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Duarte AC, Fernandes BM, Bernardes M, Tenazinha C, Martins P, Mazeda C, Mendes B, Guimarães F, Gago L, Correia AM, Valido A, Silva L, Brites L, Meirinhos T, Araújo F, Nero P, Cruz M, Teixeira L, Santos MJ. Lung disease in rheumatoid arthritis: Results from a national cohort. Pulmonology 2024; 30:87-89. [PMID: 37394340 DOI: 10.1016/j.pulmoe.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/19/2023] [Accepted: 05/24/2023] [Indexed: 07/04/2023] Open
Affiliation(s)
- A C Duarte
- Serviço de Reumatologia, Hospital Garcia de Orta, Avenida Torrado da Silva, 2805-267 Almada, Portugal.
| | - B M Fernandes
- Serviço de Reumatologia, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - M Bernardes
- Serviço de Reumatologia, Centro Hospitalar Universitário São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal; Departamento de Medicina, Faculdade de Medicina, Universidade do Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - C Tenazinha
- Serviço de Reumatologia e Doenças Ósseas Metabólicas, Centro Hospitalar Lisboa Norte, Avenida Professor Egas Moniz, 1649-035 Lisboa, Portugal; Unidade de Investigação em Reumatologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
| | - P Martins
- Serviço de Reumatologia e Doenças Ósseas Metabólicas, Centro Hospitalar Lisboa Norte, Avenida Professor Egas Moniz, 1649-035 Lisboa, Portugal; Unidade de Investigação em Reumatologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
| | - C Mazeda
- Serviço de Reumatologia, Centro Hospitalar do Baixo Vouga, Avenida Artur Ravara, 3814-501 Aveiro, Portugal
| | - B Mendes
- Serviço de Reumatologia, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, 3004-561 Coimbra, Portugal
| | - F Guimarães
- Serviço de Reumatologia, Unidade Local de Saúde do Alto Minho, Rua Conde de Bertiandos, 4990-041 Ponte de Lima, Portugal
| | - L Gago
- Serviço de Reumatologia, Centro Hospitalar de Lisboa Ocidental, Hospital Egas Moniz, Rua da Junqueira 126, 1349-019 Lisboa, Portugal
| | - A M Correia
- Serviço de Reumatologia, Hospital de Braga, Sete Fontes - São Victor, 4710-243 Braga, Portugal
| | - A Valido
- Serviço de Reumatologia, Unidade Local de Saúde do Litoral Alentejano, Monte do Gilbardinho, 7540-230 Santiago do Cacém, Portugal
| | - L Silva
- Serviço de Reumatologia, Centro Hospitalar de Trás-os-Montes e Alto Douro, Avenida Noruega/Lordelo, 5000-508 Vila Rela, Portugal
| | - L Brites
- Serviço de Reumatologia, Centro Hospitalar de Leiria, Rua de Santo André, 2410-197 Leiria, Portugal
| | - T Meirinhos
- Serviço de Reumatologia, Centro Hospitalar do Tâmega e Sousa, Av. do Hospital Padre Américo 210, 4564-007 Guilhufe, Portugal
| | - F Araújo
- Serviço de Reumatologia, Hospital Ortopédico de Sant`Ana, Rua de Benguela 2779-501 Parede, Portugal
| | - P Nero
- Serviço de Reumatologia, Hospital CUF Descobertas, Rua Mário Botas, 1998-018 Lisboa, Portugal
| | - M Cruz
- Serviço de Reumatologia, Centro Hospitalar de S. Francisco, Rua Fonte Cabeço d'El Rei 15, Leiria, Portugal
| | - L Teixeira
- Serviço de Reumatologia, Hospital Central do Funchal, Avenida Luís de Camões, nº 57 9004-514 Funchal, Portugal
| | - M J Santos
- Serviço de Reumatologia, Hospital Garcia de Orta, Avenida Torrado da Silva, 2805-267 Almada, Portugal; Unidade de Investigação em Reumatologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
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Guimarães F, Ferreira M, Soares C, Parente H, Matos CO, Costa R, Oliveira D, Abreu C, Teixeira R, Azevedo S, Dias JM, Araújo F, Ferreira CC, Santos FC, Fontes T, Faria M, Silva L, Chícharo A, Nero P, Santos H, Sepriano A, Santos-Faria D, Tavares-Costa J. Cycling versus swapping strategies in psoriatic arthritis: results from the rheumatic diseases Portuguese register. ARP Rheumatol 2023:AO230010. [PMID: 37728133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
OBJECTIVE To compare the 2-year retention rate between a second tumor necrosis factor alpha inhibitor (TNFi) and secukinumab (SEK) or ustekinumab (UST), in Psoriatic Arthritis (PsA) patients with previous inadequate response to their first TNFi. METHODS Prospective longitudinal cohort study with a follow-up period of 2 years using the Nationwide Portuguese Reuma.pt database. Patients with a clinical diagnosis of PsA who also fulfill the CASPAR classification criteria, with previous treatment failure to a first-line TNFi and having started a second biotechnological drug (TNFi, SEK or UST) were included. The Cycling group was defined as switching from a first TNFi to a second TNFi, and the Swapping group as switching from a first TNFi to SEK or UST. Sociodemographic data, disease characteristics, disease activity scores and physical function at baseline and after 6, 12 and 24 months were recorded. Cox-proportional hazards regression was used to compare retention rates between Cycling and Swapping groups. To obtain a predictor model of 2-year discontinuation, a multivariable Cox regression model was performed. RESULTS In total, 439 patients were included, 58% were female, with a mean age (standard deviation) of 49 (12) years. Globally, 75.6% initiated a second TNFi (Cycling group), and 24.4% started SEK/UST (Swapping group). The retention rates after 6, 12 and 24 months were 72%/66%/59% in the Cycling group; and 77%/66%/59% in the Swapping group. There were no significant differences in retention rates between both strategies (HR: 1.06, 95% CI 0.72-1.16). After 2 years of follow-up, 34.4% of patients discontinued their second biologic, mainly due to inefficacy (72.8%), with no differences found between groups. Baseline treatment with glucocorticoids was the only predictor of discontinuation after 2 years of follow-up (HR:1.668, 95% CI 1.154-2.409). CONCLUSIONS After failure of a first TNF inhibitor, Cycling and Swapping strategies result in similar retention rates suggesting that both are acceptable in the management of patients with psoriatic arthritis.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Lígia Silva
- Centro Hospitalar Trás-os-Montes e Alto Douro
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Mendes-Bastos P, Nero P, Ferreira P, Bernardo A, Barcelos A, Pimentel Dos Santos FM, Sousa J, Loureiro MM, Magina S, Alpalhão M, Antunes J, Vieira-Sousa E. A multidisciplinary approach in psoriatic disease: the different models of dermatology-rheumatology collaborations in Portugal. Acta Reumatol Port 2021; 46:333-341. [PMID: 34962248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Psoriatic disease (Psoriasis and Psoriatic Arthritis, PsD) is a condition that affects the skin, the musculoskeletal system, and beyond, impairing patients' quality of life. A multidisciplinary approach of combined dermatology-rheumatology clinics is recommended and valuable to respond to PsD diagnosis, management, and treatment challenges. In Portugal, five Hospitals have implemented a multidisciplinary clinic for PsD assessment. This report aims to describe how these multidisciplinary clinics were developed, their characteristics, and the main obstacles to their implementation. Although the different hospitals adopted distinct functional models, a consensus respecting the minimal core set assessment for PsD in Multidisciplinary Dermatology/Rheumatology Clinics should comprise all disease manifestations and, if possible, quality of life. The main objective of these clinics is to achieve remission/minimal disease activity. Limitations to these multidisciplinary approaches are discussed, namely financial, time management, and human resources obstacles that can be a handicap in their implementation, despite the benefits of PsD integrated care.
