Avaliação econômica das anticitocinas adalimumabe, etanercepte e infliximabe no tratamento da artrite reumatoide no Estado do Paraná

Este estudo objetivou realizar uma avaliação econômica das anticitocinas adalimumabe (ADA), etanercepte (ETA) e infliximabe (IFX) para o tratamento da artrite reumatoide no Estado do Paraná, sob a perspectiva do SUS. Os dados de eficácia e segurança dos tratamentos foram buscados na literatura, e os custos foram calculados com valores gastos pelo SUS para cada um dos tratamentos. Foi elaborado o modelo de Markov para obter a relação custo-efetividade de cada tratamento. A relação custo-efetividade incremental (ICER) comparado ao tratamento padrão também foi calculada para cada anticitocina. Análises de sensibilidade e taxas de desconto foram aplicadas. Na avaliação custo-efetividade, encontraram-se custos por QALY de R$511.633,00, R$ 437.486,00 e R$657.593,00 para ADA, ETA e IFX, respectivamente. O ICER por QALY foi R$ 628.124,00, R$509.974,00 e R$ 965.927,00 para ADA, ETA e IFX, respectivamente. Nas análises de sensibilidade, o ETA e o ADA apresentaram valores próximos. Cabe aos gestores públicos e aos médicos prescritores a escolha adequada para cada paciente, entre os tratamentos disponibilizados.This study aimed to perform an economic evaluation of anticytokines adalimumab (ADA), etanercept (ETA) and infliximab (IFX) for the treatment of rheumatoid arthritis in the State of Parana, in Brazil, in the perspective of the Brazilian Unified Health System. Data on efficacy and safety of treatment were collected in literature, and costs were calculated on the amounts spent by the Government for each treatment. A Markov model was performed to get the cost-effectiveness of each treatment. The incremental cost-effectiveness relationship (ICER) compared to a standard treatment was also calculated for each anticytokine. Sensitivity analysis and discount rates were applied. In assessing cost-effectiveness we found the following values (cost at R$per QALY): 511,633.00, 437,486.00 and 657,593.00 (respectively for ADA, ETA and IFX). The ICER (R$ per QALY) was 628,124.00, 509,974.00 and 965,927.00 (for ADA, ETA and IFX). In the sensitivity analysis, ETA and ADA showed similar values. It is for public managers and physicians the choice for each patient, among the treatments available

Clinical profile of patients with lupus nephritis

To the Editor Lupus nephritis is the strongest predictor of systemic lupus erythematosus (SLE) patient’s morbidity and mortality with a prevalence varying from 31 to 65% according to the studied population (1). As the onset of lupus nephritis is usually silent, knowing possible association with others symptoms is useful in order to keep of better vigilance on patients with higher possibility to develop it. Pistiner et al described that lupus patients with nephritis also have an increased frequency of other severe lupus manifestations (2). According to Huong et al, in a study of 180 patients with lupus renal involvement, patients with nephritis suffered more commonly from malar rash, psychosis, myocarditis, pericarditis, lymphadenopathy and hypertension..

Fibromyalgia and menopause: an open study on postmenopausal hormone therapy.

Fibromyalgia women (FM) seems to get worse at menopause suggesting some influence of estrogens on its pathophysiology. We aimed to study the influence of postmenopausal hormone therapy (HT) in FM, the relationship with sleep and FM impact. We analyzed prospectively 69 menopausal women, divided in two groups, FM group (FMG; N.=32) and comparison group (CG; N.=28) submitted to HT for twelve weeks (1.2 mg/g transdermal estradiol, 100 mg micronized natural progesterone oral/daily). Data on Utian Quality of Life Questionnaire (UQOL) and Pittsburgh Sleep Quality Index (PSQI) were obtained in both groups, at entrance and twelve weeks after HT. FM patients also completed the Fibromyalgia Impact Questionnaire - Revised (FIQ-R) and fibromyalgia severity (FS). FM patients improved significantly the FIQ-R (P=0.0001, median FIQ-R score 30% lower), mainly the severity of FM, assessed by FS (P<0.0001). Both groups had improved quality of life and sleep (UQOL: P=0.0001; P=0.001, PSQI: P<0.0001; P=0.007, respectively). Differences between first and second PSQI were greater for CG than for FMG (P=0.008). HT improving sleep and quality of life in both groups; it was a significant clinical improvement seen by FIQ and FS in FM patients. These changes characterize improvement of functional status and symptoms severity

