Abstract Sjogren’s disease (SjD) is an autoimmune disease that is characterized not only by the sicca symptoms it causes but also by its systemic nature, which is capable of several and not yet fully understood extraglandular manifestations. To gain a clearer understanding of these manifestations as well as a better practical approach, a panel of experts from the Brazilian Society of Rheumatology conducted a systematic review and meta-analysis on the identification of epidemiologic and clinical features of the extraglandular manifestations present in ESSDAI (EULAR Sjogren´s syndrome disease activity index), followed by a voting panel with recommendations for clinical practice. This publication is complementary to others already published and covers cutaneous and hematological manifestations, with prevalence data generated by a meta-analysis of 13 clinical or laboratory manifestations and 6 clinical management recommendations. Sjogrens Sjogren s SjD (SjD nature approach metaanalysis meta analysis EULAR index, index , index) practice 1

Abstract Background Hip fractures in the older adults lead to increased morbidity and mortality. Although a low bone mineral density is considered the leading risk factor, it is essential to recognize other factors that could affect the risk of hip fractures. This study aims to evaluate the contribution of clinical characteristics, patient-reported outcomes, and muscle and aerobic capacity for hip fractures in community-dwelling older adults. Methods This is a retrospective cohort study with real world-data from subjects ≥ 60 years old attending an outpatient clinic in Minas Gerais, Brazil, from May 1, 2019, to August 22, 2022. Data about clinical characteristics (multimorbidity, medications of long-term use, sedative and or tricyclic medications, number of falls), patient-reported outcomes (self-perception of health, self-report of difficulty walking, self-report of vision problems, and self-report of falls) and muscle and aerobic capacity (calf circumference, body mass index, and gait speed) were retrieved from an electronic health record. The association of each potential risk factor and hip fracture was investigated by a multivariable logistic regression analysis adjusted for age and sex. Results A total of 7,836 older adults were included with a median age of 80 years (IQR 72–86) and 5,702 (72.7%) were female. Hip fractures occurred in 121 (1.54%) patients. Multimorbidity was associated with an increased risk of hip fracture (OR = 1.12, 95%CI 1.06–1.18) and each episode of fall increased the chance of hip fracture by 1.7-fold (OR = 1.69, 95%CI 1.52–1.80). Patient-reported outcomes associated with increased fracture risk were regular or poor self-perception of health (OR = 1.59, 95%CI 1.06–2.37), self-report of walking difficulty (OR = 3.06, 95%CI 1.93–4.84), and self-report of falls (OR = 2.23, 95%CI 1.47–3.40). Body mass index and calf circumference were inversely associated with hip fractures (OR = 0.91, 95%CI 0.87–0.96 and OR = 0.93, 95%CI 0.88–0.97, respectively), while slow gait speed increased the chance of hip fractures by almost two-fold (OR = 1.80, 95%CI 1.22–2.66). Conclusion Our study reinforces the importance of identified risk factors for hip fracture in community-dwelling older adults beyond bone mineral density and available fracture risk assessment tools. Data obtained in primary care can help physicians, other health professionals, and public health policies to identify patients at increased risk of hip fractures. mortality patientreported patient reported communitydwelling community dwelling worlddata world data 6 Gerais Brazil 1 2019 22 2022 multimorbidity, multimorbidity (multimorbidity longterm long term use falls, , selfperception self perception selfreport report problems record sex 7836 7 836 7,83 8 IQR 72–86 7286 72 86 5702 5 702 5,70 72.7% 727 (72.7% female 12 1.54% 154 54 (1.54% 112 1.12 95CI CI 95 1.06–1.18 106118 06 18 1.7fold 17fold fold 1.7 169 69 1.69 1.52–1.80. 152180 1.52–1.80 . 52 1.52–1.80) Patientreported Patient 159 59 1.59 1.06–2.37, 106237 1.06–2.37 2 37 1.06–2.37) 306 3 3.06 1.93–4.84, 193484 1.93–4.84 93 4 84 1.93–4.84) 223 23 2.23 1.47–3.40. 147340 1.47–3.40 47 40 1.47–3.40) 091 0 91 0.91 087096 87 96 0.87–0.9 093 0.93 088097 88 97 0.88–0.97 respectively, respectively respectively) twofold two 180 1.80 1.22–2.66. 122266 1.22–2.66 66 1.22–2.66) tools physicians professionals 201 202 783 83 7,8 72–8 728 570 70 5,7 72.7 (72.7 1.54 15 (1.54 11 1.1 9 1.06–1.1 10611 7fold 17 1. 16 1.6 15218 1.52–1.8 1.5 10623 1.06–2.3 30 3.0 19348 1.93–4.8 2.2 14734 1.47–3.4 09 0.9 08709 0.87–0. 08809 0.88–0.9 1.8 12226 1.22–2.6 20 78 7, 72– 57 5, 72. (72. (1.5 1.06–1. 1061 1521 1.52–1. 1062 1.06–2. 3. 1934 1.93–4. 2. 1473 1.47–3. 0. 0870 0.87–0 0880 0.88–0. 1222 1.22–2. (72 (1. 1.06–1 106 152 1.52–1 1.06–2 193 1.93–4 147 1.47–3 087 0.87– 088 0.88–0 122 1.22–2 (7 (1 1.06– 10 1.52– 19 1.93– 14 1.47– 08 0.87 0.88– 1.22– ( 1.06 1.52 1.93 1.47 0.8 0.88 1.22 1.0 1.9 1.4 1.2

