Anti-SARS-CoV-2 inactivated vaccine in patients with ANCA-associated vasculitis: Immunogenicity, safety, antibody decay and the booster dose

Abstract Objective: To evaluate inactivated CoronaVac prime vaccination, antibody decay, booster dose, and safety in ANCA-Associated Vasculitis (AAV) patients. Methods: Fifty-three AAV patients and 106 Controls (CG) received CoronaVac on days: D0 (first dose), D28(second dose), and D210 (booster dose, 32 AAV: 32 CG). The primary outcome was immunogenicity after the second vaccine dose (day 69) assessed by Seroconversion Rates (SC) of anti-SARS-CoV-2 S1/S2 IgG and Neutralizing Antibodies (NAb). Secondary outcomes were safety, immunogenicity (D28/D240), 6-months antibody decay (D210) and the booster dose response (D240). Results: At D69 SC (65.1% vs. 96.8%, p = 0.0001), GMT (21.3 UA/mL vs. 67.7 UA/mL, p < 0.001) and NAb- positivity (53.7% vs. 80.6%, p = 0.001) were moderate but lower in naïve-AAV patients than CG. Patients without SC used more often IS (93.3% vs. 53.3%, p = 0.015), mycophenolate mofetil (20% vs. 0%, p = 0.037) and prednisone (60.0% vs. 28.6%, p = 0.057) than seroconverted. NAb negativity in AAV patients was associated with prednisone treatment (57.9% vs. 18.2%, p = 0.015) and IS (84.2% vs. 55.0%, p = 0.046). Logistic regression analysis models showed that only prednisone was associated with lower seroconversion (OR = 0.2, 0,95% CI 0.05-0.86, p = 0.030) and with lower NAb positivity (OR = 0.2, 0,95% CI 0.05-0.88, p = 0.034). After six months (D69-D210) a decrease in IgG positivity occurred in 32 AAV patients (15.7%, p = 0.074) and 32 CG (18.7%, p = 0.041). For the NAb positivity, the 6-month decrease was not significant (p = 0.114) whereas a major reduction occurred for CG (p < 0.001). A booster dose (D240) resulted in an increment in IgG-positivity (21.9%, p = 0.023) and NAb-positivity (34.4%, p = 0.006) in AAV patients. No moderate/severe adverse events attributable to the vaccine were observed. Conclusion: This study provides novel data on the excellent safety and moderate immunogenicity of CoronaVac in AAV patients. A six-month mild antibody waning was observed with a good response to the booster dose, although levels remained lower than CG (CoronavRheum-NCT04754698).

Does [18F]F-FDG-PET/MRI add metabolic information to magnetic resonance image in childhood-onset Takayasu's arteritis patients? A multicenter case series

Abstract Background: The observation that 2-deoxy-2[18F]fluoro-D-glucose-positron emission tomography/magnetic resonance imaging ([18F]F-FDG-PET/MRI) revealed high-grade arterial wall FDG uptake, without arterial wall thickening with contrast-enhancement, in a considerable number of c-TA patients in our previous study, encouraged us to compare patients with both PET and MR angiography (MRA) positives, with those with PET positive but MRA negative. Our aim was to evaluate the relevance of these two imaging modalities together. Methods: A three-center cross-sectional study with 17 patients who fulfilled the EULAR/PRINTO/PReS criteria for c-TA and who underwent [18F]F-FDG-PET/MRI was previously performed. Herein we compared patients/vessels with positive PET (arterial wall 18F-FDG uptake higher than liver) and positive MRA (arterial wall thickening with contrast-enhancement)—group 1, with those with positive PET but negative MRA—group 2. Results: Median disease duration of 17 c-TA patients was 10.4 years. Nine patients were classified as group 1 and six as group 2. Median of metabolic inflammatory volume (MIV) of all arterial segments was significantly higher in group 1 (2346 vs. 1177 cm3; p = 0.036). Fifty-four (19%) from 284 available arterial segments presented positive findings in vessel wall in one or both images. Positive findings were concordant between PET and MRA in only 13% arterial segments (group 1); most changes (28-59.6%) that were discordant between both images, were positive in PET and negative in MRA (group 2). Conclusions: Our study demonstrated that [18F]F-FDG-PET/MRI added information about inflammation in vessel wall of c-TA patients. Prospective multicenter studies are needed in order to get solid data to guide immunosuppressive tapering and withdrawal.

