Navegando por Palavras-chave "fenômeno de Raynaud"
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- ItemAcesso aberto (Open Access)Ausência de correlação entre as alterações morfológicas e bioquímicas na microcirculação de pacientes com esclerose sistêmica(Sociedade Brasileira de Reumatologia, 2004-02-01) Kayser, Cristiane [UNIFESP]; Andrade, Luiz Eduardo Coelho [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: The cold stimulus-fingertip lacticemy test (CS-FTL) evaluates a microcirculation biochemical component and presents abnormal results in systemic sclerosis (SSc). Nailfold capillaroscopy is a well established method for the assessment of morphological aspects of Raynaud's phenomenon associated with SSc. The present study sought to compare the nailfold capillaroscopy findings with the CS-FTL parameters in individual fingers of patients with systemic sclerosis. METHODS: 14 SSc patients with 3 fingers having discrepant degree of microangiopathic SD pattern by nailfold capillaroscopy were studied. Fingertip lacticemy was determined in the three fingers selected before (pre-CS-FTL) and 10 minutes after cold stimulus (post-CS-FTL). The percentage difference between post- and pre-CS-FTL was designated ΔCS-FTL. RESULTS: There was great intraindividual variability (between the different digits) in values of the CS-FTL test. There was no statistically significant difference in pre-CS-FTL, post-CS-FTL and ΔCS-FTL values when comparing the fingers with similar capillaroscopic pattern and the discrepant finger in the 14 SSc patients. There was no correlation between the morphological findings registered by nailfold capillaroscopy and the functional alterations measured by the CS-FTL test. CONCLUSIONS: The absence of correlation between morphological microangiopathic alterations detected by nailfold capillaroscopy and the functional perfusion alterations, verified by the CS-FTL test, suggests a relationship between the latter and proximal vascular lesions, such as arterioles, digital and palmar arch arteries.
- ItemAcesso aberto (Open Access)Bosentana no tratamento de úlceras de extremidades refratárias na esclerose sistêmica(Sociedade Brasileira de Reumatologia, 2009-06-01) Mariz, Henrique de Ataíde [UNIFESP]; Corrêa, Marcelo José Uchôa [UNIFESP]; Kayser, Cristiane [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)INTRODUCTION: Vasculopathy is a hallmark of systemic sclerosis (SSc) and may lead to complications such as ischemic ulcers, necrosis or amputation of fingers or lower limbs. Bosentan is a dual endothelin receptor antagonist currently used for prevention of digital ulcers in SSc. OBJECTIVE: To evaluate the efficacy of bosentan in the treatment of recurrent and refractory extremity ulcers in patients with SSc. PATIENTS AND METHODS: An open and observational study was performed with three patients from the Rheumatology Division of UNIFESP aged 31, 58 and 61 years with diagnosis of SSc. All patients presented one or more active extremity ulcer refractory to conventional treatment. The first one (P1) presented one digital ulcer; P2 presented three ulcers on the right lower limb; and P3 presented an ulcer on the right digit, leg and heel, and on left maleolar region. Bosentan was prescribed in a dose regimen of 62.5 mg twice a day for 4 weeks, followed by 125 mg twice a day for additional 4 or 8 weeks. All patients were evaluated regarding the number and diameter of the ulcers in weeks 0, 4, and 8, and one of them in week 12 as well. RESULTS: After the treatment with bosentan all patients presented complete resolution or reduction in the diameter of the ulcers. None of the patients presented a new ulcer. CONCLUSION: Bosentan was an effective treatment in refractory extremities ulcers and in the prevention of new ulcers in three SSc patients suggesting that this medication could be an option for patients with severe vascular involvement.
