Abstract This study evaluated the construct validity of the instrument Oral Health Literacy among diabetics. A probabilistic random sample of 239 diabetics from an infinite population answered the 10 items of the questionnaire. The structural validity was assessed by confirmatory factor analysis and goodness of fit, chi-square per degrees of freedom ratio (X2/df), comparative fit index (CFI), goodness-of-fit index (GFI), and root-mean-square error of approximation (RMSEA). Internal consistency was estimated by the average variance extracted (AVE) and composite reliability (CR). The scores were dichotomized with the upper limit of the 95% confidence interval as the cutoff point. The three-dimensional model presented good quality parameters (X2 /df = 2.459; CFI = 0.988; TLI = 0.981) and poor RMSEA (0.078). Internal consistency was adequate; AVE for the Access, Understand/appraise, and Apply subscales were 0.831, 0.981, and 0.954 and the CR for these subscales were 0.893, 0.962, and 0.822, respectively. Inadequate literacy ranged from 41.8 to 48.1%. The three-dimensional model identified (access, understand/appraise, and apply) showed structural validity, good internal consistency, and understandability.

ABSTRACT Objective: The occurrence of partial remission (honeymoon phase) in type 1 diabetes (T1D) has been associated with a reduced risk of chronic microvascular complications of diabetes. We have published case reports showing that a combination therapy with the DPP-4 inhibitor sitagliptin plus vitamin D3 (VIDPP-4i) can prolong the honeymoon phase in patients with new-onset T1D. In the present case-control study, we investigated the frequency of occurrence of clinical remission (CR) in patients with new-onset T1D after VIDPP-4i treatment. Subjects and methods: In this case-control study, we collected data spanning 10 years from medical records of 46 patients (23 females) recently diagnosed with T1D. Overall, 27 participants with CR (insulin dose-adjusted glycated hemoglobin [IDAA1c] ≤ 9) at 12 or 24 months composed the case group, and 19 participants without CR served as the control group. Chi-square with Yates correction was used to analyze the association between VIDPP-4i use and CR, and odds ratio (OR) was used to determine the chance of CR due to VIDPP-4i treatment exposure. Results: In all, 37 patients (80.4%) experienced CR at some time over 24 months. The mean CR duration was 13.15 ± 9.91 months. Treatment with VIDPP-4i was significantly associated with CR. At 24 months, the OR of CR after VIDPP-4i exposure was 9.0 (95% confidence interval [CI] 2.21-30.18, p = 0.0036). Additionally, 9 (33.6%) and 4 (14.8%) patients in the VIDPP-4i group experienced insulin-free CR at 12 and 24 months, respectively. Conclusion: Therapy with VIDPP-4i was associated with a higher frequency and duration of the honeymoon phase. Randomized controlled trials are needed to confirm these findings.

ABSTRACT BACKGROUND: Cardiac rehabilitation (CR) barriers are well-understood in high-resource settings. However, they are under-studied in low-resource settings, where access is even poorer and the context is significantly different, including two-tiered healthcare systems and greater socioeconomic challenges. OBJECTIVE: To investigate differences in characteristics of patients attending publicly versus privately funded CR and their barriers to adherence. DESIGN AND SETTING: Observational, cross-sectional study in public and private CR programs offered in Brazil. METHODS: Patients who had been attending CR for ≥ 3 months were recruited from one publicly and one privately funded CR program. They completed assessments regarding sociodemographic and clinical characteristics and the CR Barriers Scale. RESULTS: From the public program, 74 patients were recruited, and from the private, 100. Participants in the public program had significantly lower educational attainment (P < 0.001) and lower socioeconomic status (P < 0.001). Participants in the private program had more cognitive impairment (P = 0.015), and in the public program more anxiety (P = 0.001) and depressive symptoms (P = 0.008) than their counterparts. Total barriers among public CR participants were significantly higher than those among private CR participants (1.34 ± 0.26 versus 1.23 ± 0.15/5]; P = 0.003), as were scores on 3 out of 5 subscales, namely: comorbidities/functional status (P = 0.027), perceived need (P < 0.001) and access (P = 0.012). CONCLUSION: Publicly funded programs need to be tailored to meet their patients’ requirements, through consideration of educational and psychosocial matters, and be amenable to mitigation of patient barriers relating to presence of comorbidities and poorer health status.

