A nationwide cross-sectional study

Funding Information: The study was supported by unrestricted grants from Direcção-Geral da Saúde , Fundação Calouste Gulbenkian , Fundação Champalimaud , Fundação AstraZeneca , Abbvie , Merck, Sharp & Dohme , Pfizer , Roche , Servier , Bial , D3A Medical Systems , Happybrands , Center de Medicina Laboratorial Germano de Sousa , Clínica Médica da Praia da Vitória , CAL-Clínica , Galp Energia , Açoreana Seguros , and individual rheumatologists .Introduction: Multimorbidity is a worldwide health problem, especially in elderly patients who have a higher risk of fragility fracture. Currently, there is insufficient knowledge about the burden of multimorbidity in patients with previous fragility fracture. The aim of this study was to evaluate the association between multimorbidity and previous fragility fracture, and to assess the effect of fragility fracture and/or multimorbidity in the perception of quality-of-life and physical function, in women 50 years of age and older. Methods: Women aged ≥50 years from the EpiReumaPt study (2011−2013), a nationwide population-based study, were evaluated. Self-reported data regarding sociodemographics, health-related quality of life, physical functioning, fragility fracture, and multimorbidity were collected using a semi-structured questionnaire. Multimorbidity was defined as 2 or more chronic non-communicable diseases. Descriptive exploratory analysis of the data was performed using hypothesis testing. Multiple logistic regression modelling was used to assess the association between multimorbidity and fragility fractures, and linear regression was used for the quality-of-life and physical function outcomes. Results: The estimated prevalence of fragility fracture in women older than 50 years was 17.5%. A higher prevalence of multimorbidity (74.6%) was found in the group of women with previous fragility fracture than in those without previous fragility fracture. Multivariate logistic regression analysis revealed that women with multimorbidity had a higher odds of fragility fracture (adjusted odds ratio, 1.38; 95% confidence interval, 1.12–1.69), compared with women with 1 or no self-reported non-communicable chronic diseases. In women with previous fragility fracture, rheumatic diseases (62.7%) and hypertension (58.6%) were the most frequently self-reported non-communicable chronic diseases. Both multimorbidity and a previous fragility fracture were independently associated with worse health-related quality of life and physical functioning. Conclusions: Women 50 years and older with multimorbidity had a significantly increased odds of fragility fracture. Fragility fracture and multimorbidity were negatively associated with quality of life and disability. This study emphasizes the need to redesign health services to care for patients to prevent non-communicable chronic diseases and fragility fracture, particularly in women 50 years and older, in whom these diseases are likely to potentiate the risk of fragility fracture.publishersversionpublishe

An atypical case of focal myositis

A 64-year-old woman presented with a 10-day history of painful progressive bilateral temporal and right retroauricular region tumefaction, dysphonia, and a body temperature of 37.5°C. She had been previously prescribed antibiotics assuming an oral infection, with no benefit. She had no other complaints and her past medical history and clinical exam were otherwise unremarkable. Her labs revealed high levels of CRP (11.7 mg/dl), ESR (52 mm/h), creatine kinase (CK 623 U/l), myoglobin (83 U/l), aspartate transaminase (56 U/l) and alanine transaminase (69 U/l). Serologies were negative for Treponema pallidum, human immunodeficiency, hepatitis B and C, and Epstein–Barr viruses; blood cultures and immunological study, including anti-nuclear antibodies and antibodies associated with inflammatory myopathies, were negative. A facial MRI revealed thickening and T2/FLAIR hypersignal of the temporal, masseter, and pterygoid muscles with signal intensification after gadolinium injection, suggesting myositis. A temporal muscle biopsy showed marked lymphocyte infiltration (predominantly lymphocyte T CD3), as well as the marking of multiple fibres with major histocompatibility complex class I products, which supported the diagnosis. Prednisolone 0.5 mg/kg/day (30 mg) was started, with marked clinical improvement and normalization of CRP, ESR, and CK.info:eu-repo/semantics/publishedVersio

Portuguese translation, cross-cultural adaptation and reliability of the questionnaire "Start Back Screening Tool" (SBST)

