Revista Brasileira de Reumatologia (English Edition)最新文献

Clinical outcomes and survival in AA amyloidosis patients AA型淀粉样变患者的临床结局和生存期

Revista Brasileira de Reumatologia (English Edition)

Pub Date : 2017-11-01 DOI: 10.1016/j.rbre.2017.02.002

Yavuz Ayar , Alparslan Ersoy , Mustafa Ferhat Oksuz , Gokhan Ocakoglu , Berna Aytac Vuruskan , Abdülmecit Yildiz , Emel Isiktas , Aysegül Oruc , Sedat Celikci , Ismail Arslan , Ahmet Bilgehan Sahin , Mustafa Güllülü

Aim

Amyloid A amyloidosis is a rare complication of chronic inflammatory conditions. Most patients with amyloid A amyloidosis present with nephropathy and it leads to renal failure and death. We studied clinical characteristics and survival in patients with amyloid A amyloidosis.

Methods

A total of 81 patients (51 males, 30 females) with renal biopsy proven amyloid A amyloidosis were analyzed retrospectively. The patients were divided into good and poor outcomes groups according to survival results.

Results

Most of the patients (55.6%) had nephrotic range proteinuria at diagnosis. Most frequent underlying disorders were familial Mediterranean fever (21.2%) and rheumatoid arthritis (10.6%) in the good outcome group and malignancy (20%) in the poor outcome group. Only diastolic blood pressure in the good outcome group and phosphorus level in the poor outcome group was higher. Serum creatinine levels increased after treatment in both groups, while proteinuria in the good outcome group decreased. Increase in serum creatinine and decrease in estimated glomerular filtration rate of the poor outcome group were more significant in the good outcome group. At the time of diagnosis 18.5% and 27.2% of all patients had advanced chronic kidney disease (stage 4 and 5, respectively). Median duration of renal survival was 65 ± 3.54 months. Among all patients, 27.1% were started dialysis treatment during the follow-up period and 7.4% of all patients underwent kidney transplantation. Higher levels of systolic blood pressure [hazard ratios 1.03, 95% confidence interval: 1–1.06, p = 0.036], serum creatinine (hazard ratios 1.25, 95% confidence interval: 1.07–1.46, p = 0.006) and urinary protein excretion (hazard ratios 1.08, 95% confidence interval: 1.01–1.16, p = 0.027) were predictors of end-stage renal disease. Median survival of patients with organ involvement was 50.3 ± 16 months.

Conclusion

Our study indicated that familial Mediterranean fever constituted a large proportion of cases and increased number of patients with idiopathic amyloid A amyloidosis. Additionally, it was observed that patient survival was not affected by different etiological causes in amyloid A amyloidosis.

淀粉样蛋白A淀粉样变是一种罕见的慢性炎症并发症。大多数A型淀粉样蛋白淀粉样变性患者会出现肾病，并导致肾功能衰竭和死亡。我们研究了淀粉样蛋白A淀粉样变性患者的临床特征和生存率。方法回顾性分析81例经肾活检证实的A淀粉样变性患者(男51例，女30例)的临床资料。根据生存结果将患者分为预后良好组和预后不良组。结果55.6%的患者在诊断时有肾病范围蛋白尿。结果良好组中最常见的潜在疾病是家族性地中海热(21.2%)和类风湿关节炎(10.6%)，结果较差组中最常见的是恶性肿瘤(20%)。结果良好组只有舒张压升高，结果较差组只有磷水平升高。两组治疗后血清肌酐水平均升高，而预后良好组的蛋白尿水平下降。结果较差组血清肌酐升高和肾小球滤过率降低在结果较好的组中更为显著。在诊断时，18.5%和27.2%的患者患有晚期慢性肾脏疾病(分别为4期和5期)。中位肾生存期为65±3.54个月。在所有患者中，27.1%在随访期间开始透析治疗，7.4%的患者接受了肾移植。较高水平的收缩压[风险比1.03,95%可信区间:1-1.06,p = 0.036]、血清肌酐(风险比1.25,95%可信区间:1.07-1.46,p = 0.006)和尿蛋白排泄(风险比1.08,95%可信区间:1.01-1.16,p = 0.027)是终末期肾病的预测因素。器官受累患者的中位生存期为50.3±16个月。结论家族性地中海热在特发性淀粉样蛋白a淀粉样变发病中所占比例较大，且发病人数增加。此外，观察到A淀粉样蛋白淀粉样变性患者的生存不受不同病因的影响。

