Revista Brasileira De Reumatologia最新文献

Introduction

Fibromyalgia (FM) is a chronic pain syndrome characterized by generalized pain. It is known that obese patients have more skeletal muscle pain and physical dysfunction than normal weight patients. Therefore, it is important that the early diagnosis of FM be attained in obese patients.

Objective

To determine the prevalence of FM in a group of obese patients with indication of bariatric surgery.

Materials and methods

The patients were recruited from the Bariatric Surgery outpatient clinic of Hospital de Clínicas of UFPR (HC‐UFPR) before being submitted to surgery. Patient assessment consisted in verifying the presence or absence of FM using the 1990 and 2011 ACR criteria, as well as the presence of comorbidities.

Results

98 patients were evaluated, of which 84 were females. The mean age was 42.07 years and the BMI was 45.39. The prevalence of FM was 34% (n = 29) according to the 1990 criteria and 45% (n = 38) according to the 2011 criteria. There was no difference in age, BMI, Epworth score and prevalence of other diseases among patients who met or not the 1990 criteria. Only depression was more common in patients with FM. (24.14% vs. 5.45%). The same findings were seen in patients that met the 2011 criteria.

Conclusions

The prevalence of FM in patients with morbid obesity is extremely high. However, BMI does not differ in patients with or without FM. The presence of depression may be a risk factor for the development of FM in these patients.

Introduction

The objectives of this study were to assess the quality of life and functional capacity of adhesive capsulitis patients at the beginning and end of procedure and to identify risk factors associated to better outcomes after treatment with nerve blocking.

Methods

A prospective cohort study was performed. Inclusion criteria were clinical signs of adhesive capsulitis and disease changes on shoulder imaging exams. The short form of World Health Organization Quality of life and Disabilities of the Arm, Shoulder and Hand questionnaires were administered at the beginning and end of treatment. A score of 55 points or more on the Constant index was used for discontinuation of treatment. We used the Wilcoxon test for paired samples. Multiple regression analysis of Poisson was carried out using exposure variables with p <0.20 in the univariate analysis and the satisfactory quality of life and better functional capability as outcomes. The significance level was 5%.

Results

43 patients were evaluated. For the comparison between medians values at the beginning and end of treatment (Physical Domain: 46.43‐67.86; Psychologic Domain: 66.67‐79.17; Social Domain: 66.67‐75; Environment Domain: 62.5‐68.75; DASH: 64.16‐38.33), p was <0.05. Aging (Physical/Psychologic/DASH), higher educational level (Physical/Environment/DASH), less severity (only Physical) and fewer nerve blocking (only Psychologic) were these independent risk factors.

Conclusions

Quality of life and functional capacity of the patients improve at the end of procedure. Older patients and higher education levels are the risk factors most associated to satisfactory quality of life and better functional capacity after treatment with nerve blocking.

Rheumatoid arthritis (RA) is a systemic autoimmune inflammatory disease, with a progressive course, characterized by chronic synovitis that may evolve with deformities and functional disability, and whose early treatment minimizes joint damage. Its etiopathogenesis is not fully elucidated but comprises immunologic responses mediated by T helper cells (Th1). An apparent minor severity of RA in patients from regions with lower income could be associated with a higher prevalence of gut parasites, especially helminths. Strictly, a shift in the immune response towards the predominance of T helper cells (Th2), due to the chronic exposure to helminths, could modulate negatively the inflammation in RA patients, resulting in lower severity/joint injury. The interaction between the immunological responses of parasitic helminths in rheumatoid arthritis patients is the purpose of this paper.

Objective

Our aim was to investigate the effect of parity on osteoporosis by evaluating bone mineral density, markers of bone turn‐over and other factors that are effective in osteoporosis in multiparous (5 deliveries or more) and nulliparous women in the post‐menopausal period.

Methods

A total of 91 multiparous (5 deliveries or more) and 31 nulliparous postmenopausal women were included in this study. All patients were interviewed on sociodemographic characteristics, gynecologic history, personal habits, levels of physical activity, and life‐long intake of calcium. Bone mineral density was measured at lumbar (L1‐4) and femoral neck regions with Dexa.

Results

The mean age of multiparous women was 58.79 ± 7.85 years, and the mean age of nulliparous women was 55,84 ± 7,51. The femoral BMD was 0,94 ± 0,16 and lumbar BMD 1,01 ± 0,16 in multiparous women, femoral BMD was 0,99 ± 0,16 and lumbar BMD 1,07±0,14 in nulliparous women. There were no statistical differences between the femoral and lumbar T scores and BMD values of the two groups. Lumbar T scores and lumbar BMD showed a decrease with increasing total duration of breast‐feeding in multiparous women. The independent risk factors for osteoporosis in the regression analysis of multiparous women were found to be the duration of menopause and body weight of 65 kg and less.

Conclusion

There is no difference between the bone mineral densities of multiparous and nulliparous women. Females with lower body‐weight and longer duration of menopause should be followed‐up more carefully for development of osteoporosis.

Introduction

Each day, evidence accumulates related to the use of therapeutic plasma exchange (TPE) in patients with rheumatic diseases. San Ignacio University Hospital has recorded all of the TPE sessions performed by the institution's apheresis group.

