Primary biliary cirrhosis in a rheumatoid arthritis patient treated with rituximab, a case-based review

Primary biliary cirrhosis (PBC) is an autoimmune disease in which intrahepatic bile ducts are targeted by an immune-mediated injury. This disease tends to progress to fibrosis and cirrhosis with hepatic failure. The authors report a case of a 50-year-old rheumatoid arthritis (RA) patient, with erosions and seropositive for rheumatoid factor and anti-citrullinated peptide antibodies, with 18 years disease duration refractory to prednisolone and several disease-modifying antirheumatic drugs, either conventional or biological (adalimumab and etanercept). In April 2007, she started therapy with rituximab (RTX) with good European League Against Rheumatism response achieved 9 months later. In June 2008, she was admitted with intrahepatic cholestasis, steatorrhea, and spontaneous fractures of various ribs. After excluding cholelitiasis, as well as infectious and neoplastic diseases a liver biopsy was performed that was compatible with the diagnosis of PBC. The antinuclear antibodies (1/160) were positive as well as the antimitochondrial antibodies (1/640). Other antibodies were negative such as anti-SSA and anti-SSB. Afterwards, the patient started ursodesoxycholic acid 15 mg kg(-1) day(-1) with progressive improvement of cholestatic markers. A labial salivary gland biopsy was performed and showed findings compatible with the concomitant diagnosis of Sjögren's syndrome. Based on this clinical report, a detailed review of the clinical aspects of PBC is presented as well as its association with other immune-mediated inflammatory diseases, particularly, with RA

Chromosome conformation signatures define predictive markers of inadequate response to methotrexate in early rheumatoid arthritis

The authors would like to thank members of OBD Reference Facility Benjamin Foulkes, Chloe Bird, Emily Corfeld and Matthew Salter for expedient processing of clinical samples on the EpiSwitch™ platform and Magdalena Jeznach and Willem Westra for help with preparation of the manuscript. The study employed samples from the SERA Biobank used with permission and approval of the SERA Approval Group. We gratefully acknowledge the invaluable contribution of the clinicians and operating team in SERA. We would also like to thank Prof. Raju Kucherlapati (Harvard Medical School), and Prof. Jane Mellor (Oxford Univ.), Prof. John O’Shea (National Institute of Health) and Prof. John Isaacs (New Castle Univ.) for their independent and critical review of our study. A list of Scottish Early Rheumatoid Arthritis (SERA) inception cohort investigators is provided in Additional fle 1: Additional Note. Funding This work was funded by Oxford BioDynamics.Peer reviewedPublisher PD

Envelhecimento vocal em idosos instucionalizados Vocal aging of institutionalized elderly people

