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Lourenço MH, Silva AB, Sousa J, Oliveira H, Silva I, Costa M, Branco JC, Gonçalves MJ. Necrotizing mesenteric vasculitis in systemic lupus erythematosus. ARP Rheumatol 2024; 3:49-52. [PMID: 38558064 DOI: 10.63032/xvzp4159] [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] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
Systemic lupus erythematosus (SLE) is a multisystemic autoimmune disorder which may affect the gastrointestinal system. Half of the patients with SLE experience gastrointestinal symptoms, with the most common being nausea, vomiting, anorexia, and abdominal pain. Mesenteric vasculitis is a severe and rare complication of SLE and one of the most frequent causes of severe acute abdominal pain. The authors present a case of a 57-year-old woman with SLE who was diagnosed with necrotizing mesenteric vasculitis following a urinary septic shock. The patient was treated with high-dose corticosteroid therapy and cyclophosphamide, with resolution of the clinical picture.
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Affiliation(s)
| | | | - Jessica Sousa
- Radiology, Centro Hospitalar Universitário de Santo António
| | - Helena Oliveira
- Pathological Anatomy, Hospital de Cascais Dr. José de Almeida
| | - Inês Silva
- Rheumatology, Hospital de Egas Moniz, Lisbon, Portugal
| | - Manuela Costa
- Rheumatology, Hospital de Egas Moniz, Lisbon, Portugal
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Morais A, Duarte AC, Fernandes MO, Borba A, Ruano C, Marques ID, Calha J, Branco JC, Pereira JM, Salvador MJ, Bernardes M, Khmelinskii N, Pinto P, Pinto-Basto R, Freitas S, Campainha S, Alfaro T, Cordeiro A. Early detection of interstitial lung disease in rheumatic diseases: A joint statement from the Portuguese Pulmonology Society, the Portuguese Rheumatology Society, and the Portuguese Radiology and Nuclear Medicine Society. Pulmonology 2023:S2531-0437(23)00205-2. [PMID: 38148269 DOI: 10.1016/j.pulmoe.2023.11.007] [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: 06/29/2023] [Revised: 10/23/2023] [Accepted: 11/24/2023] [Indexed: 12/28/2023] Open
Abstract
INTRODUCTION Interstitial lung disease (ILD) contributes significantly to morbidity and mortality in connective tissue disease (CTD). Early detection and accurate diagnosis are essential for informing treatment decisions and prognosis in this setting. Clear guidance on CTD-ILD screening, however, is lacking. OBJECTIVE To establish recommendations for CTD-ILD screening based on the current evidence. METHOD Following an extensive literature research and evaluation of articles selected for their recency and relevance to the characterization, screening, and management of CTD-ILD, an expert panel formed by six pulmonologists from the Portuguese Society of Pulmonology, six rheumatologists from the Portuguese Society of Rheumatology, and six radiologists from the Portuguese Society of Radiology and Nuclear Medicine participated in a multidisciplinary discussion to produce a joint statement on screening recommendations for ILD in CTD. RESULTS The expert panel achieved consensus on when and how to screen for ILD in patients with systemic sclerosis, rheumatoid arthritis, mixed connective tissue disease, Sjögren syndrome, idiopathic inflammatory myopathies and systemic lupus erythematous. CONCLUSIONS Despite the lack of data on screening for CTD-ILD, an expert panel of pulmonologists, rheumatologists and radiologists agreed on a series of screening recommendations to support decision-making and enable early diagnosis of ILD to ultimately improve outcomes and prognosis in patients with CTD.
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Affiliation(s)
- A Morais
- Pulmonology Department, Hospital de São João, Centro Hospitalar Universitário São João, Porto, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal; i3S - Instituto de Biologia Molecular e Celular/Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal; Portuguese Pulmonology Society (SPP).
| | - A C Duarte
- Rheumatology Department, Hospital Garcia de Orta, Almada, Portugal; Portuguese Rheumatology Society (SPR)
| | - M O Fernandes
- Imaging Department, Hospital de Santa Marta, Centro Hospitalar e Universitário de Lisboa Central, Lisboa, Portugal; Imaging Department, Hospital da Luz Lisboa, Lisboa, Portugal; Portuguese Rheumatology Society (SPR); Portuguese Radiology and Nuclear Medicine Society (SPRMN)
| | - A Borba
- Pulmonology Department, Hospital de Santa Marta, Centro Hospitalar Universitário Lisboa Central, Lisboa, Portugal; Portuguese Pulmonology Society (SPP)
| | - C Ruano
- Imaging Department, Hospital de Santa Marta, Centro Hospitalar e Universitário de Lisboa Central, Lisboa, Portugal; Imaging Department, Hospital da Luz Lisboa, Lisboa, Portugal; Portuguese Radiology and Nuclear Medicine Society (SPRMN)
| | - I D Marques
- Imaging Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal; Portuguese Radiology and Nuclear Medicine Society (SPRMN)
| | - J Calha
- Imaging Department, Hospital Beatriz Ângelo, Loures, Portugal; Imaging Department, Hospital da Luz Lisboa, Lisboa, Portugal; Portuguese Radiology and Nuclear Medicine Society (SPRMN)
| | - J C Branco
- Imaging Department, Hospital Beatriz Ângelo, Loures, Portugal; Imaging Department, Hospital da Luz Lisboa, Lisboa, Portugal; Portuguese Radiology and Nuclear Medicine Society (SPRMN)
| | - J M Pereira
- Imaging Department, Hospital de São João, Centro Hospitalar Universitário São João, Porto, Portugal; Imaging Department, Unilabs Portugal, Porto, Portugal; Portuguese Radiology and Nuclear Medicine Society (SPRMN)
| | - M J Salvador
- Rheumatology Department Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Portuguese Rheumatology Society (SPR)
| | - M Bernardes
- Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal; Rheumatology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - N Khmelinskii
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Portugal; Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon Academic Medical Centre, Lisboa, Portugal; Portuguese Rheumatology Society (SPR)
| | - P Pinto
- Rheumatology Department, Centro Hospitalar Vila Nova de Gaia/ Espinho, Vila Nova de Gaia, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal; Portuguese Rheumatology Society (SPR)
| | - R Pinto-Basto
- Pulmonology Department, Hospital Pulido Valente, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal; Portuguese Pulmonology Society (SPP)
| | - S Freitas
- Pulmonology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Portuguese Pulmonology Society (SPP)
| | - S Campainha
- Pulmonology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal; Portuguese Pulmonology Society (SPP)
| | - T Alfaro
- Pulmonology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Portuguese Pulmonology Society (SPP)
| | - A Cordeiro
- Rheumatology Department, Hospital Garcia de Orta, Almada, Portugal; Portuguese Rheumatology Society (SPR)
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Lourenço MH, Bento da Silva A, Gago L, Branco JC, Silva I. Juvenile dermatomyositis with scleroderma features - when skin thickening is not systemic sclerosis. ARP Rheumatol 2023; 2:345-346. [PMID: 38174756] [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: 01/05/2024]
Affiliation(s)
| | | | - Laura Gago
- Rheumatology, Centro Hospitalar de Lisboa Ocidental
| | | | - Inês Silva
- Rheumatology, Centro Hospitalar de Lisboa Ocidental
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Lourenço MH, Borralho J, Silva I, Alves J, Sampaio R, Mansinho K, Branco JC. Cytomegalovirus and rheumatic diseases: cases-based review. ARP Rheumatol 2023; 2:269-274. [PMID: 37839034] [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: 10/17/2023]
Abstract
Cytomegalovirus (CMV) infection is a common and typically benign disease in immunocompetent individuals. However, immunocompromised patients are at a greater risk of reactivation, leading to more severe outcomes. Patients with rheumatic diseases have a particularly high risk of opportunistic infections due to both the inherent immunosuppressive state conveyed by the disease itself and the use of potent immunosuppressant drugs, such as glucocorticoids, cyclophosphamide, and rituximab. Limited data are available regarding prophylactic or preemptive treatment of CMV infection in patients with rheumatic diseases. In this article the authors present two cases of rheumatic conditions complicated by CMV infection. The first case describes a patient with eosinophilic granulomatosis with polyangiitis, previously treated with glucocorticoids and cyclophosphamide, who developed CMV colitis with bowel perforation. The second case involves a woman with systemic lupus erythematosus who was diagnosed with CMV meningitis. Both cases reinforce the importance of establishing guidelines for surveillance and prophylaxis of CMV infection in these patients.
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Affiliation(s)
| | | | - Inês Silva
- Hospital de Egas Moniz, Lisbon, Portugal
| | - João Alves
- Hospital de Egas Moniz, Lisbon, Portugal
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Santos HC, Henriques AR, Branco JC, Machado P, Canhão H, Pimentel-Santos F, Rodrigues AM. In a community-based setting spondyloarthritis patients report higher levels of physical disability than chronic low back pain patients - results from EpiReuma.pt. ARP Rheumatol 2023:AO230088. [PMID: 37178327] [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
OBJECTIVES Chronic low back pain (CLBP) is a common health problem and in most patients it is not possible to identify a specific cause (non-specific CLBP). Spondyloarthritis is a musculoskeletal disorder characterized by (often inflammatory) back pain and spinal stiffness. The impact of CLBP and spondyloarthritis on patients' physical function may be different. This study aims to compare physical disability in patients with spondyloarthritis and CLBP, in a population-based setting. Furthermore, we aim to identify modifiable risk factors for physical disability among these two populations. METHODS Data from EpiReumaPt, a national health cohort with 10 661 individuals, conducted from September 2011 to December 2013, was used. Physical function was accessed by the Health Assessment Questionnaire Disability Index (HAQ-DI) and by the physical function dimension of the 36-Item Short Form Survey (SF-36). Univariable and multivariable linear regression analyses were used to assess the differences between groups. Factors associated with physical disability were explored for both diseases. RESULTS We evaluated 92 patients with spondyloarthritis, 1376 patients with CLBP and 679 subjects without rheumatic and musculoskeletal diseases (RMDs). Spondyloarthritis and CLBP patients reported significantly higher levels of disability in HAQ-DI (ß=0.33; p < 0.001 and ß=0.20; p < 0.001, respectively) than subjects without RMDs. In comparison to CLBP patients, spondyloarthritis patients reported higher disability (ß=0.14; p=0.03). The physical domains of SF-36, bodily pain and general health, where more affected in spondyloarthritis patients than in CLBP patients (ß=-6.61; p=0.02 and ß=-5.94; p=0.001, respectively). Spondyloarthritis and CLBP patients had a worse physical summary score (PCS) than mental summary score (MCS), and only PCS was significantly worse in comparison to subjects without RMDs. Factors associated with physical disability in CLBP were low back pain intensity, older age, obesity, multimorbidity, and retirement. Similarly, in spondyloarthritis physical disability was associated with retirement and multimorbidity. Factors associated with lower disability were alcohol consumption and male gender in CLBP, and regular physical exercise was associated with lower disability in both disorders. CONCLUSIONS In this nationwide cohort, spondyloarthritis and CLBP patients reported significant physical disability. Regular physical exercise was associated with lower disability in both diseases.
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Bento da Silva A, Lourenço MH, Gonçalves MJ, Branco JC, Costa M, Mourão AF. Arthritis or maybe not? Pachydermodactyly: the great mimicker of juvenile idiopathic arthritis. ARP Rheumatol 2023; 2:78-82. [PMID: 36802346] [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: 04/24/2023]
Abstract
Arthritis in the paediatric population is the hallmark of many rheumatic inflammatory diseases, as well as other cutaneous, infectious, or neoplastic conditions. It can be quite devastating, whereby prompt recognition and treatment of these disorders are essential. However, arthritis can sometimes be mistaken for other cutaneous or genetic conditions leading to misdiagnosis and overtreatment. Pachydermodactyly is a rare and benign form of digital fibromatosis, usually manifested by swelling of the proximal interphalangeal joints of both hands, mimicking arthritis. The authors report a case of a 12-year-old boy with a one-year history of painless swelling of the proximal interphalangeal joints of both hands that was referred to the Paediatric Rheumatology department due to the suspicion of juvenile idiopathic arthritis. The diagnostic work-up was unremarkable, and the patient remained asymptomatic over an 18-month follow-up period. A diagnosis of pachydermodactyly was assumed and no treatment was introduced, given the benign nature of the disorder and absence of symptoms. Therefore, it was possible to safely discharge the patient from the Paediatric Rheumatology clinic.
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Affiliation(s)
| | | | | | | | - Manuela Costa
- Department of Rheumatology, Centro Hospitalar de Lisboa Ocidental EPE
| | - Ana Filipa Mourão
- Department of Rheumatology, Centro Hospitalar de Lisboa Ocidental EPE
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Torres RP, Santos FP, Branco JC. Methotrexate: Implications of pharmacogenetics in the treatment of patients with Rheumatoid Arthritis. ARP Rheumatol 2022; 1:225-229. [PMID: 35724450] [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
BACKGROUND Methotrexate (MTX) is an anti-folate drug with anti-proliferative and anti-inflammatory effects. MTX proved to be the most highly effective, fast-acting disease modifying anti-rheumatic drug (DMARD), being widely used for the treatment of rheumatoid arthritis (RA). This review aims to describe the main genetic variants identified concerning proteins that play a role in methotrexate's kinetics and efficiency profile. METHODS A literature review was conducted since January of 2000 until December 2020, by searching the PubMed and Embase bibliographic databases, employing the following MeSH terms: methotrexate, pharmacogenetics, pharmacokinetics, and rheumatoid arthritis. The search was limited to articles in English language. Two independent reviewers screened the titles and abstracts followed by a full-text review to assess papers regarding their eligibility. A total of 48 articles matched the research criteria and were analyzed. RESULTS Reduced folate carrier 1 (RFC1), a constitutively expressed folate transport protein that has high affinity for MTX is responsible, almost exclusively, for the transport of folate and MTX into the cell. The most studied variant of the gene is the 80G>A variant, mapped within exon 2, on chromosome 21. It seems to improve RA responses to MTX, clinical efficacy with long disease remission. ABC transporters are involved in the efflux of MTX from cells. An increased expression and function of these transporters should decrease MTX concentrations in target cells, resulting in lack of therapeutic response. ABCB1 3435 C/T is a high frequency polymorphism, significantly associated with RA good responses, symptom remission and reduced adverse events, due to MTX treatment. Thymidylate synthase (TYMS) is involved in thymidine synthesis. MTX decreases TYMS activity by inhibition and decreasing the access to tetrahydrofolate (THF) cofactors. The most common genetic variant of the TYMS gene consists of a 28 bp tandem repeat, with double and triple number of repeats (2R and 3R). The 3R allele genotype was associated with decreased efficacy and increased toxicity. The 5,10-methylenetetrahydrofolate reductase (MTHFR) enzyme is indirectly inhibited by MTX. The most common SNPs of the MTHFR gene are C677T and A1298C. Both are associated with a decreased efficacy and an increased toxicity of MTX. CONCLUSION MTX response is affected by many gene variants; the effect of each variant separately is likely to be small. Additionally, gene-gene interaction seems to enhance the potential role of linkage disequilibrium. This shows the emerging need for a better gene characterization and to improve the knowledge about variants distribution according to ethnicity, to explain different responses to MTX at an individual level.
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Cruz M, Marques ML, Capela S, Lopes SA, Tavares V, Branco JC, Maheu E. Validation of the Portuguese version of the Functional Index for Hand Osteoarthritis (FIHOA). ARP Rheumatol 2022; 1:143-151. [PMID: 35810373] [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
INTRODUCTION Hand osteoarthritis (HOA) is a prevalent rheumatic disease that may cause significant disability. The Functional index for HOA (FIHOA) is a validated questionnaire to evaluate loss of function in patients with HOA. OBJECTIVE To undertake a cross-cultural adaptation and validation of FIHOA into Portuguese. PATIENTS AND METHODS First, the original French version of FIHOA had been forward-backward translated into Portuguese, according to the guidelines for cross-cultural adaptation. Secondly, patients with primary HOA were consecutively recruited in three Portuguese rheumatology outpatient clinics between May 2016 and April 2018. The final consensual Portuguese version of FIHOA was administered to 52 patients. A numerical rating scale (NRS - 0 to 100mm) for hand pain and for perceived hand dysfunction was also registered. Ten randomly selected patients were re-administered the same tools 5 to 15 days later. Internal consistency, test-retest reliability, internal construct validity and external validity related to dysfunction NRS were evaluated. RESULTS Fifty-two patients were evaluated: all right-handed, 96% women, mean age of 63 (10) years and 8 (6) years of disease duration. Mean (SD) pain and dysfunction were 47 (25) and 46 (25), respectively, with 68% patients being symptomatic. Mean (SD) FIHOA was 7 (5). Cronbach's alpha for internal consistency was high and adequate (0.87) and corrected item-total correlation revealed adequate performance. For reliability, Spearman's rho coefficient was 0.88 and total intraclass correlation coefficient (ICC) between test and retest was 0.87, showing good reliability. Factor analysis revealed three factors accounting for 71% of the variance of the score, with the first one (including questions 1, 2, 3 and 10) being responsible for 47% of the variance. Spearman's rho between FIHOA and dysfunction NRS was 0.5, showing a moderate but significant correlation and moderate external validity. CONCLUSION The Portuguese version of FIHOA is a consistent, reliable, and valid instrument to measure loss of function in HOA Portuguese patients.
