Effectiveness of functional training versus resistance exercise in patients with psoriatic arthritis: randomized controlled trial

Abstract Objective This study aims to evaluate the effect of functional versus resistance exercise training on the functional capacity and quality of life of psoriatic arthritis patients. Methods Forty-one psoriatic arthritis patients (18 to 65 years old) were randomized into two groups: functional training group and resistance exercise group. The functional training group underwent functional exercises with elastic band and the functional training group underwent machine resistance exercise twice a week for 12 weeks. Outcome measures were: The Bath Ankylosing Spondylitis Functional Index (BASFI) and Health Assessment Questionnaire for the Spondyloarthropathies (HAQ-S) for functional capacity and functional status, one-repetition maximum test for muscle strength, the Short Form 36 health survey questionnaire (SF-36) for quality of life, and the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the Disease Activity Score 28 (DAS-28) for disease activity. Analyzes were performed by a blinded evaluator at baseline (T0), six (T6) and twelve (T12) weeks after the beginning of the exercise. Results At baseline, the groups were homogeneous in the clinical and demographic characteristics. There was a statistical intra-group improvement for both groups in the BASFI, BASDAI, HAQ-s, and DAS-28. In the quality-of-life assessment, both groups showed statistical intra-group improvements for all domains except the "emotional aspect" domain in the resistance exercise group. In the muscle strength, there was a statistical improvement for all exercises in both groups, except for the "alternate biceps (bilateral)" exercise. Conclusion Functional training and resistance exercise are similarly effective in improving functional capacity, functional status, disease activity, general quality of life, and muscle strength in patients with psoriatic arthritis. Trial Registration ClinicalTrials.gov: NCT04304326. Registered 11 March 2020, https://clinicaltrials.gov/ct2/show/NCT04304326?term=NCT04304326&draw=2&rank=1.

Intra-articular triamcinolone hexacetonide injections in hands osteoarthritis - A double-blinded randomized controlled trial with a one year follow-up

Abstract Objective: to evaluate the effectiveness of triamcinolone Hexacetonide (TH) Intra-Articular Injection (IAI) in hand Interphalangeal Joints (IP) of Osteoarthritis (OA) patients to improve pain and joint swelling; improve function, goniometry, and grasping force, and assess IAI influence on radiographic evolution over 1-year. Methods: A randomized, double-blind study. 60 patients who underwent IAI at the most symptomatic IP joint were randomly assigned to receive TH+Lidocaine (LD) (TH/LD group) or just LD (LD group). Patients were assessed blindly for 1-year, at baseline and 1, 4, 8, 12, and 48 weeks. The following variables were assessed: articular pain and swelling, AUSCAN and COCHIN functional questionnaires, grip and pinch strength, goniometry, perception of improvement, acetaminophen consumption, and simple radiography. Repeated-measures ANOVA test was used to analyze the intervention response. Results: Sixty patients completed the follow-up. There were nine missed assessments. 97% were women; mean age of 61-years (SD = 8.2), and approximately 5-years of disease (SD = 3.6). Half of the patients present radiographic classification Kellgren and Lawrence (KL) grades I and II, and the other half grades III and IV. The two groups evolved similarly at 48-weeks. TH/LD group had a better evaluation in joint swelling and acetaminophen consumption (p = 0.04 and p < 0.001, respectively) at 48-weeks. Radiographically there was no statistical difference between groups (KL, p = 0.564; erosive OA, p = 0.999; worsening, p = 0.573). Conclusion: The IAI IP hands OA is effective for the improvement of joint swelling and decrease of analgesic consumption and does not influence the radiographic evolution of the injected joint.

Surgical treatment for lumbar spinal stenosis: a single-blinded randomized controlled trial

Abstract Objective: To evaluate the effectiveness of surgery for the management of patients with symptomatic lumbar spinal stenosis. Methods: Sixty-three patients with lumbar canal stenosis were randomized into two groups: the intervention group (IG) and control group (CG). IG patients underwent surgery and both groups participated in the same physical therapy program twice a week for a period of 12 weeks and were followed up at 1 year. The primary endpoint was visual analogue scale for pain, and the secondary endpoints were function (6-min walk test, Roland Morris and Oswestry questionnaires), quality of life (SF-36 questionnaire) and satisfaction with treatment (Likert scale). Results: No significant difference between groups was observed for pain over time (p = 0.145). Significant differences between groups, in favor of the IG, were observed for the Oswestry score (p = 0.006) and vitality domain score of the SF-36 (p = 0.047). Function in the Roland Morris and 6-min walk test and the role of the physical domain of SF-36 also showed significant differences between the groups; however, these differences occurred due to a worsening of the IG in the short term, and the medium-term. The Likert scale demonstrated greater satisfaction with the IG treatment compared to control group. Conclusions: Lumbar stenosis surgery did not improve pain in short and medium terms. Function and vitality were better in the group that underwent surgery in the medium term, and patients were more satisfied with the surgical treatment. Trial registration: Clinicaltrials.gov (NCT02879461).

Translation to Brazilian Portuguese, cultural adaptation and psychometric properties of 8-item ArthritisSelf-Efficacy Scale (ASES-8)

ABSTRACT BACKGROUND: Self-efficacy refers to one's belief in one's ability to organize, perform actions and face challenges in order to achieve goals and motivation. High self-efficacy improves disease coping and adherence to treatment among patients with rheumatoid arthritis. The objective of this study was to translate, culturally adapt and test the reproducibility of the 8-item Arthritis Self-Efficacy Scale (ASES-8) questionnaire for use in Brazil. DESIGN AND SETTING: Validation study conducted in university outpatient clinics. METHODS: The questionnaire was translated into Brazilian Portuguese and then back-translated into English. The final version in Portuguese was tested on 30 patients with rheumatoid arthritis and was shown to be understandable and culturally adapted. A further 32 patients with rheumatoid arthritis were evaluated three times using the questionnaire. On the first occasion, two evaluators applied the questionnaire to check inter-evaluator reproducibility. After 15 days, one of the evaluators reassessed the patients to verify intra-evaluator reproducibility. At the first assessment, to test the construct validity of ASES-8, the Numerical Pain Scale, Health Assessment Questionnaire, Beck Depression Inventory and Short Form-36 questionnaire were also applied to all the patients. RESULTS: The inter and intra-evaluator correlation coefficients for ASES-8 were high. Cronbach's alpha was higher than 0.90 for the questionnaire, indicating excellent internal consistency. There were moderate correlations between ASES-8 and most of the instruments tested, indicating good construct validity. CONCLUSION: ASES-8 was translated and adapted to the Portuguese language for Brazil. This instrument is valid, reproducible and reliable for evaluating self-efficacy among patients with rheumatoid arthritis.

