Marilia Barreto Silva

Anti-cyclic citrullinated peptide antibodies and rheumatoid factor in rheumatoid arthritis patients and relatives from Brazil

OBJECTIVES To evaluate the prevalence of anti-cyclic citrullinated peptide (anti-CCP) antibodies and RF in RA patients and their relatives from Southern Brazil. METHODS Anti-CCP2 and IgM-RF were evaluated in 156 RA patients and 200 relatives. Sera from 100 healthy unrelated individuals were used as control. The anti-CCP2 was detected by ELISA and the IgM-RF using the latex agglutination test. RESULTS We identified 117 anti-CCP2 (75%)-positive and 106 RF (67.9%)-positive patients. Anti-CCP2 was increased in relatives (5.5%; 11/200) when compared with unrelated individuals (1%; P = 0.050). Titre of anti-CCP2 in RA patients did not differ from relatives [140.4 (75.7) vs 115.6 (84.2) U, respectively; P = 0.30]. Positive relatives were younger than patients for anti-CCP2 (P = 0.0081), RF (P < 0.001) and both concomitantly (P = 0.012), and although there was no difference for anti-CCP2 positivity according to gender, increased RF positivity and concomitant anti-CCP2/RF were observed in the female relatives (P = 0.067 and 0.082, respectively). No difference regarding the relative degree of tobacco use in relatives was detected. Among the 11 anti-CCP2-positive relatives, 2 females had RA diagnosis established and 6 individuals presented with joint symptoms suggestive of RA. CONCLUSION The results demonstrate a significant positivity of anti-CCP2 in relatives of RA patients from Brazil and reinforce the importance of serological tools to identify undiagnosed RA.

Alterações de tomografia pulmonar de alta resolução em pacientes com artrite reumatoide e suas associações com variáveis clínicas, demográficas, sorológicas e terapêuticas

BACKGROUND Extra-articular manifestations are found in up to 50% of the patients with rheumatoid arthritis (RA). OBJECTIVE To assess the prevalence of pulmonary changes on high-resolution computed tomography (HRCT) in patients with RA and their association with demographic, clinical, serological and therapeutic variables. METHOD Seventy-one patients with RA were assessed regarding their age at RA onset, duration of disease, gender, tobacco use, presence of rheumatoid nodules, secondary Sjögrens syndrome, rheumatoid factor, presence of anti-CCP and antinuclear factor, respiratory complaints, use of medications, and pulmonary changes on HRCT. RESULTS HRCT changes were identified in 55% of the patients, the most common being the presence of ground glass opacities, parenchymal bands, traction bronchiectasis, and honeycombing. None of the clinical variables studied associated with the HRCT findings, except for duration of the disease, which was longer in patients with pulmonary nodules and reticular lesions (ground-glass opacity). CONCLUSIONS There is a high prevalence of HRCT changes in patients with RA, which do not associate with clinical, serological, therapeutic and demographic variables, except for duration of disease.

Association of anticyclic citrullinated peptide antibodies with extra-articular manifestations, gender, and tabagism in rheumatoid arthritis patients from southern Brazil

Gender and environmental factors are known to influence the clinical heterogeneity and outcome of rheumatoid arthritis (RA). Some variables have been suggested to be associated with the severity of the disease, which can be of great value in the correct management of RA patients. The purpose of this study was to investigate the associations among anticyclic citrullinated antibody (anti-CCP2) positivity, extra-articular manifestations (EAM), gender, and tobacco exposure in a Brazilian RA population. We performed a transversal study comprising 156 RA patients which were investigated for EAM, functional class, presence of anti-CCP2, and IgM rheumatoid factor (IgM-RF). The determination of anti-CCP2 was performed using enzyme immunoassay (ELISA) kits and IgM-RF by latex agglutination test. Clinical and demographical data were obtained through review of charts. Anti-CCP positivity intensity was directly correlated with tobacco smoking, sex, and the development of rheumatoid nodules. Intense anti-CCP2 reaction was 19.8-fold higher in females vs. males, 2.7-fold higher in tobacco vs. non-tobacco users, 7.7-fold higher in female vs. male tobacco users, and 5.15-fold higher in patients with rheumatoid nodules. Tobacco smoking, gender, and rheumatoid nodules are significantly correlated with anti-CCP2 positivity in Brazilian RA patients.

