Browsing by Author "Paiva-Lopes, MJ"
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- Antibodies Towards High-Density Lipoprotein Components in Patients with PsoriasisPublication . Paiva-Lopes, MJ; Batuca, J; Gouveia, S; Alves, M; Papoila, AL; Delgado Alves, JPsoriasis is a chronic inflammatory immune disorder associated with an increased risk of atherosclerosis. This increased risk is not fully understood. High-density lipoproteins (HDL) play an important role in the prevention of atherosclerosis and any factors that may hamper HDL function such as anti-HDL antibodies (aHDL) might be associated with an increased cardiovascular risk. We aimed to determine whether anti-HDL antibodies (aHDL) are present in patients with psoriasis. Sixty-seven patients with psoriasis were compared with a healthy control group. Epidemiologic and clinical data were recorded. IgG and IgM aHDL, IgG anti-apolipoprotein A-I (aApoA-I), anti-apolipoprotein E (aApoE), and anti-paraoxonase 1 (aPON1) antibodies, as well as VCAM-1, IL-6, and TNF-α were assessed by ELISA. Apolipoprotein A-I (ApoA-I) and Apolipoprotein E (ApoE) were measured by immunoturbidimetric immunoassay. Patients with psoriasis had higher titers of IgG aHDL (p < 0.001), IgG aApoA-I (p = 0.001) and aApoE antibodies (p < 0.001). IgG aHDL and aApoE titers were higher in patients with severe psoriasis (p = 0.010 and p = 0.018, respectively). Multiple regression analysis, considering all clinical and biological variables, showed that aApoE, IL-6, and aPON1 are the biological variables that best explain aHDL variability. This is the first report showing the presence of aHDL, aApoA-I, and aApoE antibodies in patients with psoriasis. These antibodies were associated with increased disease severity and may contribute to the pathogenesis of atherosclerosis in psoriasis. They may fulfill the clinical need for biomarkers of cardiovascular risk associated with psoriasis that would help to stratify patients for prevention and therapeutic approaches.
- Atopic Dermatitis: Improving Patient Access to Health Care in DermatologyPublication . Torres, T; Gonçalo, M; Paiva-Lopes, MJ; Claro, C; Varela, P; Silva, JM; Cordeiro, A; Mendes-Bastos, PIntroduction and Objective: The present study on atopic dermatitis (AD) in Portugal aims to characterize patient needs and discuss measures to improve health care in dermatology, particularly in cases of moderate to severe disease. Methods: The study was conducted in three phases–(1) data collection on the patient access to healthcare and subsequent analysis; (2) critical evaluation of the data in individual interviews with dermatologists and one pediatrician; and lastly, (3) data discussion in consensus meetings to validate the existing care capacity in dermatology, to identify gaps in care for patients with AD and to define mitigation strategies. Results: In Portugal, it is estimated that AD affects ~ 360,000 patients, 70,000 of whom have moderate to severe disease. Healthcare capacity analysis confirmed that the private system plays an important role in the management of AD. It is estimated that 30% of patients rely solely on the Portuguese public health service. Nevertheless, patients with moderate to severe disease can only access advanced targeted therapies from public healthcare providers. Analysis of public care capacity in dermatology shows relevant gaps in the referral system, the geographical coverage of specialized centers, the number of specialists and high waiting times for first appointments. Considering the negative impact of the disease on patients’ quality of life, 86% of patients with AD use private settings to better manage their disease. Conclusion: In conclusion, private setting bridges the gaps in public health care capacity in dermatology, and therefore, it is crucial for patients with AD. However, a major limitation is the lack of reimbursement for advanced targeted therapies recommended for moderate to severe AD when they are prescribed in a private setting, thus compromising patient access to these therapies. A possible strategy could be to extend the prescription of these therapies to a private setting based on a reimbursement model similar to that outlined in Act 48/2016 of 22 March.
- Psoriasis-Associated Vascular Disease: the Role of HDLPublication . Paiva-Lopes, MJ; Delgado Alves, JPsoriasis is a chronic inflammatory systemic disease with a prevalence of 2-3%. Overwhelming evidence show an epidemiological association between psoriasis, cardiovascular disease and atherosclerosis. Cardiovascular disease is the most frequent cause of death in patients with severe psoriasis. Several cardiovascular disease classical risk factors are also increased in psoriasis but the psoriasis-associated risk persists after adjusting for other risk factors.Investigation has focused on finding explanations for these epidemiological data. Several studies have demonstrated significant lipid metabolism and HDL composition and function alterations in psoriatic patients. Altered HDL function is clearly one of the mechanisms involved, as these particles are of the utmost importance in atherosclerosis defense. Recent data indicate that biologic therapy can reverse both structural and functional HDL alterations in psoriasis, reinforcing their therapeutic potential.
- Successful Treatment of Systemic Lupus Erythematosus with Subcutaneous ImmunoglobulinPublication . Brasileiro, A; Fonseca Oliveira, J; Pinheiro, S; Paiva-Lopes, MJThe therapeutic efficacy of high-dose intravenous immunoglobulin in systemic lupus erythematosus (SLE) patients is well established. However, side effects might limit its use and lead to the consideration of therapeutic alternatives, such as the subcutaneous formulation of immunoglobulin, which has been used in some patients with other autoimmune diseases. We report a case of SLE refractory to classical therapies. High-dose intravenous immunoglobulin was effective, but gave rise to significant side effects. The patient was successfully treated with subcutaneous human immunoglobulin, achieving and maintaining clinical and laboratory remission. A lower immunoglobulin dose was needed and no side effects were observed, compared to the intravenous administration. Subcutaneous immunoglobulin could be a better-tolerated and cost-saving therapeutic option for select SLE patients.