Gait in children and adolescents with idiopathic musculoskeletal pain

Abstract Introduction: Musculoskeletal pain is a constant complaint in pediatric practice. The pain may be related to a number of organic diseases and / or be part of the amplified musculoskeletal pain syndromes. Idiopathic musculoskeletal pain (IMSP) is defined as the presence of intermittent pain in three or more body regions for at least three months, excluding organic diseases that could explain the symptoms. Objective: To study the gait of children and adolescents with IMSP by dynamic baropodometry. Methodology: Thirty-two patients with IMSP and 32 healthy controls, matched by age, sex, social class, and body mass index (BMI) were enrolled. All were evaluated for pain intensity through the visual analogue scale (VAS) and gait evaluation using dynamic baropodometry. Results: The mean age of the IMSP group was 13.6 years (SD = 2.1, range 9.8-16.9) and of the control group was 13.5 years (SD = 2.0, range 9.6-16.5). The mean pain scale was 5.4 cm in the IMSP group and 0 cm in the control group (p < 0.001). In gait, the mean right foot velocity of the IMSP group was significantly lower (p = 0.034), the time of the step of the IMSP group was significantly higher (p = 0.003) and the pace of the IMSP group was significantly lower (p = 0.001). Conclusion: In our study we observed differences between the gait of children with IMSP and healthy controls according to the dynamic baropodometry. This finding indicates the need for individualized attention to the gait of children with musculoskeletal pain.

Ultrasound of entheses in ankylosing spondylitis patients: The importance of the calcaneal and quadriceps entheses for differentiating patients from healthy individuals

OBJECTIVES: To compare the ultrasonographic findings of entheses in ankylosing spondylitis (AS) patients with those of healthy control individuals and to assess the ability of ultrasound (US) to identify aspects related to the disease. METHODS: A cross-sectional study involving 50 patients with AS and 30 healthy controls was performed. Clinical assessment included the use of a visual analog scale for pain, assessment of swelling of the enthesis, global assessments for patients and physician, use of a disease activity index, mobility and dysfunctional indices, erythrocyte sedimentation rate and clinical enthesitis index. US was performed for the following entheses by two experienced musculoskeletal radiologists: brachial triceps, distal quadriceps, proximal and distal patellar tendons, calcaneal tendon, and plantar fascia; the total and subitems of the Madrid Sonographic Enthesitis Index were used for evaluations. RESULTS: Comparison between groups showed a statistically significant difference with worse scores in AS patients, with bone erosion of the calcaneal enthesis and bone erosion and thickening of the plantar fascia. The odds ratio for thickening of the plantar fascia in the AS group was 3.47, according to logistic regression analysis. The AS group also had worse scores regarding the presence of calcification in the quadriceps enthesis, with a fivefold increased risk. CONCLUSION: US analysis showed that only entheses of the foot and quadriceps were able to differentiate AS patients from healthy individuals.

Força muscular de membros inferiores em mulheres com artrite reumatoide e mulheres sem a doença: há diferença? / Fuerza muscular de los miembros inferiores entre las mujeres con artritis reumatoide y las mujeres sin esta enfermedad: ¿habrá diferencias? / Lower-limb muscle strength in women with rheumatoid arthritis and women without the disease: is there a difference?

RESUMO A artrite reumatoide (AR) é uma doença inflamatória sistêmica, crônica, que acomete preferencialmente a membrana sinovial das articulações. Dentre as qualidades de aptidão física que podem ser reduzidas em indivíduos com AR merece destaque a força muscular, que está diretamente relacionada à capacidade de realização de todas as atividades da vida diária, desde as mais simples até as mais complexas. O objetivo deste estudo foi avaliar a força muscular de membros inferiores de mulheres com AR. Métodos: 17 voluntárias com AR (das classes funcionais I, II e III) e 17 sem a doença, com idade média de 54,7+6,63 anos, foram submetidas ao teste de uma repetição máxima para avaliar a força muscular de flexores e extensores de joelho e de abdutores e adutores de quadril. Utilizou-se o teste τ para analisar os dados, sendo considerados estatisticamente significativos os níveis de α <0,05. Em todas as avaliações o grupo de mulheres com AR apresentou valores inferiores quando comparados ao grupo sem a doença. No entanto não houve diferenças estatisticamente significativas entre os grupos. Os níveis descritivos obtidos da comparação entre a força muscular dos grupos foram: para extensores de joelho, p=0,224; flexores de joelho, p=0,467; abdutores de quadril, p=0,190; e adutores de quadril, p=0,127. A força muscular de membros inferiores não difere entre mulheres com AR (das classes funcionais I, II e III) e mulheres sem a doença.

RESUMEN La artritis reumatoide (AR) es una enfermedad inflamatoria sistémica, crónica, que afecta específicamente a la membrana sinovial de las articulaciones. Entre las cualidades de aptitud física que pueden reducirse en individuos con AR, se señala la fuerza muscular, que está directamente relacionada con la capacidad para realizar todas las actividades de la vida diaria, desde las más simples hasta las más complejas. Este estudio propone evaluar la fuerza muscular de los miembros inferiores de mujeres con AR. Métodos: Se sometieron a 17 voluntarias con AR (de categorías funcionales I, II y III) y a 17 sin la enfermedad -con un promedio de edad de 54,7+6,63 años- a la prueba de repetición máxima para que se evalúe la fuerza muscular de los flexores y los extensores de rodilla, así como los extensores y abductores de cadera. Se utilizó la prueba τ para analizar los datos, siendo considerados estadísticamente significativos los niveles de α <0,05. En todas las evaluaciones, el grupo de mujeres con AR presentó valores más bajos en comparación con el grupo sin la enfermedad. Sin embargo, no hubo ninguna diferencia estadísticamente significativa entre los grupos. Los niveles descriptivos obtenidos de la comparación entre la fuerza muscular de los grupos fueron: los extensores de rodilla, p=0,224; los flexores de rodilla, p=0,467; los abductores de cadera, p=,190; y los aductores de cadera, p=0,127. La fuerza muscular de los miembros inferiores no difirió entre las mujeres con AR (de categorías funcionales I, II y III) y las mujeres sin esta enfermedad.

ABSTRACT Rheumatoid arthritis (RA) is a systemic inflammatory disease, which is chronic and affects the joints' synovial membrane. Among the physical aptitude qualities that can be impaired in individuals with RA, muscle strength deserves attention. It is directly associated with the capacity of performing all activities of daily living, from the simplest to the most complex. The aim of this study was to assess the muscle strength of the lower limbs of women with RA. Seventeen volunteers with RA (I, II and III functional classes) and 17 women without the disease, with mean age corresponding to 54.7+6.63 years, underwent the one-maximum repetition test to assess knee flexors and extensors, hip abductors and adductors. We used Student's T test to analyze the data, considering significant p values < 0.05. In all assessments, the group of women with RA showed lower values when compared with women without the disease. However, there were no statistically significant differences between the groups. The descriptive levels obtained from the comparison between the groups' muscle strength were: knee extensors, p=0.224; knee flexors, p=0.467; hip abductors, p=0.190 and hip adductors, p=0.127. The muscle strength of the lower limbs does not differ between women with RA (I, II and III functional classes) and women without the disease.

