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World Journal of Clinical Cases 2022年第4期10卷 1454-1456页

作者： Jucier Gonçalves Júnior samuel katsuyuki shinjo Division of Rheumatology São Paulo UniversitySão Paulo 01246-903Brazil

We presented a letter about a case of a 37-year-old Black female with a history of human immunodeficiency virus and an undetectable viral *** was evaluated with weakness in the scapular(grade III)and pelvic girdles(grade II),elevation of creatine phosphokinase levels and muscle biopsy compatible with nemaline *** was treated with rituximab showing improvement of the condition.

关键词： Case report Human immunodeficiency virus Nemaline myopathy Rituximab Rheumatology Therapy

Reflections on the prevalence of human leukocyte antigen-B27 and human leukocyte antigen-B51 co-occurrence in patients with spondylarthritis

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World Journal of Clinical Cases 2022年第23期10卷 8422-8424页

作者： Jucier Gonçalves Júnior Percival Degrava Sampaio-Barros samuel katsuyuki shinjo Division of Rheumatology São Paulo UniversitySão Paulo 01246-903São PauloBrazil

We performed a literature mini-review of the clinical profile of patients with spondylarthritis who are also human leukocyte antigen(HLA)-*** seems to us that patients with HLA-B27 and HLA-B51 are more common in men,Asians and between the third and ninth decades of *** are more likely to develop peripheral joint conditions,with cutaneous manifestations(e.g.,oral ulcers)and ***,more robust epidemiological studies with more accurate methodology and multicenter locations are needed to better map the role of the interaction between HLA-B51 in patients with spondylarthritis.

关键词： HLA-B27 HLA-B51 Ankylosing spondylitis Spondylarthritis Human leukocyte antigen

Tofacitinib as a Treatment for Refractory Dermatomyositis: A Case Report

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Open Journal of Rheumatology and Autoimmune Diseases 2020年第1期10卷 39-43页

作者： samuel katsuyuki shinjo Fernando Henrique Carlos de Souza Division of Rheumatology Faculdade de Medicina FMUSP Universidade de Sao Paulo Sao Paulo Brazil

In very scarce case reports and case series, tofacitinib has been a therapeutic alternative for dermatomyositis. To corroborate the literature, we described a refractory dermatomyositis that had a good outcome with tofacitinib. Case Report: An adult female patient presented with definite dermatomyositis and with refractoriness to high doses of intravenous and oral glucocorticoids, intravenous human immunoglobulin, several immunosuppressive drugs (methotrexate, azathioprine, and leflunomide) and two previous immunobiological drugs (rituximab and abatacept). However, the patient had a good outcome with tofacitinib. Conclusions: Tofacitinib appears to be a promising alternative therapy for refractory dermatomyositis.

关键词： Dermatomyositis Immunosuppressive Agents Muscle Diseases Myositis Therapeutics

Traditional and Non-Traditional Risk Factors Involved with Endothelial Dysfunction and Arterial Stiffness in Autoimmune Rheumatic Diseases

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Open Journal of Rheumatology and Autoimmune Diseases 2019年第3期9卷 85-100页

作者： Rafael Giovani Misse Isabela Bruna Pires Borges samuel katsuyuki shinjo Division of Rheumatology Faculdade de Medicina FMUSP Universidade de Sao Paulo Sao Paulo Brazil

Autoimmune rheumatic diseases (ARDs) have been closely associated with accelerated plaque progression and the development of atherosclerosis, which lead to high morbidity and mortality rates for cardiovascular diseases. Endothelial dysfunction and arterial stiffness are greatly evidenced in several studies in the early phase of atherosclerosis. In ARDs, endothelial dysfunction and arterial stiffness are related to traditional and non-traditional risk factors. To date, no studies have clearly analyzed the main parameter involved in endothelial dysfunction and arterial stiffness. In this context, the present narrative review’s purpose was to describe the main factor in endothelial dysfunction and arterial stiffness in different ARDs. Endothelial dysfunction and arterial stiffness are related to traditional risk factors (i.e., hypertension, diabetes, dyslipidemia, metabolic syndrome, sedentary behavior) and non-traditional risk factors (linked to the immune mechanisms involved in these diseases). Moreover, in the present study, these associations were systemically analyzed in ankylosing spondylitis, antiphospholipid syndrome, rheumatoid arthritis, psoriatic arthritis, systemic autoimmune myopathies, systemic lupus erythematosus and systemic sclerosis. The present review shows that the relationship of traditional risk factors and non-traditional risk factors related to ARDs works in the worsening of function and structural properties of arterial vessels, leading to high cardiovascular morbidity and mortality.

