Lucila Stange Rezende

Registro brasileiro de biológicos: processo de implementação e resultados preliminares do BiobadaBrasil

OBJETIVOS: O presente estudo teve por objetivo descrever o processo de implementacao de um registro nacional em um pais em desenvolvimento (Brasil) e relatar os principais resultados preliminares do registro BiobadaBrasil. MATERAL E METODOS: Atraves de um acordo com a PANLAR, o protocolo Biobadaser foi utilizado como modelo para a implementacao de um novo registro no nosso pais. Durante os dois primeiros anos desse esforco, o protocolo original foi adaptado, traduzido e apresentado a todos os reumatologistas brasileiros. Durante dez meses, dados de 1.037 pacientes (750 tratados com biologicos e 287 controles) de 15 centros foram coletados. RESULTADOS: A maioria dos pacientes tinha artrite reumatoide (AR) (n = 723). Infliximabe foi o agente anti-TNF mais usado, e a exposicao total a biologicos foi 2.101 pacientes-ano. A razao mais comum para suspensao da droga foi ineficiencia ou perda de efetividade (50%), e 30% dos pacientes interromperam o tratamento devido a eventos adversos. Tres casos de tuberculose foram observados no grupo biologico, representando maior incidencia do que aquela da populacao brasileira geral. Infeccoes foram observadas em 23% dos pacientes do grupo biologico, sendo o trato respiratorio superior o local mais comumente afetado. Apenas um caso de hanseniase tuberculoide foi observado. Nenhuma morte nem malignidade atribuivel ao efeito dos medicamentos foi observada ate fevereiro de 2010. CONCLUSOES: A implementacao do registro foi bem sucedida. Embora recente, o registro BiobadaBrasil ja forneceu importantes dados.

2012 Brazilian Society of Rheumatology Consensus on vaccination of patients with rheumatoid arthritis

OBJECTIVE To elaborate recommendations to the vaccination of patients with rheumatoid arthritis (RA) in Brazil. METHOD Literature review and opinion of expert members of the Brazilian Society of Rheumatology Committee of Rheumatoid Arthritis and of an invited pediatric rheumatologist. RESULTS AND CONCLUSIONS The following 12 recommendations were established: 1) Before starting disease-modifying anti-rheumatic drugs, the vaccine card should be reviewed and updated; 2) Vaccines against seasonal influenza and against H1N1 are indicated annually for patients with RA; 3) The pneumococcal vaccine should be indicated for all patients with RA; 4) The vaccine against varicella should be indicated for patients with RA and a negative or dubious history for that disease; 5) The HPV vaccine should be considered for adolescent and young females with RA; 6) The meningococcal vaccine is indicated for patients with RA only in the presence of asplenia or complement deficiency; 7) Asplenic adults with RA should be immunized against Haemophilus influenzae type B; 8) An additional BCG vaccine is not indicated for patients diagnosed with RA; 9) Hepatitis B vaccine is indicated for patients with RA who are negative for antibodies against HBsAg; the combined hepatitis A and B vaccine should be considered; 10) Patients with RA and at high risk for tetanus, who received rituximab in the preceding 24 weeks, should undergo passive immunization with tetanus immunoglobulin in case of exposure; 11) The YF vaccine is contraindicated to patients with RA on immunosuppressive drugs; 12) The above described recommendations should be reviewed over the course of RA.