Interventional rheumatology: the competence of Brazilian rheumatologists / Reumatologia intervencionista: competência dos reumatologistas brasileiros

Abstract Objectives: Describe Brazilian rheumatologists's competence in interventional rheumatology; assess the association between this ability and demographic and training variables. Methods: A cross-sectional study with 500 Brazilian rheumatologists. Participants were assessed by self-administered questionnaire consisting of demographics, training, practice in office and knowledge in interventional rheumatology data. Results: 463 participants had their data analyzed. The mean age was 40.2 years (±11.2). 70% had performed periarticular injections and 78% had performed intra-articular injections. The sample was divided into three groups: non-interventionist, little interventionist and very interventionist. The non-interventionist group showed (p < 0.001-0.04) higher mean age, lower proportion of university bond, lower training history, higher proportion of graduates in the Southeast country, and higher proportion of graduates in the 1980s to 1989. The very interventionist group showed higher (p < 0.001-0.018) proportion of adult rheumatologists, higher proportion of university bond, longer training time with greater practice of complex procedures, and higher proportion of graduates, trained and with private practice in the South country. Variables most associated with the very interventionist subgroup are performing axial intra-articular injections (OR: 7.4, p < 0.001), synovial biopsy (OR: 5.75, p = 0.043), image-guided IAI (OR: 4.16, p < 0.001), viscosupplementation (OR = 3.41, p < 0.001), joint lavage (OR = 3.22, p = 0.019), salivary gland biopsy (OR = 2.16, p = 0.034) and over 6-month training (OR: 2.16, p = 0.008). Conclusions: Performing more complex invasive procedures and over 6-month training in interventional rheumatology were variables associated with enhanced interventional profile.

Resumo Objetivos: Descrever a competência dos reumatologistas brasileiros na reumatologia intervencionista (RI); avaliar a associação entre essa capacidade e variáveis demográficas e de treinamento. Métodos: Fez-se um estudo transversal com 500 reumatologistas brasileiros. Os participantes foram avaliados por questionário autoadministrado, constituído por dados demográficos, treinamento, prática em consultório e conhecimento em dados de RI. Resultados: Analisaram-se os dados de 463 participantes. A média foi de 40,2 anos (± 11,2). Desses, 70% fizeram injeções periarticulares (IPA) e 78% intra-articulares (IIA). A amostra foi dividida em três grupos: não intervencionista, pouco intervencionista e muito intervencionista. O grupo não intervencionista apresentou (p < 0,001 - 0,04) maior média de idade, menor proporção de vínculo universitário, menor história de treinamento, maior proporção de graduados na Região Sudeste do país e maior proporção de graduados nas décadas de 1980 a 1989. O grupo muito intervencionista apresentou (p < 0,001 - 0,018) maior proporção de reumatologias que atendem pacientes adultos, maior proporção de vínculo universitário, maior tempo de treinamento de prática de procedimentos complexos, maior proporção de graduados no sul do país, treinados e com consultório particular nessa região. As variáveis mais frequentemente associadas ao subgrupo muito intervencionista foram realização de IIA axial (OR: 7,4, p < 0,001), biópsia sinovial (OR: 5,75, p = 0,043), IIA guiada por imagem (OR: 4,16, p < 0,001), viscossuplementação (OR = 3,41, p < 0,001), lavagem articular (OR = 3,22, p = 0,019), biópsia da glândula salivar (OR = 2,16, p = 0,034) e mais de seis meses de treinamento (OR: 2,16; p = 0,008). Conclusões: Fazer procedimentos invasivos mais complexos e ter mais de seis meses de treinamento em RI foram as variáveis associadas a um maior perfil intervencionista.

Intra-articular injection with triamcinolone hexacetonide in patients with rheumatoid arthritis: prospective assessment of goniometry and joint inflammation parameters / Injeção intra-articular de hexacetonido de triancinolona em pacientes com artrite reumatoide: avaliação prospectiva da goniometria e parâmetros de inflamação articular

Abstract Objectives: To evaluate local joint variables after intra-articular injection with triamcinolone hexacetonide in rheumatoid arthritis patients. Methods: We blindly and prospectively (baseline, 1, 4, 12 and 24 weeks) evaluated metacarpophalangeal, wrist, elbow, shoulder, knee and ankle joints after triamcinolone hexacetonide intra-articular injection by the following outcome measures: visual analogue scale 0–10 cm (VAS) for rest pain (VASR); VAS for movement pain (VASM); VAS for joint swelling (VASSw); flexion (FlexG) and extension (ExtG). Results: 289 patients (635 joints) were studied. VASSw (p < 0.001) and VASR (0.001 < p < 0.016) improved from T0 to T4, T12 and T24 for all joints. VASM improved from T0 to T4 (p < 0.021) for all joints; T0 to T12 (p < 0.023) for MCF and knee; T0 to T24 (p < 0.019) only for MCF and knee. FlexG improved from T0 to T4 (p < 0.001) for all joints; T0 to T12 (p < 0.001) and T0 to T24 (p < 0.02) only for MCF and knee. ExtG improved from T0 to T4 (p < 0.001) for all joints except for elbow; T0 to T12 (p = 0.003) for wrist, metacarpophalangeal and knee; and T0 to T24 (p = 0.014) for MCF and knee. Conclusion: VASSw responded better at short and medium term after IAI with triamcinolone hexacetonide in our sample of RA patients.

Resumo Objetivos: Avaliar variáveis articulares locais após a injeção intra-articular (IIA) de hexacetonido de triancinolona (HT) em pacientes com artrite reumatoide (AR). Métodos: Avaliaram-se de modo cego e prospectivo (inicial, 1, 4, 12 e 24 semanas) as articulações metacarpofalângica (MCF), punho, cotovelo, ombro, joelho e tornozelo após a IIA de HT à procura das seguintes medidas de desfecho: escala visual analógica (EVA) de 0 a 10 cm para dor em repouso (EVAr); EVA para dor ao movimento (EVAm); EVA para inchaço das articulações (EVAi); flexão (FlexG) e extensão (ExtG). Resultados; Estudaram-se 289 pacientes (635 articulações). A EVAi (p < 0,001) e a EVAr (0,001 < p < 0,016) melhoraram de T0 a T4, T12 e T24 em todas as articulações. A EVAm melhorou de T0-T4 (p < 0,021) em todas as articulações; T0-T12 (p < 0,023) na MCF e no joelho; T0-T24 (p < 0,019) apenas na MCF e no joelho. A FlexG melhorou de T0-T4 (p < 0,001) em todas as articulações; T0-T12 (p < 0,001) e T0-T24 (p < 0,02) apenas na MCF e no joelho. A ExtG melhorou de T0-T4 (p < 0,001) em todas as articulações, exceto no cotovelo; T0-T12 (p = 0,003) no punho, na MCF e no joelho; e T0-T24 (p = 0,014) na MCF e no joelho. Conclusão: A EVAi respondeu melhor em curto e médio prazos após a IIA de HT na presente amostra de pacientes com AR.