Profile of the use of disease modifying drugs in the brazilian registry of spondyloarthritides

Few studies have evaluated the profile of use of disease modifying drugs (DMD) in Brazilian patients with spondyloarthritis (SpA). A common research protocol was applied prospectively in 1505 patients classified as SpA by criteria of the European Spondyloarthropathies Study Group (ESSG), followed at 29 referral centers in Rheumatology in Brazil. Demographic and clinical variables were obtained and evaluated, by analyzing their correlation with the use of DMDs methotrexate (MTX) and sulfasalazine (SSZ). At least one DMD was used by 73.6% of patients: MTX by 29.2% and SSZ by 21.7%, while 22.7% used both drugs. The use of MTX was significantly associated with peripheral involvement, and SSZ was associated with axial involvement, and the two drugs were more administered, separately or in combination, in the mixed involvement (p < 0.001). The use of a DMD was significantly associated with Caucasian ethnicity (MTX , p = 0.014), inflammatory back pain (SSZ, p = 0.002) , buttock pain (SSZ, p = 0.030), neck pain (MTX, p = 0.042), arthritis of the lower limbs (MTX, p < 0.001), arthritis of the upper limbs (MTX, p < 0.001), enthesitis (p = 0.007), dactylitis (MTX, p < 0.001), inflammatory bowel disease (SSZ, p < 0.001) and nail involvement (MTX, p < 0.001). The use of at least one DMD was reported by more than 70% of patients in a large cohort of Brazilian patients with SpA, with MTX use more associated with peripheral involvement and the use of SSZ more associated with axial involvement.Few studies have evaluated the profile of use of disease modifying drugs (DMD) in Brazilian patients with spondyloarthritis (SpA). A common research protocol was applied prospectively in 1505 patients classified as SpA by criteria of the European Spondylo5413337sem informaçãosem informaçã

Avaliação do desempenho do BASDAI (Bath Ankylosing Spondylitis Disease Activity Index)

Objective: To analyze the results of the application of the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) in a large series of Brazilian patients with the diagnosis of SpA and establish its correlations with specific variables into the group. Methods: A common protocol of investigation was prospectively applied to 1492 Brazilian patients classified as SpA according to the European Spondyoarthropathies Study Group (ESSG), attended at 29 referral centers of Rheumatology in Brazil. Clinical and demographic variables, and disease indices (BASDAI, Basfi, Basri, Mases, ASQol) were applicated. The total values of BASDAI were compared to the presence of the different variables. Results: The mean score of BASDAI was 4.20 +/- 2.38. The mean scores of BASDAI were higher in patients with the combined (axial + peripheral + entheseal) (4.54 +/- 2.38) clinical presentation, compared to the pure axial (3.78 +/- 2.27) or pure peripheral (4.00 +/- 2.38) clinical presentations (p<0.001). BASDAI also presented higher scores associated with the female gender (p<0.001) and patients who did not practice exercises (p<0.001). Regarding the axial component, higher values of BASDAI were significantly associated with inflammatory low back pain (p<0.049), alternating buttock pain (p<0.001), cervical pain (p<0.001) and hip involvement (p< 0.001). There was also statistical association between BASDAI scores and the peripheral involvement, related to the lower (p=0.004) and upper limbs (p=0.025). The presence of enthesitis was also associated to higher scores of BASDAI (p=0.040). Positive HLA-B27 and the presence of cutaneous psoriasis, inflammatory bowel disease, uveitis and urethritis were not correlated with the mean scores of BASDAI. Lower scores of BASDAI were associated with the use of biologic agents (p<0.001). Conclusion: In this heterogeneous Brazilian series of SpA patients, BASDAI was able to demonstrate "disease activity" in patients with axial as well as peripheral disease. (C) 2014 Elsevier Editora Ltd a. All rights reserved.To analyze the results of the application of the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) in a large series of Brazilian patients with the diagnosis of SpA and establish its correlations with specific variables into the group. Methods:5514854sem informaçãosem informaçãoTo analyze the results of the application of the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) in a large series of Brazilian patients with the diagnosis of SpA and establish its correlations with specific variables into the group. Methods