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引用次数: 10

Omega-3 fatty acids, inflammatory status and biochemical markers of patients with systemic lupus erythematosus: a pilot study Omega-3脂肪酸、系统性红斑狼疮患者的炎症状态和生化标志物:一项初步研究

Revista Brasileira de Reumatologia (English Edition)

Pub Date : 2017-11-01 DOI: 10.1016/j.rbre.2016.09.014

Mariane Curado Borges , Fabiana de Miranda Moura dos Santos , Rosa Weiss Telles , Marcus Vinícius Melo de Andrade , Maria Isabel Toulson Davisson Correia , Cristina Costa Duarte Lanna

Background

Studies have shown that omega-3 fatty acids reduce the concentrations of eicosanoids, cytokines, chemokines, C-reactive protein (CRP) and other inflammatory mediators.

Objective

To investigate the effects of omega-3 fatty acids on circulating levels of inflammatory mediators and biochemical markers in women with systemic lupus erythematosus (SLE).

Methods

Experimental clinical study (clinical trial: NCT02524795); 49 women with SLE (ACR1982/1997) were randomized: 22 to the omega-3 group (daily intake of 1080 mg EPA + 200 mg DHA, for 12 weeks) and 27 to the control group. The inflammatory mediators and biochemical markers at T0 and T1 in omega-3 group were compared using Wilcoxon test. U-Mann–Whitney test was used to compare variations of measured variables [ΔV = pre-treatment (T0) − post-treatment (T1) concentrations] between groups. p < 0.05 was considered significant.

Results

The median (interquartile range – IQR) of age was 37 (29–48) years old, of disease duration was 7 (4–13) years, and of SLEDAI-2K was 1 (0–2). The median (IQR) of variation in CRP levels between the two groups showed a decrease in omega-3 group while there was an increase in control group (p = 0.008). The serum concentrations of IL-6 and IL-10, leptin and adiponectin did not change after a 12 week treatment.

Conclusions

Supplementation with omega-3 had no impact on serum concentrations of IL-6, IL-10, leptin and adiponectin in women with SLE and low disease activity. There was a significant decrease of CRP levels as well as evidence that omega-3 may impact total and LDL-cholesterol.

研究表明，omega-3脂肪酸可以降低类二十烷酸、细胞因子、趋化因子、c反应蛋白(CRP)和其他炎症介质的浓度。目的探讨omega-3脂肪酸对系统性红斑狼疮(SLE)患者循环炎症介质及生化指标的影响。方法实验临床研究(临床试验号:NCT02524795);49名SLE女性(ACR1982/1997)被随机分组:22人加入omega-3组(每天摄入1080毫克EPA + 200毫克DHA，持续12周)，27人加入对照组。采用Wilcoxon检验比较omega-3组T0、T1时炎症介质及生化指标。采用U-Mann-Whitney检验比较各组间测量变量[ΔV =预处理(T0) -处理后(T1)浓度]的变化。p & lt;0.05为显著性。结果患者年龄中位数(四分位间距- IQR)为37(29-48)岁，病程为7(4-13)年，SLEDAI-2K为1(0-2)年。两组之间CRP水平变化的中位数(IQR)显示omega-3组降低，而对照组升高(p = 0.008)。治疗12周后血清IL-6、IL-10、瘦素、脂联素浓度无明显变化。结论补充omega-3对SLE低活动性患者血清IL-6、IL-10、瘦素和脂联素浓度无影响。c反应蛋白水平显著下降，同时有证据表明-3脂肪酸可能影响总胆固醇和低密度脂蛋白胆固醇。

