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Abstract Background Patients with immune-mediated rheumatic diseases (IMRDs) have been prioritized for COVID-19 vaccination to mitigate the infection severity risks. Patients with rheumatoid arthritis (RA) are at a high risk of severe COVID-19 outcomes, especially those under immunosuppression or with associated comorbidities. However, few studies have assessed the safety of the COVID-19 vaccine in patients with RA. Objective To evaluate the safety of vaccines against SARS-CoV-2 in patients with RA. Methods This data are from the study “Safety and Efficacy on COVID-19 Vaccine in Rheumatic Diseases,” a Brazilian multicentric prospective phase IV study to evaluate COVID-19 vaccine in IMRDs in Brazil. Adverse events (AEs) in patients with RA of all centers were assessed after two doses of ChAdOx1 (Oxford/AstraZeneca) or CoronaVac (Sinovac/Butantan). Stratification of postvaccination AEs was performed using a diary, filled out daily and returned at the end of 28 days for each dose. Results A total of 188 patients with RA were include, 90% female. CoronaVac was used in 109 patients and ChAdOx1 in 79. Only mild AEs were observed, mainly after the first dose. The most common AEs after the first dose were pain at the injection (46,7%), headache (39,4%), arthralgia (39,4%), myalgia (30,5%) and fatigue (26,6%), and ChAdOx1 had a higher frequency of pain at the injection (66% vs 32 %, p < 0.001) arthralgia (62% vs 22%, p < 0.001) and myalgia (45% vs 20%, p < 0.001) compared to CoronaVac. The more common AEs after the second dose were pain at the injection (37%), arthralgia (31%), myalgia (23%), headache (21%) and fatigue (18%). Arthralgia (41,4% vs 25%, p = 0.02) and pain at injection (51,4% vs 27%, p = 0.001) were more common with ChAdOx1. No serious AEs were related. With Regard to RA activity level, no significant difference was observed between the three time periods for both COVID-19 vaccines. Conclusion In the comparison between the two immunizers in patients with RA, local reactions and musculoskeletal symptoms were more frequent with ChAdOx1 than with CoronaVac, especially after the first dose. In summary, the AE occurred mainly after the first dose, and were mild, like previous data from others immunizing agents in patients with rheumatoid arthritis. Vaccination did not worsen the degree of disease activity. immunemediated immune mediated (IMRDs COVID19 COVID 19 COVID-1 risks (RA outcomes comorbidities However SARSCoV2 SARSCoV SARS CoV 2 SARS-CoV- Safety Diseases, Diseases Brazil (AEs ChAdOx Oxford/AstraZeneca OxfordAstraZeneca Oxford AstraZeneca (Oxford/AstraZeneca Sinovac/Butantan. SinovacButantan Sinovac/Butantan . Sinovac Butantan (Sinovac/Butantan) diary 18 include 90 female 10 79 46,7%, 467 46,7% , 46 7 (46,7%) 39,4%, 394 39,4% 39 4 (39,4%) 30,5% 305 30 5 (30,5% 26,6%, 266 26,6% 26 6 (26,6%) 66% 66 (66 3 % 0.001 0001 0 001 62% 62 (62 22 22% 45% 45 (45 20 20% 37%, 37 37% (37%) 31%, 31 31% (31%) 23%, 23 23% (23%) 21% 21 (21% 18%. 18% (18%) 41,4% 414 41 (41,4 25 25% 0.02 002 02 51,4% 514 51 (51,4 27 27% related level summary COVID1 1 COVID- SARS-CoV (Sinovac/Butantan 9 46,7 (46,7% 39,4 (39,4% 30,5 (30,5 26,6 (26,6% (6 0.00 000 00 (4 (37% (31% (23% (21 (18% 41,4 (41, 0.0 51,4 (51, 46, (46,7 39, (39,4 30, (30, 26, (26,6 ( (37 (31 (23 (2 (18 41, (41 0. 51, (51 (46, (39, (30 (26, (3 (1 (5 (46 (39 (26

https://doi.org/10.1186/s42358-024-00397-5

Nutritional effect on lipoproteins and their subfractions in patients with Psoriatic Arthritis: a 12-week randomized trial—the DIETA trial Arthritis 12week week 12 trialthe the 1
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Scherer, Daniele

; Leite, Beatriz Figueiredo

; Morimoto, Melissa Aparecida

; Oliveira, Thauana Luiza

; Klemz, Barbara N. Carvalho

; Freitas, Rosana A. M. Soares

; Pappiani, Caroline

; Damasceno, Nágila R. Teixeira

; Pinheiro, Marcelo de Medeiros

Advances in Rheumatology

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2024, Volume 64 elocation 47

