Serum Vitamin D Levels, Disease Activity Score-28 for Rheumatoid Arthritis with C-Reactive Protein (DAS28-CRP), and Cardiac Remodeling Determined by Ventricular Dimensions and Left Atrium Diameter in Patients with Rheumatoid Arthritis: A Prospective Observational Study.

BACKGROUND Rheumatoid arthritis (RA) can cause extra-articular manifestations, and the myocardium can be a target. This study aimed to describe structural and functional cardiac echocardiographic variables in RA patients and to evaluate whether vitamin D (VD) levels and inflammation markers, evaluated by Disease Activity Score-28 for Rheumatoid Arthritis with C-reactive protein (DAS28-CRP), are associated with cardiac remodeling (CR) in this population. MATERIAL AND METHODS This prospective observational study evaluated 90 patients with RA in Botucatu University Hospital wards from 2014 to 2017. Clinical data were recorded, including demographic information, comorbidities, length of disease, and treatment type. Serum VD and C-reactive protein levels were measured, and the DAS28-CRP was calculated. A transthoracic echocardiography study was performed. The outcome evaluated was CR. This parameter was assessed by left ventricular geometric patterns and left atrium diameter. RESULTS We evaluated 90 RA patients. The mean age was 52.9±10.8 years, and 17.8% were male. The length of the disease was 96 (60-180) months. Serum VD levels were 30.7±10.4 ng/mL and the DAS28 was 2.7±0.9. Regarding the CR parameters, 56.7% had altered left ventricular geometric patterns and 25.8% had enlargement of left atrium diameter. Even in multivariate analysis, the left ventricular geometric patterns were not associated with the VD levels and the inflammation marker used. However, sufficient VD levels protect from left atrium enlargement (OR: 0.905; IC 95%: 0.843-0.973; P=0.007). CONCLUSIONS Low serum vitamin D values, but not inflammation, are associated with CR in patients with RA.

HLA-DRB1 Polymorphisms and Rheumatologic Manifestations in Chronic Hepatitis C.

BACKGROUND/AIMS: Hepatitis C has been associated with rheumatologic manifestations (HCV-related RM). Clinically, HCV-related RM may be indistinguishable from the symptoms that occur in diffuse connective tissue diseases (DCTD-related RM), making the differential diagnosis difficult. Host genetic factors, such as the Human Leukocyte Antigens (HLA) polymorphisms were associated with HCV infection, however, there are no studies that discriminate between HCVrelated RM and DCTD-related RM. This study focused on verifying associations between HLADRB1 and RM in patients with chronic hepatitis C, aiming to distinguish between DCTD-related RM and HCV-related RM. METHODS: The participants were 152 individuals, of both sexes, aged between 18 and 80 years, and affected by chronic hepatitis C. The patients underwent rheumatologic physical examination and HLA-class II (HLA-DRB1) typing was performed by PCR-SSO (Polymerase Chain Reactionsequence Specific Oligonucleotides). RESULTS: A significant number of patients with rheumatologic complaints (73%) not attributed to other causes was observed. DRB1*08 allele seems to confer protection against RM in chronic hepatitis C. There is no susceptibility association between HLA-DRB1 alleles and RM. CONCLUSION: The absence of association between HLA-DRB1 and the rheumatologic manifestations studied suggests that the pathophysiological pathways of DCTD-related RM and HCV-related RM are distinct.

Human platelet antigen-3 polymorphism as a risk factor for rheumatological manifestations in hepatitis C.

INTRODUCTION: Hepatitis C virus (HCV) infection is involved in the pathogenesis of autoimmune and rheumatic disorders. Although the human platelet antigens (HPA) polymorphism are associated with HCV persistence, they have not been investigated in rheumatological manifestations (RM). This study focused on verifying associations between allele and genotype HPA and RM in patients with chronic hepatitis C. METHODS: Patients (159) with chronic hepatitis C of both genders were analyzed. RESULTS: Women showed association between HPA-3 polymorphisms and RM. CONCLUSIONS: An unprecedented strong association between rheumatological manifestations and HPA-3 polymorphism, possibly predisposing women to complications during the disease course, was observed.

