Resumen: La vasculitis reumatoidea es una complicación sistémica y poco frecuente de la Artritis Reumatoidea. Si bien su incidencia ha descendido en los últimos años con el advenimiento de las nuevas terapias inmunosupresoras y biológicas, continua teniendo una alta morbimortalidad. Predomina en el sexo masculino, en pacientes seropositivos y con un largo período de la enfermedad establecida. Requiere de alta presunción diagnostica, siendo el compromiso cutáneo y nervioso periférico el más frecuente. La biopsia de nervio o piel es requerida habitualmente para su diagnóstico. El tratamiento se basa en corticoides e inmunosupresores. Presentamos tres casos clínicos y realizamos una revisión de la literatura.

Abstract: Rheumatoid vasculitis is a rare systemic complication of rheumatoid arthritis. Although its incidence has decreased in recent years with the advent of new immunosuppressive and biological therapies, it continues to have a high morbidity and mortality. It predominates in males, in seropositive patients and with a long period of established disease. It requires high diagnostic presumption, with skin and peripheral nervous involvement being the most affected. Nerve or skin biopsy is usually required for diagnosis. Treatment is based on corticosteroids and immunosuppressants. We present three clinical cases and carry out a review of the literature.

Resumo: A vasculite reumatóide é uma complicação sistêmica rara da artrite reumatóide. Embora sua incidência tenha diminuído nos últimos anos com o advento de novas terapias imunossupressoras e biológicas, continua apresentando elevada morbidade e mortalidade. Predomina no sexo masculino, em pacientes soropositivos e com longo período de doença estabelecida. Exige alta presunção diagnóstica, sendo o envolvimento cutâneo e nervoso periférico os mais afetados. A biópsia de nervo ou pele geralmente é necessária para o diagnóstico. O tratamento é baseado em corticosteroides e imunossupressores. Apresentamos três casos clínicos e realizamos uma revisão da literatura.

Resumo Várias razões podem estar subjacentes ao aumento dramático da diabetes mellitus tipo 2. Um desses motivos é a base genética e variações. Os polimorfismos do receptor da vitamina D estão associados a diferentes doenças, como artrite reumatoide e diabetes. O objetivo deste estudo é investigar a possível associação de duas mutações identificadas ApaI (rs7975232) e TaqI (rs731236). Oitenta e nove indivíduos saudáveis e 56 pacientes com diabetes tipo 2 (T2D) foram investigados usando a técnica RFLP para genotipagem e haplotipagem também. A distribuição dos genótipos Apal não foi estatisticamente significativa entre o controle (P = 0,65), bem como para os pacientes diabéticos (P = 0,58). Para as frequências do alelo Taql, o alelo T foi de 0,61, onde o alelo G foi de 0,39. A distribuição de frequência dos genótipos Taql não foi estatisticamente significativa entre o controle (P = 0,26), bem como os pacientes diabéticos (P = 0,17). O risco relativo do alelo T do gene Apa1 é 1,28 e a razão de chances do mesmo alelo é 1,53, enquanto ambas as estimativas foram < 1,0 do alelo G. Da mesma forma, com o gene Taq1, os valores de risco relativo e razão de chances para o alelo T são 1,09 e 1,27, respectivamente, e ambas as estimativas do alelo C foram de 0,86 para o risco relativo e 0,79 para o odds ratio. O desequilíbrio de ligação par a par entre os dois SNPs Taq1 / apa1 foi estatisticamente significativo no grupo de controle (D = 0,218, D' = 0,925 e valor P < 0,001) e dados semelhantes em grupos diabéticos (D = 0,2, D' = 0,875 e valor P < 0,001). Esses dados sugerem que o alelo T de ambos os genes Apa1 e Taq1 está associado ao aumento do risco de diabetes tipo 2. Achamos que precisamos de um número maior de voluntários para chegar a uma conclusão mais precisa.

