ABSTRACT
INTRODUCTION: Ankylosing spondylitis (AS) is a chronic disease featuring axial changes, peripheral arthritis and systemic involvement. Proinflammatory cytokines are probably involved in AS pathogenesis. The relationship of circulating cytokines with instruments of AS evaluation is an open field of research. OBJECTIVE: The aim of this study was to compare serum levels of cytokines in AS patients and healthy controls, and search for correlations of cytokines with indexes of disease activity and quality of life. PATIENTS AND METHODS: In this cross-sectional study, 32 AS patients and 32 age- and sex- matched controls were evaluated. Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Funcional Index (BASFI), Bath Ankylosing Spondylitis Metrology Index (BASMI), Ankylosing Spondylitis Disease Activity Score-C reactive protein (ASDAS-CRP), Maastricht Ankylosing Spondylitis Enthesitis Score (MASES), Ankylosing Spondylitis Quality of Life (ASQol) and Patient Global Assessment score were measured in AS patients. The soluble cytokines IL-6, IL-8, IL-1, IL-10, TNF-α, IL-12p70 and IL-17 were quantified by flow cytometry. IL-23 concentrations were measured using an enzyme-linked immunosorbent assay. RESULTS: Overall, AS patients were predominantly males (59.4%) and Caucasians (96.9%). Mean age was 46.9±10.7 years. Human leukocyte antigen B27 was present in 70% of cases. Concentrations of IL-6, IL-8, IL-10 and TNF-α were higher in AS cases than controls (p<0.05). Mean concentration of IL-6 correlated with the BASMI, an index of axial mobility (r=0.354, p=0.047). Anti-TNF intake (present in 21 patients, 65.6%) associated with a high BASMI (p=0.042) and lower quality of life as measured using the ASQol scale (p=0.009). CONCLUSION: A proinflammatory cytokine profile predominated in AS patients, but interestingly, the IL-10 concentrations were also elevated, pointing to a suppressive control of inflammation. A defined correlation of serum IL-6 with the BASMI suggests a role for this cytokine in axial disease. Anti-TNF users showed more axial activity and lower quality of life.
ABSTRACT
INTRODUCTION: Ultrasonography (US) has a recent use in Rheumatology, and the reliability of the method in rheumatoid arthritis (RA) patients has yet to be clarified. OBJECTIVE: To test, in a RA survey, the reproducibility of musculoskeletal US performed by rheumatologists with one-year training through re-analysis by a Rheumatologist experienced in the method. PATIENTS AND METHODS: This cross-sectional study included consecutive RA patients from our tertiary center. US exam was performed in metacarpophalangeal joints, proximal interphalangeal joints, and wrists. Presence of synovitis, power Doppler (PD) signal, bone erosions, and cartilage changes comprised the US parameters evaluated. A kappa value in-between 0.20 and 0.40 was considered fair; in-between 0.41 and 0.60 was moderate; in-between 0.61 and 0.80 was good; and above 0.81 was excellent. RESULTS: We analyzed 1,380 joints of 60 RA patients (78% females, 78% caucasoids). Mean age was 58 ± 11.56 years, mean disease duration was 9.98 ± 7.79 years, mean DAS28 was 3.82 ± 1.53, and mean HAQ was 0.91 ± 0.67. Kappa agreement for synovitis ranged from 0.30 to 0.70; for PD signal, from 0.53 to absolute agreement; for erosions, from 0.70 to 0.97; for cartilage changes, from 0.28 to 0.63. CONCLUSION: Although good, moderate and excellent interobserver agreement were obtained for erosions and PD, concordance for synovitis and cartilage changes were less impressive in our patients with active RA. Further studies on standardization of scanning technique are necessary to improve musculoskeletal US reproducibility.
Subject(s)
Arthritis, Rheumatoid/diagnostic imaging , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Observer Variation , Reproducibility of Results , UltrasonographyABSTRACT
A Parada Cardiorrespiratória (PCR) é a ausência de atividade cardiopulmonar, uma situação tecnicamente de morte e que se precocemente detectada pode ser revertida. Nesse artigo revisaremos brevemente a evolução histórica da reversão do quadro, assim como revisaremos o manejo tanto de forma básica para leigos assim como avançada para profissionais capacitados.
The cardiorespiratory arrest it's the lack of any cardiopulmonary activity, a nearly death state that if fastly noticed can be reversed. In this article we'll discuss briefly the history, the basic and advanced practices to lay and professionals to manage this condition.