Perfil epidemiológico da espondiloartrite de início juvenil comparada com

To analyze the clinical and epidemiologic characteristics ofjuvenile-onset spondyloarthritis5519192sem informaçãosem informaçãoAnalisar as características clínicas e epidemiológicas da espondiloartrite (EspA) d

Brazilian Biologic Registry: Biobada Brasil Implementation Process And Preliminary Results

Objectives: The present study aimed at describing the implementation process of a national registry in a developing country (Brazil) and at reporting the main preliminary results of the BiobadaBrasil registry. Material and methods: Through a PANLAR agreement, the Biobadaser protocol was used as a model for implementing the new registry in our country. During the first two years of this effort, the original protocol was adapted, translated, and presented to all Brazilian rheumatologists. For ten months, data of 1,037 patients (750 subjects treated with biological drugs and 287 control subjects) from 15 centers were collected. Results: Most patients had rheumatoid arthritis (RA) (n = 723). Infliximab was the most frequently used anti-TNF agent, and the total exposure to biologic drugs was 2,101 patient-years. The most common reason for interrupting drug use was lack or loss of efficacy (50%), while 30% withdrew from the treatment arm due to adverse events. Three cases of tuberculosis were observed in the biologic group, with an incidence higher than that of the general Brazilian population. Infections were observed in 23% of the biologic group, and the upper respiratory tract was the most commonly affected site. Only one case of tuberculoid leprosy was observed. No deaths or malignancies attributed to drug effects were observed as of February 2010. Conclusions: The implementation of the BiobadaBrasil registry was successful, and, although recent, the registry has provided important data. ©Elsevier Editora Ltda.51214515

Profile Of The Use Of Disease Modifying Drugs In The Brazilian Registry Of Spondyloarthritides [perfil Do Uso De Drogas Modificadoras De Doença No Registro Brasileiro De Espondiloartrites]

