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de Figueiredo LQ, de Andrade Lopes FO, Franco AS, Giardini HAM, Guedes LKN, Bonfiglioli KR, Shimabuco AY, de Medeiros Ribeiro AC, Domiciano DS. Scleromalacia perforans as an early manifestation of late-onset rheumatoid arthritis: a case-based review. Rheumatol Int 2023:10.1007/s00296-023-05494-0. [PMID: 37925382 DOI: 10.1007/s00296-023-05494-0] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 10/11/2023] [Indexed: 11/06/2023]
Abstract
Rheumatoid arthritis is a chronic autoimmune disease that can affect different organs beyond the joints. Ocular involvement includes keratoconjunctivitis sicca, peripheral ulcerative keratitis (PUK), episcleritis, scleritis, anterior uveitis, and corneal impairment. The most severe form of scleritis, scleromalacia perforans, is an aggressive ophthalmic manifestation that can potentially lead to blindness, usually occurring in late stages of disease. We report a case of an elderly woman in which this severe ocular manifestation occurred early on disease onset, differing from most of the previously reported cases of scleromalacia perforans. Ocular symptoms started concomitantly with the polyarthritis and other extra-articular manifestations, including rheumatoid nodules and vasculitic skin lesions. Ocular disease progressed due to patient's loss to follow-up, requiring pulse therapy with methylprednisolone. However, despite treatment, right eye enucleation was required due to melting of the corneal patch with uveal exposition. The patient was then treated with rituximab with improvement of systemic disease. The present case reinforces that, although rare, this complication is severe and must be promptly diagnosed and aggressively treated to improve prognosis of ocular and systemic RA.
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Affiliation(s)
- Letícia Queiroga de Figueiredo
- Division of Rheumatology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, da Universidade de Sao Paulo, Av. Dr. Arnaldo 455, 3º. andar, sala 3105, São Paulo, SP, 01246-903, Brazil
| | - Fernanda Oliveira de Andrade Lopes
- Division of Rheumatology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, da Universidade de Sao Paulo, Av. Dr. Arnaldo 455, 3º. andar, sala 3105, São Paulo, SP, 01246-903, Brazil
| | - André Silva Franco
- Division of Rheumatology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, da Universidade de Sao Paulo, Av. Dr. Arnaldo 455, 3º. andar, sala 3105, São Paulo, SP, 01246-903, Brazil
| | - Henrique Ayres Mayrink Giardini
- Division of Rheumatology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, da Universidade de Sao Paulo, Av. Dr. Arnaldo 455, 3º. andar, sala 3105, São Paulo, SP, 01246-903, Brazil
| | - Lissiane Karine Noronha Guedes
- Division of Rheumatology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, da Universidade de Sao Paulo, Av. Dr. Arnaldo 455, 3º. andar, sala 3105, São Paulo, SP, 01246-903, Brazil
| | - Karina Rossi Bonfiglioli
- Division of Rheumatology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, da Universidade de Sao Paulo, Av. Dr. Arnaldo 455, 3º. andar, sala 3105, São Paulo, SP, 01246-903, Brazil
| | - Andrea Yukie Shimabuco
- Division of Rheumatology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, da Universidade de Sao Paulo, Av. Dr. Arnaldo 455, 3º. andar, sala 3105, São Paulo, SP, 01246-903, Brazil
| | - Ana Cristina de Medeiros Ribeiro
- Division of Rheumatology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, da Universidade de Sao Paulo, Av. Dr. Arnaldo 455, 3º. andar, sala 3105, São Paulo, SP, 01246-903, Brazil
| | - Diogo Souza Domiciano
- Division of Rheumatology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, da Universidade de Sao Paulo, Av. Dr. Arnaldo 455, 3º. andar, sala 3105, São Paulo, SP, 01246-903, Brazil.
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Sales LP, Hounkpe BW, Perez MO, Caparbo VF, Domiciano DS, Borba EF, Schett G, Figueiredo CP, Pereira RMR. Transcriptomic characterization of classical monocytes highlights the involvement of immuno-inflammation in bone erosion in Rheumatoid Arthritis. Front Immunol 2023; 14:1251034. [PMID: 37868981 PMCID: PMC10588645 DOI: 10.3389/fimmu.2023.1251034] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 09/21/2023] [Indexed: 10/24/2023] Open
Abstract
Introduction Evidence-based data suggest that under inflammatory conditions, classical monocytes are the main source of osteoclasts and might be involved in bone erosion pathophysiology. Here, we analyze the transcriptomic profile of classical monocytes in erosive and non-erosive rheumatoid arthritis patients in order to better understand their contribution to bone erosion. Methods Thirty-nine premenopausal RA patients were consecutively enrolled and divided into two groups based on the presence of bone erosions on hand joints. Classical monocytes were isolated from peripheral blood through negative selection, and RNA-seq was performed using a poly-A enrichment kit and Illumina® platform. Classical monocytes transcriptome from healthy age-matched women were also included to identify differentially expressed genes (DEGs). Therefore, gene sets analysis was performed to identify the enriched biological pathways. Results RNA-seq analysis resulted in the identification of 1,140 DEGs of which 89 were up-regulated and 1,051 down-regulated in RA patients with bone erosion compared to those without bone erosions. Among up-regulated genes, there was a highlighted expression of IL18RAP and KLF14 related to the production of pro-inflammatory cytokines, innate and adaptive immune response. Genes related to collagen metabolism (LARP6) and bone formation process (PAPPA) were down-regulated in RA patients with erosions. Enriched pathways in patients with erosions were associated with greater activation of immune activation, and inflammation. Interestingly, pathways associated with osteoblast differentiation and regulation of Wnt signaling were less activated in RA patients with erosions. Conclusion These findings suggest that alterations in expression of monocyte genes related to the inflammatory process and impairment of bone formation might have an important role in the pathophysiology of bone erosions in RA patients.
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Affiliation(s)
- Lucas Peixoto Sales
- Rheumatology Division, Bone Metabolism Laboratory, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Bidossessi Wilfried Hounkpe
- Rheumatology Division, Bone Metabolism Laboratory, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Mariana Ortega Perez
- Rheumatology Division, Bone Metabolism Laboratory, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Valéria Falco Caparbo
- Rheumatology Division, Bone Metabolism Laboratory, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Diogo Souza Domiciano
- Rheumatology Division, Bone Metabolism Laboratory, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Eduardo Ferreira Borba
- Rheumatology Division, Bone Metabolism Laboratory, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Georg Schett
- Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich Alexander Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Camille Pinto Figueiredo
- Rheumatology Division, Bone Metabolism Laboratory, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Rosa Maria Rodrigues Pereira
- Rheumatology Division, Bone Metabolism Laboratory, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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Zanetti CB, Pontes MAG, de Moura EGH, Domiciano DS. High frequency of gastrointestinal complaints, but insignificant prevalence of gluten-sensitive enteropathies in Brazilian fibromyalgia patients. Reumatol Clin (Engl Ed) 2023; 19:374-378. [PMID: 37661115 DOI: 10.1016/j.reumae.2022.12.003] [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] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 12/15/2022] [Indexed: 09/05/2023]
Abstract
INTRODUCTION/OBJECTIVES Coeliac disease (CD) and non-coeliac gluten sensitivity (NCGS) cause symptoms like those seen in patients with fibromyalgia (FM) and functional gastrointestinal disorders. There is no consistent data on frequency of these symptoms and no study performed duodenal biopsies to investigate CD/NCGS in Brazilian FM patients. Therefore, we sought to verify the prevalence of CD/NCGS in FM patients and the association between gastrointestinal manifestations and FM symptoms. MATERIAL AND METHODS Sixty-two individuals with FM (ACR2010) were recruited from FM outpatient clinics of a tertiary hospital. Clinical evaluation included the Widespread Pain Index (WPI), Severity Symptom Scale (SS), Polysymptomatic Distress Scale (PDS), and Fibromyalgia Impact Questionnaire (FIQ). Subjects were screened for the presence of coeliac antibodies and upper gastrointestinal endoscopy (duodenal biopsies) was performed for diagnosis of CD/NCGS. RESULTS 46 (74.2%) women reported at least one digestive symptom: constipation, abdominal distension, loss of weight/inappetence, and nausea/vomiting. Fourteen (31.8%) presented macroscopic duodenitis and 2(4.5%) had duodenal lymphocytic infiltrates, but none met CD criteria. In 1(1.6%) patient NCGS was confirmed. There was association between presence of any digestive symptom and WPI and SS (fatigue, waking up tired, cognition), but no difference on FIQ between patients with and without gastrointestinal symptoms. CONCLUSION Gastrointestinal complaints were frequent and associated with increased degree of polysymptomatic distress in FM patients, but presence of these symptoms was not related to overall impact of FM over different dimensions of the patient's life. Moreover, the prevalence of CD/NCGS was very low. This suggests that screening for CD in Brazilian FM patients might not be cost-effective, since the frequency of CD/NCGS was very low.
