Objetivo: analisar o padrão de doença de pacientes brasileiros com espondiloartropatias (EAP). Pacientes e Métodos: foram avaliados 156 pacientes por meio de análise descritiva e análise de associação uni e multivariada entre a distribuição das manifestações clínicas, laboratoriais e radiográficas e a presença do HLA-B27. Resultados: as doenças do grupo identificadas foram a espondilite anquilosante -EA (48,10%), a espondiloartropatia indiferenciada (20,51%), a artrite reativa -ARe (15,39%), a artrite psoriásica -AP (14,10%) e a artropatia das doenças inflamatórias intestinais (1,92%). O HLA-B27 foi positivo em 53,85% dos pacientes. O HLA-B27 positivo associou-se ao acometimento clínico e/ou radiográfico das articulações sacroilíacas (p=0,007; OR=3,13; IC 95% 1,38 a 7,06), à presença de sacroiliíte radiográfica ≥ grau II bilateral (p=0,05; OR=2,85; IC 95% 1,02 a 8,04) e ao sexo masculino (p=<0,001; OR=3,00; IC 95% 1,83 a 4,92), enquanto indivíduos com o HLA-B27 negativo apresentaram, significativamente, mais balanite como manifestação evolutiva que indivíduos HLA-B27 positivos (p=0,03; OR=0,21; IC 95% 0,05 a 0,88). Conclusão: as manifestações clínicas, laboratoriais e radiográficas foram semelhantes às descritas em outros trabalhos. O HLA-B27 apresentou-se em baixa freqüência, quando comparado com outras amostras, e ocorreram associações entre este antígeno e o sexo masculino e o envolvimento das articulações sacroilíacas. , Ricardo da Cruz Lage (2) , Gilda Aparecida Ferreira ABSTRACT Objective: to evaluate disease manifestations of Brazilian patients with spondyloarthropathies. Methods: a group of 156 patients was studied in a descriptive evaluation the analysis of the association between clinical, laboratory and radiographic aspects and the presence of the HLA-B27 was done. Results: the following diseases were identified: ankylosing spondylitis (48.10%), undifferentiated spondyloarthropathy (20.51%), reactive arthritis (15.39%), psoriatic arthritis (14.10%) and inflammatory bowel disease arthropathy (1.92%). The HLA-B27 was identified in 53.85%. HLA-B27 presence was associated with clinical and/or radiographic findings of sacroiliac joints involvement (p=0.007; OR=3.13; CI 95% 1.38 to 7.06), with the presence of radiographic bilateral sacroiliitis ≥ grade II, bilateral (p=0.05; OR=2.85; IC 95% 1.02 to 8.04) and with male gender (p=<0.001; OR=3.00; CI 95% 1.83 to 4.92). On the other hand, negative HLA-B27 was significantly associated with the occurrence of balanitis during the course of the disease (p=0.03; OR=0.21; IC 95% 0.05 to 0.88). Conclusion: clinical, laboratory and radiographic manifestations were similar to those reported by other studies. The frequency of HLA-B27 was low when compared to other studies. A significant association was observed between the HLA-B27 and gender as well as compromised sacroiliac joints. Palavras
RESUMO -Relatamos o caso de uma paciente, de 36 anos de idade, que desenvolveu quadro de coréia após dois meses do início do uso de anticoncepcional oral, acompanhando-se, posteriormente, de trombocitopenia, úlcera mucosa em cavidade oral, artrite, positividade para os anticorpos antinuclear (.AN), anti-DNA e antiSm, preenchendo critérios para lúpus eritematoso sistêmico, segundo o Colégio Americano de Reumatologia. A pesquisa para os anticorpos anticoagulante lúpico e anticardiolipina (IgG e IgM) foi negativa. A paciente foi tratada com prednisona, fenitoína, fenobarbital e clonazepam, obtendo melhora clínica e laboratorial. Discutimos a ocorrência da coréia e outros movimentos anormais como primeira manifestação do lúpus eritematoso sistêmico, sua relação com os anticoncepcionais orais e os anticorpos antifosfolípides.PALAVRAS-CHAVES: lúpus eritematoso sistêmico, coréia, anticoncepcionais orais, anticorpos