Revista Brasileira De Reumatologia最新文献

Objectives

Rheumatoid arthritis (RA) patients should receive cardiovascular (CV) risk assessment. For this purpose CV risk calculators are available. In addition, parameters of vascular function can be measured and used for risk prediction. Aim of the present study was to assess the association of these two concepts.

Methods

287 RA patients (58.4 ± 12.6 years) and 232 controls (49.9 ± 13.4 years) were included in this cross‐sectional study. We calculated 10 year CV risk with Score and QRISK2. For Score we used the recommended multiplier of 1.5 in eligible RA patients and estimated the risk also in patients younger than 40 years (mScore (0‐65)). Augmentation index (AIx) and central pulse pressure (PP), markers of vascular integrity and CV risk, were assessed by pulse wave analysis (PWA). Primary endpoint was the correlation of AIx and the estimated CV risk using mScore (0‐65).

Results

In RA patients AIx showed a statistically significant correlation with mScore (0‐65) (rho = 0.3374; p < 0.0001). The correlation of AIx with and QRISK2 was also significant (rho = 0.3307; p < 0.0001). The correlations of central PP with mScore (0‐65) (rho = 0.4692; p < 0.0001) and QRISK2 (rho = 0.5828; p < 0.0001) were also statistically significant. Increasing quartiles of central PP were associated with an increased odds of being in the “high risk” category according to Score (OR 2.18; 95%CI 1.58 ‐ 3.01) or QRISK2 (OR 2.18; 95%CI 1.75 ‐ 2.72). In control patients we also found a correlation of AIx and central PP with Score (0‐65) and QRISK2.

Conclusions

Parameters of central haemodynamics correlate with calculated CV risk. However, both do not give exactly the same information. The question arises whether a combination of both concepts would result in an improved CV risk prediction.

Objective

To assess the prevalence of fatigue in a Brazilian population with early rheumatoid arthritis using multiple instruments, and the predictors of these instruments by differents independent variables.

Methods

Cross‐sectional study with direct interview and medical records review. Fatigue, dependent variable, was assessed using eight instruments: Profile of Mood States (POMS), Multidimensional Assessment of Fatigue scale (MAF), Fatigue Severity Scale (FSS), Bristol Rheumatoid Arthritis Fatigue Multidimensional Questionnaire (BRAF‐MDQ), Numerical Rating Scales (BRAF‐NRS), Short‐form Survey 36 (SF‐36), Functional Assessment of Chronic Illness Therapy Fatigue Scale (FACIT‐F) and Visual Analogic Scale for Fatigue (VASf). Independent variables: sociodemographic, clinical and serological, were measured using medical records and direct interview. Disability and disease activity were assessed using the Health Assessment Questionnaire (HAQ) and disease activity assessed using the Disease Activity Score 28 joints (DAS28). The scores of scales demonstrated the level of fatigue and multiple linear regression method used in statistical analysis to demonstrate prediction models.

Results

A total of 80 patients was assessed, and 57 reported clinically relevant fatigue (VASf >2), representing 71.25% prevalence point (51 women [89.5%], mean age 48.35 ±15 years, and mean disease duration of 4.92 ±3.8 years). Eight predictive models showed statistical significance, one for each fatigue instrument. The highest coefficient of determination (R²) was 56% for SF‐36 and the lowest (R² = 21%) for FSS. The HAQ was the only independent variable to predict fatigue on all instruments.

Conclusion

Clinically relevant fatigue is a highly prevalent symptom and is mostly predicted by disability and age in the population assessed.

Interstitial lung disease (ILD) and pulmonary arterial hypertension (PAH) are prevalent complications of systemic sclerosis (SS) and are currently the leading causes of death related to the disease. The accurate recognition of these conditions is therefore of utmost importance for patient management.

A study was carried out with 24 SS patients being followed at the Rheumatology Department of the Hospital de Clínicas of Universidade Federal do Paraná (UFPR) and 14 healthy volunteers, with the objective of evaluating the usefulness of lung magnetic resonance imaging (MRI) when assessing ILD in SS patients. The results obtained with lung MRI were compared to those obtained by computed tomography (CT) of the chest, currently considered the examination of choice when investigating ILD in SS patients.

The assessed population was predominantly composed of women with a mean age of 50 years, limited cutaneous SS, and a disease duration of approximately 7 years. In most cases, there was agreement between the findings on chest CT and lung MRI. Considering it is a radiation‐free examination and capable of accurately identifying areas of lung tissue inflammatory involvement, lung MRI showed to be a useful examination, and further studies are needed to assess whether there is an advantage in using lung MRI instead of chest CT when assessing ILD activity in SS patients.