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Affiliation(s)
| | - Patrícia Nero
- Serviço de Reumatologia, Hospital CUF Descobertas, Lisboa, Portugal
| | - Paulo Ferreira
- Centro de Dermatologia, Hospital CUF Descobertas, Lisboa, Portugal
| | - Alexandra Bernardo
- Serviço de Reumatologia, Centro Hospitalar Universitário de São João, Porto
| | - Anabela Barcelos
- Serviço de Reumatologia, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal; NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Portugal; Comprehensive Health Research Center (CHRC)
| | - Fernando M Pimentel Dos Santos
- Serviço de Reumatologia, Centro Hospitalar de Lisboa Ocidental, Hospital de Egas Moniz, Lisboa, Portugal; NOVA Medical School|Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, Portugal
| | - João Sousa
- Serviço de Dermatologia, Centro Hospitalar de Lisboa Ocidental, Hospital de Egas Moniz, Lisboa, Portugal
| | | | - Sofia Magina
- Serviço de Dermatologia, Centro Hospitalar Universitário de São João, Porto, Portugal; Departamento de Farmacologia e Terapêutica, Faculdade de Medicina, Universidade do Porto, Portugal
| | - Miguel Alpalhão
- Serviço de Reumatologia, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, Lisboa, Portugal
| | - Joana Antunes
- Serviço de Reumatologia, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, Lisboa, Portugal
| | - Elsa Vieira-Sousa
- Serviço de Reumatologia, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, Lisboa, Portugal; Unidade de Investigação Reumatologia, Instituto de Medicina Molecular João Lobo Antunes, Faculdade Medicina Universidade de Lisboa
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Macieira C, Barreira SC, Cunha-Miranda L, Nero P, Laires PA, Bogas M, Farinha S, Freitas I, Lucas P, Sousa J, Narciso L, Mateus E, Canas da Silva J, Fonseca JE, Study Group RS. Rheuma SPACE - Standard Practice Aiming Clinical Excellence: the first Portuguese Rheumatology Department evaluation. Acta Reumatol Port 2021; 46:140-155. [PMID: 34243183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The Portuguese Rheumatology Society (SPR) embraced quality as a major goal and launched, in early 2015, a program to aim for excellence in global clinical care: Rheuma SPACE - Standard Practice Aiming Clinical Excellence. Evaluating daily reality is the first step in a quality development timeline, ultimately contributing for health gains. Herein we describe the results of the evaluation of the quality indicators defined for this project and the improvement strategies identified. The Rheuma SPACE project included three phases: 1) establishing a set of quality indicators and an excellence quality model; 2) assessment of the current care at Rheumatology departments concerning the defined quality indicators in the scope of the excellence model; and 3) elaboration of global and customized reports for each participating Rheumatology department, resulting in the identification of improvement opportunities. Ten Rheumatology departments, countrywide, including larger and smaller institutions, were asked to participate in Rheuma SPACE. This resulted in an individual report for each department along with global benchmarking practices analysis. Furthermore, a list of improvement initiatives was developed. We concluded that departments lack physicians and need exclusively dedicated nurses. Time dedicated to research and audit activities should be specifically allocated. Internal contracting is well established, and professionals are committed to targets. Processes are still suboptimal, needing standardization of triage criteria, more frequent follow-up, as well as better medical records and multidisciplinary coverage. Regarding outcomes, patients are satisfied with the provided care and professionals with the working environment. However, department facilities for the former, and career related aspects, for the latter should improve. With this innovative study conducted in Portugal we expect to have enlightened tailored opportunities for improvement, ensure patient-focused practices and be able to define the indispensable quality requirements for excellence.
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Affiliation(s)
- Carla Macieira
- Serviço de Reumatologia, Centro Hospitalar Universitário de Lisboa Norte, Centro Académico de Medicina de Lisboa
| | - Sofia Carvalho Barreira
- Serviço de Reumatologia, Centro Hospitalar Universitário de Lisboa Norte; Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Centro Académico de Medicina de Lisboa
| | | | | | - Pedro A Laires
- Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa
| | | | | | | | | | | | - Lurdes Narciso
- Associação Portuguesa de Profissionais de Saúde em Reumatologia
| | - Elsa Mateus
- Liga Portuguesa Contra as Doenças Reumáticas
| | | | - João Eurico Fonseca
- Serviço de Reumatologia, Centro Hospitalar Universitário de Lisboa Norte; Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Centro Académico de Medicina de Lisboa
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Macieira C, Cunha-Miranda L, Nero P, Laires P, Bogas M, Farinha S, Freitas I, Lucas P, Sousa J, Narciso L, Mateus E, Canas da Silva J, Fonseca JE, Study Group RS. Rheuma SPACE - Standard Practice Aiming Clinical Excellence: description of the methodological approach. Acta Reumatol Port 2019:190098. [PMID: 31543508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Quality of care is a key component of the right to health, and the route to equity and dignity. The aim of the project Rheuma SPACE - Standard Practice Aiming Clinical Excellence was to develop a set of quality indicators focused in rheumatoid arthritis care and apply them to rheumatology departments of the Portuguese National Health Service in order to benchmark the care for these patients. This article details the methodology that was applied. METHODOLOGY This was a single country, three-phase project, each phase comprising multiple steps. The first step defined quality indicators and the excellence quality model to be used. It involved a literature search for international benchmarking of quality of care initiatives and indicators, followed by a pre-selection of an initial set of indicators. The set of indicators was latter on narrowed after an online Delphi round with all Portuguese rheumatologists and two consensus meetings involving the study task force. A set of 26 quality indicators was defined, within the three classic Donabedian dimensions of healthcare quality: Structure (9), Processes (11), and Outcomes (6). These indicators cover eleven domains of quality of care: personnel and organizational structure, training and research, facilities, equipment and information technology, budgeting and financial resources, access to care, clinical records, patient communication, multidisciplinary management, clinical outcomes, and patient and personnel satisfaction. Decision on quality and excellence thresholds for each of the 26 quality indicators was agreed upon a consensus meeting gathering principal investigators of the eight Rheumatology Departments that decided to participate, task force core set members and invited representatives of all Portuguese Departments/Units. Rheumatoid arthritis was the chosen disease model of the project based on the reliability of the outcomes to be measured in the context of this condition. The second step was the assessment of the participating Rheumatology Departments. During eighteen months, research teams applied the 26 quality indicators to their own Departments. The third step comprised data analysis and the elaboration of individual Rheumatology Department reports and of a global public report. RESULTS Eight Departments, comprising 80 specialists, 20 residents and 30 nurses, covering 5.904.080 inhabitants, underwent quality evaluation. More than one thousand patients (1,325) and 113 health professionals' surveys were analysed, as well as data from 570 clinical records and 3,927 medical appointments on rheumatoid arthritis patients. DISCUSSION 26 quality indicators were used for the first evaluation of Portuguese Rheumatology Departments, turning Rheuma SPACE into a pioneer project. Data analysis and benchmarking will be the subject of a further publication.
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Affiliation(s)
- Carla Macieira
- Hospital de Santa Maria - Centro Hospitalar Universitário de Lisboa Norte, Centro Académico de Medicina de Lisboa
| | | | | | - Pedro Laires
- Merck Sharp & Dome, since 2017 Novartis Farma and Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa
| | | | | | | | - Pedro Lucas
- IQVIA (IMS Health and Quintiles are now IQVIA)
| | - Joana Sousa
- IQVIA (IMS Health and Quintiles are now IQVIA)
| | - Lurdes Narciso
- Associação Portuguesa de Profissionais de Saúde em Reumatologia
| | - Elsa Mateus
- Liga Portuguesa Contra as Doenças Reumáticas
| | | | - João Eurico Fonseca
- Hospital de Santa Maria - Centro Hospitalar Universitário de Lisboa Norte; Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa
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Vieira-Sousa E, Eusébio M, Ávila-Ribeiro P, Khmelinskii N, Cruz-Machado R, Rocha TM, Bernardes M, Santos-Faria D, Silva JL, Santos H, Miguel C, Carvalho P, Costa T, Duarte AC, Meirinhos T, Nero P, Fonseca JE, Santos MJ. Real-world Longterm Effectiveness of Tumor Necrosis Factor Inhibitors in Psoriatic Arthritis Patients from the Rheumatic Diseases Portuguese Register. J Rheumatol 2019; 47:690-700. [DOI: 10.3899/jrheum.181272] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2019] [Indexed: 01/30/2023]
Abstract
Objective.To assess longterm effectiveness of tumor necrosis factor inhibitors (TNFi) in patients with psoriatic arthritis (PsA) registered in the Rheumatic Diseases Portuguese Register, exposed to at least 1 TNFi, prospectively followed between 2001 and 2017.Methods.Kaplan-Meier analysis was performed for first-, second-, and third-line TNFi. Responses included European League Against Rheumatism (EULAR) criteria, Disease Activity Index for Psoriatic Arthritis (DAPSA), minimal disease activity (MDA), and Ankylosing Spondylitis Disease Activity Score (ASDAS) at 3 and 6 months. Baseline predictors of discontinuation and response were studied using Cox and multivariable multinomial/logistic regression models.Results.The 750 patients with PsA showed drug retention of 4.1 ± 3.4 years (followup 5.8 ± 3.8 yrs) for first TNFi. Switching to a second (189 patients) or third (50 patients) TNFi further decreased survival by 1.1 years. Female sex, higher baseline 28-joint count Disease Activity Score, and infliximab were predictors of first TNFi discontinuation. After 6 months of the first TNFi, 48.7% of patients achieved a good EULAR criteria response and 20.9% were in DAPSA remission. There were 11.4% in MDA, and 56.4% had a good ASDAS. Responses to the second TNFi were significantly inferior compared to responses to the first TNFi. Female sex and higher baseline Health Assessment Questionnaire–Disability Index were negatively associated with good EULAR response at 3 months, and obesity decreased the chance of response at 6 months.Conclusion.In this study, switching to a second or third TNFi was associated with significantly lower drug survival and response rates for patients with axial and peripheral PsA subtypes. More successful therapeutic approaches will require considering the effect of sex and obesity on TNFi effectiveness.