Resumo: En | Texto: En | PDF: En

Abstract Introduction Patients with psoriatic arthritis have some lipid metabolism changes and higher risk of metabolic syndrome (MetS) and cardiovascular diseases, regardless of traditional risk factors, suggesting that chronic inflammation itself plays a central role concerning the atherosclerosis. However, there is a lack of information regarding atherogenic pattern and lipoprotein subfractions burden in these individuals. Aim To evaluate the HDL and LDL-cholesterol plasmatic levels and their subfractions after a nutritional intervention in patients with psoriatic arthritis (PsA). Methods This was a randomized, placebo-controlled clinical trial of a 12-week nutritional intervention. PsA patients were randomly assigned to 1-Placebo: 1 g of soybean oil daily, no dietetic intervention; 2-Diet + Supplementation: an individualized diet, supplemented with 604 mg of omega-3 fatty acids, three times a day; and 3-Diet + Placebo: individualized diet + 1 g of soybean oil. The LDL subfractions were classified as non-atherogenic (NAth), atherogenic (Ath) or highly atherogenic (HAth), whereas the HDL subfractions were classified as small, medium, or large particles, according to the current recommendation based on lipoproteins electrophoresis. Results A total of 91 patients were included in the study. About 62% of patients (n = 56) had an Ath or HAth profile and the main risk factors associated were male gender, longer skin disease duration and higher BMI. Thirty-two patients (35%) had a high-risk lipoprotein profile despite having LDL plasmatic levels below 100 mg/dL. The 12-week nutritional intervention did not alter the LDL subfractions. However, there were significant improvement of HDL subfractions. Conclusion Recognizing the pro-atherogenic subfractions LDL pattern could be a relevant strategy for identifying PsA patients with higher cardiovascular risk, regardless total LDL plasmatic levels and disease activity. In addition, a short-term nutritional intervention based on supervised and individualized diet added to omega-3 fatty acids changed positively the HDLLARGE subfractions, while LDLLARGE subfraction was improved in hypercholesterolemic individuals. ClinicalTrials.gov identifier: NCT03142503 (http://www.clinicaltrials.gov/). MetS (MetS diseases atherosclerosis However individuals LDLcholesterol cholesterol PsA. . (PsA) randomized placebocontrolled placebo controlled 12week week 12 1Placebo Placebo 1-Placebo daily 2Diet Diet 2 Supplementation 60 omega3 omega 3 omega- day 3Diet nonatherogenic non NAth, NAth , (NAth) (Ath HAth, (HAth) small medium particles electrophoresis 9 study 62 n 56 gender BMI Thirtytwo Thirty two 35% 35 (35% highrisk high 10 mgdL dL mg/dL proatherogenic pro activity addition shortterm short term ClinicalTrialsgov ClinicalTrials gov identifier NCT NCT0314250 http//www.clinicaltrials.gov/. httpwwwclinicaltrialsgov http //www.clinicaltrials.gov/ www clinicaltrials (http://www.clinicaltrials.gov/) (PsA 6 (NAth (HAth 5 (35 NCT031425 http//www.clinicaltrials.gov/ wwwclinicaltrialsgov //www.clinicaltrials.gov (http://www.clinicaltrials.gov/ (3 NCT03142 http//www.clinicaltrials.gov (http://www.clinicaltrials.gov ( NCT0314 NCT031 NCT03 NCT0

https://doi.org/10.1186/s42358-024-00389-5

To be or not to B27 positive: implications for the phenotypes of axial spondyloarthritis outcomes. Data from a large multiracial cohort from the Brazilian Registry of Spondyloarthritis B B2 positive outcomes
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Resende, Gustavo Gomes

; Saad, Carla Goncalves Schahin

; Marques, Claudia Diniz Lopes

; Ribeiro, Sandra Lúcia Euzébio

; Gavi, Maria Bernadete Renoldi de Oliveira

; Yazbek, Michel Alexandre

; Marinho, Adriana de Oliveira

; Menin, Rita de Cássia

; Ochtrop, Manuella Lima Gomes

; Soares, Andressa Miozzo

; Cavalcanti, Nara Gualberto

; Carneiro, Jamille Nascimento

; Werner de Castro, Glaucio Ricardo

; Fernandes, José Mauro Carneiro

; Souza, Elziane da Cruz Ribeiro E

; Alvarenga, Corina Quental de Menezes

; Vieira, Rejane Maria Rodrigues de Abreu

; Machado, Natalia Pereira

; Ximenes, Antônio Carlos

; Gazzeta, Morgana Ohira

; Albuquerque, Cleandro Pires de

; Skare, Thelma Larocca

; Keiserman, Mauro Waldemar

; Kohem, Charles Lubianca

; Benacon, Gabriel Sarkis

; Rocha, Vítor Florêncio Santos

; Lage, Ricardo da Cruz

; Malheiro, Olivio Brito

; Golebiovski, Rywka Tenenbaum Medeiros

; Oliveira, Thauana Luiza

; Duque, Ruben Horst

; Londe, Ana Carolina

; Pinheiro, Marcelo de Medeiros

; Sampaio-Barros, Percival Degrava

Advances in Rheumatology

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2024, Volume 64 elocation 33