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引用次数: 21

Presence of riziform bodies in a patient with juvenile idiopathic arthritis: case report and literature review 青少年特发性关节炎患者出现梨形体:病例报告及文献复习

Revista Brasileira de Reumatologia (English Edition)

Pub Date : 2017-11-01 DOI: 10.1016/j.rbre.2014.09.004

Leonardo Rodrigues Campos , Fernanda Cardoso das Neves Sztajnbok , Stélio Galvão , Marise de Araújo Lessa , Ierecê Lins Aymoré , Flavio Sztajnbok

引用次数: 0

Interventional rheumatology: the competence of Brazilian rheumatologists 介入风湿病学:巴西风湿病学家的能力

Revista Brasileira de Reumatologia (English Edition)

Pub Date : 2017-11-01 DOI: 10.1016/j.rbre.2017.05.002

Aline Teixeira de Landa, Jamil Natour, Rita Nely Vilar Furtado

Objectives

Describe Brazilian rheumatologists's competence in interventional rheumatology; assess the association between this ability and demographic and training variables.

Methods

A cross-sectional study with 500 Brazilian rheumatologists. Participants were assessed by self-administered questionnaire consisting of demographics, training, practice in office and knowledge in interventional rheumatology data.

Results

463 participants had their data analyzed. The mean age was 40.2 years (±11.2). 70% had performed periarticular injections and 78% had performed intra-articular injections. The sample was divided into three groups: non-interventionist, little interventionist and very interventionist. The non-interventionist group showed (p < 0.001–0.04) higher mean age, lower proportion of university bond, lower training history, higher proportion of graduates in the Southeast country, and higher proportion of graduates in the 1980s to 1989. The very interventionist group showed higher (p < 0.001–0.018) proportion of adult rheumatologists, higher proportion of university bond, longer training time with greater practice of complex procedures, and higher proportion of graduates, trained and with private practice in the South country. Variables most associated with the very interventionist subgroup are performing axial intra-articular injections (OR: 7.4, p < 0.001), synovial biopsy (OR: 5.75, p = 0.043), image-guided IAI (OR: 4.16, p < 0.001), viscosupplementation (OR = 3.41, p < 0.001), joint lavage (OR = 3.22, p = 0.019), salivary gland biopsy (OR = 2.16, p = 0.034) and over 6-month training (OR: 2.16, p = 0.008).

Conclusions

Performing more complex invasive procedures and over 6-month training in interventional rheumatology were variables associated with enhanced interventional profile.

目的描述巴西风湿病专家在介入性风湿病学方面的能力;评估这种能力与人口统计和培训变量之间的关系。方法对500名巴西风湿病学家进行横断面研究。参与者通过自我管理的问卷进行评估，包括人口统计、培训、办公室实践和介入性风湿病学数据方面的知识。结果463名参与者的数据进行了分析。平均年龄40.2岁(±11.2岁)。70%做过关节周注射，78%做过关节内注射。样本被分为三组:不干预者、很少干预者和非常干预者。非干预组显示(p <0.001-0.04)平均年龄较高，大学bond比例较低，学历较低，东南国家毕业生比例较高，80 - 1989年毕业生比例较高。非常干预组(p <成人风湿病学家的比例(0.001-0.018)，大学债券的比例更高，更长的培训时间，更多的复杂程序实践，以及在南方国家接受培训和私人执业的毕业生比例更高。与非常介入亚组最相关的变量是轴向关节内注射(OR: 7.4, p <0.001)，滑膜活检(OR: 5.75, p = 0.043)，图像引导IAI (OR: 4.16, p <0.001)，补充粘胶(OR = 3.41, p <0.001)、关节灌洗(OR = 3.22, p = 0.019)、唾液腺活检(OR = 2.16, p = 0.034)和超过6个月的训练(OR: 2.16, p = 0.008)。结论进行更复杂的侵入性手术和超过6个月的介入性风湿病学培训是与增强的介入性资料相关的变量。

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引用次数: 0

Leprosy simulating systemic sclerosis: a case report 麻风病模拟系统性硬化症1例报告

Revista Brasileira de Reumatologia (English Edition)

