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Soares C, Teixeira V, Santos-Faria D. Digital ulcers and shortening of the second and third fingers as manifestations of carpal tunnel syndrome. Int J Dermatol 2024; 63:244-245. [PMID: 37904592 DOI: 10.1111/ijd.16893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 09/13/2023] [Accepted: 10/18/2023] [Indexed: 11/01/2023]
Affiliation(s)
- Catarina Soares
- Rheumatology Department, Local Health Unit of the Alto Minho, Viana do Castelo, Portugal
| | - Vera Teixeira
- Dermatology Department, Local Health Unit of the Alto Minho, Viana do Castelo, Portugal
| | - Daniela Santos-Faria
- Rheumatology Department, Local Health Unit of the Alto Minho, Viana do Castelo, Portugal
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Parente H, Pontes Ferreira M, Soares C, Guimarães F, Azevedo S, Santos-Faria D, Tavares-Costa J, Peixoto D, Afonso C, Roriz D, Teixeira F. Lumbosacral pain in a patient with psoriatic arthritis: when the rheumatic disease is innocent. Reumatismo 2023; 75. [PMID: 38115779 DOI: 10.4081/reumatismo.2023.1565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 08/30/2023] [Indexed: 12/21/2023] Open
Abstract
Lumbar pain is a very common symptom that derives from benign musculoskeletal conditions, rheumatic inflammatory diseases, neoplasms, and referred and/or nociplastic pain. A 70-year-old man with psoriatic arthritis presented with early-onset lumbosacral pain without evident red flags. Symptomatic treatment was unhelpful. Radiographic imaging showed subtle signs of a disease that could easily be missed. Magnetic resonance imaging revealed a massive prostatic malignancy with bone (sacral and iliopubic) metastasis. Awareness must be given not to disregard every lumbar pain as part of the preexisting rheumatic inflammatory disease (spondyloarthropathy in this case) or a common muscle/ligament/articular disarrangement. Persistence of pain, albeit not inflam-matory nor sharp in nature, despite adequate treatment might be just as important as an acute red flag and requires proper follow-up.
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Affiliation(s)
- H Parente
- Department of Rheumatology, Unidade Local de Saúde do Alto Minho, Ponte de Lima.
| | - M Pontes Ferreira
- Department of Rheumatology, Unidade Local de Saúde do Alto Minho, Ponte de Lima.
| | - C Soares
- Department of Rheumatology, Unidade Local de Saúde do Alto Minho, Ponte de Lima.
| | - F Guimarães
- Department of Rheumatology, Unidade Local de Saúde do Alto Minho, Ponte de Lima.
| | - S Azevedo
- Department of Rheumatology, Unidade Local de Saúde do Alto Minho, Ponte de Lima.
| | - D Santos-Faria
- Department of Rheumatology, Unidade Local de Saúde do Alto Minho, Ponte de Lima.
| | - J Tavares-Costa
- Department of Rheumatology, Unidade Local de Saúde do Alto Minho, Ponte de Lima.
| | - D Peixoto
- Department of Rheumatology, Unidade Local de Saúde do Alto Minho, Ponte de Lima.
| | - C Afonso
- Department of Rheumatology, Unidade Local de Saúde do Alto Minho, Ponte de Lima.
| | - D Roriz
- Department of Radiology, Unidade Local de Saúde do Alto Minho, Viana do Castelo.
| | - F Teixeira
- Department of Rheumatology, Unidade Local de Saúde do Alto Minho, Ponte de Lima.
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Soares CD, Madureira N, Santos-Faria D. Forestier Disease as a Cause of Dysphagia. Mediterr J Rheumatol 2023; 34:573-574. [PMID: 38282932 PMCID: PMC10815542 DOI: 10.31138/mjr.140923.fdd] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/19/2023] [Accepted: 05/25/2023] [Indexed: 01/30/2024] Open
Affiliation(s)
- Catarina Dantas Soares
- Rheumatology Department, Local Health Unit of Alto Minho, Hospital Conde de Bertiandos, Ponte de Lima, Portugal
| | - Nuno Madureira
- Centre for Rehabilitation Medicine in the Centro-Rovisco Pais Region, Portugal
| | - Daniela Santos-Faria
- Rheumatology Department, Local Health Unit of Alto Minho, Hospital Conde de Bertiandos, Ponte de Lima, Portugal
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Parente H, Ferreira MP, Soares C, Costa E, Guimarães F, Azevedo S, Santos-Faria D, Tavares-Costa J, Peixoto D, Afonso C, Teixeira F. A Challenging Inflammatory Myopathy Case-Report: Dermatomyositis-Like Rash in an Anti-HMGCR Positive Patient with an Uncertain Muscle Histology. Mediterr J Rheumatol 2023; 34:570-572. [PMID: 38282924 PMCID: PMC10815533 DOI: 10.31138/mjr.220823.imc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/20/2023] [Accepted: 04/21/2023] [Indexed: 01/30/2024] Open
Affiliation(s)
- Hugo Parente
- Rheumatology Department, Unidade Local de Saúde do Alto Minho, Ponte de Lima, Portugal
| | - Maria Pontes Ferreira
- Rheumatology Department, Unidade Local de Saúde do Alto Minho, Ponte de Lima, Portugal
| | - Catarina Soares
- Rheumatology Department, Unidade Local de Saúde do Alto Minho, Ponte de Lima, Portugal
| | - Emanuel Costa
- Rheumatology Department, Hospital de Braga, Braga, Portugal
| | - Francisca Guimarães
- Rheumatology Department, Unidade Local de Saúde do Alto Minho, Ponte de Lima, Portugal
| | - Soraia Azevedo
- Rheumatology Department, Unidade Local de Saúde do Alto Minho, Ponte de Lima, Portugal
| | - Daniela Santos-Faria
- Rheumatology Department, Unidade Local de Saúde do Alto Minho, Ponte de Lima, Portugal
| | - José Tavares-Costa
- Rheumatology Department, Unidade Local de Saúde do Alto Minho, Ponte de Lima, Portugal
| | - Daniela Peixoto
- Rheumatology Department, Unidade Local de Saúde do Alto Minho, Ponte de Lima, Portugal
| | - Carmo Afonso
- Rheumatology Department, Unidade Local de Saúde do Alto Minho, Ponte de Lima, Portugal
| | - Filipa Teixeira
- Rheumatology Department, Unidade Local de Saúde do Alto Minho, Ponte de Lima, Portugal
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Parente H, Ferreira MP, Soares CD, Costa E, Guimarães F, Azevedo S, Santos-Faria D, Tavares-Costa J, Teixeira F, Afonso C, Peixoto D. Barriers and alternatives to pediatric rheumatology referrals: a survey of family doctors and pediatricians in Portugal. ARP Rheumatol 2023:AO230080. [PMID: 37728158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
BACKGROUND Access to pediatric rheumatology (PR) is not well described in Portugal. The main goal of this study was to ascertain barriers to PR referrals and subsequent alternative referral patterns among family doctors and pediatricians. METHODS A web-based survey was e-mailed to family doctors and pediatricians practicing in Portugal, in order to investigate access to PR care issues. Descriptive and comparative analysis was performed. RESULTS Two hundred and ninety-two responses were obtained, 24.7% from pediatricians and 75.3% from family doctors. Only 12% claimed to have had specific education on PR. Nearly 70% worked less than one hour away from a PR center. Twenty eight percent had referred a patient to PR at least once, and 9.3% experienced a situation in which they considered referring to PR but ultimately did not. Many referred to other specialties, primarily pediatrics, adult rheumatology, and pediatric orthopedics. Pediatricians encountered more diversified rheumatic diseases. Fifty five percent had no opinion on PR centers' support, while 24% found it sufficient. Having specific training on PR, being a pediatrician and a specialist were associated with greater referrals to PR. The most rated measure for PR referrals' improvement was promoting education. Regional access to PR's discrepancies were documented. CONCLUSION Mainly lack of education on PR, but also uneven national coverage and greater distances to some PR centers were the main barriers to PR referrals, in Portugal. Pediatricians seem to have better education, greater experience and more referrals to PR. The current alternatives for referral are pediatrics, adult rheumatology and pediatric orthopedics. Educational consolidation was the biggest and most rewarding inconsistency to battle against.
