¿La periodontitis crónica modifica la morbilidad de la artritis reumatoide?: aspectos clínicos y moleculares. Una revisión sistemática / Association between chronic periodontitis and rheumatoid arthritis: a systematic review

Rheumatoid arthritis (RA) and chronic periodontitis (CP) may be related due to a bidirectional etiology. The evidence shows that CP could alter the clinical course of RA. We performed a systematic search to determine if CP alters the morbidity of RA, analyzing its clinical and molecular aspects. Of 552 initial articles found, 16 were selected for a thorough review. There is a greater prevalence of CP in patients with RA. Patients with RA have significantly higher values of periodontal clinical parameters than healthy controls. Arthritis activity is significantly greater in patients who suffer from CP and decreases with nonsurgical periodontal treatment. There is a significant relationship between the severity of CP and RA activity.

Evaluation of foot functionality in cases of rheumatoid arthritis through the FFI-BR and FHSQ-BR questionnaires: a cross-sectional observational study

ABSTRACT BACKGROUND: Rheumatoid arthritis (RA) can affect the feet, thus compromising the patient's gait and autonomy. In this study, we investigated foot disability in RA patients using the Brazilian versions of the Foot Health Status Questionnaire (FHSQ-BR) and Foot Function Index (FFI-BR). DESIGN AND SETTING: Cross-sectional, observational study conducted in a tertiary care hospital. METHODS: Two hundred individuals were studied: 100 with RA and 100 controls. Demographic variables and FFI-BR and FHSQ-BR scores were analyzed. In relation to RA patients, data on medications used and on the following clinical variables were collected: Disease Activity Score-28-ESR; erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) level and rheumatoid factor (RF) level. The groups were compared and the scores and clinical variables were correlated. RESULTS: RA patients' scores in the pain, difficulty and disability domains of the FFI-BR questionnaire were worse (P < 0.0001). The FHSQ-BR showed that there were differences between RA patients and controls in relation to the pain and foot function domains: shoes (P < 0.0001), foot health (P < 0.0001), general health (P=0.0002), physical activity (P < 0.0001), social capacity (P = 0.0006) and vigor (P = 0.01). There were correlations between FFI-BR and DAS-28-ESR scores (rho = 0.45), ESR (rho = 0.27) and CRP (rho = 0.24). According to the FHSQ-BR questionnaire, there was a correlation between DAS-28-ESR and worse foot health (rho = 0.29). CONCLUSION: RA patients' scores in the foot health assessment questionnaires were worse than those of controls. A correlation between inflammatory activity and worse foot function was found.

Eficacia de medicamentos biológicos aprobados por ley 20850, para pacientes con artritis reumatoide refractaria a tratamiento / Efficacy of biological drugs approved by law N°20. 850, for patients with rheumatoid arthritis refractory to treatment

INTRODUCCIÓN: La artritis reumatoide es una enfermedad crónica, sistémica, de origen autoinmune, caracterizada por compromiso articular simétrico. Dentro de su tratamiento destacan fármacos antirreumáticos, modificadores de la enfermedad, glucocorticoides y agentes biológicos. Estos últimos, han llegado a revolucionar la progresión de la enfermedad, otorgando una mejor calidad de vida a los pacientes. CUERPO DE LA REVISIÓN: En Chile, los fármacos biológicos están asegurados para personas con artritis reumatoide refractaria a tratamiento por la ley 20.850 "Ley Ricarte Soto", que incluye los fármacos adalimumab, etanercept, abatacept y rituximab. Por lo tanto, el objetivo de esta investigación fue resumir los principales estudios que aseguran la eficacia de estos medicamentos. CONCLUSIÓN: Se ha demostrado la eficacia de los medicamentos biológicos, con clara superioridad en relación con la progresión radiológica, síntomas, alteración funcional y nivel de actividad de la enfermedad comparativamente con los placebos.

INTRODUCTION: Rheumatoid arthritis is a chronic, systemic disease of autoimmune origin, characterized by symmetrical joint involvement. Its treatment includes antirheumatic drugs, disease modifiers, glucocorticoids and biological agents. The latter have come to revolutionize the progression of the disease, giving a better quality of life to patients. REVIEW BODY: In Chile, biological drugs are insured for people with rheumatoid arthritis refractory to treatment by the 20.850 "Ricarte Soto Law", which includes the drugs adalimumab, etanercept, abatacept and rituximab. Therefore, the objective of this research was to summarize the main studies that ensure the efficacy of these medications. CONCLUSION: The efficacy of biological drugs has been demonstrated, with clear superiority in relation to radiological progression, symptoms, functional alteration and level of disease activity compared to placebos.