Resumo: En | Texto: En | PDF: En

Abstract Background There is a remarkable variability in the frequency of HLA-B27 positivity in patients with spondyloarthritis (SpA), which may be associated with different clinical presentations worldwide. However, there is a lack of data considering ethnicity and sex on the evaluation of the main clinical and prognostic outcomes in mixed-race populations. The aim of this study was to evaluate the frequency of HLA-B27 and its correlation with disease parameters in a large population of patients from the Brazilian Registry of Spondyloarthritis (RBE). Methods The RBE is a multicenter, observational, prospective cohort that enrolled patients with SpA from 46 centers representing all five geographic regions of Brazil. The inclusion criteria were as follow: (1) diagnosis of axSpA by an expert rheumatologist; (2) age ≥18 years; (3) classification according to ASAS axial. The following data were collected via a standardized protocol: demographic data, disease parameters and treatment historical. Results A total of 1096 patients were included, with 73.4% HLA-B27 positivity and a mean age of 44.4 (±13.2) years. Positive HLA-B27 was significantly associated with male sex, earlier age at disease onset and diagnosis, uveitis, and family history of SpA. Conversely, negative HLA-B27 was associated with psoriasis, higher peripheral involvement and disease activity, worse quality of life and mobility. Conclusions Our data showed that HLA-B27 positivity was associated with a classic axSpA pattern quite similar to that of Caucasian axSpA patients around the world. Furthermore, its absence was associated with peripheral manifestations and worse outcomes, suggesting a relevant phenotypic difference in a highly miscegenated population. HLAB27 HLAB HLA B27 B HLA-B2 SpA, , (SpA) worldwide However mixedrace mixed race populations RBE. . (RBE) multicenter observational 4 Brazil follow 1 (1 rheumatologist 2 (2 18 ≥1 years 3 (3 axial protocol historical 109 included 734 73 73.4 444 44 44. ±13.2 132 13 (±13.2 uveitis Conversely psoriasis activity mobility world Furthermore HLAB2 B2 HLA-B (SpA (RBE ( ≥ 10 7 73. ±13. (±13. ±13 (±13 ±1 (±1 ± (±

https://doi.org/10.1186/s42358-024-00372-0

Tuberculin skin test repetition after TNF-α inhibitors in patients with chronic inflammatory arthritis: a long-term retrospective cohort in endemic area TNFα TNF α arthritis longterm long term
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Magalhães, Vanessa de Oliveira

; Bonfiglioli, Karina Rossi

; Gomes, Carina More Frade

; Bonfá, Eloisa

; Medeiros-Ribeiro, Ana Cristina de

; Saad, Carla Gonçalves S.

; Pinheiro, Marcelo de Medeiros

Advances in Rheumatology

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2024, Volume 64 elocation 70

Resumo: En | Texto: En | PDF: En

Abstract Objectives To evaluate the tuberculin skin test (TST) conversion in chronic inflammatory arthropathies (CIA) patients on TNFα inhibitors (TNFi) and without previous latent tuberculosis infection (LTBI) treatment. Methods Patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA) with negative LTBI were retrospectively evaluated for TST conversion and active tuberculosis (TB) after six months of exposition to TNFi. Two groups were compared: patients who repeated TST (TST-repetition) during the follow-up and patients who did not (non-TST-repetition). Results A total of 355 CIA patients on TNFi were screened and 138 (38.9%) did not fulfill the inclusion criteria. Of the remaining 217 CIA patients, 81 (37.3%) repeated TST during TNFi treatment. TST conversion rate was observed in 18 (22.2%) patients without significant differences among CIA (p = 0.578). The number of TB cases was low (n = 10; 4.6%) and was similar in TST-repetition and non-TST-repetition groups [2 (2.5%) vs. 8 (5.9%), p = 0.328]. Of note, 30% of active TB occurred early (6–12 months of TNFi exposure) and the median (full range) time to incident TB was 1.3 (0.6–10.6) years, whereas the median (full range) time to TST repetition was later [3.3 (0.5–13.4) years]. The incidence of active TB was lower among RA patients than AS patients [342 (95% CI 41 − 1446) vs. 1.454 (95% CI 594-2993)/100,000 patient-years, p = 0.049]. Conclusion These results indicate that TST repetition is associated with a high conversion rate, suggesting the need for recommended treatment. The delayed repetition of TST and low number of active TB cases hampered the evaluation of this strategy effectiveness to prevent active infection. Larger studies with systematic repetition patterns are necessary. In addition, the study highlights the need for a greater surveillance for TB in AS patients. Key messages TST repetition is associated with a high conversion rate for positive LTBI after long-term TNFi. Active tuberculosis diagnosis occurs early (1.3 years) during TNFi therapy. AS patients require greater surveillance for incident TB. (TST (CIA (TNFi (LTBI treatment RA, , (RA) (AS PsA (PsA (TB compared TSTrepetition (TST-repetition followup follow up nonTSTrepetition. nonTSTrepetition non . (non-TST-repetition) 35 13 38.9% 389 38 9 (38.9% criteria 21 37.3% 373 37 3 (37.3% 1 22.2% 222 22 2 (22.2% 0.578. 0578 0.578 0 578 0.578) n 10 4.6% 46 4 6 [ 2.5% 25 5 (2.5% vs 5.9%, 59 5.9% (5.9%) 0.328. 0328 0.328 328 0.328] note 30 6–12 612 12 (6–1 exposure full range 1. 0.6–10.6 06106 (0.6–10.6 years 3.3 33 [3. 0.5–13.4 05134 (0.5–13.4 years. years] 342 [34 95% 95 (95 1446 1454 454 1.45 5942993/100,000 5942993100000 594 2993 /100,000 100 000 594-2993)/100,00 patientyears, patientyears patient patient-years 0.049. 0049 0.049 049 0.049] necessary addition longterm long term (1. therapy (RA (non-TST-repetition 38.9 (38.9 37.3 (37.3 22.2 (22.2 057 0.57 57 4.6 2.5 (2.5 5.9 (5.9% 032 0.32 32 6–1 61 (6– 0.6–10. 0610 (0.6–10. 3. [3 0.5–13. 0513 (0.5–13. 34 (9 144 145 45 1.4 5942993 5942993/100,00 594299310000 299 100000 /100,00 00 594-2993)/100,0 004 0.04 04 (1 38. (38. 37. (37. 22. (22. 05 0.5 4. 2. (2. 5. (5.9 03 0.3 6– (6 0.6–10 061 (0.6–10 0.5–13 051 (0.5–13 ( 14 594299 5942993/100,0 59429931000 29 10000 /100,0 594-2993)/100, 0.0 (38 (37 (22 0. (2 (5. 0.6–1 06 (0.6–1 0.5–1 (0.5–1 59429 5942993/100, 5942993100 1000 /100, 594-2993)/100 (3 (5 0.6– (0.6– 0.5– (0.5– 5942 5942993/100 594299310 /100 594-2993)/10 0.6 (0.6 (0.5 5942993/10 59429931 /10 594-2993)/1 (0. 5942993/1 /1 594-2993)/ (0 5942993/ / 594-2993) 594-2993 594-299 594-29 594-2 594-

