24 research outputs found
Recommendations of the Brazilian Society of Rheumatology for the use of JAK inhibitors in the management of rheumatoid arthritis
Rheumatoid arthritis (RA) is a chronic and autoimmune systemic inflammatory disease that can cause irreversible joint deformities, with increased morbidity and mortality and a significant impact on the quality of life of the affected individual. The main objective of RA treatment is to achieve sustained clinical remission or low disease activity. However, up to 40% of patients do not respond to available treatments, including bDMARDs. New therapeutic targets for RA are emerging, such as Janus kinases (JAKs). These are essential for intracellular signaling (via JAK-STAT) in response to many cytokines involved in RA immunopathogenesis. JAK inhibitors (JAKi) have established themselves as a highly effective treatment, gaining increasing space in the therapeutic arsenal for the treatment of RA. The current recommendations aim to present a review of the main aspects related to the efficacy and safety of JAKis in RA patients, and to update the recommendations and treatment algorithm proposed by the Brazilian Society of Rheumatology in 2017
Rastreamento da infecção latente por tuberculose em pacientes com artrite idiopĂĄtica juvenil previamente Ă terapia antiâTNF em um paĂs de alto risco para tuberculose
ResumoObjetivoAvaliar, em um paĂs endĂȘmico, a eficĂĄcia em longo prazo do rastreamento Ă procura de infecção latente por tuberculose (ILTB) e profilaxia primĂĄria em pacientes com AIJ em uso de bloqueadores do TNF.MĂ©todosTrataâse de uma coorte retrospectiva que incluiu pacientes com AIJ elegĂveis para a terapia antiâTNF. Os pacientes foram rastreados Ă procura de ILTB previamente ao uso de antiâTNF por meio do teste tuberculĂnico (TT), radiografia de tĂłrax e histĂłria de exposição Ă TB. Os indivĂduos foram acompanhados regularmente em intervalos de dois meses.ResultadosIncluĂramâse 69 pacientes com AIJ com idade atual de 17,4±5,8 anos, com mĂ©dia de duração da doença de 5±4,9 anos; 47 pacientes receberam um Ășnico antiâTNF, enquanto 22 foram transferidos para outro antiâTNF uma ou duas vezes: 57 foram tratados com etanercepte, 33 com adalimumabe e trĂȘs com infliximabe. O rastreamento Ă procura de ILTB foi positivo em trĂȘs pacientes: um era TT positivo e tinha histĂłria de exposição Ă TB e dois apenas eram TT positivo. NĂŁo foi diagnosticado caso de TB ativa durante o perĂodo de estudo (mediana de seguimento de 3,8 anos).ConclusĂŁoA avaliação em longo prazo revelou que o rastreamento Ă procura de ILTB e a profilaxia primĂĄria antes do tratamento com antiâTNF foram eficazes em um paĂs de alto risco para TB e o TT foi o parĂąmetro mais sensĂvel para identificar esses pacientes.AbstractObjectivesTo evaluate, in an endemic country, the longâterm efficacy of latent tuberculosis infection (LTBI) screening and primary prophylaxis in patients with JIA receiving TNF blockers.MethodsThis was a retrospective cohort that included JIA patients eligible to antiâTNF therapy. Patients were screened for LTBI prior to antiâTNF using tuberculin skin test (TST), chest Xâray and history of exposure to TB. Subjects were regularly followed at 2âmonth intervals.ResultsSixtyânine JIA patients with current age of 17.4±5.8 years, mean disease duration of 5.0±4.9 years were included. Fortyâseven patients received a single antiâTNF, while 22 patients switched to another antiâTNF once or twice: 57 were treated with etanercepte, 33 patients with adalimumab and 3 infliximab. LTBI screening was positive in three patients: one had TSTâpositive and history of TB exposure and two had solely TSTâpositive. No active TB was diagnosed during the study period (median of followâup was 3.8 years).ConclusionLongâterm evaluation revealed that LTBI screening and primary prophylaxis before antiâTNF treatment was effective in a highârisk country and TST was the most sensitive parameter to identify these patients
Action modulates object-based selection
Cueing attention to one part of an object can facilitate discrimination in another part (Experiment 1 [Duncan, j. (1984). Selective attention and the organization of visual information. Journal of Experimental Psychology: General, 113, 501-517]; [Egly, R., Driver, J., and Rafal, R. D. (1994). Shifting visual attention between objects and locations: evidence from normal and parietal lesion divisions. Journal of Experimental Psychology: Human Perception and Performance, 123, 161-177]). We show that this object-based mediation of attention is disrupted when a pointing movement is prepared to the cued part; when a pointing response is prepared to a part of an object, discrimination does not differ between (i) stimuli at locations in the same object but distant to the part where the pointing movement is programmed and (ii) stimuli at locations equidistant from the movement but outside the object (Experiment 2). This remains true even when the pointing movement cannot be performed without first coding the whole object (Experiment 3). Our results indicate that pointing either (i) emphasizes spatial selection at the expense of object-based selection, or (ii) changes the nature of the representations(s) mediating perceptual selection. In addition, the results indicate that there can be a distinct effect on attention of movement to a specific location, separate from the top-down cueing of attention to another position (Experiment 3). Our data highlight the itneractivity between perception and action