ABSTRACT Soils classified as Alisols are very frequent in the sedimentary agricultural areas of southern Brazil. The presence of red mottles with morphology similar to plinthite and saprolite residue is very common in these soils, and its identification can be considered a difficult task, both in the field and in the laboratory. The incorrect identification of these redoximorphic features can affect soils’ taxonomic and technical classification. We aimed to compare morphological, physical, chemical and mineralogical data to identify reddish mottles, possibly plinthites or saprolite residues, that occur in soils with high textural contrast in southern Brazil. Four soil profiles classified as Argissolos Bruno-Acinzentados (Alisols) were sampled. Matrix and mottles samples from the horizon Bt, CB, C and Cr were separated and subjected to morphological, granulometric, total sand fractionation, chemical extractions of iron and potassium and mineralogical features. Peds from each horizon were submitted to the submersion test in water for 2 and 8 hours and to 5 wetting and drying cycles. The mineralogy indicated the low degree of alteration of the samples, with abundant presence of 2:1 minerals and feldspars, even in the clay fraction. The saprolite resisted in the water submersion tests, making it difficult to interpret the results for the correct identification between plinthites and saprolite fragments. The morphological field data associated with the results of the tests of submersion in water, the cycle of wetting and drying, the dissolution of K and mineralogy, indicate the saprolithic nature of the mottles in all horizons and profiles. The submersion test in water for 2 and 8 hours was not efficient for the plinthite/saprolite identification. The cycle of wetting and drying tests allowed the identification of saprolite.

Abstract The increasing number of reports of web-based experiences on the success of Cannabis-based therapies in controlling seizures in children suffering from refractory epilepsy have led to efforts by governments and associations to a recent change in legislation. The Brazilian Health Regulatory Agency (ANVISA) allowed the import of Cannabis extracts in 2015 and the registration of the first industrialized drug in 2017. In 2019, ANVISA approved procedures for the granting of a Sanitary Authorization for manufacturing and imports, establishing marketing requirements, prescribing, dispensing, monitoring and surveillance of cannabis products for medicinal purposes. Similar to other consumer products of health concern, is necessary to ensure the quality and health safety of these products worldwide. The aim of the present study to evaluate the presence of As, Cd, Pb, Ni, Cu, Co, Cr and Mn present in Cannabis extracts and resins used in the treatment of pediatric patients with neurological diseases. Samples (48 national and 24 imported) were analyzed by Inductively Coupled Plasma Mass Spectrometry - ICP-MS. The imported extracts presented more homogeneous inorganic element values, while national extracts showed varied levels, thus indicating the highest health risk.

RESUMO Os efluentes e resíduos industriais galvânicos são uma preocupação mundial, por terem em sua composição metais-traço altamente tóxicos, prejudiciais ao meio ambiente e à saúde humana. Neste artigo, é apresentado um panorama da indústria de semijoias folheadas de Juazeiro do Norte, Ceará, considerando-se os processos de produção e a concentração de metais-traço nos efluentes, bem como o resíduo sólido galvânico, gerados pelo setor. Dados primários de produção foram obtidos em 11 empresas por meio de questionário técnico. As concentrações de metais-traço foram obtidas por espectrofotometria de absorção atômica de chama. Os resultados demonstraram ineficiência no tratamento dos efluentes para cobre, níquel, cromo, chumbo e zinco. As concentrações médias de metais no resíduo sólido galvânico foram de 239 g Cu kg-1, 99 g Zn kg-1, 23,8 g Ni kg-1, 6,6 g Pb kg-1, 0,2 g Cr kg-1, 1,7 g Cd kg-1, 1,0 g Mn kg-1 e 8,2 g Fe kg-1. Os resultados evidenciaram a necessidade da adoção de medidas para o controle de qualidade dos processos de tratamento dos efluentes, com vistas à sustentabilidade do setor.

ABSTRACT Galvanic industrial effluents and wastes are a worldwide concern, as they contain highly toxic trace metals that are harmful to the environment and human health. This article presents an overview of the clad semi jewelry industry in Juazeiro do Norte, state of Ceará, Brazil, considering the production processes and the concentration of trace metals in the effluents and galvanic sludge waste generated by the sector. Primary production data were obtained from 11 companies by a technical questionnaire. Trace metal concentrations were obtained by flame atomic absorption spectrophotometry. The results showed inefficiency in the treatment of effluents for copper, nickel, chrome, lead, and zinc. The average metal concentrations in the galvanic sludge waste were 239 g Cu kg-1, 99 g Zn kg-1, 23.8 g Ni kg-1, 6.6 g Pb kg-1, 0.2 g Cr kg-1, 1.7 g Cd kg-1, 1.0 g Mn kg-1, and 8.2 g Fe kg-1. The results evidenced the need for adopting measures concerning quality control of the effluent treatment processes aiming at the sustainability of the sector.

