Latitude gradient influences the age of onset of rheumatoid arthritis : a worldwide survey

The age of onset of rheumatoid arthritis (RA) is an important outcome predictor. Northern countries report an age of RA onset of around 50 years, but apparently, variability exists across different geographical regions. The objective of the present study is to assess whether the age of onset of RA varies across latitudes worldwide. In a proof-of-concept cross-sectional worldwide survey, rheumatologists from preselected cities interviewed 20 consecutive RA patients regarding the date of RA onset (RAO, when the patient first noted a swollen joint). Other studied variables included location of each city, rheumatologist settings, latitudes (10A degrees increments, south to north), longitudes (three regions), intracountry consistency, and countries' Inequality-adjusted Human Development Index (IHDI). Data from 2481 patients (82% females) were obtained from 126 rheumatologists in 77 cities of 41 countries. Worldwide mean age of RAO was 44 +/- 14 years (95% CI 44-45). In 28% of patients, RA began before age 36 years and before age 46 years in 50% of patients. RAO was 8 years earlier around the Tropic of Cancer when compared with northern latitudes (p <0.001, 95% CI 3.5-13). Multivariate analysis showed that females, western cities, and latitudes around the Tropic of Cancer are associated with younger age of RAO (R (2) 0.045, p <0.001). A positive correlation was found between the age of RAO and IHDI (r = 0.7, p <0.01, R (2) 0.5). RA often begins at an early age and onset varies across latitudes worldwide. We postulate that countries' developmental status and their geographical and geomagnetic location influence the age of RAO.Peer reviewe

Possible mechanisms of chronic leprosy-related arthritis

Microbial agents induce arthritis through mechanisms such as direct infiltration of tissue and by inducing autoimmune phenomena. The mechanisms involved in this last type of arthritis have been investigated. In experimental models of adjuvant and reactive arthritis, the involvement of T cells and in some cases mycobacteria in the development of arthritis have been confirmed. Cross-reactivity between the 65 kD mycobacterial protein and cartilage proteoglycans has been postulated as a possible mechanism. In this study, chronic peripheral arthritis was observed in patients with Hansen's disease, in patients with resolved Hansen's and in those with paucibacillary forms. This arthritis was not related to reactional states (erythema nodosum Ieprosum and reversal reaction), in contrast to several reports in the literature. The mechanisms by which microbes could induce chronic arthritis are discussed herein

Humoral immunity in Hansen's Disease

For many years immune response in leprosy has been studied. Since 1960 several reports dealing with humoral immunity have been described in the literature. Different autoantibody rates occur in leprosy. There is an increase in the prevalence of autoantibodies in elderly patients with long standing disease, in lepromatous leprosy and in those with reactional states. The diferences in rates among various studies are attributed to different methods and variations among patient samples concerning age, gender, polar forms, therapy and other elements. The prevalence of numerous antibodies, immune complexes, cryoglobulins and complement levels have been studied by many authors. This also highlights the importance of the more recent reviews of anti-Mycobacterium leprae glycolipid antibodies such as the anti-phenolic glycolipid-I antibodies in which titers are variable and depend on genetic factors

Farmacoeconomia do tratamento da Artrite Reumatoide e seu impacto na saúde pública

A artrite reumatoide (AR) é uma doença crônica que afeta cerca de 1% da população brasileira. Nas últimas décadas, com o aprimoramento e desenvolvimento de novas tecnologias na indústria farmacêutica, novos medicamentos, em especial os imunobiológicos, foram introduzidos para o tratamento da AR. O surgimento destes agentes contribuiu, quantitativamente e qualitativamente para o controle eficaz da inflamação reumatoide. Devido à alta necessidade de investimento para desenvolvimento e fabricação desses medicamentos, o preço no mercado é muito elevado tornando-os muitas vezes, inacessíveis, sendo denominados de alto custo. Sendo o Brasil um dos poucos países que possui um Sistema Único de Saúde, há a possibilidade de tratamento da AR com esses novos medicamentos através de capital repassado pelo fundo de saúde aos órgãos responsáveis por esse controle. Na última década, alguns estudos começaram a investigar o impacto desses medicamentos no orçamento destinado a compra de medicamentos do SUS. Neste estudo, escalonamos os gastos públicos com medicamentos de alto custo para tratamento da AR, através da coleta e análise de dados de prontuários fornecidos pelo ambulatório de especialidades da Faculdade de Medicina de Jundiaí, que realiza atendimentos em reumatologia. A partir desse levantamento, pretende-se fomentar um questionamento na área da saúde a respeito do destino do capital investido pelas agências do governo, analisando o contexto e necessidade do uso de medicamentos de alto custo, que podem estar associados ao diagnóstico tardio da AR. Em última instância, este trabalho visa iniciar uma discussão sobre a política aplicada da medicina preventiva, com investimento em diagnóstico precoce, evitando que a doença chegue em estágios avançados que necessitam de medicamentos mais potentes e de custo elevado, redirecionando e até mesmo reduzindo, gastos públicos finais

Primary Meningococcal Polyarthritis in an Adult Woman

Primary joint infection caused by the Gram-negative bacteria Neisseria meningitidis is rare. Normally, joint involvement comes secondary to meningitis or severe sepsis caused by this agent. When primary arthritis is seen, monoarthritis is the most common presentation. A meningococcal polyarthritis is described in less than 10 case reports according to current literature. This case report aims to briefly review this rare clinical event in an adult woman with no previous history of rheumatological disease. Early diagnosis of polyarthritis caused by meningococcal bacteria usually present a good prognosis when properly treated