Melissa Cláudia Bisi

Antimaláricos e perfil lipídico em pacientes com lúpus eritematoso sistêmico

A beneficial influence of antimalarials on lipid profile of systemic lupus erythematosus (SLE) patients has been recently claimed. In this cross-sectional study, we evaluated the effect of chloroquine on cholesterol levels of a Brazilian population with SLE. Sixty patients were studied, 95% females. Mean age was 48.7 years (SD 13.3 years). Overweight or obesity was documented in 27 cases (45%). Thirty-four patients (56.6%) were using chloroquine in standard dosage, while 33 (55%) were on corticosteroids. Hypercholesterolemia was present in 26 patients (43.3%), while low HDL cholesterol levels were seen in 18 cases (30%). Normal cholesterolemia was documented equally in users and non-users of antimalarials (P > 0.20). After adjustment for statin and corticosteroid intake by multivariate analysis, cholesterol and HDL-cholesterol levels did not significantly differ in users or non-users of chloroquine (P > 0.05). There was no association of chloroquine intake with low body mass index (P = 0.314). Our findings suggest that antimalarial intake by itself does not distinguish cholesterol profiles in SLE patients.

Scleromyxedema with monoclonal gammopathy and neurological involvement: recovery from coma after plasmapheresis?

565–573. 3 Grant A, Gonzalez T, Montgomery MO, et al. Results of a double-blinded, placebo-controlled cross-over study evaluating longterm efficacy and safety (60 weeks) in patients with moderate to severe hidradenitis suppurativa treated with infliximab. Abstract 2213. American Academy of Dermatology Annual Meeting, March 6–10, 2009, San Francisco, CA. 4 Sotiriou E, Apalla Z, Vakirlis E, Ioannides D. Efficacy of adalimumab in recalcitrant hidradenitis suppurativa. Eur J Dermatol 2009; 19: 180–181. 5 Blanco R, Martinez-Taboada VM, Villa I, et al. Longterm successful adalimumab therapy in severe hidradenitis suppurativa. Arch Dermatol 2009; 145: 580–584. 6 Jurgensmeyer JC, Fleischer A. Clinical improvement of refractory hidradenitis suppurativa with etanercept. Poster 58. J Am Dermatol 2004; 50(Suppl 3): 15. 7 Henderson RL Jr. Treatment of atypical hidradenitis suppurativa with the tumor necrosis factor receptor-Fc fusions protein etanercept. J Drugs Dermatol 2006; 5: 1767–1770. 8 Sotiriou E, Apalla Z, Ioannidos D. Etanercept for the treatment of hidradenitis suppurativa. Acta Derm Venereol 2009; 89: 82–83.

Ultrasound power Doppler synovitis is associated with plasma IL-6 in established rheumatoid arthritis.

BACKGROUND AND OBJECTIVE Cytokines have an important role in the pathogenesis of rheumatoid arthritis (RA). Although plasma levels of IL-6 have been related to musculoskeletal ultrasound (MSUS) synovitis in early DMARD-naïve RA, there are no similar studies in established disease. METHODS 64 RA patients treated with non-biological DMARDs and 30 healthy controls were included in this prospective cross-sectional study. A blood sample was taken before evaluation of disease activity (DAS28) and ultrasonography (all tests performed in a blinded fashion). MSUS was performed by one of two ultrasound-trained rheumatologists on 10 joints of both hands. Gray scale (GS) and pD (power Doppler) synovitis were evaluated using a semi-quantitative scale (0-3) in individual joints, and their sum (score 10) was calculated. Plasma cytokines (IL-2, IL-4, IL-6, IL-10, IL-17, TNF, IFN-γ, and VEGF) were quantified by flow cytometry. RESULTS Levels of all cytokines, excepting VEGF, were significantly higher in RA patients than in controls (P⩽0.05). In RA patients, IL-6, but not other cytokines, correlated positively with DAS28 and swollen joint count (P⩽0.01), as well as with 10-joint pD score, and GS and pD of both wrists (P<0.01 for all tests). In multiple linear regression, the association of IL-6 with 10-joint pD score was maintained even after adjustment for DAS28. However, there was no correlation of IL-6 with tender joint count, 10-joint GS score, or presence of erosions. CONCLUSION We demonstrated an association of inflammatory findings on MSUS and plasma IL-6 independently of DAS28 in established RA.