Abstract Several reasons may underlie the dramatic increase in type2 diabetes mellitus. One of these reasons is the genetic basis and variations. Vitamin D receptor polymorphisms are associated with different diseases such as rheumatoid arthritis and diabetes. The aim of this study is to investigate the possible association of two identified mutations ApaI (rs7975232) and TaqI (rs731236). Eighty-nine healthy individuals and Fifty-six Type 2 Diabetic (T2D) patients were investigated using RFLP technique for genotyping and haplotyping as well. The distribution of Apal genotypes was not statistically significant among the control (P=0.65) as well as for diabetic patients (P=0.58). For Taql allele frequencies of T allele was 0.61 where of G allele was 0.39. The frequency distribution of Taql genotypes was not statistically significant among the control (P=0.26) as well as diabetic patients (P=0.17). Relative risk of the allele T of Apa1 gene is 1.28 and the odds ratio of the same allele is 1.53, while both estimates were < 1.0 of the allele G. Similarly, with the Taq1 gene the relative risk and the odds ratio values for the allele T are 1.09 and 1.27 respectively and both estimates of the allele C were 0.86 for the relative risk and 0.79 for the odds ratio. The pairwise linkage disequilibrium between the two SNPs Taq1/apa1 was statistically significant in control group (D = 0.218, D' = 0.925 and P value < 0.001) and similar data in diabetic groups (D = 0.2, D' = 0.875 and P value < 0.001). These data suggest that the T allele of both genes Apa1 and Taq1 is associated with the increased risk of type 2 diabetes. We think that we need a larger number of volunteers to reach a more accurate conclusion.

SUMMARY OBJECTIVE: Patients with rheumatic diseases have an increased risk of infections, especially tuberculosis. In this study, we aimed to recognize the positivity rate of tuberculosis skin test in patients with rheumatoid arthritis and spondyloarthritis and the characteristics of the patients with positive results. METHODS: Retrospective study of tuberculosis skin test results in patients followed from 2004 to 2021 in a single rheumatology unit. Data related to clinical and epidemiological features, along with treatment information referring to the period in which the tuberculosis skin test was performed, were collected from patients’ charts. RESULTS: A total of 723 tests were identified (448 tests in 269 rheumatoid arthritis patients and 275 in 174 spondyloarthritis patients). In the rheumatoid arthritis sample, 31/275 (11.5%) individuals had positive tests, and in the spondyloarthritis, 38/174 (21.8%) had positive tests. In the rheumatoid arthritis sample, patients with positive tuberculosis skin tests used a higher dose of methotrexate than those with negative results (median of 25 mg/week versus median of 20 mg/week respectively; p=0.02). In the spondyloarthritis sample, tuberculosis skin test positivity was associated with alcohol ingestion (13.1% versus 2.9% in users and non-users respectively; p=0.02) and sulfasalazine use (15.7% of positivity in users versus 5% in non-users; p=0.01). CONCLUSION: The tuberculosis skin test-positive prevalence in rheumatoid arthritis was lower than in the spondyloarthritis sample. Patients with rheumatoid arthritis using a higher dosage of methotrexate or with spondyloarthritis using sulfasalazine had more frequency of tuberculosis skin test positivity and should be carefully followed by the attending physician in order to avoid the appearance of full-blown tuberculosis.

ABSTRACT Introduction: Rheumatoid arthritis is a chronic, inflammatory autoimmune disease. Disorders in the sexual sphere is frequent, it affects both sexes and it is related to factors such as pain, disability and medication consumption. This condition has not been sufficiently addressed in the literature despite its prevalence and in Cuba no studies related to the topic under study have been reported to date. Objective: To determine the impact of rheumatoid arthritis on sexuality and its relationship with activity and disability. Methods: A monocentric, cross-sectional and descriptive study was carried out on patients with a diagnosis of rheumatoid arthritis, from September 2019 to June 2021. The Qualisex questionnaire was used to evaluate the impact of rheumatoid arthritis on sexuality. Results: Two hundred twenty-six patients were included, the mean age was 53.38 years (SD ± 12.22) and 82.7% were women. When answering the Qualisex self-questionnaire, 73.9% of the subjects had effects in their sexuality. No significant relationship was established between the involvement in the sexual sphere and the time of evolution. Conclusions: The impact on sexuality in the studied population was not related to the duration of rheumatoid arthritis. On the other hand, an association was found between disease activity and functional capacity with effects in the sexual sphere.

RESUMEN Introducción: La artritis reumatoide es una enfermedad autoinmune de carácter inflamatorio y crónico. La afectación en la esfera sexual es frecuente, compromete a ambos sexos y se relaciona con factores como el dolor, la discapacidad y el consumo de medicamentos. Esta afectación no ha sido suficientemente abordada en la literatura a pesar de su prevalencia, y en Cuba no se han reportado hasta el momento estudios relacionados sobre este tema de investigación. Objetivo: Determinar el impacto de la artritis reumatoide en la sexualidad y su relación en la actividad y la discapacidad. Métodos: Se realizó un estudio monocéntrico, transversal, descriptivo. Se incluyeron los pacientes con un diagnóstico de artritis reumatoide en el período comprendido de septiembre de 2019 a junio de 2021. Se utilizó el cuestionario Qualisex para evaluar el impacto de la artritis reumatoide en la sexualidad. Resultados: En el estudio doscientos veintiséis pacientes fueron incluidos, la media de edad fue de 53,38 años (DE ± 12,22) el 82,7 % fueron mujeres. Al responder el autocuestionario Qualisex el 73,9 % de los sujetos presentaron afectación en la sexualidad. No se estableció una relación significativa entre la afectación en la esfera sexual y el tiempo de evolución. A diferencia de los niveles altos de actividad y discapacidad. Conclusiones: En la población estudiada se presentó afectación en la sexualidad, no obstante, esta no se relacionó con el tiempo de evolución de la artritis reumatoide. Se encontró asociación entre la actividad de la enfermedad y la capacidad funcional con la afectación en la esfera sexual.

