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- ItemAcesso aberto (Open Access)Adaptação transcultural do EULAR Sjögren's Syndrome Disease Activity Index (ESSDAI) para a língua portuguesa(Sociedade Brasileira de Reumatologia, 2013-12-01) Serrano, Erica Vieira; Valim, Valeria [UNIFESP]; Miyamoto, Samira Tatiyama [UNIFESP]; Giovelli, Raquel Altoé; Paganotti, Maurício Aquino; Cadê, Nágela Valadão; Universidade Federal do Espírito Santo Programa de Pós-graduação em Saúde Coletiva; Santa Casa de Misericórdia de Vitória Escola Superior de Ciências Departamento de Clínica Médica; Hospital Universitário Cassiano Antônio de Moraes; Universidade Federal de São Paulo (UNIFESP); Universidade Federal do Espírito Santo Departamento de Clínica Médica; Hospital Universitário Cassiano Antônio de Moraes Ambulatório de Reumatologia; Universidade Federal do Espírito Santo; Universidade Federal do Espírito Santo Programa de Mestrado Profissional de Medicina; Universidade de Vila Velha Programa de Pós-Graduação em Ciências Farmacêuticas; Universidade de São Paulo (USP)INTRODUCTION: The EULAR Sjögren's Syndrome Disease Activity Index (ESSDAI) is an index of primary Sjögren's syndrome (PSS) systemic activity. OBJECTIVE: To perform the ESSDAI transcultural adaptation into Brazilian Portuguese. METHOD: This was a cross-sectional study with 62 patients with PSS according to the criteria of the 2002 American-European Consensus. Six stages were conducted: conceptual, item, semantic, operational, functional, and measurement equivalences (interobserver reproducibility and construct validity). For the validity assessment, the ESSDAI was compared with the Physician's Global Assessment (PhGA), the Sjögren's Syndrome Disease Activity Index (SSDAI), and the Sjögren's Systemic Clinical Activity Index (SCAI). Patients were classified by a specialist physician into two groups according to disease activity (active and inactive), and according to the intention-to-treat (increase in therapy and no increase in therapy). The ESSDAI was tested in these groups. The following statistical tests were used: intraclass correlation coefficient (ICC), Bland-Altman plot for reproducibility, and Spearman's correlation coefficient (r s) and Mann-Whitney's test for validity (P < 0.05 and 95% CI). RESULTS: The mean ESSDAI score was 4.95 ± 6.73. The reproducibility obtained a strong ICC of 0.89 and good agreement. When compared with other indices, it showed a strong r s with PhGA (0.83; P < 0.000), a moderate r s with SSDAI (0.658; P < 0.000) and a weak r s with the SCAI (0.411; P = 0.001). The group active and the groupincrease in therapy had higher ESSDAI values (P = 0.000). CONCLUSION: The Brazilian Portuguese version of ESSDAI was shown to be adaptable, reproducible, and valid for this language.
- ItemAcesso aberto (Open Access)Assessment of fatigue and dryness in primary Sjogren's syndrome: Brazilian version of Profile of Fatigue and Discomfort - Sicca Symptoms Inventory (short form) (PROFAD-SSI-SF)(Elsevier B.V., 2015-03-01) Miyamoto, Samira Tatiyama [UNIFESP]; Paganotti, Mauricio Aquino; Serrano, Erica Vieira; Giovelli, Raquel Altoé; Valim, Valeria [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Univ Fed Espirito Santo; Univ Vila Velha; Escola Super CienciasObjective: To perform a cross-cultural adaptation and validation of the Profile of Fatigue and Discomfort - Sicca Symptoms Inventory (short form) (PROFAD-SSI-SF) questionnaire assessing the subjective aspects of the symptoms of primary Sjogren syndrome (pSS), for the Brazilian Portuguese language.Method: Conceptual, of the item, semantic and operational equivalences were evaluated. the Brazilian version of PROFAD-SSI-SF was administered to 62 women with pSS according to the European-American consensus 2002 to assess measurement equivalence. alpha-Cronbach was used for internal consistency; intraclass correlation coefficient (ICC) for intraobserver reproducibility; and Spearman correlation coefficient for validity by comparing with Patient Global Assessment (PaGA), EULAR Sjogren's Syndrome Patient Reported Index (ESSPRI), Functional Assessment of Chronic Illness Therapy Fatigue Subscale (FACIT-F) and EuroQOL (EQ-5D).Results: the internal consistency of PROFAD, SSI and total score was 0.80; 0.78; and 0.87, respectively. the intraobserver reproducibility of total PROFAD was 0.89; of total SSI of 0.86; and total score of 0.89. in terms of validity, PROFAD correlated significantly with PaGA (r = 0.50), FACIT-F (r = 0.59), ESSPRI (r = 0.58) and all domains of EQ-5D, with the exception of Mobility. On the other hand, SSI correlated significantly with PaGA (r = 0.43), FACIT-F (r = 0.57), ESSPRI (r = 0.55) and most areas of EQ-5D. the total score of PROFAD-SSI-SF had a non-statistically significant correlation only with Mobility domain and with 1-100 range of EQ-5D.Conclusion: the Portuguese version of PROFAD-SSI-SF proved to be an adaptable, reproducible and valid tool for the Brazilian Portuguese language. (C) 2014 Elsevier Editora Ltda. All rights reserved.
