To be or not to B27 positive: implications for the phenotypes of axial spondyloarthritis outcomes. Data from a large multiracial cohort from the Brazilian Registry of Spondyloarthritis.

BACKGROUND: There is a remarkable variability in the frequency of HLA-B27 positivity in patients with spondyloarthritis (SpA), which may be associated with different clinical presentations worldwide. However, there is a lack of data considering ethnicity and sex on the evaluation of the main clinical and prognostic outcomes in mixed-race populations. The aim of this study was to evaluate the frequency of HLA-B27 and its correlation with disease parameters in a large population of patients from the Brazilian Registry of Spondyloarthritis (RBE). METHODS: The RBE is a multicenter, observational, prospective cohort that enrolled patients with SpA from 46 centers representing all five geographic regions of Brazil. The inclusion criteria were as follow: (1) diagnosis of axSpA by an expert rheumatologist; (2) age ≥18 years; (3) classification according to ASAS axial. The following data were collected via a standardized protocol: demographic data, disease parameters and treatment historical. RESULTS: A total of 1096 patients were included, with 73.4% HLA-B27 positivity and a mean age of 44.4 (±13.2) years. Positive HLA-B27 was significantly associated with male sex, earlier age at disease onset and diagnosis, uveitis, and family history of SpA. Conversely, negative HLA-B27 was associated with psoriasis, higher peripheral involvement and disease activity, worse quality of life and mobility. CONCLUSIONS: Our data showed that HLA-B27 positivity was associated with a classic axSpA pattern quite similar to that of Caucasian axSpA patients around the world. Furthermore, its absence was associated with peripheral manifestations and worse outcomes, suggesting a relevant phenotypic difference in a highly miscegenated population.

Salivary levels of inflammatory cytokines and their association to periodontal disease in systemic lupus erythematosus patients. A case-control study.

Both Systemic Lupus Erythematosus (SLE) and periodontal disease (PD) present a similar immunological profile mainly characterized by altered cytokine levels. In this study we sought to investigate the salivary levels of inflammatory cytokines and their association with PD in SLE patients. 60 patients with SLE and 54 systemically healthy individuals underwent a full periodontal clinical examination. They were then grouped according to their periodontal status. Stimulated saliva was collected in order to evaluate the salivary levels of interferon (IFN-γ), Interleukin (IL)-10, IL-17, IL-1ß, and IL-4. Systemically healthy individuals with periodontitis (group P) presented higher levels of cytokines when compared to systemically healthy individuals, with no periodontal disease (group S) (p<0.05). Additionally, in the P group, patients presented similar levels of cytokines to those of the patients with SLE, regardless of the presence of PD (p>0.05), for most of the analyzed cytokines. There was a positive correlation in SLE patients, including IL-1ß and all periodontal clinical parameters (p<0.05), and between IL-4 and gingival bleeding index and the presence of biofilm (p<0.05). Thus, our results confirmed, that patients with PD showed higher salivary levels of cytokines and, in SLE patients, the increased levels of salivary cytokines were observed even in the absence of periodontitis. IL-1ß and IL-4 salivary levels were also positively correlated with periodontal status indicating their potential as markers of the amount and extent of periodontal damage in patients with SLE.

Piomiosite tropical: descrição de quatro casos / Tropical pyomyositis: report of four cases

Os autores descrevem quatro casos de piomiosite tropical (PT) ocorridos na enfermaria de Reumatologia do Hospital do Servidor Público Estadual de São Paulo "Francisco Morato de Oliveria" em 1998, enfatizando a sua rara ocorrência na região cervical e a associação com lúpus eritematoso sistêmico (LES) e artrite reumatóide (AR). O Staphylococcus aureus foi detectado em 100 por cento dos casos; em três pacientes, através de hemoculturas e, em um, a partir das secreções obtidas dos abcessos intramusculares. Em relação às imagens, a ultra-sonografia foi realizada em todos os pacientes, sendo necessário complementar com tomografia computadorizada (TC) num caso em que a ultra-sonografia não demonstrou coleções. Em todos os pacientes foi realizada antibioticoterapia por no mínimo 28 dias e, em três deles, a drenagem cirúrgica ampla foi fundamental para a evolução clínica satisfatória, sem sequelas osteomusculares. A PT pode representar uma complicação infecciosa grave no LES e na AR. Por esta razão, deve ser conhecida e adequadamente investigada por métodos de imagens. Seu diagnóstico precoce e terapia eficiente são fundamentais para a obtenção de excelentes resultados