A majority of Brazilian patients with rheumatoid arthritis HLA-DRB1 alleles carry both the HLA-DRB1 shared epitope and anti-citrunillated peptide antibodies

The objective of the present study was to evaluate the contribution of the shared epitope (SE), the rheumatoid arthritis (RA) protection model, and the occurrence of anti-cyclic citrullinated peptide (anti-CCP) antibodies in RA patients from a genetically diverse population. One hundred and forty Brazilian RA patients and 161 matched controls were typed for HLA-DRB1 alleles using amplified DNA hybridized with sequence-specific oligonucleotide probes or primers. Patients were stratified according to the presence or absence of SE (DRB1*0401, *0404, *0405, *0101, *1001, and *1402), of the DERAA alleles (DRB1*0103, *0402, *1102, *1103, *1301, *1302, and *1304), and X (all other alleles). Anti-CCP antibodies were measured by ELISA. The combined frequency of SE-positive alleles was significantly greater (76.4 vs 23.6%, P < 0.0001) than the controls. The SE/SE and SE/X genotypes were over-represented (P < 0.0001, OR = 6.02) and DERAA/X was under-represented in RA patients (P < 0.001, OR = 0.49), whereas the frequencies of the SE/DERAA, X/X and X/DERAA genotypes were not significantly different from controls. The frequency of anti-CCP antibodies was higher in SE-positive patients than in SE-negative patients (64.6 vs 44.7%, P = 0.03; OR = 2.25). Although the Brazilian population is highly miscegenated, the results of this study support the findings observed in most genetically homogeneous populations with RA; however, they are not mutually exclusive but rather complementary. The participation of DRB1-DERAA alleles in protection against RA was also observed (OR = 0.4; 95%CI = 0.23-0.68).CNPqFAEP

2012 Brazilian Society Of Rheumatology Consensus On The Management Of Comorbidities In Patients With Rheumatoid Arthritis

Objective: To elaborate recommendations of the Rheumatoid Arthritis Committee of the Brazilian Society of Rheumatology (SBR) to manage comorbidities in rheumatoid arthritis (RA). Methods: To review the literature and the opinions of the SBR RA Committee experts. Results and conclusions: Recommendations: 1) Early diagnosis and proper treatment of comorbidities are recommended; 2) The specific treatment of RA should be adapted to the presence of comorbidities; 3) Angiotensin-converting-enzyme inhibitors or angiotensin II receptor blockers are preferred to treat systemic arterial hypertension; 4) In patients diagnosed with rheumatoid arthritis and diabetes mellitus, the continuous use of a high cumulative dose of corticoids should be avoided; 5) Statins should be used to maintain LDL cholesterol levels under 100 mg/dL and the atherosclerotic index lower than 3.5 in patients with RA who have other comorbidities; 6) Metabolic syndrome should be treated; 7) Performing non-invasive tests to investigate subclinical atherosclerosis is recommended; 8) Greater surveillance for the early diagnosis of occult malignancy is recommended; 9) Preventive measures of venous thrombosis are suggested; 10) Bone densitometry is recommended in RA patients over the age of 50 years and in younger patients on corticoid therapy at a dose greater than 7.5 mg for over three months; 11) Patients with RA and osteoporosis should be instructed to avoid falls, to increase their dietary calcium intake and sun exposure, and to exercise; 12) Calcium and vitamin D supplementation is suggested. Bisphosphonates are suggested for patients with T score < -2.5 on bone densitometry; 13) A multidisciplinary team, with the active participation of a rheumatologist, is recommended to treat comorbidities. © 2012 Elsevier Editora Ltda.524483495McInnes, I.B., O'Dell, J.R., State-of-the-art: rheumatoid arthritis (2010) Ann Rheum Dis, 69 (11), pp. 1898-1906. , [Erratum in: Ann Rheum Dis 201170(2):399]McInnes, I.B., Schett, G., The pathogenesis of rheumatoid arthritis (2011) N Engl J Med, 365 (23), pp. 2205-2219Allaart, C.F., Huizinga, T.W., Treatment strategies in recent onset rheumatoid arthritis (2011) Curr Opin Rheumatol, 23 (3), pp. 241-244Symmons, D.P., Rheumatoid arthritis: assessing disease activity and outcome (2010) Clin Med, 10 (3), pp. 248-251Gonzalez, A., Maradit Kremers, H., Crowson, C.S., Nicola, P.J., Davis 3rd, J.M., Therneau, T.M., The widening mortality gap between rheumatoid arthritis patients and the general population (2007) Arthritis Rheum, 56 (11), pp. 3583-3587Hemminki, K., Li, X., Sundquist, J., Sundquist, K., Familial associations of rheumatoid arthritis with autoimmune diseases and related conditions (2009) Arthritis Rheum, 60 (3), pp. 661-668Michou, L., Rat, A.C., Lasbleiz, S., Bardin, T., Cornélis, F., Prevalence and distribution of autoimmune diseases in 368 rheumatoid arthritis families (2008) J Rheumatol, 35 (5), pp. 790-796Michaud, K., Wolfe, F., Comorbidities in rheumatoid arthritis (2007) Best Pract Res Clin Rheumatol, 21 (5), pp. 885-906Crowson, C.S., Myasoedova, E., Davis 3rd, J.M., Matteson, E.L., Roger, V.L., Therneau, T.M., Increased Prevalence of metabolic syndrome associated with rheumatoid arthritis in patients without clinical cardiovascular disease (2011) J Rheumatol, 38 (1), pp. 29-35Chung, C.P., Oeser, A., Solus, J.F., Avalos, I., Gebretsadik, T., Shintani, A., Prevalence of the metabolic syndrome is increased in rheumatoid arthritis and is associated with coronary atherosclerosis (2008) Atherosclerosis, 196 (2), pp. 756-763Steiner, G., Urowitz, M.B., Lipid profiles in patients with rheumatoid arthritis: mechanisms and the impact of treatment (2009) Semin Arthritis Rheum, 38 (5), pp. 372-381Solomon, D.H., Love, T.J., Canning, C., Schneeweiss, S., Risk of diabetes among patients with rheumatoid arthritis, psoriatic arthritis and psoriasis (2010) Ann Rheum Dis, 69 (12), pp. 2114-2117van Halm, V.P., Peters, M.J., Voskuyl, A.E., Boers, M., Lems, W.F., Visser, M., Rheumatoid arthritis versus diabetes as a risk factor for cardiovascular disease: a cross-sectional study, the CARRE Investigation (2009) Ann Rheum Dis, 68 (9), pp. 1395-1400Panoulas, V.F., Douglas, K.M., Milionis, H.J., Stavropoulos-Kalinglou, A., Nightingale, P., Kita, M.D., Prevalence and associations of hypertension and its control in patients with rheumatoid arthritis (2007) Rheumatology (Oxford), 46 (9), pp. 1477-1482Kitas, G.D., Gabriel, S.E., Cardiovascular disease in rheumatoid arthritis: state of the art and future perspectives (2011) Ann Rheum Dis, 70 (1), pp. 8-14Gonzalez, A., Maradit Kremers, H., Crowson, C.S., Ballman, K.V., Roger, V.L., Jacobsen, S.J., Do cardiovascular risk factors confer the same risk for cardiovascular outcomes in rheumatoid arthritis patients as in nonrheumatoid arthritis patients? (2008) Ann Rheum Dis, 67 (1), pp. 64-69Panoulas, V.F., Douglas, K.M., Stavropoulos-Kalinoglou, A., Metsios, G.S., Nightingale, P., Kita, M.D., Long-term exposure to medium-dose glucocorticoid therapy associates with hypertension in patients with rheumatoid arthritis (2008) Rheumatology (Oxford), 47 (1), pp. 72-75Alcorn, N., Saunders, S., Madhok, R., Benefit-risk assessment of leflunomide: an appraisal of leflunomide in rheumatoid arthritis 10 years after licensing (2009) Drug Saf, 32 (12), pp. 1123-1134Robert, N., Wong, G.W., Wright, J.M., Effect of cyclosporine on blood pressure (2010) Cochrane Database Syst Rev, (1), pp. CD007893Atzeni, F., Turiel, M., Caporali, R., Cavagna, L., Tomasoni, L., Sitia, S., The effect of pharmacological therapy on the cardiovascular system of patients with systemic rheumatic diseases (2010) Autoimmunity Rev, 9 (12), pp. 835-839White, W.B., Defining the problem of treating the patient with hypertension and arthritis pain (2009) Am J Med, 122 (5 SUPPL.), pp. S3-S9Peters, M.J., Symmons, D.P., McCarey, D., Dijkmans, B.A., Nicola, P., Kvien, T.K., EULAR evidence-based recommendations for cardiovascular risk management in patients with rheumatoid arthritis and other forms of inflammatory arthritis (2010) Ann Rheum Dis, 69 (2), pp. 325-331Solomon, D.H., Massarotti, E., Garg, R., Liu, J., Canning, C., Schneeweiss, S., Association between disease-modifying antirheumatic drugs and diabetes risk in patients with rheumatoid arthritis and psoriasis (2011) JAMA, 305 (24), pp. 2525-2531Tentolouris, N., Arapostathi, C., Voulgari, C., Grammatikou, S., Andrianakos, A., Sfikakis, P.P., The effect of diabetes mellitus on the prevalence of rheumatoid arthritis: a case-control study (2008) Diabet Med, 25 (8), pp. 1010-1011Han, 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. 