https://doi.org/10.1186/s42358-024-00406-7

Socioeconomic factors and COVID-19 mortality in immune-mediated rheumatic diseases patients: regional analysis from Argentina, Mexico and Brazil COVID19 COVID 19 COVID-1 immunemediated immune mediated patients Argentina COVID1 1 COVID-
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Martinez-Martinez, Marco Ulises

; Isnardi, Carolina Ayelen

; Alpizar-Rodriguez, Deshiré

; Pons-Estel, Guillermo Javier

; Virasoro, Belén María

; Alfaro, María Agustina

; Petkovic, Ingrid

; Quintana, Rosana

; Berbotto, Guillermo

; Salinas, María Jezabel Haye

; Ornella, Sofía

; Pera, Mariana

; Colunga-Pedraza, Iris Jazmín

; Irazoque-Palazuelos, Fedra

; Reyes-Cordero, Greta

; Rodriguez-Reyna, Tatiana S

; Veloz-Aranda, Jose Antonio

; Skinner-Taylor, Cassandra Michele

; Juárez-Mora, Ingrid Maribel

; Silveira, Luis H.

; Marques, Claudia Diniz Lopes

; Xavier, Ricardo Machado

; Kakehasi, Adriana Maria

; Gomides, Ana Paula

; Reis-Neto, Edgard Torres dos

; Pileggi, Gecilmara Salviato

; Ferreira, Gilda Aparecida

; Mota, Licia Maria Henrique da

; Pinheiro, Marcelo Medeiros

; Calderaro, Débora Cerqueira

Advances in Rheumatology

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2024, Volume 64 elocation 78

Resumo: En | Texto: En | PDF: En

Abstract Background SARS-CoV-2 infection has become a major international issue, not only from a medical point of view, but also social, economic and political. Most of the available information comes from the United States, Europe, and China, where the population and the socioeconomic status are very different from Latin American countries. This study evaluates the effect of regional socioeconomic characteristics on mortality due SARS-CoV-2 infection in patients with immune-mediated rheumatic diseases (IMRD) from Argentina, Mexico and Brazil. Methods Data from three national registries, SAR-COVID (Argentina), CMR-COVID (Mexico) and ReumaCoV-Brasil (Brazil), were combined. Adult IMRD patients with SARS-CoV-2 infection were recruited. National data for each province/state, including population density, number of physicians per inhabitant, income, unemployment, GINI index, Municipal Human Development Index (MHDI), stringency index, vaccination rate and most frequent viral strains per period were assessed as risk factors for mortality due to COVID-19. Results A total of 4744 patients were included, 2534 (53.4%) from SAR-COVID, 1166 (24.6%) from CMRCOVID and 1044 (22.0%) from ReumaCoV-Brasil. Mortality due to COVID-19 was 5.4%. In the multivariable analysis, higher number of physicians per 1000 inhabitants and being infected during the vaccination period of each country were associated with lower mortality. After adjustment for socioeconomic factors, there was no association with country of residence and mortality. Conclusion These findings corroborate the complex interplay between socioeconomic factors, rheumatic disease activity, and regional disparities as determinants of death due to COVID-19 in Argentina, Brazil and Mexico. Thus, this research provides valuable insights for guiding public health policies and clinical practice in the ongoing fight against the COVID-19 pandemic. SARSCoV2 SARSCoV SARS CoV 2 SARS-CoV- issue view social political States Europe China countries immunemediated immune mediated (IMRD Argentina registries SARCOVID SAR COVID , (Argentina) CMR (Mexico ReumaCoVBrasil ReumaCoV Brasil Brazil, (Brazil) combined recruited provincestate province state province/state density inhabitant income unemployment index MHDI, MHDI (MHDI) COVID19. COVID19 19. 19 474 included 253 53.4% 534 53 4 (53.4% SARCOVID, COVID, 116 24.6% 246 24 6 (24.6% 104 22.0% 220 22 0 (22.0% ReumaCoVBrasil. Brasil. COVID-1 54 5 5.4% analysis 100 activity Thus pandemic SARS-CoV (Argentina (Brazil (MHDI COVID1 1 47 25 53.4 (53.4 11 24.6 (24.6 10 22.0 (22.0 COVID- 5.4 53. (53. 24. (24. 22. (22. 5. (53 (24 (22 (5 (2 (

https://doi.org/10.1186/s42358-024-00418-3

HLA-B27 positivity in a large miscegenated population of 5,389,143 healthy blood marrow donors in Brazil HLAB27 HLAB HLA B27 B HLA-B2 5389143 5 389 143 5,389,14 HLAB2 B2 HLA-B 538914 38 14 5,389,1 53891 3 1 5,389, 5389 5,389 538 5,38 53 5,3 5,
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Resende, Gustavo Gomes