- ItemAcesso aberto (Open Access)Capilaroscopia periungueal seriada (CPU) como parâmetro de monitoramento da evolução de pacientes com diagnóstico inicial de fenômeno de Raynaud (FRy) isolado ou de doença indiferenciada do tecido conjuntivo (DITC)(Sociedade Brasileira de Reumatologia, 2005-12-01) Higashi, Viviane Shinsato [UNIFESP]; Kayser, Cristiane [UNIFESP]; Andrade, Luiz Eduardo Coelho [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: Retrospective serial analysis of nailfold capillaroscopy (NFC) alterations and its correlation with diagnostic evolution in patients initially presenting isolated Raynaud's phenomenon (RP) or undifferentiated connective tissue disease (UCTD). METHODS: We evaluated 19 patients with previous diagnosis of isolated Raynaud's Phenomenon or UCTD who had two or more NFC exams within at least one-year interval. RESULTS: Eleven patients have had initial diagnosis of isolated RP; seven maintained the RP diagnosis, three developed Systemic Sclerosis (SSc), and one evolved to Sjögren´s Syndrome (SSj). Eight patients were diagnosed with UCTD in the first evaluation and all of them kept the initial diagnosis. Nine patients presented changes in NFC pattern. Seven patients presented intensification of SD pattern (group A). In three of these patients, the diagnosis has evolved from isolated FRy to SSc. The remaining four cases (one RP and three UCTD) maintained the initial diagnosis. Group B included two cases in which the SD pattern has been attenuated or disappeared. One of these patients has evolved from isolated RP to SSj. Ten patients had the NFC pattern unaltered (Group C) and all of them have kept the initial diagnosis (four with UCTD and six with RP). All patients who had evolved to SSc have shown intensification or appearance of SD pattern (sensitivity=100%). On the other hand, among the 16 patients who have not evolved to SSc, 12 had not shown appearance or intensification of SD pattern (specificity=75%). CONCLUSIONS: The appearance or intensification of SD pattern in serial NFC analysis during the study period has shown high sensitivity and moderate specificity in regard to the development of SSc.
- ItemAcesso aberto (Open Access)Estudo piloto sobre a eficácia do losartan no tratamento do fenômeno de Raynaud (FRy) e correlação com alterações na microcirculação em pacientes com esclerose sistêmica (ES)(Sociedade Brasileira de Reumatologia, 2005-12-01) Kayser, Cristiane [UNIFESP]; Santos, Marla Francisca dos [UNIFESP]; Andrade, Luiz Eduardo Coelho [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVES: To evaluate the efficacy of losartan for the treatment of Raynaud's phenomenon (RP) secondary to systemic sclerosis. We also evaluated the biochemical abnormalities of the microcirculation using the cold stimulus-fingertip lacticemy test (CS-FTL), and the morphological alterations of the microcirculation, by nailfold capillaroscopy, before and after treatment as well as possible correlations with losartan action at the microvascular level. METHODS: In this open study we selected ten patients with systemic sclerosis diagnosis and Raynaud's phenomenon present on the selection. Seven patients received losartan 50 mg once a day and three received 100 mg once a day for four weeks. Patients were evaluated for drug efficacy by standard questionnaire on day 0 and at the end of weeks 1, 2, 3, and 4. Nailfold capillaroscopy and the CS-FTL test were performed at baseline and at the end of treatment. RESULTS: There was a reduction in the RP severity scale between weeks 0 and 4 (p=0.048). There was a reduction on pain visual analogic scale, number of RP episodes/day, and the duration of the RP episodes between the weeks 0 and 4, but this reduction did not reach statistical significance. Additionally there was no statistically significant change in nailfold capillaroscopy parameters and FTL values between weeks 0 and 4. CONCLUSION: Losartan seems to have modest to moderate clinical benefit in RP secondary to SSc and induced no detectable modification in biochemical or morphological microcirculation parameters.
- ItemAcesso aberto (Open Access)Fenômeno de Raynaud(Sociedade Brasileira de Reumatologia, 2009-02-01) Kayser, Cristiane [UNIFESP]; Corrêa, Marcelo José Uchôa [UNIFESP]; Andrade, Luiz Eduardo Coelho [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Fleury Medicina DiagnósticaRaynaud's phenomenon (RP) is an episodic vasospasm of the peripheral arterioles, causing pallor followed by cyanosis and redness of the fingers and toes, usually in response to stress or cold exposure. Primary Raynaud's phenomenon is a benign event and occurs without an underlying disease. In contrast, secondary Raynaud's phenomenon can occur in association with several underlying diseases or conditions, mostly autoimmune rheumatic diseases. In systemic sclerosis (SSc), RP is the most frequent initial manifestation. In RP secondary to SSc-related diseases, digital ischemic lesions are a frequent problem. In recent years, advances in the understanding of the physiopathology of RP have favored the development of novel promising therapeutic alternatives for this clinical condition. This article presents a review of the pathogenesis, clinical investigation and treatment of RP, with special emphasis in novel therapeutic modalities.
