Pesquisa | SciELO

Abstract Background Fibroblast-like synoviocytes (FLS) play a prominent role in rheumatoid synovitis and degradation of the extracellular matrix through the production of inflammatory cytokines and metalloproteinases (MMPs). Since animal models are frequently used for elucidating the disease mechanism and therapeutic development, it is relevant to study the ultrastructural characteristics and functional responses in human and mouse FLS. The objective of the study was to analyze ultrastructural characteristics, Interleukin-6 (IL-6) and Metalloproteinase-3 (MMP-3) production and the activation of intracellular pathways in Fibroblast like synoviocytes (FLS) cultures obtained from patients with rheumatoid arthritis (RA) and from mice with collagen-induced arthritis (CIA). Methods FLSs were obtained from RA patients (RA-FLSs) (n = 8) and mice with CIA (CIA-FLSs) (n = 4). Morphology was assessed by transmission and scanning electron microscopy. IL-6 and MMP-3 production was measured by ELISA, and activation of intracellular signaling pathways (NF-κB and MAPK: p-ERK1/2, p-P38 and p-JNK) was measured by Western blotting in cultures of RA-FLSs and CIA-FLSs stimulated with tumor necrosis factor-alpha (TNF-α) and IL-1β. Results RA-FLS and CIA-FLS cultures exhibited rich cytoplasm, rough endoplasmic reticula and prominent and well- developed Golgi complexes. Transmission electron microscopy demonstrated the presence of lamellar bodies, which are cytoplasmic structures related to surfactant production, in FLSs from both sources. Increased levels of pinocytosis and numbers of pinocytotic vesicles were observed in RA-FLSs (p < 0.05). Basal production of MMP-3 and IL-6 was present in RA-FLSs and CIA-FLSs. Regarding the production of MMP-3 and IL-6 and the activation of signaling pathways, the present study demonstrated a lower response to IL-1β by CIA-FLSs than by RA-FLSs. Conclusion This study provides a comprehensive understanding of the biology of RA-FLS and CIA-FLS. The differences and similarities in ultrastructural morphology and important inflammatory cytokines shown, contribute to future in vitro studies using RA-FLS and CIA-FLS, in addition, they indicate that the adoption of CIA-FLS for studies should take careful and be well designed, since they do not completely resemble human diseases.

https://doi.org/10.1186/s42358-022-00281-0

First-line biologic therapy with tumor necrosis factor inhibitors for psoriatic arthritis: a prospective observational study
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Silva, Michael Ruberson Ribeiro da

; Santos, Jéssica Barreto Ribeiro dos

; Kakehasi, Adriana Maria

; Almeida, Alessandra Maciel

; Pimenta, Pedro Ricardo Kömel

; Alvares-Teodoro, Juliana

; Acurcio, Francisco de Assis

Sao Paulo Medical Journal

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Dez 2022, Volume 140 Nº 6 Páginas 787 - 797

Resumo: En | Texto: En | PDF: En

ABSTRACT BACKGROUND: Psoriatic arthritis (PsA) is a chronic inflammatory disease that affects multiple joints. It is associated with psoriasis and treated with synthetic and biologic drugs. OBJECTIVE: The objective of this study was to assess the outcomes of patients who received biologic therapy with tumor necrosis factor (TNF) inhibitors in terms of effectiveness, safety, functionality, and quality of life. DESIGN AND SETTING: A prospective observational study was performed at a single center in Belo Horizonte, Brazil. METHODS: Patients with PsA who received their first TNF inhibitor treatment were followed up for 12 months. Disease activity was measured using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Clinical Disease Activity Index (CDAI). Functionality was measured using the Health Questionnaire Assessment (HAQ), and quality of life was evaluated using the European Quality of Life Five Dimensions (EQ-5D). Multiple linear regression was used to identify predictors of the clinical response at 12 months. RESULTS: A total of 143 patients treated with adalimumab or etanercept were evaluated. Most of the clinical measures were significantly improved at 12 months. However, 31%–51% of the patients did not achieve good clinical control. No differences were observed between adalimumab and etanercept, except for poor functionality at 12 months among patients treated with etanercept. The main predictors of a worse clinical response were female sex, etanercept use, poor functionality, or lower quality of life at baseline. The main adverse reactions were alopecia, headache, injection site reaction, sinusitis, flu, dyslipidemia, and infections. CONCLUSION: TNF inhibitor therapy was effective and safe. However, despite improvements in clinical measures, most patients did not achieve satisfactory control of the disease.

https://doi.org/10.1590/1516-3180.2021.0434.r1.22022022

Guidelines on COVID-19 vaccination in patients with immune-mediated rheumatic diseases: a Brazilian Society of Rheumatology task force
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Tavares, Anna Carolina Faria Moreira Gomes

