The Burden of Spine Structural Damage on Function in Patients With Axial Spondyloarthritis: Adaptation-Mediated Uncoupling?

OBJECTIVE: To investigate the association between spinal damage and functional capacity in patients with axial spondyloarthritis (axSpA) and to compare the performance of 2 radiographic scores (modified Stoke Ankylosing Spondylitis Spine Score [mSASSS] and Combined Ankylosing Spondylitis Spine Score [CASSS]). METHODS: Radiographs from 101 patients with axSpA were scored for cervical facet joints (CFJ) and mSASSS for vertebral bodies. CASSS was calculated as the sum of both scores. Physical function was assessed by Bath Ankylosing Spondylitis Functional Index (BASFI); disease activity by Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Ankylosing Spondylitis Disease Activity Score (ASDAS); mobility by Bath Ankylosing Spondylitis Metrology Index (BASMI); and quality of life by Ankylosing Spondylitis Quality of Life (ASQOL). Univariate and multivariate analyses were performed to investigate the association between possible explanatory variables and outcomes. RESULTS: BASFI correlated strongly with ASQOL (Spearman ρ 0.66) and BASDAI (ρ 0.70), moderately with BASMI (ρ 0.46) and ASDAS (ρ 0.59), and weakly with mSASSS (ρ 0.29) and CASSS (ρ 0.28). A best-fit multivariate model for BASFI, adjusted for symptom duration, age, sex, and smoking status, included BASDAI (B 0.76, P < 0.001), BASMI (B 0.62, P < 0.001), and history of total hip arthroplasty (B 1.22, P = 0.05). Radiographic scores were predictors of BASFI only when BASMI was removed from the model (mSASSS: B 0.03, P = 0.01; CASSS: B 0.02, P = 0.01). CONCLUSION: Spinal damage was independently associated with physical function in axSpA, but to a lesser extent than disease activity and mobility. Moreover, incorporating CFJ assessment in the mSASSS did not improve the ability to predict function.

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.

Brazilian recommendations for the use of nonsteroidal anti-inflammatory drugs in patients with axial spondyloarthritis

Abstract Spondyloarthritis (SpA) is a group of chronic inflammatory systemic diseases characterized by axial and/or peripheral joints inflammation, as well as extra-articular manifestations. Over some decades, nonsteroidal anti-inflammatory drugs (NSAIDs) have been the basis for the pharmacological treatment of patients with axial spondyloarthritis (axSpA). However, the emergence of the immunobiologic agents brought up the discussion about the role of NSAIDs in the management of these patients. The objective of this guideline is to provide recommendations for the use of NSAIDs for the treatment of axSpA. A panel of experts from the Brazilian Society of Rheumatology conducted a systematic review and meta-analysis of randomized clinical trials for 15 predefined questions. The Grading of Recommendations, Assessment, Development and Evaluation methodology to assess the quality of evidence and formulate recommendations were used, and at least 70% agreement of the voting panel was needed. Fourteen recommendations for the use of NSAIDs in the treatment of patients with axSpA were elaborated. The purpose of these recommendations is to support clinicians' decision making, without taking out his/her autonomy when prescribing for an individual patient.(AU)

The Brazilian Society of Rheumatology guidelines for axial spondyloarthritis - 2019

Abstract Spondyloarthritis is a group of chronic inflammatory systemic diseases characterized by axial and/or peripheral joints inflammation, as well as extra-articular manifestations. The classification axial spondyloarthritis is adopted when the spine and/or the sacroiliac joints are predominantly involved. This version of recommendations replaces the previous guidelines published in May 2013. A systematic literature review was performed, and two hundred thirty-seven studies were selected and used to formulate 29 recommendations answering 15 clinical questions, which were divided into four sections: diagnosis, non-pharmacological therapy, conventional drug therapy and biological therapy. For each recommendation the level of evidence supporting (highest available), the strength grade according to Oxford, and the degree of expert agreement (inter-rater reliability) is informed. These guidelines bring evidence-based information on clinical management of axial SpA patients, including, diagnosis, treatment, and prognosis.

Aspectos actualizados sobre dengue / Aspects updated dengue

Se realiza una revisión bibliográfica sobre dengue con el propósito de exponer una actualización de esta enfermedad que nos azota en la actualidad, ya que a pesar de estar demostrado que es una enfermedad curable y prevenible aún no se ha logrado una total erradicación de su transmisión, ni una concientización en la población, lo cual tiene un costo emocional, social y económico para los servicios de salud que implican su atención(AU)

A literature review on dengue is done with the purpose of exposing an update of this disease that plagues us today, because despite being proven to be a curable and preventable disease has not yet achieved a total eradication of transmission, and awareness in the population, which has an emotional, social and economic costs for health services involving your attention(AU)

Avaliação clínica, laboratorial e radiográfica de brasileiros com espondiloartropatias / Clinical, laboratorial and radiographic evaluation in Brazilians with spondyloarthropaties

