Translation, transcultural adaptation into Brazilian Portuguese and concurrent validity of the rheumatoid arthritis assessment scale (RAKAS-13/Brazil)

Abstract Background Knowledge of patients about Rheumatoid Arthritis (RA) is a necessary aspect to better approach self-management support in a patient-centered manner. The research instrument known as the Rheumatoid Arthritis Knowledge Assessment Scale (RAKAS), consisting of 13 items, is simple, reliable and reproducible, and can be applied in both clinical practice and research protocols. Objectives This study aimed to translate and culturally adapt the RAKAS vocabulary into Brazilian Portuguese and to evaluate its concurrent validity. Methods The RAKAS was translated into Brazilian Portuguese and administered to 52 elderly women with RA recruited between May 2021 and May 2022. Concurrent validity was assessed using the Spearman's correlation coefficient between RAKAS and Patient Knowledge Questionnaire (PKQ). Results The participants considered RAKAS-13/BRAZIL easy to understand and did not report any doubts in answering the final version. Concurrent validity of the RAKAS-13/BRAZIL was low compared to the PKQ (ρ = 0.283, p = 0.038). Conclusion The Brazilian Portuguese version of the RAKAS (RAKAS-13/BRASIL) proved to be a questionnaire that was easy and quick to administer to assess patient knowledge about Rheumatoid Arthritis, despite its low correlation with the PKQ in the present study.

Epidemiological analysis of patients with psoriatic arthritis in follow-up at the brazilian Unified Health System

Abstract Introduction/Objectives Psoriatic arthritis (PsA) is a chronic multisystem osteoarticular disease that requires specialized care. Most Brazilians depend on the public healthcare provided by the Unified Health System (Sistema Único de Saúde, SUS). This study aimed to describe the epidemiological characteristics of patients with PsA in follow-up in SUS, focusing on the incidence and prevalence of the disease, comorbidities, and hospitalizations. Methods We collected data from the Outpatient Data System of SUS (Sistema de Informações Ambulatoriais do SUS, SIA/SUS) regarding outpatient visits and hospitalizations in the Brazilian public healthcare system from January 2008 to March 2021 using the Techtrials Disease Explorer® platform and the medical code related to PsA were selected. Results We evaluated 40,009 patients and found a prevalence of 24.4 cases of visits due to PsA per 100,000 patients in follow-up in SUS. Female patients were predominant (54.38%). The incidence of visits due to PsA has been increasing in recent years and we observed an incidence of 8,982 new visits in 2020. The main comorbidities of these patients were osteoarthritis, lower back pain, shoulder injuries, oncological diseases, crystal arthropathies, and osteoporosis. Hospitalizations were mainly due to treating clinical or cardiovascular conditions and performing orthopedic procedures. Conclusion The number of visits due to PsA in SUS has increased in recent years, mainly on account of new diagnoses of the disease, although the prevalence found in this study's population was lower than that observed in the general population.

Avaliação de fatores de risco em pacientes com doença pulmonar intersticial associada à artrite reumatoide / Assessment of risk factors in patients with rheumatoid arthritis-associated interstitial lung disease

RESUMO Objetivo Avaliar os fatores de risco para doença pulmonar intersticial (DPI) em pacientes com artrite reumatoide (AR), bem como a associação com uso de metotrexate e com a atividade da doença articular. Métodos Estudo retrospectivo, transversal, realizado entre março e dezembro de 2019 em um centro de saúde terciário, no seguimento de pacientes com AR submetidos a provas de função pulmonar (PFP) e tomografia computadorizada de tórax. Avaliamos as características tomográficas, como a presença de DPI e sua extensão, bem como a atividade da doença articular. Medidas funcionais, como capacidade vital forçada (CVF) e a medida de difusão de monóxido de carbono (DCO) também foram avaliadas. Em seguida, aplicou-se uma análise de regressão logística multivariada para identificar os fatores de risco associados à DPI. Resultados Foram avaliados 1.233 pacientes, dos quais 134 foram elegíveis para este estudo. A maioria era do sexo feminino (89,6%), com idade média de 61 anos e fator reumatoide positivo (86,2%). A DPI associada à AR (DPI-AR) foi detectada em 49 pacientes (36,6%). Encontramos associação de DPI-AR com idade ≥ 62 anos, sexo masculino, história de tabagismo,crepitações finas na ausculta pulmonar e diminuição da DCO. Idade ≥ 62 anos e atividade articular moderada ou alta da AR foram fatores independentes associados à DPI-AR, com odds ratio de 4,36 e 3,03, respectivamente. O uso de metotrexato não foi associado à maior prevalência de DPI. Conclusão A idade e a atividade da doença da AR são importantes fatores de risco associados à DPI-AR. O metotrexato não foi associado ao desenvolvimento de DPI-AR no presente estudo.