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Guimarães F, Ferreira M, Soares C, Parente H, Matos CO, Costa R, Oliveira D, Abreu C, Teixeira R, Azevedo S, Dias JM, Araújo F, Ferreira CC, Santos FC, Fontes T, Faria M, Silva L, Chícharo A, Nero P, Santos H, Sepriano A, Santos-Faria D, Tavares-Costa J. Cycling versus swapping strategies in psoriatic arthritis: results from the rheumatic diseases Portuguese register. ARP Rheumatol 2023:AO230010. [PMID: 37728133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
OBJECTIVE To compare the 2-year retention rate between a second tumor necrosis factor alpha inhibitor (TNFi) and secukinumab (SEK) or ustekinumab (UST), in Psoriatic Arthritis (PsA) patients with previous inadequate response to their first TNFi. METHODS Prospective longitudinal cohort study with a follow-up period of 2 years using the Nationwide Portuguese Reuma.pt database. Patients with a clinical diagnosis of PsA who also fulfill the CASPAR classification criteria, with previous treatment failure to a first-line TNFi and having started a second biotechnological drug (TNFi, SEK or UST) were included. The Cycling group was defined as switching from a first TNFi to a second TNFi, and the Swapping group as switching from a first TNFi to SEK or UST. Sociodemographic data, disease characteristics, disease activity scores and physical function at baseline and after 6, 12 and 24 months were recorded. Cox-proportional hazards regression was used to compare retention rates between Cycling and Swapping groups. To obtain a predictor model of 2-year discontinuation, a multivariable Cox regression model was performed. RESULTS In total, 439 patients were included, 58% were female, with a mean age (standard deviation) of 49 (12) years. Globally, 75.6% initiated a second TNFi (Cycling group), and 24.4% started SEK/UST (Swapping group). The retention rates after 6, 12 and 24 months were 72%/66%/59% in the Cycling group; and 77%/66%/59% in the Swapping group. There were no significant differences in retention rates between both strategies (HR: 1.06, 95% CI 0.72-1.16). After 2 years of follow-up, 34.4% of patients discontinued their second biologic, mainly due to inefficacy (72.8%), with no differences found between groups. Baseline treatment with glucocorticoids was the only predictor of discontinuation after 2 years of follow-up (HR:1.668, 95% CI 1.154-2.409). CONCLUSIONS After failure of a first TNF inhibitor, Cycling and Swapping strategies result in similar retention rates suggesting that both are acceptable in the management of patients with psoriatic arthritis.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Lígia Silva
- Centro Hospitalar Trás-os-Montes e Alto Douro
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Parente H, Guimarães F, Soares CD, Ferreira MP, Azevedo S, Santos-Faria D, Peixoto D, Afonso C, Tavares-Costa J, Teixeira F. A Retrospective Cohort Study to Investigate the Impact of Cardiovascular Comorbidities on Knee Osteoarthritis Progression. Mediterr J Rheumatol 2023; 34:279-281. [PMID: 37654634 PMCID: PMC10466348 DOI: 10.31138/mjr.34.2.279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 03/09/2023] [Accepted: 03/14/2023] [Indexed: 09/02/2023] Open
Affiliation(s)
- Hugo Parente
- Rheumatology Department, Unidade Local de Saúde do Alto Minho, Ponte de Lima, Portugal
| | - Francisca Guimarães
- Rheumatology Department, Unidade Local de Saúde do Alto Minho, Ponte de Lima, Portugal
| | | | - Maria Pontes Ferreira
- Rheumatology Department, Unidade Local de Saúde do Alto Minho, Ponte de Lima, Portugal
| | - Soraia Azevedo
- Rheumatology Department, Unidade Local de Saúde do Alto Minho, Ponte de Lima, Portugal
| | - Daniela Santos-Faria
- Rheumatology Department, Unidade Local de Saúde do Alto Minho, Ponte de Lima, Portugal
| | - Daniela Peixoto
- Rheumatology Department, Unidade Local de Saúde do Alto Minho, Ponte de Lima, Portugal
| | - Carmo Afonso
- Rheumatology Department, Unidade Local de Saúde do Alto Minho, Ponte de Lima, Portugal
| | - José Tavares-Costa
- Rheumatology Department, Unidade Local de Saúde do Alto Minho, Ponte de Lima, Portugal
| | - Filipa Teixeira
- Rheumatology Department, Unidade Local de Saúde do Alto Minho, Ponte de Lima, Portugal
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Soares C, Azevedo S, Parente H, Guimarães F, Ferreira MP, Teixeira F, Peixoto D, Tavares-Costa J, Afonso C, Santos-Faria D. Predictive factors of fragility fractures and associated mortality: assessment of patients observed at emergency department. ARP Rheumatol 2023:AO220322. [PMID: 37178210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
AIM To assess the predictive factors for a subsequent fragility fracture (FF) and mortality. METHODS Retrospective monocentric study including patients observed at the emergency department (ED) of a referral hospital with a FF, between 1st January 2017 and 31st December 2018. Fractures events were identified through discharge codes using the 9th International Classification of Diseases codes and FF were adjudicated after revision of the clinical files. We identified 1673 patients with FF. After calculating a representative sample (95% confidence interval), 172 hip, 173 wrist and 112 vertebral fractures were included in the analysis. Their clinical files were reviewed until 31st December 2020. A multivariate analysis was performed in order to identify predictive factors for FF. RESULTS Overall, during the follow-up period 76 patients (16.6%) had a new FF and 120 patients (26.3%) died. Multivariate analysis showed that previous visits to the ED due to falls (p=0.002) and malignancy (p=0.026) were independent risk factors for a new FF. The main predictors of mortality were age, hip fracture, oral corticosteroid treatment, normal or low BMI and cardiac, neurologic or chronic kidney disease. CONCLUSIONS FF are a very prevalent public health problem that can lead to significant morbidity and death. Certain comorbidities seem to be associated with new FF and increased mortality. There might be a substantial missed opportunity for intervention in these patients, namely in ED visits.
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Affiliation(s)
- Catarina Soares
- Rheumatology Department, Unidade Local de Saúde do Alto Minho
| | - Soraia Azevedo
- Rheumatology Department, Unidade Local de Saúde do Alto Minho
| | - Hugo Parente
- Rheumatology Department, Unidade Local de Saúde do Alto Minho
| | | | | | - Filipa Teixeira
- Rheumatology Department, Unidade Local de Saúde do Alto Minho
| | - Daniela Peixoto
- Rheumatology Department, Unidade Local de Saúde do Alto Minho
| | | | - Carmo Afonso
- Rheumatology Department, Unidade Local de Saúde do Alto Minho
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Pinto AS, Cunha MM, Pinheiro F, Bernardes M, Assunção H, Martins-Martinho J, Tenazinha C, Monteiro AM, Silva S, Martins FR, Silva L, Couto M, Faria M, Araújo F, Fontes T, Santos-Faria D, Tavares-Costa J. Effectiveness and safety of original and biosimilar etanercept (Enbrel® vs Benepali®) in bDMARD-naïve patients in a real-world cohort of Portugal. ARP Rheumatol 2022; 1:109-116. [PMID: 35810368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To compare the effectiveness and safety of original (Enbrel®) and biosimilar (Benepali®) etanercept in Biologic Disease-modifying Antirheumatic Drug (bDMARD)-naïve patients, measured by persistence rates over 36 months of follow-up. METHODS A retrospective multicentre observational study using data collected prospectively from The Rheumatic Diseases Portuguese Registry (Reuma.pt) was performed, including patients with: age ≥ 18 years old; diagnosis of Rheumatoid Arthritis (RA), Psoriatic Arthritis (PsA) or Spondyloarthritis (SpA) (axial or peripheral) with active disease and biologic-naïve who initiated treatment with etanercept as the first line biological treatment after 2010. Kaplan-Meyer and Cox regression were used to calculate the persistence rate in treatment. Disease activity at baseline and follow-up data at 6, 12, 18 and 24 months of treatment were compared. Causes for discontinuing therapy were summarized using descriptive statistics. Statistical significance was assumed for 2-sided p-values <0.05. RESULTS We included 1693 patients (413 on Benepali® and 1280 on Enbrel®): 864 diagnosed with RA, 335 with PsA and 494 with SpA. The 3-year persistence rates were not significantly different between both treatment groups in RA, PsA and SpA patients. In the adjusted Cox model, hazard ratios of discontinuation were not statistically different (p>0.05). The proportion of subjects in remission or low disease activity in each disease was similar in both groups. Overall, 535 (31.6%) patients discontinued etanercept (428 patients on Enbrel® and 107 patients on Benepali®). The major cause of discontinuation was inefficacy (57.8%). No differences for the occurrence of inefficacy or adverse effects were found between treatment groups. CONCLUSIONS Benepali® and Enbrel® demonstrated similar effectiveness and safety in RA, PsA and SpA in our cohort of patients. These data corroborate that the original and biosimilar drugs have similar quality characteristics and biological activity.
