Gathering patients and rheumatologists' perceptions to improve outcomes in idiopathic inflammatory myopathies

Objective: Therapeutic targets in Idiopathic Inflammatory Myopathies (IIM) are based on the opinions of physicians/specialists, which may not reflect the main concerns of patients. The authors, therefore, assessed the outcome concerns of patients with IIM and compared them with the concerns of rheumatologists in order to develop an IIM outcome standard set. Methods: Ninety-three IIM patients, 51 rheumatologists, and one physiotherapist were invited to participate. An open questionnaire was initially applied. The top 10 answers were selected and applied in a multiple-choice questionnaire, inquiring about the top 3 major concerns. Answers were compared, and the agreement rate was calculated. Concerns were gathered in an IIM outcome standard set with validated measures. Results: The top three outcome concerns raised by patients were medication side effects/muscle weakness/prevention functionality loss. The top three concerns among rheumatologists were to prevent loss of functionality/to ensure the quality of life/to achieve disease remission. Other's outcomes concerns only pointed out by patients were muscle pain/diffuse pain/skin lesions/fatigue. The agreement rate between both groups was 41%. Assessment of these parameters guided the development of an IIM standard set which included Myositis Disease Activity Assessment Visual Analogue Scale/Manual Muscle Testing/fatigue and pain Global Visual Analogue Scale/Health Assessment Questionnaire/level of physical activity. Conclusion: The authors propose a novel standard set to be pursued in IIM routine follow-up, which includes not only the main patients/rheumatologist outcome concerns but also additional important outcomes only indicated by patients. Future studies are necessary to confirm if this comprehensive approach will result in improved adherence and ultimately in better assistance

Abnormal chronotropic reserve and heart rate recovery in patients with SLE: a case-control study

Abnormal heart-rate (HR) response during or after a graded exercise test has been recognized as a strong and an independent predictor of all-cause mortality in healthy and diseased subjects. The purpose of the present study was to evaluate the HR response during exercise in women with systemic lupus erythematosus (SLE). In this case-control study, 22 women with SLE (age 29.5 perpendicular to 1.1 years) were compared with 20 gender-, BMI-, and age-matched healthy subjects (age 26.5 +/- 1.4 years). A treadmill cardiorespiratory test was performed and HR response during exercise was evaluated by the chronotropic reserve (CR). HR recovery (Delta HRR) was defined as the difference between HR at peak exercise and at both first (Delta HRR1) and second (Delta HRR2) minutes after exercising. SLE patients presented lower peak VO(2) when compared with healthy subjects (27.6 perpendicular to 0.9 vs. 36.7 perpendicular to 1.1 ml/kg/min, p = 0.001, respectively). Additionally, SLE patients demonstrated lower CR (71.8 +/- 2.4 vs. 98.2 +/- 2.6%, p = 0.001), Delta HRR1 (22.1 +/- 2.5 vs. 32.4 +/- 2.2%, p = 0.004) and Delta HRR2 (39.1 +/- 2.9 vs. 50.8 +/- 2.5%, p = 0.001) than their healthy peers. In conclusion, SLE patients presented abnormal HR response to exercise, characterized by chronotropic incompetence and delayed Delta HRR. Lupus (2011) 20, 717-720.Fundacao de Amparo a Pesquisa do Estado de Sao Paulo - FAPESP[2010/51428-2]Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPQ)[303165/2008-1]Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPQ)[301411/2009-3]Federico Foundatio

Black twig borer, Xylosandrus compactus (Eichhoff), as a potential threat to the coffee production

In robusta coffee, Coffea canephora, the black twig borer Xylosandrus compactus (Eichhoff) (Coleoptera: Curculionidae) causes considerable damage. Although this has been reported in many crops for years in Brazil, recently, the injury caused by X. compactus in coffee has been ignored. This present study aimed to report the current status of X. compactus in Brazil, and to investigate its attack frequency in different robusta coffee genotypes. In this study, we reported the occurrence of X. compactus in robusta coffee plants in the state of Rondônia for the first time. We also evaluated the occurrence of this pest in different robusta coffee genotypes in the state of Espírito Santo. In all plants, the plagiotropic branches were attacked; however, the genotypes G2, G6, G8, G20, G48, G50, G51 and G52 showed a high number of attacked plagiotropic branches, whereas the genotypes G24 and G41 showed a low attack frequency. Thus, these can be promising candidates for pest resistance studies. Moreover, it was reported that Almeidea rubra, Alseis floribunda, Plinia grandifolia and Casearia Sylvestris can serve as hosts of X. compactus. Thus, our findings suggest that X. compactus is a threat to coffee production, and that future studies are necessary to find appropriate tools for its management.En el café robusta, Coffea canephora, el barrenador de las ramas Xylosandrus compactus (Eichhoff ) (Coleoptera: Curculionidae) causa daños considerables. Aunque esto se ha reportado en muchos cultivos durante años en Brasil, recientemente, la lesión causada por X. compactus en el café ha sido ignorada. El presente estudio tuvo como objetivo reportar el estado actual de X. compactus en Brasil e investigar su frecuencia de ataque en diferentes genotipos de café robusta. En este estudio, reportamos la aparición de X. compactus en plantas de café robusta en el estado de Rondônia por primera vez. También evaluamos la ocurrencia de esta plaga en diferentes genotipos de café robusta en el estado de Espírito Santo. En todas las plantas, las ramas plagiotrópicas fueron atacadas; sin embargo, los genotipos G2, G6, G8, G20, G48, G50, G51 y G52 mostraron un alto número de ramas plagiotrópicas atacadas, mientras que los genotipos G24 y G41 mostraron una baja frecuencia de ataque. Por lo tanto, estos pueden ser candidatos prometedores para estudios de resistencia a plagas. Además, se reportó que Almeidea rubra, Alseis floribunda, Plinia grandifolia y Casearia sylvestris pueden servir como huéspedes de X. compactus. Por lo tanto, nuestros hallazgos sugieren que X. compactus es una amenaza para la producción de café, y que son necesarios estudios futuros para encontrar herramientas apropiadas para su manejo

