Profile Of The Use Of Disease Modifying Drugs In The Brazilian Registry Of Spondyloarthritides [perfil Do Uso De Drogas Modificadoras De Doença No Registro Brasileiro De Espondiloartrites]

Introduction: Few studies have evaluated the profile of use of disease modifying drugs (DMD) in Brazilian patients with spondyloarthritis (SpA). Methods: A common research protocol was applied prospectively in 1505 patients classified as SpA by criteria of the European Spondyloarthropathies Study Group (ESSG), followed at 29 referral centers in Rheumatology in Brazil. Demographic and clinical variables were obtained and evaluated, by analyzing their correlation with the use of DMDs methotrexate (MTX) and sulfasalazine (SSZ). Results: At least one DMD was used by 73.6 % of patients: MTX by 29.2 % and SSZ by 21.7%, while 22.7 % used both drugs. The use of MTX was significantly associated with peripheral involvement, and SSZ was associated with axial involvement, and the two drugs were more administered, separately or in combination, in the mixed involvement (p < 0.001). The use of a DMD was significantly associated with Caucasian ethnicity (MTX, p = 0.014), inflammatory back pain (SSZ, p = 0.002), buttock pain (SSZ, p = 0.030), neck pain (MTX, p = 0.042), arthritis of the lower limbs (MTX, p < 0.001), arthritis of the upper limbs (MTX, p < 0.001), enthesitis (p = 0.007), dactylitis (MTX, p < 0.001), inflammatory bowel disease (SSZ, p < 0.001) and nail involvement (MTX, p < 0.001). Conclusion: The use of at least one DMD was reported by more than 70% of patients in a large cohort of Brazilian patients with SpA, with MTX use more associated with peripheral involvement and the use of SSZ more associated with axial involvement. © 2014 Elsevier Editora Ltda.5413337Sieper, J., Rudwaleit, M., Baraliakos, X., Brandt, J., Braun, J., Burgos-Vargas, R., The Assessment of SpondyloArthritis international Society (ASAS) handbook: A guide to assess spondyloarthritis (2009) Ann Rheum Dis, 68 (SUPPL. II), pp. ii1-ii44Rudwaleit, M., van der Heijde, D., Landewé, R., Listing, J., Brandt, J., Braun, J., The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection (2009) Ann Rheum Dis, 68, pp. 770-776Rudwaleit, M., van der Heijde, D., Landewé, R., Akkoc, N., Brandt, J., Chou, C.T., The development of Assessment of SpondyloArthritis international Society classification criteria for peripheral spondyloarthritis (2011) Ann Rheum Dis, 70, pp. 25-31Sampaio-Barros, P.D., Gonçalves, C.R., Braga da Silva, J.A., Ximenes, A.C., Azevedo, V.C., Bianchi, W.A., Registro Iberoamericano de Espondiloartritis (RESPONDIA): Brasil (2008) Reumatol. Clin., 4 (SUPPL. 4), pp. 30-35Benegas, M., Muñoz-Gomariz, E., Font, P., Burgos-Vargas, R., Chaves, J., Palleiro, D., Comparison of the clinical expression of patients with ankylosing spondylitis from Europe and Latin America (2012) J Rheumatol, 39, pp. 2315-2320Braun, J., van den Berg, R., Baraliakos, X., Boehm, H., Burgos-Vargas, R., Collantes-Estevez, E., 2010 Update of the ASAS/EULAR recommendations for the management of ankylosing spondyltis (2011) Ann Rheum Dis, 70, pp. 896-904Sampaio-Barros, P.D., Pinheiro, M.M., Ximenes, A.C., Meirelles, E.S., Keiserman, M., Azevedo, V.F., Recomendações sobre o tratamento da espondilite anquilosante (2013) Rev Bras Reumatol, 53, pp. 242-257Gossec, L., Smolen, J.S., Gaujoux-Viala, C., Ash, Z., Marzo-Ortega, H., van der Heijde, D., European League Against Rheumatism recommendations for the management of psoriatic arthritis with pharmacological therapies (2012) Ann Rheum Dis, 71, pp. 4-12Carneiro, S., Azevedo, V.F., Bonfiglioli, R., Ranza, R., Gonçalves, C.R., Keiserman, C.R., Recomendações sobre o tratamento da artrite psoriásica (2013) Rev Bras Reumatol, 53, pp. 227-241Dougados, M., van