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.

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.

Validation and clinical interpretability of PsAID - psoriatic arthritis impact of disease.

BACKGROUND: Psoriatic arthritis (PsA) is a chronic inflammatory disease of widely varying presentation, which determines functional and psychological impairment, with a high negative impact on patients' quality of life. Therefore, knowing the patient's perception of their health status is of fundamental importance for understanding the real impact of PsA. Given this context, the European League Against Rheumatism (EULAR) recently developed the Psoriatic Arthritis Impact of Disease (PsAID) - instrument to specifically assess the impact of PsA for the patient. OBJECTIVE: Validate the brazilian portuguese version of PsAID-12 (Psoriatic Arthritis Impact of Disease) and to verify its interpretability in clinical practice, through its relation with measures of psoriatic arthritis activity. METHODS: A multicenter cross-sectional study, which recruited 160 patients, who met the Classification criteria for Psoriatic Arthritis (CASPAR), in six Brazilian centers of rheumatology. Reliability was assessed by Cronbach's alpha coefficient and by the intraclass correlation coefficient (ICC). The construct validity was evaluated by exploratory factorial analysis and also by Spearman correlation with other PROMs and measures of disease activity evaluation. RESULTS: Of the total number of participants, 50% were female, with a mean age (SD) of 54.0 ± 11.2 years; 68% had only peripheral arthritis and 32% had pure or mixed axial involvement. The majority (67.7%) of the patients were using biological treatment. The reliability of internal consistency (alpha-Cronbach = 0.93) and test-retest (ICC = 0.996) were good. Factor analysis revealed two factors, named physical and psychosocial, which included the skin evaluation item. PsAID-12 correlated significantly with other PROMs, demonstrating good construct validity. PsAID-12 was also significantly associated with the disease activity assessment instruments (DAS28-ESR, ASDAS, and BASDAI) and the MDA status: "Minimum Disease Activity". Fibromyalgia did not significantly affect the final PsAID-12 score. CONCLUSION: The brazilian version of PsAID-12 has been shown to be a reliable and valid measure of the impact of the disease in patients with psoriatic arthritis. Moreover, it associated significantly with the scores of disease activity assessment.

Evaluation of the occurrence of sexual dysfunction and general quality of life in female patients with psoriasis

Abstract: Background: Psoriasis has a significant impact on quality of life (QoL). Sexual life can also be affected, with sexual dysfunction being reported by 25-70% of patients. Objectives: To determine the occurrence of sexual dysfunction and evaluate QoL in women with psoriasis. Methods: This case-control study included women aged 18-69 years. The validated Brazilian Portuguese versions of the Female Sexual Function Index (FSFI) and of the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) were administered to all participants to assess sexual function and QoL, respectively. Patients with psoriasis underwent clinical evaluation for the presence of comorbidities, especially psoriatic arthritis and other rheumatic manifestations. Location of lesions and the extent of skin involvement were also assessed. Results: The sample consisted of 150 women, 75 with diagnosis of psoriasis and 75 healthy controls. Prevalence of sexual dysfunction was high in women with psoriasis (58.6% of the sample). Prevalence was statistically higher in women with psoriasis than in controls (P = 0.014). The SF-36 domain scores were also lower in women with psoriasis, with role limitations due to physical health, limitations due to emotional problems, and mental health being the most affected domains. Study limitations: Sample size was calculated to evaluate the association between the occurrence of sexual dysfunction and psoriasis, but it did not include the determination of the possible causes of this dysfunction. Conclusions: QoL and sexual function were altered in women with psoriasis and should be taken into consideration when assessing disease severity.

Evaluation of the occurrence of sexual dysfunction and general quality of life in female patients with psoriasis.

