Tuberculin skin test repetition after TNF-α inhibitors in patients with chronic inflammatory arthritis: a long-term retrospective cohort in endemic area.

OBJECTIVES: To evaluate the tuberculin skin test (TST) conversion in chronic inflammatory arthropathies (CIA) patients on TNFα inhibitors (TNFi) and without previous latent tuberculosis infection (LTBI) treatment. METHODS: Patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA) with negative LTBI were retrospectively evaluated for TST conversion and active tuberculosis (TB) after six months of exposition to TNFi. Two groups were compared: patients who repeated TST (TST-repetition) during the follow-up and patients who did not (non-TST-repetition). RESULTS: A total of 355 CIA patients on TNFi were screened and 138 (38.9%) did not fulfill the inclusion criteria. Of the remaining 217 CIA patients, 81 (37.3%) repeated TST during TNFi treatment. TST conversion rate was observed in 18 (22.2%) patients without significant differences among CIA (p = 0.578). The number of TB cases was low (n = 10; 4.6%) and was similar in TST-repetition and non-TST-repetition groups [2 (2.5%) vs. 8 (5.9%), p = 0.328]. Of note, 30% of active TB occurred early (6-12 months of TNFi exposure) and the median (full range) time to incident TB was 1.3 (0.6-10.6) years, whereas the median (full range) time to TST repetition was later [3.3 (0.5-13.4) years]. The incidence of active TB was lower among RA patients than AS patients [342 (95% CI 41 - 1446) vs. 1.454 (95% CI 594-2993)/100,000 patient-years, p = 0.049]. CONCLUSION: These results indicate that TST repetition is associated with a high conversion rate, suggesting the need for recommended treatment. The delayed repetition of TST and low number of active TB cases hampered the evaluation of this strategy effectiveness to prevent active infection. Larger studies with systematic repetition patterns are necessary. In addition, the study highlights the need for a greater surveillance for TB in AS patients.

Phenolic Compounds Characterization of Caryocar brasiliense Peel with Potential Antioxidant Activity.

The pequi (Caryocar brasiliense) fruit peel, despite being frequently discarded, has a high content of bioactive compounds, and therefore has a high nutritional value. The present study aimed to explore the bioactivities in the pequi peel, particularly their potential health benefits at the level of antioxidant activity. The exploitation of this fruit could also present significant economic benefits and applications of pequi by-products would represent a reduction in waste, having a positive impact on the environment. Phenolic compounds present in the pequi exocarp and external mesocarp were identified by paper spray mass spectrometry (PS-MS) and quantified by HPLC. The total phenolic content (TPC) along with the amount of 2,2-diphenyl-1-picrylhydrazyl (DPPH), Ferric Reducing Antioxidant Power (FRAP), and the amount of 2,2'-azino-bis(3-ethylbenzothiazoline-6-sulphonic acid (ABTS) were also determined in peel extracts. Epicatechin was the most abundant phenolic compound found, followed by the caffeic, salicylic, and gallic acids. In addition, fingerprinting revealed compounds related to several beneficial health effects. In short, the results obtained were encouraging for potential applications of pequi peel in the field of functional foods.

Long-Term Follow-Up of Anti-Infliximab Antibodies in Patients With Radiographic Axial Spondyloarthritis: A Marker of Drug Survival and Tapering.

