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Evaluation of peripheral neuropathy in lower limbs of patients with rheumatoid arthritis and its relation to fall risk
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Pereira, Fabio de Araújo

; Lourenço, Mariana de Almeida

; Assis, Marcos Renato de

Advances in Rheumatology

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2022, Volume 62 elocation 9

Resumo: En | Texto: En | PDF: En

Abstract Background: Rheumatoid Arthritis (RA) is a chronic disabling systemic disease characterized by joint inflammation, and extra-articular manifestations, including peripheral neuropathy, a condition that can be associated with changes in muscle strength, proprioception and postural balance contributing for the risk of falls. The objective of this study is to analyze the incidence of peripheral neuropathy in patients with RA and its association with the occurrence of falls. Methods: Patients were assessed by an electroneuromyography (ENMG) exam and by a questionnaire on accidental falls occurrence in the previous 12 months. They were also assessed on balance by the Short Physical Performance Battery (SPPB), functionality by the Health Assessment Questionnaire (HAQ), disease activity by the Disease Activity Score (DAS-28), neuropathic pain by the Questionnaire for the Diagnosis of Neuropathic Pain (DN4), and cutaneous sensitivity of the feet by the monofilament testing of Semmes–Weinstein. Monthly calls on falls were made in the subsequent six months. Data analysis was performed using the Shapiro–Wilk test for normality and Spearman, Chi-square, and T-student correlation tests, with a significant P level ≤0.05. Results: A sample of 33 patients were evaluated. The incidence of peripheral neuropathy was 48.5%, of which 68.7% were axonal and 31.3% myelinic. The sensorimotor type was present in 64.7%, motor in 17.6%, and sensorial in 11.7% of the cases. Neuropathy was associated to balance (P = 0.026), neuropathic pain (P =0.016), deep tendon reflexes absence (P =0,049), altered skin sensitivity of the feet (P =0.029) and fear of falling (P =0.001). No association was found between peripheral neuropathy and age, gender, disease activity, or functionality. No significant association was found between peripheral neuropathy and occurrence of falls, in a 12-month retrospective and 6-month prospective evaluation. Conclusion: Peripheral neuropathy has a high incidence in patients with RA, and is related to neuropathic pain, altered postural balance, but not to the occurrence of falls.

https://doi.org/10.1186/s42358-022-00238-3

Treatment data from the Brazilian fibromyalgia registry (EpiFibro)
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Assis, Marcos Renato de

; Paiva, Eduardo dos Santos

; Helfenstein Jr, Milton

; Heymann, Roberto Ezequiel

; Pollak, Daniel Feldman

; Provenza, Jose Roberto

; Ranzolin, Aline

; Rezende, Marcelo Cruz

; Ribeiro, Luiz Severiano

; Souza, Eduardo José R.

; Martinez, José Eduardo

Advances in Rheumatology

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2020, Volume 60 elocation 09

Resumo: En | Texto: En | PDF: En

Abstract Background: EpiFibro (Brazilian Epidemiological Study of Fibromyalgia) was created to study patients with fibromyalgia (FM). Patients were included since 2011 according to the classification criteria for FM of the American College of Rheumatology of 1990 (ACR1990). Objective: To analyze the therapeutic measures prescribed by Brazilian physicians. Materials and methods: Cross-sectional study of a multicenter cohort. The therapeutic measures were described using descriptive statistics. Results: We analyzed 456 patients who had complete data in the registry. The mean age was 54.0 ± 11.9 years; 448 were women (98.2%). Almost all patients (98.4%) used medications, 62.7% received health education, and less than half reported practicing physical exercise; these modalities were often used in combination. Most patients who practiced exercises practiced aerobic exercise only, and a significant portion of patients combined it with flexibility exercises. The most commonly used medication was amitriptyline, followed by cyclobenzaprine, and a minority used medication specifically approved for FM, such as duloxetine and pregabalin, either alone or in combination. Combinations of two or three medications were observed, with the combination of fluoxetine and amitriptyline being the most frequent (18.8%). Conclusion: In this evaluation of the care of patients with FM in Brazil, it was found that the majority of patients are treated with a combination of pharmacological measures. Non-pharmacological methods are underused, with aerobic exercise being the most commonly practiced exercise type. The most commonly prescribed single drug was amitriptyline, and the most commonly prescribed combination was fluoxetine and amitriptyline. Drugs specifically approved for FM are seldom prescribed.