; Saad, Carla Gonçalves Schahin

; Oliveira, Danielli Cristina Muniz de

; Bueno Filho, Julio Silvio de Sousa

; Sampaio-Barros, Percival Degrava

; Pinheiro, Marcelo de Medeiros

Advances in Rheumatology

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2023, Volume 63 elocation 16

Resumo: En | Texto: En | PDF: En

Abstract Background The prevalence of HLA-B27 gene positivity in healthy Caucasian communities varies between 8 and 14%. However, there is a lack of information in countries with a high rate of miscegenation, such as Brazil. Aim To estimate the frequency of HLA-B27 in the Brazilian general population using a large national registry database. Methods This is a cross-sectional ecological study using the Brazilian Registry of Volunteer Bone Marrow Donors (REDOME) database on HLA-B27 allelic frequency and proportion of positives of healthy donors (18–60 years old). Data were analyzed according to sex, age, race (by self-reported skin color recommended by the Brazilian Institute of Geography and Statistics - IBGE), and geographic region of residence. Results From 1994 to 2022, a total of 5,389,143 healthy bone marrow donors were included. The overall positivity for HLA-B27 was 4.35% (CI 95% 4.32–4.37%), regardless of sex and age (57.2% were women, mean age was 41.7yo). However, there was a difference between races: 4.85% in Whites; 2.92% in Blacks; 3.76% in Pardos (Browns i.e. mixed races); 3.95% in Amarelos (Yellows i.e. Asian Brazilians); and 3.18% in Indigenous. There was also a difference regarding geographic region of residence (North: 3.62%; Northeast: 3.63%; Southeast: 4.29%; Midwest: 4.5% and 5.25% in South). The homozygosity rate for the HLA-B27 was 1.32% of all the positives and only 0.06% in the general population. Conclusions Our findings provide the first Brazilian national prevalence for HLA-B27 in 4.35%. There is a gradient gene positivity from North to South, suggesting that the genetic background related to the miscegenation due to colonization, slavery, and some later waves of immigration together with internal migratory flows, could explain our findings. HLAB27 HLAB HLA B27 B HLA-B2 14 14% However Brazil crosssectional cross sectional REDOME (REDOME 18–60 1860 18 60 (18–6 old. old . old) selfreported self reported IBGE, IBGE , IBGE) 199 2022 5389143 5 389 143 5,389,14 included 435 4 35 4.35 CI 95 4.32–4.37%, 432437 4.32–4.37% 32 37 4.32–4.37%) 57.2% 572 57 2 (57.2 women 41.7yo. 417yo yo 41.7yo 41 7yo 41.7yo) races 485 85 4.85 Whites 292 92 2.92 Blacks 376 3 76 3.76 Browns ie i e i.e races) 395 3.95 Yellows Brazilians Brazilians) 318 3.18 Indigenous (North 3.62% 362 62 Northeast 3.63% 363 63 Southeast 4.29% 429 29 Midwest 45 4.5 525 25 5.25 South. South South) 132 1 1.32 006 0 06 0.06 colonization slavery flows HLAB2 B2 HLA-B 18–6 186 6 (18– 19 202 538914 38 5,389,1 43 4.3 9 43243 4.32–4.37 57.2 (57. 48 4.8 2.9 7 3.7 39 3.9 31 3.1 3.62 36 3.63 4.29 42 4. 52 5.2 13 1.3 00 0.0 18– (18 20 53891 5,389, 4324 4.32–4.3 57. (57 2. 3. 3.6 4.2 5. 1. 0. (1 5389 5,389 432 4.32–4. (5 ( 538 5,38 4.32–4 53 5,3 4.32– 5, 4.32

https://doi.org/10.1186/s42358-023-00302-6

Extra-musculoskeletal manifestations driving the therapeutic decision-making in patients with Spondyloarthritis: a 12-month follow-up prospective cohort study Extramusculoskeletal Extra musculoskeletal decisionmaking decision making Spondyloarthritis 12month month 12 followup follow up 1
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Annunciato, Danielle dos Reis

; Oliveira, Thauana Luiza

; Magalhães, Vanessa Oliveira

; Pinheiro, Marcelo de Medeiros

Advances in Rheumatology

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2023, Volume 63 elocation 44

