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Article ; Online: Safety of treatment with chloroquine and hydroxychloroquine: A ten-year systematic review and meta-analysis.

Edington, Fernando Luiz Barros / Gadellha, Sandra Rocha / Santiago, Mittermayer Barreto

2021 Volume 88, Page(s) 63–72

Abstract: Objective: To estimate the incidence rate ratio (IRR) of adverse events (AE) in chloroquine or hydroxychloroquine users.: Methods: We systematically reviewed randomized controlled trials (RCTs), using MEDLINE (2010-2020) and EMBASE (2010-2020) ... ...

Abstract	Objective: To estimate the incidence rate ratio (IRR) of adverse events (AE) in chloroquine or hydroxychloroquine users. Methods: We systematically reviewed randomized controlled trials (RCTs), using MEDLINE (2010-2020) and EMBASE (2010-2020) databases, reporting AE in chloroquine or hydroxychloroquine users during treatment for lupus, rheumatoid arthritis, malaria and COVID-19. The protocol for this systematic review is registered at the PROSPERO database (CRD42020197938). The quality of the included studies was assessed using the Cochrane risk-of-Bias tool and relevant data were extracted though a customized data collection form, independently, by two authors. The IRR of AE was estimated using a random-effect model meta-analysis and heterogeneity was evaluated by T Results: Forty-six RCTs met our eligibility criteria and were included in our analysis (23132 patients). There was not a single death attributed to chloroquine or hydroxychloroquine use in the included RCTs. The IRR of general AE during antimalarial use was 1.15 [CI 95% 1.01-1.31]. COVID-19 patients treated with either antimalarial presented an 83% and 165% higher risk of developing general and gastrointestinal AE, respectively, in comparison with controls. The use of antimalarial increased the risk of developing dermatological AE by 92% in malarial studies and reduced by 65% in lupus studies. We did not find a significatively higher risk of cardiovascular nor ophthalmological AE in antimalarial users. Conclusions: Our data reinforces that chloroquine and hydroxychloroquine have a good safety profile though caution is advised when using higher than usual doses in hospitalized COVID-19 patients.
Language	English
Publishing date	2021-04-05
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	1038679-8
ISSN	1879-0828 ; 0953-6205
ISSN (online)	1879-0828
ISSN	0953-6205
DOI	10.1016/j.ejim.2021.03.028
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Zs.A 2608: Show issues

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Article ; Online: Reply to Letter to the Editor Re: "Ultrasound Findings on Hands and Wrists of Patients with Systemic Lupus Erythematosus: Relationship with Physical Examination".

Lins, Carolina Freitas / Santiago, Mittermayer Barreto

Ultrasound in medicine & biology

2017 Volume 43, Issue 12, Page(s) 2959–2960

MeSH term(s)	Hand ; Humans ; Lupus Erythematosus, Systemic ; Physical Examination ; Wrist
Language	English
Publishing date	2017
Publishing country	England
Document type	Letter ; Comment
ZDB-ID	186150-5
ISSN	1879-291X ; 0301-5629
ISSN (online)	1879-291X
ISSN	0301-5629
DOI	10.1016/j.ultrasmedbio.2017.08.003
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Zs.A 963: Show issues

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Article: Pulmonary sarcoidosis with arterial involvement.

da Paz, Adriane Souza / Coelho, João Carlos / Melo, Bartira / Pedreira, Ana Luísa / Santiago, Mittermayer Barreto

Autopsy & case reports

2021 Volume 11, Page(s) e2021294

Abstract: Necrotizing sarcoid granulomatosis (NSG) is a rare and under-recognized cause of granulomatous disease, described as a variant of typical nodular sarcoidosis. It can be asymptomatic when the patient has a single pulmonary nodule or may be accompanied by ... ...