https://doi.org/10.1186/s42358-019-0108-2 665 downloads

Brazilian recommendations on the safety and effectiveness of the yellow fever vaccination in patients with chronic immune-mediated inflammatory diseases
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Pileggi, Gecilmara Salviato

; Mota, Licia Maria Henrique Da

; Kakehasi, Adriana Maria

; Souza, Alexandre Wagner De

; Rocha, Aline

; Melo, Ana Karla Guedes de

; Fonte, Caroline Araujo M. da

; Bortoletto, Cecilia

; Brenol, Claiton Viegas

; Marques, Claudia Diniz Lopes

; Zaltman, Cyrla

; Borba, Eduardo Ferreira

; Reis, Enio Ribeiro

; Freire, Eutilia Andrade Medeiros

; Klumb, Evandro Mendes

; Christopoulos, Georges Basile

; Laurindo, Ieda Maria M.

; Ballalai, Isabella

; Costa, Izaias Pereira Da

; Michelin, Lessandra

; Valadares, Lilian David de Azevêdo

; Chebli, Liliana Andrade

; Lacerda, Marcus

; Toscano, Maria Amazile Ferreira

; Yazbek, Michel Alexandre

; Vieira, Rejane Maria R. De Abreu

; Magalhães, Renata

; Kfouri, Renato

; Richtmann, Rosana

; Merenlender, Selma Da Costa Silva

; Valim, Valeria

; Assis, Marcos Renato De

; Kowalski, Sergio Candido

; Trevisani, Virginia Fernandes Moça

Advances in Rheumatology

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2019, Volume 59 elocation 17

Resumo: En | Texto: En | PDF: En

Abstract Background: In Brazil, we are facing an alarming epidemic scenario of Yellow fever (YF), which is reaching the most populous areas of the country in unvaccinated people. Vaccination is the only effective tool to prevent YF. In special situations, such as patients with chronic immune-mediated inflammatory diseases (CIMID), undergoing immunosuppressive therapy, as a higher risk of severe adverse events may occur, assessment of the risk-benefit ratio of the yellow fever vaccine (YFV) should be performed on an individual level. Main body of the abstract: Faced with the scarcity of specific orientation on YFV for this special group of patients, the Brazilian Rheumatology Society (BRS) endorsed a project aiming the development of individualized YFV recommendations for patients with CIMID, guided by questions addressed by both medical professionals and patients, followed an internationally validated methodology (GIN-McMaster Guideline Development). Firstly, a systematic review was carried out and an expert panel formed to take part of the decision process, comprising BRS clinical practitioners, as well as individuals from the Brazilian Dermatology Society (BDS), Brazilian Inflammatory Bowel Diseases Study Group (GEDIIB), and specialists on infectious diseases and vaccination (from Tropical Medicine, Infectious Diseases and Immunizations National Societies); in addition, two representatives of patient groups were included as members of the panel. When the quality of the evidence was low or there was a lack of evidence to determine the recommendations, the decisions were based on the expert opinion panel and a Delphi approach was performed. A recommendation was accepted upon achieving ≥80% agreement among the panel, including the patient representatives. As a result, eight recommendations were developed regarding the safety of YFV in patients with CIMID, considering the immunosuppression degree conferred by the treatment used. It was not possible to establish recommendations on the effectiveness of YFV in these patients as there is no consistent evidence to support these recommendations. Conclusion: This paper approaches a real need, assessed by clinicians and patient care groups, to address specific questions on the management of YFV in patients with CIMID living or traveling to YF endemic areas, involving specialists from many areas together with patients, and might have global applicability, contributing to and supporting vaccination practices. We recommended a shared decision-making approach on taking or not the YFV.

https://doi.org/10.1186/s42358-019-0056-x 1111 downloads

Hand strength in patients with RA correlates strongly with function but not with activity of disease
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Silva, Graziela Sferra da

; Lourenço, Mariana de Almeida

; Assis, Marcos Renato de

Advances in Rheumatology

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2018, Volume 58 elocation 20