Ultrasound and its clinical use in rheumatoid arthritis: where do we stand?

High-resolution musculoskeletal ultrasound (MSUS) has been increasingly employed in daily rheumatological practice and in clinical research. In rheumatoid arthritis (RA), MSUS can be now considered a complement to physical examination. This method evaluates synovitis through gray-scale and power Doppler and it is also able to identify bone erosions. The utilization of MSUS as a marker of RA activity has received attention in recent literature. Current data account for good correlation of MSUS with classical measures of clinical activity; in some instances, MSUS appears to perform even better. Diagnosis of subclinical synovitis by MSUS might help the physician in RA management. With some variation, interobserver MSUS agreement seems excellent for erosion and good for synovitis. However, lack of MSUS score standardization is still an unmet need. In this review, we describe several MSUS scores, as well as their correlation with clinical RA activity and response to therapy. Finally, we look at the relationship of MSUS with synovial tissue inflammation and discuss future perspectives for a better interpretation and integration of this imaging method into clinical practice.

Paget’s Disease of Bone

Paget’s disease is a chronic disorder characterised by increased resorption and deposition of bone mass, causing various skeletal deformities. It is the second most common bone disorder, following osteoporosis. It is manifested by excessive resorption of bone by osteoclasts and subsequent secondary increase of osteoblast activity. As a result the normal bone tissue is gradually replaced by vascular connective tissue, resulting in a thickened, disorganised trabecular pattern of bone which is of lower quality and has a decreased mechanical resistance. The disease, also known as osteitis deformans, was first described by the English pathologist Sir James Paget, at the end of the nineteenth century [1].

Correction to: Ultrasound resistive index, power Doppler, and clinical parameters in established rheumatoid arthritis

The original version of this article, unfortunately, contained an error. One of the authors name on this article was incorrectly spelled as “José Alexandre de Mendonça”. The correct spelling is “José Alexandre Mendonça” and is now presented correctly in this article.

AB0933 Treg/Th17 Cells and High Resolution Ultrasound Inflammatory Findings in Established Rheumatoid Arthritis: A Cross Sectional Study

Background Imbalance and disfuntion in regulatory T-cells (Tregs) and IL-17 producer lymphocytes (Th17) have been implicated in the pathogenesis of rheumatoid arthritis (RA). Gray scale synovial proliferation (GS), power Doppler signal (pD) and bone erosions seen on high resolution muskuloskeletal ultrasound (MSUS) are hallmarks of destructive articular disease. Objectives The present study was undertaken to evaluate the association of peripheral Tregs and Th17 with MSUS findings in RA. Methods 90 RA patients (1987 ACR criteria) treated with disease-modifying antirheumatic drugs (DMARDs) were included in this prospective cross-sectional study. A blood sample was taken just before clinical and ultrasonographic evaluation. Lymphocytes were isolated and immunophenotyped by flow cytometry to investigate regulatory FoxP3+ T cells and IL-17+ cells. MSUS (MyLab 60, Esaote, Genova, Italy, linear probe 6–18 MHz) was performed consecutively by two ultrassound-trained rheumatologists on the wrists, 2th and 3th metacarpophalangeal and 2th and 3th proximal interphalangeal joints of both hands. GS and pD were searched using a semi-quantitative scale (0–3). Bone erosions were classified as present or absent. The sum of the individual joint scores for GS and pD (score 10) was calculated and used to correlate with clinical and laboratory data. Disease acitivity and disability were measured using Disease Activity Score in 28 joints (DAS28) and Health Assessment Questionnaire (HAQ), respectively. Mann-Whitney test, Kruskal-Wallis test and Spearman correlation coefficient (rS) were used for statistical analysis. Inter-rater agreement was tested using the weighted kappa statistic (WKS) and intraclass correlation (ICC). Results Clinical and demographic features were: mean age, 55.8 ±11 years; female gender, 79%; Caucasians, 84%; positive rheumatoid factor by nephelometry, 63%; median (interquartile range) disease duration 6 (2–13) years; mean ± SD DAS28, 4.28±1.64; mean ± SD HAQ score, 1.11±0.85. WKS for erosions was 1, and ICC for GS- and pD-score10 were 0.964 (95%CI 0.899 to 0.986) and 0.859 (0.646 to 0.941), respectively. There was no significant association of bone erosions, GS- and pD-score10 with peripheral Tregs and Th17 cells (P>0.25 for all tests). Tregs but not Th17 cells were significantly associated with DAS28 level of disease activity (figure 1). Conclusions In this first study addressing MSUS features and lymphocytes subtypes in established RA, data did not support an association of circulating Tregs and Th17 lymphocytes with inflammatory and structural damage findings on MSUS. Disclosure of Interest None declared