ABSTRACT: Introduction: Vaccination in populations exposed to increased risk of severe disease and death consequent to SARS-CoV-2 infection has generated a major impact on global Public Health. Certainly, the benefit has been evidenced mostly in people with chronic comorbidities, where rheumatoid arthritis (RA) plays an important role. Objective: To analyze vaccination against Sars-CoV-2 in paraguayan patients with rheumatoid arthritis (RA) during the COVID19 pandemic. Methods: A multicenter study was carried out, in which a cohort of patients with RA was analyzed cross-sectionally, during the period from October to December 2022. For the study, clinical-epidemiological and vaccination-related variables were recorded (i.e. access to vaccination, type, number of doses). A descriptive analysis of the variables was carried out with the R-4.3.2 software. Results: 568 patients were included, 84.1% were female, with an average age of 55.5±13.9 years. 88.7% (504) patients received at least one dose of SARS-CoV-2 vaccine, 85% (483) received two doses, while 60.9% (344) patients received the first booster, and 21.2% the second booster. Conclusions: In this series of Paraguayan patients with RA the percentage of vaccination against SARS-CoV-2 was higher than that registered in the general population of the country. This could be related to the priority of this population to access vaccines and the insistence of their physicians to complete the vaccination schedule.

RESUMEN: Introducción: La vacunación en poblaciones expuestas a mayor riesgo de enfermedad grave y muerte consecuentes a la infección por SARS-CoV-2, ha generado un gran impacto en la salud pública mundial. Indudablemente, el beneficio ha sido evidenciado mayormente en personas con comorbilidades crónicas, donde la artritis reumatoide (AR) juega un rol importante. Objetivo: Analizar la vacunación contra Sars-CoV-2 en pacientes paraguayos con AR, durante la pandemia COVID-19. Métodos: Se realizó un estudio multicéntrico, en el que se analizó transversalmente a una cohorte de pacientes con AR, durante el periodo de octubre a diciembre del año 2022. Para el estudio se registraron variables clínico-epidemiológicas y relacionadas con la vacunación (i.e. acceso a la vacunación, tipo, número de dosis). Se realizó un análisis descriptivo de las variables con el software R-4.3.2. Resultados: Se incluyeron 568 pacientes, 84,1% eran mujeres, con un promedio de edad de 55,5±13,9 años. El 88,7% (504) pacientes, recibieron al menos una dosis de vacuna contra SARS-CoV-2. 85% (483) recibieron dos dosis, mientras que el 60,9% (344) pacientes recibieron el primer refuerzo, y 21,2% el segundo refuerzo. Conclusiones: En esta serie de pacientes paraguayos con AR el porcentaje de vacunación contra SARS-CoV-2 fue más elevado que el registrado en la población general del país. Esto podría estar relacionado con la prioridad de esta población para acceder a las vacunas y a la insistencia de sus médicos en completar el esquema de vacunación.

Resumen Introducción: se publica una minoría de todos los trabajos presentados en los Congresos Argentinos de Reumatología (CAR). Objetivos: analizar los temas de estudio (TDE) de los trabajos sobre artritis reumatoidea (AR) presentados en los CAR y su tasa de publicación. Materiales y métodos: se analizaron todos los resúmenes sobre AR, como motivo primario de estudio, presentados en los CAR entre 2008 y 2017. Se agruparon según TDE, y se determinaron los TDE repetidos definidos como, al menos, dos estudios similares presentados sobre el mismo tema. Se determinó la tasa de publicación, el número de estudios similares por TDE, el número de centros participantes y el número de pacientes estudiados. Resultados: sobre 346 trabajos presentados, 51 (14,7%) fueron publicados. Se publicaron 14 (11,9%) de los 118 estudios sobre TDE repetidos versus 37 (16,2%) del resto de los TDE (p=0,4). Los trabajos sobre TDE repetidos no incluyeron más pacientes ni involucraron a un número mayor de centros. Se encontraron 13 TDE repetidos con al menos tres estudios similares y ningún estudio publicado. Conclusiones: solo una minoría de los trabajos sobre AR se publicó. Un tercio de los trabajos presentados en los CAR correspondió a TDE repetidos, que no mejoraron la tasa de publicación.

