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Papers by Cristina Lanna

Clinical and Experimental Rheumatology, Nov 26, 2021

Lupus, Jul 11, 2016

To analyze the association of adipokines and tumor necrosis factor α (TNFα) and its receptors wit... more To analyze the association of adipokines and tumor necrosis factor α (TNFα) and its receptors with characteristics of systemic lupus erythematosus (SLE) and to investigate the correlation between adipokines and the TNF system. One hundred and thirty-six SLE women, aged ≥18 years old, were assessed. TNFα, soluble TNFα receptors 1 (sTNFR1) and 2 (sTNFR2) and adipokines were analyzed by ELISA kits. The median (IQR) of age was 41.5 (33.0-49.7) years old and of disease duration 11.3 (7.8-15.8) years. The median (IQR) of disease activity was 0 (0-4) and of damage index was 2 (1-3). Higher levels of sTNFR1 and sTNFR2 were associated with nephritis (p < 0.001 for both), and sTNFR1 (p = 0.025) and TNFα (p = 0.014) were positively associated with arthritis. Higher sTNFR1 levels were found in participants that were not using antimalarial drugs (p = 0.04). Independent correlation was found between sTNFR1 (β = 0.253; p = 0.003) and sTNFR2 (β = 0.297; p < 0.001) levels and disease activity and damage index (sTNFR1: β = 0.367; p < 0.001; sTNFR2: β = 0.335; p < 0.001). Higher adiponectin levels were independently associated with nephritis (p = 0.009) and antimalarial drugs use (p = 0.015). There was a positive correlation between leptin and sTNFR2 levels (p = 0.002) and between resistin levels and sTNFR1 (p < 0.001) and sTNFR2 (p < 0.001). The correlation between adipokines and TNF system allows a better understanding of the role of adipokines in the inflammatory response in SLE patients.

Cardiology in The Young, Oct 1, 2003

In order prospectively to investigate the frequency and evolution of subclinical valvitis, we sel... more In order prospectively to investigate the frequency and evolution of subclinical valvitis, we selected 40 consecutive patients suffering their initial attack of rheumatic fever, seen in our clinic from 1992 to 1994, and followed-up until 2001, with a mean period of follow-up of 8.1 years, and a standard deviation of 0.6 year. We also assembled a matched control group of 37 healthy children and adolescents. We discovered a murmur of mitral regurgitation in 28 (70.0%) of the patients. In 3 (7.5%) of these patients, there was also a murmur of aortic regurgitation. In the group of 28 symptomatic patients, Doppler echocardiography showed mitral regurgitation in all, and aortic regurgitation in 17. In the group of 12 patients without clinical evidence of cardiac involvement, Doppler echocardiography identified mitral regurgitation in 2, isolated in one and associated with aortic regurgitation in the other. Thus, the frequency of subclinical valvitis was 16.7%. In patients with subclinical valvitis only the aortic regurgitation regressed during the period of follow-up. In the group of 28 symptomatic patients, mitral regurgitation disappeared in 6 (21.4%), aortic regurgitation in 7 of the 17 having this feature (41.2%), while 2 patients (7.1%) developed mitral stenosis. The sensitivity and specificity of cardiac auscultation were, respectively, 93.3%, with 95% confidence intervals between 72.3% and 97.4%, and 100%, with 95% confidence intervals between 65.5% and 100%, for the diagnosis of mitral regurgitation, and 16.7%, with 95% confidence intervals between 4.4% and 42.3%, and 100%, with 95% confidence intervals between 81.5% and 100%, for that of aortic regurgitation. We conclude that the Doppler echocardiogram is an important means of diagnosing and assessing the evolution of subclinical rheumatic valvar lesions, which are not always transient. We suggest that Doppler echocardiography should be performed in all patients with acute rheumatic fever. Subclinical valvitis should be considered as mild carditis, provided that strict criterions are observed in the differential diagnosis from physiological regurgitation, and Doppler echocardiographic findings are analyzed in the context of the other manifestations of the disease.

Revista Médica de Minas Gerais, 2021

Relato de Caso O lipoma arborescente é uma causa incomum de lesão intra-articular que se apresent... more Relato de Caso O lipoma arborescente é uma causa incomum de lesão intra-articular que se apresenta como aumento de volume articular indolor, lentamente progressivo, que persiste por muitos anos e é acompanhado por derrames articulares intermitentes. O envolvimento de sítios extra-articulares é incomum, mas pode ocorrer em bainhas tendíneas e bursas. A ressonância magnética é o melhor exame para o diagnóstico, embora a biópsia sinovial possa ser necessária em alguns casos. Relatamos três casos com o objetivo de destacar o espectro clínico da doença, as características da imagem e a resposta ao tratamento imunossupressor. Palavras-chave: Lipoma arborescente; Lipomatose sinovial; Ressonância magnética; Membrana sinovial; Artropatia crônica. RESUMO Lipoma Arborescens: a cause of chronic synovitis? Lipoma arborescens is an uncommon cause of intra-articular masses that presents as slowly progressive painless swelling of the joint, which persists for many years and is accompanied by intermittent effusions. Extra-articular site(s) involvement is unusual, but can occur in tendon sheaths and bursas. Magnetic resonance imaging is the best diagnostic exam, although synovial biopsy may be necessary. We report three cases in order to highlight the clinical spectrum and imaging features of the disease, so that early diagnosis and appropriate treatment can be given.

