Avaliação do perfil lipídico e metabólico em pacientes com artrite reumatoide antes e depois da introdução de inibidores de Janus Quinase
Tipo
TCC
Data de publicação
2025-05-29
Periódico
Citações (Scopus)
Autores
Tabuti, Rafaela Yumi Teixeira
Ferreira, Renata Medeiros
Ferreira, Renata Medeiros
Orientador
Kahlow, Barbara Stadler
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Contexto: A artrite reumatoide (AR) é uma doença autoimune inflamatória crônica que compromete principalmente as articulações, podendo também gerar manifestações sistêmicas. Sua fisiopatologia está associada à ativação de vias inflamatórias mediadas por citocinas, o que contribui para um estado de inflamação crônica e aumento do risco cardiovascular. Nos últimos anos, os inibidores de Janus quinase (iJAKs) foram introduzidos como uma nova classe terapêutica oral para o tratamento da AR, oferecendo uma alternativa eficaz para pacientes refratários. No entanto, estudos têm apontado alterações no perfil lipídico associadas a essas medicações, levantando preocupações quanto ao possível aumento do risco de eventos cardiovasculares. Objetivo: Analisar alterações no perfil lipídico e nos parâmetros clínico-laboratoriais associados à introdução dos inibidores de iJAKs no tratamento de pacientes com AR. Metodologia: Estudo retrospectivo, realizado a partir da análise de prontuários eletrônicos do ambulatório de reumatologia do Hospital Universitário Evangélico Mackenzie (HUEM), com uma amostra de 64 pacientes adultos portadores AR em uso de iJAKs. A coleta de dados incluiu informações clínicas, epidemiológicas e exames laboratoriais em três momentos: início do uso dos iJAKs, 6 meses e 12 meses após o uso. Resultados: A amostra foi composta majoritariamente por mulheres (85,9%) e a média de idade ao diagnóstico de 41,1 anos. O Tofacitinibe foi o iJAK mais utilizado (57,8%), seguido por Upadacitinibe (21,8%) e Baricitinibe (20,3%). Não foram observadas alterações estatisticamente significativas nos níveis de colesterol total, LDL, HDL e triglicerídeos ao longo dos 12 meses. Parâmetros glicêmicos e antropométricos também permaneceram estáveis. Observou-se uma tendência à redução dos marcadores inflamatórios (PCR e VHS), embora sem significância estatística. Nenhum evento cardiovascular maior foi registrado no período analisado. Conclusão: Os resultados deste estudo sugerem que, em pacientes com AR atendidos em um contexto ambulatorial de reumatologia, o uso de iJAKs ao longo de 12 meses não se associou a alterações significativas no perfil lipídico ou a eventos cardiovasculares. Apesar da tendência de aumento lipídico descrita na literatura, os dados aqui observados apontam para um perfil metabólico globalmente estável.
Context: Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory disease that primarily affects the joints but can also lead to systemic manifestations. Its pathophysiology is associated with the activation of cytokine-mediated inflammatory pathways, contributing to a chronic inflammatory state and increased cardiovascular risk. In recent years, Janus kinase inhibitors (JAK inhibitors or iJAKs) have been introduced as a new class of oral therapy for RA, offering an effective alternative for refractory patients. However, studies have reported changes in the lipid profile associated with these medications, raising concerns about a possible increased risk of cardiovascular events. Objective: To analyze changes in the lipid profile and clinical-laboratory parameters associated with the introduction of JAK inhibitors in the treatment of patients with RA. Methodology: This is a retrospective study based on the analysis of electronic medical records from the rheumatology outpatient clinic at the Mackenzie Evangelical University Hospital (HUEM). The sample included 64 adult patients with RA undergoing treatment with JAK inhibitors. Data collection included clinical, epidemiological, and laboratory information at three time points: initiation of iJAK therapy, 6 months, and 12 months after initiation. Results: The sample consisted predominantly of women (85.9%) with a mean age at diagnosis of 41.1 years. Tofacitinib was the most commonly used iJAK (57.8%), followed by Upadacitinib (21.8%) and Baricitinib (20.3%). No statistically significant changes were observed in total cholesterol, LDL, HDL, or triglyceride levels over the 12-month period. Glycemic and anthropometric parameters also remained stable. A trend toward a reduction in inflammatory markers (CRP and ESR) was noted, although not statistically significant. No major cardiovascular events were recorded during the study period. Conclusion: The results of this study suggest that, in RA patients followed in a rheumatology outpatient setting, the use of JAK inhibitors over a 12-month period was not associated with significant changes in the lipid profile or the occurrence of cardiovascular events. Despite the lipid-increasing trend described in the literature, the data observed here point to an overall stable metabolic profile.
Context: Rheumatoid arthritis (RA) is a chronic autoimmune inflammatory disease that primarily affects the joints but can also lead to systemic manifestations. Its pathophysiology is associated with the activation of cytokine-mediated inflammatory pathways, contributing to a chronic inflammatory state and increased cardiovascular risk. In recent years, Janus kinase inhibitors (JAK inhibitors or iJAKs) have been introduced as a new class of oral therapy for RA, offering an effective alternative for refractory patients. However, studies have reported changes in the lipid profile associated with these medications, raising concerns about a possible increased risk of cardiovascular events. Objective: To analyze changes in the lipid profile and clinical-laboratory parameters associated with the introduction of JAK inhibitors in the treatment of patients with RA. Methodology: This is a retrospective study based on the analysis of electronic medical records from the rheumatology outpatient clinic at the Mackenzie Evangelical University Hospital (HUEM). The sample included 64 adult patients with RA undergoing treatment with JAK inhibitors. Data collection included clinical, epidemiological, and laboratory information at three time points: initiation of iJAK therapy, 6 months, and 12 months after initiation. Results: The sample consisted predominantly of women (85.9%) with a mean age at diagnosis of 41.1 years. Tofacitinib was the most commonly used iJAK (57.8%), followed by Upadacitinib (21.8%) and Baricitinib (20.3%). No statistically significant changes were observed in total cholesterol, LDL, HDL, or triglyceride levels over the 12-month period. Glycemic and anthropometric parameters also remained stable. A trend toward a reduction in inflammatory markers (CRP and ESR) was noted, although not statistically significant. No major cardiovascular events were recorded during the study period. Conclusion: The results of this study suggest that, in RA patients followed in a rheumatology outpatient setting, the use of JAK inhibitors over a 12-month period was not associated with significant changes in the lipid profile or the occurrence of cardiovascular events. Despite the lipid-increasing trend described in the literature, the data observed here point to an overall stable metabolic profile.
Descrição
Palavras-chave
artrite reumatoide , inibidores de Janus Quinase , colesterol , risco cardiovascular , rheumatoid arthritis , Janus Kinase inhibitors , cholesterol , cardiovascular risk