Intestinal histological findings in patients with spondyloarthritis: a study of the relationship with disease activity

The role of intestinal microbioma and subclinical bowel inflammation in the etiology of sponsyloarthritis (SpA) has gained a lot of attention recently. Almost 65% of SpA patients will have asymptomatic bowel inflammation if assessed by ileocolonoscopy. The connection between intestinal inflammation and SpA originated the gut-joint axis hypothesis in which monocytes and T cells found in the joint would have origin in the gut (AU)

Assessment of serum levels of anti-cyclic citrullinated peptide antibodies in patients with psoriatic arthritis: A cross-sectional study in a Brazilian cohort.

Presence of the anti-cyclic citrullinated peptide (CCP) antibody is considered a hallmark of rheumatoid arthritis, and may be found in patients with other rheumatic diseases, including psoriatic arthritis (PsA). The aim of the present study was to determine whether the anti-CCP antibody was present in patients with psoriasis with and without arthritis. and to determine whether its presence was associated with clinical, serological and treatment data in patients with PsA. The present study was a cross-sectional study, which included 91 patients with psoriasis (41 with arthritis and 48 without arthritis) as well as an age and sex matched control group consisting of 100 healthy individuals. Presence of the anti-CCP antibody was determined using commercially available ELISA kits. Data on clinical, serological and treatment characteristics was obtained from reviewing each patient's medical history. The quality of life and articular inflammatory activity were assessed using the Short Form Health Survey-12 questionnaire. Skin disease was evaluated using the Psoriasis Area Severity Index and body surface area. In the control group, 1% of individuals were positive for the anti-CCP antibody, whereas 17.5% of the psoriasis patients were positive (P<0.001). In the patients with PsA, 20.9% were positive for the antibody, and in patients with psoriasis without joint disease, 14.5% were positive (P=0.58). Patients with polyarticular forms of PsA were more likely to be anti-CCP positive compared with patients with skin disease without arthritis (P=0.009). In the group of patients with PsA, those who were anti-CCP positive were more likely to suffer from polyarticular forms of arthritis, but no differences were found in the quality of life, joint disease activity, degree of skin involvement and treatment requirements (all P>0.05). In conclusion, 17.5% of patients with psoriasis and 20.9% of patients with PsA were positive for anti-CCP antibodies. Polyarticular arthritis was more common in the anti-CCP positive patients compared with the anti-CCP negative patients.

Fecal Calprotectin, Gut Inflammation and Spondyloarthritis.

BACKGROUND: Gut inflammation is closely related to spondyloarthritis (SpA) pathophysiology. Fecal calprotectin has been used to measure the degree of gut inflammation. The phenotype of SpA may change according to studied population. AIM: To study the fecal calprotectin levels in a sample of SpA in Brazilian patients and its relationship with epidemiological, clinical and treatment variables as well as with the macro and microscopic degree of gut inflammation. METHODS: Eighty five SpA patients were studied for epidemiological and clinical features, functional and inflammatory indexes and fecal calprotectin levels measured using a ELISA kit. Colonoscopy with intestinal biopsies were performed in 39 of them. At time of colonoscopy a second calprotectin level was done after suspension of at least 3 weeks of used anti-inflammatory nonsteroidal drugs (NSAIDs). RESULTS: Fecal calprotectin levels were higher in Ankylosing Spondylitis (AS) patients (p <0.0001) and in those with axial involvement (p = 0.002). No relationship was found with SpA inflammatory and functional parameters (all p = ns). After suspension of NSAIDs, a drop in fecal calprotectin levels was observed (from median levels of 215.0-76.0 µg/g; p = 0.01). In the colonoscopy, 33.3% had macroscopic signs of inflammation and these patients had higher calprotectin (p = 0.009) than others. Microscopic examination showed that all patients had lymphoplasmacytic infiltrate and eosinophilic infiltrate; epithelial erosion was present in 27.2%. CONCLUSIONS: Patients with ankylosing spondylitis and axial forms of diseases have higher fecal calprotectin levels. Patients with all types of SpA have microscopic inflammatory changes in the gut.