Pub Date : 2017-11-01 DOI: 10.1016/j.rbre.2016.09.010

Bruna Burko Rocha Chu , Giorgina Falcão Brandão Côrtes Gobbo , Rafaela Copês , Glênio Gutjahr , Erick Cavalcanti Cossa , Eduardo dos Santos Paiva

引用次数: 1

Mortality from systemic erythematosus lupus in Brazil: evaluation of causes according to the government health database 巴西系统性红斑狼疮的死亡率:根据政府卫生数据库评估原因

Revista Brasileira de Reumatologia (English Edition)

Pub Date : 2017-11-01 DOI: 10.1016/j.rbre.2017.09.001

Luisa Ribeiro Costi, Hatsumi Miyashiro Iwamoto, Dilma Costa de Oliveira Neves, Cezar Augusto Muniz Caldas

Objective

To characterize the causes of mortality in patients with systemic lupus erythematosus (SLE) in Brazil between 2002 and 2011.

Methods

An exploratory ecological study of a time series using data from the Mortality Information System of DATASUS, the Department of the Unified Health System (Brazil's National Health System).

Results

Brazil's SLE mortality rate was 4.76 deaths/10⁵ inhabitants. The mortality rate was higher in the Midwest, North and Southeast regions than in the country as a whole. There were 6.3% fewer and 4.2% more deaths than expected in the Northeast and Southeast regions, respectively. The mean age at death was 40.7 ± 18 years, and 45.61% of deaths occurred between the ages of 20 and 39. Incidence was highest in women (90.7%) and whites (49.2%). Disorders of the musculoskeletal system and connective tissue were mentioned as an underlying cause of death in 77.5% of cases, and diseases of the circulatory system and infectious and parasitic diseases were also noted in fewer cases. SLE was mentioned as an underlying cause of death in 77% of cases, with no difference between the Brazilian regions (p = 0.2058). The main SLE-related causes of death were, sequentially, diseases of the respiratory and circulatory systems and infectious and parasitic diseases.

Conclusions

This study identified a need for greater control of risk factors for cardiovascular diseases and a better understanding of the pathogenesis of atherosclerosis in SLE. Infectious causes are still frequent, and management should be improved, especially in the early stages of the disease.

目的分析2002 - 2011年巴西系统性红斑狼疮(SLE)患者的死亡原因。方法采用统一卫生系统(巴西国家卫生系统)死亡率信息系统(DATASUS)的时间序列数据进行探索性生态学研究。结果巴西SLE死亡率为4.76人/105人。中西部、北部和东南部地区的死亡率高于全国整体水平。东北和东南地区的死亡人数分别比预期减少6.3%和增加4.2%。平均死亡年龄40.7±18岁，45.61%的死亡发生在20 ~ 39岁之间。发病率最高的是女性(90.7%)和白人(49.2%)。在77.5%的病例中，肌肉骨骼系统和结缔组织疾病被认为是导致死亡的根本原因，而循环系统疾病、传染病和寄生虫病也被认为是较少的病例。在77%的病例中，SLE被认为是潜在的死亡原因，巴西地区之间没有差异(p = 0.2058)。与睡眠不足有关的主要死亡原因依次是呼吸和循环系统疾病以及传染病和寄生虫病。结论:本研究表明，需要更好地控制心血管疾病的危险因素，并更好地了解SLE患者动脉粥样硬化的发病机制。感染原因仍然是常见的，应改善管理，特别是在疾病的早期阶段。

