Browsing by Author "Cunha, I"
Now showing 1 - 4 of 4
Results Per Page
Sort Options
- Amenorreia induzida por ciclofosfamida em doentes pré-menopausicas com Lúpus Eritematoso SistémicoPublication . Cunha, I; Saavedra, MJ; Pereira da Silva, JA; Malcata, ABOBJECTIVES: To determine the frequency of ovarian failure in pre-menopausal women after cyclophosphamide (cyc) treatment for systemic lupus erythematosus (SLE); identify risk factors for this complication; estimate the occurrence and viability of pregnancy during and after treatment. METHODS: Review of the data of women treated with intravenous cyc in the department of Rheumatology of Hospitais da Universidade de Coimbra, updated by interview. Information on demographic features; gynaecologic and obstetrical history; characteristics of the disease; duration and side effects of treatment were obtained. Ovarian failure was defined as a lack of menses for, at least, four months and the diagnosis was confirmed by hormonal measurements. RESULTS: Nineteen pre-menopausal women were treated with intravenous cyc in our department. The mean age at the time of cyc initiation was 28.4 years. Lupus nephritis was the most common indication for cyc treatment (89.5%). The mean number of pulses was 9.3 over a period of 16.8 months. The mean cumulative dosage was 6.973 mg. Three patients developed ovarian failure. Those women were older than the others (P=0.0016). One patient became pregnant while on treatment. Two women delivered healthy children after cyc withdrawal. CONCLUSION: Ovarian failure developed in 15.8% of our patients. As described in the literature, the age at cyc initiation appears to be a determinant risk factor. Pregnancy may occur during cyc therapy, and thus, an effective contraception is mandatory. After cyc withdrawal, pregnancy is possible with a favourable outcome.
- Aracnoidite Ossificante em Espondilartropatia SeronegativaPublication . Cunha, I; Noir, D; Pereira da Silva, JA; Silva, J; Malcata, AB; Fernandes, RA 52-year-old man, with the diagnosis of Ankylosing Spondylitis, since the age of 22, was admitted due to progressive neurological symptoms that had started two years before: paresthesias, impaired sensation and muscle weakness of the lower limbs; burning abdominal and lumbar pain; together with bladder, bowel and sexual dysfunction. Imaging investigations revealed severe lesions from D1 to L5: epidural calcification; spinal cord compression and syringomyelia. Based on this case, the authors review the neurological complications of Ankylosing Spondylitis.
- Síndrome de Hajdu-Cheney: a propósito de um caso de acroosteólisePublication . Cunha, I; Saavedra, MJ; Oliveira, MA; Salvador, MJ; Malcata, ABA acroosteólise é uma situação clínica pouco frequente, caracterizada por reabsorção das extremidades ósseas. Pode surgir no contexto de diversas patologias ou ser idiopática. Os autores descrevem o caso clínico de uma doente de 47 anos, com antecedentes de acroosteólise dos dedos das mãos e dos pés, desde a infância, amaurose congénita unilateral, perda prematura da dentição e mal perfurante plantar. A exuberância e raridade das alterações encontradas, neste caso concreto, sem uma patologia subjacente identificada, remetem-nos para uma situação de acroosteólise idiopática, tendo-se estabelecido o diagnóstico de síndrome de Hajdu-Cheney. Trata-se de uma doença rara com transmissão autossómica dominante, estando descritos casos isolados resultantes de mutações de novo. A propósito deste caso os autores fazem uma discussão do diagnóstico diferencial da acroosteólise e a descrição das características desta síndrome rara.
- 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.