High patient global assessment scores in patients with rheumatoid arthritis otherwise in remission do not reflect subclinical inflammation.

OBJECTIVES: To assess whether high patient global assessment (PGA) scores by patients with rheumatoid arthritis (RA) otherwise in remission reflect subclinical inflammation. METHODS: Cross-sectional, single-center study, including consecutive RA patients. Remission states were defined based on the ACR/EULAR Boolean definition: 4V-remission (tender and swollen 28-joint counts (TJC28/SJC28), C-reactive protein (CRP), and PGA all≤1), PGA-near-remission (the same, except PGA>1), and non-remission (any of TJC28, SJC28, CRP>1). A blinded expert musculoskeletal ultrasonographer scanned 44 joints, 38 tendon sheaths, 4 bursae on the same day of the clinical evaluation. Each structure was assessed for the presence of Grey Scale synovial hypertrophy (GS) and Power Doppler (PD), both scored using a semi-quantitative scale (0-3 points). The Global OMERACT-EULAR Synovitis Score (GLOESS, 0-132, primary outcome), and a global tenosynovitis/bursitis score (GTBS) were compared between remission states, using non-parametric tests. Different sensitivity analyses comparing GS and PD subscores were performed. RESULTS: In total, 130 patients (mean age 63 years, 86% female, average disease duration 14 years) were included 40 being in 4V-remission, 40 in PGA-near-remission, 50 in non-remission. 4v-remission and PGA-near-remission presented similar median (IQR) GLOESS, [6 (5-11) and 4 (1-7), P>0.05, respectively] and GTBS [0 (0-1) and 0 (0-2), P>0.05, respectively]. The same was observed in GS, PD scores, and in global synovitis score considering only the 16 joints not included in 28-joint counts. These observations were confirmed in patients with≤5 years disease duration. CONCLUSIONS: Subclinical inflammation is not present among persons with elevated PGA who are otherwise in remission. PGA-near-remission patients would be exposed to the risk of overtreatment if current treatment recommendations were strictly followed. This study supports the need to reconsider the role of PGA in definitions used to target immunosuppressive therapy and to provide a separate and enhanced focus to the patient's experience of the disease.

Estágio Supervisionado em Psicologia Clínica com Orientação Psicanalítica: Uma Revisão de Literatura / Supervised Traineeship in Clinical Psychology with Psychoanalytic Guidance: A Literature Review

RESUMO Este estudo tem como objetivo: analisar o conteúdo da produção de literatura sobre a prática de estágio supervisionado em psicologia clínica, com orientação psicanalítica e refletir acerca de suas dificuldades e desafios. Trata-se de uma revisão de literatura sistemática de artigos publicados sobre o tema, nas bases de dados Scielo, BVS-Psi e Portal de Periódicos CAPES, através dos descritores 'estágio, psicologia clínica, psicanálise e clínica-escola'. Após aplicação dos critérios de exclusão, foram selecionados 26 artigos, o que possibilitou verificar que essa experiência não é sem consequência para pacientes, estagiários e supervisores. Conclui-se que na formação do psicólogo clínico de orientação psicanalítica, trata-se de suportar e assentir com a posição ética, teórica e técnica da psicanálise na condução do trabalho clínico.

ABSTRACT This study aims to: analyze the content of the production of literature on the stage of supervised practice in clinical psychology, with psychoanalytic guidance, and reflect on its difficulties and challenges. It is a systematic literature review of articles published on the subject in the Scielo databases, BVS-Psi and Journals Portal CAPES, through the 'traineeship, clinical psychology, psychoanalysis and Clinical School' descriptors. After applying the exclusion criteria, 26 articles were selected, which enabled us to verify that this experience has consequences for patients, trainees, and supervisors. It concluded that the formation of clinical with psychoanalytic guidance refers above all, to bear up and consent with an ethical, theoretical, and technical psychoanalytic position in order to conduct the clinical work.

