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Doctoral Thesis
DOI
https://doi.org/10.11606/T.5.2018.tde-11012018-093801
Document
Author
Full name
Paula Angela D'Oliveira Araújo
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2017
Supervisor
Committee
Shinjo, Samuel Katsuyuki (President)
Fuller, Ricardo
Reis Neto, Edgard Torres dos
Sallum, Adriana Maluf Elias
Title in Portuguese
Alterações metabólicas em síndrome antissintetase
Keywords in Portuguese
Diabetes mellitus
Dislipidemias
Doenças autoimunes
Doenças cardiovasculares
Doenças musculares
Hipertensão
Miosite
Abstract in Portuguese
Objetivos. Alta prevalência de síndrome metabólica (SM) tem sido descrita recentemente em diferentes miopatias inflamatórias idiopáticas, mas não em síndrome antissintetase (SAS). Portanto, avaliamos a frequência de SM em SAS e a associação de SM com os fatores de risco de doenças cardiovasculares e as características da doença relacionada à SAS. Métodos. Trata-se de um estudo transversal, único centro, no qual 42 pacientes consecutivos com SAS foram pareados por sexo, idade, etnia e índice de massa corporal com 84 indivíduos saudáveis, no período de 2012 a 2015. Todos os pacientes apresentavam pelo menos quatro dos cinco itens dos critérios de Bohan e Peter (1975) e também os seguintes sinais e/ou sintomas no início da doença: artrite, acometimento pulmonar, fenômeno de Raynaud, febre, "mãos de mecânico" e autoanticorpos antissintetases. O status da SAS foi avaliado, baseando-se nos questionários de International Myositis Assessment and Clinical Studies Group (IMACS). Os dados clínicos, laboratoriais e terapêuticos foram coletados por meio de um protocolo padronizado. A SM foi definida de acordo com a Joint Interim Statement de 2009. A análise de adipocitocinas séricas (adiponectina, leptina e resistina) foi feita através de método padronizado, enquanto que a análise de resistência insulínica foi realizada através do método de Homeostatic Model Assessment (HOMA). Resultados. A idade mediana dos pacientes com SAS foi de 41,1 anos, com predominância de etnia branca e de sexo feminino. Os pacientes apresentaram prevalência maior de SM (42,9% vs. 13,1%; P < 0,001) e valor maior de resistência insulínica, quando comparados ao grupo controle. Além disso, os pacientes apresentaram maior nível sérico de resistina, em contraste com um menor nível de leptina e similar de adiponectina, quando comparado ao grupo controle. Em uma análise adicional, quando foram comparados os pacientes com SM (N=18) e sem (N=24) SM, os primeiros apresentavam maior idade (48,7 vs. 35,4 anos; P < 0,001), com duração semelhante da doença, status da doença, esquema terapêutico, resistência insulínica e nível sérico de adipocitocinas. Conclusões. Maior frequência de SM e maior valor de resistência insulínica foram observados em pacientes com SAS, com alto nível sérico de resistina e baixo nível de leptina. Além disso, os pacientes de SAS com SM apresentavam idade mais avançada, a exemplo do que ocorrem com outras miopatias inflamatórias idiopáticas com SM
Title in English
Metabolic alterations in antisynthetase syndrome
Keywords in English
Autoimmune diseases
Cardiovascular diseases
Diabetes mellitus
Dyslipidemias
Hypertension
Muscle diseases
Myositis
Abstract in English
Objectives. A high frequency of metabolic syndrome (MetS) has been recently described in different idiopathic inflammatory myopathies, but not for antisynthetase syndrome (ASS). Therefore, we determined the prevalence of MetS in ASS and the association of MetS with the risk factors of cardiovascular diseases and with ASS-related disease characteristics. Methods. A cross-sectional single center study of 42 consecutive patients with ASS was conducted from 2012 to 2015. For the control group, 84 healthy individuals were matched with patients for gender, age, ethnicity and body mass index-matched, in the same period. All patients had at least four of five items of Bohan and Peter's criteria (1975) and also the follow signal and/or symptoms at onset of disease: arthritis, pulmonary involvement, Raynaud's phenomenon, fever, "mechanics' hands" and antisynthetase autoantibodies. The disease status was defined, basing on the International Myositis Assessment and Clinical Studies Group (IMACS) questionnaires. Clinical, laboratory and treatment data were collected using a standardized protocol. MetS was defined according to the 2009 Joint Interim Statement. The serum adipocytokine analysis (adiponectin, leptin and resistin) was performed by standardized method, whereas the insulin resistance was performed by Homeostatic Model Assessment (HOMA) method. Results. ASS patients had a median age of 41.1 years and were predominantly female and of white ethnicity. The patients had a higher frequency of MetS (42.9% vs. 13.1%; P < 0.001) and of insulin resistance than controls. Moreover, patients had higher resistin, lower leptin and similar adiponectin levels in serum than controls. Further analysis of the ASS patients with (N=18) and without (N=24) MetS revealed that individuals with the syndrome were older (48.7 vs. 35.4 years; P < 0.001) age at disease onset and had similar disease duration, disease status, treatment, insulin resistance and serum adipocytokine levels. Conclusions. The prevalence of MetS was high in patients with ASS, who also had serum resistin and low leptin levels. Moreover, ASS patients with MetS were older at disease onset, mirroring findings seen in other idiopathic inflammatory myopathies
 
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Publishing Date
2018-01-11
 
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