OBJECTIVE: The aim of this study was to evaluate the influence of anti-infliximab (IFX) antibodies on three different points of care: response/tolerance to IFX, tapering strategy, and in a subsequent treatment with a second tumor necrosis factor inhibitor (TNFi). METHODS: A prospective cohort of 60 patients with radiographic axial spondyloarthritis who received IFX were evaluated retrospectively regarding clinical/laboratorial data, IFX levels, and anti-IFX antibodies at baseline, after 6, 12 to 14, 22 to 24, 48 to 54, 96 to 102 weeks, and before tapering or switching. RESULTS: Anti-IFX antibodies were detected in 27 patients (45%), of whom 23 (85.1%) became positive in the first year of IFX treatment. In comparison to the group that was negative for anti-IFX antibodies, patients who were positive for anti-IFX antibodies demonstrated the following: less use of methotrexate as a concomitant treatment to IFX (5 [18.5%] vs 14 [42.4%]; P = 0.048), more infusion reactions at 22 to 24 weeks (P = 0.020) and 48 to 54 weeks (P = 0.034), more treatment failures (P = 0.028) at 48 to 54 weeks, reduced overall IFX survival (P < 0.001), and lower sustained responses (P = 0.044). Of note, patients who were positive for anti-IFX antibodies exhibited a shorter tapering survival (9.9 months [95% confidence interval (CI) 4.0-15.8] vs 63.4 months [95% CI 27.9-98.8]; P = 0.004) in comparison with patients who were negative for anti-IFX antibodies. Conversely, for patients who failed IFX, patients who were positive for anti-IFX antibodies had better clinical response to the second TNFi at three months (15 [83.3%] vs 3 [27.3%]; P = 0.005) and six months (15 [83.3%] vs 4 [36.4%]; P = 0.017) than the patients who were negative for anti-IFX antibodies after switching. CONCLUSION: This study provided novel data that anti-IFX antibodies is a parameter for reduced tapering survival, reinforcing its detection to guide clinical decision. Additionally, we confirmed in a long-term cohort the anti-IFX antibody association with worse IFX performance and as predictor of the second TNFi good clinical response.

A single session of aerobic exercise reduces systolic blood pressure at rest and in response to stress in women with rheumatoid arthritis and hypertension.

Rheumatoid arthritis (RA) is an autoimmune inflammatory disease characterized by increased risk of cardiovascular disease and hypertension (HT). A single session of aerobic exercise may reduce blood pressure (BP) in different clinical groups; however, little is known about the acute effects of exercise on BP in RA patients. This is a randomized controlled crossover study that assessed the effects of a single session of aerobic exercise on resting BP, on BP responses to stressful stimuli, and on 24-h BP in women with RA and HT. Twenty women with RA and HT (53 ± 10 years) undertook sessions of 30-min treadmill exercise (50% VO2max) or control (no exercise) in a crossover fashion. Before and after the sessions, BP was measured at rest, and in response to the Stroop-Color Word Test (SCWT), the Cold Pressor Test (CPT), and an isometric handgrip test. After the sessions, participants were also fitted with an ambulatory BP monitor for the assessment of 24-h BP. A single session of exercise reduced resting systolic BP (SBP) (-5 ± 9 mmHg; p < 0.05), and reduced SBP response to the SCWT (-7 ± 14 mmHg; p < 0.05), and to the CPT (-5 ± 11 mmHg; p < 0.05). Exercise did not reduce resting diastolic BP (DBP), BP responses to the isometric handgrip test or 24-h BP. In conclusion, a single session of aerobic exercise reduced SBP at rest and in response to stressful stimuli in hypertensive women with RA. These results support the use of exercise as a strategy for controlling HT and, hence, reducing cardiovascular risk in women with RA.Clinical Trial Registration: This study registered at the Brazilian Clinical Trials ( https://ensaiosclinicos.gov.br/rg/RBR-867k9g ) at 12/13/2019.

Efeitos do lockdown na incidência da COVID-19 na fase de emergência sanitária da pandemia / Effects of lockdown on COVID-19 incidence in the health emergency phase of the pandemic

RESUMO Objetivo avaliar os efeitos do lockdown na incidência da COVID-19 na fase de emergência sanitária da pandemia. Métodos trata-se de um estudo ecológico transversal. Os dados foram coletados nas páginas da Fundação Sistema Estadual de Análise de Dados e da Prefeitura Municipal de Araraquara. Para analisar a incidência da COVID-19 foram considerados os casos notificados no referido município. Para comparar os períodos em relação aos casos diários, foi utilizado o modelo de regressão com distribuição binomial-negativa com função de ligação logarítmica. Resultados para todas as faixas etárias, com exceção de menores de 20 anos, verificou-se diferença estatística nos coeficientes de incidência. Para o sexo feminino o declínio na incidência da doença foi mais expressivo. Considerando ambos os sexos e todas as faixas etárias, observou-se uma redução de 49% na incidência de casos. Conclusão houve uma redução significativa na incidência da doença considerando a população geral do município. Contribuições para a prática: a disponibilidade e adoção de medidas tradicionais de saúde pública, como o lockdown, mostraram-se essenciais para reduzir casos e óbitos de doenças de vírus respiratórios emergentes sem tratamento e vacina.