XXXIX Congresso Brasileiro de Reumatologia

BACKGROUND In systemic lupus erythematosus (SLE) patients, discoid lesions may leave definitive s... more BACKGROUND In systemic lupus erythematosus (SLE) patients, discoid lesions may leave definitive scars such as atrophy, hyperpigmentation, and depigmentation, which are emotionally devastating, as they increase psychological burden of the disease and negatively impacts on health-related quality of life. Cosmetic camouflage has been integrated into medical practice to help patients disguise congenital or acquired disfigurements that are not amenable to medical or surgical treatment. Training is essential in camouflage therapy, once the application and adherence processes are different from regular makeup foundations. We aimed to present a stepby-step video produced to teach how to do cosmetic camouflage, through a QR code access. METHODS A signed authorization for image use was obtained. A video teaching the techniques of cosmetic camouflage was produced, as part of a University Extension Project, by a skillful makeup artist, a dermatology fellow, a lupus patient, medical students and rheumatology professors. After publication in the social media, patients will be able to interact with the staff to solve issues.

XXXIX Congresso Brasileiro de Reumatologia

BACKGROUND Self-esteem (SE) can be defined as the individual perception of being close or far fro... more BACKGROUND Self-esteem (SE) can be defined as the individual perception of being close or far from his/her ideal self, according to his/her values and beliefs. Rheumatic diseases (RDs) can negatively impact SE due to functional limitations and aesthetic impairment. This work aims to describe SE in patients with RD and assess the factors associated with SE in RD individuals. METHODS This is a cross-sectional, web-based survey for adult individuals reporting RDs. The study questionnaire was hosted on the Google Forms platform. SE was evaluated by applying the Rosenberg Self-Esteem Scale (RSES). The questionnaire also included questions about sociodemographic data, comorbidities, psychiatric disorders, and RD diagnosis (more than one diagnosis was allowed), and assessed self-reported RDs activity through the visual analogic scale (VAS). Factors associated with SE in RD patients were investigated. Descriptive analysis and associations are shown, with multivariate analyses using linear regressions. RESULTS The study presents data on 2,020 responses. Most (96.1%) responders were women, with a mean age of 40.8 (SD = 10.8) years. The most-reported RD were fibromyalgia (33.4%) and systemic lupus erythematosus (25.9%). Mean RSES was 27 (SD = 5.9), and 791 (21%) participants presented low SE according to RSES score ≤ 25. Most (94%) participants checked the following RD associated factors as SE determinants (more than one allowed): mood changes (68.5%), functional limitation (68.1%), side effects of medications (47.4%), aesthetic changes (46.7%), and lack of support from family and friends (37.5%). In multivariate analysis, RSES score was higher (better SE) in participants with higher educational level (B = 0.

XXXIX Congresso Brasileiro de Reumatologia

BACKGROUND In 2018, 1,050,945 aesthetic plastic surgeries (AePS) were performed in Brazil. Data o... more BACKGROUND In 2018, 1,050,945 aesthetic plastic surgeries (AePS) were performed in Brazil. Data on the intention to do and the performance of AePS among people with inflammatory rheumatic diseases (IRDs) are scarce in the literature. This work aims to describe the frequency and types of AePS most commonly performed, the desire and motivations for AePS, and the reasons for not undergoing AePS procedures among IRD patients.

SBR 2021 Congresso Brasileiro de Reumatologia, 2021

BACKGROUND As survival rate among patients with systemic lupus erythematosus (SLE) improves, the ... more BACKGROUND As survival rate among patients with systemic lupus erythematosus (SLE) improves, the risk of cancer also increases. Also, recent studies suggest a higher risk of some cancers' development in these individuals when compared to the general population. On the other hand, SLE patients seem to be less likely to undergo appropriate screening. Therefore, the present study aimed to evaluate lupus patient's awareness about most common cancers.

Anais do Congresso Brasileiro de Reumatologia 2020, 2021

BACKGROUND Since March 2020, the novel coronavirus disease (COVID-19) pandemic forced the adoptio... more BACKGROUND Since March 2020, the novel coronavirus disease (COVID-19) pandemic forced the adoption of restrictive measures to protect susceptible people and interrupt the transmission route. Considering social networks as a powerful source of information and that lupus patients have higher risk of infections, we present two projects of health education for lupus patients to provide useful information about the COVID-19 pandemic.