ABSTRACT Objective To assess the risk factors for interstitial lung disease (ILD) in patients with rheumatoid arthritis (RA) and to evaluate the association of ILD with the use of methotrexate as well as with joint disease activity. Methods A retrospective, cross-sectional study conducted between March and December 2019 at a tertiary healthcare center, in a follow-up of RA patients who had undergone pulmonary function tests (PFT) and chest computed tomography. We evaluated the tomographic characteristics, such as the presence of ILD and its extension, as well as joint disease activity. Functional measurements, such as forced vital capacity (FVC) and diffusing capacity for carbon monoxide (DLCO), were also assessed. After this, a multivariate logistic regression analysis was applied in order to identify risk factors associated with ILD. Results We evaluated 1.233 patients, of which 134 were eligible for this study. The majority were female (89.6%), with a mean age of 61 years old and with a positive rheumatoid factor (86.2%). RA-associated ILD (RA-ILD) was detected in 49 patients (36.6%). We found an association of RA-ILD with age ≥= 62 year, male sex, smoking history and fine crackles in lung auscultation and a decreased DLCO. The indicators of being aged ≥ 62 years old and having moderate or high RA disease activity were both independent factors associated with RA-ILD, with an odds ratio of 4.36 and 3.03, respectively. The use of methotrexate was not associated with a higher prevalence of ILD. Conclusion Age and RA disease activity are important risk factors associated with RA-ILD. Methotrexate was not associated with the development of RA-ILD in the present study.

Guidelines on COVID-19 vaccination in patients with immune-mediated rheumatic diseases: a Brazilian Society of Rheumatology task force

Abstract Objective: To provide guidelines on the coronavirus disease 2019 (COVID-19) vaccination in patients with immune-mediated rheumatic diseases (IMRD) to rheumatologists considering specific scenarios of the daily practice based on the shared-making decision (SMD) process. Methods: A task force was constituted by 24 rheumatologists (panel members), with clinical and research expertise in immunizations and infectious diseases in immunocompromised patients, endorsed by the Brazilian Society of Rheumatology (BSR), to develop guidelines for COVID-19 vaccination in patients with IMRD. A consensus was built through the Delphi method and involved four rounds of anonymous voting, where five options were used to determine the level of agreement (LOA), based on the Likert Scale: (1) strongly disagree; (2) disagree, (3) neither agree nor disagree (neutral); (4) agree; and (5) strongly agree. Nineteen questions were addressed and discussed via teleconference to formulate the answers. In order to identify the relevant data on COVID-19 vaccines, a search with standardized descriptors and synonyms was performed on September 10th, 2021, of the MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and LILACS to identify studies of interest. We used the Newcastle-Ottawa Scale to assess the quality of nonrandomized studies. Results: All the nineteen questions-answers (Q&A) were approved by the BSR Task Force with more than 80% of panelists voting options 4—agree—and 5—strongly agree—, and a consensus was reached. These Guidelines were focused in SMD on the most appropriate timing for IMRD patients to get vaccinated to reach the adequate covid-19 vaccination response. Conclusion: These guidelines were developed by a BSR Task Force with a high LOA among panelists, based on the literature review of published studies and expert opinion for COVID-19 vaccination in IMRD patients. Noteworthy, in the pandemic period, up to the time of the review and the consensus process for this document, high-quality evidence was scarce. Thus, it is not a substitute for clinical judgment.

Diagnóstico de espondiloartrite axial em pacientes com fibromialgia / Axial spondyloarthritis diagnosis in fibromyalgia patients

Objetivo: Avaliar pacientes com fibromialgia e dor lombar, bus- cando características clínicas de espondiloatrites axiais. Méto- dos: Neste estudo transversal, cem pacientes com fibromialgia e idades entre 18 e 65 anos foram avaliados. A avaliação consis- tiu em um questionário baseado no braço clínico dos critérios Assessment of Spondyloarthritis International Society para diag- nóstico de espondiloatrites axiais e um questionário de impacto da fibromialgia (Revised Fibromyalgia Impact Questionnaire). Re- sultados: Quando o braço clínico da Assessment of Spondyloar- thritis International Society foi aplicado em pacientes com fibro- mialgia e dor lombar, 80% dos pacientes preencheram os critérios para diagnóstico de espondiloatrites axiais. As principais carac- terísticas de espondiloatrite axial foram dor lombar inflamatória, boa resposta a drogas anti-inflmatórias não esteroidais, artrite e entesite. Pacientes com critérios de espondiloatrites axiais posi- tivos apresentaram maiores níveis séricos de proteína C-reativa (p=0,00035). O valor médio do Revised Fibromyalgia Impact Ques- tionnaire para todos os pacientes avaliados foi 63,6, e não houve di- ferença entre os pacientes que preencheram os critérios e aqueles que não preencheram. Conclusão: Pacientes com fibromialgia e dor lombar frequentemente apresentam características clínicas de espondiloatrite axial, e aqueles que preencheram os crité- rios clínicos para espondiloatrites axiais também apresentaram maiores níveis séricos de proteína C-reativa.

