Search

Objective.To analyze the clinical effect of enthesitis in a large Brazilian cohort of patients with spondyloarthritis (SpA).Methods.A common protocol of investigation was prospectively applied to 1505 patients with SpA in 29 centers in Brazil. Clinical and demographic variables and disease indexes were investigated. The Maastricht Ankylosing Spondylitis Enthesitis Score was used to investigate the enthesitis component. Ankylosing spondylitis was the most frequent disease in the group (65.4%). Others were psoriatic arthritis (18.4%), undifferentiated SpA (6.7%), reactive arthritis (3.3%), and enteropathic arthritis (3.2%).Results.At least 1 affected enthesis was observed in 54% of the patients with SpA, with a mean of 2.12 ± 2.98 entheses affected. According to the clinical presentation, enthesitis was significantly more frequent in patients with axial + peripheral joint involvement compared to isolated axial or peripheral involvement (p < 0.001). There was a statistical association between the presence of enthesites and axial symptoms (buttock pain, cervical pain, and hip pain), and peripheral symptoms (lower limb arthritis, number of painful and swollen joints; p < 0.05). Patients with enthesitis also presented higher mean scores of Bath Ankylosing Spondylitis Functional Index (BASFI; p < 0.001), Bath Ankylosing Spondylitis Disease Activity Index (p < 0.001), and Ankylosing Spondylitis Quality of Life (ASQoL; p < 0.001). Multivariate logistic regression showed that BASFI (p < 0.0001; OR 74.839), ASQoL (p = 0.0001; OR 14.645), and Achilles tendonitis (p = 0.0059; OR 7.593) were associated with work incapacity.Conclusion.The clinical presence of enthesitis in this large cohort of patients with SpA was frequent and was associated with a significant increase in disease activity and decline in functional capacity and quality of life.

Objective.Spondyloarthritides (SpA) can present different disease spectra according to ethnic background. The Brazilian Registry of Spondyloarthritis (RBE) is a nationwide registry that comprises a large databank on clinical, functional, and treatment data on Brazilian patients with SpA. The aim of our study was to analyze the influence of ethnic background in SpA disease patterns in a large series of Brazilian patients.Methods.A common protocol of investigation was prospectively applied to 1318 SpA patients in 29 centers distributed through the main geographical regions in Brazil. The group comprised whites (65%), African Brazilians (31.3%), and people of mixed origins (3.7%). Clinical and demographic variables and various disease index scores were compiled. Ankylosing spondylitis (AS) was the most frequent disease in the group (65.1%); others were psoriatic arthritis (18.3%), undifferentiated SpA (6.8%), enteropathic arthritis (3.7%), and reactive arthritis (3.4%).Results.White patients were significantly associated with psoriasis (p = 0.002), positive HLA-B27 (p = 0.014), and use of corticosteroids (p < 0.0001). Hip involvement (p = 0.02), axial inflammatory pain (p = 0.04), and radiographic sacroiliitis (p = 0.025) were associated with African Brazilian descent. Sex distribution, family history, and presence of peripheral arthritis, uveitis, dactylitis, urethritis, and inflammatory bowel disease were similar in the 3 groups, as well as age at disease onset, time from first symptom until diagnosis, and use of anti-tumor necrosis factor-α agents (p > 0.05). Schober test and thoracic expansion were similar in the 3 groups, whereas African Brazilians had higher Maastricht Ankylosing Spondylitis Enthesitis Scores (p = 0.005) and decreased lateral lumbar flexion (p = 0.003), while whites had a higher occiput-to-wall distance (p = 0.02). African Brazilians reported a worse patient global assessment of disease (p = 0.011). Other index scores and prevalence of work incapacity were similar in the 3 groups, although African Brazilians had worse performance in the Ankylosing Spondylitis Quality of Life questionnaire (p < 0.001).Conclusion.Ethnic background is associated with distinct clinical aspects of SpA in Brazilian patients. African Brazilian patients with SpA have a poorer quality of life and report worse disease compared to whites.

Some autoantibodies are associated with peculiar clinical findings. Patients with rheumatoid arthritis (RA) may have anti-Ro antibodies.To study prevalence and clinical associations of anti-Ro antibodies in RA patients.We studied 385 patients with RA for anti-Ro by Elisa testing and for clinical profile, functional assessment, DAS-28 4v. (ESR), extra-articular manifestations, thyroid function, autoantibodies and treatment.The prevalence of anti-Ro was 8.31%. There was no significant difference in sex distribution, HAQ, DAS-28 or functional classification in patients with positive anti-Ro (p=ns). Patients with anti-Ro were younger at diagnosis (p=0.02). Analyzing extra-articular disorders we found a greater prevalence of cardiac valvular lesions (p0.001) in patients with anti-Ro antibodies. No differences were found in other extra-articular manifestations, associated hypothyroidism, amyloidosis, treatment requirements, presence of rheumatoid factor (RF) or anti citrullinated protein antibodies (ACPA).We conclude that in RA patients with anti-Ro have disease onset at an earlier age. Anti-Ro may be a risk factor for the development of cardiac valvular lesions. There was no association between this antibody and thyroid disease, amyloidosis and treatment needs.