2167-2172Hoes, J.N., van der Goes, M.C., van Raalte, D.H., van der Zijl, N.J., den Uyl, D., Lems, W.F., Glucose tolerance, insulin sensitivity and β-cell function in patients with rheumatoid arthritis treated with or without low-to-medium dose glucocorticoids (2011) Ann Rheum Dis, 70 (11), pp. 1887-1894Wasko, M.C., Kay, J., Hsia, E.C., Rahman, M.U., Diabetes mellitus and insulin resistance in patients with rheumatoid arthritis: risk reduction in a chronic inflammatory disease (2011) Arthritis Care Res (Hoboken), 63 (4), pp. 512-521Antohe, J.L., Bili, A., Sartorius, J.A., Lester Kirchner, H., Morris, S.J., Dancea, S., Diabetes risk in rheumatoid arthritis: Reduced incidence with anti-tumor necrosis factor- α therapy (2012) Arthritis Care Res (Hoboken), 64 (2), pp. 215-221Bili, A., Sartorius, J.A., Kirchner, H.L., Morris, S.J., Ledwich, L.J., Antohe, J.L., Hydroxychloroquine use and decreased risk of diabetes in rheumatoid arthritis patients (2011) J Clin Rheumatol, 17 (3), pp. 115-120Liao, K.P., Gunnarsson, M., Källberg, H., Ding, B., Plenge, R.M., Padyukov, L., Specific association of type 1 diabetes mellitus with anti-cyclic citrullinated peptide-positive rheumatoid arthritis (2009) Arthritis Rheum, 60 (3), pp. 653-660Choy, E., Sattar, N., Interpreting lipid levels in the context of highgrade inflammatory states with a focus on rheumatoid arthritis: a challenge to conventional cardiovascular risk actions (2009) Ann Rheum Dis, 68 (4), pp. 460-469White, D., Fayez, S., Doube, A., Atherogenic lipid profiles in rheumatoid arthritis (2006) N Z Med J, 119 (1240), pp. U2125Nurmohamed, M.T., Atherogenic lipid profiles and its management in patients with rheumatoid arthritis (2007) Vasc Health Risk Manag, 3 (6), pp. 845-852Myasoedova, E., Crowson, C.S., Kremers, H.M., Fitz-Gibbon, P.D., Therneau, T.M., Gabriel, S.E., Total cholesterol and LDL levels decrease before rheumatoid arthritis (2010) Ann Rheum Dis, 69 (7), pp. 1310-1314Ghosh, U.C., Roy, A., Sen, K., Kundu, A.K., Saha, I., Biswas, A., Dyslipidaemia in rheumatoid arthritis in a tertiary care centre in Eastern India - a non-randomised trial (2009) J Indian Med Assoc, 107 (7), pp. 427-430Garciaa-Gómez, C., Nolla, J.M., Valverde, J., Gómez-Gerique, J.A., Castro, M.J., Pintó, X., Conventional lipid profile and lipoprotein(a) concentrations in treated patients with rheumatoid arthritis (2009) J Rheumatol, 36 (7), pp. 1365-1370Steiner, G., Urowitz, M.B., Lipid profiles in patients with rheumatoid arthritis: mechanisms and the impact of treatment (2009) Semin Arthritis Rheum, 38 (5), pp. 372-381Georgiadis, A.N., Papavasiliou, E.C., Lourida, E.S., Alamanos, Y., Kostara, C., Tselepis, A.D., Atherogenic lipid profile is a feature characteristic of patients with early rheumatoid arthritis: effect of early treatment - a prospective, controlled study (2006) Arthritis Res Ther, 8 (3), pp. R82Svenson, K.L., Lithell, H., Hallgren, R., Vessby, B., Serum lipoprotein in active rheumatoid arthritis and other chronic inflammatory arthritides. II. Effects of anti-inflammatory and disease-modifying drug treatment (1987) Arch Intern Med, 147 (11), pp. 1917-1920Raynauld, J.P., Cardiovascular mortality in rheumatoid arthritis: how harmful are corticosteroids? (1997) J Rheumatol, 24 (3), pp. 415-416Wallace, D.J., Metzger, A.L., Stecher, V.J., Turnbull, B.A., Kern, P.A., Cholesterol-lowering effect of hydroxychloroquine in patients with rheumatic disease: reversal of deleterious effects of steroids on lipids (1990) Am J Med, 89 (3), pp. 322-326van Halm, V.P., Nielen, M.M., Nurmohamed, M.T., van Schaardenburg, D., Reesink, H.W., Voskuyl, A.E., Lipids and inflammation: serial measurements of the lipid profile of blood donors who later developed rheumatoid arthritis (2007) Ann Rheum Dis, 66 (2), pp. 184-188Singh, J.A., Beg, S., Lopez-Olivo, M.A., Tocilizumab for rheumatoid arthritis. Cochrane Database of Systematic Reviews (2011) J Rheumatol, 38 (1), pp. 10-20Storage, S.S., Agrawal, H., Furst, D.E., Description of the efficacy and safety of three new biologics in the treatment of rheumatoid arthritis (2010) Korean J Intern Med, 25 (1), pp. 1-17Pollono, E.N., Lopez-Olivo, M.A., Lopez, J.A., Suarez-Almazor, M.E., A systematic review of the effect of TNF-alpha antagonists on lipid profiles in patients with rheumatoid arthritis (2010) Clin Rheumatol, 29 (9), pp. 947-955McCarey, D.W., McInnes, I.B., Madhok, R., Hampson, R., Scherbakov, O., Ford, I., Trial of Atorvastatin in Rheumatoid Arthritis (TARA): double-blind, randomised placebo-controlled trial (2004) Lancet, 363 (9426), pp. 2015-2021Chatterjee Adhikari, M., Guin, A., Chakraborty, S., Sinhamahapatra, P., Ghosh, A., Subclinical atherosclerosis and endothelial dysfunction in patients with early rheumatoid arthritis as evidenced by measurement of carotid intima-media thickness and flow-mediated vasodilatation: an observational study (2012) Semin Arthritis Rheum, 41 (5), pp. 669-675González-Juanatey, C., Llorca, J., González-Gay, M.A., Correlation between endothelial function and carotid atherosclerosis in rheumatoid arthritis patients with long-standing disease (2011) Arthritis Res Ther, 13 (3), pp. R101Pereira, I.A., Laurindo, I.M., Zimmermann, A.F., Werner Castro, G.R., Mello, F., Borba, E.F., Single measurements of C-reactive protein and disease activity scores are not predictors of carotid atherosclerosis in rheumatoid arthritis patients (2009) Acta Reumatol Port, 34 (1), pp. 58-64Chung, C.P., Oeser, A., Raggi, P., Gebretsadik, T., Shintani, A.K., Sokka, T., Increased coronary-artery atherosclerosis in rheumatoid arthritis: relationship to disease duration and cardiovascular risk factors (2005) Arthritis Rheum, 52 (10), pp. 3045-3053Maradit-Kremers, H., Crowson, C.S., Nicola, P.J., Ballman, K.V., Roger, V.L., Jacobsen, S.J., Increased unrecognized coronary heart disease and sudden deaths in rheumatoid arthritis: a population-based cohort study (2005) Arthritis Rheum, 52 (2), pp. 402-411Nicola, P.J., Maradit-Kremers, H., Roger, V.L., Jacobsen, S.J., Crowson, C.S., Ballman, K.V., The risk of congestive heart failure in rheumatoid arthritis: a population-based study over 46 years (2005) Arthritis Rheum, 52 (2), pp. 412-420Westlake, S.L., Colebatch, A.N., Baird, J., Kiely, P., Quinn, M., Choy, E., The effect of methotrexate on cardiovascular disease in patients with rheumatoid arthritis: a systematic literature review (2010) Rheumatology (Oxford), 49 (2), pp. 295-307Westlake, S.L., Colebatch, A.N., Baird, J., Curzen, N., Kiely, P., Quinn, M., Tumour necrosis factor antagonists and the risk of cardiovascular disease in patients with rheumatoid arthritis: a systematic literature review (2011) Rheumatology (Oxford), 50 (3), pp. 518-531Barnabe, C., Martin, B.J., Ghali, W.A., Systematic review and metaanalysis: anti-tumor necrosis factor a therapy and cardiovascular events in rheumatoid arthritis (2011) Arthritis Care Res (Hoboken), 63 (4), pp. 522-529Gislason, G.H., Rasmussen, J.N., Abildstrom, S.Z., Schramm, T.K., Hansen, M.L., Fosbøl, E.L., Increased mortality and cardiovascular morbidity associated with use of nonsteroidal anti-inflammatory drugs in chronic heart failure (2009) Arch Intern Med, 169 (2), pp. 141-149Solomon, D.H., Glynn, R.J., Rothman, K.J., Schneeweiss, S., Setoguchi, S., Mogun, H., Subgroup analyses to determine cardiovascular risk associated with nonsteroidal anti-inflammatory drugs and coxibs in specific patient groups (2008) Arthritis Rheum, 59 (8), pp. 1097-1104Söderlin, M., Petersson, I., Bergman, S., Svensson, B., Smoking at onset of rheumatoid arthritis (RA) and its effect on disease activity and functional status: experiences from BARFOT, a long-term observational study on early RA (2011) Scand J Rheumatol, 40 (4), pp. 249-255. , BARFOT study groupSaevarsdottir, S., Wedrén, S., Seddighzadeh, M., Bengtsson, C., Wesley, A., Lindblad, S., Patients with early rheumatoid arthritis who smoke are less likely to respond to treatment with methotrexate and tumor necrosis factor inhibitors: observations from the Epidemiological Investigation of Rheumatoid Arthritis and the Swedish Rheumatology Register cohorts (2011) Arthritis Rheum, 63 (1), pp. 26-36Alberti, K.G., Zimmet, P., Shaw, J., Metabolic syndrome - a new worldwide definition. A Consensus Statement from the International Diabetes Federation (2006) Diabet Med, 23 (5), pp. 469-480(2001) JAMA, 285 (19), pp. 2846-2897. , Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III)Grundy, S.M., Cleeman, J.I., Daniels, S.R., Donato, K.A., Eckel, R.H., Franklin, B.A., Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. [Executive summary] (2005) Circulation, 112 (17), pp. e285-e290Santos, M.J., Fonseca, J.E., Metabolic syndrome, inflammation and atherosclerosis - the role of adipokines in health and in systemic inflammatory rheumatic diseases (2009) Acta Reumatol Port, 34 (4), pp. 590-598Chung, C.P., Oeser, A., Solus, J.F., Avalos, I., Gebretsadik, T., Shintani, A., Prevalence of the metabolic syndrome is increased in rheumatoid arthritis and is associated with coronary atherosclerosis (2008) Atherosclerosis, 196 (2), pp. 