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 BACKGROUND: Advanced age, multiple chronic diseases and frailty have been correlated with worse prognosis among coronavirus disease 2019 (COVID-19) inpatients. OBJECTIVE: To investigate potential risk factors for hospitalization and death due to COVID-19 among frail community-dwelling elderly people. DESIGN AND SETTING: Retrospective cohort study of patients followed up at a geriatric outpatient clinic in Belo Horizonte, Minas Gerais, Brazil. METHODS: The associations of demographic characteristics (age and sex) and clinical characteristics (frailty, multimorbidity, number of medications with long-term use, obesity, smoking, diabetes mellitus, pulmonary diseases, cardiovascular diseases, cerebrovascular disease, and chronic kidney disease) with the risk of hospitalization and death due to COVID-19 were explored using a multivariable logistic regression model. RESULTS: 5,295 patients (mean age 78.6 ± 9.4 years; 72.6% females) were included. After adjustments, the number of medications with long-term use was found to increase the odds of hospitalization due to COVID-19 (odds ratio, OR: 1.13; 95% confidence interval, CI: 1.06-1.22). Frailty, multimorbidity and diabetes mellitus also increased the odds of hospitalization (OR: 1.06, 95% CI: 1.02-1.09; OR: 1.17, 95% CI: 1.09-1.26; and OR: 2.27, 95% CI: 1.45-3.54, respectively) and the odds of death due to COVID-19 (OR: 1.07, 95% CI: 1.00-1.14; OR: 1.16, 95% CI: 1.03-1.32; and OR: 2.69, 95% CI: 1.79-6.14, respectively). CONCLUSIONS: Multimorbidity, frailty and diabetes mellitus increased the odds of hospitalization and death due to COVID-19 and the number of medications with long-term use increased the odds of hospitalization due to COVID-19 among frail community-dwelling elderly people.

ABSTRACT This study aimed to retrospectively evaluate a cohort of patients with prostate cancer and persistent urinary incontinence after radical prostatectomy. From January 2004 to December 2015, eighty-six individuals were identified to have received an AUS implant, provided by a private nonprofit HMO operating in Belo Horizonte, Brazil. On total, there were 91 AUS implants, with a median interval between radical prostatectomy and AUS implant of 3.6 years (IQR 1.9 to 5.5). The rate of AUS cumulative survival, after a median follow-up of 4.1 years (IQR 1.7-7.2 years), was 44% (n=40). The median survival of AUS implants was 2.9 years (IQR 0.5-7.9 years). Thirty-seven AUS implants (40.7%) resulted in grade III surgical complications. There were 5 deaths at 2.1, 4.7, 5.7, 5.7 and 6.5 years of follow-up, but none due to causes directly associated to the AUS implant. Persistent severe incontinence was documented in 14 (15.3%) additional patients. From the 51 AUS implants which resulted in grade III surgical complications or persistent severe incontinence, 24 (47.1%) underwent surgical revisions. Explantation of the sphincter or its components was observed in 6 cases (25.0%). Mechanical failure, described as fluid loss and/or inability to recycle the AUS device, was observed in 4 devices (16.7%). In conclusion, although AUS implants are recommended as the gold-standard treatment of severe urinary incontinence after prostatectomy, the observed high rates of malfunction and grade III adverse events are a matter of concern warranting further assessment on the safety and efficacy of these devices.

OBJETIVO: Determinar a frequência das glomerulonefrites nos pacientes espondiloartríticos acompanhados em Serviço de Reumatologia Brasileiro e avaliar variáveis clínicas correlacionadas. PACIENTES E MÉTODOS: Os pacientes foram avaliados quanto às características sociodemográfi cas, tipo de espondiloartrite, tempo e atividade da doença, uso de anti-infl amatórios não esteroides, presença do HLA-B27, níveis de creatinina e ureia séricas, presença de comorbidades e presença de hematúria e/ou proteinúria. Os pacientes com hematúria foram submetidos à pesquisa de dismorfi smo eritrocitário, e aqueles com proteinúria submeteram-se à quantifi cação da proteína na urina de 24 horas. Biópsia renal foi indicada para aqueles com hematúria de origem glomerular e/ou proteinúria maior que 3,5 g. RESULTADOS: Foram avaliados 76 pacientes. A alteração mais frequente no exame de urina de rotina foi a hematúria microscópica (44,7%), geralmente intermitente e em amostra isolada de urina durante o seguimento do paciente. Em oito (10,5%) dos pacientes a hematúria sugeriu origem glomerular. A biópsia renal foi realizada em cinco deles, e mostrou nefropatia por IgA em quatro (5,3%) e doença da membrana fi na em um paciente. CONCLUSÕES: Notou-se alta frequência de alterações no exame de urina desse subgrupo de pacientes, assim como alta prevalência de nefropatia por IgA. Apesar de mais estudos sobre o assunto serem necessários para melhor esclarecimento desses resultados, a realização periódica de exames de urina deveria ser recomendável.