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Affiliation(s)
- Caio Bosquiero Zanetti
- Division of Rheumatology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Marco Antônio Gonçalves Pontes
- Division of Rheumatology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Diogo Souza Domiciano
- Division of Rheumatology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil.
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de Oliveira JCS, Olalla LFG, Domiciano DS, Shinjo SK. Cholesterol crystals in pericardial effusion associated with rheumatoid arthritis. Intern Emerg Med 2023; 18:1587-1588. [PMID: 36922456 DOI: 10.1007/s11739-023-03248-1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 02/23/2023] [Indexed: 03/17/2023]
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Bonfiglioli KR, de Medeiros Ribeiro AC, Carnieletto AP, Pereira I, Domiciano DS, da Silva HC, Pugliesi A, Pereira LR, Guimarães MFR, Giorgi RDN, Reis APMG, Brenol CV, Louzada-Júnior P, da Cunha Sauma MDFL, Radominski SC, da Mota LMH, da Rocha Castelar-Pinheiro G. Extra-articular manifestations of rheumatoid arthritis remain a major challenge: data from a large, multi-centric cohort. Adv Rheumatol 2023; 63:34. [PMID: 37496102 DOI: 10.1186/s42358-023-00318-y] [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: 01/16/2023] [Accepted: 07/19/2023] [Indexed: 07/28/2023] Open
Abstract
INTRODUCTION Although Rheumatoid Arthritis (RA) extra-articular manifestations (ExtRA) occurrence has been decreasing over time, they are still a major mortality risk factor for patients. OBJECTIVE To determine the prevalence of ExtRA in a large cohort, and its association with demographic and clinical variables. METHOD Cross-sectional and observational study, based on a multi-centric database from a prospective cohort, in which 11 public rheumatology centres enrolled RA patients (1987 ARA or 2010 ACR-EULAR). Data collection began in 08-2015, using a single online electronic medical record. Continuous variables were compared using Mann-Whitney U-test, and Fisher's exact test or chi-square test, as appropriate, were used for categorical variables. The level of significance was set at 5% (p < 0.05). RESULTS 1115 patients were included: 89% women, age [mean ± SD] 58.2 ± 11.5 years, disease duration 14.5 ± 12.2 years, positive Rheumatoid Factor (RF, n = 1108) in 77%, positive anti-cyclic citrullinated peptide (ACPA, n = 477) in 78%. Regarding ExtRA, 334 occurrences were registered in 261 patients, resulting in an overall prevalence of 23.4% in the cohort. The comparison among ExtRA and Non-ExtRA groups shows significant higher age (p < 0.001), disease duration (p < 0.001), RF high titers (p = 0.018), Clinical Disease Activity index (CDAI) (p < 0.001), Disease Activity Index 28 (DAS 28) (p < 0.001), and Health Assessment Questionnaire (HAQ) (p < 0.001) in ExtRA group. Treatment with Azathioprine (p = 0.002), Etanercept (p = 0.049) Glucocorticoids (GC) ('p = 0.002), and non-steroidal anti-inflammatory drugs (NSAIDs) (p < 0.001) were more frequent in ExtRA group. CONCLUSIONS ExtRA manifestations still show an expressive occurrence that should not be underestimated. Our findings reinforce that long-term seropositive disease, associated with significant disability and persistent inflammatory activity are the key factors related to ExtRA development.
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Affiliation(s)
- Karina Rossi Bonfiglioli
- Serviço de Reumatologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), Av.Dr. Arnaldo, 455 - 3º andar - Reumatologia, São Paulo, SP, 01246-903, Brazil.
| | - Ana Cristina de Medeiros Ribeiro
- Serviço de Reumatologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), Av.Dr. Arnaldo, 455 - 3º andar - Reumatologia, São Paulo, SP, 01246-903, Brazil
| | | | - Ivânio Pereira
- Serviço de Reumatologia do Hospital Universitário da Universidade Federal de Santa Catarina (UFSC), Florianópolis, Brazil
| | - Diogo Souza Domiciano
- Serviço de Reumatologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), Av.Dr. Arnaldo, 455 - 3º andar - Reumatologia, São Paulo, SP, 01246-903, Brazil
| | - Henrique Carriço da Silva
- Serviço de Reumatologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), Av.Dr. Arnaldo, 455 - 3º andar - Reumatologia, São Paulo, SP, 01246-903, Brazil
| | - Alisson Pugliesi
- Disciplina de Reumatologia da Faculdade de Ciências Médicas da Universidade Estadual de Campinas (UNICAMP), Campinas, Brazil
| | - Leticia Rocha Pereira
- Serviço de Reumatologia da Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | | | - Rina Dalva Neubarth Giorgi
- Serviço de Reumatologia do Hospital do Servidor Público Estadual de São Paulo (HSPE-IAMSPE), São Paulo, Brazil
| | | | - Claiton Viegas Brenol
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (HCPA/UFRGS), Porto Alegre, Brazil
| | - Paulo Louzada-Júnior
- Disciplina de Reumatologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (USP-RP), São Paulo, Brazil
| | | | - Sebastião Cezar Radominski
- Disciplina de Reumatologia, Faculdade de Medicina da Universidade Federal do Paraná (UFPR), Curitiba, Brazil
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Missé RG, dos Santos AM, Borges IBP, Simões MSM, Silvério LR, Correia BL, Kim AWS, Caetano AM, Pasoto SG, Saad CGS, Domiciano DS, Tanaka C, Greve JMD, Baptista AF, Shinjo SK. Transcranial direct current electrical stimulation in combination with aerobic exercise: A pilot study in post-COVID-19 systemic autoimmune rheumatic patients. World J Rheumatol 2023; 11:1-12. [DOI: 10.5499/wjr.v11.i1.1] [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] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/01/2022] [Accepted: 02/01/2023] [Indexed: 02/27/2023] Open
Abstract
BACKGROUND Systemic autoimmune rheumatic diseases (SARDs) are a group of diseases with multiorgan involvement and a high prevalence of chronic pain and fatigue. Patients with SARDs and post-coronavirus disease 2019 (COVID-19) syndrome experience aggravation of symptoms. In this context, it is essential to establish strategies to reduce chronic pain and fatigue and improve quality of life.
AIM To assess the efficacy of transcranial direct current stimulation (tDCS) for the treatment of fatigue and pain-associated post-COVID-19 syndrome in patients with SARDs.
METHODS This study included nine patients with different types of SARDs. All patients had reverse transcription-polymerase chain reaction (RT-PCR) test confirmed COVID-19 as well as significant, persistent fatigue and pain that began to worsen after infection. Anodal tDCS was administered in five daily sessions (2mA, 20 min). Concomitantly, patients were involved in aerobic exercise program. All participants were evaluated using specific questionnaires and strength assessment by handgrip and physical function by timed-up-and-go test and sit-to-stand test at baseline (within one week before tDCS protocol), and one week after tDCS protocol. During all procedures, the patients’ treatments remained unchanged.