High positivity of anti-CCP antibodies in patients with Down syndrome

The aim of the present study was to evaluate the prevalence of anti-cyclic citrullinated peptide (CCP) antibodies in patients with Down’s syndrome (DS) previously tested for IgM rheumatoid factor (RF) and to correlate the results with clinical findings. Eighty-eight patients with DS previously tested for IgM-RF were divided into two groups matched for sex and age. Group A consists of 42 RF positive patients and group B of 44 RF negative patients. The presence of anti-CCP antibody was determined using a second-generation enzyme-linked immunosorbent assay. A total of 52.3% (45/86) of DS patients were positive for anti-CCP antibodies. Twenty-four patients (57.1%) of the RF positive group and 21 (47.7%) of the RF negative group presented anti-CCP circulating antibodies. The concordance between both tests was 54.6%. None of the patients had clinical evidence of rheumatoid arthritis or juvenile idiopathic arthritis. Although a high prevalence of anti-CCP antibodies was observed in DS patients, no association has been found presently with clinical disease. Careful follow-up of these patients will be necessary to clarify the real significance of these findings.

Leucopenia e trombocitopenia induzidas por etanercepte: relato de dois casos e revisão da literatura

Tumor necrosis factor-alpha (TNF-alpha) is a proinflammatory cytokine, and its excess can lead to severe consequences. Those effects are known to be antagonized by TNF-alpha inhibitors. Etanercept is a fusion protein that inhibits TNF-alpha action. As TNF-alpha regulation is related to cellular differentiation of various cellular types involved in immune response through expression of several other cytokines, it is possible that the use of its inhibitors may cause cytopenia. We report two cases of bicytopenia induced by etanercept. Both cases recovered after drug withdrawal. We discuss the need of introduction of routine laboratorial tests in patients using anti-TNF therapy, in order to identify possible hematological changes.

Perfil dos pacientes com manifestações extra-articulares de artrite reumatoide de um serviço ambulatorial em Curitiba, Sul do Brasil

OBJECTIVES To describe the epidemiological profile of patients with extra-articular manifestations of rheumatoid arthritis (ExRA) from an university-affiliated rheumatology center; to report the prevalence of ExRA and to compare it with available data; and to identify, if possible, ExRA predictors. METHODS This study reviewed 262 medical charts of patients previously diagnosed with rheumatoid arthritis (RA) according to the 1987 American College of Rheumatology criteria, and attending that rheumatology center in 2010. The statistical analysis comprised simple mathematical calculations, Student t and chi-square tests, and a significance level of 5% (α= 0.05). RESULTS During the course of the disease, 120 patients (45.8%) had ExRA. Pulmonary manifestation, rheumatoid nodules and Sjögrens syndrome were the most common manifestations found. Rheumatoid factor and anti-cyclic citrullinated peptide antibody were positive in most patients tested. Most patients were classified as Steinbrocker functional classes 1 and 2. The mean DAS-28 was 3.629, and the mean HAQ score, 1.12. Patients with ExRA had longer disease duration (P < 0.05), and current smoking habit associated with the presence of ExRA (P < 0.05). CONCLUSIONS The prevalence of ExRA during disease course was 45.8%, and current smoking habit correlated with the presence of ExRA.

Padrão de comprometimento articular em pacientes com lúpus eritematoso sistêmico e sua associação com presença de fator reumatóide e hiperelasticidade

INTRODUCTION: the articular manifestations of systemic lupus erythematosus are diverse and its whole spectrum is not fully appreciated by rheumatologists. OBJECTIVE: this study aimed to assess the frequency of different forms of lupus joint involvement. It had also an objective of this study to determine the relationship of different joint patterns and rheumatoid factor and the occurrence of hypermobility. MATERIAL AND METHODS: we studied 147 lupus patients for pattern of joint involvement, rheumatoid factor and presence of hypermobility by Beighton index. RESULTS: in the studied population 53.1% had joint complaints at diagnosis and 80.3% during the disease. Isolated arthralgia was present in 31.3%; arthritis with additive pattern was found in 36.1% and with migratory pattern in 12.9%. In 4.8% there was deforming arthritis: 2.1% with rhupus and 2.7 with Jaccouds syndrome. We found a positive association between rheumatoid factor and additive arthritis (p<0.001). No association could be demonstrated between hypermobility and Jaccoud arthropathy. CONCLUSION: joint complaints are very common specially the presence of arthritis (additive and migratory). There is a higher positivity of rheumatoid factor in patients with the additive form.

