Revista Brasileira De Reumatologia最新文献

We aimed to detect DNA of Borrelia burgdorferi in whole blood and serum samples of patients with clinical symptoms and epidemiology compatible with Brazilian Lyme‐like disease. Four patients with positive epidemiological histories were recruited for the study. Blood samples were collected, screened by serologic testing by ELISA and Western blotting and molecular identification of B. burgdorferi by amplifying a fragment of the conserved gene that synthesizes the hook flagellar (flgE). The results showed positive serology and for the first time, the presence of Borrelia burgdorferi sensu lato in humans in the Midwest region of Brazil. The resulting sequences were similar to GenBank corresponding sequences of Borrelia burgdorferi flgE gene. By neighbor‐joining the phylogenetic analysis, the flgE sequence of the Brazilian strain clustered in a monophyletic group with the sequence of Borrelia burgdorferi sensu lato under 100% bootstrap support. This study opens up promising perspectives and reinforces the need for additional studies to determine the epidemiological characteristics of the disease, as well as the impact of the prevalence of Brazilian borreliosis in Mato Grosso do Sul State, Brazil.

Purpose

The use of bisphosphonates for osteoporosis is effective in reducing the risk of fractures. However, oral formulations are sometimes not well tolerated or are contraindicated. Due to its availability in Brazilian public health system, pamidronate is frequently prescribed for osteoporosis, despite the lack of studies demonstrating its anti‐fracture efficacy and the absence of FDA or EMEA approval for this purpose. The aim of this study was to evaluate the bone mineral density (BMD) response to pamidronate in a group of women with osteoporosis in a tertiary care hospital.

Patients and methods

The medical records of women with osteoporosis who received pamidronate for up to two years of treatment were reviewed. Patients were stratified at high or intermediate risk of fracture.

Results

A total of 70 women were in treatment with pamidronate. Among them, 74% were at high risk of fracture. A significant gain in spine BMD after 24 months of treatment was observed (p = 0.012). There was no difference between the groups of high and not high risk of fracture. At the femur, no significant increase in BMD was present, though, a strong negative correlation with high PTH levels (r = −0.61; p = 0,003) was seen. In the multivariate analysis BMI at 12 months had impact in the response to the treatment.

Conclusion

The intravenous pamidronate in a group of postmenopausal women with predominant high risk of fracture promoted an isolated gain in the spine BMD, even though, clinical randomized trials are needed to confirm its anti‐fracture efficacy.

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 M694 V 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.

Objectives

To evaluate, in an endemic country, the long‐term efficacy of latent tuberculosis infection (LTBI) screening and primary prophylaxis in patients with JIA receiving TNF blockers.

Methods

This was a retrospective cohort that included JIA patients eligible to anti‐TNF therapy. Patients were screened for LTBI prior to anti‐TNF using tuberculin skin test (TST), chest X‐ray and history of exposure to TB. Subjects were regularly followed at 2‐month intervals.

Results

Sixty‐nine JIA patients with current age of 17.4 ± 5.8 years, mean disease duration of 5.0 ± 4.9 years were included. Forty‐seven patients received a single anti‐TNF, while 22 patients switched to another anti‐TNF once or twice: 57 were treated with etanercepte, 33 patients with adalimumab and 3 infliximab. LTBI screening was positive in three patients: one had TST‐positive and history of TB exposure and two had solely TST‐positive. No active TB was diagnosed during the study period (median of follow‐up was 3.8 years).

Conclusion

Long‐term evaluation revealed that LTBI screening and primary prophylaxis before anti‐TNF treatment was effective in a high‐risk country and TST was the most sensitive parameter to identify these patients.

Objective

To evaluate the imaging features of spondyloarthritis in magnetic resonance imaging (MRI) of the sacroiliac (SI) joint, topography (in thirds) and affected margin, considering that this issue is rarely addressed in the literature.

Methods

Cross‐sectional study evaluating MRI (1.5 T) of SI joints in 16 patients with axial spondyloarthritis for the presence of acute changes (subchondral bone edema, enthesitis, synovitis and capsulitis) and chronic changes (erosions, subchondral bone sclerosis, bony bridges, and fatty infiltration), performed by two radiologists blind for clinical data. MRI findings were correlated with clinical data, including age, duration of disease, medications, HLA‐B27, BASDAI, ASDAS‐ESR and ASDAS‐CRP, BASMI, BASFI, and mSASSS.

Results

Bone edema and erosions were predominant in the upper third of SI joints (p = 0.050 and p = 0.0014, respectively). There was a correlation between disease duration and structural changes by affected third (p = 0.028‐0.037), as well as between the presence of bony bridges with BASMI (p = 0.028) and mSASSS (p = 0.014). Patients with osteitis in the lower third showed higher values of ASDAS (ESR: p = 0.011 and PCR: p = 0.017).

Conclusion

Chronic inflammatory changes and bone edema predominated in the upper third of SI joints, but a simultaneous involvement of middle or lower thirds of the joint was also noted. The location of involvement in the upper third of SI joints is insufficient to differentiate between degeneration and inflammation.

Objective

To determine the prevalence of Chronic Low Back Pain (CLBP) and predictors of Back Muscle Strength (BMS) in patients with Systemic Lupus Erythematosus (LES).

Methods

Cross‐sectional study. Ninety‐six ambulatory patients with LES were selected by non‐probability sampling and interviewed and tested during medical consultation. The outcomes measurements were: Point prevalence of CLBP, Oswestry Disability Index, Tampa Scale of Kinesiophobia, Fatigue Severity Scale and maximal voluntary isometric contractions (MVIC) of handgrip and of the back muscles. Correlation coefficient and multiple linear regression were used in statistical analysis.

Results

Of the 96 individuals interviewed, 25 had CLBP, indicating a point prevalence of 26% (92% women). The correlation between the Oswestry Index and maximal voluntary isometric contraction of the back muscles was r = ‐0.4, 95% CI [‐0.68;‐0.01] and between the MVIC of handgrip and of the back muscles was r = 0.72, 95% CI [0.51;0.88]. The regression model presented the highest value of R² being observed when MVIC of the back muscles was tested with five independent variables (63%). In this model handgrip strength was the only predictive variable (ß = 0.61, P = 0.001).

Conclusions

The prevalence of CLBP in individuals with LES was 26%. The MVIC of the back muscles was 63% predicted by five variables of interest, however, only the handgrip strength was a statistically significant predictive variable. The MVIC of the back muscles presented a linear relation directly proportional to handgrip and inversely proportional to Oswestry Index i.e. stronger back muscles are associated with lower disability scores.