Systemic autoimmune diseases and work outcomes in Brazil: a scoping review

OBJECTIVE To review articles that assessed work-related outcomes such as workability, work productivity, presenteeism, absenteeism, sick leave, return to work, and employment status of Brazilian patients with rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis, Sjögren’s syndrome, and systemic autoimmune myopathies. METHODS This study was conducted in Medline databases (PubMed), SciELO, and Lilacs through a combination of descriptors of interest. Studies published until December 2020 were considered in the search strategy. RESULTS Eight out of 90 articles met the eligibility criteria and were included in this review. The studies are highly heterogeneous. Most of them are cross-sectional, and all of them address rheumatoid arthritis or systemic lupus erythematosus. A common denominator among these studies is the high proportion of patients outside the labor market. CONCLUSIONS In general, the studies show unfavorable labor outcomes and impaired participation in the Brazilian workforce among the samples of patients assessed. There is a need to better understand several topics about Brazilian patients with systemic autoimmune diseases and their work context, as well as to conduct studies focusing on rarer diseases and on the themes of return and reintegration to work

Versão em língua portuguesa do Brasil e a reprodutibilidade do questionário de índice de mobilidade para espondilite anquilosante

PURPOSE: To translate and adapt the Bath Ankylosing Spondylitis Methodology Index (BASMI) - a metrological measurement for the assessment of patients with ankylosing spondylitis to Brazilian-Portuguese and to analyze the applicability of the questionnaire. METHODS: The Brazilian-Portuguese version of the Bath Ankylosing Spondylitis Methodology Index was achieved through a translation and back-translation process. This new Bath Ankylosing Spondylitis Methodology Index version was administered to 25 consecutive patients with ankylosing spondylitis who met the 1984 New York criteria for ankylosing spondylitis and were followed in the Soronegative Spondyloarthropathy Unit of the Rheumatology Division, São Paulo University Medical School, from May to November 2005. In order to evaluate the applicability of the questionnaire, it was administered to patients by 2 separate observers, A and B (Rheumatologists), enabling inter-observer test analysis. After 2 weeks, the second interview was administered to the same patients by observer A only to analyze the intra-observer test. All interviews were conducted in the morning. The Pearson coefficient correlation was used to evaluate applicability. RESULTS: There was no conflict stemming from translation and re-translation of Bath Ankylosing Spondylitis Methodology Index questionnaire, and cross-cultural adaptation proved unnecessary. All components had statistically significant coefficients for intra- and inter-observational applicability, with scores ranging from 0.85 to 1.00 and 0.80 to 0.94, respectively. DISCUSSION: The Brazilian-Portuguese version of the Bath Ankylosing Spondylitis Methodology Index proved to be an applicable instrument for analyzing the mobility index of Brazilian patients with ankylosing spondylitis.OBJETIVO: Traduzir e adaptar para a língua portuguesa do Brasil o Bath Ankylosing Spondylitis of Metrodology Index (BASMI) - instrumento de mensuração metrológica de pacientes com espondilite anquilosante - além de avaliar a reprodutibilidade deste questionário. MÉTODOS: O Bath Ankylosing Spondylitis of Metrodology Index em versão língua portuguesa do Brasil foi obtida após processo de tradução e retro-tradução. Essa nova versão foi aplicada em 25 pacientes consecutivos com espondilite anquilosante, que preenchiam os critérios modificados de Nova Iorque de 1984 e que estavam em acompanhamento na Unidade de Espondiloartropatia Soronegativa do Serviço de Reumatologia da Faculdade de Medicina de Universidade de São Paulo, de maio a novembro de 2005. Para avaliar a reprodutibilidade, o questionário foi aplicado aos pacientes por dois observadores fixos e independentes: A e B (Reumatologistas), no mesmo dia, para avaliar teste interobservador. Após 14 dias, o observador A reaplicou o questionário aos mesmos pacientes para avaliação de teste intra-observador. Todas as entrevistas foram feitas no período de manhã. O coeficiente de correlação de Pearson foi usado para avaliação da reprodutibilidade. RESULTADOS: Não houve conflito quanto a tradução e re-tradução do questionário Bath Ankylosing Spondylitis of Metrodology Index. Também não houve a necessidade de adaptação cultural. Todos os componentes do Bath Ankylosing Spondylitis of Metrodology Index apresentaram coeficiente estatisticamente significante para reprodutibilidade intra e interobservadores, com escores, respectivamente, variando entre 0,85 a 1,00, e 0,80 a 0,94. DISCUSSÃO: O Bath Ankylosing Spondylitis of Metrodology Index, versão para a língua portuguesa do Brasil, mostrou-se ser um instrumento reprodutível para ser utilizado na avaliação do índice de mobilidade de pacientes brasileiros com espondilite anquilosante

