Musculoskeletal manifestations in a Portuguese cohort of 235 inflammatory bowel disease patients.

BACKGROUND: Musculoskeletal symptoms represent the most common extraintestinal manifestations of inflammatory bowel disease (IBD) and a major cause of impaired quality of life in these patients. Spondyloarthritis (SpA) is classically associated with IBD, but other rheumatic manifestations may occur. OBJECTIVE: To characterize musculoskeletal symptoms and rheumatic diseases in an IBD cohort. METHODS: Retrospective monocentric descriptive study including all the patients with IBD consecutively referred from Gastroenterology to the Reumatology Department (from January of 2013 to April of 2021) in a Portuguese tertiary university hospital. Demographic and clinical data were collected and musculoskeletal symptoms and rheumatic diseases diagnosed in the Rheumatology outpatient center were registered. RESULTS: A total of 235 patients were included: 177 (75.3%) with Crohn´s disease (CD) and 58 (24.7%) with ulcerative colitis. Musculoskeletal symptoms were observed in 142 (60.4%) patients and 105 (44.7%) had some rheumatic condition. Regarding spondyloarthritis, 46 (19.6%) patients fulfilled ASAS (Assessment of SpondyloArthritis international Society) criteria for axial SpA and 5 (2.1%) for peripheral SpA. Osteoarthritis (n=70, 29.8%) and osteoporosis (n=33, 14%) were the most frequent non-inflammatory rheumatic conditions observed, mostly previously undiagnosed. No significant differences were observed between CD and UC. CONCLUSION: Rheumatic conditions are frequent in IBD patients and are not limited to SpA features. They remain mostly undiagnosed and the collaboration between gastroenterologists and rheumatologists is important for their best management.

Unusual presentations and pitfalls of secondary syphilis: Periosteitis, tenosynovitis and hepatic abnormalities / Presentaciones poco comunes y peligros de la sífilis secundaria: periosteitis, tenosinovitis y anomalías hepáticas

We herein describe two cases of secondary syphilis in patients with human immunodeficiency virus (HIV) infection with an unusual presentation, a diffuse polyostotic periosteitis. Patients referred mainly intense bone pain. Other relevant aspects of the clinical pictures were flexor tenosynovitis and hepatic abnormalities. Given the persistence of symptoms, the treatment duration performed was different from most described in literature. However, although more slowly than expected, both obtained a favorable clinical response after treatment with benzathine penicillin G

Presentamos 2 casos de la sífilis secundaria en pacientes con infección por el virus de la inmunodeficiencia humana (VIH) con una presentación inusual, una periosteitis difusa poliostótica. Los pacientes han reportado principalmente al dolor óseo intenso. Otros aspectos relevantes de los cuadros clínicos fueron tenosinovitis y anomalías hepáticas. Dada la persistencia de los síntomas, la duración del tratamiento realizado ha sido diferente de la mayoría de los descritos en la literatura. Sin embargo, aunque más lentamente de lo esperado, ambos han obtenido una respuesta clínica favorable después del tratamiento con benzatina penicilina G

Predictors and causes of first-line biologic agent discontinuation in rheumatoid arthritis: data from Reuma.pt.

OBJECTIVES: To assess the discontinuation of first-line biological treatment and to evaluate the reasons and predictors thereof in patients with rheumatoid arthritis (RA) from daily clinical practice. METHODS: RA patients registered in the Rheumatic Diseases Portuguese Register (Reuma.pt) starting treatment with biologic DMARDs (bDMARDs) were included in this prospective observational study. The main outcome was the time to discontinuation (in years) due to any cause. Discontinuation was defined as a 90-day discontinuation of treatment or the occurrence of any switch to another bDMARD during follow-up. Baseline and time-varying sociodemographic and clinical characteristics were tested as possible predictors of discontinuation using multivariable Cox models. RESULTS: Of the 1,851 RA patients included in the study, 871 (47%) discontinued their first bDMARD. The median overall persistence of the first bDMARD was 5.5 years and the leading cause of discontinuation was inefficacy [N=476 (55%)], followed by adverse events [N=262 (30%)], other causes [N=69, (8%)] and unknown causes [N=64 (7%)]. Patients with a higher HAQ score (more disability) at baseline were more likely to discontinue their first bDMARD [hazard ratio (HR):1.39 (95% CI: 1.17-1.64)], as were patients with a higher number of comorbidities [HR: 1.17 (1.05-1.29)] and patients starting treatment from 2007 onwards [HR:1.89 (1.5-2.38)]. On the contrary, receiving TNFi bDMARD [HR:0.74 (0.57-0.94)] as opposed to non-TNFi was associated with less discontinuation. Expectedly, the higher the DAS28 during follow-up the higher the likelihood to discontinue bDMARD [HR:1.08 (1.06-1.1)]. No other time-varying predictor was found. CONCLUSION: In the Portuguese RA population, maintenance of first-line bDMARD was shown to be relatively high. Inefficacy was the leading cause of discontinuation. Features found to predict drug discontinuation (e.g. baseline disability) may contribute to inform clinician's decisions in clinical practice.