756-763Sidiropoulos, P.I., Karvounaris, S.A., Boumpas, D.T., Metabolic syndrome in rheumatic diseases: epidemiology, pathophysiology, and clinical implications (2008) Arthritis Res Ther, 10 (3), p. 207Pereira, R.M., de Carvalho, J.F., Bonfa, E., Metabolic syndrome in rheumatological diseases (2009) Autoimmun Rev, 8 (5), pp. 415-419da Cunha, V., Brenol, C., Brenol, J., Fuchs, S., Arlindo, E., Melo, I., Metabolic syndrome prevalence is increased in rheumatoid arthritis patients and is associated with disease activity (2012) Scand J Rheumatol, 41 (3), pp. 186-191Karvounaris, S.A., Sidiropoulos, P.I., Papadakis, J.A., Spanakis, E.K., Bertsias, G.K., Kritikos, H.D., Metabolic syndrome is common among middle-to-older aged Mediterranean patients with rheumatoid arthritis and correlates with disease activity: a retrospective, crosssectional, controlled, study (2007) Ann Rheum Dis, 66 (1), pp. 28-33Dessein, P.H., Tobias, M., Veller, M.G., Metabolic syndrome and subclinical atherosclerosis in rheumatoid arthritis (2006) J Rheumatol, 33 (12), pp. 2425-2432La Montagna, G., Cacciapuoti, F., Buono, R., Manzella, D., Mennillo, G.A., Arciello, A., Insulin resistance is an independent risk factor for atherosclerosis in rheumatoid arthritis (2007) Diab Vasc Dis Res, 4 (2), pp. 130-135Mottillo, S., Filion, K.B., Genest, J., Joseph, L., Pilote, L., Poirier, P., The metabolic syndrome and cardiovascular risk a systematic review and meta-analysis (2010) J Am Coll Cardiol, 56 (14), pp. 1113-1132da Cunha, V.R., Brenol, C.V., Brenol, J.C., Xavier, R.M., Rheumatoid arthritis and metabolic syndrome (2011) Rev Bras Reumatol, 51 (3), pp. 260-268Toms, T.E., Panoulas, V.F., John, H., Douglas, K.M., Kitas, G.D., Methotrexate therapy associates with reduced prevalence of the metabolic syndrome in rheumatoid arthritis patients over the age of 60 - more than just an anti-inflammatory effect? A cross sectional study (2009) Arthritis Res Ther, 11 (4), pp. R110Bacani, A.K., Gabriel, S.E., Crowson, C.S., Heit, J.A., Matteson, E.L., Noncardiac vascular disease in rheumatoid arthritis: increase in venous thromboembolic events? (2012) Arthritis Rheum, 64 (1), pp. 53-61Matta, F., Singala, R., Yaekoub, A.Y., Najjar, R., Stein, P.D., Risk of venous thromboembolism with rheumatoid arthritis (2009) Thromb Haemost, 101 (1), pp. 134-138Aksu, K., Donmez, A., Keser, G., Inflammation-induced thrombosis: mechanisms, disease associations and management (2012) Curr Pharm Des, 18 (11), pp. 1478-1493Undas, A., Gissel, M., Kwasny-Krochin, B., Gluszko, P., Mann, K.G., Brummel-Ziedins, K.E., Thrombin generation in rheumatoid arthritis: dependence on plasma factor composition (2010) Thromb Haemost, 104 (2), pp. 224-230Bisoendial, R.J., Levi, M., Tak, P.P., Stroes, E.S., The prothrombotic state in rheumatoid arthritis: an additive risk factor for adverse cardiovascular events (2010) Semin Thromb Hemost, 36 (4), pp. 452-457Mameli, A., Barcellona, D., Marongiu, F., Rheumatoid arthritis and thrombosis (2009) Clin Exp Rheumatol, 27 (5), pp. 846-855Liang, K.P., Liang, K.V., Matteson, E.L., McClelland, R.L., Christianson, T.J., Turesson, C., Incidence of noncardiac vascular diseasein rheumatoid arthritis and relationship to extraarticular disease manifestations (2006) Arthritis Rheum, 54 (2), pp. 642-648Davies, R., Galloway, J.B., Watson, K.D., Lunt, M., Symmons, D.P., Hyrich, K.L., Venous thrombotic events are not increased in patients with rheumatoid arthritis treated with anti-TNF therapy: results from the British Society for Rheumatology Biologics Register (2011) Ann Rheum Dis, 70 (10), pp. 1831-1834. , BSRBR Control Centre Consortium, British Society for Rheumatology Biologics RegisterSmitten, A.L., Simon, T.A., Hochberg, M.C., Suissa, S., A meta-analysis of the incidence of malignancy in adult patients with rheumatoid arthritis (2008) Arthritis Res Ther, 10 (2), pp. R45Zintzaras, E., Voulgarelis, M., Moutsopoulos, H.M., The risk of lymphoma development in autoimmune diseases: a meta-analysis (2005) Arch Intern Med, 165 (20), pp. 2337-2344Hemminki, K., Li, X., Sundquist, K., Sundquist, J., Cancer risk in hospitalized rheumatoid arthritis patients (2008) Rheumatology (Oxford), 47 (5), pp. 698-701Kim, Y.J., Shim, J.S., Choi, C.B., Bae, S.C., Mortality and incidence of malignancy in Korean patients with rheumatoid arthritis (2012) J Rheumatol, 39 (2), pp. 226-232Bongartz, T., Sutton, A.J., Sweeting, M.J., Buchan, I., Matteson, E.L., Montori, V., Anti-TNF antibody therapy in rheumatoid arthritis and the risk of serious infections and malignancies: systematic review and meta-analysis of rare harmful effects in randomized controlled trials (2006) JAMA, 295 (19), pp. 2275-2285Thompson, A.E., Rieder, S.W., Pope, J.E., Tumor necrosis factor therapy and the risk of serious infection and malignancy in patients with early rheumatoid arthritis: a meta-analysis of randomized controlled trials (2011) Arthritis Rheum, 63 (6), pp. 1479-1485Askling, J., The risk of malignancies in RA patients treated with biologics (2010) Z Rheumatol, 69 (9), pp. 774-779Thomas, E., Symmons, D.P., Brewster, D.H., Black, R.J., Macfarlane, G.J., National study of cause-specific mortality in rheumatoid arthritis, juvenile chronic arthritis, and other rheumatic conditions: a 20 year followup study (2003) J Rheumatol, 30 (5), pp. 958-965Hemminki, K., Liu, X., Ji, J., Sundquist, J., Sundquist, K., Autoimmune disease and subsequent digestive tract cancer by histology (2012) Ann Oncol, 23 (4), pp. 927-933Hellgren, K., Smedby, K.E., Feltelius, N., Baecklund, E., Askling, J., Do rheumatoid arthritis and lymphoma

2012 Brazilian Society Of Rheumatology Consensus On Vaccination Of Patients With Rheumatoid Arthritis

Objective: To elaborate recommendations to the vaccination of patients with rheumatoid arthritis (RA) in Brazil.Method: Literature review and opinion of expert members of the Brazilian Society of Rheumatology Committee of Rheumatoid Arthritis and of an invited pediatric rheumatologist. Results and conclusions: The following 12 recommendations were established: 1) Before starting disease-modifying anti-rheumatic drugs, the vaccine card should be reviewed and updated; 2) Vaccines against seasonal infl uenza and against H1N1 are indicated annually for patients with RA; 3) The pneumococcal vaccine should be indicated for all patients with RA; 4) The vaccine against varicella should be indicated for patients with RA and a negative or dubious history for that disease; 5) The HPV vaccine should be considered for adolescent and young females with RA; 6) The meningococcal vaccine is indicated for patients with RA only in the presence of asplenia or complement defi ciency; 7) Asplenic adults with RA should be immunized against Haemophilus infl uenzae type B; 8) An additional BCG vaccine is not indicated for patients diagnosed with RA; 9) Hepatitis B vaccine is indicated for patients with RA who are negative for antibodies against HBsAg; the combined hepatitis A and B vaccine should be considered; 10) Patients with RA and at high risk for tetanus, who received rituximab in the preceding 24 weeks, should undergo passive immunization with tetanus immunoglobulin in case of exposure; 11) The YF vaccine is contraindicated to patients with RA on immunosuppressive drugs; 12) The above described recommendations should be reviewed over the course of RA. © 2013 Elsevier Editora Ltda.5311323Falagas, M.E., Manta, K.G., Betsi, G.I., Pappas, G., Infection-related morbidity and mortality in patients with connective tissue diseases: a systematic review (2007) Clin Rheumatol, 26 (5), pp. 663-670Michaud, K., Wolfe, F., Comorbidities in rheumatoid arthritis. (2007) Best Pract Res Clin Rheumatol, 21 (5), pp. 885-906Naz, S.M., Symmons, D.P., Mortality in established rheumatoid arthritis (2007) Best Pract Res Clin Rheumatol, 21 (5), pp. 871-883Doran, M.F., Crowson, C.S., Pond, G.R., O'Fallon, W.M., Gabriel, S.E., Predictors of infection in rheumatoid arthritis (2002) Arthritis Rheum, 46 (9), pp. 2294-300Tak, P.P., Kalden, J.R., Advances in rheumatology: new targeted therapeutics Arthritis Res Ther, 13 (1 SUPPL), pp. S5Desai, S.P., Turchin, A., Szent-Gyorgyi, L.E., Weinblatt, M., Coblyn, J., Solomon, D.H., Routinely measuring and reporting pneumococcal vaccination among immunosuppressed rheumatology outpatients: the fi rst step in improving quality (2011) Rheumatology (Oxford), 50 (2), pp. 366-372Lanternier, F., Henegar, C., Mouthon, L., Blanche, P., Guillevin, L., Launay, O., Low infl uenza-vaccination rate among adults receiving immunosuppressive therapy for systemic infl ammatory disease (2008) Ann Rheum Dis, 67 (7), p. 1047Marchand-Janssen, C., Loulergue, P., Mouthon, L., Mahr, A., Blanche, P., Deforges, L., Patients with systemic infl ammatory and autoimmune diseases are at risk of vaccine-preventable illnesses Rheumatology (Oxford), 50 (6), pp. 1099-1105van Assen, S., Agmon-Levin, N., Elkayam, O., Cervera, R., Doran, M.F., Dougados, M., EULAR recommendations for vaccination in adult patients with autoimmune infl ammatory rheumatic diseases (2011) Ann Rheum Dis, 70 (3), pp. 414-422Manual de vigilância epidemiológica de eventos adversos pós-vacinação (2008), p. 184. , Brasil. Ministério da Saúde. 