der Linden, S., Julin, R., Huitfeld, B., Amor, B., Calin, A., The European Spondyloarthropathy Study Group preliminary criteria for the classification of spondyloarthropathy (1991) Arthritis Rheum, 34, pp. 1218-1227van der Linden, S., Valkenburg, H.A., Cats, A., Evaluation of diagnostic criteria for ankylosing spondylitis (1984) A proposal for modification of the New York criteria. Arthritis Rheum, 27, pp. 361-368Moll, J.M.H., Wright, V., Psoriatic arthritis (1973) Semin Arthritis Rheum, 3, pp. 55-78Kingsley, G., Sieper, J., Third International Workshop on Reactive Arthritis, 23-26 September 1995, Berlin, Germany (1996) Ann Rheum Dis, 55, pp. 564-584Bodur, H., Ataman, S., Akbulut, L., Evcik, D., Kavuncu, V., Kaya, T., Characteristics and medical management of patients with rheumatoid arthritis and ankylosing spondylitis (2008) Clin Rheumatol, 27, pp. 1119-1125Altan, L., Bingöl, U., Karakoç, Y., Aydiner, S., Yurtkuran, M., Yurtkuran, M., Clinical investigation of methotrexate in the treatment of ankylosing spondylitis (2001) Scand J Rheumatol, 30, pp. 255-259Marshall, R.W., Kirwan, J.R., Methotrexate in the treatment of ankylosing spondylitis (2001) Scand J Rheumatol, 30, pp. 313-314Roychowdhury, B., Bintley-Bagot, S., Bulgen, D.Y., Thompson, R.N., Tunn, E.J., Moots, R.J., Is methotrexate effective in ankylosing spondylitis? (2002) Rheumatology (Oxford), 41, pp. 1330-1332Sampaio-Barros, P.D., Costallat, L.T., Bertolo, M.B., Marques-Neto, J.F., Samara, A.M., Methotrexate in the treatment of ankylosing spondylitis (2000) Scand J Rheumatol, 29, pp. 160-162Gonzalez-Lopez, L., Garcia-Gonzalez, A., Vazquez-Del-Mercado, M., Muñoz-Valle, J.F., Gomez-Nava, J.I., Efficacy of methotrexate in ankylosing spondylitis: a randomized, double blind, placebo controlled trial (2004) J Rheumatol, 31, pp. 1568-1574Haibel, H., Brandt, H.C., Song, I.H., Brandt, A., Listing, J., Rudwaleit, M., Sieper, J., No efficacy of subcutaneous methotrexate in active ankylosing spondylitis: a 16-week open-label trial (2007) Ann Rheum Dis., 66, pp. 419-421Abu-Shakra, M., Gladman, D.D., Thorne, J.C., Long, J., Gough, J., Farewell, V.T., Long-term methotrexate therapy in psoriatic arthritis: clinical and radiological outcome (1995) J Rheumatol, 22, pp. 241-245Scarpa, R., Peluso, R., Atteno, M., Manguso, F., Spanò, A., Iervolino, S., The effectiveness of a traditional therapeutical approach in early psoriatic arthritis: Results of a pilot randomised 6-month trial with methotrexate (2008) Clin Rheumatol, 27, pp. 823-826Lie, E., van der Heijde, D., Uhlig, T., Heiberg, M.S., Koldingsnes, W., Rødevand, E., Effectiveness and retention rates of methotrexate in psoriatic arthritis in comparison with methotrexate-treated patients with rheumatoid arthritis (2010) Ann Rheum Dis, 69, pp. 671-676Chandran, V., Raychaudhuri, S.P., Geoepidemiology and environmental factors of psoriasis and psoriatic arthritis (2010) J Autoimm, 34, pp. 314-321Skare, T.L., Bortoluzzo, A.B., Gonçalves, C.R., Braga da Silva, J.A., Ximenes, A.C., Bértolo, M.B., Ethnic influence in clinical and functional measures of Brazilian patients with spondyloarthritis (2012) J. Rheumatol, 39, pp. 141-147Clegg, D.O., Reda, D.J., Weisman, M.H., Blackburn, W.D., Cush, J.J., Cannon, G.W., Comparison of sulfasalazine and placebo in the treatment of ankylosing spondylitis (1996) A Department of Veterans Affairs Cooperative Study. Arthritis Rheum, 39, pp. 2004-2012Chen, J., Liu, C., Is sulfasalazine effective in ankylosing spondylitis? (2006) A systematic review of randomized controlled trials. J Rheumatol, 33, pp. 722-731Gupta, A.K., Grober, J.S., Hamilton, T.A., Ellis, C.N., Siegel, M.T., Voorhees, J.J., Sulfasalazine therapy for psoriatic arthritis: a double blind, placebo controlled trial (1995) J