Ja Pereira da Silva

Low bone mineral density in professional scuba divers

Scuba diving is associated with a 90% reduction in effective weight and with the loss of a weight-bearing effect on joints. These conditions are very similar to the continuous weightlessness that occurs in spaceflight and bed-rest, which are clearly associated with significant bone mass loss. Here, we studied the bone mineral density (BMD) of 66 professional scuba divers using a dual-photon densitometer, and have depicted a reduction in the BMD in comparison to a matched control group of non-divers. Our results suggest that diving is also an activity where the unloading effect alters bone metabolism, leading to a reduction in BMD.

A case of pachydermodactyly in a 16 year-old male.

Background Pachydermodactyly is a rare benign superficial fibromatosis, aetiology unknown, characterized by asymmetric painless swelling of the proximal interphalangeal (PIF) joints of the hands, most frequently in adolescent males. Radiographs and MRI show only soft tissue thickening. Histological exam reveals epidermic hiperplasia, collagen fibers and fibroblast proliferation and increased mucin deposition.

BioRePortAP, an electronic clinical record coupled with a database: an example of its use in a single centre

AIMS To evaluate the efficacy and safety of the treatment of psoriatic arthritis (PsA) patients with tumor necrosis factor (TNF) antagonists in the Rheumatology Department of Hospital de Santa Maria using the BioRePortAP. METHODS The Portuguese Society of Rheumatology (SPR) developed an electronic medical chart coupled with a database for the follow up of PsA patients, the BioRePortAP, which was launched in May 2009. This evaluation was based on all the PsA patients that were on active treatment with TNF antagonists in September 2009 and were registered in the BioRePortAP. All the previous data on these patients were introduced in BioRePortAP using the prospective paper based follow up protocol that this Department was using since 1999. Only patients with more than 9 months of treatment were analyzed. RESULTS Forty-two patients with PsA, actively treated with anti-TNF agents in September 2009, for at least 9 months, were analyzed in BioRePortAP. Twenty-three patients were male (55%) and nineteen were female (45%). The average age of these patients was 49.8+/-10.9 years old, the average disease duration was of 10.7+/-5.6 years and the mean duration of biological therapy was of 37.8+/-27.8 months. For the 81% of patients with peripheral joint disease there was a mean reduction of more than 80% in the swollen and tender joint counts, and almost 50% in the health assessment questionnaire (HAQ) value. In the 19% of the patients with axial involvement the reduction of BASDAI and BASFI was not statistically significative. On top of that, PASI score suffered a reduction of 64%. Fourteen patients (33.3%) had to switch their TNF antagonist treatment. 58.8% of the switches were due to adverse effects and 41.2% due to therapy failure. Regarding the 56 adverse reactions registered, only one was a severe reaction. The remaining adverse reactions were not severe and 67% of them were due to infections. DISCUSSION The results of this first report of the use of the BioRePortAP in clinical practice confirm the efficacy and safety of TNF antagonist treatment in PsA. The results shown here elucidate the potential applications of BioRePortAP as a tool for efficacy and safety assessment of PsA patients treated with biotechnological drugs.

PReS-FINAL-2163: Disease activity in a juvenile idiopathic arthritis population after 5 years follow-up

The main goal of juvenile idiopathic arthritis (JIA) treatment is to achieve a long-term remission or, at least, low levels of disease activity.

PReS-FINAL-2095: Older age predicts poor response to 6-months methotrexate therapy in a juvenile idiopathic arthritis cohort of patients

The identification of predictive factors of poor response to methotrexate (MTX) in juvenile idiopathic arthritis (JIA) patients could contribute to optimize the treatment strategy, namely by the earlier introduction of biological treatments.

Musculo-skeletal Ultrasound in paediatric rheumatology: experience of one University Hospital

Musculo-skeletal Ultrasound (MSK-US) has become essential in the diagnosis and follow-up of children with rheumatic diseases. It’s an innocuous exam that helps diagnostic and treatment decisions and allows treatment efficacy assessment.

Off-label use of biological agents in the management of uveitis: experience from a pediatric rheumatology centre.

Background Uveitis is a common extra-articular feature in juvenile idiopathic arthritis (JIA), particularly in female patients with the extended oligoarticular subtype. A significant number of patients already have ocular complications at time of diagnosis of uveitis. JIA-associated uveitis carries significant ocular morbidity that can progress into adulthood. Treatment with immunosuppressive agents can reduce the risk of ocular complications. Although controlled clinical trials are under way to assess the efficacy of biologic agents in JIA-associated uveitis, therapies with these agents seem to have encouraging results.

Predictors of response and anti-TNF drugs comparative efficacy

Methods Analyses were performed upon Reuma.pt. Response to therapy was defined according to EULAR criteria. Probability of response was modeled. Multivariate logistic regression model predicting response over 1 year with all variables and automated stepwise selection models were built. In addition, we performed analyses using propensity score 1:1:1 nearest neighbor matching algorithms to obtain comparable groups regarding baseline features.

Predictors of chronicity and the discriminative value of the new ACR/EULAR rheumatoid arthritis classification criteria in an untreated polyarthritis cohort with less than 6 weeks of disease duration

Thirty-seven patients were included. During the follow up most of the patients evolved into RA (57%). The median age of the patients of the RA-group was similar to the median age of the non-RA group (median (IQR) 47 (31-58.5) vs 43 (34-69) years, p=0.74). At the initial visit the DAS 28 in the RA group was significantly higher than in the non-RA group, as well as the VAS and the number of swollen joints. The ESR values did not differ significantly between RA and non-RA groups (Table 1).

Spondyloarthropathy and rheumatoid arthritis: two different diseases, a similar cytokine network

The reasons for the phenotypic differences between spondyloarthritis (SpA) and rheumatoid arthritis (RA) are still unclear. Slight divergences in the cytokine networks might contribute to this and may be the key to new treatment approaches.