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Affiliation(s)
| | - Mary Lucy Marques
- Serviço de Reumatologia,Centro Hospitalar e Universitário de Coimbra
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Neto A, Lopes C, Vasconcelos J, Mourão AF, Costa M, de Sousa R, Peres S, Branco JC. Arthritis in cat scratch disease: an unusual manifestation. ARP Rheumatol 2022; 1:98-99. [PMID: 35633583] [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
Cat scratch disease (CSD) is a zoonosis caused by Bartonella henselae, which is usually transmitted to humans through scratches or bites from infected cats. It is primarily a disease of children and adolescents, although it can affect individuals of any age. In approximately 10% of cases, patients can present atypical manifestations that may involve the musculoskeletal system. Herein, we report a case of a healthy 51-year-old man that developed low-grade fever and regional lymphadenopathy, followed by erythema nodosum and oligoarthritis. He had been scratched and bitten by his cat before the onset of symptoms. The diagnosis was confirmed serologically by the presence of high titers of specific IgG antibodies. Bartonella henselae was also detected in the blood of the owner's cat by PCR and DNA sequencing.
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Affiliation(s)
- Agna Neto
- Rheumatology Department, Hospital Central do Funchal, Madeira, Portugal; Rheumatology Department, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Portugal; Chronic Diseases Research Center (CEDOC), NOVA Medical School
| | - Carina Lopes
- Rheumatology Department, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal; Chronic Diseases Research Center (CEDOC), NOVA Medical School
| | - Joana Vasconcelos
- Department of Infectious Diseases and Tropical Medicine, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Ana Filipa Mourão
- Rheumatology Department, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal; Chronic Diseases Research Center (CEDOC), NOVA Medical School
| | - Manuela Costa
- Rheumatology Department, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal; Chronic Diseases Research Center (CEDOC), NOVA Medical School
| | - Rita de Sousa
- Centro de Estudos de Vectores e Doenças Infecciosas, National Institute of Health Dr. Ricardo Jorge, Águas de Moura, Portugal
| | - Susana Peres
- Department of Infectious Diseases and Tropical Medicine, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Jaime Cunha Branco
- Rheumatology Department, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal; Chronic Diseases Research Center (CEDOC), NOVA Medical School
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Sardoo AM, Neto A, Pinheiro Torres R, Rodrigues-Manica S, Domingues L, Lage Crespo C, Lagoas-Gomes J, Mascarenhas V, Mendes CS, Galzerano A, Fernandes de Almeida S, Sepriano A, Ramiro S, Masi AT, Nair K, Costa J, Alexandre BM, Vassilevskaia T, Cunha CV, Sobral D, Branco JC, Gomes-Alves P, Pimentel-Santos FM. The role of muscle in the susceptibility and progression of axial Spondyloarthritis: The MyoSpA Study Protocol. Acta Reumatol Port 2021; 46:342-349. [PMID: 34962249] [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: 06/14/2023]
Abstract
BACKGROUND Axial Spondyloarthritis (axSpA) is a chronic, inflammatory rheumatic disease that affects the axial skeleton, causing pain, stiffness, and fatigue. Genetics and environmental factors such as microbiota and microtrauma are known causes of disease susceptibility and progression. Murine models of axSpA found a decisive role for biomechanical stress as an inducer of enthesitis and new bone formation. Here, we hypothesize that muscle properties in axSpA patients are compromised and influenced by genetic background. OBJECTIVES To improve our current knowledge of axSpA physiopathology, we aim to characterize axial and peripheral muscle properties and identify genetic and protein biomarker that might explain such properties. METHODS A cross-sectional study will be conducted on 48 participants aged 18-50 years old, involving patients with axSpA (according to ASAS classification criteria, symptoms duration < 10 years) and healthy controls matched by gender, age, and levels of physical activity. We will collect epidemiological and clinical data and perform a detailed, whole body and segmental, myofascial characterization (focusing on multifidus, brachioradialis and the gastrocnemius lateralis) concerning: a) Physical Properties (stiffness, tone and elasticity), assessed by MyotonPRO®; b) Strength, by a dynamometer; c) Mass, by bioimpedance; d) Performance through gait speed and 60-second sit-to-stand test; e) Histological and cellular/ molecular characterization through ultrasound-guided biopsies of multifidus muscle; f) Magnetic Resonance Imaging (MRI) characterization of paravertebral muscles. Furthermore, we will perform an integrated transcriptomics and proteomics analysis of peripheral blood samples. DISCUSSION The innovative and multidisciplinary approaches of this project rely on the elucidation of myofascial physical properties in axSpA and also on the establishment of a biological signature that relates to specific muscle properties. This hitherto unstudied link between gene/protein signatures and muscle properties may enhance our understanding of axSpA physiopathology and reveal new and useful diagnostic and therapeutic targets.
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Affiliation(s)
- Atlas Mashayekhi Sardoo
- CEDOC, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal; Institute of Hygiene and Tropical Medicine, Universidade NOVA de Lisboa and Global Health and Tropical Diseases Research Centre Lisbon, Portugal
| | - Agna Neto
- CEDOC, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal; Centro Hospitalar de Lisboa Ocidental, Hospital de Egas Moniz, Lisboa, Rheumatology Department, Portugal
| | - Rita Pinheiro Torres
- CEDOC, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal; Centro Hospitalar de Lisboa Ocidental, Hospital de Egas Moniz, Lisboa, Rheumatology Department, Portugal
| | - Santiago Rodrigues-Manica
- CEDOC, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal; Centro Hospitalar de Lisboa Ocidental, Hospital de Egas Moniz, Lisboa, Rheumatology Department, Portugal
| | - Lúcia Domingues
- CEDOC, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal; Instituto Politécnico de Setúbal, Escola Superior de Saúde de Setúbal, Setúbal, Portugal
| | | | - João Lagoas-Gomes
- CEDOC, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal; Centro Hospitalar de Lisboa Ocidental, Hospital de Egas Moniz, Lisboa, Rheumatology Department, Portugal
| | - Vasco Mascarenhas
- MSK imaging Unit (UIME), Imaging Center, Hospital da Luz, Lisbon, Portugal
| | - César S Mendes
- CEDOC, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
| | | | | | - Alexandre Sepriano
- CEDOC, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal; Centro Hospitalar de Lisboa Ocidental, Hospital de Egas Moniz, Lisboa, Rheumatology Department, Portugal
| | - Sofia Ramiro
- Leiden University Medical Center, Leiden, The Netherlands
| | - Alfonse T Masi
- University of Illinois, College of Medicine at Peoria, USA
| | - Kalyani Nair
- Bradley University, Mechanical Engineering department, USA
| | - Julia Costa
- ITQB-NOVA, Instituto de Tecnologia Química e Biológica António Xavier, Oeiras, Portugal
| | | | - Tatiana Vassilevskaia
- Institute of Hygiene and Tropical Medicine, Universidade NOVA de Lisboa and Global Health and Tropical Diseases Research Centre Lisbon, Portugal
| | - Celso Vladimiro Cunha
- Institute of Hygiene and Tropical Medicine, Universidade NOVA de Lisboa and Global Health and Tropical Diseases Research Centre Lisbon, Portugal
| | | | - Jaime Cunha Branco
- CEDOC, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal; Centro Hospitalar de Lisboa Ocidental, Hospital de Egas Moniz, Lisboa, Rheumatology Department, Portugal
| | | | - Fernando M Pimentel-Santos
- CEDOC, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal; Centro Hospitalar de Lisboa Ocidental, Hospital de Egas Moniz, Lisboa, Rheumatology Department, Portugal
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Branco JC. How did we get here? Acta Reumatol Port 2021; 46:295-296. [PMID: 34962244] [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: 06/14/2023]
Affiliation(s)
- Jaime Cunha Branco
- Head of Rheumatology Department - Egas Moniz Hospital, Lisboa Ocidental Hospital Centre (HEM,CHLO-EPE); Full Professor and Dean of NOVA Medical School, NOVA University Lisbon (NMS/UNL); Principal Investigator - Comprehensive Health Research Center (CHRC)
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Cordeiro JV, Lopes CA, Faria PL, Aguiar P, Cercas MJ, Victorino G, Branco JC, Fernandes A, Santos FP. Biobanks for aging research - perceptions and choices among rheumatology outpatients. Acta Reumatol Port 2021; 46:218-229. [PMID: 34626462] [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: 06/13/2023]
Abstract
OBJECTIVE Biobanks for research (BBR) have enormous value for research, including those specifically oriented to chronic diseases. Knowing public attitudes and perceptions is key to design and implement patient-centered BBR. We assessed patient awareness, perception and choices among rheumatology outpatients regarding aging biobanking activities. METHODS We conducted a cross-sectional survey of patients, aged 50 or older, attending an outpatient rheumatology tertiary department. Demographic data and perceptions about biobanking were collected and statistical analysis was performed. RESULTS 132 valid questionnaires were obtained (mean age: 63,4; 68,2% female; mean education years: 8,35). 61,7% of respondents did not know the specific term "biobank", 57,7% knew they could donate biological material for BBR, 89,9% agreed with these infrastructures and 88,3% would consider participation Those participants with more years of education were more knowledgeable and prone to biobank participation. Willingness to participate in BBR was mainly related (86,4%) to the advancement of scientific knowledge and not individual gain. Scientific research institutes were indicated as the most adequate institutions to manage BBR. Informed consent, anonymity and confidentiality ranked as top requisites for biobank participation. 61,3% of respondents expressed their agreement with aging biobanks, considering these as a sign of respect for specific problems of people of older ages such as higher disease burdens. CONCLUSION Knowledge of biobanks was found to be limited. Participants were positive toward the setting up of biobanks in general and patient-centered aging biobanks in particular. Knowledge about biobanks and acceptance were higher among participants with higher education years.
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Affiliation(s)
- João V Cordeiro
- NOVA National School of Public Health, Public Health Research Center; Comprehensive Health Research Center; Centro Interdisciplinar de Ciências Sociais (CICS.NOVA), Universidade NOVA de Lisboa
| | - Carina Alves Lopes
- CHRC - Comprehensive Health Research Center, CEDOC, NOVA Medical School; Rheumatology Department, CHLO, EPE - Centro Hospitalar de Lisboa Ocidental, Hospital de Egas Moniz, Lisboa
| | - Paula Lobato Faria
- NOVA National School of Public Health, Public Health Research Center; Comprehensive Health Research Center; Centro Interdisciplinar de Ciências Sociais (CICS.NOVA), Universidade NOVA de Lisboa
| | - Pedro Aguiar
- NOVA National School of Public Health, Public Health Research Center; Comprehensive Health Research Center, Universidade NOVA de Lisboa
| | | | | | - Jaime Cunha Branco
- CHRC - Comprehensive Health Research Center, CEDOC, NOVA Medical School; Rheumatology Department, CHLO, EPE - Centro Hospitalar de Lisboa Ocidental, Hospital de Egas Moniz, Lisboa
| | - Ana Fernandes
- Centro Interdisciplinar de Ciências Sociais (CICS.NOVA), Universidade NOVA de Lisboa
| | - Fernando Pimentel Santos
- CHRC - Comprehensive Health Research Center, CEDOC, NOVA Medical School; Rheumatology Department, CHLO, EPE - Centro Hospitalar de Lisboa Ocidental, Hospital de Egas Moniz, Lisboa
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13
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Marona J, Sepriano A, Rodrigues-Manica S, Pimentel-Santos F, Mourão AF, Gouveia N, Branco JC, Santos H, Vieira-Sousa E, Vinagre F, Tavares-Costa J, Rovisco J, Bernardes M, Madeira N, Cruz-Machado R, Roque R, Silva JL, Marques ML, Ferreira RM, Ramiro S. Eligibility criteria for biologic disease-modifying antirheumatic drugs in axial spondyloarthritis: going beyond BASDAI. RMD Open 2021; 6:rmdopen-2019-001145. [PMID: 32144137 PMCID: PMC7061099 DOI: 10.1136/rmdopen-2019-001145] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 01/25/2020] [Accepted: 01/28/2020] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES To compare definitions of high disease activity of the Ankylosing Spondylitis Disease Activity Score (ASDAS) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) in selecting patients for treatment with biologic disease-modifying antirheumatic drugs (bDMARDs). METHODS Patients from Rheumatic Diseases Portuguese Register (Reuma.pt) with a clinical diagnosis of axial spondyloarthritis (axSpA) were included. Four subgroups (cross-tabulation between ASDAS (≥2.1) and BASDAI (≥4) definitions of high disease activity) were compared regarding baseline characteristics and response to bDMARDs at 3 and 6 months estimated in multivariable regression models. RESULTS Of the 594 patients included, the majority (82%) had both BASDAI≥4 and ASDAS ≥2.1. The frequency of ASDAS ≥2.1, if BASDAI<4 was much larger than the opposite (ie, ASDAS <2.1, if BASDAI≥4): 62% vs 0.8%. Compared to patients fulfilling both definitions, those with ASDAS ≥2.1 only were more likely to be male (77% vs 51%), human leucocyte antigen B27 positive (79% vs 65%) and have a higher C reactive protein (2.9 (SD 3.5) vs 2.1 (2.9)). Among bDMARD-treated patients (n=359), responses across subgroups were globally overlapping, except for the most 'stringent' outcomes. Patients captured only by ASDAS responded better compared to patients fulfilling both definitions (eg, ASDAS inactive disease at 3 months: 61% vs 25% and at 6 months: 42% vs 25%). CONCLUSION The ASDAS definition of high disease activity is more inclusive than the BASDAI definition in selecting patients with axSpA for bDMARD treatment. The additionally 'captured' patients respond better and have higher likelihood of predictors thereof. These results support using ASDAS≥2.1 as a criterion for treatment decisions.
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Affiliation(s)
- Jose Marona
- Rheumatology, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental EPE, Lisboa, Portugal.,CEDOC - NOVA Medical School
- Faculdade de Ciências Médicas (FCM), Universidade Nova de Lisboa, Lisboa, Portugal
| | - Alexandre Sepriano
- CEDOC - NOVA Medical School
- Faculdade de Ciências Médicas (FCM), Universidade Nova de Lisboa, Lisboa, Portugal.,Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Santiago Rodrigues-Manica
- Rheumatology, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental EPE, Lisboa, Portugal.,CEDOC - NOVA Medical School
- Faculdade de Ciências Médicas (FCM), Universidade Nova de Lisboa, Lisboa, Portugal
| | - Fernando Pimentel-Santos
- Rheumatology, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental EPE, Lisboa, Portugal.,CEDOC - NOVA Medical School
- Faculdade de Ciências Médicas (FCM), Universidade Nova de Lisboa, Lisboa, Portugal
| | - Ana Filipa Mourão
- Rheumatology, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental EPE, Lisboa, Portugal.,CEDOC - NOVA Medical School
- Faculdade de Ciências Médicas (FCM), Universidade Nova de Lisboa, Lisboa, Portugal
| | - Nélia Gouveia
- CEDOC - NOVA Medical School
- Faculdade de Ciências Médicas (FCM), Universidade Nova de Lisboa, Lisboa, Portugal
| | - Jaime Cunha Branco
- Rheumatology, Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental EPE, Lisboa, Portugal.,CEDOC - NOVA Medical School
- Faculdade de Ciências Médicas (FCM), Universidade Nova de Lisboa, Lisboa, Portugal
| | - Helena Santos
- Rheumatology, Instituto Português de Reumatologia, Lisboa, Portugal
| | - Elsa Vieira-Sousa
- Rheumatology and Metabolic Bone Diseases Department, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte EPE, Lisboa, Portugal.,Rheumatology Research Unit, Instituto de Medicina Molecular, Faculty of Medicine, Universidade de Lisboa, Lisboa, Portugal
| | - Filipe Vinagre
- Rheumatology, Hospital Garcia de Orta EPE, Almada, Portugal
| | - João Tavares-Costa
- Rheumatology, Unidade Local de Saude do Alto Minho EPE, Viana do Castelo, Portugal
| | - João Rovisco
- Rheumatology, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal.,Clínica Universitária de Reumatologia, Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal
| | - Miguel Bernardes
- Rheumatology, Centro Hospitalar de Sao Joao EPE, Porto, Portugal
| | - Nathalie Madeira
- Rheumatology, Instituto Português de Reumatologia, Lisboa, Portugal
| | - Rita Cruz-Machado
- Rheumatology and Metabolic Bone Diseases Department, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte EPE, Lisboa, Portugal.,Rheumatology Research Unit, Instituto de Medicina Molecular, Faculty of Medicine, Universidade de Lisboa, Lisboa, Portugal
| | - Raquel Roque
- Rheumatology, Hospital Garcia de Orta EPE, Almada, Portugal
| | - Joana Leite Silva
- Rheumatology, Unidade Local de Saude do Alto Minho EPE, Viana do Castelo, Portugal
| | - Mary Lucy Marques
- Rheumatology, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
| | | | - Sofia Ramiro
- CEDOC - NOVA Medical School
- Faculdade de Ciências Médicas (FCM), Universidade Nova de Lisboa, Lisboa, Portugal .,Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.,Rheumatology, Zuyderland Medical Center, Heerlen, Netherlands
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14
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Canhão H, Rodrigues AM, Dinis de Sousa R, Mourão AF, Branco JC. EpiDoC Unit - a clinical research unit open to the rheumatology community. Acta Reumatol Port 2021; 46:5-6. [PMID: 33820390] [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: 06/12/2023]
Affiliation(s)
- Helena Canhão
- EpiDoC Unit, CEDOC, NOVA Medical School, Universidade Nova de Lisboa
- Comprehensive Health Research Center, NOVA Medical School, UNL
- Unidade de Reumatologia, Centro Hospitalar Universitário Lisboa Central
| | - A M Rodrigues
- EpiDoC Unit, CEDOC, NOVA Medical School, Universidade Nova de Lisboa
- Comprehensive Health Research Center, NOVA Medical School, UNL
- Unidade de Reumatologia, Hospital dos Lusíadas, Lisboa
| | - R Dinis de Sousa
- EpiDoC Unit, CEDOC, NOVA Medical School, Universidade Nova de Lisboa
- Comprehensive Health Research Center, NOVA Medical School, UNL
| | - A F Mourão
- EpiDoC Unit, CEDOC, NOVA Medical School, Universidade Nova de Lisboa
- Comprehensive Health Research Center, NOVA Medical School, UNL
- Serviço de Reumatologia, Centro Hospitalar Lisboa Ocidental
| | - J C Branco
- EpiDoC Unit, CEDOC, NOVA Medical School, Universidade Nova de Lisboa
- Comprehensive Health Research Center, NOVA Medical School, UNL
- Serviço de Reumatologia, Centro Hospitalar Lisboa Ocidental
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15
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Duarte C, Carvalheiro H, Rodrigues AM, Dias SS, Marques A, Santiago T, Canhão H, Branco JC, da Silva JAP. Correction to: Prevalence of vitamin D deficiency and its predictors in the Portuguese population: a nationwide population-based study. Arch Osteoporos 2020; 15:55. [PMID: 32240376 DOI: 10.1007/s11657-020-00728-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The original version of this article, published on 02 March 2020, unfortunately contained an error on "Fig. 3 Prevalence of Vitamin D Levels by NUTSII."
