Overlap syndrome of systemic lupus erythematosus and systemic sclerosis in a person living with HIV: the paradox of immunodeficiency and autoimmunity coming together / Síndrome de overlap entre lupus eritematoso sistêmico e esclerose sístemica em pessoa vivendo com HIV: o paradoxo da imunodeficiência e autoimunidade

The existence of autoimmune dysfunction in HIV/AIDS patients is intriguing. Many cases are being reported around the world of the combination of HIV with systemic autoimmune diseases. We report a case of an HIV-infected patient that presented alopecia, symmetric polyarthritis, skin thickening and raynaud’s phenomenon. Diagnosis of overlap syndrome of SS and SLE was made and treatment with prednisone, methotrexate and nifedipine started. No HIV flare was documented

High levels of immunosuppression are related to unfavourable outcomes in hospitalised patients with rheumatic diseases and COVID-19 : first results of ReumaCoV Brasil registry

Objectives To evaluate risk factors associated with unfavourable outcomes: emergency care, hospitalisation, admission to intensive care unit (ICU), mechanical ventilation and death in patients with immune-mediated rheumatic disease (IMRD) and COVID-19. Methods Analysis of the first 8 weeks of observational multicentre prospective cohort study (ReumaCoV Brasil register). Patients with IMRD and COVID-19 according to the Ministry of Health criteria were classified as eligible for the study. Results 334 participants were enrolled, a majority of them women, with a median age of 45 years; systemic lupus erythematosus (32.9%) was the most frequent IMRD. Emergency care was required in 160 patients, 33.0% were hospitalised, 15.0% were admitted to the ICU and 10.5% underwent mechanical ventilation; 28 patients (8.4%) died. In the multivariate adjustment model for emergency care, diabetes (prevalence ratio, PR 1.38; 95% CI 1.11 to 1.73; p=0.004), kidney disease (PR 1.36; 95% CI 1.05 to 1.77; p=0.020), oral glucocorticoids (GC) (PR 1.49; 95% CI 1.21 to 1.85; p50 years (PR 1.89; 95% CI 1.26 to 2.85; p=0.002), no use of tumour necrosis factor inhibitor (TNFi) (PR 2.51;95% CI 1.16 to 5.45; p=0.004) and methylprednisolone pulse therapy (PR 2.50; 95% CI 1.59 to 3.92; p<0.001); for ICU admission, oral GC (PR 2.24; 95% CI 1.36 to 3.71; p<0.001) and pulse therapy with methylprednisolone (PR 1.65; 95% CI 1.00 to 2.68; p<0.043); the two variables associated with death were pulse therapy with methylprednisolone or cyclophosphamide (PR 2.86; 95% CI 1.59 to 5.14; p<0.018). Conclusions Age >50 years and immunosuppression with GC and cyclophosphamide were associated with unfavourable outcomes of COVID-19. Treatment with TNFi may have been protective, perhaps leading to the COVID-19 inflammatory process

Painful Lower Extremities Related to Diaphyseal Dysplasia: Genetic Diagnosis and Treatment

Amazon Fed Univ, HUGV, Manaus, Amazonas, BrazilAmazon Fed Univ, Med Clin, FHAJ, Manaus, Amazonas, BrazilAmazon Fed Univ, Dept Pediat & Med Genet, Manaus, Amazonas, BrazilAmazon Fed Univ, Getulio Vargas Univ Hosp, Manaus, Amazonas, BrazilUniversidade Federal de São Paulo, São Paulo, BrazilUniversidade Federal de São Paulo, EPM, São Paulo, BrazilWeb of Scienc

Impact of Risk Factors on COVID-19 Outcomes in Unvaccinated People with Rheumatic Diseases