ABSTRACT Objective to assess the effects of lockdown on the incidence of COVID-19 during the health emergency phase of the pandemic. Methods this is a cross-sectional ecological study. Data was collected from the websites of the State Data Analysis System Foundation and Araraquara City Hall. To analyze the incidence of COVID-19, cases reported in the municipality were considered. A regression model with a negative binomial distribution and a logarithmic link function was used to compare the periods in terms of daily cases. Results for all age groups except those under 20, there was a statistical difference in the incidence coefficients. For females, the decline in the incidence of the disease was more significant. Considering both sexes and all age groups, there was a 49% reduction in the incidence of cases. Conclusion there was a significant reduction in the incidence of the disease in the general population of the municipality. Contributions to practice: the availability and adoption of traditional public health measures, such as lockdown, proved essential to reducing cases and deaths from emerging respiratory virus diseases without treatment or vaccine.

Organização e assistência da atenção primária à saúde no enfrentamento da COVID-19 / Organization and assistance of primary health care facing COVID-19 / Organización y asistencia de la atención primaria de salud en el enfrentamiento al COVID-19

Objetivo: analisar a organização e assistência dos serviços da Atenção Primária à Saúde no enfrentamento da COVID-19. Método: estudo transversal realizado com 49 profissionais da saúde de unidades básicas de saúde e estratégia de saúde da família no município de São Carlos. Os dados foram coletados por meio de questionário auto respondido no período de maio de 2021 a fevereiro de 2022. As associações foram analisadas por teste qui-quadrado e estimadas as razões de prevalência. O protocolo de pesquisa foi aprovado pelo Comite de Ética em Pesquisa. Resultados: a identificação de sinais e sintomas do paciente, orientações sobre as medidas de prevenção e verificação da disponibilidade de leitos em hospitais de referência, foram variáveis que se apresentaram diferentes entre os serviços de saúde. Conclusão: a APS exerce papel central no enfrentamento da pandemia, com necessidade de os gestores identificarem as fragilidades e direcionarem ações de educação permanente diante de novos cenários(AU)

Objective: to analyze the organization and assistance of Primary Health Care services facing COVID-19. Method: cross-sectional study carried out with 49 health professionals from basic health units and family health strategy in the city of São Carlos. Data were collected through a self-answered questionnaire from May 2021 to February 2022. Associations were analyzed using the chi-square test and prevalence ratios were estimated. The research protocol was approved by the Research Ethics Committee. Results: identification of the patient's signs and symptoms, guidance on prevention measures and checking the availability of beds in reference hospitals were variables that differed between health services. Conclusion: Primary Health Care services play a central role facing COVID-19 pandemic, with managers needing to identify weaknesses and direct ongoing education actions in the face of new scenarios(AU)

Objetivo: analizar la organización y asistencia de los servicios de Atención Primaria de Salud en el combate al COVID-19. Método: estudio transversal realizado con 49 profesionales de la salud de unidades básicas de salud y estrategia de salud de la familia de la ciudad de São Carlos. Los datos se recolectaron a través de un cuestionario de auto respuesta desde mayo de 2021 hasta febrero de 2022. Se analizaron las asociaciones mediante la prueba de chi-cuadrado y se estimaron las razones de prevalencia. El protocolo de investigación lo aprobó el Comité de Ética en Investigación. Resultados: la identificación de los signos y síntomas del paciente, las orientaciones sobre medidas de prevención y la verificación de la disponibilidad de camas en los hospitales de referencia fueron variables que difirieron entre los servicios de salud. Conclusión: La APS juega un papel central en el enfrentamiento a la pandemia, siendo necesario que los gestores identifiquen debilidades y orienten acciones educativas continuas ante nuevos escenarios(AU)

Scleromalacia perforans as an early manifestation of late-onset rheumatoid arthritis: a case-based review.