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Santos H, Eusébio M, Borges J, Gonçalves D, Ávila-Ribeiro P, Faria DS, Lopes C, Rovisco J, Águeda A, Nero P, Valente P, Cravo AR, Santos MJ. Effectiveness of early adalimumab therapy in psoriatic arthritis patients from Reuma.pt - EARLY PsA. Acta Reumatol Port 2017; 42:287-299. [PMID: 29342473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Objective To compare outcomes in psoriatic arthritis (PsA) patients initiating adalimumab (ADA), with short- and long-term disease duration and to evaluate the potential effect of concomitant conventional synthetic disease-modifying antirheumatic drugs (csDMARD) or glucocorticoids. Methods Analyses included adult PsA patients registered in the Rheumatic Diseases Portuguese Register (Reuma.pt) between June 2008-June 2016 who received ADA for ≥3 months. Psoriatic Arthritis Response Criteria (PsARC) response, tender and swollen joint count, inflammatory parameters, patient (PtGA) and physician global assessment (PhGA), Disease Activity Score-28 joints (DAS28), and Health Assessment Questionnaire Disability Index (HAQ-DI) were compared between patients with <5 years of disease (early PsA) and those with ≥5 years of disease duration (late PsA). Time to achieving PsARC response was estimated using the Kaplan-Meier method. Results Of 135 PsA patients treated with ADA, 126 had information on disease duration (earlyPsA, n=41). PsARC response was achieved by 72.9% of the patients (88.0% early PsA vs 62.2% late PsA; P=0.022) after 3 months and by 85.4% after 24 months (100% early PsA vs 75.9% late PsA; P=0.044). Early PsA patients achieved significantly less painful joints (2.7 vs 6.7, p=0.006), lower mean C-reactive protein (0.5 mg/dL vs 1.3 mg/dL; P=0.011), and PhGA (18.3 vs 28.1; P=0.020) at 3 months. In the long term, early PsA patients also had fewer swollen joints (0.3 vs 1.7; P=0.030) and lower PhGA (6.3 vs 21.9; P<0.001), C-reactive protein (0.4 mg/dL vs 1.0 mg/dL; P=0.026), and DAS28 (2.2 vs 3.2; P=0.030). HAQ-DI decreased in both groups reaching a mean value at 24 months of 0.4 and 0.8 (P=ns) in early and late PsA, respectively. Early PsA patients obtained PsARC response more rapidly than late PsA (3.8 and 7.4 months, respectively; P=0.008). Concomitant csDMARDs showed clinical benefit (2-year PsARC response, 88.3% vs 60.0%; P=0.044). Concomitant glucocorticoids had no effect on PsARC response over 2 years of follow-up. Persistence on ADA was similar in both groups. Conclusion Early PsA patients had a greater chance of improvement after ADA therapy and better functional outcome, and achieved PsARC response more rapidly than late PsA. In this cohort, comedication with csDMARDs was beneficial over 2 years.
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Carvalho PD, Duarte C, Vieira-Sousa E, Cunha-Miranda L, Avila-Ribeiro P, Santos H, Bernardes M, Santos MJ, Cerqueira M, Mateus M, Nero P, Águeda A, Silva JAPD, Machado P. Predictors of response to TNF blockers in patients with polyarticular psoriatic arthritis. Acta Reumatol Port 2017; 42:55-65. [PMID: 27750274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Psoriatic arthritis (PsA) is a chronic inflammatory rheumatic disease with a broad clinical spectrum. PsA can affect the axial skeleton, peripheral joints, entheses, synovial sheaths of tendons, skin, nails and extra-articular organs. Tumour necrosis factor alpha blockers (TNF blockers) were a breakthrough development in the treatment of PsA. Identifying predictors of response to biological therapies in patients with PsA is of utmost importance, especially in view of the costs and potential side effects of these agents. The aims of the present study were to determine baseline predictive factors of response to biological therapies, at 3 and 6 months, in PsA patients with polyarticular involvement (with or without axial involvement). Data were collected from the Rheumatic Diseases Portuguese Register (Reuma.pt). Eligible patients had to be anti-TNF-naive at baseline and to have at least 3 months of follow-up after the beginning of TNF blocker therapy. Only patients with information on at least one of the response measures (at 3 or 6 months of follow-up) were included in the analysis. Univariable logistic regression analysis of potential baseline predictors of European League Against Rheumatism (EULAR) good clinical response, EULAR good/moderate response, 28-joint Disease Activity Score with three variables including the erythrocyte sedimentation rate (DAS28-3V-ESR) remission and Health Assessment Questionnaire (HAQ) response were performed. Multivariable logistic regression using a forward selection procedure was used until the best-fit model was obtained, taking confounding effects into account. A total of 180 patients were eligible for the study (mean age 52 years, 54% women). In multivariable analysis at 3 months, females were less likely to attain a good EULAR response [OR=0.082 (95% CI=0.024, 0.278)], a DAS28-3V-ESR remission [OR=0.083 (95% CI=0.017, 0.416)], a moderate or good EULAR response [OR=0.091 (95% CI=0.011, 0.091)] and a HAQ response [OR=0.074 (95% CI=0.009, 0.608)]. At 6 months, female gender was also less likely to achieve a good EULAR response [OR=0.060 (95% CI=0.011, 0.325)], DAS28-3V-ESR remission [OR=0.060 (95% CI=0.012, 0.297)], and a HAQ response [OR=0.138 (95% CI= 0.029, 0.654)]. In this study we found that gender was the most consistent predictor of response to TNF blocker therapy in patients with polyarticular PsA, with females having a lower probability of response compared to males. These findings suggest that gender-related biochemical, hormonal and psychological factors could play an important role in the response to TNF blocker therapy in PsA.
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Sousa S, Gonçalves MJ, Inês LS, Eugénio G, Jesus D, Fernandes S, Terroso G, Romão VC, Cerqueira M, Raposo A, Couto M, Nero P, Sequeira G, Nóvoa T, Melo Gomes JA, da Silva JC, Costa L, Macieira C, Silva C, Silva JAP, Canhão H, Santos MJ. Clinical features and long-term outcomes of systemic lupus erythematosus: comparative data of childhood, adult and late-onset disease in a national register. Rheumatol Int 2016; 36:955-60. [PMID: 26979603 DOI: 10.1007/s00296-016-3450-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 02/22/2016] [Indexed: 11/28/2022]
Abstract
Systemic lupus erythematosus (SLE) affects predominantly women at reproductive age but may present at any age. Age at disease onset has a modulating effect on presentation and course of disease, but controversies persist regarding its impact on long-term outcome. Our aims were to characterize clinical features, co-morbidities and cumulative damage in childhood-onset, adult-onset and late-onset SLE. Patients with childhood-onset SLE fulfilling ACR 1997 criteria were identified in a nationwide register-Reuma.pt/SLE (N = 89) and compared with adult-onset and late-onset counterparts matched 1:1:1 for disease duration. 267 SLE patients with mean disease duration of 11.9 ± 9.3 years were analyzed. Skin (62 %), kidney (58 %), neurological (11 %) and hematologic involvement (76 %) were significantly more common in childhood-onset SLE and disease activity was higher in this subset than in adult- and late-onset disease (SLEDAI-2K 3.4 ± 3.8 vs. 2.2 ± 2.7 vs. 1.6 ± 2.8, respectively; p = 0.004). Also, more childhood-onset patients received cyclophosphamide (10 %) and mycophenolate mofetil (34 %). A greater proportion of women (96 %), prevalence of arthritis (89 %) and anti-SSA antibodies (34 %) were noted in the adult-onset group. There was a significant delay in the diagnosis of SLE in older ages. Co-morbidities such as hypertension, diabetes and thyroid disease were significantly more frequent in late-onset SLE, as well as the presence of irreversible damage evaluated by the SLICC/ACR damage index (20 vs. 26 vs. 40 %; p < 0.001). Greater organ involvement as well as the frequent need for immunosuppressants supports the concept of childhood-onset being a more severe disease. In contrast, disease onset is more indolent but co-morbidity burden and irreversible damage are greater in late-onset SLE, which may have implications for patients' management.
