Maria Bernadete Renoldi de Oliveira Gavi

Strengthening exercises improve symptoms and quality of life but do not change autonomic modulation in fibromyalgia: a randomized clinical trial.

Objective Autonomic dysfunction is an important mechanism that could explain many symptoms observed in fibromyalgia (FM). Exercise is an effective treatment, with benefits potentially mediated through changes in autonomic modulation. Strengthening is one of the less studied exercises in FM, and the acute and chronic effects of strengthening on the autonomic system remain unknown. The objective of this study was to assess the chronic effects of strengthening exercises (STRE) on autonomic modulation, pain perception and the quality of life (QOL) of FM patients. Methods Eighty sedentary women with FM (ACR 1990) were randomly selected to participate in STRE or flexibility (FLEX) exercises in a blinded controlled trial. The intensity of STRE was set at 45% of the estimated load of 1 Repetition Maximum (RM) in 12 different exercises. Outcomes were Visual Analog Scale (VAS) for pain, Heart Rate Variability (HRV) analysis, treadmill test, the sit and reach test (Wells and Dillon’s Bench), maximal repetitions test and handgrip dynamometry; and quality of life by the Fibromyalgia Impact Questionnaire (FIQ), the Beck and Idate Trait-State Inventory (IDATE), a short-form health survey (SF-36). Results The STRE group was more effective to strength gain for all muscles and pain control after 4 and 16 weeks (p<0.05). The FLEX group showed higher improvements in anxiety (p<0.05). Both groups showed improvements in the QOL, and there was no significant difference observed between the groups. There was no change in the HRV of the STRE and FLEX groups. Conclusions Strengthening exercises show greater and more rapid improvements in pain and strength than flexibility exercises. Despite the benefits in fitness, pain, depression, anxiety and quality of life, no effect was observed on the autonomic modulation in both groups. This observation suggests that changes in autonomic modulation are not a target tobe clinically achieved in fibromyalgia. Trial Registration ClinicalTrials.gov NCT02004405

Gender characterization in a large series of Brazilian patients with spondyloarthritis

An increasing number of women have been diagnosed with spondyloarthritis (SpA) in recent decades. While a few studies have analyzed gender as a prognostic factor of the disease, no studies have addressed this matter with a large number of patients in South America, which is a peculiar region due to its genetic heterogeneity. The aim of the present study was to analyze the influence of gender on disease patterns in a large cohort of Brazilian patients with SpA. A prospective study was carried out involving 1,505 patients [1,090 males (72.4%) and 415 females (27.6%)] classified as SpA according to the European Spondyloarthropaties Study Group criteria who attended at 29 reference centers for rheumatology in Brazil. Clinical and demographic variables were recorded and the following disease indices were administered: Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Radiologic Index (BASRI), Maastricht Ankylosing Spondylitis Enthesitis Score (MASES), and Ankylosing Spondylitis Quality of Life (ASQoL). Ankylosing spondylitis (AS) was the most frequent disease in the group (65.4%), followed by psoriatic arthritis (18.4%), undifferentiated SpA (6.7%), reactive arthritis (3.3%), arthritis associated to inflammatory bowel disease (3.2%), and juvenile SpA (2.9%). The male-to-female ratio was 2.6:1 for the whole group and 3.6:1 for AS. The females were older (p < 0.001) and reported shorter disease duration (p = 0.002) than the male patients. The female gender was positively associated to peripheral SpA (p < 0.001), upper limb arthritis (p < 0.001), dactylitis (p = 0.011), psoriasis (p < 0.001), nail involvement (p < 0.001), and family history of SpA (p = 0.045) and negatively associated to pure axial involvement (p < 0.001), lumbar inflammatory pain (p = 0.042), radiographic sacroiliitis (p < 0.001), and positive HLA-B27 (p = 0.001). The number of painful (p < 0.001) and swollen (p = 0.006) joints was significantly higher in the female gender, who also achieved higher BASDAI (p < 0.001), BASFI (p = 0.073, trend), MASES (p = 0.019), ASQoL (p = 0.014), and patient’s global assessment (p = 0.003) scores, whereas the use of nonsteroidal anti-inflammatory drugs (p < 0.001) and biological agents (p = 0.003) was less frequent in the female gender. Moreover, BASRI values were significantly lower in females (p < 0.001). The female gender comprised one third of SpA patients in this large cohort and exhibited more significant peripheral involvement and less functional disability, despite higher values in disease indices.

