Reumatologia
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Browsing Reumatologia by Author "Ambrósio, C"
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- A articulação esternoclavicular na artrite psoriáticaPublication . Ambrósio, C; Alexandre, M; Malcata, AB
- Artralgias, dores ósseas, anticorpos anti-nucleares positivos e trombocitopenia...diagnóstico: Doença de Nieman-PickPublication . Ambrósio, C; Serra, S; Alexandre, M; Malcata, ABThe differential diagnosis of rheumatic diseases is sometimes very complex given the lack of specificity of some clinical manifestations. A careful physical examination with the aid of laboratory and radiographic findings can lead us to some rare conditions, reminding that they should never be forgotten in the differential diagnosis. The authors present a case report of a woman referred to the rheumatology department with joint and bone pain. Physical examination and laboratory findings lead us to the diagnosis of type B Niemann-Pick disease. Some considerations about the diagnostic challenge of this rare clinical condition are made.
- Condrocalcinose familiar: uma história para dois irmãosPublication . Ambrósio, C; Garcia, J; Salvador, MJ; Malcata, ABCalcium pyrophosphate dihydrate crystal deposition is frequently an asymptomatic disease. However it may cause severe acute attacks of inflammatory arthritis as well as chronic arthropathies. The authors present two case reports of two brothers with chondrocalcinosis and an unusual presentation that mimics rheumatoid arthritis. Special considerations are made about the differences between the familiar and idiopathic forms
- Exuberant calcinosis and acroosteolysis. A diagnostic challengePublication . Saavedra, MJ; Ambrósio, C; Malcata, AB; Matucci-Cerinic, M; Pereira da Silva, JAA case of exuberant acroosteolysis and subcutaneous tissue calcinosis in the absence of skin involvement is presented. Different hypotheses are discussed following the clinical unfolding of the case in practice.
- Linfedema na artrite idiopática juvenil: uma manifestação extra-articular raraPublication . Ambrósio, C; Abreu, P; Alexandre, M; Malcata, ABExtraarticular features are usually found in rheumatological diseases sometimes with no correlation with the disease's activity in that moment. Lymphoedema is one of these manifestations and it's defined as a tissue fluid accumulation with gradual onset of swelling of a limb. Because it is an unusual finding, the physiopatological explanation of this feature is still difficult to understand. We describe a case report of lymphoedema on left upper arm, in a patient with systemic juvenile arthritis, with no identified cause and with no associated systemic signs or symptoms.
- Lombalgia com sinais de alarme: um caso de espondilodiscitePublication . Couto, M; Ambrósio, C; Velez, J; Salvador, MJ; Malcata, ABSpondylodiscitis is a serious clinical entity. Despite the decrease in mortality from about 25% in the pre-antibiotic era to near 5%, it remains significant and the associated morbidity is still relevant. The rate of residual neurological deficits among survivors is around 7%. In 30% of patients some related symptoms persist, the most important being pain. The authors report the case of a 74-year-old male patient with recent onset low back pain, which caused considerable disability. With this work the authors intend to alert to the fact that in a patient with a common symptom such as low back pain, the presence of "red flags" requires a quick investigation and diagnosis in order to prevent serious damage.
- A propósito de um caso de espessamento cutâneoPublication . Serra, S; Ambrósio, C; Salvador, MJ; Silva, J; Serra, D; Reis, JP; Malcata, ABThe authors present a clinical case of a 79 years old female patient, with a progressive cutaneous thickening of the face, trunk and limbs, lasting for 6 years. She also presented exertional dyspnea and intermittent solid dysphagia. The laboratory study identified IgG KAPA monoclonal protein and antinuclear antibodies with a speckled pattern. The nailfold capillaroscopy was normal. A detailed physical examination together with cutaneous histopathology led to the diagnosis of Scleromyxedema, a rare cutaneous scleroderma like disease. The differential diagnosis of cutaneous sclerosis is discussed.
