Previous biological therapy and impairment of the IFN-γ/IL-10 axis are associated with low immune response to 17DD-YF vaccination in patients with spondyloarthritis.

Yellow fever (YF) vaccination is known to induce a suboptimal response in patients with autoimmune diseases (AIDs). To date, few studies have focused on the performance of 17DD-YF vaccination in patients with spondyloarthritis (SpA). In general, patients with SpA are young and have less comorbidities than other patients with AIDs, and frequently receive biological disease-modifying antirheumatic drugs (DMARDs) that may impact their response to vaccines. Taking this background information, the present study aimed to investigate whether the use of biological DMARDs, even after planned washout, or disease activity measured by the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), would impact the overall performance of planned 17DD-YF primary vaccination in patients with SpA. For this purpose, 74 subjects were enrolled in a prospective study, including adult patients with SpA (SpA; n = 51) and a healthy control (HC; n = 23) group. Analysis of YF specific neutralizing antibodies test (PRNT), along with YF viremia and the levels of serum chemokines, cytokines, and growth factors were performed at distinct time points (D0, D3, D4, D5, D6, D7, D14, and D28). The BASDAI scores were evaluated at D0 and D180. Data demonstrated that overall, the SpA group presented lower PRNT titers and seropositivity rates as compared to the HC group (GeoMean = 112 vs. 440; 73% vs. 96%, respectively). In SpA subgroup analyses, previous biological DMARDs (BIO-IT) led to a lower PRNT titers (BIO-IT 79, 95% CI [39-150] vs. without biological DMARDs [non-BIO-IT] 159, 95% CI [94-267], p < 0.001). The non-BIO-IT group achieved a response similar to the HC group (81% vs. 96%, p = 0.112), whereas the BIO-IT group had a lower seroconversion rate (64% vs. 96% HC, p = 0.007). The BASDAI was not associated with PRNT levels and did not change after 6 months of follow-up. No differences in YF viremia were observed amongst subgroups. Higher baseline levels of serum biomarkers were observed in the BIO-IT group vs. the non-BIO-IT group, as well as in those with a BASDAI ≥ 4 vs. those with a BASDAI < 4. Increasing levels of several biomarkers were observed in SpA, especially in the BIO-IT and BASDAI ≥ 4 subgroups throughout the timeline kinetics, with impairment/disturbance in the IFN-γ/IL-10 axis around the peak of viremia (D5). Altogether, these findings suggested that the use of biological DMARDs impacts the response to the 17DD-YF vaccine, even after planned washout. Therefore, previous biological DMARD therapy, the inflammatory status prior vaccination, and impairment of the IFN-γ/IL-10 axis at the peak of viremia may determine the immunogenicity of 17DD-YF vaccination in patients with SpA.

Serum biomarker profile orchestrating the seroconversion status of patients with autoimmune diseases upon planned primary 17DD Yellow fever vaccination.

The present study aimed to investigate whether the serum biomarkers of immune response orchestrate the seroconversion status in patients with autoimmune diseases (AID) upon planned primary 17DD-YF vaccination. For this purpose a total of 161 individuals were enrolled in a prospective study, including patients with Rheumatoid Arthritis (RA = 38), Spondyloarthritis (SpA = 51), Systemic Lupus Erythematosus (SLE = 21) and Sjögren's Syndrome (SS = 30) along with a group of healthy controls (HC = 21). Analysis of plaque reduction neutralization test (PRNT) titers and seropositivity rates along with the 17DD-YF viremia and serum biomarkers were carried out at distinct time points (D0/D3-4/D5-6/D7/D14-28). The results demonstrated an overall lower PRNT titer and seropositivity rate (170 vs. 448; 77 vs. 95%) in AID as compared to HC, especially in SpA and SLE subgroups. No significant differences were observed in the viremia levels amongst groups. In general, a more prominent serum biomarker response was observed in AID as compared to HC, throughout the timeline kinetics. Remarkably, AID/PRNT(-) exhibited higher levels of several biomarkers at baseline as compared to AID/PRNT+. Moreover, while AID/PRNT(+) exhibited earlier increase in serum biomarkers at D3-4/D5-6, the AID/PRNT(-) displayed higher response at later time points (D7/D14-D28). Of note, a synchronic increase of IFN-γ at the peak of viremia (D5-6) was observed in HC and AID/PRNT(+) groups, whereas a later asynchronous IFN-γ response was reported for AID/PRNT(-) at D7. The biomarker profile tends to deflate at post-vaccination timeline, highlighting a putative immunomodulatory effect of live attenuated 17DD-YF vaccine in AID/PRNT(+), but not in AID/PRNT(-). Altogether these data suggested that inflammatory status prior vaccination, low IFN-γ at viremia peak and the occurrence of asynchronous biomarker storm after 17DD-YF vaccination may orchestrate the lack of neutralizing antibody response γ.

