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Abstract Background: The VI Brazilian Consensus on Autoantibodies against HEp-2 cells for determination of autoantibodies against cellular constituents on HEp-2 cells was held on September, 2019, in Fortaleza (CE, Brazil). The guidelines in this edition were formulated by the group of Brazilian experts discussing the classification of complex patterns, the classification of the nuclear discrete dots (few and multiple), the identification of the discrete fine speckled pattern (AC-4a) and improvements on the ANA report. Mainbody: Sixteen Brazilian researchers and experts from universities and clinical laboratories representing the various geographical regions of Brazil participated in the meeting. Four main topics were discussed: (1) How to classify patterns with fluorescence in more than one cell compartment considering three relevant categoris: composite patterns, mixed patterns and multiple patterns; (2) The splitting of the discrete nuclear dots pattern into the multiple discrete nuclear dots (AC-6) and few discrete nuclear dots (AC-7) patterns, respectively; (3) Inclusion of a novel nuclear pattern characterized by discrete fine speckled pattern highly associated with antibodies to SS-A/Ro60, classified as AC-4a. In addition, adjustments on the Brazilian Consensus nomenclature were implemented aiming to harmonize the designation of some patterns with the International Consensus on ANA Patterns (ICAP). Furthermore, the designations of the PCNA-like pattern (AC-13), CENP-F-like pattern (AC-14) and Topo I-like pattern (AC-29) were adjusted in accordance to ICAP. Finally, there was a recommendation for adjustment in the test report in order to address the status of nuclear envelope staining. For all topics, the aim was to establish specific guidelines for laboratories and clinicians. All recommendations were based on consensus among participants. All recommendations from the V Consensus were maintained and there was relevant progress in the BCA/HEp-2 guidelines and further harmonization with ICAP. Conclusion: The VI BCA/HEp-2 edition was successful in establishing important recommendations regarding the classification of complex patterns, in supporting the identification of a novel pattern within the AC-4 group and in the harmonization process with the ICAP terminology.

https://doi.org/10.1186/s42358-022-00266-z

Brazilian recommendations for the use of nonsteroidal anti-inflammatory drugs in patients with axial spondyloarthritis
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Lage, Ricardo da Cruz

; Marques, Claudia Diniz Lopes

; Oliveira, Thauana Luiza

; Resende, Gustavo Gomes

; Kohem, Charles Lubianca

; Saad, Carla Gonçalves

; Ximenes, Antônio Carlos

; Gonçalves, Célio Roberto

; Bianchi, Washington Alves

; Meirelles, Eduardo de Souza

; Keiserman, Mauro Waldemar

; Chiereghin, Adriano

; Campanholo, Cristiano Barbosa

; Lyrio, André Marun

; Schainberg, Cláudia Goldenstein

; Pieruccetti, Lenise Brandao

; Yazbek, Michel Alexandre

; Palominos, Penelope Esther

; Goncalves, Rafaela Silva Guimarães

; Assad, Rodrigo Luppino

; Bonfiglioli, Rubens

; Lima, Sônia Maria Alvarenga Anti Loduca

; Carneiro, Sueli

; Azevedo, Valderílio Feijó

; Albuquerque, Cleandro Pires

; Bernardo, Wanderley Marques

; Sampaio-Barros, Percival Degrava

; Pinheiro, Marcelo de Medeiros

Advances in Rheumatology

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2021, Volume 61 elocation 4

Resumo: En | Texto: En | PDF: En

Abstract Spondyloarthritis (SpA) is a group of chronic inflammatory systemic diseases characterized by axial and/or peripheral joints inflammation, as well as extra-articular manifestations. Over some decades, nonsteroidal anti-inflammatory drugs (NSAIDs) have been the basis for the pharmacological treatment of patients with axial spondyloarthritis (axSpA). However, the emergence of the immunobiologic agents brought up the discussion about the role of NSAIDs in the management of these patients. The objective of this guideline is to provide recommendations for the use of NSAIDs for the treatment of axSpA. A panel of experts from the Brazilian Society of Rheumatology conducted a systematic review and meta-analysis of randomized clinical trials for 15 predefined questions. The Grading of Recommendations, Assessment, Development and Evaluation methodology to assess the quality of evidence and formulate recommendations were used, and at least 70% agreement of the voting panel was needed. Fourteen recommendations for the use of NSAIDs in the treatment of patients with axSpA were elaborated. The purpose of these recommendations is to support clinicians’ decision making, without taking out his/her autonomy when prescribing for an individual patient.