Lupus, 2020

Objective To investigate the effect of cosmetic camouflage in health-related quality of life (HRQ... more Objective To investigate the effect of cosmetic camouflage in health-related quality of life (HRQoL) in women with systemic lupus erythematosus (SLE) and permanent facial skin damage. Methods This is a randomized controlled clinical trial (Universal Trial Number: U1111-1210-2554e) with SLE women from outpatients using ACR/1997 and/or SLICC/2012 criteria, aged over 18 years old, with modified SLEDAI 2k < 4 and permanent facial skin damage, recruited in two tertiary centers to use cosmetic camouflage (n = 36) or no intervention (n = 20). Endpoints were score variations in SLE Quality of Life (SLEQoL) (total and each domain), Dermatology Life Quality Index (DLQI), Rosenberg self-esteem scale and Hospital Anxiety and Depression Scale (HADS), after daily use of cosmetic camouflage for 12 +/−2 weeks (Phase I), “as needed” use of cosmetic camouflage for another 12 +/−2 weeks (Phase II), and during total follow up (24 +/−2 weeks). Univariate and multivariate linear regressions were condu...

Blucher Medical Proceedings, 2019

Blucher Medical Proceedings, 2019

Lupus, 2018

Objectives To evaluate the incidence and variability of traditional coronary artery disease (CAD)... more Objectives To evaluate the incidence and variability of traditional coronary artery disease (CAD) risk factors in a cohort of lupus patients and to investigate if prednisone use predicts an increase in the number of risk factors. Methods A total of 151 women, 37.8 ± 11.1 (mean ± SD) years old at baseline, were reevaluated after a median period of 39 (interquartile range 36.5–42.0) months. The cumulative incidence of traditional risk factors, the incidence rate (with 95% confidence interval) of hypertension, diabetes, dyslipidemia and hypertriglyceridemia, and the frequency of the risk factors’ disappearance were calculated. Metabolic syndrome (MetS) and Framingham risk score (FRS) were computed. Logistic regression was used to investigate if maximum or cumulative prednisone dose used during follow-up predicted an increase in the cardiometabolic risk factors’ number. Results The cumulative incidence of risk factors varied from 39.1% (abdominal obesity) to zero (smoking), and the inci...

Annals of the Rheumatic Diseases, 2016

Revista Brasileira de Reumatologia, 2017

Introdução: Estudos têm mostrado que os ácidos graxos ômega-3 reduzem as concentraç ões de eicosa... more Introdução: Estudos têm mostrado que os ácidos graxos ômega-3 reduzem as concentraç ões de eicosanoides, citocinas, quimiocinas, proteína C-reativa (PCR) e outros mediadores inflamatórios. Objetivo: Investigar os efeitos dos ácidos graxos ômega-3 sobre os níveis circulantes de mediadores inflamatórios e marcadores bioquímicos em mulheres com lúpus eritematoso sistêmico (LES). Métodos: Ensaio clínico randomizado (ensaio clínico: NCT02524795); randomizaram-se 49 mulheres com LES (ACR1982/1997): 22 para o grupo ômega-3 (dose diária de 1.080 mg de EPA + 200 mg de DHA durante 12 semanas) e 27 para o grupo controle. Os mediadores inflamatórios e marcadores bioquímicos em T0 e T1 no grupo ômega-3 foram comparados pelo teste de Wilcoxon. O teste U de Mann-Whitney foi usado para comparar variaç ões das variáveis mensuradas [ V = concentraç ões pré-tratamento (T0) menos concentraç ões pós-tratamento (T1)] entre os grupos. Um p < 0,05 foi considerado significativo. Resultados: A mediana (intervalo interquartil-IIQ) da idade foi de 37 anos (29-48), a duração da doença foi de sete anos (4-13) anos e o Systemic Lupus Disease Activity Index (Sledai-2 K) foi de 1 (0-2). A mediana (IIQ) da variação nos níveis de PCR entre os dois grupos mostrou um decréscimo no grupo ômega-3, enquanto houve um aumento no grupo controle (p = 0,008). As concentraç ões séricas de IL-6 e IL-10, leptina e adiponectina não se alteraram após um tratamento de 12 semanas.

Revista Médica de Minas Gerais, 2015

Introduction: studies on chronic diseases highlight the importance of patient education to promot... more Introduction: studies on chronic diseases highlight the importance of patient education to promote adherence to treatment and improve prognosis. Objective: to know the main questions from patients with systemic lupus erythematosus (LES) as a starting point for the preparation of a Patient Education Program. Method: this was a descriptive and cross-sectional study. For six weeks, LES patients treated at the Rheumatology Department of the General Hospital wrote their questions about the disease in a white sheet and placed it in a box. Results: 260 consultations were analyzed and 111 sheets were completed, totaling 393 questions with an average of 3.54 questions per patient, which were classified into nine categories: treatment and prevention (18.8%); clinical framework and diagnostic (18.3%); etiology and pathophysiology (17.0%); prognosis and progression (16.3%); concept and epidemiology of the disease (8.1%); general guidelines (6.1%); contraception, pregnancy, and fertility (7.4%); psychological aspects and sexuality (6.9%); and excluded questions (1%). Conclusion: it was observed that most of the questions reflected themes often approached during medical consultations. Communication between the doctor, healthcare team, and patient needs to improve, and one strategy would be the development of a patient education program.

