Brazilian recommendations for the use of nonsteroidal anti-inflammatory drugs in patients with axial spondyloarthritis

Abstract Spondyloarthritis (SpA) is a group of chronic inflammatory systemic diseases characterized by axial and/or peripheral joints inflammation, as well as extra-articular manifestations. Over some decades, nonsteroidal anti-inflammatory drugs (NSAIDs) have been the basis for the pharmacological treatment of patients with axial spondyloarthritis (axSpA). However, the emergence of the immunobiologic agents brought up the discussion about the role of NSAIDs in the management of these patients. The objective of this guideline is to provide recommendations for the use of NSAIDs for the treatment of axSpA. A panel of experts from the Brazilian Society of Rheumatology conducted a systematic review and meta-analysis of randomized clinical trials for 15 predefined questions. The Grading of Recommendations, Assessment, Development and Evaluation methodology to assess the quality of evidence and formulate recommendations were used, and at least 70% agreement of the voting panel was needed. Fourteen recommendations for the use of NSAIDs in the treatment of patients with axSpA were elaborated. The purpose of these recommendations is to support clinicians' decision making, without taking out his/her autonomy when prescribing for an individual patient.(AU)

The Brazilian Society of Rheumatology guidelines for axial spondyloarthritis - 2019

Abstract Spondyloarthritis is a group of chronic inflammatory systemic diseases characterized by axial and/or peripheral joints inflammation, as well as extra-articular manifestations. The classification axial spondyloarthritis is adopted when the spine and/or the sacroiliac joints are predominantly involved. This version of recommendations replaces the previous guidelines published in May 2013. A systematic literature review was performed, and two hundred thirty-seven studies were selected and used to formulate 29 recommendations answering 15 clinical questions, which were divided into four sections: diagnosis, non-pharmacological therapy, conventional drug therapy and biological therapy. For each recommendation the level of evidence supporting (highest available), the strength grade according to Oxford, and the degree of expert agreement (inter-rater reliability) is informed. These guidelines bring evidence-based information on clinical management of axial SpA patients, including, diagnosis, treatment, and prognosis.

Decreased high-density lipoprotein cholesterol levels in polyarticular juvenile idiopathic arthritis

OBJECTIVES: To investigate the prevalence of dyslipoproteinemia in a homogeneous cohort of polyarticular juvenile idiopathic arthritis patients. METHODS: Based on the National Cholesterol Education Program, fasting lipoprotein levels and risk levels for coronary artery disease were determined in 28 patients with polyarticular juvenile idiopathic arthritis. The exclusion criteria included diabetes, thyroid dysfunction, smoking, proteinuria, lipid-lowering drugs, and hormone/diuretic therapy. Disease activity, disease duration, and therapy with corticosteroids and/or chloroquine were defined at the time of lipid measurements. RESULTS: Dyslipoproteinemia was identified in 20 of the 28 (71 percent) patients with polyarticular juvenile idiopathic arthritis. The primary lipoprotein risk factor was decreased high-density lipoprotein cholesterol (57 percent), followed by elevated levels of low-density lipoprotein cholesterol (18 percent), triglycerides (14 percent), and total cholesterol (7 percent). The male patients had decreased high-density lipoprotein cholesterol levels than the female patients (p<0.05). The incidence of decreased high-density lipoprotein cholesterol levels did not seem to be affected by disease activity or therapy because the incidence was similar in patients with active or inactive disease, with or without corticosteroid use and with or without chloroquine use. In addition, the frequency of decreased high-density lipoprotein cholesterol levels was similar in patients with short (≤5 years) vs. long (>5 years) disease duration. CONCLUSIONS: Dyslipoproteinemia is highly prevalent in patients with polyarticular juvenile idiopathic arthritis and is primarily related to decreased high-density lipoprotein cholesterol levels; therefore, early intervention is essential.

Triiodothyronine, diluted according homeopathic techniques, modifies the programmed cell death of tadpole tail?s explants / Triiodothyronine, diluted according homeopathic techniques, modifies the programmed cell death of tadpole tail?s explants

High Dilution is a solution beyond the Avogadro limits that, in the dependence of the applied succussion elicits a suppressive or a stimulant effect on a living cell, with a consequent generation of an oscillatory doseeffect curve. According to Bonamin et al. [1], ?Perhaps, the most enigmatic feature regarding the properties of high dilutions is the non-linearity of their effects. In several studies employing in vivo and ex vivo models, especially involving iso-endopathy, an oscillatory potency-effect curve has appeared. The first observations were initially considered as artifacts, but the repetition of this pattern in different studies involving completely different experimental models, in times and places equally different, points out to the existence of a property intrinsic to dynamized systems.? The entire process of anuran amphibian metamorphosis is under thyroid hormones control, included the complete resorption of the tadpole tail. In the present study, we had successfully established a protocol model to culture Rana catesbeiana tadpoles? tail tips in vitro. A random and blind study was performed, with the intent to prove that T3 5.10-24 M (10 cH) modifies the apoptosis induction of T3 100 nM in explants of Rana catesbeiana tadpoles? tail. 60 explants were distributed in three ways: Group A: without T3 action, at pharmacological and HD dose; Group B (test): under the action of T3 100 nM and treated with T3 10 cH (HD); Group C (control): under the action of T3 100 nM and treated with ethanol 70% unsuccussed. After 96 hours of tissue culture, the mean of initial and final area (1.05 vs. 0.98 cm2) and apoptotic index of the explants from Group A were with minimal difference range and for this reason it wasn?t included in the statistical study. In order to identify significant differences in the area and in the apoptotic index of the remainder explants of the 2 groups, B (test) and C (control), we used a student t-test. However, the mean initial and final explants? area from test and control groups were respectively 1.09 vs. 0.22 cm and 1.00 cm vs.0.24 cm, with a mean reduction of 0.87 cm2 and 0.76 cm2, but this difference didn?t achieve statistical significance (p>0.05). In contrast, apoptosis index was significantly higher in test than in control group 11.7 vs. 7.9 (p<0.05), with is confirmed at the table 1.