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Affiliation(s)
- Ana Sofia Pinto
- Rheumatology, Unidade Local de Saúde da Guarda; Unidade Local de Saúde do Alto Minho
| | | | | | | | | | | | | | | | | | | | - Lígia Silva
- Rheumatology, Centro Hospitalar Trás-Os-Montes e Alto Douro
| | - Maura Couto
- Rheumatology, Centro Hospitalar Tondela-Viseu
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Fernandes BM, Guimarães F, Almeida DE, Neto A, Tavares-Costa J, Ribeiro AR, Quintal A, Pereira JP, Silva L, Nóvoa TSD, Faustino A, Vaz C, Khmelinskii N, Samões B, Dourado E, Silva JL, Barcelos A, Mariz E, Guerra M, Santos MJ, Silvério-António M, Teixeira RL, Romão VC, Santos H, Santos-Faria D, Azevedo S, Rodrigues A, Dias JM, Lopes C, Pinto P, Couto M, Miranda LC, Bernardo A, Cruz M, Teixeira F, Mourão AF, Neto A, Teixeira V, Cordeiro A, Barreira S, Inês LS, Capela S, Sepriano A, Canhão H, Fonseca JE, Duarte C, Bernardes M. Portuguese recommendations for the use of biological and targeted synthetic disease-modifying antirheumatic drugs in patients with rheumatoid arthritis - 2020 update. ARP Rheumatol 2022; 1:63-82. [PMID: 35633578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 09/28/2022]
Abstract
OBJECTIVE To update the recommendations for the treatment of rheumatoid arthritis (RA) with biological and targeted synthetic disease-modifying antirheumatic drugs (bDMARDs and tsDMARDs), endorsed by the Portuguese Society of Rheumatology (SPR). METHODS These treatment recommendations were formulated by Portuguese rheumatologists taking into account previous recommendations, new literature evidence and consensus opinion. At a national meeting, in a virtual format, three of the ten previous recommendations were re-addressed and discussed after a more focused literature review. A first draft of the updated recommendations was elaborated by a team of SPR rheumatologists from the SPR rheumatoid arthritis study group, GEAR. The resulting document circulated among all SPR rheumatologists for discussion and input. The level of agreement with each of all the recommendations was anonymously voted online by all SPR rheumatologists. RESULTS These recommendations cover general aspects such as shared decision, treatment objectives, systematic assessment of disease activity and burden and its registry in Reuma.pt. Consensus was also achieved regarding specific aspects such as initiation of bDMARDs and tsDMARDs, assessment of treatment response, switching and definition of persistent remission. CONCLUSION These recommendations may be used for guidance of treatment with bDMARDs and tsDMARDs in patients with RA. As more evidence becomes available and more therapies are licensed, these recommendations will be updated.
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Affiliation(s)
| | | | | | - Agna Neto
- Centro Hospitalar do Funchal, Hospital Dr. Nélio Mendonça, Funchal
| | | | | | - Alberto Quintal
- Centro Hospitalar do Funchal, Hospital Dr. Nélio Mendonça, Funchal
| | | | - Lígia Silva
- Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real
| | | | | | | | | | - Beatriz Samões
- Centro Hospitalar de Vila Nova de Gaia/ Espinho, Vila Nova de Gaia
| | - Eduardo Dourado
- Centro Hospitalar de Lisboa Norte, Hospital de Santa Maria, Lisboa
| | | | | | - Eva Mariz
- Centro Hospitalar Universitário de São João, Porto
| | | | | | | | | | - Vasco C Romão
- Centro Hospitalar de Lisboa Norte, Hospital de Santa Maria, Lisboa
| | | | | | | | - Ana Rodrigues
- Hospital de Santo Espírito da Ilha Terceira, Angra do Heroísmo
| | | | - Carina Lopes
- Centro Hospitalar de Lisboa Ocidental, Hospital de Egas Moniz, Lisboa
| | - Patrícia Pinto
- Centro Hospitalar de Vila Nova de Gaia/ Espinho, Vila Nova de Gaia
| | | | | | | | - Margarida Cruz
- Consultórios Médicos de Caldas da Rainha, Caldas da Rainha
| | | | - Ana Filipa Mourão
- Centro Hospitalar de Lisboa Ocidental, Hospital de Egas Moniz, Lisboa
| | | | - Victor Teixeira
- Centro Hospitalar Universitário do Algarve, Hospital de Faro, Faro
| | | | - Sofia Barreira
- Centro Hospitalar de Lisboa Norte, Hospital de Santa Maria, Lisboa
| | - Luís S Inês
- Centro Hospitalar Universitário de Coimbra, Coimbra
| | - Susana Capela
- Centro Hospitalar de Lisboa Norte, Hospital de Santa Maria, Lisboa
| | | | - Helena Canhão
- Centro Hospitalar de Lisboa Central, Hospital de Santo António dos Capuchos, Lisboa
| | | | - Cátia Duarte
- Centro Hospitalar Universitário de Coimbra, Coimbra
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Sepriano A, Santos-Faria D, Cavaleiro J, Ferreira R. Welcome to ARP Rheumatology. ARP Rheumatol 2022; 1:2-3. [PMID: 35633571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Alexandre Sepriano
- NOVA Medical School Universidade Nova de Lisboa, Lisbon, Portugal; Rheumatology Department, Hospital Egas Moniz, Lisbon, Portugal
| | - Daniela Santos-Faria
- Rheumatology Department, Unidade Local de Saúde do Alto Minho, Ponte de Lima, Portugal
| | | | - Ricardo Ferreira
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra EPE (CHUC), Coimbra, Portugal; Nursing Research Unit of CHUC, Health Sciences Research Unit: Nursing (UICiSA:E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal
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12
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Rodrigues J, Santos-Faria D, Silva J, Azevedo S, Guimarães F, Esperança Almeida D, Teixeira F, Peixoto D, Alcino S, Afonso C, Tavares-Costa J. Treating Adult-Onset Still Disease With Tocilizumab: A Case-Based Review. J Clin Rheumatol 2021; 27:S414-S415. [PMID: 32251045 DOI: 10.1097/rhu.0000000000001381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Joana Rodrigues
- Serviço de Reumatologia Unidade Local de Saúde do Alto Minho Ponte de Lima, Portugal
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13
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Guimarães F, Esperança Almeida D, Azevedo S, Rodrigues J, Leite Silva J, Santos-Faria D, Teixeira F, Tavares-Costa J, Afonso C, Peixoto D. A Rare Cause of Microcrystalline Arthritis in a Young Adult. J Clin Rheumatol 2021; 27:S821-S822. [PMID: 32568946 DOI: 10.1097/rhu.0000000000001439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Francisca Guimarães
- From the Rheumatology Department, Unidade Local de Saúde do Alto Minho, Ponte de Lima
| | | | - Soraia Azevedo
- From the Rheumatology Department, Unidade Local de Saúde do Alto Minho, Ponte de Lima
| | - Joana Rodrigues
- From the Rheumatology Department, Unidade Local de Saúde do Alto Minho, Ponte de Lima
| | - Joana Leite Silva
- From the Rheumatology Department, Unidade Local de Saúde do Alto Minho, Ponte de Lima
| | - Daniela Santos-Faria
- From the Rheumatology Department, Unidade Local de Saúde do Alto Minho, Ponte de Lima
| | - Filipa Teixeira
- From the Rheumatology Department, Unidade Local de Saúde do Alto Minho, Ponte de Lima
| | - José Tavares-Costa
- From the Rheumatology Department, Unidade Local de Saúde do Alto Minho, Ponte de Lima
| | - Carmo Afonso
- From the Rheumatology Department, Unidade Local de Saúde do Alto Minho, Ponte de Lima
| | - Daniela Peixoto
- From the Rheumatology Department, Unidade Local de Saúde do Alto Minho, Ponte de Lima
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14
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Pinto AS, Guimarães F, Parente H, Azevedo S, Santos-Faria D, Teixeira F. Synovial chondromatosis of the knee: three different imaging methods. Rheumatology (Oxford) 2021; 60:5832. [PMID: 33711104 DOI: 10.1093/rheumatology/keab240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 03/06/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Ana Sofia Pinto
- Rheumatology Department, Unidade Local de Saúde da Guarda, Guarda.,Rheumatology Department, Unidade Local de Saúde do Alto Minho, Ponte de Lima, Portugal
| | - Francisca Guimarães
- Rheumatology Department, Unidade Local de Saúde do Alto Minho, Ponte de Lima, Portugal
| | - Hugo Parente
- Rheumatology Department, Unidade Local de Saúde do Alto Minho, Ponte de Lima, Portugal
| | - Soraia Azevedo
- Rheumatology Department, Unidade Local de Saúde do Alto Minho, Ponte de Lima, Portugal
| | - Daniela Santos-Faria
- Rheumatology Department, Unidade Local de Saúde do Alto Minho, Ponte de Lima, Portugal
| | - Filipa Teixeira
- Rheumatology Department, Unidade Local de Saúde do Alto Minho, Ponte de Lima, Portugal
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15
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Azevedo S, Sousa-Neves J, Santos-Faria D, Silva JL, Rodrigues JR, Peixoto D, Alcino S, Teixeira F, Afonso C, Tavares-Costa J. Septic Polyarthritis by Staphylococcus aureus of "Unknown Origin". J Clin Rheumatol 2021; 27:e249-e250. [PMID: 32251051 DOI: 10.1097/rhu.0000000000001379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT More than 90% of septic arthritis cases are monoarticular. Joint infection can occur through several mechanisms such as hematogenous dissemination, by contiguity from adjacent infected soft tissue, surgical contamination, direct inoculation, or joint trauma.We report the case of a 69-year-old man admitted to our hospital with septic polyarthritis. The presented case is remarkable given its atypical presentation. The patient had no known risk factors for septic arthritis, comorbidities, or history of recurrent infections that could suggest some degree of immunosuppression. The atypical polyarticular involvement at presentation, the absence of sustained fever, and the good general condition of the patient delayed the diagnosis and treatment.