{"title":"Mortality from systemic erythematosus lupus in Brazil: evaluation of causes according to the government health database","authors":"Luisa Ribeiro Costi, Hatsumi Miyashiro Iwamoto, Dilma Costa de Oliveira Neves, Cezar Augusto Muniz Caldas","doi":"10.1016/j.rbre.2017.09.001","DOIUrl":"10.1016/j.rbre.2017.09.001","url":null,"abstract":"<div><h3>Objective</h3><p>To characterize the causes of mortality in patients with systemic lupus erythematosus (SLE) in Brazil between 2002 and 2011.</p></div><div><h3>Methods</h3><p>An exploratory ecological study of a time series using data from the Mortality Information System of DATASUS, the Department of the Unified Health System (Brazil's National Health System).</p></div><div><h3>Results</h3><p>Brazil's SLE mortality rate was 4.76 deaths/10<sup>5</sup> inhabitants. The mortality rate was higher in the Midwest, North and Southeast regions than in the country as a whole. There were 6.3% fewer and 4.2% more deaths than expected in the Northeast and Southeast regions, respectively. The mean age at death was 40.7±18 years, and 45.61% of deaths occurred between the ages of 20 and 39. Incidence was highest in women (90.7%) and whites (49.2%). Disorders of the musculoskeletal system and connective tissue were mentioned as an underlying cause of death in 77.5% of cases, and diseases of the circulatory system and infectious and parasitic diseases were also noted in fewer cases. SLE was mentioned as an underlying cause of death in 77% of cases, with no difference between the Brazilian regions (<em>p</em>  <!-->0.2058). The main SLE-related causes of death were, sequentially, diseases of the respiratory and circulatory systems and infectious and parasitic diseases.</p></div><div><h3>Conclusions</h3><p>This study identified a need for greater control of risk factors for cardiovascular diseases and a better understanding of the pathogenesis of atherosclerosis in SLE. Infectious causes are still frequent, and management should be improved, especially in the early stages of the disease.</p></div>","PeriodicalId":101096,"journal":{"name":"Revista Brasileira de Reumatologia (English Edition)","volume":"57 6","pages":"Pages 574-582"},"PeriodicalIF":0.0,"publicationDate":"2017-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.rbre.2017.09.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35451482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 8

Esophageal abnormalities in juvenile localized scleroderma: is it associated with other extracutaneous manifestations? 青少年局限性硬皮病的食管异常:是否与其他皮外表现有关?

Revista Brasileira de Reumatologia (English Edition)

Pub Date : 2017-11-01 DOI: 10.1016/j.rbre.2016.09.011

Clarissa C.M. Valões , Glaucia V. Novak , Juliana B. Brunelli , Katia T. Kozu , Ricardo K. Toma , Clovis A. Silva

Objective

To assess esophageal involvement (EI) in juvenile localized scleroderma (JLS) population and the possible association between this gastrointestinal manifestation and demographic data, clinical features, laboratory exams, treatments and outcomes.

Methods

For a period of 30 years, 5881 patients with rheumatic diseases were followed in our Pediatric Rheumatology Division. EI was defined by the presence of symptoms (solid/liquid dysphagia, heartburn, esophageal regurgitation, nausea/vomiting and epigastralgia) and confirmed by at least one EI exam abnormality: barium contrast radiography, upper gastrointestinal endoscopy and 24-hour esophageal pH-monitoring.

Results

JLS was observed in 56/5881 patients (0.9%), mainly linear morphea subtype. EI was observed in 23/56(41%) of JLS patients. Eight(35%) of 23 EI patients with JLS were symptomatic and presented heartburn(5/8), solid and liquid dysphagia(3/8), nausea and epigastralgia(1/8). The frequency of any cumulative extracutaneous manifestations (calcinosis, arthritis/arthralgia, central nervous system, interstitial pneumonitis, mesangial nephritis and/or arrhythmia) was significantly higher in JLS patients with EI compared to those without this complication (56% vs. 24%, p = 0.024). No differences were evidenced in demographic data, JLS subtypes and in each extracutaneous manifestation in both groups (p > 0.05). The frequency of methotrexate use was significantly higher in JLS patients with EI compared to those without (52% vs. 12%, p = 0.002). Autoantibody profile (antinuclear antibodies, anti-SCL-70, rheumatoid factor, anticentromere, anti-cardiolipin, anti-Ro/SSA and anti-La/SSB) was similar in both groups (p > 0.05).

Conclusions

Our study demonstrated that EI was frequently observed in JLS patients, mainly in asymptomatic patients with linear subtype. EI occurred in JLS patients with other extracutaneous manifestations and required methotrexate therapy.