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Affiliation(s)
- S Sousa
- Hospital Garcia de Orta, Almada, Portugal.
| | - M J Gonçalves
- Hospital de Santa Maria, Lisbon, Portugal.,Rheumatology Research Unit, Instituto de Medicina Molecular, Lisbon, Portugal
| | - L S Inês
- Hospitais da Universidade de Coimbra, Coimbra, Portugal.,School of Health Sciences, University of Beira Interior, Covilhã, Portugal
| | - G Eugénio
- Hospitais da Universidade de Coimbra, Coimbra, Portugal
| | - D Jesus
- Hospitais da Universidade de Coimbra, Coimbra, Portugal
| | - S Fernandes
- Instituto Português de Reumatologia, Lisbon, Portugal
| | - G Terroso
- Centro Hospitalar de São João, Porto, Portugal
| | - V C Romão
- Hospital de Santa Maria, Lisbon, Portugal.,Rheumatology Research Unit, Instituto de Medicina Molecular, Lisbon, Portugal
| | - M Cerqueira
- Hospital Conde de Bertiandos, Ponte de Lima, Portugal
| | - A Raposo
- Hospital Conde de Bertiandos, Ponte de Lima, Portugal
| | - M Couto
- Hospital de Viseu, Viseu, Portugal
| | - P Nero
- Hospital Egas Moniz, Lisbon, Portugal
| | - G Sequeira
- Centro Hospitalar de Faro, Faro, Portugal
| | - T Nóvoa
- Hospital Divino Espírito Santo, Ponta Delgada, Portugal
| | | | | | - L Costa
- Centro Hospitalar de São João, Porto, Portugal
| | - C Macieira
- Hospital de Santa Maria, Lisbon, Portugal
| | - C Silva
- Instituto Português de Reumatologia, Lisbon, Portugal
| | - J A P Silva
- Hospitais da Universidade de Coimbra, Coimbra, Portugal
| | - H Canhão
- Hospital de Santa Maria, Lisbon, Portugal.,Rheumatology Research Unit, Instituto de Medicina Molecular, Lisbon, Portugal
| | - M J Santos
- Hospital Garcia de Orta, Almada, Portugal.,Rheumatology Research Unit, Instituto de Medicina Molecular, Lisbon, Portugal
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Inês L, Silva C, Galindo M, López-Longo FJ, Terroso G, Romão VC, Rúa-Figueroa I, Santos MJ, Pego-Reigosa JM, Nero P, Cerqueira M, Duarte C, Miranda LC, Bernardes M, Gonçalves MJ, Mouriño-Rodriguez C, Araújo F, Raposo A, Barcelos A, Couto M, Abreu P, Otón-Sanchez T, Macieira C, Ramos F, Branco JC, Silva JAP, Canhão H, Calvo-Alén J. Classification of Systemic Lupus Erythematosus: Systemic Lupus International Collaborating Clinics Versus American College of Rheumatology Criteria. A Comparative Study of 2,055 Patients From a Real-Life, International Systemic Lupus Erythematosus Cohort. Arthritis Care Res (Hoboken) 2015; 67:1180-5. [DOI: 10.1002/acr.22539] [Citation(s) in RCA: 109] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 11/16/2014] [Accepted: 12/16/2014] [Indexed: 12/27/2022]
Affiliation(s)
- Luís Inês
- University of Beira Interior, Covilhã, Portugal, and Centro Hospitalar Universitário de Coimbra and University of Coimbra; Coimbra Portugal
| | - Cândida Silva
- Instituto Português de Reumatologia; Lisboa Portugal
| | | | | | | | | | | | | | | | | | | | - Cátia Duarte
- Centro Hospitalar Universitário de Coimbra and University of Coimbra; Coimbra Portugal
| | | | | | | | | | | | - Ana Raposo
- Unidade Local de Saúde do Alto Minho; Ponte de Lima Portugal
| | | | - Maura Couto
- Centro Hospitalar Tondela-Viseu; Viseu Portugal
| | - Pedro Abreu
- Unidade Local de Saúde de Castelo Branco; Castelo Branco Portugal
| | | | | | | | - Jaime C. Branco
- Universidade Nova de Lisboa, Centro Hospitalar de Lisboa Ocidental; and Hospital Egas Moniz; Lisboa Portugal
| | - José A. P. Silva
- Centro Hospitalar Universitário de Coimbra and University of Coimbra; Coimbra Portugal
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11
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Sousa S, Gonçalves M, Inês L, Eugénio G, Jesus D, Fernandes S, Terroso G, Romão V, Cerqueira M, Raposo A, Couto M, Nero P, Sequeira G, Novoa T, Melo Gomes J, Canas da Silva J, Costa L, Macieira C, Silva C, Pereira da Silva J, Canhão H, Santos M. AB0608 Greater Organ Involvement and Disease Activity in Childhood-Onset than Adult-Onset With SLE (DATA from Reuma.Pt/Les): Table 1. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.2184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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12
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Araújo F, Silva I, Sepriano A, Reizinho C, Marques L, Nero P, Branco JC. Cervical spine involvement as initial manifestation of rheumatoid arthritis: a case report. Acta Reumatol Port 2015; 40:64-67. [PMID: 24861079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Rheumatoid arthritis' synovitis affects mostly small hand and feet joints, although it may compromise any joint with a synovial lining. Cervical involvement occurs usually in longstanding disease in over half of these patients. We report the case of a 35-year old male patient who was referred to our outpatient clinic for a 2-year severe and disabling inflammatory neck pain, with incomplete response to intramuscular non-steroidal anti-inflammatory drugs and unremarkable cervical imaging studies. He also mentioned self-limited episodes of symmetric polyarthralgia involving hands, wrists, elbows, knees and feet, which started after his cervical complaints. On laboratorial workup, positive rheumatoid factor and anti-citrullinated peptide antibody and negative HLA-B27 were found. Cervical spine magnetic resonance imaging revealed atlantoaxial subluxation and odontoid process inflammatory pannus and erosions. Rheumatoid arthritis with cervical spine involvement as initial manifestation of disease was the definite diagnosis. The patient was started on methotrexate and prednisone and he was referred to neurosurgery outpatient clinic for cervical spine fixation.