Mannose-binding lectin (MBL) deficiency and tuberculosis infection in patients with ankylosing spondylitis.

Ankylosing spondylitis (AS) patients may have higher prevalence of mannose-binding lectin (MBL) deficiency than normal individuals. MBL deficiency may influence susceptibility to infections. The aim of the study was to verify if MBL deficiency in patients with AS predisposes to infections. We studied 60 patients with AS diagnosed according to the Assessment of SpondyloArthritis international Society (ASAS) criteria. These patients had their MBL serum levels determinated. Twenty-five individuals were identified as MBL deficient (serum values 100 ng/mL). These patients were paired with 35 "sufficient" MBL producers (median serum level = 700 ng/mL; range 150-4100 ng/mL) for gender, age, use of medications, and tobacco exposure. Medical records of all patients were retrospectively investigated for the period of 5 years and the rate of infection occurrence was compared in the two groups. AS patients with MBL deficiency had higher number of urinary tract infections (p = 0.03; IRR = 2.33; 95% CI = 0.95-6.04) and tuberculosis (p = 0.008; IRR = 9.8; 95% CI = 1.2-441.6) than controls. Regarding tuberculosis infection, one patient (2.8%) in the MBL-sufficient group and six (24.0%) from the deficient group had this infection. The MBL-sufficient patient and five from the deficient group have had latent infections, detected in the screening tests done previous to anti-TNF drug use. The other, in the deficient group, had lung infection while not on anti-TNF treatment. Another patient, from the deficient group, has had tuberculosis skeletal infection in the past. We found a significant association between MBL deficiency and higher risk of tuberculosis and urinary tract infection in patients with AS. More studies with higher number of patients are needed to confirm this finding.

Orbital myosits in a patient with Behçet's disease / Miosite orbitária em paciente com doença de Behçet

Abstract The etiological diagnosis of orbital myositis (OM) is a challenge. Although it has been associated with previous infectious disease, diseases with autoimmune background, thyroidopathies or with paraneoplasic syndrome, most of them still remain as idiopathic. We describe here a case of OM uncovering a Behçet disease that is considered a rare cause for this kind of eye involvement.

Resumo Trata-se de um caso de ceratite bilateral e simultânea por Acremonium relacionada ao uso intermitente e sem respeitar a lateralidade O diagnóstico etiológico da miosite orbitária (MO) é desafiador. Embora ela tenha sido relacionada com doenças infecciosas prévias, doenças associadas à autoimunidade, tireoidopatias ou síndromes para neoplásicas, a maioria delas ainda permanece como idiopática. Descreve-se aqui, um caso de MO revelando o diagnóstico de doença de Behçet, doença considerada como uma causa pouco comum para este tipo de envolvimento ocular.

Erectile dysfunction in ankylosing spondylitis patients

ABSTRACT Background Rheumatic diseases such as ankylosing spondylitis (AS) may be associated with sexual dysfunction. Aim To study erectile function of a group of Brazilian AS patients comparing them with controls. Materials and Methods This was a cross sectional study approved by the local Committee of Ethics in Research. The questionnaire IIEF (International Index of Erectile Function) was applied to 40 AS patients and 40 healthy controls. AS patients had determination of disease activity (through BASDAI or Bath Ankylosing Spondylitis Disease activity index), ASDAS (Ankylosing Spondylitis Disease Activity Score, MASES or Maastricht Ankylosing Spondylitis Score and SPARCC or Spondyloarthritis Research Consortium of Canada), function (through BASFI or Bath Ankylosing Spondylitis Functional Index and HAQ or Health Assessment Questionnaire) and BASMI (Bath Ankylosing Spondylitis Metrological Index). Results AS patients had a median score on IIEF of 22.0 (IQR=18-25) while controls had 29 (IQR=27-30) with p<0.0001 Only 17.5% of the AS patients had no erectile dysfunction, in opposite to 87.5% of controls (p<0.0001). IIEF scores had a negative association with BASDAI (p<0.0001), HAQ (p=0.05), body mass index (P=0.03), MASES (P=0.02) and SPARCC (P=0.02) in a univariate analysis. Multiple regression showed that BASDAI was the only variable independently associated with IIEF. Conclusion There is a high prevalence of erectile dysfunction among AS patients that is associated with disease activity measured by BASDAI.