ABSTRACT Chromium contamination in soils affects plant growth and this metal can accumulate in plants tissues. In addition, Cr can affect soil microbial biomass and activity. On the other hand, plant growth-promoting rhizobacteria (PGPR) can protect plants against metals and, at the same time, promote plant growth and could alleviate adverse effects on microbial biomass. This study evaluated five PGPR on maize growth, Cr accumulation and soil microbial biomass in a Cr-contaminated soil. Five PGPR (LCC04, LCC41, LCC69, LCC81 and IPA403), isolated from soil under permanent application of composted tannery sludge and contaminated with Cr, were inoculated in maize plants grown in soils with (+Cr) and without (–Cr) Cr. In Cr-contaminated soil, LCC41 promoted the highest growth of maize, while LCC04 contributed with the highest N accumulation. The shoots of maize accumulated less Cr with LCC81, while LCC41 contributed to the highest Cr accumulation in roots. The translocation of Cr was highest with IPA403, while LCC81 contributed to reduce Cr translocation. In conclusion, LCC41 and LCC81 could be effective as PGPR inoculants to promote plant growth and reduce Cr accumulation in maize, respectively, in Cr contaminated soil.

RESUMO Objetivo Analisar a rugosidade superficial e a estabilidade da cor da resina composta após tratamento de superfície com os discos de óxido de alumínio e posterior exposição à fita clareadora Advanced Teeth Whitening Strips. Métodos Foram confeccionados 20 corpos de prova do restaurador universal Filtek Z350XT (3M®), estes, foram submetidos ao clareamento caseiro por 30 minutos diários durante 14 dias. Utilizou-se um rugosímetro de precisão para verificação da rugosidade através de 3 leituras aleatórias no mesmo sentido em cada amostra, e para estabilidade de cor foi utilizado o sistema CIELAB (valores L*, a*, b*), através do espectofotômetro (MINOLTA CR-321, Japão). As leituras coletadas possibilitaram o cálculo das médias dos corpos de prova e a média de cada grupo. Em seguida, os dados foram submetidos a tratamento estatístico pela análise de variância ANOVA. O nível de significância estabelecido foi de 5% (p≤0,05). Resultados a rugosidade não sofreu grandes variações numéricas e também não houve diferença estatisticamente significantes entre as médias obtidas em relação a rugosidade superficial da resina composta (p=0,44). Contudo, verificou-se que houve diferenças estatisticamente significantes entre as medias obtidas em relação à estabilidade de cor da resina composta, com p= 0,007. Conclusão As fitas pré-contornadas contendo peróxido de hidrogênio a 6% não provocam efeito adverso significantes sobre a rugosidade da resina Z350XT (3M®). Contudo, também concluímos que, de acordo com a análise de estabilidade de cor realizada, poderá haver indicação da substituição das restaurações após o tratamento clareador devido à alteração na coloração das mesmas.

ABSTRACT Objective to analyze the surface roughness and color stability of the composite resin after surface treatment with the aluminum oxide discs and subsequent exposure to the Advanced Teeth Whitening Strips. Methods 20 specimens of the Filtek Z350XT restorer (3M®) were prepared and daily subjected to home bleaching for 30 minutes during 14 days. A precision rugosimeter was used in order to verify the roughness by means of 3 random readings in the same direction in each sample. For color stability the CIELAB system (L*, a*, b* values) was used through the spectrophotometer (MINOLTA CR -321, Japan). The means of the test specimens as well as the mean of each group were calculated using the random readings. Data statistical analysis were performed by ANOVA- analysis of variance. The level of significance was set at 5% (p ≤ 0.05). Results Roughness did not present great numerical variations. No statistically significant difference between the means obtained concerning the surface roughness of the composite resin with p = 0.44 was observed. However, it was found that there was a statistically significant difference between the means obtained in relation to the color stability of the composite resin, p=0. 007. Conclusion It was concluded that pre-contoured strips containing 6% hydrogen peroxide do not have a significant adverse effect on the roughness of Z350XT (3M®) resin. However, it was also concluded that according to the color stability analysis performed, there may be an indication of the restoration replacement after the bleaching treatment, due to their color change.

