Oro-facial evaluation of women with rheumatoid arthritis.

Rheumatoid arthritis (RA) is an aggressive articular autoimmune disease that causes deformities and disability. The temporomandibular joint (TMJ) might be affected by this disease. Few controlled studies have evaluated bite force (BF) and oro-facial manifestations of this disease. To characterise oro-facial alterations in patients with RA, correlate these results with clinical and disease activity parameters and correlate BF with hand strength (HS). A cross-sectional study of 150 women was performed, (75 RA patients (RA group) and 75 healthy individuals (control group). The presence of articular sounds, pain on palpation of masseter, temporal and TMJ lateral pole, changes in occlusion, range of mandibular motion, measurement of BF in the incisor and molar regions and assessment of HS were evaluated. In relation to oro-facial evaluation there were statistical differences between the groups. There was correlation between BF and HS, in the RA group, this correlation was consistent in patients with natural teeth. Patients with RA had lower scores (P < 0·05) in the HAQ, DASH and OHIP-14 questionnaires than the control group. Inverse correlations were found between BF and HAQ, but not between BF and DAS-28, DASH and OHIP-14 questionnaires in the RA group. The women with RA presented more signs and symptoms in the oro-facial region and had a lower BF than the women in the control group. BF was inversely correlated with the overall function (evaluated by the HAQ) in the patients with RA, and there were correlations between BF and HS in the RA patients and in the control group.

Valor nutritivo de dietas contendo torta de mamona submetida a métodos alternativos de destoxificação para ovinos / Nutritive value of feeds containing castor bean cake subjected to alternative methods of detoxification for sheep

Avaliaram-se o consumo e a digestibilidade de nutrientes por ovinos alimentados com rações contendo torta de mamona sem tratamento (NT), tratadas com calcário calcítico (CC), ureia (UR), fosfato monobicálcico (FOS) e por autoclave (ACL). Foram utilizados 20 ovinos em delineamento em blocos ao acaso, sendo 10 machos inteiros e 10 fêmeas, mestiços de raça Morada Nova. As dietas foram isoproteicas e isoenergéticas. A ricina foi parcialmente desnaturada pelos tratamentos de destoxificação da torta de mamona. Não houve efeito dos tratamentos de destoxificação da torta de mamona sobre o consumo de nutrientes. A digestibilidade da fibra em detergente neutro no tratamento NT foi de 57,5 por cento, maior que no tratamento CC, de 52,4 por cento. A digestibilidade do extrato etéreo foi mais alta no tratamento CC, média de 71,3 por cento, em relação ao tratamento FOS, de 68,2 por cento. Houve maior consumo de fibra em detergente neutro e fibra em detergente ácido dos machos em relação às fêmeas quando o consumo foi expresso em g/dia. A torta de mamona NT pode ser utilizada em dietas de ovinos como alimento proteico alternativo, participando em até 8 por cento da dieta total, sem ocasionar redução expressiva no consumo e na digestibilidade.

Feed intake and digestibility were evaluate in sheep fed diets containing castor bean cake with no treatment (NT), treated with calcium carbonate (CC), urea (UR), phosphate monodicalcium (FOS) and autoclave (ACL). We used 20 sheep in a randomized block design, being 10 males and 10 females, crossbred Morada Nova. The diets were isonitrogenous and isocaloric. Ricin was partially denatured through the treatments of detoxification of the castor bean cake. There was no treatment effect of detoxification of the castor bean cake on the intake of nutrients. The digestibility of neutral detergent fiber in the NT treatment had a 57.52 percent average, higher than the CC treatment which had an average of 52.42 percent. The digestibility of ether extract was higher in CC treatment, which had an average of 71.29 percent compared to the FOS treatment that had an average of 68.22 percent. Regarding the effect of sex, there was a higher intake of neutral detergent fiber and acid detergent fiber in males compared to females when intake was expressed as g/day. The castor bean cake NT can be used in rations for sheep as an alternative protein source participating in up to 8 percent of the total ration, without causing significant reductions in intake and digestibility.

Monoarticular corticosteroid injection versus systemic administration in the treatment of rheumatoid arthritis patients: a randomized double-blind controlled study.

