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- Efficacy of intravenous immunoglobulin in shrinking lung syndrome associated with mixed connective tissue disease: a case reportPublication . António, Manuel; Khmelinskii, Nikita; Fonseca, João EuricoShrinking lung syndrome is a rare manifestation of connective tissue diseases, namely systemic lupus erythematosus. It is characterised by reduced lung volumes and extra-pulmonary restrictive ventilatory pattern with good response to high-dose glucocorticoids alone or in combination with a second immunosuppressive agent. Here, we describe a case associated with mixed connective tissue disease and effectively treated with intravenous immunoglobulin.
- Envelhecimento ativo e a indústria da perfeiçãoPublication . António, ManuelIn the last two decades, Active Ageing acquired significant importance in scientific and political forums as a new paradigm of public policies to meet challenges posed by the ageing population. Defined by the WHO as to emphasize society’s responsibility regarding quality of life as people age, the Active Ageing paradigm represents, nowadays, a progressive narrowing of action scope and accountability. In recent years, assuming the logic of individual accountability, it serves as basis for the accusation of individual negligence in not adopting a healthy lifestyle. This study analyses the websites of several Portuguese medical clinics specialized in anti-ageing medicine, where one can find advertisements of the services provided, and, in some cases, opinion articles drawn up by doctors of this medical specialty, for a lay audience. Considering the increasing international dimension of the aesthetic and hormonal enhancement biotechnologies market, the ideal of Active ageing can, today, be at the service of the culture of perfection.
- Gastric adenocarcinoma presenting as a rheumatoid factor and anti-cyclic citrullinated protein antibody-positive polyarthritis: a case report and review of literaturePublication . Silvério-António, Manuel; Parlato, Federica; Martins, Patrícia; Khmelinskii, Nikita; Braz, Sandra; Fonseca, João Eurico; Polido Pereira, JoaquimA 64-year-old male presented with a 6-month history of symmetric polyarthritis involving proximal interphalangeal joints and metacarpophalangeal joints of the hands, wrists, and ankles. Associated symptoms included vomiting, progressive fatigue, and weight loss. Laboratory results showed microcytic anemia, leukocytosis, thrombocytosis, elevated C-reactive protein and erythrocyte sedimentation rate, and rheumatoid factor (RF) and anti-cyclic citrullinated protein (ACPA) antibody positivity. Joints radiographs were normal, without erosions. Upper endoscopy and gastric endoscopic ultrasonography showed a gastric adenocarcinoma with lymphatic involvement. Intraoperatively, peritoneal carcinomatosis was documented, and the patient started palliative chemotherapy. A paraneoplastic seropositive arthritis was assumed, and treatment with low-dose prednisolone and hydroxychloroquine was started. Arthritis remission was achieved and sustained up to 18 months of follow-up, although gastric cancer progression was documented. We describe a unique phenotype of paraneoplastic arthritis (PA) presenting as a seropositive (RF and ACPA positivity) rheumatoid arthritis (RA) with a good response to both low dose corticosteroids and hydroxychloroquine therapy. We also review the literature of PA, mostly the RA-like pattern, and the association between PA and ACPA positivity. This case highlights the importance of considering underlying cancer in elderly male patients, presenting with polyarthritis and systemic symptoms, even in those with ACPA-positive RA-like arthritis.
- How useful is contrast-enhanced ultrasound in rheumatoid arthritis? A systematic review with meta-analysis on the comparison between contrast-enhanced ultrasound and colour or power Doppler ultrasoundPublication . Polido Pereira, Joaquim; António, Manuel; Henriques, Susana Oliveira; Sabido, João; Fernandes, Ricardo M.; Vieira de Sousa, Elsa Cristina; D’Agostino, Maria Antonietta; Fonseca, João EuricoObjective The primary objective was to evaluate the additional benefits of contrast-enhanced ultrasound (CEUS) compared to unenhanced Doppler ultrasound (DUS) for the identification of active synovitis in rheumatoid arthritis (RA). Methods We searched PubMed/MEDLINE and EMBASE (February 2024) for all English-written published reports of human studies including the use of CEUS for the study of synovitis in RA. The risk of bias of included studies was evaluated using the QUADAS tool. DUS and CEUS semiquantitative scores were transformed in binomial, and these data were extracted for meta-analysis. Results that we were unable to quantitatively aggregate were summarised qualitatively. Results Twenty-three studies using CEUS to evaluate 1117 joints from 827 subjects were included, of which 898 joints were from 669 RA patients. We performed a meta-analysis of 9 studies in active RA patients showing that from 474 joints evaluated by either PDUS/CDUS and CEUS, the synovitis detection was 49.2% and 83.8%, respectively, corresponding to a relative detection ratio (RDR) of 1.49 (95% CI 1.23–1.81) favouring CEUS. Heterogeneity of the data was moderate. In healthy subjects, CEUS detected no vascularisation in 4 studies. Discussion CEUS detects more microvascularisation than PDUS in active RA with an RDR of 1.49.
- An unusual cause of shoulder pain in a young woman with systemic sclerosis: isolated intra-articular calcinosisPublication . Fontes, Tomás; António, Manuel; Macieira, Carla; Fonseca, João Eurico; Polido Pereira, JoaquimA 25-year-old woman with a recent diagnosis of SSc (anti-topo 1), expressed by progressive scleroderma, oesophageal dysmotility, serositis and RP, presented with bilateral shoulder pain and limited mobilization. The complaints prompted an US scan, which showed no synovitis or tendinopathy. However, intra-articular calcium deposits stood out, adhering to the hyaline cartilage of both humerus heads and moving with it on dynamic exploration (Fig. 1). Deposits on the glenoid labrum were also documented. There were no signs of skin calcinosis , and peripheral joint US and radiographs were normal. Secondary causes of calcium deposition disease were excluded.