O estado da arte das síndromes autoinflamatórias associadas à criopirina / The state of the art of cryopyrin-associated periodic syndromes

As síndromes autoinflamatórias associadas à criopirina (CAPS) compreendem um grupo espectral de doenças raras autoinflamatórias. Todas estas doenças estão relacionadas ao inflamassoma NLRP3, sendo que de 50-60% dos pacientes apresentam mutações ao longo do gene NLRP3. Clinicamente, febre recorrente associada à urticária neutrofílica e outros sintomas sistêmicos são o grande marco clínico, comum a todo o espectro. O bloqueio da interleucina-1 trouxe grande alívio ao tratamento destas desordens, mas variações na resposta clínica podem ser observadas, principalmente nos espectros mais graves. Neste trabalho os autores trazem uma revisão do estado da arte das doenças autoinflamatórias CAPS. Foi realizado levantamento de literatura e, ao final, 49 artigos restaram como base para construção do texto final. O trabalho traz de forma narrativa os principais pontos relacionados a imunofisiopatologia, manifestação clínica, diagnóstico, tratamento, complicações e novas armas diagnósticas, e terapia gênica.

Cryopyrin-associated periodic syndromes (CAPS) comprise a spectrum of rare autoinflammatory disorders. They are all related to the NLRP3 inflammasome, and 50-60% of the patients harbor mutations along the NLRP3 gene. Clinically, recurrent fever associated with neutrophilic urticaria and other systemic symptoms are a hallmark of all the disorders in the spectrum. Biologic drugs that can block interleukin-1 were a milestone for the treatment of such rare diseases, although variability in clinical response to this therapeutic intervention were observed, especially in those affected by severe phenotypes. In this paper, the authors provide a state-of-the-art review of CAPS. A literature search was performed and, finally, 49 articles remained for the construction of the final manuscript. The article presents a narrative review focused on the topics related to immune pathophysiology, clinical manifestations, diagnosis, treatment, complications and new therapeutic options, and gene therapy.

Doenças autoinflamatórias em adultos: abordagem prática ao diagnóstico baseada em um caso clínico / Autoinflammatory diseases in adults: practical approaches to diagnosis based on a clinical case

As doenças autoinflamatórias são doenças inflamatórias raras cujo cerne imunológico baseia-se na imunidade inata. A maioria das doenças autoinflamatórias tem início na idade pediátrica, mas pouco se sabe sobre as doenças que se iniciam na vida adulta. O diagnóstico é feito por exclusão, e, quando possível, com auxílio de técnicas moleculares. Este artigo tem como objetivo relatar um caso de doença autoinflamatória de início na vida adulta e a partir dele estabelecer fluxograma de auxílio ao diagnóstico.

Autoinflammatory diseases are rare inflammatory conditions whose immunopathology relies essentially on innate immunity. The majority of autoinflammatory diseases have their onset in childhood, but little is known about diseases that initiate in adulthood. Diagnosis is made by exclusion and with the aid of molecular techniques whenever possible. This article describes a case of autoinflammatory disease that started in adulthood, and aims to propose a flowchart to aid in the diagnosis of these conditions.

Síndromes periódicos asociados a criopirina: etiopatogenia, características clínicas, diagnóstico y tratamiento / Cryopiryn-associated peryodic syndrome: etiopathogenesis, clinical features, diagnosis and treatment

Los desórdenes autoinflamatorios monogénicos comprenden un grupo de enfermedades caracterizadas por episodios recurrentes y espontáneos de fiebre e inflamación sistémica, en ausencia de infección, autoanticuerpos o células T específicas para antígenos propios (autorreactivas). Estas condiciones se deben a mutaciones en genes que codifican para proteínas que son claves en la regulación de la respuesta inflamatoria innata y se consideran como inmunodeficiencias primarias. Las enfermedades que comprenden estos síndromes representan un espectro clínico de diferentes mutaciones, con ganancia de función, de un gen denominado NLRP3 o CIAS1 que codifica para la proteína criopirina, de ahí que estos desórdenes sean también conocidos con el nombre de criopirinopatías. Dentro de estos se encuentran los síndromes periódicos asociados a criopirina que incluyen tres enfermedades: el síndrome autoinflamatorio familiar inducido por frío; el síndrome de Muckle-Wells y el síndrome crónico, infantil, neurológico, cutáneo y articular. Clínicamente se caracterizan por rash tipo urticariano, fiebre periódica, inflamación a nivel del sistema nervioso central, artropatía, manifestaciones oculares y riesgo de amiloidosis como complicación a largo plazo. La función clave de la criopirina en la liberación de la IL-β sugiere el criterio racional de implementar terapias anti-IL-1 para el tratamiento de estos síndromes. La administración de drogas como anakinra, canakinumab y rilonacept muestra un efecto marcado sobre el control de las manifestaciones inflamatorias, clínicas y de los parámetros de laboratorio en estos síndromes. Se describe la etiopatogenia de estas entidades, sus principales características clínicas, el diagnóstico y el tratamiento(AU)

