Revista Brasileira De Reumatologia最新文献

Objectives

To assess clinical digital vasculitis (DV) as an initial manifestation of childhood‐onset systemic lupus erythematosus (cSLE) within a large population.

Methods

Multicenter cross‐sectional study including 852 cSLE patients (ACR criteria) followed in ten Pediatric Rheumatology centers in São Paulo State, Brazil.

Results

DV was observed in 25/852 (3%) cSLE patients. Periungual hemorrhage was diagnosed in 12 (48%), periungual infarction in 7 (28%), tip finger ulceration in 4 (16%), painful nodules in 1 (4%) and gangrene in 1 (4%). A poor outcome, with digital resorption, occurred in 5 (20%). Comparison of patients with and without DV revealed higher frequency of malar rash (80% vs. 53%, p = 0.008), discoid rash (16% vs. 4%, p = 0.017), photosensitivity (76% vs. 45%, p = 0.002) and other cutaneous vasculitides (80% vs. 19%, p < 0.0001), whereas the frequency of overall constitutional features (32% vs. 61%, p = 0.003), fever (32% vs. 56%, p = 0.020) and hepatomegaly (4% vs. 23%, p = 0.026) were lower in these patients. Frequency of female gender, severe multi‐organ involvement, autoantibodies profile and low complement were alike in both groups (p > 0.05). SLEDAI‐2 K median, DV descriptor excluded, was significantly lower in patients with DV compared to those without this manifestation [10(0‐28) vs. 14(0‐58), p = 0.004]. Visceral vasculitis or death were not observed in this cSLE cohort. The frequency of cyclophosphamide use (0% vs. 18%, p = 0.014) was significantly lower in the DV group.

Conclusion

Our large multicenter study identified clinical DV as one of the rare initial manifestation of active cSLE associated with a mild multisystemic disease, in spite of digital resorption in some of these patients.

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) minus 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‐2 K 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

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 31 years, 5,881 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.

The first International Chapel Hill Consensus Conference (CHHC) was held in 1994. There have been suggestions about the nomenclature of systemic vasculitis. Important categories were added to the classification of vasculitis, and many changes were made for disease names in the second CHHC 2012, which were not included in the CHCC 1994. The new nomenclature was introduced instead of being referred to by many names such as Churg‐Strauss and Wegener”s. New categories such as Behçet”s and Cogan etc. were also added. These people are honored by the classification. They contribute to science through their case studies, scientific articles, and observations. This article reviews only eponyms present in the current classification of vasculitis. The aim of this paper is to give information about scientists mentioned in the classification of vasculitis.

Objective

To evaluate the parameters associated with quality of life in patients with Paget's disease of bone (PDB).

Methods

Patients with PDB were evaluated with SF‐36 and WHOQOL‐bref questionnaires. Patients with other diseases that could cause significant impairment of their quality of life were excluded. We searched for correlations between the results and: age, time from diagnosis, type of involvement, pain related to PDB, limitation to daily activities, deformities, bone specific alkaline phosphatase, the extent of involvement and treatment.

Results

Fifty patients were included. Results of the SF‐36 total score and its domains, physical and mental health, were significantly correlated with bone pain and deformities. Marital status was significantly correlated with the SF‐36 total score and Mental Health domain. BAP levels and disease extension were significantly correlated to SF‐36 Physical Health Domain. After multivariate analysis, the only parameters that remained significantly associated with the SF‐36 total score and to its Mental Health and Physical Health domains were pain and marital status.

The whoqol‐bref total score was significantly associated with pain, physical impairment and deformities. WHOQOL‐bref Domain 1 (physical) score was significantly associated with marital status, pain and deformities, while Domain 2 (psychological) score was associated with marital status, physical impairment and kind of involvement. After multivariate analysis, the presence of pain, deformities, and marital status were significantly associated with results of the WHOQOL‐bref total score and its Domain 1. WHOQOL‐bref domain 2 results were significantly predicted by pain and marital status.

Conclusion

The main disease‐related factor associated with SF‐36 results in PDB patients was bone pain, while bone pain and deformities were associated with WHOQOL‐bref.

Objectives

Describe Brazilian rheumatologists's competence in interventional rheumatology (IR); 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 IR data.

Results

463 participants had their data analyzed. The mean age was 40.2 years (± 11.2). 70% had performed periarticular injections (PAI) and 78% had performed intra‐articular injections (IIA). 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 rheumatologist, higher proportion of university bond, longer training time greater practice of complex procedures, higher proportion of graduates, trained and with private practice in the South country. Variables most associated to the very interventionist subgroup: performing axial IIA (OR: 7.4, p < 0.001), synovial biopsy (OR: 5.75, p = 0.043), image‐guided IIA (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 IR were variables associated with enhanced interventional profile.

Anti‐tumor necrosis factor (anti‐TNF) drugs are frequently preferred in the treatment of rheumatologic diseases and other inflammatory diseases. The development of myositis after using anti‐TNF is a rare clinical condition. Here we aimed to report cases who developed myositis after using anti‐TNF and review the current literature. We report two cases of rheumatoid arthritis (RA) and a case of ankylosing spondylitis (AS) developed idiopathic inflammatory myopathy following anti‐TNF therapy. In conclusion, myositis could develop during anti‐TNF therapy, so these patients should be evaluated carefully initially for myositis and should be closely monitored due to the potential for developing myositis in treatment process.