Ethnic Influence in Clinical and Functional Measures of Brazilian Patients with Spondyloarthritis

Objective. Spondyloarthritides (SpA) can present different disease spectra according to ethnic background. The Brazilian Registry of Spondyloarthritis (RBE) is a nationwide registry that comprises a large databank on clinical, functional, and treatment data on Brazilian patients with SpA. The aim of our study was to analyze the influence of ethnic background in SpA disease patterns in a large series of Brazilian patients. Methods. A common protocol of investigation was prospectively applied to 1318 SpA patients in 29 centers distributed through the main geographical regions in Brazil. The group comprised whites (65%), African Brazilians (31.3%), and people of mixed origins (3.7%). Clinical and demographic variables and various disease index scores were compiled. Ankylosing spondylitis (AS) was the most frequent disease in the group (65.1%); others were psoriatic arthritis (18.3%), undifferentiated SpA (6.8%), enteropathic arthritis (3.7%), and reactive arthritis (3.4%). Results. White patients were significantly associated with psoriasis (p = 0.002), positive HLA-B27 (p = 0.014), and use of corticosteroids (p < 0.0001). Hip involvement (p = 0.02), axial inflammatory pain (p = 0.04), and radiographic sacroiliitis (p = 0.025) were associated with African Brazilian descent. Sex distribution, family history, and presence of peripheral arthritis, uveitis, dactylitis, urethritis, and inflammatory bowel disease were similar in the 3 groups, as well as age at disease onset, time from first symptom until diagnosis, and use of anti-tumor necrosis factor-α agents (p > 0.05). Schober test and thoracic expansion were similar in the 3 groups, whereas African Brazilians had higher Maastricht Ankylosing Spondylitis Enthesitis Scores (p = 0.005) and decreased lateral lumbar flexion (p = 0.003), while whites had a higher occiput-to-wall distance (p = 0.02). African Brazilians reported a worse patient global assessment of disease (p = 0.011). Other index scores and prevalence of work incapacity were similar in the 3 groups, although African Brazilians had worse performance in the Ankylosing Spondylitis Quality of Life questionnaire (p < 0.001). Conclusion. Ethnic background is associated with distinct clinical aspects of SpA in Brazilian patients. African Brazilian patients with SpA have a poorer quality of life and report worse disease compared to whites.

Representações sociais de conjugalidade e fibromialgia: desdobramentos na dinâmica conjugal

Fibromyalgia consists of a disease characterized among other symptoms by widespread pain, fatigue, non-restorative sleep, and complex uncertain etiology and response to treatment. Such characteristicsFibromyalgia consists of a disease characterized among other symptoms by widespread pain, fatigue, non-restorative sleep, and complex uncertain etiology and response to treatment. Such characteristics 1 Endereço para correspondência: Universidade Federal do Espírito Santo, Avenida Fernando Ferrari, 514, Goiabeiras, Vitória, ES, Brasil 29075-910. E-mail: danielle_cfm@yahoo.com.br, priscillamartinssilva@gmail. com, mbernadetegavi@gmail.com e anapaula083@yahoo.com.br Macedo, D. C. F., Martins-Silva, P. O., Gavi, M. B. R. O., Macedo, A. P. D. 988 may precipitate the emergence of feelings of vulnerability capable of impacting the familiar routine of patients. Therefore, this study aims to understand and analyze, from the perspective of Social Psychology, such as social representations (SR) of women with fi bromyalgia and their spouses on conjugality and about the condition of illness are linked to their marital dynamic. This is a qualitative study that conducted interviews with four couples in which the wives are diagnosed with fi bromyalgia. Participants also completed a sociodemographic questionnaire. For the data analysis was employed the technique of content analysis which unveiled an extensive network of meanings accessed by participants in the processes of anchoring of RS of fi bromyalgia and conjugality, containing elements such as: the love; the male and female roles; the sick and caring; the fi bromyalgia and its consequences in the routine of the patient and his family. Finally, we found the existence of a fi eld of fragility of women with fi bromyalgia and those close to them in the process of coping with the disease. Necessary to make the health care act early in information about the disease and the identifi cation of possible confl icts in family and marital framework that can be triggered both in the diagnostic investigation and in the course of treatment and the particularities of daily living with the disease.