Presentaciones poco comunes y peligros de la sífilis secundaria: periosteitis, tenosinovitis y anomalías hepáticas. / Unusual presentations and pitfalls of secondary syphilis: Periosteitis, tenosynovitis and hepatic abnormalities.

We herein describe two cases of secondary syphilis in patients with human immunodeficiency virus (HIV) infection with an unusual presentation, a diffuse polyostotic periosteitis. Patients referred mainly intense bone pain. Other relevant aspects of the clinical pictures were flexor tenosynovitis and hepatic abnormalities. Given the persistence of symptoms, the treatment duration performed was different from most described in literature. However, although more slowly than expected, both obtained a favorable clinical response after treatment with benzathine penicillin G.

Quality of life and functional capacity in patients with rheumatoid arthritis - Cross-sectional study / Calidad de vida y capacidad funcional en pacientes con artritis reumatoide - Estudio transversal

Objectives: To analyze the Health related Quality of Life (HRQoL) and physical function in rheumatoid arthritis (RA) patients and compare it with the general population. We also intended to analyze about disease activity influence in HRQoL and functional capacity, as well as determine potential determinants for these outcomes. Material and methods: A cross-sectional study was conducted in RA patients from a university hospital of Portugal. We obtained Short Form 36, EuroQoL 5D, health assessment questionnaire, visual analog scale for pain and patient's assessment of disease activity. Comparisons between SF-36 and EQ-5D values with our population reference values were conducted using the Mann-Whitney test. Data were compared in different levels of disease activity, using Kruskal Wallis test and Fisher's exact test. A multiple regression analysis was conducted to identify the potential determinants of outcomes. Results: RA sample showed significantly lower values than the portuguese general population on physical summary measure of SF-36 (median=32 vs. 50, p<0.001) and EQ-5D (median=0.620 vs. 0.758 respectively; p<0.001). Lower disease activity levels had better PROs and this was true even when compared patients achieving remission with those in low disease activity. The HAQ (r2=67%), VAS-P (r2=62%) and VAS-DA (r2=58%) were the variables that strongly related to SF-36. Considering HAQ, the strongest relation was found with VAS-P, VAS-DA and age (r2=60%, 61% and 33%, respectively). Multiple regression analysis identified HAQ, VAS-P and educational status as determinants of the HRQoL; age, female gender, employment, VAS-P and VAS-DA as determinants of physical function. Conclusion: Impairment of HRQoL in RA patients is enormous. We found significant differences between different levels of disease activity, showing higher HRQoL and functional capacity at lower disease activity levels