Resumo: En | Texto: En | PDF: En

Abstract Background The extra-musculoskeletal manifestations (EMMs) such as recurrent acute anterior uveitis (rAAU), psoriasis (Ps), and inflammatory bowel disease (IBD), are related to the Spondyloarthritis (SpA), as well as they are associated with disease activity and poor prognosis. However, there are no data addressing its relevance regarding therapeutic decision-making in clinical practice. Objective To evaluate the impact of EMMs to drive the treatment decision-making in patients with SpA in a 12-month follow-up. Patients and methods SpA patients, according to the axial and peripheral ASAS classification criteria, as well as CASPAR criteria, with any active EMM, defined as main entry criteria, were included in this longitudinal cohort study. Individuals with a history of any disease or condition that could be associated with some of the studied endpoints, including neoplasms and infectious diseases, were excluded. Specific tools related to each EMM, including Psoriasis Area Severity Index (PASI), ophthalmologic evaluation, according to the Standardization of Uveitis Nomenclature (SUN) criteria, and gut complaints were used at baseline and during the 3-, 6- and 12-month of follow-up as outcomes measures over time. Descriptive and inferential analyses were used appropriately, including Pearson’s correlation test, chi-squared test, and ANOVA. P value less than 0.05 was considered as significant. Results A total of 560 patients were enrolled, of whom 472 meet the eligibility criteria. The majority (N = 274; 59.6%) had one or more EMM related to SpA umbrella concept. Among the EMM, the one that most influenced therapeutic decision-making was psoriasis (28.5%), followed by uveitis (17.5%) and IBD (5.5%), regardless of musculoskeletal manifestations. Clinical improvement of EMMs outcomes was observed in most patients over 12-month follow-up, especially in those with rAAU and IBD (P < 0.001). Conclusion Our results showed that EMMs guided the therapeutic decision-making in half of SpA patients, regardless of musculoskeletal condition, suggesting the inter-disciplinarity among the rheumatologist, ophthalmologist, dermatologist, and gastroenterologist plays a crucial role to manage them. extramusculoskeletal extra (EMMs rAAU, , (rAAU) Ps, Ps (Ps) IBD, (IBD) SpA, (SpA) prognosis However decisionmaking decision making practice 12month month 12 followup. followup follow up. up criteria study endpoints diseases excluded PASI, PASI (PASI) evaluation SUN (SUN 3, 3 3- 6 time appropriately Pearsons Pearson s test chisquared chi squared ANOVA 005 0 05 0.0 significant 56 enrolled 47 N 274 59.6% 596 59 concept 28.5%, 285 28.5% 28 5 (28.5%) 17.5% 175 17 (17.5% 5.5%, 55 5.5% (5.5%) followup, up, 0.001. 0001 0.001 . 001 0.001) interdisciplinarity inter disciplinarity rheumatologist ophthalmologist dermatologist them (rAAU (Ps (IBD (SpA 1 (PASI 00 0. 4 27 59.6 28.5 2 (28.5% 17.5 (17.5 5.5 (5.5% 000 0.00 59. 28. (28.5 17. (17. 5. (5.5 (28. (17 (5. (28 (1 (5 (2 (

https://doi.org/10.1186/s42358-023-00324-0

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

Factors associated with hospitalizations for Covid-19 in patients with rheumatoid arthritis: data from the Reumacov Brazil registry
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Gomides, Ana Paula Monteiro

; Albuquerque, Cleandro Pires de

; Mota, Licia Maria Henrique da

; Devidé, Guilherme

; Dias, Laiza Hombre

; Duarte, Angela Luzia Branco Pinto

; Giovelli, Raquel Altoé

; Karnopp, Thais Evelyn

; Lima, Hugo Deleon de

; Marinho, Adriana

; Oliveira, Marianne Schrader de

; Omura, Felipe

; Ranzolin, Aline

; Resende, Gustavo

; Ribeiro, Francinne Machado

; Ribeiro, Sandra Lúcia Euzébio

; Sacilotto, Nathália de Carvalho

; Santos, Wander Gonzaga dos

; Shinjo, Samuel Katsuyuki

; Studart, Samia Araujo de Sousa

; Teixeira, Flávia Patricia Sena

; Yazbek, Michel Alexandre

; Ferreira, Gilda Aparecida

; Monticielo, Odirlei A.

; Paiva, Eduardo

; Pileggi, Gecilmara Cristina Salviato

; Reis Neto, Edgard Torres dos

; Pinheiro, Marcelo de Medeiros

; Marques, Claudia D. L.

Advances in Rheumatology

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2022, Volume 62 elocation 13

Resumo: En | Texto: En | PDF: En

Abstract Background: Patients using immunosuppressive drugs may have unfavorable results after infections. However, there is a lack of information regarding COVID 19 in these patients, especially in patients with rheumatoid arthritis (RA). Therefore, the aim of this study was to evaluate the risk factors associated with COVID 19 hospitalizations in patients with RA. Methods: This multicenter, prospective cohort study is within the ReumaCoV Brazil registry and included 489 patients with RA. In this context, 269 patients who tested positive for COVID 19 were compared to 220 patients who tested negative for COVID 19 (control group). All patient data were collected from the Research Electronic Data Capture database. Results: The participants were predominantly female (90.6%) with a mean age of 53 ±12 years. Of the patients with COVID 19, 54 (20.1%) required hospitalization. After multiple adjustments, the final regression model showed that heart disease (OR =4.61, 95% CI 1.06–20.02. P < 0.001) and current use of glucocorticoids (OR =20.66, 95% CI 3.09–138. P < 0.002) were the risk factors associated with hospitalization. In addition, anosmia was associated with a lower chance of hospitalization (OR =0.26; 95% CI 0.10–0.67, P < 0.005). Conclusion: Our results demonstrated that heart disease and the use of glucocorticoids were associated with a higher number of hospital admissions for COVID 19 in patients with RA. Trial registration: Brazilian Registry of Clinical Trials RBR 33YTQC.

https://doi.org/10.1186/s42358-022-00244-5

10.

