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Lúpus eritematoso sistémico canino : revisão bibliográfica a propósito de um caso clínico
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Orientador(es)
Resumo(s)
O lúpus eritematoso sistémico (LES) é considerado o protótipo das doenças autoimunes
sistémicas e, devido à diversidade de sintomas que podem estar presentes, é conhecido
como “o grande imitador”.
A etiologia da doença é desconhecida, mas actualmente é atribuído um papel importante às
alterações do sistema imunitário, à componente genética e a diversos factores externos.
Apesar de na doença humana se verificar uma susceptibilidade relacionada com o sexo
feminino, nos cães isto não parece acontecer, sendo afectados de modo idêntico ambos os
sexos. O paciente típico tem cerca de 5 anos de idade e existem algumas raças com maior
predisposição para a doença, como o Pastor Alemão, o Pastor de Shetland, o Galgo Afegão
e o Beagle, entre outros.
O LES caracteriza-se principalmente por uma reacção de hipersensibilidade do tipo III, com
formação de autoanticorpos, dirigidos principalmente a material nuclear, e complexos
imunes. A deposição dos imunocomplexos nos diferentes órgãos é a principal responsável
pela sintomatologia, sendo mais frequentemente afectados os rins, a pele e as articulações
e existindo normalmente períodos de remissão e períodos em que a doença está mais
activa.
Não existe um teste 100% específico para o LES canino e as alterações clínicas e
laboratoriais não são exclusivas da doença. Como tal, deverão ser seguidos alguns critérios,
adaptados da doença humana, a fim de se fazer o diagnóstico definitivo.
O tratamento do LES é baseado principalmente em medicação imunosupressiva,
principalmente glucocorticóides. No entanto, na maior parte dos casos o maneio clínico é
difícil e torna-se necessária a adição de outros fármacos. Na última década têm sido feitos
progressos relacionados com a terapia molecular e celular, que podem trazer alguns
benefícios, principalmente no que respeita aos efeitos secundários adversos do tratamento
imunosupressivo a longo prazo.
O prognóstico da doença é sempre reservado, já que depende dos órgãos envolvidos e da
resposta à terapêutica. Devido à natureza complexa da doença, é necessário um
acompanhamento próximo e frequente do paciente.
ABSTRACT - Canine Systemic Lupus Erythematosus: bibliographic review regarding one clinical case - Systemic lupus erythematosus (SLE) is considered to be the prototype of the systemic autoimmune diseases and, due to the diversity of symptoms among patients, it has been called “the great imitator”. Although the aetiology of the disease is unknown, a role is credited to immune system alterations, genetic factors and several external causes. Despite an increased susceptibility related to gender – women being affected more frequently – in the human disease, this doesn’t seem to be the case in dogs, as both genders are equally affected. The typical patient is around 5 years old and there are some predisposed breeds, namely German Shepherd, Shetland Sheepdog, Afghan Hound and Beagle, among others. SLE is characterized essentially by a type III hypersensitivity reaction, with autoantibodies, directed largely to nuclear components, and antigen-antibody complexes formation. Symptoms are mainly caused by immune complex deposition in different organs, kidneys, skin and joints being the most affected ones, and usually there are periods of relapse and periods of remission. As there is not a completely specific test for canine SLE and the clinical and laboratory aspects are not disease exclusive, when trying to achieve a definitive diagnosis there are some diagnostic criteria that should be followed, these being adapted from the human disease. Treatment is based essentially on immunosuppressive drugs, mostly glucocorticoids. However, in most cases, clinical management of the disease is difficult and it becomes necessary to add more drugs. In the last decade progress has been made regarding cellular and molecular therapy. These may bring some benefits, especially concerning the adverse effects of long-term therapy with immunosuppressive medication. The prognosis of SLE is always guarded, as it depends on the affected organs and response to therapy. Due to the complex nature of the disease, a close and frequent monitoring of the patient is necessary.
ABSTRACT - Canine Systemic Lupus Erythematosus: bibliographic review regarding one clinical case - Systemic lupus erythematosus (SLE) is considered to be the prototype of the systemic autoimmune diseases and, due to the diversity of symptoms among patients, it has been called “the great imitator”. Although the aetiology of the disease is unknown, a role is credited to immune system alterations, genetic factors and several external causes. Despite an increased susceptibility related to gender – women being affected more frequently – in the human disease, this doesn’t seem to be the case in dogs, as both genders are equally affected. The typical patient is around 5 years old and there are some predisposed breeds, namely German Shepherd, Shetland Sheepdog, Afghan Hound and Beagle, among others. SLE is characterized essentially by a type III hypersensitivity reaction, with autoantibodies, directed largely to nuclear components, and antigen-antibody complexes formation. Symptoms are mainly caused by immune complex deposition in different organs, kidneys, skin and joints being the most affected ones, and usually there are periods of relapse and periods of remission. As there is not a completely specific test for canine SLE and the clinical and laboratory aspects are not disease exclusive, when trying to achieve a definitive diagnosis there are some diagnostic criteria that should be followed, these being adapted from the human disease. Treatment is based essentially on immunosuppressive drugs, mostly glucocorticoids. However, in most cases, clinical management of the disease is difficult and it becomes necessary to add more drugs. In the last decade progress has been made regarding cellular and molecular therapy. These may bring some benefits, especially concerning the adverse effects of long-term therapy with immunosuppressive medication. The prognosis of SLE is always guarded, as it depends on the affected organs and response to therapy. Due to the complex nature of the disease, a close and frequent monitoring of the patient is necessary.
Descrição
Dissertação de Mestrado Integrado em Medicina Veterinária
Palavras-chave
Lúpus eritematoso sistémico Canídeos Autoimunidade Anticorpos antinucleares Glucocorticóides Systemic lupus erythematosus Dogs Autoimmunity Antinuclear antibodies Glucocorticoids
Contexto Educativo
Citação
Pascoal, R.T.C. (2010). Lúpus eritematoso sistémico canino: revisão bibliográfica a propósito de um caso clínico. Dissertação de Mestrado. Universidade Técnica de Lisboa, Faculdade de Medicina Veterinária, Lisboa.
Editora
Universidade Técnica de Lisboa. Faculdade de Medicina Veterinária