ABSTRACT. Crambe is an oilseed plant producing oil that can be used for various industrial purposes, including the production of biofuel. It is a short-cycle, non-food plant that can be grown as a second crop following soybean or corn crops and using the same agricultural machinery. This work aimed to estimate genetic parameters and correlations between traits of genotypes grown for two years in seven locations in two Brazilian states. The cultivar FMS Brilhante and the lines CR 1101, CR 1102, CR 1105, CR 1202, CR 1303, and CR 1304 were used. The traits evaluated were grain yield (YD), plant height (PH), stem diameter (SD), first fruiting branch height (BH), 1,000-seed weight (SW), and number of branches (NB). The correlations between traits were identified from the phenotypic covariance matrix through path analysis. Based on the joint analysis, the interaction of genotypes x years x locations was observed. Expressive genetic variability was verified for all evaluated traits, which allows gains to be made with the selection of genotypes. High broad-sense heritabilities based on plot means were verified for YD, BH, and SW (82, 84 and 77%, respectively), which indicates the possibility of directly selecting them. SW and SD showed the greatest direct effects and strongest correlations with YD.

The present study evaluated the concentrations of Total Suspended Particles (TSP) and associated metals in three distinct regions of Ribeirão Preto city (Center City, Campus and Airport) in the dry and rainy seasons. There were no significant differences (p < 0.05) in TSP and metals concentrations between the sampling sites, except for Cu, Cr and Zn. Seasonal variation was observed for TSP and the following associated metals: As, Be, Cu, Mn, Ni, Pb, Sn and V, being the highest concentrations observed in the dry period. The TSP concentrations did not exceed the air quality standards in São Paulo state, but these can cause harm to the population health, especially in the dry season. Cadmium was the only element that exceeded the WHO air quality guidelines in two consecutive samplings in the Center City and the Airport during the dry season. In this way, preventive measures should be taken through public policies to improve local air quality control and reduce the health risks to the population.

The objective of this study was to evaluate the concentration of Cu, Zn, Cr and Pb in different species of fish collected in the estuarine and limnic regions of the São Gonçalo channel, located in the Patos-Mirim lagoon complex in the coastal plain of Rio Grande do Sul State (Southern Brazil) during 2013 (autumn, winter and spring) and 2014 (summer). Fish samples were decomposed in a digester block with a reflux system under conditions optimized using a central composite design as it follows: 250 mg of fish sample, 5 mL HNO3, 2 mL H2O2 during 2 h at 150 °C. The concentrations obtained ranged from 6.7 to 12.0 mg kg -1 for Cu; 1.8 to 23.6 mg kg -1 for Zn; 37 to 487 µg kg -1 for Pb; and 40 to 1268 µg kg -1 for Cr. The highest concentrations of Cu, Zn and Pb, were observed in fishes collected at locations in the estuarine region and Cr showed high levels, especially in the limnic region. The samples of the species Loricariichthys anus (viola) showed the highest concentrations of all analytes investigated.

RESUMO Os processos de adsorção podem ser empregados no tratamento de efluentes líquidos contendo metais pesados visando a reduzir os danos ambientais. Porém, o alto custo dos materiais adsorventes justifica a aplicação de adsorventes alternativos, como a fibra de coco (FC) e a quitosana (Q). Assim, este trabalho teve como objetivo desenvolver compósitos porosos adsorventes a partir da mistura de polietileno graftizado com anidrido maleico/FC/Q/NaCl, como agente porogênico (PE-g-MA/FC/Q/NaCl), e avaliar estatisticamente a capacidade de adsorção do cromo (III) em solução, com auxílio do software Statistica 5.0®. Os resultados mostraram que a eficiência do processo sofreu influência das dimensões da FC, do teor de Q e do pH da solução contendo Cr (III). A capacidade máxima de remoção de Cr (III) por unidade de massa do compósito foi de 42,28 mg.g-1.

ABSTRACT Adsorption processes can be employed in the treatment of wastewater containing heavy metals to reduce environmental damage. However, the high cost of adsorbent materials justifies the application of alternative adsorbents, such as coconut fiber (CF) and chitosan (C). Thus, this study aimed to develop porous composite adsorbents from the mixture of grafted maleic anhydride polyethylene/CF/C/NaCl, as porogen agent (PE-g-MA/CF/C/NaCl), and evaluate statistically adsorption capacity of chromium (III) solution, with the aid of software Statistica 5.0®. The results showed that the process efficiency was influenced by the size of the CF, the content of C and the pH of the solution containing Cr (III). The maximum removal capacity of Cr (III) per unit mass of the composite was 42.28 mg.g-1.

