Avalia??o de marcadores cl?nicos e imunol?gicos de idosos e portadores de artrite reumat?ide na pandemia da COVID-19
Ano de defesa: | 2023 |
---|---|
Autor(a) principal: | |
Orientador(a): | |
Banca de defesa: | |
Tipo de documento: | Tese |
Tipo de acesso: | Acesso aberto |
Idioma: | por |
Instituição de defesa: |
Pontif?cia Universidade Cat?lica do Rio Grande do Sul
|
Programa de Pós-Graduação: |
Programa de P?s-Gradua??o em Medicina e Ci?ncias da Sa?de
|
Departamento: |
Escola de Medicina
|
País: |
Brasil
|
Palavras-chave em Português: | |
Palavras-chave em Inglês: | |
Área do conhecimento CNPq: | |
Link de acesso: | https://tede2.pucrs.br/tede2/handle/tede/11122 |
Resumo: | INTRODUCTION: The COVID-19 pandemic, known as coronavirus disease 2019, is an infectious disease caused by a novel coronavirus called SARS-CoV-2. This virus, derived from the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), leads to a highly contagious disease capable of inducing pneumonia and severe acute respiratory syndromes (SARS). Certain populations, particularly the elderly, are more susceptible to developing severe manifestations of the disease. OBJECTIVE: Investigate clinical and immunological characteristics of elderly patients with Rheumatoid Arthritis (RA) during COVID-19 pandemic and compare these findings with elderly individuals without autoimmune diseases and without the use of immunosuppressive agents (control group). METHODOLOGY: The study involved the participation of 23 elderly individuals with RA and 21 elderly individuals without autoimmune diseases or the use of immunosuppressive medications. This research followed a cross-sectional, controlled design, where clinical and immunological markers were investigated and compared between the two groups. The study population consisted of patients over 60 years of age receiving care at the outpatient clinics of Hospital S?o Lucas (HSL) affiliated with the Pontifical Catholic University of Rio Grande do Sul (PUCRS) and at the PUCRS Clinical Center. Clinical assessments were conducted through presencial appointment which included physical examinations and standardized questionnaires. The analysis of hematological, biochemical, and systemic inflammation markers followed the established protocols of the clinical analysis laboratory at HSL. Flow cytometry was employed for immunophenotyping and the identification of subpopulations of peripheral blood mononuclear cells (PBMCs). The recruitment of participants occurred between June 2021 and May 2023. RESULTS: The mean age of patients with RA was 70.6 years (? 4.7) and that of controls was 77.0 years (? 10.8). The observed disparity in age between these two groups was determined to be statistically significant, and this discrepancy was taken into consideration in the comparative analyses conducted.. Other clinical characteristics, such as the presence of comorbidities, depression, and frailty assessment rates, were found to be similar across both groups. It is worth noting that all individuals diagnosed with RA were utilizing immunosuppressants. Elderly individuals with RA exhibited lower adherence to social isolation measures and the use of masks at this point in the pandemic. However, but they had greater exposure to booster doses of anti-SARS-CoV2 vaccines, and the clinical events related to the COVID-19 pandemic were comparable between the RA and control groups. Importantly, patients with RA did not necessitate additional hospital care, medical consultations, or intensive care unit management. Moreover, there were no disparities in the reports of acute flu syndrome in the month preceding the interviews. The groups demonstrated homogeneity in terms of lipid profile, renal function, glycated hemoglobin levels, as well as absolute lymphocyte and neutrophil counts. Furthermore, it was observed that RA patients had lower albumin levels in comparison to the control group. Notably, higher frequencies of certain CD4+ T Lymphocyte (LT) subpopulations, including CD3+CD4+CD25+, CD4+CTLA4+, and CD4+PD1+CTLA4+, were identified in individuals with RA. However, no distinctions were found between the total CD4+ LT, total CD8+ LT, NKT LT (known as NKT cells), monocytes, or total B Lymphocyte (LB) populations. Interestingly, the transitional LB subpopulation, characterized by CD19+CD27-CD38hi, was found to be reduced in