ABSTRACT BACKGROUND: Osteoporosis compromises bone strength and increases the risk of fractures. Zoledronate prevents loss of bone mass and reduces the risk of fractures. OBJECTIVES: To determine the efficacy and safety of zoledronate in postmenopausal women with osteopenia and osteoporosis. DESIGN AND SETTINGS A systematic review and meta-analysis was conducted within the evidence-based health program at the Universidade Federal de São Paulo. METHODS: An electronic search of the CENTRAL, MEDLINE, Embase, and LILACS databases was performed until February 2022. Randomized controlled trials comparing zoledronate with placebo or other bisphosphonates were included. Standard methodological procedures were performed according to the Cochrane Handbook and the certainty of evidence for the Grading of Recommendations Assessment, Development, and Evaluation Working Group. Two authors assessed the risk of bias and extracted data on fractures, adverse events, bone turnover markers (BTM), and bone mineral density (BMD). RESULTS: Twelve trials from 6,652 records were included: nine compared zoledronate with placebo, two trials compared zoledronate with alendronate, and one trial compared zoledronate with ibandronate. Zoledronate reduced the incidence of fractures in osteoporotic [three years: morphometric vertebral fractures (relative risk, RR = 0.30 (95% confidence interval, CI: 0.24–0.38))] and osteopenic women [six years: morphometric vertebral fractures (RR = 0.39 (95%CI: 0.25–0.61))], increased incidence of post-dose symptoms [RR = 2.56 (95%CI: 1.80–3.65)], but not serious adverse events [RR = 0.97 (95%CI: 0.91–1.04)]. Zoledronate reduced BTM and increased BMD in osteoporotic and osteopenic women. CONCLUSION: This review supports the efficacy and safety of zoledronate in postmenopausal women with osteopenia for six years and osteoporosis for three years. PROSPERO REGISTRATION NUMBER: CRD42022309708, https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=309708. BACKGROUND OBJECTIVES metaanalysis meta analysis evidencebased based Paulo METHODS CENTRAL MEDLINE Embase 2022 included Assessment Development Group BTM, , (BTM) BMD. . (BMD) RESULTS 6652 6 652 6,65 alendronate ibandronate relative 030 0 30 0.3 95% 95 (95 interval CI 0.24–0.38 024038 24 38 0.24–0.38)) 039 39 95%CI 95CI (95%CI 0.25–0.61, 025061 0.25–0.61 25 61 0.25–0.61))] postdose post dose 256 2 56 2.5 1.80–3.65, 180365 1.80–3.65 1 80 3 65 1.80–3.65)] 097 97 0.9 0.91–1.04. 091104 0.91–1.04 91 04 0.91–1.04)] CONCLUSION NUMBER CRD42022309708 CRD https//www.crd.york.ac.uk/prospero/display_record.phpRecordID=309708. httpswwwcrdyorkacukprosperodisplayrecordphpRecordID309708 httpswwwcrdyorkacukprosperodisplayrecordphpRecordID https //www.crd.york.ac.uk/prospero/display_record.php RecordID=309708. www crd york ac uk prospero display record php RecordID 309708 https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=309708 202 (BTM (BMD 665 6,6 03 0. 9 (9 0.24–0.3 02403 0.24–0.38) 02506 0.25–0.6 0.25–0.61)) 5 2. 18036 1.80–3.6 8 1.80–3.65) 09 09110 0.91–1.0 0.91–1.04) CRD4202230970 phpRecordID https//www.crd.york.ac.uk/prospero/display_record.phpRecordID=309708 httpswwwcrdyorkacukprosperodisplayrecordphpRecordID30970 wwwcrdyorkacukprosperodisplayrecordphp RecordID309708 RecordID=309708 30970 https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=30970 20 66 6, ( 0.24–0. 0240 0250 0.25–0. 0.25–0.61) 1803 1.80–3. 0911 0.91–1. CRD420223097 https//www.crd.york.ac.uk/prospero/display_record.phpRecordID=30970 httpswwwcrdyorkacukprosperodisplayrecordphpRecordID3097 RecordID30970 RecordID=30970 3097 https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=3097 0.24–0 024 025 0.25–0 180 1.80–3 091 0.91–1 CRD42022309 https//www.crd.york.ac.uk/prospero/display_record.phpRecordID=3097 httpswwwcrdyorkacukprosperodisplayrecordphpRecordID309 RecordID3097 RecordID=3097 309 https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=309 0.24– 02 0.25– 18 1.80– 0.91– CRD4202230 https//www.crd.york.ac.uk/prospero/display_record.phpRecordID=309 httpswwwcrdyorkacukprosperodisplayrecordphpRecordID30 RecordID309 RecordID=309 https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=30 0.24 0.25 1.80 0.91 CRD420223 https//www.crd.york.ac.uk/prospero/display_record.phpRecordID=30 httpswwwcrdyorkacukprosperodisplayrecordphpRecordID3 RecordID30 RecordID=30 https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=3 0.2 1.8 CRD42022 https//www.crd.york.ac.uk/prospero/display_record.phpRecordID=3 RecordID3 RecordID=3 https://www.crd.york.ac.uk/prospero/display_record.php?RecordID= 1. CRD4202 https//www.crd.york.ac.uk/prospero/display_record.phpRecordID= RecordID= https://www.crd.york.ac.uk/prospero/display_record.php?RecordID CRD420 https//www.crd.york.ac.uk/prospero/display_record.phpRecordID CRD42 CRD4