Introduction: Few studies have evaluated the profile of use of disease modifying drugs (DMD) in Brazilian patients with spondyloarthritis (SpA). Methods: A common research protocol was applied prospectively in 1505 patients classified as SpA by criteria of the European Spondyloarthropathies Study Group (ESSG), followed at 29 referral centers in Rheumatology in Brazil. Demographic and clinical variables were obtained and evaluated, by analyzing their correlation with the use of DMDs methotrexate (MTX) and sulfasalazine (SSZ). Results: At least one DMD was used by 73.6 % of patients: MTX by 29.2 % and SSZ by 21.7%, while 22.7 % used both drugs. The use of MTX was significantly associated with peripheral involvement, and SSZ was associated with axial involvement, and the two drugs were more administered, separately or in combination, in the mixed involvement (p < 0.001). The use of a DMD was significantly associated with Caucasian ethnicity (MTX, p = 0.014), inflammatory back pain (SSZ, p = 0.002), buttock pain (SSZ, p = 0.030), neck pain (MTX, p = 0.042), arthritis of the lower limbs (MTX, p < 0.001), arthritis of the upper limbs (MTX, p < 0.001), enthesitis (p = 0.007), dactylitis (MTX, p < 0.001), inflammatory bowel disease (SSZ, p < 0.001) and nail involvement (MTX, p < 0.001). Conclusion: The use of at least one DMD was reported by more than 70% of patients in a large cohort of Brazilian patients with SpA, with MTX use more associated with peripheral involvement and the use of SSZ more associated with axial involvement. © 2014 Elsevier Editora Ltda.5413337Sieper, J., Rudwaleit, M., Baraliakos, X., Brandt, J., Braun, J., Burgos-Vargas, R., The Assessment of SpondyloArthritis international Society (ASAS) handbook: A guide to assess spondyloarthritis (2009) Ann Rheum Dis, 68 (SUPPL. II), pp. ii1-ii44Rudwaleit, M., van der Heijde, D., Landewé, R., Listing, J., Brandt, J., Braun, J., The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection (2009) Ann Rheum Dis, 68, pp. 770-776Rudwaleit, M., van der Heijde, D., Landewé, R., Akkoc, N., Brandt, J., Chou, C.T., The development of Assessment of SpondyloArthritis international Society classification criteria for peripheral spondyloarthritis (2011) Ann Rheum Dis, 70, pp. 25-31Sampaio-Barros, P.D., Gonçalves, C.R., Braga da Silva, J.A., Ximenes, A.C., Azevedo, V.C., Bianchi, W.A., Registro Iberoamericano de Espondiloartritis (RESPONDIA): Brasil (2008) Reumatol. Clin., 4 (SUPPL. 4), pp. 30-35Benegas, M., Muñoz-Gomariz, E., Font, P., Burgos-Vargas, R., Chaves, J., Palleiro, D., Comparison of the clinical expression of patients with ankylosing spondylitis from Europe and Latin America (2012) J Rheumatol, 39, pp. 2315-2320Braun, J., van den Berg, R., Baraliakos, X., Boehm, H., Burgos-Vargas, R., Collantes-Estevez, E., 2010 Update of the ASAS/EULAR recommendations for the management of ankylosing spondyltis (2011) Ann Rheum Dis, 70, pp. 896-904Sampaio-Barros, P.D., Pinheiro, M.M., Ximenes, A.C., Meirelles, E.S., Keiserman, M., Azevedo, V.F., Recomendações sobre o tratamento da espondilite anquilosante (2013) Rev Bras Reumatol, 53, pp. 242-257Gossec, L., Smolen, J.S., Gaujoux-Viala, C., Ash, Z., Marzo-Ortega, H., van der Heijde, D., European League Against Rheumatism recommendations for the management of psoriatic arthritis with pharmacological therapies (2012) Ann Rheum Dis, 71, pp. 4-12Carneiro, S., Azevedo, V.F., Bonfiglioli, R., Ranza, R., Gonçalves, C.R., Keiserman, C.R., Recomendações sobre o tratamento da artrite psoriásica (2013) Rev Bras Reumatol, 53, pp. 227-241Dougados, M., van der Linden, S., Julin, R., Huitfeld, B., Amor, B., Calin, A., The European Spondyloarthropathy Study Group preliminary criteria for the classification of spondyloarthropathy (1991) Arthritis Rheum, 34, pp. 1218-1227van der Linden, S., Valkenburg, H.A., Cats, A., Evaluation of diagnostic criteria for ankylosing spondylitis (1984) A proposal for modification of the New York criteria. Arthritis Rheum, 27, pp. 361-368Moll, J.M.H., Wright, V., Psoriatic arthritis (1973) Semin Arthritis Rheum, 3, pp. 55-78Kingsley, G., Sieper, J., Third International Workshop on Reactive Arthritis, 23-26 September 1995, Berlin, Germany (1996) Ann Rheum Dis, 55, pp. 564-584Bodur, H., Ataman, S., Akbulut, L., Evcik, D., Kavuncu, V., Kaya, T., Characteristics and medical management of patients with rheumatoid arthritis and ankylosing spondylitis (2008) Clin