; Melo, Ana Karla Guedes de

; Cruz, Vítor Alves

; Souza, Viviane Angelina de

; Carvalho, Joana Starling de

; Machado, Ketty Lysie Libardi Lira

; Valadares, Lilian David de Azevedo

; Reis Neto, Edgard Torres dos

; Rezende, Rodrigo Poubel Vieira de

; Guimarães, Maria Fernanda Brandão de Resende

; Ferreira, Gilda Aparecida

; Braz, Alessandra de Sousa

; Vieira, Rejane Maria Rodrigues de Abreu

; Pinheiro, Marcelo de Medeiros

; Ribeiro, Sandra Lúcia Euzébio

; Bica, Blanca Elena Gomes Rios

; Baptista, Kátia Lino

; Costa, Izaias Pereira da

; Marques, Claudia Diniz Lopes

; Lopes, Maria Lúcia Lemos

; Martinez, José Eduardo

; Giorgi, Rina Dalva Neubarth

; Mota, Lícia Maria Henrique da

; Loures, Marcos Antônio Araújo da Rocha

; Paiva, Eduardo dos Santos

; Monticielo, Odirlei André

; Xavier, Ricardo Machado

; Kakehasi, Adriana Maria

; Pileggi, Gecilmara Cristina Salviato

Advances in Rheumatology

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2022, Volume 62 elocation 3

Resumo: En | Texto: En | PDF: En

Abstract Objective: To provide guidelines on the coronavirus disease 2019 (COVID-19) vaccination in patients with immune-mediated rheumatic diseases (IMRD) to rheumatologists considering specific scenarios of the daily practice based on the shared-making decision (SMD) process. Methods: A task force was constituted by 24 rheumatologists (panel members), with clinical and research expertise in immunizations and infectious diseases in immunocompromised patients, endorsed by the Brazilian Society of Rheumatology (BSR), to develop guidelines for COVID-19 vaccination in patients with IMRD. A consensus was built through the Delphi method and involved four rounds of anonymous voting, where five options were used to determine the level of agreement (LOA), based on the Likert Scale: (1) strongly disagree; (2) disagree, (3) neither agree nor disagree (neutral); (4) agree; and (5) strongly agree. Nineteen questions were addressed and discussed via teleconference to formulate the answers. In order to identify the relevant data on COVID-19 vaccines, a search with standardized descriptors and synonyms was performed on September 10th, 2021, of the MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and LILACS to identify studies of interest. We used the Newcastle–Ottawa Scale to assess the quality of nonrandomized studies. Results: All the nineteen questions-answers (Q&A) were approved by the BSR Task Force with more than 80% of panelists voting options 4—agree—and 5—strongly agree—, and a consensus was reached. These Guidelines were focused in SMD on the most appropriate timing for IMRD patients to get vaccinated to reach the adequate covid-19 vaccination response. Conclusion: These guidelines were developed by a BSR Task Force with a high LOA among panelists, based on the literature review of published studies and expert opinion for COVID-19 vaccination in IMRD patients. Noteworthy, in the pandemic period, up to the time of the review and the consensus process for this document, high-quality evidence was scarce. Thus, it is not a substitute for clinical judgment.

https://doi.org/10.1186/s42358-022-00234-7

Effect of biological disease-modifying antirheumatic drugs on body composition in patients with rheumatoid arthritis: a systematic review and meta-analysis
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Souza, Mariana Peixoto Guimarães Ubirajara e Silva de

; Guimarães, Nathalia Sernizon

; Guimarães, Maria Fernanda Brandão de Resende

; Souza, Viviane Angelina de

; Kakehasi, Adriana Maria

Advances in Rheumatology

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2022, Volume 62 elocation 16

Resumo: En | Texto: En | PDF: En

Abstract Background: Rheumatoid arthritis (RA) generates an inflammatory profile that predisposes to total and visceral fatty accumulation and reduced fat free mass (FFM). This metabolic disorder contributes to poor functionality, increased cardiovascular risk and higher mortality. This study aimed to address a systematic review with meta-analysis to determine the effect of biological and targeted synthetic disease-modifying antirheumatic drugs (bDMARDs and tsDMARDs) on body composition (BC) of patients with RA. Methods: The search was conducted at the electronic databases PubMed, Cochrane Library, Embase, Lilacs and grey literature. This investigation was carried until July 2021. Outcomes of interest were total weight, body mass index (BMI), fat mass (FM) and FFM. A meta-analysis comparing these outcomes in RA patients under bDMARD treatment versus controls was performed. Results: Out of 137 studies reviewed, 18 were selected: fifteen prospective cohorts, two retrospective cohorts, and one cross-sectional study. The studies comprised 1221 patients, 778 on bDMARD treatment and 443 controls, which included RA patients under conventional synthetic DMARD (csDMARD). No study addressing BC analysis in patients using tsDMARD was found. The mean age and duration of the disease was 56.7 years and 6.77 years, respectively. Ten studies demonstrated a significant increase of total weight in 88.2% of patients and 42.3% for BMI. In studies that analyzed BC by double X-ray absorptiometry (DXA), the increase in total weight and BMI correlated positively to the increase in FFM. The meta-analysis carried out in five studies showed no significant difference of the mean difference for total weight 0.12 kg (95% CI − 5.58, 5.82), BMI 0.08 kg/m2 (95% CI − 1.76, 1.92), FM − 0.08 kg (95% IC − 5.31, 5.14), and FFM − 2.08 kg (95% CI − 7.37, 3.21). Conclusion: This systematic review suggests a possible impact of bDMARDs on BC of RA patients, even though, the meta-analysis carried out in a small part of these studies was not able to confirm significant variation in BC components. Trial registration: PROSPERO code: CRD42020206949.