Abstract Introduction: only a few articles submitted to the Argentine Congress of Rheumatology (ACOR) are published. Objectives: to analyse the topics of study (TOS) and the publication rate of articles on rheumatoid arthritis (RA) submitted to the ACOR. Materials and methods: every abstract submitted to the ACOR between 2008 and 2017, whose primary research subject was RA, was analyzed and sorted according to TOS. Repeated TOS, defined as at least two similar studies on the same topic, were identified. The publication rate and the number of similar studies according to TOS, participating centers, and patients were determined. Results: out of 346 articles submitted, 51 (14.7%) were published. Fourteen (11.9%) of the 118 studies on repeated TOS were published vs. 37 (16.2%) of the rest of the TOS (p: 0.4). The articles on repeated TOS neither included more patients nor involved a higher number of centers. Thirteen repeated TOS with at least three similar studies, but no published articles were identified. Conclusions: only a few articles on RA were published. One third of the studies submitted to the ACOR are repeated TOS, a fact that does not improve the publication rate.

Introduction: Rheumatoid arthritis (RA) is treated with conventional and biological disease-modifying drugs (DMARDs). Objectives: To compare the survival of biological drugs used for the treatment of RA patients. Methods: Retrospective study of medical records of patients who used biological medication for the treatment of RA from January 2020 to January 2022 and this was suspended. Data on the causes of withdrawal, duration of use, epidemiological, clinical and comorbid data were collected. Results: The main reason for discontinuity was failure followed by side effects. Infliximab and adalimumab had the highest survival. BMI (body mass index) and smoking, sex and age did not interfere in this survival. Conclusion: Failure is the most common cause of biological discontinuity. Among the factors studied (smoking, BMI, age and gender) it was not possible to identify a variable that was associated with failure.

Introdução: A artrite reumatoide (AR) é tratada com drogas modificadoras da doença (DMARDs) convencionais e biológicas. Objetivos: Comparar a sobrevida de medicamentos biológicos utilizados para o tratamento de pacientes com AR. Método: Estudo retrospectivo de prontuários de pacientes que utilizaram medicamento biológico para tratamento de AR de janeiro de 2020 a janeiro de 2022 e este foi suspenso. Dados acerca das causas de retirada, tempo de uso, dados epidemiológicos, clínicos e de comorbidades foram coletados. Resultados: O principal motivo da descontinuidade foi a falha seguida por efeitos colaterais. Infliximabe e adalimumabe foram os que apresentaram maior sobrevida. IMC (índice de massa corporal) e o tabagismo, sexo e idade não mostraram interferência nesta sobrevida Conclusão: Falha é a causa mais comum de descontinuidade dos biológicos. Dentre os fatores estudados (fumo, IMC, idade e sexo) não foi possível identificar variável que se associasse com falha.

ABSTRACT BACKGROUND AND OBJECTIVES: Rheumatoid arthritis is an inflammatory, chronic and autoimmune disease that causes joint damage and can lead to physical disability. Patients with chronic and debilitating diseases such as arthritis need to adapt to the new reality. These changes may have less impact on patients with greater self-efficacy and resilience. Psychosocial factors influence the quality of life (QoL) of these patients, so the aim of this study was to assess resilience in this population and its relationship with pain, functional capacity and disease activity. METHODS: This is a cross-sectional study carried out with patients at a medical specialties clinic, using a sociodemographic, a clinical-laboratory, a health assessment, a disease activity score questionnaires and the Wagnild and Young Resilience Scale. The data was analyzed using Fisher’s Exact, Chi-square, Student’s t and ANOVA tests. RESULTS: 120 patients participated in the study, 89.2% female, mean age 56.9 ± 10.7 years. Pain was classified as severe by 40.8%, 65.8% had disease in remission and 50.8% had mild disability. The resilience of 49.2% was high. There was an association between lower resilience and: presence of painful joints (p=0.004) and greater pain intensity (p=0.014). There was a lower average of resilience (130.95) in participants with severe disability. CONCLUSION: Patients with less resilient rheumatoid arthritis had greater functional disability, painful joints and greater pain intensity. In addition, from the moment additional measures are adopted, such as educational actions and behavioral strategies, with an emphasis on resilience, which help in the control and clinical outcome of the disease, there will certainly be a positive impact on the quality of life of these patients.