Rheumatoid arthritis and sleep quality

BACKGROUND Sleep disturbances are common in rheumatoid arthritis (RA) patients and contribute to loss of life quality. OBJECTIVE To study associations of sleep quality with pain, depression and disease activity in RA. METHODS This is a transversal observational study of 112 RA patients submitted to measurement of DAS-28, Epworth scale for daily sleepiness, index of sleep quality by Pittsburg index, risk of sleep apnea by the Berlin questionnaire and degree of depression by the CES-D (Center for Epidemiologic Studies Depression scale) questionnaire. We also collected epidemiological, clinical, serological and treatment data. RESULTS Only 18.5% of RA patients had sleep of good quality. In univariate analysis a bad sleep measured by Pittsburg index was associated with daily doses of prednisone (p=0.03), DAS-28 (p=0.01), CES-D (p=0.0005) and showed a tendency to be associated with Berlin sleep apnea questionnaire (p=0.06). In multivariate analysis only depression (p=0.008) and Berlin sleep apnea questionnaire (p=0.004) kept this association. CONCLUSIONS Most of RA patients do not have a good sleep quality. Depression and risk of sleep apnea are independently associated with sleep impairment.

Anti-cyclic citrullinated peptide antibodies in adult patients with juvenile idiopathic arthritis.

Background Antibodies to cyclic citrullinated peptide (anti-CCP) have been found in different proportions in the juvenile idiopathic arthritis (JIA) population. The majority of studies have been done in children or mixed population (children plus adults). Aim The objective of the study was to study the prevalence of anti-CCP in JIA adult patients. Methods Anti-CCP3 was searched for in 49 adult patients with JIA and associated with clinical and demographics data. As comparisons, 156 patients with adult rheumatoid arthritis (RA) and 100 healthy volunteers were studied. Results Nine patients (18.3%) were positive for anti-CCP3. All of them had the polyarthritis form. This antibody was more common in JIA than in control subjects (P = 0.0002) and less common in JIA than in adult RA patients (P < 0.0001), but the rheumatoid factor polyarticular form of JIA had the same prevalence as in adult RA patients (P = 0.33). In JIA patients, anti-CCP had a positive association with the presence of rheumatoid factor (P < 0.0001), worse functional status (P = 0.04), need for orthopedic surgery (P = 0.01), and later disease onset (P = 0.0007). Conclusions In adult patients with JIA, the prevalence of anti-CCP3 is 18%, and its presence may define a sample of patients with worse prognosis.

Prevalência de alterações no exame citológico do colo do útero em pacientes com lúpus eritematoso sistêmico

BACKGROUND: studies have suggested that patients with systemic lupus erythematosus (SLE) have increased risk of developing abnormal results in Pap smears, when compared to the general population. OBJECT: to check the prevalence of abnormal Pap smears in patients with SLE compared to the general population relating it with disease duration, use of immunosuppressive and antimalarial agents and autoantibody profile. METHOD: we studied Pap smears of 76 patients with SLE and 80 healthy controls. In patients with SLE we assessed disease duration, use of cyclophosphamide, methotrexate, azathioprine, antimalarials and the presence of anti-RO, anti-LA and anti-DNA. RESULT: the prevalence of abnormal Pap smears was higher in the SLE group than controls (9.4% versus 1.2%, p = 0.03). No relationship was found between abnormal Pap smears and cyclophosphamide (p = 1.0), methotrexate (p = 0.58), azathioprine (p = 1.0) or antimalarial use (p = 0.051), disease duration (p = 0.85), neither with any of the studied auto antibodies. CONCLUSION: there is a higher prevalence of abnormal Pap smears in the studied SLE population than in normal people that is independent of the duration of the disease, use of immunosupressive medication or presence of autoantibodies.