https://doi.org/10.1186/s42358-022-00249-0

Vitamin D and bone health in adults: a systematic review and meta-analysis
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Segheto, Kátia Josiany

; Pereira, Marcos

; Silva, Danielle Cristina Guimarães da

; Carvalho, Cristiane Junqueira de

; Massardi, Felipe Ribeiro

; Kakehasi, Adriana Maria

; Juvanhol, Leidjaira Lopes

; Longo, Giana Zarbato

Ciência & Saúde Coletiva

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Ago 2021, Volume 26 Nº 8 Páginas 3221 - 3244

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

Resumo A baixa saúde óssea está associada à deficiência de vitamina D em indivíduos mais velhos; no entanto, isso não está bem estabelecido em adultos. O estudo objetivou-se analisar a associação entre concentrações séricas de 25-hidroxivitamina D e baixa saúde óssea em adultos por revisão sistemática e metanálise. A pesquisa foi realizada nas bases LILACS, PubMed, Scopus, Web of Science, ScienceDirect de março de 2017 a outubro de 2018 com indivíduos adultos (20-59 anos). A avaliação da saúde óssea foi realizada através da absorciometria dupla de raios X e concentrações séricas de 25(OH)D. O modelo de efeito aleatório foi utilizado para analisar dados do conteúdo mineral ósseo e densidade mineral óssea. Modelos de efeitos aleatórios foram utilizados e a heterogeneidade foi explorada por meio de meta-regressão. Trinta e cinco artigos foram selecionados. Houve correlação positiva entre a vitamina D e a saúde óssea na maioria dos locais avaliados. Observou-se correlação na análise de subgrupos da coluna lombar entre homens. Quando estratificados, os estudos apresentaram alta heterogeneidade, explicada pelo tamanho da amostra, pelos níveis séricos médios da vitamina e pelo risco de viés. A vitamina D está positivamente correlacionada com a saúde óssea em indivíduos adultos.

Abstract Low bone health is associated with vitamin D deficiency in older individuals; however, this association is not well established in adults. The aim of the study was to analyze the association between serum concentrations of 25-hydroxyvitamin D and bone health in adults by systematic review and meta-analysis. The search was carried out in the LILACS, PubMed, Scopus, Web of Science, ScienceDirect databases from March 2017 to October 2018 with adult individuals (20-59 years). Bone health was evaluation performed through dual X-ray absorptiometry and serum concentrations of 25(OH)D. The random effect model was used to analyze data from bone mineral content and bone mineral. Random effects models were used and the sources of heterogeneity were explored by means of meta-regression. Thirty-five articles were selected. There was positive correlation between vitamin D and bone health in most of the evaluated sites. Correlation was observed in the analysis of subgroups for lumbar spine among men. When stratified, the studies presented high heterogeneity, which was explained by the sample size, mean serum vitamin D levels and risk of bias. Vitamin D is positively correlated to bone health in adult individuals.

https://doi.org/10.1590/1413-81232021268.15012020

Vitamin D and bone health in adults: a systematic review and meta-analysis
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Segheto, Kátia Josiany

; Pereira, Marcos

; Silva, Danielle Cristina Guimarães da

; Carvalho, Cristiane Junqueira de

; Massardi, Felipe Ribeiro

; Kakehasi, Adriana Maria

; Juvanhol, Leidjaira Lopes

; Longo, Giana Zarbato

Ciência & Saúde Coletiva

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2021, Volume 26 Nº 8 Páginas 3221 - 3244

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

https://doi.org/10.1590/1413-81232021268.15012020

Chronic use of hydroxychloroquine did not protect against COVID-19 in a large cohort of patients with rheumatic diseases in Brazil
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Pileggi, Gecilmara Salviato

; Ferreira, Gilda Aparecida

; Gomides Reis, Ana Paula Monteiro

; Reis Neto, Edgard Torres

; Abreu, Mirhelen Mendes

; Albuquerque, Cleandro Pires

; Araújo, Nafice Costa

; Bacchiega, Ana Beatriz

; Bianchi, Dante Valdetaro

; Bica, Blanca

; Bonfa, Eloisa Duarte

; Borba, Eduardo Ferreira

; Brito, Danielle Christinne Soares Egypto

; Duarte, Ângela Luzia Branco Pinto

; Santo, Rafaela Cavalheiro Espírito

; Fernandes, Paula Reale

; Guimarães, Mariana Peixoto

; Gomes, Kirla Wagner Poti

; Kakehasi, Adriana Maria

; Klumb, Evandro Mendes

; Lanna, Cristina Costa Duarte

; Marques, Claudia Diniz Lopes

; Monticielo, Odirlei André

; Mota, Licia Maria Henrique

; Munhoz, Gabriela Araújo

; Paiva, Eduardo Santos

; Pereira, Helena Lucia Alves

; Provenza, José Roberto

; Ribeiro, Sandra Lucia Euzébio

; Rocha Junior, Laurindo Ferreira

; Sampaio, Camila Santana Justo Cintra

; Sampaio, Vanderson Souza

; Sato, Emília Inoue

; Skare, Thelma

; de Souza, Viviane Angelina

; Valim, Valeria

; Lacerda, Marcus Vinícius Guimarães

; Xavier, Ricardo Machado

; Pinheiro, Marcelo Medeiros

Advances in Rheumatology

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2021, Volume 61 elocation 60