Resumo: En | Texto: En | PDF: En

Abstract Background: Rheumatoid arthritis (RA) is a systemic autoimmune disease characterized by chronic inflammation of the joints, especially of the hands. The evaluation of handgrip strength (HS) and pinch strength can be useful to detect reduction in hand function in RA patients. The aim of the study was to compare HS and pinch strength between RA patients (RA Group - RAG) and a non-RA control group (CG) and to relate HS and pinch strength to functional capacity, duration and disease activity in the RAG. Methods: A cross-sectional case control study. The RAG was assessed for disease activity by the Disease Activity Score (DAS-28); for functional capacity by the Health Assessment Questionnaire (HAQ), the Cochin Hand Functional Scale (CHFS) questionnaire, and the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire; and for HS and pinch strength (2-point tip-to-tip, lateral or key, and 3-point) using Jamar® and pinch gauge dynamometers, respectively. Associations were analyzed by Pearson and Spearman tests, and groups were compared by the independent samples t test, with a significance level of P < 0.05. Results: The convenience sample included 121 rheumatoid patients and a control group matched by age, sex, and body mass index. The RAG showed lower strength values compared with the CG in all measurements (P < 0.01, 95% CI) and these values were associated with worse performance in the functional questionnaires and greater disease activity and duration. There was a strong correlation among the functional assessment instruments. Conclusions: The decrease in grip and pinch strength, easily measured by portable dynamometers, is a strong indicator of functional disability in RA patients.

https://doi.org/10.1186/s42358-018-0020-1 365 downloads

Characterization of falls in adults with established rheumatoid arthritis and associated factors
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Lourenço, Mariana de Almeida

; Carli, Flávia Vilas Boas Ortiz

; Assis, Marcos Renato de

Advances in Rheumatology

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2018, Volume 58 elocation 16

Resumo: En | Texto: En | PDF: En

Abstract Background: Rheumatoid arthritis patients may have an increased risk of falls due to changes caused by the disease such as muscle weakness, joint impairment, reduced mobility and postural instability. The aim of this study was to prospectively analyze the occurrence of falls in RA patients and its risk factors. Methods: A cohort of 86 RA patients were assessed over 1 year for disease activity using the Disease Activity Score (DAS-28), for functionality using the Health Assessment Questionnaire (HAQ), for the characterization of falls and for the use of medications, and they were subjected to the Berg Balance Scale (Berg), Timed Up and Go (TUG), 6-Minute Walk (6MWT) and Short Physical Performance Battery (SPPB) tests. The Kolmogorov-Smirnov, Spearman's correlation, Student's t, Mann-Whitney and chi-square tests were performed with a significance level of P ≤ 0.05. Results: A total of 86 patients were evaluated, of which 48.8% had at least one fall and 75.6% reported having a fear of falling. No association of falls with age, disease duration, functional capacity, disease activity or physical performance was found. Patients with poorer performance in the physical tests had more functional impairment, higher disease activity and more advanced age. No differences in physical or functional performance, disease activity, gender or fear of falling were found between fallers and non-fallers; only a greater amount of medications used was found in the group of fallers. Conclusions: The occurrence of falls was high and associated with a previous history of falls and polypharmacy, with no association with disease activity or duration, functional capacity, physical performance, age or gender.

https://doi.org/10.1186/s42358-018-0021-0 343 downloads

DUPLO-PRODUTO E VARIAÇÃO DA FREQUÊNCIA CARDÍACA APÓS ESFORÇO ISOCINÉTICO EM ADULTOS E IDOSOS
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Antonio, Tiago Tsunoda Del

; Assis, Marcos Renato de

Revista Brasileira de Medicina do Esporte

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Set 2017, Volume 23 Nº 5 Páginas 394 - 398