Consenso 2012 da Sociedade Brasileira de Reumatologia sobre vacinação em pacientes com artrite reumatoide

OBJECTIVE: To elaborate recommendations to the vaccination of patients with rheumatoid arthritis (RA) in Brazil. METHOD: Literature review and opinion of expert members of the Brazilian Society of Rheumatology Committee of Rheumatoid Arthritis and of an invited pediatric rheumatologist. RESULTS AND CONCLUSIONS: The following 12 recommendations were established: 1) Before starting disease-modifying anti-rheumatic drugs, the vaccine card should be reviewed and updated; 2) Vaccines against seasonal influenza and against H1N1 are indicated annually for patients with RA; 3) The pneumococcal vaccine should be indicated for all patients with RA; 4) The vaccine against varicella should be indicated for patients with RA and a negative or dubious history for that disease; 5) The HPV vaccine should be considered for adolescent and young females with RA; 6) The meningococcal vaccine is indicated for patients with RA only in the presence of asplenia or complement deficiency; 7) Asplenic adults with RA should be immunized against Haemophilus influenzae type B; 8) An additional BCG vaccine is not indicated for patients diagnosed with RA; 9) Hepatitis B vaccine is indicated for patients with RA who are negative for antibodies against HBsAg; the combined hepatitis A and B vaccine should be considered; 10) Patients with RA and at high risk for tetanus, who received rituximab in the preceding 24 weeks, should undergo passive immunization with tetanus immunoglobulin in case of exposure; 11) The YF vaccine is contraindicated to patients with RA on immunosuppressive drugs; 12) The above described recommendations should be reviewed over the course of RA.

A relevância da dosagem do hormônio estimulante da tireóide em pacientes com fibromialgia

A fibromialgia (FM) e uma sindrome reumatologica nao-inflamatoria e nao-auto-imune caracterizada por dores musculoesqueleticas generalizadas cronicas, frequentemente acompanhadas por alteracao do sono (sono nao restaurador) e por fadiga. As alteracoes tireoideanas, especialmente o hipotireoidismo, podem apresentar como caracteristicas clinicas sinais e sintomas inespecificos como cansaco, fraqueza, pele seca, dificuldade em concentrar-se e deficit de memoria, parestesias, ganho de peso, intolerância ao frio, dores vagas, constipacao, dentre outros, que se assemelham a algumas das manifestacoes da FM, com excecao a presenca dos tender points, caracteristicos da ultima.

Infliximabe no tratamento de uveíte posterior refratária em paciente com doença de Behçet

Permanent vision loss resulting from relapsing ocular inflammation occurs frequently in patients with Behcets disease, despite intensive and chronic immunosuppressive therapy. The authors report the case of a 35-year-old man with chronic bilateral posterior uveitis refractory to corticosteroids and immunosuppressive agents (methotrexate and cyclosporine) with a beneficial effect from treatment with infliximab.

SAT0585 Barriers To T2T Implementation: RA Patient's Perspectives about Comorbidities and Structural Damage in Therapeutic Decisions

Background T2T strategies have been largely recognized and incorporated in national guidelines. Structural changes, functional impairment and comorbidities should be considered along with RA disease activity state when making therapeutic decisions. Objectives To evaluate patients perspectives on the interference of comorbidities and structural changes/functional impairment in treatment decisions. Methods RA patients (1987 criteria) in regular follow-up were recruited from community (private practice) and academic public medical centers by 11 investigators in different urban and rural areas of the country. Structured questionnaires were applied and socio-demographics, disease activity and treatment data were collected. The focus of this study was two main questions: a) In your opinion, other diseases that you have can change the arthritis treatment? b) Do you think that having deformities modify your treatment? Affirmative answers would be followed by more specific questions. Statistical analysis: ANOVA or Kruskal-Wallis; Fisher or Fisher-Freeman-Halton (FFH) as needed; p<0.05. Data expressed as % [95%CI} or mean (SD). Results 485 RA patients were included, 89.7% females, mean age 52.3 (13.8) years, 8.0 (5.2) years of education; 32.4% in use of biologics and 28.3% in private practice. Less than 40% of the patients considered that any of these conditions influenced the treatment. Deformities, surrogate for structural damage, were considered to imply in more severe disease or more pain and medications by respectively 54.8% and 34% of the positive responders (n=177); these patients were more frequently living in the northwest area (60.2vs 31.7%; =0.0001; [16.2–40]), were from higher socio-economic level (43.2vs30.2%; p=0.0001; [4,1–21.7]), younger (49.4 (12.3) vs 54.3 (12,7); p<0,001) and with shorter disease duration (median 8.0 (range4.0–15) vs 12 (6.0–19); p<0.001). Regarding comorbidities, there were 39.4% (n=191) positive answers, predominantly from younger patients [51.3 (13.1) vs 54.5 (11.6); p<0.003]. The patients from private system (80.3 vs 56.3%;p=0.0004; [9.3–36.7]) and higher socio-economic level (71.8 vs55%; p=0.01;[2.9–30.1]), as well as patients with more schooling years (p<0.001) and shorter disease duration (p<0.041) worried that comorbidities could hinder the choice of arthritis medication, while some patients from public service (25.5vs9.8%;p=0,01;[3.2–25.8]) and low socio-economic levels (14 vs 1.99%;p=0,001;[4.1–20.6]) had concerns about too many pills. Conclusions patients skepticism about comorbidities or structural changes interfering with their therapeutic decisions is prevalent and needs to be addressed. Disclosure of Interest None declared

