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[PMID]:29367532
[Au] Autor:Michitsuji T; Horai Y; Sako A; Asano T; Iwanaga N; Izumi Y; Kawakami A
[Ad] Endereço:Department of General and Internal Medicine, National Hospital Organization Nagasaki Medical Center.
[Ti] Título:[A case of mixed connective tissue disease positive for proteinase 3 antineutrophil cytoplasmic antibody in a patient with slowly progressive type 1 diabetes mellitus and chronic thyroiditis].
[So] Source:Nihon Rinsho Meneki Gakkai Kaishi;40(6):467-470, 2017.
[Is] ISSN:1349-7413
[Cp] País de publicação:Japan
[La] Idioma:jpn
[Ab] Resumo:  A female in her sixties with slowly progressive type 1 diabetes mellitus (SPT1DM) and chronic thyroiditis was referred to our rheumatology department with swelling in her fingers. A prominent atherosclerotic lesion was revealed upon brain magnetic resonance imaging, and she was found to have mixed connective tissue disease (MCTD) positive for proteinase 3 (PR3)-antineutrophil cytoplasmic antibody (ANCA). This rare case of MCTD accompanying SPT1DM and PR3-ANCA suggested that a synergy between MCTD and PR3-ANCA triggers atherosclerosis.
[Mh] Termos MeSH primário: Anticorpos Anticitoplasma de Neutrófilos
Aterosclerose/etiologia
Diabetes Mellitus Tipo 1/complicações
Doença de Hashimoto/complicações
Doença Mista do Tecido Conjuntivo/diagnóstico
Doença Mista do Tecido Conjuntivo/imunologia
Mieloblastina/imunologia
Tireoidite/complicações
[Mh] Termos MeSH secundário: Idoso
Aterosclerose/diagnóstico por imagem
Aterosclerose/imunologia
Encéfalo/diagnóstico por imagem
Progressão da Doença
Feminino
Seres Humanos
Imagem por Ressonância Magnética
Meia-Idade
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antibodies, Antineutrophil Cytoplasmic); EC 3.4.21.76 (Myeloblastin)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180227
[Lr] Data última revisão:
180227
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180126
[St] Status:MEDLINE
[do] DOI:10.2177/jsci.40.467


  2 / 5024 MEDLINE  
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[PMID]:29390440
[Au] Autor:Li XL; Xu PC; Chen T; Yan TK; Jiang JQ; Jia JY; Wei L; Shang WY; Hu SY
[Ad] Endereço:Department of Nephrology.
[Ti] Título:Myeloperoxidase-antineutrophil cytoplasmic antibody (ANCA)-associated systemic vasculitis developed from ANCA negative renal limited vasculitis: A case report.
[So] Source:Medicine (Baltimore);96(51):e9128, 2017 Dec.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: The relationship between antineutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis (AAV) and ANCA-negative vasculitis has not been elucidated. PATIENT CONCERNS: A 64-year-old female with edema and proteinuria was admitted. A kidney biopsy indicated focal proliferative nephritis with crescents in 25% of glomeruli. Serum ANCA was negative. Eighteen months later, systemic symptoms emerged and acute kidney injury occurred. Serum ANCA against myeloperoxidase (MPO) turned positive. Repeated kidney biopsy showed more severe lesion than last time. Immunoglobulin (Ig)G was purified from serum obtained before the first kidney biopsy. Weak ANCA which could not be detected in serum was found in IgG. DIAGNOSES: MPO-ANCA-associated AAV developed from ANCA-negative renal-limited AAV. INTERVENTIONS: The patient was treated with glucocorticoid. OUTCOMES: The serum creatinine decreased to 2.17 mg/dL a week later. MPO-ANCA turned negative when re-examined 3 weeks later. No relapse has been observed during follow-up for 6 months. LESSONS: This is the first reported case about the spontaneous transformation from ANCA-negative renal-limited AAV to ANCA-positive systemic vasculitis. There might be a slow process of epitope spreading in the pathogenesis of disease. Physicians should try their best to detect the ANCA in the diagnose and treatment of ANCA-negative AAV.
