2011 Portuguese recommendations for the use of biological therapies in patients with psoriatic arthritis.

OBJECTIVE: To develop recommendations for the treatment of psoriatic arthritis (PsA) with biological therapies, endorsed by the Portuguese Society of Rheumatology. METHODS: These treatment recommendations were formulated by Portuguese rheumatologists based on literature evidence and consensus opinion. A draft of the recommendations was first circulated to all Portuguese rheumatologists and their suggestions were incorporated in the draft. At a national meeting the recommendations were discussed and all attending rheumatologists voted on the level of agreement for each recommendation. A second draft was again circulated before publication. RESULTS: A consensus was achieved regarding the initiation, assessment of response and switching biological therapies in patients with PsA. Specific recommendations were developed for several disease domains: peripheral arthritis, axial disease, enthesitis and dactylitis. CONCLUSION: These recommendations may be used for guidance in deciding which patients with PsA should be treated with biological therapies. They cover a rapidly evolving area of therapeutic intervention. As more evidence becomes available and more biological therapies are licensed, these recommendations will have to be updated.

Portuguese guidelines for the use of biological agents in rheumatoid arthritis - October 2011 update.

The authors present the revised version of the Portuguese Society of Rheumatology (SPR) guidelines for the treatment of Rheumatoid Arthritis (RA) with biological therapies. In these guidelines the criteria for introduction and maintenance of biological agents are discussed as well as the contraindications and procedures in the case of nonresponders. Biological treatment (with a tumour necrosis factor antagonist, abatacept or tocilizumab) should be considered in RA patients with a disease activity score 28 (DAS 28) equal to or greater than 3.2 despite treatment with at least 20mg-weekly-dose of methotrexate (MTX) for at least 3 months or, if such treatment is not possible, after 3 months of other conventional disease modifying drug or combination therapy. A DAS 28 score between 2.6 and 3.2 with a significant functional or radiological deterioration under treatment with conventional regimens could also constitute an indication for biological treatment. The treatment goal should be remission or, if that is not achievable, at least a low disease activity, defined by a DAS28 lower than 3.2, without significative functional or radiological worsening. The response criteria, at the end of the first 3 months of treatment, are a decrease of at least 0.6 in the DAS28 score. After 6 months of treatment res­ponse criteria is defined as a decrease greater than 1.2 in the DAS28 score. Non-responders, in accordance to the Rheumatologist's clinical opinion, should try a switch to another biological agent (tumour necrosis factor antagonist, abatacept, rituximab or tocilizumab).

Tocilizumab - a new step in rheumatoid arthritis treatment.

Rheumatoid Arthritis is a chronic systemic inflammatory disease characterized by joint pain, stiffness and swelling, with progressive destruction of small joints of the hands and feet. Methotrexate remains the most commonly used therapy and has been the recommended standard against which new drugs should be evaluated and, to date, there is limited evidence that monotherapy with other treatments is superior to MTX. The introduction of biologic agents, such as TNFα-antagonists, represented an advance in the treatment of RA. However, there are still patients with no or inadequate response, patients in whom responsiveness to treatment is lost over time, and patients in whom safety issues may develop. Thus, patients may benefit from treatment with newer biologic agents with a different mechanism of action. Tocilizumab is an IL-6 receptor inhibitor which shows significant (and rapid) clinical efficacy in the treatment of Rheumatoid Arthritis patients, as assessed by ACR responses and DAS remission rates, with an acceptable safety profile.

[Hospitalization of patients with systemic sclerosis: characteristics of a population]. / Hospitalização de doentes com Esclerose Sistémica: caracterização de uma população.