Association of vascular function and estimated cardiovascular risk in patients with rheumatoid arthritis / Associação entre a função vascular e o risco cardiovascular estimado em pacientes com artrite reumatoide

Abstract Objectives: Rheumatoid arthritis (RA) patients should receive cardiovascular (CV) risk assessment. For this purpose CV risk calculators are available. In addition, parameters of vascular function can be measured and used for risk prediction. Aim of the present study was to assess the association of these two concepts. Methods: 287 RA patients (58.4 ± 12.6 years) and 232 controls (49.9 ± 13.4 years) were included in this cross-sectional study. We calculated 10 year CV risk with SCORE and QRISK2. For SCORE we used the recommended multiplier of 1.5 in eligible RA patients and estimated the risk also in patients younger than 40 years (mSCORE (0-65)). Augmentation index (AIx) and central pulse pressure (PP), markers of vascular integrity and CV risk, were assessed by pulse wave analysis (PWA). Primary endpoint was the correlation of AIx and the estimated CV risk using mSCORE (0-65). Results: In RA patients AIx showed a statistically significant correlation with mSCORE (0-65) (rho = 0.3374; p < 0.0001) and QRISK2 (rho = 0.3307; p < 0.0001). The correlations of central PP with mSCORE (0-65) (rho = 0.4692; p < 0.0001) and QRISK2 (rho = 0.5828; p < 0.0001) were also statistically significant. Increasing quartiles of central PP were associated with an increased odds of being in the "high risk"category according to SCORE (OR 2.18; 95% CI 1.58-3.01) or QRISK2 (OR 2.18; 95% CI 1.75-2.72). In control patients we also found a correlation of AIx and central PP with SCORE (0-65) and QRISK2. Conclusions: Parameters of central haemodynamics correlate with calculated CV risk. However, both do not give exactly the same information. The question arises whether a combination of both concepts would result in an improved CV risk prediction.

Resumo Objetivos: Os pacientes com artrite reumatoide (AR) devem receber uma avaliação do risco cardiovascular (CV). Para esse fim, existem as calculadoras de risco CV. Além disso, parâmetros da função vascular podem ser medidos e usados para predição do risco. O objetivo deste estudo foi avaliar a associação entre esses dois conceitos. Métodos: Foram incluídos neste estudo transversal 287 pacientes com AR (58,4 ± 12,6 anos) e 232 controles (49,9 ± 13,4 anos). Calculou-se o risco CV em 10 anos com o Score e o QRISK2. No Score, usou-se o multiplicador recomendado de 1,5 em pacientes com AR elegíveis e estimou-se também o risco em pacientes com menos de 40 anos [mScore (0-65)]. O índice de aumento (AIx) e a pressão de pulso (PP) central, marcadores da integridade vascular e risco CV, foram avaliados pela análise de onda de pulso (PWA). O desfecho primário foi a correlação entre o AIx e o risco CV estimado com o mScore (0-65). Resultados: Em pacientes com AR, o AIx mostrou correlação estatisticamente significativa com o mScore (0-65) (rho = 0,3374; p < 0,0001). A correlação entre o AIx e o QRISK2 também foi significativa (rho = 0,3307, p < 0,0001). As correlações entre a PP central e o mScore (0-65) (rho = 0,4692; p < 0,0001) e QRISK2 (rho = 0,5828; p < 0,0001) também foram estatisticamente significativas. Os quartis incrementais da PP central estiveram associados a uma maior probabilidade de estar na categoria de "alto risco"de acordo com o Score (OR 2,18; IC 95% 1,58 a 3,01) ou QRISK2 (OR 2,18; IC 95% 1,75-2,72). Nos pacientes do grupo controle também se encontrou uma correlação entre o AIx e a PP central no Score (0-65) e no QRISK2. Conclusões: Os parâmetros de hemodinâmica central se correlacionam com o risco CV calculado. No entanto, ambos não fornecem exatamente as mesmas informações. Pergunta-se se uma combinação de ambos os conceitos resultaria em uma melhor predição do risco CV.

Falls and their association with physical tests, functional capacity, clinical and demographic factors in patients with rheumatoid arthritis / Ocorrência de quedas e sua associação com testes físicos, capacidade funcional e aspectos clínicos e demográficos em pacientes com artrite reumatoide