2.ed. BrasíliaRibeiro, A.C., Guedes, L.K., Moraes, J.C., Saad, C.G., Aikawa, N.E., Calich, A.L., Reduced seroprotection after pandemic H1N1 infl uenza adjuvantfree vaccination in patients with rheumatoid arthritis: implications for clinical practice (2011) Ann Rheum Dis, 70 (12), pp. 2144-2147Coyne, P., Hamilton, J., Heycock, C., Saravanan, V., Coulson, E., Kelly, C.A., Acute lower respiratory tract infections in patients with rheumatoid arthritis (2007) J Rheumatol, 34 (9), pp. 1832-1836van Assen, S., Agmon-Levin, N., Elkayam, O., Cervera, R., Doran, M.F., Dougados, M., EULAR recommendations for vaccination in adult patients with autoimmune infl ammatory rheumatic diseases (2011) Ann Rheum Dis, 70 (3), pp. 414-422Kubota, T., Nii, T., Nanki, T., Kohsaka, H., Harigai, M., Komano, Y., nti-tumor necrosis factor therapy does not diminish the immune response to infl uenza vaccine in Japanese patients with rheumatoid arthritis (2007) Mod Rheumatol, 17 (6), pp. 531-533Kaine, J.L., Kivitz, A.J., Birbara, C., Luo, A.Y., Immune responses following administration of infl uenza and pneumococcal vaccines to patients with rheumatoid arthritis receiving adalimumab (2007) J Rheumatol, 34 (2), pp. 272-279Fomin, I., Caspi, D., Levy, V., Varsano, N., Shalev, Y., Paran, D., Vaccination against infl uenza in rheumatoid arthritis: the effect of disease modifying drugs, including TNF alpha blockers (2006) Ann Rheum Dis, 65 (2), pp. 191-194Kapetanovic, M.C., Saxne, T., Nilsson, J.A., Geborek, P., Influenzavaccination as model for testing immune modulation induced by anti-TNF and methotrexate therapy in rheumatoid arthritis patients (2007) Rheumatology (Oxford), 46 (4), pp. 608-611Bingham III, C.O., Looney, R.J., Deodhar, A., Halsey, N., Greenwald, M., Codding, C., Immunization responses in rheumatoid arthritis patients treated with rituximab: results from a controlled clinical trial (2010) Arthritis Rheum, 62 (1), pp. 64-74Buch, M.H., Smolen, J.S., Betteridge, N., Breedveld, F.C., Burmester, G., Dorner, T., Updated consensus statement on the use of rituximab in patients with rheumatoid arthritis (2011) Ann Rheum Dis, 70 (6), pp. 909-920Buch, M.H., Smolen, J.S., Betteridge, N., Breedveld, F.C., Burmester, G., Dorner, T., Updated consensus statement on the use of rituximab in patients with rheumatoid arthritis (2011) Ann Rheum Dis, 70 (6), pp. 909-920Doran, M.F., Crowson, C.S., Pond, G.R., O'Fallon, W.M., Gabriel, S.E., Frequency of infection in patients with rheumatoid arthritis compared with controls: a population-based study (2002) Arthritis Rheum, 46 (9), pp. 2287-2293. , SepTitton, D.C., Silveira, I.G., Louzada-Junior, P., Hayata, A.L., Carvalho, H.M., Ranza, R., Brazilian biologic registry: BiobadaBrasil implementation process and preliminary results (2011) Rev Bras Reumatol, 51 (2), pp. 152-160Kapetanovic, M.C., Lindqvist, E., Geborek, P., Saxne, T., Eberhard, K., Long-term mortality rate in rheumatoid arthritis patients with disease onset in the 1980s (2011) Scand J Rheumatol, 40 (6), pp. 433-438Coulson, E., Saravanan, V., Hamilton, J., So, K.L., Morgan, L., Heycock, C., Pneumococcal antibody levels after pneumovax in patients with rheumatoid arthritis on methotrexate (2011) Ann Rheum Dis, 70 (7), pp. 1289-1291Calendário de Vacinação do adulto e do idoso (2011), http://www.sbim.org.br/calendario-devacinacao/adultos-e-idosos/, Imunizações ABd. Available from: [Accessed on Feb/2012]Klumb, E.M., Pinto, A.C., Jesus, G.R., Araujo Jr., M., Jascone, L., Gayer, C.R., Are women with lupus at higher risk of HPV infection? Lupus, 19 (13), pp. 1485-1491WHO position on HPV vaccines (2009) Vaccine, 27 (52), pp. 7236-7237Relatório fi nal do grupo de trabalho instituído pela portaria MS 310, de 10 de fevereiro de 2010 (2010), Brasil. Ministério da Saúde. In: Ministério da Saúde INdC, editorNath, R., Mant, C., Luxton, J., Hughes, G., Raju, K.S., Shepherd, P., High risk of human papillomavirus type 16 infections and of development of cervical squamous intraepithelial lesions in systemic lupus erythematosus patients (2007) Arthritis Rheum, 57 (4), pp. 619-625Zonneveld-Huijssoon, E., Ronaghy, A., Van Rossum, M.A., Rijkers, G.T., van der Klis, F.R., Sanders, E.A., Safety and efficacy of meningococcal c vaccination in juvenile idiopathic arthritis (2007) Arthritis Rheum, 56 (2), pp. 639-646Silva, C.A.A., Terreri, M.T.R.A., Barbosa, C.M.P.L., Hilário, M.O.E., Pillegi, G.C.S., Ferriani, V.P.L., Immunization consensus for children and adolescents with rheumatic diseases (2009) Rev Bras Reumatol, 49 (5), pp. 562-589Davies, K., Woo, P., Immunization in rheumatic diseases of childhood: an audit of the clinical practice of British Paediatric Rheumatology Group members and a review of the evidence (2002) Rheumatology (Oxford), 41 (8), pp. 937-941Silva, C.A., Terreri, M.T., Aikawa, N.E., Carvalho, J.F., Pileggi, G.C., Ferriani, V.P., Vaccination practice in children with rheumatic disease (2010) Rev Bras Reumatol, 50 (4), pp. 351-361Ministério da Saúde. Secretaria de Vigilância em Saúde (2006), Brasil. Departamento de Vigilância Epidemiológica. Manual dos Centros de Referência para Imunobiológicos Especiais (CRIES). Brasília: Ministério da Saúde;Migowski, E.H.A., uma doença benigna? (2012), www.apamt.org.br/anais_2008/jornada2008-anais/conferencias/hepatiteA-uma_doenca_benigna.pdf, Available from: [Accessed on 11,]. FebElkayam, O., Yaron, M., Caspi, D., Safety and effi cacy of vaccination against hepatitis B in patients with rheumatoid arthritis (2002) Ann Rheum Dis, 61 (7), pp. 623-625. , JulGarrido Lopez, B.C., Navarro Compain, M.V., Navarro Sarabia, F., Vaccines and chemo-prophylaxis in rhemautoid arthritis: is a vaccine calendar necessary? (2011) Reumatol Clin, 7 (6), pp. 412-416Russo, R.A., Rosenzweig, S.D., Katsicas, M.M., Hepatitis A-associated macrophage activation syndrome in children with systemic juvenile idiopathic arthritis: report of 2 cases (2008) J Rheumatol, 35 (1), pp. 166-168Pham, H., Geraci, S.A., Burton, M.J., Adult immunizations: update on recommendations (2011) Am J Med, 124 (8), pp. 698-701Mota, L.M., Oliveira, A.C., Lima, R.A., Santos-Neto, L.L., Tauil, P.L., Vaccination against yellow fever among patients on immunosuppressors with diagnoses of rheumatic diseases (2009) Rev Soc Bras Med Trop, 42 (1), pp. 23-27Manual de Recomendações para o Controle da Tuberculose no Brasil (2010), In: Saúde Md, editor. BrasíliaDixon, W.G., Hyrich, K.L., Watson, K.D., Lunt, M., Galloway, J., Ustianowski, A., Drug-specifi c risk of tuberculosis in patients with rheumatoid arthritis treated with anti-TNF therapy: results from the British Society for Rheumatology Biologics Register (BSRBR) (2010) Ann Rheum Dis, 69 (3), pp. 522-528Gomez-Reino, J.J., Carmona, L., Valverde, V.R., Mola, E.M., Montero, M.D., Treatment of rheumatoid arthritis with tumor necrosis factor inhibitors may predispose to signifi cant increase in tuberculosis risk: a multicenter active-surveillance report (2003) Arthritis Rheum, 48 (8), pp. 2122-2127Smitten, A.L., Choi, H.K., Hochberg, M.C., Suissa, S., Simon, T.A., Testa, M.A., The risk of herpes zoster in patients with rheumatoid arthritis in the United States and the United Kingdom (2007) Arthritis Rheum, 57 (8), pp. 1431-1438Strangfeld, A., Listing, J., Herzer, P., Liebhaber, A., Rockwitz, K., Richter, C., Risk of herpes zoster in patients with rheumatoid arthritis treated with anti-TNF-alpha agents (2009) JAMA, 301 (7), pp. 737-744Brisson, M.E.W., Gay, N.J., Law, B., De Serres, G., Modelling the impact of immunization on the epidemiology of varicella zoster virus (2000) Epidemiol Infect, 125 (3), pp. 651-669Oxman, M.N., Levin, M.J., Johnson, G.R., Schmader, K.E., Straus, S.E., Gelb, L.D., A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults (2005) N Engl J Med, 352 (22), pp. 2271-2284Zhang, J., Delzell, E., Xie, F., Baddley, J.W., Spettell, C., McMahan, R.M., The use, safety, and effectiveness of herpes zoster vaccination in individuals with inflammatory and autoimmune diseases: a longitudinal observational study (2011) Arthritis Res Ther, 13 (5), p. 174Harpaz, R., Ortega-Sanchez, I.R., Seward, J.F., Prevention of herpes zoster: recommendations of the Advisory Committee on Immunization Practices (ACIP) (2008) MMWR Recomm Rep, 57 (5 RR), pp. 1-30. , quiz CE2-4Pileggi, G.S., de Souza, C.B., Ferriani, V.P., Safety and immunogenicity of varicella vaccine in patients with juvenile rheumatic diseases receiving methotrexate and corticosteroids (2010) Arthritis