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Affiliation(s)
- Soraia Azevedo
- From the Rheumatology Department, Unidade Local de Saúde do Alto Minho, Ponte de Lima
| | | | - Daniela Santos-Faria
- From the Rheumatology Department, Unidade Local de Saúde do Alto Minho, Ponte de Lima
| | - Joana Leite Silva
- From the Rheumatology Department, Unidade Local de Saúde do Alto Minho, Ponte de Lima
| | - Joana Ramos Rodrigues
- From the Rheumatology Department, Unidade Local de Saúde do Alto Minho, Ponte de Lima
| | - Daniela Peixoto
- From the Rheumatology Department, Unidade Local de Saúde do Alto Minho, Ponte de Lima
| | - Sérgio Alcino
- From the Rheumatology Department, Unidade Local de Saúde do Alto Minho, Ponte de Lima
| | - Filipa Teixeira
- From the Rheumatology Department, Unidade Local de Saúde do Alto Minho, Ponte de Lima
| | - Carmo Afonso
- From the Rheumatology Department, Unidade Local de Saúde do Alto Minho, Ponte de Lima
| | - José Tavares-Costa
- From the Rheumatology Department, Unidade Local de Saúde do Alto Minho, Ponte de Lima
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Rodrigues JR, Santos-Faria D, Afonso C, Tavares-Costa J. Reply to: Biological Therapy in Patients with Rheumatoid Arthritis in a Tertiary Center in Portugal: A Cross-Sectional Study. ACTA MEDICA PORT 2021; 34:562. [PMID: 34851817 DOI: 10.20344/amp.16513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 05/06/2021] [Indexed: 11/20/2022]
Affiliation(s)
- Joana Ramos Rodrigues
- Serviço de Reumatologia. Hospital Conde de Bertiandos. Unidade Local de Saúde do Alto Minho. Ponte de Lima. Portugal
| | - Daniela Santos-Faria
- Serviço de Reumatologia. Hospital Conde de Bertiandos. Unidade Local de Saúde do Alto Minho. Ponte de Lima. Portugal
| | - Carmo Afonso
- Serviço de Reumatologia. Hospital Conde de Bertiandos. Unidade Local de Saúde do Alto Minho. Ponte de Lima. Portugal
| | - José Tavares-Costa
- Serviço de Reumatologia. Hospital Conde de Bertiandos. Unidade Local de Saúde do Alto Minho. Ponte de Lima. Portugal
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17
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Silva JL, Santos-Faria D, Cerqueira M, Sousa-Neves J, Peixoto D, Teixeira F. Ultrasound features in patients with gout: A comparative analysis with matched controls. Reumatol Clin (Engl Ed) 2021; 17:242-243. [PMID: 31515059 DOI: 10.1016/j.reuma.2019.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 07/19/2019] [Accepted: 08/07/2019] [Indexed: 06/10/2023]
Affiliation(s)
- Joana Leite Silva
- Rheumatology Department, Unidade Local de Saúde do Alto Minho, Ponte de Lima, Portugal.
| | - Daniela Santos-Faria
- Rheumatology Department, Unidade Local de Saúde do Alto Minho, Ponte de Lima, Portugal
| | | | | | - Daniela Peixoto
- Rheumatology Department, Unidade Local de Saúde do Alto Minho, Ponte de Lima, Portugal
| | - Filipa Teixeira
- Rheumatology Department, Unidade Local de Saúde do Alto Minho, Ponte de Lima, Portugal
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18
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Guimarães F, Santos-Faria D, Azevedo S, Ramos Rodrigues J, Leite Silva J, Esperança-Almeida D, Ribeiro B, Vaz R, Teixeira F, Tavares-Costa J, Afonso C, Peixoto D. ANCA-associated vasculitis in a patient with enteropathic spondylarthritis: a case report and literature review. Clin Rheumatol 2021; 40:3351-3355. [PMID: 33517484 DOI: 10.1007/s10067-021-05612-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 01/18/2021] [Accepted: 01/25/2021] [Indexed: 11/28/2022]
Abstract
Coexistence of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) and inflammatory bowel disease (IBD) is rare (Sy et al. in Semin Arthritis Rheum 45:475-482, 2016). Nevertheless, we present a case of an AAV in a 53-year-old female with enteropathic spondylarthritis previously treated with tumor necrosis factor α inhibitors (TNFi). Management of vasculitis in a patient with IBD may be problematic due to the difficulty in distinguishing if the vasculitis is an extraintestinal manifestation of the IBD or a new coexistent entity. Moreover, in our report, the previous treatment with TNFi is a possible confounding factor due to the paradoxical effects induced by TNFi, including vasculitis (Ramos-Casals et al. in Curr Rheumatol Rep 10:442-448, 2008). The reported case alerts to the complexity in the management of patients with enteropathic spondylarthritis and vasculitis, as well as discusses the diversity of differential diagnosis in this particular clinical scenario.
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Affiliation(s)
- Francisca Guimarães
- Rheumatology Department, Unidade Local de Saúde do Alto Minho, Largo Conde Bertiandos, 4990-041, Ponte de Lima, Portugal.
| | - Daniela Santos-Faria
- Rheumatology Department, Unidade Local de Saúde do Alto Minho, Largo Conde Bertiandos, 4990-041, Ponte de Lima, Portugal
| | - Soraia Azevedo
- Rheumatology Department, Unidade Local de Saúde do Alto Minho, Largo Conde Bertiandos, 4990-041, Ponte de Lima, Portugal
| | - Joana Ramos Rodrigues
- Rheumatology Department, Unidade Local de Saúde do Alto Minho, Largo Conde Bertiandos, 4990-041, Ponte de Lima, Portugal
| | - Joana Leite Silva
- Rheumatology Department, Unidade Local de Saúde do Alto Minho, Largo Conde Bertiandos, 4990-041, Ponte de Lima, Portugal
| | | | | | - Raquel Vaz
- Nephrology Department, Hospital de Braga, Braga, Portugal
| | - Filipa Teixeira
- Rheumatology Department, Unidade Local de Saúde do Alto Minho, Largo Conde Bertiandos, 4990-041, Ponte de Lima, Portugal
| | - José Tavares-Costa
- Rheumatology Department, Unidade Local de Saúde do Alto Minho, Largo Conde Bertiandos, 4990-041, Ponte de Lima, Portugal
| | - Carmo Afonso
- Rheumatology Department, Unidade Local de Saúde do Alto Minho, Largo Conde Bertiandos, 4990-041, Ponte de Lima, Portugal
| | - Daniela Peixoto
- Rheumatology Department, Unidade Local de Saúde do Alto Minho, Largo Conde Bertiandos, 4990-041, Ponte de Lima, Portugal
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Azevedo S, Sousa-Neves J, Santos-Faria D, Leite Silva J, Ramos Rodrigues J, Peixoto D, Tavares-Costa J, Alcino S, Afonso C, Teixeira F. Prevalence and clinical manifestations of Erasmus syndrome in systemic sclerosis: a cross-sectional study. Acta Reumatol Port 2020; 45:183-190. [PMID: 33139685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Erasmus syndrome (ErS) is a rare entity in which Systemic Sclerosis (SSc) develops following exposure to silica, with or without associated silicosis. The objectives of this study were: 1) to evaluate the prevalence of ErS in our SSc cohort; 2) to characterize the cases; 3) to evaluate the clinical and laboratory characteristics of SSc in patients with (Ers) or without silica exposure. METHODS Cross-sectional and analytical study. Sociodemographic, clinical and laboratory data were collected from all patients with SSc diagnosed in our department according to ACR / EULAR criteria. Data on professional activity and possible exposure to silica were obtained by phone interview. RESULTS Among 48 patients with SSc, the prevalence of ErS was 16.7% (8/48). All cases identified were male, corresponding to 72.7% of men with SSc followed at our department. There was a statistically significant association between ErS and male gender (p.