- ItemAcesso aberto (Open Access)Avaliação dos efeitos da Relaxina exógena sobre olho seco em modelo de síndrome de Sjögren (SjS)(Universidade Federal de São Paulo, 2022-12-12) Carvalho, Lucimeire Nova de [UNIFESP]; Gomes, José Álvaro Pereira [UNIFESP]; Miotto, Priscila Cardoso Cristovam [UNIFESP]; http://lattes.cnpq.br/4581855390314828; http://lattes.cnpq.br/2506247984223015; https://lattes.cnpq.br/3924454300822046O objetivo deste trabalho foi avaliar o potencial da relaxina (RLX) no tratamento da doença do olho seco (DOS) em modelo experimental animal com SjS. Métodos Camundongos NOD diagnosticados com SjS foram tratados durante trinta dias, 4x/dia, com colírio a base de RLX (100ng/ml). Os animais foram submetidos à análise clínica para verificar a produção lacrimal e a ceratite antes, durante e após o tratamento. Tecidos oculares, glândulas de Meibomius, glândula lacrimal exorbitária e glândula de Harder foram retirados e submetidos a diferentes técnicas. As glândulas lacrimais (GL) foram analisadas por PCR array para verificar as citocinas inflamatórias IL-1b, IL-6, IL-10, IL-12a, IL-17a, TNFα e INFϒ e também RLX e RXFP1. A técnica da imunofluorescência foi usada para detecção do hormônio RLX e seu receptor RXFP1 nos órgãos citados e análise histológica foi empregada para verificar possíveis diferenças entre os órgãos citados anteriormente. Resultados: O grupo tratado apresentou melhora significativa em todos os aspectos clínicos analisados, como aumento da produção lacrimal, reversão da ceratite, inclusive no olho que não recebeu o tratamento (contralateral). Todos os tecidos analisados mostraram marcação positiva para a RLX e seu receptor (RXFP1). Quando verificado o aumento na expressão da RLX e RXFP1, o grupo tratado com RLX mostrou um aumento significante na expressão gênica em relação aos demais grupos. Ainda por RT-PCR, as análises das citocinas IL1b, IL-6, IL-12, IL-17 e TNF estavam significantemente menores no grupo tratado em relação aos demais. Conclusão: Esses resultados sugerem que a RLX exógena apresenta potencial ação no tratamento da DOS, podendo ser usada em forma de colírio, uma vez que houve melhora no quadro clínico e diminuição das citocinas inflamatórias típicas da DOS por SjS.
- ItemAcesso aberto (Open Access)Correlação entre sinais e sintomas de olho seco em pacientes portadores da síndrome de Sjögren(Conselho Brasileiro de Oftalmologia, 2008-08-01) Barboza, Marcello Novoa Colombo; Barboza, Guilherme Novoa Colombo; Melo, Gustavo Mendonça de; Sato, Elcio Hideo [UNIFESP]; Dantas, Maria Cristina Nishiwaki; Dantas, Paulo Elias Correa; Felberg, Sérgio; Santa Casa de Misericórdia de São Paulo; Universidade Federal de São Paulo (UNIFESP); Santa Casa de Misericórdia de São Paulo Departamento de OftalmologiaPURPOSE: To study the correlation between the signals and symptoms of dry eye in Sjögren's syndrome patients. METHODS: We formed the case group with 17 Sjögren's syndrome patients and the control group with 25 normal patients. For evaluation of the symptoms the Ocular Surface Disease Index (OSDI) questionnaire was applied to both groups and, after that, all the individuals were submitted to the ocular tests: Schirmer I and II, coloration of the ocular surface with rose bengal, pachymetry and esthesiometry. Spearman's correlation test was used to analyze the correlations between signals and symptoms and Student's t test for independent samples was used for comparison of the averages of the values found by the Ocular Surface Disease Index (OSDI) questionnaire and the ocular tests between the patients of the groups. RESULTS: This study had evidenced a weak correlation between Ocular Surface Disease Index (OSDI) symptoms and ocular tests, which it indicates that not all the patients who presented exuberant symptoms, showed proportionally modified tests. The cornea sensitivity of the case group was reduced when compared with that of the control group. All the studied parameters in the case group presented significant differences (p<0.05) when compared with the control group. CONCLUSION: There was a weak correlation between Sjögren's syndrome patients' ocular symptoms and signals that indicate the severity of the illness. The variation of cornea sensitivity found in the Sjögren's syndrome patient group may be one of the responsible factors for this weak correlation. All the studied parameters were significantly modified in the Sjögren's syndrome patients group when compared with those found in the control group.