ABSTRACT Objective: To evaluate the occurrence of falls reported by rheumatoid arthritis patients and its relation to disease activity, functional capacity and physical fitness. Materials and methods: A cross-sectional study constituted by a sample of 97 rheumatoid arthritis patients from the city of Marília (SP) from 2012 to 2013, were assessed for disease activity. Instruments validated for Brazilian population in order to evaluate physical and functional capacity were used. Data analysis was carried out with descriptive statistics, Spearman correlation and Chi-squared test, considering p < 0.05. Results: 88.7% were female subjects with a mean age of 56 (±11.7) years. The median duration of rheumatoid arthritis was 10 years (P25 = 6 and P75 = 17) and the mean of disease activity was 3.6 (±1.3), what was considered a moderate activity. In the last 12 months 37.1% of patients experienced at least one fall, with a total of 52 episodes, and fear of falling was reported by 74.2% of them, but this was not associated to the occurrence of a fall (χ 2 = 1.19, p = 0.27). Gender, number of medications, age, disease activity, duration of rheumatoid arthritis, functional capacity, and physical tests showed no associations with history of falls in the past year. Conclusion: It was observed that the occurrence of falls and the fear of falling are quite common in this population. The occurrence of falls in this sample of rheumatoid arthritis patients bears no relation to disease activity, functional capacity, or physical fitness tests.

RESUMO Objetivo: Avaliar a ocorrência de quedas reportadas por pacientes com artrite reumatoide (AR) e sua associação com a atividade da doença, capacidade funcional e aptidão física. Material e métodos: Estudo transversal com uma amostra de 97 pacientes com AR em Marília (SP), entre 2012 e 2013. Foram usados instrumentos validados na população brasileira para avaliar capacidade física e funcional. Análise dos dados com estatística descritiva, correlações de Spearman e qui-quadrado, considerado p < 0,05. Resultados: Dos pacientes, 88% eram mulheres, média de 56, anos (± 11,7), duração mediana da AR de 10 anos (P25 = 6 e P75 = 17) e média da atividade da doença 3,6 (± 1,3). Nos últimos 12 meses, 37,1% tiveram pelo menos uma queda (total 52 episódios), 74,2% relataram medo de cair, porém sem associação com a ocorrência de quedas (χ2 = 1,19, p = 0,27). Sexo, quantidade de medicamentos, idade, atividade da doença, duração da AR, capacidade funcional e testes físicos não estão associados com história de queda no último ano. Conclusões: Observou-se que a ocorrência de quedas e o medo de cair é frequente nessa população. A ocorrência de quedas nessa amostra de pacientes com AR não está relacionada à atividade da doença, à capacidade funcional e a testes de aptidão física.

Sensory disturbance and polyneuropathy in rheumatoid arthritis patients with foot deformity / Perturbações sensitivas e polineuropatia em pacientes com artrite reumatoide com deformidade do pé

Abstract Introduction Our aim in this study was to present the results of sensory evaluation tests and electrophysiological evaluations in rheumatoid arthritis (RA) patients with foot deformity and to determine their relation with general health status and lower extremity functionality. Materials and methods Fifty-one patients with RA diagnosis and foot deformity were included in the study. Demographic and disease characteristics of the patients were recorded, and a detailed neurological examination was performed. Superficial sensation, pain, heat, vibration, and two-point discrimination sensation were evaluated in each foot, and their sum was used to determine the sensory deficits index (SDI) of 0–10. The presence of polyneuropathy was evaluated with electrophysiological methods. The Health Assessment Questionnaire and mobility and walking subscales of the Arthritis Impact Measurement Scales-2 were used to assess general health status and lower extremity functionality, respectively. According to the sensory examination and electromyography results, patients were compared in terms of their general health status and lower extremity functional status. Results Sensory disturbance was detected in 39 patients (74%) during the examination; however, 27 patients (52.9%) had polyneuropathy determined electrophysiologically. In patients with sensory deficits, statistically significant deterioration was detected in general health and foot functionality, including mobility and walking, when compared to patients with a normal sensory evaluation. Conclusions Even in the presence of normal electrophysiological tests, sensory dysfunction alone seems to be associated with severe disability in general health status and foot functionality when compared to patients with a normal sensory examination.

Resumo Introdução O objetivo deste estudo foi apresentar os resultados dos testes de avaliação sensitiva e do exame eletrofisiológico em pacientes com artrite reumatoide (AR) com deformidade do pé e determinar a sua relação com o estado geral de saúde e o aspecto funcional dos membros inferiores. Materiais e métodos Foram incluídos no estudo 51 pacientes com diagnóstico de AR e deformidade do pé. Foram registradas as características demográficas e da doença de cada indivíduo e foi feito um exame neurológico detalhado. Foi avaliada a sensibilidade superficial, dolorosa, térmica e vibratória e aplicado o teste de discriminação de dois pontos em cada um dos pés. A soma dos escores foi usada para determinar o índice de déficits sensitivos (IDS) de 0‐10. A presença de polineuropatia foi avaliada com métodos eletrofisiológicos. Foram usados o Health Assessment Questionnaire e as subescalas mobilidade e deambulação da Arthritis Impact Measurement Scales‐2 para avaliar o estado geral de saúde e o aspecto funcional de membros inferiores, respectivamente. De acordo com os resultados dos exames de eletromiografia e de sensibilidade, os pacientes foram comparados em relação ao seu estado geral de saúde e estado funcional de membros inferiores. Resultados Foram detectados distúrbios sensitivos em 39 pacientes (74%) durante o exame; contudo, 27 (52,9%) tinham polineuropatia determinada eletrofisiologicamente. Em pacientes com déficits sensitivos, foi detectada deterioração estatisticamente significativa no estado geral de saúde e no aspecto funcional do pé, inclusive na mobilidade e deambulação, quando comparados com os pacientes com uma avaliação sensitiva normal. Conclusão Mesmo na presença de testes eletrofisiológicos normais, a disfunção sensitiva isolada parece estar associada a incapacidade grave no estado geral de saúde e ao aspecto funcional do pé em comparação com pacientes com um exame sensitivo normal.