OBJECTIVES: The authors propose to characterize a population in the area of reference of the Hospital de São João (HSJ) in Oporto, with severe manifestations of Systemic Sclerosis (SS), and need of hospitalization in this institution. Given the lack of data referring to SS in inpatient set (and its inexistence in Portugal), this elements may obviate a parallelism with populations described in other countries, or even identify specificities of this population, that in the future, can be important to study measures directed to optimizing their care, in Portugal. METHODS: The cases were collected from a computerized database containing all discharge registers of the Rheumatology Department of HSJ from 1/1/2003 to 31/12/2008 (6 years), diagnosed of SS (ICD9-CM code of 710,1). All the 40 inpatient records, reporting to 25 patients, were submitted to medical review, and for each of them, fulfilled a clinical protocol, focusing on multiple epidemiological and clinical characteristics, relative to evolution, manifestations and therapies, reason and outcome of hospitalization, and co-morbidities. RESULTS: The characteristics found in this population approach, globally, to the ones described previously, in other countries. However, the prevalence and severity of the cutaneous lesions suggest a higher impact of the cutaneous attainment in this casuistic. It would be of all interest to develop studies that could properly evaluate this observation. DISCUSSION: It is essential to profoundly know the disease, and the individual and population particularities, so we can act adequately. This study may have put on evidence some problems that, in the future, will probably have major impact on personal life and public health care resources in Portugal. They reflect direct and indirect costs, explained by the high rate of recurrent and long hospitalizations, making use of more expensive diagnostic tests and treatments, and the risk of higher morbidity. Early intervention may be modifying of the natural course of the disease in the long term.

Fatores de risco cardiovascular em estudantes de graduação da Universidade Federal de Viçosa-MG / Cardiovascular risk factors in students of Viçosa Federal University-MG

Objetivo - O desenvolvimento de doenças cardiovasculares (DCV) pode ser ampliado por fatores como hipertensão arterial, tabagismo, sedentarismo, obesidade, estresse e dislipidemias. A identificação destes fatores torna-se importante para melhor entendimento dos mecanismos de desenvolvimento de DCV em nossa população. O presente estudo analisou a prevalência de tabagismo, sedentarismo, história familiar para DCV, hipertensão arterial e obesidade em indivíduos supostamente saudáveis, estudantes de graduação da Universidade Federal de Viçosa (UFV). Métodos - Foi conduzido um estudo observacional descritivo do tipo transversal. Participaram do estudo 167 estudantes, sendo 43,1% do sexo masculino, com média de idade de 20,5 ± 1,8 anos. Os estudantes preencheram um questionário contemplando dados demográficos, antecedente pessoal e familiar de DCV, além de hábitos e estilo de vida. Os critérios para a detecção dos fatores de risco tiveram como base as recomendações da Sociedade Brasileira de Cardiologia .Resultados - Foram observadas prevalências de 1,8%, 41,3%, 68,9%, 1,2% e 1,2% para tabagismo, sedentarismo, história familiar, hipertensão arterial e obesidade, respectivamente. A prevalência de sedentarismo foi significativamente (p<0,01) mais elevada em mulheres (51,6%) do que em homens (27,8%). Foram observadas correlações significativas entre algumas das variáveis estudadas.Conclusão - Os fatores de risco mais prevalentes foram história familiar e sedentarismo, um destes modificáveis. O achado mais importante deste estudo foi a correlação negativa entre tabagismo e história familiar, sugerindo que os indivíduos que apresentam história familiar para DCV tendem, em geral, a ser não-tabagistas. Apesar de a correlação ser apenas de 20%, o estudo pode apontar novos caminhos de investigação.

Objective - Cardiovascular disesase (CVD) development can be enlarged by factors such as hypertension, smoking, physical inactivity, obesity, stress, and dyslipidemia. The identification of these factors becomes important to better understand the mechanisms of CVD development in our population. This study aimed to evaluate the prevalence of smoking, sedentary lifestyle, family history of CVD, hypertension and obesity in supposedly health, graduate of a public University of Minas Gerais. Methods - This is a descriptive cross-sectional study. We included 167 students, with 43.1% male, mean age of 20.5 ± 1.8 years. Students completed a questionnaire covering demographics, personal and family history of CVD, as well as habits and lifestyle. The criteria for the detection of risk factors were based on the recommendations of the Brazilian Society of Cardiology. Results - Prevalence rates were 1.8%, 41.3%, 68.9%, 1.2%and 1.2% for smoking, sedentary lifestyle, family history, hypertension and obesity, respectively. The prevalence of sedentary lifestyle was significantly higher (p<0.01) in women (51.6%) when compared with men (27.8%). There were significant correlations between some of the variables. Conclusion - The most prevalent risk factors were family history and sedentary lifestyle, the last modifiable. The most important finding of this study was the negative correlation between smoking and family history, suggesting that individuals who have a family history for CVD tend generally to be non-smokers. Although the correlation is only 20%, the study may point to new research strategies.