José Caetano Macieira

Signs and symptoms of temporomandibular dysfunction in fibromyalgic patients.

ObjectiveThe objective of this study was to determine the frequency of signs and symptoms of temporomandibular disorder (TMD) in fibromyalgic patients. MethodsSixty subjects of both sexes (mean age, 49.2 ± 13.8 years) with fibromyalgia (FM) diagnosis were included in this study. All patients were examined by a calibrated investigator to identify the presence of TMD using the Research Diagnostic Criteria for TMD. ResultsThe most common signs (A) and symptoms (B) reported by FM patients were (A) pain in the masticatory muscles (masseter, 80%; posterior digastric, 76.7%), pain in the temporomandibular joint (83.3%), and 33.3% and 28.3%, respectively, presented joint sounds when opening and closing the mouth; (B) headache (97%) and facial pain (81.7%). In regard to the classic triad for the diagnosis of the TMD, it was found that 35% of the FM patients presented, at the same time, pain, joint sounds, and alteration of the mandibular movements. It was verified that myofascial pain without limitation of mouth opening was the most prevalent diagnosis (47%) for the RDC subgroup I. For the subgroup II, the disk displacement with reduction was the most prevalent diagnosis (21.6%). For the subgroup III, 36.7% of the subjects presented osteoarthritis. ConclusionsThus, there is a high prevalence of signs and symptoms of TMD in FM patients, indicating the need for an integrated diagnosis and treatment of these patients, which suggest that the FM could be a medium- or long-term risk factor for the development of TMD.

Avaliação dos sintomas de ansiedade e depressão em fibromiálgicos

Se objetivo identificar la frecuencia de sintomas de ansiedad y depresion y verificar la asociacion entre ansiedad-rasgo y sintomas actuales de depresion y ansiedad en fibromialgicos. Fueron entrevistados 60 sujetos con diagnostico de fibromialgia en Ambulatorio de Reumatologia de Universidad Federal de Sergipe, de agosto 2007 a marzo 2008. Se aplicaron dos cuestionarios: Escala Hospitalaria de Ansiedad y Depresion (EHAD) e Inventario de Ansiedad Rasgo-Estado (IDATE-T). La frecuencia de sintomas depresivos y ansiosos fue, respectivamente, 50% y 86% para los fibromialgicos y el promedio de puntaje del rasgo ansioso fue de 59,38. Se observo asociacion entre ansiedad-rasgo y estado. La ansiedad y la depresion fueron sintomas frecuentes en pacientes con fibromialgia. Entretanto, la ansiedad fue un sintoma secundario mas frecuente que la depresion y se presento de forma mas grave, resultando una comorbilidad que necesita ser mas valorizada y estudiada.The objective of this study was to identify the frequency of anxiety and depression symptoms by verifying the association between anxiety traits, current depression and anxiety symptoms in fibromyalgia patients. Interviews were performed with 60 subjects diagnosed with fibromyalgia at the Rheumatology Outpatient Clinic at Universidade Federal de Sergipe between August 2007 and March 2008, in which two questionnaires were administered: the Hospital Anxiety and Depression Scale (HADS) and the State-Trait Anxiety Inventory (STAI). The frequency of anxiety and depression symptoms was, respectively, 50% and 86% for individuals with fibromyalgia, and the mean trait-anxiety score was 59.38. An association was observed between trait and state anxiety. Anxiety and depression were frequent symptoms among patients with fibromyalgia. However, anxiety appeared as a secondary symptom to depression, appearing in a more severe form, and, therefore, this comorbidity should be more valued and studied.