A psicanálise e o mal-estar na contemporaneidade / The psychoanalysis and the malaise in the contemporaneity

O trabalho se propõe a discutir como a psicanálise conceitua desde Freud o mal-estar na civilização, analisar o mal-estar contemporâneo com a ferramenta dos discursos em Lacan e refletir sobre o que esperar da psicanálise diante do mal-estar na contemporaneidade. Considera-se que ao psicanalista cabe acolher o mal-estar, mas ele não pode sonhar em suprimi-lo. A psicanálise vai em busca do resgate do sujeito, do que o causa e o constitui. Conclui-se que, numa cultura capitalista, encontra-se em contrapartida a proposta psicanalítica, que continua apostando na recuperação do laço do ser falante com a palavra em sua dimensão discursiva. Nesse sentido, é preciso que cada um invente a sua arte de viver.(AU)

The paper proposes to discuss how psychoanalysis conceptualizes since Freud the malaise in civilization; to analyze contemporary malaise with the tool of discourses in Lacan and to reflect on what to expect from psychoanalysis in the face of discontent in contemporary times. It is considered that the psychoanalyst should accept the malaise, but he can not dream of suppressing it. Psychoanalysis goes in search of the subject's rescue, of what causes and constitutes it. It is concluded that in a capitalist culture, the psychoanalytic proposal is in counterpart, which continues to bet on the recovery of the bond of the speaking being with the word in its discursive dimension. In this sense, each one must invent his art of living.(AU)

Predictors of response to TNF blockers in patients with polyarticular psoriatic arthritis.

Psoriatic arthritis (PsA) is a chronic inflammatory rheumatic disease with a broad clinical spectrum. PsA can affect the axial skeleton, peripheral joints, entheses, synovial sheaths of tendons, skin, nails and extra-articular organs. Tumour necrosis factor alpha blockers (TNF blockers) were a breakthrough development in the treatment of PsA. Identifying predictors of response to biological therapies in patients with PsA is of utmost importance, especially in view of the costs and potential side effects of these agents. The aims of the present study were to determine baseline predictive factors of response to biological therapies, at 3 and 6 months, in PsA patients with polyarticular involvement (with or without axial involvement). Data were collected from the Rheumatic Diseases Portuguese Register (Reuma.pt). Eligible patients had to be anti-TNF-naive at baseline and to have at least 3 months of follow-up after the beginning of TNF blocker therapy. Only patients with information on at least one of the response measures (at 3 or 6 months of follow-up) were included in the analysis. Univariable logistic regression analysis of potential baseline predictors of European League Against Rheumatism (EULAR) good clinical response, EULAR good/moderate response, 28-joint Disease Activity Score with three variables including the erythrocyte sedimentation rate (DAS28-3V-ESR) remission and Health Assessment Questionnaire (HAQ) response were performed. Multivariable logistic regression using a forward selection procedure was used until the best-fit model was obtained, taking confounding effects into account. A total of 180 patients were eligible for the study (mean age 52 years, 54% women). In multivariable analysis at 3 months, females were less likely to attain a good EULAR response [OR=0.082 (95% CI=0.024, 0.278)], a DAS28-3V-ESR remission [OR=0.083 (95% CI=0.017, 0.416)], a moderate or good EULAR response [OR=0.091 (95% CI=0.011, 0.091)] and a HAQ response [OR=0.074 (95% CI=0.009, 0.608)]. At 6 months, female gender was also less likely to achieve a good EULAR response [OR=0.060 (95% CI=0.011, 0.325)], DAS28-3V-ESR remission [OR=0.060 (95% CI=0.012, 0.297)], and a HAQ response [OR=0.138 (95% CI= 0.029, 0.654)]. In this study we found that gender was the most consistent predictor of response to TNF blocker therapy in patients with polyarticular PsA, with females having a lower probability of response compared to males. These findings suggest that gender-related biochemical, hormonal and psychological factors could play an important role in the response to TNF blocker therapy in PsA.