Objective: To evaluate patients with fibromyalgia and back pain for clinical features of axial spondyloarthritis. Methods: In this cross-sectional study, one hundred fibromyalgia patients between 18 and 65 years old were assessed. The assessment consisted of a questionnaire based on the clinical arm ofthe Assessment of Spondyloarthritis International Society criteria for the diagnosis of axial spondyloarthritis and a questionnaire on the impact of fibromyalgia (Revised Fibromyalgia Impact Questionnaire). Re- sults: When the clinical arm of the Assessment of Spondyloarthri- tis International Society was applied in patients with fibromyal- gia and back pain, 80% of the patients met the clinical criteria for diagnosis of axial spondyloarthritis. The main features of axial spondyloarthritis in fibromyalgia patients were inflammatory back pain, good response to non-steroidal anti-inflammatory drugs (NSAIDs), arthritis, and enthesitis. Patients with positive axial spondyloarthritis criteria presented with higher C- reac- tive protein levels (p=0.00035). The mean value of the Revised Fibromyalgia Impact Questionnaire for all patients assessed was 63.6 and there was no difference between patients that met the criteria for axial spondyloarthritis and those who did not. Con- clusion: Patients with fibromyalgia and back pain often present clinical features of axial spondyloarthritis, and those who met the clinical criteria for axial spondyloarthritis also presented with higher levels of C-reactive protein.

Revisiting hydroxychloroquine and chloroquine for patients with chronic immunity-mediated inflammatory rheumatic diseases

Abstract Hydroxychloroquine and chloroquine, also known as antimalarial drugs, are widely used in the treatment of rheumatic diseases and have recently become the focus of attention because of the ongoing COVID-19 pandemic. Rheumatologists have been using antimalarials to manage patients with chronic immune-mediated inflammatory rheumatic diseases for decades. It is an appropriate time to review their immunomodulatory and anti-inflammatory mechanisms impact on disease activity and survival of systemic lupus erythematosus patient, including antiplatelet effect, metabolic and lipid benefits. We also discuss possible adverse effects, adding a practical and comprehensive approach to monitoring rheumatic patients during treatment with these drugs.(AU)

Treatment data from the Brazilian fibromyalgia registry (EpiFibro)

Abstract Background: EpiFibro (Brazilian Epidemiological Study of Fibromyalgia) was created to study patients with fibromyalgia (FM). Patients were included since 2011 according to the classification criteria for FM of the American College of Rheumatology of 1990 (ACR1990). Objective: To analyze the therapeutic measures prescribed by Brazilian physicians. Materials and methods: Cross-sectional study of a multicenter cohort. The therapeutic measures were described using descriptive statistics. Results: We analyzed 456 patients who had complete data in the registry. The mean age was 54.0 ± 11.9 years; 448 were women (98.2%). Almost all patients (98.4%) used medications, 62.7% received health education, and less than half reported practicing physical exercise; these modalities were often used in combination. Most patients who practiced exercises practiced aerobic exercise only, and a significant portion of patients combined it with flexibility exercises. The most commonly used medication was amitriptyline, followed by cyclobenzaprine, and a minority used medication specifically approved for FM, such as duloxetine and pregabalin, either alone or in combination. Combinations of two or three medications were observed, with the combination of fluoxetine and amitriptyline being the most frequent (18.8%). Conclusion: In this evaluation of the care of patients with FM in Brazil, it was found that the majority of patients are treated with a combination of pharmacological measures. Non-pharmacological methods are underused, with aerobic exercise being the most commonly practiced exercise type. The most commonly prescribed single drug was amitriptyline, and the most commonly prescribed combination was fluoxetine and amitriptyline. Drugs specifically approved for FM are seldom prescribed.(AU)

Relations between serum magnesium and calcium levels and body composition and metabolic parameters in women with fibromyalgia

Abstract Objective: Correlate serum magnesium (Mg) and Calcium (Ca) levels with body composition and metabolic parameters in women with fibromyalgia (FM). Patients and methods: Cross-sectional study compared with a control group paired by age and body mass index (BMI) of adult women diagnosed with fibromyalgia. All participants went through assessment of their body composition through dual-energy X-ray absorptiometry (DXA) and had blood samples collected for dosing of Mg, Ca, C-reactive Protein (CRP), lipidogram and glycemia. Results: 53 women with FM (average age 48.1 ±8.2 years, average BMI 26.6 ±4.5 kg/m2) and 50 control women (average age 47.1 ±9.9 years, average BMI 25.6 ± 3.6 kg/m2) participated in the study. Serum levels turned out to have inverse correlation with CRP in the FM group (r = −0.29, p = 0.03) and with BMI and glycemia in the control group (r = 0.31; p = 0.02 and r = 0.48; p = 0.0004 respectively). Serum levels of calcium correlated with triglycerides (r = 0.29; p = 0.03) in the FM group and with glycemia in the control group (r = 0.64; p = 0.0001). Conclusions: In patients with FM, magnesemia turned out to have inverse correlation with CRP and calcemia had positive association with triglycerides.(AU)

Benzbromarone in the treatment of gout

Abstract Background Benzbromarone is a uricosuric drug that has been used in the treatment of gout over the last 30 years. Due to its potent inhibition of the dominant apical (luminal) urate exchanger in the human proximal tubule URAT1, it reduces the urate reabsorption, diminishing serum urate levels and therefore preventing gout flares. Main body of the abstract Through several clinical trials, Benzbromarone has been proved effective and safe, inclusive in patients with chronic kidney disease and as combination therapy with allopurinol. Due to hepatotoxicity reports, it was withdrawn from the European market by the manufacturer, however many authors have questioned the product's withdrawal due to a lack of clinical evidence in order to support its hepatotoxicity. Benzbromarone is still available in several European countries, New Zealand, Brazil and several other countries. Despite the product's marketing over more than 20 years after the first hepatotoxicity reports, we have found only five reports in our literature search, and no prospective or retrospective study correlating hepatotoxicity with benzbromarone use. Short conclusion Benzbromarone is a safe and effective molecule for the treatment of gout. However, due to in vitro and in vivo data related to hepatotoxicity, it is prudent to prescribe it with some caution, especially for patients with an already known liver condition.

