RESUMO
Biopolymer-induced human adjuvant disease (BHAD) is a chronic clinical condition that requires surgical intervention, regardless of the presence of symptoms, to minimize the risk of functional, aesthetic, and systemic sequelae and the development of conditions simulating autoimmune disease. We propose a classification for BHAD on the basis of course of the disease, which will make it possible to assess the damage and difficulty in patients, leading to a more appropriate therapeutic approach. METHODS: A protocol study was implemented. A casuistry of patients with a diagnosis of autoimmune/inflammatory syndrome induced by adjuvants was taken into account according to the Shoenfeld criteria. Qualitative variables were analyzed through frequencies and percentages, and quantitative variables were analyzed with measures of central tendency and dispersion. The diagnostic validity of the signs and symptoms was analyzed using some paraclinical tests. RESULTS: A total of 190 patients diagnosed with autoimmune/inflammatory syndrome induced by adjuvants with biopolymers in the buttocks and who underwent a surgical procedure by the open, masked technique between January 2017 and December 2020 were selected. Considering each sign and symptom, the location of the biopolymers in different planes, and pathophysiology of the clinical course of the disease, a classification was proposed that takes into account diagnostic imaging findings, local clinical signs, systemic symptoms, systemic clinical signs, and autoimmune markers. CONCLUSION: Some signs associated with biomarkers with sensitivity and specificity values can influence the pretest decision to request paraclinicals, improving the diagnostic probability and cost effectiveness in these patients.
RESUMO
Biopolymers consist of non-biocompatible allogeneic materials. They have been associated with autoimmune inflammatory syndrome induced by adjuvants, as described by Yehuda Shoenfeld and Nancy Agmon-Levin. Therefore, this study aimed to evaluate the clinical and immunological characteristics of patients with autoimmune inflammatory syndrome induced by adjuvants treated at a plastic surgery clinic in Colombia. METHODS: This cross-sectional, descriptive observational study included 190 patients with biopolymers in the buttocks with no evidence of autoimmune disease who were diagnosed with autoimmune inflammatory syndrome induced by adjuvants and underwent treatment at a private plastic surgery clinic from 2017 to 2020. The clinical and paraclinical parameters were measured preoperatively, when the diagnosis of autoimmune inflammatory syndrome induced by adjuvants and the need for material removal were established, and postoperatively after 3 months. RESULTS: The most frequent symptoms were myalgia (92%), arthralgia (77.9%), asthenia (77.9%), adynamia (77.9%), and neurological symptoms (55.8%). Preoperatively, patients were positive for antinuclear antibody, lactate dehydrogenase, complement proteins C3 and C4, and lupus anticoagulant. However, after removal of the biopolymer, there was a decrease in positivity or conversion to a negative status of paraclinical tests. Moreover, there was an association between LDH positivity and disease severity (odds ratio: 4.1, 95% confidence interval: 1.94-8.92). CONCLUSIONS: The removal of biopolymers using an open surgical technique in symptomatic or asymptomatic patients is crucial for functional and reconstructive purposes and to improve the quality of life. Therefore, this condition should be known as "human adjuvant disease caused by biopolymers." Further, this condition mimics autoimmune diseases, with clinical and paraclinical manifestations that improve biopolymer removal.