individuals with RA. In conclusion, this study sheds light on various aspects of elderly individuals with RA in the context of the COVID-19 pandemic and provides insights into immune checkpoints, activated T lymphocytes, and transitional B lymphocytes. CONCLUSIONS: From a clinical standpoint, patients with RA did not experience a worsened condition during this stage of the pandemic and within the outpatient setting, even thoughRA patients exhibited a more activated and more exhausted TL profilein comparison to elderly individuals without of RA. The population of transitional BL was reduced in the RA group , which may suggest that treatment of the disease can influence the immune response to vaccines via this route. RA and the use of immunosuppressive drugs have the potential to alter lymphocyte subpopulations. |
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Sato, Douglas kazutoshihttp://lattes.cnpq.br/1138053643046606http://lattes.cnpq.br/0877292856605674Rabelo, Cristina Ferreira2024-03-20T18:07:21Z2023-11-27https://tede2.pucrs.br/tede2/handle/tede/11122INTRODUCTION: The COVID-19 pandemic, known as coronavirus disease 2019, is an infectious disease caused by a novel coronavirus called SARS-CoV-2. This virus, derived from the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), leads to a highly contagious disease capable of inducing pneumonia and severe acute respiratory syndromes (SARS). Certain populations, particularly the elderly, are more susceptible to developing severe manifestations of the disease. OBJECTIVE: Investigate clinical and immunological characteristics of elderly patients with Rheumatoid Arthritis (RA) during COVID-19 pandemic and compare these findings with elderly individuals without autoimmune diseases and without the use of immunosuppressive agents (control group). METHODOLOGY: The study involved the participation of 23 elderly individuals with RA and 21 elderly individuals without autoimmune diseases or the use of immunosuppressive medications. This research followed a cross-sectional, controlled design, where clinical and immunological markers were investigated and compared between the two groups. The study population consisted of patients over 60 years of age receiving care at the outpatient clinics of Hospital S?o Lucas (HSL) affiliated with the Pontifical Catholic University of Rio Grande do Sul (PUCRS) and at the PUCRS Clinical Center. Clinical assessments were conducted through presencial appointment which included physical examinations and standardized questionnaires. The analysis of hematological, biochemical, and systemic inflammation markers followed the established protocols of the clinical analysis laboratory at HSL. Flow cytometry was employed for immunophenotyping and the identification of subpopulations of peripheral blood mononuclear cells (PBMCs). The recruitment of participants occurred between June 2021 and May 2023. RESULTS: The mean age of patients with RA was 70.6 years (? 4.7) and that of controls was 77.0 years (? 10.8). The observed disparity in age between these two groups was determined to be statistically significant, and this discrepancy was taken into consideration in the comparative analyses conducted.. Other clinical characteristics, such as the presence of comorbidities, depression, and frailty assessment rates, were found to be similar across both groups. It is worth noting that all individuals diagnosed with RA were utilizing immunosuppressants. Elderly individuals with RA exhibited lower adherence to social isolation measures and the use of masks at this point in the pandemic. However, but they had greater exposure to booster doses of anti-SARS-CoV2 vaccines, and the clinical events related to the COVID-19 pandemic were comparable between the RA and control groups. Importantly, patients with RA did not necessitate additional hospital care, medical consultations, or intensive care unit management. Moreover, there were no disparities in the reports of acute flu syndrome in the month preceding the interviews. The groups demonstrated homogeneity in terms of lipid profile, renal function, glycated hemoglobin levels, as well as absolute lymphocyte and neutrophil counts. Furthermore, it was observed that RA patients had lower albumin levels in comparison to the control group. Notably, higher frequencies of certain CD4+ T Lymphocyte (LT) subpopulations, including CD3+CD4+CD25+, CD4+CTLA4+, and CD4+PD1+CTLA4+, were identified in individuals with RA. However, no distinctions were found between the total CD4+ LT, total CD8+ LT, NKT LT (known as NKT cells), monocytes, or total B Lymphocyte (LB) populations. Interestingly, the transitional LB subpopulation, characterized by CD19+CD27-CD38hi, was found to be reduced in individuals with RA. In conclusion, this study sheds light on various aspects of elderly individuals with RA in the context of the COVID-19 pandemic and provides insights into immune checkpoints, activated T lymphocytes, and transitional B lymphocytes. CONCLUSIONS: From a clinical standpoint, patients with RA did not experience a worsened condition during this stage of the pandemic and within the outpatient setting, even thoughRA patients exhibited a more activated and more exhausted TL profilein comparison to elderly individuals without of RA. The population of transitional BL was reduced in the RA group , which may suggest that treatment of the disease can influence the immune response to vaccines via this route. RA and the use of immunosuppressive drugs have the potential to alter lymphocyte subpopulations.INTRODU??O: A pandemia da COVID-19 (que significa doen?a pelo coronav?rus 2019) ? uma infec??o causada um novo tipo de coronav?rus nomeado SARS-CoV-2, do ingl?s severe acute respiratory syndrome coronavirus 2. O v?rus causou uma doen?a com r?pida dissemina??o , com capacidade de causar pneumonia e s?ndromes respirat?rias agudas graves (SRAG). Existem grupos vulner?veis ? doen?a, como os idosos, que possuem uma maior probabilidade de desenvolver a forma grave. OBJETIVO: Investigar caracter?sticas cl?nicas e imunol?gicas de idosos com Artrite Reumat?ide (AR) durante a pandemia da COVID-19 e comparar estes dados com idosos sem doen?a autoimune e sem uso de imunossupressores (grupo controle). METODOLOGIA: 23 idosos com AR e 21 idosos sem doen?a autoimune e sem uso de medicamentos imunossupressores participaram da pesquisa. Este foi um estudo transversal, controlado, que investigou e comparou entre os grupos os marcadores cl?nicos e imunol?gicos de pacientes com idade acima de 60 anos em atendimento nos ambulat?rios do Hospital S?o Lucas (HSL) da Pontif?cia Universidade Cat?lica do Rio Grande do Sul (PUCRS) e no Centro Cl?nico da PUCRS. A an?lise cl?nica foi realizada atrav?s de exame f?sico em consulta presencial e atrav?s de question?rios padronizados. A avalia??o laboratorial hematol?gica, bioqu?mica e de marcadores de inflama??o sist?mica respeitou as normas padronizadas do laborat?rio de an?lises cl?nicas do HSL. A imunofenotipagem e identifica??o das subpopula??es de c?lulas mononucleares de sangue perif?rico (CMSP) foi realizada por citmetria de fluxo. O recrutamento da amostra ocorreu entre junho de 2021 e maio de 2023. RESULTADOS: A m?dia de idade dos pacientes com AR foi de 70,6 anos (? 4,7) e dos controles de 77,0 anos (? 10,8). A diferen?a de idade foi estatisticamente significativa e foi ajustada para as an?lises comparativas entre os grupos. Outras caracter?sticas cl?nicas como a presen?a de comorbidades e os ?ndices de avalia??o de depress?o e fragilidade foram semelhantes entre os grupos. Todos os indiv?dulos com AR estavam usando imunossupressores. O idosos com AR foram menos aderentes ao isolamento social e ao uso de m?scara neste momento da pandemia, mas apresentavam uma maior exposi??o a doses de vacinas anti-SARS-CoV2 e os eventos cl?nicos relacionados ? pandemia da COVID-19 foram homog?neos entre os grupos. Pacientes portadores de AR n?o necessitaram de mais atendimentos hospitalares, consultas m?dicas, necessidade de manejo em unidade de terapia intensiva. Tamb?m n?o houve disparidades nos relatos de s?ndrome gripal aguda no m?s anterior ? entrevista. Os grupos estavam homog?neos em rela??o ao perfil lip?dico, fun??o renal, hemoglobina glicada e a contagem absoluta de linf?citos e neutr?filos. Os n?veis de albumina estavam inferiores nos pacientes com AR em rela??o aos controles. Foram observadas frequ?ncias mais elevadas de algumas subpopula??es de Linf?cito T (LT) CD4+ na AR: CD3+CD4+CD25+, CD4+CTLA4+, e CD4+PD1+CTLA4+. N?o foramencontradas diferencas entre as popula??es LT CD4+totais, LT CD8+totais,LT NKT (conhecidas como c?lulas NKT ),mon?citos ouLinf?citos B (LB) totais. A subpopula??o de LB