Relation between magnesium and calcium and parameters of pain, quality of life and depression in women with fibromyalgia

Abstract Objective: Determine food intake and levels of serum magnesium (Mg) and calcium (Ca) and correlate these minerals with pain, quality of life and depression risk in women with and without fibromyalgia (FM). Patients and methods: Fifty-three women diagnosed with FM and 50 healthy women participated in the study, where all of them had equivalent age and body mass index (BMI). All women underwent anthropometric assessment, physical exams of pain perception threshold and tender point (TP) count, blood sample collection, and filling out of FM impact questionnaire (FIQ), Patient Health Questionnaire-9 (PHQ-9), and 3-day dietary record (DR). Results: Dietary intake of Mg and Ca was substantially lower by women with FM. There were no differences in levels of serum Mg and Ca in the groups under analysis. For the FM group, dietary intake of Mg and Ca had inverse correlation with TP and direct relation with the pain threshold. Conclusions: Although women with FM had lower dietary intake of Mg and Ca, serum levels for these nutrients were not different between the groups. Low dietary intake of minerals correlated with worsened pain threshold parameters.

Prevalence of fibromyalgia in patients treated at the bariatric surgery outpatient clinic of Hospital de Clínicas do Paraná - Curitiba / Prevalência de fibromialgia em pacientes acompanhados no ambulatório de cirurgia bariátrica do Hospital de Clínicas do Paraná - Curitiba

Abstract Introduction: Fibromyalgia (FM) is a chronic pain syndrome characterized by generalized pain. It is known that obese patients have more skeletal muscle pain and physical dysfunction than normal weight patients. Therefore, it is important that the early diagnosis of FM be attained in obese patients. Objective: To determine the prevalence of FM in a group of obese patients with indication of bariatric surgery. Materials and methods: The patients were recruited from the Bariatric Surgery outpatient clinic of Hospital de Clínicas of UFPR (HC-UFPR) before being submitted to surgery. Patient assessment consisted in verifying the presence or absence of FM using the 1990 and 2011 ACR criteria, as well as the presence of comorbidities. Results: 98 patients were evaluated, of which 84 were females. The mean age was 42.07 years and the BMI was 45.39. The prevalence of FM was 34% (n = 29) according to the 1990 criteria and 45% (n = 38) according to the 2011 criteria. There was no difference in age, BMI, Epworth score and prevalence of other diseases among patients who met or not the 1990 criteria. Only depression was more common in patients with FM. (24.14% vs. 5.45%). The same findings were seen in patients that met the 2011 criteria. Conclusions: The prevalence of FM in patients with morbid obesity is extremely high. However, BMI does not differ in patients with or without FM. The presence of depression may be a risk factor for the development of FM in these patients.

Resumo Introdução: Fibromialgia (FM) é uma síndrome de dor crônica caracterizada por dor generalizada. Sabe-se que pacientes obesos têm mais dor músculo esquelética e disfunção física do que pacientes de peso normal. Portanto, é importante que o diagnóstico precoce da FM seja feito em pacientes obesos. Objetivo: Determinar a prevalência de FM em um grupo de pacientes obesos com indicação de cirurgia bariátrica. Materiais e métodos: Os pacientes foram captados do ambulatório de Cirurgia Bariátrica do Hospital de Clínicas da UFPR (HC-UFPR), antes de serem submetidos à cirurgia. A avaliação dos pacientes consistia em constatar a presença ou ausência de FMG pelos critérios ACR 1990 e 2011 e também a presença de comorbidades. Resultados: Foram avaliados 98 pacientes, 84 mulheres. A idade média foi de 42,07 anos e o IMC de 45,39. A prevalência de FM foi de 34% (n = 29) pelos critérios de 1990 e de 45% (n = 38) pelos de 2011. Não houve diferença em idade, IMC, escala de Epworth e prevalência de outras doenças entre pacientes que preenchiam ou não os critérios de 1990. Apenas depressão foi mais comum nas pacientes com FM (24,14% vs. 5,45%). Os mesmos achados foram vistos nas pacientes que preenchiam os critérios de 2011. Conclusões: A prevalência de FM em pacientes com obesidade mórbida é extremamente alta. Porém o IMC não difere nos pacientes com ou sem FM. A presença de depressão pode ser um fator de risco para o desenvolvimento de FM nesses pacientes.

