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

Psoriatic arthritis and ankylosing spondylitis impact on health-related quality of life and working life : a comparative population-based study

© 2001-2020 Sociedade Portuguesa de ReumatologiaIntroduction: Psoriatic arthritis (PsA) and ankylosing spondylitis (AS) are chronic disorders that significantly impact patients’ quality of life (QoL), health care systems and society. There is very limited data on the epidemiology and the impact of PsA and AS in Portugal, so in this study we aim to: 1) estimate the prevalence of PsA and AS in the adult Portuguese population; 2) compare health-related quality of life (QoL) of PsA and AS with the one of other rheumatic and musculoskeletal diseases (RMD) and with subjects with no rheumatic diseases; 3) compare early retirement and productivity loss among PsA and AS with other RMD. Methods: We used data from EpiReumaPt, a population-based survey, conducted from 2011 to 2013, in which 10661 subjects, over 18 years old, were screened for RMD. Spondyloarthritis (SpA) was defined by a positive expert opinion combined with the fulfillment of the Assessment of Spondyloarthritis International Society (ASAS) criteria for axial and peripheral SpA. Estimates were computed as weighted proportions considering the study design. Logistic regressions were used to compare AS/PsA subjects with other RMD and the adult Portuguese population without rheumatic diseases. Results: Prevalence rate of SpA was of 1.6% (95% CI 1.2% to 2.1%). Subjects with AS or PsA had worse QoL, reflected by EQ5D score when compared with the adult Portuguese population without rheumatic diseases (b=- 0.08; p=0.031). AS and PsA also had worse QoL when compared with participants with other RMD (b=-0.22; p>0.001). AS and in comparison to patients with other RMD, PsA subjects retired early due to their illness (OR=4.95; 95% CI 1.54% to 15.93%). A significant proportion of patients with SpA (13.6%) referred absenteeism in the previous 12 months to the interview. Conclusions: AS and PsA were found to be associated with poor QoL and a high rate of disease-related early retirement, emphasizing the burden of such rheumatic conditions in Portugal.info:eu-repo/semantics/publishedVersio

A Comparative Population-Based Study

INTRODUCTION: Psoriatic arthritis (PsA) and ankylosing spondylitis (AS) are chronic disorders that significantly impact patients' quality of life (QoL), health care systems and society. There is very little data on the epidemiology and the impact of PsA and AS in Portugal, so in this study we aim to: 1) estimate the prevalence of PsA and AS in the adult Portuguese population; 2) compare health-related quality of life (QoL) of PsA and AS with the one of other rheumatic and musculoskeletal diseases (RMD) and with subjects with no rheumatic diseases; 3) compare early retirement and productivity loss among PsA and AS with other RMD. METHODS: We used data from EpiReumaPt, a population-based survey, conducted from 2011 to 2013, in which 10661 subjects over 18 years old were screened for RMD. Spondyloarthritis (SpA) was defined by a positive expert opinion combined with the fulfillment of the assessment of spondyloarthritis international society (ASAS) criteria for axial and peripheral SpA. Estimates were computed as weighted proportions considering the study design. Logistic regressions were used to compare AS/PsA subjects with other RMD and the adult Portuguese population without rheumatic diseases. RESULTS: Prevalence rate of SpA was 1.6% (95% CI 1.2% to 2.1%). Subjects with AS or PsA had worse QoL, reflected by EQ5D score when compared with the adult Portuguese population without rheumatic diseases (β=- 0.08; p=0.031). AS and PsA also had worst QoL when compared with participants with other RMD (β=-0.22; p>0.001). AS and in comparison to patients with other RMD, PsA subjects retired early due to their illness (OR=4.95; 95% CI 1.54% to 15.93%). A significant proportion of patients with SpA (13.6%) referred absenteeism in the previous 12 months to the interview. CONCLUSIONS: AS and PsA were found to be associated with poor QoL and a high rate of disease-related early retirement, emphasizing the burden of such rheumatic conditions in Portugal.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

Association between EBV serological patterns and lymphocytic profile of SjS patients support a virally triggered autoimmune epithelitis