关键词： Arterial Stiffness Atherosclerosis Autoimmune Endothelial Dysfunction Rheumatic Diseases

Previous Pulmonary Fibrosis in Dermatomyositis/Polymyositis: A Predictive Factor for Pulmonary and Extra-Pulmonary Tuberculosis

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Open Journal of Rheumatology and Autoimmune Diseases 2018年第4期8卷 99-110页

作者： Taysa Cristiane Moreira da Silva Adriana Coracini Tonacio de Proenca samuel katsuyuki shinjo Division of Rheumatology Hospital das Clinicas HCFMUSPFaculdade de MedicinaUniversidade de Sao PauloSao PauloBrazil Department of Infectious and Parasitic Diseases Hospital das Clinicas HCFMUSPFaculdade de MedicinaUniversidade de Sao PauloSao PauloBrazil

Objective: With scant studies in the literature, little is known about the risk factors for tuberculosis in patients with dermatomyositis/polymyositis. Therefore, the aim of the present study was to analyze the predictive factors for tuberculosis development in dermatomyositis/polymyositis. Methods: This single-center, retrospective, cohort study initially included 290 patients with dermatomyositis/polymyositis, from 2002 to 2016. Tuberculosis (pulmonary and/or extra-pulmonary) was confirmed after dermatomyositis/polymyositis diagnosis in 12 patients (4.1%) (Tuberculosis+ group). For the control group (Tuberculosis−), 24 patients without tuberculosis were arbitrarily selected in the same period and matched for age, ethnicity, gender, age at disease diagnosis, disease duration and type (dermatomyositis or polymyositis). Results: Tuberculosis occurred for a median of 16 months after dermatomyositis/polymyositis diagnosis. Clinical, laboratory and treatment features were similar in Tuberculosis+ and Tuberculosis−groups (P > 0.05). However, previous pulmonary fibrosis in dermatomyositis/polymyositis was more prevalent in the Tuberculosis+ group (41.7 vs. 8.3%;P = 0.029). Moreover, on a multivariate logistic regression model, pulmonary fibrosis was significantly associated with Tuberculosis (Odds ratio: 9.59, 95% confidence interval: 1.17 - 78.82). Tuberculosis affected 3 dermatomyositis cases for every 1 polymyositis case, with predominantly pulmonary followed by extra-pulmonary involvement (pleura, cutaneous, muscular, joint, soft tissue and hematologic). Two or more sites were affected in 41.7% of cases. Conclusions: Previous pulmonary fibrosis in dermatomyositis/polymyositis was a predictive factor associated with tuberculosis development. Further studies are needed to confirm these results.

关键词： Dermatomyositis Infectious Myositis Polymyositis Tuberculosis

Transcranial Direct Current Stimulation Is Safe and Relieves Post-Herpetic Neuralgia in Patient with Dermatomyositis: A Case Report

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Open Journal of Rheumatology and Autoimmune Diseases 2022年第4期12卷 114-118页

作者： Rafael Giovani Misse Alexandre Moura dos Santos Abrahão Fontes Baptista samuel katsuyuki shinjo Division of Rheumatology Faculdade de Medicina FMUSP Universidade de S&#227 o Paulo S&#227 o Paulo Brazil Center for Mathematics Computation and Cognition Federal University of ABC (UFABC) S&#227 o Bernardo do Campo Brazil

To the best of our knowledge, this is the first report in the literature showing the efficacy of transcranial direct current stimulation (tDCS) in treating refractory post-herpetic neuralgia in a patient with dermatomyositis. In addition, our results showed that tDCS sessions are safe and do not lead to disease relapse. Therefore, despite the limitations of being a case report, this study provides encouraging results that need to be widely explored in studies with a representative number of patients and with an appropriate design for patients with this systemic rheumatic autoimmune disease.