Human platelet antigen-3 polymorphism as a risk factor for rheumatological manifestations in hepatitis C

Abstract INTRODUCTION: Hepatitis C virus (HCV) infection is involved in the pathogenesis of autoimmune and rheumatic disorders. Although the human platelet antigens (HPA) polymorphism are associated with HCV persistence, they have not been investigated in rheumatological manifestations (RM). This study focused on verifying associations between allele and genotype HPA and RM in patients with chronic hepatitis C. METHODS: Patients (159) with chronic hepatitis C of both genders were analyzed. RESULTS: Women showed association between HPA-3 polymorphisms and RM. CONCLUSIONS: An unprecedented strong association between rheumatological manifestations and HPA-3 polymorphism, possibly predisposing women to complications during the disease course, was observed.

Cáncer de próstata con metástasis en pene / Prostate cancer metastases penis

Las lesiones metastásicas en pene de carcinoma prostático son infrecuentes, menores al 0.3%. Los casos comunicados en la literatura son pocos. Esta manifestación suele ser de mal pronóstico y un signo de enfermedad avanzada con una supervivencia menor de un año. Presentamos el caso de un paciente en quien se constató un nódulo en el pene de progreso acelerado. Se comprobó metástasis de próstata y falleció 8 meses después de la penectomía total.

Metastatic lesions in penis of prostatic carcinoma are rare,less than 0.3 %. The cases reported in the literature arefew. This event is usually of poor prognosis and a sign ofadvanced disease, with less than one year of survival. Wereport the case of a patient whose clinical manifestationwas a nodule on the penis of accelerated progress. Prostatemetastasis was found and the patient died eight monthsafter total penectomy.

Púrpura de Henoch-Schõnlein em adulto / Henoch-Schõnlein purpura in adults

A púrpura de Henoch-Schõnlein é uma vasculite de pequenos vasos, mais comum em crianças, com acometimento cutâneo, articular, gastrointestinal e renal. É raro o acometimento em adultos, conferindo nestes pior prognóstico. Relatamos o caso de um paciente de 54 anos com púrpura de Henoch-Schõnlein com acometimento de pele, articulação, abdominal e renal, sem resposta clínica com altas doses de prednisona, mantendo quadro de claudicação abdominal e proteinúria nefrótica.

Henoch-Schõnlein purpura is a vasculitis of small vessels, more common in children with involvement cutaneous, articular, gastrointestinal and renal. It rarely affects adults, giving these worse prognosis. We report a patient aged 54 with Henoch-Schõnlein purpura with involvement of skin, joint, abdominal and renal, without clinical response with high doses of prednisone keeping a lameness abdominal and nephrotic proteinuria.

Revisando doença de Still do adulto / Reviewing adult-onset Still's disease

A doença de Still do adulto (DSA) é uma doença inflamatória sistêmica rara, de etiologia desconhecida, caracterizada por febre associada a rash maculoso cor de salmão durante os picos febris, podendo apresentar odinofagia, artralgia/artrite, além de hepatoesplenomegalia e linfadenopatia. Laboratorialmente não possui nenhum exame que seja específico desta enfermidade, apresentando elevação dos níveis de PCR, VHS e ferritina, além de leucocitose e elevação de enzimas de dano hepático. Trata-se de um diagnóstico de exclusão, e deve ser lembrado nos casos de febre de origem indeterminada (FOI), propiciando um diagnóstico precoce e evitando gastos desnecessários com exames subsidiários e internações hospitalares prolongadas.