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Azevedo S, Guimarães F, Leite Silva J, Barros R, Capela S, Abreu P, Cunha Miranda L, Dourado E, Faustino A, Ferreira J, Las V, Martins F, Martins Rocha T, Meirinhos T, Salvador MJ, Santos-Faria D, Soares Rodrigues M, Teixeira F, Cunha I. The role of opioid analgesics in rheumatic disorders: a position paper from the Portuguese Rheumatology Society. Acta Reumatol Port 2020; 45:7-19. [PMID: 32572015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Pain is a common feature of most rheumatic diseases and it is often the main reason for the patient to seek for a clinical appointment. Chronic pain has a major impact on patient's quality of life, being frequently associated with functional incapacity, sleep and mood disorders. This leads to absenteeism and heavy consumption of health resources, both representing huge burdens on national economy. Managing musculoskeletal pain is pivotal but can be challenging. The use of the available pharmaceutical armamentarium should be parsimonious. Opioids are strong analgesic drugs that mostly act through their agonist action on µ-receptors in the central nervous system. Opioid-related side effects are not negligible and are mediated through both central and peripheral opioid receptors. The use of opioids is well established in the treatment of oncologic pain but their role in the management of musculoskeletal pain is still controversial. Inflammatory rheumatic diseases, osteoarthritis, osteoporotic fractures, chronic low back pain and fibromyalgia represent diverse major rheumatic conditions that frequently lead to chronic pain. In order to standardize and optimize management of musculoskeletal chronic pain in these prevalent diseases, the Portuguese Rheumatology Society elaborated this position paper. The objectives were: a) to define the importance of pain assessment and classification; b) to guide patient selection, appropriate choice of opioids, their management, and raise awareness of their adverse effects; c) to review the existent data on possible indications of opioid therapy on rheumatic diseases.
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Rodrigues M, Rodrigues J, Afonso C, Santos-Faria D, Peixoto D, Teixeira F, Neves J, Silva J, Tavares-Costa J, Alcino S, Azevedo S, Gandarez F. Hand function and adaptive equipment use in patients with rheumatoid arthritis. Acta Reumatol Port 2019; 44:273-280. [PMID: 32281611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVES Evaluation and characterization of hand function in patients with rheumatoid (RA) arthritis and, secondarily, identification of the use of adaptive equipments. MATERIAL AND METHODS Firstly, a written informed consent was obtained and then an anonymous questionnaire was filled by RA outpatients after observation at the rheumatology consultation with no other musculoskeletal or neuromuscular disorders that would determine major functional impairment of hand function. Sociodemographic and clinical variables were collected and the Cochin Hand Functional Scale (CHFS) was applied. Classical deformities of hand and/or wrist were observed and recorded by the attending physician. RESULTS A total of 79 patients were enrolled. In the overall sample, most patients were female A sample of 79 patients, mostly female (69.60%), with a mean age of 59.72 ± 11.77 years and with a mean diagnosis duration of 11.72 ± 8.29 years. The majority (73.40%) had at least one hand or wrist deformity, the most frequent being atrophy of the interosseous muscles followed by ulnar deviation of the metacarpophalangeal joints and piano key deformity of the wrist. The mean CHFS score was 17.94 ± 18.26 points with a minimum and maximum value recorded of 0 and 80 points, respectively. The presence of hand deformities, Health Assessment Questionnaire score (HAQ), hand pain and diagnosis duration were correlated with the CHFS score. Six patients had assistive devices and only in one case it was used to overcome hand's functional impairment. CONCLUSIONS Most patients presented at least one classic RA deformity after a mean diagnosis duration of approximately 12 years and under pharmacological treatment. Despite this, most patients scored significantly below CHFS maximum score, but only 18 reported no difficulty in any of the tasks mentioned in the scale. The fact that only a minority of these patients had assistive devices should alerts us to the need for a more thorough functional assessment and identification of needs among RA patients.
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Azevedo S, Santos-Faria D, Leite Silva J, Ramos Rodrigues J, Sousa Neves J, Peixoto D, Tavares-Costa J, Alcino S, Afonso C, Teixeira F. Obesity, metabolic syndrome and other comorbidities in rheumatoid arthritis and psoriatic arthritis: influence on disease activity and quality of life. Acta Reumatol Port 2019; 44:322-324. [PMID: 32281967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
In obesity, especially if visceral, and in rheumatic diseases, the production of pro-inflammatory cytokines contributes to an increased cardiovascular risk. Moreover, classic cardiovascular risk factors are more common in these patients. We intended to assess the influence of body mass index (BMI), abdominal circumference (AC) and metabolic syndrome (MS) on disease activity and quality of life in Rheumatoid Arthritis (RA) and Psoriatic Arthritis patients and to compare the results between the RA and PsA patients. We performed a cross-sectional study, including 150 patients with RA and 75 patients with PsA. PsA patients had significantly higher BMI, AC and total of comorbidities than RA patients . Independently the underlying pathology (RA or PsA), the number of comorbidities was correlated positively with DAS28, HAQ , CRP and ESR. In RA group, overweight/obesity (BMI≥25kg/m2) were associated with at least one painful joint and the risk of having at least one swollen joint was 3.4 times higher in patients with increased AC. There was an association between the BMI and AC and the CRP value. Patients with BMI≥25 kg/m2 and increased AC had significantly higher DAS28 scores. MS was associated with significantly higher ESR. There was a positive correlation of both BMI and AC with HAQ and also MS was associated with highest HAQ values. In PsA group, patients with BMI≥25kg/m2 had equally more painful joints and higher CRP values. Patients with MS had higher CRP values, more joint pain and higher disease activity according to DAS28. None of the patients with normal BMI had swollen joints, however 20.4% of overweight patients had at least one swollen joint. The number of comorbidities showed to influence inflammatory parameters, disease activity and quality of life. We found that BMI, AC and MS are associated with disease activity, which may be improved by weight reduction and comorbidities control.
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Affiliation(s)
- Soraia Azevedo
- Rheumatology department, Unidade Local de Saúde do Alto Minho, Ponte de Lima
| | | | - Joana Leite Silva
- Rheumatology department, Unidade Local de Saúde do Alto Minho, Ponte de Lima
| | | | - Joana Sousa Neves
- Rheumatology department, Unidade Local de Saúde do Alto Minho, Ponte de Lima
| | - Daniela Peixoto
- Rheumatology department, Unidade Local de Saúde do Alto Minho, Ponte de Lima
| | - José Tavares-Costa
- Rheumatology department, Unidade Local de Saúde do Alto Minho, Ponte de Lima
| | - Sérgio Alcino
- Rheumatology department, Unidade Local de Saúde do Alto Minho, Ponte de Lima
| | - Carmo Afonso
- Rheumatology department, Unidade Local de Saúde do Alto Minho, Ponte de Lima
| | - Filipa Teixeira
- Rheumatology department, Unidade Local de Saúde do Alto Minho, Ponte de Lima
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Vieira-Sousa E, Eusébio M, Ávila-Ribeiro P, Khmelinskii N, Cruz-Machado R, Rocha TM, Bernardes M, Santos-Faria D, Silva JL, Santos H, Miguel C, Carvalho P, Costa T, Duarte AC, Meirinhos T, Nero P, Fonseca JE, Santos MJ. Real-world Longterm Effectiveness of Tumor Necrosis Factor Inhibitors in Psoriatic Arthritis Patients from the Rheumatic Diseases Portuguese Register. J Rheumatol 2019; 47:690-700. [DOI: 10.3899/jrheum.181272] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2019] [Indexed: 01/30/2023]
Abstract
Objective.To assess longterm effectiveness of tumor necrosis factor inhibitors (TNFi) in patients with psoriatic arthritis (PsA) registered in the Rheumatic Diseases Portuguese Register, exposed to at least 1 TNFi, prospectively followed between 2001 and 2017.Methods.Kaplan-Meier analysis was performed for first-, second-, and third-line TNFi. Responses included European League Against Rheumatism (EULAR) criteria, Disease Activity Index for Psoriatic Arthritis (DAPSA), minimal disease activity (MDA), and Ankylosing Spondylitis Disease Activity Score (ASDAS) at 3 and 6 months. Baseline predictors of discontinuation and response were studied using Cox and multivariable multinomial/logistic regression models.Results.The 750 patients with PsA showed drug retention of 4.1 ± 3.4 years (followup 5.8 ± 3.8 yrs) for first TNFi. Switching to a second (189 patients) or third (50 patients) TNFi further decreased survival by 1.1 years. Female sex, higher baseline 28-joint count Disease Activity Score, and infliximab were predictors of first TNFi discontinuation. After 6 months of the first TNFi, 48.7% of patients achieved a good EULAR criteria response and 20.9% were in DAPSA remission. There were 11.4% in MDA, and 56.4% had a good ASDAS. Responses to the second TNFi were significantly inferior compared to responses to the first TNFi. Female sex and higher baseline Health Assessment Questionnaire–Disability Index were negatively associated with good EULAR response at 3 months, and obesity decreased the chance of response at 6 months.Conclusion.In this study, switching to a second or third TNFi was associated with significantly lower drug survival and response rates for patients with axial and peripheral PsA subtypes. More successful therapeutic approaches will require considering the effect of sex and obesity on TNFi effectiveness.
