Predictors of cardiac involvement in idiopathic inflammatory myopathies.

Objectives: Idiopathic inflammatory myopathies (IIM) are a group of rare disorders that can affect the heart. This work aimed to find predictors of cardiac involvement in IIM. Methods: Multicenter, open cohort study, including patients registered in the IIM module of the Rheumatic Diseases Portuguese Register (Reuma.pt/Myositis) until January 2022. Patients without cardiac involvement information were excluded. Myo(peri)carditis, dilated cardiomyopathy, conduction abnormalities, and/or premature coronary artery disease were considered. Results: 230 patients were included, 163 (70.9%) of whom were females. Thirteen patients (5.7%) had cardiac involvement. Compared with IIM patients without cardiac involvement, these patients had a lower bilateral manual muscle testing score (MMT) at the peak of muscle weakness [108.0 ± 55.0 vs 147.5 ± 22.0, p=0.008] and more frequently had oesophageal [6/12 (50.0%) vs 33/207 (15.9%), p=0.009] and lung [10/13 (76.9%) vs 68/216 (31.5%), p=0.001] involvements. Anti-SRP antibodies were more commonly identified in patients with cardiac involvement [3/11 (27.3%) vs 9/174 (5.2%), p=0.026]. In the multivariate analysis, positivity for anti-SRP antibodies (OR 104.3, 95% CI: 2.5-4277.8, p=0.014) was a predictor of cardiac involvement, regardless of sex, ethnicity, age at diagnosis, and lung involvement. Sensitivity analysis confirmed these results. Conclusion: Anti-SRP antibodies were predictors of cardiac involvement in our cohort of IIM patients, irrespective of demographical characteristics and lung involvement. We suggest considering frequent screening for heart involvement in anti-SRP-positive IIM patients.

A breeding program for Nile tilapia in Brazil: Results from nine generations of selection to increase the growth rate in cages.

Variance components and heritabilities for daily weight gain (DWG) were estimated for Nile tilapia farmed in cages across nine generations (G1-G9) of selection in a breeding program in Brazil. DWG was measured in 16,272 accumulated tagged animals representing 535 full- and half-sib families of Nile tilapia under cage farming. The additive genetic variance showed a slight variation (0.051-0.066), and heritability estimates ranged from 0.20 to 0.33. The common environmental effect accounted for a higher proportion of the total variance in DWG, especially in the last generations (6%-24%). A genetic trend based on all data available showed a substantial increase in the DWG (about 3.3% per generation) of Nile tilapia across nine generations of selection. Furthermore, our results demonstrate ample scope for further genetic improvement.

Impact of the mandatory confinement during the first wave of the SARS-CoV-2/COVID-19 pandemic in Portuguese patients with rheumatoid arthritis: results from the COVID in RA (COVIDRA) survey.

OBJECTIVE: The aim of this study was to evaluate the self-reported impact of mandatory confinement occurring in the first wave of the SARS-CoV-2 pandemic in Portuguese patients with rheumatoid arthritis (RA), as a means to improve care during this and in future pandemics. MATERIAL AND METHODS: The web-based survey COVIDRA was developed to assess 5 domains including RA symptoms, attitudes towards medication, employment status, physical exercise and mental health. The questionnaire was sent to RA patients through e-mail and social media of the Portuguese Society of Rheumatology and two patient associations; and it was filled locally at two rheumatology centers in Lisbon. Recruitment took place during June and July 2020. RESULTS: We obtained 441 valid questionnaires. Most respondents were female (88.4%), caucasian (93.6%) with a mean age of 58 years. The majority had disease lasting >10 years and were treated with csDMARDs (63.2%) and/or bDMARDs/tsDMARDS (23.7%). Over 40% experienced symptom worsening during confinement, almost half considered moderate or severe. Mobility restriction and increased stress, anxiety or depression were responsible for this worsening. Only 2.5% reduced or withheld their immunosuppressive medication due to fear of becoming infected with SARS-CoV-2. After confinement, 16.2% of those previously employed were in a lay-off regime and 3% lost their jobs. Most employed RA patients practiced telework during confinement. The majority of patients decreased or did not practice any physical exercise (80.5%). Symptoms of anxiety and depression developed or worsened in 67.3% and 51.9% respectively, approximately one third were considered moderate or severe. CONCLUSIONS: Portuguese RA patients experienced significant symptom worsening, anxiety and depression during the first wave confinement. Only a minority changed their immunosuppressive treatment for fear of SARS-CoV-2 infection. Published literature on these matters shows results very similar to ours.

Performance of referral strategies for spondyloarthritis: a population-based nationwide study.

OBJECTIVES: To evaluate the performance of the referral strategy (RS) for SpA of a nationwide epidemiological study (EpiReumaPt), as compared with previously proposed RSs. METHODS: EpiReumaPt was a three-stage national epidemiologic study. In phase one, 10 661 adult participants were randomly selected and screened for rheumatic and musculoskeletal diseases. In the second phase, positive screenings for ⩾1 rheumatic and musculoskeletal disease plus 20% negative screenings were assessed by a rheumatologist. Finally, three rheumatologists revised all the information and defined the final diagnosis. All participants from phase two were included. Thirteen RS were tested against the SpA diagnosis using several metrics, including sensitivity, specificity, the post-test probability of SpA given a positive RS (positive predictive value) and given a negative RS (1 - negative predictive value). RESULTS: From the total 3877 participants, 92 received a SpA diagnosis [weighted national prevalence: 1.6% (95% confidence interval: 1.2, 2.1)]. Modified versions of the Assessment of SpondyloArthritis international Society-RS and EpiReumaPt-RS were the most sensitive (85% and 72%, respectively) and yielded the lowest post-test probabilities of SpA if negative (0.6% and 0.7%, respectively). Considering the national prevalence (pre-test probability) of SpA (1.6%), a negative screening by these two RSs decreased the probability of SpA substantially (Assessment of SpondyloArthritis international Society: -63%; EpiReumaPt: -56%). Other RSs performed less well in reducing disease probability (range: -6.3%; -37.5%). Overall, the probability of SpA given a positive RS was small (positive predictive value range: 2.2%; 7.6%) and the EpiReumaPt RS yielded the best balance between sensitivity and positive predictive value. CONCLUSION: The proposed EpiReumaPt RS performed the best as a screening tool for SpA in patients from the general population when laboratory and imaging data were not available.