Planned Yellow Fever Primary Vaccination Is Safe and Immunogenic in Patients With Autoimmune Diseases: A Prospective Non-interventional Study.

Yellow Fever (YF) vaccination is suggested to induce a large number of adverse events (AE) and suboptimal responses in patients with autoimmune diseases (AID); however, there have been no studies on 17DD-YF primary vaccination performance in patients with AID. This prospective non-interventional study conducted between March and July, 2017 assessed the safety and immunogenicity of planned 17DD-YF primary vaccination in patients with AID. Adult patients with AID (both sexes) were enrolled, along with healthy controls, at a single hospital (Vitória, Brazil). Included patients were referred for planned vaccination by a rheumatologist; in remission, or with low disease activity; and had low level immunosuppression or the attending physician advised interruption of immunosuppression for safety reasons. The occurrence of AE, neutralizing antibody kinetics, seropositivity rates, and 17DD-YF viremia were evaluated at various time points (day 0 (D0), D3, D4, D5, D6, D14, and D28). Individuals evaluated (n = 278), including patients with rheumatoid arthritis (RA; 79), spondyloarthritis (SpA; 59), systemic sclerosis (8), systemic lupus erythematosus (SLE; 27), primary Sjögren's syndrome (SS; 54), and healthy controls (HC; 51). Only mild AE were reported. The frequency of local and systemic AE in patients with AID and HC did not differ significantly (8 vs. 10% and 21 vs. 32%; p = 1.00 and 0.18, respectively). Patients with AID presented late seroconversion profiles according to kinetic timelines of the plaque reduction neutralization test (PRNT). PRNT-determined virus titers (copies/mL) [181 (95% confidence interval (CI), 144-228) vs. 440 (95% CI, 291-665), p = 0.004] and seropositivity rate (78 vs. 96%, p = 0.01) were lower in patients with AID after 28 days, particularly those with SpA (73%) and SLE (73%), relative to HC. The YF viremia peak (RNAnemia) was 5-6 days after vaccination in all groups. In conclusion, consistent seroconversion rates were observed in patients with AID and our findings support that planned 17DD-YF primary vaccination is safe and immunogenic in patients with AID.

O uso do Mini-Exame do estado Mental colabora notratamento da fibromialgia / The use of the Mini-Mental State Examination is an auxiliary tool in the treatment offibromyalgia

A presença de alterações cognitivas em pacientes com Fibromialgia (FM) desafia aclínica e a pesquisa. Com o objetivo de contribuir com a melhora do tratamento deuma síndrome tão prevalente e que causa incapacidade funcional significativa, foirealizado estudo transversal de abordagem quantitativa com 61 pacientes,utilizando-se o Mini-Exame do Estado Mental (MEEM), a Escala UnidimensionalNumérica Verbal, um questionário para coleta de dados sociodemográficos e pararegistrar a presença de sintomas associados. Os resultados do MEEM mostraramelevado percentual de rastreio positivo para déficit cognitivo associado à FM (60,7%),sendo que os domínios com menor desempenho foram “atenção e cálculo” e“evocação”. Os principais sintomas associados foram: dificuldade de memória, deconcentração e sono não reparador. O segmento da amostra com queixa dedificuldade de concentração apresentou maiores escores na pontuação de dor ecorrelação com os domínios específicos do MEEM “orientação tempo/espaço” e“linguagem”. Esses resultados demonstraram que a aplicação do MEEM pode melhorsubsidiar o tratamento pela equipe interdisciplinar ao fornecer informaçõescomplementares na exploração da queixa do paciente.

The presence of cognitive disabilities in patients with fibromyalgia (FM) challengesclinical practice and research. With the goal of improving the treatment of such aprevalent syndrome that causes significant functional inability, it was made a crosssectionalstudy with a quantitative approach with 61 patients, using the Mini-MentalState Exam (MMSE), the Verbal Numeric Scale and a questionnaire for collectingsociodemographic data and to register the presence of associated symptoms. TheMMSE results showed high percentage of cognitive impairment associated with FM(60.7%) in this sample, and the domains of the MMSE that showed the worseperformance were “attention and calculation” and “recall”. The most frequent associated symptoms were: attention and memory complaints and non-restorativesleep. The part of the sample with concentration complaints had higher scores in thepain scale and a correlation with the MMSE specific domains “orientationtime/space” and “language”. These results showed that applying the MMSE canallow a more satisfying treatment for the interdisciplinary team by bringingcomplementary information in exploring the patient’s complaints.