Abstract Clinical practice guidelines (CPG) are developed to align standards of health care around the world, aiming to reduce the incidence of misconducts and enabling more effective use of health resources. Considering the complexity, cost, and time involved in formulating CPG, strategies should be used to facilitate and guide authors through each step of this process. The main objective of this document is to present a methodological guide prepared by the Epidemiology Committee of the Brazilian Society of Rheumatology for the elaboration of CPG in rheumatology. Through an extensive review of the literature, this study compiles the main practical recommendations regarding the following steps of CPG drafting: distribution of working groups, development of the research question, search, identification and selection of relevant studies, evidence synthesis and quality assessment of the body of evidence, the Delphi methodology for consensus achievement, presentation and dissemination ofthe recommendations, CPG quality assessment and updating. This methodological guide serves as an important tool for rheumatologists to develop reliable and high-quality CPG, standardizing clinical practices worldwide. (CPG world resources complexity cost process rheumatology literature drafting groups question search studies achievement updating highquality high worldwide

Abstract Objective: To identify and assess the current evidence available about the costs of managing hospitalized pediatric patients diagnosed with Respiratory Syncytial Virus (RSV) and Parainfluenza Virus Type 3 (PIV3) in upper-middle-income countries. Methods: The authors conducted a systematic review across seven key databases from database inception to July 2022. Costs extracted were converted into 2022 International Dollars using the Purchasing Power Parity-adjusted. PROSPERO identifier: CRD42020225757. Results: No eligible study for PIV3 was recovered. For RSV, cost analysis and COI studies were performed for populations in Colombia, China, Malaysia, and Mexico. Comparing the total economic impact, the lowest cost per patient at the pediatric ward was observed in Malaysia ($ 347.60), while the highest was in Colombia ($ 709.66). On the other hand, at pediatric ICU, the lowest cost was observed in China ($ 1068.26), while the highest was in Mexico ($ 3815.56). Although there is no consensus on the major cost driver, all included studies described that the medications (treatment) consumed over 30% of the total cost. A high rate of inappropriate prescription drugs was observed. Conclusion: The present study highlighted how RSV infection represents a substantial economic burden to health care systems and to society. The findings of the included studies suggest a possible association between baseline risk status and expenditures. Moreover, it was observed that an important amount of the cost is destinated to treatments that have no evidence or support in most clinical practice guidelines. Objective (RSV PIV (PIV3 uppermiddleincome upper middle income countries Methods 202 Parityadjusted. Parityadjusted Parity adjusted. adjusted Parity-adjusted identifier CRD42020225757 CRD Results recovered impact $ ( 347.60, 34760 347.60 , 347 60 347.60) 709.66. 70966 709.66 . 709 66 709.66) hand ICU 1068.26, 106826 1068.26 1068 26 1068.26) 3815.56. 381556 3815.56 3815 56 3815.56) driver treatment (treatment 30 Conclusion society expenditures Moreover guidelines (PIV 20 CRD4202022575 3476 347.6 34 6 7096 709.6 70 10682 1068.2 106 2 38155 3815.5 381 5 CRD420202257 347. 709. 7 1068. 10 3815. 38 CRD42020225 1 CRD4202022 CRD420202 CRD42020 CRD4202 CRD420 CRD42 CRD4

Abstract Sjogren's syndrome (SS) is an autoimmune disease characterized by lymphocytic infiltration of the exocrine glands and other organs, associated with sicca syndrome but also with systemic involvement with varying degrees of severity. Despite their importance, some systemic manifestations, mainly liver, gastrointestinal, and pancreatic are not routinely evaluated. To address these manifestations, the Sjögren's Syndrome Committee of the Brazilian Society of Rheumatology conducted a broad systematic review of the literature on studies investigating prevalence and diagnosis of these symptoms in Sjogren´s patients and made recommendations based on the findings. Agreement between the experts was achieved using the Delphi method. This is the second part of this guideline, providing 6 recommendations for liver, gastrointestinal, and pancreatic care of SS patients.

Abstract Sjogren’s Syndrome (SS) is an autoimmune disease characterized by lymphocytic infiltration of the exocrine glands and other organs, associated with sicca syndrome but also with systemic involvement with varying degrees of severity. Despite their importance, these systemic manifestations are not routinely evaluated and there is no homogenous approach to their diagnosis or evaluation. To close this gap, a panel of experts from the Brazilian Society of Rheumatology conducted a systematic review and meta-analysis on the identification of epidemiologic and clinical features of these manifestations and made recommendations based on the findings. Agreement between the experts was achieved using the Delphi method. The first part of this guideline summarizes the most important topics, and 11 recommendations are provided for the articular, pulmonary, and renal care of SS patients.

Abstract Sjogren’s syndrome (SS) is an autoimmune disease characterized by lymphocytic infiltration of the exocrine glands and other organs. Women with SS often experience gynecological symptoms due to the disease and need extra care regarding their sexual activity, reproductive health and during pregnancy, conditions that are not properly conducted in the clinical practice. To cover this gap, a panel of experts from the Brazilian Society of Rheumatology conducted a systematic review and meta-analysis on the identification of symptoms, diagnosis, monitoring, prognosis, and treatment of these manifestations. A Focus Group meeting was held and included experts in the field and methodologists, based on a previously developed script, with themes related to the objective of the study. The most important topics were summarized and 11 recommendations were provided.