Lúpus eritematoso sistêmico juvenil: resultados do estudo multicêntrico nacional / Juvenile systemic lupus erythematosus: results of the multicentric national study

Objetivo: estudar as características clínicas e demográficas de crianças e adolescentes brasileiros com lúpus eritematoso sistêmico juvenil (LESj), seguidos em centros de referência em Reumatologia Pediátrica. Métodos: o estudo foi multicêntrico retrospectivo (análise de prontuários) e envolveu 12 centros de São Paulo, Rio de Janeiro, Goiás, Rio Grande do Norte e Rio Grande do Sul. Foram analisados 280 prontuários de crianças e adolescentes com LESj dos quais 234 eram do sexo feminino (83,6%). A idade de início variou de 1 a 16 anos, com média de 11,4 anos. Foram analisados os dados clínicos e laboratoriais iniciais e de seguimento. Para o cálculo da taxa de mortalidade foram excluídos os pacientes que abandonaram o seguimento. Resultados: a presença de anticorpos antinucleares (AAN) foi descrita em 259 pacientes (93%). As manifestações iniciais mais freqüentes foram: artrite (73%), citopenia (67%), presença de anti-DNA (59%), fotossensibilidade (50%) e nefrite (45%). O comprometimento do sistema nervoso central foi observado em 15% dos pacientes, sendo que destes 50% apresentaram convulsões e 38% psicose lúpica. Vinte e sete pacientes (9,7%) abandonaram o acompanhamento médico. Quinze dos 253 pacientes restantes (5,9% evoluíram para óbito durante o seguimento, sendo as principais causas a infecção (73%) e a falência renal (33%), isoladas ou associadas. A mortalidade foi relativamente maior no sexo masculino (11:210 meninas [5,2%] e 4:43 meninos [9,3%]). Não se observou correlação entre a mortalidade e a idade de início da doença, o tempo de seguimento ou o número de critérios presentes na primeira consulta. Conclusão: as crianças e adolescentes brasileiros com LESj apresentam características clínicas semelhantes às observadas em outras populações. As infecções e a insuficiência renal são as principais causas de óbito.

Tratamento farmacologico da artrite cronica juvenil / Drug treatment in juvenile chronic arthritis

Antiinflamatorios nao hormonais sao as drogas de primeira linha para o tratamento de criancas com Artrite Cronica Juvenil (ACJ), principalmente as com doenca pauciarticular. Os novos agentes como naproxeno e ibuprofeno, apesar de terem custo mais elevado que os salicilicos sao preferidos devido a eficacia equivalente, menor toxicidade e meia-vida maior. Antimalaricos, sulfassalazina e penicilamina sao boas opcoes para ACJ soronegativa, principalmente com envolvimento articular e para as pauciarticulares que evoluem para comprometimento poliarticular. No entanto, na ausencia de resposta com estas drogas e nos casos de ACJ poliarticular grave, soropositiva e poliarticular associada a quadro sistemico, o metotrexate em baixas doses e a droga de nossa primeira escolha...

Osteopetrose: relato de dois casos e revisao da literatura / Osteopetrosis: report of two cases and review of the literature

A osteopetrose e uma rara enfermidade genetica com incidencia de 1:500.000 na populacao americana, caracterizada por esclerose ossea generalizada e fraturas. Do ponto de vista clinico classificada em tres formas: maligna infantil, benigna do adulto e intermediaria. Apresentamos dois casos de osteopetrose forma intermediaria com manifestacoes clinicas e radiologicas classicas. Comentamos as diferentes hipoteses etiopatogenicas e as inumeras tentativas terapeuticas citadas na literatura

Tratamento das artrites crônicas juvenis / Treatment of the juvenile chronic arthritis

A artrite crônica juvenil (ACJ) engloba uma variedade de desordens com manifestaçöes articulares e extra-articulares variadas e heterogêneas. A maioria melhora com antiinflamatório näo hormonal associado a medidas físicas, principalmente os portadores de doença pauciarticular. Uma vez que o objetivo da terapia é assegurar que os pacientes entrem em remissäo na melhor condiçäo possível, abordagem medicamentosa sensível e medidas físicas säo mandatórias. Crianças com ACJ poliarticular soropositiva e com ACJ poliarticular associada a quadro sistêmico têm pior prognóstico e devem receber drogas de açäo lenta (DAL) precocemente; ouro injetável é droga de escolha para os soropositivos e antimaláricos e D-penicilamina (DPA) säo boa opçäo para os soronegativos, principalmente para aqueles com envolvimento articular limitado e para pauciarticulares que evoluem para comprometimento poliarticular. Se existem dificuldades com injeçöes de ouro e com efeitos colaterais de antimaláricos, a auronofina, a sulfassalazina e, atualmente, o metotrexato (MTX) säo bastante atrativos. Corticosteróides (CE) devem ser reservados para situaçöes específicas e retirados o mais cedo possível, e drogas citotoxícas para doença ativa, apesar de cursos completos com DAL, ou para crianças que manifestem intolerância ou efeitos colaterais com o uso destas últimas