https://doi.org/10.1186/s42358-020-00160-6 505 downloads

Treatment of knee osteoarthritis with a new formulation of a fixed-dose combination of glucosamine sulfate and bovine chondroitin: a multicenter, randomized, single-blind, non-inferiority clinical trial
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Lomonte, Andrea Barranjard Vannucci

; Gimenez, Emerson

; Silva, Antônio Carlos da

; Radominski, Sebastião Cezar

; Scheinberg, Morton Aaron

; Ximenes, Antônio Carlos

; Zerbini, Cristiano Augusto de Freitas

Advances in Rheumatology

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2021, Volume 61 elocation 7

Resumo: En | Texto: En | PDF: En

Abstract Objectives: To compare the efficacy and safety of a new formulation of a fixed dose combination of glucosamine sulfate (GS; 1500 mg) and bovine chondroitin sulfate (CS; 1200 mg) versus the reference product (RP) in patients with knee osteoarthritis (OA). Methods: In this multicenter, randomized, single-blind trial, 627 patients with knee osteoarthritis (OA)—Kellgren-Lawrence grades 2 or 3 and mean score ≥ 40 mm in the WOMAC pain subscale—were randomized to receive GS/ CS or the RP for 24 weeks. The primary efficacy endpoint was the absolute change in WOMAC pain subscale score. The secondary endpoints included the following: WOMAC total and subscale scores, overall assessment of the disease by the patient and the investigator, SF-12 score, OMERACT-OARSI response rate to the treatment, and rescue medication use. Results: Mean reductions of WOMAC pain score were – 35.1 (sd = 23.2) mm in the GS/CS group and – 36.5 (sd = 24.9) mm in the RP group. The difference between the adjusted means of both treatments confirmed the noninferiority of GS/CS versus the RP. Improvement was observed in pain, stiffness, physical function and total WOMAC score, as well as in overall OA assessment by the patient and the investigator for both groups. No improvement was observed in SF-12. The rate of OMERACT-OARSI responders was 89.4% in GS/CS group and 87.9% in the RP group. Headache and changes in glucose tolerance were the most frequent treatment-related adverse events. Conclusions: The new formulation of a fixed-dose combination of glucosamine sulfate and bovine chondroitin sulfate was non-inferior to the RP in symptomatic treatment of knee OA, with a high responder rate and good tolerability profile. Trial registration: ClinicalTrials.gov; Registration number NCT02830919; Date of registration: July 13, 2016; First randomization date: December 05, 2016).

https://doi.org/10.1186/s42358-021-00165-9 590 downloads

Brazilian Society of Rheumatology 2020 guidelines for psoriatic arthritis
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Carneiro, Sueli

; Palominos, Penelope Esther

; Anti, Sônia Maria Alvarenga

; Assad, Rodrigo Luppino

; Gonçalves, Rafaela Silva Guimarães

; Chiereghin, Adriano

; Lyrio, Andre Marun

; Ximenes, Antônio Carlos

; Saad, Carla Gonçalves

; Gonçalves, Célio Roberto

; Kohem, Charles Lubianca

; Marques, Cláudia Diniz Lopes

; Schainberg, Cláudia Goldenstein

; Meirelles, Eduardo de Souza

; Resende, Gustavo Gomes

; Pieruccetti, Lenise Brandao

; Keiserman, Mauro Waldemar

; Yazbek, Michel Alexandre

; Sampaio-Barros, Percival Degrava

; Lage, Ricardo da Cruz

; Bonfiglioli, Rubens

; Oliveira, Thauana Luíza

; Azevedo, Valderílio Feijó

; Bianchi, Washington Alves

; Bernardo, Wanderley Marques

; Simões, Ricardo dos Santos

; Pinheiro, Marcelo de Medeiros

; Campanholo, Cristiano Barbosa

Advances in Rheumatology

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2021, Volume 61 elocation 69

