Portuguese recommendations for the use of biological therapies in patients with axial spondyloarthritis - 2016 update.

OBJECTIVE: To update the recommendations for the treatment of axial spondyloarthritis (axSpA) with biological therapies, endorsed by the Portuguese Society of Rheumatology. METHODS: These treatment recommendations were formulated by Portuguese rheumatologists based on literature evidence and consensus opinion. At a national meeting, the 7 recommendations included in this document were discussed and updated. A draft of the full text of the recommendations was then circulated and suggestions were incorporated. A final version was again circulated before publication and the level of agreement among Portuguese Rheumatologists was anonymously assessed using an online survey. RESULTS: A consensus was achieved regarding the initiation, assessment of response and switching of biological therapies in patients with axSpA. In total, seven recommendations were produced. The first recommendation is a general statement indicating that biological therapy is not a first-line drug treatment option and should only be used after conventional treatment has failed. The second recommendation is also a general statement about the broad concept of axSpA adopted by these recommendations that includes both non-radiographic and radiographic axSpA. Recommendations 3 to 7 deal with the definition of active disease (including the recommended threshold of 2.1 for the Ankylosing Spondylitis Disease Activity Score [ASDAS] or the threshold of 4 [0-10 scale] for the Bath Ankylosing Spondylitis Disease Activity Index [BASDAI]), conventional treatment failure (nonsteroidal anti-inflammatory drugs being the first-line drug treatment), assessment of response to treatment (based on an ASDAS improvement  of at least 1.1 units or a BASDAI improvement of at least 2 units [0-10 scale] or at least 50%), and strategy in the presence of an inadequate response (where switching is recommended) or in the presence of long-term remission (where a process of biological therapy optimization can be considered, either a gradual increase in the interval between doses or a decrease of each dose of the biological therapy). CONCLUSION: These recommendations may be used for guidance in deciding which patients with axSpA should be treated with biological therapies. They cover a rapidly evolving area of therapeutic intervention. As more evidence becomes available and more biological therapies are licensed, these recommendations will have to be updated.

SLC19A1 80G allele as a biomarker of methotrexate-related gastrointestinal toxicity in Portuguese rheumatoid arthritis patients.

AIM: The aim of our study was to characterize the association of clinicopathological variables and the SLC19A1/RFC-1 G80A polymorphism in methotrexate (MTX)-related toxicity in Portuguese patients with rheumatoid arthritis. PATIENTS & METHODS: The study included 233 consecutively recruited patients with rheumatoid arthritis under MTX treatment. The SLC19A1 G80A polymorphism was evaluated by PCR-RFLP. RESULTS: Statistical analysis revealed that SLC19A1 80G carriers had increased risk of gastrointestinal toxicity (odds ratio [OR]: 2.61, p = 0.019) and that regular folic acid supplementation was associated with both overall and gastrointestinal toxicity protection (OR: 0.15, p < 0.001 and OR: 0.19, p < 0.001, respectively). Multivariate analysis confirmed the association of SLC19A1 80G and regular folic acid supplementation to gastrointestinal toxicity (OR: 5.53 and 0.13, respectively). Moreover, a multivariate Cox regression model demonstrated a higher risk of earlier gastrointestinal toxicity in SLC19A1 80G carriers (hazard ratio: 3.63, p = 0.002). CONCLUSION: SLC19A1 G80A genotyping may be a useful tool for clinicians to identify patients at higher risk for developing gastrointestinal toxicity related to MTX treatment.

2011 Portuguese recommendations for the use of biological therapies in patients with psoriatic arthritis.

OBJECTIVE: To develop recommendations for the treatment of psoriatic arthritis (PsA) with biological therapies, endorsed by the Portuguese Society of Rheumatology. METHODS: These treatment recommendations were formulated by Portuguese rheumatologists based on literature evidence and consensus opinion. A draft of the recommendations was first circulated to all Portuguese rheumatologists and their suggestions were incorporated in the draft. At a national meeting the recommendations were discussed and all attending rheumatologists voted on the level of agreement for each recommendation. A second draft was again circulated before publication. RESULTS: A consensus was achieved regarding the initiation, assessment of response and switching biological therapies in patients with PsA. Specific recommendations were developed for several disease domains: peripheral arthritis, axial disease, enthesitis and dactylitis. CONCLUSION: These recommendations may be used for guidance in deciding which patients with PsA should be treated with biological therapies. They cover a rapidly evolving area of therapeutic intervention. As more evidence becomes available and more biological therapies are licensed, these recommendations will have to be updated.

Portuguese recommendations for the use of biological therapies in patients with axial spondyloarthritis--December 2011 update.

OBJECTIVE: To develop recommendations for the treatment of axial spondyloarthritis with biological therapies, endorsed by the Portuguese Society of Rheumatology. METHODS: These treatment recommendations were formulated by Portuguese rheumatologists based on literature evidence and consensus opinion. A draft of the recommendations and supporting evidence was first circulated to all Portuguese rheumatologists and their suggestions were incorporated in the draft. Secondly, at a national meeting the recommendations were presented, discussed and revised. Finally, the document resulting from this meeting was again circulated to all Portuguese rheumatologists, who anonymously voted online on the level of agreement with the recommendations. RESULTS: A consensus was achieved regarding the initiation, assessment of response and switching biological therapies in patients with axial spondyloarthritis. CONCLUSION: These recommendations may be used for guidance in deciding which patients with axial spondyloarthritis should be treated with biological therapies. They cover a rapidly evolving area of therapeutic intervention. As more evidence becomes available and more biological therapies are licensed, these recommendations will have to be updated.