COVID-19 severity and vaccine breakthrough infections in idiopathic inflammatory myopathies, other systemic autoimmune and inflammatory diseases, and healthy controls: a multicenter cross-sectional study from the COVID-19 Vaccination in Autoimmune Diseases (COVAD) survey

OBJECTIVES: We aimed to compare the spectrum and severity of COVID-19 and vaccine breakthrough infections (BIs) among patients with IIMs, other systemic autoimmune and inflammatory diseases (SAIDs), and healthy controls (HCs). METHODS: This is a cross-sectional study with data from the COVAD study, a self-reported online global survey that collected demographics, COVID-19 history, and vaccination details from April to September 2021. Adult patients with at least one COVID-19 vaccine dose were included. BIs were defined as infections occurring > 2 weeks after any dose of vaccine. Characteristics associated with BI were analyzed with a multivariate regression analysis. RESULTS: Among 10,900 respondents [42 (30-55) years, 74%-females, 45%-Caucasians] HCs were (47%), SAIDs (42%) and IIMs (11%). Patients with IIMs reported fewer COVID-19 cases before vaccination (6.2%-IIM vs 10.5%-SAIDs vs 14.6%-HC; OR = 0.6, 95% CI 0.4-0.8, and OR = 0.3, 95% CI 0.2-0.5, respectively). BIs were uncommon (1.4%-IIM; 1.9%-SAIDs; 3.2%-HC) and occurred in 17 IIM patients, 13 of whom were on immunosuppressants, and 3(18%) required hospitalization. All-cause hospitalization was higher in patients with IIM compared to HCs [23 (30%) vs 59 (8%), OR = 2.5, 95% CI 1.2-5.1 before vaccination, and 3 (18%) vs 9 (5%), OR = 2.6, 95% CI 1.3-5.3 in BI]. In a multivariate regression analysis, age 30-60 years was associated with a lower odds of BI (OR = 0.7, 95% CI 0.5-1.0), while the use of immunosuppressants had a higher odds of BI (OR = 1.6, 95% CI 1.1-2.7). CONCLUSIONS: Patients with IIMs reported fewer COVID-19 cases than HCs and other SAIDs, but had higher odds of all-cause hospitalization from COVID-19 than HCs. BIs were associated with the use of immunosuppressants and were uncommon in IIMs

Different aspects of magnetic resonance imaging of muscles between dermatomyositis and polymyositis

AbstractIntroductionAlthough dermatomyositis (DM) and polymyositis (PM) share many clinical features in common, they have distinct pathophysiological and histological features. It is possible that these distinctions reflect also macroscopically, for example, in muscle alterations seen in magnetic resonance images (MRI).ObjectivesTo compare simultaneously the MRI of various muscle compartments of the thighs of adult DM and PM.MaterialsThe present study is a cross-sectional that included, between 2010 and 2013, 11 newly diagnosed DM and 11 PM patients (Bohan and Peter's criteria, 1975), with clinical and laboratory activity. They were valued at RM thighs, T1 and T2 with fat suppression, 1.5 T MRI scanner sequences.ResultsThe mean age at the time of MRI, the time between onset of symptoms and the realization of the MRI distribution of sex and drug therapy were comparable between the two groups (p>0.050). Concerning the MRI, muscle edema was significantly found in DM, and mainly in the proximal region of the muscles. The area of fat replacement was found predominantly in PM. The partial fat replacement area occurred mainly in the medial and distal region, whereas the total fat replacement area occurred mainly in the distal muscles. There was no area of muscle fibrosis.ConclusionsDM and PM have different characteristics on MRI muscles, alike pathophysiological and histological distinctions

Skeletal muscle major histocompatibility complex class I and II expression differences in adult and juvenile dermatomyositis