Rheumatoid arthritis is a chronic autoimmune disease that can affect different organs beyond the joints. Ocular involvement includes keratoconjunctivitis sicca, peripheral ulcerative keratitis (PUK), episcleritis, scleritis, anterior uveitis, and corneal impairment. The most severe form of scleritis, scleromalacia perforans, is an aggressive ophthalmic manifestation that can potentially lead to blindness, usually occurring in late stages of disease. We report a case of an elderly woman in which this severe ocular manifestation occurred early on disease onset, differing from most of the previously reported cases of scleromalacia perforans. Ocular symptoms started concomitantly with the polyarthritis and other extra-articular manifestations, including rheumatoid nodules and vasculitic skin lesions. Ocular disease progressed due to patient's loss to follow-up, requiring pulse therapy with methylprednisolone. However, despite treatment, right eye enucleation was required due to melting of the corneal patch with uveal exposition. The patient was then treated with rituximab with improvement of systemic disease. The present case reinforces that, although rare, this complication is severe and must be promptly diagnosed and aggressively treated to improve prognosis of ocular and systemic RA.

Respiratory failure in systemic sclerosis.

Systemic sclerosis (SSc) can lead to dyspnea and respiratory failure through multiple mechanisms, making a precise diagnosis particularly challenging, especially amid the current COVID-19 pandemic. In this report, we present a case involving a 26-year-old female who had previously undiagnosed SSc. She experienced acute respiratory failure necessitating orotracheal intubation. Following an extensive evaluation, the patient exhibited skin thickening, kidney failure, thrombocytopenia, microangiopathic anemia, and an antinuclear antibody with a nuclear fine speckled pattern at a titer of 1:320. A diagnosis of SSc complicated by scleroderma renal crisis (SRC) was established. The patient's condition improved after undergoing hemodialysis, receiving an angiotensin-converting enzyme inhibitor, and undergoing cyclophosphamide treatment. Subsequently, she demonstrated sustained improvement during a follow-up period of 20 months.

Impact of switching between reference biologics and biosimilars of tumour necrosis factor inhibitors for rheumatoid arthritis: a systematic review and network meta-analysis.

What is the impact of switching between biologics and biosimilars of adalimumab, etanercept, and infliximab on efficacy and safety for rheumatoid arthritis? A systematic review and network meta-analysis were performed to compare switching and non-switching groups of treatments. Pooled Risk Relative (RR) or standardised mean differences (SMD) with 95% credible intervals (95% CrIs) were obtained. Seventeen randomized trials with a switching phase involving 6,562 patients were included. Results showed that a single switch from biologics to biosimilars compared to continuing biologics had comparable effects for primary and co-primary outcomes, the American College of Rheumatology criteria with 20% response (ACR20) (7 trials, 1,926 patients, RR 0.98, 95% CrIs 0.93 to 1.03) and the Health Assessment Questionnaire-Disability Index (HAQ-DI) (5 trials, 1,609 patients, SMD - 0.07, 95% CrIs - 0.23 to 0.1), and within the equivalence margins: ACR20 [RR 0.94, 1.06] and HAQ-DI [SMD - 0.22, 0.22]. The risk of treatment-emergent adverse events, discontinuation, and positive anti-drug antibodies were comparable after switching. Safety results were imprecise, and the follow-up period might not be sufficient to evaluate long-term effects, especially malignancies. Overall, the practice of single switching between approved biologics and biosimilars of Tumour Necrosis Factor inhibitors is efficacious and safe for rheumatoid arthritis.

Extra-articular manifestations of rheumatoid arthritis remain a major challenge: data from a large, multi-centric cohort.

