Serum Vitamin D Levels, Disease Activity Score-28 for Rheumatoid Arthritis with C-Reactive Protein (DAS28-CRP), and Cardiac Remodeling Determined by Ventricular Dimensions and Left Atrium Diameter in Patients with Rheumatoid Arthritis: A Prospective Observational Study.

BACKGROUND Rheumatoid arthritis (RA) can cause extra-articular manifestations, and the myocardium can be a target. This study aimed to describe structural and functional cardiac echocardiographic variables in RA patients and to evaluate whether vitamin D (VD) levels and inflammation markers, evaluated by Disease Activity Score-28 for Rheumatoid Arthritis with C-reactive protein (DAS28-CRP), are associated with cardiac remodeling (CR) in this population. MATERIAL AND METHODS This prospective observational study evaluated 90 patients with RA in Botucatu University Hospital wards from 2014 to 2017. Clinical data were recorded, including demographic information, comorbidities, length of disease, and treatment type. Serum VD and C-reactive protein levels were measured, and the DAS28-CRP was calculated. A transthoracic echocardiography study was performed. The outcome evaluated was CR. This parameter was assessed by left ventricular geometric patterns and left atrium diameter. RESULTS We evaluated 90 RA patients. The mean age was 52.9±10.8 years, and 17.8% were male. The length of the disease was 96 (60-180) months. Serum VD levels were 30.7±10.4 ng/mL and the DAS28 was 2.7±0.9. Regarding the CR parameters, 56.7% had altered left ventricular geometric patterns and 25.8% had enlargement of left atrium diameter. Even in multivariate analysis, the left ventricular geometric patterns were not associated with the VD levels and the inflammation marker used. However, sufficient VD levels protect from left atrium enlargement (OR: 0.905; IC 95%: 0.843-0.973; P=0.007). CONCLUSIONS Low serum vitamin D values, but not inflammation, are associated with CR in patients with RA.

[Proposal of a questionnaire for the characterization of the prevalence of digestive symptoms in connective tissue diseases]. / Proposta de questionário para caracterização da prevalência de sintomas digestivos nas doenças difusas do tecido conjuntivo.

BACKGROUND: Connective tissue diseases may damage multiple organic systems, including digestive system. In this one, the degree of injury vary according to the associated disease. Despite the significant frequency of gastrointestinal involvement, there are few studies characterizing the prevalence of digestive symptoms in connective tissue diseases. Furthermore, most of the studies available are less detailed and based in personal experiences or reviews of records. AIM: To establish a reliable list of gastrointestinal symptoms found in the progressive systemic sclerosis, rheumatoid arthritis, polymyositis/dermatomyositis, mixed connective tissue disease and systemic lupus erythematosus, through a medical interview and a predefined questionnaire of symptoms. PATIENTS AND METHODS: There were studied 99 patients, 90% females, mean age 45 years. The whole group were composed of 35 rheumatoid arthritis, 26 progressive systemic sclerosis, 21 systemic lupus erythematosus, 12 polymyositis/dermatomyositis and 5 mixed connective tissue disease. Each patient was submitted to an interview with a well trained doctor and answered a structured questionnaire, containing 17 questions. RESULTS: It was found a high prevalence of digestive symptoms in all five connective tissue diseases searched. Many of them were present in more than 50% of the patients. Called special attention the detection of some manifestations neglected by the literature like, for example, fecal incontinence. Also, disagreeing with other authors, was the finding of multiple gastrointestinal manifestations associated with rheumatoid arthritis. It was particularly surprising the occurrence of dysphagia in one third of the rheumatoid arthritis group. CONCLUSIONS: The connective tissue diseases are usual causes of many gastrointestinal complaints. The use of an interview plus predefined questionnaire seems a very effective way to identify and characterize symptoms and is even sometimes able to uncover features unknown before. Finally, the lack of studies, specially updated studies, did not allow more comprehensive comparisons.

Proposta de questionário para caracterização da prevalência de sintomas digestivos nas doenças difusas do tecido conjuntivo / Proposal of a questionnaire for prevalence's characterization of the digestive symptoms in the connective tissue diseases

RACIONAL: As doenças difusas do tecido conjuntivo afetam vários sistemas orgânicos, inclusive o digestório. Neste, as lesões variam em intensidade e freqüência na dependência da doença envolvida. A descrição das diferentes manifestações digestivas tem sido pouco freqüente, pouco detalhada e, não raro, baseada em experiências individuais e levantamentos retrospectivos. Tais formas de registro de dados produzem resultados muitas vezes conflitantes entre as diferentes casuísticas. OBJETIVO: Estabelecer de forma mais consistente, por intermédio de entrevista e questionário predefinido de sintomas, o conjunto e freqüência dos sintomas digestivos observados na esclerose sistêmica progressiva, artrite reumatóide, polimiosite/dermatomiosite, doença mista do tecido conjuntivo e lúpus eritematoso sistêmico. PACIENTES E MÉTODO: Estudaram-se 99 pacientes, 90 por cento mulheres, com idade média de 45 anos. Do total, 35 tinham artrite reumatóide, 26 esclerose sistêmica progressiva, 21 lúpus eritematoso sistêmico, 12 dermatomiosite/polimiosite e 5 doença mista do tecido conjuntivo. Todos foram submetidos, por investigador treinado, a entrevista e preenchimento de um questionário de sintomas digestivos, composto de 17 itens, previamente definidos. RESULTADOS: O estudo revelou elevada prevalência de sintomas gastrointestinais nas cinco doenças investigadas, muitas vezes afetando mais de 50 por cento dos casos. Chamou a atenção a presença significativa de sintomas negligenciados pela literatura como a incontinência fecal. Discordante de trabalhos anteriores, os pacientes desta série com artrite reumatóide apresentaram variadas queixas digestivas, surpreendendo o achado de disfagia em 1/3 deles. CONCLUSÕES: As doenças difusas do tecido conjuntivo são causas de freqüentes e numerosos sintomas digestivos. O uso de questionários predefinidos mostrou-se instrumento válido na identificação de substancial número de sintomas, alguns deles ainda não referidos pela literatura. Por fim, foi constatada escassez de trabalhos passados e atuais relativos às manifestações gastrointestinais das doenças difusas do tecido conjuntivo, o que prejudicou análises comparativas mais amplas.