Long-term thalidomide use in refractory cutaneous lesions of systemic lupus erythematosus

Objective. To evaluate the efficacy of long-term thalidomide treatment in cutaneous lesions os systemic lupus erythematosus (SLE), not responsive to conventional therapy. Patients and Methods. Were selected 18 SLE patients (ACR criteria) with active cutaneous lesions not responsive to chloroquine, photoprotectors and low doses prednisone and who presented good response to thalidomide but relapsed after withdrawal of the drug. All female patients had no risk of pregnancy. Thalidomide was reintroduced and maintained at low dose (25-100 mg/day) for a minimum of 6 months. Results. Eighteen patients (16 females) with mean age of 34.2yo (16-57y.o.) received thalidomide for 6-21 months (mean 8.5m). The mean dose of prednisone at beginning of study was 38.3 mg/d and at the end was 9.7 mg/d (p<0.05). Complete remission of cutaneous lesions was observed in thirteen patients (72 per cent) and partial remission in five (28 per cent). Side effects observed were: drowsiness in eight patients, intestinal constipation in 5, transient oliguria in 1, paresthesia of hand with normal electromyography in another one. All side effects disappeared with reduction of thalidomide dose and no patient needed to stop treatment owing to side effect. Conclusion. Thalidomide is a good alternative therapy to SLE patients with refractory cutaneous lesions and without any risk of pregnancy.

Estudo da reprodutibilidade e validade do índice de atividade do lúpus eritematoso sistêmico / Reproductibility and validity study of activity index of systemic lupus erythematosus

Com o objetivo de testar a reprodutibilidade e validade do índice de atividade do LES (SLEDAI), foram feitas análises de correspondência dos escores obtidos através da aplicaçäo do SLEDAI e da avaliaçäo global subjetiva em 46 pacientes com LES, encontrando-se correlaçäo de Pearson de 0,722 (p < 0,05). Em 23 dos pacientes a correspondência das avaliaçöes globais feitas por dois diferentes reumatologistas mostrou correlaçäo de 0,831 (p < 0,05), enquanto a correlaçäo entre os escores obtidos por dois outros pesquisadores, de forma independente, utilizando o SLEDAI em 20 pacientes, foi de 0,942 (p < 0,05). Conclui-se que o SLEDAI é um bom método para se avaliar a atividade do LES e apresenta boa reprodutibilidade e boa correlaçäo com avaliaçäo subjetiva