Influência das comorbidades na capacidade funcional de pacientes com artrite reumatoide / The impact of comorbidities on the physical function in patients with rheumatoid arthritis

Resumo Objetivos: Investigar a associação das comorbidades com a limitação da mobilidade e com a incapacidade funcional em pacientes com artrite reumatoide (AR), bem como identificar o indicador de comorbidade mais apropriado para determinar essa associação. Métodos: Em um estudo transversal foram incluídos 60 pacientes com AR por um período de 11 meses. Comorbidades foram avaliadas por meio de três indicadores: (i) número total de comorbidades (NCom); (ii) índice de comorbidade de Charlson (ICC); e (iii) índice de comorbidade funcional (ICF). A atividade da doença foi avaliada pelo Índice de Atividade da Doença 28 (DAS-28/VHS). A capacidade funcional foi mensurada pelo Questionário de Avaliação da Saúde (HAQ) e a mobilidade foi mensurada pelos testes senta-levanta da cadeira cinco vezes (TSL) e timed get up and go (TUG). A análise estatística foi feita por meio de regressão múltipla log-linear Stepwise com nível de significância de 5%. Resultados: No modelo final, apenas o fator comorbidades (ICF) esteve associado à mobilidade (TSL e TUG). O escore no ICF explicou 19,1% da variabilidade do TSL (coeficiente de determinação [R2] = 0,191) e 19,5% da variabilidade do TUG (R2 = 0,195). Em relação à incapacidade funcional (HAQ), os fatores associados foram o fator comorbidades (ICF) e a atividade da doença (DAS-28/VHS) que em conjunto explicaram 32,9% da variabilidade do escore do HAQ (R2 ajustado = 0,329). Conclusão: As comorbidades estão associadas com a limitação da mobilidade e a incapacidade funcional em pacientes com AR. O ICF demonstrou ser um indicador de comorbidade apropriado para determinar essa associação.

Abstract Objectives: To investigate the association of comorbidities with mobility limitation and functional disability in patients with rheumatoid arthritis (RA) and to identify which comorbidity indicator is the most appropriate to determine this association. Methods: Sixty RA patients were enrolled in a cross-sectional study for a period of 11 months. Comorbidities were assessed using three indicators: (i) the total number of comorbidities (NCom); (ii) the Charlson comorbidity index (CCI); and (iii) the functional comorbidity index (FCI). Disease activity was assessed using the Disease Activity Score 28 (DAS-28/ESR). Functional capacity was measured using the Health Assessment Questionnaire (HAQ), and mobility was measured using Timed Up and Go Test (TUG) and Five Times Sit To Stand Test (FTSTS). Statistical analysis was performed using a stepwise log-linear multiple regression with a significance level of 5%. Results: In the final model, only comorbidity (FCI) was associated with mobility limitation (FTSTS and TUG). The FCI score explained 19.1% of the variability of the FTSTS (coefficient of determination [R2] = 0.191) and 19.5% of the TUG variability (R2 = 0.195). With regard to functional disability (HAQ), the associated factors were comorbidity (FCI) and disease activity (DAS-28/ESR), which together explained 32.9% of the variability of the HAQ score (adjusted R2 = 0.329). Conclusion: Comorbidities were associated with mobility limitation and functional disability in RA patients. The FCI proved to be an appropriate comorbidity indicator to determine this association.

