Abstract | OBJECTIVE: METHODS: RESULTS: The frequency of microsporidia was significantly higher in rheumatic disease patients than in control subjects (36 vs. 4%, respectively; p<0.0001), as well as in those with rheumatic diseases (32 vs. 4%, respectively; p<0.0001), ankylosing spondylitis (45 vs. 4%, respectively; p<0.0001) and psoriatic arthritis (40 vs. 4%, respectively; p<0.0001), despite a similar social-economic class distribution in both the patient and control groups (p = 0.1153). Of note, concomitant fecal leukocytes were observed in the majority of the microsporidia-positive patients (79.5%). Approximately 80% of the patients had gastrointestinal symptoms, such as diarrhea (26%), abdominal pain (31%) and weight loss (5%), although the frequencies of these symptoms were comparable in patients with and without this infection (p>0.05). Rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis disease activity parameters were comparable in both groups (p>0.05). The duration of anti- tumor necrosis factor/disease-modifying anti-rheumatic drugs and glucocorticoid use were also similar in both groups. CONCLUSION: We have documented that microsporidiosis with intestinal mucosa disruption is frequent in patients undergoing concomitant anti- tumor necrosis factor/disease-modifying anti-rheumatic drug therapy. Impaired host defenses due to the combination of the underlying disease and the immunosuppressive therapy is the most likely explanation for this finding, and this increased susceptibility reinforces the need for the investigation of microsporidia and implementation of treatment strategies in this population.
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Authors | Nadia Emi Aikawa, Aline de Oliveira Twardowsky, Jozélio Freire de Carvalho, Clovis A Silva, Ivan Leonardo Avelino França E Silva, Ana Cristina de Medeiros Ribeiro, Carla Goncalves Schain Saad, Julio César Bertacini Moraes, Roberto Acayaba de Toledo, Eloísa Bonfá |
Journal | Clinics (Sao Paulo, Brazil)
(Clinics (Sao Paulo))
Vol. 66
Issue 7
Pg. 1171-5
( 2011)
ISSN: 1980-5322 [Electronic] United States |
PMID | 21876969
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
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Chemical References |
- Antirheumatic Agents
- Immunosuppressive Agents
- Tumor Necrosis Factor-alpha
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Topics |
- Adult
- Antirheumatic Agents
(adverse effects)
- Case-Control Studies
- Drug Therapy, Combination
(adverse effects)
- Female
- Humans
- Immunocompromised Host
(immunology)
- Immunosuppressive Agents
(adverse effects)
- Intestinal Diseases
(microbiology)
- Male
- Microsporidiosis
(immunology)
- Middle Aged
- Rheumatic Diseases
(drug therapy, immunology)
- Risk Factors
- Socioeconomic Factors
- Statistics, Nonparametric
- Tumor Necrosis Factor-alpha
(antagonists & inhibitors)
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