Revista Brasileira De Reumatologia最新文献

Rheumatic fever is still currently a prevalent disease, especially in developing countries. Triggered by a Group A β‐hemolytic Streptococcus infection, the disease may affect genetically predisposed patients. Rheumatic carditis is the most important of its clinical manifestations, which can generate incapacitating sequelae of great impact for the individual and for society. Currently, its diagnosis is made based on the Jones Criteria, established in 1992 by the American Heart Association (AHA). In 2015, the AHA carried out a significant review of these criteria, with new diagnostic parameters and recommendations. In the present study, the authors perform a critical analysis of this new review, emphasizing the most relevant points for clinical practice.

Background

Sleep disturbances are common in rheumatoid arthritis (RA) patients and contribute to loss of life quality.

Objective

To study associations of sleep quality with pain, depression and disease activity in RA.

Methods

This is a transversal observational study of 112 RA patients submitted to measurement of DAS‐28, Epworth scale for daily sleepiness, index of sleep quality by Pittsburg index, risk of sleep apnea by the Berlin questionnaire and degree of depression by the CES‐D (Center for Epidemiologic Studies Depression scale) questionnaire. We also collected epidemiological, clinical, serological and treatment data.

Results

Only 18.5% of RA patients had sleep of good quality. In univariate analysis a bad sleep measured by Pittsburg index was associated with daily doses of prednisone (p = 0.03), DAS‐28 (p = 0.01), CES‐D (p = 0.0005) and showed a tendency to be associated with Berlin sleep apnea questionnaire (p = 0.06). In multivariate analysis only depression (p = 0.008) and Berlin sleep apnea questionnaire (p = 0.004) kept this association.

Conclusions

Most of RA patients do not have a good sleep quality. Depression and risk of sleep apnea are independently associated with sleep impairment.

Background

Systemic blockade of TNF‐α in Rheumatoid arthritis (RA) with insulin resistance (IR) seems to produce more improvement in insulin sensitivity in normal weight patients with RA than in obese patients with RA, suggesting that systemic‐inflammation and obesity are independent risk factors for IR in RA patients.

Objectives

To evaluate the insulin resistance in: normal weight patients with RA (RA NW), overweight patients with RA (RA OW), obese RA patients (RA OB), and matched control subjects with normal weight (NW) and obesity (OB); and its association with major cytokines involved in the pathogenesis of the disease.

Methods

Assessments included: body mass index (BMI), insulin resistance by HOMA‐IR, ELISA method, and enzymatic colorimetric assay.

Results

Outstanding results from these studies include: (1) In RA patients, IR was well correlated with Body Mass Index (the higher the BMI, the higher IR), but not with levels of serum cytokines. In fact, levels of cytokines were similar in all RA patients, regardless of being obese, overweight or normal weight (2) IR was significantly higher in RA NW than in NW (3) No significant difference was observed between IRs of RA OB and OB (4) As expected, levels of circulating cytokines were significantly higher in RA patients than in OB.

Conclusions

Obesity appears to be a dominant condition above inflammation to produce IR in RA patients. The dissociation of the inflammation and obesity components to produce IR suggests the need of an independent therapeutic strategy in obese patients with RA.

Objectives

To evaluate the frequency of four serum biomarkers in RA patients and their relatives and identify possible associations with clinical findings of the disease.

Methods

This was a transversal analytical study. Anti‐cyclic citrullinated peptide (anti‐CCP), anti‐mutated citrullinated vimentin (anti‐MCV) and IgA‐rheumatoid factor (RF) were determined by ELISA and IgM‐RF by latex agglutination in 210 RA patients, 198 relatives and 92 healthy controls from Southern Brazil. Clinical and demographic data were obtained through charts review and questionnaires.

Results

A higher positivity for all antibodies was observed in RA patients when compared to relatives and controls (p < 0.0001). IgA‐RF was more frequent in relatives compared to controls (14.6% vs. 5.4%, p = 0.03, OR = 2.98; 95%CI = 1.11‐7.98) whereas anti‐CCP was the most common biomarker among RA patients (75.6%). Concomitant positivity for the four biomarkers was more common in patients (46.2%, p < 0.0001). Relatives and controls were mostly positive for just one biomarker (20.2%, p < 0.0001 and 15.2%, p = 0.016, respectively). No association was observed between the number of positive biomarkers and age of disease onset, functional class or tobacco exposure. In seronegative patients predominate absence of extra articular manifestations (EAMs) (p = 0.01; OR = 3.25; CI = 1.16‐10.66). Arthralgia was present in positive relatives, regardless the type of biomarker.

Conclusions

A higher number of biomarkers was present in RA patients with EAMs. Positivity of biomarkers was related to arthralgia in relatives. These findings reinforce the link between distinct biomarkers and the pathophysiologic mechanisms of AR.