Pulmonary magnetic resonance imaging is similar to chest tomography in detecting inflammation in patients with systemic sclerosis / Ressonância magnética pulmonar é semelhante à tomografia de tórax para detectar inflamação em pacientes com esclerose sistêmica

Abstract Interstitial lung disease (ILD) and pulmonary arterial hypertension (PAH) are prevalent complications of systemic sclerosis (SSc) and are currently the leading causes of death related to the disease. The accurate recognition of these conditions is therefore of utmost importance for patient management. A study was carried out with 24 SSc patients being followed at the Rheumatology Department of the Hospital de Clínicas of Universidade Federal do Paraná (UFPR) and 14 healthy volunteers, with the objective of evaluating the usefulness of lung magnetic resonance imaging (MRI) when assessing ILD in SS patients. The results obtained with lung MRI were compared to those obtained by computed tomography (CT) of the chest, currently considered the examination of choice when investigating ILD in SS patients. The assessed population was predominantly composed of women with a mean age of 50 years, limited cutaneous SS, and a disease duration of approximately 7 years. In most cases, there was agreement between the findings on chest CT and lung MRI. Considering it is a radiation-free examination and capable of accurately identifying areas of lung tissue inflammatory involvement, lung MRI showed to be a useful examination, and further studies are needed to assess whether there is an advantage in using lung MRI instead of chest CT when assessing ILD activity in SS patients.

Resumo A doença intersticial pulmonar (DIP) e a hipertensão arterial pulmonar (HAP) são complicações prevalentes na esclerose sistêmica (ES) e constituem atualmente as principais causas de morte relacionadas à doença. O reconhecimento preciso dessas condições é, portanto, de fundamental importância no manejo dos pacientes. Fez-se um estudo com 24 pacientes com ES em acompanhamento no serviço de reumatologia do Hospital de Clínicas da Universidade Federal do Paraná (UFPR) e 14 voluntários sadios com objetivo de avaliar a utilidade do exame de ressonância magnética (RM) do pulmão na avaliação da DIP em pacientes com ES. Os resultados obtidos com a RM pulmonar foram comparados com os obtidos na tomografia computadorizada (TC) de tórax, exame atualmente considerado de eleição na investigação da DIP em pacientes com ES. A população avaliada era predominantemente composta por mulheres com idade média de 50 anos, ES cutânea limitada e tempo de doença de aproximadamente sete anos. Na maioria dos casos, houve concordância entre os achados na TC de tórax e RM do pulmão. Em se tratando de um exame isento de radiação e capaz de identificar com adequada precisão áreas de acometimento inflamatório do tecido pulmonar, a RM do pulmão de revelou um exame útil. São necessários mais estudos para avaliar se há vantagem da RM do pulmão sobre a TC de tórax na avaliação da atividade da DIP em pacientes com ES.

Critical revision of the medical treatment of gout in Brazil / Revisão crítica do tratamento medicamentoso da gota no Brasil

ABSTRACT Gout is considered the most common form of inflammatory arthritis in men over 40 years. The authors present a brief review of the current treatment of gout and discuss the existing pharmacological limitations in Brazil for the treatment of this disease. Although allopurinol is still the main drug administered for decreasing serum levels of uric acid in gout patients in this country, the authors also present data that show a great opportunity for the Brazilian drug market for the treatment of hyperuricemia and gout and especially for patients using private and public (SUS) health care systems.

RESUMO A gota é considerada a forma mais comum de artrite inflamatória em homens acima de 40 anos. Os autores apresentam uma breve revisão sobre o tratamento atual da gota e discutem as limitações farmacológicas existentes no Brasil para o tratamento dessa enfermidade. Apesar de o alopurinol ainda ser a principal medicação para a redução dos níveis de uricemia de pacientes com gota no país, os autores também apresentam dados que apontam para uma grande oportunidade para o mercado farmacológico brasileiro em relação ao tratamento da hiperuricemia e da artrite gotosa e especialmente para pacientes usuários de sistemas privados de saúde e do SUS (Sistema Único de Saúde).

Perfil clínico de gestantes portadoras de lúpus eritematoso sistêmico do Hospital de Clínicas da Universidade Federal do Paraná / Clinical profile of pregnant women with systemic lupus erythematosus of the Hospital de Clínicas of the UFPR

Modelo do estudo: estudo descritivo, observacional, transversal e parte retrospectivo. Objetivo: Avaliar o perfil clínico e desfecho materno-fetal das gestantes com lúpus eritematoso sistêmico (LES) em acompanhamento no Hospital de Clínicas da Universidade Federal do Paraná (UFPR). Metodologia: O estudo descreveu o histórico clínico e obstétrico preconcepção, aspectos clínicos durante a gestação e o desfecho materno-fetal de 30 gestantes com LES, atendidas no ambulatório de Pré-natal do Hospital de Clínicas da UFPR, entre março de 2012 a novembro de 2015. Resultados: Verificou-se que 46,7% das gestantes apresentavam manifestação renal do LES, 50% tinham histórico de complicação obstétrica prévia e 13,3% apresentavam atividade de doença antes da gravidez. Na gestação, 26,7% apresentaram atividade de doença e 46,7% evoluíram com complicações materno-fetais (hipertensão gestacional, pré-eclâmpsia, perdas gestacionais, restrição do crescimento intrauterino, prematuridade, baixo peso ao nascer ou óbito neonatal). Houve relevância estatística entre atividade de doença durante a gestação e atividade de doença preconcepção, assim como entre prematuridade e presença de anticorpos antifosfolípides e síndrome antifosfolípide e também do conjunto de complicações materno-fetais com atividade preconcepção e uso de doses de prednisona >10mg/dia. Conclusão: Neste estudo encontramos uma frequência elevada (46,7%) de complicações maternas e/ou fetais em gestações de pacientes lúpicas, portanto, gestantes com LES são consideradas de alto risco. Recomenda-se que a gravidez destas pacientes seja planejada e acompanhada por profissionais com conhecimento no manejo da doença de base. (AU)