Lower genital tract infections in young female juvenile idiopathic arthritis patients

Abstract Background: To evaluate human papillomavirus (HPV), Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections in juvenile idiopathic arthritis (JIA) patients. Methods: After exclusion, 33 female adolescent and young JIA patients (ILAR criteria) and 28 healthy controls were selected for this study. Demographic data, gynecological, sexual function, cervical cytology and histological abnormalities were evaluated. JIA clinical/laboratorial parameters and treatment were also assessed. HPV-DNA, CT-DNA and NG-DNA testing in cervical specimens were performed by Hybrid Capture 2 assays. Results: The mean current age was similar in JIA patients and controls (23.3 ± 6.24 vs. 26.1 ± 6.03 years, p = 0.09). The frequencies of sexual intercourse (76% vs. 89%, p = 0.201) and abnormal cervical cytology (24% vs. 11%, p = 0.201) were similar in JIA compared to controls. The higher frequency of HPV infection in JIA patients than controls (30% vs. 11%, p = 0.155) did not reach statistical significance. CT (0% vs. 7%, p = 0.207) and NG infections (0% vs. 4%, p = 0.459) were also alike in both groups. Further evaluation of JIA patients with abnormal and normal cervical cytology showed that the former group had a higher frequency of HPV infection (87% vs. 12%, p = 0.0002) with a low frequency of HPV vaccination (0% vs. 8%, p = 1.0). No differences were evidenced between these two JIA groups regarding demographic data, sexual function and clinical/laboratorial parameters. The frequencies of methotrexate (p =0.206) and biological agent use (p =0.238) were similar in both JIA groups. Conclusions: To our knowledge, this was the first study to assess lower genital infections in JIA patients allowing the identification of HPV as main cause of cervical dysplasia. Methotrexate and biological agents do not seem to increase risk of lower genital tract infections in JIA patients.

Serum 25-hydroxyvitamin D levels in patients with Granulomatosis with Polyangiitis: association with respiratory infection

OBJECTIVES: To determine the possible association of serum 25-hydroxyvitamin D (25OHD) levels with disease activity and respiratory infection in granulomatosis with polyangiitis patients during two different periods: winter/spring and summer/autumn. METHODS: Thirty-two granulomatosis with polyangiitis patients were evaluated in the winter/spring, and the same patients (except 5) were evaluated in summer/autumn (n=27). The 25OHD levels were measured by radioimmunoassay. Disease activity was assessed by the Birmingham Vasculitis Activity Score Modified for Wegener's Granulomatosis (BVAS/WG) and antineutrophil cytoplasmic antibody (ANCA) positivity. Respiratory infection was defined according the Centers for Disease Control and Prevention criteria. RESULTS: 25OHD levels were lower among patients in winter/spring than in summer/autumn (32.31±13.10 vs. 38.98±10.97 ng/mL, p=0.04). Seven patients met the criteria for respiratory infection: 5 in winter/spring and 2 in summer/autumn. Patients with respiratory infection presented lower 25OHD levels than those without infection (25.15±11.70 vs. 36.73±12.08 ng/mL, p=0.02). A higher frequency of low vitamin D levels (25OHD<20 ng/mL) was observed in patients with respiratory infection (37.5% vs. 7.8, p=0.04). Serum 25OHD levels were comparable between patients with (BVAS/WG≥1 plus positive ANCA) and without disease activity (BVAS/WG=0 plus negative ANCA) (35.40±11.48 vs. 35.34±13.13 ng/mL, p=0.98). CONCLUSIONS: Lower 25OHD levels were associated with respiratory infection but not disease activity in granulomatosis with polyangiitis patients. Our data suggest that hypovitaminosis D could be an important risk factor for respiratory infection in granulomatosis with polyangiitis patients.

Brazilian guidelines for the diagnosis and treatment of postmenopausal osteoporosis / Diretrizes brasileiras para o diagnóstico e tratamento da osteoporose em mulheres na pós-menopausa

Abstract Osteoporosis is the leading cause of fractures in the population older than 50 years. This silent disease affects primarily postmenopausal women and the elderly, and the morbidity and mortality rates are high. The main goal of treating osteoporosis is the prevention of fractures. The identification of populations at risk through early diagnosis and treatment is essential. The last Brazilian guideline for the treatment of postmenopausal osteoporosis was elaborated in 2002. Since then, new strategies for diagnosis and risk stratification have been developed, and drugs with novel action mechanisms have been added to the therapeutic arsenal. The Osteoporosis and Osteometabolic Diseases Committee of the Brazilian Society of Rheumatology, in conjunction with the Brazilian Medical Association and other Societies, has developed this update of the guidelines for the treatment of postmenopausal osteoporosis according to the best scientific evidence available. This update is intended for professionals in many medical and health specialties involved in the treatment of osteoporosis, for physicians in general and for health-related organizations.