RESUMO A incorporação da matéria orgânica é usada no manejo de doenças causadas por patógenos habitantes do solo, mas existe uma lacuna no uso de resíduos de café na supressão de doenças. O objetivo deste estudo foi avaliar o efeito de fontes de matéria orgânica contra a podridão radicular da mandioca, causada por Fusarium solani CFF 109. A fertilização com resíduo de café (CR), esterco bovino (CM), húmus de minhoca (EE) e esterco caprino (GM) resultou na supressão da podridão radicular da mandioca. Os tratamentos CR e CM apresentaram alta redução na severidade da doença em mandioca. Houveram mudanças na estrutura da comunidade microbiana do solo pela incorporação de matéria orgânica, principalmente na população de fungos totais e bactérias Gram-negativa. O carbono orgânico total e magnésio são negativamente associados com a severidade da doença. O quociente microbiano, fosfatases alcalina e ácida foram positivamente e o biomarcador a-15:0 foi negativamente associado com a severidade da doença. Este estudo indica que resíduos agroindustriais podem ser reciclados para fornecer matéria orgânica e nutrientes com efeito para o manejo de doenças de plantas por suprimir patógenos habitantes do solo. Esta é a primeira evidência que o resíduo da indústria de café pode ser usado no manejo da podridão radicular da mandioca, causado por F. solani.

ABSTRACT The incorporation of organic matter has been used to manage of diseases caused by soilborne pathogen, but there is a gap in the use of coffee residues on disease supressiveness. The objective of this study was to evaluate the effect of organic matter sources against cassava root rot caused by F. solani CFF109. Fertilization with coffee residue (CR), cattle manure (CM), earthworm excrements (EE) and goat manure (GM) resulted in suppression of cassava root rot. The treatments of CR and CM presented higher reduction in the cassava disease severity. There were changes in the soil microbial community structure by organic matter incorporation, mainly in total fungi and Gram-negative bacteria populations. The total organic carbon and magnesium are negatively associated with disease severity. The microbial quotient, alkaline and acid phosphatase activities were positively and the biomarker a-15:0 was negatively associated with disease severity. This study indicated that agro-industrial residues can be recycled for providing organic matter and nutrients with effect for management of plant diseases by suppressing soilborne pathogens. This is the first evidence that the industrial residue of coffee can be use in the management of cassava root rot, caused by F. solani.

Resumo O objetivo do estudo foi avaliar as condições fisico-químicas e microbiológicas do Córrego do Tanquinho, localizado em área altamente urbanizada e industrializada no município de Ribeirão Preto, SP, Brasil, considerando variações espaciais e temporais. Os parâmetros limnológicos avaliados foram: pH, temperatura, turbidez, condutividade e oxigênio dissolvido (OD), com medições realizadas in situ. Os níveis de metais no sedimento e em água superficial foram analisados por Espectrofotometria de Absorção Atômica. Para a determinação dos Coliformes Totais e Escherichia coli foi empregada a técnica dos Tubos Múltiplos com utilização de substrato cromogênico. Os parâmetros OD, E. coli e a concentração dos metais Cu e Mn na água encontram-se em desacordo com a legislação. Os metais encontrados em maior concentração no sedimento foram Mn, Cr e Zn. A avaliação microbiológica evidenciou o despejo de esgoto doméstico no córrego e as concentrações de metais indicam a possível ocorrência de efluentes industriais, podendo gerar graves problemas de saúde pública. O diagnóstico espacial indicou os locais de amostragem com as piores condições microbiológicas e altas concentrações de metais, enquanto que a influência temporal foi observada no pH, Mn e Cr em água superficial, e Mn, Cr e Pb nos sedimentos. Os resultados mostraram que o Córrego do Tanquinho é um corpo hídrico impactado. Recomenda-se a realização de outros estudos que possam esclarecer melhor a origem das cargas poluidoras, além da conscientização da população e da adoção de medidas que possibilitem a recuperação e proteção desse corpo hídrico.