Abstract	Necrotizing sarcoid granulomatosis (NSG) is a rare and under-recognized cause of granulomatous disease, described as a variant of typical nodular sarcoidosis. It can be asymptomatic when the patient has a single pulmonary nodule or may be accompanied by cough, fever, and dyspnea, or even symptoms due to the involvement of other organs such as the eyes, liver, and central nervous system. The histopathological analysis is essential for the differential diagnosis of other infectious and non-infectious causes of granuloma and to determine the appropriate treatment. NSG is characterized by the presence of a granuloma with extensive coagulative necrosis associated with the occurrence of vasculitis. We present the case of a patient diagnosed with NSG who had an unusual outcome with recurrent pulmonary thromboembolisms followed by hemodynamic instability and death.
Language	English
Publishing date	2021-07-08
Publishing country	Brazil
Document type	Case Reports
ZDB-ID	2815488-5
ISSN	2236-1960
ISSN	2236-1960
DOI	10.4322/acr.2021.294
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Article ; Online: Efficacy of hydroxychloroquine in the prevention of thromboembolic events: A systematic review and meta-analysis.

Barros Edington, Fernando Luiz / de Rezende, Daniel Fraga / Dos Santos, Luis Fernando Simões / Garcia, Rayssa Valandro / Gadelha, Sandra Rocha / Santiago, Mittermayer Barreto

Lupus

2022 Volume 31, Issue 2, Page(s) 238–245

Abstract: Objective: To estimate the risk ratio (RR) of thromboembolic events in chloroquine and hydroxychloroquine users compared to non-users.: Methods: We systematically reviewed randomized controlled trials (RCTs), using MEDLINE and EMBASE databases from ... ...

Abstract	Objective: To estimate the risk ratio (RR) of thromboembolic events in chloroquine and hydroxychloroquine users compared to non-users. Methods: We systematically reviewed randomized controlled trials (RCTs), using MEDLINE and EMBASE databases from inception to the present, reporting thromboembolic events in chloroquine and hydroxychloroquine users compared to non-users. Four authors independently screened all the records obtained through our search strategy and later revised the selected full-text articles for eligibility, according to our inclusion criteria. The same four authors independently extracted relevant data through a customized data collection form while two other authors assessed the quality of the included RCTs using the Cochrane risk-of-bias tool (Version 2.0). All the disagreements were resolved through discussions among the authors. We calculated the risk ratio (RR) and its respective standard error of developing thromboembolic events in hydroxychloroquine users and non-users for each individual study and pooled the results using a random effects model meta-analysis. We assessed Heterogeneity using the Tau Results: Thirteen RCTs met our eligibility criteria and were included in our analysis (2663 patients). We found that hydroxychloroquine-no study on chloroquine was found-reduced the risk of thromboembolic events by 49% (RR 0.51[IC 95% 0.31-0.84]) with a medium heterogeneity (I Conclusion: Our data reinforce the idea that hydroxychloroquine reduces the risk of thromboembolic events.
MeSH term(s)	Chloroquine/adverse effects ; Humans ; Hydroxychloroquine/adverse effects ; Lupus Erythematosus, Systemic
Chemical Substances	Hydroxychloroquine (4QWG6N8QKH) ; Chloroquine (886U3H6UFF)
Language	English
Publishing date	2022-01-18
Publishing country	England
Document type	Journal Article ; Meta-Analysis ; Systematic Review
ZDB-ID	1154407-7
ISSN	1477-0962 ; 0961-2033
ISSN (online)	1477-0962
ISSN	0961-2033
DOI	10.1177/09612033221074192
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Zs.A 3717: Show issues

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Article ; Online: Biological therapy in rheumatoid vasculitis: a systematic review.

de Cerqueira, Débora Patrícia Alves / Pedreira, Ana Luisa Souza / de Cerqueira, Marcelo Gomes / Santiago, Mittermayer Barreto

Clinical rheumatology

2020 Volume 40, Issue 5, Page(s) 1717–1724

Abstract: Rheumatoid vasculitis (RV) is one of the most severe extra-articular manifestations of rheumatoid arthritis, with significant morbidity and mortality, requiring aggressive treatment with corticosteroids and/or immunosuppressants. Recently, biological ... ...