关键词： Cerebral Neuromodulation Dermatomyositis Neuralgia Pain Treatment

Transcranial Direct Current Stimulation Combined with Peripheral Neuromuscular Stimulation Improves Quality of Life, Fatigue, and Pain in a Patient with Rheumatoid Arthritis and Refractory Radicular Pain Related to Spinal Stenosis

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Open Journal of Rheumatology and Autoimmune Diseases 2023年第1期13卷 1-7页

作者： Rafael Giovani Missé Lucas De Macedo Dos Santos Clarice Tanaka Abrahão Fontes Baptista samuel katsuyuki shinjo Division of Rheumatology Faculdade de Medicina FMUSP Universidade de Sao Paulo Sao Paulo Brazil Department of Physical Therapy Speech Therapy and Ocupacional Therapy Hospital das Clinicas HCFMUSP Faculdade de Medicina Universidade de Sao Paulo Sao Paulo Brazil Center for Mathematics Computing and Cognition Universidade Federal de ABC Sao Paulo Brazil

Background: Transcranial direct current stimulation (tDCS) has emerged as an adjuvant noninvasive neuromodulation tool to control fatigue and pain. To date, no studies have assessed the safety and efficiency of tDCS in patients with rheumatoid arthritis and with fatigue, poor quality of life, and refractory radicular pain associated with spinal stenosis. Case Presentation: An 85-year-old woman patient presented with rheumatoid arthritis in remission, refractory radicular pain-associated spinal stenosis, fatigue, and impaired quality of life. The patient underwent 16 daily sessions of tDCS intervention (2 mA, 20 min, positively and negatively charged electrodes were positioned at C1 and Fp2, respectively), in addition to simultaneous peripheral neuromuscular electrical stimulation (frequency of 100 Hz and amplitude of 500 μs). After the intervention, neither disease relapse nor clinical intercurrence occurred. Moreover, there was a significant and sustained improvement in her health-related quality of life, with a reduction in the level of pain and chronic fatigue. Conclusion: The present case report shows that tDCS is safe and may be an adjuvant tool for the treatment of pain and fatigue in patients with systemic autoimmune disease, as well as for improving quality of life. Further studies are required to corroborate this case report.

关键词： Neuromodulation Pain Radiculopathy Rheumatoid Arthritis Treatment

Functional and Structural Arterial Vessel Features of Female Patients with Stable Dermatomyositis and Antisynthetase Syndrome

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Open Journal of Rheumatology and Autoimmune Diseases 2019年第3期9卷 101-110页

作者： Rafael Giovani Misse Isabela Bruna Pires Borges Valéria Aparecida Costa Hong Luiz Aparecido Bortolotto samuel katsuyuki shinjo Division of Rheumatology Faculdade de Medicina FMUSP Universidade de Sao Paulo Sao Paulo SP Brazil (BR) Hypertension Unit Instituto do Cora&#231 o Hospital das Clinicas HCFMUSP Faculdade de Medicina Universidade de Sao Paulo Sao Paulo SP Brazil (BR)

Introduction: Dermatomyositis (DM) and antisynthetase syndrome (ASS) show a high frequency of metabolic syndrome, which can be preceded by endothelial dysfunction and arterial stiffness. To date, only one study has evaluated these vessel parameters in DM, and no study of ASS exists. Therefore, the aim of the study was to assess the structural and functional arterial of arterial vessels in DM and ASS. Methods: This cross-sectional study enrolled 21 adult female patients (14 DM and 7 ASS) who were age-, gender- and ethnicity-matched to 12 healthy individuals. Patients using lipid lowering agents or prednisone at doses ≥ 0.25 mg/kg/day, and patients with uncontrolled systemic arterial hypertension, diabetes mellitus, cardiac insufficiency, and disease activity were excluded. Arterial stiffness was evaluated using carotid-femoral pulse wave velocity (PWV), and endothelial function was evaluated using dependent flow-mediated dilatation (FMD) of the brachial artery. Results: The mean age of patients with DM or ASS were 45.4 ± 8.6 and 44.0 ± 6.1 years, respectively (P = 1.000), and patients were predominantly of white ethnicity. Six DM patients and three ASS patients had systemic arterial hypertension, whereas 9 DM patients and six ASS patients had dyslipidemia. Endothelial baseline diameter, hyperemia diameter and FMD values were similar among the three groups (P > 0.05). Moreover, the median FMD values were also similar between the patients with DM and patients with ASS [8.3% (4.5% - 10.9%) vs. 6.0% (−1.8% - 8.2%);P = 0.585]. The PWV values were comparable among the three groups (P = 0.253). In addition, no difference was observed between patients with DM and patients with ASS (7.4 ± 0.8 m/s vs. 7.4 ± 0.9 m/s;P = 1.000). Conclusions: Despite the high prevalence of dyslipidemia and systemic arterial hypertension, our female patients with stable DM and ASS had FMD and PWV values comparable to those of the control group.