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Affiliation(s)
- Catia Duarte
- Department of Rheumatology, Centro Hospitalar e Universitário de Coimbra, Praceita Prof. Mota Pinto, 3000-075, Coimbra, Portugal. .,Coimbra Institute for Clinical and Biomedical Research (iCBR)-Faculty of Medicine, University of Coimbra, Azinhaga Santa Comba, Celas, 3000-548, Coimbra, Portugal.
| | - Helena Carvalheiro
- Department of Rheumatology, Centro Hospitalar e Universitário de Coimbra, Praceita Prof. Mota Pinto, 3000-075, Coimbra, Portugal.,Center for Neuroscience and Cell Biology, Faculdade de Medicina, University of Coimbra, Rua Larga, Pólo I,1°, 3004-504, Coimbra, Portugal
| | - Ana M Rodrigues
- EpiDoC Unit, CEDOC, NOVA Medical School, Universidade Nova de Lisboa (NMS-UNL), Rua Câmara Pestana, n°6, 6-A Edificio CEDOC II, 1150-082, Lisbon, Portugal.,Faculdade de Medicina, Universidade de Lisboa, Avenida Professor Egas Moniz, 1649-028, Lisbon, Portugal
| | - Sara S Dias
- EpiDoC Unit, CEDOC, NOVA Medical School, Universidade Nova de Lisboa (NMS-UNL), Rua Câmara Pestana, n°6, 6-A Edificio CEDOC II, 1150-082, Lisbon, Portugal.,Center for Innovative Care and Health Technology (ciTechCare), Escola Superior de Saúde de Leiria (ESSLei), Instituto Politécnico de Leiria (IPLeiria), Campus 2-Morro do Lena-Alto do Vieiro, Apartado 4137, 2411-901, Leiria, Portugal
| | - Andréa Marques
- Department of Rheumatology, Centro Hospitalar e Universitário de Coimbra, Praceita Prof. Mota Pinto, 3000-075, Coimbra, Portugal.,Health Sciences Research Unit: Nursing Coimbra, Coimbra Nursing School, ESEnfc, Avenida Bissaya Barreto, Apartado 700, 3046-851, Coimbra, Portugal
| | - Tânia Santiago
- Department of Rheumatology, Centro Hospitalar e Universitário de Coimbra, Praceita Prof. Mota Pinto, 3000-075, Coimbra, Portugal.,Coimbra Institute for Clinical and Biomedical Research (iCBR)-Faculty of Medicine, University of Coimbra, Azinhaga Santa Comba, Celas, 3000-548, Coimbra, Portugal
| | - Helena Canhão
- EpiDoC Unit, CEDOC, NOVA Medical School, Universidade Nova de Lisboa (NMS-UNL), Rua Câmara Pestana, n°6, 6-A Edificio CEDOC II, 1150-082, Lisbon, Portugal.,National School of Public Health, Universidade Nova de Lisboa, Avenida Padre Cruz, 1600-560, Lisbon, Portugal.,CHLC - Hospital Curry Cabral, Rua da Beneficência n.° 8, 1069-166, Lisbon, Portugal
| | - Jaime Cunha Branco
- EpiDoC Unit, CEDOC, NOVA Medical School, Universidade Nova de Lisboa (NMS-UNL), Rua Câmara Pestana, n°6, 6-A Edificio CEDOC II, 1150-082, Lisbon, Portugal.,Rheumatology Department, Centro Hospitalar de Lisboa Ocidental
- Egas Moniz Hospital, Rua da Junqueira, 126, 1349-019, Lisbon, Portugal
| | - José António Pereira da Silva
- Department of Rheumatology, Centro Hospitalar e Universitário de Coimbra, Praceita Prof. Mota Pinto, 3000-075, Coimbra, Portugal.,Coimbra Institute for Clinical and Biomedical Research (iCBR)-Faculty of Medicine, University of Coimbra, Azinhaga Santa Comba, Celas, 3000-548, Coimbra, Portugal
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16
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Mota IB, Castelo I, Morais J, Anjos M, Costa JP, Dias M, Fernandes A, Leitão I, Mohanlal U, Campos E, Cascais MJ, Faria A, Marques C, Patarrão R, Pestana D, Teixeira D, Branco JC, Calhau C. Nutrition Education in Portuguese Medical Students: Impact on the Attitudes and Knowledge. ACTA MEDICA PORT 2020; 33:246-251. [PMID: 32238238 DOI: 10.20344/amp.11817] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 01/25/2019] [Accepted: 11/06/2019] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Nutrition has been underrepresented in the curriculum of many medical schools and therefore physicians do not feel adequately prepared to provide dietary counselling. The aim of the present study is to determine the impact of a Nutrition and Metabolism curricular unit on nutrition attitudes, knowledge and confidence on future clinical practice of medical students. MATERIAL AND METHODS All the students enrolled in the curricular unit (2017/2018) were invited to complete a questionnaire assessing their nutritional knowledge and eating habits at the beginning and at the end of the semester (n = 310). RESULTS Initially, students reported good eating habits and nutrition knowledge. These aspects improved at the end of the study. Moreover, students reported that they felt more confident to do dietary counselling after intervention. DISCUSSION Most medical students answered affirmatively to all questions related with good habits or eating behaviours, and the acquisition of knowledge had an impact in specific attitudes. After the Nutrition and Metabolism classes the students felt able to provide dietary counselling in different clinical settings, but none of the students felt extremely confident about their competencies for dietary counselling. This can be due to the fact that the students involved were in the first year of the integrated master's degree in medicine, which is a preclinical year, and thus distant from the medical reality and from contact with patients. CONCLUSION Nutrition education can have a positive impact on attitudes and eating behaviours, knowledge and in the perception of competencies for dietary counselling.
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Affiliation(s)
- Inês Barreiros Mota
- This author contributed equally to the work; Nutrition and Metabolism. NOVA Medical School. Faculdade de Ciências Médicas. Universidade NOVA de Lisboa. Lisboa; Center for Health Technology and Services Research. Porto. Portugal
| | - Inês Castelo
- Este autor contribuiu de forma equitativa para o estudo. Nutrition and Metabolism. NOVA Medical School. Faculdade de Ciências Médicas. Universidade NOVA de Lisboa. Lisboa. Center for Health Technology and Services Research. Porto. Escola Superior de Saúde. Universidade do Algarve. Faro. Portugal
| | - Juliana Morais
- Este autor contribuiu de forma equitativa para o estudo. Nutrition and Metabolism. NOVA Medical School. Faculdade de Ciências Médicas. Universidade NOVA de Lisboa. Lisboa. Center for Health Technology and Services Research. Porto. Portugal
| | - Miguel Anjos
- Nutrition and Metabolism. NOVA Medical School. Faculdade de Ciências Médicas. Universidade NOVA de Lisboa. Lisboa. Portugal
| | - João Pedro Costa
- Nutrition and Metabolism. NOVA Medical School. Faculdade de Ciências Médicas. Universidade NOVA de Lisboa. Lisboa. Portugal
| | - Marta Dias
- Nutrition and Metabolism. NOVA Medical School. Faculdade de Ciências Médicas. Universidade NOVA de Lisboa. Lisboa. Portugal
| | - Ana Fernandes
- Nutrition and Metabolism. NOVA Medical School. Faculdade de Ciências Médicas. Universidade NOVA de Lisboa. Lisboa. Portugal
| | - Iara Leitão
- Nutrition and Metabolism. NOVA Medical School. Faculdade de Ciências Médicas. Universidade NOVA de Lisboa. Lisboa. Portugal
| | - Urmilk Mohanlal
- Nutrition and Metabolism. NOVA Medical School. Faculdade de Ciências Médicas. Universidade NOVA de Lisboa. Lisboa. Portugal
| | - Elisa Campos
- Nutrition and Metabolism. NOVA Medical School. Faculdade de Ciências Médicas. Universidade NOVA de Lisboa. Lisboa. Portugal
| | - Maria João Cascais
- Nutrition and Metabolism. NOVA Medical School. Faculdade de Ciências Médicas. Universidade NOVA de Lisboa. Lisboa. Portugal
| | - Ana Faria
- Nutrition and Metabolism. NOVA Medical School. Faculdade de Ciências Médicas. Universidade NOVA de Lisboa. Lisboa. Center for Health Technology and Services Research. Porto. Comprehensive Health Research Centre. Universidade NOVA de Lisboa. Lisboa. Portugal
| | - Cláudia Marques
- Nutrition and Metabolism. NOVA Medical School. Faculdade de Ciências Médicas. Universidade NOVA de Lisboa. Lisboa. Center for Health Technology and Services Research. Porto. Portugal
| | - Rita Patarrão
- Nutrition and Metabolism. NOVA Medical School. Faculdade de Ciências Médicas. Universidade NOVA de Lisboa. Lisboa. Portugal
| | - Diogo Pestana
- Nutrition and Metabolism. NOVA Medical School. Faculdade de Ciências Médicas. Universidade NOVA de Lisboa. Lisboa. Center for Health Technology and Services Research. Porto. Portugal
| | - Diana Teixeira
- Nutrition and Metabolism. NOVA Medical School. Faculdade de Ciências Médicas. Universidade NOVA de Lisboa. Lisboa. Center for Health Technology and Services Research. Porto. Comprehensive Health Research Centre. Universidade NOVA de Lisboa. Lisboa. Portugal
| | - Jaime Cunha Branco
- Comprehensive Health Research Centre. Universidade NOVA de Lisboa. Lisboa. Unidade de Epidemiologia de Doenças Crónicas. NOVA Medical School. Faculdade de Ciências Médicas. Universidade NOVA de Lisboa. Lisboa. Serviço de Reumatologia. Hospital Egas Moniz. Centro Hospitalar de Lisboa Ocidental. Lisboa. Portugal
| | - Conceição Calhau
- Nutrition and Metabolism. NOVA Medical School. Faculdade de Ciências Médicas. Universidade NOVA de Lisboa. Lisboa. Center for Health Technology and Services Research. Porto
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Rodrigues J, Rodrigues AM, Dias SS, Sousa RD, Branco JC, Canhão H. Psoriatic arthritis and ankylosing spondylitis impact on health-related quality of life and working life: a comparative population-based study. Acta Reumatol Port 2019; 44:254-265. [PMID: 32008031] [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: 06/10/2023]
Abstract
INTRODUCTION Psoriatic arthritis (PsA) and ankylosing spondylitis (AS) are chronic disorders that significantly impact patients' quality of life (QoL), health care systems and society. There is very little data on the epidemiology and the impact of PsA and AS in Portugal, so in this study we aim to: 1) estimate the prevalence of PsA and AS in the adult Portuguese population; 2) compare health-related quality of life (QoL) of PsA and AS with the one of other rheumatic and musculoskeletal diseases (RMD) and with subjects with no rheumatic diseases; 3) compare early retirement and productivity loss among PsA and AS with other RMD. METHODS We used data from EpiReumaPt, a population-based survey, conducted from 2011 to 2013, in which 10661 subjects over 18 years old were screened for RMD. Spondyloarthritis (SpA) was defined by a positive expert opinion combined with the fulfillment of the assessment of spondyloarthritis international society (ASAS) criteria for axial and peripheral SpA. Estimates were computed as weighted proportions considering the study design. Logistic regressions were used to compare AS/PsA subjects with other RMD and the adult Portuguese population without rheumatic diseases. RESULTS Prevalence rate of SpA was 1.6% (95% CI 1.2% to 2.1%). Subjects with AS or PsA had worse QoL, reflected by EQ5D score when compared with the adult Portuguese population without rheumatic diseases (β=- 0.08; p=0.031). AS and PsA also had worst QoL when compared with participants with other RMD (β=-0.22; p>0.001). AS and in comparison to patients with other RMD, PsA subjects retired early due to their illness (OR=4.95; 95% CI 1.54% to 15.93%). A significant proportion of patients with SpA (13.6%) referred absenteeism in the previous 12 months to the interview. CONCLUSIONS AS and PsA were found to be associated with poor QoL and a high rate of disease-related early retirement, emphasizing the burden of such rheumatic conditions in Portugal.
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Affiliation(s)
| | | | - Sara S Dias
- Centro de Estudo de Doenças Crónicas (CEDOC), EpiDoc Unit, NOVA Medical School, Universidade Nova de Lisboa (NMS/UNL)
| | - Rute Dinis Sousa
- Centro de Estudo de Doenças Crónicas (CEDOC), EpiDoc Unit, NOVA Medical School, Universidade Nova de Lisboa (NMS/UNL)
| | - Jaime Cunha Branco
- EpiReumaPt Study Group - Sociedade Portuguesa de Reumatologia; Centro de Estudo de Doenças Crónicas (CEDOC), EpiDoc Unit, NOVA Medical School, Universidade Nova de Lisboa (NMS/UNL)
| | - Helena Canhão
- EpiReumaPt Study Group - Sociedade Portuguesa de Reumatologia; Centro de Estudo de Doenças Crónicas (CEDOC), EpiDoc Unit, NOVA Medical School, Universidade Nova de Lisboa (NMS/UNL)
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18
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Domingues L, Pimentel-Santos FM, Cruz EB, Sousa AC, Santos A, Cordovil A, Correia A, Torres LS, Silva A, Branco PS, Branco JC. Is a combined programme of manual therapy and exercise more effective than usual care in patients with non-specific chronic neck pain? A randomized controlled trial. Clin Rehabil 2019; 33:1908-1918. [PMID: 31549519 DOI: 10.1177/0269215519876675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The aim of this study was to compare the effectiveness of a combined intervention of manual therapy and exercise (MET) versus usual care (UC), on disability, pain intensity and global perceived recovery, in patients with non-specific chronic neck pain (CNP). DESIGN Randomized controlled trial. SETTING Outpatient care units. SUBJECTS Sixty-four non-specific CNP patients were randomly allocated to MET (n = 32) or UC (n = 32) groups. INTERVENTIONS Participants in the MET group received 12 sessions of mobilization and exercise, whereas the UC group received 15 sessions of usual care in physiotherapy. MAIN MEASURES The primary outcome was disability (Neck Disability Index). The secondary outcomes were pain intensity (Numeric Pain Rating Scale) and global perceived recovery (Patient Global Impression Change). Patients were assessed at baseline, three weeks, six weeks (end of treatment) and at a three-month follow-up. RESULTS Fifty-eight participants completed the study. No significant between-group difference was observed on disability and pain intensity at baseline. A significant between-group difference was observed on disability at three-week, six-week and three-month follow-up (median (P25-P75): 6 (3.25-9.81) vs. 15.5 (11.28-20.75); P < 0.001), favouring the MET group. Regarding pain intensity, a significant between-group difference was observed at six-week and three-month follow-up (median (P25-P75): 2 (1-2.51) vs. 5 (3.33-6); P < 0.001), with superiority of effect in MET group. Concerning the global perceived recovery, a significant between-group difference was observed only at the three-month follow-up (P = 0.001), favouring the MET group. CONCLUSION This study's findings suggest that a combination of manual therapy and exercise is more effective than usual care on disability, pain intensity and global perceived recovery.