Diagnosis and treatment of interstitial lung disease related to systemic autoimmune myopathies: a narrative review

Systemic autoimmune myopathies (SAMs) are rare diseases that lead to muscle inflammation and may be associated with a variety of systemic manifestations. Although there is great heterogeneity in the spectrum of extra-muscular involvement in SAMs, interstitial lung disease (ILD) is the most frequent lung manifestation. SAM-related ILD (SAM-ILD) presents significant variations according to geographic location and temporal trends and is associated with increased morbidity and mortality. Several myositis autoantibodies have been discovered over the last decades, including antibodies targeting aminoacyl-tRNA synthetase enzymes, which are associated with a variable risk of developing ILD and a myriad of other clinical features. In this review, the most relevant topics regarding clinical manifestations, risk factors, diagnostic tests, autoantibodies, treatment, and prognosis of SAM-ILD are highlighted. We searched PubMed for relevant articles published in English, Portuguese, or Spanish from January 2002 to September 2022. The most common SAM-ILD patterns are nonspecific interstitial pneumonia and organizing pneumonia. The combination of clinical, functional, laboratory, and tomographic features is usually sufficient for diagnostic confirmation, without the need for additional invasive methods. Glucocorticoids remain the first-line treatment for SAM-ILD, although other traditional immunosuppressants, such as azathioprine, mycophenolate, and cyclophosphamide have demonstrated some efficacy and, therefore, have an important role as steroid-sparing agents

Using exercise training to counterbalance chronotropic incompetence and delayed heart rate recovery in systemic lupus erythematosus: a randomized trial

Objective. To evaluate the efficacy of a 3-month exercise training program in counteracting the chronotropic incompetence and delayed heart rate recovery in patients with systemic lupus erythematosus (SLE). Methods. A 12-week randomized trial was conducted. Twenty-four inactive SLE patients were randomly assigned into 2 groups: trained (T; n = 15, 3-month exercise program) and nontrained (NT; n = 13). A sex-, body mass index-, and age-matched healthy control (C) group (n = 8) also underwent the exercise program. Subjects were assessed at baseline and at 12 weeks after training. Main measurements included the chronotropic reserve (CR) and the heart rate (HR) recovery (Delta HRR) as defined by the difference between HR at peak exercise and at both the first (Delta HRR1) and second (Delta HRR2) minutes after the exercise test. Results. Neither the NT SLE patients nor the C group presented any change in the CR or in Delta HRR1 and Delta HRR2 (P > 0.05). The exercise training program was effective in promoting significant increases in CR (P = 0.007, effect size [ES] 1.15) and in Delta HRR1 and Delta HRR2 (P = 0.009, ES 1.12 and P = 0.002, ES 1.11, respectively) in the SLE T group when compared with the NT group. Moreover, the HR response in SLE patients after training achieved parameters comparable to the C group, as evidenced by the analysis of variance and by the Z score analysis (P > 0.05, T versus C). Systemic Lupus Erythematosus Disease Activity Index scores remained stable throughout the study. Conclusion. A 3-month exercise training program was safe and capable of reducing the chronotropic incompetence and the delayed Delta HRR observed in physically inactive SLE patients.Fundacao de Amparo a Pesquisa do Estado de Sao Paulo [2011/53319-3]Fundacao de Amparo a Pesquisa do Estado de Sao PauloConselho Nacional de Desenvolvimento Cientifico e Tecnologico [303165/2008-1, 2010/10749-0]Conselho Nacional de Desenvolvimento Cientifico e TecnologicoFederico FoundationFederico Foundatio