Gout is considered the most common form of inflammatory arthritis in men over 40 years. The authors present a brief review of the current treatment of gout and discuss the existing pharmacological limitations in Brazil for the treatment of this disease. Although allopurinol is still the main drug administered for decreasing serum levels of uric acid in gout patients in this country, the authors also present data that show a great opportunity for the Brazilian drug market for the treatment of hyperuricemia and gout and especially for patients using private and public (SUS) health care systems.

Objective

The development of anti‐drug antibodies (ADAbs) against tumor necrosis factor (TNF) inhibitors is a likely explanation for the failure of TNF‐inhibitors in patients with spondyloarthritis (SpA). Our study determined the existence and clinical implications of ADAbs in axial SpA patients.

Methods

According to the Assessment of SpondyloArthritis International Society classification criteria for axial SpA, patients treated with adalimumab or infliximab were recruited consecutively. Serum samples were collected at enrollment to measure ADAb and drug levels.

Results

Of 100 patients, the mean duration of current TNF inhibitor use was 22.3 ± 17.9 months. ADAbs were detected in 5 of 72 adalimumab users compared to 5 of 28 infliximab users (6.9% vs. 17.9%). ADAb‐positive patients had a significantly higher body mass index than ADAb‐negative patients among both adalimumab (28.4 ± 5.9 kg/m² vs. 24.3 ± 2.9 kg/m², respectively, p = 0.01) and infliximab users (25.9 ± 2.8 kg/m² vs. 22.6 ± 2.8 kg/m², respectively, p = 0.02). During the median 15‐month follow‐up period, drug discontinuation occurred more frequently in the ADAb‐positive group than the ADAb‐negative group (30.0% vs. 6.5%, respectively, p = 0.04). In logistic regression, ADAb positivity (OR = 5.85, 95% CI 1.19–28.61, p = 0.029) and BMI (OR = 4.35, 95% CI 1.01–18.69, p = 0.048) were associated with a greater risk of stopping TNF inhibitor treatment.

Conclusions

Our result suggests that the presence of ADAbs against adalimumab and infliximab as well as a higher BMI can predict subsequent drug discontinuation in axial SpA patients.

Background

Fear‐avoidance beliefs are related to the prognosis of chronicity in low back pain in subacute stages, however in chronic pain, is no clear the influence of these factors; it has been suggested that the study population can determine the magnitude of influence on disability and pain of those suffering from back pain. Currently, information does not exist in the Mexican population.

Objective

To analyze the relationship between fear‐avoidance beliefs with pain and disability in Mexicans with chronic low back pain; analyze potentials differences between subgroups according to the time of evolution.

Methods

Cross‐sectional study in Mexicans with chronic LBP aged between 18 and 45. Data were collected on general socio demographic characteristics, time of evolution, body mass index, pain, disability and fear‐avoidance beliefs.

Results

33 men and 47 women, with an average age of 34.19 ± 7.65 years. Higher scores of fear‐avoidance beliefs were obtained in women (47.2 ± 20.99 versus 38.5 ± 9.7; p = 0.05) and single participants (p = 0.04). A positive correlation was found between disability (r = 0.603, p < 0.001) and pain (r = 0.234, p = 0.03) with high scores of fear‐avoidance beliefs. Through generalized linear models for disability, total score of the fear avoidance beliefs questionnaire showed a standardized beta coefficient of 0.603, p < 0.001 (R² of 0.656); for pain showed a standardized beta coefficient of 0.29, p = 0.01 (R² of 0.721)

Conclusion

The present study suggests that there is a strong relationship between pain severity, FABQ scores, and functional disability in Mexicans with chronic LBP.

The comorbidities in relapsing polychondritis (RP) have been scarcely described in the literature. Moreover, apart from a few RP epidemiological studies, no studies specifically addressing RP distribution according to gender are available. Therefore, the objetives of the present study were: (a) to analyse the prevalence of cardiovascular diseases and its risk factors in a series of patients with RP; (b) to determine the influence of gender on RP. A cross‐sectional tertiary single center study evaluating 30 RP cases from 1990 to 2016 was carried out. To compare comorbidities, 60 healthy individuals matched for age‐, gender‐, ethnicity‐ and body mass index were recruted. The mean age of RP patientes was 49.0 ± 12.4 years, the median disease duration 6.0 years, and 70% were women. A higher frequency of arterial hypertension (53.3% vs. 23.3%; p = 0.008) and diabetes mellitus (16.7% vs. 3.3%; p = 0.039) was found in the RP group, compared to the control group. As an additional analysis, patients were compared according to gender distribution (9 men vs. 21 women). The clinical disease onset features were comparable in both genders. However, over the follow‐up period, male patients had a greater prevalence of hearing loss, vestibular disorder and uveitis events, and also received more cyclophosphamide therapy (p < 0.05). There was a high prevalence of arterial hypertension and diabetes mellitus, and the male patients seemed to have worse prognosis than the female patients in the follow up.