Résumé
Abstract Background Nail involvement is frequent in patients with psoriasis (Pso) and psoriatic arthritis (PsA) and there is a relationship between nail involvement and inflammation of the enthesis. The main objective of the present study is to describe the ultrasound findings and clinical characteristics of nails from patients with psoriasis and psoriatic arthritis with and without nail dystrophy. Methods A cross-sectional study including consecutive patients with PsO and PsA was carried out. The study patients were divided into 4 groups, totaling 120 participants. Group 1: patients with psoriasis vulgaris and clinically normal nails; Group 2: patients with psoriasis vulgaris and onychodystrophy; Group 3: patients with psoriatic arthritis and clinically normal nails; Group 4: patients with psoriatic arthritis and onychodystrophy; All patients were submitted to dermatological and rheumatological clinical analysis. Ultrasound examinations was performed by a single examiner, blinded to all clinical data, with ultrasound high resolution, in B-mode or gray-scale (GS), Power Doppler (PD) and Spectral Doppler. Results A significant difference was found between the groups regarding the variable Psoriasis Area and Severity Index (PASI) (p = 0.008) and body surface area (BSA) (p = 0.005), with patients with psoriatic arthritis having lower PASI and BSA compared to patients with only cutaneous psoriasis. A positive relationship was found with the average ultrasound thickness of the nail bed and the Nail Psoriasis Severity Index (NAPSI) in correlation analysis (rho = 0.344). When we grouped patients with psoriasis and psoriatic arthritis, there was no significant difference between the cutaneous psoriasis groups and the psoriatic arthritis groups in terms of nail plate GS (p = 0.442), nail bed PD (p = 0.124). Conclusion Greater nail bed thickness indicates early psoriatic nail disease, as confirmed in our study correlating NAPSI with nail bed thickness. Ultrasonography is a low-cost exam, promising in the evaluation, showing that the ultrasound grayscale is consistent with those who have dystrophic nails, but it can't distinguish psoriasis from psoriatic arthritis, even in those with nail dystrophy.
Résumé
Descrevemos um caso de paciente com lúpus eritematoso sitêmico (LES) com infecção pulmonar oportunista por Paracoccidioides brasiliensis, diagnosticado através de biópsia pulmonar, com boa resposta ao tratamento específico com itraconazol. Discutimos as infecções fúngicas em paciente com LES, sua importância diagnóstica e tratamento adequado
We describe a case of a systemic lupus erythematosus (SLE) pacient with opportunistic pulmonary infection from Paracoccidioides brasiliensis, which was diagnosed by pulmonary biopsy and with a good response for especific treatment with Itraconazole. The fungal infections, their diagnostic importance and adequate treatment were discussed in a patient with SLE
Résumé
Nodular sclerosis is a rare form of presentation related to both systemic and localized forms of scleroderma. We describe the case of a patient with nodular sclerosis in order to alert the medical community to recognize this entity.
Esclerose nodular é uma forma de apresentação cutânea rara relacionada tanto com a forma sistêmica como com a forma localizada da esclerodermia. Descrevemos aqui o caso de uma paciente esta forma nodular de esclerose, no sentido de alertar a comunidade médica para o reconhecimento dessa entidade.
Sujets)
Adulte , Femelle , Humains , Chéloïde/anatomopathologie , Sclérodermie systémique/anatomopathologie , Biopsie , Peau/anatomopathologieRésumé
BACKGROUND: It has been observed that patients with systemic lupus erythematosus and discoid lesions have a milder systemic disease. OBJECTIVE: To compare the clinical, demographic and autoantibody profile of systemic lupus erythematosus patients with and without discoid lesions. METHODS: We carried out a retrospective study involving 288 systemic lupus erythematosus patients who met at least four classification criteria of the American College of Rheumatology for systemic lupus erythematosus, comparing the clinical, serological and demographic factors between patients with and without discoid manifestations. RESULTS: Of the 288 patients, 13.8% had discoid lesions. Univariate analysis found no differences in the prevalence of malar rash, photosensitivity, arthritis, serositis, leukopenia, lymphopenia and hemolytic anemia or anemia of the central nervous system (p = ns). Renal lesions were more common in those without discoid lesions (p =0.016), and hemolysis (p<0.0001) was more common in those with discoid lesions. Regarding the profile of autoantibodies, only the anti-RNP antibody was more common in those with discoid events (p =0.04). In a logistic regression study, only the renal lesions and anti-RNP maintained their associations with discoid manifestations. CONCLUSION: Patients with lesions of systemic lupus erythematosus and discoid lesions have lower prevalence of renal involvement and a greater presence of anti RNP. .
FUNDAMENTOS: Existe a observação de que pacientes com lúpus eritematoso sistêmico e lesões discoides têm uma doença sistêmica mais branda. OBJETIVO: Comparar o perfil clínico, demográfico e de autoanticorpos de pacientes com lúpus eritematoso sistêmico com e sem lesões discoides. MÉTODOS: Estudo retrospectivo de 288 pacientes com lúpus eritematoso sistêmico que satisfizeram pelo menos 4 critérios classificatórios do Colégio Americano de Reumatologia para o diagnóstico de lúpus eritematoso sistêmico, comparando-se os achados clínicos, sorológicos e demográficos entre pacientes com e sem manifestações discoides. RESULTADOS: Dos 288 pacientes, 13,8% tinham lesões discoides. Na análise univariada não se encontraram diferenças quanto à prevalência de eritema malar, fotossensibilidade, artrite, serosite, leucopenia, linfopenia e anemia hemolítica ou de sistema nervoso central (p=ns). Lesões renais foram mais comuns naqueles sem lesão discoide (p =0,016), e a hemólise (p<0.0001) foi mais comum nos com lesão discoide. No que se refere ao perfil de autoanticorpos apenas o anticorpo anti-RNP foi mais comum naqueles com manifestações discoides (p=0,04). Em estudo por regressão logística, só as lesões renais e o anticorpo anti-RNP mantiveram suas associações com manifestações discoides. CONCLUSÃO: Pacientes de lúpus eritematoso sistêmico com lesões discoides têm menor prevalência de envolvimento renal e uma maior presença do anticorpo anti RNP. .