INTRODUCTION: Although Rheumatoid Arthritis (RA) extra-articular manifestations (ExtRA) occurrence has been decreasing over time, they are still a major mortality risk factor for patients. OBJECTIVE: To determine the prevalence of ExtRA in a large cohort, and its association with demographic and clinical variables. METHOD: Cross-sectional and observational study, based on a multi-centric database from a prospective cohort, in which 11 public rheumatology centres enrolled RA patients (1987 ARA or 2010 ACR-EULAR). Data collection began in 08-2015, using a single online electronic medical record. Continuous variables were compared using Mann-Whitney U-test, and Fisher's exact test or chi-square test, as appropriate, were used for categorical variables. The level of significance was set at 5% (p < 0.05). RESULTS: 1115 patients were included: 89% women, age [mean ± SD] 58.2 ± 11.5 years, disease duration 14.5 ± 12.2 years, positive Rheumatoid Factor (RF, n = 1108) in 77%, positive anti-cyclic citrullinated peptide (ACPA, n = 477) in 78%. Regarding ExtRA, 334 occurrences were registered in 261 patients, resulting in an overall prevalence of 23.4% in the cohort. The comparison among ExtRA and Non-ExtRA groups shows significant higher age (p < 0.001), disease duration (p < 0.001), RF high titers (p = 0.018), Clinical Disease Activity index (CDAI) (p < 0.001), Disease Activity Index 28 (DAS 28) (p < 0.001), and Health Assessment Questionnaire (HAQ) (p < 0.001) in ExtRA group. Treatment with Azathioprine (p = 0.002), Etanercept (p = 0.049) Glucocorticoids (GC) ('p = 0.002), and non-steroidal anti-inflammatory drugs (NSAIDs) (p < 0.001) were more frequent in ExtRA group. CONCLUSIONS: ExtRA manifestations still show an expressive occurrence that should not be underestimated. Our findings reinforce that long-term seropositive disease, associated with significant disability and persistent inflammatory activity are the key factors related to ExtRA development.

Post-acute COVID-19 in three doses vaccinated autoimmune rheumatic diseases patients: frequency and pattern of this condition.

BACKGROUND: Data on post-acute COVID-19 in autoimmune rheumatic diseases (ARD) are scarce, focusing on a single disease, with variable definitions of this condition and time of vaccination. The aim of this study was to evaluate the frequency and pattern of post-acute COVID-19 in vaccinated patients with ARD using established diagnosis criteria. METHODS: Retrospective evaluation of a prospective cohort of 108 ARD patients and 32 non-ARD controls, diagnosed with SARS-CoV-2 infection (RT-PCR/antigen test) after the third dose of the CoronaVac vaccine. Post-acute COVID-19 (≥ 4 weeks and > 12 weeks of SARS-CoV-2 symptoms) were registered according to the established international criteria. RESULTS: ARD patients and non-ARD controls, balanced for age and sex, had high and comparable frequencies of ≥ 4 weeks post-acute COVID-19 (58.3% vs. 53.1%, p = 0.6854) and > 12 weeks post-acute COVID-19 (39.8% vs. 46.9%, p = 0.5419). Regarding ≥ 4 weeks post-acute COVID-19, frequencies of ≥ 3 symptoms were similar in ARD and non-ARD controls (54% vs. 41.2%, p = 0.7886), and this was also similar in > 12 weeks post-acute COVID-19 (68.3% vs. 88.2%, p = 0.1322). Further analysis of the risk factors for ≥ 4 weeks post-acute COVID-19 in ARD patients revealed that age, sex, clinical severity of COVID-19, reinfection, and autoimmune diseases were not associated with this condition (p > 0.05). The clinical manifestations of post-acute COVID-19 were similar in both groups (p > 0.05), with fatigue and memory loss being the most frequent manifestations. CONCLUSION: We provide novel data demonstrating that immune/inflammatory ARD disturbances after third dose vaccination do not seem to be a major determinant of post-acute COVID-19 since its pattern is very similar to that of the general population. Clinical Trials platform (NCT04754698).

Therapeutic Equivalence of Biosimilar and Reference Biologic Drugs in Rheumatoid Arthritis: A Systematic Review and Meta-analysis.