RESULTS The sample comprised eight women and one man with a mean age of 48.7 ± 9.6 years. After the tDCS protocol, pain and fatigue significantly improved on the visual analog scale (P < 0.05). The physical function also improved 9.5 ± 2.7 vs 6.8 ± 0.8 (P = 0.001) for timed-up-go-test and 10.3 ± 3.7 vs 15.1 ± 4.0 (P = 0.037) for sit-to-stand test. None of the patients experienced any adverse events.
CONCLUSION The present study showed that tDCS in combination with aerobic exercise was effective in improving physical function, and reducing fatigue/pain in SARDs patients with post-COVID-19 syndrome.
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Affiliation(s)
- Rafael Giovani Missé
- Division of Rheumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Alexandre Moura dos Santos
- Division of Rheumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Isabela Bruna Pires Borges
- Division of Rheumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Marlise Sítima Mendes Simões
- Division of Rheumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Lorenza Rosa Silvério
- Division of Rheumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Bruna Lindoso Correia
- Division of Rheumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Ana Wook Sook Kim
- Division of Rheumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Aline Marques Caetano
- Division of Rheumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Sandra Gofinet Pasoto
- Division of Rheumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Carla Gonçalves Schahin Saad
- Division of Rheumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Diogo Souza Domiciano
- Division of Rheumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Clarice Tanaka
- Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Núcleo de Assistência e Pesquisa em Neuromodulação, Sao Paulo, Brazil
| | - Julia Maria D’Andrea Greve
- Laboratório de Estudos do Movimento, Instituto de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | - Samuel Katsuyuki Shinjo
- Division of Rheumatology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
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Macêdo MB, Shinjo SK, Domiciano DS. Editorial Expression of Concern: Breaking the diagnosis: ankylosing spondylitis evidenced by cervical fracture following spine manipulation. Intern Emerg Med 2022; 17:1559. [PMID: 35536430 DOI: 10.1007/s11739-022-02998-8] [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] [Indexed: 11/28/2022]
Affiliation(s)
- Marina Barguil Macêdo
- Faculdade de Medicina (FMUSP), Universidade de Sao Paulo, Av. Dr. Arnaldo, 455, 3º andar, sala 3193, Cerqueira César, São Paulo, SP, 01246-903, Brazil.
| | - Samuel Katsuyuki Shinjo
- Faculdade de Medicina (FMUSP), Universidade de Sao Paulo, Av. Dr. Arnaldo, 455, 3º andar, sala 3193, Cerqueira César, São Paulo, SP, 01246-903, Brazil
| | - Diogo Souza Domiciano
- Faculdade de Medicina (FMUSP), Universidade de Sao Paulo, Av. Dr. Arnaldo, 455, 3º andar, sala 3193, Cerqueira César, São Paulo, SP, 01246-903, Brazil
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Figueiredo CP, Perez MO, Sales LP, Domiciano DS, Sampaio-Barros MM, Caparbo VDF, Pereira RMR. Lower hand grip in rheumatoid arthritis patients is associated with low finite element analysis using high resolution peripheral quantitative computed tomography scan of the 2nd metacarpophalangeal joint. Int J Rheum Dis 2022; 25:1038-1045. [PMID: 35766182 DOI: 10.1111/1756-185x.14376] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/27/2022] [Accepted: 06/17/2022] [Indexed: 12/01/2022]
Abstract
AIM To evaluate hand function by hand grip test in rheumatoid arthritis (RA) patients, and its association with bone erosions and the estimated bone strength (finite element - FE analysis) through the analysis of the 2nd metacarpal head of the dominant hand using high resolution peripheral quantitative computed tomography (HR-pQCT). METHOD Eighty-two female RA patients between 18-50 years old were selected. Demographic data, Health Questionnaire Assessment Disability Index (HAQ), Disease Activity Score of 28 joints (DAS)-28, simplified disease activity index (SDAI) and the hand grip test were set. The HR-pQCT scans of 2nd metacarpophalangeal joints of the dominant hand of all patients were performed according to SPECTRA group protocols. The images were used to assess bone erosions and FE analysis. The hand grip test was categorized in 2 groups and separately compared (< 18 vs ≥18 kgf). A logistic regression was performed using hand grip test <18 kgf as a dependent variable. RESULTS A significant difference was found between the 2 groups regarding HAQ, inflammatory markers (erythrocyte sedimentation rate, C-reactive protein), DAS-28, SDAI, total volume of erosion and bone strength parameter (FE analysis - Failure Load [F.Load]). The logistic regression analysis showed that the risk factors associated with hand grip test <18 kgf were higher SDAI (odds ratio [OR] 0.912; 95% CI 0.837-0.993) and lower values of bone strength parameter (F.Load) (OR 1.007; 95% CI 1.002-1.012). CONCLUSION Lower values of hand grip test were associated with higher disease activity score-SDAI and lower bone strength of 2nd metacarpal bone head of the dominant hand evaluated here through a FE analysis using HR-pQCT scan.
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Affiliation(s)
- Camille Pinto Figueiredo
- Bone Metabolism Laboratory, Rheumatology Division, Faculdade de Medicina FMUSP Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Mariana Ortega Perez
- Bone Metabolism Laboratory, Rheumatology Division, Faculdade de Medicina FMUSP Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Lucas Peixoto Sales
- Bone Metabolism Laboratory, Rheumatology Division, Faculdade de Medicina FMUSP Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | - Marília M Sampaio-Barros
- Bone Metabolism Laboratory, Rheumatology Division, Faculdade de Medicina FMUSP Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Valeria de Falco Caparbo
- Bone Metabolism Laboratory, Rheumatology Division, Faculdade de Medicina FMUSP Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Rosa Maria Rodrigues Pereira
- Bone Metabolism Laboratory, Rheumatology Division, Faculdade de Medicina FMUSP Universidade de Sao Paulo, Sao Paulo, Brazil.,Faculdade de Medicina da Universidade de Sao Paulo HCFMUSP, Sao Paulo, Brazil
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Alvarenga JC, Caparbo VF, Domiciano DS, Pereira RMR. Age-related reference data of bone microarchitecture, volumetric bone density, and bone strength parameters in a population of healthy Brazilian men: an HR-pQCT study. Osteoporos Int 2022; 33:1309-1321. [PMID: 35059775 DOI: 10.1007/s00198-021-06288-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 12/21/2021] [Indexed: 11/25/2022]
Abstract
UNLABELLED In a cross-sectional cohort of 340 healthy Brazilian men aged 20 to 92 years, data on density, structure, and strength of the distal radius and tibia were obtained using high-resolution peripheral quantitative computed tomography (HR-pQCT) to develop age- and site-specific reference curves. Age-dependent changes differed between the sites and bone compartments (trabecular and cortical). INTRODUCTION The aim of this study was to establish age-related reference curves for bone densities, microarchitectural properties, and estimated failure load measured by HR-pQCT (distal radius and tibia) in men. Also, to correlate bone stiffness with the other HR-pQCT parameters, areal bone mineral density (BMD) by DXA and trabecular bone score (TBS). METHODS Healthy Brazilian men (n = 340) between the ages of 20 and 92 years were recruited. Non-dominant radius and left tibia were scanned using HR-pQCT (Xtreme CT I). Standard and automated segmentation methods were performed, and bone strength estimated by FE analysis. Bone mineral density at lumbar spine, total hip, femoral neck, and TBS were measured using DXA (Hologic, QDR4500). RESULTS Age-related reference curves were constructed at the distal radius and tibia for volumetric bone density, morphometry, and estimated bone strength parameters. There was a linear relationship with age only for thickness measurements of distal radius (trabecular: R2 0.108, p<0.001; cortical: R2 0.062, p=0.002) and tibia (trabecular: R2 0.109, p<0.001; cortical: R2 0.063, p=0.010), and bone strength at distal radius (R2 0.157, p<0.001). The significant correlations (p <0.05) found by Pearson's correlations (r) between bone stiffness and all other variables measured by HR-pQCT and DXA showed to be stronger at the tibia site than the distal radius. CONCLUSION The current study expands the HR-pQCT worldwide database and presents an adequate methodology for the construction of reference data in other populations. Moreover, the correlation of bone strength estimated by FEA with other bone microstructural parameters provided by HR-pQCT helps to determine the contribution of each of these variables to fracture risk prediction in men.