Resumo A osteoporose é a principal causa de fraturas na população acima de 50 anos. É uma doença silenciosa que afeta especialmente as mulheres na pós-menopausa e idosos e tem elevada taxa de morbimortalidade. O principal objetivo do tratamento da osteoporose é a prevenção das fraturas. A identificação dessa população de risco através do diagnóstico e tratamento precoces é de fundamental importância. A última diretriz brasileira para tratamento da osteoporose em mulheres na pós-menopausa foi elaborada em 2002. Desde então foram desenvolvidas novas estratégias de diagnóstico da osteoporose, bem como fármacos com novos mecanismos de ação foram adicionados ao arsenal terapêutico. A Comissão de Osteoporose e Doenças Osteometabólicas da Sociedade Brasileira de Reumatologia em conjunto com a Associação Médica Brasileira e sociedades afins desenvolveu esta atualização da diretriz do tratamento da osteoporose em mulheres na pós-menopausa de acordo com as melhores evidências científicas disponíveis. Esta atualização é destinada aos profissionais das várias especialidades médicas e da área da saúde envolvidos no tratamento da osteoporose, médicos em geral e organizações relacionadas à saúde.

Bone densitometry by dual-energy X-ray absorptiometry (DXA) in preterm newborns compared with full-term peers in the first six months of life / Densitometria óssea de dupla absorção de raio-X (DXA) em crianças nascidas pré-termo comparada com seus pares a termo nos primeiros 6 meses

OBJECTIVES: To longitudinally assess bone mineral content (BMC), bone mineral density (BMD), and whole-body lean mass obtained through bone densitometry by dual-energy X-ray absorptiometry (DXA) in preterm newborns (PTNs) and compare them with full-term newborns (FTNs) from birth to 6 months of corrected postnatal age. METHODS: A total of 28 adequate for gestational age (AGA) newborns were studied: 14 preterm and 14 full-term newborns. DXA was used to determine BMC, BMD, and lean mass in three moments: 40 weeks corrected post-conceptual age, as well as 3 and 6 months of corrected postnatal age. PTNs had gestational age ≤ 32 weeks at birth and were fed their mother's own milk or milk from the human milk bank. RESULTS: All infants had an increase in BMC, BMD, and lean body mass values during the study. PTNs had lower BMC, BMD, and lean mass at 40 weeks of corrected post-conceptual age in relation to FTNs (p < 0.001, p < 0.001, p = 0.047, respectively). However, there was an acceleration in the mineralization process of PTNs, which was sufficient to achieve the normal values of FTNs at 6 months of corrected age. CONCLUSIONS: This study suggests that bone densitometry by dual-energy X-ray absorptiometry is a good method for the assessment of body composition parameters at baseline, and at the follow-up of these PTNs. .

OBJETIVOS: Avaliar longitudinalmente o conteúdo mineral ósseo (CMO), a densidade mineral óssea (DMO) e a massa magra do corpo inteiro obtidos através da densitometria óssea de dupla absorção de Raios-X (DXA) em recém-nascidos pré-termo (RNPT) e comparar com seus pares a termo (RNT) desde o nascimento até 6 meses de idade pós-natal corrigida. MÉTODOS: Foram estudados 28 recém-nascidos adequados para a idade gestacional: 14 recém-nascidos pré-termo e 14 recém-nascidos a termo. Utilizando-se a DXA, foram determinados CMO, DMO e massa magra em três momentos: 40 semanas de idade pós-concepcional corrigida, 3 e 6 meses de idade pós-natal corrigida. Os recém-nascidos pré-termo apresentavam ao nascimento uma idade gestacional igual ou inferior a 32 semanas e receberam leite da própria mãe ou leite humano de banco. RESULTADOS: Todos os recém-nascidos apresentaram um aumento nos valores de CMO, DMO e massa magra durante o estudo. Os recém-nascidos pré-termo apresentaram menor CMO, DMO e massa magra, com 40 semanas de idade pós-concepcional corrigida, em relação aos recém-nascidos a termo (p < 0,001, p < 0,001, e p = 0,047, respectivamente). Entretanto, houve uma aceleração no processo de mineralização nos pré-termos, suficiente para atingirem os valores normais do recém-nascidos a termo aos 6 meses de idade corrigida. CONCLUSÕES: Este estudo sugere que a densitometria óssea de dupla absorção de Raios-X constitui um bom método para a avaliação dos parâmetros de composição corporal no início e no seguimento destes recém-nascidos pré-termo. .