An evaluation of anxiety and depression symptoms in fibromyalgia

Se objetivo identificar la frecuencia de sintomas de ansiedad y depresion y verificar la asociacion entre ansiedad-rasgo y sintomas actuales de depresion y ansiedad en fibromialgicos. Fueron entrevistados 60 sujetos con diagnostico de fibromialgia en Ambulatorio de Reumatologia de Universidad Federal de Sergipe, de agosto 2007 a marzo 2008. Se aplicaron dos cuestionarios: Escala Hospitalaria de Ansiedad y Depresion (EHAD) e Inventario de Ansiedad Rasgo-Estado (IDATE-T). La frecuencia de sintomas depresivos y ansiosos fue, respectivamente, 50% y 86% para los fibromialgicos y el promedio de puntaje del rasgo ansioso fue de 59,38. Se observo asociacion entre ansiedad-rasgo y estado. La ansiedad y la depresion fueron sintomas frecuentes en pacientes con fibromialgia. Entretanto, la ansiedad fue un sintoma secundario mas frecuente que la depresion y se presento de forma mas grave, resultando una comorbilidad que necesita ser mas valorizada y estudiada.The objective of this study was to identify the frequency of anxiety and depression symptoms by verifying the association between anxiety traits, current depression and anxiety symptoms in fibromyalgia patients. Interviews were performed with 60 subjects diagnosed with fibromyalgia at the Rheumatology Outpatient Clinic at Universidade Federal de Sergipe between August 2007 and March 2008, in which two questionnaires were administered: the Hospital Anxiety and Depression Scale (HADS) and the State-Trait Anxiety Inventory (STAI). The frequency of anxiety and depression symptoms was, respectively, 50% and 86% for individuals with fibromyalgia, and the mean trait-anxiety score was 59.38. An association was observed between trait and state anxiety. Anxiety and depression were frequent symptoms among patients with fibromyalgia. However, anxiety appeared as a secondary symptom to depression, appearing in a more severe form, and, therefore, this comorbidity should be more valued and studied.

Polimiosite associada a infecção por HTLV-I: relato de caso

We report the case of a 57 years-old woman presenting polymyositis associated to HTLV-I infection without clinical signs of involvement of the central and peripheral nervous system. Pathophysiologic aspects of muscular involvement in HTLV-I infection are discussed.

Incidence of tuberculosis among patients with rheumatoid arthritis using TNF blockers in Brazil: data from the Brazilian Registry of Biological Therapies in Rheumatic Diseases (Registro Brasileiro de Monitoração de Terapias Biológicas – BiobadaBrasil)

OBJECTIVES To assess the incidence of tuberculosis and to screen for latent tuberculosis infection among Brazilians with rheumatoid arthritis using biologics in clinical practice. PATIENTS AND METHODS This cohort study used data from the Brazilian Registry of Biological Therapies in Rheumatic Diseases (Registro Brasileiro de Monitoração de Terapias Biológicas - BiobadaBrasil), from 01/2009 to 05/2013, encompassing 1552 treatments, including 415 with only synthetic disease-modifying anti-rheumatic drugs, 942 synthetic DMARDs combined with anti-tumor necrosis factor (etanercept, infliximab, adalimumab) and 195 synthetic DMARDs combined with other biologics (abatacept, rituximab and tocilizumab). The occurrence of tuberculosis and the drug exposure time were assessed, and screening for tuberculosis was performed. STATISTICAL ANALYSIS Unpaired t-test and Fishers two-tailed test; p<0.05. RESULTS The exposure times were 981 patient-years in the controls, 1744 patient-years in the anti-TNF group (adalimumab=676, infliximab=547 and etanercept=521 patient-years) and 336 patient-years in the other biologics group. The incidence rates of tuberculosis were 1.01/1000 patient-years in the controls and 2.87 patient-years among anti-TNF users (adalimumab=4.43/1000 patient-years; etanercept=1.92/1000 patient-years and infliximab=1.82/1000 patient-years). No cases of tuberculosis occurred in the other biologics group. The mean drug exposure time until the occurrence of tuberculosis was 27(11) months for the anti-TNF group. CONCLUSIONS The incidence of tuberculosis was higher among users of synthetic DMARDs and anti-TNF than among users of synthetic DMARDs and synthetic DMARDs and non-anti-TNF biologics and also occurred later, suggesting infection during treatment and no screening failure.