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Affiliation(s)
- Lucia Domingues
- Rheumatic Diseases, Chronic Diseases Research Center (CEDOC), Nova Medical School - Faculdade de Ciencias Medicas, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Fernando Manuel Pimentel-Santos
- Rheumatic Diseases, Chronic Diseases Research Center (CEDOC), Nova Medical School - Faculdade de Ciencias Medicas, Universidade Nova de Lisboa, Lisboa, Portugal.,Rheumatology Department CHLO, Hospital Egas Moniz, Lisboa, Portugal
| | - Eduardo Brazete Cruz
- Department of Physiotherapy, Escola Superior de Saúde - Instituto Politecnico de Setúbal, Setúbal, Portugal
| | - Ana Cristina Sousa
- Ambulatory Care Unit, Centro de Medicina de Reabilitação de Alcoitão, Alcabideche, Portugal
| | - Ana Santos
- Ambulatory Care Unit, Centro de Medicina de Reabilitação de Alcoitão, Alcabideche, Portugal
| | - Ana Cordovil
- Ambulatory Care Unit, Centro de Medicina de Reabilitação de Alcoitão, Alcabideche, Portugal
| | - Anabela Correia
- Department of Physical Medicine and Rehabilitation, Hospital Curry Cabral, Centro Hospitalar Lisboa Central, Lisboa, Portugal
| | - Laura Sa Torres
- Department of Physical Medicine and Rehabilitation, Hospital Curry Cabral, Centro Hospitalar Lisboa Central, Lisboa, Portugal
| | - Antonio Silva
- Department of Physical Medicine and Rehabilitation, Hospital Curry Cabral, Centro Hospitalar Lisboa Central, Lisboa, Portugal
| | - Pedro Soares Branco
- Department of Physical Medicine and Rehabilitation, Hospital Curry Cabral, Centro Hospitalar Lisboa Central, Lisboa, Portugal
| | - Jaime Cunha Branco
- Rheumatic Diseases, Chronic Diseases Research Center (CEDOC), Nova Medical School - Faculdade de Ciencias Medicas, Universidade Nova de Lisboa, Lisboa, Portugal.,Rheumatology Department CHLO, Hospital Egas Moniz, Lisboa, Portugal
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19
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Maia I, Monjardino T, Frias B, Canhão H, Cunha Branco J, Lucas R, Santos AC. Food Insecurity in Portugal Among Middle- and Older-Aged Adults at a Time of Economic Crisis Recovery: Prevalence and Determinants. Food Nutr Bull 2019; 40:504-513. [PMID: 31272218 DOI: 10.1177/0379572119858170] [Citation(s) in RCA: 10] [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] [Indexed: 12/21/2022]
Abstract
BACKGROUND To characterize the scenario of food insecurity in Portugal at a time of economic crisis recovery is of the utmost relevance. OBJECTIVE This study aimed to estimate the prevalence and to identify the determinants of food insecurity during economic crisis recovery in a population-based urban sample of middle- and older-aged Portuguese adults. METHODS A cross-sectional study including 604 participants of the EPIPorto cohort was conducted. Data on sociodemographic characteristics and on food security status were collected. Food security status was assessed using the US Household Food Security Survey Module: Six-Item Short Form. Logistic regression models, crude and adjusted for sex, age, education, and household income perception, were performed. RESULTS The prevalence of food insecurity was 16.6%. Women (odds ratio [OR] = 1.96; 95% confidence interval [CI]: 1.09-3.54), those less educated (OR = 5.46; 95% CI: 2.84-10.46), and those who had the perception of an insufficient household income (OR = 10.39; 95% CI: 5.00-21.56) were more likely to belong to a food insecure household. Unmarried individuals (OR = 1.79; 95% CI: 1.05-3.06) and lower white-collar workers (OR = 2.22; 95% CI: 1.03-4.77) were also more prone to live within a food insecure household, regardless of sex, age, education, and household income perception. CONCLUSIONS The obtained information is valuable for the development of intervention strategies to reduce food insecurity in middle- and older-aged adults, suggesting that women, unmarried, less educated individuals, less skilled workers, and lower income families should be targeted.
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Affiliation(s)
- Isabel Maia
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, Porto, Portugal
| | - Teresa Monjardino
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, Porto, Portugal.,Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Alameda Prof. Hernâni Monteiro, Porto, Portugal
| | - Brenda Frias
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, Porto, Portugal
| | - Helena Canhão
- EpiDoC Unit, Centro de Estudos de Doenças Crónicas, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal.,Sociedade Portuguesa de Reumatologia, Lisboa, Portugal
| | - Jaime Cunha Branco
- EpiDoC Unit, Centro de Estudos de Doenças Crónicas, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal.,Sociedade Portuguesa de Reumatologia, Lisboa, Portugal.,Serviço de Reumatologia do Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | - Raquel Lucas
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, Porto, Portugal.,Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Alameda Prof. Hernâni Monteiro, Porto, Portugal
| | - Ana Cristina Santos
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, Porto, Portugal.,Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Alameda Prof. Hernâni Monteiro, Porto, Portugal
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20
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Dias SS, Rodrigues AM, Gregório MJ, de Sousa RD, Branco JC, Canhão H. Cohort Profile: The Epidemiology of Chronic Diseases Cohort (EpiDoC). Int J Epidemiol 2019; 47:1741-1742j. [PMID: 30212889 PMCID: PMC6280929 DOI: 10.1093/ije/dyy185] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sara Simões Dias
- EpiDoC Unit, CEDOC, NOVA Medical School, Universidade Nova de Lisboa (NMS-UNL), Lisboa, Portugal.,Center for Innovative Care and Health Technology (ciTechCare), Polytechnic Institute of Leiria, Leiria, Portugal.,Episaúde - Associação Científica, Évora, Portugal
| | - Ana Maria Rodrigues
- EpiDoC Unit, CEDOC, NOVA Medical School, Universidade Nova de Lisboa (NMS-UNL), Lisboa, Portugal.,Episaúde - Associação Científica, Évora, Portugal
| | - Maria João Gregório
- EpiDoC Unit, CEDOC, NOVA Medical School, Universidade Nova de Lisboa (NMS-UNL), Lisboa, Portugal.,Episaúde - Associação Científica, Évora, Portugal
| | - Rute Dinis de Sousa
- EpiDoC Unit, CEDOC, NOVA Medical School, Universidade Nova de Lisboa (NMS-UNL), Lisboa, Portugal.,Episaúde - Associação Científica, Évora, Portugal
| | - Jaime Cunha Branco
- EpiDoC Unit, CEDOC, NOVA Medical School, Universidade Nova de Lisboa (NMS-UNL), Lisboa, Portugal.,Episaúde - Associação Científica, Évora, Portugal.,Serviço de Reumatologia, CHLO, EPE
- Hospital Egas Moniz, Lisboa, Portugal
| | - Helena Canhão
- EpiDoC Unit, CEDOC, NOVA Medical School, Universidade Nova de Lisboa (NMS-UNL), Lisboa, Portugal.,Episaúde - Associação Científica, Évora, Portugal
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21
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Gomes JL, Sepriano A, Eusébio M, Serra S, Fonseca JE, Saavedra MJ, Cunha-Miranda L, Silva C, Bernardes M, Rosa-Gonçalves D, Costa J, Castelão W, Branco JC, Santos MJ. Predictors and causes of first-line biologic agent discontinuation in rheumatoid arthritis: data from Reuma.pt. Acta Reumatol Port 2019; 44:57-64. [PMID: 31249276] [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 assess the discontinuation of first-line biological treatment and to evaluate the reasons and predictors thereof in patients with rheumatoid arthritis (RA) from daily clinical practice. METHODS RA patients registered in the Rheumatic Diseases Portuguese Register (Reuma.pt) starting treatment with biologic DMARDs (bDMARDs) were included in this prospective observational study. The main outcome was the time to discontinuation (in years) due to any cause. Discontinuation was defined as a 90-day discontinuation of treatment or the occurrence of any switch to another bDMARD during follow-up. Baseline and time-varying sociodemographic and clinical characteristics were tested as possible predictors of discontinuation using multivariable Cox models. RESULTS Of the 1,851 RA patients included in the study, 871 (47%) discontinued their first bDMARD. The median overall persistence of the first bDMARD was 5.5 years and the leading cause of discontinuation was inefficacy [N=476 (55%)], followed by adverse events [N=262 (30%)], other causes [N=69, (8%)] and unknown causes [N=64 (7%)]. Patients with a higher HAQ score (more disability) at baseline were more likely to discontinue their first bDMARD [hazard ratio (HR):1.39 (95% CI: 1.17-1.64)], as were patients with a higher number of comorbidities [HR: 1.17 (1.05-1.29)] and patients starting treatment from 2007 onwards [HR:1.89 (1.5-2.38)]. On the contrary, receiving TNFi bDMARD [HR:0.74 (0.57-0.94)] as opposed to non-TNFi was associated with less discontinuation. Expectedly, the higher the DAS28 during follow-up the higher the likelihood to discontinue bDMARD [HR:1.08 (1.06-1.1)]. No other time-varying predictor was found. CONCLUSION In the Portuguese RA population, maintenance of first-line bDMARD was shown to be relatively high. Inefficacy was the leading cause of discontinuation. Features found to predict drug discontinuation (e.g. baseline disability) may contribute to inform clinician's decisions in clinical practice.
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Affiliation(s)
- Joao Lagoas Gomes
- Centro Hospitalar de Lisboa Ocidental- Hospital Egas Moniz; CEDOC / NOVA Medical School, Nova University of Lisbon
| | - Alexandre Sepriano
- NOVA Medical School, Nova University of Lisbon, Rheumatology / Leiden University Medical Center
| | | | - Sofia Serra
- Centro Hospitalar de Lisboa Ocidental- Hospital Egas Moniz
| | - João Eurico Fonseca
- Hospital de Santa Maria (CHLN), Lisbon Academic Medical Centre, Unidade de Investigação em Reumatologia, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa
| | | | | | | | | | | | | | | | - Jaime Cunha Branco
- Centro Hospitalar de Lisboa Ocidental- Hospital Egas Moniz; CEDOC / NOVA Medical School, Nova University of Lisbon
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22
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Lopes C, Costa T, Mateus M, Branco JC. POEMS Syndrome: a puzzling case. Acta Reumatol Port 2019; 44:84-85. [PMID: 31249280] [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: 06/09/2023]
Affiliation(s)
- Carina Lopes
- Hospital de Egas Moniz, CHLO, Lisbon, Portugal; CEDOC, NOVA Medical School | Faculdade de Ciências Médicas - NOVA University of Lisbon, Lisbon, Portugal
| | - Tiago Costa
- Hospital de Egas Moniz, CHLO, Lisbon, Portugal; CEDOC, NOVA Medical School | Faculdade de Ciências Médicas - NOVA University of Lisbon, Lisbon, Portugal
| | | | - Jaime Cunha Branco
- CEDOC, NOVA Medical School | Faculdade de Ciências Médicas - NOVA University of Lisbon, Lisbon, Portugal; Hospital de Egas Moniz, CHLO, Lisbon, Portugal
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23
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Rodrigues AM, Canhão H, Marques A, Ambrósio C, Borges J, Coelho P, Costa L, Fernandes S, Gonçalves I, Gonçalves M, Guerra M, Marques ML, Pimenta S, Pinto P, Sequeira G, Simões E, Teixeira L, Vaz C, Vieira-Sousa E, Vieira R, Alvarenga F, Araújo F, Barcelos A, Barcelos F, Barros R, Bernardes M, Canas da Silva J, Cordeiro A, Costa M, Cunha-Miranda L, Cruz M, Duarte AC, Duarte C, Faustino A, Figueiredo G, Fonseca JE, Furtado C, Gomes J, Lopes C, Mourão AF, Oliveira M, Pimentel-Santos FM, Ribeiro A, Sampaio da Nóvoa T, Santiago M, Silva C, Silva-Dinis A, Sousa S, Tavares-Costa J, Terroso G, Vilar A, Branco JC, Tavares V, Romeu JC, da Silva J. Portuguese recommendations for the prevention, diagnosis and management of primary osteoporosis - 2018 update. Acta Reumatol Port 2018; 43:10-31. [PMID: 29602163] [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: 06/08/2023]
Abstract
BACKGROUND Advances in osteoporosis (OP)case definition, treatment options, optimal therapy duration and pharmacoeconomic evidence in the national context motivated the Portuguese Society of Rheumatology (SPR) to update the Portuguese recommendations for the diagnosis and management of osteoporosis published in 2007. METHODS SPR bone diseases' working group organized meetings involving 55 participants (rheumatologists, rheumatology fellows and one OP specialist nurse) to debate and develop the document. First, the working group selected 11 pertinent clinical questions for the diagnosis and management of osteoporosis in standard clinical practice. Then, each question was investigated through literature review and draft recommendations were built through consensus. When insufficient evidence was available, recommendations were based on experts' opinion and on good clinical practice. At two national meetings, the recommendations were discussed and updated. A draft of the recommendations full text was submitted to critical review among the working group and suggestions were incorporated. A final version was circulated among all Portuguese rheumatologists before publication and the level of agreement was anonymously assessed using an online survey. RESULTS The 2018 SPR recommendations provide comprehensive guidance on osteoporosis prevention, diagnosis, fracture risk assessment, pharmacological treatment initiation, therapy options and duration of treatment, based on the best available evidence. They attained desirable agreement among Portuguese rheumatologists. As more evidence becomes available, periodic revisions will be performed. Target audience and patient population: The target audience for these guidelines includes all clinicians. The target patient population includes adult Portuguese people. Intended use: These recommendations provide general guidance for typical cases. They may not be appropriate in all situations - clinicians are encouraged to consider this information together with updated evidence and their best clinical judgment in individual cases.
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24
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Sepriano A, Ramiro S, van der Heijde D, Ávila-Ribeiro P, Fonseca R, Borges J, Teixeira L, Carvalho PD, Cerqueira M, Neves J, Meirinhos T, Barcelos A, Sequeira G, Salvador MJ, Canas da Silva J, Santos H, Bernardes M, Vieira-Sousa E, Canhão H, Branco JC, Pimentel-Santos F, Landewé R. Effect of Comedication With Conventional Synthetic Disease-Modifying Antirheumatic Drugs on Retention of Tumor Necrosis Factor Inhibitors in Patients With Spondyloarthritis: A Prospective Cohort Study. Arthritis Rheumatol 2017; 68:2671-2679. [PMID: 27273894 DOI: 10.1002/art.39772] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 05/26/2016] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To evaluate whether use of comedication with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) influences the retention of tumor necrosis factor inhibitors (TNFi) in patients with spondyloarthritis (SpA). METHODS Patients with SpA from the Rheumatic Diseases Portuguese Register who started treatment with their first TNFi between 2001 and 2014 were included in this study. Cox regression analysis was used to estimate the effect of comedication with csDMARDs on TNFi retention in 2 types of models: a model in which baseline (time-fixed) variables were included, and a second model incorporating time-varying variables, including sociodemographic features, measures of disease activity, measures of physical function, and cotreatment with other drugs (nonsteroidal antiinflammatory drugs and oral steroids). To control for possible confounding by indication, the effect of csDMARD comedication on TNFi retention was also tested after adjustment for the treatment propensity score. RESULTS In total, 954 patients were included in the study, of whom 289 (30.3%) discontinued treatment with their first TNFi after a median follow-up time of 2.5 years (range 0.08-13 years). Inefficacy was the most common reason for TNFi discontinuation (55.7% of patients). In the multivariable analyses, comedication with csDMARDs had no measurable effect on TNFi retention, neither in the baseline model (hazard ratio [HR] 0.83, 95% confidence interval [95% CI] 0.59-1.16) nor during follow-up in the model adjusted for time-varying covariates (HR 1.07, 95% CI 0.68-1.68). The effect of csDMARD comedication remained nonsignificant after propensity score adjustment. CONCLUSION Comedication with csDMARDs does not prolong TNFi retention in patients with SpA in clinical practice, suggesting that there is no benefit conferred by the concomitant use of these drugs.
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Affiliation(s)
- A Sepriano
- Universidade Nova de Lisboa, Lisbon, Portugal, and Leiden University Medical Center, Leiden, The Netherlands.
| | - S Ramiro
- Universidade Nova de Lisboa, Lisbon, Portugal, and Leiden University Medical Center, Leiden, The Netherlands
| | | | | | - R Fonseca
- Centro Hospitalar São João, Porto, Portugal
| | - J Borges
- Instituto Português de Reumatologia, Lisbon, Portugal
| | - L Teixeira
- Hospital Garcia de Orta, Almada, Portugal
| | - P D Carvalho
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - M Cerqueira
- Unidade Local de Saúde do Alto Minho, Ponte de Lima, Portugal
| | - J Neves
- Unidade Local de Saúde do Alto Minho, Ponte de Lima, Portugal
| | | | - A Barcelos
- Hospital Infante D. Pedro, Aveiro, Portugal
| | | | - M J Salvador
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | | | - H Santos
- Instituto Português de Reumatologia, Lisbon, Portugal
| | | | - E Vieira-Sousa
- Lisbon Academic Medical Center and Instituto de Medicina Molecular, Lisbon, Portugal
| | - H Canhão
- Lisbon Academic Medical Center and Instituto de Medicina Molecular, Lisbon, Portugal
| | - J C Branco
- Universidade Nova de Lisboa and Hospital de Egas Moniz-CHLO, Lisbon, Portugal
| | - F Pimentel-Santos
- Universidade Nova de Lisboa and Hospital de Egas Moniz-CHLO, Lisbon, Portugal
| | - R Landewé
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands, and Atrium Medical Center, Heerlen, The Netherlands
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25
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Garrido M, Castaño MY, Biehl-Printes C, Gomez MA, Branco JC, Tomas-Carus P, Rodriguez AB. Effects of a respiratory functional training program on pain and sleep quality in patients with fibromyalgia: A pilot study. Complement Ther Clin Pract 2017; 28:116-121. [PMID: 28779918 DOI: 10.1016/j.ctcp.2017.05.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 01/09/2017] [Revised: 05/17/2017] [Accepted: 05/25/2017] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To evaluate the effect of 8-week respiratory functional training program on pain tolerance, sleep, and urinary antioxidant and cortisol levels in 18 patients with fibromyalgia. METHODS Participants underwent a 12-week intervention: 4 weeks as control and 8 weeks of breathing exercises. Pain tolerance assay was done by using an algometer, whereas sleep quality was evaluated by actigraphy and by the Pittsburgh Sleep Quality Index. Cortisol and antioxidant levels were determined using commercial assay kits. RESULTS Increases in the pain tolerance threshold were detected in the occiput point after one month of intervention as well as in the low cervical and second rib points after one and two months. Actigraphy revealed a decrease in sleep latency, whereas sleep questionnaire showed improvements in sleep quality, sleep duration and sleep efficiency. No changes in cortisol and antioxidant levels were detected. CONCLUSION The 8-week breathing exercise intervention reduced pain and improved sleep quality.