Resumo: En | Texto: En | PDF: En

Abstract Psoriatic arthritis (PsA) is a chronic and systemic immune disease characterized by inflammation of peripheral and/ or axial joints and entheses in patients with psoriasis (PsO). Extra-articular and extracutaneous manifestations and numerous comorbidities can also be present. These recommendations replace the previous version published in May 2013. A systematic review of the literature retrieved 191 articles that were used to formulate 12 recommendations in response to 12 clinical questions, divided into 4 sections: diagnosis, non-pharmacological treatment, conventional drug therapy and biologic therapy. These guidelines provide evidence-based information on the clinical management for PsA patients. For each recommendation, the level of evidence (highest available), degree of strength (Oxford) and degree of expert agreement (interrater reliability) are reported.

https://doi.org/10.1186/s42358-021-00219-y

The Brazilian Society of Rheumatology guidelines for axial spondyloarthritis – 2019
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Resende, Gustavo Gomes

; Meirelles, Eduardo de Souza

; Marques, Cláudia Diniz Lopes

; Chiereghin, Adriano

; Lyrio, Andre Marun

; Ximenes, Antônio Carlos

; Saad, Carla Gonçalves

; Gonçalves, Célio Roberto

; Kohem, Charles Lubianca

; Schainberg, Cláudia Goldenstein

; Campanholo, Cristiano Barbosa

; Bueno Filho, Júlio Silvio de Sousa

; Pieruccetti, Lenise Brandao

; Keiserman, Mauro Waldemar

; Yazbek, Michel Alexandre

; Palominos, Penelope Esther

; Goncalves, Rafaela Silva Guimarães

; Lage, Ricardo da Cruz

; Assad, Rodrigo Luppino

; Bonfiglioli, Rubens

; Anti, Sônia Maria Alvarenga

; Carneiro, Sueli

; Oliveira, Thauana Luíza

; Azevedo, Valderílio Feijó

; Bianchi, Washington Alves

; Bernardo, Wanderley Marques

; Pinheiro, Marcelo de Medeiros

; Sampaio-Barros, Percival Degrava

Advances in Rheumatology

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2020, Volume 60 elocation 19

Resumo: En | Texto: En | PDF: En

Abstract Spondyloarthritis is a group of chronic inflammatory systemic diseases characterized by axial and/or peripheral joints inflammation, as well as extra-articular manifestations. The classification axial spondyloarthritis is adopted when the spine and/or the sacroiliac joints are predominantly involved. This version of recommendations replaces the previous guidelines published in May 2013. A systematic literature review was performed, and two hundred thirty-seven studies were selected and used to formulate 29 recommendations answering 15 clinical questions, which were divided into four sections: diagnosis, non-pharmacological therapy, conventional drug therapy and biological therapy. For each recommendation the level of evidence supporting (highest available), the strength grade according to Oxford, and the degree of expert agreement (inter-rater reliability) is informed. These guidelines bring evidence-based information on clinical management of axial SpA patients, including, diagnosis, treatment, and prognosis.

https://doi.org/10.1186/s42358-020-0116-2 1116 downloads

V Brazilian consensus guidelines for detection of anti-cell autoantibodies on hep-2 cells
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Cruvinel, Wilson de Melo

; Andrade, Luis Eduardo Coelho

; von Mühlen, Carlos Alberto

; Dellavance, Alessandra

; Ximenes, Antônio Carlos

; Bichara, Carlos David

; Bueno, Cleonice

; Mangueira, Cristóvão Luis Pitangueira

; Bonfá, Eloísa

; Brito, Fabiano de Almeida

; Flumian, Fernanda Bull

; Silva, Glaucielen Gomes da

; Rêgo, Jozelia

; Anjos, Lisiane Maria Ericoni dos

; Slhessarenko, Natasha

; Pasoto, Sandra Gofinet

; Neves, Suzane Pretti Figueiredo

; Valim, Valéria

; Santos, Wilton Silva dos

; Francescantonio, Paulo Luiz Carvalho

Advances in Rheumatology

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2019, Volume 59 elocation 28