Adult-onset Still's disease is a rare inflammatory systemic condition of unknown aetiology. The main clinical feature is fever accompained by salmon-pink maculous rash that appears along with fever spikes. Other symptoms are odynophagia, arthralgia or arthritis, enlargement of the spleen and liver, and lymphadenopathy. Although there are no specific laboratorial tests to confirm the condition, C-reactive protein, VHS, ferritin, white blood cells count and liver enzymes are usually elevated. Diagnosis is established by exclusion and must be considered in patients presenting with fever of obscure origin. Early identification reduces costs by avoiding unnecessary tests and long hospital admission.

Curso de reumatologia: aula 10: tratamento atual da artrite reumatoide / Course of rheumatology: class 10: current treatment of rheumatoid arthritis

Os autores discutem a terapêutica para a artrite reumatoide (AR), com foco no tratamento biológico. Novos conhecimentos dos mecanismos patogênicos da AR mais a aplicação de biotecnologia propiciaram o desenvolvimento de tratamentos específicos contra moléculas envolvidas na inflamação da doença, os chamados tratamentos biológicos. Estes fármacos representam o maior avanço no controle da AR nesta última década. 0s agentes biológicos habitualmente aprovados para uso na AR são: etanercepte, receptor solúvel do TNE infliximabe e adalimumabe, ambos anticorpos monoclonais contra TNF. Todos estão disponíveis para uso pela secretaria de saúde. Outros aprovados para uso e não disponibilizados pela secretaria são o rituximabe e o abatacepte. Neste artigo discutimos cada um destes biológicos.

Authors discuss the therapies for rheumatoid arthritis focused on biological therapies. Biological therapies are the result of new insights into the pathogenic mechanisms of RA and the application of biotechnology on the development of therapies directed specifically against molecules involved with the inflammatory process of the disease. These agents represent the greatest advance in the control of RA during the last decade. Biological agents currently approved and accessible by government for the treatment of RA include: etanercept, a soluble recombinant anti-TNF receptor construct, in fliximab and adalimumab, both monoclonal antibodies against TNF. The others biologic, rituximab and abatacept, are also approved for treatment of RA but not available by government. In this essay authors study each one of these biologics agents.

Ascite cirrótica: aspectos clínicos / Cirrhotic ascites: clinical aspects

A ascite é a mais comum das três complicações da cirrose. A sua presença é indicativo de mau prognóstico, e está associada a complicações que aumentam a morbidade e a mortalidade. O gradiente de albumina sérico-ascítico é o método utilizado para se fazer o diagnóstico diferencial da ascite associada à hipertensão portal daquela de outra etiologia. A patogênese da ascite cirrótica revela primordialmente dois fatores: alterações na hemodinâmica portal e retenção de sódio e água. A teoria que explica a formação da ascite e as alterações hemodinâmicas na cirrose é a da vasodilatação. Esta vasodilatação é associada às altas concentrações de substâncias como o óxido nítrico dentre outras. O tratamento da ascite consiste na restrição de sódio, diuréticos orais, paracentese abdominal, derivação peritoneovenosa, TIPS e transplante de fígado.

Ascites is the most common of the three major complications of cirrhosis (the others complications are hepatic encephalopathy and visceral haemorrhage). Its presence is an indicative sign of poor prognosis, predisposing the patient to many complications which increase morbidity and death rate. The serum-ascites albumin gradient is the method which you can differentiate ascites caused by portal hypertension from others etiologies. In ascites pathogenesis there are two factors to be considered: The portal hemodynamic and the sodium and water retainers. The theory which explains the ascites formation and the hemodynamics alterations in cirrhosis is the vasodilatation one. The vasodilatation would be secondary to high serum concentrations of vasodilators, including nitric oxide and others. The treatment of ascites in cirrhotic patients includes clinical and surgical procedures like saline restriction, oral diuretics, abdominal paracentesis, peritoneovenousderivation, TIPS, and liver transplantation.