- ItemAcesso aberto (Open Access)Laser Doppler Imaging para quantificação do fluxo sanguíneo de polpa digital em condições basais e após estímulo frio em pacientes com esclerose sistêmica(Sociedade Brasileira de Reumatologia, 2010-04-01) Correa, Marcelo Jose Uchoa [UNIFESP]; Perazzio, Sandro Felix [UNIFESP]; Andrade, Luiz Eduardo Coelho [UNIFESP]; Kayser, Cristiane [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVES: The objective of this study was to investigate the dynamic behavior of the blood flow of the microvascular circulation of the fingertips before and after two cold stimuli (CS), using Laser Doppler Imaging with different intensities in patients with systemic sclerosis (SSc) and in healthy individuals. PATIENTS AND METHODS: Fourteen SSc patients (51.2 ± 5.5 years) with Raynaud's phenomenon and 12 healthy controls (44.8 ± 9.0 years) were included in this study. Two CS protocols (submersion of the hands in water at 10 ºC or 15 ºC for 1 minute) were performed on the same day. Mean fingertip blood flow (FBF) of four digits of the left hand was measured using LDI (Moor LDI-VR, Moor Instruments) at baseline and at 1, 4, 10, 25, and 40 minutes after CS. RESULTS: Baseline blood flow was significantly lower in both CS protocols in SSc patients when compared to controls (312.9 ± 102.7 vs 465.4 ± 135.4 PU, P = 0.006 at 15 ºC; 305.2 ± 121.0 vs 437.9 ± 119.8 PU; P = 0.01 at 10 ºC). In the control group, a significant decrease in FBF after CS, when compared to baseline, was observed 1 minute (P = 0.001) after CS at 15 ºC and at 1 (P = 0.005) and 25 minutes (P = 0.001) after CS at 10 ºC. In SSc patients, a significant decrease in FBF was observed in both CS protocols at 1, 4, and 10 minutes (P < 0.000; P = 0.002; P = 0.014, after CS at 15 ºC; P < 0.000; P = 0.004; P = 0.001, after CS at 10 ºC). CONCLUSIONS: Laser Doppler Imaging showed lower baseline fingertip perfusion and further reduction after CS in SSc patients compared to controls. Quantification of fingertip blood flow by LDI may be useful in the longitudinal monitoring of the disease status and therapeutic interventions in SSc.
- ItemAcesso aberto (Open Access)Tratamento de pacientes com úlceras isquêmicas secundárias à esclerose sistêmica com N-acetilcisteína endovenosa(Sociedade Brasileira de Reumatologia, 2006-04-01) Kayser, Cristiane [UNIFESP]; Luz, Karine Rodrigues da [UNIFESP]; Rocha, Livanio Ferreira da [UNIFESP]; Andrade, Luiz Eduardo Coelho [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)The repetitive ischemic-reperfusion episodes in patients with systemic sclerosis (SSc) cause an increase in free radical activity, which may be implicated in the inflammatory and vascular lesions observed in this illness. Endovenous N-acetylicysteine is a potent anti-oxidant agent and might be beneficial to the treatment of vascular events in SSc. This communication reports on the use of endovenous N-acetylcysteine in three SSc patients with active ulcers in fingers and toes. At baseline, two patients presented two finger ulcers each, and a third patient had three ulcers in the toes. All patients presented a decrease in the dimensions of at least one ulcer. Two patients presented complete healing of one ulcer. These preliminary results suggest that endovenous N-acetylcysteine may be an efficient therapeutic option for extremity ulcers in SSc patients and support future randomized double blind placebo-controlled trials.