Resumo: En | Texto: En | PDF: En

Abstract Background: The V Brazilian Consensus for determination of autoantibodies against cellular constituents on HEp-2 cells, held in Brasilia (DF, Brazil) on August 27, 2016, discussed the harmonization between the Brazilian Consensus on ANA (BCA) guidelines and the International Consensus on ANA Patterns (ICAP) recommendations (www.anapatterns.org). Initial guidelines were formulated by the group of Brazilian experts with the purpose of guiding and enabling Brazilian clinical laboratories to adopt recommendations and to provide a common standard for national and international consensuses. Mainbody: Twenty Brazilian researchers and experts from universities and clinical laboratories representing the various geographical regions of the country participated in the meeting. Three main topics were discussed, namely the harmonization between the BCA guidelines and latest recommendations of the ICAP initiative, the adjustment of the terminology and report on HEp-2 patterns, and a reassessment of quality assurance parameters. For the three topics, our aim was to establish specific guidelines. All recommendations were based on consensus among participants. There was concrete progress in the adjustment of the BCA guidelines to match the ICAP guidelines. To a certain extent, this derives from the fact that ICAP recommendations were largely based on the algorithm and recommendations of the IV Brazilian ANA Consensus, as consistently recognized in the ICAP publications and presentations. However, although there is great overlap between the two Consensuses, there are some point divergences. These specific items were individually and extensively discussed, and it was acknowledged that in several points ICAP improved recommendations previously issued by the Brazilian ANA Consensus and these changes were readily implemented. Regarding some specific topics, the BCA panel of experts felt that the previously issued recommendations remained relevant and possibly will require further discussion with ICAP. The term anti-cell antibodies was adopted as the recommended designation, recognizing that the assay addresses antibodies against antigens in the nucleus and in other cell compartments. However, the acronym ANA HEp-2 was maintained due to historical and regulatory reasons. It was also signalized that the latest trend in ICAP is to adopt the term Indirect Immunofluorescent Assay on HEp-2 cell substrate (HEp-2 IIFA). In addition, the quality assurance strategies previously presented were ratified and emphasized. Conclusion: The V BCA edition was successful in establishing an overall harmonization with the ICAP recommendations for interpretation of the HEp-2 IIFA test, pinpointing the perspectives in filling the remaining gaps between both initiatives.

https://doi.org/10.1186/s42358-019-0069-5 1618 downloads

Detecção do DNA de Chlamydia trachomatis em espondiloartropatias e artrite reumatóide
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Navarrete Fernandez, Rafael

; Ximenes, Antônio Carlos

; Costa Alves, Maria de Fátima

Revista Brasileira de Reumatologia

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Out 2005, Volume 45 Nº 5 Páginas 280 - 290

