Leopoldo Luiz dos Santos Neto

Avaliação prospectiva da qualidade de vida em uma coorte de pacientes com artrite reumatoide inicial

INTRODUCTION Few studies have prospectively assessed the tools used to measure quality of life, both generic and specific, in patients with early rheumatoid arthritis (RA). OBJECTIVE The objective of this study was to characterize a population of patients with early RA (less than 12 months after symptom onset at the time of the diagnosis) prospectively followed for the pattern of responses to questionnaires addressing quality of life, the Health Assessment Questionnaire (HAQ) and Medical Outcomes Study SF-36 Health Survey (SF-36). PATIENTS AND METHODS Forty patients with early RA at the time of diagnosis, treated with a standard treatment regimen, were prospectively followed for 3 years. Demographic and clinical data were recorded, and HAQ and SF-36 questionnaires were applied at baseline and after 3, 6, 12, 18, 24, and 36 months. Paired Student t test and Wilcoxon test were used for comparisons (significance level of 5%). RESULTS The mean age was 45 years, with a prevalence of the female gender (90%). The average score of the initial HAQ was 1.89, with a progressive decline to 0.77 in the third year (P < 0.0001). Most domains of the SF-36 questionnaire presented significant improvement during the three years of follow-up, except for general health and vitality. CONCLUSION In this population of patients with early RA at the time of diagnosis, the results showed significant impact on quality of life at the time of diagnosis, as measured by HAQ and SF-36 questionnaires. The early treatment of RA seems to be associated with improved health-related quality of life reported by patients.

Frequency of sexual dysfunction in women with rheumatic diseases.

OBJECTIVE To assess the prevalence of sexual dysfunction in women followed up at the Rheumatology Outpatient Clinic of the Hospital Universitário de Brasília and of the Hospital das Clínicas da Universidade de São Paulo with the following rheumatic diseases: systemic lupus erythematosus; rheumatoid arthritis; systemic sclerosis; antiphospholipid antibody syndrome; and fibromyalgia. METHODS The Female Sexual Function Index (FSfi), obtained by applying a 19-item questionnaire that assesses six domains (sexual desire, arousal, vaginal lubrication, orgasm, sexual satisfaction and pain), was used. RESULTS This study assessed 163 patients. The mean age was 40.4 years. The prevalence of sexual dysfunction was 18.4%, but 24.2% of the patients reported no sexual activity over the past 4 weeks. Patients with fibromyalgia and systemic sclerosis had the highest sexual dysfunction index (33%). Excluding patients with no sexual activity, the sexual dysfunction rate reaches 24.2%. CONCLUSION The prevalence of sexual dysfunction found in this study was lower than that reported in the literature. However, 24.2% of the patients interviewed reported no sexual activity over the past 4 weeks, which might have contributed to the low sexual dysfunction index found.

Autoantibodies and other serological markers in rheumatoid arthritis: predictors of disease activity?

The description of potential serological markers of rheumatoid arthritis (RA) activity can be quite useful in optimizing RA treatment, since the laboratory markers currently used, namely erythrocyte sedimentation rate and C-reactive protein, are not specific for RA and are influenced by several other variables. The markers proposed for assessing RA activity include rheumatoid factor, anti-citrullinated protein/peptide antibodies, immunoglobulin M (IgM) anti-IgG advanced glycation end products, markers of bone/cartilage metabolism, mannose-binding lectin, E-selectin, interleukin-6, and leptin. Various studies have investigated the correlation between some of these markers and other variables that might indicate disease activity, e.g., inflammatory activity tests and disease activity scores. However, there is as yet insufficient evidence that any of these markers, in isolation or in combination, are useful in the assessment of RA activity.The description of potential serological markers of rheumatoid arthritis (RA) activity can be quite useful in optimizing RA treatment, since the laboratory markers currently used, namely erythrocyte sedimentation rate and C-reactive protein, are not specific for RA and are influenced by several other variables. The markers proposed for assessing RA activity include rheumatoid factor, anti-citrullinated protein/peptide antibodies, immunoglobulin M (IgM) anti-IgG advanced glycation end products, markers of bone/cartilage metabolism, mannose-binding lectin, E-selectin, interleukin-6, and leptin. Various studies have investigated the correlation between some of these markers and other variables that might indicate disease activity, e.g., inflammatory activity tests and disease activity scores. However, there is as yet insufficient evidence that any of these markers, in isolation or in combination, are useful in the assessment of RA activity.