OBJETIVOS: avaliar de forma perceptivo-auditiva as características vocais de idosos institucionalizados, identificar se essas características interferem no processo de comunicação e correlacioná-las com a avaliação das estruturas do sistema estomatognático e do padrão de fala. MÉTODOS: estudo clínico do tipo transversal, no qual foram realizadas anamneses e avaliações fonoaudiológicas em uma amostra aleatória de 48 indivíduos idosos, residentes na Casa do Ancião Francisco Azevedo - Belo Horizonte/MG, que não apresentavam nenhum tipo de alteração neurológica, uma vez que, buscou-se traçar as manifestações fonoaudiológicas de idosos em processo de envelhecimento sadio. Utilizou-se protocolos específicos, desenvolvidos pelas autoras, de acordo com os aspectos pertinentes aos objetivos do presente estudo. RESULTADOS: na avaliação perceptivo-auditiva da qualidade vocal, constatou-se predominantemente qualidade vocal rouca (70,8%), em grau moderado (33,3%), loudness reduzida (56,2%), pitch grave (62,5%) e tempos máximos de fonação reduzidos (81,2%). Dos 48 participantes, 85,4% relataram que a voz não interfere no processo de comunicação. Em relação aos padrões de fala, predominaram inteligibilidade preservada (83,3%), articulação preservada (72,9%) e precisão articulatória preservada (83,3%). CONCLUSÕES: existem alterações nos parâmetros referentes à voz decorrentes da idade, sendo que elas não interferem na comunicação e mantêm relação diversa com outras mudanças nas estruturas do sistema estomatognático. Este estudo veio complementar as pesquisas na área de voz envolvendo indivíduos da terceira idade, sob processo de envelhecimento sadio e residentes em instituições de longa permanência.<br>PURPOSES: to investigate vocal aspects related to healthy aging in the institutionalized elderly people, and to identify if these aspects interfer with communication and correlate vocal changes with motor oral system evaluation and speech patterns. METHODS: transversal clinic research in which the methods used were interview and phonoaudiological examination of a randomized sample of 48 aged patients, resident in Casa do Ancião Francisco Azevedo - Belo Horizonte/MG, who did not show neurological disabilities. Specific protocols were used, developed by the authors, according to aspects related to the purposes of this study RESULTS: vocal parameters were analyzed and the following conditions were observed: hoarse voice (70,8%), in moderate degree (33,3%), reduced loudness (56,2%), bass pitch (62,5%) and short maximum phonation periods (81,2%). About 41 (85,4%) patients reported that vocal problems do not interfer with their communication process. Normal aging did not result directly in alterations in speech patterns, but changes in motor oral system due to health aging showed different associations with those patterns. CONCLUSIONS: this study showed the presence of alterations in the aspects related to voice but they do not interfer with the communication process. There were not alterations in speech patterns due to health aging but changes in motor oral system showed different association with those patterns. This study has contributed to improve knowledge about voice and elderly that suffer changes due to health aging and live in old people's homes

Percepção de voz e qualidade de vida em idosos professores e não professores Voice perception and quality of life of elder teachers and non teachers

Este artigo tem como objetivos comparar os escores do protocolo de qualidade de vida e voz (QVV) de idosos professores (GP) e não professores (GNP) e verificar a relação entre os escores, a idade cronológica e a percepção da mudança vocal. Método: em 47 sujeitos, 23 GP e 24 GNP, acima de 65 anos, homens e mulheres, foram coletados dados sobre percepção de mudança vocal e aplicado o protocolo QVV. Resultados: não houve diferença significante entre os escores do QVV dos sujeitos GP e GNP, nem relação entre escores e percepção de mudança vocal. A idade cronológica apresentou correlação positiva (p=0,039) com escores do domínio físico para os GP. Para os sujeitos GP e GNP que perceberam a mudança vocal, houve diferença significante nas respostas às questões 2 (p=0,02), 4 (p=0,007), 5 (p=0,012) e 9 (p=0,002). Conclusão: Para ambos os grupos, o impacto das mudanças vocais foi maior no domínio físico do que no socioemocional do QVV. A autopercep��ão do envelhecimento vocal esteve relacionada à diferença quanto ao uso ou não da voz profissionalmente. Os professores, independentemente dessa percepção, têm maior problema em questões do domínio físico do QVV relacionadas à exigência profissional. Os não professores que perceberam o envelhecimento vocal apresentaram dificuldade em aspectos físicos e socioemocionais.<br>The aim of this article is to compare elder teachers (GP) and non-teachers' (GNP) scores from the voice related quality of life (VR-QOL) protocol and verify the relation between these scores, chronological age and voice change perception. Data from the vocal change perception was collected in 47 subjects, 23 GP and 24 GNP, over 65 years old, both sexes, and the VR-QOL protocol has been applied. There was no significant difference between the score of the two groups or between these scores and the voice change perception. There was a positive correlation (p=0,039) between chronological age and the VR-QOL physical domain scores for the GP. There was significant difference between the two groups of subjects that realized the vocal change, for the VR-QOL answers to questions 2 (p=0,02), 4 (p=0,007), 5 (p=0,012) and 9 (p=0,002). In both groups, the impact of the voice changes was higher in the VR-QOL physical than in the socio-emotional domain. The self perception of vocal aging was related to the professional or non-professional use of the voice. Teachers, apart from having this perception had more problems in the VR-QOL questions of the physical domain, related to the professional requests. Non-teachers that noticed the vocal aging had difficulties with the socio-emotional and physical aspects