Annals of the Rheumatic Diseases, 2015

Background Adipokines, tumor necrosis factor α(TNFα)and its receptors, participate in the regulat... more Background Adipokines, tumor necrosis factor α(TNFα)and its receptors, participate in the regulation of the immune system and inflammation in immune disease (1). The role and interactions between those cytokines and systemic lupus erythematosus (SLE) characteristics and treatment is poorly studied and understood. Objectives To analyze the association of adipokines and TNFα and its receptors with clinical, laboratory and treatment-related manifestations of SLE, and to investigate the correlation between adipokines and the TNF system. Methods A 136 women with SLE, aged >18 years old, were included in this cross-sectional study. Disease activity was measured by modified SLEDAI-2K and irreversible cumulative damage by SLICC-ACR damage index. Serum concentrations of TNFα, soluble TNFα receptors 1 (sTNFR1) and 2 (sTNFR2) and adipokines were analyzed by ELISA kits. Results The median of age was 41.5 (33.0-49.7) years old and of disease duration was 11.3 (7.8-15.8) years. 105 (77.2%) participants were nonwhite and 67 (49.3%) were postmenopausal. The median of cumulative dose of prednisone was 36.5 (22.9-51.1) g, and of daily dose of prednisone was 5.0 (0.0-10.0) mg/day. The median of disease activity and of damage index scores were 0 (0-4) and 2 (1-3). Higher levels of sTNFR1 and sTNFR2 were associated with nephritis (p<0.001 for both), and concentrations of sTNFR1 and TNFα were positively associated with arthritis (p=0.025 and p=0.014). Higher sTNFR1 levels were found in participants that were not using antimalarial drugs (p=0.04). Independent correlation was found between sTNFR1 and sTNFR2 levels and disease activity (sTNFR1: β=0.253; p=0.003; sTNFR2: β=0.297; p<0.001) and damage index (sTNFR1: β=0.367; p<0.001; sTNFR2: β=0.335; p<0.001). Regarding serum concentrations of adipokines, creatinine clearance was inversely correlated with resistin levels (rs= -0.219; p=0.011) and higher leptin concentrations were associated with azathioprine use (not using: 1.71ng/ml versus using: 1.93mg/ml; p=0.013). Higher adiponectin levels were independent associated with nephritis (p=0.009) and use of antimalarial drugs (p=0.015). There was a positive correlation between leptin and sTNFR2 levels (rs=0.414; p=0.002) and between resistin levels and sTNFR1 (rs=0.489; p<0.001) and sTNFR2 (rs=0.298; p<0.001). Conclusions TNFα, its receptors and adipokines were associated with arthritis and nephritis. Higher levels of sTNFR1 were correlated with lupus global activity and organ damage, suggesting that this could be used as a marker of disease activity and prognosis. Resistin and leptin were associated with higher TNF receptors concentrations. The correlation between adipokines and TNF system allows a better understanding of the role of adipokines in the inflammatory response in SLE patients. References Su DL, Lu ZM, Shen MN, Li X, Sun LY. Roles of pro-and anti-inflammatory cytokines in the pathogenesis of SLE. J Biomed Biotechnol 2012:347-141. Disclosure of Interest None declared

Imaging and radiation research, Apr 22, 2007

Introduction: the presence of anti-CCP is an important prognostic tool for rheumatoid arthritis (... more Introduction: the presence of anti-CCP is an important prognostic tool for rheumatoid arthritis (RA), but its relationship with the activity of the disease and functional capacity is still being investigated. Objectives: to study the relationship between anti-CCP and the indices of disease activity, functional capacity and structural damage, by means of conventional radiography (CR) and magnetic resonance imaging (MRI), in stabilized RA. Methods: cross-sectional study of RA patients with one to 10 years of disease. The participants were subjected to clinical evaluation with anti-CCP screening. Disease activity was assessed by means of the Clinical Disease Activity Index (CDAI) and functional capacity by means of the Health Assessment Questionnaire (HAQ). CR was analyzed by the Sharp van der Heijde index (SmvH) and MRI by the Rheumatoid Arthritis Magnetic Resonance Image Scoring System (RAMRIS). Results: 56 patients were evaluated, with median (IIq) of 55 (47.5-60.0) years, 50 (89.3%) were female among whom 37 (66.1%) were positive for anti-CCP. The median (IIq) of CDAI, HAQ, SmvH and RAMRIS were 14.75 (5.42-24.97), 1.06 (0.28-1.75), 2 (0-8) and 15 (7-35), respectively. There was no association between anti-CCP and CDAI, HAQ, SmvH and RAMRIS. Conclusion: our results did not establish the association of anti-CCP with the severity of the disease. So far, we cannot corroborate the anti-CCP as a prognostic tool in RA established.

