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Abstract(s)
Miofasceíte macrofágica é uma doença imunomediada, que se enquadra numa síndrome mais abrangente intitulada de Síndrome ASIA – Síndrome Autoimune/inflamatória induzida por adjuvantes.
A sua etiologia é desconhecida, embora esteja frequentemente associada ao uso de vacinas contendo hidróxido de alumínio como adjuvante (vacinas contra o vírus da hepatite A e B e vacina contra o tétano). A administração destas vacinas vai desencadear uma resposta imunitária no local da injeção, uma vez que os adjuvantes contendo alumínio irão estimular a ativação de células dendríticas, macrófagos e linfócitos. Para além disso, os adjuvantes são responsáveis pela criação de depósitos de antigénios no local da infeção, permitindo a sua libertação lenta e uma contínua estimulação do sistema imunológico. Contudo, a predisposição genética também exerce um papel importante na manifestação da doença.
Apesar da sua frequência relativamente rara, os estudos demonstram um aumento do número de casos detetados. Este aumento deve-se a uma crescente adesão por parte das populações, nos últimos anos, à vacinação. Nos vários estudos realizados também se constatou uma prevalência semelhante entre ambos os sexos e uma média de idades por volta dos 43 anos.
A sua apresentação clínica pode gerar alguma controvérsia, na medida em que apresenta sintomas inespecíficos. Normalmente, a miofasceíte macrofágica apresenta-se com mialgias de intensidade variável e agravadas pelo esforço, artralgias, astenia marcada, fraqueza muscular, fadiga crónica e febre ligeira. No entanto, também pode estar associada a disfunção cognitiva e depressão. Estas manifestações também surgem noutros contextos como, por exemplo, a fibromialgia, sendo esta considerada um dos diagnósticos diferenciais.
Tendo em conta que se trata de uma patologia relativamente rara e com manifestações bastante inespecíficas, o diagnóstico torna-se bastante difícil e, portanto, são utilizadas outras ferramentas que permitem distinguir a miofasceíte macrofágica dos restantes diagnósticos diferenciais. Um dos meios de diagnóstico utilizado é, precisamente, a biópsia realizada no músculo deltóide (adulto) ou quadricípite (criança) e que evidencia a presença de infiltrados macrofágicos perifasciculares. O aumento da creatina cinase e aldolase, a nível laboratorial, também pode ser usado como meio de diagnóstico.
Atualmente, não existe uma terapêutica específica para a miofasceíte macrofágica. A base do tratamento consiste na evicção de produtos contendo alumínio e utilização de imunomoduladores, anti-inflamatórios não esteroides, analgésicos e antidepressivos.
Macrophagic myofasciitis is an immune-mediated disease that is part of a more comprehensive syndrome called ASIA - Autoimmune / inflammatory syndrome induced by adjuvants. Its etiology is unknown, although it is often associated with the use of aluminum hydroxide-containing vaccines as adjuvants (vaccines against hepatitis A and B and tetanus vaccines). Administration of these vaccines will trigger an immune response at the site of injection, since aluminum-containing adjuvants will stimulate the activation of dendritic cells, macrophages and lymphocytes. In addition, adjuvants are responsible for the creation of antigen deposits at the site of infection, allowing for their slow release and continuous stimulation of the immune system. However, genetic predisposition also plays an important role in the manifestation of the disease. Despite their relatively rare frequency, studies have shown an increase in the number of cases detected. This increase is due to a growing commitment by the population in recent years to vaccination. In the various studies also found a similar prevalence between both sexes and an average age of around 43 years. Its clinical presentation may generate some controversy, since it presents nonspecific symptoms. Usually, macrophagic myofasceitis presents with myalgias of varying intensity and aggravated by exertion, arthralgia, marked asthenia, muscular weakness, chronic fatigue and mild fever. However, it may also be associated with cognitive dysfunction and depression. These manifestations also appear in other contexts, such as fibromyalgia, which is considered one of the differential diagnoses. Considering that this is a relatively rare pathology with rather nonspecific manifestations, the diagnosis becomes quite difficult and, therefore, other tools are used to distinguish macrophagic myofasceitis from other differential diagnoses. One of the means of diagnosis used is precisely the biopsy performed on the deltoid (adult) muscle or quadricypus (child), which shows the presence of peripheral macrophagic infiltrates. Increased creatine kinase and aldolase, at the laboratory level, can also be used as a diagnostic medium. Currently, there is no specific therapy for macrophage myofasciitis. The basis of treatment is the eviction of aluminum-containing products and the use of immunomodulators, non-steroidal anti-inflammatory drugs, analgesics and antidepressants.
Macrophagic myofasciitis is an immune-mediated disease that is part of a more comprehensive syndrome called ASIA - Autoimmune / inflammatory syndrome induced by adjuvants. Its etiology is unknown, although it is often associated with the use of aluminum hydroxide-containing vaccines as adjuvants (vaccines against hepatitis A and B and tetanus vaccines). Administration of these vaccines will trigger an immune response at the site of injection, since aluminum-containing adjuvants will stimulate the activation of dendritic cells, macrophages and lymphocytes. In addition, adjuvants are responsible for the creation of antigen deposits at the site of infection, allowing for their slow release and continuous stimulation of the immune system. However, genetic predisposition also plays an important role in the manifestation of the disease. Despite their relatively rare frequency, studies have shown an increase in the number of cases detected. This increase is due to a growing commitment by the population in recent years to vaccination. In the various studies also found a similar prevalence between both sexes and an average age of around 43 years. Its clinical presentation may generate some controversy, since it presents nonspecific symptoms. Usually, macrophagic myofasceitis presents with myalgias of varying intensity and aggravated by exertion, arthralgia, marked asthenia, muscular weakness, chronic fatigue and mild fever. However, it may also be associated with cognitive dysfunction and depression. These manifestations also appear in other contexts, such as fibromyalgia, which is considered one of the differential diagnoses. Considering that this is a relatively rare pathology with rather nonspecific manifestations, the diagnosis becomes quite difficult and, therefore, other tools are used to distinguish macrophagic myofasceitis from other differential diagnoses. One of the means of diagnosis used is precisely the biopsy performed on the deltoid (adult) muscle or quadricypus (child), which shows the presence of peripheral macrophagic infiltrates. Increased creatine kinase and aldolase, at the laboratory level, can also be used as a diagnostic medium. Currently, there is no specific therapy for macrophage myofasciitis. The basis of treatment is the eviction of aluminum-containing products and the use of immunomodulators, non-steroidal anti-inflammatory drugs, analgesics and antidepressants.
Description
Keywords
Adjuvante Asia Hidróxido de Alumínio Miofasceíte Macrofágica Síndrome da Fadiga Crónica