OBJETIVO: analisar o padrão de doença de pacientes brasileiros com espondiloartropatias (EAP). PACIENTES E MÉTODOS: foram avaliados 156 pacientes por meio de análise descritiva e análise de associação uni e multivariada entre a distribuição das manifestações clínicas, laboratoriais e radiográficas e a presença do HLA-B27. RESULTADOS: as doenças do grupo identificadas foram a espondilite anquilosante - EA (48,10 por cento), a espondiloartropatia indiferenciada (20,51 por cento), a artrite reativa - ARe (15,39 por cento), a artrite psoriásica - AP (14,10 por cento) e a artropatia das doenças inflamatórias intestinais (1,92 por cento). O HLA-B27 foi positivo em 53,85 por cento dos pacientes. O HLA-B27 positivo associou-se ao acometimento clínico e/ou radiográfico das articulações sacroilíacas (p=0,007; OR=3,13; IC 95 por cento 1,38 a 7,06), à presença de sacroiliíte radiográfica > grau II bilateral (p=0,05; OR=2,85; IC 95 por cento 1,02 a 8,04) e ao sexo masculino (p=<0,001; OR=3,00; IC 95 por cento 1,83 a 4,92), enquanto indivíduos com o HLA-B27 negativo apresentaram, significativamente, mais balanite como manifestação evolutiva que indivíduos HLA-B27 positivos (p=0,03; OR=0,21; IC 95 por cento 0,05 a 0,88). CONCLUSÃO: as manifestações clínicas, laboratoriais e radiográficas foram semelhantes às descritas em outros trabalhos. O HLA-B27 apresentou-se em baixa freqüência, quando comparado com outras amostras, e ocorreram associações entre este antígeno e o sexo masculino e o envolvimento das articulações sacroilíacas.

OBJECTIVE: to evaluate disease manifestations of Brazilian patients with spondyloarthropathies. METHODS: a group of 156 patients was studied in a descriptive evaluation the analysis of the association between clinical, laboratory and radiographic aspects and the presence of the HLA-B27 was done. RESULTS: the following diseases were identified: ankylosing spondylitis (48.10 percent), undifferentiated spondyloarthropathy (20.51 percent), reactive arthritis (15.39 percent), psoriatic arthritis (14.10 percent) and inflammatory bowel disease arthropathy (1.92 percent). The HLA-B27 was identified in 53.85 percent. HLA-B27 presence was associated with clinical and/or radiographic findings of sacroiliac joints involvement (p=0.007; OR=3.13; CI 95 percent 1.38 to 7.06), with the presence of radiographic bilateral sacroiliitis > grade II, bilateral (p=0.05; OR=2.85; IC 95 percent 1.02 to 8.04) and with male gender (p=<0.001; OR=3.00; CI 95 percent 1.83 to 4.92). On the other hand, negative HLA-B27 was significantly associated with the occurrence of balanitis during the course of the disease (p=0.03; OR=0.21; IC 95 percent 0.05 to 0.88). CONCLUSION: clinical, laboratory and radiographic manifestations were similar to those reported by other studies. The frequency of HLA-B27 was low when compared to other studies. A significant association was observed between the HLA-B27 and gender as well as compromised sacroiliac joints.

Paquidermoperiostose: relato de caso / Pachydermoperiostosis: case report

A paquidermoperiostose, forma primária da osteoartropatia hipertrófica, é doença rara de etiologia desconhecida e incidência familiar, caracterizada por periostose de ossos longos e alterações hipertróficas da pele. As manifestações articulares ocorrem em 30% a 40% dos casos e podem ser a principal queixa do paciente. Neste artigo, é relatado o caso de paciente jovem, do sexo masculino, encaminhado ao reumatologista com dor e derrame em joelhos e tornozelos. Foram observadas ainda acne na face, acentuação das pregas cutâneas na região frontal, ptose bipalpebral, alongamento dos dedos das mãos e baqueteamento digital. As radiografias dos ossos longos dos membros superiores e inferiores evidenciaram periostose. Iniciou-se piroxican 20mg/dia, com melhora das manifestações articulares, entretanto essa medicação foi suspensa devido a hemorragia digestiva alta. Prescreveu-se, então, prednisona 10 mg/dia, com boa resposta.

Pachydermoperiostosis or primary hypertrophic osteoarthropathy is a rare disease of unknown etiology with a familial incidence. It is characterized by periostosis of long bones and hypertrophic skin changes. Joint manifestations occur in 30 to 40% of cases and may be the main complaint. A case of a young male patient, referred to a rheumatologist with pain and effusion of the knees and ankles, is described. Coarse facial features, acne, ptosis of the eyelids, and digital clubbing were also observed. Periostosis of the appendicular bones were demonstrated by x-rays. Joint manifestations were successfullv treated with Piroxican, 20 mg, daily, but the occurrence of high digestive hemorrhage required the interruption of this medication. Prednisone, 10 mg, daily, was then administered with positive response.

Variaçöes anatómicas da via biliar principal em estudos radiológicos / Anatomic variances in principal biliary tract in radiologics studies

A via biliar é uma sede frequente de variaçöes anatômicas. Seu conhecimento é importante principalmente sob o ponto de vista cirúrgico. Com o objetivo de estudar as principais alteraçöes anatômicas da via biliar principal "in vivo", investigaram-se retrospectivamente 86 colangiografias peroperatórias de colescistectomias por litíase biliar. Os resultados mostraram variaçöes da drenagem da via biliar direita em 13,1 por cento dos casos . A confluência dos ductos principais apresentou variaçöes em 14,5 por cento dos casos. O ducto cístico apresentou trajeto retilíneo em 87,5 por cento, dos casos, sendo espiralado em 2,5 por cento e inserido próximo ao duodeno em 10 por cento. Concluindo, o exame colangiográfico peroperatório evidenciou algumas variaçöes morfológicas. Julgamos prudente a realizaçäo desse exame näo só para caracterizar doenças das vias biliares, mas também para orientar o cirurgiäo, com vista a possíveis alteraçöes anatômicas que podem ser causa de incidentes cirúrgicos