[Mh] Termos MeSH primário: Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/diagnóstico
Anticorpos Anticitoplasma de Neutrófilos/sangue
Glomerulonefrite/etiologia
Peroxidase/imunologia
[Mh] Termos MeSH secundário: Lesão Renal Aguda/etiologia
Feminino
Glomerulonefrite/diagnóstico
Seres Humanos
Meia-Idade
Proteinúria/etiologia
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antibodies, Antineutrophil Cytoplasmic); EC 1.11.1.7 (Peroxidase)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180220
[Lr] Data última revisão:
180220
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180203
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009128


  3 / 5024 MEDLINE  
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[PMID]:29315316
[Au] Autor:Dick J; Gan PY; Kitching AR; Holdsworth SR
[Ad] Endereço:Centre for Inflammatory Diseases, Monash University Department of Medicine, Clayton, Victoria, Australia.
[Ti] Título:The C3aR promotes macrophage infiltration and regulates ANCA production but does not affect glomerular injury in experimental anti-myeloperoxidase glomerulonephritis.
[So] Source:PLoS One;13(1):e0190655, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitides are autoimmune diseases associated with significant morbidity and mortality. They often affect the kidney causing rapidly progressive glomerulonephritis. While signalling by complement anaphylatoxin C5a though the C5a receptor is important in this disease, the role of the anaphylatoxin C3a signalling via the C3a receptor (C3aR) is not known. Using two different murine models of anti-myeloperoxidase (MPO) glomerulonephritis, one mediated by passive transfer of anti-MPO antibodies, the other by cell-mediated immunity, we found that the C3aR did not alter histological disease severity. However, it promoted macrophage recruitment to the inflamed glomerulus and inhibited the generation of MPO-ANCA whilst not influencing T cell autoimmunity. Thus, whilst the C3aR modulates some elements of disease pathogenesis, overall it is not critical in effector responses and glomerular injury caused by autoimmunity to MPO.
[Mh] Termos MeSH primário: Anticorpos Anticitoplasma de Neutrófilos/imunologia
Complemento C3a/metabolismo
Glomerulonefrite/patologia
Macrófagos/patologia
Peroxidase/imunologia
Receptores de Complemento/fisiologia
[Mh] Termos MeSH secundário: Animais
Formação de Anticorpos
Autoimunidade
Glomerulonefrite/imunologia
Imunidade Celular
Camundongos
Camundongos Endogâmicos C57BL
Receptores de Complemento/metabolismo
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Antibodies, Antineutrophil Cytoplasmic); 0 (Receptors, Complement); 80295-42-7 (Complement C3a); EC 1.11.1.7 (Peroxidase)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180215
[Lr] Data última revisão:
180215
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180110
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0190655


  4 / 5024 MEDLINE  
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[PMID]:29390537
[Au] Autor:Xuan YY; Li TF; Zhang L; Liu SY
[Ad] Endereço:Department of Rheumatology and Immunology, First Affiliated Hospital of Zhengzhou University, Zhengzhou City, Henan Province, P.R. China.
[Ti] Título:ANCA positive relapsing polychondritis, Graves disease, and suspected moyamoya disease: A case report.
[So] Source:Medicine (Baltimore);96(51):e9378, 2017 Dec.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIOINALE: Relapsing polychondritis (RP) is a rare and heterogeneous disease complex of unknown origin which basically affects cartilaginous structures, 40% of which accompanied by rheumatic, hematologic, and endocrine disease. Among them, vasculitis is the most common accompanying type and usually presented with positive antineutrophilic cytoplasmic antibody (ANCA). The presence of ANCA could be primary or drug-induced like propylthiouracil (PTU). Central involvement of RP is very rare, and there is almost no report of cerebral vasculopathy manifested as moyamoya. PATIENT CONCERNS: A 26-year-old woman complained about recurrent fever, auricular chondritis, ocular inflammation, and arthritis. She had an 8-year drug intake of PTU for Graves disease. Myeloperoxidase antineutrophilc cytoplasmic antibodies (MPO-ANCA) were found positive. Magnetic resonance angiography (MRA) detected multiple intracranial vasculopathy which we highly suspected it as moyamoya disease. DIAGNOSES: Relapsing polychondritis, Graves disease and suspected moyamoya disease were clinically diagnosed. INTERVENTIONS AND OUTCOMES: In case of possible PTU-induced vasculitis and the aggravation of vasculopathy, PTU was replaced by Iodine-131 (I) therapy. Induction treatment included oral prednisone 30 mg daily and oral cyclophosphamide 100 mg daily. Symptoms rapidly relieved before discharge. Inflammation markers were normal and MPO-ANCA decreased in 3 weeks after admission. Prednisone was gradually tapered to 7.5 mg daily and at month 10 azathioprine was continued for maintenance. LESSONS: RP can overlap with Graves disease and moyamoya disease; comprehensive tests should be performed when admission. When relapsing polychondritis is accompanied with Graves disease, especially when ANCA is positive, PTU should be avoided.