ABSTRACT BACKGROUND: Patients with immune-mediated inflammatory diseases (IMID) are at increased risk of infection. OBJECTIVE: To assess whether patients undergoing pharmacological treatment for IMID present higher risk of worse outcomes when diagnosed with COVID-19. DESIGN AND SETTING: Rapid systematic review conducted in the medical school of the Federal University of São Paulo (SP), Brazil. METHODS: We searched CENTRAL, MEDLINE, EMBASE, LILACS, SCOPUS, Web of Science, L·OVE, ClinicalTrials.gov and WHO-ICTRP for studies evaluating patients diagnosed with COVID-19 who were undergoing pharmacological treatment for IMID. Two authors selected studies, extracted data and assessed risk of bias and certainty of evidence, following the Cochrane recommendations. RESULTS: We identified 1,498 references, from which one cohort study was included. This compared patients with and without rheumatic diseases (RD) who all had been diagnosed with COVID-19. Those with RD seemed to have higher chances of hospitalization and mortality, but no statistical difference was detected between the groups: hospitalization: odds ratio (OR) 1.17; 95% confidence interval (CI) 0.6 to 2.29; mortality rate: OR 1.53; 95% CI 0.33 to 7.11 (very low certainty of evidence). Patients with RD were three times more likely to require admission to intensive care units (ICUs), with invasive mechanical ventilation (IMV), than those without RD: OR 3.72; 95% CI 1.35 to 10.26 (for both outcomes; very low certainty of evidence). CONCLUSION: Patients undergoing pharmacological treatment for IMID seem to present higher chances of requiring admission to ICUs, with IMV. Additional high-quality studies are needed to analyze the effects of different treatments for IMID.

ABSTRACT BACKGROUND: The numbers of cases of arboviral diseases have increased in tropical and subtropical regions while the coronavirus disease (COVID-19) pandemic overwhelms healthcare systems worldwide. The clinical manifestations of arboviral diseases, especially dengue fever, can be very similar to COVID-19, and misdiagnoses are still a reality. In the meantime, outcomes for patients and healthcare systems in situations of possible syndemic have not yet been clarified. OBJECTIVE: We set out to conduct a systematic review to understand and summarize the evidence relating to clinical manifestations, disease severity and prognoses among patients coinfected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and arboviruses. METHODS: We conducted a rapid systematic review with meta-analysis, on prospective and retrospective cohorts, case-control studies and case series of patients with confirmed diagnoses of SARS-CoV-2 and arboviral infection. We followed the Cochrane Handbook recommendations. We searched EMBASE, MEDLINE, Cochrane Library, LILACS, Scopus and Web of Science to identify published, ongoing and unpublished studies. We planned to extract data and assess the risk of bias and the certainty of evidence of the studies included, using the Quality in Prognosis Studies tool and the Grading of Recommendations Assessment. RESULTS: We were able to retrieve 2,407 citations using the search strategy, but none of the studies fulfilled the inclusion criteria. CONCLUSION: The clinical presentations, disease severity and prognoses of patients coinfected with SARS-CoV-2 and arboviruses remain unclear. Further prospective studies are necessary in order to provide useful information for clinical decision-making processes. Protocol registration number in the PROSPERO database: CRD42020183460

Context and objective: While cases of COVID-19 disease increase daily worldwide, outbreaks of arboviral infections have affected health systems of countries in tropical regions. The outcomes for patients and health systems of a possible syndemic are not clarified yet. Thus, we aim to systematically review the literature searching for evidence that describes the clinical presentation, severity and prognostic of SARS-CoV-2 and Arboviral coinfection. Design and setting: Protocol for a rapid living systematic review, that will follow the Cochrane Handbook for Systematic Reviews recommendations. We will include prospective and retrospective cohort, case-control studies and case series of patients with confirmed diagnosis of SARS-CoV-2 and Arboviral infection. We will perform the search strategy with no language restrictions on Medline via PubMed, Embase via Elsevier, Cochrane Library - Cochrane Central Register of Controlled Trials (CENTRAL), Portal Regional BVS - LILACS, Scopus and WebOfScience to identify published, ongoing, and unpublished studies. The selection and extraction will be performed by two authors. We will perform the critical appraisal of included studies with the Newcastle-Ottawa Scale and the certainty of evidence will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE).    