RESUMO JUSTIFICATIVA E OBJETIVOS: A artrite reumatoide é uma doença inflamatória, crônica e autoimune, que acarreta lesão articular e pode ocasionar incapacidade física. Pacientes com doenças crônicas e debilitantes como a artrite necessitam se adaptar à nova realidade. Essas mudanças podem ser menos impactantes em pacientes com maior autoeficácia e resiliência. Os fatores psicossociais exercem influência na qualidade de vida (QV) desses pacientes, portanto o objetivo deste estudo foi avaliar a resiliência nessa população e sua relação com dor, capacidade funcional e atividade da doença. MÉTODOS: Trata-se de uma pesquisa transversal, realizada com pacientes de uma clínica de especialidades médicas, através dos questionários sociodemográfico, clínico-laboratorial, de avaliação da saúde, de escore da atividade da doença,e avaliação da saúde, de escore da atividade da doença, e da escala de Resiliência de Wagnild e Young. A análise dos dados foi feita através dos testes Exato de Fisher, Qui-quadrado, t de Student e ANOVA. RESULTADOS: Participaram do estudo 120 pacientes, sendo 89,2% do sexo feminino, com média de idade de 56,9±10,7 anos. A dor foi classificada como intensa por 40,8%; 65,8% dos pacientes estavam com doença em remissão e 50,8% com incapacidade leve. A resiliência de 49,2% foi elevada. Foi verificada uma associação entre menor resiliência e: presença de articulações dolorosas (p=0,004) e maior intensidade de dor (p=0,014). Foi verificada menor média de resiliência (130,95) nos participantes com incapacidade grave. CONCLUSÃO: Pacientes com artrite reumatoide menos resilientes apresentaram maior incapacidade funcional, articulações dolorosas e maior intensidade de dor. Além disso, a partir do momento em que se adota medidas adicionais, tais como ações educativas e estratégias comportamentais, com ênfase na resiliência, que auxiliem no controle e no desfecho clínico da doença, certamente haverá impacto positivo na QV dos pacientes.

ABSTRACT Introduction: Introduction: Rheumatoid arthritis is a chronic inflammatory disease affecting the joints, with a poorly understood etiology. About 1% of the world population suffers from this disease without distinction of ethnicity, with preference in women between 40 and 50 years of age.Objective: To describe the level of knowledge about rheumatoid arthritis in adults in Paraguay February-March 2022. Methods: an observational, descriptive, cross-sectional, descriptive study was designed and a survey was conducted among Paraguayan residents. A non-probabilistic, snowball type sampling was applied for data collection consisting of an online survey disseminated via WhatsApp. Results: 103 surveys collected from urban and rural cities of Paraguay were analyzed on the knowledge of rheumatoid arthritis, the median age was 23 years +/- RI 12, the maximum age was 78 years and the minimum was 18 years Regarding knowledge of the disease, 67, 66% (70/103) know about the disease, 80% defined correctly; 81% know the symptoms and 54% know the causes of rheumatoid arthritis. Conclusions: importance should be given to the question of the knowledge that the population has about rheumatoid arthritis, although there is a majority level of knowledge, there is still a lack of knowledge of a certain proportion of individuals, therefore the integration of certain didactic methods or a plan that facilitates the learning of society on this subject would be a fundamental objective and goal.

RESUMEN Introducción: La artritis reumatoide es una enfermedad inflamatoria crónica que afecta las articulaciones, con una etiología poco conocida. Alrededor del 1% de la población mundial padece esta enfermedad sin distinción de etnias, con preferencia en mujeres de 40 a 50 años de edad. Objetivo: Describir el nivel de conocimiento sobre la artritis reumatoide en adultos del Paraguay de febrero a marzo del 2022. Métodos: se diseñó un estudio de tipo observacional, descriptivo, de corte transversal, se realizó una encuesta a personas residentes en Paraguay. Se aplicó un muestreo no probabilístico, de tipo bola de nieve para la recolección de datos que consistió en una encuesta online difundida por vía WhatsApp. Resultados: se analizó 103 encuestas recolectadas de ciudades urbanas y rurales del Paraguay sobre el conocimiento de la artritis reumatoide, la mediana de edad fue de 23 años +/- RI 12, el máximo de edad fue de 78 años y el mínimo fue de18 años. En cuanto al conocimiento de la enfermedad, el 67,6%conoce sobre la enfermedad, el 80% la definieron correctamente; el 81% conoce los síntomas y el 54% conoce las causas de la artritis reumatoide. Conclusiones: se debe tomar importancia y dar una mirada a la cuestión del conocimiento que la población posee acerca de la artritis reumatoide, a pesar de que existe un nivel mayoritario de conocimiento aún, sigue persistiendo un desconocimiento de cierta proporción de individuos, por ende, la integración de ciertos métodos didácticos o un plan que facilite el aprendizaje de la sociedad sobre este tema sería un objetivo y una meta fundamental.