Rheumatol, 27, pp. 1119-1125Altan, L., Bingöl, U., Karakoç, Y., Aydiner, S., Yurtkuran, M., Yurtkuran, M., Clinical investigation of methotrexate in the treatment of ankylosing spondylitis (2001) Scand J Rheumatol, 30, pp. 255-259Marshall, R.W., Kirwan, J.R., Methotrexate in the treatment of ankylosing spondylitis (2001) Scand J Rheumatol, 30, pp. 313-314Roychowdhury, B., Bintley-Bagot, S., Bulgen, D.Y., Thompson, R.N., Tunn, E.J., Moots, R.J., Is methotrexate effective in ankylosing spondylitis? (2002) Rheumatology (Oxford), 41, pp. 1330-1332Sampaio-Barros, P.D., Costallat, L.T., Bertolo, M.B., Marques-Neto, J.F., Samara, A.M., Methotrexate in the treatment of ankylosing spondylitis (2000) Scand J Rheumatol, 29, pp. 160-162Gonzalez-Lopez, L., Garcia-Gonzalez, A., Vazquez-Del-Mercado, M., Muñoz-Valle, J.F., Gomez-Nava, J.I., Efficacy of methotrexate in ankylosing spondylitis: a randomized, double blind, placebo controlled trial (2004) J Rheumatol, 31, pp. 1568-1574Haibel, H., Brandt, H.C., Song, I.H., Brandt, A., Listing, J., Rudwaleit, M., Sieper, J., No efficacy of subcutaneous methotrexate in active ankylosing spondylitis: a 16-week open-label trial (2007) Ann Rheum Dis., 66, pp. 419-421Abu-Shakra, M., Gladman, D.D., Thorne, J.C., Long, J., Gough, J., Farewell, V.T., Long-term methotrexate therapy in psoriatic arthritis: clinical and radiological outcome (1995) J Rheumatol, 22, pp. 241-245Scarpa, R., Peluso, R., Atteno, M., Manguso, F., Spanò, A., Iervolino, S., The effectiveness of a traditional therapeutical approach in early psoriatic arthritis: Results of a pilot randomised 6-month trial with methotrexate (2008) Clin Rheumatol, 27, pp. 823-826Lie, E., van der Heijde, D., Uhlig, T., Heiberg, M.S., Koldingsnes, W., Rødevand, E., Effectiveness and retention rates of methotrexate in psoriatic arthritis in comparison with methotrexate-treated patients with rheumatoid arthritis (2010) Ann Rheum Dis, 69, pp. 671-676Chandran, V., Raychaudhuri, S.P., Geoepidemiology and environmental factors of psoriasis and psoriatic arthritis (2010) J Autoimm, 34, pp. 314-321Skare, T.L., Bortoluzzo, A.B., Gonçalves, C.R., Braga da Silva, J.A., Ximenes, A.C., Bértolo, M.B., Ethnic influence in clinical and functional measures of Brazilian patients with spondyloarthritis (2012) J. Rheumatol, 39, pp. 141-147Clegg, D.O., Reda, D.J., Weisman, M.H., Blackburn, W.D., Cush, J.J., Cannon, G.W., Comparison of sulfasalazine and placebo in the treatment of ankylosing spondylitis (1996) A Department of Veterans Affairs Cooperative Study. Arthritis Rheum, 39, pp. 2004-2012Chen, J., Liu, C., Is sulfasalazine effective in ankylosing spondylitis? (2006) A systematic review of randomized controlled trials. J Rheumatol, 33, pp. 722-731Gupta, A.K., Grober, J.S., Hamilton, T.A., Ellis, C.N., Siegel, M.T., Voorhees, J.J., Sulfasalazine therapy for psoriatic arthritis: a double blind, placebo controlled trial (1995) J Rheumatol, 22, pp. 894-898Combe, B., Goupille, P., Kuntz, J.L., Tebib, J., Lioté, F., Bregeon, C., Sulphasalazine in psoriatic arthritis: a randomized, multicentre, placebo-controlled study (1996) Br J Rheumatol, 35, pp. 664-668Clegg, D.O., Reda, D.J., Mejias, E., Cannon, G.W., Weisman, M.H., Taylor, T., Comparison of sulfasalazine and placebo in the treatment of psoriatic arthritis (1996) A Department of Veterans Affairs Cooperative Study. Arthritis Rheum, 39, pp. 2004-2012Clegg, D.O., Reda, D.J., Weisman, M.H., Cush, J.J., Vasey, F.B., Schumacher Jr., H.R., Comparison of sulfasalazine and placebo in the treatment of reactive arthritis (Reiter's syndrome) (1996) A Department of Veterans Affairs Cooperative Study. Arthritis Rheum, 39, pp. 2021-2027Consensus guidelines for the management of inflammatory bowel disease (2010) Arq Gastroenterol, 47, pp. 313-325. , Brazilian Study Group of Inflammatory Bowel DiseasesD'Haens, G.R., Panaccione, R., Higgins, P.D., Vermeire, S., Gassull, M., Chowers, Y., The London Position Statement of the World Congress of Gastroenterology on Biological Therapy for IBD with the European Crohn's and Colitis Organization: When to start, when to stop, which drug to choose, and how to predict response? (2011) Am J Gastroenterol, 106, pp. 199-212Carneiro, S., Bortoluzzo, A.B., Gonçalves, C.R., Braga da Silva, J.A., Ximenes, A.C., Bértolo, M.B., Impact of enthesitis in 1505 Brazilian patients with spondyloarthritis (2013) J Rheumatol, 40, pp. 1719-172

