Autoimmune hepatitis (AIH) is a chronic liver disease of unknown etiology. It is composed of immune-mediated liver injury and significant immunological aspects. Arthritis can be observed in patients with AIH before recognition of the disease, which can lead to a diagnostic challenge. Although there are few reported cases in literature, peripheral blood eosinophilia might also play a part in such diagnosis. We report an intriguing case of a 41-year-old man who presented to our service with arthritis and eosinophilia as initial manifestations and was eventually diagnosed with overlap syndrome: AIH and primary sclerosing cholangitis. The present report aims to include eosinophilia among the clinical features of AIH, highlighting the possibility of its detection before the onset of either articular or hepatic disturbances.

Despite the advances in the hematology field, blood transfusion-related iatrogenesis is still a major issue to be considered during such procedures due to blood antigenic incompatibility. This places pluripotent stem cells as a possible ally in the production of more suitable blood products. The present review article aims to provide a comprehensive summary of the state-of-the-art concerning the differentiation of both embryonic stem cells and induced pluripotent stem cells to hematopoietic cell lines. Here, we review the most recently published protocols to achieve the production of blood cells for future application in hemotherapy, cancer therapy and basic research.

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BACKGROUNDThe COVID-19 pandemic has caused both direct and indirect challenges to healthcare services worldwide. Decline in outpatient visits has been reported in the United States and across Europe. However, objective data in South America is still scarce on how the follow-up of chronic autoimmune diseases has been impaired. METHODSHere we evaluated the profile of rheumatoid arthritis (RA) outpatient care at the Rheumatology Department of a Brazilian university hospital during the COVID-19 pandemic. Through chart reviews of in-person and telemedicine visits between January 2020 and May 2022, we aimed to evaluate the follow-up of a long-term RA patient cohort, previously approved by national and local research ethics committees. Deaths were evaluated through the Brazilian National Death Registry website. RESULTSSince 2004, a cohort of 182 patients with RA was followed-up in our database. In 2022, they would have a mean age of 71.2 (± 0.7) years, with 29.5 (± 9.8) years of symptoms and 25.0 (± 6.7) years of treatment. In total, only 37 of those patients (20.32%) attended to at least one outpatient visit between January 2020 and May 2022, of which 1 was excluded due to change in diagnosis. There were 73 deaths (40.1%), of which 3 occurred during the pandemic. The remaining 72 patients (39.56%) were lost to follow-up by other causes. We further evaluated the 36 patients with regular follow-up. They had a mean age of 65.2 (± 8.8) years, with 27.4 (± 7.7) years of symptoms and 24.1 (± 6.3) years of treatment. Between 2004-2008, they had a mean disease activity by DAS28 of 3.94 (± 1.99) and only 4 patients (23.62%) achieved remission. In comparison, between 2020-2022, they had a mean DAS28 of 3.18 (± 1.49) and 14 patients (38.88%) achieved remission. CONCLUSIONWe evaluated a cohort consisting of several patients with long-term RA, not usually covered in studies. We observed many losses since the start of follow-up in 2006. Despite the long-term disease, the patients who maintained the follow up achieved better disease control, higher remission rates and optimized treatment (with an increase in the number of patients using immunobiological therapy). However, a limitation of the study was that we could not evaluate the causes of death. We intend to maintain the follow-up of the patients in the sample, focusing on the evaluation of disease progression and control in long-term RA.

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