ABSTRACT Introduction: The doctor Francois-Sigismond Jaccoud, described in 1869 in a young patient with rheumatic fever (RF), some joint deformities that consisted of classic deformations observed in rheumatoid arthritis (RA), such as the swan neck, the thumb subluxation, ulnar deviation, but that the main difference had the characteristic that they were reducible to passive movement, for which they were called Jaccoud‘s arthropathy (JA). Clinical Case: First case: 23-year-old female patient, by profession a housewife, with a history of deformity in the hands and feet since she was approximately 6 years old, without treatment. He denied systemic manifestations, arthralgia. Second case: A 61-year-old female patient, housewife by profession, from a rural area, diagnosed with Systemic Lupus Erythematosus (SLE) since she was 23 years old, with a history of deformity in the hands and feet since approximately the same age, currently with treatment with hydroxychloroquine and prednisone. He referred joint manifestations such as occasional arthralgia in the hands with significant edema in the fingers. Conclusion: Jaccoud‘s arthropathy (JA) is a reversible chronic nonerosive joint disorder that can occur after repeated episodes of arthritis.

RESUMEN Introducción: El médico Francois-Sigismond Jaccoud, describió en 1869 en un paciente joven con fiebre reumática (FR), algunas deformidades articulares que las mismas consistían en deformaciones clásicas observadas en la artritis reumatoide (AR), tales como el cuello de cisne, la subluxación del pulgar, la desviación cubital, pero que la principal diferencia tenían la característica de que las mismas eran reductibles al movimiento pasivo, por lo cual se las denominó con el nombre de artropatía de Jaccoud (AJ). Caso Clínico: Primer caso: Paciente femenino de 23 años, de profesión ama de casa, con antecedente de deformidad en manos y pies desde los 6 años aproximadamente, sin tratamiento. Niega manifestaciones sistémicas, artralgias. Segundo caso: Paciente femenino de 61 años, de profesión ama de casa, procedente del área rural, con diagnóstico de Lupus Eritematoso Sistémico (LES) desde los 23 años, con antecedente de deformidad en manos y pies desde esa misma edad aproximadamente, actualmente con tratamiento con hidroxicloroquina y prednisona. Refiere manifestaciones articulares como artralgias ocasionales en manos con edema importante en los dedos. Conclusión: La artropatía de Jaccoud (AJ) es un transtorno articular reversible crónico no erosivo que puede ocurrir después de episodios repetidos de artritis.

ABSTRACT Rituximab, a monoclonal antibody with the ability to bind itself to CD20, leads to a rapid depletion of B-cells (in around 24-72 hours), limiting antibody formation. The marker CD20 does not exist in any other cell type, which makes the action of rituximab specific. This antibody has been used in autoimmune entities such as rheumatoid arthritis and in hematological malignancies, but recently it has gained popularity as an important immunosuppressor in selected kidney diseases. In nephrology, this anti-CD20 antibody had its first indication in anti-neutrophil cytoplasmic antibody-associated vasculitis, but can now be used in primary membranous nephropathy, minimal change disease, lupus nephritis and others. There is also some data that indicates rituximab might have a promising role in other glomerular diseases in the future, but to date evidence is still lacking to recommend its widespread use. The aim of this document is to compile the most recent scientific evidence as to when rituximab should be used in the treatment of various glomerular diseases, and which other may come to benefit from it in the future.

Resumen Objetivos: Analizar la introducción de medicamentos biosimilares anti-TNF en primera línea para pacientes con artritis reumatoide (AR). Métodos: Estudio unicéntrico, retrospectivo y observacional en un hospital de tercer nivel. Se incluyeron pacientes con diagnóstico de AR tratados por primera vez con un fármaco biológico (biosimilar u original), entre febrero 2017-febrero 2021. Las variables de resultado recogidas fueron: porcentaje de pacientes que iniciaban tratamiento cada año con cada fármaco biológico y porcentaje de variación anual de utilización de fármacos anti-TNF que tenían biosimilar respecto al resto de alternativas. Resultados: 178 pacientes con diagnóstico de AR fueron tratados por primera vez con un fármaco biológico. Durante los dos primeros años de introducción de biosimilares, el porcentaje de pacientes con AR tratados en primera línea con adalimumab, infliximab y etanercept fue 23,9%, mientras que los dos últimos años aumentaron las prescripciones con estos fármacos, a pesar de la aparición de nuevos originales, de forma que durante el último año de estudio cubrían un 44,6% de las prescripciones. El uso de estos tres fármacos anti-TNF biosimilares en pacientes con AR ha supuesto un ahorro de 213.530 €. Conclusiones: En nuestro centro el uso de biosimilares antiTNF se ha consolidado en los dos últimos años, a pesar de la incorporación de nuevos originales en el tratamiento de la AR. Considerando las diferentes políticas de introducción de biosimilares existentes, sería interesante que se realizarán estudios similares en otras regiones de nuestro país para poder establecer que política de uso de biosimilares puede ser más aceptada.