Model study: descriptive, observational, cross-sectional and partially retrospective study. Objective: The aim of this study was to evaluate the clinical profile and maternal-fetal outcomes of pregnant women with systemic lupus erythematosus (SLE) followed at Hospital de Clínicas of the UFPR. Methodology: The study described the clinical and preconception obstetric history, clinical and laboratory aspects during pregnancy and maternal-fetal outcomes of 30 pregnant women with SLE assisted at Prenatal Clinic of the Hospital de Clínicas of the UFPR, between March 2012 and November 2015. Results: It was found that 46,7% of the pregnant women presented renal manifestation of the SLE, history of maternal or fetal complications was observed in 50% of them and 13,3% of the patients had preconception active disease. During pregnancy, 26,7% had disease activity and 46,7% developed maternal or fetal complications (gestational hypertension, preeclampsia, pregnancy loss, delayed intrauterine growth, prematurity birth, low birth weight or neonatal death). There was statistical significance between disease activity during pregnancy and preconception active disease, as well between prematurity and the presence of antiphospholipid antibodies and antiphospholipid syndrome and also between the maternal and fetal complications as a whole and preconception activity and the use of prednisone >10mg/day. Conclusions: In this study we found a high frequency (46.7%) of maternal and/or fetal complications in pregnancies of lupus patients, therefore, pregnant women with SLE are considered to be at high risk. It is recommended that pregnancy in SLE patients should be planned and monitored by professionals who are experts in the disease management. (AU)

Food intake assessment and quality of life in women with fibromyalgia / Avaliação da ingestão alimentar e qualidade de vida de mulheres com fibromialgia

ABSTRACT Objective: To compare the food intake of women with and without fibromyalgia and verify if the food intake of patients with fibromyalgia interferes with the pain and quality of life. Methods: Study participants were women with fibromyalgia (FM) seen in Fibromyalgia Outpatient Clinic, Hospital das Clínicas/UFPR and a control group (CT) with healthy women. Data collection was conducted from March to October 2012. For the assessment of food intake we used the Food Registration and analyzed items were: total calories, carbohydrates, proteins, lipids, vitamins (A, C, B12, D and E) and minerals (folate, selenium, zinc, iron, calcium and magnesium). The software used was Avanutri Online®. To evaluate the quality of life, the Fibromyalgia Impact Questionnaire (FIQ) and pain threshold were used. Results: 43 patients with FM and 44 healthy women were evaluated. CT group showed a mean consumption of nutrients greater than FM group except for iron. However, only caloric intake, carbohydrates, proteins and lipids in grams and percentage of lipids, vitamin A, E, B12, folate, selenium and calcium were statistically significant. In FM group there was a negative correlation between vitamin E and FIQ and a positive correlation between percentage of protein and pain threshold. Conclusion: Women with FM showed a lower qualitatively and quantitatively intake in comparison with CT group. Only vitamin E correlated with quality of life and percentage of protein in the diet with sensation of pain.

RESUMO Comparar a ingestão alimentar de mulheres com e sem fibromialgia e verificar se a ingestão alimentar das pacientes com fibromialgia interfere na sensação de dor e qualidade de vida.Participaram do estudo mulheres com fibromialgia (FM) atendidas no Ambulatório de Fibromialgia do Hospital de Clínicas/UFPR e para o grupo controle (CT) foram convidadas mulheres saudáveis. A coleta de dados foi feita de março a outubro de 2012. Para a avaliação do consumo alimentar foi usado o Registro Alimentar e os itens analisados foram: calorias totais, carboidratos, proteínas, lipídeos, vitaminas (A, C, B12, D e E) e minerais (folato, selênio, zinco, cálcio, ferro e magnésio). O software usado foi o Avanutri Online®. Para avaliação da qualidade de vida foi usado o Questionário de Impacto da Fibromialgia (FIQ) e limiar doloroso.Foram avaliadas 43 pacientes com FM e 44 mulheres saudáveis. O grupo CT apresentou consumo médio de nutrientes superior ao grupo FM, com exceção para o ferro. Entretanto, somente a ingestão calórica, carboidratos, proteínas e lipídeos em gramas, porcentagem de lipídios, vitamina A, E, B12, folato, selênio e cálcio foram estatisticamente significativas. No grupo FM houve correlação negativa entre vitamina E e FIQ e correlação positiva entre porcentagem de proteína e limiar doloroso.As mulheres com FM apresentaram ingestão qualitativamente e quantitativamente inferior ao grupo CT. Somente a vitamina E apresentou correlação com a qualidade de vida e a porcentagem de proteína na dieta com a sensação de dor.