Avaliação da densidade mineral óssea em crianças com dermatite atópica moderada ou grave / Bone mineral density in children with moderate or severe atopic dermatitis

Objetivo: Determinar o impacto da Dermatite Atópica (DA) no estado nutricional e metabolismo ósseo em crianças.Métodos: Quarenta e nove crianças com DA moderada ou grave (4-12 anos) e 48 crianças saudáveis foram avaliadas por z-escore altura/idade, z-escore peso/idade, z-escore IMC, duração e gravidade da doença, uso de Glicocorticoides (GC) tópico e parâmetros ósseos. Conteúdo mineral ósseo (CMO), densidade mineral óssea (DMO) e z-escores foram medidos por absormetria de dupla emissão de raios-X (DXA). Níveis séricos de cálcio, fósforo, fosfatase alcalina, cortisol e telopeptídeo carboxiterminal do colágeno tipo 1 (CTX), e níveis plasmáticos de 25 hidroxivitamina D (25OHD) e hormônio da paratireoide (PTH), foram determinados.Resultados: Crianças com DA apresentaram menor altura para idade quando comparadas às crianças controle (p = 0,007). Menor CMO em coluna lombar [16,5 (6,4) vs. 19,8 (8,3)g, p = 0,027] e fêmur total [12,2 (4,0) vs. 14,2 (5,0)g, p = 0,029] foi encontrado em crianças com DA. Níveis de CTX foram menores em pacientes com DA [1,36 (0,59) vs. 1,67 (0,79)ng/mL, p = 0,026] e tendência a níveis mais baixos de fosfatase alcalina foi observada em crianças com DA [228 (75,3) vs. 255 (70,7) ng/mL, p = 0,074]. Crianças com DA apresentaram níveis mais baixos de cortisol que crianças saudáveis [9,06 (4.8) 10,57 vs. (4,9), p = 0,061], sem diferença significante.Conclusões: Redução em altura para idade, remodelamento ósseo e conteúdo mineral ósseo em crianças com DA moderada ou grave poderia estar associada a fatores incluindo determinantes genéticos, baixa exposição solar, inflamação crônica e uso crônico do GC tópico.

Objective: To determine the impact of atopic dermatitis (AD) on nutritional status and bonemetabolism parameters in children. Methods: Forty-nine children with moderate to severe AD (4-12 years old) and 48 healthy children were assessed using height/age z-scores, weight/agez-scores, body mass index z-scores, disease activity and severity, topical use of glucocorticoids (GC), and bone parameters. Bone mineral content (BMC), bone mineral density (BMD), andz-scores were measured using dual-energy X-ray absorptiometry (DXA). Serum levels ofcalcium, phosphorus, alkaline phosphatase, cortisol, and carboxy terminal telopeptide of type1 collagen (CTX), and plasma levels of 25 hidroxy vitamin D (25OHD) and parathyroid hormone,were determined. Results: AD children presented lower height/age z-score, as compared tocontrols (p = 0.007). Lower BMC at lumbar spine [16.5(6.4) vs. 19.8(8.3)g, p = 0.027] and totalfemur [12.2(4.0) vs. 14.2 (5.0) g, p = 0.029] was found in AD children. CTX levels were lower in ADpatients, as compared to healthy children [1.36(0.59) vs. 1.67(0.79)ng/mL, p = 0.026] and a trendto lower levels of alkaline phosphatase was observed in AD children [228(75.3) vs. 255 (70.7) ng/mL, p = 0.074]. Children with AD presented lower levels of serum cortisol in comparison to thehealthy group [9.06(4.8) vs. 10.57(4.9), p = 0.061], without statistical significance. Conclusions: Reduced height for age, BMD, and bone turnover in children with moderate to severe AD couldbe associated with genetic determinants, insufficient sun exposure, chronic inflammation, andchronic use of topical GC.