BACKGROUND: Psoriasis has a significant impact on quality of life (QoL). Sexual life can also be affected, with sexual dysfunction being reported by 25-70% of patients. OBJECTIVES: To determine the occurrence of sexual dysfunction and evaluate QoL in women with psoriasis. METHODS: This case-control study included women aged 18-69 years. The validated Brazilian Portuguese versions of the Female Sexual Function Index (FSFI) and of the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) were administered to all participants to assess sexual function and QoL, respectively. Patients with psoriasis underwent clinical evaluation for the presence of comorbidities, especially psoriatic arthritis and other rheumatic manifestations. Location of lesions and the extent of skin involvement were also assessed. RESULTS: The sample consisted of 150 women, 75 with diagnosis of psoriasis and 75 healthy controls. Prevalence of sexual dysfunction was high in women with psoriasis (58.6% of the sample). Prevalence was statistically higher in women with psoriasis than in controls (P = 0.014). The SF-36 domain scores were also lower in women with psoriasis, with role limitations due to physical health, limitations due to emotional problems, and mental health being the most affected domains. STUDY LIMITATIONS: Sample size was calculated to evaluate the association between the occurrence of sexual dysfunction and psoriasis, but it did not include the determination of the possible causes of this dysfunction. CONCLUSIONS: QoL and sexual function were altered in women with psoriasis and should be taken into consideration when assessing disease severity.

Psoriatic arthritis in patients with psoriasis: evaluation of clinical and epidemiological features in 133 patients followed at the University Hospital of Brasília.

BACKGROUND: Psoriatic arthritis is an inflammatory arthritis associated with psoriasis. Its prevalence in patients with psoriasis varies from 7 to 42% but its exact prevalence is unknown. OBJECTIVES: Considering the lack of national data related to its diagnosis in patients with psoriasis, this study aims to describe the clinical, laboratorial and radiological manifestations of psoriatic arthritis in these patients. METHODS: We evaluated 133 patients with psoriasis, treated as outpatients. These patients were asked to fill in the forms with data about the disease and were submitted to a clinical evaluation by a dermatologist and a rheumatologist. Suspected cases of arthritis were referred for further investigation and were classified according to presence or absence of psoriatic arthritis according to CASPAR criteria. RESULTS: The number of patients with psoriatic arthritis was 47 (35%), 17 of them were new cases. There was no difference between the groups regarding the type of psoriasis, nail involvement, presence of scalp lesions and psoriatic arthritis. Patients with psoriatic arthritis had more enthesitis and dactylitis (46.7%) than those without arthritis. CONCLUSIONS: Despite the high prevalence of arthritis found, we know that results from epidemiological studies are variable, which limits their use and interpretation. We conclude that more studies are needed to draw a profile of rheumatic manifestations in our population of psoriasis patients.

Psoriatic arthritis in patients with psoriasis: evaluation of clinical and epidemiological features in 133 patients followed at the University Hospital of Brasília / Artrite psoriásica em pacientes com psoríase: avaliação de características clínicas e epidemiológicas em 133 pacientes atendidos no Hospital Universitário de Brasília

BACKGROUND: Psoriatic arthritis is an inflammatory arthritis associated with psoriasis. Its prevalence in patients with psoriasis varies from 7 to 42% but its exact prevalence is unknown. OBJECTIVES: Considering the lack of national data related to its diagnosis in patients with psoriasis, this study aims to describe the clinical, laboratorial and radiological manifestations of psoriatic arthritis in these patients. METHODS: We evaluated 133 patients with psoriasis, treated as outpatients. These patients were asked to fill in the forms with data about the disease and were submitted to a clinical evaluation by a dermatologist and a rheumatologist. Suspected cases of arthritis were referred for further investigation and were classified according to presence or absence of psoriatic arthritis according to CASPAR criteria. RESULTS: The number of patients with psoriatic arthritis was 47 (35%), 17 of them were new cases. There was no difference between the groups regarding the type of psoriasis, nail involvement, presence of scalp lesions and psoriatic arthritis. Patients with psoriatic arthritis had more enthesitis and dactylitis (46.7%) than those without arthritis. CONCLUSIONS: Despite the high prevalence of arthritis found, we know that results from epidemiological studies are variable, which limits their use and interpretation. We conclude that more studies are needed to draw a profile of rheumatic manifestations in our population of psoriasis patients.