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

RESUMO Introdução: O envelhecimento predispõe a alterações multissistêmicas, por exemplo, nos sistemas cardiovascular e musculoesquelético. A prática de exercício físico é um importante recurso terapêutico para retardar perdas de funções orgânicas. No entanto, existe pouco conhecimento sobre as respostas cardiovasculares durante e após o exercício isocinético em idosos. Objetivo: O objetivo deste estudo é analisar as respostas de frequência cardíaca, pressão arterial e duplo-produto em indivíduos de distintas faixas etárias submetidos ao esforço muscular isocinético. Método: O estudo foi constituído por 60 voluntários distribuídos em três faixas etárias - G1: 30 a 45 anos, G2: 45 a 60 anos e G3: 60 a 75 anos - submetidos a teste bilateral de flexão-extensão de joelhos em dinamômetro isocinético com velocidade angular de 60º/segundo para verificação das respostas hemodinâmicas. Os dados foram analisados por meio do Software Bioestat® 5.3, pelo teste de Kruskal-Wallis seguido pelo teste de Dunn para as amostras independentes e de Friedman para amostras dependentes, além da comparação das curvas de Kaplan-Meier por meio do teste de log-rank, considerando P ≤ 0,05. Resultados: O grupo de idosos (G3) apresentou maiores valores de pressão arterial sistólica, duplo-produto e tempo para o retorno à frequência cardíaca basal comparado com o grupo mais jovem (G1). Conclusão: O grupo de 60 a 75 anos de idade apresentou maior consumo de oxigênio pelo miocárdio durante e após o exercício, assim como maior tempo para retornar à FC basal em comparação com os mais jovens.

ABSTRACT Introduction: Aging predisposes to multisystem changes, for example, in the cardiovascular and musculoskeletal systems. The practice of physical exercise is an important therapeutic resource to delay losses of organic functions. However, there is little knowledge about cardiovascular responses during and after isokinetic exercise in the elderly. Objective: The objective of this study is to analyze the responses of heart rate, blood pressure, and rate-pressure product in individuals of different age groups submitted to isokinetic muscular effort. Method: The study consisted of 60 volunteers distributed into three age groups - G1: 30-45 years, G2: 45-60 years, and G3: 60-75 years - submitted to bilateral flexion-extension knee test in isokinetic dynamometer with angular velocity of 60°/second to verify hemodynamic responses. Data were analyzed using the Bioestat® 5.3 software, by the Kruskal-Wallis test followed by Dunn’s test for independent samples and Friedman’s test for dependent samples, as well as comparing the Kaplan-Meier curves by means of log-rank test, considering P≤0.05. Results: The elderly group (G3) presented higher values of systolic blood pressure, rate-pressure product, and time to return to baseline heart rate compared to the younger group (G1). Conclusion: The 60-75 year old group had higher myocardial oxygen consumption during and after the exercise, as well as longer time to return to baseline HR compared with younger patients.

RESUMEN Introducción: El envejecimiento predispone a cambios multisistémicos, por ejemplo en los sistemas cardiovascular y musculoesquelético. La práctica de ejercicio físico es un importante recurso terapéutico para retardar las pérdidas de funciones orgánicas. Sin embargo, existe poco conocimiento sobre las respuestas cardiovasculares durante y después del ejercicio isocinético en ancianos. Objetivo: El objetivo de este estudio es analizar las respuestas de frecuencia cardiaca, presión arterial y doble producto en individuos de distintas edades sometidos al esfuerzo muscular isocinético. Método: El estudio fue constituido por 60 voluntarios distribuidos en tres grupos de edad - G1: 30 a 45 años, G2: 45 a 60 años y G3: 60 a 75 años - sometidos a prueba bilateral de flexión-extensión de rodillas en dinamómetro isocinético con velocidad angular de 60º/segundo para verificación de las respuestas hemodinámicas. Los datos fueron analizados a través del software Bioestat® 5.3, utilizando la prueba de Kruskal-Wallis seguida por la prueba de Dunn para las muestras independientes y de Friedman para muestras dependientes, además de la comparación de las curvas de Kaplan-Meier con el test de log-rango, considerando P ≤ 0,05. Resultados: El grupo de ancianos (G3) presentó mayores valores de presión arterial sistólica, doble producto y tiempo para el retorno a la frecuencia cardiaca basal comparado con el grupo más joven (G1). Conclusión: El grupo de 60 a 75 años de edad presentó mayor consumo de oxígeno por el miocardio durante y después del ejercicio, así como mayor tiempo para regresar a la FC basal en comparación con los más jóvenes.

https://doi.org/10.1590/1517-869220172305165363 11955 downloads

Falls and their association with physical tests, functional capacity, clinical and demographic factors in patients with rheumatoid arthritis
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Lourenço, Mariana de Almeida

; Roma, Izabela

; Assis, Marcos Renato de

Revista Brasileira de Reumatologia

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Mai 2017, Volume 57 Nº 3 Páginas 217 - 223