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Affiliation(s)
- M Garrido
- Department of Physiology (Neuroimmunophysiology and Chrononutrition Research Group), Faculty of Science, University of Extremadura, Badajoz, Spain.
| | - M Y Castaño
- Department of Physiology (Neuroimmunophysiology and Chrononutrition Research Group), Faculty of Science, University of Extremadura, Badajoz, Spain
| | - C Biehl-Printes
- Department of Sport Science, High Institute of Educational Sciences, Lisbon, Portugal
| | - M A Gomez
- Department of Physiology (Neuroimmunophysiology and Chrononutrition Research Group), Faculty of Science, University of Extremadura, Badajoz, Spain
| | - J C Branco
- CEDOC, Faculdade de Ciências Médicas e Serviço de Reumatologia, CHLO/Universidade Nova de Lisboa e EPE-Hospital Egas Moniz, Lisbon, Portugal
| | - P Tomas-Carus
- Departamento de Desporto e Saúde, Escola de Ciências e Tecnologia, Universidade de Evora, Evora, Portugal; Research Centre for Sports, Health and Human Development, CIDESD, GERON Research Community, Evora, Portugal
| | - A B Rodriguez
- Department of Physiology (Neuroimmunophysiology and Chrononutrition Research Group), Faculty of Science, University of Extremadura, Badajoz, Spain
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Serra SS, Pedrosa T, Falcão S, Branco JC. [Severe Interstitial Lung Disease and Manic Symptoms Secondary to Corticosteroids in a Patient with Systemic Lupus Erythematosus and Secondary Sjögren's Syndrome]. ACTA MEDICA PORT 2017; 30:246-250. [PMID: 28550835 DOI: 10.20344/amp.7297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 09/12/2016] [Indexed: 11/20/2022]
Abstract
Interstitial lung disease occurs in up to 25% of patients with Sjögren's syndrome and 2% - 8 % of patients with systemic lupus erythematosus. Corticosteroid therapy remains the main treatment for systemic lupus erythematosus. However, it can be associated with several neuropsychiatric disorders especially with prednisolone at a dose of more than 40 mg/day. We present the case of a 51-year-old patient with systemic lupus erythematosus and secondary Sjögren's syndrome with severe pulmonary involvement four years after the diagnosis. Chest computed tomography revealed neofibrosis and ground glass appearance pattern. After increasing the dose of prednisolone to 60 mg/day, the patient presented a manic episode. There was need of hospitalization and the situation was considered to be secondary to corticosteroids at high doses. Central neurological involvement by organic disease was excluded. We introduced monthly perfusion of cyclophosphamide for six months and later started mycophenolate mofetil 2 g/day, reducing prednisolone to 10 mg/day and maintaining hydroxychloroquine 400 mg/day, with control of disease activity.
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Affiliation(s)
- Sofia Silvério Serra
- Serviço de Reumatologia. Hospital de Egas Moniz. Centro Hospitalar de Lisboa Ocidental. Lisboa. Portugal
| | - Teresa Pedrosa
- Serviço de Reumatologia. Hospital de Egas Moniz. Centro Hospitalar de Lisboa Ocidental. Lisboa. Portugal. CEDOC. NOVA Medical School/Faculdade de Ciências Médicas. Universidade NOVA de Lisboa. Lisboa. Portugal
| | - Sandra Falcão
- Serviço de Reumatologia. Hospital de Egas Moniz. Centro Hospitalar de Lisboa Ocidental. Lisboa. Portugal. CEDOC. NOVA Medical School/Faculdade de Ciências Médicas. Universidade NOVA de Lisboa. Lisboa. Portugal
| | - Jaime Cunha Branco
- Serviço de Reumatologia. Hospital de Egas Moniz. Centro Hospitalar de Lisboa Ocidental. Lisboa. Portugal. CEDOC. NOVA Medical School/Faculdade de Ciências Médicas. Universidade NOVA de Lisboa. Lisboa. Portugal
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27
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Marques A, Rodrigues AM, Romeu JC, Ruano A, Barbosa AP, Simões E, Águas F, Canhão H, Alves JD, Lucas R, Branco JC, Laíns J, Mascarenhas M, Simões S, Tavares V, Lourenço O, da Silva JAP. Multidisciplinary Portuguese recommendations on DXA request and indication to treat in the prevention of fragility fractures. Acta Reumatol Port 2016; 41:305-321. [PMID: 27750276] [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: 06/06/2023]
Abstract
OBJECTIVE To establish Portuguese recommendations regarding the indication to perform DXA and to initiate medication aimed at the prevention of fragility fractures. METHODS A multidisciplinary panel, representing the full spectrum of medical specialties and patient associations devoted to osteoporosis, as well as national experts in this field and in health economics, was gathered to developed recommendations based on available evidence and expert consensus. Recently obtained data on the Portuguese epidemiologic, economic and quality-of-life aspects of fragility fractures were used to support decisions. RESULTS 10 recommendations were developed covering the issues of whom to investigate with DXA and whom to treat with antifracture medications. Thresholds for assessment and intervention are based on the cost-effectiveness analysis of interventions at different thresholds of ten-year probability of osteoporotic fracture, calculated with the Portuguese version of FRAX® (FRAX®Port), and taking into account Portuguese epidemiologic and economic data. Limitations of FRAX® are highlighted and guidance for appropriate adjustment is provided, when possible. CONCLUSIONS Cost-effectiveness thresholds for DXA examination and drug intervention aiming at fragility fracture prevention are now provided for the Portuguese population. These are practical, based on national epidemiological and economic data, evidence-based and supported by a wide scope multidisciplinary panel of experts and scientific societies. Implementation of these recommendations holds great promise in assuring the most effective use of health resources in the prevention of osteoporotic fractures in Portugal.
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Jansen K, Cardoso TA, Fries GR, Branco JC, Silva RA, Kauer-Sant'Anna M, Kapczinski F, Magalhaes PVS. Childhood trauma, family history, and their association with mood disorders in early adulthood. Acta Psychiatr Scand 2016; 134:281-6. [PMID: 26826334 DOI: 10.1111/acps.12551] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/14/2015] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To assess the prevalence of childhood trauma and types of trauma on mood disorders among young adults in a population-based sample. We further gathered data on family history of mood disorders to test the hypothesis that childhood trauma is a mediating factor for the association between family history of mood disorder and mood disorder in adulthood. METHOD This is a cross-sectional study, including young adults with bipolar disorder, major depressive disorder, and matched controls without any mood disorder. Childhood trauma was assessed using the Childhood Trauma Questionnaire (CTQ). The Hicks and Tingley implementation was employed to assess whether trauma is a mediator of the effect of family history on diagnosis of any mood disorder. RESULTS All types of trauma were associated with both major depression and bipolar disorder, with the exception of sexual abuse, which was only associated with bipolar disorder. Moreover, family history of psychiatric illness was also associated with mood disorder in adulthood and with childhood trauma. Using the presence of any mood disorder as the outcome, a third of the effect of having any family history of mood disorder was mediated via childhood trauma. CONCLUSION This investigation provides further support, in a population-based sample of young adults, of the association between childhood trauma and mood disorders, with sexual abuse being specifically linked with bipolar disorder. The hypothesis that childhood trauma would function as a partial mediator of the association between family history of mood disorder and mood disorder in adulthood was also confirmed.
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Affiliation(s)
- K Jansen
- Translational Science on Brain Disorders, Department of Health and Behavior, Catholic University of Pelotas (Universidade Católica de Pelotas), Pelotas, Brazil. .,Department of Psychiatry & Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA.
| | - T A Cardoso
- Translational Science on Brain Disorders, Department of Health and Behavior, Catholic University of Pelotas (Universidade Católica de Pelotas), Pelotas, Brazil.,Department of Psychiatry & Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - G R Fries
- Department of Psychiatry & Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA.,Laboratório de Psiquiatria Molecular, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - J C Branco
- Translational Science on Brain Disorders, Department of Health and Behavior, Catholic University of Pelotas (Universidade Católica de Pelotas), Pelotas, Brazil
| | - R A Silva
- Translational Science on Brain Disorders, Department of Health and Behavior, Catholic University of Pelotas (Universidade Católica de Pelotas), Pelotas, Brazil
| | - M Kauer-Sant'Anna
- Laboratório de Psiquiatria Molecular, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - F Kapczinski
- Department of Psychiatry & Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA.,Laboratório de Psiquiatria Molecular, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - P V S Magalhaes
- Laboratório de Psiquiatria Molecular, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Laires PA, Gouveia M, Canhão H, Branco JC. The economic impact of early retirement attributed to rheumatic diseases: results from a nationwide population-based epidemiologic study. Public Health 2016; 140:151-162. [PMID: 27527846 DOI: 10.1016/j.puhe.2016.07.004] [Citation(s) in RCA: 8] [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: 01/29/2016] [Revised: 05/17/2016] [Accepted: 07/06/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To measure early retirement due to self-reported rheumatic diseases (RDs) and to estimate the respective indirect costs and years of working life lost (YWLL). METHODS We used individual level data from the national, cross-sectional, population-based EpiReumaPt study (September 2011-December 2013) where 10,661 inhabitants were randomly surveyed in order to capture and characterize all cases of RD within a representative sample of the Portuguese population. In this analysis, we used all participants aged between 50 and 64 years, near the official retirement age. A national database was used to calculate productivity values by gender, age and region, using the human capital approach. YWLL were estimated as the difference between each participant's current age and the respective retirement age, while the potential years of working life lost (PYWLL) were given by the difference between official and actual retirement ages. We also calculated the percentage of time in inactivity (inactivity ratio = YWLL/Active age-range [15-64 years old]). RESULTS 29.9% of the Portuguese population with ages between 50 and 64 years were retired with 13.1% self-reporting retirement due to RD. The estimated annual indirect cost following premature retirement attributed to RD was €910 million (€555 per capita; €1625 per self-reported RD patient and €13,592 per early retiree due to RD). Females contributed with 84% for these costs (€766 million; €882 per capita vs €187 from males). We observed a total number of 389,939 accumulated YWLL (228 per 1000 inhabitants) and 684,960 PYWLL (401 per 1000 inhabitants). The mean YWLL and PYWLL inactivity ratios were 12% and 21%, respectively. RD patients with higher values of disability have the highest risk of early retirement. CONCLUSIONS Early retirement attributed to self-reported RD amounts to approximately 0.5% of the national gross domestic product (GDP) in 2013, due to large YWLL. Both the public health concern and the economic impact highlight the need to prioritize investments in health and social protection policies targeting patients with rheumatic conditions.
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Affiliation(s)
- P A Laires
- Faculdade de Medicina da Universidade de Lisboa, Lisbon Academic Medical Center, Lisbon, Portugal; Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Lisbon, Portugal; EpiReumaPt Study Group - Sociedade Portuguesa de Reumatologia, Lisbon, Portugal.
| | - M Gouveia
- Catolica Lisbon School of Business and Economics, Lisbon, Portugal
| | - H Canhão
- EpiReumaPt Study Group - Sociedade Portuguesa de Reumatologia, Lisbon, Portugal; Chronic Diseases Research Center (CEDOC), NOVA Medical School, Universidade Nova de Lisboa (NMS/UNL), Lisboa, Portugal
| | - J C Branco
- EpiReumaPt Study Group - Sociedade Portuguesa de Reumatologia, Lisbon, Portugal; Chronic Diseases Research Center (CEDOC), NOVA Medical School, Universidade Nova de Lisboa (NMS/UNL), Lisboa, Portugal; Rheumatology Department, Hospital Egas Moniz - Centro Hospitalar Lisboa Ocidental (CHLO-E.P.E.), Lisbon, Portugal
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Rodrigues AM, Branco JC, Canhão H. Do rheumatologists have a role in health promotion among elderly? Acta Reumatol Port 2016; 41:181-182. [PMID: 27770753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Tomas-Carus P, Branco JC, Raimundo A, Garcia J, Sousa PM, Biehl-Printes C. [Relationships between widespread pain and thresholds pain tolerance on tender points in Portuguese women with fibromyalgia: impact on daily life]. Acta Reumatol Port 2015; 40:254-261. [PMID: 25941898] [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: 06/04/2023]
Abstract
OBJECTIVES to establish a relationship between widespread pain subjectively perceived and threshold pain tolerance on tender points, and to determine whether there are differences in threshold pain tolerance on tender points between the upper and lower body, as well as between the dominant and non-dominant side, and whether these differences have an impact on the daily life of Portuguese women with fibromyalgia (FM). MATERIAL & METHODS thirty-one women with FM aged between 34 and 67 years volunteered for the study. Threshold pain tolerance was assessed at critical points using a digital algometer pressure; the widespread pain index (WPI) was constructed by the addition of 19 painful body regions; and the impact on the daily life assessed by the Portuguese version of the Fibromyalgia Impact Questionnaire (FIQ), with individual interviews. RESULTS significant differences between the percentage of threshold pain tolerance of the whole body and the scales of widespread pain subjectively perceived were observed, showing that the widespread pain subjectively perceived by patients was between +25.9% and +27.5%. Also, significant differences between threshold pain tolerance of tender points located on the upper and lower body (1.9 ± 0.5 kg/cm2 vs. 2.6 ± 0.7 kg/cm2; respectively) were observed. However, no significant differences were found between threshold pain tolerance of tender points located on dominant and non-dominant sides (2.1 ± 0.5 kg/cm2 e 2.1 ± 0.6 kg/cm2; respectively). Additionally, the analysis showed significant correlations between pain and patient`s daily life in: FIQ total score, physical function, feel good, job ability and fatigue. CONCLUSIONS the women with FM show higher widespread pain subjectively perceived than threshold pain tolerance on tender points. Furthermore, the pain suffered by the patients with FM, especially that located on the upper body, either on the dominant or on the non-dominant side, has a negative influence on physical function, job ability, fatigue and feel good, affecting daily life.
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Laires PA, Perelman J, Consciência JG, Monteiro J, Branco JC. [Epidemiology of hip fractures and its social and economic impact. An update for 2014]. Acta Reumatol Port 2015; 40:223-230. [PMID: 25984784] [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: 06/04/2023]
Abstract
Hip fractures (HF) following low-impact trauma are the most visible and dramatic consequences of osteoporosis (OP). It is estimated that within one year after HF, 20 to 30% of the patients die, 50-60% become disabled and only 30-40% fully recover their previous functional levels. Therefore, its medical, societal and economic impact is huge and it is not fully delivered by the event itself, but rather by its consequences. This paper aims to update data published by Branco et al. 2009 about epidemiology and burden of HF, specifically to revise the national data. In Portugal there have been 77,083 HF reported between 2000 and 2008 with increasing numbers with ageing along with due associated refracture and mortality rates. Recent results suggest a slight change at clinical level concerning the pharmacological approach for the treatment of HF, however it is still important to stay alert to the patients' needs and to their bone mineral density losses in order to avoid repeating the occurrence of these events, aiming to generate significant benefits in terms of health outcomes and due public expenditure.
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Martins FM, da Silva JAP, Santos MJ, Vieira-Sousa E, Duarte C, Santos H, Costa JA, Pimentel-Santos FM, Cunha I, Cunha Miranda L, Nóvoa T, Cruz M, Bernardes M, Araujo D, Pereira Silva JA, Silva JC, Branco JC, Gomes JAM, Faustino A, Fonseca JE, Canhão H. DAS28, CDAI and SDAI cut-offs do not translate the same information: results from the Rheumatic Diseases Portuguese Register Reuma.pt. Rheumatology (Oxford) 2014; 54:286-91. [PMID: 25173347 DOI: 10.1093/rheumatology/keu313] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES . The 28-joint DAS (DAS28), clinical disease activity index (CDAI) and simplified disease activity index (SDAI) are indices frequently used to assess disease activity in RA patients. Cut-off values were defined to classify the states of RA disease activity: remission, low, moderate and high. The aim of this work was to assess disease activity states classified by DAS28, CDAI and SDAI and to analyse their agreement in the Rheumatic Diseases Portuguese Register Reuma.pt. METHODS . A total of 2795 patients and 14 440 visits were selected from Reuma.pt for analysis. Pearson's correlation coefficients (PCCs) were calculated for the three indices. McNemar's chi-squared tests, PCCs and kappa statistics were performed to analyse and compare the distribution of visits among all disease activity states and indices. RESULTS A strong correlation was found between the three indices throughout the 14 440 visits: r = 0.874 for DAS28/CDAI, r = 0.877 for DAS28/SDAI and r = 0.984 for CDAI/SDAI (all PCCs with P < 0.0001). However, when categorization in the different disease activity states was analysed, McNemar's chi-squared tests and PCCs revealed significant disagreement between the cut-offs of the three indices. CONCLUSION DAS28, CDAI and SDAI cut-offs do not translate into the same clinical information in Reuma.pt. Although this might be expected for the original DAS28 cut-offs, when compared with CDAI and SDAI significant disagreement was also found for the DAS28 modified cut-offs. For visits where patients are in CDAI or SDAI remission, we also find disagreement between these two indices, which may contradict previous conclusions that acute phase reactants add little to composite disease activity indices for RA.