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13
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Araújo F, Sepriano A, Madureira P, Aguiar R, Bernardo A, Silva C, Sousa E, Santos F, Sequeira G, Canhão H, Santos H, Garcia J, Pereira Silva J, Canas Silva J, Oliveira M, Salvador M, Nero P, Monteiro P, Nόvoa T, Branco J. AB0660 Predictive Factors of Treatment Response to A Second Tnf-α Inhibitor in Patients with Ankylosing Spondylitis - Results from the Portuguese Register Reuma.Pt. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.5590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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14
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Romao V, Santos M, Polido-Pereira J, Duarte C, Nero P, Miguel C, Costa J, Pimentel-Santos F, Barcelos F, Costa L, Melo Gomes J, Pereira da Silva J, Branco J, Canas da Silva J, Da Silva J, Fonseca J, Canhao H. OP0031 Tocilizumab is Associated with Higher CDai/Sdai Remission in Biologic-Naïve Rheumatoid Arthritis Patients – Data from Reuma.Pt: Table 1. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.2668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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15
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Romao V, Santos M, Polido-Pereira J, Duarte C, Nero P, Miguel C, Costa J, Pimentel-Santos F, Barcelos F, Costa L, Melo Gomes J, Pereira da Silva J, Branco J, Canas da Silva J, Da Silva J, Fonseca J, Canhao H. AB0451 Changes in DAS28, CDAI and SDAI are Associated with Biologic Class, Gender, Previous Biologic Therapy and ACPA/RF Status – Results from Reuma.PT. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.3414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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16
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Inês L, Silva C, Galindo M, Lopez-Longo F, Terroso G, Romão V, Rúa-Figueroa I, Santos M, Pego-Reigosa J, Nero P, Cerqueira M, Duarte C, Miranda L, Almaraz E, Bernardes M, Gonçalves M, Raposo A, Mouriño-Rodriguez C, Araújo F, Barcelos A, Sequeira G, Nόvoa T, Couto M, Abreu P, Otόn-Sanchez T, Macieira C, Ramos F, Branco J, Da Silva J, Canhão H, Canhão H. THU0011 The SLICC 2012 Classification Criteria Have Higher Sensitivity for SLE than the ACR 1997 Criteria: A Study of 2055 Patients from A Real-Life, Multicenter, International SLE Cohort. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.2506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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17
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Sousa S, Gonçalves M, Inês L, Duarte C, Fernandes S, Terroso G, Romão V, Cerqueira M, Raposo A, Couto M, Nero P, Novoa T, Pinto P, Melo Gomes J, Canas da Silva J, Costa L, Pereira da Silva J, Cunha-Miranda L, Da Silva J, Canhão H, Santos M. THU0026 Greater Diagnostic Delay in Early-Onset than in Late-Onset Systemic Lupus Erythematosus - Data from Reuma.Pt/Les: Table 1. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.5306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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18
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Araújo F, Sepriano A, Pedrosa T, Nero P, Branco J. THU0312 Microcirculation Comparative Study in Fibromyalgia Patients with and without Raynaud's Phenomenon: Table 1. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.2157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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19
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Araújo F, Silva I, Sepriano A, Nero P, Branco JC. Off-label use of rituximab in systemic rheumatic diseases: case series and review. Acta Reumatol Port 2013; 38:290-294. [PMID: 24435034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
B-cells play an important role not only in cellular but also in humoral immunity through differentiation into plasma cells and antibody production. B-cell depletion may, theoretically, change the course of systemic rheumatic diseases (SRD) in which self-reactive antibodies are part of the pathogenic pathway. In Rheumatology, anti-B-cell antibody Rituximab is currently licensed for the treatment of rheumatoid arthritis, however there is growing evidence of its potential use in other SRD. The authors present a case series of eight patients in which Rituximab was used off-label including overlap syndrome Rhupus, systemic lupus erythematosus and Wegener's granulomatosis. In the end, a brief literature review about this subject is performed.
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Araújo F, Ribeiro C, Silva I, Nero P, Branco JC. Klebsiella pneumoniae Spinal Epidural Abscess treated conservatively: case report and review. Acta Reumatol Port 2012; 37:260-263. [PMID: 23348115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Spinal infections are rare but potentially life-threatening disorders. A high level of clinical suspicion is necessary for rapid diagnosis and treatment initiation. The treatment combines both antibiotics and surgical intervention in the vast majority of cases. The authors report the case of a 84-year old female patient with a three week history of persistent lumbar back pain radiating to both thighs following a lower respiratory tract infection. She had lumbar spine tenderness but no neurological compromise. Her inflammatory markers were elevated and lumbar spine magnetic resonance imaging revealed L4-L5 spondylodiscitis with spinal epidural abscess. Blood cultures isolated Klebsiella pneumoniae and, since she was neurologically stable, conservative treatment with two-week intravenous gentamicin and eight-week intravenous ceftriaxone was initiated with positive inpatient and outpatient evolution.
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Affiliation(s)
- Filipe Araújo
- Department of Rheumatology, Centro Hospitalar de Lisboa Ocidental, Hospital de Egas Moniz, Lisboa, Portugal.
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Silva I, Mourão AF, Ramiro S, Rodrigues A, Miguel C, Sampaio L, Faustino A, Vaz C, Canhão H, Cruz M, Neto A, Cravo AR, Ribeiro A, Brandão A, Peixoto D, Medeiros D, Santos FA, Teixeira F, Gonçalves I, Silva JP, Gomes JM, Maurício L, Simões E, Salvador MJ, Silva M, Nero P, Roque R, Barros R, André R, Falcão S, Serra S, Tavares V, Branco JC. [Portuguese recommendations for pain management by pharmocotherapy in inflammatory arthritis]. Acta Reumatol Port 2012; 37:160-174. [PMID: 23149639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVES To develop Portuguese evidence-based recommendations for pain management by pharmocotherapy in inflammatory arthritis. METHODS The Portuguese project was integrated in the multinational 3E Initiative (Evidence, Expertise, Exchange) 2010 where a total of 453 rheumatologists from 17 countries have participated. The clinical questions concerning pain were formulated and the Portuguese group added 2 more questions. A systematic literature search was performed in Medline, Embase, Cochrane Library and 2008-2009 EULAR and ACR abstracts. The selected articles were systematically reviewed and the evidence was defined according to the Oxford Levels of Evidence. In each country a group of experts joined to discuss their national recommendations. In Portugal, the national meeting was held in October 2010, where 33 rheumatologists discussed and voted by Delphi method the national recommendations. Finally, the agreement among the rheumatologists and the potential impact on their clinical practice was assessed. RESULTS Thirteen national recommendations were formulated: pain measure scores; analgesic combination therapy; pharmacotherapy in preconception, pregnancy and lactation periods; pharmacotherapy according to comorbilities; safety of NSAIDs and/or paracetamol with methotrexate combination therapy; efficacy and safety of continuous/on-demand NSAIDs; opioids, paracetamol, corticosteroids, antidepressants, neuromodulators and muscle relaxants role and effectiveness; risk factors for the development of chronic pain and the role of topic analgesics. CONCLUSION The portuguese recommendations for the pain management by pharmacotherapy in inflammatory arthritis were formulated according to the best evidence and supported by a panel of 63 rheumatologists. The differences between the national and international recommendations are reported in this article.
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Affiliation(s)
- Inês Silva
- Serviço de Reumatologia do Centro Hospitalar de Lisboa Ocidental, EPE - Hospital de Egas Moniz, Lisboa, Portugal
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22
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Santos MJ, Vinagre F, Nero P, Barcelos F, Barcelos A, Rodrigues AM, De Matos AA, Silva C, Miranda L, Capela S, Marques A, Branco J, Da Silva JC. Predictors of Damage Progression in Portuguese Patients with Systemic Lupus Erythematosus. Ann N Y Acad Sci 2009; 1173:822-8. [DOI: 10.1111/j.1749-6632.2009.04669.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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23
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Vaz CC, Couto M, Medeiros D, Miranda L, Costa J, Nero P, Barros R, Santos MJ, Sousa E, Barcelos A, Inês L. Undifferentiated connective tissue disease: a seven-center cross-sectional study of 184 patients. Clin Rheumatol 2009; 28:915-21. [PMID: 19390908 DOI: 10.1007/s10067-009-1175-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2009] [Revised: 03/25/2009] [Accepted: 03/26/2009] [Indexed: 11/24/2022]
Abstract
The purpose of this study was to characterize the clinical and serological features of a large cohort of patients with antinuclear antibody (ANA) positive undifferentiated connective tissue disease (UCTD). Consecutive patients with UCTD, followed up at the Rheumatology Clinic of the participating centers, were included. Data from these patients were obtained by clinical evaluation and chart review. All patients were diagnosed as having UCTD on basis of the following criteria: positive ANA plus at least one clinical feature of connective tissue disease, but not fulfilling classification criteria for any differentiated connective tissue disease. One hundred eighty-four patients were studied (female patients-94.5%; mean age at time of evaluation-47 years). The most prevalent manifestations were arthralgia (66%), arthritis (32%), Raynaud's phenomenon (30%), sicca symptoms (30%), and leukopenia (19%). The prevalence of ANA was 100%, anti-SSA 20%, anti-dsDNA 14%, and anti-SSB 7%. Patients with anti-dsDNA/anti-Sm, anticentromere/anti-Scl70, or anti-SSA/anti-SSB antibodies more frequently presented a set of manifestations close to systemic lupus erythematosus (SLE), systemic sclerosis, or Sjögren syndrome, respectively. We analyze a large cohort of UCTD. Seventy-two percent of these UCTD patients present lupus-, scleroderma-, or Sjögren-like features but do not fulfill classification criteria and mostly present a mild disease.
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Affiliation(s)
- C C Vaz
- Department of Rheumatology, Coimbra University Hospital, Praceta Prof. Mota Pinto, Coimbra 3000-075, Portugal.