Objetivos: Analizar la evaluación del Health related Quality of Life (HRQoL) y la función física en pacientes con artritis reumatoide (AR) y compararla con la población general. También se pretende analizar la influencia de la actividad de la enfermedad en el HRQoL y la capacidad funcional, así como definir los determinantes potenciales de estos resultados. Material y métodos: Se realizó un estudio transversal en pacientes con AR de un hospital universitario de Portugal. Se obtuvieron los cuestionarios Short Form 36, EuroQol 5D, Health Assessment Questionnaire, la escala analógica visual de dolor y la evaluación de la actividad de la enfermedad. Las comparaciones entre los valores de SF-36 y EQ-5D con los valores de referencia de nuestra población se conducierón utilizando el test de Mann-Whitney. Los datos se compararon en diferentes niveles de actividad de la enfermedad utilizando el test de Kruskal Wallis y la prueba exacta de Fisher. Se realizó un análisis de regresión múltiple para identificar los determinantes potenciales de los resultados. Resultados: La muestra de AR mostró valores significativamente más bajos que la población general portuguesa en la medición física de SF-36 (mediana=32 vs. 50, p<0,001) y EQ-5D (mediana=0,620 vs. 0,758, respectivamente, p<0,001). Los pacientes con niveles de actividad de la enfermedad más bajos tuvieron mejores PRO y esto fue cierto incluso cuando se compararon los pacientes que alcanzaron la remisión con aquellos en baja actividad de la enfermedad. El HAQ (r2=67%), VAS-P (r2=62%) y VAS-DA (r2=58%) fueron las variables fuertemente relacionadas con SF-36. Con respecto a el HAQ, se encontró una relación más fuerte con VAS-P, VAS-DA y la edad (r2=60%, el 61 y el 33%, respectivamente). El análisis de regresión múltiple identificó el HAQ, el VAS-P y el nivel de estudios como determinantes del HRQoL y la edad, el género femenino, el empleo, VAS-P y VAS-DA como determinantes de la función física. Conclusión: El deterioro del HRQoL en los pacientes con AR es enorme. Se encontraron diferencias significativas entre los diferentes niveles de actividad de la enfermedad, mostrando mayor HRQoL y capacidad funcional en niveles más bajos de actividad de la enfermedad

Necrotizing fasciitis in a patient receiving tocilizumab for rheumatoid arthritis - Case report / Fascitis necrosante en un paciente bajo tocilizumab para la artritis reumatoide. Presentación de un caso

We present a case of necrotizing fasciitis in a 66-year-old Caucasian woman with rheumatoid arthritis receiving tocilizumab, and provide a review of published cases. The patient exhibited no systemic symptoms and discreet cutaneous inflammatory signals at presentation. She was successfully treated with broad-spectrum empiric antibiotic therapy and surgical debridement

Presentamos un caso de fascitis necrosante en una mujer caucásica de 66 años de edad con artritis reumatoide en tratamiento con tocilizumab y se ha realizado una revisión de casos publicados. La paciente ha presentado falta de síntomas sistémicos y señales inflamatorias cutáneas discretas. Ha sido tratada con éxito con terapia antibiótica empírica de amplio espectro y desbridamiento quirúrgico

Necrotizing fasciitis in a patient receiving tocilizumab for rheumatoid arthritis - Case report.

We present a case of necrotizing fasciitis in a 66-year-old Caucasian woman with rheumatoid arthritis receiving tocilizumab, and provide a review of published cases. The patient exhibited no systemic symptoms and discreet cutaneous inflammatory signals at presentation. She was successfully treated with broad-spectrum empiric antibiotic therapy and surgical debridement.

Quality of life and functional capacity in patients with rheumatoid arthritis - Cross-sectional study.

OBJECTIVES: To analyze the Health related Quality of Life (HRQoL) and physical function in rheumatoid arthritis (RA) patients and compare it with the general population. We also intended to analyze about disease activity influence in HRQoL and functional capacity, as well as determine potential determinants for these outcomes. MATERIAL AND METHODS: A cross-sectional study was conducted in RA patients from a university hospital of Portugal. We obtained Short Form 36, EuroQoL 5D, health assessment questionnaire, visual analog scale for pain and patient's assessment of disease activity. Comparisons between SF-36 and EQ-5D values with our population reference values were conducted using the Mann-Whitney test. Data were compared in different levels of disease activity, using Kruskal Wallis test and Fisher's exact test. A multiple regression analysis was conducted to identify the potential determinants of outcomes. RESULTS: RA sample showed significantly lower values than the portuguese general population on physical summary measure of SF-36 (median=32 vs. 50, p<0.001) and EQ-5D (median=0.620 vs. 0.758 respectively; p<0.001). Lower disease activity levels had better PROs and this was true even when compared patients achieving remission with those in low disease activity. The HAQ (r2=67%), VAS-P (r2=62%) and VAS-DA (r2=58%) were the variables that strongly related to SF-36. Considering HAQ, the strongest relation was found with VAS-P, VAS-DA and age (r2=60%, 61% and 33%, respectively). Multiple regression analysis identified HAQ, VAS-P and educational status as determinants of the HRQoL; age, female gender, employment, VAS-P and VAS-DA as determinants of physical function. CONCLUSION: Impairment of HRQoL in RA patients is enormous. We found significant differences between different levels of disease activity, showing higher HRQoL and functional capacity at lower disease activity levels.