Care Res (Hoboken), 62 (7), pp. 1034-1039Vasconcelos, P.F., Yellow Fever (2003) Rev Soc Bras Med Trop, 36 (2), pp. 275-293Camara, F.P., Gomes, A.L., Carvalho, L.M., Castello, L.G., Dynamic behavior of sylvatic yellow fever in Brazil (1954-2008) (2011) Rev Soc Bras Med Trop, 44 (3), pp. 297-299Barrett, A.D., Teuwen, D.E., Yellow fever vaccine - how does it work and why do rare cases of serious adverse events take place? (2009) Curr Opin Immunol, 21 (3), pp. 308-313Vellozzi, C., Mitchell, T., Miller, E., Casey, C.G., Eidex, R.B., Hayes, E.B., Yellow fever vaccine-associated viscerotropic disease (YEL-AVD) and corticosteroid therapy: eleven United States cases, 1996-2004 (2006) Am J Trop Med Hyg, 75 (2), pp. 333-336Monath, T.P., Cetron, M.S., McCarthy, K., Nichols, R., Archambault, W.T., Weld, L., Yellow fever 17D vaccine safety and immunogenicity in the elderly (2005) Hum Vaccin, 1 (5), pp. 207-214Bruyand, M., Receveur, M.C., Pistone, T., Verdiere, C.H., Thiebaut, R., Malvy, D., Yellow fever vaccination in non-immunocompetent patients (2008) Med Mal Infect, 38 (10), pp. 524-532Whittembury, A., Ramirez, G., Hernandez, H., Ropero, A.M., Waterman, S., Ticona, M., Viscerotropic disease following yellow fever vaccination in Peru (2009) Vaccine, 27 (43), pp. 5974-5981Martin, M., Tsai, T.F., Cropp, B., Chang, G.J., Holmes, D.A., Tseng, J., Fever and multisystem organ failure associated with 17D-204 yellow fever vaccination: a report of four cases (2001) Lancet, 358 (9276), pp. 98-104Martins, R.M., Maia, M.L.S., Santos, E.M., Cruz, R.L.S., Santos, P.G., Carvalho, S.M.D., Yellow Fever Vaccine Post-marketing Surveillance in Brazil (2010) Procedia in Vaccinology, 2, pp. 178-183Hayes, E.B., Is it time for a new yellow fever vaccine? (2010) Vaccine, 28 (51), pp. 8073-8076Lindsey, N.P., Schroeder, B.A., Miller, E.R., Braun, M.M., Hinckley, A.F., Marano, N., Adverse event reports following yellow fever vaccination (2008) Vaccine, 26 (48), pp. 6077-6082Vasconcelos, P.F., Luna, E.J., Galler, R., Silva, L.J., Coimbra, T.L., Barros, V.L., Serious adverse events associated with yellow fever 17DD vaccine in Brazil: a report of two cases (2001) Lancet, 358 (9276), pp. 91-97Scheinberg, M., Guedes-Barbosa, L.S., Mangueira, C., Rosseto, E.A., Mota, L., Oliveira, A.C., Yellow fever revaccination during infl iximab therapy (2010) Arthritis Care Res (Hoboken), 62 (6), pp. 896-898Kavanaugh, A., Infection prophylaxis in antirheumatic therapy: emphasis on vaccination (2009) Curr Opin Rheumatol, 21 (4), pp. 419-424Oliveira Acv, M.L., Santos-Neto, L.L., Tauil, P.L., What a Rheumatologist needs to know about yellow fever vaccine (2012) Rev Bras Reumatol [In Press]Heijstek, M.W., Pileggi, G.C., Zonneveld-Huijssoon, E., Armbrust, W., Hoppenreijs, E.P., Uiterwaal, C.S., Safety of measles, mumps and rubella vaccination in juvenile idiopathic arthritis (2007) Ann Rheum Dis, 66 (10), pp. 1384-1387Borte, S., Liebert, U.G., Borte, M., Sack, U., Effi cacy of measles, mumps and rubella revaccination in children with juvenile idiopathic arthritis treated with methotrexate and etanercept (2009) Rheumatology (Oxford), 48 (2), pp. 144-14

2011 Consensus Of The Brazilian Society Of Rheumatology For Diagnosis And Early Assessment Of Rheumatoid Arthritis

Objective: Develop guidelines for management of rheumatoid arthritis (RA) in Brazil, focusing on diagnosis and early assessment of the disease. Method: Literature review and expert opinions of RA Committee members of the Brazilian Society of Rheumatology. Results and conclusions: The following ten reccommendations were established: 1) RA diagnosis should be established onsidering clinical findings and complementary test results; 2) Special attention should be given to the differential diagnosis of arthritis; 3) Rheumatoid factor (RF) is an important diagnostic test, but has limited sensitivity and specificity, mainly in early RA; 4) Anti-CCP (anti-cyclic citrullinated peptide antibody) is a marker with sensitivity similar to that of the RF, but with higher specificity, mainly in the initial phase of disease; 5) Although unspecific, acute-phase reactants should be measured in patients with clinical suspicion of RA; 6) Conventional radiography should be performed for diagnostic and prognostic assessment of the disease. When necessary and available, ultrasound and magnetic resonance may be used; 7) Rheumatoid arthritis classification criteria (ACR/EULAR 2010), although not yet validated, may be used as a guide to aid in diagnosing patients with early RA; 8) One of the combined disease activity indices should be used to assess disease activity; 9) At least one of the functional capacity assessment instruments, such as mHAQ or HAQ-DI, should be regularly used; 10) At the early assessment of the disease, the presence of worse prognostic factors, such as polyarticular involvement, high titers of RF and/or anti-CCP, and early joint erosion, should be investigated. © Elsevier Editora Ltda.513199219Lee, D.M., Weinblatt, M.E., Rheumatoid arthritis (2001) Lancet, 358, pp. 903-911Alarcón, G.S., Epidemiology of rheumatoid arthritis (1995) Rheum Dis Clin North Am, 21, pp. 589-604Silman, A.J., Pearson, J.E., Epidemiology and genetics of rheumatoid arthritis (2002) Arthritis Res, 4, pp. S265-S272Marques-Neto, J.F., Gonçalves, E.T., Langen, L.F.O.B., Cunha, M.F.L., Radominski, S., Oliveira, S.M., Multicentric study of the prevalence of adult rheumatoid arthritis in Brazilian population samples (1993) Rev Bras Reumatol, 33, pp. 169-173Emery, P., The optimal management of early rheumatoid arthritis: The key to preventing disability (1994) British J Rheumatol, 33, pp. 765-768Sokka, T., Work disability in early rheumatoid arthritis (2003) Clin Exp Rheumatol, 21, pp. S71-S74Chehata, J.C., Hassell, A.B., Clarke, S.A., Mattey, D.L., Jones, M.A., Jones, W., Mortality in rheumatoid arthritis: Relationship to single and composite measures of disease activity (2001) Rheumatology, 40, pp. 447-452van der Horst-Bruinsma, L.E., Speyer, I., Visser, H., Breedvelt, F.C., Hazes, G.M., Diagnosis and course of early-onset arthritis: Results of a special early arthritis clinic compared to routine patient care (1998) Br J Rheumatol, 37, pp. 1084-1088Majithia, V., Geraci, S.A., Rheumatoid arthritis: Diagnosis and management (2007) Am J Med, 120, pp. 936-939Haque, U.J., Bathon, J.M., The role of biological in early rheumatoid arthritis (2005) Best Pract & Res Clin Rheum, 19, pp. 179-189Cabral, D., Katz, J.N., Weinblatt, M.E., Ting, G., Avorn, J., Solomon, D.H., Development and assessment of indicators of rheumatoid arthritis severity: Results of a Delphi panel (2005) Arthritis Rheum, 53, pp. 61-66Sokka, T., Kautiainen, H., Pincus, T., Verstappen, S.M., Aggarwal, A., Alten, R., Work disability remains a major problem in rheumatoid arthritis in the 2000s: Data from 32 countries in the QUEST-RA study (2010) Arthritis Res Ther, 12 (2), pp. R42Saag, K.G., Teng, G.G., Patkar, N.M., Anuntiyo, J., Finney, C., Curtis, J.R., American College of Rheumatology. American College of Rheumatology 2008 recommendations for the use of nonbiologic and biologic disease-modifying antirheumatic drugs in rheumatoid arthritis (2008) Arthritis Rheum, 59 (6), pp. 762-784Smolen, J.S., Landewé, R., Breedveld, F.C., Dougados, M., Emery, P., Gaujoux-Viala, C., EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs (2010) Ann Rheum Dis, 69 (6), pp. 964-975da Mota, L.M., Laurindo, I.M., dos Santos, N.L.L., Demographic and clinical characteristics of a cohort of patients with early rheumatoid arthritis (2010) Rev Bras Reumatol, 50 (3), pp. 235-248Louzada-Junior, P., Souza, B.D.B., Toledo, R.A., Ciconelli, R.M., Descriptive analysis of the demographical and clinical characteristics of the patients with rheumatoid arthritis in the State of São Paulo, Brazil (2007) Rev Bras Reumatol, 47 (2), pp. 84-90Schoels, M., Wong, J., Scott, D.L., Zink, A., Richards, P., Landewé, R., Economic aspects of treatment options in rheumatoid arthritis: A systematic literature review informing the EULAR recommendations for the management of rheumatoid arthritis (2010) Ann Rheum Dis, 69 (6), pp. 995-1003de Azevedo, A.B., Ferraz, M.B., Ciconelli, R.M., Indirect costs of rheumatoid arthritis in Brazil (2008) Value Health, 11 (5), pp. 869-877Chermont, G.C., Kowalski, S.C., Ciconelli, R.M., Ferraz, M.B., Resource utilization and the cost of rheumatoid arthritis in Brazil (2008) Clin Exp Rheumatol, 26 (1), pp. 24-31Mease, P.J., Inflammatory musculoskeletal disease: Identification and assessment (2011) J Rheumatol, 38 (3), pp. 557-561Scott, D.L., Wolfe, F., Huizinga, T.W., Rheumatoid arthritis (2010) Lancet, 376 (9746), pp. 1094-1108Dixon, W.G., Symmons, D.P., Does early rheumatoid arthritis exist? (2005) Best Pract Res Clin Rheumatol, 19, pp. 37-53Woolf, A.D., How to assess musculoskeletal