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24
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Mourão AF, Pinto TL, Falcão S, Ribeiro C, Vieira H, Caetano-Lopes J, Nero P, dos Santos FP, Guimarães J, Branco JC. [Juvenile dermatomyositis associated with anasarca - a clinical case]. Acta Reumatol Port 2009; 34:276-280. [PMID: 19569283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Juvenile dermatomyositis (JDM) is a rare systemic disease of unknown etiology characterized by inflammation of the muscle, skin and digestive tract, with variable outcome. The diagnostic criteria include proximal symmetrical muscular weakness, characteristic skin rashes, elevation of skeletal muscle enzymes and specific electromyographic and muscle biopsy abnormalities. Pulmonary and gastro-intestinal involvements, calcinosis and generalized edema usually indicate severe disease. Recent data suggest an association between the genotype -308 AA of the Tumour Necrosis Factor (TNF) gene and disease chronicity. We present a case of a 14 year-old female with JDM and generalized oedema which is a rare manifestation of the disease and it is associated to a poor outcome.
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Affiliation(s)
- Ana Filipa Mourão
- Serviço de Reumatologia, Centro Hospitalar de Lisboa Ocidental, EPE, Hospital Egas Moniz, 1349-019 Lisboa.
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25
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Falcão S, Mourão AF, Ribeiro C, Pinto TL, Mateus M, Araújo P, Nero P, Pimentão JB, Branco JC. [Eosinophilic fasciitis and aplastic anemia]. Acta Reumatol Port 2009; 34:120-126. [PMID: 19365308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Eosinophilic fasciitis is a rare rheumatic condition characterized by inflammatory thickening of the skin and fascia, peripheral eosinophilia, elevated erythrocyte sedimentation rate and hypergammaglobulinemia. Internal organ involvement is uncommon. It is often difficult to diagnose eosinophilic fasciitis and its course may be variable. Glucocorticoids are most commonly used in the treatment but in many cases they are ineffective, requiring combined immunosuppressive treatment. Several cases of eosinophilic fasciitis and serious haematological disorders such as immune thrombocytopenia, Hodgkin's disease and aplastic anaemia have been described. The authors report an atypical severe case of eosinophilic fasciitis complicated by aplastic anaemia non responsive to treatment.
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Affiliation(s)
- Sandra Falcão
- Serviço de Reumatologia, Centro Hospitalar de Lisboa Ocidental, EPE, Hospital Egas Moniz, Lisboa.
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26
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Mourão AF, Santos FP, Falcão S, Barros R, Pinto TL, Mendes A, Castelão W, Nero P, Fonseca JE, Matos AA, Branco JC. [Is the response to anti-TNFalpha treatment influenced by the presence of IgM rheumatoid factor, in Rheumatoid Arthritis patients?]. Acta Reumatol Port 2008; 33:430-434. [PMID: 19078861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
AIM To verify if the response to TNFalpha inhibitors is influenced by the presence of IgM rheumatoid factor (RF), in patients with RA. MATERIAL AND METHODS In this study, the patients with the diagnosis of RA treated with TNFa inhibitors followed in our hospital were recruited. A protocol was applied including demographic, clinical and laboratory data, in order to calculate DAS 28. The presence/absence of IgM RF and associated therapies were record. RESULTS Fifty-seven patients, 52 female, with a mean duration of anti-TNFa treatment of 30,9+/-15,9 months were studied. Twenty-four patients were being treated with infliximab, 17 with adalimumab and 16 with etanercept. Forty-one patients had IgM RF detectable in serum (RF positive group). In the RF positive group, the variation of DAS 28 was -1,75 +/- 1,53 vs -1,04 +/- 1,76 in the RF negative group (p=0,135). The mean duration of anti-TNFalpha treatment was similar in both groups (31,9+/-15,9 vs 29,5+/-16,16 months). Patients who were treated with methotrexate presented a higher variation of DAS 28 (-1,87 +/- 1,70 vs -0,80 +/- 1,09; p=0,041) and this variation was dose dependent (p=0,056). CONCLUSIONS Despite needing a replication in a larger cohort, our results suggest that the presence of IgM RF in the serum did not interfere with the response to treatment with TNFalpha inhibitors.
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Affiliation(s)
- Ana Filipa Mourão
- Serviço de Reumatologia do Centro Hospitalar de Lisboa Ocidental (CHLO), EPE, Hospital Egas Moniz, Lisboa, Portugal.
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27
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Santos MJ, Capela S, Figueira R, Nero P, Matos AA, Silva C, Miranda L, Barcelos A, Marques A, Teixeira A, Branco J, da Silva JC, de Queiroz MV. [Characterization of a Portuguese population with systemic lupus erytematosus]. Acta Reumatol Port 2007; 32:153-61. [PMID: 17576395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
UNLABELLED To characterize systemic lupus erythematosus (SLE) in Portuguese patients and to identify differences in diseases expression related to sex and ethnicity. PATIENTS AND METHODS Retrospective cohort analysis of patients with SLE followed at five Rheumatology Departments between 1976 and 2006. Demographic data, diseases manifestations, medications used, co morbidity and damage scores were recorded. RESULTS Five hundred forty four patients were studied, 93% female, 89% Caucasians, with an average age at disease diagnosis of 35 years. The most frequent clinical features were musculoskeletal (91%), cutaneous and mucous membrane (90%) and the hematological involvement (58%). Renal diseases and serositis occurred more often in males while myositis was more common in black patients. Immunological features included the presence of anti-nuclear antibodies in 99% of the patients, anti-DNA (76%) anti-SSA (33%), anti-SSB (20%), anti-RNP (26%), anti-Sm (22%), anticardiolipine (31%) and lupus anticoagulant (21%). Anti-SSA, anti-RNP, and anti-Sm antibodies were significantly more prevalent among black patients. The presence and severity of damage measured by SLICC/ACR was similar between sexes and ethnicities. In multivariate analyses diseases duration and the presence of hypertension showed a positive association, while educational and antimalarials were negatively associated with the presence of damage. CONCLUSION In this cohort of Portuguese patients SLE present clinical features similar to those observed in other predominantly Caucasian populations, albeit a higher prevalence of anti-RNP and anti-Sm antibodies was observed. Some particular features were associated with male sex and African ethnicity. Some socio-demographic and clinical variables were associated with damage accrual.
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Affiliation(s)
- M J Santos
- Servicio de Reumatologia do Hospital Garcia de Orta, Almada.
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28
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Falcão S, Barros R, Mateus M, Nero P, de Matos AA, Pimentão JB, Ribeiro I, Weigert A, Branco JC. [Systemic lupus erythematosus and anaemia]. Acta Reumatol Port 2007; 32:73-9. [PMID: 17450768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
The authors report the case of a 48-years-old Caucasian women, with a previous diagnosis of systemic lupus erythematosus characterized by asthenia, fever, skin rash, alopecia, Raynaud's phenomenon, arthritis, pericardial effusion, interstitial pulmonary involvement, diffuse proliferative glomerulonephritis with crescents and anemia. The presence of severe anemia refractory to high doses of glucocorticoids (1 mg/ /Kg/day), iron therapy and blood transfusions, associated with a low reticulocyte count determined the execution of a bone marrow aspiration, biopsy and immunophenotyping, which were compatible with the diagnosis of Myelodysplastic Syndrome. The treatment with erythropoietin (5.000U 3x/week) and cyclophosphamide pulses (1 gr/m(2) month) induced complete regression of morphologic bone marrow changes and anemia. The main causes of anemia in lupus patients are discussed.
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Affiliation(s)
- S Falcão
- Serviço de Reumatologia, Hospital Egas Moniz, Lisboa.