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Affiliation(s)
- Fernando M Martins
- Portuguese Society of Rheumatology, Lisbon, Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Clínica Universitária de Reumatologia, Centro Hospitalar e Faculdade de Medicina da Universidade de Coimbra, Rheumatology Department, Garcia de Orta Hospital, Almada, Rheumatology Department, CHLN-Santa Maria Hospital, CAML, Lisbon, Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Portuguese Institute of Rheumatology, Lisbon, Rheumatology Department, ULSAM, EPE - Unidade Local de Saúde do Alto Minho, Ponte de Lima, CEDOC-Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Rheumatology Department, CHLO-Egas Moniz Hospital, Lisbon, Rheumatology Department, CHBV-Infante D. Pedro Hospital, Aveiro, Rheumatology Department, Divino Espírito Santo Hospital, Ponta Delgada, Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Lisbon, Rheumatology Department, São João University Hospital, Porto and Clínica Reumatológica Dr Melo Gomes, Lisbon, Portugal. Portuguese Society of Rheumatology, Lisbon, Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Clínica Universitária de Reumatologia, Centro Hospitalar e Faculdade de Medicina da Universidade de Coimbra, Rheumatology Department, Garcia de Orta Hospital, Almada, Rheumatology Department, CHLN-Santa Maria Hospital, CAML, Lisbon, Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Portuguese Institute of Rheumatology, Lisbon, Rheumatology Department, ULSAM, EPE - Unidade Local de Saúde do Alto Minho, Ponte de Lima, CEDOC-Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Rheumatology Department, CHLO-Egas Moniz Hospital, Lisbon, Rheumatology Department, CHBV-Infante D. Pedro Hospital, Aveiro, Rheumatology Department, Divino Espírito Santo Hospital, Ponta Delgada, Faculdade de Ciências Médicas da Universidade Nova de
| | - José António Pereira da Silva
- Portuguese Society of Rheumatology, Lisbon, Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Clínica Universitária de Reumatologia, Centro Hospitalar e Faculdade de Medicina da Universidade de Coimbra, Rheumatology Department, Garcia de Orta Hospital, Almada, Rheumatology Department, CHLN-Santa Maria Hospital, CAML, Lisbon, Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Portuguese Institute of Rheumatology, Lisbon, Rheumatology Department, ULSAM, EPE - Unidade Local de Saúde do Alto Minho, Ponte de Lima, CEDOC-Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Rheumatology Department, CHLO-Egas Moniz Hospital, Lisbon, Rheumatology Department, CHBV-Infante D. Pedro Hospital, Aveiro, Rheumatology Department, Divino Espírito Santo Hospital, Ponta Delgada, Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Lisbon, Rheumatology Department, São João University Hospital, Porto and Clínica Reumatológica Dr Melo Gomes, Lisbon, Portugal
| | - Maria José Santos
- Portuguese Society of Rheumatology, Lisbon, Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Clínica Universitária de Reumatologia, Centro Hospitalar e Faculdade de Medicina da Universidade de Coimbra, Rheumatology Department, Garcia de Orta Hospital, Almada, Rheumatology Department, CHLN-Santa Maria Hospital, CAML, Lisbon, Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Portuguese Institute of Rheumatology, Lisbon, Rheumatology Department, ULSAM, EPE - Unidade Local de Saúde do Alto Minho, Ponte de Lima, CEDOC-Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Rheumatology Department, CHLO-Egas Moniz Hospital, Lisbon, Rheumatology Department, CHBV-Infante D. Pedro Hospital, Aveiro, Rheumatology Department, Divino Espírito Santo Hospital, Ponta Delgada, Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Lisbon, Rheumatology Department, São João University Hospital, Porto and Clínica Reumatológica Dr Melo Gomes, Lisbon, Portugal. Portuguese Society of Rheumatology, Lisbon, Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Clínica Universitária de Reumatologia, Centro Hospitalar e Faculdade de Medicina da Universidade de Coimbra, Rheumatology Department, Garcia de Orta Hospital, Almada, Rheumatology Department, CHLN-Santa Maria Hospital, CAML, Lisbon, Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Portuguese Institute of Rheumatology, Lisbon, Rheumatology Department, ULSAM, EPE - Unidade Local de Saúde do Alto Minho, Ponte de Lima, CEDOC-Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Rheumatology Department, CHLO-Egas Moniz Hospital, Lisbon, Rheumatology Department, CHBV-Infante D. Pedro Hospital, Aveiro, Rheumatology Department, Divino Espírito Santo Hospital, Ponta Delgada, Faculdade de Ciências Médicas da Universidade Nova de
| | - Elsa Vieira-Sousa
- Portuguese Society of Rheumatology, Lisbon, Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Clínica Universitária de Reumatologia, Centro Hospitalar e Faculdade de Medicina da Universidade de Coimbra, Rheumatology Department, Garcia de Orta Hospital, Almada, Rheumatology Department, CHLN-Santa Maria Hospital, CAML, Lisbon, Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Portuguese Institute of Rheumatology, Lisbon, Rheumatology Department, ULSAM, EPE - Unidade Local de Saúde do Alto Minho, Ponte de Lima, CEDOC-Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Rheumatology Department, CHLO-Egas Moniz Hospital, Lisbon, Rheumatology Department, CHBV-Infante D. Pedro Hospital, Aveiro, Rheumatology Department, Divino Espírito Santo Hospital, Ponta Delgada, Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Lisbon, Rheumatology Department, São João University Hospital, Porto and Clínica Reumatológica Dr Melo Gomes, Lisbon, Portugal. Portuguese Society of Rheumatology, Lisbon, Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Clínica Universitária de Reumatologia, Centro Hospitalar e Faculdade de Medicina da Universidade de Coimbra, Rheumatology Department, Garcia de Orta Hospital, Almada, Rheumatology Department, CHLN-Santa Maria Hospital, CAML, Lisbon, Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Portuguese Institute of Rheumatology, Lisbon, Rheumatology Department, ULSAM, EPE - Unidade Local de Saúde do Alto Minho, Ponte de Lima, CEDOC-Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Rheumatology Department, CHLO-Egas Moniz Hospital, Lisbon, Rheumatology Department, CHBV-Infante D. Pedro Hospital, Aveiro, Rheumatology Department, Divino Espírito Santo Hospital, Ponta Delgada, Faculdade de Ciências Médicas da Universidade Nova de
| | - Cátia Duarte
- Portuguese Society of Rheumatology, Lisbon, Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Clínica Universitária de Reumatologia, Centro Hospitalar e Faculdade de Medicina da Universidade de Coimbra, Rheumatology Department, Garcia de Orta Hospital, Almada, Rheumatology Department, CHLN-Santa Maria Hospital, CAML, Lisbon, Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Portuguese Institute of Rheumatology, Lisbon, Rheumatology Department, ULSAM, EPE - Unidade Local de Saúde do Alto Minho, Ponte de Lima, CEDOC-Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Rheumatology Department, CHLO-Egas Moniz Hospital, Lisbon, Rheumatology Department, CHBV-Infante D. Pedro Hospital, Aveiro, Rheumatology Department, Divino Espírito Santo Hospital, Ponta Delgada, Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Lisbon, Rheumatology Department, São João University Hospital, Porto and Clínica Reumatológica Dr Melo Gomes, Lisbon, Portugal
| | - Helena Santos
- Portuguese Society of Rheumatology, Lisbon, Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Clínica Universitária de Reumatologia, Centro Hospitalar e Faculdade de Medicina da Universidade de Coimbra, Rheumatology Department, Garcia de Orta Hospital, Almada, Rheumatology Department, CHLN-Santa Maria Hospital, CAML, Lisbon, Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Portuguese Institute of Rheumatology, Lisbon, Rheumatology Department, ULSAM, EPE - Unidade Local de Saúde do Alto Minho, Ponte de Lima, CEDOC-Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Rheumatology Department, CHLO-Egas Moniz Hospital, Lisbon, Rheumatology Department, CHBV-Infante D. Pedro Hospital, Aveiro, Rheumatology Department, Divino Espírito Santo Hospital, Ponta Delgada, Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Lisbon, Rheumatology Department, São João University Hospital, Porto and Clínica Reumatológica Dr Melo Gomes, Lisbon, Portugal
| | - José António Costa
- Portuguese Society of Rheumatology, Lisbon, Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Clínica Universitária de Reumatologia, Centro Hospitalar e Faculdade de Medicina da Universidade de Coimbra, Rheumatology Department, Garcia de Orta Hospital, Almada, Rheumatology Department, CHLN-Santa Maria Hospital, CAML, Lisbon, Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Portuguese Institute of Rheumatology, Lisbon, Rheumatology Department, ULSAM, EPE - Unidade Local de Saúde do Alto Minho, Ponte de Lima, CEDOC-Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Rheumatology Department, CHLO-Egas Moniz Hospital, Lisbon, Rheumatology Department, CHBV-Infante D. Pedro Hospital, Aveiro, Rheumatology Department, Divino Espírito Santo Hospital, Ponta Delgada, Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Lisbon, Rheumatology Department, São João University Hospital, Porto and Clínica Reumatológica Dr Melo Gomes, Lisbon, Portugal
| | - Fernando M Pimentel-Santos
- Portuguese Society of Rheumatology, Lisbon, Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Clínica Universitária de Reumatologia, Centro Hospitalar e Faculdade de Medicina da Universidade de Coimbra, Rheumatology Department, Garcia de Orta Hospital, Almada, Rheumatology Department, CHLN-Santa Maria Hospital, CAML, Lisbon, Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Portuguese Institute of Rheumatology, Lisbon, Rheumatology Department, ULSAM, EPE - Unidade Local de Saúde do Alto Minho, Ponte de Lima, CEDOC-Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Rheumatology Department, CHLO-Egas Moniz Hospital, Lisbon, Rheumatology Department, CHBV-Infante D. Pedro Hospital, Aveiro, Rheumatology Department, Divino Espírito Santo Hospital, Ponta Delgada, Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Lisbon, Rheumatology Department, São João University Hospital, Porto and Clínica Reumatológica Dr Melo Gomes, Lisbon, Portugal. Portuguese Society of Rheumatology, Lisbon, Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Clínica Universitária de Reumatologia, Centro Hospitalar e Faculdade de Medicina da Universidade de Coimbra, Rheumatology Department, Garcia de Orta Hospital, Almada, Rheumatology Department, CHLN-Santa Maria Hospital, CAML, Lisbon, Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Portuguese Institute of Rheumatology, Lisbon, Rheumatology Department, ULSAM, EPE - Unidade Local de Saúde do Alto Minho, Ponte de Lima, CEDOC-Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Rheumatology Department, CHLO-Egas Moniz Hospital, Lisbon, Rheumatology Department, CHBV-Infante D. Pedro Hospital, Aveiro, Rheumatology Department, Divino Espírito Santo Hospital, Ponta Delgada, Faculdade de Ciências Médicas da Universidade Nova de
| | - Inês Cunha
- Portuguese Society of Rheumatology, Lisbon, Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Clínica Universitária de Reumatologia, Centro Hospitalar e Faculdade de Medicina da Universidade de Coimbra, Rheumatology Department, Garcia de Orta Hospital, Almada, Rheumatology Department, CHLN-Santa Maria Hospital, CAML, Lisbon, Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Portuguese Institute of Rheumatology, Lisbon, Rheumatology Department, ULSAM, EPE - Unidade Local de Saúde do Alto Minho, Ponte de Lima, CEDOC-Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Rheumatology Department, CHLO-Egas Moniz Hospital, Lisbon, Rheumatology Department, CHBV-Infante D. Pedro Hospital, Aveiro, Rheumatology Department, Divino Espírito Santo Hospital, Ponta Delgada, Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Lisbon, Rheumatology Department, São João University Hospital, Porto and Clínica Reumatológica Dr Melo Gomes, Lisbon, Portugal
| | - Luís Cunha Miranda
- Portuguese Society of Rheumatology, Lisbon, Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Clínica Universitária de Reumatologia, Centro Hospitalar e Faculdade de Medicina da Universidade de Coimbra, Rheumatology Department, Garcia de Orta Hospital, Almada, Rheumatology Department, CHLN-Santa Maria Hospital, CAML, Lisbon, Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Portuguese Institute of Rheumatology, Lisbon, Rheumatology Department, ULSAM, EPE - Unidade Local de Saúde do Alto Minho, Ponte de Lima, CEDOC-Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Rheumatology Department, CHLO-Egas Moniz Hospital, Lisbon, Rheumatology Department, CHBV-Infante D. Pedro Hospital, Aveiro, Rheumatology Department, Divino Espírito Santo Hospital, Ponta Delgada, Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Lisbon, Rheumatology Department, São João University Hospital, Porto and Clínica Reumatológica Dr Melo Gomes, Lisbon, Portugal
| | - Teresa Nóvoa
- Portuguese Society of Rheumatology, Lisbon, Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Clínica Universitária de Reumatologia, Centro Hospitalar e Faculdade de Medicina da Universidade de Coimbra, Rheumatology Department, Garcia de Orta Hospital, Almada, Rheumatology Department, CHLN-Santa Maria Hospital, CAML, Lisbon, Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Portuguese Institute of Rheumatology, Lisbon, Rheumatology Department, ULSAM, EPE - Unidade Local de Saúde do Alto Minho, Ponte de Lima, CEDOC-Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Rheumatology Department, CHLO-Egas Moniz Hospital, Lisbon, Rheumatology Department, CHBV-Infante D. Pedro Hospital, Aveiro, Rheumatology Department, Divino Espírito Santo Hospital, Ponta Delgada, Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Lisbon, Rheumatology Department, São João University Hospital, Porto and Clínica Reumatológica Dr Melo Gomes, Lisbon, Portugal
| | - Margarida Cruz
- Portuguese Society of Rheumatology, Lisbon, Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Clínica Universitária de Reumatologia, Centro Hospitalar e Faculdade de Medicina da Universidade de Coimbra, Rheumatology Department, Garcia de Orta Hospital, Almada, Rheumatology Department, CHLN-Santa Maria Hospital, CAML, Lisbon, Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Portuguese Institute of Rheumatology, Lisbon, Rheumatology Department, ULSAM, EPE - Unidade Local de Saúde do Alto Minho, Ponte de Lima, CEDOC-Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Rheumatology Department, CHLO-Egas Moniz Hospital, Lisbon, Rheumatology Department, CHBV-Infante D. Pedro Hospital, Aveiro, Rheumatology Department, Divino Espírito Santo Hospital, Ponta Delgada, Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Lisbon, Rheumatology Department, São João University Hospital, Porto and Clínica Reumatológica Dr Melo Gomes, Lisbon, Portugal
| | - Miguel Bernardes
- Portuguese Society of Rheumatology, Lisbon, Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Clínica Universitária de Reumatologia, Centro Hospitalar e Faculdade de Medicina da Universidade de Coimbra, Rheumatology Department, Garcia de Orta Hospital, Almada, Rheumatology Department, CHLN-Santa Maria Hospital, CAML, Lisbon, Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Portuguese Institute of Rheumatology, Lisbon, Rheumatology Department, ULSAM, EPE - Unidade Local de Saúde do Alto Minho, Ponte de Lima, CEDOC-Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Rheumatology Department, CHLO-Egas Moniz Hospital, Lisbon, Rheumatology Department, CHBV-Infante D. Pedro Hospital, Aveiro, Rheumatology Department, Divino Espírito Santo Hospital, Ponta Delgada, Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Lisbon, Rheumatology Department, São João University Hospital, Porto and Clínica Reumatológica Dr Melo Gomes, Lisbon, Portugal
| | - Domingos Araujo
- Portuguese Society of Rheumatology, Lisbon, Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Clínica Universitária de Reumatologia, Centro Hospitalar e Faculdade de Medicina da Universidade de Coimbra, Rheumatology Department, Garcia de Orta Hospital, Almada, Rheumatology Department, CHLN-Santa Maria Hospital, CAML, Lisbon, Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Portuguese Institute of Rheumatology, Lisbon, Rheumatology Department, ULSAM, EPE - Unidade Local de Saúde do Alto Minho, Ponte de Lima, CEDOC-Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Rheumatology Department, CHLO-Egas Moniz Hospital, Lisbon, Rheumatology Department, CHBV-Infante D. Pedro Hospital, Aveiro, Rheumatology Department, Divino Espírito Santo Hospital, Ponta Delgada, Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Lisbon, Rheumatology Department, São João University Hospital, Porto and Clínica Reumatológica Dr Melo Gomes, Lisbon, Portugal
| | - José Alberto Pereira Silva
- Portuguese Society of Rheumatology, Lisbon, Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Clínica Universitária de Reumatologia, Centro Hospitalar e Faculdade de Medicina da Universidade de Coimbra, Rheumatology Department, Garcia de Orta Hospital, Almada, Rheumatology Department, CHLN-Santa Maria Hospital, CAML, Lisbon, Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Portuguese Institute of Rheumatology, Lisbon, Rheumatology Department, ULSAM, EPE - Unidade Local de Saúde do Alto Minho, Ponte de Lima, CEDOC-Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Rheumatology Department, CHLO-Egas Moniz Hospital, Lisbon, Rheumatology Department, CHBV-Infante D. Pedro Hospital, Aveiro, Rheumatology Department, Divino Espírito Santo Hospital, Ponta Delgada, Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Lisbon, Rheumatology Department, São João University Hospital, Porto and Clínica Reumatológica Dr Melo Gomes, Lisbon, Portugal
| | - José Canas Silva
- Portuguese Society of Rheumatology, Lisbon, Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Clínica Universitária de Reumatologia, Centro Hospitalar e Faculdade de Medicina da Universidade de Coimbra, Rheumatology Department, Garcia de Orta Hospital, Almada, Rheumatology Department, CHLN-Santa Maria Hospital, CAML, Lisbon, Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Portuguese Institute of Rheumatology, Lisbon, Rheumatology Department, ULSAM, EPE - Unidade Local de Saúde do Alto Minho, Ponte de Lima, CEDOC-Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Rheumatology Department, CHLO-Egas Moniz Hospital, Lisbon, Rheumatology Department, CHBV-Infante D. Pedro Hospital, Aveiro, Rheumatology Department, Divino Espírito Santo Hospital, Ponta Delgada, Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Lisbon, Rheumatology Department, São João University Hospital, Porto and Clínica Reumatológica Dr Melo Gomes, Lisbon, Portugal