Quality of life measurements in patients with osteoporosis and fractures

To review all specific questionnaires regarding quality of life in osteoporosis and to describe their distinctive indications, we searched Medline, the Scientific Electronic Library Online database, and the Latin-American and Caribbean Health Sciences Literature database. Nine specific questionnaires related to osteoporosis quality of life were found: 1) the Women's Health Questionnaire, 2) Osteoporosis Quality of Life Questionnaire, 3) Osteoporosis Assessment Questionnaire, 4) Osteoporosis Functional Disability Questionnaire, 5) Quality of Life Questionnaire of the European Foundation for Osteoporosis, 6) Osteoporosis-Targeted Quality of Life Questionnaire, 7) Japanese Osteoporosis Quality of Life Questionnaire, 8) the 16-item Assessment of Health-Related Quality of Life in Osteoporosis, and 9) the Quality of Life Questionnaire in Osteoporosis (QUALIOST TM). The Quality of Life Questionnaire of the European Foundation for Osteoporosis is the osteoporosis-specific questionnaire most commonly used in the literature. The Quality of Life Questionnaire of the European Foundation for Osteoporosis and the Osteoporosis Quality of Life Questionnaire are targeted more toward fracture assessment, and the Osteoporosis Functional Disability Questionnaire can be used for longitudinal studies involving exercise. In the present study, the authors summarize all of the specific questionnaires for osteoporosis and demonstrate that these questionnaires should be selected based on the objectives to be evaluated. Osteoporosis-specific quality of life questionnaires should be validated in the language of the country of origin before being used.

Osteoporose na infância e na adolescência / Osteoporosis in childhood and adolescence

OBJETIVO: Revisar a literatura acerca da osteoporose na infância e adolescência, abordando diagnóstico, prevençäo e tratamento de osteopenia e osteoporose. FONTE DOS DADOS: Foram utilizadas informações através de revisäo bibliográfica, realizada por busca direta de artigos científicos e por pesquisa nas bases de dados Medline e Lilacs, no período de 1992 a 2002. SíNTESE DOS DADOS: O artigo é estruturado em tópicos, nos quais procura-se definir e classificar a osteoporose na infância, enfatizar os métodos diagnósticos de imagem e laboratoriais e abordar sua terapêutica preventiva e medicamentosa. CONCLUSÄO: É de responsabilidade dos pediatras a identificaçäo de fatores de risco para osteoporose e a orientaçäo de seus pacientes quanto a prevençäo e tratamento

Estudo da densidade mineral óssea em 100 alunos de graduação da Faculdade de Medicina da Universidade de São Paulo / Bone mineral density in one hundred medical students of University of São Paulo

Objetivo: Analisar a relação entre os valores encontrados na densidade mineral óssea (DMO) da coluna lombar e colo de fêmur de graduandos da Faculdade de medicina da Universidade de São Paulo, clinicamente sadios, com fatores que influenciam o pico da massa óssea mais comuns na vida quotidiana destes alunos. Método: Cem graduandos com média de idade de 20,2 anos (DP mais ou menos 1,67 ano) responderam um protocolo contendo perguntas sobre atividade física, ingesta de leite e derivados, tabagismo, ingesta de álcool, índices antropométricos, sexo, história familiar de fraturas, idade da menarca, uso de corticosteróides, anticonvulsivantes, inibidores de apetite e doenças associadas à osteoporose. A densidade mineral ósea foi medida por DXA (densitometria de dupla emissão com fonte de raios X) usando o densitômetro Hologic QDR-2000. Os alunos foram classificados, de acordo com os valores da DMO, em três grupos: normais, osteopênicos e osteoporóticos, segundo os critérios da Organização Mundial de Saúde. Para análise estatística utilizou-se o teste t de Student para comparação dos índices antropométricos entre os três grupos e teste do qui-quadrado ou exato de Fisher para comparação dos outros fatores de risco. Resultados: dos 100 alunos estudados 50 eram normais, 42 osteopênicos e 8 osteoporóticos em coluna lombar e/ou colo de fêmur. Houve uma relação estatisticamente significativa entre os índices antropométricos (peso, altura, índice de massa corpórea e área corpórea) e valores mais altos de densidade mineral ósssea. A prática de atividade física também esteve relacionada com valores mais elevados de DMO. Conclusão: Neste estudo, a DMO mais elevada correlacionou-se com a prática de atividade física e dados antropométricos maiores

Coréia de Sydenham: revisäo da literatura / Sydenham's Chorea: literature review

A coréia de Sydenham, descrita em 1685 por Thomas Sydenham, caracteriza-se pelo aparecimento de movimentos involuntários arrítmicos, hipotonia muscular e é, por vezes, acompanhada de distúrbios psicológicos. Já no século XIX a coréia de Sydenham foi associada a infecçäo estreptocócica prévia e é considerada atualmente uma das manifestaçöes maiores da febre reumática. Anticorpos antineuronais säo descritos em 46 por cento dos casos e especula-se que possam representar reaçäo cruzada às membranas do Streptococcus do grupo A. Episódios recorrentes säo observados em 20-30 por cento dos casos. Tratamento sintomático com neurolépticos ou ácido valpróico é recomendado em pacientes incapacitados