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Fonseca JE, Cavaleiro J, Teles J, Sousa E, Andreozzi VL, Antunes M, Amaral-Turkman MA, Canhão H, Mourão AF, Lopes J, Caetano-Lopes J, Weinmann P, Sobral M, Nero P, Saavedra MJ, Malcata A, Cruz M, Melo R, Braña A, Miranda L, Patto JV, Barcelos A, da Silva JC, Santos LM, Figueiredo G, Rodrigues M, Jesus H, Quintal A, Carvalho T, da Silva JAP, Branco J, Queiroz MV. Contribution for new genetic markers of rheumatoid arthritis activity and severity: sequencing of the tumor necrosis factor-alpha gene promoter. Arthritis Res Ther 2007; 9:R37. [PMID: 17408492 PMCID: PMC1906815 DOI: 10.1186/ar2173] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2006] [Revised: 03/02/2007] [Accepted: 04/04/2007] [Indexed: 11/15/2022] Open
Abstract
The objective of this study was to assess whether clinical measures of rheumatoid arthritis activity and severity were influenced by tumor necrosis factor-alpha (TNF-alpha) promoter genotype/haplotype markers. Each patient's disease activity was assessed by the disease activity score using 28 joint counts (DAS28) and functional capacity by the Health Assessment Questionnaire (HAQ) score. Systemic manifestations, radiological damage evaluated by the Sharp/van der Heijde (SvdH) score, disease-modifying anti-rheumatic drug use, joint surgeries, and work disability were also assessed. The promoter region of the TNF-alpha gene, between nucleotides -1,318 and +49, was sequenced using an automated platform. Five hundred fifty-four patients were evaluated and genotyped for 10 single-nucleotide polymorphism (SNP) markers, but 5 of these markers were excluded due to failure to fall within Hardy-Weinberg equilibrium or to monomorphism. Patients with more than 10 years of disease duration (DD) presented significant associations between the -857 SNP and systemic manifestations, as well as joint surgeries. Associations were also found between the -308 SNP and work disability in patients with more than 2 years of DD and radiological damage in patients with less than 10 years of DD. A borderline effect was found between the -238 SNP and HAQ score and radiological damage in patients with 2 to 10 years of DD. An association was also found between haplotypes and the SvdH score for those with more than 10 years of DD. An association was found between some TNF-alpha promoter SNPs and systemic manifestations, radiological progression, HAQ score, work disability, and joint surgeries, particularly in some classes of DD and between haplotypes and radiological progression for those with more than 10 years of DD.
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Affiliation(s)
- João Eurico Fonseca
- Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Av. Professor Egas Moniz, 1649-028, Lisboa, Portugal
- Santa Maria Hospital, Av. Professor Egas Moniz, 1649-035, Lisboa, Portugal
| | - João Cavaleiro
- Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Av. Professor Egas Moniz, 1649-028, Lisboa, Portugal
| | - José Teles
- Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Av. Professor Egas Moniz, 1649-028, Lisboa, Portugal
| | - Elsa Sousa
- Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Av. Professor Egas Moniz, 1649-028, Lisboa, Portugal
- Santa Maria Hospital, Av. Professor Egas Moniz, 1649-035, Lisboa, Portugal
| | - Valeska L Andreozzi
- Escola Nacional de Saúde Pública Sérgio Arouca, R. Leopoldo Bulhões, 1480, 21031-210, Rio de Janeiro, Brasil
| | - Marília Antunes
- Centro de Estatística e Aplicações, Faculdade de Ciências, Universidade de Lisboa, Campo Grande, 1749-016, Lisboa, Portugal
| | - Maria A Amaral-Turkman
- Centro de Estatística e Aplicações, Faculdade de Ciências, Universidade de Lisboa, Campo Grande, 1749-016, Lisboa, Portugal
| | - Helena Canhão
- Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Av. Professor Egas Moniz, 1649-028, Lisboa, Portugal
- Santa Maria Hospital, Av. Professor Egas Moniz, 1649-035, Lisboa, Portugal
| | - Ana F Mourão
- Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Av. Professor Egas Moniz, 1649-028, Lisboa, Portugal
- Egas Moniz Hospital, Rua da Junqueira, 126, 1349-019, Lisboa, Portugal
| | - Joana Lopes
- Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Av. Professor Egas Moniz, 1649-028, Lisboa, Portugal
| | - Joana Caetano-Lopes
- Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Av. Professor Egas Moniz, 1649-028, Lisboa, Portugal
| | - Pamela Weinmann
- Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Av. Professor Egas Moniz, 1649-028, Lisboa, Portugal
| | - Marta Sobral
- Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Av. Professor Egas Moniz, 1649-028, Lisboa, Portugal
| | - Patrícia Nero
- Egas Moniz Hospital, Rua da Junqueira, 126, 1349-019, Lisboa, Portugal
| | - Maria J Saavedra
- Coimbra University Hospital, Praceta Mota Pinto, 3000-075, Coimbra, Portugal
| | - Armando Malcata
- Coimbra University Hospital, Praceta Mota Pinto, 3000-075, Coimbra, Portugal
| | - Margarida Cruz
- Faro Hospital, Rua Leão Penedo, 8000-386, Faro, Portugal
| | - Rui Melo
- Nossa Senhora da Assunção Hospital, Rua D. Alexandrina Soares de Albergaria, 6270-498, Seia, Portugal
| | - Araceli Braña
- Caldas da Rainha Hospital, Largo Rainha Dona Leonor, 2500-176, Caldas da Rainha, Portugal
| | - Luis Miranda
- Portuguese Institute of Rheumatology, Rua da Beneficência, 7, 1050-034, Lisboa, Portugal
| | - José V Patto
- Portuguese Institute of Rheumatology, Rua da Beneficência, 7, 1050-034, Lisboa, Portugal
| | - Anabela Barcelos
- Infante D. Pedro Hospital, Avenida Artur Ravara, 3814-501, Aveiro, Portugal
| | | | - Luís M Santos
- Divino Espírito Santo Hospital, Praça 5 de Outubro, 9500, Ponta Delgada, Portugal
| | - Guilherme Figueiredo
- Divino Espírito Santo Hospital, Praça 5 de Outubro, 9500, Ponta Delgada, Portugal
| | - Mário Rodrigues
- Funchal Central Hospital, Avenida Luís de Camões, 9000, Funchal, Portugal
| | - Herberto Jesus
- Funchal Central Hospital, Avenida Luís de Camões, 9000, Funchal, Portugal
| | - Alberto Quintal
- Funchal Central Hospital, Avenida Luís de Camões, 9000, Funchal, Portugal
| | - Teresa Carvalho
- Cell Biology Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Av. Professor Egas Moniz, 1649-028, Lisboa, Portugal
| | | | - Jaime Branco
- Egas Moniz Hospital, Rua da Junqueira, 126, 1349-019, Lisboa, Portugal
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Fonseca JE, Canhão H, Silva C, Miguel C, Mediavilla MJ, Teixeira A, Castelão W, Nero P, Bernardes M, Bernardo A, Mariz E, Godinho F, Santos MJ, Bogas M, Oliveira M, Saavedra MJ, Barcelos A, Cruz M, Santos RA, Maurício L, Rodrigues M, Figueiredo G, Quintal A, Patto JV, Malcata A, da Silva JC, Araújo D, Ventura F, Branco J, Queiroz MV. [Tuberculosis in rheumatic patients treated with tumour necrosis factor alpha antagonists: the Portuguese experience]. Acta Reumatol Port 2006; 31:247-53. [PMID: 17094336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
In Portugal, 13 cases of tuberculosis (TB) were reported, in the period between 1999 and 2005, in 960 patients exposed to anti-TNFalpha treatment (1.35%), 8 females and 5 males. Mean age was 46.7 +/- 13.8 years. 9 patients had rheumatoid arthritis (RA), in 639 exposed patients (1.4%), 3 had ankylosing spondylitis (AS), in 200 exposed patients (1.5%) and 1 had psoriatic arthritis (PA), in 101 exposed patients (1%). The anti-TNFa used was in 8 cases infliximab (in 456 patients exposed, 1.5%), in 4 adalimumab (in 171 patients exposed, 2.3%) and in 1 etanercept (in 333 exposed, 0.3%). Treatment with a biological agent was started 11.1 +/- 8.7 months (min 3 and max 50) before TB onset. Tuberculin skin test (TST) was performed in 9 out of the 13 patients (the other 4 had started biological therapy before 2002). In 3 cases the TST response was 0 mm, in 3 less than 10 mm, in one was 14 mm and in two 20 mm. In the 3 cases with a TST response superior to 10 mm, isoniazid treatment 300 mg/d was prescribed, during 9 months. The time between first symptoms and TB diagnosis was 2.6 +/- 2.9 months. TB involvement was pulmonary in 6 patients, lymph node disease in 2, peritoneal and pulmonary in 2, osteoarticular in one case, lymph node disease and splenic in another and miliar TB in the last case. One death was reported; all of the other cases had a good outcome after anti-TB treatment. In two cases (one treated with adalimumab and the other with infliximab), paradoxical response to treatment occurred. None of the patients has restarted biological therapy after TB treatment.