FUNDAMENTOS: A artrite psoriásica é uma artrite inflamatória associada à psoríase. Sua prevalência nos pacientes com psoríase de 7 a 42% mas sua exata prevalência ainda é desconhecida. OBJETIVOS: Considerando a escassez de dados nacionais relacionados ao seu diagnóstico em pacientes com psoríase o presente estudo visa descrever o quadro clínico, laboratorial e radiológico da doença nesses pacientes. MÉTODOS: Foram avaliados 133 pacientes com diagnóstico de psoríase acompanhados no ambulatório de Psoríase: Esses pacientes foram submetidos ao preenchimento de fichas com dados sobre sua doença e depois a uma avaliação clínica pelo dermatologista e reumatologista. Casos suspeitos de artrite foram encaminhados para realização de investigação complementar e foram classificados quanto à presença ou não de artrite psoriásica segundo critérios de CASPAR. RESULTADOS: O número de pacientes com Artrite Psoriásica foi de 47 pacientes (35% ) sendo 17 desses casos novos. Não houve diferença entre os grupos quanto ao tipo de psoríase, envolvimento ungueal e de couro cabeludo e presença de artrite psoriásica. Pacientes com artrite psoriásica apresentaram mais entesites e dactilite (46,7%) do que os sem artrite. CONCLUSÕES: Apesar da alta prevalência de artrite encontrada como sabemos que resultados de estudos epidemiológicos são variáveis levando a limitação em seu uso e interpretação concluímos que mais estudos são necessários para se traçar um perfil de manifestações reumatológicas em nossa população de pacientes psoriásicos.

Qualidade de vida de 304 mulheres na pós-menopausa / Quality of life of 304 women in post-menopausal women

Objetivo. Avaliar a qualidade de vida de mulheres na pós-menopausa com uso do questionário SF-36. Método. Foram avaliadas consecutivamente 304 pacientes na pós-menopausa. Pacientes com doenças concomitantes que influenciassem a qualidade de vida foram excluídas. Foram avaliadas no dia agendado para sua consulta médica. Os dados clínicos avaliados das doentes foram idade, história ginecológica e obstétrica, história de tabagismo e alcoolismo e presença de fraturas traumáticas ou por trauma mínimo e doenças associadas. Foram verificadas as possíveis correlações entre idade, peso corporal, estatura e índice de massa corporal e os componentes do SF-36 obtidos durante o estudo mediante a aplicação do teste de correlação de Spearman. Resultados. As médias e desvios-padrão de idade, peso corporal, estatura e índice de massa corporal foram respectivamente 69 ± 6,3 anos, 62 ± 12,7 kg, 152 ± 6,1 cm e 27 ± 5 kg/m2. Houve fracas correlações entre a estatura e os domínios de capacidade funcional (r = 0,159), dor (r = 0,158), vitalidade (r = 0,129) e saúde mental (r = 0,146). Não houve qualquer outra correlação entre os domínios do SF-36 e o peso, a idade e a estatura. Houve correlações apenas entre os domínios de capacidade funcional e densidade mineral óssea do colo femoral (r = 0,129) e estado geral de saúde e a densidade mineral óssea do trocânter (r = -0,155). Não houve diferença quanto aos domínios do SF-36, considerando-se os grupos etários e grupos de diagnóstico densitométrico. Conclusão. As pacientes com história de fraturas receberam pior pontuação no estado geral de saúde, maior idade e menor estatura.

Objective. To evaluate the quality of life in post-menopausal women, using the SF-36.Method. We evaluated 304 consecutive post-menopausal female patients. Patients with concomitant diseases that affect the quality of life were excluded from the study. The patients were assessed on the day scheduled for their medical consultation. Clinical data assessed were age, gynecologic and obstetric history, history of smoking, alcoholism, fracture with or without trauma and associated diseases. We verified the possible correlations between age, body weight, height and body mass index and components of the SF-36 obtained during the study by applying the Spearman’s correlation tests. Results. The mean and standard deviation of age, body weight, the height and body mass index were respectively 69 ± 6.3 years, 62 ± 12.7 kg, 152 ± 6.1 cm and 27 ± 5 kg/m2. There were weak correlations between height and functional capacity (r = 0.159), pain (r = 0.158), vitality (r = 0.129) and mental health (r = 0.146). There was no correlation between the domains of the SF-36, weight and age. There were only correlations between the functional capacity and femoral neck bone mineral density (r = 0.129) and between general health status and trochanter bone mineral density (r = -0.155). There was no difference in the domains of the SF-36 considering the age groups and groups of densitometric diagnosis. Conclusion. The patients with history of fractures had worse scores in general health status, older age and smaller height.