Clinical and Experimental Rheumatology, Nov 26, 2021

Lupus, Jul 11, 2016

To analyze the association of adipokines and tumor necrosis factor α (TNFα) and its receptors wit... more To analyze the association of adipokines and tumor necrosis factor α (TNFα) and its receptors with characteristics of systemic lupus erythematosus (SLE) and to investigate the correlation between adipokines and the TNF system. One hundred and thirty-six SLE women, aged ≥18 years old, were assessed. TNFα, soluble TNFα receptors 1 (sTNFR1) and 2 (sTNFR2) and adipokines were analyzed by ELISA kits. The median (IQR) of age was 41.5 (33.0-49.7) years old and of disease duration 11.3 (7.8-15.8) years. The median (IQR) of disease activity was 0 (0-4) and of damage index was 2 (1-3). Higher levels of sTNFR1 and sTNFR2 were associated with nephritis (p &amp;amp;lt; 0.001 for both), and sTNFR1 (p = 0.025) and TNFα (p = 0.014) were positively associated with arthritis. Higher sTNFR1 levels were found in participants that were not using antimalarial drugs (p = 0.04). Independent correlation was found between sTNFR1 (β = 0.253; p = 0.003) and sTNFR2 (β = 0.297; p &amp;amp;lt; 0.001) levels and disease activity and damage index (sTNFR1: β = 0.367; p &amp;amp;lt; 0.001; sTNFR2: β = 0.335; p &amp;amp;lt; 0.001). Higher adiponectin levels were independently associated with nephritis (p = 0.009) and antimalarial drugs use (p = 0.015). There was a positive correlation between leptin and sTNFR2 levels (p = 0.002) and between resistin levels and sTNFR1 (p &amp;amp;lt; 0.001) and sTNFR2 (p &amp;amp;lt; 0.001). The correlation between adipokines and TNF system allows a better understanding of the role of adipokines in the inflammatory response in SLE patients.

Cardiology in The Young, Oct 1, 2003

In order prospectively to investigate the frequency and evolution of subclinical valvitis, we sel... more In order prospectively to investigate the frequency and evolution of subclinical valvitis, we selected 40 consecutive patients suffering their initial attack of rheumatic fever, seen in our clinic from 1992 to 1994, and followed-up until 2001, with a mean period of follow-up of 8.1 years, and a standard deviation of 0.6 year. We also assembled a matched control group of 37 healthy children and adolescents. We discovered a murmur of mitral regurgitation in 28 (70.0%) of the patients. In 3 (7.5%) of these patients, there was also a murmur of aortic regurgitation. In the group of 28 symptomatic patients, Doppler echocardiography showed mitral regurgitation in all, and aortic regurgitation in 17. In the group of 12 patients without clinical evidence of cardiac involvement, Doppler echocardiography identified mitral regurgitation in 2, isolated in one and associated with aortic regurgitation in the other. Thus, the frequency of subclinical valvitis was 16.7%. In patients with subclinical valvitis only the aortic regurgitation regressed during the period of follow-up. In the group of 28 symptomatic patients, mitral regurgitation disappeared in 6 (21.4%), aortic regurgitation in 7 of the 17 having this feature (41.2%), while 2 patients (7.1%) developed mitral stenosis. The sensitivity and specificity of cardiac auscultation were, respectively, 93.3%, with 95% confidence intervals between 72.3% and 97.4%, and 100%, with 95% confidence intervals between 65.5% and 100%, for the diagnosis of mitral regurgitation, and 16.7%, with 95% confidence intervals between 4.4% and 42.3%, and 100%, with 95% confidence intervals between 81.5% and 100%, for that of aortic regurgitation. We conclude that the Doppler echocardiogram is an important means of diagnosing and assessing the evolution of subclinical rheumatic valvar lesions, which are not always transient. We suggest that Doppler echocardiography should be performed in all patients with acute rheumatic fever. Subclinical valvitis should be considered as mild carditis, provided that strict criterions are observed in the differential diagnosis from physiological regurgitation, and Doppler echocardiographic findings are analyzed in the context of the other manifestations of the disease.

Revista Médica de Minas Gerais, 2021

Relato de Caso O lipoma arborescente é uma causa incomum de lesão intra-articular que se apresent... more Relato de Caso O lipoma arborescente é uma causa incomum de lesão intra-articular que se apresenta como aumento de volume articular indolor, lentamente progressivo, que persiste por muitos anos e é acompanhado por derrames articulares intermitentes. O envolvimento de sítios extra-articulares é incomum, mas pode ocorrer em bainhas tendíneas e bursas. A ressonância magnética é o melhor exame para o diagnóstico, embora a biópsia sinovial possa ser necessária em alguns casos. Relatamos três casos com o objetivo de destacar o espectro clínico da doença, as características da imagem e a resposta ao tratamento imunossupressor. Palavras-chave: Lipoma arborescente; Lipomatose sinovial; Ressonância magnética; Membrana sinovial; Artropatia crônica. RESUMO Lipoma Arborescens: a cause of chronic synovitis? Lipoma arborescens is an uncommon cause of intra-articular masses that presents as slowly progressive painless swelling of the joint, which persists for many years and is accompanied by intermittent effusions. Extra-articular site(s) involvement is unusual, but can occur in tendon sheaths and bursas. Magnetic resonance imaging is the best diagnostic exam, although synovial biopsy may be necessary. We report three cases in order to highlight the clinical spectrum and imaging features of the disease, so that early diagnosis and appropriate treatment can be given.

