A comprehensive systematic review of leishmaniasis in patients undergoing drug-induced immunosuppression for the treatment of dermatological, rheumatological and gastroenterological diseases

Immunosuppression is an important risk factor for leishmaniasis. We assessed the clinical profile, geographic distribution and prevalence of leishmaniasis in patients undergoing immunosuppressive therapy for dermatological, rheumatological or gastroenterological autoimmune diseases. We identified relevant studies in PubMed, EMBASE, Scopus, Web of Science and LILACS on July 3rd, 2018. We included articles that reported at least one case of leishmaniasis in patients undergoing immunosuppressive treatment for dermatological, rheumatological or gastroenterological diseases. Our protocol was registered in PROSPERO (CRD42018103050). We assessed the quality of the included studies with the Joanna Briggs Institute Critical Appraisal Tool. After the removal of duplicates, 5,431 articles were collected and screened. We included 138 articles; the prevalence of leishmaniasis in six methodologically similar studies varied from three to 1,282 cases per 100,000 patients using anti-TNF\u3b1 drugs, but the results were significantly heterogeneous. Leishmaniasis in patients treated with immunosuppressive drugs is a health problem mostly reported in European countries bordering the Mediterranean Sea; sporadic activities, such as travelling, seem not to be associated with a significant risk of leishmaniasis, although effective control measures must always be observed

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

Update on the 2012 brazilian society of rheumatology guidelines for the treatment of rheumatoid arthritis: position on the use of tofacitinib / QUANDO ABRE PDF, abre EM PORTUGUÊS.

In 2014, tofacitinib, a target-specific, synthetic disease modifying anti rheumatic drug (DMARD) and a selective inhibitor of Janus kinase (JAK) was approved for use in Brazil. This position paper aims to update the recommendations of the Brazilian Society of Rheumatology (SBR) on the treatment of rheumatoid arthritis (RA) in Brazil, specifically regarding the use of target-specific synthetic DMARDs. The method of this recommendation consisted of a literature review of scientific papers held on the Medline database. After this review, a text was produced, answering questions in Pico structure, considering efficacy and safety issues of tofacitinib use for RA treatment in different scenarios (such as first-line treatment after failure with methotrexate [MTX] or other conventional synthetic DMARDs after failure with biological therapy). Based on existing evidence, and considering the available data on efficacy, safety and cost of medications available to treat the disease in Brazil, the RA Commission of SBR, after a process of discussion and voting on proposals, established the following position on the use of tofacitinib for treatment of RA in Brazil: Tofacitinib, alone or in combination with MTX, is an alternative for RA patients with moderate or high activity after failure of at least two different synthetic DMARDs and one biological DMARD. The level of agreement with this recommendation was 7.5. This position may be reviewed in the coming years, in the face of a greater experience with the use of this medication.Em 2014, o tofacitinibe, um medicamento modificador do curso da doença (MMCD) sintético, alvo‐específico, inibidor seletivo das Janus quinases (JAK), foi aprovado para uso no Brasil. Este documento de posicionamento tem o objetivo de atualizar as recomend556512521sem informaçãosem informaçãoIn 2014, tofacitinib, a target-specific, synthetic disease modifying anti rheumatic drug (DMARD) and a selective inhibitor of Janus kinase (JAK) was approved for use in Brazil. This position paper aims to update the recommendations of the Brazilian Socie

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. 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(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? 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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, 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High levels of polypharmacy in rheumatoid arthritis—a challenge not covered by current management recommendations : data from a large real-life study

Rheumatoid arthritis (RA) is associated with high frequency of comorbidities and increased risk of polypharmacy. Although there is a great potential for complications, there is a gap in literature on polypharmacy in patients with rheumatic arthritis. To evaluate the prevalence and factors associated with polypharmacy in a population in a real-life setting. Methods: A cross-sectional multicenter study was conducted in Brazil. Patients underwent clinical evaluation and medical records analysis. Polypharmacy was considered as a dependent variable. To test independent variables, we used Poisson regression. We evaluated 792 patients (89% female, median age 56.6 years). Median duration of disease was 12.7 years, 78.73% had a positive rheumatoid factor. The median of disease activity score-28 was 3.5 (disease with mild activity), median of the clinical disease activity index score was 9, and median of health assessment questionnaire-disability index was 0.875; 47% used corticosteroids, 9.1% used nonsteroidal anti-inflammatory drugs, 90.9% used synthetic disease-modifying antirheumatic drugs, 35.7% used biologic disease-modifying antirheumatic drugs (DMARDs). In total, 537 (67.9%) patients used 5 or more drugs. Polypharmacy showed a relationship with a number of comorbidities and use of specific drugs (corticosteroids, methotrexate, and biological DMARDs). We found a high prevalence of polypharmacy (67.9%) in RA. Solutions to management this problem should be stimulatedThe author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the Brazilian Society of Rheumatology (BSR). For this project, BSR received specific grant support from the following companies: Bristol-Myers Squibb Farmacêutica Ltda; Eli Lilly do Brasil Ltda; Janssen-Cilag Farmacêuticos Ltda; Laboratórios Pfizer Ltda; Produtos Roche Químicos e Farmacêuticos S.A.; and UCB Biopharma Ltda. The funding body or the companies had no role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscrip

The association of fatigue, comorbidity burden, disease activity, disability and gross domestic product in patients with rheumatiod arthritis. Results from 34 countries participating in the Quest-RA programme

OBJECTIVES: The aim is to assess the prevalence of comorbidities and to further analyse to which degree fatigue can be explained by comorbidity burden, disease activity, disability and gross domestic product (GDP) in patients with rheumatoid arthritis (RA).METHODS: Nine thousands eight hundred seventy-four patients from 34 countries, 16 with high GDP (>24.000 US dollars [USD] per capita) and 18 low-GDP countries (6.6) compared with 23.0% in high-GDP countries (p<0.001). In univariate analysis, fatigue increased with increasing number of comorbidities, disease activity and disability in both high- and low-GDP countries. In multivariate analysis of all countries, these 3 variables explained 29.4% of the variability, whereas GDP was not significant.CONCLUSIONS: Fatigue is a widespread problem associated with high comorbidity burden, disease activity and disability regardless of GDP