Objective

To describe the TPE experience of patients with rheumatologic diseases in a hospital setting (?).

Methods

Descriptive, observational, retrospective analysis. This study included analyses of the TPE sessions that were performed in patients with rheumatic diseases from November 2009 to November 2013.

Results

The apheresis group performed 136 sessions in 27 patients. The mean patient age was 43 years (SD 18.5), and 59.3% of the patients were female. Regarding the diagnosis, the most frequents ones where: ANCA‐associated vasculitis followed by systemic lupus erythematosus and catastrophic antiphospholipid syndrome. The average number of sessions per patient was 5 (SD 1.8), and the average plasma exchange per patient was 1.3 plasma volume replacement units. The most used replacement solution was frozen fresh plasma (FFP; 63.2% of the sessions). Of all the sessions, 4.4% presented complications, and the majority of the complications were related to vascular access. Fifteen patients required renal replacement therapy (RRT) secondary to the same cause that created the need for TPE, 3 patients required RRT due to causes other than the TPE diagnostic intervention and 1 patient had undergone chronic dialysis.

Conclusions

TPE is a therapeutic alternative that is needed for the management of patients with rheumatic diseases with renal involvement and those who are refractory to conventional management. Our clinical results were in agreement with the global literature.

The objective of this systematic review was to analyze clinical trials carried out for the investigation of the effect of vitamin D supplementation on systemic lupus erythematosus. The research was performed from August to September 2016, without limits regarding year of publication, restriction of gender, age, and ethnicity. For the guiding question, the PICO strategy was employed. To evaluate the quality of the publications the PRISMA protocol and Jadad scale were used. The risk of bias analysis of the clinical trials was performed using the Cochrane collaboration tool. After the process of article selection and removal of duplicates, four articles were identified as eligible. The results of three studies showed a positive effect of supplementation on disease activity reduction and significant improvement in levels of inflammatory markers, fatigue, and endothelial function. Only one study showed no improvement in disease activity after supplementation. Moreover, all studies showed an increase in serum vitamin D levels. The data from this review provide evidence on the benefits of vitamin D supplementation in patients with lupus and vitamin D insufficiency/deficiency. However, it is still necessary to elucidate whether vitamin D acts in the protection against this metabolic disorder, as well as the standardization of the type, dose and time of vitamin D supplementation.

Objective

To investigate the association between body mass index (BMI) and bone mineral density (BMD) in postmenopausal women.

Methods

Observational study with postmenopausal women who underwent bone densitometry in Palmeira das Missões ‐ RS. Sociodemographic data, risk for osteoporosis and food intake were assessed through a specific form. BMI was calculated according to WHO criteria. The assessment of BMD was performed by Dual‐energy X‐ray absorptiometry (DXA) and classified according to WHO. Statistical analysis was performed using prevalence ratios (PR) and their respective 95% confidence intervals for the factors studied. Variables associated with p < 0.20 with the different outcomes (osteopenia and osteoporosis) were included in a Poisson regression model with robust variance to adjust for potential confounding factors. A 5% significance level was considered.

Results

393 postmenopausal women with a mean age of 59.6 ± 8.2 years participated.

After the adjustments, the normal weight women had 1.2 times the prevalence of osteopenia of obese women (PR = 1.2; CI 95% 1.3‐1.5). Considering osteoporosis, the PR of euthophic women was twice the PR of obese women (PR = 2; CI 95% 1.4‐2.9) and was 1.7 times greater for overweight group compared to obese category (PR = 1.7; CI 95% 1.2‐2.5).

Conclusion

Obese women had lower prevalence of osteopenia compared with normal weight subjects and also with lower prevalence of osteoporosis as compared to normal‐ and overweight women.

Objective

To assess the prevalence and describe the clinical, laboratory and radiological findings, treatment and outcome of children with cancer initially referred to a tertiary outpatient pediatric rheumatology clinic.

Methods

Retrospective analysis of medical records from patients identified in a list of 250 new patients attending the tertiary Pediatric Rheumatology Clinic, Ribeirão Preto Medical School hospital, University of São Paulo, from July 2013 to July 2015, whose final diagnosis was cancer.

Results

Of 250 patients seen during the study period, 5 (2%) had a cancer diagnosis. Among them, 80% had constitutional symptoms, especially weight loss and asthenia, and 60% had arthritis. Initially, all patients had at least one alteration in their blood count, lactate dehydrogenase (LDH) was increased in 80% and a bone marrow smear was conclusive in 60% of patients. Bone and intestine biopsies were necessary for the diagnosis in 2 patients. JIA was the most common initial diagnosis. The definitive diagnosis was acute lymphoblastic leukemia (2 patients), M3 acute myeloid leukemia, lymphoma, and neuroblastoma (one case each). Of 5 patients studied, 3 (60%) are in remission and 2 (40%) died, one of them with prior use of steroids.

Conclusion

The constitutional and musculoskeletal symptoms common to rheumatic and neoplastic diseases can delay the diagnosis and consequently worsen the prognosis of neoplasms. Initial blood count and bone marrow smear may be normal in the initial framework of neoplasms. Thus, the clinical follow‐up of these cases becomes imperative and the treatment, mainly with corticosteroids, should be delayed until diagnostic definition.