A single session of aerobic exercise reduces systolic blood pressure at rest and in response to stress in women with rheumatoid arthritis and hypertension
Rheumatoid arthritis (RA) is an autoimmune inflammatory disease characterized by increased risk of cardiovascular disease and hypertension (HT). A single session of aerobic exercise may reduce blood pressure (BP) in different clinical groups; however, little is known about the acute effects of exercise on BP in RA patients. This is a randomized controlled crossover study that assessed the effects of a single session of aerobic exercise on resting BP, on BP responses to stressful stimuli, and on 24-h BP in women with RA and HT. Twenty women with RA and HT (53â±â10 years) undertook sessions of 30-min treadmill exercise (50% VO2max) or control (no exercise) in a crossover fashion. Before and after the sessions, BP was measured at rest, and in response to the Stroop-Color Word Test (SCWT), the Cold Pressor Test (CPT), and an isometric handgrip test. After the sessions, participants were also fitted with an ambulatory BP monitor for the assessment of 24-h BP. A single session of exercise reduced resting systolic BP (SBP) (-5â±â9âmmHg; pâ<â0.05), and reduced SBP response to the SCWT (-7â±â14âmmHg; pâ<â0.05), and to the CPT (-5â±â11âmmHg; pâ<â0.05). Exercise did not reduce resting diastolic BP (DBP), BP responses to the isometric handgrip test or 24-h BP. In conclusion, a single session of aerobic exercise reduced SBP at rest and in response to stressful stimuli in hypertensive women with RA. These results support the use of exercise as a strategy for controlling HT and, hence, reducing cardiovascular risk in women with RA.Clinical Trial Registration: This study registered at the Brazilian Clinical Trials ( https://ensaiosclinicos.gov.br/rg/RBR-867k9g ) at 12/13/2019
Reliability assessment of ultrasound muscle echogenicity in patients with rheumatic diseases: Results of a multicenter international web-based study
ObjectivesTo investigate the inter/intra-reliability of ultrasound (US) muscle echogenicity in patients with rheumatic diseases.MethodsForty-two rheumatologists and 2 radiologists from 13 countries were asked to assess US muscle echogenicity of quadriceps muscle in 80 static images and 20 clips from 64 patients with different rheumatic diseases and 8 healthy subjects. Two visual scales were evaluated, a visual semi-quantitative scale (0â3) and a continuous quantitative measurement (âVAS echogenicity,â 0â100). The same assessment was repeated to calculate intra-observer reliability. US muscle echogenicity was also calculated by an independent research assistant using a software for the analysis of scientific images (ImageJ). Inter and intra reliabilities were assessed by means of prevalence-adjusted bias-adjusted Kappa (PABAK), intraclass correlation coefficient (ICC) and correlations through Kendallâs Tau and Pearsonâs Rho coefficients.ResultsThe semi-quantitative scale showed a moderate inter-reliability [PABAK = 0.58 (0.57â0.59)] and a substantial intra-reliability [PABAK = 0.71 (0.68â0.73)]. The lowest inter and intra-reliability results were obtained for the intermediate grades (i.e., grade 1 and 2) of the semi-quantitative scale. âVAS echogenicityâ showed a high reliability both in the inter-observer [ICC = 0.80 (0.75â0.85)] and intra-observer [ICC = 0.88 (0.88â0.89)] evaluations. A substantial association was found between the participants assessment of the semi-quantitative scale and âVAS echogenicityâ [ICC = 0.52 (0.50â0.54)]. The correlation between these two visual scales and ImageJ analysis was high (tau = 0.76 and rho = 0.89, respectively).ConclusionThe results of this large, multicenter study highlighted the overall good inter and intra-reliability of the US assessment of muscle echogenicity in patients with different rheumatic diseases
Latitude gradient influences the age of onset of rheumatoid arthritis : a worldwide survey