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Rodrigues J, Santos-Faria D, Silva J, Azevedo S, Tavares-Costa J, Teixeira F. Sonoanatomy of anterior forearm muscles. J Ultrasound 2019; 22:401-405. [PMID: 31183837 DOI: 10.1007/s40477-019-00388-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 04/22/2019] [Accepted: 05/25/2019] [Indexed: 10/26/2022] Open
Abstract
The anterior or volar compartment of the forearm contains eight muscles: five belong to the superficial group (pronator teres, flexor carpi radialis, palmaris longus, flexor digitorum superficialis and flexor carpi ulnaris), and three to the deep group (flexor digitorum profundus, flexor pollicis longus and pronator quadratus). Knowledge of the topographic anatomy is essential for correct performance of ultrasound (US) examinations and correct interpretation of the images provided.
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Affiliation(s)
- Joana Rodrigues
- Serviço de Reumatologia, Unidade Local de Saúde Do Alto Minho, Ponte de Lima, Portugal.
| | - Daniela Santos-Faria
- Serviço de Reumatologia, Unidade Local de Saúde Do Alto Minho, Ponte de Lima, Portugal
| | - Joana Silva
- Serviço de Reumatologia, Unidade Local de Saúde Do Alto Minho, Ponte de Lima, Portugal
| | - Soraia Azevedo
- Serviço de Reumatologia, Unidade Local de Saúde Do Alto Minho, Ponte de Lima, Portugal
| | - José Tavares-Costa
- Serviço de Reumatologia, Unidade Local de Saúde Do Alto Minho, Ponte de Lima, Portugal
| | - Filipa Teixeira
- Serviço de Reumatologia, Unidade Local de Saúde Do Alto Minho, Ponte de Lima, Portugal
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Santos-Faria D, Tavares-Costa J, Eusébio M, Leite Silva J, Ramos Rodrigues J, Sousa-Neves J, Duarte AC, Lopes C, Valido A, Dinis J, Freitas J, Santiago M, Ferreira R, Ganhão S, Miranda L, Peixoto D, Teixeira F, Alcino S, Afonso C, Santos MJ. Tocilizumab and rituximab have similar effectiveness and are both superior to a second tumour necrosis factor inhibitor in rheumatoid arthritis patients who discontinued a first TNF inhibitor. Acta Reumatol Port 2019; 44:103-113. [PMID: 31243259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To compare the effectiveness of a 2nd TNF inhibitor (TNFi), Tocilizumab (TCZ) and Rituximab (RTX), measured by drug retention and by response rates, in RA patients after discontinuing a first-line TNFi and to clarify the reasons and predictors for discontinuation of a second-line biologic. MATERIAL AND METHODS Non-interventional prospective study of RA patients exposed to a 2nd TNFi, TCZ or RTX after previous TNFi discontinuation using real-world data from Reuma.pt database. Drug retention was estimated using Kaplan-Meier analysis and Cox models. Crude and LUNDEX adjusted response rates were evaluated at 6 months, 1 and 2 years and reasons for discontinuation were compared according to biologic class. RESULTS In total, 643 patients were included, 88.8% females, with a mean age of 59.4±12.8 years. Of those, 390 (60.7%) initiated a 2nd TNFi, 147 (22.9%) TCZ and 106 (16.5%) RTX. Drug retention was significantly greater among patients who initiated TCZ (76.4±4.3 months) or RTX (80.8±4.8 months), compared with those who initiated a 2nd TNFi (52.7±2.6 months) (log rank test, p < 0.001). In the adjusted Cox model, hazards of discontinuation were significantly lower for TCZ (HR 0.39, 95% CI 0.23-0.64, p < 0.001) and RTX (HR 0.42, 95% CI 0.25-0.72, p=0.001). Smokers had a significantly higher risk for discontinuation (HR 2.43, 95%CI 1.50-3.95, p < 0.001) as well as patients with higher HAQ at baseline (HR 1.51, 95%CI 1.14-2.00, p=0.004). The proportion of patients in remission or low disease activity according to Clinical Disease Activity Index (CDAI) at 6 months, 1 and 2 years was, respectively, 46.5%/50.0%/61.2% for TNFi, 52.9%/53.6%/ 69.2% for TCZ and 37.7%/48.0%/50.0% for RTX. After LUNDEX adjustment, response rates were, respectively, 33.0%/31.0%/31.8% for 2nd TNFi, 42.8%/41.8%/53.3% for TCZ and 32.0%/39.4%/39.0% for RTX. The main reasons for discontinuation were inefficacy for 2nd TNFi and RTX and adverse events for TCZ (p < 0.001). CONCLUSIONS Our findings showed a significantly higher drug retention for TCZ and RTX, compared with 2nd TNFi, and similar persistence among TCZ and RTX, in patients who discontinued a first-line TNFi. These data corroborate the notion that switching to a biologic with a different mode of action is more effective than to a second TNFi.
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Affiliation(s)
- Daniela Santos-Faria
- Hospital Conde de Bertiandos - Unidade Local de Saúde do Alto Minho, Ponte de Lima
| | - José Tavares-Costa
- Hospital Conde de Bertiandos - Unidade Local de Saúde do Alto Minho, Ponte de Lima
| | | | - Joana Leite Silva
- Hospital Conde de Bertiandos - Unidade Local de Saúde do Alto Minho, Ponte de Lima
| | | | - Joana Sousa-Neves
- Hospital Conde de Bertiandos - Unidade Local de Saúde do Alto Minho, Ponte de Lima
| | | | | | | | | | - João Freitas
- Centro Hospitalar e Universitário de Coimbra, Coimbra
| | | | | | | | | | - Daniela Peixoto
- Hospital Conde de Bertiandos - Unidade Local de Saúde do Alto Minho, Ponte de Lima
| | - Filipa Teixeira
- Hospital Conde de Bertiandos - Unidade Local de Saúde do Alto Minho, Ponte de Lima
| | - Sérgio Alcino
- Hospital Conde de Bertiandos - Unidade Local de Saúde do Alto Minho, Ponte de Lima
| | - Carmo Afonso
- Hospital Conde de Bertiandos - Unidade Local de Saúde do Alto Minho, Ponte de Lima
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Duarte C, Fernandes F, Madeira N, Pinto P, Furtado C, Ribeiro C, Couto M, Santos-Faria D, Martins-Rocha T, Freitas R, Cunha R, Heaney A, McKena S, Pereira da Silva JA. Validation of Rheumatoid Arthritis Quality of Life (RAQoL) Questionnaire into Portuguese Language. Acta Reumatol Port 2019; 44:65-70. [PMID: 31249277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Rheumatoid Arthritis (RA) is a chronic inflammatory disease with high impact on patients´ quality of life (QoL). The Rheumatoid Arthritis Quality of Life Questionnaire (RAQoL) is a self-completed questionnaire designed to assess QoL in patients with RA. A Portuguese adaptation of the RAQoL was available but required formal validation. AIM To validate the RAQoL into the Portuguese language. METHODS Patients with diagnosis of RA were included. The Portuguese RAQoL was administered on two occasions, 14 days apart. Participants also completed the Nottingham Health Profile (NHP) and Health Assessment Questionnaire (HAQ) at Time 1. Internal consistency was assessed using Cronbach's alpha and reliability through Spearman's Correlation Coefficient. Construct validity was evaluated through Spearman's correlation analyses between RAQoL, NHP and HAQ. Known-group validity was tested comparing the RAQoL across different groups, considering self-perceived general health status, flare symptoms and RA severity through non-parametric tests. RESULTS 178 RA patients (mean age 56.6, 82% female, mean disease duration 13.6 years) were included. The mean score of RAQoL was 11, with low rates of missing data (3.9%), floor (4.5%) and ceiling (2.2%) effects. Cronbach's α was 0.95 and test-retest reliability 0.92. RAQoL scores correlated moderately with scores on the NHP Physical Mobility (r=0.77), Emotional reactions (r=0.69), Pain (r=0.68) and Energy (r=0.65) section scores. RAQoL showed to be discriminative for groups according to self-perceived general health status, flare of arthritis and disease severity. CONCLUSION The Portuguese version of the RAQoL is a valid, feasible and reliable questionnaire, suitable for use in clinical practice and research purposes.
