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.

[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.

Diabetes fosforada idiopática do adulto: a propósito de um caso clínico / Acquired hypophosphatemic osteomalacia: case report

O fósforo é elemento essencial e muitas vezes pouco valo rizado na prática clínica. A diabetes fosforada idiopática do adulto (DFIA) é causa de alteraçao da homeostase do fósforo, resultante de defeito da reabsorçao deste elemento no túbulo proximal, de causa nao conhecida. Caracteriza-se clinicamente por raquialgias, radiculalgias, fadiga, dores ósseas e articulares e sintomas neuropsiquiátricos. As características laboratoriais típicas sao: hipofos fatemia, hiperfosfatúria e índices de reabsorçao tubular do fósforo que demons tram diminuiçao da reabsorçao renal desse elemento. A hipofosfatemia moderada que se verifica na DFIA provoca alteraçao do metabolismo ósseo, que resulta em osteopenia. A terapeutica com fósforo e vitamina D leva a normalizaçao da fosfa temia e dos índices de reabsorçao renal de fósforo, a melhoria clínica e o aumento da densidade mineral óssea. Os autores escrevem o caso de paciente com DFIA e discutem alguns pontos de etiopatogenia, clínica e terapeutica dessa doença