Rheumatol, 22, pp. 894-898Combe, B., Goupille, P., Kuntz, J.L., Tebib, J., Lioté, F., Bregeon, C., Sulphasalazine in psoriatic arthritis: a randomized, multicentre, placebo-controlled study (1996) Br J Rheumatol, 35, pp. 664-668Clegg, D.O., Reda, D.J., Mejias, E., Cannon, G.W., Weisman, M.H., Taylor, T., Comparison of sulfasalazine and placebo in the treatment of psoriatic arthritis (1996) A Department of Veterans Affairs Cooperative Study. Arthritis Rheum, 39, pp. 2004-2012Clegg, D.O., Reda, D.J., Weisman, M.H., Cush, J.J., Vasey, F.B., Schumacher Jr., H.R., Comparison of sulfasalazine and placebo in the treatment of reactive arthritis (Reiter's syndrome) (1996) A Department of Veterans Affairs Cooperative Study. Arthritis Rheum, 39, pp. 2021-2027Consensus guidelines for the management of inflammatory bowel disease (2010) Arq Gastroenterol, 47, pp. 313-325. , Brazilian Study Group of Inflammatory Bowel DiseasesD'Haens, G.R., Panaccione, R., Higgins, P.D., Vermeire, S., Gassull, M., Chowers, Y., The London Position Statement of the World Congress of Gastroenterology on Biological Therapy for IBD with the European Crohn's and Colitis Organization: When to start, when to stop, which drug to choose, and how to predict response? (2011) Am J Gastroenterol, 106, pp. 199-212Carneiro, S., Bortoluzzo, A.B., Gonçalves, C.R., Braga da Silva, J.A., Ximenes, A.C., Bértolo, M.B., Impact of enthesitis in 1505 Brazilian patients with spondyloarthritis (2013) J Rheumatol, 40, pp. 1719-172

Topographic abnormality of slow cortical potentials in schizophrenia

A recent study from our laboratory has provided evidence for the generation of slow potentials occurring in anticipation to task-performance feedback stimuli, in multiple association cortical areas, consistently including two prefrontal areas. In the present study, we intended to determine whether these slow potentials would indicate some abnormality (topographic) in schizophrenic patients, and thus serve as an indication of abnormal association cortex activity. We recorded slow potentials while subjects performed a paired-associates memory task. A 123-channel EEG montage and common average reference were used for 20 unmedicated schizophrenic (mean duration of illness: 11.3 ± 9.2 years; mean number of previous hospitalizations: 1.2 ± 1.9) and 22 healthy control subjects during a visual paired-associates matching task. For the topographic analysis, we used a simple index of individual topographic deviation from normality, corrected for absolute potential intensities. Slow potentials were observed in all subjects. Control subjects showed a simple spatial pattern of voltage extrema (left central positive and right prefrontal negative), whereas schizophrenic patients presented a more complex, fragmented pattern. Topographic deviation was significantly different between groups (P < 0.001). The increased topographic complexity in schizophrenics could be visualized in grand averages computed across subjects. Increased topographic complexity could also be seen when grand averages were computed for subgroups of patients assembled either according to task-performance (high versus low) or by their scores on psychopathological scales. There was no significant correlation between topographic deviation and psychopathology scores. We conclude that the slow potential topographic abnormalities of schizophrenia indicate an abnormality in the configuration of large-scale electrical activity in association cortices

Low Prevalence Of Renal, Cardiac, Pulmonary, And Neurological Extra-articular Clinical Manifestations In Spondyloarthritis: Analysis Of The Brazilian Registry Of Spondyloarthritis