CONTEXT AND OBJECTIVE: The current health crisis due to COVID-19 is forcing us to profoundly rethink our social organizations and practices in health. While there is no effective treatment for the virus, staying home and social isolation are the control measures recommended by health authorities. The aim of this study is to perform a scoping review in order to summarize the current evidence in telehealth for COVID-19. METHODS: This study is a protocol to describe the rationale, hypothesis and planned methods of our scoping review. We will include randomized controlled trials (RCTs), observational cohort studies, case-control studies, cross-sectional studies, qualitative studies, and/or case series that describe telehealth interventions applied or developed to respond to COVID-19. We will search Medline via PubMed, Embase via Elsevier, Cochrane Library - Cochrane Central Register of Controlled Trials (CENTRAL), Portal Regional BVS - LILACS, and Scopus. We will include studies performed since December 2019 with no language restrictions. We will use the Risk of Bias tool and the Newcastle-Ottawa Scale to perform the critical appraisal of included studies. We will assess the certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE).

CONTEXT AND OBJECTIVE: Coronavirus disease 2019 (COVID-19) has emerged in China in December 2019 and rapidly spread. Although extraordinary efforts have been made on research regarding pharmacological interventions, none have proven effective. This is the protocol for a rapid living systematic review that aims to compare the effectiveness and safety of different pharmacological interventions for the treatment of COVID-19. METHODS: rapid living systematic review methodology with Network Meta-Analysis following the recommendations of Cochrane Handbook. We will include randomized controlled trials (RCT) and quasi-RCTs that evaluate single and/or combined pharmacological interventions at any dose for the treatment of COVID-19. We will search Medline via PubMed, Embase via Elsevier, Cochrane Library - Cochrane Central Register of Controlled Trials (CENTRAL), Portal Regional BVS - LILACS, Scopus and WebofScience to identify potentially eligible studies. No language restrictions will be used in the selection. We will perform the critical appraisal of included studies with the Risk of Bias tool and the certainty of evidence will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE).

CONTEXT AND OBJECTIVE: Determining prognostic factors in a context of health crises such as the COVID-19 scenario may provide the best possible care for patients and optimize the management and the resource utilization of the health system. Thus, we aim to systematically review the prognostic factors for different outcomes of patients with COVID-19. DESIGN AND SETTING: Protocol for a rapid living systematic review methodology following the recommendations proposed by the Cochrane Handbook. METHODS: We will include cohorts and case‐control studies. We will search Medline via PubMed, Embase via Elsevier, Cochrane Library - Cochrane Central Register of Controlled Trials (CENTRAL), Portal Regional BVS- LILACS, Scopus and WebofScience to identify studies. No language restrictions will be applied. We will perform the critical appraisal of included studies with the Quality in Prognosis Studies (QUIPS) tool and the certainty of evidence will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE).

CONTEXT AND OBJECTIVE: We propose to systematically review the available evidence to evaluate if patients with immune mediated or inflammatory diseases under pharmacological treatment with immunosuppressants, immunobiologics, DMARDs or targeted synthetic DMARDs have better or worse outcomes when infected by SARS-CoV-2. This study is a protocol for our rapid living systematic review. METHODS: Protocol for a rapid living systematic review methodology following the preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) guidance. To conduct the rapid systematic review, we will employ abbreviated systematic review methods, including: not performing independent screens of abstracts and not searching grey literature. As this will be a living review, it will be continuously updated.