Importance: Biosimilar drugs are potentially lower-cost versions of biologics that may improve access to therapy. However, there is a lack of adequate systematic reviews demonstrating equivalence between these drugs for the treatment of rheumatoid arthritis (RA). Objectives: To assess the efficacy, safety, and immunogenicity associated with biosimilars of adalimumab, etanercept, and infliximab compared with their reference biologics in patients with RA. Data Sources: MEDLINE via PubMed, Embase, Cochrane Central Register of Controlled Trials, and LILACS databases were searched from inception to September 2021. Study Selection: Head-to-head randomized clinical trials (RCTs) of biosimilars of adalimumab, etanercept, and infliximab and their biologic reference drugs for RA were assessed. Data Extraction and Synthesis: Two authors independently abstracted all data. Meta-analysis was conducted with bayesian random effects using relative risks (RRs) for binary outcomes and standardized mean differences (SMDs) for continuous outcomes, with 95% credible intervals (CrIs) and trial sequential analysis. Specific domains were assessed for the risk of bias in equivalence and noninferiority trials. This study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline. Main Outcomes and Measures: Equivalence was tested using prespecified margins for the American College of Rheumatology criteria, with at least 20% improvement in the core set measures (ACR20) (ie, RR, 0.94 to 1.06), and for the Health Assessment Questionnaire-Disability Index (HAQ-DI) (ie, SMD, -0.22 to 0.22). Secondary outcomes included 14 items measuring safety and immunogenicity. Results: A total of 25 head-to-head trials provided data on 10 642 randomized patients with moderate to severe RA. Biosimilars met equivalence with reference biologics in terms of ACR20 response (24 RCTs with 10 259 patients; RR, 1.01; 95% CrI, 0.98 to 1.04; τ2 = 0.000) and change of HAQ-DI scores (14 RCTs with 5579 patients; SMD, -0.04; 95% CrI, -0.11 to 0.02; τ2 = 0.002) considering prespecified margins of equivalence. Trial sequential analysis found evidence for equivalence for ACR20 since 2017 and HAQ-DI since 2016. Overall, biosimilars were associated with similar safety and immunogenicity profiles compared with reference biologics. Conclusion and Relevance: In this systematic review and meta-analysis, biosimilars of adalimumab, infliximab, and etanercept were associated with clinically equivalent treatment effects compared with their reference biologics for the treatment of RA.

Increased Prolonged Sitting in Patients with Rheumatoid Arthritis during the COVID-19 Pandemic: A Within-Subjects, Accelerometer-Based Study.

BACKGROUND: Social distancing measures designed to contain the COVID-19 pandemic can restrict physical activity, a particular concern for high-risk patient groups. We assessed rheumatoid arthritis patients' physical activity and sedentary behavior level, pain, fatigue, and health-related quality of life prior to and during the social distancing measures implemented in Sao Paulo, Brazil. METHODS: Post-menopausal females diagnosed with rheumatoid arthritis were assessed before (from March 2018 to March 2020) and during (from 24 May to 7 July 2020) social distancing measures to contain COVID-19 pandemic, using a within-subjects, repeated-measure design. Physical activity and sedentary behavior were assessed using accelerometry (ActivPAL micro). Pain, fatigue, and health-related quality of life were assessed by questionnaires. RESULTS: Mean age was 60.9 years and BMI was 29.5 Kg/m2. Disease activity ranged from remission to moderate activity. During social distancing, there were reductions in light-intensity activity (13.0% [-0.2 h/day, 95% CI: -0.4 to -0.04; p = 0.016]) and moderate-to-vigorous physical activity (38.8% [-4.5 min/day, 95% CI: -8.1 to -0.9; p = 0.015]), but not in standing time and sedentary time. However, time spent in prolonged bouts of sitting ≥30 min increased by 34% (1.0 h/day, 95% CI: 0.3 to 1.7; p = 0.006) and ≥60 min increased by 85% (1.0 h/day, 95% CI: 0.5 to 1.6). There were no changes in pain, fatigue, and health-related quality of life (all p > 0.050). CONCLUSIONS: Imposed social distancing measures to contain the COVID-19 outbreak were associated with decreased physical activity and increased prolonged sedentary behavior, but did not change clinical symptoms sitting among patients with rheumatoid arthritis.

Extra-articular manifestations of rheumatoid arthritis remain a major challenge: data from a large, multi-centric cohort