Translation, cultural adaptation and reproducibility of the Oxford Shoulder Score questionnaire for Brazil, among patients with rheumatoid arthritis / Tradução, adaptação cultural e reprodutibilidade do questionário Oxford Shoulder Score para o Brasil em pacientes com artrite reumatoide

ABSTRACT CONTEXT AND OBJECTIVE Although shoulder questionnaires validated for Brazil do exist, none of them are aimed at populations with rheumatic disease. We believe that the Oxford Shoulder Score (OSS) may be useful in this population. The objective of this study was to translate the OSS, adapt it to Brazilian culture and test its reproducibility. DESIGN AND SETTING Validation study conducted in university outpatient clinics. METHODS The OSS was translated into Portuguese by two English teachers and was then retranslated into English by two native English teachers. These translations were reviewed by a committee to establish the version of OSS-Brazil to be administered to 30 patients with rheumatoid arthritis (RA) and shoulder pain, in order to test the cultural adaptation. The validity and reproducibility was tested among another 30 patients with RA and shoulder pain, of both genders and aged 18 to 65 years. The internal consistency and reproducibility were analyzed. The following instruments were evaluated: OSS-Brazil; a numerical scale for shoulder pain; DASH; HAQ and SF-36. RESULTS The internal consistency was 0.957 and the intra and inter-rater reproducibility was 0.917 and 0.861, respectively. A high level of correlation was found between OSS-Brazil and the following: HAQ (-0.663), DASH (-0.731) and the SF-36 domains of functional capacity (0.589), physical aspects (0.507), pain (0.624), general state of health (0.444), vitality (0.634) and mental health (0.578). CONCLUSION OSS-Brazil was successfully translated and adapted, and this version exhibited good internal consistency, reliability and construct validity.

RESUMO CONTEXTO E OBJETIVO Apesar de existirem questionários de ombro validados para o Brasil, nenhum deles é voltado para a população com doenças reumáticas. Acreditamos que o Oxford Shoulder Score (OSS) possa ser útil nessa população. O objetivo deste estudo foi traduzir, adaptar à cultura brasileira e testar a reprodutibilidade do OSS. TIPO DE ESTUDO E LOCAL Estudo de validação realizado nos ambulatórios da universidade. MÉTODOS Foi realizada a tradução para o português por dois professores de inglês e depois a retradução para o inglês por dois professores nativos da língua inglesa. Essas traduções foram revisadas por um comitê para estabelecer a versão do OSS-Brasil, que foi aplicada em 30 pacientes com artrite reumatoide (AR) e dor no ombro para testar a adaptação cultural. A validade e a reprodutibilidade foram testadas em outros 30 pacientes com AR e dor no ombro de ambos os gêneros com idade entre 18 a 65 anos. Foram analisadas a consistência interna e a reprodutibilidade. Foram avaliados os seguintes instrumentos: OSS-Brasil; escala numérica de dor no ombro; DASH; HAQ e SF-36. RESULTADOS A consistência interna foi 0,957 e a reprodutibilidade intra-avaliador e interavaliador foi 0,917 e 0,861, respectivamente. Foi observado alto nível de correlação do OSS-Brasil com HAQ (-0,663), DASH (-0,731) e os domínios do SF-36: capacidade funcional (0,589); aspectos físicos (0,507); dor (0,624); estado geral de saúde (0,444); vitalidade (0,634); saúde mental (0,578). CONCLUSÃO O OSS-Brasil foi traduzido e adaptado com sucesso, com boa consistência interna, confiabilidade e validade de construção.

Coorte Sarar: atividade de doença, capacidade funcional e dano radiológico em pacientes com artrite reumatoide submetidos à artroplastia total de quadril e joelho / Sarar cohort: disease activity, functional capacity, and radiological damage in rheumatoid arthritis patients undergoing total hip and knee arthroplasty

RESUMOObjetivos:A coorte Sarar é composta por pacientes portadores de artrite reumatoide (AR) e artrite idiopática juvenil (AIJ) submetidos a artroplastias de quadril e joelho no hospital Sarah-Brasília. O objetivo deste estudo foi avaliar fatores clínicos e laboratoriais associados à atividade de doença, capacidade funcional e dano radiológico em pacientes com AR, participantes dessa coorte.Métodos:Estudo transversal, com coleta de dados em revisão de prontuário.Resultados:Foram incluídos 32 pacientes, com tempo médio de início da doença de 240 meses. Dezenove pacientes foram submetidos a ATJ e 17, a ATQ. Foi encontrada correlação positiva entre dose máxima de metotrexato (MTX) durante a evolução e Clinical Disease Activity Index (CDAI) (R = -0,46, p = 0,011) e negativa com Simplified Erosion and Narrowing Score (SENS) (R = -0,58, p = 0,004). Valores de SENS foram maiores nos pacientes com fator reumatoide (FR) (p = 0,005) e anticorpo antipeptídeo cíclico citrulinado 3 (anti-CCP3) positivo (p = 0,044), nos com maiores títulos de FR (p = 0,037) e anti-CCP3 (p = 0,025) e menores nos pacientes com história familiar de AR (p = 0,009). Valores de HAQ foram maiores em pacientes mais idosos (p = 0,031). Na regressão linear múltipla, somente “dose máxima de MTX” e “história familiar” permaneceram com associação significativa com SENS (r2= 0,73, p < 0,001 para ambas as variáveis). No modelo que avaliou CDAI, apenas “dose máxima de MTX” permaneceu com associação significativa (r2 = 0,35, p = 0,016).Conclusão:Na coorte Sarar, fatores clínicos e laboratoriais estiveram relacionados à atividade de doença, capacidade funcional e dano radiológico, semelhantemente a estudos que avaliaram pacientes com menor tempo de doença.