Curso de reumatologia: aula 9: Anticorpo anticitoplasma de neutrófilos: significado clínico / Course of rheumatology: class 9: Antibodies antineutrophil cytoplasmic: clinical meaning

Os anticorpos anticitoplasma de neutrófilos são autoanticorps contra componentes neutrofílicos, úteis nos dianósticos diferenciais das vasculites. A imunofluorescência indireta determina três padrões de fluorescência: citoplasmático (cANCA), específico para granulomatose de Wegener; perinuclear (pANCA), observado na síndrome de Churg-Strauss, poliangiite microscópica e em outras vasculites; o terceiro padrão, atípico (aANCA), ocorre na doença de Crohn, colite ulcerativa e em outras doenças. O objetivo deste artigo é abordar os pontos importantes para a correta valorização dos achados da pesquisa de ANCAs, que possa auxiliar o clínico nos diagnósticos das síndromes vasculíticas. Os autores descutem a importância dos padrões de fluorescência, sua correlação antigênica e a possível significação clínica do ANCA positivo.

Antineutrophil cytoplasmatic antibodies (ANCA) are autoantibodies against components of neutrophils, and they help with the identification of different forms of vasculitis. The ANCA pattern, determined by indirect immunofluorescence, can be either cytoplasmatic (cANCA), which are predominantly associated sith Wegener's granulomatosis; or perinuclear (PANCA) are more likely seen in mocroscopic polyangiitis, Churg-Strauss syndrome and other vasculitides. The third pattern is atypical (aANCA) and it's reported in patients with ulcerative colitis, in patients with Crohn's disease and other illnesses. The present article seeks to make an approach on the most important points to be considered in the analyses and evaluation of ANCA test that might help the physician on diagnostic of vasculitis diseases. Authors discuss the importance of these immunofluorescence patterns, the antigen's correlation and the probably clinical significance of ANCA positive.

Reumatologia: aula 8: manifestações reumatológicas da Hepatite C / Rheumatology: class 8: rheumatologic manifestations of Hepatitis C

A infecção pelo vírus C da hepatite é frequentemente associada a manifestações extra-hepáticas - dentre elas, manifestações reumatológicas. Na maioria dos casos, o mecanismo patogenético é imunologicamente mediado, como evidenciam a presença de autoanticorpos: crioglobulinemia mista, fator reumatoide e anticorpo antinuclear. O foco deste artigo são as manifestações clínicas reumatológicas mais comuns da infecção crônica pelo vírus da hepatite C.

Chronic hepatitis C virus (HCV) infection is frequently associated with extrahepatic complications, like rheumatologic manifestations. The majority cases of these manifestations, the underlying pathogenetic mechanisms are immune mediated; this is evidenced by the presence of circulating autoantibodies: mixed cryoglobulinemia, rheumatoid factor and antinuclear antibodies. The focus of this article is the most common clinical rheumatic manifestations of the chronic HCV infection.

Curso de reumatologia: aula 7: manifestações neurológicas nas colagenoses / Course of rheumatology: class 7: neurologic manifestations in collagenosis

O propósito deste artigo é focar as principais manifestações neurológicas das doenças difusas do tecido conjuntivo, com ênfase nas suas manifestações clínicas. Os autores discutem as várias complicações do sistema nervoso central e periférico na doença muscular inflamatória (polimiosite e dermatomiosite), policondrite recidivante, esclerose sistêmica, artrite reumatoide, síndrome de Sjõgren, doença mista do tecido conjuntivo (doença de Sharp), lúpus eritematoso sistêmico e síndrome do anticorpo antifosfolipide.

The purpose of this article is to focus on the major nervous system manifestations in connective tissue diseases, with emphasis on their clinica findings. Authors discuss several complications in inflammatory muscle disease (polymyositis an dermatomyositis), relapsing polychondritis, systemic sclarosis, rheumatoid arthritis, Sjõgren syndorme, mixed connective tissue (Sharp disease), systemic lupus erythematosus and antiphospholipid syndrome.

