Perfil clínico dos pacientes com lúpus de início tardio
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TCC
Data de publicação
2023-11-27
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Citações (Scopus)
Autores
Martins, João Rafael do Prado
Ruiz, Lizzi Naldi
Ruiz, Lizzi Naldi
Orientador
Skare, Thelma Larocca
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Introdução: O Lúpus Eritematoso Sistêmico (LES) é uma doença autoimune sistêmica crônica do tecido conjuntivo, que apresenta inúmeras apresentações clínicas e expressões de autoanticorpos. Nela ocorre produção de autoanticorpos, formação e deposição de imunocomplexos, sendo a principal consequência da doença a inflamação de órgãos e danos teciduais, com possível disfunção. Embora o LES seja frequente e mais conhecido em pessoas na faixa etária reprodutiva, é possível que ele ocorra também em idades extremas, recebendo a denominação de late-onset SLE ou, de LES de início tardio, o qual apresenta algumas particularidades e peculiaridades. Essa condição acomete pacientes após os 50 anos de idade, apresentando aspectos clínicos e epidemiológicos não idênticos às demais apresentações da doença, levantando a pergunta: Os pacientes com Lúpus eritematoso sistêmico tardio possuem uma doença diferente dos pacientes diagnosticados com Lúpus antes dos 50 anos? Objetivos: Comparar aspectos clínicos, sorológicos e danos cumulativos da doença entre pacientes com lúpus de início antes e depois dos 50 anos de idade. Metodologia: Estudo retrospectivo transversal observacional realizado por meio da análise de prontuários de pacientes com LES do ambulatório de reumatologia do Hospital Universitário Evangélico Mackenzie, de ambos os sexos e idade superior a 16 anos no momento do atendimento, e que tivessem sido atendidos entre janeiro de 2003 e janeiro de 2023. Considerou-se LES de início tardio aquele em que o início da doença aconteceu a partir dos 50 anos. Coletaram-se dados de perfil clinico e sorológico. Resultados: Estudaram-se 560 prontuários. Observou-se que a grande maioria - 519 (92,68%) dos pacientes pertenciam ao sexo feminino e eram da raça caucasiana (58,96%), com idade média ao diagnóstico de 31 anos. Nesta amostra 43 (7,6%) tiveram doença de início tardio. A comparação do perfil clinico mostrou diferenças quanto à presença de artrite deformante (mais comum nos idosos; p<0.0001) e sintomas sicca (também mais comum em idosos; p<0.0001). Do ponto de vista sorológico, o anticorpo anti-Sm foi mais comum nos indivíduos com doença de inicio antes dos 50 anos (p=0.04). Conclusão: A única diferença relevante observada entre os dois grupos foi a da presença de artrite deformante, mais comum nos idosos. De resto o comportamento clinico, sorológico foi bastante semelhante.
Introduction: Systemic Lupus Erythematosus (SLE) is a chronic systemic autoimmune disease of the connective tissue, which presents numerous clinical presentations and expressions of autoantibodies. In it, there is production of autoantibodies, formation and deposition of immune complexes. The main consequence of the disease is inflammation of organs and tissue damage, with possible dysfunction. Although SLE is frequent and better known in people at the reproductive age group, it is possible that it also occurs at extreme ages, receiving the name of late-onset SLE, which presents some particularities. This condition affects patients after 50 years of age, presenting clinical and epidemiological aspects that are not identical to the other presentations of the disease, raising the question: Patients with late systemic lupus erythematosus have a different disease from patients diagnosed with lupus before the age of 50 years? Objectives: To compare clinical and serological aspects and cumulative damage of the disease between patients with lupus of onset before and after 50 years of age. Methodology: Retrospective cross-sectional observational study conducted through the analysis of medical records of patients with SLE at the rheumatology outpatient clinic of the Mackenzie Evangelical University Hospital, of both sexes and older than 16 years, and who had been treated between January 2003 and January 2023. Late-onset SLE was defined as one in which the onset of the disease occurred after the age of 50 years. Clinical and serological profile data were collected. Results: A total of 560 medical records were studied. It was observed that the majority - 519 (92.68%) of the patients were female and Caucasian (58.96%), with a mean age at diagnosis of 31 years old. In this sample, 43 (7.6%) had late-onset disease. The comparison of the clinical profile showed differences in the presence of deforming arthritis (more common in the elderly; p<0.0001) and sicca symptoms (also more common in the elderly; p<0.0001). From the serological point of view, the anti-Sm antibody was more common in individuals with disease onset before the age of 50 years (p=0.04). Conclusion: The only relevant difference observed between the two groups was the presence of deforming arthritis, which is more common in the elderly. Moreover, the clinical and serological behavior was quite similar.
Introduction: Systemic Lupus Erythematosus (SLE) is a chronic systemic autoimmune disease of the connective tissue, which presents numerous clinical presentations and expressions of autoantibodies. In it, there is production of autoantibodies, formation and deposition of immune complexes. The main consequence of the disease is inflammation of organs and tissue damage, with possible dysfunction. Although SLE is frequent and better known in people at the reproductive age group, it is possible that it also occurs at extreme ages, receiving the name of late-onset SLE, which presents some particularities. This condition affects patients after 50 years of age, presenting clinical and epidemiological aspects that are not identical to the other presentations of the disease, raising the question: Patients with late systemic lupus erythematosus have a different disease from patients diagnosed with lupus before the age of 50 years? Objectives: To compare clinical and serological aspects and cumulative damage of the disease between patients with lupus of onset before and after 50 years of age. Methodology: Retrospective cross-sectional observational study conducted through the analysis of medical records of patients with SLE at the rheumatology outpatient clinic of the Mackenzie Evangelical University Hospital, of both sexes and older than 16 years, and who had been treated between January 2003 and January 2023. Late-onset SLE was defined as one in which the onset of the disease occurred after the age of 50 years. Clinical and serological profile data were collected. Results: A total of 560 medical records were studied. It was observed that the majority - 519 (92.68%) of the patients were female and Caucasian (58.96%), with a mean age at diagnosis of 31 years old. In this sample, 43 (7.6%) had late-onset disease. The comparison of the clinical profile showed differences in the presence of deforming arthritis (more common in the elderly; p<0.0001) and sicca symptoms (also more common in the elderly; p<0.0001). From the serological point of view, the anti-Sm antibody was more common in individuals with disease onset before the age of 50 years (p=0.04). Conclusion: The only relevant difference observed between the two groups was the presence of deforming arthritis, which is more common in the elderly. Moreover, the clinical and serological behavior was quite similar.
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Palavras-chave
lúpus eritematoso sistêmico , diagnóstico tardio , marcadores imunológicos , atividade imunológica , systemic lupus erythematosus , late diagnosis , immunological markers , immune activity