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Affiliation(s)
- J C Alvarenga
- Bone Metabolism Laboratory, Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av Dr Arnaldo, 455, 3° andar, sala 3193, Sao Paulo, SP, 01246-903, Brazil
| | - V F Caparbo
- Bone Metabolism Laboratory, Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av Dr Arnaldo, 455, 3° andar, sala 3193, Sao Paulo, SP, 01246-903, Brazil
| | - D S Domiciano
- Bone Metabolism Laboratory, Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av Dr Arnaldo, 455, 3° andar, sala 3193, Sao Paulo, SP, 01246-903, Brazil
| | - R M R Pereira
- Bone Metabolism Laboratory, Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av Dr Arnaldo, 455, 3° andar, sala 3193, Sao Paulo, SP, 01246-903, Brazil.
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Maeda SS, Albergaria BH, Szejnfeld VL, Lazaretti-Castro M, Arantes HP, Ushida M, Domiciano DS, Pereira RMR, Marin-Mio RV, de Oliveira ML, de Mendonça LMC, do Prado M, de Souza GC, Palchetti CZ, Sarni ROS, Terreri MT, de Castro LCG, Artoni SMB, Amoroso L, Karcher DE, Prado CM, Gonzalez MC, de Medeiros Pinheiro M. Official Position of the Brazilian Association of Bone Assessment and Metabolism (ABRASSO) on the evaluation of body composition by densitometry-part II (clinical aspects): interpretation, reporting, and special situations. Adv Rheumatol 2022; 62:11. [PMID: 35365246 DOI: 10.1186/s42358-022-00240-9] [Citation(s) in RCA: 2] [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: 05/21/2021] [Accepted: 03/04/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To present an updated and evidence-based guideline for the use of dual-energy x-ray absorptiometry (DXA) to assess body composition in clinical practice. MATERIALS AND METHODS This Official Position was developed by the Scientific Committee of the Brazilian Association of Bone Assessment and Metabolism (Associação Brasileira de Avaliação Óssea e Osteometabolismo, ABRASSO) and experts in the field who were invited to contribute to the preparation of this document. The authors searched current databases for relevant publications in the area of body composition assessment. In this second part of the Official Position, the authors discuss the interpretation and reporting of body composition parameters assessed by DXA and the use of DXA for body composition evaluation in special situations, including evaluation of children, persons with HIV, and animals. CONCLUSION This document offers recommendations for the use of DXA in body composition evaluation, including indications, interpretation, and applications, to serve as a guiding tool in clinical practice and research for health care professionals in Brazil.
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Affiliation(s)
- Sergio Setsuo Maeda
- Discipline of Endocrinology, Department of Medicine, Universidade Federal de São Paulo (UNIFESP), Rua Estado de Israel, 639, São Paulo, SP, CEP: 04022-001, Brazil.
| | - Ben-Hur Albergaria
- Department of Epidemiology, Universidade Federal do Espírito Santo (UFES), Vitória, ES, Brazil
| | - Vera Lúcia Szejnfeld
- Discipline of Rheumatology, Department of Medicine, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Marise Lazaretti-Castro
- Discipline of Endocrinology, Department of Medicine, Universidade Federal de São Paulo (UNIFESP), Rua Estado de Israel, 639, São Paulo, SP, CEP: 04022-001, Brazil
| | - Henrique Pierotti Arantes
- School of Medicine, Instituto Master de Ensino Presidente Antônio Carlos (IMEPAC), Uberlândia, MG, Brazil
| | - Marcela Ushida
- Discipline of Rheumatology, Department of Medicine, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Diogo Souza Domiciano
- Discipline of Rheumatology, Department of Medicine, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | | | - Rosângela Villa Marin-Mio
- Discipline of Endocrinology, Department of Medicine, Universidade Federal de São Paulo (UNIFESP), Rua Estado de Israel, 639, São Paulo, SP, CEP: 04022-001, Brazil
| | - Mônica Longo de Oliveira
- Discipline of Endocrinology, Department of Medicine, Universidade Federal de São Paulo (UNIFESP), Rua Estado de Israel, 639, São Paulo, SP, CEP: 04022-001, Brazil
| | | | | | | | - Cecília Zanin Palchetti
- Department of Nutrition, School of Public Health, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Roseli Oselka Saccardo Sarni
- Discipline of Allergy, Clinical Immunology, and Rheumatology, Department of Pediatrics, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Maria Teresa Terreri
- Section of Pediatric Rheumatology, Department of Pediatrics, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | | | | | - Lizandra Amoroso
- School of Agricultural and Veterinary Sciences, Universidade Estadual de São Paulo (UNESP), Jaboticabal, SP, Brazil
| | - Débora Emy Karcher
- School of Agricultural and Veterinary Sciences, Universidade Estadual de São Paulo (UNESP), Jaboticabal, SP, Brazil
| | - Carla M Prado
- Department of Agricultural, Food and Nutritional Science, Division of Human Nutrition, University of Alberta, Edmonton, Canada
| | - Maria Cristina Gonzalez
- Postgraduate Program in Health and Behavior, Universidade Católica de Pelotas (UCPel), Pelotas, RS, Brazil.,Postgraduate Program in Nutrition and Food, Universidade Federal de Pelotas (UFPel), Pelotas, RS, Brazil
| | - Marcelo de Medeiros Pinheiro
- Discipline of Rheumatology, Department of Medicine, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
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11
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Araujo CSR, Medeiros-Ribeiro AC, Saad CGS, Bonfiglioli KR, Domiciano DS, Shimabuco AY, Silva MSR, Yuki EFN, Pasoto SG, Pedrosa T, Kupa LDVK, Zou G, Pereira RMR, Silva CA, Aikawa NE, Bonfa E. Two-week methotrexate discontinuation in patients with rheumatoid arthritis vaccinated with inactivated SARS-CoV-2 vaccine: a randomised clinical trial. Ann Rheum Dis 2022; 81:889-897. [PMID: 35193873 DOI: 10.1136/annrheumdis-2021-221916] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [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: 11/24/2021] [Accepted: 02/07/2022] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To evaluate the effect on immunogenicity and safety of 2-week methotrexate (MTX) discontinuation after each dose of the Sinovac-CoronaVac vaccine versus MTX maintenance in patients with rheumatoid arthritis (RA). METHODS This was a single-centre, prospective, randomised, investigator-blinded, intervention study (NCT04754698, CoronavRheum) including adult patients with RA (stable Clinical Disease Activity Index (CDAI) ≤10, prednisone ≤7.5 mg/day) randomised (1:1) to withdraw MTX (MTX-hold) for 2 weeks after each vaccine dose or maintain MTX (MTX-maintain), evaluated at day 0 (D0), D28 and D69. Coprimary outcomes were anti-SARS-CoV-2 S1/S2 IgG seroconversion (SC) and neutralising antibody (NAb) positivity at D69. Secondary outcomes were geometric mean titres (GMT) and flare rates. For immunogenicity analyses, we excluded patients with baseline positive IgG/NAb, and for safety reasons those who flared at D28 (CDAI >10) and did not withdraw MTX twice. RESULTS Randomisation included 138 patients with 9 exclusions (5 COVID-19, 4 protocol violations). Safety evaluation included 60 patients in the MTX-hold and 69 patients in the MTX-maintain group. Further exclusions included 27 patients (13 (21.7%) vs 14 (20.3%), p=0.848) with positive baseline IgG/NAb and 10 patients (21.3%) in MTX-hold with CDAI >10 at D28. At D69, the MTX-hold group (n=37) had a higher rate of SC than the MTX-maintain group (n=55) (29 (78.4%) vs 30 (54.5%), p=0.019), with parallel augmentation in GMT (34.2 (25.2-46.4) vs 16.8 (11.9-23.6), p=0.006). No differences were observed for NAb positivity (23 (62.2%) vs 27 (49.1%), p=0.217). At D28 flare, the rates were comparable in both groups (CDAI, p=0.122; Disease Activity Score in 28 joints with C reactive protein, p=0.576), whereas CDAI >10 was more frequent in MTX-hold at D69 (p=0.024). CONCLUSION We provided novel data that 2-week MTX withdrawal after each dose of the Sinovac-CoronaVac vaccine improves anti-SARS-CoV-2 IgG response. The increased flare rates after the second MTX withdrawal may be attributed to the short-term interval between vaccine doses. This strategy requires close surveillance and shared decision making due to the possibility of flares.
