Advances in Rheumatology最新文献

Background: Chikungunya fever (CF) is marked by acute, subacute, and chronic phases, with a significant proportion of patients experiencing persistent joint and neuropathic pain. These symptoms may mimic those of rheumatic diseases such as rheumatoid arthritis (RA) and spondyloarthritis (SpA). There is currently no consensus on whether the infection directly causes chronic joint disease or serves as an immunological trigger for the development of rheumatic conditions.

Aim: This study aims to evaluate the overall proportion of CF patients who progress to chronic arthropathy, and to identify how many of these patients meet the classification criteria for RA and SpA (including ankylosing spondylitis (AS) and psoriatic arthritis (PsA)).

Methods: A thorough search was conducted in electronic databases, including PubMed, Embase, LILACS, and the Cochrane Library. The primary endpoint was the occurrence of chronic arthropathy, defined as joint signs and symptoms lasting more than six weeks following the acute phase of CF. The secondary endpoint involved the proportion of patients meeting the classification criteria for RA, SpA, AS, and PsA. A random-effects meta-analysis model was utilized to combine studies and determine the pooled frequency of persistent joint symptoms. Subgroup analyses were performed based on the fulfillment of classification criteria for rheumatic diseases. The risk of bias was assessed using the Joanna Briggs Institute critical appraisal tools. The study protocol was registered with PROSPERO (CRD42020211430).

Results: A total of thirty-eight studies, comprising data from 12.524 individuals with CF published between 2008 and 2022, met the inclusion criteria. Of these, 4.324 (34.5%) patients developed chronic arthropathy; among them, 11.43% (240 in 2099) patients met the criteria for RA, 12.1% (86 in 711) patients for SpA, 3.42% (36 in 1052) patients for AS, and 2.05% (25 in 1220) patients for PsA.

Conclusion: This study found that approximately one-third of CF patients experience persistent joint pain lasting over six weeks. However, only a minority of these individuals meet classification criteria for rheumatic diseases.

Background: Systemic lupus erythematosus (SLE) directly impacts pregnancy outcomes, and few studies have analyzed the related risk factors for maternal and fetal/perinatal complications in Brazil. We described and analyzed the risk factors for maternal and fetal complications in SLE pregnancies at an outpatient clinic in the State of Amazonas, Northern Brazil.

Methods: Pregnancies that occurred after the SLE diagnosis between 2001 and 2020 were analyzed. Risk factors for adverse outcomes were determined using logistic regression.

Results: A total of 155 pregnancies from 109 women were included; the mean age was 28.2 (±5.5) years, the median disease duration was 72 [36; 108] months, 56 (36.1%) had active disease prior to pregnancy, 39 (26.5%) had nephritis, 30 (20.3%) had cutaneous manifestations, and the incidence of disease activity during pregnancy was 29.7%; there was a 12.3% (95% CI, [4.2; 20.4]) increase in the proportion of patients with active disease, there were 35 (22.9%) fetal deaths, 26 (16.8%) cases of preeclampsia, 44 (37.3%) preterm births, 16 (16.2%) cases of low birth weight for gestational age, and 18 (18.8%) cases of intrauterine growth restriction. Risk factors for maternal events included immunological alterations (OR=3.02; 95% CI [1.11; 8.21]), renal involvement (OR=3.74; 95% CI [1.25; 11.21]), and disease activity before pregnancy (OR=1.30; 95% CI [1.04; 1.64]); the use of hydroxychloroquine before pregnancy was protective (OR=0.23; 95% CI [0.08; 0.67]). Risk factors for fetal events included the use of acetylsalicylic acid (ASA) during pregnancy (OR=5.22; 95% CI [1.33; 20.54]) and disease activity during pregnancy (OR=1.31; 95% CI [1.14; 1.52]); the use of antimalarials before and during pregnancy was protective (OR=0.14; 95% CI [0.04; 0.44]). According to the post-hoc analysis, the probability of a Type S error in the ASA association was 100%. The retrospective nature and the presence of missing data about laboratory tests are the main limitations of this study.

Conclusion: Pregnancy management in SLE presents a unique set of challenges that require a comprehensive and multidisciplinary approach. Careful monitoring of disease activity, appropriate medication management, and psychosocial support are essential for optimizing maternal and fetal health outcomes.

Introduction: Systemic sclerosis (SSc) often leads to decreased muscle strength and mass, impairing physical performance and causing disability. Interventions with resistance exercise (RE) is an effective non-pharmacological approach to mitigate these issues. This systematic review aims to evaluate the effects of interventions with RE on muscle strength, muscle mass, physical performance, physical disability, and quality of life (QOL) in SSc patients, as well as to assess its adherence and safety.

Methods: A systematic review and meta-analysis were conducted based on a PICOS framework: Patient = Systemic Sclerosis; Intervention = Resistance exercise; Study design = Randomized clinical trials. Searches were performed across MEDLINE (PubMed), PMC, Web of Science, Cochrane Library, LILACS, and EMBASE up to January 2025.