Representaciones sociales del matrimonio y la fibromialgia: desarrollos en la dinámica conyugal

Fibromyalgia consists of a disease characterized among other symptoms by widespread pain, fatigue, non-restorative sleep, and complex uncertain etiology and response to treatment. Such characteristicsFibromyalgia consists of a disease characterized among other symptoms by widespread pain, fatigue, non-restorative sleep, and complex uncertain etiology and response to treatment. Such characteristics 1 Endereço para correspondência: Universidade Federal do Espírito Santo, Avenida Fernando Ferrari, 514, Goiabeiras, Vitória, ES, Brasil 29075-910. E-mail: danielle_cfm@yahoo.com.br, priscillamartinssilva@gmail. com, mbernadetegavi@gmail.com e anapaula083@yahoo.com.br Macedo, D. C. F., Martins-Silva, P. O., Gavi, M. B. R. O., Macedo, A. P. D. 988 may precipitate the emergence of feelings of vulnerability capable of impacting the familiar routine of patients. Therefore, this study aims to understand and analyze, from the perspective of Social Psychology, such as social representations (SR) of women with fi bromyalgia and their spouses on conjugality and about the condition of illness are linked to their marital dynamic. This is a qualitative study that conducted interviews with four couples in which the wives are diagnosed with fi bromyalgia. Participants also completed a sociodemographic questionnaire. For the data analysis was employed the technique of content analysis which unveiled an extensive network of meanings accessed by participants in the processes of anchoring of RS of fi bromyalgia and conjugality, containing elements such as: the love; the male and female roles; the sick and caring; the fi bromyalgia and its consequences in the routine of the patient and his family. Finally, we found the existence of a fi eld of fragility of women with fi bromyalgia and those close to them in the process of coping with the disease. Necessary to make the health care act early in information about the disease and the identifi cation of possible confl icts in family and marital framework that can be triggered both in the diagnostic investigation and in the course of treatment and the particularities of daily living with the disease.

Social representations of marriage and fibromyalgia: developments in marital dynamics

Fibromyalgia consists of a disease characterized among other symptoms by widespread pain, fatigue, non-restorative sleep, and complex uncertain etiology and response to treatment. Such characteristicsFibromyalgia consists of a disease characterized among other symptoms by widespread pain, fatigue, non-restorative sleep, and complex uncertain etiology and response to treatment. Such characteristics 1 Endereço para correspondência: Universidade Federal do Espírito Santo, Avenida Fernando Ferrari, 514, Goiabeiras, Vitória, ES, Brasil 29075-910. E-mail: danielle_cfm@yahoo.com.br, priscillamartinssilva@gmail. com, mbernadetegavi@gmail.com e anapaula083@yahoo.com.br Macedo, D. C. F., Martins-Silva, P. O., Gavi, M. B. R. O., Macedo, A. P. D. 988 may precipitate the emergence of feelings of vulnerability capable of impacting the familiar routine of patients. Therefore, this study aims to understand and analyze, from the perspective of Social Psychology, such as social representations (SR) of women with fi bromyalgia and their spouses on conjugality and about the condition of illness are linked to their marital dynamic. This is a qualitative study that conducted interviews with four couples in which the wives are diagnosed with fi bromyalgia. Participants also completed a sociodemographic questionnaire. For the data analysis was employed the technique of content analysis which unveiled an extensive network of meanings accessed by participants in the processes of anchoring of RS of fi bromyalgia and conjugality, containing elements such as: the love; the male and female roles; the sick and caring; the fi bromyalgia and its consequences in the routine of the patient and his family. Finally, we found the existence of a fi eld of fragility of women with fi bromyalgia and those close to them in the process of coping with the disease. Necessary to make the health care act early in information about the disease and the identifi cation of possible confl icts in family and marital framework that can be triggered both in the diagnostic investigation and in the course of treatment and the particularities of daily living with the disease.