Low Prevalence Of Renal, Cardiac, Pulmonary, And Neurological Extra-articular Clinical Manifestations In Spondyloarthritis: Analysis Of The Brazilian Registry Of Spondyloarthritis

Objective: To describe the extra-articular manifestations (cardiac, renal, pulmonary, and neurological), usually not related to spondyloarthritis (SpA), in a large cohort of Brazilian patients. Materials and methods: This retrospective study analyzed 1,472 patients diagnosed with SpA and cared for at 29 health care centers distributed in the five major geographic regions in the country, participating in the Brazilian Registry of Spondyloarthritis (BRS). All patients were assessed for the prevalence of major extra-articular manifestations (cardiac, renal, pulmonary, and neurological), classify ed according to the diagnosis [ankylosing spondylitis (AS), psoriatic arthritis (PsA), reactive arthritis (ReA), arthritis associated with inflammatory bowel disease (IBD), undifferentiated spondyloarthritis (uSpA), and juvenile SpA], and according to the clinical presentation (axial, peripheral, mixed, and enthesitis). Results: Of the patients with SpA assessed, 963 had AS, 271 PsA, 49 ReA, 48 arthritis associated with IBD, 98 uSpA, and 43 juvenile SpA. Cardiac involvement was reported in 44 patients (3.0%), pulmonary involvement in 19 (1.3%), renal involvement in 17 (1.2%), and neurological involvement in 13 patients (0.9%). Most patients with visceral involvement had AS or PsA, and the mixed (axial + peripheral) and/or predominantly axial clinical form. Conclusion: Cardiac, renal, pulmonary, and neurological extra-articular manifestations are quite infrequent in SpA, ranging from 0.9% to 3% in this large Brazilian cohort, and affected predominantly patients with AS and PsA. © 2012 Elsevier Editora Ltda. All rights reserved.523375383Sieper, J., Rudwaleit, M., Baraliakos, X., Brandt, J., Braun, J., Burgos-Vargas, R., The Assessment of SpondyloArthritis international Society (ASAS) handbook: A guide to assess spondyloarthritis (2009) Ann Rheum Dis, 68 (SUPPL 2), pp. ii1-44Mielants, H., van den Bosh, F., Extra-articular manifestations (2009) Clin Exp Rheumatol, 27 (4 SUPPL 55), pp. S56-S61van der Cruyssen, B., Ribbens, C., Boonen, A., Mielants, H., de Vlam, K., Lenaerts, J., The epidemiology of ankylosing spondylitis and the commencement of anti-TNF therapy in daily rheumatology practice (2007) Ann Rheum Dis, 66 (8), pp. 1072-1077van der Linden, S., Valkenburg, H.A., Cats, A., Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria (1984) Arthritis Rheum, 27 (4), pp. 361-368Moll, J.M.H., Wright, V., Psoriatic arthritis (1973) Semin Arthritis Rheum, 3 (1), pp. 55-78Kingsley, G., Sieper, J., Third International Workshop on Reactive Arthritis. 23-26 September 1995, Berlin, Germany. Report and abstracts (1996) Ann Rheum Dis, 55 (8), pp. 564-584Bergfeldt, L., HLA-B27-associated cardiac disease (1997) Ann Intern Med, 127 (8 PT 1), pp. 621-629Peeters, A.J., ten Wolde, S., Sedney, M.I., de Vries, R.R., Dijkmans, B.A., Heart conduction disturbance: An HLA-B27 associated disease (1991) Ann Rheum Dis, 50 (6), pp. 348-350Brunner, F., Kunz, A., Weber, U., Kissling, R., Ankylosing spondylitis and heart abnormalities: Do cardiac conduction disorders, valve regurgitation and diastolic dysfunction occur more often in male patients with diagnosed ankylosing spondylitis for over 15 years than in the normal population? (2006) Clin Rheumatol, 25 (1), pp. 24-29Palazzi, C., D'angelo, S., Lubrano, E., Olivieri, I., Aortic involvement in ankylosing spondylitis (2008) Clin Exp Rheumatol, 26 (3 SUPPL 49), pp. S131-S134Eder, L., Sadek, M., McDonald-Blumer, H., Gladman, D.D., Aortitis and spondyloarthritis - an unusual presentation: Case report and review of the literature (2010) Semin Arthritis Rheum, 39 (6), pp. 510-514Peters, M., van der Horst-Bruinsma, I.E., Dijkmans, B.A., Nurmohamed, M.T., Cardiovascular risk profile of patients with spondyloarthropathies, particularly ankylosing spondylitis and psoriatic arthritis (2004) Semin Arthritis Rheum, 34 (3), pp. 585-592Heeneman, S., Daemen, M.J., Cardiovascular risks in spondyloarthritides (2007) Curr Opin Rheumatol, 19 (4), pp. 358-362Han, 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. 