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

Chlamydia trachomatis é a bactéria responsável pela doença sexualmente transmissível mais prevalente no mundo. A maioria das infecções em homens e mulheres é assintomática e, quando não diagnosticada e tratada, pode causar artrite e complicações relacionadas ao aparelho reprodutor feminino. OBJETIVO: pesquisar o DNA de C. trachomatis no líquido sinovial e urina de pacientes com espondiloartropatias e artrite reumatóide (AR), avaliar a presença de anticorpos séricos IgG e IgM anti-C. trachomatis nesses dois grupos de doenças e identificar o antígeno HLA-B27 em pacientes com espondiloartropatias. MÉTODOS: a população do estudo consistiu em 15 pacientes com espondiloartropatias: nove com espondiloartropatia indiferenciada (EI) e seis com artrite reativa (ARe) (grupo I) e 15 pacientes com AR (grupo II). O DNA clamidial foi pesquisado em amostras de líquido sinovial e urina de todos os pacientes, empregando-se a PCR (Amplicor Roche, Suíça). Os anticorpos IgG e IgM anticlamidiais foram quantificados por imunofluorescência indireta (IFI), enquanto o HLA-B27 foi tipado em 15 pacientes do grupo I por citometria de fluxo. RESULTADOS: o DNA da C. trachomatis foi evidenciado apenas em uma amostra de líquido sinovial do grupo I (6,7%), sendo o paciente portador de ARe. Em dois pacientes com AR, o DNA clamidial foi identificado na urina (13,3%). Os anticorpos IgG anticlamidiais estavam presentes em oito pacientes da população estudada, três do grupo I (20%) e cinco do grupo II (33,3%). O maior título desse anticorpo (1/256) associou-se com a presença do DNA clamidial na urina de um paciente do grupo II. O anticorpo IgM não foi detectado em nenhuma amostra dos dois grupos. O antígeno HLA-B27 foi positivo em quatro indivíduos do grupo II (26,7%) e sua presença relacionou-se com sacroileíte. CONCLUSÕES: os resultados deste estudo indicam que em pacientes com diagnóstico de espondiloartropatias e artrite reumatóide, com quadro articular em atividade, a C. trachomatis não pode ser excluída como agente desencadeador.

Chlamydia trachomatis is the bacteria responsible for the most prevalent sexually transmitted disease worldwide. Most of the infections in men and women is asymptomatic and when undiagnosed and untreated may reach the joints causing not only arthritis, but also other acknowledged complications related to the female reproductive system. OBJECTIVE: To investigate C. trachomatis DNA in the urine and synovial fluid from patients with spondyloarthropathies (SpA) and rheumatoid arthritis (RA) and evaluate serum anti-C. trachomatis IgG and IgM antibodies. METHODS: The population consisted of 15 patients with spondyloarthropathies, being 9 with undifferentiated spondyloarthropathy (US) and 6 with reactive arthritis (ReA) (group I), and 15 patients with rheumatoid arthritis (RA) (group II). The chlamydial DNA was assessed in synovial fluid and urine samples of all patients by Amplicor (Roche, Swiss) PCR. The anti-chlamydial IgG and IgM antibodies were quantified through indirect imunofluorescence (IIF), while 15 patients of group I were typed for HLA-B27 by the use of flow citometry. Sociodemographical data and all information on sexual behaviour and presence of symptoms were collected through a (questionnaire in the form of) an interview. RESULTS: C. trachomatis DNA was found in only one synovial fluid sample from patient with ReA (6,7%). In two patients with RA, chlamydial DNA was identified in the urine sample (13,3%). The anti-chlamydial IgG antibodies were present in eight patients of the population studied; being three patients from group I (20%), and five from group II (33,3%). The greatest titer of this antibody 1/256 was associated with the presence of chlamydial DNA in a patient from group II. The IgM antibody was not detected in any of the samples from both groups. Four individuals from group II (26,7%) were HLA-B27 positive and its presence was related to sacroiliitis. CONCLUSIONS: The results in this study show that in patients with spondyloarthropathies and rheumatoid arthritis, presenting a picture of articular activity, one might not exclude C. trachomatis as the triggering agent

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Infliximab no tratamento da artrite psoriásica grave
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Loyola, Adriano Jaime Consorte

; Castro, Lia Cândida Miranda de

; Chaibub, Sulamita Costa Wirth

; Ximenes, Antônio Carlos

Anais Brasileiros de Dermatologia

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Out 2005, Volume 80 Nº 5 Páginas 535 - 537

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

A artrite psoriásica tem sido reconhecida como doença imunomediada, em que há participação de células T produtoras de citocinas (fator de necrose tumoral-alfa). O infliximab é anticorpo monoclonal que se liga e inativa o fator de necrose tumoral-alfa. Relata-se um caso de artrite psoriásica grave, refratária a várias terapêuticas sistêmicas, tratado com infliximab 5mg/kg, em infusão venosa de três horas, nas semanas 0, 2, 6 e 14, associado com baixa dose de metotrexato, que apresentou excelente resposta terapêutica.