| | - Jaime Cunha Branco
- Portuguese Society of Rheumatology, Lisbon, Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Clínica Universitária de Reumatologia, Centro Hospitalar e Faculdade de Medicina da Universidade de Coimbra, Rheumatology Department, Garcia de Orta Hospital, Almada, Rheumatology Department, CHLN-Santa Maria Hospital, CAML, Lisbon, Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Portuguese Institute of Rheumatology, Lisbon, Rheumatology Department, ULSAM, EPE - Unidade Local de Saúde do Alto Minho, Ponte de Lima, CEDOC-Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Rheumatology Department, CHLO-Egas Moniz Hospital, Lisbon, Rheumatology Department, CHBV-Infante D. Pedro Hospital, Aveiro, Rheumatology Department, Divino Espírito Santo Hospital, Ponta Delgada, Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Lisbon, Rheumatology Department, São João University Hospital, Porto and Clínica Reumatológica Dr Melo Gomes, Lisbon, Portugal. Portuguese Society of Rheumatology, Lisbon, Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Clínica Universitária de Reumatologia, Centro Hospitalar e Faculdade de Medicina da Universidade de Coimbra, Rheumatology Department, Garcia de Orta Hospital, Almada, Rheumatology Department, CHLN-Santa Maria Hospital, CAML, Lisbon, Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Portuguese Institute of Rheumatology, Lisbon, Rheumatology Department, ULSAM, EPE - Unidade Local de Saúde do Alto Minho, Ponte de Lima, CEDOC-Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Rheumatology Department, CHLO-Egas Moniz Hospital, Lisbon, Rheumatology Department, CHBV-Infante D. Pedro Hospital, Aveiro, Rheumatology Department, Divino Espírito Santo Hospital, Ponta Delgada, Faculdade de Ciências Médicas da Universidade Nova de
| | - José António Melo Gomes
- Portuguese Society of Rheumatology, Lisbon, Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Clínica Universitária de Reumatologia, Centro Hospitalar e Faculdade de Medicina da Universidade de Coimbra, Rheumatology Department, Garcia de Orta Hospital, Almada, Rheumatology Department, CHLN-Santa Maria Hospital, CAML, Lisbon, Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Portuguese Institute of Rheumatology, Lisbon, Rheumatology Department, ULSAM, EPE - Unidade Local de Saúde do Alto Minho, Ponte de Lima, CEDOC-Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Rheumatology Department, CHLO-Egas Moniz Hospital, Lisbon, Rheumatology Department, CHBV-Infante D. Pedro Hospital, Aveiro, Rheumatology Department, Divino Espírito Santo Hospital, Ponta Delgada, Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Lisbon, Rheumatology Department, São João University Hospital, Porto and Clínica Reumatológica Dr Melo Gomes, Lisbon, Portugal
| | - Augusto Faustino
- Portuguese Society of Rheumatology, Lisbon, Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Clínica Universitária de Reumatologia, Centro Hospitalar e Faculdade de Medicina da Universidade de Coimbra, Rheumatology Department, Garcia de Orta Hospital, Almada, Rheumatology Department, CHLN-Santa Maria Hospital, CAML, Lisbon, Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Portuguese Institute of Rheumatology, Lisbon, Rheumatology Department, ULSAM, EPE - Unidade Local de Saúde do Alto Minho, Ponte de Lima, CEDOC-Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Rheumatology Department, CHLO-Egas Moniz Hospital, Lisbon, Rheumatology Department, CHBV-Infante D. Pedro Hospital, Aveiro, Rheumatology Department, Divino Espírito Santo Hospital, Ponta Delgada, Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Lisbon, Rheumatology Department, São João University Hospital, Porto and Clínica Reumatológica Dr Melo Gomes, Lisbon, Portugal
| | - João Eurico Fonseca
- Portuguese Society of Rheumatology, Lisbon, Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Clínica Universitária de Reumatologia, Centro Hospitalar e Faculdade de Medicina da Universidade de Coimbra, Rheumatology Department, Garcia de Orta Hospital, Almada, Rheumatology Department, CHLN-Santa Maria Hospital, CAML, Lisbon, Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Portuguese Institute of Rheumatology, Lisbon, Rheumatology Department, ULSAM, EPE - Unidade Local de Saúde do Alto Minho, Ponte de Lima, CEDOC-Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Rheumatology Department, CHLO-Egas Moniz Hospital, Lisbon, Rheumatology Department, CHBV-Infante D. Pedro Hospital, Aveiro, Rheumatology Department, Divino Espírito Santo Hospital, Ponta Delgada, Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Lisbon, Rheumatology Department, São João University Hospital, Porto and Clínica Reumatológica Dr Melo Gomes, Lisbon, Portugal. Portuguese Society of Rheumatology, Lisbon, Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Clínica Universitária de Reumatologia, Centro Hospitalar e Faculdade de Medicina da Universidade de Coimbra, Rheumatology Department, Garcia de Orta Hospital, Almada, Rheumatology Department, CHLN-Santa Maria Hospital, CAML, Lisbon, Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Portuguese Institute of Rheumatology, Lisbon, Rheumatology Department, ULSAM, EPE - Unidade Local de Saúde do Alto Minho, Ponte de Lima, CEDOC-Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Rheumatology Department, CHLO-Egas Moniz Hospital, Lisbon, Rheumatology Department, CHBV-Infante D. Pedro Hospital, Aveiro, Rheumatology Department, Divino Espírito Santo Hospital, Ponta Delgada, Faculdade de Ciências Médicas da Universidade Nova de
| | - Helena Canhão
- Portuguese Society of Rheumatology, Lisbon, Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Clínica Universitária de Reumatologia, Centro Hospitalar e Faculdade de Medicina da Universidade de Coimbra, Rheumatology Department, Garcia de Orta Hospital, Almada, Rheumatology Department, CHLN-Santa Maria Hospital, CAML, Lisbon, Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Portuguese Institute of Rheumatology, Lisbon, Rheumatology Department, ULSAM, EPE - Unidade Local de Saúde do Alto Minho, Ponte de Lima, CEDOC-Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Rheumatology Department, CHLO-Egas Moniz Hospital, Lisbon, Rheumatology Department, CHBV-Infante D. Pedro Hospital, Aveiro, Rheumatology Department, Divino Espírito Santo Hospital, Ponta Delgada, Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Lisbon, Rheumatology Department, São João University Hospital, Porto and Clínica Reumatológica Dr Melo Gomes, Lisbon, Portugal. Portuguese Society of Rheumatology, Lisbon, Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Clínica Universitária de Reumatologia, Centro Hospitalar e Faculdade de Medicina da Universidade de Coimbra, Rheumatology Department, Garcia de Orta Hospital, Almada, Rheumatology Department, CHLN-Santa Maria Hospital, CAML, Lisbon, Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Portuguese Institute of Rheumatology, Lisbon, Rheumatology Department, ULSAM, EPE - Unidade Local de Saúde do Alto Minho, Ponte de Lima, CEDOC-Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Rheumatology Department, CHLO-Egas Moniz Hospital, Lisbon, Rheumatology Department, CHBV-Infante D. Pedro Hospital, Aveiro, Rheumatology Department, Divino Espírito Santo Hospital, Ponta Delgada, Faculdade de Ciências Médicas da Universidade Nova de
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Araújo F, Cordeiro I, Teixeira F, Rovisco J, Ramiro S, Mourão AF, Costa JA, Pimentão JB, Malcata A, Santos MJ, Branco JC. Portuguese recommendations for the diagnosis and management of gout. Acta Reumatol Port 2014; 39:158-171. [PMID: 24850289] [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: 06/03/2023]
Abstract
OBJECTIVE To develop Portuguese evidence-based recommendations for the Diagnosis and Management of Gout. METHODS As part of the 3e Initiative (Evidence, Expertise and Exchange), a panel of 78 international rheumatologists developed 10 relevant clinical questions which were investigated with systematic literature reviews. MEDLINE, EMBASE, Cochrane CENTRAL and abstracts from 2010-2011 EULAR and ACR meetings were searched. Based on the evidence found in the published literature, rheumatologists from 14 countries developed national recommendations that were merged and voted into multinational recommendations. We present the Portuguese recommendations for the Diagnosis and Management of Gout which were formulated and voted by Delphi method in April 2012, in Lisbon. The level of agreement and potential impact in clinical practice was also assessed. RESULTS Twelve national recommendations were elaborated from 10 international and 2 national questions. These recommendations addressed the diagnosis of gout; the treatment of acute flares and urate-lowering therapy; monitoring of gout and comorbidity screening; the influence of comorbidities in drug choice; lifestyle; flare prophylaxis; management of tophi and asymptomatic hyperuricaemia; the role of urine alkalinization; and the burden of gout. The level of agreement with the recommendations ranged from 6.8 to 9.0 (mean 7.7) on a 1-10 point visual analogue scale, in which 10 stands for full agreement. CONCLUSION The 12 Portuguese recommendations for the Diagnosis and Management of Gout were formulated according to the best evidence and endorsed by a panel of 42 rheumatologists, enhancing their validity and practical use in daily clinical practice.
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Pimentel-Santos FM, Matos M, Ligeiro D, Mourão AF, Ribeiro C, Costa J, Santos H, Barcelos A, Pinto P, Cruz M, Sousa E, Santos RA, Fonseca JE, Trindade H, Guedes-Pinto H, Branco JC. HLA alleles and HLA-B27 haplotypes associated with susceptibility and severity of ankylosing spondylitis in a Portuguese population. Tissue Antigens 2013; 82:374-9. [PMID: 24498993 DOI: 10.1111/tan.12238] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [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: 07/06/2013] [Revised: 09/11/2013] [Accepted: 10/09/2013] [Indexed: 12/19/2022]
Abstract
Human leukocyte antigen (HLA)-B27 is the mostly known major histocompatibility complex (MHC) gene associated with ankylosing spondylitis (AS). Nonetheless, there is substantial evidence that other MHC genes appear to be associated with the disease, although it has not yet been established whether these associations are driven by direct associations or by linkage disequilibrium (LD) mechanisms. We aimed to investigate the contributions of HLA class I and II alleles and B27-haplotypes for AS in a case-control study. A total of 188 HLA-B27 AS cases and 189 HLA-B27 healthy controls were selected and typed for HLA class I and II by the Luminex polymerase chain reaction-sequence specific oligonucleotide probe (PCR-SSOP) method. Allelic and haplotypic distributions were estimated by maximum likelihood method using Arlequin v3.11 and statistical analysis were performed by Stata10.1. No associations were found between non-HLA-B27 loci and AS susceptibility, but several associations were observed for phenotypic features of the disease. DRB1*08 was identified as a risk factor for uveitis and DQB1*04 seems to provide protection for AS severity (functional, metrological and radiological indexes). A*02/B27/C*02/DRB1*01/DQB1*05 [P<0.0001; odds ratio (OR) = 39.06; 95% confidence interval (CI) (2.34-651)] is the only haplotype that seems to confer susceptibility to AS. Moreover, the haplotype A*02/B27/C*01/DRB1*08/DQB1*04 seems to provide protection for disease functional and radiological repercussions. Our findings are compatible with the hypothesis that other genes within the HLA region besides HLA-B27 might play some role in AS susceptibility and severity.
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Affiliation(s)
- F M Pimentel-Santos
- CEDOC, Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Lisbon, Portugal; Centro Hospitalar Lisboa Ocidental (CHLO), Hospital de Egas Moniz, EPE, Lisbon, Portugal
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Silva I, Mateus M, Branco JC. Poncet's disease: a symmetric seronegative polyarthritis with enthesopathy refractory to the therapy. Acta Reumatol Port 2013; 38:192-195. [PMID: 24149016] [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: 06/02/2023]
Abstract
Poncet's disease is a reactive polyarthritis associated to active tuberculosis (TB), with excluded presence of mycobacterium in the joints and bones affected, and no other cause for the clinical arthritis. It is a frequently forgotten entity, especially in countries with low tuberculosis prevalence. It is described a case report of a man of Guinea-Bissau that presented symmetrical generalized polyarthralgias and hands swelling, clinical sacroiliítis and multiple enthesopathies. Serum and urinary biochemical testing were normal. Immunologic studies were negative and serum levels of angiotensin-converting enzyme and calcium were normal. Sexual transmitted diseases were excluded. The initial diagnose was undifferentiated polyarthritis or reactive arthritis. A persistent and refractory monoarthritis of the right wrist demanded a direct and cultural exam of the synovial fluid, synovial biopsy and protein chain reaction for TB that were negative. After he developed right wrist arthritis with purulent synovial fluid positive to TB in the direct exam and the detection of M. tuberculosis in the cultural exam. Granula was found in his chest radiograph. He was diagnosed a Poncet's disease reactive to a pulmonary TB infection.
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Marques A, Mota A, Canhão H, Romeu JC, Machado P, Ruano A, Barbosa AP, Dias AA, Silva D, Araújo D, Simões E, Aguas F, Rosendo I, Silva I, Crespo J, Alves JD, Costa L, Mascarenhas M, Lourenço Ó, Ferreira PL, Lucas R, Roque R, Branco JC, Tavares V, Johansson H, Kanis J, Pereira da Silva JA. A FRAX model for the estimation of osteoporotic fracture probability in Portugal. Acta Reumatol Port 2013; 38:104-112. [PMID: 24141347] [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: 06/02/2023]
Abstract
INTRODUCTION The objective of this study was to develop a Portuguese version of the World Health Organization fracture risk assessment tool (FRAX®). METHODS All cases of hip fracture occurred at or after 40 years of age were extracted from the Portuguese National Hospital Discharge Register from 2006 to 2010. Age and sex-ranked population estimates and mortality rates were obtained from National Statistics. Age- and gender stratified incidences were computed and the average of the five years under consideration was taken. Rates for other major fractures were imputed from the epidemiology of Sweden, as undertaken for most national FRAX® models. All methodological aspects and results were submitted to critical appraisal by a wide panel of national experts and representatives of the different stakeholders, including patients. RESULTS Hip fracture incidence rates were higher in women than in men and increased with age. The lowest incidence was observed in 40-44 years group (14.1 and 4.0 per 100,000 inhabitants for men and women, respectively). The highest rate was observed among the 95-100 age-group (2,577.6 and 3,551.8/100,000 inhabitants, for men and women, respectively). The estimated ten-year probability for major osteoporotic fracture or hip fracture increased with decreasing T-score and with increasing age. CONCLUSIONS Portugal has one of the lowest fracture incidences among European countries. The FRAX® tool has been successfully calibrated to the Portuguese population, and can now be used to estimate the ten-year risk of osteoporotic fractures in this country. All major stakeholders officially endorsed the Portuguese FRAX® model and co-authored this paper.
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Canhão H, Rodrigues AM, Mourão AF, Martins F, Santos MJ, Canas-Silva J, Polido-Pereira J, Pereira Silva JA, Costa JA, Araújo D, Silva C, Santos H, Duarte C, da Silva JAP, Pimentel-Santos FM, Branco JC, Karlson EW, Fonseca JE, Solomon DH. Comparative effectiveness and predictors of response to tumour necrosis factor inhibitor therapies in rheumatoid arthritis. Rheumatology (Oxford) 2012; 51:2020-6. [PMID: 22843791 DOI: 10.1093/rheumatology/kes184] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES Adalimumab, etanercept and infliximab are effective TNF inhibitors (TNFis) in the treatment of RA, but no randomized clinical trials have compared the three agents. Prior observational data are not consistent. We compared their effectiveness over 1 year in a prospective cohort. METHODS Analyses were performed on subjects' first episode of TNFi use in the Rheumatic Diseases Portuguese Register, Reuma.pt. The primary outcome was the proportion of patients with European League Against Rheumatism good response sustained at two consecutive observations separated by 3 months during the first year of TNFi use. Comparisons were performed using conventional adjusted logistic regression, as well as matching subjects across the three agents using a propensity score. In addition, baseline predictors of treatment response to TNFi were identified. RESULTS The study cohort included 617 RA patients, 250 starting etanercept, 206 infliximab and 161 adalimumab. Good response was achieved by 59.6% for adalimumab, 59.2% for etanercept and 51.9% for infliximab (P = 0.21). The modelled probability of good response did not significantly differ across agents (etanercept vs adalimumab OR = 0.97, 95% CI 0.55, 1.71; etanercept vs infliximab OR = 1.25, 95% CI 0.74, 2.12; infliximab vs adalimumab OR = 0.80, 95% CI 0.47, 1.36). Matched propensity score analyses also showed no significant treatment response differences. Greater educational attainment was a predictor of better response, while smoking, presence of ACPA, glucocorticoid use and worse physician assessment of disease activity at baseline each predicted a reduced likelihood of treatment response. CONCLUSION Over 1 year, we found no difference in effectiveness between adalimumab, etanercept and infliximab.
