{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T21:09:50Z","timestamp":1788901790547,"version":"build-2803163510"},"reference-count":34,"publisher":"FapUNIFESP (SciELO)","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"am","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. vasc. bras."],"abstract":"<jats:p>Abstract  Background The Question\u00e1rio de avalia\u00e7\u00e3o sintom\u00e1tica do lipedema (QuASiL \u2013 Lipedema Symptom Assessment Questionnaire) assesses 13 distinct inflammatory symptoms of lipedema, but whether these symptoms resolve and recur simultaneously or follow a consistent order remains unknown.  Objectives To characterize the persistence hierarchy of the 13 QuASiL inflammatory symptoms in a retrospective lipedema cohort under heterogeneous conservative treatment, using 6 complementary rank-order analyses and testing the null hypothesis that symptoms resolve with equal magnitude.  Methods This retrospective longitudinal study included 1,300 patients who were clinically diagnosed with lipedema by a vascular surgeon and who completed the QuASiL on at least 2 occasions (minimum 14-day interval; median follow-up 181 days, IQR 92\u2013380, maximum 1,787 days). A consensus ranking was computed across all analyses. A sensitivity analysis was conducted using the conventional T0 = first visit, T1 = last visit convention, and a Kaplan-Meier survival analysis estimated the time (in absolute days) to \u2265 50% reduction from baseline per symptom.  Results The symptoms did not resolve simultaneously (Friedman \u03c72 (12) = 168.08, p &lt; 0.001). All 13 symptoms improved during follow-up, showing a consistent order across the 6 analyses. A slower-resolving core was identified: bruising (consensus rank 1.7), swelling (2.0), touch sensitivity (4.3), leg heaviness (4.7), and fatigue (4.7). A rapidly-responding group comprised skin irritation (66.4% proportional reduction), itching (62.0%), and walking difficulty (62.6%). Even the most resistant symptom (bruising) achieved a mean 39.1% proportional reduction, with half of patients reaching \u2265 50% improvement. During worsening, swelling and pressure\/tension re-emerged first. The sensitivity analysis (T0 = first, T1 = last) produced an essentially identical ranking (Spearman \u03c1 = 0.945, p &lt; 10\u22125). The Kaplan-Meier analysis estimated a median of 546 days for bruising vs 207 days for itching to reach \u2265 50% reduction from baseline (log-rank \u03c72 = 44.6, p &lt; 10\u221210); the fastest-resolving symptom was heat\/burning at 203 days.  Conclusions In this retrospective cohort of patients under heterogeneous conservative treatment, the 13 QuASiL inflammatory symptoms improved following a consistent order across 6 independent analyses, with bruising and swelling as the most persistent symptoms.<\/jats:p>","DOI":"10.1590\/1677-5449.202600562","type":"journal-article","created":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T20:31:24Z","timestamp":1788899484000},"source":"Crossref","is-referenced-by-count":0,"title":["Order of resolution and recurrence of inflammatory symptoms in lipedema: a longitudinal study of 1,300 patients"],"prefix":"10.1590","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4008-4029","authenticated-orcid":false,"given":"Alexandre Campos Moraes","family":"Amato","sequence":"first","affiliation":[{"name":"Amato Duo Instituto,  Brasil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5744-476X","authenticated-orcid":false,"given":"Juliana Lelis Spirandeli","family":"Amato","sequence":"additional","affiliation":[{"name":"Amato Duo Instituto,  Brasil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3295-1236","authenticated-orcid":false,"given":"Daniel Augusto","family":"Benitti","sequence":"additional","affiliation":[{"name":"Valens Medical Center,  Brasil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"530","published-online":{"date-parts":[[2026]]},"reference":[{"issue":"4","key":"ref1","doi-asserted-by":"crossref","first-page":"345","DOI":"10.23736\/S0392-9590.21.04604-6","article-title":"Update in the management of lipedema","volume":"40","author":"Forner-Cordero I","year":"2021","journal-title":"Int Angiol"},{"issue":"12","key":"ref2","doi-asserted-by":"crossref","first-page":"6621","DOI":"10.3390\/ijms23126621","article-title":"Current mechanistic understandings of lymphedema and lipedema: tales of fluid, fat, and fibrosis","volume":"23","author":"Duhon BH","year":"2022","journal-title":"Int J Mol Sci"},{"issue":"12","key":"ref3","doi-asserted-by":"crossref","first-page":"3081","DOI":"10.3390\/biomedicines10123081","article-title":"Lipedema: insights into morphology, pathophysiology, and challenges","volume":"10","author":"Poojari A","year":"2022","journal-title":"Biomedicines"},{"issue":"4","key":"ref4","first-page":"213","article-title":"Lipedema: a misdiagnosed entity","volume":"37","author":"Vignes S","year":"2012","journal-title":"J Mal Vasc"},{"key":"ref5","article-title":"Brazilian Consensus Statement on Lipedema using the Delphi methodology","volume":"24","author":"Amato ACM","year":"2025","journal-title":"J Vasc Bras"},{"issue":"1","key":"ref6","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1186\/s12905-021-01174-y","article-title":"Quality of life, its factors, and sociodemographic characteristics of Polish women with lipedema","volume":"21","author":"Dudek JE","year":"2021","journal-title":"BMC Womens Health"},{"issue":"7","key":"ref7","doi-asserted-by":"crossref","first-page":"846","DOI":"10.1080\/13548506.2018.1459750","article-title":"Depression and appearance-related distress in functioning with lipedema","volume":"23","author":"Dudek JE","year":"2018","journal-title":"Psychol Health Med"},{"issue":"1","key":"ref8","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1016\/j.ejvs.2013.10.009","article-title":"Evaluation of patient-relevant outcomes of lymphedema and lipedema treatment: development and validation of a new benefit tool","volume":"47","author":"Blome C","year":"2014","journal-title":"Eur J Vasc Endovasc Surg"},{"issue":"5","key":"ref9","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1016\/j.mehy.2014.08.011","article-title":"Pathophysiological dilemmas of lipedema","volume":"83","author":"Sz\u00e9l E","year":"2014","journal-title":"Med Hypotheses"},{"key":"ref10","doi-asserted-by":"crossref","DOI":"10.1155\/2019\/8747461","article-title":"Dilated blood and lymphatic microvessels, angiogenesis, increased macrophages, and adipocyte hypertrophy in lipedema thigh skin and fat tissue","volume":"2019","author":"Al-Ghadban S","year":"2019","journal-title":"J Obes"},{"issue":"10","key":"ref11","doi-asserted-by":"crossref","DOI":"10.1111\/obr.13953","article-title":"Lipedema: progress, challenges, and the road ahead","volume":"26","author":"Cifarelli V","year":"2025","journal-title":"Obes Rev"},{"issue":"3","key":"ref12","doi-asserted-by":"crossref","first-page":"561","DOI":"10.3390\/biomedicines13030561","article-title":"Lipedema: a disease triggered by M2 polarized macrophages?","volume":"13","author":"Grewal T","year":"2025","journal-title":"Biomedicines"},{"issue":"1","key":"ref13","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1111\/j.1610-0387.2010.07504.x","article-title":"Liposuction is an effective treatment for lipedema - 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