Swiss ball exercises improve muscle strength and walking performance in ankylosing spondylitis: a randomized controlled trial / Exercícios na bola suíça melhoram a força muscular e o desempenho na caminhada na espondilite anquilosante: estudo clínico, controlado e randomizado

ABSTRACT Objective: The purpose was to evaluate the effectiveness of a progressive muscle strengthening program using a Swiss ball for AS patients. Methods: Sixty patients with AS were randomized into the intervention group (IG) or the control group (CG). Eight exercises were performed by the IG patients with free weights on a Swiss ball two times per week for 16 weeks. The evaluations were performed by a blinded evaluator at baseline and after 4, 8, 12 and 16 weeks using the following instruments: the one-repetition maximum test (1 RM), BASMI, BASFI, HAQ-S, SF-36, 6-minute walk test, time up and go test, BASDAI, ASDAS, ESR and CRP dosage and Likert scale. Results: There was a statistical difference between groups for: strength (1 RM capacity) in the following exercises: abdominal, rowing, squat, triceps and reverse fly (p < 0.005); 6-minute walk test (p < 0.001); timed up and go test (p = 0.025) and Likert scale (p < 0.001), all of them with better results for the IG. No differences were observed between the groups with respect to the functional capacity evaluation using the BASFI, HAQ-S, BASMI, SF-36, TUG, ASDAS, ESR and CPR dosage. Conclusions: Progressive muscle strengthening using a Swiss ball is effective for improving muscle strength and walking performance in patients with AS.

RESUMO Objetivo: Avaliar a efetividade de um programa de fortalecimento muscular progressivo com o uso de uma bola suíça em pacientes com espondilite anquilosante (EA). Métodos: Sessenta pacientes com EA foram randomizados em grupo intervenção (GI) ou grupo controle (GC). Os pacientes com EA fizeram oito exercícios com pesos livres em uma bola suíça duas vezes por semana durante 16 semanas. As avaliações foram feitas por um avaliador cego no início do estudo e após quatro, oito, 12 e 16 semanas com os seguintes instrumentos: teste de uma repetição máxima (1 RM), Basmi, Basfi, HAQ-S, SF-36, teste de caminhada de seis minutos, Timed up and go test, Basdai, Asdas, dosagem de VHS e PCR e escala de Likert. Resultados: Houve uma diferença estatisticamente significativa entre os grupos em relação à força (capacidade no teste de 1 RM) nos seguintes exercícios: abdominal, remada, agachamento, tríceps e crucifixo invertido (p < 0,005); teste de caminhada de seis minutos (p < 0,001); Timed up and go test (p = 0,025); e escala de Likert (p < 0,001), todos com melhores resultados no GI. Não foram observadas diferenças entre os grupos em relação à avaliação da capacidade funcional com Basfi, HAQ-S, Basmi, SF-36, TUG, Asdas, VHS e dosagem de PCR. Conclusões: O fortalecimento muscular progressivo com uma bola suíça é efetivo em melhorar a força muscular e o desempenho na caminhada em pacientes com EA.

Intra-articular injection in patients with juvenile idiopathic arthritis: factors associated with a good response / Infiltração intra-articular em pacientes com artrite idiopática juvenil: fatores associados à boa resposta

ABSTRACT Introduction: Intra-articular injection of corticosteroids (IIC) for treatment of patients with juvenile idiopathic arthritis (JIA) is increasingly used in Pediatric Rheumatology. Objectives: To describe the clinical course of patients undergoing IIC in our Pediatric Rheumatology Unit. Methods: Retrospective study of patients with JIA undergoing IIC from January 2008 to December 2012, with a minimum follow-up of six months after the injection. Good response to IIC was set as the presence of inactivity on the infiltrated joint by at least six months. Results: Eighty-eight patients underwent a total of 165 IICs. Of these, 75% were girls and 35.2% had persistent oligoarticular JIA. The mean age at diagnosis was 6.8 years, and when IIC was carried out, 12.2 years. Regarding patients, younger age at diagnosis (p = 0.037) and the occurrence of uveitis in the course of the disease (p = 0.015) were associated with good response to IIC. From 165 IICs, 63% had a good response and joints remained inactive for a median of 18.1 months. The type of joint injection (p = 0.001), lesser values stated in the overall visual analog scale by the physician (p = 0.015) and by parents/patient (p = 0.01) have been associated with a good response to IIC. Nine adverse events (5.4%) were observed. Conclusion: In our study, more than half of the joints showed a good response to IIC. Younger patients at diagnosis and uveitis during the course of the disease had good response to IIC. Knees, wrists and elbows were the joints that best responded to IIC. IIC proved to be a safe procedure.

RESUMO Introdução: A infiltração intra-articular de corticosteroides (IIC) para tratamento de pacientes com artrite idiopática juvenil (AIJ) é cada vez mais usada em reumatologia pediátrica. Objetivos: Descrever a evolução clínica dos pacientes submetidos à IIC em nosso setor de reumatologia pediátrica. Métodos: Estudo retrospectivo de pacientes com AIJ submetidos à IIC de janeiro/2008 a dezembro/2012, com seguimento mínimo de seis meses após a infiltração. Boa resposta à IIC foi definida como inatividade na articulação infiltrada por, no mínimo, seis meses. Resultados: Foram submetidos a 88 pacientes a 165 IICs. Desses, 75% eram meninas e 35,2% apresentavam AIJ oligoarticular persistente. A média de idade ao diagnóstico foi de 6,8 anos e à IIC de 12,2 anos. Em relação aos pacientes, a menor idade ao diagnóstico (p = 0,037) e a ocorrência de uveíte no curso da doença (p = 0,015) foram associados à boa resposta à IIC. Das 165 IICs, 63% apresentaram boa resposta e as articulações permaneceram inativas por um tempo médio de 18,1 meses. O tipo de articulação infiltrada (p = 0,001), menores valores na escala visual analógica global do médico (p = 0,015) e dos pais/paciente (p = 0,01) foram associados a uma boa resposta à IIC. Nove efeitos adversos (5,4%) foram observados. Conclusão: Em nosso estudo, mais da metade das articulações mostrou boa resposta à IIC. Os pacientes com menor idade ao diagnóstico e uveíte durante o curso da doença tiveram boa resposta à IIC. Os joelhos, punhos e cotovelos foram as articulações que mais bem responderam à IIC. A IIC mostrou ser um procedimento seguro.

