Patients' and rheumatologists' perspectives on the efficacy and safety of low-dose glucocorticoids in rheumatoid arthritis-an international survey within the GLORIA study.

OBJECTIVE: To evaluate the current perspectives of patients and health professionals regarding the efficacy and safety of low-dose glucocorticoids (GCs) in RA. METHODS: Two online surveys were disseminated to patients and health professionals, in their native language, through national patient organizations and national rheumatology medical societies, respectively. SurveyMonkey®, MediGuard.org and the Glucocorticoid Low-dose Outcome in RA Study (GLORIA) website were used to offer and deliver these surveys. RESULTS: A total of 1221 RA patients with exposure to GCs, and 414 rheumatologists completed the surveys. Patients and rheumatologists reported high levels of agreement regarding the efficacy of low-dose GCs: at least 70% considered that they are very rapid and effective in the control of signs and symptoms of RA. However, half of the patients also reported having suffered serious adverse events with GCs, and 83% described concerns about safety. The majority of rheumatologists estimated that endocrine, ophthalmologic and cutaneous adverse events affect >4% of all patients treated with low-dose GCs for 2 years, based on a heat map. CONCLUSIONS: RA patients with self-reported exposure to GCs express high levels of satisfaction with low-dose GCs efficacy, as do rheumatologists. However, both expressed excessive concerns regarding the safety of GCs (greatly exceeding the published evidence data), which may compromise the optimal use of this medication. This study indicates that there is an unmet need for appropriately designed prospective trials that shed light on the real risk associated with low-dose GCs, as well as a need for renovated educational programs on the real benefits and harms of low-dose GCs, for both patients and physicians.

Abortion in association with transplacental Theileria equi infection in a mare from the State of Espírito Santo, southeast Brazil: case report / Aborto equino associado à infecção transplacentária de Theileria equi, Espírito Santo, Brasil: relato de caso

Equine piroplasmosis is a tick-borne disease caused by the protozoan parasites Babesia caballi and Theileria equi. We report a case of abortion in association with transplacental Theileria equi infection in a mare from the State of Espírito Santo, southeast Brazil. An apparently healthy mare aborted at the tenth month of gestation. At necropsy, the subcutaneous tissue, skeletal muscles, and visible mucosae of the aborted fetus were pale, and there was moderate hydrothorax and marked splenomegaly. Microscopic findings included splenic lymphoid hyperplasia and nephrosis. Merozoite-infected erythrocytes were found within blood vessels of all organs examined and were most numerous in the brain. DNA extracted from the spleen, liver, kidney, and thymus was used as a template for PCR. Generic primers were employed for the detection of piroplasm 18S ribosomal gene. All samples were positive for piroplasm DNA by PCR. Amplicons were purified and then sequenced. Sequencing analysis of these amplicons revealed 98% identity to T. equi sequences. Based on our findings, we suggest that abortion in this case resulted from transplacental Theileria infection.(AU)

A piroplasmose equina é transmitida por carrapatos, sendo causada pelos protozoários Babesia caballi e Theileria equi. O objetivo deste trabalho foi relatar um caso de aborto equino associado à piroplasmose fetal. Uma égua gestante, aparentemente saudável, abortou no 10º mês de gestação. Na necropsia do feto, foi observada palidez de subcutâneo, da musculatura esquelética e das mucosas visíveis, moderado hidrotórax e acentuada esplenomegalia. Histologicamente, havia hiperplasia linfoide esplênica e nefrose. Muitos merozoítos foram observados em eritrócitos nos vasos sanguíneos de todos os órgãos examinados, com maior intensidade no encéfalo. Amostras de DNA do baço, fígado, rim e timo foram utilizadas para PCR com primers genéricos para detecção de sequências do gene 18S ribossomal de piroplasmas, com resultado positivo para todas as amostras. Em seguida, os amplicons das amostras de baço foram purificados, sequenciados e, após análise, mostraram 98% de identidade com a sequência de T. equi. Portanto, as alterações microscópicas, os resultados de PCR e sequenciamento confirmam aborto associado à T. equi por transmissão transplacentária.(AU)

Serum vascular endothelial growth factor in late rheumatoid arthritis.