The age of onset of rheumatoid arthritis (RA) is an important outcome predictor. Northern countries report an age of RA onset of around 50 years, but apparently, variability exists across different geographical regions. The objective of the present study is to assess whether the age of onset of RA varies across latitudes worldwide. In a proof-of-concept cross-sectional worldwide survey, rheumatologists from preselected cities interviewed 20 consecutive RA patients regarding the date of RA onset (RAO, when the patient first noted a swollen joint). Other studied variables included location of each city, rheumatologist settings, latitudes (10A degrees increments, south to north), longitudes (three regions), intracountry consistency, and countries' Inequality-adjusted Human Development Index (IHDI). Data from 2481 patients (82% females) were obtained from 126 rheumatologists in 77 cities of 41 countries. Worldwide mean age of RAO was 44 +/- 14 years (95% CI 44-45). In 28% of patients, RA began before age 36 years and before age 46 years in 50% of patients. RAO was 8 years earlier around the Tropic of Cancer when compared with northern latitudes (p <0.001, 95% CI 3.5-13). Multivariate analysis showed that females, western cities, and latitudes around the Tropic of Cancer are associated with younger age of RAO (R (2) 0.045, p <0.001). A positive correlation was found between the age of RAO and IHDI (r = 0.7, p <0.01, R (2) 0.5). RA often begins at an early age and onset varies across latitudes worldwide. We postulate that countries' developmental status and their geographical and geomagnetic location influence the age of RAO.Peer reviewe
Latent tuberculosis screening before anti-TNF therapy in rheumatoid arthritis patients from an endemic area
RecomendaçÔes para rastreamento de Tuberculoses Latente (TBL) em pacientes que receberĂŁo tratamento com antagonistas do TNF-alfa (anti- TNF) permanecem controversas para regiĂ”es endĂȘmicas Objetivo: Esse estudo buscou demonstrar a eficĂĄcia em longo prazo do rastreamento e tratamento da TBL em pacientes portadores de Artrite Reumatoide (AR) recebendo anti-TNF. MĂ©todos: 202 pacientes com AR, antes do inĂcio do anti-TNF, foram rastreados para TBL por meio do teste tuberculĂnico (TT), Radiografia de tĂłrax (RX) e histĂłria de prĂ©via de exposição Ă tuberculose (EXP). Todos os pacientes foram seguidos com intervalos de um a trĂȘs meses. Resultados: 85 pacientes (42%) foram tratados com um Ășnico agente anti-TNF e 117 pacientes (58%) mudaram de anti-TNF uma ou duas vezes. O rastreamento para TBL foi positivo em 66 pacientes, 44 apresentaram TT positivo, 23 apresentavam histĂłria de exposição (EXP), e 14, alteraçÔes radiogrĂĄficas (RX). EXP isoladamente foi responsĂĄvel por 14 diagnĂłsticos em pacientes TT negativos. Pacientes portadores de TBL receberam tratamento com Isoniazida (300 mg/dia por seis meses) e nenhum deles desenvolveu TB. Durante os seguimentos, o TT foi repetido em 51 pacientes. A conversĂŁo foi observada em cinco: trĂȘs foram diagnosticados com TBL e dois com TB ativa (14 e 36 meses apĂłs receber terapia anti-TNF), sugerindo nova exposição a TB. ConclusĂŁo: O rastreamento e tratamento da TBL antes do inĂcio da terapia com anti-TNF Ă© efetiva em regiĂ”es endĂȘmicas, e reforça a relevĂąncia da histĂłria de contato com TB para o diagnĂłstico da TBL em pacientes com ARRecommendations for screening of latent tuberculosis infection (LTBI) in patients eligible for anti-TNF agents remain unclear in endemic regions. Objective: This study aimed to evaluate the long-term efficacy of LTBI screening/treatment in patients with rheumatoid arthritis (RA) receiving TNF blockers. Design: 202 RA patients were screened for LTBI prior to receiving anti-TNF treatment, by means of tuberculin skin test (TST), chest radiography (X-Ray), and history of tuberculosis exposure (EXP). All subjects were regularly followed at 1- to 3-month intervals. Results: Eighty-five patients (42%) were treated with a single anti-TNF agent, and 117 patients (58%) switched anti-TNF agents once or twice. LTBI screening was positive in 66 patients, 44 presented positive TST, 23 had a history of EXP, and 14, abnormal X-Ray. Exposure alone accounted for LTBI diagnosis in 14 patients with negative TSTs. LTBI patients were treated with Isoniazid (300 mg/day during six months) and none developed TB. During follow up, TST was repeated in 51 patients. Conversion was observed in five: three were diagnosed with LTBI and two with active TB (14 and 36 months after receiving anti-TNF therapy, suggesting new TB exposure). Conclusion: LTBI screening and treatment prior to anti-TNF treatment is effective in endemic areas and reinforces the relevance of contact history for diagnosing LTBI in RA patient
Linfadenopatia e lĂșpus eritematoso sistĂȘmico
A linfadenopatia no lĂșpus eritematoso sistĂȘmico (LES) Ă© um achado benigno encontrado comumente em jovens, com atividade cutĂąnea e sintomas constitucionais, apresentando boa resposta Ă corticoterapia. O achado mais frequente Ă biĂłpsia Ă© a hiperplasia folicular reacional. Relatamos o caso de um paciente que, desde os 13 anos de idade, apresentava surtos recorrentes de linfadenopatia, acompanhados de hepatoesplenomegalia, febre e emagrecimento. Na evolução, apareceram artrite, hipertensĂŁo arterial, proteinĂșria, miocardiopatia e neuropatia perifĂ©rica. Foi amplamente investigado sem esclarecimento diagnĂłstico e submetido a tratamento empĂrico de tuberculose. Somente apĂłs cinco anos de evolução firmou-se o diagnĂłstico de LES e recebeu tratamento especĂfico. O diagnĂłstico precoce nestes casos Ă© difĂcil, pois a investigação laboratorial pode ainda nĂŁo demonstrar presença de autoanticorpos ou hipocomplementemia