Resumo: En | Texto: En | PDF: En

Abstract Background: There is a lack of information on the role of chronic use of hydroxychloroquine during the SARS-CoV-2 outbreak. Our aim was to compare the occurrence of COVID-19 between rheumatic disease patients on hydroxychloroquine with individuals from the same household not taking the drug during the first 8 weeks of community viral transmission in Brazil. Methods: This baseline cross-sectional analysis is part of a 24-week observational multi-center study involving 22 Brazilian academic outpatient centers. All information regarding COVID-19 symptoms, epidemiological, clinical, and demographic data were recorded on a specific web-based platform using telephone calls from physicians and medical students. COVID-19 was defined according to the Brazilian Ministry of Health (BMH) criteria. Mann-Whitney, Chi-square and Exact Fisher tests were used for statistical analysis and two binary Final Logistic Regression Model by Wald test were developed using a backward-stepwise method for the presence of COVID-19. Results: From March 29th to May 17st, 2020, a total of 10,443 participants were enrolled, including 5166 (53.9%) rheumatic disease patients, of whom 82.5% had systemic erythematosus lupus, 7.8% rheumatoid arthritis, 3.7% Sjögren’s syndrome and 0.8% systemic sclerosis. In total, 1822 (19.1%) participants reported flu symptoms within the 30 days prior to enrollment, of which 3.1% fulfilled the BMH criteria, but with no significant difference between rheumatic disease patients (4.03%) and controls (3.25%). After adjustments for multiple confounders, the main risk factor significantly associated with a COVID-19 diagnosis was lung disease (OR 1.63; 95% CI 1.03-2.58); and for rheumatic disease patients were diagnosis of systemic sclerosis (OR 2.8; 95% CI 1.19-6.63) and glucocorticoids above 10 mg/ day (OR 2.05; 95% CI 1.31-3.19). In addition, a recent influenza vaccination had a protective effect (OR 0.674; 95% CI 0.46-0.98). Conclusion: Patients with rheumatic disease on hydroxychloroquine presented a similar occurrence of COVID-19 to household cohabitants, suggesting a lack of any protective role against SARS-CoV-2 infection. Trial registration Brazilian Registry of Clinical Trials (ReBEC; RBR - 9KTWX6).

https://doi.org/10.1186/s42358-021-00217-0 22 downloads

Recommendations of the Brazilian Society of Rheumatology for the use of JAK inhibitors in the management of rheumatoid arthritis
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Bonfiglioli, Karina Rossi

; Mota, Licia Maria Henrique da

; Ribeiro, Ana Cristina de Medeiros

; Kakehasi, Adriana Maria

; Laurindo, Ieda Maria Magalhães

; Giorgi, Rina Dalva Neubarth

; Duarte, Angela Luzia Branco Pinto

; Reis, Ana Paula Monteiro Gomides

; Souza, Mariana Peixoto Guimarães Ubirajara e Silva de

; Brenol, Claiton Viegas

; Pinheiro, Geraldo da Rocha Castelar

; Albuquerque, Cleandro Pires de

; Castro, Charlles Heldan de Moura

; Pinto, Gustavo Luiz Behrens

; Verztman, Jose Fernando

; Muniz, Luciana Feitosa

; Bertolo, Manoel Barros

; Pinto, Maria Raquel da Costa

; Louzada Júnior, Paulo

; Cruz, Vitor Alves

; Pereira, Ivanio Alves

; Freitas, Max Vitor Carioca de

; Cruz, Bóris Afonso

; Paiva, Eduardo

; Monticielo, Odirlei

; Provenza, José Roberto

; Xavier, Ricardo Machado

Advances in Rheumatology

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2021, Volume 61 elocation 70

Resumo: En | Texto: En | PDF: En

Abstract Rheumatoid arthritis (RA) is a chronic and autoimmune systemic inflammatory disease that can cause irreversible joint deformities, with increased morbidity and mortality and a significant impact on the quality of life of the affected individual. The main objective of RA treatment is to achieve sustained clinical remission or low disease activity. However, up to 40% of patients do not respond to available treatments, including bDMARDs. New therapeutic targets for RA are emerging, such as Janus kinases (JAKs). These are essential for intracellular signaling (via JAK-STAT) in response to many cytokines involved in RA immunopathogenesis. JAK inhibitors (JAKi) have established themselves as a highly effective treatment, gaining increasing space in the therapeutic arsenal for the treatment of RA. The current recommendations aim to present a review of the main aspects related to the efficacy and safety of JAKis in RA patients, and to update the recommendations and treatment algorithm proposed by the Brazilian Society of Rheumatology in 2017.

https://doi.org/10.1186/s42358-021-00228-x

10.