Abstract Objectives: To analyze the introduction of first-line anti-TNF biosimilar drugs for patients with rheumatoid arthritis (RA). Methods: Single-center, retrospective, observational study in a tertiary hospital. Patients with a diagnosis of RA treated for the first time with a biologic drug (biosimilar or original) between February 2017-February 2021 were included. The outcome variables collected were: percentage of patients initiating treatment each year with each biologic drug and percentage of annual variation in the use of anti-TNF drugs that had a biosimilar with respect to the other alternatives. Results: 178 patients diagnosed with RA were treated for the first time with a biologic drug. During the first two years of the introduction of biosimilars, the percentage of RA patients treated first line with adalimumab, infliximab and etanercept was 23.9%, while in the last two years prescriptions with these drugs increased, despite the appearance of new originals, so that during the last year of the study they covered 44.6% of prescriptions. The use of these three biosimilar anti-TNF drugs in patients with RA has resulted in savings of 213,530 €. Conclusions: In our center, the use of anti-TNF biosimilars has been consolidated in the last two years, despite the incorporation of new originals in the treatment of RA. Considering the different existing biosimilar introduction policies, it would be interesting to carry out similar studies in other regions of our country in order to establish which biosimilar use policy may be more accepted.

Resumo Este artigo tem como objetivo analisar características do fornecimento e fatores associados ao tratamento da artrite reumatoide no Brasil, com foco nos medicamentos biológicos modificadores do curso da doença (MMCDbio). Foi realizado um estudo retrospectivo com dados secundários do Sistema de Informação Ambulatorial do Sistema Único de Saúde. Foram incluídos pacientes com 16 anos ou mais, atendidos nos doze meses do ano de 2019. As análises foram feitas com fatores de exposição em relação aos desfechos: uso de MMCDbio e porte populacional. O estudo incluiu 155.679 pacientes, sendo 84,6% mulheres. Observou-se maior troca de MMCDbio e maior provisão de médicos reumatologistas nos municípios de maior porte (mais de 500 mil habitantes). Quase 40% dos pacientes utilizaram MMCDbio e estes apresentaram maior adesão ao tratamento (57,0% versus 64%, p=0,001). A dispensação de MMCDbio ocorreu para mais de um terço dos pacientes tratados para AR no Brasil e esteve associada ao maior percentual de disponibilidade de médicos reumatologistas e ao maior porte populacional dos municípios.

Abstract This study analyzes supply characteristics and factors associated with the treatment of rheumatoid arthritis in Brazil, with a focus on disease course-modifying biological drugs (bioDMARDs). A retrospective study was conducted with secondary data from the Outpatient Information System of the Unified Health System. Patients aged 16 years or older who were treated in 2019 were eligible. The analyses were performed with exposure factors in relation to the outcomes: bioDMARD use and population size. The study included 155,679 patients, 84.6% of whom were women. There was a greater exchange of bioDMARDs and a greater supply of rheumatologists in the larger municipalities (more than 500,000 inhabitants). Almost 40% of the patients used bioDMARDs, and they showed greater adherence to treatment (57.0% versus 64%, p=0.001). The dispensing of bioDMARDs occurred in more than one-third of the patients treated for rheumatoid arthritis (RA) in Brazil and was associated with a higher percentage of availability of rheumatologists and larger population size.

Abstract This study analyzes supply characteristics and factors associated with the treatment of rheumatoid arthritis in Brazil, with a focus on disease course-modifying biological drugs (bioDMARDs). A retrospective study was conducted with secondary data from the Outpatient Information System of the Unified Health System. Patients aged 16 years or older who were treated in 2019 were eligible. The analyses were performed with exposure factors in relation to the outcomes: bioDMARD use and population size. The study included 155,679 patients, 84.6% of whom were women. There was a greater exchange of bioDMARDs and a greater supply of rheumatologists in the larger municipalities (more than 500,000 inhabitants). Almost 40% of the patients used bioDMARDs, and they showed greater adherence to treatment (57.0% versus 64%, p=0.001). The dispensing of bioDMARDs occurred in more than one-third of the patients treated for rheumatoid arthritis (RA) in Brazil and was associated with a higher percentage of availability of rheumatologists and larger population size.