- ItemAcesso aberto (Open Access)Diagnóstico e tratamento da síndrome de Sjögren(Conselho Brasileiro de Oftalmologia, 2006-12-01) Felberg, Sergio [UNIFESP]; Dantas, Paulo Elias Correa; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP)Sjögren's syndrome is a systemic inflammatory autoimmune disease with worldwide distribution, responsible for considerable impact on the patient's quality of life. The aim of this article is to describe its main symptoms, the currently used different diagnostic criteria and the available treatment for the syndrome.
- ItemAcesso aberto (Open Access)Efeitos do laser de baixa potência e da luz pulsada intensa em modelo experimental de Síndrome de Sjögren(Universidade Federal de São Paulo, 2023-12-15) Takiishi, Alessandra Yoshie [UNIFESP]; Gomes, José Álvaro Pereira [UNIFESP]; Wakamatsu, Tais Hitomi [UNIFESP]; http://lattes.cnpq.br/1618881266650136; http://lattes.cnpq.br/2506247984223015; http://lattes.cnpq.br/3099140405441529Objetivo: O objetivo é avaliar em primeira instância o efeito tanto do Laser quanto da Luz Pulsada Intensa (IPL) como formas de tratamento para Doença do Olho Seco (DOS) em modelos experimentais da Síndrome de Sjögren (SS). Métodos: Avaliação de 3 grupos de camundongos NOD, modelos experimentais de Síndrome de Sjögren: grupo controle, grupo tratado com Laser (600nm) e grupo tratado com IPL. Os camundongos foram avaliados nos seguintes critérios: superfície da córnea por meio da coloração com fluoresceína, produção de lágrima por meio do fenol vermelho. Os tecidos das glândulas lacrimais desses modelos foram avaliados histologicamente e processados para avaliação de citocinas (IL – 1b, IL – 6, IL – 10, IL – 12a, IL – 17, INF – gama, TNF e MPK9) por meio do RTPCR. Resultados: O teste do fenol vermelho mostrou que, após o tratamento, os camundongos dos grupos Laser e IPL apresentaram um aumento na produção lacrimal no primeiro dia, que diminui no sétimo dia, embora ainda maior do que os valores iniciais. Em relação à avaliação da superfície da córnea, apenas o grupo Laser apresentou melhora no D1, porém sem diferença estatística. Já em relação à análise histológica, o grupo Laser apresentou infiltrado inflamatório considerável, o que não se encontrou no grupo IPL. Por fim, em relação às interleucinas, no grupo Laser houve maiores níveis de citocinas inflamatórias interleucina – 1 (IL – 1), IL – 6, interferon – gama (INF – gama) e menores níveis de proteína quinase 9 ativada por mitógeno (MAKP9), fator de necrose tumoral alfa (TNF – alfa) e a interleucina antiinflamatória IL – 10. Já no grupo IPL, menores níveis de IL – 1 e maior nível de IL 10. Porém, sem diferença estatística nessas avaliações. Conclusões: A terapia com Laser de Baixa Potência e o IPL apresentaram efeito de aumentar a produção aquosa pelas glândulas lacrimais tratadas. Além disso, o IPL melhorou a condição inflamatória no tecido glandular tratado.