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

RESUMO Objetivo: Avaliar a ocorrência de quedas reportadas por pacientes com artrite reumatoide (AR) e sua associação com a atividade da doença, capacidade funcional e aptidão física. Material e métodos: Estudo transversal com uma amostra de 97 pacientes com AR em Marília (SP), entre 2012 e 2013. Foram usados instrumentos validados na população brasileira para avaliar capacidade física e funcional. Análise dos dados com estatística descritiva, correlações de Spearman e qui-quadrado, considerado p < 0,05. Resultados: Dos pacientes, 88% eram mulheres, média de 56, anos (± 11,7), duração mediana da AR de 10 anos (P25 = 6 e P75 = 17) e média da atividade da doença 3,6 (± 1,3). Nos últimos 12 meses, 37,1% tiveram pelo menos uma queda (total 52 episódios), 74,2% relataram medo de cair, porém sem associação com a ocorrência de quedas (χ2 = 1,19, p = 0,27). Sexo, quantidade de medicamentos, idade, atividade da doença, duração da AR, capacidade funcional e testes físicos não estão associados com história de queda no último ano. Conclusões: Observou-se que a ocorrência de quedas e o medo de cair é frequente nessa população. A ocorrência de quedas nessa amostra de pacientes com AR não está relacionada à atividade da doença, à capacidade funcional e a testes de aptidão física.

ABSTRACT Objective: To evaluate the occurrence of falls reported by rheumatoid arthritis patients and its relation to disease activity, functional capacity and physical fitness. Materials and methods: A cross-sectional study constituted by a sample of 97 rheumatoid arthritis patients from the city of Marília (SP) from 2012 to 2013, were assessed for disease activity. Instruments validated for Brazilian population in order to evaluate physical and functional capacity were used. Data analysis was carried out with descriptive statistics, Spearman correlation and Chi-squared test, considering p < 0.05. Results: 88.7% were female subjects with a mean age of 56 (±11.7) years. The median duration of rheumatoid arthritis was 10 years (P25 = 6 and P75 = 17) and the mean of disease activity was 3.6 (±1.3), what was considered a moderate activity. In the last 12 months 37.1% of patients experienced at least one fall, with a total of 52 episodes, and fear of falling was reported by 74.2% of them, but this was not associated to the occurrence of a fall (χ 2 = 1.19, p = 0.27). Gender, number of medications, age, disease activity, duration of rheumatoid arthritis, functional capacity, and physical tests showed no associations with history of falls in the past year. Conclusion: It was observed that the occurrence of falls and the fear of falling are quite common in this population. The occurrence of falls in this sample of rheumatoid arthritis patients bears no relation to disease activity, functional capacity, or physical fitness tests.

https://doi.org/10.1016/j.rbre.2016.09.013 1366 downloads

EpiFibro (Brazilian Fibromyalgia Registry): data on the ACR classification and diagnostic preliminary criteria fulfillment and the follow-up evaluation
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Martinez, José Eduardo

; Paiva, Eduardo S.

; Rezende, Marcelo C.

; Heymann, Roberto E.

; Helfenstein Jr., Milton

; Ranzolin, Aline

; Provenza, Jose Roberto

; Ribeiro, Luiz Severiano

; Souza, Eduardo J.R.

; Feldman, Daniel P.

; Assis, Marcos Renato de

Revista Brasileira de Reumatologia

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Abr 2017, Volume 57 Nº 2 Páginas 129 - 133