Reduced bone mineral content and density in neurofibromatosis type 1 and its association with nutrient intake
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Souza, Marcio Leandro Ribeiro de

; Jansen, Ann Kristine

; Rodrigues, Luiz Oswaldo Carneiro

; Vilela, Darlene Larissa de Souza

; Kakehasi, Adriana Maria

; Martins, Aline Stangherlin

; Souza, Juliana Ferreira de

; Rezende, Nilton Alves de

Revista da Associação Médica Brasileira

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Mai 2020, Volume 66 Nº 5 Páginas 666 - 672

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

RESUMO INTRODUÇÃO A Neurofibromatose tipo 1 (NF1) é uma doença genética autossômica dominante caracterizada por envolvimento neurocutâneo e multissistêmico, incluindo baixa densidade mineral óssea (DMO). OBJETIVOS Avaliar características ósseas em indivíduos com NF1 e verificar associação com a ingestão de nutrientes. METODOLOGIA 26 adultos com NF1 submeteram-se a avaliação dos parâmetros ósseos usando absorciometria com raios-X de dupla energia (DXA), além da avaliação da ingestão alimentar. O grupo NF1 foi comparado e pareado com 26 indivíduos sem a doença. Peso, estatura e circunferência da cintura foram avaliados. DXA forneceu o conteúdo mineral ósseo (CMO) e a DMO do corpo total, coluna e fêmur. A ingestão de calorias, macronutrientes e micronutrientes foi avaliada. RESULTADOS O grupo NF1 apresentou redução da estatura (1,68 ± 0,1; 1,61 ± 0,1 cm; P=0,003) e do CMO (2,3 ± 0,4; 2,0 ± 0,5 kg; P=0,046). Indivíduos com NF1 também apresentaram redução da DMO de corpo total e coluna (g/cm2) (1,1 ± 0,1, 1,0 ± 0,1, P=0,036; 1,0 ± 0,1, 0,9 ± 0,1; P=0,015, respectivamente). A frequência de indivíduos com massa óssea abaixo do esperado para a idade foi maior no grupo NF1 (7,7%; 34,6%, P=0,016). Não houve diferenças no consumo energético. Não houve correlação entre CMO e DMO com a ingestão de nutrientes no grupo NF1. CONCLUSÕES O grupo NF1 apresentou redução do CMO e da DMO. Apesar de menor consumo de cálcio, ferro e vitamina A, e maior consumo de sódio e ômega-6, não foi observada relação entre o fenótipo ósseo e a ingestão de nutrientes.

SUMMARY BACKGROUND Neurofibromatosis type 1 (NF1) is an autosomal dominant genetic disease characterized by multisystem involvement including low bone mineral density (BMD). OBJECTIVE To assess the bone phenotype of individuals with NF1 and verify its association with nutrient intake. METHODS Twenty-six adults with NF1 underwent bone phenotype assessments using dual-energy X-ray absorptiometry (DXA) and food intake evaluations. They were compared to 26 unaffected matched control patients. Weight, height, and waist circumference (WC) were measured. DXA provided total body, spine, and hip BMDs and bone mineral content (BMC) for all patients. Food intake was evaluated for energy, macro- and micro-nutrients. RESULTS Height (1.68 ± 0.1; 1.61 ± 0.1 cm; P = 0.003) and BMC (2.3 ± 0.4; 2.0 ± 0.5 kg; P = 0.046) were lower in the NF1 group. Individuals with NF1 also presented lower total body and spine BMDs (g/cm2) (1.1 ± 0.1, 1.0 ± 0.1, P = 0.036; 1.0 ± 0.1, 0.9 ± 0.1; P = 0.015, respectively). The frequency of total body bone mass below the expected level for patients’ ages was higher in the NF1 group (7.7%; 34.6%, P = 0.016). There were no differences in energy consumption. No correlations between BMC and BMD with nutrient intake were observed in the NF1 group. CONCLUSIONS The NF1 group presented lower BMCs and BMDs. Although a lower consumption of calcium, iron, and vitamin A, and a higher intake of sodium and omega-6 were observed, there was no relationship between bone phenotype and nutrient intake.

https://doi.org/10.1590/1806-9282.66.5.666 662 downloads

11.