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Affiliation(s)
| | | | - Carla G S Saad
- Rheumatology Division, Universidade de Sao Paulo Faculdade de Medicina, Sao Paulo, Sao Paulo, Brazil
| | - Karina Rossi Bonfiglioli
- Rheumatology Division, Universidade de Sao Paulo Faculdade de Medicina, Sao Paulo, Sao Paulo, Brazil
| | - Diogo Souza Domiciano
- Rheumatology Division, Universidade de Sao Paulo Faculdade de Medicina, Sao Paulo, Sao Paulo, Brazil
| | - Andrea Yukie Shimabuco
- Rheumatology Division, Universidade de Sao Paulo Faculdade de Medicina, Sao Paulo, Sao Paulo, Brazil
| | | | | | - Sandra Gofinet Pasoto
- Rheumatology Division, Universidade de Sao Paulo Faculdade de Medicina, Sao Paulo, Sao Paulo, Brazil
| | - Tatiana Pedrosa
- Rheumatology Division, Universidade de Sao Paulo Faculdade de Medicina, Sao Paulo, Sao Paulo, Brazil
| | | | - Gioanna Zou
- Rheumatology Division, Universidade de Sao Paulo Faculdade de Medicina, Sao Paulo, Sao Paulo, Brazil
| | - Rosa M R Pereira
- Rheumatology Division, Universidade de Sao Paulo Faculdade de Medicina, Sao Paulo, Sao Paulo, Brazil
| | - Clóvis Artur Silva
- Pediatric Rheumatology Division, Universidade de Sao Paulo Faculdade de Medicina, Sao Paulo, Sao Paulo, Brazil
| | - Nádia Emi Aikawa
- Rheumatology Division, Universidade de Sao Paulo Faculdade de Medicina, Sao Paulo, Sao Paulo, Brazil
| | - Eloisa Bonfa
- Rheumatology Division, Universidade de Sao Paulo Faculdade de Medicina, Sao Paulo, Sao Paulo, Brazil
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12
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Medeiros-Ribeiro AC, Bonfiglioli KR, Domiciano DS, Shimabuco AY, da Silva HC, Saad CGS, Yuki EFN, Pasoto SG, Araujo CSR, Nakai TL, Silva CA, Pedrosa T, Kupa LDVK, Silva MSR, Balbi GGM, Kallas EG, Aikawa NE, Bonfa E. Distinct impact of DMARD combination and monotherapy in immunogenicity of an inactivated SARS-CoV-2 vaccine in rheumatoid arthritis. Ann Rheum Dis 2022; 81:710-719. [PMID: 35135832 DOI: 10.1136/annrheumdis-2021-221735] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 10/23/2021] [Accepted: 01/20/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVES To evaluate the distinct impact of disease modifying antirheumatic drugs (DMARD) combination and monotherapy in immune response to an inactivated SARS-CoV-2 vaccine in patients with rheumatoid arthritis (RA). METHODS This phase 4 prospective study analysed seroconversion (SC) of anti-SARS-CoV-2 immunoglobulin G (IgG) and neutralising antibodies (NAb) induced by the inactivated vaccine (CoronaVac) in patients with RA in comparison to controls (CG). Disease activity and treatment were also assessed. Only participants with baseline negative IgG/NAb were included. RESULTS Patients with RA (N=260) and CG (N=104) had comparable median ages (59 years (50-65 years) vs 58 years (49.8-64 years), p=0.483). Patients with RA had moderate but lower SC (61.8% vs 94.2%, p<0.001) and NAb positivity (45% vs 78.6%, p<0.001) in comparison to CG after full vaccination. Baseline disease activity did not influence immunogenicity (p>0.05). After multivariate analyses, factors independently related to reduced SC were: older age (OR=0.79 (0.70-0.89) for each 5-year interval, p<0.001), methotrexate (OR=0.54 (0.29-0.98), p=0.044), abatacept (OR=0.37 (0.19-0.73), p=0.004) and number of DMARD (OR=0.55 (0.33-0.90), p=0.018). Regarding NAb, age (OR=0.87 (0.78-0.96) for each 5-year interval, p=0.007) and prednisone >7.5 mg/day (OR=0.38 (0.19-0.74), p=0.004) were negatively related to the presence of NAb. Further comparison of SC/NAb positivity among RA treatment subgroups and CG revealed that methotrexate/tofacitinib/abatacept/tocilizumab use, in monotherapy or in combination, resulted in lower responses (p<0.05), while tumour necrosis factor inhibitor and other conventional synthetic DMARD interfered solely when combined with other therapies. CONCLUSIONS Patients with RA under DMARD have a moderate immunogenicity to CoronaVac. We identified that nearly all DMARD combinations have a deleterious effect in immunogenicity, whereas a more restricted number of drugs (methotrexate/tofacitinib/abatacept/tocilizumab) also hampered this response as monotherapy. These findings reinforce the need of a broader approach, not limited to specific drugs, to improve vaccine response for this population. TRIAL REGISTRATION DETAILS NCT04754698.
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Affiliation(s)
| | - Karina Rossi Bonfiglioli
- Rheumatology Division, Hospital das Clinicas da Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Diogo Souza Domiciano
- Rheumatology Division, Hospital das Clinicas da Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Andrea Yukie Shimabuco
- Rheumatology Division, Hospital das Clinicas da Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Henrique Carriço da Silva
- Rheumatology Division, Hospital das Clinicas da Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Carla G S Saad
- Rheumatology Division, Hospital das Clinicas da Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Emily Figueiredo Neves Yuki
- Rheumatology Division, Hospital das Clinicas da Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Sandra Gofinet Pasoto
- Rheumatology Division, Hospital das Clinicas da Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | - Tatiane Lie Nakai
- Rheumatology Division, Hospital das Clinicas da Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Clóvis Artur Silva
- Pediatric Rheumatology Unit, Instituto da Criança, Hospital das Clinicas da Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Tatiana Pedrosa
- Rheumatology Division, Hospital das Clinicas da Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Léonard de Vinci Kanda Kupa
- Rheumatology Division, Hospital das Clinicas da Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | | | - Esper Georges Kallas
- Infectious and Parasitic Diseases Division, Hospital das Clinicas da Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Nádia Emi Aikawa
- Rheumatology Division, Hospital das Clinicas da Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Eloisa Bonfa
- Rheumatology Division, Hospital das Clinicas da Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
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Macêdo MB, Shinjo SK, Domiciano DS. Breaking the diagnosis: ankylosing spondylitis evidenced by cervical fracture following spine manipulation. Intern Emerg Med 2022; 17:273-274. [PMID: 34415490 DOI: 10.1007/s11739-021-02829-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 08/10/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Marina Barguil Macêdo
- Faculdade de Medicina (FMUSP), Universidade de Sao Paulo, Av. Dr. Arnaldo, 455, 3º andar, sala 3193, Cerqueira César, São Paulo, SP, 01246-903, Brazil.