Curso de Reumatologia: aula 5: anti-inflamatórios não hormonais e alterações intestinais / Course of Rheumatology: class 5: nonsteroidal anti-inflammatory drugs and intestinal alterations

A enteropatia relacionada aos anti-inflamatórios não hormonais (ou não esteroides) é um processo gradual que envolve efeito tóxico direto à mucosa, lesão mitocondrial, quebra da integridade intercelular, recirculação êntero-hepática do anti-inflamatório e ativação neutrofílica pelo conteúdo intraluminal, inclusive por bactérias. A mediação pela cicloxigenase provavelmente é menos importante do que no trato gastrointestinal superior. Estudos com a nova modalidade endoscópica, como a que se utiliza de cápsula endoscópica, demonstram anormalidades relacionadas aos anti-inflamatórios não esteroides (AINEs), que incluem inflamação, erosões, fibrose, estenoses, lesões enantemáticas, erosões patequiais, perfurações e formação de membranas diafragmáticas no jejuno, íleo e colon.

Nonsteroidal anti-inflammatory drug enteropathy is a stepwise process involving direct mucosal toxity, mitochondrial damage, breakdown of intercellular integrity enterohepatic recirculation and neutrophil activation by liminal contents including bacteria. Unlike upper gastrointestinal toxity, cyclooxygenase-mediated mechanisms are probably less important. Newer imaging modalities such as capsule endoscopy studies demonstrate nonsteroidal anti-inflammatory drug-induced abonormalities that include inflammation, erosion, fibrosis, stricture, red spots, petechiae erosions, perforation, and formation of mucosal diaphragms in the jejunum, ileum and colon.

Sarcopenia in rheumatoid cachexia: definition, mechanisms, clinical consequences and potential therapies / Sarcopenia da caquexia reumatoide: conceituação, mecanismos, consequências clínicas e tratamentos possíveis

A caquexia relacionada à artrite reumatoide é conceituada como perda involuntária de massa magra, predominantemente de músculo esquelético, que também ocorre em vísceras e sistema imune, com massa gorda estável ou um pouco elevada e com pequena ou nenhuma perda de peso. A causa é multifatorial, incluindo a produção acentuada de citocinas, principalmente TNF± e IL-1², diminuição da ação periférica da insulina e pouca atividade física. A caquexia se faz presente em doentes com AR ativa ou mesmo inativa. Neste artigo discutem-se aspectos relacionados à patogenia, implicações clínicas e possíveis opções terapêuticas.

Rheumatoid cachexia can be defined as an involuntary loss of body cell mass, which predominates in skeletal muscle, but is also observed in the viscera and immune system. It occurs with little or no weight loss in the presence of stable or increased fat mass. The etiology is likely multifactorial, and involves excessive inflammatory cytokine production, namely excess tumor necrosis factor-± and interleukin-1² production, reduced peripheral insulin action, and low habitual physical activity. Cachexia occurs in active rheumatoid arthritis and even in the presence of disease control. In this article, we discuss the pathogenesis of rheumatoid cachexia, its clinical implications and potential therapies.

Curso de Reumatologia: Aula 3: Síndrome de Sjõgren: Aspectos clínicos e condutas terapêuticas / Course of Reumatologia: Class 3: Syndrome of Sjõgren: Clinical aspects and therapeutic conducts

A síndrome de Sjõgren caracteriza-se por apresentar boca seca (xerostomia) e olhos secos (ceratoconjuntivite secal), associados a outras doenças difusas do tecido conjuntivo (forma secundária) ou manifestações isoladas (forma primária). Essa síndrome tem preferência pelo sexo feminino e apresenta distribuição mundial. Apesar de descrita em 1933, ainda hoje é subdiagnosticada, trazendo aos pacientes sofrimentos e repercussões socioeconômicas. O objetivo deste artigo é descrever as principais manifestações clínicas, os critérios utilizados para facilitar o seu diagnóstico e as modalidades terapêuticas disponíveis.