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Affiliation(s)
- Helena Canhão
- Rheumatology Research Unit, Instituto de Medicina Molecular, Edificio Egas Moniz, Faculdade de Medicina de Lisboa, Av Egas Moniz, 1649-028 Lisbon, Portugal.
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Silva I, Castelão W, Mateus M, Branco JC. Childhood hypophosphatasia with myopathy: clinical report with recent update. Acta Reumatol Port 2012; 37:92-96. [PMID: 22781519] [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: 06/01/2023]
Abstract
Hypophosphatasia is a rare genetic disease with low tissue nonspeficic alkaline phosphatase activity (TNSALP), due to ALPL gene mutation. There are 6 clinical forms. Childhood form is caractherized by short stature, premature loss of decidous teeth and diffuse bone pain associated with a pathological bone fracture in the past. Laboratory findings present low serum level of alkaline phosphatase and high levels of serum and urinary extracelular metabolytes. It is described a case report of a 34 years old woman with previous diagnosis of childhood hypophosphatasia, caryotype 46,XX, and molecular screening for the gene ALPL with a c.1426>A p.E476K mutation, who complained of proximal muscular weakness intensified with the cold weather, exercise, and a waddling gait. The electromyography was compatible with myopathy but the muscle biopsy was normal. The serum creatine kinase levels were normal, as well as the others muscle enzymes. Clinical and laboratory/ /imaging dissociation is frequent in other metabolic bone diseases as osteomalacia. The rarity of this case of childhood hypophosphatasia with "de novo" non-progressive myopathy of the lower limbs, justified a case report with literature revision.
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Affiliation(s)
- I Silva
- Serviço de Reumatologia do Centro Hospitalar de Lisboa Ocidental, Hospital de Egas Moniz, EPE, Portugal.
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Mourão AF, Fonseca JE, Canhão H, Santos MJ, Bernardo A, Cordeiro A, Cravo AR, Ribeiro A, Teixeira A, Barcelos A, Malcata A, Faustino A, Duarte C, Ribeiro C, Nour D, Araújo D, Sousa E, Mariz E, Ramos F, Vinagre F, Ventura FS, Sequeira G, Santos H, Branco JC, Gomes JA, Silva JA, Ramos J, Santo JE, Costa JA, Silva JA, Ribeiro JS, Inês L, Miranda L, Sampaio L, Costa ML, Rodrigues M, Afonso MC, Cunha MI, Saavedra MJ, Queiroz MV, Couto M, Bernardes M, Bogas M, Pinto P, Valente P, Coelho P, Abreu P, Cortes S, Pimenta S, Ramiro S, Figueira R, Nóvoa T. [Practical guide for the use of biological agents in rheumatoid arthritis - December 2011 update]. Acta Reumatol Port 2011; 36:389-395. [PMID: 22472930] [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: 05/31/2023]
Abstract
The authors review the practical aspects of biological therapy use for rheumatoid arthritis patients, commenting safety issues before and after treatment initiation and the best treatment strategies to optimize efficacy.
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Affiliation(s)
- Ana Filipa Mourão
- Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Portugal.
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Carvalho JF, Barros SM, Branco JC, Fonseca JE. Asia or Shoenfeld's syndrome: highlighting different perspectives for diffuse chronic pain. Acta Reumatol Port 2011; 36:10-12. [PMID: 21483274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Silva I, Mateus M, Branco JC. [Assessment of erythrocyte sedimentation rate (ESR) and C- reactive protein (CRP) on rheumatoid arthritis activity prediction]. Acta Reumatol Port 2010; 35:456-462. [PMID: 21245814] [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: 05/30/2023]
Abstract
OBJECTIVE Rheumatoid Arthritis (RA) disease activity plays an important role in patients disability. A standardized approach to measure it was achieved by using disease activity score (DAS) based on erythrocyte sedimentation rate (ESR) and more recently C-reactive protein (CRP). In this study we will assess the role and influence of ESR and CRP in evaluating and assessing the disease activity. METHODS This is a retrospective, longitudinal study, whose data was obtained from the national RA patient clinical database BioreportAR (following ACR criteria) under biological disease modifying anti-rheumatic drugs (BDMARDs), involving 71 patients from CHLO-Hospital Egas Moniz. The ESR and CRP of each patient were recorded from 2 separated visits. The swollen joint counts (SJC), tender joint counts (TJC), visual analog scale (VAS) for pain, patient global assessment and physician global assessment were also recorded. DAS 28-ESR, DAS 28-CRP, simplified disease activity index (SDAI) and clinical disease activity index (CDAI) were calculated. The relevant Pearson correlations were established between variables. RESULTS A sample of 71 patients with an average age of 55 years old and an average RA duration of 9,8 years, was analysed. ESR and CRP correlated poorly between themselves (r=0,31, p<0,001) and they were shown not to be significant predictors of SJC (ESR r=0,29 p< 0,001 and CRP r=0,089 p<0,001) or TJC (ESR r=0,28 p<0,001 and CRP r=0,072 p<0,001). However DAS-ESR and DAS-CRP were highly correlated (r=0,88, p<0,001) as also as, DAS ESR-CDAI (r=0,89, p<0,001), DAS RCP-CDAI (r= 0,88 p< 0,001) and SDAI-CDAI (r=0,89 p<0,001). DAS-CRP values were lower than those in DAS-ESR, but in 84,7% of the visits disease activity status were. CONCLUSIONS The significant correlation between DAS-ESR and DAS-CRP, indicated that it will not be necessary to perform both evaluations. DAS-CRP yielded a better activity score more often than DAS-ESR, but with 84,7% of concordance in the disease activity status, indicating that both measures are useful for assessing disease activity in RA. Furthermore the correlation between DAS scores and CDAI, and also between SDAI-CDAI may enable physicians to easily assess the disease activity without ESR or CRP values.
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Affiliation(s)
- I Silva
- Centro Hospitalar de Lisboa Ocidental, Hospital de Egas Moniz, EPE, Portugal.
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Silva I, Mateus M, Branco JC. [Fibrous dysplasia and McCune-Albright syndrome: case-report and differential diagnose with Paget bone disease]. Acta Reumatol Port 2010; 35:497-503. [PMID: 21245817] [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: 05/30/2023]
Abstract
Fibrous dysplasia of bone or Jaffe Lischtenstein's disease is a genetic, non-inheritable disease of bone development, characterized by bone pain, deformities and fracture, mainly observed in yo ung adults. The frequency is equal between sexes. Mutations in the gene coding the Gsα, GNAS complex, results in osteoblastic differentiation defects, and bone resorption. The disease can have a monostotic or polyostotic form, or be associated with café-au-lait skin spots and precocious puberty (McCune-Al bright syndrome). The normal bone and bone marrow is replaced with abnormal benign intramedullary fibro-osseous tissue, and can involve any bone in the body. The vertebral involvement is rare. Radiological and pathological findings can be diagnostic. Biphosphonates and calcium, vitamin D and phosphorus supplements have been used in fibrous dysplasia treatment. Osteosarcoma is a rare, but serious malignant complication. We report the case of a 68 year old woman with a history of hypofisectomy, with a progressive low back pain, without systemic or neurological symptoms. The bone scan, the ra di o graphs and the computed tomography findings revealed polyostotic fibrous dysplasia, with vertebral and mandibular involvement. In this paper we compared fibrous dysplasia of bone with Paget bone disease.
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Affiliation(s)
- I Silva
- Centro Hospitalar de Lisboa Ocidental, Hospital de Egas Moniz, EPE, Portugal.
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Pinto L, Castelão W, Branco JC. [Muscle involvement in Systemic Sclerosis - diagnosis evaluation]. Acta Reumatol Port 2010; 35:142-145. [PMID: 20711089] [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
In Systemic Sclerosis skeletal muscle may be involved. Several published series describe different involvement percentages, depending on the diagnostic criteria used. To date, there are no uniform criteria for the diagnosis of this entity and, the use of new methods, namely imunohistoquimic techniques, will be necessary to highlight the different types of muscle involvement occurring in this disease. The present article intends to make a review about the diagnosis of the myopathy occurring in Systemic Sclerosis.
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Affiliation(s)
- Laura Pinto
- Serviço de Reumatologia do Centro Hospital de Lisboa Ocidental, EPE, Hospital Egas Moniz, Lisboa.
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Pimentel-Santos FM, Ligeiro D, Matos M, Mourão AF, Sousa E, Pinto P, Ribeiro A, Sousa M, Barcelos A, Godinho F, Cruz M, Fonseca JE, Guedes-Pinto H, Trindade H, Evans DM, Brown MA, Branco JC. Association of IL23R and ERAP1 genes with ankylosing spondylitis in a Portuguese population. Clin Exp Rheumatol 2009; 27:800-806. [PMID: 19917163] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE Association between ankylosing spondylitis (AS) and two genes, ERAP1 and IL23R, has recently been reported in North American and British populations. The population attributable risk fraction for ERAP1 in this study was 25%, and for IL23R, 9%. Confirmation of these findings to ERAP1 in other ethnic groups has not yet been demonstrated. We sought to test the association between single nucleotide polymorphisms (SNPs) in these genes and susceptibility to AS among a Portuguese population. We also investigated the role of these genes in clinical manifestations of AS, including age of symptom onset, the Bath Ankylosing Spondylitis Disease Activity, Metrology and Functional Indices, and the modified Stoke Ankylosing Spondylitis Spinal Score. METHODS The study was conducted on 358 AS cases and 285 ethnically matched Portuguese healthy controls. AS was defined according to the modified New York Criteria. Genotyping of IL23R and ERAP1 allelic variants was carried out with TaqMan allelic discrimination assays. Association analysis was performed using the Cochrane-Armitage and linear regression tests of genotypes as implemented in PLINK for dichotomous and quantitative variables respectively. A meta-analysis for Portuguese and previously published Spanish IL23R data was performed using the StatsDirect Statistical tools, by fixed and random effects models. RESULTS A total of 14 nsSNPs markers (8 for IL23R, 5 for ERAP1, 1 for LN-PEP) were analysed. Three markers (2 for IL23R and 1 for ERAP1) showed significant single-locus disease associations, confirming that the association of these genes with AS in the Portuguese population. The strongest associated SNP in IL23R was rs1004819 (OR=1.4, p=0.0049), and in ERAP1 was rs30187 (OR=1.26, p=0.035). The population attributable risk fractions in the Portuguese population for these SNPs are 11% and 9.7% respectively. No association was seen with any SNP in LN-PEP, which flanks ERAP1 and was associated with AS in the British population. No association was seen with clinical manifestations of AS. CONCLUSION These results show that IL23R and ERAP1 genes are also associated with susceptibility to AS in the Portuguese population, and that they contribute a significant proportion of the population risk for this disease.
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Fonseca JE, Silva JAC, Canhão H, Santos MJ, Barcelos A, Inês L, Costa ML, Rodrigues M, Bernardo A, Cordeiro A, Cravo AR, Ribeiro A, Teixeira A, Malcata A, Faustino A, Ribeiro C, Nour D, Araújo D, Sousa E, Mariz E, Ramos F, Vinagre F, Ventura FS, Sequeira G, Santos H, Branco JC, Ramos J, Santo JE, Costa JA, da Silva JAP, Miranda L, Sampaio L, Afonso MC, Saavedra MJ, Cunha MI, Queiroz MV, Couto M, Pinto P, Valente P, Abreu P, Figueira RO, Ramiro S, Nóvoa T, Bernardes M. [Practical guide for the use of biotechnological therapies in rheumatoid arthritis]. Acta Reumatol Port 2009; 34:395-399. [PMID: 19727050] [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: 05/28/2023]
Affiliation(s)
- João Eurico Fonseca
- Rheumatology Research Unit, Instituto de Medicina Molecular, Edifício Egas Moniz, Faculdade de Medicina da Universidade de Lisboa, 1649-028 Lisboa, Portugal.
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Mourão AF, Pinto TL, Falcão S, Ribeiro C, Vieira H, Caetano-Lopes J, Nero P, dos Santos FP, Guimarães J, Branco JC. [Juvenile dermatomyositis associated with anasarca - a clinical case]. Acta Reumatol Port 2009; 34:276-280. [PMID: 19569283] [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: 05/28/2023]
Abstract
Juvenile dermatomyositis (JDM) is a rare systemic disease of unknown etiology characterized by inflammation of the muscle, skin and digestive tract, with variable outcome. The diagnostic criteria include proximal symmetrical muscular weakness, characteristic skin rashes, elevation of skeletal muscle enzymes and specific electromyographic and muscle biopsy abnormalities. Pulmonary and gastro-intestinal involvements, calcinosis and generalized edema usually indicate severe disease. Recent data suggest an association between the genotype -308 AA of the Tumour Necrosis Factor (TNF) gene and disease chronicity. We present a case of a 14 year-old female with JDM and generalized oedema which is a rare manifestation of the disease and it is associated to a poor outcome.
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Affiliation(s)
- Ana Filipa Mourão
- Serviço de Reumatologia, Centro Hospitalar de Lisboa Ocidental, EPE, Hospital Egas Moniz, 1349-019 Lisboa.
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Falcão S, Gamero F, Miguel ED, Mourão AF, Pimentão JB, Branco JC, Mola EM. [Foreign body reaction to palm leaf]. Acta Reumatol Port 2009; 34:136-137. [PMID: 19377404] [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: 05/27/2023]
Affiliation(s)
- Sandra Falcão
- Serviço de Reumatologia, Centro Hospitalar de Lisboa Ocidental, EPE, Hospital Egas Moniz, Lisboa.
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Mourão AF, Santos FP, Falcão S, Pinto TL, Barros R, de Matos AA, Branco JC. [Cystic Rheumatoid Arthritis--case report]. Acta Reumatol Port 2007; 32:381-384. [PMID: 18159206] [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: 05/25/2023]
Abstract
Among the many radiological findings seen in Rheumatoid Arthritis RA small subchondral geodes and erosions are typical. Large geodes are far less common abnormalities and their presence may indicate diagnostic and therapeutic difficulties. We present a case report of a 55-year old woman with seronegative RA that developed a large geode in the knee with extensive joint destruction.
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Affiliation(s)
- Ana Filipa Mourão
- Serviço de Reumatologia, Centro Hospitalar de Lisboa Ocidental, EPE, Hospital Egas Moniz Lisboa.
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Carville SF, Arendt-Nielsen L, Arendt-Nielsen S, Bliddal H, Blotman F, Branco JC, Buskila D, Da Silva JAP, Danneskiold-Samsøe B, Dincer F, Henriksson C, Henriksson KG, Kosek E, Longley K, McCarthy GM, Perrot S, Puszczewicz M, Sarzi-Puttini P, Silman A, Späth M, Choy EH. EULAR evidence-based recommendations for the management of fibromyalgia syndrome. Ann Rheum Dis 2007; 67:536-41. [PMID: 17644548 DOI: 10.1136/ard.2007.071522] [Citation(s) in RCA: 455] [Impact Index Per Article: 26.8] [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: 11/03/2022]
Abstract
OBJECTIVE To develop evidence-based recommendations for the management of fibromyalgia syndrome. METHODS A multidisciplinary task force was formed representing 11 European countries. The design of the study, including search strategy, participants, interventions, outcome measures, data collection and analytical method, was defined at the outset. A systematic review was undertaken with the keywords "fibromyalgia", "treatment or management" and "trial". Studies were excluded if they did not utilise the American College of Rheumatology classification criteria, were not clinical trials, or included patients with chronic fatigue syndrome or myalgic encephalomyelitis. Primary outcome measures were change in pain assessed by visual analogue scale and fibromyalgia impact questionnaire. The quality of the studies was categorised based on randomisation, blinding and allocation concealment. Only the highest quality studies were used to base recommendations on. When there was insufficient evidence from the literature, a Delphi process was used to provide basis for recommendation. RESULTS 146 studies were eligible for the review. 39 pharmacological intervention studies and 59 non-pharmacological were included in the final recommendation summary tables once those of a lower quality or with insufficient data were separated. The categories of treatment identified were antidepressants, analgesics, and "other pharmacological" and exercise, cognitive behavioural therapy, education, dietary interventions and "other non-pharmacological". In many studies sample size was small and the quality of the study was insufficient for strong recommendations to be made. CONCLUSIONS Nine recommendations for the management of fibromyalgia syndrome were developed using a systematic review and expert consensus.
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Affiliation(s)
- S F Carville
- Academic Rheumatology Unit, King's College London, Weston Education Centre, Cutcombe Road, London SE5 9RJ, UK.
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