[Mh] Termos MeSH primário: Anticorpos Anticitoplasma de Neutrófilos/sangue
Doença de Graves/diagnóstico
Doença de Moyamoya/diagnóstico
Policondrite Recidivante/diagnóstico
[Mh] Termos MeSH secundário: Adulto
Antitireóideos/uso terapêutico
Biomarcadores/sangue
Feminino
Doença de Graves/complicações
Doença de Graves/tratamento farmacológico
Seres Humanos
Doença de Moyamoya/complicações
Policondrite Recidivante/sangue
Policondrite Recidivante/complicações
Propiltiouracila/uso terapêutico
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antibodies, Antineutrophil Cytoplasmic); 0 (Antithyroid Agents); 0 (Biomarkers); 721M9407IY (Propylthiouracil)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180214
[Lr] Data última revisão:
180214
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180203
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009378


  5 / 5024 MEDLINE  
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[PMID]:29238021
[Au] Autor:Kiboshi T; Isoda K; Furukawa K; Wakahara T; Otani K; Ueda K; Konma J; Teramura K; Ueno N; Fujiwara H; Shoda T
[Ad] Endereço:Department of Rheumatology, Yodogawa Christian Hospital.
[Ti] Título:[Granulomatosis with Polyangiitis Complicated with Gastrointestinal Perforation: A Case Report and Review of Literature].
[So] Source:Nihon Rinsho Meneki Gakkai Kaishi;40(5):382-386, 2017.
[Is] ISSN:1349-7413
[Cp] País de publicação:Japan
[La] Idioma:jpn
[Ab] Resumo:  A 51-year-old man was detected nasal bleeding, multiple pulmonary nodule and mass, urinalysis abnormality, renal involvement and high titer of proteinase 3-anti-neutrophil cytoplasmic antibody (PR3-ANCA), and was suspected of granulomatosis with polyangiitis and initiated with steroid pulse therapy. On the day after the start of steroid pulse therapy, generalized peritonitis due to ileal perforation occurred, and emergency ileectomy and peritonitis surgery were performed. Induction therapy with steroid pulse therapy, plasma exchange and intravenous cyclophosphamide therapy (IVCY) and maintenance therapy with glucocorticoid and azathioprine led to good therapeutic outcomes. Gastrointestinal perforation in GPA is a rare complication, and we examined the clinical features, treatment contents, and prognosis of GPA with gastrointestinal perforation from this case and previous reports. Lung involvements were complicated in all reported cases. Gastrointestinal perforations in GPA were frequent in the small intestine, occurred just before and immediately after the start of treatment, and were severe involvement with poor prognosis because of the high mortality rate (46.7%). The frequency of ear, nose and upper respiratory tract lesions in the surviving group was significantly higher than in the dead group (survival 87.5%, death 28.3%, P = 0.041). IVCY were more frequently used in the surviving group (62.5%) than the death group (16.7%), but it was not significantly. GPA complicated with gastrointestinal perforation is a severe condition with poor prognosis, but there is a possibility to improve prognosis by early diagnosis and early initiation of strong treatment.