Objective: To describe the extra-articular manifestations (cardiac, renal, pulmonary, and neurological), usually not related to spondyloarthritis (SpA), in a large cohort of Brazilian patients. Materials and methods: This retrospective study analyzed 1,472 patients diagnosed with SpA and cared for at 29 health care centers distributed in the five major geographic regions in the country, participating in the Brazilian Registry of Spondyloarthritis (BRS). All patients were assessed for the prevalence of major extra-articular manifestations (cardiac, renal, pulmonary, and neurological), classify ed according to the diagnosis [ankylosing spondylitis (AS), psoriatic arthritis (PsA), reactive arthritis (ReA), arthritis associated with inflammatory bowel disease (IBD), undifferentiated spondyloarthritis (uSpA), and juvenile SpA], and according to the clinical presentation (axial, peripheral, mixed, and enthesitis). Results: Of the patients with SpA assessed, 963 had AS, 271 PsA, 49 ReA, 48 arthritis associated with IBD, 98 uSpA, and 43 juvenile SpA. Cardiac involvement was reported in 44 patients (3.0%), pulmonary involvement in 19 (1.3%), renal involvement in 17 (1.2%), and neurological involvement in 13 patients (0.9%). Most patients with visceral involvement had AS or PsA, and the mixed (axial + peripheral) and/or predominantly axial clinical form. Conclusion: Cardiac, renal, pulmonary, and neurological extra-articular manifestations are quite infrequent in SpA, ranging from 0.9% to 3% in this large Brazilian cohort, and affected predominantly patients with AS and PsA. © 2012 Elsevier Editora Ltda. All rights reserved.523375383Sieper, J., Rudwaleit, M., Baraliakos, X., Brandt, J., Braun, J., Burgos-Vargas, R., The Assessment of SpondyloArthritis international Society (ASAS) handbook: A guide to assess spondyloarthritis (2009) Ann Rheum Dis, 68 (SUPPL 2), pp. ii1-44Mielants, H., van den Bosh, F., Extra-articular manifestations (2009) Clin Exp Rheumatol, 27 (4 SUPPL 55), pp. S56-S61van der Cruyssen, B., Ribbens, C., Boonen, A., Mielants, H., de Vlam, K., Lenaerts, J., The epidemiology of ankylosing spondylitis and the commencement of anti-TNF therapy in daily rheumatology practice (2007) Ann Rheum Dis, 66 (8), pp. 1072-1077van der Linden, S., Valkenburg, H.A., Cats, A., Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria (1984) Arthritis Rheum, 27 (4), pp. 361-368Moll, J.M.H., Wright, V., Psoriatic arthritis (1973) Semin Arthritis Rheum, 3 (1), pp. 55-78Kingsley, G., Sieper, J., Third International Workshop on Reactive Arthritis. 23-26 September 1995, Berlin, Germany. Report and abstracts (1996) Ann Rheum Dis, 55 (8), pp. 564-584Bergfeldt, L., HLA-B27-associated cardiac disease (1997) Ann Intern Med, 127 (8 PT 1), pp. 621-629Peeters, A.J., ten Wolde, S., Sedney, M.I., de Vries, R.R., Dijkmans, B.A., Heart conduction disturbance: An HLA-B27 associated disease (1991) Ann Rheum Dis, 50 (6), pp. 348-350Brunner, F., Kunz, A., Weber, U., Kissling, R., Ankylosing spondylitis and heart abnormalities: Do cardiac conduction disorders, valve regurgitation and diastolic dysfunction occur more often in male patients with diagnosed ankylosing spondylitis for over 15 years than in the normal population? (2006) Clin Rheumatol, 25 (1), pp. 24-29Palazzi, C., D'angelo, S., Lubrano, E., Olivieri, I., Aortic involvement in ankylosing spondylitis (2008) Clin Exp Rheumatol, 26 (3 SUPPL 49), pp. S131-S134Eder, L., Sadek, M., McDonald-Blumer, H., Gladman, D.D., Aortitis and spondyloarthritis - an unusual presentation: Case report and review of the literature (2010) Semin Arthritis Rheum, 39 (6), pp. 510-514Peters, M., van der Horst-Bruinsma, I.E., Dijkmans, B.A., Nurmohamed, M.T., Cardiovascular risk profile of patients with spondyloarthropathies, particularly ankylosing spondylitis and psoriatic arthritis (2004) Semin Arthritis