A new musculoskeletal ultrasound scoring system (US10) of the hands and wrist joints for evaluation of early rheumatoid arthritis patients / Novo sistema de escore ultrassonográfico (US10) musculoesquelético das articulações das mãos e punho para avaliação de pacientes com artrite reumatoide em fase inicial

ABSTRACT Objective: To propose a novel ultrasound scoring system for hand and wrist joints (US10) for evaluation of patients with early rheumatoid arthritis (RA) and to correlate the US10 with clinical, laboratory and functional variables. Methods: Forty-eight early RA patients underwent clinical and laboratory evaluations as well as blinded ultrasound (US) examinations at baseline, three, six and 12 months. The proposed US10 system involved the assessment of the wrist, second and third metacarpophalangeal and proximal interphalangeal joints. The score consisted of inflammation parameters (synovial proliferation [SP], power Doppler [PD] and tenosynovitis [TN]) and joint damage parameters (bone erosion [BE] and cartilage damage [CD]). SP, PD, BE and CD were scored qualitatively (0–1) and semi-quantitatively (grades 0–3). Tenosynovitis was scored as presence/absence. The evaluation also involved the 28-Joint Disease Activity Score (DAS28), Health Assessment Questionnaire (HAQ) and C-reactive protein level (CRP). Results: Mean duration of symptoms was 7.58 ± 3.59 months. Significant correlations (p < 0.05) were found between inflammation parameters and CRP at baseline and between the changes in these variables throughout the study. Significant correlations (p < 0.05) were found between DAS28 score and both PD and TN at baseline and between the changes in DAS28 score and both SP and TN throughout the follow up. Moreover, significant correlations were found between the changes in inflammation parameter scores and HAQ score throughout the follow up. Conclusion: The proposed US10 scoring system proved to be a useful tool for monitoring inflammation and joint damage in early RA patients, demonstrating significant correlations with longitudinal changes in disease activity and functional status.

RESUMO Objetivo: Propor um novo sistema de escore ultrassonográfico das articulações da mão e punho (US10) para a avaliação de pacientes com artrite reumatoide (AR) e correlacionar o US10 com variáveis clínicas, laboratoriais e funcionais. Métodos: Foram submetidos 48 pacientes com AR em fase inicial a avaliações clínicas e laboratoriais, bem como a exames cegos de ultrassom (US) no início do estudo e com 3, 6 e 12 meses. O sistema US10 proposto envolveu a avaliação do punho e das articulações metacarpofalângicas e interfalângicas proximais do segundo e terceiro dígitos. O escore consistiu em parâmetros inflamatórios (proliferação sinovial [PS], Power Doppler [PD] e tenossinovite [TN]) e parâmetros de danos articulares (erosão óssea [EO] e danos na cartilagem [DC]). PS, PD, EO e DC foram pontuados qualitativamente (0 a 1) e semiquantitativamente (graus 0 a 3). A tenossinovite foi pontuada como presença/ausência. A avaliação envolveu também o escore 28-Joint Disease Activity (DAS28), o Health Assessment Questionnaire (HAQ) e o nível de proteína C-reativa (PCR). Resultados: A duração média dos sintomas foi de 7,58 ± 3,59 meses. Foram encontradas correlações estatisticamente significativas (p < 0,05) entre os parâmetros de inflamação e a PCR no início do estudo e entre as mudanças nessas variáveis ao longo do estudo. Foram encontradas também correlações significativas (p < 0,05) entre o escore DAS28 e a PD e TN no início do estudo e entre as mudanças no escore DAS28 e PS e TN em todo o seguimento. Além disso, foram encontradas correlações significativas entre as mudanças no escore dos parâmetros de inflamação e no escore HAQ ao longo do seguimento. Conclusão: O sistema de escore US10 proposto provou ser uma ferramenta útil para monitorar a inflamação e o dano articular em pacientes com AR em fase inicial, demonstra correlações significativas com as alterações longitudinais na atividade da doença e no estado funcional.

Translation to Brazilian Portuguese, cultural adaptation and reproducibility of the questionnaire "Ankylosing Spondylitis: What do you know?" / Tradução para a língua portuguesa brasileira, adaptação cultural e reprodutibilidade do questionário "Ankylosing Spondylitis: What do you know?"

ABSTRACT CONTEXT AND OBJECTIVE: Ankylosing spondylitis (AS) generates inflammation and pain in entheses, peripheral joints and the spine. Education regarding AS can improve patients' disability. Thus, it is important to assess patients' knowledge. There is no instrument in the literature for assessing knowledge of AS in Portuguese. The aim here was to translate to the Brazilian Portuguese language, culturally adapt and test the reliability of the questionnaire "Ankylosing Spondylitis: What do you know?" and to correlate the findings with other factors. DESIGN AND SETTING: Original article regarding validation of questionnaire, produced at the Federal University of Sao Paulo (Unifesp). METHODS: For translation and cultural adaptation, Guilleman methodology was used. After the first phase, the reliability was tested on 30 patients. Correlations between these scores and other factors were examined. RESULTS: In the interobserver assessment, the Pearson correlation coefficient and Cronbach's alpha were 0.831 and 0.895, respectively. In the intraobserver evaluation, the intraclass correlation coefficient and Cronbach's alpha were 0.79 and 0.883, respectively. At this stage, the score for area of knowledge A showed correlations with ethnicity and education; the score for area D, with age; the total score and scores for areas A and B with "social aspects" of SF-36; and the score for area D with "pain", "vitality" and "emotional aspects" of SF-36. CONCLUSION: The Brazilian version of the questionnaire "Ankylosing Spondylitis: What do you know?" was created. It is reproducible and correlates with education level, ethnicity and the SF-36 domains "social aspects" and "emotional aspects".

RESUMO CONTEXTO E OBJETIVO: A espondilite anquilosante (EA) gera inflamação e dor em enteses, articulações periféricas e coluna vertebral. A educação na EA pode melhorar a incapacidade dos pacientes. Assim, é importante avaliar o conhecimento do paciente. Não há na literatura instrumento que avalie o conhecimento da EA na língua portuguesa. O objetivo foi traduzir para a língua portuguesa brasileira, realizar a adaptação cultural e testar a confiabilidade do questionário Ankylosing Spondylitis: What do you know? e relacionar os resultados com outros fatores. TIPO DE ESTUDO E LOCAL: Artigo original de validação de questionário realizado na Universidade Federal de São Paulo (Unifesp). MÉTODOS: Para tradução e adaptação cultural, foi utilizada a metodologia de Guilleman. Depois da primeira fase, a confiabilidade foi testada em 30 pacientes. Correlações entre esses escores e outros fatores foram avaliadas. RESULTADOS: Na avaliação interobservador, o coeficiente de correlação de Pearson e o alpha de Cronbach foram de 0,831 e 0,895, respectivamente. Na avaliação intra-observador, o coeficiente de correlação intraclasse e o alpha de Cronbach foram de 0,79 e 0,883, respectivamente. Nesta etapa, foram encontradas correlações entre etnia e escolaridade e a área de conhecimento A, e entre idade e a área D; entre o escore total e escores das áreas A e B e "aspectos sociais" do SF-36 e entre a área D e "dor", "vitalidade" e "aspectos emocionais" do SF-36. CONCLUSÃO: Foi criada a versão brasileira do questionário "Ankylosing Spondylitis: What do you know?", que é reprodutível e se correlaciona com escolaridade, etnia e os domínios "aspectos sociais" e "aspectos emocionais" do SF-36.

