Perfil do uso de drogas modificadoras de doença no Registro Brasileiro de Espondiloartrites

IntroductionFew studies have evaluated the profile of use of disease modifying drugs (DMD) in Brazilian patients with spondyloarthritis (SpA).MethodsA common research protocol was applied prospectively in 1505 patients classified as SpA by criteria of the European Spondyloarthropathies Study Group (ESSG), followed at 29 referral centers in Rheumatology in Brazil. Demographic and clinical variables were obtained and evaluated, by analyzing their correlation with the use of DMDs methotrexate (MTX) and sulfasalazine (SSZ).ResultsAt least one DMD was used by 73.6% of patients: MTX by 29.2% and SSZ by 21.7%, while 22.7% used both drugs. The use of MTX was significantly associated with peripheral involvement, and SSZ was associated with axial involvement, and the two drugs were more administered, separately or in combination, in the mixed involvement (p < 0.001). The use of a DMD was significantly associated with Caucasian ethnicity (MTX, p = 0.014), inflam- matory back pain (SSZ, p = 0.002), buttock pain (SSZ, p = 0.030), neck pain (MTX, p = 0.042), arthritis of the lower limbs (MTX, p < 0.001), arthritis of the upper limbs (MTX, p < 0.001), enthesitis (p = 0.007), dactylitis (MTX, p < 0.001), inflammatory bowel disease (SSZ, p < 0.001) and nail involvement (MTX, p < 0.001).ConclusionThe use of at least one DMD was reported by more than 70% of patients in a large cohort of Brazilian patients with SpA, with MTX use more associated with peripheral involvement and the use of SSZ more associated with axial involvement.     

Doença de Still do Adulto associada à neoplasia de ovário – relato de caso

We report a case of adult-onset Still's disease in a female patient with fever, myalgia, van- ishing rash and bilateral inguinal lymphadenopathy, diagnosed after extensive workup to exclude other rheumatic, infectious and neoplastic diseases. The patient initially respond- ed to corticosteroid therapy, but progressed to increased lymph nodes size that when biop- sied, revealed serous ovarian adenocarcinoma. To our knowledge, this is the first report of ovarian neoplasm associated with adult-onset Still's disease.     

Perfil de especialistas e de serviços em reumatologia pediátrica no estado de São Paulo

IntroductionPaediatric rheumatology (PR) is an emerging specialty, practised by a limited number of specialists. Currently, there is neither a record of the profile of rheumatology patients being treated in Brazil nor data on the training of qualified rheumatology professionals in the country.ObjectiveTo investigate the profile of PR specialists and services, as well as the characteristics of paediatric patients with rheumatic diseases, for estimating the current state of rheumatology in the state of São Paulo.Patients and methodsIn 2010, the scientific department of PR of the Paediatric Society of São Paulo administered a questionnaire that was answered by 24/31 accredited specialists in PR practising in state of São Paulo and by 8/21 institutions that provide PR care.ResultsMost (91%) of the surveyed professionals practise in public institutions. Private clinics (28.6%) and public institutions (37.5%) reported not having access to nailfold capillaroscopy, and 50% of the private clinics reported not having access to acupuncture. The average duration of professional practise in PR was 9.4 years, and 67% of the physicians had attended postgraduate programmes. Seven (87.5%) public institutions perform teaching activities, in which new paediatric rheumatologists are trained, and five (62.5%) offer postgraduate programmes. Two-thirds of the surveyed specialists use immunosuppressants and biological agents classified as “restricted use” by the Health Secretariat. The disease most frequently reported was juvenile idiopathic arthritis (29.1–34.5%), followed by juvenile systemic lupus erythematosus (JSLE) (11.6–12.3%) and rheumatic fever (9.1-15.9%). The incidence of vasculitis (including Henoch-Schönlein purpura, Wegener's granulomatosis, and Takayasu's arteritis) and autoinflammatory syndromes was higher in public institutions compared to other institutions (P = 0.03, P = 0.04, P = 0.002, and P < 0.0001, respectively). Patients with JSLE had the highest mortality rate (68% of deaths), mainly due to infection.ConclusionThe field of PR in the state of São Paulo has a significant number of specialists with postgraduate degrees who mostly practise at teaching institutions with infrastructures appropriate for the care of high-complexity patients.     

Eficácia do escore simplificado preditivo de dificuldade de intubação e da altura tiromentoniana em cirurgias de cabeça e pescoço: estudo observacional

Background and objectivesIn this study, we aimed to investigate the predictive value of different airway assessment tools, including parts of the Simplified Predictive Intubation Difficulty Score (SPIDS), the SPIDS itself and the Thyromental Height Test (TMHT), in intubations defined as difficult by the Intubation Difficulty Score (IDS) in a group of patients who have head and neck pathologies.MethodsOne hundred fifty‐three patients who underwent head and neck surgeries were included in the study. The Modified Mallampati Test (MMT) result, Thyromental Distance (TMD), Ratio of the Height/Thyromental Distance (RHTMD), TMHT, maximum range of head and neck motion, and mouth opening were measured. The SPIDSs were calculated, and the IDSs were determined.ResultsA total of 25.4% of the patients had difficult intubations. SPIDS scores > 10 had 86.27% sensitivity, 71.57% specificity and 91.2% Negative Predictive Value (NPV). The results of the Receiver Operating Curve (ROC) analysis for the airway screening tests and SPIDS revealed that the SPIDS had the highest area under the curve; however, it was statistically similar to other tests, except for the MMT.ConclusionsThe current study demonstrates the practical use of the SPIDS in predicting intubation difficulty in patients with head and neck pathologies. The performance of the SPIDS in predicting airway difficulty was found to be as efficient as those of the other tests evaluated in this study. The SPIDS may be considered a comprehensive, detailed tool for predicting airway difficulty.     