Portuguese recommendations for the use of biological therapies in children and adolescents with juvenile idiopathic arthritis--December 2011 update.

OBJECTIVE: To update the Portuguese recommendations in order to assist the rational and safe prescribing of biological therapies in children and adolescents with Juvenile Idiopathic Arthritis (JIA) as more evidence and experience with these drugs are available. METHODS: The recommendations were formulated by Rheumatologists and Pediatricians, with experience in Pediatric Rheumatology, based on literature evidence and consensus opinion. The evidence was sought through a MEDLINE search. The retrieved results were discussed and a set of recommendations proposed. All propositions were extensively debated and the final recommendations formulated. RESULTS: A consensus was achieved regarding the eligibility, response criteria, maintenance of biologic thera py, and procedures in case of non-response. Also, specific recommendations concerning safety procedures before and while on biologic therapies were formulated. CONCLUSIONS: Thirteen recommendations for guidance biological therapy in children and adolescents with JIA were developed using both evidence-based and expert consensus. These recommendations will be updated as more evidence becomes available and more biological therapies are licensed.

[Guidelines for prescribing and monitoring biologic therapies in juvenile idiopathic arthritis]. / Consensos para início e manutenção de teraprêutica biológica na artrite idiopática juvenil.

The Pediatric RheumatologyWorking Group of the Portuguese Society of Rheumatology recommends the use of biological treatments in children with polyarticular course Juvenile Idiopathic Arthritis (JIA) with active disease (5 or more active joints) refractory to subcutaneous or intramuscular methotrexate (MTX) 15 mg/m(2)/week during 3 to 6 months. If toxicity occurs, or if there is contraindication for the use of MTX in this optimum dose, biological treatment can be started, as a first option, or the use of other conventional Disease ModifyingAnti Rheumatic Drug (DMARD) either alone or in combination with MTX might be considered. Prior to starting treatment, children should be screened for latent tuberculosis through clinical evaluation, chest X ray and PPD skin test. The suspension of the biological treatment should be considered if the American College of Rheumatology (ACR) definition of improvement in JIA is not fulfilled in two consecutive visits 3 months apart. Etanercept is the only biological agent currently approved for JIA in Portugal. In refractory cases the use of infliximab is accepted, in accordance with preliminary published evidence. In case of systemic manifestations of JIA refractory to conventional treatment, anakinra can be considered.

[Normative data for quantitative ultrasound measurement of the calcaneus in a Portuguese population]. / Valores de referência para uma população urbana Portuguesa da avaliação quantitativa por ultrasons do calcâneo.

BACKGROUND: Quantitative ultrasound (QUS) measurement of the calcaneus is a safe and reliable method for evaluating skeletal status. Although central bone densitometry (DXA) measurement is the gold-standard to classify osteopenic and osteoporotic patients, QUS can give supplementary information and its use is expanding. Up to now there are no published normative data for QUS measurements in the Portuguese population. OBJECTIVES: The aims of this study were to determine normative QUS data in the Sahara Clinical Sonometer (Hologic) for the Portuguese population. METHODS: Cross-sectional evaluation of consecutive subjects selected as part of the EpiPorto study, Portugal. Calcaneus QUS (Sahara Clinical Sonometer, Hologic) parameters were obtained: Broadband Ultrasound Attenuation (BUA), Speed of Sound (SOS), Quantitative Ultrasound Index (QUI) and Estimated Bone Mineral Density (EBMD) were determined for men and women, stratified by their age group. RESULTS: 1,482 consecutive subjects (1,010 females and 472 males), aged from 18 to 92 years. Higher levels of QUS parameters were found in the lower age group and, for both gender, progressive decrease with age were reported. Men showed higher values as compared to women in all parameters and differences between them increased with age. Differences were significant for BUA after the age of 39 and for SOS after the age of 59. Short-term in vivo precision was 5.5% for BUA and 0.4% for SOS, while in vitro precision was 3.23% for BUA and 0.15% for SOS. DISCUSSION: Our data are comparable to other Southern European data and represent the first QUS normative data for the Portuguese population.

Memórias de parteiras: entrelaçando gênero e história de uma prática feminina do cuidar

O presente estudo procurou resgatar através da memória de parteiras um fazer que historicamente está associado a uma prática feminina, tentando uma aproximação desse fazer com o que se tem proposto atualmente como “humanização do parto”. Trata-se de um estudo qualitativo que utilizou a História Oral Temática como método de apreensão dos dados. Seguindo uma tendência de vários oralistas da atualidade, as narrativas coletadas através das entrevistas foram apresentadas na íntegra, textualizadas pela autora, na tentativa de manter toda a força e singularidade contidas nesses discursos. Da pesquisa participaram sete colaboradoras, sendo três do Estado de Santa Catarina e quatro do norte do estado de Minas Gerais. A colônia foi composta por mulheres que durante o período compreendido entre as décadas de quarenta e a década de oitenta dedicaram-se ao ato de partejar, quer seja em âmbito domiciliar ou hospitalar, independente da forma como aprenderam a fazer partos. Tendo como objetivo desvelar o ideário contido nas narrativas à luz de um referencial de gênero, o estudo analisou alguns aspectos codificados como “lugares de significados” que foram: o perfil das parteiras; como e onde partejavam; a vocação; o cuidado, a humanização e a ética. Os dados obtidos evidenciam um fazer já bastante atrelado ao saber/fazer médico, mesclando-se com conhecimentos de senso comum adquiridos com outras mulheres, principalmente no caso das parteiras que não passaram por um aprendizado formal, além de que a maioria delas, direta ou indiretamente estavam ligadas à Enfermagem. ...