Official Position of the Brazilian Association of Bone Assessment and Metabolism (ABRASSO) on the evaluation of body composition by densitometry—part II (clinical aspects): interpretation, reporting, and special situations
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Maeda, Sergio Setsuo

; Albergaria, Ben-Hur

; Szejnfeld, Vera Lúcia

; Lazaretti-Castro, Marise

; Arantes, Henrique Pierotti

; Ushida, Marcela

; Domiciano, Diogo Souza

; Pereira, Rosa Maria Rodrigues

; Marin-Mio, Rosângela Villa

; Oliveira, Mônica Longo de

; Mendonça, Laura Maria Carvalho de

; Prado, Mirley do

; Souza, Guilherme Cardenaz de

; Palchetti, Cecília Zanin

; Sarni, Roseli Oselka Saccardo

; Terreri, Maria Teresa

; Castro, Luiz Claudio Gonçalves de

; Artoni, Silvana Martinez Baraldi

; Amoroso, Lizandra

; Karcher, Débora Emy

; Prado, Carla M.

; Gonzalez, Maria Cristina

; Pinheiro, Marcelo de Medeiros

Advances in Rheumatology

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2022, Volume 62 elocation 11

Resumo: En | Texto: En | PDF: En

Abstract Objective: To present an updated and evidence-based guideline for the use of dual-energy x-ray absorptiometry (DXA) to assess body composition in clinical practice. Materials and methods: This Official Position was developed by the Scientific Committee of the Brazilian Association of Bone Assessment and Metabolism ( Associação Brasileira de Avaliação Óssea e Osteometabolismo , ABRASSO) and experts in the field who were invited to contribute to the preparation of this document. The authors searched current databases for relevant publications in the area of body composition assessment. In this second part of the Official Position, the authors discuss the interpretation and reporting of body composition parameters assessed by DXA and the use of DXA for body composition evaluation in special situations, including evaluation of children, persons with HIV, and animals. Conclusion: This document offers recommendations for the use of DXA in body composition evaluation, including indications, interpretation, and applications, to serve as a guiding tool in clinical practice and research for health care professionals in Brazil.

https://doi.org/10.1186/s42358-022-00240-9

11.

Official position of the Brazilian Association of Bone Assessment and Metabolism (ABRASSO) on the evaluation of body composition by densitometry: part I (technical aspects)— general concepts, indications, acquisition, and analysis
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Maeda, Sergio Setsuo

; Peters, Barbara Santarosa Emo

; Martini, Lígia Araújo

; Antunes, Hannah Karen Moreira

; Gonzalez, Maria Cristina

; Arantes, Henrique Pierotti

; Prado, Carla M.

; Pinto, Camila Lemos

; Araújo, Iana Mizumukai de

; Paula, Francisco José Albuquerque de

; Borges, Joao Lindolfo Cunha

; Albergaria, Ben-Hur

; Ushida, Marcela

; Souza, Guilherme Cardenaz de

; Mendonça, Laura Maria Carvalho de

; Prado, Mirley do

; Pinheiro, Marcelo de Medeiros

Advances in Rheumatology

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2022, Volume 62 elocation 7

Resumo: En | Texto: En | PDF: En

Abstract Objective: To review the technical aspects of body composition assessment by dual-energy X-ray absorptiometry (DXA) and other methods based on the most recent scientific evidence. Materials and methods: This Official Position is a result of efforts by the Scientific Committee of the Brazilian Association of Bone Assessment and Metabolism (Associação Brasileira de Avaliação Óssea e Osteometabolismo, ABRASSO) and health care professionals with expertise in body composition assessment who were invited to contribute to the preparation of this document. The authors searched current databases for relevant publications. In this first part of the Official Position, the authors discuss the different methods and parameters used for body composition assessment, general principles of DXA, and aspects of the acquisition and analysis of DXA scans. Conclusion: Considering aspects of accuracy, precision, cost, duration, and ability to evaluate all three compartments, DXA is considered the gold-standard method for body composition assessment, particularly for the evaluation of fat mass. In order to ensure reliable, adequate, and reproducible DXA reports, great attention is required regarding quality control procedures, preparation, removal of external artifacts, imaging acquisition, and data analysis and interpretation.

https://doi.org/10.1186/s42358-022-00241-8

12.

Posicionamento Brasileiro sobre o Uso da Multimodalidade de Imagens na Cardio-Oncologia – 2021
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Melo, Marcelo Dantas Tavares de

; Paiva, Marcelo Goulart

; Santos, Maria Verônica Câmara

; Rochitte, Carlos Eduardo

; Moreira, Valéria de Melo

; Saleh, Mohamed Hassan

; Brandão, Simone Cristina Soares

; Gallafrio, Claudia Cosentino

; Goldwasser, Daniel

; Gripp, Eliza de Almeida

; Piveta, Rafael Bonafim

; Silva, Tonnison Oliveira

; Santo, Thais Harada Campos Espirito

; Ferreira, Waldinai Pereira

; Salemi, Vera Maria Cury

; Cauduro, Sanderson A.