ABSTRACTObjectives:The Sarar cohort consists of patients with rheumatoid arthritis and juvenile idiopathic arthritis who underwent hip or knee arthroplasties at hospital SARAH-Brasília. The objective of this study was to evaluate clinical and laboratory factors associated with disease activity, functional capacity and radiological damage in rheumatoid arthritis patients, participants in this cohort.Methods:Cross-secal study, with data collection achieved from medical records review.Results:Thirty-two patients were included, with a mean time of disease onset of 240 months. Nineteen patients underwent total knee and 17 total hip arthroplasty. There was a positive correlation between maximum dose of methotrexate and Clinical Disease Activity Index (R = −0.46, p = 0.011), and a negative one with Simplified Erosion and Narrowing Score (R = −0.58, p= 0.004). Simplified Erosion and Narrowing Score values were higher in patients with rheumatoid factor (p = 0.005) and anti-cyclic citrullinated peptide antibody 3 positivity (p = 0.044), in those with higher rheumatoid factor (p = 0.037) and anti-cyclic citrullinated peptide antibody 3 (p = 0.025) titers, and lower in patients with family history of rheumatoid factor (p = 0.009). Health Assessment Questionnaire values were higher in older patients (p = 0.031). In multiple linear regression, only “maximum dose of methotrexate” and “family history” remained with significant association with Simplified Erosion and Narrowing Score (r2 = 0.73, p < 0.001 for both variables). In the model evaluating “Clinical Disease Activity Index” only “maximum dose of methotrexate” remained significantly associated (r2 = 0.35, p = 0.016).Conclusion:In the Sarar cohort, clinical and laboratory factors were related to disease activity, functional capacity and radiological damage, similar to studies evaluating patients with lower disease duration.

Avaliação da capacidade funcional em pacientes com artrite reumatoide: implicações para a recomendação de exercícios físicos / Assessment of functional capacity in patients with rheumatoid arthritis: implications for recommending exercise

A artrite reumatoide (AR) é uma doença autoimune que se caracteriza por poliartrite crônica simétrica, de grandes e pequenas articulações, e rigidez matinal que pode levar a comprometimento musculoesquelético, com impotência funcional. O conceito da funcionalidade diz respeito à capacidade de o indivíduo realizar atividades e tarefas da vida diária e cotidiana, de forma eficaz e independente. O objetivo desta revisão é familiarizar o reumatologista com o conceito de avaliação da capacidade funcional e os testes que podem ser aplicados nessa população, pois são passos importantes para uma prescrição adequada de exercícios físicos, A partir de testes funcionais já utilizados em população idosa, o Laboratório de Aptidão Física e Reumatologia - LAR - Brasília, que acompanha os pacientes da Coorte Brasília de Artrite Reumatoide Inicial, descreve neste artigo um protocolo de testes para avaliação da capacidade funcional para aplicação nos pacientes com diagnóstico de AR, incluindo a descrição dos seguintes testes: 1) Sentar e Alcançar; 2) Agilidade/Equilíbrio Dinâmico; 3) Dinamometria Manual; 4) Sentar e Levantar; 5) Rosca Bíceps e 6) Teste da Caminhada de Seis Minutos.

Rheumatoid arthritis (RA) is an autoimmune disease characterized by chronic symmetric polyarthritis of large and small joints and by morning stiffness that may lead to musculoskeletal impairment, with functional impotence. The concept of functionality relates to the ability of an individual to perform effectively and independently daily activities and tasks of everyday life. The aim of this review is to familiarize the rheumatologist with the concept of functional capacity evaluation and with the tests that can be applied in this population, as these are important steps for a proper exercise prescription. From functional tests already used in the elderly population, the Physical Fitness and Rheumatology Laboratory - LAR - Brasilia, which is accompanying patients from Brasilia Cohort of Early Rheumatoid Arthritis, describes in this article a protocol of tests to assess functional capacity for application in patients with RA, including the description of tests: 1) Sit and Reach; 2) Agility/Dynamic Balance; 3) Manual Dynamometry; 4) Sit Back and Lift; 5) Biceps Curl and 6) Six-minute Walk Test.