Artrite reumatoide inicial: conceitos

Generalization of the concept of early rheumatoid arthritis -RA and existence of a window of therapeutic opportunity, the period when appropriate therapy for this disease would determine clinical improvement, led to the concept that early diagnosis and treatment can change the diseases course. Currently, the goal is to evaluate patients with joint symptoms at the earliest opportunity. Definition of the initial phase of RA includes the first few weeks or months of symptoms (usually less than 12 months), and the first 12 weeks of symptoms of very early or initial RA are considered to be the critical period. Although all patients require early assessment and treatment, there are specific reasons for the involvement of a specialist soon in the evaluation of patients with early RA, since the inflammation that characterizes the disease should be treated as soon as possible. Failure to diagnose or treat a patient with RA at the very early stage of the disease increases the risk of progression to persistent joint inflammation and damage. On the other hand, aggressively treating patients with mild arthritis, which probably will not evolve to erosive forms is equally damaging. It exposes patients to risk without proven benefits and represents the opposite of effective early treatment. Therefore, within the current concept of a window of opportunity, early diagnosis of RA is essential and to establish, as soon as possible those patients who will progress to more severe forms, and therefore require more aggressive therapy.

Frequência de disfunção sexual em mulheres com doenças reumáticas

OBJECTIVE: To assess the prevalence of sexual dysfunction in women followed up at the Rheumatology Outpatient Clinic of the Hospital Universitario de Brasilia and of the Hospital das Clinicas da Universidade de Sao Paulo with the following rheumatic diseases: systemic lupus erythematosus; rheumatoid arthritis; systemic sclerosis; antiphospholipid antibody syndrome; and fibromyalgia. METHODS: The Female Sexual Function Index (FSfi), obtained by applying a 19-item questionnaire that assesses six domains (sexual desire, arousal, vaginal lubrication, orgasm, sexual satisfaction and pain), was used. RESULTS: This study assessed 163 patients. The mean age was 40.4 years. The prevalence of sexual dysfunction was 18.4%, but 24.2% of the patients reported no sexual activity over the past 4 weeks. Patients with fibromyalgia and systemic sclerosis had the highest sexual dysfunction index (33%). Excluding patients with no sexual activity, the sexual dysfunction rate reaches 24.2%. CONCLUSION: The prevalence of sexual dysfunction found in this study was lower than that reported in the literature. However, 24.2% of the patients interviewed reported no sexual activity over the past 4 weeks, which might have contributed to the low sexual dysfunction index found.

Incapacitação e qualidade de vida não são influenciadas pela prevalência de autoanticorpos em pacientes com artrite reumatoide inicial - resultados da Coorte Brasília

INTRODUCTION Although many studies have suggested that the presence of autoantibodies, such as rheumatoid factor (RF) and/or anti-cyclic citrullinated peptide (anti-CCP) in rheumatoid arthritis (RA) are predictors of joint damage, the association with disability and quality of life questionnaires are not known. OBJECTIVES To evaluate the correlation between the Health Assessment Questionnaire (HAQ) and the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) scores with serological markers, such as RF, anti-CCP, and anti-citrullinated vimentin (anti-Sa). PATIENTS AND METHODS Sixty five patients with early RA (ERA) from the Brasília Cohort of ERA were evaluated. Serology tests (ELISA) for RF (IgM, IgG, and IgA), anti-CCP (CCP2, CCP3, and CCP3.1), and anti-Sa were performed, with the application of the HAQ and SF-36 questionnaires in the initial evaluation. RESULTS The mean age was 45 years, with a female predominance (86%). At the initial evaluation, RF was positive in 32 individuals (49.23%), anti-CCP in 34 (52.3%), and anti-Sa in nine (13.8%). The initial HAQ score was 1.8. The SF-36 scores were as follow: role-emotional, 19.3; social functioning, 43.1; bodily pain, 25.43; general health, 57.6; mental health, 48.1; vitality, 49.5; role-physical, 4.6; and physical functioning, 24.7. The HAQ and SF-36 scores did not vary with autoantibody levels. CONCLUSION In many patients, ERA has a major impact on physical ability and health-related quality of life. Although RF and anti-CCP tests have been related with joint destruction and worse clinical prognosis, there is no correlation with the results of questionnaires of quality of life and disability.

