Dermatomiosite em adulto: experiência de um centro terciário brasileiro

Abstract

Objective: To report the results of a retrospective cohort involving 139 patients with dermatomyositis, conducted from 1991 to 2011. Methods: All patients met at least four of the fi ve Bohan and Peter criteria (1975). Results: The patients' mean age at disease onset was 41.7 ± 14.1 years, and mean disease duration was 7.2 ± 5.2 years. The sample comprised 90.2% white patients and 79.9% female patients. Constitutional symptoms occurred in less than half of the patients. Cutaneous and joint involvements occurred in 95.7% and 41.7% of the patients, respectively. Incipient pneumopathy, ground glass opacities and/or pulmonary fi brosis were present in 48.2% of the patients. All patients received prednisone (1 mg/kg/day) and 51.1% also received intravenous methylprednisolone (1 g/day for three days). Several immunosuppressants were used as corticosteroid sparing agents according to tolerance, side effects and/or refractoriness. Although disease relapse (clinical and/or laboratory) occurred in 53.2% of the patients, 76.3% were in disease remission at the end of the study. The rate of severe infection was 35.3%, and herpes zoster predominated. There were 15 (10.8%) cases of cancer, 12 within one year after the diagnosis. There were 16 deaths (11.5%), and their major causes were sepsis/septic shock (27.5%), pneumopathy attributed to the disease (31.3%), neoplasms (31.3%), and cardiovascular events (12.5%). Conclusions: In this study, the clinical and laboratory data were similar to those of other population groups described in the literature, with minimal differences regarding the frequency and characteristics of the extramuscular manifestations.

Insulin resistance is increased in adult patients with dermatomyositis

“…Clinical manifestations include symmetrical muscle weakness of limbs and cutaneous lesions, including heliotrope rash and Gottron's papules. [1][2][3][4] Moreover, extra-skeletal manifestations can also occur such as joint, pulmonary, gastrointestinal and/or cardiorespiratory involvement. [2][3][4] Recent studies have shown a high prevalence of metabolic syndrome [5][6][7][8] and basal insulinemia 5,6 in systemic autoimmune myopathies.…”

Morphological alterations of upper gastrointestinal tract in patients with new onset-dermatomyositis: correlation with demographic, clinical and laboratory features

“…[1][2][3][4][5][6] DM is an immune-mediated microangiopathy which affects both the skin and skeletal muscles diagnosed by confirming the presence of inflammatory infiltrate composed of B lymphocytes, macrophages and CD4+ lymphocytes, especially in the perivascular region of muscle tissue biopsy. [3][4][5]7 In the case of upper gastrointestinal tract involvement, patients with DM may be asymptomatic or present a variety of symptoms such as dysphagia, (dyspnea and computed tomography scan with evidence of interstitial lung disease and/or lung disease in "groundglass" abnormality), muscle strength of limbs (grade 0: no muscle contraction; grade I: trace of contraction; grade II: normal amplitude movements but incapable of countering the action of gravity; grade III: normal amplitude movements against gravity; grade IV: full mobility against gravity and degree of resistance; grade V: complete mobility against strong resistance against the action of gravity).…”

Características epidemiológicas, clínicas, laboratoriais, terapêuticas e evolutivas de 105 pacientes com dermatomiosite e polimiosite do ambulatório de reumatologia do Hospital de Clínicas da Unicamp

“…A relação sexo feminino:masculino deste trabalho foi de 2,08:1. A raça majoritária foi a branca, assim como relatado em outros trabalhos (50,120), mas com distribuição de acordo com a população local, assim como mostrado em estudos (111,121).…”

“…O FAN é comumente encontrado em pacientes com MII, variando de 36 a 90% de positividade dos pacientes testados (7,50). O padrão pode ser nuclear ou citoplasmático, sendo este último relacionado às antissintetases.…”