Factors associated with bone mineral content in adults: a population-based study
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Segheto, Kátia Josiany

; Juvanhol, Leidjaira Lopes

; Carvalho, Cristiane Junqueira de

; Silva, Danielle Cristina Guimarães da

; Kakehasi, Adriana Maria

; Longo, Giana Zarbato

einstein (São Paulo)

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2020, Volume 18 elocation eAO4694

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

RESUMO Objetivo Verificar a associação entre o conteúdo mineral ósseo e fatores sociodemográficos, antropométricos, comportamentais e condições de saúde em adultos brasileiros. Métodos Estudo transversal, de base populacional, realizado com 701 indivíduos de ambos os sexos, com idade entre 20 e 59 anos. A variável dependente foi avaliada por DEXA. As associações foram avaliadas por modelos de regressão linear estratificados baseados no sexo dos indivíduos. Resultados Quando comparados os valores médios do conteúdo mineral ósseo, observamos diferença estatisticamente significante em relação aos sexos e para todas as variáveis independentes avaliadas. Nos modelos ajustados, identificamos associação inversa entre o conteúdo mineral ósseo e a idade em ambos os sexos. Entre os homens, sobrepeso e obesidade, alta escolaridade e suficiência de 25(OH)D foram associados a maiores valores de conteúdo mineral ósseo. Entre as mulheres, por sua vez, cor da pele não branca, sobrepeso e obesidade foram associados a melhor saúde óssea. Os principais fatores associados à baixa massa óssea total foram idade avançada, cor da pele branca, baixa escolaridade, eutrofia e deficiência de 25(OH)D. Conclusão Esses resultados podem auxiliar na identificação de adultos com maior risco e que devem ser alvo de medidas de prevenção e diagnóstico precoce.

ABSTRACT Objective To determine the association among bone mineral content, sociodemographic, anthropometric and behavioral factors, and health status of Brazilian adults. Methods This was a cross-sectional, population-based study including 701 individuals from both sexes aged between 20 and 59 years. DEXA was used to evaluate dependent variable. The associations were evaluated using linear regression models stratified by sex. Results When mean bone mineral content values were compared, we found significant differences related to sex and all the independent variables evaluated. In the adjusted models, we identified an inverse association between bone mineral content and age in both sexes. Among men, to be overweight and/or obese, be highly educated, and have almost sufficiency of 25(OH)D were associated with higher bone mineral content values. On the other hand, among women, to be non-white skin color, overweight and/or obese were associated with better bone health. The main factors associated with low total bone mineral density were advanced age, white skin color, low level of formal education, eutrophy, and 25(OH)D deficiency. Conclusion Our results may help to identify adults who are at higher risk, and these findings should be used as guidelines for prevention and early diagnosis.

https://doi.org/10.31744/einstein_journal/2020ao4694 1068 downloads

12.

Concurrent validity of handgrip strength between the jamar and bulb dynamometers in women with rheumatoid arthitis
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Lustosa, Lygia Paccini

; Diogo, Karla Gonçalves

; Ribeiro-Samora, Giane Amorim

; Kakehasi, Adriana Maria

; Alencar, Mariana Asmar

Fisioterapia em Movimento

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2020, Volume 33 elocation e003319

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

Resumo Introdução: Artrite reumatóide (AR) é uma doença progressiva que causa deformação e comprometimento articular. A força de preensão palmar (FPP) tem sido usada por vários profissionais de saúde, na prática clínica, para avaliar força muscular e desempenho. Objetivo: Analisar a concordância das medidas de força de preensão palmar usando o dinamômetro pneumático (Bulbo) e hidráulico (Jamar) em mulheres com artrite reumatoide. Método: As medidas de FPP pelos dois dinamômetros seguiram as normas da American Society of Hand Therapists. A concordância entre as medidas foi por meio do método de Bland-Altman. Nível de significância de 5%. Resultados: Participaram 41 mulheres (60,63 ± 8,35 anos). A análise entre os dois dinamômetros demonstrou não haver concordância (bias = 9,04, p < 0,01), com uma relação linear entre a diferença das medidas e a média (r = 0,73, p < 0,01) e, os limites de concordância foram muito extensos (-2,74 to 20,81). Conclusão: Como a artrite reumatoide compromete as mãos com consequente diminuição da FPP, é importante explorar melhor este tema para definir a melhor medida para a prática clínica nos diferentes níveis de atenção à saúde. No entanto, devido ao grande número de tipo de dinamômetros, sugere-se novos estudos sobre a concordância destas medidas em populações de diferentes condições.

Abstract Introduction: Rheumatoid arthritis (RA) is a progressive disease that causes deformation and constant joint damage. Handgrip strength (HGS) has been used by several health professionals in clinical practice as a mechanism for assessing muscle strength and overall performance. Objective: To perform the concordance analysis of handgrip strength measurements using a pneumatic dynamometer (Bulb) and a hydraulic dynamometer (Jamar) in women with rheumatoid arthritis. Method: The HGS measurements by the two dynamometers followed the norms of the American Society of Hand Therapists. The concordance between measurements was performed by the Bland-Altman method. Significance level was 5%. Results: In total, 41 women (60.63 ± 8.35 years) participated in the study. Analysis showed that the measures between the two dynamometers were not concordant (bias = 9.04, p < 0.01), there was a linear relationship between the difference of the measures and the mean (r = 0.73, p < 0.01), and the limits of agreement were very extensive (−2.74 to 20.81). Conclusion: Assuming that the rheumatoid arthritis compromises the hands, with a consequent decrease in HGS, further exploration of the subject is suggested in future studies to define the best measure for clinical practice at the different levels of health care. However, since there are many different dynamometers, we suggest to better explore the agreement between the measurements obtained by them in populations under different conditions.