Translation, cultural adaptation and reproducibility of the Oxford Shoulder Score questionnaire for Brazil, among patients with rheumatoid arthritis / Tradução, adaptação cultural e reprodutibilidade do questionário Oxford Shoulder Score para o Brasil em pacientes com artrite reumatoide

ABSTRACT CONTEXT AND OBJECTIVE Although shoulder questionnaires validated for Brazil do exist, none of them are aimed at populations with rheumatic disease. We believe that the Oxford Shoulder Score (OSS) may be useful in this population. The objective of this study was to translate the OSS, adapt it to Brazilian culture and test its reproducibility. DESIGN AND SETTING Validation study conducted in university outpatient clinics. METHODS The OSS was translated into Portuguese by two English teachers and was then retranslated into English by two native English teachers. These translations were reviewed by a committee to establish the version of OSS-Brazil to be administered to 30 patients with rheumatoid arthritis (RA) and shoulder pain, in order to test the cultural adaptation. The validity and reproducibility was tested among another 30 patients with RA and shoulder pain, of both genders and aged 18 to 65 years. The internal consistency and reproducibility were analyzed. The following instruments were evaluated: OSS-Brazil; a numerical scale for shoulder pain; DASH; HAQ and SF-36. RESULTS The internal consistency was 0.957 and the intra and inter-rater reproducibility was 0.917 and 0.861, respectively. A high level of correlation was found between OSS-Brazil and the following: HAQ (-0.663), DASH (-0.731) and the SF-36 domains of functional capacity (0.589), physical aspects (0.507), pain (0.624), general state of health (0.444), vitality (0.634) and mental health (0.578). CONCLUSION OSS-Brazil was successfully translated and adapted, and this version exhibited good internal consistency, reliability and construct validity.

RESUMO CONTEXTO E OBJETIVO Apesar de existirem questionários de ombro validados para o Brasil, nenhum deles é voltado para a população com doenças reumáticas. Acreditamos que o Oxford Shoulder Score (OSS) possa ser útil nessa população. O objetivo deste estudo foi traduzir, adaptar à cultura brasileira e testar a reprodutibilidade do OSS. TIPO DE ESTUDO E LOCAL Estudo de validação realizado nos ambulatórios da universidade. MÉTODOS Foi realizada a tradução para o português por dois professores de inglês e depois a retradução para o inglês por dois professores nativos da língua inglesa. Essas traduções foram revisadas por um comitê para estabelecer a versão do OSS-Brasil, que foi aplicada em 30 pacientes com artrite reumatoide (AR) e dor no ombro para testar a adaptação cultural. A validade e a reprodutibilidade foram testadas em outros 30 pacientes com AR e dor no ombro de ambos os gêneros com idade entre 18 a 65 anos. Foram analisadas a consistência interna e a reprodutibilidade. Foram avaliados os seguintes instrumentos: OSS-Brasil; escala numérica de dor no ombro; DASH; HAQ e SF-36. RESULTADOS A consistência interna foi 0,957 e a reprodutibilidade intra-avaliador e interavaliador foi 0,917 e 0,861, respectivamente. Foi observado alto nível de correlação do OSS-Brasil com HAQ (-0,663), DASH (-0,731) e os domínios do SF-36: capacidade funcional (0,589); aspectos físicos (0,507); dor (0,624); estado geral de saúde (0,444); vitalidade (0,634); saúde mental (0,578). CONCLUSÃO O OSS-Brasil foi traduzido e adaptado com sucesso, com boa consistência interna, confiabilidade e validade de construção.

Avaliação isocinética do tornozelo de pacientes com artrite reumatoide / Isokinetic assessment of ankles in patients with rheumatoid arthritis

RESUMOIntroduçãoO pé e o tornozelo na artrite reumatoide passam por sinovite altamente destrutiva, com perda de força muscular.ObjetivoAvaliar a força muscular do tornozelo de pacientes com artrite reumatoide com base em parâmetros da dinamometria isocinética.Materiais e métodosForam estudados 30 pacientes com diagnóstico de artrite reumatoide. O estudo envolveu 30 indivíduos saudáveis (grupo controle) pareados por idade, sexo, etnia, índice de massa corporal e dominância de membro inferior. Todos os indivíduos foram submetidos a avaliação da flexão dorsal, flexão plantar, inversão e eversão com o dinamômetro isocinético Cybex Norm. As variáveis foram comparadas entre os grupos artrite reumatoide e controle e entre os tornozelos direito e esquerdo. Foi determinada a relação de força muscular flexores dorsais/flexores plantares e inversores/eversores.ResultadosOs pacientes com artrite reumatoide tiveram resultados estatisticamente piores no teste de dinamometria isocinética para todos os movimentos do tornozelo. A relação de força muscular entre flexores dorsais e flexores plantares foi diferente nos dois grupos. Não foram observadas diferenças significativas na relação entre inversores e eversores. Nos dois grupos, os músculos flexores plantares eram estatisticamente mais fortes do que os flexores dorsais.ConclusãoOs pacientes com artrite reumatoide têm pior desempenho na dinamometria isocinética em todos os movimentos do tornozelo do que os indivíduos do grupo controle. Foram observados resultados semelhantes no teste isocinético para o lado direito e esquerdo, em ambos os grupos, com poucas exceções. A avaliação isocinética não representou risco adicional, como dor importante ou atividade inflamatória, em pacientes com artrite reumatoide.

ABSTRACTIntroductionThe foot and ankle in rheumatoid arthritis undergo highly destructive synovitis with loss of muscle strength.ObjectiveTo evaluate the muscle strength of ankles in patients with rheumatoid arthritis based on isokinetic dynamometry parameters.Materials and methodsThirty patients with a diagnosis of rheumatoid arthritis involving the ankle(s) and 30 healthy subjects (control group) matched for age, gender, race, body mass index and lower limb dominance were studied. Dorsiflexion, plantar flexion, inversion and eversion were evaluated in all subjects on an isokinetic Cybex Norm dynamometer. The variables were compared between the rheumatoid arthritis and control groups and between the right and left ankles, and the dorsiflexor/plantar flexor and invertor/evertor muscle strength ratio was determined.ResultsPatients with rheumatoid arthritis performed statistically worse in the isokinetic dynamometry test for all ankle movements. The muscle strength ratio between dorsiflexors and plantar flexors was different in the two groups. No significant differences were observed in the invertor and evertor ratios. In the two groups the plantar flexor musculature was statistically stronger than dorsiflexors.ConclusionWe conclude that patients with rheumatoid arthritis perform worse in isokinetic dynamometry regarding all ankle movements than control subjects, with similar isokinetic test results being observed for the right and left side in both groups, with few exceptions. Isokinetic evaluation posed no additional risk such as important pain or inflammatory activity to patients with rheumatoid arthritis.

