Ana Letícia Pirozzi Buosi

Behçet disease: clinical features and management in a Brazilian tertiary hospital.

Background Behçet disease (BD) is prevalent in Central and East Asia and in the Eastern Mediterranean area where most studies have been performed. Few studies have evaluated patients with BD in Brazil. Objectives The objective of the study was to describe clinical manifestations of BD and their therapy in a single center in Brazil. Methods Sixty patients who met the International Study Group Criteria for BD and were under follow-up at the Vasculitis Unit of the Universidade Federal de São Paulo were evaluated in a retrospective observational study. Results Mean age at study was 40.0 (SD, 10.7) years, and the female-male ratio was 1.2:1.0. The frequency of disease manifestations was as follows: oral ulcers, 100%; genital ulcers, 93.3%; ocular manifestations, 63.3%; arthritis, 46.7%; cutaneous lesions, 71.7%; positive pathergy test, 22.7%; neurologic involvement, 28.3%; thrombosis, 13.3%; and gastrointestinal involvement, 3.3%. Arthritis and erythema nodosum were more prevalent among women, whereas papulopustular lesions were more common in men. The frequency of each treatment modality was as follows: colchicine, 78.3%; thalidomide, 26.7%; colchicine and penicillin, 21.7%; dapsone, 8.3%; and pentoxyphyline, 8.3%. These treatments were mainly used for mucocutaneous manifestations. Immunosuppressive drugs were prescribed for 70% of the patients, including azathioprine (35.0%), cyclophosphamide (28.3%), cyclosporin A (21.7%), methotrexate (18.3%), and chlorambucil (6.7%). Infliximab was used in 5.0% of refractory patients. No differences were observed between sexes related to severe manifestations of BD. Conclusions Although reported elsewhere, Brazilian men with BD did not have a worse prognosis. Women had a higher frequency of arthritis manifestations.

Sonographic Assessment of Healthy Peripheral Joints Evaluation According to Demographic Parameters

To describe quantitative and semiquantitative sonographic joint measurements in healthy adults and compare them with demographic parameters.

Hand ultrasound: Comparative study between “no rhupus” lupus erythematosus and rheumatoid arthritis

Abstract Objective. To compare hand US between systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) patients. Methods. Hands (1st–5th metacarpophalangeal [MCP] and 1st–5th proximal interphalangeal [PIP] joints) and wrists (radiocarpal and distal radioulnar joints) of 62 “no rhupus” SLE and 60 RA patients were compared through US (linear probe, 6–18 MHz). The findings were compared to clinical, functional, serological outcomes, and disease activity indices. Results. 2108 and 2040 joint recesses were evaluated in SLE and AR patients, respectively. Synovitis was found in 46.8% and 75% of wrists, 83.9% and 86.7% of MCPs and 58.1% and 70% of PIPs in the SLE and RA groups, respectively. More significant US findings were found in RA group. Greater values of synovitis (mm) in RA group were only found in the joint recesses of wrist (p < 0.001–0.002). In SLE group, US findings were associated with “puffy hands,” Health Assessment Questionnaire score and dynamometry. Twenty-two SLE patients (35.5%) had erosion in any of joints studied. SLE patient subgroup with US erosion was associated with hematological involvement and Jaccouds arthropathy. Conclusions. US of “no rhupus” SLE and RA patients is different, especially in wrists. In SLE patients the clinical variable most associated with US findings was “puffy hands.”

Swimming Improves Pain and Functional Capacity of Patients With Fibromyalgia: A Randomized Controlled Trial

OBJECTIVE To evaluate the effect of swimming on pain, functional capacity, aerobic capacity, and quality of life in patients with fibromyalgia (FM). DESIGN Randomized controlled trial. SETTING Rheumatology outpatient clinics of a university hospital. PARTICIPANTS Women with FM (N=75; age range, 18-60y) randomly assigned to a swimming group (SG) (n=39) or a walking group (WG) (n=36). INTERVENTION The SG performed 50 minutes of swimming 3 times a week for 12 weeks, with a heart rate at 11 beats under the anaerobic threshold. The WG performed walking with a heart rate at the anaerobic threshold, with the same duration and frequency as the SG. MAIN OUTCOME MEASURES Participants were evaluated before the exercise protocols (t0), at 6 weeks (t6), and at 12 weeks (t12) after the onset of the protocols. The primary outcome measure was the visual analog scale for pain. The secondary measurements were the Fibromyalgia Impact Questionnaire and the Medical Outcomes Study 36-Item Short-Form Health Survey for quality of life; a spiroergometric test for cardiorespiratory variables; and the timed Up & Go test for functional performance. RESULTS Patients in both groups experienced improvement in pain after the 12-week program, with no difference between groups (P=.658). The same results were found regarding functional capacity and quality of life. Moreover, no statistical difference between groups was found regarding aerobic capacity over time. CONCLUSIONS Swimming, like walking, is an effective method for reducing pain and improving both functional capacity and quality of life in patients with FM.