A importância de ácido láctico na enxaqueca e na fibromialgia / The importance of lactic acid in migraines and fibromyalgia

Resumo Introdução: O ácido láctico é um subproduto do metabolismo muscular e do sistema nervoso central. As alterações no metabolismo estão relacionadas com diversas condições fisiológicas e patológicas. O objetivo deste estudo foi determinar a relação entre a enxaqueca e a fibromialgia com os níveis de ácido láctico no sangue. Métodos: Foram estudados 93 pacientes, divididos em cinco grupos: 1) fibromialgia (n = 20); 2) enxaqueca episódica (n = 20); 3) enxaqueca crônica (n = 20); 4) fibromialgia e enxaqueca episódica (n = 13); e 5) fibromialgia e enxaqueca crônica (n = 20), além de 20 indivíduos saudáveis (grupo controle). Os níveis sanguíneos de ácido láctico foram medidos em quatro momentos : em repouso, durante o exercício aeróbico, durante a atividade física anaeróbica e durante o descanso depois do exercício anaeróbico. Resultados: O ácido láctico aumentou em todos os grupos durante a atividade física anaeróbica, sem predominância em qualquer grupo. Durante a atividade física aeróbica, todos os grupos apresentaram um aumento nos níveis de ácido láctico, mas esse aumento foi mais expressivo nos grupos de enxaqueca crônica e enxaqueca crônica com fibromialgia, sem significância estatística. Conclusões: Não foram encontradas anormalidades que envolvessem o metabolismo do ácido láctico na enxaqueca episódica e crônica, na presença ou não de fibromialgia.

Abstract Background: Lactic acid is a byproduct of both muscle metabolism and the central nervous system. Changes in metabolism are related to various physiological and pathological conditions. The aim of this study was to determine the relationship between migraine and fibromyalgia with the levels of lactic acid in the blood. Methods: We study 93 patients divided into five groups: (1) patients with fibromyalgia (n = 20); (2) episodic migraine (n = 20); (3) chronic migraine (n = 20); (4) fibromyalgia and episodic migraine (n = 13); and (5) fibromyalgia and chronic migraine (n = 20), and 20 healthy subjects (control group). Blood levels of lactic acid were measured at four different time points: at rest, during aerobic exercise, during anaerobic physical activity and while resting after anaerobic exercise. Results: Lactic acid increased in all groups during anaerobic physical activity without predominance for either group. During aerobic physical activity, all groups increased lactic acid levels, but the increase was more expressive in the chronic migraine group and the chronic migraine with fibromyalgia group without statistical significance. Conclusions: We did not found abnormalities involving the metabolism of lactic acid in episodic and chronic migraine with or without fibromyalgia.

Composição corporal por absorciometria radiológica de dupla energia de mulheres com fibromialgia / Body composition by dual-energy x-ray absorptiometry in women with fibromyalgia

Objetivos: Avaliar a composição corporal de mulheres com fibromialgia (FM) em relação ao valor de referência para mulheres saudáveis. Pacientes e Métodos: Estudo transversal observacional, composto por 52 mulheres diagnosticadas com fibromialgia conforme os critérios do American College of Rheumatology (ACR, 1990), selecionadas no Ambulatório de Fibromialgia do Hospital de Clínicas da Universidade Federal do Paraná (HC-UFPR). As pacientes voluntárias foram divididas em dois grupos, 28 pacientes com Índice de Massa Corporal (IMC) igual ou superior (≥) a 25 kg/m2, e 24 pacientes com IMC igual ou inferior (≤) a 24,99 kg/m2 e submetidas ao exame físico para a contagem dos tender points (TP), além de preencherem o questionário de impacto da fibromialgia (FIQ). A avaliação da composição corporal foi realizada por meio da Absorciometria Radiológica de Dupla Energia (DXA). Os valores do percentual de massa gorda (% de MG), encontrados nos dois grupos, foram comparados ao percentual médio de MG por idade e sexo, descrito por Heward (2004). Resultados: A idade média dos grupos pesquisados foi de 47,8 ± 8,6 anos, o score do FIQ foi de 70,5 ± 18,6 e TP 16,2 ± 2,0. O IMC médio foi de 26,4 ± 4,1 kg/m2, e a quantidade de MG foi de 25,2 ± 7,8 kg ou 39,5% ± 6,8%, e de massa magra (MM) foi de 37,2 ± 3,7 kg ou 60,4% ± 7,3%. No grupo com IMC ≤ 25 kg/m2 o percentual de MG foi de 33,8% (21,5 - 42,4), e no grupo com IMC ≥ 25 kg/m2 o percentual de MG foi de 44,4% (37,6 - 56,2). Conclusão: Tanto mulheres com FM eutróficas quanto as com sobrepeso e obesas apresentaram percentual de MG acima dos valores de referência de mulheres saudáveis. .