Fisiopatología, tratamiento y modelos experimentales de artritis reumatoide / Pathophysiology, treatment and experimental models of rheumatoid arthritis

La artritis reumatoide, poliartritis inflamatoria más común del adulto, que afecta cerca del 1 % de la población mundial, predomina más en mujeres que en hombres, se presenta con mayor frecuencia entre los 30 y 50 años de edad, y conlleva a una gran discapacidad del paciente. Se caracteriza por una sinovitis erosiva simétrica, en la cual el tejido conjuntivo prolifera (pannus), invade y erosiona el cartílago y el hueso de las articulaciones y, a veces, por una afectación multisistémica. En la mayoría de los pacientes la enfermedad sigue una evolución crónica fluctuante que, si no se trata, ocasiona una progresiva destrucción, deformidad e incapacidad de las articulaciones afectadas. La enfermedad evoluciona con cifras elevadas de factor reumatoideo y /o anticuerpos anti-citrulinas. Constituyen aspectos esenciales del tratamiento óptimo de la enfermedad: el diagnóstico diferencial precoz; el tratamiento inicial con antiinflamatorios no esteroideos; el uso de fármacos modificadores del curso de la enfermedad; el uso posible de glucocorticoides, a dosis bajas por vía oral, o en inyección intraarticular; la evaluación periódica de la adecuación del tratamiento (monitorización radiológica, sérica y funcional de la progresión de la enfermedad y de la toxicidad asociada al tratamiento), y las intervenciones de educación y rehabilitación del paciente. Para evaluar nuevas terapias para el tratamiento de la artritis reumatoide, los modelos más usados son: el de la artritis inducida por adyuvante en ratas y artritis inducida por colágeno en ratas y ratones. Otros modelos recientes muestran datos limitados. La eficacia de varios compuestos revela que su efecto terapéutico es más predictivo de eficacia clínica en humano cuando se estudian los modelos de artritis por adyuvante y por colágeno, que los datos de un solo modelo

The rheumatoid arthritis, is the inflammatory polyarthritis commonest in adults affecting about the 1 % of world population, more predominant in women than men and more frequent in those aged 30 and 50 and entails a high level of inability of patient. It is characterized by a symmetrical erosive synovitis with proliferation of conjunctival tissue (pannus), invading and eroding the cartilage and joint bones, and sometimes, by a multisystem affection. In most patients the disease follows a fluctuating chronic course, which it is not treated, provoke a progressive destruction, deformity and inability of involved joints. The disease evolves with high figures of rheumatoid factor and/or anti- citrulline antibodies. These are essential features of an optimal treatment of this entity include: early differential diagnosis, initial treatment with non-steroidal anti-inflammatory drugs (NSAIDs), the use of disease course modifying drugs, the potential use of oral low-dose glucocorticoid agents or intra-articular injections, and a periodical assessment of treatment fitting (radiological serum and functional monitoring of disease progression and of treatment-associated toxicity) and the educational and rehabilitations interventions of patient. To assess the new therapies for treatment of rheumatoid arthritis, the more uses models are: that of the arthritis induced by adjuvant drugs in rats and the arthritis induced by collagen in rats and mice. Other new models show limited data. Effectiveness of several compounds reveals that its therapeutic effect is more predictive of the clinical effect in the human being when models of arthritis due to adjuvant drugs and collagen than data from an only one model

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.

Artritis reumatoídea precoz / Early rheumatoid arthritis

Early rheumatoid arthritis, defined as being diagnosed between 6 months and 2 years of the onset of symptoms, is a picture that has gained great importance in recent times because its detection involves possibility of early aggressive treatment from the beginning, avoiding evolution to a chronic and disabling poli symptomtics. It is characterized by pain and stiffness polyarticular symmetrical what can be correlated with physical examination in the presence of arthritis and synovitis. In its management and diagnosis are keys specific examinations as rheumatoid factor and antibodies anti peptide cyclical citrulline, when both are positive allow confirm the diagnosis by 100% along with confer prognostic value, like the x-ray study of hands or feet to confirm the presence of erosions joints. The treatment includes drugs that influence the management of symptomatic patients and the early introduction of disease-modifying drugs, which gets a better prognosis in the medium and long term.

La artritis reumatoídea precoz, definida como aquella que se diagnostica entre 6 meses y 2 años del inicio de los síntomas, es un cuadro que ha adquirido gran importancia en el último tiempo debido a que su detección implica posibilidad de tratamiento agresivo precoz desde el inicio, evitando la evolución a una enfermedad crónica polisintomática e incapacitante. Se caracteriza por dolor poliarticular simétrico y rigidez lo que puede correlacionarse en el examen físico con presencia de artritis y sinovitis. En su manejo y diagnóstico son claves los exámenes específicos como el factor reumatoídeo y anticuerpos antipéptido cíclico citrulinado, que cuando ambos son positivos permiten confirmar el diagnóstico en un 100% junto con conferir valor pronóstico, al igual que el estudio radio lógico de manos o pies para confirmar la presencia de erosiones articulares. El tratamiento, incluye drogas que influyen en el manejo sintomático del paciente y la introducción precoz de fármacos modificadores de la enfermedad, con lo que se obtiene un mejor pronóstico en el mediano y largo plazo.