O uso do Mini-Exame do estado Mental colabora no tratamento da fibromialgia / The use of the Mini-Mental State Examination is an auxiliary tool in the treatment of fibromyalgia

A presença de alterações cognitivas em pacientes com Fibromialgia (FM) desafia aclínica e a pesquisa. Com o objetivo de contribuir com a melhora do tratamento deu ma síndrome tão prevalente e que causa incapacidade funcional significativa, foi realizado estudo transversal de abordagem quantitativa com 61 pacientes,utilizando-se o Mini-Exame do Estado Mental (MEEM), a Escala Unidimensiona lNumérica Verbal, um questionário para coleta de dados sociodemográficos e para registrar a presença de sintomas associados. Os resultados do MEEM mostraram elevado percentual de rastreio positivo para déficit cognitivo associado à FM (60,7%),sendo que os domínios com menor desempenho foram "atenção e cálculo" e"evocação". Os principais sintomas associados foram: dificuldade de memória, de concentração e sono não reparador. O segmento da amostra com queixa d edificuldade de concentração apresentou maiores escores na pontuação de dor e correlação com os domínios específicos do MEEM "orientação tempo/espaço" e"linguagem". Esses resultados demonstraram que a aplicação do MEEM pode melhor subsidiar o tratamento pela equipe interdisciplinar ao fornecer informações complementares na exploração da queixa do paciente.

The presence of cognitive disabilities in patients with fibromyalgia (FM) challengesclinical practice and research. With the goal of improving the treatment of such aprevalent syndrome that causes significant functional inability, it was made a crosssectionalstudy with a quantitative approach with 61 patients, using the Mini-MentalState Exam (MMSE), the Verbal Numeric Scale and a questionnaire for collectingsociodemographic data and to register the presence of associated symptoms. TheMMSE results showed high percentage of cognitive impairment associated with FM(60.7%) in this sample, and the domains of the MMSE that showed the worseperformance were "attention and calculation" and "recall". The most frequent associated symptoms were: attention and memory complaints and non-restorativesleep. The part of the sample with concentration complaints had higher scores in thepain scale and a correlation with the MMSE specific domains "orientationtime/space" and "language". These results showed that applying the MMSE canallow a more satisfying treatment for the interdisciplinary team by bringingcomplementary information in exploring the patient's complaints.

Representações sociais de conjugalidade e fibromialgia: desdobramentos na dinâmica conjugal / Social representations of marriage and fibromyalgia: developments in marital dynamics / Representaciones sociales del matrimonio y la fibromialgia: desarrollos en la dinámica conyugal

A fibromialgia consiste em uma doença caracterizada, entre outros sintomas, por dor generalizada, fadiga, sono não reparador, apresentando etiologia complexa e resposta incerta ao tratamento. Tais características podem precipitar o surgimento de sentimentos de vulnerabilidade capazes de impactar a rotina familiar dos doentes. Diante disso, o presente trabalho objetiva compreender e analisar, na perspectiva da Psicologia Social, como as representações sociais (RS) de mulheres com fibromialgia e de seus respectivos cônjuges sobre conjugalidade e sobre a própria condição de adoecimento estão articuladas a sua dinâmica conjugal. Trata-se de uma pesquisa de abordagem qualitativa que realizou entrevistas com quatro casais em que as esposas são diagnosticadas com fibromialgia. Os participantes também responderam a um questionário sociodemográfico. Para a análise dos dados empregou-se a técnica análise de conteúdo que desvelou uma ampla rede de significações acessada pelos participantes nos processos de ancoragem das RS de fibromialgia e de conjugalidade, contendo elementos como: o amor; os papéis masculinos e femininos; o adoecer e o cuidar; a fibromialgia e seus desdobramentos na rotina do doente e sua família. Por fim, constatou-se a existência de um campo de fragilidade das mulheres com fibro-mialgia e pessoas próximas a elas no processo de enfrentamento da doença. Faz-se necessário que os serviços de saúde atuem precocemente no esclarecimento sobre a doença e na identificação de possíveis conflitos no âmbito familiar e conjugal que podem ser desencadeados tanto na investigação diagnóstica como no decorrer do tratamento e nas particularidades da convivência diária com a doença.(AU).