OBJECTIVE: To determine the frequency of glomerulonephritis in patients with spondyloarthritis followed-up at a Brazilian Rheumatology Service, and to evaluate the clinical variables associated. PATIENTS AND METHODS: Patients were assessed for sociodemographic characteristics, type of spondyloarthritis, time since diagnosis and disease activity, non-steroidal anti-infl ammatory drug use, HLA-B27 positivity, creatinine and urea serum levels, major comorbidities, hematuria and proteinuria. Patients with hematuria were subsequently assessed for the presence of dysmorphic red blood cells in urine, and those with proteinuria underwent 24-hour urine protein measurement. Renal biopsy was performed in patients with glomerular hematuria and/or proteinuria over 3.5 g/24-hour. RESULTS: Seventy-six patients were assessed. Microscopic hematuria was the most frequently found abnormality in urinalysis (44.7%), usually intermittent and in spot urine samples during patients' follow-up. In eight patients (10.5%), glomerular hematuria was suspected. Renal biopsy was performed in fi ve of them, showing IgA nephropathy in four (5.3%) and thin membrane disease in one patient. CONCLUSIONS: A high frequency of urinalysis alterations was observed in that subgroup of patients, as well as a high prevalence of IgA nephropathy. Although further studies on this subject are needed to better clarify these results, periodic urinalysis of patients with spondyloarthritis should be recommended.

Pacientes com espondiloartrites poderiam ser mais acometidos pela nefropatia por IgA do que a população geral, havendo, possivelmente, um mecanismo etiopatogênico comum. O seguinte artigo relaciona quatro casos que exemplificam essa possível associação

Spondyloarthritis patients can be more frequently affected by IgA nephropathy than the general population, and a common etiopathogenic mechanism can be involved. We report four cases that may exemplify that association

OBJETIVO: avaliar a possível associação entre fibromialgia e infecção crônica pelo vírus da hepatite C (VHC). MÉTODOS: estudo transversal com 186 pacientes fibromiálgicas e 55 pacientes com diagnóstico de doenças difusas do tecido conjuntivo (DDTC) não-fibromiálgicas, e em 33 pacientes com infecção crônica pelo VHC e 34 controles sem doenças infecciosas relacionadas ao fígado, todas do sexo feminino e de idade igual ou superior a 18 anos. A fibromialgia foi diagnosticada segundo os critérios classificatórios do American College of Rheumatology (ACR) de 1990. Infecção crônica pelo VHC foi definida pela presença do RNA do vírus por meio da reação em cadeia da polimerase (PCR). As demais variáveis consideradas para as manifestações extra-hepáticas associadas à infecção crônica compreenderam: fadiga, parestesias, fenômeno de Raynaud, sintomas de boca e/ou olhos secos, depressão e presença de títulos detectáveis de anticorpos antitireoidianos. RESULTADOS: a infecção crônica pelo VHC foi detectada em três pacientes (1,6%) do grupo fibromiálgico e em nenhuma das pacientes com o diagnóstico de DDTC (p = 0,39). A dor musculoesquelética crônica disseminada foi mais prevalente no grupo de pacientes infectadas pelo VHC (45,5%) do que no grupo-controle (26,5%), mas não foi detectada associação entre fibromialgia e infecção crônica pelo VHC (OR = 1,39; IC 95% = 0,43-4,57). Dentre as manifestações extra-hepáticas, apenas os sintomas relativos a boca e/ou olhos secos apresentaram uma associação com a infecção crônica (OR = 6,40; IC 95% = 1,94-21,87). CONCLUSÃO: o estudo não detectou uma associação entre fibromialgia e infecção crônica pelo VHC.

OBJECTIVE: to evaluate a possible association between fibromyalgia and hepatitis C virus (HCV) chronic infection. METHODS: cross-sectional study comprising 186 fibromyalgic women, 55 non-fibromyalgic controls with a diagnosis of diffuse connective tissue diseases (DCTD), 33 HCV chronically infected women and 34 selected from the gastroenterology outpatient clinic with no liver related infection disease, all aged 18 or older. Fibromyalgia was diagnosed according to the American College of Rheumatology (ACR) classification criteria. Chronic HCV infection was defined by detection of HCV-RNA using the polymerase chain reaction (PCR). Other extra-hepatic manifestations comprised: fatigue, paresthesia, Raynaud´s phenomenon, sicca symptoms, depression and detectable thyroid autoantibodies. RESULTS: HCV-RNA was detected in 3 of the 185 fibromyalgic women (1.6%) and in none of the 55 DCTD group (p = 0.39). Chronic widespread musculoskeletal pain was more prevalent in the infected group (45.5%) than in the non-infected (26.5%), but no association was found between fibromyalgia and HCV chronic infection (OR = 1.39; 95% CI = 0.43-4.57). With the regard to other variables, only sicca symptoms were found to be associated with chronic infection (OR = 6.40; 95% CI = 1.94-21.87). CONCLUSION: we found no association between fibromyalgia and chronic HCV infection.