Blog - INTERNET MÉDICA

Poliarterite Nodosa: Casos Clínicos (Polyarteritis Nodosa: Case Reports)

Por Paulo Leite 25/11/2019

¨A poliarterite nodosa (PAN) é uma vasculite necrosante sistêmica caracterizada pela presença de um processo inflamatório agudo e necrose fibrinoide das artérias de pequeno e médio calibre. É uma doença considerada rara, com uma prevalência na população geral de cerca de seis por 100.000 pessoas. É mais comum nos homens entre 40 e 60 anos, com uma proporção de cerca de 2:1 em relação às mulheres. O curso pode ser agudo ou crônico, com longos intervalos assintomáticos. Há grande variabilidade dos sinais e sintomas devido aos diversos órgãos que podem ser afetados, atingindo preferencialmente o sistema nervoso periférico, o rim, a pele, o aparelho digestivo, o coração e as articulações. Em mais de 70% dos doentes, a febre é a manifestação inicial. Artralgias ou artrite surgem em cerca de 50% dos casos, sendo a poliarterite assimétrica não deformante das grandes articulações das extremidades inferiores a mais comum. Na PAN, são frequentes as manifestações cutâneas, sendo as mais comuns: livedo reticularis, fenômeno de Raynaud e úlceras e alterações isquêmicas das extremidades dos dedos. Sintomas sistêmicos, como a dor em vísceras e nos músculos esqueléticos, ocorrem devido ao declínio do suprimento arterial. É comum no quadro, a hipertensão arterial de início rápido. A doença pode progredir para uma insuficiência renal devido à vasculite. A patogênese é ainda pouco conhecida, mas relacionada a mecanismos imunes. Cerca de 30% dos pacientes com PAN possuem os antígenos de superfície HbSAg e Anti-Hbs do vírus da hepatite B no soro. O diagnóstico é histopatológico e baseia-se na demonstração das lesões vasculares características em biópsias de, por exemplo, pele ou músculo. Sem tratamento, a doença é fatal na maioria dos casos por insuficiência renal crônica ou complicações da hipertensão. Terapia com corticosteroides e quimioterápicos como a ciclofosfamida resultam em sobrevida maior que 5 anos em 80% dos casos. O tratamento eficiente da hipertensão é fundamental para um prognóstico melhor. ¨

■ Polyarteritis nodosa

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■ Blue toe syndrome in cutaneous polyateritis nodosa

T M Tounkara, M Jachiet, L Frumholts

Rheumatology (Oxford): 2018, vol 57 (7): 1281

https://academic.oup.com/rheumatology/article/57/7/1281/4925530

■ Cutaneous polyarteritis nodosa presenting atypicaly with severe pharyngeal ulceration

Bayanne Olabi, Justin C. Mason, Ziad Farah

Case Rep Rheumatol. 2019; 2019: 2631948

https://www.hindawi.com/journals/crirh/2019/2631948/

■ Miopatia multifocal en paciente con polarteritis nodosa: utilidad de la resonancia nuclear magnética como prueba diagnóstica

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■ PET-CT and polyarteritis nodosa-associated artery aneurysm

T T Watababe, T Shiojiri

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■ Sudden death from spontaneous coronary artery dissection due to polyarteritis nodosa

Cyrus M Munguti, Paul M Ndunda, Tabitha M Muutu

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■ Severe disabling myalgia as an initial presentation of polyarteritis nodosa

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■ Poliartrite crônica como primeira manifestação de poliarterite nodosa sistêmica pediátric

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■ A case of isolated renal involvement of polyarteritis nodosa successfully treated with steroid monotherapy

Negiin Pourafshar, Eric Sobel, Mark Segal

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■ Polyarteritis nodosa presenting as profuse gastrointestinal bleeding

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■ Minocycline-induced renal polyarteritis nodosa

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■ Poliarterite nodosa: revisão de literatura a propósito de um caso clínico.

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■ Dr Paulo Fernando Leite

Cardiologia/Prevenção Cardiovascular

Estratificação de Risco Cardiovascular

Consultório: Rua Padre Rolim 815/sala 601

Tel: 33245518

Belo Horizonte – MG/Brasil

CRMMG: 7026

Email: pfleite1873@gmail.com

Data: nov 2019

Medicina do Trabalho: Artigos de Revisão Online (Occupational Medicine: Reviews)

Por Paulo Leite 21/11/2019

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■ Occupational exposure to inhaled nanoparticles: Are young workers being left in the dust?

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■ Glutathione S-transferase is a good biomarkers in acrylamide induced neurotoxicity and genotocicity

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■ Advances in acute toxicity testing: strengths, weaknesses and regulatory acceptance

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■ Antidotal effects of thymoquinone against neurotoxic agents

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■ Dichlorvos toxicity: a public health perspective

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■ Scoping review occupational therapy interventions in primary care

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■ The relationship between occupational demands and well-being of performing artists: a systematic review

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■ How safe is chicken litter for land application as an organic fertilizer? A review

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■ Childhood lead exposure and adult neurodegenerative disease

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■ Improving the job-retention strategies in multiple sclerosis workers: the role of occupational physicians

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■ Ioga na saúde do trabalhador: revisão integrativa de estudos de intervenção

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■ A ginática laboral no Brasil entre os anos de 2006 e 2016: uma scoping review

R F Neves, S P A Araújo, L V Magalhães, M A G de Lima

Rev Bras Med Trab 2018, vol 16 (1): 82—96

http://www.rbmt.org.br/details/297/pt-BR/a-ginastica-laboral-no-brasil-entre-os-anos-de-2006-e-2016–uma-scoping-review

■ Device-measured physical activity, sedentary behavior and cardiometabolic health and fitness across occupational groups: a systematic review and meta-analysis

Stephanie A. Prince, Cara G. Elliott, Kyle Scott, Sarah Visintini, Jennifer L. Reed

Int J Behav Nutr Phys Act. 2019; 16: 30

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6444868/

■ A restrição da jornada de trabalho do médico e seu impacto na segurança do paciente: uma revisão integrativa

F S Moura, E I M Moura, M A P de Novais

Rev Bras Med Trab 2018, vol 16 (4): 484-492

http://www.rbmt.org.br/details/388/pt-BR/a-restricao-da-jornada-de-trabalho-do-medico-e-seu-impacto-na-seguranca-do-paciente–uma-revisao-integrativa

■ Estresse ocupacional no ambiente hospitalar: revisão das estratégias de enfrentamento dos trabalhadores de Enfermagem

R C Souza, S M Silva, M L A S Costa

Rev Bras Med Trab 2018, vol 16 (4): 493-502

http://www.rbmt.org.br/details/389/pt-BR/estresse-ocupacional-no-ambiente-hospitalar–revisao-das-estrategias-de-enfrentamento-dos-trabalhadores-de-enfermagem

■ Uma revisão narrativa associando a vulnerabilidade à saúde e os fatores ambientais de trabalhadores rurais