| | - Samuel Katsuyuki Shinjo
- Faculdade de Medicina (FMUSP), Universidade de Sao Paulo, Av. Dr. Arnaldo, 455, 3º andar, sala 3193, Cerqueira César, São Paulo, SP, 01246-903, Brazil
| | - Diogo Souza Domiciano
- Faculdade de Medicina (FMUSP), Universidade de Sao Paulo, Av. Dr. Arnaldo, 455, 3º andar, sala 3193, Cerqueira César, São Paulo, SP, 01246-903, Brazil
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14
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Domiciano DS, Machado LG, Figueiredo CP, Caparbo VF, Oliveira RM, Menezes PR, Pereira RMR. Incidence and risk factors for osteoporotic non-vertebral fracture in low-income community-dwelling elderly: a population-based prospective cohort study in Brazil. The São Paulo Ageing and Health (SPAH) study. Osteoporos Int 2021; 32:747-757. [PMID: 33037462 DOI: 10.1007/s00198-020-05669-6] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 10/05/2020] [Indexed: 10/23/2022]
Abstract
UNLABELLED We ascertained the incidence of non-vertebral fracture in a low-income Brazilian elderly cohort. To the best of our knowledge, this is the first population-based study to demonstrate the frequency of non-vertebral fracture in elderly Latin Americans. Age, prior fracture, and bone mineral density (BMD) at hip were predictors of fracture. INTRODUCTION No data on incidence of osteoporotic non-vertebral fracture have been reported in low-income countries where the population's aging has been faster. Even in developed countries, currently available prospective data on major fracture rates beyond hip are scarce. The aim of this study is to describe the incidence and risk factors for non-vertebral fracture in a longitudinal prospective Brazilian population-based elderly cohort. METHODS Seven hundred seven older adults (449 women, 258 men) were evaluated at baseline and after a mean follow-up of 4.3 ± 0.8 years. Clinical questionnaire, bone mineral density (BMD), and laboratory tests were performed at baseline. New non-vertebral fracture (hip, proximal humerus, rib, forearm) was determined during the follow-up. Multivariate Poisson regression models were used to identify independent predictors of fracture. RESULTS The age-standardized incidence of non-vertebral fracture was 1562.3/100,000 (1085.7-2248.1/100,000) person-years (pyr) in women and 632.8/100,000 (301.7-1327.3/100,000) in men. Concerning to hip fractures, the incidence was 421.2/100,000 (210.7-842.3/100,000) pyr in women and 89.9/100,000 (12.7-638.5/100,000) in men. In a multivariate analysis, age (RR 2.07, 95% CI 1.13-3.82, p = 0.019, each 10-year increase), prior non-vertebral fracture (RR 3.08, 95% CI 1.36-6.95, p = 0.007), and total hip BMD (RR 1.68, 95% CI 1.11-2.56, p = 0.015, each 1 SD decrease) were predictors of new non-vertebral fracture. In men, fitting a model of risk factors for fracture was prevented by the limited number of events in male sample. CONCLUSION This is the first population-based study to ascertain the incidence of major non-vertebral fractures in elderly Latin Americans, confirming the high frequency of the disorder. Age, prior fracture, and hip BMD were predictors of the short-term incidence of fracture.
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Affiliation(s)
- D S Domiciano
- Bone Metabolism Laboratory, Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455, 3° andar, sala 3105, São Paulo, SP, 01246-903, Brazil
| | - L G Machado
- Bone Metabolism Laboratory, Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455, 3° andar, sala 3105, São Paulo, SP, 01246-903, Brazil
| | - C P Figueiredo
- Bone Metabolism Laboratory, Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455, 3° andar, sala 3105, São Paulo, SP, 01246-903, Brazil
| | - V F Caparbo
- Bone Metabolism Laboratory, Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455, 3° andar, sala 3105, São Paulo, SP, 01246-903, Brazil
| | | | - P R Menezes
- Department of Preventive Medicine, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - R M R Pereira
- Bone Metabolism Laboratory, Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455, 3° andar, sala 3105, São Paulo, SP, 01246-903, Brazil.
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15
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Barreto-Neto N, Reis-Neto ETD, Dório M, Fuller R, Pinheiro MDM, Domiciano DS. Calcium Pyrophosphate Deposition Disease in the Craniovertebral Junction: An Unusual Cause of Neck Pain. J Clin Diagn Res 2021. [DOI: 10.7860/jcdr/2021/49707.15273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Crowned Dens Syndrome (CDS) is a rare manifestation of Calcium Pyrophosphate Deposition (CPPD) disease characterised by calcification around the odontoid process in the atlantoaxial joint. It manifests as intense neck pain with signs of systemic inflammation, including elevated acute phase reactants. Thus, it can simulate other causes of neck pain and diagnosis can be challenging. Moreover, CPPD disease can be asymptomatic and observed as radiological finding. Here in, two cases of spinal CPPD disease with distinct presentations are reported. The first of 83-year-old woman describes CDS that was misdiagnosed as Polymyalgia Rheumatica (PMR) whereas in the second case of 70-year-old female calcification around the odontoid process was incidentally found in a patient with acute cervical spine fracture. These two reported cases highlight the spectrum of manifestations of spinal CPPD disease and support the notion that careful discrimination of the cause of neck pain is essential for improving outcomes.
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Machado LG, Domiciano DS, Figueiredo CP, Caparbo VF, Takayama L, Oliveira RM, Lopes JB, Menezes PR, Pereira RMR. Visceral fat measured by DXA is associated with increased risk of non-spine fractures in nonobese elderly women: a population-based prospective cohort analysis from the São Paulo Ageing & Health (SPAH) Study. Osteoporos Int 2016; 27:3525-3533. [PMID: 27351667 DOI: 10.1007/s00198-016-3682-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 06/19/2016] [Indexed: 01/19/2023]
Abstract
UNLABELLED The present study investigates the relationship between visceral fat measured by dual-energy X-ray absorptiometry (DXA) and the incidence of non-spine fractures in community-dwelling elderly women. We demonstrated a potential negative effect of visceral fat on bone health in nonobese women. INTRODUCTION The protective effect of obesity on bone health has been questioned because visceral fat has been demonstrated to have a deleterious effect on bone. The aim of this study was to investigate the association of visceral fat measured by DXA with the incidence of non-spine fractures in community-dwelling elderly women. METHODS This longitudinal prospective population-based cohort study evaluated 433 community-dwelling women aged 65 years or older. A specific clinical questionnaire, including personal history of a fragility fracture in non-spine osteoporotic sites, was administered at baseline and after an average of 4.3 years. All incidences of fragility fractures during the study period were confirmed by affected-site radiography. Visceral adipose tissue (VAT) was measured in the android region of a whole-body DXA scan. RESULTS The mean age was 72.8 ± 4.7 years, and 28 incident non-spine osteoporotic fractures were identified after a mean follow-up time of 4.3 ± 0.8 years. According to the Lipschitz classification for nutritional status in the elderly, 38.6 % of women were nonobese (BMI ≤ 27 kg/m2) and 61.4 % were obese/overweight. Logistic regression models were used to estimate the relationship between VAT and non-spine fractures in elderly women. After adjusting for age, race, previous fractures, and BMD, VAT (mass, area, volume) had a significant association with the incidence of non-spine fractures only in nonobese elderly women (VAT mass: OR, 1.42 [95 % CI, 1.09-1.85; p = 0.010]; VAT area: OR, 1.19 [95 % CI, 1.05-1.36; p = 0.008]; VAT volume: OR, 1.40 [95 % CI, 1.09-1.80; p = 0.009]). CONCLUSION This study suggests a potential negative effect of visceral adiposity on bone health in nonobese women.