- ItemEmbargoEstudo da expressão dos auto-antígenos SS-A/Ro (polipeptídeos 52kda e 60kda) e SS-B/La (polipeptídeo 48kda) e de seus RNAs mensageiros em glândulas salivares menores de pacientes com síndrome de Sjögren(Universidade Federal de São Paulo (UNIFESP), 2006-12-31) Silveira, Karin Spat Albino Barcellos [UNIFESP]; Andrade, Luiz Eduardo Coelho [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Purpose: The strong association between primary Sjögren syndrome (pSS) and autoantibodies to SS-A/Ro (52kDa and 60kDa) and SS-B/La may be indicative of a possible role for these autoantigens in the pathophysiology of the disease. The present study aimed to analyze protein and mRNA expression of SS-A/Ro and SS-B/La antigens in a preferential tissue target of pSS, i.e., minor salivary glands (MSGs). Methods: SS-A/Ro (60kDa & 52kDa) and SS-B/La protein expression was studied by immunohistochemistry in MSG samples of 26 pSS patients and 16 control subjects. Analysis was carried out by two independent blinded observers according to the topography and intensity (semiquantitative score) of the staining. Total RNA extracted from MSG samples of 10 pSS patients and 7 control subjects was submitted to reverse transcription and quantified by Real Time PCR with primers specific to SS-A/Ro (60kDa & 52kDa) and SS-B/La cDNA. Samples were normalized by ß-actin and GAPDH mRNA expression. Relative mRNA expression (2-ΔΔCT) was compared between pSS patients and control subjects. Results: In general the semiquantitative protein expression for the three autoantigens did not differ among pSS patients and control subjects, and was more prominent in the cytoplasm as compared to the nucleus in all cell types. However, SS-B/La protein had higher expression in the cytoplasm of ductal cells than in the cytoplasm of mucous acinar cells in pSS patients (p=0.013), while no significant difference was detected in the control group (p=0.704). SS-A/Ro 60kDa protein had higher expression in the cytoplasm of ductal cells than in the cytoplasm of serous acinar cells of pSS patients (p=0.006) but the same was not observed for controls (p=0.156). SS-A/Ro 52kDa protein topographic expression pattern was the same in patients and controls. SS-B/La mRNA expression was higher in samples from pSS patients (5.326±5.107) than in controls (0.856±1.255) (p=0.0311). The same was true for SS-A/Ro 60kDa mRNA expression (6.866±7.868 vs 1.045±1.329; p=0.0330). On the other hand, SS-A/Ro 52kDa mRNA expression showed a modest trend for higher expression in samples from pSS patients but the difference did not reach statistical significance (5.616±4.885 vs 2.648±4.223; p=0.0879). Samples with the highest histological inflammation score at MSG showed decreased expression of SS-A/Ro 60kDa, SS-A/Ro 52kDa and SS-B/La mRNAs. Conclusions: The increased SS-A/Ro 60kDa and SS-B/La mRNA expression in MSGs of pSS patients as well as the differential SS-A/Ro 60kDa and SS-B/La protein expression in ductal cells of MSGs in pSS patients suggest that these antigens are probably involved in triggering and maintaining the tissue-specific autoimmune response in pSS MSGs. The observed differential expression may contribute to the antigen-driven immune response and local autoantibody production in pSS.
- ItemAcesso aberto (Open Access)Exercício aeróbico na síndrome de sjögren primária: estudo controlado e randomizado(Universidade Federal de São Paulo (UNIFESP), 2016-01-12) Miyamoto, Samira Tatiyama [UNIFESP]; Natour, Jamil [UNIFESP]; http://lattes.cnpq.br/4969546467649519; http://lattes.cnpq.br/4268064887892110; Universidade Federal de São Paulo (UNIFESP)Objective: to investigate the effects of a supervised walking program in women with primary Sjögren?s syndrome (pSS). Methods: this randomized controlled trial with intention-to-treat analysis included 45 women fulfilling the American European Consensus Criteria (2002) for pSS. They were randomized into Training Group (GT, n= 23) and Control Group (GC, n= 22). The evaluation tools Functional Assessment of Chronic Illness Therapy Fatigue Subscale (FACIT-Fatigue), Beck Depression Inventory (BDI) and EULAR Sjögren?s Syndrome Patient Reported Index (ESSPRI) were performed prior to intervention (T0), after 8 weeks (T8) and 16 weeks (T16). The EULAR Sjögren?s Syndrome Disease Activity Index (ESSDAI), Medical Outcomes Study 36 (SF-36) and maximal exercise test on the treadmill were performed at T0 and T16. The supervised walking occurred 3 times a week for 16 weeks, from 30 to 60 minutes each session. The intensity of the exercise was based on the heart rate at 80% of the maximum heart rate (HRmax) reached in the treadmill test. Results: Four patients in GT and 2 in GC