Sjõrgren's syndrome is a systemic inflammatory autoimmune disease with worldwide distribution. It affects primaly females during the forth and fifth decades of life. The disease's clinical features are: mucosal dryness manifested in keratoconjunctivitis sicca, xerostomia, xerotrachea and vaginal dryness. There are two forms of manifestation. The primary has isolated symptoms and the secondary associated with some connective tissue disease like rheumatoid arthritis, systemic lupus erythamatosus, systemic sclerosis and polymyositis. The aim of this article is to describe its clinical disclosures, the currently used diagnostic criteria and the available treatment for the syndrome.

Curso de Reumatologia: aula 2: Importância Clínica da Caquexia Reumatoide / Course of Rheumatology: class 2: Clinical importance of rheumatoid arthistis

A artrite reumatoide é doença autoimune sistêmica de etiologia ainda desconhecida que pode causar destruição de cartilagem e osso. Afeta aproximadamente 1 por cento da população e é duas a três vezes mais frequente nas mulheres do que nos homens. Apesar de agredir predominantemente as articulações, apresenta inúmeras manifestações sistêmicas, entre elas a caquexia - que se manifesta em aproximadamente 66 por cento dos pacientes reumatoides. A caquexia reumatoide é conceituada como perda involuntária de massa celular, predominantemente de músculo esquelético, mas que também ocorre em vísceras e sistema imune. A causa é multifatorial, mas os mecanismos mais importantes são a produção de citocinas, principalmente TNFα e II-1ß, diminuição da ação periférica da insulina e pouca atividade física. Neste artigo discutem-se aspectos relacionados à patogenia, às implicações clínicas e abordagens terapêuticas.

Rheumatoid arthristis is a chronic, systemic, autoimmune disease of unknow etiology that causes destruction of joint cartilage and bone. It affects approximately 1 per cent of the population and predominates among womwn than men. Cachexia, from the Greek "bad condition", generally connotes as state of advanced malnutrition and wasting. However, more recently cachexia has been used to denote the loss of body cell mass which occurs in illness. So rheumatoid cachexia can be defined as an involuntary loss of body cell mass, that predominates in skeletal muscle, and occurs with little or no wegith in the presence of stable or increased fat mass. The etiology is likely multifactorial, and involves excess inflamatory cytokine production, namely excess tumor necrosis factor-α and interleukin-1ß production; reduced peripheral insulin action; and low habitual physical activity. In this article, we evaluate pathogenesis of rheumotoid cachexia, its clinical disclosures and discuss potential therapies.

Curso de reumatologia: aula 1: significado clínico do FAN anticorpos antinucleares / Course of rheumatology: class 1: clinical significance of antinuclear antibodies ANA

A utilização de células HEp-2 na detecção dos anticorpos antinucleares (FAN-HEp-2) constituiu-se em grande avanço metodológico. Como consequência, o teste tornou-se muito sensível, porém com diminuição da especificidade, fato comprovado pelo crescente número de exames positivos em indivíduos sabidamente hígidos. O objetivo deste artigo é fazer uma abordagem sobre os pontos importantes, para correta valorização dos achados do teste de FAN, que possa auxiliar o clínico na exata identificação de pacientes com doenças autoimunes, particularmente o lúpus eritematoso sistêmico. Os autores discutem a importância do título e do padrão na interpretação de um FAN positivo. Discutem também os possíveis significados do teste positivo em pacientes sem evidências objetivas de doenças imunológicas.

Antinuclear antibody (ANA) tests are frequently used to screen patients for chronic inflammatory diseases such as lupus erythematosus (SLE). However, the methodological advances have brought up a considerable improvement in the test's sensitivity and consequently a decrease in its specificity. This has resulted in an increasing number of positive tests in apparently healthy subjects. The present article brigs an approach on the most important points to be considered in the analyses and evaluation of an ANA test, like titer and immunofluorescence pattern of a positive test. Those points are importants parameters in the evaluation of the significance of a positive ANA-HEp-2 test that might help the identification of patients with autoimmune disease. Also, it is important to consider the possible and alternative significance of a positive ANA test in patients without objective evidence of autoimmune diseases.