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Affiliation(s)
- L G Machado
- Bone Metabolism Laboratory of Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455, 3° andar, sala 3093, São Paulo, SP, 01246-903, Brazil
| | - D S Domiciano
- Bone Metabolism Laboratory of Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455, 3° andar, sala 3093, São Paulo, SP, 01246-903, Brazil
| | - C P Figueiredo
- Bone Metabolism Laboratory of Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455, 3° andar, sala 3093, São Paulo, SP, 01246-903, Brazil
| | - V F Caparbo
- Bone Metabolism Laboratory of Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455, 3° andar, sala 3093, São Paulo, SP, 01246-903, Brazil
| | - L Takayama
- Bone Metabolism Laboratory of Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455, 3° andar, sala 3093, São Paulo, SP, 01246-903, Brazil
| | | | - J B Lopes
- Bone Metabolism Laboratory of Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455, 3° andar, sala 3093, São Paulo, SP, 01246-903, Brazil
| | - P R Menezes
- Department of Preventive Medicine, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - R M R Pereira
- Bone Metabolism Laboratory of Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455, 3° andar, sala 3093, São Paulo, SP, 01246-903, Brazil.
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Machado KLLL, Domiciano DS, Machado LG, Lopes JB, Figueiredo CP, Takayama L, Oliveira RM, Menezes PR, Pereira RMR. Persistent hypovitaminosis D and loss of hip bone mineral density over time as additional risk factors for recurrent falls in a population-based prospective cohort of elderly persons living in the community. The São Paulo Ageing & Health (SPAH) Study. Osteoporos Int 2015; 26:1535-42. [PMID: 25600475 DOI: 10.1007/s00198-014-3024-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 12/26/2014] [Indexed: 01/06/2023]
Abstract
UNLABELLED We performed concomitant evaluation of clinical, laboratory, and bone mineral density (BMD) parameters as potential risk factors for falls in a population-based prospective cohort of older adults, since previous studies have focused mostly in clinical risk factors. Loss of hip BMD and persistent hypovitaminosis D were associated with recurrent falls in community-dwelling elderly. INTRODUCTION Few studies have performed a concomitant evaluation of clinical data, laboratory bone parameters, and bone mineral density (BMD) to determine more accurately the contribution of each of these variables to risk of falls in elderly persons. We investigated the association between bone parameters and recurrent falls in a population-based prospective cohort of community-dwelling older adults. METHODS A total of 705 elderly individuals (448 women, 257 men) were evaluated with clinical data, BMD, and laboratory bone tests at baseline and after a mean follow-up of 4.3 ± 0.8 years. Individuals with recurrent falls (≥2 falls in the previous year from the date of the second evaluation) were considered chronic fallers. Logistic regression models were used to identify independent risk factors for recurrent falls. RESULTS The frequency of chronic fallers was 16.5%. In multivariate analyses, risk factors for recurrent falls were visual impairment (odds ratio (OR) = 2.49, 95% confidence interval (CI) 1.30-4.74, p = 0.006), use of psychotropic drugs (OR = 2.47, 95% CI 1.37-4.49, p = 0.003), clinical fracture (OR = 2.78, 95% CI 1.48-5.20, p = 0.001), persistently low 25-hydroxyvitamin D (25OHD) (<20 ng/mL) (OR = 1.71, 95% CI 1.10-2.64, p = 0.016), and loss of total hip BMD during the study (OR = 1.21, 95% CI 1.17-1.25, p = 0.035 for each 4% decrease). CONCLUSIONS In addition to traditional clinical risk factors for falls, loss of hip BMD and hypovitaminosis D were associated with recurrent falls in community-dwelling elderly persons. Thus, recognizing these factors is essential to preventing falls and improving the outcomes of this population.
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Affiliation(s)
- K L L L Machado
- Bone Metabolism Laboratory, Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455, 3° andar, sala 3193, São Paulo, SP, 01246-903, Brazil
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Domiciano DS, Machado LG, Lopes JB, Figueiredo CP, Caparbo VF, Takayama L, Oliveira RM, Menezes PR, Pereira RMR. Incidence and risk factors for osteoporotic vertebral fracture in low-income community-dwelling elderly: a population-based prospective cohort study in Brazil. The São Paulo Ageing & Health (SPAH) Study. Osteoporos Int 2014; 25:2805-15. [PMID: 25092058 DOI: 10.1007/s00198-014-2821-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 07/22/2014] [Indexed: 11/29/2022]
Abstract
UNLABELLED We ascertained the incidence and predictors of radiographic vertebral fracture in a Brazilian elderly cohort, since no data in this field have been reported in low-income countries. This is the first population-based study to demonstrate the high frequency of vertebral fracture in elderly Latin Americans. Age, prior fracture, BMD, and bone turnover were predictors of fracture. INTRODUCTION Vertebral fractures are associated with increased future fracture risk and mortality. No data on incidence of osteoporotic vertebral fracture have been reported in low-income countries where the population's aging has been faster. Thus, we sought to describe the incidence and risk factors for radiographic vertebral fracture in a longitudinal prospective Brazilian population-based elderly cohort. METHODS 707 older adults (449 women and 258 men) were evaluated with spinal radiographs obtained at baseline and after a mean follow-up of 4.3 ± 0.8 years. New vertebral fracture was defined as distinct alteration in the morphology of vertebrae resulting in higher grade of deformity on the second radiograph when compared to the baseline radiograph. Clinical questionnaire, bone mineral density (BMD), and laboratory tests were performed at baseline. Multivariate Poisson regression models were used to identify independent predictors of fracture. RESULTS The age-standardized incidence of vertebral fracture was 40.3/1,000 person-years in women and 30.6/1,000 in men. In women, three models of risk factors for fracture were fitted: (1) age (relative risks (RR) 2.46, 95 % confidence interval (CI) 1.66-3.65), previous osteoporotic fracture (RR 1.65, 95 % CI 1.00-2.71), and lumbar spine BMD (RR 1.21, 95 % CI 1.03-1.41); (2) age (RR 2.25, 95 % CI 1.52-3.34) and femoral neck BMD (RR 1.42, 95 % CI 1.11-1.81); (3) age (RR 2.11, 95 % CI 1.41-3.15) and total hip BMD (RR 1.56, 95 % CI 1.21-2.0). In men, the highest quartile of cross-linked C-telopeptide (CTx) (RR 1.96, 95 % CI 0.98-3.91) and prior fracture (RR 2.10, 95 % CI 1.00-4.39) were predictors of new vertebral fracture. CONCLUSIONS This is the first population-based study to ascertain the incidence of vertebral fracture in elderly Latin Americans, confirming the high frequency of the disorder. Age, prior fracture, BMD, and bone turnover were predictors of the short-term incidence of vertebral fracture.