Fibromyalgia consists of a disease characterized among other symptoms by widespread pain, fatigue, non-restorative sleep, and complex uncertain etiology and response to treatment. Such characteristics may precipitate the emergence of feelings of vulnerability capable of impacting the familiar routine of patients. Therefore, this study aims to understand and analyze, from the perspective of Social Psychology, such as social representations (SR) of women with fibromyalgia and their spouses on conjugality and about the condition of illness are linked to their marital dynamic. This is a qualitative study that conducted interviews with four couples in which the wives are diagnosed with fibromyalgia. Participants also completed a sociodemographic questionnaire. For the data analysis was employed the technique of content analysis which unveiled an extensive network of meanings accessed by participants in the processes of anchoring of RS of fibromyalgia and conjugality, containing elements such as: the love; the male and female roles; the sick and caring; the fibromyalgia and its consequences in the routine of the patient and his family. Finally, we found the existence of a field of fragility of women with fibromyalgia and those close to them in the process of coping with the disease. Necessary to make the health care act early in information about the disease and the identification of possible conflicts in family and marital framework that can be triggered both in the diagnostic investigation and in the course of treatment and the particularities of daily living with the disease.(AU).

La fibromialgia consiste en una enfermedad que se caracteriza entre otros síntomas por dolor generalizado, fatiga, sueño no reparador, y compleja etiología incierta y respuesta al tratamiento. Tales características pueden precipitar la aparición de sentimientos de vulnerabilidad capaz de impactar en la rutina familiar de los pacientes. Así, este estudio tiene como objetivo comprender y analizar, desde la psicología social, como las representaciones sociales (RS) de las mujeres con fibromialgia y sus cónyuges en el matrimonio y sobre la condición de la enfermedad están vinculados a su dinámica conyugal. Se trata de un estudio cualitativo que realizó entrevistas con cuatro parejas en las que las mujeres son diagnosticadas con fibromialgia. Estos también completaron un cuestionario sociodemográfico. Para el análisis de los datos se utilizó la técnica de análisis de contenido reveló una extensa red de significados que contiene elementos tales como: el amor; los roles masculinos y femeninos; el enfermo y el cuidado; la fibromialgia y sus consecuencias en la rutina del paciente y su familia. Por último, encontramos la existencia de un campo de la fragilidad de las mujeres con fibromialgia y personas cercanas a ellos en el proceso de hacer frente a la enfermedad. Necesario para hacer el acto de atención médica temprano en la información sobre la enfermedad y la identificación de posibles conflictos en la familia y el marco conyugal que puede activarse tanto en la investigación de diagnóstico y en el curso del tratamiento y de las particularidades de la vida diaria con la enfermedad.(AU).

Representações sociais de conjugalidade e fibromialgia: desdobramentos na dinâmica conjugal / Social representations of marriage and fibromyalgia: developments in marital dynamics / Representaciones sociales del matrimonio y la fibromialgia: desarrollos en la dinámica conyugal

A fibromialgia consiste em uma doença caracterizada, entre outros sintomas, por dor generalizada, fadiga, sono não reparador, apresentando etiologia complexa e resposta incerta ao tratamento. Tais características podem precipitar o surgimento de sentimentos de vulnerabilidade capazes de impactar a rotina familiar dos doentes. Diante disso, o presente trabalho objetiva compreender e analisar, na perspectiva da Psicologia Social, como as representações sociais (RS) de mulheres com fibromialgia e de seus respectivos cônjuges sobre conjugalidade e sobre a própria condição de adoecimento estão articuladas a sua dinâmica conjugal. Trata-se de uma pesquisa de abordagem qualitativa que realizou entrevistas com quatro casais em que as esposas são diagnosticadas com fibromialgia. Os participantes também responderam a um questionário sociodemográfico. Para a análise dos dados empregou-se a técnica análise de conteúdo que desvelou uma ampla rede de significações acessada pelos participantes nos processos de ancoragem das RS de fibromialgia e de conjugalidade, contendo elementos como: o amor; os papéis masculinos e femininos; o adoecer e o cuidar; a fibromialgia e seus desdobramentos na rotina do doente e sua família. Por fim, constatou-se a existência de um campo de fragilidade das mulheres com fibro-mialgia e pessoas próximas a elas no processo de enfrentamento da doença. Faz-se necessário que os serviços de saúde atuem precocemente no esclarecimento sobre a doença e na identificação de possíveis conflitos no âmbito familiar e conjugal que podem ser desencadeados tanto na investigação diagnóstica como no decorrer do tratamento e nas particularidades da convivência diária com a doença...