目的探讨小儿局限性硬皮病(JLS)患者的食道累及情况，并探讨其胃肠道表现与人口统计学、临床特征、实验室检查、治疗及预后的关系。方法对我院儿科风湿病科5881例风湿病患者进行了30年的随访。EI通过出现症状(固体/液体吞咽困难、胃灼热、食管反流、恶心/呕吐和胃脘痛)来定义，并通过至少一项EI检查异常来确诊:钡剂造影术、上消化道内镜检查和24小时食管ph值监测。结果5881例患者中56例(0.9%)出现jls，以线性morphea亚型为主。56例JLS患者中有23例(41%)出现EI。23例EI合并JLS患者中有8例(35%)出现症状，表现为胃灼热(5/8)、固体和液体吞咽困难(3/8)、恶心和胃脘痛(1/8)。任何累积的皮外表现(钙质沉着症、关节炎/关节痛、中枢神经系统、间质性肺炎、系膜肾炎和/或心律失常)的频率在伴有EI的JLS患者中明显高于没有这些并发症的患者(56%对24%，p = 0.024)。两组在人口统计学数据、JLS亚型和各皮外表现方面均无差异(p >0.05)。合并EI的JLS患者使用甲氨蝶呤的频率明显高于未合并EI的患者(52% vs. 12%， p = 0.002)。两组的自身抗体谱(抗核抗体、抗scl -70、类风湿因子、抗着丝粒、抗心磷脂、抗ro /SSA和抗la /SSB)相似(p >0.05)。结论本研究表明，EI在JLS患者中较为常见，且以线性亚型无症状患者为主。EI发生在有其他皮外表现的JLS患者中，需要甲氨蝶呤治疗。

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引用次数: 1

Case-control study of vitamin D receptor gene polymorphism in Pakistani rheumatoid arthritis patients 巴基斯坦类风湿性关节炎患者维生素D受体基因多态性的病例对照研究

Revista Brasileira de Reumatologia (English Edition)

Pub Date : 2017-11-01 DOI: 10.1016/j.rbre.2015.07.003

Peter John , Attya Bhatti , Noor ul Ain , Tahir Iqbal , Tayyaba Sadaf , Javed Mehmood Malik

引用次数: 7

Investigation of MEFV gene polymorphisms (G138G and A165A) in adult patients with familial Mediterranean fever 成人家族性地中海热MEFV基因多态性(G138G和A165A)的研究

Revista Brasileira de Reumatologia (English Edition)

Pub Date : 2017-11-01 DOI: 10.1016/j.rbre.2016.02.004

Mustafa Ferhat Öksuz , Mutlu Karkucak , Orhan Görukmez , Gökhan Ocakoğlu , Abdulmecit Yıldız , Mehmet Ture , Tahsin Yakut , Kamil Dilek

Aim

Various mutations have been identified in the Mediterranean fever (MEFV) gene which is reported to be responsible from Familial Mediterranean fever (FMF). In our study, we aimed to determine the frequency of the MEFV mutations in our region and to investigate the impact of G138G (rs224224, c.414A>G) and A165A (rs224223, c.495C>A) gene polymorphisms on the clinical findings of the disease.

Methods

One hundred and sixteen patients diagnosed with FMF and 95 control subjects were included in this study. We used the DNA sequence analysis method to identify the most prevailing 10 mutations located in exon 2 and 10 of MEFV gene.

Results

As a result of the MEFV mutation analysis, the most common mutation was the M694V mutation allele with a frequency rate of 41.8%. When the patients group and control group were compared in terms of frequency of both polymorphic alleles (G polymorphic allele, observed in G138G and the A polymorphic allele, observed in A165A), the variation was observed to be statistically significant (p < 0.001). It was found that the MEFV mutation types have no relation with clinical findings and amyloidosis (p > 0.05).

Conclusions

To our knowledge, our study is the first study in the Southern Marmara region that reports the frequency of MEFV mutations. Our findings imply that the polymorphisms of G138G and A165A may have an impact on progress of the disease. We think that more studies, having higher number of cases and investigating the polymorphisms of MEFV gene, are needed.