Infiltrações intra-articulares de triancinolona hexacetonida na artrite reumatóide: preditores de melhora a curto e longo prazo / Intra-articular injections of triamcinolone hexacetonide in rheumatoid arthritis: short and long-term improvement predictors

Objetivos: Identificar fatores preditivos de resposta à infiltração intra-articular (IIA) com triancinolona hexacetonida (TH). Métodos: Este estudo foi realizado em pacientes de artrite reumatóide (AR) (segundo critérios do American College of Rheumatology) submetidos à IIA (infiltração mono, pauci ou poliarticular). Avaliação: Um observador “cego” avaliou prospectivamente as articulações uma semana (T1), quatro semanas (T4), 12 semanas (T12) e 24 semanas (T24) após IIA. As medidas de desfecho foram Escala Visual Analógica (0-10 cm) em repouso, em movimento e para articulações edemaciadas. As variáveis clínicas e demográficas e aquelas relacionadas à infiltração no início do estudo foram analisadas de acordo com a resposta à IIA. Resultados: Foram estudados 289 pacientes com AR (635 articulações) com média de idade de 48,7 (± 10,68) anos; 48,5% eram caucasianos, EVA para dor global = 6,52 (± 1,73). Na análise univariada, as variáveis relativas às melhores respostas em seguida à IIA (melhora >70%) foram: “IIA no cotovelo e metacarpofalangeanas (MCF)” e “classe funcional II”. Na análise multivariada, “homens” e “não brancos” foram os preditores com melhor resposta à IIA na T4, enquanto “IIA no cotovelo e MCF”, “infiltração poliarticular”, “uso de metotrexato” e “dose total maior de TH” obtiveram a melhor resposta na T24. Conclusão: Foram identificados diversos fatores preditivos de boa resposta à IIA em pacientes com AR. Os preditores de melhor resposta para IIA de TH em longo prazo foram “aplicar IIA no cotovelo e MCF” e “aplicar infiltração poliarticular”. .

Objectives: Identify good response predictors to intra-articular injection (IAI) with triamcinolone hexacetonide (TH). Methods: This study was carried out in rheumatoid arthritis (RA) patients (American College of Rheumatology criteria) submitted to IAI (mono, pauci or polyarticular injection). Assessment: a “blinded” observer prospectively evaluated joints at one week (T1), four weeks (T4), twelve weeks (T12) and 24 weeks (T24) after IAI. Outcome measurements included Visual Analogue Scale (0-10 cm) at rest, in movement and for swollen joints. Clinical, demographic and variables related to injection at baseline were analyzed according to IAI response. Results: We studied 289 patients with RA (635 joints) with a mean age of 48.7 years (±10.68), 48.5% of them Caucasians, VAS for global pain = 6.52 (±1.73). Under univariate analysis, the variables relating the best responses following IAI (improvement > 70%) were: “elbow and metacarpophalangeal (MCP) IAI, and functional class II”. Under multivariate analysis, “males” and “non-whites” were the predictors with the best response to IAI at T4, while “elbow and MCP IAI”, “polyarticular injection”, “use of methotrexate” and “higher total dose of TH” obtained the best response at T24. Conclusion: Several predictors of good response to IAI in patients with RA were identified. The best-response predictors for TH IAI of long term were “inject elbow and MCP IAI” and “perform polyarticular injection”. .

Acompanhamento da capacidade funcional de pacientes com artrite reumatoide por três anos / Monitoring the functional capacity of patients with rheumatoid arthritis for three years

Objetivo Quantificar a modificação da capacidade funcional em um período de três anos em um grupo de pacientes com artrite reumatoide (AR), utilizando os inventários HAQ e EPM-ROM. Métodos Quarenta pacientes com AR em tratamento com metotrexato (MTX) como fármaco antirreumático modificador da doença (DMARD) foram acompanhados por até três anos. O estado funcional foi avaliado no início e no final do período por HAQ e EPM-ROM. Resultados Trinta e dois pacientes foram recuperados, com escore HAQ inicial de 1,14 ± 0,49 (média ± DP) e EPM-ROM de 5,8 ± 2,75. Após um período médio de três anos, o HAQ foi de 1,13 ± 0,49 e EPM-ROM em 6,81 ± 3,66. No subgrupo de sete pacientes submetidos a cirurgia ortopédica, o HAQ diminuiu de 0,84 ± 0,72 para 1,64 ± 0,56; e o EPM-ROM, de 5,8 ± 1,80 para 8,3 ± 0,74. No subgrupo de pacientes não operados, o HAQ variou de 1,2 ± 0,45 para 1,07 ± 0,70; e o EPM-ROM, de 5,7 ± 3,06 para 6,4 ± 3,90. Conclusão Em um grupo de pacientes com AR medicados apenas com MTX como DMARD, houve pouca mudança nas pontuações HAQ e EPM-ROM durante o período médio de três anos. Observou-se agravamento da capacidade funcional no grupo de pacientes operados, em comparação com os não operados. Este fato nos alerta para a necessidade do uso de esquemas terapêuticos mais abrangentes e de maior disponibilidade de cirurgias musculoesqueléticas, em tempo hábil, em pacientes com AR. .

Objective To quantify modification of functional capacity in a three-year period in a group of patients with rheumatoid arthritis (RA) using HAQ and EPM-ROM inventories. Methods Forty patients with RA on methotrexate (MTX) as disease-modifying antirheumatic drug (DMARD) were followed for up to three years. The functional status was assessed at the beginning and end of the period by HAQ and EPM-ROM. Results Thirty-two patients were retrieved, with initial HAQ score of 1.14 ± 0.49 (mean ± SD) and EPM-ROM score of 5.8 ± 2.75. After an average period of three years, the HAQ score was 1.13 ± 0.49 and EPM-ROM score, 6.81 ± 3.66. In the subgroup of seven patients submitted to orthopedic surgery, HAQ score decreased from 0.84 ± 0.72 to 1.64 ± 0.56 and the EPM-ROM score, from 5.8 ± 1.80 to 8.3 ± 0.74. In the subgroup of non-operated patients, HAQ score varied from 1.2 ± 0.45 to 1.07 ± 0.70 and EPM-ROM score, from 5.7 ± 3.06 to 6.4 ± 3.90. Conclusion In a group of RA patients in use of only MTX as DMARD, there was little change on HAQ score and EPM-ROM scores over the average period of three years. Worsening functional capacity was observed in the group of operated patients in comparison to the not operated ones. This fact alerts us to the need for use of broader therapeutic regimens availability of musculoskeletal surgeries in a timely manner in patients with RA. .

Cross-cultural adaptation and validation of the Michigan Hand Outcomes Questionnaire (MHQ) for Brazil: validation study / Adaptação transcultural e validação do Michigan Hand Outcomes Questionnaire (MHQ) para o Brasil: estudo de validação

CONTEXT AND OBJECTIVE: Rheumatoid arthritis is a chronic systemic disease that causes joint damage. A variety of methods have been used to evaluate the general health status of these patients but few have specifically evaluated the hands. The objective of this study was to translate, perform cultural adaptation and assess the validity of the Michigan Hand Outcomes Questionnaire for Brazil. DESIGN AND SETTING: Validation study conducted at a university hospital in Curitiba, Brazil. METHODS: Firstly, the questionnaire was translated into Brazilian Portuguese and back-translated into English. The Portuguese version was tested on 30 patients with rheumatoid arthritis and proved to be understandable and culturally adapted. After that, 30 patients with rheumatoid arthritis were evaluated three times. On the first occasion, two evaluators applied the questionnaire to check inter-rater reproducibility. After 15 days, one of the evaluators reassessed the patients to verify intra rater reproducibility. To check the construct validity at the first assessment, one of the evaluators also applied other similar instruments. RESULTS: There were strong inter and intra rater correlations in all the domains of the Michigan Hand Outcomes Questionnaire. Cronbach's alpha was higher than 0.90 for all the domains of the questionnaire, thus indicating excellent internal validity. Almost all domains of the questionnaire presented moderate or strong correlation with other instruments, thereby showing good construct validity. CONCLUSION: The Brazilian Portuguese version of the Michigan Hand Outcomes Questionnaire was translated and culturally adapted successfully, and it showed excellent internal consistency, reproducibility and construct validity. .