; Barberato, Silvio Henrique

; Lopes, Heloísa M. Christovam

; Pena, José Luiz Barros

; Rached, Heron Rhydan Saad

; Miglioranza, Marcelo Haertel

; Pinheiro, Aurélio Carvalho

; Vrandecic, Bárbara Athayde Linhares Martins

; Cruz, Cecilia Beatriz Bittencourt Viana

; Nomura, César Higa

; Cerbino, Fernanda Mello Erthal

; Costa, Isabela Bispo Santos da Silva

; Coelho Filho, Otavio Rizzi

; Carneiro, Adriano Camargo de Castro

; Burgos, Ursula Maria Moreira Costa

; Fernandes, Juliano Lara

; Uellendahl, Marly

; Calado, Eveline Barros

; Senra, Tiago

; Assunção, Bruna Leal

; Freire, Claudia Maria Vilas

; Martins, Cristiane Nunes

; Sawamura, Karen Saori Shiraishi

; Brito, Márcio Miranda

; Jardim, Maria Fernanda Silva

; Bernardes, Renata Junqueira Moll

; Diógenes, Tereza Cristina

; Vieira, Lucas de Oliveira

; Mesquita, Claudio Tinoco

; Lopes, Rafael Willain

; Segundo Neto, Elry Medeiros Vieira

; Rigo, Letícia

; Marin, Valeska Leite Siqueira

; Santos, Marcelo José

; Grossman, Gabriel Blacher

; Quagliato, Priscila Cestari

; Alcantara, Monica Luiza de

; Teodoro, José Aldo Ribeiro

; Albricker, Ana Cristina Lopes

; Barros, Fanilda Souto

; Amaral, Salomon Israel do

; Porto, Carmen Lúcia Lascasas

; Barros, Marcio Vinícius Lins

; Santos, Simone Nascimento dos

; Cantisano, Armando Luís

; Petisco, Ana Cláudia Gomes Pereira

; Barbosa, José Eduardo Martins

; Veloso, Orlando Carlos Glória

; Spina, Salvador

; Pignatelli, Ricardo

; Hajjar, Ludhmilla Abrahão

; Kalil Filho, Roberto

; Lopes, Marcelo Antônio Cartaxo Queiroga

; Vieira, Marcelo Luiz Campos

; Almeida, André Luiz Cerqueira

Arquivos Brasileiros de Cardiologia

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Out 2021, Volume 117 Nº 4 Páginas 845 - 909

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

https://doi.org/10.36660/abc.20200266 103 downloads

13.

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

14.

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

; Palominos, Penelope Esther

; Anti, Sônia Maria Alvarenga

; Assad, Rodrigo Luppino

; Gonçalves, Rafaela Silva Guimarães

; Chiereghin, Adriano

; Lyrio, Andre Marun

; Ximenes, Antônio Carlos

; Saad, Carla Gonçalves

; Gonçalves, Célio Roberto

; Kohem, Charles Lubianca

; Marques, Cláudia Diniz Lopes

; Schainberg, Cláudia Goldenstein

; Meirelles, Eduardo de Souza

; Resende, Gustavo Gomes

; Pieruccetti, Lenise Brandao

; Keiserman, Mauro Waldemar

; Yazbek, Michel Alexandre

; Sampaio-Barros, Percival Degrava

; Lage, Ricardo da Cruz

; Bonfiglioli, Rubens

; Oliveira, Thauana Luíza

; Azevedo, Valderílio Feijó

; Bianchi, Washington Alves

; Bernardo, Wanderley Marques

; Simões, Ricardo dos Santos

; Pinheiro, Marcelo de Medeiros

; Campanholo, Cristiano Barbosa

Advances in Rheumatology

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2021, Volume 61 elocation 69

Resumo: En | Texto: En | PDF: En

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

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

15.

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

; Marques, Claudia Diniz Lopes

; Oliveira, Thauana Luiza

; Resende, Gustavo Gomes

; Kohem, Charles Lubianca

; Saad, Carla Gonçalves

; Ximenes, Antônio Carlos

; Gonçalves, Célio Roberto

; Bianchi, Washington Alves

; Meirelles, Eduardo de Souza

; Keiserman, Mauro Waldemar

; Chiereghin, Adriano

; Campanholo, Cristiano Barbosa

; Lyrio, André Marun

; Schainberg, Cláudia Goldenstein

; Pieruccetti, Lenise Brandao

; Yazbek, Michel Alexandre

; Palominos, Penelope Esther

; Goncalves, Rafaela Silva Guimarães

; Assad, Rodrigo Luppino

; Bonfiglioli, Rubens

; Lima, Sônia Maria Alvarenga Anti Loduca

; Carneiro, Sueli

; Azevedo, Valderílio Feijó

; Albuquerque, Cleandro Pires

; Bernardo, Wanderley Marques

; Sampaio-Barros, Percival Degrava

; Pinheiro, Marcelo de Medeiros

Advances in Rheumatology

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2021, Volume 61 elocation 4

Resumo: En | Texto: En | PDF: En

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

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

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