Positive affect as a predictor of adherence in patients with Rheumatoid Arthritis.

The study was conducted in order to investigate adherence in patients with Rheumatoid arthritis (RA), correlating it with other variables such as affect and self-esteem. Seventy-eight patients with RA between 20 and 81 years of age were evaluated. Patients were assessed for Medical Outcomes Study (MOS) Measures of Patient Adherence, Rosenberg self-esteem scale and Short Portuguese version of the Positive and Negative Affect Schedule (PANAS). Pearson's correlation coefficient was used to assess the correlation between the therapeutic compliance and age, disease activity, disability, GPA, self-esteem, affect and inflammatory parameters. An independent T-test was used to evaluate differences in adherence within gender. The one-way analysis of variance (ANOVA) was used to determine associations between adherence and marital status, education level and employment status. A linear regression model was adjusted with stepwise data entry to determine predictors of therapeutic compliance. Patients had a mean age of 57 years and disease duration of 12.8 years. We observed higher levels of adherence in patients with higher self-esteem (r= 0.343, p<0.05) and positive affect (r= 0.345, p<0.01). The adjusted linear regression model allowed the identification of positive affect as a RA patient's adherence predictor (R = 0.347, p<0.05). In our study, high levels of self-reported adherence in RA patients were found. Positive affect seems to be an important determinant of therapeutic adherence in RA patients. These results suggest a relevant role of psychosocial aspects in therapeutic compliance and outcome, which should alert physicians to the need of an holistic approach of the patient.

Relevance of ultrasonography in assessing disease activity in patients with idiopathic inflammatory myopathies.

AIM: Idiopathic inflammatory myopathies (IIM) comprise a group of rare and heterogeneous diseases difficult to diagnose and follow up. Precise measures for assessing disease activity are not available at the moment. Our objective was to evaluate the usefulness of ultrasonography (US) as a monitoring tool in IIM. METHOD: The study evaluated IIM patients diagnosed and followed up from 2005 to 2015 in our department. Fifteen patients with a mean age of 52.2 ± 22.09 years and mean disease duration of 4.6 ± 3.20 years were included. Physical examination including muscle strength tests, laboratorial analysis and a selective muscle US assessment were performed for each patient at a scheduled visit. RESULTS: Nine of the 15 patients were in clinical remission and US assessment revealed a preserved muscle pattern. Symmetrical proximal muscle atrophy was found on US in one patient with longstanding polymyositis (PM) with proximal weakness. Inflammation and focal or generalized muscle edema were present on US in the remaining five patients with muscular weakness suggesting active disease. One of these patients in acute flare presented with atrophy changes in addition to edema. Early untreated myositis presented in one patient with moderate power Doppler (PD) signal. CONCLUSION: As far as muscle US assessment is concerned, a single specific pattern was not observed in our study. A mixture of muscle edema and atrophy was detected depending on disease activity and duration. US findings seem to correlate well with disease activity, suggested by clinical data, and may be a useful tool to complement patient evaluation.

Portuguese recommendations for the use of biological therapies in patients with axial spondyloarthritis - 2016 update.

OBJECTIVE: To update the recommendations for the treatment of axial spondyloarthritis (axSpA) with biological therapies, endorsed by the Portuguese Society of Rheumatology. METHODS: These treatment recommendations were formulated by Portuguese rheumatologists based on literature evidence and consensus opinion. At a national meeting, the 7 recommendations included in this document were discussed and updated. A draft of the full text of the recommendations was then circulated and suggestions were incorporated. A final version was again circulated before publication and the level of agreement among Portuguese Rheumatologists was anonymously assessed using an online survey. RESULTS: A consensus was achieved regarding the initiation, assessment of response and switching of biological therapies in patients with axSpA. In total, seven recommendations were produced. The first recommendation is a general statement indicating that biological therapy is not a first-line drug treatment option and should only be used after conventional treatment has failed. The second recommendation is also a general statement about the broad concept of axSpA adopted by these recommendations that includes both non-radiographic and radiographic axSpA. Recommendations 3 to 7 deal with the definition of active disease (including the recommended threshold of 2.1 for the Ankylosing Spondylitis Disease Activity Score [ASDAS] or the threshold of 4 [0-10 scale] for the Bath Ankylosing Spondylitis Disease Activity Index [BASDAI]), conventional treatment failure (nonsteroidal anti-inflammatory drugs being the first-line drug treatment), assessment of response to treatment (based on an ASDAS improvement  of at least 1.1 units or a BASDAI improvement of at least 2 units [0-10 scale] or at least 50%), and strategy in the presence of an inadequate response (where switching is recommended) or in the presence of long-term remission (where a process of biological therapy optimization can be considered, either a gradual increase in the interval between doses or a decrease of each dose of the biological therapy). CONCLUSION: These recommendations may be used for guidance in deciding which patients with axSpA should be treated with biological therapies. They cover a rapidly evolving area of therapeutic intervention. As more evidence becomes available and more biological therapies are licensed, these recommendations will have to be updated.

Systemic sclerosis induced by interferon-alfa treatment of melanoma.

Systemic sclerosis is a connective tissue disease characterized by a complex pathogenesis and a multi organ involvement of unknown etiology. Genetic features and environmental factors, as the use of some drugs, influence the onset of the clinical picture. The authors describe a case of a patient who developed systemic sclerosis after treatment of melanoma with interferon alfa-2b, drug rarely implicated in the induction of this disease.

Relationship between clinical evaluation and ultrasound assessment of rheumatoid arthritis patients using a 12 joint score.

AIM: To identify if the use of a systematic ultrasound (US) evaluation has relevance in the determination of disease activity in rheumatoid arthritis patients on biological disease-modifying anti-rheumatic drug treatment. METHODS: A 12 joint US assessment was performed on the same day of the routine clinical examination. Both Grey-scale (GS) and Power Doppler (PD) were graded semi-quantitatively (0-3 scale). RESULTS: Forty-one patients were included. GS or PD > 0 were found in 24% and 3% of the ankles, 21% and 17% of the wrists, 19% and 9% of the second metacarpophalangeal joints (MCP), 7% and 2% of the third MCP, 6% and 0% of the knees and 5% and 0% of the elbows, respectively; tenosynovitis of the tibialis posterior was found in 19% of the ankles. Eight of the patients with Disease Activity Score of 28 joints (DAS28) ≤ 2.6 (n = 15) had an US score of 0. Twenty-seven joints (6.7%) had US evidence of synovitis but were not considered to be swollen; 10 (2.5%) were considered to be swollen but had no US evidence of synovitis. CONCLUSIONS: Using a 12 joint US assessment, a high proportion of patients with DAS28 < 2.6 were found to have inflammatory US activity, and a significant proportion of patients had evidence of tenosynovitis of the tibialis posterior, which may be difficult to clinically detect. A regular and standardized US assessment of RA patients is therefore warranted to complement clinical evaluation and better define disease activity.

[Practical guide for the use of biological agents in rheumatoid arthritis - December 2011 update]. / Guia prático de utilização de terapêuticas biotecnológicas na artrite reumatóide - actualização de Dezembro 2011.

The authors review the practical aspects of biological therapy use for rheumatoid arthritis patients, commenting safety issues before and after treatment initiation and the best treatment strategies to optimize efficacy.