BACKGROUND: Approximately one-third of individuals worldwide have not received a COVID-19 vaccine. While studies have investigated risk factors linked to severe COVID-19 among unvaccinated people with rheumatic diseases(RD), we know less about whether these factors changed as the pandemic progressed. We aimed to identify risk factors associated with severe COVID-19 in unvaccinated individuals in different pandemic epochs corresponding to major variants of concern. METHODS: Patients with RD and COVID-19 were entered into the COVID-19 Global Rheumatology Alliance registry between March 2020 and June 2022. An ordinal logistic regression model (not hospitalized, hospitalized, and death) was used with date of COVID-19 diagnosis, age, sex, race and/or ethnicity, comorbidities, RD activity, medications, and the human development index(HDI) as covariates. The main analysis included all unvaccinated patients across COVID-19 pandemic epochs; sub-analyses stratified patients according to rheumatic disease types. RESULTS: Among 19,256 unvaccinated people with RD and COVID-19, those who were older, male, had more comorbidities, used glucocorticoids, had higher disease activity, or lived in lower HDI regions had worse outcomes across epochs. For those with rheumatoid arthritis, sulfasalazine and B-cell depleting therapy were associated with worse outcomes, and TNF-inhibitors were associated with improved outcomes. In those with connective tissue disease or vasculitis, B-cell depleting therapy was associated with worse outcomes. CONCLUSIONS: Risk factors for severe COVID-19 outcomes were similar throughout pandemic epochs in unvaccinated people with RD. Ongoing efforts, including vaccination, are needed to reduce COVID-19 severity in this population, particularly in those with medical and social vulnerabilities identified in this study. This article is protected by copyright. All rights reserved

Recommendations of the Brazilian Society of Rheumatology for the diagnosis and treatment of chikungunya fever. Part 2 – Treatment

Universidade Federal de Pernambuco. Recife, PE, Brasil; Universidade Federal de Pernambuco. Hospital das Clínicas. Recife, PE, Brasil; Universidade Federal de Pernambuco. Hospital das Clínicas. Serviço de Reumatologia. Recife, PE, Brasil; Instituto de Medicina Integral Professor Fernando Figueira. Recife, PE, Brasil; Hospital Getúlio Vargas. Ambulatório de Chikungunya. Recife, PE, Brasil; Universidade Federal da Paraíba. João Pessoa, PB, Brasil; Universidade Federal da Paraíba. Hospital Universitário Lauro Wanderley. Serviço de Reumatologia. João Pessoa, PB, Brasil; Universidade Estadual de Ciências da Saúde de Alagoas. Maceió, AL, Brasil; Universidade Federal do Rio Grande do Norte. Natal, RN, Brasil; Universidade Federal do Ceará. Faculdade de Medicina. Departamento de Medicina Clínica. Fortaleza, CE, Brasil; Universidade Federal da Bahia. Instituto de Ciências da Saúde. Salvador, BA, Brasil; Universidade Estadual do Piauí. Faculdade de Medicina. Teresina, PI, Brasil; Universidade Federal de Sergipe. Aracaju, SE, Brasil; Universidade do Estado do Rio de Janeiro. Disciplina de Reumatologia. Rio de Janeiro, RJ, Brasil; Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sérgio Arouca. Rio de Janeiro, RJ, Brasil; Universidade Federal do Rio de Janeiro. Hospital Universitário Clementino Fraga Filho. Rio de Janeiro, RJ, Brasil; Hospital dos Servidores do Estado do Rio de Janeiro. Rio de Janeiro, RJ, Brasil; Hospital Estadual Eduardo Rabello. Serviço de Reumatologia. Rio de Janeiro, RJ, Brasil; Universidade Federal do Amazonas. Faculdade de Medicina. Manaus, AM, Brasil; Universidade Federal de Mato Grosso do Sul. Campo Grande, MS, Brasil; Universidade Federal de Mato Grosso do Sul. Hospital Universitário Maria Aparecida Pedrossian. Serviço de Reumatologia. Campo Grande, MS, Brasil; Universidade de São Paulo. Faculdade de Medicina de Ribeirão Preto. Serviço de Reumatologia e Imunologia Pediátrica. Ribeirão Preto, SP, Brasil; Universidade Federal de São Paulo. São Paulo, SP, Brasil; Universidade de Santo Amaro. São Paulo, SP, Brasil; Universidade de São Paulo. Hospital das Clínicas. Ambulatório da Divisão de Moléstias Infecciosas de Parasitárias. São Paulo, SP, Brasil; Instituto de Medicina Integral Professor Fernando Figueira. Hospital Miguel Arraes. Paulista, PE, Brasil; Universidade Federal de Pernambuco. Hospital das Clínicas. Divisão de Gestão do Cuidado. Recife, PE, Brasil; CRP Fisioterapia. Rio de Janeiro, RJ, Brasil; Universidade Estadual do Piauí. Teresina, PI, Brasil; Sociedade Brasileira de Reumatologia. São Paulo, SP, Brasil; Santa Casa de Misericórdia de Maceió. Maceió, AL, BrasilSubmitted by Fátima Lopes ([email protected]) on 2017-10-24T13:42:18Z No. of bitstreams: 1 RecomendaçõesSociedadeBrasileiraP2.pdf: 984331 bytes, checksum: 9e4f277be0f65c545e7ac6b277aac848 (MD5)Approved for entry into archive by Fátima Lopes ([email protected]) on 2017-10-24T13:58:50Z (GMT) No. of bitstreams: 1 RecomendaçõesSociedadeBrasileiraP2.pdf: 984331 bytes, checksum: 9e4f277be0f65c545e7ac6b277aac848 (MD5)Made available in DSpace on 2017-10-24T13:58:50Z (GMT). No. of bitstreams: 1 RecomendaçõesSociedadeBrasileiraP2.pdf: 984331 bytes, checksum: 9e4f277be0f65c545e7ac6b277aac848 (MD5) Previous issue date: 2017Multipla - ver em NotasA febre chikungunya tem se tornado um importante problema de saúde pública nos países onde ocorrem as epidemias, visto que metade dos casos evolui com artrite crônica, persistente e incapacitante. Os dados na literatura sobre terapêuticas específicas nas diversas fases da artropatia ocasionada pela infecção pelo vírus chikungunya (CHIKV) são limitados, não existem estudos randomizados de qualidade que avaliem a eficácia das diferentes terapias. Há algumas poucas publicações sobre o tratamento das manifestações musculoesqueléticas da febre chikungunya, porém com importantes limitações metodológicas. Os dados atualmente disponíveis não permitem conclusões favoráveis ou contrárias a terapêuticas específicas, bem como uma adequada avaliação quanto à superioridade entre as diferentes medicações empregadas. O objetivo deste trabalho foi elaborar recomendações para o tratamento da febre chikungunya no Brasil. Foi feita uma revisão da literatura com seleção de artigos baseados em evidência, nas bases de dados Medline, SciELO, PubMed e Embase e de resumos de anais de congressos, além da opinião dos especialistas para dar apoio às decisões tomadas para definir as recomendações. Para a definição do grau de concordância foi feita uma metodologia Delphi, em duas reuniões presenciais e várias rodadas de votação on line. Este artigo refere-se à parte 2 das Recomendações da Sociedade Brasileira de Reumatologia para Diagnóstico e Tratamento da Febre Chikungunya, que trata especificamente do tratamento