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

Resumo Introdução: O EpiFibro (Estudo Epidemiológico Brasileiro de Fibromialgia) foi criado para estudar pacientes com fibromialgia. Foram incluídos pacientes desde 2011 de acordo com os critérios de classificação para a fibromialgia do American College of Rheumatology de 1990 (ACR1990). Objetivos: Determinar quantos pacientes ainda atendem aos critérios ACR1990 e ACR2010 em 2014; determinar a correlação entre o impacto da FM medido pelo Questionário de Impacto da Fibromialgia (FIQ) e pela Polysymptomatic Distress Scale (PDS) e descrever dados sobre a avaliação de seguimento. Métodos: Estudo transversal em uma coorte multicêntrica de pacientes. Os dados foram coletados entre 2013 e 2015. O médico incluiu pacientes que atenderam aos critérios ACR1990 no momento da entrada. Consideraram-se os dados de seguimento apenas dos pacientes com pelo menos duas avaliações. Uma variação de 30% nos escores dos parâmetros foi considerada uma alteração minimamente significativa. Resultados: Analisaram-se os dados de 810 pacientes. Os pacientes apresentaram média de 51,8 ± 11,5 anos. Havia 786 mulheres. A maior parte dos pacientes atendeu a ambos os critérios. Houve um maior atendimento aos critérios ACR2010. Houve uma correlação moderada entre a PDS e o FIQ. Encontraram-se 314 pacientes com mais de uma avaliação, mas 88 pacientes foram excluídos. Assim, foram considerados 226 pacientes com um parâmetro de monitoramento no seguimento. (FIQ: 222; PDS: 199; ambos: 195). O tempo médio de seguimento foi de 9,1 ± 7,5 meses (1 a 44). A maior parte dos pacientes tornou-se estável. Conclusão: No EpiFibro, a maior parte dos pacientes atendia simultaneamente ao ACR1990 e ao ACR2010. Uma maior quantidade de pacientes atendia ao ACR2010 no momento da avaliação. Houve uma correlação moderada. A maior parte dos pacientes manteve-se estável ao longo do tempo.

Abstract Introduction: EpiFibro (Brazilian Epidemiological Study of Fibromyalgia) was created to study Fibromyalgia patients. Patients were included since 2011 according to the 1990 American College of Rheumatology Classification Criteria for Fibromyalgia (ACR1990). Objectives: To determine how many patients still fulfill the ACR1990 and the ACR2010 criteria in 2014; to determine the correlation between the impact of FM and to describe data on the follow-up evaluation. Methods: This is a cross sectional study in a multicenter cohort of patients. The data was collected between 2013 and 2015. Physician included patients that fulfilled the ACR1990 criteria on the date of entry. The follow-up data were considered only for patients with at least two evaluations. A minimally significant change was considered to be a 30% variation of parameters scores. Results: 810 patients’ data were analyzed. Patients presented a mean age of 51.8 ± 11.5 years old. There were 786 female. Most patients met both criteria. There was a greater fulfilling of the ACR2010. There was a moderate correlation between Polysymptomatic Distress Scale and Fibromyalgia Impact Questionnaire. Three hundred fourteen patients with more than one assessment were found, but 88 patients were excluded. Thus, 226 patients with one follow-up monitoring parameter were considered (Fibromyalgia Impact Questionnaire: 222; Polysymptomatic Distress Scale: 199; both: 195). The mean follow-up time was 9.1 ± 7.5 months (1–44). Most patients became stable. Conclusion: InEpiFibro, most patients fulfill simultaneously the ACR1990 and ACR2010. A larger number of patients fulfill the ACR2010 at the time of the evaluation. There was a moderate correlation between the Polysymptomatic Distress Scale and the Fibromyalgia Impact Questionnaire. Most patients remained stable over time.

https://doi.org/10.1016/j.rbre.2016.09.012 8286 downloads

New guidelines for the diagnosis of fibromyalgia
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Heymann, Roberto E.

; Paiva, Eduardo S.

; Martinez, José Eduardo

; Helfenstein Jr., Milton

; Rezende, Marcelo C.

; Provenza, Jose Roberto

; Ranzolin, Aline

; Assis, Marcos Renato de

; Feldman, Daniel P.

; Ribeiro, Luiz Severiano

; Souza, Eduardo J.R.

Revista Brasileira de Reumatologia

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2017, Volume 57 Supl. 2 Páginas s467 - s476

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

Resumo Objetivo Estabelecer diretrizes baseadas em evidências científicas para o diagnóstico da fibromialgia. Material e métodos A coleta de evidências foi elaborada a partir de nove questões sobre diagnóstico da fibromialgia, estruturadas por meio do PICO (Paciente, Intervenção ou Indicador, Comparação e Outcome), com busca nas principais bases primárias de informação científica. Após definir os estudos potenciais para sustentação das recomendações, esses foram graduados pela força da evidência e grau de recomendação. Resultados e conclusões As questões resultaram em nove recomendações para o diagnóstico da fibromialgia com base nas evidências de literatura e na opinião dos experts que participaram do trabalho.