Abstract Introduction Although Rheumatoid Arthritis (RA) extra-articular manifestations (ExtRA) occurrence has been decreasing over time, they are still a major mortality risk factor for patients. Objective To determine the prevalence of ExtRA in a large cohort, and its association with demographic and clinical variables. Method Cross-sectional and observational study, based on a multi-centric database from a prospective cohort, in which 11 public rheumatology centres enrolled RA patients (1987 ARA or 2010 ACR-EULAR). Data collection began in 08-2015, using a single online electronic medical record. Continuous variables were compared using Mann-Whit-ney U-test, and Fisher's exact test or chi-square test, as appropriate, were used for categorical variables. The level of significance was set at 5% (p < 0.05). Results 1115 patients were included: 89% women, age [mean ± SD] 58.2 ± 11.5 years, disease duration 14.5 ± 12.2 years, positive Rheumatoid Factor (RF, n = 1108) in 77%, positive anti-cyclic citrullinated peptide (ACPA, n = 477) in 78%. Regarding ExtRA, 334 occurrences were registered in 261 patients, resulting in an overall prevalence of 23.4% in the cohort. The comparison among ExtRA and Non-ExtRA groups shows significant higher age (p < 0.001), disease duration (p < 0.001), RF high titers (p = 0.018), Clinical Disease Activity index (CDAI) (p < 0.001), Disease Activity Index 28 (DAS 28) (p < 0.001), and Health Assessment Questionnaire (HAQ) (p < 0.001) in ExtRA group. Treatment with Azathioprine (p = 0.002), Etanercept (p = 0.049) Glucocorticoids (GC) ('p = 0.002), and non-steroidal anti-inflammatory drugs (NSAIDs) (p < 0.001) were more frequent in ExtRA group. Conclusions ExtRA manifestations still show an expressive occurrence that should not be underestimated. Our findings reinforce that long-term seropositive disease, associated with significant disability and persistent inflammatory activity are the key factors related to ExtRA development.

Influência dos fatores socioeconômicos na mortalidade por COVID-19 na população infantil: revisão de escopo / Influence of socioeconomic factors on COVID-19 mortality in children: a scoping review

RESUMO Objetivo identificar as evidências científicas sobre a relação entre os fatores socioeconômicos e a mortalidade em crianças por COVID-19. Métodos trata-se de uma revisão de escopo. As buscas foram realizadas nas seguintes bases de dados: US National Library of Medicine - National Institutes of Health; Scientific Electronic Library Online; Institute for Scientific Information; Cumulative Index to Nursing and Allied Health Literature; e SciVerse Scopus. Resultados foram selecionados 15 artigos que evidenciaram a influência dos fatores socioeconômicos na mortalidade infantil pelo Severe Acute Respiratory Syndrome Coronavirus 2. Conclusão evidenciou-se que os fatores socioeconômicos estão relacionados ao aumento da mortalidade por COVID-19 na população infantil, baixa renda e à residência em localidades consideradas de maior vulnerabilidade socioeconômica, as quais se apresentaram como importantes variáveis a serem consideradas na pandemia de COVID-19. Contribuições para a prática diversos fatores estão relacionados ao aumento da suscetibilidade à infecção do Severe Acute Respiratory Syndrome Coronavirus e agravamento da doença em crianças. No entanto, compreender que os fatores socioeconômicos podem se apresentar como um determinante na incidência e mortalidade por COVID-19 na população infantil ressalta a necessidade de investimentos em ações direcionadas à redução das desigualdades socioeconômicas, para assim reduzir as mortes evitáveis.

ABSTRACT Objective to identify the scientific evidence on the relationship between socioeconomic factors and mortality in children due to COVID-19. Methods this is a scoping review. Searches were carried out in the following databases: US National Library of Medicine - National Institutes of Health; Scientific Electronic Library Online; Institute for Scientific Information; Cumulative Index to Nursing and Allied Health Literature; and SciVerse Scopus. Results 15 articles were selected that showed the influence of socioeconomic factors on infant mortality from Severe Acute Respiratory Syndrome Coronavirus 2. Conclusion it was shown that socioeconomic factors are related to increased mortality from COVID-19 in the infant population, low income and residence in locations considered to be of greater socioeconomic vulnerability, which were presented as important variables to be considered in the COVID-19 pandemic. Contributions to practice several factors are related to increased susceptibility to Severe Acute Respiratory Syndrome Coronavirus infection and worsening of the disease in children. However, understanding that socioeconomic factors can be a determinant of COVID-19 incidence and mortality in children highlights the need to invest in actions aimed at reducing socioeconomic inequalities, to reduce preventable deaths.