OBJECTIVE: To compare the efficacy and safety of intraarticular glucocorticoid injection to its systemic use for treatment of knee synovitis in rheumatoid patients. METHODS: A randomized double-blind controlled study was conducted including 60 patients with RA. Patients were randomized to receive either a single intraarticular knee injection with triamcinolone hexacetonide 60 mg (3 ml) and xylocaine chloride 2% (1 ml) associated to a single intramuscular injection of 1 ml of xylocaine chloride 2% (IAI group) or 1 ml of xylocaine chloride 2% by intraarticular injection and a intramuscular injection of triamcinolone acetonide 60 mg (3 ml) and xylocaine chloride 2% (1 ml) (IM group). All patients were blindfolded for the procedure. Evaluations were performed at baseline and 1, 4, 8 and 12 weeks post-intervention. The following instruments were used: VAS for knee pain, as primary outcome, VAS for knee morning stiffness and edema; the ACR 20, 50 and 70% improvement criteria; knee circumference and goniometry; Likert's scale of improvement; daily use of oral glucocorticoid and NSAIDs, blood pressure and adverse effects. RESULTS: Patients in the IAI group had significantly better results for VAS for knee pain, edema and morning stiffness as well as for improvement evaluation after intervention according to the patient (p<0.001) and physician (p=0.02). CONCLUSION: Our results demonstrate that intraarticular injection with glucocorticoids is superior to its systemic use for the management of monoarticular synovitis in rheumatoid patients. The intraarticular approach showed better results in terms of local inflammatory variables and improvement evaluation by the patient and physician.

Accuracy of intra-articular injections in peripheral joints performed blindly in patients with rheumatoid arthritis.

OBJECTIVES: To assess the accuracy of blind IA injections (IAIs) in patients with RA and determine their effectiveness. METHODS: A controlled prospective study including 96 RA patients undergoing blind IAIs in peripheral joints was carried out. Clinical evaluation was performed at baseline (T(0)), 1 (T(1)) and 4 (T(4)) weeks after IAI using the following instruments: visual analogue scale (VAS) for pain at rest and movement, VAS for oedema (range 0-10 cm) and morning stiffness. Following IAI, radiographic exam was performed in all joints for further analysis by two 'blinded' radiologists. The kappa-statistic, chi-square and analysis of variance tests were performed to determine potential differences between time-points of evaluation. Significance level was set as P < 0.05. RESULTS: A total of 232 injections were performed. Accuracy observed for the shoulder, elbow, wrist, MCP joints, knee and ankle were 82, 100, 97, 97, 100 and 77%, respectively. A statistically significant improvement was observed for all variables at both T(1) and T(4) when compared with T(0). CONCLUSIONS: Blind IAI proved safe and accurate when performed by a trained professional. Significant improvement was seen in the VAS for pain at rest and during movement, VAS for oedema and morning stiffness.

Scleroderma-like nailfold capillaroscopic abnormalities are associated with anti-U1-RNP antibodies and Raynaud's phenomenon in SLE patients.

This study aimed to evaluate the association between nailfold capillary abnormalities and the presence of Raynaud's phenomenon (RP), anti-U1-RNP, and anti-cardiolipin (aCL) antibodies in SLE patients. One-hundred SLE patients were studied. Widefield nailfold capillaroscopy was considered abnormal according to five criteria. Intercapillary distance, capillary width and capillary length were registered by videomorphometry in two fingers in 100 patients and in four fingers in 40 of these patients. Both the presence of alterated capillaroscopy and the presence of scleroderma-pattern (SD-pattern), characterized by the presence of avascular areas and enlarged or giant loops, were associated with the isolated presence of RP (P < 0.001) or anti-U1-RNP antibodies (P < 0.01), as well as with the simultaneous presence of RP and anti-U1RNP antibodies (P < 0.001). There was a negative association between the presence of aCL antibodies and SD-pattern (P < 0.05). Higher figures for the videomorphometric parameters capillary width, intercapillary distance and capillary length (measured on four fingers) were observed in patients with RP. Patients presenting both RP and anti-U1-RNP antibodies showed higher figures for intercapillary distance and capillary width. This study demonstrated significant association between nailfold capillaroscopic abnormalities and either RP or anti-U1-RNP antibodies in SLE patients. The association of RP, anti-U1-RNP antibodies, and 'scleroderma-like' findings on nailfold capillaroscopy (SD-pattern) in patients with SLE may suggest a new SLE subset with subclinical features of systemic sclerosis.