Erectile dysfunction in ankylosing spondylitis patients.

BACKGROUND: Rheumatic diseases such as ankylosing spondylitis (AS) may be associated with sexual dysfunction. AIM: To study erectile function of a group of Brazilian AS patients comparing them with controls. MATERIALS AND METHODS: This was a cross sectional study approved by the local Committee of Ethics in Research. The questionnaire IIEF (International Index of Erectile Function) was applied to 40 AS patients and 40 healthy controls. AS patients had determination of disease activity (through BASDAI or Bath Ankylosing Spondylitis Disease activity index), ASDAS (Ankylosing Spondylitis Disease Activity Score, MASES or Maastricht Ankylosing Spondylitis Score and SPARCC or Spondyloarthritis Research Consortium of Canada), function (through BASFI or Bath Ankylosing Spondylitis Functional Index and HAQ or Health Assessment Questionnaire) and BASMI (Bath Ankylosing Spondylitis Metrological Index). RESULTS: AS patients had a median score on IIEF of 22.0 (IQR=18-25) while controls had 29 (IQR=27-30) with p<0.0001 Only 17.5% of the AS patients had no erectile dysfunction, in opposite to 87.5% of controls (p<0.0001). IIEF scores had a negative association with BASDAI (p<0.0001), HAQ (p=0.05), body mass index (P=0.03), MASES (P=0.02) and SPARCC (P=0.02) in a univariate analysis. Multiple regression showed that BASDAI was the only variable independently associated with IIEF. CONCLUSION: There is a high prevalence of erectile dysfunction among AS patients that is associated with disease activity measured by BASDAI.

Atividade das espondiloartrites e níveis séricos de vitamin D / Serum vitamin D levels and spondyloarthritis activity

Objetivo: Estudar se os níveis de vitamina D influem na atividade das espondiloartrites. Métodos: Estudo transversal observacional de 92 pacientes com ES e 92 controles para níveis de vitamina D. Níveis de vitamina D foram associados com perfil clinico e laboratorial e com dados de atividade da doença medidos pelo BASDAI (Bath Ankylosing Spondylitis Disease Activity Index) e dados de função medidos pelo BASFI (Bath Ankylosing Spondylitis Disease Functional Index). Resultados: Os níveis de vitamina D dos controles eram semelhantes ao dos indivíduos normais (p=0.36). Encontrou-se associação dos níveis de vitamina D com BASDAI (p= 0,01) e com os valores de hemoglobina (p=0,04) dos pacientes. Nenhum dos demais parâmetros estudados associou-se com níveis de vitamina D. Conclusão: Níveis séricos de vitamina D estão associados com maior atividade de doença em pacientes com espondiloartrites.

Objective: To study whether vitamin D levels influence the activity of spondyloarthritis. Methods: This is an observational cross-sectional study of 92 patients with SpAand 92 controls for vitamin D. Vitamin D serum levels were associated with clinical and laboratory profile as well as activity data of the disease measured by the BASDAI (Bath Ankylosing Spondylitis Disease Activity Index) and functional data measured by BASFI (Bath Ankylosing Spondylitis Disease Functional Index). Results: Vitamin D levels of controls were similar to that of normal subjects (p = 0.36). Vitamin D levels associated with BASDAI (p = 0.01) and hemoglobin values (p = 0.04) of patients. None of the other studied parameters related with levels of vitamin D. Conclusion: Serum vitamin D levels are associated with increased disease activity in patients with SpA.