Vasculite testicular: uma manifestação rara de artrite reumatoide

Testicular vasculitis is a very rare extra-articular manifestation of rheumatoid arthritis (RA). We describe the case of a 53-year-old man diagnosed with RA for eight years, who was poorly controlled and developed rheumatoid vasculitis, which manifested as leg ulcers and peripheral polyneuropathy. The patient also had acute neutrophilic meningitis and was treated with antibiotics and intravenous pulse therapy with methylprednisolone (500 mg daily) for three days, followed by oral cyclophosphamide (2 mg/kg daily) and prednisone. Overall improvement was observed, and the patient was discharged. But 15 days later, the meningitis recurred, and the patient was readmitted and treated again with antibiotics. Three days later, he developed pain and enlargement of his left testicle with gangrene. Unilateral orchiectomy was performed, revealing lymphocytic vasculitis. The patient died two days later due to aspiration pneumonia. This case illustrates a rare and severe manifestation of rheumatoid vasculitis.

Association of anti-glomerular basement membrane antibody disease with dermatomyositis and psoriasis: case report

CONTEXT anti-glomerular basement membrane (anti-GBM) antibody syndrome is characterized by deposition of anti-GBM antibodies on affected tissues, associated with glomerulonephritis and/or pulmonary involvement. This syndrome has been described in association with other autoimmune disorders, but as far as we know, it has not been described in association with dermatomyositis and psoriasis. CASE REPORT a 51-year-old man with a history of dermatomyositis and vulgar psoriasis presented with a condition of sensitive-motor polyneuropathy of the hands and feet, weight loss of 4 kg, malaise and fever. On admission, he had been making chronic use of cyclosporin and antihypertensive drugs for three months because of mild arterial hypertension. Laboratory tests showed anemia and leukocytosis, elevated serum urea and creatinine and urine presenting proteinuria, hematuria, leukocyturia and granular casts. The 24-hour proteinuria was 2.3 g. Renal biopsy showed crescentic necrotizing glomerulonephritis with linear immunoglobulin G (IgG) deposits on the glomerular basement membrane by means of direct immunofluorescence, which were suggestive of anti-GBM antibodies. The patient was then treated initially with methylprednisolone and with monthly cyclophosphamide in the form of pulse therapy.

Is painless synovitis different from painful synovitis? A controlled, ultrasound, radiographic, clinical trial

OBJECTIVE: This study compares the clinical, ultrasonography, radiography, and laboratory outcomes of painless and painful chronic synovitis in patients with established rheumatoid arthritis. METHODS: This cross-sectional study involved 60 patients with rheumatoid arthritis and synovitis in the metacarpophalangeal joints; 30 of the patients did not experience pain, and 30 had experienced pain for at least 6 months prior to the study. The radiocarpal, distal radioulnar, and metacarpophalangeal joints were evaluated using the ultrasound gray scale, power Doppler, and radiography. Past and present clinical and laboratory findings were also evaluated. RESULTS: There were no statistically significant differences between the groups for most of the outcomes. The group with pain scored worse on the disease activity indices (e.g., DAS 28 and SDAI), function questionnaires (HAQ and Cochin), and pinch strength test. A logistic regression analysis revealed that the use of an immunobiological agent was associated with a 3-fold greater chance of belonging to the group that experienced pain. The painless group had worse erosion scores in the second and fifth metacarpophalangeal with odd ratios (ORs) of 6.5 and 3.5, respectively. The painless group had more cartilage with grade 4 damage in the third metacarpophalangeal. CONCLUSIONS: The rheumatoid arthritis patients with both painless and painful synovitis exhibited similar disease histories and radiographic and ultrasound findings. However, the ultrasonography evaluation revealed worse scores in the second and fifth metacarpophalangeal of the synovitis patients who did not experience pain.

Testicular vasculitis: a rare manifestation of rheumatoid arthritis

Testicular vasculitis is a very rare extra-articular manifestation of rheumatoid arthritis (RA). We describe the case of a 53-year-old man diagnosed with RA for eight years, who was poorly controlled and developed rheumatoid vasculitis, which manifested as leg ulcers and peripheral polyneuropathy. The patient also had acute neutrophilic meningitis and was treated with antibiotics and intravenous pulse therapy with methylprednisolone (500 mg daily) for three days, followed by oral cyclophosphamide (2 mg/kg daily) and prednisone. Overall improvement was observed, and the patient was discharged. But 15 days later, the meningitis recurred, and the patient was readmitted and treated again with antibiotics. Three days later, he developed pain and enlargement of his left testicle with gangrene. Unilateral orchiectomy was performed, revealing lymphocytic vasculitis. The patient died two days later due to aspiration pneumonia. This case illustrates a rare and severe manifestation of rheumatoid vasculitis.