CONTEXTO E OBJETIVO: Artrite reumatoide é uma doença crônica, sistêmica, que provoca danos articulares. Diversos métodos têm sido usados para avaliar o estado geral de saúde desses pacientes, mas poucos avaliam especificamente as mãos. O objetivo deste estudo foi traduzir, realizar a adaptação cultural e testar a validade do Michigan Hand Outcomes Questionnaire para o Brasil. TIPO DE ESTUDO E LOCAL: Estudo de validação feito em um hospital universitário em Curitiba, Brasil. MÉTODOS: Na primeira etapa, o questionário foi traduzido para o português do Brasil e traduzido de volta para o inglês. A versão em português foi testada em 30 pacientes com artrite reumatoide e mostrou-se compreensível e adaptada culturalmente. Na segunda etapa, 30 pacientes com artrite reumatoide foram avaliados três vezes. Na primeira vez, dois avaliadores aplicaram o questionário para verificação da reprodutibilidade interavaliadores. Após 15 dias, um dos avaliadores reavaliou os pacientes para verificação da reprodutibilidade intra-avaliadores. Para verificar a validade construtiva, na primeira avaliação, um dos avaliadores aplicou também outros instrumentos de avaliação similares. RESULTADOS: Foram observadas fortes correlações interavaliadores e intra-avaliadores em todos os domínios do Michigan Hand Outcomes Questionnaire. O alfa de Cronbach foi maior que 0.90 para todos os domínios, indicando ótima validade interna. A maioria dos domínios do questionário apresentou correlação moderada ou forte com outros instrumentos, determinando boa validade construtiva. CONCLUSÃO: A versão brasileira do Michigan Hand Outcomes Questionnaire foi traduzida, adaptada culturalmente com sucesso e apresentou ótima consistência interna, r...

Assessment of light touch sensation in the hands of systemic sclerosis patients

INTRODUCTION: Systemic sclerosis is a relatively rare connective tissue disorder characterized by severe and progressive fibrosis of the skin. Due to the current lack of available information on this subject, the aim of the present study was to assess light touch sensations in the hands of patients with systemic sclerosis. METHODS: We completed a cross-sectional comparative study. Light touch sensations were evaluated in 30 individuals, including 15 patients with systemic sclerosis who exhibited changes in the dermis of their hands without loss of the distal phalanx and 15 subjects who did not exhibit changes in the upper limbs (control group). The groups were age- and sex-matched. Tactile sensory evaluations were performed using the Semmes-Weinstein monofilament test and the two-point discrimination test. RESULTS: Statistically significant differences were found between groups in the monofilament test. The study group had lower scores across all points of the hand when compared with the control group. Differences were also found when dominant and non-dominant hands were compared (p<0.05). Statistically significant differences were found between groups for a subset of the assessed points in the two-point discrimination test. CONCLUSIONS: The results of a monofilament test showed that tactile sensation, specifically light touch and deep pressure sensations, is altered in the hands of systemic sclerosis patients. .

Translation and cross-cultural adaptation of the Scleroderma Health Assessment Questionnaire to Brazilian Portuguese / Tradução e adaptação cultural do Scleroderma Health Assessment Questionnaire para a língua portuguesa

CONTEXT AND OBJECTIVE: Systemic sclerosis is an autoimmune disease characterized by abnormalities of vascularization that may cause fibrosis of the skin and other organs and lead to dysfunction. It is therefore essential to have tools capable of evaluating function in individuals with this condition. The aim of this study was to translate the Scleroderma Health Assessment Questionnaire (SHAQ) into Portuguese, adapt it to Brazilian culture and test its validity and reliability. DESIGN AND SETTING: The validation of SHAQ followed internationally accepted methodology, and was performed in university outpatient clinics. METHODS: SHAQ was translated into Portuguese and back-translated. In the cultural adaptation phase, it was applied to 20 outpatients. Items not understood by 20% of the patients were modified and applied to another 20 outpatients. Twenty patients were interviewed on two different occasions to determine the validity and reliability of the questionnaire: two interviewers on the first occasion and one interviewer 14 days later. To determine the external validity, comparisons were made with Health Assessment Questionnaire (HAQ), Disabilities of the Arm, Shoulder and Hand (DASH) and short form-36 (SF-36). RESULTS: In the interobserver evaluation, Pearson's correlation coefficient and the intraclass correlation coefficient were both 0.967. In the intraobserver evaluation, Pearson's correlation coefficient was 0.735 and the intraclass correlation coefficient was 0.687. Regarding external validity, SHAQ scores were statistically correlated with all measurements, except the general health domain of SF-36 and the work-related score (Q2) of DASH. CONCLUSION: The Brazilian version of SHAQ proved to be valid and reliable for assessing function in patients with diffuse systemic sclerosis. .

CONTEXTO E OBJETIVO: A esclerose sistêmica (ES) é uma doença autoimune caracterizada por anormalidades da vascularização, que podem gerar fibrose da pele e outros órgãos, podendo levar a disfunção. Assim, torna-se imprescindível a elaboração de instrumentos capazes de avaliar a função de indivíduos com ES. O objetivo deste estudo foi traduzir para o português, adaptar à cultura brasileira e testar a validade e confiabilidade do Scleroderma Health Assessment Questionnaire (SHAQ). TIPO DE ESTUDO E LOCAL: A validação do SHAQ seguiu uma metodologia aceita internacionalmente, e foi realizada nos ambulatórios da universidade. MÉTODOS: Foi realizada tradução e contra-tradução do instrumento. Na fase de adaptação cultural, o SHAQ foi aplicado a 20 pacientes. As questões que apresentaram mais de 20% de incompreensão foram modificadas e aplicadas em outros 20 pacientes. Para validade e confiabilidade, 20 pacientes foram entrevistados em dois momentos: no primeiro, por dois entrevistadores e após 14 dias por um deles. Foram aplicados o Health Assessment Questionnaire (HAQ), o Disabilities of the Arm, Shoulder and Hand (DASH) e o short form-36 (SF-36), para a validade externa. RESULTADOS: Na avaliação interobservador, o coeficiente de correlação de Pearson e o coeficiente de correlação intraclasse foram ambos de 0,967. Na avaliação intraobservador o coeficiente de correlação de Pearson foi de 0,735, e o coeficiente de correlação intraclasse foi de 0,687. Na validade externa, os escores do SHAQ foram associados estatisticamente com todos os instrumentos, exceto com o domínio estado geral de saúde do SF-36 e o escore relacionado ao trabalho (Q2) do DASH. CONCLUSÃO: A versão brasileira do SHAQ mostrou ser válida ...