Abstract Background: Fibromyalgia is a common chronic disease characterized by persistent diffuse pain, fatigue, sleep disorders and functional symptoms. The disease can have negative consequences in personal and social life, in addition to significant public health expenses caused by treatment and work leave. The purpose of this article is to evaluate the number of social security benefits granted due to incapacity for work in Brazil in patients with ICD M79 and variants in the period 2006-2015. There has been no previous study with data referring to work withdrawals caused by fibromyalgia in Brazil. Methods: Data for this study were obtained through an official Social Security platform. The disability and retirement benefits were analyzed. Results: A total of 95,882 social security disability benefits were granted to ICD M79 and variants in the period from 2006 to 2015. Regarding gender, 69,420 benefits (72.3%) were granted to women and 26,562 (27.7%) to men. Regarding the types of benefits, we found 93,556 (97.5%) temporary withdrawals from work and 2426 (2.5%) permanent withdrawals. When comparing the initial and final years, we observed a significant reduction in the number of awards: 15,562 in 2006 to 6163 in 2015. Conclusion: Fibromyalgia was an important cause of withdrawal due to incapacity for work in Brazil, with consequent public health expenditure. These data may serve as a basis for new studies and can alert professionals of the need for adequate management of fibromyalgia to reduce work withdrawal and its consequences.

A capilaroscopia periungueal é um método simples, de baixo custo, e de extrema relevância na avaliação de pacientes com fenômeno de Raynaud ou portadores de doenças do espectro da esclerose sistêmica (ES). Além de sua importância para o diagnóstico precoce da ES, constitui instrumento útil na identificação de pacientes esclerodérmicos com risco elevado para o desenvolvimento de complicações vasculares, viscerais e de óbito. A inclusão da capilaroscopia nos novos critérios para classificação da ES do Colégio Americano de Reumatologia (ACR) e da Liga Europeia Contra o Reumatismo (Eular) dá novo impulso para a utilização e disseminação do método. No presente artigo, pretendemos apresentar uma revisão didática, não sistemática, sobre o tema, com ênfase nos avanços recentemente descritos.

Nailfold capillaroscopy is a simple, low-cost method, that is extremely important in the evaluation of patients with Raynaud's phenomenon and of patients with systemic sclerosis (SSc) spectrum diseases. Besides its importance for the early diagnosis of SSc, nailfold capillaroscopy is a useful tool to identify scleroderma patients with high risk for development of vascular and visceral complications and death. The inclusion of capillaroscopy in the new classification criteria for SSc of the American College of Rheumatology (ACR) and European League Against Rheumatism (Eular) gives a new impetus to the use and dissemination of the method. In this paper, we present a didactic, non-systematic review on the subject, with emphasis on advances recently described.

Os autores relatam o caso de uma paciente com artrite reumatoide que evoluiu com grave neutropenia e esplenomegalia, sendo firmado o diagnóstico de Síndrome de Felty, que posteriormente desenvolveu Calazar. Ambas têm apresentação clínica e laboratorial semelhantes, tornando o diagnóstico diferencial difícil. O relato deste caso objetiva chamar a atenção para o reconhecimento da infecção por leishmaniose visceral em pacientes portadores de doenças reumáticas, assim como a possibilidade de um paciente com Calazar mimetizar um quadro de doença reumática sistêmica

Case report of a patient with rheumatoid arthritis who developed severe neutropenia, splenomegaly and was diagnosed with Felty's syndrome. The patient later developed Kala-azar. Both diseases have similar clinical and laboratory presentation, making the differential diagnosis difficult. The present case report aims at drawing attention to the identification of visceral Leishmaniasis infection in patients with rheumatic diseases, as well as possibility of a patient with Kala-azar mimicking a set of symptoms of systemic rheumatic disease

OBJETIVO: avaliar anormalidades bioquímicas que possam estar relacionadas à fibromialgia, mais especificamente o metabolismo oxidante de granulócitos de pacientes com fibromialgia primária (FMP). MÉTODOS: foram selecionados 10 pacientes (9 mulheres e 1 homem) portadores de FMP, com idade entre 20 e 40 anos, de acordo com os critérios do Colégio Americano de Reumatologia, que não apresentavam qualquer outra doença de curso agudo ou crônico e estavam sem utilizar medicamentos no mínimo durante duas semanas. Controles normais (n = 19) pareados por sexo e idade foram selecionados. Os granulócitos de pacientes e controles foram separados do sangue periférico e utilizados como célula de trabalho. A produção de espécies reativas de oxigênio (ERO) foi determinada por meio de ensaio de quimioluminescência dependente de luminol. RESULTADOS: demonstramos, pela primeira vez, uma produção significantemente elevada de ERO (3,2 vezes maior) em granulócitos de sangue periférico de pacientes com FMP (p < 0,05). CONCLUSÕES: estes resultados demonstraram um comportamento anormal dos granulócitos de pacientes com FMP, em que uma produção aumentada de espécies reativas do oxigênio foi observada. Estudos futuros serão necessários para melhor esclarecer estes resultados, delineando uma nova perspectiva na compreensão e abordagem destes pacientes.

OBJECTIVE: Our aim in this paper was to evaluate the biochemical abnormalities that may be correlated with fibromyalgia, such as the ROS production by granulocytes from patients with fibromyalgia in comparison to cells from healthy subjects. METHODS: Ten patients (9 women and 1 man, age ranging from 20 to 40 years old) with primary fibromyalgia, according to the American College of Rheumatology criteria, were selected. None of them were using medications 2 weeks before starting the study. Patients with rheumatic and non-rheumatic associated disease were excluded. Sex and age-matched healthy controls (n = 19) were simultaneously selected. The granulocytes from patients and controls were collected from peripheral blood. The quantification of reactive oxygen species was performed in a luminol-dependent chemiluminescence assay. RESULTS: We have demonstrated, for the first time, the increase of ROS production (3.2 times) in peripheral blood granulocytes from patients with fibromyalgia in comparison to the same cells from healthy subjects. CONCLUSIONS: The present result may indicate a possible role of free radicals in fibromyalgia subjects, once they have already been shown in other human diseases, including painful states. We suggest that further studies are needed to understand the importance of these findings, delineating a new perspective in understanding and approach of fibromyalgia patients.

Hipertensão pulmonar grave é uma doença debilitante, com expectativa de vida reduzida, que acomete adultos jovens. Complicações pleuropulmonares no lúpus eritematoso sistêmico ocorrem em 50% a 70% dos pacientes. A hipertensão pulmonar grave no lúpus eritematoso sistêmico é rara e tem prognóstico reservado. Descreve-se, pela primeira vez, um paciente com hipertensão pulmonar grave associada a lúpus eritematoso sistêmico e síndrome antifosfolipídio secundário que apresentou boa resposta ao uso do sildenafil oral, após falha do tratamento convencional com corticosteróides, ciclofosfamida, warfarin e diltiazem.

Severe pulmonary hypertension is a debilitating disease with short life expectancy that often affects young people. Pleuropulmonary complications of systemic lupus erythematosus occur in 50-70% of patients. Severe symptomatic pulmonary hypertension in systemic lupus erythematosus is rare and carries a bad prognosis because a fatal outcome can occur within months. The authors describe, for the first time, a patient with systemic lupus erythematosus with severe pulmonary hypertension and secondary antiphospholipid syndrome who responded favorably to oral sildenafil, after unsuccessful use of prednisone, intravenous cyclophosphamide, warfarin and diltiazem.