Psoriatic arthritis has been recognized as an auto-immune disease in which there is participation of the cytokine-producing T cells (tumor necrosis factor-alpha). Infliximab is a monoclonal antibody that binds to and inactivates tumor necrosis factor-alpha. Reported is a case of severe psoriatic arthritis which was unresponsive to multiple systemic therapies and treated with an intravenous infusion of infliximab, 5mg/Kg in three hours, in weeks 0,2,6 and 14, associated with a low dose of methotrexate, with an excellent therapeutical response.

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II Consenso Brasileiro de Fator Antinuclear em Células HEp-2: Definitions for standardization of autoantibody testing against the nucleus (ANA HEp-2), nucleolus, cytoplasm and mitotic apparatus, as wel as its clinical associations
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Dellavance, Alessandra

; Gabriel Júnior, Alexandre

; Cintra, Alice F. U.

; Ximenes, Antônio Carlos

; Nuccitelli, Barbara

; Taliberti, Ben Hur

; Moreira, Caio

; von Mühlen, Carlos Alberto

; Bichara, Carlos David

; Santos, Cláudio Henrique Ramos dos

; Yano, Cristiane Martinez

; Mangueira, Cristóvão Luis Pitangueira

; Carvalho, Darlene Gonçalves

; Bonfá, Eloísa Silva Dutra de O.

; Doi, Elvira M.

; Guimarães, Fabiana Nunes de Carvalho

; Araújo, Flávia Ikeda e

; Mundim, Hugo Mendonça

; Rego, Jozelia

; Vieira, Lisiane Ericonio dos Anjos

; Poli, Luciana

; Andrade, Luís Eduardo Coelho

; Callado, Maria Roseli

; Mesquita, Mauro Meira

; Sugiyama, Mitiko

; Slhessarenko, Natasha

; Silva, Nilzio Antônio da

; Carballo, Orlando Gabriel

; Leser, Paulo Guilherme

; Francescantonio, Paulo Luiz Carvalho

; Jarach, Renata

; Xavier, Ricardo Machado

; Levy, Roger Abramino

; Neves, Suzane P. F.

; Cruvinel, Wilson de Melo

; Santos, Wilton Silva dos

Revista Brasileira de Reumatologia

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Jun 2003, Volume 43 Nº 3 Páginas 129 - 140

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

OBJETIVO: O Segundo Consenso Brasileiro de Fator Antinuclear (FAN) em Células HEp-2 ratificou os algoritmos de decisão para leitura dos padrões do FAN na imunofluorescência indireta vistos na primeira edição do Consenso Brasileiro, adicionando ainda um novo algoritmo relacionado com os padrões mistos. MÉTODOS: Tendo em vista a habilidade do teste em detectar autoantígenos nos distintos compartimentos celulares, e não apenas no núcleo, propõe-se novas denominações para este exame laboratorial. RESULTADOS E CONCLUSÕES: Como novas denominações algumas sugestões foram igualmente aceitas, dentro do tema "pesquisa de auto-anticorpos contra constituintes do núcleo (FAN HEp-2), nucléolo, citoplasma e aparelho mitótico". Foram abordadas as principais relevâncias clínicas com os padrões de FAN descritos, facilitando o melhor uso do ensaio pelo médico.

OBJECTIVE: The Second Brazilian Consensus on Antinuclear Antibodies (ANA) in HEp-2 Cells approved and extended the decision trees developed during the First Brazilian Consensus in order to also offer information about mixed patterns of fluorescence. METHODS: Since this test elicits reactions not only to nuclear autoimmune antigens but also to different cell compartments, new denominations for the test were approved. Results and CONCLUSIONS: These new denominations encompass variations on the "autoantibody testing against the nucleus (ANA HEp-2), nucleolus, cytoplasm, and mitotic apparatus" issue. Furthermore, major clinical associations were described for each immunofluorescent pattern, facilitating the interpretation of laboratory results in the clinical practice.

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