conditions. History and physical examination (2003) Best Pract Res Clin Rheumatol, 17 (3), pp. 381-402Hazes, J.M., Hayton, R., Silman, A.J., A reevaluation of the symptom of morning stiffness (1993) J Rheumatol, 20 (7), pp. 1138-1142Yazici, Y., Pincus, T., Kautiainen, H., Sokka, T., Morning stiffness in patients with early rheumatoid arthritis is associated more strongly with functional disability than with joint swelling and erythrocyte sedimentation rate (2004) J Rheumatol, 31, pp. 1723-1726Turesson, C., Eberhardt, K., Jacobsson, L.T., Lindqvist, E., Incidence and predictors of severe extra-articular disease manifestations in an early rheumatoid arthritis inception cohort (2007) Ann Rheum Dis, 66 (11), pp. 1543-1544Goeldner, I., Skare, T.L., de Messias, R.I.T., Nisihara, R.M., Silva, M.B., da Rosa, U.S.R., Association of anticyclic citrullinated peptide antibodies with extra-articular manifestations, gender, and tabagism in rheumatoid arthritis patients from southern Brazil (2011) Clin Rheumatol, p. 22. , epub ahead of printDevlin, J., The acute phase and function in early rheumatoid arthritis. C-reactive protein levels correlate with functional outcome (1997) J Rheumatol, 24, pp. 9-13da Mota, L.M., dos Santos, N.L.L., de Carvalho, J.F., Autoantibodies and other serological markers in rheumatoid arthritis: Predictors of disease activity? (2009) Clin Rheumatol, 28 (10), pp. 1127-1134da Mota, L.M., dos Santos, N.L.L., Burlingame, R., Ménard, H.A., Laurindo, I.M., Laboratory characteristics of a cohort of patients with early rheumatoid arthritis (2010) Rev Bras Reumatol, 50 (4), pp. 375-388Visser, H., Early diagnosis of rheumatoid arthritis (2005) Best Pract & Res Clin Rheum, 19, pp. 55-72Renaudineau, Y., Jamin, C., Saraux, A., Youinou, P., Rheumatoid factor on a daily basis (2005) Autoimmunity, 38, pp. 11-16Vittecoq, O., Pouplin, S., Krzanowska, K., Jouen-Beades, F., Menard, J.F., Gayet, A., Rheumatoid factor is the strongest predictor of radiological progression of rheumatoid arthritis in a three-year prospective study in community-recruited patients (2003) Rheumatology, 42 (8), pp. 939-946Visser, H., Gelinck, L.B., Kampfraath, A.H., Breedveld, F.C., Hazes, J.M., Diagnostic and prognostic characteristics of the enzyme linked immunosorbent rheumatoid factor assays in rheumatoid arthritis (1996) Ann Rheum Dis, 55, pp. 157-161Wolfe, F., Cathey, M.A., Roberts, F.K., The latex test revised rheumatoid factor testing in 8,287 rheumatic disease patients (1991) Arthritis Rheum, 34, pp. 951-960Vallbracht, I., Rieber, J., Oppermann, M., Förger, F., Siebert, U., Helmke, K., Diagnostic and clinical value of anti-cyclic citrullinated peptide antibodies compared with rheumatoid factor isotypes in rheumatoid arthritis (2004) Ann Rheum Dis, 63, pp. 1079-1084Greiner, A., Plischke, H., Kellner, H., Gruber, R., Association of anticyclic citrullinated peptide antibodies, anti-citrullin antibodies, and IgM and IgA rheumatoid factors with serological parameters of disease activity in rheumatoid arthritis (2005) Ann N Y Acad Sci, 1050, pp. 295-303Raza, K., Breese, M., Nightingale, P., Kumar, K., Potter, T., Carruthers, D.M., Predictive value of antibodies to cyclic citrullinated peptides in patients with very early inflammatory arthritis (2005) J Rheumatol, 32, pp. 231-238Klareskog, L., Widhe, M., Hermansson, M., Rönnelid, J., Antibodies to citrullinated proteins in arthritis: Pathology and promise (2008) Curr Opin Rheumatol, 20, pp. 300-305van der Linden, M.P., van der Woude, D., Ioan-Facsinay, A., Levarht, E., Stoeken-Rijsbergen, G., Huizinga, T.W., Value of anti-modified citrullinated vimentin and third-generation anti-cyclic citrullinated peptide compared with second-generation anti-cyclic citrullinated peptide and rheumatoid factor in predicting disease outcome in undifferentiated arthritis and rheumatoid arthritis (2009) Arthritis Rheum, 60, pp. 2232-22341Ioan-Facsinay, A., Willemze, A., Robinson, D.B., Peschken, C.A., Markland, J., van der Woude, D., Marked differences in fine specificity and isotype usage of the anti-citrullinated protein antibody in health and disease (2008) Arthritis Rheum, 58, pp. 3000-3008van der Helm, van Mil, A.H.M., Verpoort, K.N., Breedveld, F.C., Toes, R.E.M., Huizinga, T.W.J., Antibodies to citrullinated proteins and differences in clinical progression of rheumatoid arthritis (2005) Arthritis Res Ther, 7, pp. R949-R958Scott, D.L., Wolf, F., Huizinga, T.W.J., Rheumatoid arthritis (2010) Lancet, 376, pp. 1094-1108Mutlu, N., Bicakcigil, M., Tasan, D.A., Kaya, A., Yavuz, S., Ozden, A.I., Comparative performance analysis of 4 different anti-citrullinated protein assays in the diagnosis of rheumatoid arthritis (2009) J Rheumatol, 36 (3), pp. 491-500Santiago, M., Baron, M., Miyachi, K., Fritzler, M.J., Abu-Hakima, M., Leclercq, S., A comparison of the frequency of antibodies to cyclic citrullinated peptides using a third generation anti-CCP assay (CCP3) in systemic sclerosis, primary biliary cirrhosis and rheumatoid arthritis (2008) Clin Rheumatol, 27, pp. 77-83Anjos, L.M.E., Pereira, I.A., D'orsi, E., Seaman, A., Burlingame, R.W., Morato, E.F., A comparative study of IgG second and third generation anti-cyclic citrullinated peptide (CCP) ELISAs and their combination with IgA third generation ELISA for the diagnosis of RA (2009) Clin Reumatol, 28, pp. 153-158Caro-Oleas, J.L., Fernandez-Suarez, A., Reneses-Casteros, S., Porrino, C., Nunes-Roldan, A., Wichmann-Schlipf, I., Diagnostic usefulness of a third generation anti-cyclic citrulline antibody test in patients with recent-onset polyarthritis (2007) Clin Chem Lab Med, 45, pp. 1396-1401Lutteri, L., Malaise, M., Chapelle, J.P., Comparison of second- and third-generation anti-cyclic citrullinated peptide antibodies assays for detecting rheumatoid arthritis (2007) Clin Chim Acta, 386, pp. 76-81Besada, E., Nikolaisen, C., Nossent, H., Diagnostic value of antibodies against mutated citrullinated vimentin for rheumatoid arthritis (2011) Clin Exp Rheumatol, 29 (1), pp. 85-88Ursum, J., Nielen, M.M.J., van Schaardenburg, D., van der Horst, A.R., van de Stadt, R.J., Dijkmans, B.A., Antibodies to mutated citrullinated vimentin and disease activity score in early arthritis: A cohort study (2008) Arthritis Res Ther, 10, pp. R12Mathson, L., Mullazei, M., Wick, M.C., Sjöberg, O., van Vollenhoven, R., Klareskog, L., Antibodies against citrullinated vimentin in rheumatoid arthritis: Higher sensitivity and extended prognostic value concerning future radiographic progression as compared with antibodies against cyclic citrullinated peptides (2008) Arthritis Rheum, 58, pp. 36-45Cordonnier, C., Meyer, O., Palazzo, E., de Bandt, M., Elias, A., Nicaise, P., Diagnostic value of anti-RA33 antibody, antikeratin antibody, antiperinuclear factor and antinuclear antibody in early rheumatoid arthritis: Comparison with rheumatoid factor (1996) Br J Rheumatol, 35, pp. 620-624Vittecoq, O., Incaurgarat, B., Jouen-Beades, F., Legoedec, J., Letourneur, O., Rolland, D., Autoantibodies recognizing citrullinated rat filaggrin in na ELISA using citrullinatted and non-citrullinated recombinant proteins as antigens are highly diagnostic for rheumatoid arthritis (2004) Clin Exp Rheumatol, 135, pp. 173-180Nielen, M.M., van der Horst, A.R., van Schaardenburg, D., van der Horst-Bruinsma, I.E., van de Stadt, R.J., Aarden, L., Antibodies to citrullinated human fibrinogen (ACF) have diagnostic and prognostic value in early arthritis (2005) Ann Rheum Dis, 64, pp. 1199-1204Graudal, N., Svenson, M., Tarp, U., Garred, P., Jurik, A., Bendtzen, K., Autoantibodies against interleukin-1 alfa in rheumatoid arthritis: Association with long-term radiographic outcome (2002) Ann Rheum Dis, 61, pp. 598-602Saulot, V., Vittecoq, O., Charlionet, R., Fardellone, P., Lange, C., Marvin, L., Presence of autoantibodies to the glycolytic enzyme alphaenolase in sera from patients with early rheumatoid arthritis (2002) Arthritis Rheum, 46, pp. 1196-1201Newkirk, M.M., Goldbach-Mansky, R., Lee, J., Hoxworth, J., McCoy, A., Yarboro, C., Advanced glycation end-product (AGE)-damaged IgG and IgM autoantivodies to IgG-AGE in patients with early synovitis (2003) Arthritis Res Ther, 5, pp. R82-R90Aletaha, D., Neogi, T., Silman, A.J., Funovits, J., Felson, D.T., Bingham 3rd, C.O., 2010 rheumatoid arthritis classification criteria: An American College of Rheumatology/European League Against Rheumatism collaborative initiative (2010) Ann Rheum Dis, 69 (9), pp. 1580-1588Klareskog, L., Catrina, A.I., Paget, S., Rheumatoid arthritis (2009) Lancet, 373, pp. 659-672McInnes, I.B., Odell, J.R., State-of-the-art: Rheumatoid arthritis (2010) Ann Rheum Dis, 69, pp. 1898-1906Guidelines for the management of rheumatoid arthritis: 2002 Update (2002) Arthritis Rheum, 46, pp. 328-346. , American College of Rheumatology Subcommittee on