[Mh] Termos MeSH primário: Granulomatose com Poliangiite/complicações
Granulomatose com Poliangiite/terapia
Íleo
Perfuração Intestinal/etiologia
Troca Plasmática
[Mh] Termos MeSH secundário: Anticorpos Anticitoplasma de Neutrófilos/sangue
Azatioprina/administração & dosagem
Biomarcadores/sangue
Ciclofosfamida/administração & dosagem
Diagnóstico Precoce
Granulomatose com Poliangiite/diagnóstico
Seres Humanos
Perfuração Intestinal/cirurgia
Masculino
Metilprednisolona/administração & dosagem
Meia-Idade
Mieloblastina/imunologia
Prognóstico
Pulsoterapia
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Antibodies, Antineutrophil Cytoplasmic); 0 (Biomarkers); 8N3DW7272P (Cyclophosphamide); EC 3.4.21.76 (Myeloblastin); MRK240IY2L (Azathioprine); X4W7ZR7023 (Methylprednisolone)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180112
[Lr] Data última revisão:
180112
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171215
[St] Status:MEDLINE
[do] DOI:10.2177/jsci.40.382


  6 / 5024 MEDLINE  
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[PMID]:28745694
[Au] Autor:Androsova TV; Kozlovskaya LV; Taranova MV; Strizhakov LA; Gulyaev SV; Russkikh AV
[Ad] Endereço:I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow, Russia.
[Ti] Título:[Difficulties in the differential diagnosis of kidney injury in a patient with infective endocarditis associated with antineutrophil cytoplasmic antibodies].
[Ti] Título:Trudnosti differentsial'noi diagnostiki porazheniia pochek u bol'nogo infektsionnym éndokarditom, assotsiirovannym s antineitrofil'nymi tsitoplazmaticheskimi antitelami..
[So] Source:Ter Arkh;89(6):84-88, 2017.
[Is] ISSN:0040-3660
[Cp] País de publicação:Russia (Federation)
[La] Idioma:rus
[Ab] Resumo:Infective endocarditis (IE) may be accompanied by the production of a broad spectrum of autoantibodies, including antineutrophil cytoplasmic antibodies (ANCA). ANCA detection creates difficulties in the differential diagnosis of IE, especially in relation to kidney injury, the determination of the mechanism of which is important for choosing a treatment policy and estimating a prognosis. The paper describes a clinical case of a 57-year-old man who was found to have higher proteinase-3 (PR-3) ANCA titers along with the symptoms of anemia, purpura, and kidney injury during his hospitalization; echocardiography revealed vegetation on the aortic valve. IE was diagnosed; 2-week antibiotic therapy was ineffective; there was progressive aortic insufficiency necessitating aortic valve replacement. In the postoperative period, there was progression of renal failure and higher PR-3 ANCA titers, which made it possible to regard kidney injury as a manifestation of ANCA-associated glomerulonephritis. Intensive immunosuppressive therapy with intravenous and oral prednisolone was initiated, which showed positive effects in reducing proteinuria, erythrocyturia, serum creatinine levels, and simultaneously PR-3 ANCA titers. The paper gives the data available in the literature on the frequency of an association of IE with ANCA, the clinical features, diagnostic criteria, and treatment approaches. It discusses the mechanisms of ANCA formation in patients with IE.
[Mh] Termos MeSH primário: Anticorpos Anticitoplasma de Neutrófilos/sangue
Endocardite/sangue
Glomerulonefrite/diagnóstico
Mieloblastina/sangue
[Mh] Termos MeSH secundário: Endocardite/complicações
Seres Humanos
Masculino
Meia-Idade
[Pt] Tipo de publicação:CASE REPORTS
[Nm] Nome de substância:
0 (Antibodies, Antineutrophil Cytoplasmic); EC 3.4.21.76 (Myeloblastin)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171129
[Lr] Data última revisão:
171129
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170727
[St] Status:MEDLINE
[do] DOI:10.17116/terarkh201789684-88


  7 / 5024 MEDLINE  
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[PMID]:28745689
[Au] Autor:Bulanov NM; Serova AG; Kuznetsova EI; Bulanova ML; Novikov PI; Kozlovskaya LV; Moiseev SV
[Ad] Endereço:I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow, Russia.
[Ti] Título:[Kidney injury molecules (KIM-1, MCP-1) and type IV collagen in the assessment of activity of antineutrophil cytoplasmic antibody-associated glomerulonephritis].
[Ti] Título:Molekuly povrezhdeniia pochechnoi tkani (KIM-1, MCP-1) i kollagen IV tipa v otsenke aktivnosti assotsiirovannogo s antineitrofil'nymi tsitoplazmaticheskimi antitelami glomerulonefrita..
[So] Source:Ter Arkh;89(6):48-55, 2017.