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Affiliation(s)
- Catia Duarte
- Centro Hospitalar Universitário de Coimbra; Coimbra Institute for Clinical and Biomedical Research (iCBR) - Faculty of Medicine, University of Coimbra, Portugal
| | | | | | | | | | | | | | | | | | | | | | | | | | - Jose António Pereira da Silva
- Centro Hospitalar Universitário de Coimbra; Coimbra Institute for Clinical and Biomedical Research (iCBR) - Faculty of Medicine, University of Coimbra, Portugal
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Polido-Pereira J, Serra S, Teixeira F, Ponte C, Cerqueira M, Cruz M, Araújo F, Barros R, Costa T, Santos-Faria D, Lopes C, Madruga-Dias J, Oliveira M, Teixeira R, Vilar A, Falcão S, Saraiva F, Figueiredo G. Portuguese recommendations for the use of ultrasound in rheumatology. Acta Reumatol Port 2019; 44:7-28. [PMID: 31249273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Ultrasound (US) is a relatively cheap, easily available and reliable method to improve the care of rheumatic patients. However, its use in rheumatology practice is very heterogeneous and needs to be standardized. OBJECTIVES To develop recommendations for the use of US in rheumatic diseases endorsed by the Portuguese Society of Rheumatology. METHODS A systematic literature review of the available recommendations on the use of ultrasound in rheumatic diseases was performed and presented in a Portuguese Society of Rheumatology meeting to a subgroup of rheumatologists and rheumatology trainees with special interest in the subject. The most important topics to be addressed were selected and assigned to subgroups for literature review and draft recommendations. Following an iterative process of consensus, the final recommendations were developed, and their level of agreement voted anonymously online. A recommendation was approved when the average level of agreement was ≥ 7.5 in a 10-point Likert scale. RESULTS Fourteen recommendations were produced regarding nine rheumatology topics: rheumatoid arthritis, spondyloarthritis, connective tissue diseases, polymyalgia rheumatica, vasculitis, crystal-deposition diseases, soft tissue rheumatism, osteoarthritis and ultrasound-guided procedures. CONCLUSION We developed an up-to-date guidance in the form of recommendations for the use of US in nine different areas of rheumatology. As ultrasound is an important imaging modality with increasing use in the rheumatology setting, and there are frequent technological advances in the ultrasound machines and probes, in parallel with continuous associated research, these recommendations should be regularly updated.
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Affiliation(s)
- Joaquim Polido-Pereira
- Hospital de Santa Maria, Centro Hospitalar e Universitário Lisboa Norte, Lisbon Academic Medical Centre, Lisboa, Portugal and Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Sara Serra
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Filipa Teixeira
- Unidade Local de Saúde do Alto Minho, Ponte de Lima, Portugal
| | - Cristina Ponte
- Hospital de Santa Maria, Centro Hospitalar e Universitário Lisboa Norte, Lisbon Academic Medical Centre, Lisboa, Portugal and Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | | | | | | | - Rita Barros
- Hospital de Santa Maria, Centro Hospitalar e Universitário Lisboa Norte, Lisbon Academic Medical Centre, Lisboa, Portugal and Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Tiago Costa
- Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | | | - Carina Lopes
- Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | | | - Margarida Oliveira
- Centro Hospitalar e Universitário da Cova da Beira, Covilhã, Portugal and Universidade da Beira Interior, Portugal
| | - Rui Teixeira
- Hospital de Santa Maria, Centro Hospitalar e Universitário Lisboa Norte, Lisbon Academic Medical Centre, Lisboa, Portugal and Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | | | - Sandra Falcão
- Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal and Faculdade de Ciência Médicas, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Fernando Saraiva
- Hospital de Santa Maria, Centro Hospitalar e Universitário Lisboa Norte, Lisbon Academic Medical Centre, Lisboa, Portugal
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Santos-Faria D, Sousa-Neves J, Leite Silva J, Ramos Rodrigues J, Azevedo S, Alcino S, Afonso C, Teixeira F. Intravenous human immunoglobulin for the treatment of recurrent focal myositis. Acta Reumatol Port 2019; 44:88-89. [PMID: 31249282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
We present a case of recurrent focal myositis treated with intravenous human immunoglobulin, after ineffectiveness of analgesics, non-steroidal anti-inflammatory drugs, corticosteroids and immunosuppressive therapies. There was a prompt clinical and laboratorial improvement. To the best of our knowledge, this is the first case reporting the administration of this treatment in recurrent focal myositis.
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Affiliation(s)
- Daniela Santos-Faria
- Hospital Conde de Bertiandos - Unidade Local de Saúde do Alto Minho, Ponte de Lima, Portugal
| | - Joana Sousa-Neves
- Hospital Conde de Bertiandos - Unidade Local de Saúde do Alto Minho, Ponte de Lima, Portugal
| | - Joana Leite Silva
- Hospital Conde de Bertiandos - Unidade Local de Saúde do Alto Minho, Ponte de Lima, Portugal
| | - Joana Ramos Rodrigues
- Hospital Conde de Bertiandos - Unidade Local de Saúde do Alto Minho, Ponte de Lima, Portugal
| | - Soraia Azevedo
- Hospital Conde de Bertiandos - Unidade Local de Saúde do Alto Minho, Ponte de Lima, Portugal
| | - Sérgio Alcino
- Hospital Conde de Bertiandos - Unidade Local de Saúde do Alto Minho, Ponte de Lima, Portugal
| | - Carmo Afonso
- Hospital Conde de Bertiandos - Unidade Local de Saúde do Alto Minho, Ponte de Lima, Portugal
| | - Filipa Teixeira
- Hospital Conde de Bertiandos - Unidade Local de Saúde do Alto Minho, Ponte de Lima, Portugal
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Santos-Faria D, Dougados M, Gossec L, Perrot S, Moltó A. Evaluation of the performance of extreme patient-reported outcomes as surrogate markers for fibromyalgia in axial spondyloarthritis. Rheumatol Int 2018; 39:141-146. [PMID: 30413924 DOI: 10.1007/s00296-018-4200-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Accepted: 11/02/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVES The aim of the study is to evaluate the performance of extreme patient-reported outcomes (PRO) against definitions of fibromyalgia (FM) in patients with axial spondyloarthritis (axSpA). METHODS Ancillary analysis of the Predict-SpA trial, an observational study of axSpA patients receiving TNF-α inhibitor, was performed. 'Extreme PRO' was defined as a score ≥ 8 on three out of the first five Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) questions (scored 0-10). FM was defined by the American College of Rheumatology (ACR) 1990 criteria and the Fibromyalgia Rapid Screening Test (FiRST). Performances of 'extreme PRO' for FM were evaluated by the sensitivity, specificity and positive likelihood ratio using the 1990 ACR criteria as gold standard. As secondary analysis, the FiRST was used as the external standard. RESULTS The prevalence of 'extreme PRO' in this population was 28.8% at baseline and decreased to 9.9% at 12 weeks. 'Extreme PRO' had low sensitivity 12 weeks after TNF initiation (0.18, 95% confidence interval [CI] 0.10-0.27 vs 0.60, 95% CI 0.50-0.71, at baseline), but high specificity (0.92, 95% CI 0.89-0.94 vs 0.78, 95% 0.74-0.82, at baseline), using ACR 1990 criteria as gold standard. Performances when tested against FiRST at 12 weeks showed higher sensitivity (0.27, 95% CI 0.20-0.35) and specificity (0.96, 95% CI 0.94-0.98). CONCLUSION The proposed extreme PRO definition showed great specificity for FM recognition in patients with axSpA, suggesting it could be used in observational studies when specific items for FM classification are not available.