2167-2172Rosenow, E., Strimlan, C.V., Muhm, J.R., Ferguson, R.H., Pleuropulmonary manifestations of ankylosing spondylitis (1977) Mayo Clin Proc, 52 (10), pp. 641-649Casserly, I.P., Fenlon, H.M., Breatnach, E., Sant, S.M., Lung findings on high-resolution computed tomography in idiopathic ankylosing spondylitis - correlation with clinical findings, pulmonary function testing and plain radiograph (1997) Br J Rheumatol, 36 (6), pp. 677-682El-Maghraoui, A., Chaouir, S., Abid, A., Bezza, A., Tabache, F., Achemlal, L., Lung findings on thoracic high-resolution computed tomography in patients with ankylosing spondylitis. Correlations with disease duration, clinical findings and pulmonary function testing (2004) Clin Rheumatol, 23 (2), pp. 123-128Sampaio-Barros, P.D., Cerqueira, E.M., Rezende, S.M., Maeda, L., Conde, R.A., Zanardi, V.A., Pulmonary involvement in ankylosing spondylitis (2007) Clin Rheumatol, 26 (2), pp. 225-230Bruneau, C., Villiaumey, J., Avouac, B., Martigny, J., Laurent, J., Pichot, A., Seronegative spondyloarthropathies and IgA glomerulonephritis: A report of four cases and a review of the literature (1986) Semin Arthritis Rheum, 15 (3), pp. 179-184Strobel, E.S., Frithschka, E., Renal diseases in ankylosing spondylitis: Review of the literature illustrated by case reports (1998) Clin Rheumatol, 17 (6), pp. 524-530Vilar, M.J., Cury, S.E., Ferraz, M.B., Sesso, R., Atra, E., Renal abnormalities in ankylosing spondylitis (1997) Scand J Rheumatol, 26 (1), pp. 19-23Lange, U., Stapfer, G., Ditting, T., Geiger, H., Teichmann, J., Müller-Ladner, U., Pathologic alterations of the heart and the kidney in patients with ankylosing spondylitis (2007) Eur J Med Res, 12 (12), pp. 573-581Azevedo, D.C., Ferreira, G.A., Carvalho, M.A., Nefropatia por IgA em portadores de espondiloartrites acompanhados no Serviço de Reumatologia do Hospital das Clínicas da UFMG (2011) Rev Bras Reumatol, 51 (5), pp. 412-422Gallinaro, A.L., Ventura, C., Barros, P.D., Gonçalves, C.R., Spondyloarthritis: Analysis of a Brazilian series compared with a large Ibero-American registry (RESPONDIA group) (2010) Rev Bras Reumatol, 50 (5), pp. 581-589Lehtinen, K., Mortality and causes of death in 398 patients admitted to hospital with ankylosing spondylitis (1993) Ann Rheum Dis, 52 (3), pp. 174-176Gratacos, J., Orellana, C., Sanmarti, R., Sole, M., Collado, A., Gomez-Casanovas, E., Secondary amyloidosis in ankylosing spondylitis. A systematic survey of 137 patients using abdominal fat aspiration (1997) J Rheumatol, 24 (5), pp. 912-915Hunter, T., The spinal complications of ankylosing spondylitis (1989) Semin Arthritis Rheum, 19 (3), pp. 172-182Ahn, N.U., Ahn, U.M., Nallamshetty, L., Springer, B.D., Buchowski, J.M., Funches, L., Cauda equina syndrome in ankylosing spondylitis (the CES-AS syndrome): Meta-analysis of outcomes after medical and surgical treatments (2001) J Spinal Disord, 14 (5), pp. 427-433Ramos-Remus, C., Gomez-Vargas, A., Hernandez-Chavez, A., Gamez-Nava, J.I., Gonzalez-Lopez, L., Russell, A.S., Two year followup of anterior and vertical atlantoaxial subluxation in ankylosing spondylitis (1997) J Rheumatol, 24 (3), pp. 507-510Westerveld, L.A., Verlaan, J.J., Oner, F.C., Spinal fractures in patients with ankylosing spinal disorders: A systematic review of the literature on treatment, neurological status and complications (2009) Eur Spine J, 18 (2), pp. 145-15