Rheumatoid ArthritisVisser, H., Le, C.S., Vos, K., Breedveld, F.C., Hazes, J.M., How to diagnose rheumatoid arthritis early: A prediction model for persistent (erosive) arthritis (2002) Arthritis Rheum, 46, pp. 357-365Kaarela, K., Prognostic factors and diagnostic criteria in early rheumatoid arthritis (1985) Scand J Rheumatol Suppl, 57, pp. 1-54Jain, M., Samuels, J., Musculoskeletal ultrasound in the diagnosis of rheumatic disease (2010) Bulletin of the NYU Hospital For Joint Diseases, 68 (3), pp. 183-190Rahmani, M., Chegini, H., Najafizadeh, S.R., Azimi, M., Habiblollahi, P., Shakiba, M., Detection of bone erosion in early rheumatoid arthritis: Ultrasonography and conventional radiography versus non-contrast magnetic resonance imaging (2010) Clin Rheumatol, 29, pp. 883-891Wakefield, R.J., D'agostinho, M.A., Iagnocco, A., Filippucci, E., Backhaus, M., Scheel, A.K., The OMERACT ultrasound group: Status of current activities and research direction (2007) J Rheumatol, 34, pp. 848-851Fernandes, E.A., Castro Jr., M.R., Mistraud, S.A.V., Kubota, E.S., Fernandes, A.R.C., Ultrasonography in rheumatoid arthritis: Applicability and expectations (2008) Rev Bras Reumatol, 48, pp. 25-30Iagnocco, A., Epis, O., Delle, S.A., Meenagh, G., Filippucci, E., Riente, L., Ultrasoud imaging for the rheumatologist. XVII. Role of colour doppler and power doppler (2008) Clin Exp Rheumatol, 26, pp. 759-762Dohn, U.M., Ejbjerg, B.J., Hasselquist, M., Narvestad, E., Møller, J., Thomsen, H.S., Detection of bone erosions in rheumatoid arthritis wrist joints with magnetic resonance imaging, computed tomography and radiography (2008) Arthritis Res Ther, 10 (1), pp. R25Brown, A.K., Wakefield, R.J., Conaghan, P.G., Karim, Z., Oconnor, P.J., Emery, P., New approaches to imaging early inflammatory arthritis (2004) Clin Exp Rheumatol, 22, pp. S18-S25Kubota, K., Ito, K., Morooka, M., Mitsumoto, T., Kurihara, K., Yamashita, H., Whole -body FDG-PET/CT on rheumatoid arthritis of large joints (2009) Ann Nucl Med, 23 (9), pp. 783-791Basu, S., Zhuang, H., Torigian, D.A., Rosenbaum, J., Chen, W., Alayi, A., Functional imaging of inflammatory diseases using nuclear medicine techniques (2009) Semin Nucl Med, 29, pp. 124-145Arnett, F.C., Edworthy, S.M., Bloch, D.A., McShane, D.J., Fries, J.F., Cooper, N.S., The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis (1988) Arthritis Rheum, 31, pp. 315-324Saraux, A., Berthelot, J.M., Chales, G., le Henaff, C., Thorel, J.B., Hoang, S., Ability of the American College of Rheumatology 1987 criteria to predict rheumatoid arthritis in patients with early arthritis and classification of these patients two years later (2001) Arthritis Rheum, 44, pp. 2485-2491Banal, F., Dougados, M., Combescure, C., Gossec, L., Sensitivity and specificity of the American College of Rheumatology 1987 criteria for the diagnosis of rheumatoid arthritis according to disease duration: A systematic literature review and meta-analysis (2009) Ann Rheum Dis, 68, pp. 1184-9191Scott, D.L., Panayi, G.S., van Riel, P.L., Smolen, J., van de Putte, L.B., Disease activity in rheumatoid arthritis: Preliminary report of the Consensus Study Group of the European Workshop for Rheumatology Research (1992) Clin Exp Rheumatol, 10, pp. 521-525Felson, D.T., Anderson, J.J., Boers, M., Bombardier, C., Chernoff, M., Fried, B., The American College of Rheumatology preliminary core set of disease activity measures for rheumatoid arthritis clinical trials (1993) Arthritis Rheum, 36, pp. 729-740. , The Committee on Outcome Measures in Rheumatoid Arthritis Clinical TrialsBoers, M., Tugwell, P., Felson, D.T., van Riel, P.L., Kirwan, J.R., Edmonds, J.P., World Health Organization and International League of Associations for Rheumatology core endpoints for symptom modifying antirheumatic drugs in rheumatoid arthritis clinical trials (1994) J Rheumatol Suppl, 41, pp. 86-89Tugwell, P., Bombardier, C., A methodologic framework for developing and selecting endpoints in clinical trials (1982) J Rheumatol, 9, pp. 758-762van der Heijde, D.M., vant Hof, M.A., van Riel, P.L., van Leeuwen, M.A., van Rijswijk, M.H., van de Putte, L.B., Validity of single variables and composite indices for measuring disease activity in rheumatoid arthritis (1992) Ann Rheum Dis, 51, pp. 177-181Goldsmith, C.H., Boers, M., Bombardier, C., Tugwell, P., Criteria for clinically important changes in outcomes: Development, scoring and evaluation of rheumatoid arthritis patient and trial profiles. OMERACT Committee (1993) J Rheumatol, 20, pp. 561-565Aletaha, D., Nell, V.P., Stamm, T., Uffmann, M., Pflugbeil, S., Machold, K., Acute phase reactants add little to composite disease activity indices for rheumatoid arthritis: Validation of a clinical activity score (2005) Arthritis Res Ther, 7, pp. R796-R806Aletaha, D., Smolen, J.S., The Simplified Disease Activity Index (SDAI) and the Clinical Disease Activity Index (CDAI): A review of their usefulness and validity in rheumatoid arthritis (2005) Clin Exp Rheumatol, 23 (SUPPL. 39), pp. S100-S108Schulz, K.F., Grimes, D.A., Multiplicity in randomized trials I: Endpoints and treatments (2005) Lancet, 365, pp. 1591-1595van der Heijde, D.M., Vant Hof, M., van Riel, P.L., van de Putte, L.B., Development of a disease activity score based on judgment in clinical practice by rheumatologists (1993) J Rheumatol, 20, pp. 579-581Ritchie, D.M., Boyle, J.A., McInnes, J.M., Jasani, M.K., Dalakos, T.G., Grieveson, P., Clinical studies with an articular index for the assessment of joint tenderness in patients with rheumatoid arthritis (1968) Q J Med, 37, pp. 393-406Smolen, J.S., Breedveld, F.C., Schiff, M.H., Kalden, J.R., Emery, P., Eberl, G., A simplified disease activity index for rheumatoid arthritis for use in clinical practice (2003) Rheumatology, 42, pp. 244-257Siegel, J.N., Zhen, B.G., Use of the American College of Rheumatology N (ACR-N) index of improvement in rheumatoid arthritis: Argument in favor (2005) Arthritis Rheum, 52, pp. 1637-1641van Gestel, A.M., Prevoo, M.L., vant Hof, M.A., van Rijswijk, M.H., van de Putte, L.B., van Riel, P.L., Development and validation of the European League Against Rheumatism response criteria for rheumatoid arthritis (1996) Arthritis Rheum, 39, pp. 34-40. , , Comparison with the preliminary American College of Rheumatology and the World Health Organization/International League Against Rheumatism Criteriavan Gestel, A.M., Haagsma, C.J., van Riel, P.L., Validation of rheumatoid arthritis improvement criteria that include simplified joint counts (1998) Arthritis Rheum, 41, pp. 1845-1850Aletaha, D., Funovits, J., Wards, M.M., Smolen, J.S., Kvien, T.K., Perception of improvement in patients with rheumatoid arthritis varies with disease activity levels at baseline (2009) Arthritis Rheum, 61 (3), pp. 313-320Brandão, L., Ferraz, M.B., Zerbini, C.A.F., Evaluation of quality of life in rheumatoid arthritis (1997) Rev Bras Reumatol, 37, pp. 275-281Kosinski, M., Kujawski, S.C., Martin, R., Wanke, L.A., Buatti, M.C., Ware, J.R.J.E., Health-related quality of life in early rheumatoid arthritis: Impact of disease and treatment response (2002) Am J Manag Care, 8, pp. 231-240Ward, M.M., Outcome measurement: Health status and quality of life (2004) Curr Opin Rheumatol, 16, pp

Update On The Brazilian Consensus For The Diagnosis And Treatment Of Rheumatoid Arthritis [atualização Do Consenso Brasileiro No Diagnóstico E Tratamento Da Artrite Reumatóide]

[No abstract available]473151159Lipski, P.E., Rheumatoid arthitis (1998) Harrison's Principles of Internal Medicine, , Kasper DL, Braunwald. E, Fauci AS, et al, International edition, 14th ed, New York: McGraw HillGuidelines for the management of rheumatoid arthritis (2002) Arthitis Rheum, 46, pp. 328-346. , American College of Rheumatology Subcommittee on Rheumatoid Arthritis GuidelinesArnett, F.C., Edworthy, S.M., Bloch, D.A., The American Rheumatism Association 1987 revised criteria for classification of rheumatoid arthritis (1988) Arthritis Rheum, 31, pp. 315-324Emery P, Breedveld FC, Dougados M, Kalden Jr, Schiff MH, Smolen JS: Early referral recommendation for newly diagnosed rheumatoid arthritis: evidence based development of a clinical guide. Ann Rheum Dis 61:290, 2002Van der Heijde DM: Joint erosions and patients with early rheumatoid arthritis. Br J Rheumatol 34(suppl)2:74-8, 1995Dixey, J., Solymossy, C., Young, A., Early RA Study: Is it possible to predict radiological damage in early rheumatoid arthritis (RA)? A report on the occurrence, progression and prognostic factors of radiological erosions over the first 3 years in 866 patients from the Early RA Study (ERAS) (2004) J Rheumatol, 69 (SUPPL.), pp. 48-54Venrooij, V., van de, Putte, L.B., Is assaying autoantibodies useful for diagnosing early rheumatoid arthritis? Nat Clin Pract (2005) Rheumatol, 1, pp. 