THU0141 Painless Synovitis – A Silent Enemy? A Controlled, Ultrasound, Radiographic, Clinical Trial

Background Some rheumatoid arthritis (RA) patients exhibit persistent chronic synovitis marked by joint swelling that may or may not be accompanied by pain. Objectives The aim of the present study was to compare painless and painful chronic synovitis in established RA with regard to clinical, ultrasonography (US), radiography and laboratory outcomes. Methods A cross-sectional study was carried out involving 60 patients with RA and synovitis in the metacarpophalangeal joints (MCPs): 30 patients without pain and 30 patients with pain for at least 6 months. The radiocarpal, distal radioulnar joints and MCPs were evaluated using US gray scale (US-GS), power Doppler (US-PD) and radiography. Past and present clinical and laboratory findings were also evaluated. Results No statistically differences between groups were found for the most of outcomes analyzed. Worse scores on the disease activity indices (DAS 28 and SDAI) (p<0.001), questionnaires of function (HAQ and Cochin) and pinch strength (p < 0.001 to 0.039) were found in the group with pain. The logistic regression analysis revealed that the use of an immunobiological agent was associated with a threefold greater chance of belonging to the group with pain (p = 0.049). No statistically significant differences were found for the majority of variables analyzed by radiography and US (including PD assessment). However, worse joint damage scores (erosion and cartilage) were found in the group without pain. Conclusions Patients with RA and painless chronic synovitis exhibited similar disease progression, radiographic and US findings to those with painful chronic synovitis. Although similar between groups, the US evaluation demonstrated worse joint damage scores in patients with painless synovitis. References Bugatti S, Manzo A, Caporati R et al. Assessment of synovitis to predict bone erosions in rheumatoid arthritis. Ther Adv Musculoskeletal Dis 2012; 4(4):235-244. Naredo E, Bonilla G, Gamero F et al. Assessment of inflamatory activity in rheumatoid arthritis: a comparative study of clinical evaluation with gray scale e power Doppler ultrasonography. Ann Rheum Dis 2005;64:375-381. Brown AK, Quinn MA, Karim Z, Conaghan PG, Peterfy CG, Hensor E, Wakefield RJ, O’Connor PJ, Emery P. Presence of significant synovitis in rheumatoid arthritis patients with disease-modifying antirheumatic drug-induced clinical remission – Evidence from an imaging study may explain structural progression. Arthritis Rheum. 2006;54(12):3761-3773. Filippucci E, da Luz KR, Di Geso L, et al. Interobserver reliability of ultrasonography in the assessment of cartilage damage in rheumatoid arthritis. Ann Rheum Dis 2010; 69(10):1845-8. Disclosure of Interest None Declared

SAT0588-HPR Swimming is as Effective as Walking for Treating Fibromyalgia: a Randomized Controlled Trial.

Background Background: Fibromyalgia (FM) is a chronic widespread pain syndrome that causes deterioration of physical capacity. Exercises are fundamental in the treatment of FM, however, it is not known the effects of swimming in patients with FM. Objectives Objective: To evaluate the effects of swimming on pain, functional capacity, quality of life, and aerobic capacity in patients with FM, compared to walking. Methods Methods: Seventy-five women with diagnosis of FM according to ACR criteria with age between 18 and 60 years were selected. The patients were randomized to swimming group (SG) or walking group (WG). The SG performed swimming in front-crawl style and the heart rate (HR) training was defined by subtracting 10 beats from anaerobic threshold heart rate to compensate underwater horizontal position. The WG performed walking at anaerobic threshold HR. Exercise sessions had duration of 50 minutes and were performed three times a week for 12 weeks. The outcome measures were visual analogue scale (VAS) for pain, Time Up and Go Test (TUG) for functional capacity, Fibromyalgia Impact Questionnaire (FIQ) for health-related quality of life and SF 36 for general quality of life. Aerobic capacity was measured by an incremental cardiopulmonary exercise testing protocol by treadmill. The evaluations were done by a blinded assessor at baseline (T0), 6 (T6) and 12 weeks (T12) after randomization. Results Results: Thirty-nine patients were randomized to SG and 36 to WG. The groups were homogeneous at baseline regarding clinical and demographic characteristics. After 12 weeks, both groups improved pain, functional capacity and quality of life (FIQ and SF 36) compared to baseline, however there were no differences between groups. Regarding aerobic capacity, both groups did not show changes over time. Tolerance to exercise, measured by adherence to programs, was similar in both groups (77.8% in SG and 72.2% in WG). Conclusions Conclusions: Swimming is as effective as walking in improving pain, functional capacity, health-related quality of life and general quality of life in patients with FM. In addition, swimming is well-tolerated by patients with FM. However, clinical improvements are not associated to aerobic capacity. References Altan L, Bingöl U, Aykaç M, et al. Investigation of the effects of pool-based exercise on fibromyalgia syndrome. Rheumatol Int, 2004; 24: 272–277. Häuser W, Klose P, Langhorst J, Moradi B, Steinbach M, Schiltenwolf M, Busch A: Efficacy of different types of aerobic exercise in fibromyalgia syndrome: a systematic review and meta-analysis of randomized controlled trials. Arthritis Res Ther 2010, 12: R79. Disclosure of Interest G. Fernandes: None Declared, F. Jennings: None Declared, A. L. Buosi: None Declared, M. Nery: None Declared, J. Natour Grant/research support from: FAPESP- Fundação de Apoio a Pesquisa de São Paulo