Resumen Introducción: La artritis reumatoide (AR) es una enfermedad progresiva que causa deformación y compromiso articular. La fuerza de prensión palmar (FPP) ha sido utilizada por varios profesionales de la salud, en la práctica clínica, para evaluar la fuerza muscular y el rendimiento. Objetivo: Analizar la concordancia de las medidas de fuerza de prensión palmar usando el dinamómetro neumático (Bulbo) e hidráulico (Jamar) en mujeres con artritis reumatoide. Método: Las medidas de FPP por los dos dinamómetros siguieron las normas de la American Society of Hand Therapists. La concordancia entre las medidas fue mediante el método de Bland-Altman. Nivel de significancia del 5%. Resultados: Participaron 41 mujeres (60,63 ± 8,35 años). El análisis entre los dos dinamómetros demostró no haber concordancia (bias = 9,04, p < 0,01), con una relación lineal entre la diferencia de las medidas y la media (r = 0,73, p < 0,01), los límites de concordancia fueron muy extensos (-2,74 a 20,81). Conclusión: Como la artritis reumatoide compromete las manos con consecuente disminución de la FPP, es importante explorar mejor este tema para definir la mejor medida para la práctica clínica en los diferentes niveles de atención a la salud. Sin embargo, debido al gran número de dinamómetros, se sugiere nuevos estudios sobre la concordancia de estas medidas en poblaciones de diferentes condiciones.

https://doi.org/10.1590/1980-5918.033.ao19 1305 downloads

13.

Revisiting hydroxychloroquine and chloroquine for patients with chronic immunity-mediated inflammatory rheumatic diseases
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Reis Neto, Edgard Torres dos

; Kakehasi, Adriana Maria

; Pinheiro, Marcelo de Medeiros

; Ferreira, Gilda Aparecida

; Marques, Cláudia Diniz Lopes

; Mota, Licia Maria Henrique da

; Paiva, Eduardo dos Santos

; Pileggi, Gecilmara Cristina Salviato

; Sato, Emília Inoue

; Reis, Ana Paula Monteiro Gomides

; Xavier, Ricardo Machado

; Provenza, José Roberto

Advances in Rheumatology

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2020, Volume 60 elocation 32

Resumo: En | Texto: En | PDF: En

Abstract Hydroxychloroquine and chloroquine, also known as antimalarial drugs, are widely used in the treatment of rheumatic diseases and have recently become the focus of attention because of the ongoing COVID-19 pandemic. Rheumatologists have been using antimalarials to manage patients with chronic immune-mediated inflammatory rheumatic diseases for decades. It is an appropriate time to review their immunomodulatory and anti-inflammatory mechanisms impact on disease activity and survival of systemic lupus erythematosus patient, including antiplatelet effect, metabolic and lipid benefits. We also discuss possible adverse effects, adding a practical and comprehensive approach to monitoring rheumatic patients during treatment with these drugs.

https://doi.org/10.1186/s42358-020-00134-8 2393 downloads

14.

High frequency of methotrexate intolerance in longstanding rheumatoid arthritis: using the methotrexate intolerance severity score (MISS)
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Amaral, Jéssica Martins

; Brito, Maria José Menezes

; Kakehasi, Adriana Maria

Advances in Rheumatology

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2020, Volume 60 elocation 43

Resumo: En | Texto: En | PDF: En

Abstract Background: Methotrexate (MTX) intolerance is frequent, and its early identification may impact treatment, leading to timely changes in medication that may promote patient compliance and better control of rheumatoid arthritis (RA). The objective of this study was to identify the frequency of, and risk factors for, MTX intolerance using the Brazilian Portuguese version of the Methotrexate Intolerance Severity Score (MISS) questionnaire in patients with RA. Methods: This cross-sectional study was performed between April 2018 and April 2019 and enrolled patients with RA in regular use of oral or subcutaneous MTX for at least 3 months. Patients were invited to answer the Brazilian Portuguese version of the MISS questionnaire, and MTX intolerance was defined by a score ≥ 6 points. Age, sex, disease duration, time of MTX use, dose, route of administration, concomitant medications, comorbidities, smoking, and Disease Activity Score for 28joint (DAS28) data were collected from institutional medical records. Results: Among 120 patients, 103 (85.8%) were female, the mean age was 61 (±12.5) years, the mean duration of disease was 16 (±10.3) years, and the average duration of MTX use was 7 (±5.5) years. The frequency of MTX intolerance was 21.6%. The most frequent symptoms reported after the use of MTX were nausea (92.3%), abdominal pain (46.1%), and vomiting (30.7%). Behavioral symptoms occurred in 96.1% of patients with MTX intolerance, the most frequent being restlessness and irritability. Patients who used corticosteroids were more likely to develop MTX intolerance than those not using corticosteroids (odds ratio = 2.73; 95% confidence interval, 1.06 to 7.06; p = 0.038). Conversely, increasing age showed marginally significant association with decreased risk of MTX intolerance (p = 0.059). Conclusions: The use of the MISS questionnaire disclosed high frequencies of anticipatory, associative, and behavioral symptoms in MTX-intolerant patients, and the use of corticosteroid increases the risk of MTX intolerance. We suggest that the MISS questionnaire be used routinely in clinical practice.

https://doi.org/10.1186/s42358-020-00145-5 562 downloads

15.