XXXIX Congresso Brasileiro de Reumatologia

BACKGROUND In systemic lupus erythematosus (SLE) patients, discoid lesions may leave definitive s... more BACKGROUND In systemic lupus erythematosus (SLE) patients, discoid lesions may leave definitive scars such as atrophy, hyperpigmentation, and depigmentation, which are emotionally devastating, as they increase psychological burden of the disease and negatively impacts on health-related quality of life. Cosmetic camouflage has been integrated into medical practice to help patients disguise congenital or acquired disfigurements that are not amenable to medical or surgical treatment. Training is essential in camouflage therapy, once the application and adherence processes are different from regular makeup foundations. We aimed to present a stepby-step video produced to teach how to do cosmetic camouflage, through a QR code access. METHODS A signed authorization for image use was obtained. A video teaching the techniques of cosmetic camouflage was produced, as part of a University Extension Project, by a skillful makeup artist, a dermatology fellow, a lupus patient, medical students and rheumatology professors. After publication in the social media, patients will be able to interact with the staff to solve issues.

XXXIX Congresso Brasileiro de Reumatologia

BACKGROUND Self-esteem (SE) can be defined as the individual perception of being close or far fro... more BACKGROUND Self-esteem (SE) can be defined as the individual perception of being close or far from his/her ideal self, according to his/her values and beliefs. Rheumatic diseases (RDs) can negatively impact SE due to functional limitations and aesthetic impairment. This work aims to describe SE in patients with RD and assess the factors associated with SE in RD individuals. METHODS This is a cross-sectional, web-based survey for adult individuals reporting RDs. The study questionnaire was hosted on the Google Forms platform. SE was evaluated by applying the Rosenberg Self-Esteem Scale (RSES). The questionnaire also included questions about sociodemographic data, comorbidities, psychiatric disorders, and RD diagnosis (more than one diagnosis was allowed), and assessed self-reported RDs activity through the visual analogic scale (VAS). Factors associated with SE in RD patients were investigated. Descriptive analysis and associations are shown, with multivariate analyses using linear regressions. RESULTS The study presents data on 2,020 responses. Most (96.1%) responders were women, with a mean age of 40.8 (SD = 10.8) years. The most-reported RD were fibromyalgia (33.4%) and systemic lupus erythematosus (25.9%). Mean RSES was 27 (SD = 5.9), and 791 (21%) participants presented low SE according to RSES score ≤ 25. Most (94%) participants checked the following RD associated factors as SE determinants (more than one allowed): mood changes (68.5%), functional limitation (68.1%), side effects of medications (47.4%), aesthetic changes (46.7%), and lack of support from family and friends (37.5%). In multivariate analysis, RSES score was higher (better SE) in participants with higher educational level (B = 0.

XXXIX Congresso Brasileiro de Reumatologia

BACKGROUND In 2018, 1,050,945 aesthetic plastic surgeries (AePS) were performed in Brazil. Data o... more BACKGROUND In 2018, 1,050,945 aesthetic plastic surgeries (AePS) were performed in Brazil. Data on the intention to do and the performance of AePS among people with inflammatory rheumatic diseases (IRDs) are scarce in the literature. This work aims to describe the frequency and types of AePS most commonly performed, the desire and motivations for AePS, and the reasons for not undergoing AePS procedures among IRD patients.

SBR 2021 Congresso Brasileiro de Reumatologia, 2021

BACKGROUND As survival rate among patients with systemic lupus erythematosus (SLE) improves, the ... more BACKGROUND As survival rate among patients with systemic lupus erythematosus (SLE) improves, the risk of cancer also increases. Also, recent studies suggest a higher risk of some cancers' development in these individuals when compared to the general population. On the other hand, SLE patients seem to be less likely to undergo appropriate screening. Therefore, the present study aimed to evaluate lupus patient's awareness about most common cancers.

Anais do Congresso Brasileiro de Reumatologia 2020, 2021

BACKGROUND Since March 2020, the novel coronavirus disease (COVID-19) pandemic forced the adoptio... more BACKGROUND Since March 2020, the novel coronavirus disease (COVID-19) pandemic forced the adoption of restrictive measures to protect susceptible people and interrupt the transmission route. Considering social networks as a powerful source of information and that lupus patients have higher risk of infections, we present two projects of health education for lupus patients to provide useful information about the COVID-19 pandemic.