Monogenic autoinflammatory disorders encompass a group of diseases characterized by spontaneous and recurring fever and systemic inflammation in the absence of infection, autoantibodies or specific T cells for self antigens (self-reactive). These conditions are caused by mutations in genes encoding proteins that play a key role in the regulation of innate inflammatory response and are considered primary immunodeficiencies. Diseases comprising these syndromes represent a different clinical spectrum of mutations, with gain of function of a gene called NLRP3 or CIAS1 encoding cryopyrin protein, hence these disorders are also known under the name cryopyrinpathies. Among these are the cryopyrin-associated periodic syndrome which include three conditions: familial cold autoinflammatory syndrome; Muckle-Wells syndrome and chronic infantile neurological, cutaneous and articular syndrome. In clinical terms, it is characterized by urticarial rash, periodic fever, inflammation of central nervous system (CNS), arthropathy, ocular manifestations and risk of amyloidosis as a long-term complication. The key role of cryopirin in the release of IL-β suggests rational approach to implement anti-IL-1 therapy for the treatment of these syndromes. The administration of drugs such as anakinra, canakinumab, and rilonacept shows a marked effect on the control of inflammatory manifestations, as well as clinical and laboratory parameters in these syndromes effect. The pathogenesis of these entities, as well as their main clinical features, diagnosis and treatment are described(AU)

Síndromes periódicos asociados a criopirina: etiopatogenia, características clínicas, diagnóstico y tratamiento / Cryopiryn-associated peryodic syndrome: etiopathogenesis, clinical features, diagnosis and treatment

Los desórdenes autoinflamatorios monogénicos comprenden un grupo de enfermedades caracterizadas por episodios recurrentes y espontáneos de fiebre e inflamación sistémica, en ausencia de infección, autoanticuerpos o células T específicas para antígenos propios (autorreactivas). Estas condiciones se deben a mutaciones en genes que codifican para proteínas que son claves en la regulación de la respuesta inflamatoria innata y se consideran como inmunodeficiencias primarias. Las enfermedades que comprenden estos síndromes representan un espectro clínico de diferentes mutaciones, con ganancia de función, de un gen denominado NLRP3 o CIAS1 que codifica para la proteína criopirina, de ahí que estos desórdenes sean también conocidos con el nombre de criopirinopatías. Dentro de estos se encuentran los síndromes periódicos asociados a criopirina que incluyen tres enfermedades: el síndrome autoinflamatorio familiar inducido por frío; el síndrome de Muckle-Wells y el síndrome crónico, infantil, neurológico, cutáneo y articular. Clínicamente se caracterizan por rash tipo urticariano, fiebre periódica, inflamación a nivel del sistema nervioso central, artropatía, manifestaciones oculares y riesgo de amiloidosis como complicación a largo plazo. La función clave de la criopirina en la liberación de la IL-β sugiere el criterio racional de implementar terapias anti-IL-1 para el tratamiento de estos síndromes. La administración de drogas como anakinra, canakinumab y rilonacept muestra un efecto marcado sobre el control de las manifestaciones inflamatorias, clínicas y de los parámetros de laboratorio en estos síndromes. Se describe la etiopatogenia de estas entidades, sus principales características clínicas, el diagnóstico y el tratamiento(AU)

Monogenic autoinflammatory disorders encompass a group of diseases characterized by spontaneous and recurring fever and systemic inflammation in the absence of infection, autoantibodies or specific T cells for self antigens (self-reactive). These conditions are caused by mutations in genes encoding proteins that play a key role in the regulation of innate inflammatory response and are considered primary immunodeficiencies. Diseases comprising these syndromes represent a different clinical spectrum of mutations, with gain of function of a gene called NLRP3 or CIAS1 encoding cryopyrin protein, hence these disorders are also known under the name cryopyrinpathies. Among these are the cryopyrin-associated periodic syndrome which include three conditions: familial cold autoinflammatory syndrome; Muckle-Wells syndrome and chronic infantile neurological, cutaneous and articular syndrome. In clinical terms, it is characterized by urticarial rash, periodic fever, inflammation of central nervous system (CNS), arthropathy, ocular manifestations and risk of amyloidosis as a long-term complication. The key role of cryopirin in the release of IL-β suggests rational approach to implement anti-IL-1 therapy for the treatment of these syndromes. The administration of drugs such as anakinra, canakinumab, and rilonacept shows a marked effect on the control of inflammatory manifestations, as well as clinical and laboratory parameters in these syndromes effect. The pathogenesis of these entities, as well as their main clinical features, diagnosis and treatment are described(AU)

Enfermedades Autoinflamatorias / Autoinflammatory Diseases

Presentamos un artículo de revisión sobre las enfermedades autoinflamatorias, narrando su origen histórico y describiendo la estructura proteica y molecular del Inflamosoma, la clasificación actual de los trastornos autoinflamatorios y una descripción de las características inmunogenéticas y clínicas más sobresalientes de cada enfermedad.

We present a review article on the autoinflammatory diseases, narrating its historical origin and describing the protein and molecular structure of the Inflammasome, the current classification of the autoinflammatory diseases and a description of the immunogenetics and clinical characteristics more important of every disease.