[Portuguese recommendations for pain management by pharmocotherapy in inflammatory arthritis]. / Recomendações portuguesas para o tratamento e controlo farmacológico da dor nas artropatias inflamatórias.

OBJECTIVES: To develop Portuguese evidence-based recommendations for pain management by pharmocotherapy in inflammatory arthritis. METHODS: The Portuguese project was integrated in the multinational 3E Initiative (Evidence, Expertise, Exchange) 2010 where a total of 453 rheumatologists from 17 countries have participated. The clinical questions concerning pain were formulated and the Portuguese group added 2 more questions. A systematic literature search was performed in Medline, Embase, Cochrane Library and 2008-2009 EULAR and ACR abstracts. The selected articles were systematically reviewed and the evidence was defined according to the Oxford Levels of Evidence. In each country a group of experts joined to discuss their national recommendations. In Portugal, the national meeting was held in October 2010, where 33 rheumatologists discussed and voted by Delphi method the national recommendations. Finally, the agreement among the rheumatologists and the potential impact on their clinical practice was assessed. RESULTS: Thirteen national recommendations were formulated: pain measure scores; analgesic combination therapy; pharmacotherapy in preconception, pregnancy and lactation periods; pharmacotherapy according to comorbilities; safety of NSAIDs and/or paracetamol with methotrexate combination therapy; efficacy and safety of continuous/on-demand NSAIDs; opioids, paracetamol, corticosteroids, antidepressants, neuromodulators and muscle relaxants role and effectiveness; risk factors for the development of chronic pain and the role of topic analgesics. CONCLUSION: The portuguese recommendations for the pain management by pharmacotherapy in inflammatory arthritis were formulated according to the best evidence and supported by a panel of 63 rheumatologists. The differences between the national and international recommendations are reported in this article.

Respiratory manifestations of systemic lupus erythematosus: old and new concepts.

The respiratory system is commonly involved in systemic lupus erythematosus. Lung disorders are classified as primary (due to lupus) and secondary to other conditions. Pleuritis and pulmonary infections are the most prevalent respiratory manifestations of each type. Other infrequent manifestations include interstitial lung disease, acute lupus pneumonitis, diffuse alveolar haemorrhage, pulmonary arterial hypertension, acute reversible hypoxaemia and shrinking lung syndrome. Even when current diagnostic tests contribute to an earlier diagnosis, the treatment of these manifestations is based on clinical experience and small series. Larger controlled trials of the different therapies in the treatment of those lung manifestations of lupus are needed. Overall malignancy is little increased in lupus, but lung cancer and non-Hodgkin's lymphoma are among the most frequent types of cancer found in these patients. As survival in lupus patients has improved over recent decades, avoiding pulmonary damage emerges as an important objective.

[Applicability of syalometry and other instruments to evaluate xerostomia and xerophtalmia in a Sjögren's Syndrome outpatient clinic]. / Aplicabilidade da sialometria e instrumentos de avaliação de queixas secas numa consulta de Síndroma de Sjögren.

OBJECTIVES: To evaluate the applicability and utility of unstimulated syalometry and instruments of evaluation of sicca complaints in a Sjögren's syndrome outpatient clinic. MATERIAL AND METHODS: We performed unstimulated syalometry to 45 consecutive Primary Sjögren's Syndrome patients (PSS) and 21 healthy asymptomatic individuals age and sex-matched. PSS patients were further evaluated with Schirmer's test. We applied 3 published questionnaires to PSS patients: Xerostomia Inventory (XI), Oral Health Impact Profile-short form (OHIP) and Ocular Surface Disease Index (OSDI), and correlated the results with syalometry and Schirmer's test. Statistical analysis was performed with SPSS (Mann-Whitney U-test and Spearman's correlation). RESULTS: Salivary flux was significantly lower in PSS patients, as compared to controls (0.08+/-0.01 ml/min versus 0.38+/-0.25 ml/min, p=0.000), and decreased with age. Syalometry didn't correlate with Schirmer's test. OHIP scores (mean 26.8 points, ranging from 2 to 43 for a maximum of 56 points) didn't correlate with syalometry neither with Schirmer's test, but showed an association with the XI (p<0.0005) and OSDI (p<0.0005) tests. The XI questionnaire (mean 28.4 points, ranging from 11 to 41 for a maximum of 44 points) correlated with syalometry (p=0.018), with the OHIP questionary (p<0.0005) and with the OSDI scale (p=0.004), although it didn't correlate with Schirmer's test. OSDI scores (mean 56.5 points, ranging from 7 to 90 for a maximum of 100 points) didn't correlate with Schirmer's test neither with syalometry, but associated with the XI (p=0.004) and OHIP (p<0.0005) scales. CONCLUSIONS: Unstimulated syalometry is useful in the evaluation of patients suspected of suffering from Sjögren's syndrome, since it can confirm salivary hypofunction in a quick and cheap manner, allowing to differentiate between healthy individuals and patients. In a specialized clinic, the immediate availability of a salivary functional test is important in the classification of PSS or sicca syndrome. The xerostomia and xerophtalmia impact scales were mutually concordant, and since they evaluate the effects of the disease through time, could be helpful in our daily consultation.

[Doppler color echocardiography in the diagnosis of giant cell arteritis]. / A ecografia doppler com cor no diagnóstico da arterite das células gigantes.

Although temporal artery biopsy is still the gold standard for the diagnosis of giant cell arteritis (GCA), there is growing evidence that characteristic findings in color Doppler ultrasonography (CD US) of superficial temporal arteries may be of diagnostic relevance. The current question is if CD US can replace biopsy in the diagnosis of temporal artery arteritis. Several studies have been conducted comparing the validity of the American College of Rheumatology criteria (ACR), biopsy and CD US, in the diagnosis of this vasculitis. It has been demonstrated that temporal artery biopsy is the most specific; however it was showed that the sensibility for the biopsy and ACR criteria is not sufficient and that the ACR criteria have a very low positive predictive value, which may have negative implications on the therapeutic approach of the patients. On the other hand, US CD has a better sensibility when compared to the biopsy and the ACR criteria, with a good specificity, positive and negative predictive values. US CD is a cheap, quick and non-invasive test, with a good viability and reliability, as several studies have demonstrated, namely a study held by the authors of this paper. In conclusion, US CD is an effective method in the diagnosis of GCA, especially with a high suspicion index, working also as an auxiliary method in biopsy-guidance, disease activity and recurrence monitoring.