Lupus, 2020

Objective To investigate the effect of cosmetic camouflage in health-related quality of life (HRQ... more Objective To investigate the effect of cosmetic camouflage in health-related quality of life (HRQoL) in women with systemic lupus erythematosus (SLE) and permanent facial skin damage. Methods This is a randomized controlled clinical trial (Universal Trial Number: U1111-1210-2554e) with SLE women from outpatients using ACR/1997 and/or SLICC/2012 criteria, aged over 18 years old, with modified SLEDAI 2k < 4 and permanent facial skin damage, recruited in two tertiary centers to use cosmetic camouflage (n = 36) or no intervention (n = 20). Endpoints were score variations in SLE Quality of Life (SLEQoL) (total and each domain), Dermatology Life Quality Index (DLQI), Rosenberg self-esteem scale and Hospital Anxiety and Depression Scale (HADS), after daily use of cosmetic camouflage for 12 +/−2 weeks (Phase I), “as needed” use of cosmetic camouflage for another 12 +/−2 weeks (Phase II), and during total follow up (24 +/−2 weeks). Univariate and multivariate linear regressions were condu...

Blucher Medical Proceedings, 2019

Blucher Medical Proceedings, 2019

Lupus, 2018

Objectives To evaluate the incidence and variability of traditional coronary artery disease (CAD)... more Objectives To evaluate the incidence and variability of traditional coronary artery disease (CAD) risk factors in a cohort of lupus patients and to investigate if prednisone use predicts an increase in the number of risk factors. Methods A total of 151 women, 37.8 ± 11.1 (mean ± SD) years old at baseline, were reevaluated after a median period of 39 (interquartile range 36.5–42.0) months. The cumulative incidence of traditional risk factors, the incidence rate (with 95% confidence interval) of hypertension, diabetes, dyslipidemia and hypertriglyceridemia, and the frequency of the risk factors’ disappearance were calculated. Metabolic syndrome (MetS) and Framingham risk score (FRS) were computed. Logistic regression was used to investigate if maximum or cumulative prednisone dose used during follow-up predicted an increase in the cardiometabolic risk factors’ number. Results The cumulative incidence of risk factors varied from 39.1% (abdominal obesity) to zero (smoking), and the inci...

Annals of the Rheumatic Diseases, 2016

Revista Brasileira de Reumatologia, 2017

Introdução: Estudos têm mostrado que os ácidos graxos ômega-3 reduzem as concentraç ões de eicosa... more Introdução: Estudos têm mostrado que os ácidos graxos ômega-3 reduzem as concentraç ões de eicosanoides, citocinas, quimiocinas, proteína C-reativa (PCR) e outros mediadores inflamatórios. Objetivo: Investigar os efeitos dos ácidos graxos ômega-3 sobre os níveis circulantes de mediadores inflamatórios e marcadores bioquímicos em mulheres com lúpus eritematoso sistêmico (LES). Métodos: Ensaio clínico randomizado (ensaio clínico: NCT02524795); randomizaram-se 49 mulheres com LES (ACR1982/1997): 22 para o grupo ômega-3 (dose diária de 1.080 mg de EPA + 200 mg de DHA durante 12 semanas) e 27 para o grupo controle. Os mediadores inflamatórios e marcadores bioquímicos em T0 e T1 no grupo ômega-3 foram comparados pelo teste de Wilcoxon. O teste U de Mann-Whitney foi usado para comparar variaç ões das variáveis mensuradas [ V = concentraç ões pré-tratamento (T0) menos concentraç ões pós-tratamento (T1)] entre os grupos. Um p < 0,05 foi considerado significativo. Resultados: A mediana (intervalo interquartil-IIQ) da idade foi de 37 anos (29-48), a duração da doença foi de sete anos (4-13) anos e o Systemic Lupus Disease Activity Index (Sledai-2 K) foi de 1 (0-2). A mediana (IIQ) da variação nos níveis de PCR entre os dois grupos mostrou um decréscimo no grupo ômega-3, enquanto houve um aumento no grupo controle (p = 0,008). As concentraç ões séricas de IL-6 e IL-10, leptina e adiponectina não se alteraram após um tratamento de 12 semanas.

Revista Médica de Minas Gerais, 2015

Introduction: studies on chronic diseases highlight the importance of patient education to promot... more Introduction: studies on chronic diseases highlight the importance of patient education to promote adherence to treatment and improve prognosis. Objective: to know the main questions from patients with systemic lupus erythematosus (LES) as a starting point for the preparation of a Patient Education Program. Method: this was a descriptive and cross-sectional study. For six weeks, LES patients treated at the Rheumatology Department of the General Hospital wrote their questions about the disease in a white sheet and placed it in a box. Results: 260 consultations were analyzed and 111 sheets were completed, totaling 393 questions with an average of 3.54 questions per patient, which were classified into nine categories: treatment and prevention (18.8%); clinical framework and diagnostic (18.3%); etiology and pathophysiology (17.0%); prognosis and progression (16.3%); concept and epidemiology of the disease (8.1%); general guidelines (6.1%); contraception, pregnancy, and fertility (7.4%); psychological aspects and sexuality (6.9%); and excluded questions (1%). Conclusion: it was observed that most of the questions reflected themes often approached during medical consultations. Communication between the doctor, healthcare team, and patient needs to improve, and one strategy would be the development of a patient education program.