Factors associated with bone mineral density in adults: a cross-sectional population-based study
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Segheto, Kátia Josiany

; Juvanhol, Leidjaira Lopes

; Carvalho, Cristiane Junqueira de

; Silva, Danielle Cristina Guimarães da

; Kakehasi, Adriana Maria

; Longo, Giana Zarbato

Revista da Escola de Enfermagem da USP

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2020, Volume 54 elocation e03572

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

Resumo Objetivo: Este estudo tem como objetivo analisar a associação entre coluna lombar, colo femoral, densidade mineral óssea total do quadril (parâmetro biofísico de avaliação da saúde óssea) e fatores sociodemográficos, antropométricos, comportamentais e de condição de saúde nos adultos brasileiros. Método: Este é um estudo transversal, baseado em população, realizado com indivíduos de ambos os gêneros, com idades entre 20 e 59 anos (n=701). As variáveis dependentes foram avaliadas por Absorciometria com Raios-X de Dupla Energia. As variáveis independentes foram avaliadas por meio de um questionário, avaliação antropométrica e coleta de sangue. A associação entre densidade mineral óssea e variáveis independentes foi avaliada por análise de regressão linear. Todas as análises foram estratificadas por gênero. Resultados: Os homens apresentaram densidade mineral óssea mais alta do que as mulheres. A densidade mineral óssea foi inversamente associada à faixa etária e diretamente associada ao estado nutricional em ambos os gêneros e nos três locais ósseos analisados. Além disso, o estado de deficiência de 25-Hidroxivitamina D entre os homens e o uso de contraceptivos entre as mulheres foram associados a uma densidade mineral óssea mais baixa, e uma associação significativa só foi encontrada com a densidade mineral óssea da coluna lombar nas mulheres. Conclusão: Os fatores associados à saúde óssea entre os homens foram idade, cor da pele, estado nutricional e estado da vitamina D. Para as mulheres, os fatores associados à saúde óssea foram idade, cor da pele, estado nutricional e uso de contraceptivos.

Abstract Objective: This study aimed to analyze the association between lumbar spine, femoral neck, total hip bone mineral density (biophysical bone health assessment parameter), and sociodemographic, anthropometric, behavioral, and health condition factors in Brazilian adults. Method: This is a cross-sectional, population-based study performed with individuals of both genders, aged between 20 and 59 (n=701). The dependent variables were evaluated by Dual Energy X-ray Absorptiometry. The independent variables were evaluated through a questionnaire, anthropometric evaluation and blood collection. The association between bone mineral density and the independent variables was evaluated by linear regression analysis. All analyses were stratified by gender. Results: Men presented higher bone mineral density than women. Bone mineral density was inversely associated with age range and directly associated with nutritional status in both genders and in the three bone sites analyzed. In addition, 25 Hydroxyvitamin D deficient status among men and contraceptive use among women were associated with lower bone mineral density, and a significant association was only found with lumbar spine bone mineral density in women. Conclusion: The factors associated with bone health among men were age, skin color, nutritional status, and vitamin D status. For women, the associated factors with bone health were age, skin color, nutritional status and contraceptive use.

Resumen Objetivo: Este estudio tiene como fin analizar la asociación entre columna lumbar, cuello femoral, densidad mineral ósea total de la cadera (parámetro biofísico de evaluación de la salud ósea) y factores sociodemográficos, antropométricos, comportamentales y de condición de salud en los adultos brasileños. Método: Este es un estudio transversal, basado en población, llevado a cabo con individuos de ambos géneros, con edades entre 20 y 59 años (n=701). Las variables dependientes fueron evaluadas por Absorciometría con Rayos X de Doble Energía. Las variables independientes fueron evaluadas mediante un cuestionario, evaluación antropométrica y recolección de sangre. La asociación entre densidad mineral ósea y variables independientes fue valorado por análisis de regresión lineal. Todos los análisis fueron estratificados por género. Resultados: Los varones presentaron densidad mineral ósea más alta que las mujeres. La densidad mineral ósea estuvo inversamente asociada con el rango de edad y directamente asociada con el estado nutritivo en ambos géneros y en los tres sitios óseos analizados. Además, el estado de deficiencia de 25-Hidroxivitamina D entre los hombres y el uso de contraceptivos entre las mujeres estuvieron asociados con una densidad mineral ósea más baja, y una asociación significativa solo fue encontrada con la densidad mineral ósea de la columna lumbar en las mujeres. Conclusión: Los factores asociados con la salud ósea entre los varones fueron edad, color de la piel, estado nutritivo y estado de la vitamina D. Para las mujeres, los factores asociados con la salud ósea fueron edad, color de la piel, estado nutritivo y uso de contraceptivos.

https://doi.org/10.1590/s1980-220x2018039903572 705 downloads

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