THU0184 Patients Centered Barriers to Treat to Target (T2T) Implementation

Background Despite being a sound treatment strategy, T2T still faces barriers to implementation. Objectives To analyze the barriers to T2T implementation from patients perspective, including associations with socio-economic cultural background and disease activity status. Methods A structured questionnaire addressing main points of T2T strategy was applied to 485 RA patients (1987 criteria) from private and public hospitals in different regions of Brazil, Importante points were repeated in different phrased questions. Social-economic-cultural status (Graffar scale), medication in use, demographic and disease activity data were collected. Association between categorical and continuous variables – mean (SD) – tested by ANOVA or Kruskal-Wallis, between categorical variables by Fisher or Fisher-Freeman-Halton (FFH); p<0,05. Results Population: 485 patients, 89.7% female, age 52.3 (13,8) yrs, disease duration 11.5 (8.9) yrs, years of study 8.0 (5.2) yrs. Willingness to learn about RA and to share treatment decisions were prevalent, reported by more than 90% although only 64.1% actively searched for disease information. Higher social-economical levels (p=0.001), years of study (p=0.01), age (p=0.02), and private consultations (p=0,006) were significantly associated with active search of information. Desire to know the aim of the treatment (97.1% of the patients) was unrelated to any parameter studied. In general, the rheumatologist is source of information of about 80% of the patients and this search of information was associated with higher disease activity (p=0,012). Neither friends nor Brazilian Society of Rheumatology were routinely used as means of information about AR. Shared treatment decisions appealed to more than 90% of the patients unrelated to social-economic-cultural, private practice or RA activity. Knowledge of treatments, desire to discuss and share decisions, private practice were associated to use of biologics (p=0.04) but not DMARDs. Monthly consultations (while RA in high activity) were accepted by 84.3% of the patients and it was considered useful for disease activity control by 79%, althought male pacientes were less enthusiastic vs females (70 vs 86%), with 12,5% of them considering frequent visits of no use. Private or public service also affected the agreement with frequent visits (respectively 71.3 vs 89.9). Composite index of disease activity was considered useful by 64.3%, but negatively perceived by patients in private practice (33,1% considered their perception more accurate), however joint exam in all visits received 90% of approval and was considered useful for disease control by 71,6% of the patients, independently of age,sex, medication and socio-economic background. Conclusions Patients barriers to T2T implementation are less prevalent than expected. Shared decisions and frequent disease activity evaluations were supported for most patients. Social-economic-cultural factors had a discrete impact. Unmet need was to provide information about RA outside the direct contact physitian-patient. Disclosure of Interest None declared

Sinovite hipertrófica familiar

Familial hyperthrophic synovitis is a rare condition, of familial origin, that must be remembered in the differential diagnosis of childhood arthritis. The authors report a case of a 7 years old boy with flexion finger deformities and painless joint effusion of the large joints since birth, without systemic involvement. The patient has a cousin with similar manifestations.