Recommendations of the Brazilian Society of Rheumatology for diagnosis and treatment of Chikungunya fever. Part 1 - Diagnosis and special situations

Abstract Chikungunya fever has become a relevant public health problem in countries where epidemics occur. Until 2013, only imported cases occurred in the Americas, but in October of that year, the first cases were reported in Saint Marin island in the Caribbean. The first autochthonous cases were confirmed in Brazil in September 2014; until epidemiological week 37 of 2016, 236,287 probable cases of infection with Chikungunya virus had been registered, 116,523 of which had serological confirmation. Environmental changes caused by humans, disorderly urban growth and an ever-increasing number of international travelers were described as the factors responsible for the emergence of large-scale epidemics. Clinically characterized by fever and joint pain in the acute stage, approximately half of patients progress to the chronic stage (beyond 3 months), which is accompanied by persistent and disabling pain. The aim of the present study was to formulate recommendations for the diagnosis and treatment of Chikungunya fever in Brazil. A literature review was performed in the MEDLINE, SciELO and PubMed databases to ground the decisions for recommendations. The degree of concordance among experts was established through the Delphi method, involving 2 in-person meetings and several online voting rounds. In total, 25 recommendations were formulated and divided into 3 thematic groups: (1) clinical, laboratory and imaging diagnosis; (2) special situations; and (3) treatment. The first 2 themes are presented in part 1, and treatment is presented in part 2