Abstract	Rheumatoid vasculitis (RV) is one of the most severe extra-articular manifestations of rheumatoid arthritis, with significant morbidity and mortality, requiring aggressive treatment with corticosteroids and/or immunosuppressants. Recently, biological drugs were included in its therapeutic armamentarium. The objective of this study was to perform a systematic review on the use of biological drugs in the treatment of RV. A systematic literature review was performed based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) recommendations and searching articles in MEDLINE/PubMed, Cochrane, SciELO, Scopus, and Virtual Health Library electronic databases. Secondary references were also evaluated. The methodological quality of the selected studies was evaluated by the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) criteria. Altogether, five articles, assessing the use of biological drugs, were included. Globally, 35 patients participated in the studies, of which 21 were treated with rituximab (RTX) in cycles of 1000 mg every 2 weeks; 9 used infliximab 5 mg/kg; 3 used infliximab 3 mg/kg; and 2 used etanercept 25 mg twice/week. In general, an improvement in clinical picture, reduction of the mean daily dose of corticosteroids, and improvement in the Birmingham Vasculitis Activity Score was achieved by the end of the treatment. Complete remission occurred in almost 70% of the cases. The adverse effect rate was 34%, mainly due to infections. There were two deaths, one due to sepsis and the other due to uncontrolled vasculitis, after the biological drug withdrawal, following the development of sepsis. Based on the results of the present review, we believe that the use of biological therapy such as RTX and anti-tumor necrosis factor α can be beneficial in treating this complication.
MeSH term(s)	Adalimumab ; Antibodies, Monoclonal/therapeutic use ; Antirheumatic Agents/therapeutic use ; Biological Therapy ; Etanercept/therapeutic use ; Humans ; Infliximab/therapeutic use ; Rheumatoid Vasculitis/drug therapy
Chemical Substances	Antibodies, Monoclonal ; Antirheumatic Agents ; Infliximab (B72HH48FLU) ; Adalimumab (FYS6T7F842) ; Etanercept (OP401G7OJC)
Language	English
Publishing date	2020-10-14
Publishing country	Germany
Document type	Journal Article ; Systematic Review
ZDB-ID	604755-5
ISSN	1434-9949 ; 0770-3198
ISSN (online)	1434-9949
ISSN	0770-3198
DOI	10.1007/s10067-020-05459-9
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Zs.A 1740: Show issues

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Article ; Online: Concomitance of Elephantiasis Nostras Verrucosa and Systemic Sclerosis.

Camargo, Pedro Herrera / Moreira, Thiara Pacheco / de Souza, Bianca Carla Azevedo / Santiago, Mittermayer Barreto

Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases

2020 Volume 27, Issue 8S, Page(s) S371–S374

MeSH term(s)	Elephantiasis/diagnosis ; Elephantiasis/etiology ; Humans ; Scleroderma, Systemic/complications ; Scleroderma, Systemic/diagnosis
Language	English
Publishing date	2020-07-30
Publishing country	United States
Document type	Journal Article
ZDB-ID	1283266-2
ISSN	1536-7355 ; 1076-1608
ISSN (online)	1536-7355
ISSN	1076-1608
DOI	10.1097/RHU.0000000000001537
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Zs.A 4815: Show issues

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Article ; Online: Surgery for Jaccoud Arthropathy: A Systematic Review.

Santos, Willer D / Baleeiro, Carla / Santiago, Mittermayer Barreto

Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases

2016 Volume 22, Issue 1, Page(s) 35–38

Abstract: Introduction: Jaccoud arthropathy (JA) is characterized by the presence of joint deformities similar to those seen in rheumatoid arthritis but generally with a "reversible" pattern. The etiopathogenic mechanisms are not known, and its therapeutical ... ...