Curso de Reumatologia: aula 4: manifestações gastrointestinais nas colagenoses / Course of Rheumatology: class 4: gastrointestinal manifestations in collagenosis

O termo colagenose, surgido em 1942, é hoje substituído por doenças difusas do tecido conjuntivo, que se constituem em um grupo de moléstias que afetam o tecido conjuntivo, rico em colágeno. São enfermidades que podem comprometer vários sistemas e múltiplos órgãos, sendo, portanto, de caráter sistêmico. O objetivo desta aula é discutir as manifestações gastrointestinais e sua abordagem terapêutica. Serão focadas algumas doenças difusas do tecido conjuntivo, a saber: esclerose sistêmica, lúpis eritematoso sistêmico, dermatopolimiosite e Sjõgren.

The term "collagen diseases" was first introduced by Klemperer in 1942, and is currently been called connective tissue diseases. All the organ and systems are both affected by them, so that's why it can be called systemic diseases. The aim of this lesson is to discuss gastrointestinal manifestations and its therapeutic approach, while it will be detailed the connective tissue diseases like systemic sclerosis, systemic lupus erythematosus, polymyositis/dermatomyositis and Sjõgren's syndrome.

Rabdomiosarcoma paratesticular / Rhabdomyosarcoma Paratesticular

De todos los tumores paratesticulares el 70 por ciento son benignos y de estos los lipomas son los más frecuentes. Mientras que el 30 por ciento restante son tumores malignos, la mayoría de estos son sarcomas como el rabdomiosarcoma, el leiomiosarcoma, fibrosarcoma, liposarcoma.

[Proposal of a questionnaire for the characterization of the prevalence of digestive symptoms in connective tissue diseases]. / Proposta de questionário para caracterização da prevalência de sintomas digestivos nas doenças difusas do tecido conjuntivo.

BACKGROUND: Connective tissue diseases may damage multiple organic systems, including digestive system. In this one, the degree of injury vary according to the associated disease. Despite the significant frequency of gastrointestinal involvement, there are few studies characterizing the prevalence of digestive symptoms in connective tissue diseases. Furthermore, most of the studies available are less detailed and based in personal experiences or reviews of records. AIM: To establish a reliable list of gastrointestinal symptoms found in the progressive systemic sclerosis, rheumatoid arthritis, polymyositis/dermatomyositis, mixed connective tissue disease and systemic lupus erythematosus, through a medical interview and a predefined questionnaire of symptoms. PATIENTS AND METHODS: There were studied 99 patients, 90% females, mean age 45 years. The whole group were composed of 35 rheumatoid arthritis, 26 progressive systemic sclerosis, 21 systemic lupus erythematosus, 12 polymyositis/dermatomyositis and 5 mixed connective tissue disease. Each patient was submitted to an interview with a well trained doctor and answered a structured questionnaire, containing 17 questions. RESULTS: It was found a high prevalence of digestive symptoms in all five connective tissue diseases searched. Many of them were present in more than 50% of the patients. Called special attention the detection of some manifestations neglected by the literature like, for example, fecal incontinence. Also, disagreeing with other authors, was the finding of multiple gastrointestinal manifestations associated with rheumatoid arthritis. It was particularly surprising the occurrence of dysphagia in one third of the rheumatoid arthritis group. CONCLUSIONS: The connective tissue diseases are usual causes of many gastrointestinal complaints. The use of an interview plus predefined questionnaire seems a very effective way to identify and characterize symptoms and is even sometimes able to uncover features unknown before. Finally, the lack of studies, specially updated studies, did not allow more comprehensive comparisons.