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Ligeiro D, Fonseca JE, Abade O, Abreu I, Cruz M, Nero P, Cavaleiro J, Teles J, Trindade H, Caetano JM, Branco J. Influence of human leucocyte antigen-DRB1 on the susceptibility to rheumatoid arthritis and on the production of anti-cyclic citrullinated peptide antibodies in a Portuguese population. Ann Rheum Dis 2006; 66:246-8. [PMID: 16793843 PMCID: PMC1798513 DOI: 10.1136/ard.2005.051177] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To clarify the influence of the HLA-DRB1 locus on the susceptibility to rheumatoid arthritis and the production of anti-cyclic citrullinated peptide antibodies (anti-CCP) in a Portuguese population. METHODS 141 patients with rheumatoid arthritis fulfilling the American College of Rheumatology 1987 revised criteria for rheumatoid arthritis were compared with 150 healthy controls. Human leucocyte antigen (HLA)-DRB1 locus genotyping was assessed by polymerase chain reaction reverse probing assays and sequence-specific primers. Anti-CCP antibodies were quantified by ELISA in patients with rheumatoid arthritis. Frequencies between groups were compared by the two-sided Fisher's exact test and considered significant if p<0.05. RESULTS The HLA-DRB1*04 and HLA-DRB1*10 groups were highly associated with rheumatoid arthritis (p<0.001 and p = 0.031, respectively). High titres of anti-CCP antibodies were largely associated with the presence of HLA-DRB1*04/10. CONCLUSION The well-recognised susceptibility alleles to rheumatoid arthritis, HLA-DRB1*04, were associated with rheumatoid arthritis in Portuguese patients. The relatively rare DRB1*10 was also associated with rheumatoid arthritis, as was described previously in other southern European countries. Both groups were associated with high anti-CCP titres, reinforcing its relevance to disease onset.
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Affiliation(s)
- D Ligeiro
- Centro de Histocompatibilidade do Sul, Lisboa, Portugal
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Nero P, Nogueira I, Vilar R, Pimentão JB, Branco JC. [Synovial fluid crystal identification by electron microscopy]. Acta Reumatol Port 2006; 31:75-81. [PMID: 17058386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
BACKGROUND In clinical practice crystal identification in synovial fluid is made by polarized light microscopy and with some specific stainings. Nevertheless, sometimes we are unable to identify crystals by these means, either because they are too small or because they are widespread on the fluid. AIMS To compare the identification of crystals in synovial fluid from patients with non-infectious monoarthritis but no history of local trauma or articular disease, using polarized light and electronic microscopy. METHODS We analized synovial fluid samples from patients with non-infectious monoarthritis and no history of local trauma or articular disease. First we used a polarized light microscope and alizarin red staining. Later we used conventional transmission electron microscopy and energy dispersive spectroscopy, in order to identify and characterize crystals. RESULTS Fourty-five samples from 23 synovial fluids were analyzed. Under polarized light microscopy we identified crystals on 11 samples: 3 with calcium pyrophosphate crystals, 6 with calcium basic phosphate crystals and 2 with sodium monourate crystals. On the remaining 12 samples we were unable to identify crystals. Samples were then analyzed by conventional transmission electron microscopy and energy dispersive spectroscopy confirming the presence of the previously identified crystals. On the remainig 12 samples we were able to identify calcium basic phosphate crystals. DISCUSSION Microcrystals seem to be an universal finding in synovial fluid of patients with osteoarthritis. The prevention of their deposition in joints might contribute to stop joint damage in this disease.
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Affiliation(s)
- Patrícia Nero
- Serviço de Reumatologia, Hospital de Egas Moniz, Lisboa
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Abreu I, Laroche P, Bastos A, Issert V, Cruz M, Nero P, Fonseca JE, Branco J, Machado Caetano JA. Multiplexed immunoassay for detection of rheumatoid factors by FIDISTM technology. Ann N Y Acad Sci 2005; 1050:357-63. [PMID: 16014552 DOI: 10.1196/annals.1313.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Our objective was to (i) compare FIDIS Rheuma, a new multiplexed immunoassay designed for simultaneous detection of IgM class rheumatoid factors (RF) directed against Fc determinants of IgG from humans and animals, with agglutination and ELISA (conventional methods) and (ii) evaluate the clinical sensitivity and specificity of biological markers for rheumatoid arthritis (RA). To do this, FIDIS technology was employed using the Luminex system. It consists of distinct color-coded microsphere sets, a flow cytometer, and digital signal processing hardware and software. Agglutination and ELISA tests were performed with commercial kits. The study included 134 samples from RA patients and 105 from healthy blood donors. For human specificity, we compared FIDIS with latex agglutination and ELISA. Relative sensitivities were 98.9% and 88.5% and specificities were 90.2% and 94.6%, respectively. For animal specificity, we compared FIDIS with Waaler-Rose and ELISA. The results were 84.9% and 71.9% for the sensitivities and 97.5% and 98.4% for the specificities, respectively. Detection of IgG anti-CCP by ELISA and IgG antikeratin by immunofluorescence was also determined in order to compare their clinical sensitivity and specificity with IgM-RF, according to the method used. The results were: IgG anti-CCP 72.3%, 97.2%; IgG antikeratin 36.6%, 100%; latex agglutination 66.4%, 97.2%; Waaler-Rose 55.9%, 96.3%; FIDIS human 73.9%, 92.1%; FIDIS animal 49.2%, 97.2%; ELISA human 93.2%, 95.5%; and ELISA animal 74.6%, 91.3%. The results showed the efficiency of FIDIS with analytical performance equivalent to the conventional methods, but having the advantage of giving quantitative results (IU/mL).
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Affiliation(s)
- I Abreu
- Faculty of Medical Sciences, Department of Immunology, New University of Lisbon, Lisbon, Portugal.
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Fonseca JE, Carvalho T, Cruz M, Nero P, Sobral M, Mourão AF, Cavaleiro J, Ligeiro D, Abreu I, Carmo-Fonseca M, Branco JC. Polymorphism at position -308 of the tumour necrosis factor alpha gene and rheumatoid arthritis pharmacogenetics. Ann Rheum Dis 2005; 64:793-4. [PMID: 15834068 PMCID: PMC1755496 DOI: 10.1136/ard.2004.028167] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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35
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Nero P, Rahman A, Isenberg DA. Does long term treatment with azathioprine predispose to malignancy and death in patients with systemic lupus erythematosus? Ann Rheum Dis 2004; 63:325-6. [PMID: 14962972 PMCID: PMC1754909 DOI: 10.1136/ard.2002.005371] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Garay M, Gaarde W, Monia BP, Nero P, Cioffi CL. Inhibition of hypoxia/reoxygenation-induced apoptosis by an antisense oligonucleotide targeted to JNK1 in human kidney cells. Biochem Pharmacol 2000; 59:1033-43. [PMID: 10704932 DOI: 10.1016/s0006-2952(99)00412-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
17-fold) increase in DNA fragmentation. Fluorescence microscopy, using DNA binding dyes, demonstrated that cell death following hypoxia/reoxygenation was due predominantly to apoptosis and not necrosis. Furthermore, reoxygenation, but not hypoxia alone, caused a time-dependent increase in the activation of JNK as monitored by western blot analysis using a phospho-specific JNK antibody. In contrast, p38 mitogen-activated protein kinase was activated following hypoxia, but this activation was not augmented during reoxygenation. Exposure of human kidney cells to a 2'-methoxyethyl mixed backbone antisense oligonucleotide directed against human JNK1 (JNK1 AS) resulted in a potent suppression of JNK mRNA and protein expression, whereas a 6-base mismatch control oligonucleotide was without effect. Moreover, a significant diminution of reoxygenation-induced apoptosis was observed in cells exposed to JNK1 AS but not to the mismatch control oligonucleotide. Taken together, these results strongly indicate that activation of the JNK signaling cascade is a major mechanism whereby hypoxia/reoxygenation induces apoptosis.
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Affiliation(s)
- M Garay
- Department of Metabolic and Cardiovascular Diseases, Novartis Institute for Biomedical Research, Summit, NJ 07901, USA
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Schweisguth F, Nero P, Posakony JW. The sequence similarity of the Drosophila suppressor of hairless protein to the integrase domain has no functional significance in vivo. Dev Biol 1994; 166:812-4. [PMID: 7813798 DOI: 10.1006/dbio.1994.1359] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Suppressor of Hairless [Su(H)] plays an essential role in neurogenesis in Drosophila by controlling successive alternative cell fate decisions in the developing adult epidermis. Analysis of the predicted amino acid sequence of the Su(H) protein revealed a weak similarity to the catalytic domain of a family of phage integrases and yeast recombinases. We present here the results of a site-directed mutagenesis of the integrase-related region of Su(H), which indicate that this sequence similarity has no functional significance in vivo. We suggest that the JK-RBP protein, encoded by the mouse homologue of Su(H), does not act as a recombinase, as originally proposed.
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Affiliation(s)
- F Schweisguth
- Institut Jacques Monod, CNRS-Université Paris VII, France
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