CD19+CD27-CD38hi (transicional) estava reduzida nos indiv?duos com AR.Suban?lises no grupo com AR: pacientes em uso de cortic?ide exibiram valores significativamente maiores de CD3+CD8+CD57+ em compara??o com aqueles que n?o estavam usando cortic?ide; quanto maior a frequ?ncia de CD3+CD8+CD28-CD27- maiores os n?veis de PCR (prote?na C reativa); quanto maior os frequ?ncia de CD3+CD8+CD57+, maior foi o tempo de doen?a. CONCLUS?ES:Os pacientes com AR n?o apresentaram pior evolu??o cl?nica durante esta fase da pandemia e no contexto de seguimento ambulatorial, apesar do grupo AR exibir perfil de LT mais ativado e mais exausto em compara??o aos idosos sem AR. A popula??o de LB transicional est? reduzida no grupo com AR, o que pode sugerir que o tratamento da doen?a pode influenciar a resposta imune ?s vacinas por esta via. A AR e as medica??es usadas no seu tratamento, podem modificar subpopula??es de LT e LB.Submitted by PPG Medicina e Ci?ncias da Sa?de (medicina-pg@pucrs.br) on 2024-01-31T11:38:04Z No. of bitstreams: 1 TESE COVID & AR (VersaoFinal).pdf: 1645590 bytes, checksum: a14bd2cf6bcb5e56ee6c06d7584d0c04 (MD5)Approved for entry into archive by Sarajane Pan (sarajane.pan@pucrs.br) on 2024-03-20T17:49:31Z (GMT) No. of bitstreams: 1 TESE COVID & AR (VersaoFinal).pdf: 1645590 bytes, checksum: a14bd2cf6bcb5e56ee6c06d7584d0c04 (MD5)Made available in DSpace on 2024-03-20T18:07:21Z (GMT). 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dc.title.por.fl_str_mv |
Avalia??o de marcadores cl?nicos e imunol?gicos de idosos e portadores de artrite reumat?ide na pandemia da COVID-19 |
title |
Avalia??o de marcadores cl?nicos e imunol?gicos de idosos e portadores de artrite reumat?ide na pandemia da COVID-19 |
spellingShingle |
Avalia??o de marcadores cl?nicos e imunol?gicos de idosos e portadores de artrite reumat?ide na pandemia da COVID-19 Rabelo, Cristina Ferreira COVID-19 Idosos Artrite Reumat?ide Perfil Imunol?gico COVID-19 Elderly Rheumatoid Arthritis Immune Profile CIENCIAS DA SAUDE::MEDICINA |
title_short |
Avalia??o de marcadores cl?nicos e imunol?gicos de idosos e portadores de artrite reumat?ide na pandemia da COVID-19 |
title_full |
Avalia??o de marcadores cl?nicos e imunol?gicos de idosos e portadores de artrite reumat?ide na pandemia da COVID-19 |
title_fullStr |
Avalia??o de marcadores cl?nicos e imunol?gicos de idosos e portadores de artrite reumat?ide na pandemia da COVID-19 |
title_full_unstemmed |
Avalia??o de marcadores cl?nicos e imunol?gicos de idosos e portadores de artrite reumat?ide na pandemia da COVID-19 |
title_sort |
Avalia??o de marcadores cl?nicos e imunol?gicos de idosos e portadores de artrite reumat?ide na pandemia da COVID-19 |
author |
Rabelo, Cristina Ferreira |
author_facet |
Rabelo, Cristina Ferreira |
author_role |
author |
dc.contributor.advisor1.fl_str_mv |
Sato, Douglas kazutoshi |
dc.contributor.advisor1Lattes.fl_str_mv |
http://lattes.cnpq.br/1138053643046606 |
dc.contributor.authorLattes.fl_str_mv |
http://lattes.cnpq.br/0877292856605674 |
dc.contributor.author.fl_str_mv |
Rabelo, Cristina Ferreira |
contributor_str_mv |
Sato, Douglas kazutoshi |
dc.subject.por.fl_str_mv |
COVID-19 Idosos Artrite Reumat?ide Perfil Imunol?gico |
topic |
COVID-19 Idosos Artrite Reumat?ide Perfil Imunol?gico COVID-19 Elderly Rheumatoid Arthritis Immune Profile CIENCIAS DA SAUDE::MEDICINA |
dc.subject.eng.fl_str_mv |
COVID-19 Elderly Rheumatoid Arthritis Immune Profile |
dc.subject.cnpq.fl_str_mv |
CIENCIAS DA SAUDE::MEDICINA |
description |
INTRODUCTION: The COVID-19 pandemic, known as coronavirus disease 2019, is an infectious disease caused by a novel coronavirus called SARS-CoV-2. This virus, derived from the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), leads to a highly contagious disease capable of inducing pneumonia and severe acute respiratory syndromes (SARS). Certain populations, particularly the elderly, are more susceptible to developing severe manifestations of the disease. OBJECTIVE: Investigate clinical and immunological characteristics of elderly patients with Rheumatoid Arthritis (RA) during COVID-19 pandemic and compare these findings with elderly individuals without autoimmune diseases and without the use of immunosuppressive agents (control group). METHODOLOGY: The study involved the participation of 23 elderly individuals with RA and 21 elderly