antifosfolípides. Involuntary movement disorders as first manifestation of systemic lupus erythematosus: case reportABSTRACT We describe a 36 year-old woman who developed chorea two months after starting the use of oral contraceptives. She also developed thrombocitopenia, oral ulcers, arthritis, positive antinuclear antibodies (ANA), anti-Sm and anti-DNA, filling criteria for sistemic lupus erythematosus, as defined by the American College of Rheumatology. The tests for lupus anticoagulant and anticardiolipin (IgG and IgM) were negative. The patient was treated with prednisone, phenitoin, phenobarbital and clonazepam, obtaining clinical and laboratorial improvement. We discuss the ocurrence of chorea and other movement disorders as first manifestation of systemic lupus erythematosus, its relationship with oral contraceptives and antiphospholipid antibodies.KEY WORDS: systemic lupus erythematosus, chorea, oral contraceptives, antiphospholipids antibodies. As manifestações neurológicas no lúpus eritematoso sistêmico (LES) são comuns, ocorrendo em 14 a 75% dos pacientes 1 . Ao contrário do que ocorre com a cefaléia e o acidente vascular cerebral, a coréia é infrequente, incidindo em menos de 4% dos casos, usualmente acompanhada de outros sintomas de disfunção do sistema nervoso central 2 e, raramente, como primeira manifestação da enfermidade. A coréia pode também ocorrer como manifestação da síndrome antifosfolípide primária 3,4 ou como efeito colateral do uso dos anticoncepcionais orais [5][6][7] . Descrevemos um caso clínico onde a coréia foi a primeira manifestação do LES, em paciente com história pregressa de uso recente de anticontraceptivo hormonal, e pesquisa para anticorpos antifosfolípide negativa. CASOMulher de 36 anos, assintomática até dezembro de 1999, quando passou a apresentar movimentos involuntários e repetitivos da cabeça para o lado esquerdo, associados a febre, linfadenomegalia cervical e submandibular. Evoluiu com aparecimento de movimentos nos membros superiores e inferiores, alucinações visuais e idéias persecutórias, tendo sido internada pela Clínica Médica, inici-
The aim of the present study was to describe the outcomes of Brazilian patients with undifferentiated spondyloarthritis during an eight-year follow-up period. Patients fulfilling the European Spondyloarthritis (SpA) Study Group Classification Criteria were enrolled. Forty patients were seen at baseline, and 36 participated in the follow-up study. Twenty-three (58%) were female, and there were 24 (60%) African Brazilians enrolled. HLA-B27 was positive in 18 (45%) patients. At disease onset, the first presenting symptoms were pure peripheral manifestations in 26 (72.2%) patients. After the study period, mixed disease (axial + peripheral) predominated occurring in 25 (69.4%) patients. The Assessment of SpA International society (ASAS) classification criteria for axial SpA were fulfilled by 77% of patients, and the ASAS criteria for peripheral SpA were fulfilled by 59% of patients. After 2.5 years, 6 (16.7%) of the 36 patients fulfilled the modified New York Criteria for ankylosing spondylitis and 1 (2.7%) progressed to psoriatic arthritis. A total of 10 (27.8%) patients progressed to definite SpA during the eight-year study period. Buttock pain (p = 0.006, OR 10.55; 95% CI 2.00-65.90) and low-grade radiographic sacroiliitis (p = 0.025, OR = 11.50; 95% CI 1.33-83.39) at baseline were associated with definite SpA. Thus, in this Brazilian cohort, which had a predominance of female African-Brazilian patients, prevalent peripheral onset symptoms were followed by a high frequency of axial manifestations during the follow-up period. Evidence of clinical or radiological sacroiliitis was associated with progression to definite SpA.
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