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Affiliation(s)
- D S Domiciano
- Bone Metabolism Laboratory, Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455, 3 andar, sala 3105, São Paulo, SP, 01246-903, Brazil
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Figueiredo CP, Domiciano DS, Lopes JB, Caparbo VF, Scazufca M, Bonfá E, Pereira RMR. Prevalence of sarcopenia and associated risk factors by two diagnostic criteria in community-dwelling older men: the São Paulo Ageing & Health Study (SPAH). Osteoporos Int 2014; 25:589-96. [PMID: 23892584 DOI: 10.1007/s00198-013-2455-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2013] [Accepted: 06/24/2013] [Indexed: 01/13/2023]
Abstract
UNLABELLED Sarcopenia is an aging syndrome that can be characterized by many criteria adjusted or not by fat mass. This study suggested that the optimal criteria should be selected according to body mass index (BMI) in older men and identified age, BMI, race, smoking, physical activity, hip bone mineral density (BMD) as risk factors for this syndrome. INTRODUCTION This study aims to analyze the prevalence of sarcopenia and associated risk factors using appendicular skeletal mass (ASM)/height(2) and ASM adjusted for total fat mass criteria in older men from community. METHODS Three hundred ninety-nine men were included and answered a questionnaire about lifestyle and medical history. Individuals were classified by their BMI using the classification adjusted by age. Body composition and bone mineral density were measured by dual X-ray absorptiometry. Sarcopenia was classified according to both criteria. Logistic regression models were used to analyze risk factors associated with sarcopenia. RESULTS The mean BMI was 26.46 kg/m(2): 12.5 % underweight, 43.6 % normal, and 43.9 % overweight/obese. Fifty-four (13.5 %) were considered sarcopenic by ASM/height(2) and 79 (19.8 %) by ASM adjusted for fat (p = 0.001). Fifty-one (12.8 %) individuals had discordant sarcopenia classification: 13 were classified only by ASM/height(2) and 38 only by ASM adjusted for fat. Of the 13 subjects classified as sarcopenic only by ASM/height(2), 84.6 % (11/13) were underweight and solely one (7.7 %) was considered overweight/obese. In contrast, of those 38 older men classified as sarcopenic only by ASM adjusted for fat, none were underweight and 53 % (20/38) were overweight/obese. Subjects classified as sarcopenic according to both criteria had the same risk factors in the final model analyses (age, BMI, race, smoking, physical activity, hip BMD; p < 0.05). CONCLUSION This study suggested that the optimal criteria for sarcopenia should be selected according to BMI in community-dwelling older men.
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Affiliation(s)
- C P Figueiredo
- Bone Metabolism Laboratory, Rheumatology Division, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Arnaldo, 455, 3º andar, sala 3105, São Paulo, SP, 01246-903, Brazil
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Domiciano DS, Figueiredo CP, Lopes JB, Caparbo VF, Takayama L, Menezes PR, Bonfa E, Pereira RMR. Discriminating sarcopenia in community-dwelling older women with high frequency of overweight/obesity: the São Paulo Ageing & Health Study (SPAH). Osteoporos Int 2013; 24:595-603. [PMID: 22588184 DOI: 10.1007/s00198-012-2002-1] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2011] [Accepted: 03/05/2012] [Indexed: 01/29/2023]
Abstract
SUMMARY The criteria most used for the definition of sarcopenia, those based on the ratio between the appendicular skeletal muscle mass (ASM) and the square of the height (h(2)) underestimate prevalence in overweight/obese people whereas another criteria consider ASM adjusted for total fat mass. We have shown that ASM adjusted for fat seems to be more appropriate for sarcopenia diagnosis. INTRODUCTION Since the prevalence of overweight and obesity is a growing public health issue, the aim of this study was to evaluate the prevalence and risk factors associated with sarcopenia, based on these two criteria, among older women. METHODS Six hundred eleven community-dwelling women were evaluated by specific questionnaire including clinical data. Body composition and bone mineral density were evaluated by dual X-ray absorptiometry. Logistic regression models were used to identify factors independently related to sarcopenia by ASM/h(2) and ASM adjusted for total fat mass criteria. RESULTS The prevalence of overweight/obesity was high (74.3 %). The frequency of sarcopenia was lower using the criteria of ASM/h(2) (3.7 %) than ASM adjusted for fat (19.9 %) (P < 0.0001). We also note that less than 5 %(1/23) of sarcopenic women, according to ASM/h(2), had overweight/obesity, whereas 60 % (74/122) of sarcopenic women by ASM adjusted for fat had this complication. Using ASM/h(2), the associated factors observed in regression models were femoral neck T-score (OR = 1.90; 95 % CI 1.06-3.41; P = 0.03) and current alcohol intake (OR = 4.13, 95 % CI 1.18-14.45, P = 0.03). In contrast, we have identified that creatinine (OR = 0.21; 95 % CI 0.07-0.63; P = 0.005) and the White race (OR = 1.81; 95 % CI 1.15-2.84; P = 0.01) showed a significant association with sarcopenia using ASM adjusted for fat. CONCLUSIONS In women with overweight/obesity, ASM adjusted for fat seems to be the more appropriate criteria for sarcopenia diagnosis. This finding has relevant public health implications, considering the high prevalence of overweight/obesity in older women.
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Affiliation(s)
- D S Domiciano
- Bone Metabolism Laboratory, Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455, 3° andar, sala 3105, São Paulo, São Paulo, 01246-903, Brazil
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Domiciano DS, Shinjo SK. Autoimmune hemolytic anemia in systemic lupus erythematosus: association with thrombocytopenia. Clin Rheumatol 2010; 29:1427-31. [DOI: 10.1007/s10067-010-1479-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2009] [Revised: 01/13/2010] [Accepted: 04/29/2010] [Indexed: 11/30/2022]
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Domiciano DS, de Carvalho JF, Macedo AR, Laurindo IMM. Central diabetes insipidus induced by tuberculosis in a rheumatoid arthritis patient. Acta Reumatol Port 2010; 35:232-235. [PMID: 20711095] [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: 05/29/2023]
Abstract
Tuberculosis, a polymorphic disease, is a diagnostic challenge, particularly when arises concomitantly to an autoimmune disease such as rheumatoid arthritis (RA). Herein, the authors describe a 33-year-old woman with nodular RA who was being treated with methotrexate, sulfasalazine and corticosteroids and presented with subcutaneous nodules simultaneously with aseptic meningitis. Mycobacterium tuberculosis was identified in cultures from a biopsy of an axillary nodule. The patient also developed polyuria and polydipsia with normal glycemia; antidiuretic hormone (ADH) treatment before and after a 3% saline infusion test was performed and diabetes insipidus was diagnosed. An encephalic MRI showed sellar and suprasellar masses, suggesting central diabetes insipidus (CDI). The patient received standard tuberculosis (TB) treatment for 6 months and also DDAVP (desmopressin acetate) during this period. Control of CDI was observed. A pre-surgical magnetic resonance imaging (MRI) showed no pituitary mass. It is known that intrasellar tuberculoma occurs in only 1% of TB patients. TB should be considered in the differential diagnosis of CDI, especially in immunosupressed patients and in countries where this infection is a serious public health problem.
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Affiliation(s)
- Diogo Souza Domiciano
- Rheumatology Division, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo-SP, Brazil
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Abstract
Anti-endothelial cells antibodies have been detected in numerous autoimmune and inflammatory diseases, including systemic lupus erythematous, rheumatoid arthritis, vasculitis and sarcoidosis. Anti-endothelial cells antibodies bind to endothelial cell antigens and induce endothelial damage. Their effects on the endothelial cell have been considered responsible, at least in part, by the vascular injury which occurs in these pathological conditions.
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Affiliation(s)
- DS Domiciano
- Rheumatology Division, São Paulo University School of Medicine, São Paulo, Brazil
| | - JF Carvalho
- Rheumatology Division, São Paulo University School of Medicine, São Paulo, Brazil, Department of Internal Medicine B, Center for Autoimmune Diseases, affiliated to Tel-Aviv University Sackler Faculty of Medicine, Sheba Medical Center, Tel-Hashomer, Israel
| | - Y. Shoenfeld
- Department of Internal Medicine B, Center for Autoimmune Diseases, affiliated to Tel-Aviv University Sackler Faculty of Medicine, Sheba Medical Center, Tel-Hashomer, Israel,
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Costa LP, Domiciano DS, Pereira RMR. Características demográficas, clínicas, laboratoriais e radiológicas da febre reumática no Brasil: revisão sistemática. Rev Bras Reumatol 2009. [DOI: 10.1590/s0482-50042009000500010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Domiciano DS, de Carvalho JF. Primary localized amyloidosis of the ureter. Isr Med Assoc J 2008; 10:237-238. [PMID: 18494242] [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: 05/26/2023]
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