Sjögren's syndrome (SjS) is characterized by lymphocytic infiltration of exocrine glands, i.e. autoimmune epithelitis. Lymphocytes are central in SjS pathogenesis, with B-cell hyperactivity mediated by T-cells. B-cells are main targets of Epstein-Barr virus (EBV) infection, a frequently-suggested trigger for SjS. We aimed to evaluate how the EBV infection modulates B and T-cell subsets in SjS, including as controls Rheumatoid arthritis patients (RA) and healthy participants (HC). SjS patients presented decreased CXCR5+T-cells, although IL21-secreting Tfh and Tfc cells were increased. Tfc were positively correlated with ESSDAI scores, suggesting their relevant role in SjS pathogenesis. As previously described, SjS patients showed expanded circulating naïve B-cell compartments. SjS patients had a higher incidence of EBV-EA-D-IgG+ antibodies, characteristic of recent EBV-infection/reactivation. SjS patients with past infection or recent infection/reactivation showed increased CXCR3+Th1 and CXCR3+Tfh1 cells compared to those without active infection. SjS patients with a recent infection/reactivation profile presented increased transitional B-cells compared to patients with past infection and increased plasmablasts, compared to those without infection. Our results suggest EBV-infection contributes to B and T-cell differentiation towards the effector phenotypes typical of SjS. Local lymphocyte activation at ectopic germinal centres, mediated by Tfh and Tfc, can be EBV-driven, perpetuating autoimmune epithelitis, which leads to gland destruction in SjS.publishersversionpublishe

perceptions and choices among rheumatology outpatients

OBJECTIVE: Biobanks for research (BBR) have enormous value for research, including those specifically oriented to chronic diseases. Knowing public attitudes and perceptions is key to design and implement patient-centered BBR. We assessed patient awareness, perception and choices among rheumatology outpatients regarding aging biobanking activities. METHODS: We conducted a cross-sectional survey of patients, aged 50 or older, attending an outpatient rheumatology tertiary department. Demographic data and perceptions about biobanking were collected and statistical analysis was performed. RESULTS: 132 valid questionnaires were obtained (mean age: 63,4; 68,2% female; mean education years: 8,35). 61,7% of respondents did not know the specific term "biobank", 57,7% knew they could donate biological material for BBR, 89,9% agreed with these infrastructures and 88,3% would consider participation Those participants with more years of education were more knowledgeable and prone to biobank participation. Willingness to participate in BBR was mainly related (86,4%) to the advancement of scientific knowledge and not individual gain. Scientific research institutes were indicated as the most adequate institutions to manage BBR. Informed consent, anonymity and confidentiality ranked as top requisites for biobank participation. 61,3% of respondents expressed their agreement with aging biobanks, considering these as a sign of respect for specific problems of people of older ages such as higher disease burdens. CONCLUSION: Knowledge of biobanks was found to be limited. Participants were positive toward the setting up of biobanks in general and patient-centered aging biobanks in particular. Knowledge about biobanks and acceptance were higher among participants with higher education years.publishersversionpublishe

Nutrition education in portuguese medical students: impact on the attitudes and knowledge

Nutrition has been underrepresented in the curriculum of many medical schools and therefore physicians do not feel adequately prepared to provide dietary counselling. The aim of the present study is to determine the impact of a Nutrition and Metabolism curricular unit on nutrition attitudes, knowledge and confidence on future clinical practice of medical students.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

going beyond BASDAI

This work was supported by a Research Grant from the InvestigatorInitiated Studies program of Merck Sharp & Dohme (Grant No. 56078). The sponsor did not interfere with the study question, analysis or interpretation of results. AS is supported by a doctoral grant from Fundação para a Ciência e Tecnologia (Foundation for Science and Technology) (SFRH/BD/108246/2015).OBJECTIVES: To compare definitions of high disease activity of the Ankylosing Spondylitis Disease Activity Score (ASDAS) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) in selecting patients for treatment with biologic disease-modifying antirheumatic drugs (bDMARDs). METHODS: Patients from Rheumatic Diseases Portuguese Register (Reuma.pt) with a clinical diagnosis of axial spondyloarthritis (axSpA) were included. Four subgroups (cross-tabulation between ASDAS (≥2.1) and BASDAI (≥4) definitions of high disease activity) were compared regarding baseline characteristics and response to bDMARDs at 3 and 6 months estimated in multivariable regression models. RESULTS: Of the 594 patients included, the majority (82%) had both BASDAI≥4 and ASDAS ≥2.1. The frequency of ASDAS ≥2.1, if BASDAI<4 was much larger than the opposite (ie, ASDAS <2.1, if BASDAI≥4): 62% vs 0.8%. Compared to patients fulfilling both definitions, those with ASDAS ≥2.1 only were more likely to be male (77% vs 51%), human leucocyte antigen B27 positive (79% vs 65%) and have a higher C reactive protein (2.9 (SD 3.5) vs 2.1 (2.9)). Among bDMARD-treated patients (n=359), responses across subgroups were globally overlapping, except for the most 'stringent' outcomes. Patients captured only by ASDAS responded better compared to patients fulfilling both definitions (eg, ASDAS inactive disease at 3 months: 61% vs 25% and at 6 months: 42% vs 25%). CONCLUSION: The ASDAS definition of high disease activity is more inclusive than the BASDAI definition in selecting patients with axSpA for bDMARD treatment. The additionally 'captured' patients respond better and have higher likelihood of predictors thereof. These results support using ASDAS≥2.1 as a criterion for treatment decisions.publishersversionpublishe

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