OBJECTIVE: To analyze major histocompatibility complex expression in the muscle fibers of juvenile and adult dermatomyositis. METHOD: In total, 28 untreated adult dermatomyositis patients, 28 juvenile dermatomyositis patients (Bohan and Peter's criteria) and a control group consisting of four dystrophic and five Pompe's disease patients were analyzed. Routine histological and immunohistochemical (major histocompatibility complex I and II, StreptoABComplex/HRP, Dakopatts) analyses were performed on serial frozen muscle sections. Inflammatory cells, fiber damage, perifascicular atrophy and increased connective tissue were analyzed relative to the expression of major histocompatibility complexes I and II, which were assessed as negatively or positively stained fibers in 10 fields (200X). RESULTS: The mean ages at disease onset were 42.0±15.9 and 7.3±3.4 years in adult and juvenile dermatomyositis, respectively, and the symptom durations before muscle biopsy were similar in both groups. No significant differences were observed regarding gender, ethnicity and frequency of organ involvement, except for higher creatine kinase and lactate dehydrogenase levels in adult dermatomyositis (

Serum adipocytokine profile and metabolic syndrome in young adult female dermatomyositis patients

OBJECTIVES: To analyse the frequency of metabolic syndrome in young adult female dermatomyositis patients and its possible association with clinical and laboratory dermatomyositis-related features and serum adipocytokines. METHOD: This cross-sectional study included 35 dermatomyositis patients and 48 healthy controls. Metabolic syndrome was defined according to the 2009 Joint Interim Statement. RESULTS: Patient age was comparable in the dermatomyositis and control groups, and the median disease duration was 1.0 year. An increased prevalence of metabolic syndrome was detected in the dermatomyositis group (34.3% vs. 6.3%; p=0.001). In addition, increased serum adiponectin and resistin levels were noted in contrast to lower leptin levels. In dermatomyositis patients, adipocytokine levels were correlated with the levels of total cholesterol, low-density cholesterol, triglycerides and muscle enzymes. A comparison of dermatomyositis patients with (n=12) and without (n=23) syndrome metabolic revealed that adipocytokine levels were also correlated with age, and that dermatomyositis patients with metabolic syndrome tended to have more disease activity despite similar adipocytokine levels. CONCLUSIONS: Metabolic syndrome is highly prevalent in young adult female dermatomyositis patients and is related to age and disease activity. Moreover, increased serum adiponectin and resistin levels were detected in dermatomyositis patients, but lower serum leptin levels were observed

Polimorfismo no gene de metilenetetrahidrofolato redutase não está relacionado com o risco de doença cerebrovascular isquêmica em uma população brasileira

OBJETIVO: Os dados são conflitantes em relação a risco de acidente cerebrovascular associado a polimorfismo do gene 5,10-metilenetetrahidrofolato redutase C677T, o qual predispõe a hiperhomocisteinemia. Um estudo de meta-análise sugere que o genotipo 5,10-metilenetetrahidrofolato redutase 677TT poderia ter uma pequena influência em determinar susceptibilidade a acidente cerebrovascular. MÉTODOS: Analisamos este polimorfismo em indivíduos brasileiros com acidente cerebrovascular isquêmico, baseando-se em um estudo de caso-controle. RESULTADOS: Comparamos os genótipos 5,10-metilenetetrahidrofolato redutase em grupos de indivíduos com acidente cerebrovascular isquêmico (n=127) e controle normal (n=126), e encontramos Odds Ratio de 1,97 (IC 95% 0,84 - 4,64) em uma análise multivariada, na qual os resultados foram ajustados a características clínicas basais dos indivíduos estudados. DISCUSSÃO: Nossos estudos indicam que o genótipo 5,10-metilenetetrahidrofolato redutase C677T não é um fator de risco para acidente cerebrovascular isquêmico entre indivíduos brasileiros.PURPOSE: Data are conflicting concerning the risk for ischemic stroke associated with a common polymorphism in the gene encoding 5,10-methylenetetrahydrofolate reductase C677T, which predisposes carriers to hyperhomocysteinemia. A meta-analysis study suggested that the 5,10-methylenetetrahydrofolate reductase 677TT genotype might have a small influence in determining susceptibility to ischemic stroke. METHODS: We analyzed the 5,10-methylenetetrahydrofolate reductase 677TT genotype polymorphism in Brazilian subjects with ischemic stroke, using a case-control design. RESULTS: We compared 5,10-methylenetetrahydrofolate reductase genotypes in groups of subjects presenting ischemic stroke (n = 127) and normal control (n = 126) and found an odds ratio of 1.97 (95% CI, 0.84-4.64) in a multivariate analysis in which results were adjusted to baseline clinical characteristics of study participants. CONCLUSION: We found that the homozygous 5,10-methylenetetrahydrofolate reductase C677T genotype was not a risk factor for ischemic stroke in these Brazilian subjects