Abstract The aim of the study was to evaluate the physico-chemical and microbiological conditions of Tanquinho's Stream, located in a highly urbanized and industrialized area in Ribeirão Preto, SP, Brazil, taking into account spatial and temporal variations. The following limnological parameters were evaluated: pH, temperature, turbidity, conductivity and dissolved oxygen (DO), with measurements in situ. Metal levels in sediment and surface water were analyzed by Atomic Absorption Spectrometry. The Multiple Tubes technique with chromogenic substrate was used to determine Total Coliforms and Escherichia coli. The parameters of DO, E. coli and the concentration of Cu and Mn in the water are not in accordance with national legislation. The metals found in higher concentrations in the sediment were Mn, Cr and Zn. The microbiological evaluation showed sewage discharges into the stream and the metal concentrations indicate possible industrial effluents, which may cause serious public health problems. The spatial diagnosis indicated the sampling sites with the worst microbiological conditions and high concentrations of metals, while the temporal influence was observed in the pH, Mn and Cr in surface water, and Mn, Cr and Pb in the sediments. The results indicate that Tanquinho's Stream is an impacted water body. It is recommended that further studies be conducted to clarify the source of pollutants and to assess the degree of public awareness, and that measures be adopted to ensure the recovery and protection of this water body.

RESUMO Introdução: A presença do anti-CCP constitui importante ferramenta prognóstica da artrite reumatoide (AR), mas ainda se investiga sua relação com a atividade da doença e a a capacidade funcional. Objetivos: Estudar a relação do anti-CCP com os índices de atividade da doença, de capacidade funcional e de dano estrutural, por meio de radiografia convencional (RC) e de ressonância magnética (RM), em AR estabelecida. Métodos: Estudo transversal com pacientes com AR, com um a 10 anos de doença. Os participantes foram submetidos à avaliação clínica com pesquisa do anti-CCP. A atividade de doença foi avaliada por meio do Clinical Disease Activity Index (CDAI) e a capacidade funcional por meio do Health Assessment Questionnaire (HAQ). A análise da RC foi feita pelo índice de Sharp van der Heijde (SmvH) e da RM pelo Sistema de Pontuação de Imagem por Ressonância Magnética na Artrite Reumatoide (RAMRIS, Rheumatoid Arthritis Magnetic Resonance Image Scoring). Resultados: Foram avaliados 56 pacientes, com mediana (IIq) de 55 (47,5-60,0) anos, 50 (89,3%) do sexo feminino e 37 (66,1%) anti-CCP positivos. As medianas (IIq) do CDAI, do HAQ, de SmvH e do RAMRIS foram de 14,75 (5,42-24,97), 1,06 (0,28-1,75), 2 (0-8) e 15 (7-35), respectivamente. Não houve associação do anti-CCP com o CDAI, com o HAQ e com os escores SmvH e RAMRIS. Conclusão: Nossos resultados não estabeleceram a associação do anti-CCP com a gravidade da doença. Até o momento, não podemos corroborar o anti-CCP como uma ferramenta prognóstica em AR estabelecida.

ABSTRACT Introduction: The presence of anti-CCP is an important prognostic tool of rheumatoid arthritis (RA). But research is still ongoing on its relationship with disease activity and functional capacity. Objectives: To study the relationship between anti-CCP and disease activity, functional capacity and structural damage indexes, by means of conventional radiography (CR) and magnetic resonance imaging (MRI), in cases of established RA. Methods: Cross-sectional study with RA patients with 1–10 disease duration. Participants underwent clinical evaluation with anti-CCP. Disease activity was assessed using the Clinical Disease Activity Index (CDAI), and functional capacity through the Health Assessment Questionnaire (HAQ). CR analysis was carried out by the Sharp van der Heijde index (SvdH), and MRI analysis by RAMRIS (Rheumatoid Arthritis Magnetic Resonance Image Scoring). Results: We evaluated 56 patients, with a median (IqR) age of 55 (47.5–60) years; 50 (89.3%) participants were female and 37 (66.1%) were positive for anti-CCP. Medians (IqR) of CDAI, HAQ, SvdH and RAMRIS were 14.75 (5.42–24.97) 1.06 (0.28–1.75), 2 (0–8) and 15 (7–35), respectively. There was no association between anti-CCP and CDAI, HAQ and SvdH and RAMRIS scores. Conclusion: Our results have not established an association of anti-CCP with the severity of disease. To date, we cannot corroborate anti-CCP as a prognostic tool in patients with established RA.