OBJECTIVES: To investigate the serum levels of VEGF in patients with rheumatoid arthritis of long duration. METHODS: Serum VEGF levels were measured in 118 patients with long-standing rheumatoid arthritis according to the ACR criteria (mean duration 12 years). The disease activity score was evaluated by the method of van der Heijde et al. RESULTS: Serum levels of VEGF in patients with RA were significantly higher than in healthy controls. VEGF levels showed no correlation with CRP, SAA amyloid protein, or the disease activity score. CONCLUSIONS: Our findings suggest that, contrary to the results reported in patients with early onset RA, where VEGF appears to play an active part in joint inflammation, in long-standing RA elevated VEGF serum levels may be an independent marker although its significance remain to be established.

Combination therapy with methotrexate and chloroquine in rheumatoid arthritis. A multicenter randomized placebo-controlled trial.

To compare the efficacy of the combination therapy Methotrexate (MTX) and Chloroquine (CHLO) with MTX and Placebo (PLA) in the treatment of Rheumatoid Arthritis. A total of 82 patients with Rheumatoid Arthritis (RA), diagnosed according to the American College of Rheumatology criteria, received orally either MTX 7.5 mg/week and CHLO 250 mg/day or MTX 7.5 mg/week and PLA 1 tablet/day. Adverse effects (AE) were monitored monthly and disease activity was assessed at 0, 2, 4 and 6 months. Sixty-eight patients completed the study. All outcome measures improved significantly in both treatment groups. Patients receiving MTX/CHLO ended the study with a significantly lower joint count, greater grip strength and better functional ability the patients in the MTX/PLA group, respectively; 4.5 vs 7.5 (P < 0.05), 113.3 vs 89.1 (P < 0.05) and 0.636 vs 0.811 (P < 0.05). Mild AE were more frequently observed in the MTX/CHLO, 17 events in 15 patients, compared to 9 events in 8 patients in the MTX/PLA group (NS). These data indicate that MTX/CHLO is slightly more efficacious and toxic than is MTX/PLA in the treatment of RA.

Estudo controlado e randomizado a curto prazo com metotrexato na artrite reumatóide / A short term randomized controlled study with methotrexate in rheumatoid arthritis

O estudo teve por finalidade avaliar a efetividade e toxicidade do metotrexato (MTX) no tratamento da artrite reumatóide. Trinta e seis pacientes foram incluídos no estudo. Vinte e oito pacientes completaram 12 semanas de tratamento, sendo 14 pertencentes ao grupo de MTX e 14 ao grupo placebo. Os pacientes tratdos com MTX apresentaram uma melhora nos parâmetros dor, força de preensäo e capacidade funcional estatsticamente superior (p < 0,05) à observada no grupo placebo. Efeitos colaterais de leve intensidade foram observados em quatro pacientes tratados com MTX e em dois pacientes tratados com placebo. Esses achados sustentam aqueles encontrados em outros estudos e conferem ao metotrexato uma posiçäo relativante no tratamento da artrite reumatóide, devido à sua cômoda posologia, favorável efetividade e tolerabilidade

[A short-term randomized controlled study with methotrexate in rheumatoid arthritis]. / Estudo controlado e randomizado a curto prazo com metotrexato na artrite reumatóide.

Randomized, controlled and double-blind study of 36 patients aimed at the evaluation of the efficacy and toxicity of MTX in the treatment of rheumatoid arthritis. Twenty-eight patients completed the study period: 14 in the MTX group and 14 in the placebo group. The patients treated with MTX presented a statistically significant improvement (p < 0.05) in pain, grip strength and functional ability when compared to placebo treated patients. Mild adverse effects were observed in 4 patients treated with MTX and in 2 patients treated with placebo. These findings support other studies and give to methotrexate a relevant position in the treatment of rheumatoid arthritis, owing to its convenient posology, beneficial effectivity and favourable toxicity.