To evaluate the intima-media thickness of the common carotid artery in patients with and without scleroderma; to verify a possible association with disease severity; to assess the relationship of intima-media thickness with known cardiovascular risk factors.In a case-control study, were selected 30 patients with scleroderma and 30 without the disease and matched according to age, sex and cardiovascular risk factors such as hypertension, diabetes mellitus and hypercholesterolemia. The age ranged from 17 to 79 years (mean 49). All patients underwent carotid artery evaluation by high-resolution vascular Doppler in order to measure the intima-medial thickness of the carotid 2 cm from the bifurcation. In all the analysis was considered the greatest value of intima-media thickness in right and left carotid arteries.The sample consisted of 30 patients, being 29 (96.67%) women and one man (3.3%). In this sample, 11/30 (36.67%) had high blood pressure, 5/30 (16.67%) had diabetes mellitus, 6/30 (20%) had dyslipidemia and 2/30 (6.67%) were smokers. Comparing the measure of the increased risk (maximum intima-media thickness between the left and right side), was obtained an average of 0.77 mm for group scleroderma and a value of 0.70 mm for the control group (p = 0.21). In assessing the association between disease severity and carotid intima-media thickness, was found no significant association (p= 0.925).Was found a slight increase in intima-medial thickness of common carotid artery in patients with scleroderma but without statistical significance. Regarding the severity of the disease and intima-medial thickness of common carotid artery, there was no significant difference.

Scleritis are entities that may have rheumatic diseases, infections or tumors as etiologic factors or may be a disease restricted only to the eye.To share a three year experience of a rheumato-ophthalmologic ambulatory in the diagnosis and treatment of patients with scleritis.This was a study of 29 cases. All of them were analyzed by the Ophthalmology and Rheumatology Services.From the 29 cases, an underlying disease was found in 55.17%. Rheumatic diseases were present in 34.4%; infectious in 20.6%. Idiophatic forms of scleritis did not differ from the rheumatic ones although a higher number of necrotizing cases were seen in the later group (with no statistical significance). Scleritis due to rheumatic diseases was treated more frequently with oral corticosteroids and immunosuppressive drugs.Patients with scleritis have a high rate of infectious and rheumatic diseases. Cooperation of rheumatologists and ophthalmologists was useful for the etiologic identification of patients with scleritis.

To evaluated the retinal nerve fiber layer in chloroquine patients with optical coherence tomography (OCT).Nerve fibers layer thickness was measured by a proprietary OCT Stratus through the fast retinal nerve fiber layer protocol in ninety-four eyes of 48 patients exposed to chloroquine for at least one year with no apparent macular disorder. Cumulative dose, maximum daily dose (mg/kg/day) and time of chloroquine use were correlated with the retinal nerve fiber layer thickness. Data were compared with a control group of 30 patients who did not use chloroquine. All patients underwent a complete ophthalmologic examination including visual acuity, refraction, intraocular pressure, fundoscopy, angiography and measurement of cup-to-disc ratio.The average thickness of retinal nerve fiber layer between antimalaric users (107.60 +/- 13.25 microm) and the control group (99.05 +/- 13.08 microm) had a statistically significant difference (p=0.0137). Furthermore, a positive association of the peripapillary thickness measurements between temporal, upper and lower quadrants of both groups was found. Twelve clock hours retinal nerve fiber layer analysis detected at least one focal defect in more than 50% of the medication users. Particularly, a statistical correlation with the maximum daily dose was found in patients with focal defects (p=0.0120).Optical coherence tomography is effective in detecting nerve fiber layer loss in chloroquine patients without apparent fundus changes. Thus, optical coherence tomography may contribute to the early diagnosis of chloroquine retinopathy.

Ischemia is common in systemic scleroderma and it is caused by vasospasm and thrombosis. In the present study we analyzed the association of peripheral vascular events and anticardiolipin (aCl) antibodies in 54 patients suffering from systemic scleroderma. The results showed that 100% of the patients presented Raynaud; 59.2% presented digital micro scars; 43.3%, presented teleangiectasies and 14.8%, presented peripheral thromboembolism. ACl IgG were positive in 9.2% and IgM, in 7.4%. Peripheral tromboembolic phenomena had a positive association with aCl IgG (p=0.03). No other associations were found.