[Is] ISSN:0040-3660
[Cp] País de publicação:Russia (Federation)
[La] Idioma:rus
[Ab] Resumo:AIM: To assess the significance of determining the serum and urinary concentrations of monocyte chemotactic protein-1 (MCP-1), kidney injury molecule-1 (KIM-1), and type IV collagen in patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) to estimate the activity of renal involvement in AAV. SUBJECTS AND METHODS: 78 patients (32 men and 46 women) (median age 55 (45; 61) years) with AAV were examined. The patients were divided into 3 groups according to the AAV activity estimated using the Birmingham vasculitis activity Score (BVAS): 1) 25 patients with active ANCA-associated glomerulonephritis (GN); 2) 26 patients with active AAV without renal involvement; 3) 27 patients in sustained AAV remission. The serum and urinary concentrations of the markers were measured by enzyme immunoassay. RESULTS: The urinary concentration of all 3 biomarkers was higher in patients with renal involvement (Group 1); the differences in the levels of MCP-1 and type IV collagen were statistically significant as compared to Groups 2 and 3 (p<0.01), while that in KIM-1 level was only in Group 2. There were statistically significant correlations between the urinary concentration of these biomarkers and the traditional GN activity indices (erythrocyturia, daily proteinuria (DPU), total BVAS scores that reflect renal involvement, as well as serum creatinine levels and estimated glomerular filtration rate (p<0.05). ROC curve analysis showed that the urinary MCP-1 excretion of ≥159 pg/ml had the highest (92%) sensitivity and urinary type IV collagen excretion of ≥3.09 µg/l had the highest (86%) specificity in assessing the activity of ANCA-associated GN. At the same time, their diagnostic value increased in terms of a combination of DPU and ESR (96% sensitivity, 84.9% specificity). CONCLUSION: The urinary excretion of MCP-1, KIM-1, and type IV collagen reflects the severity of local renal inflammation in AAV patients and a study of these indicators is a promising diagnostic tool for assessing the activity of ANCA-associated GN.
[Mh] Termos MeSH primário: Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos
Anticorpos Anticitoplasma de Neutrófilos/imunologia
Quimiocina CCL2
Colágeno Tipo IV
Glomerulonefrite
Receptor Celular 1 do Vírus da Hepatite A
[Mh] Termos MeSH secundário: Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/sangue
Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/imunologia
Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/urina
Biomarcadores/sangue
Biomarcadores/urina
Quimiocina CCL2/sangue
Quimiocina CCL2/imunologia
Quimiocina CCL2/urina
Colágeno Tipo IV/sangue
Colágeno Tipo IV/imunologia
Colágeno Tipo IV/urina
Feminino
Glomerulonefrite/sangue
Glomerulonefrite/imunologia
Glomerulonefrite/urina
Receptor Celular 1 do Vírus da Hepatite A/sangue
Receptor Celular 1 do Vírus da Hepatite A/imunologia
Seres Humanos
Masculino
Meia-Idade
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antibodies, Antineutrophil Cytoplasmic); 0 (Biomarkers); 0 (CCL2 protein, human); 0 (Chemokine CCL2); 0 (Collagen Type IV); 0 (HAVCR1 protein, human); 0 (Hepatitis A Virus Cellular Receptor 1)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171129
[Lr] Data última revisão:
171129
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170727
[St] Status:MEDLINE
[do] DOI:10.17116/terarkh201789648-55


  8 / 5024 MEDLINE  
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[PMID]:29045211
[Au] Autor:Palamara K; Nagarur A; Fintelmann FJ; Kohler MJ; Cortazar FB
[Ad] Endereço:From the Departments of Medicine (K.P., A.N., M.J.K., F.B.C.) and Radiology (F.J.F.), Massachusetts General Hospital, and the Departments of Medicine (K.P., A.N., M.J.K., F.B.C.) and Radiology (F.J.F.), Harvard Medical School - both in Boston.
[Ti] Título:Case 32-2017. A 64-Year-Old Man with Dyspnea, Wheezing, Headache, Cough, and Night Sweats.
[So] Source:N Engl J Med;377(16):1569-1578, 2017 10 19.