Multivariate analysis of milk yield, lactation length, and calving interval in female buffaloes / Análisis multivariado de la producción de leche, duración de la lactancia y el intervalo entre partos en búfalas / Análise multivariada da produção de leite, duração da lactação e intervalo de parto em búfalas

Abstract Background: The global market has an increasing demand for buffalo by-products due to their unique nutritional characteristics. Many buffalo herds lack suitable breeding control programs, hindering the implementation of selection programs. Objective: To evaluate milk production per lactation (MP), lactation length (LL), and calving interval (CI) of a herd of crossbred Murrah buffaloes to support buffalo clustering according to their potential. Methods: Data from 543 lactations between 2002 and 2014 from 105 crossbred Murrah female buffaloes were used. Data were subjected to principal component analysis (PCA) and cluster analysis. Results: The first components (PCs) were responsible for 92.32% of the total variation, of which 61.45 and 30.87% were explained by the first (PC1) and second (PC2) components, respectively. The cluster analysis allowed three female buffalo groups according to their potentials. Conclusion: Buffalo farmers can make decisions on nutritional, reproductive management and cow culling based on grouping.

Resumen Antecedentes: La demanda de productos de leche de búfala en el mercado mundial viene creciendo en virtud de sus características nutricionales únicas. La mayoría de los hatos bufalinos no tienen adecuados controles, lo que dificulta la implementación de programas de selección. Objetivo: Analizar la producción de leche por lactancia (MP), duración de la lactancia (LL) y el intervalo entre partos (CI) para apoyar la clasificación de búfalos según su potencial. Métodos: Se recogieron 543 registros de lactancia de 105 búfalas Murrah mestizas entre los años 2002 y 2014. Los datos fueron sometidos a análisis de componentes principales (PCA) y análisis de conglomerados. Resultados: Los primeros componentes (PCs) fueron responsables del 92.32% de la variación total, de los cuales 61.45 y 30.87% fueron explicados por el primer (PC1) y segundo (PC2) componentes, respectivamente. El análisis de conglomerados permitió la formación de tres grupos de búfalas, según su potencial. Conclusión: Los productores pueden tomar decisiones específicas con respecto a la gestión nutricional, reproductiva, y el descarte de hembras bufalinas basados en estas agrupaciones.

Resumo Antecedentes: A demanda por produtos de origem do leite de búfalas no mercado mundial tem crescido em virtude de suas características nutricionais singulares. Grande parte dos rebanhos de búfalos não possuem controle zootécnicos adequados, dificultando a implementação de programas de seleção. Objetivo: Analisar conjuntamente as características produção de leite por lactação (MP), duração da lactação (LL) e intervalo de partos (CI) para subsidiar a classificação das búfalas de acordo com seu potencial. Métodos: Para esse estudo, 543 dados de lactação de 105 búfalas mestiças Murrah foram coletadas entre 2002 e 2014. Os dados foram analisados por análises de componentes principais (PCA) e análises de cluster. Resultados: Os primeiros componentes (PCs) foram responsáveis por 92.32% da variação total, dos quais 61.45 e 30.87% foram explicados pelo primeiro (PC1) e segundo (PC2) componentes, respectivamente. A análise de cluster permitiu a formação de três grupos de búfalas de acordo com o potencial das características estudadas. Conclusão: Baseado nesses agrupamentos, os produtores podem tomar decisões específicas quanto aos manejos nutricional e reprodutivo, e sobre o descarte de búfalas, de acordo com os agrupamentos.

The Portuguese Society of Rheumatology position paper on the use of biosimilars - 2017 update.

Biosimilars are new and more affordable similar versions of previously approved reference biological drugs. Following the approval of the first monoclonal antibody biosimilar in 2013, the Portuguese Society of Rheumatology issued a position paper on the use of biosimilars in rheumatic conditions covering efficacy, safety, extrapolation, interchangeability, substitution and pharmacovigilance. However, as this is a rapidly evolving field, it was felt that the knowledge and evidence gathered since then justified an update of these statements. Literature searches on these issues were performed and the search results were presented and discussed in a national meeting. Portuguese rheumatologists considered that affordability should be taken into consideration when initiating a biological drug, but other factors were equally important. In patients already on reference biological treatment, switch to a more affordable biosimilar is desirable, provided a set of conditions is rigorously met. Automatic substitution is not acceptable and current evidence is insufficient to support interchangeability. Extrapolation of clinical indications is endorsed by Portuguese rheumatologists, and the statements on safety, pharmacovigilance and traceability are in accordance with the previous position paper.

Pharmacoeconomics of Biosimilars: What Is There to Gain from Them?

Despite representing a breakthrough in the treatment of immune-mediated rheumatic diseases, the direct costs of biotechnological therapies represent a burden to healthcare budgets worldwide. Furthermore, several studies demonstrated that socioeconomically constrained countries have poorer access to these therapies and this has consequences on the optimal management of rheumatic patients. Experience with small peptide biosimilars like filgrastim and epoetin confirmed significant cost savings but revealed variable market uptake. In this report, we summarize the available budget impact models and discuss possible determinants of the pharmacoeconomic performance of antirheumatic biosimilar drugs.