individuals without autoimmune diseases or the use of immunosuppressive medications. This research followed a cross-sectional, controlled design, where clinical and immunological markers were investigated and compared between the two groups. The study population consisted of patients over 60 years of age receiving care at the outpatient clinics of Hospital S?o Lucas (HSL) affiliated with the Pontifical Catholic University of Rio Grande do Sul (PUCRS) and at the PUCRS Clinical Center. Clinical assessments were conducted through presencial appointment which included physical examinations and standardized questionnaires. The analysis of hematological, biochemical, and systemic inflammation markers followed the established protocols of the clinical analysis laboratory at HSL. Flow cytometry was employed for immunophenotyping and the identification of subpopulations of peripheral blood mononuclear cells (PBMCs). The recruitment of participants occurred between June 2021 and May 2023. RESULTS: The mean age of patients with RA was 70.6 years (? 4.7) and that of controls was 77.0 years (? 10.8). The observed disparity in age between these two groups was determined to be statistically significant, and this discrepancy was taken into consideration in the comparative analyses conducted.. Other clinical characteristics, such as the presence of comorbidities, depression, and frailty assessment rates, were found to be similar across both groups. It is worth noting that all individuals diagnosed with RA were utilizing immunosuppressants. Elderly individuals with RA exhibited lower adherence to social isolation measures and the use of masks at this point in the pandemic. However, but they had greater exposure to booster doses of anti-SARS-CoV2 vaccines, and the clinical events related to the COVID-19 pandemic were comparable between the RA and control groups. Importantly, patients with RA did not necessitate additional hospital care, medical consultations, or intensive care unit management. Moreover, there were no disparities in the reports of acute flu syndrome in the month preceding the interviews. The groups demonstrated homogeneity in terms of lipid profile, renal function, glycated hemoglobin levels, as well as absolute lymphocyte and neutrophil counts. Furthermore, it was observed that RA patients had lower albumin levels in comparison to the control group. Notably, higher frequencies of certain CD4+ T Lymphocyte (LT) subpopulations, including CD3+CD4+CD25+, CD4+CTLA4+, and CD4+PD1+CTLA4+, were identified in individuals with RA. However, no distinctions were found between the total CD4+ LT, total CD8+ LT, NKT LT (known as NKT cells), monocytes, or total B Lymphocyte (LB) populations. Interestingly, the transitional LB subpopulation, characterized by CD19+CD27-CD38hi, was found to be reduced in individuals with RA. In conclusion, this study sheds light on various aspects of elderly individuals with RA in the context of the COVID-19 pandemic and provides insights into immune checkpoints, activated T lymphocytes, and transitional B lymphocytes. CONCLUSIONS: From a clinical standpoint, patients with RA did not experience a worsened condition during this stage of the pandemic and within the outpatient setting, even thoughRA patients exhibited a more activated and more exhausted TL profilein comparison to elderly individuals without of RA. The population of transitional BL was reduced in the RA group , which may suggest that treatment of the disease can influence the immune response to vaccines via this route. RA and the use of immunosuppressive drugs have the potential to alter lymphocyte subpopulations. |
publishDate |
2023 |
dc.date.issued.fl_str_mv |
2023-11-27 |
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2024-03-20T18:07:21Z |
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Pontif?cia Universidade Cat?lica do Rio Grande do Sul |
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Programa de P?s-Gradua??o em Medicina e Ci?ncias da Sa?de |
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PUCRS |
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Brasil |
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Escola de Medicina |
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Pontif?cia Universidade Cat?lica do Rio Grande do Sul |
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