Objetivo: Traducir y realizar la adaptación intercultural del cuestionario StarT Back Screening Tool (SBST) para evaluar el dolor lumbar en su aplicación en portugués, y probar su fiabilidad. Método: Para establecer la equivalencia conceptual, la preocupación semántica y operativa, se realizaron dos traducciones al portugués de forma independiente. Se obtuvo una versión combinada por consenso entre los autores de las traducciones para lograr una versión notable en términos semánticos y fácil de entender. La versión de síntesis se administró a 40 sujetos distribuidos por sexo, jóvenes y adultos mayores, con y sin dolor lumbar. A través de entrevistas cognitivas con los sujetos de la muestra, se evaluó la claridad, la aceptabilidad, así como la familiarización de la versión en portugués, promoviendo los cambios necesarios para una mejor comprensión. La versión final en portugués del cuestionario fue traducida nuevamente al idioma original. Para evaluar las propiedades psicométricas de SBST-Portugal, 31 sujetos con dolor lumbar realizaron dos entrevistas. Resultados: Los participantes entrevistados informaron que, en general, los ítems eran claros y comprensibles, logrando la validez de la cara. La fiabilidad del SBST-Portugal mostró un valor de Kappa de 0,74 (95% IC 0,53-0,95) y la consistencia interna (alfa de Cronbach) fue de 0,93 para el puntaje total y de 0,93 para la subescala psicosocial Conclusión: La versión portuguesa del cuestionario SBST resultó ser equivalente a la versión original en inglés y fiable para la población portuguesa con dolor lumbar. Al ser un instrumento de fácil acceso y aplicación, podría utilizarse en la atención primaria.Objective: To translate and perform the cross-cultural adaptation of the StarT Back Screening Tool (SBST) questionnaire to assessment and screening low back pain for Portuguese application, and test their reliability. Method: To establish conceptual equivalence in item, semantic and operational concern, there were performed two translations into Portuguese in a independently way. A combined version was obtained by consensus among the authors of the translations in order to be achieved a noticeable version in semantic terms and easy to understand. The synthesis version was administered to 40 subjects distributed by gender, young and older adults, with and without low back pain. Through cognitive interviews with the subjects of the sample, clarity, the acceptability, as well as the familiarization of the Portuguese version was evaluated, promoting the changes necessary for a better understanding. The final Portuguese version of the questionnaire was then back-translated into the original language. To evaluate the SBST-Portugal psychometric properties, 31 subjects with low back pain performed two interviews. Results: Participants interviewees reported that in general the items were clear and comprehensible achieving face validity. The reliability of the SBST-Portugal showed a Kappa value of 0,74 (95%IC 0,53-0,95), and the internal consistency (Cronbach's alpha) was 0,93 for the total score and 0,93 for the psychosocial subscale.peerReviewe

Comparative effectiveness and predictors of response to tumour necrosis factor inhibitor therapies in rheumatoid arthritis

Funding Information: positions on two Pfizer sponsored trials and has directed an educational course supported by Bristol Myers Squibb. He serves as an epidemiology consultant to CORRONA. J.A.P.S. has received honoraria as a speaker or consultant and benefited from research support from several pharmaceutical companies involved in the production of biologic agents (Abbott, Amgen, MSD, Pfizer and Roche), always at sums less than E10 000. All other authors have declared no conflicts of interest. Funding Information: Funding: This work was supported by a grant from Harvard-Portugal Program HMSP-ICS/SAU-ICT/0002/ 2010.Objectives: Adalimumab, etanercept and infliximab are effective TNF inhibitors (TNFis) in the treatment of RA, but no randomized clinical trials have compared the three agents. Prior observational data are not consistent. We compared their effectiveness over 1 year in a prospective cohort.Methods: Analyses were performed on subjects' first episode of TNFi use in the Rheumatic Diseases Portuguese Register, Reuma.pt. The primary outcome was the proportion of patients with European League Against Rheumatism good response sustained at two consecutive observations separated by 3 months during the first year of TNFi use. Comparisons were performed using conventional adjusted logistic regression, as well as matching subjects across the three agents using a propensity score. In addition, baseline predictors of treatment response to TNFi were identified.Results: The study cohort included 617 RA patients, 250 starting etanercept, 206 infliximab and 161 adalimumab. Good response was achieved by 59.6% for adalimumab, 59.2% for etanercept and 51.9% for infliximab (P = 0.21). The modelled probability of good response did not significantly differ across agents (etanercept vs adalimumab OR = 0.97, 95% CI 0.55, 1.71; etanercept vs infliximab OR = 1.25, 95% CI 0.74, 2.12; infliximab vs adalimumab OR = 0.80, 95% CI 0.47, 1.36). Matched propensity score analyses also showed no significant treatment response differences. Greater educational attainment was a predictor of better response, while smoking, presence of ACPA, glucocorticoid use and worse physician assessment of disease activity at baseline each predicted a reduced likelihood of treatment response.Conclusion: Over 1 year, we found no difference in effectiveness between adalimumab, etanercept and infliximab.publishersversionpublishe

description of the methodological approach

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Anxiety and Depression in the Portuguese Older Adults: Prevalence and Associated Factors