- Síndrome de Löfgren: a importância da radiografia torácicaPublication . Ambrósio, C; Malcata, ABSarcoidosis is a systemic granulomatosis of unknown origin characterized by a formation of non-caseating granulomas in multiple organs, which can present as a chronic, sub acute or an acute form. Löfgren’s syndrome is an acute form of sarcoidosis characterized by the presence of arthritis/arthralgia, eritema nodosum lesions and hilar lymphadenopathy. The authors present 3 case reports of arthritis/ /arthralgia and eritema nodosum lesions in 3 young patients in which the diagnosis was Löfgren’s syndrome. The radiological findings were essencial for the final diagnosis, especially in the presence of a normal value of serum angiotensin-converting enzyme
- The Portuguese Society of Rheumatology position paper on the use of biosimilarsPublication . Fonseca, JE; Gonçalves, J; Araújo, F; Cordeiro, I; Teixeira, F; Canhão, H; Pereira da Silva, JA; Garcês, S; Miranda, LC; Ramiro, Sofia; Roxo, Ana; Pimentel-Santos, FM; Tavares, V; Neto, A; Sepriano, A; Malcata, A; Faustino, A; Silva, C; Ambrósio, C; Duarte, C; Miguel, C; Barcelos, F; Santos, H; Cunha, I; Ramos, JC; Melo-Gomes, JA; Pimentão, JB; Costa, L; Maurício, L; Silva, M; Bernardes, M; Bogas, M; Coelho, PC; Monteiro, P; Aguiar, R; André, R; Leitão, R; Pimenta, S; Meirinhos, T; Fernandes, S; Las, V; Castelão, WBiotechnological drugs have become a fundamental resource for the treatment of rheumatic patients. Patent expiry of some of these drugs created the opportunity for biopharmaceutical manufacturers to develop biosimilar drugs intended to be as efficacious as the originator product but with a lower cost to healthcare systems. Due to the complex manufacturing process and highly intricate structure of biologicals, a biosimilar can never be an exact copy of its reference product. Consequently, regulatory authorities issued strict preclinical and clinical guidelines to ensure safety and efficacy equivalence and, in September 2013, the biosimilar of infliximab was the first biosimilar monoclonal antibody to be authorized for use in the European Union. The current document is a position statement of the "Sociedade Portuguesa de Reumatologia" (Portuguese Society of Rheumatology) on the use of biosimilar drugs in rheumatic diseases. Two systematic literature reviews were performed, one concerning clinical trials and the other one concerning international position papers on biosimilars. The results were presented and discussed in a national meeting and a final position document was discussed, written and approved by Portuguese rheumatologists. Briefly, this position statement is contrary to automatic substitution of the originator by the biosimilar, defends either a different INN or the prescription by brand name, supports that switching between biosimilars and the originator molecule should be done after at least 6 months of treatment and based on the attending physician decision and after adequate patient information, recommends the registration of all biosimilar treated patients in Reuma.pt for efficacy, safety and immunogenicity surveillance, following the strategy already ongoing for originators, and opposes to extrapolation of indications approved to the originator to completely different diseases and/or age groups without adequate pre-clinical, safety or efficacy data.
- US-guided interventional joint procedures in patients with rheumatic diseases--when and how we do it?Publication . Gonçalves, B; Ambrósio, C; Serra, S; Alves, F; Gil-Agostinho, A; Caseiro-Alves, FOBJECTIVE: To describe the main indications and the technical steps to perform ultrasound guided procedures in patients with rheumatic diseases. To access procedures accuracy, safety and effectiveness. MATERIALS AND METHODS: 27 patients with pain related to articular complications of rheumatic diseases and according to previous radiographic or US exam were submitted to several US-guided procedures. 42% of patients (n=11) had rheumatoid arthritis, 11% (n=3) spondyloarthropathies, 18% (n=5) psoriatic arthritis, 15% (n=4) undifferentiated arthritis, 3% (n=1) Sjögren syndrome and 11% (n=3) had gout. Described procedures are synovial biopsies, intra-articular injections of corticosteroids, radiation synovectomy and synovial cysts drainage procedures. When a therapeutical procedure was made, patients were evaluated by 2 rheumatologists. Corticosteroids used were Prednisolone and Triamcinolone. Yttrium-90 was used for synovectomy. RESULTS: In all cases success was achieved with correct needle placement inside the joint. After injection/aspiration symptoms successfully solved with all patients improving their health status. No complications were recorded during follow-up period. CONCLUSIONS: US-guidance is very reliable to afford a safety procedure always checking the injection, biopsy or aspiration. Guided-biopsy has high success rates obtaining several samples. Thus is also possible to use more powerful/long acting therapeutic drugs aggressive to extra-articular structures avoiding complications.