4-5Avouac, J., Gossec, L., Dougados, M., Diagnostic and predictive value of anti-ciclyc citrulinate antibodies in rheumatoid arthritis: A systematic literature review (2006) Ann Rheum Dis, 65, pp. 845-851van der Heijde, D.M., van't Hof, M.A., van Riel, P.L., Judging disease activity in clinical practice in rheumtoid arthritis: First step in the development of a disease activity score (1990) Ann Rheum Dis, 49, pp. 916-920Prevoo, M.L., van't Hof, M.A., Kuper, H.H., Modified disease activity scores that include twenty eight-joint counts. Development and validation in a prospective longitudinal study of patients with rheumatoid arthritis (1995) Arthritis Rheum, 38, pp. 44-48Smolen, J.S., Breedveld, F.C., Schiff, M.H., A simplified disease activity index for rheumatoid arthritis for use in clinical practice (2003) Rheumatology (Oxford), 42, pp. 244-257Aletaha, D., Nell, V.P., Stamm, T., Acute phase reactants add little to composite disease activity indices for rheumatoid arthritis: Validation of a clinical activity score (2005) Arthritis Res Ther, 7, pp. R-796-R-806Aletaha, D., Pooled indices to measure rheumatoid arthritis activity: A good reflection of the physician's mind? (2006) Arthritis Res Ther, 8, p. 102Aletaha, D., Smolen, J., The simplified disease activity index (SDAI) and the clinical disease activity index (CDAI): A review of their usefulness and validity in rheumatoid arthritis (2005) Clin Exp Rheumatol, 23 (SUPPL. 39), pp. SI00-SI08Albers, J.M.C., Paimela, L., Kurki, P., Treatment strategy, disease activity, and outcome in four cohorts of patients with early rheumatoid artrhitis (2001) Ann Rehm Dis, 60, pp. 453-458Gotzsche PC, Johansen HK: Short-term low-dose corticosteroids vs placebo and nonsteroidal antiinflammatory drugs in rheumatoid arthritis. Cochrane Database Syst Rwv 2:CD000189, 2000Moreland, L.W., O'Dell, J.R., Glucocorticoids and rheumatoid arthritis: Back to the future? (2002) Arthritis Rheum, 46, pp. 2553-2563Recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis: 2001 update (2001) Arthritis Rheum, 44, pp. 1496-1503. , American College of Rheumatology Ad Hoc Committee on Glucocorticoid-Induced OsteoporosisHelin-Salmivaara, A., Virtanen, A., Vesalamen, R., NSAID use and the risk of hospitalization for first myocardial infarction in the general population: A nationwide case-control study from Finland (2006) Eur Heart J, 27 (14), pp. 1657-1663Suissa S, Bernatsky S, Hudson M: Antirheumatic drug use and the risk of acute myocardial infarction. Arthritis Rheum 55(4):53 1-6, 2006Suarez-Almazor, M.E., Belseck, E., Shea, B., Antimalarials for treating rheumatoid arthritis (2000) Cochrane Database Syst Rev, 4. , CD000959van den Borne, B.E., Landewe, R.B., Rietveld, J.H., Choroquine therapy in patients with recent-onset rheumatoid arthritis: The clinical response can be predicted by the low level of acte-phase reaction at baseline (1999) Clin Rheum, 18, pp. 309-372Suarez-Almazor, M.E., Belseck, E., Shea, B., Wells, G., Tugwell, P., Sulfasalazine for rheumatoid arthritis (2000) Cochrane Database Syst Rev, 2. , CD000958Sharp, J.T., Strand, V., Leung, H., Hurley, F., Loew-Frierich (Leflunomide rheumatoid arthritis investigators group): Treatment with leflunomide slows radiographic progression of rheumatoid Arthritis. Results from three randomized controlled trials of leflunomide in patients with active rheumatoid arthritis. Leflunomide Rheumatoid Arthritis Investigators Group (2000) Arthritis Rheum, 43, pp. 495-505Suarez-Almazor, M.E., Belseck, E., Shea, B., Wells, G., Tugwell, P., Methotrexate for rheumatoid arthritis (2000) Cochrane Database Syst Rev, 2. , CD000957Choen, S., Cannon, G.W., Schiff, M., (1984) Two-Year, blinded, randomized, controlled trial of treatment of active rheumatoid arthritis with leflunomide compared with methotrexate, 44. , Utilization of Leflunomide in the treatment of Rheumatoid Arthritis Trial Investigator Group. Arthritis Rheum, 92Suarez-Almazor, M.E., Spooner, C., Belseck, E., Azathioprine for rheumatoid arthritis (2000) Cochrane Database Syst Rev, 4. , CD001461Wells, G., Haguenauer, D., Shea, B., Suarez-Almazor, M.E., Welch, V.A., Tugwell, R., Cyclosporin for Rheumatoid Arthritis (2000) Cochrane Database Syst Rev, 2. , CD001083Stein, C.M., Pincus, T., Yocum, D., Combination treatment of severe rheumatoid arthritis with cyclosporine and methotrexate for forty-eight weeks: An open-label extension study. The Methotrexate-Cyclosporine Combination Study Group (1997) Arthritis Rheum, 40, pp. 1843-1851O'Dell, J.R., Leff, R., Paulsen, G., (RAIN): Treatment of rheumatoid artritis with methotrexate and hydroxycloroquine, methotrexate and sulfasalazine, or a combination of the three medications. Results of a two-year, randomized, double blind, placebo-controlled trial (2002) Arthritis Rheum, 46, pp. 1164-1170Weinblatt, M.E., Kremer, J.M., Coblyn, J.S., Pharmacokinetics, safety, and efficacy of combination treatment with methotrexate and leflunomide in patients with active rheumatoid arthritis (1999) Arthritis Rheum, 42, pp. 1322-1328Criscione, L.G., St. Clair, E.W., Tumor necrosis factor - alfa antagonists for the treatment of rheumatic diseases (2002) Current Op Rheumatol, 14, pp. 204-211Furst DE, Breedveld FC, Burmester GER, et al.: Update consensus statement on tumor necrosis factor blocking agents for the treatment of rheumatoid arthritis (May 2000). Ann Rheum Dis 59(suppl.I):il-2, 2000Weinblatt, M.E., Keystone, E.C., Furst, D.E., Adalimumab, a fully human anti-tumor necrosis factor alpha monoclonal antibody, for the treatment of rheumatoid arthritis in patients taking concomitant methotrexate: The ARMADA trial (2003) Arthritis Rheum, 48, pp. 35-45Furst, D.E., Schiff, M.H., fleischmann, R.M., Adalimumab, a fully human anti tumor necrosis factor-alpha monoclonal antibody, and concomitant standard antirheumatic therapy for the treatment of rheumatoid arthritis: Results of STAR (Safety Trial of Adalimumab in Rheumatoid arthritis) (2003) J Rheumatol, 30, pp. 2563-2571Moreland, L.W., Schiff, M.H., Baumgartener, S.W., Etanercept therapy in Rheumatoid Arthritis: A randomized, controlled trial (1999) Ann Intern Med, 130, pp. 478-486Weinblatt, M.E., Kremer, J.M., Bankhurst, A.D., A trial of etanercept, a recombinant tumor necrosis factor receptor: Fc fusion protein, in patients with rheumatoid arthritis receiving methotrexate (1999) N Engl J Med, 340, pp. 253-259Maini, R.N., Breedveld, F.C., Kalden, J.R., Therapeutic efficacy of multiple intravenous infusions of anti-tumor necrosis factor aloha monoclonal antibody combined with low-dose weekly methotrexate in rheumatoid arthritis (1998) Arthritis Rheum, 41, pp. 1552-1563Lipsky, P.E., van der Heijde, D.M., St Clair, E.W., Infliximab and methotrexate in the treatment of rheumatoid arthritis. Anti-Tumor Necrosis Factor Trial in Rheumatoid Arthritis with Concomitant Therapy Study Group (2000) N Engl J Med, 343, pp. 1594-1602Perdriger, A., Mariette, X., Kuntz, Safety of infliximab used in combination with leflunomide or azathioprine in daily clinical practice (2006) J Rheumatol, 33, p. 865Mangini C, Melo FAF. Artrite reumatóide, terapia imunossupressora e tuberculose. Ver Bras Reumatol 43:XI(editorial), 2003Hochberg MC, Tracy JK, Hawkins-Holt M, Flores RH: Comparison of the efficacy of the tumour necrosis factor alpha blocking agents adalimumab, etanercept, and infliximab when added to methotrexate in patients with active rheumatoid arthritis. Ann Rheum Dis 62(suppl2):ii13-6, 2003Cohen, S.B., Emery, P., Greenwald, M.W., Reflex Trial Group. Rituximab for rheumatoid arthritis refractory to anti-tumor necrosis factor therapy. Results of a multicenter, randomized, double-blind, placebo-contoled, phase III trial evaluating primary efficacy and safety at twenty four weeks (2006) Arthritis Rheum, 54, pp. 2793-2806Popa, C., Leandro, M.J., Cambridge, G., Edwards, J.C., Repeated B lymphocyte depletion with rituximab in rheumatoid arthritis over 7 yrs (2006) Rheumatology, , Oxford, Epub ahead of printvan Vollenhoven, R., Emery, P., Bingham, C., Safety of rituximab in rheumatoid arthritis: Results of a pooled analysis (2006) Ann Rheum Dis, 65, p. 332Genovese, M.C., Becker, J.C., Schiff, M., Abatacept for rheumatoid arthritis refractory to tumor necrosis factor alpha inhibition (2005) N Engl J Med, 353, pp. 1114-1123van Vollenhoven, R., Harju, A., Brannernark, S., Klareskog, L., Treatment with infliximab (Remicade) when etanercept (Embrel) has failed or vice versa: Data from the STURE registry showing that switching tumour necrosis factor alpha blockers can make sense (2003) Ann Rheum Dis, 62, pp. 1195-1198Wick, M.C., Lindblad, S., Klareskog, L., Van Vollenhoven, R.F., Adalimumab restores clinical response in patients who have lost response to infliximab (Remicade) or Etanercept (Embrel): Data from the STURE registry (2004) Ann Rheum Dis 63(suppll), 26