Changing rate of serious infections in biologic-exposed rheumatoid arthritis patients. Data from South American registries BIOBADABRASIL and BIOBADASAR.

OBJECTIVE: Most reports on serious infections (SI) in rheumatoid arthritis (RA) patients treated with biological disease-modifying antirheumatic drugs (bDMARDs) are from the USA and Western Europe. Data from other regions are largely missing. We report data from South American countries with different backgrounds and health-care systems but similar registries. METHODS: We merged 2010-2016 data from two registries, BIOBADABRASIL (Brazil) and BIOBADASAR (Argentina), which share the same protocol, online platform and data monitoring process. Patients with active RA were included when they began the first bDMARD or a conventional synthetic DMARD (csDMARD, control group). The SI incidence rate (IR) per 1000 patient/years and adjusted IR ratio (aIRR) were estimated for bDMARDs and csDMARDs. RESULTS: Data were analysed for 3717 RA patients with an exposure of 13,380 patient/years. The 2591 patients treated with bDMARDs (64% tumour necrosis factor-α inhibitors (TNFi)) had a follow-up of 9300 years, and the 1126 treated with csDMARDs had an exposure of 4081 patient/years. The SI IR was 30.54 (CI 27.18-34.30) for all bDMARDs and 5.15 (CI 3.36-7.89) for csDMARDs. The aIRR between the two groups was 2.03 ([1.05, 3.9] p = 0.034) for the first 6 months of treatment but subsequently increased to 8.26 ([4.32, 15.76] p < 0.001). The SI IR for bDMARDs decreased over time in both registries, dropping from 36.59 (28.41-47.12) in 2012 to 7.27 (4.79-11.05) in 2016. CONCLUSION: While SI remains a major concern in South American patients with RA treated with bDMARDs, a favourable trend toward a reduction was observed in the last years.Key Points• New comprehensive data on biologic drugs safety from international collaboration in South America.• First proposal for national registries data merging in South America.• Serious infections remain a major concern in RA patients treated with biologics.• A significant reduction of serious infections in RA patients exposed to biologics was observed over a 7 years period.

Manifestações clínicas e laboratoriais de polimiosite em um caso de leptospirose / Clinical and laboratorial features of polymyositis in a case of leptospirosis

Nem sempre é possível estabelecer uma clara distinção entre as doenças musculares de causa infecciosa e as miosites idiopáticas. Há situações, inclusive, em que se considera existir uma relação causal entre ambas as doenças. Descrevemos o caso de uma paciente com manifestações clínicas e laboratoriais de polimiosite que apresentou infecção precedente de leptospirose, em que se considera a hipótese de ação de "gatilho" do agente infeccioso no quadro muscular inflamatório.

Sometimes, it is not possible to establish an obvious distinction between the muscular manifestations due to infectious diseases and the idiopathic myositis. In fact, in some situations it is believed there is a causal relationship between those diseases. We describe the case of a patient with clinical and laboratorial features of polymyositis who had developed leptospirosis previously. The hypothesis of the infectious agent acting as a "trigger" to the muscular disease is discussed.

Síndrome de Marfan associada à artrite reumatóide / Marfan syndrome associated with rheumatoid arthritis

Os autores apresentam dois casos de artrite reumatóide que ocorreram em pacientes com doença de Marfan, com características idênticas as reumatóides seropositivas. Justificam pela curiosidade, embora näo única na literatura mundial, de afecçöes congênitas e adquiridas do tecido conjuntivo

Uma causa rara de osteoporose: homocistinúria / A rare cause of osteoporosis: homocystinuria

Os autores apresentam uma rara causa de osteoporose - a homocistinúria. O paciente apresentavva osteoporose generalizada, fratura espontânea e graves complicaçöes vasculares. Säo revistos a patogenia e o quadro clínico a apontadas as sugestöes terapêuticas

Mixoma cardíaco como causa de poliartrite / Cardiac myxoma as cause of polyarthritis

Os autores apresentam um caso de mixoma cardíaco cuja única sintomatologia era um quadro clínico articular. A paciente, que já tinha dez anos de observaçäo, sem diagnóstico, foi operada, com ampla ressecçäo do tumor e involuçäo clínica. Julgam os autores, com outros casos revistos na literatura, que o mixoma pode simular uma colagenose

Artrite reumatóide com mais de dez anos de atendimento / Rheumatoid arthritis with more than 10 years of attendance

Analisaram-se os prontuários de 25 doentes de artrite reumatóide observados ao longo de dez anos, como amostragem näo randomizada, procurando mostrar as nuanças clínicas, as complicaçöes, as interrupçöes de tratamento, os medicamentos empregados, a evoluçäo e os resultados obtidos. Esses doentes foram atendidos no Hospital de Clínicas da Universidade Federal do Paraná e serviräo como comparaçäo com doentes atendidos em consultório particular