Results: Ten randomized clinical trials, including 422 participants (~85% female), were eligible for analysis. Participants' ages ranged from 42 to 64 years, with body mass indices between 22.5 and 28.0 kg/m². The intervention period was standardized to 12 weeks. Interventions with RE significantly improved muscle strength (SMD = 2.76 kg; 95% CI, 1.32 to 4.20; p = 0.0002) and functional disability (SMD = -0.47; 95% CI, -0.93 to -0.00; p = 0.05) compared to controls. Interventions with RE also showed superiority in the physical component of QOL (SMD = 0.42; 95% CI, 0.04 to 0.81; p = 0.03). Although enhanced physical performance was observed, statistical pooling was not possible due to limited data. Interventions with RE had a low incidence of adverse events, but data on disease progression and adherence were insufficient.

Conclusion: Interventions with RE benefits muscle strength, physical function, and QOL in SSc patients, though optimal protocols and adherence strategies need further investigation. More robust studies are required to refine training methods and enhance clinical trial designs.

Introduction: Biosimilars reduce the cost of biologic therapy without compromising safety and effectiveness. In this study we evaluated Brazilian rheumatologists' knowledge and perceptions of biosimilars.

Methods: Cross-sectional and descriptive study based on a questionnaire containing 17 items on familiarity, knowledge and perceptions of biosimilars.

Results: Answers were received from 135 rheumatologists, of whom 97.8% were familiar with biosimilars and 92.5% had at some time prescribed them, but only 47.7% felt comfortable prescribing them to stable patients and 62.2% strongly disagreed with automatic substitution. In addition, 51.9% preferred naive patients when starting treatment with biosimilars.

Conclusion: Despite the growing acceptance of biosimilars, many physicians remain reluctant. Evidence-based continuing education is essential to clarify these issues.

Objective: To determine the prevalence of metabolic syndrome (MetS) in patients with childhood onset Systemic Lupus Erithematosus (cSLE) and controls from Northeastern Brazil and to verify its association with specific SLE parameters and cardiovascular risk factors.

Methods: The prevalence of MetS was assessed cross-sectionally in 58 patients with cSLE and 33 age -matched controls. Information was collected by clinical examination and standardized questionnaires, investigating personal and family history of cardiovascular disease and obesity and socioeconomic and demographic characteristics.

Results: The prevalence of MetS was higher in cSLE patients than in controls according to both ABRAN criteria (8.6% vs. 0%; p = 0.083) and IDF criteria (10,3% vs. 3.0%; p = 0.208), but without statistical significance. Importantly, 91.4% of patients were from a low-income household. Patients with MetS according to ABRAN also had lower ESR levels (p = 0.039), higher total cholesterol (p = 0.013), HDL-c (p = 0.007) and triglycerides (p = 0.001) and a lower albumin level (p = 0.016). Patients with MetS according to IDF had higher SDI scores (p = 0.039) and higher C3 and C4 levels (p < 0.001 and p < 0.001, respectively). The multivariate logistic regression identified higher levels C4 (OR = 32.6; 95% CI = 1.0-544.0; p = 0.015) and increase in the number of leukocytes (OR = 1.9, 95%CI = 1.1-3.2; p = 0.022) as independent risk factors for MetS in patients with cSLE.

Conclusion: The prevalence of Mets in the patients with cSLE seems to be low in this population. There was association of MetS with higher cumulative damage indices and levels of complement. We did not observe any association with clinical manifestations, autoantibody profile and dose of corticosteroids.

Background: Cognitive impairment (CI) is a significant problem in systemic lupus erythematosus (SLE) patients. In recent years, total cerebral small vessel disease (CSVD) burden scores have had substantial value in predicting cognitive impairment. However, its application in treating concurrent cognitive impairment in SLE patients is unclear. To explore the relationship between total CSVD burden scores and cognitive dysfunction in SLE patients and to analyze its predictive value.

Methods: The Montreal Cognitive Assessment (MoCA) score was used to evaluate the cognitive function of 50 patients with SLE, and the total load score of patients with CSVD was analyzed via magnetic resonance imaging (MRI). Multivariate regression was used to evaluate the relationship between total CSVD burden scores and cognitive dysfunction, and the predictive value of total CSVD burden scores was assessed.

Results: Multivariate logistic regression analysis revealed that years of education (OR = 0.975, 95% CI [0.952-0.998], P = 0.035), neuropsychiatric systemic lupus erythematosus (NPSLE) (OR = 4.152, 95% CI [2.158-7.990], P < 0.001), and the CSVD total burden score (OR = 3.884, 95% CI [0.840-0.928], P < 0.001) were independently associated with cognitive impairment in SLE patients. The results of the ROC curve analysis revealed that the area under the curve (AUC) of the CSVD total burden score for the prediction of cognitive impairment in SLE patients was 0.885.

Conclusions: Years of education, NPSLE score, and total CSVD burden score are closely related to the occurrence of cognitive impairment in SLE patients. In particular, the total CSVD burden score is beneficial for the prediction of cognitive impairment.

Clinical trial number: Not applicable.

Trial registration: Not applicable.