Resumo Este artigo tem como objetivo analisar características do fornecimento e fatores associados ao tratamento da artrite reumatoide no Brasil, com foco nos medicamentos biológicos modificadores do curso da doença (MMCDbio). Foi realizado um estudo retrospectivo com dados secundários do Sistema de Informação Ambulatorial do Sistema Único de Saúde. Foram incluídos pacientes com 16 anos ou mais, atendidos nos doze meses do ano de 2019. As análises foram feitas com fatores de exposição em relação aos desfechos: uso de MMCDbio e porte populacional. O estudo incluiu 155.679 pacientes, sendo 84,6% mulheres. Observou-se maior troca de MMCDbio e maior provisão de médicos reumatologistas nos municípios de maior porte (mais de 500 mil habitantes). Quase 40% dos pacientes utilizaram MMCDbio e estes apresentaram maior adesão ao tratamento (57,0% versus 64%, p=0,001). A dispensação de MMCDbio ocorreu para mais de um terço dos pacientes tratados para AR no Brasil e esteve associada ao maior percentual de disponibilidade de médicos reumatologistas e ao maior porte populacional dos municípios.

ABSTRACT Background: Observational studies have described a high prevalence of depression and anxiety in rheumatoid arthritis: major depressive disorders are detected in 17 % of patients with the pathology, and local and systemic inflammation play an important role in anxiety and depression. Objectives: The overall objective of this research was to determine the frequency of anxiety, depression, and vulnerability to stress in patients diagnosed with rheumatoid arthritis. Materials and methods: This was an observational, descriptive, temporally prospective, cross-association study. Sampling was non-probabilistic of consecutive cases. We included adults with a diagnosis of rheumatoid arthritis who consulted at the Rheumatology Department of the Hospital de Clínicas between August and October 2022. The following instruments were used for psychiatric diagnosis: Generalized Anxiety Scale (GAD-7), Patient Health Questionnaire (PHQ-2) and Smith and Miller's Stress Vulnerability Scale. Results: Thirty-six patients, all women, aged between 20 and 77 years, were included in the study. The 27.8 % had depression, according to the cut-off points of the PHQ-2. Anxiety was present in 22.2 %, according to the GAD-7 cut-off points. Regarding stress, 22.2 % were vulnerable to stress and 5.6 % were seriously vulnerable. Conclusion: Depression, anxiety and vulnerability to stress are frequently observed comorbidities in patients with rheumatoid arthritis. Specific mental health interventions are required to address these issues and improve the quality of life of affected patients.

RESUMEN Antecedentes: Estudios observacionales han descrito una alta prevalencia de depresión y ansiedad en la artritis reumatoidea: los trastornos depresivos mayores se detectan en el 17 % de los pacientes con la patología, y la inflamación local y sistémica desempeña un papel importante en la ansiedad y la depresión. Objetivos: El objetivo general de esta investigación fue determinar la frecuencia de ansiedad, depresión y vulnerabilidad al estrés en pacientes con diagnóstico de artritis reumatoidea. Materiales y métodos: Este fue un estudio observacional, descriptivo de asociación cruzada y temporalmente prospectivo. El muestreo fue no probabilístico de casos consecutivos. Se incluyó a personas adultas con diagnóstico de artritis reumatoide que consultaron en el Departamento de Reumatología del Hospital de Clínicas, entre agosto y octubre del 2022. Para el diagnóstico psiquiátrico se utilizaron los siguientes instrumentos: Escala de Ansiedad Generalizada (GAD-7), Patient Health Questionnaire (PHQ-2) y Escala de Vulnerabilidad al Estrés de Smith y Miller. Resultados: Se incluyó a 36 pacientes, todas mujeres, con edades comprendidas entre los 20 y 77 años. El 27,8 % tenía depresión, según los puntos de corte del PHQ-2. El 22,2 % presentaba ansiedad, según los puntos de corte de GAD-7. En cuanto al estrés, el 22,2 % tenía vulnerabilidad a este y el 5,6 % era seriamente vulnerable. Conclusión: Depresión, ansiedad y vulnerabilidad al estrés son comorbilidades frecuentemente observadas en pacientes con artritis reumatoidea. Se requieren de intervenciones específicas de salud mental para abordar estas cuestiones y mejorar la calidad de vida de los pacientes afectados.