dropped out during the study. CRP (p= 0,005), CK (p= 0,018), C4 (p< 0,001), VO2max (ml.kg-1.min-1) (p= 0,002), BDI (p= 0,001), vitality (p= 0,003) and role emotional (p= 0,012) domains and mental component summary (p= 0,009) of the SF-36 increased in both groups. FACIT-fatigue (p= 0,042) and distance covered on the test (p= 0,020) improved only in GT. There were no differences over time in the other variables and neither between groups by repeated-measures analysis of variance (ANOVA). The mean change after 16 weeks of VO2max (ml.kg-1.min-1) (p= 0,016), distance (p= 0,043) and FACIT-fatigue (p= 0,030) was higher in the GT than in the GC. There was correlation between the improvement of VO2max (ml.kg-1.min-1) and improvement of FACIT-fatigue (r= 0,418, p= 0,047), physical functioning (r= 0,557, p= 0,006) and general health domains of the SF-36 (r= 0,525, p= 0,010) and physical component summary of the SF-36 (r= 0,478, p= 0,021) in GT. The improvement of fatigue (FACIT-fatigue) in the GT correlated with the improvement of the VO2max (ml.kg-1.min-1) (r= 0,418, p= 0,047), ESSPRI fatigue (r= -0,677, p< 0,001), ESSPRI pain (r= -0,429, p= 0,041), ESSPRI total (r= -0,630, p= 0,001), BDI (r= -0,474, p=0,022), physical functioning (r= 0,682, p< 0,001), role-physical (r= 0,552, p= 0,006), general health (r= 0,423, p= 0,044), social functioning (r= 0,425, p= 0,043) and mental health (r= 0,586, p=0,003) domains of the SF-36 and physical component summary (r= 0,522, p= 0,011) and mental component summary (r= 0,456, p= 0,029) of the SF-36. From the GT, 95,4% of the patients rated themselves as clinically improved versus 62% of the patients in the GC (p= 0,049). The compliance rate for the exercise program sessions averaged 72,4% (21 - 92%). Conclusion: This supervised walking program was demonstrated to be feasible and safe with improvement of the aerobic capacity, exercise tolerance, fatigue and perception of clinical improvement in pSS patients. There were also association between improvement of aerobic capacity and improvement of fatigue and physical component of the quality of life, as well association between improvement of fatigue and improvement of depression and physical and mental components of the quality of life.
- ItemAcesso aberto (Open Access)Uso oral do óleo de linhaça (Linum usitatissimum) no tratamento do olhoseco de pacientesportadores da síndrome de Sjögren(Conselho Brasileiro de Oftalmologia, 2007-08-01) Pinheiro Jr., Manuel Neuzimar; Santos, Procópio Miguel dos [UNIFESP]; Santos, Regina Cândido Ribeiro dos [UNIFESP]; Barros, Jeison de Nadai [UNIFESP]; Passos, Luiz Fernando; Cardoso Neto, José; Universidade de Brasília; Universidade Federal de São Paulo (UNIFESP); UnB Faculdade de Ciências da Saúde; UnB Faculdade de Ciências; Universidade Federal do Amazonas; UFAM Hospital Universitário Getúlio Vargas; Universidade de São Paulo (USP); UFAM Departamento de EstatísticaPURPOSE: To evaluate if oral flaxseed oil (Linum usitatissimum), which reduces the inflammation in rheumatoid arthritis, may help keratoconjunctivitis sicca's treatment in Sjögren's syndrome patients. METHODS: In a randomized clinical trial, 38 female patients with rheumatoid arthritis or systemic lupus erithematosus associated with keratoconjunctivitis sicca and Sjögren's syndrome were consecutively selected from patients of the Departament of Reumatology of the Amazonas University Hospital. Keratoconjunctivitis sicca diagnosis was based on a dry-eye symptom survey score (Ocular Surface Disease Index - OSDI®), Schirmer-I test, fluorescein break-up time, 1% Rose Bengal staining of ocular surface measured by the van Bijsterveld scale. All patients had ocular surface inflammation evaluated and quantified by conjunctival impression cytology, before and after the study. The subjects were divided into three groups with 13 (Group I), 12 (Group II) and 13 (Group III) patients. Group I received flaxseed oil capsules with a final 1 g/day dosis, Group II flaxseed oil capsules with a final 2 g/day dosis and Group III - controls - placebo, for 180 days. RESULTS: Comparing the results at the beginning and at the end of the treatment, statistically significant changes (p<0.05) in symptoms (OSDI®), ocular surface inflammation quantified by conjunctival impression cytology, Schirmer-I test and fluorescein break-up time occurred in Groups I e II when compared to controls. CONCLUSIONS: Therapy with oral flaxseed oil capsules 1 or 2 g/day reduces ocular surface inflammation and ameliorates the symptoms of keratoconjunctivitis sicca in Sjögren's syndrome patients. Long-term studies are needed to confirm the role of this therapy for keratoconjunctivitis sicca in Sjögren's syndrome.