Brazilian version of the foot health status questionnaire (FHSQ-BR): cross-cultural adaptation and evaluation of measurement properties

OBJECTIVE: To conduct a cross-cultural adaptation of the Foot Health Status Questionnaire into Brazilian-Portuguese and to assess its measurement properties. INTRODUCTION: This instrument is an outcome measure with 10 domains with scores ranging from 0-100, worst to best, respectively. The translated instrument will improve the examinations and foot care of rheumatoid arthritis patients. METHODS: The questions were translated, back-translated, evaluated by a multidisciplinary committee and pre-tested (n = 40 rheumatoid arthritis subjects). The new version was submitted to a field test (n = 65) to evaluate measurement properties such as test-retest reliability, internal consistency and construct validity. The Health Assessment Questionnaire, Numeric Rating Scale for foot pain and Sharp/van der Heijde scores for foot X-rays were used to test the construct validity. RESULTS: The cross-cultural adaptation was completed with minor wording adaptations from the original instrument. The evaluation of measurement properties showed high reliability with low variation coefficients between interviews. The a-Cronbach coefficients varied from 0.468 to 0.855, while correlation to the Health Assessment Questionnaire and Numeric Rating Scale was statistically significant for five out of eight domains. DISCUSSION: Intra- and inter-observer correlations showed high reliability. Internal consistency coefficients were high for all domains, revealing higher values for less subjective domains. As for construct validity, each domain revealed correlations with a specific group of parameters according to what the domains intended to measure. CONCLUSION: The FHSQ was cross-culturally adapted, generating a reliable, consistent, and valid instrument that is useful for evaluating foot health in patients with rheumatoid arthritis.

Artrite reumatóide e aterosclerose / Rheumatoid arthritis and atherosclerosis

A artrite reumatóide (AR) é uma doença sistêmica inflamatória de etiologia auto-imune, caracterizada por sinovite crônica, simétrica e erosiva, principalmente de pequenas articulações. Associa-se ao aumento da prevalência de doença arterial coronariana, com alta mortalidade cardiovascular. Isto se deve a um processo de aterogênese acelerada, que não é explicado somente pela presença dos tradicionais fatores de risco como tabagismo, hipercolesterolemia, idade, diabetes melito e hipertensão arterial sistêmica. Níveis elevados de velocidade de sedimentação globular e proteína C reativa se correlacionam diretamente com o aumento de eventos cardiovasculares. Citocinas pró-inflamatórias contribuem com a disfunção endotelial, resistência insulínica, dislipidemia, efeitos pró-trombóticos e estresse oxidativo, que são fundamentais para o processo aterogênico. O conhecimento atual da etiopatogênese da aterosclerose na AR permite identificar fatores de risco implicados no processo aterosclerótico que podem ser melhor controlados, o que poderia resultar na diminuição do surgimento e na desaceleração deste processo e conseqüente redução da morbidade e mortalidade associadas à doença cardiovascular.

Rheumatoid arthritis is a systemic inflammatory autoimmune disease characterized by symmetric, erosive and chronic synovitis, especially of minor joints. It is associated with increased prevalence of cardiovascular disease and with high mortality. This occurs because of an accelerated atherogenic process, explained by traditional cardiovascular risk factors such as smoking, hypercholesterolemia, age, diabetes mellitus and systemic arterial hypertension. High levels of hemosedimentation velocity and C-reactive protein are directly correlated with increased cardiovascular events. Pro-inflammatory cytokines contribute with endothelial dysfunction, insulin resistance, dyslipidemia, prothrombotic effects and oxidative stress that are at the basis of the atherogenic process. Recent information about atherosclerosis in rheumatoid arthritis allows for identification of the risk factors involved in atherosclerosis that can be best controlled. This could result in a reduced manifestation of the process and its cutback, with consequent decrease of mortality and morbidity related to rheumatoid arthritis.

Artrite reumatóide / Rheumatoid Arthritis

Artrite reumatóide é uma poliartrite progressiva crônica, com achados sistêmicos variados, associada com substancial inaptidão e perdas econômicas. O tratamento bem sucedido visa limitar o dano à articulação e a perda funcional. Portanto, exige diagnóstico precoce e início oportuno de agentes modificadores da doença