Polimiosite associada à síndrome nefrótica

Polymyositis (PM) is a systemic disease of the idiopathic inflammatory myopathy group, clinically characterized by symmetric and proximal muscle weakness. There are reports in literature of PM associated with malignancies, autoimmune diseases, and viral infections. However, the association between PM and nephropathy is not common. We describe a case report of a patient with polymyositis who developed nephrotic syndrome due to mesangial glomerulonephritis.

Intervenção fonoaudiológica na esclerose sistêmica: relato de casos

Systemic sclerosis is a rare, progressive of unknown etiology and variable evolution, autoimmune rheumatic connective tissue disease. It reaches vital organs and perioral tissues, causing limitation of mouth opening, hypertonia of the phonoarticulatory organs, face with the appearance of a mask, difficulty in chewing and swallowing. Aiming to compare the pre and post miofuncional orofacial intervention in subjects with systemic sclerosis, it was performed a quali quantitative exploratory clinical study in the Rheumatology department of the University Hospital and in the School Clinic of Speech, Language and Hearing Sciences of the Federal University of Sergipe (UFS), from July/2012 to December/2013. The sample consisted of five individuals, of both genders, aged between 24 and 60 years and with confirmed medical diagnosis of that condition. The subjects underwent through evaluation by MBGR protocol and 36 sessions of speech therapy (myofunctional and myotheray). At the end, the initial and final results were compared from the clinical indicators worked. After analyzing the results obtained, improvements in all aspects were observed. The previous Speech Therapy evaluation revealed restriction of mouth opening in all subjects and the final results presented gains between 5.3 and 14.2mm of opening (average: 9.26). Regarding muscle tonus, mobility of the phonoarticulatory organs and orofacial dormancy, improvements and evidences of adequacy of oral functions were observed. It can be concluded that, although some patients still show changes, the rehabilitation promoted significant improvements in the clinical condition and quality of life of the individuals of the study group.

Evaluación de los síntomas de ansiedad y depresión en fibromiálgicos

Se objetivo identificar la frecuencia de sintomas de ansiedad y depresion y verificar la asociacion entre ansiedad-rasgo y sintomas actuales de depresion y ansiedad en fibromialgicos. Fueron entrevistados 60 sujetos con diagnostico de fibromialgia en Ambulatorio de Reumatologia de Universidad Federal de Sergipe, de agosto 2007 a marzo 2008. Se aplicaron dos cuestionarios: Escala Hospitalaria de Ansiedad y Depresion (EHAD) e Inventario de Ansiedad Rasgo-Estado (IDATE-T). La frecuencia de sintomas depresivos y ansiosos fue, respectivamente, 50% y 86% para los fibromialgicos y el promedio de puntaje del rasgo ansioso fue de 59,38. Se observo asociacion entre ansiedad-rasgo y estado. La ansiedad y la depresion fueron sintomas frecuentes en pacientes con fibromialgia. Entretanto, la ansiedad fue un sintoma secundario mas frecuente que la depresion y se presento de forma mas grave, resultando una comorbilidad que necesita ser mas valorizada y estudiada.The objective of this study was to identify the frequency of anxiety and depression symptoms by verifying the association between anxiety traits, current depression and anxiety symptoms in fibromyalgia patients. Interviews were performed with 60 subjects diagnosed with fibromyalgia at the Rheumatology Outpatient Clinic at Universidade Federal de Sergipe between August 2007 and March 2008, in which two questionnaires were administered: the Hospital Anxiety and Depression Scale (HADS) and the State-Trait Anxiety Inventory (STAI). The frequency of anxiety and depression symptoms was, respectively, 50% and 86% for individuals with fibromyalgia, and the mean trait-anxiety score was 59.38. An association was observed between trait and state anxiety. Anxiety and depression were frequent symptoms among patients with fibromyalgia. However, anxiety appeared as a secondary symptom to depression, appearing in a more severe form, and, therefore, this comorbidity should be more valued and studied.