Digital ulcers predict a worse disease course in patients with systemic sclerosis

Objective: Systemic sclerosis (SSc) is a systemic autoimmune disease with high morbidity and significant mortality. There is a great need of predictors that would allow risk stratification of patients with SSc and ultimately initiation of treatment early enough to ensure optimal clinical results. In this study, we evaluated whether a history of digital ulcers (HDU) at presentation may be a predictor of vascular outcomes and of overall clinical worsening and death in patients with SSc. Methods: Patients from the EULAR Scleroderma Trials and Research (EUSTAR) database, satisfying at inclusion the 1980 American College of Rheumatology classification criteria for SSc, who had a follow-up of at least 3 years since baseline or who have died, were included in the analysis. HDU at presentation as a predictor of disease worsening or death was evaluated by Cox proportional hazards regression analysis. Results :3196 patients matched the inclusion criteria (male sex 13.2%, 33.4% diffuse subset). At presentation, 1092/3196 patients had an HDU (34.1%). In multivariable analysis adjusting for age, gender and all parameters considered potentially significant, HDU was predictive for the presence of active digital ulcers (DUs) at prospective visits (HR (95% CI)): 2.41(1.91 to 3.03), p<0.001, for an elevated systolic pulmonary arterial pressure on heart ultrasound (US-PAPs):1.36 (1.03 to 1.80), p=0.032, for any cardiovascular event (new DUs, elevated US-PAPs or LV failure):3.56 (2.26 to 5.62), p<0.001, and for death (1.53 (1.16 to 2.02), p=0.003). Conclusions :In patients with SSc, HDU at presentation predicts the occurrence of DUs at follow-up and is associated with cardiovascular worsening and decreased survival

Predictors of disease worsening defined by progression of organ damage in diffuse systemic sclerosis: a European Scleroderma Trials and Research (EUSTAR) analysis.

Objectives Mortality and worsening of organ function are desirable endpoints for clinical trials in systemic sclerosis (SSc). The aim of this study was to identify factors that allow enrichment of patients with these endpoints, in a population of patients from the European Scleroderma Trials and Research group database. Methods Inclusion criteria were diagnosis of diffuse SSc and follow-up over 12\ub13 months. Disease worsening/organ progression was fulfilled if any of the following events occurred: new renal crisis; decrease of lung or heart function; new echocardiography-suspected pulmonary hypertension or death. In total, 42 clinical parameters were chosen as predictors for the analysis by using (1) imputation of missing data on the basis of multivariate imputation and (2) least absolute shrinkage and selection operator regression. Results Of 1451 patients meeting the inclusion criteria, 706 had complete data on outcome parameters and were included in the analysis. Of the 42 outcome predictors, eight remained in the final regression model. There was substantial evidence for a strong association between disease progression and age, active digital ulcer (DU), lung fibrosis, muscle weakness and elevated C-reactive protein (CRP) level. Active DU, CRP elevation, lung fibrosis and muscle weakness were also associated with a significantly shorter time to disease progression. A bootstrap validation step with 10 000 repetitions successfully validated the model. Conclusions The use of the predictive factors presented here could enable cohort enrichment with patients at risk for overall disease worsening in SSc clinical trial

Phenotypes Determined by Cluster Analysis and Their Survival in the Prospective European Scleroderma Trials and Research Cohort of Patients With Systemic Sclerosis

Objective: Systemic sclerosis (SSc) is a heterogeneous connective tissue disease that is typically subdivided into limited cutaneous SSc (lcSSc) and diffuse cutaneous SSc (dcSSc) depending on the extent of skin involvement. This subclassification may not capture the entire variability of clinical phenotypes. The European Scleroderma Trials and Research (EUSTAR) database includes data on a prospective cohort of SSc patients from 122 European referral centers. This study was undertaken to perform a cluster analysis of EUSTAR data to distinguish and characterize homogeneous phenotypes without any a priori assumptions, and to examine survival among the clusters obtained. / Methods: A total of 11,318 patients were registered in the EUSTAR database, and 6,927 were included in the study. Twenty‐four clinical and serologic variables were used for clustering. / Results: Clustering analyses provided a first delineation of 2 clusters showing moderate stability. In an exploratory attempt, we further characterized 6 homogeneous groups that differed with regard to their clinical features, autoantibody profile, and mortality. Some groups resembled usual dcSSc or lcSSc prototypes, but others exhibited unique features, such as a majority of lcSSc patients with a high rate of visceral damage and antitopoisomerase antibodies. Prognosis varied among groups and the presence of organ damage markedly impacted survival regardless of cutaneous involvement. / Conclusion: Our findings suggest that restricting subsets of SSc patients to only those based on cutaneous involvement may not capture the complete heterogeneity of the disease. Organ damage and antibody profile should be taken into consideration when individuating homogeneous groups of patients with a distinct prognosis