Rheum, 34 (3), pp. 585-592Heeneman, S., Daemen, M.J., Cardiovascular risks in spondyloarthritides (2007) Curr Opin Rheumatol, 19 (4), pp. 358-362Han, C., Robinson Jr., D.W., Hackett, M.V., Paramore, L.C., Fraeman, K.H., Bala, M.V., Cardiovascular disease and risk factors in patients with rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis (2006) J Rheumatol, 33 (11), pp. 2167-2172Rosenow, E., Strimlan, C.V., Muhm, J.R., Ferguson, R.H., Pleuropulmonary manifestations of ankylosing spondylitis (1977) Mayo Clin Proc, 52 (10), pp. 641-649Casserly, I.P., Fenlon, H.M., Breatnach, E., Sant, S.M., Lung findings on high-resolution computed tomography in idiopathic ankylosing spondylitis - correlation with clinical findings, pulmonary function testing and plain radiograph (1997) Br J Rheumatol, 36 (6), pp. 677-682El-Maghraoui, A., Chaouir, S., Abid, A., Bezza, A., Tabache, F., Achemlal, L., Lung findings on thoracic high-resolution computed tomography in patients with ankylosing spondylitis. Correlations with disease duration, clinical findings and pulmonary function testing (2004) Clin Rheumatol, 23 (2), pp. 123-128Sampaio-Barros, P.D., Cerqueira, E.M., Rezende, S.M., Maeda, L., Conde, R.A., Zanardi, V.A., Pulmonary involvement in ankylosing spondylitis (2007) Clin Rheumatol, 26 (2), pp. 225-230Bruneau, C., Villiaumey, J., Avouac, B., Martigny, J., Laurent, J., Pichot, A., Seronegative spondyloarthropathies and IgA glomerulonephritis: A report of four cases and a review of the literature (1986) Semin Arthritis Rheum, 15 (3), pp. 179-184Strobel, E.S., Frithschka, E., Renal diseases in ankylosing spondylitis: Review of the literature illustrated by case reports (1998) Clin Rheumatol, 17 (6), pp. 524-530Vilar, M.J., Cury, S.E., Ferraz, M.B., Sesso, R., Atra, E., Renal abnormalities in ankylosing spondylitis (1997) Scand J Rheumatol, 26 (1), pp. 19-23Lange, U., Stapfer, G., Ditting, T., Geiger, H., Teichmann, J., Müller-Ladner, U., Pathologic alterations of the heart and the kidney in patients with ankylosing spondylitis (2007) Eur J Med Res, 12 (12), pp. 573-581Azevedo, D.C., Ferreira, G.A., Carvalho, M.A., Nefropatia por IgA em portadores de espondiloartrites acompanhados no Serviço de Reumatologia do Hospital das Clínicas da UFMG (2011) Rev Bras Reumatol, 51 (5), pp. 412-422Gallinaro, A.L., Ventura, C., Barros, P.D., Gonçalves, C.R., Spondyloarthritis: Analysis of a Brazilian series compared with a large Ibero-American registry (RESPONDIA group) (2010) Rev Bras Reumatol, 50 (5), pp. 581-589Lehtinen, K., Mortality and causes of death in 398 patients admitted to hospital with ankylosing spondylitis (1993) Ann Rheum Dis, 52 (3), pp. 174-176Gratacos, J., Orellana, C., Sanmarti, R., Sole, M., Collado, A., Gomez-Casanovas, E., Secondary amyloidosis in ankylosing spondylitis. A systematic survey of 137 patients using abdominal fat aspiration (1997) J Rheumatol, 24 (5), pp. 912-915Hunter, T., The spinal complications of ankylosing spondylitis (1989) Semin Arthritis Rheum, 19 (3), pp. 172-182Ahn, N.U., Ahn, U.M., Nallamshetty, L., Springer, B.D., Buchowski, J.M., Funches, L., Cauda equina syndrome in ankylosing spondylitis (the CES-AS syndrome): Meta-analysis of outcomes after medical and surgical treatments (2001) J Spinal Disord, 14 (5), pp. 427-433Ramos-Remus, C., Gomez-Vargas, A., Hernandez-Chavez, A., Gamez-Nava, J.I., Gonzalez-Lopez, L., Russell, A.S., Two year followup of anterior and vertical atlantoaxial subluxation in ankylosing spondylitis (1997) J Rheumatol, 24 (3), pp. 507-510Westerveld, L.A., Verlaan, J.J., Oner, F.C., Spinal fractures in patients with ankylosing spinal disorders: A systematic review of the literature on treatment, neurological status and complications (2009) Eur Spine J, 18 (2), pp. 145-15