RESUMO
To our knowledge, only three cases of remitting symmetrical pitting oedema in systemic lupus erythematosus have been reported so far. This is the first report of two patients with asymmetrical pitting oedema and systemic lupus erythematosus. The first patient presented two consecutive episodes of unilateral oedema. The first episode involved the distal part of the right lower extremity and remitted spontaneously while the second involved the volar region of the left wrist and distal half of the forearm and promptly responded to steroids. Magnetic resonance imaging of the left wrist and forearm showed tenosynovitis of the flexor tendons and subcutaneous oedema. The second patient instead developed a single episode of pitting oedema of the distal part of the right lower extremity that resolved spontaneously. Magnetic resonance imaging of the right ankle and foot showed subcutaneous oedema without involvement of the tendon sheaths or osteoarticular and ligamental structures. These two cases suggest that pitting oedema in systemic lupus erythematosus may occasionally be asymmetric and associated or not with tenosynovitis.
Assuntos
Edema/etiologia , Edema/patologia , Lúpus Eritematoso Sistêmico/complicações , Adulto , Tornozelo/patologia , Tornozelo/fisiopatologia , Ciclosporina/administração & dosagem , Progressão da Doença , Quimioterapia Combinada , Edema/tratamento farmacológico , Feminino , Lateralidade Funcional/fisiologia , Humanos , Imageamento por Ressonância Magnética , Metotrexato/administração & dosagem , Prednisona/administração & dosagem , Remissão Espontânea , Resultado do Tratamento , Punho/patologia , Punho/fisiopatologiaRESUMO
Alpha-interferon (alpha-IFN) therapy may induce, reveal or exacerbate various autoimmune-related disorders. The most common is the development of autoantibodies, while clinically overt autoimmune diseases are rare. We describe a 49-year-old woman who developed seronegative rheumatoid-like arthritis and autoimmune hypothyroidism after 7 months of human lymphoblastoid alpha-IFN therapy given for hepatitis C virus-related chronic active hepatitis (CAH-HCV). There was no family or personal history of autoimmune, thyroid or articular diseases. Our patient required continuous therapy for arthritis and hypothyroidism despite discontinuation of alpha-IFN. This suggests that alpha-IFN therapy may induce the contemporary appearance of two different persistent autoimmune-related diseases in the same patient. However, chronic HCV infection may play an important adjuvant role in the development of these diseases.
Assuntos
Antivirais/efeitos adversos , Artrite Reumatoide/induzido quimicamente , Hepatite C/terapia , Hipotireoidismo/induzido quimicamente , Interferon-alfa/efeitos adversos , Antivirais/uso terapêutico , Artrite Reumatoide/imunologia , Autoanticorpos/análise , Doença Crônica , Feminino , Humanos , Hipotireoidismo/imunologia , Interferon-alfa/uso terapêutico , Pessoa de Meia-Idade , Tireoglobulina/imunologia , Testes de Função TireóideaRESUMO
RS3PE syndrome (Remitting Seronegative Symmetrical Synovitis with Pitting Edema) is a new form of arthritis in the elderly, characterized by symmetrical polysynovitis of acute onset associated with distal pitting edema. Tests for serum IgM rheumatoid factor are typically negative. RS3PE syndrome affects Caucasians aged over 60, predominantly males. It has a benign course and remits completely without residua.