Aumento do risco de mortalidade por COVID-19 em pessoas com obesidade / Increased risk of mortality from COVID-19 in people with obesity

RESUMO Objetivo analisar o risco de mortalidade por COVID-19 em pessoas com obesidade. Métodos estudo observacional, retrospectivo e analítico. Os dados foram coletados no Sistema Estadual de Análise de Dados. Para a análise comparativa de pessoas com e sem obesidade, adotou-se n=168.808. As análises foram realizadas por meio do modelo de regressão log-binomial e cálculo de risco relativo. O modelo comparativo foi ajustado ao sexo, faixa etária, cardiopatia e diabetes. Resultados em mais de 95% das notificações de COVID-19, a informação quanto ao fator de risco obesidade foi registrada como ignorado. Pessoas obesas com COVID-19 apresentaram 26% maior risco de óbito quando comparadas às pessoas sem obesidade. Indivíduos obesos nas faixas etárias entre 11 a 60 anos apresentaram os maiores riscos de mortalidade comparados aos indivíduos sem obesidade. As mulheres obesas nas faixas etárias de 31 a 50 anos e idosas acima de 71 anos apresentaram menor risco de mortalidade quando comparadas aos homens obesos. Conclusão pessoas obesas, principalmente os adultos, possuem risco aumentado de mortalidade por COVID-19. Contribuições para a prática auxiliar o estabelecimento de estratégias de saúde pública que atuem na identificação dos perfis dos indivíduos considerados de alto risco na pandemia ocasionada pelo vírus SARS-CoV-2.

ABSTRACT Objective to analyze the risk of mortality from COVID-19 in people with obesity. Methods observational, retrospective, and analytical study. Data were collected in the State System of Data Analysis. For the comparative analysis of people with and without obesity, n=168,808 was adopted. The analyses were performed using the log-binomial regression model and relative risk calculation. The comparative model was adjusted for sex, age group, heart disease and diabetes. Results in more than 95% of COVID-19 notifications, information regarding the risk factor obesity was recorded as ignored. Obese individuals with COVID-19 had 26% higher risk of death when compared to those without obesity. Obese individuals in the 11 to 60 age groups had the highest mortality risks compared to individuals without obesity. Obese women in the age groups 31 to 50 years and elderly women over 71 years had the lowest mortality risk when compared to obese men. Conclusion obese people, especially adults, have an increased risk of mortality from COVID-19. Contributions to practice to help establish public health strategies to identify the profiles of individuals considered at high risk in the SARS-CoV-2 pandemic.

Post-acute COVID-19 in three doses vaccinated autoimmune rheumatic diseases patients: frequency and pattern of this condition

Abstract Background Data on post-acute COVID-19 in autoimmune rheumatic diseases (ARD) are scarce, focusing on a single disease, with variable definitions of this condition and time of vaccination. The aim of this study was to evaluate the frequency and pattern of post-acute COVID-19 in vaccinated patients with ARD using established diagnosis criteria. Methods Retrospective evaluation of a prospective cohort of 108 ARD patients and 32 non-ARD controls, diagnosed with SARS-CoV-2 infection (RT-PCR/antigen test) after the third dose of the CoronaVac vaccine. Post-acute COVID-19 (≥ 4 weeks and > 12 weeks of SARS-CoV-2 symptoms) were registered according to the established international criteria. Results ARD patients and non-ARD controls, balanced for age and sex, had high and comparable frequencies of ≥ 4 weeks post-acute COVID-19 (58.3% vs. 53.1%, p = 0.6854) and > 12 weeks post-acute COVID-19 (39.8% vs. 46.9%, p = 0.5419). Regarding ≥ 4 weeks post-acute COVID-19, frequencies of ≥ 3 symptoms were similar in ARD and non-ARD controls (54% vs. 41.2%, p = 0.7886), and this was also similar in > 12 weeks post-acute COVID-19 (68.3% vs. 88.2%, p = 0.1322). Further analysis of the risk factors for ≥ 4 weeks post-acute COVID-19 in ARD patients revealed that age, sex, clinical severity of COVID-19, reinfection, and autoimmune diseases were not associated with this condition (p > 0.05). The clinical manifestations of post-acute COVID-19 were similar in both groups (p > 0.05), with fatigue and memory loss being the most frequent manifestations. Conclusion We provide novel data demonstrating that immune/inflammatory ARD disturbances after third dose vaccination do not seem to be a major determinant of post-acute COVID-19 since its pattern is very similar to that of the general population. Clinical Trials platform (NCT04754698).