Osteoporose em mulheres na pós-menopausa

DESCRIÇÃO DO MÉTODO DE COLETA DE EVIDÊNCIAS: Foi feita uma pesquisa de referências bibliográficas na Biblioteca Cochrane e na base de dados do MEDLINE, utilizando os seguintes termos: osteoporosis, bone density, postmenopausal women. Selecionados os artigos mais relevantes publicados nos últimos cinco anos. A partir da lista de referências bibliográficas foi feita consulta a citações de artigos anteriores. GRAU DE RECOMENDAÇÃO E FORÇA DE EVIDÊNCIA: A: Estudos experimentais e observacionais de melhor consistência. B: Estudos experimentais e observacionais de menor consistência. C: Relatos ou séries de casos. D: Publicações baseadas em consensos ou opiniões de especialistas. OBJETIVOS: 1. Rever os fundamentos da osteoporose pós-menopausa; 2. Estabelecer os principais procedimentos para diagnóstico da osteoporose e de fraturas osteoporóticas em mulheres na pós-menopausa; 3. Estabelecer as terapêuticas para prevenção e tratamento da osteoporose e de fraturas osteoporóticas em mulheres na pós-menopausa. PROCEDIMENTOS: 1. História clínica; 2. Medidas da massa óssea; 3. Prevenção e tratamento. EVOLUÇÃO E DESFECHOS: 1. Identificação das mulheres de risco para osteoporose pósmenopáusica; 2. Prevenção da osteoropose e fraturas; 3. Eficácia dos tratamentos e redução de fraturas

Dor musculoesquelética em membros inferiores de pacientes obesos antes e depois da cirurgia bariàtrica Musculoskeletal pain in lower limbs in obese patients before and after bariatric surgery

RACIONAL: A Organização Mundial da Saúde calcula que em 2015 haverá aproximadamente 2,3 bilhões de adultos com sobrepeso e mais de 700 milhões com obesidade no mundo. O excesso de peso pode levar a inúmeras complicações, dentre elas as doenças articulares degenerativas. OBJETIVO: Estimar a frequência e local da dor músculoesquelética em membros inferiores antes e depois da cirurgia bariátrica. MÉTODO: Estudo descritivo de corte transversal, composto por 22 indivíduos obesos que preencheram questionários antes e seis meses depois de submetidos à cirurgia bariátrica. Os dados foram expressos através de uma análise descritiva e avaliados estatiscamente com nível de significância de 5%. RESULTADOS: A dor foi referida pelos pacientes no pré-operatório em 87,5% no tornozelo e pé, 80% em joelho e 91,7% no quadril. No pós-operatório ela diminuiu para 12,5% no tornozelo e pé, 20% no joelho e 8,3% no quadril atingindo significância estatística (p<0,001). CONCLUSÃO: Indivíduos obesos submetidos à cirurgia bariátrica apresentaram acentuada redução tanto na frequência quanto na intensidade das dores músculoesqueléticas localizadas em ordem no quadril, tornozelo e pé e joelho.<br>BACKGROUND: The World Health Organization estimates that in 2015 there will be approximately 2.3 billion overweight adults and more than 700 million obese individuals worldwide. Excess weight can lead to several complications, such degenerative diseases. AIM: To estimate the frequency and local of musculoskeletal pain in the lower limbs before and after bariatric surgery. METHODS: Cross-sectional descriptive study consisting of 22 obese individuals who filled in questionnaires before and six months after undergoing bariatric surgery. Data were shown through a descriptive analysis. The statistical analysis was performed with significance level at 5%. RESULTS: Musculoskeletal pain in the lower limbs was placed preoperatively in 87.5% in the ankle and foot, knee 80% and 91.7% in the hip. Postoperative pain remained present in 12.5% in the ankle and foot, knee 20% and 8.3% in the hip, with statistical significance (p <0.001). CONCLUSION: Obese people who underwent bariatric surgery experienced a marked reduction in both frequency and intensity of musculoskeletal pain located in order in the hip, ankle and foot, and knee

Denosumab treatment of postmenopausal women with osteoporosis for 6 years : results from the first 3 years of the freedom extension

Bone and mineral researc