Homens idosos com osteoporose são mais magros, têm menor índice de massa corporal e menor índice de rigidez / Elderly men with osteoporosis are thinner, have lower body mass index and lower stiffness index

Objetivo. Correlacionar o índice de rigidez com os resultados das densitometrias ósseas da coluna lombar, do fêmur proximal e do antebraço distal. Métodos. Foram avaliados 171 homens idosos moradores da comunidade sem diagnóstico de doenças osteometabólicas. A avaliação clínica buscou os fatores de risco de baixa massa óssea e fratura por trauma mínimo. A densitometria óssea considerou para a análise densitométrica as regiões de L1-L4, colo femoral, trocânter, quadril total, rádio 33%. O índice de rigidez foi o parâmetro considerado na ultrassonometria. Os resultados da densitometria e da ultrassonometria ósseas foram avaliados quanto ao T-Score ≤ -2,0 ou > -2,0. Resultados. A idade variou de 60 a 88 anos, com média de 69 ± 6,1. A média do índice de massa corporal foi 25,8 ± 3,6. Verificou-se tabagismo atual em 31,6% e 5,1% referiram etilismo. Receberam diagnóstico de osteoporose 39,2%, e 18,1% tiveram densitometria normal. Houve diferença quanto ao peso, índice de massa corporal, índice de rigidez e o T-Score do índice de rigidez entre os grupos quanto ao T-Score ≤ -2,0. Houve correlações fracas entre o índice de rigidez e as densidades minerais ósseas. Conclusão. As fracas correlações entre o índice de rigidez e as densidades minerais ósseas limitam o uso do método no diagnóstico de osteoporose nessa população. Os achados indicam que o índice de rigidez não é bom preditor da densidade mineral óssea avaliada pela densitometria. Entretanto, os homens com diagnóstico de osteoporose foram mais magros, com menor índice de massa corporal e tiveram menor índice de rigidez.

Objective. To correlate the stiffness index with results of bone densitometry of the lumbar spine, proximal fêmur and distal forearm. Methods. We evaluated 171 community-dwelling elderly men without diagnosed bone diseases. Clinical evaluation assessed risk factors for low bone mass and fracture by minor trauma. Densitometry evaluation considered the boné density measures at the regions of L1-L4, femoral neck, trochanter, total hip, radio 33%. Quantitative ultrasound considered stiffness index in the analysis. The results of bone densitometry and quantitative ultrasound were assessed for T-score ≤ -2.0 or > -2.0. Results. The age ranged from 60 to 88 years, averaging 69 ± 6.1. The mean body mass index was 25.8 ± 3.6. Patients reported smoking in 31.6% and alcohol abuse in 5.1% of times. Osteoporosis was diagnosed in 39.2% and 18.1% had normal density. There was difference as to weight, body mass index, stiffness index and the index T-score of stiffness index between the groups in the T-Score ≤ -2.0. There were weak correlations between the stiffness index and bone mineral density. Conclusion. The poor correlation between stiffness index and bone mineral density limit the use of the method in the diagnosis of osteoporosis in this population. These findings indicate that stiffness index does not predict bone density as effectively as bone densitometry by the current standard methodology. However, men diagnosed with osteoporosis were thinner, with lower body mass index and had lower stiffness index.

[Reactive arthritis in HIV-infected patients: immunopathogenic aspects]. / Artrite reactiva em pacientes infectados pelo HIV: aspectos imunopatogênicos.

Reactive arthritis ReA is still an incompletely understood rheumatic disorder whose immunopathogeny involves several mechanisms. There is an association with Class-I histocompatibility antigens HLA-B27 and history of previous gastrointestinal or genitourinary infections. The molecular mimicry between bacterial and self antigens suggests the possibility of cross reactivity as a disease mechanism. The infection pandemics by the human immunodeficiency virus HIV changed the profile of the occurrence of a number of rheumatic diseases including ReA which appears to be more frequent more severe and refractory to the usual treatment for retrovirus-infected patients. The intensity of articular and extra-articular manifestations of ReA often makes the use of immunosuppressant drugs in these patients necessary. Due to the immunosuppression resulting from the retrovirosis itself the treatment becomes a dilemma for rheumatologists. HIV seems to play a role in the main ReA immunopathogenesis mechanisms either acting as direct arthritogenic agent or causing an immune dysfunction in the CD4 T lymphocytes T CD8 relationship leading to the deregulation in the production of cytokines or in advanced immunosuppression stages predisposing to infection by other arthritogenic pathogens. The use of highly active anti-retroviral therapy HAART has changed the profile of rheumatic events and the immunopathogeny of the HIV ReA association. The understanding of the basic ReA immunopathogenic mechanisms in HIV-infected patients is vital in the attempt of elucidating many still existing questions.