Abstract	Introduction: Jaccoud arthropathy (JA) is characterized by the presence of joint deformities similar to those seen in rheumatoid arthritis but generally with a "reversible" pattern. The etiopathogenic mechanisms are not known, and its therapeutical approach has been regarded as disappointing. The aim of the present study was to perform a systematic review of the literature on the scientific evidence of the surgical procedures for JA. Methods: The MEDLINE, LILACS, and Scielo databases were searched using the following keywords: "systemic lupus erythematosus," "rheumatic fever," "Jaccoud arthropathy," "deforming arthropathy," "surgery," and their corresponding terms in Portuguese and Spanish. The search period was between 1966 and 2014. Results: Only 7 articles fulfilled the inclusion criteria, and a total of 58 patients underwent surgical procedures for JA. Such studies were limited to small case series, there was no uniform definition of the outcome, and the follow-up time varied largely. Conclusions: There is no consensus on the best approach for the surgical procedures in patients with JA, who are the best candidates to undergo this, and when to indicate the procedure.
MeSH term(s)	Arthritis, Rheumatoid/complications ; Humans ; Joint Deformities, Acquired/etiology ; Joint Deformities, Acquired/surgery ; Orthopedic Procedures/methods
Language	English
Publishing date	2016-01
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1283266-2
ISSN	1536-7355 ; 1076-1608
ISSN (online)	1536-7355
ISSN	1076-1608
DOI	10.1097/RHU.0000000000000334
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Zs.A 4815: Show issues

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Article ; Online: Non-criteria Antiphospholipid Antibodies: a narrative review.

Funke, Andreas / Staub, Henrique Luiz / Monticielo, Odirlei Andre / Balbi, Gustavo Guimarães Moreira / Danowski, Adriana / Santiago, Mittermayer Barreto / Andrade, Danieli Castro Oliveira de / Rêgo, Jozelia

Revista da Associacao Medica Brasileira (1992)

2020 Volume 66, Issue 11, Page(s) 1595–1601

Abstract: The 2006 Revised Sapporo Classification Criteria for Definite Antiphospholipid Syndrome included as laboratory criteria the tests for antiphospholipid antibodies whose accuracy was regarded as satisfactory according to the evidence available at that time. ...

Abstract	The 2006 Revised Sapporo Classification Criteria for Definite Antiphospholipid Syndrome included as laboratory criteria the tests for antiphospholipid antibodies whose accuracy was regarded as satisfactory according to the evidence available at that time. In practice, however, the sensitivity and specificity of these "criteria" of antiphospholipid antibodies are sometimes insufficient for identifying or ruling out antiphospholipid syndrome. It has been studied whether the accuracy of the laboratory diagnosis of the syndrome could be improved by testing for non-criteria antiphospholipid antibodies. In this work, we review evidence on the clinical associations and diagnostic value of the most commonly studied non-criteria antibodies, namely: antiphosphatidylethanolamine, anti-annexin A5, anti-prothrombin, anti-phosphatidylserine/prothrombin complex, IgA anticardiolipin, and IgG anti-domain I of the β2 glycoprotein antibodies.
MeSH term(s)	Antibodies, Anticardiolipin ; Antibodies, Antiphospholipid ; Antiphospholipid Syndrome/diagnosis ; Humans ; Prothrombin ; Sensitivity and Specificity ; beta 2-Glycoprotein I
Chemical Substances	Antibodies, Anticardiolipin ; Antibodies, Antiphospholipid ; beta 2-Glycoprotein I ; Prothrombin (9001-26-7)
Language	English
Publishing date	2020-12-09
Publishing country	Brazil
Document type	Journal Article ; Review
ZDB-ID	731969-1
ISSN	1806-9282 ; 0104-4230 ; 0004-5241 ; 0102-843X
ISSN (online)	1806-9282
ISSN	0104-4230 ; 0004-5241 ; 0102-843X
DOI	10.1590/1806-9282.66.11.1595
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Zs.B 654: Show issues

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Article: IgG4-Related Disease: A Multispecialty Condition.

Usêda Santana, Iuri / da Fonseca, Emanuela Pimenta / Santiago, Mittermayer Barreto

Case reports in rheumatology

2014 Volume 2014, Page(s) 723493

Abstract: IgG4-related disease (IgG4-RD) is a recently recognized group of conditions, characterized by tumor-like swelling of involved organs, lymphoplasmacytic infiltrate rich in IgG4-positive plasma cells, variable degrees of fibrosis, and elevated serum IgG4 ... ...