Abstract Objective To establish guidelines based on scientific evidence for the diagnosis of fibromyalgia. Material and methods Evidence collection was performed based on 9 questions regarding the diagnosis of fibromyalgia, structured using the Patient, Intervention or Indicator, Comparison and Outcome (P.I.C.O.), with searches in the main, primary databases of scientific information. After defining the potential studies to support the recommendations, they were graded according to evidence and degree of recommendation.

https://doi.org/10.1016/j.rbre.2017.07.002 96030 downloads

10.

Foundations, facts, photos and Facebook
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Assis, Marcos Renato de

; Rocha, Francisco Airton Castro

; Andrade, Luís Eduardo Coelho

; Levy, Roger Abramino

; Seda, Hilton

Revista Brasileira de Reumatologia

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2017, Volume 57 Supl. 2 Páginas s414 - s420

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

https://doi.org/10.1016/j.rbre.2017.07.005 1090 downloads

11.

Rheumatoid arthritis and metabolic syndrome
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Assis, Marcos Renato de

; Serafim, Patrícia Amanda

Revista Brasileira de Reumatologia

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Abr 2016, Volume 56 Nº 2 Páginas 93 - 94

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

https://doi.org/10.1016/j.rbre.2016.02.015 2278 downloads

12.

E a história continua
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Heymann, Roberto Ezequiel

; Assis, Marcos Renato de

Revista Brasileira de Reumatologia

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Out 2015, Volume 55 Nº 5 Páginas 395 - 395

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

https://doi.org/10.1016/j.rbr.2015.08.001 658 downloads

13.

Correlação entre instrumentos de avaliação da funcionalidade e equilíbrio em pacientes com artrite reumatoide
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LOURENÇO, Mariana de Almeida

; ROMA, Izabela

; ASSIS, Marcos Renato de

Revista Brasileira de Educação Física e Esporte

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Set 2015, Volume 29 Nº 3 Páginas 345 - 353

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

ResumoA artrite reumatoide (AR) é uma doença autoimune inflamatória sistêmica, crônica e progressiva, que pode causar diminuição da mobilidade, força e atividade física, levando a alterações de propriocepção, equilíbrio postural e marcha, que aumentam o risco de queda nesses pacientes. O presente estudo teve como objetivo verificar se existe correlação entre testes de funcionalidade e equilíbrio em pacientes com AR. Para isso foi feito um corte transversal com a amostra composta por 99 pacientes com diagnóstico de AR de ambos os sexos. Os instrumentos de avaliação do risco de queda usados foram: Escala de Equilíbrio de Berg (Berg), Teste "Timed Up and Go" (TUG), Teste de Caminhada de 6 Minutos e Short Physical Performance Battery (SPPB) ou Bateria de Testes de Guralnik. Feito teste de Kolmogorov-Smirnov para normalidade de distribuição e correlação de Spearman, com nível de significância de p < 0,05. Os pacientes eram 88,9% do sexo feminino e com idade média de 56,15 anos (± 11,64). A idade apresentou correlação fraca, porém significativa de modo que quanto mais velho, pior o desempenho nos testes. O desempenho médio nos instrumentos não colocou esses pacientes com AR como alto risco de queda, porém não há valores de corte específicos para essa população. Os instrumentos mostraram correlação de moderada a forte entre si (p < 0,01). Conclui-se, portanto, que os testes físicos realizados são correlacionados e representam bem a capacidade física desses pacientes com AR,principalmente entre pessoas a partir dos 41 anos e homens.

AbstractRheumatoid arthritis (RA) is a systemic inflammatory autoimmune disease, chronic and progressive, which can cause pain, decreased mobility, physical strength and activity, leading to changes in proprioception, postural balance and gait, which increase the risk of falls in these patients. The present study aimed to verify if there´s correlation among functionality and balance tests in RA patients. This study was conducted with a cross-section sample of 99 patients diagnosed with RA of both sexes. Assessment instruments fall risk were used: Berg Balance Scale (BBS), Test "Timed Up and Go" (TUG), 6 Minutes Walking Test (6MWT) and Short Physical Performance Battery (SPPB) or Guralnik Battery Test. Made Kolmogorov-Smirnov test for normality of distribution and Spearman correlation, with significance level of p < 0.05. Patients were 88,9% female with a mean age of 56.15 years (± 11.64). Age showed a weak correlation, but significant o that the older, worse performance on tests. The average performance of the instruments do not put these RA patients as high risk of falling, but there is no specific cut off values for this population. The instruments showed moderate to strong correlation with each other (p < 0.01). We conclude, therefore, that the physical tests are performed and correlated well represent the physical capacity of RA patients, especially among people over 41 years old and men.

https://doi.org/10.1590/1807-55092015000300345 4667 downloads

14.