在地中海热(MEFV)基因中发现了各种突变，据报道，该基因与家族性地中海热(FMF)有关。在我们的研究中，我们旨在确定我们地区MEFV突变的频率，并研究G138G (rs224224, c.414A>G)和A165A (rs224223, c.495C>A)基因多态性对疾病临床表现的影响。方法选取116例确诊为FMF的患者和95名对照组进行研究。利用DNA序列分析方法，鉴定出MEFV基因外显子2和外显子10中最常见的10个突变。结果MEFV突变分析结果显示，最常见的突变为M694V突变等位基因，频率为41.8%。比较患者组和对照组的多态性等位基因频率(G138G中观察到的G多态性等位基因和A165A中观察到的A多态性等位基因)，差异有统计学意义(p <0.001)。发现MEFV突变类型与临床表现和淀粉样变性无关(p >0.05)。据我们所知，我们的研究是第一个在南马尔马拉地区报道MEFV突变频率的研究。我们的研究结果提示G138G和A165A的多态性可能对疾病的进展有影响。我们认为需要开展更多的研究，对MEFV基因的多态性进行更多的研究。

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引用次数: 7

Development of rheumatology training in Brazil: the option for a medical residency program 巴西风湿病学培训的发展:医疗住院医师计划的选择

Revista Brasileira de Reumatologia (English Edition)

Pub Date : 2017-11-01 DOI: 10.1016/j.rbre.2016.04.001

Cleandro Pires Albuquerque, Leopoldo Luiz dos Santos-Neto

Objective

To describe the characteristics and progression of the supply of new rheumatologists in Brazil, from 2000 to 2015.

Methods

Consultations to databases and official documents of institutions related to training and certification of rheumatologists in Brazil took place. The data were compared, summarized and presented descriptively.

Results

From 2000 to 2015, Brazil qualified 1091 physicians as rheumatologists, of which 76.9% (n = 839) completed a medical residency program in rheumatology (MRPR); the others (n = 252) achieved this title without MRPR training. There was an expansion of MRPR positions. At the same time, there was a change in the profile of the newly qualified doctors. Early in the series, the fraction of new rheumatologists without MRPR, entering the market annually, was approaching 50%, dropping to about 15% in recent years. In 2015, Brazil offered 49 MRPR accredited programs, with 120 positions per year for access. There was an imbalance in the distribution of MRPR positions across the country, with a strong concentration in the southeast region, which in 2015 held 59.2% of the positions. Public institutions accounted for 94% (n = 789) of graduates in MRPR during the study period, while still maintaining 93.3% (n = 112) of seats for admission in 2015.

Conclusions

In the last sixteen years, in parallel with the expansion of places of access, MRPR has established itself as the preferred route for rheumatology training in Brazil, mainly supported by public funds. Regional inequalities in the provision of MRPR positions still persist, as challenges that must be faced.

目的分析2000 - 2015年巴西风湿病专科医生新增供应的特点和发展趋势。方法查阅巴西风湿病学家培训和认证相关机构的数据库和官方文件。对数据进行比较、总结和描述。结果2000 - 2015年，巴西共有1091名医生获得风湿病医师资格，其中76.9% (n = 839)完成了风湿病住院医师培训(MRPR);其他人(n = 252)在没有MRPR培训的情况下获得了这个头衔。MRPR职位有所增加。与此同时，新获得资格的医生的形象也发生了变化。在该系列的早期，每年进入市场的新风湿病学家中没有MRPR的比例接近50%，近年来降至15%左右。2015年，巴西提供了49个MRPR认证项目，每年提供120个职位。MRPR职位在全国范围内分布不平衡，东南地区集中度较强，2015年占比59.2%。在研究期间，MRPR毕业生中，公立院校占94% (n = 789)， 2015年仍保持93.3% (n = 112)的招生名额。结论在过去的16年里，随着可及场所的扩大，MRPR已成为巴西风湿病学培训的首选途径，主要由公共资金支持。提供MRPR职位方面的区域不平等仍然存在，这是必须面对的挑战。

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引用次数: 7