Fibromyalgia consists of a disease characterized among other symptoms by widespread pain, fatigue, non-restorative sleep, and complex uncertain etiology and response to treatment. Such characteristics may precipitate the emergence of feelings of vulnerability capable of impacting the familiar routine of patients. Therefore, this study aims to understand and analyze, from the perspective of Social Psychology, such as social representations (SR) of women with fibromyalgia and their spouses on conjugality and about the condition of illness are linked to their marital dynamic. This is a qualitative study that conducted interviews with four couples in which the wives are diagnosed with fibromyalgia. Participants also completed a sociodemographic questionnaire. For the data analysis was employed the technique of content analysis which unveiled an extensive network of meanings accessed by participants in the processes of anchoring of RS of fibromyalgia and conjugality, containing elements such as: the love; the male and female roles; the sick and caring; the fibromyalgia and its consequences in the routine of the patient and his family. Finally, we found the existence of a field of fragility of women with fibromyalgia and those close to them in the process of coping with the disease. Necessary to make the health care act early in information about the disease and the identification of possible conflicts in family and marital framework that can be triggered both in the diagnostic investigation and in the course of treatment and the particularities of daily living with the disease...

La fibromialgia consiste en una enfermedad que se caracteriza entre otros síntomas por dolor generalizado, fatiga, sueño no reparador, y compleja etiología incierta y respuesta al tratamiento. Tales características pueden precipitar la aparición de sentimientos de vulnerabilidad capaz de impactar en la rutina familiar de los pacientes. Así, este estudio tiene como objetivo comprender y analizar, desde la psicología social, como las representaciones sociales (RS) de las mujeres con fibromialgia y sus cónyuges en el matrimonio y sobre la condición de la enfermedad están vinculados a su dinámica conyugal. Se trata de un estudio cualitativo que realizó entrevistas con cuatro parejas en las que las mujeres son diagnosticadas con fibromialgia. Estos también completaron un cuestionario sociodemográfico. Para el análisis de los datos se utilizó la técnica de análisis de contenido reveló una extensa red de significados que contiene elementos tales como: el amor; los roles masculinos y femeninos; el enfermo y el cuidado; la fibromialgia y sus consecuencias en la rutina del paciente y su familia. Por último, encontramos la existencia de un campo de la fragilidad de las mujeres con fibromialgia y personas cercanas a ellos en el proceso de hacer frente a la enfermedad. Necesario para hacer el acto de atención médica temprano en la información sobre la enfermedad y la identificación de posibles conflictos en la familia y el marco conyugal que puede activarse tanto en la investigación de diagnóstico y en el curso del tratamiento y de las particularidades de la vida diaria con la enfermedad...

Manifestaçöes articulares na doença de Crohn / Articular manifestations in Crohn's disease

Säo relatados dois casos de doença de Crohn com manifestaçöes articulares diferentes. Em uma paciente houve acometimento de sacroilíacas com presença de antígeno HLA B27, na outra observou-se artrite periférica sem a presença do HLA B27 ou qualquer outro antígeno do grupo CREG (B7, BW22, B40). As diferentes formas de apresentaçäo da artropatia na doença säo discutidas, correlacionando-se com os dois casos apresentados

Manifestaçöes articulares da sífilis secundária / Articular manifestations of secondary syphilis

Foi feito um estudo em 21 pacientes que apresentaram, como manifestaçäo mais importante da sífilis secundária, uma poliartrite. O padräo de envolvimento que predominou foi o poliarticular, cumulativo e simétrico, e as articulaçöes acometidas, em ordem decrescente, foram: tornozelos, joelhos, punhos e interfalangianas proximais. A rigidez matinal esteve presente em 71,4% dos pacientes. Houve lombalgia aguda em 52,4% dos casos, sendo que 36,4% tiveram caráter noturno. Em todos os casos observou-se reposta excelente à penicilinoterapia

Gota e nefropatia crônica por urato / Gout and chronic nephropathy by urate

Os autores relatam a ocorrência de nefropatia manifestada em três pacientes portadores de hiperuricemia e gota por período prolongado, e que concomitantemente apresentaram hipertensäo arterial, nefrolitíase, coronariopatia e tendência à obesidade. Discute-se que contribuiçäo poderiam ter estas alteraçöes no desenvolvimento da nefropatia somando-se aos efeitos deletérios renais já bem descritos da hiperuricemia. Säo descritas ainda a forma de apresentaçäo da doença, bem como seu aspecto histológico e evoluçäo

Manifestaçöes articulares na doença do Crohn / Articular manifestations in Crohn's disease

Säo relatados dois casos de doença de Crohn com manifestaçöes articulares diferentes. Em uma paciente, houve acometimento de sacroilíacas, com presença do antigeno HLA B27; na outra, observou-se artrite periférica, sem presença de HLA B27 ou qualquer outro antígeno do grupo CREG (B7' BW22' B40). As diferentes formas de apresentaçäo da artropatia na doença säo discutidas, correlacionando-se com dois casos apresentados