Comportamento distinto dos sorotipos do fator reumatoide em avaliação seriada de pacientes com artrite reumatoide inicial

INTRODUCAO: O fator reumatoide (FR), apesar de suas limitacoes, ainda e o marcador sorologico mais utilizado para diagnostico da artrite reumatoide (AR) inicial. Ha controversias sobre sensibilidade, especificidade, correlacao com prognostico radiologico e variacao ao longo do tempo dos titulos dos sorotipos IgG, IgM e IgA. OBJETIVO: Avaliar o comportamento dos diferentes sorotipos de FR (IgG, IgM e IgA), em avaliacoes seriadas, e sua correlacao com a ocorrencia de erosoes radiograficas. PACIENTES E METODOS: Foram avaliados 40 pacientes com o diagnostico de AR inicial (menos de 12 meses de sintomas) durante tres anos de acompanhamento. A titulacao dos sorotipos de FR foi feita por ELISA, na avaliacao inicial, e seriadamente ao longo de 36 meses. Aplicou-se um modelo de regressao de efeitos mistos, considerando-se como desfecho a ocorrencia de erosoes radiograficas (radiografia de maos e punhos, pes e tornozelos anuais). RESULTADOS: Na avaliacao inicial, 30%, 42,5% e 50% dos pacientes foram positivos para FR IgG, IgA e IgM, respectivamente. Os titulos de FR IgA e FR IgM foram maiores nos pacientes que apresentaram erosoes radiograficas durante o acompanhamento (10-220 UI/dL contra 0 a 10 UI/dL nos pacientes sem erosoes, P < 0,05). Os titulos de FR IgM e IgG nao variaram ao longo dos tres anos de acompanhamento. Por outro lado, em relacao aos titulos de FR IgA houve uma tendencia linear positiva ascendente significativa (P = 0,0013) apenas no grupo que apresentou erosoes radiograficas. CONCLUSAO: 1) Pesquisa dos sorotipos FR IgA e FR IgG nao aumenta a frequencia de positividade do FR e, portanto, nao contribui para o diagnostico de AR; 2) a estabilidade observada do FR IgM ao longo do tempo nao justifica solicitacoes repetidas do FR durante a evolucao da AR; 3) titulos mais altos de FR IgA e FR IgM sao observados nos pacientes mais graves, com erosoes radiograficas; 4) FR IgA apresenta um comportamento claramente distinto nos pacientes que apresentam ou nao erosoes radiograficas, o que pode ter implicacoes na fisiopatogenia e na avaliacao prognostica da doenca.

Princípios gerais do tratamento da artrite reumatoide inicial

The main goals of the treatment of a patient with RA are: to reduce pain, joint swelling and constitutional symptoms such as fatigue, to improve joint function, stop progression of bone-cartilage damage , prevent disabilities and reduce morbidity and mortality. In recent years, the therapeutic concept of early RA (first 12 months of symptoms) has undergone major changes. Three aspects in particular have become the basis of the new treatment paradigm: early diagnosis, immediate beginning of Disease Modifying Antirheumatic Drugs therapy (DMARD) and strict control of the inflammatory activity. In this article, the authors review the general principles of management of patients with early RA.

Lingual tonsil pseudolymphoma and obstructive sleep apnea

Lingual tonsils are the most neglec-ted element of Waldeyer’s ring; they cannot be visualized in a plain oropharyngeal examination. Lingual tonsillar hypertrophy (LTH) is frequently asymptomatic and underdiagnosed, but may be associated with obstructive sleep apnea (OSA); it is also included in the differential diagnosis of tongue base lymphoma.

Avaliação da capacidade funcional em pacientes com artrite reumatoide: implicações para a recomendação de exercícios físicos

Rheumatoid arthritis (RA) is an autoimmune disease characterized by chronic symmetric polyarthritis of large and small joints and by morning stiffness that may lead to musculoskeletal impairment, with functional impotence. The concept of functionality relates to the ability of an individual to perform effectively and independently daily activities and tasks of everyday life. The aim of this review is to familiarize the rheumatologist with the concept of functional capacity evaluation and with the tests that can be applied in this population, as these are important steps for a proper exercise prescription. From functional tests already used in the elderly population, the Physical Fitness and Rheumatology Laboratory - LAR - Brasilia, which is accompanying patients from Brasilia Cohort of Early Rheumatoid Arthritis, describes in this article a protocol of tests to assess functional capacity for application in patients with RA, including the description of tests: 1) Sit and Reach; 2) Agility/Dynamic Balance; 3) Manual Dynamometry; 4) Sit Back and Lift; 5) Biceps Curl and 6) Six-minute Walk Test.