[Is] ISSN:1533-4406
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Anticorpos Anticitoplasma de Neutrófilos/sangue
Granulomatose com Poliangiite/diagnóstico
Peroxidase/imunologia
[Mh] Termos MeSH secundário: Tosse/etiologia
Diagnóstico Diferencial
Dispneia/etiologia
Eosinofilia/etiologia
Fibromialgia/complicações
Granulomatose com Poliangiite/complicações
Granulomatose com Poliangiite/tratamento farmacológico
Cefaleia/etiologia
Seres Humanos
Imunossupressores/uso terapêutico
Pulmão/diagnóstico por imagem
Pulmão/patologia
Masculino
Meia-Idade
Sons Respiratórios/etiologia
Sudorese
Tomografia Computadorizada por Raios X
[Pt] Tipo de publicação:CASE REPORTS; CLINICAL CONFERENCE; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antibodies, Antineutrophil Cytoplasmic); 0 (Immunosuppressive Agents); EC 1.11.1.7 (Peroxidase)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171026
[Lr] Data última revisão:
171026
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171019
[St] Status:MEDLINE
[do] DOI:10.1056/NEJMcpc1703513


  9 / 5024 MEDLINE  
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[PMID]:29016646
[Au] Autor:Maritati F; Alberici F; Oliva E; Urban ML; Palmisano A; Santarsia F; Andrulli S; Pavone L; Pesci A; Grasselli C; Santi R; Tumiati B; Manenti L; Buzio C; Vaglio A
[Ad] Endereço:Nephrology Unit, University Hospital of Parma, Italy.
[Ti] Título:Methotrexate versus cyclophosphamide for remission maintenance in ANCA-associated vasculitis: A randomised trial.
[So] Source:PLoS One;12(10):e0185880, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: The treatment of anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is based on remission-induction and remission-maintenance. Methotrexate is a widely used immunosuppressant but only a few studies explored its role for maintenance in AAV. This trial investigated the efficacy and safety of methotrexate as maintenance therapy for AAV. METHODS: In this single-centre, open-label, randomised trial we compared methotrexate and cyclophosphamide for maintenance in AAV. We enrolled patients with granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA) and eosinophilic granulomatosis with polyangiitis (EGPA), the latter with poor-prognosis factors and/or peripheral neuropathy. Remission was induced with cyclophosphamide. At remission, the patients were randomised to receive methotrexate or to continue with cyclophosphamide for 12 months; after treatment, they were followed for another 12 months. The primary end-point was relapse; secondary end-points included renal outcomes and treatment-related toxicity. RESULTS: Of the 94 enrolled patients, 23 were excluded during remission-induction or did not achieve remission; the remaining 71 were randomised to cyclophosphamide (n = 33) or methotrexate (n = 38). Relapse frequencies at months 12 and 24 after randomisation were not different between the two groups (p = 1.00 and 1.00). Relapse-free survival was also comparable (log-rank test p = 0.99). No differences in relapses were detected between the two treatments when GPA+MPA and EGPA were analysed separately. There were no differences in eGFR at months 12 and 24; proteinuria declined significantly (from diagnosis to month 24) only in the cyclophosphamide group (p = 0.0007). No significant differences in adverse event frequencies were observed. CONCLUSIONS: MTX may be effective and safe for remission-maintenance in AAV. TRIAL REGISTRATION: clinicaltrials.gov NCT00751517.
[Mh] Termos MeSH primário: Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/tratamento farmacológico
Síndrome de Churg-Strauss/tratamento farmacológico
Ciclofosfamida/uso terapêutico
Granulomatose com Poliangiite/tratamento farmacológico
Imunossupressores/uso terapêutico
Metotrexato/uso terapêutico
Poliangiite Microscópica/tratamento farmacológico
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/complicações
Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/imunologia
Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/mortalidade
Anticorpos Anticitoplasma de Neutrófilos/sangue
Síndrome de Churg-Strauss/complicações
Síndrome de Churg-Strauss/imunologia
Síndrome de Churg-Strauss/mortalidade
Feminino
Granulomatose com Poliangiite/complicações
Granulomatose com Poliangiite/imunologia
Granulomatose com Poliangiite/mortalidade
Seres Humanos
Masculino
Poliangiite Microscópica/complicações
Poliangiite Microscópica/imunologia
Poliangiite Microscópica/mortalidade
Meia-Idade
Segurança do Paciente
Seleção de Pacientes
Doenças do Sistema Nervoso Periférico/complicações
Doenças do Sistema Nervoso Periférico/tratamento farmacológico
Doenças do Sistema Nervoso Periférico/imunologia
Doenças do Sistema Nervoso Periférico/mortalidade
Proteinúria/complicações
Proteinúria/tratamento farmacológico
Proteinúria/imunologia
Proteinúria/mortalidade
Distribuição Aleatória
Recidiva
Indução de Remissão
Análise de Sobrevida
Resultado do Tratamento
[Pt] Tipo de publicação:CLINICAL TRIAL; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antibodies, Antineutrophil Cytoplasmic); 0 (Immunosuppressive Agents); 8N3DW7272P (Cyclophosphamide); YL5FZ2Y5U1 (Methotrexate)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171031
[Lr] Data última revisão:
171031
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171011
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0185880


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[PMID]:28977502
[Au] Autor:de Joode AAE; Sanders JSF; Puéchal X; Guillevin LP; Hiemstra TF; Flossmann O; Rasmussen N; Westman K; Jayne DR; Stegeman CA
[Ad] Endereço:Department of Internal Medicine and Nephrology, University Medical Center Groningen, Groningen, the Netherlands.
