The antiphospholipid syndrome (APS) is characterized by obstetric and thrombotic complications in the presence of antiphospholipid antibodies. It can happen in an isolated way or in association with diffuse connective tissue diseases, mainly systemic lupus erythematosus. The association of APS with Takayasu arteritis (TA) is rarely described in the literature. We described a case of primary APS in a female patient who developed obstruction in large-size arteries, in spite of the use of oral anticoagulant, and increase of erythrocyte sedimentation rate, suggesting TA. The favorable response to prednisone treatment and later to infliximab reinforced the diagnosis of TA. The present report illustrates the existence of APS associated to TA, whose recognition is very important once the therapeutic strategy is radically different.
Behçet's disease is a chronic inflammatory disease of unknown aetiology, characterized by recurrent oral and genital aphthous ulcerations, uveitis, skin lesions and other multisystem affections associated with vasculitis. Different types of vessels, predominantly veins, can be affected in Behçet's disease. The frequency of vascular lesions in Behçet's disease, such as superficial and deep venous thromboses, arterial aneurysms and occlusions, ranges between 7-29%. Budd-Chiari syndrome is a rare and serious complication of Behçet's disease and implies thrombosis of the hepatic veins and/or the intrahepatic or suprahepatic inferior vena cava. We report a case of a 25-year-old man with Behçet's disease that developed Budd-Chiari syndrome. The correlation of dermatological, pathological and imaging studies confirmed the diagnosis.
OBJETIVO: Apresentar a experiência de uma instituição brasileira no ensino da Reumatologia na graduação médica, cujo projeto pedagógico é estruturado em metodologias ativas de aprendizado. MÉTODOS: Realizou-se um estudo descritivo, com abordagem qualitativa dos conteúdos referentes à Reumatologia no curso de Medicina do Centro Universitário do Estado do Pará (Cesupa). RESULTADOS: O sistema musculoesquelético é abordado no segundo e sétimo semestres, nos módulos referentes ao sistema locomotor e Clínica Médica II, respectivamente, sendo que cada etapa e cada atividade apresentam objetivos específicos mínimos. Além do conteúdo teórico, no sétimo semestre, os alunos realizam atendimentos no ambulatório de Reumatologia, quando existe maior ênfase na elaboração correta de anamnese e exame físico. No internato, os alunos retornam ao ambulatório de Reumatologia e, neste momento, as habilidades de diagnóstico, de investigação e de terapêutica são as mais exigidas. CONCLUSÃO: Ainda há muito para evoluir em busca de um modelo ideal para o ensino da Reumatologia, porém, cumprindo as principais recomendações disponíveis para a boa prática do ensino na graduação, podemos proporcionar ao futuro médico conhecimento, habilidade e experiências capazes de ajudá-lo na condução desses pacientes.
é uma entidade clínica rara, caracterizada pelo surgimento de oligoartrite secundária à infecção pelo Mycobacterium tuberculosis e deve ser sempre componente no diagnóstico diferencial das oligoartrites. O presente artigo aborda um relato de caso de tuberculose pleuropulmonar associado a oligoartrite asséptica de joelhos cujo estabelecimento da terapia empírica contribuiu para resolução do quadro articular.
A 63-year-old non-smoker woman with a 15 years history of rheumatoid arthritis characterized by erosive poliarthrtitis, rheumatoid factor elevated titers, and positive testing for anti-CCP antibodies. The treatment included methotrexate, prednisolone and hydroxicloroquine. Despite of treatment, developed isquemic ulcer at left hand dorsum and nailfod infarction and digital ischemia of the left fingers [1].Rheumatoid vasculitis is an inflammatory process that primarily affects small to medium-sized vessels. It's highly heterogeneous clinically, with wide-spread organ involvement. The incidence has declined in the past several decades, but cutaneous remains the most common presentation. It tipically occurs in patients with long-standing erosive deforming Rheumatoid Arthritis, and its manifestation is heterogeneous, dependeing the size of the blood vessel. The skin can present purpura, nailfold infarcts, digital gangrene and cutaneous ulcers [2].The photographs demonstrates a typical rheumatoid hand, with ulnar deviation, atrophy of interosseous muscles, metacarpophalangeal subluxation, and deformities (swan's neck and boutonnière). there are two forms of rheumatoid vasculitis, represented by ulceration in the area of the third metacarpophalangeal joint and periungual infarction in the second one, as well as the discrete points of ischemia in the digital pulps. This image reflects the heterogeneity of the clinical presentations of this single entity (Figures 1 and 2) [3].
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