Validité de lˈutilisation de la version francophone de lˈéchelle de Québec chez des lombalgiques chroniques de culture française

Objectives. The primary objectives were to evaluate the acceptability in France of the Quebec Back Pain Disability Scale (QBPDS) in its original French-language version and to study its correlational validity against indicators of impairment, pain, disability, psychological status, and perceived health status. Methods. Thirty-two patients with chronic low back pain were recruited at the rheumatology outpatient clinic of a French hospital. A physical examination was performed for determination of an impairment score, and scales were completed for pain (visual analog scale and Saint-Antoine Questionnaire), disability (QBPDS and Dallas Scale 〚DS〛), perceived health status (Nottingham Health Profile, NHP), and psychological status (Hospital Anxiety and Depression Scale, HADS). Results. Acceptability, internal consistency, and content validity of the QBPDS were satisfactory. Investigation of correlational validity showed good agreement with the DPQ (r=0.755) and NHP (r=0.739) and fair agreement with the impairment score (r=0.449), the VAS pain score (r=0.448), and the HADS score (r=0.473). The QBPDS showed good discriminating power. Validity of the QBPDS was confirmed. Discussion. Our results confirm the good measurement properties of the original French-language version of the QBPDS in French hospital-clinic patients with chronic low back pain. Comparison of the QBPDS and DPQ in this study shows that the QBPDS is better for evaluating disability, whereas the DPQ evaluates the overall, functional, psychological, and social impact of low back pain.     

Anestesia e doença de Alzheimer – Percepções atuais

Background and objectives

It has been speculated that the use of anesthetic agents may be a risk factor for the development of Alzheimer disease. The objective of this review is to describe and discuss pre‐clinical and clinical data related to anesthesia and this disease.

Prévalence de la maladie osseuse de Paget et de l'hémangiome rachidien chez la femme française de plus de 75 ans : résultats de l'étude Epidos

Prevalence of paget's disease of bone and spinal hemangioma in French women older than 75 years. Data from the Epidos study. Objective. To evaluate the prevalence in France of Paget's disease in elderly women. Patients and methods. The prevalences of Paget's disease and of thoracic and lumbar vertebral hemangioma were determined in a random nested cohort of 770 women from the EPIDOS study cohort. EPIDOS is a prospective study of the risk of proximal femoral fracture in 7598 female, community-dwelling volunteers older than 75 years of age. The EPIDOS study patients were recruited at five centers in France (Amiens, Lyon, Paris, Montpellier, and Toulouse). For the nested study, anteroposterior and lateral radiographs of the thoracic and lumbar spine were read by two rheumatologists and classified into four groups: no Paget's disease or hemangioma, possible Paget's disease or hemangioma, definite Paget's disease, and definite hemangioma. Radiographs in the last three groups were read by a rheumatology professor and a radiology professor, both independent from the study. Results. Twenty-five patients had incomplete or poor-quality radiograph sets, leaving 745 patients for the study. A vertebral hemangioma was found in four patients (0.54%; 95% confidence interval [Cl], 0.01–1.1%) and vertebral Paget's disease in four other patients (0.54%, 95% Cl, 0.01–1.1%). All the pagetic vertebrae were at the lumbar spine. Three of the four Paget's disease patients were unaware of the condition before their inclusion in the study. Based on previous estimates that thoracic and lumbar foci are present in 30% to 50% of Paget's disease patients, our data suggest that the overall prevalence of Paget's disease in French women older than 75 years may be in the 1.1%–1.8% range. Conclusion. The prevalence of Paget's disease in elderly French women is similar to that recently reported in Britain.     

Faut-il traiter de façon agressive une polyarthrite débutante ?

The diagnostic and therapeutic management of rheumatoid arthritis has benefited considerably in recent years not only from the introduction of new treatments (including new disease-modifying antirheumatic drugs, new combinations of these drugs, and TNF inhibitors), but also from the development of new concepts. Important new concepts include the use of novel diagnostic approaches, very early management within the first three to six months of symptom onset, periodic assessments of clinical disease activity based on objective clinical criteria and radiographic progression, and earlier use of aggressive treatments. The goal is to induce a clinical remission, thereby preventing radiographic deterioration. These concepts are firmly supported by sound scientific data. At present, patients at risk for progression to severe rheumatoid arthritis must be identified early on, and disease activity and progression must be monitored closely. This should enable patients with highly progressive disease to receive aggressive treatment (e.g., a combination of disease-modifying antirheumatic drugs or biological therapy) very early on with the goal of minimizing joint destruction and subsequent functional impairments.     

Maladie de Kienböck chez un garçon de neuf ans : à propos d’un cas

The authors report a case of Kienböck's disease in a nine-year-old male gymnast, treated conservatively. It resulted in a clinically normal wrist and complete revascularisation of the lunate on MRI. This case suggests that the natural course of Kienböck's disease can be more favourable in children as compared to adults.