Objectives: To assess body composition in women with fibromyalgia (FM) comparing to the reference value for healthy women. Patients and Methods: Cross-sectional observational analytical study, with 52 women selected with Fibromyalgia, according American College of Rheumatology (ACR, 1990) criteria. The patients were selected in Hospital de Clínicas da Universidade Federal do Paraná (HC-UFPR) and divided into two groups, 28 patients with a BMI (Body Mass Index) equal or higher (≥) than 25 kg/m2 and 24 patients with BMI less or equal (≤) 24.99 kg/m2, subjected to physical examination for the count of tender points (TP) and completing the fibromyalgia impact questionnaire (FIQ). The assessment of body composition was performed by the Dual-Energy X-Ray Absorptiometry (DXA). The values of the fat mass percentage (MG %) found in the two groups were compared to the average percentage of MG by age and sex, described by Heward (2004). Results: The mean age of the study groups was 47.8 ± 8.6 years, the FIQ score was 70.5 ± 18.6 and TP 16.2 ± 2.0. The mean BMI was 26.4 ± 4.1 kg/m2, and the amount of MG was 25.2 ± 7.8 kg and 39.5 ± 6.8%, and lean mass (LM) was 37 2 ± 3.7 kg and 60.4 ± 7.3%. In the group with BMI ≤ 25 kg/m2, the MG % was 33.8% (21.5 - 42.4) and in the group with BMI ≥ 25 kg/m2 of the MG was 44.4% (37.6 - 56.2). Conclusion: Both groups women with FM eutrophic as the overweight and obese group, presented higher reference MG% levels comparing with the standard levels for healthy women. .

Doença de Still do Adulto associada à neoplasia de ovário: relato de caso / Adult Still's disease associated with ovarian cancer: case report

Relatamos um caso de diagnóstico de Doença de Still do Adulto (DSA) em paciente feminina com febre, mialgia, rash cutâneo fugaz e linfonodomegalia inguinal bilateral, após extensa investigação para exclusão de outras doenças reumatológicas, infecciosas e neoplásicas. A paciente inicialmente apresentou resposta ao tratamento com prednisona, porém evoluiu com aumento de volume de linfonodos inguinais, cuja biópsia revelou adenocarcinoma seroso de ovário. De acordo com nosso conhecimento, esse é o primeiro relato de neoplasia ovariana associada ao diagnóstico de DSA.

We report a case of adult-onset Still's disease in a female patient with fever, myalgia, vanishing rash and bilateral inguinal lymphadenopathy, diagnosed after extensive workup to exclude other rheumatic, infectious and neoplastic diseases. The patient initially responded to corticosteroid therapy, but progressed to increased lymph nodes size that when biopsied, revealed serous ovarian adenocarcinoma. To our knowledge, this is the first report of ovarian neoplasm associated with adult-onset Still's disease.

Estudo clínico-epidemiológico de fibromialgia em um hospital universitário do Sul do Brasil / Clinical and epidemiological study of fibromyalgia in a university hospital in Southern Brazil

JUSTIFICATIVA E OBJETIVO: A fibromialgia é uma condição caracterizada por dor generalizada, comumente associada à fadiga e a distúrbios cognitivos, afetivos e do sono. O objetivo deste estudo foi descrever o perfil socioeducacional e o desempenho em escalas de avaliação da doença, além de comparar os diferentes critérios de classificação da fibromialgia e descrever outras características dos pacientes atendidos em um ambulatório de fibromialgia de um hospital universitário. MÉTODOS: Estudo realizado por meio de análise de questionários com padrão EpiFibro aplicados a 146 mulheres com fibromialgia durante consulta ambulatorial. RESULTADOS: Entre os resultados, destacaram-se os seguintes: maior sensibilidade dos critérios do Colégio Americano de Reumatologia de 2010 em relação aos de 1990; baixas renda e escolaridade das pacientes; alta prevalência de distúrbios do sono, cefaleia e parestesias; longo tempo entre o início dos sintomas e o diagnóstico; e não utilização dos tratamentos farmacológicos e não farmacológicos de primeira linha na fibromialgia. CONCLUSÃO: Em nosso meio, os pacientes com fibromialgia geralmente passam por problemas como a demora diagnóstica, mau controle dos sintomas e tratamento não otimizado...

BACKGROUND AND OBJECTIVE: Fibromyalgia is acondition featured by generalized pain, usually associated with fatigue, and cognitive, affective, and sleep disorders. The aim of this study was to describe the social-economical profile, and the performance in scales for evaluation of the disease; to compare the different classification criteria of fibromyalgia; and to describe other features of patients seen in an outpatient clinic of a university hospital. METHODS: The study was conducted through the analysis of EpiFibro questionnaires, applied to 146 women with fibromyalgia during medical consultation. RESULTS: Among the results, we highlight: greater sensibility of the 2010 American College of Rheumatology Criteria, compared to those of 1990's; patients low income and instruction levels; high prevalence of sleep disorders, headache and numbness; the long time between symptoms onset and diagnosis, and non-utilization of first line pharmacological and non-pharmacological therapies for fibromyalgia. CONCLUSION: In our area, patients with fibromyalgia have problems such as delay in diagnosis, poor symptom control and non-optimized treatment...