Avaliação da resposta inflamatória e da capacidade funcional em pacientes com Lúpus Eritematoso Sistêmico: efeito da intervenção fisioterapêutica

Abstract

The Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by cutaneous lesions and systemic manifestations, with periods of exacerbation and remission. In the physiopathology of the disease, an autoantibody production, B and T lymphocyte hyperactivity, and alteration in the expression of cytokines. The general aim was to essay the inflammatory response, the functional capacity and the quality of life of the patients with SLE under medication, submitted or not to the kinesiotherapy. Avaluated 16 women with SLE in different evolutive stages, using corticoids and/or rheumatic disease modifying drugs and 18 women volunteers constituted the control group. In the first stage the inflammatory response was assessed between the control and the patients with SLE, by the serum dosage of cytokines (ELISA) of the pattern IL-2, IL-5, IL-6, IL-8, IL-10 and TNF-a, an assay of neutrophil phagocytosis and quantification of the receptor expression CXCR2 and the integrin CD11b in the surface of neutrophil and lymphocyte by flow cytometry. There was a significant increase in serum levels of IL-6, IL-8 e IL-10 in patients with SLE compared to the control group. Yet, the group of patients there was a reduction in the phagocitic index and expression of CD11b in lymphocytes in the compared to the control group. In the second stage, the patients were divided into two groups, being group 1: medication (n=10) e group 2: medication + kinesiotherapy (n=6) and again assessed. The functional capacity of the group of patients, was evaluated by postural, flexibility (Wells bench, chest and ischiotibials), anthropometric, balance (Tinetti) as well as muscular strength analyzing. The quality of life was assessed by the questionnaire SF-36. The questionnaire SLEDAI was used to assess the illness severity, which did not present significant difference between the groups. After following the treatment, there was reduction of serum levels of IL-5 and IL-6 in both groups, and IL-8 and IL-10 in the group treated only with medication. In the groups treated with medication and kinesiotherapy there was a reduction of IL-2 in serum, reduction of the expression CD11b in neutrophils, as well as an increase of the expression of CXCR2 in neutrophils and CD11b in lymphocyte. Yet, in this group, it was observed a meaningful increase of flexibility and muscular strength, and significative improvement in the limitation by physical aspects and in the pain, after following, while the group treated only with medication presented increase in the waist and hip circumferences. In conclusion there was no difference in relation to the SLEDAI index between the groups. In conclusion, patients with SLE under medication therapy, without disease in activity, presented differences in the parameters of the inflammatory response in relation to the control group, as increase of cytokines IL-6 e IL-10, reduction of the phagocytic capacity and expression of CD11b in lymphocytes. The kinesiotherapy increased the expression of CXCR2 in neutrophils and CD11b in lymphocyte, decreased IL-2 serum, increased the strength and the flexibility of patients treated with, with a following improviment of the pain and limitation by physical aspects.