AB1039 Is Ultrasound the Mirror of Physical Examination? Association of Physical Examination Findings with Gray Scale and Power Doppler in Rheumatoid Arthritis

Background High-resolution sonography enables assessment of intraarticular abnormalities of joints affected by rheumatoid arthritis (RA).Its use has been well described on international consensus (1). Objectives The present study was undertaken to evaluate the association of physical examination (PE) findings with gray scale synovitis (GSS) and power Doppler signal (pD) in hands of RA patients., Methods Eighty-four RA patients (according to the 1987 American College of Rheumatology criteria) treated with disease-modifying antirheumatic drugs (DMARDs) were included in this prospective transversal study. PE of the hands (pain and/or edema) was performed by a rheumatologist unaware of the ultrasound findings. High resolution muskuloskeletal ultrasound (MSUS) – MyLab 60, Esaote, Genova, Italy, linear probe 6-18 MHz – was performed on the wrists, 2th and 3th metacarpophalangeal (MCP) and 2th and 3th proximal interphalangeal (PI) joints of both hands by two ultrassound-trained rheumatologists (unaware of clinical data) immmediately after PE. GSS and pD were searched and evaluated using a semi-quantitative scale (0-3). The sum of the individual joint scores for GSS and pD (score 10) was calculated and used to correlate with the clinical variables. Disease acitivity and disability were measured using Disease Activity Score in 28 joints (DAS28) and Health Assessment Questionnaire (HAQ), respectively. Mann-Whitney test and Spearman correlation coefficient (rS) were used for statistical analysis. Results Clinical and demographic features of included patients were: mean age, 55.6±11.8 years; female gender, 79%; Caucasians, 85.7%; positive rheumatoid factor by nephelometry, 63%; median (interquartile range) disease duration 6 (2-13) years; mean ± SD DAS28, 4.55±1.62; mean ± SD HAQ score, 1.13±0.87. Interobserver agreement (measured by kappa values) for US examination varied from 0.53 to 0.86. We observed a significant association (P≤0.05) of the presence of articular edema with higher GSS and pD in all joints, except for the 3rd right PI. There was no association of pain on PE with GSS or pD in any of the evaluated joints. There was no significant correlation of GSS- and pD-score10 with DAS28 (rS=0.21, P=0.060 and rS=0.04, P=0.722, respectively), HAQ score (rS=-0.02, P=0.862 and rS=0.00, P=0.997), and tender joint count (rS=0.07, P=0.564 and rS=-0.20, P=0.078). However, there was a significant association of GSS- and pD score10 with the swollen joint count (rS=0.54, P<0.001 and rS=0.39, P<0.001). Conclusions Our data show that only articular edema on PE is associated with proliferative (GSS) and microcirculatory (pD) findings on MSUS in RA patients. Isolated pain (without edema) does not reflect inflammatory ultrasound abnormalities in this group of patients. References Colebatch AN et al. EULAR recomendations for the use of imaging of the joints in the clinical management of rheumatoid arthritis. Ann Rheum Dis, 2013 Jun; 72(6):804-14. Disclosure of Interest None declared