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Affiliation(s)
- Daniela Santos-Faria
- Rheumatology Department, Unidade Local de Saúde do Alto Minho (ULSAM), Hospital Conde de Bertiandos, Largo Conde de Bertiandos, 4990-078, Ponte de Lima, Portugal. .,Rheumatology Department, Cochin Hospital, Paris Descartes University, AP-HP, Paris, France.
| | - Maxime Dougados
- Rheumatology Department, Cochin Hospital, Paris Descartes University, AP-HP, Paris, France.,INSERM (U1153), Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris, France
| | - Laure Gossec
- Department of Rheumatology, Pitié-Salpêtrière Hospital, Sorbonne Universités, UPMC Université, AP-HP, Paris, France
| | - Serge Perrot
- Pain Center and INSERM U987, Cochin Hospital, Paris Descartes University, AP-HP, Paris, France
| | - Anna Moltó
- Rheumatology Department, Cochin Hospital, Paris Descartes University, AP-HP, Paris, France.,INSERM (U1153), Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris, France
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Santos-Faria D, Leite Silva J, Sousa-Neves J, Ramos Rodrigues J, Afonso C, Peixoto D. Systemic sclerosis and myositis as a paraneoplastic syndrome secondary to multiple myeloma. Acta Reumatol Port 2018; 43:316-317. [PMID: 30641542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
We present a case of paraneoplastic systemic sclerosis (SSc) and myositis associated to a multiple myeloma (MM) in a 52-year-old Caucasian man. After MM treatment, skin and muscle changes improved, with no further relapses. Although rare, "scleroderma-like" or myositis lesions may be associated with MM. However, to the best of our knowledge, this is the first case reporting these two clinical conditions simultaneously associated with MM.
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Affiliation(s)
- Daniela Santos-Faria
- Hospital Conde de Bertiandos - Unidade Local de Saúde do Alto Minho, Ponte de Lima, Portugal
| | - Joana Leite Silva
- Hospital Conde de Bertiandos - Unidade Local de Saúde do Alto Minho, Ponte de Lima, Portugal
| | - Joana Sousa-Neves
- Hospital Conde de Bertiandos - Unidade Local de Saúde do Alto Minho, Ponte de Lima, Portugal
| | - Joana Ramos Rodrigues
- Hospital Conde de Bertiandos - Unidade Local de Saúde do Alto Minho, Ponte de Lima, Portugal
| | - Carmo Afonso
- Hospital Conde de Bertiandos - Unidade Local de Saúde do Alto Minho, Ponte de Lima, Portugal
| | - Daniela Peixoto
- Hospital Conde de Bertiandos - Unidade Local de Saúde do Alto Minho, Ponte de Lima, Portugal
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Sousa-Neves J, Cerqueira M, Santos-Faria D, Afonso C, Teixeira F. Neuropathic pain in Systemic Sclerosis patients: A cross-sectional study. ACTA ACUST UNITED AC 2018; 15:e99-e101. [PMID: 29397326 DOI: 10.1016/j.reuma.2017.12.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Revised: 11/12/2017] [Accepted: 12/21/2017] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To investigate if patients with Systemic Sclerosis (SSc) show a higher prevalence of neuropathic pain (NP) in comparison with controls. To study the relationship between clinical variables of the disease and NP among SSc patients. MATERIAL AND METHODS 48 patients and 45 controls were included. Presence of NP was assessed applying the DN4 "Douleur Neuropathique en 4 Questions" questionnaire. Different clinical variables were also assessed in patients. Statistical analysis included parametric, nonparametric tests and multivariate logistic regression. RESULTS NP was significantly higher in SSc patients (56.2% vs 13.3%, p<0.001). Mean Modified Rodnan Skin Score was independently associated with the presence of NP (p<0.05, OR 1.90). CONCLUSIONS Peripheral nervous system involvement in SSc is not well studied and, as far as the authors are aware, this is the first study published evaluating NP in SSc patients and controls. These findings should raise the awareness of the clinician to recognize and address the presence of NP in these patients, especially in those with severe skin involvement.
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Affiliation(s)
- Joana Sousa-Neves
- Rheumatology Department, Conde de Bertiandos Hospital, Ponte de Lima, Portugal.
| | - Marcos Cerqueira
- Rheumatology Department, Conde de Bertiandos Hospital, Ponte de Lima, Portugal
| | | | - Carmo Afonso
- Rheumatology Department, Conde de Bertiandos Hospital, Ponte de Lima, Portugal
| | - Filipa Teixeira
- Rheumatology Department, Conde de Bertiandos Hospital, Ponte de Lima, Portugal
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Sousa-Neves J, Cerqueira M, Santos-Faria D, Afonso C, Teixeira F. Ultrasound assessment of skin thickness performed on fingers: a tool for estimating overall severity of skin disease in Systemic Sclerosis patients? Acta Reumatol Port 2017; 42:339-340. [PMID: 28917220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
| | - Marcos Cerqueira
- Unidade Local de Saude do Alto Minho, Hospital Conde de Bertiandos
| | | | - Carmo Afonso
- Unidade Local de Saude do Alto Minho, Hospital Conde de Bertiandos
| | - Filipa Teixeira
- Unidade Local de Saude do Alto Minho, Hospital Conde de Bertiandos
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Sousa-Neves J, Mota P, Melo N, Santos-Faria D, Bernardes M, Morais A. Transbronchial cryobiopsy: a new way to assess lung disease in rheumatic disorders. Acta Reumatol Port 2017; 42:275-276. [PMID: 28663536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
| | - Patrícia Mota
- Centro Hospitalar de São João, Porto; Faculdade de Medicina da Universidade do Porto
| | | | | | - Miguel Bernardes
- Centro Hospitalar de São João, Porto; Faculdade de Medicina da Universidade do Porto
| | - António Morais
- Centro Hospitalar de São João, Porto; Faculdade de Medicina da Universidade do Porto
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Duarte AC, Santos-Faria D, Gonçalves MJ, Sepriano A, Mourão AF, Duarte C, Neves JS, Águeda AF, Ribeiro PA, Daniel A, Neto A, Cordeiro A, Rodrigues A, Barcelos A, Silva C, Ponte C, Vieira-Sousa E, Teixeira F, Oliveira-Ramos F, Araújo F, Barcelos F, Canhão H, Santos H, Ramos J, Polido-Pereira J, Tavares-Costa J, Melo Gomes JA, Cunha-Miranda L, Costa L, Cerqueira M, Cruz M, Santos MJ, Bernardes M, Oliveira P, Abreu P, Figueira R, Barros R, Falcão S, Pinto P, Pimenta S, Capela S, Teixeira V, Fonseca JE. Portuguese recommendations for the use of methotrexate in rheumatic diseases - 2016 update. Acta Reumatol Port 2017; 42:127-140. [PMID: 28535545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Methotrexate (MTX) is the first-line drug in the treatment of rheumatoid arthritis (RA) and the most commonly prescribed disease modifying anti-rheumatic drug. Moreover, it is also used as an adjuvant drug in patients under biologic therapies, enhancing the efficacy of biologic agents. OBJECTIVES To review the literature and update the Portuguese recommendations for the use of MTX in rheumatic diseases first published in 2009. METHODS The first Portuguese guidelines for the use of MTX in rheumatic diseases were published in 2009 and were integrated in the multinational 3E Initiative (Evidence Expertise Exchange) project. The Portuguese rheumatologists based on literature evidence and consensus opinion formulated 13 recommendations. At a national meeting, the recommendations included in this document were further discussed and updated. The document resulting from this meeting circulated to all Portuguese rheumatologists, who anonymously voted online on the level of agreement with the updated recommendations. RESULTS Results presented in this article are mainly in accordance with previous guidelines, with some new information regarding hepatitis B infection during MTX treatment, pulmonary toxicity monitoring, hepatotoxicity management, association with hematologic neoplasms, combination therapy and tuberculosis screening during treatment. CONCLUSION The present recommendations combine scientific evidence with expert opinion and attained desirable agreement among Portuguese rheumatologists. The regular update of these recommendations is essential in order to keep them a valid and useful tool in daily practice.
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Affiliation(s)
| | | | - Maria João Gonçalves
- Hospital de Santa Maria, Centro Hospitalar Lisboa Norte; Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisbon
| | | | - Ana Filipa Mourão
- Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental; CEDOC - Nova Medical School, Universidade Nova de Lisboa; Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisbon
| | - Cátia Duarte
- on behalf of the Portuguese Society of Rheumatology
| | | | | | | | | | - Adriano Neto
- on behalf of the Portuguese Society of Rheumatology
| | - Ana Cordeiro
- on behalf of the Portuguese Society of Rheumatology
| | | | | | | | | | | | | | | | | | | | | | | | - João Ramos
- on behalf of the Portuguese Society of Rheumatology
| | | | | | | | | | - Lúcia Costa
- on behalf of the Portuguese Society of Rheumatology
| | | | | | | | | | | | - Pedro Abreu
- on behalf of the Portuguese Society of Rheumatology
| | | | - Rita Barros
- on behalf of the Portuguese Society of Rheumatology
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