Anxiety and depression in the elderly individuals have been studied around the world, and some authors consider them among the most serious problems faced by modern societies. With recent economic crisis—very important in Southern European countries—isolation, loneliness, and exclusion of the active society, mental problems are probably raising and associated with distinct factors. In this cross-sectional analysis, nested in a longitudinal population-based cohort study, we analyze anxiety and depression prevalence, and their related factors, in a representative cohort of Portuguese seniors. We used data retrieved from second wave of follow-up of EpiDoC Cohort—EpiDoC 2 study, which is composed by 10,661 adults, representative of adult Portuguese population. This study included all ≥65 years old EpiDoC 2 study participants, who responded to Hospital Anxiety and Depression Scale (HADS), n = 1,680. Sociodemographic, lifestyles, self-reported non-communicable diseases, health-related quality of life (EQ-5D-3D), physical function (HAQ), and health resources consumption data were collected. Anxiety and depression were assessed with HADS. Anxiety and depression prevalence were estimated. Multivariable logistic regression was used to assess anxiety and depression score determinants. The estimated prevalence of anxiety among Portuguese elderly is 9.6% and depression is 11.8%. Seniors with anxiety and seniors with depression have a higher probability to self-report higher levels of physical disability (OR = 3.10; 96% CI 2.12–4.52; OR = 3.08, 95% CI 2.29–4.14, respectively) and lower levels of quality of life (OR = 0.03, 95% CI 0.01–0.09; OR = 0.03, 95% CI 0.01–0.06, respectively). Female gender (OR = 2.77, 95% CI 1.53–5.00), low educational level (OR = 2.30, 95% CI 1.22–4.36), allergic (OR = 2.02, 95% CI 1.14–3.55), and rheumatic disease (OR = 2.92, 95% CI 1.74–4.90) were significantly and independently associated with the presence of anxiety symptoms. Physical inactivity (OR = 1.64, 95% CI 1.11–2.42) and low educational level (OR = 2.40, 95% CI 1.41–4.09) were significantly and independently associated with depression symptoms. Subjects that reported to drink alcohol daily or occasionally were negatively associated with depression symptoms. Anxiety and depression are frequent among Portuguese elderly. These prevalence rates suggest that preventing mental illness in senior population is a crucial need. A well-designed prevention strategy might have an effective action in raising the well-being of elderly

Fetal safety profile of drugs used in the treatment of inflammatory rheumatic diseases

The high prevalence of inflammatory rheumatic diseases in women of childbearing age increases the risk of exposure to antirheumatic agents during conception, pregnancy and breast feeding. The decision for pharmacological treatment initiation/ maintenance should be the result between the severity of maternal disease and the risk/benefits with treatment. The aim of this paper was to review recent literature about drug fetal safety profile, strength the importance of monitoring the pregnancy in patients with inflammatory rheumatic diseases and stress the need for further research in this area.publishersversionpublishe

Prevalence of vitamin D deficiency and its predictors in the Portuguese population: a nationwide population-based study

Summary Vitamin D deficiency is prevalent worldwide, but its prevalence is unknown in adult Portuguese population. In Portugal, 66% of adults present Vitamin D insufficiency/deficiency. Winter, living in Azores, older age, and obesity were the most important risk factors. It highlights the need of strategies to prevent vitamin D deficiency in Portugal. Objective To estimate the prevalence and risk factors of vitamin D deficiency in the adult Portuguese population. Methods Adults (≥ 18 years old) from the EpiReumaPt Study (2011–2013) were included. Standardized questionnaires on sociodemographic and lifestyle features were obtained. Serum 25-hydroxyvitamin D [25(OH)D] concentrations were evaluated using ADVIA Centaur VitD competitive immunoassay (Siemens Healthineers) in 2015–2017 as 25 (OH)D Level 0: ≤ 10 ng/mL; Level 1: 11–19 ng/mL; Level 2: 20–29 ng/mL, and Level 3: ≥ 30 ng/mL. Weighted multinomial regression analysis was conducted to evaluate the association between socio-demographic and lifestyle variables and vitamin D status. Results Based on weighted analysis, the estimated prevalence of levels of 25(OH)D ≤ 10, < 20, and < 30 ng/mL was 21.2, 66.6, and 96.4%, respectively. The strongest independent predictors of serum 25 (OH)D ≤ 10 ng/mL were living in the Azores archipelagos (OR 9.39; 95%CI 1.27–69.6) and having the blood sample collection in winter (OR 18.53; 95%CI 7.83–43.87) or spring (11.55; 95%CI 5.18–25.74). Other significant predictors included older age (OR 5.65, 95%CI 2.08–15.35), obesity (OR 2.61; 95%CI 1.35–5.08), current smoking (OR 2.33; 95%CI 1.23–4.43), and female gender (OR 1.9, 95%CI 1.1–3.28). Conversely, physical exercise (OR 0.48, 95%CI 0.28–0.81) and occasional alcohol intake (OR 0.48, 95%CI 0.29–0.81) were associated with a lower risk of 25(OH)D ≤ 10 ng/mL. Conclusion Vitamin D deficiency/insufficiency [25(OH)D 60% of all Portuguese adults, with strong geographical and seasonal variation. This study highlights the need to critically assess the relevance of vitamin D deficiency as a public health problem and the urgent need for a wide and scientifically robust debate about the most appropriate interventions at the individual and societal levels.info:eu-repo/semantics/publishedVersio