[Ti] Título:Long term azathioprine maintenance therapy in ANCA-associated vasculitis: combined results of long-term follow-up data.
[So] Source:Rheumatology (Oxford);56(11):1894-1901, 2017 Nov 01.
[Is] ISSN:1462-0332
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Objective: We studied whether in ANCA-associated vasculitis patients, duration of AZA maintenance influenced relapse rate during long-term follow-up. Methods: Three hundred and eighty newly diagnosed ANCA-associated vasculitis patients from six European multicentre studies treated with AZA maintenance were included; 58% were male, median age at diagnosis 59.4 years (interquartile range: 48.3-68.2 years); granulomatosis with polyangiitis, n = 236; microscopic polyangiitis, n = 132; or renal limited vasculitis, n = 12. Patients were grouped according to the duration of AZA maintenance after remission induction: ⩽18 months, ⩽24 months, ⩽36 months, ⩽48 months or > 48 months. Primary outcome was relapse-free survival at 60 months. Results: During follow-up, 84 first relapses occurred during AZA-maintenance therapy (1 relapse per 117 patient months) and 71 after withdrawal of AZA (1 relapse/113 months). During the first 12 months after withdrawal, 20 relapses occurred (1 relapse/119 months) and 29 relapses >12 months after withdrawal (1 relapse/186 months). Relapse-free survival at 60 months was 65.3% for patients receiving AZA maintenance >18 months after diagnosis vs 55% for those who discontinued maintenance ⩽18 months (P = 0.11). Relapse-free survival was associated with induction therapy (i.v. vs oral) and ANCA specificity (PR3-ANCA vs MPO-ANCA/negative). Conclusion: Post hoc analysis of combined trial data suggest that stopping AZA maintenance therapy does not lead to a significant increase in relapse rate and AZA maintenance for more than 18 months after diagnosis does not significantly influence relapse-free survival. ANCA specificity has more effect on relapse-free survival than duration of maintenance therapy and should be used to tailor therapy individually.
[Mh] Termos MeSH primário: Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/tratamento farmacológico
Azatioprina/uso terapêutico
Imunossupressores/uso terapêutico
[Mh] Termos MeSH secundário: Adulto
Idoso
Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/imunologia
Anticorpos Anticitoplasma de Neutrófilos/imunologia
Intervalo Livre de Doença
Feminino
Seguimentos
Granulomatose com Poliangiite/tratamento farmacológico
Granulomatose com Poliangiite/imunologia
Seres Humanos
Nefropatias/tratamento farmacológico
Nefropatias/imunologia
Quimioterapia de Manutenção
Masculino
Poliangiite Microscópica/tratamento farmacológico
Poliangiite Microscópica/imunologia
Meia-Idade
Mieloblastina/imunologia
Peroxidase/imunologia
Recidiva
Fatores de Tempo
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antibodies, Antineutrophil Cytoplasmic); 0 (Immunosuppressive Agents); EC 1.11.1.7 (Peroxidase); EC 3.4.21.76 (Myeloblastin); MRK240IY2L (Azathioprine)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171106
[Lr] Data última revisão:
171106
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171005
[St] Status:MEDLINE
[do] DOI:10.1093/rheumatology/kex281



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