ao LES (P = 1,00). Sintomas psiquiatricos tambem nao se correlacionaram com idade de inicio da doenca (rs = −0,16) ou duracao da doença (rs = −0,11). Houve associacao de QMPA anormal com baixo nivel educacional (P = 0,02), mas nao com renda familiar destinada ao paciente (P = 0,24). A frequência de sintomas psiquiátricos medidos pelo QMPA foi alta em nossa populaçáo com LES. Um QMPA anormal esteve dissociado da atividade do LES, mas se associou com baixo nivel educacional. While the neurolupus criteria are well-established, global psychiatric manifestations are of variable frequency in patients with systemic lupus erythematosus (SLE); their relation with disease activity is unknown. To evaluate the frequency of psychiatric symptoms in SLE using the Adult Psychiatric Morbidity Questionnaire (APMQ); to correlate APMQ changes with disease activity and socio-economic variables. This cross-sectional study evaluated patients with active or inactive SLE as to the prevalence of psychiatric symptoms utilizing, for the first time, the APMQ. Eight or more affirmative replies out of 45 questions defined the APMQ as abnormal. Patients were classified according to the American Collge of Rheumatology 1997 criteria, and disease activity was measured by the SLEDAI. Seventy-two SLE patients entered the study, being 68 females (94.4%). Mean age was 46.1 years ( ± 12 SD). The frequency of abnormal APMQ was of 89%. Out of the 64 SLE patients with altered APMQ, 60 (93.7%) had common mental disorders, mostly anxiety and somatization. There was no correlation of psychiatric symptoms with active disease (rs = 0.09; P = 0.46), or with history of psychosis and/or seizures attributable to SLE (P = 1.00). Psychiatric symptoms also did not correlate with age at disease onset (rs = 0.16) or disease duration (rs = 0.11). There was an association of abnormal APMQ with low education level (P = 0.02), but not with family income allotted to the patient (P = 0.24). The frequency of psychiatric symptoms measured by the APMQ was high in our SLE population. An abnormal APMQ was disconnected from SLE activity, but it did associate with low education level.
While the neurolupus criteria are well-established, global psychiatric manifestations are of variable frequency in patients with systemic lupus erythematosus (SLE); their relation with disease activity is unknown. To evaluate the frequency of psychiatric symptoms in SLE using the Adult Psychiatric Morbidity Questionnaire (APMQ); to correlate APMQ changes with disease activity and socio-economic variables. This cross-sectional study evaluated patients with active or inactive SLE as to the prevalence of psychiatric symptoms utilizing, for the first time, the APMQ. Eight or more affirmative replies out of 45 questions defined the APMQ as abnormal. Patients were classified according to the American Collge of Rheumatology 1997 criteria, and disease activity was measured by the SLEDAI. Seventy-two SLE patients entered the study, being 68 females (94.4%). Mean age was 46.1 years (± 12 SD). The frequency of abnormal APMQ was of 89%. Out of the 64 SLE patients with altered APMQ, 60 (93.7%) had common mental disorders, mostly anxiety and somatization. There was no correlation of psychiatric symptoms with active disease (rs = 0.09; P = 0.46), or with history of psychosis and/or seizures attributable to SLE (P = 1.00). Psychiatric symptoms also did not correlate with age at disease onset (rs = −0.16) or disease duration (rs = −0.11). There was an association of abnormal APMQ with low education level (P = 0.02), but not with family income allotted to the patient (P = 0.24). The frequency of psychiatric symptoms measured by the APMQ was high in our SLE population. An abnormal APMQ was disconnected from SLE activity, but it did associate with low education level. Enquanto os critérios de neurolúpus estão bem-estabelecidos, manifestações psiquiátricas globais são de frequência variável em pacientes com lúpus eritematoso sistêmico (LES); suas relações com atividade da doença e prognóstico são desconhecidas. Avaliar a frequência de sintomas psiquiátricos no LES utilizando o Questionário de Morbidade Psiquiátrica em Adultos (QMPA); correlacionar alterações no QMPA com atividade da doença e variáveis socioeconômicas. Este estudo transversal avaliou pacientes com LES ativo ou inativo quanto à prevalência de sintomas psiquiátricos utilizando, pela primeira vez, o QMPA. Oito ou mais respostas afirmativas entre 45 perguntas definiram um QMPA como anormal. Os pacientes foram classificados de acordo com os critérios de 1997, e o grau de atividade da doença foi mensurado pelo SLEDAI. Participaram do estudo 72 pacientes com LES, dos quais 68 eram do sexo feminino (94,4%). A média de idade foi de 46,1 anos (± 12 DP). A frequência de QMPA anormal foi de 89%. Entre os 64 pacientes lúpicos com QMPA alterado, 60 (93,7%) apresentavam distúrbios mentais comuns, a maioria ansiedade e somatização. Não houve correlação de sintomas psiquiátricos com atividade da doença (P = 0,46; rs = 0,09) ou com história de psicose e/ou convulsões atribuíveis ao LES (P = 1,00). Sintomas psiquiátricos também não se correlacionaram com idade de início da doença (rs = −0,16) ou duração da doença (rs = −0,11). Houve associação de QMPA anormal com baixo nível educacional (P=0,02), mas não com renda familiar destinada ao paciente (P = 0,24). A frequência de sintomas psiquiátricos medidos pelo QMPA foi alta em nossa população com LES. Um QMPA anormal esteve dissociado da atividade do LES, mas se associou com baixo nível educacional.