ABSTRACT
INTRODUÇÃO: O fenômeno de Raynaud (FR) é uma isquemia acral recorrente resultante de resposta vasoespástica arterial anormal ao frio ou ao estresse emocional. A homocisteína, um aminoácido sulfurado, foi relacionada a doenças cardiovasculares e neurodegenerativas, diabetes mellitus, trombose e fragilidade óssea. Também foi relacionada à patogênese do FR, por terem sido observadas elevações nos níveis séricos de homocisteína (S-homocisteína) em pacientes com FR. OBJETIVO: Considerando que todas as publicações concernentes à S-homocisteína em casos de FR envolviam apenas pacientes adultos, o objetivo deste estudo foi avaliar a S-homocisteína em crianças e adolescentes com FR. MÉTODOS: Foram recrutados 19 pacientes (dois meninos e 17 meninas; idade média 16,1 ± 2,2 DP) com FR primário. Como controles, foram recrutados 51 crianças e adolescentes (21 meninos e 30 meninas; idade média 15,1 ± 1,8 DP). RESULTADOS: O nível de S-homocisteína estava significativamente mais elevado no grupo FR, em comparação com os controles (11,2 ± 2,4 vs. 8,0 ± 2,0 µmol/L; P = 0,00001). Os níveis de S-homocisteína nos participantes com FR não dependeram da idade. CONCLUSÃO: Pacientes pediátricos com FR apresentam níveis elevados de S-homocisteína, sugerindo que a homocisteína desempenha papel importante no desenvolvimento da disfunção vascular, mesmo em pacientes muito jovens.
INTRODUCTION: Raynaud's phenomenon (RP) is a paroxysmal and recurrent acral ischemia resulting from an abnormal arterial vasospastic response to cold or emotional stress. Homocysteine, a sulphured amino acid, has been linked to cardiovascular and neurodegenerative diseases, diabetes, thrombosis, and bone fragility. Homocysteine has been also linked to the pathogenesis of RP, as increased serum homocysteine (S-homocysteine) levels were observed in patients with RP. OBJECTIVE: As all publications concerning S-homocysteine in RP involved only adult patients, our aim was to evaluate S-homocysteine in children and adolescents with RP. METHODS: Nineteen patients (two boys and 17 girls; mean age 16.1 ± 2.2 SD) with primary RP were enrolled. The controls were 51 children and adolescents (21 boys and 30 girls; mean age 15.1 ± 1.8 SD). RESULTS: The S-homocysteine level was significantly higher in the RP group in comparison with controls (11.2 ± 2.4 vs. 8.0 ± 2.0 µmol/L; P = 0.00001). S-homocysteine levels in RP were not age-dependent. CONCLUSION: Paediatric patients with RP have increased S-homocysteine levels, suggesting that homocysteine plays an important role in the development of vascular dysfunction, even at an early age.
Subject(s)
Adolescent , Child , Female , Humans , Male , Young Adult , Homocysteine/blood , Raynaud Disease/bloodABSTRACT
BACKGROUND: Raynaud's phenomenon (RP) and anticardiolipin antibodies (ACL) are two common clinical manifestations in patients with systemic lupus erythematosus (SLE). RP may lead to digital or limb loss. ACL are associated to thrombotic episodes. It is not yet clear if there is an association between RP and the presence of ACL in patients with SLE. OBJECTIVES: To study if the presence of both RP and ACL in patients with SLE may be associated with certain clinical manifestations or thrombotic events compared to SLE patients without RP or ACL. METHODS: SLE patients from two lupus clinics were recruited. The patients were divided into 4 groups. Patients with RP and positive ACL (RP+ ACL+), patients with RP but negative ACL (RP+ ACL-), patients with negative RP and positive ACL (RP- ACL+), and patients that were negative for RP and ACL (RP- ACL-) used as the control group. Demographic data, diagnostic criteria, clinical manifestations, history of arterial thrombosis, venous thrombosis and abortions were recorded. A physical examination was done. Anticardiolipin antibodies IgG and IgM were done in the rheumatology laboratory at the University of Puerto Rico School of Medicine. Descriptive statistics as well as analysis of variances (ANOVA), and polytomous logistic regression were used. RESULTS: 236 patients with SLE were studied. There was a tendency toward an increase in arterial thrombosis (p-value = 0.094) and venous thrombosis (p-value = 0.067) in the group that were positive for RP and ACL (RP+ ACL+). Although it was not statistical significant, when polytomous logistic regression was used, both arterial and venous thrombosis had an increase in relative risk 3.21 for arterial and 3.11 for venous thrombosis. Abortions were not increased in any of the four groups. Clinical manifestations from SLE did not differ among the four groups. CONCLUSIONS: Patients with both RP and ACL seem to be at an increase risk for both arterial and venous thrombotic events; these patients may benefit from an antiplatelet medication to prevent these events to occur.