Objective

To compare DMARD use in patients with and without FM over time, including overtreatment and undertreatment rates in both groups.

Methods

A prospective cohort study with patients attending an RA outpatient clinic was conducted. Participants were consecutively recruited between March 2006 and June 2007 and were followed through December 2013. Data on DMARD use (prevalences, doses and escalation rates), DAS28, HAQ and radiographic progression were compared among RA patients with FM and without FM. Mistreatment clinical scenarios were allegedly identified and compared between groups.

Results

256 RA patients (32 with FM) were followed for 6.2 ± 2.0 (mean ± SD) years comprising 2,986 visits. At baseline, RA duration was 11.1 ± 7.4 years. DAS28 and HAQ were greater in RA with FM group, and were closer to RA without FM group towards the end. RA patients with FM used higher doses of tricyclic antidepressants, leflunomide and prednisone, and lower doses of methotrexate. When compared to RA patients without FM, participants with RA and FM used more often tricyclic antidepressants, leflunomide, prednisone, continuous analgesics and less often methotrexate. Groups presented similar 7‐year biologic‐free survival, and radiographic progression‐free survival in Cox regression. RA patients with FM had greater proportions of visits in mistreatment scenarios when compared to RA patients without FM (28.4 vs. 19.8%, p < 0.001).

Conclusions

RA patients with FM used more leflunomide and prednisone, and RA mistreatment was more frequent in FM patients. Certainly, RA patients with FM will benefit from a personalized T2 T strategy, including ultrasound (when suitable) and proper FM treatment.

Objectives

To correlate the basal expression of complement regulatory proteins (CRPs) CD55, CD59, CD35, and CD46 in B‐lymphocytes from the peripheral blood of a cohort of 10 patients with rheumatoid arthritis (RA) initiating treatment with rituximab (RTX) with depletion and time repopulation of such cells.

Methods

Ten patients with RA received two infusions of 1 g of RTX with an interval of 14 days. Immunophenotypic analysis for the detection of CD55, CD59, CD35, and CD46 on B‐lymphocytes was carried out immediately before the first infusion. The population of B‐lymphocytes was analyzed by means of basal CD19 expression and after 1, 2, and 6 months after the infusion of RTX, and then quarterly until clinical relapse. Depletion of B‐lymphocytes in peripheral blood was defined as a CD19 expression <0,005 × 109/L.

Results

Ten women with a median of 49 years and a baseline DAS28 = 5.6 were evaluated; 9 were seropositive for rheumatoid factor. Five patients showed a repopulation of B‐lymphocytes after 2 months, and the other five after 6 months. There was a correlation between the basal expression of CD46 and the time of repopulation (correlation coefficient = ‐0.733, p = 0.0016). A similar trend was observed with CD35, but without statistical significance (correction coefficient = ‐0.522, p = 0.12).

Conclusion

The increased CD46 expression was predictive of a faster repopulation of B‐lymphocytes in patients treated with RTX. Studies involving a larger number of patients will be needed to confirm the utility of basal expression of CRPs as a predictor of clinical response.

Objective

To estimate the prevalence of ischemic heart disease and associated factors in patients with rheumatoid arthritis.

Methods

A cross‐sectional study using the American College of Rheumatology diagnostic criteria in order to select patients seen at primary or secondary health care units in Blumenau, Santa Catarina, Southern Brazil, in 2014. The presence of ischemic heart disease was defined as an acute myocardial infarction with percutaneous coronary intervention or coronary artery bypass graft surgery that has occurred after diagnosis. Fischer's exact test, Wald's linear trend test, and multivariate logistic regression analysis were used to test the associations.

Results

Among 296 patients (83.1% female) with a mean age of 56.6 years and a mean rheumatoid arthritis duration of 11.3 years, 13 reported having acute myocardial infarction requiring a percutaneous or surgical reperfusion procedure, a prevalence of 4.4% (95% CI 2.0‐6.7). Diabetes Mellitus (odds ratio [OR] 4.9 (95% CI 1.6‐13.8) and disease duration >10 years (OR 8.2 [95% CI 1.8‐39.7]) were the only factors associated with an ischemic disease that remained in the final model, after the multivariate analysis.

Conclusion

The prevalence of acute myocardial infarction was similar to that observed in other studies. Among the traditional risk factors, Diabetes Mellitus, and among the factors related to rheumatoid arthritis, disease duration, were the variables associated with comorbidity.