Cuidados contra infecções em doenças reumáticas autoimunes
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Assis, Marcos Renato de

; Heymann, Roberto Ezequiel

Revista Brasileira de Reumatologia

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Ago 2015, Volume 55 Nº 4 Páginas 317 - 317

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

https://doi.org/10.1016/j.rbr.2015.06.001 1203 downloads

15.

EFFECTS OF VITAMIN C SUPPLEMENTATION ON THE CHRONIC PHASE OF CHAGAS DISEASE
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MARIM, Ricardo Guimarães

; GUSMÃO, Alex Silva de

; CASTANHO, Roberto Esteves Pires

; DEMINICE, Rafael

; THEREZO, Altino Luiz Silva

; JORDÃO JÚNIOR, Alceu Afonso

; ASSIS, Marcos Renato de

; TAIPEIRO, Elane de Fátima

; MARTINS, Luciamare Perinetti Alves

Revista do Instituto de Medicina Tropical de São Paulo

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Jun 2015, Volume 57 Nº 3 Páginas 245 - 250

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

Introdução:Para verificar a eficácia da vitamina C em combater o insulto oxidativo causado pelo Trypanosoma cruzi durante a evolução da fase crônica da doença de Chagas, camundongos Swiss foram previamente infectados via intraperitoneal com 5.0 × 104 tripomastigotas da cepa QM1 de T. cruzi.Métodos:Camundongos foram suplementados com duas diferentes doses de vitamina C por 180 dias. Foram mensurados os níveis de peroxidação lipídica (indicado por substâncias reativas ao ácido tiobarbitúrico-TBARS), peróxido total, vitamina C, e glutationa reduzida no plasma e TBARS, peróxido total e vitamina C no miocárdio, e foi realizado o estudo histopatológico em coração, cólon e músculo esquelético.Resultados:Animais que receberam diariamente uma dosagem equivalente a 500 mg de vitamina C apresentaram aumento na produção de ROS e RNS no plasma e no miocárdio e maior grau de inflamação e necrose em músculo esquelético em comparação àqueles que receberam doses menores ou nenhuma vitamina C.Conclusão:Embora muitas pesquisas tenham mostrado o efeito antioxidante da vitamina C, nossos resultados mostraram que os animais que foram expostos a 500 mg de vitamina C apresentaram maior dano tecidual na fase crônica da doença de Chagas, provavelmente devido a ações paradoxais desta substância, onde nesta patologia, poderá agir como pró-oxidante ou pró-inflamatória.

Introduction:In order to examine the effectiveness of vitamin C (ascorbic acid) in combating the oxidative insult caused by Trypanosoma cruzi during the development of the chronic phase of Chagas disease, Swiss mice were infected intraperitoneally with 5.0 × 104 trypomastigotes of T. cruzi QM1strain.Methods:Mice were given supplements of two different doses of vitamin C for 180 days. Levels of lipid oxidation (as indicated by thiobarbituric acid reactive substances-TBARS), total peroxide, vitamin C, and reduced glutathione were measured in the plasma, TBARS, total peroxide and vitamin C were measured in the myocardium and histopathologic analysis was undertaken in heart, colon and skeletal muscle.Results:Animals that received a dose equivalent to 500 mg of vitamin C daily showed increased production of ROS in plasma and myocardium and a greater degree of inflammation and necrosis in skeletal muscles than those that received a lower dose or no vitamin C whatsoever.Conclusion:Although some research has shown the antioxidant effect of vitamin C, the results showed that animals subject to a 500 mg dose of vitamin C showed greater tissue damage in the chronic phase of Chagas disease, probably due to the paradoxical actions of the substance, which in this pathology, will have acted as a pro-oxidant or pro-inflammatory.

https://doi.org/10.1590/S0036-46652015000300011 2402 downloads

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