Abstract	IgG4-related disease (IgG4-RD) is a recently recognized group of conditions, characterized by tumor-like swelling of involved organs, lymphoplasmacytic infiltrate rich in IgG4-positive plasma cells, variable degrees of fibrosis, and elevated serum IgG4 concentrations. Currently IgG4-RD is recognized as a systemic condition that can affect several organs and tissues. Herein we report the case of a 34-year-old male patient who was admitted to our hospital with diffuse abdominal pain, weight loss, and painful stiffness in his neck. He had a history of tumoral mass of the left maxillary region, right palpebral ptosis with protrusion of the eyeball, and chronic dry cough for about 6 years. Laboratory tests revealed polyclonal hypergammaglobulinemia and increased serum IgG4 levels. Immunohistochemical staining of the maxillary biopsy was compatible with IgG4-RD. He had an excellent response to corticosteroid therapy. This case highlights that IgG4-RD should be included in the differential diagnosis with multisystem diseases.
Language	English
Publishing date	2014-11-24
Publishing country	United States
Document type	Journal Article
ZDB-ID	2666708-3
ISSN	2090-6897 ; 2090-6889
ISSN (online)	2090-6897
ISSN	2090-6889
DOI	10.1155/2014/723493
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Article ; Online: Antiphospholipid Syndrome Committee of the Brazilian Society of Rheumatology position statement on the use of direct oral anticoagulants (DOACs) in antiphospholipid syndrome (APS).

Balbi, Gustavo Guimarães Moreira / Pacheco, Marcelo de Souza / Monticielo, Odirlei Andre / Funke, Andreas / Danowski, Adriana / Santiago, Mittermayer Barreto / Staub, Henrique Luiz / Rêgo, Jozelia / de Andrade, Danieli Castro Oliveira

Advances in rheumatology (London, England)

2020 Volume 60, Issue 1, Page(s) 29

Abstract: Background: The term Direct Oral Anticoagulants (DOACs) refers to a group of drugs that inhibit factor Xa or thrombin. Even though their use for treating different thrombotic or prothrombotic conditions is increasing recently, there is no compelling ... ...

Abstract	Background: The term Direct Oral Anticoagulants (DOACs) refers to a group of drugs that inhibit factor Xa or thrombin. Even though their use for treating different thrombotic or prothrombotic conditions is increasing recently, there is no compelling evidence indicating that those medications are safe in all antiphospholipid syndrome (APS) patients. Methodology: To address this issue, specialists from the Antiphospholipid Syndrome Committee of the Brazilian Society of Rheumatology performed a comprehensive review of the literature regarding DOACs use in APS to answer the three following questions: (1) potential mechanisms of action of these drugs that could be relevant to APS pathogenesis, (2) DOACs interference on lupus anticoagulant testing, and (3) the efficacy of DOACs in APS. Position statement: After critically reviewing the relevant evidence, the authors formulated 8 Position Statements about DOACs use in APS. Conclusion: DOACs should not be routinely used in APS patients, especially in those with a high-risk profile (triple positivity to aPL, arterial thrombosis, and recurrent thrombotic events). In addition, DOACs interferes with LA testing, leading to false-positive results in patients investigating APS.
MeSH term(s)	Administration, Oral ; Advisory Committees ; Antiphospholipid Syndrome/drug therapy ; Antithrombins/adverse effects ; Antithrombins/pharmacology ; Antithrombins/therapeutic use ; Brazil ; Consensus ; Contraindications, Drug ; Drug Interactions ; Drug Substitution ; Humans ; Lupus Coagulation Inhibitor/analysis ; Observational Studies as Topic ; Randomized Controlled Trials as Topic ; Recurrence ; Rheumatology ; Societies, Medical ; Thrombosis/drug therapy ; Treatment Outcome
Chemical Substances	Antithrombins ; Lupus Coagulation Inhibitor
Language	English
Publishing date	2020-05-27
Publishing country	England
Document type	Journal Article ; Review
ISSN	2523-3106
ISSN (online)	2523-3106
DOI	10.1186/s42358-020-00125-9
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