关键词： Arterial Stiffness Atherosclerosis Endothelial Dysfunction Systemic Autoimmune Myopathies

Musculoskeletal Tuberculosis in Dermatomyositis: Association or Coincidence?

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Open Journal of Rheumatology and Autoimmune Diseases 2014年第1期4卷 58-61页

作者： Andressa Silva Abreu Geórgea Hermogenes Fernandes Eduardo Ferreira Borba Lissiane Karine Noronha Guedes Jéssica Fernandes Ramos samuel katsuyuki shinjo Division of Rheumatology and Infectious Disease Department Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo Sao Paulo Brazil.

Dermatomyositis is a rare idiopathic inflammatory myopathy characterized by proximal muscle weakness associated with typical skin abnormalities and compatible electromyographic finds. Tuberculosis could determine several clinical manifestations but the classic one is the lung presentation. Among the extra pulmonary manifestations of tuberculosis, the musculoskeletal form is rare and it is usually a direct extension of the bone involvement nearby. In the present study, the authors described two dermatomyositis patients and musculoskeletal tuberculosis. In both cases, there was presence of bilateral tenosynovitis, which is considered atypical for further infectious.

关键词： Dermatomyositis Tenosynovitis Tuberculosis

Pain and Fatigue Perceptions of Patients with Systemic Autoimmune Myopathies before and during the COVID-19 Pandemic Period

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Open Journal of Rheumatology and Autoimmune Diseases 2022年第4期12卷 83-98页

作者： Rafael Giovani Missé Isabela Bruna Pires Borges Bruna Lindoso Correia Lorenza Rosa Silvério da Silva Marlise Sítima Mendes Simões Alexandre Moura dos Santos samuel katsuyuki shinjo Division of Rheumatology Faculdade de Medicina FMUSP Universidade de Sao Paulo Brazil

Objective: To assess general pain and fatigue and their association with the disease status of patients with systemic autoimmune myopathies (SAMs), in terms of the impact of the COVID-19 pandemic on these parameters. Methods: This is a cross-sectional and prospective cohort study that included 72 patients with SAMs who were matched by age and gender with 67 healthy individuals. The patients engaged in an interview via a validity survey to measure disease status, and assess a visual analog scale (VAS) for pain and fatigue in two periods: before (phase I) and during (phase II) of the Brazilian COVID-19 pandemic. For cross-sectional analysis, patients’ data from phase I were compared to healthy individuals’ information, whereas for prospective analysis, data of the patients who were assessed in phase II were compared to the same patients’ data from phase I. Results: The patients had significantly more pain perception, comparable fatigue perception and fatigue severity, when compared to the healthy individuals. During the COVID-19 pandemic period, the disease activity, pain and fatigue perceptions, and fatigue severity remained unchanged. Despite this, the pain and fatigue perceptions correlated significantly with patients’ VAS, the patient health outcome, and fatigue severity. In addition, the pain perception correlated to creatine phosphokinase, whereas fatigue perceptions correlated to physicians' VAS. Conclusions: The study showed that patients with SAMs have significantly increased pain perceptions compared to healthy individuals. During the COVID-19 pandemic period, the pain and fatigue perceptions remained unchanged in patients with SAMs but they correlated to several disease status parameters.

关键词： COVID-19 Pandemic Fatigue Inflammatory Myopathies Myositis Physical Activity