Annals of the Rheumatic Diseases, 2015

Background Adipokines, tumor necrosis factor α(TNFα)and its receptors, participate in the regulat... more Background Adipokines, tumor necrosis factor α(TNFα)and its receptors, participate in the regulation of the immune system and inflammation in immune disease (1). The role and interactions between those cytokines and systemic lupus erythematosus (SLE) characteristics and treatment is poorly studied and understood. Objectives To analyze the association of adipokines and TNFα and its receptors with clinical, laboratory and treatment-related manifestations of SLE, and to investigate the correlation between adipokines and the TNF system. Methods A 136 women with SLE, aged >18 years old, were included in this cross-sectional study. Disease activity was measured by modified SLEDAI-2K and irreversible cumulative damage by SLICC-ACR damage index. Serum concentrations of TNFα, soluble TNFα receptors 1 (sTNFR1) and 2 (sTNFR2) and adipokines were analyzed by ELISA kits. Results The median of age was 41.5 (33.0-49.7) years old and of disease duration was 11.3 (7.8-15.8) years. 105 (77.2%) participants were nonwhite and 67 (49.3%) were postmenopausal. The median of cumulative dose of prednisone was 36.5 (22.9-51.1) g, and of daily dose of prednisone was 5.0 (0.0-10.0) mg/day. The median of disease activity and of damage index scores were 0 (0-4) and 2 (1-3). Higher levels of sTNFR1 and sTNFR2 were associated with nephritis (p<0.001 for both), and concentrations of sTNFR1 and TNFα were positively associated with arthritis (p=0.025 and p=0.014). Higher sTNFR1 levels were found in participants that were not using antimalarial drugs (p=0.04). Independent correlation was found between sTNFR1 and sTNFR2 levels and disease activity (sTNFR1: β=0.253; p=0.003; sTNFR2: β=0.297; p<0.001) and damage index (sTNFR1: β=0.367; p<0.001; sTNFR2: β=0.335; p<0.001). Regarding serum concentrations of adipokines, creatinine clearance was inversely correlated with resistin levels (rs= -0.219; p=0.011) and higher leptin concentrations were associated with azathioprine use (not using: 1.71ng/ml versus using: 1.93mg/ml; p=0.013). Higher adiponectin levels were independent associated with nephritis (p=0.009) and use of antimalarial drugs (p=0.015). There was a positive correlation between leptin and sTNFR2 levels (rs=0.414; p=0.002) and between resistin levels and sTNFR1 (rs=0.489; p<0.001) and sTNFR2 (rs=0.298; p<0.001). Conclusions TNFα, its receptors and adipokines were associated with arthritis and nephritis. Higher levels of sTNFR1 were correlated with lupus global activity and organ damage, suggesting that this could be used as a marker of disease activity and prognosis. Resistin and leptin were associated with higher TNF receptors concentrations. The correlation between adipokines and TNF system allows a better understanding of the role of adipokines in the inflammatory response in SLE patients. References Su DL, Lu ZM, Shen MN, Li X, Sun LY. Roles of pro-and anti-inflammatory cytokines in the pathogenesis of SLE. J Biomed Biotechnol 2012:347-141. Disclosure of Interest None declared

Imaging and radiation research, Apr 22, 2007

Introduction: the presence of anti-CCP is an important prognostic tool for rheumatoid arthritis (... more Introduction: the presence of anti-CCP is an important prognostic tool for rheumatoid arthritis (RA), but its relationship with the activity of the disease and functional capacity is still being investigated. Objectives: to study the relationship between anti-CCP and the indices of disease activity, functional capacity and structural damage, by means of conventional radiography (CR) and magnetic resonance imaging (MRI), in stabilized RA. Methods: cross-sectional study of RA patients with one to 10 years of disease. The participants were subjected to clinical evaluation with anti-CCP screening. Disease activity was assessed by means of the Clinical Disease Activity Index (CDAI) and functional capacity by means of the Health Assessment Questionnaire (HAQ). CR was analyzed by the Sharp van der Heijde index (SmvH) and MRI by the Rheumatoid Arthritis Magnetic Resonance Image Scoring System (RAMRIS). Results: 56 patients were evaluated, with median (IIq) of 55 (47.5-60.0) years, 50 (89.3%) were female among whom 37 (66.1%) were positive for anti-CCP. The median (IIq) of CDAI, HAQ, SmvH and RAMRIS were 14.75 (5.42-24.97), 1.06 (0.28-1.75), 2 (0-8) and 15 (7-35), respectively. There was no association between anti-CCP and CDAI, HAQ, SmvH and RAMRIS. Conclusion: our results did not establish the association of anti-CCP with the severity of the disease. So far, we cannot corroborate the anti-CCP as a prognostic tool in RA established.